Other Types of Care–Information for Providers
Beyond general and specialty care from community providers, VA also provides other types of care to eligible Veterans in their community in some circumstances. There are specific eligibility criteria and other policies that determine how Veterans can access these services. In most cases, these services require preauthorization unless the medical event is an emergency.
More information about these services can be found below. If you are interested in providing these services or treatment to Veterans, please contact VA through the contact information listed below each service.
- Bowel and Bladder Care
- Dental Care
- Foreign Medical Care
- Home Health and Hospice Care
- In Vitro Fertilization
- State Veterans Homes
- Transplant Guidance
Bowel and Bladder Care
Bowel and bladder providers play an important role in caring for Veterans at home and in the community. Providers who have been approved to provide bowel and bladder care to an eligible Veteran will be issued a VA referral that contains pertinent clinical information to include the services that have been authorized for payment.
Request and Coordinate Care
Information on VA referrals and coordinating care.
There are two types of bowel and bladder providers: Individual (health care services provided by a family member, friend, or a caregiver) and agency providers.
Individual Providers
File a Bowel and Bladder Claim
Information on how individual providers file a claim for payment of services with VA.
Agency Providers
File a Claim for Veteran Care
Information on how agency providers file a claim for payment of authorized services.
Contacts
Customer Call Center: 877-881-7618
8:00 a.m. to 9:00 p.m. Eastern Time
Monday–Friday
Resources
Provider Advisor newsletter
Subscribe to our monthly community provider newsletter for the latest updates and information about Veteran community care.
Dental Care
VA provides dental care services to eligible Veterans at VA medical facilities and in-network dental clinics. Some of the services offered include regular teeth cleaning, x-rays, fillings, crowns, bridges, dentures, and oral surgery. For more information on VA dental care services and how to file a claim, review the information below.
Frequently Asked Questions
Does all dental care in the community need to be preauthorized by VA?
All dental care in the community must be preauthorized by a VA provider.
Community providers must follow the authorized care per the treatment plan developed by the VA dentist. The community provider MUST ONLY provide the services on the consult order including the specific ADA CDT code and appropriate area of the oral cavity.
Please note: The Urgent Treatment SEOC may not have a specific ADA CDT code and appropriate area of the oral cavity.
How do I request additional care for a Veteran referred to my clinic?
When additional services are needed for a Veteran receiving community care, the performing dentist must submit a request detailing the type of care and receive prior approval for reimbursement. These requests are referred to as a “Request for Service" (RFS) and must include a complete ADA Dental Claim form. The VA RFS Form 10-10172 is NOT required for dental RFS but may be submitted in addition to the ADA Dental Claim form, if preferred.
For more information on how to file a dental claim, refer to the File a Dental Claim page. For more information on the Community Care RFS process, view the Request for Service Requirements on the Request and Coordinate Care page.
Does the Oral Appliance Therapy (OAT) SEOC cover routine dental care?
No. The OAT SEOC covers the medical benefit, not routine dental care. Sleep-related breathing disorders (SRBD) are diagnosed and treated by a licensed independent provider (LIP). The medical LIP is responsible for evaluating, diagnosing, and managing the treatment of SRBD. Oral appliance therapy for conditions such as sleep apnea is part of the medical benefits package and the medical LIP may prescribe OAT when treating a patient with a sleep disorder.
If services within the local VA dental clinic are available, the medical LIP can request OAT with a consult. If services are unavailable within the local VA, the medical LIP can request the service through community care via the Oral Appliance or Mandibular Repositioning Device SEOC. The OAT SEOC covers the care done by a dentist but is billed with medical codes including evaluations, fitting, procurement of the oral device, and follow up.
Does VA cover orthodontics as a standard VA dental benefit?
No, the Dental Orthodontics Phase SEOC is only used for correction of a malocclusion due to a dental-facial deformity. Orthodontics treatment is not authorized unless there is specific documentation of service-connected trauma resulting in a malocclusion or if there is evidence that a congenital disease or defect increased beyond its natural progression as a result of military service. Malposed teeth are considered a developmental abnormality and a pre-existing condition relative to the start of military service.
Foreign Medical Care
VA’s Foreign Medical Program (FMP) is a health care benefits program for Veterans with VA-rated, service-connected disabilities who are residing or traveling abroad. Through FMP, VA assumes payment responsibility for certain health care services, medication, and durable medical equipment necessary for treatment of a service-connected disability or condition associated with a service-connected disability.
VA administers FMP and is responsible for all aspects of the program including the Veterans’ registration process, verification of eligibility, authorization of benefits, and the processing and payment of claims.
All FMP claims should include the patient’s full name, VA Claim Number, mailing address, and the FMP Claim Cover Sheet, VA Form 10-7959f-2. Additional documentation may be necessary depending on the type of claim. For more information, please view the How to File a FMP Claim fact sheet.
Please note: To speed up claims processing, providers should submit claims in English. Claim information submitted in a language other than English requires translation and may delay processing of claims.
Frequently Asked Questions
How do I know if a Veteran is FMP eligible?
Veterans will have a FMP benefits authorization letter outlining their covered, service-connected disabilities.
