CHAMPVA for provider billing offices: quick reference

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For billing and front-desk staff. A patient’s family may have handed you this. Every value below comes from VA’s own provider page, the CHAMPVA Guidebook, or federal regulations (source links at askchampva.com/for-providers/, checked October 10, 2026). AskCHAMPVA is independent and not VA.

Why accept CHAMPVA

• No network and no contract. VA says there is no specific network of CHAMPVA providers. You just bill CHAMPVA for the patient.
• Accepting assignment means you accept the CHAMPVA allowable amount as full payment; the patient owes only the deductible and cost share (38 CFR 17.270).
• Fee basis is Medicare-like (DRG inpatient, OPPS outpatient, DMEPOS and ambulance on Medicare fee schedules).
• Electronic claims and real-time eligibility through VA’s clearinghouse or the clearinghouse you already use.
• Hospitals in Medicare must already accept CHAMPVA for inpatient care (42 CFR 489.25), and VA says hospital-based providers that accept Medicare must also accept CHAMPVA.

CHAMPVA vs. Medicare billing at a glance

	CHAMPVA	Medicare (for comparison)
Payer	VHA Office of Integrated Veteran Care	Your Medicare Administrative Contractor (MAC)
Electronic payer IDs	Medical 84146 · Dental 84147 · Real-time eligibility (270/271) VAHAC	Varies by MAC (ask your MAC or clearinghouse)
Claim format / clearinghouse	HIPAA 837 via VA’s clearinghouse, Optum Insight (Change Healthcare), or your own clearinghouse; status via 276/277	837 to your MAC
Paper claims	VHA Office of Integrated Veteran Care, CHAMPVA Claims, PO Box 30750, Tampa, FL 33630-3750	Per your MAC
Fee basis	Inpatient: CHAMPVA DRG (some hospitals cost-to-charge). Outpatient hospital: CHAMPVA OPPS. Professional: lesser of CHAMPVA Maximum Allowable Charge, prevailing amount, or billed. DMEPOS and ambulance: Medicare fee schedules (38 CFR 17.275)	Medicare fee schedules
Prior authorization	Dental; organ (and bone marrow) transplants; non-emergent inpatient mental health and substance use; all partial hospitalization admissions. Not needed when the patient’s other insurance covers it (38 CFR 17.273). Rx: Wegovy and Zepbound via OptumRx	Varies by service
Patient cost share (CHAMPVA primary)	Outpatient deductible $50/person, $100/family per calendar year; 25% of allowable; $3,000 family catastrophic cap (38 CFR 17.274; Guidebook)	Part B deductible and coinsurance
Balance billing	If you accept assignment, the allowable amount is payment in full except the patient’s deductible and cost share (38 CFR 17.270)	Non-participating: limiting charge of 115% of fee schedule (42 CFR 414.48)
Other insurance / Medicare	CHAMPVA pays last: bill other health insurance first and attach its EOB. Exceptions where CHAMPVA pays before: Medicaid, Indian Health Service, state victims-of-crime compensation, supplemental CHAMPVA policies. CHAMPVA is secondary to Medicare	Medicare primary or secondary under MSP rules
Filing deadline	1 year from date of service; inpatient, 1 year from discharge; 180 days after a retroactive approval (38 CFR 17.276)	1 calendar year after date of service (42 CFR 424.44)

Provider phone lines

Line	Number	Notes
CHAMPVA customer call center	800-733-8387	Mon–Fri, 8:05 a.m.–7:30 p.m. ET
Eligibility verification	888-820-1756	24/7. Have the patient’s SSN and your tax ID
Preauthorization	800-733-8387	Per the CHAMPVA Guidebook (see note below)
EDI support (Optum Insight)	866-678-8646	Mon–Fri, 8 a.m.–8 p.m. ET
OptumRx Pharmacy Help Desk	888-546-5503	Pharmacy claims and network contracting
OptumRx prior authorization (Wegovy, Zepbound)	844-403-1029

Note: On VA's provider page (checked Oct 10, 2026), the preauthorization line shows 833-930-0816, but its link dials 888-820-1756. We list the Guidebook's number. Confirm with the call center.

Pharmacy claims: BIN 610593 · PCN VA · Group HAC · Cardholder ID = beneficiary SSN (NCPDP 302-C2).

How to verify eligibility

1. Electronic (24/7): send a 270 eligibility and benefit inquiry to payer ID VAHAC through Optum Insight or your clearinghouse.
2. Phone (24/7): call 888-820-1756 with the patient’s SSN and your tax ID number.
3. Ask the patient for their CHAMPVA ID card and any other insurance cards. Bill other insurance first.

Clean-claim tips from VA

• Full 9-digit TIN; billing address and physical service address (no PO box).
• Patient’s legal name, SSN, date of birth as on file.
• Attach adjudicated EOBs from all other payers.
• Professional and facility charges on separate claim forms; each service and date on its own line.
• When resubmitting, include the CHAMPVA EOB (not just a claim number).