|
|
Education & Training
Veteran Spotlight
Podcasts
|
|
 |
VA relies on timely and complete clinical documentation submission from community providers to ensure the care we provide our Veterans accounts for all aspects of their care. When you submit it to us, the documentation is placed in the Veteran’s electronic health record.
Providing VA with the Veteran’s clinical documentation allows us to maintain a holistic clinical picture of the Veteran, coordinate and improve quality of care, and facilitate claims processing and payment, resulting in better care coordination.
What to Include
Documentation should be legible and include the following:
-
Veteran’s unique identifier, full name, date of birth
-
Referral number
- Provider authentication (including typed name and phone number)
- Facility name (where applicable)
Additionally, include the following, depending on condition(s) being treated:
-
Encounter notes, including procedures performed and recommendations for additional testing/follow-up
-
Clinical summary for ancillary services, when appropriate (e.g., PT/OT, speech and language pathology, and nutrition)
-
Testing or imaging results (images must be provided to VA upon request)
-
Results of testing/imaging/studies/procedures that impact recommended follow up (e.g., biopsy results from provider recommending surgery)
-
Recommended prescriptions, medical devices, supplies/equipment, and treatment plans
-
Other documentation, based on clinical need
How to Provide to VA
Provide it to the referring VA medical center or provider via approved secure electronic transmission where available, preferably via HealthShare Referral Manager (HSRM). Learn about HSRM.
When to Submit
Generally, medical documentation should be provided within 30 days of an initial appointment or after completion of a standardized episode of care. The following table provides specifics:
|
DOCUMENT TYPE
|
SUBMISSION TIME
|
|
Outpatient – Initial
|
Within 30 days of initial appointment
|
|
Outpatient – Final
|
Within 30 days after completion of standardized episode of care (SEOC)
|
|
Inpatient
|
Within 30 days (consisting of discharge summary)
|
|
Urgent Care*
*See - Care Coordination
|
When complete, but within 30 days
|
|
Emergent care*
*See - Supporting Documentation
|
When complete, but within 30 days
|
|
Documentation requested by VA
for urgent follow up
|
|
|
|
Although some Veterans are eligible for health care through both VA and the Department of Defense TRICARE program, you can only submit a claim to VA or TRICARE for payment, not to both.
If you send a claim to both VA and TRICARE for the same services, it can lead to double payments, and it may appear that the provider is intentionally collecting double payments. This can result in recoupment actions, administrative fees, penalties and fines and potential suspension of a community provider from providing care to Veterans through VA or TRICARE.
Claims for routine care
When sending routine claims to VA or TRICARE, remember the following:
-
Submit claims to only one agency.
-
If VA referred, submit only to VA.
-
If TRICARE referred, submit only to TRICARE.
-
Veterans using their VA benefit must have a VA referral for provider payment.
-
If unsure, ask the Veteran if they would like to use VA or TRICARE.
-
Providers must obtain the appropriate referral and bill the correct agency for payment.
Claims for emergency care
If you provided emergency care, a referral is not required, but please remember the following:
-
Ask the Veteran to choose VA or TRICARE for billing purposes (if they are eligible for both).
-
If the Veteran is not able to respond, you must contact VA within 72 hours using https://EmergencyCareReporting.CommunityCare.va.gov, or by calling 844-72HR-VHA (844-724-7842) to authorize the care provided. This hotline is available 24 hours a day.
-
If VA authorizes the care, you should bill VA.
-
Be sure to contact the Veteran’s local VA facility to coordinate follow-on care.
- If the Veteran chooses to use TRICARE, you should bill TRICARE.
Decision Tree for VA /Tricare Dual-Eligible Veterans
For providers who are part of the VA’s Community Care Network (CCN), please refer to the third party administrator as noted on the authorization – Optum Serve or TriWest Healthcare Alliance when filing a claim.
Did you know? When you provide care to Veterans that is unrelated to their service-connected (SC) disability or Special Authority (SA) care, VA is legally required to bill their Third Party Payer (TPP), such as their health insurance company, for the care. As a result, some types of care require precertification.
For community providers, this means you must submit a precertification request to VA via the HealthShare Referral Manager (HSRM) portal, before providing care that requires precertification.
Types of Services Requiring Precertification
To identify services that require VA precertification, refer to the referral packet which contains a form called Offline Referrals/Billing and Other Referral Information. You can refer to the View your Billing and Other Referral Information section to see if the Standardized Episode of Care (SEOC) in your VA referral has codes that require precertification.
