June 2025 Provider Pulse

RFS Form Updates: What You Need to Know

Effective June 1, 2025, the following updates were released to the Request for Service (RFS) form 10-10172. These updates will allow VA to streamline the RFS process.

Reduced the form length from three pages to two pages. Note: Providers should submit a new RFS 10-10172 page 1 for medical services, or page 2 for durable medical equipment (DME)/prosthetics services.
Updated all links and removed broken links.
Added RFS Submission Requirements for clarity.
Added a note, “Requests are approved/denied at the VA facility’s discretion and supporting documentation must accompany each request” to reduce the number of incomplete RFS submissions.
Combined the Veteran and Ordering Provider Information sections. Removed unnecessary information that often arrived unanswered and caused delays in processing.
Combined the Type of Care Request, Type of Service Requested, GEC Services, and Home Oxygen Information sections removing unnecessary section information that often arrived incomplete and caused delays in processing.
Made the DME/Prosthetics Services section its own page, which can be submitted individually.
Ensured all language is clear and commonly used by those who would typically complete the form.
Reordered information to make the most chronological sense for those pulling information from the electronic health record (EHR) to complete the form. This reordering also expedites entering information from the RFS back into the EHR for review and adjudication.

Access the updated RFS form.

Reminder: Do Not Bill Veterans for Fees, No-Shows Under CCN

Please remember that Veterans should not be charged directly for any medical procedures or fees under the VA Community Care Network (CCN).

If issues persist regarding no-shows or coverage for authorized procedures, please contact the VA nurse manager listed on the referral/authorization for assistance.

Please remember:

Do not balance bill Veterans or TriWest for services provided under the CCN contract. A payment for authorized services under this contract is always deemed payment in full.
Do not charge a Veteran for not keeping a scheduled appointment.
Do not solicit Veterans or VA medical centers (VAMC) for services.

For reference, please review the Provider Responsibilities to Veterans subsection of the Veteran Eligibility and Covered Services section of the Provider Handbook.

VA Expands Veterans’ Community Care Access to Simplify Non-VA Referrals

A new change to the Community Care Network (CCN) makes it easier for VA-enrolled Veterans to receive health care from non-VA providers in their community.

Effective immediately, VA will remove the second review step and make it easier for Veterans to receive health care when and where it is most convenient for them.

According to VA, the CCN access change will be implemented as directed by the Senator Elizabeth Dole 21^st Century Veterans Healthcare and Benefits Improvement Act, which was signed into law in January 2025.

The change will allow Veterans to access care in their communities upon referral from a VA provider without requiring review from a second VA provider, in best medical interest cases. It will enable eligible Veterans faster access to CCN providers with VA absorbing the health care costs.

Enrolled Veterans can learn more in this news release announcing VA’s CCN access change making it easier for Veterans to see providers in their communities.

Understanding VA CCN Referrals and Billing Requirements

As a provider rendering care to Veterans under the CCN, please follow the guidelines below for obtaining referrals, billing properly, and aligning services with VA-approved care.

Ensuring the Correct Referral is Issued

Providers are responsible for verifying that the referral issued by VA aligns with the services they can render. Before accepting a referral, please review the Standardized Episode of Care (SEOC) and confirm that the services fall within your scope of practice and capability.

Providers must also ensure that services rendered are:

Authorized within the SEOC, including the number of visits/hours/procedures specified.
Billed according to the authorization received, even if the SEOC outlines broader service categories.
Rendered within the approved timeframe specified in the referral.

SEOC and Fee Schedule Limitations

The presence of a CPT/HPCS code on the SEOC or VA CCN Fee Schedule (FS) does not guarantee reimbursement.
Providers must follow CMS billing guidelines unless directed by VA or your contract with TriWest.
Some services may be reimbursed by VA but not covered under CMS rules based on VA-specific policies and authorization limits.

Coverage vs. Reimbursement: Know the Difference

CMS Covered: Item/device/service is recognized by Medicare as medically necessary under certain conditions.
CMS Reimbursable: CMS guidelines that determine if a covered item/device/service is payable. For example, status B codes are covered by CMS but not separately reimbursable as payment is included in another service.
VA Covered: VA may cover an item/device/service that is not covered by CMS and reimburse it at a VA-specific rate (VA FS, rate waiver or % of billed). Medicare coverage of a procedure code does not dictate whether the service is covered by VA.
VA or TriWest may initiate a recoupment. Providers should retain documentation to support all billed services.
FAQs
1. If a code is on the VA Fee Schedule, does that mean it will be reimbursed?
  No. The VA Fee Schedule only indicates potential reimbursement rates. Reimbursement is contingent upon proper authorization and billing guidelines.
2. Can additional visits beyond what is authorized be provided if the SEOC lists a broader number?
  No. The authorization dictates the exact number of visits/hours/procedures approved. Rendering additional services without a separate authorization may result in denied claims or recoupment.
3. What should I do if I receive an audit request?
  Provide the requested medical records, billing documentation, and authorization details to the requestor.
4. How do I avoid recoupments?
  Ensure that the service is authorized in the referral and claims are billed according to VA CCN and CMS guidelines.
5. What if the date(s) services were rendered are not covered by the approved referral?
  Providers are responsible for ensuring an approved authorization is in place prior to rendering services. Providers are also responsible for the timely submission of a Request for Services (RFS) to VA.
6. What if I need to render additional services?
  If a provider determines that additional services are needed beyond what is authorized in the initial referral, they must submit an RFS through VA. Providers must await VA approval before rendering services.
Failure to adhere to these guidelines may result in claim denials or recoupments upon audit. Providers should verify authorization details before rendering services to ensure reimbursement eligibility.