Last updated: November 2026
VA Community Care provider readiness prepares provider groups for Community Care Network (CCN) enrollment or, in limited situations, a Veterans Care Agreement (VCA). Integral Healthcare Solutions (IHS) organizes evidence and drafts procedures for your leaders, clinicians and counsel to approve. Your organization handles enrollment, certification and submissions directly with VA or the regional administrator.
What are the Community Care Network and a Veterans Care Agreement?
The Community Care Network is the preferred national network VA uses to purchase care for eligible Veterans in their community, according to the VA Community Care provider overview (updated May 21, 2026; page opened November 5, 2026). The VA Community Care Network page (updated July 6, 2026; page opened November 5, 2026) says five regional networks are managed by third-party administrators (TPAs), and a provider contacts the TPA for its region to begin enrollment.
Optum administers regions 1 through 3; TriWest administers regions 4 and 5. VA's page lists the states in each region, including California and Texas in region 4 and Alaska in region 5.
The VA Veteran Care Agreements page (updated July 6, 2026; page opened November 5, 2026) describes the second route. VA uses VCAs where services through CCN are not provided or not sufficient, and the provider is paid directly by VA. The provider starts with its nearest VA medical facility, which determines whether a VCA is needed. 38 CFR 17.4105 and 38 CFR 17.4115 (current eCFR text opened November 5, 2026) limit VCA use to a covered individual who is eligible for and requires the care, when VA determines that a VA facility, contract or sharing agreement is impracticable or inadvisable because of the medical condition, travel, nature of care, or a combination of those factors.
VA may revise these pages. We did not review the CCN provider handbooks or the credentialing criteria Optum and TriWest apply; the administrator for your region supplies them.
What does VCA certification require under 38 CFR 17.4110?
Source: 38 CFR 17.4110 (current eCFR text opened November 5, 2026). A provider must be certified by VA to enter a VCA and stay certified while furnishing care under it. The application needs documentation of applicable medical licenses and all other information VA requires, which may include, but is not limited to, names, NPI, NPI type, tax identification number, taxonomy code and business, billing and care site addresses.
- VA will deny certification if it determines the applicant is excluded from a Federal health care program or appears on the System for Award Management exclusions list.
- VA will deny certification if it determines the applicant is already barred from furnishing care under 38 U.S.C. chapter 17 because VA previously determined it submitted a fraudulent claim to VA for care. VA may also deny certification when programmatic considerations make a VCA with the applicant unlikely.
- VA will issue a decision within 120 calendar days of receipt, if practicable. A denial is VA's final decision.
- Certification lasts three years unless VA revokes it. The provider must maintain eligibility and notify VA within 30 calendar days of any change or event affecting eligibility.
- To recertify, apply at least 60 calendar days before expiration. A later application is processed as a new application.
During the agreement, 38 CFR 17.4115 requires notice within 30 calendar days of the existence of an indictment, charge, conviction, civil judgment, or Federal tax delinquency exceeding 3,500 dollars. A tax liability counts as delinquent only when finally determined, after review rights are exhausted or lapse, and unpaid when due, and not where enforced collection is precluded.
What happens after approval: referrals, requests for service, claims and disputes?
After credentialing is complete and a VCA is signed, the provider may begin receiving referrals. VA says referrals define the authorized scope of services for each Veteran and typically arrive through the HealthShare Referral Manager (HSRM).
For care beyond an active referral, the provider sends a Request for Service (RFS) to the local VA community care office. The VA Request for Service requirements (updated June 3, 2026; page opened November 5, 2026) require a separate VA Form 10-10172 per request, supporting records, and the requesting provider's signature and date; requests missing records or signature are denied. Dental and IVF/ART services do not require this form: dental requests use the ADA Dental Claim form, and IVF/ART coordination goes through the local VA community care office. VA states that requests are processed within 3 business days.
The VA precertification page (updated September 9, 2026; page opened November 5, 2026) says that effective September 8, 2026, VA no longer requires precertification before authorized care, the VA Precertification Portal is offline, and the change has no impact on claims processing or payment.
VCA rates are set in the agreement's price terms. Under 38 CFR 17.4120 the ceiling is the applicable Medicare fee schedule or prospective payment system amount, if any, for the period of service, without changes based on later-developed Medicare information. In a State with an All-Payer Model Agreement effective on or after January 1, 2014, that Medicare rate is calculated under the agreement. Rates may exceed that ceiling in highly rural counties (fewer than seven residents per square mile), VA may depart from it when it determines the ceiling is not practicable, and Alaska is exempt. VA's VCA page says the facility that issued the referral resolves payment disputes, and 38 CFR 17.4135 sets a formal dispute procedure with a notice deadline that counsel should read against the signed agreement.
Who needs readiness work, and what triggers it?
Triggers that VA's pages and the regulation support:
- A service is not provided through CCN, so a VCA with the nearest VA medical facility may be the route. VA decides whether one is needed.
- A group practice wants one VCA covering every provider, with every NPI listed.
How IHS helps
- Route check. IHS lays the CCN and VCA descriptions beside your services so your leaders see which route fits. VA decides whether a VCA is needed.
