Filing Dental Claims at Your Local VA Medical Center
If you’re considering filing a claim to receive dental care benefits from the Department of Veteran Affairs (VA), the process may be confusing, and it can be difficult to know where to begin. Here’s a guide to help you better understand what to expect from the process of filing dental claims at your local VA medical center.
Step One: Are You Eligible for VA Dental Care Benefits?
Before submitting a dental claim, you first need to determine if you are eligible to receive VA dental care benefits. Eligibility depends on a variety of factors, such as your military service history, current health status, and living situation. Depending on these factors, the VA determines your benefits class as well as the benefits you are eligible for within that class:
- Class I: If you have a service-connected dental disability or condition, you are eligible to receive VA dental care through Class I.
- Class II: If you request dental care within 180 days of discharge or release from active duty service which lasted 90 days or more, you are eligible to receive one-time dental care. You can receive this care if your DD214 certificate of discharge does not state that a complete dental examination and all other necessary dental treatment was given before your discharge.
- Class IIA: If you have a service-connected, non-compensable (0% rating) dental condition resulting from combat wounds or service trauma, you are eligible to receive any dental care to provide and maintain a functioning dentition. The VA Regional Office Rating Decision letter or the historical Dental Trauma Rating shows which teeth conditions are trauma related.
- Class IIB: If you are enrolled in a qualifying VA-sponsored homeless residential rehabilitation program and have been for at least 60 days, you are eligible to receive a one-time course of dental care that is deemed medically necessary. This can be to relieve pain, help you gain employment, or treat severe or complicated conditions.
- Class IIC: If you are a former prisoner of war, you are eligible to receive VA dental care through Class IIC
- Class III: If you have a dental condition that the VA associates with and affects a service-connected medical condition, you are eligible to receive dental care for these dental conditions.
- Class IV: If you have service-connected disabilities rated 100% or are unemployable and receive the 100% disability rate due to service-connected conditions, you are eligible to receive VA dental care through Class IV. It should be noted that veterans paid at the 100% rating based on a temporary condition are not eligible for this outpatient dental program.
- Class V: If you are actively engaged in a Title 38, USC Chapter 31 Vocational Rehabilitation and Employment Program, you are eligible for dental care to the extent necessary as determined by a VA dental professional. This care is focused on your involvement in the rehabilitation and employment program, and how to help you through the program.
Step Two: Apply for VA Health Care Benefits
If you are eligible to apply for VA dental care benefits, you can do so through the VA health care application (VA Form 10-10EZ). To apply, you will need your Social Security number, military discharge information, and insurance cards. You may also provide optional information, such as last year’s gross household income and deductible expenses.
This application can be filled out online, over the phone, by mail, or in person. If you are looking to apply in person, you can do so by bringing a signed application for health benefits with you to your local VA medical center or with the help of your state’s VA. After submitting your application, the VA will make a decision about your benefits in less than a week.
Step Three: Filing Dental Claims
There are two ways to file VA dental claims: via 837 Electronic Data Interchange (EDI) Transaction or with the most current American Dental Association (ADA) form. Both ways to file a dental claim must comply with ADA and specific VA requirements. If you are filing the form electronically, the electronic 837 claim can be submitted through the VA’s clearinghouse, Change Healthcare, or another clearinghouse of your choice.
If you plan on filing your VA dental claim at your local VA medical center, you will need to bring the ADA form and be able to provide your Social Security number, a predetermined/preauthorization number from the VA, and any other insurance information.
Contact a Veterans’ Disability Lawyer for Help
Applying and filing for dental care can be a confusing process. If you or a loved one are looking to file a dental claim or apply for VA health care benefits, reach out to a member of our team today. Our team is happy to guide you through the process and answer any questions you may have.