Community Care
IHS/THP/UIO Reimbursement Agreements Program (RAP)–Information for Providers about Direct Care
Direct Care Claims
Health Care Claims
VA will reimburse participating tribes for direct care services provided to eligible American Indian and Alaska Native (AI/AN) Veterans. VA prefers to receive EDI claims but also accepts paper claims.
Unique VA Requirements:
Generally, VA follows National Correct Coding Initiative (NCII) standard submission processes; however, VA does require specific identifiers to be added to claims for proper program routing:
• EDI Claims – VA payer IDs
• VA Program Identifier
• Agreement Number
Additional details and samples regarding direct care services can be found in the IHS/THP/UIO RAP Provider Guide listed in the Resources section below.
Pharmacy Claims
VA will reimburse facilities for outpatient pharmaceutical on the Indian Health Services/Tribal Health Programs (IHS/THP) formulary. For Urban Indian Organizations (UIO), VA will only reimburse facilities for pharmaceutical drugs listed on the VA National Formulary.
VA accepts paper and EDI pharmacy claims and follows the direct care services claim submission process. VA does not accept CMS Standard pharmacy claims submission. Facilities submit pharmacy claims on CMS medical claim forms (i.e. EDI 837 and CMS 1500).
Refer to the "Pharmacy Claims Submission" section of the IHS/THP/UIO RAP Provider Guide for detailed information on how to submit pharmacy claims.
Direct Care Claim Submission Process
Electronic billing (Electronic Data Interchange)
Facilities submitting Electronic Data Interchange (EDI) claims need to register with Change Healthcare by phone or online.
Once registered, billing staff should ensure “IHS," "THP" or "UIO” is added to the SBR03 segment of the 837 for proper routing. VA payer IDs are:
- 12115 for medical claim submissions
- 12116 for dental claims
- 00231 for any inquiry transaction
Change Healthcare Customer Support:
866-371-9066
Mon.–Fri., 8 a.m.–4 p.m. Central Time (CT)
Paper Claims
VA has a centralized claims processing center for paper claims.
THP/UIO may send paper claims to:
VHA Office of Finance
P.O. Box 30780
Tampa FL 33630-3780
IHS must submit paper claims to the following address via Certified Mail (per the Social Security Number Fraud Prevention Act of 2017):
VHA Office of Finance
5401 W. Kennedy Blvd., Suite 150
Tampa, FL 33609-2433
