Who is a Tri-West Provider
This evening I had a conversation with a provider representative at Tri-West on behalf of a Veteran who contacted me with a concern that left him perplexed. Now that the Mission Act has kicked in some things have changed and it is confusing for veterans to know just to find a Tri-West Provider.
His question was “If the VA has provided a letter saying you can select to receive your care in the community, what should you do next?”
Who is suppose to do what?
How does this Veteran get his care initiated? Does he need to do something specific or is it up to his personal community physician? He told me that his community physician tried calling the Orlando VA but got no help.
How providers get credentialed with Tri-West
If you live in an area that is beyond the service area of a local VAMC and you received a letter saying you can received your care in the local community, you should do the following:
- If the Veteran intends on seeing a specialist, I suggest validating with your VA PCP that a Specialist is covered by the letter.
- Any providers the Veteran wishes to see in local community must be a Tri-West provider. If the provider is not already participating in the Tri-West network, the provider can request to join by going to the Tri-West website at www.triwest.com and select join our network.
The length of the credentialing process depends on the providers history and how many physicians and other practitioners work within the practice or facility.
A provider must be credentialed with TriWest to provide services if the VA is releasing care to the TriWest.
But … There are always buts with the VA
If all of the Veterans physicians are within the VAMC and Veteran is only being referred our for a few services that:
1) the VA does not provide or
2) the VA cannot provide services within their service agreement level
then the Community Care Referral is handled within the VAMC. If you are having trouble getting Authorizations moving in Orlando please let me know as soon as possible.
Getting VAMC Community Care Referrals moving
If a provider has submitted an authorization for a community care service, the Veteran must become a self advocate. If you don’t hear from a community care associate within seven days, I recommend sending the PCP a message letting them know the has not been any message or call from Community Care. Or, if the Veteran knows who the Community Care associate is, call them and get them ask them to move the authorization.
Personally, I see this process as a little confusing but in the end a good thing. I want the VAMC in charge of as much of my care as possible.
On another note
I have a meeting with Congressman Darren Soto in late July to discuss the Mission Act and other issues. If you have any questions you would like me to discuss with the Congressman, please let me know. Please try to keep your questions formed in a simple question.