Printable checklist: filing a CHAMPVA claim (VA Form 10-7959a)

Educational information only, not medical, legal, or insurance advice. Confirm with CHAMPVA and your provider. Last verified against VA.gov: October 9, 2026 (VA page updated Jul 15, 2026). Changelog

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• Date of care: ____________ · File by (1 year later): ____________
• Direct deposit set up (VA Financial Services Center Customer Engagement Portal)
• VA Form 10-7959a completed (or file online)
• Proof of payment: receipt or bill marked “paid”
• Itemized bill with: patient name and date of birth · provider name, title, tax ID · service address · dates, charges, quantities · ICD-10 diagnosis codes · CPT or HCPCS codes
• Other insurance? Its EOB with date of service, provider name, NPI, services paid, amount paid
• Kaiser? Copy of the card showing copays
• Prescription? Pharmacy printout with NDC, drug, strength, quantity, cost and copay, fill date, prescriber
• Copies of the backs of any two-sided pages
• Mailed to: VHA Office of Integrated Veteran Care, CHAMPVA Claims, PO Box 500, Spring City, PA 19475 · Date: ____________
• Expect an EOB in about 90 days