CHAMPVA has no network and no provider contract. If your practice is licensed and not on the Medicare exclusion list, you can bill it today. Electronic claims go to payer ID 84146 through Optum Insight, CHAMPVA pays about what Medicare allows, and you have one year to file. The rule that catches offices out is the one on balance billing, and it is federal.
There is no contract to sign, and no network to join
This is the question that stops most offices, so it goes first. From the VA's own fact sheet for outpatient providers and office managers:
"No. CHAMPVA does not have contract providers. You must be properly licensed in your state to receive payment from CHAMPVA and cannot be on the Medicare exclusion list."
That is the whole requirement. There is no enrollment portal, no credentialing packet, no participation agreement, and no directory to get added to. If you are licensed and not excluded from Medicare, you can see a CHAMPVA patient this afternoon and bill for it.
It also means nobody at the VA will ever tell a family that your practice takes CHAMPVA, because the VA does not keep a list. That gap is worth understanding, and we come back to it at the end.
What CHAMPVA pays
The VA puts it plainly: "In most cases, CHAMPVA pays equivalent to Medicare and TRICARE allowable charges." If you already know your Medicare allowable for a code, you are within range of the CHAMPVA allowable.
The patient's share of a covered outpatient service:
| Item | Amount | Who collects it |
|---|---|---|
| Annual outpatient deductible | $50 per person, $100 per family per calendar year | You, at the visit |
| Cost share after the deductible | 25 percent of the allowable | You, at the visit |
| Cost share when the patient has other insurance | Normally none | Collect nothing |
| Catastrophic cap | $3,000 per family per calendar year | Nothing after it is met |
The VA's instruction on collection is specific: "You should collect the 25% allowable cost share from the patient except when the patient has OHI." When there is other insurance, CHAMPVA pays the lesser of 100 percent of the allowable or the remainder of the charges, and the beneficiary "will normally have no cost share." Billing a cost share anyway is the single most common complaint families bring to us.
There is no published CHAMPVA fee schedule document to download. The allowable is derived from Medicare and TRICARE rates, so the practical answer to "what is the CHAMPVA fee schedule" is your Medicare allowable for that code.
Filing electronically: payer IDs and transactions
Electronic claims are paid materially faster. The VA says paper adds about 20 days to turnaround.
| What you need | Value |
|---|---|
| Clearinghouse | Optum Insight, formerly Change Healthcare |
| Medical claims payer ID | 84146 |
| Dental claims payer ID | 84147 |
| Real-time eligibility payer ID | VAHAC |
| Accepted transactions | 837 institutional, professional and dental; 276 claim status; 270 eligibility; X12N 275 attachments |
| Optum Insight provider support | 866-678-8646, Monday to Friday, 8 a.m. to 8 p.m. Eastern |
If your clearinghouse is not connected to Optum Insight, the VA's guidance is to ask them to add the payer IDs to their system rather than to switch clearinghouses.
For electronic attachments, your vendor must support the X12 275 attachment transaction. PDF, JPEG and GIF are accepted, each attachment under 64 megabytes, no more than 10 per claim.
Medicare crossover: if your patient has Medicare Parts A and B and CHAMPVA has the Medicare number on file, claims sent to Medicare are forwarded to CHAMPVA automatically. One trap worth knowing: Medicare will only forward if the name on the CHAMPVA card matches the Medicare card letter for letter. A middle initial on one and not the other is enough to stop it.
Paper claims, and why two addresses are circulating
The VA's provider fact sheet and its current Community Care page both give this address for paper claims:
VHA Office of Integrated Veteran Care
ATTN: CHAMPVA Claims
PO Box 30750
Tampa, FL 33630-3750
The VA's claim-filing instructions written for beneficiaries give a different mailbox, PO Box 500, Spring City, PA 19475. Both appear on current VA pages, which is why your patients may hand you the other one. File electronically with payer ID 84146 and the question does not arise. If you must mail, use the Tampa address from the provider materials, or call 800-733-8387 and confirm before the envelope goes out.
The VA also asks that paper claims avoid staples, tape, paper clips and sticky notes, and that everything be on standard 8.5 by 11 paper, because the documents are scanned. Dark highlighter can black out text on the scan.
The full contact list, including the eligibility and general correspondence mailboxes, is in our CHAMPVA phone numbers and addresses guide.
You have one year to file
"Claims must be received within one year from the date of service or one year from the date of discharge from an inpatient facility. Claims sent after the filing deadline will be denied."
There is no tiered timely-filing window and no routine extension. A claim that has been bouncing between the patient's primary insurer and your office for eleven months needs attention now, not after the primary finishes.
What needs preauthorization, and what does not
Most of what a practice does needs no advance approval. The VA requires preauthorization for exactly four categories:
- Durable medical equipment with a purchase or total rental price of $2,000 or more
- Mental health and substance abuse services
- Organ and bone marrow transplants
- Dental procedures directly related to a covered medical condition
Referrals to specialists and diagnostic tests do not require approval when they are medically necessary. CHAMPVA does not require referrals at all, so a practice asking a CHAMPVA patient to obtain one is adding a step the program does not have.
Preauthorization requests go to 833-930-0816. Failure to obtain it where it is required can result in denial of the claim, and that denial is not the patient's fault or bill.
The balance billing rule, in the VA's own words
This is the rule that generates the most disputes, and it is federal regulation rather than policy preference.
"Yes, under Title 38 CFR, Section 17.272(b)(3) and (4), providers who agree to accept the beneficiary must accept the CHAMPVA allowable charges and cannot balance bill the beneficiary."
