It is only relevant for claims linked to VistA patients. Available at: http://vaww.virec.research.va.gov/CDW/Overview.htm. VA CCN OptumP.O. More information can be found at the OPES website: http://opes.vssc.med.va.gov. Users interested in learning the rules in force at a particular point in time should contact the VHA Office of Community Care. In SAS, this variable is called DISTYP, or disposition type, and is located in the Inpatient and Ancillary tables. SAS Fee Basis data can be linked to other SAS files with additional demographic data (e.g., Vital Status files, enrollment files). Billing & Insurance - South Central VA Health Care Network In this chapter, we discuss general aspects of Fee Basis data. For additional information or assistance regarding Section 508, please contact the Section 508 Office at Section508@va.gov. Persons looking to classify Veterans military service are encouraged to read the Data Quality Analysis Teams guidance on Identifying Veterans in the CDW(VA intranet only:http://vaww.vhadataportal.med.va.gov/Portals/0/DataQualityProgram/Reports/Identifying_Veterans_in_CDW.pdf).14. Updated August 26, 2015. However, in Table 4, we present some comparisons to demonstrate the different between SAS and SQL data. 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). NPI and Medicare IDs have an M to M relationship. VA Palo Alto, Health Economics Resource Center; October 2013. Business Product Management. Va Fee Basis Program Claims Address - rutrackersplus Table 3 lists their file names and gives a general description of their contents.10. In SQL, the patient ID will be the PatientICN or PatientSID, and the admit date is the admission date.. and constitutes unconditional consent to review and action including (but not limited However, in all data files, the vast majority of observations are missing values for this variable. 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. This act expands the non-VA care veterans were able to receive before the act was passed. Table 8 denotes on which CDW servers Fee Basis data are housed. HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. If the payment was made outside of FBCS, they wont show here. 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. In SAS, data are stored in variables, observations and datasets. The data files in each fiscal year represent all claims processed in the FMS during the year. You can use NPI to link providers in VA and Medicare. In the SAS data, the patient identifier is the scrambled social security number (SCRSSN). (Anything), but would not cover any version of 7.5.x or 7.6.x on the TRM. 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. This guide serves as an addendum to any technical documentation supplied by the healthcare clearinghouse when establishing a trading partner agreement. 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). VAntage Point. VA Form 10-583, Claim for Payment of Cost of Unauthorized Medical Services. These geographic variables indicate the VA station paying for the service. (refer to the Category tab under Runtime Dependencies), Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. Data from FY1998 and FY1999 have a greater degree of discordance. Here, ICDProcedureSID is a primary key in the [Dim]. This schema contains sensitive information such as SSNs, bank accounts, and the actual name of personnel. 1725 or 38 U.S.C. SQL data are housed at CDW, which is a collection of many servers. To access the menus on this page please perform the following steps. To enter and activate the submenu links, hit the down arrow. FBCS is designed to be used in the Fee Basis Departments of the Veteran Affairs Medical Centers (VAMCs). Of note, the relevant SQL tables for Fee Basis data are not only the [Fee]. The alternative, putting the procedure code fields in the invoice table, would not be as efficient. Researchers will need to link to the Patient and SPatient domains to access this geographic information in the SQL data. 2. Researchers using this tactic also run the risk of not being able to properly link their cohort, as other HERC investigations have revealed an imperfect relationship between SCRSSN and ICN; some SCRSSNs do not have an accompanying PatientICN; some SCRSSNs have multiple PatientICNs. VA has set a goal of processing all clean claims within 30 days. Billing & Insurance - New York/New Jersey VA Health Care Network 1728. There are substantial differences in quantity of inpatient diagnosis and procedure data available in SAS versus SQL. TRM Proper Use Tab/Section. 