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Claims for NATO and CHAMPVA Beneficiaries
      


Claims for NATO Beneficiaries

TRICARE covers North Atlantic Treaty Organization (NATO) foreign nations’ armed forces members who are stationed in the United States, or in the United States at the invitation of the United States Government. They receive the same benefits as American ADSMs, including no out-of-pocket expenses for care if the care is directed by the military treatment facility (MTF). Eligible accompanying family members of ADSMs of NATO nations who are stationed in, or passing through, the United States in connection with their official duties can receive outpatient services under TRICARE Standard and TRICARE Extra. A copy of the family member’s identification card will have a Foreign Identification Number or a SSN and indicate on the reverse “Outpatient Services Only.”

NATO family members do not need MTF referrals prior to receiving outpatient services from civilian providers, follow the same prior authorization requirements as TRICARE Standard beneficiaries, and are responsible for TRICARE Standard deductibles and cost-shares. To collect charges for services not covered by TRICARE, you must have the NATO beneficiary agree, in advance and in writing, to accept financial responsibility for any non-covered service by completing the TRICARE Non-Covered Services Waiver form.

TRICARE will not cover inpatient services for NATO beneficiaries. To be reimbursed for inpatient services, have the NATO beneficiary make the appropriate arrangements with the NATO nation embassy or consulate in advance.

NATO beneficiary eligibility is maintained in the Defense Enrollment Eligibility Reporting System (DEERS). Claims submission procedures are the same as for U.S. ADFMs.

Claims for CHAMPVA

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is not a TRICARE program. For questions or general correspondence, you may contact CHAMPVA using the information found in Figure 8.7.

Figure 8.7 CHAMPVA Contact Information

Phone 1-800-733-8387
Mail VA Health Administration Center
CHAMPVA
P. O. Box 469063
Denver, CO  80246-9063
Web site Veterans Affairs web site 

Claims for current treatment must be filed within 365 days of the date of service. Providers may file health care claims electronically on behalf of their patients. If you wish to file a paper health care claim, download CHAMPVA claim forms from the CHAMPVA Web site, and file them within the one-year claim-filing deadline. Send the claim to:
VA Health Administration Center
CHAMPVA
P.O. Box 469064
Denver, CO 80246-9064
You may request a written appeal if exceptional circumstances prevented you from filing a claim in a timely fashion. Send written appeals to:
VA Health Administration Center
CHAMPVA
ATTN: Appeals
P.O. Box 460948
Denver, CO 80246-0948
Note: Do not send appeals to the claims-processing address. This will delay your appeal.

If your CHAMPVA claim is misdirected to PGBA, PGBA will forward it to the CHAMPVA Veterans Affairs (VA) Health Administration Center in Denver within 72 hours, and will send a letter to the claimant informing him or her of the transfer. The letter includes instructions on how to submit future CHAMPVA claims and to direct any correspondence for CHAMPVA beneficiaries to the CHAMPVA VA Health Administration Center.

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Last Update: January 15, 2011