VA Payment Safeguards

20.3.1 - VA Payment Safeguards (Rev. 11550; Issued: 08-12-22; Effective: 10-13-22; Implementation:10-13-22) When the beneficiary is identified as possibly having VA entitlement, the A/B MAC and the DME MAC may contact the provider, physician/supplier to determine whether a claim has been, or will be, submitted to the VA for payment for the procedures listed. It does not contact the beneficiary or the VA. It uses only information from the provider, physician/supplier to determine whether VA liability is involved. It processes the claim according to the following rules: • If a claim has not, and will not, be filed with the VA, the A/B MAC and the DME MAC processes the claim; • If the provider, physician/supplier responds that the claim is being, or has been, sent to the VA, the A/B MAC and the DME MAC denies the claim; and • If the claim was for multiple services and the physician/supplier states that the VA has assumed responsibility for some, the A/B MAC and the DME MAC denies those services the VA has responsibility for and processes the other Medicare covered services. See Pub. 100-02, Medicare Benefit Policy Manual, Chapter 16, §50.1, for policy and procedures describing when Medicare may take into consideration VA claims paid for by the VA to: 1) credit the beneficiary Medicare deductible, and 2) to reimburse the beneficiary their VA copayment amounts charged for VA authorized services furnished by non-VA sources.