va fee basis program claims address

Menlo Park, CA. Note that the vendor may represent the hospital, a hospital chain or the entity billing on behalf of the provider. 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. Accessed October 16, 2015. 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. The SAS PHARVEN dataset contains information only about pharmacy vendors. actions by all authorized VA and law enforcement personnel. In both SQL and SAS data, there is also a variable regarding the fee specialty code. No new extracts will occur. The table can be linked to the [Dim]. DSS Fee Basis Claims Systems (FBCS) - oit.va.gov VA-station related information includes STA3N, STA6A and STANUM in SAS and Sta3n and PrimaryServiceInstitution in SQL. VA evaluates these claims and decides how much to reimburse these providers for care. Details about the VA rules governing reimbursement can be found in Chapter 7 of this guidebook. Each prescription record has a fill date and a patient identifier (either PatientICN or scrambled social security number). 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. In SAS, the inpatient (INPT) file includes PAMT, the Medicare prospective payment that would apply to the stay. 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. Section 508 compliance may be reviewed by the Section 508 Office and appropriate remedial action required if necessary. Quality of Life and Veterans Affairs Appropriations Act of 2006 (Public Law 109-114),the FSC offers a wide range of financial and accounting products and services to both the VA and Other Government Agencies (OGA). SQL data contain the following vendor information: NPI, FeeVendorSID, FeeVendorIEN, NPI, VendorType and FeeSpecialtyCodeName. It appears that starting in FY2016, Choice data is now bypassing FBCS and residing in the PIT. The new temporary end date is the maximum of the discharge date of the third observation and temporary end date from Step 2. 17. In general, persons on active duty in the U.S. military are excluded even if they are transitioning to VA care. Each patient should have only one ICN in the entire VA, regardless of the number of facilities at which he is seen. DSS Fee Basis Claims Systems (FBCS) - DigitalVA As of April 2019, this guidebook is no longer being updated. Thus, unauthorized care is not unpaid care it is simply not PRE-authorized care. To evaluate the time it takes VA to process Fee Basis claims, we evaluated SAS data for FY2014. We give an example here that relates to FeeInpatInvoice table. 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. In the SAS data, the patient identifier is the scrambled social security number (SCRSSN). 2. Many classes of Veterans are eligible for travel payments. For example, to understand the ICD-9 codes associated with a particular inpatient encounter, one would have to link the [Fee]. Claims for Non-VA Emergency Care [Patient], [PatSub]. If you are in crisis or having thoughts of suicide, This application reads, creates, edits authorization data in VistA, and copies critical information into the central SQL database for off-line VistA applications to consume. a. There are nine situations in which Non-VA Medical Care is authorized. This component allows the site access to Communications, Configuration and Reporting options for FBCS. A claim void must be identical to the original claim that it is intended to cancel. Some missingness may indicate not applicable.. 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." [FeePrescription] tables. [Spatient], and [Spatient]. HERC: Identifying Providers in VA Administrative Data - Veterans Affairs Community providers should remain in contact with the referring VA Medical Center to ensure proper care coordination. The veteran must wait over 30 days past their preferred appointment date or the date deemed medically necessary by their provider, b. Download the tables here. 6. 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. *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. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. This component distributes fee workload to particular users using the FBCS MS SQL database and the VistA Gateway. March 2015. Sort data by the patient ID, STA3N, VEN13N, and the admission dates. FBCS is an auditing system which provides instructional prompts designed to interface with the Veterans Information Systems and Technology Architecture (VistA) package to track, report, and analyze fee claim data. Most files contain the invoice date, obligation number; check number and date, several variables pertaining to check cancellation and denials of payment, and the DHCP internal control number. VHA Office of FinanceP.O. 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. The vendor represents the entity billing for the non-VA care, while the provider represents the person who was involved in care provision. As noted above, in SAS, the patient identifier is the SCRSSN; this is unique to each patient across the entire VA. You can find more information about eligibility on the VHA Office of Community Care website. There may be many providers that use the same vendor for billing. 