CHAMPVA | Provider Resources

Provider Toolkit

The CHAMPVA Provider Toolkit is a complete resource of information regarding, how to connect with CHAMPVA, How to Become a Provider, Submitting Claims and Claims Status, Locate Forms, Publications and Fact Sheets.

Provider Contact Information

CHAMPVA Provider contact information contains the addresses and phone numbers for the various VHA Office of Community Care health care benefit programs. For PC3/Choice providers with concerns, please first contact Health Net and TriWest directly.

Providers may send questions and feedback to HACProviderFeedback@va.gov

CHAMPVA Handbook

The contact information contains important benefit information that is of interest to you. You are highly encouraged to carefully read the handbook prior to using CHAMPVA benefits.

You can view the online version here

Locate CHAMPVA Provider

We do not maintain a provider listing. Most Medicare and TRICARE providers will also accept CHAMPVA (but be sure you ask the provider). If you are having difficulty finding a provider, we recommend you visit the Medicare website and use the “Search Tools” at the bottom of that page to locate a Medicare provider.

If you choose to see a provider who does not accept CHAMPVA, the CHAMPVA SUPPLEMENT INSURANCE will pay or reimburse the cost share. Remember that CHAMPVA cost shares are based on the CHAMPVA allowable amount.

General Medications by Mail

The CHAMPVA program offers a robust pharmacy benefit, paying 75% of the allowable charge at any pharmacy for prescription medication. The Meds By Mail program offers prescription medication delivered to your home. The best part of Meds By Mail is that there is NO cost share or co-pay. CHAMPVA also offers a medication by mail program called MEDS BY MAIL.

 

Pharmacies That Accept CHAMPVA

Pharmacies that are a part of the SXC Health Solutions, Inc. (SXC) network, agree to collect your cost share and send a claim via SXC to CHAMPVA for the remaining amount. However, not all pharmacies are a part of the SXC pharmacy network. In those cases, you may have to pay the entire amount and submit a claim to CHAMPVA yourself. A good way to find a pharmacy that participates in the SXC network, is to visit their website at https://vahac.rxportal.sxc.com.

CHAMPVA

An eligible CHAMPVA sponsor may be entitled to receive medical care through the VA health care system based on his or her own veteran status. Additionally, as the result of a recent policy change, if the eligible CHAMPVA sponsor is the spouse of another eligible CHAMPVA sponsor, both may now be eligible for CHAMPVA benefits. In each instance where the eligible spouse requires medical attention, he or she may choose the VA health care system or coverage under CHAMPVA for his/her health care needs. If you have been previously denied CHAMPVA benefits and you believe you would now be qualified, please submit an application following the guidelines as listed on the “How to apply” section.

 

CHAMPVA eligibility can be impacted by changes such as marriage, divorce from the sponsor, or eligibility for Medicare or TRICARE. Changes in status should be reported immediately to:

 

CHAMPVA, ATTN: Eligibility Unit
PO Box 469028
Denver, CO 80246-9028

 

Phone: 1-800-733-8387

 

Email: hac.inq@med.va.gov

 

How to Apply for CHAMPVA BENEFITS

 

Once you provide all of the required and optional documents, and your application is complete, it takes CHAMPVA approximately six weeks after receiving your package until you receive your CHAMPVA identification card and related materials.

 

If you provide only the required documents, and not the optional documents, processing can take two to eight months to confirm information with other federal agencies.

 

Once CHAMPVA receives your application, they will review to be sure it is complete and all the required forms are included. If your application is not complete, CHAMPVA will return it to you with further instructions. For additional information refer to Fact Sheet 01-03 : Instructions for CHAMPVA Applicants.

 

CHAMPVA APPLICATION This application is for CHAMPVA Beneficiaries who are eligble but have not applied.

 

CHAMPVA OHI Form  Notify CHAMPVA when you are on Medicare as primary or other health insurance (OHI).

 

CHAMPVA GUIDE This guide provides important information about CHAMPVA.

APPLY NOW: Application Download

Click on the application and brochure below:

Print Enrollment Form

Brochure CHAMPVA Supplement

CHAMPVA Supplement Plan Details
CHAMPVA Handbook

The CHAMPVA Handbook contains important benefit information that is of interest to you. You are highly encouraged to carefully read the handbook prior to using CHAMPVA benefits.

CHAMPVA | MEDS BY MAIL

The CHAMPVA program offers a robust pharmacy benefit, paying 100% of the allowable charge at any pharmacy for prescription medication. The Meds By Mail program offers prescription medication delivered to your home. The best part of Meds By Mail is that there is NO cost share or co-pay. CHAMPVA also offers a medication by mail program called MEDS BY MAIL.

Pharmacies That Accept CHAMPVA

Pharmacies that are a part of the SXC Health Solutions, Inc. (SXC) network, agree to collect your cost share and send a claim via SXC to CHAMPVA for the remaining amount. However, not all pharmacies are a part of the SXC pharmacy network. In those cases, you may have to pay the entire amount and submit a claim to CHAMPVA yourself. A good way to find a pharmacy that participates in the SXC network, is to visit their website at https://vahac.rxportal.sxc.com.