How do I get my outside doctor to bill the VA properly for Community Care?

When the VA authorizes Community Care because it cannot provide timely care, the billing process is handled through the VA's third-party administrators, currently Optum (TriWest handles some regions). The key thing to understand is that your community provider does not bill you or your regular health insurance for the authorized care; they must bill the VA directly through the designated administrator, using the specific authorization or referral number tied to your case.

To get billing set up correctly, you generally need to give your provider's billing office three things: the referral or authorization number from the VA (which you say you already have), the administering network (Optum or TriWest, depending on your VISN/region), and the correct claims submission address or portal information for that network. Optum, for example, has a dedicated provider portal and specific mailing addresses and payer IDs for VA Community Care claims, which are different from standard commercial insurance billing. Many billing offices are unfamiliar with this because it is a government-administered network rather than a typical insurance company, so they may need the payer ID and claims address explicitly, not just a verbal instruction to 'bill the VA.'

You can get these specifics by calling the VA Community Care office at your local VA medical center, or by calling Optum's provider services line directly, since they can give your provider's billing staff the exact submission details tied to your ICN and referral number. The VA's Community Care Network (CCN) provider portal also has resources providers can use to verify authorization details before submitting a claim, which can prevent delays or improper billing to you personally.

If your provider bills you directly, or bills your personal insurance, before this is sorted out, do not pay the bill outright. Contact the VA Community Care coordinator at the facility that issued your referral, explain that the provider needs claims submission guidance, and ask them to send the provider the necessary CCN billing packet or fact sheet. Keep your referral number, ICN, and any correspondence in case you need to dispute an erroneous bill later. As a next step, call the VA Community Care office that issued your referral and ask them to send your provider's billing department the specific CCN claims submission instructions and payer information directly, rather than relying on verbal guidance.