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NON VA CARE
COORDINATION
(NVCC)

FEE BASIS

OBJECTIVES








2

BASICS
DEFINITION
PROGRAMS
APPEALS
AUTHORITY & REGULATIONS

Last update: January 22, 2008

2

HEIRARCHY OF CARE

First here!
VA Health Care Facilities
DoD Sharing Agreements

next here!

Sharing Agreements/
Contracts
Fee

3

next here!

then here!

3

HEIRARCHY OF
CARE
VA Health Care Facilities

4

4

HEIRARCHY OF CARE

DoD/ Sharing Agreements

5

5

HEIRARCHY OF CARE

Contracts

6

6

HEIRARCHY OF CARE

Fee

7

7

How does NVCC work?
Scenario 1: Veteran comes in for appointment and primary care provider (PCP) requests consult (authorized). Consult is received and authorized by Non VA Care Coordination team.

Scenario 2: Veteran goes to ED. Required to notify the VA within
72 hours (unauthorized). Claim is received and processed by Non
VA Care Coordination team. Requirements: Claim needs to be clinically AND administratively meet criteria.

8

PROGRAMS






9

Outpatient Medical
Non-VA Hospital
Unauthorized Claims
Mill Bill

Last update: January 22, 2008

9

PREAUTHORIZED
OUTPATIENT


When VA facilities are not capable of furnishing care we may authorize care for:





10

A service-connected disability
A disability for which a veteran was discharged from active duty
Any disability of a veteran rated Permanently and
Totally ( P&T)
An adjunct condition

PREAUTHORIZED
OUTPATIENT


Continued…






11

Any disability of a veteran in Vocational
Rehabilitation
Any disability for a veteran rated at 50 percent or more A veteran of World War I
A veteran who is in receipt of Aid and Attendance
(A&A) and/or house bound benefits

PREAUTHORIZED
OUTPATIENT


Continued…


12

Any disability of a veteran who has previously…...

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