Champva fax number

For general questions, information on payment, or to reprocess a denied claim, please send your request to. VHA Office of Integrated Veteran Care. ATTN: CHAMPVA Claims. PO Box 469063. Denver CO 80246-9063. For reconsiderations and appeals. VHA Office of Integrated Veteran Care. APPEALS. PO Box 460948.

Phone Toll Free: 1-800-733-8387 Monday through Friday (excluding holidays) Hours of operation: 8:05 a.m. to 7:30 p.m. Eastern Time. We have recently implemented a Virtual Hold system to allow us to call you back when our estimated wait time exceeds three minutes. If you are an eligible CHAMPVA beneficiary with no other prescription coverage, you can use Meds by Mail. ... can find MbM in their e-prescribing software by searching “Meds by Mail CHAMPVA” or by searching for telephone number 1-888-385-0235. ... automated refill phone line at 1‑888‑370‑1699. Be sure to have your Social …Regional Office Fax Numbers. State Regional Office Fax Number; Alabama: Montgomery (334) 213-3565: Alaska: Anchorage (907) 257-6750: Arizona: Phoenix (602) 627-3039 ... Learn about the options VA offers for community providers to submit Veteran medical documentation in a timely manner. Help VA provide Veterans with seamless care by supporting these efforts. Join CCN. If you are a community provider located in Regions 1-5 and are ready to partner with VA to care for Veterans, sign up to join CCN today! Contact Optum or TriWest below: Regions 1, 2 and 3–Contact Optum: Region 1: 888-901-7407. Region 2: 844-839-6108. Region 3: 888-901-6613. Optum provider website. Regions 4 and 5–Contact TriWest: Phone Toll Free: 1-800-733-8387 Monday through Friday (excluding holidays) Hours of operation: 8:05 a.m. to 7:30 p.m. Eastern Time. We have recently implemented a Virtual Hold system to allow us to call you back when our estimated wait time exceeds three minutes. Learn about the options VA offers for community providers to submit Veteran medical documentation in a timely manner. Help VA provide Veterans with seamless care by supporting these efforts.

In the world of email, we’ve become accustomed to sending messages that include personal details automatically. When sending a paper or email fax, however, you need to be sure to i...When to use this form. Use VA Form 10-7959C or Formulario VA 10-7959c (español) when: You’re applying for CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), and have other health insurance to declare as part of your VA Form 10-10d application. Or you need to report changes in your other non-VA health ...My HealtheVet is a secure online portal that lets you access your VA health care information and services. Manage your appointments, prescriptions, records, and more.Join CCN. If you are a community provider located in Regions 1-5 and are ready to partner with VA to care for Veterans, sign up to join CCN today! Contact Optum or TriWest below: Regions 1, 2 and 3–Contact Optum: Region 1: 888-901-7407. Region 2: 844-839-6108. Region 3: 888-901-6613. Optum provider website. Regions 4 and 5–Contact TriWest:Application for CHAMPVA Benefits. VA Health CHAMPVA PO Box Denver, CO 1-800-733-8387 FAX Administration Center Eligibility 469028 80246-9028 303-331-7809. Attention:After reviewing the reverse side, complete form in its entirety (print or typewritten only) and return with a copy of the veteran's DD214 (Report of separation from Active Duty ...In this section, give us the veteran's identification information to include name, social security number, VA file number, date of birth and the veteran's ...It’s the same system as Tricare. If the private dr takes Tricare (which 90% do) they also take ChampVA. You meet the family deductible of 100$ then you don’t have copays or depending if a specialist 15$ for major work you pay 25% of the total cost. If you’re a vet married to a vet you can both get ChampVA fantastic alternative to VA.Business Details. Location of This Business. PO Box 30750, Tampa, FL 33630. BBB File Opened: 2/18/2016. Contact Information. Customer Contact. Owner Manager, Owner/Manager. Read More Business ...

