Community Care
Spina Bifida Health Care Benefits Program–Information for Providers
The Spina Bifida Health Care Benefits Program (SBHCBP) is administered by VA for Vietnam and certain Korean Veterans’ birth children who have been diagnosed with spina bifida (except spina bifida occulta). Under the SBHCBP, comprehensive health care considered medically necessary and appropriate is covered.
To be eligible for the Spina Bifida Health Care Benefits Program, a child must first be eligible for a monetary award under the Veterans Benefits Administration (VBA). The Denver VA Regional Office makes the determination regarding that entitlement. The VBA notifies the Office of Integrated Veteran Care after they have made a monetary award, and enrollment in the Spina Bifida Health Care Program is automatic.
To participate in the SBHCBP, providers must be properly licensed in their state and must not be on the Medicare exclusion list. Additionally, providers must accept the VA-determined allowable amount for care.
IMPORTANT NOTE: Community care providers, including under SBHCBP, must enroll for Electronic Funds Transfer (EFT) and payments will be deposited directly into a bank account.
Change Healthcare (CHC) Cybersecurity Incident
For those VA community providers serving beneficiaries of CHAMPVA, Spina Bifida Healthcare Benefits Program, Camp Lejeune Family Member Program, and Children of Women Vietnam Veterans Health Care Benefits Program, please follow the guidelines at the link below.
Change Healthcare (CHC) Cybersecurity Incident–Information for Family Member Care Claims
Spina Bifida Claims
Providers should use a standard billing form (UB-04/CMS 1500) to pro vide required information. For information about filing claims for payments, including a list of required documentation, review How to File a Claim for the Spina Bifida Health Care Benefits Program.
Preauthorization is required for the following:
- Attendants
- Day health care as an outpatient service
- Dental services
- Durable medical equipment in excess of $2,000
- Homemaker services (must be health-related services)
- Outpatient mental health services in excess of 23 visits per calendar year
- Substance abuse treatment
- Training of family members, guardians and members of the child's household
- Transplantation services
- Travel (other than mileage for local travel) in private automobiles at the general services administration rate
FAX preauthorization requests to: 303-331-7807
Contacts
Customer Service Center: 833-930-0816
Paper Claims:
VHA Office of Integrated Veteran Care
ATTN: SB Claims
PO Box 30750, Tampa FL 33630-3750
