Precertification Requirements - Community Care
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Precertification Requirements

The VA is required by law to bill Third Party Payers (TTP) for care that is not related to a Veteran’s service-connected disability or Special Authority. This requires VA to call TPPs for precertification for patients who are VHA beneficiaries with other billable health insurance (OHI). Please note that claims for ancillary services will be processed in accordance with Medicare National Correct Coding Initiative(NCCI), Medically Unlikely Edits (MUE), and related edits.

The preferred method for submitting requests is via the HealthShare Referral Management (HSRM) provider portal using the Task: CCN PRECERTIFICATION NOTIFICATION. Although this is the preferred method of notifying Revenue Operations of precertification, the request can also be submitted via fax.

Once the community care provider has notified VHA Revenue Operations that the test/procedure/admission requiring TPP precertification is scheduled, there is no requirement to wait for the TPP approval or response prior to performing the test/procedure/admission included as part of the SEOC referral.

If you are interested in more information about HealthShare Referral Manager, please review our Care Coordination page. To sign up for the HSRM Provider Portal, please select the Community Care Referral and Authorization (CCRA) option from the AccessVA website.

HSRM Provider Portal: AccessVA website

Fax numbers by Consolidated Patient Account Center (CPAC) Region are listed below:

Fax numbers by Consolidated Patient Account Center (CPAC) Region
CPAC / Fax numberVISNs included
Northeast CPAC
(717) 270-3002
VISN 1: Togus, ME; Manchester, NH; Central Western Massachusetts; Bedford, MA; Boston, MA; Providence, RI; White River Jct, VT; Connecticut

VISN 2: Western New York; East Orange, NJ; Bronx, NY; New York, NY; Northport, NY; Hudson Valley, NY

VISN 4: Pittsburgh, PA; Altoona, PA; Coatesville, PA; Erie, PA; Lebanon, PA; Wilkes Barre, PA; Philadelphia, PA; Butler, PA; Wilmington, DE
Mid-Atlantic CPAC
(828) 257-3758
VISN 5: Martinsburg, WV; Huntington, WV;Beckley, WV; Clarksburg, WV; Washington, DC; Baltimore, MD

VISN 6: Hampton, VA; Richmond, VA;Salem, VA; Asheville, NC; Fayetteville, NC; Durham, NC; Salisbury, NC

VISN 7: Birmingham, AL; Central Alabama, AL; Tuscaloosa, AL; Atlanta, GA; Dublin, GA; Augusta, GA; Charleston, SC; Columbia, SC
Florida/Caribbean CPAC
(407) 599-8095
VISN 8: Orlando, FL; N Florida/S Georgia; Tampa, FL; Miami, FL; West Palm Beach, FL; Bay Pines, FL; San Juan, PR
Mid-South CPAC
(629) 224-5062
VISN 9: Lexington, KY; Louisville, KY; Tennessee Valley, TN; Memphis, TN; Mountain Home, TN

VISN 16: Central Arkansas, AR; Fayetteville, AR; Biloxi, MS; Jackson, MS; Shreveport, LA; New Orleans, LA; Alexandria, LA

VISN 17: North Texas, TX; Amarillo, TX; Central Texas, TX; El Paso, TX; West Texas, TX; Houston, TX; South Texas, TX; Texas Valley Coastal Bend
North Central CPAC
(608) 821-7525
VISN 10: Battle Creek, MI; Saginaw, MI; Ann Arbor, MI; Detroit, MI; Marion, IN; Indianapolis, IN; Cleveland, OH; Columbus, OH; Cincinnati, OH; Dayton, OH; Chillicothe, OH

VISN 12: Iron Mountain, MI; Madison, WI; Milwaukee, WI; Tomah, WI; Chicago, IL; Hines, IL; North Chicago, IL; Illiana, IL
Central Plains CPAC
(913) 578-4538
VISN 15: Heartland (E. Kansas; Wichita, KS; Columbia, MO); St Louis/Poplar Bluff, MO; Marion, IL

VISN 19: Montana; Cheyenne, WY; Sheridan, WY; Salt Lake City, UT; Eastern Colorado, CO; Grand Junction, CO; Muskogee, OK; Oklahoma City, OK

VISN 23: Fargo, ND; Minneapolis, MN; St Cloud, MN; Black Hills, SD; Sioux Falls, SD; Omaha, NE
(702) 341-3562
VISN 20: Alaska; Puget Sound, WA; Spokane, WA; Walla Walla, WA; Boise, ID; Portland, OR; Roseburg, OR; White City, OR

VISN 21: Northern California; Central California; San Francisco, CA; Palo Alto, CA; Pacific Islands; Sierra Nevada, NV; Southern Nevada, NV

VISN 22: Los Angeles, CA; Long Beach, CA; Loma Linda, CA; San Diego, CA; N. Arizona, AZ; Phoenix, AZ; S. Arizona, AZ; New Mexico, NM

Standardized Episodes of Care (SEOC) Billing Code Information

The VA SEOC Billing Code List provides preapproved billing codes associated to the services within each available SEOC. The list also contains billing codes that require TPP precertification, called "Precertification (Precert) Codes.” While the codes have been clinically approved in the referral by the VA as part of the SEOC, an additional precertification request must be submitted by VHA Revenue Operations to the Veteran’s TPP for the precert codes.

Prior to viewing the VA SEOC Billing Code List, you must accept the terms and conditions defined
in the License for Use Of Current Procedural Terminology.

Additional Coding Information

Ancillary Codes: Please note that claims for ancillary services will be processed in accordance with CMS NCCI, MUE, and related edits.

If code(s) are not on SEOC: Services provided must be appropriate and necessary to accomplish the intent of the referring providers order/consult request. The Standardized Episode of Care (SEOC) describes the most likely scope of care necessary, but other services may be allowed in certain circumstances if necessary for completing the referral.