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CHAMPVA

icon family CHAMPVAThe Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries. The program is administered by the Veterans Health Administration Office of Community Care (VHA OCC) in Denver, Colorado.

Due to the similarity between CHAMPVA and the Department of Defense (DoD) TRICARE program (sometimes referred to by its old name, CHAMPUS), the two are often mistaken for each other. CHAMPVA is a Department of Veterans Affairs program while TRICARE is a regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors. In some cases, a Veteran may appear to be eligible for both or either program on paper; however, if you are a military retiree, or the spouse of a Veteran who was killed in action, you are and will always be a TRICARE beneficiary and cannot choose between the two programs.

CHAMPVA and the Affordable Care Act

The Affordable Care Act (ACA) is a health care law that was created to expand access to affordable health care coverage for all Americans, lower costs, and improve quality and care coordination. Under the health care law, people will have health coverage that meets a minimum standard (called "minimum essential coverage"). The health care law designates CHAMPVA as fulfilling the minimum essential coverage requirement.

For additional information, view the ACA information on the VA website at https://www.va.gov/health/ACA/.

If you are enrolled in CHAMPVA, you do not need to take additional steps to meet the health care law coverage standards. CHAMPVA will send IRS Form 1095-B, Health Coverage, annually. The ACA does not change CHAMPVA benefits or out-of-pocket costs.

Benefits

In general, CHAMPVA covers most health care services and supplies that are medically and psychologically necessary. Upon confirmation of eligibility, you will receive a CHAMPVA Program Guide that specifically addresses covered and non-covered services and supplies. For a complete listing of non-covered services and supplies please consult the CHAMPVA Policy Manual.

CHAMPVA Program GuideCHAMPVA Policy Manual

Pharmacy Benefits

Meds by Mail: Meds by Mail is a voluntary service that provides a safe, easy and cost-free way for eligible CHAMPVA and Spina Bifida beneficiaries to receive non-urgent maintenance medications delivered right to your door.

OptumRx (formerly Catamaran) Retail Pharmacy Network: OptumRx electronically processes pharmacy claims nationwide, including Puerto Rico, Guam, and the Virgin Islands. Beneficiaries are serviced through a network of more than 82,000 retail pharmacies. When you use a OptumRx pharmacy, the pharmacy may collect a 25 percent cost share (after the annual deductible has been met) before submitting the claim – saving you time.

Pharmacy Benefits

Other Health Insurance (OHI)

If you have any other health insurance (OHI), you must notify us of any changes (dropped insurance, changes in health plans, etc.) immediately upon those changes taking effect so that proper payment can be made on your claims. If you obtain a major medical policy, you must also notify us that you have a new policy and when it takes effect.

Update Your OHI File

We offer several methods to update your other health insurance file.

Phone: 800-733-8387
Call our Customer Call Center with the name of the insurance company, type of policy and effective dates of the policy.

Fax: 303-331-7808

Mail:
CHAMPVA
PO Box 469063
Denver, CO 80246-9063

Change of Address

If you change your address, it is vital that you update your address with CHAMPVA by using one of the three contact options below. Please sign and date mailed address change requests. If calling to update your address, please have available your old address information, as our customer service representatives will need to verify this information before updating your file.

CHAMPVA Contacts

Phone:
800-733-8387
8:05 a.m. to 7:30 p.m. EST
Monday through Friday

Mail:
CHAMPVA
PO Box 469063
Denver, CO 80246-9063

Self-Service Options for CHAMPVA Providers

Eligibility, Other Health Insurance (OHI) Coverage, and Claims

Interactive Voice Response (IVR) System
800-733-8387

Payments

Eligibility/Claims Status Inquiry (Payer ID: VAHAC)
AND
Medical Claims/Electronic Remittance Advice (ERA) (Payer ID: 84146)

Change Health Care (formerly Emdeon Inc.) Electronic Claim Submissions
http://changehealthcare.com/

800-845-6592

For more information on receiving ERAs, view Electronic Claims—Information for Providers