Community Care

NOTE: This video has not been updated to reflect UIO inclusions.

Eligible American Indian (AI) and Alaska Native (AN) Veterans do not need VA preauthorization to receive health care services at participating I/T/U RAP health facilities and have no VA copay for services. VA recognizes the preference AI/AN Veterans may have to access culturally sensitive care, and this program supports resource sharing while creating greater access to care for AI/AN Veterans.

The reimbursement program was first initiated in 2012 with IHS and THPs. In 2022, the program expanded to include UIOs. In 2023/2024 VA expanded the scope of reimbursements to also include Purchased/Referred Care (PRC) and contracted travel, in addition to direct care provided by I/T/U operated facilities. On December 6, 2023, VA and IHS signed a new reimbursement agreement. In June, VA finalized the THP template and anticipates the UIO template being completed in July.

Listed below are several resources to include how to initiate an agreement and operational updates for the Reimbursement Agreement Program.

On this Page:

• Agreement Initiation
• Eligibility
• Other Health Insurance Billing
• Claims and Invoice Submission
• Claims Status Check
• Secure Data Transfer
• Care Coordination
• Training
• I/T/U Healthcare Facilities/Clinics
• Operational Updates
• Contacts & Resources

Agreement Initiation and Onboarding

I/T/U RAP Initiation and Onboarding
Information outlining the process for entering into a reimbursement agreement.

Veteran Eligibility and Enrollment Verification

Eligibility and Enrollment Verification
Explanation of how I/T/U facilities can verify American Indian/Alaska Native (AI/AN) Veteran eligibility.

Other Health Insurance Billing

Direct Care

The I/T/U will seek payment from all other liable payers before seeking payment from VA. VA will be responsible for the remaining balance, up to the agreed upon rate. I/T/Us are required to submit a copy of the Explanation of Benefit (EOB) or Payment (EOP) from the primary payer with the claim to the VA.

Purchased Referred Care (PRC)

The IHS/THP facility is considered the payer of last resort for PRC, and as such, the use of alternate resources is required when such resources are available (defined in 42 CFR § 136.61). This Agreement does not exempt or replace the IHS/THP from being payer of last resort. OHI must be sought before VA will reimburse. IHS/THP must submit a copy of proof of their payment (i.e. Explanation of Benefit (EOP) or Payment (EOP)), as well as a copy of the claim form (CMS 1450/1500) and any OHI EOP/EOB billed to them by the Servicing Facility with the supporting documentation.

Claim and Invoice Submission

VA billing for Direct Care and Purchase Referred/Care (PRC) are different. Detailed information on submission can be found at the links below. ITU Facilities have 36 months from the date of service to submit claims and invoices to VA.

Both claim types are processed at a centralized claims and invoice processing center, Western Region Payment Operations (WR PO).

Claims Status Check

To check the status of IHS, THP, and UIO submitted claims, the following options are available:

VA Customer Engagement Portal (CEP)
Registered IHS/THP providers can research the status of claims received by VA. Explanations of Payment are not available via CEP. Your System for Award Management (SAM) unique identifier number will be needed to register for CEP.
NOTE: As of 09/30/2023, CEP will be the sole resource available for providers to update their vendor files/billing information with the VA. VA will no longer accept paper VA 10091 forms.

For assistance with CEP, please contact Provider Portal Customer Support.

eCAMS Provider Portal (ePP)
Registered I/T/U providers can research the status of claims received by VA and being processed in the VA Electronic Claims Adjudication Management System (eCAMS). Copies of EOBs/EOPs may also be obtained in ePP. RAP providers may register on ePP to view VA payment information and claim status. If you need assistance, please contact eCAMS Customer Service.

Northwest Region Payment Operations (NW PO)
For questions and issues with submitted IHS, THP and UIO claims.

VA Office of Integrated Veteran Care National Contact Center
877-881-7618, Monday – Friday, 6:05 a.m. – 4:45 p.m. MT
NOTE: When contacting the call center, identify yourself as a non-CCN provider (option 2).

I/T/U facilities should call the Office of Integrated Veteran Care National Contact Center to obtain claims status information. VA call center staff are not trained in RAP claims processing. They can only provide you the claims status and direct you to NW PO if you have a claims issue or need further assistance.
IMPORTANT: If asked for your facility zip code, please use the NW PO zip code: 98661.

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Secure Data Transfer

Secure messaging is to be used when I/T/U RAP facilities send files for eligibility checks and claims related information to VA. For AI/AN Veteran eligibility checks, email the I/T/U RAP team. The Secure Data Transfer process varies based on the type of I/T/U facility.

