CHAMPVA covers most care without advance approval, but a short list of services needs preauthorization before they are delivered. Clinicians meet this when planning non-emergent inpatient mental health or substance use treatment, residential, partial hospital or intensive outpatient programs, dental care, applied behavior analysis treatment or an organ transplant for a CHAMPVA beneficiary. CHAMPVA reviews the clinical documentation and issues a determination that can be challenged in writing.
The treating provider or facility makes the request and supplies the clinical documentation, such as a transplant team summary of medical necessity or a medical provider's statement supporting dental care. There is no CHAMPVA preauthorization form, and the beneficiary has no section to complete.
Download the current version from the source each time; forms change without notice.
CHAMPVA Preauthorization Request (mental health, dental, transplant and other listed services)
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
No. CHAMPVA does not publish a provider preauthorization form. The treating provider contacts the VHA Office of Integrated Veteran Care by phone, email or mail and supplies clinical documentation of medical necessity. For dental care, that documentation should preferably come from a medical provider and be sent in advance with the request.
Yes, for treatment. The CHAMPVA Guidebook lists applied behavior analysis as needing preauthorization for treatment only, not for the evaluation. As with the other listed services, CHAMPVA approval is not needed when the beneficiary's other health insurance has already authorized the ABA treatment.
Send CHAMPVA Appeals a written statement explaining why the decision is wrong, with any new or relevant documentation and a copy of the denial notice, within one year of the VA notification. This review cannot be used for services that have already been provided or for eligibility decisions.