The short answer
Usually your provider files the CHAMPVA claim, and VA pays them directly. You file it yourself when the provider won't bill CHAMPVA, or you paid out of pocket, like at an out-of-network pharmacy. Then you'll need an itemized bill and proof of payment, plus direct deposit. Either way, the 1-year deadline applies, and a slow provider doesn't extend it.
Who usually files?
VA's CHAMPVA claim page says that in most cases the provider should file.
| Situation | Who files |
|---|---|
| Provider bills CHAMPVA directly | Provider |
| Provider won't file | You |
| Out-of-network pharmacy, you paid | You |
| You have other insurance | Usually the provider, after the other plan; if not, you |
| VA asks for more information | Whoever has the document |
When the provider files
You still have a part:
- Confirm they'll actually bill CHAMPVA. Willing to see you isn't the same as filing for you.
- Give them all your insurance cards.
- Ask if they accept assignment. That's a separate question. More here: CHAMPVA assignment and balance billing.
- Keep your bills and EOBs.
- Follow up if nothing seems to happen.
For billing offices, VA's provider page lists what claims need: complete tax ID, billing and service addresses, the patient's legal name, address, Social Security number, and birth date, EOBs from other insurance, accurate codes, and separate facility and professional claims. More here: CHAMPVA provider quick start.
When you file
File online or by mail with VA Form 10-7959a.
For medical care:
- proof you paid, and
- an itemized bill with the provider's tax ID, service address, dates, charges, diagnosis codes, and procedure codes.
If you know you'll file yourself, ask for an itemized bill or superbill before you leave.
With other insurance: include that plan's EOB.
For prescriptions: pharmacy records with the drug details and NDC number.
Set up direct deposit. VA pays you only that way. More here: CHAMPVA direct deposit.
More here: How to file a CHAMPVA claim online and by mail.
Don't miss the deadline
38 CFR 17.276 generally requires claims within 1 year of the care, or 1 year from hospital discharge. It also says delays caused by a provider's billing process don't, by themselves, justify an exception.
If a provider said they'd file and months pass with no EOB, call the office, keep notes, and file yourself if needed. More here: CHAMPVA claim filing deadlines.
Two questions before planned care
- "Do you accept CHAMPVA assignment?"
- "Will you file the CHAMPVA claim for me?"