CHAMPVA | Provider Resources

Provider Toolkit

The 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

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. We recommend you carefully read the handbook prior to using benefits.

 

You can view the online version here

Locate CHAMPVA Provider

The VA does not maintain a provider listing. Most Medicare and TRICARE providers will also see beneficaries (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 SUPPLEMENT INSURANCE will pay or reimburse the cost share. Remember that cost shares are based on the allowable amount.

General Medications by Mail

The 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

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  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 sponsor may be entitled to receive medical care through the VA health care system based on his or her own veteran status. If the eligible sponsor is the spouse of another eligible sponsor, both may now be eligible for CHAMPVA benefits. In each case 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 benefits and you believe you would now be qualified, please submit an application following the guidelines as listed on the “How to apply” section.

 

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 approximately six weeks after receiving your package until you receive your 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.

 

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

 

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

 

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
Medicare and Veteran’s Affair (VA) Benefits

Although the VA Veteran’s Affair (VA) and Medicare are both Government Health Programs and if you are eligible for both, it is important to know your options.

  • Medicare Supplement Plan, 
  • Medicare Advantage Plan
  • Medicare Part D Plan

Medicare and Veterans