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. 6. For EDI 837, Referral Number is Loop = 2300, Segment = REF*9F, Position = REF02 or Prior Authorization. The status value R stands for re-routed, meaning the claim was re-routed to the Health Administration Center (HAC). PLSER values overlap considerably with those of the Medicare Carrier Line Place of Service codes. Some Fee Basis data will also appear in the non-VA medical SAS inpatient file (formerly called the Patient Treatment File). Therefore, on the outpatient side as well one must aggregate multiple records to get a full picture of the outpatient encounter. In FY 2014, the longest length of stay associated with a single nursing home invoice was 31 days. 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. There are three routes for filing claims for authorized care which depend on your status in VAs network and how the care was authorized: All non-urgent and non-emergent care requires authorization from VA in advance. The SAS data are stored at AITC. 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. Use Azure Rights Management Services (Azure RMS) for encrypted email. Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. 15. More information on the proper use of the TRM can be found on the MDCAREID is not available in the outpatient SAS Fee Basis data, even though some outpatient services are provided in a hospital. Medications dispensed in a health care facility such as a doctor's office, dialysis clinic, or hospital outpatient clinic, such as injectable medications or infusions, will be found in the outpatient data, where they will be identified by CPT code. There are exceptions. MDCAREID is available in most inpatient SAS Fee Basis records. Electronic Data Interchange (EDI): Payer ID for medical and dental claims is VA CCN. This is true for both the inpatient and outpatient data. Researchers evaluating care over time may want to use the DRG variable. a. It will often times not be possible to determine the reason for an outpatient visit, as there will be multiple observations/CPT codes that denote a single visit. 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. Business Product Management. If the Veteran went to the ED and was not admitted to the hospital, this would be considered outpatient care. If the Veteran has insurance, VA cannot pay even when the entire claim is less than the deductible. If a claim is filed for an eligible episode of care, VA must pay the whole amount according to the payment rules noted above. This most likely reflects a low frequency of surgery rather than missing data. Claims related to this care are considered authorized care. VINCI. This table contains information on inpatient care. For the inpatient data, we compared observations with the same patient identifier, based on PaidDate in SQL and TRANSDAT in SAS. When MDCAREID is not available, it is possible to assign MCCAREID based on the relationship between VEN13N and STA6A. Veterans Health Administration. HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. Training - Exposure - Experience (TEE) Tournament. In SQL, these variables can be found in the [Dim]. *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. The outpatient pharmacy data includes medications dispensed in a pharmacy. Emergent care patient liabilities not tied to copayments or deductibles will continue to be considered for secondary payment by VA. For additional questions, contact VA by phone, tollfree, at (877) 881-7618. There are also a number of other financial variables denoted in SAS (see Table 7). With few exceptions these variables will be of little interest to researchers. and constitutes unconditional consent to review and action including (but not limited A claim without errors or omissions is said to be clean. If VA has authority to pay the claim and the submitted documentation is sufficient then the claim is approved for payment. VA has established rules for timely filing of unauthorized and Mill Bill claims (i.e. PDF Frequently Asked Questions for Providers - Logistics Health The 2 sets of DRGs are not interchangeable. 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. These correspond to fields, rows and tables in a relational database. NPI is available within the VA CDW SStaff table. 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. The conversion happens before claims and records are accepted into our claims processing system. For example, an interest payment of $14.21 would appear as 1421. INTAMT is part of DISAMT; it should not be added to them. The prescription must be for a service-connected condition or must otherwise have specific approval. 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. A summary of the payment guidelines can be found in Appendix I. YESInstitutional/UB Claims. The local VA facilities put claims through a claim scrubber that checks to see if the claim was authorized and evaluates any errors or inconsistencies in the data. Download the tables here. 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.. (Anything) - 7.(Anything). First, it includes both the payment amount and any interest that may apply. Review the Filing Electronically section above to learn how to file a claim electronically. More detailed information about the vendor can be found in the SQL [Dim]. For dual pension and compensation claims, use the mailing address below for compensation claims. To access the menus on this page please perform the following steps. You can submit a corrected claim or void (cancel) a claim you have already submitted to VA for processing, either electronically or in paper. DSS Fee Basis Claims Systems (FBCS) - DigitalVA If the payment was made outside of FBCS, they wont show here. 