Veterans Choice Program
<p><strong><strong><sup>PROVIDERS</sup></strong><br /> CARE FOR VETERANS</strong><br /> Provider information for veteran emergency care, inpatient care, behavioral health, critical findings, secondary authorizations, referrals, and screenings</p> VeteransProviders

PROVIDERS
CARE FOR VETERANS

Provider information for veteran emergency care, inpatient care, behavioral health, critical findings, secondary authorizations, referrals, and screenings

Care for Veterans

Ascension sites of care can provide primary care, inpatient care, outpatient specialty care and mental health services to veterans who receive preauthorization. Long-term care and emergency care is not currently covered under the Veterans Choice Program. The VA has other options for veterans requiring emergency care.

Emergency care should be provided to any eligible veteran who self presents to an emergency facility seeking care. The VA Medical Center (VAMC) staff will determine the veteran’s eligibility and authorize care. 

If a veteran presents for emergency care, the servicing provider must notify the closest VAMC as soon as possible within 72 hours.

Office and Appointment Access Standards
Providers must comply with the following office and appointment access standards:

AccessChart

Urgent care is defined as care considered essential to evaluate and stabilize conditions that may result in loss of life, limb or vision; care that if not provided will likely result in unacceptable morbidity/pain when there is significant delay in evaluation or treatment.
 

Provider Services for Veterans

After an appointment is scheduled, an information packet is sent to the scheduled provider or facility. The provider notification packets provide case-specific requirements, VA standards, and guidelines of the authorized care. The provider packets include, but are not limited to:

  • Authorization, and any clinical notes or medical documentation provided with the authorization
  • Veteran’s name and demographics, diagnosis, specific services authorized, date and time of appointment already arranged, and authorization begin and end dates
  • Information and instructions regarding completing and returning medical documentation, ongoing treatment / service requests, reporting of critical findings, notification of test results

Inpatient Care
Health Net requires prior authorization and notification of all inpatient facility admissions and discharge dates within 24 hours or by the next business day following admission and discharge.

TriWest will coordinate and communicate admissions and discharges with an inpatient facility whenever inpatient healthcare is ordered and approved by the VA Medical Center. Care coordination will be performed by VA or TriWest in coordination with network facilities. The provider will coordinate discharges with TriWest to arrange for necessary supplies, home health services and equipment.

Behavioral Health
Behavioral Health outpatient treatment and inpatient behavioral health is a covered benefit under the Veterans Choice Program. Specific criteria are outlined by Health Net and TriWest and include, but are not limited to:

  • Medication prescription and monitoring
  • Counseling session start and stop times
  • Modalities and frequencies of treatment
  • Clinical test results and diagnosis summary
  • Functional status, symptoms, prognosis and treatment plans
  • Suicide risk (specific criteria outlined by TPA)

Critical Findings

VA defines Critical Findings as a test result value or interpretation that, if left untreated, could be life threatening or place the veteran at serious health risk. Critical values/results are those results from laboratory, cardiology, radiology departments and other diagnostic areas that, upon analysis, are determined to be critical, regardless of the ordering priority.

Refer to the chart below for critical findings reporting expectations:

CriticalFindingChart

Provider Menu
Secondary Authorization and additional services

Health Net: If any additional visits and/or services are needed to treat the veteran, the provider must complete a Request for Additional Services form and obtain approval from Health Net by faxing it to 1-855-300-1705. The request must be submitted to and approved by Health Net prior to rendering services outside of the current authorization. This includes services not included under the episode of care as well as rending services outside the approved dates.

TriWest: In the event the provider believes additional care (beyond that authorized) is medically necessary, the provider shall submit a Secondary Authorization Request (SAR) form. TriWest will then process the SAR and either approve or deny the care based on the requirements of the program. SARs will be communicated and displayed on the secure Provider Portal.
 

Providers for Referral

Should you need to refer a patient for specialty care or other needs, please reference the participating provider lists for each TPA: 

For participating providers and sites of care across Ascension, visit our veterans sites of care page.


Military Screening questions for diagnosis

  • What dates did you serve and when did you separate from the military, if you have?
  • Have you ever served in the National Guard or Reserve components?
  • What branch and rank were you?
  • What job did you have when you were serving?
  • Were you ever deployed?
  • Did you ever serve in a combat theater?
  • Are there other things you would like to tell me about your military service?

Download additional resources here: http://www.mentalhealth.va.gov/communityproviders/docs/Military_Service_Screening.pdf