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There may be multiple vendor IDs (VENDIDs) for a single inpatient stay. HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. 3. Updated September 21, 2015. 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 . These represent cases in which payment is disallowed. The Department of Veterans Affairs (VA) often pays providers in the community to provide care to Veterans when it is unable to provide such care itself (e.g., due to a lack of resources or delays in providing care), or when it is infeasible to do so (e.g., emergency care). 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). Records that relate PatientSID to PatientICN are found two tables: Patient.Patient and SPatient.Spatient. For more details, including rules for handling patients transferred during a stay, see federal regulation 38 CFR 17.55. Domains generally indicate the application in the VistA electronic health record system from which most of the data elements come (e.g., Vital Signs or Mental Health Assessment).6. Five additional variables Financial Management System (FMS) transaction number, line number, date, batch number, and release date reflect processing of payments through the FMS. A single inpatient encounter may generate zero, one, or multiple ancillary records, depending on the number of ancillary procedures and physician services received. Use Azure Rights Management Services (Azure RMS) for encrypted email. [FeePrescription] tables. Researchers will have to select observations from the SQL FeeServiceProvided table in order to ensure they are only evaluating outpatient data. 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: Claims Assistance | Veterans' Affairs Home Claims Assistance Claims Assistance Contacting the Columbia VA Regional Office Call us at (803) 647-2488, or email VetAsst.VBACMS@va.gov, and provide your: Name Contact information and, Best time of day for contact between 8:00am and 4:00pm This guide was published in October 2015; the same month the United States switched from ICD-9 to ICD-10. Those with access to the VA intranet can find a list of SQL fields on the CDW MetaData site. 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. Some encounters have multiple procedures that are paid as a single encounter; other encounters have multiple procedures and there are separate payments for each procedure. The definition of the DXLSF variable changes depending on the year of analysis. Get the latest updates on VA community care, including program changes, resources and more! There are 34 Fee Basis Claims Systems (FBCS) servers, which were originally designed for episodes of care. Paper claims and supporting documentation submitted to us are converted to Electronic Data Interchange (EDI) transactions. The invoice table would have to have a sufficient number of fields to accommodate the maximum number of procedures report on any invoice. [FeeTravelPayment] contain information on travel type and payment. As noted above, in SAS, the patient identifier is the SCRSSN; this is unique to each patient across the entire VA. Unlike the inpatient data, there can be multiple records with the same invoice number. When a claim is linked to VistA, the variable Other_Hlth_ins_present is populated. They do not represent all claims received during the year. In SQL, the outpatient data are housed in the FeeServiceProvided table. Box 14830Albany, NY 12212. Visit the VHA Data Portal for further information on accessing restricted VSSC web reports. One can use the FeeInitialTreatmentSID variable in the FeeServiceProvided table to link to the Fee.FeeInitialTreatment table. YESInstitutional/UB Claims. Data are presented in Table 4. National Institute of Standards and Technology (NIST) standards. This care will be approved (or denied) by the local VA Fee Office; the Veteran is then free to seek non-VA care. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). The Fee Basis files' primary purpose is to record VA payments to non-VA providers. This technology can use a VA-preferred database. If the claims and records do not conform to the minimum requirements for conversion to the 837 or 275 electronic formats, they are rejected and sent back for correction. If the patient was transported to a VA hospital after stabilization (as indicated by the DISTYP, or disposition type, variable), the record of the VA stay should appear in VA utilization databases. All SAS prescription-related data is found in two files: the PHR file and the PHARMVEN file. 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. business and limited personal use under VA policy. VA may reconsider and provide retroactive reimbursements for emergency treatment that was provided prior to the date of enactment (July 19, 2001), if documentation sufficiently demonstrates the original denial was because the Veteran received partial third party payment. Current Decision Matrix (10/21/2022) This is true for both the inpatient and outpatient data. SQL Fee Basis data are stored in CDW in multiple individual tables. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. Four FPOV (Fee Purpose of Visit) codes can be used to identify payment for unauthorized claims. Assistance with claims is free and covers all state and federal veterans' programs. If you are submitting a paper claim, please review the Filing Paper Claims section below for paper claim requirements. (Available at the VHA Data Portal. To enter and activate the submenu links, hit the down arrow. Facility Information Security Officers (ISOs) are often the CUPS POC. VA may be a secondary payer for unauthorized emergent claims under 38 U.S.C. VSSC provides numerous relevant web reports, data resources, and analytics support, including summary data by facility and VISN and national summary data. VA Information Resource Center. 6. VA systems are intended to be used by authorized VA network users for viewing and The potential exists to store Personally Identifiable Information (PII), Protected Health Information (PHI) and/or VA Sensitive data and proper security standards must be followed in these cases. This means the data were placed in the PIT and the claim was not paid through FBCS. The new temporary end date is the maximum of the discharge date of the third observation and temporary end date from Step 2. NNPO. have hearing loss. 