Community Care
IHS/THP/UIO Reimbursement Agreements Program–Information for Providers about Purchase Referred Care
Purchase Referred Care (PRC) and Contract Travel (IHS/THP Facilities Only)
PRC and contracted travel health care service billing and submission requirements follow a different process than those used for direct care services. VA cannot accept invoices through the standard health care claims submission process using Electronic Data Interchange (EDI), CMS1500 (HCFA), or CMS1450 (UB). Invoices for reimbursement of PRC and contracted travel services must be submitted to VA Western Region Payment Operations via a secure messaging process.
Required Documents
The invoice submission package will include:
- Either the THP-PRC and Contracted Travel Cover Letter or IHS-PRC and Contracted Travel Cover Letter, in Excel format, provided below.
THP-PRC Contracted Travel Billing Template
(Excel template)IHS-PRC Contracted Travel Billing Template
(Excel template) - From the servicing provider to billed IHS/THP:
- A copy of the claim form (CMS 1450/1500)
- A copy of the Explanation of Benefit (EOB), or Payment (EOP), from any primary payer/other health insurance (OHI) billed prior to IHS/THP
- From IHS/THP facility:
- Proof of IHS/THP payment (i.e. Explanation of Benefit [EOB], or Payment [EOP]) from the THP facility or IHS site/area showing IHS/THP payment
Additional Requirements
- The total invoice amount included on the cover letter must match the supporting documentation submission.
- For the time period when only COVID-19 PRC is reimbursable under the agreements (COVID-19 “Emergency period” from January 27, 2020, to May 11, 2023), a COVID-19 diagnosis code must be included in the submitted supporting documentation. Allowable diagnoses codes are:
Cover Letter tab elements include:
- Facility or IHS area information
- If THP: Facility name, TIN, billing provider NPI, and address
- If IHS: IHS area name, TIN, billing provider NPI, and address
- Veteran information
- Dates of service (From Date/To Date)
- Name of community provider Veteran was referred to
- IHS/THP payment amount
If submitting a pharmacy invoice, the pharmacy tab must also be completed.
Pharmacy tab elements include:
- Date of fill
- Drug name, NDC code, quantity, strength
- Prescription number
- Prescribing provider information
- IHS/THP payment amount
- Associated Explanation of Benefit (EOB), or Payment (EOP) from the IHS/THP
- U07.1 COVID-19
- U09.9 Post COVID-19
- B34.2 Coronavirus Infection, unspecified
- B97.29 Other Coronavirus as the cause of diseases
- J12.81 Pneumonia due to SARS-associated coronavirus
- B97.21 SARS-associated coronavirus causing diseases classified elsewhere
- B97.29 Other coronavirus as the cause of diseases classified elsewhere
More details can be found in our COVID-19 PRC Billing presentation and the Medicare.gov, Medicare & Coronavirus webpage.
Submission Process
- IHS/THP facilities send a secure message with the required contents to the VA Payment Operations RAP Support Group
- IHS facilities must use the IHS Secure Data Transfer Service (SDTS)
- THP facilities will initiate a secure message by emailing the VA Payment Operations RAP Support Group requesting VA to initiate a secure email. VA will reply with a secure email through our Outlook RMS Secure, and the THP will attach the submission to that email reply. Even if THPs have their own secure email system, VA requests you utilize this process.
- VA Payment Operations will review the cover letter and supporting documentation, add the adjudication decision (approved/rejected), and return to IHS/THP facilities via the same secure email or message used to submit to VA.
Submission of Corrected Invoices
Corrected invoices may be submitted to VA in the event missing or incorrect information was provided initially.
- Corrected invoices will be submitted via the same process as initial invoices to the VA Payment Operations RAP Support Group.
- IHS/THP will attach the corrected invoice/supporting documentation and annotate that the submission is a correction in the body of the email/message.
Receiving Payment
VA Payment Operations will reimburse PRC invoices within 45 days of the received date. VA PRC reimbursement and Explanation of Benefit (EOB) or Payment (EOP) may take 4-6 weeks to be delivered.
Electronic Fund Transfers (EFT) or paper checks will be sent to the bank account or address included in the VA facilities vendor file.
Invoice and Payment Inquiries
Email the VA Payment Operations RAP Support Group with questions about invoice and payment status.
