[FeePharmacyInvoice] and the [Fee]. Patient identifiers are also different across SAS and SQL data. [FeePrescription] tables. This improves claim accuracy and reduces the amount of time it takes for us to process claim determinations. Plan Name or Program Name," as this is a required field. 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. Care provided to persons associated with a particular VA station can be found by selecting records by STA3N. NPI is available within the VA CDW SStaff table. one episode of care, which can have multiple dates within the prescribed treatment, one provider, as identified by the Tax Identification Number (TIN), and. visit VeteransCrisisLine.net for more resources. 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. The key field indicates which invoice they appeared on. If billing electronically, please include "Other Payers Information" in Loop 2320, 2330A, 2330B, and 2430. VA Fee Schedule. 16. 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. Prescription information: Prescribing provider's name. VA Informatics and Computing Resource Center (VINCI). The generosity of the coverage is immaterial; if it covers any part of the providers bill, then VA may not pay anything. The charge for an ambulance trip to a non-VA hospital may be paid through the Non-VA Medical Care program if the medical center determines that the hospital services meet the criteria for an unauthorized claim or a 38 U.S.C 1725 (Mill Bill) claim, or if the patient died while in route to the facility. The new temporary end date is the maximum of the discharge date of the third observation and temporary end date from Step 2. Emergency care can also be authorized by VA in certain circumstances when the VA is notified within 72 hours. 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. It is also possible that researchers will find a slight difference in the observations that the SAS versus SQL data contain. [FeeInpatInvoice] table, one must first link that table to the [Fee]. [Patient], [PatSub]. If you are in crisis or having thoughts of suicide, Lump sum payments are not paid via FBCS. Updated September 21, 2015. No, only one type of care can be covered by a single authorization. The Implementer of this technology has the responsibility to ensure the version deployed is 508-compliant. Missingness can vary substantially by year and by file. For authorized care, the referral number listed on the Billing and Other Referral Information form. As noted in Chapter 2, the important variables capturing cost of care are AMOUNT and DISAMT. SAS and SQL data are organized differently and contain different variables. Using the Non-VA Medical Care data for research requires a basic understanding of laws and regulations that govern it. Through patient identifier and travel date (TravelPaymentDate), one can link these payments to inpatient and outpatient encounters. VINCI Data Description: Fee/Purchased Care [online; VA intranet only]. How Much Life Insurance Do You Really Need? June 5, 2009. U.S. Department of Veterans Affairs. http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf. This seeming complicated arrangement is an efficient way to store data. (2) Additionally, a Veteran must also meet at least one of the following criteria. If your claim was submitted to VA, call (877) 881-7618, If your claim was submitted to TriWest, call (877) 226-8749. Of note, the FBCS was not in place nationwide prior to FY 2008. Non-VA providers submit claims for reimbursement to VA. Health Information Governance. The clinic of jurisdiction, or medical facility, authorizes such care under the fee-basis program . The 2 sets of DRGs are not interchangeable. To access the menus on this page please perform the following steps. 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. In both SAS and SQL, it can be difficult to determine the provider the Veteran saw for Fee Basis care. The payment category (PAYCAT) is missing for all records in the inpatient services (ANCIL) file. 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. 866-505-7263, Veterans Crisis Line: 3. VA Fee Basis Programs. This technology can use a VA-preferred database. Care for dependent children, except newborns, in situations where VA pays for the mothers obstetric care during the same stay. access; blocking; tracking; disclosing to authorized personnel; or any other authorized The vendor has verified that the VA no longer has an active contract for this technology and any instances of this software on the VA network should be removed. A missing value of the primary diagnosis code should therefore be treated as truly missing. Because coding varies by station, users are encouraged to employ multiple variables in an effort to find all care associated with a particular setting or service type. Prescription-related data in the PHARVEN file contain only summary payments by month. 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. One may therefore assume that all patients receiving treatment through the Non-VA Medical Care program are Veterans. VA intranet users can visit https://vaww.va.gov/communitycare/ (intranet only). We are the third-party administrator for the VA CCN for Regions 1, 2 and 3, encompassing 36 states, Puerto Rico, the U.S. Virgin Islands and the District of Columbia. Important: The mailing address below only pertains to disability compensation claims. The travel payment data contains reimbursements for particular travel events (TravelAmount). SQL data contain the following vendor information: NPI, FeeVendorSID, FeeVendorIEN, NPI, VendorType and FeeSpecialtyCodeName. 