In some cases it may appear that single encounters have duplicate payments. Outpatient data are housed in the FeeServiceProvided table. Summary data are also available through the VHA Support Services Center (VSSC) website on the VA intranet. Additional information appears in a federal regulation, 38 CFR 17.52. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. Treatment date correlates to covered from/to. One can use the same approach as for the inpatient SQL data described above to locate the date of service. The CDW is a relational database organized into a collection of data domains implemented on the Microsoft SQL server in VINCI. If a Veteran has only Medicare Part B or has both Medicare Parts A and B, no VA payment may be made. This technology can use a VA-preferred database. If notification was not made to VA and you wish to have claims considered for payment, please submit claims and supporting documentation to VA as listed in the "Where to Send Claims" dropdown below. 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 Medicare hospital provider ID (MDCAREID) is entered by fee basis staff in order to calculate hospital reimbursement using the Medicare Pricer software. There are 3 categories of geographic data: veteran-related information, vendor-related information and VA-station related information. Include the authorization number on the claim form for all non-emergent care. Va Fee Basis Program Claims Address - filecloudbarcode [Spatient], and [Spatient]. Seven refer explicitly to Veterans alone, while the remaining two are for diagnostic services or eligibility exams, neither of which constitutes treatment. Each prescription record has a fill date and a patient identifier (either PatientICN or scrambled social security number). How to create a secondary claims in eclinicalworks electronically; . Below are some answers to general questions about the FBCS tables. Primary keys are denoted by (PK) and foreign keys are denoted by (FK). Please visit Emergency Care Claims to learn more. Researchers will need to link to the Patient and SPatient domains to access this geographic information in the SQL data. 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. To access the menus on this page please perform the following steps. The procedure code table has just as many records as there were procedures on the invoice. VA Form 10-583, Claim for Payment of Cost of Unauthorized Medical Services. VA decisions for specific versions may include + symbols; which denotes that the decision for the version specified also includes versions greater than The diagram below (Figure 1) displays how payment is processed and sent to the non-VA provider. SQL data must be linked from multiple tables in order to create an analysis dataset. Defining a cohort is an activity that is different for each project and depends on the research question at hand. 4. One may therefore assume that all patients receiving treatment through the Non-VA Medical Care program are Veterans. 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. Veterans Access, Choice, and Accountability Act of 2014 (VACAA): The Choice Program and the Choice Card [presentation]. These include Fee purpose of visit (FPOV), place of service (PLSER), type of treatment (TRETYPE), HCFA payment type (HCFATYPE), and record type (TYPE). Unauthorized inpatient or outpatient claims must be submitted within 90 days from the date of care. 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 If, however, VA is authorized to pay for only certain days in an inpatient stay, then the provider may bill the patient for the remaining days. Most commonly, authorized care refers to medical or dental care that was approved and arranged by VA to be completed in the community. A claim void must be identical to the original claim that it is intended to cancel. Therefore, it is not possible to do an exact comparison across the datasets. Researchers evaluating care over time may want to use the DRG variable. 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. If the claims and records do not conform to the minimum requirements for conversion to the 837 or 275 electronic formats, they are rejected and sent back for correction. 16. Mark Smith and Adam Chow were the authors of the original HERC guidebook, upon which this document builds. 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. Researchers wishing to work with SAS Fee Basis data can access them at the Austin Information Technology Center (AITC). The Non-VA Payment Methodology Matrix, prepared by the National Non-VA Medical Care Program Office (now the VHA Office of Community Care), presents guidelines for preauthorized care and emergency care for service and non-service connected conditions for both inpatient and outpatient care.17 VA will reimburse the same non-VA provider a different rate depending on whether the Veteran received: a) pre-authorized care; b) emergency care for a service-connected condition; or c) emergency care for non-service connected conditions and non-service connected Veterans. The status value A stands for accepted, meaning the claim was paid. In SAS, these data can be found in the Vendor file. Most, if not all, of this care should be emergency care. 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. [FeePharmacyInvoice] and the [Fee]. The SAS Fee Basis data are organized by fiscal year. VINCI. 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. The temporary end date is the maximum of these two values. One can use the FeeInitialTreatmentSID variable in the FeeServiceProvided table to link to the Fee.FeeInitialTreatment table. With few exceptions these variables will be of little interest to researchers. There is no separate payment for items such as oxygen or other supplies, the number of attendants, providing an EKG during the trip, etc. The outpatient pharmacy data includes medications dispensed in a pharmacy. 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.. U.S. Department of Veterans Affairs. Hit enter to expand a main menu option (Health, Benefits, etc). [ICDProcedure] table through the ICDProcedureSID. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). This component communicates with the FBCS MS SQL and VistA database in real time. Fee Basis data live in both SAS and SQL format. 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. If FIPS 140-2 encryption at the application level is not technically possible, FIPS 140-2 compliant full disk encryption (FOE) must be implemented on the hard drive where the DBMS resides. The Veteran files contain the richest patient demographic information in the SAS data; these include the Veterans date of birth, sex, prisoner of war status and war code. [FeePharmacyInvoice] table contains information on vendor, amount claimed, and amount paid. Make sure the services provided are within the scope of the authorization. Va Fee Basis Program Claims Address - pijonajalin.weebly.com This component is a service that communicates with the Program Integrity Tool (PIT) which scores claims and sends results to FBCS. Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. 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. 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 . VA evaluates these claims and decides how much to reimburse these providers for care. 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. We gratefully acknowledge comments and contributions from Sharon Dally, Susan Schmitt and Paul Barnett. b. Fee Basis Services - VetsFirst Thus, one could not simply use the patient identifier and the admission and discharge dates to collapse these observations into one inpatient stay. Review the Where to Send Claims section below to learn where to send claims. 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. VIReC Research User Guide: VHA Medical SAS Outpatient Datasets FY2006. visit VeteransCrisisLine.net for more resources. For some years, there may be high rates of missingness of ICD-9 data in the Ancillary files. Persons who wish to access data in the secure tables on CDW (denoted by a S prefix) must complete a Real SSN Access Request Form. This form must be signed by the IRB and Associate Chief of Staff for Research and submitted with the DART data request. The VHA Office of Community Care is the contact for all VA community care programs. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, New York/New Jersey VA Health Care Network, Call TTY if you _____________________________________________________________________________. 2. Payer ID for dental claims is 12116. If a Veteran has only Medicare Part A then VA may consider payment for ancillary and professional services usually covered under Part B. 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). Each table has only one primary key field. For example, a technology approved with a decision for 7.x would cover any version of 7. Microsoft Internet Explorer, a dependency of this technology, is in End of Life status and must no longer be used. Paper claims and supporting documentation submitted to us are converted to Electronic Data Interchange (EDI) transactions. As of April 2019, this guidebook is no longer being updated. 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). Prior to FY 2007, INTAMT has two implied decimal places. This application completes the update of critical claims data into the FBCS shared MS SQL database for further processing and reporting. Use the column 'estimated cost' and it is available in the CDW FBCS data. Hit enter to expand a main menu option (Health, Benefits, etc). 3. 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). The funds are used to provide the best care possible to our Veterans. In the SAS data, the patient identifier is the scrambled social security number (SCRSSN). However, in all data files, the vast majority of observations are missing values for this variable. Most importantly, they do not represent all care provided during the fiscal year. [FeeServiceProvided], [Fee]. Attention A T users. Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. They could form part of an overall strategy to locate care provided in specialized settings, such as state homes, or of specialized services like kidney dialysis. Attention A T users. 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. In the SAS data, the provider component of the inpatient stay is captured in the ancillary file. The Implementer of this technology has the responsibility to ensure the version deployed is 508-compliant. VA evaluates these claims and decides how much to reimburse these providers for care. 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. For care received under the Choice Act, Veterans will work with the third party administrators of the Choice program to find an eligible provider in their area.4. 3. . 6. The table can be linked to the [Dim]. However, previous HERC investigation confirmed these are partial payments made for a single encounter or procedure. SAS Fee Basis data can be linked to other SAS files with additional demographic data (e.g., Vital Status files, enrollment files). Linking Patient Data in the CDW Update [online; VA intranet only]. SAS data are housed in 8 ready-to-use datasets per fiscal year. Sort data by the patient ID, STA3N, VEN13N, and the admission dates. More information on the proper use of the TRM can be found on the If you are in crisis or having thoughts of suicide, Inpatient stays in both SAS and SQL Fee Basis data can denote hospital stays, nursing home stays, or hospice stays. Records that relate PatientSID to PatientICN are found two tables: Patient.Patient and SPatient.Spatient. PatientIEN and PatientSID are found in the general Fee Basis tables. We give an example here that relates to FeeInpatInvoice table. 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. June 5, 2009. 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. Those options are: Utilize HealthShare Referral Manager (HSRM) for referrals, authorizations and documentation exchange. Compare the admission date of the third observation to the temporary end date from above. Billing & Insurance - New York/New Jersey VA Health Care Network U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. This component provides a front end for validation and/or correcting the data that was read from the claim via the OCR module. Researchers can look at the disposition variable as an indicator of transfer between VA and non-VA care. field. 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. VA Information Resource Center. [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. In some cases, there is a one-to-one relationship between VEN13N and MDCAREID. To access the menus on this page please perform the following steps. VA has set a goal of processing all clean claims within 30 days. VA Fee Basis Programs. Health - Veterans Affairs The vendor identity can be found through the VENDID or VEN13N variables in SAS. SAS has more data on inpatient diagnosis and procedure variables than do SQL data. The process for filing a claim for services rendered to a Veteran in the community varies depending upon whether or not the services were referred by VA and by the entity through which the services were authorizedVA or one of the VA Third Party Administrators (TriWest Healthcare Alliance or Optum United Health Care). A Non-VA Medical Care claim is defined by four elements: The remainder of section 7.4 details payment rules as of early 2015.