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HNFS' PCCC and VCP Contract Transition: What You Need to Know

Health Net Federal Services, LLC’s (HNFS’) contracted duties with the U.S. Department of Veterans Affairs (VA) to manage care under Patient-Centered Community Care (PCCC) and the Veterans Choice Program (VCP) were transitioned back to VA on Oct. 1, 2018. 

Last updated Aug. 31, 2020.

Appointments

  • As of Oct. 1, 2018, HNFS is no longer scheduling/rescheduling VCP/PCCC appointments for veterans.
  • Providers and veterans can visit VA’s website, www.vets.gov/facilities, to locate the appropriate phone number to the veteran’s local or assigned VA Medical Center (VAMC) to coordinate care. 

Authorizations

  • As of Aug. 1, 2018, HNFS was directed to stop accepting new PCCC and VCP referrals/authorizations from VA.
  • We have adjusted existing authorizations that extended beyond the contract expiration date to reflect an end date of Sept. 30, 2018, and issued specific guidance for affected authorizations. Please review carefully to avoid unexpected claims denials. 
  • Care on or after Oct. 1, 2018, has transitioned to the veteran’s local VAMC, Office of Community Care.
  • Providers must submit requests for additional services through the veteran's local or assigned VAMC. Visit www.vets.gov/facilities to locate the appropriate VAMC's phone number. If asked to submit the request in writing, providers can submit their requests to the VAMC via Virtru Pro secure mail or fax. Written requests should include supporting medical documentation to support the request, specify which additional services are being requested and be signed by the requesting provider.

Claims

  • HNFS can only process claims for services authorized by HNFS. Claims for services authorized by an entity other than HNFS must be sent to that entity. 
  • Providers can continue to use www.availity.com to check claim status for HNFS-authorized PCCC and VCP services.

Medical documentation

  • As of Jan. 1, 2019, HNFS stopped accepting medical documentation for HNFS-authorized PCCC and VCP care. 

Customer service

Frequently asked questions

Q: Are the Veterans Choice Program and Patient-Centered Community Care Programs ending?
A: 
The VCP and PCCC program eligibility is not ending. The VA's contract with HNFS as the third party administrator to assist VA in administering care under the programs has ended.
 

Q: If I signed a VCP Provider Agreement, can I continue to treat veterans?
A:
Community providers who are (or will be) using a VCP Provider Agreement to provide care to veterans under VCP will work directly with VA as of Oct. 1, 2018. VA medical facilities and community providers will work together, instead of through HNFS, for care authorization, coordination, billing, and payments for the care veterans receive.
 

Q: Do I need to submit my PCCC/VCP claims to HNFS by Sept. 30, 2018, in order to be paid for services rendered?
A:
 The deadline to submit PCCC/VCP claims to HNFS for services rendered on or before Sept. 30, 2018 was Dec. 31, 2019. HNFS is no longer accepting new claim submissions as of Jan 1., 2020. Reconsiderations requests must be submitted to HNFS within 90 days of the last remittance advice date. HNFS cannot accept reconsiderations requests submitted beyond 90 days from the remittance advice date.


Q: How will outstanding claims already submitted to HNFS be paid after Sept. 30, 2018?
A:
We will follow our contractual obligations and guidelines for claims processing and will process clean claims submitted for authorized services rendered on or before Sept. 30, 2018.