Attention A T users. To access the menus on this page please perform the following steps. 1. Please switch auto forms mode to off. 2. Hit enter to expand a main menu option (Health, Benefits, etc). 3. To enter and activate the submenu links, hit the down arrow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links.

Community Care

Menu
Menu

Quick Links

Veterans Crisis Line Badge
My healthevet badge
EBenefits Badge
 

Top 20 Providers with High Dollar Value of Unpaid Claims

VA has created rapid response teams to work with the following list of top 20 providers with high dollar value of unpaid claims to to assist with account receivable reconciliation of outstanding claims. Actions will address the issue of delayed payments to create sustainable fixes that solve ongoing payment issues which affect Veterans, community providers and other VA partners.

Providers can email questions or inquiries to Provider.Response@va.gov. Providing the following information may help to expedite your request:

  • Provider name
  • Provider address
  • Email address
  • Phone number
  • Claim number(s), if available
  • Desired resolution date, if required
  • Taxpayer Identification Number (TIN)
  • National Provider Identifier (NPI) number
  • Points of contact
  • Brief description of the issue
  • Have you contacted VA, Health Net or TriWest about this issue before? If yes, when?
  • Is this an issue with the Veterans Choice Program (VCP)1, VA Community Care (VACC)2, or a Provider Agreement2?
1 If VCP, you would be receiving authorizations and sending claims to TriWest or Health Net.
2 If VACC and/or Provider Agreements, you would be receiving authorizations and sending claims directly to your local VA medical center (VAMC).

Top 20 Providers with High Dollar Value of Unpaid Claims

PROVIDERSTATE
HCA Florida; Texas; Louisiana; Colorado; South Carolina
Adventist Health System  Florida
UF Health Florida
Orlando Health  Florida
Ohio Health Ohio
Health First Florida
Dignity Health California; Arizona; Texas
Bay Care Health System Florida
Cape Fear Valley Health System North Carolina
Tenet Health California; Texas
Centracare Health Minnesota
Carolinas Healthcare System North Carolina
University of Cincinnati Health Ohio
Sanford North Dakota; South Dakota
Universal Health Services Florida; District of Columbia
University of Colorado Health Colorado
Wake Health North Carolina
Mount Carmel Health Ohio
Lee Health Florida
Vanderbilt Health Tennessee

Frequently Asked Questions

How were the Top 20 providers determined?

The Top 20 providers were identified by extracting a list based on the total volume of claims pending as determined by total billed charges, however, VA does not imply reimbursement will be based on billed charges. Providers will be reimbursed according to current regulatory guidance associated with the authorization for care. In addition to the identification of the Top 20 providers, VA is actively working with several large provider networks not listed in the Top 20, but who are national provider networks with independent healthcare providers within their coverage area.

I have submitted many claims that have been rejected. Why am I not on the Top 20 provider list?

The list of Top 20 providers was based on total claims pending according to billed charges. VA intends on working with all providers to assist with reconciling their accounts receivable associated with traditional referrals, Choice provider agreements, and Third Party Administrator (TPA) Choice claims status. Once VA works through the Top 20 provider list, VA will continue to work with additional providers.

Why does it matter if care is authorized by VA?

All care must be authorized by VA for payment to be made, to include emergency care. A phone call to schedule an appointment is not considered as preauthorization at this time. Each community provider will receive a written authorization for care authorized by VA.

How will providers be notified that a rapid response team will be working with us?

VA will reach out to providers and establish a meeting or phone call to discuss the steps necessary to reconcile their accounts receivable and claims status with VA and the Choice Third Party Administrators (TPAs). VA will also provide a timeline on the review process as well as provider education to include differentiation of claim types and authorities.

What will the rapid response teams accomplish?

The intent of the rapid response team is to expedite assistance with reconciling the provider accounts receivable status, claims status, and provider education on VA referrals, authorizations, and regulatory authorities to provide care in the community.

What if we can’t reach a financial settlement within 90 days?

VA intends to reconcile a provider’s accounts receivable status within 90 days. However, due to volume of claims outstanding and the issues associated with the claims status, VA and the provider will discuss the reasons for a delay in resolution and will develop a plan with an expected timeline to resolve any outstanding claims issues.

What if we can’t reach a financial settlement within 90 days?

VA intends to reconcile a provider’s accounts receivable status within 90 days. However, due to volume of claims outstanding and the issues associated with the claims status, VA and the provider will discuss the reasons for a delay in resolution and will develop a plan with an expected timeline to resolve any outstanding claims issues.