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Fee Basis: 214-857-1397 C & P. VA Claims Representation; RESOURCES. VINCI. 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. The National Provider Identifier (NPI) is a unique 10-digit identification number issued by the Centers for Medicare and Medicaid Services to all health care providers in the United States. Ready. 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). These data records cannot be linked to particular patient identifiers or encounters. We give an example here that relates to FeeInpatInvoice table. This latter table contains a variable called InitialTreatmentDateTime. 8. 1725 may only be made if payment to the facility for the emergency care is authorized, or death occurred during transport. FBCS is designed to be used in the Fee Basis Departments of the Veteran Affairs Medical Centers (VAMCs). How to create a secondary claims in eclinicalworks electronically; . Under this regulation, ambulances will be reimbursed at the lesser of (a) the amount the Veteran is personally liable or (b) 70 percent of the applicable Medicare Ambulance Fee Schedule. Payer ID: 1. 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). Payment of ambulance transportation under 38 U.S.C. Fee Basis data are housed in both SAS and SQL format. 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). Using SQL data will allow the researcher to link to other rich data found in CDW, such as the Health Factors data. Users must ensure sensitive data is properly protected in compliance with all VA regulations. The 2 sets of DRGs are not interchangeable. Of note, the relevant SQL tables for Fee Basis data are not only the [Fee]. Lump sum payments are not paid via FBCS. In SAS, the Patient ID will be the SCRSSN and the admit date is the treatment from date. Facility charges vs. ancillary charges: There are instances when there may be claims for facility charges with no corresponding ancillary provider charge. Veterans Health Administration. Mark Smith and Adam Chow were the authors of the original HERC guidebook, upon which this document builds. Researchers will need to decide whether they will use the SAS or the SQL data and apply for appropriate IRB approval for use. American Society of Health-System Pharmacy (ASHP). DART is a workflow application that guides users through the request by collecting the appropriate documents, distributing documentation to reviewers, and assisting in communication between requestors and reviewers. Payment guidelines for non-VA are outlined in federal regulations 17.55 and 17.56. Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. As a Class 2 or Class 3 product, it MUST NOT be assumed to having been released into production through all OI&T product release and sustainment process controls for project management; requirements, development and testing management; and configuration, change, and release management necessary to satisfy OI&T process and product compliance. A subsequent report will contain the results of an audit conducted to assess National Provider Identifier: Submit all that are applicable, including, but not limited to billing, rendering/servicing, and referring. If FIPS 140-2 encryption at the application level is not technically possible, FIPS 140-2 compliant full disk encryption (FOE) must be implemented on the hard drive where the DBMS resides. is ok, 12.6.5 is ok, 12.6.9 is ok, however 12.7.0 or 13.0 is not. Researchers will need to link to the Patient and SPatient domains to access this geographic information in the SQL data. _____________________________________________________________________________. Of note, the FBCS was not in place nationwide prior to FY 2008. Box 108851Florence SC29502-8851, Delta Dental of CaliforniaVA Community Care NetworkP.O. to) monitoring; recording; copying; auditing; inspecting; investigating; restricting Through the CCN, Veterans have access to regional networks of high-performing, licensed health care . They appear in Table 6, where an X indicates that the variable appears in the file.10 Vendor type (TYPE), payment category (PAYCAT), treatment code (TRETYPE), and place of service (PLSER) all provide information on the type or setting of care. 2. There is a lack of publicly available technical documentation and support may be limited to specific forums. 1. Accessed October 16, 2015. The prescription must be for a service-connected condition or must otherwise have specific approval. Domains represent logically or conceptually related sets of data tables. 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. 1-800-273-8255 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. VA CCN OptumP.O. The status value A stands for accepted, meaning the claim was paid. Money collected by VA from private health insurance carriers is returned back to the VA medical center providing the care. To evaluate the time it takes VA to process Fee Basis claims, we evaluated SAS data for FY2014. Given these delays in processing claims, we recommend that analyses use Fee Basis data from 2 years prior to the current date to ensure almost complete capture of inpatient, ancillary and outpatient data. Non-VA Payment Methodology Matrix [online; VA intranet only]. A claims scrubber software program is run to ensure completeness and to locate possible errors. 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). Each year represents the year in which the claim was processed, not the year in which the service was rendered. This guidebook is intended to help researchers understand and use the National Fee Basis files, which come in both SQL and SAS formats. For current information on Community Care data, please visit the page. http://www.mssny.org/Documents/Enews/Aug%208%202014/VA%20ProvidersGuide.pdf, http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. This application reads/creates/edits fee payment data in VistA and copies critical information into the central SQL database for off-line VistA applications to consume, and now includes Unauthorized payments. Researchers should use PatientICN to link patient data within CDW. [Patient], [Spatient]. Most importantly, they do not represent all care provided during the fiscal year. Data Quality Program. Subscribe to our E-newsletter The Service Connection Our monthly newsletter features about important and up-to-date veterans' law news, keeping you informed about the changes that matter. 1725 or 38 U.S.C. 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. 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. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). There is a CPT field in the inpatient files, but this is always missing; hospitals do not use CPT codes to bill. VA Palo Alto, Health Economics Resource Center;November 2015. To enter and activate the submenu links, hit the down arrow. Make sure the services provided are within the scope of the authorization. These data indicate the specialty code associated with the vendor, such as orthopedic surgery, cardiology, family practice, etc. Download the tables here. Access; upload; download; change; or delete information on this system; Otherwise misuse this system are strictly prohibited. Defining a cohort is an activity that is different for each project and depends on the research question at hand. These represent cases in which payment is disallowed. NNPO. 13. The UB-92 equivalent variables would be: facility (after merging in facility name from the FBCS_Facilities table), vistapatkey, and vistaauthkey, respectively. At the time of writing, version 4.2 is the most current version. 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. Medication dosage/strength. The two tables can be joined through FeePharmacyInvoiceSID. Multiple SQL tables contain these variables. VA Form 10-583, Claim for Payment of Cost of Unauthorized Medical Services. Therefore, to get an understanding of the total cost of this care, one would have to link the Fee Basis data to VA utilization datasets. The mileage is calculated using the fastest route. Claims. The veteran must wait over 30 days past their preferred appointment date or the date deemed medically necessary by their provider, b. Technology must remain patched and operated in accordance with Federal and Department security policies and guidelines in order to mitigate known and future security vulnerabilities. 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. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. We are grateful for their cogent work. Unlike the other patient identifiers in SQL such as PatientIEN or PatientSID, PatientICN is supposed to be unique to each patient across VA. Claims for Non-VA Emergency Care In VA datasets, the MDCAREID does not have an accompanying address, but one can use other non-VA datasets (e.g., Hospital Compare) and determine the address of the hospitals physical location through the common MDCAREID variable. PatientIEN and PatientSID are found in the general Fee Basis tables. However, we conducted some comparisons for inpatient data. Available at:http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. Note: records with status= R can have missing values for the variables vistapatkey and vistaauthkey, depending on whether or not these were linked before rejecting as a re-route to HAC. Optum is a proud partner with the VA through its Community Care Network (CCN). More information about can be found on their website: https://www.va.gov/communitycare/. Up to FY2008 data, DXLSF is labeled as 1st Diagnosis Code. In FY2009 and on, DXLSF is labeled as the Admitting or Primary Diagnosis Code. In FY 2009 and later SAS data, there is also another variable, DX1, which is not present in SAS data prior to FY2009. 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. The SAS files also include a patient type variable (PATTYPE). Please switch auto forms mode to off. For example, a technology approved with a decision for 12.6.4+ would cover any version that is greater than 12.6.4, but would not exceed the .6 decimal ie: 12.6.401 PLSER values overlap considerably with those of the Medicare Carrier Line Place of Service codes. More detailed information about the vendor can be found in the SQL [Dim]. TRM Proper Use Tab/Section. This is true for both the inpatient and outpatient data. Multiple claims can be paid against a single authorization. Some missingness may indicate not applicable.. a. 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. [FeePrescription] tables. Payer ID for dental claims is 12116. In that case, use payment amount instead. Payer ID for dental claims is CDCA1. Researchers will thus need permissions to allow the CDW data manager to obtain SCRSSN or SSN to PatientICN crosswalk to allow for the necessary data linkages. SAS data are housed in 8 ready-to-use datasets per fiscal year. In some cases it may appear that single encounters have duplicate payments. No, only one type of care can be covered by a single authorization. Last updated August 21, 2017 Business Product Management. Plan Name or Program Name," as this is a required field. 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). We gratefully acknowledge comments and contributions from Sharon Dally, Susan Schmitt and Paul Barnett. In both the SAS and the SQL data, there are usually multiple observations per patient encounter. The specific locations of the SAS payment variables and the SQL payment variables can be found in Chapters 4 and 5, respectively. To enter and activate the submenu links, hit the down arrow. Summary Fee Basis expenditure data are also available through the VHA Support Services Center (VSSC) intranet site, further information about accessing these summary data can be found in Chapter 6. FBCS supports payment of claims via VistA. The PatientSID is a CDW assigned identifier that uniquely identifies a patient within a facility. Training - Exposure - Experience (TEE) Tournament. The travel payment data contains reimbursements for particular travel events (TravelAmount). Fee Basis data live in both SAS and SQL format. Journal of Rehabilitation Research and Development. Thus, unauthorized care is not unpaid care it is simply not PRE-authorized care. This component allows the site access to Communications, Configuration and Reporting options for FBCS. [ICD] table, the latter of which contains a list of all possible ICD-9 codes. In FY05, DRG001 means CRANIOTOMY- >17 W CC, compared to HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC for DRG001 in FY15 DRG001. 