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�� &#x/Att;¬he; [/;ott;&#xom ];&#x/BBo;&#xx [6;.69;3 3;.08;e 5;X 9;�.06;&#x ]/S;&#xubty;&#xpe /;oot;r /;&#xType;&#x /Pa;&#xgina;&#xtion;&#x 000;&#x/Att;¬he; [/;ott;&#xom ];&#x/BBo;&#xx [6;.69;3 3;.08;e 5;X 9;�.06;&#x ]/S;&#xubty;&#xpe /;oot;r /;&#xType;&#x /Pa;&#xgina;&#xtion;&#x 000; Page 1Users are responsible for ensuring they work from the latest approved version. This document was last modified on PCA1425Optum VA Community Care Network call CCN Provider Services for your region Optum is assisting select VA Medical Centers (VAMC) with appointment scheduling. Providers may be contacted by VAOptum �� &#x/Att;¬he; [/;ott;&#xom ];&#x/BBo;&#xx [6;.69;3 3;.08;e 5;X 9;�.12;&#x ]/S;&#xubty;&#xpe /;oot;r /;&#xType;&#x /Pa;&#xgina;&#xtion;&#x 000;&#x/Att;¬he; [/;ott;&#xom ];&#x/BBo;&#xx [6;.69;3 3;.08;e 5;X 9;�.12;&#x ]/S;&#xubty;&#xpe /;oot;r /;&#xType;&#x /Pa;&#xgina;&#xtion;&#x 000;Page Users are responsible for ensuring they work from the latest approved version. This document was last modified on PCA1425OptumQRG_04212021 VA Community Care Network Receivingeferral Eligibility VA ontacts rovider Schedule ppointment Reviews onsult rder VA confirms a Veteran’s eligibility to receive Community CareVA requests CCN provider accept referral and confirms providerpreferred method to receive referralVeteranVA staff member or Optum schedules an appointment with a CCN ProviderProvider reviews consult order included with the approved referral for services being requested by VA Upon a CCN provider acceptinga referral from VAan approved referral packet will be sentusingthe provider’spreferred method to receive it.Options for preferred methodsareHealthShare

2 Referral Manager (HSRM)Secure Secure mai
Referral Manager (HSRM)Secure Secure mail(VA only)Direct essaging(VA only)CCN providers can find more information about the methods directly from VA at va.gov/COMMUNITYCARE/providers/index.asp . Included in a Referral PacketThe referral packet will containfacilitcontact informationReferral numberIssue and expiration datesServices authorizedategory of care or subspecialty Standardized pisode are (SEOC)Billing information �� &#x/Att;¬he; [/;ott;&#xom ];&#x/BBo;&#xx [6;.69;3 3;.08;e 5;X 9;�.12;&#x ]/S;&#xubty;&#xpe /;oot;r /;&#xType;&#x /Pa;&#xgina;&#xtion;&#x 000;&#x/Att;¬he; [/;ott;&#xom ];&#x/BBo;&#xx [6;.69;3 3;.08;e 5;X 9;�.12;&#x ]/S;&#xubty;&#xpe /;oot;r /;&#xType;&#x /Pa;&#xgina;&#xtion;&#x 000;Page Users are responsible for ensuring they work from the latest approved version. This document was last modified on PCA1425OptumQRG_04212021 VA Community Care Network Referral Example:Note:The expiration date is subject to changebased on the first appointment to allow for the complete timeframe from appointment to expiration date. When recalculateda new referral is issuedoweverprovider will be able to see the update in HSRM or the provider portal.Standardized Episode of Care (SEOC)A SEOC indicates a set of services and procedures that relate to a specific category of care or subspecialty that is already approved for the Veteranif medically necessary. The SEOC also indicates the number of visits that are authorized. �� &#x/Att;¬he; [/;ott;&#xom ];&#x/BBo;&#xx [6;.69;3 3;.08;e 5;X 9;�.12;&#x ]/S;&#xubty;&#xpe /;oot;r /;&#xType;&#x /Pa;&#xgina;&#xtion;&#x 000;&#x/Att;¬he; [/;ott;&#xom ];&#x/BBo;&#xx [6;.69;3 3;.08;e 5;X 9;�.12;&#x ]/S;&#xubty;&#xpe /;oot;r /;&#xType

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;&#x /Pa;&#xgina;&#xtion;&#x 000;Page Users are responsible for ensuring they work from the latest approved version. This document was last modified on PCA1425OptumQRG_04212021 VA Community Care Network If a service or procedure states that the number of visits authorized is 999this indicates there is a standard number of visitsse clinical judgment to evaluate and treat the Veteran. During the COVID19 public health emergency, VA will allow providers to care for CCN patients through telehealth and telephonic consults, when clinically appropriate and with an approved referral from a VAMC.For additional details, please see the Treating Veterans during the COVID10 Public Health Emergency reference document at provider.vacommunitycare.com . SEOC Example:With an approved referral, VA is always primary, and claims should be submitted to Optum. If a Veteran has other health insuranceplease see va.gov/COMMUNITYCARE/providers/PRCT_requirements.asp for additional information. Optum is assisting select VAMCs with appointment scheduling. Providers may be contacted by VA or Optum to request acceptance of a referral and schedule an appointment. A Veteran may also choose to contact the provider directly to schedule an appointment. Once the referral is assigned to the provider, the referral will be available in HSRM. The provider will receive a referral in one of the following ways:VA will send the approved referral based on the provider’s preferred method of communication and VA or the Veteran will schedule the appointment. Optum will call the provider and once the provider accepts the referral Optum will schedule the appointmentfax or mail the referral to the provider.Veteran will contact the provider to schedule an appointment and advise Optum of the appointment. Optum will fax or mail the referral to the provider. Request for ServicesProviders must submit a Request

