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Community Care

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.

Step 1

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 select option 2.

What if my referral goes to Community Care?

Contact Community Care to see if your referral is approved and opt in.

Contact the Community Care Office at select option 6, then option 5 and follow the prompts. You can also contact the Community Care Office by using secure messaging in myhealth.va.gov. 

Community Care Office will:

  1. Assist you in choosing a network preferred community provider.
  2. Send your referral and medical documentation.
  3. Send you a scheduling letter in the mail with instructions on how to schedule your appointment with the community provider.

    OR
  4. Schedule your appointment for you.

Step 2

You are responsible to:

  1. Watch the mail for the authorization letter. This letter will contain important information about your approved authorization.
  2. Schedule your appointment with the community provider if you choose to self-schedule.
  3. Notify the Community Care Office of the appointment by calling select option 6, then option 3 or use My HealtheVet.

What do I do once I obtain my authorization letter?

Keep the letter for your records and take it to your first appointment. You are responsible for:

  1. Attending your appointments within the dates of authorization.
  2. Ensuring your community provider submits a Request For Services (RFS) form to VA if additional services are needed 60 days before 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 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.

Step 3

What is the fastest way to contact the VA medical teams?

Create an account online at www.myhealth.va.gov. 

Or you can call the My HealtheVet help desk at .

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.

Step 4

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 ension 17224.

How to prevent billing challenges:

  1. 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 select option 6.
  2. 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?

Access the TriWest Website, sign up and then see all your authorizations.

My community provider wants me to continue care services in the community. What do I do?

Ask your community provider to send a fax for continued services to the Cheyenne VA Community Care office at: .

I went to the Emergency Room in the community, who do I call to report so I don’t get a bill?

Call 844-724-7842 within 72 hours of going to the Emergency Room.

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.

  1. 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.
  2. 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.
  3. 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.

  1. They can call the 877 number above and follow the prompts to the Claims Dept.
  2. They can email ProviderServices@triwest.com
  3. They can contact PGBA (Palmetto Government Benefits Administrators) who pay the claims. Contact information is in their Provider Handbook.
  4. They can check the status of their claims using their provider portal account with TriWest.
  5. They can use their provider portal to send an email to TriWest Claims Dept. to obtain a status.
  6. They can contact the state Provider Relations Representative who can check on the status of their claims.

Important Information

Patient Advocate:

or Secure Messaging

Local VAMC Pharmacy: 

option 1

TriWest

Optum

 

Urgent Care:

To verify your eligibility for VA urgent care, call 800- MyVA411 ) and select option 1, then option 3. To locate in-network urgent care providers and pharmacies, visit www.va.gov/find-locations . For more information, visit: www.va.gov/communitycare/programs/veterans/urgent_care.asp

Emergency Care:

VA must be notified within 72 hours of your hospital visit, at 844-72HRVHA ). For more information, visit: www.va.gov/communitycare/programs/veterans/emergency_care.asp

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