Overview

The Children of Women Vietnam Veterans (CWVV) Health Care Benefits Program provides health care benefits to the birth children of women Vietnam Veterans who have certain covered birth defects. The program covers health care services needed to treat the covered birth defect and related medical conditions. CWVV is not a comprehensive health care plan.

CWVV beneficiary eligibility and preauthorization

Individuals whose biological mother entered the Republic of Vietnam between February 28, 1961 and May 7, 1975, may be eligible. Providers may verify beneficiary eligibility electronically or by phone.

• Electronic verification
  Check eligibility status 24/7 through your electronic data interchange (EDI) system. After connecting with VA’s clearinghouse, Change Healthcare (Optum), or another clearinghouse of your choice, submit an eligibility and benefit inquiry (270) transaction.
  • VA’s real-time payer ID is VAHAC.
    
    
• Phone verification
  Contact CWVV customer service at 833-930-0816 to determine eligibility.

Preauthorization is required for the following types of care:

• Dental care
• Medical equipment that costs more than $2,000 to rent or purchase
• Outpatient day health care
• Outpatient mental health care (more than 23 visits per year)
• Care for substance use disorders
• Organ transplants

CWVV claims

Include the following information when submitting CWVV 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
• The Explanation of Benefits (EOB) from the OHI, if applicable

How to file a CWVV claim

For CWVV claims, the determined allowable amount for payment is considered payment-in-full. A provider may not bill the beneficiary for the difference between the billed amount and the VA-determined allowed amount.

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

• Electronic claims
  Submit a HIPAA-compliant 837 electronic data interchange (EDI) health care claim through the VA clearinghouse, Optum Insight.
  • Medical Payer ID: 84146
  • Dental Payer ID: 84147
    

• Paper claims

For questions about submitting electronic claims through the VA clearinghouse, contact Optum Insight Customer Support.

Check CWVV claims status

Check medical claim status electronically through the VA clearinghouse using the 276/277 HIPAA transactions.

Pharmacy benefits for CWVV

Pharmacies participating in the OptumRx Network may fill prescriptions for CWVV beneficiaries. If you are not currently a participant, contact the OptumRx Pharmacy Help Desk for contracting information.

Prescriptions filled at pharmacies outside the OptumRx network must be paid in full by the patient. The patient may then submit a claim to the VHA Office of Integrated Veteran Care for reimbursement.

Pharmacy claims routing information

• BIN: 610593
  PCN: VA
  Group: HAC
  
  
• Use the beneficiary’s Social Security Number (SSN) as the NCPDP Cardholder ID (302-C2). For security and privacy reasons, OptumRx will not provide a beneficiary’s SSN to anyone.
  
  
• All compliant pharmacy claims are automatically transmitted electronically to OptumRx. Contact the OptumRx Help Desk if you have questions or need assistance submitting a claim.

Pharmacy benefits contact