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. Domains represent logically or conceptually related sets of data tables. To enter and activate the submenu links, hit the down arrow. Submit a corrected claim when you need to replace an entire claim previously submitted and processed. Address. Note that some physicians use the same ID number as the hospital. The VA Fee Basis medical program provides payment authorization for eligible Veterans to obtain routine medical treatment services through non-VA health care providers. 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. Money collected by VA from private health insurance carriers is returned back to the VA medical center providing the care. 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). 2010;47(8):725-37. As noted above, in SAS, the patient identifier is the SCRSSN; this is unique to each patient across the entire VA. This is true for both the inpatient and outpatient data. Note: records with status= R can have missing values for the variables vistapatkey and vistaauthkey, depending on whether or not these were linked before rejecting as a re-route to HAC. SQL inpatient data contain up to 5 diagnoses and 5 procedure codes, while SAS inpatient data contain up to 25 diagnosis codes and up to 25 procedure codes. [FeeInpatInvoiceICDProcedure] table. Each year represents the year in which the claim was processed, not the year in which the service was rendered. There is a deductible of $3 per trip up to a limit of $18 per month. 3. . Veterans Crisis Line: Attention A T users. In most cases, if you don't sign up for Part B when you are first eligible, you'll have to pay a late enrollment penalty. If the Veteran received care in the community that was not pre-authorized, it is considered unauthorized by VA. Persons interested in studying care provided under the Choice Act may wish to explore the VACAA tables or the FBCS tables at VA Corporate Data Warehouse (CDW). 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. There is very limited outpatient pharmacy data in the Fee files. _________________________________________________________________. 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. 400, Wittman Drive Grand Rapids Itasca County MN - 55744 United States. [Patient], [Spatient]. 1. Below are some answers to general questions about linking the UB-92 form to the FBCS data. Additional information appears in a federal regulation, 38 CFR 17.52. Appendix D contains information on the primary and foreign keys needed to link the various SQL tables. A primary key is a key that is unique for each record. Among non-missing observations, HERC analyses found a many-to-many relationship among NPI and VEN13N. Veterans Access, Choice, and Accountability Act of 2014 (VACAA): The Choice Program and the Choice Card [presentation]. 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. Users of the data should keep in mind that these data represent the physical location of the entity billing for care, which may or may not be the same as the providers location. As part of the process, claims and supporting documentation are scanned for compliance prior to conversion to electronic format. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. Data Quality Analysis Team. Please visit Provider Education and Training for upcoming events. Compare the discharge date of the first observation to the admission date of the next (second) observation. The zip code accompanying the VEN13 variable denotes the zip code to which VA sent reimbursement, not the zip code where the service was rendered. As noted above, non-VA care may be authorized under the Non-VA Medical Care program when VA cannot offer needed care. Fee Basis data are housed in VA in both SAS dataset format and Microsoft SQL server tables (hereafter referred to as SQL data). [SpatientAddress] tables. 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. [ SFeeVendor] table. This guidebook is intended to help researchers understand and use the National Fee Basis files, which come in both SQL and SAS formats. Defining a cohort is an activity that is different for each project and depends on the research question at hand. 7. Contact: 1-877-353-9791; Email Customer Engagement; Customer Engagement Portal Login. Fee Basis tables, however, only list PatientSID and do not list PatientICN. Community providers should remain in contact with the referring VA Medical Center to ensure proper care coordination. Bowel and Bladder Care. Given the stronger guidance from the Fee Office regarding use of the FPOV code, we recommend using the FPOV code to discern which observations are ancillary care, as the FeeProgram may not be as reliable. Please contact the referring VAMC for e-fax number. For current information on Community Care data, please visit the page. Guidance can be found under "VHA Data Quality Program Reports. The Fee Purpose of Visit Code (FPOV) has strong guidance from VA Fee Basis Office and thus may be a more accurate way of categorizing care. There are up to 25 ICD-9 diagnosis codes and 25 ICD-9 surgical procedure codes in the inpatient data. The DSS Fee Basis Claims System (FBCS) is a web-based claim management system. These tables involve payments paid only through FBCS. 