Friday, August 17, 2012

CHAMPVA claim submission and appeal submission address


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



Medical Services for Dependents and Survivors Of Veterans

The VA’s health care program for dependents and survivors of veterans is called the VA Civilian Health and Medical Program (“CHAMPVA”). CHAMPVA is a cost-sharing program in which the VA shares the cost of certain covered medical services with dependents or survivors. CHAMPVA provides medical care and is usually subject to the same limitations as found in the military’s TRICARE health care plan.

In the past, survivors lost eligibility for CHAMPVA when they turned age 65 and became eligible for Medicare Part A. Currently, those age 65 and older who are enrolled in Medicare Parts A and B may be eligible for  CHAMPVA as a secondary payer to Medicare.

Now, surviving spouses who remarry on or after turning age 57 and apply for benefits on or after December 16, 2003 are eligible for serviceconnected death benefits (DIC), VA home loan benefits, and other VA benefits, such as medical care (CHAMPVA). The remarriage need not end in order for these spouses to be eligible. They may remain remarried and still be entitled to benefits based on their earlier marriage to the veteran. This means that a spouse who remarried in 2002 (but after he or she turned 57) would be eligible for DIC if the application was filed after December 16, 2003. Still, the surviving spouse is not eligible for non-service-connected death pension.

Women eligible for survivor benefits (payments to dependents who have lost family members due to injuries or illnesses incurred during military service) and CHAMPVA (a health insurance program for dependents) can also be assisted by women benefits coordinators.

If your claim is denied, you can appeal it. Again obtaining your benefits can require a lot of persistence.


TRICARE and CHAMPVA (Civilian Health and Medical Program of Veterans Administration)

TRICARE and CHAMPVA are similar programs administered by the Department of Defense, except that the Veterans Administration determines the eligibility of persons seeking to establish entitlement to CHAMPVA coverage. TRICARE provides benefits for health care services furnished by civilian providers, physicians, and suppliers to retired members of the Uniformed Services and to spouses and children of active duty, retired, and deceased members. The term “Uniformed Services” includes the Army, Navy, Air Force, Marine Corps, Coast Guard, and the Commissioned Corps of the U.S. Public Health Service and of the National Oceanic and Atmospheric Administration. CHAMPVA provides similar benefits for spouses and children of veterans who are entitled to VA permanent and total disability benefits and to widows and children of bveterans who died of service-connected disabilities.

The governmental entity exclusion does not preclude Medicare payment for items or services furnished to a beneficiary who is also eligible for TRICARE/CHAMPVA benefit payments for the same services. Medicare is the primary payer for such items and services, and TRICARE/CHAMPVA is a supplementary payer.

Effect of Medicare Eligibility on TRICARE/CHAMPVA Entitlement

TRICARE/CHAMPVA beneficiaries, other than dependents of active duty members, lose their entitlement to TRICARE/CHAMPVA if they qualify for Medicare Part A on any basis and do not enroll in Medicare Part B

Individuals who are eligible for Medicare Part B benefits only, do not lose their entitlement to TRICARE/CHAMPVA benefits. If a Medicare beneficiary, who has lost entitlement to CHAMPVA upon becoming entitled to Part A of Medicare, thereafter exhausts any Part A benefits, the individual can again be entitled to CHAMPVA. Once the individual re-attains CHAMPVA benefits, the individual will not lose them by virtue of later again becoming eligible for Medicare Part A benefits. There is no similar provision for TRICARE which enables an individual to re-attain TRICARE eligibility after exhausting Medicare Part A benefits. A/B MACs (A) and (B) will direct questions concerning this provision to the CHAMPVA Center.

Medicare-TRICARE/CHAMPVA Relationship

If a TRICARE/CHAMPVA beneficiary also has Medicare coverage, TRICARE/ CHAMPVA reduces its liability in all cases by the amount payable by Medicare, i.e., Medicare is the primary payer and TRICARE/CHAMPVA supplements Medicare by paying the Medicare deductible and coinsurance amounts and portions of the bill not covered by Medicare. Thus, dually entitled individuals may be reimbursed up to 100 percent of expenses for items and services covered by both programs.

TRICARE/CHAMPVA has established policies and procedures which provide for (a) the identification of claimants who have coverage under both TRICARE/CHAMPVA and Medicare and (b) the detection of duplicate payments under both programs. If TRICARE/CHAMPVA inadvertently pays amounts which duplicate Medicare payments for the same items or services, TRICARE/CHAMPVA will take steps to recover the incorrect TRICARE/CHAMPVA payments.

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