Veteran Care Agreements (VCA)
VCA overview
Veteran Care Agreements (VCA) give VA the flexibility to partner directly with community providers to ensure Veterans can access timely, high-quality care.
VCAs are used in limited situations where services through the VA Community Care Network (CCN) are either not provided or not sufficient. Providers who enter into a VCA provide services at VA’s request and receive payment directly from VA.
Credentialing and certification
Community providers interested in establishing a VCA can contact your nearest VA medical facility to start the process. They will determine if a VCA is needed and help you get started.
If a VCA is appropriate, you must complete a credentialing process managed by RLDatix/Verge Health. This process verifies that you are licensed, qualified, and competent to deliver care to Veterans.
- All new and existing VCA providers must complete the credentialing assessment.
- You will submit documentation through the RLDatix/Verge Health portal.
- Once approved, your VCA will remain active for three years as long as you maintain VA certification standards.
Referrals and authorizations
After credentialing is complete and a VCA is signed, you may begin receiving referrals from VA.
- Referrals define the scope of services you are authorized to provide to each Veteran.
- Veterans must receive VA approval before obtaining care in most cases.
- You will typically receive referrals through the HealthShare Referral Manager (HSRM) system.
Claims and payments
As a VCA community provider, you will submit claims directly to VA. You can do this either through electronic data interchange (EDI) or by mailing the claim to the address provided in the referral.
IMPORTANT: Community providers cannot receive payment for care provided to Veterans through a VCA until the VCA is established and signed. VA is not responsible for payments prior to approval of a VCA.
VA reimburses claims based on established payment standards:
- For Medicare-recognized services, VA follows Medicare reimbursement rates.
- For non-Medicare services, VA pays according to the appropriate VA fee schedule or billed charges.
VA is responsible for any payments arising from authorized VCA care. You may not collect, or attempt to collect, payment from a Veteran or a Veteran’s other health insurance for care authorized under a VCA.
Claim status
To check the status of a claim, you can use VA Customer Engagement Portal (CEP). This secure web application allows you to:
- Track claims submitted to VA
- Review previous, current, and future payments
- Check the status of CMS 1500 (HCFA-1500) or CMS 1450 (UB-04) claims forms
Frequently asked questions
Can a group practice sign one VCA?
Yes. A single agreement can cover a group practice if it lists the National Provider Identifier (NPI) numbers of all included providers.
When can a VCA be terminated?
Termination terms are outlined in the signed agreement.
How often must information be updated after a VCA is established?
Any changes that affect provider status must be reported to VA within 10 business days, as specified in the agreement.
How are referrals received under a VCA?
Referrals are issued on an authorized VA form through HSRM, secure fax, email, or mail.
Who resolves payment disputes?
The VA medical facility that issued the referral or authorization is responsible for resolving disputes.