The vendor and the provider may or may not be the same entities. If disbursed amount is missing, use payment amount instead. 2. Table 1 in the Data Quality Analysis teams guide Linking Patient Data in the CDW Updateprovides a brief summary for each identifier (Available atthe VHA Data Portal. 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. Veterans applying for and using VA medical care must provide their health insurance information, including coverage provided under policies of their spouses. This improves our claims processing efficiency. Most nursing home care is billed monthly, so there is one claim for each month of nursing home stay. When there is no available rate in the Medicare Fee Schedule, the VA will follow the payment guidelines for Non-VA Medical Care. Journal of Rehabilitation Research and Development. The Vendor Release table provides the known releases for the. VA employees working on research studies cannot create their own crosswalk file as they do not have permission to use these files. Veterans should mail or fax correspondence pertaining to compensation claims to the below location. If you have additional questions about the form or your portal account access, please contact the Provider Services Solution (PRSS) help desk at 888-829-5373. The Fee Basis VA program allows Veterans to be seen by a community provider. 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. If electronic capability is not available, providers can submit claims by mail or secure fax. Research requests for data from CDW/VINCI must be submitted via the Data Access Request Tracker (DART) application. VA is also the primary and sole payer for unauthorized emergent care approved under 38 U.S.C. If the Veteran went to the ED and was not admitted to the hospital, this would be considered outpatient care. Class 2 or Class 3 products must restrict their interfaces to Class 1 National Software to use of publicly-supported APIs ONLY. [FeeInitialTreatment], [Fee]. Accessed October 07, 2015. To enter and activate the submenu links, hit the down arrow. 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. VAntage Point. Note that the vendor may represent the hospital, a hospital chain or the entity billing on behalf of the provider. Submit a corrected claim when you need to replace an entire claim previously submitted and processed. 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. Health plans include private health insurance, Medicare, Medicaid, and other forms of insurance that will pay for medical treatment arising from the patients injury or illness (e.g., automobile insurance following a car accident). U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Box 202117Florence SC 29502, Logistics Health, Inc.ATTN: VA CCN Claims328 Front St. S.La Crosse WI 54601, Secure Fax: 608-793-2143(Specify VA CCN on fax). 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. Four FPOV (Fee Purpose of Visit) codes can be used to identify payment for unauthorized claims. U.S. Department of Veterans Affairs. While NPI is available in SQL data, it does require special permissions to access, as it is located in the [Sstaff]. We detail differences amongst the SAS and SQL Fee Basis data in the guidebook below. The PatientSID is a CDW assigned identifier that uniquely identifies a patient within a facility. Claims Assistance | Veterans' Affairs - South Carolina VA evaluates these claims and decides how much to reimburse these providers for care. 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. [FeeVendor] table. For more detailed information, researchers should visit the VHA Office of Community Care website. This guide serves as an addendum to any technical documentation supplied by the healthcare clearinghouse when establishing a trading partner agreement. SAS Fee Basis data can be linked to other SAS files with additional demographic data (e.g., Vital Status files, enrollment 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. Researchers with VA intranet access can access these images by copying and pasting the URLs into their browser. 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. Starting in 2009, there are also a number of DXPOA variables in the SAS data, which indicate diagnoses that are present on admission. Through patient identifier and travel date (TravelPaymentDate), one can link these payments to inpatient and outpatient encounters. Claims related to this care are considered authorized care. However, a 7.4.x decision The status value A stands for accepted, meaning the claim was paid. visit VeteransCrisisLine.net for more resources. The FPOV variable can be found in both the SAS and SQL data. All SAS prescription-related data is found in two files: the PHR file and the PHARMVEN file. [FeeInpatInvoice], [Fee]. Nevertheless, the National Non-VA Medical Care Program Office (now the VHA Office of Community Care) has interpreted VHA Directive 2006-029 to preclude Non-VA Medical Care providers from receiving payment for prosthetics. The amount of interest paid on the claim, if any, appears as the variable INTAMT. VA can also pay for hospice care for Veterans when the VA facility is unable to provide the needed care; this happens frequently, as VA provides only inpatient-based hospice care and many Veterans may wish to receive hospice at home or in the community. One can use the same approach as for the inpatient SQL data described above to locate the date of service. more information please visit www.fsc.va.gov. http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. This application queues critical claims data into the FBCS shared MS SQL database for further processing and reporting. CLAIM.MD | Payer Information | VA Fee Basis Programs privacy policies and guidelines. There are 34 Fee Basis Claims Systems (FBCS) servers, which were originally designed for episodes of care. There are also a number of other financial variables denoted in SAS (see Table 7). The VA Fee Schedule is available at provider.vacommunitycare.com > Documents & Links. Thus, unauthorized care is not unpaid care it is simply not PRE-authorized care. [XXX] tables, but also the [DIM]. would cover any version of 7.4. 