VA Improves Timeliness of Provider Payments

Modification Enhances Veterans Access to Receive Timely, High-Quality Care

WASHINGTON – To enhance Veterans’ access to care and eliminate delays in Choice provider payment, the Department of Veterans Affairs (VA) is eliminating administrative burdens placed on VA community providers. Previously, payments to Choice providers were not allowed until a copy of the Veteran’s medical record was submitted. Now, community providers, under the Choice program, will no longer be required to submit medical records prior to payment being made. To facilitate the change, VA has modified the Choice Program contract, making it easier for Health Net and TriWest to promptly pay providers.

VA continues to require pertinent medical information be returned to ensure continuity of care; however, it is no longer tied to payment. VA is taking these steps to more closely align with industry standards.

“This administrative step just makes sense,” said VA Under Secretary for Health Dr. David J. Shulkin. “It ensures Veteran access, timely payments and strengthens our partnerships with our Choice providers. We know that providing Veterans access to high-quality, timely healthcare would be impossible without collaboration with our community providers.”

VA’s Plan to Consolidate Community Care Programs outlines additional solutions to improving timely provider payment. VA is moving forward on two paths to further improve timely payment.  First, VA is working toward a single community care program that is easy to understand, simple to administer and meets the needs of Veterans, community providers and VA staff.  Secondly, VA plans to pursue a claims solution that moves to a more automated process for payment. VA envisions a future state where it is able to auto-adjudicate or process a high percentage of claims, enabling the Department to pay community providers promptly and correctly, while adopting a standardized regional fee schedule to promote consistency in reimbursement.