These variables relate to the VA station at which the Fee Basis care requests and claims are input. Accessed October 16, 2015. VA is required by law to bill private health insurance carriers for medical care, supplies and prescriptions provided for treatment of Veterans' nonservice-connected conditions. 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. In SAS, the inpatient (INPT) file includes PAMT, the Medicare prospective payment that would apply to the stay. After a claim is submitted electronically it must be entered manually into a Non-VA Medical Care approval system. This is specific to certain claims for Non-Service Connected emergency medical care under Title 38 USC 1725. This technology is not portable as it runs only on Windows operating systems. [Patient], [PatSub]. Available at: http://vaww.vhadataportal.med.va.gov/Portals/0/DataQualityProgram/Reports/Identifying_Veterans_in_CDW.pdf. These rules are subject to change by statute or regulation. The SAS files also include a patient type variable (PATTYPE). The PHR file contains information on the cost-related data associated with the prescription, while the PHARMVEN file contains information on the vendor associated with the prescription. However, there are some outliers; some claims can take up to 8 years to process. In general, we recommend using the disbursed amount to capture the cost of care, for two reasons. In the SAS data prior to FY 2007, the disbursed amount (DISAMT) had an implied decimal point whereas the payment amount (AMOUNT) did not. Researchers with VA intranet access can access these images by copying and pasting the URLs into their browser. The VA Fee Basis medical program provides payment authorization for eligible Veterans to obtain routine medical treatment services through non-VA health care providers. VA Informatics and Computing Resource Center (VINCI). [Spatient], and [Spatient]. Unscheduled trips may be reimbursed for the return mileage only. 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. These represent cases in which payment is disallowed. 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. Smith MW, Su P, Phibbs CS. Chapter 4 offers detailed information SAS Fee Basis data; Chapter 5 provides detailed information about SQL Fee Basis data. 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. 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. VSSC web reports are organized into nine domains: Business Operations, Capital & Planning, Clinical Care, Customer Service, Quality & Performance, Resource Management, Special Focus, Systems Redesign, and Workload. Veterans are not responsible for the remaining balance shown as patient responsibility on the explanation of benefits from their insurance carrier. [FeePharmacyInvoice] table contains information on vendor, amount claimed, and amount paid. [FeeInpatInvoice], [Fee]. First, it includes both the payment amount and any interest that may apply. [Patient], [SPatient]. The Fee Basis files are stored in two formats: SAS and SQL. Of note, SQL and SAS data contain similar, but not exactly the same, information. There are no references identified for this entry. Sign up to receive the VA Provider Advisor newsletter. Information from this system resides on and transmits through computer systems and networks funded by the VA. SAS and SQL data are organized differently and contain different variables. A primary key is a key that is unique for each record. Chapter 1 presents an overview of Fee Basis data in general; Chapter 2 presents an overview of the variables in the Fee Basis data; and Chapter 3 describes how SAS versus SQL forms of Fee Basis data differ. 7. Conversely, all stays should have at least one discharge diagnosis. The VendorType contains information about whether the service was provided by a laboratory, radiology, physician, pharmacy, other, travel, prosthetics, federal hospital, public hospital or private hospital. More detailed information about the vendor can be found in the SQL [Dim]. They could form part of an overall strategy to locate care provided in specialized settings, such as state homes, or of specialized services like kidney dialysis. Health Information Governance. In FY 2014, the longest length of stay associated with a single nursing home invoice was 31 days. Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. For inpatient and outpatient care, in general, VA will pay the lesser of the Medicare rate (or MPFS rate) or the billed charges. 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. This component is a service that communicates directly with the High Availability Controller (HAC) SQL database for syncing critical fee data back into the local FBCS MS SQL database. Claims for Non-VA Emergency Care The FeeSpecialtyCodeName contains information on the specialty of the provider seen, such as oncology, chiropractic, pathology, neurosurgery, etc., but is missing much data. To locate the facility at which the Veteran usually receives VA care, the VA Information Resource Center (VIReC) recommends consulting the preferred facility indicator in the VHA Enrollment Database.7. Available at: http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. In both the SAS and the SQL data, there are usually multiple observations per patient encounter. 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. 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). Inpatient procedures are captured by ICD-9 procedure codes (SURG9CD1-SURG9CD25) in the hospital claims file. [ModeOfTransportation] and [Fee]. Another approach is to search other fee claims submitted by the same vendor to see if a Medicare hospital ID was assigned to those claims. Q. 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
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. Payer ID: 1. In this table, some ancillary data are associated with an inpatient FPOV code but have an outpatient FeeProgramProvided field. 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. Electronic Data Interchange (EDI): Payer ID for medical claims is TWVACCN. Office of Media and Public Relations. PO BOX 4444. Accessed October 07, 2015. Each observation in the SAS and SQL data has an accompanying vendor ID. TRM Proper Use Tab/Section. Box 537007Sacramento CA 95853-7007, CCN Region 5(Kodiak, Alaska, only)Submit to TriWest. [FeePharmacyInvoice] and the [Fee]. 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. Federal law puts prosthetics into a special payment category that mandates full financial support from VA. As implemented in VA policy, it requires that VA facilities provide all necessary prosthetics, orthotics, and assistive devices (prosthetics) needed by patients. VA systems are intended to be used by authorized VA network users for viewing and retrieving information only; except as otherwise explicitly authorized for official business and limited personal use under VA policy. Many private health insurance companies will apply VA health care charges towards satisfying a Veteran's annual deductible and maximum out of pocket expnse. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, Outreach, Transition and Economic Development Home, Warrior Training Advancement Course (WARTAC), Staff Appraisal Reviewer (SAR) Information, How to Apply for Nonsupervised Automatic Authority, VALERI (VA Loan Electronic Reporting Interface). There may be multiple CPT codes associated with a single encounter. [ICD9] tables. 9.2. Eligibility and claims submission information for emergent care will be provided after notification is made to the VA. Claims for emergent care not eligible for authorization upon notification, may be eligible for consideration as Unauthorized Care. One can evaluate which encounters were unauthorized by joining the FeeUnauthorizedClaim table through the FeeUnauthorizedClaimSID key. 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. As noted above, in SAS, the patient identifier is the SCRSSN; this is unique to each patient across the entire VA. Medication dosage/strength. 1725 or 38 U.S.C. 2. If you are in crisis or having thoughts of suicide,
YESThis insurance is also known as: Veterans Administration. Fee Basis Services. In particular, CDW also recommends Patient SIDs with a value of less than 1 be deleted. 1728. In the Fee Basis inpatient data, each record represents a separate claim; these separate claims must be aggregated to capture the totality of the inpatient stay. Mail to: DEPARTMENT OF VETERANS AFFAIRS. 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. Most nursing home care is billed monthly, so there is one claim for each month of nursing home stay. 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). Sort data by the patient ID, STA3N, VEN13N, and the admission dates. All Choice claims are processed by VISN 15. (2) Additionally, a Veteran must also meet at least one of the following criteria. To learn more, please visit the Provider Training section on the MES website . It appears that starting in FY2016, Choice data is now bypassing FBCS and residing in the PIT. Actual processing time has varied considerably over the years. Users must ensure that Microsoft .NET Framework, Microsoft Structured Query Language (SQL) Server, and Microsoft Excel are implemented with VA-approved baselines.