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. Unauthorized Care is that which was not pre-authorized but was still reimbursed, such as emergency care. Please switch auto forms mode to off. However, there are data available regarding the category of visit. VA can make payments to non-VA health care providers under many arrangements. Non-VA providers submit claims for reimbursement to VA. [1] The Health Care Financing Administration (HCFA) was renamed the Centers for Medicare and Medicaid Services. March 2015. In SAS, the outpatient data are housed in the MED files. If notification was not made to VA and you wish to have claims considered for payment, please submit claims and supporting documentation to VA as listed in the "Where to Send Claims" dropdown below. [FeeInpatInvoiceICDDiagnosis] with the [Dim]. YESElectronic Remittance (ERA)YESICD- 1. Mark Smith and Adam Chow were the authors of the original HERC guidebook, upon which this document builds. DSS Fee Basis Claims Systems (FBCS) - oit.va.gov More information about can be found on their website: https://www.va.gov/communitycare/. 2. visit VeteransCrisisLine.net for more resources. [Patient], [SPatient]. If a researcher wishes to find the Medicare hospital provider ID, one approach is to use the vendor identification variables (VEN13N, VENDID) to locate the vendors name and location in the VEN file, and then to use this information to find the Medicare provider ID using publicly available files from CMS, the agency that oversees the Medicare program. VIReC. Additionally, our health care providers make certain that Veterans' VA medical records remain updated by returning information about Veteran care and treatment to VA. 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. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. Claims Assistance | Veterans' Affairs - South Carolina 4. Dental claims must be filed via 837 EDI transaction or using the most current. These rules are subject to change by statute or regulation. In SQL, there are additional variables that will denote the type and location of the care provided along with the vendor. This table contains information on inpatient care. In SQL, there are multiple patient identifiers, with the most useful being the PatientICN. For more detailed information, researchers should visit the VHA Office of Community Care website. This rare event most likely indicates a transfer. Make sure the services provided are within the scope of the authorization. The CDW is a relational database organized into a collection of data domains implemented on the Microsoft SQL server in VINCI. For inpatient and outpatient care, in general, VA will pay the lesser of the Medicare rate (or MPFS rate) or the billed charges. No new extracts will occur. 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. 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. 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. Compare the admission date of the third observation to the temporary end date from above. The quantity dispensed. This act expands the non-VA care veterans were able to receive before the act was passed. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. All Fee Basis care will be found in the Fee files. [XXX] tables.9,12 Tables under the DIM schema contain attributes that describe the records in the Fee tables. Some vendors use centralized billing services located in other cities, in a few cases in other states. VA CCN OptumP.O. 15. 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. The new temporary end date is the maximum of the discharge date of the third observation and temporary end date from Step 2. National Non-VA Medical Care Program Office (NNPO). Bowel and Bladder Care. In SQL, these variables can be found in the [Dim]. 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. Veterans are not responsible for the remaining balance shown as patient responsibility on the explanation of benefits from their insurance carrier. Each year represents the year in which the claim was processed, not the year in which the service was rendered. Electronic 837 claim and 275 supporting documentation submissions can be completed through VAs contracted clearinghouse, Change Healthcare, or through another clearinghouse of your choice. If the payment was made outside of FBCS, they wont show here. Important: The mailing address below only pertains to disability compensation claims. PMS-DRG was effective in FY 2008; prior to this time CMS-DRGs were used. 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. This guidebook describes characteristics of Fee Basis care data such as contents and missingness, and makes recommendations about its use for research purposes. 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. 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. 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. 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. Compare the discharge date of the first observation to the admission date of the next (second) observation. To enter and activate the submenu links, hit the down arrow. E-fax: Documentation sent via email to Veterans Affairs Medical Center (VAMC) fax machine. 3. . When a key field is missing, SQL indicates this with a value of -1. See 38 USC 1725 and 1728.). The same cannot be said for DX2-DX25, however, as additional diagnosis codes are optional. VA will arrange for transportation for them or will reimburse expenses on the basis of vouchers submitted. 