Community Provider Action Needed – VA Authorization/Referral Number Required!

Providers must report the VA authorization/referral number on all EDI and paper claim submissions to VA that are for pre-approved services.  Beginning October 1, 2019, VA will deny all non-emergent claims and transactions submitted without an authorization/referral number.  Community providers treating Veterans under one of VA’s third party administrators (TPA) must submit their claims directly to the authorizing TPA and in accordance with TPA requirements.

Healthcare providers who render VA referred care to Veterans must obtain and supply the VA authorization/referral number for that care on all invoices for the referred episode of care. 

• For paper claims, include this information in field 23 on a HCFA or field 63 on a UB-04.
• For EDI 837, Referral Number is Loop = 2300, Segment = REF*9F, Position = REF02
• Prior Authorization, Loop = 2300, Segment = REF*G1, Position = REF02.  

If you are a Home Health Agency billing with an OASIS Treatment number, you will continue to place the TAC in field 63a on a UB-04 and the VA referral/authorization number in field 63b.  For EDI 837I, use the Prior Authorization segment for the TAC and the Referral Number segment for the VA referral/authorization number.

Please ensure your billing staff populates the VA authorization/referral number correctly when they submit claims for non-emergent services provided to Veterans. 

For questions contact ProviderComms@va.gov

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