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Veteran Home Care: A Deeper Look At Optum & TriWest

by 
Shereen Thomas
May 12, 2023
6 min
 read
VA Community Care Network, Optum and TriWest.

Home care agencies getting started in Veteran care are often confronted by many names and terms they have to remember such as Third-Party Administrators (TPA’s), Optum, TriWest, Veterans Care Agreement (VCA), Veterans Affairs Medical Center (VAMC), and more.

What does it all mean? Shouldn't caring for Veterans be as simple as getting a contract with the VA and then billing them for the care you provide? If only it was that easy.

Optum and TriWest are the two companies that the Department of Veterans Affairs (VA) has subcontracted to as Third-Party Administrators (TPAs). Their role is to absorb much of the bureaucratic load when it comes to credentialing and billing so that community providers have an easier time interacting with the VA and ultimately are able to serve eligible Veterans better and improve their quality of life.

If you own a home care agency, or work for one in billing, credentialing, or collections, read on to learn more about Optum and TriWest.

A Brief History Of Community Home Care For Veterans

In the past, providers have had their fair share of horror stories about dealing with the Department of Veterans Affairs (VA). Payments would take an excessively long time to come through, often taking over 90 days. The number of hours authorized each week was low and billing had to be mailed in paper forms which led to rejections for even a single mistake, leading to mounds of unpaid accounts receivables.

The lack of standardization meant that each VA Medical Center had its own unique processes, making it challenging for individual agencies to get started and tougher for franchise networks and state associations to assist their members or franchisees.

As a result, many providers stopped working with the Department of Veterans Affairs (VA) and new providers hesitated to get started due to the industry sentiment. Sadly, this meant that Veterans were not receiving the health care they deserved.

How The CCN Has Improved For Home Care Providers

The Department of Veterans Affairs (VA) has an obligation to Veterans, therefore they introduced a number of changes to encourage community providers to care for Veterans again.

For starters, it has increased rates and authorized hours, making it more attractive for community providers to care for Veterans. Additionally, the TPAs have streamlined the billing and enrollment process for home care providers, who need only to enroll with either Optum or TriWest to get started.

Overall, these improvements have made it easier for home care providers to deliver high-quality care to Veterans.

Understanding The Interplay Between Optum, TriWest, And The VA

You can think of the Community Care Network as a spectrum. On the one end, the TPAs (Optum and TriWest) deal with enrollment and the credentialing process for VA home care. In the middle, the VA and the local VA Medical Centers deal with case management and referrals. Then it is back to the TPAs again who deal with all invoices and billing. By 'offloading' credentialing and billing to the TPAs, the VA has alleviated a lot of operational burden on the local VA Medical Centers, allowing them to simply focus on the coordination of Veteran care.

How Home Care Agencies Can Get Started With The VACCN

The first step is to get enrolled, or credentialed in official terms, in the Community Care Network. The Department of Veterans Affairs (VA) has split the country into regions. Depending on your state, you will fall into one of five regions, and your path to enrollment differs depending on where your agency is located. Home Care Agencies in VA regions 1, 2, and 3, need to join the VA via Optum. Agencies in regions 4 and 5 will need to go through TriWest.

Map of Community Care Regions
Image Source: US Department Of Veterans Affairs

To get started with Optum, you can call their call center to open a case, and for TriWest you can visit their website and fill out a form. Typically, the enrollment process spans a duration of 6 to 12 months, which is generally influenced by factors such as the urgency of provider requirements in a specific area or prioritization of enrollment in other locations due to saturation.

Talk to Paradigm, to see how we can help support your enrollment

A Brighter Future For Home Care

To sum things up, the VA Community Care Network (VACCN) has increased rates and authorized hours, and Optum and TriWest are now responsible for handling the billing and enrollment process for home care providers. These changes have made it easier for home care agencies to deliver the care that our Veterans deserve to improve their quality of life. As a result, the future of Veteran home care is looking brighter and more promising.

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