VHA Office of Community Care
Provider Reference Library
The fact sheets listed below provide specific information that providers and office managers need to know in order to participate in VHA Community Care programs. You can view fact sheets about our Veteran programs and beneficiary programs on our Fact Sheets page.
- Billing for VA Community Care Programs
- How to Read a Preliminary Fee Remittance Advice Report (20-04)
- Overview of ICD-10 (20-07)
- Veterans Choice Program Provider Network
- Complaint Process for PC3/Veterans Choice Program
- Choice First Episode of Care, Expansion of 60-day Authorization–Not to Exceed One Year
- FMP–Information for Outpatient Providers and Office Managers (04-20)
Fact Sheet 04-20 is also available in the languages listed below.
- FMP Fact Sheet 04-20—GERMAN
- FMP Fact Sheet 04-20—GREEK
- FMP Fact Sheet 04-20—ITALIAN
- FMP Fact Sheet 04-20—JAPANESE
- FMP Fact Sheet 04-20—KOREAN
- FMP Fact Sheet 04-20—SPANISH
- FMP Fact Sheet 04-20—THAI
- Ambulance Transport at VA Expense – A Guide for Community Ambulance Providers (20-06)
Family Member Programs
- CHAMPVA Payment Methodology (01-04)
- CHAMPVA and the Use of Durable Medical Equipment (01-07)
- CHAMPVA– Information for Providers and Office Managers (01-20)
- CWVV Payment Methodology (03-02)
- Spina Bifida Health Care Benefits Program Payment Methodology (06-02)
- SBHCBP–Information for Providers and Office Managers (06-20)
Below are forms frequently used by our providers. Other forms for VHA Community Care programs can be found on our Forms page.
- FSC Vendor File Request Form, VA Form 10091 (Fillable PDF)
This form enables all vendors to apply for payment via Electronic Funds Transfer, or to submit changes/updates to their Financial Management System (FMS) Vendor Record in order to receive VA payments that comply with the 1996 Debt Collection Improvement Act. For questions regarding VA Form 10091, send an email to VAFSCVENDOT@VA.GOV or call 1-877-353-9791.
- CMS-1500 (OMB NO. 0938-0999), Health Insurance Claim Form
- UB-04 CMS-1450 (OMB NO. 0938-0997), Medical Billing Claim Form
You can download a sample of the form from the CMS Forms – CMS 1450 Details web page. However, copies of the CMS-1450 should not be downloaded for submission of claims, since they may not accurately replicate colors included in the form. These colors are needed to enable automated reading of information on the form. Visit the Institutional Paper Claim Form (CMS-1450) web page for information on obtaining the CMS-1450.
- UB-92 HCFA-1450 (OMB NO. 0938-0279), Medical Billing Claim Form
As of May 23, 2007, the use of form UB-92 HCFA-1450 has been discontinued; only the new UB-04 billing form is to be used. All rebilling of claims should use the UB-04 billing form, even though earlier submissions may have been on the UB-92. For more information, visit the National Uniform Billing Committee website at www.nubc.org.
Manuals and Guides
- VHA CC Policy Manuals
Details on payment methodology and covered benefits for each of our health plans are covered in our policy manuals.
- Pregnancy Management: Clinical Practice Guidelines
A detailed, VA/DoD reference guide of current industry best practices for symptoms and diagnoses related to the management of pregnancy.
Training and Presentations
- VHA TrainingFinder Real-time Affiliate Integrated Network (TRAIN)
An external learning management system to provide valuable, Veteran-focused, accredited, continuing medical education at no cost to community health care providers. The linked guide above contains information on how to enroll and a sampling of courses offered.
- Veterans Choice Program Toolkit for Outreach Partners
A compilation of materials designed to make it easy to share information and spread awareness about the Veterans Choice Program. It includes customizable communications and templates.
- Learn About Military Culture
- Fact Sheet: Military Culture Training for Community Providers
- Military Culture: Core Competencies for Healthcare Professionals
A training course for community providers on treating the unique Veteran patient community.
- PTSD Consultation Program
Post-traumatic stress disorder training offered for health care professionals who treat Veterans.
- Fraud, Waste and Abuse Prevention
VHA Office of Community Care Department of Program Integrity provides news and information on fraud, waste and abuse – including a robust suite of resources and training – to guide your understanding of these issues and how you can help prevent them.
- Preliminary Fee Remittance Advice Report (PFRAR)
This training will help providers understand the format of the PFRAR, a customized, vendor-specific document that supplies data to identify claim dates and services, reasons for disapproval and/or payment amounts. An interactive training module is being developed that will familiarize providers with the PFRAR including what individual fields mean, how to find outstanding balances and how to use the report to reconcile bills with outstanding claims.
- ICD-10 Resources
Please note: This is not a fully inclusive listing of all sites providing ICD-10 information and assistance.
- Fact Sheet 20-07: Overview of ICD-10 – VHA Office of Community Care
- Road to 10: The Small Physician Practice's Route to ICD-10 – Centers for Medicare and Medicaid Services
- Medicare ICD 9 – ICD 10 Crosswalk Basics – Centers for Medicare and Medicaid Services
- Solutions for Managing Your Practice: ICD-10 Code Set – American Medical Association (AMA)
- ICD-10 FAQs – American Health Information Management Association (AHIMA)
- ICD-10 Project: VA's Transition to ICD-10 – VA Health Information Management (VA HIM)
- Training modules for VA Stakeholders–VA MyVeHu Campus
- Clinical Education Products
Free clinical education products on a range of mental health and substance use topics developed by the VA are available to our VA Community Care partners. Below is a sample of the products that are available on the Mental Illness Research, Education and Clinical Centers (MIRECC) website.
- A Therapist's Guide to Brief Cognitive Behavioral Therapy
- Get Moving and Get Well Manual
- Multi-Setting Peaceful Mind: A Manual to Aid in the Management of Anxiety in Veterans with Memory Impairment
- A Veteran’s Guide to Talking With Kids About PTSD
- Collaborative Safety Planning for Older Adults