VA Community Care Network credentialing in Texas: TriWest, referrals and claims

Part of our credentialing guide for Texas practices and programs. Related: TRICARE in Texas · Humana · UnitedHealthcare / Optum.

VA community care at a glance

• What it is: the network of non-VA providers that the VA pays to see veterans when the VA can't provide the care itself within its access standards. The VA buys the care through third-party administrators that build and pay the network.
• Texas administrator: TriWest Healthcare Alliance, which the VA names as the administrator for CCN Regions 4 and 5. VA's Community Care Network page lists Texas in Region 4.
• Where to apply: TriWest's Join Our Network site, which TriWest's CCN materials point to for providers who aren't yet in its VA network.
• Credentialing: TriWest verifies your credentials from CAQH or its own application and recredentials every three years.
• Authorization: nothing is covered without an approved VA referral (urgent care is the exception). Behavioral health referrals are usually episodes of care with set services, visits and dates.
• Records: back to the authorizing VA medical center, preferably uploaded in HSRM, within 30 days of care.
• Claims: to TriWest, electronic payer ID TWVACCN, with the VA referral number, within 180 days of the date of service.
• Rates: by law the VA pays Medicare rates where practicable, with a VA Fee Schedule for codes Medicare doesn't price.

Who runs CCN in Texas

The VA split its community care network into five regions when it awarded the CCN contracts: Optum Public Sector Solutions got Regions 1, 2 and 3 in December 2018, and TriWest got Region 4 in August 2019 and Region 5 in 2020 (VA's Region 4 award announcement).

CCN region	Administrator	What it means for you
Region 4	TriWest	Covers Texas, along with the Mountain and Pacific states and the Pacific territories. This is your region.
Region 5	TriWest	Alaska.
Regions 1–3	Optum	Eastern and central states. Region 3 includes Louisiana, Oklahoma, Arkansas and the Southeast, so a program near the Texas line may see veterans referred by a VA facility in an Optum region; their referral and claims follow that region's rules.

Texas veterans are served by VA health care systems in two networks: Houston in VISN 16, and VISN 17 facilities such as Central Texas, El Paso and Amarillo. VA's Region 4 map puts both under Region 4. Your referrals will come from the community care office of the VA system that serves the veteran, so learn who staffs the community care office at the VA systems near you.

Contracts are changing. The VA's Strategic Acquisition Center administers the current CCN contracts and is buying "next-generation" community care contracts; its September 30, 2026 community care dental award to Optum Serve was made under that new structure (VA News). We couldn't find a VA announcement on October 24, 2026 that moves Texas medical and behavioral health care off TriWest's Region 4 contract. Until one does, TriWest is the network you join; when a transition is announced, read the new administrator's provider notices on agreements, referrals and claims addresses before the cutover date.

CCN isn't TRICARE, even though TriWest runs both

Since January 1, 2025 TriWest has also run the TRICARE West region, which includes Texas (see our TRICARE credentialing guide). Same company, two different programs:

• Different patients. TRICARE covers active-duty service members, retirees and their families through the Defense Health Agency. VA community care covers veterans enrolled in VA health care, paid by the VA.
• Different handbooks and claims. TriWest keeps a separate CCN Provider Handbook and a separate TRICARE West handbook. CCN claims follow a 180-day filing limit; TRICARE's is longer. Don't use the TRICARE rules on a VA claim.
• Separate participation. Being in one network doesn't put you in the other. If you serve a military town (Killeen, El Paso, San Antonio), you probably want both, and each is its own application.

How veterans get referred to you

A veteran can't just pick you from a directory and send the VA the bill. The VA decides the veteran is eligible for community care, then authorizes a specific community provider. VA's community care eligibility page sets six criteria; the ones that drive most behavioral health referrals are the access standards:

Care type	Average drive time	Wait time
Mental health, primary care, extended outpatient care	30 minutes	20 days
Specialty care	60 minutes	28 days

The standards are measured against a specific VA facility, and VA says meeting any one of the six criteria may result in a community referral. Another criterion is that the veteran and their VA provider agree community care is in the veteran's best medical interest. What this means for a Texas program: you'll get more VA referrals where the nearest VA mental health clinic is far away or booked out, which is much of rural Texas and some fast-growing suburbs. You can't solicit veterans or pay anyone for referrals (see our guide to patient brokering laws); what you can do is make sure the VA community care offices nearby know you're in the network, what levels of care you offer and how fast you can admit.

