In order to gain access to the AITC mainframe, VA system users must contact their local Customer User Provisioning System (CUPS) Points of Contact (POC) and submit a VA Form 9957 to create a Time Sharing Option (TSO) account. The unique patient identifier by which to conduct SQL-based Fee Basis analyses is PatientICN. Austin Information Technology Center (AITC) is one of the VAs five national data centers. Data are presented in Table 4. 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). [ICD9] tables. The variable DTStamp represent the date the claim was received. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, New York/New Jersey VA Health Care Network, Call TTY if you Questions about non-VA care claims may be directed to the Fee Basis Unit between the hours of 8:00 a.m. Email Address Required. Important: The mailing address below only pertains to disability compensation claims. 1. 2. For billing questions contact: Health Resource Center U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. There may be multiple STA3Ns for a single inpatient stay. For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/. . VA can also pay for hospice care for Veterans when the VA facility is unable to provide the needed care; this happens frequently, as VA provides only inpatient-based hospice care and many Veterans may wish to receive hospice at home or in the community. 1725 or 38 U.S.C. The second record would have an admission date of Jan 5, 2010 and a discharge date of Jan 5, 2010. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). 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. 1. Updated August 26, 2015. VA contracts out its hospice; therefore, the Fee Basis files contain a great deal of data related to hospice care. The vendor identity can be found through the VENDID or VEN13N variables in SAS. This application queues critical claims data into the FBCS shared MS SQL database for further processing and reporting. If the Veteran received care in the community that was not pre-authorized, it is considered unauthorized by VA. Attention A T users. Use the column 'estimated cost' and it is available in the CDW FBCS data. Seven refer explicitly to Veterans alone, while the remaining two are for diagnostic services or eligibility exams, neither of which constitutes treatment. 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). This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. actions by all authorized VA and law enforcement personnel. Veterans Choice Program (VCP) Overview [online]. In most cases, if you don't sign up for Part B when you are first eligible, you'll have to pay a late enrollment penalty. Other work by HERC researchers indicates that in the FY 2014 data, DXLSF and DX1 were identical 47% of the time. Fee-for-Service Providers | DMAS - Department of Medical - Virginia VA Palo Alto, Health Economics Resource Center;November 2015. Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. Most ED visits will be identified through FPOV values of 32 or 33. There is also a host of non-emergency surgery provided through Fee Basis mechanisms that may be of interest to researchers. field. Non-VA CareP.O. VHA Office of FinanceP.O. When a key field is missing, SQL indicates this with a value of -1. The Act amends 38 U.S.C. VA is the primary and sole payer when VA issues an authorization. HIPAA Transaction Standard Companion Guide (275 TR3)The purpose of this companion guide is to assist in development and deployment of applications transmitting health care claim attachments intending to support health care claim payment and processing by VA community care health care programs. In some cases, there is a one-to-one relationship between VEN13N and MDCAREID. 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. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. This schema contains sensitive information such as SSNs, bank accounts, and the actual name of personnel. U.S. Department of Veterans Affairs. 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. 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. Linking Patient Data in the CDW Update [online; VA intranet only]. Again, date of service is not available in the FeeServiceProvided table. Benefits Delivery at Discharge - Pre-Discharge - Veterans Affairs To file a claim for services authorized by VA, follow instructions included in the Submitting Claims section of the referral. At the time of writing, SAS data at CDW are available only to those persons with VA operations access. If electronic capability isnot available, providers can submit claims by mail or secure fax. http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf. Visit the VHA Data Portal for further information on accessing restricted VSSC web reports. Persons looking to classify patients Veterans by race and ethnicity are encouraged to read VHA guidance available on the Data Reports page of the VHA Data Portal (available on the intranet at http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). We crosswalked the ScrSSN to allow for comparison with SAS data. How Much Life Insurance Do You Really Need? Get the latest updates on VA community care, including program changes, resources and more! PracticeBridge. All persons working with these data should review this information before conducting any analyses. resides on and transmits through computer systems and networks funded by the VA. Available at:http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. The travel payments data contains reimbursements for particular travel events (TVLAMT). SQL Fee Basis data are stored in CDW in multiple individual tables. With few exceptions these variables will be of little interest to researchers. 