Introducing The HFX 'Healthcare Freedom for Veterans' Program

An HFX Coalition Program for The U.S. Dept. of Veterans Affairs


HFX, Healthcare Financial Exchange, is not a commercial healthcare exchange, rather a unique and innovative integrated healthcare solution that is not available any where else in the market today. What makes our solution so unique is the coalition of industry leading companies that have, for the first time, agreed to integrate their services in an innovative program specifically designed for the benefit of the U.S. veterans and the VA.

This broad range of integrated services will deliver significant benefits to the VA and our nation’s veterans by its efficiency, cost savings, accountability and oversight, reporting, and the ability to continue to enhance the program in unmatched ways because of the unique coalition of partners.

HFX has a unique approach to integrating both benefit and ID cards as outlined in the Veterans Identification Card Act of 2015. The HFX Digital Wallet, powered by FIS, combines these two cards into the HFX PFDirect™ Card.

HFX currently has the ability to issue and manage over 9 million PFDirect™ cards, to qualified U.S. veterans and reservists. The PFDirect™ eligibility, authorization, ID and guaranteed payment card combines financial, healthcare, claim processing, and a loyalty rewards system tied to its general spend functionality.

The HFX Coalition can provide an integrated repricing and claims payment system which can quickly pay claims in 12-15 days using Medicare-based payments.

The HFX Team provides TPA (Third Party Administration) in all 50 states, repricing of Medicare, commercial, and some VA claims now on a national basis.

Our Healthcare Freedom for Veterans Program outlines alternative solutions to many of the requirements set forth in the Mission Act. The HFX Healthcare Freedom for Veterans Program is designed to collaboratively integrate the existing VA healthcare system AND the private sector healthcare system.

We estimate that HFX and its coalition partners can reduce VA costs annually by over $5 Billion1 through the implementation of our ‘Healthcare Freedom for Veterans’ program.

The HFX coalition has the experience, expertise, strength and extensive healthcare and financial services capabilities to deliver a program unmatched in the industry to meet the VA’s and veteran’s needs.



HFX/PFDirect™ Community Care Medical Program Solution - Estimates First Year Costs and Claim Savings:

Summary • Initial Group of Veterans




The Problem:

The Veterans Health Administration is the largest integrated health care system in the United States, providing care at 1,233 health care facilities, including 170 VA Medical Centers and 1,063 outpatient sites of varying complexity (VHA outpatient clinics), serving more than 9 million enrolled veterans. With all of those resources, veterans still find it difficult to get the treatment they need in part because they live outside of a 40 mile radius from their covered VA medical facilities. Furthermore, they may struggle to arrange a timely appointment for access and treatment due to the over-populated system. The physical limitations on the veteran including access to - or assistance with - transportation, traffic and other impediments are often challenges they face as well.

  • It has been difficult for veterans to receive covered treatment from private doctors at private facilities because the doctor reimbursement rate for VA care is lower than that of Medicare. Doctors simply won’t take the appointments.
  • Healthcare claims are taking far too long to be authorized, processed, and paid, in some cases up to 8 weeks. And to top it off, insurance and banking card fraud is in the billions.
  • Government expenditures for necessary healthcare continue to rise. In this fluid healthcare market, more focus must be placed on solutions that increase accessibility but leverage efficient and integrated solutions.
  • Many of the requirements outlined in the Mission Act, and in the Veterans Identification Card Act of 2015 are either not being met, or the means to implement them do not yet exist.
  • Suicide rates are heavily increasing within the U.S. veteran population.
  • Some veterans are not receiving their benefits simply because of where they live, or because of the inabilities they have to manage their accounts.
  • The U.S. Dept. of Veterans Affairs’ reputation has suffered over time, while making meaningful attempts at finding solutions to many of these problems.


The Solution:

United States Dept. of Veterans Affairs... meet Healthcare Financial Exchange.

