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!
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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.
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.
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.
For more information:
Call Community Care Contact Center: 877-881-7618
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.
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.
Additional HSRM Information
For more information about HealthShare Referral Manager (HSRM) for community providers, please visit the Care Coordination Overview Webpage.
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
Additional Questions within the TriWest Network
- Contact PC3 Provider Services: 855-722-2838
- Contact CCN Provider Services for CCN Region 4: 866-286-4174
TriWest Provider Services is available by phone from 8 a.m. – 5 p.m. MST, Monday – Friday, excluding federal holidays.
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.
Becoming a VA Dental Provider Under CCN
February 21, 2020
Are you a dental provider interested in partnering with VA to serve Veterans in your community? VA encourages high-performing dental providers to be part of VA’s Community Care Network (CCN). As a CCN dental provider, you can take pride in providing high-quality health care to Veterans with convenience and improved access to dental care.
Key benefits of becoming a CCN dental provider:
- Prompt payment within 30 days of receipt of clean claims, including resubmissions.
- Ability to deliver high-quality dental care to our nation’s Veterans.
- Utilization of industry-standard approaches and guidelines to administer services and a managed healthcare network.
VA provider webinar series: free community provider education
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.
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
VA implemented new email encryption software, Azure Rights Management Services (Azure RMS), on August 24, 2019, to continue to protect the security of Veterans’ protected health information and personally identifiable information (PHI/PII).
Community providers previously used Virtru Pro encryption to exchange sensitive information with the Veterans Health Administration (VHA) Office of Community Care (OCC). On August 24, 2019, VA transitioned away from Virtru Pro and implemented Azure RMS as its enterprise-authorized email encryption software.
Emails encrypted with Azure RMS can be seamlessly read and responded to securely through existing email providers, once the settings are adjusted correctly, or opened in a web browser.
Providers still have access to emails encrypted with Virtru Pro and are able to read and reply to those messages. VA users can then open those emails in the Virtru Pro Secure Reader via a web browser.
Contact and Resources
*Please note: This website is external to the VA network. VA is not responsible for the privacy practices or content of non-VA websites.
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.
Register for access to the Customer Engagement Portal:
- Go online to the Customer Engagement Portal
- Select Login and Continue
- Secure your access to VA by selecting Register for a Sign-in Partner
- Follow the prompts to register with ID.me for secure access.
VA has partnered with ID.me to provide two-factor authentication verification for increased security.
- Once the ID.me registration is complete, users will be returned to CEP to:
- Register their Tax ID information via the “My Profile” link
- Access the User Guide, FAQs and other training materials
- Search claims and payment information
- Execute, schedule and export reports
Financial Services Center (FSC) Customer Support
7:15 a.m.–4:15 p.m. CST
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.
- Visit the Availity website and login
- Navigate to the TriWest Payer Space
- Click on the “TriWest Learning Center” application
- Register for training
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.
HNFS Provider Service Line: 844-728-1914
Open October 1, 2018 – June 30, 2020
Health Net Federal Services Contract Close Out – Filing Deadline Extended February 5, 2019
February 5, 2019
VA has reached an agreement with Health Net Federal Services (Health Net) to extend the final date for filing initial claims to March 26, 2019. Originally, community providers were required to file claims within 180 days of health care delivery.
Health Net was a Third Party Administrator for the Patient-Centered Community Care (PCCC) and Veterans Choice Program (VCP) community provider networks. (VCP ended on June 6, 2019.) Veteran health care provided through Health Net ceased in June 2018, and VA’s contract with Health Net ended September 30, 2018.
To meet the extended deadline, community providers must file initial claims for Health Net-authorized services with Health Net by March 26, 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.
HNFS Provider Service Line:
- December 2020 - Monthly Provider Advisor
- November 2020 - Monthly Provider Advisor
- October 2020 - Monthly Provider Advisor
- September 2020 - Monthly Provider Advisor
- August 2020 - Monthly Provider Advisor
- July 2020 - Monthly Provider Advisor
- June 2020 - Monthly Provider Advisor
- May 2020 - Monthly Provider Advisor
- April 2020 - Monthly Provider Advisor
- March 2020–Monthly Provider Advisor
- February 2020–Monthly Provider Advisor
- January 2020–Monthly Provider Advisor