Researchers interested in linking SQL Fee Basis data to the rich patient-level or vendor and/or provider information available in the rest of the Corporate Data Warehouse should apply for permissions to access these other datasets. Class 2 or Class 3 products must restrict their interfaces to Class 1 National Software to use of publicly-supported APIs ONLY. A missing value of the primary diagnosis code should therefore be treated as truly missing. Note that the vendor may represent the hospital, a hospital chain or the entity billing on behalf of the provider. In SQL, there are multiple patient identifiers, with the most useful being the PatientICN. However, there are some outliers; some claims can take up to 8 years to process. On March 17, 2022, The U.S. Court of Appeals for the Federal Circuit issued a ruling that changes VA's ability to reimburse as secondary payer under 38 U.S.C.1725. would cover any version of 7.4. PatientIEN is assigned by the facility. NPI and Medicare IDs have an M to M relationship. Questions about care and authorization should be directed to the referring VA Medical Center. Get Help from Our VA Disability Claim Appeals Lawyers Today. Include the 17 alpha-numeric (10 digits + "V" + 6 digits) VA-assigned internal control number (ICN) in the insured's I.D. Hit enter to expand a main menu option (Health, Benefits, etc). VA Claims Representation; RESOURCES. The new temporary end date is the maximum of the discharge date of the third observation and temporary end date from Step 2. Some vendors use centralized billing services located in other cities, in a few cases in other states. Chapter 6 provides information about how to access the Fee Basis data, while Chapter 7 provides information about the rules governing Fee Basis care. The Fee Basis files primary purpose is to record VA payments to non-VA providers. The PatientSID is a CDW assigned identifier that uniquely identifies a patient within a facility. 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. Patient type can take one of seven values: surgical; medical; home nursing; psych contract; psychiatric, neuro contract; or neurological. Compare the admission date of the third observation to the temporary end date from above. 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. In both the SAS and the SQL data, there are usually multiple observations per patient encounter. Accessed October 16, 2015. Data in any of the any S tables require Staff Real SSN access. Box 30780 Tampa, FL 33630-3780, P2E Documentation Cover Sheet, VA Form 10-10143f. Procedures are identified by CPT code (CPT1) in the non-hospital inpatient services (the ancillary file) and in the outpatient procedures file. 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. Most files contain the invoice date, obligation number; check number and date, several variables pertaining to check cancellation and denials of payment, and the DHCP internal control number. Payer ID: 1. All preauthorized claims are then processed through the Fee Basis Claims System (FBCS) at the local facility as well as sent to the payment team. See 38 USC 1725 and 1728.). Download the tables here. In both SQL and SAS data, there is also a variable regarding the fee specialty code. It may duplicate the PatientIEN of another patient at another facility, and should not be used as an identifier. Veterans Health Administration. This component is a service that communicates with the Program Integrity Tool (PIT) which scores claims and sends results to FBCS. This component distributes fee workload to particular users using the FBCS MS SQL database and the VistA Gateway. The vendor identity can be found through the FeeVendorSID or the FeeVendorIEN variables in SQL. VA calculates PAMT from CMS pricer software on the basis of DRG and length of stay. All access 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. 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. As of April 2019, this guidebook is no longer being updated. For example, there are observations in which INTIND = 1 and INTAMT = $0. Training - Exposure - Experience (TEE) Tournament. The quantity dispensed. Five additional variables Financial Management System (FMS) transaction number, line number, date, batch number, and release date reflect processing of payments through the FMS. Available at: http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf.. 3. This is the main utility that passes information back into the FBCS Payment application. Outpatient data are housed in the FeeServiceProvided table. 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. 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. What documents are required by VA to process claims for. March 2018: Due to the transition of the National Non-VA Medical Care Program Office to the VHA Office of Community Care and updates to the VINCI website, some documents may no longer be available. Payer ID for dental claims is 12116. 2. However, Veterans may be responsible for a VA copayment depending on their assigned Priority Group. Of note, the relevant SQL tables for Fee Basis data are not only the [Fee]. 