This page provides the latest information for community providers who are partnering with VA to care for our nation’s Veterans. From here, you can access the latest news, policy changes, and health care program updates!
To get the latest updates directly in your e-mail inbox, we encourage you to sign up for our monthly community provider newsletter.
Updates to VA community emergency treatment reporting process
VA implemented changes to its community provider emergency treatment reporting process on Feb. 15, 2021. As of Feb. 15, 2021, VA requested all emergency notifications must be reported through either:
VA is allowing a two-week transition period before discontinuing email and fax as an acceptable method of notification. On Mar. 1, 2021, email and fax notification will no longer be accepted to minimize vulnerabilities to Veterans’ protected health information and streamline the notification and decision process. As part of this change, providers will also be required to include a valid email address for decision correspondence when reporting emergency treatment.
Emergency care decision communication has historically been returned to community providers via encrypted email. The encrypted email securely contained both personal identification information (PII) and decision information. To improve decision communication, as of Mar. 1, 2021, VA will no longer include PII in outgoing correspondence. Providers will need the notification identification number assigned upon submission of reporting to correlate authorization decision to reported emergency events.
Please send questions to ProviderExperience@va.gov.
Update: COVID-19 Testing and Treatment Reimbursement
The Department of Veterans Affairs (VA) continues to rely on community providers to ensure eligible Veterans have access to COVID-19 antigen testing and services through as many avenues as possible, whether through VA health care centers or through our community health care partners.
Eligible Veterans who meet criteria provided by the Centers for Disease Control and Prevention (CDC) and local public health department guidelines can receive COVID-19 antigen testing and services from community providers, paid for by VA. Eligible Veterans do not pay a VA copayment for COVID-19 testing or services. Consistent with guidance VA released on July 10, 2020, VA reimburses community providers for COVID-19 antigen testing and services provided to eligible Veterans at one of the following outlets:
- In-network Urgent Care/Retail locations, if it is in conjunction with a clinical visit for care
- In-network Community Care Network providers, if a referral or authorization exists
- Emergency Departments, if the visit otherwise meets criteria for VA coverage of emergency care services (either through the PC3 or CCN networks or care that is paid for directly by VA)
To expedite COVID-19 testing and services for Veterans early in the pandemic, when coverage in VA was limited, VA decided in 2020 to temporarily reimburse all COVID-19 testing, urgent and emergent care claims for eligible Veterans, including claims made without a VA referral. This means that COVID-19 testing and services with dates of service prior to January 1, 2021, that were not authorized (do not have a VA referral) can be submitted to VA for payment.
However, now that coverage is more widely available, claims for reimbursement for COVID-19 testing and services on and after January 1, 2021, must be approved via VA referral or meet urgent or emergent care eligibility requirements in order to receive payment.
If you are filing a claim for authorized COVID-19 testing and services, please ensure the claim meets all requirements, including timely filing, and is submitted to the appropriate payer (i.e. Third Party Administrator or VA).
For more information about how to properly file a claim, visit our File a Claim for Veteran Care webpage. Questions? Please call VA Customer Service or contact us via email.
VA Customer Service:
2021 VA Fee Schedule Published
Beginning January 1, 2021, the U.S. Department of Veterans Affairs (VA) will phase in a new approach for its community care fee schedule payment rate calculations that better aligns VA to industry best practices.
Instead of rates being calculated based on the location of the referring VA medical center, rates will now be calculated based on the location of where the care is provided (i.e. rendering locality). This means that beginning January 1, 2021, payment rates under the VA fee schedule may be different from 2020.
Impact of Rate Changes on Providers
VA generally reimburses hospital care, medical services and extended services at the applicable Medicare rate published by the Centers for Medicare and Medicaid Services (CMS). When no CMS rate is available, VA and Third Party Administrators reimburse at the lesser amount of (1) billed charges or (2) the VA fee schedule rate.* The VA fee schedule rate is the amount published for the designated date of service time period.
The rate changes only apply to services being reimbursed under the VA fee schedule, which is mainly used for Geriatrics and Extended Care services, along with a small number of health care services not covered by the CMS schedule.
With the 2021 VA fee schedule rates based on where the care is provided, community providers can expect better consistency with industry standard practices and alignment with the CMS schedule. In addition, please note the following:
- VA Fee schedule rates for 2021 are calculated to limit decreases in provider reimbursement as much as possible. However, VA could not eliminate every instance of a rate decrease.
- Rates for home care services were increased to cover the average cost of personal protective equipment per visit, in accordance with the CARES Act.
- VA’s dental schedule is not publicly available due to the terms of VA’s contract for compiling a dental services fee schedule.
- Reimbursement rates are subject to change annually and more often if required.
- *Alaska VA fee schedule and methodology is an exception and can be accessed from the updated VA Fee Schedule page.
VA Fee Schedule page
For questions or concerns, please contact VA Customer Service at 877-881-7618.
VA to Eliminate Spinal Decompression from Standardized Episodes of Care
VA has reviewed its policy relating to chiropractic care and will no longer reimburse spinal decompression–Healthcare Common Procedure Coding System (HCPCS) code S9090–on VA standardized episodes of care (SEOC) with dates of service effective January 1, 2021, and later.