Who uses fax machines anymore? Faxing is still relevant in today’s business environment, believe it or not. You may have a dusty fax machine in the basement with outdated technolog...VHA Office of Community Care. CHAMPVA. PO Box 469063 Denver, CO 80246-9063. 800-733-8387 Monday–Friday 8:05 a.m. to 7:30 p.m. Eastern Time. Create a profile and message us securly using Ask VA (AVA). VHA OCC at the following link.... FAX (303-331-7807). E. The following information ... Name, address, and telephone number of the provider who will actually furnish the requested services.Mar 29, 2024 · You can check on the eligibility status of a CHAMPVA beneficiary or the status of a claim 24/7 through our Interactive Voice Recognition (IVR) system. Please have the beneficiary's Social Security Number and your tax ID number available when calling. Interactive Voice Recognition System: 800-733-8387. CHAMPVA Preauthorization Phone directory and mailing address. Find phone numbers for many of the administrative and program offices at VA Dublin health care. Mailing address. Carl Vinson VA Medical Center 1826 Veterans Boulevard Dublin, GA 31021. Main phone numbers. Local: 478-272-1210 Toll-free: 888-651-2684. To use TeleType for the Deaf (TTY) …BONUS: Helpful CHAMPVA Resources. CHAMPVA Phone Number: 1-800-733-8387. CHAMPVA Deductibles and Copay FACT SHEET Filing CHAMPVA claims HELPFUL HINTS. Filing a CHAMPVA claim Information for Beneficiaries. CHAMPVA Provider Portal. CHAMPVA Information for Providers

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E-fax: Documentation sent via email to Veterans Affairs Medical Center (VAMC) fax machine. Please contact the referring VAMC for e-fax number. Request and ...The telehone hours for CHAMPVA -- “Civilian Health and Medical Program of the Department of Veterans Affairs” -- have changed.Updates can be sent by FAX or call by phone. PLEASE READ INSTRUCTIONS AND INFORMATION ON THE REVERSE SIDE BEFORE COMPLETING THIS FORM SECTION II: MEDICARE BENEFICIARIES: ATTACH A COPY OF YOUR MEDICARE CARD. CHAMPVA Other Health Insurance (OHI) Certification. OMB Number 2900-0219 Estimated burden: 10 minutes. 10-7959c. Page 1File a claim for general health care travel reimbursement online. General health care travel reimbursement covers these expenses for eligible Veterans and caregivers: Regular transportation, such as by car, plane, train, bus, taxi, or light rail. Approved meals and lodging expenses. You can file a claim online through the …BONUS: Helpful CHAMPVA Resources. CHAMPVA Phone Number: 1-800-733-8387. CHAMPVA Deductibles and Copay FACT SHEET Filing CHAMPVA claims HELPFUL HINTS. Filing a CHAMPVA claim Information for Beneficiaries. CHAMPVA Provider Portal. CHAMPVA Information for Providersmay contact CHAMPVA. • Mail: CHAMPVA PO Box 469063 Denver, CO 80246-9063 • Phone: For general questions about mental health benefits call 1-800-733-8387 For pre …

Mar 31, 2022 · Applying for CHAMPVA. In order to apply for CHAMPVA, eligible participants must fill out a form, attach the required documentation (such as Medicare cards or school enrollment letters, if necessary) and mail or fax the completed package to the Veterans Health Administration Office of Community Care in Denver, Colorado, which administers the CHAMPVA program. Updates can be sent by FAX or call by phone. PLEASE READ INSTRUCTIONS AND INFORMATION ON THE REVERSE SIDE BEFORE COMPLETING THIS FORM SECTION II: MEDICARE BENEFICIARIES: ATTACH A COPY OF YOUR MEDICARE CARD. CHAMPVA Other Health Insurance (OHI) Certification. OMB Number 2900-0219 …To apply for benefits, send the following to the VHA Ofice of Community Care (VHA CC): • Application for CHAMPVA Benefits (VA Form 10-10d) • CHAMPVA Other Health Insurance Certification (VA Form 10-7959c) • A copy of your Medicare card, if you are also eligible for Medicare. Contact information for the organization is available at the end ... Phone Toll Free: 1-800-733-8387 Monday through Friday (excluding holidays) Hours of operation: 8:05 a.m. to 7:30 p.m. Eastern Time. We have recently implemented a Virtual Hold system to allow us to call you back when our estimated wait time exceeds three minutes. The CHAMPVA Supplement plan has a calendar year Plan deductible of $250 per person and $500 family maximum. Premiums increase as a person moves from one 5-year age bracket to another (40, 45, 50, 55, 60). The company reserves the right to change premiums on a group wide basis to maintain the financial solvency of the plan.In most cases, CHAMPVA's allowable amount—what we pay for specific services and supplies—is equivalent to Medicare/TRICARE rates. CHAMPVA has an outpatient …Feb 6, 2020 · CHAMPVA Fax Number. The 2020 CHAMPVA fax number is: (303) 331-7809. You DESERVE a HIGHER VA rating. WE CAN HELP. Applying for CHAMPVA. In order to apply for CHAMPVA, eligible participants must fill out a form, attach the required documentation (such as Medicare cards or school enrollment letters, if necessary) and mail or fax the completed package to the Veterans Health Administration Office of Community Care in Denver, Colorado, which administers … Mail prescriptions to: Meds by Mail P.O. Box 331178 Murfreesboro, TN 37133. Allow up to 14 days for processing and delivery. Refills. How to request a prescription refill: Phone: Call the automated refill line (fastest/ safest): 888-370-1699. Online: Register for a MyHealtheVet account to request refills and track delivery. www. To apply for CHAMPVA benefits, you must submit the following documents: Application for CHAMPVA Benefits, VA Form 10-10d. Other Health Insurance (OHI) Certification, VA Form 10-7959c or Forma 10-7959c, Certificacion CHAMPVA de Otros Seguros de Salud (OSS) For individuals who are eligible for Medicare, for any reason, the VA also need a copy of ...

