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It details claim submission methods (electronic 837 with X12N 275 and paper claim turnaround), payer rules regarding other health insurance, and key claim filing and documentation instructions, including required forms and patient identifiers.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/champva-information-for-outpatient-providers-and-office-managers/283910/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/champva-information-for-outpatient-providers-and-office-managers/283910.png","ImageObject",442,249,{"name":42,"@type":43},"Levi","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-03","2026-09-17",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",14,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Is preauthorization required for CHAMPVA services?","Question",{"text":63,"@type":64},"Yes. Certain services require advance approval (preauthorization). Failure to obtain preauthorization may result in denial of the claim.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"Are dental procedures covered under CHAMPVA?",{"text":68,"@type":64},"With very few exceptions, dental care is not a covered benefit. When dental care is covered, preauthorization is still required.",{"name":70,"@type":61,"acceptedAnswer":71},"How can providers submit CHAMPVA claims and what must claims include?",{"text":72,"@type":64},"CHAMPVA accepts electronically submitted 837 claim transactions with X12N 275 attachments and also accepts paper claims (with longer turnaround). Claims must include a completed CHAMPVA Claim Form when required, patient identifiers, itemized billing statements, diagnosis/procedure codes, and supporting documentation such as EOBs when other health insurance is billed.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},283910,1790240264,{"code":4,"msg":82,"data":83},"success",[84,89,94,98,103,108,112,117,122],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":55,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},"Invoices",70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":110,"slug":111},17,40,"forms",{"id":113,"doc_module":22,"doc_module_name":25,"category_name":114,"show_sort_weight":115,"slug":116},18,"Letters",30,"letters",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},21,"Paper Templates",5,"papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":82,"data":127},{"doc_id":79,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":109,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":33,"language":135,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":12,"update_tm":139,"read_time":26},7971461740909,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Fact Sheet  \nU.S. Department of Veterans Affairs   \nVeterans Health Administration  \nOffice of Community Care  \nCHAMPVA – Information for Outpatient Providers and Office Managers  \nIs preauthorization required for services?  \nCertain types of care/services require advance approval, commonly known as preauthorization. Preauthorization is extremely important and the failure to obtain it may result in denial of the claim. Preauthorization is required for:  \n• Durable medical equipment with a purchase price or total rental price of $2,000 or more  \n• Mental health/substance abuse services  \n• Organ and bone marrow transplants  \n• Dental procedures that are directly related to covered medical conditions  \nApprovals for referrals to specialists or for diagnostic tests are not required if they are medically necessary.  \nAre dental procedures covered under CHAMPVA?  \nWith very few exceptions, dental care is not a covered benefit. There may be times when dental care is covered, but in all cases, preauthorization is required. An example of when dental care is covered would be for a dental condition resulting from the treatment of an otherwise covered medical condition (not dental), such as radiation therapy for oral or facial cancer.  \nIs there a contract or agreement that I must sign to accept/participate in CHAMPVA?  \nNo. CHAMPVA does not have contract providers. You must be properly licensed in your state to receive payment from CHAMPVA and cannot be on the Medicare exclusion list.  \nDo I have to accept the CHAMPVA allowable rate?  \nYes, under Title 38 CFR, Section 17.272(b) (3) and (4), providers who agree to accept the beneficiary must accept the CHAMPVA allowable charges and cannot  \nbalance bill the beneficiary. The sole exception is when the beneficiary is notified prior to any services being rendered that you do not accept CHAMPVA and the beneficiary must pay the entire billed amount up front and file the claim to CHAMPVA.  \nHow do I get a claim paid?  \nVeterans Health Administration (VHA) accepts electronically submitted 837 claim transactions and X12N 275 attachments. These include the  \n837 institutional, 837 professional and 837 dental transactions. Transactions are accepted from providers for medical services and supplies provided in the United States, a U.S. Commonwealth or U.S. territories. You must submit electronic claims through our clearing¬house, Change Healthcare. Our Payer ID number is 84146 for medical claims and 84147 for dental claims. You can also check medical claim status and eligibility status through Change Healthcare using the  \n276 and 270 HIPAA transactions, respectively.  \nWe also accept paper claims, but the turnaround time to payment is, on average, an additional 20 days. The only address for submission of paper claims to CHAMPVA is:  \nVHA Office of Integrated Veteran Care ATTN: CHAMPVA Claims  \nPO Box 30750  \nTampa, FL 33630-3750  \nIf the beneficiary has other health insurance (OHI), the OHI should be billed first. The explanation of benefits (EOB) from the OHI should be submitted with the claim for reimbursement to CHAMPVA. By law, CHAMPVA is always the secondary payer, except to Medicaid, Indian Health Service, State Victims of Crime Compensation Programs and supplemental CHAMPVA policies.  \nIB-10-1587—CHAMPVA Updated Date: September 20, 2023 Page 1 of 4  \nFact Sheet  \nAs of September 27, 2010, VHA can receive Medicare Cross¬over Part A and B, and DMERC claims for CHAMPVA beneficiaries. If your patient is a Medicare beneficiary and we have the Medicare Health Insurance Claim Number (HICN) on file, the claim will be forwarded electronically to CHAMPVA. Review your electronic remittance advice from Medicare to determine if the claim has been forwarded to us.  \nClaim Filing Instructions  \nWe encourage beneficiaries to have their health care providers file claims directly with CHAMPVA since providers are more likely to submit all the information necessary for CHAMPVA to process claims. CHAMPVA will pr","cbCainF5BBgWaM1Y","https://ap.wps.com/l/cbCainF5BBgWaM1Y","pdf",371399,"English","# CHAMPVA Preauthorization and Coverage\n## Preauthorization requirements\n## Dental coverage\n## Contract or agreement requirements\n## CHAMPVA allowable rate and balance billing","[{\"question\":\"Is preauthorization required for CHAMPVA services?\",\"answer\":\"Yes. Certain services require advance approval (preauthorization). Failure to obtain preauthorization may result in denial of the claim.\"},{\"question\":\"Are dental procedures covered under CHAMPVA?\",\"answer\":\"With very few exceptions, dental care is not a covered benefit. When dental care is covered, preauthorization is still required.\"},{\"question\":\"How can providers submit CHAMPVA claims and what must claims include?\",\"answer\":\"CHAMPVA accepts electronically submitted 837 claim transactions with X12N 275 attachments and also accepts paper claims (with longer turnaround). Claims must include a completed CHAMPVA Claim Form when required, patient identifiers, itemized billing statements, diagnosis/procedure codes, and supporting documentation such as EOBs when other health insurance is billed.\"}]","CHAMPVA - Information for Outpatient Providers and Office Managers | PDF",1789622363]