The Department of Veterans Affairs (VA) classifies acupuncture as a complementary and integrative health (CIH) approach within the innovative VA’s Whole Health system of care. This is great news for acupuncture practices because it means they can be reimbursed for providing services to veterans when acupuncture care is deemed clinically necessary by the patient’s care team.
Acupuncture can be a great treatment for veterans suffering from a variety of complications. Besides its benefits as a pain reliever, acupuncture treatments are also a safer method than opioids for pain management. As an acupuncture insurance billing company, we know many acupuncture providers are interested in providing services to military veterans. However, it seems most providers still are not familiar with the process of enrolling with the VA. If you’re looking for how to optimize your VA medical billing, or have questions about the billing process in general, then follow this guide for billing the VA for acupuncture in six easy steps!
The Advantages of Acupuncture For Veterans
Acupuncture has been growing in popularity as an effective and minimally invasive pain relief method, as opposed to conventional pain relievers. Besides their minimal burden on the patient, acupuncture treatments have been shown to be sufficient in treating veterans for a wide range of conditions.
Acupuncture as a Pain Reliever
Acupuncture treatments have been increasingly gaining traction as an integrative therapy method for effective pain relief. As a minimally invasive procedure, acupuncture is considered generally very safe when administered by a trained provider. While ongoing studies are finding that acupuncture may offer more benefits than for pain management alone, the VA considers acupuncture effective for veterans who suffer from:
- Pain associated with an injury or illness
- Nausea and vomiting after an operation
- Nausea and vomiting related to chemotherapy
- Knee pain from osteoarthritis
- Low back pain
- Depression or other mental health concerns
- Substance dependency
Acupuncture for veterans may be effective as a stand-alone treatment or adjunctive with other medical treatments.
Acupuncture as an Opioid Drug Alternative
Acupuncture has the potential to become a front-line treatment for pain management as an alternative to opioid drug prescriptions. Acupuncture and other holistic practices have been helping reduce the number of active service members prescribed opioids. In 2011, 26 percent of all service members were prescribed at least one type of opioid medication. That number has since gone down due to the armed forces offering alternatives, such as acupuncture, for conventional pain killers.
Veterans can take advantage of the health benefits of acupuncture without the need to subscribe to painkillers. As an opioid drug alternative, acupuncture can be used in place of the prescriptions for acute to chronic pain for the same effects with none of the side effects.
Acupuncture as a PTSD Treatment
Although more research needs to be done, acupuncture holds promise to help treat PTSD and stress-related conditions. The prevalence of PTSD among veterans ranges widely throughout different eras and wars. While one major study of 60,000 Iraq and Afghanistan veterans found that over 13% of them tested positive for PTSD, other studies have found the rate to be as high as 20% to 30%.
According to the American Massage Therapy Association (AMTA), over 40 percent of adults suffer adverse health conditions due to stress and 70 to 90 percent of visits to primary care physicians are for stress-related problems. Studies show that acupuncture, as well as other holistic practices, can significantly help reduce stress, anxiety and depression — which all contribute to PTSD. Acupuncture for veterans and active military members can have a significant impact on their well-being of life and overall wellness.
How to Start Treating Veterans at Your Acupuncture Practice
While the VA may hire licensed acupuncturists to provide direct care at VA Medical Centers, this is not always a convenient solution for patients or for acupuncture practices. Fortunately, the VA’s Community Care Network (CCN) allows you to become credentialed as a VA healthcare provider, which makes it possible for your practice to deliver acupuncture for veterans outside of the VA Medical Center system. Working through your VA region’s CCN is a great opportunity to grow your practice due to the unique patient population, reasonable reimbursement rates, and patient visit pre-authorization
If a VA beneficiary lives too far away from a VA location or the facility isn’t able to treat a patient within 30 days, the VA refers them to registered community providers. Depending on which region of the country you’re located in, one of two companies, TriWest or Optum, will be responsible for credentialing, administering, and processing CCN payments. Given the high level of organization, the CCN is a great opportunity for licensed acupuncture practices that are just starting out accepting insurance payments.
