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Veteran's ICN can be found on the VA issued HSRM referral. Mail to: DEPARTMENT OF VETERANS AFFAIRS. [FeeInpatInvoice] table, one must first link that table to the [Fee]. The zip code accompanying the VEN13 variable denotes the zip code to which VA sent reimbursement, not the zip code where the service was rendered. As of April 2019, this guidebook is no longer being updated. For EDI 837, Referral Number is Loop = 2300, Segment = REF*9F, Position = REF02 or Prior Authorization. For more information, please visit the Data Access Request Tracker (DART) Request Process page on the VHA Data Portal(VA intranet only: http://vaww.vhadataportal.med.va.gov/DataAccess/DARTRequestProcess.aspx#resources). Payer ID for dental claims is 12116. More information about provider reimbursement can be found in the document Working with the Veterans Health Administration: A Guide for Providers (available on the VHA Office of Community Care website, on the Provider Resources page).5. Analyses of FY 2014 data indicate approximately 50% of inpatient observations and 43% of outpatient observations are missing NPI. Of note, the relevant SQL tables for Fee Basis data are not only the [Fee]. In this situation, a given VA medical center has a preferred hospital from which it purchases care. At the time of writing, version 4.2 is the most current version. The Department of Veterans Affairs (VA) often pays providers in the community to provide care to Veterans when it is unable to provide such care itself (e.g., due to a lack of resources or delays in providing care), or when it is infeasible to do so (e.g., emergency care). Payment of ambulance transportation under 38 U.S.C. This is a critical difference from VA utilization files, which are organized by date of service. A claim void must be identical to the original claim that it is intended to cancel. National Non-VA Medical Care Program Office (NNPO). There are substantial differences in quantity of inpatient diagnosis and procedure data available in SAS versus SQL. PatientICN is assigned by CDW. Inpatient stays in both SAS and SQL Fee Basis data can denote hospital stays, nursing home stays, or hospice stays. 15. The clinic of jurisdiction, or medical facility, authorizes such care under the fee-basis program . This rare event most likely indicates a transfer. Bowel and bladder care for certain Veterans with SCI/D are considered supportive medical services due to the possibility of medical complications which would result in the need for hospitalization. If the VA Fee Schedule does not include a rate for the covered service provided, reimbursement will be made at 100% of customary charges, as defined in the provider's VA CCN Payment Appendix. https://vaww.cdw.va.gov/metadata/Reports/ERDiagramsOfViews/Purchased%20Care%20Authorized_5638.jpg, https://vaww.cdw.va.gov/metadata/Reports/ERDiagramsOfViews/Purchased%20Care%20Unauthorized_242.jpg, https://vaww.cdw.va.gov/metadata/Reports/ERDiagramsOfViews/Purchased%20Care%20Service_5480.jpg. To link an authorization to a claim, use the trifecta of what VistA would consider sta3n, PatientIEN, and AuthorizationIEN. Contact: 1-877-353-9791; Email Customer Engagement; Customer Engagement Portal Login. The vendor identity can be found through the VENDID or VEN13N variables in SAS. Emergency care can also be authorized by VA in certain circumstances when the VA is notified within 72 hours. There is a strong, but imperfect, concordance, between the observations housed in the SAS and SQL data. This FPOV variable broadly categorizes the reason for the encounter, such as hospice or respite care. Smith MW, Chow A. Non-VA Medical Care (Fee Basis) Data: A Guide for Researchers. This application reads, creates, edits authorization data in VistA, and copies critical information into the central SQL database for off-line VistA applications to consume. Medical specialty type (SPECCODE) is a provider-specific variable and indicates the specialty type of the provider rendering the service. In most cases, if you don't sign up for Part B when you are first eligible, you'll have to pay a late enrollment penalty. Values for Fee Purpose of Visit (FPOV), HCFA Payment Type (HCFATYPE), Treatment Code (TRETYPE), Place of Service (PLSER), and Vendor Type (TYPE) appear in Appendix B. SQL data contain both SCRSSN and SSN, but these data reside in the SPatient table at CDW, and cannot be accessed by researchers without the CDW data manager and IRB approval. The UB-92 equivalent variables would be: facility (after merging in facility name from the FBCS_Facilities table), vistapatkey, and vistaauthkey, respectively. The travel payments data contains reimbursements for particular travel events (TVLAMT). You are strongly encouraged to electronically submit claims and required supporting documentation. Attention A T users. CLAIM.MD | Payer Information | VA Fee Basis Programs Payer Information VA Fee Basis Programs Payer ID: 12115 This insurance is also known as: Veterans Administration Need to submit transactions to this insurance carrier? Accessed October 07, 2015. For a list of VA acronyms, please visit the VA AcronymLookup on the VA intranet at http://vaww.va.gov/Acronyms/fulllist.cfm. Customer Call Center: 877-881-76188:05 a.m. to 6:45 p.m. Eastern TimeMondayFriday, Sign up for the Provider Advisor newsletter, Veterans Crisis Line: October 1, 2015. Given the stronger guidance from the Fee Office regarding use of the FPOV code, we recommend using the FPOV code to discern which observations are ancillary care, as the FeeProgram may not be as reliable. Inpatient data are housed in the FeeInpatInvoice table as well as the FeeServiceProvided table, although the latter does not contain only inpatient data. There are up to 25 ICD-9 diagnosis codes and 25 ICD-9 surgical procedure codes in the inpatient data. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. However, one also needs to exercise caution with DRG; there are 2 different sets of DRGs used over time. The NPI is the national provider identifier, which is provider-specific but often missing in the Fee Basis data. Please visit Provider Education and Training for upcoming events. A record is created only if there is a code on the invoice to be recorded. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. E-fax: Documentation sent via email to Veterans Affairs Medical Center (VAMC) fax machine. However, investigation has confirmed these are partial payments made for a single encounter or procedure. There may be many providers that use the same vendor for billing. For example, an interest payment of $14.21 would appear as 1421. INTAMT is part of DISAMT; it should not be added to them. There are also a number of other financial variables denoted in SAS (see Table 7). In SQL, the outpatient data are housed in the FeeServiceProvided table. Request and Coordinate Care: Find more information about submitting documentation for authorized care. VA HEALTH CARE Management and Oversight of Fee Basis Care Need. The Caregivers and Veterans Omnibus Health Services Act of 2010 (Public Law 111-163) authorizes VA to provide post-delivery and routine care to a newborn child of qualifying women Veterans receiving VA maternity care for up to seven days following the birth. If a researcher wishes to find the Medicare hospital provider ID, one approach is to use the vendor identification variables (VEN13N, VENDID) to locate the vendors name and location in the VEN file, and then to use this information to find the Medicare provider ID using publicly available files from CMS, the agency that oversees the Medicare program. All Fee Basis care will be found in the Fee files. The SAS files also include a patient type variable (PATTYPE). Thus, unauthorized care is not unpaid care it is simply not PRE-authorized care. In SQL, the patient ID will be the PatientICN or PatientSID, and the admit date is the admission date.. For more information call 1-800-396-7929.Claims for Non-VA Emergency CareVeterans need to make sure any bills for non-VA emergency care of non-service connected conditions are submitted to the VA Medical Centers NVCC Office within 90 days. The impact on inpatient and emergent care is unclear, however, as the definition of prosthetic in VA is so broad as to include items placed inside the body, such as internal fixation devices, coronary stents, and cardioverter defibrillators. Please switch auto forms mode to off. Through the CCN, Veterans have access to regional networks of high-performing, licensed health care . Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. Emergency claims covered under the Veterans Millennium Care and Benefits Act, Public Law 106-117); see 29 CFR 17.120 and 38 CFR 17.1004. Use of this technology is strictly controlled and not available for use within the general population. PLSER values overlap considerably with those of the Medicare Carrier Line Place of Service codes. Each year represents the year in which the claim was processed, not the year in which the service was rendered. However, there is one situation in which the payment amount will be more accurate than the disbursed amount: when the disbursed amount is missing, and the payment was not cancelled, one should use the payment amount to capture the cost of care. Primary keys are denoted by (PK) and foreign keys are denoted by (FK). Given the variable definitions, it is not clear whether DX1 or DXLSF is the better choice to determine primary reason for inpatient stay. All preauthorized claims are then processed through the Fee Basis Claims System (FBCS) at the local facility as well as sent to the payment team. Include the 17 alpha-numeric (10 digits + "V" + 6 digits) VA-assigned internal control number (ICN) in the insured's I.D. Dental claims must be filed via 837 EDI transaction or using the most current. 