PGBA & TriWest Working to Resolve June Claims Issues

HCAOA has an update for members providing care under the VA Community Care Network. Effective June 9, TriWest began subcontracting all VACCN Region 4 health care claims processing and payment with PGBA. However, due to various technical issues on PGBA’s end, the first post-transition payments didn’t go out from PGBA until the week of July 12. “HCAOA members may have received a number of denials for June claims, but TriWest and PGBA are currently working to resolve those issues. Other than the June discrepancies, payments appear to be flowing correctly,” reported Doug Robertson, Chair of HCAOA’s Veteran Services Council. HCAOA continues to maintain contact with TriWest leadership on the transition status.

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Providers who continue to encounter issues with TriWest can email the new claim support address: Claims-HomeHealth@TriWest.com, which is monitored by a team at TriWest. When submitting a claim, be sure to include: Veteran name, DOB, SSN, and dates of service in question in an excel report to get an investigation started. Use a secure email service when sending veteran PHI. 

Additionally, TriWest will be launching Availity Plus (an Availity upgrade) on September 18.  HCAOA will provide more information on that release in the Fall.