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Author: UCA Admin/Thursday, May 16, 2019/Categories: Industry News
(Below is a message from UCA and Camille Bonta, MHS, Principal of Summit Health Care Consulting and UCA Policy Consultant):
Over the past year UCA has been advocating on behalf of urgent care centers across the country that urgent care can and should be a solution for veterans seeking care. We are pleased to report that TriWest Healthcare Alliance reached out to UCA to assist them in creating a national network of urgent care centers. The goal is to provide urgent care access to eligible veterans via a substantial network by the launch date of June 6th, 2019. Payment will be per the Medicare fee schedule. UCA will also be hosting a free webinar in collaboration with TriWest as a member benefit to clarify contracting, enrollment, payment and other details to assist you. Look for more information on this webinar in the coming week. Details related to UCA advocacy and how to enroll with TriWest if you are not already contracted can be found below. The opportunity to care for our nation’s veterans is truly a win-win.
The Department of Veteran’s Affairs (VA) will launch its urgent care benefit, as required by law, on June 6, 2019. To make this benefit widely accessible to veterans, VA contractors are working under a tight timeline to build their urgent care provider network. TriWest, which administers the VA’s Patient-Centered Community Care (PC3) program and the Veterans Choice Program (VCP) (which ends on June 6, 2019), has requested UCA's assistance in actively soliciting urgent care providers to join the TriWest network. The MISSION Act, enacted into law last year, requires coverage of “walk-in care” for non-emergent care for eligible veterans. Specifically, the law requires the VA to develop procedures to ensure veterans are able to access walk-in care from qualifying non-Department entities or providers. In March, UCA commented on proposed regulations governing the urgent care benefit. Specifically, UCA took issue with the VA’s proposal to define episodic care as a single visit and disallowing preventive services (other than flu shots, and therapeutic vaccines that are furnished in the course of treatment of another condition). UCA also asked the VA to clearly distinguish between urgent care facilities and retail clinics. Final regulations are still under review at the Office of Management and Budget. In 2017, UCA pushed for introduction of the Veterans Emergency Room Relief Act (S. 2785, H.R. 1261), advocacy that culminated with the inclusion of an urgent care benefit for veterans in the MISSION Act.
(Information from TriWest):
New Urgent Care Program Launching Under VA MISSION Act
The Department of Veterans Affairs (VA) is launching a new urgent care benefit under its Community Care programs starting June 6, 2019.
Under the new benefit, urgent care clinics in TriWest’s network will be able to provide care to a Veteran without a prior authorization. Instead, urgent care staff will have to confirm the Veteran’s eligibility before providing care.
As part of this urgent care benefit, providers do not collect co-pays, cost-shares, or deductibles from Veterans.
Join the TriWest Network
TriWest hired Constantia Healthcare as consultants to assist us with provider contracting activities. If you are interested in participating in the new Urgent Care Program and are not already contracted with TriWest, please email us at firstname.lastname@example.org and a TriWest consultant will be in contact with you.
How Will the Process Work?
Under the VA Community Care programs, the urgent care process will work as follows:
The Veteran will self-present to the TriWest network urgent care clinic.
The urgent care clinic will call TriWest at a dedicated, toll-free line to confirm the Veteran’s eligibility. The following information is needed to input into the automated phone system:
The last four digits of the Veteran’s Social Security number
The Veteran’s date of birth
If eligibility is confirmed, the urgent care clinic may treat the Veteran for his or her medical condition.
The urgent care provider may write a medically necessary prescription for up to a 14-day supply for those medications on the VA’s Urgent Care Formulary and the Veteran may fulfill the prescription at any in-network pharmacy with ExpressScripts.
After the Veteran leaves, the urgent care clinic will submit medical documentation from the visit to the Veteran’s VA Medical Center (VAMC).
The urgent care clinic will then submit its claim to WPS Military and Veterans Health (WPS MVH), TriWest’s claims processor. TriWest will be responsible for paying claims on behalf of VA.
More Training Coming Soon
TriWest Provider Education is currently preparing a new training course on the urgent care benefit and how it will work. Please stay tuned for more information coming soon!
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