There’s never been a mechanism in place for seamless exchange of health and VA benefit information between the VA and non-VA healthcare systems. That is, until now.
VA Interoperability is a major initiative uniting the U.S. Department of Veterans Affairs (VA) with Epic and Oracle Health (Cerner) — the leading electronic health record (EHR) vendors — to improve veterans‘ access to and coordination of healthcare.
The primary goal of VA Interoperability is to facilitate data exchange so veterans can receive better-coordinated care when seeking treatment in the VA Community Care Network (CNN).
13 Community Health Systems Take the VA Pledge
In October 2023, the VA kicked off its pilot interoperability program by teaming up with 13 community health systems. The providers that were the first to sign the Veteran Interoperability Pledge include:
- Sanford Health
- Tufts Medicine
- Marshfield Clinic Health System
- Emory Healthcare
- Inova
- Jefferson Health
- UC Davis Health
- Intermountain Health
- Mass General Brigham
- Rush Health
- Kaiser Permanente
- University of Pittsburgh Medical Center
- Atrium Health
By signing the Pledge, these health systems agreed to work with the VA to plan better care for the veteran while the VA can update the veteran concerning their benefits. This initiative marks a major step forward in achieving instant data exchange, helping ensure veterans better understand their full benefits. It also gives clinicians immediate access to healthcare records required to deliver the best care to their VA patients.
The VA Interoperability API Is Now Live
On September 18, 2024, the VA announced its Interoperability Application Programming Interface (API) was now available to all healthcare systems that use either Epic or Oracle Health EHRs. Healthcare systems must connect to the VA API to participate in the program.
Given that over half of U.S. healthcare providers use Epic and Oracle Health EHR systems, this development is a significant milestone.
By leveraging this API, the VA hopes that more veterans will access their VA benefits and providers can make more informed treatment decisions while reducing administrative burdens associated with accessing VA data separately.
FAQs About VA Interoperability
Q: What does joining the Interoperability Pledge mean for my health system?
A: Joining the Interoperability pledge allows your health system to integrate with the VA’s open API. This integration provides real-time access to identify veteran patients, view their VA benefit eligibility, and coordinate patient care.
Q: Do I have to use a specific EHR to participate?
A: Yes, the program is currently available only to providers using Epic or Oracle Health EHR systems that have connected to the VA API.
Q: What’s the cost?
A: While the VA provides the API for free, you will incur costs when integrating it into your existing infrastructure. Your healthcare organization must adapt its platforms to meet interoperability standards and allocate resources to managing challenges typically associated with periodic software and API glitches and upgrades.
You will also need to retrain case managers and physicians who must learn how to navigate between the VA data and internal systems; retraining costs can add up.
Q: Does this benefit my veteran patients?
A: Absolutely. Interoperability allows you to better coordinate care by having more complete access to veterans’ medical histories. You’ll also know which VA benefits your veteran patients are eligible to receive.
Q: How does Interoperability work with Community Care Network (CCN) Claims?
A: Interoperability interacts with CCN claims by enabling active sharing of medical records between the hospital and VA Case Management. This collaboration helps determine the best course of medical treatment for the veteran and whether a transfer to a local VA facility is appropriate.
Q: How does Interoperability work with VA Fee Basis Claims?
A: Interoperability does not interact with Fee Basis Claims, as the hospital does not communicate with the VA regarding care in these instances.
Q: How does Interoperability work with TRICARE claims?
A: Interoperability does not interact with TRICARE claims. The only connection between the VA and TRICARE is through the Department of Defense’s eligibility link with the Veterans Benefits Administration.
Q: How does Interoperability work with CHAMPVA claims?
A: Interoperability does not interact with CHAMPVA claims. The VA’s only link with a CHAMPVA claim is the eligibility component; they do not house spouse or dependent medical records for care coordination.
Q: Are there security or privacy risks with VA Interoperability?
A: The VA enforces strict data security measures to protect veterans’ information. However, as with any data exchange, some exposure risk remains. To mitigate these risks, it’s essential to adhere to stringent privacy and security guidelines.
Q: How long does it take to implement the VA API?
A: Implementation timelines can vary depending on hospital/health system size and current infrastructure. Consult with your EHR vendor and your IT team for a more precise estimate based on your unique infrastructure.
Q: How do I participate in VA Interoperability?
A: To participate, contact your Epic or Oracle Health representative to initiate the VA’s API setup process.
What VA Interoperability Will Accomplish
The three main benefits to VA Interoperability include:
- Real-time exchange of clinical information between the VA and non-VA providers so caregivers can better diagnose and plan the veteran’s episode of care
- Identify the veteran’s eligibility for care via the VA database
- Data access: The hospital now has the data required to inform a veteran of his or her potential benefits through the VA
What VA Interoperability Will NOT Accomplish or Replace
There’s been considerable confusion among healthcare providers about what will NOT change with VA Interoperability.
Here’s a short list of what will NOT change in terms of VA claims processing and management:
| No Change | The 72-hour notification window for the VA for when treatment starts |
| No Change | Coordination of benefits regarding other health insurance |
| No Change | The HealthShare Referral Management Portal and requirements |
| No Change | The Standard Episode of Code listing that requires authorization |
| No Change | The requirement that portions of the medical record be submitted for claim processing |
| No Change | Bill submission to any of the military payers |
| No Change | Operating manuals across all military payers |
| No Change | Process for appealing a denied VA claim |
VA Claims Complexity Persists, Even as Interoperability Advances
The intricate regulations, frequent policy changes, detailed documentation, and payer requirements for handling VA claims can make timely and complete reimbursement difficult to achieve. Understanding the nuances of the VA system is essential to maximize revenue and minimize claim denials.
- Do you understand the top reasons your VA hospital claims are rejected?
- Do you want to expedite payment for your VA claims?
- Should you outsource your VA processing?
If these questions resonate with you, it’s time to consider partnering with a specialized VA claims management expert.
“We partner with EnableComp because of their professionalism, engagement and integrity demonstrated by their team members. They take ownership and pride in their work and understand how to make their client’s needs a priority. Thank you EnableComp for becoming part of our team at WellSpan!” – Chris Stottlemyer Senior Director Patient Financial Services, WellSpan Health
Why EnableComp Is the Smart Choice for VA Claims Management
EnableComp transforms VA claims management by leveraging our E360 RCM™ platform and deep expertise in VA claims processing and billing.
With strong relationships with payers and seamless integration across all EHRs, we deliver exceptional results, helping clients navigate the complexities of claims effectively while the Department of Veteran Affairs modernizes care coordination.
On average, EnableComp’s client partners achieve a 25% average cash uplift and a 41% decrease in time to collect for their VA claims.
By letting EnableComp handle the complexities of your VA claims, you can focus on providing exceptional care to your veteran patients while still capturing all the revenue you’re due. Contact us now to learn more.
