If you serve Veterans through the VA’s Community Care Network (CCN), it is important to know that your contracts are valid for three years, and it is up to you as the provider to know when your contracts expire.
Providers can expect Optum and TriWest to reach out to them to let them know that their contract term is nearly over and that they need to re-credential.
However, this communication is often missed by providers. In worst-case scenarios, some providers claim that they were not notified at all.
Providers who are not careful about keeping track of their contract term risk lapses in coverage and payment gaps. In one instance a home care agency was notified that their contract was expiring, but the notification landed in their spam folder. Without realizing that their contract had expired, they kept serving Veteran clients and now have hundreds of thousands of dollars in AR due to this coverage gap.
Additionally, providers who have a valid contract with the CCN, but don’t serve Veterans, may not even realize that their contract has expired, with this line of revenue now closed off to them.
Relying On Your Own Data
Re-credentialing is important both from a bureaucratic and quality assurance point of view. It ensures that the Veterans receive the highest quality of care from providers who maintain up-to-date qualifications and credentials, as verified by the VA or its Third-Party Administrators (TPAs).
It is crucial for agencies to take the initiative in keeping track of when these credentials need to be renewed. Although you may receive reminders, it is always advisable to proactively monitor this yourself. Government processes can be slow and may not always function optimally, so staying ahead of credentialing renewals is important.
Re-credentialing Reminder Emails
TriWest and Optum send out email reminders to the primary contact from the initial enrollment. So, if you are coming up to a renewal, make sure you are checking your spam and junk mail 60 days prior to your contract expiration. Emails from Optum and TriWest may go to spam boxes so checking them regularly, well in advance, will be beneficial to you.
If you are in Optum regions (1,2,3 of the CCN) you may get an email from UHC, UnitedHealthCare, Optum, OptumServe, or the like.
In the TriWest regions (4,5 of the CCN) providers may receive a reminder directly from Triwest.
Not Sure Of Your Contract Dates?
For providers in regions 1,2,3 you can call Optum support at 888-901-7407 (region 1), 844-839-6108 (region 2), or 888-901-6613 (region 3).
For providers in regions 4 and 5, you can call TriWest support at 877-226-8749, or email them at ProviderServices@TriWest.com or credentialing@triwest.com
If you’re a Paradigm customer and haven’t received any communication about the re-credentialing process and are within 30 days of your contract expiring, please contact your account manager or our support line so that we can assist you.
If you’re not a Paradigm client yet, reach out to your TPA, or book a call with us to learn how we make re-credentialing a seamless process.
Documentation And Submission Process
As part of the re-credentialing process, providers will be asked to submit specific documentation. These essential documents include a current W-9, proof of insurance, business information, and, if applicable, a current home care license.
There may also be requests for Medicare certifications or additional accreditations. If these are not relevant to you, you do not have to provide them.
To streamline the re-credentialing process, it is advisable to prepare your documents well in advance. Gather all the necessary paperwork and ensure it is current and accurate. This proactive approach will help you minimize delays.
Need Better Support?
If you have any issues with Optum or TriWest, the re-credentialing process, short payments, or growing AR, Paradigm’s got your back!
If you're currently partnered with Paradigm, please reach out to your account manager. If you're not yet working with us, please don't hesitate to book a call here. We are happy to assist you every step of the way and ensure that your service to Veterans remains streamlined and uninterrupted.
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