Community Care
VA Fargo provides care to Veterans through community providers in our catchment area 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. Community care must be first authorized by VA before a Veteran can receive care from a community provider.
Making Informed Decisions
Veterans Health Administration (VHA) is focused on putting Veterans at the center of their care. To make informed decisions, VA Fargo will discuss each individual Veteran's eligible care modalities at the VA (face-to-face (F2F), VA Video Connect (VVC), E-Consult, Telehealth, CRH) or with a participating VA community care provider. Veterans are in control of where, when and how they receive their care.
Many times, these discussions reveal that a community appointment may actually take longer than a VA Fargo appointment.
Additionally, Veterans many times choose to get their care at the VA instead of in the community as a way to ensure continuity of care. In the agreement between VA and participating community care providers, the provider is required to send medical documentation and imaging back to VA Fargo. Community care staff receive this documentation and upload it into your VA records. Unfortunately, there can be delays in Fargo VA receiving your documentation which can be troublesome when the documentation or imaging is required for your next visit with your VA provider.
Understanding the VA Community Care Process
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Consult Creation and Review
- A consult is a request from your Fargo VA doctor to refer you for medical and/or behavioral care from a VA community provider. When your Fargo VA provider recommends you seek additional care, they create the consult and Fargo VA staff review it for accuracy.
- Once your provider submits a referral, Fargo VA Specialty Care team reviews the referral and looks at your care options.
- The Specialty Care team will then call you to discuss all your care options and capture your provider preferences.
- You choose where, when, and how you want to receive care.
- Options include: face to face or virtual
- If the specialty care team does not reach you by telephone, they will send you text messages, letters, or secure messages from the downloadable MyHealtheVet app on your phone.
- You choose where, when, and how you want to receive care.
DO NOT SCHEDULE AN APPOINTMENT UNTIL VA CONTACTS YOU WITH THE APPROVED CONSULT INFORMATION
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Scheduling
- Once Fargo VA has contacted you with the approved consult information, we will contact you to schedule your appointment.
SCHEDULING WARNING:
If VA Fargo cannot reach you within 14-BUSINESS DAYS, your consult will be DISCONTINUED and you will have to request a new one from your referring Fargo VA Provider (Not the Community Care Department).
Click here or below for an example VA Fargo community care scheduling attempted contact letter.
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Authorization
- After your appointment is scheduled, your authorization is created.
An authorization is IMPORTANT because it is an approval from Fargo VA for you to receive care from a community provider.
- You will receive a letter in the mail with:
- Your authorization number
- The in-network community provider you are approved to visit
- A description of the care you are approved to receive.
- The time period you are authorized to receive care
Bring the authorization letter with you to your appointment with the community provider
Retro-authorizations are NOT allowed according to 38 U.S.C. 1703(a)(3), which states: A covered Veteran may only receive care or services under this section upon the authorization of such care or services. To clarify, this means the care must be Pre-authorized.
Pay Attention to Authorization Date Expirations: If, for some reason, you had to reschedule your appointment with your community care provider you must NOT reschedule outside the authorization date range.
Call VA Fargo Community Care Customer Service 1-866-517-9363. VA Fargo must update the approved date range on your authorization.
Click here or below for an example VA Fargo Community Care Authorization Letter.
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Community Care Visit
At the scheduled day and time, you will attend your community care appointment. The Fargo VA will send any relevant medical records to your community provider. However, if instructed by the community provider, you may need to bring copies of diagnostic imaging (CT or MRI) with you.
You are responsible for your VA copayment amount, as applicable, whether you receive care in VA or the community. You will be billed for this Separately by VA.
DO NOT pay a copayment to a community care provider.
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Scheduling Additional Appointments
If your provider recommends a follow-up, you must ensure that your authorization approves the additional appointments. If not authorized, you should contact your provider to determine your next steps.
If you are authorized for ongoing care from a participating VA community provider, you may schedule recurring appointments directly with their office.
However,
Keep track of how many appointments you attend and when they are authorized. The Fargo VA will not cover services beyond what is described in your authorization.
DO NOT schedule care past the expiration date listed on your community care authorization.
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Reauthorization
If you require care beyond the limits of your authorization, you will need to be reauthorized.
You or your community provider may submit a new referral request to Fargo VA. Fargo VA will review the referral request and, if appropriate, issue a new authorization for this care. However, in some circumstances, Fargo VA may determine that you should return to VA to receive this care.
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Prescription and Durable Medical Equipment (DME) Pick-Up
Prescriptions:
To find an in-network pharmacy, use the VA Facility Locator Tool and select Facility Type: Community pharmacies.
You may fill a prescription for 14-day (or fewer) supply written by your community provider at:
- A VA medical facility pharmacy
- A participating in-network pharmacy with no out-of-pocket payment at the pharmacy
- An out-of-network pharmacy, but you must pay at the pharmacy and submit a reimbursement claim at Fargo VA.
For prescriptions that exceed the 14-day supply limit or are not urgently needed, the community provider must send the prescription to the local VAMC pharmacy to be filled.
Durable Medical Equipment (DME):
If your provider identifies an immediate need for DME, orthotics or prosthetic items, the provider may provide the DME to you and submit a bill to the Third Party Administrator (TPA).
