Usually a health care provider will bill CHAMPVA directly; that is, the provider accepts “assignment.” But sometimes the beneficiary may be the one to file a claim. If you paid upfront for a medical service or supply and want CHAMPVA to pay you back, you can file a claim to get reimbursed for covered services. One possible instance of this is if you married your veteran spouse, received a service and enrolled in CHAMPVA only later.
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Please Note: If you see a provider that doesn’t accept CHAMPVA assignment, you may be obligated to pay more than your share of the CHAMPVA allowable amount. Providers who agree to bill CHAMPVA directly must accept CHAMPVA’s allowable amount as the full payment.
Claim Filing Instructions for Beneficiaries
To file a CHAMPVA claim yourself if you are the beneficiary, submit:
- VA Form 10-7959a: CHAMPVA Claim Form, duly completed and signed
- Itemized billing statement on CMS 1500 or UB-04 with the same information that a provider enters when it’s the provider who makes the claim
- An Explanation of Benefits (EOB) from your other health insurance (if you have one) for the same service you file a claim for, so CHAMPVA knows what the other insurer has already paid for
Make sure that:
- You use your full name just as it appears on your CHAMPVA authorization card
- You use the beneficiary’s Social Security Number, not the veteran sponsor’s
- You keep copies of all receipts, bills, EOB’s, etc.
Claim Tips and Reminders
- CHAMPVA and health insurance companies rely on a provider’s itemized billing statement to identify the type of service and other related information. So it is important to provide it.
- If you file a claim without VA Form 10-7959a, VA will pay the provider instead of you.
- You have one year from the date of service to file a claim. If inpatient, you count from the date of discharge. An exception to this is retroactive eligibility. Then you can file a claim for all the way back to the date of eligibility. You have 180 days or 6 months from the time you become eligible to apply for such claims.
- You must use a separate claim form for each CHAMPVA beneficiary.
Please see the CHAMPVA Handbook for more details and claim filing instructions.
CHAMPVA Claim for Reimbursement for Overseas Medical Services
CHAMPVA provides the same coverage abroad with few exceptions. You can file a claim for a medical service overseas and use the receipts, invoices, etc. to help CHAMPVA identify the service(s) given. Of course, the more complete (detailed) the billing, the better. CHAMPVA will let you know if more information is required. Or you can call CHAMPVA and follow up on your claim. Keep in mind the annual deductible is subtracted from your claim(s).
If a claim for reimbursement is approved, you will receive a check in the mail (from the Department of Treasury, I believe) for the amount you get paid back. You should also receive a CHAMPVA Explanation of Benefits.
You can file a claim up to a year from the date of service. If it’s inpatient (like if you were “confined”), you count from the day of discharge from the hospital. If using retroactive benefits, you can claim all the way back to your eligibility date.