HCAOA’s Veterans Affairs Advisory Council held a productive meeting last week with leadership at the U.S. Department of Veterans Affairs (VA) and the CEO of TriWest Healthcare Alliance. Many members have a contract with TriWest to provide home care to veterans in the western U.S. through the VA Community Care Network (VACCN). The meeting is part of a series of advocacy meetings the Council is having with the VA and its contractors to improve member experiences with providing care to veterans.
“It was encouraging to have the CEO and COO of TriWest on the call with the Council for the entire hour. They committed to resolving issues facing home care agencies and moved quickly after the call to get resources to HCAOA and respond to member requests for assistance with credentialing,” said Doug Robertson, Council Chair.
Providing services in the network is not without challenges, and the Council reviewed several issues Franchisees are experiencing with TriWest. TriWest recently announced that it is ceasing its relationship with WPS, a claims processor vendor, and contracting instead with PGBA, effective in June. WPS is no longer enrolling new providers in Electronic Funds Transfer (EFT) and is not issuing payments to existing providers like it should. New providers that are not enrolled with WPS for EFT will need to mail paper claims to the WPS address on the TriWest website until June 9. PGBA is enrolling new providers in EFT now (enrollment forms are on the Availity website under resources) and will accept paper claims at this address from providers with no payment history from WPS. TriWest assured the Council that WPS will meet its contractual obligations to providers and pay claims submitted to them.
The Council also informed TriWest that they have sent lists of home care agency entities in Region 4 to the VA to forward to TriWest to resolve credentialing issues, and that they look forward to the processing of the credentialing and contracting applications that are stalled. After the meeting, TriWest leadership began sending contracts to those members that needed them.
If HCAOA members are undergoing a change of ownership, the buyer should send their TriWest credentialing contract to Laurie Medina at TriWest with a cover note indicating it is for a change of ownership.
TriWest staff in different parts of Region 4 are giving different instructions to home care agencies on which forms to use for claim submission. TriWest provided a guide on what forms to use for different services.
TriWest brought up the issue surrounding the use of ICD-10 codes. The VA has their list of ICD-10 codes that they put on authorizations, but TriWest understands their VACCN contract to mean that they can only accept Medicare’s approved ICD-10 codes. During the meeting, TriWest and VA leadership agreed to plan to discuss the use of the codes.
The Council reiterated to the VA team that the lack of issuance of timely reauthorizations coupled with a 180-day timely filing deadline puts providers in a difficult position; the Council stated that it looks forward to the VA making changes to their process to issue timely authorizations.
HCAOA will continue to engage the VA and the contractors to advocate for reforms and improvements to the provider experience in the VACCN. The Council is scheduled to meet with Optum and VA leadership in May.
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