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. 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). Through the CCN, Veterans have access to regional networks of high-performing, licensed health care . October 1, 2015. The Implementer of this technology has the responsibility to ensure the version deployed is 508-compliant. For emergency care of service connected conditions, there is a two-year limit to submit any bills. Smith MW, Su P, Phibbs CS. Details about the VA rules governing reimbursement can be found in Chapter 7 of this guidebook. 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). If it cannot be located in the PTF Main file or DSS NDE for inpatient care, search other inpatient files. Providers who continue to elect to submit paper claims and paper documentation to support claims for unauthorized emergency care should be aware of the following: VHA Office of Integrated Veteran Care P.O. Domains represent logically or conceptually related sets of data tables. The Medicare ID is missing if the payment is determined via a different mechanism (e.g., a contract). one episode of care, which can have multiple dates within the prescribed treatment, one provider, as identified by the Tax Identification Number (TIN), and. 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. 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. It will often times not be possible to determine the reason for an outpatient visit, as there will be multiple observations/CPT codes that denote a single visit. VA medical centers may purchase prosthetics and related items, such as clothing specialized for prosthetic limbs, and then dispense them through VA facilities. For authorized care, the referral number listed on the Billing and Other Referral Information form. In VA datasets, the MDCAREID does not have an accompanying address, but one can use other non-VA datasets (e.g., Hospital Compare) and determine the address of the hospitals physical location through the common MDCAREID variable. Researchers with VA intranet access can access these images by copying and pasting the URLs into their browser. Thus, one could not simply use the patient identifier and the admission and discharge dates to collapse these observations into one inpatient stay. Please switch auto forms mode to off. Make sure the services provided are within the scope of the authorization. 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. Note that some physicians use the same ID number as the hospital. In this chapter, we discuss general aspects of Fee Basis data. Through patient identifier and travel date (TravelPaymentDate), one can link these payments to inpatient and outpatient encounters. The local VA facilities put claims through a claim scrubber that checks to see if the claim was authorized and evaluates any errors or inconsistencies in the data. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. SAS data are also available in CDW, but are currently limited to those VA employees with operational access. Download the tables here. Edward J. Hines, Jr. VA Hospital, Hines, Ill. 2007. 21. VHA Office of FinanceP.O. In SQL, there are multiple patient identifiers, with the most useful being the PatientICN. 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. More information can be found at the OPES website: http://opes.vssc.med.va.gov. Additionally, our health care providers make certain that Veterans' VA medical records remain updated by returning information about Veteran care and treatment to VA. Additional information appears in a federal regulation, 38 CFR 17.52. SAS data are housed in 8 ready-to-use datasets per fiscal year. VA calculates PAMT from CMS pricer software on the basis of DRG and length of stay. 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: FBCS is designed to be used in the Fee Basis Departments of the Veteran Affairs Medical Centers (VAMCs). VA-station related information includes STA3N, STA6A and STANUM in SAS and Sta3n and PrimaryServiceInstitution in SQL. Veterans Health Administration. The Fee Basis VA program allows Veterans to be seen by a community provider. 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. VA Informatics and Computing Resource Center (VINCI). However, there are some outliers; some claims can take up to 8 years to process. This could indicate a transfer between facilities or a physician bill for an inpatient stay. There may be many providers that use the same vendor for billing. VA Information Resource Center. Many URLs are not live because they are VA intranet only. 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. The SAS data are stored at AITC. VA contracts out its hospice; therefore, the Fee Basis files contain a great deal of data related to hospice care. 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. Bowel and bladder care for certain Veterans with SCI/D are considered supportive medical services due to the possibility of medical complications which would result in the need for hospitalization. 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. 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. NNPO. Quality of Life and Veterans Affairs Appropriations Act of 2006 (Public Law 109-114),the FSC offers a wide range of financial and accounting products and services to both the VA and Other Government Agencies (OGA). Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. SQL inpatient data contain up to 5 diagnoses and 5 procedure codes, while SAS inpatient data contain up to 25 diagnosis codes and up to 25 procedure codes. Users must ensure sensitive data is properly protected in compliance with all VA regulations. a. This latter table contains a variable called InitialTreatmentDateTime. HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. For these reasons, the program does not pay for 100% of care that was otherwise eligible. There are nine situations in which Non-VA Medical Care is authorized. Researchers will notice a high degree of concordance between SAS and SQL data in most years of analysis. Chief Business Office. The process for filing a claim for services rendered to a Veteran in the community varies depending upon whether or not the services were referred by VA and by the entity through which the services were authorizedVA or one of the VA Third Party Administrators (TriWest Healthcare Alliance or Optum United Health Care). Linking Patient Data in the CDW Update [online; VA intranet only]. Information from this system resides on and transmits through computer