va fee basis program claims address

The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. Sort data by the patient ID, STA3N, VEN13N, and the admission dates. Of note, the FBCS was not in place nationwide prior to FY 2008. If the gap is 0 or 1, it is part of the same hospital stay and we then want to assess its discharge date. If you are submitting a paper claim, please review the Filing Paper Claims section below for paper claim requirements. [ICDProcedure] table and a foreign key in the [Fee]. *From the date the Veteran was discharged from the facility that furnished the emergency treatment; the date of death, but only if the death occurred during transportation to a facility for emergency treatment or if the death occurred during the stay in the facility that included the provision of the emergency treatment; or the date the Veteran exhausted, without success, action to obtain payment or reimbursement for treatment from a third party. 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. The length of stay for a single hospital invoice varied greatly, with a maximum length of stay of 980 days. The invoice table would have to have a sufficient number of fields to accommodate the maximum number of procedures report on any invoice. To access the menus on this page please perform the following steps. 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. Please switch auto forms mode to off. 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. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). At the time of writing (October 2015), only operations staff will have permission to access the SAS data at VINCI. visit VeteransCrisisLine.net for more resources. The disbursed amount should be used to calculate the cost of care, except in the case where disbursed amount is missing. The travel payments data contains reimbursements for particular travel events (TVLAMT). [Patient], [SPatient]. In this situation, a given VA medical center has a preferred hospital from which it purchases care. Cunningham, K. VA implements the first of several Veterans Choice Program eligibility expansions. Hit enter to expand a main menu option (Health, Benefits, etc). Please review the Where To Send Claims and the Where To Send Documentation sections below for mailing addresses and Electronic Data Interchange (EDI) details. One can use the FeeInitialTreatmentSID variable in the FeeServiceProvided table to link to the Fee.FeeInitialTreatment table. 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). What documents are required by VA to process claims for. Guidance can be found under "VHA Data Quality Program Reports. As with the SAS data, the important variables in the SQL data are the AmountPaid and the DisbursedAmount. The [Fee]. Veterans Access, Choice, and Accountability Act of 2014 (VACAA): The Choice Program and the Choice Card [presentation]. SAS has more data on inpatient diagnosis and procedure variables than do SQL data. Providers cannot bill both VA and the patient or another insurer for the same encounter. In the SAS data, the patient identifier is the scrambled social security number (SCRSSN). Researchers with VA intranet access can access these images by copying and pasting the URLs into their browser. 2. 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. VA evaluates these claims and decides how much to reimburse these providers for care. Electronic Data Interchange (EDI) Interface. If the patient was transported to a VA hospital after stabilization (as indicated by the DISTYP, or disposition type, variable), the record of the VA stay should appear in VA utilization databases. Hit enter to expand a main menu option (Health, Benefits, etc). We gratefully acknowledge comments and contributions from Sharon Dally, Susan Schmitt and Paul Barnett. There may be multiple vendor IDs (VENDIDs) for a single inpatient stay. VA can make payments to non-VA health care providers under many arrangements. The definition of the DXLSF variable changes depending on the year of analysis. No, only one type of care can be covered by a single authorization. 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. Fee Basis data will be most useful for studying conditions where contract care is common, such as home-based care and nursing care, and for determining typical non-VA charges for health care services (both charges and payments are reported) and comparing those to VA costs. In both SAS and SQL data, outpatient data are organized in long format, with one record per CPT code. Note: A Veterans insurance coverage or lack of insurance coverage does not determine their eligibility for treatment at a VA health care facility. Claims should be mailed to the following address: VA Eastern Kansas Health Care System Attn: Fee Basis Office 2200 SW Gage Blvd Topeka. https://vaww.cdw.va.gov/metadata/Reports/ERDiagramsOfViews/Purchased%20Care%20Authorized_5638.jpg, https://vaww.cdw.va.gov/metadata/Reports/ERDiagramsOfViews/Purchased%20Care%20Unauthorized_242.jpg, https://vaww.cdw.va.gov/metadata/Reports/ERDiagramsOfViews/Purchased%20Care%20Service_5480.jpg. In particular, CDW also recommends Patient SIDs with a value of less than 1 be deleted. The UB-92 equivalent variables would be: facility (after merging in facility name from the FBCS_Facilities table), vistapatkey, and vistaauthkey, respectively. VA systems are intended to be used by authorized VA network users for viewing and National Provider Identifier: Submit all that are applicable, including, but not limited to billing, rendering/servicing, and referring. 16. For additional information or assistance regarding Section 508, please contact the Section 508 Office at Section508@va.gov. VINCI. However, not all data in the FeeServiceProvided table are outpatient data; some may pertain to inpatient stays. Mailing Address for Disability Compensation Claims - Veterans Affairs 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. Treatment date correlates to covered from/to. MDCAREID is not available in the outpatient SAS Fee Basis data, even though some outpatient services are provided in a hospital. Please visit Emergency Care Claims to learn more. Data in any of the any S tables require Staff Real SSN access. 