Update: More Changes in Store for VA

Karen Lee

Update: More Changes in store for VA

On October 2, 2018 the VA threw another contractor into the mix of the already ever-changing world of VA Contracting. TriWest has been offered the contract to become one of the third-party administrators (TPA) for VA. As background to the change of contracting we have discovered the following information.

On June 6, 2018 President Donald Trump signed into legislation the VA MISSION Act. This act aims to provider better and more access to Veterans who need healthcare services. Currently there are a multitude of programs that offer care to Veterans: Centered Community Care (PC3), Veterans Choice Program (VCP), ChampVA, and other programs. As part of the VA MISSION Act a new network of providers will be formed. This new network will be titled the Community Care Network (CCN). The Community Care Network (CCN) will be broken out based on the volume of Veterans enrolled in the VA’s healthcare systems and the number of community care referrals by state. Each region will be managed by Third Party Administrators (TPAs). These Third-Party Administrators are set to develop and administer networks of licensed health care providers. Each regional network will serve as the contract vehicle for VA to purchase care in the community. There may be a total of four different Third-Party Administrators based on the four regions. Each region will implement the CCN based on the date a contract is awarded to a TPA to administer the work. Implementation is set to occur region-by-region in a phased approach. This will ensure that Veterans experience is not impacted or interrupted.

TriWest has already begun to contact provider directly about extending and executing a new contract to help breach the gap for this period of partnered care. Provider agreements that have already been executed with PC3 agreements will still be valid, however the contracts with TriWest will have first rights to serving the Veterans. So, it is highly encouraged that all provider sign with the new TriWest contract commitments. If you have any questions or concerns about this process, please reach out to your account manager for clarification.

Source: https://www.va.gov/COMMUNITYCARE/programs/veterans/CCN.asp

Original Post: Big Changes for Veterans Affairs Healthcare!

The US Department of Veteran Affairs (VA) is now offering two types of programs that allow Veterans better access to care. The first is the Veterans Choice Program (VCP). The VCP program is designed for Veterans who need a specific type of care, and the VA cannot provide that care in a timely manner or the nearest VA medical facility is too far way or too difficult to get to. To utilize the VCP the Veteran must receive prior authorization from the VA for the service.

The VA has changed the Veterans Choice Program (VCP) into the Patient Centered Community Care (PC3) Program. There  are no additional requirements to become a PC3 provider if you were already an existing VCP provider. Patient-Centered Community Care is a national program of community providers that provide veterans access to primary care, inpatient/outpatient specialty care, mental health care, limited emergency care, and limited new born care.

The VA also offers ChampVA. To be eligible for ChampVA you cannot 

already qualify for Tricare. In addition you must be one of the  following: spouse or child of a veteran has been disabled for a service-connected disability; surviving spouse or child of Veteran who passed from VA disability; surviving spouse or child of a Veteran who at time of death was permanently or totally disabled; surviving spouse or child of a military member who died in line of duty (but not already eligible for Tricare).

The benefits of these two different programs mean that Veterans can have access to care when they need it.

In the past the third-party administration for the western region of Veterans Choice Program (VCP) and Patient-Centered Community Care (PC3) was Healthnet Federal Services (HNFS). However, starting October 1, 2018 HNFS will no longer administer the contract for any VA Programs in the West. VA Programs in the West will be taken over by local VA centers. All care, credentialing, contracting, and provider items will now be coordinated directly thru the local VA center closest to provider or patient.

Existing providers for the VCP/PC3 program are being enrolled in the new program at Ponderosa Billing Services, Inc. If you are unsure if you are a VCP/PC3 provider, we encourage you to contact your account manager directly.

If you would like more information on VA care, VA provider information, or the VA process please contact Ponderosa Billing Services, Inc directly. You can call: 800-452-9284 or e-mail: GetHelp@ponderosabilling.com today!