My Doctor Didn t Submit a Sar Form to Triwest for Continued Medical Visits

Community Care

Request and Coordinate Care

Strong care coordination between VA and community providers ensures Veterans receive timely and high-quality care. VA's care coordination model is a Veteran-centered, team-based approach involving five steps:

1. Receive request for community care:
   Several events can trigger the receipt of a request for community care, such as:
   • A new Veteran clinical appointment
   • A hospital notification
   • Referral from VA or community provider
   • An inpatient admission or emergency department visit.

It is the responsibility of the VA facility community care team to receive these requests, assign staff to manage them, and to confirm eligibility and authorize services indicated in the consult. Referrals and authorizations for community care are managed through the HealthShare Referral Manager (HSRM) system. See below for more information.

2. Assess Veteran needs: The VA facility community care staff determines the appropriate level of care coordination for each Veteran through the use of the Screening Triage Tool combined with clinical judgment.
3. Develop care coordination plan: Community providers and VA facility community care integrated team will develop an individualized care coordination plan to include: scheduling, navigation and other follow-up activities. Care coordination involves determining the complexity of care needs of Veterans who receive community care followed by coordination of care delivery and transition back to VA.
4. Implement care coordination plan: VA facility community care integrated team will facilitate a collaborative relationship regarding all aspects of the care coordination process. This helps streamline the flow of information between Veterans, VA community care integrated teams, VA providers, and the community provider.
5. Follow-up and complete episode: VA facility community care team will follow-up with the Veteran to ensure all services were performed appropriately, perform any necessary handoff and close the consult. Throughout the episode of care, facility community care staff should be monitoring and tracking the Veteran.

Facility Contact Numbers for Care Coordination
Use this list of VA medical facility contacts to locate and contact the nearest VA medical facility community care office in order to coordinate care for a Veteran.

Care Coordination Tools

VA has several tools available for community providers that help support the continuity of care Veterans receive, including HealthShare Referral Manager, Community Viewer, and Azure RMS.

• Request for Service (RFS)
• HealthShare Referral Manager (HSRM)
• Community Viewer (CV)
• Azure Rights Management Services (RMS)
• Veterans Health Information Exchange (VHIE)

Request for Service (RFS) Requirements

VA has implemented a standardized form for Community Providers to request additional or continued care or services for Veterans. The purpose of the Community Care Provider-Request for Service, VA Form 10-10172, is to manage requests from community providers and to allow for placement, tracking, managing, and reporting of those requests. Approved care may be performed within VA or at community facilities. The location is dependent on the service availability within VA as well as the Veteran's community care eligibility and preferences.

The use of the RFS form is recommended for clinical requests from a community provider to facilitate review and authorization. All supporting medical documentation must accompany the completed form, this may include laboratory and radiology reports or provider progress notes. If additional information is needed to authorize the request, the community provider will be contacted and will have three business days to provide the necessary requested documentation or the request will be denied.

The VA facility staff will process all requests within three business days and the community provider will be notified of the decision or outcome via their preferred method of communication. The notification will also indicate if the care will be provided within VA or in the community. If the care is denied, it is the responsibility of the requesting community provider to contact the Veteran and discuss alternate treatment plans.

A blank RFS Form will be sent with all referral packets and is also available online. To complete VA Form 10-10172, fill-out the required fields and indicate the type of service being requested.

Please note: A separate form is required for each service requested.

Community Care Provider-Request for Service (RFS), VA Form 10-10172

HealthShare Referral Manager

HealthShare Referral Manager (HSRM) is a secure, web-based system VA uses to generate and submit referrals and authorizations to community providers. HSRM allows community providers and VA to better manage community care for Veterans. The system's robust functionality facilitates reduced turnaround time for processing referrals, providing care, submitting claims, and receiving payment. Registration, training, and technical support for HSRM are available to community providers at no cost!

Benefits

• Fosters health information exchange (HIE) between VA and community providers through one unified platform
• Promotes reduced turnaround time for authorizations and reimbursement
• Provides easy access to bundled care/standardized episode of care (SEOC) details
• Indicates which services are required and how to acquire precertification when necessary
• Reduces time spent waiting for fax, phone, or email contact prior to serving a Veteran

To receive HSRM updates, please sign up for VHA Office of Community Care (VHA OCC) Provider Updates newsletter.

How to Access HSRM

If you are interested in using HSRM, first confirm your facility has an active Community Care Network (CCN) agreement with TriWest or Optum, or a Veterans Care Agreement (VCA) with VA. Next, follow the steps below to obtain access to HSRM. Resources mentioned in the following steps are available in the HSRM Training and HSRM Resources sections below.

1. Attend the training webinar on Veteran Health Administration (VHA) Training Finder Real-time Affiliate Integrated Network (TRAIN) or access the eLearning lessons available in the HSRM Training section below to learn how to use HSRM.

NOTE: It is highly recommended that the training webinar hosted on VHA TRAIN is attended prior to obtaining access to HSRM. The training sessions include an overview of HSRM, an in-depth walkthrough of the system, registration guidance and additional time for questions.

2. All users sign up for an ID.me account and verify their identity using the steps outlined in the HSRM Single Sign-On External (SSOe) Quick Reference fact sheet.
3. One facility point of contact from your organization fills out the End User Tracker (EUT) with information for staff requiring HSRM access, then submits the EUT to HSRMSupport@va.gov.

NOTE: Please ensure the email addresses entered in the EUT match those used for each respective user's ID.me account.

4. The HSRM Help Desk provides the facility point of contact with confirmation that staff access has been granted.
5. All end users access HSRM via the Community Care Referrals and Authorization (CCR&A) website at https://ccracommunity.va.gov.

