Accessed October 16, 2015. SAS Fee Basis data can be linked to other SAS files with additional demographic data (e.g., Vital Status files, enrollment files). Non-VA CareP.O. In SAS, the Patient ID will be the SCRSSN and the admit date is the treatment from date.
Payer Name: VA Fee Basis Programs - thePracticeBridge There is no information available in the SAS data that identifies the actual medication dispensed. There are nine situations in which Non-VA Medical Care is authorized. In this way, records that are missing MDCAREID can be given a MDCAREID based on the value of VEN13N and STA6A in the record. NPI and Medicare IDs have an M to M relationship. 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. Fee Basis data live in both SAS and SQL format. Accessed October 16, 2015. [Patient], [PatSub]. 13. Hit enter to expand a main menu option (Health, Benefits, etc). This application is directly attached to TWAIN compliant scanners and works offline to VistA and the FBCS MS SQL databases. In particular, CDW also recommends Patient SIDs with a value of less than 1 be deleted. [FeePharmacyInvoice] and the [Fee]. All instances of deployment using this technology should be reviewed by the local ISSO (Information System Security Officer) to ensure compliance with. Use of this technology is strictly controlled and not available for use within the general population. Many URLs are not live because they are VA intranet only. Money collected by VA from private health insurance carriers is returned back to the VA medical center providing the care. You are strongly encouraged to electronically submit claims and required supporting documentation. _________________________________________________________________. In both SAS and SQL data, outpatient data are organized in long format, with one record per CPT code. The PatientSID is a CDW assigned identifier that uniquely identifies a patient within a facility.
VA Health Care: Management and Oversight of Fee Basis Care Need However, there are data available regarding the category of visit. Thus, in SQL the total cost of an inpatient stay would be determined by evaluating the DisbursedAmount in the [Fee]. If it cannot be located in the PTF Main file or DSS NDE for inpatient care, search other inpatient files. Researchers will need to decide whether they will use the SAS or the SQL data and apply for appropriate IRB approval for use. To access the menus on this page please perform the following steps. If a researcher wishes to find the Medicare hospital provider ID, one approach is to use the vendor identification variables (VEN13N, VENDID) to locate the vendors name and location in the VEN file, and then to use this information to find the Medicare provider ID using publicly available files from CMS, the agency that oversees the Medicare program. 1-800-273-8255 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. We found SPECIALPROVCAT was missing in 93% of records. NPI is available within the VA CDW SStaff table. Some encounters have multiple procedures that are paid as a single encounter; other encounters have multiple procedures and there are separate payments for each procedure. Each VA facility has a local Fee Office to which the non-VA provider submits a claim for reimbursement. 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).
Fee-for-Service Providers | DMAS - Department of Medical - Virginia Submit a claim void when you need to cancel a claim already submitted and processed. The payment category (PAYCAT) is missing for all records in the inpatient services (ANCIL) file. There is no separate payment for items such as oxygen or other supplies, the number of attendants, providing an EKG during the trip, etc. When there is no available rate in the Medicare Fee Schedule, the VA will follow the payment guidelines for Non-VA Medical Care. How Much Life Insurance Do You Really Need? These vendors are presumably hospital chains. VINCI Data Description: Dimension [online; VA intranet only]. Available at: http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. is ok, 12.6.5 is ok, 12.6.9 is ok, however 12.7.0 or 13.0 is not. The key that allows for this linkage is the FeeInpatInvoiceSID which is a primary key in the [Fee]. VA Palo Alto, Health Economics Resource Center; October 2013. 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. 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.
