Provder Services and Resources AAG

VA Community Care Network

Provider Services and Resources

Key Points

? Department of Veterans Affairs (VA) selected Optum as a third-party administrator for Regions 1, 2 and 3 of the VA Community Care Network (CCN).

? Optum VA Community Care Network portal, available at provider., contains the Provider Manual, quick reference guides and additional resources VA CCN providers need to deliver care to Veterans.

? Resources to help VA CCN providers submit claims, reconsiderations, grievances, and fraud, waste and abuse issues, begin on page 2.

? CCN Provider Services is available from 8 a.m. to 6 p.m. provider's local time, Monday through Friday, excluding federal holidays.

? Online assistance is available through online chat from 8 a.m. to 6 p.m. provider's local time, Monday through Friday, excluding federal holidays, at provider. > Medical/Behavioral Provider.

Regions are based on provider location. Locate your applicable region below:

Region 1

Connecticut Delaware District of Columbia Maine Maryland Massachusetts New Hampshire New Jersey New York North Carolina Pennsylvania Rhode Island Vermont Virginia West Virginia

Region 2

Illinois Indiana Iowa Kansas Kentucky Michigan Minnesota Missouri Nebraska North Dakota Ohio South Dakota Wisconsin

Region 3

Alabama Arkansas Florida Georgia Louisiana Mississippi Oklahoma Puerto Rico South Carolina Tennessee U.S. Virgin Islands

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Provider Services Assistance and Resources

There are several resources for contacting Optum with questions.

Optum VA CCN Provider Portal

Go to provider. to find: ? Documents & Links ? Formulary & Pharmacy Search ? News and Announcements ? Training & Guides ? Link to Medical/Behavioral Provider Portal to view: ? Claim status and submission ? Real-time pharmacy dispensing information ? Referral status ? Veteran eligibility

CCN Provider Services Region 1: 888-901-7407 Region 2: 844-839-6108 Region 3: 888-901-6613

Can assist VA CCN providers with information regarding:

? Benefit issue resolution ? Claim status and

issue resolution ? Pharmacy issue resolution ? Provider enrollment ? Referral status ? Veteran eligibility

Online Chat

Go to provider.

? Select Medical/Behavioral Provider

? Log in to the portal ? Select "Let's Talk" ? Choose Chat

Submitting Claims

VA CCN providers must submit claims through Electronic Data Interchange (EDI), Optum VA Community Care provider portal, by mail or by fax.

Medical/Behavioral Claims ? Payer ID: VACCN ? Address: P.O. Box 202117 Florence, SC 29502 ? Secure Fax: 833-376-3047

? Online: Go to provider. > Medical/Behavioral Provider

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Claim Reconsiderations and Grievances

Claim Reconsiderations ? Send reconsideration requests to the address or fax number on the remittance advice within 90 calendar days from the date of denial. ? If unable to locate the address, please submit reconsideration requests by mail, email or fax to: ? Address: VA Community Care Network Appeals and Grievance Team MS-21 3237 Airport Road La Crosse, WI 54603 ? Secure Fax: 877-666-6597 ? Secure Email: o Region 1: FaxAG1@ o Region 2: FaxAG2@ o Region 3: FaxAG3@

? All other medical claim inquiries, including where a provider believes the claim was incorrectly paid must be submitted by mail or fax within 12 months after the claim was initially processed. Please submit the request by mail or secure fax: ? Mail: VA Community Care Network Claims P.O. Box 202118 Florence, SC 29502 ? Secure Fax: 833-376-3047

Grievances A grievance can be filed by completing the Grievance form available at provider. > Documents & Links.

Fraud, Waste and Abuse

Fraud, Waste and Abuse ? As a VA CCN provider, if potential fraud, waste or abuse is identified, report it to Optum immediately. ? To report suspected fraud, waste or abuse, please complete the Fraud, Waste and Abuse Reporting form available at provider. > Documents & Links.

? Phone: ? Region 1: 844-883-3461 ? Region 2: 844-883-3669 ? Region 3: 844-883-3684

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IT Help Desk Inquiries

IT Help Desk ? If, after clicking Medical/Behavioral Provider, the VA CCN provider needs a new password, a password reset or has been locked out of your account, call the Portal IT Help Desk at 888-273-5805. ? VA CCN providers with IT-related questions should call the IT Help Desk at 844-883-3802.

Getting Additional Assistance

? For issues related to a new or existing approved referral, please contact the VA medical facility listed on the referral.

? For all other questions, contact CCN Provider Services.

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