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. 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. Inpatient care, regardless of patients health status, if VA was not notified within 72 hours of admission. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). If a Veteran has only Medicare Part A then VA may consider payment for ancillary and professional services usually covered under Part B. This component allows the site access to Communications, Configuration and Reporting options for FBCS. [ICD9] tables. Persons who wish to access data in the secure tables on CDW (denoted by a S prefix) must complete a Real SSN Access Request Form. This form must be signed by the IRB and Associate Chief of Staff for Research and submitted with the DART data request. 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. This technology has not been assessed by the Section 508 Office. Data Quality Analysis Team. The specific locations of the SAS payment variables and the SQL payment variables can be found in Chapters 4 and 5, respectively. For current information on Community Care data, please visit the page. Below are some answers to general questions about linking the UB-92 form to the FBCS data. 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. Then, to see which ICD procedure codes were coded for this inpatient stay, one must link to the [Dim]. Each VA facility has a local Fee Office to which the non-VA provider submits a claim for reimbursement. Given these delays in processing claims, we recommend that analyses use Fee Basis data from 2 years prior to the current date to ensure almost complete capture of inpatient, ancillary and outpatient data. We compared the service date (TREATDTO in inpatient and ancillary, TREATDT in outpatient, and FILLDTE in pharmacy files) to the FMS processing date (PROCDTE) (See Table 1). Billing & Insurance - New York/New Jersey VA Health Care Network Coverage will start July 1 of that year. 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. Types of VA Disability Claims | PTSD Lawyers - Berry Law If the Veteran has insurance, VA cannot pay even when the entire claim is less than the deductible. 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. In some cases it may appear that single encounters have duplicate payments. Fee Basis data are housed in both SAS and SQL format. 6. [Patient], [PatSub]. MDCAREID is the Medicare OSCAR number, which is a hospital identifier. There may be multiple CPT codes associated with a single encounter. PDF Office of Inspector General - Oversight.gov Attention A T users. For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/. In SAS, data are stored in variables, observations and datasets. Health - Veterans Affairs Chapter 6 provides information about how to access the Fee Basis data, while Chapter 7 provides information about the rules governing Fee Basis care. This service communicates via native SQL Server 2005 encrypted connections through the VA Wide Area Network (WAN). Health Information Governance. 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. This is true for both the inpatient and the outpatient data, albeit for different reasons. March 2015. 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. 1. 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. Florida Department of Veterans' Affairs | Connecting veterans to For EDI 837, Referral Number is Loop = 2300, Segment = REF*9F, Position = REF02 or Prior Authorization. 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. JANESVILLE, WI 53547-4444. or Fax to: TOLL FREE: 844-531-7818 & 248-524-4260 (Utilized for Foreign Claimants) return to top. 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). Unauthorized inpatient or outpatient claims must be submitted within 90 days from the date of care. Payer ID: 1. Reimbursement for Pharmacists Services in a Hospital-based, Pharmacist-managed Anticoagulation Clinic. Presence of this software on the One-VA TRM does not equate to designation as a Class 1 National Software product and MUST NOT be assumed to comply with all VA programming standards, namespacing and interface control agreement standards, data management standards, documentation standards, information assurance standards, security standards and 508 compliance standards. Health Information Governance. This table also includes claims related to inpatient care and other services. A valid receipt showing the amount paid for the prescription. NPI and Medicare IDs have an M to M relationship. Of note, the relevant SQL tables for Fee Basis data are not only the [Fee]. _____________________________________________________________________________. The codes for the procedures provided for a given hospital stay are kept in a separate table, a table of procedures. The SAS PHARVEN dataset contains information only about pharmacy vendors. A primary key is a key that is unique for each record. 13. Veteran Services - TriWest Note that some physicians use the same ID number as the hospital. This component distributes fee workload to particular users using the FBCS MS SQL database and the VistA Gateway. Data Quality Analysis Team. In SQL, the outpatient data are housed in the FeeServiceProvided table. Steps to collapse records into a single inpatient stay: 1. Additional information appears in a federal regulation, 38 CFR 17.52. Veterans who meet certain criteria may be eligible for mileage reimbursement for travel to and from VA or Non-VA care. Persons interested in studying care provided under the Choice Act may wish to explore the VACAA tables or the FBCS tables at VA Corporate Data Warehouse (CDW). The 275 transaction process should not be utilized for the submission of any other documentation for authorized care. DSS Fee Basis Claims Systems (FBCS) - oit.va.gov For example, an interest payment of $14.21 would appear as 1421. INTAMT is part of DISAMT; it should not be added to them. Va Fee Basis Program Claims Address - rutrackersplus Two domains in which researchers can find reports on Non-VA Care are Resource Management and Workload. 