The short answer
If your provider won't file, you can file a CHAMPVA claim online on VA.gov instead of mailing Form 10-7959a. You'll need an itemized bill and proof you paid, plus your other insurance's EOB if you have other coverage. Set up direct deposit, since that's the only way VA pays you. File within 1 year. Processing takes about 90 days.
Do you need to file?
Usually the provider files and CHAMPVA pays them. You file when:
- the provider won't bill CHAMPVA,
- you paid out of pocket, or
- you paid at a pharmacy outside the network.
Check whether the provider already filed. Duplicate claims cause problems. More here: Who files the CHAMPVA claim?
What do you need?
For a medical claim
- Proof of payment, like a receipt or a bill marked paid.
- An itemized bill, such as a UB-04, CMS-1500, or superbill, showing:
- your name and date of birth,
- the provider's name, title, and tax ID,
- the service address,
- dates of service, charges, and quantities,
- diagnosis (ICD-10) codes, and
- procedure (CPT or HCPCS) codes.
A regular balance-due statement usually isn't enough. Ask the office for an itemized bill or superbill.
If you have other insurance
The other plan's EOB, showing the date, provider, services, and what it paid. A plan summary isn't an EOB. More here: CHAMPVA and other health insurance.
For a prescription
Pharmacy records showing the pharmacy's name and contact information, the drug name, dosage, strength, quantity, cost, 11-digit NDC number, fill date, and prescriber. More here: CHAMPVA prescription reimbursement.
How do you file?
- Go to VA's CHAMPVA claim page and choose the online option. VA's Form 10-7959a page says this replaces the paper form.
- Pick new claim or resubmission. If VA asked for missing documents, choose "A resubmission for an existing claim" so they're linked.
- Answer the questions. Make names, dates, and amounts match your documents.
- Upload your documents. Make sure they're readable and complete.
- Review and submit. Save any confirmation and keep copies.
Set up direct deposit
VA requires it to pay you. You set it up through VA's Financial Services Center, not your VA.gov profile. More here: CHAMPVA direct deposit.
What happens next?
VA says processing takes about 90 days.
- Paid: you get an EOB and a direct deposit.
- VA needs more: you get an EOB or letter. You have 1 year from its date to respond. Use the resubmission option. VA can also help get records from your provider, though that takes longer.
- Not covered: read the EOB to see why before deciding what to do. More here: CHAMPVA claim denials.
How do you check status?
There's no beneficiary claim tracker. Keep your submission date and copies, watch for an EOB, and use Ask VA or call 800-733-8387 if needed.
Deadline
Within 1 year of the care, or 1 year from discharge for a hospital stay. Special rules apply after retroactive eligibility. More here: CHAMPVA claim filing deadlines.
Common mistakes
- Filing when the provider already did
- Uploading a regular bill instead of an itemized one
- Forgetting proof of payment
- Skipping the other insurance's EOB
- Not setting up direct deposit
- Filing missing documents as a new claim