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Recovery audits beginning for Veteran, beneficiary community care claims

VA is beginning recovery audits for community care claims submitted for Veteran and beneficiary care.

The audits, which cover claims submitted from 2024 – 2029, are required by and support the Payment Integrity Information Act of 2019. As part of the audit process, providers may hear from Cotiviti or Machinify, who are performing the reviews on behalf of VA.

What to expect

• Audits will focus on claims for inpatient, outpatient, and skilled nursing facility.
• Claims paid to beneficiaries, secondary payer pharmacy claims, and bowel and bladder claims are excluded.
• The VA Financial Services Center will oversee any validated overpayment collections.
• Providers may request reconsideration of findings or explore repayment options.

Providers can reach Cotiviti at 855‑287‑1667 (Monday-Friday, 9 a.m. – 8 p.m. ET). Machinify contact details will be shared once available.

Updated guidance for decision reviews, appeals for VA family member programs

VA has updated its guidance for providers who disagree with decisions related to care delivered under the following family member programs:

• Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
• Spina Bifida Health Care Benefits Program
• Children of Women Vietnam Veterans Health Care Benefits Program
• Camp Lejeune Family Member Program

If your claim is denied or you disagree with VA’s decision, you may submit new evidence through a supplemental claim, request a higher-level review, or file an appeal to the Board of Veterans’ Appeals. You may use only one option at a time.

The updated guidance clarifies what information and supporting documentation is needed to submit a review or file an appeal, which helps avoid processing delays.

Providing complete information the first time helps minimize administrative delays and supports timely payment resolution.

Speed up Veteran scheduling with EPS’ secure, digital scheduling integration

VA’s External Provider Scheduling (EPS) is now live at every VA facility nationwide. Over 27,000 Community Care Network providers have already integrated EPS into their existing systems — and you can, too!

EPS simplifies scheduling so you can focus on patient care. With a secure, digital connection to your system, EPS lets VA view your real-time availability based on the appointments slots you choose to share. This reduces back-and-forth phone calls and helps VA staff book up to 25 appointments per day.

Help Veterans get the care they have earned with fewer steps! To get started, email us at EPSProvider@va.gov.

Whole Health makes a data-driven difference

Show Veterans how Whole Health helps them become happier, healthier versions of themselves. Studies suggest that Veterans who use Whole Health services experience improved physical and mental health compared with those who rely on conventional care alone.

Research also demonstrates that a Whole Health approach supports Veterans in quitting opioids and tobacco and in managing chronic conditions such as diabetes, hypertension, and chronic pain.

This Whole Health Month, help Veterans get started.

Core Training

Opioid safety for Veterans with chronic pain (required)

Education & Training

COMMUNITY PROVIDERS: Thank you for all you do to support Veterans.

R E S O U R C E S

• Provider Website  
• Community Care Network 
• Urgent Care - Information for providers 
• Emergency Care - Information for providers 

Contact the National Call Center at 877-881-7618 for provider process questions.

Questions on this bulletin? Email us at VHA_IVC_Strategic_Communications@va.gov.