If TriWest has demanded recoupment of previously paid VA Community Care Network (VACCN) massage therapy claims, respond promptly.

1. Review the notice and deadlines

Record the notice date and date received, total demanded, claim count, service dates, refund control numbers and all deadlines. Some notices provide only 30 days. Record whether you received advance notice of the July 15, 2025 MPPR change, and calculate the days between that date and your first recoupment notice. Separate any claims involving more than 60 minutes, other CPT codes, or authorization limits from the common MPPR issue.

2. Send the updated WSMTA dispute letter to TriWest

Customize the template, remove optional statements that do not apply, identify all disputed claims, and attach the notice and claim list. The letter disputes both the amount and enforceability of the alleged debt without conceding an overpayment. Request immediate suspension of recoupment demands and offsets, restoration of payment for newly authorized care, cancellation of historical demands, and return of funds already recovered.

Ask for claim-level accounting showing original and recalculated payments, applicable rate files and MPPR calculations; a worked four-unit CPT 97124 (or whichever CPT code you billed) example; the original 2021 VA payment instructions and approval records; the authority to reopen claims and recover funds; and whether VA or TriWest owns the alleged debt. Ask whether VA has recovered the same amounts from TriWest and how duplicate recovery is prevented.

3. Protect formal review rights

TriWest’s ordinary claims reconsideration instructions describe a 90-day period from original claim processing and separate submissions for individual claims. It remains unclear whether those rules govern newly issued historical recoupment demands. Ask TriWest in writing to identify the controlling deadline and procedure and confirm whether your consolidated letter and claim list preserve review rights for every claim. If not, request exact claim-by-claim instructions and written extensions where authorized.

A letter to TriWest or Congress does not automatically suspend collection, extend a deadline, or preserve every appeal right. Do not wait for an unanswered clarification request if an applicable deadline is approaching; consider qualified legal assistance.

4. Document offsets and request immediate relief

Save remittance records showing any partial or 100% withholding of current reimbursements, including offsets against other clinicians or services. Request a separate written decision on suspension while the broader dispute is investigated. If TriWest says it lacks authority, ask it to refer the matter to the responsible VA official and identify that person. Request an accounting and restoration of amounts improperly withheld or later subject to relief.

5. Contact your congressional representative

Customize WSMTA’s congressional memo with your dates, amounts, claim count, responses received, and effects on your practice and veteran appointments. Ask for VA oversight, a systemwide pause, and an examination of original payment instructions, recovery authority, contractor responsibility, review protections and network adequacy. Find your representative: https://www.house.gov/representatives/find-your-representative. Do not include identifiable patient medical information.

6. Use the three WSMTA documents

These are intended to be living documents.  As things change, we will keep these documents updated as well.  Our suggestion is when you decide to make your initial outreach to TriWest, check this page to see if these documents have changed to ensure you're using the latest version.

• Provider Recommendations and Instructions
• Provider Memo to TriWest
• Provider Memo to Congressional Representative

Remember to retain copies and proof of delivery and keep a log of your contacts with TriWest.

7. Report your experience to WSMTA

Complete WSMTA’s confidential provider survey: https://mailchi.mp/d053ac7e84e9/important-triwest-payment-demand-survey-19495035. WSMTA uses aggregated findings for advocacy and will not share personally identifying provider information without permission.

This helps us to know how many providers/clinics are affected as well as allows us to channel communications specific to affected providers.

Questions: gr@mywsmta.org.

This guidance is educational, not legal advice. The applicability of federal debt-compromise provisions to these particular TriWest demands remains unresolved.