Department of Veterans Affairs Veterans Choice Program ......For Veterans who are eligible because of a 30-day wait list or Choice First, providers will also receive clinical/consult
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Confidential and Proprietary Confidential and Proprietary Overview: Department of Veterans Affairs Veterans Community Care Programs
Confidential and Proprietary Confidential and Proprietary
Overview: Department of Veterans Affairs Veterans Community Care
Programs
Presenter
Presentation Notes
Good morning / afternoon everybody, my name is ____ and I’m the webinar trainer here at TriWest Healthcare Alliance. I would like to welcome you all today. Today, I’ll be presenting the webinar, “Overview of the Department of Veterans Affairs Community Care Programs.”
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Communication Overview of VA Community Care Programs – Webinar
Questions? Just ask! Please use the Q&A pod section to
submit your questions! We don’t want to miss them!
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Presentation Outline
Who is TriWest? VA Programs Background Which VA Region Are You In? Updating Claims Information Provider Resources
Overview of VA Community Care Programs – Webinar
Presenter
Presentation Notes
So what will we discuss today? Who is TriWest? VA Programs Background Which VA Region Are You In? Updating Claims Information Provider Resources
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Who is TriWest?
Current contract administrator for VA’s Community Care programs across entire country (formerly in 28 states in western and southern U.S.) Current network = 500,000 providers in 900,000 locations
Overview of VA Community Care Programs – Webinar
Presenter
Presentation Notes
So to kick things off, who is TriWest? TriWest is the current contract administrator responsible for administering VA’s Community Care programs across the entire country. Formerly, we administered these programs in 28 states in the western and southern parts of the U.S. We currently have 500,000 community providers in our network across 900,000 locations.
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Overview of VCP and PC3 – Webinar
Presenter
Presentation Notes
So a little background on these programs - why are they here in the first place? The short answer is that VA needed to expand health care access for Veterans in communities across the nation. But let’s get into some more context: Many of you might recall hearing the news stories several years ago that some Veterans were waiting as long as two years to receive care at their local VA medical centers. Naturally, the VA said this is unacceptable. We must do something to ensure our Veterans can get care when our resources are overstretched. Therefore, VA developed the original Patient-Centered Community Care Program, commonly referred to as PC3, and awarded TriWest the contract to administer PC3 across the western and southern U.S. in 2013. Since then, the VA Community Care programs have undergone several changes. Most recently, starting June 6, 2019, a new law goes into effect called the VA MISSION Act. The MISSION Act was developed and passed by Congress, then signed into law by the President. This new Act makes several changes to the VA programs that allow Veterans to receive care in their local communities when VA is unable to provide it. We refer to these programs collectively as the VA Community Care programs. So … before June 6, 2019, three programs were in effect: The Patient-Centered Community Care Program, or PC3. This is the original program that many of our providers signed a network contract under. There was the Veterans Choice Program, or VCP. This came into effect shortly after PC3. And there were Individual Authorizations and Provider Agreements, also called IA/PAs, where VA directly authorized care.
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Presenter
Presentation Notes
After the MISSION Act goes into effect on June 6, 2019, both Choice and IA/PAs are going away, and two new programs are kicking in: The Urgent Care/Walk-In benefit for Veterans; and Veteran Care Agreements, or VCAs. These will eventually replace the old IA/PAs. We’re not going to talk about all of these specific changes right now, as it can be confusing. However, the most important thing to remember is they are all part of the same thing: the VA Community Care programs under the MISSION Act. And TriWest is the contractor responsible for administering them.
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For More on MISSION Act
Overview of VA Community Care Programs – Webinar
Presenter
Presentation Notes
If you have more questions on the MISSION Act, you can always visit the VA page at https://missionact.va.gov. This is also a great place to send Veterans who have questions on the MISSION Act.
Which VA PC3 Region Are You In? Overview of VA Community Care Programs – Webinar
Presenter
Presentation Notes
Moving on, here is a map of the country and its various VA Regions. When VA first launched PC3 back in 2013, it split the country into six different regions. Originally, TriWest administered the VA programs in Regions 3, 5, and 6. Since then, we temporarily expanded to administer the programs across Regions 1, 2, and 4, as well. Before we go any further, please take a moment to look at this map and write down which VA Region or Regions you practice in. I’ll pause so you can write down your Region now. [PAUSE FOR A FEW MOMENTS]
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VA Programs Referral Process Overview of VA Community Care Programs – Webinar
1 Visit at VA Medical Center (VAMC)
2 Physician determines need for care
3 VA determines wait within VA is too long or unavailable
4 Veteran is referred to community provider by VA
5 Veteran returns to VAMC after episode of care Referral Process
Presenter
Presentation Notes
Here’s the gist of how the VA Community Care programs work: Let’s say a Veteran goes for his/her yearly checkup with their Primary care provider at the local VA medical center. This can actually start with any visit to the VAMC, but for the sake of an example, we’ll say it’s a yearly check-up. During the patient’s exam, the doctor says, “I’m concerned about something I heard on your heart test, therefore, I’d like to send you to a cardiologist, but our VA cardiologist isn’t available for 8 months.” Instead of making that Veteran wait 8 months, VA refers the patient to see a private, local cardiologist through the VA Community Care programs. The patient gets the care faster, then returns to their primary care manager at the local VAMC.
