Community Care

The agreements program was first initiated in 2012 with IHS/THP and in 2022 expanded to include Urban Indian Organization (UIO). The program is part of a larger effort to improve access to care and coordination for our nation’s AI and AN Veterans under a broader VA-IHS Memorandum of Understanding managed by VHA.

Listed below are several resources for initiating agreements and implementing the reimbursement agreement.

On this Page:

• Submitting Claims
• Care Coordination
• Training
• Operational Updates
• I/T/U Healthcare Facilities or Clinics
• Contacts & Resources

Eligibility and Enrollment Verification

Eligibility and Enrollment Verification explains how I/T/U facilities can verify American Indian/Alaska Native (AI/AN) Veteran eligibility.

Initiation and Implementation

I/T/U Initiation and Implementation outlines the process for starting and implementing the I/T/U reimbursement agreement. Through the agreement process, VA encourages I/T/U facility staff to enroll eligible Veterans for care at VA.

Submitting Claims

I/T/U facility staff may submit claims electronically or on paper:

Pharmacy Claims

VA will only reimburse IHS/THP/UIO for pharmaceutical drugs listed on VA National Formulary.

VA accepts paper and EDI pharmacy claims and follows the same claim submission process as IHS/THP. UIO must be annotated in the EDI and paper claims. Refer to the Pharmacy Claims Submission Guide for information on how to submit pharmacy claims.

Electronic billing (Electronic Data Interchange)

Facilities submitting Electronic Data Interchange (EDI) claims need to register with Change Healthcare by phone or online:

Once registered, billing staff should ensure “IHS, THP or UIO” is added to the SBR03 segment of the 837 for proper routing. VA payer IDs are:

• 12115 for medical claim submissions • 12116 for dental claims • 00231 for any inquiry transaction

Paper Claims

VA has a centralized claims processing center for paper claims. Send paper claims to:

Billing

Third Party Billing

IHS/THP/UIO will bill all third-party payers before billing VA. VA will be responsible for the remaining balance. I/T/U providers are responsible for submitting health care claims to other health insurance before billing VA. VA does not reimburse copayments, deductibles or participate in balance billing. VA will not pay for services covered by Medicare/Medicaid.

Coronavirus-related Billing

The 2020 VA–IHS and THP Reimbursement Agreements Modification will allow VA pay for direct care or Purchased Referred Care (PRC) related to COVID-19 healthcare services as defined in the section 11.5. Other PRC services are not reimbursable, as healthcare services must be provided directly by your facility per the agreement.

For VA to pay for direct care or PRC treatment due to COVID 19, the diagnosis and CPT code must follow Medicare guidance for COVID-19 billing and as such must be identified as COVID-19 in the claims. Outpatient or inpatient claims submissions must follow industry standard guidelines. Current VA billing process or requirements is not changing except for use of COVID-19 specific codes.

Refer to the Medicare.gov Medicare & Coronavirus webpage for further information.

Claims Status Check

To check the status of IHS, THP, and UIO submitted claims:

VA I/T/U Claims Payment Processing Center: 877-881-7618
6:05 a.m.–4:45 p.m. MT, Monday–Friday
IMPORTANT: Do not enter your facility zip code, instead use the NW POM zip code: 98661.

VA Customer Engagement Portal (CEP)
Registered IHS/THP providers can research the status of claims received by VA.
NOTE: If the CEP is down and claims information is required, please contact Provider Portal Customer Support.

eCAMS Provider Portal (ePP)
Registered I/T/U providers to research the status of claims received by VA and being processed in the VA Electronic Claims Adjudication Management System (eCAMS). I/T/U providers may register on the eCAMS Provider Portal to view VA payment information and claim status. If you need assistance, please contact eCAMS Customer Service.

Northwest Region Payment Operations and Management (NW POM)
For questions and issues with submitted IHS, THP and UIO claims.

Care Coordination

When eligible AI/AN Veteran care is not available at participating I/T/U RAP facilities, care must be referred to non-I/T/U providers. This includes referrals to VA health care facilities where VA may provide the care directly or refer to a community care provider.

To ensure enhanced care coordination, VA established the Healthcare Coordination Advisory Board (HCAB) with participation from IHS and Tribes, to assist VA in developing standardized processes for care coordination. In 2020, VA adopted a multifaceted approach leveraging VA’s Care Coordination Request for Services (RFS) process, a standardized process to receive requests for care form community providers.

More details on how to refer care to VA and the RFS process, as well as local point of contacts, can be found on the VA Request and Coordinate Care page. Participating I/T/U Facilities with additional questions can also contact the RAP team for assistance.

Training

I/T/U Reimbursement Agreements Program (RAP) Joint Orientation Brief

The VA I/T/U RAP Office provides training for IHS and tribal staff on the VA IHS/THP Reimbursement Agreements Program and claims submission process. The duration is approximately 30 minutes. Please use PIN 442595 to download the files.

IHS/THP RAP 2022 Refresher Training (Last updated on 05/05/2022.)

Native Cultural Awareness

Cultural awareness is an essential component of Veteran-centered care. Providers who do not regularly work with AI/AN patients may lack awareness of specific cultural aspects of care. To boost cultural awareness of this group, VA has identified material that could benefit both clinical and administrative staff. They are:

• SAMHSA Native Culture Card–a guide to build cultural awareness; it is intended to serve as a general briefing to enhance cultural competence while providing services to American Indian and Alaska Native communities.
• IHS Gold Book–a four-part publication in which IHS reviews progress from the agency’s first 50 years of operation, including lessons learned regarding culturally acceptable public health services.

Operational Updates

In 2022, the Department of Veterans Affairs (VA) Reimbursement Agreements Program (RAP) is expanding to include Urban Indian Organizations (UIO), nonprofit facilities located in urban centers.

Eligible American Indian/Alaska Native (AI/AN) Veterans can now receive greater access to healthcare and direct care services in a culturally sensitive setting without a preauthorization or a copayment.

UIOs offer unique access to quality health care and culturally appropriate services for urban AI/AN people who may not have access to these resources because they do not live on or near a reservation. Urban American Indians not only share the same health problems as the general American Indian population they are compounded by their distance from family and traditional cultural environments.

I/T/U Healthcare Facilities or Clinics

The following is a list of current participating Indian Health Service, Tribal Health Program and Urban Indian Organization (I/T/U) healthcare facilities or clinics under the VA Reimbursement Agreements Program.

IHS-THP RAP Participating Facilities List (Excel file)