Overview

The Camp Lejeune Family Member Program (CLFMP) covers treatment costs for one or more of the 15 conditions listed in the Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012.

CLFMP does not have contract providers. You must be properly licensed in your state and cannot be on the Medicare exclusion list to receive payment from the CLFMP.

What CLFMP covers

VA will reimburse qualified family members as the last payer of medical claims for the following illnesses and conditions:

View the pharmacy formulary on the CLFMP website for allowable prescriptions.

CLFMP beneficiary eligibility and preauthorization

This program is only for family members of Veterans who were stationed at Camp Lejeune.

Providers can verify CLFMP beneficiary eligibility electronically or by phone. Have the beneficiary’s Social Security Number and your tax ID number available when calling.

• Electronic verification
  • Check eligibility status through your electronic data interchange (EDI) system by submitting an eligibility and benefit inquiry (270) transaction through your clearinghouse.
    
    
• Phone verification
  • CLFMP Customer Service: 866-372-1144

CLFMP preauthorization

Preauthorization is not required, but you should only bill CLFMP for services related to treatment of the 15 covered conditions.

CLFMP claims

Include the following information when submitting CLFMP claims:

• Standard billing form: UB-04 Uniform Bill (CMS 1450) or Centers for Medicare and Medicaid Services-Health Insurance Claim Form (CMS 1500)
• Patient’s first and last name as it appears on the VA program identification card. The patient is always the subscriber.
• Member ID (Social Security Number)
• Patient’s date of birth
• Explanation of Benefits (EOB) from the Other Health Insurance (OHI), if applicable

How to file a CLFMP claim

There are two ways to file a CLFMP claim: electronically or by mail. Submit claims electronically for faster processing times.

If the family member has Other Health Insurance (OHI), the OHI must be billed first. The explanation of benefits from the OHI should be submitted to CLFMP with the claim for reimbursement. By law, CLFMP is always the last payer.

• Electronic claims
  Submit a HIPAA-compliant 837 electronic data interchange (EDI) health care claim through the VA clearinghouse, PNT Data.
  • Medical Payer ID: CLFM1

• Paper claims

For questions about submitting electronic claims through the VA clearinghouse, contact PNT Data Customer Support.