Get Claim Filing Instructions For New Champva Beneficiaries Claim Filing Instructions For New Champva

This guide provides detailed instructions for new CHAMPVA beneficiaries on how to effectively fill out and submit the Claim Filing Instructions Form. Following these steps will help ensure that your claims for reimbursement are processed smoothly and efficiently.

Follow the steps to complete your claim filing instructions

1. Click ‘Get Form’ button to obtain the form and open it for completion.
2. Fill out the CHAMPVA Claim Form, VA Form 10-7959a*. Ensure that your name is exactly as it appears on your CHAMPVA Identification Card. Each patient or beneficiary must have a separate signed and dated claim form, even if they belong to the same family.
3. Attach an itemized bill from your healthcare provider(s). It is recommended that your provider submits claims directly to CHAMPVA, as they are likely to include all necessary information.
4. Include your Social Security number (SSN) on the claim, ensuring that you do not use the qualifying Veteran’s SSN.
5. Provide the full name, address, and Tax Identification Number (TIN) of your healthcare provider. Also, indicate the address where payment should be sent, the address where services were provided, and the provider’s professional status.
6. List the specific date of each service, along with itemized charges, appropriate diagnosis and procedure codes (DX, CPT, HCPCS) for each service.
7. If you have other health insurance, include a copy of their Explanation of Benefits (EOB) detailing payments made. Be aware that CHAMPVA's mailroom equipment scans only one side of a page, so photocopy any important details on the back.
8. For pharmacy claims, complete a separate CHAMPVA Claim Form, VA Form 10-7959a*, and attach an invoice or bill from the pharmacy. This should include the pharmacy’s contact information, prescribing physician's name, drug details, National Drug Code (NDC), and charges.
9. Once all fields are completed, review your entries for accuracy, and then save any changes. You can download, print, or share the form as needed.

Start filing your claims online today to ensure you receive the reimbursements you deserve.