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.
Why it matters operationally
The two administrators are not interchangeable from a billing standpoint. Portals, claim formats, escalation paths, documentation expectations and payment timelines all differ. An agency that moves between regions, or serves a border market, is effectively running two billing processes.
Contract re-awards make this a live risk rather than a one-time setup decision. When a region changes administrator, agencies face re-credentialing, new portal onboarding, and a transition window where authorizations and claims can fall between the two systems.
What to do before a transition
Front-load submissions ahead of a known cut-over date, confirm whether existing authorizations carry across, and start any re-credentialing early. The agencies that get hurt in a transition are the ones that discover it from a denial.
People also ask
- Can I contract with both TriWest and Optum?
- If you serve areas that fall into regions administered by each, yes. Multi-state and border-market agencies commonly hold both, and each brings its own portal, timelines and claim rules.
- How do I find out which region I am in?
- Region assignments are set by the VA and change when CCN contracts are re-awarded. Confirm your current region against VA community care documentation rather than relying on what was true at your last contract.
Last reviewed · Payer rules change and vary by state - confirm specifics against your payer.
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Related answers
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.
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.