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VA contracts out its hospice; therefore, the Fee Basis files contain a great deal of data related to hospice care. Details about the VA rules governing reimbursement can be found in Chapter 7 of this guidebook. Non-VA Medical Care consumes a significant portion of VA spending; indeed, contract costs (i.e., the cost of all things purchased from non-VA health care providers) accounted for approximately 11% of VA expenditures in fiscal year 2014. 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). Payment guidelines for non-VA are outlined in federal regulations 17.55 and 17.56. 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. VA evaluates these claims and decides how much to reimburse these providers for care. This technology is not portable as it runs only on Windows operating systems. Box 30780, Tampa FL 33630-3780. 3. visit VeteransCrisisLine.net for more resources. We tried to link the UB-92 form to identify Choice authorizations; however, we found few records and decided to use obligation number. 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. 3. (formerly known as VA Fee Basis or NonVA)-Community provider submits the claim and supporting documentation through their EDI provider services in . In SQL, there are additional variables that will denote the type and location of the care provided along with the vendor. For example, the meaning of DRG001 is not the same in FY05 vs FY15. [FeeInpatInvoiceICDDiagnosis], [Dim]. 2. See 38 USC 1725 and 1728.). Note: records with status= R can have missing values for the variables vistapatkey and vistaauthkey, depending on whether or not these were linked before rejecting as a re-route to HAC. There are additional payments for direct medical education, capital-related costs, and other factors as appropriate. [Patient], [Spatient]. Claims for Non-VA Emergency Care By June 2017, no Choice stays are found in FBCS. The NPI is the national provider identifier, which is provider-specific but often missing in the Fee Basis data. Bowel and bladder care for certain Veterans with SCI/D are considered supportive medical services due to the possibility of medical complications which would result in the need for hospitalization. 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. A foreign key is a key that uniquely identifies a record of another table. 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. the rates paid by the United States to Medicare providers). More information about can be found on their website: https://www.va.gov/communitycare/. NPI and Medicare IDs have an M to M relationship. Identify Choice records by using tax ID and specialprovcat= CHOICE. 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. VA will arrange for transportation for them or will reimburse expenses on the basis of vouchers submitted. Claims should be mailed to the following address: VA Eastern Kansas Health Care System Attn: Fee Basis Office 2200 SW Gage Blvd Topeka. To understand what procedures were performed during an inpatient stay in the [Fee]. The amount claimed (PAMTCL) appears in the inpatient (INPT) file alone; there is no claimed amount on the outpatient side. The Choice Act represents one of the largest shifts in the organization and financing of healthcare in the Department of Veterans Affairs (VA) in recent years. 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). There are nine situations in which Non-VA Medical Care is authorized. The National Provider Identifier (NPI) is a unique 10 digit identifier mandated to be used in health claims under the Health Insurance Portability and Accountability Act (HIPAA). The VA Fee Schedule is available at provider.vacommunitycare.com > Documents & Links. This component communicates with the FBCS MS SQL and VistA database in real time. This component provides a front end for recognizing claim data through optical character recognition (OCR) software. Non-VA Medical Care data may be tabulated at the VHA Support Services Center (VSSC) (VA intranet only: http://vssc.med.va.gov/). 3. In SAS, the outpatient data are housed in the MED files. Unlike the inpatient data, there can be multiple records with the same invoice number. If the payment was made outside of FBCS, they wont show here. HERC investigation of Fee Files reveals certain data anomalies of which researchers should be aware. PMS-DRG was effective in FY 2008; prior to this time CMS-DRGs were used. 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. SQL Fee data are available through the VA Corporate Data Warehouse (CDW)/VA Informatics and Computing Infrastructure (VINCI). The SQL Fee Basis data at CDW and the SAS Fee Basis data at AITC are available for VA researchers following a standard approval process. If disbursed amount is missing (but not $0), use payment amount instead. Many variables in the Fee Basis files record details of invoice and check processing. Driving distance between a veterans residence and their closest VA facility is over 40 miles, c. The veteran must travel by boat or plane to access the VA facility closest to their home (excluding Guam, American Samoa, or the Republic of the Philippines), d. The veteran faces an excessive burden in traveling to a VA, including a body of water or geologic formation that cannot be crossed by road. If the claims and records do not conform to the minimum requirements for conversion to the 837 or 275 electronic formats, they are rejected and sent back for correction. VA-station related information includes STA3N, STA6A and STANUM in SAS and Sta3n and PrimaryServiceInstitution in SQL. YESInstitutional/UB Claims. From there, it is sent weekly to AITC in SAS format and nightly to CDW in SQL format. VA decisions for specific versions may include + symbols; which denotes that the decision for the version specified also includes versions greater than Non-VA providers submit claims for reimbursement to VA. The variable DTStamp represent the date the claim was received. A primary key is a key that is unique for each record. The [Fee]. Persons working with SPatient or Patient data are also recommended to refer to the CDW guidance about how to delete test observations. 