systems and networks funded by the VA. 1. One can use the same approach as for the inpatient SQL data described above to locate the date of service. All persons working with these data should review this information before conducting any analyses. Passed in 2014 with bipartisan support in Congress, its purpose is to increase Veterans access to health care.1 The Choice Act allows Veterans to receive health care through non-VA providers in the community if they are unable to schedule an appointment at their local VA within 30 days or by a date determined by their provider (wait-time goals), if they reside over 40 miles from a VA facility, or if they face an unusual or excessive burden in travelling to a VA facility.2 Under the Choice Act, ten ($10) billion dollars has been allocated towards Non-VA Medical Care for eligible Veterans through 2017.1 The Fee Basis files contain data for care received through the Choice Act, but in this guide, we do not distinguish for care provided under the Non-VA Medical Care program and that provided under the Choice Act. Under this regulation, ambulances will be reimbursed at the lesser of (a) the amount the Veteran is personally liable or (b) 70 percent of the applicable Medicare Ambulance Fee Schedule. The 2015 update to the Fee Basis Medical Care guidebook describes for the first time the SQL Fee Basis files, and contains a host of information about how SAS versus SQL Fee Basis files differ. 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. VA Directive 6402, Modifications to Standardized National Software, Document Storage Systems (DSS) DocManager, Microsoft Structured Query Language (SQL) Server, Optical Character Recognition (OCR) Module, Fidelity National Information Service (FIS) Compass. The conversion happens before claims and records are accepted into our claims processing system. If FIPS 140-2 encryption at the application level is not technically possible, FIPS 140-2 compliant full disk encryption (FOE) must be implemented on the hard drive where the DBMS resides. 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. PDF VA Community Care - Veterans Affairs Note: A Veterans insurance coverage or lack of insurance coverage does not determine their eligibility for treatment at a VA health care facility. However, there are data available regarding the category of visit. Box 30780, Tampa FL 33630-3780. Dental claims must be filed via 837 EDI transaction or using the most current. To access the menus on this page please perform the following steps. A claim void must be identical to the original claim that it is intended to cancel. In particular, CDW also recommends Patient SIDs with a value of less than 1 be deleted. 1. 2. Electronic Data Interchange (EDI): Payer ID for medical and dental claims is VA CCN. Every one of the 700,000 health care professionals in the TriWest network has to meet VA-required quality standards to ensure that Veterans always receive the highest quality care. Claims Assistance | Veterans' Affairs - South Carolina Coverage will start July 1 of that year. For dual pension and compensation claims, use the mailing address below for compensation claims. 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. Facility Information Security Officers (ISOs) are often the CUPS POC. Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. This Technology is currently being evaluated, reviewed, and tested in controlled environments. FBCS is where weve spent the bulk of our time investigating. 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. A primary key is a key that is unique for each record. 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). 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. Learn how to prevent paper claim rejections. Veterans Choice Program Eligibility Details [online]. 2. 3. U.S. Department of Veterans Affairs. 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. Of note, SQL and SAS data contain similar, but not exactly the same, information. This technology is not portable as it runs only on Windows operating systems. Such care is called Non-VA Medical Care, or Fee Basis care. Provider Portal - Veterans Affairs Through patient ID (SCRSSN) and travel date (TVLDTE) one can link these payments to inpatient and outpatient encounters. [FeeInpatInvoice] and [Fee]. In SQL, the outpatient data are housed in the FeeServiceProvided table. This is the main utility that passes information back into the FBCS Payment application. Get the latest updates on VA community care, including program changes, resources and more! Please see Section 2.1.4. for HERC advice about how to collapse multiple observations to evaluate the length and cost of a single inpatient stay. 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. We encourage readers to seek out the latest guidance before conducting analyses, as CDW Data Quality Analysis team may have updates to this information. Use the column 'estimated cost' and it is available in the CDW FBCS data. Detailed information about accessing each of these data sources is available at the VHA Data Portal (VA intranet only: http://vaww.vhadataportal.med.va.gov).See Table 10 for a summary of the data sources. If disbursed amount is missing (but not $0), use payment amount instead. Go to CDW Home, click on CDW MetaData, then click on the link for Purchased Care. Patient identifiers are also different across SAS and SQL data. The alternative, putting the procedure code fields in the invoice table, would not be as efficient. As of July 2015, the current mileage reimbursement rate is 41.5 cents per mile. 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. 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. In SQL, these variables can be found in the [Dim]. 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. Veterans Health Administration. 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 . April 08, 2014. MDCAREID is the Medicare OSCAR number, which is a hospital identifier. If your claim was submitted to VA, call (877) 881-7618, If your claim was submitted to TriWest, call (877) 226-8749. For example, to understand the ICD-9 codes associated with a particular inpatient encounter, one would have to link the [Fee]. Data are presented in Table 4. All tablesmentioned in the Fee Basis guidebookare storedin an Excel file. U.S. Department of Veterans Affairs. Data from FY1998 and FY1999 have a greater degree of discordance. Thus, unauthorized care is not unpaid care it is simply not PRE-authorized care. This seeming complicated arrangement is an efficient way to store data. 