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Spina Bifida Health Care Benefits Program–Information for Providers

icon spineThe Department of Veterans Affairs (VA) Spina Bifida Health Care Benefits Program (SBHCBP) is for Vietnam and certain Korean Veterans’ birth children who have been diagnosed with spina bifida (except spina bifida occulta). The program covers comprehensive health care considered medically necessary and appropriate. The VHA Office of Community Care in Denver, Colorado manages the Spina Bifida program, including the authorization of benefits and the subsequent processing and payment of claims.

The SBHCBP does not have contract providers. In order to participate in this program, providers must be properly licensed in their state to receive payment and must not be on the Medicare exclusion list.

Fact Sheet: SBHCBP–Information for Outpatient Providers and Office Managers

Preauthorization is required for the following:

  • Attendants
  • Day health care as an outpatient service
  • Dental services
  • Durable medical equipment (DME) in excess of $2,000
  • Homemaker services (must be health-related services)
  • Outpatient mental health services in excess of 23 visits per calendar year
  • Substance abuse treatment
  • Training of family members, guardians and members of the child's household
  • Transplantation services
  • Travel (other than mileage for local travel) in private automobiles at the general services administration rate

To obtain preauthorization, send requests to:

VHA Office of Community Care/Spina Bifida
ATTN: Preauthorization
PO Box 469065, Denver CO 80246-9065

Fax: 303-331-7807

Spina Bifida Claims Mailing Address

VHA Office of Community Care
Spina Bifida Health Care Benenfits Program
PO Box 469065, Denver CO 80246-9065

Phone: 888-820-1756

Providers should use a standard billing form (UB-04, CMS 1500) to provide required information. View Spina Bifida Claims for a listing of required documentation.

Spina Bifida Claims

Resources

  • Rejected Claims–Explanation of Codes
    Rejected Claims A list of the top 10 reasons claims are rejected/denied along with additional explanations for the rejection codes and what needs to be done to get the claim processed correctly.
  • Provider Resources
    Please visit Provider Resources for more information and tools regarding how to conduct business with the VHA Office of Community Care and the programs it administers.