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. In both SAS and SQL, it can be difficult to determine the provider the Veteran saw for Fee Basis care. To file a claim for services authorized by VA, follow instructions included in the Submitting Claims section of the referral. SAS and SQL also have several geographic fields related to the vendor providing the non-VA care, such as the vendors city, county, state and zip code. Some Fee Basis data will also appear in the non-VA medical SAS inpatient file (formerly called the Patient Treatment File). VA will arrange for transportation for them or will reimburse expenses on the basis of vouchers submitted. and constitutes unconditional consent to review and action including (but not limited These vendors are presumably hospital chains. Institutional Aspects of the Non-VA Medical Care System, https://www.va.gov/health-care/get-reimbursed-for-travel-pay/, http://www.va.gov/opa/choiceact/documents/Choice-Program-Fact-Sheet-Final.pdf. Persons looking to find the date of service should be advised that it will not be contained in the FeeServiceProvided table. Much Fee Basis care is pre-authorized prior to the Veteran obtaining care and is thus considered Authorized Care. Payment for care provided under the Veterans Choice Act may not exceed the Medicare Fee Schedule (i.e. Data Quality Program. 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. [OEFOIFService]and [Dim].[POWLocation]. Non-VA providers submit claims for reimbursement to VA. Non-VA Medical Care data may be tabulated at the VHA Support Services Center (VSSC) (VA intranet only: http://vssc.med.va.gov/). 988 (Press 1). 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 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. This component provides a front end for scanning claim forms into a temporary image queue for a given patient. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. Request and Coordinate Care: Find more information about submitting documentation for authorized care. 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. Claims for Non-VA Emergency Care A description of the Patient and SPatient schema is available on the VIReC CDW Documentation webpage: http://vaww.virec.research.va.gov/CDW/Documentation.htm (intranet only). Available at: http://www.mssny.org/Documents/Enews/Aug%208%202014/VA%20ProvidersGuide.pdf, 6. ______________________________________________________________________________. Persons working with the SAS data should keep in mind that prior to FY 2007, the disbursed amount (DISAMT) had an implied decimal point whereas the payment amount (AMOUNT) did not. Facility Information Security Officers (ISOs) are often the CUPS POC. Treatment date correlates to covered from/to. Most, if not all, of this care should be emergency care. have hearing loss, Community Care Network Region 1 (authorized), Community Care Network Region 2 (authorized), Community Care Network Region 3 (authorized), Community Care Network Region 4 (authorized), Unauthorized Emergent Care (unauthorized). 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. The discussion below pertains to both SAS and SQL data. 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. Department of Veterans Affairs Claims Intake Center PO Box 4444 Janesville, WI 53547-4444 Or, you can fax it to: (844) 531-7818 (inside the U.S.) (248) 524-4260 (outside the U.S.) Visit your local VA regional office or Benefits Delivery at Discharge Intake Site and speak with a VA representative to assist you. FPOV values of 32 and 33 also indicate ED visits, but are only observed in the Ancillary file. The Veteran's full 9-digit social security number (SSN) may be used if the ICN is not available. http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf. The diagram below (Figure 1) displays how payment is processed and sent to the non-VA provider. 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. A Fee table will contain a record for an ICD-9 code, whereas a DIM table will contain the possible values of that ICD-9 code. 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. There are a number of different variables that denote the category of care a Veteran received through Fee Basis (see Table 2) Appendices B and H present more details about the values these variables can take. VA HEALTH CARE Management and Oversight of Fee Basis Care Need. Questions about care and authorization should be directed to the referring VA Medical Center. CLAIMS INTAKE CENTER. 3. SAS and SQL data are organized differently and contain different variables. [SPatient] and[PatSub] tables. [FeeServiceProvided], [Fee]. Each prescription record has a fill date and a patient identifier (either PatientICN or scrambled social security number). However, one also needs to exercise caution with DRG; there are 2 different sets of DRGs used over time. The quantity dispensed. With few exceptions these variables will be of little interest to researchers. The new temporary end date is the maximum of the discharge date of the third observation and temporary end date from Step 2. The SAS data are stored at AITC. However, not all dates on the claim are approved. or use of this system constitutes user understanding and acceptance of these terms Available at: http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf.. 3. . VA has established rules for timely filing of unauthorized and Mill Bill claims (i.e. In SAS, data are stored in variables, observations and datasets. The PHR file contains information on the cost-related data associated with the prescription, while the PHARMVEN file contains information on the vendor associated with the prescription. access; blocking; tracking; disclosing to authorized personnel; or any other authorized Not all of these variables appear in every utilization file. [Spatient], and [Spatient]. The SQL tables [Dim]. How Much Life Insurance Do You Really Need? 3. National Institute of Standards and Technology (NIST) standards. The unique patient identifier by which to conduct SQL-based Fee Basis analyses is PatientICN. Name of the medication. Inpatient care beyond the time when a patient is stabilized and can be transferred to a VA facility, except where a VA facility is not feasibly available. 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: Include the 17 alpha-numeric (10 digits + "V" + 6 digits) VA-assigned internal control number (ICN) in the insured's I.D. This care will be approved (or denied) by the local VA Fee Office; the Veteran is then free to seek non-VA care. *From the date the Veteran was discharged from the facility that furnished the emergency treatment; the date of death, but only if the death occurred during transportation to a facility for emergency treatment or if the death occurred during the stay in the facility that included the provision of the emergency treatment; or the date the Veteran exhausted, without success, action to obtain payment or reimbursement for treatment from a third party. The variable DTStamp represent the date the claim was received. Steps to collapse records into a single inpatient stay: 1.