VA's fee basis care program. VA patients who receive prescriptions from non-VA providers fill them from a VA pharmacy, often the VA Certified Mail Order Pharmacy (CMOP). Because coding varies by station, users are encouraged to employ multiple variables in an effort to find all care associated with a particular setting or service type. 9.2. VA Technical Reference Model - DigitalVA The Fee Basis files primary purpose is to record VA payments to non-VA providers. Domains generally indicate the application in the VistA electronic health record system from which most of the data elements come (e.g., Vital Signs or Mental Health Assessment).6. No, only one type of care can be covered by a single authorization. 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. The SQL tables [Dim]. The VEN13N is the vendor ID with a suffix; VEN13N is more detailed than VENDID and is thus recommended for use. Hit enter to expand a main menu option (Health, Benefits, etc). 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. Multiple SAS datasets have VENID and VEN13N. Journal of Rehabilitation Research and Development. There are multiple methods by which community providers may electronically provide VA with the required medical documentation for care coordination purposes. Updated August 26, 2015. There may be multiple CPT codes associated with a single encounter. VSSC provides numerous relevant web reports, data resources, and analytics support, including summary data by facility and VISN and national summary data. NNPO. VA decisions for specific versions may include + symbols; which denotes that the decision for the version specified also includes versions greater than The FeeSpecialtyCodeName contains information on the specialty of the provider seen, such as oncology, chiropractic, pathology, neurosurgery, etc., but is missing much data. Contact the VA North Texas Health Care System. VA Information Resource Center. All analyses using this cohort should use PatientICN as indicative of a unique patient. Benefits Delivery at Discharge - Pre-Discharge - Veterans Affairs Accessed October 16, 2015. 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. SQL data contain the following vendor information: NPI, FeeVendorSID, FeeVendorIEN, NPI, VendorType and FeeSpecialtyCodeName. More information can be found at the OPES website: http://opes.vssc.med.va.gov. [FeeServiceProvided] tables. Researchers with the appropriate DART permissions can ask the studys VINCI data manager to create a crosswalk file. Dental claims must be filed via 837 EDI transaction or using the most current. Payer ID for dental claims is 12116. 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. In SQL, these variables can be found in the [Dim]. The Vendor Release table provides the known releases for the. 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. Operating Systems Supported by the Technology. The VA pays for both emergency and non-emergency care through Fee Basis mechanisms. Researchers can read more information about accessing CDW on the VHA Data Portal (http://vaww.vhadataportal.med.va.gov/DataSources/CDW.aspx; VA intranet only). Six additional variables indicate the setting of care and vendor or care type. National Non-VA Medical Care Program Office (NNPO). VA evaluates these claims and decides how much to reimburse these providers for care. Driving distance between a veterans residence and their closest VA facility is over 40 miles, c. The veteran must travel by boat or plane to access the VA facility closest to their home (excluding Guam, American Samoa, or the Republic of the Philippines), d. The veteran faces an excessive burden in traveling to a VA, including a body of water or geologic formation that cannot be crossed by road. U.S. Department of Veterans Affairs. This is a critical difference from VA utilization files, which are organized by date of service. Facility charges vs. ancillary charges: There are instances when there may be claims for facility charges with no corresponding ancillary provider charge. Available at: http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. 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. To learn more, please visit the Provider Training section on the MES website . In addition, VA may place a Veteran in a private or state-run nursing home when a bed in a VA nursing home is unavailable or if the nursing home is distant from the patients residence. 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. (Available at the VHA Data Portal. The funds are used to provide the best care possible to our Veterans. VA Technical Reference Model v 23.2 DSS Fee Basis Claims Systems (FBCS) General Decision Reference Component Category Analysis General Information Technologies must be operated and maintained in accordance with Federal and Department security and privacy policies and guidelines. Not all of these variables appear in every utilization file. a. We gratefully acknowledge comments and contributions from Sharon Dally, Susan Schmitt and Paul Barnett. Payment for these types of care falls under the Non-VA Medical Care program. The 275 transaction process should not be utilized for the submission of any other documentation for authorized care. Claims for Non-VA Emergency Care [SpatientAddress] tables. For billing questions contact: Health Resource Center Please visit Emergency Care Claims to learn more. 