Providers can check Veterans Choice Program (VCP) and Patient-Centered Community Care (PCCC) claims status online, using the Availity Claim Status Tool. This tool is a fast, easy-to-use online claim status tool that provides real-time claim status and payment information.
To access Availity’s Claim Research Tool:
- Visit www.availity.com and log in or register (registration is required).
- Select the “Claims Status Inquiry" option under the “Claims & Payments” option in the navigation bar at the top of the page.
- Choose “Health Net VA PCCC” (this applies for both VCP and PCCC) in the payer field when submitting your claim status inquiry.
- Search for claims by patient and claim information.
Using this site, providers can view the same information as they would see on their Explanation of Benefits (EOB). This includes:
- claim status
- billed amount
- ineligible amount(s)
- paid amount
- check date
Providers with questions on Availity registration or questions on how to use their website should refer to the “My Support Tickets” option in the “Help & Training” dropdown menu or call 1-800-282-4548 for support.
Rejected Claims at Submission
Paper claims submitted to HNFS that do not pass HIPAA edit rules for clean claims submission will be rejected. HNFS will issue a rejection letter to the provider should this occur. For information on a rejected claim, refer to the rejection notice or visit our Rejected Claims at Submission page.
Denials and Reconsideration Requests
Review our Information on Denied Claims page should your claim deny.
To request reconsideration of a claim or an allowable charge review for HNFS-authorized services, contact HNFS within 90 days from the remittance advice (remit) date. HNFS cannot consider requests received outside this 90-day window. Adjustment determinations are made on a claim-by-claim basis. Please allow 30–45 days for HNFS review. You will receive a new remit from HNFS with its determination.
If you are having difficulties checking claim status online at www.availity.com, please use the following tips to locate your claim:
- If you are using the Express Entry feature, try manually entering the NPI instead.
- When asked, "Is the provider name the same as the organization name?" answer, "No."
- The NPI is the billing NPI from the submitted claim.
- The subscriber ID can be the 10-digit number from the Veteran’s card or his/her Social Security number.
- The date of service can be the exact date the service(s) were rendered or a date range (30-day maximum).
- Only complete the required fields that are marked with a red asterisk.
If you still are having trouble, please contact Availity Client Services at 1-800-282-4548. A fully staffed team will provide technical support and will immediately open a ticket to triage provider issues.
Availity Learning Center
Availity offers a learning center with relevant courses at your fingertips. The Availity Learning Center brochure provides an overview of the curriculum offered including instructions on how to access these resources online. Also, you can view these two training demonstrations for assistance:
Log in to the Availity Web portal and get started today.