VA provides care to Veterans through community providers when VA cannot provide the care needed. Community care is based on specific eligibility requirements, availability of VA care, and the needs and circumstances of individual Veterans.
Your provider has entered your referral, now what?
The specialty care service will review your referral to determine if the service is available in the VA or if it needs to be deferred to the community.
What happens if my referral is kept in VA?
- If the VA offers the requested services, expect a call from a VA staff member within 3 business days.
- After one unsuccessful telephone contact attempt, you will receive a letter in the mail to help you schedule your appointment.
- Your referral may be canceled after 14 days of unsuccessful contact.
- Please have your voicemail turned on and do not block calls from the VA. Read the letters the VA sends to you. If you have questions, please call us at 307-778-7550, select option 6.
What if my referral goes to Community Care?
- Expect a call from the Community Care Office after 3 business days. If you do not receive a call, please contact the Community Care Office at 307-778-7550, select option 6 and follow the prompts.
- You can also contact the Community Care Office by sending a secure message on MyHealtheVet
Community Care Office will:
- Assist you in choosing a network preferred community provider.
- Send your referral and medical documentation.
- Send you a scheduling letter in the mail with instructions on how to schedule your appointment with the community provider.
You are responsible for:
- Scheduling your appointment with the community provider.
- Notifying the Community Care Office of the appointment by calling 307-778-7550, select option 6.
- Watching the mail for the authorization letter. This letter will contain the number of authorized visits, approved services, the specialist's contact information, and the approved timeframe for treatment.
What do I do once I obtain my authorization letter?
Keep this letter for your records and take it to your first appointment. You are responsible for:
- Attending your appointments within the dates of authorization.
- Contacting your referring provider if additional services are needed after the authorization expiration date.
How can my VA provider review my community records?
- Ask the community provider to fax the results of your visit to 307-778-7360 to be added to your electronic health record for your provider to review.
- You can obtain the community records and bring them to the VA to be loaded into your medical chart.
What is the fastest way to contact the VA medical teams?
- Create an account online with MyHealtheVet.
- Or you can call the My HealtheVet help desk at 877-327-0022.
What should I do if I receive a bill for care that has been authorized?
- If you disagree with the balance on your bill, call the phone number listed on the bill to ensure the community provider has a copy of your referral authorization and correct sponsor/ guarantor information. If they have your referral authorization correct, but are still unable to resolve the issue, call the Community Care Office for assistance.
Other Important Referral Information
- Seeking care from a community provider without a valid authorization can result in significant out of pocket costs to you. Please make sure you have the proper authorization before seeking community non-emergent care.
- Understand appointment types may vary. Many providers may conduct appointments by telephone, telehealth (virtual), record reviews, or in-person.
- If you are eligible for beneficiary travel, please contact the travel office for the requirements of reimbursement for VA and community appointments by calling 307-778-7550 extension 7224.
- The Beneficiary Travel Department requires verification that you have completed your Community Care appointment in order to process your travel claim. Please have the treating facility/physician complete the Verification of Community Care Appointment form.
How to prevent billing challenges:
- Never go to a community provider without an authorization or go outside of your authorization dates. If you need an authorization number or service dates, consider calling 307-778-7550, select option 6.
- If you go to the Emergency Room in the community, call 844-724-7842 within 72 hours.
What To Do if Contacted by a Provider for Bills/Payment
If you have a bill or questions about a claims payment
Contact the VA C4 (Community Care Contact Center) - Includes U.S. Pacific Territories.
C4 Phone: 877-881-7618.
Hours of Operation: 5:45 a.m. to 6:15 p.m.
If you are contacted by a community provider regarding a bill or unpaid claim
Refer the community provider to the TriWest Claims Call Center at 877-226-8749 (This phone line is only for TriWest Network Providers).
The TriWest Claims Call Center will assist providers with how to submit claims, claims status updates, and claims denials.
If you have adverse credit reporting and debt collection issues as a result of using community care
Contact the VA Adverse Credit Helpline at 877-881-7618.
Community Care Frequently Asked Questions
How do I track my authorizations?
My community provider wants me to continue care services in the community. What do I do?
I went to the Emergency Room in the community, who do I call to report so I don’t get a bill?
Do Veterans need to provide their insurance information to a community provider?
No. If they have an authorization from the VA for the care, their insurance has no influence on their care. They should take a copy of their authorization letter with them to the appointment and present it if the office asks for insurance information.
When a Veteran is billed by a community provider for services authorized and service dates by the VHA, where should the Veteran turn to?
Veterans have multiple options.
- They can call 877-226-8479 which is the TriWest customer line and follow the prompts to speak with a Customer Service Rep who will take their information and forward it to our Claims office to follow-up with the provider.
- They can report the bill to the local Community Care Office at the VAMC who will refer the case to TriWest who will educate the provider as to how to handle these issues without billing the veteran.
- They can report the issue to the Patient Advocate at the VAMC who will forward the information to the Community Care Office.
When a community provider is struggling with getting their claim paid, who should they call?
Community Providers have multiple options.
- They can call the 877 number above and follow the prompts to the Claims Dept.
- They can email ProviderServices@triwest.com
- They can contact PGBA (Palmetto Government Benefits Administrators) who pay the claims. Contact information is in their Provider Handbook.
- They can check the status of their claims using their provider portal account with TriWest.
- They can use their provider portal to send an email to TriWest Claims Dept. to obtain a status.
- They can contact the state Provider Relations Representative who can check on the status of their claims.