Provider Payments
Once you file a claim for care provided to a Veteran or Veteran family member, VA adjudicates the claim and provides an electronic payment. VA is required to pay all medical and dental claims from providers electronically.
For claims submitted to one of the VA Third Party Administrators (TPAs), such as TriWest Healthcare Alliance, for care provided through the Veterans Choice Program (VCP) you will receive a payment from the same TPA. For claims submitted for care provided through a Veterans Care Agreement, you will receive a payment directly from VA.
Please note: Veterans Choice Program ended on June 6, 2019.
If you have specific questions regarding your claims, please contact the claims processing unit that adjudicated your claim. This information can be found on your claim and they will be able to provide clear guidance on the steps you need to correct your claims.
For information on how to check the status of a claim, please visit Check Claim Status.
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Electronic Payments
The U.S. Department of Treasury published a final rule on Electronic Funds Transfer (31 C.F.R. 208) that requires all federal payments be made electronically. This requirement includes payments made to community medical and dental providers. Community care providers must enroll for Electronic Funds Transfer (EFT) in order to meet this requirement. With EFT, payments are deposited directly into a bank account.
On September 1, 2022, the VA Financial Services Center (VA-FSC) released a web version of its legacy VA Form 10091, VA-FSC Vendor File Request Form. To apply for payment via EFT, complete the "PAYEE/VENDOR INFORMATION" and "EFT/ACH" sections of VA Form 10091 via the VA-FSC Customer Engagement Portal.
VA-FSC Customer Engagement Portal
You also need to contact your financial institution to arrange for delivery of the CORE-required Minimum Cash Concentration of Disbursement plus (CCD+) Data Elements necessary for successful reassociation of the EFT payment with the Electronic Remittance Advice (ERA).
Updates and Changes to EFT Information
If you are already receiving EFT payments from the federal government through another program such as Medicare, Medicaid, or Tricare, you can update your EFT information on file to receive payment from VA.Complete VA Form 10091 via the FSC Customer Engagement Portal and check the box marked "UPDATE."
For questions regarding enrollment or updates to EFT information on file, please contact the VA-FSC, Vendor Support Section via phone or email.
VA-FSC Resources
VA-FSC Customer Engagement Portal
VA Financial Services Center
Main: 512-460-5049
VA-FSC, Vendor Support Section
Email: vafsccshd@va.gov
Phone: 877-353-9791
Fax: 512-460-5221
Mailing Address:
Department of Veterans Affairs
Financial Services Center
PO BOX 149971
Austin, TX 78717-8971
VA Recovery Audits to Return Overpayments
IMPORTANT: For up-to-date information on Recovery Audit Contractor (RAC) Provider Updates, visit the Cotiviti VARAC website.
The Department of Veterans Affairs (VA) will conduct claim recovery audits to fulfill Payment Integrity Information Act of 2019 requirements to review payments made to community providers during Fiscal Years 2018–2023.
Recovery Audit Authority: Payment Integrity Information Act of 2019
VA awarded the recovery audit contract to Cotiviti GOV Services (Cotiviti). VA’s Debt Management Center (DMC) will assist with the management of the associated collection activities.
Reviews will vary between fiscal year and health benefits programs, and will cover VA claims paid to community providers for inpatient and outpatient services as well as claims for the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) and the Spina Bifida Health Care Benefits Program.
Exclusions
The audits exclude claims paid to beneficiaries, claims where VA was a secondary payer and pharmacy, bowel and bladder and dental claims. Since the Community Care Network (CCN) contracts include their own requirements for recovery/recapture audits, CCN claims are excluded from the scope of this contract.
The issuing of Notices of Indebtedness (NOIs) to community providers associated with the recovery audit findings is anticipated to begin in July 2024.
The contract is at no cost to VA; Cotiviti will be paid a percentage of the recovered funds. A portion of the recovered funds will be returned to the authorizing VA Medical Centers (VAMCs) but must be used for the original purpose and fiscal year in which it was originally obligated.
