CHAMPVA Claim Form

1. 1

   Do now · 01

   Before you start

   Deadline

   VA generally must receive a CHAMPVA claim within 1 year of the date of service, or within 1 year of discharge for inpatient care.

   Use this form when: When you've seen a healthcare provider who didn't bill CHAMPVA directly. You pay out of pocket and submit this form for reimbursement.

2. Gather · 02

   Gather your documents

   Required

   • ✓Itemized bill from the healthcare provider — Must include the information VA lists for the type of care or prescription claim.
   • ✓Proof that you paid the provider — Include a receipt or other proof of payment when requesting reimbursement.

   Helpful when available

   • +Explanation of Benefits (EOB) from other insurance — If you have other insurance that was billed first.
3. Go next · 03

   Submit the form

   Available methods

   • Online
   • Mail
   • Fax

   Mail to

   VHA Office of Integrated Veteran Care, CHAMPVA Claims, PO Box 500, Spring City, PA 19475

   Fax to

   303-331-7808

   Submission note

   File online or include the current claim form and all required supporting records when mailing or faxing.

   Start on VA.gov↗ (opens in a new tab)View or download official form↗ (opens in a new tab)

Continue the route

Forms are just one piece. Make sure your full claim is solid.