2. We detail differences amongst the SAS and SQL Fee Basis data in the guidebook below. Get Help from Our VA Disability Claim Appeals Lawyers Today. Not all of these variables appear in every utilization file. Fee Basis data are housed in VA in both SAS dataset format and Microsoft SQL server tables (hereafter referred to as SQL data). These data indicate the specialty code associated with the vendor, such as orthopedic surgery, cardiology, family practice, etc. Accessed October 07, 2015. VA Informatics and Computing Resource Center (VINCI). This component is a service that communicates with an outside `Adjudication Engine` which scrubs claims data and sends back scrub results to the service via a secure Pretty Good Privacy (PGP) Secure Sockets Layer (SSL) web service connection. In SAS, the outpatient data are housed in the MED files. Accessed October 16, 2015. A record is created only if there is a code on the invoice to be recorded. Menlo Park, CA. There are delays in the processing of Fee Basis claims. TRM Proper Use Tab/Section. Name of the medication. Six additional variables indicate the setting of care and vendor or care type. Table 9 lists a number of financial variables the SQL data contain. Below are some answers to general questions about linking the UB-92 form to the FBCS data. Attention A T users. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. 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. The status value A stands for accepted, meaning the claim was paid. 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. VA Information Resource Center. This service communicates via native SQL Server 2005 encrypted connections through the VA Wide Area Network (WAN). Veterans Crisis Line: VA can waive the deductible in hardship cases. For more detailed information, researchers should visit the VHA Office of Community Care website. 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. 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. Using SQL data will allow the researcher to link to other rich data found in CDW, such as the Health Factors data. As noted in Chapter 2, the important variables capturing cost of care are AMOUNT and DISAMT. [FeeTravelPayment] contain information on travel type and payment. One can use the same approach as for the inpatient SQL data described above to locate the date of service. YESElectronic Remittance (ERA)YESICD- 1. A claim for which the Veteran had coverage by a health plan as defined in statute. Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. [FeeServiceProvided] table. In some cases it may appear that single encounters have duplicate payments. [FeeServiceProvided], [Fee]. 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). The Choice Act represents one of the largest shifts in the organization and financing of healthcare in the Department of Veterans Affairs (VA) in recent years. If a patient received care at another facility, that patient will be have a different PatientSID assigned for that facility. Review the Supporting Documentation section below to learn how to properly submit supporting documentation with your claim. Emergency claims covered under the Veterans Millennium Care and Benefits Act, Public Law 106-117); see 29 CFR 17.120 and 38 CFR 17.1004. Our office is located at 6940 O St, Suite 400 Lincoln NE 68510. In particular, CDW also recommends Patient SIDs with a value of less than 1 be deleted. Treatment date correlates to covered from/to. VA Fee Basis Programs. 2010;47(8):725-37. 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. Unlike the other patient identifiers in SQL such as PatientIEN or PatientSID, PatientICN is supposed to be unique to each patient across VA. Veterans who meet certain criteria may be eligible for mileage reimbursement for travel to and from VA or Non-VA care. In SAS, this variable is called DISTYP, or disposition type, and is located in the Inpatient and Ancillary tables. VIReC Research User Guide: VHA Medical SAS Outpatient Datasets FY2006. Note: A Veterans insurance coverage or lack of insurance coverage does not determine their eligibility for treatment at a VA health care facility. Accessed October 07, 2015. Yes. Medical specialty type (SPECCODE) is a provider-specific variable and indicates the specialty type of the provider rendering the service. 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). In SQL, there are additional variables that will denote the type and location of the care provided along with the vendor. Emergency care can also be authorized by VA in certain circumstances when the VA is notified within 72 hours. 5. We found SPECIALPROVCAT was missing in 93% of records. For example, there are observations in which INTIND = 1 and INTAMT = $0. Community providers have three options that allow for that linkage: Submit the claim electronically via 837 transaction and the supporting documentation via 275 transaction. 11. SQL Fee data are available through the VA Corporate Data Warehouse (CDW)/VA Informatics and Computing Infrastructure (VINCI). Hospice also appears to be billed monthly, with longest length of stay for a single hospice invoice of 31 days. or acts to, The Financial Services Center (FSC) is a franchise fund (fee for service) organization in the Department of Veterans Affairs (VA).Under the authority of the Government Management Reform Act of 1994 and the Military Other work by HERC researchers indicates that in the FY 2014 data, DXLSF and DX1 were identical 47% of the time. When a claim is linked to VistA, the variable Other_Hlth_ins_present is populated. VA is the primary and sole payer when VA issues an authorization. VA will arrange for transportation for them or will reimburse expenses on the basis of vouchers submitted. PMS-DRG was effective in FY 2008; prior to this time CMS-DRGs were used. Most nursing home care is billed monthly, so there is one claim for each month of