va fee basis program claims address

to) monitoring; recording; copying; auditing; inspecting; investigating; restricting VA has established rules for timely filing of unauthorized and Mill Bill claims (i.e. The Veterans Access, Choice, and Accountability Act (Veterans Choice Act), passed in 2014, expanded veterans access to non-VA care. Identify Choice records by using tax ID and specialprovcat= CHOICE. Current Decision Matrix (10/21/2022) Chapter 1 presents an overview of Fee Basis data in general; Chapter 2 presents an overview of the variables in the Fee Basis data; and Chapter 3 describes how SAS versus SQL forms of Fee Basis data differ. To enter and activate the submenu links, hit the down arrow. Any variable that has an S prefix indicates secure data and requires special permission to access; researchers should be aware of this when submitting their IRB applications and their CDW DART data access requests. 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. 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. Below we describe the general types of information in both the SAS and SQL data. The vendor represents the entity billing for the non-VA care, while the provider represents the person who was involved in care provision. YESElectronic Remittance (ERA)YESICD- 1. The unique patient identifier by which to conduct SQL-based Fee Basis analyses is PatientICN. 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. However, 99% of inpatient hospital invoices were associated with a length of stay of 33 days or less. The Customer Engagement Portal is a reporting tool for VA Medical providers to verify the status of claims as well as run payment reconciliation reports. There are 34 Fee Basis Claims Systems (FBCS) servers, which were originally designed for episodes of care. [Patient], [Spatient]. VA systems are intended to be used by authorized VA network users for viewing and For more information call 1-800-396-7929. To access the menus on this page please perform the following steps. 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. 8. Prescription information: Prescribing provider's name. Claims for Non-VA Emergency Care All tablesmentioned in the Fee Basis guidebookare storedin an Excel file. 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). You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. Last updated August 21, 2017 In SQL, there are multiple patient identifiers, with the most useful being the PatientICN. Please visit Emergency Care Claims to learn more. (2) Additionally, a Veteran must also meet at least one of the following criteria. VA patients who receive prescriptions from non-VA providers fill them from a VA pharmacy, often the VA Certified Mail Order Pharmacy (CMOP). The Fee Basis files' primary purpose is to record VA payments to non-VA providers. Four FPOV (Fee Purpose of Visit) codes can be used to identify payment for unauthorized claims. All instances of deployment using this technology should be reviewed by the local ISO (Information Security Officer) to ensure compliance with. How to create a secondary claims in eclinicalworks electronically; . Inpatient data are housed in the FeeInpatInvoice table as well as the FeeServiceProvided table, although the latter does not contain only inpatient data. Thus, our recommendation is as follows: Use disbursed amount to calculate the cost of care, except in the case where disbursed amount is missing and the payment was not cancelled. 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: For example, if the Veteran had an Emergency Department (ED) visit and then was admitted to the hospital, this would be considered inpatient care. This technology is not portable as it runs only on Windows operating systems. 1728. HERC did not investigate use of NPI for this guidebook. U.S. Department of Veterans Affairs. Fee Basis data are housed in both SAS and SQL format. 2. NPI and Medicare IDs have an M to M relationship. In addition, VA may place a Veteran in a private or state-run nursing home when a bed in a VA nursing home is unavailable or if the nursing home is distant from the patients residence. If the patient is transferred from a non-VA to a VA hospital, the non-VA component of this care will be captured through Fee Basis, while the VA component of this care will be in the VA inpatient datasets. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). [FeeTravelPayment] contain information on travel type and payment. VA CCN OptumP.O. Care for dependent children, except newborns, in situations where VA pays for the mothers obstetric care during the same stay. Previously, VA could reimburse Veterans or pay non-VA hospitals directly only if a Veteran has no other health insurance. Both the SAS and SQL Fee Basis are housed at VINCI; the SQL data is also found at the Corporate Data Warehouse (CDW). 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. Mark Smith and Adam Chow were the authors of the original HERC guidebook, upon which this document builds. MDCAREID is the Medicare OSCAR number, which is a hospital identifier. Non-VA providers submit claims for reimbursement to VA. In SAS, the inpatient (INPT) file includes PAMT, the Medicare prospective payment that would apply to the stay. The SQL tables [Dim]. There is a lack of publicly available technical documentation and support may be limited to specific forums. March 2018: Due to the transition of the National Non-VA Medical Care Program Office to the VHA Office of Community Care and updates to the VINCI website, some documents may no longer be available. 13. 