Helpful Hints for Providers
By Michael Miller
With an expanding number of eligible CHAMPVA beneficiaries, we want to ensure that reimbursements for medical services provided are paid correctly in both an accurate and timely manner. We have compiled the following list of hints to help ensure that your request for payment is processed correctly the first time it is submitted.
Dealing with health insurance that is primary to CHAMPVA
- CHAMPVA identifies each provider by their 9-digit EIN/TIN (Employer Identification Number/Taxpayer Identification Number). Please ensure you are including the complete 9-digit EIN on your claim. EINs that include additional digits or alphas can slow the processing of your claim and even cause a payment to be submitted to the incorrect provider of service.
- Please ensure that both the billing address and the physical address where services were actually provided are on the claim submission. *Please note that PO boxes are not true physical addresses and should not be used as a physical address for services rendered.*
Billing and coding
- When a CHAMPVA beneficiary has two insurances that pay prior to CHAMPVA, please provide a copy of both the primary and secondary insurances, with an explanation of remarks codes for each. Submitting only the secondary explanation of benefits could delay processing or cause a denial of payment for your claim.
- Please ensure that all items billed are also included on the beneficiary’s primary and secondary explanations of benefits (EOBs), even if it is a service that is not covered by the beneficiary’s primary insurance policy.
- Please ensure that the beneficiary’s name and SSN or PCN (patient control number) are included on all submitted items. We must be able to identify each attachment as the beneficiary’s and cannot process claims submitted with EOBs that do not identify the receiver of services rendered.
- Please ensure that the EOB submitted is adjudicated, showing payment or denial as appropriate.
Resubmissions for payment of services rendered
- When billing both the professional fees and the facility fees for a service rendered, please submit these items on separate forms to ensure correct processing. If the profees and facility fees are submitted on the same form, there is a greater chance of your claim for payment being processed incorrectly.
- If you are billing for the anesthesia professional fee, please use the correct anesthesia code, not the surgical equivalent. This will help ensure that you are reimbursed the correct amount.
- Before submitting your claim, please make sure that the type is not offset and that all items are in the correct fields. Failure to do this can possibly cause a delay in payment, erroneous payment or denial in some circumstances.
- Please bill each service rendered, for each date of service as a separate line item. This will ensure that you are correctly reimbursed for each service rendered and will help avoid underpayments being remitted to you. *This is especially important when submitting Evaluation and Management (these are codes that fall in the 99201–99288, 99304–99318 and 99354–99499 ranges).*
- Please avoid the use of highlighters, because they can obscure, distort or actually completely black out text images.
- When submitting a bill for ambulatory surgery services, please make sure the surgery code(s) with corresponding charge(s) are included on the bill. Omitting the surgical code will cause a delay in processing your submission.
- When submitting a handwritten bill, please ensure that the writing is legible.
When resubmitting a claim for payment, please include the CHAMPVA EOB with your resubmission. Writing the CHAMPVA claim number on the resubmission without resubmitting the CHAMPVA EOB could cause a delay in reimbursement or duplicate processing of your claim.
Here are tips for avoiding seven common pitfalls in claims processing.