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. Each VA facility has a local Fee Office to which the non-VA provider submits a claim for reimbursement. Researchers with VA intranet access can access these images by copying and pasting the URLs into their browser. The electronic 275 transaction process may be utilized to supply Remittance Advice documentation for timely filing purposes. This is true for both the inpatient and the outpatient data, albeit for different reasons. U.S. Department of Veterans Affairs. 1725 (the Mill Bill) by enabling VA to pay for or reimburse Veterans enrolled in VA health care for the remaining cost of emergency care if the liability insurance only covered part of the cost. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. Use Azure Rights Management Services (Azure RMS) for encrypted email. Primary keys are denoted by (PK) and foreign keys are denoted by (FK). For additional information or assistance regarding Section 508, please contact the Section 508 Office at Section508@va.gov. would cover any version of 7.4. The data regarding the clinical encounter as well as the charge and payment for that encounter are populated into the VA Health Information Systems and Technology Architecture (VistA). 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. 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. 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 is the main utility that passes information back into the FBCS Payment application. The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. The travel payments data contains reimbursements for particular travel events (TVLAMT). 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. 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]. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). This section describes two elements of the program: the range of services covered and the payment rules used to determine the amount that VA will pay (DISAMT). (refer to the Category tab under Runtime Dependencies), Users must ensure that Microsoft Structured Query Language (SQL) Server, Microsoft Internet Explorer (IE), and Microsoft Excel are implemented with VA-approved baselines. However, there are data available regarding the category of visit. Government contractor DSS Inc a new plan to fix VA's failing non-VA fee basis claims processing and management system with certain software updates - self-funded - to improve the system. Many veterans now have access to Non-VA medical care through the new Veterans Access, Choice, and Accountability Act (VACAA, or Choice Act). 11. MDCAREID is the Medicare OSCAR number, which is a hospital identifier. It can be difficult to determine the provider and the location of the Non-VA care provider. What documents are required by VA to process claims for. Name of the medication. This guide serves as an addendum to any technical documentation supplied by the healthcare clearinghouse when establishing a trading partner agreement. Most of these fields would be empty. The VendorType contains information about whether the service was provided by a laboratory, radiology, physician, pharmacy, other, travel, prosthetics, federal hospital, public hospital or private hospital. Veterans are not responsible for the remaining balance shown as patient responsibility on the explanation of benefits from their insurance carrier. 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. 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. If electronic capability is not available, providers can submit claims by mail. 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. 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. 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. 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. This technology can integrate with and alter database technologies. Unauthorized Care is that which was not pre-authorized but was still reimbursed, such as emergency care. Current Decision Matrix (10/21/2022) [SPatient] and[PatSub] tables. Fee Basis providers vary in how frequently they submit an invoice for Fee Basis care. Please visit Emergency Care Claims to learn more. This improves our claims processing efficiency. This application queues critical claims data into the FBCS shared MS SQL database for further processing and reporting. VAntage Point. With few exceptions these variables will be of little interest to researchers. These rules are subject to change by statute or regulation. 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. [FeeVendor] table. (refer to the Category tab under Runtime Dependencies), Users must ensure that Microsoft Structured Query Language (SQL) Server is implemented with VA-approved baselines. For billing questions contact: Health Resource Center The temporary end date is the maximum of these two values. Inpatient procedures are captured by ICD-9 procedure codes (SURG9CD1-SURG9CD25) in the hospital claims file. For example, there are observations in which INTIND = 1 and INTAMT = $0. 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. Data from FY1998 and FY1999 have a greater degree of discordance. In SAS, ICD-9 diagnosis codes are in the Inpatient, Outpatient and Ancillary files. Hospice also appears to be billed monthly, with longest length of stay for a single hospice invoice of 31 days. 