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. If the patient is transferred from a non-VA to a VA hospital, the non-VA component of this care will be captured through Fee Basis, while the VA component of this care will be in the VA inpatient datasets. 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. 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. 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. Last updated August 21, 2017 Through the CCN, Veterans have access to regional networks of high-performing, licensed health care . 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. It is only relevant for claims linked to VistA patients. Under the Veterans Choice Act, eligible veterans are able to obtain outpatient care outside the VA using their Choice Card. U.S. Department of Veterans Affairs. 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. 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. Treatment date correlates to covered from/to. For education claims, refer to the appropriate Regional Processing Office. This improves claim accuracy and reduces the amount of time it takes for us to process claim determinations. If a claim is filed for an eligible episode of care, VA must pay the whole amount according to the payment rules noted above. Health Information Governance. 7. If it cannot be located in the PTF Main file or DSS NDE for inpatient care, search other inpatient files. Regardless of whether the care was pre-authorized or not, non-VA providers submit claims to VA if they wish to be reimbursed for care. 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.). The variable DTStamp represent the date the claim was received. Address. 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. For the purpose of this guidebook, we focus on Fee Basis files only. U.S. Department of Veterans Affairs. The National Provider Identifier (NPI) is a unique 10-digit identification number issued by the Centers for Medicare and Medicaid Services to all health care providers in the United States. JANESVILLE, WI 53547-4444. or Fax to: TOLL FREE: 844-531-7818 & 248-524-4260 (Utilized for Foreign Claimants) return to top. Previously, VA could reimburse Veterans or pay non-VA hospitals directly only if a Veteran has no other health insurance. Compare the admission date of the third observation to the temporary end date from above. 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. Electronic Data Interchange (EDI): Payer ID for medical claims is TWVACCN. 1. Multiple claims can be paid against a single authorization. TriWest VA CCN ClaimsP.O. 2. The DSS Fee Basis Claims System (FBCS) is a web-based claim management system. If, however, VA is authorized to pay for only certain days in an inpatient stay, then the provider may bill the patient for the remaining days. Care provided in foreign countries other than the Philippines. Attention A T users. 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. For more information call 1-800-396-7929. This most likely reflects a low frequency of surgery rather than missing data. VIReC. A foreign key is a key that uniquely identifies a record of another table. 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. [FeeInpatInvoice], and a foreign key in the [Fee].[FeeInpatInvoiceICDProcedure]. The two tables can be joined through FeePharmacyInvoiceSID. One may therefore assume that all patients receiving treatment through the Non-VA Medical Care program are Veterans. VA Palo Alto, Health Economics Resource Center;November 2015. Mail to: DEPARTMENT OF VETERANS AFFAIRSCLAIMS INTAKE CENTERPO BOX 4444JANESVILLE, WI 53547-4444, or Fax to: TOLL FREE: 844-531-7818 & 248-524-4260 (Utilized for Foreign Claimants), Veterans Crisis Line: The values of Adjustment Codes 1 and 2 (ADJCD1 and ADJCD2) explain the reason for non-payment. 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. 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). Table 9 lists a number of financial variables the SQL data contain. There may be multiple CPT codes associated with a single encounter. a. Claims should be mailed to the following address: VA Eastern Kansas Health Care System Attn: Fee Basis Office 2200 SW Gage Blvd Topeka. The PatientSID is a CDW assigned identifier that uniquely identifies a patient within a facility. Defining a cohort is an activity that is different for each project and depends on the research question at hand. The VA Fee Basis medical program provides payment authorization for eligible Veterans to obtain routine medical treatment services through non-VA health care providers. 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. 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. INTIND and INTAMT are not always concordant. 1. Community providers have three options that allow for that linkage: Submit the claim electronically via 837 transaction and the supporting documentation via 275 transaction. The FMS disbursed amount is the payment amount plus any interest payment. Note: The last extract occurred in December 2020. The vendor no longer supports VA installations of this technology. Inpatient stays in both SAS and SQL Fee Basis data can denote hospital stays, nursing home stays, or hospice stays. Get Help from Our VA Disability Claim Appeals Lawyers Today. For example, a hospital stay may last from Jan 1, 2010 to Jan 10, 2010, and have another claim for treatment provided on Jan 5, 2010. Most commonly, authorized care refers to medical or dental care that was approved and arranged by VA to be completed in the community. The key field indicates which invoice they appeared on. We encourage readers to seek out the latest guidance before conducting analyses, as CDW Data Quality Analysis team may have updates to this information. This technology can integrate with and alter database technologies. All instances of deployment using this technology should be reviewed by the local ISO (Information Security Officer) to ensure compliance with. You can further refine by selecting records on or after November 4, 2014, when Choice was first enacted. In SAS, the inpatient (INPT) file includes PAMT, the Medicare prospective payment that would apply to the stay. American Society of Health-System Pharmacy (ASHP). As part of the process, claims and supporting documentation are scanned for compliance prior to conversion to electronic format. 