Any change to claims processing procedures can be frustrating for hospitals. When those changes involve federal agencies, frustrations can quickly compound. The federal government announced several planned changes to the Veterans Choice Program (VCP) in 2018 and 2019. Hospitals will need to stay on top of these anticipated changes affecting VA patients at community care centers to avoid unnecessary frustrations, lost man hours, and unclaimed revenue.
The Veterans Choice Program (VCP) was intended to be a temporary program within the Veterans Access, Choice, and Accountability Act of 2013. The program expanded medical care access for veterans to community medical facilities in response to a nationwide access crisis within the VA system. Under the VCP veterans are able to receive health care services from participating community care facilities. These facilities include: federally qualified health centers, Department of Defense medical facilities, Indian Health Service outpatient health facilities or facilities operated by a tribe or tribal organization, hospitals, physicians, and non-physician practitioners or entities participating in the Medicare or Medicaid programs. Funding extensions and a consistent need for services has made it difficult to discontinue the VCP program. In 2018, congress passed the VA MISSION act, which included a permanent program called Veterans Community Care Program (VCCP), which is designed to replace VCP. Additionally in 2018, the federal government announced it was not renewing the contract with HealthNet, a VCP third party administrator. Therefore, all contract services with HealthNet ended as of the contract termination date, September 30th, 2018
Since 2013, the VCP has been administrated by HealthNet and TriWest. These administrators manage: appointments, counseling services, card distribution, and a customer service call center. They also oversee provider related services, including: medical service reporting, billing, and coordination of care. However, the VA ended its contract with HealthNet on September 30th, 2018. Reportedly, this cancellation was due to low patient participation, customer service issues and delayed payments to providers. The cancellation of HealthNet directly affects VA patients and VCP providers in the south and north east, including Georgia and South Carolina. Moving processes for veteran programs and changing authorization standards could leave health care providers scrambling with complications affecting patient authorizations and claim processing. Here are a few changes hospitals should be aware of to ensure veterans receive a seamless transition of care, billing and payments.
Upon the cancellation of the HealthNet contract, the PC3 network in the HealthNet Service area will not continue. The VCP program will continue. If a provider has a HeathNet authorization that hasn’t expired, it will not be honored by the VA administration. Hospitals and other providers who would like to continue providing care to veterans must work directly with VA medical facilities to coordinate care and billing. Providers will need new authorization forms even if their current form extends past the HealthNet contract termination date. Patient appointments scheduled for dates after September 30th, 2018, will need to be coordinated and possibly rescheduled through a local VA medical facility. VA staff will issue referrals and authorizations directly to community providers.
HealthNet will continue to process and pay claims for services rendered on or prior to September 30th, 2018. Providers have 90 days for PC3, and 120 days for VCP, to file claims for authorized services that were performed prior to the contract termination. If continued care is required, or requested by the veteran, providers will need to contact the local VA medical facility’s community care office to coordinate care.
Concerned about claim status? As of October 1st, 2018 HealthNet has a new customer service line for both PC3 and VCP providers to reach HeathNet regarding claims for services prior to September 30th, 2018. The Veterans Choice Call Center, 1-866-606-8198, is a national number. Beginning Oct. 1, 2018, this number will be redirected to VA. PCCC customer service line, 1-800-979-9620, is discontinued as of Oct. 1, 2018. More information about the cancellation of HealthNet can be found here.
This information is a summary of changes affecting the termination of the VCP contract with HealthNet. Please contact our office for a full explanation of changes, or you can review the Congressional Research Service Publication here.
These changes relate only to the cancellation of HealthNet from the VCP. Additional changes are anticipated for veteran centered health care with the implementation of Veteran Community Care Program (VCCP). The VCCP is scheduled to be operational in June 2019. Our office will follow changes in VA patient administration and provide information updates as they become available.