nursing home stay. Veterans Health Administration. Review the Filing Electronically section above to learn how to file a claim electronically. This is true for both the inpatient and the outpatient data, albeit for different reasons. The clinic of jurisdiction, or medical facility, authorizes such care under the fee-basis program . There is a deductible of $3 per trip up to a limit of $18 per month. For some vendors, there may be more than on possible hospital, for example, if the vendor is a hospital chain or an organization with a VA contract. Every one of the 700,000 health care professionals in the TriWest network has to meet VA-required quality standards to ensure that Veterans always receive the highest quality care. HERC investigation of Fee Files reveals certain data anomalies of which researchers should be aware. More than 99% of claims for inpatient, ancillary and outpatient care are processed within 2 years. [PatientRace] tables. Most ED visits will be identified through FPOV values of 32 or 33. This seeming complicated arrangement is an efficient way to store data. U.S. Department of Veterans Affairs. However, one also needs to exercise caution with DRG; there are 2 different sets of DRGs used over time. This component communicates with the FBCS MS SQL database and Veterans Health Information Systems and Technology Architecture (VistA) database in real time. The data that is not available is the data element that indicates if it was generated by FBCS or manually entered by the user in FBCS. VINCI. We recommend researchers use the FeePurposeOfVisit codes (FPOV) codes to eliminate observations related to non-outpatient care before beginning analyses. PDF Frequently Asked Questions for Providers - Logistics Health National Provider Identifier: Submit all that are applicable, including, but not limited to billing, rendering/servicing, and referring. 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. 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. Benefits Delivery at Discharge - Pre-Discharge - Veterans Affairs Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. is ok, 12.6.5 is ok, 12.6.9 is ok, however 12.7.0 or 13.0 is not. VA Palo Alto, Health Economics Resource Center; October 2013. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). would cover any version of 7.4. Outpatient data are housed in the FeeServiceProvided table. Business Product Management. Providers who continue to elect to submit paper claims and paper documentation to support claims for unauthorized emergency care should be aware of the following: VHA Office of Integrated Veteran Care P.O. This act expands the non-VA care veterans were able to receive before the act was passed. If you are in crisis or having thoughts of suicide, Appendix H lists their current values. U.S. Department of Veterans Affairs. In this situation, a given VA medical center has a preferred hospital from which it purchases care. In SQL, the outpatient data are housed in the FeeServiceProvided table. We gratefully acknowledge comments and contributions from Sharon Dally, Susan Schmitt and Paul Barnett. 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. For a list of VA acronyms, please visit the VA AcronymLookup on the VA intranet at http://vaww.va.gov/Acronyms/fulllist.cfm. For some years, there may be high rates of missingness of ICD-9 data in the Ancillary files. 3. Private health insurance coverage through a Veteran or Veteran's spouse is insurance provided by an employer, Veteran or other non-federal source, including Medicare supplemental plans. The process for filing a claim for services rendered to a Veteran in the community varies depending upon whether or not the services were referred by VA and by the entity through which the services were authorizedVA or one of the VA Third Party Administrators (TriWest Healthcare Alliance or Optum United Health Care). This guidebook is intended to help researchers understand and use the National Fee Basis files, which come in both SQL and SAS formats. 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. National Institute of Standards and Technology (NIST) standards. FPOV values of 32 and 33 also indicate ED visits, but are only observed in the Ancillary file. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up for it. Therefore, it is not possible to do an exact comparison across the datasets. Hit enter to expand a main menu option (Health, Benefits, etc). 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. Please switch auto forms mode to off. 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. 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 travel payment data contains reimbursements for particular travel events (TravelAmount). The Fee Card (VET) file contains only summary payment figures by month, although researchers can match the records to other data by SCRSSN and other identifiers. Hit enter to expand a main menu option (Health, Benefits, etc). 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. 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. NOTE: The processes outlined below are exclusive to supplying documentation for unauthorized emergent care. MDCAREID is not available in the outpatient SAS Fee Basis data, even though some outpatient services are provided in a hospital. In both the SAS and the SQL data, there are usually multiple observations per patient encounter. How Does VGLI Compare to Other Insurance Programs? There are exceptions. Guidance can be found under "VHA Data Quality Program Reports. This component communicates with the FBCS MS SQL and VistA database in real time. A claim without errors or omissions is said to be clean. If VA has authority to pay the claim and the submitted documentation is sufficient then the claim is approved for payment. More detailed information about the vendor can be found in the SQL [Dim]. If the Veteran went to the ED and was not admitted to the hospital, this would be considered outpatient care. 