[Patient], [PatSub]. A claim void must be identical to the original claim that it is intended to cancel. While there is limited information about the vendor available in the SAS datasets; the most comprehensive information about the vendor can be found in the SAS VEN and SAS PHARVEN datasets. 21. In SAS, the inpatient (INPT) file includes PAMT, the Medicare prospective payment that would apply to the stay. 3. 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. Note: A Veterans insurance coverage or lack of insurance coverage does not determine their eligibility for treatment at a VA health care facility. Fee Basis: 214-857-1397 C & P. VA Claims Representation; RESOURCES. PO BOX 4444. Fee Basis data are housed in VA in both SAS dataset format and Microsoft SQL server tables (hereafter referred to as SQL data). These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). To access the menus on this page please perform the following steps. SQL tables can be joined through linking keys. Medication dosage/strength. Updated August 26, 2015. Emergent care patient liabilities not tied to copayments or deductibles will continue to be considered for secondary payment by VA. For additional questions, contact VA by phone, tollfree, at (877) 881-7618. 2. Box 30780, Tampa FL 33630-3780. Non-VA providers submit claims for reimbursement to VA. 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. SAS versus SQL data differ in three main ways: Appendix A lists all variables in the SAS files. 1. 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. This can become complicated by the fact that not all encounters relating to the same inpatient stay will have the same admission and discharge dates. Non-emergency care must be approved before the Veteran seeks care in the community.3 For traditional Non-VA care, a Veterans VA provider will submit a request at the local VA facility for Veteran care provided by Fee Basis. In general, persons on active duty in the U.S. military are excluded even if they are transitioning to VA care. The VA pays for both emergency and non-emergency care through Fee Basis mechanisms. Given the variable definitions, it is not clear whether DX1 or DXLSF is the better choice to determine primary reason for inpatient stay. In SAS, ICD-9 diagnosis codes are in the Inpatient, Outpatient and Ancillary files. After a claim is submitted electronically it must be entered manually into a Non-VA Medical Care approval system. 1. VA Information Resource Center. [FeeServiceProvided] tables. Accessed October 16, 2015. See the FBCS page (CDW Raw) on the CDW SharePoint site (VA intranet only: https://vaww.cdw.va.gov/bisl/Database/SitePages/Raw%20Extractor.aspx) for more information. Menlo Park, CA. 2. 15. These include Fee purpose of visit (FPOV), place of service (PLSER), type of treatment (TRETYPE), HCFA payment type (HCFATYPE), and record type (TYPE). Patient type can take one of seven values: surgical; medical; home nursing; psych contract; psychiatric, neuro contract; or neurological. Users interested in learning the rules in force at a particular point in time should contact the VHA Office of Community Care. In general, we recommend using the disbursed amount to capture the cost of care, for two reasons. Prior to use of this technology, users should check with their supervisor, Information Security Officer (ISO), Facility Chief Information Officer (CIO), or local Office of Information and Technology (OI&T) representative to ensure that all actions are consistent with current VA policies and procedures prior to implementation. Our office is located at 6940 O St, Suite 400 Lincoln NE 68510. In the SQL files, there is no separate ancillary file; rather, data regarding the physician cost of the inpatient stay is denoted in the [Fee]. For example, DISAMT=1000 in FY06 really indicates DISAMT=10.00. 2. Move on to the next patient ID, STA3N, VEN13N combination and repeat the entire process above. 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. The dates of service are represented by the covered from/to fields of the UB-92. More information on the proper use of the TRM can be found on the 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. Box 14830Albany, NY 12212. 3. There is a strong, but imperfect, concordance, between the observations housed in the SAS and SQL data. The Fee Purpose of Visit (FPOV) and Health Care Financing Agency Payment Type (HCFATYPE) variables feature values pertaining to setting (inpatient, outpatient, home-based), specific items (e.g., supplies and diagnostics), and miscellaneous purposes.[1]. 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. 7. VENDID is the vendor ID. This is the main utility that passes information back into the FBCS Payment application. Fee Basis tables, however, only list PatientSID and do not list PatientICN. 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/. Veterans Health Administration. The amount claimed (PAMTCL) appears in the inpatient (INPT) file alone; there is no claimed amount on the outpatient side. Prescription information: Prescribing provider's name. 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 application completes the update of critical claims data into the FBCS shared MS SQL database for further processing and reporting. Thus, one could not simply use the patient identifier and the admission and discharge dates to collapse these observations into one inpatient stay. The definition of the DXLSF variable changes depending on the year of analysis. The temporary end date is the maximum of these two values. Attention A T users. Box 537007Sacramento CA 95853-7007, CCN Region 5(Kodiak, Alaska, only)Submit to TriWest. Fee Purpose of Visit is the recommended way to evaluate the category of the visit. Fee Purpose of Visit (FPOV) Document [online; VA intranet only]. There is a deductible of $3 per trip up to a limit of $18 per month. 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. There are nine situations in which Non-VA Medical Care is authorized. Data from FY1998 and FY1999 have a greater degree of discordance. Given these delays in processing claims, we recommend that analyses use Fee Basis data from 2 years prior to the current date to ensure almost complete capture of inpatient, ancillary and outpatient data. In the outpatient data, one observation represents a single CPT code. Veterans Choice Program (VCP) Overview [online]. 