Joining as a clinician or group

1. Confirm the region. A Texas practice location is Region 4, TriWest. A second location across a state line may be in an Optum region and need its own application there.
2. Build and attest CAQH. TriWest's individual credentialing application starts with either your CAQH profile or TriWest's own application. If you use CAQH, TriWest pulls your data for primary source verification, and TriWest says that if it isn't authorized to view your profile, it can't complete credentialing and you can't see patients. Authorize TriWest in CAQH (now DataSpring); our CAQH ProView guide walks through it.
3. Have your NPIs and Tax ID straight. Your Type 1 NPI, and the group's Type 2 NPI and Tax ID if you bill as a group (see NPI Type 1 vs Type 2). They must match the W-9 and CAQH exactly.
4. Submit the Join Our Network request at joinournetwork.triwest.com for each clinician, group or facility. Keep the confirmation.
5. Complete and sign every page. TriWest's application says an application that isn't fully complete, signed and dated won't be processed, and that it applies specialty-specific requirements under VA and TRICARE guidelines.
6. Read and sign the network agreement. TriWest's Credentialing and Contract Provisions page is incorporated by reference into the agreement, so read it with the contract, along with the rate exhibit.
7. Wait for your effective date in writing. Don't treat a veteran under CCN until you're in the network and hold an approved referral naming you.

Which licenses? The VA refers for mental health care that Texas licensed professionals provide independently: psychiatrists, psychologists, psychiatric nurse practitioners, LCSWs, LPCs and LMFTs. Ask TriWest about LCDCs before you build a VA plan around them; our LCDC credentialing guide explains why many plans pay LCDC services only through a program.

Joining as an IOP or PHP program

A licensed program joins as a facility, through the same Join Our Network site, and its clinicians work under the facility's agreement for facility services. TriWest's ancillary facility credentialing application lists psychiatric partial hospitalization programs, residential treatment centers, substance use disorder rehabilitation facilities and several outpatient mental health clinic types among the facility types it credentials. That form sits on TriWest's TRICARE site, so ask whether TriWest wants the same form or a CCN version for your VA application.

• License for every level of care. Your HHSC license must cover each service you want contracted (see the Texas chemical dependency treatment facility license and mental health IOP licensing guides).
• Accreditation: ask, in writing. TRICARE requires accreditation and a participation agreement for IOP and PHP. We couldn't find a published CCN rule that says the same for an outpatient program, so ask TriWest what it requires for your levels of care before you plan around it. If you're not accredited yet, our guide to accreditation for new programs shows the usual timeline.
• Have the facility packet ready: Type 2 NPI, W-9, HHSC license, accreditation letter and latest survey (if any), liability certificates, medical director's license, and a one-page program description by level of care with your schedule and the codes you bill (for example H0015 or S9480 for IOP, H0035 for PHP; see the IOP and PHP billing codes guide).
• Know what your episode covers. Program care runs on one VA referral at a time. A program admission that needs more days than the referral allows needs an approved Request for Service before the extra days, not after.

Opening a program from scratch? The IOP / PHP Program Launch includes facility contracts with your first plans, and the Program Launch + Accreditation carries you through the survey that TRICARE, and many commercial plans, ask for.

The referral, step by step

This is the flow your front desk and billing staff have to know cold. Get one piece wrong and the claim rejects.