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. If this is the case, then it can be assumed that any care provided by the vendor with that VEN13N is actually a hospital with that MDCAREID. Payer ID for dental claims is 12116. In SAS, these data can be found in the Vendor file. Documentation in support of a claim may include: *NOTE: Documentation not required includes flowsheets and medication administration. Data Quality Analysis Team. Thus, researchers using later years of data should be aware that files are not static and will continue to be updated. This is specific to certain claims for Non-Service Connected emergency medical care under Title 38 USC 1725. These data records cannot be linked to particular patient identifiers or encounters. There is another category of Fee Basis care that is considered unauthorized care. Plan Name or Program Name," as this is a required field. It is available in the PHARVEN and VEN files, albeit with a high degree of missingness. Use of this technology is strictly controlled and not available for use within the general population. VA Information Resource Center VHA Corporate Data Warehouse [webpage]. 1725 when remaining liability to the Veteran is not a copayment or similar payment. FBCS is where weve spent the bulk of our time investigating. 1725 may only be made if payment to the facility for the emergency care is authorized, or death occurred during transport. [FeeInpatInvoiceICDDiagnosis] with the [Dim]. Data from FY1998 and FY1999 have a greater degree of discordance. Prior to FY 2007, INTAMT has two implied decimal places. Important: The mailing address below only pertains to disability compensation claims. 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. 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. VA contracts out its hospice; therefore, the Fee Basis files contain a great deal of data related to hospice care. Previously, VA could reimburse Veterans or pay non-VA hospitals directly only if a Veteran has no other health insurance. [FeePharmacyInvoice] table contains information on vendor, amount claimed, and amount paid. PatientIEN is assigned by the facility. Researchers interested in linking SQL Fee Basis data to the rich patient-level or vendor and/or provider information available in the rest of the Corporate Data Warehouse should apply for permissions to access these other datasets. VA patients who receive prescriptions from non-VA providers fill them from a VA pharmacy, often the VA Certified Mail Order Pharmacy (CMOP). U.S. Department of Veterans Affairs. [FeeInpatInvoiceICDProcedure] table. Include the authorization number on the claim form for all non-emergent care. 3. It can be difficult to determine the provider and the location of the Non-VA care provider. CLAIM.MD | Payer Information | VA Fee Basis Programs or use of this system constitutes user understanding and acceptance of these terms 1. Non-VA providers submit claims for reimbursement to VA. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). 2. Available at:http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. Attention A T users. The following information should help you understand who to submit claims to and the requirements you must follow when submitting claims. 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]. 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. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. At the time of writing (October 2015), only operations staff will have permission to access the SAS data at VINCI. . In the SAS data prior to FY 2007, the disbursed amount (DISAMT) had an implied decimal point whereas the payment amount (AMOUNT) did not. VA medical centers may purchase prosthetics and related items, such as clothing specialized for prosthetic limbs, and then dispense them through VA facilities. 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. Money collected by VA from private health insurance carriers is returned back to the VA medical center providing the care. SAS has more data on inpatient diagnosis and procedure variables than do SQL data. U.S. Department of Veterans Affairs. Submit a corrected claim when you need to replace an entire claim previously submitted and processed. The vendor identity can be found through the FeeVendorSID or the FeeVendorIEN variables in SQL. Please note that this method providers an indication of the care provided to a Veteran on a single day, rather than in a single encounter, because multiple providers may use the same billing vendor. Florida Department of Veterans' Affairs | Connecting veterans to More information can be found at the OPES website: http://opes.vssc.med.va.gov. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Of note, the FBCS was not in place nationwide prior to FY 2008. Review the Where to Send Claims section below to learn where to send claims. For additional information or assistance regarding Section 508, please contact the Section 508 Office at [email protected]. 13. 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.

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