Community Care

Request and Coordinate Care

Strong care care coordination between VA and community providers ensures Veterans receive timely, high-quality care. VA’s care coordination model is a Veteran-centered, team-based approach involving five steps:

1. Receive request for community care: Several events can trigger the receipt of a request for community care, such as:
   • A new Veteran visit
   • Receipt of a referral from a VA or community provider
   • A hospital notification
   • An inpatient admission or emergency department visit.

It is the responsibility of the community care team to receive these requests, assign staff to manage them, and to confirm eligibility and authorize services indicated in the consult. Referrals and authorizations for community care are managed through the HealthShare Referral Manager (HSRM) system. See below for more information about HSRM.

2. Assess Veteran needs: The VA facility community care staff determines the appropriate level of care coordination for each Veteran through the use of the Screening Triage Tool combined with clinical judgement.
3. Develop care coordination plan: Community providers and the VA facility community care integrated team will develop an individualized care coordination plan to include: scheduling, navigation and other follow-up activities. Care coordination involves determining the complexity of care needs of the Veteran who receives care in the community followed by coordination of care delivery and transition back to the VA.
4. Implement care coordination plan: The VA facility community care integrated team will facilitate a collaborative relationship regarding all aspects of the care coordination process. This helps streamline the flow of information between Veterans, the VA community care integrated team, VA providers, and the community provider.
5. Follow-up and complete episode: The VA facility community care team will follow-up with the Veteran to ensure all services were performed appropriately, perform any necessary handoff and close the consult. Throughout the episode of care, the facility community care staff should be monitoring and tracking the Veteran.

Facility Contact Numbers for Care Coordination
Use this list of VA medical facility contacts to locate and contact the nearest VA medical facility community care office in order to coordinate care for a Veteran.

VA has several tools available for community providers that help support the continuity of care Veterans receive, including HealthShare Referral Manager, Community Viewer, and Azure RMS.

• Request for Service
• HealthShare Referral Manager
• Community Viewer
• Azure Rights Management Services (RMS)
• Veterans Health Information Exchange

Request for Service (RFS) Requirements

VHA has implemented a standardized form for Community Providers to request additional or continued care or services for Veterans. The purpose of the Community Care Provider-Request for Service, VA Form 10-10172, is to manage requests from community providers and to allow for placement, tracking, managing, and reporting of those requests. Approved care may be performed within VA or at community facilities. The location is dependent on the service availability within VA as well as the Veteran’s community care eligibility and preferences.

The use of the RFS form is recommended for clinical requests from a community provider to facilitate review and authorization. All supporting medical documentation must accompany the completed form, this may include laboratory and radiology reports or provider progress notes. If additional information is needed to authorize the request, the community provider will be contacted and will have three business days to provide the necessary requested documentation or the request will be denied.

The VA Medical Center staff will process all requests within three business days and the community provider will be notified of the decision or outcome via their preferred method of communication. The notification will also indicate if the care will be provided within VA or in the community. If the care is denied, it is the responsibility of the requesting community provider to contact the Veteran and discuss alternate treatment plans.

Community Care Provider-Request for Service (RFS), VA Form 10-10172

HealthShare Referral Manager

HealthShare Referral Manager (HSRM) is a secure, web-based system VA uses to generate and submit referrals and authorizations to community providers. HSRM allows community providers and VA to better manage community care for Veterans. The system’s robust functionality facilitates reduced turnaround time for processing referrals, providing care, submitting claims, and receiving payment. Registration, training, and technical support for HSRM are available to community providers at no cost!

