NNPO. There is a strong, but imperfect, concordance, between the observations housed in the SAS and SQL data. Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. National Non-VA Medical Care Program Office (NNPO). At the time of writing (October 2015), only operations staff will have permission to access the SAS data at VINCI. This application is directly attached to TWAIN compliant scanners and works offline to VistA and the FBCS MS SQL databases. While not required to process a claim for authorized services, medical documentation must be submitted to the authorizing VA medical facility as soon as possible after care has been provided. DART is a workflow application that guides users through the request by collecting the appropriate documents, distributing documentation to reviewers, and assisting in communication between requestors and reviewers. 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. There is also a host of non-emergency surgery provided through Fee Basis mechanisms that may be of interest to researchers. Thus, unauthorized care is not unpaid care it is simply not PRE-authorized care. This rare event most likely indicates a transfer. There is a lack of publicly available technical documentation and support may be limited to specific forums. Prior to the passage of this law on May 1, 2010, VA did not cover the cost of health care provided to dependent children, including newborns in situations where VA pays for the mothers obstetric care during the same stay. American Society of Health-System Pharmacy (ASHP). Mark Smith and Adam Chow were the authors of the original HERC guidebook, upon which this document builds. Accessed October 07, 2015. We detail differences amongst the SAS and SQL Fee Basis data in the guidebook below. For these reasons, VA strongly encourages Veterans to consider important factors, risks and benefits before making any changes to their private health insurance. There is a CPT field in the inpatient files, but this is always missing; hospitals do not use CPT codes to bill. Fee Basis: 214-857-1397 C & P. VA Claims Representation; RESOURCES. FSGLI: Family Servicemembers Group Life Insurance, Schedule of Payments for Traumatic Losses, S-DVI: Service-Disabled Veterans Life Insurance, Beneficiary Financial Counseling and Online Will, Lesbian Gay, Bisexual & Transgender Veterans, Pension Management Center (PMC) that serves your state, Claims Adjudication Procedures Manual/Live Manual, Link to subscribe to receive email notice of changes to the Live Manual. In some cases it may appear that single encounters have duplicate payments. Box 30780, Tampa FL 33630-3780. Microsoft Internet Explorer, a dependency of this technology, is in End of Life status and must no longer be used. U.S. Department of Veterans Affairs. VA patients who receive prescriptions from non-VA providers fill them from a VA pharmacy, often the VA Certified Mail Order Pharmacy (CMOP). Both ancillary and outpatient files have one record per CPT code. [FeeInpatInvoice] table, one must first link that table to the [Fee]. 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. Care for dependent children, except newborns, in situations where VA pays for the mothers obstetric care during the same stay. SAS and SQL data are organized differently and contain different variables. How Does VGLI Compare to Other Insurance Programs? 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.. We are grateful for their cogent work. 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. 1725 when remaining liability to the Veteran is not a copayment or similar payment. The SQL tables [Dim]. Veterans Choice Program (VCP) Overview [online]. VINCI. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. 16. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). No new extracts will occur. This technologysupports advanced data encryption methods and role-based access control. Some important DIM tables that will be useful in analyzing Fee Basis data are FeePurposeOfVisit, FeeSpecialtyCode, FeeVendor, ICD, ICDProcedure Code, DRG, CPT, and CPT Category. Office of Media and Public Relations. To access the menus on this page please perform the following steps. Beware of VISNS 4, 15, and 23, as they have their own integrated system. The Customer Engagement Portal is a reporting tool for VA Medical providers to verify the status of claims as well as run payment reconciliation reports. [Patient], [Spatient]. Last updated August 21, 2017 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. 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. 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). This component distributes fee workload to particular users using the FBCS MS SQL database and the VistA Gateway. Below we describe the general types of information in both the SAS and SQL data. The two tables can be joined through FeePharmacyInvoiceSID. The VA Fee Basis medical program provides payment authorization for eligible Veterans to obtain routine medical treatment services through non-VA health care providers. This can become complicated by the fact that not all encounters relating to the same inpatient stay will have the same admission and discharge dates. The VEN13N is the vendor ID with a suffix; VEN13N is more detailed than VENDID and is thus recommended for use. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). 9. The Non-VA Payment Methodology Matrix, prepared by the National Non-VA Medical Care Program Office (now the VHA Office of Community Care), presents guidelines for preauthorized care and emergency care for service and non-service connected conditions for both inpatient and outpatient care.17 VA will reimburse the same non-VA provider a different rate depending on whether the Veteran received: a) pre-authorized care; b) emergency care for a service-connected condition; or c) emergency care for non-service connected conditions and non-service connected Veterans. With the exception of supplying remittance advice supporting documentation for timely filing purposes, these processes do not apply to authorized care. Much Fee Basis care is pre-authorized prior to the Veteran obtaining care and is thus considered Authorized Care. Box 14830Albany, NY 12212. Below are some answers to general questions about the FBCS tables. Edward J. Hines, Jr. VA Hospital, Hines, Ill. 2007. VA may be a secondary payer for unauthorized emergent claims under 38 U.S.C. SAS has more data on inpatient diagnosis and procedure variables than do SQL data. It is not available for claims in which payment was based on a contract amount. In SAS, the outpatient data are housed in the MED files. VA Fee Basis Programs. PO BOX 4444. If the gap is 0 or 1, evaluate the discharge date of the first and second observation. Veterans Access, Choice, and Accountability Act of 2014 (VACAA): The Choice Program and the Choice Card [presentation]. Additionally, our health care providers make certain that Veterans' VA medical records remain updated by returning information about Veteran care and treatment to VA. You can use NPI to link providers in VA and Medicare. There may be multiple vendor IDs (VENDIDs) for a single inpatient stay. Here, ICDProcedureSID is a primary key in the [Dim]. 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. The potential exists to store Personally Identifiable Information (PII), Protected Health Information (PHI) and/or VA Sensitive data and proper security standards must be followed in these cases. This guide serves as an addendum to any technical documentation supplied by the healthcare clearinghouse when establishing a trading partner agreement. For more detailed information, researchers should visit the VHA Office of Community Care website. This is true for both the inpatient and outpatient data. These represent cases in which payment is disallowed. The instructions differ based on the type of submission.NOTE: For specific information on submitting claims to Optum or TriWest, please refer to their resources. Available at: http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. 400, Wittman Drive Grand Rapids Itasca County MN - 55744 United States. If you have additional questions about the form or your portal account access, please contact the Provider Services Solution (PRSS) help desk at 888-829-5373. The FMS disbursed amount is the payment amount plus any interest payment. For emergency care of service connected conditions, there is a two-year limit to submit any bills. 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. The travel payments data contains reimbursements for particular travel events (TVLAMT). The vendor represents the entity billing for the non-VA care, while the provider represents the person who was involved in care provision. 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. However, not all dates on the claim are approved. Inpatient care beyond the time when a patient is stabilized and can be transferred to a VA facility, except where a VA facility is not feasibly available. Unauthorized user attempts Attention A T users. The Fee Basis files' primary purpose is to record VA payments to non-VA providers. Veterans Choice Program - Fee Basis Claims System in CDW 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). VA will arrange for transportation for them or will reimburse expenses on the basis of vouchers submitted. A claim void must be identical to the original claim that it is intended to cancel. It may duplicate the PatientIEN of another patient at another facility, and should not be used as an identifier. 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). However, in Table 4, we present some comparisons to demonstrate the different between SAS and SQL data. [ModeOfTransportation] and [Fee]. It is also possible that researchers will find a slight difference in the observations that the SAS versus SQL data contain. If the patient is transferred from a non-VA to a VA hospital, the non-VA component of this care will be captured through Fee Basis, while the VA component of this care will be in the VA inpatient datasets. However, 99% of inpatient hospital invoices were associated with a length of stay of 33 days or less. 3. One way to do this is to concatenate the vendor identifier, the patient identifier, and the visit date. Fee Basis data files contain information regarding both the care the Veteran received and the reimbursement of the care. In the outpatient data, one observation represents a single CPT code. VINCI Data Description: Fee/Purchased Care [online; VA intranet only]. Journal of Rehabilitation Research and Development. U.S. Department of Veterans Affairs. April 14, 2014. Available at: http://www.mssny.org/Documents/Enews/Aug%208%202014/VA%20ProvidersGuide.pdf, 6. Payment of ambulance transportation under 38 U.S.C. Technologies must be operated and maintained in accordance with Federal and Department security and what is specified but is not to exceed or affect previous decimal places. There may be multiple CPT codes associated with a single encounter. more information please visit www.fsc.va.gov. While NPI is available in SQL data, it does require special permissions to access, as it is located in the [Sstaff]. In order to qualify for round trip mileage, an appointment must be scheduled. HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. 3. (Veterans may submit unauthorized claims, however, and VA has legal authority to pay them under certain conditions. Accessed October 27, 2015. 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. 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 Eligibility Details [online]. 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. There are multiple potential identifiers for provider/vendor in the SAS data: the VENDID, VEN13N, MDCAREID, SPECCODE and NPI. Name of the medication. Fee Basis providers vary in how frequently they submit an invoice for Fee Basis care. Hospice also appears to be billed monthly, with longest length of stay for a single hospice invoice of 31 days. Please switch auto forms mode to off. Chief Business Office. Table 9 lists a number of financial variables the SQL data contain. Claims for Non-VA Emergency Care However, there are data available regarding the category of visit. Last updated validated on Tuesday, January 3, 2023 The NPI is the national provider identifier, which is provider-specific but often missing in the Fee Basis data. There are up to 25 ICD-9 diagnosis codes and 25 ICD-9 surgical procedure codes in the inpatient data. Contact: 1-877-353-9791; Email Customer Engagement; Customer Engagement Portal Login. Each VA facility has a local Fee Office to which the non-VA provider submits a claim for reimbursement. Non-VA providers submit claims for reimbursement to VA. Passed in 2014 with bipartisan support in Congress, its purpose is to increase Veterans access to health care.1 The Choice Act allows Veterans to receive health care through non-VA providers in the community if they are unable to schedule an appointment at their local VA within 30 days or by a date determined by their provider (wait-time goals), if they reside over 40 miles from a VA facility, or if they face an unusual or excessive burden in travelling to a VA facility.2 Under the Choice Act, ten ($10) billion dollars has been allocated towards Non-VA Medical Care for eligible Veterans through 2017.1 The Fee Basis files contain data for care received through the Choice Act, but in this guide, we do not distinguish for care provided under the Non-VA Medical Care program and that provided under the Choice Act. [FeePrescription] table contains rich information on the type of drug prescribed and dispensed, including the drug name, manufacturer, strength, quantity, date filled and charge and disbursed (payment) amount. For a list of VA acronyms, please visit the VA AcronymLookup on the VA intranet at http://vaww.va.gov/Acronyms/fulllist.cfm. 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]. VA Information Resource Center. Office of Information and Analytics. Cunningham, K. VA implements the first of several Veterans Choice Program eligibility expansions. [XXX] tables.9,12 Tables under the DIM schema contain attributes that describe the records in the Fee tables. Once the VA system user has a TSO account, s/he may connect to the AITC mainframe through the Attachmate Reflection File Transfer Protocol (FTP). Thus, in SQL the total cost of an inpatient stay would be determined by evaluating the DisbursedAmount in the [Fee]. have hearing loss. If disbursed amount is missing (but not $0), use payment amount instead. If a Veteran has only Medicare Part A then VA may consider payment for ancillary and professional services usually covered under Part B. The specific locations of the SAS payment variables and the SQL payment variables can be found in Chapters 4 and 5, respectively. 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). This is a critical difference from VA utilization files, which are organized by date of service. b. Not all of these variables appear in every utilization file. There are also differences in the variables contained in the SAS versus SQL data. 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). All Choice claims are processed by VISN 15. October 1, 2015. File a Claim for Veteran Care - Community Care - Veterans Affairs Accessed October 16, 2015. 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. 2. NNPO. Review the Where to Send Claims section below to learn where to send claims. Many URLs are not live because they are VA intranet only. VA Palo Alto, Health Economics Resource Center; October 2013. In this table, some ancillary data are associated with an inpatient FPOV code but have an outpatient FeeProgramProvided field.