Tribal Health Programs/Urban Indian Organizations

Secure Messaging Instructions

• For claims status checks or Veteran eligibly: THP/UIOs may send encrypted messages directly, if they are able to.
• For PRC and contracted travel invoices, or if THP/UIOs do not have encryption:

1. Request a secure message by emailing VA.

   Veteran Eligibility Checks: I/T/U Reimbursement Agreements Program Team

   Claims Inquiry: VA Payment Operations RAP Support Group

2. Recipients will receive an email message that has a link to read the message in Microsoft’s Office 365 web portal. The recipient should click the “Read the message” link in the email to launch the portal.
3. Once the Office 365 portal loads click the “Sign in with a one-time passcode” and an email will be sent to the recipient's email with a one-time passcode.
4. Copy the one-time passcode from the email, enter the one-time passcode into the portal, and click “Continue.” An encrypted message will open.
5. From here, THP/UIO staff can respond to the sender’s message securely and attach documents as needed.

Indian Health Services

IHS facilities use the IHS Secure Data Transfer Service (SDTS) to share secure emails with VA. To request access to the IHS Secure Data Transfer Service, email Cynthia Larsen, IHS Office of Resource Access and Partnerships.
NOTE: This email is for secure messaging and IHS claim system questions ONLY. Other questions will not be addressed.

Cynthia.Larsen@ihs.gov

Care Coordination

When eligible AI/AN Veteran care is not available at participating I/T/U RAP facilities, care must be referred to non-I/T/U providers. This includes referrals to VA health care facilities where VA may provide the care directly or refer to a community care provider.

VA has established the Care Coordination Request for Services (RFS) process, a standardized process to receive requests for care from community providers. More details on how to refer care to VA and the RFS process, as well as local point of contacts, can be found on the VA Request and Coordinate Care page. Participating facilities with additional questions can also contact the RAP team for assistance.

Training

I/T/U Reimbursement Agreements Program (RAP) Joint Orientation Brief

The VA I/T/U RAP Office provides training for I/T/U facility staff on the VA IHS/THP Reimbursement Agreements Program and claims submission process. The duration is approximately 30 minutes.

IHS/THP RAP 2022 Refresher Training (Last updated on 05/05/2022)
Please use PIN 442595 to download the files.

Military Culture: Core Competencies for Healthcare Professionals

Understanding military culture can allow clinicians to tailor clinical services. This course (four modules, two-hours each), jointly developed by the Department of Veterans Affairs and Department of Defense, describes military organizations and roles, reviews military-specific stressors, and provides treatment resources and tools for best practices with military patients.

Military Culture: Core Competencies for Healthcare Professionals
Offered by the VA National Center for PTSD

Native Cultural Awareness

Cultural awareness is an essential component of Veteran-centered care. Providers who do not regularly work with AI/AN patients may lack awareness of specific cultural aspects of care. To boost cultural awareness of this group, VA has identified material that could benefit both clinical and administrative staff. They are:

• AI/AN Culture Card–a guide to build cultural awareness provided by the Substance Abuse and Mental Health Services Administration (SAMHSA). It is intended to serve as a general briefing to enhance cultural competence while providing services to American Indian and Alaska Native communities.
• IHS Gold Book–a four-part publication in which IHS reviews progress from the agency’s first 50 years of operation, including lessons learned regarding culturally acceptable public health services.

Operational Updates

VA is pleased to announce the release of the new VA-IHS, VA-THP Lower 48 states, and VA-UIO Reimbursement Agreements regarding reimbursement for health care services provided by IHS, THP, and UIOs to eligible American Indian and Alaska Native Veterans. The new agreement builds upon the current Reimbursement Agreement for Direct Care Services by removing some limitations on the scope of direct care. The IHS/THP Agreements also expand the scope of reimbursements to include Purchased Referred Care (PRC) and contracted travel.

The VA-IHS national agreement covers all currently participating IHS facilities and no action is needed by IHS facilities. For details, please see the VA-THP Tribal Leader Letter issued December 6, 2023. The THP and UIO Agreements require facilities to enter into new agreements with the VA. For details, please see the VA-THP Dear Tribal Leader Letter issued June 20, 2024, and the VA-UIO Dear Facility Leader Letter dated July 11, 2024. VA is still negotiating with Alaska THP stakeholders and hopes to announce new agreements to cover those facilities soon.

I/T/U Healthcare Facilities or Clinics

The following is a list of current participating Indian Health Service, Tribal Health Program and Urban Indian Organization (I/T/U) healthcare facilities or clinics under the VA Reimbursement Agreements Program.

IHS-THP RAP Participating Facilities List (Excel file)