Veterans Choice Program–Information for Providers - Community Care
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Veterans Choice Program–Information for Providers

VA will no longer offer community care to Veterans under the Veterans Choice Program (VCP). As a result, VCP eligibility criteria will no longer be used to determine eligibility for community care beyond that date. To prepare for the end of VCP, VA began transitioning its authorizations for care away from VCP to ensure Veterans do not experience a lapse in care after June 6, 2019.

Fact Sheet: Sunset of Choice Program

Providing Community Care

Community providers caring for Veterans through VCP may continue to provide Veteran care if both the following criteria are met:

  • The provider participates in the VA’s contracted network, Patient-Centered Community Care (PC3), administered by TriWest Healthcare Alliance, a Third Party Administrator (TPA) under contract with VA, AND
  • The Veteran continues to be eligible for and authorized to receive community care under the new Veteran community care.

Community providers that currently have a VCP Provider Agreement in place with a VA medical facility will no longer be able to provide care to Veterans through these agreements after June 6, 2019. However, if a community provider wishes to continue to provide care to Veterans, they have the option to:

  • Establish a new Veterans Care Agreement (VCA) with their local VA medical facility, OR
  • Join an existing VA community care network assigned to their region: PC3 or Community Care Network (CCN), as applicable. Network regions may be managed by TriWest Healthcare Alliance or Optum Public Sector Solutions, Inc., as applicable.

For more information on existing networks, visit Community Care Network.

Claims and Payments for Care Provided Under VCP

Although VCP ends on June 6, 2019, there are no changes to how claims are submitted for payment. Community providers are strongly encouraged to submit claims electronically using electronic data interchange (EDI).

For billing questions, please review the Billing Fact Sheet for Community Providers.

For specific questions regarding claims, please contact the claims processing unit that adjudicated your claim. This information can be found on your claim. A claims processing associate will be able to provide clear guidance on the steps you need to correct your claims.

To check the status of a claim, please visit Check Claim Status.

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 FAQsHNFS 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

Contacts

To find the nearest VA medical facility, use the VA Facility Locator.

VA Facility Locator

TriWest Healthcare Alliance

855-722-2838
Monday-Friday, 8:00 a.m–10:00 p.m. EST
excluding federal holidays

providerservices@triwest.com