Provider Guidelines
Standards and best practices for VA Community Care providers
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Overview
As a VA Community Care Network provider, you play a vital role in serving our nation's Veterans. These guidelines ensure consistent, high-quality care across the network while maintaining compliance with VA standards.
These guidelines are updated regularly. Always refer to the most current version and check for updates quarterly.
Core Provider Responsibilities
Verify Eligibility
- • Confirm valid VA authorization before treatment
- • Verify Veteran identity with photo ID
- • Check authorization scope and dates
Maintain Standards
- • Meet or exceed community standards of care
- • Maintain all required licenses and certifications
- • Follow evidence-based treatment protocols
Documentation
- • Complete thorough medical records
- • Submit required reports to VA
- • Maintain records per VA requirements
Coordination
- • Coordinate with VA providers as needed
- • Share medical records promptly
- • Participate in care transitions
Clinical Guidelines
Treatment Standards
Evidence-Based Care
: Use current clinical practice guidelines and evidence-based treatments
Scope of Practice
: Only provide services within your licensed scope and the authorization
Cultural Competency
: Provide culturally sensitive care respecting Veteran experiences
Trauma-Informed Care
: Understand and respond to trauma-related needs of Veterans
Special Considerations for Veterans
Mental Health
: Screen for PTSD, depression, and substance use. Know VA crisis resources.
Service-Connected Conditions
: Be aware of common service-related injuries and exposures.
Medication Management
: Coordinate with VA pharmacy. Follow VA formulary when possible.
Suicide Prevention
: Know warning signs. Have Veterans Crisis Line: 988, Press 1.
Administrative Requirements
Timely Access
- • Appointment within 30 days
- • Urgent care within 48 hours
- • Return calls within 24 hours
Privacy & Security
- • HIPAA compliance required
- • Secure communication only
- • Proper records disposal
Quality Reporting
- • Submit quality metrics
- • Participate in reviews
- • Report adverse events
Prohibited Practices
The following practices are strictly prohibited:
- Billing Veterans for covered services
- Requiring deposits or advance payments
- Refusing service based on VA payment rates
- Marketing non-covered services during visits
- Discriminating against Veterans
- Altering medical records after submission
- Providing services beyond authorization
- Delegating care without approval
Resources & Support
Quick Reference
Emergency Contacts
Veterans Crisis Line: 988, Press 1
: 24/7 crisis support for Veterans