CHAMPVA–Information for Providers

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} } </style> <script> $(function() { document.getElementById("sub-footer").style.marginBottom = "60px"; var alertMsg = "<div id=\"footer-alert\"><div class=\"va-banner-body\" role=\"banner\"><p><i class=\"fas fa-bullhorn icon-left\" aria-hidden=\"true\"> </i><a href=\"https://www.va.gov/resources/the-pact-act-and-your-va-benefits\" title=\"PACT Act and your VA benefits\">Learn what the PACT Act means for your VA benefits <i class=\"fas fa-angle-double-right\" aria-hidden=\"true\"></i><\/a><\/p><\/div><\/div>"; $("body").append(alertMsg); }); </script> </div>   </div> </div> <span style="position:absolute;"><a id="main-content"> </a></span>  <div class="col-md-9"> <div class="fill"> <div id="innerContentWrapper" class="innerContentWrapperFeature"> <div id="tier4innerContent">  <h2 class="page-title">CHAMPVA–Information for Providers</h2>  <style></style> <main> <p><img alt="icon stethoscope CHAMPVA" class="page-icon" height="196" src="/COMMUNITYCARE/images/icons/icons_provider-champva.png" width="201">The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program for the spouse or widow(er) and children of an eligible Veteran. Through CHAMPVA, VA shares the cost of certain health care services and supplies with eligible beneficiaries. CHAMPVA may also provide benefits to the Primary Family Caregiver through the Caregiver Support Program. For more information, check out the CHAMPVA and the Caregiver programs.</p> <a href="/COMMUNITYCARE/programs/dependents/champva/index.asp" title="Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)" class="btn-blue">CHAMPVA</a>&emsp;<a href="/COMMUNITYCARE/programs/caregiver/index.asp" title="CHAMPVA for Primary Family Caregivers" class="btn-blue">CHAMPVA for Primary Family Caregivers</a> <div style="margin-top: 5px;" class="note"> <p style="padding-bottom: 10px;"><strong>IMPORTANT NOTE: </strong>Community care providers, including under CHAMPVA, must enroll for Electronic Funds Transfer (EFT) and payments will be deposited directly into a bank account.</p> <p class="id-web" style="padding-top: 10px; padding-bottom: 15px;"><a href="https://www.va.gov/COMMUNITYCARE/revenue-ops/provider-payments.asp" title="EFT - Electronic Payments">EFT - Electronic Payments</a></p> </div> <div class="clear"></div> <p style="margin-top: 5px;">The VHA Office of Integrated Veteran Care (IVC) processes CHAMPVA applications, determines eligibility, authorizes benefits, and processes medical claims. Providers are encouraged to file claims directly with CHAMPVA. For information on filing claims, visit the <em>Filing a CHAMPVA Claim</em> page.</p> <div style="border-right: 1px solid;" class="col-sm-4 left"> <p class="id-web" style="padding-top: 10px;"><a href="/COMMUNITYCARE/programs/dependents/champva/champva-claim.asp" title="Filing a CHAMPVA Claim">Filing a CHAMPVA Claim</a></p> </div> <div class="col-sm-8"> <p class="id-email" style="padding-top: 10px;"><a href="https://ask.va.gov/" title="Ask VA (AVA)">Ask VA (AVA)</a></p> </div> <div class="clear"></div>  <h3 class="rule-above">Change Healthcare (CHC) Cybersecurity Incident</h3> <p>For those VA community providers serving beneficiaries of CHAMPVA, Spina Bifida Healthcare Benefits Program, Camp Lejeune Family Member Program, and Children of Women Vietnam Veterans Health Care Benefits Program, please follow the guidelines at the link below.</p> <p class="id-web" style="padding-top: 10px; margin-bottom: 15px;"><a href="/COMMUNITYCARE/programs/dependents/CHC-Breach.asp" title="Change Healthcare (CHC) Cybersecurity Incident–Information for Family Member Care Claims">Change Healthcare (CHC) Cybersecurity Incident–Information for Family Member Care Claims</a></p> <h3 class="rule-above">Frequently Asked Questions</h3>  <details> <summary title="Is preauthorization required for services?">Is preauthorization required for services?