The [Fee]. The second record would have an admission date of Jan 5, 2010 and a discharge date of Jan 5, 2010. If the payment was made outside of FBCS, they wont show here. Electronic Data Interchange (EDI): Payer ID for medical and dental claims is VA CCN. 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. Note: Admission date is only relevant for inpatient stays; it is not relevant for outpatient visits. These represent cases in which payment is disallowed. 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. - The information contained on this page is accurate as of the Decision Date (11/02/2022). Therefore, it is not possible to do an exact comparison across the datasets. Therefore, on the outpatient side as well one must aggregate multiple records to get a full picture of the outpatient encounter. MDCAREID is available in most inpatient SAS Fee Basis records. 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. 16. 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). However, there are some outliers; some claims can take up to 8 years to process. A single inpatient encounter may generate zero, one, or multiple ancillary records, depending on the number of ancillary procedures and physician services received. PracticeBridge. Another approach is to search other fee claims submitted by the same vendor to see if a Medicare hospital ID was assigned to those claims. a. VINCI Data Description: Dimension [online; VA intranet only]. Researchers with VA intranet access can access these sites by copying and pasting the URLs into their browser. Below we describe the general types of information in both the SAS and SQL data. VA's fee basis care program. 1728. Non-VA Medical Care data are available in SAS form at the Austin Information Technology Center (AITC) and in SAS form and SQL form through the VA Corporate Data Warehouse (CDW)/VA Informatics and Computing Infrastructure (VINCI). 17. 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 UB-92 equivalent variables would be: facility (after merging in facility name from the FBCS_Facilities table), vistapatkey, and vistaauthkey, respectively. Accessed October 16, 2015. JANESVILLE, WI 53547-4444. or Fax to: TOLL FREE: 844-531-7818 & 248-524-4260 (Utilized for Foreign Claimants) return to top. [FeePharmacyInvoice] and the [Fee]. Accessed October 16, 2015. The Department of Veterans Affairs (VA) often pays providers in the community to provide care to Veterans when it is unable to provide such care itself (e.g., due to a lack of resources or delays in providing care), or when it is infeasible to do so (e.g., emergency care). [FeeServiceProvided] table. 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. [ SFeeVendor] table. There are 3 categories of geographic data: veteran-related information, vendor-related information and VA-station related information. resides on and transmits through computer systems and networks funded by the VA. We view the patients insurance data in the VistA file if the claim is flagged as reimbursable in VistA and encompasses the dates on the claim. Payment of ambulance transportation under 38 U.S.C. Note that the vendor may represent the hospital, a hospital chain or the entity billing on behalf of the provider. Some Fee Basis data will also appear in the non-VA medical SAS inpatient file (formerly called the Patient Treatment File). Some vendors use centralized billing services located in other cities, in a few cases in other states. 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. [FeeInpatInvoiceICDDiagnosis] with the [Dim]. All instances of deployment using this technology should be reviewed to ensure compliance with. Gidwani R, Hong J, Murrell S. Fee Basis Data: A Guide for Researchers. Steps to collapse records into a single inpatient stay: 1. The process of linking can be complex; analysts should take care to reduce errors during this process. 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. 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. 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). If researchers wish to identify ED visits, they may want to use CPT codes or Place of Service codes, rather than FPOV. Payer ID for dental claims is CDCA1. 3. The codes for the procedures provided for a given hospital stay are kept in a separate table, a table of procedures. Researchers will have to select observations from the SQL FeeServiceProvided table in order to ensure they are only evaluating outpatient data. How to create a secondary claims in eclinicalworks electronically; . Multiple claims can be paid against a single authorization. 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. If billing electronically, please include "Other Payers Information" in Loop 2320, 2330A, 2330B, and 2430. 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. U.S. Department of Veterans Affairs. YESInstitutional/UB Claims. The Fee Basis files are stored in two formats: SAS and SQL. VA systems are intended to be used by authorized VA network users for viewing and 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. 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. There are two important variables to consider if evaluating the cost (VA reimbursement) of Fee Basis Care: the payment amount (AMOUNT in SAS, PaidAmount in SQL) or the Financial Management System (FMS) disbursed amount (DISAMT in SAS, DisbursedAmount in SQL). SAS data also contain an additional diagnosis variable that is not present in the SQL data -- DXLSF. Unauthorized Care is that which was not pre-authorized but was still reimbursed, such as emergency care. The Fee Basis files' primary purpose is to record VA payments to non-VA providers. This service communicates via native SQL Server 2005 encrypted connections through the VA Wide Area Network (WAN). Box 537007Sacramento CA 95853-7007, CCN Region 5(Kodiak, Alaska, only)Submit to TriWest. 3. 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. This most likely reflects a low frequency of surgery rather than missing data. You can find more information about eligibility on the VHA Office of Community Care website. All SAS variables are denoted in capital letters, while SQL fields are denoted without spaces, in accordance with how these fields are labeled in the SQL tables. [FeeTravelPayment] contain information on travel type and payment. This component is a service that communicates directly with the High Availability Controller (HAC) SQL database for syncing critical fee data back into the local FBCS MS SQL database. As with the SAS data, it is not straightforward to determine the cost of, length of stay or care provided during a specific inpatient stay. The CDW SharePoint site has a document that lists the purchased care SQL tables, the fields of that they contain, and some sample SQL queries (VA intranet only: https://vaww.cdw.va.gov/metadata/Metadata%20Documents/Forms/AllItems.aspx). This table contains information on inpatient care. If a patient saw two different providers on the same date who use the same vendor for billing, it will not be possible to distinguish the two encounters. While NPI is available in SQL data, it does require special permissions to access, as it is located in the [Sstaff]. A claim for which the Veteran had coverage by a health plan as defined in statute. There is a deductible of $3 per trip up to a limit of $18 per month. 