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  • Triwest Healthcare Alliance Pc3 - Initial Evaluation Report 2018

Get Triwest Healthcare Alliance Pc3 - Initial Evaluation Report 2018-2026

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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How to fill out the TriWest Healthcare Alliance PC3 - Initial Evaluation Report online

Filling out the TriWest Healthcare Alliance PC3 - Initial Evaluation Report is an essential step in providing comprehensive care for veterans. This guide will help you navigate the form online, ensuring all necessary information is accurately captured.

Follow the steps to complete the evaluation report efficiently.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Enter the veteran’s name clearly in the designated field to ensure proper identification.
  3. Fill in the DoD ID/Benefits # or Sponsor SSN. This is crucial for verifying the veteran's eligibility and benefits.
  4. Record the evaluation date in the appropriate section. Ensure this date reflects when the evaluation is performed.
  5. Input the VA authorization number, which is necessary for processing this report.
  6. Provide the veteran’s address, ensuring it is complete with city, state, and zip code.

Complete the evaluation report online today to ensure timely and effective care for veterans.

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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.

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.

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