Community Care Update: COVID-19 Testing and Treatment Reimbursement

Veterans Health Administration sent this bulletin at 01/21/2021 11:57 AM EST

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A Message from the Veterans Health Administration Office of Community Care

Update: COVID-19 Testing and Treatment Reimbursement

Hunter Holmes MC Image

The Department of Veterans Affairs (VA) continues to rely on community providers to ensure eligible Veterans have access to COVID-19 antigen testing and services through as many avenues as possible, whether through VA health care centers or through our community health care partners.

Eligible Veterans who meet criteria provided by the Centers for Disease Control and Prevention (CDC) and local public health department guidelines can receive COVID-19 antigen testing and services from community providers, paid for by VA. Consistent with guidance VA released on July 10, 2020, VA reimburses community providers for COVID-19 antigen testing and services provided to eligible Veterans at one of the following outlets:

  • In-network Urgent Care/Retail locations, if it is in conjunction with a clinical visit for care
  • In-network Community Care Network providers, if a referral or authorization exists
  • Emergency Departments, if the visit otherwise meets criteria for VA coverage of emergency care services (either through the PC3 or CCN networks or care that is paid for directly by VA)

Eligible Veterans do not pay a VA copayment for COVID-19 testing or services.

Reimbursement 

To expedite COVID-19 testing and services for Veterans early in the pandemic, when coverage in VA was limited, VA decided in 2020 to temporarily reimburse all COVID-19 testing, urgent and emergent care claims for eligible Veterans, including claims made without a VA referral. This means that COVID-19 testing and services with dates of service prior to January 1, 2021 that were not authorized (do not have a VA referral) can be submitted to VA for payment.

However, now that coverage is more widely available, claims for reimbursement for COVID-19 testing and services on and after January 1, 2021 must be approved via VA referral or meet urgent or emergent care eligibility requirements in order to receive payment.

If you are filing a claim for authorized COVID-19 testing and services, please ensure the claim meets all requirements, including timely filing, and is submitted to the appropriate payer (i.e. Third Party Administrator or VA).

For more information about how to properly file a claim, visit our File a Claim for Veteran Care webpage.

Questions? Please call VA Customer Service 877-881-7618 or contact us at ProviderComms@va.gov.