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– Facility Contact Numbers · – Request for Service ... Toll Free Numbers. skip to page content. U.S. flag. An ... (CHAMPVA). This care is also provided based on ...1-866-984-2337. TRICARE Dental Program. United Concordia. TDD/TTY: 711. CONUS50 United States, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands: 844-653-4061. OCONUSAreas outside of the 50 United States, the District of Columbia, American Samoa, Guam, the Northern …Mar 1, 2022 · What Is The Fax Number For CHAMPVA? The fax number for CHAMPVA is: 303-331-7808. What Is The Mailing Address For CHAMPVA? The mailing address for CHAMPVA is: PO Box 469063 Denver, CO 80246-9063. What Is The Phone Number For CHAMPVA Customer Service? CHAMPVA Help Line: 800-733-8387 Monday–Friday 8:05 a.m.–7:30 p.m., ET In most cases, CHAMPVA pays equivalent to Medicare and TRICARE allowable charges. CHAMPVA has 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 the patient except when the patient has OHI.It covers vision benefits for diabetes patients only. Dental benefits are limited. For most care, including medical screening, mental health, emergency room, hospital stay, ambulance, vaccinations ...Learn about the options VA offers for community providers to submit Veteran medical documentation in a timely manner. Help VA provide Veterans with seamless care by supporting these efforts.Faxing documents with a fax machine may seem outdated with the widespread use of the Internet, but there are still situations when you need to know how to send a fax. The good news...CHAMPVA has an outpatient deductible ($50 per person up to $100 per family per calendar year) and a cost share of 25% up to the catastrophic cap ($3,000 per calendar year). A 25% cost share, and any applicable deductible amounts, should be collected from the patient except when the beneficiary has other health insurance (OHI).In today’s digital age, faxing may seem like a thing of the past. However, there are still instances where faxing is necessary, particularly in business environments. And when it c...E-fax: Documentation sent via email to Veterans Affairs Medical Center (VAMC) fax machine. Please contact the referring VAMC for e-fax number. Please contact the referring VAMC for e-fax number. Request and Coordinate Care : More information about submitting documentation for authorized care.

