Authorizations & Referrals

This guide unpacks how VA referrals are generated, how authorizations are issued and managed, and what home care agencies must do to ensure uninterrupted service and reimbursement.

For the purposes of VA billing, we’ll use the terms ‘authorizations’ and ‘referrals’ interchangeably unless specifically noted.

3.1How VA Referrals are Generated

In the VA system, referrals are typically clinician-initiated and triggered by a veteran’s changing health status or care needs.

VA Physician-Driven Referrals

Referrals often originate from a VA physician, nurse practitioner, or clinical team who determines that a Veteran requires community-based care, such as personal care assistance or respite. These are documented in the Veteran’s VA medical record and move through the Community Care process for external servicing.

Community Care Consults and the Approval Chain

Once a referral is created, it flows into a Community Care consult, which goes through a multi-layered approval process:

• The referring clinician enters the request.
• VA administrative teams validate eligibility and coverage.
• A VA case manager or social worker assigns the referral to an approved provider.

Only after this chain is complete is an agency eligible to receive the referral.

Role of VA Case Managers in Home Care

Case managers are the linchpins between the VA and community providers. They:

• Assign referrals
• Coordinate the generation of service authorizations
• Monitor Veteran progress and care quality
• Communicate changes in scope or discontinuation of services

Building a strong working relationship with your local VA case managers is key to securing consistent referrals and clarifying ambiguities in care plans.

3.2Requesting and Securing Authorizations

Agencies can’t assume authorizations will arrive automatically. In some cases, especially with Medicaid or when transitioning care, providers must actively request them.

Online Portals vs. Fax/Phone Requests

• Authorizations are typically received through the HSRM portal.
• In other cases, authorizations are sent via fax, secure email, or phone coordination with the VA case manager.
• Some VAMCs still rely on legacy methods; providers must adapt.

Timelines for Approval

Authorizations can take anywhere from 3–14 days depending on:

• The VA’s workload
• The complexity of the request
• The clarity of the referral documentation

Agencies should build a buffer into their onboarding workflows and avoid scheduling care until written authorization is received.

Best Practices: Verifying Exact Services and Frequency

Before beginning care:

• Review the authorization for the correct SEOC
• Confirm the number of hours or units per week
• Note the start and end dates
• Match the authorization to the care plan and referral

Missing or mismatched data leads to denials. If anything is unclear, request clarification from the case manager

before service starts

3.3Managing Expired or Soon-to-Expire Authorizations

Most VA authorizations are time-limited and tied to 60- to 90-day periods. Agencies must track expiration dates and renew proactively.

Authorization Renewals

To continue care:

• Contact the VA case manager ahead of time
• Provide documentation with justification for ongoing need
• Submit a request for a renewal authorization (not just a referral)

Ensure there's no lapse between the old and new authorization. Billing for unauthorized care - even for a known client - will result in denials.

How much lead time is needed to secure an authorizations depends on the case manager. Ask and document their preferences to ensure you reach out early enough.

Common Reasons for Reauthorization Denials and How to Overcome Them

• Missing documentation: Include detailed care summaries, ADL needs, and caregiver status updates.
• Service overages: Stay within the authorized scope or request a revised authorization before exceeding units.

Read our Census Growth section for information on getting more authorizations.

3.4HealthShare Referral Manager (HSRM)

What Is HSRM?

HSRM (HealthShare Referral Manager) is the VA’s centralized system for managing Community Care referrals. It’s used to create, share, and track authorizations between VA Medical Centers and community providers. For agencies that have contracts with Triwest or Optum, using HSRM is a must.

The platform streamlines the care coordination process by enabling real-time communication between providers and the VA, supporting faster turnaround times for referrals, documentation, and payment.

What Is HSRM’s Role?

For providers, HSRM is a single point of access for:

• Receiving and reviewing referrals
• Uploading required care documentation (visit notes, care plans, discharge summaries)
• Communicating directly with the VA on specific cases
• Submitting Requests for Services (RFS)
• Accessing clinical summaries through the platform’s Clinical Viewer
• Tracking referral progress to stay ahead of expiring authorizations

Getting Set Up and Navigating HSRM

To gain access to HSRM, your agency must be credentialed with either Optum (Regions 1–3) or TriWest (Regions 4–5) and have an active CCN contract. From there, the setup process involves a few key steps:

1. 1
   Create an ID.me account

All users must create and verify an identity with ID.me to use HSRM. The email used here must match what you submit later.

1. 1
   Complete the End User Tracker (EUT)

The designated point of contact at your agency fills out the VA’s End User Tracker spreadsheet with key info - agency name, address, NPI, user names and roles (Community Staff Member vs. View Only), and associated VA Medical Centers.

1. 1
   Submit the EUT to the VA

Email the completed End User Tracker to HSRMsupport@va.gov with a short message including your facility’s name and point of contact info.

1. 1
   Log in through the VA portal

Once confirmed, users can access HSRM at ccracommunity.va.gov. Users must log in at least once every 35 days to maintain access.

Tip: Be sure to whitelist “@va.gov” emails and check spam folders during the setup process. Access confirmation and credentialing follow-ups often end up there.

Additional Resources

• VA HSRM User Guide
• Download the End User Tracker

3.5Ensocare

What Is Ensocare?

Ensocare is a digital discharge referral platform used by social workers and case managers at VA Medical Centers to send real-time referrals for post-acute services. Ensocare helps VAMCs identify available community providers fast - especially for time-sensitive discharges or urgent home care starts.

Ensocare vs. HSRM

• While HSRM sends providers referrals on a one-to-one basis, Ensocare makes referrals available to providers on a first-come, first-served basis.
• Ensocare focuses specifically on referrals, while HSRM is the go-to portal for the entire authorization process, care documentation, communication with case managers, and general compliance.