[Update] As of Wednesday, September 6, 2023, TriWest has notified Paradigm that this issue has been resolved, but we urge all providers to remain cautious and keep a close eye on payments going forward.
Many home care agencies that are part of the Community Care Network in states where TriWest is the Third-Party Administrator are experiencing underpayments on their VA billing.
TriWest has been underpaying some claims by 25%, stating that they are billed at the incorrect rate when in fact they have been billed correctly.
This issue first arose in California and was said to be resolved, but it has resurfaced and has now spread across all 12 states that TriWest administrates, namely: Alaska, Arizona, Colorado, Hawaii, Idaho, Montana, New Mexico, Nevada, Oregon, Texas, Utah, and Washington.
How The Issue Is Being Resolved
Paradigm brought this problem to TriWest’s attention and PGBA (TriWest’s claim processor) has identified the underlying issue causing the errors. PGBA is currently working on correcting the issue and will then be reprocessing all the affected claims. Paradigm will be keeping a close eye on these claims to ensure that all claims affected get the remaining balance paid.
How Paradigm Is Helping Community Providers
By proactively working with TriWest and PGBA, Paradigm will identify 75% payment issues, help get claims paid in full, and provide agencies with support through this difficult time.
Paradigm also employs real-time monitoring to identify and resolve issues that may lead to underpayments, making sure no issues go unnoticed.
By utilizing Paradigm's expertise and technology, agencies can catch and correct payment and remittance errors in the VA billing process, ensuring that accounts receivable are not affected.
If you’re facing these challenges and require assistance, we strongly encourage you to reach out. Experience Paradigm’s unwavering support firsthand by completing the form below or booking a demo here.
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