New Information and Training on Veteran Community Care Networks

Posted on July 2, 2019 by Roni Falck

The U.S. Department of Veterans Affairs (VA) is shifting the way in which it works with community providers to expand the provider network and improve customer service for veterans and timeliness of payment for providers. 

Historically, Veterans who are eligible for VA health care, meet one of six criteria and have approved authorizations have been served by non-VA programs as part of the Veterans Choice Program. This program will be replaced by Community Care Networks (CCNs).

Six CCN regions are being implemented in a phased approach across the country in 2019 and 2020. The CCNs will be managed by a separate contractor responsible for contracting and payments for community-based providers. Optum Public Sector Solutions, part of United Healthcare (Optum) has been selected to manage Region 2 (Minnesota’s region) and is currently in the process of building its provider network. 

Providers who wish to continue serving Veterans will need to be a participating provider under the current Patient-Centered Community Care (PC3) contract, through TriWest Healthcare Alliance (TriWest). Participating under PC3 will allow community providers to continue serving Veterans during the transition time before the new CCN is deployed.

Adult Day Programs who wish to continue serving Veterans will need to complete Veterans Care Agreements (VCAs).

An FAQ has been developed with information accurate as of July 1. Updated information will be shared as soon as it becomes available.

I would like to be part of the Community Care Network but haven’t heard from Optum.

Providers who have not heard from Optum can send an email to get information about becoming part of the Community Care Network: vaccnprovidercontracting@optum.com

How quickly will contracts be effective?

It is our understanding that the implementation date for Minnesota is Feb. 4, 2020.   

How will providers bill?

Providers should submit all claims to the location that is specified on the referral that is sent to the provider. Verifying this address each time a referral is received is important throughout the transition.

When can payment be expected?

Most claims should be paid within 30 days of submission; however, there may be extenuating circumstances where a claim may take longer to be paid.

Who will determine authorizations and eligible services?

VA will continue to set authorizations/limits.   

How can I get a Veterans Care Agreement?

Providers should reach out to their local VA office to receive a Veterans Care Agreement.

How long are Community Care Network contracts effective?  Is annual renewal required? 

Each CCN contract is awarded for one year. VA will review the contractor’s performance annually to determine if the contract will be extended.

For current outstanding claims, should providers continue to work with the VA or will that shift to Optum?

All current outstanding payments will need to be resolved with VA. Optum is not handling backlog issues.

How can I get more information?

Providers are encouraged to participate in a monthly webinar hosted by VA on Community Care Programs. Additional information can be found here.