About Us

Introduction

Our primary mission is to administer federal health benefit programs for veterans and their family members. These benefit programs include the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) including the CHAMPVA In House Treatment Initiative (CITI) and the CHAMPVA Meds by Mail program. We also administer the Spina Bifida Health Care Program, the Children of Women Vietnam Veterans Health Care Program, and the Persian Gulf Examination Program for Dependents. We also run two programs specifically designed to cater to veterans: the Foreign Medical Program, which provides service to veterans living or traveling throughout the world, and the Fee program, which provides services to veterans who need care outside a VA medical center. Our responsibility for these programs includes: benefits management, eligibility determination, customer service, outreach and education, claims processing, appeals and grievances and fraud, waste and abuse prevention.

Things we do at the HAC to support the primary mission include:

• Maintaining a robust, advanced technology information system that includes an automated claims processing system that employs electronic document imaging, artificial intelligence and a commercial claims scrubber.
  
• Actively engaging Electronic Data Interchange (EDI) technology and developing electronic commerce applications for health care claims processing.

Our other HAC missions include:

• Serving as the VHA Office of Mail Management providing support to all VHA facilities.
  
• Managing the national recovery audit -- a multi-year, multi-million dollar contract identifying overpayment for inpatient services for veterans and their family members.
  
• Providing human resource, contract/acquisition, financial and information systems support to various VHA field activities. The HAC supports almost 200 staff across the United States.
  
• Housing representatives from the VA Office of Information and the Office of the Inspector General.

Our History

In June 1986, the VA centralized management of the CHAMPVA Program at the Denver VA Medical Center and from 1973 through 1986, VA medical centers were responsible for processing CHAMPVA applications and determining if applicants were eligible for the program.

Initially, the Denver VA Medical Center was responsible only for beneficiary eligibility determinations, however, in 1990, our then fledgling organization began to assume responsibility for all aspects of the program including claims processing, which previously had been done by the Department of Defense. In the early 1990s, the organization separated from the Denver VA Medical Center and we became the CHAMPVA Center, a field activity of VHA´s central office.

By January 1, 1994, we had become fully responsible for performing all CHAMPVA program administrative functions, including claims processing, beneficiary eligibility determinations and payments for beneficiaries residing in the 50 States, the District of Columbia and Puerto Rico. For this effort, the Center was honored with a National Performance Review Hammer Award in 1995. We complete the transition into our own organization January 1, 1996, when we assumed responsibility for all foreign CHAMPVA claims processing and payments.

With the implementation of numerous program initiatives between 1990 and 1996, the role of the CHAMPVA Center continued to expand.

In 1992, we instituted the CHAMPVA In House Treatment Initiative (CITI), which gave VA medical centers the option to provide care to CHAMPVA beneficiaries when the medical center has the space and capacity to do so after serving veterans. Currently 95 VA medical centers participate in this program, each with a unique offering of services based on local capability.

In 1994, we assumed responsibility for the VA´s Foreign Medical Program (FMP). Under this program, we pay for health services required for veterans with service-connected disabilities who live or travel overseas. The successful transfer of the program resulted in significant reduction of costs and increases in efficiency, earning us a VA Scissors Award.

The same year we also took the lead to initiate and negotiate an interagency process redesign that changed the process by which payment checks and explanation of benefits could be mailed together instead of separately. With the Department of Treasury´s Austin Center as our partner, we saved the Federal Government over $225,000 in postage costs and received another Scissors Award for this effort.

Late in 1995 we further expanded services to CHAMPVA beneficiaries through a mail-order pharmacy program providing improved access to care and decreased costs to the beneficiary and to the government. The mail order pharmacy program, called Meds by Mail, received a VA Scissors Award in 2000 for excellence and innovation. In fiscal year 2004, the program reached 52,700 beneficiaries and saved the VA $61.93 million. We expect the program to continue to expand as controlled medications have recently been added. In fact, to provide quality service to our ever-growing population of users, and to ensure redundancy, we have expanded our Meds by Mail operations, which currently include the Cheyenne VA Medical Center and the Leavenworth CMOP, to include the Dublin VA Medical Center. The VA medical centers serve as "the pharmacy" where beneficiaries send prescriptions and as points of contact for Meds by Mail users.

In 1996, we were selected to process claims for family members of Gulf War veterans who needed a physical examination. Sadly, this program is slowly coming to an end and very few family members are still obtaining physicals at VA expense.

In 1996, the Department of Veterans Affairs officially changed the name of the CHAMPVA Center to the VA Health Administration Center.

In 1997 we became the home of the Spina Bifida Healthcare Program. Under this program, children of Vietnam veterans with spina bifida are provided a full range of health care services related to their spina bifida related conditions. At the end of June 2004, there were 1180 beneficiaries enrolled in this program. Of this number, five we added as a result of recent legislation extending benefits to certain Korea veterans.

