va fee basis program claims address

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. _____________________________________________________________________________. For these reasons, the program does not pay for 100% of care that was otherwise eligible. Data are presented in Table 4. Accessed October 16, 2015. VSSC web reports are organized into nine domains: Business Operations, Capital & Planning, Clinical Care, Customer Service, Quality & Performance, Resource Management, Special Focus, Systems Redesign, and Workload. Authorized care claims must be submitted within 6 years of the date of service, service-connected emergency care claims must be submitted within 2 years of the date of service, and non-service-connected emergency care claims must be submitted within 90 days of the date of service/discharge. This research was supported by the Health Services Research and Development Service, U.S. Department of Veterans Affairs (ECN 99017-1). 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 Office of Media and Public Relations. The OI&T Enterprise Program Management Office does not endorse nor support Class 2 and Class 3 products and does not support data usage or application programmer interfaces (APIs) between Class 1 National Software products and Class 2 or Class 3 products. In both the SAS and the SQL data, there are usually multiple observations per patient encounter. [FeeInpatInvoice] table, one must first link that table to the [Fee]. 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. VA Information Resource Center VHA Corporate Data Warehouse [webpage]. 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. Fee Basis data will be most useful for studying conditions where contract care is common, such as home-based care and nursing care, and for determining typical non-VA charges for health care services (both charges and payments are reported) and comparing those to VA costs. These variables relate to the VA station at which the Fee Basis care requests and claims are input. 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. 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). Race and ethnicity are found in the [PatientEthnicity], [PatSub]. 1. 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. [FeeInpatInvoice], and a foreign key in the [Fee].[FeeInpatInvoiceICDProcedure]. No, only one type of care can be covered by a single authorization. The following information should help you understand who to submit claims to and the requirements you must follow when submitting claims. Steps to collapse records into a single inpatient stay: 1. For education claims, refer to the appropriate Regional Processing Office. In SQL, there are multiple patient identifiers, with the most useful being the PatientICN. Thus, one could not simply use the patient identifier and the admission and discharge dates to collapse these observations into one inpatient stay. 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. According to the Health Administration Center Internet website, the proportion of claims processed within 30 days rose from under 40% in 2007 to over 97% by the end of 2008. 7. There is also a host of non-emergency surgery provided through Fee Basis mechanisms that may be of interest to researchers. Accessed October 16, 2015. Reimbursements appear in the Travel Expenses (TVL) file. On March 17, 2022, The U.S. Court of Appeals for the Federal Circuit issued a ruling that changes VAs ability to reimburse as secondary payer under 38 U.S.C.1725. The VEN13N is the vendor ID with a suffix; VEN13N is more detailed than VENDID and is thus recommended for use. Identifying Veterans in the CDW [online; VA intranet only]. Available at:http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. Non-VA providers submit claims for reimbursement to VA. Multiple claims can be paid against a single authorization. For example, if the Veteran had an Emergency Department (ED) visit and then was admitted to the hospital, this would be considered inpatient care. As of July 2015, the current mileage reimbursement rate is 41.5 cents per mile. 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). TriWest VA CCN ClaimsP.O. Please switch auto forms mode to off. [FeeServiceProvided], [Fee]. In both SQL and SAS data, there is also a variable regarding the fee specialty code. Below are some answers to general questions about the FBCS tables. field. The status value R stands for re-routed, meaning the claim was re-routed to the Health Administration Center (HAC). Researchers evaluating care over time may want to use the DRG variable. The Routing tool manages how Health Care Finance Administration (HCFA) and Uniform Billing (UB) claims will electronically flow through the FBCS program. Veterans who have private health insurance should consider a number of important factors before canceling their health insurance, such as: If you cancel your Medicare Part B Coverage, you need to know that you cannot be reinstated until January of the following year, and you may be penalized for reinstatement. Again, date of service is not available in the FeeServiceProvided table. Missingness can vary substantially by year and by file. 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. Researchers wishing to work with SAS Fee Basis data can access them at the Austin Information Technology Center (AITC). SQL tables require linking before conducting any data analyses. Health Information Governance. 