The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) offers a comprehensive healthcare claims management system for providers serving eligible Veterans’ family members. This article explores the essential aspects of working with CHAMPVA’s provider claims process.
Official Links
What Providers Need to Know
Provider Eligibility Requirements
- Must be properly licensed in your state
- Cannot be on the Medicare exclusion list
- No specific contract or agreement required to participate
Claims Submission Process
Electronic Claims Submission
The most efficient method for filing CHAMPVA claims is electronically through the VA clearinghouse:
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Payer ID Numbers:
- Medical Claims: 84146
- Dental Claims: 84147
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Accepted Transactions:
- 837 Institutional
- 837 Professional
- 837 Dental
Paper Claims Alternative
While electronic submission is preferred, paper claims can be mailed to:
VHA Office of Integrated Veteran CareCHAMPVA ClaimsPO Box 30750Tampa, FL 33630-3750Important Billing Considerations
Reimbursement Rates
- Providers must accept the CHAMPVA allowable charges
- Balance billing is prohibited, with rare exceptions
Preauthorization Requirements
Advance approval is crucial for:
- Adjunctive Dental Procedures
- Mental Health/Substance Abuse Services
- Organ and Bone Marrow Transplants
Payment and Compliance
Electronic Funds Transfer (EFT)
IMPORTANT: Providers must enroll in EFT for direct bank deposits.
Claim Status and Eligibility
Providers can:
- Check medical claim status electronically
- Verify patient eligibility through VA clearinghouse
- Utilize HIPAA transactions (276 and 270)
Contact Information
Provider Support
- VA Customer Call Center: 800-733-8387
- Hours: 8:05 a.m. to 7:30 p.m. ET, Monday-Friday
Additional Resources
- Helpful Claims Filing Hints
- Rejected Claims Explanation Codes
- CHAMPVA Outpatient Provider Fact Sheet
Key Compliance Notes
- Medicare Crossover claims are automatically processed
- Ensure you have the Medicare Health Insurance Claim Number (HICN)
Unprovided Information
While the sources provide comprehensive details about CHAMPVA claims processing, specific information about a dedicated provider portal interface is not explicitly described in the available documentation.
Healthcare providers serving CHAMPVA beneficiaries should prioritize electronic claims submission, understand preauthorization requirements, and ensure compliance with VA billing guidelines.
Pro Tip: Always verify patient eligibility and maintain accurate documentation to streamline the claims process.
FAQ
How do providers check eligibility for Champva?
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VA.govhttps://www.va.govCHAMPVA–Information for Providers – Community Care – VA.govYou can also check medical claim status and eligibility status electronically through the VA clearinghouse using the 276 and 270 HIPAA transactions. CHAMPVA rec…
What are the eligibility criteria for Champva?Eligibility for CHAMPVA
You’re the surviving spouse or dependent child of a Veteran who died from a service-connected disability, or. You’re the surviving spouse or dependent child of a Veteran who was at the time of their death rated permanently and totally disabled from a service-connected disability.
Does Champva have a patient portal?
Do providers have to accept Champva?You’ll need to pay any costs above that amount. Hospitals and hospital-based providers that accept Medicare must also accept CHAMPVA.Mar 19, 2025
https://www.va.gov/COMMUNITYCARE/providers/info-champva.asp
The VHA Office of Integrated Veteran Care (IVC) processes CHAMPVA applications, determines eligibility, authorizes benefits, and processes medical claims.
https://www.va.gov/family-and-caregiver-benefits/health-and-disability/champva/
Eligibility for CHAMPVA You may be eligible for CHAMPVA if you don’t qualify for TRICARE (the Defense Department’s health care program for