The team at Holistic Billing highly recommends that practices get involved with their regional CCN. It’s a great way to help grow your patient pipeline and while also contributing to the strengthening relationship between the VA and holistic healthcare providers like acupuncturists, massage therapists, and chiropractors.
Checklist to Complete Before Seeing VA Patients at Your Acupuncture Practice
Before you can start receiving VA patients at your practice, there are some VA billing guidelines you must follow. Make sure you complete this checklist before receiving patients so you can bill the VA for acupuncture treatments.
Step 1: Apply for an NPI Number.
We recommend you use a web-based application for NPI applications. To complete the process, you can visit the National Plan and Provider Enumeration System (NPPES) website (https://nppes.cms.hhs.gov/#/).
Step 2: Obtain a CAQH number.
You need a CAQH ID and a login and password for the website to build an online profile so that healthcare entities can access your credentials. A CAQH ID can be obtained straight from the website with the new CAQH Proview. https://proview.caqh.org/PR/Registration. We recommend authorizing access to “any organization that requests access” to avoid future changes.
Step 3: Establish your region.
The VA Community Care Network is divided into six regions covering the continental United States and Hawaii, the Caribbean, and the Pacific Islands. TriWest manages the Western networks, while Optum handles the Eastern regions. You can visit the VA website to determine which region your practice resides in.
Then get credentialed with the region’s administrator.
Before the network will refer patients to your practices, you must be credentialed. In most circumstances, completing the credentialing process takes at least three months. You can start the process by contacting Optum or Triwest directly.
Region 1: 888-901-7407 (Optum)
Region 2: 844-839-6108 (Optum)
Region 3: 888-901-6613 (Optum)
Region 4: 866-286-4174 (Triwest)
Step 4: Complete registration paperwork.
After the preliminary credentialing process, you must sign the necessary paperwork to become fully registered with the network. Forms are typically submitted electronically through DocuSign and will stipulate any final requirements that must be met to complete the credentialing.
Once your practice has been accepted into the network, you will receive referrals for VA patients authorized to receive acupuncture or massage treatments. Your CCN administrator will email the patient’s authorization letters before their initial visits.
How to Submit a VA Insurance Claim
After you’ve received a VA patient’s authorization letters, you’re able to begin treatment. In most cases, the VA will authorize a certain number of visits. While you are certainly free to schedule additional visits, keep in mind that you will not be able to bill the VA for these visits. Make sure patients understand which treatments will be covered by the VA and which will be out-of-pocket or require another source of insurance.
When submitting a VA insurance claim for the first time, you will need to submit all the authorization letter pages together with the claim. Make sure that you transmit all the following information with your claim to avoid a denial:
- A cover letter.
- The date range for services.
- Authorization numbers.
- The total visits authorized.
- The patient’s demographics will also need to be attached, including address, date of birth, and social security number.
- Documentation and CPT codes of reatments administered.
By following this checklist, you can ensure your Veterans Administration insurance claim will have all the accurate information it needs for a smooth billing process.
Additional VA Medical Billing Questions
Find the answers to some of the more common VA medical billing questions.
Does the VA Bill Medicare or Medicaid for Services?
The VA does not currently bill Medicare or Medicaid. However, there is information for veterans about the new Medicare prescription drug benefits.
Will the VA Pay for Massage Therapy?
Clinical massage therapy is one of the complementary integrative health (CIH) approaches covered by the VA’s Whole Health system of care. The provider must have passed requirements for basic or advanced training and maintains the required licenses and credentials to practice massage therapy.
What are the Requirements for VA Covered Acupuncture Practices?
Credentialed acupuncturists must be properly licensed and meet the proper training requirements based on the scope of their practice to ensure veterans are receiving the highest quality of care.
What Types of Acupuncture Does the VA Cover?
Besides traditional acupuncture, providers may be eligible to become certified providers for Battlefield Acupuncture (BFA). BFA is an acupuncture protocol where needles are placed in the ear to reduce pain. Since BFA believes the entire body is represented in the ear, inserting small needles in the ear alone can affect pain throughout the whole body.