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. VA is also the primary and sole payer for unauthorized emergent care approved under 38 U.S.C. Please switch auto forms mode to off. Available at: http://www.mssny.org/Documents/Enews/Aug%208%202014/VA%20ProvidersGuide.pdf, 6. The procedure code table has just as many records as there were procedures on the invoice. The dates of service are represented by the covered from/to fields of the UB-92. 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. Outpatient data are housed in the FeeServiceProvided table. Payment of ambulance transportation under 38 U.S.C. Some VA medical centers purchase care from only one of the hospitals in the chain. In some cases, there is a one-to-one relationship between VEN13N and MDCAREID. 1725 or 38 U.S.C. The slight decrease in fiscal year 2012 spending from the fiscal year 2011 level was due to VA's adoption of Medicare rates as its primary payment method for fee basis providers. 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. We encourage readers to seek out the latest guidance before conducting analyses, as CDW Data Quality Analysis team may have updates to this information. The mileage is calculated using the fastest route. [ICD] table, the latter of which contains a list of all possible ICD-9 codes. Unauthorized inpatient or outpatient claims must be submitted within 90 days from the date of care. VIReC Research User Guide: VHA Medical SAS Outpatient Datasets FY2006. The Fee Card (VET) file contains only summary payment figures by month, although researchers can match the records to other data by SCRSSN and other identifiers. Documentation, including data contents, field frequencies, and record counts, is also available on VIReCs CDW Data Documentation page (VA intranet only: http://vaww.virec.research.va.gov/CDW/Documentation.htm). With additional permissions, researchers can also access City, Postal Code, Street Address, and Zip. Non-VA Payment Methodology Matrix [online; VA intranet only]. The FPOV variable can be found in both the SAS and SQL data. 1725 may only be made if payment to the facility for the emergency care is authorized, or death occurred during transport. [FeeInpatInvoice], and a foreign key in the [Fee].[FeeInpatInvoiceICDProcedure]. ______________________________________________________________________________. A description of the Patient and SPatient schema is available on the VIReC CDW Documentation webpage: http://vaww.virec.research.va.gov/CDW/Documentation.htm (intranet only). For these reasons, the program does not pay for 100% of care that was otherwise eligible. would cover any version of 7.4. 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. Non-VA providers submit claims for reimbursement to VA. Data in any of the any S tables require Staff Real SSN access. Florida Department of Veterans' Affairs | Connecting veterans to Please switch auto forms mode to off. Please switch auto forms mode to off. Submit a corrected claim when you need to replace an entire claim previously submitted and processed. Class 2 or Class 3 products must restrict their interfaces to Class 1 National Software to use of publicly-supported APIs ONLY. We present here one way to collapse records into a single inpatient stay, but users may wish to develop their own method specific to the research question at hand. File a Claim-Information for Veterans - Community Care - Veterans Affairs Data are presented in Table 4. In SAS, the inpatient (INPT) file includes PAMT, the Medicare prospective payment that would apply to the stay. 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. Veterans should mail or fax correspondence pertaining to compensation claims to the below location. Include the authorization number on the claim form for all non-emergent care. Please switch auto forms mode to off. One exception to this is when identifying emergency department (ED) visits. In summary, in order to create a research cohort, one must first identify the cohort based on PatientSID, then request the CDW data manager to link the PatientSIDs in her cohort to unique PatientICNs, and finally remove test/dummy/unnecessary PatientSIDs and PatientICNs. Patient type can take one of seven values: surgical; medical; home nursing; psych contract; psychiatric, neuro contract; or neurological. Unauthorized care can be of an inpatient or outpatient nature. VA must be capable of linking submitted supporting documentation to a corresponding claim. Accessed October 16, 2015. The Implementer of this technology has the responsibility to ensure the version deployed is 508-compliant. Attention A T users. Two domains in which researchers can find reports on Non-VA Care are Resource Management and Workload. 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.