(And How to Avoid Them)
For home care agencies working with veterans, the Department of Veterans Affairs Community Care Network (VACCN) can provide a stable and scalable reimbursement stream. But with strict coding requirements, tight filing deadlines, and multiple third-party administrator (TPA) portals to navigate, the margin for error is razor-thin. Even seasoned providers run into claim denials that delay cash flow and increase administrative burden.
The good news? Most denials can be prevented with the right systems and attention to detail. Below are five of the most common reasons VA claims are denied, as well as practical steps to help your agency avoid them. 
1. Incorrect or Mismatched Codes
The VA primarily relies on HCPCS codes for home care billing. Each code identifies the exact service provided, and it must match the authorization on file. Even minor mismatches or outdated codes can trigger an automatic rejection.
How to avoid it:
- Always cross-reference the HCPCS code, modifiers, and number of units against the authorization.
- Update your billing templates regularly to reflect current VA and TPA guidance.
- Train staff to double-check before submission
For a detailed breakdown of common home care HCPCS codes, visit the VA Vault, which offers reference tools and best practices for billing accuracy.
2. Missing or Expired Referrals
Every VA claim requires a valid referral or authorization. If the authorization lapses or is missing entirely, the claim will be denied regardless of whether services were legitimately provided.
How to avoid it:
- Use a tracking system for authorization start and end dates.
- Confirm that referrals are converted into valid authorizations before beginning care.
- Don’t assume coverage is in place just because a referral exists; verify the authorization ID is active and correct.
3. Filing Claims Too Late
The VA enforces a 180-day deadline for claim submissions. Miss that window and your claim is automatically denied, with no exceptions. For denied claims, resubmission or appeal must happen within 30–60 days, depending on the TPA.
How to avoid it:
- Implement weekly claim submission cycles to prevent backlog.
- Set internal alerts for the 120-day mark so nothing slips through the cracks.
- If using a clearinghouse or software integration, monitor for transmission errors that could delay claim acceptance.
Timeliness isn’t just a compliance issue; it directly impacts cash flow. If your agency operates in a region with high Veteran demand, staying disciplined about deadlines is essential to financial stability.
4. Patient Identification Errors
It may sound trivial, but small mistakes in patient data are a leading cause of claim rejection. A misspelled name, an incorrect date of birth, or a mistyped Veteran Integrated Control Number (ICN) is all it takes for a claim to bounce back.
How to avoid it:
- Cross-check demographic data against VA records before submission.
- Use software validation tools to flag potential mismatches.
- Make data verification part of every intake and billing workflow.
5. Documentation Gaps or Non-Covered Services
Even when services are correctly authorized and coded, incomplete documentation can derail reimbursement. Claims missing care notes, shift logs, or required signatures are often denied. In other cases, providers unintentionally bill for services the VA doesn’t cover, such as holiday rates, mileage reimbursement, or overtime.
How to avoid it:
- Standardize documentation requirements across your staff and caregivers.
- Audit claims for completeness before submission, ensuring all supporting documents are included.
- Familiarize your team with services that the VA does not reimburse, and adjust billing practices accordingly.
For agencies looking to stay ahead of coverage and reimbursement nuances, Paradigm maintains a VA Fee Schedule Access tool that simplifies rate lookups and helps confirm what is (and isn’t) billable.
Why It Matters
Every denied claim isn’t just a paperwork issue; it represents delayed revenue, additional staff hours, and potential strain on relationships with veterans and their families. Worse, repeated denials can increase the risk of audits, recoupments, or contract issues with the VA.
By building strong internal processes around coding, authorizations, timeliness, patient data, and documentation, agencies can dramatically reduce denials and improve their revenue cycle.
Final Thoughts
VA billing is challenging, but not insurmountable. With the right systems, training, and attention to detail, agencies can ensure clean claims, faster payments, and fewer headaches.
If your team struggles with VA billing or simply wants to free up staff time to focus on care, Paradigm can help. We process thousands of VA claims every month with the highest clean claim rates in the industry. Reach out to us to learn how we can support your agency.
A big thank you to our friends at Paradigm for shedding light on the complexities of VA claims. To pair their expert advice with a platform designed to simplify your back-office operations, explore Rosemark’s home care management software.