Issue 2 VHA Office of Community Care Monthly Provider Updates

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u s department of veterans affairs - veterans health administration - office of community care

VHA Office of Community Care
Monthly Provider Updates


VA to Cease Current Community Care Overpayment Recovery Audit

Audit Recovery

VA is committed to maintaining a strong relationship with community providers, who are critical to ensuring Veterans receive timely, high-quality care, while also ensuring proper stewardship of public funds.

 As required by federal law, in 2016 VA awarded a contract to perform an audit of community care payments to identify potential overpayments and recover funds. The audit, much like recovery audit contracts with Medicare or commercial insurances, is a review of claims and supporting medical documentation. VA subsequently became aware that certain claims were not being processed in accordance with VA’s payment regulations, resulting in overpayments; these claims were included in the recovery audit contract. Through the recovery audit contract, the VA recouped approximately $36M in overpayments for fiscal years 2013 and 2014, the majority of which was returned to VA Medical Centers to support Veteran care.  

VA takes our relationships with community providers very seriously and, after listening to concerns raised by providers and evaluating VA’s internal processes and federal financial requirements, VA has decided that the current audit will cease. As a result, VA is temporarily suspending debt collections for Community Care payments through a third-party auditor while we pursue additional approaches that will take into account individual community provider circumstances and alternative payment options while also ensuring proper stewardship of public funds.


VHA Provider Monthly Webinars – November Offerings

provider webinar

November 15, 2018VHA Office of Community Care Overview, provides an overview of Community Care programs and policies, focuses on how to file clean claims, and goes into other topics such as eligibility, referral, top rejection reasons and other provider issues.  Register for the webinar.

November 29, 2018:  Understanding the Context of Military Culture in Treating Veterans, describes how military culture affects veterans seeking healthy, how help-seeking Veterans are affected by healthcare providers who are not familiar with military culture and much more.  Registration is available for VA employess  via  VA’s Talent Management System (TMS) ID 37063  and VHA TrainingFinder Real-time Affiliate Integrated Network (TRAIN) for non-VA attendees, a direct link to be posted soon .  Both VA TMS and VHA TRAIN require attendees to have accounts prior to registering for the webinar.

HealthShare Referral Manager

hsrm 2

HealthShare Referral Manager (HSRM) is a commercial off-the-shelf solution that VA has selected to accelerate and better manage community care referrals and authorizations. HSRM streamlines referral and authorization management, and improves information-sharing between VA and community providers. These improvements allow more timely access to care for Veterans and greater coordination between community providers and VA.

To review the key benefits community providers will see with the use of HealthShare Referral Manager read this HealthShare Referral Manager Information Sheet. 

Checking Claim Status with the VA Vendor Inquiry System (VIS) and Referral/Authorization Number Requirement on Claims Update


Did you know VA offers 24/7 online access to claim status and VA Treasury payment information via the Vendor Inquiry System (VIS)? VIS is a web application that allows community providers and registered vendors to research the status of claims received by VA. Visit VA FSC VIS to find specialized training, create and account and access claim status information.  

VA will now require a referral/authorization number to be submitted on all EDI and paper claim submissions that are pre-approved. The compliance date for this is Janaury 2019, so please begin adjusting processes and systems now. This additional claim data will enable faster claims processing for authorized care. For paper claims, include this information in field 23 on an HCFA 1500, or field 63 on a UB-04. For EDI 837, Referral Number is Loop = 2300, Segment = REF*9F, Position = FEF02, or Prior Authorization, Loop = 2300, Segment = REF*G1, Position = REF02.

New Paper Claims Submission Process Coming in 2019


As mentioned in the September edition of the Community Provider Monthly Updates Newsletter, the VHA Office of Community Care (OCC) is implementing a new initiative to transition Veteran paper claims to an electronic format. This initiative consolidates the receipt location of eligible paper claim submissions to a central location, where they are converted to an electronic format known as Electronic Data Interchange (EDI) transactions for processing.

During the current transition phase, providers should continue to submit claims using the normal process. However, beginning in what is currently scheduled for early-to-mid 2019, community providers will begin mailing paper claims submissions for Veterans directly to the new location, the address of which will be shared upon national release.

The new intake system automatically scans claims for compliance based on national standards, which should reduce the need to correct non-compliant form fields throughout claims processing. Community providers should be aware, however, that this scan may cause an increase in rejections at the beginning of claims processing.

While this new mailing and scanning process improves timeliness for paper claims, we continue to encourage providers and their billing services to file EDI claims directly through VHA’s EDI clearinghouse, Change Healthcare, when possible. Community providers can work with Change Healthcare to submit electronic claims to VA by contacting 888-545-6127.

Both EDI submissions and a new, single mailing location for paper claims scanning and EDI conversion are important solutions for reducing the community care claims backlog and provide timely and accurate payments to community health care providers.

For more information about the transition from paper to electronic claims, please visit the “Paper to Electronic Claims” page on the VHA Office of Community Care website. Here you will find general guidance on the new paper claims submission process as well as details about how to prevent the most common paper claims rejections.  Click here to view a list of the most common claims rejections. 

Please continue to check this and other communications for more information such as the new address as it becomes available in the coming months. Finally, if you have questions or comments related to the transition from paper to electronic claims initiative, please email

National Provider Identifier (NPI) Required for all Providers


The Department of Veterans Affairs (VA) requires the use of the National Provider Identifier (NPI) for all providers conducting business with VA including all inbound medical, dental and pharmacy transactions. All Health Insurance Portability and Accountability Act (HIPAA)-covered health care providers who electronically bill for services to VA programs, or submit other electronic transactions through VA’s clearinghouse, need an NPI.

Providers apply for cost-free NPIs in one of three ways:

  1. Online through the National Plan and Provider Enumeration Systems (NPPES) at
  2. Through any Electronic File Interchange Organization (EFIO); arrange an agreement allowing the EFIO to submit application data on behalf of the provider.  For more information visit:  
  3. Download and complete a copy of the paper NIP Application/Updates Form (CMS-10114) at Mail completed, signed forms to the NPI Enumerator. 

                         Mailing Address:     

                         NPI Enumerator  
                         P.O. Box 6059 
                         Fargo, ND 58108-6059 

Additional information about NPIs can be found at the Centers for Medicare & Medicaid Services website at

Questions or comments may be sent to

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