2. Get the latest updates on VA community care, including program changes, resources and more! 2. [FeeInpatInvoiceICDDiagnosis] with the [Dim]. Community provider mails the paper claims and documentation to the new mailing address of VA's central claims intake location. Box 108851Florence SC29502-8851, Delta Dental of CaliforniaVA Community Care NetworkP.O. privacy policies and guidelines. Money collected by VA from private health insurance carriers is returned back to the VA medical center providing the care. 4. [Patient], [SPatient]. The potential exists to store Personally Identifiable Information (PII), Protected Health Information (PHI) and/or VA Sensitive data and proper security standards must be followed in these cases. The inpatient data will also need to be linked to the ancillary data, or the data representing the professional services provided to a patient while in the hospital, in order to determine the total cost of the inpatient stay. Researchers can look at the disposition variable as an indicator of transfer between VA and non-VA care. This improves claim accuracy and reduces the amount of time it takes for us to process claim determinations. [PatientRace] tables. In the outpatient data, one observation represents a single CPT code. Download the tables here. Health Information Governance. This component communicates with the FBCS MS SQL and VistA database in real time. Among non-missing observations, HERC analyses found a many-to-many relationship among NPI and VEN13N. (1) A Veteran must be enrolled in VA health care16. All access (Veterans may submit unauthorized claims, however, and VA has legal authority to pay them under certain conditions. This act expands the non-VA care veterans were able to receive before the act was passed. National Institute of Standards and Technology (NIST) standards. Include the claim, or a copy of the claim, on top of the supporting documentation that is mailed to the following address: Include a completed cover sheet with the supporting documentation that is mailed to the above address. It is also possible that researchers will find a slight difference in the observations that the SAS versus SQL data contain. The Medicare ID is missing if the payment is determined via a different mechanism (e.g., a contract). 866-505-7263, Veterans Crisis Line: 1725 when remaining liability to the Veteran is not a copayment or similar payment. From 1998 to 2014, approximately 50% of claims were paid within 30 days of VA receiving the invoice, and 95% of claims are paid in 200 days or less. For billing questions contact: Health Resource Center VHA Office of FinanceP.O. [XXX] tables, but also the [DIM]. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up for it. If, however, VA is authorized to pay for only certain days in an inpatient stay, then the provider may bill the patient for the remaining days. The Routing tool manages how Health Care Finance Administration (HCFA) and Uniform Billing (UB) claims will electronically flow through the FBCS program. VA systems are intended to be used by authorized VA network users for viewing and retrieving information only; except as otherwise explicitly authorized for official business and limited personal use under VA policy. You will have to pay this penalty for as long as you have Part B. In the SQL files, there is no separate ancillary file; rather, data regarding the physician cost of the inpatient stay is denoted in the [Fee]. Hit enter to expand a main menu option (Health, Benefits, etc). We continue on this process until we find a gap greater than 1 day or we have evaluated all observations with that patient ID, STA3N and VEN13N. There are three routes for filing claims for authorized care which depend on your status in VAs network and how the care was authorized: All non-urgent and non-emergent care requires authorization from VA in advance. Accessed October 16, 2015. In the Fee Basis inpatient data, each record represents a separate claim; these separate claims must be aggregated to capture the totality of the inpatient stay. This service communicates via native SQL Server 2005 encrypted connections through the VA Wide Area Network (WAN). VINCI. There are five forms of patient identifiers in SQL files at CDW (including but not limited to the Fee Basis files): PatientICN, PatientSID, PatientSSN, ScrSSN, and PatientIEN. In this chapter, we discuss general aspects of Fee Basis data. [FeeServiceProvided] table. Under the Veterans Choice Act, eligible veterans are able to obtain outpatient care outside the VA using their Choice Card. 5. Community providers should remain in contact with the referring VA Medical Center to ensure proper care coordination. Quality of Life and Veterans Affairs Appropriations Act of 2006 (Public Law 109-114),the FSC offers a wide range of financial and accounting products and services to both the VA and Other Government Agencies (OGA). Some important DIM tables that will be useful in analyzing Fee Basis data are FeePurposeOfVisit, FeeSpecialtyCode, FeeVendor, ICD, ICDProcedure Code, DRG, CPT, and CPT Category. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). Our office is located at 6940 O St, Suite 400 Lincoln NE 68510. Researchers can read more information about accessing CDW on the VHA Data Portal (http://vaww.vhadataportal.med.va.gov/DataSources/CDW.aspx; VA intranet only). Race and ethnicity are found in the [PatientEthnicity], [PatSub]. For the inpatient data, we compared observations with the same patient identifier, based on PaidDate in SQL and TRANSDAT in SAS. As with inpatient data, researchers will need to collapse multiple observations in order to get a complete picture of the outpatient care provided on a single day. To access the menus on this page please perform the following steps. A summary of the payment guidelines can be found in Appendix I. The VendorType contains information about whether the service was provided by a laboratory, radiology, physician, pharmacy, other, travel, prosthetics, federal hospital, public hospital or private hospital. Available at: http://www.va.gov/opa/choiceact/documents/Choice-Program-Fact-Sheet-Final.pdf. In SQL, there are multiple patient identifiers, with the most useful being the PatientICN. Claims and other FBCS data will be found in PIT or Community Care Referral & Authorization domains. VA contracts out its hospice; therefore, the Fee Basis files contain a great deal of data related to hospice care. Data from FY1998 and FY1999 have a greater degree of discordance. This rule applies even when the patient is incapable of making a call. In both SAS and SQL data, outpatient data are organized in long format, with one record per CPT code. One can evaluate which encounters were unauthorized by joining the FeeUnauthorizedClaim table through the FeeUnauthorizedClaimSID key. The 2015 update to the Fee Basis Medical Care guidebook describes for the first time the SQL Fee Basis files, and contains a host of information about how SAS versus SQL Fee Basis files differ. Fee Basis data files contain information regarding both the care the Veteran received and the reimbursement of the care. We found SPECIALPROVCAT was missing in 93% of records. The DSS Fee Basis Claims System (FBCS) is a web-based claim management system. Claims for Non-VA Emergency Care This schema contains sensitive information such as SSNs, bank accounts, and the actual name of personnel. Patient identifiers are also different across SAS and SQL data. U.S. Department of Veterans Affairs. Note that the vendor may represent the hospital, a hospital chain or the entity billing on behalf of the provider. Note: Admission date is only relevant for inpatient stays; it is not relevant for outpatient visits. No, only one type of care can be covered by a single authorization. Veterans Choice Program (VCP) Overview [online]. Providers are not required to accept VA payment in all cases. There are very limited data in both the SAS and the SQL Fee Basis data regarding the provider associated with care; the closest one can get to this information is to denote the vendor associated with the encounter (detailed more in sections 4.11 and 5.10). Payment guidelines for non-VA are outlined in federal regulations 17.55 and 17.56. Hit enter to expand a main menu option (Health, Benefits, etc). Guidance can be found under "VHA Data Quality Program Reports. The vendor and the provider may or may not be the same entities. Additional information appears in a federal regulation, 38 CFR 17.52. In SAS, the inpatient (INPT) file includes PAMT, the Medicare prospective payment that would apply to the stay. To access the menus on this page please perform the following steps. Information from this system Q. Health Information Governance. NNPO. Access; upload; download; change; or delete information on this system; Otherwise misuse this system are strictly prohibited. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. The definition of the DXLSF variable changes depending on the year of analysis. This means the data were placed in the PIT and the claim was not paid through FBCS. Because coding varies by station, users are encouraged to employ multiple variables in an effort to find all care associated with a particular setting or service type. This latter table contains a variable called InitialTreatmentDateTime. For more information call 1-800-396-7929. Thus, researchers using later years of data should be aware that files are not static and will continue to be updated. Two domains in which researchers can find reports on Non-VA Care are Resource Management and Workload. FBCS is designed to be used in the Fee Basis Departments of the Veteran Affairs Medical Centers (VAMCs). The Implementer of this