VA CCN April 2026 Provider Pulse

Medicare Interim Rate Letter Reminder

This is a reminder that it is time to submit the Medicare Interim Rate Letter for the upcoming fiscal period. This letter is essential for ensuring that our interim reimbursement rates from Medicare accurately reflect our current cost structure and service volume projections. Medicare interim rate letters are needed for critical-access hospitals, children’s hospitals, cancer hospitals and rural health clinics.

Why this matters:

• It ensures timely and appropriate interim payments from Medicare.
• It helps maintain financial stability and cash flow.
• It supports compliance with Medicare regulations and audit readiness.

Action Required: Please prepare and submit your updated Medicare Interim Rate Letter to providerservices@triwest.com. Ensure all relevant financial and operational data is current and accurately represented.

If you have any questions or need assistance with the submission process, please contact providerservices@triwest.com.

Thank you for your attention to this important matter and for your continued commitment to compliance and operational excellence.

TriWest Seeks CCN Participants for Clinical Committees

TriWest is seeking VA CCN providers to participate in its clinical committees for peer review and credentialing.

TriWest holds virtual committee meetings monthly and sends materials to participants in advance via encrypted email. Providers call in to the meeting to participate (some meetings include screen sharing). There is no travel required and providers are compensated for the hours they dedicate to this valuable work.

We are actively seeking participants on each of the following committees:

• Peer Review Committee: Responsible for oversight of the TriWest peer review process. Peer reviews are completed outside this committee by similar specialists, and the confirmed clinical quality concerns are discussed monthly. Cases include medical, surgical, behavioral, and integrated health. TriWest seeks community providers who are in active practice to review the peer review information and discuss appropriate improvement plans for quality of care with the committee. The completed peer reviews are provided prior to the meetings and may take several hours to review per month. Committee meetings are approximately two hours long.
• Credentialing Committee: TriWest seeks community providers who are in active practice to evaluate and make decisions regarding qualifications for the VA provider network in accordance with TriWest policy and URAC accreditation standards, including review of subcontracted provider networks. Members are provided with the application packets of providers who have had actions on their licensure, malpractice or legal issues to review in advance of the meeting, which may require several hours to complete. Committee meetings are approximately two hours long.

It’s important that network providers have a say about the network they participate in. If you’re interested in serving as a committee member, please contact Eric A. Heuck, Vice President, Procurement, at eheuck@triwest.com.

Reminder: Do Not Schedule Veteran Care Without an Active VA Referral

To avoid potential issues with continued care or reimbursement, please do not schedule or deliver care to Veterans without first receiving a referral from VA.

Under VA’s Community Care Network (CCN), an active referral or authorization is required before services can be scheduled or provided. This process ensures that the care is eligible and approved, and that Veterans get the services they need through the appropriate processes.

Scheduling care without an active referral could result in a claim being denied, delays in treatment, or confusion in the care process for both you and the Veteran.

For more information, please visit the Approved Referrals and Authorizations page of the CCN Provider Handbook or the claims submission tips quick reference guide.

VA CCN Provider Handbook Updates

1. The following point will be added to the Termination subsection of the Credentialing and Contract Provisions section of the CCN Provider Handbook:

7. Provider fails to comply with VA reimbursement and claims policy directives.

The Compliance subsection will be modified to the following:

Provider shall comply with all applicable state and federal laws as well as regulations and all rules, directives, policies and procedures of the applicable program including without limitation to credentialing, peer review, referrals, utilization review/management, clinical practice guidelines, VA Beneficiary complaints and grievances procedures, case management and quality assurance programs and procedures established by TriWest or the applicable health care program including submission of information concerning provider and compliance with Preauthorization requirements, care approvals, pharmacy, dental and DME utilization requirements, care approvals, concurrent reviews, retrospective reviews, discharge planning for inpatient admissions, critical event notifications, quality of care audits, return of medical records and Prior Authorization of referrals.

2. A “Disputes Impacting Network Status” section will be added. It will outline the process if the TriWest Credentialing Committee denies or restricts a provider’s network participation status.