[FeeInpatInvoice], [Fee]. A foreign key is a key that uniquely identifies a record of another table. This is a critical difference from VA utilization files, which are organized by date of service. The FPOV variable can be found in both the SAS and SQL data. 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. Review the Where to Send Claims section below to learn where to send claims. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. All Choice claims are processed by VISN 15. Most importantly, they do not represent all care provided during the fiscal year. Inpatient stays in both SAS and SQL Fee Basis data can denote hospital stays, nursing home stays, or hospice stays. Internal use only. Several variables are available for locating care in particular settings. Veterans Health Administration. the rates paid by the United States to Medicare providers). The zip code accompanying the VEN13 variable denotes the zip code to which VA sent reimbursement, not the zip code where the service was rendered. [FeePrescription] table contains rich information on the type of drug prescribed and dispensed, including the drug name, manufacturer, strength, quantity, date filled and charge and disbursed (payment) amount. 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. would cover any version of 7.4. Payer ID for dental claims is 12116. Download the tables here. 1. This technology has not been assessed by the Section 508 Office. Community provider mails the paper claims and documentation to the new mailing address of VA's central claims intake location. We give an example here that relates to FeeInpatInvoice table. 11. VA is also the primary and sole payer for unauthorized emergent care approved under 38 U.S.C. VA Informatics and Computing Resource Center (VINCI). One can use the same approach as for the inpatient SQL data described above to locate the date of service. 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. 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). 7. For billing questions contact: Health Resource Center In FY05, DRG001 means CRANIOTOMY- >17 W CC, compared to HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC for DRG001 in FY15 DRG001. For example, sta3n 589A5 will be found as 589. VA's fee basis care program. 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). This guide serves as an addendum to any technical documentation supplied by the healthcare clearinghouse when establishing a trading partner agreement. 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. 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. privacy policies and guidelines. 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. Updated September 21, 2015. U.S. Department of Veterans Affairs. SQL data must be linked from multiple tables in order to create an analysis dataset. http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf. However, we conducted some comparisons for inpatient data. The data files in each fiscal year represent all claims processed in the FMS during the year. Identifying Veterans in the CDW [online; VA intranet only]. Again, date of service is not available in the FeeServiceProvided table. It appears that starting in FY2016, Choice data is now bypassing FBCS and residing in the PIT. When possible, VA will seek reimbursement for Non-VA Medical Care payments from sources such as workers compensation payments; payments resulting from motor vehicle accidents, crimes of personal violence, or torts; other agencies when the patient is a beneficiary; and third-party insurance plans. We present here one way to collapse records into a single inpatient stay, but users may wish to develop their own method specific to the research question at hand. While a researcher could theoretically conduct a Fee Basis analysis using SAS data and then upload these SAS data to CDW and pull in the relevant variables from the SQL Patient domain, this poses some logistical challenges. The amount of interest paid on the claim, if any, appears as the variable INTAMT. There is no separate payment for items such as oxygen or other supplies, the number of attendants, providing an EKG during the trip, etc. 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. SQL Fee Basis data are stored in CDW in multiple individual tables. They do not represent all claims received during the year. Sign up to receive the VA Provider Advisor newsletter. 1725 may only be made if payment to the facility for the emergency care is authorized, or death occurred during transport. To access the menus on this page please perform the following steps. Two domains in which researchers can find reports on Non-VA Care are Resource Management and Workload. Last updated August 21, 2017 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. [FeeInpatInvoiceICDDiagnosis] with the [Dim]. This act expands the non-VA care veterans were able to receive before the act was passed. Thus, researchers using later years of data should be aware that files are not static and will continue to be updated. field. As noted in Chapter 2, the important variables capturing cost of care are AMOUNT and DISAMT. The invoice table would have to have a sufficient number of fields to accommodate the maximum number of procedures report on any invoice. Claims for Non-VA Emergency Care Six additional variables indicate the setting of care and vendor or care type. There are very limited data in both the SAS and the SQL Fee Basis data regarding the provider associated with care; the closest one can get to this information is to denote the vendor associated with the encounter (detailed more in sections 4.11 and 5.10). If researchers wish to identify ED visits, they may want to use CPT codes or Place of Service codes, rather than FPOV. 