CCN Next Gen - Referrals_Authorizations_SEOC Slides.pdf

This document is a presentation slide deck prepared by the VHA Office of Integrated Veteran Care describing the Community Care Referrals and Authorizations (CCRA) system and Standardized Episodes of Care (SEOC) framework as of February 13, 2026.

The presentation outlines VA's community care program, which provides care to Veterans through community providers when VA cannot provide the needed services in-house. Community care eligibility is based on 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 referral process. HealthShare Referral Manager (HSRM) is the operational system used to generate and manage referrals and authorizations, locate providers through the Provider Profile Management System, send referrals to Third Party Administrators (TPAs), and schedule community care appointments. The referral and authorization process flow includes ten sequential steps: Veteran determination for care, VA eligibility verification, referral initiation with SEOC attachment, authorization generation, approval and TPA/provider notification, provider location, appointment scheduling, care delivery, medical documentation upload, documentation indexing and storage, and consult closure.

SEOCs are defined as 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 view allowable services and procedures. Key SEOC benefits include streamlining stakeholder communication, reducing administrative burden, and improving access. While referrals and authorizations ensure Veterans receive care when VA cannot provide it in-house, SEOCs standardize which services are included in each episode of care.