CHAMPVA Claim Checklist: What Billing Staff Should Verify

What should billing staff check before sending a CHAMPVA claim?

Five things: the patient, the provider, each service line, other insurance, and attachments. VA's CHAMPVA provider page names the most common problems: incomplete tax IDs, missing service addresses, mismatched patient details, incomplete other insurance EOBs, combined professional and facility fees, and services lumped onto one line. The checklist below works for electronic and paper claims. A clean claim still does not guarantee coverage or payment.

1. Patient information

• Legal name as recorded with CHAMPVA, not a nickname.
• Member number. VA uses the beneficiary's Social Security number as the CHAMPVA member number. Send it only through secure billing systems.
• Date of birth and address match CHAMPVA and your records.
• Attachments show the same patient details as the claim.
• Eligibility verified for the date of service, using a 270 to payer ID VAHAC or the phone line at 888-820-1756.

2. Provider information

• Provider name and degree where it applies.
• Full 9-digit EIN/TIN, no extra characters, belonging to the billing entity.
• Two addresses: the billing address and the physical place of service. VA says not to use a PO Box as the service address.
• Phone number and other contact fields your claim format requires.
• NPIs and taxonomy where your claim format and clearinghouse require them. VA's checklist calls out the TIN and addresses specifically. It does not set a universal NPI-role or taxonomy rule, so follow your claim format and clearinghouse edits. An NPI or taxonomy code does not replace the TIN.

3. Service lines

Check each line against the clinical record, not just the total.

• Date of service on every line.
• Diagnosis codes supported by the clinician's documentation.
• Procedure codes and modifiers where the service calls for them.
• Units that match the work or supply.
• Itemized charges for each procedure.
• One line per service and per date. VA recommends this, including for evaluation and management codes, to avoid errors and underpayment.
• Separate claims for professional and facility fees.
• Anesthesia billed with the anesthesia code, not the surgery code. Ambulatory surgery with every procedure code and its charge.
• Place of service that matches where care actually happened, on formats that use it.

Each line should answer: who got which service, on what date, from whom, how many units, and at what charge?

A note on coding

Only use codes and modifiers the documentation supports. Do not change a diagnosis or add a modifier just to get past an edit. Place of service codes describe the location; they do not make a service covered. Correct coding also does not set the payment amount, which comes from the CHAMPVA allowable amount rules in 38 CFR 17.275. See CHAMPVA Allowable Amount.

4. Other health insurance

CHAMPVA usually pays after other insurance. VA's provider page lists exceptions: Medicaid, Indian Health Service, state victims of crime compensation, and CHAMPVA supplemental policies. Confirm the patient's actual coverage.

• Payer order identified for every plan.
• Other plans processed the claim first. A pending claim is not an EOB.
• EOBs from every plan that paid before CHAMPVA.
• Every billed service appears on the EOBs, even services the other plan denied.
• Names, dates, codes, and amounts on the EOBs match the CHAMPVA claim.

See CHAMPVA and Other Health Insurance.

5. Attachments

• All processed other insurance EOBs, not only the ones that paid.
• Any records VA asked for on this claim. Not every claim needs a records packet.
• Matching identifiers on every attachment.
• For resubmissions, the CHAMPVA EOB. VA warns against resubmitting with only a claim number. See Correcting or Resubmitting a CHAMPVA Claim.
• An office copy of the claim, attachments, and transmission record.

How do we route it?

Electronic: Send a HIPAA 837 to medical payer ID 84146 through the VA clearinghouse. Dental claims use 84147. VAHAC is for eligibility only. Fix any clearinghouse rejection before assuming VA has the claim.

Paper: Use an itemized CMS-1500 or UB-04 and mail it to the provider claims address in Tampa. No highlighters, staples, clips, or tape. See CHAMPVA Paper Claims for Providers.

What can't the claim check cover?

• Coverage and preauthorization. Check these before care. See Which CHAMPVA Services Need Preauthorization?
• Filing deadline. Generally 1 year from the date of service, or from discharge for inpatient care, under 38 CFR 17.276. Delays in your own billing do not qualify for an exception. See CHAMPVA Claim Filing Deadlines.
• EFT. You must be enrolled to be paid. See CHAMPVA EFT Enrollment.
• Follow-up. Check status before resubmitting. See How to Check CHAMPVA Claim Status.

Which denials does this checklist prevent?

VA's family member denial code guidance lists the common ones:

Code	What to check
391, invalid or missing diagnosis	Compare the diagnosis to the clinician's documentation and fix real errors.
27, service not covered for diagnosis	Check coverage rules and the record. Do not swap in an unsupported diagnosis.
78, other insurance EOB needed	Get the processed EOB from every plan that pays first.
218 / 220, other insurance info missing	Have the patient update their other insurance record.
224, medical records needed	Send the records with the CHAMPVA EOB.
124, filed late	Check service dates and proof of submission against the deadline.
65 / 159 / 177, duplicate	Check status. Do not resubmit unless VA tells you to.
CARC 299 / RARC N24, EFT needed	Enroll in EFT. Do not resubmit.

Five-minute quality check

1. Identity: name, member number, date of birth, address, and attachments match.
2. Provider: 9-digit TIN, billing address, service address, and any required NPIs.
3. Lines: dates, codes, modifiers, units, charges, and separate professional and facility claims.
4. Payers and documents: payer order, EOBs for every plan and service, and any records VA asked for.
5. Submission: right payer ID or paper address, within the deadline, with proof kept.