1-800-273-8255 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. VINCI Data Description: Dimension [online; VA intranet only]. Accessed October 16, 2015. These include Fee purpose of visit (FPOV), place of service (PLSER), type of treatment (TRETYPE), HCFA payment type (HCFATYPE), and record type (TYPE). The vendor represents the entity billing for the non-VA care, while the provider represents the person who was involved in care provision. Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. U.S. Department of Veterans Affairs. U.S. Department of Veterans Affairs. Researchers will need to decide whether they will use the SAS or the SQL data and apply for appropriate IRB approval for use. HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. 866-505-7263, Veterans Crisis Line: Chapter 6 provides information about how to access the Fee Basis data, while Chapter 7 provides information about the rules governing Fee Basis care. Hit enter to expand a main menu option (Health, Benefits, etc). How Does VGLI Compare to Other Insurance Programs? In the outpatient data, one observation represents a single CPT code. In both the SAS and the SQL data, there are usually multiple observations per patient encounter. VA Information Resource Center VHA Corporate Data Warehouse [webpage]. Learn how to prevent paper claim rejections. When a key field is missing, SQL indicates this with a value of -1. When a claim has reached terminal status (A, P, D, R), the field ImportedDTStamp on the UB-92/HCFA tables represents the date it was processed. 15. As noted above, in SAS, the patient identifier is the SCRSSN; this is unique to each patient across the entire VA. Each VA facility has a local Fee Office to which the non-VA provider submits a claim for reimbursement. TriWest VA CCN ClaimsP.O. 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 Fee Basis files primary purpose is to record VA payments to non-VA providers. VA Form 10-583, Claim for Payment of Cost of Unauthorized Medical Services. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. In FY 2014, the longest length of stay associated with a single nursing home invoice was 31 days. If you are in crisis or having thoughts of suicide, Some missingness may indicate not applicable.. [LocalDrug] table through LocalDrugSID to see whether there was the generic equivalent found in the VA drug file that was dispensed to the patient. For education claims, refer to the appropriate Regional Processing Office. Operating Systems Supported by the Technology. Name of the medication. Table 8 denotes on which CDW servers Fee Basis data are housed. To enter and activate the submenu links, hit the down arrow. 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. The Veterans Access, Choice, and Accountability Act (Veterans Choice Act), passed in 2014, expanded veterans access to non-VA care. With the exception of supplying remittance advice supporting documentation for timely filing purposes, these processes do not apply to authorized care. The data files in each fiscal year represent all claims processed in the FMS during the year. The veteran must wait over 30 days past their preferred appointment date or the date deemed medically necessary by their provider, b. 11. Fee Purpose of Visit (FPOV) Document [online; VA intranet only]. However, in all data files, the vast majority of observations are missing values for this variable. 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). Community provider mails the paper claims and documentation to the new mailing address of VA's central claims intake location. The DSS Fee Basis Claims System (FBCS) is a web-based claim management system. Two domains in which researchers can find reports on Non-VA Care are Resource Management and Workload. Accessed October 16, 2015. When MDCAREID is not available, it is possible to assign MCCAREID based on the relationship between VEN13N and STA6A. 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. This could indicate a transfer between facilities or a physician bill for an inpatient stay. Important: The mailing address below only pertains to disability compensation claims. 5. Veterans should mail or fax correspondence pertaining to compensation claims to the below location. Unauthorized care can be of an inpatient or outpatient nature. On March 17, 2022, The U.S. Court of Appeals for the Federal Circuit issued a ruling that changes VAs ability to reimburse as secondary payer under 38 U.S.C.1725. Appropriate access enforcement and physical security control must also be implemented. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. 5. If the Veteran went to the ED and was not admitted to the hospital, this would be considered outpatient care. This technology integrates with Veterans Information Systems and Technology Architecture (VistA) through Massachusetts General Hospital Utility Multi-Programming System (MUMPS) or a Structured Query Language (SQL) database system on the backend. However, we conducted some comparisons for inpatient data. Menlo Park, CA. Most nursing home care is billed monthly, so there is one claim for each month of nursing home stay. Many classes of Veterans are eligible for travel payments. Unauthorized user attempts In SQL, there are multiple patient identifiers, with the most useful being the PatientICN. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. 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. ", Military service variables can be found in [PatSub],[PatientServicePeriod], [Patient]. We gratefully acknowledge comments and contributions from Sharon Dally, Susan Schmitt and Paul Barnett. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. This service communicates via native SQL Server 2005 encrypted connections through the VA Wide Area Network (WAN). 13. Claims. The 2 sets of DRGs are not interchangeable. In order to qualify for round trip mileage, an appointment must be scheduled. For care received under the Choice Act, Veterans will work with the third party administrators of the Choice program to find an eligible provider in their area.4. The SAS PHARVEN dataset contains information only about pharmacy vendors. Prior to use of this technology, users should check with their supervisor, Information Security Officer (ISO), Facility Chief Information Officer (CIO), or local Office of Information and Technology (OI&T) representative to ensure that all actions are consistent with current VA policies and procedures prior to implementation. . 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. Data Quality Analysis Team. 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. (Anything) - 7.(Anything). JANESVILLE, WI 53547-4444. or Fax to: TOLL FREE: 844-531-7818 & 248-524-4260 (Utilized for Foreign Claimants) return to top. Our office is located at 6940 O St, Suite 400 Lincoln NE 68510. SQL data contain both SCRSSN and SSN, but these data reside in the SPatient table at CDW, and cannot be accessed by researchers without the CDW data manager and IRB approval. Researchers evaluating care over time may want to use the DRG variable. In the SAS data, the provider component of the inpatient stay is captured in the ancillary file. If disbursed amount is missing, use payment amount instead. For pension claims, use the Pension Management Center (PMC) that serves your state. There are also a number of other financial variables denoted in SAS (see Table 7). Table 1 in the Data Quality Analysis teams guide Linking Patient Data in the CDW Updateprovides a brief summary for each identifier (Available atthe VHA Data Portal. 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). Inpatient data are housed in the FeeInpatInvoice table as well as the FeeServiceProvided table, although the latter does not contain only inpatient data. 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). Under the Veterans Choice Act, eligible veterans are able to obtain outpatient care outside the VA using their Choice Card. Additional information on accessing the AITC mainframe is available on the VHA Data Portal (VA intranet only: http://vaww.vhadataportal.med.va.gov/Home.aspx). Address. PLSER values overlap considerably with those of the Medicare Carrier Line Place of Service codes. We suggest using only the first 3 characters from sta3n for the merge. U.S. Department of Veterans Affairs. PracticeBridge. (1) A Veteran must be enrolled in VA health care16. Get Help from Our VA Disability Claim Appeals Lawyers Today. 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. To access the menus on this page please perform the following steps. The procedure code table has just as many records as there were procedures on the invoice. The slight decrease in fiscal year 2012 spending from the fiscal year 2011 level was due to VA's adoption of Medicare rates as its primary payment method for fee basis providers. These variables relate to the VA station at which the Fee Basis care requests and claims are input. VA can make payments to non-VA health care providers under many arrangements. As noted earlier, there are often multiple records that indicate a single inpatient stay each record pertains to a unique invoice number. SAS and SQL data are organized differently and contain different variables. 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. Of note, the FBCS was not in place nationwide prior to FY 2008. to) monitoring; recording; copying; auditing; inspecting; investigating; restricting This most likely reflects a low frequency of surgery rather than missing data. The data that is not available is the data element that indicates if it was generated by FBCS or manually entered by the user in FBCS. 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. 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). In some cases it may appear that single encounters have duplicate payments. This Technology is currently being evaluated, reviewed, and tested in controlled environments. Below we describe the general types of information in both the SAS and SQL data. 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. VA evaluates these claims and decides how much to reimburse these providers for care. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. The UB-92 equivalent variables would be: facility (after merging in facility name from the FBCS_Facilities table), vistapatkey, and vistaauthkey, respectively. As noted above, there are differences in the patient identifier and the date variables in the SAS versus SQL data; both data sources do not contain the same variables regarding patient identifier or date the claim was paid. Under this regulation, ambulances will be reimbursed at the lesser of (a) the amount the Veteran is personally liable or (b) 70 percent of the applicable Medicare Ambulance Fee Schedule. To access the menus on this page please perform the following steps. Information from this system resides on and transmits through computer systems and networks funded by the VA. The FPOV variable can be found in both the SAS and SQL data. Missingness can vary substantially by year and by file. 4. The Fee Basis files are stored in two formats: SAS and SQL. You will have to pay this penalty for as long as you have Part B. The status value A stands for accepted, meaning the claim was paid. 