VA CCN August 2026 Provider Pulse

Updated VA CCN Substance Abuse and Behavioral Health Programs QRG

We’ve updated the Facility-Based Substance Abuse and Behavioral Health Programs Quick Reference Guide (QRG) for VA CCN providers with streamlined guidance and to simplify billing requirements.

To avoid claim denials, please bill using the updated code for Dates of Service on or after December 1, 2024.

Please review the full updated QRG for facility-based substance abuse and behavioral health programs.

What to Know Before Collecting Payment from a Veteran

Providers rendering care to Veterans under VA CCN are reminded that Veteran billing requirements are governed by the Participating Provider Agreement. Except for applicable copayments, providers may not bill Veterans for covered services.

For services that are excluded or not covered, providers may only collect payment when all required conditions have been met before the service is provided.

Please note that a general financial responsibility form or routine consent signed at the time of service does not satisfy this requirement.

Excluded or Non-Covered Services

Providers may collect payment for excluded or non-covered services only when all required conditions have been met before the service is provided.

Additionally, the Veteran must receive specific details about which services are covered and which are not, so that any agreement to pay is informed. A general acknowledgement that the Veteran may owe money for unspecified non-covered items does not meet this standard.

Prior to furnishing an excluded or non-covered service, providers must:

Inform the Veteran that the service is excluded or not covered.
Explain that the Veteran will be financially responsible for the service.
Obtain the Veteran’s written agreement before the service is rendered.
Ensure the written agreement specifically identifies the service(s) that are excluded or non-covered.

To help ensure compliance, discuss financial responsibility before scheduling or performing the service, and retain the signed documentation in the patient’s medical record.

If you have questions regarding Veteran billing requirements or coverage determinations, please contact 877-226-8749 before collecting payment from a Veteran.

New VA Precertification ID Requirement

The Department of Veterans Affairs (VA) has implemented a new requirement where select procedure codes require providers to obtain a precertification ID from VA. See VA’s Precertification Billing Code List.

What’s changing

For certain services, VA CCN providers must request a precertification ID through the VA Precertification Portal (VAPP). This ID is required to be obtained prior to rendering services.

Log into the VA Precertification Portal to request the precertification ID for applicable procedure codes. Please note that the process to request a precertification code is completed entirely within the VAPP portal.
Precertification ID requests should be submitted 14 calendar days prior to the planned date of service.
Once the precertification ID is approved by VA, providers will immediately receive the precertification ID, and the ID will be transmitted to TriWest via HealthShare Referral Manager (HSRM).
The precertification ID will then be ingested by our claims processor, PGBA, where it will be referenced during claims adjudication and payment.
Precertification ID requirements are to be met for all authorizations regardless of when the VA issued the authorization.
Services for which a precertification ID was not obtained, providers should utilize the retrospective precertification process and obtain a precertification ID.
Note: A referral issued by the VA does not automatically authorize the services which require a precertification ID.

Beginning  September 25, 2026, VA CCN claims submitted for services that do not include the required precertification ID will be denied.

For more information visit the VA CCN Precertification ID Requirement web page or the precertification ID quick reference guide.

Want to learn more? Training classes are available for providers.

Flu Vaccine Available for Veterans

Under the Department of Veterans Affairs Community Care Network (CCN), flu shots are a covered benefit at retail network pharmacy locations without a prescription. They are available for eligible Veterans at the following locations:

A network urgent care clinic retail walk-in location
A primary care provider office
A specialty provider office
The ExpressScripts Network Pharmacy

Providers may provide a flu vaccine to eligible Veterans without an approved referral/authorization. Flu vaccines may also be provided in conjunction with any visit for urgent care.

Veterans enrolled in VA care can learn more about no cost flu vaccine coverage on VA’s Flu Shots web page.

VA External Provider Scheduling (EPS) Webinar Series

You are invited to join VA’s External Provider Scheduling (EPS) webinar series, happening daily through Sept. 30, 2026. These sessions are a simple way for you to get familiar with our new scheduling technology. EPS is a secure tool that lets you quickly book VA appointments into your scheduling system and help Veterans get care faster.

Each webinar gives you a quick walkthrough of EPS, a live demo of the scheduling tools, easy onboarding tips, and time to ask questions. It’s designed to make getting started with EPS feel straightforward and doable.

Questions about EPS or this webinar series may be directed to epsprovider@va.gov. You can also visit the EPS webpage for more information.

TriWest’s Commitment to Serving Veterans Remains Strong

TriWest is grateful for the strong partnership we’ve built together in support of Veterans’ access to community care.

We wanted to make you aware that the Department of Veterans Affairs is currently in the bid process for the next generation of VA Community Care Network contracts. TriWest was recently notified that we were selected as an eligible bidder moving forward.

We are pleased to receive this news and share it with you. TriWest has every intention of continuing in this meaningful work alongside our valued provider network. Thank you for your ongoing commitment and collaboration in service to those who served.