Not All Military Payers Are the Same — And That Matters More Than Ever

Reimbursement in healthcare is complicated — and military insurance adds another layer. A common misconception is that the Department of Veterans Affairs (VA) directly processes and pays all claims. In reality, the VA oversees the process, but other entities increasingly handle administrative tasks. This misunderstanding leads to billing errors, denials, and delays that impact veterans and their families.

This issue isn’t new, but it’s worsening. As VA staffing cuts and attrition increase, more veterans are seeking care in the community. Health systems that don’t understand how military payers operate risk being quickly overwhelmed. Having navigated this system both personally and professionally, I’ve seen firsthand how confusion can delay care and jeopardize access.

Military payers aren’t interchangeable

Too often, providers handle all military claims the same way — sending them to the VA and hoping for the best. But there are multiple payer types, and they function very differently.

The MISSION Act of 2018 reshaped the landscape by expanding eligibility and establishing the Community Care Network (CCN), which allows veterans to receive care outside of VA facilities. While this broadened access, it also introduced new payer complexity. CCN is managed by third-party administrators, such as Optum and TriWest, rather than the VA. If a provider mistakenly submits a CCN claim directly to the VA, it will be denied because the VA does not have a record of the care episode.

Some claims are still processed through VA Fee Basis, a legacy system used in limited cases. Confusing Fee Basis with CCN is a common error that causes denials and delays.

The Millennium Bill (Mill Bill) covers emergency care when veterans are unable to reach a VA facility. These are highly time-sensitive: facilities must notify the VA within 72 hours and file the claim within 90 days. Missing those deadlines leads to automatic denials, even when the care was valid and necessary.

Another misunderstood payer is CHAMPVA, which covers spouses and dependents of veterans with service-connected disabilities — not the veterans themselves. It is entirely separate from TRICARE, which has five distinct plans covering active-duty members, reservists, and retirees, each with its own eligibility and reimbursement rules.

Treating all these programs as interchangeable isn’t just a clerical mistake — it disrupts billing, reimbursement, and ultimately, veterans’ care.

Why it’s getting harder — and why it matters now

This confusion has long existed, but pressure on the system is increasing. Recent plans to cut over 80,000 VA jobs, primarily in billing and administrative roles, have been scaled back but not abandoned. The department now aims to eliminate 30,000 positions by fiscal 2025, mostly through attrition. With fewer staff, more care will shift to community providers through CCN — but with less administrative support to manage it.

The shift is already underway. Between 2018 and 2021, the number of veterans treated by community primary care providers rose 107%. A 2024 report showed a 15–20% growth in referrals to community care, and that number is likely to continue climbing.

Legislation continues to expand eligibility. The COMPACT Act of 2020 increased access to community-based emergency mental health care to prevent veteran suicide. The PACT Act of 2022 expanded again in 2024, extending eligibility for veterans exposed to toxic substances. These were essential steps forward, but they also spiked claim volumes and complexity.

Fewer VA staff, more veterans, and expanding eligibility mean longer wait times, more denials, and greater administrative strain. Veterans must still obtain referrals and authorizations through the VA — a process that can take up to 28 days and may be interrupted at any point.

Common pitfalls include:

• Authorization & eligibility – Missing authorizations, mismatched places of service, or unlisted procedures in the SAR/RFS.
• Billing & submission – Late filing (beyond 180 days), unsupported codes, missing modifiers, or duplicate claims.
• Provider coordination – Mismatched NPI/TIN information or incorrect payer sequencing that delays reimbursement.

All of this is happening as claim volumes climb and VA staffing thins. Without process improvements and stronger partnerships, delays and denials will multiply — with veterans paying the price.

What providers must do: prepare and partner

The biggest mistake providers make is assuming the VA operates like a commercial payer. It doesn’t. Submitting a Mill Bill emergency claim to CCN, or a CCN claim directly to the VA, guarantees denial. Understanding payer type is essential.

Providers should ask:

• Are our billing teams trained to distinguish between military payers?
• Do we know which payers require the veteran to initiate authorization?
• Are we ready for a potential 15–20% increase in veteran volume over the next year?

Many facilities handle their military claims well — for now. But as volume increases and VA capacity decreases, workloads will quickly surpass staffing.

At the other end of every breakdown is a veteran who may not know the difference between the VA, CCN, or TRICARE. Many veterans are unaware that they’re eligible for CCN. Helping them navigate the system with accuracy and empathy is part of the provider’s duty of care.

That’s where preparation and partnerships play a crucial role. Collaborating with organizations that specialize in military claims can help providers streamline operations, reduce denials, and ensure timely reimbursement.

Specialized partners can help providers:

• Identify payer type accurately to avoid misrouted claims.
• Use automation to flag missing documentation or errors before submission.
• Track authorizations so veterans don’t fall through the cracks.
• Monitor reimbursement trends to anticipate delays and respond quickly.
• Lighten administrative load, freeing staff to focus on patient care.

Outside expertise doesn’t replace internal teams — it reinforces them. It builds resilience at a time when veteran volumes and claim complexities are both rising.

Serving those who served

Behind every claim is a person — a widow, a spouse, a child, or a veteran coping with trauma or loss. Understanding these systems isn’t just an administrative requirement; it’s a service.

When claims are denied because they were sent to the wrong payer, someone must rectify the error — often, it is the veteran or a grieving family member. It’s a preventable burden that compounds stress at already difficult times.

As claim volumes rise and VA systems evolve, providers can protect both their operations and patients by partnering with experts who thoroughly understand military reimbursement. The right partner not only speeds up payment and reduces denials — it ensures that those who serve our country receive the care and respect they deserve.

Photo: mstahlphoto, Getty Images

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