NARRATOR: The Department of Veterans Affairs Community
Care Network, or CCN, is VA’s direct link with
community providers to ensure we provide Veterans
with timely, high-quality health care. CCN serves
as a contract vehicle and a network of high-performing,
credentialed community providers that VA partners with to provide
health care to Veterans in their local community. VA’s
partnership with community providers is critical for
meeting the health care needs of Veterans across the United
States and its territories. For community providers, joining CCN
is the best way to serve and care for our nation’s Veterans.
CCN is VA’s preferred method of purchasing community care
through all VA medical facilities. VA contracts with
Third Party Administrators, or TPAs, to perform certain
functions. This includes developing and administering the
regional networks of community providers that make up CCN,
resulting in familiar business practices for community
providers. CCN is made up of six regions aligned to state
boundaries: Region 1 consists of northeastern states; Region 2
includes midwestern states; Region 3 covers southeastern
states, Puerto Rico, and the U.S. Virgin Islands; Region 4
includes most western states and Hawaii; Region 5 covers Alaska;
and Region 6 consists of American Samoa, Guam, and the
Northern Mariana Islands. Services offered through CCN
include the following: medical, behavioral health, surgical,
complementary and integrative health services, durable medical
equipment for an immediate need, pharmacy for an immediate need,
and dental. In addition, with CCN, along with other
improvements VA is making, Veterans and community providers
can expect expanded health care services, improved provider
customer service, improved accountability, improved health
information exchange, improved referrals and scheduling, and
improved payment timeliness to community providers. To be part
of CCN, community providers must establish a contract with the
TPA for your region of CCN; have a National Provider Identifier
(NPI) from the National Plan and Provider Enumeration System,
which is issued at no cost; use the NPI and referral number to
conduct all business activities with VA, including medical,
dental, and pharmacy transactions; be credentialed in
accordance with the requirements for your region of CCN.
Community providers work directly with the TPA to
complete the credentialing processes. Under CCN, VA
directly manages Veteran customer service touch points,
while TPAs respond to inquiries from VA staff and community
providers. When VA refers a Veteran to a community provider
who is part of CCN, the referral goes directly to the community
provider. Referrals are not sent through a TPA, which allows the
provider-to-provider relationship and communication
to remain intact. Community providers must receive an
approved referral from VA before treating an eligible Veteran in
most circumstances. Exceptions include emergency and urgent
care. With CCN, appointment scheduling usually occurs
directly through the Veteran’s local VA medical facility or
directly by the Veteran. VA maintains a master directory of
all community providers authorized to care for Veterans.
To support proper care coordination, community
providers who are part of CCN must submit medical
documentation directly to VA, preferably by an accepted and
secure method of electronic transmission. Through CCN, the
claim and payment process allows for consistent and timely
payments to community providers. As part of this process,
community providers must submit claims to the appropriate TPA
assigned to your CCN region, with the referral number, and
within the timeline required. Once the claim is received, the
TPA processes, adjudicates, and pays the claim. Participation in
CCN means community providers are paid in a timely manner
because TPAs have contractual requirements for timeliness and
accuracy of payments. Generally, health care services provided by
community providers are reimbursed based on rates
established by the Centers for Medicare and Medicaid Services,
or CMS. CCN is a key part of making community care work
better for Veterans, community providers, and VA staff. For
community providers, joining CCN is a great way to honor and care
for those who have served our country. We hope you will
consider joining the VA network. To join CCN, community providers
should contact the TPA assigned to your region. To learn more,
visit our website at this address.