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Health Administration Center

How to File a Claim

Claims Submitted by the Provider

Claims submitted by the provider must include the following:

  • An itemized billing statement. This can be submitted on a HCFA 1500 form or UB-92 form. The following information must be provided:
    • Full name, address, and tax identification number of the provider
    • Address where payment is to be sent
    • Address where services were provided
    • Provider professional status (doctor, nurse, physician assistant, etc.)
    • Specific date of each service provided. Date ranges are acceptable only when they match the number of services/units of services
    • Itemized charges for each service
    • Appropriate code (ICD-9, CPT, HCPCS) for each service
  • If other health insurance was billed, provide a copy of their explanation of benefits detailing what they paid. Sometimes the definition / explanation of their codes is on the reverse of their explanation of benefits (please include a copy of that as well).
  • Medical records or notes must be submitted with the bill in some cases. The handbook notes many of those services that require the medical documentation such as for skilled nursing, home health, physical therapy, specialized testing and some surgical procedures.

Pharmacy Claims

Most pharmacies submit claims to us electronically. The following information is required for us to process pharmacy claims regardless of whether the claim is submitted electronically or on paper and regardless of whether submitted by the pharmacy or by the patient (CHAMPVA beneficiary):

  • An invoice/billing statement that includes:
    • Name, address, and phone number of the pharmacy
    • Name of prescribing physician
    • Name, strength, quantity for each drug
    • National Drug Code for each drug
    • Charge for each drug
    • Date prescription was filled

Bills submitted by the patient (paper only) must include a CHAMPVA Claim Form (VA Form 10-7959a).

Where to Mail Claims

Mail claims to: VA Health Administration Center

CHAMPVA
PO Box 469064
Denver CO 80246-9064

How to Obtain Additional Claim Forms

Additional claim forms can be requested at any time (including evenings and weekends) by calling us and selecting the claim form option from our voicemail menu or by printing a copy from our website (VA Form 10-7959a).

Other Information