Quick Facts: Community Care For Routine Needs | VA St Cloud Health Care

The Veterans Community Care Program provides health care to eligible Veterans through local, in-network providers in local communities. Here is a process overview to help ensure your community care experience meets your needs and expectations.

Step 1: CONSULT CREATION AND REVIEW

A consult is a request from your VA doctor to refer you for medical and/or behavioral care from an in-network community provider. Your VA provider creates the consult and Community Care department staff review it for accuracy.

Step 2: SCHEDULING

Once the Community Care department has contacted you with the approved consult information, they will attempt to contact the facility of your choice to confirm in-network and setup an appointment. NOTE: Veterans scheduling their own appointment MUST contact the VA to confirm authorization is in place and clinic is in network, by calling 320-255-6401.

Step 3: AUTHORIZATION

After your appointment is scheduled, an authorization (approval from VA for you to receive care from a community provider) is created. Care must be authorized by VA prior to attending an appointment.

You will receive a letter in the mail with:

  • Your authorization number.
  • The in-network community provider you are approved to visit.
  • A description of the care you are approved to receive.
  • The duration of time you are authorized to receive care.

Step 4: COMMUNITY CARE VISIT

At the scheduled day and time, you will attend your community care appointment. VA will send any relevant medical records to your community provider.

Step 5: SCHEDULING ADDITIONAL APPOINTMENTS

If you are authorized ongoing care from an in-network community provider, you may schedule recurring appointments directly with their office. Keep track of how many appointments you attend and when they are authorized. VA cannot pay for services beyond what is described in the authorization.

Step 6: REAUTHORIZATION

If you require care beyond the limits of your authorization, additional care will need to be reauthorized. You or your community provider may submit a new referral request to VA. VA will review the referral request and, if appropriate, issue a new authorization for this care.

Step 7: PRESCIPTIONS: If the community provider prescribes medication an up to 14-day supply can be obtained at an in- or out-of-network pharmacy; longer prescriptions must be filled at the VA. To avoid out-of-pocket expense, fill at a VA medical facility pharmacy or a participating in-network pharmacy. If you use an out-of-network pharmacy you must pay at the pharmacy and submit a claim to VA for reimbursement. Claim should include a copy of the prescription and receipt mailed to:

OCC Claims Processing

PO Box 1004

Fort Harrison, MT 59636-1004

For prescriptions that exceed the 14-day supply limit, or are not urgently needed, the community provider must send the prescriptions to the local VAMC pharmacy to be filled.

Step 8: RECEIVING AND PAYING YOUR BILL

Depending on your disability rating and private insurance (including Medicare and Medicaid) you may receive a bill from VA for the services you received.

HOW CAN I GET HELP?

The Community Care Department can be contracted at 320-255-6401 from 8:30 am to 3:30 pm, weekdays (except federal holidays). Please visit the Frequently Asked Questions on the next page prior to calling.

FOR MORE INORMATION

www.va.gov/health-care/pay-copay-bill/

Frequently Asked Questions

Q- How do I schedule an appointment with a community provider?

A-If your VA provider has placed a referral for you to be seen via Community Care, call 320-252-1670, ext. 6401 between 8:30 am to 3:30 pm for assistance.

Q- My referral has been sent to a community clinic and I have not been contacted to schedule my appointment. What should I do?

A-Contact the community facility using the phone number listed on the authorization letter. If you are unable to schedule or need additional assistance, call 320-252-1670, ext. 6401 between 8:30 am to 3:30 pm

Q- How do I obtain a copy of my authorization for care?

A-Call 320-252-1670, ext. 6401 between 8:30 am to 3:30 pm

Q- I am receiving bills from a community provider/clinic that were approved through my local VA. Who can I contact for assistance?

A-Contact Community Care Billing: 877-881-7618

Q- How do I get a prescription filled that was written by a community provider.

A-Contact VA Pharmacy 320-252-1670 Ext. 6339

Q- What will my co-pay be for an appointment with a community provider/facility/clinic?

A-Please contact VA Billing at 320-255-6384 for assistance.

Q- What if my community provider orders additional visits or testing after my initial visit?

A-Call 320-252-1670, ext. 6401 between 8:30 am to 3:30 pm

Q- My authorization expired, now what?

A-The community provider must submit a Request for Services (RFS) to the VA for review and authorization. If questions arise, call 320-252-1670, ext. 6401 between 8:30 am to 3:30 pm

Q- I went to the Emergency Room. Who do I contact or what are my next steps?

A-To facilitate treatment and claims payment, emergency care episodes must be reported to VA within 72 hours. Veterans, family members, community hospitals and providers can report emergency visits to VA using the VA Community Care portal at https://emergencycarereporting.communitycare.va.gov/#/request or by phone at 1-844-72HRVHA or 844-724-7842). Reporting emergency admissions helps your VA team arrange additional care or transfer to a VA facility.

Q- Where can I find a list of urgent care providers/clinics in my community?

A-By calling 1-833-4VETNOW (1-833-483-8669), or visiting https://www.va.gov/find-locations/

To locate in-network urgent care pharmacies visit:https://www.caremark.com/wps/myportal/PHARMACY_LOCATOR_FAST