Medical Claims (Outside the VA System)

Occasionally veterans go to or are transported to non-VA civilian health care facilities for "emergent" treatment of their particular medical condition.  To obtain VA payment for this care certain procedures must be followed to file a claim for payment for these services.  Beginning with dates of service on and after 1 MAR 09 you must submit claims for VA payment consideration for emergency care not previously authorized to: Department of Veterans Affairs, Financial Services Center (FSC), Non-VA Emergency Claims, P.O. Box 149364, Austin, TX 78714-9364.  All claims with dates of service before 1 MAR 09 must be mailed to your local VA Medical Center. To expedite claims processing, be sure that each claim is complete and filed within 90 days following the episode of care.  Incomplete claims will be returned. Do not forget to include documentation of any communication with the VA regarding patient treatment or disposition.  A call center at FSC is available to assist you with payment and claims processing inquiries.  You may contact the customer call center at 1(866) 372-1144, M-F 08-1630 (CST) excluding Federal holidays. A claim file is complete if it has the following documentation:

a.  Complete UB-04 or CMS-1500 claim form to include the National Provider Identification (NPI) number

b.  Supporting medical documentation for the following services is needed for claims adjudication:

·        Inpatient: Admission sheet, discharge summary, operation reports, daily progress notes, and doctor orders.

·        Outpatient: Emergency room treatment notes (including chief complaint, and examination/evaluation results), applicable observation notes, any consultation reports, and diagnostic findings.

·        Emergency Transportation:  Transportation notes indicating location the episode of emergency care took place and facility and address the patient was transported to.  The transportation notes should include the chief complaint, examination/evaluation results, applicable observation notes, and any diagnostic findings

[Source: California VFW]