Veterans Care Agreements
VA may enter into agreements with certain community providers to care for Veterans when they are not part of the VA contracted community care network. These agreements are known as Veterans Care Agreements (VCA), which are intended to be used in limited situations where contracted services through the VA community care network are either not provided or not sufficient to ensure Veterans can get the care they need. VA may only purchase care for Veterans through these contract vehicles such as Community Care Network (CCN), or by establishing a VCA.
On This Page:
- Establishing a VCA
- Certification and Credentialing
- Referrals and Authorizations
- Claims and Payments
- Frequently Asked Questions
- Contacts and Resources
Establishing a VCA
Either a community provider or a local VA medical facility may initiate the process for establishing a VCA.
- Providers interested in establishing a VCA should contact their closest VA medical facility.
- In some cases, VA medical facilities may reach out to community providers to request they establish a VCA where there is a need for services not adequately covered through VA’s contracted network.
VCA Credentialing Process for Community Providers
All providers and agencies with a VCA are required to complete a full assessment and credentialing process administered by VA’s contractor RLDatix/Verge Health to continue or begin to provide services to Veterans.
RLDatix/Verge Health will assist VA in assessing all non-CCN providers and agencies to deliver care to Veterans on behalf of VA.
What You Need to Know
- VA has a contract with RLDatix/Verge Health to perform the VCA assessment and credentialing.
- All existing and new VCA providers and agencies are required to undergo the full assessment and credentialing process.
- The assessment will address whether providers/agencies are medically qualified, licensed and competent to provide care to Veterans.
- VCA providers and agencies will receive a notification from RLDatix/Verge Health regarding credentialing activities to include updating peer references, updating expiring records and applying for reappointment.
- Providers will be required to submit requested credentialing documentation through RL Datix/Verge Health’s website on time for reappointment once they have been contacted by RL Datix/Verge Health for credentialing.
Provider Appeals
- Providers and agencies under appeal are not allowed to provide care to Veterans until their appeal is resolved.
- Existing providers and agencies not reapproved for a VA VCA due to this process can submit an appeal to the Office of Integrated Veteran Care (IVC) Credentialing Verification Organization (CVO) Team.
- VHA will assist RLDatix/Verge Health in determining an outcome.
Certification and Credentialing
An approved VCA is active for three years. Community providers must maintain a high level of quality-of-care performance by staying in compliance with VA’s certification standards through the entire length of the agreement.
Referrals and Authorizations
Once a VCA credentialing is approved and signed by a community provider and local VA medical facility, the community provider will be notified to begin receiving referrals and authorizations from VA to provide care to Veterans. The referral and authorization contain the scope of services authorized for the community provider to provide to a specific Veteran.
IMPORTANT: Veterans must receive approval from VA prior to obtaining care from a community provider in most circumstances.
Referrals and authorizations are sent to community providers through a system called HealthShare Referral Manager (HSRM), an electronic referrals management system. HSRM allows community providers and VA to better manage community care referrals and authorizations using a standardized process based on clinical and business rules. Community providers can also receive referrals and authorizations using secure email, fax, or mail.
Community providers can register for the HSRM training by signing up and viewing the webinar through the VHA TRAIN website. An account in VHA TRAIN is required before registering for the webinar.
Claims and Payments
VCA community providers submit claims directly to VA using electronic data interchange (EDI) or by mailing the claim to the address contained within the referral.
IMPORTANT: Community providers cannot receive payment for care provided to Veterans through a VCA until the VCA is established and signed. VA is not responsible for payments prior to approval of a VCA.
VA follows Medicare reimbursement rates for all Medicare-recognized services. For non-Medicare recognized services, VA reimburses at the appropriate VA fee schedule or billed charges. VA is responsible for any payment or fee arising from care authorized through VCAs. Community providers cannot collect or seek to collect payments from any entity for VA-authorized care, including from a Veteran or a Veteran’s other health insurance.
Community providers can check the status of a claim through VA’s Customer Engagement Portal (CEP), a web application that allows community providers and other registered vendors to research the status of claims received by VA. This includes information on previous, current, and future payments, and provides the option to check the status of CMS 1500 (HCFA-1500) or CMS 1450 (UB-04) claims forms.
Frequently Asked Questions
For community providers who are part of a group practice, can the group practice sign one VCA for the entire practice?
Yes, VCAs may be signed by an entity such as a group practice. The VCA will need to include the National Provider Identifier (NPI) numbers of all providers covered under the VCA.
Under what circumstances would a VCA be terminated?
The terms by which a provider’s VCA can be terminated are specified in the VCA.
How often do community providers need to update their information after establishing a VCA?
Community providers must submit any changes to VA that may affect their status according to the process specified in the VCA within 10 business days, as outlined in the VCA.
How do community providers receive referrals through a VCA?
Provider will receive referrals on an authorized VA form through their preferred method - either HSRM, secure fax, email, or mail.
How do community providers with a VCA resolve a payment dispute?
The VA medical facility from which a community provider has received the referral or authorization, under the VCA, is responsible for addressing payment disputes.
Contact Us
VA Facility Locator
If you are a community provider interested in establishing a VCA to provide care for Veterans, contact the nearest VA medical facility for more information.