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. To access the menus on this page please perform the following steps. There is another category of Fee Basis care that is considered unauthorized care. 4. Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. Smith MW, Chow A. Non-VA Medical Care (Fee Basis) Data: A Guide for Researchers. Inpatient data are housed in the FeeInpatInvoice table as well as the FeeServiceProvided table, although the latter does not contain only inpatient data. In SQL, the patient ID will be the PatientICN or PatientSID, and the admit date is the admission date.. This schema contains sensitive information such as SSNs, bank accounts, and the actual name of personnel. To evaluate the time it takes VA to process Fee Basis claims, we evaluated SAS data for FY2014. The UB-92 equivalent variables would be: facility (after merging in facility name from the FBCS_Facilities table), vistapatkey, and vistaauthkey, respectively. In SAS, data are stored in variables, observations and datasets. VA calculates PAMT from CMS pricer software on the basis of DRG and length of stay. 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. Many variables in the Fee Basis files record details of invoice and check processing. VA can waive the deductible in hardship cases. June 5, 2009. In this way, records that are missing MDCAREID can be given a MDCAREID based on the value of VEN13N and STA6A in the record. For more information call 1-800-396-7929. To access the menus on this page please perform the following steps. There is also a host of non-emergency surgery provided through Fee Basis mechanisms that may be of interest to researchers. In FY 2014, the longest length of stay associated with a single nursing home invoice was 31 days. Researchers should use PatientICN to link patient data within CDW. [SpatientAddress] tables. 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. SQL data contain the following vendor information: NPI, FeeVendorSID, FeeVendorIEN, NPI, VendorType and FeeSpecialtyCodeName. Additionally, we found 0.94% of records were approved Choice claims (e.g., records where SPECIALPROVCAT= CHOICE and STATUS= A (approved)). Basic demographic variables can be found in the [Patient]. National Non-VA Medical Care Program Office (NNPO). Include the claim, or a copy of the claim, on top of the supporting documentation that is mailed to the following address: Include a completed cover sheet with the supporting documentation that is mailed to the above address. ____________________________________________________________________________. Information from this system resides on and transmits through computer systems and networks funded by the VA. Researchers will need to decide whether they will use the SAS or the SQL data and apply for appropriate IRB approval for use. Each observation in the SAS and SQL data has an accompanying vendor ID. Plan Name or Program Name," as this is a required field. Accessed October 16, 2015. Guidance can be found under "VHA Data Quality Program Reports. In the outpatient data, each record represents a different procedure, as assessed through the Current Procedural Terminology (CPT) code. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). SAS data also contain an additional diagnosis variable that is not present in the SQL data -- DXLSF. 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. YESThis insurance is also known as: Veterans Administration. If a researcher decides to use FPOV, please note that an FPOV value of 52 indicates ED visit for persons whose care is covered under the Millennium Bill and should thus be included in evaluating ED care. 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. Care for dependent children, except newborns, in situations where VA pays for the mothers obstetric care during the same stay. Fee Basis Services. Operating Systems Supported by the Technology. 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). Institutional Aspects of the Non-VA Medical Care System, https://www.va.gov/health-care/get-reimbursed-for-travel-pay/, http://www.va.gov/opa/choiceact/documents/Choice-Program-Fact-Sheet-Final.pdf. Business Product Management. FBCS is designed to be used in the Fee Basis Departments of the Veteran Affairs Medical Centers (VAMCs). Office of Information and Analytics. Authorized care claims must be submitted within 6 years of the date of service, service-connected emergency care claims must be submitted within 2 years of the date of service, and non-service-connected emergency care claims must be submitted within 90 days of the date of service/discharge. [ SFeeVendor] table. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B. Emergency care can also be authorized by VA in certain circumstances when the VA is notified within 72 hours. 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. Payment for these types of care falls under the Non-VA Medical Care program. The mileage fee varies by type of ambulance service: ground, fixed wing, or rotary wing, POP zip code classification, and loaded mileage. Hit enter to expand a main menu option (Health, Benefits, etc). 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. 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. [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. Fee Basis data files contain information regarding both the care the Veteran received and the reimbursement of the care. 15. VA has established rules for timely filing of unauthorized and Mill Bill claims (i.e. Section 508 compliance may be reviewed by the Section 508 Office and appropriate remedial action required if necessary. All Fee Basis care will be found in the Fee files. All Choice claims are processed by VISN 15. 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. Assistance with claims is free and covers all state and federal veterans' programs. Before working with any SQL tables in CDW, we recommended familiarizing yourself with the schema diagram in order to understand how to link tables to one another. Complete and accurate standard Center for Medicare & Medicaid Services (CMS) or electronic transaction containing false claims notice (such as CMS 1450, CMS 1500 or 837 EDI transaction). Below are some answers to general questions about the FBCS tables. To access the menus on this page please perform the following steps. This technology can use a VA-preferred database. Please switch auto forms mode to off. 