Q: How do I stay truly compliant with VA Community Care (CCN) billing and keep cash flowing?

A: Treat VA compliance like a production line: tight authorizations in, clean documentation and codes through, no surprises out. Here’s a field-tested playbook you can run tomorrow.

The non-negotiables

• SEOC alignment, every time: Dates, hours, place of service, discipline (for example, homemaker vs HHA), units. No rounding and no scope creep.
• Reauth radar: Track remaining hours and SEOC expiry. Trigger reauths at 75% hours used or 30 days before expiry, whichever comes first.
• Visit documentation that stands up: Caregiver, time in and time out, tasks tied to SEOC scope, client verification (digital or signed). Avoid generic notes.
• Correct codes and units: VA HCPCS, modifiers, and holiday or OT rules can differ from Medicaid. Lock a VA-specific code map.
• Portal parity: What is in HSRM or the TPA portal (Optum or TriWest) must match your EHR and EVV and the 837 you submit. Reconcile weekly.
• Respond fast: Set a two-business-day SLA on any VA or TPA document request to avoid payment holds.

Controls that prevent denials

• Pre-claim edit: Block submission if SEOC number, dates, discipline, or units do not match.
• EVV to claim match: Reject visits with missing GPS, missing attestations, or out-of-scope tasks before they become claims.
• Holiday or OT guardrails: Apply special rates only where your SEOC allows them.
• Reauth worklist: Daily list of members needing extensions, including last service date and hours remaining.

Your monthly compliance scorecard (green, yellow, red)

• SEOC mismatch rate (percent of claims needing fix before submission)
• First-pass yield (VA) (percent paid without rework)
• Docs-on-request turnaround (average days)
• Reauth on-time rate (percent renewed before lapse)
• Denied dollars due to scope or date errors (trend down)

Audit ready in one click

Keep a “claim packet” template: SEOC, care plan (if applicable), visit notes, EVV logs, caregiver credentials (on request), and submission plus remit. Store by claim ID for 12 to 24 months.

Common traps and quick fixes

• Billing outside SEOC: Lock claim creation to active SEOC lines.
• Expired authorizations: Use a calendar, automated alerts, and a reauth SLA.
• Generic notes: Use task pick-lists tied to SEOC scope and require free-text rationale for variances.
• Portal or EHR drift: Do a weekly three-way reconcile across EHR, EVV, and HSRM or the TPA portal.

Prefer not to build all this yourself? Paradigm runs the whole VA cycle: SEOC tracking, EVV and visit reconciliation, pre-claim edits, portal parity checks, and documentation responses so you stay compliant and get paid without disruptions.