We understand that community providers have been paid for this code in the past. As part of our efforts to continually review the services provided to our Veterans, it was determined that there was insufficient evidence regarding unique benefits of this service to justify continued reimbursement for this code.
Other types of lumbar traction can be used for care provided to Veterans and will be reimbursed by VA. As with any non-emergent Veteran community care, the services must be authorized in advance.
Flu Shots Now Available for Eligible Veterans (#FightFlu)
VA’s community seasonal flu shot program launched Sept. 1, 2020, providing eligible Veterans with a no-cost seasonal flu shot. VA currently partners with more than 60,000 in-network retail pharmacies and urgent care locations to provide flu shots to Veterans.
To serve Veterans using this benefit, retail pharmacies or urgent care clinics must be in-network through one of VA's third-party administrators (TPAs), either Optum Public Sector Solutions, Inc. (Optum), part of UnitedHealth Group, Inc.; or TriWest Healthcare Alliance (TriWest).
For current in-network retail pharmacies or urgent care locations, the chart below describes how to submit claims when you provide eligible Veterans a seasonal flu shot. Please use the information listed below depending upon the Community Care Network (CCN) region where your facility is located and the appropriate TPA.
Billing for In-Network Retail Pharmacies/Urgent Care Locations
After the Veteran’s visit, follow these steps:
- Retail Pharmacies: Provide a copy of the flu shot documentation to the Veteran and recommend they provide it to their VA primary care provider’s office.
- Urgent Care: Submit medical documentation to the Veteran’s home VA medical center (VAMC) within 30 calendar days of the date of service.
VA and its Third-Party Administrators Able to Consider Some Denied Claims for Payment
VA and its third-party administrators (TPA), Optum and TriWest, will reconsider payment to providers who had a claim denied for simple routing errors.
Providers whose claims were denied because they were submitted to the wrong VA payer (VA or a TPA) are eligible for reconsideration if the original claim was filed with a VA payer on time (within 180 days of the date of service).
The provider must resubmit a reconsideration request to the correct VA payer within 180 days of the initial denial. A copy of the remittance advice from a claim that was submitted to a VA payer within 180 days of date of service satisfies this requirement.
Optum and TriWest also have the authority to process provider payment requests that were previously denied prior to this direction and over 180 days after the date of the remittance advice if the original claim was submitted on time. The 180 days from the date of the remittance advice is through Dec. 1, 2020.
In addition, claims not submitted because of missing affiliation/network information on the VA referral are also eligible to be reconsidered if the claim is within 180 days of the date of the referral allocation. VAMC staff will send the provider an offline referral created in Health Share Referral Manager (HSRM) to the community provider with the authorization number. The HSRM offline referral will also explain who to correctly bill.
In-network providers can view the authorization number and original received date in HSRM. Providers in Optum’s network can also find the original received date in the Optum Provider Portal.
For more information:
Call Community Care Contact Center: 877-881-7618
HealthShare Referral Manager (HSRM)
HealthShare Referral Manager (HSRM) is the Department of Veterans Affairs (VA) online system for sending referrals and authorizations to community providers. HSRM allows community providers and VA to better manage community care for Veterans. Registering for HSRM is available for community providers at no cost!
HSRM Virtual Training
For interested community providers, HSRM trainings are offered weekly. The HSRM training sessions include an overview of HSRM, an in-depth walkthrough of the system, and 30 minutes allotted for audience questions/demos. Registration for one of the live weekly HSRM trainings can be completed by creating an account and logging into the Veterans Health Administration (VHA) Training Finder Real-time Affiliate Integrated Network (TRAIN) website.
HSRM Online eLearning Modules
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.
Additional HSRM Information
For more information about HealthShare Referral Manager (HSRM) for community providers, please visit the Care Coordination Overview Webpage.
Becoming a VA Dental Provider Under CCN
February 21, 2020
Are you a dental provider interested in partnering with VA to serve Veterans in your community? VA encourages high-performing dental providers to be part of VA’s Community Care Network (CCN). As a CCN dental provider, you can take pride in providing high-quality health care to Veterans with convenience and improved access to dental care.
Key benefits of becoming a CCN dental provider:
- Prompt payment within 30 days of receipt of clean claims, including resubmissions.
- Ability to deliver high-quality dental care to our nation’s Veterans.
- Utilization of industry-standard approaches and guidelines to administer services and a managed healthcare network.
VA provider webinar series: free community provider education
Applying to become a VA dental provider is simple and quick. The first step is finding your CCN region. CCN provider partnerships are administered by a third-party administrator (TPA) in each of six regions. Provider partnerships for Regions 1, 2 and 3 are administered by Optum Public Sector Solutions, Inc. (Optum), part of UnitedHealth Group, Inc., while the Region 4 TPA is TriWest Healthcare Alliance (TriWest). VA will announce the Region 5 TPA at a later date.
After identifying your CCN region, please follow the instructions on the following webpages to apply to become a CCN dental provider.
• In CCN Regions 1, 2, and 3, access the Logistics Health Incorporated (LHI) Provider Portal. For Optum CCN dental provider resources, visit the Training & Guides section of the Optum VA Community Care Network portal.
• In CCN Region 4, email TriWest. For more information on becoming a dental provider for CCN in Region 4, access the TriWest VA CCN website.