St. Cloud VA Health care System announcement

News & Announcements

VA Community Care update for Veterans, family members and caregivers

Urgent Care transition from Tri-West to Optum

Visit the Locator tool before every Urgent Care visit as network providers may change

VA’s goal is to give eligible Veterans who need same-day urgent care for minor illnesses or injuries as many avenues as possible at the right time, right place and right provider.

VA is transitioning its Community Care Network (CCN) urgent care network managers in Minnesota on Sept. 1, 2020, from TriWest Healthcare Alliance (TriWest) to Optum Public Sector Solutions, Inc. (Optum), which is part of UnitedHealth Group, Inc.

VA’s goal is for the transition to be seamless for Veterans. However, the change will result in new urgent care providers being added to its contracted networks while others may be removed.

While the contractor is changing there is no change to the urgent care benefit or the way Veterans access care. Eligible Veterans can receive care from an in-network community urgent care provider if the provider is part of VA’s contracted network of providers, and services are not excluded under the benefit (excluded services include preventive services and dental services). 

The change in network management will also affect pharmacies. Veterans who require urgent care prescriptions of 14 days or less can find an authorized in-network provider to avoid paying out-of-pocket costs.

Veterans seeking to obtain urgent care from a CCN provider are reminded of the following key points: 

• Urgent care visits in community settings must be made to providers in the VA's Community Care Network (CCN).
• To find an urgent care location in VA’s network, use the VA.gov Provider Locator at https://www.va.gov/find-locations/.
• The Locator tool also contains driving directions and phone numbers for network providers. Enter your location to find nearby providers and call the location to get hours of operation.
• Please visit the Locator tool before every visit as network provider lists may change, particularly for visits after Sept. 1.  
• In addition to the urgent care location, Veterans must check whether their pharmacy is in-network. To find an urgent care pharmacy location use the VA.gov Provider Locator at https://www.va.gov/find-locations/.

To find URGENT CARE locations, visit https://www.va.gov/find-locations/

Step 1: Enter zip code and select Facility Type “Urgent care”

Step 2: Select Service Type, either “All urgent care” or “Community urgent care providers (in VA’s network)”

Step 3: Review results

To find PHARMACY locations, visit https://www.va.gov/find-locations/

Step 1: Enter zip code and select “Urgent Care Pharmacies (in VA’s network)”

Step 2: Review results

If Veterans need additional help they can also call 877-881-7618 for assistance finding an urgent care or pharmacy location.

Reporting emergency visits

In an emergency, Veterans should call 911 or go to the nearest emergency department. Veterans do not need to check with VA before calling for an ambulance or going to an emergency room.

An important part of determining eligibility for VA payment for community emergency care visits is prompt notification of VA within three days of the visit. To help this process, VA has established a single national location, the Community Care Centralized Call Center, to accept reports of Veteran visits to an emergency department. VA is asking that all community hospitals and/or community providers notify the Call Center when a Veteran visits an emergency department. Community hospitals and providers can report emergency visits to VA either by email at:  VHAEmergencyNotification@va.gov or by phone at 1-844-72HRVHA or (844-724-7842).

Veterans can print and keep the attached reference card available so you or your family members can assist community hospitals in reporting this information.

Finally, some important Community Care reminders

To use community providers for routine care and services, VA must authorize the care and refer the Veteran to a specific community provider (pre-authorizations are not required for emergencies and urgent care services).

Veterans can identify VA and participating community providers through the VA Facility Locator available at: https://www.va.gov/find-locations/ or through the Optum portal at https://www.vacommunitycare.com/.

Veterans can verify the status of their referral or view claims payment status through the Optum portal available at:  https://www.vacommunitycare.com/.

Veterans seeking assistance with approved referrals from the Community Care Department at the St. Cloud VA can get help from the following service points:

• Walk-in service: currently not available due to COVID-19 precautions.
• Phone service: 320-252-1670 Ext. 6401 (or press option 2, then press option 7), 8 a.m. to 4:30 p.m. weekdays.
• Veterans seeking assistance with Community Care billing can call 877-881-7618. There is no local service point for billing matters.

 

• Veteran Emergency Notification Reminder Card.pdf