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FS01-16 For Outpatient Providers and Office Managers. Fact Sheet 01-16 For Outpatient Providers and Office Managers - va

FS01-16 For Outpatient Providers and Office Managers. Fact Sheet 01-16 For Outpatient Providers and Office Managers - va 2025

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CHAMPVA is a health benefits program managed by the Department of Veterans Affairs that shares healthcare costs with eligible beneficiaries. It differs from TRICARE, as those eligible for TRICARE cannot access CHAMPVA. Preauthorization is required for certain services, and dental care is generally not covered unless related to a medical condition. Claims can be submitted electronically or via paper, with CHAMPVA typically paying 95% of claims within 30 days. Providers must accept CHAMPVA's allowable rates and cannot balance bill beneficiaries.

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Click ‘Get Form’ to open it in the editor.
Begin by reviewing the introductory section that outlines what CHAMPVA is. This will provide context for the information you will be filling out.
Proceed to the eligibility criteria section. Ensure you understand who qualifies for CHAMPVA benefits, as this is crucial for accurate completion.
Fill out any required fields regarding preauthorization for services. Familiarize yourself with which services require prior approval to avoid claim denials.
Review the claims submission process outlined in the document. If applicable, enter details related to electronic claims submissions, including payer IDs.
Finally, check the contact information section for any additional queries or clarifications needed after completing your form.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I verify champva eligibility for providers?

Check the card to determine eligibility. Photocopy or scan the front and back of the card. Keep the card to return to the patient at a later date. What are the steps taken by the providers office when they receive the CHAMPVA Authorization Card from the beneficiary?

How do I know if a provider accepts Champva?

Theres no specific network of CHAMPVA providers. When you find a new provider, ask if they accept assignment from CHAMPVA. This means they agree to accept CHAMPVA insurance and to charge only the allowable amount. If you go to a provider who doesnt accept CHAMPVA, we may still cover some of the cost.

What is the phone number for Champva eligibility verification?

For questions, please contact CHAMPVA (800-733-8387) or OptumRx Pharmacy (888-546-5503). The VHA Office of Integrated Veteran Care (IVC) processes CHAMPVA applications, determines eligibility, authorizes benefits, and processes medical claims.