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

by  Wyn Staheli, Director of Research
April 1st, 2019

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.

References:

Q/A: I Submitted a Claim to the VA and it’s Being Denied. Why?. (2019, April 1). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/q-a-i-submitted-a-claim-to-the-va-and-it-s-being-denied-why-34865.html

© InnoviHealth Systems Inc

Article Tags  (click on a tag to see related articles)


Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.


contact

innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
Email:
free demo
request yours today
pricing
for any budget
sign IN
welcome back!

Thank you for choosing Find-A-Code, please Sign In to remove ads.