Provider Resources



Veteran’s Affairs Patient-Centered Community Care (VAPC3)


TriWest Healthcare Alliance and WPS Military and Veterans Health (MVH) are expanding the Patient-Centered Community Care (PC3)/Veterans Choice Program (VCP) coverage to include ALL regions – 1, 2, 3, 4, 5A, 5B, and 6.

For providers located in a region previously covered by Health Net Federal Services (HNFS) Regions 1, 2, and 4, at the request of VA, TriWest will become the administrator supporting VA community care needs. This is happening in a phased approach beginning with Veterans Integrated Service Network (VISN) 19 in early December and all VISNs by the end of January 2019. This is for care that VA is unable to provide within one of its own facilities. Providers will be required to re-enroll for electronic transactions (EDI, ERA, and EFT) with WPS.

For providers located in a region currently under TriWest (3, 5A, 5B, & 6), nothing has changed. TriWest will continue to coordinate PC3 and VCP care under these programs and WPS MVH will continue to process these claims.

Please check triwest.com/triwest-expansion for updates pertaining to the expansion, including your state’s phase-in timeline for health care delivery authorized by TriWest.

  • On Dec. 7, the first Veterans Integrated Service Network (VISN) to be operational is VISN 19, the Rocky Mountain Network.
  • TriWest will continue to set up the provider network and administrative services through the end of January 2019.
  • In the interim, if providers have been providing care to veterans under contract with HNFS, the Veteran’s local VA Medical Center (VAMC) Office of Community Care will coordinate care. This will continue until TriWest is actively administering the PC3 and VCP programs in your region.
    • Please visit vets.gov/facilities to locate the veteran’s care coordinating VAMC
    • Providers must submit claims for care provided during the interim period to the VAMC Office of Community Care
    • Providers must submit claims for care authorized by HNFS and provided prior to Oct. 1, 2018, to HNFS; HNFS can accept these claims through March 26, 2019
    • After the transition, providers must submit claims for care authorized by TriWest, to WPS Military and Veterans Health.
    • For more information on HNFS claims, please visit the HNFS article on the transition

These contracts serve the health care needs of nearly half of the eligible veterans in the country.

Your VA claims can be submitted electronically. The Health Insurance Portability and Accountability Act (HIPAA) requires health insurance payers in the United States to comply with the EDI standards for health care as established by the Secretary of Health and Human Services. The ANSI X12N 837 implementation guides have been established as the standard for compliance for claim transactions.

The implementation guides for the 837 professional and institutional transactions are available electronically at the ASCX12 website.

For detailed reimbursement or claims questions, please contact 1-855-PCCCVET (722-2838). Choose Option 3 as a provider and then Option 3 to speak to a representative.

VAPC3

Getting Started

Note: If your office submits EDI claims through a clearinghouse, they may already be an approved clearinghouse with WPS. VAPC3 EDI Connection

New VA Receiver IDs (Payer IDs) and Other Important X12 837 Data Elements – Please refer to the Companion Guides.

Electronic Funds Transfer (EFT) is available for VA providers. EFT replaces the paper checks you currently receive for claim payments. This process allows your payment to be deposited directly into your checking or savings account, and eliminates the delay or inconsistencies you may encounter with mail procedures.

EFT payments are typically deposited into your specified bank account two business days following the budget approval. Electronic Funds Transfer payments have a different number sequence than your current paper checks.

The number of EFT transactions initiated by WPS is dependent on the number of bank accounts to which your office requires EFT payments to be posted. If you currently use more than one legacy provider number or NPI there will be more than one EFT transaction per day.

Your Electronic Remittance Advice will be your office's notification of the payment that is posted to your accounts. Notification of your payment into your accounts will come from your bank. Contact your bank for their notification procedures. To enroll for EFT, go to our Enrollments page.

The easiest way to receive your Provider Remittance Advice (PRA) is through ERA, which is an electronic version of a payment explanation. ERA is more convenient for you. When you sign up for EFT and ERA, you will find out about your payment via ERA about two days prior to the funds transfer. You can also request to suppress your paper PRAs for even further paper savings.

When you choose to receive Electronic Remittance Advice or ERA directly, your files will be sent to you in the X12 835 format, version 5010A1, and can be downloaded from our secured internet site WPS Gateway Express.

For enrollment to receive and download ERA (835) directly from WPS, you will need to go to our Enrollments page.

To receive Electronic Remittance Advice (ERA) through a clearinghouse, go to our Enrollments page.

We look forward to developing successful relationships with all our trading partners. If you have any questions or concerns regarding your EDI transition for the new VA contracts for VAPC3, please contact us at:

Wisconsin Physicians Service

Electronic Data Services
P.O. Box 8128
1717 W. Broadway
Madison, WI 53713

800-782-2680, option 1
Email EDI
Fax: 608-223-3824


For further updates visit our EDI website. We also encourage you to contact your clearinghouse, billing service, or software vendor to discuss transition related issues.

   

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