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VA Mission Act Providers Meeting 05/29/2019 Report

Thursday, May 30, 2019   (0 Comments)
Posted by: Sheri Ryan
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I attended the VA Mission Act Providers Meeting in Anchorage, AK on Wednesday, May 29 along with the following Alaska Chiropractic Society representatives - Debbie Ryan, Chief Executive Officer, Dr. John Pairmore, Treasurer, and Dr. Edward Barrington, Legislative Committee Chair.  

Information Provided at the Meeting:   

VA Mission Act Meeting Handout - Please download and read

VA Brochure - Enhanced VA Option Under the MISSION Act: Important Information for Veterans

My notes taken at the meeting:  

  1. Previously providers had 2 years to file a claim.  You now have only 180 days to submit a VA claim for reimbursement.  TriWest has sent notification to some providers that there was only 120 days for filing.  VA is getting clarification on this.  MISSION Act clearly states 180 days.  
  2. Make sure you have valid authorization for care prior to providing care.  VA can no longer do retro authorizations.  You do not have to have the paper authorization in hand - you can have confirmation of the authorization # for care.  Contact (907) 257-6904 for VA Authorizations.  When MISSION Act takes effect 6/6/2019, local VA will continue to issue all authorizations for care.  
  3. Time frame for paying pre-authorized claims -  Electronic filing of claims = 30 days; Paper claims = 45 days.  Preferred method is electronic filing of claims.  
  4. Documentation - Chart notes - will continue to be faxed to local VA office.  This change was effective 5/1/2019 and will continue under MISSION Act.  Fax number for chart notes is (907) 257-7443.  Fax initial visit chart notes within 72 hours of first visit.  
  5. Authorization "000" (triple-zero) number is the authorization number that guarantees payment.  Look for triple-zero number on your authorization (sometimes listed further down on authorization).  The "463" number is the consult#.  TriWest is listing both numbers on authorizations.  All authorizations that are expiring by 6/6/2019 will be extended by both VA and TriWest automatically. 
  6. Continue to bill directly to VA for VA direct authorizations.  Due to delays in the VA central office and Office of Community Care dispensing information, Va has been given an extension for direct VA authorizations—these can now run through 9/30/19. If you have a VA authorization, please continue to submit claims directly to the VA Regional Payment Center.
  7. Authorizations and scheduling services will continue to remain with local VA and those services will not be provided by TriWest or outside entity.  Contact (907) 257-6904 for VA Authorizations.  
  8. Chiropractic benefits maximum is 26 visits per year.  Acupuncture is 28 visits per year.  
  9. Veterans will continue to be able to direct schedule with a chiropractor for care.  Previously called Choice40 under Choice Act - will be grandfathered under Mission Act.  Important that offices ensure they have authorization# prior to providing care as VA no longer able to do retro authorizations.  See #2 above.    
  10. Do I have to join EmpowerChiro Network? - NO.  EmpowerChiro is the PC3 network and it is encouraged, but not mandatory.  Chiropractic offices can continue to see VA patients and be reimbursed from the Regional Payment Center under Veteran Care Agreements (VCAs).  Deadline to get VCAs in place extended to 9/30/2019 as credentialing is now required.  VA is currently looking for national credentialing company to provide that service in Alaska.  NOTE - There is a difference in payment between the AK fee schedule and the PC3 network fee schedule.  ACS Members - Click Here for more information on both fee schedules to make an informed choice as to which direction your office will move towards.  9/30/2019 date is a hard date for full implementation of VCAs.  Keep in mind that the credentialing process for either program will take approximately 30 days to complete.  VA's preference is for chiropractic offices to participate in the PC3 network, but it is NOT mandatory that you do so.  
  11. Choice Act had 2-3 different payers.  MISSION Act has consolidated to one payer system = TriWest @ this time. EXCEPT in #6 above
  12. Only 3 states qualify for community care - NH, HI, and AK because no full-service VA Hospital available.  
  13. VA held Industry Day in March, 2019 for companies interested in the Region 5 (AK) PC3 contract.  30 people representing 6 different contractors attended.  VA did not release the names of the contractors.  TriWest will remain VA TPA until 6/30/2020.  Region 5 contract going out for bid is to develop + maintain a network for entire state for veterans to receive services in a timely manner as well as processing/paying claims.  Region 1 has been awarded to Optum.  Region 2+3 have also been awarded to Optum but are under protest.  
  14.  Urgent Care under MISSION Act allows veterans to see an in-network urgent care provider 3x/year for free. 4+ = $30/visit.  NOTE:  There is no urgent care network currently developed in Alaska.  
  15. Travel reimbursement for care benefits - If service(s) needed for veteran are deemed available in OR, WA, AK, or ID area, VA will no longer reimburse for travel to an area outside OR, WA, AK, or ID for care.  If care needed not available in that 4-state area, travel will be reimbursed.

VA Contact Information:

  • Michelle Wyatt, Department Chief, ICS  907.257.4862 or michelle.wyatt@va.gov
  • Julie Reloza-Keating, Nurse Manager, ICS  907.257.4733
  • One-Stop Shop  907.257.5463
  • Patient Advocate  907.257.5449
  • Melody, Supervisor w/chart notes  907.257.7457
  • Medical Records FAX number  907.257.7443
  • VA Authorizations  907.257.6904

Please feel free to contact ACS at 907.903.1350 or sryan@akchiro.org if you have any questions.  

Sheri Ryan  |  Chief Operating Officer

Alaska Chiropractic Society | 550 E. Tudor Rd., Suite 202 |  Anchorage, AK 99503

Direct/Mobile: (907) 903-1350 | Fax: (907) 770-3790

sryan@akchiro.org

 

UPDATE 06/05/2019


Michelle Wyatt, Associate Chief Nurse, Integrated Care Services

 

Good afternoon,


I want to thank you all, again, for attending the Vendor Information Sessions last week; I appreciate you taking time out of your schedules to come listen to the numerous changes the VA is and will be going through over the next few months. As promised, attached is the electronic version of the Power Point slides I distributed at the meetings last week. Please feel free to share with other providers’ offices who may be interested in this information.

Some clarification on Veteran Care Agreements (VCAs)—these agreements, once signed by the vendors’ offices, will be uploaded to a VA sharepoint and will then be reviewed at the regional level to determine if they meet the criteria to opt out of participating in the PC3 network. Criteria that are considered would be how many other vendors of the same specialty are in the area and are currently enrolled in the PC3 network; is the specialty one of the excluded services (ex: Home Health Aides, dialysis); and is the specialty medically critical. As I stated, VA Central Office and the Office of Community Care want providers to participate in the PC3 network; this allows for standardized quality measures and oversight, as well as centralized billing and claims. We are reaching out to providers currently signed to Provider Agreements to offer VCAs but those vendors who have been PC3-participating should remain in the network as justification for leaving PC3 to become a VCA vendor would be difficult to prove.

The Request for Service (RFS) form has still not been released by Office of Community Care. Please continue to use the current SAR form until the RFS is sent to you. I am hoping to see the new form within the next few days and will forward to you as soon as I receive it.

Please let me know if you have any questions or concerns; I will send updates as frequently as I receive them, but will try not to inundate you with information that is not pertinent to your offices. Thank you!

Michelle Wyatt, MSN, RN
Associate Chief Nurse
Integrated Care Services
(907)257-4862

 

Mission Act Information (12 color slides)


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Alaska Chiropractic Society, PO Box 111507, Anchorage, AK  99511-1507 
    
Phone: (907) 903-1350   Fax:  (907) 770-3790   Email:  info@akchiro.org