NF/SGVHS 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.
Customer Service:
Hours of Operation: Monday-Friday 8:30 a.m. – 4:00 p.m.
*Closed on Federal Holidays & for required trainings.
NF/SGVHS Community Care Eligibility
Mission Act/COMPACT Act Eligibility
VA’s goal is to deliver community care through a single consolidated program that is easy to understand, simple to administer, and meets the needs of Veterans, their Families, Community Providers and VA Staff-right time, at the right place, from the right provider.
For more information regarding Mission Act Eligibility, click HERE.
The VA COMPACT Act provides eligible veterans with free emergency mental health and suicide care at VA and non-VA facilities, covering inpatient and outpatient services, transportation, and follow-up care.
For more information regarding COMPACT ACT Eligibility, click HERE.
Understanding the NF/SGVHS Community Care Scheduling Process
The Community Care Scheduling process allows Veterans to take charge of their own health care by scheduling their community appointments to fit their own schedule.
1. Consult Referral Creation and Review
A consult referral is a request from a VA Provider that refers a Veteran for specialty, medical, and/or mental health services.
Most consults are entered directly to our VA specialist for clinical review. Once the clinician approves, a VA staff member will reach out to the Veteran to review their scheduling preferences. At that time, the VA staff will assess the Veteran's community care eligibility.
If the Veteran is interested in Community Care, our team is here to support them. Once the Veterans request is submitted, their VA specialist team will discuss all available care options. This includes:
- VA appointment availability
- Department of Defense (DOD) eligibility
- Community Care eligibility
In‑network community providers
Scheduling preferences with your preferred community provider
In-Network Provider Locator Tool
If the Veteran has chosen to go through the community, their consult will be sent to Community Care for processing.
2. Scheduling and Authorization
After the Veterans consult is accepted by the Community Care team, the referral will be sent to the preferred in-network provider (or the closest specialist to the Veterans residential address on file). The Veteran will then be provided with a letter informing them to schedule directly with the Community Provider.
The Veteran is asked to provide the details of the appointment so a final authorization can be sent to the Community Provider. The Veteran can provide the appointment details and/or any scheduling difficulties by responding to the VEText message/automated call, by calling into the Community Care customer service line, or utilizing the Appointment Information link listed below.
3. Community Care Visit
The Veteran may be requested to fill out paperwork and provide additional information at their appointment.
Once the Veteran is seen, their Community Provider is requested to send clinical documentation back to the VA within 30 days for care coordination needs.
If additional services or continued care is needed past the end date on the authorization, the provider is required to send in supporting clinical documentation and complete the Request for Service paperwork for review.
What to Expect: Automated Calls and Texts About Your Community Care
The Veteran will receive automated calls and VEText messages advising and requesting information for the following:
- Automated call informing the Veteran that their Community Care consult has been approved, and a letter will be mailed.
- Automated call/VEText message asking if the Veteran has scheduled their Community Care appointment.
- Automated call/VEText message asking the Veteran if they have attended their scheduled Community Care appointment.
Timely response to these automated messages will decrease repeated calls and texts, allowing VA Community Care staff to finalize the Veterans authorization to the Community Provider.
Urgent Care vs. Emergency Care
Urgent Care
Urgent care consists of medical services provided for minor illnesses or injuries that are not life-threatening such as strep throat, pink eye, or influenza.
For more information regarding Urgent Care visits, select the link below:
Getting urgent care at VA or in-network community providers | Veterans Affairs
Emergency Care
Emergency care is inpatient or outpatient hospital services that are necessary to prevent death or serious impairment of health such as severe chest pain; seizures or loss of awareness; heavy uncontrollable bleeding; or moderate to severe burns.
For more information regarding Emergency Care visits, select the link below:
Getting emergency care at non-VA facilities | Veterans Affairs
Veterans Crisis Line
Please remember you can always call the Veterans Crisis Line (Dial 988 then press 1)
For more information regarding the Veterans Crisis Line, select the link below:
NF/SGVHS Community Care - OPTUM Billing Procedures and Contact Information
Pre-Authorized Services for NF/SGVHS Community Care
For any claims or billing concerns regarding a VA Community Care authorization, contact OPTUM at the below phone number or click HERE.
Phone:
Unauthorized Services in the Community
If the Veteran was not authorized to receive care in the community and received a bill, they may send all information for review for options regarding possible reimbursement.
Please click HERE for more information.