QUEST Integration – Veterans Administration

Original Effective Date:

08/01/1994

Current Effective Date:

01/01/2015

Service-Connected Disabilities

A veteran with VA coverage for a service-connected disability will have “VA-Service Connected Disability” as a TPL (third party liability) on his/her QUEST Integration membership card provided this coverage was reported to the Med-QUEST Integration worker. These members must receive care for the service-connected condition through the local Veterans Administration medical facility or be authorized by the VA for services by other providers. If these procedures are not followed, VA will not pay for services and HMSA QUEST Integration will not be able to pay for services that should have been provided through the VA. QUEST Integration will pay only for claims not related to the service-connected condition.

If you see a patient with this TPL, you must find out from the patient what the service-connected condition is. If the condition you are about to treat is service-connected, you should have a referral from the VA. If there is no VA referral, please refer the patient to the local VA medical facility for care. VA denials because the patient was not authorized or did not receive a referral for care outside the VA facility are not valid reasons for payment by HMSA QUEST Integration because the patient chose not to use available benefit from the VA.

Services that are not related to the service-connected condition may be billed to QUEST Integration. To avoid processing delays, please notate on the claim what the patient’s service-connected condition is so that we will know that the claim is unrelated to the condition and can process the claim.

Revision History