Hospital Emergency Room (ER) Visits – Please ensure you, or the facility, contact the VA at 844-724-7842 within 72 hours of reporting to an ER if you would like to have VA considered as payee. Mission Act criteria must be met before final approval is made: 1) Report to an in-network ER facility: 2) Services deemed emergent by prudent lay-person: 3) VA received notification within 72 hours of reporting to ER.
Urgent Care – To use your urgent care benefits you should call 833-483-8669 to verify you are eligible for these services. You do not need to contact the VA. You must go to an in-network facility and verify they are in-network at the time you report as these facilities may change daily. It is your responsibility to ensure the facility contacts the above number as well to start your authorization. Failure to comply with these requirements will result in a denial of the claim.
Pharmacy Reimbursement – Prescriptions written by a Community Care Provider under VA authorization must be presented to a VA facility for dispensing, or you may fill at an outside pharmacy at your own expense. Prescriptions can be sent to the VA via fax, paper mail, e-prescription or hand carried. The medications prescribed must be related to authorized services and follow the Veterans Health Administration (VHA) Formulary Management Process. Questions regarding prescriptions or the formulary may be directed to the VA pharmacy at (608) 372-1709.
Prescriptions may only be filled by a non-VA pharmacy when the
medication is needed promptly to treat an emergent or urgent medical
condition; in such instances, You may use a participating community pharmacy to obtain up to a 14-day supply of medication at no charge, or you may fill at any pharmacy and submit for reimbursement. To receive reimbursement you must submit the medication slip with your name, the name of the medication, prescription number and quantity received as well as a copy of the paid receipt. This should be sent to VAMC-Office of Community Care; 500 E. Veterans Street; Tomah, WI 54660. When appropriate, Community Care Providers should write two prescriptions for urgently needed medications – one for the 14-day supply to be filled at the local pharmacy, and a second prescription for the VA pharmacy.
Primary Care – Authorization for Primary Care covers only services related to Primary Care. Any additional specialty services require a new referral and a separate authorization. Request for additional services needs to be sent to the VA from the Primary Care provider. You must wait for an approved authorization before proceeding with care if you are requesting the VA to cover payment of services.
Copays – If you are being seen through a Mission Act referral and you would normally have a VA co-payment for VA services you may have a copay for each Community visit you attend.
Durable Medical Equipment (DME) – Prosthetic/durable medical equipment (DME) items must be issued by the VA Prosthetics Department unless it is an urgent need for an emergency issue. Community Care Providers should submit DME request to the VA to be filled prior to its need.
Authorizations – It is very important that you pay attention to the dates of your authorization. Each authorization has a start date and an expiration date and services received before the start date or after the authorization expires will be at your own expense.