It can be difficult to identify the specific type of provider associated with Fee Basis care in the currently available national extracts of Fee Basis data. This section describes two elements of the program: the range of services covered and the payment rules used to determine the amount that VA will pay (DISAMT). A foreign key is a key that uniquely identifies a record of another table. There is no official data dictionary for the SAS Fee Basis data. Four FPOV (Fee Purpose of Visit) codes can be used to identify payment for unauthorized claims. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. The Fee Basis files primary purpose is to record VA payments to non-VA providers. Electronic Services Available (EDI): Professional/1. This could indicate a transfer between facilities or a physician bill for an inpatient stay. The Veteran's full 9-digit social security number (SSN) may be used if the ICN is not available. Request and Coordinate Care: Find more information about submitting documentation for authorized care. 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. The procedure code table has just as many records as there were procedures on the invoice. VA Claims Representation; RESOURCES. Appendix H lists their current values. NNPO. However, not all dates on the claim are approved. Make sure you have received an official authorization to provide care or that the care is of an emergent nature. SAS and SQL data are organized differently and contain different variables. There may be multiple CPT codes associated with a single encounter. A primary key is a key that is unique for each record. Edward J. Hines, Jr. VA Hospital, Hines, Ill. 2007. 1. This improves claim accuracy and reduces the amount of time it takes for us to process claim determinations. These rules are subject to change by statute or regulation. 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. Primary keys are denoted by (PK) and foreign keys are denoted by (FK). [FeeInpatInvoiceICDProcedure] table. This service communicates via native SQL Server 2005 encrypted connections through the VA Wide Area Network (WAN). 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. Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. [XXX] tables.9,12 Tables under the DIM schema contain attributes that describe the records in the Fee tables. Fee Basis providers vary in how frequently they submit an invoice for Fee Basis care. Table 9 lists a number of financial variables the SQL data contain. The same concept (such as fiscal year, state, or county) may be represented by several variables, sometimes in differing formats. In SQL, there are multiple patient identifiers, with the most useful being the PatientICN. More information about can be found on their website: https://www.va.gov/communitycare/. U.S. Department of Veterans Affairs. We are the third-party administrator for the VA CCN for Regions 1, 2 and 3, encompassing 36 states, Puerto Rico, the U.S. Virgin Islands and the District of Columbia. The VA pays for both emergency and non-emergency care through Fee Basis mechanisms. To evaluate the time it takes VA to process Fee Basis claims, we evaluated SAS data for FY2014. U.S. Department of Veterans Affairs. 1725 may only be made if payment to the facility for the emergency care is authorized, or death occurred during transport. 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. While NPI is available in SQL data, it does require special permissions to access, as it is located in the [Sstaff]. Authorized care claims must be submitted within 6 years of the date of service, service-connected emergency care claims must be submitted within 2 years of the date of service, and non-service-connected emergency care claims must be submitted within 90 days of the date of service/discharge. The veteran must wait over 30 days past their preferred appointment date or the date deemed medically necessary by their provider, b. Once the process is exhausted for a particular patient, STA3N and VEN13N combination, we calculate length of stay as the difference between the admission date of the first record and the temporary end date.. National Provider Identifier: Submit all that are applicable, including, but not limited to billing, rendering/servicing, and referring. There are additional payments for direct medical education, capital-related costs, and other factors as appropriate. Training - Exposure - Experience (TEE) Tournament, Observational Medical Outcomes Partnership (OMOP), Personnel & Accounting Integrated System (PAID), Decision Analysis: Decision Trees, Simulation Models, Sensitivity Analyses, Measuring the Cost of a Program or Practice: Microcosting, List of VA Economists and Researchers with Health Economic Interests, 7. Claims for Non-VA Emergency Care A claim void must be identical to the original claim that it is intended to cancel. If the patient was transported to a VA hospital after stabilization (as indicated by the DISTYP, or disposition type, variable), the record of the VA stay should appear in VA utilization databases. This