NOTE: If your HSRM account becomes deactivated, email hsrmsupport@va.gov requesting reactivation.

Once these steps are complete, contact the VA facility you work with to let them know you have access to HSRM and to discuss your transition to using HSRM.

Figure 1: Sign Up Steps for Community Provider Referral Processing Staff

HSRM System Training

For interested community providers, HSRM trainings are offered weekly through the VHA TRAIN website. The HSRM trainings provide an in-depth walkthrough of the system's functionality, as well as discussion of how to get an account in HSRM. Please check VHA TRAIN for available dates and to register in advance. A free account in VHA TRAIN is required in order to register for the webinar.

Register for a virtual Community Provider HSRM Training

A two-part extended HSRM training event is also being offered weekly for community providers. This event will be slower paced, have more time for system demonstrations, and allow for live Q&A throughout. Please check VHA TRAIN for available dates and to register in advance. A free account in VHA TRAIN is required in order to register for the webinar.

Register for the two-part extended virtual Community Provider HSRM Training

HSRM Registration Information Session

For interested community providers, HSRM registration information sessions are offered weekly through the VHA TRAIN website. The HSRM registration information sessions walk community providers through the process of obtaining access to HSRM (i.e. creating an ID.me account and completing the End User Tracker). Please check VHA TRAIN for available dates and to register in advance. A free account in VHA TRAIN is required in order to register for the webinar.

Register for a virtual Community Provider HSRM Registration Information Session

HSRM eLearning

Community providers can also learn about HSRM system functionality through self-paced eLearning, available 24/7 through VHA TRAIN. A free account in VHA TRAIN is required in order to access the eLearning.

Access all Community Provider HSRM eLearning Lessons

Frequently Asked Questions about HSRM

Can a VA medical facility still refer a Veteran to a community provider who is not using HSRM?

Yes, VA can still refer a patient to a community provider who is not using HSRM as long as the provider is listed in VA's Provider Profile Management System (PPMS). VA creates the referral in HSRM, generates the "Offline Referral Form", and sends it to the provider via traditional referral processing methods (e.g. fax, email). The provider's preferred method of communication is logged into HSRM under the notes field for reference.

Community Viewer (CV)

CV is a web-based application that enables community providers to view the full, VA electronic health record of each Veteran assigned to them in CV.

Community providers in an "Active" status will be eligible for access to CV as one of the following:

• Community Care Network (CCN)
• Provider Agreement (PA)
• Local Contract

Request Access to Community Viewer

To request access to CV, email the Community Provider Technical Service Desk, or the VA staff resource who assigns patients to you. When requesting access, please provide your Community Provider NPI number and email address. You will use your NPI number as your user name and receive a password from VA staff which will allow you to log into CV to view the Veteran's VA health history.

Frequently Asked Questions about Community Viewer

How do I get access to CV?

Community providers have multiple means to request access to CV:

1. Contact the VA staff located at the VA facility that referred the Veteran for care.
2. Contact the Community Provider Technical Service Desk at 844-788-6161 or via email.
3. Request access through the CV Community Care Provider website.

A valid NPI number with a status of 'Active' is required as a login ID to CV. Password and link to the application can be provided by the VA staff that refer the Veteran for care. Please note, that VA staff at the local VA or local Community Care facility must assign a Veteran record to a Community Provider in CV for the health record to be available for viewing.

Is support available?

For access issues contact your local VA facility for assistance. For technical issues, contact the Community Provider Technical Service Desk

Azure Rights Management Services (Azure RMS)

As of August 24, 2019, VA has transitioned from Virtru Pro to Azure RMS for encrypted email. Azure RMS allows VA to securely exchange information with community providers using encrypted email. With Azure RMS, community providers no longer have to wait for a Veteran's information via fax or mail. Azure RMS enables safe communication about Veterans' health information through email.

How Azure RMS Works

When a community provider receives an email from VA encrypted through Azure RMS, they will be able to seamlessly read and respond to the email through the existing email provider or open the email in a web browser and read and respond securely.

Access to Azure RMS

To access Azure RMS, you do not need to install any software to receive and reply to secure messages from VA. Azure RMS is accessed directly through email in the same way you receive other emails.

If you, as a provider, want to reply to an older message that was encrypted with Virtru Pro (the previous encryption software), you will continue to have the ability to do so. On the VA side, VA users will still get notice of the email response and can open the email in the Virtru Pro Secure Reader via a web browser.

Frequently Asked Questions about Azure RMS

Should I use Azure RMS or Community Viewer?

You can use both! To access Community Viewer (CV), you must have a username and password. You can use Azure RMS to transmit this information securely. More information about CV can be found above.

Veterans Health Information Exchange (VHIE)

Many Veterans see providers from VA as well as providers in the community outside of VA. This can make it difficult for providers to access the records they need to manage a Veteran's care. By sharing a Veteran's health information electronically, VA and participating community care providers are better able to coordinate and improve the overall quality of care for our Veterans.

VA Exchange enables bi-directional sharing of Veteran Health Information between the VA and participating community providers. The Information is exchanged over a secure network and includes medical history, allergies, medications, immunizations, problems and more. If your hospital or health care system is interested in creating this connection please see our VA Exchange Onboarding Flyer below.

VA Exchange

Allows providers in the community to exchange Veteran health information with the VA

Health information is exchanged over a secure network and accessible through your Electronic Medical Record (EMR)

Partners include other federal agencies, health care organizations, and health information exchange networks

Please note: If you are trying to view a referral submitted by VA, please utilize HealthShare Referral Manager (HSRM).

VA Exchange Onboarding Flyer 2022

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Source: https://www.va.gov/communitycare/providers/Care_Coordination.asp

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