va fee basis program claims address
Facility Information Security Officers (ISOs) are often the CUPS POC. Researchers with VA intranet access can access these images by copying and pasting the URLs into their browser. For the purpose of this guidebook, we focus on Fee Basis files only. VHA Office of FinanceP.O. 7. Non-VA providers submit claims for reimbursement to VA. After a claim is submitted electronically it must be entered manually into a Non-VA Medical Care approval system. Both ancillary and outpatient files have one record per CPT code. Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. Chapter 4 offers detailed information SAS Fee Basis data; Chapter 5 provides detailed information about SQL Fee Basis data. Austin Information Technology Center (AITC) is one of the VAs five national data centers. Current Decision Matrix (10/21/2022) However, a 7.4.x decision If the gap is 0 or 1, it is part of the same hospital stay and we then want to assess its discharge date. Mail to: DEPARTMENT OF VETERANS AFFAIRSCLAIMS INTAKE CENTERPO BOX 4444JANESVILLE, WI 53547-4444, or Fax to: TOLL FREE: 844-531-7818 & 248-524-4260 (Utilized for Foreign Claimants), Veterans Crisis Line: In particular, CDW also recommends Patient SIDs with a value of less than 1 be deleted. A claim void must be identical to the original claim that it is intended to cancel. Attention A T users. The CDW SharePoint site has a document that lists the purchased care SQL tables, the fields of that they contain, and some sample SQL queries (VA intranet only: https://vaww.cdw.va.gov/metadata/Metadata%20Documents/Forms/AllItems.aspx). Below are some answers to general questions about linking the UB-92 form to the FBCS data. 8. As part of the process, claims and supporting documentation are scanned for compliance prior to conversion to electronic format. The SQL tables [Dim]. 2. [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. Medication dosage/strength. VINCI Data Description: Fee/Purchased Care [online; VA intranet only]. This component provides a front end for validation and/or correcting the data that was read from the claim via the OCR module. This table contains information on inpatient care. For billing questions contact: Health Resource Center Each patient should have only one ICN in the entire VA, regardless of the number of facilities at which he is seen. Data in any of the any S tables require Staff Real SSN access. While there is limited information about the vendor available in the SAS datasets; the most comprehensive information about the vendor can be found in the SAS VEN and SAS PHARVEN datasets. The SAS PHARVEN dataset contains information only about pharmacy vendors. 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. (refer to the Category tab under Runtime Dependencies), Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. Researchers and analysts will have to take care to collapse observations properly if warranted, for example to determine the costs, procedures or diagnosis associated with a single stay or visit. Inpatient care, regardless of patients health status, if VA was not notified within 72 hours of admission. The discussion below pertains to both SAS and SQL data. Care provided to persons associated with a particular VA station can be found by selecting records by STA3N. Conversely, all stays should have at least one discharge diagnosis. The status value A stands for accepted, meaning the claim was paid. Accessed October 27, 2015. 3. Primary keys are denoted by (PK) and foreign keys are denoted by (FK). Please contact the referring VAMC for e-fax number. [FeeInpatInvoiceICDProcedure] table. In the outpatient data, one observation represents a single CPT code. The temporary end date is the maximum of these two values. Here, ICDProcedureSID is a primary key in the [Dim]. Fee Basis data are housed in VA in both SAS dataset format and Microsoft SQL server tables (hereafter referred to as SQL data). Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up for it. While many Veterans qualify for free health care services based on a VA compensable service-connected condition or other qualifying factor, most Veterans are asked to complete an annual financial assessment, to determine if they qualify for free services. 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. SAS has more data on inpatient diagnosis and procedure variables than do SQL data. Summary Fee Basis expenditure data are also available through the VHA Support Services Center (VSSC) intranet site, further information about accessing these summary data can be found in Chapter 6. Chief Business Office. 15. Providers are not required to accept VA payment in all cases. There is also a host of non-emergency surgery provided through Fee Basis mechanisms that may be of interest to researchers. VA employees working on operations studies can build their own crosswalk file as they have permission to use these file. This application queues critical claims data into the FBCS shared MS SQL database for further processing and reporting. Veterans Crisis Line: These represent cases in which payment is disallowed. To file a claim for services authorized by VA, follow instructions included in the Submitting Claims section of the referral. SQL Fee Basis files themselves contain limited patient demographic variables, but can be linked to other SQL data. 5. SAS data are housed in 8 ready-to-use datasets per fiscal year. In SAS, the cost of an inpatient stay