Maximize Your Reimbursements for VA Insurance Claims with Holistic Billing
As a medical billing provider with a special focus on holistic and integrative health practices, Holistic Billing Services can help you get credentialed by your region’s CCN and help you start treating veterans right away. We have plenty of experience navigating the unique VA billing guidelines, which allows us to maximize your reimbursements and keep your practice’s revenue flowing.
To learn more about how you can get started providing acupuncture for veterans and active service members without worrying about having your VA claims denied, talk to our acupuncture billing and coding experts today!
When it comes to expanding government coverage of holistic and complementary treatments, the task of getting everyone on board can be tedious and take years for legislative consideration.
Delivering substantial and comprehensive evidence of the benefits of holistic treatments, however, does help streamline the process and make a compelling case for incorporating integrative medicine into government programs and private insurance plans. Performing research and providing results that speak to how effective these treatments are for veterans and patients takes time and money, but is ultimately worth it for encouraging the inclusion of holistic treatments.
One such organization that performs research and reports on the results of various healthcare initiatives is the Quality Enhancement Research Initiative, known as QUERI, which operates under the umbrella of the Veterans Affairs department. This organization is instrumental in leveraging a vast network of researchers and investigators around the country to examine a multitude of healthcare actions.
In January 2014, QUERI presented an evidence map of acupuncture that analyzed the effects of acupuncture on mental health, wellness, and pain, plus elaborated on future research efforts and potential drawbacks to this treatment.
More than three years later, acupuncture was adopted into coverage for veterans as included in VHA Directive 1137, published in May 2017. Nearly a year after that Directive was announced, a Qualification Standard was published that permitted licensed acupuncturists to be hired to provide acupuncture care at VA Medical Centers (VAMC) in February 2018.
How did the VA come to the decision to promote acupuncture as part of their benefits for veterans? As with most bureaucratic processes, there were a lot of factors; one key player was QUERI’s evidence map of acupuncture. In this article, we’ll expand on QUERI’s research methods and some of the key takeaways from their report on the effects of acupuncture.
History of the Quality Enhancement Research Initiative for the VA
Founded in 1998 with the mission to “accelerate the use of research evidence, tools, and methods into routine care and ensure U.S. Military Veterans benefit from research discoveries,” QUERI plays a pivotal role in analyzing the effects of healthcare treatments with the ultimate goal of improving care quality and access for veterans.
Since its founding, QUERI has implemented numerous programs and leveraged partnerships to continue expanding care for veterans. Just a few notable examples in recent history include the following:
- National implementation with the VA Office of Mental Health and Suicide Prevention of the Behavioral Health Interdisciplinary Program of team-based care that reduced mental health hospitalizations for Veterans
- Launching several ongoing studies related to COVID, on topics ranging from racial and ethnic disparities in COVID-19 infection and complications to identifying Veterans’ experiences during the COVID-19 pandemic
- Improving Veterans’ experience and quality of virtual care options in VA and community care venues
QUERI’s Strategic Methodology
QUERI’s initiatives operate under a variety of frameworks or roadmaps depending on which facet of the organization you look at; regarding their overarching strategic methodology of operation, they employ a three-fold approach:
- Implement: Enhance Veteran access to cutting-edge, personalized treatments
- Evaluate: Develop mutually beneficial partnerships and inform the rollout of high-priority initiatives
- Disseminate & Sustain: Drive a culture of learning and knowledge translation across the VA as a whole
Pertaining to their research approaches, QUERI leverages a network of more than 200 investigators who have completed more than 500 peer-reviewed studies addressing VA priorities. This rigorous process ensures that research is performed and data is analyzed by those with a high degree of expertise and demonstrated dedication to improving care for veterans.
Key Takeaways From QUERI’s Evidence Map of Acupuncture
Now that we’ve established QUERI’s authority and importance in terms of gathering evidence for important healthcare initiatives for veterans, let’s review a few key takeaways from their evidence map of acupuncture:
Acupuncture Evidence for Pain
QUERI reports with high confidence that acupuncture has a positive impact—or potential positive impact—on several different ailments:
High confidence in the evidence of positive impact:
- Chronic pain
- Migraines
- Headaches
High confidence in the evidence of potential positive effects:
- Dysmenorrhea, also known as severe menstrual cramping
- Cancer pain
- Labor pain
There is also medium confidence in potential positive effects that acupuncture adequately treats pain related to osteoarthritis, pregnancy pain, Temporomandibular joint dysfunction (also known as TMJ), Plantar heel pain, prostatitis, and more.
