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. With additional permissions, researchers can also access City, Postal Code, Street Address, and Zip. 400, Wittman Drive Grand Rapids Itasca County MN - 55744 United States. For education claims, refer to the appropriate Regional Processing Office. VA Technical Reference Model v 23.2 DSS Fee Basis Claims Systems (FBCS) General Decision Reference Component Category Analysis General Information Technologies must be operated and maintained in accordance with Federal and Department security and privacy policies and guidelines. This table also includes claims related to inpatient care and other services. The Fee Basis files are stored in two formats: SAS and SQL. This component provides administration, reporting, and letter generation for all of the components of the Fee Basis Claims Systems (FBCS) via native Microsoft Structured Query Language (SQL) Server database communication drivers. For these reasons, VA strongly encourages Veterans to consider important factors, risks and benefits before making any changes to their private health insurance. 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. 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. 2. Care provided to persons associated with a particular VA station can be found by selecting records by STA3N. 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. Veterans Choice Program (VCP) Overview [online]. 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. The veteran must wait over 30 days past their preferred appointment date or the date deemed medically necessary by their provider, b. Hit enter to expand a main menu option (Health, Benefits, etc). 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. At the time of writing, version 4.2 is the most current version. [Spatient], and [Spatient]. (Anything), but would not cover any version of 7.5.x or 7.6.x on the TRM. one setting of care (inpatient or outpatient). 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). 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. 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. Researchers can do this using the FeePurposeOfVisit (FPOV) code.11 We recommend this approach over using another variable, such as the Fee Program. There is no information available in the SAS data that identifies the actual medication dispensed. VA employees working on operations studies can build their own crosswalk file as they have permission to use these file. SQL Fee data are available through the VA Corporate Data Warehouse (CDW)/VA Informatics and Computing Infrastructure (VINCI). There are multiple potential identifiers for provider/vendor in the SAS data: the VENDID, VEN13N, MDCAREID, SPECCODE and NPI. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, New York/New Jersey VA Health Care Network, Call TTY if you 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). 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. [Patient], [PatSub]. If it cannot be located in the PTF Main file or DSS NDE for inpatient care, search other inpatient files. Available at: http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. Technology must remain patched and operated in accordance with Federal and Department security policies and guidelines in order to mitigate known and future security vulnerabilities. Detailed information about accessing each of these data sources is available at the VHA Data Portal (VA intranet only: http://vaww.vhadataportal.med.va.gov).See Table 10 for a summary of the data sources. Several variables are available for locating care in particular settings. Hit enter to expand a main menu option (Health, Benefits, etc). _____________________________________________________________________________. Veterans Health Administration. Summary data are also available through the VHA Support Services Center (VSSC) website on the VA intranet. The amount claimed (PAMTCL) appears in the inpatient (INPT) file alone; there is no claimed amount on the outpatient side. VA may reconsider and provide retroactive reimbursements for emergency treatment that was provided prior to the date of enactment (July 19, 2001), if documentation sufficiently demonstrates the original denial was because the Veteran received partial third party payment. Please switch auto forms mode to off. This technology can integrate with and alter database technologies. _________________________________________________________________. This technology has not been assessed by the Section 508 Office. 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. A single inpatient encounter may generate zero, one, or multiple ancillary records, depending on the number of ancillary procedures and physician services received. A record is created only if there is a code on the invoice to be recorded. In particular, CDW also recommends Patient SIDs with a value of less than 1 be deleted. Training - Exposure - Experience (TEE) Tournament. You may use VA Form 10-583 to fulfill this requirement. To link an authorization to a claim, use the trifecta of what VistA would consider sta3n, PatientIEN, and AuthorizationIEN. Health Information Governance. 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. We gratefully acknowledge comments and contributions from Sharon Dally, Susan Schmitt and Paul Barnett. VA systems are intended to be used by authorized VA network users for viewing and VA evaluates these claims and decides how much to reimburse these providers for care. HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. Hit enter to expand a main menu option (Health, Benefits, etc). U.S. Department of Veterans Affairs. 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. SAS and SQL data are very similar, but not exact copies of each other. Treatment date correlates to covered from/to. Facility charges vs. ancillary charges: There are instances when there may be claims for facility charges with no corresponding ancillary provider charge. 