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 Penn Behavioral Health Services Out of Network Claim Form for 2013

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♪♪ At VA, our community partners are key to making sure Veterans have access to timely, high-quality health care. When VA refers a Veteran to a community provider, a detailed authorization is issued by VA or one of VA’s Third Party Administrators (TPAs). The authorization allows the community provider to provide care to the Veteran and for VA or the TPA to pay for the care. After a community provider furnishes care to a Veteran based on the scope of services in the authorization, a claim for reimbursement should be filed with the appropriate authorizing party, either VA or a TPA. Instructions for filing the claim are included in the authorization. Filing claims and supporting documentation electronically is recommended because it reduces the risk of errors and speeds up reimbursement. While not required to process a claim for authorized services, medical documentation should be submitted to the authorizing VA medical facility as soon as possible after care has been provided. This

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