veterans choice provider

Thought about Becoming a Veterans Choice Provider?

The value of health care provided to America’s veterans is at risk because of a shortage of physicians working for Veterans Administration (VA) hospitals and for other institutions associated with the Department of Veterans Affairs (DVA). There are more than 1,400 unfilled positions in the nation’s VA health system, causing a physician shortage crisis nationwide. VHA OCC (Veterans Health Administration Office of Community Care) purchases health care for eligible Veterans when a VA medical center (VAMC), clinic or other federal facility is not feasibly available to furnish care. All VAMCs can use community care when needed. The different types of Veteran care include Patient-Centered Community Care (PC3)/Choice contracts, community emergency medical care, individual authorizations, and special programs.

The use of community care is governed by federal laws containing eligibility criteria and other policies specifying when and why it can be used. In most cases, a preapproval for treatment is required for community care unless the medical event is an emergency. Emergency events may be reimbursed on behalf of the Veteran in certain cases.

Veterans Choice Program (VCP)

The Veterans Choice Program is one of several programs through which a Veteran can receive care from a community provider, paid for by the Department of Veterans Affairs (VA). For example, if a Veteran needs an appointment for a specific type of care, and VA cannot provide the care in a timely manner or the nearest VA medical facility is too far away or too difficult to get to, then a Veteran may be eligible for care through the Veterans Choice Program.

To use the Veterans Choice Program, Veterans must receive prior authorization from VA to receive care from a provider that is part of VA’s VCP network of community providers. The authorization is based on specific eligibility requirements and discussions with the Veteran’s VA provider. VA must authorize care that is needed beyond the scope of the first authorization.

Eligibility

Veterans may be eligible to receive care through the Veterans Choice Program based on one or more of the following conditions:

  • VA can’t provide the services the Veteran needs
  • VA can’t make an appointment for the Veteran at the nearest VA medical facility within 30 days of the clinically indicated date (the date the Veteran and their VA provider agree should be the next date the Veteran is seen for care)—or, if VA can’t determine this date—the date the Veteran prefers to be seen next
  • Veteran lives more than 40 miles (driving distance) from the nearest VA medical facility with a full-time primary care physician
  • Veteran must travel by air, boat, or ferry to get to the nearest VA medical facility
  • Veteran faces an excessive burden in traveling to the nearest VA medical facility (such as geographic challenges, environmental factors, or a health problem that makes it hard for you to travel)
  • VA will work with the Veteran to determine eligibility based on the above conditions and the Veteran’s specific circumstances.

 

Check out this PDF Fact Sheet to learn more about how to become a VA community provider.

VHA_How-to-become-a-Provider.pdf

 

Click below to learn more about claim submission, claim payment, and provider tools.

VA Provider Information

 

For more on Medical Billing & Coding, Healthcare Administration, and Insurance News and Updates, you’re already at the right place. Be sure to stay on top of everything by subscribing to the Rx for Success Medical Billing Blog here!

Resources & Credits:
“Any trademarks, logos, or links (sources) used throughout this blog are the property of their respective owners.”

%d bloggers like this: