Tri-West VA Referral Fix

Providers who render services to veterans within the Patient Centered Community Care (PC3) network can resolve referral and claim issues until September 30, 2022. If your PC3 is managed by Tri-West, they have set up a process to submit retroactive referrals.   

Per VA, “ Any referrals for services between June 6, 2019, and March 31, 2021, that were not created and/or accepted by TriWest before the contract end date will now be accepted by TriWest through Sept. 30, 2022, following a new VA contract modification….Under the terms of VA’s Community Care Network (CCN), providers have 180 days from the date of referral issuance to submit claims to TriWest for payment.”  

How to Submit PC3 Retro Claims 

    • Each claim must include the corresponding VA authorization number. 
    • For claims submitted electronically via EDI, use the PGBA Payer ID: TWVACCN. 
    • You may log in to availity.com and select “Claims and Payments” at the top left of the toolbar.  Please include a “9” in the CLM 20 field (reason for delay). 
    • Paper submissions must include a completed “Attestation of Timely Filing” on top of the claim (place Attestation form first, then claim form in the same mailing), and mail it to TriWest VA CCN Claims, P.O. Box 108851, Florence, SC 295028851.  
    • TriWest has reopened its PC3 customer service lines through March 31, 2023. 

Contact Information 

Providers with specific PC3 Retro Referral claim-related questions can contact TriWest by calling 866-651-4977. 

Providers who have all other PC3 claims processing questions should contact TriWest customer service by calling 855-722-2838. 

TriWest has reopened its PC3 customer service lines through March 31, 2023. 

Providers with specific PC3 Retro Referral claim-related questions can contact TriWest by calling 866-651-4977. 

Providers who have all other PC3 claims processing questions should contact TriWest customer service by calling 877-226-2832.  

TriWest PC3 Customer Service Hours of Operation  

SUN: 3pm-3am MST/1200-0000 HST/1100-2300 SST/0800-2000 CST 

M-TH: 7am-3am MST, FRI: 7 am-12am MST, SAT: Closed 

For more on TriWest’s claims processing guidelines, visit here.