Can You Outsource TRICARE, VA Community Care, and Union Plan Billing?
Dedicated HIPAA-trained teams run your TRICARE eligibility checks, referrals and prior authorizations, regional-contractor claim follow-up, VA community care paperwork, and union and public-employee plan verification inside your own PM system and portals. Flat weekly pricing from $299 per FTE (volume based), with a trained backup included at no charge. Live in 14 days.
The Government-Payer Work Your Team Does, We Staff
What Sits Behind Military, Veteran, and Union Cards?
These payers share one trait that decides how they bill: the program is public, but the desk you deal with is usually a contractor. TRICARE is the Defense Health Agency’s program for uniformed service members, retirees, and their families, administered regionally, Humana Military in the East and TriWest in the West since January 2025. VA community care pays outside providers to treat veterans, but only on a VA referral, with claims handled by the network’s administrators, Optum and TriWest, rather than VA itself. CHAMPVA is a separate VA program for certain dependents and survivors. FEHB covers federal employees through dozens of competing carriers, so the card names an insurer, not the government. States run their own versions for public employees, CalPERS in California among the largest, and union members are often covered by Taft-Hartley trust funds, jointly managed labor-management plans that are typically self-funded and run by a fund office or TPA. Different programs, one billing rule: find the administrator first.
TRICARE Eligibility Verification Before the Visit
Our specialists verify TRICARE patients from the schedule: they confirm eligibility, record the plan the family actually holds, Prime, Select, TRICARE For Life, or another option, and flag the referral and authorization requirements that follow from it, so the claim that follows starts clean. The payer-side detail we absorb for you: TRICARE eligibility lives in DEERS, the Defense Enrollment Eligibility Reporting System, and providers check it through the regional contractor’s portal, which means the first fact to establish is which region owns the patient. Since January 1, 2025, Humana Military administers the East region and TriWest administers the West, and six states, Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin, moved from East to West in that transition, so a returning patient’s region is worth re-checking rather than assuming. Plan type matters just as much as region: a Prime patient without a referral on file is a different billing problem than a Select patient without one. This is work we already deliver as a dedicated TRICARE eligibility verification service today.
TRICARE Referrals and Prior Authorization Support
Our authorization specialists confirm the requirement during eligibility, submit through the regional contractor’s portal, chase the determination, and log the approval where billing will find it, the same workflow behind our dedicated TRICARE prior authorization service. The complexity we take off your desk: TRICARE runs two gates, not one. Referrals are a plan-design feature, Prime enrollees generally need one from their primary care manager for specialty care, while Select enrollees largely self-refer, and prior authorization is a separate medical-necessity review that either plan can require for defined services. Both are worked through the regional contractor, Humana Military or TriWest, each with its own portal and forms, and the answer changes when the patient moves, changes plans, or the region boundary shifts. Keeping a current answer, per plan and per service, to where does this request go and what does it need is exactly what a dedicated specialist has the time to do. Working those portals is administrative routing, not clinical judgment; medical decisions stay with your providers and the contractor.
TRICARE Claims and AR Follow-Up
Our billers submit TRICARE claims to the correct regional processor, work the rejection and denial queues on a standing cadence, and keep TRICARE AR visible in its own slice of the aging instead of blending it into commercial follow-up. The payer-side facts we build the cadence around: claims route by region, not by preference, East region claims are processed through PGBA under the Humana Military contract while West region claims go through TriWest’s channels, and TRICARE’s timely filing standard is one year from the date of service, generous enough that missing it usually means a queue nobody owned rather than a deadline nobody knew. The 2025 contractor transition also left its mark on follow-up desks: accounts that lived in one region for years now answer to the other, and claim status, appeals, and correspondence follow the new contractor’s process. A dedicated specialist statuses claims through the contractor portal, calls when the portal answer is not enough, and reports it to you daily in your own format, alongside the rest of your revenue cycle.
VA Community Care Referral and Claim Support
VA community care pays practices outside the VA to treat veterans, and the billing rules are unforgiving of improvisation: care generally requires a VA referral and authorization before the visit, the claim goes to the Community Care Network’s administrator for your region, Optum for regions 1 through 3, TriWest for regions 4 and 5, not to VA itself, and CCN claims carry a 180-day filing standard that is far shorter than TRICARE’s year. That combination, an authorization that must exist first, a payer that is not the agency, and a short clock, is why veteran accounts stall on desks that treat them like commercial claims. Our teams bring the same discipline we run on TRICARE accounts to this queue: they confirm the referral and authorization are on file before the visit, verify what the authorization actually covers, submit to the correct administrator, and track the claim and any secondary balances until they resolve, working inside your PM system and the portals you already hold, with our prior authorization and verification teams covering the front end.
Union and Taft-Hartley Fund Billing Support
Union health coverage usually arrives at your desk as a Taft-Hartley fund: a multiemployer benefit trust, jointly governed by labor and management trustees, typically self-funded, and administered by a fund office or a contracted TPA. Funds such as the 1199SEIU Benefit Funds or plans covering UFCW and AFSCME members each keep their own eligibility rules, and eligibility often turns on hours worked, members bank hours with the fund, and coverage starts and stops with the hour bank, which means a member can lose and regain eligibility without changing jobs or cards. The plan document governs benefits, the fund office or TPA answers eligibility and claim questions, and the network on the card may be a rented one. Our teams handle these accounts the way the funds themselves work, one plan at a time: they call and verify eligibility with the fund office before the visit, record the fund’s claims address, payer ID, and filing limit on the account, submit to the administrator the fund names, and keep follow-up on the same daily cadence as the rest of your verification and revenue cycle work.
