How do I bill the VA for home care?
You bill the VA through its Community Care Network. You need a signed referral and Standardized Episode of Care from the VA medical centre, a contract with the third-party administrator for your region - TriWest or Optum - and a Type 2 NPI. Claims go to the administrator, not the VA directly.
The sequence, start to finish
VA home care billing follows a fixed order, and skipping any step turns delivered care into unbillable hours.
- Get contracted with the third-party administrator for your VA region - TriWest or Optum.
- Receive a referral from the VA medical centre, typically through HSRM.
- Confirm the Standardized Episode of Care: which services are approved, how many hours, at what rate, over what date range.
- Deliver care strictly inside those limits.
- Submit the claim to the administrator with the correct HCPCS codes and modifiers.
- Reconcile the remittance against the shifts you billed, and appeal anything short-paid.
Where agencies lose money
Almost every VA denial we see traces to a mismatch between what was delivered and what the SEOC authorized. Hours beyond the cap, a service code the episode does not cover, or a visit dated outside the authorization window will all be denied, and the caregiver has already been paid.
The second most common loss is quieter: care delivered correctly and then never billed at all, usually because the shift did not make it from the scheduling system into the claim run.
What good looks like
A healthy VA billing operation checks every shift against its authorization before submission rather than after denial, submits weekly instead of monthly, and tracks authorization end dates so renewals start before care is interrupted.
People also ask
- Do I bill the VA or the TPA?
- Under the Community Care Network you submit claims to the third-party administrator for your region - TriWest or Optum - not to the VA medical centre directly.
- Can I bill the VA without a referral?
- No. Care delivered before an authorization is in hand is generally unbillable, and it is the single most common way agencies lose money on VA work.
Last reviewed · Payer rules change and vary by state - confirm specifics against your payer.
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Related answers
What is a SEOC in VA community care?
A SEOC - Standardized Episode of Care - is the VA authorization that defines exactly what care you may deliver and bill: the approved services, the number of hours, the rate, and the date range. Anything delivered outside those four limits is generally not billable, even if the veteran needed it.
TriWest or Optum - which VA administrator do I contract with?
It depends on your region, not your preference. The VA Community Care Network is split into regions, each administered by either TriWest Healthcare Alliance or Optum. You contract with whichever administers the region your agency serves, and you submit claims to that administrator.
How long does the VA take to pay home care claims?
Clean claims submitted to a VA third-party administrator are typically paid within a few weeks. Agencies reporting 60–90 day waits are usually seeing the cost of rework, not administrator processing time - denied claims restart the clock, and every correction cycle adds weeks.
Do I need a Type 2 NPI to bill the VA or Medicaid?
Yes. A Type 2 (organisational) NPI identifies the agency as a billing entity, as opposed to a Type 1 which identifies an individual clinician. You also need your taxonomy in NPPES to reflect the home care services you deliver, because a mismatch there causes denials that surface months later.