This application queues critical claims data into the FBCS shared MS SQL database for further processing and reporting. URLs are not live because they are VA intranet only. 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. However, in Table 4, we present some comparisons to demonstrate the different between SAS and SQL data. SQL data contain both SCRSSN and SSN, but these data reside in the SPatient table at CDW, and cannot be accessed by researchers without the CDW data manager and IRB approval. There are two types of keys: primary keys and foreign keys. In the outpatient data, one observation represents a single CPT code. These variables relate to the VA station at which the Fee Basis care requests and claims are input. Coverage will start July 1 of that year. When a key field is missing, SQL indicates this with a value of -1. For the inpatient data, we compared observations with the same patient identifier, based on PaidDate in SQL and TRANSDAT in SAS. In some cases it may appear that single encounters have duplicate payments. PracticeBridge. If you are submitting a paper claim, please review the Filing Paper Claims section below for paper claim requirements. In SQL, the patient ID will be the PatientICN or PatientSID, and the admit date is the admission date.. U.S. Department of Veterans Affairs. Data Quality Program. Missingness can vary substantially by year and by file. The SAS PHARVEN dataset contains information only about pharmacy vendors. Here, ICDProcedureSID is a primary key in the [Dim]. Patient type can take one of seven values: surgical; medical; home nursing; psych contract; psychiatric, neuro contract; or neurological. This component provides a front end for recognizing claim data through optical character recognition (OCR) software. [FeeInpatInvoice], [Fee]. 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. Bowel and Bladder Care. Care for dependent children, except newborns, in situations where VA pays for the mothers obstetric care during the same stay. To enter and activate the submenu links, hit the down arrow. The values of Adjustment Codes 1 and 2 (ADJCD1 and ADJCD2) explain the reason for non-payment. 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. 3. Optum is a proud partner with the VA through its Community Care Network (CCN). VA evaluates these claims and decides how much to reimburse these providers for care. 14. The key that allows for this linkage is the FeeInpatInvoiceSID which is a primary key in the [Fee]. Please review the Where To Send Claims and the Where To Send Documentation sections below for mailing addresses and Electronic Data Interchange (EDI) details. 4. VA is also the primary and sole payer for unauthorized emergent care approved under 38 U.S.C. 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. E-fax: Documentation sent via email to Veterans Affairs Medical Center (VAMC) fax machine. Community providers have three options that allow for that linkage: Submit the claim electronically via 837 transaction and the supporting documentation via 275 transaction. VA contracts out its hospice; therefore, the Fee Basis files contain a great deal of data related to hospice care. Below we describe the general types of information in both the SAS and SQL data. Community providers should remain in contact with the referring VA Medical Center to ensure proper care coordination. It is only relevant for claims linked to VistA patients. 1. Table 9 lists a number of financial variables the SQL data contain. FPOV values of 32 and 33 also indicate ED visits, but are only observed in the Ancillary file. Of note, SQL and SAS data contain similar, but not exactly the same, information. By June 2017, no Choice stays are found in FBCS. As with the SAS data, the important variables in the SQL data are the AmountPaid and the DisbursedAmount. U.S. Department of Veterans Affairs. The Florida Department of Veterans' Affairs has Claims Examiners co-located with the VA Regional Office in Bay Pines, each VA Medical Center and many VA Outpatient Clinics. This improves our claims processing efficiency. You may use VA Form 10-583 to fulfill this requirement. 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). Plan Name or Program Name," as this is a required field. This is a critical difference from VA utilization files, which are organized by date of service. 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. For example, if a physician billed for a complete blood count and a venipuncture in the same day, there would be two records with the same invoice number, but different CPT codes and different claimed amounts. 2. For the purpose of this guidebook, we focus on Fee Basis files only. All access Attention A T users. 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 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. For example, there are observations in which INTIND = 1 and INTAMT = $0. 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. For example, sta3n 589A5 will be found as 589. Below are some answers to general questions about linking the UB-92 form to the FBCS data. 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. U.S. Department of Veterans Affairs. Not all of these variables appear in every utilization file. In SQL, these variables can be found in the [Dim]. 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. The CDW is a relational database organized into a collection of data domains implemented on the Microsoft SQL server in VINCI. If the gap is 0 or 1, it is part of the same hospital stay and we then want to assess its discharge date. Federal law puts prosthetics into a special payment category that mandates full financial support from VA. As implemented in VA policy, it requires that VA facilities provide all necessary prosthetics, orthotics, and assistive devices (prosthetics) needed by patients. A Non-VA Medical Care claim is defined by four elements: The remainder of section 7.4 details payment rules as of early 2015. Of note, the relevant SQL tables for Fee Basis data are not only the [Fee]. Dental claims must be filed via 837 EDI transaction or using the most current. 