Another feather in our cap during 1997-1998 was when VISN 19 and we partnered in a centralized claims processing demonstration for the VA´s Fee Program. This pilot provided tremendous information that has been of value to the VA in other areas of claims management.

In June 2001, the President authorized the extension of benefits for CHAMPVA beneficiaries over the age of 65 to become effective October 1, 2001. We contacted over 250,000 individuals notifying them of their eligibility for this program. Since October of 2001, CHAMPVA has added 118,000 new enrollees, growing at a rate of 40% in FY03 and 33% in FY 04.

In the summer of 2002, we were tasked to begin the centralization of claims processing for the VA´s "Fee" program and to ensure that the program met HIPAA mandates by October 2003. To do this our management team used an innovative web-based approach to claims processing that provides centralized claims processing, maintains control of funds and health care access at the VAMC level.

Because of our claims management expertise, in 2003 we were given program responsibility for the national Fee program. As such we provide policy and program guidance to all VHA activities and sponsors the National Non-VA Advisory Council. In late March 2004, our Fee team rolled out Fee 101, the first standardized national training program for fee clerks and recently in the Spring of 2005, the Center rolled out a second national training program for fee supervisors.

Staffing

Our staff has grown slowly over the 15 years since its creation. An initial staff of three or four programmers began developing the eligibility and claims software in 1986, before we were even chartered. However over time as our mission changed from eligibility determination to claims processing for CHAMPVA, to new and expanded benefits programs and then to include other non-health benefits missions, the staff has grown to approximately 485 civil servants and 80 contracted staff.

Through the use of imaging technology and EDI applications, the HAC has developed a state-of-the-art claims processing system that is among the most advanced in the industry. The system contains an artificial intelligence component and utilizes a commercial software system called ClaimCheck ®. Our artificial intelligence system saved us $10.5 million from FY96-03. The use of ClaimCheck ® software saved $26.8 million from FY96-03. The Center accepts institutional and hospital-outpatient claims through EDI. EDI and HIPAA hold the promise of being able to help the Center control costs. In late 2002, we implemented optical character recognition technology, which is expected to reduce claims processing times. In the Fall of 2003, our claims management met HIPAA transaction set standards for all programs including Fee. According to a March 31, 2004 report of an audit of our HIPAA compliance practices by Price Waterhouse Coopers, the "HAC is on par with the leading health plan organizations and well ahead of many others."

Currently we are the only health care plan management organization in the Federal Government that is directly involved in claims processing (Medicare and TRICARE both utilize commercial claims processors).

We also currently utilize technology to provide quality services and minimize staffing needs. For example, beneficiaries can use a state of the art phone system to check on claims status as well as through the Internet. Additional features include the ability to update other health insurance information via the Internet and a process for providers to check on payments due them via the phone and Internet.

Industry Comparison

We continually look to our industry competitors to compare our performance in all facets of health care management. A recent review showed that the HAC continues to be a great bargain for the taxpayer. The table below summarizes the latest comparative information.

Customer Satisfaction

We pride ourselves on having a robust customer satisfaction program. Major surveys of beneficiaries are conducted about every other year. However, ongoing surveys include polling beneficiaries who have used the call center, sending out surveys in correspondence and analyzing web site usage data.

Since the multi-million dollar expansion of our phone system in June 2001, we have virtually eliminated busy signals, and the average wait time to reach a live operator is rarely over 3 minutes with over 40% of our calls answered in 30 seconds or less. Our post-call satisfaction survey shows that beneficiaries are satisfied with the service provided more than 97% of the time. Comments from the survey were very positive as these two examples demonstrate; "You´ve come a long way! Thanks!" and "I just don´t know what I would do without you folks. I thank you."

Our 2003 Spina Bifida survey showed that more than half of the Spina Bifida beneficiaries noticed a significant improvement in call center services. We also decreased the dissatisfaction rate with the preauthorization process from 13% in 2001 to 8% in 2003. Since the survey, additional changes have been made to the preauthorization process.

In 2001, in a joint survey with VBA, we asked over 1000 veterans living overseas about the Foreign Medical Program. The primary concerns were the need for toll free lines and the length of time it takes to process a claim. The HAC is in the process of providing toll free service for countries where we have the 10 largest veteran populations. Since the Fall of 2003, processing time for claims has dropped from more than 60 days to 12-18 days. Our newest survey, which was released in March 2004, allows the veterans to respond online via the Internet or on paper. So far, over 100 veterans have responded via the Internet.

Center Leadership

The Center Directors have included: Charles DeCoste, 1989-1996, Michael Hartford, 1997-1999, Mary Beth Saldin (Acting) 1999-2000, and Ralph Charlip, 2000-2007. Mary Beth Saldin was appointed HAC Director in March 2008.