VA CCN March 2026 Provider Pulse

Reminder: Preauthorization Required for All Non-Emergent Special Mode Transport

Please be reminded that all non-emergent transportation services for Veterans must be authorized and initiated by VA prior to transport.

Additionally, all transports must be arranged through and tracked in the VetRide system.

Requirements:

• Preauthorization: All non-emergent transport must be preauthorized and initiated by an authorizing VA facility.
• Non-VA entities are not authorized to obligate VA for Veteran transportation costs.
• Any unauthorized or ineligible payments for Veteran travel may be subject to recapture under applicable laws.

For more information, please visit VA’s Veteran Transportation Program web page.

Take Advantage of VA’s Digital Scheduling System

The Department of Veterans Affairs (VA) is now using External Provider Scheduling (EPS), a digital platform and process designed to improve and simplify appointment scheduling for Community Care Network (CCN) providers caring for Veterans.

EPS helps you streamline scheduling, provides referral authorization numbers, and eliminates back and forth phone calls with VA. Your data remains secure, and you maintain full control over your schedule.

Benefits for Veterans:

• Reduced appointment wait times.
• Faster access to care.
• Easier to match Veterans’ preferences with your availability, increasing the chances of getting an appointment on the first attempt.
• Minimizes scheduling challenges for Veterans who need multiple appointments.

With faster scheduling and real-time authorization numbers, providers can focus on what matters - delivering quality care to Veterans.

Complete the EPS intake form to start the process.

Questions before you sign up? Email the EPS Provider Engagement Team at EPSProvider@VA.gov.

Review Qualifications for the High Performing Provider Designation

The Department of Veterans Affairs (VA) designates Community Care Network (CCN) providers who excel in a set of standard health care evaluation metrics as High Performing Providers (HPP). The HPP designation is one, but not the only, measure of provider practice quality.

Provider performance is analyzed and monitored against a standard set of quality metrics determined by TriWest, including clinical outcomes, patient satisfaction, cost-effectiveness, and adherence to established guidelines. Providers can achieve the HPP designation by consistently meeting or exceeding measures of performance expected under the guidelines set forth by Blue Health Intelligence and Centers for Medicare and Medicaid Services (CMS). VA staff take the HPP designation into account during the Veteran appointment scheduling process to help Veterans select a community provider that best meets their needs.

Scoring and Eligibility

VA’s HPP designation applies to individual practitioners, practitioners in a group setting, and institutional providers, such as hospitals. The three types of providers are scored differently:

• Individual providers are evaluated based on Primary Care and Specialty Measures from Blue Health Intelligence.
• Provider practice groups are scored as a single entity, and providers in those groups are assigned the score of the overall group.
• Institutional providers are scored on a selection of CMS measures from the Hospital Compare system.

No action is required from providers. The HPP designation is informative and does not serve as an endorsement or guarantee of a provider’s ability to provide health care services. Contact us to learn more about HPP eligibility.

More Resources

A summary of your specific provider metric results is available on request by completing the HPP Inquiry Form on the TriWest Payer Space on Availity.

For more information on the HPP designation, please review the HPP Quick Reference Guide and CCN Provider Handbook. Providers should send the completed HPP Inquiry Form to CQHPP@TriWest.com.

VA CCN Provider Handbook Updates

A) Please note that every reference of “abortion” in the CCN Provider Handbook will be changed to “pregnancy termination.”

B) A new section will be added to the Medical Records and Documentation Requirements section:

Submitting High Risk Medical Documentation for VISN 22

VA has designated a separate process for submitting high-risk medical documentation for CCN providers in Veterans Integrated Service Network (VISN) 22, which is comprised of eight health care systems and 80 community clinics in Arizona, New Mexico and Southern California.

High risk medical documentation includes the following:

• Emergency department visits and admissions.
• Mental health treatments and acute suicidal event records.
• Cardiology consult results (including cardiac catheterization reports and corresponding radiologic images).
• Cancer surgeries and treatments, including operative reports and pathology reports.
• Dialysis Interdisciplinary Care Plan and monthly encounter notes.
• Screening tests (e.g., lung cancer screening).
• Mammography reports.
• GI colonoscopy reports with pathology results.

Submit high-risk medical documentation by faxing 888-798-0815.

C) A new section will be added to the CCN Processes and Procedures page:

VA Clinical Determinations and Indications

VA develops Clinical Determinations and Indications (CDI) as a reference to help determine whether a service is considered medically necessary for a Veteran. CDIs define clinical criteria and parameters to determine medical necessity to drive the most appropriate, evidence-based determinations for care.

All current CDIs are available online in the CDI Library. Bookmark the webpage and check back for updates. To submit a question about a published CDI, please use the CDI Question Submission Form and follow the instructions located at the bottom of the CDI webpage.