You have many choices in selecting a provider, but
be sure the provider is properly licensed in your state and is not on
the Medicare exclusion list. CHAMPVA will pay for covered services and
supplies (note limitations for some services described in this handbook),
including those needed for pre-existing conditions, when received from
these professional providers. In the case of physician assistants, some
counselors, anesthetists, audiologists, and therapists there is a requirement
that the services be supervised (overseen) by the physician. Here is a
list of most of the providers covered by CHAMPVA (not all inclusive).
Chapter
3, Section 5.1
Anesthetist
Audiologist
Certified Midwife
Certified Nurse Anesthetist (CRNA)
Certified Nurse Practitioner
Certified Physician Assistant
Certified Psychiatric Nurse SpeMarch 2, 2007
Clinical Social Worker
Dentist (when services are a covered benefit and
preauthorized)
Family Counselor/Therapist
Licensed Clinical Social Worker (Masters Level)
Licensed Practical Nurse (LPN)
Licensed Vocational Nurse (LVN)
Medical Doctor (MD)
Occupational Therapist
Osteopath (DO)
Pastoral Counselor
Physical Therapist
Physician (Medical Doctor, MD)
Podiatrist
Psychiatrist
Physiologist
Registered Nurse
Services from the following types of providers are not
payable under CHAMPVA:
Acupuncturist
Chiropractor
Naturopath
CHAMPVA does not maintain a provider listing. If you
need to find a provider, we recommend you go to the TRICARE website at
www.tricare.osd.mil to search
for a provider in your area. From the pull-down menu, select Provider
Directory and then select TRICARE Standard. Most TRICARE providers will
also accept CHAMPVA, but be sure you ask the provider. If you wish to
see a provider who does not accept CHAMPVA, you will likely have to pay
for the care received and then file a claim with CHAMPVA.
If there is a VA medical facility in your area, check with them
to see if they participate in the CHAMPVA In-house Treatment Initiative
(CITI - pronounced city) program. CITI is a voluntary program for CHAMPVA
beneficiaries. You can receive treatment at VA medical facilities, on
a space available basis, with no cost share or deductible. There is no
enrollment in the CITI program. If the VA medical facility in your area
participates in the program and has available services, then you can receive
care at that facility.
Most VA medical facilities participate in the CITI
program and there is a good chance that a VA medical facility near you
is a participant. You can check the CITI website at www.va.gov/hac,
select CHAMPVA and then select CITI to find a VA medical center near you.
You can also call the nearest VA medical facility in your area to see
if they participate in the CITI program and the types of medical care
that are available to you through their facility. You may also call us
at 1-800-733-8387 or contact us via the Inquiry Routing & Information System (IRIS). IRIS is a tool that allows us to communicate in a secure format and will be used instead of our traditional email links. For specific guidance when using IRIS for your inquiry click here.
Please remember that the VA medical facility decides
whether or not they have capacity to provide care. That decision is not
made by CHAMPVA.
The CITI program is not available to beneficiaries with Medicare or with
an HMO insurance plan.
The VA cannot bill Medicare for services
provided in their facilities.
The VA is not a provider under any private
HMO plan and as a result beneficiaries may not use the VA as their
primary care physician. Beneficiaries are required to find a primary
care provider covered by their plan and to follow the HMO rules
and requirements for obtaining care.
Pharmacy Providers:
There are several options available to you for pharmacy services. Please
refer to the Pharmacy Services section in this handbook for more information.