FEHB, CHAMPVA, IHS, and Public-Employee Plan Support
The rest of the government-payer landscape is a routing exercise, and routing is desk work we staff. FEHB, the federal employees’ program, is not a payer at all from a billing standpoint: the member picks a carrier, and you bill that carrier under its rules, with the Blue Cross Blue Shield Federal Employee Program the most common card, covered in depth on our BCBS payer page. CHAMPVA is VA’s own program for certain dependents and survivors of disabled or deceased veterans, administered by VA and separate from both TRICARE and community care, so it gets its own account setup rather than a TRICARE template. Indian Health Service care involves federal and tribal facilities and purchased/referred care authorizations for outside treatment. State and public-employee plans, CalPERS in California, PEEHIP in Alabama, ERS in Texas, OPERS in Ohio, SEGIP in Minnesota, cover government workers through contracted carriers and TPAs, so the working payer is the administrator on the card. CHIP accounts route through the state’s program rules, covered on our Medicaid payer page. Our specialists verify each of these before the visit, document the administrator and filing rules on the account, and work the follow-up on the same cadence as every other queue.
Put a Dedicated Specialist on Your Government-Payer Queues
TRICARE eligibility and auths, VA community care paperwork, union fund verification, and contractor follow-up, owned daily by a trained team inside your own systems. Meet us, pick the seats you need, and watch the work move before you commit to anything.
Book Your 2-Week Free TrialThe Government and Union Payers Your Practice May See
The programs and funds from our payer master. Whichever of these is on your patient’s card, the six workflows above are the same discipline applied to that program’s administrator and rules.
Program and fund names are the property of the respective federal and state agencies, benefit funds, and unions, shown here only to identify the payers practices bill. Staffingly, Inc. is not a government agency, contractor, or benefit fund, and no affiliation or endorsement is implied.
Flat Weekly Pricing Per Dedicated Specialist
1 to 4 dedicated payer-desk FTEs.
5 to 9 FTEs.
10+ FTEs.
45 hours of coverage for less than others charge for 40.
$399 per week works out to $8.87 per hour across 2,340 hours of coverage a year, flat. Your dedicated specialist covers a 9 hour day, Monday to Friday, a full hour more than a standard shift: the day starts by clearing what arrived after you closed, overnight portal messages, payer correspondence, and the morning eligibility batch, and it ends past your close so far less rolls into tomorrow. A trained backup steps in at no charge whenever they are out. Flat weekly fee per dedicated specialist, never a percentage of your collections, no setup fees.
Start with a 2-Week Free Trial. Month-to-month after, with no long-term contract.
- Salary + payroll taxes + benefits
- Recruiting + turnover replacement
- Training on your payers + PM system
- PM seat + equipment + PTO coverage
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Government and Union Payer Billing: Real Questions From the Desk
Who handles TRICARE in our region now?
Humana Military administers the East region and TriWest Healthcare Alliance administers the West, under the contracts that began January 1, 2025. Six states, Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin, moved from East to West in that transition, so practices in those states now verify, authorize, and follow up through TriWest.
Do TRICARE patients need a referral before we can see them?
It depends on the plan, not the program. Prime enrollees generally need a referral from their primary care manager for specialty care, while Select enrollees can largely self-refer, and prior authorization is a separate requirement either plan can carry for defined services. Verify plan type first; the referral answer follows from it.
What is the timely filing limit on TRICARE claims?
One year from the date of service as the standard. That is generous compared with many commercial contracts, which is exactly why TRICARE misses are usually a symptom of an unowned queue rather than a tight deadline: the claims sat, nobody statused them, and the year ran out quietly.
Do we bill VA or the community care contractor for treating a veteran?
For Community Care Network care, you bill the network’s administrator for your region, Optum in regions 1 through 3, TriWest in regions 4 and 5, and the care must be referred and authorized by VA before the visit. Claims without an authorization on file are the most common way veteran accounts go unpaid.
How long do we have to file VA community care claims?
The Community Care Network standard is 180 days from the date of service, roughly half a commercial year and far shorter than TRICARE’s clock. Veteran accounts need their own filing calendar; treating them like commercial AR is how the deadline gets missed.
Is CHAMPVA the same as TRICARE or VA community care?
No to both. CHAMPVA is VA’s program for certain dependents and survivors of disabled or deceased veterans, people who are not TRICARE-eligible, and it is administered by VA itself rather than the regional TRICARE contractors or the CCN administrators. It needs its own account setup, claims routing, and follow-up notes.
What is a Taft-Hartley fund, and why can nobody verify the patient online?
A multiemployer benefit trust jointly governed by union and employer trustees, usually self-funded and run by a fund office or TPA. Many funds have no real-time eligibility feed, and coverage can turn on hours banked with the fund, so verification is a phone call to the fund office and the answer belongs on the account record.
Can your team work inside our portals and PM system?
Yes. Our specialists work under named individual logins you grant and can revoke, inside your PM system, clearinghouse, and contractor and plan portals. Your data stays in your systems, we report production daily, and you can review our activity in your own system.
Written By
Dan Nandan has spent 25+ years in IT consulting and healthcare BPO, was among the first in the US to build an RPO/BPO delivery network overseas, and has been featured in Computerworld. He runs the operations and the dedicated virtual teams behind the payer workflows on this page, including the TRICARE prior authorization and eligibility services linked above.
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Claim Your 2-Week Free TrialStaffingly, Inc. is an independent outsourcing provider. It is not affiliated with, endorsed by, or acting for the Department of Defense, the Defense Health Agency, the Department of Veterans Affairs, the Office of Personnel Management, the Indian Health Service, any state agency, any regional contractor or third-party administrator, or any union benefit fund, and it works inside client-owned systems and portal accounts under client-granted access. Program details on this page are summarized from public government and program materials and can change; confirm current requirements with the program’s administrator before acting on a specific claim.