PC3 and Choice are among several VA community care programs, each of which has varying eligibility requirements and types of services offered. While the amount of claims VA paid for the treatment of veterans under PC3 decreased by about half over the past year, the amount has more than tripled for the treatment of veterans under Choice. PC3 was not specifically enacted by law, but was created by VA under existing statutory authorities to provide veterans with needed care that is not feasibly available from a VHA medical facility. VA originally required its PC3 contractors, Health Net and TriWest, to each develop regional networks, made up of community providers of specialty care, mental health care, limited emergency care, and maternity and limited newborn care. VA and the contractors began implementing PC3 in October 2013, and it was fully implemented nationwide as of April 2014. In August 2014, VA expanded PC3 to allow community providers of primary care to join Health Net’s and TriWest’s networks. Veterans may be eligible to obtain care under PC3 when they are unable to access a particular service from a VHA medical facility, either because the service is not offered or the veteran would have to travel a long distance to obtain it from a VHA medical facility. The veteran’s VHA provider requests an authorization for care, and if approved, the responsible contractor tries to arrange for care for the veteran with one of the providers in its PC3 network. The Choice Act provides, among other things, temporary authority and funding for veterans to obtain certain types of health care services from community providers to address long wait times, lengthy travel distances, or other challenges accessing care at a VHA medical facility. Under this authority, VHA introduced Choice in November 2014. As stated in VHA’s December 2015 guidance, Choice allows eligible veterans to obtain health care services from community providers if the veteran meets any of the following criteria: the next available medical appointment with a VA provider is more than 30 days from the veteran’s preferred date or the date the veteran’s physician determines he or she should be seen; the veteran lives more than 40 miles driving distance from the nearest VHA medical facility with a full-time primary care physician; the veteran needs to travel by air, boat, or ferry to the VHA medical facility that is closest to his or her home; the veteran faces an unusual or excessive burden in traveling to a VHA medical facility based on geographic challenges, environmental factors, or a medical condition; the veteran’s specific health care needs, including the nature and frequency of care needed, warrants participation in the program; or the veteran lives in a state or territory without a full-service VHA medical facility. Choice is primarily implemented through VA’s contracts with Health Net and TriWest; however, staff at VHA medical facilities have also, under certain conditions, begun entering into VHA Choice provider agreements. Specifically, VHA Choice provider agreements can be used when 1) the services are not covered under VA’s contracts with Health Net and TriWest, or 2) Health Net or TriWest cannot deliver the care and returns the authorization request to the VHA medical facility for certain reasons. If the needed services are covered by the VA contracts for Choice care, VHA must give Health Net and TriWest the first opportunity to arrange the care for the veteran. VHA began entering into Choice provider agreements in February 2016. As of July 14, 2016, VHA reported that its medical facilities had 4,859 VHA Choice provider agreements in place, and had used 925 of them to authorize Choice care for veterans. Because some veterans could be eligible for more than one type of VA community care—for example, if they live a long distance from a VHA medical facility—VHA issued guidance on the hierarchy of community care referrals. Given that Congress designated funding specifically for Choice, the guidance communicates a preference for the use of Choice, whenever possible. Specifically, when a VHA medical facility determines that there is a need for community care, VHA instructs them to first refer the veteran to the appropriate contractor for Choice care if the veteran meets the eligibility criteria and the needed services are covered by Choice. If the veteran is eligible for Choice care, but the contractor is unable to arrange for the care, the facility may use a VHA Choice provider agreement or another type of community care, such as PC3. If the veteran is not eligible for Choice or the needed services are not covered by Choice, the VHA guidance says VHA medical facility staff may use their discretion to refer the veteran to another type of community care. As of July 2016, both Health Net and TriWest reported that Choice care made up the vast majority of their authorizations. The process of reviewing and verifying physicians’ credentials, also known as credentialing, includes inspecting and authenticating the documents that constitute evidence of appropriate education, training, licensure, and experience to ensure the physician is qualified to practice medicine in the designated setting. Industry standards for credentialing, developed by various accreditation organizations, such as URAC, generally require accredited organizations to verify credentials in order to confirm the factual accuracy and authenticity of the information submitted