va fee basis program claims addressva fee basis program claims address

Each table has only one primary key field. One exception to this is when identifying emergency department (ED) visits. When there is no available rate in the Medicare Fee Schedule, the VA will follow the payment guidelines for Non-VA Medical Care. This is true for both the inpatient and outpatient 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. Electronic Services Available (EDI): Professional/1. When a claim is linked to VistA, the variable Other_Hlth_ins_present is populated. and constitutes unconditional consent to review and action including (but not limited *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. Prosthetic items. Please visit Provider Education and Training for upcoming events. Below are some answers to general questions about linking the UB-92 form to the FBCS data. While a researcher could theoretically conduct a Fee Basis analysis using SAS data and then upload these SAS data to CDW and pull in the relevant variables from the SQL Patient domain, this poses some logistical challenges. 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. Lump sum payments are not paid via FBCS. 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. Make sure the services provided are within the scope of the authorization. One can evaluate which encounters were unauthorized by joining the FeeUnauthorizedClaim table through the FeeUnauthorizedClaimSID key. The amount of interest paid on the claim, if any, appears as the variable INTAMT. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. Review the Filing Electronically section above to learn how to file a claim electronically. One way to do this is to concatenate the vendor identifier, the patient identifier, and the visit date. A description of the Patient and SPatient schema is available on the VIReC CDW Documentation webpage: http://vaww.virec.research.va.gov/CDW/Documentation.htm (intranet only). 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. In general, persons on active duty in the U.S. military are excluded even if they are transitioning to VA care. MDCAREID is the Medicare OSCAR number, which is a hospital identifier. Given the stronger guidance from the Fee Office regarding use of the FPOV code, we recommend using the FPOV code to discern which observations are ancillary care, as the FeeProgram may not be as reliable. A summary of the payment guidelines can be found in Appendix I. 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). The second record would have an admission date of Jan 5, 2010 and a discharge date of Jan 5, 2010. Up to FY2008 data, DXLSF is labeled as 1st Diagnosis Code. In FY2009 and on, DXLSF is labeled as the Admitting or Primary Diagnosis Code. In FY 2009 and later SAS data, there is also another variable, DX1, which is not present in SAS data prior to FY2009. 15. The VA Fee Schedule is available at provider.vacommunitycare.com > Documents & Links. 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. Fee Basis data files contain information regarding both the care the Veteran received and the reimbursement of the care. Given these different patient identifiers, it is difficult to conduct exact comparisons between SAS and SQL data. In SAS, the cost of an inpatient stay can be determined by summing the cost from DISAMT in the inpatient files with the DISAMT from the ancillary observations that correspond to the inpatient stay; however, the inpatient and ancillary files alone may not be sufficient to account for the entire cost of care. All SAS prescription-related data is found in two files: the PHR file and the PHARMVEN file. VA will arrange for transportation for them or will reimburse expenses on the basis of vouchers submitted. would cover any version of 7.4. Include the authorization number on the claim form for all non-emergent care. Missingness can vary substantially by year and by file. [XXX] tables, but also the [DIM]. FBCS is where weve spent the bulk of our time investigating. 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. Many variables in the Fee Basis files record details of invoice and check processing. Health Information Governance. The [Fee]. The values of Adjustment Codes 1 and 2 (ADJCD1 and ADJCD2) explain the reason for non-payment. PO BOX 4444. Information from this system resides on and transmits through computer systems and networks funded by the VA. This guidebook is intended to help researchers understand and use the National Fee Basis files, which come in both SQL and SAS formats. If the Veteran has insurance, VA cannot pay even when the entire claim is less than the deductible. With the exception of supplying remittance advice supporting documentation for timely filing purposes, these processes do not apply to authorized care. Updated August 26, 2015. The Fee Basis files are stored in two formats: SAS and SQL. National Institute of Standards and Technology (NIST) standards. To access the menus on this page please perform the following steps. Some missingness may indicate not applicable.. to) monitoring; recording; copying; auditing; inspecting; investigating; restricting 5. 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. All observations for this particular patient ID, STA3N and VEN13N where the admission date comes on or after the admission date of the first record AND the discharge date comes on or before the temporary end date are considered to be part of the same inpatient stay. VA can make payments to non-VA health care providers under many arrangements. VA Information Resource Center VHA Corporate Data Warehouse [webpage]. 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). [FeePrescription] tables. The Veterans Emergency Care Fairness Act (Public Law 111-137), signed February 1, 2010, authorizes VA as a secondary payer to third party liability insurance not related to health insurance. Assistance with claims is free and covers all state and federal veterans' programs. However, not all dates on the claim are approved. VINCI Data Description: Fee/Purchased Care [online; VA intranet only]. 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. Veterans Choice Program Eligibility Details [online]. We recommend researchers use the FeePurposeOfVisit codes (FPOV) codes to eliminate observations related to non-outpatient care before beginning analyses. (Veterans may submit unauthorized claims, however, and VA has legal authority to pay them under certain conditions. It is not available for claims in which payment was based on a contract amount. 