4 or Service (RFS) orm 1010172 to VA, when
or Service (RFS) orm 1010172 to VA, when a need is identified for additional care that falls outside of the original referral and SEOCor if there is a need to extend the duration of the referral. �� &#x/Att;¬he; [/;ott;&#xom ];&#x/BBo;&#xx [6;.69;3 3;.08;e 5;X 9;�.12;&#x ]/S;&#xubty;&#xpe /;oot;r /;&#xType;&#x /Pa;&#xgina;&#xtion;&#x 000;&#x/Att;¬he; [/;ott;&#xom ];&#x/BBo;&#xx [6;.69;3 3;.08;e 5;X 9;�.12;&#x ]/S;&#xubty;&#xpe /;oot;r /;&#xType;&#x /Pa;&#xgina;&#xtion;&#x 000;Page Users are responsible for ensuring they work from the latest approved version. This document was last modified on PCA1425OptumQRG_04212021 VA Community Care Network If care is needed within 48 hours, please contact the VA Medical Center (VAMC) on the approved referral. VA will process all requests within three business days, and the provider will be notified of the decision or outcome through their preferred method of communication. The notification will also indicate if the care will be provided within VA or in thecommunity. This form is also used for DME, medical devices, orthotics, prosthetics, eyeglasses and oxygen requests.This form can be uploaded into HSRM or sent to VA through secure email or secure fax and must include the provider signature. The signatureis necessary, since the RFS serves as physician orders. This form is available at provider.vacommunitycare.com� Documents & Links. A separate form is required for each service requested.When it is necessary for a CCN provider to refer care to another provider for services on the approved referral and SEOC, the referring provider must call CCN Provider Services for your region to verify participation status and confirm they are referring to an innetwork CCN provider. To help ensure timely claims processing, the referri

5 ng provider shall forward the approved r
ng provider shall forward the approved referral, including the referral number, to the referred provider.Urgent and Emergent CareVA CCN urgent care providers are required to call the Urgent Care Eligibility Call Center to verify eligibility at 8889016609 prior to providing care to a Veteran. The automated Interactive Voice Response (IVR) is available 24 hours a day, seven days a week. If eligibility is not verified, it will cause a delay in the Veteran filling a prescription and may lead to the claim being denied if the Veteran is not eligible.For more information on the urgent care requirements, visit provider.vacommunitycare.com � Training & Guides� Benefits� Urgent Care Benefits . Veterans are allowed to seek emergent medical care in a VA CCN emergency department without a referral. The provider must notify the Emergency Care Centralized Notification Center online or by phone within 72 hours of a Veteran presenting to the emergency department. Casespecific details are needed for care coordination and eligibility determinationsincluding an email address to receive VA’s authorization determination.Use the following options to notify VAEmergency Care Reporting (ECR) portal EmergencyCareReporting.CommunityCare.va.gov Phone:72HRVHA (844As of March 1, 2021, VA will assign a notification identification number during emergency notification submission. To help ensure the safety of Veteran’s Protected Health Information (PHI) and Personal Identifiable Information (PII), VA will communicate anauthorization decision using encrypted email and the notification identification number provided during submission. Additional information on emergency careincluding a list of Veteran and treating facility requiredinformation is available at va.gov/COMMUNITYCARE/providers/info_EmergencyCare.asp . �� &#x/Att;¬he; [/;&

6 #xBott;&#xom ];&#x/BBo;&#xx [6;.69;&
#xBott;&#xom ];&#x/BBo;&#xx [6;.69;3 3;.08;e 5;X 9;�.12;&#x ]/S;&#xubty;&#xpe /;oot;r /;&#xType;&#x /Pa;&#xgina;&#xtion;&#x 000;&#x/Att;¬he; [/;ott;&#xom ];&#x/BBo;&#xx [6;.69;3 3;.08;e 5;X 9;�.12;&#x ]/S;&#xubty;&#xpe /;oot;r /;&#xType;&#x /Pa;&#xgina;&#xtion;&#x 000;Page Users are responsible for ensuring they work from the latest approved version. This document was last modified on PCA1425OptumQRG_04212021 VA Community Care Network Providers hat erform ental ervicesIt is important for providers that are performing dental services recognize the difference etween a medical and dental referral. A dental referralis identified the category of care with a dental SEOCA medical referral is identified by a medical SEOC.CCN providers can find information regarding appropriate billing and reimbursement for medical and dental services in the CCN Provider Manual provider.vacommunitycare.com � Training & Guides. Identifying Optum as the hirdarty dministratorReferrals for authorized care from VA may show onethreedifferent networks: Optum (Community Care Networkfor Regions 1, 2 and 3TriWest PC3 (PatientCentered Community Care)VCA(Veterans Care Agreement)s VA CCN is implemented, it is imperative registration and billing staff are aware of the appropriate TPAto bill and be paid quickly. On the VA CCN referral, look for the following AffiliationsNetworksspecific to the VA CCN Regionsignifying Optum is the thirdparty administratorMore Information and TrainingProviders participating inVA CCNcan find more information atprovider.vacommunitycare.com � Training Guides. providers will findVA CCN Provider ManualSelfervice esources and ducational ideosResources and ools to iew and manage referrals Affiliations: •CCN1 •CCN2 • CCN3 Network: etwork etwork • CC N etwor