Filing a Claim for Non-VA Care

The VA may authorize veterans to receive care at a non-VA health care facility when the needed services are not available at the VA health care facility, or when the veteran is unable to travel the distance to the VA health care facility, or in the case of an emergency. Non-VA care must be authorized by VA in advance. Veterans may also obtain services not covered in the benefits package through private health care providers at their own expense.

In limited circumstances, VA may authorize payment for health care services outside a VA Medical Center. Payment for care outside VA is governed by strict federal regulations; service-connected disability rating is the basic criteria for most authorized care outside a VA facility.

Contact your local VA health care facility’s Fee Basis office or the Health Benefits Services Call Center at 1-877-222-VETS (8387) for additional information.

Payment decisions are based upon eligibility criteria, medical necessity, and availability of the service within the VA HealthCare system. A veteran may always submit a claim for payment consideration.

How to File a Claim for Preauthorized Non-VA Provided Care

Claims submitted for payment consideration of costs of preauthorized medical services provided to veterans must include a completed CMS 1500 and/or UB-04 billing forms to include, at a minimum the following information:

• Full name (include middle initial)

• Full address (include zip code)

• Patient Full Social Security Number

• Full name of provider

• National Provider Identifier (NPI) Number

• Provider taxonomy code(s), if known

• Tax Identification Number (TIN/EIN)

• Professional Status of Provider (ex. MD, PhD, CRNA, etc.)

• Physical address where care was provided

• Mailing address where payment should be sent

• All appropriate medical coding

• Any other health insurance information

Note: If you are requesting reimbursement for bills you’ve paid “out-of-pocket”, you must have the claims information listed above, as well as receipts (cash, check, or credit card) clearly acknowledging payment made for specific medical care and services

Claims for payments for your health care should be submitted to the Fee Department of the VA facility that authorized payment of care in advance. If you are not sure if VA authorized payment of care in advance, you may submit health care claims to the nearest VA Medical Center Fee Department. Please keep copies of all documents submitted to the Fee Office.

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