Step	Who	What happens
1. Eligibility	VA	The veteran's VA team finds they're eligible for community care and enters a consult for the service.
2. Referral	VA community care office	The VA issues a referral and authorization naming your practice or program. Behavioral health referrals are usually a Standardized Episode of Care (SEOC): a set list of services, any visit or unit limits, and a start and end date. TriWest's notices say SEOC authorizations carry a bolded "SEOC" call-out; see TriWest's sample behavioral health authorization letter.
3. Check it	Your intake staff	Before the first visit, confirm the referral number, the services and codes it covers, the visit count, the date range and the authorizing VA facility. Put the end date and visits remaining on your tracker.
4. Treat within scope	Your clinicians	Provide only what the referral covers, within its dates. Anything outside it (more visits, a new service, a higher level of care) needs a Request for Service first.
5. Records	Your clinicians	Initial and final outpatient documentation back to the authorizing VA medical center, preferably uploaded in HSRM, within 30 days.
6. Claim	Your biller	To TriWest with the VA referral number, within 180 days of the service.

Referrals and authorizations are the same discipline as any prior authorization; our sister product's prior authorization guide covers tracking. Cima EHR's program plan keeps each client's authorization, visits used and end date on the chart, so the VA referral number is on every claim.

More visits: the Request for Service (VA Form 10-10172)

When a veteran needs more than the referral allows, the community provider asks the VA on VA Form 10-10172, the Request for Service (RFS). VA's RFS requirements page and TriWest's RFS quick reference guide cover the details. What matters most:

• When: more visits or time on an active referral that's running out, a referral to a new specialty, or a service that isn't in the original episode.
• How: through HSRM, the VA's HealthShare Referral Manager portal, is the preferred route; an electronic signature is accepted.
• With what: the supporting records (progress notes, assessments, test results) attached. VA says requests without the needed documentation and a signature will be denied.
• One request per form. A separate form is needed for each service.
• Timing: send it as soon as you know the extra care is needed, before you deliver it. Build it into your clinical calendar: for an IOP, review the remaining days at each weekly treatment team meeting and send the RFS while there are still days left.

Sending records back to the VA

Commercial plans rarely ask for your notes unless they're reviewing a claim. The VA does, because the veteran's VA team stays responsible for their care. TriWest's medical records and documentation requirements say:

• Where: directly to the authorizing VA medical center, preferably uploaded in HSRM.
• When: initial outpatient documentation within 30 days, final outpatient documentation within 30 days after the episode ends, and an inpatient discharge summary within 30 days. Urgent follow-up documentation is due on request.
• What: signed (written or electronic) by the treating provider, with the veteran's identifiers and the referral number on each page.

TriWest has described 30 days as preferred; the VA's Inspector General describes the contracts as requiring it, and says VA staff must make three requests for missing records within 90 days of an appointment (VA OIG report). Treat it as a deadline. For a substance use program, check your release: our 42 CFR Part 2 guide covers consent for disclosures of SUD treatment records.

Claims and timely filing

Item	The rule	Source
Electronic payer ID	TWVACCN for Region 4 medical claims (dental is CDCA1)	VA, Veteran Care Claims
Paper claims	TriWest VA CCN Claims, P.O. Box 108851, Florence, SC 29502-8851	VA, Veteran Care Claims
Referral number	Required on every CCN claim; claims without it are rejected (urgent care excepted). Ancillary providers in the episode use the same number.	TriWest claims quick reference guide
Timely filing	180 days from the date of service; later claims are denied automatically. TriWest asks for claims within 30 days.	TriWest CCN billing and claims
Timely filing denials	Can't be billed to the veteran or the VA. A reconsideration needs a properly billed claim with a valid referral and proof you filed on time with a VA payer (TriWest, Optum or the VA).	TriWest CCN billing and claims
Claims processor	TriWest's handbook names PGBA as the processor for authorized claims; you submit electronically or on paper as above.	TriWest CCN billing and claims

180 days is half what many commercial plans allow, and it's the limit that hurts programs most, because a batch of IOP days held back while an RFS is pending can age out. Bill each authorized day as it's documented; our timely filing limits guide compares payers.

