Create and publish new FMB R&S page: Filing a claim through CHAMPVA

[laurwill]

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[laurwill]

Blocked by SME review in CC migration epic: #66682

[laurwill]

Notes and questions for SMEs:

• The team building the online CHAMPVA claim form is not allowing people with Kaiser Permanente insurance to use the online form. Existing webpage content says that itemized billing statements from Kaiser don't contain all the info we need for claims. For now, we've included the instruction to upload a copy of your Kaiser insurance card that lists your copays, since that seems to be the only additional requirement noted on the existing webpage. Can you confirm what people with Kaiser insurance need to do differently in order for their claims to be accepted?
• Based on our work on the Foreign Medical Program claim form, we've added an instruction for people who are filing for reimbursement to submit proof that they already paid the provider. Can you confirm if this is needed? If it's not needed, how does CHAMPVA know whether to pay the beneficiary or the provider?
• The CHAMPVA claim form team heard from SMEs that we may need to list specific types of diagnosis and procedure codes that must be on supporting documents (like CPT codes). Is it necessary to specify the type of code, or will an itemized billing statement most likely include the codes we need? We want to avoid asking beneficiaries to try to identify specific medical codes if it's not necessary.
• The existing webpage says “If you fail to complete VA Form 10-7959a, CHAMPVA Claim Form, your health care provider will be paid directly.” It was our understanding that CHAMPVA always pays providers directly, unless the beneficiary goes to a provider that doesn't accept CHAMPVA and pays out of pocket. Can you explain what this sentence means?
• Does CHAMPVA contact beneficiaries to get missing information on a submitted claim, or would they automatically deny the claim instead?
• Is there a time limit for appeals of denied claims?
• We also saw a different mailing address on the existing webpage for “reprocessing denied claims.” Is this different from requesting an appeal?

[laurwill]

SMEs approved updates, tracking copy edit and publishing in #95769, moving this to validate.