Acupuncture Evidence for Mental Health
QUERI’s investigation found that acupuncture had the potential for a positive effect on the following mental health conditions:
- Depression
- Schizophrenia
- Anxiety
- PTSD
Acupuncture Evidence for Wellness
This evidence map of acupuncture found acupuncture had the potential for positive effects on a few ailments, including:
- Insomnia
- Smoking cessation
- Postoperative nausea and vomiting (PONV)
- Restless legs
But ultimately there was unclear evidence that acupuncture impacts the following ailments and conditions:
- Cancer AE
- IBS
- PMS
- Menopausal symptoms
- Overall quality of life
While there have been significant studies on the effectiveness of acupuncture in more recent years, understanding this fundamental acupuncture evidence map and its relation to providing coverage to veterans can give insight into the process of increasing coverage for holistic treatments.
Is your acupuncture practice ready to start treating the veterans in your community? Worried about how stressful the medical billing process can be—especially in terms of billing the VA for services rendered? Partner with a medical billing firm!
At Holistic Billing Services, we deal exclusively with holistic healthcare practices that deliver acupuncture, massage therapy, and chiropractic treatments to communities around the country. Whether you have questions on acupuncture insurance billing or other methods to enhance your revenue cycle management, feel free to contact our team today and let us know how we can help your acupuncture practice.
In the enduring fight to reduce the severity of opioid addiction, traditional and holistic approaches continue to overlap and present alternative methods for treating chronic ailments and improving mental health. One significant treatment that is a proven opioid alternative is acupuncture.
Acupuncture has its origins in traditional Chinese medicine and recent studies over the last few decades prove time and again its effectiveness in treating a variety of chronic pain conditions and more. In particular, acupuncture research has investigated its benefits for veterans—and the federal department of Veterans Affairs recently included acupuncture in its efforts to promote complementary and integrative health.
How did the VA come to this conclusion? And what does this relationship mean for your acupuncture practice and the veterans in your community? Keep reading to learn more about the history of acupuncture and the VA, plus some tips for billing the VA for acupuncture services provided to veterans.
Acupuncture & The VA: A Timeline
Let’s look at a brief timeline of acupuncture and the VA:
- 1998: The National Center for Complementary and Alternative Medicine (NCCAM) is established with the goal of rigorously testing the effectiveness of “alternative” medicines that existed outside the scope of traditional medicine
- 2005: The Institute of Medicine (IOM)—now known as the National Academy of Medicine (NAM)—reports on the relationship between “alternative” medicines and Americans partaking in them for their overall wellness; this report encourages educational curriculum regarding “alternative” medicines be included in the medical field so traditional physicians can help their patients navigate these treatments
- 2014: Congress changes NCCAM’s name to the National Center for Complementary and Integrative Health (NCCIH), indicating a change in attitude towards “alternative” medicines as a more serious and important approach to health and wellness
- 2015: A report conducted by the Veterans Health Administration (VHA) Healthcare Analysis and Information Group recognizes acupuncture as one of the most common complementary treatments, further validating acupuncture’s role in treating a variety of ailments
- 2017: VA Directive 1137 – Provision of Complementary and Integrative Health is approved, which establishes national VHA policy regarding the provision of CIH approaches; this includes acupuncture as a vetted and recognized complementary treatment for veterans
Evidence of Acupuncture’s Benefits for Veterans
The VA found that acupuncture provides numerous benefits to common ailments and conditions that veterans must live with, including:
- Lower Back Pain: A 2012 analysis of data on participants in acupuncture studies found that actual acupuncture was more helpful than either no acupuncture or placebo acupuncture
- Mobility: A 2008 study found that there was a significant improvement in mobility for patients with osteoarthritis of the knee when acupuncture treatments were included in their wellness plan
- PTSD: According to research published by the National Center for Biotechnology Information (NCBI), acupuncture can affect the autonomic nervous system, and the prefrontal as well as limbic brain structures, making it able to relieve the symptoms of PTSD
5 Steps for Billing VA for Acupuncture Treatments
The medical billing process for the Veterans Affairs department requires a few steps to accurately bill them and develop a relationship with them along the way; start with these foundational steps:
Acquire Your National Provider Identifier (NPI)
The first step to billing the VA for acupuncture is to acquire a National Provider Identifier (NPI). A National Provider Identifier, or NPI, is a 10-digit identification number issued to healthcare providers in the U.S. by the Centers for Medicare and Medicaid Services. Your acupuncture practice will need to apply for an NPI if you are a HIPAA-covered health care provider or if you bill insurance for your services.
