CHAMPVA Fact Sheet for Medical Billers

How to Bill CHAMPVA for Medical Services

The Civilian Health and Medical Program of the Department of Veteran Affairs (CHAMPVA) is a comprehensive health care program for civilians who qualify and who are not eligible for TRICARE. It is administered by the Veterans Health Administration Office of Community Care in Denver, Colorado. It covers spouses and children of veterans who are permanently and totally disabled. It also covers survivors of military members who died in the line of duty but who are not eligible for TRICARE.

General Information for CHAMPVA for Medical Billing

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Payer ID

84146 (Medical)

Contact Numbers

Phone 1-800-733-8387 

Fax 1-303-331-7804

Address Information

VA Health Administration Center

CHAMPVA
PO Box 469063 
Denver CO 80246-9063

Email Address

Submit e-mail via IRIS.

Eligibility, Benefits, and Claim Status

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Spouses (current or surviving) and children of veterans may be eligible for CHAMPVA if the veteran is permanently and totally disabled (or was at the time of death), or died of a service-connected disability. It is also open to the surviving spouse or child of a military member who died in the line of duty. However, in all cases, persons eligible for TRICARE are not eligible for CHAMPVA

To check on eligibility, benefits, and claim status, a health care provider can use the CHAMPVA Interactive Voice Recognition (IVR) System

  • 24 hours a day
  • Obtain CHAMPVA beneficiary claims or beneficiary status
  • 1-800-733-8387 follow voice commands.

How to Submit a Prior Authorization Request to CHAMPVA

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Prior Authorization from CHAMPVA is required for: 

  • Durable Medical Equipment (DME) $2,000.00 or more (to be purchased or rented)
  • Mental health and/or substance abuse services
  • Organ and bone marrow transplants
  • Dental care

Submit prior authorization requests prior to rendering services by phone using the telephone number on the member identification card.

  • For mental health and substance abuse, prior authorizations call 1-800-424-4018
  • For durable medical equipment and other prior authorizations call 1-800-733-8387

Billing Information

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There are two ways to bill claims to CHAMPVA

  1. Electronic claims can be submitted through an electronic vendor/clearinghouse.
  2. Paper claims can be submitted to the CHAMPVA claims mailing address.​
    • Paper claims should be mailed to:
      VA Health Administration Center
      CHAMPVA Claims
      PO Box 469064
      Denver CO 80246-9064

Secondary claims:

  • Medicare will forward electronically to CHAMPVA if the Medicare Health Insurance Claim number (HICN) is on file
  • Submit electronically or paper with primary payer explanation of benefits (EOB) at the address listed above
  • Include adjustment amounts - at both claim level and/or service line level (if available)
  • Include adjustment reasons - contractual obligation, deductible, coinsurance, etc. Use the codes furnished by the primary payer's remittance
  • Primary payer paid amount - at both claim level and/or service line level (if available)

Timely Filing Requirements

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Claims must be received by CHAMPVA within one year from the date of service or within one year from the date of discharge from an inpatient facility. Any claim submitted after one year will be denied.

Corrected Claims

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When making changes to previously paid claims, contact the office that processed the original claim with supporting documentation that validates the change in coding and/or billing with a cover letter explaining why.

Refunds

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Overpayments must be returned by check made payable to CHAMPVA:

VA Health Administration Center
CHAMPVA
PO Box 469063 
Denver CO 80246-9063

Appeal Information

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Providers should submit a reconsideration request to:

VA Health Administration Center
CHAMPVA
Attn: Appeals
PO Box 460948
Denver, CO 80246-0948

For first level mental health appeals submit to:

Magellan Behavioral Health
CHAMPVA
PO Box 3567
Englewood, CO 80155

Level 1 Appeal

  • Submit within one year of the date of the initial denial or payment
  • Identify the reason why you are requesting a reconsideration
  • Include a copy of the EOB or determination letter.
  • Include new information not previously submitted

Level 2 Appeal

  • If you are not satisfied with the resolution of the first-level review, you may submit the appeal to a second-level review within 90 calendar days of the date of the first-level review determination. For Second-Level appeals, follow the same guidelines as outlined for First-Level Appeals but indicate "Second-Level Appeal Request" on the appeal form or letter.
  • Second level appeal determinations decisions are final.
  • Second level mental health reconsideration requests should be submitted to:
    VA Health Administration Center
    CHAMPVA
    Attn: Appeals
    PO Box 460948
    Denver, CO 80246-0948
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