What CCN pays

The VA's community care statute, 38 U.S.C. 1703(i), tells the VA to limit payments to Medicare rates where practicable. In a 2024 rule the VA explained that it treats paying the Medicare rate when possible as its policy, and that it built a VA Fee Schedule for covered codes that have no Medicare rate (Federal Register, March 27, 2024). Your TriWest agreement sets your actual rates. Two things to check in the rate exhibit:

• Professional codes (90791, 90837, 90853 and so on) usually track the Medicare physician fee schedule for your area and license.
• Program codes. Medicare doesn't price H0015, S9480 or H0035 for freestanding programs, so ask which rate applies to each code you bill, per day or per unit, before you sign. Our guide to negotiating insurance rates covers how to read a rate exhibit.

Bills in the current Congress (for example H.R. 874 and H.R. 8057) would change how 1703(i) rates are set; none had been enacted when we checked.

Training the VA expects

• Prescribers with a DEA number: TriWest says each individual provider who can prescribe controlled medications to veterans must complete the VA's opioid safety training (VHA TRAIN course 1086479, about 20–30 minutes). See TriWest's CCN training page.
• Suicide prevention: VA highly recommends community providers complete suicide prevention courses, such as Preventing Suicide Through Lethal Means Safety and Safety Planning (VHA TRAIN 1075258). See VA's community provider training page.
• Military culture: VA strongly encourages training on military and veteran culture. For a program, it belongs in annual staff training anyway.

Keep the certificates in each clinician's file (our staff credential file checklist has a slot for them). TriWest also says the VA may use a High Performing Provider designation, based on quality metrics, when choosing a provider for a veteran.

How we work a CCN file

Step	What we do	Status you see
1. Region and route	Confirm Region 4 for each Texas location, the right route (clinician, group or facility) and whether you also want TRICARE.	Gathering documents
2. Packet	CAQH built, attested and authorized for TriWest; NPIs, Tax ID and W-9 matched; for programs, license, accreditation (if any), liability certificates and program description.	Submitted
3. Follow-up	Every two weeks, sooner when TriWest asks for something, each contact logged with date and reference.	In review · Payer asked for more
4. Agreement	Rate exhibit checked code by code, the contract provisions read, effective date confirmed. You sign; we don't.	Contract to sign · Contract signed
5. Go live	Payer ID TWVACCN loaded, a referral tracker set up (number, services, visits, end date), staff shown the RFS and records steps, training certificates filed.	In network

You can see how this looks in the client portal tour, with a made-up practice.

Why CCN files and claims stall

1. Applying to the wrong administrator, such as Optum for a Texas location, or assuming TRICARE participation covers the VA.
2. CAQH not authorized for TriWest, or not attested, so TriWest can't verify you.
3. An unsigned or incomplete application; TriWest won't process it.
4. Treating without a referral, or before the referral's start date, or after it ends.
5. Services outside the episode without an approved RFS first.
6. No referral number on the claim, which TriWest rejects.
7. Claims filed after 180 days, which can't be billed to anyone.
8. Records not returned, which strains the relationship with the VA office that sends you referrals.

What we do, and what it costs

Cima Consulting files TriWest's VA network the way this page describes: route and region confirmed first, CAQH built and authorized, the application complete and signed, follow-up every two weeks, the rate exhibit checked before you sign, and your team set up to work referrals, RFSs and records. You sign every application and agreement yourself.

Service	Price
CAQH ProView profile Your CAQH profile built from your documents, uploaded, authorized for your payers and attested. Includes: Profile built and documents uploaded; Payers authorized to view it; First attestation.	$250 per clinician
Credentialing: one insurance plan One clinician with one insurance plan, from application to effective date. Includes: Application filed; Follow-up every 2 weeks until decided; Contract review checklist (rates, timely filing, termination); Effective date confirmed and loaded in your EHR.	$175 per plan
Facility or group contract: one plan A program or group contract with one insurance plan: the organization application, site visit and contract. Includes: Organization application; Site visit preparation if the plan does one; Contract and rate review checklist; Effective date and billing set-up confirmed.	$450 per plan

A clinician with the VA network is $175 per plan; a program's facility agreement is $450 per plan. Adding TRICARE too counts as a second plan. See all credentialing services.