Establish Your Community Care Network Region
The VA Community Care Network (CCN) is divided into six regions that cover the continental United States in addition to Hawaii, the Caribbean, and the Pacific Islands. TriWest manages the western networks while Optum handles the eastern regions. Find out which region your acupuncture practice resides in.
Get Credentialed in Your CCN Region
In order to provide great care for veterans at your holistic practice with acupuncture services, you’ll need to be credentialed with the region’s third-party administrator. This process typically takes at least three months to complete. Depending on your region, contact the following to get started with the credentialing process:
- Region 1: 888-901-7407 (Optum)
- Region 2: 844-839-6108 (Optum)
- Region 3: 888-901-6613 (Optum)
- Region 4: 866-286-4174 (Triwest)
- Region 5: 877-226-8749 (Triwest)
The VA has not officially contracted with an agency for Region 6; contact information is pending for that region.
Fill Out Registration Paperwork
Upon completing the credentialing process with your region’s third-party administrator, you’ll need to submit the necessary paperwork to become fully registered with the VA’s Community Care Network. This paperwork is submitted electronically and will include details regarding any final requirements that must be met in order to finish the credentialing process for your acupuncture practice.
Begin to Receive Patient Authorizations
Once your holistic practice has been verified and authorized by the VA’s network, you’ll start to receive referrals to treat veterans who are approved to start acupuncture treatments. Your CCN administrator will provide the patient’s authorization letters before the patient’s first visit to your acupuncture practice.
After completing these important foundational steps, you’re ready to start billing the VA and treating veterans in your community!
When submitting an insurance claim to the VA for the first time, you’ll need to submit all the authorization letter pages together with the claim. Make sure you transmit all the following information with your acupuncture services claim to avoid a denial:
- A cover letter
- The date range for services
- Authorization numbers
- The total number of visits authorized
- The patient’s demographics including address, date of birth, and social security number
- Documentation and CPT codes of treatments administered
By following this checklist, you can ensure your Veterans Administration insurance claim will have all the accurate information it needs for a smooth billing process.
Want to streamline your acupuncture practice’s overall revenue cycle? Partner with Holistic Billing Services to optimize your medical billing and coding processes, minimize your rejected claims, and instantly improve your revenue cycle. Our experts have experience in your specialty and we’re eager to help your holistic practice.
A recent consumer study found that 88% of respondents reported massage therapy was beneficial to their overall health and wellness. Want to offer massage therapy services to the veterans in your community, but aren’t sure how to manage billing the VA? We’re here to help you understand this process better so you can deliver quality care to veterans at your holistic practice.
There are numerous methods of massage therapy, including:
- Medical massage
- Hot stone massage
- Swedish massage
- Reflexology
- Trigger point massage
- Thai massage
Each method implements a particular set of movements that target muscles in order to increase blood flow, promote relaxation, alleviate physical pain, and encourage overall wellness.
Does the VA Cover Massage Therapy?
It depends on the specific circumstances and location. Some VA facilities may offer massage therapy as a form of rehabilitation for veterans, but it is not a widely covered service under VA benefits. It is best to check with your local VA facility or speak with a VA representative to determine if massage therapy is covered in your area.
Benefits of VA Massage Therapy
Massage therapy has been proven to treat a wide array of conditions veterans might be suffering from, including:
- Chronic pain: Massage therapy treatments help stimulate blood flow to parts of the body experiencing pain, which helps promote the release of natural painkillers; since massage therapy results in relaxation, overall chronic pain conditions can be managed with treatments. This is an especially timely holistic approach in light of the ongoing opioid epidemic.