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. Name of the medication. Fee Basis tables, however, only list PatientSID and do not list PatientICN. 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 Patient residence related geographic information is available in the [Patient]. Hit enter to expand a main menu option (Health, Benefits, etc). Please contact the referring VAMC for e-fax number. Missingness can vary substantially by year and by file. [FeePharmacyInvoice] and the [Fee]. The status value R stands for re-routed, meaning the claim was re-routed to the Health Administration Center (HAC). For example, if one wishes to evaluate the cost of certain diagnoses in inpatient care through SQL data, this would require the linking of multiple tables before being able to conduct any analyses such as [Fee]. Attention A T users. more information please visit www.fsc.va.gov. Please switch auto forms mode to off. Inpatient care, regardless of patients health status, if VA was not notified within 72 hours of admission. Data in any of the any S tables require Staff Real SSN access. This component is a service that communicates directly with the High Availability Controller (HAC) SQL database for syncing critical fee data back into the local FBCS MS SQL database. In SQL, there are additional variables that will denote the type and location of the care provided along with the vendor. However, not all dates on the claim are approved. It can be difficult to determine the provider and the location of the Non-VA care provider. NPI is available within the VA CDW SStaff table. 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. The 2 sets of DRGs are not interchangeable. FPOV values of 32 and 33 also indicate ED visits, but are only observed in the Ancillary file. Chapter 8 provides references for further information about the Fee Basis program and data. Mail to: DEPARTMENT OF VETERANS AFFAIRS. SQL data contain the following vendor information: NPI, FeeVendorSID, FeeVendorIEN, NPI, VendorType and FeeSpecialtyCodeName. We believe that payments are then made from the claim data available from the Claims Reconciliation and Auditing: Program Integrity Tool (PIT) with lump sum/expedited payments being made on a weekly basis and retrospective review, as well as recoupment efforts for overpayments/duplicates. A foreign key is a key that uniquely identifies a record of another table. VA systems are intended to be used by authorized VA network users for viewing and retrieving information only; except as otherwise explicitly authorized for official business and limited personal use under VA policy. Office of Information and Analytics. 3. Appendix G lists all available FPOV codes and classifies them as inpatient or outpatient. (2) Additionally, a Veteran must also meet at least one of the following criteria. With few exceptions these variables will be of little interest to researchers. There is a lack of publicly available technical documentation and support may be limited to specific forums. The Fee Basis files' primary purpose is to record VA payments to non-VA providers. 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. Office of Information and Analytics. *From the date the Veteran was discharged from the facility that furnished the emergency treatment; the date of death, but only if the death occurred during transportation to a facility for emergency treatment or if the death occurred during the stay in the facility that included the provision of the emergency treatment; or the date the Veteran exhausted, without success, action to obtain payment or reimbursement for treatment from a third party. More information about provider reimbursement can be found in the document Working with the Veterans Health Administration: A Guide for Providers (available on the VHA Office of Community Care website, on the Provider Resources page).5. VA systems are intended to be used by authorized VA network users for viewing and Users of the data should keep in mind that these data represent the physical location of the entity billing for care, which may or may not be the same as the providers location. Payer Name: VA Fee Basis Programs - thePracticeBridge In order to gain access to the AITC mainframe, VA system users must contact their local Customer User Provisioning System (CUPS) Points of Contact (POC) and submit a VA Form 9957 to create a Time Sharing Option (TSO) account. (refer to the Category tab under Runtime Dependencies), Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. The VendorType contains information about whether the service was provided by a laboratory, radiology, physician, pharmacy, other, travel, prosthetics, federal hospital, public hospital or private hospital. Attention A T users. 1-800-273-8255 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. This improves our claims processing efficiency. As noted above, non-VA care may be authorized under the Non-VA Medical Care program when VA cannot offer needed care. Thus, researchers using later years of data should be aware that files are not static and will continue to be updated. MDCAREID is available in most inpatient SAS Fee Basis records. Emergent care patient liabilities not tied to copayments or deductibles will continue to be considered for secondary payment by VA. For additional questions, contact VA by phone, tollfree, at (877) 881-7618. Unauthorized inpatient or outpatient claims must be submitted within 90 days from the date of care. There are two types of keys: primary keys and foreign keys. The VA payment (DISAMT) is typically less than or equal to the PAMT value, although in some cases VA will pay more than Medicare would pay. To enter and activate the submenu links, hit the down arrow. For education claims, refer to the appropriate Regional Processing Office. It would seem logical to use the vendors location, found in the vendor files PHARVEN and VEN, to associate care with a particular station, but this should be approached with caution. 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. Researchers can do this using the FeePurposeOfVisit (FPOV) code.11 We recommend this approach over using another variable, such as the Fee Program. The mileage fee varies by type of ambulance service: ground, fixed wing, or rotary wing, POP zip code classification, and loaded mileage. VINCI Data Description: Fee/Purchased Care [online; VA intranet only]. VA can waive the deductible in hardship cases.