Technology is currently being evaluated, reviewed, and tested in controlled environments. (2) Additionally, a Veteran must also meet at least one of the following criteria. (Anything), but would not cover any version of 7.5.x or 7.6.x on the TRM. [SpatientAddress] tables. One may therefore assume that all patients receiving treatment through the Non-VA Medical Care program are Veterans. Patient residence related geographic information is available in the [Patient]. Prescription-related data in the PHARVEN file contain only summary payments by month. VA Palo Alto, Health Economics Resource Center; October 2013. In SAS, ICD-9 diagnosis codes are in the Inpatient, Outpatient and Ancillary files. For example, if a physician billed for a complete blood count and a venipuncture in the same day, there would be two records with the same invoice number, but different CPT codes and different claimed amounts. Given these different patient identifiers, it is difficult to conduct exact comparisons between SAS and SQL data. Non-VA providers submit claims for reimbursement to VA. Mail to: DEPARTMENT OF VETERANS AFFAIRSCLAIMS INTAKE CENTERPO BOX 4444JANESVILLE, WI 53547-4444, or Fax to: TOLL FREE: 844-531-7818 & 248-524-4260 (Utilized for Foreign Claimants), Veterans Crisis Line: Users interested in learning the rules in force at a particular point in time should contact the VHA Office of Community Care. INTIND and INTAMT are not always concordant. Fee Basis data can be broadly categorized into 4 classes: inpatient care, outpatient care, pharmacy, and travel data. 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. Our office is located at 6940 O St, Suite 400 Lincoln NE 68510. If disbursed amount is missing, use payment amount instead. Private health insurance coverage through a Veteran or Veteran's spouse is insurance provided by an employer, Veteran or other non-federal source, including Medicare . 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. In particular, CDW also recommends Patient SIDs with a value of less than 1 be deleted. 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. Unauthorized Care is that which was not pre-authorized but was still reimbursed, such as emergency care. Veterans whose income exceed the established VA Income Thresholds as well as those who choose not to complete the financial assessment must agree to pay required copays to become eligible for VA health care services. For example: services provided at a hospital anticoagulation clinic are billable for facility charges only if the anticoagulation is considered incident to physician services and certain other conditions are met.8. VA is required by law to bill private health insurance carriers for medical care, supplies and prescriptions provided for treatment of Veterans' nonservice-connected conditions. Driving distance between a veterans residence and their closest VA facility is over 40 miles, c. The veteran must travel by boat or plane to access the VA facility closest to their home (excluding Guam, American Samoa, or the Republic of the Philippines), d. The veteran faces an excessive burden in traveling to a VA, including a body of water or geologic formation that cannot be crossed by road. Hospice also appears to be billed monthly, with longest length of stay for a single hospice invoice of 31 days. Veterans who have private health insurance should consider a number of important factors before canceling their health insurance, such as: If you cancel your Medicare Part B Coverage, you need to know that you cannot be reinstated until January of the following year, and you may be penalized for reinstatement. Many variables in the Fee Basis files record details of invoice and check processing. Available at: http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf.. 3. The process of linking can be complex; analysts should take care to reduce errors during this process. VA evaluates these claims and decides how much to reimburse these providers for care. [FeePrescription] table contains rich information on the type of drug prescribed and dispensed, including the drug name, manufacturer, strength, quantity, date filled and charge and disbursed (payment) amount. We tried to link the UB-92 form to identify Choice authorizations; however, we found few records and decided to use obligation number. Chief Business Office. Non-VA Medical Care data are available in SAS form at the Austin Information Technology Center (AITC) and in SAS form and SQL form through the VA Corporate Data Warehouse (CDW)/VA Informatics and Computing Infrastructure (VINCI). 6. HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. All access If researchers wish to identify ED visits, they may want to use CPT codes or Place of Service codes, rather than FPOV. The NPI is the national provider identifier, which is provider-specific but often missing in the Fee Basis data. Microsoft Internet Explorer, a dependency of this technology, is in End of Life status and must no longer be used. There are exceptions. 21. 