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. 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). Claims for Non-VA Emergency Care However, there are best practices that all SQL-based analyses should follow. Much Fee Basis care is pre-authorized prior to the Veteran obtaining care and is thus considered Authorized Care. Veterans Choice Program - Fee Basis Claims System in CDW Data Quality Analysis Team. Health Information Governance. 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). 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. To enter and activate the submenu links, hit the down arrow. 988 (Press 1). Coverage will start July 1 of that year. However, investigation has confirmed these are partial payments made for a single encounter or procedure. Learn how to prevent paper claim rejections. or use of this system constitutes user understanding and acceptance of these terms There is limited information on the providers associated with Fee Basis care. 9.2. The Fee Basis files' primary purpose is to record VA payments to non-VA providers. To find all care provided in a particular fiscal year requires searching by treatment date over several years of Non-VA Medical Care claims. [ICD9] tables. Attention A T users. As with the SAS data, the important variables in the SQL data are the AmountPaid and the DisbursedAmount. Given the stronger guidance from the Fee Office regarding use of the FPOV code, we recommend using the FPOV code to discern which observations are ancillary care, as the FeeProgram may not be as reliable. The table can be linked to the [Dim]. Cunningham, K. VA implements the first of several Veterans Choice Program eligibility expansions. VA Information Resource Center VHA Corporate Data Warehouse [webpage]. The Routing tool manages how Health Care Finance Administration (HCFA) and Uniform Billing (UB) claims will electronically flow through the FBCS program. [FeeInpatInvoice], [Fee]. For a list of VA acronyms, please visit the VA AcronymLookup on the VA intranet at http://vaww.va.gov/Acronyms/fulllist.cfm. If billing electronically, please include "Other Payers Information" in Loop 2320, 2330A, 2330B, and 2430. 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). However, not all dates on the claim are approved. Billing & Insurance - South Central VA Health Care Network Accessed October 16, 2015. Several variables are available for locating care in particular settings. You are strongly encouraged to electronically submit claims and required supporting documentation. In the SQL files, there is no separate ancillary file; rather, data regarding the physician cost of the inpatient stay is denoted in the [Fee]. The Fee Purpose of Visit (FPOV) and Health Care Financing Agency Payment Type (HCFATYPE) variables feature values pertaining to setting (inpatient, outpatient, home-based), specific items (e.g., supplies and diagnostics), and miscellaneous purposes.[1]. No, only one type of care can be covered by a single authorization. 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. Hit enter to expand a main menu option (Health, Benefits, etc). Non-VA providers submit claims for reimbursement to VA. Attention A T users. One can use the FeeInitialTreatmentSID variable in the FeeServiceProvided table to link to the Fee.FeeInitialTreatment table. Make sure you have received an official authorization to provide care or that the care is of an emergent nature. - The information contained on this page is accurate as of the Decision Date (11/02/2022). We recommend researchers use the FeePurposeOfVisit codes (FPOV) codes to eliminate observations related to non-outpatient care before beginning analyses. A description of the Patient and SPatient schema is available on the VIReC CDW Documentation webpage: http://vaww.virec.research.va.gov/CDW/Documentation.htm (intranet only). Outpatient prescriptions beyond a 10-day supply. U.S. Department of Veterans Affairs. Available at: http://www.va.gov/opa/choiceact/documents/Choice-Program-Fact-Sheet-Final.pdf. To access the menus on this page please perform the following steps. This technology can integrate with and alter database technologies. The [Fee]. Researchers with VA intranet access can access these sites by copying and pasting the URLs into their browser. You may use VA Form 10-583 to fulfill this requirement. 1725 when remaining liability to the Veteran is not a copayment or similar payment. A claim for which the Veteran had coverage by a health plan as defined in statute. Submit a claim void when you need to cancel a claim already submitted and processed. 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. We assume here that new inpatient stays are defined by a change in vendor or a gap in treatment day more than 1 day. Gidwani R, Hong J, Murrell S. Fee Basis Data: A Guide for Researchers. Identify Choice records by using tax ID and specialprovcat= CHOICE. All access 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. In FY 2014, the longest length of stay associated with a single nursing home invoice was 31 days. In some cases it may appear that single encounters have duplicate payments. Veterans applying for and using VA medical care must provide their health insurance information, including coverage provided under policies of their spouses. In SAS, these data can be found in the Vendor file. They appear in Table 6, where an X indicates that the variable appears in the file.10 Vendor type (TYPE), payment category (PAYCAT), treatment code (TRETYPE), and place of service (PLSER) all provide information on the type or setting of care. The two tables can be joined through FeePharmacyInvoiceSID. 