HERC: Fee Basis Data: A Guide for Researchers - Veterans Affairs 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. 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. Prescription information: Prescribing provider's name. There is limited information on the providers associated with Fee Basis care. These include Fee purpose of visit (FPOV), place of service (PLSER), type of treatment (TRETYPE), HCFA payment type (HCFATYPE), and record type (TYPE). 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. In this situation, a given VA medical center has a preferred hospital from which it purchases care. The VA Fee Basis medical program provides payment authorization for eligible Veterans to obtain routine medical treatment services through non-VA health care providers. 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. [FeeVendor] table. would cover any version of 7.4. CLAIMS INTAKE CENTER. 3. However, we conducted some comparisons for inpatient data. To enter and activate the submenu links, hit the down arrow. SAS data also contain an additional diagnosis variable that is not present in the SQL data -- DXLSF. Accessed October 16, 2015. In this chapter, we discuss general aspects of Fee Basis data. The vendor identity can be found through the VENDID or VEN13N variables in SAS. Note: Admission date is only relevant for inpatient stays; it is not relevant for outpatient visits. If the Veteran received care in the community that was not pre-authorized, it is considered unauthorized by VA. 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. Therefore, on the outpatient side as well one must aggregate multiple records to get a full picture of the outpatient encounter. Some missingness may indicate not applicable.. Multiple claims may be submitted for each inpatient stay and the various claims do not have a common identifier indicating they are all part of the same inpatient stay. 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. Each year represents the year in which the claim was processed, not the year in which the service was rendered. 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. Veterans should mail or fax correspondence pertaining to compensation claims to the below location. 3. The values of Adjustment Codes 1 and 2 (ADJCD1 and ADJCD2) explain the reason for non-payment.
Gidwani R, Hong J, Murrell S. Fee Basis Data: A Guide for Researchers. There are 3 categories of geographic data: veteran-related information, vendor-related information and VA-station related information. U.S. Department of Veterans Affairs. The Veteran's full 9-digit social security number (SSN) may be used if the ICN is not available. 12. Chief Business Office. Veteran's ICN can be found on the VA issued HSRM referral. In the SAS data, the provider component of the inpatient stay is captured in the ancillary file. New values may be added over time. The data files in each fiscal year represent all claims processed in the FMS during the year. 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. One can use the FeeInitialTreatmentSID variable in the FeeServiceProvided table to link to the Fee.FeeInitialTreatment table.
Department of Veterans Affairs Health Care Programs | Optum In SAS data, there is also a primary service area variable (HOMEPSA) that indicates the station to which the Veterans residence is assigned based on geography. 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/. 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.
DSS Fee Basis Claims Systems (FBCS) - oit.va.gov 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. SAS data are housed in 8 ready-to-use datasets per fiscal year. Some important DIM tables that will be useful in analyzing Fee Basis data are FeePurposeOfVisit, FeeSpecialtyCode, FeeVendor, ICD, ICDProcedure Code, DRG, CPT, and CPT Category. While VA always encourages providers to submit claims electronically, on and after May 1, 2020, it is important that all documentation submitted in support of a claim comply with one of the two paper submission processes described.
Provider Portal - Veterans Affairs VA evaluates these claims and decides how much to reimburse these providers for care. Chapter 8 provides references for further information about the Fee Basis program and data. Facility Information Security Officers (ISOs) are often the CUPS POC. They do not represent all claims received during the year. It will often times not be possible to determine the reason for an outpatient visit, as there will be multiple observations/CPT codes that denote a single visit. FSGLI: Family Servicemembers Group Life Insurance, Schedule of Payments for Traumatic Losses, S-DVI: Service-Disabled Veterans Life Insurance, Beneficiary Financial Counseling and Online Will, Lesbian Gay, Bisexual & Transgender Veterans, Pension Management Center (PMC) that serves your state, Claims Adjudication Procedures Manual/Live Manual, Link to subscribe to receive email notice of changes to the Live Manual. If using payment amount, one would overestimate the cost of care. NNPO. A claim for which the Veteran had coverage by a health plan as defined in statute. By store procedure codes as records in another table, the SQL relational database uses the minimum amount of storable space. Much Fee Basis care is pre-authorized prior to the Veteran obtaining care and is thus considered Authorized Care. These rules are subject to change by statute or regulation. No, only one type of care can be covered by a single authorization. Additionally, our health care providers make certain that Veterans' VA medical records remain updated by returning information about Veteran care and treatment to VA. The invoice table would have to have a sufficient number of fields to accommodate the maximum number of procedures report on any invoice. 