SQL Fee Basis data are stored in CDW in multiple individual tables. Box 30780, Tampa FL 33630-3780. In SAS, the inpatient (INPT) file includes PAMT, the Medicare prospective payment that would apply to the stay. This component is a service that communicates with an outside `Adjudication Engine` which scrubs claims data and sends back scrub results to the service via a secure Pretty Good Privacy (PGP) Secure Sockets Layer (SSL) web service connection. The amount of interest paid on the claim, if any, appears as the variable INTAMT. To access the menus on this page please perform the following steps. MDCAREID is the Medicare OSCAR number, which is a hospital identifier. We crosswalked the ScrSSN to allow for comparison with SAS data. 1725 when remaining liability to the Veteran is not a copayment or similar payment. If you are submitting a paper claim, please review the Filing Paper Claims section below for paper claim requirements. All Choice claims are processed by VISN 15. . Please visit Emergency Care Claims to learn more. They do not represent all claims received during the year. There is a deductible of $3 per trip up to a limit of $18 per month. _____________________________________________________________________________. This rule applies even when the patient is incapable of making a call. Summary Fee Basis expenditure data are also available through the VHA Support Services Center (VSSC) intranet site, further information about accessing these summary data can be found in Chapter 6. Note that some physicians use the same ID number as the hospital. Researchers will need to decide whether they will use the SAS or the SQL data and apply for appropriate IRB approval for use. 2. Thus the variable INTIND (interest indicator) equals 1 if the claim is eligible for interest and 0 otherwise. The electronic 275 transaction process may be utilized to supply Remittance Advice documentation for timely filing purposes. [XXX] tables.9,12 Tables under the DIM schema contain attributes that describe the records in the Fee tables. 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. 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. Electronic Data Interchange (EDI): Payer ID for medical claims is 12115. A claim void must be identical to the original claim that it is intended to cancel. [ICD9] tables. Data Quality Program. This component communicates with the FBCS MS SQL and VistA database in real time. In particular, CDW also recommends Patient SIDs with a value of less than 1 be deleted. The data files in each fiscal year represent all claims processed in the FMS during the year. Hit enter to expand a main menu option (Health, Benefits, etc). Health Information Governance. Smith MW, Su P, Phibbs CS. 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. Non-VA providers submit claims for reimbursement to VA. Fee Purpose of Visit (FPOV) Document [online; VA intranet only]. The Choice Act represents one of the largest shifts in the organization and financing of healthcare in the Department of Veterans Affairs (VA) in recent years. Chapter 6 contains more information about how to access these data. The charge for an ambulance trip to a non-VA hospital may be paid through the Non-VA Medical Care program if the medical center determines that the hospital services meet the criteria for an unauthorized claim or a 38 U.S.C 1725 (Mill Bill) claim, or if the patient died while in route to the facility. 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. If a Veteran has only Medicare Part A then VA may consider payment for ancillary and professional services usually covered under Part B. Nevertheless, the National Non-VA Medical Care Program Office (now the VHA Office of Community Care) has interpreted VHA Directive 2006-029 to preclude Non-VA Medical Care providers from receiving payment for prosthetics. Driving distance between a veterans residence and their closest VA facility is over 40 miles, c. The veteran must travel by boat or plane to access the VA facility closest to their home (excluding Guam, American Samoa, or the Republic of the Philippines), d. The veteran faces an excessive burden in traveling to a VA, including a body of water or geologic formation that cannot be crossed by road. 5. Care provided under contract is eligible for interest payments. NNPO. VINCI Data Description: Fee/Purchased Care [online; VA intranet only]. 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. Analyses of FY 2014 data indicate approximately 50% of inpatient observations and 43% of outpatient observations are missing NPI. [LocalDrug] table through LocalDrugSID to see whether there was the generic equivalent found in the VA drug file that was dispensed to the patient. Claims for Non-VA Emergency Care The Implementer of this technology has the responsibility to ensure the version deployed is 508-compliant. 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. Fee Basis Services. We found SPECIALPROVCAT was missing in 93% of records. [FeeServiceProvided] tables. Thus, the mailing address of the vendor is not always the vendors actual location. 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). This technology can use a VA-preferred database. 1. 