Finding a Provider
There is no provider network for CHAMPVA or any of the family member programs administered by the Department of Veterans Affairs (VA) Chief Business Office Purchased Care. The VA CBOPC website does suggest that the Medicare and TRICARE provider pages may be helpful.
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The VA advises CHAMPVA beneficiaries (and those enrolled in their other health care programs) to make sure that the providers they see will participate in the program that covers them. 1 This is referred to as “accepting assignment.” The CBOPC page for locating providers states:
When you locate a medical provider, confirm that they will participate in the VA family member health care program you belong to. Providers most often refer to participation as “accepting assignment.” Providers that accept assignment will bill us directly for covered services, items and supplies. Doctors or other providers who accept assignment must accept the Chief Business Office Purchased Care (CBOPC) allowable amount as payment-in-full and cannot collect additional amounts from you beyond your cost share and deductible.
The page goes on to say that if a provider does not accept assignment, a CHAMPVA beneficiary can still see that provider. But the beneficiary may have to pay the entire cost at the time of service. He or she may also be charged more than the VA CBOPC allowable amount. So seeing a provider who does not accept assignment may result in higher expenses for the beneficiary. The CBOPC may reimburse charges, but only its share of the allowable amount.
An important note about the Medicare exlcusions list. This is a list of providers that are prohibited from giving services and supplies to beneficiaries of federal health care programs, including CHAMPVA. According to the same CBOPC page cited previously:
The Department of Health and Human Services, Office of Inspector General (HHS OIG) maintains and publishes a monthly list of individual medical providers that are not allowed to provide medical services and supplies to federal health care program participants. Medical providers on this list have been convicted in state or federal court of certain felonies, criminal offenses, or have had other offenses toward federal agencies related to the delivery of health care. Mandatory exclusions include, but are not limited to, convictions related to patient abuse or neglect, felony convictions related to health care fraud, and controlled substances.
Excluded individual medical providers and medical institutions cannot, by law, receive payments for health care services or supplies from any federal health care program. That exclusion includes programs funded by the Department of Veterans Affairs such as CHAMPVA, the Spina Bifida Health Care Program, and the Children of Women Vietnam Veterans Health Care Program.2
For more important, and most current information on finding a provider, see the VA Chief Business Office Purchased Care: Locating a Provider page. That page also links to TRICARE and Medicare.
Are you a provider? Please refer to the official CHAMPVA page for providers at the VA website. That page addresses questions about verifying CHAMPVA eligibility, submitting claims, pharmacy claims, pre-authorizations and more.
1-2. “Locating a Provider – Chief Business Office Purchased Care.” U.S. Department of Veterans Affairs. September 30, 2014. Accessed April 4, 2015. http://www.va.gov/PURCHASEDCARE/programs/dependents/locate_provider.asp.
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For the most current information about CHAMPVA, please visit the official CHAMPVA site. Or to find a specific page or resource, see a list of CHAMPVA resource links. Please always check with official sources before doing anything with your CHAMPVA coverage!
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If you need to contact CHAMPVA, check the official VA contact info here! Note, the VA warns that email is not secure and that they will NOT send you personal or sensitive information through email. Read more about their warnings and communication safety here.