Please switch auto forms mode to off. Hit enter to expand a main menu option (Health, Benefits, etc). 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). MDCAREID is available in most inpatient SAS Fee Basis records. Electronic Data Interchange (EDI): Payer ID for medical claims is TWVACCN. Each table has only one primary key field. VA Technical Reference Model v 23.2 DSS Fee Basis Claims Systems (FBCS) General Decision Reference Component Category Analysis General Information Technologies must be operated and maintained in accordance with Federal and Department security and privacy policies and guidelines. Fee Basis providers vary in how frequently they submit an invoice for Fee Basis care. U.S. Department of Veterans Affairs. HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. For additional information or assistance regarding Section 508, please contact the Section 508 Office at Section508@va.gov. Conversely, all stays should have at least one discharge diagnosis. Box 30780 Tampa, FL 33630-3780, P2E Documentation Cover Sheet, VA Form 10-10143f. CLAIMS INTAKE CENTER. Of note, the FBCS was not in place nationwide prior to FY 2008. 2. FBCS is where weve spent the bulk of our time investigating. Menlo Park, CA. Emergent care patient liabilities not tied to copayments or deductibles will continue to be considered for secondary payment by VA. For additional questions, contact VA by phone, tollfree, at (877) 881-7618. Non-emergency care must be approved before the Veteran seeks care in the community.3 For traditional Non-VA care, a Veterans VA provider will submit a request at the local VA facility for Veteran care provided by Fee Basis. The Fee Basis data contain a unique variable not found in the traditional VA inpatient and outpatient datasets: the Fee Purpose of Visit (FPOV) variable. Users must ensure that Microsoft .NET Framework, Microsoft Structured Query Language (SQL) Server, and Microsoft Excel are implemented with VA-approved baselines. The vendor and the provider may or may not be the same entities. The travel payment data contains reimbursements for particular travel events (TravelAmount). Please contact the referring VAMC for e-fax number. 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. 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. 1-800-273-8255 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. For The Act amends 38 U.S.C. For pension claims, use the Pension Management Center (PMC) that serves your state. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. At the time of writing, SAS data at CDW are available only to those persons with VA operations access. Non-VA providers submit claims for reimbursement to VA. These data records cannot be linked to particular patient identifiers or encounters. 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/. 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. [FeePharmacyInvoice] table contains information on vendor, amount claimed, and amount paid. In this way, records that are missing MDCAREID can be given a MDCAREID based on the value of VEN13N and STA6A in the record. Claims for Non-VA Emergency Care U.S. Department of Veterans Affairs. Seven refer explicitly to Veterans alone, while the remaining two are for diagnostic services or eligibility exams, neither of which constitutes treatment. From there, it is sent weekly to AITC in SAS format and nightly to CDW in SQL format. 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. This component is a service that communicates with the Program Integrity Tool (PIT) which scores claims and sends results to FBCS. As a single encounter may have more than one CPT code, users may have to aggregate multiple observations in order to evaluate the care received on a particular day. In both SQL and SAS data, there is also a variable regarding the fee specialty code. Hit enter to expand a main menu option (Health, Benefits, etc). Menlo Park, CA. Not all of these variables appear in every utilization file. However, previous HERC investigation confirmed these are partial payments made for a single encounter or procedure. There are multiple methods by which community providers may electronically provide VA with the required medical documentation for care coordination purposes. Linking Patient Data in the CDW Update [online; VA intranet only]. To enter and activate the submenu links, hit the down arrow. VA-station related information includes STA3N, STA6A and STANUM in SAS and Sta3n and PrimaryServiceInstitution in SQL. 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. We compared the service date (TREATDTO in inpatient and ancillary, TREATDT in outpatient, and FILLDTE in pharmacy files) to the FMS processing date (PROCDTE) (See Table 1). The data regarding the clinical encounter as well as the charge and payment for that encounter are populated into the VA Health Information Systems and Technology Architecture (VistA). Using the Non-VA Medical Care data for research requires a basic understanding of laws and regulations that govern it. This technology can integrate with and alter database technologies. If you are in crisis or having thoughts of suicide, would cover any version of 7.4. The SQL prescription data are housed in the [Fee]. Attention A T users. SAS versus SQL data differ in three main ways: Appendix A lists all variables in the SAS files. There may be multiple STA3Ns for a single inpatient stay. Persons looking to find the date of service should be advised that it will not be contained in the FeeServiceProvided table. There may be multiple CPT codes associated with a single encounter. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. In some cases, there is a one-to-one relationship between VEN13N and MDCAREID. NOTE: The processes outlined below are exclusive to supplying documentation for unauthorized emergent care. However, not all data in the FeeServiceProvided table are outpatient data; some may pertain to inpatient stays. VA employees working on operations studies can build their own crosswalk file as they have permission to use these file. 1. Most ED visits will be identified through FPOV values of 32 or 33. 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. VA decisions for specific versions may include + symbols; which denotes that the decision for the version specified also includes versions greater than 2. Documentation in support of a claim may include: *NOTE: Documentation not required includes flowsheets and medication administration. 