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. business and limited personal use under VA policy. As a Class 2 or Class 3 product, it MUST NOT be assumed to having been released into production through all OI&T product release and sustainment process controls for project management; requirements, development and testing management; and configuration, change, and release management necessary to satisfy OI&T process and product compliance. See 38 USC 1725 and 1728.). [FeePharmacyInvoice] and the [Fee]. There are limited data available regarding the specific non-VA provider associated with a visit; much information available pertains to the vendor who is billing for the care provided. Search VA Fee Basis Programs PayerID 12115 and find the complete info about VA Fee Basis Programs Insurance Type, LOB, ENR, RTE, RTS, ERA, SEC, Customer Service Number and more . Both the SAS and SQL Fee Basis are housed at VINCI; the SQL data is also found at the Corporate Data Warehouse (CDW). Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B. Researchers can read more information about accessing CDW on the VHA Data Portal (http://vaww.vhadataportal.med.va.gov/DataSources/CDW.aspx; VA intranet only). Austin Information Technology Center (AITC) is one of the VAs five national data centers. More than 99% of claims for inpatient, ancillary and outpatient care are processed within 2 years. The SAS Fee Basis data are organized by fiscal year. One exception to this is when identifying emergency department (ED) visits. The vendor identity can be found through the VENDID or VEN13N variables in SAS. HERC investigation of Fee Files reveals certain data anomalies of which researchers should be aware. However, in Table 4, we present some comparisons to demonstrate the different between SAS and SQL data. 2. Claims and other FBCS data will be found in PIT or Community Care Referral & Authorization domains. If there are multiple providers using the same entity to bill their claims, it will not be possible to disaggregate what type of provider the patient saw (e.g., an internal medicine physician or an infectious disease specialist). Many veterans now have access to Non-VA medical care through the new Veterans Access, Choice, and Accountability Act (VACAA, or Choice Act). Below are some answers to general questions about the FBCS tables. There are delays in the processing of Fee Basis claims. Our office is located at 6940 O St, Suite 400 Lincoln NE 68510. Q. NNPO. Unscheduled trips may be reimbursed for the return mileage only. (Veterans may submit unauthorized claims, however, and VA has legal authority to pay them under certain conditions. Assistance with claims is free and covers all state and federal veterans' programs. Attention A T users. U.S. Department of Veterans Affairs. Records that relate PatientSID to PatientICN are found two tables: Patient.Patient and SPatient.Spatient. In both SAS and SQL, it can be difficult to determine the provider the Veteran saw for Fee Basis care. 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). CLAIM.MD | Payer Information | VA Fee Basis Programs Payer Information VA Fee Basis Programs Payer ID: 12115 This insurance is also known as: Veterans Administration Need to submit transactions to this insurance carrier? Available at:http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. Money collected by VA from private health insurance carriers is returned back to the VA medical center providing the care. Accessed October 16, 2015. HIPAA Transaction Standard Companion Guide (275 TR3)The purpose of this companion guide is to assist in development and deployment of applications transmitting health care claim attachments intending to support health care claim payment and processing by VA community care health care programs. As of April 2019, this guidebook is no longer being updated. a. In SAS data, there is also a primary service area variable (HOMEPSA) that indicates the station to which the Veterans residence is assigned based on geography. 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. PO BOX 4444. a. Prosthetic items. 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 VA payment constitutes payment in full. 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. [FeeTravelPayment] contain information on travel type and payment. This guidebook describes characteristics of Fee Basis care data such as contents and missingness, and makes recommendations about its use for research purposes. Office of Media and Public Relations. VA Palo Alto, Health Economics Resource Center; October 2013. 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/. Name of the medication. 3. It is not necessarily the station at which the Veteran receives most VA care or the station which will pay for a particular Non-VA Medical Care service. Payment for these types of care falls under the Non-VA Medical Care program. [FeeVendor] table. All analyses using this cohort should use PatientICN as indicative of a unique patient. There are three routes for filing claims for authorized care which depend on your status in VAs network and how the care was authorized: All non-urgent and non-emergent care requires authorization from VA in advance. For pension claims, use the Pension Management Center (PMC) that serves your state. No new extracts will occur. Non-VA Medical Care data may be tabulated at the VHA Support Services Center (VSSC) (VA intranet only: http://vssc.med.va.gov/). U.S. Department of Veterans Affairs. They could form part of an overall strategy to locate care provided in specialized settings, such as state homes, or of specialized services like kidney dialysis. 