15. ", Military service variables can be found in [PatSub],[PatientServicePeriod], [Patient]. Researchers with VA intranet access can access these images by copying and pasting the URLs into their browser. Box 30780, Tampa FL 33630-3780. The Medicare hospital provider ID (MDCAREID) is entered by fee basis staff in order to calculate hospital reimbursement using the Medicare Pricer software. Go to CDW Home, click on CDW MetaData, then click on the link for Purchased Care. SAS has more data on inpatient diagnosis and procedure variables than do SQL data. Dental claims must be filed via 837 EDI transaction or using the most current. _____________________________________________________________________________. Researchers with VA intranet access can access these sites by copying and pasting the URLs into their browser. On March 17, 2022, The U.S. Court of Appeals for the Federal Circuit issued a ruling that changes VA's ability to reimburse as secondary payer under 38 U.S.C.1725. We tried to link the UB-92 form to identify Choice authorizations; however, we found few records and decided to use obligation number. HIPAA Transaction Standard Companion Guide (275 TR3)The purpose of this companion guide is to assist in development and deployment of applications transmitting health care claim attachments intending to support health care claim payment and processing by VA community care health care programs. YESInstitutional/UB Claims. Health Information Governance. Claims and other FBCS data will be found in PIT or Community Care Referral & Authorization domains. Researchers will need to decide whether they will use the SAS or the SQL data and apply for appropriate IRB approval for use. Attention A T users. For home loan matters, contact a Regional Loan Center and for Veteran Readiness and Employment matters, contact your local regional office at their physical address. However, the VA may pay a rate higher than the Medicare Fee Schedule rate for care provided in highly rural areas, as long as this rate is determined to be fair and reasonable by VA. One can find more information on payment rates under the Veterans Choice Act in federal regulation 17.1500. PatientIEN and PatientSID are unique to a patient within a facility, but not unique to a patient across VA facilities (e.g., a patient who had visited multiple VA facilities will have multiple PatientIENs and multiple PatientSIDs). This care will be approved (or denied) by the local VA Fee Office; the Veteran is then free to seek non-VA care. NOTE: The processes outlined below are exclusive to supplying documentation for unauthorized emergent care. These data indicate the specialty code associated with the vendor, such as orthopedic surgery, cardiology, family practice, etc. For example, an interest payment of $14.21 would appear as 1421. INTAMT is part of DISAMT; it should not be added to them. Some Fee Basis data will also appear in the non-VA medical SAS inpatient file (formerly called the Patient Treatment File). This technology integrates with Veterans Information Systems and Technology Architecture (VistA) through Massachusetts General Hospital Utility Multi-Programming System (MUMPS) or a Structured Query Language (SQL) database system on the backend. Fee Basis data files contain information regarding both the care the Veteran received and the reimbursement of the care. In some cases it may appear that single encounters have duplicate payments. In the outpatient data, one observation represents a single CPT code. VINCI. Review the Supporting Documentation section below to learn how to properly submit supporting documentation with your claim. Attention A T users. No new extracts will occur. A valid receipt showing the amount paid for the prescription. Consult the latest CDW schematic diagrams to understand the tables in which your variables of interest are housed and the primary key and foreign keys needed to link each pair of tables. FBCS Upload leverages LEADTOOLS Professional Optical Character Recognition (OCR) and is included in the FBCS workstation install package. A foreign key is a key that uniquely identifies a record of another table. The 2 sets of DRGs are not interchangeable. 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. Analyses of FY 2014 data indicate approximately 50% of inpatient observations and 43% of outpatient observations are missing NPI. Data Quality Program. Many URLs are not live because they are VA intranet only. This can become complicated by the fact that not all encounters relating to the same inpatient stay will have the same admission and discharge dates. 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. Conversely, all stays should have at least one discharge diagnosis. In SQL, the patient ID will be the PatientICN or PatientSID, and the admit date is the admission date.. All observations for this particular patient ID, STA3N and VEN13N where the admission date comes on or after the admission date of the first record AND the discharge date comes on or before the temporary end date are considered to be part of the same inpatient stay. If the gap is 0 or 1, it is part of the same hospital stay and we then want to assess its discharge date. Non-VA providers submit claims for reimbursement to VA. Name of the medication. In this way, records that are missing MDCAREID can be given a MDCAREID based on the value of VEN13N and STA6A in the record. The vendor has verified that the VA no longer has an active contract for this technology and any instances of this software on the VA network should be removed. Thus, one could not simply use the patient identifier and the admission and discharge dates to collapse these observations into one inpatient stay. Lump sum payments are not paid via FBCS. 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.. In SAS, the outpatient data are housed in the MED files. Therefore, to make a complete assessment of the payments for inpatient cases, researchers should evaluate the outpatient files along with the inpatient and ancillary files. 