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CHAMPVA

icon stethoscope CHAMPVACHAMPVA is a health care benefits program in which the Department of Veterans Affairs (VA) shares the cost of certain health care services and supplies with eligible beneficiaries. CHAMPVA is managed by the VHA Office of Community Care in Denver, Colorado. We process CHAMPVA applications, determine eligibility, authorize benefits and process medical claims. View the fact sheets listed below for information on specific topics or view our Publications for more program references.

VHA OCC Publications

CHAMPVA Informational Fact Sheets

CHAMPVA Claims and Eligibility Status

You can check on the eligibility status of a CHAMPVA beneficiary or the status of payment for a claim 24 hours a day through our Interactive Voice Recognition (IVR) system. Please have the beneficiary's Social Security Number and your tax ID number available when calling.

Interactive Voice Recognition System: 800-733-8387

Frequently Asked Questions

Is preauthorization required for services?

Certain types of care/services require advance approval, commonly known as preauthorization. This approval, or preauthorization, is extremely important, and the failure to obtain it may result in denial of the claim. Preauthorization is required for:

  • Durable medical equipment (DME) with a purchase price or total rental price of $2,000 or more
    (View Fact Sheet: CHAMPVA Durable Medical Equipment listed above for more information)
  • Mental health/substance abuse services
    (View Fact Sheet: Mental Health and Substance Use Disorder Benefits listed above for more information)
  • Organ and bone marrow transplants
  • Adjunctive Dental (procedures that are directly related to covered medical conditions)
What dental procedures are covered under CHAMPVA?

With very few exceptions, dental care is not a covered benefit. There may be times when dental care is covered, but in all cases, preauthorization is required. An example of when dental care is covered would be for a dental condition resulting from the treatment of an otherwise covered medical condition (not dental), such as radiation therapy for oral or facial cancer.

Is there a contract or agreement that I must sign to accept/participate in CHAMPVA?

No. CHAMPVA does not have contract providers. You must be properly licensed in your state to receive payment from CHAMPVA and cannot be on the Medicare exclusion list

Do I have to accept the CHAMPVA allowable rate?

Yes, under 38 CFR section 272(b) (3) and (4), providers who agree to accept the beneficiary must accept the CHAMPVA allowable charges and cannot balance bill the beneficiary. The sole exception is when the beneficiary is notified prior to any services being rendered that you do not accept CHAMPVA and the beneficiary must pay the entire billed amount up front and file the claim to CHAMPVA.

How do I get a claim paid?

The most efficient way to file a claim for CHAMPVA is electronically. The VHA Office of Community Care accepts electronically submitted 837 claim transactions. These include the 837 Institutional, 837 Professional, and 837 Dental transactions. Transactions are accepted from providers for medical services and supplies provided in the United States, a U.S. Commonwealth or the territories. You must submit electronic claims through our clearinghouse, Change Healthcare (formerly Emdeon™). Our Payer ID number is 84146 for medical claims and 84147 for dental claims. You can also check medical claim status and eligibility status electronically through Change Healthcare using the 276 and 270 HIPAA transactions.

CHAMPVA receives Medicare Crossover Parts A & B and DMERC claims for our beneficiaries. If your patient is a Medicare beneficiary your claim will be forwarded electronically to CHAMPVA if we have the Medicare Health Insurance Claim number (HICN) on file. Please review your electronic remittance advice from Medicare to determine if your claim has been forwarded to us.

Claims can be mailed to:

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

For CHAMPVA beneficiaries who do not have other presciptions coverage, pharmacy claims can be submitted electronically to:

RxBIN: 610593  |  RxPCN: VA  |  RxGroup: HAC

Resources

  • Provider Resources
    Please visit our Provider Resoures Toolkit for more information and resources regarding how to conduct business with the VHA Office of Community Care and the programs it administers.