General Claim Filing Instructions
Most medical providers bill CHAMPVA directly. CHAMPVA patients may also submit medical claims to CHAMPVA; however, doing so may result in higher out-of-pocket costs paid by the patient. If a provider will not bill CHAMPVA for services, consider finding a new provider.
Here are some general instructions:
- Your name MUST BE listed on the claim form EXACTLY as it is on the CHAMPVA Authorization Card.
- Your social security number MUST BE on the claim. Please do not submit a claim with the social security number of another family member, such as the Veteran, a spouse, or a parent (For example, if a bill is being filed for a minor, it MUST BE filed with the child’s Social Security number).
- If you have other health insurance (OHI), INCLUDE A COPY of the OHI explanation of benefits.
- After billing your other health insurance, you can file a claim with CHAMPVA for the remaining balance.
- Separate claim forms are required for each patient.
- If you fail to complete the VA Form 10-7959a, payment will be made directly to the health care provider.
- In general, inpatient payments are made directly to the hospital. On rare occasion will reimbursement be made to the patient.
- Keep copies of all claim documents and Explanation of Benefits (EOBs) invoices.
Here are some simple suggestions to efficiently expedite the processing of your claim:
- Ensure Medical Providers are Billing with the Correct Information
Please ensure that the name, social security number (SSN), and date of birth (DOB) of the person receiving the medical services appears on the claim. When a CHAMPVA-insured patient receives medical services, their legal name (no nickname) and social security number should appear on the claim. Any supporting documents submitted with the claim must clearly show patient information that matches the information on the claim.
In addition, if two or more people in your family have similar first and last names, please spell out the middle name on the claim form. It would also be beneficial if you inform medical service(s) provider(s) so they can bill us correctly.
- Submitting Pharmacy Summaries
Your pharmacy can provide a printout of all medications for the date range you specify. If it is necessary to submit prescription labels and we ask that you send copies of those labels on standard 8½ by 11 inch printing paper. You should retain the originals for yourself.
It is also unnecessary to send drug descriptions.
- Stapling and Taping Claims
Please AVOID USING staples, tape, paper clips, or sticky notes with your documents. This includes the inside of envelopes. Staples cause damage to the equipment used to scan your claim(s) and taping may cause damages upon extraction from envelopes; thus delaying you claim.
Our processes ensure that claims and all pertinent documents stay together.
Also, if a document is small, frayed, or torn, copy all of information to standard 8½ by 11 inch printing paper.
- Document Size (Standard 8½ by 11 inches)
It is more efficient to process your claims if all submitted documents are copied or printed on standard 8½ by 11 inches. If you have continuous-feed documents, separate them along the perforated areas and ensure that there are no torn or frayed documents.
Here are some other helpful tips that will help speed the accurate and timely payment of your claim:
- Align your claim form in your printer so that all data is printed in the proper fields.
- Print your claim with legible font and make sure that the print is not light. Darker Font improves accurate reading of the data as it passes through optical scanners.
- Use caution when marking text with highlighters; dark-colored highlighters tend to distort or black out text images.
Although we always do our best to rapidly process any claim that you submit, following these simple hints helps us increase the speed of our service to you.