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. Persons looking to find the date of service should be advised that it will not be contained in the FeeServiceProvided table. The Department of Veterans Affairs' (VA) fee basis care spending increased from about $3.04 billion in fiscal year 2008 to about $4.48 billion in fiscal year 2012. Researchers must consider whether a missing value means not applicable. For example, many inpatient (INPT) records lack a value for any of the surgery codes (SURG9CD1-SURG9CD5). 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. Therefore, on the outpatient side as well one must aggregate multiple records to get a full picture of the outpatient encounter. 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. The Fee Basis files primary purpose is to record VA payments to non-VA providers. Treatment date correlates to covered from/to. Optum is a proud partner with the VA through its Community Care Network (CCN). Use of this technology is strictly controlled and not available for use within the general population. When possible, VA will seek reimbursement for Non-VA Medical Care payments from sources such as workers compensation payments; payments resulting from motor vehicle accidents, crimes of personal violence, or torts; other agencies when the patient is a beneficiary; and third-party insurance plans. However, in all data files, the vast majority of observations are missing values for this variable. Review the Supporting Documentation section below to learn how to properly submit supporting documentation with your claim. The Non-VA Medical Care program covers the full range of medical and dental care, with these exceptions: Although VA utilization files contain many non-Veterans, Non-VA Medical Care files do not. These include Fee purpose of visit (FPOV), place of service (PLSER), type of treatment (TRETYPE), HCFA payment type (HCFATYPE), and record type (TYPE). Box 30780 Tampa, FL 33630-3780, P2E Documentation Cover Sheet, VA Form 10-10143f. In general, we recommend using the disbursed amount to capture the cost of care, for two reasons. Persons working with SPatient or Patient data are also recommended to refer to the CDW guidance about how to delete test observations. Attention A T users. [ICDProcedure] table and a foreign key in the [Fee]. The CDW SharePoint site has a document that lists the purchased care SQL tables, the fields of that they contain, and some sample SQL queries (VA intranet only: https://vaww.cdw.va.gov/metadata/Metadata%20Documents/Forms/AllItems.aspx). If a Veteran has only Medicare Part B or has both Medicare Parts A and B, no VA payment may be made. [1] The Health Care Financing Administration (HCFA) was renamed the Centers for Medicare and Medicaid Services. To access the menus on this page please perform the following steps. If it cannot be located in the PTF Main file or DSS NDE for inpatient care, search other inpatient files. This application reads/creates/edits fee payment data in VistA and copies critical information into the central SQL database for off-line VistA applications to consume, and now includes Unauthorized payments. Most commonly, authorized care refers to medical or dental care that was approved and arranged by VA to be completed in the community. A record is created only if there is a code on the invoice to be recorded. However, we conducted some comparisons for inpatient data. For example, if one wishes to evaluate the cost of certain diagnoses in inpatient care through SQL data, this would require the linking of multiple tables before being able to conduct any analyses such as [Fee]. Defining a cohort is an activity that is different for each project and depends on the research question at hand. 3. SQL Fee Basis data are stored in the form of multiple relational tables that must be linked, or in SQL parlance, joined, in order to create an analysis dataset. For current information on Community Care data, please visit the page VA Community Care Data. 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. We encourage readers to seek out the latest guidance before conducting analyses, as CDW Data Quality Analysis team may have updates to this information. There are substantial differences in quantity of inpatient diagnosis and procedure data available in SAS versus SQL. Six additional variables indicate the setting of care and vendor or care type. The veteran must wait over 30 days past their preferred appointment date or the date deemed medically necessary by their provider, b. E-fax: Documentation sent via email to Veterans Affairs Medical Center (VAMC) fax machine. To learn more, please visit the Provider Training section on the MES website . American Society of Health-System Pharmacy (ASHP). Facility charges vs. ancillary charges: There are instances when there may be claims for facility charges with no corresponding ancillary provider charge. This section describes two elements of the program: the range of services covered and the payment rules used to determine the amount that VA will pay (DISAMT). 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. 