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. Attention A T users. 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. Community providers have three options that allow for that linkage: Submit the claim electronically via 837 transaction and the supporting documentation via 275 transaction. SAS data are also available in CDW, but are currently limited to those VA employees with operational access. VA payment constitutes payment in full. 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. The vendor no longer supports VA installations of this technology. Procedures are identified by CPT code (CPT1) in the non-hospital inpatient services (the ancillary file) and in the outpatient procedures file. There is a CPT field in the inpatient files, but this is always missing; hospitals do not use CPT codes to bill. VA decisions for specific versions may include + symbols; which denotes that the decision for the version specified also includes versions greater than The discussion below pertains to both SAS and SQL data. Unauthorized care can be of an inpatient or outpatient nature. The alternative, putting the procedure code fields in the invoice table, would not be as efficient. All SAS prescription-related data is found in two files: the PHR file and the PHARMVEN file. Fee Basis Services - VetsFirst 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. You can use NPI to link providers in VA and Medicare. The SAS Fee Basis data are organized by fiscal year. [FeeServiceProvided] table. We detail differences amongst the SAS and SQL Fee Basis data in the guidebook below. Second, there are some cases where the disbursed amount is $0, while the payment amount is greater than $0; these are cases in which the payment was cancelled and the true cost of care is thus $0. Class 2 or Class 3 products must restrict their interfaces to Class 1 National Software to use of publicly-supported APIs ONLY. Using SQL data will allow the researcher to link to other rich data found in CDW, such as the Health Factors data. One way to do this is to concatenate the vendor identifier, the patient identifier, and the visit date. While all non-VA providers must submit a claim to VA in order to be reimbursed for care, the claim filing deadline depends on the type of claim. 11. 1. U.S. Department of Veterans Affairs. Please switch auto forms mode to off. Health plans include private health insurance, Medicare, Medicaid, and other forms of insurance that will pay for medical treatment arising from the patients injury or illness (e.g., automobile insurance following a car accident). Please switch auto forms mode to off. Electronic Services Available (EDI): Professional/1. or use of this system constitutes user understanding and acceptance of these terms one setting of care (inpatient or outpatient). Use Azure Rights Management Services (Azure RMS) for encrypted email. Values for Fee Purpose of Visit (FPOV), HCFA Payment Type (HCFATYPE), Treatment Code (TRETYPE), Place of Service (PLSER), and Vendor Type (TYPE) appear in Appendix B. Florida Department of Veterans' Affairs | Connecting veterans to Available at: http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf.. 3. All SAS variables are denoted in capital letters, while SQL fields are denoted without spaces, in accordance with how these fields are labeled in the SQL tables. For EDI 837, Referral Number is Loop = 2300, Segment = REF*9F, Position = REF02 or Prior Authorization. Please switch auto forms mode to off. If researchers wish to identify ED visits, they may want to use CPT codes or Place of Service codes, rather than FPOV. For more details, including rules for handling patients transferred during a stay, see federal regulation 38 CFR 17.55. [XXX] tables.9,12 Tables under the DIM schema contain attributes that describe the records in the Fee tables. INTIND and INTAMT are not always concordant. These variables relate to the VA station at which the Fee Basis care requests and claims are input. 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. 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. 1-800-273-8255 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Note: A Veterans insurance coverage or lack of insurance coverage does not determine their eligibility for treatment at a VA health care facility. However, one also needs to exercise caution with DRG; there are 2 different sets of DRGs used over time. VIReC. For current information on Community Care data, please visit the page VA Community Care Data. These vendors are presumably hospital chains. There may be many providers that use the same vendor for billing. Address. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. 