Community Care

Region 1 map | Region 2 map | Region 3 map | Region 4 map | Region 5 map | Region 6 map

When a Veteran presents at an urgent care provider, you must check their eligibility for the urgent care benefit (this also activates their pharmacy benefit).

Check the Veteran’s eligibility by calling:

• For Regions 1-3, contact Optum at 888-901-6609
• For Regions 4-6, contact TriWest at 833-4VETNOW (833-483-8669)

If you need to contact a VA medical facility to obtain additional clinical information, please use the Emergency and Urgent Care Facility Contact List.

DO NOT charge the Veteran a copayment. Copayment charges are billed separately by VA as part of the VA billing process.

To encourage eligible Veterans to seek care when and where they need it, VA does not publish a specific list of covered services for urgent care.

However, VA excludes from the urgent care benefit preventive and dental services, as well as other items that are not included in the medical benefits package. Contact the TPA assigned to your region for more information.

Submit medical documentation within 30 calendar days to the Veteran’s home VA medical center (VAMC) via an approved method, such as Veterans Health Information Exchange (VHIE) or fax. Please also notify VA about any clinical concern needing follow-up.

Using the ZIP code of the Veteran’s residence, find the appropriate VA medical facility using the VA Facility Locator. Once the VA medical facility is determined, find the appropriate VA contact by using the Emergency and Urgent Care VA Facility Contact List.

Ensure you have activated the Veteran’s pharmacy benefit by calling to check their eligibility, AND
ensure the 14-day Rx is on the VA Urgent/Emergent Formulary.

The Veteran must fill their urgent care prescription in the same state as their urgent care visit to avoid any issues. To help a Veteran find an in-network pharmacy to fill their prescription in the same state as the urgent care visit, use the VA Facility Locator.

For telephone assistance finding an in-network, in-state pharmacy for a Veteran to fill their prescription:

• Call 888-901-6609 for AL, AR, CT, DC, DE, FL, GA, IA, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, NC, ND, NE, NH, NJ, NY, OH, OK, PA, PR, RI, SC, SD, TN, VA, VI, VT, WI, WV
• Call 866-620-2071 for AK, AS, AZ, CA, CO, GU, HI, ID, MP, MT, NM, NV, OR, TX, UT, WA, WY

In addition, please note:

• VA covers a 14-day supply (no refills) of prescription medication for urgent care.
• Prescriptions can be filled at an in-network pharmacy, at VA, or at a non-network pharmacy.
• If a non-network pharmacy is used, Veterans must pay for the prescription and then file a claim for reimbursement with their local VA medical facility.
• For a 14-day supply or greater, the prescription must be submitted to VA to be filled.
• Opiates are limited to seven days or less, consistent with state law covering the pharmacy’s location.

After providing urgent care to a Veteran, the in-network urgent care provider must file a claim within 180 calendar days with the TPA assigned to their region. The TPA will adjudicate and pay claims on behalf of VA.

Instructions for Regions 1-3 Urgent Care Providers (Optum)

For urgent care providers in AL, AR, CT, DC, DE, FL, GA, IA, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, NC, ND, NE, NH, NJ, NY, OH, OK, PA, PR, RI, SC, SD, TN, VA, VI, VT, WI, WV

• Regional Support:
  • Region 1: Call 888-901-7407 (M-F, 8:00 a.m. – 6:00 p.m. EST, excluding federal holidays)
  • Region 2: Call 844-839-6108 (M-F, 8:00 a.m. – 6:00 p.m. EST, excluding federal holidays)
  • Region 3: Call 888-901-6613 (M-F, 8:00 a.m. – 6:00 p.m. EST, excluding federal holidays)
• Electronic claims:
  • Use Payer ID "VACCN" OR
  • Visit the secure Optum Provider Portal. Select “I am a Provider” and then select "Medical/Behavioral Provider"
• Paper claims:
  • Mail to VA CCN Claims – MEDICAL, P.O. Box 202117, Florence SC 29502
  • Fax to 833-376-3047

Instructions for Regions 4-6 Urgent Care Providers (TriWest)

For urgent care providers in AK, AS, AZ, CA, CO, GU, HI, ID, MP, MT, NM, NV, OR, TX, UT, WA, WY

Please file claims within 30 calendar days with TriWest. TriWest will adjudicate and pay claims on behalf of VA.

• Regional Support: Call 877-226-8749 (8:00 a.m. – 4:30 p.m. CST)
• Electronic claims: Enroll for electronic transactions at the WPS Health Solutions website.
• Paper claims:
  • Mail to: MPS MVH, P.O. Box 7926, Madison WI 53707-7926

Instructions for Regions 1-3 Pharmacies (Optum/CVS Caremark Pharmacy Network)

For pharmacies in AL, AR, CT, DC, DE, FL, GA, IA, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, NC, ND, NE, NH, NJ, NY, OH, OK, PA, PR, RI, SC, SD, TN, VA, VI, VT, WI, WV

• Enter VA pharmacy claims using the following information:
  
  
  1. Step 1: Enter BIN: 004336
  2. Step 2: Enter PCN: ADV
  3. Step 3: Enter Rx Group: RX4136
  4. Step 4: Enter 10-digit Veteran ID
  5. Step 5: Enter Veteran’s date of birth (YYMMDD format)

For questions, please call the CVS Caremark Pharmacy Help Desk at 800-364-6331 (24/7).
NOTE: If the Veteran does not have their 10-digit Veteran ID, please use the patient's 9-digit Social Security number and call the on-site assistance line at 888-901-6609 (7 a.m. - 10 a.m. EST).

Instructions for Regions 4-6 Pharmacies (TriWest/Express Scripts Pharmacy Network)

For pharmacies in AK, AS, AZ, CA, CO, GU, HI, ID, MP, MT, NM, NV, OR, TX, UT, WA, WY

• Enter VA pharmacy claims using the following information:
  
  
  1. Step 1: Enter BIN: 003858
  2. Step 2: Person Code: 01
  3. Step 3: Enter PCN: A4
  4. Step 4: Enter Rx Group: VAPC3RX
  5. Step 5: Enter 9-digit member ID: Patient SSN
  6. Step 6: Enter Veteran’s date of birth (YYYYMMDD format)

For questions, please call the Express Scripts Pharmacy Help Desk at 800-922-1557 (24/7).

Can the urgent care benefit be used by a Veteran’s family member?
Only eligible Veterans can use this benefit. The urgent care benefit does not extend to family members and is nontransferrable.

How many times may a Veteran use the urgent care benefit in a calendar year?
There is no limit to the number of times a Veteran can access urgent care.