Attention A T users. To access the menus on this page please perform the following steps. 1. Please switch auto forms mode to off. 2. Hit enter to expand a main menu option (Health, Benefits, etc). 3. To enter and activate the submenu links, hit the down arrow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links.

VHA Office of Community Care

Menu
Menu

Quick Links

Veterans Crisis Line Badge
My healthevet badge
EBenefits Badge
 

Electronic Claims–Information for Providers

ICD-10  |  National Provider Identifier  |  Electronic Pharmacy Claims
Electronic Data Interchange  |  Claims Payment  |  Real-Time Communications 

ICD-10

The U.S. Department of Health and Human Services has confirmed in a final rule that October 1, 2015, will be the deadline for the implementation of the International Classification of Diseases, 10th Revision (ICD-10). The final rule requires the use of ICD-9 through September 30, 2015. Visit the Centers for Medicare & Medicaid Services (CMS) industry resources for the ICD-10 transition for information about ICD-10.

How to Prepare for the ICD-10 Transition

In an effort to keep community providers engaged during the transition to the new ICD-10 code sets, the Department of Veterans Affairs is actively seeking providers, facilities and clearinghouses to participate in ongoing ICD-10 discussion forums and end-to-end testing. Feedback received during the discussion forums will be integrated into end-to-end testing scenarios to ensure that on October 1, 2015, our ICD-10 remediated systems and processes successfully administer the new code sets and provide expected claim outcomes to our customers and Veterans. Information on how to participate in the discussion forums and end-to-end testing will be posted on this website.

ICD-10 went live on OCT. 1, 2015. Information regarding ICD-10 training, resources and much more can be found in Provider Resources.

National Provider Identifier (NPI)

The Veteans Health Administration Office of Community Care (OCC) requires the use of the NPI on all inbound medical, dental and pharmacy transactions. If you are a HIPAA-covered health care provider who electronically bills for services to VA programs, or submits other electronic transactions through our clearinghouse, you need an NPI. NPIs that should be sent include, but are not limited to, rendering, referring, and prescribing NPIs.

More information on the use of NPIs can be found on the CMS NPI page of the CMS website. 

Electronic Pharmacy Claims

The National Council for Prescription Drug Programs' Telecommunications Standards utilizes Version D.0, along with Medicaid Subrogation, Version 3.0, as of January 1, 2012. For information regarding changes to electronic pharmacy claim standards, please visit D.0 Resources on the Centers for Medicare & Medicaid Services (CMS) website.

Please visit our Pharmacy Benefits for detailed pharmacy benefit information for the dependent care programs administered by OCC: CHAMPVA, Spina Bifida and Children of Women Vietnam Veterans.

Electronic Data Interchange (EDI)

The VHA Office of Community Care accepts HIPAA-compliant 837 EDI health care claims through our clearinghouse, Change Healthcare (formerly Emdeon Inc.).

For all compliant EDI claims sent to us through Change Healthcare, we can provide an 835 remittance advice (ERA). Providers must complete an enrollment form at Emdeon to receive OCC 835s. The form can be found at http://www.emdeon.com/enrollment. Please note: You should enroll with Change Healthcare to receive both regular network ERAs as well as ERAs created from claims that are received from Medicare crossover through the Coordination of Benefits Contractor (COBC).

An 835 remittance advice is not provided for paper claims submitted to OCC. At this time, we will continue to send a paper explanation of benefits (EOB) for all paper and EDI claims processed.

To change or cancel enrollment, contact Change Healthcare directly at 1‑800-845-6592 or visit the Change Healthcare Contacts on their website.

If you are not connected to Change Healthcare, contact your EDI clearinghouse and have our payer IDs added to their software system. If you are interested in submitting claims through Change Healthcare, you can contact them at 1‑800‑845‑6592 or visit the Change Healthcare Contacts.

EDI Claims for Dependent Care Programs

The OCC Change Healthcare (formerly Emdeon Inc.) payer ID number for dependent care claims is 84146 for medical claims/ERA and 84147 for dental claims/ERA.

You must submit non-pharmacy claims and other EDI transactions through Change Healthcare for dependent care programs administered by OCC: CHAMPVA, Spina Bifida and Children of Women Vietnam Veterans. Please remember that for all dependent care programs administered by OCC, our beneficiary/your patient is always the subscriber. To ensure an accurate response to your claim or inquiry, please submit the patient's first and last name as it appears on the OCC program identification card, their member ID (SSN) and their date of birth for all transactions.

EDI Claims for Non-VA Medical Care

To register and/or submit an EDI claim for non-VA medical care to your local VA health care facility, please use the following payer IDs: 12115 for  medical claims/ERA, 12116 for dental claims/ERA, and VAFEE for an eligibility inquiry transaction.

Claims Payment Information

For information on claims payment or if you would like details about payment via Electronic Funds Transfer, please visit Claims Payment Information.

View our Rejected Claims for a list of the top 10 reasons claims are rejected/denied along with additional explanations for the rejection codes and what a beneficiary/provider needs to do to get the claim processed correctly.

Real-time Communications for Dependent Care Programs

For dependent care programs, the VHA Office of Community Care provides real-time information through Emdeon for eligibility, benefits and claim verification. Our real-time payer ID at Emdeon is VAHAC.

  • Health Care Claims Status (277–Health Care Claim Status Response)
  • Health Care Services Review (278–Response to an EDI Health Care Services Request for Review)
  • Eligibility Status (271–Health Care Eligibility Benefit Response).
    We can respond with an acknowledgment that tells the requester if the patient is unknown or has active coverage for our programs. For patients with active coverage, our response would include:
    • The dates of the most recent coverage
    • Response to Service Type Code “30” or Explicit Service Type Inquiries
    • Patient Responsibility for Individual and Family including deducible amounts, co-insurance amounts, and catastrophic cap amounts

Provider Resources

Our Provider Resources contain more information and tools regarding how to conduct business with the VHA Office of Community Care and the programs it administers.