The short answer
Look at the code on your EOB first. Most problems are fixable: missing other insurance information, missing documents or codes, eligibility dates, duplicate claims, deadlines, preauthorization, or a service CHAMPVA doesn't cover. If VA just needs something, send it. Don't resend the same claim or appeal right away. Claims normally take about 90 days.
Start with the EOB
VA's claim page says claims take about 90 days. If something's wrong, VA sends an EOB or letter with a reason. Write down the claim number, date, provider, code, and what VA asks for. More here: How to read a CHAMPVA EOB.
| What VA says | What it means | What to do |
|---|---|---|
| Needs more information | Claim is incomplete | Resubmit to the existing claim |
| Needs other insurance info or EOB | Can't coordinate benefits yet | Update insurance info and send EOBs |
| Duplicate claim | Matched an earlier claim | Don't resend unless told to |
| Can't cover it, and you disagree | A real decision | Use a decision review |
Common reasons and fixes
Codes come from VA's denial code guide.
Other insurance (codes 78, 218, 220, 278)
CHAMPVA needs the other plan's EOB, or its insurance info is incomplete or outdated. Code 278 means more than one primary plan is on file. Fix: send EOBs from every plan, and update with Form 10-7959c if coverage changed. More here: CHAMPVA and other health insurance.
Missing documents or codes (224, 391)
VA needs medical records, or the diagnosis code is missing or invalid. Fix: send what's missing with a copy of the EOB, or have the provider correct the codes. More here: How to resubmit a claim.
Not eligible on that date (137)
VA's records show no eligibility on the date of care. Fix: check your eligibility dates. If VA's record is wrong, fix that first.
Duplicate (65, 159, 177)
Fix: don't resend. If you think VA matched the wrong claim, call 800-733-8387.
Late filing (124)
Fix: check which deadline applies. Some claims get 180 days, and VA can grant good-cause exceptions. More here: CHAMPVA claim filing deadlines.
Missed preauthorization
Fix: confirm approval was really required. If it was, CHAMPVA may review the care after the fact under 38 CFR 17.273. More here: Missed CHAMPVA preauthorization.
Not covered (27, 148)
Code 27 means not covered for the diagnosis submitted, which is often a coding issue. Code 148 means CHAMPVA doesn't cover the service under 38 CFR 17.272. Fix: for 27, ask the provider to check the diagnosis code. For 148, consider a decision review if you disagree.
Provider payment setup (CARC 299 / RARC N24)
The provider isn't enrolled in electronic funds transfer. Fix: the provider enrolls. Don't resubmit the claim. More here: CHAMPVA provider EFT enrollment.
Check four things separately
- Eligible on that date?
- Filed on time?
- Preauthorization needed?
- Covered and medically necessary?
When to request a review
VA's review page says you don't need a review to send missing documents, an other insurance EOB, or proof of payment. Use a review only when VA made a decision you disagree with. More here: CHAMPVA dispute help.
Preventing problems
Beneficiaries: use itemized bills with codes, send all other insurance EOBs, file on time, and respond to the specific letter.
Providers: include the full 9-digit tax ID, billing and service addresses, the patient's legal name, all EOBs covering every billed line, complete codes, and the CHAMPVA EOB when resubmitting. VA says a resubmission with only a claim number may be delayed. More here: CHAMPVA provider claim checklist.