CHAMPVA claims Address - Billing Guidelines

How do I get a claim paid?

The HCFA-1500 should be sent to:

VA Health Administration Center
CHAMPVA
PO Box 65024
Denver, CO 80206-9024

This is the only address that should be used for CHAMPVA claim submissions.  If the beneficiary has other health insurance (OHI), they should be billed first. The explanation of benefits (EOB) from the OH1 should then be submitted with the claim for reimbursement to CHAMPVA. By law, CHAMPVA is always secondary payer except to Medicaid, State Victims of Crime Compensation Programs, and supplemental  CHAMPVA policies.


Claims for CHAMPVA

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is
not a TRICARE program. For questions or general correspondence, you may contact CHAMPVA
by any of the means listed


CHAMPVA Contact Information

Phone 1-800-733-8387

Mail VA Health Administration Center

          CHAMPVA
         P.O. Box 469063
        Denver, CO 80246-9063

Web site  www.va.gov/hac/forproviders

Claims for current treatment must be filed within 365 days of the date of service. Providers may file
health care claims electronically on behalf of their patients. If you wish to file a paper health care claim,


CHAMPVA claim forms may be downloaded from the CHAMPVA Web site. To file a paper health
care claim within the one-year filing deadline, send the claim to:

VA Health Administration Center
CHAMPVA
P.O. Box 469064
Denver, CO 80246-9064

Written appeals may be requested if exceptional circumstances prevented you from filing a claim
in a timely fashion. Send written appeals to:

VA Health Administration Center
CHAMPVA
ATTN: Appeals
P.O. Box 460948
Denver, CO 80246-0948

Note: Do not send appeals to the claims-processing address. This will delay your appeal.


CHANGE OF ADDRESS It is very important that you notify us if your address or phone number changes by contacting us at: Mail Claims Claims can be mailed to CHAMPVA at:

Department of Veterans Affairs Chief Business Office Purchased Care

CHAMPVA
PO Box 469063
Denver CO 80246-9063


ELIGIBILITY REQUIREMENTS

Eligibility for CHAMPVA benefits can be impacted by changes to your marriage status, eligibility for Medicare or TRICARE, and by the student status of children ages 18 to 23. Such changes must be reported to us immediately.

Call us at 1-800-733-8387
or write us at:

CHAMPVA Eligibility
PO Box 469028
Denver CO 80246-9028

Interactive voice response (IVR) system Phone

Toll Free: 1-800-733-8387 Hours of Availability: 24 Hours a Day, Seven Days a Week


Talk to a customer service representative • Phone

Toll Free: 1-800-733-8387, Monday through Friday (excluding holidays) • Hours of operation: 8:05 a.m. to 7:30 p.m. Eastern Time




What is CHAMPVA?

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a health 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 (VHA CC) in Denver, Colorado, which processes CHAMPVA applications and medical claims, verifies eligibility and authorizes benefits.

How does CHAMPVA relate to TRICARE? 

Both are federal programs, however, an individual who is eligible for TRICARE is not eligible for CHAMPVA. Although similar, TRICARE (formerly CHAMPUS), which is administered by the Department of Defense, should not be confused with CHAMPVA. TRICARE provides coverage to the families of active duty service members, families ofservice members who died while on active duty and retirees and their families, whether or not the Veteran is disabled.

Is preauthorization required for services? 

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

• Durable medical equipment with a purchase price or total rental price of $2,000 or more
• Mental health/substance abuse services (see Fact Sheet 01-08: CHAMPVA Mental Health and Substance Use Disorder Benefits for more information)
• Organ and bone marrow transplants
• Dental procedures that are directly related to covered medical conditions

Approvals for referrals to specialists or for diagnostic tests are not required as long as they are medically necessary. Are dental procedures 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.

Are case management and utilization reviews performed?

Yes, clinical claim reviews are performed for a variety of medical services including physical, occupational and speech therapies, home health, skilled nursing, rehabilitation and use of controlled substances. Simply submit the medical documentation along with your claim. Utilization reviews are also performed for services requiring preauthorization.

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 Title 38 CFR, Section 17.272(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?

VHA CC 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 U.S. territories. You must submit electronic claims through our clearinghouse, 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 through Emdeon using the 276 and 270 HIPAA transactions, respectively. We also accept paper claims, but the turnaround time to payment is, on average, an additional 20 days. The only address for submission of paper claims to CHAMPVA is:

VHA Office of Community Care
CHAMPVA Claims
PO Box 469064, Denver CO 80246-9064

If the beneficiary has other health insurance (OHI), the OHI should be billed first. The explanation of benefits (EOB) from the OHI should be submitted with the claim for reimbursement to CHAMPVA. By law, CHAMPVA is always the secondary payer, except to Medicaid, Indian Health Service, State Victims of Crime Compensation Programs and supplemental CHAMPVA policies.

As of September 27, 2010, we can receive Medicare Crossover Part A and B, and DMERC claims for CHAMPVA beneficiaries. If your patient is a Medicare beneficiary and we have the Medicare Health Insurance Claim number (HICN) on file, the claim will be forwarded electronically to CHAMPVA. Review your electronic remittance advice from Medicare to determine if the claim has been forwarded to us.

What does CHAMPVA pay and how fast does it pay?

In most cases, CHAMPVA pays equivalent to Medicare and TRICARE allowable charges. CHAMPVA has an outpatient deductible ($50 per person up to $100 per family per calendar year) and a cost share of 25%. You should collect the 25% allowable cost share from the patient, except when the patient has other health insurance. If the beneficiary has OHI, CHAMPVA pays the lesser of either 100% of the allowable amount or the remainder of the charges, and the beneficiary will normally have no cost share. CHAMPVA normally pays 95% of claims within 30 days. Electronic claims are paid faster than paper claims. To help us process claims in a timely manner, submit the patient name exactly as it is shown on the CHAMPVA Identification Card. If different names are used, it will cause a delay in the handling of claims.

Are there special considerations for Ambulatory Surgery Centers?

Yes, they must have Medicare approval to perform the specific procedure at free-standing surgical centers. For a listing by procedure of those services that are approved to be performed in a free-standing ambulatory setting, refer to the CHAMPVA Policy Manual, Chapter 3, Section 7.1 and addendums on our website listed below.

How do I know if someone is CHAMPVA eligible? 

Every CHAMPVA beneficiary has a CHAMPVA Identification Card that looks like the sample shown on this page. You may recertify eligibility through our contact center by talking to a agent or by using your phone’s keypad to input the patient’s Social Security number into our Interactive Voice Response system. We also accept EDI requests to validate eligibility through our clearinghouse, Emdeon, using the HIPAA 270 transaction.

How do I get more information?

• Mail: VHA Office of Community Care
CHAMPVA
PO Box 469063
Denver, CO 80246-9063

• Phone: 1-800-733-8387, Monday-Friday 8:05 a.m. to 7:30 p.m., Eastern Standard Time
• Email: Follow the directions for submitting email via IRIS at https://iris.custhelp.com/app/ask
• Website: http://www.va.gov/purchasedcare/


Blue cross blue shield address
Medicaid Address and phone number - List 1
Medicaid claim submission address - List 2
Medicare claim submission address
United Health care billing Address
Aetna Address
BCBS billing address
Medicare copay and coins

1 comment:

Anonymous said...

how long does a claim take to get your reward in general ?

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