can be determined by summing the cost from DISAMT in the inpatient files with the DISAMT from the ancillary observations that correspond to the inpatient stay; however, the inpatient and ancillary files alone may not be sufficient to account for the entire cost of care. Hit enter to expand a main menu option (Health, Benefits, etc). All access Journal of Rehabilitation Research and Development. Technologies must be operated and maintained in accordance with Federal and Department security and We recommend researchers use the FeePurposeOfVisit codes (FPOV) codes to eliminate observations related to non-outpatient care before beginning analyses. If there are multiple providers using the same entity to bill their claims, it will not be possible to disaggregate what type of provider the patient saw (e.g., an internal medicine physician or an infectious disease specialist). This component provides a front end for scanning claim forms into a temporary image queue for a given patient. FBCS is designed to be used in the Fee Basis Departments of the Veteran Affairs Medical Centers (VAMCs). Section 508 compliance may be reviewed by the Section 508 Office and appropriate remedial action required if necessary. Not all of these variables appear in every utilization file. Fee Basis data live in both SAS and SQL format. Note: A Veterans insurance coverage or lack of insurance coverage does not determine their eligibility for treatment at a VA health care facility. One may therefore assume that all patients receiving treatment through the Non-VA Medical Care program are Veterans. Subscribe to our E-newsletter The Service Connection Our monthly newsletter features about important and up-to-date veterans' law news, keeping you informed about the changes that matter. National Provider Identifier: Submit all that are applicable, including, but not limited to billing, rendering/servicing, and referring. [SpatientAddress] tables. NNPO. 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. 4. Veterans who have private health insurance should consider a number of important factors before canceling their health insurance, such as: If you cancel your Medicare Part B Coverage, you need to know that you cannot be reinstated until January of the following year, and you may be penalized for reinstatement. 6. National Non-VA Medical Care Program Office (NNPO). Thus, one could not simply use the patient identifier and the admission and discharge dates to collapse these observations into one inpatient stay. Using the Non-VA Medical Care data for research requires a basic understanding of laws and regulations that govern it. Outpatient data are housed in the FeeServiceProvided table. U.S. Department of Veterans Affairs. This component is a service that communicates with the Program Integrity Tool (PIT) which scores claims and sends results to FBCS. Available at: http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf.. 3. This product is Class 2 or Class 3 VA-designed and built Local Software OR is a commercially-licensed software product purchased or leased that will run in a VA VISTA environment or integrate with Class 1 National VISTA Software. Table 8 denotes on which CDW servers Fee Basis data are housed. However, there are best practices that all SQL-based analyses should follow. The vendor identity can be found through the FeeVendorSID or the FeeVendorIEN variables in SQL. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. Some Fee Basis data will also appear in the non-VA medical SAS inpatient file (formerly called the Patient Treatment File). The Veterans Emergency Care Fairness Act (Public Law 111-137), signed February 1, 2010, authorizes VA as a secondary payer to third party liability insurance not related to health insurance. Analyses of FY 2014 data indicate approximately 50% of inpatient observations and 43% of outpatient observations are missing NPI. Training - Exposure - Experience (TEE) Tournament. Please note that this method providers an indication of the care provided to a Veteran on a single day, rather than in a single encounter, because multiple providers may use the same billing vendor. Care provided in foreign countries other than the Philippines. Among non-missing observations, HERC analyses found a many-to-many relationship among NPI and VEN13N. If disbursed amount is missing (but not $0), use payment amount instead. For additional information or assistance regarding Section 508, please contact the Section 508 Office at Section508@va.gov. have hearing loss. Thus, researchers using later years of data should be aware that files are not static and will continue to be updated. Nevertheless, the National Non-VA Medical Care Program Office (now the VHA Office of Community Care) has interpreted VHA Directive 2006-029 to preclude Non-VA Medical Care providers from receiving payment for prosthetics. Name of the medication. How Much Life Insurance Do You Really Need? Generally, VA does not bill Medicare or Medicaid for reimbursement; however, VA does bill other types of health insurance including Medicare Supplemental plans for covered services. The deadline for claims submission is dependent upon which program the care has been authorized through or which program the emergency care will be considered under. The mileage fee varies by type of ambulance service: ground, fixed wing, or rotary wing, POP zip code classification, and loaded mileage. If your claim was submitted to VA, call (877) 881-7618, If