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. 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. 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. Prescription-related data in the PHARVEN file contain only summary payments by month. Payer ID for dental claims is CDCA1. The vendor represents the entity billing for the non-VA care, while the provider represents the person who was involved in care provision. One may therefore assume that all patients receiving treatment through the Non-VA Medical Care program are Veterans. The unique patient identifier by which to conduct SQL-based Fee Basis analyses is PatientICN. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. There is limited information on the providers associated with Fee Basis care. Get Help from Our VA Disability Claim Appeals Lawyers Today. (Anything) - 7.(Anything). 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. If electronic capability isnot available, providers can submit claims by mail or secure fax. 3. In particular, CDW also recommends Patient SIDs with a value of less than 1 be deleted. We assume here that new inpatient stays are defined by a change in vendor or a gap in treatment day more than 1 day. In this table, some ancillary data are associated with an inpatient FPOV code but have an outpatient FeeProgramProvided field. Fee Basis: 214-857-1397 C & P. VA Claims Representation; RESOURCES. Researchers with VA intranet access can access these images by copying and pasting the URLs into their browser. The 275 transaction process should not be utilized for the submission of any other documentation for authorized care. In this case the first record would have an admission date of Jan 1, 2010 and a discharge date of Jan 10, 2010. The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. 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. Researchers and analysts will have to take care to collapse observations properly if warranted, for example to determine the costs, procedures or diagnosis associated with a single stay or visit. There are nine situations in which Non-VA Medical Care is authorized. Unlike the inpatient data, there can be multiple records with the same invoice number. This improves our claims processing efficiency. Menlo Park, CA. VA systems are intended to be used by authorized VA network users for viewing and Available at: http://www.va.gov/opa/choiceact/documents/Choice-Program-Fact-Sheet-Final.pdf. VA Claims Representation; RESOURCES. Office of Information and Analytics. At the time of this writing, the NPI number was often missing from fee basis claims. 16. 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. The mileage fee varies by type of ambulance service: ground, fixed wing, or rotary wing, POP zip code classification, and loaded mileage. The clinic of jurisdiction, or medical facility, authorizes such care under the fee-basis program . Microsoft Internet Explorer, a dependency of this technology, is in End of Life status and must no longer be used. SQL tables require linking before conducting any data analyses. However, there is one situation in which the payment amount will be more accurate than the disbursed amount: when the disbursed amount is missing, and the payment was not cancelled, one should use the payment amount to capture the cost of care. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. FBCS is designed to be used in the Fee Basis Departments of the Veteran Affairs Medical Centers (VAMCs). The majority of claims, 99%, were processed within 2 years, with the exception of pharmacy data in FY 2004 and FY2008. However, Veterans may be responsible for a VA copayment depending on their assigned Priority Group. VINCI Data Description: Dimension [online; VA intranet only]. We tried to link the UB-92 form to identify Choice authorizations; however, we found few records and decided to use obligation 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 general, we recommend using the disbursed amount to capture the cost of care, for two reasons. [FeeInpatInvoice] table, one must first link that table to the [Fee]. 5. Class 2 or Class 3 products must restrict their interfaces to Class 1 National Software to use of publicly-supported APIs ONLY. 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. From there, it is sent weekly to AITC in SAS format and nightly to CDW in SQL format. For dual pension and compensation claims, use the mailing address below for compensation claims. In both the SAS and the SQL data, there are usually multiple observations per patient encounter. PatientIEN and PatientSID are unique to a patient within a facility, but not unique to a patient across VA facilities (e.g., a patient who had visited multiple VA facilities will have multiple PatientIENs and multiple PatientSIDs). (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. Questions about non-VA care claims may be directed to the Fee Basis Unit between the hours of 8:00 a.m. Email Address Required. Generally, VA does not bill Medicare or Medicaid for reimbursement; however, VA does bill other types of health insurance including Medicare Supplemental plans for covered services. and constitutes unconditional consent to review and action including (but not limited Unauthorized user attempts Given these different patient identifiers, it is difficult to conduct exact comparisons between SAS and SQL data. E-fax: Documentation sent via email to Veterans Affairs Medical Center (VAMC) fax machine. Researchers evaluating care over time may want to use the DRG variable. This schema contains sensitive information such as SSNs, bank accounts, and the actual name of personnel. VA must be capable of linking submitted supporting documentation to a corresponding claim. Claims. Last updated validated on Tuesday, January 3, 2023 The table can be linked to the [Dim]. URLs are not live because they are VA intranet only. 