15. The Fee Purpose of Visit Code (FPOV) has strong guidance from VA Fee Basis Office and thus may be a more accurate way of categorizing care. Smith MW, Su P, Phibbs CS. The OI&T Enterprise Program Management Office does not endorse nor support Class 2 and Class 3 products and does not support data usage or application programmer interfaces (APIs) between Class 1 National Software products and Class 2 or Class 3 products. For some vendors, there may be more than on possible hospital, for example, if the vendor is a hospital chain or an organization with a VA contract. 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. Veterans applying for and using VA medical care must provide their health insurance information, including coverage provided under policies of their spouses. Reimbursements appear in the Travel Expenses (TVL) file. This component provides administration, reporting, and letter generation for all of the components of the Fee Basis Claims Systems (FBCS) via native Microsoft Structured Query Language (SQL) Server database communication drivers. In SAS, the inpatient (INPT) file includes PAMT, the Medicare prospective payment that would apply to the stay. The charge for an ambulance trip to a non-VA hospital may be paid through the Non-VA Medical Care program if the medical center determines that the hospital services meet the criteria for an unauthorized claim or a 38 U.S.C 1725 (Mill Bill) claim, or if the patient died while in route to the facility. Actual processing time has varied considerably over the years. 3. These represent cases in which payment is disallowed. Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. In this chapter, we discuss general aspects of Fee Basis data. Many URLs are not live because they are VA intranet only. As part of the process, claims and supporting documentation are scanned for compliance prior to conversion to electronic format. Chief Business Office. 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). Many private health insurance companies will apply VA health care charges towards satisfying a Veteran's annual deductible and maximum out of pocket expnse. 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. However, not all dates on the claim are approved. There is no separate payment for items such as oxygen or other supplies, the number of attendants, providing an EKG during the trip, etc. The mileage fee varies by type of ambulance service: ground, fixed wing, or rotary wing, POP zip code classification, and loaded mileage. In the SQL files, there is no separate ancillary file; rather, data regarding the physician cost of the inpatient stay is denoted in the [Fee]. For example, sta3n 589A5 will be found as 589. April 14, 2014. There is very limited outpatient pharmacy data in the Fee files. The Fee Basis files are stored in two formats: SAS and SQL. If billing electronically, please include "Other Payers Information" in Loop 2320, 2330A, 2330B, and 2430. Appropriate access enforcement and physical security control must also be implemented. Payer ID: 1. The Medicare ID is missing if the payment is determined via a different mechanism (e.g., a contract). 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. Of note, the relevant SQL tables for Fee Basis data are not only the [Fee]. Each table has only one primary key field. The VA pays for both emergency and non-emergency care through Fee Basis mechanisms. If a Veteran has only Medicare Part A then VA may consider payment for ancillary and professional services usually covered under Part B. [Spatient], and [Spatient]. The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. (formerly known as VA Fee Basis or NonVA)-Community provider submits the claim and supporting documentation through their EDI provider services in . However, investigation has confirmed these are partial payments made for a single encounter or procedure. This technology can integrate with and alter database technologies. HERC: Fee Basis Data: A Guide for Researchers - Veterans Affairs Operating Systems Supported by the Technology. Facility Information Security Officers (ISOs) are often the CUPS POC. VA Form 10-583, Claim for Payment of Cost of Unauthorized Medical Services. The travel payment data contains reimbursements for particular travel events (TravelAmount). If a patient received care at another facility, that patient will be have a different PatientSID assigned for that facility. Multiple SQL tables contain these variables. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. [OEFOIFService]and [Dim].[POWLocation]. This guide was published in October 2015; the same month the United States switched from ICD-9 to ICD-10. [ SFeeVendor] table. 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. Business Product Management. However, we conducted some comparisons for inpatient data. When evaluating the cost of care, use the disbursed amount. As noted in Chapter 2, the important variables capturing cost of care are AMOUNT and DISAMT. Attention A T users. This technology is not portable as it runs only on Windows operating systems. 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). For current information on Community Care data, please visit the page. 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). 12. VINCI. As a single encounter may have more than one CPT code, users may have to aggregate multiple observations in order to evaluate the care received on a particular day.