va fee basis program claims address

In some cases, there is a one-to-one relationship between VEN13N and MDCAREID. The Routing tool manages how Health Care Finance Administration (HCFA) and Uniform Billing (UB) claims will electronically flow through the FBCS program. Thus, researchers using later years of data should be aware that files are not static and will continue to be updated. Each observation in the SAS and SQL data has an accompanying vendor ID. [ICD] table, the latter of which contains a list of all possible ICD-9 codes. How Much Life Insurance Do You Really Need? 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). 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. . INTIND and INTAMT are not always concordant. SQL data must be linked from multiple tables in order to create an analysis dataset. 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. 7. The inpatient data will also need to be linked to the ancillary data, or the data representing the professional services provided to a patient while in the hospital, in order to determine the total cost of the inpatient stay. In SAS, the cost of an inpatient stay can be determined by summing the cost from DISAMT in the inpatient files with the DISAMT from the ancillary observations that correspond to the inpatient stay; however, the inpatient and ancillary files alone may not be sufficient to account for the entire cost of care. There are delays in the processing of Fee Basis claims. There is a CPT field in the inpatient files, but this is always missing; hospitals do not use CPT codes to bill. Through patient ID (SCRSSN) and travel date (TVLDTE) one can link these payments to inpatient and outpatient encounters. [XXX] tables, but also the [DIM]. 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. Primary keys are denoted by (PK) and foreign keys are denoted by (FK). Use of this technology is strictly controlled and not available for use within the general population. All Fee Basis care will be found in the Fee files. The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. When a claim has reached terminal status (A, P, D, R), the field ImportedDTStamp on the UB-92/HCFA tables represents the date it was processed. Sign up to receive the VA Provider Advisor newsletter. In the SAS data, the patient identifier is the scrambled social security number (SCRSSN). Additional information appears in a federal regulation, 38 CFR 17.52. Payment guidelines for non-VA are outlined in federal regulations 17.55 and 17.56. [FeeInpatInvoiceICDDiagnosis], [Dim]. For more information, please visit the Data Access Request Tracker (DART) Request Process page on the VHA Data Portal(VA intranet only: http://vaww.vhadataportal.med.va.gov/DataAccess/DARTRequestProcess.aspx#resources). For dual pension and compensation claims, use the mailing address below for compensation claims. 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). If researchers wish to identify ED visits, they may want to use CPT codes or Place of Service codes, rather than FPOV. In general, persons on active duty in the U.S. military are excluded even if they are transitioning to VA care. Some vendors use centralized billing services located in other cities, in a few cases in other states. In SAS, data are stored in variables, observations and datasets. 17. Therefore, on the outpatient side as well one must aggregate multiple records to get a full picture of the outpatient encounter. Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. 2. If the provider declines VA payment then it may be able to charge the patient a greater total amount. 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. HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. Non-VA Medical Care data may be tabulated at the VHA Support Services Center (VSSC) (VA intranet only: http://vssc.med.va.gov/). Make sure the services provided are within the scope of the authorization. Here, ICDProcedureSID is a primary key in the [Dim]. National Institute of Standards and Technology (NIST) standards. VA will not pay merely a deductible, copayment, or COB (coordination of benefits) amount. 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. For example, if the Veteran had an Emergency Department (ED) visit and then was admitted to the hospital, this would be considered inpatient care. Unlike the inpatient data, there can be multiple records with the same invoice number. Fact Sheet: Medical Document Submission Requirements for Care Coordination, ADA Dental Claim Form > American Dental Association website. [FeeVendor] table. 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. 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. Attention A T users. 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. We present here one way to collapse records into a single inpatient stay, but users may wish to develop their own method specific to the research question at hand. This is in line with the way VHA Office of Productivity, Efficiency & Staffing (OPES) ascertains ED visit. Last updated validated on Tuesday, January 3, 2023 Other work by HERC researchers indicates that in the FY 2014 data, DXLSF and DX1 were identical 47% of the time. 1-800-273-8255 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. More information about can be found on their website: https://www.va.gov/communitycare/. The Act amends 38 U.S.C. 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. Hit enter to expand a main menu option (Health, Benefits, etc). SQL Fee Basis data are stored in the form of multiple relational tables that must be linked, or in SQL parlance, joined, in order to create an analysis dataset. 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 . For EDI 837, Referral Number is Loop = 2300, Segment = REF*9F, Position = REF02 or Prior Authorization. There are limited data available regarding the specific non-VA provider associated with a visit; much information available pertains to the vendor who is billing for the care provided. [ICD9] tables. The table can be linked to the [Dim]. Austin Information Technology Center (AITC) is one of the VAs five national data centers. Electronic Data Interchange (EDI) Interface. At the time of writing (October 2015), only operations staff will have permission to access the SAS data at VINCI. There are two types of keys: primary keys and foreign keys. National Provider Identifier: Submit all that are applicable, including, but not limited to billing, rendering/servicing, and referring. First, it includes both the payment amount and any interest that may apply. Please switch auto forms mode to off. U.S. Department of Veterans Affairs. To file a claim for services authorized by VA, follow instructions included in the Submitting Claims section of the referral. 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. U.S. Department of Veterans Affairs. Users must ensure sensitive data is properly protected in compliance with all VA regulations. Six additional variables indicate the setting of care and vendor or care type. When there is no available rate in the Medicare Fee Schedule, the VA will follow the payment guidelines for Non-VA Medical Care. To enter and activate the submenu links, hit the down arrow. The [Fee]. 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. 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. For the inpatient data, we compared observations with the same patient identifier, based on PaidDate in SQL and TRANSDAT in SAS. 1728. This FPOV variable broadly categorizes the reason for the encounter, such as hospice or respite care. When a key field is missing, SQL indicates this with a value of -1. VA Palo Alto, Health Economics Resource Center;November 2015. One exception to this is when identifying emergency department (ED) visits. SQL data contain the following vendor information: NPI, FeeVendorSID, FeeVendorIEN, NPI, VendorType and FeeSpecialtyCodeName. There is also a host of non-emergency surgery provided through Fee Basis mechanisms that may be of interest to researchers. 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. It is not necessarily the station at which the Veteran receives most VA care or the station which will pay for a particular Non-VA Medical Care service. Thus, one could not simply use the patient identifier and the admission and discharge dates to collapse these observations into one inpatient stay. and constitutes unconditional consent to review and action including (but not limited 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. Available at: http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf.. 3. NPI and Medicare IDs have an M to M relationship. 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. Training - Exposure - Experience (TEE) Tournament. NPI is available within the VA CDW SStaff table. This is true for both the inpatient and outpatient data. 2. This research was supported by the Health Services Research and Development Service, U.S. Department of Veterans Affairs (ECN 99017-1). Such care is called Non-VA Medical Care, or Fee Basis care. The data files in each fiscal year represent all claims processed in the FMS during the year. The FPOV variable can be found in both the SAS and SQL data. 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. 3. 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. According to the Health Administration Center Internet website, the proportion of claims processed within 30 days rose from under 40% in 2007 to over 97% by the end of 2008. However, there are best practices that all SQL-based analyses should follow. NOTE: The processes outlined below are exclusive to supplying documentation for unauthorized emergent care. Updated September 21, 2015. privacy policies and guidelines. Most nursing home care is billed monthly, so there is one claim for each month of nursing home stay. VA evaluates these claims and decides how much to reimburse these providers for care. This guidebook is intended to help researchers understand and use the National Fee Basis files, which come in both SQL and SAS formats. to) monitoring; recording; copying; auditing; inspecting; investigating; restricting One may therefore assume that all patients receiving treatment through the Non-VA Medical Care program are Veterans. It is not available for claims in which payment was based on a contract amount. A summary of the payment guidelines can be found in Appendix I. It appears that starting in FY2016, Choice data is now bypassing FBCS and residing in the PIT. The status value A stands for accepted, meaning the claim was paid. Box 30780, Tampa FL 33630-3780. 3. PLSER values overlap considerably with those of the Medicare Carrier Line Place of Service codes. This component is a service that communicates with the Program Integrity Tool (PIT) which scores claims and sends results to FBCS. All tablesmentioned in the Fee Basis guidebookare storedin an Excel file. However, there are data available regarding the category of visit. We give an example here that relates to FeeInpatInvoice table. VIReC. SQL tables can be joined through linking keys. While NPI is available in SQL data, it does require special permissions to access, as it is located in the [Sstaff]. Data Quality Analysis Team. This technology integrates with Veterans Information Systems and Technology Architecture (VistA) through Massachusetts General Hospital Utility Multi-Programming System (MUMPS) or a Structured Query Language (SQL) database system on the backend. 1. It is the patient identifier that uniquely defines a patient across all facilities. HERC investigation of Fee Files reveals certain data anomalies of which researchers should be aware. Thus, the mailing address of the vendor is not always the vendors actual location. There is a deductible of $3 per trip up to a limit of $18 per month. [Spatient], and [Spatient]. 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. (refer to the Category tab under Runtime Dependencies), Users must ensure that Microsoft Structured Query Language (SQL) Server is implemented with VA-approved baselines. Get Help from Our VA Disability Claim Appeals Lawyers Today. Available at: http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. 