12. DSS Fee Basis Claims Systems (FBCS) - oit.va.gov Veterans Health Administration. Non-VA CareP.O. For more information call 1-800-396-7929. The two tables can be joined through FeePharmacyInvoiceSID. There may be multiple STA3Ns for a single inpatient stay. Each patient should have only one ICN in the entire VA, regardless of the number of facilities at which he is seen. Fee Basis data are housed in both SAS and SQL format. A subsequent report will contain the results of an audit conducted to assess Those options are: Utilize HealthShare Referral Manager (HSRM) for referrals, authorizations and documentation exchange. Fee Purpose of Visit (FPOV) Document [online; VA intranet only]. Updated August 26, 2015. (Anything), but would not cover any version of 7.5.x or 7.6.x on the TRM. The alternative, putting the procedure code fields in the invoice table, would not be as efficient. 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. 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). Electronic Data Interchange (EDI): Payer ID for medical claims is 12115. FBCS Upload leverages LEADTOOLS Professional Optical Character Recognition (OCR) and is included in the FBCS workstation install package. Veterans Choice Program Eligibility Details [online]. 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. For a list of VA acronyms, please visit the VA AcronymLookup on the VA intranet at http://vaww.va.gov/Acronyms/fulllist.cfm. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. Attention A T users. Updated September 21, 2015. Previous work conducted for the HERC 2008 Fee Basis guidebook found that the cost of inpatient pharmacy was included in the inpatient records of the SAS INPT file. Optum is a proud partner with the VA through its Community Care Network (CCN). In order to gain access to the AITC mainframe, VA system users must contact their local Customer User Provisioning System (CUPS) Points of Contact (POC) and submit a VA Form 9957 to create a Time Sharing Option (TSO) account. actions by all authorized VA and law enforcement personnel. SQL tables can be joined through linking keys. 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. By store procedure codes as records in another table, the SQL relational database uses the minimum amount of storable space. 11. U.S. Department of Veterans Affairs. How to create a secondary claims in eclinicalworks electronically; . It is available in the PHARVEN and VEN files, albeit with a high degree of missingness. Such care is called Non-VA Medical Care, or Fee Basis care. Veterans are not responsible for the remaining balance shown as patient responsibility on the explanation of benefits from their insurance carrier. visit VeteransCrisisLine.net for more resources. While Unauthorized care is considered a separate domain, the data pertaining to Unauthorized care are stored alongside the Authorized care data in the FeeInpatInvoice table and the FeeServiceProvided table. Many private health insurance companies will apply VA health care charges towards satisfying a Veteran's annual deductible and maximum out of pocket expnse. It is also possible that researchers will find a slight difference in the observations that the SAS versus SQL data contain. The temporary end date is the maximum of these two values. Working with the Veterans Health Adminstration: A Guide for Providers [online]. The SAS files also include a patient type variable (PATTYPE). Researchers will notice a high degree of concordance between SAS and SQL data in most years of analysis. All Choice claims are processed by VISN 15. 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. 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. 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. The Veterans Emergency Care Fairness Act (Public Law 111-137), signed February 1, 2010, authorizes VA as a secondary payer to third party liability insurance not related to health insurance. In the outpatient data, one observation represents a single CPT code. VA Informatics and Computing Resource Center (VINCI). VA CCN OptumP.O. For the purpose of this guidebook, we focus on Fee Basis files only. 2. Accessed October 16, 2015. Name of the medication. Payment for care provided under the Veterans Choice Act may not exceed the Medicare Fee Schedule (i.e. In both SQL and SAS data, there is also a variable regarding the fee specialty code. In SQL, there are multiple patient identifiers, with the most useful being the PatientICN. Some Non-VA Medical Care claims are rejected for untimeliness or lack of statutory authority. VA Claims Representation; RESOURCES. All instances of deployment using this technology should be reviewed to ensure compliance with. U.S. Department of Veterans Affairs. http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf. Care provided in foreign countries other than the Philippines. Unauthorized inpatient or outpatient claims must be submitted within 90 days from the date of care. Several variables are available for locating care in particular settings. Inpatient care, regardless of patients health status, if VA was not notified within 72 hours of admission. There are 3 categories of geographic data: veteran-related information, vendor-related information and VA-station related information. Accessed October 16, 2015. For some years, there may be high rates of missingness of ICD-9 data in the Ancillary files. 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. The travel payments data contains reimbursements for particular travel events (TVLAMT). 