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. With the exception of supplying remittance advice supporting documentation for timely filing purposes, these processes do not apply to authorized care. The second record would have an admission date of Jan 5, 2010 and a discharge date of Jan 5, 2010. 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. There are often multiple observations per inpatient stay and multiple observations per outpatient encounter. [Spatient], and [Spatient]. 4. Last updated validated on Tuesday, January 3, 2023 The vendor identity can be found through the VENDID or VEN13N variables in SAS. resides on and transmits through computer systems and networks funded by the VA. In FY 2014, the longest length of stay associated with a single nursing home invoice was 31 days. Medication dosage/strength. Available at: http://www.va.gov/opa/choiceact/documents/Choice-Program-Fact-Sheet-Final.pdf. 14. For Veterans whose income exceed the established VA Income Thresholds as well as those who choose not to complete the financial assessment must agree to pay required copays to become eligible for VA health care services. PatientIEN is assigned by the facility. How Does VGLI Compare to Other Insurance Programs? VA contracts out its hospice; therefore, the Fee Basis files contain a great deal of data related to hospice care. 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 . Users must ensure that Microsoft .NET Framework, Microsoft Structured Query Language (SQL) Server, and Microsoft Excel are implemented with VA-approved baselines. VIReC Research User Guide: VHA Medical SAS Outpatient Datasets FY2006. National Institute of Standards and Technology (NIST) standards. [FeeServiceProvided] tables. field. 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. would cover any version of 7.4. Q. In this case the first record would have an admission date of Jan 1, 2010 and a discharge date of Jan 10, 2010. However, investigation has confirmed these are partial payments made for a single encounter or procedure. 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. CLAIM.MD | Payer Information | VA Fee Basis Programs Payer Information VA Fee Basis Programs Payer ID: 12115 This insurance is also known as: Veterans Administration Need to submit transactions to this insurance carrier? If electronic capability is not available, providers can submit claims by mail or secure fax. Veterans Choice Program (VCP) Overview [online]. The dates of service are represented by the covered from/to fields of the UB-92. Smith MW, Chow A. Non-VA Medical Care (Fee Basis) Data: A Guide for Researchers. Veterans Health Administration. U.S. Department of Veterans Affairs. Appendix E includes a list of SQL fields related to the type of care a patient receives. SAS data are also available in CDW, but are currently limited to those VA employees with operational access. While NPI is available in SQL data, it does require special permissions to access, as it is located in the [Sstaff]. Actual processing time has varied considerably over the years. Unlike the inpatient data, there can be multiple records with the same invoice number. Once the process is exhausted for a particular patient, STA3N and VEN13N combination, we calculate length of stay as the difference between the admission date of the first record and the temporary end date.. For inpatient and outpatient care, in general, VA will pay the lesser of the Medicare rate (or MPFS rate) or the billed charges. Inpatient stays in both SAS and SQL Fee Basis data can denote hospital stays, nursing home stays, or hospice stays. Payment of ambulance transportation under 38 U.S.C. The amount of interest paid on the claim, if any, appears as the variable INTAMT. Working with the Veterans Health Adminstration: A Guide for Providers [online]. Internal use only. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). Electronic Data Interchange (EDI) Interface. the rates paid by the United States to Medicare providers). To access the menus on this page please perform the following steps. National Provider Identifier: Submit all that are applicable, including, but not limited to billing, rendering/servicing, and referring. [ModeOfTransportation] and [Fee]. How Much Life Insurance Do You Really Need? Unauthorized inpatient or outpatient claims must be submitted within 90 days from the date of care. 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. These correspond to fields, rows and tables in a relational database. 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. Ready. The VA Fee Schedule is available at provider.vacommunitycare.com > Documents & Links. A valid receipt showing the amount paid for the prescription. Bowel and Bladder Care. http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. 2. 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. Last updated August 21, 2017 You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. 9. 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. 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). For example, to understand the ICD-9 codes associated with a particular inpatient encounter, one would have to link the [Fee]. For education claims, refer to the appropriate Regional Processing Office. Multiple claims can be paid against a single authorization. There is no separate payment for items such as oxygen or other supplies, the number of attendants, providing an EKG during the trip, etc. 