Before this time, data were entered by hand, and there was no easy way to tell whether the claim being entered was a duplicate one. . If the Veteran received care in the community that was not pre-authorized, it is considered unauthorized by VA. 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. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, New York/New Jersey VA Health Care Network, Call TTY if you Researchers can do this using the FeePurposeOfVisit (FPOV) code.11 We recommend this approach over using another variable, such as the Fee Program. VA Informatics and Computing Resource Center (VINCI). For current information on Community Care data, please visit the page. 16. Inpatient data are housed in the FeeInpatInvoice table as well as the FeeServiceProvided table, although the latter does not contain only inpatient data. Inpatient care, regardless of patients health status, if VA was not notified within 72 hours of admission. Some missingness may indicate not applicable.. FBCS supports payment of claims via VistA. Get Help from Our VA Disability Claim Appeals Lawyers Today. While NPI is available in SQL data, it does require special permissions to access, as it is located in the [Sstaff]. This means the data were placed in the PIT and the claim was not paid through FBCS. Beware of VISNS 4, 15, and 23, as they have their own integrated system. 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. (refer to the Category tab under Runtime Dependencies), Users must ensure that Microsoft Structured Query Language (SQL) Server is implemented with VA-approved baselines. VA has adopted a policy of processing payments for certain EDI claims outside of FBCS (Choice/PCCC) by rerouting the EDI claims back to the HAC, causing them to reach terminal status in FBCS and triggering a transition to the PIT repository. Attention A T users. access; blocking; tracking; disclosing to authorized personnel; or any other authorized 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. Office of Information and Analytics. National Non-VA Medical Care Program Office (NNPO). Non-VA Medical Care data may be tabulated at the VHA Support Services Center (VSSC) (VA intranet only: http://vssc.med.va.gov/). Basic demographic variables can be found in the [Patient]. Payment for these types of care falls under the Non-VA Medical Care program. Include the 17 alpha-numeric (10 digits + "V" + 6 digits) VA-assigned internal control number (ICN) in the insured's I.D. However, previous HERC investigation confirmed these are partial payments made for a single encounter or procedure. When evaluating the cost of care, use the disbursed amount. Hit enter to expand a main menu option (Health, Benefits, etc). You may use VA Form 10-583 to fulfill this requirement. The Non-VA Medical Care program covers the full range of medical and dental care, with these exceptions: Although VA utilization files contain many non-Veterans, Non-VA Medical Care files do not. A single inpatient encounter may generate zero, one, or multiple ancillary records, depending on the number of ancillary procedures and physician services received. [FeeInpatInvoiceICDProcedure] table. Nevertheless, the National Non-VA Medical Care Program Office (now the VHA Office of Community Care) has interpreted VHA Directive 2006-029 to preclude Non-VA Medical Care providers from receiving payment for prosthetics. 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. However, we conducted some comparisons for inpatient data. This application reads/creates/edits fee payment data in VistA and copies critical information into the central SQL database for off-line VistA applications to consume, and now includes Unauthorized payments. For more information call 1-800-396-7929.Claims for Non-VA Emergency CareVeterans need to make sure any bills for non-VA emergency care of non-service connected conditions are submitted to the VA Medical Centers NVCC Office within 90 days. There are 34 Fee Basis Claims Systems (FBCS) servers, which were originally designed for episodes of care. Some encounters have multiple procedures that are paid as a single encounter; other encounters have multiple procedures and there are separate payments for each procedure. Please switch auto forms mode to off. In the SAS data, the provider component of the inpatient stay is captured in the ancillary file. Access; upload; download; change; or delete information on this system; Otherwise misuse this system are strictly prohibited. DART is a workflow application that guides users through the request by collecting the appropriate documents, distributing documentation to reviewers, and assisting in communication between requestors and reviewers. Those options are: Utilize HealthShare Referral Manager (HSRM) for referrals, authorizations and documentation exchange. Most nursing home care is billed monthly, so there is one claim for each month of nursing home stay. For these reasons, VA strongly encourages Veterans to consider important factors, risks and benefits before making any changes to their private health insurance. UB-92 box 56 (ProviderNPI) represents the providers National Provider Identifier. This Technology is currently being evaluated, reviewed, and tested in controlled environments. Claims and other FBCS data will be found in PIT or Community Care Referral & Authorization domains. To enter and activate the submenu links, hit the down arrow. Analyses of FY 2014 data indicate approximately 50% of inpatient observations and 43% of outpatient observations are missing NPI. A Fee table will contain a record for an ICD-9 code, whereas a DIM table will contain the possible values of that ICD-9 code. 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. In both SAS and SQL, it can be difficult to determine the provider the Veteran saw for Fee Basis care. one episode of care, which can have multiple dates within the prescribed treatment, one provider, as identified by the Tax Identification Number (TIN), and. One exception to this is when identifying emergency department (ED) visits. 