Oklahoma City Clearinghouse
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84146 | 84147 CHAMPVA HAC - Avoid Claim Rejections for Veterans Administration
Incident
Report for Optum OKC Clearinghouse
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Update
It has been determined that the most common clearinghouse rejection for claims submitted to the CHAMPVA program is invalid Member ID format. The *only* acceptable Member ID format for claims submitted to CHAMPVA, Payer IDs 84146 (institutional/professional) and 84147 (dental), is a 9-digit numeric Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN).
The second most common clearinghouse rejection reason is invalid Patient’s Relationship to Insured: the *only* valid relationship code is “self”. The patient is always the member, there are no sponsors.
It has also been determined that the most common rejections from the payer CHAMPVA are mismatches on Member ID, Date of Birth, or the First/Last Name of the Patient/Insured identified on the claim. The VA requires that the Patient/Insured name on the claim, including hyphenated last names, be an exact match to the name it has on file. Strict matching requirements on claims make it especially important that providers submit an eligibility check and update their systems prior to submitting a claim to CHAMPVA.
CHAMPVA is a health benefits program in which the department of Veterans Affairs shares the cost of certain health care services and supplies with eligible beneficiaries. CHAMPVA provides coverage to the spouse or widow(er) and to the children of veterans who meet very specific criteria which are further defined on the VA’s website:
https://www.va.gov/COMMUNITYCARE/programs/dependents/champva/champva-eligibility.asp
PLEASE NOTE: *CHAMPVA does not provide coverage to the veteran.*
Providers should always check the Member ID card to establish if the patient is enrolled with CHAMPVA: Insurance Cards for CHAMPVA will have "Department of Veterans Affairs Health Administration Center" in the top left corner. Please also note that in order to be eligible for CHAMPVA a member cannot be eligible for TRICARE.
To avoid claims being rejected for invalid Member ID format or the VA’s inability to identify the member/patient please check the ID card to be sure you are submitting to the correct program. If your patient is a veteran, submit an eligibility inquiry to the VHA Office of Integrated Veteran Care (IVC), Payer ID VAFEE, to verify active benefits and correct demographics prior to submitting a claim. If your patient is a spouse/widow(er) or dependent of a veteran AND has a CHAMPVA insurance card please send an eligibility inquiry to CHAMPVA, Payer ID VAHAC, to verify active benefits and correct demographics prior to submitting a claim. Once you have confirmed that your patient is enrolled with the CHAMPVA program, then submit your claims to Payer IDs 84146 or 84147 as appropriate.
REF 633752
The second most common clearinghouse rejection reason is invalid Patient’s Relationship to Insured: the *only* valid relationship code is “self”. The patient is always the member, there are no sponsors.
It has also been determined that the most common rejections from the payer CHAMPVA are mismatches on Member ID, Date of Birth, or the First/Last Name of the Patient/Insured identified on the claim. The VA requires that the Patient/Insured name on the claim, including hyphenated last names, be an exact match to the name it has on file. Strict matching requirements on claims make it especially important that providers submit an eligibility check and update their systems prior to submitting a claim to CHAMPVA.
CHAMPVA is a health benefits program in which the department of Veterans Affairs shares the cost of certain health care services and supplies with eligible beneficiaries. CHAMPVA provides coverage to the spouse or widow(er) and to the children of veterans who meet very specific criteria which are further defined on the VA’s website:
https://www.va.gov/COMMUNITYCARE/programs/dependents/champva/champva-eligibility.asp
PLEASE NOTE: *CHAMPVA does not provide coverage to the veteran.*
Providers should always check the Member ID card to establish if the patient is enrolled with CHAMPVA: Insurance Cards for CHAMPVA will have "Department of Veterans Affairs Health Administration Center" in the top left corner. Please also note that in order to be eligible for CHAMPVA a member cannot be eligible for TRICARE.
To avoid claims being rejected for invalid Member ID format or the VA’s inability to identify the member/patient please check the ID card to be sure you are submitting to the correct program. If your patient is a veteran, submit an eligibility inquiry to the VHA Office of Integrated Veteran Care (IVC), Payer ID VAFEE, to verify active benefits and correct demographics prior to submitting a claim. If your patient is a spouse/widow(er) or dependent of a veteran AND has a CHAMPVA insurance card please send an eligibility inquiry to CHAMPVA, Payer ID VAHAC, to verify active benefits and correct demographics prior to submitting a claim. Once you have confirmed that your patient is enrolled with the CHAMPVA program, then submit your claims to Payer IDs 84146 or 84147 as appropriate.