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. You can further refine by selecting records on or after November 4, 2014, when Choice was first enacted. The Fee Basis files are stored in two formats: SAS and SQL. 866-505-7263, Veterans Crisis Line: There is also a host of non-emergency surgery provided through Fee Basis mechanisms that may be of interest to researchers. SQL Fee Basis files themselves contain limited patient demographic variables, but can be linked to other SQL data. Chapter 4 offers detailed information SAS Fee Basis data; Chapter 5 provides detailed information about SQL Fee Basis data. Table 9 lists a number of financial variables the SQL data contain. Data in any of the any S tables require Staff Real SSN access. VA can waive the deductible in hardship cases. To access the menus on this page please perform the following steps. To understand what procedures were performed during an inpatient stay in the [Fee]. All SAS prescription-related data is found in two files: the PHR file and the PHARMVEN file. Linking Patient Data in the CDW Update [online; VA intranet only]. 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. Most nursing home care is billed monthly, so there is one claim for each month of nursing home stay. The codes for the procedures provided for a given hospital stay are kept in a separate table, a table of procedures. How to create a secondary claims in eclinicalworks electronically; . [FeeVendor] table. This technologysupports advanced data encryption methods and role-based access control. 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. As a Class 2 or Class 3 product, it MUST NOT be assumed to having been released into production through all OI&T product release and sustainment process controls for project management; requirements, development and testing management; and configuration, change, and release management necessary to satisfy OI&T process and product compliance. 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). Before this time, data were entered by hand, and there was no easy way to tell whether the claim being entered was a duplicate one. 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). Many veterans now have access to Non-VA medical care through the new Veterans Access, Choice, and Accountability Act (VACAA, or Choice Act). 1. Department of Veterans Affairs Health Care Programs | Optum Chapter 6 contains more information about how to access these data. After a claim is submitted electronically it must be entered manually into a Non-VA Medical Care approval system. Identify Choice records by using tax ID and specialprovcat= CHOICE. In this case the first record would have an admission date of Jan 1, 2010 and a discharge date of Jan 10, 2010. Payer ID for dental claims is CDCA1. 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. [FeeServiceProvided], [Fee]. Fee Basis Services. Attention A T users. Bowel and Bladder Care. HERC: Fee Basis Data: A Guide for Researchers - Veterans Affairs The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. [Patient], [SPatient]. 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. If you are in crisis or having thoughts of suicide, For current information on Community Care data, please visit the page. There is a lack of publicly available technical documentation and support may be limited to specific forums. Attention A T users. Additionally, our health care providers make certain that Veterans' VA medical records remain updated by returning information about Veteran care and treatment to VA. expectation of privacy in the use of Government networks or systems. 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. There may be multiple CPT codes associated with a single encounter. Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. [FeeInpatInvoice] table, one must first link that table to the [Fee]. Fee Basis data are housed in VA in both SAS dataset format and Microsoft SQL server tables (hereafter referred to as SQL data). This research was supported by the Health Services Research and Development Service, U.S. Department of Veterans Affairs (ECN 99017-1). This component provides a front end for recognizing claim data through optical character recognition (OCR) software. Some missingness may indicate not applicable.. Facility charges vs. ancillary charges: There are instances when there may be claims for facility charges with no corresponding ancillary provider charge. [FeeInitialTreatment], [Fee]. To enter and activate the submenu links, hit the down arrow. Unscheduled trips may be reimbursed for the return mileage only. Training - Exposure - Experience (TEE) Tournament, Observational Medical Outcomes Partnership (OMOP), Personnel & Accounting Integrated System (PAID), Decision Analysis: Decision Trees, Simulation Models, Sensitivity Analyses, Measuring the Cost of a Program or Practice: Microcosting, List of VA Economists and Researchers with Health Economic Interests, 7. Of note, the FBCS was not in place nationwide prior to FY 2008. the rates paid by the United States to Medicare providers). We give an example here that relates to FeeInpatInvoice table. To learn more, please visit the Provider Training section on the MES website . 