For questions about durable medical equipment (DME), contact the Fargo Prosthetic and Sensory Aids Service at:
vhafarProsthetics@va.gov
701-237-3900 Ext. 3039
For routine DME, orthotics and prosthetic items you must return to Fargo VA for a consult at the Prosthetics and Sensory Aids Service (PSAS) unit.
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Receiving and Paying your Bill
Depending on your disability rating and private insurance (including Medicare and Medicaid), you may receive a bill from Fargo VA for services you received. If you owe a copay, send payment to VA at the address on your bill. You should never pay a community provider directly.
To inquire about your bill, please call the Community Care Claims/Payment Customer Service: 1-877-881-7618
Understanding Urgent and Emergency Care
Urgent Care
For Veterans
If you are registered with the VA and have seen your primary care provider within the last 24 months, you are eligible for VAs urgent care benefit. You can visit an in-network urgent care clinic to treat minor injuries and illnesses that are not life-threatening. If you are an eligible Veteran, you DO NOT need a VA referral or prior authorization to visit an in-network urgent care location.
- Verify Your Eligibility: Call 844-MyVA411
) | Select option 1 | and then option 3 to verify your eligibility for urgent care services, or for general question related to the urgent care benefit. - Locate an in-network urgent care and pharmacy location via the VA Facility Locator
- You must visit an in-network pharmacy location in the same state as your urgent care visit to avoid any issues filling your urgent care prescription.
- Bring a valid, government-issued photo ID to the in-network urgent care location / pharmacy. Ask and verify the urgent care provider / pharmacy is in VA network.
- Call
for assistance if you have difficulty receiving urgent care or filing your urgent care prescription. - DO NOT pay a copayment at the time of urgent care visit.
To verify your eligibility for VA urgent care, call 844-MyVA311
Click here to Find VA In-Network Urgent Care Facility Locations
For Providers
- Call
to confirm the Veteran's eligibility for urgent care services. - Ensure 14-day Rx is on VA Urgent/Emergent Formulary (https://www.pbm.va.gov/nationalformulary.asp) if prescribing an urgent care prescription.
- Make sure you have activated the Veteran's pharmacy benefit by calling to check their eligibility.
- DO NOT charge a copayment to the Veteran
- File an urgent care claim within 180 days with Optum.
- After the visit, submit medical documentation to Fargo VA medical center (VAMC) within 30 calendar days of the date of service.
For more detailed information on filing Veteran urgent care claims go to: https://www.va.gov/COMMUNITYCARE/revenue-ops/Veteran-Care-Claims.asp
For Pharmacists
- The maximum day supply for a Veteran's initial fill is 14 days (7 days or fewer for opioids). No Refills.
- Medication must be on the VA Urgent/Emergent Formulary
- DO NOT Charge the Veteran a copayment for dispensed medications
- Instruct the Veteran to fill prescription(s) in the same state as their urgent care visit
- Enter VA pharmacy claims using the following information:
- Step 1: Enter BIN: 004336
- Step 2: Enter PCN: ADV
- Step 3: Enter Rx Group: RX4136
- Step 4: Enter Veterans 9-digit SSN or 10-digit Veterans ID number
- Step 5: Enter Veteran's date of birth (YYMMDD format)
- If a non-contracted pharmacy is used, the Veteran must pay out-of-pocket
Emergency Care
If you are seen by a community emergency department, Fargo VA Must Be Notified Within 72 Hours of Your Hospital Visit by you, your representative, or your provider.
72-Hour VA Notification is Extremely Important
Contact options are listed below:
844-72HRVHA (844-724-7842)
Community Care Network (Third-party Administrator)
Our VA community care network helps us offer Veterans quality health care outside VA, in the local community. VA Fargo is in Region 2 under Optum Serve.
Optum Serve Information
Veteran Contact Information
Optum VA Community Care Veteran Portal
877-881-7618
Monday–Friday, 8 a.m. – 9 p.m., ET
• Select option 1
Provider Contact Information
Optum VA Community Care Provider Portal
888-901-7407
Monday–Friday, 7 a.m. – 7 p.m. local time
More Information
Travel Costs
Fargo VA HCS Beneficiary Travel Customer Service
Monday through Friday
VA Fargo health care
Phone: 1-800-410-9723 ext. 3429
Email: VHAFARBENETRAVEL@va.gov
Travel Costs
Veterans may be eligible for travel cost reimbursement through VAs beneficiary travel program, which provides Veteran reimbursement for travel costs to the closest provider. Veterans can contact Fargo VA Medical Center to learn about this benefit.
Contact Us
To contact VA Fargo's Community Care customer service line, please call 701-239-3700 ext. 3411.
Contact your Fargo VA referring provider or the Fargo VA community care office for the following services. You can also call the IVC National Contact Center.
- General Billing and Copayment Questions
- Eligibility and Consults
- Scheduling, Referrals and Authorizations: You must have a VA referral for community care before receiving care. Without a VA referral, you may be responsible for the full cost of care.
- Reauthorization (Additional Care)
You can also call the IVC National Contact Center at:
Office of Integrated Veteran Care (IVC)
National Contact Center
877-881-7618
Monday–Friday, 8 a.m.–9 p.m. ET
• Option 1 for Veterans
• Option 2 for Providers
Fargo VA HCS Community Care Call Center
1000-1600 (CST) Monday through Friday
VA Fargo health care
Phone: 701-239-3700 Ext. 3411