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 database and Veterans Health Information Systems and Technology Architecture (VistA) database in real time. This rule applies even when the patient is incapable of making a call. If the provider declines VA payment then it may be able to charge the patient a greater total amount. From there, it is sent weekly to AITC in SAS format and nightly to CDW in SQL format. 2010;47(8):725-37. 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. In SAS, this variable is called DISTYP, or disposition type, and is located in the Inpatient and Ancillary tables. A claims scrubber software program is run to ensure completeness and to locate possible errors. Available at: http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. The SAS files also include a patient type variable (PATTYPE). Researchers will thus need permissions to allow the CDW data manager to obtain SCRSSN or SSN to PatientICN crosswalk to allow for the necessary data linkages. 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). These inpatient tables have to be linked to FeeInpatInvoiceICDDiagnosis, FeeInpatInvoiceICDProcedure, FeeInitialTreatment and the appropriate DIM tables in order to understand the specific diagnoses and procedures associated with the inpatient observations in these tables. This is helpful in determining the location of care in inpatient claims in which MDCAREID is missing, and in outpatient claims for hospital-provided services. [FeeTravelPayment] contain information on travel type and payment. 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. VA evaluates these claims and decides how much to reimburse these providers for care. VA Fee Schedule. Technologies must be operated and maintained in accordance with Federal and Department security and Veterans who have private health insurance should consider a number of important factors before canceling their health insurance, such as: If you cancel your Medicare Part B Coverage, you need to know that you cannot be reinstated until January of the following year, and you may be penalized for reinstatement. [FeeInpatInvoice] table, one must first link that table to the [Fee]. To find all care provided in a particular fiscal year requires searching by treatment date over several years of Non-VA Medical Care claims. 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. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. There is very limited outpatient pharmacy data in the Fee files. access; blocking; tracking; disclosing to authorized personnel; or any other authorized (formerly known as VA Fee Basis or NonVA)-Community provider submits the claim and supporting documentation through their EDI provider services in . Inpatient stays in both SAS and SQL Fee Basis data can denote hospital stays, nursing home stays, or hospice stays. 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 The process of linking can be complex; analysts should take care to reduce errors during this process. The DSS Fee Basis Claims System (FBCS) is a web-based claim management system. 2. Researchers evaluating care over time may want to use the DRG variable. Many veterans now have access to Non-VA medical care through the new Veterans Access, Choice, and Accountability Act (VACAA, or Choice Act). 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). Chapter 6 provides information about how to access the Fee Basis data, while Chapter 7 provides information about the rules governing Fee Basis care. Current Decision Matrix (10/21/2022) Prior to the passage of this law on May 1, 2010, VA did not cover the cost of health care provided to dependent children, including newborns in situations where VA pays for the mothers obstetric care during the same stay. Five additional variables Financial Management System (FMS) transaction number, line number, date, batch number, and release date reflect processing of payments through the FMS. Available at: http://vaww.virec.research.va.gov/CDW/Overview.htm. Last updated August 21, 2017 If disbursed amount is missing, use payment amount instead. 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 [FeeInpatInvoiceICDProcedure] table. 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 . 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. Records that relate PatientSID to PatientICN are found two tables: Patient.Patient and SPatient.Spatient. There are substantial differences in quantity of inpatient diagnosis and procedure data available in SAS versus SQL. To enter and activate the submenu links, hit the down arrow. Identify Choice records by using tax ID and specialprovcat= CHOICE. New values may be added over time. field. One may therefore assume that all patients receiving treatment through the Non-VA Medical Care program are Veterans. Non-VA providers submit claims for reimbursement to VA. Fee Basis providers vary in how frequently they submit an invoice for Fee Basis care. Bowel and Bladder Care. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up for it. 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. However, there are best practices that all SQL-based analyses should follow. Important: The mailing address below only pertains to disability compensation claims. 1725 may only be made if payment to the facility for the emergency care is authorized, or death occurred during transport. This technology is not portable as it runs only on Windows operating systems. Review the Corrections and Voids page for more information. Some Fee Basis data will also appear in the non-VA medical SAS inpatient file (formerly called the Patient Treatment File). To enter and activate the submenu links, hit the down arrow. For pension claims, use the Pension Management Center (PMC) that serves your state. VA Fee Basis Programs. SAS has more data on inpatient diagnosis and procedure variables than do SQL data. Values for Fee Purpose of Visit (FPOV), HCFA Payment Type (HCFATYPE), Treatment Code (TRETYPE), Place of Service (PLSER), and Vendor Type (TYPE) appear in Appendix B. In that case, use payment amount instead. To access the menus on this page please perform the following steps. Accessed October 16, 2015.