“Questions have been raised about the lack of timeliness of TPAs’ payments to community providers under the Choice Program and how this may affect the willingness of providers to participate in the program as well as in the forthcoming Veterans Community Care Program. You asked GAO to review issues related to the timeliness of TPAs’ payments to community providers under the Choice Program.”
“This report examines, among other things, (1) the length of time TPAs have taken to pay community providers’ claims and factors affecting timeliness of payments, and (2) actions taken by VA and the TPAs to reduce the length of time TPAs take to pay community providers for Choice Program claims…”
“GAO’s analysis of TPA data available for November 2014 through June 2018 shows that the length of time the TPAs took to pay community providers’ clean claims each month varied widely—from 7 days to 68 days. VA and its TPAs identified several key factors affecting timeliness of payments to community providers under the Choice Program, including VA’s untimely payments to TPAs, which in turn extended the length of time TPAs took to pay community providers’ claims; and inadequate provider education on filing claims…”
“GAO is making two recommendations, including that VA should collect data on and monitor compliance with its requirements pertaining to customer service for community providers…” Read the full report here.
Source: Veterans Choice Program – Further Improvements Needed to Help Ensure Timely Payments to Community Providers, September 28, 2018. GAO.gov.
