The U.S. Department of Veterans Affairs (VA) launched its new and improved Veterans Community Care Program on June 6, 2019, officially ending the Veterans Choice Program. It is hoped that this change will strengthen the nationwide VA Health Care System by empowering Veterans with more health care options.
“The changes not only improve our ability to provide the health care Veterans need, but also when and where they need it,” said VA Secretary Robert Wilkie. “It will also put Veterans at the center of their care and offer options… so they can find the balance in the system that is right for them.”
Under the new Veterans Community Care Program, Veterans can work with their VA health care provider or other VA staff to see if they are eligible to receive community care based on the following six eligibility criteria:
There are a few different ways that a Veteran could be eligible for community care under this criteria. Initially, the following two requirements must be met in every case:
If both have been met, a Veteran may be eligible if one of the following is also true:
Designated Access Standards
To be eligible under this criterion, Veterans must meet specific access standards for average drive time or appointment wait-times.
Drive Time to a Specific VA Facility
Appointment Wait Time at a Specific VA Facility:
VA News Release, “VA launches new health care options under MISSION Act,” June 6, 2019
As of May 1, 2019, VA now requires documentation to the authorizing VA Medical Center (VAMC), rather than to TriWest. The authorizing VAMC (and the fax number to which documentation should be sent) is located on the first page of the authorization letter.
TriWest reminds providers to submit your initial visit and end-of-episode-of-care records to the VAMC. This ensures coordination of care for Veterans.
Grace Period Ended June 30th
The grace period (in which TriWest would forward documentation to the correct VAMC) ended June 30. However, beginning July 1, 2019, TriWest will shred any medical documents it receives in error, so be sure to update your procedures ASAP.
For more information, including the three exceptions to the rule, see the article entitled “REMINDER! Medical Documents Now Go to VA (not TriWest)” in the May 2019 edition of the TriWest Provider Pulse, available online here.
VA Community Care programs have timely filing limits for claims of 120 days from the date of service. Claims denied for timely filing cannot be billed back to the Veteran or VA.
TriWest suggests a 30-day timeframe from claims submission, so the sooner you submit your claims, the better!
For more information, see the article entitled “Timely Claims Filing Deadline Returning – 120-Day Limit” in the May 2019 edition of the TriWest Provider Pulse, available online here.
To support community-based care for Veterans, VA has created HealthShare Referral Manager (HSRM), a new software solution that is transforming the way VA community care providers partner with VA to serve Veterans. The new system simplifies and streamlines the referral and authorization process and improves information exchange through one easy-to-use and secure work platform. According to TriWest, HSRM means less time faxing and emailing to VA, less time on hold with VA, and shorter turn-around time for clinical utilization and care coordination processes.
For more information, including information on how to get started with HSRM, see the article entitled “New VA Portal to Help Providers Care for Veterans” in the June 2019 edition of the TriWest Provider Pulse, available online here.