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.
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.
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
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.
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