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Veterans Choice Program

    How do I view provider rates?

    Provider rates can be viewed online at the Centers for Medicare and Medicaid website. For assistance, download step-by-step instructions.

    Reimbursement methodologies for your HNFS PPN Participating Provider Agreement (PPA) are found in the applicable PPA rate exhibits.

    How do I submit a claim?

    Providers had through Dec. 31, 2019, to submit new claims to HNFS for HNFS-authorized services rendered on or before Sept. 30, 2018. See our Claims Submission and Contract Transition pages for details.

    How do I sign up for electronic funds transfer?

    Providers must complete the Electronic Funds Transfer form.

    Who do I contact if I have claims issues?

    If you have questions about claims for HNFS-authorized services rendered on or before Sept. 30, 2018, contact our Provider Services Line at 1-844-728-1914.

    How do I request a claims adjustment?

    To request reconsideration of a claim or an allowable charge review for HNFS-authorized services, contact HNFS within 90 days from the remittance advice (remit) date. HNFS cannot consider requests received outside this 90-day window.

    Adjustment determinations are made on a claim-by-claim basis. Please allow 30–45 days for HNFS review You will receive a new remit from HNFS with its determination.

    What is a clean claim?

    A clean claim is a claim that complies with billing guidelines and requirements, has no defects or improprieties and does not require special processing that would prevent timely payment. Remember to include the VA authorization number in the appropriate segment, exactly as it appears on the authorization. Omitting or adding additional characters to the authorization field may cause rejections of the submission or denials.

    Providers are required to submit substantiating medical documentation within the time frame(s) listed in each provider notification packet to prevent recoupment efforts.

    How soon will my claims be paid?

    Clean claims will be processed within 30 calendar days of receipt.

    What is required for my claims to be paid?

    Claims must comply with billing guidelines and requirements, have no defects or improprieties and must not require special processing that would prevent timely payment.

    Providers are required to submit substantiating medical documentation within the time frame(s) listed in each provider notification packet to prevent recoupment efforts.

    My claim rejected. What does that mean?

    When key elements on a paper claim are missing, the system will reject the claim and the submitting provider will receive a letter explaining this rejection. Learn more on our Rejected Claims at Submission page.