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HNFS' PCCC and VCP Contract Transition: What You Need to Know

Health Net Federal Services, LLC’s (HNFS’) contracted duties with the U.S. Department of Veterans Affairs (VA) to manage care under Patient-Centered Community Care (PCCC) and the Veterans Choice Program (VCP) were transitioned back to VA on Oct. 1, 2018. 

For information about VA’s contract with TriWest Healthcare Alliance, visit www.triwest.com.

Last updated Jan. 2, 2020.

Appointments

  • As of Oct. 1, 2018, HNFS is no longer scheduling/rescheduling VCP/PCCC appointments for veterans.
  • Providers and veterans can visit VA’s website, www.vets.gov/facilities, to locate the appropriate phone number to the veteran’s local or assigned VA Medical Center (VAMC) to coordinate care. 

Authorizations

  • As of Aug. 1, 2018, HNFS was directed to stop accepting new PCCC and VCP referrals/authorizations from VA.
  • We have adjusted existing authorizations that extended beyond the contract expiration date to reflect an end date of Sept. 30, 2018, and issued specific guidance for affected authorizations. Please review carefully to avoid unexpected claims denials. 
  • Care on or after Oct. 1, 2018, has transitioned to the veteran’s local VAMC, Office of Community Care.
  • Providers must submit requests for additional services through the veteran's local or assigned VAMC. Visit www.vets.gov/facilities to locate the appropriate VAMC's phone number. If asked to submit the request in writing, providers can submit their requests to the VAMC via Virtru Pro secure mail or fax. Written requests should include supporting medical documentation to support the request, specify which additional services are being requested and be signed by the requesting provider.

Claims

  • On Dec. 6, 2019, VA directed HNFS to extend the original claims timely filing deadline of March 26, 2019, to Dec. 31, 2019. As such, providers had through Dec. 31, 2019, to submit new claims to HNFS for HNFS-authorized services rendered on or before Sept. 30, 2018. 
  • The deadline to submit corrected claims is 90 days from the date of the last remittance advice. 
  • HNFS can only process claims for services authorized by HNFS. Claims for services authorized by an entity other than HNFS must be sent to that entity.
  • HNFS continues to accept electronic remittance advice (ERA) registrations and electronic funds transfer (EFT) enrollments.
  • Providers can continue to use www.availity.com to check claim status for HNFS-authorized PCCC and VCP services.

Medical documentation

  • As of Jan. 1, 2019, HNFS stopped accepting medical documentation for HNFS-authorized PCCC and VCP care. 

Customer service

Frequently asked questions

Q: Are the Veterans Choice Program and Patient-Centered Community Care Programs ending?
A: 
The VCP and PCCC program eligibility is not ending. The VA's contract with HNFS as the third party administrator to assist VA in administering care under the programs has ended.
 

Q: If I signed a VCP Provider Agreement, can I continue to treat veterans?
A:
Community providers who are (or will be) using a VCP Provider Agreement to provide care to veterans under VCP will work directly with VA as of Oct. 1, 2018. VA medical facilities and community providers will work together, instead of through HNFS, for care authorization, coordination, billing, and payments for the care veterans receive.
 

Q: Do I need to submit my PCCC/VCP claims to HNFS by Sept. 30, 2018, in order to be paid for services rendered?
A:
 All  new claims for HNFS-authorized services with dates of service Sept. 30, 2018, and earlier must be submitted to HNFS no later than Dec. 31, 2019.


Q: How will outstanding claims already submitted to HNFS be paid after Sept. 30, 2018?
A:
We will follow our contractual obligations and guidelines for claims processing and will process clean claims submitted for authorized services rendered on or before Sept. 30, 2018. 

Q: Will do I request a claims reconsideration review?
A: 
To request reconsideration of a claim or an allowable charge review for HNFS-authorized services, contact HNFS’ Provider Services line within 90 days from the remittance advice date. HNFS cannot consider requests received outside this 90-day window. Adjustment determinations are made on a claim-by-claim basis. Please allow 30–45 days for HNFS review You will receive a new remit from HNFS with its determination.