Provider News

Filing Requirements

By law, CHAMPVA is always secondary payer except to Medicaid, State Victims of Crime Compensation, and supplemental CHAMPVA policies. If the patient has other health insurance coverage, they should be billed first. A claim can then be sent to CHAMPVA, with the Explanation of Benefits (EOB) from the other insurer.

Electronic Claims

The best way to file a claim is electronically. The HAC will accept electronic HIPAA mandated claim transactions. These include the 837 Institutional, 837 Professional, 837 Dental and NCPDP Pharmacy claim billing from providers for services, supplies or drugs provided in the United States, a U.S. Commonwealth or territory. You can also check claims status and eligibility status electronically. Click here for more HIPAA transaction details.

Paper Claims

We also accept paper claims, but the turnaround time to payment is, on average, an additional 20 days. Paper claims should be mailed to:

VA Health Administration Center
CHAMPVA
PO Box 469064
Denver CO 80246-9064

Claims and Eligibility Status

You can check on the eligibility status of a CHAMPVA or Spina Bifida beneficiary or the status of payment for a claim 24 hours a day through our Interactive Voice Recognition (IVR) system. To access this feature, dial 1-800-733-8387 and select option 1, then option 3, then option 2. You will be asked for the claim number or the beneficiary social security number, and your tax ID number.

Policy Manuals

Details on payment methodology and covered benefits for each of our health plans are covered in our policy manuals.

• CHAMPVA Policy Manual
• Spina Bifida Policy Manual
• Foreign Medical Program Policy Manual

Provider Fact Sheets

These fact sheets will provide you with the information you need to participate in the CHAMPVA program, Spina Bifida Healthcare Program, or the Foreign Medical Program. None of these benefit programs requires a contract and the fact sheets will include information for providers and office managers.

• Participating Providers (01-15)
• CHAMPVA Fact Sheet for Office Managers (01-16)
• CHAMPVA Payment Methodology (01-11)
• CHAMPVA Durable Medical Equipment (01-8)
• Spina Bifida Fact Sheet for Office Managers (01-12)
• Spina Bifida Payment Methodology (01-10)
• Foreign Medical Program Fact Sheet for Office Managers (01-17)

Pre-authorization Requirement

The only pre-authorization requirements for CHAMPVA are for:

• Organ and bone marrow transplants
• Hospice
• Dental care
• DME worth more than $300, and
• Most mental health or substance abuse services.

Additionally, some payments are made based on specific clinical guidelines. Two common examples are breast reduction and weight reduction surgical procedures. Please be sure to check the CHAMPVA handbook for a complete listing of pre-authorization services and supplies.

EFT Signup Information

• SF-3881 Form

Providers, if you would like to apply for payment via Electronic Funds Transfer, complete the "Payee/Company Information" and "Financial Institution" sections of the SF-3881 form, and mail the signed form to:

Department of Veterans Affairs
Financial Services Center
PO Box 149971
Austin TX 78714-8971

Or, fax the signed form to: (512) 460-5221

This service is only available to US providers.