1. Electronic Services Available (EDI): Professional/1. MDCAREID is not available in the outpatient SAS Fee Basis data, even though some outpatient services are provided in a hospital. Health Information Governance. In that case, use payment amount instead. If this is the case, then it can be assumed that any care provided by the vendor with that VEN13N is actually a hospital with that MDCAREID. 5. The vendor no longer supports VA installations of this technology. Some vendors use centralized billing services located in other cities, in a few cases in other states. Under the Veterans Choice Act, eligible veterans are able to obtain outpatient care outside the VA using their Choice Card. For authorized care, the referral number listed on the Billing and Other Referral Information form. VA patients who receive prescriptions from non-VA providers fill them from a VA pharmacy, often the VA Certified Mail Order Pharmacy (CMOP). Generally, VA does not bill Medicare or Medicaid for reimbursement; however, VA does bill other types of health insurance including Medicare Supplemental plans for covered services. All access
By June 2017, no Choice stays are found in FBCS. VA may be a secondary payer for unauthorized emergent claims under 38 U.S.C. Payment for care provided under the Veterans Choice Act may not exceed the Medicare Fee Schedule (i.e. 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. URLs are not live because they are VA intranet only. 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). Chapter 1 presents an overview of Fee Basis data in general; Chapter 2 presents an overview of the variables in the Fee Basis data; and Chapter 3 describes how SAS versus SQL forms of Fee Basis data differ. 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. Claims. In SQL, the fields containing these data can be found in the FeeDispositionCode and FeeDispositionName Refer to Appendix C for a list of Fee Disposition Codes. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. October 1, 2015. There may be many providers that use the same vendor for billing. If disbursed amount is missing, use payment amount instead. Unauthorized user attempts
At the time of writing, version 4.2 is the most current version. 11. [FeeInpatInvoice] table, one must first link that table to the [Fee]. Claims and other FBCS data will be found in PIT or Community Care Referral & Authorization domains. 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. There are no references identified for this entry. For more information call 1-800-396-7929. We suggest using only the first 3 characters from sta3n for the merge. VA contracts out its hospice; therefore, the Fee Basis files contain a great deal of data related to hospice care. Clinical variables in SAS format include ICD-9 diagnosis codes, ICD-9 surgical codes, CPT codes and CPT modifier codes, DRG codes and Present on Admission codes. The Fee Basis files' primary purpose is to record VA payments to non-VA providers. In SAS, the outpatient data are housed in the MED files. Treatment date correlates to covered from/to. A claims scrubber software program is run to ensure completeness and to locate possible errors. 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. visit VeteransCrisisLine.net for more resources. For
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. SQL tables require linking before conducting any data analyses. Coverage will start July 1 of that year. Include the 17 alpha-numeric (10 digits + "V" + 6 digits) VA-assigned internal control number (ICN) in the insured's I.D. FBCS is an auditing system which provides instructional prompts designed to interface with the Veterans Information Systems and Technology Architecture (VistA) package to track, report, and analyze fee claim data. Veterans whose income exceed the established VA Income Thresholds as well as those who choose not to complete the financial assessment must agree to pay required copays to become eligible for VA health care services. FBCS Upload leverages LEADTOOLS Professional Optical Character Recognition (OCR) and is included in the FBCS workstation install package. All Fee Basis care will be found in the Fee files. 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. To access the menus on this page please perform the following steps. Additionally, we found 0.94% of records were approved Choice claims (e.g., records where SPECIALPROVCAT= CHOICE and STATUS= A (approved)). Claims Assistance | Veterans' Affairs Home Claims Assistance Claims Assistance Contacting the Columbia VA Regional Office Call us at (803) 647-2488, or email
[email protected], and provide your: Name Contact information and, Best time of day for contact between 8:00am and 4:00pm Users interested in learning the rules in force at a particular point in time should contact the VHA Office of Community Care. Contact: 1-877-353-9791; Email Customer Engagement; Customer Engagement Portal Login. one episode of care, which can have multiple dates within the prescribed treatment, one provider, as identified by the Tax Identification Number (TIN), and. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, Outreach, Transition and Economic Development Home, Warrior Training Advancement Course (WARTAC), Staff Appraisal Reviewer (SAR) Information, How to Apply for Nonsupervised Automatic Authority, VALERI (VA Loan Electronic Reporting Interface). SQL data contain the following vendor information: NPI, FeeVendorSID, FeeVendorIEN, NPI, VendorType and FeeSpecialtyCodeName. [Patient], [SPatient]. Training - Exposure - Experience (TEE) Tournament. Box 202117Florence SC 29502, Logistics Health, Inc.ATTN: VA CCN Claims328 Front St. S.La Crosse WI 54601, Secure Fax: 608-793-2143(Specify VA CCN on fax).