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Community Care

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Patient-Centered Community Care (PC3)

icon PC3 with heart and medical crossPatient-Centered Community Care (PC3) is a nationwide network of community providers that provides eligible Veterans access to primary care, inpatient/outpatient specialty care, mental health care, limited emergency care, and limited newborn care for enrolled female Veterans following the birth of a child.

In instances where you require primary and specialty care that is not readily available through your VA Health Care Facility (HCF), your HCF may use a Patient-Centered Community Care (PC3) contract to purchase your care. Your HCF’s clinical and Non-VA care teams coordinate to determine if the care is available at your HCF, a nearby HCF or another health care partner. If not, they will look to the PC3 contract to buy the care. If you need care, you should always start with your VA health care provider at your local facility.

To locate a facility near you, please visit the VA Facility Locator page.


Availability

VA has has reached an agreement with TriWest Health Care Alliance (TriWest) on a one-year extension of its current coverage of the Patient-Centered Community Care (PC3) and Veterans Choice Program (VCP). The agreement with TriWest will expand TriWest’s services to all regions across the country under this program.

IMPORTANT: The Department of Veterans Affairs (VA) contract with Health Net Federal Services (HNFS) ended on September 30, 2018.

HNFS was the third party administrator for the eastern region of the Veterans Choice Program (VCP) and Patient-Centered Community Care (PC3) network. When the contract with HNFS ends, VA will take over all activity previously performed by HNFS. The end of the VA contract with HNFS does not affect the VA contract with TriWest Healthcare Alliance, which administers the western region of the VCP and the PC3 network.

VA will work with Veterans, community providers, and VA staff to transition care coordination from HNFS to your local VA medical facility as seamlessly as possible. No immediate action is needed on your part. However, if you are requesting care in the community, please contact your local VA medical facility to coordinate all care after September 30, 2018. If you are unaware of whom you should contact, visit the VA Facility Locator to find your local facility. Please view the annoucement below for more information.

Health Net Federal Services Contract Close OutFacility and Service Locator

Process for Receiving Care Under PC3

If your VA provider has authorized health care for you through a PC3 contract, you should receive a flyer from your HCF for your respective contractor at the time of referral. You can reference them below:

Veterans Receiving Care from a TriWest Provider

Accessing Community Care

Follow the steps below to see if you are eligible for community care:

1. Go to VA

  • Schedule an appointment with a VA provider (doctor).
  • Your VA care team will work with you to see if you are eligible for community care.
  • Eligibility is based on your medical needs, care that is available at VA, and other requirements.

2. Make an Appointment

  • VA will work with you to find a community provider and make an appointment.
  • You can select a community provider or VA can select one for you.

3. Receive Care

  • Arrive promptly for your appointment.
  • If you need to schedule a follow-up appointment, check with your community provider to make sure VA has authorized the care.

IMPORTANT: Make sure VA confirms you are eligible and authorized before proceeding to Step 2.

IMPORTANT: The community provider selected must be in VA’s network and be willing to accept payment from VA.

IMPORTANT: If VA has not authorized follow-up care, your community provider should contact VA to arrange the care you need.

Contract Benefits

PC3 sets contractual requirements* that benefit Veterans and the VA Medical Centers. These contracts:

  • Ensure quality as providers and facilities meet quality standards
  • Provide efficiency as providers help the VA Medical Centers (VAMC) manage high volumes of one type of care. Contractors set appointments and authorizations do not require additional contracting review
  • Convenient for Veterans who can be seen quickly and within required commute times
  • Decrease improper payments as payment rates are defined by the contract and contractors perform an additional level of review to ensure services performed match the authorization and were billed correctly to VA
  • Support care coordination by providing medical documentation back to the VAMC in a timely manner
  • Standardize processes by providing national contract administration and oversight from the VHA Office of Community Care, and integrating into the Community Care Coordination processes
  • Support reimbursement as appointment information provided by the contractor allows for review of third party payer precertification

Contract requirements were developed by VHA clinical, policy, administration and acquisition subject matter experts. The requirements also reflect input from Congress, Veterans Service Organizations and industry.

Credentialing and Certification FAQs

Is credentialing required for providers to join the TriWest or Community Care Network (CCN) and be listed in the Provider Profile Management System (PPMS)?

Yes, through one of two options:

  • Certification (CHOICE) – The review of elements, including: provider licensing, sanctions, Medicare participation or waiver, and eligibility to participate in government programs.
  • Credentialing (PC3) – The full review of provider licensing, certification, education, training, work history, sanctions, malpractice, and eligibility to participate in government programs. Health plans must follow the credentialing standards of their national accrediting organizations.

Please rest assured that all providers listed in PPMS have received certification or credentialing from TriWest or the CCN contractor, and are authorized to be appointed for patient care.

Is certification authorized?

Yes. The Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 (H.R. 3230; Pub.L. 113–146), also known as the Veterans Choice Act, authorizes a defined certification process prior to Community Care network appointment. Per VA agreement with TriWest, certification is an approved process to begin Veteran care, but credentialing must be completed within 12 months for the provider to continue receiving authorizations to treat Veteran patients.

Who are the national accrediting organizations?

There are two nationally recognized accrediting organizations for health plan networks, URAC and National Committee for Quality Assurance (NCQA). URAC and NCQA have similar credentialing standards and require accreditation renewal every three years.

Nationally Recognized Accrediting Organizations

*Required if applicable.
Requirement Veterans Choice Program
(Certified)
Patient-Centered Community Care (PC3)
(Credentialed)
License
Board certification  
Education and training  
Employment history  
Malpractice history  
Absence of sanctions
Malpractice insurance  
Certification to write
controlled substances*
National Provider Identifier
Number (NPI)
Medicare participation
(or approved waiver)
 
Frequency At least every 12 months At least every 3 years

Contact

We value your feedback, please email us at PCCC.Info@va.gov

Resources

If you are a community provider interested in joining the TriWest network, we thank you for your interest. For more information, please visit: