Denied claim? Common reasons and fixes
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
Start with your Explanation of Benefits (EOB) or VA’s letter. It says why the claim was denied or what’s missing. Then match it below.
| What the EOB or letter says | Likely cause | How to fix it |
|---|---|---|
| Other health insurance (OHI) information needed | VA thinks you have other insurance it doesn’t have on file, or your coverage changed | Send VA Form 10-7959c with copies of the front and back of every insurance card. See Other insurance |
| Need other insurance’s EOB | You have other insurance but didn’t include its EOB | Send the other plan’s EOB showing the date of service, provider name, services paid, and amount paid |
| Missing or incomplete itemized bill | A receipt or balance statement was sent instead | Ask the provider for an itemized bill (CMS-1500, UB-04, or superbill) with diagnosis and procedure codes, the provider’s tax ID, and the service address |
| Provider NPI missing | The provider’s 10-digit NPI wasn’t on the bill or EOB | Ask the office for its NPI and include it |
| Filed too late | The claim arrived more than 1 year after care (or after hospital discharge) | Late claims are generally not paid. If you think VA’s date is wrong, call CHAMPVA |
| Not a covered service | The service is excluded, such as routine eye exams, glasses, or routine dental | Check Vision & dental or the CHAMPVA Guidebook. If you think it should be covered, request a review |
| Prior approval required | Care like inpatient mental health, substance use treatment, transplants, or dental needed approval first | Ask the provider to contact CHAMPVA about approval, then call CHAMPVA about the claim |
| Prescription details missing | The pharmacy receipt lacks the 11-digit NDC, quantity, or prescriber | Ask the pharmacy for a printout with all the details |
How to send the fix
- Online: file the claim again and choose “A resubmission for an existing claim,” then upload what’s missing.
- By mail: send a copy of the EOB or letter with the documents to VHA Office of Integrated Veteran Care, CHAMPVA Claims, PO Box 500, Spring City, PA 19475.
- Or ask VA to get records from your provider. It may take longer.
- You have 1 year from VA’s request letter to respond.
If you still disagree
You generally have 1 year from the decision to request a review: a Supplemental Claim (new evidence), a Higher-Level Review, or a Board Appeal. See the step-by-step process and forms. Free accredited VSOs can help. Nobody should charge you to fix a claim.