</summary> <div class="tab-content"> <p>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:</p> <ul> <li>Adjunctive Dental (procedures that are directly related to covered medical conditions)</li> <li>Mental health/substance abuse services<em><br></em></li> <li>Organ and bone marrow transplants</li> </ul> </div> </details>  <details> <summary title="Is there something to sign to accept/participate in CHAMPVA?">Is there a contract or agreement that I must sign to accept/participate in CHAMPVA?</summary> <div class="tab-content"> <p>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.</p> </div> </details>  <details> <summary title="Do I have to accept the CHAMPVA allowable rate?">Do I have to accept the CHAMPVA allowable rate?</summary> <div class="tab-content"> <p>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.</p> </div> </details>  <details> <summary title="How do I get a claim paid?">How do I get a claim paid?</summary> <div class="tab-content"> <p>The most efficient way to file a claim for CHAMPVA is electronically. The VHA Office of Integrated Veteran 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.</p> <p>You must submit electronic claims through the VA clearinghouse. 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 the VA clearinghouse using the 276 and 270 HIPAA transactions.</p> <p>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 the address listed in the contacts below.</p> <p class="id-web" style="padding-top: 10px;">Visit <a href="/COMMUNITYCARE/programs/dependents/champva/champva-claim.asp" title="Filing a CHAMPVA Claim">Filing a CHAMPVA Claim</a> for more information on filing CHAMPVA claims.</p> </div> </details> <div class="col-sm-12 rule-below"></div> <div class="clear"></div>  <div class=" col-sm-12 contact-box" id="contacts"> <div style="border-right: 1px solid;" class="col-sm-6 left"> <h3 style="margin-bottom: 20px;">Contacts</h3> <p class="id-phone top"><strong>VA Customer Call Center</strong><br><a aria-label="8 0 0. 7 3 3. 8 3 8 7." href="tel:+18007338387">800-733-8387</a><br>8:05 a.m. to 7:30 p.m. ET, Monday-Friday</p> <p class="id-mail"><strong>VHA Office of Integrated Veteran Care</strong><br>ATTN: CHAMPVA<br>PO Box 469063, Denver CO 80246-9063</p> <p class="id-email"><a href="https://ask.va.gov/">Ask VA (AVA)</a></p> </div> <div class="col-sm-6"> <h3>Resources</h3> <ul style="margin: 0 0 50px 0;"> <li><a href="/COMMUNITYCARE/docs/pubfiles/factsheets/FactSheet_01-20.pdf#" target="_blank" title="Fact Sheet: CHAMPVA Information for Outpatient Providers and Office Managers (01-20)">Fact Sheet: <em>CHAMPVA Information for Outpatient Providers and Office Managers</em></a></li> <li><a href="/COMMUNITYCARE/docs/pubfiles/factsheets/FactSheet_01-04.pdf#" target="_blank" title="Fact Sheet: CHAMPVA Deductibles and Copays (01-04)">Fact Sheet: <em>CHAMPVA Deductibles and Copays</em></a></li> <li><a href="/COMMUNITYCARE/programs/dependents/champva/Helpful-Hints.asp" title="Helpful Hints: Filing Claims for CHAMPVA">Helpful Hints: Filing Claims for CHAMPVA</a></li> </ul> </div> </div> </main> <div class="clearfix"></div> <div class="top_link"><a href="#top">return to top <img height="10" width="7" src="/va_files/2014/responsive/images/arrow_up.png" alt="go"></a></div> </div>  </div> </div> </div>  </div> </section> </div> </div> </div>  <div id="footer-effect"> <div 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CHAMPVA–Information for Providers - Community Care