VA Form 10-7959c
CHAMPVA Claims Form
Submit a claim for CHAMPVA reimbursement after seeing a provider.
CHAMPVA Claims Form
In Plain English
Submit a claim for CHAMPVA reimbursement after seeing a provider.
Used to file claims for CHAMPVA benefits reimbursement when a provider doesn't bill CHAMPVA directly.
Step-by-Step Guide
How to file 10-7959c
When to use this form
When you've seen a healthcare provider who didn't bill CHAMPVA directly. You pay out of pocket and submit this form for reimbursement.
Required
- ✓Itemized bill from the healthcare provider
Must show services provided, dates, and charges.
Recommended (if applicable)
- +Explanation of Benefits (EOB) from other insurance
If you have other insurance that was billed first.
Mail to
VHA Office of Community Care, CHAMPVA, PO Box 469064, Denver, CO 80246-9064
Fax to
303-331-7809
Include all supporting documentation with your claim for faster processing.
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