VA intranet users can visit https://vaww.va.gov/communitycare/ (intranet only). VA Technical Reference Model - DigitalVA To access the menus on this page please perform the following steps. Accessed October 16, 2015. Researchers should pay special attention to reducing duplicates in the pre-2008 data. 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. Providers who continue to elect to submit paper claims and paper documentation to support claims for unauthorized emergency care should be aware of the following: VHA Office of Integrated Veteran Care P.O. Fee Basis Services - VetsFirst 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. 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. The Vendor Release table provides the known releases for the. This component allows the site access to Communications, Configuration and Reporting options for FBCS. 2. The status value A stands for accepted, meaning the claim was paid. 1-800-273-8255 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. There is a lack of publicly available technical documentation and support may be limited to specific forums. Several variables are available for locating care in particular settings. By store procedure codes as records in another table, the SQL relational database uses the minimum amount of storable space. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. Then, to see which ICD procedure codes were coded for this inpatient stay, one must link to the [Dim]. There is also a host of non-emergency surgery provided through Fee Basis mechanisms that may be of interest to researchers. For more details, including rules for handling patients transferred during a stay, see federal regulation 38 CFR 17.55. PatientIEN is assigned by the facility. If the VA Fee Schedule does not include a rate for the covered service provided, reimbursement will be made at 100% of customary charges, as defined in the provider's VA CCN Payment Appendix. For example, if the Veteran had an Emergency Department (ED) visit and then was admitted to the hospital, this would be considered inpatient care. In this way, records that are missing MDCAREID can be given a MDCAREID based on the value of VEN13N and STA6A in the record. [Patient], [Spatient]. Sort data by the patient ID, STA3N, VEN13N, and the admission dates. 21. 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. Please switch auto forms mode to off. [FeeInitialTreatment], [Fee]. The same concept (such as fiscal year, state, or county) may be represented by several variables, sometimes in differing formats. This is true for both the inpatient and outpatient data. The SAS files also include a patient type variable (PATTYPE). The 2 sets of DRGs are not interchangeable. In this situation, a given VA medical center has a preferred hospital from which it purchases care. Office of Media and Public Relations. Persons looking to find the date of service should be advised that it will not be contained in the FeeServiceProvided table. Please switch auto forms mode to off. 15. Please review the Where To Send Claims and the Where To Send Documentation sections below for mailing addresses and Electronic Data Interchange (EDI) details. Contact: 1-877-353-9791; Email Customer Engagement; Customer Engagement Portal Login. 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. SAS and SQL data are very similar, but not exact copies of each other. Additionally, we found 0.94% of records were approved Choice claims (e.g., records where SPECIALPROVCAT= CHOICE and STATUS= A (approved)). However, not all dates on the claim are approved. Such care is called Non-VA Medical Care, or Fee Basis care. [FeeVendor] table. The dates of service are represented by the covered from/to fields of the UB-92. Procedures are identified by CPT code (CPT1) in the non-hospital inpatient services (the ancillary file) and in the outpatient procedures file. This application is directly attached to TWAIN compliant scanners and works offline to VistA and the FBCS MS SQL databases. For current information on Community Care data, please visit the page VA Community Care Data. 3. Our review of the data suggests that pharmacy and ancillary claims take longer to process than inpatient or outpatient claims. The mileage fee varies by type of ambulance service: ground, fixed wing, or rotary wing, POP zip code classification, and loaded mileage. Technologies must be operated and maintained in accordance with Federal and Department security and Multiple SQL tables contain these variables. Matching outpatient prosthetics order records in the VA National Prosthetics Patient Database (NPPD) to health care utilization databases. In both SQL and SAS data, there is also a variable regarding the fee specialty code. This component distributes fee workload to particular users using the FBCS MS SQL database and the VistA Gateway. All SAS prescription-related data is found in two files: the PHR file and the PHARMVEN file. 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. 400, Wittman Drive Grand Rapids Itasca County MN - 55744 United States. This rule applies even when the patient is incapable of making a call. However, Veterans may be responsible for a VA copayment depending on their assigned Priority Group. Again, date of service is not available in the FeeServiceProvided table. is ok, 12.6.5 is ok, 12.6.9 is ok, however 12.7.0 or 13.0 is not. VA CCN OptumP.O. Working with the Veterans Health Adminstration: A Guide for Providers [online]. In SAS, the outpatient data are housed in the MED files. No, only one type of care can be covered by a single authorization. TRM Proper Use Tab/Section. This table contains information on inpatient care. 