Benefits

• Fosters health information exchange (HIE) between VA and community providers through one unified platform
• Promotes reduced turnaround time for authorizations and reimbursement
• Provides easy access to bundled care/standardized episode of care (SEOC) details
• Indicates which services are required and how to acquire precertification when necessary
• Reduces time spent waiting for fax, phone, or email contact prior to serving a Veteran

How to Access HSRM

If you are interested in using HSRM, confirm your facility meets the following criteria:

1. Your facility has an active network agreement (i.e. Community Care Network (CCN), TriWest) or Veterans Care Agreement (VCA) with VA.
2. A point of contact from your facility has reached out to the Community Care Point of Contact at the VA Medical Center(s) you partner with to:
   • Confirm that your facility’s specialty can be processed in HSRM
   • Request the exact facility name/location on the Provider Profile Management System (PPMS) record for your National Provider Identifier (NPI) numbers
   • Obtain concurrence to move forward with HSRM at this time

HSRM Community Care Points of Contact List

Follow the steps below to obtain access to HSRM. Resources mentioned in the following steps are available in the HSRM Training and HSRM Resources sections below.

1. Attend the training webinar on VHA TRAIN or access the eLearning lessons listed in the HSRM Training section below, or review the HSRM Community Provider User Guide to learn how to use HSRM.

NOTE: It is highly recommended that the training webinar hosted on VHA TRAIN is attended prior to obtaining access to HSRM. The training sessions include an overview of HSRM, an in-depth walkthrough of the system, and additional time for questions.

2. All users sign up for an ID.me account using the steps outlined in the HSRM Single Sign-On External (SSOe) Quick Reference fact sheet.
3. One facility point of contact from your organization fills out the End User Tracker Template with all the names and emails of end users requiring HSRM access.

NOTE: Please ensure the email addresses listed match those used for each respective user’s ID.me account.

4. The facility point of contact submits the End User Tracker to the HSRM Help Desk.
5. The HSRM Help Desk will provide the facility point of contact with confirmation that staff access has been granted.

Figure 1: Sign Up Steps for Community Provider Referral Processing Staff

HSRM System Training

For interested community providers, HSRM trainings are offered weekly through the Veterans Health Administration (VHA) Training Finder Real-time Affiliate Integrated Network (TRAIN) website. The HSRMregistration information sessions will provide an in-depth walkthrough of the process to obtain access to HSRM (i.e. creating an ID.me account and completing the End User Tracker). Please check VHA TRAIN for available dates and register in advance. A free account in VHA TRAIN is required in order to register for the webinar.

HSRM Registration Information Session

For interested community providers, HSRM registration information sessions are now offered weekly through the VHA TRAIN website. The HSRM registration information sessions will provide an in-depth walkthrough of the process to obtain access to HSRM (i.e. creating an ID.me account and completing the End User Tracker). Please check VHA TRAIN for available dates and register in advance. A free account in VHA TRAIN is required in order to register for the webinar.

HSRM eLearning

Community providers can also learn about HSRM system functionality through self-paced eLearning, available 24/7 through VHA TRAIN. A free account in VHA TRAIN is required in order to access the eLearning.

Frequently Asked Questions about HSRM

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Request Access to Community Viewer

To request access to CV, email the Community Provider Technical Service Desk, or the VA staff resource who assigns patients to you. When requesting access, please provide your Community Provider NPI number and email address. You will use your NPI number as your user name and receive a password from VA staff which will allow you to log into CV to view the Veteran’s VA health history.

Frequently Asked Questions about Community Viewer

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Azure Rights Management Services (Azure RMS )

As of August 24, 2019, VA has transitioned from Virtru Pro to Azure RMS for encrypted email. Azure RMS allows VA to securely exchange information with community providers using encrypted email. With Azure RMS, community providers no longer have to wait for a Veteran’s information via fax or mail. Azure RMS enables safe communication about Veterans’ health information through email.

How Azure RMS Works

When a community provider receives an email from VA encrypted through Azure RMS, they will be able to seamlessly read and respond to the email through the existing email provider or open the email in a web browser and read and respond securely.

Access to Azure RMS

To access Azure RMS, you do not need to install any software to receive and reply to secure messages from VA. Azure RMS is accessed directly through email in the same way you receive other emails.

If you, as a provider, want to reply to an older message that was encrypted with Virtru Pro (the previous encryption software), you will continue to have the ability to do so. On the VA side, the VA user will still get notice of the email response and can open the email in the Virtru Pro Secure Reader via a web browser.

Frequently Asked Questions about Azure RMS

Veterans Health Information Exchange (VHIE)

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