- Depression: One study found that 11% of veterans were experiencing elevated levels of depression; massage therapy can help alleviate the physical symptoms of this mental condition, such as back pain, body aches, sluggishness, and more.
- Anxiety: A 2016 research study demonstrated that Swedish massage therapy treatment was successful in reducing the symptoms of Generalized Anxiety Disorder (GAD). Veterans often experience complicated symptoms of anxiety linked to PTSD and homelessness, which can increase the risk of suicide; incorporating a massage therapy treatment plan into an overall wellness plan can help mediate these symptoms.
How To Start Treating Veterans at Your Massage Therapy Practice
The US Department of Veterans Affairs recognizes clinical massage therapy as “one of the evidence-based, complementary and integrative health (CIH) approaches within the VHA Whole Health System of care” and covers the cost of this care when deemed necessary. Follow these steps to start treating veterans with massage therapy at your holistic practice!
Apply for Your National Provider Identifier (NPI)
A National Provider Identifier, or NPI, is a 10-digit identification number issued to healthcare providers in the U.S. by the Centers for Medicare and Medicaid Services. Your massage therapy practice will need to apply for an NPI if you are a HIPAA-covered health care provider or if you bill insurance for your services.
Determine Your Region
The VA Community Care Network (CCN) is divided into six regions that cover the continental United States in addition to Hawaii, the Caribbean, and the Pacific Islands. TriWest manages the western networks while Optum handles the eastern regions. Find out which region your practice resides in.
Get Credentialed
In order to provide quality care for veterans at your holistic practice with massage therapy, you’ll need to be credentialed with the region’s third-party administrator. This process typically takes at least three months to complete. Depending on your region, contact the following to get started with the credentialing process:
- Region 1: 888-901-7407 (Optum)
- Region 2: 844-839-6108 (Optum)
- Region 3: 888-901-6613 (Optum)
- Region 4: 866-286-4174 (Triwest)
- Region 5: 877-226-8749 (Triwest)
The VA has not officially contracted with an agency for Region 6; contact information is pending for that region.
Complete Registration Paperwork
Upon completing the credentialing process, you’ll need to submit the necessary paperwork to become fully registered with the network. This paperwork is submitted electronically and will include details regarding any final requirements that must be met in order to finish the credentialing process.
Receive Patient Authorizations
Once your holistic practice has been verified and authorized by the VA’s network, you’ll start to receive referrals to treat veterans who are approved to start massage therapy treatment. Your CCN administrator will provide the patient’s authorization letters before the patient’s first visit to your practice.
Checklist for Initial Claims Processing
When submitting an insurance claim to the VA for the first time, you’ll need to submit all the authorization letter pages together with the claim. Make sure you transmit all the following information with your massage therapy claim to avoid a denial:
- A cover letter
- The date range for services
- Authorization numbers
- The total number of visits authorized
- The patient’s demographics including address, date of birth, and social security number
- Documentation and CPT codes of treatments administered
By following this checklist, you can ensure your Veterans Administration insurance claim will have all the accurate information it needs for a smooth billing process.
Maximize Your Reimbursements for VA Insurance Claims with Holistic Billing
As a medical billing provider with a special focus on holistic and integrative health practices, such as massage therapy practices, Holistic Billing Services can help you get credentialed by your region’s CCN and help you start treating veterans right away. We have plenty of experience navigating the unique VA billing guidelines, which allows us to maximize your reimbursements and keep your practice’s revenue flowing.
To learn more about how you can get started providing acupuncture for veterans and active service members without worrying about having your VA claims denied, talk to our massage therapy billing and coding experts today!
The VA Community Care Network (CCN) is VA’s direct link with community providers to ensure Veterans receive timely, high-quality care. CCN uses industry-standard approaches and guidelines to administer services, pay for services promptly, and manage the network to its full potential.
There have been some recent changes to how providers receive electronic funds transfers through the CCN. Triwest EFT enrollment used to go through CAQH Enrollhub. However, due to recent changes of Triwest/VA CCN EDI going through PGBA, providers must now enroll for EFT/ERA through PGBA.