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. 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. Unauthorized user attempts There are 3 categories of geographic data: veteran-related information, vendor-related information and VA-station related information. These vendors are presumably hospital chains. The PatientSID is a CDW assigned identifier that uniquely identifies a patient within a facility. SAS and SQL data are organized differently and contain different variables. In some cases it may appear that single encounters have duplicate payments. (Available at the VHA Data Portal. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). 8. Submit a corrected claim when you need to replace an entire claim previously submitted and processed. 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. 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. Prosthetic items. YESElectronic Remittance (ERA)YESICD- 1. New values may be added over time. FBCS is designed to be used in the Fee Basis Departments of the Veteran Affairs Medical Centers (VAMCs). Payer ID for dental claims is CDCA1. VINCI. VA can make payments to non-VA health care providers under many arrangements. The Caregivers and Veterans Omnibus Health Services Act of 2010 (Public Law 111-163) authorizes VA to provide post-delivery and routine care to a newborn child of qualifying women Veterans receiving VA maternity care for up to seven days following the birth. 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. 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. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. 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. Table 8 denotes on which CDW servers Fee Basis data are housed. Among non-missing observations, HERC analyses found a many-to-many relationship among NPI and VEN13N. All persons working with these data should review this information before conducting any analyses. Data Quality Analysis Team. [FeeInpatInvoice] table, one must first link that table to the [Fee]. Per the May 5th, 2015 memorandum from the VA Chief Information Security Officer (CISO) FIPS 140-2 Validate Full Disk Encryption (FOE) for Data at Rest in Database Management Systems (DBMS) and in accordance with Federal requirements and VA policy, database management must use Federal Information Processing Standards (FIPS) 140-2 compliant encryption to protect the confidentiality and integrity of VA information at rest at the application level. 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. 1. [PatientRace] tables. Box 14830Albany, NY 12212. Please switch auto forms mode to off. 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. Emergency claims covered under the Veterans Millennium Care and Benefits Act, Public Law 106-117); see 29 CFR 17.120 and 38 CFR 17.1004. Inpatient procedures are captured by ICD-9 procedure codes (SURG9CD1-SURG9CD25) in the hospital claims file. In the Fee Basis inpatient data, each record represents a separate claim; these separate claims must be aggregated to capture the totality of the inpatient stay. Submit a claim void when you need to cancel a claim already submitted and processed. The conversion happens before claims and records are accepted into our claims processing system. There may be multiple STA3Ns for a single inpatient stay. We present here one way to collapse records into a single inpatient stay, but users may wish to develop their own method specific to the research question at hand. VINCI Data Description: Dimension [online; VA intranet only]. There are a number of different variables that denote the category of care a Veteran received through Fee Basis (see Table 2) Appendices B and H present more details about the values these variables can take. For more details, including rules for handling patients transferred during a stay, see federal regulation 38 CFR 17.55. SAS data also contain an additional diagnosis variable that is not present in the SQL data -- DXLSF. Users interested in learning the rules in force at a particular point in time should contact the VHA Office of Community Care. Payer ID for dental claims is 12116. Many URLs are not live because they are VA intranet only. SQL data must be linked from multiple tables in order to create an analysis dataset. 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. and constitutes unconditional consent to review and action including (but not limited Attention A T users. Appendix E includes a list of SQL fields related to the type of care a patient receives. [FeeInitialTreatment], [Fee]. The amount of interest paid on the claim, if any, appears as the variable INTAMT. Emergency care can also be authorized by VA in certain circumstances when the VA is notified within 72 hours. 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. There are also a number of other financial variables denoted in SAS (see Table 7). Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. Inpatient data are housed in the FeeInpatInvoice table as well as the FeeServiceProvided table, although the latter does not contain only inpatient data. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. This research was supported by the Health Services Research and Development Service, U.S. Department of Veterans Affairs (ECN 99017-1). If using payment amount, one would overestimate the cost of care. The VendorType contains information about whether the service was provided by a laboratory, radiology, physician, pharmacy, other, travel, prosthetics, federal hospital, public hospital or private hospital. 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. Home Health Agencies billing with an OASIS Treatment number use the Prior Authorization segment for the TAC and the Referral Number segment on the 837I submission. 4. 