VA Community Care
VA Community Care claims, explained to the dollar.
Community Care pays on a network agreement, needs a valid referral and authorization behind every visit, and runs on a filing clock that does not forgive. ClaimYours AI matches every claim to its referral before it goes out and checks what you were paid against what you were owed.
How VA Community Care billing works
Community Care lets veterans get care from community providers when VA authorizes it. Every visit starts with a VA referral, and claims are paid under your network agreement.
The referral
VA approves care before it starts. The referral names the services, the number of visits and the dates they cover.
HSRM
Referrals and their documents are shared through HSRM, VA’s HealthShare Referral Manager.
Community Care Network
Most community providers join VA’s Community Care Network through a regional third-party administrator, which processes the claims.
The claim
Claims go out on the standard 837P with the referral number on them, and are paid at the rates in your network agreement.
Medical records
VA expects the medical documentation from each episode of care to come back to it.
Filing deadlines
Claims have a firm filing deadline counted from the date of service. Late claims are denied.
Where the money goes missing
- Visits after the referral’s end date
- More visits than the referral approved
- Claims sent without the referral number
- Claims filed after the deadline
- Payments below your network agreement rate
Where ClaimYours AI fits
ClaimYours AI matches every claim to its HSRM referral before it goes out, tracks visits left and the filing clock, and compares what you were paid with your network agreement.
The claims engine works for Community Care now
Upload your claims, remittances and your Community Care Network agreement. Every line is compared against the rate you agreed, and every fix waits for a person on your team.
Connect
Upload or connect your claims, remittances and payer contracts. Works from the files your clearinghouse and EHR already produce (837, 835, 999, 277CA); direct connections are set up and tested with each practice and vendor.
Compare
Every line checked: expected vs paid, against your contract or your payer’s real history.
Propose
We draft the fix, the appeal, or the records packet, with the reason and the source.
Approve
One inbox. One click. Tracked until the money lands.
Built for how you bill
Each item is marked as available now, in build, or coming next. We do not describe a feature as live until it is.
Paid below your network agreement
Each paid line is compared with your Community Care Network agreement rate, or with what the payer has really paid you, and the difference is traced to its source.
Denials sorted by reason
Every denial is placed in one bucket from its reason code, including timely filing, authorization missing, eligibility and records requested.
Filing clock per payer
Set the Community Care filing window once and see the days left on every claim, so the work is done while it still counts.
Records packets
When documentation is requested, the packet is assembled from what you have on file and waits for your approval.
Appeals drafted with the source
Appeal letters are drafted from the denial reason and the record. A person approves each one.
Authorization tracking
Authorizations on file show visits authorized, used and remaining.
Provider status on the date of service
Each claim’s rendering provider is checked against your roster. An NPI deactivated before the date of service or a confirmed exclusion holds the claim; a possible match waits for a person.
Referral match before submission
Import your HSRM referral export. Each claim to a VA payer needs its referral number (VA + 10 digits), a date of service inside the referral and visits left on it; when the number is missing and one referral covers the visit, it is added for your approval.
Visits left on every referral
The referral list shows the dates each referral covers, the visits used from your claims, and the referrals ending in the next 30 days.
Community Care denial playbook
VA-specific denial reasons mapped to the fix that clears them.
Referrals pulled from HSRM
Today referrals come from a file you export; a direct pull is not built.
How a Community Care claim moves
Five steps. The last decision is always a person’s.
Step 1: Upload
Claims, remittances and your network agreement land in your workspace.
Step 2: Compare
Expected versus paid on every line, with the source.
Step 3: Watch the clock
Days left to file or correct, on every claim.
Step 4: Propose
The fix, the appeal or the records packet is drafted for you.
Step 5: Approve
A person approves. Paid lines reconcile against the next remittance.
Honest status
Available today
- Expected-versus-paid against your network agreement or payer history
- Denial sorting by reason code
- Per-payer filing clock
- Records packets and appeal letters for approval
- Authorization tracking
- Provider status on the date of service
- Referral number, dates and visits checked before submission
Still to come
- A Community Care denial playbook
- Referrals pulled directly from HSRM instead of a file
Everything marked Available works today, from the referrals you import. The referral rules follow the Optum VA CCN provider manual and apply only to claims billed to a VA payer. The items still to come are not built yet.
Built for Community Care providers
Independent practices in the network
Primary care, specialty and therapy practices that see veterans through Community Care alongside other payers.
Behavioral health and rehab providers
Providers whose Community Care visits depend on authorizations that have to line up exactly.
Billing teams
Billers who need every short pay traced to the agreement and every filing deadline in view.
Questions Community Care providers ask.
What works for VA Community Care today?
Expected versus paid against your network agreement, denials sorted by reason, the filing clock, appeal letters and records packets, each waiting for your approval.
Does it match claims to referrals?
Yes. Import your HSRM referral export; claims outside a referral, past its visits or missing the number are held before they go out.
Do you submit claims for us?
No. Everything is staged for a person on your team to approve and submit through your own route.
Can I try it?
Yes. The Community Care sandbox loads synthetic claims and remittances, runs them through the engine and gives you sample 837P and 835 files to upload. No real patient information.
How do I get early access?
Request a demo and tell us you bill Community Care. Providers on the early list see each piece first as it is released.
Bill Community Care? Get on the early list.
Tell us how many Community Care claims you send and what comes back denied. It decides what we build first.
Three problems every billing office knows
Claims sit denied for weeks
A denial shows up days after you submit, then waits in a queue until someone has time to work out why.
Nobody knows which rule failed
A denial code tells you something is wrong. It rarely tells you which rule, or what to change.
Adjustments never get filed
Short pays and underbilling are easy to miss, and easy to put off until the window closes.
Made around the systems Community Care actually runs on
Community Care pays on a network agreement and a valid referral behind every visit. ClaimYours AI checks both before the claim goes out.
HSRM referrals
Import your HSRM referral export. Each VA claim needs its referral number (VA + 10 digits).
Referral dates & visits
The date of service must fall inside the referral, with visits left on it. Referrals ending in the next 30 days are listed.
Community Care Network
Each paid line is compared with your Community Care Network agreement rate, and the difference traced to its source.
Filing window
Set the Community Care filing window once and see the days left on every claim.
Provider roster
Each rendering provider checked on the date of service: a deactivated NPI or a confirmed exclusion holds the claim.
837P and 835
Claims and remittances in the standard formats, with records packets assembled when documentation is requested.
Patient data stays inside the platform
From sign-up to your first checked claim
Sign up
Create an account, or start with the demo to see the platform first.
Approved
A person at ClaimYours AI reviews and approves your account.
BAA accepted
Your practice accepts the Business Associate Agreement inside the platform.
Upload & check
Upload claims inside your account and see every result with its source.
See how every claim gets checked.
Try the demo yourself, or ask for a walkthrough. No patient information needed.