Get Claim Cover Sheet Foreign Medical Program Fmp Va Health

Completing the Claim Cover Sheet for the Foreign Medical Program (FMP) through VA Health is a straightforward process. This guide will help you navigate each section of the form to ensure accurate and complete submissions for reimbursement of medical services received outside the United States.

Follow the steps to successfully fill out your claim cover sheet.

1. Click ‘Get Form’ button to obtain the Claim Cover Sheet online. This action allows you to access the form in an editable format.
2. In Section I, provide your veteran information. Fill in your last name, first name, and middle initial, your VA claim number, and your Social Security number. Include your complete mailing address, date of birth in the format mm/dd/yyyy, telephone number with international prefixes, and email address.
3. In Section II, detail the diagnosis or nature of your illness or injury. Include the provider's full name, medical title, office address, office telephone number, and billing address if different from the office address.
4. List the diagnoses treated, narrative descriptions of each service received, the charges billed for each service, and the corresponding date(s) of service.
5. Indicate where you would like the payment to be sent by checking either the box for 'Veteran' or 'Provider'.
6. Prepare any itemized invoices or receipts from the medical services used and attach them to your claim. If you have other health insurance, include the Explanation of Benefits (EOB) as well.
7. Once all information is filled out correctly, review the form for accuracy, then save changes, download or print the form, or share it as necessary.

Complete and submit your Claim Cover Sheet for Foreign Medical Program online today to ensure timely reimbursement.