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. Presence of this software on the One-VA TRM does not equate to designation as a Class 1 National Software product and MUST NOT be assumed to comply with all VA programming standards, namespacing and interface control agreement standards, data management standards, documentation standards, information assurance standards, security standards and 508 compliance standards. 1. Optum is a proud partner with the VA through its Community Care Network (CCN). VA decisions for specific versions may include + symbols; which denotes that the decision for the version specified also includes versions greater than If a claim is filed for an eligible episode of care, VA must pay the whole amount according to the payment rules noted above. 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. It is only relevant for claims linked to VistA patients. Summary data are also available through the VHA Support Services Center (VSSC) website on the VA intranet. Please switch auto forms mode to off. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. NPI is available within the VA CDW SStaff table. Users must ensure sensitive data is properly protected in compliance with all VA regulations. There are delays in the processing of Fee Basis claims. The Department of Veterans Affairs' (VA) fee basis care spending increased from about $3.04 billion in fiscal year 2008 to about $4.48 billion in fiscal year 2012. 400, Wittman Drive Grand Rapids Itasca County MN - 55744 United States. The VEN13N is the vendor ID with a suffix; VEN13N is more detailed than VENDID and is thus recommended for use. Sign up to receive the VA Provider Advisor newsletter. Second, there are some cases where the disbursed amount is $0, while the payment amount is greater than $0; these are cases in which the payment was cancelled and the true cost of care is thus $0. Accessed October 07, 2015. have hearing loss. Thus the variable INTIND (interest indicator) equals 1 if the claim is eligible for interest and 0 otherwise. In the SAS data prior to FY 2007, the disbursed amount (DISAMT) had an implied decimal point whereas the payment amount (AMOUNT) did not. For these reasons, VA strongly encourages Veterans to consider important factors, risks and benefits before making any changes to their private health insurance. one setting of care (inpatient or outpatient). There are often multiple observations per inpatient stay and multiple observations per outpatient encounter. The impact on inpatient and emergent care is unclear, however, as the definition of prosthetic in VA is so broad as to include items placed inside the body, such as internal fixation devices, coronary stents, and cardioverter defibrillators. Two domains in which researchers can find reports on Non-VA Care are Resource Management and Workload. 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. This latter table contains a variable called InitialTreatmentDateTime. 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. Any variable that has an S prefix indicates secure data and requires special permission to access; researchers should be aware of this when submitting their IRB applications and their CDW DART data access requests. 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. Chapter 1 presents an overview of Fee Basis data in general; Chapter 2 presents an overview of the variables in the Fee Basis data; and Chapter 3 describes how SAS versus SQL forms of Fee Basis data differ. Non-VA Medical Care data may be tabulated at the VHA Support Services Center (VSSC) (VA intranet only: http://vssc.med.va.gov/). With few exceptions these variables will be of little interest to researchers. 3. If electronic capability is not available, providers can submit claims by mail or secure fax. [FeeServiceProvided] tables. http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. If the Veteran received care in the community that was not pre-authorized, it is considered unauthorized by VA. The travel payments data contains reimbursements for particular travel events (TVLAMT). 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. The Veterans Emergency Care Fairness Act (Public Law 111-137), signed February 1, 2010, authorizes VA as a secondary payer to third party liability insurance not related to health insurance. There are substantial differences in quantity of inpatient diagnosis and procedure data available in SAS versus SQL. However, a 7.4.x decision 3. It may duplicate the PatientIEN of another patient at another facility, and should not be used as an identifier. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). 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. This application completes the update of critical claims data into the FBCS shared MS SQL database for further processing and reporting. Once the process is exhausted for a particular patient, STA3N and VEN13N combination, we calculate length of stay as the difference between the admission date of the first record and the temporary end date.. 