Urgent Care–Information for Providers
VA’s new urgent care benefit will provide Veterans with an efficient way to treat nonlife-threatening injuries and illnesses. VA’s top priority is to ensure Veterans have access to timely and high-quality health care.
Urgent care providers, who are a part of the VA contracted network, can treat Veterans without prior authorization. This means community providers must enter into a contract with one of VA’s Third Party Administrators (TPA). Once a community provider is part of VA’s contracted network, they can begin providing urgent care services to Veterans.
When a Veteran presents at an urgent care provider, community providers must check a Veteran’s eligibility for the urgent care benefit before providing care by confirming with the TPA assigned to their region. Community providers can check Veteran’s eligibility by calling the TriWest Interactive Voice Recording (IVR) system or the local VA medical facility.
If a Veteran arrives at an Urgent Care network location and has any difficulty receiving care, they can call the VA Urgent Care Support Line at 866-620-2071 to receive assistance.
TriWest Interactive Voice Recording:
Urgent Care Support Line: 866-620-2071
The urgent care benefit also covers diagnostic services like X-Rays, some lab testing, and some medications (with limitations). However, not all facilities in VA’s network will be able to offer these services. Therapeutic vaccines are covered when these are required for the treatment of certain conditions covered under the urgent care benefit. For example, an eligible Veteran seeking treatment for a wound caused by rusted metal requires treatment for the wound and may require a tetanus vaccine as part of the course of treatment.
With the exception of a flu shot, vaccines and other preventive care services are not covered, and eligible Veterans should not manage chronic conditions, or otherwise manage their care over the long term, through the urgent care benefit.
IMPORTANT: Urgent care is not a replacement for an eligible Veteran’s preventive health care. Eligible Veterans should work with their primary care provider for this type of care. If an eligible Veteran goes to an urgent care provider and receives services not covered by this benefit, they may be required to pay the full cost of care.
After providing urgent care to a Veteran, the community provider must:
- File a claim with the TPA assigned to their region. The TPA will adjudicate and pay the claim on behalf of VA.
- Send follow-up medical documentation to the nearest VA medical center via an approved method such as Veterans Health Information Exchange (VHIE) or fax. Urgent care providers can use the VA facility locator tool for VA contact information.
Community providers should not collect copayments from Veterans. Copayments are not paid out-of-pocket at the time the Veteran receives urgent care. Veterans are billed separately by VA as part of VA’s billing process.
VA will pay for or fill prescriptions for urgent care. For urgent care prescription medication longer than a 14-day supply, the prescription must be submitted to VA to be filled. For urgent prescriptions written by an urgent care provider, Veterans can fill a 14-day supply of medication at a contracted pharmacy within the VA network, in VA, or at a noncontracted pharmacy. If a noncontracted pharmacy is used, Veterans must pay for the prescription and then file a claim for reimbursement with their local VA medical facility.
Individual health conditions are complex and unique to each Veteran. To encourage eligible Veterans to seek care when and where they need it, VA does not publish a specific list of covered services for urgent care. However, VA does exclude from the urgent care benefit preventive services and dental services, as well as other items that are not included in the medical benefits package.
If the emergency department is part of VA’s contracted network and has agreed to furnish urgent care services in accordance with the contract requirements, VA can pay for these services for eligible Veterans under this benefit.
Only eligible Veterans can use this benefit. The urgent care benefit does not extend to family members and is nontransferrable.
There is no limit to the number of times a Veteran can access urgent care.
For questions and support, community providers should contact the TPA assigned to their region of the VA community care network or their local VA medical facility.
VA Facility Locator
If you are a community provider interested in providing care for Veterans, you must establish a contract with TriWest Healthcare Alliance (TriWest).
Join the TriWest Network