Community Care

Provider News

This page provides the latest information for community providers who are partnering with VA to care for our nation’s Veterans. From here, you can access the latest news, policy changes, and health care program updates!

To get the latest updates directly in your e-mail inbox, we encourage you to sign up for our monthly community provider newsletter.

Flu Shots Now Available for Eligible Veterans (#FightFlu)

VA’s community seasonal flu shot program launched Sept. 1, 2020, providing eligible Veterans with a no-cost seasonal flu shot. VA currently partners with more than 60,000 in-network retail pharmacies and urgent care locations to provide flu shots to Veterans.

To serve Veterans using this benefit, retail pharmacies or urgent care clinics must be in-network through one of VA's third-party administrators (TPAs), either Optum Public Sector Solutions, Inc. (Optum), part of UnitedHealth Group, Inc.; or TriWest Healthcare Alliance (TriWest).

For current in-network retail pharmacies or urgent care locations, the chart below describes how to submit claims when you provide eligible Veterans a seasonal flu shot. Please use the information listed below depending upon the Community Care Network (CCN) region where your facility is located and the appropriate TPA.

VA Flu Shot Program   CCN with Optum   CCN with TriWest   CCN Regional Networks Map

Billing for In-Network Retail Pharmacies/Urgent Care Locations

After the Veteran’s visit, follow these steps:

• Retail Pharmacies: Provide a copy of the flu shot documentation to the Veteran and recommend they provide it to their VA primary care provider’s office.
• Urgent Care: Submit medical documentation to the Veteran’s home VA medical center (VAMC) within 30 calendar days of the date of service.

Find VA Facility Locations

VA and its Third-Party Administrators Able to Consider Some Denied Claims for Payment

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.

Optum Provider Portal

For more information:

HealthShare Referral Manager (HSRM)

HealthShare Referral Manager (HSRM) is the Department of Veterans Affairs (VA) online system for sending referrals and authorizations to community providers. HSRM allows community providers and VA to better manage community care for Veterans. Registering for HSRM is available for community providers at no cost!

HSRM Virtual Training

For interested community providers, HSRM trainings are offered weekly. The HSRM training sessions include an overview of HSRM, an in-depth walkthrough of the system, and 30 minutes allotted for audience questions/demos. Registration for one of the live weekly HSRM trainings can be completed by creating an account and logging into the Veterans Health Administration (VHA) Training Finder Real-time Affiliate Integrated Network (TRAIN) website.

Register for a Community Provider HSRM Virtual Training Session

HSRM Online eLearning Modules

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.

Access all Community Provider HSRM eLearning Lessons

Additional HSRM Information

For more information about HealthShare Referral Manager (HSRM) for community providers, please visit the Care Coordination Overview Webpage.

HealthShare Referral Manager Care Coordination Overview

COVID-19 Guidance for Community Providers

The Department of Veterans Affairs (VA) is paying special attention to Veteran health due to the Coronavirus Disease 2019 (COVID-19) outbreak and escalation. To assist community providers during the pandemic, VA developed the COVID-19 Guidance for Community Providers fact sheet which provides information such as:

• Sources of assistance for a Veteran
• What VA facilities are doing to contain potential infections
• What resources VA is making available for Veterans during the pandemic
• What COVID-19 care costs VA will cover
• Community Care Network (CCN) and Patient-Centered Community Care (PC3) Third-Party Administrators contact information

COVID-19 Guidance Letter to Community Providers

Veterans Care Agreements (VCA)

Community providers still seeing Veterans via a VCA should contact the point of contact identified in Section O of the VCA template.

Applying to become a VA dental provider is simple and quick. The first step is finding your CCN region. CCN provider partnerships are administered by a third-party administrator (TPA) in each of six regions. Provider partnerships for Regions 1, 2 and 3 are administered by Optum Public Sector Solutions, Inc. (Optum), part of UnitedHealth Group, Inc., while the Region 4 TPA is TriWest Healthcare Alliance (TriWest). VA will announce the Region 5 TPA at a later date.

Find your CCN region

After identifying your CCN region, please follow the instructions on the following webpages to apply to become a CCN dental provider.

• In CCN Regions 1, 2, and 3, access the Logistics Health Incorporated (LHI) Provider Portal. For Optum CCN dental provider resources, visit the Training & Guides section of the Optum VA Community Care Network portal.

• In CCN Region 4, email TriWest. For more information on becoming a dental provider for CCN in Region 4, access the TriWest VA CCN website.

VA changes email encryption software

September 25, 2019

This software update is part of VA’s Office of Information and Technology (OIT) modernization efforts to make communications more secure and reliable.

VA’s New Customer Engagement Portal Goes Live!

July 30, 2019

VA has developed a new portal with more robust capabilities to replace the existing Vendor Inquiry System (VIS) and better serve our provider community. The new Customer Engagement Portal (CEP) offers improved, more timely access management along with two-factor authentication for increased security. CEP also offers bulk upload capabilities for providers with multiple tax identification numbers, enhanced querying and reporting capabilities as it relates to claim status, payments, check information and offsets.

Urgent Care Offered Under MISSION Act

June 6, 2019

As part of implementing the VA MISSION Act of 2018, VA offers an urgent care benefit that provides eligible Veterans with greater choice and access to timely, high-quality care. With urgent care Veterans have a new option for care for the treatment of minor injuries and illnesses such as colds such as strep throat, or pink eye. Eligible Veterans will be able to receive urgent care from an urgent care provider that is part of VA’s and TriWest's contracted network of community providers without prior authorization from VA. VA can pay for an urgent care claim only if:

• The Veteran is eligible for the benefit,
• the urgent care provider is part of VA’s contracted network of community providers, and
• the services are not excluded under the benefit (excluded services include preventive services and dental services).

To learn more, go to TriWest Healthcare Alliance’s (TriWest) training on the Availity website.

HNFS Has Stopped Accepting Medical Documentation As of January 1, 2019

February 5, 2019

Health Net Federal Services, LLC (HNFS) stopped accepting faxed medical records effective January 1, 2019 and deactivated their medical documentation fax line. Community providers must now send relevant medical records to the referring VA Medical Center. For more information, view the Patient-Centered Community Care (PCCC) and Veterans Choice Program (VCP) Provider News articles on the HNFS website or call the HNFS Provider Service Line.

Health Net Federal Services Contract Close Out – Filing Deadline Extended February 5, 2019

February 5, 2019

For more information about the Health Net close out, please see PCCC and VCP Provider News articles. If you have questions and would like more information, please call the Health Net provider service line, or visit the Health Net website.

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