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VA and its third-party administrators (TPA), Optum and TriWest, will reconsider payment to providers who had a claim denied for simple routing errors.
Providers whose claims were denied because they were submitted to the wrong VA payer (VA or a TPA) are eligible for reconsideration if the original claim was filed with a VA payer on time (within 180 days of the date of service).
The provider must resubmit a reconsideration request to the correct VA payer within 180 days of the initial denial. A copy of the remittance advice from a claim that was submitted to a VA payer within 180 days of date of service satisfies this requirement.
Optum and TriWest also have the authority to process provider payment requests that were previously denied prior to this direction and over 180 days after the date of the remittance advice if the original claim was submitted on time. The 180 days from the date of the remittance advice is through Dec. 1, 2020.
In addition, claims not submitted because of missing affiliation/network information on the VA referral are also eligible to be reconsidered if the claim is within 180 days of the date of the referral allocation. VAMC staff will send the provider an offline referral created in Health Share Referral Manager (HSRM) to the community provider with the authorization number. The HSRM offline referral will also explain who to correctly bill.
In-network providers can view the authorization number and original received date in HSRM. Providers in Optum’s network can also find the original received date in the Optum Provider Portal, https://provider.vacommunitycare.com.
For more information, visit VA’s “File a Claim for Veteran Care” web page https://www.va.gov/COMMUNITYCARE/revenue_ops/Veteran_Care_Claims.asp or call the Community Care Contact Center, 877-881-7618.
The U.S. Department of Veterans Affairs (VA) announced it awarded a contract, Oct. 1, to TriWest Healthcare Alliance (TriWest) to serve as third-party administrator to manage Region 5 of its Community Care Network (CCN), which includes all of Alaska.
CCN is the department’s direct link with community providers to ensure VA provides the right care at the right time to Veterans.
“This contract award reflects the department’s ongoing efforts to increase Veteran access to care,” said VA Secretary Robert Wilkie. “As part of VA’s modernization, we designed the new network based on feedback from Veterans and other stakeholders, along with lessons learned from the Veterans Choice Program. We have already seen improved customer service for Veterans and faster payments to community providers with the implementation of CCN in Regions 1 through 4.”
CCN is VA’s standard contract vehicle enabling Veterans to access services from community health care providers using industry-standard approaches and guidelines. The existing Patient Centered Community Care contract will continue to be used to support Veterans community care in Alaska, until CCN is fully implemented no later than 6 months of award.
Regions 1, 2 and 3 of VA’s Community Care Network were previously awarded to Optum Public Sector Solutions Inc., part of UnitedHealth Group Inc., Dec. 28, 2018, and Region 4 was awarded to TriWest Aug. 6, 2019.
Learn more about VA’s Community Care Network.
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VA’s ECHO (Extension for Community Healthcare Outcomes) program is offering regular continuing education sessions for providers on COVID-19 clinical topics. The sessions combine live practice-relevant didactic training with case-based learning. Continuing education credits are available without charge for accredited sessions on VHA TRAIN.
Upcoming Live Sessions and Registration
Live sessions are held Wednesdays 2:00PM-3:00PM (ET) / 11:00AM-12:00PM (PT). Below is a list of upcoming sessions:
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Outpatient Management of COVID-19 (October update) (Oct. 28, 2020)
- Happy Hypoxemia and COVID-19 (Nov. 4, 2020)
- Hospital to Home: Safe Transitions & Reducing Length of Stay (Nov. 18, 2020)
- Employee Wellbeing and Resilience During COVID-19 (Dec. 2, 2020)
- Expanding Clinical Skills During Pandemic (Dec 9, 2020)
- Acute Complications of COVID-19 (December update) (Dec. 16, 2020)
- COVID-19 & 2020: A Year in Review (Jan. 6, 2021)
- Testing for SARS-CoV-2 Infection (January update) (Jan. 24, 2021)
We are also planning to release recordings of prior sessions, including:
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Testing for SARS-CoV-2 Infection (September 2020 update)
- Long Term Sequalae of Severe COVID-19
- COVID-19: Ethics and Moral Distress
- Delirium & COVID-19; The Hidden Comorbidity
- Inpatient Management of COVID-19 (August 2020 update)
- Key Concepts in Geriatric Emergency Care During COVID-19
To register for a session go here. For more information contact VA-ECHO@va.gov
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