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. Veterans Choice Program (VCP) Overview [online]. The [Fee]. There are often multiple observations per inpatient stay and multiple observations per outpatient encounter. Working with the Veterans Health Adminstration: A Guide for Providers [online]. If a Veteran has only Medicare Part A then VA may consider payment for ancillary and professional services usually covered under Part B. It would seem logical to use the vendors location, found in the vendor files PHARVEN and VEN, to associate care with a particular station, but this should be approached with caution. SAS has more data on inpatient diagnosis and procedure variables than do SQL data. U.S. Department of Veterans Affairs. SAS data are housed in 8 ready-to-use datasets per fiscal year. Contractor Announces Plan To Fix Non-VA Fee Basis Claims However, previous HERC investigation confirmed these are partial payments made for a single encounter or procedure. [FeeInpatInvoice] and [Fee]. 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. 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. If the Veteran went to the ED and was not admitted to the hospital, this would be considered outpatient care. Several variables are available for locating care in particular settings. Providers are not required to accept VA payment in all cases. Outpatient prescriptions beyond a 10-day supply. Consult the latest CDW schematic diagrams to understand the tables in which your variables of interest are housed and the primary key and foreign keys needed to link each pair of tables. Use of this technology is strictly controlled and not available for use within the general population. However, the VA may pay a rate higher than the Medicare Fee Schedule rate for care provided in highly rural areas, as long as this rate is determined to be fair and reasonable by VA. One can find more information on payment rates under the Veterans Choice Act in federal regulation 17.1500. have hearing loss. Fee Basis providers vary in how frequently they submit an invoice for Fee Basis care. The VHA Office of Community Care is the contact for all VA community care programs. VA must be capable of linking submitted supporting documentation to a corresponding claim. Electronic Data Interchange (EDI) Interface. Documentation in support of a claim may include: *NOTE: Documentation not required includes flowsheets and medication administration. Two domains in which researchers can find reports on Non-VA Care are Resource Management and Workload. 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). The unique patient identifier by which to conduct SQL-based Fee Basis analyses is PatientICN. is ok, 12.6.5 is ok, 12.6.9 is ok, however 12.7.0 or 13.0 is not. [LocalDrug] table through LocalDrugSID to see whether there was the generic equivalent found in the VA drug file that was dispensed to the patient. 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. Thus, in SQL the total cost of an inpatient stay would be determined by evaluating the DisbursedAmount in the [Fee]. Research requests for data from CDW/VINCI must be submitted via the Data Access Request Tracker (DART) application. 17. 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. Inpatient stays in both SAS and SQL Fee Basis data can denote hospital stays, nursing home stays, or hospice stays. 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. These represent cases in which payment is disallowed. Types of VA Disability Claims | PTSD Lawyers - Berry Law Health Information Governance. Accessed October 16, 2015. SAS and SQL also have several geographic fields related to the vendor providing the non-VA care, such as the vendors city, county, state and zip code. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). Dental claims must be filed via 837 EDI transaction or using the most current. A claim without errors or omissions is said to be clean. If VA has authority to pay the claim and the submitted documentation is sufficient then the claim is approved for payment. Mail to: DEPARTMENT OF VETERANS AFFAIRS. More information about can be found on their website: https://www.va.gov/communitycare/. 3. Among non-missing observations, HERC analyses found a many-to-many relationship among NPI and VEN13N. The SAS files also include a patient type variable (PATTYPE). Plan Name or Program Name," as this is a required field. If the provider declines VA payment then it may be able to charge the patient a greater total amount. Fee Basis data files contain information regarding both the care the Veteran received and the reimbursement of the care. The National Provider Identifier (NPI) is a unique 10-digit identification number issued by the Centers for Medicare and Medicaid Services to all health care providers in the United States. For example, the meaning of DRG001 is not the same in FY05 vs FY15. Accessed October 16, 2015. 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. Records that relate PatientSID to PatientICN are found two tables: Patient.Patient and SPatient.Spatient. This is true for both the inpatient and the outpatient data, albeit for different reasons. The Veterans Access, Choice, and Accountability Act (Veterans Choice Act), passed in 2014, expanded veterans access to non-VA care. There are 3 categories of geographic data: veteran-related information, vendor-related information and VA-station related information. SAS data are also available in CDW, but are currently limited to those VA employees with operational access. Please switch auto forms mode to off. 