Welcome

Veterans Choice Program

    How do I get reimbursed under VCP?

    Providers may submit claims to HNFS after rendering services authorized under VCP.

    Read more about how to submit claims for reimbursement on our Claims page.

    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 can submit claims electronically by using electronic data interchange, commonly known as EDI, or manually by mailing in paper claims.

    The electronic claims submission process is recommended as it eliminates the expense, delay and uncertainty of a paper claims environment.

    For more information, view our Claim Submission page.

    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.

    Where do I mail my claims?

    Health Net Federal Services encourages providers to submit claims electronically. Providers unable to submit claims electronically can mail VCP paper claims to:

    Veterans Choice Program – VACAA
    PO Box 2748
    Virginia Beach, VA 23450

    Faxed claims will not be accepted for processing. For more information, view our Claims Submission page.

    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.

    How do I sign up for electronic data interchange?

    VCP accepts electronic data interchange (EDI) claim submissions through Change Healthcare (formerly Emdeon). To register, visit Change Healthcare's website.

    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.