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. With the exception of supplying remittance advice supporting documentation for timely filing purposes, these processes do not apply to authorized care. There are 34 Fee Basis Claims Systems (FBCS) servers, which were originally designed for episodes of care. Chapter 6 contains more information about how to access these data. June 5, 2009. Find out More 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. . The Florida Department of Veterans' Affairs has Claims Examiners co-located with the VA Regional Office in Bay Pines, each VA Medical Center and many VA Outpatient Clinics. Researchers with the appropriate DART permissions can ask the studys VINCI data manager to create a crosswalk file. one episode of care, which can have multiple dates within the prescribed treatment, one provider, as identified by the Tax Identification Number (TIN), and. access; blocking; tracking; disclosing to authorized personnel; or any other authorized You can further refine by selecting records on or after November 4, 2014, when Choice was first enacted. Electronic 837 claim and 275 supporting documentation submissions can be completed through VAs contracted clearinghouse, Change Healthcare, or through another clearinghouse of your choice. 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. SQL tables can be joined through linking keys. 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. The Fee Basis files' primary purpose is to record VA payments to non-VA providers. ______________________________________________________________________________. 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. To enter and activate the submenu links, hit the down arrow. However, in all data files, the vast majority of observations are missing values for this variable. Below are some answers to general questions about linking the UB-92 form to the FBCS data. VA may be a secondary payer for unauthorized emergent claims under 38 U.S.C. On March 17, 2022, The U.S. Court of Appeals for the Federal Circuit issued a ruling that changes VA's ability to reimburse as secondary payer under 38 U.S.C.1725. For Primary keys are denoted by (PK) and foreign keys are denoted by (FK). 2. Non-VA CareP.O. Seven refer explicitly to Veterans alone, while the remaining two are for diagnostic services or eligibility exams, neither of which constitutes treatment. Training - Exposure - Experience (TEE) Tournament. more information please visit www.fsc.va.gov. The SAS data are stored at AITC. It can be difficult to determine the provider and the location of the Non-VA care provider. The disbursed amount should be used to calculate the cost of care, except in the case where disbursed amount is missing. Multiple SAS datasets have VENID and VEN13N. 3. A single inpatient encounter may generate zero, one, or multiple ancillary records, depending on the number of ancillary procedures and physician services received. This is true for both the inpatient and the outpatient data, albeit for different reasons. However, there are best practices that all SQL-based analyses should follow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. Values for Fee Purpose of Visit (FPOV), HCFA Payment Type (HCFATYPE), Treatment Code (TRETYPE), Place of Service (PLSER), and Vendor Type (TYPE) appear in Appendix B. Some important DIM tables that will be useful in analyzing Fee Basis data are FeePurposeOfVisit, FeeSpecialtyCode, FeeVendor, ICD, ICDProcedure Code, DRG, CPT, and CPT Category. Important: The mailing address below only pertains to disability compensation claims. Visit the VHA Data Portal for further information on accessing restricted VSSC web reports. Compare the discharge date of the first observation to the admission date of the next (second) observation. _________________________________________________________________. For example, there could be many NPIs associated with a VEN13N (e.g., a hospital employing multiple providers), or many VEN13Ns for a single provider (e.g., a surgeon with privileges at multiple hospitals). Mark Smith and Adam Chow were the authors of the original HERC guidebook, upon which this document builds. There are exceptions. SQL Fee Basis data are stored in the form of multiple relational tables that must be linked, or in SQL parlance, joined, in order to create an analysis dataset. This means the data were placed in the PIT and the claim was not paid through FBCS. Electronic Services Available (EDI): Professional/1. Submit a corrected claim when you need to replace an entire claim previously submitted and processed. It is not available for claims in which payment was based on a contract amount. (In SAS the admission date is denoted by the TREATDTF variable and the discharge date by the TREATDTO variable, in SQL the admission date is denoted by the AdmissionDate field and the discharge date is denoted by the DischargeDate field). The Implementer of this technology has the responsibility to ensure the version deployed is 508-compliant. 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. Compare the admission date of the third observation to the temporary end date from above. Many private health insurance companies will apply VA health care charges towards satisfying a Veteran's annual deductible and maximum out of pocket expnse.
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