This article, sent on March 13, 2020, contained incorrect contact information for Optum; the website link has been corrected in the article below*.

As part of implementing the VA MISSION Act of 2018, VA offers an urgent care benefit that provides eligible Veterans with greater choice and access to timely, high-quality care when and where they need it. As of June 6, 2019, eligible Veterans have the option to receive urgent care treatment of minor injuries and illnesses such as colds, sore throats, and minor skin infections from community providers participating in VA’s Community Care Network (CCN). This benefit is offered in addition to the opportunity to receive same-day urgent care treatment from a VA medical facility provider.

The current third party administrator (TPA) for urgent care benefits in CCN Region 1, TriWest Healthcare Alliance, will transition its responsibilities to Optum Public Sector Solutions, Inc., (Optum), part of United Healthcare Group Inc., on March 18, 2020. The transition is part of the broader shift from Patient-Centered Community Care (PC3) to CCN.

CCN Region 1 includes the following states

Sources of assistance for a Veteran

• Veterans can call their local VA medical Center and request to speak to their care team directly. If the closest VAMC is unkown, a Veteran can call MyVA311 (844-698-2311, press #3 to be connected) for any questions or concerns.
• You may also refer to the VA.Gov site for Veteran information regarding Coronavirus at: https://www.publichealth.va.gov/n-coronavirus/.

What are VA facilities doing to contain potential infections?

• All VA medical facilities are in the initial stages of implementing screening measures for signs of respiratory illness and exposure to COVID-19. Via telehealth services, VHA will provide a first line of defense using virtual screening for symptoms or potential exposure. Standardized screening questions are in place for all administrative call centers and Clinical Contact Centers (CCC). Onsite at medical facilities, VHA is instituting screening at all points of entry and following escalation pathways for positive screening. Facilities will use standardized screening questions at appointment check in and during initial clinical screening. In addition, facilities will use a two-tiered system with an “active” COVID-19 zone and a “passive” zone for standard care unrelated to COVID-19.

What resources is VA making available for Veterans during the pandemic?

• If a Veteran has flu-like symptoms such as fever, cough and shortness of breath, please direct the Veteran to call their local VA medical center or MyVA311 (844-698-2311, press #3 to be connected) before sending a Veteran to your local VA medical center or clinic.
• In addition to calling first, Veterans may contact their VA health care team to learn about VA’s telephone and video care options, as well as My HealtheVet Secure Messaging.

Will VA cover the cost of COVID-19 testing?

• The current test available in the United States is the one provided by the CDC and some state public health departments at no charge. Any new COVID-19 tests that meet the required standards will be covered in accordance with CDC guidelines.
• If a Veteran has flu-like symptoms such as fever, cough and shortness of breath, or otherwise screens suspected positive for coronavirus, please follow your local instructions for testing. Do not send a Veteran to VA directly. If there are any questions, please direct the Veteran to call their local VA medical center or MyVA311 (844-698-2311, press #3 to be connected) before sending them to your local VA medical center or clinic.

Will VA cover the cost of COVID-19 care?

• Right now there is no specific treatment or vaccine for COVID-19, but VA will cover medically indicated symptom treatment.
• VA will cover authorized provider visits in the same way that we cover other provider visits through the Veteran Community Care Program or other reimbursement authorities.
• Urgent care visits through the VA contracted network will be covered based on Veteran eligibility.
• VA will cover emergency department visits, associated inpatient admissions, and urgent care visits the same way that we cover other acute needs.
  • Providers that are contracted with a VA Third Party Administrator (TPA) should continue to submit claims directly to the TPA. Emergency room and/or inpatient care providers must call within 72 hours of care being processed to get an approved referral so they can be paid.
  • For providers that are not contracted with a TPA, emergency care is covered but with specific eligibility per Veteran (e.g. enrolled in VA, seen in VA or through VA community care in the last 24 months, no VA emergency services are reasonably available, care is emergently needed). Suspected coronavirus or similar infection symptoms will be presumptively considered Emergent Care, but other eligibility criteria does need to be met in order for payment to be made by VA.
• For coding purposes, please follow Centers for Medicare and Medicaid Services (CMS) guidance found at https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page

For Additional Questions within the Optum Network:

• Contact CCN Provider Services for your region:
  • Region 1: 888-901-7407
  • Region 2: 844-839-6108
  • Region 3: 888-901-6613
• CCN Provider Services is available from 8 a.m. – 6 p.m. provider’s local time, Monday – Friday, excluding federal holidays.

 For Additional Questions within the TriWest Network:

• Contact PC3 Provider Services
  • 855-722-2838
• Contact CCN Provider Services for CCN Region 4
  • 866-286-4174
• TriWest Provider Services is available by phone from 8 a.m. – 5 p.m. MST, Monday – Friday, excluding federal holiday.

Resource:  

• COVID-19 Community Provider Guidelines Fact Sheet