DEPARTMENT OF VETERANS AFFAIRS Insurance Center P O Box 42954: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by entering the full name of the deceased Service Member or Veteran in Item 1, followed by their Social Security Number in Item 2 and date of death in Item 3.
For Items 4, 5, and 6, provide details about the branch of service, duty status on the date of death, and discharge date if applicable.
In Items 7 through 10, fill out your full name, relationship to the deceased, your date of birth, and your Social Security Number.
If you were married to the deceased but not named as a beneficiary, complete Items 11A through 14C. If not married or not named as a beneficiary, proceed to Part II.
Complete Parts IV and V for payment method selection and certification. Ensure all information is accurate before submission.

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Is there a VA portal for providers?

Use VA Form 21p-8416 to report medical or dental expenses that you have paid for yourself or for a family member living in your household. These must be expenses you werent reimbursed for and dont expect to be reimbursed for.

Where do they process VA claims?

After it is received at your local VA Regional Office, a claim is established in the VA computer system. The paperwork you sent in (either through mail or electronically) is scanned to see which types of benefits you are seeking, and end products are established.

How do I submit medical bills to the VA?

Department of Veterans Affairs. Evidence Intake Center. PO Box 4444. Janesville, WI 53547-4444.

Where do providers send VA claims?

Transactions are accepted from providers for medical services and supplies provided in the United States, a U.S. Commonwealth or the territories. You must submit electronic claims through the VA clearinghouse. Our Payer ID number is 84146 for medical claims and 84147 for dental claims.