1. There are limited data available regarding the specific non-VA provider associated with a visit; much information available pertains to the vendor who is billing for the care provided. Researchers evaluating care over time may want to use the DRG variable. The Veteran files contain the richest patient demographic information in the SAS data; these include the Veterans date of birth, sex, prisoner of war status and war code. If you are in crisis or having thoughts of suicide, or use of this system constitutes user understanding and acceptance of these terms VIReC. CDW Data Quality Analysis Team has particular recommendations for excluding observations before beginning analyses on your cohort.13 Corporate Data Warehouse (CDW) contains dummy data as well as test patients that will need to be removed from tables before conducting analyses. It may duplicate the PatientIEN of another patient at another facility, and should not be used as an identifier. Accessed October 16, 2015. Please switch auto forms mode to off. VINCI. Please contact the referring VAMC for e-fax number. TriWest VA CCN ClaimsP.O. Both ancillary and outpatient files have one record per CPT code. One can use the same approach as for the inpatient SQL data described above to locate the date of service. Passed in 2014 with bipartisan support in Congress, its purpose is to increase Veterans access to health care.1 The Choice Act allows Veterans to receive health care through non-VA providers in the community if they are unable to schedule an appointment at their local VA within 30 days or by a date determined by their provider (wait-time goals), if they reside over 40 miles from a VA facility, or if they face an unusual or excessive burden in travelling to a VA facility.2 Under the Choice Act, ten ($10) billion dollars has been allocated towards Non-VA Medical Care for eligible Veterans through 2017.1 The Fee Basis files contain data for care received through the Choice Act, but in this guide, we do not distinguish for care provided under the Non-VA Medical Care program and that provided under the Choice Act. To access the menus on this page please perform the following steps. In SAS, these data can be found in the Vendor file. To access the menus on this page please perform the following steps. 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]. 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. Providers who continue to elect to submit paper claims and paper documentation to support claims for unauthorized emergency care should be aware of the following: VHA Office of Integrated Veteran Care P.O. The [Fee]. In order to evaluate the care received, length of stay and/or costs associated with a single inpatient stay, the user will often have to roll up multiple claims. However, we conducted some comparisons for inpatient data. These inpatient tables have to be linked to FeeInpatInvoiceICDDiagnosis, FeeInpatInvoiceICDProcedure, FeeInitialTreatment and the appropriate DIM tables in order to understand the specific diagnoses and procedures associated with the inpatient observations in these tables. There is a CPT field in the inpatient files, but this is always missing; hospitals do not use CPT codes to bill. You are strongly encouraged to electronically submit claims and required supporting documentation. There may be many providers that use the same vendor for billing. Two domains in which researchers can find reports on Non-VA Care are Resource Management and Workload. Those options are: Utilize HealthShare Referral Manager (HSRM) for referrals, authorizations and documentation exchange. This is a critical difference from VA utilization files, which are organized by date of service. Sort data by the patient ID, STA3N, VEN13N, and the admission dates. Researchers must consider whether a missing value means not applicable. For example, many inpatient (INPT) records lack a value for any of the surgery codes (SURG9CD1-SURG9CD5). Veterans Choice Program (VCP) Overview [online]. The instructions differ based on the type of submission.NOTE: For specific information on submitting claims to Optum or TriWest, please refer to their resources. Researchers with VA intranet access can access these sites by copying and pasting the URLs into their browser. Accessed October 16, 2015. The temporary end date is the maximum of these two values. 