Authorization Requirements

All initial care under the Veterans Choice Program (VCP) and Patient-Centered Community Care (PCCC) require prior authorization from Health Net Federal Services, LLC (HNFS). When the veteran’s local U.S. Department of Veterans Affairs (VA) health care facility indicates a veteran is eligible to receive care in the community, HNFS processes the request from VA and coordinates with the veteran to assign a provider for care.

For information on what is covered under an authorization, visit our Covered Services page.

Provider Packet and VA Consult

When a provider in your practice is selected to render services, he or she will receive an authorization (also called a provider packet) from HNFS. The provider packet contains veteran-specific information, including authorization validity dates, services and number of visits approved, services excluded (when specified by VA), and reminders of general program guidelines to follow for coordination of care and payment.

Please share the HNFS provider packet details with all treating providers to ensure proper claims processing.

Health Net Federal Services will fax VA referral documents/consult details under a separate cover sheet, when available.

See additional program-specific authorization information below.

Veterans Choice Program

Eligibility for VCP is determined by VA and dependent upon certain criteria. Upon determining the veteran's eligibility, VA will send notification to HNFS.

Once an authorization is approved, HNFS will gather the veteran's appointment preferences and begin the appointment setting process*. An episode of care authorization may be valid up to one year from the date of the first appointment. However, the approved date(s) of care will be located in the provider packet.

*This process is slightly different for veterans living in or around the Fargo, North Dakota, Ft. Harrison, Montana, and the Madison and Tomah, Wisconsin areas. Visit our Scheduling Initiative page for additional information.

Important Note: VA has implemented standardized episodes of care, also known as bundled services, on certain authorizations. These authorizations encompass an overall course of treatment, rather than a specific service(s). Learn more on our Bundled Services page.

Patient-Centered Community Care

Eligibility for PCCC is determined by VA and dependent upon the care needed outside of VA facilities.

Upon determining the veteran's eligibility for PCCC care, VA will send notification to HNFS. Once an authorization is approved, HNFS will gather the veteran's appointment preferences and begin the appointment setting process.

If the servicing provider determines it is necessary to continue care after the approved date(s) of service or additional services are needed, they must complete a Request for Additional Services form and submit it to HNFS for review. Visit our Requesting Authorization for Additional Services page to learn more on secondary authorization requests.

Veterans Crisis Support

Support for your patients who are U.S. Veterans:

  • 1-800-273-8255 Press 1
  • Confidential chat at VeteransCrisisLine.net or text to 838255

Because one small act can make a difference.