How to file a CHAMPVA claim

What to know before you file a CHAMPVA claim

In most cases, your provider should file your CHAMPVA claim for you. We’ll then pay the provider directly for the part of your care that we cover.

If you get care from a provider who doesn’t accept CHAMPVA or you go to an out-of-network pharmacy, you’ll need to pay out of pocket and then file a claim for reimbursement.

Time limits for filing a claim

You must file your claim within 1 year of when you received the care.

If you stayed in a hospital for care, you must file your claim within 1 year of when you left the hospital.

Supporting documents to send with your claim

You’ll need to send these documents with your claim:

• Proof that you paid the provider. You can send a receipt or a billing statement that’s marked as “paid,” and
• An itemized billing statement (often called a superbill) from your provider

Make sure the itemized billing statement includes all of this information:

• Your full name and date of birth, and
• Your provider’s full name and medical title, and
• Your provider’s tax identification number (TIN) or Tax ID (example: 12-1234567), and
• Your provider’s National Provider Identifier (NPI), and
• Office and building address of service, and
• List of charges with the date you received care, and
• Diagnosis (DX) codes for specific diagnoses (example: A12.345)

Your itemized billing statement should also include either of these additional procedure codes:

• Current Procedural Terminology (CPT) codes (example: Lab work, 12345), or
• Healthcare Common Procedure Coding System (HCPCS) codes (example: A1234)

Note: If your billing statement is missing this information, it could lead to a delay in processing your claim. Ask your provider for an itemized billing statement, which includes more information than a regular bill.

If you have other health insurance

You’ll also need to submit a document called an Explanation of Benefits (EOB). This is different than the summary of benefits for the health insurance policy. The EOB lists what your other health insurance already paid for your care so we know how much to reimburse you. You can access your EOB 30-90 days after receiving care. Contact your insurance provider if you have questions about where to find your EOB.

The EOB must include all of this information:

• Date of service that matches the date of care, and
• Your provider’s full name, and
• Your provider’s 10-digit National Provider Identifier (NPI) code if not shown on the itemized billing statement, and
• Services the insurance provider paid for, and
• Amount paid by the insurance provider

Note: For services the insurance provider paid for, include the CPT code, HCPCS code, or a description of the service or medical procedure.

If your other health insurance is Kaiser Permanente

You’ll also need to submit a copy of your Kaiser Permanente insurance card that shows the amount of your copayments. This is because itemized billing statements from Kaiser Permanente providers don’t include all the information we need to process your claim.

If you’re filing a claim for prescription medications

Instead of an itemized billing statement from your provider, you’ll need to submit a document from your pharmacy that includes all of this information:

• Name, address, and phone number of the pharmacy, and
• Name, dosage, strength, quantity, and cost of the medication—including the amount of your copay, and
• 11-digit National Drug Code (NDC) for each medication—including the amount of your copay, and
• Date the pharmacy filled the prescription, and
• Name of the provider who wrote the prescription

Note: The documents your pharmacy attaches to your prescription usually include the information we need. You can also ask your pharmacy for a document with this information.

What to expect after you file your claim

We’ll review your documents. If we need more information, we’ll contact you.

If we decide we can cover your claim under CHAMPVA

We’ll send you an explanation of benefits. This document explains the amount we’ll cover and the amount you’ll need to pay.

In most cases, we’ll pay the provider directly for the part of your care that we cover. If you already paid your provider out of pocket, we’ll pay you back for the part of your care that we cover. 

If we decide we can’t cover your claim under CHAMPVA

If you disagree with our decision, you can request a decision review.

Learn about your decision review options

If you choose to mail us your decision review request, include a copy of our decision or explanation of benefits. Mail the letter and any supporting documents to this address: 

VHA Office of Integrated Veteran Care
Appeals
PO Box 600
Spring City, PA 19475

How to contact us about CHAMPVA claims

Call us at (TTY: 711). We’re here Monday through Friday, 8:00 a.m. to 7:30 p.m. ET.

Or you can send a letter with questions about claims to this address:

VHA Office of Integrated Veteran Care
CHAMPVA Claims
PO Box 500
Spring City, PA 19475

You can also contact us online through Ask VA.

Contact us online through Ask VA