- Gap assessment. IHS maps licenses, NPIs, credentialing evidence and policies to the governing requirements and the handbook or agreement you supply.
- Drafting. IHS drafts program content and procedures for your leaders and counsel to approve, with clinical content subject to your clinicians' approval.
- Mock review and readiness support. IHS tests the evidence file against the requirements, identifies gaps and supports your team's corrections.
Your organization supplies licenses, NPIs, organizational documents, policies, credentialing files, and any handbook, form or agreement from VA or the administrator. The real limit: IHS does not enroll providers and does not contact VA, Optum or TriWest; your named contact does, and VA decides what it requires.
What to have ready
- Each site's region and administrator: VA Community Care Network, updated July 6, 2026.
- Medical licenses and the identity, NPI, tax, taxonomy and address information VA requests: 38 CFR 17.4110(b)(1).
- Exclusion-screening evidence for the entity and each provider: 38 CFR 17.4110(b)(2).
- Every covered provider's NPI for a group VCA, and VA Form 10-10171 read by counsel, including discontinuation terms: VA Veteran Care Agreements, updated July 6, 2026, and 38 CFR 17.4130.
- A certification calendar, including application at least 60 calendar days before expiration: 38 CFR 17.4110(b)(3).
- Separate tracking of the agreement's status-change notice and the regulation's eligibility-change notice: VA Veteran Care Agreements and 38 CFR 17.4110(b)(3)(ii).
- Referral and claims procedures that bar collecting, or trying to collect, from Veterans or their other health insurance for authorized VCA care: VA Veteran Care Agreements.
- RFS procedures that keep the dental and IVF/ART exceptions: VA Request for Service requirements, updated June 3, 2026.
If several items are missing, bring the list to the free introductory call and IHS will scope the work around your timeline.
How do CCN and a Veterans Care Agreement compare?
The routes differ in who you deal with, when VA uses them and how the provider is paid. This page does not tell you which to use.
| Point | Community Care Network | Veterans Care Agreement |
|---|---|---|
| When VA uses it | Preferred national network for purchasing community care | Limited situations where CCN services are not provided or not sufficient |
| Who you deal with | The administrator for your region | The nearest VA medical facility; credentialing by RLDatix/Verge Health |
| Payment | Not stated on the pages reviewed | Paid directly by VA after the VCA is signed; rates set in the agreement |
What it costs
The VA pages we reviewed do not list a fee to join CCN or to establish a VCA. Confirm current terms with VA and your regional administrator.
IHS scopes each engagement after a free introductory call.
What this is not
- It is not legal advice. IHS is a consulting firm, not a law firm, and your counsel reviews the agreement and your policies.
- It is not enrollment. IHS does not enroll a provider or contact VA, Optum or TriWest for the client.
- It is not a prediction that VA or an administrator will approve a provider or refer patients.
Frequently asked questions
How does a provider join the VA Community Care Network?
VA says a community provider ready to partner with VA contacts the third-party administrator for its region to begin enrollment. Optum handles regions 1 through 3 and TriWest handles regions 4 and 5.
What is a Veterans Care Agreement and when does VA use one?
VA says it uses Veterans Care Agreements in limited situations where services through the Community Care Network are not provided or not sufficient. Under 38 CFR 17.4115, VA may use a VCA for a covered individual eligible for and requiring the care when VA determines that the medical condition, travel, nature of care, or a combination makes a VA facility, contract or sharing agreement impracticable or inadvisable. The provider is paid directly by VA.
Who credentials a Veterans Care Agreement provider, and what is submitted?
VA says credentialing is managed by RLDatix/Verge Health and that documentation goes through its portal. The regulation requires documentation of applicable medical licenses plus other information VA requires, which may include NPI, tax identification number, taxonomy code and care site address.
How long does a Veterans Care Agreement last, and when must a provider renew?
VA says an approved agreement stays active for three years as long as the provider maintains VA certification standards. Under 38 CFR 17.4110(b)(3), a provider seeking recertification must apply at least 60 calendar days before the current certification expires, or the application is treated as a new one.
Can a group practice sign one Veterans Care Agreement?
Yes, according to VA. A single agreement can cover a group practice if it lists the NPI numbers of all included providers.
When can a provider be paid, and how are claims filed under a Veterans Care Agreement?
VA says payment cannot be received until the VCA is established and signed, and it is not responsible for payments before approval. Providers submit claims directly to VA by electronic data interchange or mail to the address in the referral. Providers may neither collect nor attempt to collect payment from Veterans or their other health insurance for authorized VCA care.
What changes must a Veterans Care Agreement provider report, and how fast?
VA's VCA page states that status changes must be reported within 10 business days as the agreement specifies. Separately, 38 CFR 17.4110(b)(3)(ii) requires continued eligibility and notice within 30 calendar days of a change or event affecting eligibility. Your counsel should assess each requirement against the signed agreement.
Does VA still require precertification, and what is a Request for Service?
VA says that effective September 8, 2026 it no longer requires precertification before authorized care, and the VA Precertification Portal is offline. For care beyond an active referral, providers follow the Request for Service process; VA states a 3-business-day processing period. Dental and IVF/ART services do not require VA Form 10-10172.