 VA will deny all non-emergent claims and transactions submitted without an authorization/referral number. Providers must include the VA authorization/referral number on all EDI and paper claim submissions to VA for pre-approved services.
 Healthcare providers who render VA referred/authorized 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 or Prior Authorization, Loop = 2300, Segment = REF*G1, Position = REF02
Home Health Agencies
- If you are a Home Health Agency billing with an OASIS Treatment number, you will continue to place the Treatment Authorization Code (TAC) in field 63a on a UB-04 and the VA referral/authorization number in field 63b
- For EDI 837I (Institutional Health Care Claim), use the Prior Authorization segment for the TAC and the Referral Number segment for the VA referral/authorization number
NOTE: If you are billing for emergent services that have not been authorized, please do not populate information in any of these fields. Populating incorrect/inaccurate information will cause delays in processing.
 Please ensure your billing staff populate the VA authorization/referral number correctly when they submit claims for authorized services provided to Veterans.
Authorization/referral formats can vary based upon the authorizing entity and system being used. The following three formats are acceptable:
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Format: XXX-YYYYYY-ZZ
Example: 402-123456-12
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Format: XXX-PC-YYYYYYY
Example: 402-PC-1234567
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Format: VAYYYYYYYYYY
Example: VA1234567890
Community providers treating Veterans under one of VA’s third-party administrators (TPA) must submit their claims directly to the authorizing TPA for processing in accordance with TPA requirements.
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