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Tip: Check VA financial enrollment, then evaluate billing.

If you are treating patients under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) and not receiving reimbursement, ensure electronic funds transfer (EFT) is properly set up with the Department of Veterans Affairs (VA), then take a closer look at your claims.

Keep reading to find out more about CHAMPVA and how to get your claims paid.

Understand the Background

CHAMPVA is a healthcare program for qualified spouses, widow[er]s, and children of eligible veterans. Once a veteran or veteran鈥檚 family member鈥檚 medical or dental claim is filed, the VA adjudicates the claim and will pay electronically.

Warning: Per the VA, providers accepting CHAMPVA who are not enrolled in EFT will see a pause in payments until EFT enrollment is complete. Once EFT is properly set up, payments will be deposited directly in the bank.

In 1998 the U.S. Treasury published 31 C.F.R. 208 鈥� Electronic Funds Transfer final rule requiring all federal payments be made electronically.

In February 2024, was amended to mandate EFT unless there was an appropriate waiver. At the same time, the rule tightened existing waivers by either narrowing their scope or requiring the entity seeking the waiver to file a written waiver request.

Beware: Waivers are available for agencies and individual recipients, but not vendors. Regardless of available waivers, the VA indicates they are moving toward 100 percent use of EFT for paying CHAMPVA claims.

It鈥檚 easy to enroll in EFT. Visit the VA Financial Services Center >Customer Engagement Portal. Then, complete the following steps:

• Complete the Payment Account Setup web form. 
• If you need help, review the for step-by-step instructions.
• For additional assistance, contact the help desk at 877-353-9791.
• Contact your financial institution to arrange for delivery of the data elements necessary to successfully re-associate the EFT payment with the electronic remittance advice (ERA).

Good to know: If you are already receiving EFT payments through another federal program such as Medicare or Medicaid, simply update your EFT information on file to receive payment from the VA.

Check These Issues if You鈥檙e Having Other Payment Problems

A lot of payment problems might be related to EFT, but not all of them. There are other reasons your CHAMPVA claims may not be paid.

The current shows of about 80 percent, so there is still room for improvement.

The VA classifies all processed claims as:

• Accepted: Correctly billed, pre-authorized claims for care
• Denied: Care was not preauthorized, or the veteran does not meet eligibility requirements
• Rejected: Claims that cannot be paid or denied due to billing errors or the need for additional information.

Important: For claims submitted to one of the VA third -party administrators (TPAs), such as TriWest Healthcare Alliance, payment is made directly from that TPA. Payment comes directly from the VA for claims submitted to the VA.

Know this: If you filed a claim with the VA directly, check the status of the claim through the . The ePP is an essential tool that allows registered users on-demand access to claim status and line level adjudication information.

The ePP also provides access to remittance advices, check/EFT information, and explanation of payment documents. The VA encourages providers using the for claim info to migrate to ePP for the enhanced functionality/detail. In addition to web-based access, customer service staff are available to assist with claim questions. It is important to contact the service center where claims were submitted.

If you filed a claim with Optum United HealthCare, refer to . For claims with TriWest Healthcare Alliance, refer to .

Know the Current Common Denial Reasons

The VA identifies the following as the :

Implement pre-billing claim checks for the above issues as well as the following pitfalls. Apply the edits before claim submission to preemptively address problems and improve your bottom line.

Address Additional Claim Pitfalls

Here are some tips from the VA to help speed accurate and timely payments:

• Ensure all patient information is correct鈥攍egal name (no nicknames), correct address, Social Security number (SSN) and date of birth (DOB).
• Verify that any attachments clearly show patient information that matches the info on the claim.
• Confirm claim forms are properly aligned in the printer. If the type is offset and items are not in the correct fields, it can cause payment delays, erroneous payment, or even denials.
• Bill each service rendered, for each date of service (DOS), as a separate line item. This will help avoid underpayments and ensure correct reimbursement.
• Print claims using a legible font and make sure the print is not too light to ensure proper reading by optical scanners.
• Do not mark text with highlighters; it can obscure, distort, or completely black out text.
• Check that claims/attachments are not torn, taped, or bent.
• Do not staple or place paper clips on the pages.
• When submitting a handwritten bill, ensure the writing is legible.
• Ensure the complete 9-digit employer identification number/taxpayer identification number (EIN/TIN) is on the claim. CHAMPVA identifies each provider by this number. Any additional digits or alphas can slow the processing of claims and even cause payment to be submitted to an incorrect provider.
• Ensure both the billing address and physical address where services were actually provided appears properly. Do not use P.O. boxes; they are not considered true addresses.

• When a patient has other primary insurance, provide a copy of the other policies鈥� explanations of benefits (EOBs) along with an explanation of the VA remarks codes for each.
• Ensure all items and services are included on the other EOBs, even if noncovered by the other insurer(s).
• Confirm the patient name and SSN or patient control number (PCN) are included. The VA cannot process claims with EOBs that do not.
• Ensure the EOB submitted is adjudicated, meaning it shows payment/denial details.
• For professional and facility services: Submit on separate forms to ensure correct processing. If submitted on the same form, it increases the chance payment will be incorrectly processed.
• For professional anesthesia fees: Use the precise anesthesia code for correct reimbursement, not the surgical equivalent.
• For ambulatory surgery services: Ensure the surgery code(s) as well as the corresponding charge(s) are listed. Missing surgical code(s) will cause a delay.
• Resubmitting a claim? Include the CHAMPVA EOB. A CHAMPVA claim number on the resubmission without the EOB can cause a delay in reimbursement or duplicate processing of your claim.

For additional billing guidance, check out the >VA Billing Guidebook.

Patricia Zubritzky, BS, CRCE-I, Contributing Writer, Pittsburgh