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. The impact on inpatient and emergent care is unclear, however, as the definition of prosthetic in VA is so broad as to include items placed inside the body, such as internal fixation devices, coronary stents, and cardioverter defibrillators. Business Product Management. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. http://www.mssny.org/Documents/Enews/Aug%208%202014/VA%20ProvidersGuide.pdf, http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. There may be multiple STA3Ns for a single inpatient stay. Inpatient data are housed in the FeeInpatInvoice table as well as the FeeServiceProvided table, although the latter does not contain only inpatient data. VA employees working on operations studies can build their own crosswalk file as they have permission to use these file. [FeeServiceProvided] tables. have hearing loss. 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. However, investigation has confirmed these are partial payments made for a single encounter or procedure. Appendices G and H, copied from the Non-VA Medical Care program website, describes in detail the types of records for which each Fee Purpose of Visit (FPOV) codes are assigned. This improves our claims processing efficiency. The process of linking can be complex; analysts should take care to reduce errors during this process. 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. For more information call 1-800-396-7929. Payer ID for dental claims is 12116. SQL Fee Basis files themselves contain limited patient demographic variables, but can be linked to other SQL data. However, in Table 4, we present some comparisons to demonstrate the different between SAS and SQL data. We tried to link the UB-92 form to identify Choice authorizations; however, we found few records and decided to use obligation number. 1. TRM Proper Use Tab/Section. If your claim was submitted to VA, call (877) 881-7618, If your claim was submitted to TriWest, call (877) 226-8749. Inpatient care, regardless of patients health status, if VA was not notified within 72 hours of admission. U.S. Department of Veterans Affairs. This technology has not been assessed by the Section 508 Office. 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. Attention A T users. Reimbursement for Pharmacists Services in a Hospital-based, Pharmacist-managed Anticoagulation Clinic. The electronic 275 transaction process may be utilized to supply Remittance Advice documentation for timely filing purposes. The two tables can be joined through FeePharmacyInvoiceSID. 4. 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. Some Non-VA Medical Care claims are rejected for untimeliness or lack of statutory authority. VA regulations 38 CFR 17.1000-17.1008. NPI and Medicare IDs have an M to M relationship. How Does VGLI Compare to Other Insurance Programs? However, previous HERC investigation confirmed these are partial payments made for a single encounter or procedure. ", Military service variables can be found in [PatSub],[PatientServicePeriod], [Patient]. There is very limited outpatient pharmacy data in the Fee files. retrieving information only; except as otherwise explicitly authorized for official Many veterans now have access to Non-VA medical care through the new Veterans Access, Choice, and Accountability Act (VACAA, or Choice Act). PatientIEN and PatientSID are unique to a patient within a facility, but not unique to a patient across VA facilities (e.g., a patient who had visited multiple VA facilities will have multiple PatientIENs and multiple PatientSIDs). Chapter 8 provides references for further information about the Fee Basis program and data. 1725 (the Mill Bill) by enabling VA to pay for or reimburse Veterans enrolled in VA health care for the remaining cost of emergency care if the liability insurance only covered part of the cost. Bowel and Bladder Care. [FeeInpatInvoice] and [Fee]. [ICD] table, the latter of which contains a list of all possible ICD-9 codes. FBCS supports payment of claims via VistA. We detail differences amongst the SAS and SQL Fee Basis data in the guidebook below. VA medical centers may purchase prosthetics and related items, such as clothing specialized for prosthetic limbs, and then dispense them through VA facilities. Of note, the FBCS was not in place nationwide prior to FY 2008. 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. There are multiple potential identifiers for provider/vendor in the SAS data: the VENDID, VEN13N, MDCAREID, SPECCODE and NPI. Six additional variables indicate the setting of care and vendor or care type. This component provides a front end for recognizing claim data through optical character recognition (OCR) software. All tablesmentioned in the Fee Basis guidebookare storedin an Excel file. The process for filing a claim for services rendered to a Veteran in the community varies depending upon whether or not the services were referred by VA and by the entity through which the services were authorizedVA or one of the VA Third Party Administrators (TriWest Healthcare Alliance or Optum United Health Care). Researchers will need to link to the Patient and SPatient domains to access this geographic information in the SQL data. Most nursing home care is billed monthly, so there is one claim for each month of nursing home stay. Research requests for data from CDW/VINCI must be submitted via the Data Access Request Tracker (DART) application. For example, the meaning of DRG001 is not the same in FY05 vs FY15. Review the Corrections and Voids page for more information. Edward J. Hines, Jr. VA Hospital, Hines, Ill. 2007. For dual pension and compensation claims, use the mailing address below for compensation claims. Care provided to persons associated with a particular VA station can be found by selecting records by STA3N. When a key field is missing, SQL indicates this with a value of -1. For example, a technology approved with a decision for 7.x would cover any version of 7. This report covers the audit of payments made through VA's Fee Basis Claims System (FBCS), encompassing claims paid via that payment process from November 1, 2014 through September 30, 2016. You will have to pay this penalty for as long as you have Part B. Other Health Insurance (OHI) and Explanation of Benefits (EOBs), Any other document type normally sent via paper in support of a Veteran unauthorized emergency claim.
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