Welcome

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?

    HNFS stopped accepting new claims for services rendered prior to Sept. 30, 2018, as of March 27, 2019. Claims for dates of service on or after Sept. 30, 2018, should be submitted to the entity that authorized that care. (Also see our Contract Transition page.)

    HNFS will accept claims for review or reconsideration under the following circumstances: 

    • Care was authorized by HNFS and rendered prior to Sept. 30, 2019, and
    • the reconsideration request is submitted within 90 days of the last remittance advice date.

    Contact HNFS' Provider Services to request additional information on how to submit a reconsideration request. HNFS cannot consider requests received outside this 90-day window. 

    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?

    Questions about claims or inquiries as to claim status should be directed to HNFS at 1-866-606-8198.

    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.