REF 633752
Update
Reminder:
It has been determined that the most common clearinghouse rejection for claims submitted to the CHAMPVA program is invalid Member ID format. The *only* acceptable Member ID format for claims submitted to CHAMPVA, Payer IDs 84146 (institutional/professional) and 84147 (dental), is a 9-digit numeric Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN).
The second most common clearinghouse rejection reason is invalid Patient’s Relationship to Insured: the *only* valid relationship code is “self”. The patient is always the member, there are no sponsors.
It has also been determined that the most common rejections from the payer CHAMPVA are mismatches on Member ID, Date of Birth, or the First/Last Name of the Patient/Insured identified on the claim. The VA requires that the Patient/Insured name on the claim, including hyphenated last names, be an exact match to the name it has on file. Strict matching requirements on claims make it especially important that providers submit an eligibility check and update their systems prior to submitting a claim to CHAMPVA.
CHAMPVA is a health benefits program in which the department of Veterans Affairs shares the cost of certain health care services and supplies with eligible beneficiaries. CHAMPVA provides coverage to the spouse or widow(er) and to the children of veterans who meet very specific criteria which are further defined on the VA’s website:
https://www.va.gov/COMMUNITYCARE/programs/dependents/champva/champva-eligibility.asp
PLEASE NOTE: *CHAMPVA does not provide coverage to the veteran.*
Providers should always check the Member ID card to establish if the patient is enrolled with CHAMPVA: Insurance Cards for CHAMPVA will have "Department of Veterans Affairs Health Administration Center" in the top left corner. Please also note that in order to be eligible for CHAMPVA a member cannot be eligible for TRICARE.
To avoid claims being rejected for invalid Member ID format or the VA’s inability to identify the member/patient please check the ID card to be sure you are submitting to the correct program. If your patient is a veteran, submit an eligibility inquiry to the VHA Office of Integrated Veteran Care (IVC), Payer ID VAFEE, to verify active benefits and correct demographics prior to submitting a claim. If your patient is a spouse/widow(er) or dependent of a veteran AND has a CHAMPVA insurance card please send an eligibility inquiry to CHAMPVA, Payer ID VAHAC, to verify active benefits and correct demographics prior to submitting a claim. Once you have confirmed that your patient is enrolled with the CHAMPVA program, then submit your claims to Payer IDs 84146 or 84147 as appropriate.
REF 633752
It has been determined that the most common clearinghouse rejection for claims submitted to the CHAMPVA program is invalid Member ID format. The *only* acceptable Member ID format for claims submitted to CHAMPVA, Payer IDs 84146 (institutional/professional) and 84147 (dental), is a 9-digit numeric Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN).
The second most common clearinghouse rejection reason is invalid Patient’s Relationship to Insured: the *only* valid relationship code is “self”. The patient is always the member, there are no sponsors.
It has also been determined that the most common rejections from the payer CHAMPVA are mismatches on Member ID, Date of Birth, or the First/Last Name of the Patient/Insured identified on the claim. The VA requires that the Patient/Insured name on the claim, including hyphenated last names, be an exact match to the name it has on file. Strict matching requirements on claims make it especially important that providers submit an eligibility check and update their systems prior to submitting a claim to CHAMPVA.
CHAMPVA is a health benefits program in which the department of Veterans Affairs shares the cost of certain health care services and supplies with eligible beneficiaries. CHAMPVA provides coverage to the spouse or widow(er) and to the children of veterans who meet very specific criteria which are further defined on the VA’s website:
https://www.va.gov/COMMUNITYCARE/programs/dependents/champva/champva-eligibility.asp
PLEASE NOTE: *CHAMPVA does not provide coverage to the veteran.*
Providers should always check the Member ID card to establish if the patient is enrolled with CHAMPVA: Insurance Cards for CHAMPVA will have "Department of Veterans Affairs Health Administration Center" in the top left corner. Please also note that in order to be eligible for CHAMPVA a member cannot be eligible for TRICARE.
To avoid claims being rejected for invalid Member ID format or the VA’s inability to identify the member/patient please check the ID card to be sure you are submitting to the correct program. If your patient is a veteran, submit an eligibility inquiry to the VHA Office of Integrated Veteran Care (IVC), Payer ID VAFEE, to verify active benefits and correct demographics prior to submitting a claim. If your patient is a spouse/widow(er) or dependent of a veteran AND has a CHAMPVA insurance card please send an eligibility inquiry to CHAMPVA, Payer ID VAHAC, to verify active benefits and correct demographics prior to submitting a claim. Once you have confirmed that your patient is enrolled with the CHAMPVA program, then submit your claims to Payer IDs 84146 or 84147 as appropriate.
