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 one of VA’s third party administrators (TPA), currently Health Net Federal (Health Net) or TriWest Healthcare Alliance (TriWest). The 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
If you meet the eligibility requirements, contact the appropriate TPA using the information listed below. The map shows which third party administrators (TPA) to contact depending on your location. Complete the process to establish a contract or provider agreement with the appropriate TPA, which will allow you to care for Veterans through VCP.
Health Net Federal Services Contract Ending: The VA contract with Health Net Federal Services (HNFS) is ending and will expire on September 30, 2018. When the contract with HNFS ends, VA will take over all activity previously performed by HNFS. VA will work with Veterans, community providers, and VA staff to transition care coordination from HNFS to a local VA medical facility as seamlessly as possible. The end of the VA-HNFS contract does not affect the VA contract with TriWest Healthcare Alliance. For more information, please review the provider frequently asked questions.HNFS Contract Ending – Provider FAQs
- 10 Things to Know About Choice
Describes important elements of the Veterans Choice Program.
- How to Become a VCP/PC3 Community Care Provider
Describes how a community provider can participate in the VCP/PC3 programs.
- Fact Sheet: Billing for VA Community Care Programs
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.
- Fact Sheet: Health Net and TriWest Complaint Process
Explains the process for filing a grievance with Health Net and TriWest, third party administrators that work with VA to administer VCP.