Providers who were previously enrolled with EFT through CAQH Enrollhub will start receiving paper checks until they are re-enrolled through PGBA. PGBA requires two paper check numbers issued within the past 30 days to process Triwest/VA CCN EFT enrollment.
What are Electronic Fund Transfers and Why Do They Matter?
An electronic funds transfer is the electronic transfer of money from one bank account to another, either within a single financial institution or across multiple institutions, via computer-based systems, without the direct intervention of bank staff.
Receiving your VA CCN payments faster because EFTs transmit money directly into your bank account. You no longer have to go to the bank to deposit your money or wait for a check in the mail. Utilizing EFTs further streamlines your revenue cycle and reduces the number of daily tasks your practice has to perform.
What are Regional Networks in the VA CNN Program?
CCN comprises six regional networks covering all U.S. states and territories and is being deployed in a phased approach. Once fully implemented, CCN will be the preferred national network VA uses to purchase care for Veterans in their community. 
CCN comprises six regional networks. It covers all U.S. states and territories and relies on Third Party Administrators (TPAs) to develop and administer regional networks of high-performing licensed health care providers on behalf of VA. CCN has an established set of regional boundaries aligned to state boundaries to provide local flexibility and increased access to care. Each regional network of CCN serves as the contract vehicle for VA to purchase care in the community. With CCN, there is a focus on transparency, accountability, quality, and increased communications between VA and Veterans.
The regions are as follows:
Region 1:
- Connecticut
- Delaware
- District of Columbia
- Maine
- Maryland
- Massachusetts
- New Hampshire
- New Jersey
- New York
- North Carolina
- Pennsylvania
- Rhode Island
- West Virginia
- Vermont
- Virginia
Region 2:
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Michigan
- Minnesota
- Missouri
- Nebraska
- North Dakota
- Ohio
- South Dakota
- Wisconsin
Region 3:
- Alabama
- Arkansas
- Florida
- Georgia
- Louisiana
- Mississippi
- Oklahoma
- Puerto Rico
- South Carolina
- Tennessee
- Virgin Islands (U.S.)
Region 4:
- Arizona
- California
- Colorado
- Hawaii
- Idaho
- Montana
- New Mexico
- Nevada
- Oregon
- Texas
- Utah
- Washington
- Wyoming
Region 5:
- Alaska
Region 6:
- American Samoa
- Guam
- Northern Mariana Islands
What is the Latest Development of EFTs and the VA PC3 Program?
If you are in TriWest Region 4 or 5 (Alaska) and previously received EFTs from the VA PC3 program, you may begin seeing paper remittance. This is due to the transition of the VA PC3 program to VA CCN program. PGBA handles electronic claims and fund transfers for the VA CCN program in Region 4 and 5. To continue receiving EFT, you will need to register for PGBA EFT enrollment in the link below. PGBA requires 2 paper check numbers issued by VA CCN within the past 30 days to process the EFT enrollment.
What To Do In Order to Continue Receiving Electronic Fund Transfers?
Once you have submitted your EFT application, it takes approximately thirty (30) days to receive and process EFT requests. After your EFT application is processed, it takes seven (7) days for EFT to begin. After the 7-day period, you will receive EFT payments (for any VA CCN claims you submit) in the next payment cycle. A payment cycle is generally 2-3 days. Claims received after your EFT enrollment has been processed will be paid electronically. Until then, you will receive paper checks.
The good news is that you can submit VA CCN claims for multiple providers. PGBA processes EFT payments based on NPI. Payment for all locations under the registered NPI will be transmitted to the financial institution transit/routing and account number indicated on the EFT Authorization Agreement. If a specific location requires payment to a different account, it must have a different NPI and you must submit a separate EFT Authorization Agreement form.
Where Can You Register for the PGBA EFT Enrollment?
Download the EFT Authorization Form found on TriWest Payer Space on Availity.com. Print and complete the EFT registration package and mail it to: PGBA, LLC., PO Box 108853, Florence, SC 29502-8853. Once you receive a notification letter, you’ll start receiving your payments through EFT.
There are no fees to sign up for EFT, but you are encouraged to double-check with your bank to determine if they apply any fees to EFT.