REF 633752
Update
Reminder:
It has been determined that the most common clearinghouse rejection for claims submitted to the CHAMPVA program is invalid Member ID format. The *only* acceptable Member ID format for claims submitted to CHAMPVA, Payer IDs 84146 (institutional/professional) and 84147 (dental), is a 9-digit numeric Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN).
The second most common clearinghouse rejection reason is invalid Patient’s Relationship to Insured: the *only* valid relationship code is “self”. The patient is always the member, there are no sponsors.
It has also been determined that the most common rejections from the payer CHAMPVA are mismatches on Member ID, Date of Birth, or the First/Last Name of the Patient/Insured identified on the claim. The VA requires that the Patient/Insured name on the claim, including hyphenated last names, be an exact match to the name it has on file. Strict matching requirements on claims make it especially important that providers submit an eligibility check and update their systems prior to submitting a claim to CHAMPVA.
CHAMPVA is a health benefits program in which the department of Veterans Affairs shares the cost of certain health care services and supplies with eligible beneficiaries. CHAMPVA provides coverage to the spouse or widow(er) and to the children of veterans who meet very specific criteria which are further defined on the VA’s website:
https://www.va.gov/COMMUNITYCARE/programs/dependents/champva/champva-eligibility.asp
PLEASE NOTE: *CHAMPVA does not provide coverage to the veteran.*
Providers should always check the Member ID card to establish if the patient is enrolled with CHAMPVA: Insurance Cards for CHAMPVA will have "Department of Veterans Affairs Health Administration Center" in the top left corner. Please also note that in order to be eligible for CHAMPVA a member cannot be eligible for TRICARE.
To avoid claims being rejected for invalid Member ID format or the VA’s inability to identify the member/patient please check the ID card to be sure you are submitting to the correct program. If your patient is a veteran, submit an eligibility inquiry to the VHA Office of Integrated Veteran Care (IVC), Payer ID VAFEE, to verify active benefits and correct demographics prior to submitting a claim. If your patient is a spouse/widow(er) or dependent of a veteran AND has a CHAMPVA insurance card please send an eligibility inquiry to CHAMPVA, Payer ID VAHAC, to verify active benefits and correct demographics prior to submitting a claim. Once you have confirmed that your patient is enrolled with the CHAMPVA program, then submit your claims to Payer IDs 84146 or 84147 as appropriate.
REF 633752
It has been determined that the most common clearinghouse rejection for claims submitted to the CHAMPVA program is invalid Member ID format. The *only* acceptable Member ID format for claims submitted to CHAMPVA, Payer IDs 84146 (institutional/professional) and 84147 (dental), is a 9-digit numeric Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN).
The second most common clearinghouse rejection reason is invalid Patient’s Relationship to Insured: the *only* valid relationship code is “self”. The patient is always the member, there are no sponsors.
It has also been determined that the most common rejections from the payer CHAMPVA are mismatches on Member ID, Date of Birth, or the First/Last Name of the Patient/Insured identified on the claim. The VA requires that the Patient/Insured name on the claim, including hyphenated last names, be an exact match to the name it has on file. Strict matching requirements on claims make it especially important that providers submit an eligibility check and update their systems prior to submitting a claim to CHAMPVA.
CHAMPVA is a health benefits program in which the department of Veterans Affairs shares the cost of certain health care services and supplies with eligible beneficiaries. CHAMPVA provides coverage to the spouse or widow(er) and to the children of veterans who meet very specific criteria which are further defined on the VA’s website:
https://www.va.gov/COMMUNITYCARE/programs/dependents/champva/champva-eligibility.asp
PLEASE NOTE: *CHAMPVA does not provide coverage to the veteran.*
Providers should always check the Member ID card to establish if the patient is enrolled with CHAMPVA: Insurance Cards for CHAMPVA will have "Department of Veterans Affairs Health Administration Center" in the top left corner. Please also note that in order to be eligible for CHAMPVA a member cannot be eligible for TRICARE.
To avoid claims being rejected for invalid Member ID format or the VA’s inability to identify the member/patient please check the ID card to be sure you are submitting to the correct program. If your patient is a veteran, submit an eligibility inquiry to the VHA Office of Integrated Veteran Care (IVC), Payer ID VAFEE, to verify active benefits and correct demographics prior to submitting a claim. If your patient is a spouse/widow(er) or dependent of a veteran AND has a CHAMPVA insurance card please send an eligibility inquiry to CHAMPVA, Payer ID VAHAC, to verify active benefits and correct demographics prior to submitting a claim. Once you have confirmed that your patient is enrolled with the CHAMPVA program, then submit your claims to Payer IDs 84146 or 84147 as appropriate.