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. No new extracts will occur. Department of Veterans Affairs Claims Intake Center PO Box 4444 Janesville, WI 53547-4444 Or, you can fax it to: (844) 531-7818 (inside the U.S.) (248) 524-4260 (outside the U.S.) Visit your local VA regional office or Benefits Delivery at Discharge Intake Site and speak with a VA representative to assist you. SAS data also contain an additional diagnosis variable that is not present in the SQL data -- DXLSF. There is another category of Fee Basis care that is considered unauthorized care. All preauthorized claims are then processed through the Fee Basis Claims System (FBCS) at the local facility as well as sent to the payment team. We found SPECIALPROVCAT was missing in 93% of records. To find all care provided in a particular fiscal year requires searching by treatment date over several years of Non-VA Medical Care claims. If you submit a noncompliant claim and/or record, you will receive a letter from us that includes the rejection code and reason for rejection. The vendor represents the entity billing for the non-VA care, while the provider represents the person who was involved in care provision. Medical specialty type (SPECCODE) is a provider-specific variable and indicates the specialty type of the provider rendering the service. one episode of care, which can have multiple dates within the prescribed treatment, one provider, as identified by the Tax Identification Number (TIN), and. 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. If you are submitting a paper claim, please review the Filing Paper Claims section below for paper claim requirements. It can be difficult to determine the provider and the location of the Non-VA care provider. PatientICN is assigned by CDW. In this case the first record would have an admission date of Jan 1, 2010 and a discharge date of Jan 10, 2010. From 1998 to 2014, approximately 50% of claims were paid within 30 days of VA receiving the invoice, and 95% of claims are paid in 200 days or less. b. The Veteran's full 9-digit social security number (SSN) may be used if the ICN is not available. Data Quality Program. 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. U.S. Department of Veterans Affairs. In summary, in order to create a research cohort, one must first identify the cohort based on PatientSID, then request the CDW data manager to link the PatientSIDs in her cohort to unique PatientICNs, and finally remove test/dummy/unnecessary PatientSIDs and PatientICNs. The SAS PHARVEN dataset contains information only about pharmacy vendors. 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. Providers cannot bill both VA and the patient or another insurer for the same encounter. Hit enter to expand a main menu option (Health, Benefits, etc). Summary Fee Basis expenditure data are also available through the VHA Support Services Center (VSSC) intranet site, further information about accessing these summary data can be found in Chapter 6. However, we conducted some comparisons for inpatient data. Coverage will start July 1 of that year. Researchers evaluating care over time may want to use the DRG variable. The 2 sets of DRGs are not interchangeable. Box 30780 Tampa, FL 33630-3780, P2E Documentation Cover Sheet, VA Form 10-10143f. PMS-DRG was effective in FY 2008; prior to this time CMS-DRGs were used. Among non-missing observations, HERC analyses found a many-to-many relationship among NPI and VEN13N. Users must ensure that Microsoft .NET Framework, Microsoft Structured Query Language (SQL) Server, and Microsoft Excel are implemented with VA-approved baselines. Of note, the FBCS was not in place nationwide prior to FY 2008. These tables involve payments paid only through FBCS. After a claim is submitted electronically it must be entered manually into a Non-VA Medical Care approval system. At the time of this writing, the NPI number was often missing from fee basis claims. In the Fee Basis inpatient data, each record represents a separate claim; these separate claims must be aggregated to capture the totality of the inpatient stay. 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. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. VA Fee Basis Programs. VA can make payments to non-VA health care providers under many arrangements. There are also a number of other financial variables denoted in SAS (see Table 7). U.S. Department of Veterans Affairs. Medication dosage/strength. There are additional payments for direct medical education, capital-related costs, and other factors as appropriate. Our office is located at 6940 O St, Suite 400 Lincoln NE 68510. There are a number of different variables that denote the category of care a Veteran received through Fee Basis (see Table 2) Appendices B and H present more details about the values these variables can take. Up to FY2008 data, DXLSF is labeled as 1st Diagnosis Code. In FY2009 and on, DXLSF is labeled as the Admitting or Primary Diagnosis Code. In FY 2009 and later SAS data, there is also another variable, DX1, which is not present in SAS data prior to FY2009. Electronic Data Interchange (EDI): Payer ID for medical claims is 12115. The Fee Basis data contain a unique variable not found in the traditional VA inpatient and outpatient datasets: the Fee Purpose of Visit (FPOV) variable. 10. In SAS, this variable is called DISTYP, or disposition type, and is located in the Inpatient and Ancillary tables. Again, date of service is not available in the FeeServiceProvided table. 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. Care provided under contract is eligible for interest payments. Many private health insurance companies will apply VA health care charges towards satisfying a Veteran's annual deductible and maximum out of pocket expnse. 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). SAS data have limited patient demographic data. Current Decision Matrix (10/21/2022) 2. 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. Hit enter to expand a main menu option (Health, Benefits, etc). Multiple SQL tables contain these variables. _________________________________________________________________. Table 8 denotes on which CDW servers Fee Basis data are housed. Inpatient care, regardless of patients health status, if VA was not notified within 72 hours of admission. This technology can use a VA-preferred database. (formerly known as VA Fee Basis or NonVA)-Community provider submits the claim and supporting documentation through their EDI provider services in . 2. This technology has not been assessed by the Section 508 Office. Once the VA system user has a TSO account, s/he may connect to the AITC mainframe through the Attachmate Reflection File Transfer Protocol (FTP). VSSC web reports are organized into nine domains: Business Operations, Capital & Planning, Clinical Care, Customer Service, Quality & Performance, Resource Management, Special Focus, Systems Redesign, and Workload. Accessed October 07, 2015. 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.

va fee basis program claims address 2023