VA provides veterans care through community providers when VA cannot provide needed care. Community care is based on specific eligibility criteria, the availability of VA care, and each veteran’s needs and circumstances.
Your supplier has entered your recommendation, now what?
The Specialty Care Service will review your referral to determine if the service is available in the VA or should be deferred to the community.
What happens if my reference is kept in VA?
- If the VA provides the requested services, expect a call from a VA staff member within 3 business days.
- After an unsuccessful telephone contact attempt, you will receive a letter in the post to help you schedule your appointment.
- Your sponsorship can be canceled after 14 days of unsuccessful contact.
- Please activate your voicemail and do not block VA calls. Read the letters the VA sends you. If you have any questions, please call us at 307-778-7550, select option 6.
What if my referral goes to Community Care?
- Expect a call from the Community Care office after 3 business days. If you do not receive a call, please contact the Community Care Office at 307-778-7550, select option 6 and follow the instructions.
- You can also contact the Community Care Office by sending a secure message to MyHealtheVet
The Community Care Office:
- Help you choose a preferred community network provider.
- Send your referral and medical documentation.
- Mail you a scheduling letter with instructions on how to schedule your appointment with the community provider.
You are responsible for:
- Scheduling your appointment with the community provider.
- Notify the Community Care office of the appointment by calling 307-778-7550, select option 6.
- Watch the mail for the authorization letter. This letter will contain the number of authorized visits, the approved services, the specialist’s contact details and the approved timeframe for treatment.
What should I do once I have obtained my authorization letter?
Keep this letter for your records and bring it to your first appointment. You are responsible for:
- Show up for your appointments on time.
- Contact your referral provider if additional services are required after the authorization expiration date.
How can my VA provider view my community records?
- Ask the community provider to fax your visit results to 307-778-7360 to have them added to your electronic health record so your provider can review them.
- You can get community records and bring them to the VA to upload to your medical record.
What is the fastest way to contact VA medical teams?
What should I do if I receive a bill for authorized care?
- If you disagree with your invoice balance, call the phone number listed on the invoice to ensure the community provider has a copy of your referral authorization and correct sponsor/guarantor information. If they have your correct referral clearance, but still can’t resolve the issue, call the Community Care office for assistance.
Other Important Reference Information
- Seeking care from a community provider without valid authorization can result in significant costs to you. Please ensure you have the proper authorization before seeking non-emergency community care.
- Understand that appointment types may vary. Many providers can arrange appointments by phone, telehealth (virtual), chart review, or in person.
- If you are eligible for Beneficiary Travel, please contact the travel office for VA and community appointment reimbursement requirements by calling 307-778-7550 ext. 7224.
How to avoid billing issues:
- Never go to a community provider without authorization or go past your authorization dates. If you need an authorization number or service dates, consider calling 307-778-7550, select option 6.
- If you go to the community emergency room, call 844-724-7842 within 72 hours.
What to do if contacted by a supplier for invoices/payments
If you have an invoice or questions about claim payment
Contact the VA C4 (Community Care Contact Center) – Includes US Pacific territories.
Phone C4: 877-881-7618.
Opening hours: 5:45 a.m. to 6:15 p.m.
If you are contacted by a community provider regarding an unpaid bill or claim
Refer the community provider to the TriWest Claims Call Center at 877-226-8749 (this phone line is for TriWest network providers only).
The TriWest Claims Call Center will assist providers with submitting claims, updating claims status and denying claims.
If you have adverse credit and debt collection issues as a result of using Community Care
Contact the VA Adverse Credit Hotline at 877-881-7618.