Provider Resources & Reference Library
Welcome to the Community Care Provider Reference Library! Here you will find key information and links to other information to make it easier for you to do business with VA.
Fact sheets, program guides and forms located throughout the Community Care provider website are housed on this page and cross linked with the topic.
Please click on the image above to sign up for the newsletter.
On This Page:
- Support Resources
- Fact Sheets for Veteran Care
- Fact Sheets for Family Member Care
- Forms & Guides
- Contacts and Locator Links
Support Resources
There are a number of resources readily available to Veterans listed below. We encourage you to share them with the Veterans and their beneficiaries that you serve.
VA Resources
- Veterans Crisis Line: If you are having thoughts of suicide, the Veterans Crisis Line can help even if you’re not enrolled in VA benefits or health care. Free, 24/7, confidential support is a click away.
800-273-8255, then PRESS 1
or Text 838255
- Find a VA location: for emergency mental health care, you can go directly to your local VA medical center 24/7 regardless of your discharge status or enrollment in other VA health care.
- Vet Centers: Discuss how you feel with other Veterans in these community-based counseling centers. 70% of Vet Center staff are Veterans.
- VA Mental Health Services Guide: This guide will help you sign up and access mental health services.
- MakeTheConnection.net: Information, resources and Veteran to Veteran videos for challenging life events and experiences with mental health issues.
- Center for Minority Veterans: Serves as an advocate for minority Veterans by conducting outreach activities to promote the awareness and use of VA benefits and services.
- VA Self-Help Apps: Download tools to help deal with common reactions like stress, sadness and anxiety. You can also track your symptoms over time.
- VA Women Veterans Call Center: Health care and benefits services, and programs for women Veterans
- VA Caregiver Support Line: A toll-free number for caregivers, family members, friends, Veterans, and community partners to contact for information related to caregiving and available supports and services.
Find a VA medical center or Vet Center location
Vet Center Call Center:
877-WAR-VETS (927-8387)
VA Mental Health Services Guide
VA Women Veterans Call Center:
Call/Text 855-829-6636 (M-F 8am–10pm & SAT 8am–6:30pm ET)
VA Caregiver Support Line:
855-260-3274 (M-F 8am–10pm & SAT 8am–5pm ET)
Other Resources
American Red Cross Military Veteran Caregiver Network: Connect online, find mentoring and join a peer support group.
Elizabeth Dole Foundation Hidden Heroes: Sign up on the National Caregiver Registry for access to local events and resources.
George W. Bush Institute Veteran Wellness Alliance: Connecting veterans with the support and services they need.
- Call: (630) 522-4904
- Email: checkin@veteranwellnessalliance.org
Student Veterans of America: Use our directory to find an SVA Chapter on a campus near you.
Team Red, White & Blue: Find a chapter for local and virtual opportunities for Veterans and the community to connect through physical and social activity.
Team Rubicon: Serves communities by mobilizing veterans to continue their service, leveraging their skills and experience to help people affected by disaster.
Together We Served: A secure platform for all Veterans to engage with other Veterans. Find your battle buddies. Honor military service.
Tragedy Assistance Program for Survivors (TAPS): Compassionate care to all those grieving the death of a military loved one. Programs include seminars, youth events, peer mentors, an online community and more.
VA News: Four-part series–How Afghanistan Veterans can get help through VA.
VAntage Point blog: Official blog of the U.S. Department of Veterans Affairs. Find stories from around VA and the Veteran community.
VetResources newsletter: A weekly newsletter for Veterans, their families, caregivers and survivors.
Fact Sheets for Veteran Care Programs
The fact sheets listed below provide specific information that may help providers and office staff who have questions about participating in Community Care Network programs.
