Provider Payments - Community Care
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Provider Payments

icon paymentsOnce you file a claim for care provided to a Veteran or Veteran family member, VA adjudicates the claim and provides an electronic payment. VA is required to pay all medical and dental claims from providers electronically.

For claims submitted to one of VA’s Third Party Administrators (TPAs), such as TriWest Healthcare Alliance, for care provided through the Veterans Choice Program (VCP) or Patient-Centered Community Care (PC3) networks, you will receive a payment from the same TPA. For claims submitted for care provided through a Veterans Care Agreement, you will receive a payment directly from VA.
Please note: VCP ended on June 6, 2019.

If you have specific questions regarding your claims, please contact the claims processing unit that adjudicated your claim. This information can be found on your claim and they will be able to provide clear guidance on the steps you need to correct your claims.

For information on how to check the status of a claim, please visit Check Claim Status.

Electronic Payments

The U.S. Department of Treasury published a final rule on Electronic Funds Transfer (31 C.F.R. 208) that requires all federal payments be made electronically. This requirement includes payments made to community medical and dental providers. Community care providers must enroll for Electronic Funds Transfer (EFT) in order to to meet this requirement. With EFT, payments are deposited directly into a bank account.

To apply for payment via EFT, complete the "Payee/Vendor Information" and "EFT/ACH" sections of the VA-FSC Vendor File Request Form, Form VA 10091. Fax the signed, completed form to the VA Financial Services Center (FSC), Vendor Support Section.

You will also need to contact your financial institution to arrange for the delivery of the CORE-required Minimum CCD+ Data Elements necessary for successful reassociation of the EFT payment with the ERA remittance advice.

Updates and Changes to EFT Information

If you are already receiving EFT payments from the federal government through another program such as Medicare, Medicaid, or Tricare, you can update your EFT information on file to receive payment from VA.

Complete VA Form 10091, VA-FSC Vendor File Request Form, and be sure to check the box marked "Update." Fax the completed, signed form to the FSC, Vendor Support Section.

VA Financial Services Center

Main: 512-460-5049

FSC, Vendor Support Section

Email: vafsccshd@va.gov

Phone: 877-353-9791

Fax: 512-460-5221

For questions regarding enrollment or updates to EFT information on file, please contact the VA-FSC, Vendor Support Section at the phone or email listed above.

Financial Service Center Nationwide Vendor File
Fax: 512-460-5221

VA Recovery Audits Return Overpayments to Support Veteran Programs

The Department of Veterans Affairs (VA) will conduct claim recovery audits to fulfill Payment Integrity Information Act of 2019 requirements to review payments made to community providers during Fiscal Years 2018–2023.

VA awarded the recovery audit contract to Cotiviti GOV Services (Cotiviti). VA’s Debt Management Center (DMC) will assist with the management of the associated collection activities.

Reviews will vary between fiscal year and health benefits programs, and will cover VA claims paid to community providers for inpatient and outpatient services as well as claims for the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) and the Spina Bifida Health Care Benefits Program.

Exclusions

The audits exclude claims paid to beneficiaries, claims where VA was a secondary payer and pharmacy, bowel and bladder and dental claims. Since the Community Care Network (CCN) contracts include their own requirements for recovery/recapture audits, CCN claims are excluded from the scope of this contract.

The issuing of Notices of Indebtedness (NOIs) to community providers associated with the recovery audit findings is anticipated to begin in March 2022.

The contract is at no cost to VA; Cotiviti will be paid a percentage of the recovered funds. A portion of the recovered funds will be returned to the authorizing VA Medical Centers (VAMCs) but must be used for the original purpose and fiscal year in which it was originally obligated.

Customer Service

VA has applied lessons learned from prior recovery audits to create a more transparent and provider-friendly audit process. The Cotiviti Provider Services number is 855-287-1667, available Monday–Friday, 9 a.m.–8 p.m. ET.

Reconsiderations and payment plans

The recovery audit contract allows providers to request reconsideration of findings, as well as alternative repayment options (e.g., compromise or payment plans). VA has retained the final authority on all provider appeals. If a significant number of findings are reversed on appeal, Cotiviti is required to submit a corrective action plan to mitigate any further issues. VA will conduct quarterly reviews to validate the accuracy of the audit findings.

Public comments

Before the start of each new audit, Cotiviti will post a preliminary audit plan to their public-facing website for 30 calendar days for public review and comment. VA and Cotiviti will review comments and make appropriate adjustments before the plan is finalized. The final audit plans will be posted to Cotiviti’s public website before each audit begins.

Additional Resources

Cotiviti Provider Services: 855-287-1667
Monday–Friday, 9 a.m.8 p.m. ET

Cotiviti public website: https://www.cotiviti.com/varac

Recovery Audit Authority: Payment Integrity Information Act of 2019

Frequently Asked Questions

What types of improper payments will be identified?

Claim reimbursement rates, reimbursement of non-covered or unauthorized services, incorrectly coded services, and duplicate services.

Who can I contact if the RAC identifies a payment previously collected?

A provider receiving an overpayment Notice of Indebtedness (NOI) previously collected or reimbursed should contact Cotiviti Provider Services at 855-287-1667, 9 a.m.8 p.m. ET, Monday–Friday. Providers must provide evidence of the previous collection.

How long do I have to respond to Cotiviti once notified of an overpayment?

Submit supporting documentation or information within 30 business days of notification.

Will I receive a bill for each overpayment?

To reduce the administrative burden on providers, each audit will group overpayments by provider tax ID number (TIN) and issue one notice of indebtedness (NOI) per TIN, per audit. The NOI may include multiple overpayments in an itemized list.

How will I know what payments are being reviewed?

Cotiviti will post the OCC-approved preliminary audit plan on the Cotiviti public website for no less than 30 days for public review and comment. After the comment period, Cotiviti and OCC will review and address comments as appropriate. The final audit plan will be posted to the Provider Portal before Cotiviti begins any audit.

Cotiviti public website

Where do I send payments?

Your Notice of Indebtedness (NOI) and Notice of Rights and Responsibilities (NRR) will include all information on how and where to remit repayment. Call Cotiviti Provider Services at 855-287-1667 between the hours of 9:00 a.m.–8:00 p.m. ET, Monday–Friday, with questions.