Our goal is to meet the objectives and goals of the VA in servicing our veterans. Although we need to work collaboratively on solutions, we have outlined a program in this document to generate discussion and highlight some of the capabilities we bring to the VA.

  • Healthcare Financial Exchange (HFX) is currently prepared to enroll ALL qualified veterans and reservists into the ‘Healthcare Freedom for Veterans’ Program.
  • HFX is expanding veteran access into private sector healthcare facilities and provider networks.
  • With VA approval, HFX will implement a unique Real-Time Claim Adjudication (RTA) process to authorize, process, and pay specific claims within 12-15 days.
  • HFX has a solution that provides doctor reimbursement rates equal to that of Medicare, which means our veterans won’t be turned away for treatment with private doctors at private medical facilities.
  • HFX will issue millions of PFDirect™ cards to qualified veterans and reservists of the United States, to be used to authorize doctor office visits with payment guarantees. Each card provides real-time clinic authorization subject to CMS1500 or 837P provider requests. Private sector patients qualify for payment guarantees and cash discounts starting at 5-10%.
  • HFX will work with the VA to provide medical plan options exclusively for the U.S. veterans and their families, having limited out of pocket expenses and low deductibles.
  • The HFX ‘Healthcare Freedom for Veterans Program’ is designed to work with the existing VA healthcare system AND the private sector healthcare system.


HFX - The Healthcare Freedom for Veterans Program!

Healthcare Financial Exchange provides a new-generation healthcare services platform for those who use health services, those who provide health services, and those who pay for health services.

Now, for the first time, a healthcare payment and eligibility ID Card will provide the “AUTH” to auto-adjudicate certain claims on a real-time basis POS (Point of Service). PFDirect™ is a next generation virtual payment system and customer loyalty program for the healthcare industry. This new virtual payment platform upgrades insurance ID cards. Each card provides real-time clinic authorization subject to CMS1500 or 837P provider requests. Private sector patients qualify for payment guarantees and cash discounts starting at 5-10%.

Our vision is to Restore America’s Healthcare System using a back to basics approach, by combining quality affordable medical insurance with our unique financial payment platform; a first of its kind virtual payment, eligibility and authorization card.

In doing so, this will:

  • Provide our nation’s veterans with affordable medical, dental and vision plans.
  • Expand veteran access to private-sector healthcare facilities and provider networks, allowing them the opportunity to get the treatment they need from any doctor, at any facility of their choice.
  • Enroll our nation’s veterans and reservists into our ‘Healthcare Freedom for Veterans’ program, giving veterans a medical payment, eligibility and authorization ID card that can authorize, process, and pay specific claims within 12-15 days - with VA approval of our unique Real Time Claim Adjudication (RTA).
  • Provide doctor reimbursement rates at least equal to that of Medicare, so that our veterans won’t be turned away for medical care with private doctors at private medical facilities.
  • Reduce insurance and bank card fraud.
  • Provide alternative solutions to many of the requirements set forth in the Mission Act, and in the Veterans Identification Card Act of 2015.

A PFDirect Plan for Veterans VA Administration

HFX will Issue 1.8 million cards (initial run) to be used to authorize 21 million office visits with payment guarantees. Each card provides real-time clinic authorization subject to CMS15001 or 837P2 provider requests. Private sector patients qualify for payment guarantees and cash discounts starting at 5-10%.




HFX Financial Services • Transaction Platform

  • HIPAA transaction format integration
  • Eligibility verification
  • Claims submission and payment status
  • Remittance processing
  • Accounts receivable reconciliation
  • Online accounts statement verification
  • Real-time adjudication
  • Claims submission, tracking, payment status
  • Complete Analytic Services and Support



More Information

For more information regarding The Healthcare Freedom for Veterans program, we encourage you to connect with us via email or phone. Click here to visit the CONNECT page of our website or call 818.259.0440.

Feel free to download and review the following eFiles in PDF format: