For example, DISAMT=1000 in FY06 really indicates DISAMT=10.00. [FeePrescription] tables. Attention A T users. The FeeSpecialtyCodeName contains information on the specialty of the provider seen, such as oncology, chiropractic, pathology, neurosurgery, etc., but is missing much data. Care provided to persons associated with a particular VA station can be found by selecting records by STA3N. March 2015. 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). Seven refer explicitly to Veterans alone, while the remaining two are for diagnostic services or eligibility exams, neither of which constitutes treatment. Providers cannot bill both VA and the patient or another insurer for the same encounter. Electronic Data Interchange (EDI): Payer ID for medical and dental claims is VA CCN. You are strongly encouraged to electronically submit claims and required supporting documentation. The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. 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. We therefore use the PROC CONTENTS to describe SAS variables, found in Appendix A. SAS data use patient scrambled social security number (SCRSSN) as the patient identifier. The invoice table would have to have a sufficient number of fields to accommodate the maximum number of procedures report on any invoice. The Veterans Access, Choice, and Accountability Act (Veterans Choice Act), passed in 2014, expanded veterans access to non-VA care. Six additional variables indicate the setting of care and vendor or care type. 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. For example, to understand the ICD-9 codes associated with a particular inpatient encounter, one would have to link the [Fee]. 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. We tried to link the UB-92 form to identify Choice authorizations; however, we found few records and decided to use obligation number. The PHR file contains information on the cost-related data associated with the prescription, while the PHARMVEN file contains information on the vendor associated with the prescription. Updated August 26, 2015. U.S. Department of Veterans Affairs. Inpatient stays in both SAS and SQL Fee Basis data can denote hospital stays, nursing home stays, or hospice stays. We encourage readers to seek out the latest guidance before conducting analyses, as CDW Data Quality Analysis team may have updates to this information. PatientIEN and PatientSID are found in the general Fee Basis tables. For EDI 837, Referral Number is Loop = 2300, Segment = REF*9F, Position = REF02 or Prior Authorization. One may therefore assume that all patients receiving treatment through the Non-VA Medical Care program are Veterans. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). VA contracts out its hospice; therefore, the Fee Basis files contain a great deal of data related to hospice care. Business Product Management. 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. 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. The veteran must wait over 30 days past their preferred appointment date or the date deemed medically necessary by their provider, b. 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. The Implementer of this technology has the responsibility to ensure the version deployed is 508-compliant. Matching outpatient prosthetics order records in the VA National Prosthetics Patient Database (NPPD) to health care utilization databases. Researchers should use PatientICN to link patient data within CDW. The prescriptions filled by fee-basis pharmacies are often small quantities of medication to meet the patients emergency or short-term needs while a CMOP prescription is being filled. expectation of privacy in the use of Government networks or systems. FBCS is designed to be used in the Fee Basis Departments of the Veteran Affairs Medical Centers (VAMCs). Veterans applying for and using VA medical care must provide their health insurance information, including coverage provided under policies of their spouses. These data indicate the specialty code associated with the vendor, such as orthopedic surgery, cardiology, family practice, etc. Basic demographic variables can be found in the [Patient]. FBCS is where weve spent the bulk of our time investigating. For emergency care of service connected conditions, there is a two-year limit to submit any bills. is ok, 12.6.5 is ok, 12.6.9 is ok, however 12.7.0 or 13.0 is not. Non-VA Medical Care data may be tabulated at the VHA Support Services Center (VSSC) (VA intranet only: http://vssc.med.va.gov/). 9. For more details, including rules for handling patients transferred during a stay, see federal regulation 38 CFR 17.55. 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. NOTE: The processes outlined below are exclusive to supplying documentation for unauthorized emergent care. 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. The data that is not available is the data element that indicates if it was generated by FBCS or manually entered by the user in FBCS. The prescription must be for a service-connected condition or must otherwise have specific approval. The unique patient identifier by which to conduct SQL-based Fee Basis analyses is PatientICN. PMS-DRG was effective in FY 2008; prior to this time CMS-DRGs were used. Electronic Data Interchange (EDI): Payer ID for medical claims is TWVACCN. Relational Database Management Systems (RDBMS) such as Microsoft SQL server have multiple hierarchies for storing data: a domain contains many schemas, which in turn contain many tables. Researchers with VA intranet access can access these images by copying and pasting the URLs into their browser. How Much Life Insurance Do You Really Need? The specific locations of the SAS payment variables and the SQL payment variables can be found in Chapters 4 and 5, respectively. INTIND and INTAMT are not always concordant. a. Hit enter to expand a main menu option (Health, Benefits, etc). Important: The mailing address below only pertains to disability compensation claims. All instances of deployment using this technology should be reviewed by the local ISO (Information Security Officer) to ensure compliance with. Authorized care claims must be submitted within 6 years of the date of service, service-connected emergency care claims must be submitted within 2 years of the date of service, and non-service-connected emergency care claims must be submitted within 90 days of the date of service/discharge. VA medical centers may purchase prosthetics and related items, such as clothing specialized for prosthetic limbs, and then dispense them through VA facilities. To file a claim for services authorized by VA, follow instructions included in the Submitting Claims section of the referral. Download the tables here. 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? Chief Business Office. Then, to see which ICD procedure codes were coded for this inpatient stay, one must link to the [Dim]. For authorized care, the referral number listed on the Billing and Other Referral Information form. _________________________________________________________________. If a claim is filed for an eligible episode of care, VA must pay the whole amount according to the payment rules noted above. The quantity dispensed. 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. This means the data were placed in the PIT and the claim was not paid through FBCS. 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. There are up to 25 ICD-9 diagnosis codes and 25 ICD-9 surgical procedure codes in the inpatient data. Make sure the services provided are within the scope of the authorization. If your claim was submitted to VA, call (877) 881-7618, If your claim was submitted to TriWest, call (877) 226-8749. 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 supplemental plans. PLSER values overlap considerably with those of the Medicare Carrier Line Place of Service codes. Much Fee Basis care is pre-authorized prior to the Veteran obtaining care and is thus considered Authorized Care. If electronic capability is not available, providers can submit claims by mail or secure fax. Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. As of July 2015, the current mileage reimbursement rate is 41.5 cents per mile. FPOV values of 32 and 33 also indicate ED visits, but are only observed in the Ancillary file. By store procedure codes as records in another table, the SQL relational database uses the minimum amount of storable space. There are 3 categories of geographic data: veteran-related information, vendor-related information and VA-station related information. There are delays in the processing of Fee Basis claims. The definition of the DXLSF variable changes depending on the year of analysis. This is true for both the inpatient and the outpatient data, albeit for different reasons. Hit enter to expand a main menu option (Health, Benefits, etc). Non-VA CareP.O. The payment category (PAYCAT) is missing for all records in the inpatient services (ANCIL) file. Veterans are not responsible for the remaining balance shown as patient responsibility on the explanation of benefits from their insurance carrier. Unauthorized Care is that which was not pre-authorized but was still reimbursed, such as emergency care. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. 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. [XXX] tables, but also the [DIM]. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. 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. [1] The Health Care Financing Administration (HCFA) was renamed the Centers for Medicare and Medicaid Services. The vendor identity can be found through the FeeVendorSID or the FeeVendorIEN variables in SQL. For example, if the Veteran had an Emergency Department (ED) visit and then was admitted to the hospital, this would be considered inpatient care. This is a critical difference from VA utilization files, which are organized by date of service. A claim for which the Veteran had coverage by a health plan as defined in statute. MDCAREID is available in most inpatient SAS Fee Basis records. 15. Fee Basis Services. Accessed October 27, 2015. The SAS data are stored at AITC. For example, DISAMT=1000 in FY06 really indicates DISAMT=10.00. 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. U.S. Department of Veterans Affairs. Fee Basis data will be most useful for studying conditions where contract care is common, such as home-based care and nursing care, and for determining typical non-VA charges for health care services (both charges and payments are reported) and comparing those to VA costs. 1. National Non-VA Medical Care Program Office (NNPO). If you are in crisis or having thoughts of suicide, The amount claimed (PAMTCL) appears in the inpatient (INPT) file alone; there is no claimed amount on the outpatient side. All observations for this particular patient ID, STA3N and VEN13N where the admission date comes on or after the admission date of the first record AND the discharge date comes on or before the temporary end date are considered to be part of the same inpatient stay. The generosity of the coverage is immaterial; if it covers any part of the providers bill, then VA may not pay anything. Users interested in learning the rules in force at a particular point in time should contact the VHA Office of Community Care. Two domains in which researchers can find reports on Non-VA Care are Resource Management and Workload. Payment guidelines for non-VA are outlined in federal regulations 17.55 and 17.56. In both the SAS and the SQL data, there are usually multiple observations per patient encounter. Non-emergency care must be approved before the Veteran seeks care in the community.3 For traditional Non-VA care, a Veterans VA provider will submit a request at the local VA facility for Veteran care provided by Fee Basis. This component communicates with the FBCS MS SQL and VistA database in real time. If electronic capability isnot available, providers can submit claims by mail or secure fax. If the Veteran received care in the community that was not pre-authorized, it is considered unauthorized by VA. [FeeVendor] table. 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. NPI and Medicare IDs have an M to M relationship. Most ED visits will be identified through FPOV values of 32 or 33. This is in line with the way VHA Office of Productivity, Efficiency & Staffing (OPES) ascertains ED visit. The clinic of jurisdiction, or medical facility, authorizes such care under the fee-basis program . 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). Please contact the referring VAMC for e-fax number. VA employees working on operations studies can build their own crosswalk file as they have permission to use these file. This rule applies even when the patient is incapable of making a call. Unauthorized inpatient or outpatient claims must be submitted within 90 days from the date of care. We recommend researchers use the FeePurposeOfVisit codes (FPOV) codes to eliminate observations related to non-outpatient care before beginning analyses. Therefore, on the outpatient side as well one must aggregate multiple records to get a full picture of the outpatient encounter. Among non-missing observations, HERC analyses found a many-to-many relationship among NPI and VEN13N. Fee Basis providers vary in how frequently they submit an invoice for Fee Basis care. 11. Updated September 21, 2015. Researchers with VA intranet access can access these sites by copying and pasting the URLs into their browser. 13. The SQL prescription data are housed in the [Fee]. Electronic Data Interchange (EDI) Interface. For the purpose of this guidebook, we focus on Fee Basis files only. 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. VA Palo Alto, Health Economics Resource Center; October 2013. 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). Journal of Rehabilitation Research and Development. As noted in Chapter 2, the important variables capturing cost of care are AMOUNT and DISAMT. The [Fee]. 2. HERC Veterans Choice Program - Fee Basis Claims System in CDW Fee Basis Claims System (FBCS) in the VA Corporate Data Warehouse All Choice claims are processed by VISN 15. The funds are used to provide the best care possible to our Veterans. The Fee Basis schema data can be found at the CDW SharePoint portal at the links below (VA intranet only). Review the Corrections and Voids page for more information. However, not all dates on the claim are approved. Submit a corrected claim when you need to replace an entire claim previously submitted and processed. In SAS, this variable is called DISTYP, or disposition type, and is located in the Inpatient and Ancillary tables. [Patient], [PatSub]. VENDID is the vendor ID. Emergency claims covered under the Veterans Millennium Care and Benefits Act, Public Law 106-117); see 29 CFR 17.120 and 38 CFR 17.1004. These vendors are presumably hospital chains. All information in this guidebook pertains to use of ICD-9 codes. 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]. The VA Fee Basis medical program provides payment authorization for eligible Veterans to obtain routine medical treatment services through non-VA health care providers. Veterans Health Administration. Thus, unauthorized care is not unpaid care it is simply not PRE-authorized care. 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. Fee Purpose of Visit is the recommended way to evaluate the category of the visit. 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. All instances of deployment using this technology should be reviewed to ensure compliance with. Non-VA providers submit claims for reimbursement to VA. Our office is located at 6940 O St, Suite 400 Lincoln NE 68510. Appendix H lists their current values. A primary key is a key that is unique for each record. However, previous HERC investigation confirmed these are partial payments made for a single encounter or procedure. 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. ", Military service variables can be found in [PatSub],[PatientServicePeriod], [Patient]. actions by all authorized VA and law enforcement personnel. Training - Exposure - Experience (TEE) Tournament. 988 (Press 1). 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. URLs are not live because they are VA intranet only. A foreign key is a key that uniquely identifies a record of another table. As of April 2019, this guidebook is no longer being updated. National Institute of Standards and Technology (NIST) standards. Researchers will have to select observations from the SQL FeeServiceProvided table in order to ensure they are only evaluating outpatient data. Research requests for data from CDW/VINCI must be submitted via the Data Access Request Tracker (DART) application. These represent cases in which payment is disallowed. In general, we recommend using the disbursed amount to capture the cost of care, for two reasons. We found SPECIALPROVCAT was missing in 93% of records. Hit enter to expand a main menu option (Health, Benefits, etc). The vendor and the provider may or may not be the same entities. Researchers can look at the disposition variable as an indicator of transfer between VA and non-VA care. If it cannot be located in the PTF Main file or DSS NDE for inpatient care, search other inpatient files. Researchers who have never before used CDW are encouraged to read the VA CDW First Time Users guide, available from the VIReC website (VAintranet only:http://vaww.virec.research.va.gov/CDW/Overview.htm). The Routing tool manages how Health Care Finance Administration (HCFA) and Uniform Billing (UB) claims will electronically flow through the FBCS program. Payments received from a Veterans private health insurance carrier are credited towards any applicable VA copayments, reducing all or part of the Veterans out-of-pocket expenses. One can use the FeeInitialTreatmentSID variable in the FeeServiceProvided table to link to the Fee.FeeInitialTreatment table. 1725 may only be made if payment to the facility for the emergency care is authorized, or death occurred during transport. 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. Non-VA providers submit claims for reimbursement to VA. 14. As noted above, in SAS, the patient identifier is the SCRSSN; this is unique to each patient across the entire VA. Researchers will notice a high degree of concordance between SAS and SQL data in most years of analysis. Accessed October 16, 2015. 3. Each year represents the year in which the claim was processed, not the year in which the service was rendered. More information can be found at the OPES website: http://opes.vssc.med.va.gov. 7. SQL Fee Basis data are stored in CDW in multiple individual tables. Additional information appears in a federal regulation, 38 CFR 17.52. Please review the Where To Send Claims and the Where To Send Documentation sections below for mailing addresses and Electronic Data Interchange (EDI) details. 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. We suggest using only the first 3 characters from sta3n for the merge. Each patient should have only one ICN in the entire VA, regardless of the number of facilities at which he is seen. With few exceptions these variables will be of little interest to researchers. All access or use constitutes understanding and acceptance that there is no reasonable 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. Providers are not required to accept VA payment in all cases. This service communicates via native SQL Server 2005 encrypted connections through the VA Wide Area Network (WAN). There is no separate payment for items such as oxygen or other supplies, the number of attendants, providing an EKG during the trip, etc. This FPOV variable broadly categorizes the reason for the encounter, such as hospice or respite care. [SPatient] and[PatSub] tables. 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. In some cases, there is a one-to-one relationship between VEN13N and MDCAREID. To access the menus on this page please perform the following steps. 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 For education claims, refer to the appropriate Regional Processing Office. While many Veterans qualify for free health care services based on a VA compensable service-connected condition or other qualifying factor, most Veterans are asked to complete an annual financial assessment, to determine if they qualify for free services. This table contains information on inpatient care. These data records cannot be linked to particular patient identifiers or encounters. 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: Attention A T users. For example, sta3n 589A5 will be found as 589. The key that allows for this linkage is the FeeInpatInvoiceSID which is a primary key in the [Fee]. visit VeteransCrisisLine.net for more resources. Community provider mails the paper claims and documentation to the new mailing address of VA's central claims intake location. Microsoft Internet Explorer, a dependency of this technology, is in End of Life status and must no longer be used. Through the CCN, Veterans have access to regional networks of high-performing, licensed health care . ____________________________________________________________________________. Before working with any SQL tables in CDW, we recommended familiarizing yourself with the schema diagram in order to understand how to link tables to one another. This seeming complicated arrangement is an efficient way to store data. There is another category of Fee Basis care that is considered unauthorized care. (Available at the VHA Data Portal. Claims and other FBCS data will be found in PIT or Community Care Referral & Authorization domains. The Veteran's full 9-digit social security number (SSN) may be used if the ICN is not available. National Provider Identifier: Submit all that are applicable, including, but not limited to billing, rendering/servicing, and referring. Each observation in the SAS and SQL data has an accompanying vendor ID. Prior to FY 2007, INTAMT has two implied decimal places. Care for dependent children, except newborns, in situations where VA pays for the mothers obstetric care during the same stay. In general, persons on active duty in the U.S. military are excluded even if they are transitioning to VA care. FBCS supports payment of claims via VistA. 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. [FeePharmacyInvoice] and the [Fee]. SQL tables require linking before conducting any data analyses. Starting in 2009, there are also a number of DXPOA variables in the SAS data, which indicate diagnoses that are present on admission. Some VA medical centers purchase care from only one of the hospitals in the chain. 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. VSSC provides numerous relevant web reports, data resources, and analytics support, including summary data by facility and VISN and national summary data. 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. 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. The majority of claims, 99%, were processed within 2 years, with the exception of pharmacy data in FY 2004 and FY2008. Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. Accessed October 16, 2015. This component provides a front end for validation and/or correcting the data that was read from the claim via the OCR module. For pension claims, use the Pension Management Center (PMC) that serves your state.
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