by the physician. The industry standards call for some credentials, such as medical licenses, to be verified using the primary source—the original or issuing source of the credential. In the case of a medical license, the primary source would be the state licensing board that issued the license. Other credentials may be verified using accepted secondary sources, such as the National Practitioners Data Bank for verifying malpractice history. The standards also call for documentation of credentials verification activities, such that there is evidence that verification was conducted consistent with requirements and standards. VA contracted with Health Net and TriWest to conduct credentials verification for PC3 physicians in their respective networks, and maintain documentation of this verification. To implement contractual requirements for PC3, Health Net and TriWest verify PC3 physicians’ credentials in accordance with URAC accreditation standards for credentialing. For example, Health Net and TriWest verify licenses, education and training, and malpractice history for each PC3 physician, and conduct reverification at least once every three years. Health Net and TriWest are also required to verify the credentials of Choice physicians; however, to further the goal of getting veterans access to care quickly under Choice, VA chose to require fewer credentials for Choice physicians. According to a VHA official, it generally takes between 5 and 10 days to complete the credentials verification process for Choice physicians, compared to 90 days for PC3. Specifically, in contrast to traditional credentialing, VA’s contracts only require Health Net and TriWest to ensure that Choice physicians hold an active, unrestricted license in the state where Choice service have a national provider identification (NPI) number; have a Drug Enforcement Agency (DEA) number to prescribe are not excluded from participation in federally funded health care participate in Medicare. Health Net’s and TriWest’s contracts require them to comply with section 101 of the Choice Act, which also requires Choice physicians to submit verification of their credentials at least annually. VHA policy requires Choice physicians who participate in VHA Choice provider agreements to submit a similar set of credentials at least annually. For additional detail on the different credentials requirements, see figure 1. The VA Budget and Choice Improvement Act required VHA to develop a plan for consolidating community care, and VHA submitted its plan to Congress on October 30, 2015. In its submission to Congress, VHA outlined its plan to consolidate all of its existing community care programs, including PC3 and Choice, into a single program with uniform credentials requirements for all participating physicians. VHA’s plan stated that it does not currently have a standard approach to credentialing under the various existing community care programs. In April 2016, VA published a draft of a performance work statement for a future contract for consolidated community care in order to solicit comments and suggestions from interested parties. The April 2016 draft specifies that the contractors’ credentialing program will be accredited by a national organization and shall perform credentialing in accordance with the accreditation standards. We found that both Health Net and TriWest complied with contractual requirements to verify PC3 physicians’ credentials and maintain documentation for our selected sample. To meet these requirements, both Health Net and TriWest developed written policies on the types of credentials required and how to verify them, and both contractors submitted an outline of their credentials verification procedures to VHA. Both contractors also have quality assurance mechanisms in place that include routinely reviewing a sample of files for errors and missing information. We reviewed the credentials files for 50 PC3 physicians and found that Health Net always conducted credentials verification consistent with its policies and procedures, and TriWest almost always did so. We identified three deficiencies among the 25 selected PC3 physicians from TriWest. Specifically, we found that TriWest did not verify one physician’s license, one physician’s absence from the exclusionary list, and one physician’s malpractice insurance coverage. We found that Health Net and TriWest document credentials verification in different ways. TriWest’s procedure is to maintain copies of credentials verification from primary sources (such as a printout from the state licensing board website for each physician), while Health Net’s procedure is to document discrete data elements from the verification sources (such as the name of the source and the date the credential expires). Both approaches are acceptable under URAC accreditation standards and allowed us to observe that credentials verification had been conducted. We identified deficiencies in both Health Net’s and TriWest’s verification of credentials for the 50 selected Choice physicians we reviewed. VA’s contracts specify five types of credentials that are required for Choice physicians and incorporate the Choice Act requirement that Choice physicians submit verification of their credentials at least annually. We found that the contractors did not always verify the credentials of Choice physicians in a timely manner and often could not produce documentation to demonstrate that verification occurred.