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. Persons looking to classify patients Veterans by race and ethnicity are encouraged to read VHA guidance available on the Data Reports page of the VHA Data Portal (available on the intranet at http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). In both SAS and SQL data, outpatient data are organized in long format, with one record per CPT code. The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. If that analyst examines VEN13N and STA6A (in inpatient Fee Basis data, this field represents the VA hospital arranging care), there is often only one MDCAREID. Submit a claim void when you need to cancel a claim already submitted and processed. http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. For example, sta3n 589A5 will be found as 589. 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). Note: The last extract occurred in December 2020. Under the Veterans Choice Act, eligible veterans are able to obtain outpatient care outside the VA using their Choice Card. Chapter 4 offers detailed information SAS Fee Basis data; Chapter 5 provides detailed information about SQL Fee Basis data. Veterans Health Administration. [FeeInpatInvoiceICDProcedure] table. There are two types of keys: primary keys and foreign keys. There is limited information on the providers associated with Fee Basis care. SAS Fee Basis data can be linked to other SAS files with additional demographic data (e.g., Vital Status files, enrollment files). Fee Basis data are housed in VA in both SAS dataset format and Microsoft SQL server tables (hereafter referred to as SQL data). 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. U.S. Department of Veterans Affairs. Smith MW, Su P, Phibbs CS. The Medicare Ambulance Fee Schedule consists of a base rate plus mileage. The mileage is calculated using the fastest route. A Non-VA Medical Care claim is defined by four elements: The remainder of section 7.4 details payment rules as of early 2015. U.S. Department of Veterans Affairs. The same cannot be said for DX2-DX25, however, as additional diagnosis codes are optional. If the provider declines VA payment then it may be able to charge the patient a greater total amount. [ICDProcedure] table and a foreign key in the [Fee]. There are substantial differences in quantity of inpatient diagnosis and procedure data available in SAS versus SQL. A claims scrubber software program is run to ensure completeness and to locate possible errors. Again, date of service is not available in the FeeServiceProvided table. March 2015. 11. 1. 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. 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. Prescription-related data in the PHARVEN file contain only summary payments by month. However, we conducted some comparisons for inpatient data. Each year represents the year in which the claim was processed, not the year in which the service was rendered. See the FBCS page (CDW Raw) on the CDW SharePoint site (VA intranet only: https://vaww.cdw.va.gov/bisl/Database/SitePages/Raw%20Extractor.aspx) for more information. When a key field is missing, SQL indicates this with a value of -1. Appendix H lists their current values. 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 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 improves claim accuracy and reduces the amount of time it takes for us to process claim determinations. In SAS, the cost of an inpatient stay can be determined by summing the cost from DISAMT in the inpatient files with the DISAMT from the ancillary observations that correspond to the inpatient stay; however, the inpatient and ancillary files alone may not be sufficient to account for the entire cost of care. Many veterans now have access to Non-VA medical care through the new Veterans Access, Choice, and Accountability Act (VACAA, or Choice Act). As noted in Chapter 2, the important variables capturing cost of care are AMOUNT and DISAMT. For current information on Community Care data, please visit the page VA Community Care Data. Each prescription record has a fill date and a patient identifier (either PatientICN or scrambled social security number). Researchers will have to select observations from the SQL FeeServiceProvided table in order to ensure they are only evaluating outpatient data. Much Fee Basis care is pre-authorized prior to the Veteran obtaining care and is thus considered Authorized Care. Make sure you have received an official authorization to provide care or that the care is of an emergent nature. Each observation in the SAS and SQL data has an accompanying vendor ID. When evaluating the cost of care, use the disbursed amount. The NPI is the national provider identifier, which is provider-specific but often missing in the Fee Basis data. 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. [ICDProcedure] table through the ICDProcedureSID. For example, if one wishes to evaluate the cost of certain diagnoses in inpatient care through SQL data, this would require the linking of multiple tables before being able to conduct any analyses such as [Fee]. To learn more, please visit the Provider Training section on the MES website . There are different ways of costing out an inpatient stay in SAS and SQL data. A valid receipt showing the amount paid for the prescription. This is true for both the inpatient and outpatient data. As of April 2019, this guidebook is no longer being updated. Move on to the next patient ID, STA3N, VEN13N combination and repeat the entire process above. Important: The mailing address below only pertains to disability compensation claims. VA has adopted a policy of processing payments for certain EDI claims outside of FBCS (Choice/PCCC) by rerouting the EDI claims back to the HAC, causing them to reach terminal status in FBCS and triggering a transition to the PIT repository. Fee Basis data are housed in both SAS and SQL format. 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. Note: A Veterans insurance coverage or lack of insurance coverage does not determine their eligibility for treatment at a VA health care facility. The Department of Veterans Affairs' (VA) fee basis care spending increased from about $3.04 billion in fiscal year 2008 to about $4.48 billion in fiscal year 2012. Veterans Crisis Line: 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. For example, the meaning of DRG001 is not the same in FY05 vs FY15. U.S. Department of Veterans Affairs. Claims related to this care are considered authorized care. 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. