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Reasons for Returned Scheduling Referral CCN Next Generation contractors are required to document a reason when returning a VA referral for scheduling community care. The following represent the valid reason codes:
Table 1 CCN Next Generation Scheduling Return Reason Codes
| # |
| Return Reason Code |
| Description |
| 1 |
| No Network Provider Available |
| Network Provider is not available to provide the services requested on the VA Approved Referral |
| 2 |
| Appointed with Incorrect Provider/Type of Care |
| Contractor appoints Veteran to wrong type provider or care (not in accordance with VA Approved Referral). |
| 3 |
| Veteran Declined - Geographic Accessibility Outside of Standards |
| Contractor cannot meet geographic accessibility standards; results in Veteran declining care. |
| 4 |
| Veteran Declined - Timeliness Outside of Contract Appointment Timeliness Standards |
| Contractor cannot meet timeliness standards; results in Veteran declining care. |
| 5 |
| Missing VA Data |
| Missing required elements in accordance with Ordering Procedures. |
| 6 |
| Duplicate |
| A duplicate referral was received for the same Veteran, for the same service, with the same start date |
| 7 |
| Excluded CCN Healthcare Service |
| Referred service is not within the scope of the contract, per the Health Benefit Package |
| 8 |
| Already Appointed |
| VA has already scheduled the care requested in the VA Approved Referral |
| 9 |
| Veteran Declined - Network Provider Meets Geographic Accessibility Standards |
| Veteran declined care, despite the network provider being within geographic accessibility standards |
Return must include provider name and location
| 10 |
| Veteran Declined - Network Provider Meets Appointment Timeliness Standards |
| Veteran declined care, despite the network provider meeting timeliness standards = |
Return must include provider name
| 11 |
| Veteran Declined Care |
| Veteran declines care authorized in the Approved Referral |
| 12 |
| Veteran No-Show |
| Veteran does not attend appointment and does not notify the Contractor of needing to cancel and reschedule appointment |
| 17 |
| VA Requested Return of VA Approved Referral: Care Not Scheduled within Contract |
| Contractor to return referral at the request of the VA when care has not been scheduled for the Veteran |
| 13 |
| VA Requested Return of VA Approved Referral: Care Already Scheduled |
| Contractor to return referral at the request of the VA when care has been scheduled. |
| 14 |
| Care Scheduled - Veteran Cancelled |
| Veteran cancels and the Contractor cannot contact Veteran within 10 calendar days for re-appointing. |
| 15 |
| Veteran Elects to Self-Schedule - |
Contractor returns for no activity No appointment activity happens within 90 calendar days of Veteran election to self-schedule or the validity period of the Approved Referral, whichever comes sooner.
| 16 |
| Network Provider Not Accepting Patients |
| The requested network provider will not take on additional patients for appointments |
| Veteran Requested Non-CCN Network Provider |
| Requested a specific provider outside of CCN Network and refuses other in-network options for care |
| 18 |
| Veteran Deceased or Incapacitated |
| Veteran is deceased or incapacitated, preventing the Veteran from attending appointment |
| 19 |
| Veteran Requested Specific Provider Outside of Network |
| Veteran‘s requested provider is outside of the Network |
| 20 |
| Veteran Declined Care - Veteran was Unaware of the Referral |
| Veteran is not aware of this referral to community care for appointing within CCN and declines appointment |
| 21 |
| Veteran Declined Care – Does Not Want to Utilize Community Care |
| Veteran does not want care in the community at all, and only wants care in the VA |
| 22 |
| Veteran Declined Care - Veteran Experiencing Transportation Challenges |
| Veteran has exhausted all forms of transportation to get to the appointment in the community |
| 23 |
| SEOC on Referral Does Not Provide Services Needed |
| Veteran/referral SEOC does not cover services needed. |
| 24 |
| Contractor is Unable to Schedule within Timeliness Standard |
| Contractor successfully contacts Veteran – CCN Contractor cannot schedule care within appointment scheduling standards due to community provider being unable to accommodate an appointment within the timeliness standard. (Veterans self-scheduling are exempt from this return code) |
| 25 |
| Unable to Contact Veteran within Required Timeframe |
| Contractor unable to contact Veteran within the required timeframe. |
| 26 |
| Unable to review VA Approved Referral within timelines requirements |
| Contractor does not accept or reject the VA Approved Referral within the requirement turnaround time timelines standards. |
Authorized Use Only Attachment O – Reasons for Returned Referral image1.png
