Veterans Choice Program–Information for Providers
The Veterans Choice Program (VCP) is one of several programs VA uses to provide care to Veterans through community providers. For example, if a Veteran needs an appointment for a specific type of care, and VA cannot provide the care in a timely manner or the nearest VA medical facility is too far away or too difficult to get to, then VA may refer the Veteran to a community provider who participates in VCP.
If you are a community provider interested in providing care for Veterans through VCP, you must establish a contract with the VA’s third party administrator (TPA), currently TriWest Healthcare Alliance (TriWest). TPAs help administer VCP on behalf of VA.
NOTE: Providers do not need to join PC3 to participate in VCP, and all current PC3 providers are automatically eligible to participate in VCP.
Community providers interested in participating in VCP must meet the following eligibility requirements:
- Must accept Medicare rates
- Must meet Medicare Conditions for Coverage and Conditions of Participation, or other criteria established by VA
- Be in compliance with all applicable federal and state regulatory requirements
- Have same or similar credentials as VA staff
- Submit a copy of the medical records to the TPA for medical care and services provided to Veterans for inclusion in the VA electronic record
- Must be eligible according to the U.S. Department of Health and Human Services Office of Inspector General (OIG) Exclusion Program
Yes, through one of two options:
- Certification (CHOICE) – The review of elements, including: provider licensing, sanctions, Medicare participation or waiver, and eligibility to participate in government programs.
- Credentialing (PC3) – The full review of provider licensing, certification, education, training, work history, sanctions, malpractice, and eligibility to participate in government programs. Health plans must follow the credentialing standards of their national accrediting organizations.
Please rest assured that all providers listed in PPMS have received certification or credentialing from TriWest or the CCN contractor, and are authorized to be appointed for patient care.
Yes. The Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 (H.R. 3230; Pub.L. 113–146), also known as the Veterans Choice Act, authorizes a defined certification process prior to Community Care network appointment. Per VA agreement with TriWest, certification is an approved process to begin Veteran care, but credentialing must be completed within 12 months for the provider to continue receiving authorizations to treat Veteran patients.
There are two nationally recognized accrediting organizations for health plan networks, URAC and National Committee for Quality Assurance (NCQA). URAC and NCQA have similar credentialing standards and require accreditation renewal every three years.
Nationally Recognized Accrediting Organizations
|Requirement||Veterans Choice Program
|Patient-Centered Community Care (PC3)
|Education and training||✓|
|Absence of sanctions||✓||✓|
|Certification to write
|National Provider Identifier
(or approved waiver)
|Frequency||At least every 12 months||At least every 3 years|
If you meet the eligibility requirements, contact TriWest Healthcare Alliance, the third-party administrator (TPA), using the information listed below. Complete the process to establish a contract or provider agreement with TriWest, which will allow you to care for Veterans through VCP.
VA and TriWest have reached an agreement that expands TriWest’s services to all regions across the country under this program. The expansion ensures access to community care where needed until the next generation of Community Care Network contracts are awarded and implemented.
VA-TriWest Expansion Agreement News Release
Hours: 8:00 a.m.–10:00 p.m. EST, Monday–Friday, excluding federal holidays
Health Net Federal Services Contract Close Out
The Health Net Federal Services (HNFS) contract with the VA ended on September 30, 2018. Providers with questions about claims submitted to HNFS prior to September 30, 2018 can contact HNFS directly.
For more information, please review the Frequently Asked Questions and the HNFS Provider newsletter below.HNFS Contract Ending – Provider FAQs HNFS Provider Newsletter
HNFS Stopped Accepting Medical Documentation on January 1, 2019
Health Net Financial Services, LLC (HNFS) stopped accepting faxed medical records effective January 1, 2019; their medical documentation fax line was deactivated. From that point forward, community providers are to send medical records to the referring VA Medical Center (VAMC). For more information, view the Medical Documentation Update on the HNFS website or call the HNFS Provider Service Line.
HNFS Provider Service Line: 844-728-1914
open October 1, 2018–June 30, 2020
- 10 Things to Know About Choice
Describes important elements of the Veterans Choice Program.
- Fact Sheet: Billing for Community Providers
Describes billing processes for PC3, VCP, VCP Provider Agreements, and Traditional Community Care.
- Fact Sheet: Vendor Inquiry System (VIS)
Describes a website that allows community providers to research the status of community care claims received by VA.