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  • Triwest Healthcare Alliance Pc3 - Initial Evaluation Report 2018

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The Tritest Healthcare Alliance Veterans Affairs (VA) PatientCentered Community Care (PC3) ProgramPC3 Initial Evaluation Report Veterans Name:DoD ID/Benefits # or Sponsor SSN:Evaluation Date:VA Auth.

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If you submit electronically through a clearinghouse, please use the PGBA Payer ID of TWVACCN.

Simply put, CCN augments local VAMC resources or availability. Most importantly, CCN allows Veterans to receive health care services in their communities when appropriate. TriWest Healthcare Alliance (TriWest) is the CCN Regions 4 and 5 third-party administrator.

TriWest cannot pay for out-of-network claims or for care that does not have an approved referral/prior authorization (except for urgent care and emergency care).

All authorized claims must be filed within 180 days from the date the service was rendered. Claims that are submitted beyond the 180-day limit will be automatically denied for timely filing without additional review (See 38 U.S.C. §1703).

Page 4. Version 2. TriWest Healthcare Alliance. Veterans Affairs (VA) Patient-Centered Community Care (PC3) Program.

TRICARE covers active duty service members, retirees, and their family members. TriWest manages care for military veterans and some members of the National Guard and Reserves.

TriWest is VA's third party administrator for CCN Regions 4 and 5. CCN covers all U.S. states and territories with an established set of regional boundaries aligned to state borders to provide local flexibility and increased access to care.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232