Notifying VA with a Precertification Request
Submit a precertification request to VHA Revenue Operations via the HealthShare Referral Manager (HSRM) portal, before performing care that requires precertification.
Submission can be done using the task called "Provider Precert Notification.” Instructions on how to submit precertification requests in HSRM and information on what types of SEOC services may require precertification are available in the HSRM Community Provider User Guide, starting on page 33.
Once you have notified VHA Revenue Operations that the test/procedure/admission requiring TPP precertification is scheduled, you don’t need to wait for approval or response prior to performing the test/procedure/admission included as part of the SEOC referral.
If you have questions about using HSRM to submit precertification requests, please contact ccra@va.gov.
Learn more about Precertification
Additional Resources for community providers
|
|
|
With flu season upon us, we’re encouraging Veterans to get their flu shot. Flu shots are available at facilities now at no cost for eligible Veterans. Calling ahead is advised to ensure a Veteran can receive the flu shot.
Flu shots will be available through April 30, 2023, at all VA medical centers or one of 70,000 Community Care Network (CCN) retail pharmacies or urgent care locations.
Veterans should be advised to call ahead to confirm the facility they plan to visit has flu shots available. Eligible Veterans are those who have used VA health care services within the last 24 months. Please remind Veterans it’s safe to get a COVID vaccine during their flu shot appointment.
If you are part of VA’s Community Care Network and want to provide a flu shot for an eligible Veteran, visit our Flu Vaccine Billing Information Page for instructions and billing information.
|
Webinar: Opioid Safety Initiative (Available 24/7)
Learn about VA’s Opioid Safety Initiative, designed to improve the quality of life for Veterans suffering chronic pain, help decrease opioid prescribing practices associated with adverse outcomes and promote safer opioid-related prescribing for Veterans.
|
How to obtain your credit certificate:
Once you complete a credited training, you can obtain your credential certificate(s) in four easy steps:
-
Log in to VHA Train - https://vha.train.org/vha/login
- Go to “Your Learning”
- Go to “Your Certificates”
- Download your certificate
|
|
Alex Haley – U.S. Coast Guard Veteran, Journalist, Author
Before becoming an award-winning journalist and author, Alex Haley served in the U.S. Coast Guard for 20 years, including during World War II. Haley is probably best remembered for writing the epic story, “Roots: The Saga of an American Family,” for which he earned a Pulitzer Prize Special Award in 1977. The book was made into a landmark television miniseries watched by an estimated 100+ million people. His journalism career included serving as senior editor for Reader’s Digest magazine.
Learn more about Alex Haley’s impressive military and professional writing career.
|
VA is highlighting 250 Veterans leading up to July 4, 2026, which marks 250 years of independence. Learn more about the count down to 250 years of the American spirit at america250.org. |
|
 |
Below are podcast episodes released by the VA Podcast Network. You can find any of these podcasts on Spotify, Apple Podcasts, Google Podcasts, iHeartRADIO, or any other podcast app.
PTSD Bytes
"PTSD Bytes" is a weekly podcast hosted by clinical psychologist Pearl McGee-Vincent from the VA National Center for PTSD featuring an expert or innovator about how technology can support people with PTSD or other mental health concerns. Join us for “bite-sized” pieces of practical information you can use or share.
LEARN MORE
Host Pearl McGee-Vincent discusses Cognitive Behavior Therapy for Insomnia with Elissa McCarthy, a clinical psychologist at the National Center for PTSD at the White River Junction VA Medical Center in Vermont.
Host Pearl McGee-Vincent discusses mindfulness with Dr. Timothy J. Avery, a clinical psychologist and readjustment counselor at the Peninsula Vet Center in Menlo Park, Calif.
|
IN OTHER NEWS
VA Leads America in Long COVID Care and Research
VA has diagnosed more than 620,000 Veterans with COVID-19, and between 4% and 7% of this group may have developed Long COVID symptoms.
The Centers for Disease Control and Prevention (CDC) defines Long COVID as long-term health problems following infection with the virus that causes COVID-19.
The condition can be debilitating for patients. That’s why VA is focused on research and personalized program care for the illness through the Whole Health initiative.
To date, VA has equipped 22 facilities with Long COVID clinics to provide in-person and virtual care. They also deliver multidisciplinary treatment.
RESOURCES
|
|
|
|
|
