Patient-Centered Community Care–Information for Providers
Patient-Centered Community Care (PC3) is a nation-wide network of community providers VA uses to refer Veterans to community care under specific circumstances. PC3 is intended to provide eligible Veterans with access to medical care when services are not readily available or accessible at their local VA medical facility.
PC3 is managed by a Third Party Administrator (TPA), TriWest Healthcare Alliance (TriWest), which performs certain functions on behalf of VA, such as scheduling appointments and paying claims.
The following health care services are covered under PC3:
- Primary care
- Mental health care
- Inpatient and outpatient specialty care
- Limited emergency care
- Limited newborn care for enrolled female Veterans following the birth of a child
PC3 is one of the national contract vehicles and network of community providers VA uses to purchase community care when the services are not available within VA medical facilities. TriWest, VA's TPA, manages appointment scheduling for PC3 based on the Veteran's appointment preference, and does this through a network of over half a million community providers across the United States.
Below is the process community providers use to care for Veterans through PC3:
- VA contacts the Veteran and obtains information about the preferred community provider.
- VA creates a packet of referral information and an authorization for care.
For the sites where VA does not do the scheduling, the packet of referral information and an authorization for care are uploaded to the TPA’s portal.
- VA or the TPA contacts the Veteran and coordinates an appointment between you (the provider) and the Veteran for an agreeable date and time.
- After the appointment, community providers must submit the medical documentation to the TPA.
- Once the TPA receives the medical documentation, it is uploaded to the TPA portal for VA facility staff.
- VA staff then downloads the medical documents and places them in the Veteran’s Electronic Health Record.
- After this process is complete, the TPA will reimburse you for the medical care provided.
If you are interested in partnering with VA, you must become a PC3 provider by establishing a contract with TriWest. To join the TriWest provider network, start by filling out the Provider Contract Request form.
VA also requires all PC3 community providers:
- Must accept Medicare rates.
- Must have a full, current, and unrestricted license in the state where the service(s) are delivered and must have same or similar credentials as VA staff.
- Must be able to submit a copy of the medical records to TriWest for the medical care and services provided to Veterans for inclusion in the VA electronic record.
- Must follow all applicable federal and state regulatory requirements.
- Must be eligible according to the U.S. Department of Health and Human Services Office of Inspector General Exclusion Program.
- Must meet all of the Centers for Medicare and Medicaid Services' Conditions of Participation and Conditions for Coverage, or other criteria established by VA.
If you meet the eligibility requirements, contact TriWest using the information listed below. Complete the process to establish a contract with TriWest, which will allow you to care for Veterans through the PC3 network.
Triwest Provider Services: 855-722-2838
Monday–Friday, 8:00 a.m.–10:00 p.m. EST
excluding federal holidays
VA reached an agreement with TriWest on a one-year extension of its management of the PC3 network, through September 30, 2019. This agreement expands TriWest’s services to all regions across the country under this program.
IMPORTANT: The Health Net Federal Services (HNFS) contract with the VA ended on September 30, 2018. Providers with questions about claims submitted to HNFS can contact HNFS directly.
Health Net Federal Services: 844-728-1914
For more information, please review the Frequently Asked Questions and the HNFS Provider newsletter below.HNFS Contract Close Out–FAQs HNFS Provider Newsletter–September 2018