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. Accessed October 16, 2015. Electronic 837 claim and 275 supporting documentation submissions can be completed through VAs contracted clearinghouse, Change Healthcare, or through another clearinghouse of your choice. Veterans who meet certain criteria may be eligible for mileage reimbursement for travel to and from VA or Non-VA 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. At the time of writing, SAS data at CDW are available only to those persons with VA operations access. Available at: http://vaww.virec.research.va.gov/CDW/Overview.htm. VA medical centers may purchase prosthetics and related items, such as clothing specialized for prosthetic limbs, and then dispense them through VA facilities. 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. Non-VA Medical Care data may be tabulated at the VHA Support Services Center (VSSC) (VA intranet only: http://vssc.med.va.gov/). [Spatient], and [Spatient]. For example, a technology approved with a decision for 7.x would cover any version of 7. The [Fee]. [FeeServiceProvided], [Fee]. A subsequent report will contain the results of an audit conducted to assess Medication dosage/strength. The unique patient identifier by which to conduct SQL-based Fee Basis analyses is PatientICN. Mark Smith and Adam Chow were the authors of the original HERC guidebook, upon which this document builds. (formerly known as VA Fee Basis or NonVA)-Community provider submits the claim and supporting documentation through their EDI provider services in . 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). This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. The conversion happens before claims and records are accepted into our claims processing system. In the SAS data prior to FY 2007, the disbursed amount (DISAMT) had an implied decimal point whereas the payment amount (AMOUNT) did not. one setting of care (inpatient or outpatient). 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). One can evaluate which encounters were unauthorized by joining the FeeUnauthorizedClaim table through the FeeUnauthorizedClaimSID key. Seven refer explicitly to Veterans alone, while the remaining two are for diagnostic services or eligibility exams, neither of which constitutes treatment. From there, it is sent weekly to AITC in SAS format and nightly to CDW in SQL format. Actual processing time has varied considerably over the years. b. The vendor no longer supports VA installations of this technology. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. In addition, VA may place a Veteran in a private or state-run nursing home when a bed in a VA nursing home is unavailable or if the nursing home is distant from the patients residence. Access; upload; download; change; or delete information on this system; Otherwise misuse this system are strictly prohibited. Researchers should use PatientICN to link patient data within CDW. - The information contained on this page is accurate as of the Decision Date (11/02/2022). This component distributes fee workload to particular users using the FBCS MS SQL database and the VistA Gateway. 5. Documentation in support of a claim may include: *NOTE: Documentation not required includes flowsheets and medication administration. 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). 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. FBCS supports payment of claims via VistA. 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. Users must ensure that Microsoft .NET Framework, Microsoft Structured Query Language (SQL) Server, and Microsoft Excel are implemented with VA-approved baselines. Veterans Health Administration. VSSC provides numerous relevant web reports, data resources, and analytics support, including summary data by facility and VISN and national summary data. 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. PMS-DRG was effective in FY 2008; prior to this time CMS-DRGs were used. 1. 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. MDCAREID is available in most inpatient SAS Fee Basis records. 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. [ICD9] tables. VIReC Research User Guide: VHA Medical SAS Outpatient Datasets FY2006. Matching outpatient prosthetics order records in the VA National Prosthetics Patient Database (NPPD) to health care utilization databases. Non-VA providers submit claims for reimbursement to VA. Chief Business Office. We tried to link the UB-92 form to identify Choice authorizations; however, we found few records and decided to use obligation number. SQL tables can be joined through linking keys. Available at: http://www.va.gov/opa/choiceact/documents/Choice-Program-Fact-Sheet-Final.pdf. Researchers with VA intranet access can access these sites by copying and pasting the URLs into their browser. VA-station related information includes STA3N, STA6A and STANUM in SAS and Sta3n and PrimaryServiceInstitution in SQL. There is no separate payment for items such as oxygen or other supplies, the number of attendants, providing an EKG during the trip, etc. To determine the location of care, MDCAREID will be more useful than VEN13N. Thus, in SQL the total cost of an inpatient stay would be determined by evaluating the DisbursedAmount in the [Fee]. There is limited information on the providers associated with Fee Basis care. April 14, 2014. Some missingness may indicate not applicable..
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