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 EDI. However, beginning early 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 Electronic Data Interchange (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. Once converted to an EDI transaction, claims and 275 Attachments will be submitted to VA using the normal EDI process through the Change Healthcare clearinghouse.
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.