Health care delivery in Community Care Network (CCN) Region 5 officially launched on April 1 in Kodiak, Alaska. CCN will start health care delivery in the rest of Alaska in mid-June 2021.

TriWest Healthcare Alliance, Corp. (TriWest), VA’s third-party administrator (TPA) for Region 5, manages the network of high-performing, licensed health care providers in Alaska.

Please note the following if you are a provider located in Alaska:

• Providers must be fully contracted, credentialed, and in-network under CCN with TriWest to receive referrals for Veterans’ care. Community providers should continue to partner with TriWest’s existing Patient-Centered Community Care (PC3) network until CCN is fully deployed in Alaska to ensure Veterans continue to receive the care they need.
• Providers who currently provide care through the PC3 network in Alaska must sign a contract to join TriWest’s network to continue receiving referrals for Veterans under CCN.
• Community providers with existing PC3 referrals are authorized to complete those Standardized Episodes of Care (SEOC). However, new PC3 referrals will not be issued after June 28, 2021.
• CCN is different from PC3; additional services available through CCN include dental, pharmacy, durable medical equipment, dialysis, skilled and unskilled home health, urgent and emergent care, telehealth, immunizations and comprehensive and integrated health care.

CCN is comprised of six regional networks that encompass U.S. states and its territories. It’s being deployed in a phased approach. Once fully deployed, CCN will be the preferred national network VA uses to purchase care for Veterans in their communities.

A contract has not yet been awarded for CCN Region 6.

For questions about provider processes, email ProviderExperience@va.gov.

HealthShare Referral Manager (HSRM) now offers an Eligibility Check feature, ensuring that VA does not send community providers any referrals for Veterans who are ineligible for community care.

The Eligibility Check uses data from VA’s enrollment database to identify whether a Veteran is eligible for community care. If a Veteran is eligible for community care, the normal referral workflow will occur and the referral can be assigned to a community provider. If a Veteran is ineligible, HSRM will stop the VA end user and not allow them to move forward unless a change to the Veteran’s eligibility is made.

With the introduction of this feature, community providers can be confident they should not encounter reimbursement issues stemming from eligibility issues.

Additional Resources 

• HSRM Support Points of Contact
• Office of Community Care Webpage – HSRM Information
• HSRM eLearning Lessons

HealthShare Referral Manager (HSRM), VA’s portal for processing community care referrals and authorizations, offers community providers a convenient way to submit requests for additional services or additional time to provide services by allowing users to upload the Request for Services (RFS) form.

Rather than faxing or emailing the RFS form to VA, community providers can fill out the form (available under the Reports menu in HSRM), save it to their desktop, and use the Add/View Documents link to attach the RFS directly to the referral in HSRM. Step-by-step instructions for uploading documents, including RFS forms, are provided in the ‘Manage Documents’ section of the HSRM Community Provider Quick Reference Guide.

For community providers who are not using HSRM, the blank RFS form is available to download online. Please continue submitting RFS forms via fax or email to the VA Medical Center(s) you partner with.

As an additional note, regardless of how the RFS is submitted, a signature must be included on the form in order for the request to be completed. RFS submissions without a signature cannot be processed. If you have any questions regarding how your RFS, please reach out to the Care Coordination point of contact for the VA Medical Center(s) you partner with.

Additional Resources 

• HSRM Support Points of Contact
• Office of Community Care Webpage – HSRM Information
• HSRM eLearning Lessons

Check out the latest community care articles posted to VA’s official VantagePoint blog:

• Veteran women get a little love and a mammogram (March 30, 2021)
• Making community emergency care easier for Veterans (March 24, 2021)
• Community care specialists help Veteran amputee thrive (Feb. 28, 2021)