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. The Medicare hospital provider ID (MDCAREID) is entered by fee basis staff in order to calculate hospital reimbursement using the Medicare Pricer software. Include the authorization number on the claim form for all non-emergent care. For education claims, refer to the appropriate Regional Processing Office. Accessed October 16, 2015. The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. For inpatient and outpatient care, in general, VA will pay the lesser of the Medicare rate (or MPFS rate) or the billed charges. YESElectronic Remittance (ERA)YESICD- 1. There are substantial differences in quantity of inpatient diagnosis and procedure data available in SAS versus SQL. [ICDProcedure] table and a foreign key in the [Fee]. In SAS, these data can be found in the Vendor file. In SQL, the outpatient data are housed in the FeeServiceProvided table. Working with the Veterans Health Adminstration: A Guide for Providers [online]. Thus, in SQL the total cost of an inpatient stay would be determined by evaluating the DisbursedAmount in the [Fee]. Veterans Health Administration. Thus, one could not simply use the patient identifier and the admission and discharge dates to collapse these observations into one inpatient stay. Review the Supporting Documentation section below to learn how to properly submit supporting documentation with your claim. have hearing loss, Community Care Network Region 1 (authorized), Community Care Network Region 2 (authorized), Community Care Network Region 3 (authorized), Community Care Network Region 4 (authorized), Unauthorized Emergent Care (unauthorized). 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. 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. expectation of privacy in the use of Government networks or systems. A claim for which the Veteran had coverage by a health plan as defined in statute. Accessed October 16, 2015. National Provider Identifier: Submit all that are applicable, including, but not limited to billing, rendering/servicing, and referring. Seven refer explicitly to Veterans alone, while the remaining two are for diagnostic services or eligibility exams, neither of which constitutes treatment. The Department of Veterans Affairs' (VA) fee basis care spending increased from about $3.04 billion in fiscal year 2008 to about $4.48 billion in fiscal year 2012. SAS and SQL contain different variables to identify the provider and/or vendor associated with the care. The status value A stands for accepted, meaning the claim was paid. Veterans applying for and using VA medical care must provide their health insurance information, including coverage provided under policies of their spouses. Hospice also appears to be billed monthly, with longest length of stay for a single hospice invoice of 31 days. We compared the service date (TREATDTO in inpatient and ancillary, TREATDT in outpatient, and FILLDTE in pharmacy files) to the FMS processing date (PROCDTE) (See Table 1). (Anything) - 7.(Anything). U.S. Department of Veterans Affairs. Care provided in foreign countries other than the Philippines. U.S. Department of Veterans Affairs. 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. It is available in the PHARVEN and VEN files, albeit with a high degree of missingness. A claim void must be identical to the original claim that it is intended to cancel. 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. 12. All Fee Basis care will be found in the Fee files. Operating Systems Supported by the Technology. The two tables can be joined through FeePharmacyInvoiceSID. [FeeInpatInvoiceICDProcedure] table. 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. Edward J. Hines, Jr. VA Hospital, Hines, Ill. 2007. Paper claims and supporting documentation submitted to us are converted to Electronic Data Interchange (EDI) transactions. Compare the discharge date of the first observation to the admission date of the next (second) observation. VA evaluates these claims and decides how much to reimburse these providers for care. This is true for both the inpatient and the outpatient data, albeit for different reasons. If notification was not made to VA and you wish to have claims considered for payment, please submit claims and supporting documentation to VA as listed in the "Where to Send Claims" dropdown below. [FeeServiceProvided], [Fee]. 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. This technology integrates with Veterans Information Systems and Technology Architecture (VistA) through Massachusetts General Hospital Utility Multi-Programming System (MUMPS) or a Structured Query Language (SQL) database system on the backend. 2. There is a lack of publicly available technical documentation and support may be limited to specific forums. Six additional variables indicate the setting of care and vendor or care type. This service communicates via native SQL Server 2005 encrypted connections through the VA Wide Area Network (WAN). This act expands the non-VA care veterans were able to receive before the act was passed. 2010;47(8):725-37. Appendix E includes a list of SQL fields related to the type of care a patient receives. 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. 10. To determine the location of care, MDCAREID will be more useful than VEN13N. VA evaluates these claims and decides how much to reimburse these providers for care.