Fact Sheets for Family Member Care Programs
| Program | Fact Sheet Title | Associated Page |
|---|---|---|
| CHAMPVA | CHAMPVA–Information for Outpatient Providers and Office Managers | File a Claim for Family Member Care |
Forms & Guides
Specific forms are used to request information or provide information as requested. Guides give more detailed information that may be needed to sign up for a program or use a specific tool.
| Item Title / Description | Associated Page / Website |
|---|---|
| Fillable PDF Forms | |
| Community Care Provider Request for Service (RFS),VA Form 10-10172 | Request and Coordinate Care–Request for Service (RFS) Requirements |
| FMP Claim Cover Sheet, VA Form 10-7959f-2 | Other Types of Care–FMP |
| HSRM End User Tracker Template (Excel download) | Request and Coordinate Care–HSRM |
| P2E Documentation Cover Sheet, VA Form 10-10143f | File a Veteran Claim–Supporting Documentation |
| Refusal of Transfer to VA Health Care Facility, VA Form 10-8001
VA Form 10-8001 is used when a Veteran refuses to transfer to a VA Health Care Facility. |
Emergency Medical Care–Information for Providers |
| Third Party Payer Precertification Form | Precertification Requirements |
| VA-FSC Vendor File Request Form, VA Form 10091
VA Form 10091 enables all vendors to apply for payment via Electronic Funds Transfer (EFT), or to submit changes/updates to their Financial Management System Vendor Record in order to receive VA payments that comply with the 1996 Debt Collection Improvement Act. For questions regarding VA Form 10091, please contact the Nationwide Vendor File Division via email or phone listed below. 877-353-9791 |
Provider Payments Claims Status |
| Veterans Care Agreement Form, VA Form 10-10171 | Veteran Care Agreements |
| Print-Only Forms | |
| Medical Billing Claim Form, UB-04 (CMS‑1450) Institutional Paper Claim Form
The CMS-1450 form can be used by an institutional provider to bill a Medicare fiscal intermediary when a provider qualifies for a waiver from the Administrative Simplification Compliance Act requirement for electronic submission of claims. It is also used for billing of institutional charges to most Medicaid State Agencies. PLEASE NOTE: You can download a sample CMS-1450 from the Centers for Medicare & Medicaid Services (CMS) website. However, copies of the form should not be downloaded for submission of claims, since they may not accurately replicate colors included in the form. These colors are needed to enable automated reading of information on the form. |
CMS-1450 on CMS.gov |
| Health Insurance Claim Form (CMS-1500)
The CMS-1500 Claim Form is the basic paper claim form prescribed by many health care payers for claims submitted by physicians, other providers, and suppliers, and in some cases, for ambulance services. |
CMS 1500 on CMS.gov |
Guides
| Item Title / Description | Associated Page / Website |
|---|---|
| Guides | |
| Dialysis Provider Portal User Guide | Claims Status |
| HIPAA Transaction Standard Companion Guide (275 TR3) | File a Veteran Care Claim |
| HSRM Account Creation Information Sheet | Request and Coordinate Care–HSRM |
| HSRM Community Provider Quick Reference Guide | |
| HSRM Community Provider User Guide | |
| IHS/THP Provider Guide | IHS/THP RA Program–Information for Providers |
| VA Manual | |
| VHA Directive 1108.08, VHA Formulary Management Process | DME Requirements / Pharmacy Requirements |
Contact Lists and Locator Links
The following contact lists, customer call center phone numbers and locator links are valuable tools for providers when looking for additional information or answers to questions.
| Item Type | Contact Information |
|---|---|
| Contact Lists | Office of Integrated Veteran Care Support page |
| Facility Contact Numbers for Care Coordination | |
| Customer Service Call Centers |
VA Claims: 877-881-7618 |
| Region 1, Optum Claims: 888-901-7407 | |
| Region 2, Optum Claims: 844-839-6108 | |
| Region 3, Optum Claims: 888-901-6613 | |
| Regions 4 and 5, TriWest Claims: 877-226-8749 | |
| Locator Links | VA Facility Locator |
| CVS Caremark Pharmacy Locator | |
| Third Party Administrator (TPA) websites | Optum–CCN Regions 1, 2, and 3 |
| TriWest Health Care Alliance–CCN Regions 4 and 5 |
