VA Community Care Billing: A Guide for Homecare Agencies
VA Community Care billing for homecare agencies: referrals and SEOCs, Optum vs. TriWest, CMS-1500 units, the 180-day limit and the visit records VA expects.
Resources
How Does VA Community Care Billing Work for Homecare?
Sagar Kumar, COO and Co-Founder, Verveware
VA Community Care billing works differently from Medicaid billing, even when your homecare agency sends the same caregiver to a veteran and a Medicaid client on the same day. A missing referral number or an hour past the VA physician's order can get a claim denied. Here's how to bill VA for homemaker, home health aide and in-home respite care.
VA must authorize homecare before the first visit. You then provide only the hours VA ordered, bill the administrator named on the referral within 180 days, and keep a visit record that proves each hour.
Step | Rule | What your billing team checks |
|---|---|---|
Authorization | Approved referral (VA Form 10-7080) with a SEOC | Referral dates, ordered hours per week, approved codes |
Where to bill | Optum for Regions 1 to 3, TriWest for Regions 4 and 5, VA for Veterans Care Agreements | The payer the referral names |
Claim | CMS-1500 or 837P with the veteran's ID and one referral number | ID and referral number typed exactly as issued |
Deadline | 180 days from the date of service (38 U.S.C. 1703D) | Claims sent well before day 180 |
Skilled home health billed on a UB-04 follows different rules, which this guide doesn't cover.
Start With the Referral and SEOC
The approved referral comes with a Standardized Episode of Care (SEOC) and tells you where to send the claim. VA authorizes homemaker, home health aide and in-home respite care for 30, 90, 180 or 365 days at a time.
The SEOC sets the most hours VA will allow each week, but the VA physician's order can be lower. Provide and bill only the ordered hours. If the SEOC allows 20 hours a week and the order says 10, bill 10. Weeks run Sunday through Saturday, and the weekly hours include every service you provide.
If the veteran needs more hours or the referral is about to expire, send VA a Request for Services (VA Form 10-10172) with supporting records. Visits outside the referral's dates won't be paid.
Send the Claim to the Right Payer
VA's Community Care Network (CCN) has five regions, each run by a third-party administrator:
Regions 1 to 3, Optum: payer ID VACCN. New Jersey is in Region 1. Illinois and Wisconsin are in Region 2.
Regions 4 and 5, TriWest: claims go to its processor, PGBA, with payer ID TWVACCN. Arizona is in Region 4.
Veterans Care Agreement: if your agency has one instead of a CCN contract, bill VA directly with payer ID 12115.
VA's provider claims page is clear on the tie-breaker: the referral says where the claim goes.
Build a Clean VA Homecare Claim
VA homecare claims go on a CMS-1500 or an electronic 837P. Each claim needs:
The veteran's ICN (the 17-character VA ID on the referral) or Social Security number, with no dashes or spaces
One referral number per claim, typed exactly as issued, with no "Auth #" or "Ref" in front
Your NPI
Only the codes approved on the SEOC
G0156 covers home health aide services in 15-minute units, so one hour is four units. TriWest's unskilled home health guide also lists S5120, S5125, S5130 and S9122 as codes typically allowed. It asks for all same-day visits on one claim, with modifier 76 and a time-of-day modifier (UF morning, UG afternoon, UH evening, UJ night). In Regions 1 to 3, follow the referral and Optum's guidance.
A missing ID, referral number or NPI gets the claim denied. So does care outside the referral's scope or dates, or a duplicate claim. For more on working denials, see our post on MCO reject codes.
VA Timely Filing, Payment and Corrections
You have 180 days from the date of service to file. TriWest recommends filing within 30 days. Federal law sets a 30-day payment standard for clean electronic claims and 45 days for paper.
If you need to change something on a processed claim, send a corrected claim (frequency code 7). Ask for reconsideration only when the original claim was complete and you disagree with the decision.
Veterans are held harmless. You can't bill the veteran or their other insurance for referral services, even when a claim is late or denied.
Visit Documentation VA Expects
Optum's VA CCN Provider Manual lists what each homecare visit record should show:
Date of service
The veteran's full name and address
Time in and time out of the home, recorded by the aide
Tasks performed, such as bathing, dressing or housekeeping
The aide's full name and signature
The veteran's or representative's signature and date, confirming the time and tasks
The record must be legible and support every hour you bill.
How Verveware Helps With VA Billing
Verveware's VA billing tracks authorizations, manages SEOCs and generates VA Community Care claims from verified caregiver visits, EVV data, service documentation and authorizations. It supports CCN Regions 1 to 5, including billing administered by Optum and TriWest, and tracks each claim from invoice to reimbursement.
The visit record starts in the field. With Verveware EVV and the Vervecare caregiver app, caregivers clock in and out with GPS location or by phone, check off plan-of-care tasks, and the client signs to verify the visit's times and tasks.
Verveware supports your records. It doesn't replace the referral, the SEOC or your administrator's instructions.
Frequently Asked Questions
Who Do I Bill for VA Homecare?
Bill the administrator named on the veteran's referral. That's Optum for Community Care Network Regions 1 to 3, TriWest (through its processor PGBA) for Regions 4 and 5, or VA directly if your agency has a Veterans Care Agreement.
What Is the Timely Filing Limit for VA Community Care?
Claims are due within 180 days from the date of service under federal law, and late claims are denied. TriWest recommends filing within 30 days of the service.
Can a Homecare Agency Bill the Veteran?
No. Veterans are held harmless for services on an approved referral. You can't bill the veteran or their other insurance, even if a claim is filed late or denied.
How Do I Get More VA Homecare Hours Approved?
Send VA a Request for Services (VA Form 10-10172) with supporting records. Until VA approves it, provide and bill only the hours the VA physician ordered, even if the SEOC allows more.
Does VA Community Care Cover In-Home Respite Care?
Yes. VA can authorize in-home respite care through the Community Care Network, along with homemaker and home health aide care. It needs an approved referral and SEOC first, and you bill within the hours VA authorizes.
See VA Community Care Billing in Verveware
Schedule a Verveware demo to see VA Community Care claims built from verified visits and live authorizations.
