March 26, 2019 Claims Submission Deadline and Other Key Dates
Friday, March 1, 2019
updated Sept. 27, 2019
Health Net Federal Services, LLC’s (HNFS) contracted duties with the U.S. Department of Veterans Affairs (VA) to manage care under Patient-Centered Community Care (PCCC) and the Veterans Choice Program (VCP) were transitioned back to VA on Sept. 30, 2018. All initial claims for HNFS-authorized PCCC/VCP services rendered prior to Oct. 1, 2018, must be submitted to HNFS by March 26, 2019, to be eligible for reimbursement. (An initial claim is one that hasn’t already been received and processed by HNFS.)
March 26, 2019
- Last date HNFS can accept new claims for HNFS-authorized PCCC and VCP services. Find complete submittal instructions on our Submitting Claims page.
- HNFS can only process claims for services authorized by HNFS. Claims for services authorized by an entity other than HNFS must be sent to that entity.
- Claims rejected by HNFS' optical character recognition system must be resubmitted as a new claim, as they never entered our system for processing. HNFS must receive the resubmission of rejected claims by the March 26, 2019 deadline. (See below for information on claims reconsiderations.)
- Do not submit medical documentation with your claim. All medical documentation, regardless of whether HNFS authorized the service, must be sent to the VA Medical Center listed in the authorization paperwork provided to you.
Claims reconsideration requests
To request reconsideration of a claim or an allowable charge review for HNFS-authorized services, contact HNFS’ Provider Services line at 1-844-728-1914 within 90 days from the remittance advice 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 the determination.
In accordance with VA policy, providers are not to bill veterans or collect copayments for authorized VCP and PCCC services. Under PCCC, veterans do not have any out-of-pocket costs or copayments. Under VCP, the veteran may have a copayment, but he or she will be billed directly by VA, not by the provider or HNFS. If your effort to bill the veteran is related to claims payment, please contact HNFS to request a claim review.