The short answer
Fill out the current VA Form 10-7959a, attach an itemized bill and proof you paid, plus your other insurance's EOB if you have one, and mail it to VHA Office of Integrated Veteran Care, CHAMPVA Claims, PO Box 500, Spring City, PA 19475. Use one form per person, copy both sides of two-sided papers, and set up direct deposit.
Do you need to file?
Usually the provider files. You file when they won't and you paid. Check that they haven't already filed, to avoid a duplicate. More here: Who files the CHAMPVA claim?
Prefer online? See How to file a CHAMPVA claim online.
Step 1: Get the current form
Download VA Form 10-7959a from VA each time. Old copies can have outdated addresses.
The CHAMPVA Guidebook says to:
- use a separate form for each person,
- write the name exactly as it appears on the CHAMPVA card,
- include the CHAMPVA member number, and
- keep copies.
Fill in the patient, other insurance, sponsor, and signature sections. Sign and date it.
Step 2: Gather documents
For medical care:
- Proof of payment: a receipt or bill marked paid.
- Itemized bill: a superbill, CMS-1500, UB-04, or similar, showing:
- patient name and birth date,
- provider name, title, NPI, tax ID, address, and phone,
- dates of service,
- charges and quantities,
- diagnosis codes, and
- procedure codes.
A regular balance-due bill usually isn't enough.
If you have other insurance: its EOB, matching the bill. Under 38 CFR 17.276, CHAMPVA generally waits for it.
Special cases:
- Prescriptions: pharmacy records with the drug, strength, quantity, cost, 11-digit NDC, fill date, and prescriber. More here: CHAMPVA prescription reimbursement.
- Kaiser Permanente: VA says to include a copy of your Kaiser card showing the copay.
- Two-sided papers: VA scans one side only. Copy the back as a separate page.
More here: VA Form 10-7959a guide.
Step 3: Check the packet
- Current form, signed and dated
- Info matches your CHAMPVA card
- Proof of payment
- Itemized bill with codes
- Other insurance EOB, if any
- Back sides copied
- Direct deposit set up. More here: CHAMPVA direct deposit
- A full copy kept for you
Step 4: Mail it
VHA Office of Integrated Veteran Care
CHAMPVA Claims
PO Box 500
Spring City, PA 19475
That's the claims address. Applications (PO Box 137) and appeals go elsewhere. More here: CHAMPVA contacts and addresses.
VA doesn't require certified mail, but tracking gives you proof of delivery.
Deadlines
Within 1 year of the care, or 1 year from hospital discharge. Special 180-day rules apply after retroactive approval. More here: CHAMPVA claim filing deadlines.
What happens next?
About 90 days. If VA needs something, it sends a letter or EOB. Questions: 800-733-8387.
Common mistakes
- Old form or address
- Regular bill instead of itemized
- No proof of payment
- Missing other insurance EOB
- Unsigned form
- Back sides not copied
- Mailing your only copy