 Community providers can now contact VA’s new Emergency Care Centralized Notification Center to ensure proper care coordination, eligibility determination and payment authorization information, as applicable.
72 Hour Notification
It is vital that VA be notified about emergency treatment within 72 hours. If VA is notified of the emergent event within 72 hours, in most instances, Veterans are eligible to receive VA-authorized emergency care in an emergency department that is part of VA’s contracted network. These networks are managed by Optum Public Sector Solutions, Inc., part of the UnitedHealth Group, Inc., (Optum) and TriWest Healthcare Alliance (TriWest).
However, if VA is not notified within 72 hours, it may delay or prevent VA from authorizing the emergency care, and thus prevent payments from being made through VA’s contracted network third-party administrators, Optum and TriWest.
How to Notify VA
To notify VA about emergency care being provided to a Veteran, community providers, can now contact VA’s Emergency Care Centralized Notification Center. Contacting this center simplifies access to VA for care coordination, eligibility determination and payment authorization information. It also facilitates communication, documentation and collaboration.
Contact the Emergency Care Centralized Notification Center by e-mail or phone:
Providing Case-Specific Information
The person notifying VA should be prepared to supply the following case-specific information detailed in VA Form 10-10143g, Non-VA Hospital Emergency Notification, available online here https://www.va.gov/vaforms/medical/pdf/10-10143g_Non-VA_Hospital_Emergency_Notification_Fill.pdf.
Case-specific details are necessary for care coordination and eligibility determination. If the person notifying VA is unable to supply all the necessary information, VA will contact the appropriate parties to collect the information.
For each emergent episode of care, treating community providers will receive authorization decision information and, if applicable, directions on how to submit claims through the appropriate third-party administrator.
More Information
Visit our Emergency Care page for more information.
The following guidance replaces the prior 60-day extension language communicated via #5 “Episodes of Care extended by 60 days” in the updated April 1, 2020, Veterans Health Administration (VHA) Office of Community Care (OCC) Letter to Community Providers.
All community care referrals in HealthShare Referral Manager (HSRM), except for those in a cancelled or Episode of Care (EoC) complete status that have an expiration date between March 1, 2020, to July 31, 2020, will be extended to September 30, 2020, except for the following episodes of care:
- Emergency Care
- Unauthorized Emergency Care
- Inpatient
- Transportation
- Adult Day Health Care
- Homemaker-Home Health Aide
- In-Home Respite Care
This change will allow adequate time to complete all services associated with each episode of care.
For additional frequently asked questions, please reference our COVID-19 guidance for community providers at https://www.va.gov/COMMUNITYCARE/providers/Latest_news.asp.
If you have any questions, please email us at ProviderComms@va.gov.
Thank you for your continued support of our mission.
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Whether or not community care is authorized is an important distinction for community providers to understand when providing care to Veterans on behalf of VA. It is important because it affects whether or not VA can pay for the care and who claims should be submitted to for payment consideration. Regardless if care is authorized or not, care coordination between community providers and VA is critical for all Veterans to achieve high quality, timely care.
Generally, only care that is officially authorized by VA can be reimbursed. However, in some limited cases unauthorized emergency medical care may be reimbursable.
Authorized care usually refers to medical or dental care that was approved and arranged by VA, including the following types of care:
- General community care
- Home, health and hospice care
- Care at a state Veterans home
- *Emergency care
*Emergency care can be authorized by VA in certain circumstances when the VA is notified within 72 hours. If the emergency care isn’t eligible for authorization, it may be eligible for consideration as unauthorized care for payment purposes.
Unauthorized care is care that has not been authorized by VA. With the exception of Urgent Care, which does not require authorization, all other unauthorized care is not payable by VA.
To learn more, visit the newly-revised File a Claim for Veteran Care and Emergency Medical Care – Information for Providers webpages for more information.
Our partnerships with our community providers are invaluable, and you help to make sure we continue to provide the healthcare and services our Veterans need.
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VA requires the submission of all community care medical documentation to VA, which is critical for ensuring proper care coordination for Veterans.
Medical documentation should be sent to the local VA medical facility that is coordinating care as soon as possible after care has been provided.* There are several methods by which community providers may electronically provide VA with the required medical documentation for care coordination purposes:
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Join the Veterans Health Information Exchange (VHIE) which enables bi-directional sharing of Veteran Health Information.
*Per contract, CCN community providers have 30 days to submit medical documentation.
**Note: Community providers can securely reply to VA-initiated emails. Other software may need to be installed, and licenses may be required for recipients to send unsolicited emails to VA. For questions on Azure RMS, please contact VHARMSTeam@va.gov.
Resources
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