Veterans across the nation rely on the Veterans Affairs Community Care Network (VACCN) to access essential home care services. However, the complex interplay between the Veterans Affairs Medical Centers (VAMC), Third-Party Administrators (TPAs) like Optum and TriWest, and local VA agencies can sometimes leave providers very confused about who to contact at various points during the process.
In this article, we aim to shed light on the roles played by these entities and how they collaborate to provide optimal care for our Veterans.
Optum and TriWest's Role as a TPA: Enrolling and Managing Claims
As Third-Party Administrators (TPAs) for the VACCN, Optum, and TriWest take on the crucial responsibility of enrolling and managing claims for providers working with Veterans in the VACCN. This involves streamlining the administrative processes, ensuring a seamless experience when it comes to billing and other matters. Optum and TriWest operate on a regional level, making it an integral part of the broader VACCN infrastructure.
VAMC's Role: Local Care Coordination for Veterans
On the other hand, Veterans Affairs Medical Centers (VAMCs), often referred to as local hospitals, are entrusted with the hands-on care coordination and referral management for Veterans. This includes a wide range of services, from scheduling appointments to managing and assigning referrals and ensuring that Veterans receive the care they require. While TPAs handle administrative aspects, VAMCs are on the frontline, actively involved in the day-to-day home care journey of Veterans.
Simply put, VA Medical Centers coordinate Veteran care, and Optum and TriWest handle all the bureaucratic billing work in the background.
CCN Providers and Local VA Dynamics
If your agency is enrolled and active as a CCN provider, you may encounter instances where the local VA has its own "internal/preferred" list of providers. In some cases, the local VA might require an orientation or screening process for an agency to be added to this list. This nuanced approach ensures that the local VA maintains a network of trusted providers and can tailor care to the unique needs of the Veteran population in their region.
It's important to note that Veterans have the right to exercise "patient choice." This means that, even if there's a preferred list, Veterans can express a preference for a specific agency as long as it is contracted at a federal level. However, in cases where a Veteran's request is not being honored, they have the option to escalate the matter to a patient advocate.
Provider Empowerment
Despite this complexity, providers are encouraged to navigate the VACCN with a clear understanding of the system. Acknowledging the diverse roles played by Optum, TriWest, and Veterans Affairs Medical Centers (VAMCs) enables providers to not merely exist within this system but to thrive. If you still feel that you need more guidance on this then fill out the form below and our team of experts will reach out to better assist you.
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