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VA Transition -VCP is No More

3rd Party Billing and Collections
in 3rd Party Billing and Collections

VA Transition -VCP is No More

Starts June 6, 2019

If you are a network provider with VA you need to pay close attention to the many changes that have occurred over the past year regarding how you receive referrals, where supporting documentation is sent, how claims should be billed and who pays the claims. Many times, the process required the provider to connect with a variety of sources; some internal with VA and others via 3rd party carriers or network administrators.

However, in an effort to streamline the provider network and claims processing VA is doing away with the Veterans Choice Program (VCP). All community care will transition to the Patient Centered Community Care (PC3) program effective June 6, 2019.

What You Need to Know

During this transition period, the authorization and referral processes will change the most. VA will not issue any new VCP referrals after May 1st and TriWest will not accept any new VCP referrals on or after May 1st.

VCP providers are now known as certified providers. Certified providers who want to continue treating Veterans through PC3 referrals and authorizations can continue to do so but will need to become a contracted PC3 provider within one year from the date the certified provider initially accepts a referral and treats a patient as a certified provider.

Additional Highlights and Key Facts are available from TriWest in the following documents:

HEADS UP!

  • If you are currently a VCP certified provider and want to continue to treat Veterans, you need to sign a PC3 contract with TriWest. Check out the Join Our Network page here.
  • Don’t forget to append the GP modifier on all authorized Physical Therapy services and AVOID the GY excluded services modifier; appending a GY modifier and a missing GP modifier will cause your claim to be denied.
  • You will not get paid for services that are not authorized. Pay attention to those authorization forms.

KMC University members can check out VA resources in the Billing and Collections Lesson 1.6, The Other Type of Payer.

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