We started getting authorizations from Tri West a month ago.  They are confusing.  At the bottom of the authorization it has procedure codes: G0151 – G0153 and G0299 – G0300, which as you know are Therapy and SN codes.  The authorization also says Quantity is 1 Unit.   1 unit means the duration of the 60 day episode, the 60 day episode = 1 unit.  In other words, the authorization is good for SN visits and Therapy visits during that 60 day episode.   Tri West requires a RAP and Final claim in 60 day episodes just like Medicare.   Since we get a code from the OASIS for the authorization number on Medicare type claims, I asked them where we are to put the authorization number that we get from Tri West.  The person I spoke to told me to put that in the Remarks.  We have not been paid yet for the RAPs that I have sent, so I cannot say for sure how this is working out. 

 

I agree – this reminds me of health net all over again.

 

Here is an attachment that might be helpful:

http://www.triwest.com/en/vapc3-provider/FAQs/Billing-Frequently-Asked-Questions.pdf

 

Marnie

Lakewood Health System Home Health

 

 

 

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No, Triwest will be the payer source as well so you will not get paid if you do not switch to Triwest.

 

 

Can we refuse to transition to TRIWEST?

 

 

 

 

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Tracy,

We work mostly with the St Cloud VA but what we were told is that Triwest will only be managing skilled nursing at this time, VA will still manage and authorize aide and homemaker visits. Nurse visits will transition to Triwest  as authorizations renew.  We are still waiting to get set up correctly with Triwest, the info they had for us is incorrect, we’ve been working on this for over a month. It has not been a great experience

 

 

We work with the Minneapolis VA mostly. WE had a provider agreement with them during the Healthnet contract where we worked directly with the VA. Now that Healthnet contract is over, Triwest has taken over managing the veterans Choice program. So they are sending us authorizations that are very confusing. They also said we are supposed to bill Triwest. I am not sure where we stand as we had a provider agreement with the VA and I have no clue who to talk to. Does anyone else have this happening to them? I don’t even know who to contact at the Minneapolis VA.

 

Tracy Salin

Billing Specialist

Fairview Range Home Care and Hospice