VA Creates Call Center to Reduce Claims Reimbursement Delays
A community call center was created by the VA to help veterans and healthcare providers with debt collection and credit reporting issues due to delays in claims reimbursement for the Choice program.
By - The Department of Veterans Affairs (VA) has established a community care call center to assist veterans and healthcare providers who are experiencing issues with debt collection because of incorrect or delayed claims reimbursement payments under the Veterans Choice Program, according to a recent announcement.
The call center was created to help veterans who are being improperly billed for treatment because healthcare providers are not being reimbursed for claims under the Choice program. The VA staff can help medical providers repair negative credit reports for veterans and assist veterans with debt collection issues.
“As a result of the Veterans Choice Program, community providers have seen thousands of Veterans. We continue to work to make the program more Veteran-friendly,” Dr. David Shulkin, Under Secretary for Health, said. “There should be no bureaucratic burden that stands in the way of Veterans getting care.”
The Veterans Choice Program allows eligible veterans to seek care outside of VA healthcare facilities for primary care physicians, specialists, and behavioral health providers. Veterans can receive approved care from community-based providers when the local VA health care facility does not have the available specialists, extended wait times of 30 days or more, or the VA facility is 40 miles or more from the veteran’s home.
To seek care from non-VA healthcare providers, Choice program veterans need prior authorization from Health Net Federal Services, LLC, who will authorize and schedule the appointment with the healthcare provider.
Healthcare providers can then submit claims and medical documentation to Health Net for reimbursement within 120 days of care. The VA reports that clean claims will be processed within 30 days and claims that are older than 30 days will be paid interest in addition to the reimbursement payment.
Non-VA physicians are experiencing excessive delays in reimbursement payments. In many situations, the healthcare providers end up billing veterans for the care provided. Veterans foot the medical bills and oftentimes, cannot pay, resulting in negative credit reporting. Many physicians stop treatment because of failure to pay.
What was designed to shorten wait times and provider a wider net of quality care for veterans is leaving veterans with lengthy waits for Health Net approval for appointments, hefty bills, and, in some cases, no care at all.
The VA also recently announced efforts to reduce administrative burdens on community providers. To improve timeliness of provider reimbursement, healthcare providers no longer need to submit patient medical records before being reimbursed. Medical records will need to be submitted, but it will not delay payment. This is another effort of the VA to automate its reimbursement system to ensure all providers are paid quickly and correctly.
“This administrative step just makes sense,” Shulkin said in a March 1 announcement. “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.”
The VA acknowledges that delays with claims reimbursement has caused significant stress for veterans and providers. With this in mind, the VA hopes to create a single community care program that is simpler and more convenient for veterans and community healthcare providers.
For assistance with debt collection and claims reimbursement issues, veterans and medical providers can call the Community Care Call Center at 1-877-881-7618.
