Q/A: I Submitted a Claim to the VA and it’s Being Denied. Why?

April 1st, 2019 - Wyn Staheli, Director of Research
Categories:   CPT® Coding   Modifiers   Chiropractic   Reimbursement  
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Question

I submitted a claim to the VA and it’s being denied. Why?

Answer

There are several reasons why your claim might be denied by the Veterans Administration (VA). However, without more information about the claim itself (e.g., services billed), we can only provide the following general information about the VA and chiropractic care.

Although the VA has expanded care options for veterans, like all payers, they do have policies that need to be followed. Unless you are contracted directly with the VA, you are most likely billing through their Patient-Centered Community Care Program (PC3) or the Veterans Choice Program (VCP). The information presented here relates to these programs.

The following are some key points to evaluate when deciding why the claim has been denied:

If you have all of the previous items in order, it may be necessary to contact the provider relations department of the applicable program to address specific questions.

Correction Notice 2019-04-01: While technically you may treat the patient with one visit under the Choice Program, additional visits must be authorized through TriWest. To clarify the policy, the paragraph relating to authorizations was revised to state that subsequent visits must have an authorization number.

Also, as of September 30, 2018, HealthNet no longer has a contract with the VA so they were removed from the bullet about contracts.

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