Timely filing · federal (VA Community Care Network)
VA Community Care timely filing limit
Short answer
The VA Community Care timely filing limit is 180 days. Federal law, 38 U.S.C. 1703D(b), requires a community provider to submit its claim no later than 180 days after the date it furnished the care, and Optum's VA CCN provider manual applies that as 180 calendar days from the date of service for outpatient care or the date of discharge for inpatient care; late claims are denied.
Claims go to Optum for Community Care Network Regions 1 to 3, to TriWest for Regions 4 and 5, and to VA itself under a Veterans Care Agreement. Optum takes a reconsideration of a denied claim within 90 calendar days of the denial. Compare other payers in the timely filing limits table.
Last reviewed by the Remitwright billing team. Editorial policy
The windows
- Initial claim
- 180 calendar days from the date of service for outpatient care, or from the date of discharge for inpatient care1
- Counted from
- The date of service for outpatient care, or the date of discharge for inpatient care. When Optum receives the referral after that date, it can count 180 days from the day it received the referral. A claim first sent in error to VA or another VA administrator gets 180 days from that denial.
- Appeal
- 90 calendar days from the date of denial to file a reconsideration request with Optum for Regions 1 to 3
- Corrected claim
- VA's corrections and voids page gives no separate window; a correction (frequency code 7) or void (8) of a claim VA processed carries the original 18-digit claim ID from the explanation of payment. Optum takes claim inquiries within 12 months of first processing, and a claim resubmitted on an approved claim form must still be inside the 180 days.
- Verified
- , against the payer document in the sources
Your participation agreement can set a different window. Where the contract and the manual disagree, the contract applies.
A visit on Monday, March 2, 2026
Counting 180 days forward from a date of service of Monday, March 2, 2026 gives Saturday, August 29, 2026. That is the last day to file under the first limit shown above; a claim filed after it is outside the window unless one of the exceptions below applies.
Exceptions the payer allows
The claim went to VA or the other administrator by mistake
When a claim was submitted in error to VA or to another third-party administrator acting for VA, Optum accepts it within 180 calendar days of that denial, as long as you include proof that the first submission was itself on time.
The referral reached Optum after the care
If Optum receives the VA referral after the date of service or discharge, it can use 180 calendar days from the date it received the referral as the filing deadline instead.
What counts as proof of timely filing
- An explanation of payment (EOP) from VA for the first submission
- A provider remittance advice (PRA) from VA or from another third-party administrator acting for VA
- A 277 EDI rejection notice from Optum, VA or another VA administrator whose submission date shows the claim went in on time
Notes for billers
- Billing a non-VA payer first does not buy time. Optum's manual says a claim that went to any other payer still has to reach Optum within 180 calendar days of the date of service or discharge, and other health insurance should never be billed when the Veteran has an approved referral.
- A service denied because there was no referral, the care went beyond the referral, or no timely clean claim was filed cannot be billed to the Veteran; the provider holds the Veteran harmless. For care under an approved referral with VA as primary payer, Optum's payment is payment in full.
- Optum reconsideration requests are in writing with the claim number, date of service, Veteran name, reason and justification, and several claims can go in one letter. Send them to the address or fax on the remittance advice, or to VA Community Care Network, Appeals and Grievance, Team MS-21, 3237 Airport Road, La Crosse, WI 54603, secure fax 1-877-666-6597.
- VA's own side of the clock, under 38 U.S.C. 1703D(a): pay a clean electronic claim within 30 calendar days and a clean paper claim within 45, and on a denial, tell the provider the reason and any information needed within the same 30 or 45 days; after the information arrives, adjudicate within 30 days.
- VA claim decisions follow a different route. A claim under a Veterans Care Agreement goes to a VCA dispute, one under a VA contract follows the contract's dispute terms, and for unauthorized emergency care a Supplemental Claim or a Higher-Level Review must be filed within one year of the decision. TriWest publishes its own CCN Provider Handbook for Regions 4 and 5.
FAQ
Questions about VA Community Care deadlines
What is the VA Community Care timely filing limit?
Who do I send a VA Community Care claim to?
I sent the claim to the wrong VA payer. Is it lost?
How long do I have to ask Optum to reconsider a denial?
Does a home care agency follow the same deadline?
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