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. VA Information Resource Center. (refer to the Category tab under Runtime Dependencies), Users must ensure that Microsoft Structured Query Language (SQL) Server, Microsoft Internet Explorer (IE), and Microsoft Excel are implemented with VA-approved baselines. As part of the process, claims and supporting documentation are scanned for compliance prior to conversion to electronic format. 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). Yes. Provider Portal - Veterans Affairs This product is Class 2 or Class 3 VA-designed and built Local Software OR is a commercially-licensed software product purchased or leased that will run in a VA VISTA environment or integrate with Class 1 National VISTA Software. 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. Some vendors use centralized billing services located in other cities, in a few cases in other states. File a Claim-Information for Veterans - Community Care - Veterans Affairs This application reads, creates, edits authorization data in VistA, and copies critical information into the central SQL database for off-line VistA applications to consume. 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. The two tables can be joined through FeePharmacyInvoiceSID. 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. Optum is a proud partner with the VA through its Community Care Network (CCN). If electronic capability isnot available, providers can submit claims by mail or secure fax. 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. This technology can integrate with and alter database technologies. The same cannot be said for DX2-DX25, however, as additional diagnosis codes are optional. _____________________________________________________________________________. FBCS Upload leverages LEADTOOLS Professional Optical Character Recognition (OCR) and is included in the FBCS workstation install package. 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. Include the 17 alpha-numeric (10 digits + "V" + 6 digits) VA-assigned internal control number (ICN) in the insured's I.D. [Patient], [Spatient]. VA Informatics and Computing Resource Center (VINCI). VA is the primary and sole payer when VA issues an authorization. Treatment date correlates to covered from/to. This component distributes fee workload to particular users using the FBCS MS SQL database and the VistA Gateway. 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. Important: The mailing address below only pertains to disability compensation claims. There is another category of Fee Basis care that is considered unauthorized care. In both SAS and SQL data, outpatient data are organized in long format, with one record per CPT code. 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. Appendix E includes a list of SQL fields related to the type of care a patient receives. The funds are used to provide the best care possible to our Veterans. Detailed instructions and documentation required for DART data requests can be found on the VHA Data Portal intranet website at http://vaww.vhadataportal.med.va.gov/DataAccess/DARTRequestProcess.aspx. Veteran Services - TriWest When a claim is linked to VistA, the variable Other_Hlth_ins_present is populated. Make sure the services provided are within the scope of the authorization. In order to evaluate the care received, length of stay and/or costs associated with a single inpatient stay, the user will often have to roll up multiple claims. 2. CDW Data Quality Analysis Team has particular recommendations for excluding observations before beginning analyses on your cohort.13 Corporate Data Warehouse (CDW) contains dummy data as well as test patients that will need to be removed from tables before conducting analyses. Payment of ambulance transportation under 38 U.S.C. Inpatient care, regardless of patients health status, if VA was not notified within 72 hours of admission. VSSC provides numerous relevant web reports, data resources, and analytics support, including summary data by facility and VISN and national summary data. At the time of writing, version 4.2 is the most current version. With the exception of supplying remittance advice supporting documentation for timely filing purposes, these processes do not apply to authorized care. 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. Attention A T users. 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. This seeming complicated arrangement is an efficient way to store data. Veterans Choice Program Eligibility Details [online]. 10. Compare the admission date of the third observation to the temporary end date from above. Mailing Address for Disability Compensation Claims - Veterans Affairs You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. In SAS, the outpatient data are housed in the MED files.