Payment may be held because you are not enrolled in Electronic Funds Transfer (EFT). Enroll in EFT to receive payment. Do not resubmit the claim.

The billed service is not covered for the diagnosis submitted. Review CHAMPVA policy guidelines and confirm the diagnosis supports the service before resubmitting.

This claim matches one previously processed. The related claim number is listed on the EOB. Do not resubmit the claim unless instructed, as it will result in another denial. Contact customer service if you believe the claim is not a duplicate.

The patient has other health insurance (OHI) that must be billed before CHAMPVA. Resubmit the claim with the primary insurer’s EOB. If the patient has multiple plans, include EOBs from all plans.

Claims must be submitted within 365 days of the date of service. Claims submitted after this timeframe may be denied. You may submit a written appeal if there were exceptional circumstances.

The patient was not eligible for CHAMPVA on the date of service. Verify eligibility and confirm the dates of service before resubmitting.

The billed service is not covered under CHAMPVA. Review CHAMPVA coverage guidelines. Contact customer service if you believe the service should be covered.

Other health insurance (OHI) information is missing or incomplete. Submit the required OHI certification (VA Form 10-7959c) or update the patient’s insurance information. Claims cannot be processed until this information is received.

Additional medical documentation is needed to support the services billed. Resubmit the claim with supporting documentation and a copy of the CHAMPVA EOB.

The patient has more than one primary insurance plan. Resubmit the claim with EOBs from each primary insurer.

A valid diagnosis code is required. Correct the claim and resubmit with a valid ICD diagnosis code and a copy of the CHAMPVA EOB.