The gap between what you charged and what CHAMPVA allowed is a write-off, not a patient balance. It cannot be billed to the family, sent to collections, or applied to a future visit.
There is one exception, and it has to happen first:
"The sole exception is when the beneficiary is notified prior to any services being rendered that you do not accept CHAMPVA and the beneficiary must pay the entire billed amount up front and file the claim to CHAMPVA."
Read that timing carefully. Declining CHAMPVA is a decision made before the appointment, communicated to the patient, with payment collected up front. It is not something that can be applied afterwards to a balance CHAMPVA did not cover in full. A service CHAMPVA genuinely does not cover is a different matter, and can be billed.
When the patient has other insurance
By law CHAMPVA is always the secondary payer, with four exceptions: Medicaid, Indian Health Service, State Victims of Crime Compensation Programs, and supplemental CHAMPVA policies. Bill the other insurance first and submit its explanation of benefits with the claim.
The practical consequence for your front desk: when a patient has primary coverage, the expected collection at the visit is nothing. CHAMPVA pays the lesser of 100 percent of the allowable or the remainder, and the VA states the beneficiary will normally have no cost share. If your system is generating a patient balance in that situation, the claim was probably processed in the wrong order.
Verifying that someone is actually eligible
Every beneficiary carries a CHAMPVA Identification Card. Three ways to confirm coverage:
- Electronically: a HIPAA 270 eligibility transaction through Optum Insight, real-time payer ID VAHAC.
- By phone, 24 hours: 888-820-1756, with the patient's Social Security number and your tax ID.
- Through the main line: 800-733-8387, Monday to Friday, 8:05 a.m. to 7:30 p.m. Eastern.
One detail that causes rejected claims: for all VHA programs the beneficiary is the subscriber, and the member ID is the patient's Social Security number, never the veteran's.
What has to be on the claim
Submit on a CMS-1500 or UB-04, electronically where possible. The VA requires:
- Full name, address and Tax Identification Number of the provider
- The address where payment should be sent, and the address where services were provided
- Provider professional status, such as doctor, nurse, or physician assistant
- The specific date of each service. Date ranges only where they match the number of units
- Itemized charges for each service
- Diagnosis and procedure codes for each service
- The other insurer's explanation of benefits, including remark and reason codes, if it was billed
The patient's name must appear exactly as it reads on the CHAMPVA ID card. Mismatched names are one of the most common causes of delay.
Ambulatory surgery centers: free-standing centers must hold Medicare approval for the specific procedure being performed.
The part the VA cannot help you with
Everything above is about getting paid once a CHAMPVA patient is in your chair. Getting them there is a different problem, and it is the one the program does not solve.
Because CHAMPVA has no network and no contracts, the VA publishes no directory of providers who accept it. When a spouse or surviving family member needs a cardiologist, there is no list to consult. They call practice after practice asking the same question, and many of the offices they reach say no simply because nobody there has heard of CHAMPVA.
This site exists to answer that question. We list clinicians from the federal registry so families can search by city and specialty, and your practice is very likely already here.
If your practice bills CHAMPVA, say so on your listing. Telling us you accept it costs nothing and we add the confirmation free. If you want your website, a description in your own words, and an accepting-new-patients flag on it, that is the paid tier.
You can also check what families see when they look for you: search by state and city or by specialty.
Common questions
Do I need a contract or agreement to accept CHAMPVA?
No. The VA states that CHAMPVA does not have contract providers. You must be properly licensed in your state and not on the Medicare exclusion list. There is no enrollment step and no network to join.
What is the CHAMPVA payer ID?
84146 for medical claims and 84147 for dental claims, submitted through the Optum Insight clearinghouse. The real-time eligibility payer ID is VAHAC. Optum Insight provider support is 866-678-8646.
What is the CHAMPVA fee schedule?
There is no separate downloadable fee schedule. The VA says CHAMPVA pays equivalent to Medicare and TRICARE allowable charges in most cases, so your Medicare allowable for a code is the practical reference.
How long do I have to file a CHAMPVA claim?
One year from the date of service, or one year from the date of discharge for an inpatient stay. Claims received after that are denied.
Can I bill a CHAMPVA patient the difference between my charge and the allowable?
No. Under 38 CFR 17.272(b)(3) and (4) a provider who accepts the beneficiary must accept the CHAMPVA allowable and cannot balance bill. The only exception is telling the patient before any services are rendered that you do not accept CHAMPVA, in which case they pay in full up front and file the claim themselves.
Does CHAMPVA require a referral or preauthorization?
No referrals, ever. Preauthorization is required only for durable medical equipment of $2,000 or more, mental health and substance abuse services, organ and bone marrow transplants, and dental work tied to a covered medical condition. Specialist referrals and diagnostic tests need no approval when medically necessary.
How much do I collect from the patient at the visit?
Twenty five percent of the allowable after a $50 per person annual deductible, up to $100 per family. If the patient has other health insurance, collect nothing: CHAMPVA pays the lesser of 100 percent of the allowable or the remainder, and the VA says the beneficiary will normally have no cost share.
How do I verify CHAMPVA eligibility?
Run a HIPAA 270 transaction through Optum Insight using payer ID VAHAC, or call the 24-hour line at 888-820-1756 with the patient's Social Security number and your tax ID. The member ID is the patient's Social Security number, not the veteran's.
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Keep reading
- How to Find a CHAMPVA Provider Near You
- Can You Go to Any Doctor With CHAMPVA?
- How Much Does CHAMPVA Cost in 2026?
- The Pros and Cons of CHAMPVA, Honestly