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. Additionally, our health care providers make certain that Veterans' VA medical records remain updated by returning information about Veteran care and treatment to VA. Plan Name or Program Name," as this is a required field. In the outpatient data, one observation represents a single CPT code. [FeeInpatInvoice] and [Fee]. 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. Q. All instances of deployment using this technology should be reviewed by the local ISO (Information Security Officer) to ensure compliance with. Non-VA providers submit claims for reimbursement to VA. Each patient should have only one ICN in the entire VA, regardless of the number of facilities at which he is seen. For more detailed information, researchers should visit the VHA Office of Community Care website. 10. 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. We believe that payments are then made from the claim data available from the Claims Reconciliation and Auditing: Program Integrity Tool (PIT) with lump sum/expedited payments being made on a weekly basis and retrospective review, as well as recoupment efforts for overpayments/duplicates. There is a strong, but imperfect, concordance, between the observations housed in the SAS and 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. 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. Smith MW, Chow A. Non-VA Medical Care (Fee Basis) Data: A Guide for Researchers. For more information call 1-800-396-7929. Documentation, including data contents, field frequencies, and record counts, is also available on VIReCs CDW Data Documentation page (VA intranet only: http://vaww.virec.research.va.gov/CDW/Documentation.htm). expectation of privacy in the use of Government networks or systems. For EDI 837, Referral Number is Loop = 2300, Segment = REF*9F, Position = REF02 or Prior Authorization. 988 (Press 1). All information in this guidebook pertains to use of ICD-9 codes. Veterans Health Administration. It may duplicate the PatientIEN of another patient at another facility, and should not be used as an identifier. The Fee Basis program or Non-VA Care is health care provided outside VA. NVCC Office coordinates services and payments for Veterans receiving non-VA care for emergent and non-emergent medical care. Electronic Data Interchange (EDI) Interface. SAS has more data on inpatient diagnosis and procedure variables than do SQL data. 3. We assume here that new inpatient stays are defined by a change in vendor or a gap in treatment day more than 1 day. Lump sum payments are not paid via FBCS. The vendor has verified that the VA no longer has an active contract for this technology and any instances of this software on the VA network should be removed. There is very limited outpatient pharmacy data in the Fee files. Find out More Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B. This component distributes fee workload to particular users using the FBCS MS SQL database and the VistA Gateway. There is a lack of publicly available technical documentation and support may be limited to specific forums. There are additional payments for direct medical education, capital-related costs, and other factors as appropriate. 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. PatientIEN and PatientSID are unique to a patient within a facility, but not unique to a patient across VA facilities (e.g., a patient who had visited multiple VA facilities will have multiple PatientIENs and multiple PatientSIDs). Users must ensure that Microsoft .NET Framework, Microsoft Structured Query Language (SQL) Server, and Microsoft Excel are implemented with VA-approved baselines. Researchers interested in linking SQL Fee Basis data to the rich patient-level or vendor and/or provider information available in the rest of the Corporate Data Warehouse should apply for permissions to access these other datasets. 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. All instances of deployment using this technology should be reviewed to ensure compliance with. is ok, 12.6.5 is ok, 12.6.9 is ok, however 12.7.0 or 13.0 is not. Non-VA CareP.O. [FeeInpatInvoiceICDDiagnosis] with the [Dim]. FBCS supports payment of claims via VistA. Assistance with claims is free and covers all state and federal veterans' programs. There may be multiple vendor IDs (VENDIDs) for a single inpatient stay. Microsoft Internet Explorer, a dependency of this technology, is in End of Life status and must no longer be used. Accessed October 16, 2015. As noted earlier, there are often multiple records that indicate a single inpatient stay each record pertains to a unique invoice number. INTIND and INTAMT are not always concordant. [1] The Health Care Financing Administration (HCFA) was renamed the Centers for Medicare and Medicaid Services. Quality of Life and Veterans Affairs Appropriations Act of 2006 (Public Law 109-114),the FSC offers a wide range of financial and accounting products and services to both the VA and Other Government Agencies (OGA). Pre-2007, DISAMT and INTAMT each have two implied decimal places a value of 1000 would indicate $10.00. 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. This guidebook describes characteristics of Fee Basis care data such as contents and missingness, and makes recommendations about its use for research purposes. 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. The status value A stands for accepted, meaning the claim was paid. Learn how to prevent paper claim rejections. SAS Fee Basis data can be linked to other SAS files with additional demographic data (e.g., Vital Status files, enrollment files). Go to CDW Home, click on CDW MetaData, then click on the link for Purchased Care. 3. Hit enter to expand a main menu option (Health, Benefits, etc). Non-VA Payment Methodology Matrix [online; VA intranet only]. Accessed October 07, 2015. 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.
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