REF 633752
Identified
It has been determined that the most common clearinghouse rejection for claims submitted to the CHAMPVA program is invalid Member ID format. The *only* acceptable Member ID format for claims submitted to CHAMPVA, Payer IDs 84146 (institutional/professional) and 84147 (dental), is a 9-digit numeric Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN).
The second most common clearinghouse rejection reason is invalid Patient’s Relationship to Insured: the *only* valid relationship code is “self”. The patient is always the member, there are no sponsors.
It has also been determined that the most common rejections from the payer CHAMPVA are mismatches on Member ID, Date of Birth, or the First/Last Name of the Patient/Insured identified on the claim. The VA requires that the Patient/Insured name on the claim, including hyphenated last names, be an exact match to the name it has on file. Strict matching requirements on claims make it especially important that providers submit an eligibility check and update their systems prior to submitting a claim to CHAMPVA.
CHAMPVA is a health benefits program in which the department of Veterans Affairs shares the cost of certain health care services and supplies with eligible beneficiaries. CHAMPVA provides coverage to the spouse or widow(er) and to the children of veterans who meet very specific criteria which are further defined on the VA’s website:
https://www.va.gov/COMMUNITYCARE/programs/dependents/champva/champva-eligibility.asp
PLEASE NOTE: *CHAMPVA does not provide coverage to the veteran.*
Providers should always check the Member ID card to establish if the patient is enrolled with CHAMPVA: Insurance Cards for CHAMPVA will have "Department of Veterans Affairs Health Administration Center" in the top left corner. Please also note that in order to be eligible for CHAMPVA a member cannot be eligible for TRICARE.
To avoid claims being rejected for invalid Member ID format or the VA’s inability to identify the member/patient please check the ID card to be sure you are submitting to the correct program. If your patient is a veteran, submit an eligibility inquiry to the VHA Office of Integrated Veteran Care (IVC), Payer ID VAFEE, to verify active benefits and correct demographics prior to submitting a claim. If your patient is a spouse/widow(er) or dependent of a veteran AND has a CHAMPVA insurance card please send an eligibility inquiry to CHAMPVA, Payer ID VAHAC, to verify active benefits and correct demographics prior to submitting a claim. Once you have confirmed that your patient is enrolled with the CHAMPVA program, then submit your claims to Payer IDs 84146 or 84147 as appropriate.
REF 633752
The second most common clearinghouse rejection reason is invalid Patient’s Relationship to Insured: the *only* valid relationship code is “self”. The patient is always the member, there are no sponsors.
It has also been determined that the most common rejections from the payer CHAMPVA are mismatches on Member ID, Date of Birth, or the First/Last Name of the Patient/Insured identified on the claim. The VA requires that the Patient/Insured name on the claim, including hyphenated last names, be an exact match to the name it has on file. Strict matching requirements on claims make it especially important that providers submit an eligibility check and update their systems prior to submitting a claim to CHAMPVA.
CHAMPVA is a health benefits program in which the department of Veterans Affairs shares the cost of certain health care services and supplies with eligible beneficiaries. CHAMPVA provides coverage to the spouse or widow(er) and to the children of veterans who meet very specific criteria which are further defined on the VA’s website:
https://www.va.gov/COMMUNITYCARE/programs/dependents/champva/champva-eligibility.asp
PLEASE NOTE: *CHAMPVA does not provide coverage to the veteran.*
Providers should always check the Member ID card to establish if the patient is enrolled with CHAMPVA: Insurance Cards for CHAMPVA will have "Department of Veterans Affairs Health Administration Center" in the top left corner. Please also note that in order to be eligible for CHAMPVA a member cannot be eligible for TRICARE.
To avoid claims being rejected for invalid Member ID format or the VA’s inability to identify the member/patient please check the ID card to be sure you are submitting to the correct program. If your patient is a veteran, submit an eligibility inquiry to the VHA Office of Integrated Veteran Care (IVC), Payer ID VAFEE, to verify active benefits and correct demographics prior to submitting a claim. If your patient is a spouse/widow(er) or dependent of a veteran AND has a CHAMPVA insurance card please send an eligibility inquiry to CHAMPVA, Payer ID VAHAC, to verify active benefits and correct demographics prior to submitting a claim. Once you have confirmed that your patient is enrolled with the CHAMPVA program, then submit your claims to Payer IDs 84146 or 84147 as appropriate.
REF 633752
This incident affects: Institutional, Professional, and Dental.