Eligibility for CHAMPVA ends at midnight on the date of remarriage if the widow(er) remarries prior to age 55. Previously, CHAMPVA benefits terminated for all widow(er)s when they remarried, regardless of the age of the widow(er). The Veterans Benefit Act of 2002, Public Law 107-330, authorizes the VA to provide benefits, effective February 4, 2003, to a CHAMPVA-qualifying widow(er) who remarries at age 55 or older.
As a result of new legislation passed in December, you now have until December 16, 2004, to apply for benefits under this provision of the law:
Current CHAMPVA eligible widows and widowers, age 55 and older, who remarry after February 4, 2003, can extend their benefits by notifying the Health Administration Center that they had remarried.
For more information on the CHAMPVA Program, see the CHAMPVA Newsletter.
The National Provider Identifier (NPI) will be required in all electronic claim transactions as of the compliance date of May 23, 2007. The NPI will replace all legacy identifiers currently used by health plans. The HAC will need both your NPI and your Tax Identification Number (TIN) for the "pay to" provider identified in your electronic claims transactions.
Getting your NPI is the first step in the process of meeting the compliance date. Learn more about the NPI and how to apply by visiting the Centers for Medicare and Medicaid Services (CMS) website at:
On September 27th, 2010 the Health Administration Center (HAC) will go into production with Medicare Crossover claims. Medicare Crossover Claims are the electronic (EDI) claims that the Medicare Coordination of Benefits Contractor (COBC) forwards via our clearinghouse, Emdeon, to the HAC for CHAMPVA beneficiaries with Medicare A & B coverage. As a provider you will know that a claim has been forwarded by looking at the Crossover Carrier name on your Electronic Remittance Advice (835) you receive from Medicare. You will not need to change how you are billing Medicare, as this process will happen automatically after Medicare has finished adjudicating your claim.
You can receive an electronic remittance advice on Medicare Crossover claims from the HAC by following the directions below.
As of October 16, 2003, the Health Administration Center (HAC) accepts HIPAA compliant electronic 837 Institutional, Professional and Dental claims! Using this service, doctors, dentists, hospitals and other medical service providers can cut claims processing time by weeks! You must submit electronic claims for CHAMPVA, Spina Bifida and Children of Women Vietnam Veterans patients through our clearinghouse, Emdeon®, formerly know as WebMD. Our EDI payer ID number at Emdeon is 84146 for Medical claims and 84147 for Dental claims. If you are not connected to Emdeon, contact your clearinghouse to be sure our payer IDs have been added to their software system. If you are interested in submitting claims through Emdeon, you can contact them by clicking on http://www.emdeon.com/payerlists/.
Please remember that for all the programs administered by the HAC (CHAMPVA, Spina Bifida Program, and Children of Women Vietnam Veterans), our beneficiary/your patient is the always the subscriber. Please ensure that the information submitted on your claims uses the first and last name as it appears on the patient's HAC program identification card and the Member ID (patients' SSN).
We can also receive pharmacy claims for our program beneficiaries electronically through SXC Health Solutions, Inc. (SXC). If you are not a part of the SXC network and are interested in finding out more about SXC, you can contact the SXC Provider Network Line at 480-362-5227.
For all compliant electronic claims sent to us through Emdeon we can provide a HIPAA mandated electronic 835 Remittance Advice to you through our clearinghouses Emdeon® Providers must complete the ERA Provider setup form at Emdeon to receive the HAC 835's. The form and additional information about the ERA can be found at the following link: http://www.emdeon.com/enrollment to receive the 835.
At this time we will also continue to provide you with a paper explanation of benefits(EOB) for all electronic claims processed.
As of October 16, 2003 the HAC is able to provide you with a real time 277 electronic Health Care Claim Status Response for electronic claims submitted through our clearinghouse Emdeon®, formerly known as WebMD. Our real time payer ID at Emdeon is 00232.
Pharmacy providers may also inquire about electronic pharmacy claims submitted to SXC Health Solutions, Inc (SXC) by submitting an NCPDP claims status inquiry.
As of October 16, 2003 the HAC is able to provide you with a real time 271 electronic Health Care Eligibility Benefit Response through our clearinghouse Emdeon® Envoy. We can respond with an acknowledgment that the patient is unknown, has active or no coverage for our programs. The response for patients with active coverage would include the dates of the most recent coverage. So that we can respond accurately to your inquiry, please submit the first and last name as it appears on the patient's HAC program identification card, the Member ID (Patient's SSN) and the patient's date of birth. Our real time payer ID at Emdeon is 00232.
Pharmacy providers may also inquire about eligibility for the HAC programs by sending an NCPDP eligibility request to SXC Health Solutions, Inc (SXC).
Starting on January 1, 2012, in compliance with the final rule issued by the U.S. Department of Health and Human Services (HHS) of January 16, 2009 under the Health Insurance Portability and Accountability Act of 1996, the Health Administration Center will only accept HIPAA compliant ASC X12 5010 claims and transactions.
The Health Administration Center will still maintain our EDI payer ID's with Emdeon® as 84146 for Medical claims, and 84147 for Dental claims, and will support all of the transactions listed above in the same manner.