CHAMPVA payment

What does CHAMPVA pay?

In most cases, CHAMPVA pays equivalent to Medicare/TRlCARE rates. CHAMPVAhas an outpatient deductible ($50 per person up to $100 per family per calendar year)and a cost share of 25%. You should collect the 25% allowable cost share from thepatient except when the patient has other health insurance.If the beneficiary has other health insurance, then CHAMPVA pays the lessor ofeither 75% of the allowable amount after $50 calendar year deductible is satisfied, orthe remainder of the charges and the beneficiary will normally have no cost share.

How fast does CHAMPVA pay?

CHAMPVA normally pays 95% of claims within 30 days.
Are there special considerations for Ambulatory Surgery Centers?Yes, they must have Medicare approval to perform the specific procedure at freestandingsurgical centers.

For More information

Mail: VA Health Administration Center
Denver, CO 80206-9023Phone: 1-800-733-8387
FAX: 1-303-331 -7804

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  1. A question of clarification.

    My wife is fully covered as I am a 100% disabled vet. We have no other health care.

    She had an accident, broken back, the medical Bill ChampVa paid were near $9000 over 3 yrs.

    We filed a law suit against the company that caused the fall.
    We are anticipating a small settlemant, I understand that we are not expected or liable to pay back funds, (1) the source is not another care provider. (2) suit was brought for pain and suffering(3) as a 100% disabled Vet I am not required to provide funds from legal action brought by myself against another.

    What id the regulation number/paragraph/ that has the information I need

    And a point of contact –Person I can follow thru with..
    Thanks Bob Carlson 256 762 4737 :lol:

  2. I am a biller at the VA Medical Center, Wilkes Barre, PA and have recently inherited the ChampVa billing. I was told that when billing ChampVa for perscriptions we are to bill the cost of the RX plus $5.00 for their co-pay which they do not pay us. Is this correct?

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