VA Community Care Network for Behavioral

VA Community Care Network

Department of Veterans Affairs Community Care Network (VA CCN)

VA Community Care Network provider guide for behavioral health — Optum and TriWest regions, referrals, authorization, and claims for Veteran care.

Quick Reference

Payer Type

Government

Parent Company

US Department of Veterans Affairs

Headquarters

Washington, DC

Provider Portal

Open Portal

Portal Guide

View Guide →

Credentialing

Network administrator credentialing — Optum Serve for Regions 1-3; TriWest Healthcare Alliance for Regions 4-5; most use CAQH ProView

Timeline

Typically 60-120 days (varies by region and administrator)

Coverage

1 states

Last Verified

Apr 19, 2026

Published

Apr 19, 2026

Reading Time

8 min

Covered Levels of Care

• Medically Managed Detoxification
• Residential Treatment (SUD and mental health)
• Partial Hospitalization Program (PHP)
• Intensive Outpatient Program (IOP)
• Outpatient Treatment
• Medication-Assisted Treatment (MAT)
• Psychological testing and assessment

Medical Necessity Criteria

• VA clinical practice guidelines (VA/DoD CPGs)
• ASAM Criteria (for substance use disorders)
• CCN third-party administrator utilization management policies

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Overview

The VA Community Care Network (CCN) is the Department of Veterans Affairs ↗ program for purchasing health care from non-VA community providers for eligible Veterans. Authorized by the VA MISSION Act of 2018 and its implementing regulations, CCN replaced a patchwork of earlier community care arrangements — including the Veterans Choice Program — with a unified national network administered by two third-party administrators under contract to the VA.

CCN exists because the VA’s own medical centers and clinics cannot always provide timely, geographically convenient care for all enrolled Veterans. When a Veteran meets one of the MISSION Act eligibility criteria — distance from a VA facility, excessive wait time, unavailability of the needed service at the VA, best medical interest as determined by a VA clinician, or grandfathered access under earlier programs — the VA can authorize the Veteran to receive care from a community provider and pay for that care through CCN.

For behavioral health treatment facilities, CCN is a significant referral source. Mental health and substance use disorder care represent a substantial share of CCN authorizations because VA medical centers frequently lack local capacity for residential SUD treatment, specialty programs for post-traumatic stress disorder, or intensive outpatient programming in rural areas. Understanding the CCN’s two-administrator structure, referral-first model, and claims workflow is essential for any facility that wants to serve Veterans through this program.

Behavioral Health Coverage

CCN can authorize the full continuum of behavioral health services when a VA referring clinician determines the Veteran needs community care for a given level of treatment. Authorized services include outpatient individual and group therapy, psychiatric evaluation and medication management, psychological and neuropsychological testing, intensive outpatient programs, partial hospitalization, residential treatment for substance use disorders and serious mental illness, medically managed and medically monitored detoxification, and medication-assisted treatment including buprenorphine management, injectable naltrexone, and referral to opioid treatment programs where methadone is appropriate.

The scope of any individual authorization is defined by the Standardized Episode of Care (SEOC) issued with the referral. SEOCs are templated authorization packages that specify which services are covered, how many visits or days are approved, and the date range of the authorization. Providers must deliver only the services enumerated on the SEOC unless they obtain an amended authorization from the VA. Services rendered outside the SEOC scope will not be paid.

Medical necessity is evaluated against the VA/DoD clinical practice guidelines published at healthquality.va.gov ↗, ASAM Criteria for SUD services, and the administrator’s own utilization management policies for concurrent review of residential and PHP stays. The VA places heavy emphasis on evidence-based practices for conditions prevalent in the Veteran population — cognitive processing therapy and prolonged exposure for PTSD, medication-assisted treatment for opioid use disorder, and integrated treatment for co-occurring mental health and SUD conditions are preferred approaches.

Credentialing and Provider Enrollment

CCN credentialing is handled by the regional administrator rather than the VA directly. The network is divided into five regions:

Facilities in Regions 1-3 credential through Optum Serve at vacommunitycare.com ↗. Facilities in Regions 4-5 credential through TriWest at triwest.com/en/provider ↗. Facilities operating across regions must credential with both administrators.

Both administrators use CAQH ProView as the primary credentialing data source for individual clinicians. Facility-level credentialing typically requires current state behavioral health license, accreditation (Joint Commission, CARF, or COA depending on level of care), professional and general liability insurance, an organizational NPI, Tax ID and W-9, ownership and control disclosure under federal regulations, DEA and state controlled substance registrations for prescribing staff, SAMHSA OTP certification and DEA OTP registration if operating an opioid treatment program, and program descriptions for each level of care offered. Timelines typically run approximately 60 to 120 days from submission of a complete application.

