Notice: Revised VCF Private Physician Process Affecting Applicants for Membership in the World Trade Center Health Program

The VCF has updated the criteria for claimants to seek verification of their conditions through the Private Physician Process. On July 6, 2017, the VCF posted information on its website (https://www.vcf.gov/privatephysicianprocess-forms.html) regarding these changes.

If you are a VCF claimant wanting to be certified for a health condition(s) by the WTC Health Program, information for applying to the Program can be found on our How to Apply to the Program page.

• Once a member is enrolled in the Program, the member will then have to make an appointment with their Clinical Center of Excellence (CCE) or the Nationwide Provider Network (NPN) to have a monitoring appointment (responders) or an initial evaluation (survivors).
• The first appointment requires history-taking, medical testing, and physical examination. The initial appointment may sometimes require additional diagnostic testing to determine if the member has a condition on the list of 9/11-related health conditions covered by the Program and meets the Program’s requirements for coverage (certification) of a condition (visit our Administrative Manual to learn more about the certification process).
• If the member has a health condition covered by the WTC Health Program, the CCE or NPN will submit a certification request to the Program. It will be reviewed and a decision will be made to approve or deny the certification request. Once a decision is made, the WTC Health Program will notify the member, in writing, of the decision.

Notice: The WTC Health Program will closely monitor any fraudulent activity including the submission of fraudulent information in support of a claim of eligibility or for necessary and covered services, fraudulent misuse of the WTC Health Program by health care providers participating in the program, and submission of claims for services not provided or needed as claimed. The WTC Health Program will report fraudulent conduct to federal law enforcement agencies and violators may be subject to criminal, civil, or administrative penalties. Information concerning suspected fraud related to the WTC Health Program by contractors, grantees, health care providers, or individual recipients should be reported to the Department of Health and Human Services Office of Inspector General by phone at 1-800-HHS-TIPS (1-800-447-8477); online at forms.oig.hhs.gov/hotlineoperations/; or in writing to the following address: U.S. Department of Health and Human Services, Office of Inspector General, ATTN: OIG HOTLINE OPERATIONS, P.O. Box 23489, Washington, DC 20026.

Page last reviewed: Sep 03, 2015 | Page last updated: July 11, 2017