technology has the responsibility to ensure the version deployed is 508-compliant. The prescriptions filled by fee-basis pharmacies are often small quantities of medication to meet the patients emergency or short-term needs while a CMOP prescription is being filled. Optum is a proud partner with the VA through its Community Care Network (CCN). Non-VA providers submit claims for reimbursement to VA. is ok, 12.6.5 is ok, 12.6.9 is ok, however 12.7.0 or 13.0 is not. Box 30780, Tampa FL 33630-3780. VA is also the primary and sole payer for unauthorized emergent care approved under 38 U.S.C. June 5, 2009. As noted above, there are differences in the patient identifier and the date variables in the SAS versus SQL data; both data sources do not contain the same variables regarding patient identifier or date the claim was paid. have hearing loss. Contact the VA North Texas Health Care System. Please switch auto forms mode to off. There are 3 categories of geographic data: veteran-related information, vendor-related information and VA-station related information. Make sure you have received an official authorization to provide care or that the care is of an emergent nature. When there is no available rate in the Medicare Fee Schedule, the VA will follow the payment guidelines for Non-VA Medical Care. The vendor represents the entity billing for the non-VA care, while the provider represents the person who was involved in care provision. Payment for these types of care falls under the Non-VA Medical Care program. Through patient identifier and travel date (TravelPaymentDate), one can link these payments to inpatient and outpatient encounters. Multiple claims can be paid against a single authorization. Claims processed after March 17, 2022, will be reviewed and aligned with the federal ruling which prohibits secondary payment on emergency care copayments and deductibles. This most likely reflects a low frequency of surgery rather than missing data. The variable DTStamp represent the date the claim was received. U.S. Department of Veterans Affairs. As of April 2019, this guidebook is no longer being updated. To evaluate the time it takes VA to process Fee Basis claims, we evaluated SAS data for FY2014. In this case the first record would have an admission date of Jan 1, 2010 and a discharge date of Jan 10, 2010. Journal of Rehabilitation Research and Development. VA evaluates these claims and decides how much to reimburse these providers for care. See 38 USC 1725 and 1728.). Government contractor DSS Inc a new plan to fix VA's failing non-VA fee basis claims processing and management system with certain software updates - self-funded - to improve the system. Researchers using this tactic also run the risk of not being able to properly link their cohort, as other HERC investigations have revealed an imperfect relationship between SCRSSN and ICN; some SCRSSNs do not have an accompanying PatientICN; some SCRSSNs have multiple PatientICNs. When evaluating the cost of care, use the disbursed amount. Office of Media and Public Relations. All Choice claims are processed by VISN 15. Documentation, including data contents, field frequencies, and record counts, is also available on VIReCs CDW Data Documentation page (VA intranet only: http://vaww.virec.research.va.gov/CDW/Documentation.htm). Assistance with claims is free and covers all state and federal veterans' programs. [FeeVendor] table. Office of Information and Analytics. Fact Sheet: Medical Document Submission Requirements for Care Coordination, ADA Dental Claim Form > American Dental Association website. Section 508 compliance may be reviewed by the Section 508 Office and appropriate remedial action required if necessary. The key that allows for this linkage is the FeeInpatInvoiceSID which is a primary key in the [Fee]. These tables involve payments paid only through FBCS. 2. The codes for the procedures provided for a given hospital stay are kept in a separate table, a table of procedures. Training - Exposure - Experience (TEE) Tournament. Not all of these variables appear in every utilization file. Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. Non-VA providers submit claims for reimbursement to VA. Community providers have three options that allow for that linkage: Submit the claim electronically via 837 transaction and the supporting documentation via 275 transaction. VA Informatics and Computing Resource Center (VINCI). In some cases, there is a one-to-one relationship between VEN13N and MDCAREID. If billing electronically, please include "Other Payers Information" in Loop 2320, 2330A, 2330B, and 2430. Research requests for data from CDW/VINCI must be submitted via the Data Access Request Tracker (DART) application. To enter and activate the submenu links, hit the down arrow. We crosswalked the ScrSSN to allow for comparison with SAS data. Some missingness may indicate not applicable..