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. FPOV values of 32 and 33 also indicate ED visits, but are only observed in the Ancillary file. 400, Wittman Drive Grand Rapids Itasca County MN - 55744 United States. 1. VA payment constitutes payment in full. June 5, 2009. In SQL, these variables can be found in the [Dim]. If using payment amount, one would overestimate the cost of care. 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. It is not necessarily the station at which the Veteran receives most VA care or the station which will pay for a particular Non-VA Medical Care service. We encourage readers to seek out the latest guidance before conducting analyses, as CDW Data Quality Analysis team may have updates to this information. A Fee table will contain a record for an ICD-9 code, whereas a DIM table will contain the possible values of that ICD-9 code. U.S. Department of Veterans Affairs. Under the Veterans Choice Act, eligible veterans are able to obtain outpatient care outside the VA using their Choice Card. We detail differences amongst the SAS and SQL Fee Basis data in the guidebook below. VA Health Care: Management and Oversight of Fee Basis Care Need Non-VA Payment Methodology Matrix [online; VA intranet only]. Thus, one could not simply use the patient identifier and the admission and discharge dates to collapse these observations into one inpatient stay. To find all care provided in a particular fiscal year requires searching by treatment date over several years of Non-VA Medical Care claims. have hearing loss. The Routing tool manages how Health Care Finance Administration (HCFA) and Uniform Billing (UB) claims will electronically flow through the FBCS program. 4. VA evaluates these claims and decides how much to reimburse these providers for care. Journal of Rehabilitation Research and Development. This application completes the update of critical claims data into the FBCS shared MS SQL database for further processing and reporting. 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. Attention A T users. For VHA Office of FinanceP.O. VA Technical Reference Model v 23.1 DSS Fee Basis Claims Systems (FBCS) General Decision Reference Component Category Analysis Vendor Release Information The Vendor Release table provides the known releases for the TRM Technology, obtained from the vendor (or from the release source). Researchers can look at the disposition variable as an indicator of transfer between VA and non-VA care. 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 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. VA Palo Alto, Health Economics Resource Center;November 2015. 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. The SAS Fee Basis data are organized by fiscal year. - The information contained on this page is accurate as of the Decision Date (11/02/2022). Address. This act expands the non-VA care veterans were able to receive before the act was passed. There are multiple methods by which community providers may electronically provide VA with the required medical documentation for care coordination purposes. To evaluate the time it takes VA to process Fee Basis claims, we evaluated SAS data for FY2014. There are also differences in the variables contained in the SAS versus SQL data. Identify Choice records by using tax ID and specialprovcat= CHOICE. VA evaluates these claims and decides how much to reimburse these providers for care. 3. If the gap is 0 or 1, evaluate the discharge date of the first and second observation. This application is directly attached to TWAIN compliant scanners and works offline to VistA and the FBCS MS SQL databases. 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). As noted above, in SAS, the patient identifier is the SCRSSN; this is unique to each patient across the entire VA. VA Fee Schedule. U.S. Department of Veterans Affairs. Department of Veterans Affairs Claims Intake Center PO Box 4444 Janesville, WI 53547-4444 Or, you can fax it to: (844) 531-7818 (inside the U.S.) (248) 524-4260 (outside the U.S.) Visit your local VA regional office or Benefits Delivery at Discharge Intake Site and speak with a VA representative to assist you. 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. [ SFeeVendor] table. There is no separate payment for items such as oxygen or other supplies, the number of attendants, providing an EKG during the trip, etc. This schema contains sensitive information such as SSNs, bank accounts, and the actual name of personnel. 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. In SAS, these data can be found in the Vendor file. E-fax: Documentation sent via email to Veterans Affairs Medical Center (VAMC) fax machine. The SQL tables [Dim]. As noted earlier, there are often multiple records that indicate a single inpatient stay each record pertains to a unique invoice number. 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. Patient type can take one of seven values: surgical; medical; home nursing; psych contract; psychiatric, neuro contract; or neurological. Get Help from Our VA Disability Claim Appeals Lawyers Today. Missing values of PAYCAT could be imputed by finding the corresponding inpatient stay in the INPT file. For example, there are observations in which INTIND = 1 and INTAMT = $0. VAntage Point. Much Fee Basis care is pre-authorized prior to the Veteran obtaining care and is thus considered Authorized Care. You are strongly encouraged to electronically submit claims and required supporting documentation. There may be multiple STA3Ns for a single inpatient stay. Questions about care and authorization should be directed to the referring VA Medical Center. Payment for care provided under the Veterans Choice Act may not exceed the Medicare Fee Schedule (i.e. 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. VA HEALTH CARE Management and Oversight of Fee Basis Care Need. For some VEN13N, however, there is more than one MDCAREID. VA employees working on research studies cannot create their own crosswalk file as they do not have permission to use these files. VA Claims Representation; RESOURCES. 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. Payer ID for dental claims is CDCA1. 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.