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HNFS Contract Close Out—Provider Frequently Asked Questions

The Department of Veterans Affairs (VA) contract with Health Net Federal Services (HNFS), a third party administrator for the Veterans Choice Program (VCP) and the Patient-Centered Community Care (PC3) networks, expired on September 30, 2018. HNFS administered the eastern region of VA’s contracted network and performed certain administrative tasks on behalf of VA.

When the contract with HNFS ended, VA took over all activity previously performed by HNFS. VA is working with Veterans, community providers, and VA staff to transition care as seamlessly as possible. The end of the VA contract with HNFS does not affect the VA contract with TriWest Healthcare Alliance who administers the western region of the VCP and PC3 networks.

 Fact Sheet: Claim Submission to HNFS – Community Provider FAQs

If I signed a VCP provider agreement, can I continue to treat Veterans?

Community providers who are (or will be) using a VCP provider agreement to provide care to Veterans will work directly with VA medical facilities for care coordination and billing. All new authorizations for former HNFS regions will now be authorized by the VA medical facility. VA will contact you concerning continued participation for Veteran care through VCP provider agreements. If you would like to see more information on this program, please visit the Veterans Choice Program – Information for Providers.

Veterans Choice Program – Information for ProvidersIVF Provider Information
I have an authorization from HNFS for PC3/VCP services with an end date of November 1, 2018; will that be honored?

No, HNFS is in the process of adjusting existing authorizations that extend beyond the contract expiration date of September 30, 2018 to reflect an end date of September 30, 2018. HNFS will be issuing updated provider packets or authorization letters in the coming weeks. Please review these carefully to avoid unexpected claims denials as HNFS will be unable to provide reimbursement for services that occur after September 30, 2018. Continued care authorization and rescheduling of appointments on or after October 1, 2018, will transition to a local VA medical facility's community care office.

What if a Veteran has an appointment scheduled by HNFS after September 30, 2018?

Existing appointments under the HNFS contract will be completed before the end of the contract. Appointments after September 30, 2018 must be coordinated by a VA medical facility. VA medical facilities and community providers will work together to ensure a seamless transition for care authorization, coordination, billing, and payments.

Do I need to submit PC3/VCP claims by September 30, 2018 to be paid for services rendered?

Providers will have through March 26, 2019, to submit claims for covered services rendered up through September. 30, 2018, to HNFS for payment. Claims for services provided on or after October 1, 2018, will be coordinated directly through VA.

How will outstanding claims already submitted to HNFS be paid after September 30, 2018?

HNFS will follow contractual obligations and guidelines for claims processing and will process clean claims submitted for authorized services rendered on or before September 30, 2018. VA will continue to work collaboratively with HNFS to ensure providers receive prompt and timely payments during this period of transition.

Who do providers call to check payment status on claims after September 30, 2018?

Providers can call the HNFS provider service line for PC3/VCP claims and authorization inquiries related to HNFS-authorized services, or visit the HNFS website.

HNFS Provider Service Line: 844-728-1914
Monday – Friday, 8:00 a.m. – 5:30 p.m. EST, excluding certain holidays

HNFS Provider News and Updates:

You can continue to check claim status and history at the Availity website through October 1, 2019.

Availity website:

Who do providers contact if they still have unresolved claims with HNFS?

Community providers should first try to resolve any outstanding PC3/VCP claims and authorization inquiries related to HNFS-authorized services claims with HNFS directly using the HNFS provider service line or visit HNFS’ website.

HNFS Provider Service Line: 844-728-1914
Monday – Friday, 8:00 a.m. – 5:30 p.m. EST, excluding certain holidays

HNFS Provider News and Updates:

If after working with HNFS, a provider is unable to get resolution for outstanding claims they may contact OCC, Provider Relations & Services, Network Management. A staff member will be assigned to work with the community provider and HNFS toward resolution.

Email: OCC, Provider Relations & Services, Network Management