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VHA Office of Community Care

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Provider Toolkit

Connect With Us  |  How to Become a Provider  |  Claims  |  Training 
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VA Community Care Provider Toolkit
Community providers play a key role in ensuring Veterans have access to care. VA welcomes the opportunity to work with community providers to improve the health and well-being of our nation’s Veterans. We want to combine the best of VA’s health care system with the best in industry to meet Veterans’ needs. The purpose of this toolkit is to connect community providers with information and resources they need to successfully collaborate with VA. View the toolkit at the link below.
Claims Filing Instructions
This fact sheet is a tool to help community providers deliver care through the Veterans Choice Program (VCP), VCP Provider Agreements, Patient-Centered Community Care (PC3), or traditional VA Community Care to submit claims and get paid faster. VA is working with Congress to further simplify and streamline the process. Until we get there, we will continue to provide tools like this fact sheet to help community providers and Veterans navigate VA Community Care. View the Billing Fact Sheet for VA Community Care Programs for more details.
VA announces Community Care Call Center to help Veterans with Choice Program billing issues
Veterans can now work directly with the Department of Veterans Affairs (VA) to resolve debt collection issues resulting from inappropriate or delayed Choice Program billing. A Community Care Call Center has been set up for Veterans experiencing adverse credit reporting or debt collection resulting from inappropriately billed Choice Program claims. Veterans experiencing these problems can call 1-877-881-7618 (9 a.m. to 5 p.m. Eastern Standard Time) for assistance. View Fact Sheet 20-08: VA Community Care — Choice Program Billing Issues for more details.
How to become a PC3/Choice Provider
Join our network! Providers interested in participating in the community care network must establish a contract with one of the Patient-Centered Community Care (PC3)/Choice contractors, Health Net Federal Services or TriWest Healthcare Alliance. View our resources on how to become a PC3/Choice provider below.

Connect With Us

Our contact information contains the addresses and phone numbers for the various VHA Office of Community Care health care benefit programs. For PC3/Choice providers with concerns, please first contact Health Net and TriWest directly.

Providers may send questions and feedback to HACProviderFeedback@va.gov

Need help? Online Chat

For information on authorization/claims paid by VA, contact your local VA Office. If you need assistance in determining your local office, or for immediate general information, use the Online Chat function. Click on the Online Chat image (left) to open a live chat session with a VA Health Resource Center customer service representative during normal business hours – 8 a.m. to 8 p.m., EST, Monday through Friday – or you can use the chat to send them a message.

Provide your email and stay up to date with Non-VA Medical Care Program information.

Stay up to date with the VA community care program by subscribing to our email distribution list. At least once per month, helpful information is provided to those on our Community Provider Listserv about doing business with the VA. Click the email image link (left) and include the words “SUBSCRIBE COMMUNITYPROVIDERS-L” along with your name in the body of the email.

You can also visit the VA Public ListServ for more information about electronic newsletters, discussion groups and direct e-mail lists.

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How to Become a Provider

Developing, Submitting and Checking Claims Status

For the PC3/Choice programs administered by VA contractors (Health Net and TriWest), claims are submitted to and paid by the contactors. You can find specific instructions and contact information on their websites:

For programs that file claims directly with VA, instructions and helpful information are listed below:

  • Fact Sheet 20-07: Overview of ICD-10
    VA has adopted the industry standard to use valid ICD-10 codes for all diagnoses and for inpatient procedures. For additional information and training, view the list of fact sheets and training available below.

  • How to File a Claim–Instructions for Providers
    Details about the information and documentation needed when filing paper claims, including helpful claim-filing hints. You will also find information for CHAMPVA claims filing and authorization requirements.

  • Electronic Claims Information
    Contains information about ICD-10, VHA Office of Community Care's National Provider Identifier (NPI) requirements, electronic pharmacy claims and how to register and/or submit an EDI claim to your local VA health care facility.

  • Claims Payment Information
    Instructions for customers who would like to apply for payment via Electronic Funds Transfer (EFT), information on file changes and updates for current EFT vendors as well as requirements for electronic payments for non-VA community providers.

  • Rejected Claims–Explanation of Codes
    A list of the top 10 reasons claims are rejected/denied along with additional explanations for the rejections and what a beneficiary/provider needs to do to get the claim processed correctly.

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Frequently Used Forms

Frequently used forms for VACC programs as well as VA Form 10091, FSC Vendor File Request Form, which is used to apply for payment or to submit changes/updates for Electronic Funds Transfer can be found at Forms.

Publications

Manuals and Guides

Fact Sheets

The fact sheets listed below provide specific information that providers and office managers need to know in order to participate in CBOPC programs. You can view fact sheets for all of our VACC Veteran and Beneficiary programs on our Fact Sheets page.

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Training Modules and Presentations

In the News

View VHA CC News articles and VA Press Releases with information and helpful advice about or relating to VHA Office of Community Care programs, or read and comment on stories posted by VA employees on VAntage Point, the official VA blog.

Prevent Fraud, Waste and Abuse

View Program Integrity for information and training on fraud, waste and abuse prevention.