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Filing a CHAMPVA Claim–Information for Beneficiaries

icon filing a paperWe encourage beneficiaries to have their provider(s) file claims directly with CHAMPVA. Providers are more likely to submit all the information necessary for CHAMPVA to process claims.

Required Documentation for Claims Submitted to CHAMPVA

Medical Claims Documentation

Use CHAMPVA Claim Form, VA Form 10-7959a (Forma S10-7959a en Español). If you fail to complete VA Form 10-7959a, your health care provider will be paid directly.

  • Your name must be listed on the claim form exactly as it is on your CHAMPVA Identification Card.
  • Separate signed and dated claim forms are required for each patient/ beneficiary, even if they are members of the same family.
  • Itemized bill(s) from your provider with the following information:
    • Your Social Security number (SSN) must be on the claim. (DO NOT use the qualifying Veteran’s SSN.)
    • Full name, address, and tax identification number (TIN) 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
    • Itemized charges for each service
    • Appropriate diagnosis and procedure codes (DX, CPT, HCPCS) for each service
  • If you have other health insurance, a copy of their explanation of benefits (EOB) detailing what they paid. (Please note: our mailroom equipment will only scan one side of the page. If important information is on the back of a page [processing remark codes], please photocopy the back page to include with the submission.)

NOTE: Ask your provider for an itemized bill as the patient copy is often missing critical information required by CHAMPVA to process claims. Also, please retain a copy of all documents submitted to CHAMPVA.

Pharmacy Claims Documentation

Use CHAMPVA Claim Form, VA Form 10-7959a (Forma S10-7959a en Español).

  • Your name must be listed on the claim form exactly as it is on your CHAMPVA Identification Card.
  • Separate signed and dated claim forms are required for each patient/ beneficiary, even if they are members of the same family.
  • An itemized bill/statement from your pharmacy is required.
  • An itemized pharmacy bill/statement that includes:
    • Name, address, and phone number of the pharmacy
    • Name of prescribing physician
    • Name, strength, and quantity for each drug
    • Eleven-digit National Drug Code (NDC) for each drug
      (Please note that the “NDC” number is not the same as the “RX” number.)
    • Charge for each drug
    • Copayment for each drug
    • Date prescription was filled

If Kaiser Permanente is your primary insurance:

Kaiser does not provide beneficiaries the necessary information needed to submit claims for reimbursement to CHAMPVA. To process a claim for a Kaiser Permanente bill, which does not include a medical diagnosis or procedure code, CHAMPVA can use code V70 for the diagnosis and code 99499 for the procedure.

For CHAMPVA to process claims using this method, please provide the following documentation with your claim:

  • A copy of your Kaiser Permanente card showing the amount of your copayments with your claims.
  • A bill from Kaiser that includes the following information:
    • Tax Identification Number (TIN)
    • Address of the Kaiser provider
    • Date of service
    • Medical code or description for the diagnosis and the procedure
    • Patient’s responsibility or patient copayment

NOTE: Please retain a copy of all documents submitted to CHAMPVA.

Where to Mail Claims

For new claims

VHA Office of Community Care
CHAMPVA
PO Box 469064
Denver CO 80246-9064

For general questions, information on payment, or to reprocess a denied claim, please send your request to

VHA Office of Community Care
CHAMPVA
PO Box 469063
Denver CO 80246-9063

For reconsiderations and appeals

VHA Office of Community Care
APPEALS
PO Box 460948
Denver CO 80246-0948

Avoid Payment Delay

The United States Postal Service has contacted us stating that some providers and beneficiaries are sending mail to the wrong zip code. Please send your claims to the addresses listed above.

How to Get Additional Claim Forms

Download a CHAMPVA Claim Form, VA Form 10-7959a from the VA Forms website.

Order forms via the Inquiry Routing & Information System (IRIS).

800-733-8387
Request additional forms at any time (including evenings and weekends) by calling our Interactive Voice Response system and selecting the claim form option.

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