> ## Documentation Index
> Fetch the complete documentation index at: https://mso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.

# VA Community Care

> VA Community Care Network profile: the regional administrators, the referral-first model, and why unauthorized care is generally not payable.

**VA Community Care** allows eligible veterans to receive care from non-VA providers, administered through the **Community Care Network (CCN)** by regional third-party administrators. The defining operational fact is that it is **referral-first**: care must generally be authorized by the VA before it is delivered.

**Payer content ages fastest of anything on this site.** Portals move, forms change, payer IDs get reassigned, and **timely filing limits are contract-specific regardless of what any table says**. Treat this page as orientation; the payer's own current documentation and **your executed contract** are authoritative. **Checked August 2026.**

## Structure

The Community Care Network is divided into regions administered by third-party administrators — **Optum** for some regions and **TriWest** for others. Confirm the current administrator for your region.

Start at **[VA Community Care for providers](https://www.va.gov/COMMUNITYCARE/providers/index.asp)**.

**Regional administrator assignments have changed over time.** Verify the current administrator for your region rather than relying on a saved reference.

## The referral-first model

**This is the thing to get right.** Unlike commercial insurance, VA Community Care generally requires that the **VA authorize the care in advance** and issue a referral with a specified scope, duration, and number of visits.

Care delivered without a valid referral — or outside a referral's scope or dates — is generally **not payable**, and the veteran generally cannot be billed. Verify the referral before the visit and track its limits.

## Enrollment

Through the regional CCN administrator. Requires the standard credentialing packet plus VA-specific requirements.

## Claims submission

Through the regional administrator's process. Payer IDs and submission channels differ by region and by administrator.

## Timely filing

Set by the CCN contract. Confirm with your regional administrator.

## Medical documentation return

**Returning medical documentation to the VA is a contractual obligation**, not an optional courtesy. Failure to return records can affect payment and future referrals. Build it into the post-visit workflow rather than treating it as administrative overflow.

## Quirks worth knowing

* **Referral scope is specific** — a referral for a consultation does not cover a procedure
* **Referral duration is limited** — care after expiration needs a new referral
* **The veteran generally cannot be balance billed** for authorized care
* **Rates** are generally benchmarked to Medicare
* **The program is federal**, so state insurance law generally does not apply


## Related topics

- [The US payer landscape](/concepts/payments/the-payer-landscape.md)
- [Payers vs insurance companies (they're not synonyms)](/concepts/payments/payers-vs-insurance-companies.md)
- [Enroll and contract with commercial payers](/guides/enrollment/enroll-with-commercial-payers.md)
- [Set up EDI, ERA, and EFT with each payer](/guides/enrollment/set-up-edi-era-eft.md)
- [File appeals](/guides/billing/file-appeals.md)
- [How to use the payer reference](/reference/payers/overview.md)
- [Payer enrollment & submission links](/reference/payers/enrollment-links.md)
- [Timely filing limits by payer](/reference/payers/timely-filing-limits.md)