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. National Non-VA Medical Care Program Office (NNPO). In SQL, there are additional variables that will denote the type and location of the care provided along with the vendor. To access the menus on this page please perform the following steps. Procedures are identified by CPT code (CPT1) in the non-hospital inpatient services (the ancillary file) and in the outpatient procedures file. All information in this guidebook pertains to use of ICD-9 codes. 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. CDW Data Quality Analysis Team has particular recommendations for excluding observations before beginning analyses on your cohort.13 Corporate Data Warehouse (CDW) contains dummy data as well as test patients that will need to be removed from tables before conducting analyses. Care provided under contract is eligible for interest payments. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. 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). Request and Coordinate Care: Find more information about submitting documentation for authorized care. 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. 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. 5. 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. 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. 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. Summary data are also available through the VHA Support Services Center (VSSC) website on the VA intranet. 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. Compare the discharge date of the first observation to the admission date of the next (second) observation. Second, there are some cases where the disbursed amount is $0, while the payment amount is greater than $0; these are cases in which the payment was cancelled and the true cost of care is thus $0. It can be difficult to determine the provider and the location of the Non-VA care provider. Facility Information Security Officers (ISOs) are often the CUPS POC. As noted above, non-VA care may be authorized under the Non-VA Medical Care program when VA cannot offer needed care. the rates paid by the United States to Medicare providers). 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. There is a deductible of $3 per trip up to a limit of $18 per month. Menlo Park, CA. 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. 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). Fee Basis data can be broadly categorized into 4 classes: inpatient care, outpatient care, pharmacy, and travel data. 2. Name of the medication. FBCS is designed to be used in the Fee Basis Departments of the Veteran Affairs Medical Centers (VAMCs). VAntage Point. Hit enter to expand a main menu option (Health, Benefits, etc). The Implementer of this technology has the responsibility to ensure the version deployed is 508-compliant. Reimbursements appear in the Travel Expenses (TVL) file. [ICD9] tables. Fee Basis data are housed in VA in both SAS dataset format and Microsoft SQL server tables (hereafter referred to as SQL data). Each VA facility has a local Fee Office to which the non-VA provider submits a claim for reimbursement. However, not all dates on the claim are approved. These data records cannot be linked to particular patient identifiers or encounters. For emergency care of service connected conditions, there is a two-year limit to submit any bills. Q. As noted earlier, there are often multiple records that indicate a single inpatient stay each record pertains to a unique invoice number. 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. The VA Fee Schedule is available at provider.vacommunitycare.com > Documents & Links. The SQL tables [Dim]. SAS versus SQL data differ in three main ways: Appendix A lists all variables in the SAS files. This rare event most likely indicates a transfer. The quantity dispensed. Sort data by the patient ID, STA3N, VEN13N, and the admission dates. For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/. Attention A T users. In both the SAS and the SQL data, there are usually multiple observations per patient encounter. The impact on inpatient and emergent care is unclear, however, as the definition of prosthetic in VA is so broad as to include items placed inside the body, such as internal fixation devices, coronary stents, and cardioverter defibrillators. There is no information available in the SAS data that identifies the actual medication dispensed. Office of Information and Analytics. TRM Proper Use Tab/Section. Attention A T users. Available at:http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. Users must ensure that Microsoft .NET Framework, Microsoft Structured Query Language (SQL) Server, and Microsoft Excel are implemented with VA-approved baselines. Persons looking to classify Veterans military service are encouraged to read the Data Quality Analysis Teams guidance on Identifying Veterans in the CDW(VA intranet only:http://vaww.vhadataportal.med.va.gov/Portals/0/DataQualityProgram/Reports/Identifying_Veterans_in_CDW.pdf).14. There are substantial differences in quantity of inpatient diagnosis and procedure data available in SAS versus SQL. Multiple claims may be submitted for each inpatient stay and the various claims do not have a common identifier indicating they are all part of the same inpatient stay. No, only one type of care can be covered by a single authorization. This improves claim accuracy and reduces the amount of time it takes for us to process claim determinations. Claims and other FBCS data will be found in PIT or Community Care Referral & Authorization domains. VINCI. Researchers evaluating care over time may want to use the DRG variable. 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? In FY 2014, the longest length of stay associated with a single nursing home invoice was 31 days. The Medicare hospital provider ID (MDCAREID) is entered by fee basis staff in order to calculate hospital reimbursement using the Medicare Pricer software. This component allows the site access to Communications, Configuration and Reporting options for FBCS. Electronic Services Available (EDI): Professional/1. Steps to collapse records into a single inpatient stay: 1. The following information should help you understand who to submit claims to and the requirements you must follow when submitting claims. SAS data also contain an additional diagnosis variable that is not present in the SQL data -- DXLSF. 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. Note that the vendor may represent the hospital, a hospital chain or the entity billing on behalf of the provider. 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. Box 14830Albany, NY 12212. There is also a host of non-emergency surgery provided through Fee Basis mechanisms that may be of interest to researchers. We give an example here that relates to FeeInpatInvoice table. Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. For example, if the Veteran had an Emergency Department (ED) visit and then was admitted to the hospital, this would be considered inpatient care. Payment for these types of care falls under the Non-VA Medical Care program. Inpatient procedures are captured by ICD-9 procedure codes (SURG9CD1-SURG9CD25) in the hospital claims file. VA has set a goal of processing all clean claims within 30 days. One can evaluate which encounters were unauthorized by joining the FeeUnauthorizedClaim table through the FeeUnauthorizedClaimSID key. Accessed October 16, 2015. Data Quality Analysis Team. VA must be capable of linking submitted supporting documentation to a corresponding claim. 2. 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. YESElectronic Remittance (ERA)YESICD- 1. Box 537007Sacramento CA 95853-7007, CCN Region 5(Kodiak, Alaska, only)Submit to TriWest. 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. 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. 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). Below are some answers to general questions about the FBCS tables. In this table, some ancillary data are associated with an inpatient FPOV code but have an outpatient FeeProgramProvided field. business and limited personal use under VA policy. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Office of Information and Analytics. Prescription-related data in the PHARVEN file contain only summary payments by month. The FMS disbursed amount is the payment amount plus any interest payment. To file a claim for services authorized by VA, follow instructions included in the Submitting Claims section of the referral. The new temporary end date is the maximum of the discharge date of the third observation and temporary end date from Step 2. This is the main utility that passes information back into the FBCS Payment application. VINCI Data Description: Fee/Purchased Care [online; VA intranet 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. HIPAA Transaction Standard Companion Guide (275 TR3)The purpose of this companion guide is to assist in development and deployment of applications transmitting health care claim attachments intending to support health care claim payment and processing by VA community care health care programs. To access the menus on this page please perform the following steps. Inpatient data are housed in the FeeInpatInvoice table as well as the FeeServiceProvided table, although the latter does not contain only inpatient data. Researchers wishing to work with SAS Fee Basis data can access them at the Austin Information Technology Center (AITC). SQL data must be linked from multiple tables in order to create an analysis dataset. Microsoft Internet Explorer, a dependency of this technology, is in End of Life status and must no longer be used. to) monitoring; recording; copying; auditing; inspecting; investigating; restricting Non-VA Medical Care data may be tabulated at the VHA Support Services Center (VSSC) (VA intranet only: http://vssc.med.va.gov/). 1. For current information on Community Care data, please visit the page VA Community Care Data. Payment for care provided under the Veterans Choice Act may not exceed the Medicare Fee Schedule (i.e. VA calculates PAMT from CMS pricer software on the basis of DRG and length of stay. VIReC. All tablesmentioned in the Fee Basis guidebookare storedin an Excel file. 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. Researchers should use PatientICN to link patient data within CDW. The travel payment data contains reimbursements for particular travel events (TravelAmount). or acts to, The Financial Services Center (FSC) is a franchise fund (fee for service) organization in the Department of Veterans Affairs (VA).Under the authority of the Government Management Reform Act of 1994 and the Military Please visit Provider Education and Training for upcoming events. Lump sum payments are not paid via FBCS. Health Information Governance. Consult the latest CDW schematic diagrams to understand the tables in which your variables of interest are housed and the primary key and foreign keys needed to link each pair of tables. Through patient identifier and travel date (TravelPaymentDate), one can link these payments to inpatient and outpatient encounters.
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