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Signing a Contract with TriWest
Choice program is transitioning to align with PC3 Providers are encouraged to sign a network contract with TriWest to continue caring for Veterans in the future: https://joinournetwork.triwest.com
Overview of VA Community Care Programs – Webinar
Presenter
Presentation Notes
For those of you who had provided care to veterans under the Veterans Choice Program, Choice is transitioning to align with PC3 under the new VA MISSION Act. Overall, VA is moving toward one, streamlined community care network. Therefore, TriWest encourages providers to consider signing a network contract with TriWest, if they haven’t already. This is the only way to ensure you can continue treating Veterans in the future. To request a contract, simply go to the link on the screen: joinournetwork.triwest.com.
TriWest uses WPS Military and Veterans Health (WPS MVH) as its claims processor
Parent company is WPS Health Solutions (WPS) For care authorized by TriWest, change your claims submission to WPS MVH
Overview of VA Community Care Programs – Webinar
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Presentation Notes
If you recently joined the TriWest network, please be sure to update your claims submission information to WPS Military and Veterans Health, which is our claims processor here at TriWest. You may frequently hear them referred to as WPS MVH. WPS MVH is a subsidiary of WPS Health Solutions, frequently called just “WPS.” We recommend updating your systems as soon as possible.
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Updating Claims: Regions 1, 2, 4
For care rendered BEFORE Oct. 1, 2018 under Health Net:
Submit claims to Health Net Federal Services More information: https://www.hnfs.com/content/dam/hnfs/va/provider/pdf/VCP_PCCC_Sept2018_Prov_Newsletter.pdf
For care authorized directly by your local VAMC: Submit claims and medical documentation to your local VAMC Office of Community Care More information: https://www.hnfs.com/content/dam/hnfs/va/provider/pdf/VCP_PCCC_Sept2018_Prov_Newsletter.pdf
Overview of VA Community Care Programs – Webinar
Presenter
Presentation Notes
For Regions 1, 2, or 4, if you’re submitting claims for care you rendered under Health Net BEFORE Oct. 1, 2018, please submit your claims to Health Net Federal Services. They are still responsible for paying those claims. If you’re billing for care authorized directly by your local VA Medical Center, submit claims and medical documentation to your local VAMC’s Office of Community Care. For more information on either one of these processes, you can visit the link posted here. It’s an article from Health Net on the transition.
That concludes our overview of the VA programs! Now, all I have left are some “Support Resources” to assist in remembering the information presented in today’s webinar.
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TriWest Provider Resources
TriWest.com/provider and TriWest’s Payer Space on Availity – Your one-stop shop for information on filing claims and navigating VA Programs
Provider Handbook Reference guides Webinar registration Newsletters Additional resources and links to important information
Overview of VA Community Care Programs – Webinar
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First up are the TriWest provider portals. Currently, we exist on two portals: the TriWest Provider Portal on www.triwest.com/provider, and the TriWest Payer Space on Availity at www.availity.com. Eventually, TriWest will phase out our current portal on triwest.com, and move completely to Availity. In the interim, though, we exist in both places, and therefore encourage providers to register on both platforms. Between Availity and the existing TriWest Provider Portal, you will be able to find: The Provider Handbook A library of quick reference guides Webinar registration The Provider Pulse e-newsletter And many other resources and links to important information!
It’s EASY! Register for a secure account to: Check authorization status (including SARs) Print authorization information Check claims status
Visit www.triwest.com/provider and click “Register for Secure Access”
Overview of VA Community Care Programs – Webinar
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Registering for a secure account on TriWest’s existing Provider Portal will give you access to important information you need, including authorization information, and the status of your claims. Just go to www.triwest.com/provider and click the big, blue button that says, “Register for Secure Access.”
TriWest Customer Service Line: 1-855-PCCCVET (1-855-722-2838)
Please access the Provider menu and enter the ZIP code for your practice if requested You can reach our team for authorization questions, assistance with the provider portal, claims questions and contracting or credentialing questions
Claims questions? Contact a dedicated claims representative by phone – 1-866-651-4977 EMAIL: [email protected]
Overview of VA Community Care Programs – Webinar
Presenter
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You can call the following numbers for questions on authorizations, claims, and contracts: TriWest Customer Service Line: 1-855-PCCCVET (1-855-722-2838) is the 800 number that gives you a menu to contact claims, the provider portal support team, or the operations team for authorization questions. You can also contact the TriWest or WPS claims team by calling our direct claims line. If you want to write us – you can send your questions about contracting and participation to our [email protected] in box. We have a team working these emails who can help get you the answers you need!
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Thank You!
Presenter
Presentation Notes
I want to take a moment to thank you all for your time today and for helping us to care for our nation’s Veterans! We know it’s not always easy and sometimes there are extra layers of paperwork or red tape, but we’re all very passionate about serving our Veterans here at TriWest, and we cannot do it without you! You, as a provider, are filling a vital need in our society and we thank you for your service. Thank you again and have a wonderful rest of your day! Good-bye.