Some Veterans may alternatively receive care through VA direct contracts (Sharing Agreements, Direct Care Agreements) or through emergent care pathways. These arrangements are separate from CCN and have their own contracting processes handled by individual VA medical centers.

• Region 1 (Northeast): Administered by Optum Serve — CT, DE, ME, MD, MA, NH, NJ, NY, NC, PA, RI, VT, VA, WV, and Washington DC.
• Region 2 (Midwest): Administered by Optum Serve — IL, IN, IA, KS, KY, MI, MN, MO, NE, ND, OH, SD, and WI.
• Region 3 (Southeast): Administered by Optum Serve — AL, AR, FL, GA, LA, MS, OK, PR, SC, TN, and the US Virgin Islands.
• Region 4 (West): Administered by TriWest Healthcare Alliance — AZ, CA, CO, HI, ID, MT, NV, NM, OR, TX, UT, WA, WY, American Samoa, Guam, and the Northern Mariana Islands.
• Region 5 (Alaska): Administered by TriWest Healthcare Alliance.

Verification of Benefits (VOB)

CCN does not work like a conventional insurance plan. There is no standing eligibility to verify before services — the authorization itself defines the Veteran’s access. Every Veteran episode of care must be preceded by a VA-issued referral and authorization, which the community provider receives through the administrator’s portal or the VA’s HealthShare Referral Manager.

When a referral is received, providers should confirm the following before the first visit: the Veteran’s identity against the referral documentation; the specific services authorized on the SEOC; the authorization start and end dates; the maximum number of visits or days authorized; the billing administrator (Optum Serve or TriWest based on region); and whether the Veteran has other health insurance that may be primary. The VA is the payer of last resort for community care — other insurance must be billed first where the Veteran has coverage.

For episode extensions or additional services beyond the SEOC, providers must contact the VA referring facility (not the administrator) to request an amended or new authorization. Amended authorizations are not automatic and may require clinical justification, especially for residential stays extending beyond an initial 30 days.

Prior Authorization Requirements

The VA-issued referral and SEOC constitute the prior authorization for CCN care. There is no separate administrator-issued prior authorization for the initial episode. However, the administrators perform concurrent review for residential, inpatient, and PHP stays to confirm continued medical necessity. Concurrent reviews typically run every 5 to 10 days for residential and require clinical documentation demonstrating progress, ongoing medical necessity, and a step-down plan.

When concurrent review supports continued treatment beyond the original SEOC limits, the administrator coordinates with the VA referring facility to extend the authorization. When continued stay is not supported, the administrator issues an adverse determination and the Veteran and provider have appeal rights through the administrator’s clinical appeals process, with ultimate review available through the VA.

For services that fall outside the SEOC — for example, a medically necessary psychological evaluation that was not anticipated in the initial referral — providers must contact the VA referring facility to request an amendment. The administrator cannot unilaterally authorize services beyond the SEOC scope.

Emergency behavioral health services for Veterans may be covered under separate VA emergency care authorities rather than CCN. In an emergency admission, notify the VA promptly (generally within 72 hours) so the appropriate authorization pathway — CCN or emergency care — can be determined.

Claims and Billing

Claims for CCN services submit to the applicable regional administrator rather than to the VA. Regions 1-3 claims route to Optum Serve using Optum’s VA CCN payer ID. Regions 4-5 claims route to TriWest Healthcare Alliance. Confirm current payer IDs with your clearinghouse before submitting volume.

Electronic submission uses standard 837I (institutional, UB-04 based) for facility claims and 837P (professional, CMS-1500 based) for clinician claims. Every claim must reference the VA authorization number from the referral — claims without a valid authorization number are rejected or denied. The timely filing limit for CCN claims is generally 180 days from the date of service, though specific terms are defined in the administrator contracts and summarized on their provider portals.

The VA is the payer of last resort for community care. Where the Veteran has other health insurance — private coverage, Medicare, or Medicaid — that coverage must be billed first, and the CCN claim is submitted with the primary explanation of benefits. Failure to bill other insurance first is a common denial cause.

Common denial reasons include missing or invalid authorization number, services rendered outside the SEOC scope, services delivered after the authorization end date, timely filing exceeded, missing or incorrect primary insurance information, and coding errors. Appeals process through the administrator first; unresolved issues may be escalated to the VA.