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. Claims Assistance | Veterans' Affairs Home Claims Assistance Claims Assistance Contacting the Columbia VA Regional Office Call us at (803) 647-2488, or email VetAsst.VBACMS@va.gov, and provide your: Name Contact information and, Best time of day for contact between 8:00am and 4:00pm All SAS prescription-related data is found in two files: the PHR file and the PHARMVEN file. To evaluate the time it takes VA to process Fee Basis claims, we evaluated SAS data for FY2014. TRM Proper Use Tab/Section. New values may be added over time. Non-VA Medical Care consumes a significant portion of VA spending; indeed, contract costs (i.e., the cost of all things purchased from non-VA health care providers) accounted for approximately 11% of VA expenditures in fiscal year 2014. Community providers have three options that allow for that linkage: Submit the claim electronically via 837 transaction and the supporting documentation via 275 transaction. 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. All access For more information call 1-800-396-7929. Researchers wishing to work with SAS Fee Basis data can access them at the Austin Information Technology Center (AITC). field. In the SAS data prior to FY 2007, the disbursed amount (DISAMT) had an implied decimal point whereas the payment amount (AMOUNT) did not. Electronic Data Interchange (EDI) Interface. Some Non-VA Medical Care claims are rejected for untimeliness or lack of statutory authority. Veterans Crisis Line: Thus the variable INTIND (interest indicator) equals 1 if the claim is eligible for interest and 0 otherwise. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. SQL tables require linking before conducting any data analyses. A summary of the payment guidelines can be found in Appendix I. Some missingness may indicate not applicable.. Fee Basis data are housed in both SAS and SQL format. It can be difficult to identify the specific type of provider associated with Fee Basis care in the currently available national extracts of Fee Basis data. Records that relate PatientSID to PatientICN are found two tables: Patient.Patient and SPatient.Spatient. April 08, 2014. To link an authorization to a claim, use the trifecta of what VistA would consider sta3n, PatientIEN, and AuthorizationIEN. Prosthetic items. Outpatient data are housed in the FeeServiceProvided table. Fee Basis data can be broadly categorized into 4 classes: inpatient care, outpatient care, pharmacy, and travel data. To enter and activate the submenu links, hit the down arrow. NPI and Medicare IDs have an M to M relationship. One can use the same approach as for the inpatient SQL data described above to locate the date of service. Note: A Veterans insurance coverage or lack of insurance coverage does not determine their eligibility for treatment at a VA health care facility. 2. SAS Fee Basis data can be linked to other SAS files with additional demographic data (e.g., Vital Status files, enrollment files). Training - Exposure - Experience (TEE) Tournament. Visit the VHA Data Portal for further information on accessing restricted VSSC web reports. As of April 2019, this guidebook is no longer being updated. No new extracts will occur. The VHA Office of Community Care is the contact for all VA community care programs. The National Provider Identifier (NPI) is a unique 10 digit identifier mandated to be used in health claims under the Health Insurance Portability and Accountability Act (HIPAA). There are nine situations in which Non-VA Medical Care is authorized. However, a 7.4.x decision VA evaluates these claims and decides how much to reimburse these providers for care. There are multiple methods by which community providers may electronically provide VA with the required medical documentation for care coordination purposes. 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 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. 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. Care provided under contract is eligible for interest payments. 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). Veterans Health Administration. Questions about non-VA care claims may be directed to the Fee Basis Unit between the hours of 8:00 a.m. Email Address Required. This guide was published in October 2015; the same month the United States switched from ICD-9 to ICD-10. Inpatient care beyond the time when a patient is stabilized and can be transferred to a VA facility, except where a VA facility is not feasibly available. The instructions differ based on the type of submission.NOTE: For specific information on submitting claims to Optum or TriWest, please refer to their resources. 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). Users interested in learning the rules in force at a particular point in time should contact the VHA Office of Community Care. It appears that starting in FY2016, Choice data is now bypassing FBCS and residing in the PIT. This component communicates with the FBCS MS SQL and VistA database in real time. In FY 2014, the longest length of stay associated with a single nursing home invoice was 31 days. For the inpatient data, we compared observations with the same patient identifier, based on PaidDate in SQL and TRANSDAT in SAS. These variables relate to the VA station at which the Fee Basis care requests and claims are input. For additional information or assistance regarding Section 508, please contact the Section 508 Office at Section508@va.gov. There is limited information on the providers associated with Fee Basis care. This improves our claims processing efficiency. 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 payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. Search VA Fee Basis Programs PayerID 12115 and find the complete info about VA Fee Basis Programs Insurance Type, LOB, ENR, RTE, RTS, ERA, SEC, Customer Service Number and more . For 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. 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. The SAS files also include a patient type variable (PATTYPE). The diagram below (Figure 1) displays how payment is processed and sent to the non-VA provider. http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. As of April 2019, this guidebook is no longer being updated. [XXX] tables, but also the [DIM]. (1) A Veteran must be enrolled in VA health care16. Payer ID for dental claims is 12116. b. These include Fee purpose of visit (FPOV), place of service (PLSER), type of treatment (TRETYPE), HCFA payment type (HCFATYPE), and record type (TYPE). There are multiple potential identifiers for provider/vendor in the SAS data: the VENDID, VEN13N, MDCAREID, SPECCODE and NPI. HERC did not investigate use of NPI for this guidebook. business and limited personal use under VA policy.
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