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Electronic claims: Enroll for electronic transactions on.TriWest will adjudicate and pay claims on behalf of VA. Instructions for Regions 4-5 Urgent Care Providers (TriWest)įor urgent care providers in AK, AS, AZ, CA, CO, GU, HI, ID, MP, MT, NM, NV, OR, TX, UT, WA, WY Select “I am a Provider,” and then select 'Medical/Behavioral Provider.' Visit the secure Optum Provider Portal.Instructions for Regions 1-3 Urgent Care Providers (Optum)įor urgent care providers in AL, AR, CT, DC, DE, FL, GA, IA, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, NC, ND, NE, NH, NJ, NY, OH, OK, PA, PR, RI, SC, SD, TN, VA, VI, VT, WI, WV The TPA will adjudicate and pay claims on behalf of VA. Opiates are limited to seven days or less, consistent with state law covering the pharmacy’s location.Īfter providing urgent care to a Veteran, the in-network urgent care provider must file a claim within 180 calendar days with the TPA assigned to their region.For a 14-day supply or greater, the prescription must be submitted to VA to be filled.If a non-network pharmacy is used, Veterans must pay for the prescription and then file a claim for reimbursement with their local VA medical facility.Prescriptions can be filled at an in-network pharmacy, at VA, or at a non-network pharmacy.VA covers a 14-day supply (no refills) of prescription medication for urgent care.For telephone assistance finding an in-network, in-state pharmacy for a Veteran to fill their prescription, call:Ĩ8 for AL, AR, CT, DC, DE, FL, GA, IA, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, NC, ND, NE, NH, NJ, NY, OH, OK, PA, PR, RI, SC, SD, TN, VA, VI, VT, WI, WVĨ6 for AK, AS, AZ, CA, CO, GU, HI, ID, MP, MT, NM, NV, OR, TX, UT, WA, WY.To help a Veteran find an in-network pharmacy to fill their prescription in the same state as the urgent care visit, use VA Facility Locator. The Veteran must fill their urgent care prescription in the same state as their urgent care visit to avoid any issues.Ensure you have activated the Veteran’s pharmacy benefit by calling to check their eligibility, ANDĮnsure the 14-day Rx is on the VA Urgent/Emergent Formulary.

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VA Software Documentation Library (VDL).

Clinical Trainees (Academic Affiliations).War Related Illness & Injury Study Center.Average Administrative Cost for Prescriptions.Durable Medical Equipment/ Pharmacy Requirements.–Veterans Health Information Exchange Program.Spina Bifida Health Care Benefits Program.Indian Health Services/Tribal Health/Urban Indian.CHAMPVA In-house Treatment Initiative (CITI).Indian Health Service/Tribal Health Program.

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