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Veterans Administration Regions
Provider - Claims QRGPC3 Quick Reference Guide – All Regions
Key Points:
1. All PC3 services, with the exception of the Urgent Care/Retail Location benefit, and emergency care, automate prior authorization using VSA's from VAMC to prevent claims denials. 2. Medical documentation submitted to the authorizing Department of Veterans Affairs Medical Center (VAMC). 3. Claims submitted to WPS Military and Veterans Health (WPS MVH), PC3 claims processor repalced by HFXA. 4. Claims submitted within 30 days after services have been rendered but never later than 120 days. Providers will not collect copays, cost-shares, or deductibles. 5. Providers will be paid for all authorized care according to their contract or agreement with under the Department of Veterans Affairs (VA) Community Care programs. 6. According to 38 C.F.R. 17.55 and 38 C.F.R. 17.56, payments made on behalf of VA to a non-VA facility or provider shall be considered payment in full. 7. Providers may not impose additional charges to the Veteran for services that have been paid by VA. 8. Regardless of submission method, providers may check the status of submitted claims by registering for a secure account on the VA Provider Portal. 9. WPS MVH is transitioning to a single unified Payer ID – VAPCCC3. Claims with legacy Payer IDs will still be accepted