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. All instances of deployment using this technology should be reviewed by the local ISSO (Information System Security Officer) to ensure compliance with. Claims for Non-VA Emergency Care [PatientRace] tables. Per the May 5th, 2015 memorandum from the VA Chief Information Security Officer (CISO) FIPS 140-2 Validate Full Disk Encryption (FOE) for Data at Rest in Database Management Systems (DBMS) and in accordance with Federal requirements and VA policy, database management must use Federal Information Processing Standards (FIPS) 140-2 compliant encryption to protect the confidentiality and integrity of VA information at rest at the application level. The VEN13N is the vendor ID with a suffix; VEN13N is more detailed than VENDID and is thus recommended for use. Non-VA providers submit claims for reimbursement to VA. All Fee Basis care will be found in the Fee files. VA Palo Alto, Health Economics Resource Center;November 2015. Journal of Rehabilitation Research and Development. This research was supported by the Health Services Research and Development Service, U.S. Department of Veterans Affairs (ECN 99017-1). However, there are some outliers; some claims can take up to 8 years to process. VA payment constitutes payment in full. 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. Electronic 837 claim and 275 supporting documentation submissions can be completed through VAs contracted clearinghouse, Change Healthcare, or through another clearinghouse of your choice. This table also includes claims related to inpatient care and other services. National Institute of Standards and Technology (NIST) standards. 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. Make sure the services provided are within the scope of the authorization. File a Claim-Information for Veterans - Community Care - Veterans Affairs If electronic capability is not available, providers can submit claims by mail. The disbursed amount should be used to calculate the cost of care, except in the case where disbursed amount is missing. If you are in crisis or having thoughts of suicide, Hospice also appears to be billed monthly, with longest length of stay for a single hospice invoice of 31 days. For Veterans Choice Program (VCP) Overview [online]. Beware of VISNS 4, 15, and 23, as they have their own integrated system. Va Fee Basis Program Claims Address - filecloudbarcode 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. 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. VA calculates PAMT from CMS pricer software on the basis of DRG and length of stay. The SQL tables [Dim]. Please switch auto forms mode to off. What documents are required by VA to process claims for. Researchers should use PatientICN to link patient data within CDW. 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. 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 instructions differ based on the type of submission.NOTE: For specific information on submitting claims to Optum or TriWest, please refer to their resources. 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. a. The SQL prescription data are housed in the [Fee]. In SAS, the inpatient (INPT) file includes PAMT, the Medicare prospective payment that would apply to the stay. Veterans Health Administration. 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. The Fee Basis schema data can be found at the CDW SharePoint portal at the links below (VA intranet only). The mileage is calculated using the fastest route. Non-VA Medical Care data may be tabulated at the VHA Support Services Center (VSSC) (VA intranet only: http://vssc.med.va.gov/). 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. [XXX] tables.9,12 Tables under the DIM schema contain attributes that describe the records in the Fee tables. There are two important variables to consider if evaluating the cost (VA reimbursement) of Fee Basis Care: the payment amount (AMOUNT in SAS, PaidAmount in SQL) or the Financial Management System (FMS) disbursed amount (DISAMT in SAS, DisbursedAmount in SQL). To enter and activate the submenu links, hit the down arrow. Sort data by the patient ID, STA3N, VEN13N, and the admission dates. There is no information available in the SAS data that identifies the actual medication dispensed. Additionally, we found 0.94% of records were approved Choice claims (e.g., records where SPECIALPROVCAT= CHOICE and STATUS= A (approved)). 14. In the outpatient data, one observation represents a single CPT code. [FeeServiceProvided] table. By store procedure codes as records in another table, the SQL relational database uses the minimum amount of storable space. Starting in 2009, there are also a number of DXPOA variables in the SAS data, which indicate diagnoses that are present on admission. All analyses using this cohort should use PatientICN as indicative of a unique patient. More information can be found at the OPES website: http://opes.vssc.med.va.gov. The following information should help you understand who to submit claims to and the requirements you must follow when submitting claims. Health - Veterans Affairs The VA Fee Basis medical program provides payment authorization for eligible Veterans to obtain routine medical treatment services through non-VA health care providers. [FeeInitialTreatment], [Fee]. Under the Veterans Choice Act, eligible veterans are able to obtain outpatient care outside the VA using their Choice Card. Users must ensure that Microsoft .NET Framework, Microsoft Structured Query Language (SQL) Server, and Microsoft Excel are implemented with VA-approved baselines.