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. 3. Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. Claims processed after March 17, 2022, will be reviewed and aligned with the federal ruling which prohibits secondary payment on emergency care copayments and deductibles. 4. There are often multiple observations per inpatient stay and multiple observations per outpatient encounter. SAS Fee Basis data can be linked to other SAS files with additional demographic data (e.g., Vital Status files, enrollment files). 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. Sort data by the patient ID, STA3N, VEN13N, and the admission dates. Information from this system resides on and transmits through computer systems and networks funded by the VA. For some VEN13N, however, there is more than one MDCAREID. Many URLs are not live because they are VA intranet only. 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. The same cannot be said for DX2-DX25, however, as additional diagnosis codes are optional. These data records cannot be linked to particular patient identifiers or encounters. YESThis insurance is also known as: Veterans Administration. 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. There are two types of keys: primary keys and foreign keys. Many variables in the Fee Basis files record details of invoice and check processing. For these reasons, VA strongly encourages Veterans to consider important factors, risks and benefits before making any changes to their private health insurance. PLSER values overlap considerably with those of the Medicare Carrier Line Place of Service codes. The conversion happens before claims and records are accepted into our claims processing system. Payer ID: 1. 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. Each record in the pharmacy services (PHR) file represents a single prescription, whether for a medication or a pharmacy supply (e.g., skin cleanser, bathing cloths). For example, the meaning of DRG001 is not the same in FY05 vs FY15. However, there are data available regarding the category of visit. The deadline for claims submission is dependent upon which program the care has been authorized through or which program the emergency care will be considered under. We found SPECIALPROVCAT was missing in 93% of records. (Anything), but would not cover any version of 7.5.x or 7.6.x on the TRM. Non-VA providers submit claims for reimbursement to VA. SAS data are also available in CDW, but are currently limited to those VA employees with operational 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. Move on to the next patient ID, STA3N, VEN13N combination and repeat the entire process above. For example, if the Veteran had an Emergency Department (ED) visit and then was admitted to the hospital, this would be considered inpatient care. YESElectronic Remittance (ERA)YESICD- 1. To enter and activate the submenu links, hit the down arrow. There is no official data dictionary for the SAS Fee Basis data. The Non-VA Medical Care program covers the full range of medical and dental care, with these exceptions: Although VA utilization files contain many non-Veterans, Non-VA Medical Care files do not. 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). Analyses of FY 2014 data indicate approximately 50% of inpatient observations and 43% of outpatient observations are missing NPI. Seven refer explicitly to Veterans alone, while the remaining two are for diagnostic services or eligibility exams, neither of which constitutes treatment. Appendices G and H, copied from the Non-VA Medical Care program website, describes in detail the types of records for which each Fee Purpose of Visit (FPOV) codes are assigned. When there is no available rate in the Medicare Fee Schedule, the VA will follow the payment guidelines for Non-VA Medical Care. When evaluating the cost of care, use the disbursed amount. The Veterans Access, Choice, and Accountability Act (Veterans Choice Act), passed in 2014, expanded veterans access to non-VA care. Procedures are identified by CPT code (CPT1) in the non-hospital inpatient services (the ancillary file) and in the outpatient procedures file. [FeeInpatInvoiceICDProcedure] table. The SAS PHARVEN dataset contains information only about pharmacy vendors. This technology is not portable as it runs only on Windows operating systems. The SQL tables [Dim]. More detailed information about the vendor can be found in the SQL [Dim]. No new extracts will occur. You may use VA Form 10-583 to fulfill this requirement. 21. The Medicare Ambulance Fee Schedule consists of a base rate plus mileage. Payment guidelines for non-VA are outlined in federal regulations 17.55 and 17.56. VA medical centers may purchase prosthetics and related items, such as clothing specialized for prosthetic limbs, and then dispense them through VA facilities. If the payment was made outside of FBCS, they wont show here. 16. Table 3 lists their file names and gives a general description of their contents.10. 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. The Act amends 38 U.S.C. If you are in crisis or having thoughts of suicide, For current information on Community Care data, please visit the page. The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. Some Fee Basis data will also appear in the non-VA medical SAS inpatient file (formerly called the Patient Treatment File). 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. All persons working with these data should review this information before conducting any analyses. Veterans are not responsible for the remaining balance shown as patient responsibility on the explanation of benefits from their insurance carrier. The vendor identity can be found through the VENDID or VEN13N variables in SAS. For example, an interest payment of $14.21 would appear as 1421. INTAMT is part of DISAMT; it should not be added to them. This is specific to certain claims for Non-Service Connected emergency medical care under Title 38 USC 1725. NOTE: The processes outlined below are exclusive to supplying documentation for unauthorized emergent care. 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. If that analyst examines VEN13N and STA6A (in inpatient Fee Basis data, this field represents the VA hospital arranging care), there is often only one MDCAREID.