Urgent Care–Information for Providers - Community Care
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Urgent Care–Information for Providers

VA offers urgent care services to eligible Veterans at in-network urgent care clinics to treat minor injuries and illnesses that are not life-threatening, such as colds, strep throat, sprained muscles, and skin and ear infections.

To serve Veterans under this benefit, you must be an in-network urgent care provider through a VA Third Party Administrator (TPA). Optum is TPA for Region 1, and TriWest is TPA for Regions 2-6.


For Region 1, contact Optum at 888-901-7407

For Regions 2-6, contact TriWest


Intake and Checking Eligibility

When a Veteran presents at an urgent care provider, you must check their eligibility for the urgent care benefit (this also activates their pharmacy benefit).

Check the Veteran’s eligibility by calling:

  • For Region 1, contact Optum at 888-901-6609
  • For Regions 2-6, contact TriWest at 833-4VETNOW (833-483-8669)

If you need to contact a VA medical facility to obtain additional clinical information, please use the Emergency and Urgent Care Facility Contact List.

DO NOT charge the Veteran a copayment. Copayment charges are billed separately by VA as part of the VA billing process.

Covered Services

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 excludes from the urgent care benefit preventive services and dental services, as well as other items that are not included in the medical benefits package. Contact the TPA assigned to your region for more information.

Care Coordination

Submit medical documentation within 30 calendar days to the Veteran’s home VA medical center (VAMC) via an approved method, such as Veterans Health Information Exchange (VHIE) or fax. Please also notify VA about any clinical concern needing follow-up.

Using the ZIP code of the Veteran’s residence, find the appropriate VA medical facility using the Emergency and Urgent Care VA Facility Contact List or the VA Facility Locator.

Prescribing Urgent Care Medication

Ensure you have activated the Veteran’s pharmacy benefit by calling to check their eligibility, AND
ensure 14-day Rx is on the VA Urgent/Emergent Formulary.

To help a Veteran find an in-network pharmacy to fill their prescription in the same state as the urgent care visit:

For telephone assistance finding an in-network, in-state pharmacy for a Veteran to fill their prescription:

  • Call 888-901-6609 for CT, DC, DE, MA, MD, ME, NC, NH, NJ, NY, PA, RI, VA, VT, WV
  • Call 866-620-2071 for all other states/territories

In addition, please note:

  • VA covers a 14-day supply (no refills) of prescription medication for urgent care.
  • Prescriptions can be filled at an in-network pharmacy, at VA, or at a non-network pharmacy.
  • If a non-network pharmacy is used, Veterans must pay for the prescription and then file a claim for reimbursement with their local VA medical facility.
  • Prescriptions must be filled in the same state as the Veteran’s urgent care visit.
  • For a 14-day supply or greater, the prescription must be submitted to VA to be filled.
  • Opiates are limited to seven days or less, consistent with state law covering the pharmacy’s location.

Filing an Urgent Care Claim

After providing urgent care to a Veteran, the urgent care provider must:

  • File a claim within 30 calendar days with the TPA assigned to their region. The TPA will adjudicate and pay the claim on behalf of VA.
  • Make sure to submit medical documentation within 30 calendar days to the Veteran’s home VA medical center (VAMC) via an approved method, such as Veterans Health Information Exchange (VHIE) or fax. Please also notify VA about any clinical concern needing follow-up.

Using the ZIP code of the Veteran’s residence, find the appropriate VA medical facility using the Emergency and Urgent Care VA Facility Contact List or the VA Facility Locator.

Instructions for Region 1 Urgent Care Providers (Optum)

For urgent care providers in CT, DC, DE, MA, MD, ME, NC, NH, NJ, NY, PA, RI, VA, VT, WV

  • Support: Call 888-901-7407 (M-F, 8:00 a.m. – 6:00 p.m. EST, excluding federal holidays)
  • Electronic claims:
    • Use Payer ID "VACCN" OR
    • Visit the secure Optum Provider Portal. Select “I am a Provider,” and then select "Medical/Behavioral Provider."
  • Paper claims:
    • Mail to VA CCN Claims – MEDICAL, P.O. Box 202117, Florence SC 29502
    • Fax to 833-376-3047

Instructions for Region 2-6 Urgent Care Providers (TriWest)

For urgent care providers in all states/areas EXCEPT CT, DC, DE, MA, MD, ME, NC, NH, NJ, NY, PA, RI, VA, VT, WV

  • Support: Call 866-651-4977 (8 a.m. – 4:30 p.m. CT)
  • Electronic claims: Enroll for electronic transactions at the WPS Health Solutions website.
  • Paper claims:
    • Mail to: MPS MVH, P.O. Box 7926, Madison WI 53707-7926
Filing a Pharmacy Claim

Instructions for Region 1 Pharmacies (Optum/CVS Caremark Pharmacy Network)

For pharmacies in CT, DC, DE, MA, MD, ME, NC, NH, NJ, NY, PA, RI, VA, VT, WV

  • Enter VA pharmacy claims using the following information:

    1. Step 1: Enter BIN: 004336
    2. Step 2: Enter PCN: ADV
    3. Step 3: Enter Rx Group: RX4136
    4. Step 4: Enter 9-digit Veteran ID: Patient SSN
    5. Step 5: Enter Veteran’s date of birth (YYMMDD format)

For questions, please call the CVS Caremark Pharmacy Help Desk at 800-364-6331 (24/7).

Instructions for Region 2-6 Pharmacies (TriWest/Express Scripts Pharmacy Network)

For pharmacies in all states/areas except CT, DC, DE, MA, MD, ME, NC, NH, NJ, NY, PA, RI, VA, VT, WV

  • Enter VA pharmacy claims using the following information:

    1. Step 1: Enter BIN: 003858
    2. Step 2: Person Code: 01
    3. Step 3: Enter PCN: A4
    4. Step 4: Enter Rx Group: VAPC3RX
    5. Step 5: Enter 9-digit member ID: Patient SSN
    6. Step 6: Enter Veteran’s date of birth (YYYYMMDD format)

For questions, please call the Express Scripts Pharmacy Help Desk at 800-922-1557 (24/7).

Frequently Asked Questions

Are urgent care services provided at an emergency department covered by VA?
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.

Can the urgent care benefit be used by a Veteran’s family member?
Only eligible Veterans can use this benefit. The urgent care benefit does not extend to family members and is nontransferrable.

How many times may a Veteran use the urgent care benefit in a calendar year?
There is no limit to the number of times a Veteran can access urgent care.

Contact Us

To confirm a Veteran’s eligibility for urgent care services, call:

  • 888-901-6609 if located in CT, DC, DE, MA, MD, ME, NC, NH, NJ, NY, PA, RI, VA, VT, WV
  • 833-4VETNOW (833-483-8669) for all other states and territories

For general support, call the appropriate phone number listed below:

Urgent Care General Support Numbers
 Region 1Regions 2-6
Providers 888-901-6609 833-483-8669
Pharmacists 888-901-6609 (Optum)
800-364-6331 (Caremark)
866-620-2071(Urgent Care Support)
800-922-1557 (Express Scripts)
Veterans (Eligibility and General
Questions about the Benefit)
MyVA311 (844-698-2311) MyVA311 (844-698-2311)
Veterans (Issues at the Urgent
Care Location)
888-901-6609 866-620-2071