Veterans Care Agreements
VA may enter into agreements with certain community providers to care for Veterans when they are not part of VA’s contracted community care network. These agreements are known as Veterans Care Agreements (VCA), which are intended to be used in limited situations where contracted services through VA’s community care network are either not provided or not sufficient to ensure Veterans can get the care they need. VA may only purchase care for Veterans through these contract vehicles such as the Patient-Centered Community Care (PC3) network or the Community Care Network (CCN), or by establishing a VCA.
Either a community provider or a local VA medical facility may initiate the process for establishing a VCA.
- Providers interested in establishing a VCA should contact their closest VA medical facility.
- In some cases, VA medical facilities may reach out to community providers to request they establish a VCA where there is a need for services not adequately covered through VA’s contracted network.
VCA Process for Community Providers
Providers may submit an application for certification to enter into a VCA, but are strongly encouraged to join our contracting partner networks to receive referrals. In order to apply for VCA certification, a provider must submit their name, address, phone number, National Provider Identifier (NPI), and a copy of their current valid state licensure to the OCC VCA Review Team.
After VA receives the request and required documentation from a community provider, the local VA medical facility will notify the provider of the status of the request within 120 days.
A signed VCA is active for three (3) years and must be recertified every 12 months. Community providers must maintain a high level of quality care by staying in compliance with VA’s certification standards throughout the length of the agreement.
VA verifies the credentials of licensed medical professionals providing care to Veterans by assessing their background and legitimacy to provide care. To do this, VA normally uses the Centers for Medicare and Medicaid Services (CMS) process to certify CMS-participating providers. Alternatively, VA can use its Interim Certification Process to certify non-CMS participating providers for a VCA until VA establishes a national contract with a Credentials Verification Organization (CVO).
Once a VCA is signed by a community provider and local VA medical facility, the community provider will be notified to begin receiving referrals and authorizations from VA to provide care to Veterans. The referral and authorization contain the scope of services authorized for the community provider to provide to a specific Veteran.
IMPORTANT: Veterans must receive approval from VA prior to obtaining care from a community provider in most circumstances.
Referrals and authorizations are sent to community providers through a system called HealthShare Referral Manager (HSRM), an electronic referrals management system. HSRM allows community providers and VA to better manage community care referrals and authorizations using a standardized process based on clinical and business rules. Community providers can also receive referrals and authorizations using secure email, fax, or mail.
Community providers can register for the HSRM training by signing up and viewing the webinar through the VHA TRAIN website. An account in VHA TRAIN is required before registering for the webinar.HSRM Information Sheet HSRM Training Create a TRAIN Account
With VCAs, community providers submit claims directly to VA using electronic data interchange (EDI) or by mailing the claim to the address contained within the referral.
IMPORTANT: Community providers cannot receive payment for care provided to Veterans through a VCA until the VCA is established and signed. VA is not responsible for payments prior to approval of a VCA.
VA follows Medicare reimbursement rates for all Medicare-recognized services. For non-Medicare recognized services, VA reimburses at the appropriate VA fee schedule or billed charges. VA is responsible for any payment or fee arising from care authorized through VCAs. Community providers cannot collect or seek to collect payments from any entity for VA-authorized care, including from a Veteran or a Veteran’s other health insurance.
Community providers can check the status of a claim through VA’s Customer Engagement Portal (CEP), a web application that allows community providers and other registered vendors to research the status of claims received by VA. This includes information on previous, current, and future payments, and provides the option to check the status of CMS 1500 (HCFA-1500) or CMS 1450 (UB-04) claims forms.Customer Engagement Portal
Yes, VCAs may be signed by an entity such as a group practice. The VCA will need to include the National Provider Identifier (NPI) numbers of all providers covered under the VCA.
The terms by which a provider’s VCA can be terminated are specified in the VCA.
Community providers must submit any changes to VA that may affect their status according to the process specified in the VCA within 10 business days, as outlined in the VCA.
Provider will receive referrals on an authorized VA form through their preferred method - either HSRM, secure fax, email, or mail.
The VA medical facility from which a community provider has received the referral or authorization, under the VCA, is responsible for addressing payment disputes.
If you are a community provider interested in establishing a VCA to provide care for Veterans, contact the nearest VA medical facility by using the VA Facility Locator.
VA Facility Locator