Community Care

Consult Creation and Review

• A consult is a request from your Fargo VA doctor to refer you for medical and/or behavioral care from a VA community provider. When your Fargo VA provider recommends you seek additional care, they create the consult and Fargo VA staff review it for accuracy. 
• Once your provider submits a referral, Fargo VA Specialty Care team reviews the referral and looks at your care options. 
• The Specialty Care  team will then call you to discuss all your care options and capture your provider preferences.
  • You choose where, when, and how you want to receive care.
    • Options include: face to face or virtual
  • If the specialty care team does not reach you by telephone, they will send you text messages, letters, or secure messages from the downloadable MyHealtheVet app on your phone.

DO NOT SCHEDULE AN APPOINTMENT UNTIL VA CONTACTS YOU WITH THE APPROVED CONSULT INFORMATION

Scheduling

• Once Fargo VA has contacted you with the approved consult information, we will contact you to schedule your appointment. 

SCHEDULING WARNING:

If VA Fargo cannot reach you within 14-BUSINESS DAYS, your consult will be DISCONTINUED and you will have to request a new one from your referring Fargo VA Provider (Not the Community Care Department).

Click here or below for an example VA Fargo community care scheduling attempted contact letter.

Authorization

• After your appointment is scheduled, your authorization is created. 

An authorization is IMPORTANT because it is an approval from Fargo VA for you to receive care from a community provider.

• You will receive a letter in the mail with:
  • Your authorization number
  • The in-network community provider you are approved to visit
  • A description of the care you are approved to receive.
  • The time period you are authorized to receive care

Bring the authorization letter with you to your appointment with the community provider

Retro-authorizations are NOT allowed according to 38 U.S.C. 1703(a)(3), which states: A covered Veteran may only receive care or services under this section upon the authorization of such care or services. To clarify, this means the care must be Pre-authorized. 

Pay Attention to Authorization Date Expirations: If, for some reason, you had to reschedule your appointment with your community care provider you must NOT reschedule outside the authorization date range. 

Call VA Fargo Community Care Customer Service 1-866-517-9363. VA Fargo must update the approved date range on your authorization. 

Click here or below for an example VA Fargo Community Care Authorization Letter.

Community Care Visit

At the scheduled day and time, you will attend your community care appointment. The Fargo VA will send any relevant medical records to your community provider. However, if instructed by the community provider, you may need to bring copies of diagnostic imaging (CT or MRI) with you.

You are responsible for your VA copayment amount, as applicable, whether you receive care in VA or the community. You will be billed for this Separately by VA. 

DO NOT pay a copayment to a community care provider.

Scheduling Additional Appointments

If your provider recommends a follow-up, you must ensure that your authorization approves the additional appointments. If not authorized, you should contact your provider to determine your next steps.

 If you are authorized for ongoing care from a participating VA community provider, you may schedule recurring appointments directly with their office. 

However, 

Keep track of how many appointments you attend and when they are authorized. The Fargo VA will not cover services beyond what is described in your authorization.

DO NOT schedule care past the expiration date listed on your community care authorization.

Reauthorization

If you require care beyond the limits of your authorization, you will need to be reauthorized. 

You or your community provider may submit a new referral request to Fargo VA. Fargo VA will review the referral request and, if appropriate, issue a new authorization for this care. However, in some circumstances, Fargo VA may determine that you should return to VA to receive this care. 

Prescription and Durable Medical Equipment (DME) Pick-Up

Prescriptions:

To find an in-network pharmacy, use the VA Facility Locator Tool and select Facility Type: Community pharmacies.

You may fill a prescription for 14-day (or fewer) supply written by your community provider at:

• A VA medical facility pharmacy
• A participating in-network pharmacy with no out-of-pocket payment at the pharmacy
• An out-of-network pharmacy, but you must pay at the pharmacy and submit a reimbursement claim at Fargo VA. 

For prescriptions that exceed the 14-day supply limit or are not urgently needed, the community provider must send the prescription to the local VAMC pharmacy to be filled. 

Durable Medical Equipment (DME):

If your provider identifies an immediate need for DME, orthotics or prosthetic items, the provider may provide the DME to you and submit a bill to the Third Party Administrator (TPA).

For questions about durable medical equipment (DME), contact the Fargo Prosthetic and Sensory Aids Service at:

vhafarProsthetics@va.gov

701-237-3900 Ext. 3039

For routine DME, orthotics and prosthetic items you must return to Fargo VA for a consult at the Prosthetics and Sensory Aids Service (PSAS) unit.

Receiving and Paying your Bill

Depending on your disability rating and private insurance (including Medicare and Medicaid), you may receive a bill from Fargo VA for services you received. If you owe a copay, send payment to VA at the address on your bill. You should never pay a community provider directly.

To inquire about your bill, please call the Community Care Claims/Payment Customer Service: 1-877-881-7618