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To apply for CHAMPVA benefits, you must submit the following documents: Application for CHAMPVA Benefits, VA Form 10-10d. Other Health Insurance (OHI) Certification, VA Form 10-7959c or Forma 10-7959c, Certificacion CHAMPVA de Otros Seguros de Salud (OSS) For individuals who are eligible for Medicare, for any reason, the VA also need a copy of ... VHA Form 10-7959a, CHAMPVA Claim Form. OMB Control Number: 2900-0219 Estimated Burden: 10 minutes Expiration Date: 10/31/2024. CHAMPVA Claim Form. Chief Business Office Purchased Care, CHAMPVA, PO Box 469064, Denver CO 80246-9064 | Customer Service Center: 1-800-733-8387.Jun 3, 2021 ... Title: CHAMPVA Benefits—Application, Claim, Other Health Insurance, Potential Liability & Miscellaneous Expenses. OMB Control Number: 2900–0219.You can call us at 1-800-733-8387, or write to: CHAMPVA. PO Box 469063 Denver CO 80246-9063 You can also inform us of any changes in your address by calling 1-800-733-8387 or writing to: CHAMPVA Eligibility PO Box 469028.Don’t think they accept fax. Yes, they do. The fax number is listed right at the top of the application. jrp419. 100 12. Mar 22, 2021 #5. Can you fax claims in. JNoxon. 2,099 874.Feb 6, 2020 · CHAMPVA Fax Number. The 2020 CHAMPVA fax number is: (303) 331-7809. You DESERVE a HIGHER VA rating. WE CAN HELP. CHAMPVA is managed by the VA’s Health Administration Center. You can call them at 800-733-8387, Monday through Friday from 8:15 AM to 6:00 PM Eastern Time. You can e-mail them at [email protected]. E-mail is the best way to communicate with them if you have this capability. You can also fax them at 1-303-331-7804.Contact Information. VFMP Beneficiary Services. 800-733-8387. OptumRx Beneficiary Services. 888-546-5502. OptumRx Pharmacy Technical Helpdesk. 888-546-5503. Meds by Mail. Dublin, GA 866-229-7389.Toll Free Numbers. I AM A... Select One ... Required Wireless Number. 1 (US), 1. Required Email ... You may mail or fax Veteran compensation claims and evidence to:.CHAMPVA. Civilian Health and Medical Program of the Veterans Affairs. 1-800-733-8387. This is a federal health benefits program for family members of totally and permanently disabled veterans who have a service-related disability. Civilian Health and Medical Program of the Veterans Affairs (CHAMPVA) is administered by the Department of Veterans ...VA FORM DEC 2016. 10-0426. Page 2 of 2. Telephone: 1-888-385-0235. Address: Meds by Mail PO Box 20330 Cheyenne, WY 82003-7008. Telephone: 1-866-229-7389 ….

Updating Your Contact Information. Contact information includes your address, email addresses or phone number (s). Family members can update contact information after they're registered in DEERS. Log into milConnect. Call 1-800-538-9552 (TTY/TDD: 1-866-363-2883) Fax updates to 1-800-336-4416 (Primary) or 1-502-335-9980 (Alternate) Mail updates to:Where to mail claims. For new claims: VHA Office of Community Care CHAMPVA PO Box 469064 Denver, CO 80246-9064. For general questions, information on payment, or to reprocess a denied claim, please send your request to: VHA Office of Community Care CHAMPVA PO Box 469063 Denver, CO 80246-9063. For …Phone: 877-353-9791. Fax: 512-460-5221. Mailing Address: Department of Veterans Affairs ... (CHAMPVA) and the Spina Bifida Health Care Benefits Program. ... VA has retained the final authority on all provider appeals. If a significant number of findings are reversed on appeal, Cotiviti is required to submit a corrective action plan to mitigate ...Phone directory and mailing address. Find phone numbers for many of the administrative and program offices at VA Southern Nevada health care. Mailing address. North Las Vegas VA Medical Center 6900 N. Pecos Road N. Las Vegas, NV 89086. Main phone numbers. Local: 702-791-9000 Toll-free: 888-633-7554. To use teletype (TTY) …Call: 630-522-4904. Email: [email protected]. Student Veterans of America: Use our directory to find an SVA Chapter on a campus near you. Team Red, White & Blue: Find a chapter for local and virtual opportunities for Veterans and the community to connect through physical and social activity.Aug 17, 2012 · CHAMPVA Eligibility PO Box 469028 Denver CO 80246-9028. Interactive voice response (IVR) system Phone . Toll Free: 1-800-733-8387 Hours of Availability: 24 Hours a Day, Seven Days a Week. Talk to a customer service representative • Phone . Toll Free: 1-800-733-8387, Monday through Friday (excluding holidays) • Hours of operation: 8:05 a.m ... You will need to use your CHAMPVA benefits when receiving care from this provider. You will be responsible for your standard cost-share under the CHAMPVA program which is typically 