VA offers Indian Health Service (IHS), Tribal Health Programs (THP), and Urban Indian Organization (UIO) reimbursement agreements that allow VA to reimburse participating IHS/THP/UIO (I/T/U) health care facilities for care provided to eligible American Indian and Alaska Native Veterans. Reimbursement agreements are a key partnership that improves access to care, supports resource sharing, and respects Veterans’ preference for Native healthcare.

Eligible American Indian and Alaska Native Veterans participating in this program:

• Do not need VA preauthorization to receive services at participating facilities
• Do not pay VA copays for care at these facilities
• Can choose to receive culturally sensitive care in their home community

For Alaska, VA reimburses the Alaska THPs for VA preauthorized care provided to Non-Native Veterans.

Start a reimbursement agreement

Indian Health Service, Tribal, and Urban Indian health facilities must have a signed reimbursement agreement in place to receive payment for care provided to eligible American Indian and Alaska Native Veterans.

Contact the I/T/U Reimbursement Agreements Program Team to begin a reimbursement agreement. Include your facility’s name, address, phone number, and primary contact.

Steps in the agreement process:

1. Onboarding meeting. We will cover how reimbursement agreements work, required documentation, and next steps.
2. Required documentation. Your facility must provide:
   • An implementation plan identifying services offered, facility points of contact and a documentation completion checklist.
   • Electronic payment setup (VA Form 10091 submitted through the Financial Services Customer Engagement Portal).

3. Agreement execution. Once the agreement is signed, your facility may begin submitting claims for reimbursement.
4. Orientation. We will connect you with a local VA medical facility for billing and coordination support.

Verify Veteran eligibility

Facilities must confirm that a Veteran is enrolled in VA health care before submitting claims.

How to verify eligibility

Small number of Veterans (5 or less)

• Contact VA Health Eligibility
  • Health Eligibility Center: 855-488-8441, Monday-Friday, 7:00 a.m.–5:30 p.m. ET.
  • Health Resource Center: 877-222-VETS (8387), Monday–Friday, 8:00 a.m.–8:00 p.m. ET
    
    
• Contact the enrollment and eligibility office at the VA medical facility listed in your facility’s implementation plan. VA staff can confirm enrollment status and other benefits.
  • Provide the Veteran’s name and Social Security Number. Staff will confirm enrollment status and enrollment date.
    

Larger groups of Veterans

• Complete the Veteran Eligibility and Enrollment Verification Template
• Send a message to the I/T/U Reimbursement Agreements Program (RAP) Team for a secure email message.

Secure data transfer

Some reimbursement agreement processes require facilities to send sensitive information (such as PRC invoices or supporting documents). This information must be sent through secure messaging.

Tribal and Urban Indian facilities

Begin by sending an email to VA. VA will reply with an encrypted email link. Open it, sign in with a one-time passcode, and reply with your documents attached.

• For AI/AN Veteran eligibility check, email the I/T/U Reimbursement Agreements Program Team
• For claims inquiry, email the VA Payment Operations Support Group

Indian Health Service (IHS) facilities

Use the IHS Secure Data Transfer Service to send and receive documents. To request access, email Cynthia Larsen, IHS Office of Resource Access and Partnerships.

File a claim

Facilities may submit 2 types of claims under a reimbursement agreement:

• Direct care claims for services your facility provides directly to Veterans.
• Purchased/Referred Care (PRC) claims for services your facility pays for when a Veteran is referred to an outside community provider or when contracted travel is used.

The billing process is similar for both, but the documentation requirements are different.

Direct care claim

Direct care claims are for services your facility provides directly. VA reimburses for these services after any other health insurance has been billed.

Primary insurance is billed first. If the Veteran has other health insurance, bill that plan first. VA pays the balance that remains, up to the agreed reimbursement rate.

For pharmacy claims

• For Indian Health Services and Tribal Health Programs, VA will reimburse claims for outpatient pharmaceutical on the IHS/THP formulary.
• For Urban Indian Organizations, VA will only reimburse claims for pharmaceutical drugs listed on the VA National Formulary.

What to include

• A copy of the Explanation of Benefits (EOB) or Explanation of Payment (EOP) from the primary insurer.
• A completed medical/pharmacy claim form (an 837 EDI is preferred; paper CMS 1500 or 1450 accepted). Ensure IHS, THP, or UIO is added to the SBR03 segment of the 837 for proper routing.

How to submit

• Electronic (preferred): Submit through a clearinghouse using VA payer IDs
  • Medical claims: 12115
  • Dental claims: 12116
  • Inquiry transactions: 00231
    
    
• Paper (if needed): IHS facilities must send paper claims by Certified Mail.

Claim submission deadline

Claims must be submitted within 36 months of the date of service.

Purchased/Referred Care claim

PRC claims apply when your facility pays for outside care or contracted travel for a Veteran. Because your facility is responsible for paying those outside costs first, the documentation requirements are more extensive.

Outside providers must bill other insurers before your facility pays the claim. VA reimburses your facility for the portion you paid to the outside provider, once all other payers have been processed.

VA reimburses approved PRC invoices within 45 days. Payments are made by EFT or mailed check, using the account or address on file in the VA vendor system.

What to include

• Claim form (CMS 1450 or 1500) from the outside provider.
• Explanation of Benefit (EOB), or Payment (EOP), from any primary payer/other health insurance billed.
• Completed invoice using the provided templates. The invoice amount must match supporting documentation.

How to submit

IHS facilities submit through the IHS Secure Data Transfer Service. IHS facilities use the IHS Secure Data Transfer Service to share secure emails with VA.

THP facilities request a secure message from the VA Payment Operations Support Group, then reply with your invoice and supporting documentation attached. VA Payment Operations will review your submission and reply with an approved/rejected decision using the same secure email or message you submitted to VA.

Corrected invoices: Submit corrections using the same process, but mark as “correction.”

Claims status check

To check the status of IHS/THP/UIO submitted claims, the following options are available:

eCAMS Provider Portal

eCAMS Provider Portal provides claims status information as well as copies of Explanations of Benefit and Explanations of Payment. Providers must register to access payment information through eCAMS.

For assistance, call or email eCAMS Support.

National Contact Center

You may also call the Office of Integrated Veteran Care National Contact Center to obtain claims status information. If needed, we can direct you to Western Region Payment Operations for specific claims help. 

Western Region Payment Operations

You can email Western Region Payment Operations directly for questions or issues with claims.

Care coordination

If your facility cannot provide the care a Veteran needs, the Veteran may be referred to VA or to a community care provider.

Facilities must use the VA standardized Request for Services (RFS) process for these referrals. The RFS process ensures VA can coordinate and authorize the appropriate care. More information, including local VA points of contact, is available on the Care coordination page.

Training

Military Culture training: Understanding military culture helps providers tailor services to Veterans. The VA and Department of Defense developed this interactive, four-module training covering:

• Military organizations and roles
• Stressors unique to military service
• Treatment resources and best practices

Native Cultural Awareness: VA also recommends the following resources to strengthen cultural awareness when serving American Indian and Alaska Native Veterans:

• SAMHSA Native Culture Card : A practical guide for building cultural awareness.
• IHS Gold Book : A four-part publication reviewing lessons learned and culturally acceptable health practices from first 50 years of IHS.
  • IHS Gold Book–Part 1
  • IHS Gold Book–Part 2
  • IHS Gold Book–Part 3
  • IHS Gold Book–Part 4