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). VA's fee basis care program. Information from this system This component communicates with the FBCS MS SQL and VistA database in real time. It is available in the PHARVEN and VEN files, albeit with a high degree of missingness. In the SAS data, the provider component of the inpatient stay is captured in the ancillary file. Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. Lump sum payments are not paid via FBCS. 17. The VA Fee Basis medical program provides payment authorization for eligible Veterans to obtain routine medical treatment services through non-VA health care providers. 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). This improves claim accuracy and reduces the amount of time it takes for us to process claim determinations. 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. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). 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). The payment category (PAYCAT) is missing for all records in the inpatient services (ANCIL) file. These inpatient tables have to be linked to FeeInpatInvoiceICDDiagnosis, FeeInpatInvoiceICDProcedure, FeeInitialTreatment and the appropriate DIM tables in order to understand the specific diagnoses and procedures associated with the inpatient observations in these tables. 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. CLAIMS INTAKE CENTER. U.S. Department of Veterans Affairs. Eligibility and claims submission information for emergent care will be provided after notification is made to the VA. Claims for emergent care not eligible for authorization upon notification, may be eligible for consideration as Unauthorized Care. For example: services provided at a hospital anticoagulation clinic are billable for facility charges only if the anticoagulation is considered incident to physician services and certain other conditions are met.8. If you have additional questions about the form or your portal account access, please contact the Provider Services Solution (PRSS) help desk at 888-829-5373. Thus, unauthorized care is not unpaid care it is simply not PRE-authorized care. 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. 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. If a patient received care at another facility, that patient will be have a different PatientSID assigned for that facility. VA must be capable of linking submitted supporting documentation to a corresponding claim. This research was supported by the Health Services Research and Development Service, U.S. Department of Veterans Affairs (ECN 99017-1). Fee Basis: 214-857-1397 C & P. VA Claims Representation; RESOURCES. We detail differences amongst the SAS and SQL Fee Basis data in the guidebook below. While not required to process a claim for authorized services, medical documentation must be submitted to the authorizing VA medical facility as soon as possible after care has been provided. To access the menus on this page please perform the following steps. Mailing Address for Disability Compensation Claims - Veterans Affairs 2. Below we describe the general types of information in both the SAS and SQL data. (Available at the VHA Data Portal. When evaluating the cost of care, use the disbursed amount. Seven refer explicitly to Veterans alone, while the remaining two are for diagnostic services or eligibility exams, neither of which constitutes treatment. The Act amends 38 U.S.C. 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. [FeeVendor] table. . SQL data are housed at CDW, which is a collection of many servers. VA Health Care: Management and Oversight of Fee Basis Care Need UB-92 box 56 (ProviderNPI) represents the providers National Provider Identifier. visit VeteransCrisisLine.net for more resources. Chief Business Office. 1. 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. The key field indicates which invoice they appeared on. Accessed October 16, 2015. 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. There are 34 Fee Basis Claims Systems (FBCS) servers, which were originally designed for episodes of care. [LocalDrug] table through LocalDrugSID to see whether there was the generic equivalent found in the VA drug file that was dispensed to the patient. Of note, SQL and SAS data contain similar, but not exactly the same, information. would cover any version of 7.4. At the time of this writing, the NPI number was often missing from fee basis claims. Q. [FeeInpatInvoiceICDDiagnosis], [Dim]. Community providers have three options that allow for that linkage: Submit the claim electronically via 837 transaction and the supporting documentation via 275 transaction. (Anything) - 7.(Anything). (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). Users must ensure that Microsoft .NET Framework, Microsoft Structured Query Language (SQL) Server, and Microsoft Excel are implemented with VA-approved baselines. Complete and accurate standard Center for Medicare & Medicaid Services (CMS) or electronic transaction containing false claims notice (such as CMS 1450, CMS 1500 or 837 EDI transaction). Below are some answers to general questions about the FBCS tables. How Does VGLI Compare to Other Insurance Programs? They do not represent all claims received during the year.

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