Glossary of Terms

10-10EZ Form

The VA Form 10-10EZ is used for applying for healthcare benefits through the Department of Veterans Affairs.

10-7080 Form

An approved referral for medical care through the VA.

ADLs

Activities of Daily Living. Daily self-care activities that include but not limited to: eating, getting dressed, personal grooming, bathing, using the bathroom, and moving from one place to another.

Aid and Attendance

A VA pension benefit provides a monthly stipend for veterans, their spouse or surviving who needs help with daily activities or are housebound.

Area Agency on Aging

Local agencies that provide social services to seniors, helping them to stay as independent as possible.

Authorization

A formal approval from the VA that specifies the amount and type of care a Veteran is approved to receive from a community provider.

Availity

Availity is a multi-payer site for managing health care services for veterans within the TriWest region. View eligibility for veterans, and access real-time status updates for claims and payments.

Billing Unit

A standardized measure of service delivery, often in 15-minute increments, used by the VA for billing purposes. The smallest measurable amount of service for which a provider can bill.

Care Notes

Documentation of care provided, observations, and any other relevant information concerning the patient's condition.

Case Management

A collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs.

CCN

The Community Care Network is the Department of Veteran's Affairs' (VA) direct link with community providers to ensure eligible Veterans receive timely and high-quality care.The CCN is a network of high-performing, credentialed community providers that partners with VA to provide health care to Veterans in their local community.

Consult

Specific section within authorization that contains specific instructions and details regarding the services to be provided. The directives found in this section should be given priority over other instructions.

Consult Adherence

Always follow what is instructed in the consult even if it differes from what is written in the SEOC section of the referral.

Credentialing

The process through which community providers are vetted and approved to deliver services within the VACCN, ensuring they meet specific quality and compliance standards.

Customer Engagement Portal (CEP)

An online platform used by community providers to track the status of claims filed directly with the VA.

DD214

The Department of Defense form issued upon a military service member's retirement, separation, or discharge from active duty.

Effective Date

The date on which a policy, plan, or service becomes active or enforceable.

EFT

Electronic Funds Transfer. Refers to the electronic exchange or transfer of money from one account to another, either within a single financial institution or across multiple institutions.

Electronic Visit Verification (EVV)

A system mandated by federal law to electronically verify home healthcare visits to reduce fraud. EVV requires tracking specific details such as the date, location, service performed, and provider identity.

End User Tracker (EUT)

Spreadsheet required by HSRM Support to provision staff within your organization needing HSRM access.

ERA

Electronic Remittance Advice. An electronic version of a payment explanation which provides details about providers' claim payment, and if the claims are denied, it would explain the reasons for denial.

EVV

Electronic Visit Verification. A computer-based system that verifies service delivery dates and times, thereby helping to prevent fraud.

External Provider Scheduling (EPS)

A streamlined scheduling process that allows VA schedulers to directly book appointments into a community provider's scheduling system.

Fee-for-Service (FFS)

A billing model where providers are reimbursed by the VA for each specific service delivered, typically based on hourly rates or per-visit charges.

High Performing Provider (HPP)

A VA designation given to CCN providers who consistently meet or exceed specific quality metrics established by the VA’s TPAs.

Homemaker/Home Health Aide

A Homemaker and Home Health Aide is a trained person who can come to a Veteran's home and help the Veteran take care of themselves and their daily activities.

HSRM

HealthShare Referral Manager. A secure, web-based system the VA uses to generate and submit referrals and authorizations to community providers.

Medicaid

A joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare.

myVACCN

Payer portal for Optum providers to manage claim status, veteran eligibility, and view referrals and authorizations.

NPI

The National Provider Identifier (NPI) is a unique identification number for covered health care providers.

Optum

Third-party administration for VA CCN for Regions 1, 2, 3, encompassing 36 states.

Optum Pay

A health care payment delivery system desgined to streamline access to historical claims data and improve cash flow. It empowers Optum providers to choose how to receive payments across a broad network of payers.

Patient Advocate

Employee at the VA trained to handle the concerns of patients and family members at every VA Medical Center. They address concerns with the medical care team and advocate for the patient's rights when necessary.

Program of Comprehensive Assistance for Family Caregivers (PCAFC)

This program provides support and services for family members who provide care to eligible Veterans severely injured in the line of duty.

Program of General Caregiver Support Services (PGCSS)

Offers resources and education to caregivers of Veterans who may not qualify for PCAFC.

Referral

Transfer of care for a patient. VA will send a referral to the Veteran and to the selected community provider. A referral authorizes the Veteran to receive care from the community provider. Without the referral, VA has not authorized and cannot pay for care.

Renewals

Process of re-authorizing services.

Respite Care

Respite Care is a program that pays for care for a short time when family caregivers need a break, need to run errands, or need to go out of town for a few days.

RFS Form

Request for Service form, which is a document submitted to request certain types of services.

Service Connected Disability

A disability that the VA has officially rated as connected to service, often related to injuries or diseases that developed during or were exacerbated by military service.

Standardized Episode of Care (SEOC)

A standard framework used by the VA to define and authorize specific care episodes or treatments for Veterans. This term refers to a specific section in all referrals. The SEOC outlines the services authorized by the VA for the client.

Taxonomy Code

Taxonomy codes are administrative codes set for identifying the provider type and area of specialization.

Third-Party Administrators (TPAs)

Private companies contracted by the VA to manage community provider networks and facilitate administrative tasks, including authorization and claims processing. The primary TPAs in the VACCN are Optum and TriWest.

TriWest

Third-party administration for VA CCN for Regions 4 and 5.

VA Community Care Network (VACCN)

The network used by the VA to deliver healthcare services to Veterans through community providers. It involves third-party administrators (TPAs), primarily Optum and TriWest.

VAMC

Veterans Affairs Medical Center. A network of hospitals operated by the Department of Veterans Affairs to provide healthcare services to eligible veterans.

VA PCP

VA Primary Care Provider. A healthcare provider who manages the primary healthcare needs of veterans.

Veterans Care Agreements (VCA)

Agreements used in limited circumstances between community providers and VA medical facilities when standard CCN contracts are unavailable or insufficient.

Veteran Directed Care

This program provides Veterans with the opportunity to receive the Home and Community Based Services (HCBS) of their choice, control their own budget, and hire their own workers.

Veteran Eligibility

Criteria that determine a veteran's entitlement to benefits through the VA.