25 percent of allowable charges up to $3,000 per year after a $50 annual deductible.The fax cover sheet is faxed to the person who’s getting your facsimile document before the actual document is faxed. While a fax cover sheet is optional, the information on the co...Security number. • Other health insurance certification. If you have other health insurance, a signed and dated VA Form 10-7959c, CHAMPVA Other Health Insurance (OHI) Certification, is required. • School certification of full-time enrollment for children ages 18–23. Please refer to . Fact Sheet 01-15: School Champva fax number, The fax cover sheet is faxed to the person who’s getting your facsimile document before the actual document is faxed. While a fax cover sheet is optional, the information on the co..., CHAMPVA Application for Benefits, VA Form 10-10d (Fillable PDF) CHAMPVA Claim Form, VA Form 10-7959a (Fillable PDF) NOTE: This form is not for provider use. CHAMPVA Other Health Insurance (OHI) Certification, VA Form 10-7959c (Fillable PDF) CHAMPVA School Enrollment Certification Letter (Fillable PDF), Please enter a valid phone number. Submitting... Or Call Now (888) 666-8161. Thank you! ... CHAMPVA providers in Las Vegas, NV listed on Doctor.com have been practicing for an average of: 29.8 year(s) Average ProfilePoints™ Score for Providers in Las Vegas, NV who take CHAMPVA:, 888-370-1699. CHAMPVA Call Center. 800-733-8387. Contact CHAMPVA directly for any questions regarding eligibility, or to update insurance information (including pharmacy coverage) on file with CHAMPVA. Spina Bifida Call Center. 888-820-1756. Contact the Spina Bifida Health Care Benefits Program directly for any questions regarding eligibility. , Mail prescriptions to: Meds by Mail P.O. Box 331178 Murfreesboro, TN 37133. Allow up to 14 days for processing and delivery. Refills. How to request a prescription refill: Phone: Call the automated refill line (fastest/ safest): 888-370-1699. Online: Register for a MyHealtheVet account to request refills and track delivery. www., Mail prescriptions to: Meds by Mail P.O. Box 331178 Murfreesboro, TN 37133. Allow up to 14 days for processing and delivery. Refills. How to request a prescription refill: Phone: Call the automated refill line (fastest/ safest): 888-370-1699. Online: Register for a MyHealtheVet account to request refills and track delivery. www., You can call us at 1-800-733-8387, or write to: CHAMPVA. PO Box 469063 Denver CO 80246-9063 You can also inform us of any changes in your address by calling 1-800-733-8387 or writing to: CHAMPVA Eligibility PO Box 469028., E-fax: Documentation sent via email to Veterans Affairs Medical Center (VAMC) fax machine. Please contact the referring VAMC for e-fax number. Request and ..., While many consumers have done away with faxing items, it’s still very common for businesses to use faxes. This is because faxes ensure a higher level of security than other forms ..., It’s the same system as Tricare. If the private dr takes Tricare (which 90% do) they also take ChampVA. You meet the family deductible of 100$ then you don’t have copays or depending if a specialist 15$ for major work you pay 25% of the total cost. If you’re a vet married to a vet you can both get ChampVA fantastic alternative to VA., The Department of Veterans Affairs provides approximately 80% of all outpatient prescriptions to Veterans via mail order utilizing the VA Mail Order Pharmacy, a system of 7 highly automated pharmacies. The VA Mail Order Pharmacy processes 470,000 prescriptions daily and every work day over 330,000 Veterans receive a package of prescriptions in ..., Option 2: Pay by phone. Call us at 888-827-4817. Be sure to have your account number ready. Option 3: Pay by mail. Send your payment stub, along with a check or money order made payable to “VA,” to this address. Include your account number on the check or money order. Department of Veterans Affairs PO Box 3978 Portland, OR …, you will need concerning the number of refills remaining and the prescription expiration date. Where to Mail your Prescriptions: Telephone: 1-888-385-0235. Address: Meds by …, MyVA411 main information line. 800-698-2411 Hours: 24/7. If you need an interpreter: Call 800-698-2411 and select 0. We’ll connect you with a VA call center agent. Tell the agent that you want a language interpreter to join the call., CHAMPVA. The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries. ... Please no phone numbers, emails, license numbers, or other contact information. This also includes ..., For questions about Delta Dental, call 855-370-3303. For questions about MetLife, call 888-310-1681. The VA Dental Insurance Program (VADIP) offers