VHA Office of Community Care
Helpful Hints: Claim-Filing for Providers
With an expanding number of eligible CHAMPVA beneficiaries, we want to ensure that reimbursements for medical services provided are paid correctly and in a 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.
Common Claim-Filing Pitfalls
Here are seven tips that will help speed the accurate and timely payment of your claim:
- Ensure that all patient information is correct—legal name (no nicknames), correct address, SSN and DOB.
- Any attachments submitted with the claim must clearly show patient information that matches the information on the claim.
- Align your claim form in your printer so that all data is printed in the proper fields.
- Print your claim with a legible font and make sure that the print is not too light. This improves accurate reading of the data as it passes through optical scanners.
- Please avoid marking text with highlighters; they can obscure, distort or completely black out text images.
- Claims and attachments should not be torn, taped or have bent pages.
- Do not staple or place paper clips on the pages.
CHAMPVA identifies each provider by their nine-digit EIN/TIN (Employer Identification Number/Taxpayer Identification Number). Please ensure you are including the complete nine-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. NOTE: Be aware that PO boxes are not true physical addresses and should not be used as a physical address for services rendered.
Dealing with Health Insurance That is Primary to CHAMPVA
When a CHAMPVA beneficiary has two insurance policies that pay prior to CHAMPVA, please provide a copy of both the primary and secondary insurance policies' explanations of benefits (EOBs) along 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.
Billing and Coding
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 professional fees and facility fees are submitted on the same form, there is a greater chance your claim for payment will be processed incorrectly.
If you are billing for an anesthesia professional fee, please use the correct anesthesia code, not the surgical equivalent. This will help ensure that you are reimbursed the correct amount.
When submitting a bill for ambulatory surgery services, please make sure the surgery code(s) as well as the corresponding charge(s) are included on the bill. Omitting the surgical code will cause a delay in processing your submission.
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.
NOTE: This is especially important when submitting Evaluation and Management (these are codes that fall in the 99201 – 99288, 99304 – 99318 and 99354 – 99499 ranges).
Before submitting your claim, make sure 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.
When submitting a handwritten bill, please ensure that the writing is legible.
Resubmissions for Payment of Services Rendered
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.