How to file a CHAMPVA claim

What to know before you file a CHAMPVA claim

In most cases, your provider should file your CHAMPVA claim for you. We’ll then pay the provider directly for the part of your care that we cover.

If you get care from a provider who doesn’t accept CHAMPVA or you go to an out-of-network pharmacy, you’ll need to pay out of pocket and then file a claim for reimbursement.

Time limits for filing a claim

You must file your claim within 1 year of when you received the care.

If you stayed in a hospital for care, you must file your claim within 1 year of when you left the hospital.

How to file your claim if your provider doesn’t file for you

You can file your claim by mail.

You’ll need to include a completed CHAMPVA Claim Form (VA Form 10-7959A) and your supporting documents. Keep reading to find the supporting documents you need based on the type of claim.

Get VA Form 10-7959A to download

Mail your completed form and supporting documents to this address:

VHA Office of Integrated Veteran Care
CHAMPVA Claims
PO Box 500
Spring City, PA 19475

Note: We can only scan one side of each document. If any of your documents are double-sided, you’ll need to include photocopies of the backs of those documents with your claim.

Supporting documents to send with your claim

You’ll need to send these documents with your claim:

• An itemized billing statement from your provider. Keep reading to learn what information must be on the statement.
• Proof that you paid the provider. You can send a receipt or a billing statement that’s marked as “paid.”

Make sure the itemized billing statement includes this information:

• Your full name, date of birth, and Social Security number
• Your provider’s full name, medical title, office address, billing address, and tax identification number
• A list of charges for your care, the diagnosis and procedure codes for that care, and the dates you received the care 

Note: Regular bills from providers usually don't include all the information we need. Ask your provider for an itemized billing statement instead.

If you have other health insurance

You’ll also need to submit a document called an explanation of benefits. This document lists what your other health insurance already paid for your care. Make sure it includes this information:

• Date of service that matches the date on your itemized billing statement
• Your provider’s full name and National Provider Identifier (NPI) code (usually a 10-digit number)
• Diagnosis and procedure codes for your care
• Total charges for your care and the amount your other insurance already paid

If your other health insurance is Kaiser Permanente

You’ll also need to submit a copy of your Kaiser Permanente insurance card that shows the amount of your copayments. This is because itemized billing statements from Kaiser Permanente providers don’t include all the information we need to process your claim.

If you’re filing a claim for prescription medications

Instead of an itemized billing statement from your provider, you'll need to submit a document from your pharmacy that includes this information:

• Name, address, and phone number of the pharmacy
• Name, dosage, strength, quantity, and cost of the medication—including the amount of your copay
• National drug code for each medication (an 11-digit number that’s different from the Rx number)
• Date the pharmacy filled the prescription
• Name of the provider who wrote the prescription

Note: The documents your pharmacy attaches to your prescription usually include the information we need. You can also ask your pharmacy for a document with this information.

What to expect after you file your claim

We’ll review your documents. If we need more information, we’ll contact you.

If we decide we can cover your claim under CHAMPVA

We’ll send you an explanation of benefits. This document explains the amount we’ll cover and the amount you’ll need to pay.

In most cases, we’ll pay the provider directly for the part of your care that we cover. If you already paid your provider out of pocket, we’ll pay you back for the part of your care that we cover. 

If we decide we can’t cover your claim under CHAMPVA

If you disagree with our decision, you can request a decision review.

Learn about your decision review options

If you choose to mail us your decision review request, include a copy of our decision or explanation of benefits. Mail the letter and any supporting documents to this address: 

VHA Office of Integrated Veteran Care
Appeals
PO Box 600
Spring City, PA 19475

How to contact us about CHAMPVA claims

Call us at 800-733-8387 (TTY: 711). We’re here Monday through Friday, 8:00 a.m. to 7:30 p.m. ET.

Or you can send a letter with questions about claims to this address:

VHA Office of Integrated Veteran Care
CHAMPVA Claims
PO Box 500
Spring City, PA 19475

You can also contact us online through Ask VA.

Contact us online through Ask VA