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. There are also variables pertaining to Veteran geographic information, particularly ZIP, HOMECNTY and HOMESTATE in the SAS data and County, Country, Province, and State in the SQL data. 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. It appears that starting in FY2016, Choice data is now bypassing FBCS and residing in the PIT. NPI is available within the VA CDW SStaff table. Multiple SAS datasets have VENID and VEN13N. If the gap is 0 or 1, evaluate the discharge date of the first and second observation. 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. VA is the primary and sole payer when VA issues an authorization. HERC investigation of Fee Files reveals certain data anomalies of which researchers should be aware. 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. As a Class 2 or Class 3 product, it MUST NOT be assumed to having been released into production through all OI&T product release and sustainment process controls for project management; requirements, development and testing management; and configuration, change, and release management necessary to satisfy OI&T process and product compliance. The mileage is calculated using the fastest route. The Veteran's full 9-digit social security number (SSN) may be used if the ICN is not available. The Fee Card (VET) file contains only summary payment figures by month, although researchers can match the records to other data by SCRSSN and other identifiers. 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. This is true for both the inpatient and the outpatient data, albeit for different reasons. 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. VA-station related information includes STA3N, STA6A and STANUM in SAS and Sta3n and PrimaryServiceInstitution in SQL. When MDCAREID is not available, it is possible to assign MCCAREID based on the relationship between VEN13N and STA6A. _____________________________________________________________________________. VA's fee basis care program. Five additional variables Financial Management System (FMS) transaction number, line number, date, batch number, and release date reflect processing of payments through the FMS. 3. The process of linking can be complex; analysts should take care to reduce errors during this process. Previous work conducted for the HERC 2008 Fee Basis guidebook found that the cost of inpatient pharmacy was included in the inpatient records of the SAS INPT file. In the outpatient data, each record represents a different procedure, as assessed through the Current Procedural Terminology (CPT) code. 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. It can be difficult to determine the provider and the location of the Non-VA care provider. The Customer Engagement Portal is a reporting tool for VA Medical providers to verify the status of claims as well as run payment reconciliation reports. 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. Attention A T users. If electronic capability is not available, providers can submit claims by mail. For more information call 1-800-396-7929. Non-VA providers submit claims for reimbursement to VA. HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. Thus, our recommendation is as follows: Use disbursed amount to calculate the cost of care, except in the case where disbursed amount is missing and the payment was not cancelled. Chief Business Office. Available at:http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. [SpatientAddress] tables. Domains represent logically or conceptually related sets of data tables. Accessed October 07, 2015. The procedure code table has just as many records as there were procedures on the invoice. http://www.mssny.org/Documents/Enews/Aug%208%202014/VA%20ProvidersGuide.pdf, http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. Payment of ambulance transportation under 38 U.S.C. There is no separate payment for items such as oxygen or other supplies, the number of attendants, providing an EKG during the trip, etc. Hit enter to expand a main menu option (Health, Benefits, etc). Operating Systems Supported by the Technology. Through patient ID (SCRSSN) and travel date (TVLDTE) one can link these payments to inpatient and outpatient encounters. [FeeInpatInvoiceICDDiagnosis], [Dim]. 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. Unscheduled trips may be reimbursed for the return mileage only. The potential exists to store Personally Identifiable Information (PII), Protected Health Information (PHI) and/or VA Sensitive data and proper security standards must be followed in these cases. To locate the facility at which the Veteran usually receives VA care, the VA Information Resource Center (VIReC) recommends consulting the preferred facility indicator in the VHA Enrollment Database.7. 12. Some web reports contain PHI and access to these is restricted. The Fee Basis files are stored in two formats: SAS and SQL. The data files in each fiscal year represent all claims processed in the FMS during the year. This is in line with the way VHA Office of Productivity, Efficiency & Staffing (OPES) ascertains ED visit. resides on and transmits through computer systems and networks funded by the VA. How Does VGLI Compare to Other Insurance Programs? Use Azure Rights Management Services (Azure RMS) for encrypted email. 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? All instances of deployment using this technology should be reviewed to ensure compliance with. To enter and activate the submenu links, hit the down arrow. 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.. 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. Available at: http://vaww.virec.research.va.gov/CDW/Overview.htm. Mark Smith and Adam Chow were the authors of the original HERC guidebook, upon which this document builds. ____________________________________________________________________________. When possible, VA will seek reimbursement for Non-VA Medical Care payments from sources such as workers compensation payments; payments resulting from motor vehicle accidents, crimes of personal violence, or torts; other agencies when the patient is a beneficiary; and third-party insurance plans. Facility Information Security Officers (ISOs) are often the CUPS POC. In SAS, data are stored in variables, observations and datasets. Per the May 5th, 2015 memorandum from the VA Chief Information Security Officer (CISO) FIPS 140-2 Validate Full Disk Encryption (FOE) for Data at Rest in Database Management Systems (DBMS) and in accordance with Federal requirements and VA policy, database management must use Federal Information Processing Standards (FIPS) 140-2 compliant encryption to protect the confidentiality and integrity of VA information at rest at the application level. 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. 1725 when remaining liability to the Veteran is not a copayment or similar payment. Journal of Rehabilitation Research and Development. U.S. Department of Veterans Affairs. 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. VA has established rules for timely filing of unauthorized and Mill Bill claims (i.e. As a single encounter may have more than one CPT code, users may have to aggregate multiple observations in order to evaluate the care received on a particular day. There are nine situations in which Non-VA Medical Care is authorized. Gidwani R, Hong J, Murrell S. Fee Basis Data: A Guide for Researchers. 21. Most of these fields would be empty. NOTE: The processes outlined below are exclusive to supplying documentation for unauthorized emergent care. VA Information Resource Center VHA Corporate Data Warehouse [webpage]. 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 intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). 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. VA can waive the deductible in hardship cases. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. Persons looking to classify patients Veterans by race and ethnicity are encouraged to read VHA guidance available on the Data Reports page of the VHA Data Portal (available on the intranet at http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). As of April 2019, this guidebook is no longer being updated. The codes for the procedures provided for a given hospital stay are kept in a separate table, a table of procedures. October 1, 2015. [FeePrescription] tables. 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. Fee Basis data files contain information regarding both the care the Veteran received and the reimbursement of the care. 15. Outpatient prescriptions beyond a 10-day supply. The alternative, putting the procedure code fields in the invoice table, would not be as efficient. Other Health Insurance (OHI) and Explanation of Benefits (EOBs), Any other document type normally sent via paper in support of a Veteran unauthorized emergency claim. [FeeInpatInvoiceICDDiagnosis] with the [Dim]. March 2018: Due to the transition of the National Non-VA Medical Care Program Office to the VHA Office of Community Care and updates to the VINCI website, some documents may no longer be available. The definition of the DXLSF variable changes depending on the year of analysis. There are often multiple observations per inpatient stay and multiple observations per outpatient encounter. However, there are data available regarding the category of visit. For more details, including rules for handling patients transferred during a stay, see federal regulation 38 CFR 17.55. VA evaluates these claims and decides how much to reimburse these providers for care. Veterans Health Administration. 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. Appendix E includes a list of SQL fields related to the type of care a patient receives. Users must ensure their use of this technology/standard is consistent with VA policies and standards, including, but not limited to, VA Handbooks 6102 and 6500; VA Directives 6004, 6513, and 6517; and National Institute of Standards and Technology (NIST) standards, including Federal Information Processing Standards (FIPS). As noted earlier, there are often multiple records that indicate a single inpatient stay each record pertains to a unique invoice number. Defining a cohort is an activity that is different for each project and depends on the research question at hand. Then, to see which ICD procedure codes were coded for this inpatient stay, one must link to the [Dim]. 7. This act expands the non-VA care veterans were able to receive before the act was passed. The key that allows for this linkage is the FeeInpatInvoiceSID which is a primary key in the [Fee]. The 2 sets of DRGs are not interchangeable. 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. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Learn how to prevent paper claim rejections. VA may be a secondary payer for unauthorized emergent claims under 38 U.S.C. SQL Fee data are available through the VA Corporate Data Warehouse (CDW)/VA Informatics and Computing Infrastructure (VINCI). This report covers the audit of payments made through VA's Fee Basis Claims System (FBCS), encompassing claims paid via that payment process from November 1, 2014 through September 30, 2016. Care provided to persons associated with a particular VA station can be found by selecting records by STA3N. Claims for Non-VA Emergency Care Patient identifiers are also different across SAS and SQL data. 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. The prescription must be for a service-connected condition or must otherwise have specific approval. (2) Additionally, a Veteran must also meet at least one of the following criteria. Available at: http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf.. 3. The Fee Basis VA program allows Veterans to be seen by a community provider. [FeePrescription] table contains rich information on the type of drug prescribed and dispensed, including the drug name, manufacturer, strength, quantity, date filled and charge and disbursed (payment) amount. Electronic Services Available (EDI): Professional/1. Optum is a proud partner with the VA through its Community Care Network (CCN). More than 99% of claims for inpatient, ancillary and outpatient care are processed within 2 years. Our office is located at 6940 O St, Suite 400 Lincoln NE 68510. 2. - The information contained on this page is accurate as of the Decision Date (11/02/2022). 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. Below are some answers to general questions about the FBCS tables. (Available at the VHA Data Portal. Available at: http://vaww.vhadataportal.med.va.gov/Portals/0/DataQualityProgram/Reports/Identifying_Veterans_in_CDW.pdf. All instances of deployment using this technology should be reviewed by the local ISO (Information Security Officer) to ensure compliance with. We recommend researchers use the FeePurposeOfVisit codes (FPOV) codes to eliminate observations related to non-outpatient care before beginning analyses. The Fee Basis files' primary purpose is to record VA payments to non-VA providers. The Fee Basis schema data can be found at the CDW SharePoint portal at the links below (VA intranet only). Menlo Park, CA. Therefore, to get an understanding of the total cost of this care, one would have to link the Fee Basis data to VA utilization datasets. In that case, use payment amount instead. In SQL, these variables can be found in the [Dim]. 1-800-273-8255 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Six additional variables indicate the setting of care and vendor or care type. Non-VA CareP.O. We encourage readers to seek out the latest guidance before conducting analyses, as CDW Data Quality Analysis team may have updates to this information. However, a 7.4.x decision If researchers wish to identify ED visits, they may want to use CPT codes or Place of Service codes, rather than FPOV. 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 amount of interest paid on the claim, if any, appears as the variable INTAMT. These geographic variables indicate the VA station paying for the service. To enter and activate the submenu links, hit the down arrow. PatientIEN and PatientSID are unique to a patient within a facility, but not unique to a patient across VA facilities (e.g., a patient who had visited multiple VA facilities will have multiple PatientIENs and multiple PatientSIDs). These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). It is not available for claims in which payment was based on a contract amount. All access This table also includes claims related to inpatient care and other services. 4. Information from this system resides on and transmits through computer systems and networks funded by the VA. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. [FeeVendor] table. The VHA Office of Community Care is the contact for all VA community care programs. If you are in crisis or having thoughts of suicide, [SPatient] and[PatSub] tables. 8. E-fax: Documentation sent via email to Veterans Affairs Medical Center (VAMC) fax machine. VINCI. (Veterans may submit unauthorized claims, however, and VA has legal authority to pay them under certain conditions. We found SPECIALPROVCAT was missing in 93% of records. This schema contains sensitive information such as SSNs, bank accounts, and the actual name of personnel. Accessed October 27, 2015. This most likely reflects a low frequency of surgery rather than missing data. If the patient was transported to a VA hospital after stabilization (as indicated by the DISTYP, or disposition type, variable), the record of the VA stay should appear in VA utilization databases. 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. 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. Steps to collapse records into a single inpatient stay: 1. In FY 2014, the longest length of stay associated with a single nursing home invoice was 31 days. For billing questions contact: Health Resource Center Accessed October 16, 2015. 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. One can evaluate which encounters were unauthorized by joining the FeeUnauthorizedClaim table through the FeeUnauthorizedClaimSID key. This technologysupports advanced data encryption methods and role-based access control. There may be multiple CPT codes associated with a single encounter. 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. Microsoft Internet Explorer, a dependency of this technology, is in End of Life status and must no longer be used. For example, there are observations in which INTIND = 1 and INTAMT = $0. Detailed instructions and documentation required for DART data requests can be found on the VHA Data Portal intranet website at http://vaww.vhadataportal.med.va.gov/DataAccess/DARTRequestProcess.aspx. 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. However, not all data in the FeeServiceProvided table are outpatient data; some may pertain to inpatient stays. If that analyst examines VEN13N and STA6A (in inpatient Fee Basis data, this field represents the VA hospital arranging care), there is often only one MDCAREID. Hospice also appears to be billed monthly, with longest length of stay for a single hospice invoice of 31 days. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. _________________________________________________________________. Documentation in support of a claim may include: *NOTE: Documentation not required includes flowsheets and medication administration. There is a lack of publicly available technical documentation and support may be limited to specific forums. Data Quality Program. SAS data also contain an additional diagnosis variable that is not present in the SQL data -- DXLSF. Accessed October 16, 2015. There are no references identified for this entry. visit VeteransCrisisLine.net for more resources. SQL data must be linked from multiple tables in order to create an analysis dataset.

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