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." This is true for both the inpatient and outpatient data. In order to qualify for round trip mileage, an appointment must be scheduled. Unlike the other patient identifiers in SQL such as PatientIEN or PatientSID, PatientICN is supposed to be unique to each patient across VA. 2. This technology can integrate with and alter database technologies. The vendor has verified that the VA no longer has an active contract for this technology and any instances of this software on the VA network should be removed. Request and Coordinate Care: Find more information about submitting documentation for authorized care. As noted above, there are differences in the patient identifier and the date variables in the SAS versus SQL data; both data sources do not contain the same variables regarding patient identifier or date the claim was paid. 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. [1] The Health Care Financing Administration (HCFA) was renamed the Centers for Medicare and Medicaid Services. The slight decrease in fiscal year 2012 spending from the fiscal year 2011 level was due to VA's adoption of Medicare rates as its primary payment method for fee basis providers. PDF Frequently Asked Questions for Providers - Logistics Health 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. b. For example, a technology approved with a decision for 7.x would cover any version of 7. [ModeOfTransportation] and [Fee]. 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. (refer to the Category tab under Runtime Dependencies), Users must ensure that Microsoft Structured Query Language (SQL) Server, Microsoft Internet Explorer (IE), and Microsoft Excel are implemented with VA-approved baselines. The payment category (PAYCAT) is missing for all records in the inpatient services (ANCIL) file. Please switch auto forms mode to off. PracticeBridge. This most likely reflects a low frequency of surgery rather than missing data. While NPI is available in SQL data, it does require special permissions to access, as it is located in the [Sstaff]. VA HEALTH CARE Management and Oversight of Fee Basis Care Need. Among non-missing observations, HERC analyses found a many-to-many relationship among NPI and VEN13N. Relational Database Management Systems (RDBMS) such as Microsoft SQL server have multiple hierarchies for storing data: a domain contains many schemas, which in turn contain many tables. These vendors are presumably hospital chains. If the provider declines VA payment then it may be able to charge the patient a greater total amount. 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. Through the CCN, Veterans have access to regional networks of high-performing, licensed health care . There are also variables pertaining to Veteran geographic information, particularly ZIP, HOMECNTY and HOMESTATE in the SAS data and County, Country, Province, and State in the SQL data. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. The table can be linked to the [Dim]. 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. When MDCAREID is not available, it is possible to assign MCCAREID based on the relationship between VEN13N and STA6A. Gidwani R, Hong J, Murrell S. Fee Basis Data: A Guide for Researchers. Multiple claims may be submitted for each inpatient stay and the various claims do not have a common identifier indicating they are all part of the same inpatient stay. For example, to understand the ICD-9 codes associated with a particular inpatient encounter, one would have to link the [Fee]. VA-station related information includes STA3N, STA6A and STANUM in SAS and Sta3n and PrimaryServiceInstitution in SQL. In SAS, the Patient ID will be the SCRSSN and the admit date is the treatment from date. For the purpose of this guidebook, we focus on Fee Basis files only. VA patients who receive prescriptions from non-VA providers fill them from a VA pharmacy, often the VA Certified Mail Order Pharmacy (CMOP). The second record would have an admission date of Jan 5, 2010 and a discharge date of Jan 5, 2010. 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. SQL data contain the following vendor information: NPI, FeeVendorSID, FeeVendorIEN, NPI, VendorType and FeeSpecialtyCodeName. 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. See 38 USC 1725 and 1728.). A foreign key is a key that uniquely identifies a record of another table. At the time of writing, version 4.2 is the most current version. For current information on Community Care data, please visit the page. A single inpatient encounter may generate zero, one, or multiple ancillary records, depending on the number of ancillary procedures and physician services received. All observations for this particular patient ID, STA3N and VEN13N where the admission date comes on or after the admission date of the first record AND the discharge date comes on or before the temporary end date are considered to be part of the same inpatient stay. The same concept (such as fiscal year, state, or county) may be represented by several variables, sometimes in differing formats. Veterans Crisis Line: NNPO. NNPO. The Fee Basis schema data can be found at the CDW SharePoint portal at the links below (VA intranet only). Researchers should use PatientICN to link patient data within CDW. All instances of deployment using this technology should be reviewed by the local ISO (Information Security Officer) to ensure compliance with. 