1. Hit enter to expand a main menu option (Health, Benefits, etc). Through the CCN, Veterans have access to regional networks of high-performing, licensed health care . However, not all data in the FeeServiceProvided table are outpatient data; some may pertain to inpatient stays. The VA Fee Basis medical program provides payment authorization for eligible Veterans to obtain routine medical treatment services through non-VA health care providers. Persons looking to classify Veterans military service are encouraged to read the Data Quality Analysis Teams guidance on Identifying Veterans in the CDW(VA intranet only:http://vaww.vhadataportal.med.va.gov/Portals/0/DataQualityProgram/Reports/Identifying_Veterans_in_CDW.pdf).14. 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. Community providers have three options that allow for that linkage: Submit the claim electronically via 837 transaction and the supporting documentation via 275 transaction. Facility charges vs. ancillary charges: There are instances when there may be claims for facility charges with no corresponding ancillary provider charge. There are different ways of costing out an inpatient stay in SAS and SQL data. If a claim is filed for an eligible episode of care, VA must pay the whole amount according to the payment rules noted above. To access the menus on this page please perform the following steps. On March 17, 2022, The U.S. Court of Appeals for the Federal Circuit issued a ruling that changes VAs ability to reimburse as secondary payer under 38 U.S.C.1725. 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. Accessed October 16, 2015. SQL data must be linked from multiple tables in order to create an analysis dataset. Additional information on accessing the AITC mainframe is available on the VHA Data Portal (VA intranet only: http://vaww.vhadataportal.med.va.gov/Home.aspx). Given these different patient identifiers, it is difficult to conduct exact comparisons between SAS and SQL data. 4. However, there are some outliers; some claims can take up to 8 years to process. The CDW SharePoint site has a document that lists the purchased care SQL tables, the fields of that they contain, and some sample SQL queries (VA intranet only: https://vaww.cdw.va.gov/metadata/Metadata%20Documents/Forms/AllItems.aspx). For authorized care, the referral number listed on the Billing and Other Referral Information form. The CDW is a relational database organized into a collection of data domains implemented on the Microsoft SQL server in VINCI. To understand what procedures were performed during an inpatient stay in the [Fee]. http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. 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]. Outpatient prescriptions beyond a 10-day supply. Researchers and analysts will have to take care to collapse observations properly if warranted, for example to determine the costs, procedures or diagnosis associated with a single stay or visit. Persons who wish to access data in the secure tables on CDW (denoted by a S prefix) must complete a Real SSN Access Request Form. This form must be signed by the IRB and Associate Chief of Staff for Research and submitted with the DART data request. VA is the primary and sole payer when VA issues an authorization. VA Informatics and Computing Resource Center (VINCI). To enter and activate the submenu links, hit the down arrow. 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. Veterans Health Administration. There is no separate payment for items such as oxygen or other supplies, the number of attendants, providing an EKG during the trip, etc. The Fee Basis files are stored in two formats: SAS and SQL. To learn more, please visit the Provider Training section on the MES website . access; blocking; tracking; disclosing to authorized personnel; or any other authorized [OEFOIFService]and [Dim].[POWLocation]. For example, sta3n 589A5 will be found as 589. 7. A record is created only if there is a code on the invoice to be recorded. At the time of writing, SAS data at CDW are available only to those persons with VA operations access. Internal use only. This table also includes claims related to inpatient care and other services. Download the tables here. U.S. Department of Veterans Affairs. 3. SQL inpatient data contain up to 5 diagnoses and 5 procedure codes, while SAS inpatient data contain up to 25 diagnosis codes and up to 25 procedure codes. Box 14830Albany, NY 12212. As noted above, in SAS, the patient identifier is the SCRSSN; this is unique to each patient across the entire VA. is ok, 12.6.5 is ok, 12.6.9 is ok, however 12.7.0 or 13.0 is not. Accessed October 16, 2015. How Much Life Insurance Do You Really Need? VINCI Data Description: Fee/Purchased Care [online; VA intranet only]. For more information call 1-800-396-7929. 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. VIReC. 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. Last updated validated on Tuesday, January 3, 2023 Get the latest updates on VA community care, including program changes, resources and more! In some cases it may appear that single encounters have duplicate payments. Regardless of whether the care was pre-authorized or not, non-VA providers submit claims to VA if they wish to be reimbursed for care. 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. The discussion below pertains to both SAS and SQL data. Hit enter to expand a main menu option (Health, Benefits, etc). To access the menus on this page please perform the following steps. The vendor and the provider may or may not be the same entities. SQL data are housed at CDW, which is a collection of many servers. The vendor no longer supports VA installations of this technology. Claims. 12. 1. Through patient identifier and travel date (TravelPaymentDate), one can link these payments to inpatient and outpatient encounters. 