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. Subscribe to our E-newsletter The Service Connection Our monthly newsletter features about important and up-to-date veterans' law news, keeping you informed about the changes that matter. 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]. SQL tables require linking before conducting any data analyses. Claims should be mailed to the following address: VA Eastern Kansas Health Care System Attn: Fee Basis Office 2200 SW Gage Blvd Topeka. For additional information or assistance regarding Section 508, please contact the Section 508 Office at Section508@va.gov. 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. Government contractor DSS Inc a new plan to fix VA's failing non-VA fee basis claims processing and management system with certain software updates - self-funded - to improve the system. The [Fee]. 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). Available at:http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. VA has adopted a policy of processing payments for certain EDI claims outside of FBCS (Choice/PCCC) by rerouting the EDI claims back to the HAC, causing them to reach terminal status in FBCS and triggering a transition to the PIT repository. There are also differences in the variables contained in the SAS versus SQL data. 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. 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. NPI and Medicare IDs have an M to M relationship. Attention A T users. 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. 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. If you are in crisis or having thoughts of suicide, Chapter 6 provides information about how to access the Fee Basis data, while Chapter 7 provides information about the rules governing Fee Basis care. The VA payment (DISAMT) is typically less than or equal to the PAMT value, although in some cases VA will pay more than Medicare would pay. The funds are used to provide the best care possible to our Veterans. Most nursing home care is billed monthly, so there is one claim for each month of nursing home stay. Therefore, on the outpatient side as well one must aggregate multiple records to get a full picture of the outpatient encounter. Each year represents the year in which the claim was processed, not the year in which the service was rendered. 13. VAntage Point. In SAS, ICD-9 diagnosis codes are in the Inpatient, Outpatient and Ancillary files. To find all care provided in a particular fiscal year requires searching by treatment date over several years of Non-VA Medical Care claims. More information about provider reimbursement can be found in the document Working with the Veterans Health Administration: A Guide for Providers (available on the VHA Office of Community Care website, on the Provider Resources page).5. The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. A single inpatient encounter may generate zero, one, or multiple ancillary records, depending on the number of ancillary procedures and physician services received. This care will be approved (or denied) by the local VA Fee Office; the Veteran is then free to seek non-VA care. To access the menus on this page please perform the following steps. While all non-VA providers must submit a claim to VA in order to be reimbursed for care, the claim filing deadline depends on the type of claim. Important: The mailing address below only pertains to disability compensation claims. However, 99% of inpatient hospital invoices were associated with a length of stay of 33 days or less. To enter and activate the submenu links, hit the down arrow. To enter and activate the submenu links, hit the down arrow. SQL Fee data are available through the VA Corporate Data Warehouse (CDW)/VA Informatics and Computing Infrastructure (VINCI). VA may be a secondary payer for unauthorized emergent claims under 38 U.S.C. NOTE: The processes outlined below are exclusive to supplying documentation for unauthorized emergent care. By June 2017, no Choice stays are found in FBCS. Previously, VA could reimburse Veterans or pay non-VA hospitals directly only if a Veteran has no other health insurance. 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. Hit enter to expand a main menu option (Health, Benefits, etc). For example, a hospital stay may last from Jan 1, 2010 to Jan 10, 2010, and have another claim for treatment provided on Jan 5, 2010. VA employees working on research studies cannot create their own crosswalk file as they do not have permission to use these files. Contact the VA North Texas Health Care System. Missing values of PAYCAT could be imputed by finding the corresponding inpatient stay in the INPT file. This is the main utility that passes information back into the FBCS Payment application. SQL data are housed at CDW, which is a collection of many servers. Researchers can look at the disposition variable as an indicator of transfer between VA and non-VA care. Procedures are identified by CPT code (CPT1) in the non-hospital inpatient services (the ancillary file) and in the outpatient procedures file. For the purpose of this guidebook, we focus on Fee Basis files only. The conversion happens before claims and records are accepted into our claims processing system. The SQL tables [Dim]. Dental claims must be filed via 837 EDI transaction or using the most current. (In SAS the admission date is denoted by the TREATDTF variable and the discharge date by the TREATDTO variable, in SQL the admission date is denoted by the AdmissionDate field and the discharge date is denoted by the DischargeDate field). The mileage fee varies by type of ambulance service: ground, fixed wing, or rotary wing, POP zip code classification, and loaded mileage. Therefore, it is not possible to do an exact comparison across the datasets. No, only one type of care can be covered by a single authorization. In FY05, DRG001 means CRANIOTOMY- >17 W CC, compared to HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC for DRG001 in FY15 DRG001. There are five forms of patient identifiers in SQL files at CDW (including but not limited to the Fee Basis files): PatientICN, PatientSID, PatientSSN, ScrSSN, and PatientIEN. 1. If it still cannot be found, then the stay may have ended on the day the person stabilized. The travel payments data contains reimbursements for particular travel events (TVLAMT). [FeeInpatInvoiceICDProcedure] table. 1. 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). VA will not pay merely a deductible, copayment, or COB (coordination of benefits) amount. VIReC. HERC investigation of Fee Files reveals certain data anomalies of which researchers should be aware. When a key field is missing, SQL indicates this with a value of -1. Mail to: DEPARTMENT OF VETERANS AFFAIRS. [SpatientAddress] tables. Most, if not all, of this care should be emergency care. 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. [Patient], [SPatient]. Given these different patient identifiers, it is difficult to conduct exact comparisons between SAS and SQL data. 5. Data Quality Program. 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). more information please visit www.fsc.va.gov. 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. The data that is not available is the data element that indicates if it was generated by FBCS or manually entered by the user in FBCS. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. 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). Thus, unauthorized care is not unpaid care it is simply not PRE-authorized care. Providers cannot bill both VA and the patient or another insurer for the same encounter. 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. However, there are some outliers; some claims can take up to 8 years to process. For these reasons, VA strongly encourages Veterans to consider important factors, risks and benefits before making any changes to their private health insurance. visit VeteransCrisisLine.net for more resources. 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. However, not all data in the FeeServiceProvided table are outpatient data; some may pertain to inpatient stays. VA employees working on operations studies can build their own crosswalk file as they have permission to use these file. A subsequent report will contain the results of an audit conducted to assess For EDI 837, Referral Number is Loop = 2300, Segment = REF*9F, Position = REF02 or Prior Authorization. The 2015 update to the Fee Basis Medical Care guidebook describes for the first time the SQL Fee Basis files, and contains a host of information about how SAS versus SQL Fee Basis files differ. 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). This component communicates with the FBCS MS SQL database and Veterans Health Information Systems and Technology Architecture (VistA) database in real time. Learn how to prevent paper claim rejections. In this chapter, we discuss general aspects of Fee Basis data. If the payment was made outside of FBCS, they wont show here. How Much Life Insurance Do You Really Need? This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. For authorized care, the referral number listed on the Billing and Other Referral Information form. 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: Five additional variables Financial Management System (FMS) transaction number, line number, date, batch number, and release date reflect processing of payments through the FMS. Electronic Data Interchange (EDI): Payer ID for medical and dental claims is VA CCN. We tried to link the UB-92 form to identify Choice authorizations; however, we found few records and decided to use obligation number. 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. PLSER values overlap considerably with those of the Medicare Carrier Line Place of Service codes. The key that allows for this linkage is the FeeInpatInvoiceSID which is a primary key in the [Fee]. To evaluate the time it takes VA to process Fee Basis claims, we evaluated SAS data for FY2014. If it cannot be located in the PTF Main file or DSS NDE for inpatient care, search other inpatient files. If your claim was submitted to VA, call (877) 881-7618, If your claim was submitted to TriWest, call (877) 226-8749. 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. For these reasons, the program does not pay for 100% of care that was otherwise eligible. Domains generally indicate the application in the VistA electronic health record system from which most of the data elements come (e.g., Vital Signs or Mental Health Assessment).6. As of April 2019, this guidebook is no longer being updated. 