IHS/THP Reimbursement Agreements Program–Information for Providers
The VA Indian Health Services/Tribal Health Programs (IHS/THP) Reimbursement Agreements Program provides a means for IHS and THP health facilities to receive reimbursement from the VA for direct care services provided to eligible American Indian/Alaska Native (AI/AN) Veterans. This program is part of a larger effort set forth in the VA and IHS Memorandum of Understanding signed in October 2010 to improve care coordination and access to care for our nation’s Native Veterans.
Listed below are several resources for initiating agreements and implementing the reimbursement agreement.
Eligibility and Enrollment Verification
Eligibility and Enrollment Verification explains ways in which IHS/THP facilities can verify American Indian/Alaska Native (AI/AN) Veteran eligibility.
Initiation and Implementation
IHS/THP Initiation and Implementation outlines the process for starting and implementing the IHS/THP reimbursement agreement. While working through the agreement process, the VA encourages IHS/THP facility staff to ensure Veterans are enrolled in the VA health system.
Tribal facility staff may submit claims electronically or on paper:
Electronic billing (Electronic Data Interchange)
Facilities submitting electronic/Electronic Data Interchange (EDI) claims will need to register with Change Healthcare (formerly Emdeon) by phone or web:
Change Healthcare customer support line: 800-845-6592
Once registered, billing staff should ensure that “THP” is added to the SBR03 segment of the 837 for proper routing through the VA. The VA payer IDs are:
- 12115 for medical claim submissions
- 12116 for dental claims
- 00231 for any inquiry transaction
Where to Mail Paper Claims
VA has a centralized claims processing center for paper claims. Send paper claims to:
VA Portland Health Care System, 10N20NPC
1601 E Fourth Plain Blvd.
Vancouver, WA 98661
When AI/AN Veterans need care that is not available within IHS/THP-participating Reimbursement Agreement Program (RAP) facilities, care must be referred to non-IHS/THP providers to provide such care. For eligible Veterans, this includes referrals to VA health care facilities where VA may provide the care directly, or referral to a community care provider which requires enhanced care coordination and associated collaboration between VHA and IHS and/or THPs.
To ensure enhanced care coordination, VHA Office of Community Care (OCC) established the Healthcare Coordination Advisory Board (HCAB) with participation from IHS and tribes to assist VA in developing standardized processes for care coordination of eligible AI/AN Veterans, including referrals from IHS/THP facilities to the respective VA medical centers (VAMCs) to receive care not available within the IHS/THP health care facilities. The HCAB convened to develop a draft care coordination approach which ensures Veterans are at the center of the process. VA hosted additional events to gain stakeholder input including a February 2020 listening session to begin formal stakeholder discussions on care coordination and a tribal consultation in August 2020 to introduce the draft care coordination approach and receive further feedback.
In September 2020, Veterans Health Administration (VHA) announced an amendment to the Indian Health Service/Tribal Health Programs (IHS/THP) Reimbursement Agreement program for direct care services for eligible American Indian and Alaska Native (AI/AN) Veterans. The agreement allows eligible Veterans to receive direct care services at their local tribal facility, and in turn, the tribal facility will be reimbursed by VA for that care per the terms of the agreement.
- Expands reimbursement to include services provided through telehealth, at the outpatient all-inclusive rate, by clarifying the definition of the term “direct care services.”
This excludes the Alaska THP agreements as telehealth was previously included.
- Expands reimbursement to include COVID-19 related testing and care provided by contracts established by the IHS/THPs (i.e., purchased referred care program) for health care provided outside of the facility during the COVID-19 emergency period that meet certain conditions.
- Clarifies language in the quality section of the agreement relating to certification and accreditation requirements.
- Extends the terms of agreement to June 30, 2024; an additional two years beyond the existing term.
To view the Tribal Leader Letter issued on the amendment, please visit the Indian Health Service newsroom.
For additional questions or information:
IHS/THP Reimbursement Agreements Team
IHS/THP Claims Payment Processing Center