United States Department of Veterans Affairs

How to File a Claim

Electronic claims

As of October 16, 2003, the Chief Business Office Purchased Care (CBOPC) 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 known 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 CBOPC (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 CBOPC program identification card and the Member ID (patients' SSN).

Paper Claims

Claims submitted by the provider must include the following:

  • An itemized billing statement. This can be submitted on a CMS-1500 form or UB-04 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, 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


Retail:
Electronic pharmacy claims should be submitted through Catamaran (Formerly SXC Health Solutions, Inc). The claims should be submitted using:

  • BIN: 610593
  • PCN: VA
  • GROUP: HAC

Catamaran contact information:

The following information is required for us to process pharmacy claims on paper:

  • 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

Where to Mail Claims

Mail claims to: Chief Business Office Purchased Care

CHAMPVA
PO Box 469064
Denver CO 80246-9064

Claim Filing

Payment Information

National Provider Identifier

Other Information