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. 1725 or 38 U.S.C. Appendix H lists their current values. The FeeSpecialtyCodeName contains information on the specialty of the provider seen, such as oncology, chiropractic, pathology, neurosurgery, etc., but is missing much data. MDCAREID is available in most inpatient SAS Fee Basis records. 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. 2. Additionally, our health care providers make certain that Veterans' VA medical records remain updated by returning information about Veteran care and treatment to VA. This means the data were placed in the PIT and the claim was not paid through FBCS. For more details, including rules for handling patients transferred during a stay, see federal regulation 38 CFR 17.55. [ICDProcedure] table and a foreign key in the [Fee]. For example, to understand the ICD-9 codes associated with a particular inpatient encounter, one would have to link the [Fee]. SQL data contain the following vendor information: NPI, FeeVendorSID, FeeVendorIEN, NPI, VendorType and FeeSpecialtyCodeName. The table can be linked to the [Dim]. For dual pension and compensation claims, use the mailing address below for compensation claims. VENDID is the vendor ID. If billing electronically, please include "Other Payers Information" in Loop 2320, 2330A, 2330B, and 2430. In some cases it may appear that single encounters have duplicate payments. Please switch auto forms mode to off. For example, an interest payment of $14.21 would appear as 1421. INTAMT is part of DISAMT; it should not be added to them. Below are some answers to general questions about the FBCS tables. Review the Supporting Documentation section below to learn how to properly submit supporting documentation with your claim. 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. Most files contain the invoice date, obligation number; check number and date, several variables pertaining to check cancellation and denials of payment, and the DHCP internal control number. 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. The Medicare hospital provider ID (MDCAREID) is entered by fee basis staff in order to calculate hospital reimbursement using the Medicare Pricer software. Primary keys are denoted by (PK) and foreign keys are denoted by (FK). For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/. Available at: http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. The vendor identity can be found through the VENDID or VEN13N variables in SAS. Access; upload; download; change; or delete information on this system; Otherwise misuse this system are strictly prohibited. Fee Basis data can be broadly categorized into 4 classes: inpatient care, outpatient care, pharmacy, and travel data. Starting in 2009, there are also a number of DXPOA variables in the SAS data, which indicate diagnoses that are present on admission. Documentation in support of a claim may include: *NOTE: Documentation not required includes flowsheets and medication administration. VA has set a goal of processing all clean claims within 30 days. Available at: http://www.mssny.org/Documents/Enews/Aug%208%202014/VA%20ProvidersGuide.pdf, 6. March 2018: Due to the transition of the National Non-VA Medical Care Program Office to the VHA Office of Community Care and updates to the VINCI website, some documents may no longer be available. This technology has not been assessed by the Section 508 Office. After a claim is submitted electronically it must be entered manually into a Non-VA Medical Care approval system. The [Fee]. VA will arrange for transportation for them or will reimburse expenses on the basis of vouchers submitted. VSSC provides numerous relevant web reports, data resources, and analytics support, including summary data by facility and VISN and national summary data. This is specific to certain claims for Non-Service Connected emergency medical care under Title 38 USC 1725. To enter and activate the submenu links, hit the down arrow. Gidwani R, Hong J, Murrell S. Fee Basis Data: A Guide for Researchers. 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. To file a claim for services authorized by VA, follow instructions included in the Submitting Claims section of the referral. If you submit a noncompliant claim and/or record, you will receive a letter from us that includes the rejection code and reason for rejection. one setting of care (inpatient or outpatient). All access or use constitutes understanding and acceptance that there is no reasonable VA evaluates these claims and decides how much to reimburse these providers for care. This component provides a front end for recognizing claim data through optical character recognition (OCR) software. Working with the Veterans Health Adminstration: A Guide for Providers [online]. The SQL Fee Basis data at CDW and the SAS Fee Basis data at AITC are available for VA researchers following a standard approval process. The 2 sets of DRGs are not interchangeable. Researchers will need to link to the Patient and SPatient domains to access this geographic information in the SQL data.