discounted private dental insurance for Veterans and family members who meet certain requirements. Find out if you’re eligible, and how to enroll in a plan that meets your needs and budget., CHAMPVA Application for Benefits, VA Form 10-10d (Fillable PDF) CHAMPVA Claim Form, VA Form 10-7959a (Fillable PDF) NOTE: This form is not for provider use. CHAMPVA Other Health Insurance (OHI) Certification, VA Form 10-7959c (Fillable PDF) CHAMPVA School Enrollment Certification Letter (Fillable PDF), Most pharmacies submit claims to CHAMPVA electronically. The following information is required for any pharmacy claim: Invoice/billing statement that includes the pharmacy name, address and phone number. Name of prescribing physician. Name, strength and quantity for each drug. Eleven-digit National Drug Code for each drug., In today’s fast-paced digital world, businesses are constantly seeking ways to streamline their processes and enhance productivity. One area that often requires attention is faxing..., In today’s digital age, faxing may seem like an outdated method of communication. However, there are still many industries and businesses that rely on faxing for important document..., CHAMPVA Fax Number. The 2020 CHAMPVA fax number is: (303) 331-7809. You DESERVE a HIGHER VA rating. WE CAN HELP., If you are an eligible CHAMPVA beneficiary with no other prescription coverage, you can use Meds by Mail. ... can find MbM in their e-prescribing software by searching “Meds by Mail CHAMPVA” or by searching for telephone number 1-888-385-0235. ... automated refill phone line at 1‑888‑370‑1699. Be sure to have your Social …, In today’s digital age, businesses are constantly seeking more efficient and cost-effective ways to communicate. One area that has seen significant advancements is faxing. One of t..., VHA Form 10-7959a, CHAMPVA Claim Form. OMB Control Number: 2900-0219 Estimated Burden: 10 minutes Expiration Date: 10/31/2024. CHAMPVA Claim Form. Chief Business Office Purchased Care, CHAMPVA, PO Box 469064, Denver CO 80246-9064 | Customer Service Center: 1-800-733-8387., E-fax: Documentation sent via email to Veterans Affairs Medical Center (VAMC) fax machine. Please contact the referring VAMC for e-fax number. Please contact the referring VAMC for e-fax number. Request and Coordinate Care : More information about submitting documentation for authorized care., VA FORM DEC 2016. 10-0426. Page 2 of 2. Telephone: 1-888-385-0235. Address: Meds by Mail PO Box 20330 Cheyenne, WY 82003-7008. Telephone: 1-866-229-7389, There are several fax numbers for the Internal Revenue Service depending on whether the matter is business or personal and the geographic location where the taxpayer resides, expla..., Phone refills (automated refill line) 478-277-2851, ext. 2735 800-595-5229, ext. 2735 (toll free from outside the Dublin area) Mail refills. Mail back the refill request form that comes with your prescription to the provided address. Note: Please don’t drop off the form at the pharmacy when you pick up your new prescription. We can’t ..., Phone: 877-353-9791. Fax: 512-460-5221. Mailing Address: Department of Veterans Affairs ... (CHAMPVA) and the Spina Bifida Health Care Benefits Program. ... VA has retained the final authority on all provider appeals. If a significant number of findings are reversed on appeal, Cotiviti is required to submit a corrective action plan to mitigate ..., Sep 21, 2016 · To access this feature, call 1-800-733-8387 and respond to the voice prompts. Please have the beneficiary's Social Security Number and your tax ID number available when calling. CHAMPVA informational fact sheets. Fact Sheet 01-20: CHAMPVA–Information for Outpatient Providers and Office Managers; Fact Sheet 01-04: CHAMPVA Payment Methodology , Toll Free Numbers; VA ... For those VA community providers serving beneficiaries of CHAMPVA, Spina Bifida Healthcare Benefits Program, Camp Lejeune Family Member Program, and Children of Women Vietnam Veterans Health Care Benefits Program, please follow the guidelines at the link below. ... FAX preauthorization …, CHAMPVA Home; CHAMPVA Eligibility; Applying for CHAMPVA; Filing CHAMPVA Claims; CHAMPVA In-house Treatment Initiative (CITI) Camp Lejeune Family Member Program; ... Call for fax number: N/A: El Paso/ El Paso VAHCS: 915-564-7899: 915-497-3028: 915-564-7818: ELP CCS Medical Records: Houston/ Michael E. …, CHAMPVA Application for Benefits, VA Form 10-10d (Fillable PDF) CHAMPVA Claim Form, VA Form 10-7959a (Fillable PDF) NOTE: This form is not for provider use. CHAMPVA Other Health Insurance (OHI) Certification, VA Form 10-7959c (Fillable PDF) CHAMPVA School Enrollment Certification Letter (Fillable PDF)