• Reduce font size | Increase font size Text Size

TRICARE & Veterans' Affairs

The following resources provide payment information related to TRICARE and Veterans' Affairs.

For additional assistance with payment and reimbursement issues, contact APTA's Payment Policy & Advocacy department at 800/999-2782, ext 8511 or advocacy@apta.org.

Non-VA Providers

  • Non-Va Care

    Medical care provided to eligible Veterans outside of VA when VA facilities are not available. Non-VA Care is used when VA medical facilities are not "feasibly available." The local VA medical facility has criteria to determine whether Non-VA Care may be used. If a Veteran is eligible for certain medical care, the VA hospital or clinic should provide it as the first option. If they can't - due to a lack of available specialists, long wait times, or extraordinary distances from the Veteran's home - the VA may consider Non-VA Care in the Veteran's community.

  • Non-VA Care Provider Information

    Once Purchased Care (non-VA Care) is authorized, Veterans may seek treatment from a provider in their community. This guide details what non-VA providers should expect in terms of authorizations and referrals, claims payment, and the return of medical documentation back to the authorizing VA Medical Center (VAMC).

  • Becoming a Non-VA Care Provider Information (.pdf)

    This link includes information on contacting your local VA facility and payment system registration.

  • Non-VA Provider's Guide (.pdf)

    Contains information on authorizations, sample authorization forms, claims submissions, and claims denial procedure.

  • Program Integrity in the VA Health Care System

    Provides resources and training to combat fraud, waste, and abuse (FWA) through various system safeguards, detailed auditing, and continuous awareness training.

Summaries

Tricare

  • Tricare Official Website

    Includes information on rates and reimbursement.

  • Outpatient Prospective Payment System (OPPS)

    Includes therapy codes.

  • Tricare Allowable Charges Tool

    This interactive tool allows zip code input to find the CHAMPUS Maximum Allowable Charges (CMAC) for the most frequently used procedures or services. These charges are the maximum amounts TRICARE is allowed to pay for each procedure or service and are tied by law to Medicare’s allowable charges. These amounts do not reflect TRICARE Beneficiary out of pocket cost shares, copayments, deductibles, or payments made by any other Health Plan Coverages.

ADVERTISEMENT