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. Internal use only. A primary key is a key that is unique for each record. U.S. Department of Veterans Affairs. However, there is one situation in which the payment amount will be more accurate than the disbursed amount: when the disbursed amount is missing, and the payment was not cancelled, one should use the payment amount to capture the cost of care. A foreign key is a key that uniquely identifies a record of another table. Regardless of whether the care was pre-authorized or not, non-VA providers submit claims to VA if they wish to be reimbursed for care. Use of this technology is strictly controlled and not available for use within the general population. Unauthorized Care is that which was not pre-authorized but was still reimbursed, such as emergency care. U.S. Department of Veterans Affairs. Prescription information: Prescribing provider's name. 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. Each VA facility has a local Fee Office to which the non-VA provider submits a claim for reimbursement. The invoice table would have to have a sufficient number of fields to accommodate the maximum number of procedures report on any invoice. Some vendors use centralized billing services located in other cities, in a few cases in other states. 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. File a Claim-Information for Veterans - Community Care - 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. privacy policies and guidelines. VA Informatics and Computing Resource Center (VINCI). For some years, there may be high rates of missingness of ICD-9 data in the Ancillary files. Data from FY1998 and FY1999 have a greater degree of discordance. The conversion happens before claims and records are accepted into our claims processing system. A Non-VA Medical Care claim is defined by four elements: The remainder of section 7.4 details payment rules as of early 2015. Inpatient data are housed in the FeeInpatInvoice table as well as the FeeServiceProvided table, although the latter does not contain only inpatient data. Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. VA-station related information includes STA3N, STA6A and STANUM in SAS and Sta3n and PrimaryServiceInstitution in SQL. VA can also pay for hospice care for Veterans when the VA facility is unable to provide the needed care; this happens frequently, as VA provides only inpatient-based hospice care and many Veterans may wish to receive hospice at home or in the community. VIReC. 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). HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. 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 are substantial differences in quantity of inpatient diagnosis and procedure data available in SAS versus SQL. This schema contains sensitive information such as SSNs, bank accounts, and the actual name of personnel. If you are in crisis or having thoughts of suicide, HERC did not investigate use of NPI for this guidebook. Of note, SQL and SAS data contain similar, but not exactly the same, information. Section 508 compliance may be reviewed by the Section 508 Office and appropriate remedial action required if necessary. This is the main utility that passes information back into the FBCS Payment application. 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). The alternative, putting the procedure code fields in the invoice table, would not be as efficient. For example, accessing FY2014 data on Dec 1, 2014 will likely result in fewer observations than when accessing FY 2014 data on Dec 1, 2015. 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. Cunningham, K. VA implements the first of several Veterans Choice Program eligibility expansions. Most of these fields would be empty. How Does VGLI Compare to Other Insurance Programs? 14. More than 99% of claims for inpatient, ancillary and outpatient care are processed within 2 years. Each patient should have only one ICN in the entire VA, regardless of the number of facilities at which he is seen. VA has established rules for timely filing of unauthorized and Mill Bill claims (i.e. For example, a technology approved with a decision for 12.6.4+ would cover any version that is greater than 12.6.4, but would not exceed the .6 decimal ie: 12.6.401 Appendices G and H, copied from the Non-VA Medical Care program website, describes in detail the types of records for which each Fee Purpose of Visit (FPOV) codes are assigned. To access the menus on this page please perform the following steps. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). The SAS data are stored at AITC. Please visit Provider Education and Training for upcoming events. access; blocking; tracking; disclosing to authorized personnel; or any other authorized For example, there could be many NPIs associated with a VEN13N (e.g., a hospital employing multiple providers), or many VEN13Ns for a single provider (e.g., a surgeon with privileges at multiple hospitals). 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). PMS-DRG was effective in FY 2008; prior to this time CMS-DRGs were used. National Non-VA Medical Care Program Office (NNPO). Outpatient data are housed in the FeeServiceProvided table. From there, it is sent weekly to AITC in SAS format and nightly to CDW in SQL format. 1-800-273-8255 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. 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. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. There are delays in the processing of Fee Basis claims. Both ancillary and outpatient files have one record per CPT code. You can use NPI to link providers in VA and Medicare. 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. The VHA Office of Community Care is the contact for all VA community care programs. 1725 may only be made if payment to the facility for the emergency care is authorized, or death occurred during transport. 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. This most likely reflects a low frequency of surgery rather than missing data. Box 30780 Tampa, FL 33630-3780, P2E Documentation Cover Sheet, VA Form 10-10143f. The slight decrease in fiscal year 2012 spending from the fiscal year 2011 level was due to VA's adoption of Medicare rates as its primary payment method for fee basis providers. Billing & Insurance - South Central VA Health Care Network When possible, VA will seek reimbursement for Non-VA Medical Care payments from sources such as workers compensation payments; payments resulting from motor vehicle accidents, crimes of personal violence, or torts; other agencies when the patient is a beneficiary; and third-party insurance plans. VA employees working on research studies cannot create their own crosswalk file as they do not have permission to use these files. If researchers wish to identify ED visits, they may want to use CPT codes or Place of Service codes, rather than FPOV. Additionally, our health care providers make certain that Veterans' VA medical records remain updated by returning information about Veteran care and treatment to VA. VA systems are intended to be used by authorized VA network users for viewing and retrieving information only; except as otherwise explicitly authorized for official business and limited personal use under VA policy. 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. Veterans Choice Program (VCP) Overview [online]. Please switch auto forms mode to off. Non-VA Medical Care data may be tabulated at the VHA Support Services Center (VSSC) (VA intranet only: http://vssc.med.va.gov/). However, there are some outliers; some claims can take up to 8 years to process. Each year represents the year in which the claim was processed, not the year in which the service was rendered. It is also possible that researchers will find a slight difference in the observations that the SAS versus SQL data contain. How Much Life Insurance Do You Really Need? Appendix H lists their current values. More information can be found at the OPES website: http://opes.vssc.med.va.gov. Attention A T users. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Florida Department of Veterans' Affairs | Connecting veterans to If billing electronically, please include "Other Payers Information" in Loop 2320, 2330A, 2330B, and 2430. MDCAREID is available in most inpatient SAS Fee Basis records. Any variable that has an S prefix indicates secure data and requires special permission to access; researchers should be aware of this when submitting their IRB applications and their CDW DART data access requests. 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. This technology has not been assessed by the Section 508 Office. It is only relevant for claims linked to VistA patients. Unauthorized inpatient or outpatient claims must be submitted within 90 days from the date of care. For education claims, refer to the appropriate Regional Processing Office. 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. Claims for Non-VA Emergency Care 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. In some cases, there is a one-to-one relationship between VEN13N and MDCAREID. 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. Mail to: DEPARTMENT OF VETERANS AFFAIRSCLAIMS INTAKE CENTERPO BOX 4444JANESVILLE, WI 53547-4444, or Fax to: TOLL FREE: 844-531-7818 & 248-524-4260 (Utilized for Foreign Claimants), Veterans Crisis Line: Claims for Non-VA Emergency Care PatientIEN and PatientSID are found in the general Fee Basis tables. 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. In this chapter, we discuss general aspects of Fee Basis data. Ready. They do not represent all claims received during the year. For emergency care of service connected conditions, there is a two-year limit to submit any bills. We crosswalked the ScrSSN to allow for comparison with SAS data. Persons working with the SAS data should keep in mind that prior to FY 2007, the disbursed amount (DISAMT) had an implied decimal point whereas the payment amount (AMOUNT) did not. One may therefore assume that all patients receiving treatment through the Non-VA Medical Care program are Veterans. However, in all data files, the vast majority of observations are missing values for this variable. Researchers evaluating care over time may want to use the DRG variable. However, 99% of inpatient hospital invoices were associated with a length of stay of 33 days or less. 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. 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. Fee Purpose of Visit (FPOV) Document [online; VA intranet only]. Unauthorized care can be of an inpatient or outpatient nature. 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. Please see Section 2.1.4. for HERC advice about how to collapse multiple observations to evaluate the length and cost of a single inpatient stay. The quantity dispensed. The amount claimed (PAMTCL) appears in the inpatient (INPT) file alone; there is no claimed amount on the outpatient side. There is a deductible of $3 per trip up to a limit of $18 per month.
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