Paper to Electronic Claims - Community Care
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Paper to Electronic Claims

Submission Process for Veteran Community Care Claims

VA is transitioning paper claims for community care to an electronic format in order to improve the claims submission and processing capabilities. VA is currently sending paper claims from community providers to a centralized location for scanning and conversion to Electronic Data Interchange (EDI). However, beginning in what is currently scheduled for mid-to-late 2019, community providers who submit paper claims and supporting documentation should mail them to a single location, VA’s centralized claims intake site, where they will be scanned, converted to EDI transactions, and submitted to VA electronically. This address will be shared when the initiative launches nationally.

PLEASE NOTE: VA first encourages providers to submit claims electronically through VA’s clearinghouse, Change Healthcare, when possible. (To begin doing so, please see the number below.) Additionally, to make electronic claims submission easier and more convenient, starting in what is currently scheduled for mid-to-late 2019, VA will be adding a new capability for providers to send electronic unsolicited attachments (275) with electronic claims.

Change Healthcare: 888-545-6127

Avoiding Paper Claims Rejections

To increase efficiency and accuracy in claims processing, the paper submission intake system will automatically scan for noncompliant form fields based on national standards. The scan may increase claim rejections at first as national standards are applied and errors are automatically identified. However, it will reduce processing time for claims overall since fewer corrections to noncomplaint fields will be needed during claims processing. Providers who submit noncompliant claims will receive a letter from VA that includes the rejection code and reason for any claims rejected.

The following are a few of the most common reasons for claim rejections:

  • The most common reason any paper claim form is rejected is the “Insured ID” field, which is also the patient’s social security number, in box 1a of the CMS‑1500 (HCFA‑1500) form and box 60 of the CMS‑1450 (UB‑04) form, must total exactly nine numeric digits. A combination of numbers and letters, or an incomplete entry, will result in rejection of the claim.
  • CMS-1450 (UB-04) claim submissions must include the “Patient Control Number” in box 3a as this is a required field.
  • If box 11d in the CMS-1500 (HCFA-1500) claim form indicates there is other health insurance, then boxes 9, 9a, and 9d must be populated as this is a required field.

For additional questions related to the new paper claims submission process