your claim was submitted to TriWest, call (877) 226-8749. There may be many providers that use the same vendor for billing. Unauthorized care can be of an inpatient or outpatient nature. Appendix E includes a list of SQL fields related to the type of care a patient receives. privacy policies and guidelines. Ready. Veterans Health Administration. Data Quality Analysis Team. Veterans Health Administration. Thus, the mailing address of the vendor is not always the vendors actual location. Claims for Non-VA Emergency Care Hit enter to expand a main menu option (Health, Benefits, etc). There are 3 categories of geographic data: veteran-related information, vendor-related information and VA-station related information. In some cases it may appear that single encounters have duplicate payments. Most commonly, authorized care refers to medical or dental care that was approved and arranged by VA to be completed in the community. Most nursing home care is billed monthly, so there is one claim for each month of nursing home stay. [FeeInpatInvoiceICDDiagnosis] with the [Dim]. You are strongly encouraged to electronically submit claims and required supporting documentation. 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. Inpatient data are housed in the FeeInpatInvoice table as well as the FeeServiceProvided table, although the latter does not contain only inpatient data. Before working with any SQL tables in CDW, we recommended familiarizing yourself with the schema diagram in order to understand how to link tables to one another. VA Informatics and Computing Resource Center (VINCI). It may duplicate the PatientIEN of another patient at another facility, and should not be used as an identifier. The PatientSID is a CDW assigned identifier that uniquely identifies a patient within a facility. Of note, the FBCS was not in place nationwide prior to FY 2008. There is a lack of publicly available technical documentation and support may be limited to specific forums. [ICDProcedure] table and a foreign key in the [Fee]. Of note, SQL and SAS data contain similar, but not exactly the same, information. This rare event most likely indicates a transfer. The following information should help you understand who to submit claims to and the requirements you must follow when submitting claims. [ SFeeVendor] table. Emergency claims covered under the Veterans Millennium Care and Benefits Act, Public Law 106-117); see 29 CFR 17.120 and 38 CFR 17.1004. In both SQL and SAS data, there is also a variable regarding the fee specialty code. Private health insurance coverage through a Veteran or Veteran's spouse is insurance provided by an employer, Veteran or other non-federal source, including Medicare . This application is directly attached to TWAIN compliant scanners and works offline to VistA and the FBCS MS SQL databases. Department of Veterans Affairs Claims Intake Center PO Box 4444 Janesville, WI 53547-4444 Or, you can fax it to: (844) 531-7818 (inside the U.S.) (248) 524-4260 (outside the U.S.) Visit your local VA regional office or Benefits Delivery at Discharge Intake Site and speak with a VA representative to assist you. The dates of service are represented by the covered from/to fields of the UB-92. We are the third-party administrator for the VA CCN for Regions 1, 2 and 3, encompassing 36 states, Puerto Rico, the U.S. Virgin Islands and the District of Columbia. E-fax: Documentation sent via email to Veterans Affairs Medical Center (VAMC) fax machine. Below we describe the general types of information in both the SAS and SQL data. The SAS files also include a patient type variable (PATTYPE). 2. In this situation, a given VA medical center has a preferred hospital from which it purchases care. March 2015. The Department of Veterans Affairs (VA) often pays providers in the community to provide care to Veterans when it is unable to provide such care itself (e.g., due to a lack of resources or delays in providing care), or when it is infeasible to do so (e.g., emergency care). 2. 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. See 38 USC 1725 and 1728.). 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. PatientIEN is assigned by the facility. The Fee Basis files primary purpose is to record VA payments to non-VA providers. In both SAS and SQL, it can be difficult to determine the provider the Veteran saw for Fee Basis care. what is specified but is not to exceed or affect previous decimal places. would cover any version of 7.4. All persons working with these data should review this information before conducting any analyses. For education claims, refer to the appropriate Regional Processing Office. Compare the discharge date of the first observation to the admission date of the next (second) observation. A record is created only if there is a code on the invoice to be recorded. U.S. Department of Veterans Affairs. Menlo Park, CA. Providers cannot bill both VA and the patient or another insurer for the same encounter. FPOV values of 32 and 33 also indicate ED visits, but are only observed in the Ancillary file. For pension claims, use the Pension Management Center (PMC) that serves your state. As noted above, non-VA care may be authorized under the Non-VA Medical Care program when VA cannot offer needed care. If that analyst examines VEN13N and STA6A (in inpatient Fee Basis data, this field represents the VA hospital arranging care), there is often only one MDCAREID. Most of these fields would be empty.