Questions

Who runs the VA Community Care Network in Texas?

TriWest Healthcare Alliance. VA lists Texas in CCN Region 4, and TriWest is the third-party administrator for Regions 4 and 5. Texas providers join through TriWest's Join Our Network site. VA is moving to next-generation contracts, so check for a transition notice before you apply.

How do I become a VA community care provider?

Request to join at joinournetwork.triwest.com, complete TriWest's credentialing (it uses your CAQH profile or its own application), and sign the TriWest network agreement. Then you can see veterans whom the VA refers to you with an approved referral.

Can a veteran come to me without a VA referral?

Not under community care. The VA must find the veteran eligible and authorize the care in advance (urgent care is the exception). Without an approved referral naming you, the VA won't pay, and TriWest rejects claims that don't carry the referral number.

Is VA community care the same as TRICARE?

No. TRICARE covers service members, retirees and families; VA community care covers veterans enrolled in VA health care. TriWest runs both in Texas, but they're separate networks with separate handbooks, applications and claim rules.

What is the timely filing limit for VA community care claims?

180 days from the date of service for CCN claims to TriWest. Late claims are denied automatically and can't be billed to the veteran or the VA. TriWest asks providers to submit within 30 days.

How do I get more sessions approved for a veteran?

Send a Request for Service on VA Form 10-10172, preferably through HSRM, with the supporting notes attached, before the extra care. Each service needs its own form.

How much does VA community care pay?

Your TriWest agreement sets the rates. By law the VA pays Medicare rates where practicable, and it uses a VA Fee Schedule for covered codes Medicare doesn't price. Ask how each program code you bill is priced before you sign.

Back to credentialing for Texas practices and programs, or read the TRICARE guide.

Sources

All checked October 24, 2026. VA and TriWest update these pages; open the current version before you rely on any detail.

1. U.S. Department of Veterans Affairs, Community Care Network (regions and administrators). va.gov
2. VA, CCN Region 4 map. va.gov
3. VA News, VA awards contract for Region 4 of Community Care Network. news.va.gov
4. VA Office of Procurement, Acquisition and Logistics, SAC: The VA Community Care Network. department.va.gov
5. VA News, VA awards Optum Serve community care dental contract (September 30, 2026). news.va.gov
6. VA, Eligibility for community care outside VA. va.gov
7. TriWest, Join Our Network. triwest.com
8. TriWest, CCN Provider Handbook. triwest.com
9. TriWest, Credentialing and Contract Provisions (CCN). triwest.com
10. TriWest, Individual provider credentialing application. triwest.com
11. TriWest, Ancillary facility credentialing application. triwest.com
12. TriWest, Behavioral health authorization letter (sample). triwest.com
13. VA Form 10-10172, Community Care Provider Request for Service. va.gov
14. VA, Request for Service requirements. department.va.gov
15. TriWest, Request for Service quick reference guide. triwest.com
16. TriWest, Medical records and documentation requirements (CCN). triwest.com
17. VA Office of Inspector General, report 24-02154-154 (August 2025). oversight.gov
18. VA, Veteran Care Claims (payer IDs and claims addresses). va.gov
19. TriWest, Claims submission quick reference guide. triwest.com
20. TriWest, CCN Provider Handbook: Billing and Claims. triwest.com
21. 38 U.S.C. 1703, Veterans Community Care Program. law.cornell.edu
22. Federal Register, VA rule on payment rates (March 27, 2024). govinfo.gov
23. TriWest, CCN training for providers. triwest.com
24. VA, Community provider training. va.gov

General information, not legal or billing advice. Cima Consulting isn't a law firm and isn't affiliated with the VA or TriWest; TriWest and the VA make their own network and referral decisions, and we don't guarantee a contract, rate, referral or date.