1725 may only be made if payment to the facility for the emergency care is authorized, or death occurred during transport. 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. The NPI is the national provider identifier, which is provider-specific but often missing in the Fee Basis data. If the payment was made outside of FBCS, they wont show here. [Patient], [Spatient]. The variable DTStamp represent the date the claim was received. Sign up to receive the VA Provider Advisor newsletter. 4. You are strongly encouraged to electronically submit claims and required supporting documentation. The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. 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. Once the VA system user has a TSO account, s/he may connect to the AITC mainframe through the Attachmate Reflection File Transfer Protocol (FTP). Go to CDW Home, click on CDW MetaData, then click on the link for Purchased Care. For example, DISAMT=1000 in FY06 really indicates DISAMT=10.00. 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. In both SAS and SQL, it can be difficult to determine the provider the Veteran saw for Fee Basis care. VA Palo Alto, Health Economics Resource Center; October 2013. Records that relate PatientSID to PatientICN are found two tables: Patient.Patient and SPatient.Spatient. A claim for which the Veteran had coverage by a health plan as defined in statute. Some web reports contain PHI and access to these is restricted. YESElectronic Remittance (ERA)YESICD- 1. We encourage readers to seek out the latest guidance before conducting analyses, as CDW Data Quality Analysis team may have updates to this information. 1. VA evaluates these claims and decides how much to reimburse these providers for care. Yes. 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. In this case the first record would have an admission date of Jan 1, 2010 and a discharge date of Jan 10, 2010. SQL data are housed at CDW, which is a collection of many servers. 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. 1. There is no official data dictionary for the SAS Fee Basis data. 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. HERC: Identifying Providers in VA Administrative Data - Veterans Affairs You can submit a corrected claim or void (cancel) a claim you have already submitted to VA for processing, either electronically or in paper. Contact the VA North Texas Health Care System. If electronic capability is not available, providers can submit claims by mail. For billing questions contact: Health Resource Center This guidebook describes characteristics of Fee Basis care data such as contents and missingness, and makes recommendations about its use for research purposes. The vendor represents the entity billing for the non-VA care, while the provider represents the person who was involved in care provision. Thus, the mailing address of the vendor is not always the vendors actual location. 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). The 275 transaction process should not be utilized for the submission of any other documentation for authorized care. Health Information Governance. 3. 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). Some VA medical centers purchase care from only one of the hospitals in the chain. Appendix H lists their current values. There is a CPT field in the inpatient files, but this is always missing; hospitals do not use CPT codes to bill. Using the Non-VA Medical Care data for research requires a basic understanding of laws and regulations that govern it. If a Veteran has only Medicare Part B or has both Medicare Parts A and B, no VA payment may be made. If you are submitting a paper claim, please review the Filing Paper Claims section below for paper claim requirements. The Routing tool manages how Health Care Finance Administration (HCFA) and Uniform Billing (UB) claims will electronically flow through the FBCS program. 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). 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. Users of the data should keep in mind that these data represent the physical location of the entity billing for care, which may or may not be the same as the providers location. Visit the VHA Data Portal for further information on accessing restricted VSSC web reports. 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 . See 38 USC 1725 and 1728.). For more information call 1-800-396-7929. The Fee Purpose of Visit (FPOV) and Health Care Financing Agency Payment Type (HCFATYPE) variables feature values pertaining to setting (inpatient, outpatient, home-based), specific items (e.g., supplies and diagnostics), and miscellaneous purposes.[1]. Other work by HERC researchers indicates that in the FY 2014 data, DXLSF and DX1 were identical 47% of the time. Multiple SQL tables contain these variables. For additional information or assistance regarding Section 508, please contact the Section 508 Office at [email protected]. However, there are data available regarding the category of visit. U.S. Department of Veterans Affairs. VA Palo Alto, Health Economics Resource Center;November 2015. The VEN13N is the vendor ID with a suffix; VEN13N is more detailed than VENDID and is thus recommended for use. Researchers should pay special attention to reducing duplicates in the pre-2008 data. Payer ID: 1. We tried to link the UB-92 form to identify Choice authorizations; however, we found few records and decided to use obligation number. Data Quality Analysis Team. - The information contained on this page is accurate as of the Decision Date (11/02/2022). Actual processing time has varied considerably over the years. 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. Accessed October 16, 2015. 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.
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