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. For example, a technology approved with a decision for 12.6.4+ would cover any version that is greater than 12.6.4, but would not exceed the .6 decimal ie: 12.6.401 Gidwani R, Hong J, Murrell S. Fee Basis Data: A Guide for Researchers. 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. Contact: 1-877-353-9791; Email Customer Engagement; Customer Engagement Portal Login. The process of linking can be complex; analysts should take care to reduce errors during this process. 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. 1. The mileage is calculated using the fastest route. As noted above, in SAS, the patient identifier is the SCRSSN; this is unique to each patient across the entire VA. However, one also needs to exercise caution with DRG; there are 2 different sets of DRGs used over time. The PatientSID is a CDW assigned identifier that uniquely identifies a patient within a facility. Multiple SAS datasets have VENID and VEN13N. All Fee Basis care will be found in the Fee files. VA can make payments to non-VA health care providers under many arrangements. Chief Business Office. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). Missing values of PAYCAT could be imputed by finding the corresponding inpatient stay in the INPT file. Accessed October 07, 2015. They appear in Table 6, where an X indicates that the variable appears in the file.10 Vendor type (TYPE), payment category (PAYCAT), treatment code (TRETYPE), and place of service (PLSER) all provide information on the type or setting of care. Current Decision Matrix (10/21/2022) [LocalDrug] table through LocalDrugSID to see whether there was the generic equivalent found in the VA drug file that was dispensed to the patient. Unscheduled trips may be reimbursed for the return mileage only. VINCI Data Description: Fee/Purchased Care [online; VA intranet only]. To enter and activate the submenu links, hit the down arrow. SAS has more data on inpatient diagnosis and procedure variables than do SQL data. Those with access to the VA intranet can find a list of SQL fields on the CDW MetaData site. Hit enter to expand a main menu option (Health, Benefits, etc). Researchers will thus need permissions to allow the CDW data manager to obtain SCRSSN or SSN to PatientICN crosswalk to allow for the necessary data linkages. To access the menus on this page please perform the following steps. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. 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. Clinical variables in SAS format include ICD-9 diagnosis codes, ICD-9 surgical codes, CPT codes and CPT modifier codes, DRG codes and Present on Admission codes. VA CCN OptumP.O. This act expands the non-VA care veterans were able to receive before the act was passed. The specific locations of the SAS payment variables and the SQL payment variables can be found in Chapters 4 and 5, respectively. VA decisions for specific versions may include + symbols; which denotes that the decision for the version specified also includes versions greater than However, not all data in the FeeServiceProvided table are outpatient data; some may pertain to inpatient stays. Electronic 837 claim and 275 supporting documentation submissions can be completed through VAs contracted clearinghouse, Change Healthcare, or through another clearinghouse of your choice. 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). April 14, 2014. Claims should be mailed to the following address: VA Eastern Kansas Health Care System Attn: Fee Basis Office 2200 SW Gage Blvd Topeka. Dental claims must be filed via 837 EDI transaction or using the most current. For more information, please visit the Data Access Request Tracker (DART) Request Process page on the VHA Data Portal(VA intranet only: http://vaww.vhadataportal.med.va.gov/DataAccess/DARTRequestProcess.aspx#resources). 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. Medications dispensed in a health care facility such as a doctor's office, dialysis clinic, or hospital outpatient clinic, such as injectable medications or infusions, will be found in the outpatient data, where they will be identified by CPT code. If that analyst examines VEN13N and STA6A (in inpatient Fee Basis data, this field represents the VA hospital arranging care), there is often only one MDCAREID. VA is also the primary and sole payer for unauthorized emergent care approved under 38 U.S.C. 9.2. Accessed October 16, 2015. It is only relevant for claims linked to VistA patients. Veterans Choice Program Eligibility Details [online]. There are delays in the processing of Fee Basis claims. 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. 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 Fee Basis Program Claims Address - filecloudbarcode In SQL, these variables can be found in the [Dim]. SAS data also contain an additional diagnosis variable that is not present in the SQL data -- DXLSF. Providers cannot bill both VA and the patient or another insurer for the same encounter. 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.
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