Telehealth Guidelines
TriWest’s Telehealth program includes services through VA’s Community Care Network. It is available for eligible Veterans as an option for care in the community for both initial and follow-up appointments, as appropriate.
Important Details
- Telehealth services may be provided through the Community Care Network (CCN) utilizing current Medicare guidelines
- TriWest will pay the providers’ claims for the telehealth services if there is an authorization on file (except Urgent Care where no authorization is required), the scope of services are appropriate for a telehealth visit (no physical procedures are billed that would require face-to-face delivery of care), and the claim is consistent with Medicare guidance for place of service and modifiers.
- The CPT codes on the SEOCs do not need to include any additional telehealth specific codes for a telehealth claim to be paid.
- Telehealth is an option for community care appointments under CCN for both initial and follow-up appointments as appropriate for the referred condition. It can be used as needed along with face-to-face care where some physical evaluation or procedures are required.
General Telehealth Information
Telehealth Visit: The use of interactive audio and video communications in real time between a distant site provider and a patient at home (in-home telehealth) or at a local facility (point-to-point telehealth). This service can be provided for new or established patients.
Virtual Check-Ins: Brief 5-10 minute communications with established patients using various technology devices, such as phone or the transfer of recorded video and images, to determine whether an office visit or other service is necessary.
E-Visits: Communication between established patients and their providers through an online patient portal.
To deliver care to Veterans via telehealth, a provider must:
- Have an approved referral/authorization, excluding Urgent Care
- Submit a request to TriWest to provide telehealth services
- Have access to a confidential work space to conduct video conferencing
- Deliver services through a HIPAA-compliant platform
- Maintain medical documentation for all telehealth services delivered
- Possess proof of professional liability insurance to include telehealth services as required by state guidelines
- Have protocols for emergency situations for each Veteran with local emergency contact information prior to delivery of care
- Establish an alternative plan should there be a failure in the technology, developed at the onset of care.
A Veteran can request to receive face-to-face care at any time. A face-to-face visit is not required prior to starting telehealth. If the current provider is unable to provide routine face-to-face visits then a new approved referral/authorization will be required from the referring VA Medical Center.
No, any service that can be effectively and safely delivered by telehealth can be applied to an approved referral at this time.
Yes, telehealth providers can prescribe medications subject to TriWest requirements and state and federal guidelines.
- The Veteran must be dressed appropriately for the session. Inform the Veteran that this session is no different than that of a face-to-face appointment. Inappropriate clothing or lack thereof will result in termination of the session.
- All weapons must be secured prior to the session to avoid any confusion or inadvertent cause for alarm.
- The Veteran must have a space that is private, safe, and secure to perform a telehealth visit. This is to protect the Veteran’s privacy.
Telehealth Self-Assessment
The self-assessment below assists providers in gauging their comfort level with telehealth practices. Certifications in telehealth studies are not a requirement to use the program.
- Have you performed telehealth services in the past?
- Do you possess the technical requirements to conduct telehealth effectively? Minimum technical requirements include:
- Video Camera, microphone or headset with microphone, computer/mobile device
- Internet connection with sufficient bandwidth to conduct video transfers without delays, minimum of 15 Mbps download speed and 5 Mbps upload speed (Go to speedtest.net to check your connection.)
- HIPPAA-compliant software platform
- Do you have access to a clean, quiet, confidential work space to conduct video conferencing for telehealth?
- Are you aware of your state laws governing your ability to perform telehealth?
- Do you have the ability to complete a technical assessment with your Veteran 48 hours before their initial telehealth session? A technical assessment is when the Veteran is introduced to your platform using their personal system. This ensures that the Veteran has the device, Internet speed, and knowledge to utilize the program.
- Do you have any certifications or trainings that you would like to include in your telehealth provider profile? (Optional; certifications are not a tele-health requirement.)
Claims/Billing for Telehealth Services
CCN providers can provide telehealth services and bill TriWest using appropriate telemedicine code(s). VA will reimburse TriWest in accordance with Medicare telemedicine methodology and guidance. Medicare telemedicine methodology and guidance references:
For 2023, bill telehealth claims with the POS indicator for an in-person visit. Through Dec. 31, 2023, use Modifier 95 appended to identify the claims as telehealth services.
Beginning Jan. 1, 2024, use POS 02-Telehealth with Modifier 95 appended to indicate the claim as a telehealth service when the originating site is not the patient’s home.
Modifier 95 should be used for synchronous telehealth services.
Yes. Per CMS guidelines, there are no changes in the UB04 billing practice.
Telehealth - Behavioral Health
When appointing for Tele-Behavioral Health, extra considerations should be made. Below are questions TriWest asks Veterans to determine Tele-Behavioral Health capabilities and comfort level:
- When would you prefer to use Tele-Behavioral Health appointing?
- Do you have a secure (i.e., password-protected) Internet connection?
- Do you have either a webcam with a microphone on your computer or front-facing camera on your tablet/smartphone?
- Are you comfortable, able and willing to download a Tele-Behavioral Health application and/or other Tele-Behavioral Health information to your device?
- Do you have a room or location in your home that will allow you privacy for your Tele-Behavioral Health session?
- If Veteran does not have a private location, they are then asked: Are you interested in a point-to-point location?
- A point-to-point location would involve the Veteran commuting to an originating site (usually a small clinic or health center) and attending a telehealth session there via high speed network with a distance telehealth provider.
Providers can bill using the Medicare telemedicine methodology and guidance. There are no differences for the provision of services or how to bill them when behavioral health care is being delivered.
There is no difference in behavioral health billing of telehealth care. To receive reimbursement for telehealth services offered between facilities, known as Point-to-Point services, a code of Q3014 should also be submitted. If offering telehealth services into the home, do not bill the Q3014 code.
Yes, if you have the necessary capabilities required to deliver tele-behavioral health services to Veterans, please send an email indicating your interest to telehealth@triwest.com.
Urgent Care
Yes, VA and TriWest reimburse urgent care services if they are delivered via telehealth by a network Urgent Care provider.
No. Tele-Urgent Care providers are subject to the same requirements for a face-to-face urgent care appointment. An eligibility check is required in either circumstance to verify Veteran eligibility and to activate the eligibility to fill a prescription that results from the Urgent Care visit in a community network pharmacy. For further details regarding the urgent care process, please see here.
There are no differences from billing other telehealth care. Follow Medicare guidance for the appropriate POS for an Urgent Care location and use modifier -95 if delivered into the Veteran’s home.
Other Telehealth Resources:
Points of Contact for Additional Telehealth Questions
- General Telehealth Questions
- Email: Telehealth@TriWest.com
- Tele-Behavioral Health Questions
- Email: Telehealth@TriWest.com
- Claims and Billing Questions
- Phone: 866-651-4977
- Customer Service (Claims, Authorization Questions/Support, Provider Portal Registration)
- Phone: 855-722-2838