Community Care

If you do not agree with the decision VA has made regarding a claim for payment for services in the community, you have the right to seek further review. If VA denied a claim for payment for care in the community, VA issued Form 10‑0998, Your Right to Seek Further Review of Our Healthcare Benefits Decision, explains how to begin the process.

VA Form 10-0998, Your Rights to Seek Further Review of Our Healthcare Benefits Decision

Please read the information contained in that form carefully to understand your procedural and appeal rights in connection with the decision. Providers have appeal/dispute rights that may differ from those available to Veterans.

On this Page

• Review Options
• Appeal and Dispute Options
• How to Submit a Dispute or Appeal
• Timelines for Submission

Review Options

There are multiple options available to providers who do not agree with a payment decision. Not every option is available to every provider in every circumstance. Please refer to the “Appeal and Dispute Options” section below to find out which of the following options are available to you.

Assistance Request

As a community provider you have the option to discuss any VA claims processing question with a customer service representative. VA Customer Support staff will gladly explain your options.

VA Customer Support: 877-881-7618

Veterans Care Agreement (VCA) Dispute

A VCA payment dispute is exclusive to claims processed against VA Form 10-7080, Approved Referral for Medical Care, with a “VCA” Affiliation. The VCA dispute review option is appropriate if you believe the claim processing outcome does not align with the terms listed in the signed VCA and/or on VA Form 10-7080. VCA payment disputes must be submitted in accordance with the terms outlined in the VCA. A VCA dispute must be filed in writing to the designated claims official located in section O of VA Form 10-10171, Veterans Health Administration (VHA) Veterans Care Agreement, within 90 days of the date the explanation of payment was received by the community provider.

NOTE: Disputes regarding VCA authorizations and/or the terms of the VCA, must be received by the designated VA official identified on VA Form 10-10171, section O, for receipt of disputes pertaining to the authorization.

VA Form 10-10171, Veterans Health Administration (VHA) Veterans Care Agreement

Supplemental Claim

If you disagree with the payment decision and have new and relevant evidence to submit or want to request a review of your claim based on a change in law, a supplemental claim may be an option for you.

• New evidence is information we haven’t considered before.
• Relevant evidence is information that proves or disproves something in your claim.

Unless your supplemental claim is based on a change in law, you’ll need to submit supporting evidence that’s new and relevant for your application to be complete.

Higher-Level Review

If you disagree with a VA payment decision, you can request a new review of your claim by a higher-level reviewer. The reviewer will determine whether an error or a difference of opinion changes the claims processing decision. You can’t submit new evidence with a Higher-Level Review.

NOTE: You can’t request a Higher-Level Review after a previous Higher-Level Review or Board Appeal on the same claim.

Appeal to the Board of Veterans’ Appeals

For information on filing an appeal with the Board of Veterans’ Appeals, please visit VA’s Board Appeals webpage.

VA Board Appeals

Appeal and Dispute Options

Appeal/dispute options available to you depend on the contract status of the care you provided, and if the care you provided was authorized. Please review the following information and select the appropriate option based upon your status:

I have a VCA and provided authorized treatment covered under that VCA.

• Request assistance
• Refer to the dispute terms within your signed VCA. The dispute terms dictate your options.

I have a contract with VA and provided authorized treatment covered under that contract.

• Request assistance
• Refer to the terms of your contract. The contract terms dictate your options.

I provided treatment to a Veteran in an emergency without authorization from VA.

• You have several options available to you. You may choose from one or more of the following:
  • Request assistance
  • Supplemental claim
  • Higher-Level Review
  • Appeal to the Board of Veterans’ Appeals

How to Submit a Dispute or Appeal

The review option you select will determine how to submit your claim for further review. Information about how to file a dispute or appeal will accompany the initial claim adjudication decision. You must submit the appropriate form to the appropriate office for review within the allotted timeframe.

Timelines for Dispute or Appeal Submission