Who: Intake, Eligibility and Accounts Receivable Staff at community facilities rendering EMERGENT CARE to Veterans.
What: Live, online training. As part of VA’s efforts to modernize business practices and reinforce those partnerships, VA will be delivering providers the ability to centrally notify VA of Veterans presenting emergently to community facilities and for those providers to receive feedback from VA about care coverage. Come learn more about the new process that VA is set to deliver in June 2020!
When: Attend one of the below offerings, all contain the same material:
Sessions:
- Monday, June 1, 2020; 11 – 12:30 ET
- Monday, June 8, 2020; 11 – 12:30 ET
- Monday, June 15, 2020; 11 – 12:30 ET
- Monday, June 22, 2020; 11 – 12:30 ET
- Monday, June 29, 2020; 11 – 12:30 ET
Log-in Information: All sessions have the same log-in and dial-in information
Adobe Connect: https://vacctraining.adobeconnect.com/newcaecprocess/
Call in on your phone via VANTS:
- Dial-in Number: 800-767-1750
- Participant Code: 85286#
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VA is working hard to make it easier to file claims for care and services community providers provide. This message is to help clarify where to file a claim for authorized community care for Veterans.
Most commonly, authorized care refers to medical or dental care that was approved and arranged by VA to be completed in the community. Emergency care can also be authorized by VA in certain circumstances, when the VA is notified within 72 hours.
The best way to determine where to file a claim for services delivered to a Veteran is to refer to the actual authorization/care referral. In general, there are three methods for filing claims for authorized care depending on your status in VA’s network and how the care was authorized:
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Community Care Network (CCN) – If you are part of CCN, you must file the claim with your regional CCN Third Party Administrator (TPA) as noted in the authorization/referral. For Regions 1-3, file claims with Optum. For Region 4, file claims with TriWest.
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 2. Patient Centered-Community Care (PC3) Network – If you are part of
VA’s PC3 network, file claims with TriWest.
Note: Once fully deployed, CCN will replace PC3. Any and all existing PC3
referrals will remain intact and valid for the entire scope and length of the
approved referral.
3. Veterans Care Agreement (VCA)/Local Contract – If you have a VCA with
VA or are not part of one of VA’s formal networks, file claims directly with VA.
Claim Submission Requirements
- Complete an accurate standard Centers for Medicare & Medicaid Services (CMS) or American Dental Association (ADA) billing form or electronic transaction (such as CMS 1450, CMS 1500 or 837 EDI transaction), containing false claims notice.
- For authorized care, the “referral number” listed on the “Billing and Other Referral Information” form.
- National Provider Identifier – submit all that are applicable, including, but not limited to billing, rendering/servicing, and referring.
To Avoid a Denied Claim
- Make sure you have received an official authorization to provide care or that the care is of an emergent nature.
- Submit the claim to the correct payer.
- Include the authorization number on the claim form for all non-emergent care.
- Make sure the services provided are within the scope of the authorization.
- Check the accuracy of billing codes.
- Include the Veteran’s full nine-digit Social Security number in the insured’s I.D. number field.
If you have questions about a claim, call your regional TPA or VA (depending on your network status).
Thank you for your continued support of our mission.
Resources:
File a Claim for Veteran Care web page
Rejected Claims – Explanation of Codes web page
Emergency Medical Care-Information for Providers web page
Fact Sheet: ADA Dental Claim Form and Completion Instructions
 This video message, from Dr. Kameron Matthews, VA's Deputy Under Secretary for Health for Community Care, provides an update and thanks community providers who are serving Veterans during the COVID-19 pandemic.
HealthShare Referral Manager (HSRM) is VA’s online system that was introduced to significantly streamline and improve the referral and authorization management process for Veteran care.
To get access to HSRM, community providers need to complete the five-step HSRM account creation process. Step 3 in this process requires one facility point of contact to fill out the End User Tracker with information about end users requiring HSRM access. Take a look at some tips and tricks you can follow to successfully fill out the End User Tracker.
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HSRM Training Opportunities
Registration for one of the live weekly HSRM trainings can be completed by creating an account and logging into VHA TRAIN. Training is available at no cost and is hosted by HSRM staff who are ready to answer your questions!
 Community providers can also learn about HSRM system functionality through self-paced eLearning, available 24/7 through VHA TRAIN. A free account in VHA TRAIN is required in order to access the eLearning.
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