Is there a contract or agreement I must sign to accept/participate in FMP?
No, FMP does not have contract providers.
Does the Veteran need approval for referrals to specialists or for diagnostic tests?
No, approvals are not required for referrals or diagnostic tests related to treating service-connected disabilities.
What kind of clinical cases are reviewed for medical claims?
Claims are reviewed to determine whether the care provided is related to the service-connected disability. Reviews may include:
- Physical, occupational and speech therapy; home health care
- Inpatient skilled nursing services and rehabilitation
- Mental health/substance abuse
- Durable medical equipment
How do I get a claim paid?
Submit your claim with the following information:
- FMP Claim Cover Sheet
- Patient’s full name, mailing address, and Social Security Number
- Billed charge(s) and date(s) for each service
- Provider’s full name, medical title, office address, phone number, and billing address (if different from office address)
- Narrative description of service provided
- Diagnosis treated
Send all documentation via mail or email to:
Veterans Health Administration
ATTN: Foreign Medical Program
P.O. Box 469061, Denver CO 80246-9061
United States of America
For more information on submitting a claim, please contact the FMP office.
What kind of medication is covered under FMP?
Prescription and over-the-counter medications are covered if the drug is appropriate for the treatment of a service-connected disability, or any condition associated with and held to be aggravating a service-connected disability. All medications must be approved by the U.S. Food and Drug Administration (FDA). Medication purchased in the U.S. and mailed or shipped to a foreign country is not covered.
Does FMP issue preauthorizations?
It is important to note that FMP is unable to issue preauthorization for foreign medical services. Veterans are encouraged to use the Ask VA (AVA) system to communicate directly with FMP to obtain a treatment predetermination screening. This process will provide reasonable assurance on whether a claim will be paid, if billed appropriately.
FMP Contacts
If you are a community provider and have a question, please contact FMP at any of the phone numbers listed below:
- USA/Canada: 877-345-8179
- Australia: 1800 354 965
- Costa Rica: 0800-013-0759
- Germany: 0800 1800011
- Italy: 800 782655
- Japan: 00531-13-0871
- Mexico: (001) 877-345-8179
- Spain: 900 981 776
- UK: 0800-032 7425
Home Health Services and Hospice Care
VA provides supportive medical services to help chronically ill or disabled eligible Veterans of any age remain in their home. These services are referred to as home health care and are considered extended care services prescribed by and under the direction of a VA physician.
VA provides several types of home health care including:
- Skilled home health care
- Home health aide services
- Homemaker services
- Hospice care
- Palliative care
- Remote monitoring care
- Respite care
For more information about home health care, please visit the Geriatrics and Extended Care website or contact your local VA medical facility.
Geriatrics and Extended Care website VA Facility Locator
Contacts
OCCAN98SupportGroup@va.gov
For AN98 non-contracted skilled home health and hospice care payment methodology questions, contact the AN98 Support Group.
Resources
- Filing A Claim for Veteran Care
- Provider Advisor newsletter
Subscribe to our monthly community provider newsletter for the latest updates and information about Veteran community care.
In Vitro Fertilization
Veterans with certain service-connected conditions that result in infertility may be eligible for in vitro fertilization (IVF), another form of assisted reproductive technology (ART), or other infertility services. VA may provide these services to Veterans if:
- The Veteran has a service-connected condition that causes infertility
- The Veteran is legally married
- Male spouses can produce sperm
- Female spouses have an intact uterus and ability to produce eggs
VA provides infertility treatment and services through Reproductive Endocrinology and Infertility (REI) community providers who are part of VA’s Community Care network. REI providers play an integral part in making sure Veterans get the infertility treatment they need.
If you are interested in providing treatment and services to Veterans, you must enroll in VA’s Community Care network through third party administrators Optum United in Regions 1-3 and TriWest Healthcare Alliance in Regions 4 and 5.
What does VA cover?
VA does not cover the costs associated with donor sperm, donor eggs, donor embryos, or gestational surrogacy. In addition, VA does not cover the cost of IVF related to donor sperm, donor eggs, donor embryos, or gestational surrogacy.
State Veterans Homes
State Veterans Homes are facilities that provide eligible Veterans with nursing home, domiciliary, or adult day care. These facilities are owned and operated by state governments. Each state establishes eligibility and admission criteria for its homes and some State Veterans Homes may admit non-Veteran spouses and gold star parents. VA’s State Home Program provides an economical alternative to constructing, maintaining, and operating facilities for the provision of care to eligible Veterans.
VA also provides per diem payments to states for the care of eligible Veterans in state homes. There are several policies and regulations that affect the State Home Per Diem Program. For more information about State Veterans Homes and to see a list of current regulations, laws, policies and handbooks relating to the program, please visit the VA Geriatrics and Extended Care (GEC) State Veterans Home Program website.
Transplant Guidance
VA provides integrated care of acute and chronic diseases for which transplantation may be an option. Management of such advanced diseases (e.g., heart failure, cirrhosis) is coordinated among referring VA medical centers (VAMC), and regional referral VA medical centers, VA Transplant Centers (VATC), and/or community specialists as appropriate.
