Claims for NATO and CHAMPVA Beneficiaries
Claims for NATO Beneficiaries
TRICARE covers the North Atlantic Treaty Organization (NATO) foreign nations’ armed forces members who are stationed in the United States or are in the United States at the invitation of the U.S. Government. The benefits are the same as for American ADSMs, including no out-of-pocket expenses for care if the care is directed by the military treatment facility (MTF). Eligible family members of ADSMs of NATO nations who are stationed in, or passing through, the United States in connection with their official duties are eligible for outpatient services under TRICARE Standard and TRICARE Extra. A copy of the family member’s identification (ID) card will have a Foreign Identification Number or an actual Social Security number (SSN) and indicate on the reverse “Outpatient Services Only.”
NATO family members do not need an MTF referral prior to receiving outpatient services from civilian providers. NATO family members follow the same prior authorization requirements as TRICARE Standard beneficiaries. Like all TRICARE Standard beneficiaries, NATO family members 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. In order to be reimbursed for inpatient services, have the NATO beneficiary make the appropriate arrangements with the NATO nation embassy or consulate in advance.
The eligibility for NATO beneficiaries is now 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 by any of the following means:
VA Health Administration Center
CHAMPVA
P. O. Box 469063
Denver, CO 80246-9063
Phone: 1-800-733-8387
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, CHAMPVA claim forms can be downloaded from the CHAMPVA Web site. To file a paper health care claim within the one-year claim-filing deadline, send the claim to:
VA Health Administration Center
CHAMPVA
P.O. Box 469064
Denver, CO 80246-9064
Fax: 1-303-331-7804
Written appeals may be requested 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 VA Health Administration Center in Denver within 72 hours of its identification as a CHAMPVA claim. A letter will be sent 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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