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. 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). 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. There are two important variables to consider if evaluating the cost (VA reimbursement) of Fee Basis Care: the payment amount (AMOUNT in SAS, PaidAmount in SQL) or the Financial Management System (FMS) disbursed amount (DISAMT in SAS, DisbursedAmount in SQL). Payment for these types of care falls under the Non-VA Medical Care program. Veterans whose income exceed the established VA Income Thresholds as well as those who choose not to complete the financial assessment must agree to pay required copays to become eligible for VA health care services. We gratefully acknowledge comments and contributions from Sharon Dally, Susan Schmitt and Paul Barnett. At the time of writing, SAS data at CDW are available only to those persons with VA operations access. FSGLI: Family Servicemembers Group Life Insurance, Schedule of Payments for Traumatic Losses, S-DVI: Service-Disabled Veterans Life Insurance, Beneficiary Financial Counseling and Online Will, Lesbian Gay, Bisexual & Transgender Veterans, Pension Management Center (PMC) that serves your state, Claims Adjudication Procedures Manual/Live Manual, Link to subscribe to receive email notice of changes to the Live Manual. Box 108851Florence SC29502-8851, Delta Dental of CaliforniaVA Community Care NetworkP.O. SAS data are housed in 8 ready-to-use datasets per fiscal year. We continue on this process until we find a gap greater than 1 day or we have evaluated all observations with that patient ID, STA3N and VEN13N. Accessed October 07, 2015. MDCAREID is the Medicare OSCAR number, which is a hospital identifier. If disbursed amount is missing, use payment amount instead. It is the patient identifier that uniquely defines a patient across all facilities. Box 14830Albany, NY 12212. SQL data are housed at CDW, which is a collection of many servers. is ok, 12.6.5 is ok, 12.6.9 is ok, however 12.7.0 or 13.0 is not. Please visit Provider Education and Training for upcoming events. This guide serves as an addendum to any technical documentation supplied by the healthcare clearinghouse when establishing a trading partner agreement. More information on the proper use of the TRM can be found on the However, investigation has confirmed these are partial payments made for a single encounter or procedure. 1725 when remaining liability to the Veteran is not a copayment or similar payment. Conversely, all stays should have at least one discharge diagnosis. The 275 transaction process should not be utilized for the submission of any other documentation for authorized care. actions by all authorized VA and law enforcement personnel. There are no references identified for this entry. Veterans Health Administration. 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 CDW is a relational database organized into a collection of data domains implemented on the Microsoft SQL server in VINCI. 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. 16. It appears that starting in FY2016, Choice data is now bypassing FBCS and residing in the PIT. JANESVILLE, WI 53547-4444. or Fax to: TOLL FREE: 844-531-7818 & 248-524-4260 (Utilized for Foreign Claimants) return to top. Veterans Health Administration. SQL data must be linked from multiple tables in order to create an analysis dataset. However, not all dates on the claim are approved. There is a lack of publicly available technical documentation and support may be limited to specific forums. A primary key is a key that is unique for each record. 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. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. 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 SAS and SQL data are very similar, but not exact copies of each other. Please switch auto forms mode to off. Non-VA providers submit claims for reimbursement to VA. Researchers with VA intranet access can access these images by copying and pasting the URLs into their browser. 1. 1. Information from this system resides on and transmits through computer systems and networks funded by the VA. In the outpatient data, each record represents a different procedure, as assessed through the Current Procedural Terminology (CPT) code. You can submit a corrected claim or void (cancel) a claim you have already submitted to VA for processing, either electronically or in paper. Appendix G lists all available FPOV codes and classifies them as inpatient or outpatient. For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/. more information please visit www.fsc.va.gov. 1. If a researcher decides to use FPOV, please note that an FPOV value of 52 indicates ED visit for persons whose care is covered under the Millennium Bill and should thus be included in evaluating ED care. However, not all data in the FeeServiceProvided table are outpatient data; some may pertain to inpatient stays. These rules are subject to change by statute or regulation. Persons interested in studying care provided under the Choice Act may wish to explore the VACAA tables or the FBCS tables at VA Corporate Data Warehouse (CDW). In SQL, these variables can be found in the [Dim]. While many Veterans qualify for free health care services based on a VA compensable service-connected condition or other qualifying factor, most Veterans are asked to complete an annual financial assessment, to determine if they qualify for free services. There is no information available in the SAS data that identifies the actual medication dispensed. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Fee Basis providers vary in how frequently they submit an invoice for Fee Basis care. All instances of deployment using this technology should be reviewed to ensure compliance with. Compare the discharge date of the first observation to the admission date of the next (second) observation. VA can waive the deductible in hardship cases. As with the SAS data, it is not straightforward to determine the cost of, length of stay or care provided during a specific inpatient stay. Inpatient procedures are captured by ICD-9 procedure codes (SURG9CD1-SURG9CD25) in the hospital claims file. Please switch auto forms mode to off. 15. April 08, 2014. In some cases it may appear that single encounters have duplicate payments. Details about the VA rules governing reimbursement can be found in Chapter 7 of this guidebook. 2. This improves our claims processing efficiency. 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: However, 99% of inpatient hospital invoices were associated with a length of stay of 33 days or less. The outpatient pharmacy data includes medications dispensed in a pharmacy. When a claim is linked to VistA, the variable Other_Hlth_ins_present is populated. VA systems are intended to be used by authorized VA network users for viewing and One can use the same approach as for the inpatient SQL data described above to locate the date of service. We view the patients insurance data in the VistA file if the claim is flagged as reimbursable in VistA and encompasses the dates on the claim. 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). 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. 14. Table 3 lists their file names and gives a general description of their contents.10. Many variables in the Fee Basis files record details of invoice and check processing. It can be difficult to identify the specific type of provider associated with Fee Basis care in the currently available national extracts of Fee Basis data. SAS data also contain an additional diagnosis variable that is not present in the SQL data -- DXLSF. Payer ID for dental claims is 12116. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. Veterans Choice Program - Fee Basis Claims System in CDW - Veterans Affairs These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). There are nine situations in which Non-VA Medical Care is authorized. Business Product Management. March 2018: Due to the transition of the National Non-VA Medical Care Program Office to the VHA Office of Community Care and updates to the VINCI website, some documents may no longer be available. Prior to the passage of this law on May 1, 2010, VA did not cover the cost of health care provided to dependent children, including newborns in situations where VA pays for the mothers obstetric care during the same stay. Operating Systems Supported by the Technology. For billing questions contact: Health Resource Center Detailed instructions and documentation required for DART data requests can be found on the VHA Data Portal intranet website at http://vaww.vhadataportal.med.va.gov/DataAccess/DARTRequestProcess.aspx. Billing & Insurance - New York/New Jersey VA Health Care Network Inpatient care, regardless of patients health status, if VA was not notified within 72 hours of admission. How to create a secondary claims in eclinicalworks electronically; . It can be difficult to determine the provider and the location of the Non-VA care provider. This means the data were placed in the PIT and the claim was not paid through FBCS. Prior to FY 2007, INTAMT has two implied decimal places. U.S. Department of Veterans Affairs. At the time of this writing, the NPI number was often missing from fee basis claims. Go to CDW Home, click on CDW MetaData, then click on the link for Purchased Care. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). To access the menus on this page please perform the following steps. These geographic variables indicate the VA station paying for the service. 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. Seven refer explicitly to Veterans alone, while the remaining two are for diagnostic services or eligibility exams, neither of which constitutes treatment. Veterans Health Administration. 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. 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). 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. Data Quality Analysis Team. As with inpatient data, researchers will need to collapse multiple observations in order to get a complete picture of the outpatient care provided on a single day. Some VA medical centers purchase care from only one of the hospitals in the chain. 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. 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. 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). Available at: http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. Six additional variables indicate the setting of care and vendor or care type. [FeeServiceProvided] tables. 1. The VA Fee Basis medical program provides payment authorization for eligible Veterans to obtain routine medical treatment services through non-VA health care providers. 3. 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.

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