I am sure we all remember the huge Veteran’s Administration scandal from earlier this year.  The public became aware of how thinly stretched this system that provides care to our valued veteran’s truly is.

Generally speaking, a person who served in the active military service and who was discharged or released under conditions other than dishonorable is a Veteran and may be eligible for VA health benefits and services.

Military retirees without a service-connected disease or injury are eligible for TRICARE.

Medically-retired Veterans typically receive care for their service-connected disability at the VA, but they may be eligible to receive all other care through TRICARE Prime, Standard or Extra plans.

For those veterans who are covered for medical services by the VA, they may not always receive their needed care solely through the VA system.  Some have services provided by regular private practice physicians as part of the “Purchased Care” program.  Non-VA provided services can include inpatient, outpatient, emergent medication prescriptions, and long-term care.  The Purchased Care must be authorized and coordinated through the VA.

 

Becoming a non-VA Community Provider:  http://www.nonvacare.va.gov/docs/provider-resources/ISMP_Becoming_a_Non-VA_Community_Provider.pdf

Operational Guide for Non-VA Community Providers: http://www.nonvacare.va.gov/docs/providers/ProvidersGuide.pdf

 

 

Medical Business System’s practice management software Iridium Suite allows you to electronically bill claims for the VA, ChampVA and Tricare plans.

 

 

For family members that qualify for health benefits, they may participate in one of these programs: the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), Spina Bifida (SB), Children of Women Vietnam Veterans (CWVV), Foreign Medical Program (FMP) and Caregiver.

CHAMPVA INFORMATION:

A family member that is not eligible for TRICARE can be eligible for CHAMPVA eligibility if:

The spouse or child of a Veteran who has been rated permanently and totally disabled for a service-connected disability by a VA regional office

The surviving spouse or child of a Veteran who died from a VA-rated service-connected disability

The surviving spouse or child of a Veteran who was at the time death rated permanently and totally disabled from a service-connected disability

The surviving spouse or child of a military member who died in the line of duty, not due to misconduct (in most of these cases, these family members are eligible for TRICARE, not CHAMPVA).

 

Benefit information:  The annual deductible in $50 per beneficiary with a maximum of $100 per family. CHAMPVA covers 75% of the allowable amount.  In most instances, no pre-authorization is required, but contact payer for full details.

 

Billing note: CHAMPVA is always the secondary payer to Medicare.

 

Claims news:  Many claims never reach CHAMPVA because they are sent to the incorrect address.

 

New Claims:  VA Health Administration Center Claim                               Appeals: VA Health Administration Center
                      CHAMPVA                                                                                      Appeals
                      PO Box 469064                                                                               PO Box 460948
                      Denver, CO 80246-9064                                                                    Denver, CO 80246-0948

 

SAMPLE BENEFICIARY CARD:

Providing the best care possible to our valued Veteran’s and their families is an important responsibility.  Being properly reimbursed for the care provided is important as well. Familiarizing office staff with the multiple of coverage options is crucial in your financial success.