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. Not all of these variables appear in every utilization file. [ SFeeVendor] table. For these reasons, VA strongly encourages Veterans to consider important factors, risks and benefits before making any changes to their private health insurance. The travel payment data contains reimbursements for particular travel events (TravelAmount). Access; upload; download; change; or delete information on this system; Otherwise misuse this system are strictly prohibited. Of note, the relevant SQL tables for Fee Basis data are not only the [Fee]. Inpatient procedures are captured by ICD-9 procedure codes (SURG9CD1-SURG9CD25) in the hospital claims file. The same cannot be said for DX2-DX25, however, as additional diagnosis codes are optional. New values may be added over time. Review the Filing Electronically section above to learn how to file a claim electronically. Pre-2007, DISAMT and INTAMT each have two implied decimal places a value of 1000 would indicate $10.00. It is only relevant for claims linked to VistA patients. In the SAS data, the patient identifier is the scrambled social security number (SCRSSN). In both SAS and SQL, it can be difficult to determine the provider the Veteran saw for Fee Basis care. This is the main utility that passes information back into the FBCS Payment application. The vendor no longer supports VA installations of this technology. The conversion happens before claims and records are accepted into our claims processing system. VA Informatics and Computing Resource Center (VINCI). PO BOX 4444. These correspond to fields, rows and tables in a relational database. We detail differences amongst the SAS and SQL Fee Basis data in the guidebook below. American Society of Health-System Pharmacy (ASHP). Review the Supporting Documentation section below to learn how to properly submit supporting documentation with your claim. In particular, CDW also recommends Patient SIDs with a value of less than 1 be deleted. It is available in the PHARVEN and VEN files, albeit with a high degree of missingness. As part of the process, claims and supporting documentation are scanned for compliance prior to conversion to electronic format. If a patient received care at another facility, that patient will be have a different PatientSID assigned for that facility. This guide serves as an addendum to any technical documentation supplied by the healthcare clearinghouse when establishing a trading partner agreement. The travel payments data contains reimbursements for particular travel events (TVLAMT). The vendor and the provider may or may not be the same entities. FBCS is where weve spent the bulk of our time investigating. VA can waive the deductible in hardship cases. As with inpatient data, researchers will need to collapse multiple observations in order to get a complete picture of the outpatient care provided on a single day. Those with access to the VA intranet can find a list of SQL fields on the CDW MetaData site. See the FBCS page (CDW Raw) on the CDW SharePoint site (VA intranet only: https://vaww.cdw.va.gov/bisl/Database/SitePages/Raw%20Extractor.aspx) for more information. These data records cannot be linked to particular patient identifiers or encounters. 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. Each table has only one primary key field. If you are in crisis or having thoughts of suicide, VA is also the primary and sole payer for unauthorized emergent care approved under 38 U.S.C. As with the SAS data, the important variables in the SQL data are the AmountPaid and the DisbursedAmount. Hospice also appears to be billed monthly, with longest length of stay for a single hospice invoice of 31 days. 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). There are multiple potential identifiers for provider/vendor in the SAS data: the VENDID, VEN13N, MDCAREID, SPECCODE and NPI. In SAS, these data can be found in the Vendor file. The same concept (such as fiscal year, state, or county) may be represented by several variables, sometimes in differing formats. Table 9 lists a number of financial variables the SQL data contain. 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. Facility charges vs. ancillary charges: There are instances when there may be claims for facility charges with no corresponding ancillary provider charge. Office of Information and Analytics. Basic demographic variables can be found in the [Patient]. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). 16. 2. No new extracts will occur. You can find more information about eligibility on the VHA Office of Community Care website. In both SAS and SQL data, outpatient data are organized in long format, with one record per CPT code. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). Reimbursements appear in the Travel Expenses (TVL) file. SAS and SQL contain different variables to identify the provider and/or vendor associated with the care. Fee Basis data are housed in VA in both SAS dataset format and Microsoft SQL server tables (hereafter referred to as SQL data). When a claim is linked to VistA, the variable Other_Hlth_ins_present is populated.