Reimbursement rates under CCN are generally based on Medicare-equivalent rates with VA modifications, as specified in the administrator contracts. Rates for behavioral health services are defined in the CCN rate schedules available to credentialed providers through the administrator’s portal.

Key Contact Information

• VA Community Care Home: va.gov/communitycare ↗
• Regions 1-3 Administrator (Optum Serve / VA CCN): vacommunitycare.com ↗
• Regions 4-5 Administrator (TriWest): triwest.com/en/provider ↗
• VA MISSION Act information: va.gov/communitycare/programs/veterans/General_Care.asp ↗
• VA/DoD Clinical Practice Guidelines: healthquality.va.gov ↗
• HealthShare Referral Manager (HSRM): The VA’s referral management system — access is coordinated through the local VA medical center
• VA Office of Community Care Provider Resources: va.gov/communitycare/providers ↗

Frequently Asked Questions

VA CCN is divided into five regions. [Optum Serve](https://vacommunitycare.com) administers Regions 1 through 3, which cover the Northeast, Midwest, Southeast, Puerto Rico, and the US Virgin Islands. [TriWest Healthcare Alliance](https://www.triwest.com/en/provider/) administers Region 4 (Western states including Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Texas, Utah, Washington, Wyoming, and the Pacific territories) and Region 5 (Alaska). The full region assignments are published at [va.gov/communitycare](https://www.va.gov/communitycare). Facilities operating in multiple regions must credential with both administrators.

Community care referrals originate at the VA. A VA clinician assesses the Veteran's eligibility for community care under the MISSION Act criteria (distance, wait time, service availability, best medical interest, or grandfathered access) and initiates a referral and authorization for the specific services needed. The referral flows through the VA's HealthShare Referral Manager to the regional CCN administrator (Optum or TriWest), which then places the Veteran with a credentialed community provider. Community providers cannot self-refer Veterans — authorized care must originate from the VA. Providers that see Veterans without a VA referral and authorization will not be paid by CCN.

VA CCN can cover a full continuum of mental health and SUD services when authorized by the referring VA facility, including outpatient therapy, psychiatric medication management, psychological testing, intensive outpatient, partial hospitalization, residential SUD and mental health treatment, and medically managed detoxification. Medication-assisted treatment with buprenorphine, methadone (through OTPs), and naltrexone is covered when clinically indicated. The scope of each individual authorization is defined by the VA referring clinician and documented on the Standardized Episode of Care (SEOC) that accompanies the referral. Providers must deliver only the services on the SEOC unless additional authorization is obtained.

Credentialing is handled by the regional administrator, not the VA directly. In Regions 1-3, apply through [Optum Serve's VA CCN provider portal](https://vacommunitycare.com); in Regions 4-5, apply through [TriWest's provider portal](https://www.triwest.com/en/provider/). Both administrators use CAQH ProView for individual clinician credentialing and collect facility-level documentation separately. Typical requirements include state behavioral health license, accreditation (Joint Commission, CARF, or COA as applicable), professional liability coverage, NPI, W-9, ownership disclosure, and program descriptions for each level of care. Timelines generally run approximately 60 to 120 days. Credentialing with the VA directly (non-CCN contracts) is a separate process handled by individual VA medical centers or consolidated credentialing programs.

Claims submit to the regional administrator, not to the VA. For Regions 1-3, claims route to [Optum Serve / VA CCN](https://vacommunitycare.com) using Optum's designated payer ID. For Regions 4-5, claims route to [TriWest Healthcare Alliance](https://www.triwest.com/en/provider/). Electronic submission uses standard 837I and 837P formats; paper claims use UB-04 and CMS-1500. Each claim must reference the VA authorization number issued with the referral. The timely filing limit for CCN claims is generally 180 days from the date of service, though specific terms are defined in the administrator contract and summarized on the administrator's provider portal. The VA is the payer of last resort — other health insurance must be billed first where applicable.

Related Payers

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Revenue Cycle Resources

This guide is provided for informational purposes only and does not constitute legal, regulatory, or professional advice. Payer requirements, phone numbers, and portal URLs are subject to change. Always verify current information directly with the payer. is not affiliated with the insurance companies described on this page.

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Common questions

Official sources

• Department of Veterans Affairsva.gov
• healthquality.va.govhealthquality.va.gov
• va.gov/communitycareva.gov
• va.gov/communitycare/programs/veterans/General_Care.aspva.gov
• va.gov/communitycare/providersva.gov