Community Care

Provider Payments

Once you file a claim for care provided to a Veteran or Veteran family member, VA adjudicates the claim and provides an electronic payment. VA is required to pay all medical and dental claims from providers electronically.

For claims submitted to one of VA’s Third Party Administrators (TPAs), such as TriWest Healthcare Alliance, for care provided through the Veterans Choice Program (VCP) or Patient-Centered Community Care (PC3) networks, you will receive a payment from the same TPA. For claims submitted for care provided through a Veterans Care Agreement, you will receive a payment directly from VA. Please note: VCP ended on June 6, 2019.

If you have specific questions regarding your claims, please contact the claims processing unit that adjudicated your claim. This information can be found on your claim and they will be able to provide clear guidance on the steps you need to correct your claims.

For information on how to check the status of a claim, please visit Check Claim Status.

Electronic Payments

The U.S. Department of Treasury published a final rule on Electronic Funds Transfer (31 C.F.R. 208) that requires all federal payments be made electronically. This requirement includes payments made to community medical and dental providers. Community care providers must enroll for Electronic Funds Transfer (EFT) in order to to meet this requirement. With EFT, payments are deposited directly into a bank account.

Complete VA Form 10091, VA-FSC Vendor File Request Form, and be sure to check the box marked "Update."
Fax the completed, signed form to the FSC, Vendor Support Section.

Financial Service Center Nationwide Vendor File
Fax: 512-460-5221

For questions regarding enrollment or updates to EFT information on file, please contact the VA-FSC, Vendor Support Section at the phone or email listed above.

Audit for Recovery of Community Care Overpayments

VA is committed to maintaining a strong relationship with community providers, who are critical to ensuring Veterans receive timely, high-quality care, while also ensuring proper stewardship of public funds.

As required by federal law, in 2016 VA awarded a contract to perform an audit of community care payments to identify potential overpayments and recover funds. The audit, much like recovery audit contracts with Medicare or commercial insurances, is a review of claims and supporting medical documentation. VA subsequently became aware that certain claims were not being processed in accordance with VA’s payment regulations, resulting in overpayments; these claims were included in the recovery audit contract.

VA takes our relationships with community providers very seriously and, after listening to concerns raised by providers and evaluating VA’s internal processes and federal financial requirements, VA ended the audit. As a result, VA suspended debt collections for community care payments through a third-party auditor while it pursues additional approaches that will take into account individual community provider circumstances and alternative payment options while also ensuring proper stewardship of public funds.

If you have a question or concern about the audit, please contact VHAOCC.RecoveryAudit@va.gov.

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