CCN Next Gen - Referrals_Authorizations_SEOC Slides.pdf

This is a presentation document from the Veterans Health Administration (VHA) Office of Integrated Veteran Care dated February 13, 2026, describing the Community Care Referrals and Authorizations (CCRA) system and Standardized Episodes of Care (SEOC) framework.

The presentation outlines VA's process for providing community care to Veterans when VA facilities cannot deliver required services. Community care authorization is based on three factors: specific eligibility requirements, availability of VA care, and Veteran needs. The CCRA system enables VA staff to generate referrals and authorizations, submit precertification and emergency notifications, and manage the entire referral lifecycle. The HealthShare Referral Manager (HSRM) serves as the operational platform, allowing staff to generate and manage referrals, locate community providers through the Provider Profile Management System, send referrals to Third Party Administrators (TPAs), and schedule appointments. The referral and authorization process flow includes nine sequential steps: determination of care need, eligibility verification, referral initiation with SEOC attachment, authorization generation, approval transmission to TPA and provider, provider location, appointment scheduling, care delivery with medical documentation upload, documentation indexing and storage in the Veteran's health record, and consult closure.

SEOCs are defined as standardized lists of allowable services and procedures customary to specific specialties, sub-specialties, procedures, or tests, including procedural overviews and related billing/CPT codes. SEOCs provide support to consult/referral orders and help providers understand allowable services and procedures. Key SEOC benefits include streamlining stakeholder communication, reducing administrative burden, and improving access to care. The presentation emphasizes that while referrals and authorizations ensure Veterans receive community care when VA cannot provide services in-house, SEOCs standardize which services are included in those referrals.