Requesting Authorization for Additional Services

Visit our Authorization Requirements page for initial authorization and provider packet information.

Note: Secondary Authorization Requests (Request for Additional Services) for veterans attached to the Fargo, North Dakota, Ft. Harrison, Montana and Madison, Wisconsin VA Medical Centers (VAMCs) should be submitted to the VAMC for review. Visit our Scheduling Initiative page for additional information.

Veterans Choice Program

When to request additional services

Please review the guidelines below before faxing a Request for Additional Services form to Health Net Federal Services, LLC (HNFS) for your Veterans Choice Program (VCP) patients. Most services will be covered under the initial authorization, even if the veteran must be seen by a different provider.

Under VCP, additional prior authorization from HNFS is required when the veteran:

  • requires care beyond the approved dates;
  • requires care beyond the number of visits/units authorized;
  • needs care for another medical condition or body part (including other joints); and/or
  • requires an inpatient admission, when specifically excluded on an existing authorization. (Note: If inpatient services are not specifically excluded, HNFS only requires providers submit an Inpatient Notification Form.)

Providers also must request additional authorization for the following:

  • services specifically excluded from the authorization
  • urgent consultations required as a result of a newly identified critical finding (such as cancer)

Important Note: When determining if additional authorization is required, and your provider packet indicates ‘bundled services’ in the clinical notes, visit our Bundled Services page to learn more on what services are already covered under your existing authorization.

How to request additional services

The process for requesting additional services under VCP is based upon the veteran’s eligibility type, which is specified on the provider packet you received for the initial services.

  • If the eligibility type is VA Choice-40 Mile, the veteran must call HNFS to request authorization for additional outpatient services.
  • To request additional outpatient services for Wait List- or Choice First-eligible veterans, or an inpatient authorization, when excluded from an existing authorization, for all eligible veterans, providers should complete the Request for Additional Services form and fax it to HNFS at 1-855-300-1705.

Patient-Centered Community Care

When to request additional services

Under Patient-Centered Community Care (PCCC), additional prior authorization from HNFS is required when the veteran:

  • requires care beyond the approved dates,
  • requires care beyond the number of visits/units authorized,
  • needs care for another medical condition or body part (including other joints), and/or
  • must see a different non-ancillary provider for evaluation/treatment.

Also, the following services require an additional authorization from HNFS when not already specified as covered in the existing authorization:

  • home health*
  • home infusion*
  • imaging – only when requiring sedation
  • inpatient admission
  • physical, occupational or speech therapy
  • skilled nursing
  • surgery (outpatient or inpatient), if specifically excluded from the original authorization
  • urgent consultations required as a result of a newly identified critical finding (such as cancer)

*Providers must coordinate home health and home infusion care directly with VA unless this care is covered under a standardized episode of care.

How to request additional services

To request additional authorization, submit a completed Request for Additional Services form and fax it to HNFS at 1-855-300-1705.

Once HNFS receives a completed Request for Additional Services form, HNFS will coordinate with the veteran’s authorizing VA health care facility, as appropriate, to determine whether additional care can be authorized in the community or if VA can provide care to the veteran.

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.