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. Persons looking to find the date of service should be advised that it will not be contained in the FeeServiceProvided table. This variable is defined as 1st Diagnosis Code. A comparison from FY 2009 to 2014 data reveals that DX1 in SAS corresponds to DX1 in SQL data, and up to 2008, DXLSF in SAS corresponds to DX1 in SQL (see Table 5). VA can make payments to non-VA health care providers under many arrangements. There are two important variables to consider if evaluating the cost (VA reimbursement) of Fee Basis Care: the payment amount (AMOUNT in SAS, PaidAmount in SQL) or the Financial Management System (FMS) disbursed amount (DISAMT in SAS, DisbursedAmount in SQL). VA patients who receive prescriptions from non-VA providers fill them from a VA pharmacy, often the VA Certified Mail Order Pharmacy (CMOP). CLAIMS INTAKE CENTER. Electronic Data Interchange (EDI) Interface. According to the Health Administration Center Internet website, the proportion of claims processed within 30 days rose from under 40% in 2007 to over 97% by the end of 2008. FBCS is moving to a centralized system in the near future, where there will be centralized rules and national policies with 3 distinct groups: CCN (network), CCRA (authorization), and CCRS (reimbursement system; an IBM product). Please switch auto forms mode to off. Data in any of the any S tables require Staff Real SSN access. To enter and activate the submenu links, hit the down arrow. All SAS variables are denoted in capital letters, while SQL fields are denoted without spaces, in accordance with how these fields are labeled in the SQL tables. Medications dispensed in a health care facility such as a doctor's office, dialysis clinic, or hospital outpatient clinic, such as injectable medications or infusions, will be found in the outpatient data, where they will be identified by CPT code. [FeeInpatInvoiceICDProcedure] table. Table 8 denotes on which CDW servers Fee Basis data are housed. [OEFOIFService]and [Dim].[POWLocation]. Learn how to prevent paper claim rejections. For billing questions contact: Health Resource Center 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. The Florida Department of Veterans' Affairs has Claims Examiners co-located with the VA Regional Office in Bay Pines, each VA Medical Center and many VA Outpatient Clinics. Claims and other FBCS data will be found in PIT or Community Care Referral & Authorization domains. Electronic Data Interchange (EDI): Payer ID for medical claims is 12115. How Does VGLI Compare to Other Insurance Programs? A claims scrubber software program is run to ensure completeness and to locate possible errors. More information can be found at the OPES website: http://opes.vssc.med.va.gov. one episode of care, which can have multiple dates within the prescribed treatment, one provider, as identified by the Tax Identification Number (TIN), and. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. The Implementer of this technology has the responsibility to ensure the version deployed is 508-compliant. Coverage will start July 1 of that year. All instances of deployment using this technology should be reviewed by the local ISO (Information Security Officer) to ensure compliance with. The values of Adjustment Codes 1 and 2 (ADJCD1 and ADJCD2) explain the reason for non-payment. Class 2 or Class 3 products must restrict their interfaces to Class 1 National Software to use of publicly-supported APIs ONLY. 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). Generally, VA does not bill Medicare or Medicaid for reimbursement; however, VA does bill other types of health insurance including Medicare Supplemental plans for covered services. [FeeInpatInvoice], [Fee]. Clinical variables in SAS format include ICD-9 diagnosis codes, ICD-9 surgical codes, CPT codes and CPT modifier codes, DRG codes and Present on Admission codes. Treatment date correlates to covered from/to. The invoice table would have to have a sufficient number of fields to accommodate the maximum number of procedures report on any invoice. All access or use constitutes understanding and acceptance that there is no reasonable There is a lack of publicly available technical documentation and support may be limited to specific forums. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). ", Military service variables can be found in [PatSub],[PatientServicePeriod], [Patient]. Most nursing home care is billed monthly, so there is one claim for each month of nursing home stay. SAS and SQL data are very similar, but not exact copies of each other. If a patient saw two different providers on the same date who use the same vendor for billing, it will not be possible to distinguish the two encounters. Prior to use of this technology, users should check with their supervisor, Information Security Officer (ISO), Facility Chief Information Officer (CIO), or local Office of Information and Technology (OI&T) representative to ensure that all actions are consistent with current VA policies and procedures prior to implementation. VIReC. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, Outreach, Transition and Economic Development Home, Warrior Training Advancement Course (WARTAC), Staff Appraisal Reviewer (SAR) Information, How to Apply for Nonsupervised Automatic Authority, VALERI (VA Loan Electronic Reporting Interface). Please see Section 2.1.4. for HERC advice about how to collapse multiple observations to evaluate the length and cost of a single inpatient stay. VA payment constitutes payment in full. There are substantial differences in quantity of inpatient diagnosis and procedure data available in SAS versus SQL. YESElectronic Remittance (ERA)YESICD- 1. VA can waive the deductible in hardship cases. The charge for an ambulance trip to a non-VA hospital may be paid through the Non-VA Medical Care program if the medical center determines that the hospital services meet the criteria for an unauthorized claim or a 38 U.S.C 1725 (Mill Bill) claim, or if the patient died while in route to the facility. Accessed October 16, 2015. Some missingness may indicate not applicable.. The discussion below pertains to both SAS and SQL data. Matching outpatient prosthetics order records in the VA National Prosthetics Patient Database (NPPD) to health care utilization databases. Before this time, data were entered by hand, and there was no easy way to tell whether the claim being entered was a duplicate one. In SQL, the fields containing these data can be found in the FeeDispositionCode and FeeDispositionName Refer to Appendix C for a list of Fee Disposition Codes. VA may be a secondary payer for unauthorized emergent claims under 38 U.S.C. When MDCAREID is not available, it is possible to assign MCCAREID based on the relationship between VEN13N and STA6A. Accessed October 16, 2015. Private health insurance coverage through a Veteran or Veteran's spouse is insurance provided by an employer, Veteran or other non-federal source, including Medicare supplemental plans. This care will be approved (or denied) by the local VA Fee Office; the Veteran is then free to seek non-VA care. VA evaluates these claims and decides how much to reimburse these providers for care. Please review the Where To Send Claims and the Where To Send Documentation sections below for mailing addresses and Electronic Data Interchange (EDI) details. For more detailed information, researchers should visit the VHA Office of Community Care website. Review the Supporting Documentation section below to learn how to properly submit supporting documentation with your claim. Use Azure Rights Management Services (Azure RMS) for encrypted email. VA-station related information includes STA3N, STA6A and STANUM in SAS and Sta3n and PrimaryServiceInstitution in SQL. The FeeSpecialtyCodeName contains information on the specialty of the provider seen, such as oncology, chiropractic, pathology, neurosurgery, etc., but is missing much data. With additional permissions, researchers can also access City, Postal Code, Street Address, and Zip. Patient identifiers are also different across SAS and SQL data. Business Product Management. 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. Menlo Park, CA. We view the patients insurance data in the VistA file if the claim is flagged as reimbursable in VistA and encompasses the dates on the claim. If a claim is filed for an eligible episode of care, VA must pay the whole amount according to the payment rules noted above. The VA payment (DISAMT) is typically less than or equal to the PAMT value, although in some cases VA will pay more than Medicare would pay. YESInstitutional/UB Claims. Payer ID: 1. Payer ID for dental claims is CDCA1. Eligibility and claims submission information for emergent care will be provided after notification is made to the VA. Claims for emergent care not eligible for authorization upon notification, may be eligible for consideration as Unauthorized Care. 2. The travel payments data contains reimbursements for particular travel events (TVLAMT). Note that some physicians use the same ID number as the hospital. Home Health Agencies billing with an OASIS Treatment number use the Prior Authorization segment for the TAC and the Referral Number segment on the 837I submission. The Fee Basis files are stored in two formats: SAS and SQL. It is not available for claims in which payment was based on a contract amount. A single inpatient encounter may generate zero, one, or multiple ancillary records, depending on the number of ancillary procedures and physician services received. Please note that this method providers an indication of the care provided to a Veteran on a single day, rather than in a single encounter, because multiple providers may use the same billing vendor. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. This application is directly attached to TWAIN compliant scanners and works offline to VistA and the FBCS MS SQL databases. The key field indicates which invoice they appeared on. Chief Business Office. Fee Basis tables, however, only list PatientSID and do not list PatientICN. Summary data are also available through the VHA Support Services Center (VSSC) website on the VA intranet. It will often times not be possible to determine the reason for an outpatient visit, as there will be multiple observations/CPT codes that denote a single visit. Fee Purpose of Visit is the recommended way to evaluate the category of the visit. Journal of Rehabilitation Research and Development. Veterans Crisis Line: This research was supported by the Health Services Research and Development Service, U.S. Department of Veterans Affairs (ECN 99017-1). Data Quality Analysis Team. Use of this technology is strictly controlled and not available for use within the general population.

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