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. For example, an interest payment of $14.21 would appear as 1421. INTAMT is part of DISAMT; it should not be added to them. 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 . (Anything) - 7.(Anything). Each VA facility has a local Fee Office to which the non-VA provider submits a claim for reimbursement. 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. Analyses of FY 2014 data indicate approximately 50% of inpatient observations and 43% of outpatient observations are missing NPI. Another approach is to search other fee claims submitted by the same vendor to see if a Medicare hospital ID was assigned to those claims. 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 the main utility that passes information back into the FBCS Payment application. VHA Office of FinanceP.O. This component provides administration, reporting, and letter generation for all of the components of the Fee Basis Claims Systems (FBCS) via native Microsoft Structured Query Language (SQL) Server database communication drivers. 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. When there is no available rate in the Medicare Fee Schedule, the VA will follow the payment guidelines for Non-VA Medical Care. Unauthorized care can be of an inpatient or outpatient nature. Office of Information and Analytics. October 1, 2015. Review the Supporting Documentation section below to learn how to properly submit supporting documentation with your claim. A claim void must be identical to the original claim that it is intended to cancel. To locate the facility at which the Veteran usually receives VA care, the VA Information Resource Center (VIReC) recommends consulting the preferred facility indicator in the VHA Enrollment Database.7. 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. In order to qualify for round trip mileage, an appointment must be scheduled. Complete and accurate standard Center for Medicare & Medicaid Services (CMS) or electronic transaction containing false claims notice (such as CMS 1450, CMS 1500 or 837 EDI transaction). Other work by HERC researchers indicates that in the FY 2014 data, DXLSF and DX1 were identical 47% of the time. This component allows the site access to Communications, Configuration and Reporting options for FBCS. A primary key is a key that is unique for each record. This is in line with the way VHA Office of Productivity, Efficiency & Staffing (OPES) ascertains ED visit. Available at: http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. 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. We crosswalked the ScrSSN to allow for comparison with SAS data. Claims Assistance | Veterans' Affairs Home Claims Assistance Claims Assistance Contacting the Columbia VA Regional Office Call us at (803) 647-2488, or email VetAsst.VBACMS@va.gov, and provide your: Name Contact information and, Best time of day for contact between 8:00am and 4:00pm Our review of the data suggests that pharmacy and ancillary claims take longer to process than inpatient or outpatient claims. If the Veteran received care in the community that was not pre-authorized, it is considered unauthorized by VA. 4. This latter table contains a variable called InitialTreatmentDateTime. The alternative, putting the procedure code fields in the invoice table, would not be as efficient. We therefore use the PROC CONTENTS to describe SAS variables, found in Appendix A. SAS data use patient scrambled social security number (SCRSSN) as the patient identifier. VA is also the primary and sole payer for unauthorized emergent care approved under 38 U.S.C. For example, DISAMT=1000 in FY06 really indicates DISAMT=10.00. Care provided in foreign countries other than the Philippines. 1725 (the Mill Bill) by enabling VA to pay for or reimburse Veterans enrolled in VA health care for the remaining cost of emergency care if the liability insurance only covered part of the cost. VA Information Resource Center. 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. The Veteran's full 9-digit social security number (SSN) may be used if the ICN is not available. Researchers wishing to work with SAS Fee Basis data can access them at the Austin Information Technology Center (AITC). The SQL Fee Basis data at CDW and the SAS Fee Basis data at AITC are available for VA researchers following a standard approval process. In the SAS data prior to FY 2007, the disbursed amount (DISAMT) had an implied decimal point whereas the payment amount (AMOUNT) did not. 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. [FeeServiceProvided] table. 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. 1. When MDCAREID is not available, it is possible to assign MCCAREID based on the relationship between VEN13N and STA6A. 1725 when remaining liability to the Veteran is not a copayment or similar payment. VA Form 10-583, Claim for Payment of Cost of Unauthorized Medical Services. (Veterans may submit unauthorized claims, however, and VA has legal authority to pay them under certain conditions. Therefore, it is not possible to do an exact comparison across the datasets. There are no references identified for this entry. Primary keys are denoted by (PK) and foreign keys are denoted by (FK). Plan Name or Program Name," as this is a required field. Non-VA CareP.O. Accessed October 07, 2015. Using SQL data will allow the researcher to link to other rich data found in CDW, such as the Health Factors data. If you are in crisis or having thoughts of suicide, 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: These variables relate to the VA station at which the Fee Basis care requests and claims are input. SAS data are housed in 8 ready-to-use datasets per fiscal year. 2. Researchers can look at the disposition variable as an indicator of transfer between VA and non-VA 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. Community Care Network Region 5 (authorized), Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, Indian Health Service/Tribal Health Program, CHAMPVA In-house Treatment Initiative (CITI), Indian Health Services/Tribal Health/Urban Indian, Spina Bifida Health Care Benefits Program, Veterans Health Information Exchange Program, Durable Medical Equipment/ Pharmacy Requirements, War Related Illness & Injury Study Center, Clinical Trainees (Academic Affiliations), Medical Document Submission Requirements for Care Coordination, Azure Rights Management Services (Azure RMS), Call TTY if you
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