November 2025 Provider Pulse

VA Introduces New Digital Scheduling System for CCN Providers

The Department of Veterans Affairs (VA) recently introduced External Provider Scheduling (EPS) to improve the speed and convenience of the community care appointment scheduling process. As of today, EPS is available at all VA medical centers nationwide.

If you are interested in connecting Veterans to care faster with fewer potential errors, EPS can help you streamline scheduling by using automated scheduling grids, reducing time spent waiting for authorization numbers, and eliminating additional phone calls to verify patient references.

Security settings only allow VA access to your availability in your scheduling system, ensuring no electronic health record information is shared. Your data remains exclusively yours.

Benefits to Your Organization

• Save time for your staff.
• Maintain your current system and workflows.
• Immediate referral authorizations.

Benefits for Veterans

• Reduced appointment wait times.
• More timely access to care.
• Enhanced appointment accuracy.

With faster scheduling that includes real-time authorization numbers, you can focus on delivering quality care to Veterans.

For more information on EPS email EPSProviderEngagementTeam@va.gov.

Notice: Upcoming Change to Claims Processing for IOP/PHP Services

To maintain alignment with Medicare reimbursement policy, IOP and PHP services will now be required to follow Medicare billing requirements. This change creates consistency in reimbursement practices and reduces claim denials or reprocessing. This change will be applied to VA-authorized IOP/PHP community providers regardless of their Medicare certification status.

Billing Requirements

Beginning December 16, 2025, providers are required to submit IOP/PHP claims as follows:

• Use the UB-04 claim form.
• Include the correct HCPCS/CPT codes for the services rendered.*
  • *Note: Critical Access Hospitals (CAH) are not required to bill HCPCS codes on IOP/PHP claims.
• The proper revenue code is based on bill type and taxonomy code.
• Include the ICD diagnosis code.
• Include the applicable condition codes.
• Include the date for each service rendered.

This change applies to claims with dates of service on or after December 16, 2025.

Note: The change is date of service driven, not date of claim submission. The change will not be retroactive and will occur on a go-forward basis. TriWest Healthcare Alliance will not initiate recoupments related to this change.

Action for Providers

• Review your billing systems and processes to ensure compliance with Medicare IOP/PHP billing requirements.
• Review the detailed billing guidance and available reference materials.

Questions?

If you have questions regarding this change, please contact TriWest VA Claims Customer Service at 877-226-8749.

Nationwide Recall of Sulfamethoxazole/Trimethoprim Tablets

A major recall has been issued for the combination antibiotic sulfamethoxazole/trimethoprim (SMZ/TMP) tablets.

Manufacturer, Amneal Pharmaceuticals LLC has voluntarily recalled lots of SMZ/TMP tablets in the 400mg/80mg strength because of a microbial contamination that may pose health risks in immunocompromised patients. These lots were distributed nationwide between December 4, 2024, and May 15, 2025.

This combination is used to treat bacterial infections including urinary tract infections (UTIs), respiratory infections, skin infections, and some stomach and intestinal infections.

What’s being recalled?

• Lot AM241019 – NDC 65162-271-10 (100-tablet bottle)
• Lot AM241020 – NDC 65162-271-10 (100-tablet bottle)
• Lot AM241019A – NDC 65165-271-50 (500-tablet bottle)

For more information on this recall please see the Food and Drug Administration’s (FDA) Sulfamethoxazole/Trimethoprim Tablets announcement.

Billing Guidelines for Evaluation and Management Codes by Place of Service

Accurate reporting of Evaluation and Management (E/M) codes requires correct selection of both the E/M Current Procedural Terminology (CPT) code, and the Place of Service (POS). Professional billing services are reimbursed under the Medicare Physician Fee Schedule (MPFS).

For more information visit the American Medical Association’s Evaluation and Management Code and Guideline Changes, the CMS Place of Service Code Set, or CMS Evaluation and Management Services.

VA CCN Provider Handbook Updates

There are currently no updates to the VA CCN Provider Handbook.