The short answer
If you have other health insurance, it pays first and CHAMPVA pays last. The other plan has to process the claim and send an explanation of benefits (EOB) before CHAMPVA pays. CHAMPVA pays first only when the other coverage is Medicaid, Indian Health Service, a state crime-victim program, or a policy bought to supplement CHAMPVA.
Who pays first?
Under 38 CFR 17.270 and 38 CFR 17.276, CHAMPVA is the last payer when you have other coverage. It generally won't pay until the other plan has made a final decision or sent an EOB.
| Your coverage | Order |
|---|---|
| CHAMPVA only | CHAMPVA |
| Job-based or private plan + CHAMPVA | Other plan, then CHAMPVA |
| Marketplace plan + CHAMPVA | Marketplace plan, then CHAMPVA |
| Medicare + CHAMPVA | Medicare, then CHAMPVA |
| Medicare + Medigap + CHAMPVA | Medicare, Medigap, then CHAMPVA |
| Medicaid, Indian Health Service, or state crime-victim program + CHAMPVA | CHAMPVA first |
| CHAMPVA supplement policy + CHAMPVA | CHAMPVA first, then the supplement |
The four exceptions come from 38 CFR 17.272. A Medigap plan isn't a CHAMPVA supplement. Medigap pays before CHAMPVA.
How do you file when another plan pays first?
- Keep CHAMPVA's records current with VA Form 10-7959c. More here: How to report other insurance.
- Bill the other plan first. The provider usually does this.
- Let any second plan process next.
- Get the EOB from every plan that paid or denied.
- Send the claim to CHAMPVA with those EOBs. VA's claim page asks for the other plan's EOB and an itemized bill.
- Check whether the provider already sent it before you file. Duplicate claims get denied.
What has to be on the EOB?
VA asks that it show the date of service, the provider (and NPI if it's not on the bill), the services processed with codes or descriptions, and what the other plan paid. Denied lines should appear too. A plan's benefit summary isn't an EOB.
What if the other plan denied it?
CHAMPVA can still pay if the service is something CHAMPVA covers. The CHAMPVA Guidebook says CHAMPVA may pay up to its allowable amount after another plan denies. But a denial elsewhere doesn't automatically mean CHAMPVA pays.
Do you have to appeal the other plan first?
Not as a general rule for current claims. CHAMPVA needs the other plan's final decision or EOB. The rule requiring an appeal to the other plan first, 38 CFR 17.277, applies only to legacy claims.
If CHAMPVA only asks for the other plan's EOB, send it. VA's review page says that doesn't need a formal review.
What about the filing deadline?
CHAMPVA claims are generally due within 1 year. If the other plan's delay holds you up, VA can grant an exception for good cause, but it isn't automatic. Keep records of the other plan's dates. More here: CHAMPVA claim filing deadlines.
Will you owe less?
Often. With two plans, you may owe little or nothing. But you can still owe for services CHAMPVA doesn't cover or charges above its allowable amount.
For providers billing CHAMPVA as secondary
- Confirm the payer order, including the four exceptions.
- Bill every earlier payer and wait for adjudicated EOBs. A transmission receipt isn't an EOB.
- Match every line. Every service billed to CHAMPVA should appear on the earlier EOBs, including denied lines.
- Send one complete secondary claim with all EOBs, electronically to payer ID 84146.
- Reconcile before billing the patient. The unpaid amount on the primary EOB isn't automatically what CHAMPVA pays or what the patient owes. If you accept assignment, don't bill above CHAMPVA's allowable amount.
- Check claim status before resubmitting.
More here: CHAMPVA provider claim checklist.
Keep your insurance info current
VA's CHAMPVA care page says it may reprocess claims and recover overpayments if it learns about other insurance later. Missing information can stop payments.