Who pays a VA Community Care claim?

The third-party administrator for the Community Care Network region the Veteran's referral came from: Optum for regions 1 to 3 and TriWest for regions 4 and 5, as VA lists on its claims page. The referral names the region, and the claim goes to that administrator's process, not to the VA medical center.

What has to be on the claim?

VA requires the authorization number on the claim for all non-emergent care and the VA-assigned internal control number in the insured's identification field, alongside the usual provider, service and date information. VA lists the authorization number among the things to check before a claim is filed.

What is a referral, and why does it matter more than an authorization elsewhere?

A VA referral is the authorization: it names the service, the number of visits or the period, and the dates. Care delivered outside any of the three is not paid, and the fix is a new referral from VA, not a corrected claim. Tracking visits and dates against the referral is the whole job.

How fast does VA pay?

Each administrator publishes its own processing standards and VA publishes payment guidance on its community care pages. What an agency can control is submitting a complete claim with the referral number inside the window and chasing it at the administrator's stated turnaround.

Can we bill the Veteran for anything?

Not for care covered by the referral. Copayments, where they apply, are billed to the Veteran separately by VA, and VA tells Veterans not to pay a copayment to the community provider. Services outside the referral are the Veteran's choice to pay for privately, agreed in writing before they are delivered.

What do you need from an agency to start?

A signed BAA, a user for your biller in your agency software and the administrator's provider portal, your active referrals with their dates and visit counts, and your network agreement. Bring an aging report to the review if you have one.

VA Community Care Billing for Home Care

VA Community Care billing for home care agencies

VA Community Care billing pays a community agency for care VA referred a Veteran to receive at home.

The referral is the authorization, the claim goes to the third-party administrator for the Veteran's region, and the claim must carry the referral's authorization number and VA's internal control number for the Veteran. Remitwright gives agencies a dedicated biller who tracks every referral by visits and dates, submits complete claims to the right administrator, and chases them to payment.

Last reviewed October 21, 2026 by the Remitwright billing team. Editorial policy

How the program pays

VA works with community providers to deliver care when VA cannot provide it directly.² Community Care is one of the payers home care billing has to cover, and its rules are its own. For a home care agency it means a referral from VA for a named Veteran, a service, a number of visits or a period, and a set of dates. Claims for that care go to the administrator for the Veteran's Community Care Network region: Optum for regions 1, 2 and 3, and TriWest for regions 4 and 5.¹ The administrator processes and pays the claim under its own portal, edits and timelines. Any copayment the Veteran owes is billed to the Veteran separately by VA, not collected by the agency.³

What the claim has to carry

The authorization number from the referral, which VA requires on the claim for all non-emergent care.¹
The VA-assigned internal control number for the Veteran in the insured's identification field, in the format VA specifies.¹
Service codes, dates and units inside the referral's service, visit count and date range.
The rendering and billing provider identifiers that match your network agreement with the administrator.

Why VA claims fail

Care outside the referral. A visit after the end date, beyond the visit count, or for a service the referral did not name. The fix is a new or amended referral from VA, requested before the care, not a corrected claim after it.
Referral number missing or wrong. The claim is denied or returned, and the window keeps running.
Wrong administrator. A claim sent to the other region's administrator, or to VA directly, when the referral came through the network.
Veteran identifier wrong. The internal control number missing or in the wrong field.
Late submission. Each administrator and program has its own window; a claim held while the referral was sorted out can miss it.

The routine

Every referral logged on receipt with its number, service, visit count, dates and region.
Visits counted down against the referral as they are delivered, with the renewal request sent to VA before the last authorized visit.
Claims built with the referral number and the Veteran's identifier, sent to the right administrator on its cycle.
Remittances posted, denials traced to the referral, the identifier or the window, and resubmitted or escalated.
A line on the weekly report: referrals active, visits remaining, claims paid, claims held and why.