1-800-273-8255 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. All Fee Basis care will be found in the Fee files. NNPO. Beware of VISNS 4, 15, and 23, as they have their own integrated system. Attention A T users. For The Fee Basis program or Non-VA Care is health care provided outside VA. NVCC Office coordinates services and payments for Veterans receiving non-VA care for emergent and non-emergent medical care. The FMS disbursed amount is the payment amount plus any interest payment. You can submit a corrected claim or void (cancel) a claim you have already submitted to VA for processing, either electronically or in paper. [PatientRace] tables. If a patient received care at another facility, that patient will be have a different PatientSID assigned for that facility. Patient identifiers are also different across SAS and SQL data. Steps to collapse records into a single inpatient stay: 1. visit VeteransCrisisLine.net for more resources. As noted earlier, there are often multiple records that indicate a single inpatient stay each record pertains to a unique invoice number. Below are some answers to general questions about the FBCS tables. Through patient ID (SCRSSN) and travel date (TVLDTE) one can link these payments to inpatient and outpatient encounters. 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. This component communicates with the FBCS MS SQL and VistA database in real time. Payment for care provided under the Veterans Choice Act may not exceed the Medicare Fee Schedule (i.e. visit VeteransCrisisLine.net for more resources. Office of Information and Analytics. If notification was not made to VA and you wish to have claims considered for payment, please submit claims and supporting documentation to VA as listed in the "Where to Send Claims" dropdown below. All instances of deployment using this technology should be reviewed to ensure compliance with. Procedures are identified by CPT code (CPT1) in the non-hospital inpatient services (the ancillary file) and in the outpatient procedures file. Actual processing time has varied considerably over the years. 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. Researchers evaluating care over time may want to use the DRG variable. 1. If the Veteran went to the ED and was not admitted to the hospital, this would be considered outpatient care. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. Please switch auto forms mode to off. VA employees working on operations studies can build their own crosswalk file as they have permission to use these file. The second record would have an admission date of Jan 5, 2010 and a discharge date of Jan 5, 2010. The base rate varies by level of ambulance service provided, locality of the Medicare carrier area, and Point of Pickup (POP) zip code classification: urban, rural, or "super rural." To enter and activate the submenu links, hit the down arrow. 2. [XXX] tables.9,12 Tables under the DIM schema contain attributes that describe the records in the Fee tables. Non-VA Medical Care data may be tabulated at the VHA Support Services Center (VSSC) (VA intranet only: http://vssc.med.va.gov/). 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. For example, accessing FY2014 data on Dec 1, 2014 will likely result in fewer observations than when accessing FY 2014 data on Dec 1, 2015. 400, Wittman Drive Grand Rapids Itasca County MN - 55744 United States. Bowel and Bladder Care. Most nursing home care is billed monthly, so there is one claim for each month of nursing home stay. In both SAS and SQL data, outpatient data are organized in long format, with one record per CPT code. Please contact the referring VAMC for e-fax number. We present here one way to collapse records into a single inpatient stay, but users may wish to develop their own method specific to the research question at hand. The Fee Purpose of Visit Code (FPOV) has strong guidance from VA Fee Basis Office and thus may be a more accurate way of categorizing care. It is not necessarily the station at which the Veteran receives most VA care or the station which will pay for a particular Non-VA Medical Care service. Chapter 4 offers detailed information SAS Fee Basis data; Chapter 5 provides detailed information about SQL Fee Basis data. Users interested in learning the rules in force at a particular point in time should contact the VHA Office of Community Care. For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/. Veterans Choice Program - Fee Basis Claims System in CDW Fee Basis Claims System (FBCS) in the VA Corporate Data Warehouse All Choice claims are processed by VISN 15. VA can waive the deductible in hardship cases. The amount claimed (PAMTCL) appears in the inpatient (INPT) file alone; there is no claimed amount on the outpatient side. April 14, 2014. VA Directive 6402, Modifications to Standardized National Software, Document Storage Systems (DSS) DocManager, Microsoft Structured Query Language (SQL) Server, Optical Character Recognition (OCR) Module, Fidelity National Information Service (FIS) Compass. 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). This application completes the update of critical claims data into the FBCS shared MS SQL database for further processing and reporting. 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. This is helpful in determining the location of care in inpatient claims in which MDCAREID is missing, and in outpatient claims for hospital-provided services. [FeeInpatInvoiceICDDiagnosis] with the [Dim]. 9. 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. Appendix E includes a list of SQL fields related to the type of care a patient receives. These vendors are presumably hospital chains. 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. With few exceptions these variables will be of little interest to researchers. 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. What documents are required by VA to process claims for. While VA always encourages providers to submit claims electronically, on and after May 1, 2020, it is important that all documentation submitted in support of a claim comply with one of the two paper submission processes described. The prescription must be for a service-connected condition or must otherwise have specific approval. Note that the vendor may represent the hospital, a hospital chain or the entity billing on behalf of the provider.