Reconsiderations and payment plans
The recovery audit contract allows providers to request reconsideration of findings, as well as alternative repayment options (e.g., compromise or payment plans). VA has retained the final authority on all provider appeals. If a significant number of findings are reversed on appeal, Cotiviti is required to submit a corrective action plan to mitigate any further issues. VA will conduct quarterly reviews to validate the accuracy of the audit findings.
Public comments
Before the start of each new audit, Cotiviti will post a preliminary audit plan to their public-facing website for 30 calendar days for public review and comment. VA and Cotiviti will review comments and make appropriate adjustments before the plan is finalized. The final audit plans will be posted to Cotiviti’s public website before each audit begins.
Customer Service
VA has applied lessons learned from prior recovery audits to create a more transparent and provider-friendly audit process. Cotiviti Provider Services is available Monday–Friday, 9:00 a.m.–8:00 p.m. ET.
Cotiviti Provider Services: 855-287-1667
Monday–Friday, 9:00 a.m.–8:00 p.m. ET
Cotiviti public website:
https://www.cotiviti.com/varac
Recovery Audit Questions
What types of improper payments will be identified?
Claim reimbursement rates, reimbursement of non-covered or unauthorized services, incorrectly coded services, and duplicate services.
Who can I contact if the RAC identifies a payment previously collected?
A provider receiving an overpayment Notice of Indebtedness (NOI) previously collected or reimbursed should contact Cotiviti Provider Services. Providers must provide evidence of the previous collection.
Cotiviti Provider Services: 855-287-1667, 9:00 a.m.–8:00 p.m. ET, Monday–Friday
How long do I have to respond to Cotiviti once notified of an overpayment?
Submit supporting documentation or information within 30 business days of notification.
Will I receive a bill for each overpayment?
To reduce the administrative burden on providers, each audit will group overpayments by provider Tax ID Number (TIN) and issue one Notice of Indebtedness (NOI) per TIN, per audit. The NOI may include multiple overpayments in an itemized list.
How will I know what payments are being reviewed?
Cotiviti will post preliminary audit plans approved by the Office of Integrated Veteran Care (IVC) on the Cotiviti public website for no less than 30 days for public review and comment. After the comment period, Cotiviti and IVC will review and address comments as appropriate. The final audit plan will be posted to the Provider Portal before Cotiviti begins any audit.
Where do I send payments?
Your Notice of Indebtedness (NOI) and Notice of Rights and Responsibilities (NRR) will include all information on how and where to remit repayment. Call Cotiviti Provider Services with questions.
Cotiviti Provider Services: 855-287-1667, 9:00 a.m.–8:00 p.m. ET, Monday–Friday
Treasury Offset Program (TOP) to Collect Unpaid Debt
VA financial policy requires delinquency referrals to TOP for community care provider debts that have gone unpaid for over 120 days. The TOP collects past due debts owed to state and federal agencies. TOP withholds all or part of a VA payment to a community care provider who is past due to satisfy the debt. The community care provider remains in the TOP database until VA tells TOP to stop collecting the debt.
TOP Questions
How are debts discovered?
Debts can be discovered several ways, to include during a quality review, recapture recovery, an Office of Inspector General (OIG) audit, or a community care provider’s acknowledgement of an overpayment made by VA.
How does the collection process work to resolve debt?
VHA undergoes a specific, two-step collection process:
- VHA issues a bill of collection (BOC) to the community care provider.
- The provider returns funds to the address listed on the BOC, or
- Exercises their due process rights within 30 days of the BOC. If due process rights are not exercised, then VHA proceeds with the debt collection.
- VHA issues a Notice of Indebtedness (NOI) to the community care provider that states the collection process will begin if payment is not received.
- If the provider does not send payment, VA attempts to offset the next payment via the VA Financial Management System (FMS).
- If the provider does not send payment or the BOC cannot be offset by future payments, debt is referred to TOP after 120 days past due.
Who do I contact if I have a question?
Please contact VA Community Care Customer Service with any questions
VA Community Care Customer Service: 877-881-7618, 8:00 a.m.—9:00 p.m. ET, Monday—Friday.
