Non-VA providers submit claims for reimbursement to VA. The Fee Basis schema data can be found at the CDW SharePoint portal at the links below (VA intranet only). What documents are required by VA to process claims for. The quantity dispensed. a. VA calculates PAMT from CMS pricer software on the basis of DRG and length of stay. The SAS files also include a patient type variable (PATTYPE). The Fee Basis files are stored in two formats: SAS and SQL. In SAS, data are stored in variables, observations and datasets. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). The Florida Department of Veterans' Affairs has Claims Examiners co-located with the VA Regional Office in Bay Pines, each VA Medical Center and many VA Outpatient Clinics. Veterans Crisis Line:
To enter and activate the submenu links, hit the down arrow. However, the VA may pay a rate higher than the Medicare Fee Schedule rate for care provided in highly rural areas, as long as this rate is determined to be fair and reasonable by VA. One can find more information on payment rates under the Veterans Choice Act in federal regulation 17.1500. 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. ", Military service variables can be found in [PatSub],[PatientServicePeriod], [Patient]. In SAS, the Patient ID will be the SCRSSN and the admit date is the treatment from date. Payer ID for dental claims is 12116. With additional permissions, researchers can also access City, Postal Code, Street Address, and Zip. Most ED visits will be identified through FPOV values of 32 or 33. This rare event most likely indicates a transfer. This latter table contains a variable called InitialTreatmentDateTime. In both the SAS and the SQL data, there are usually multiple observations per patient encounter. In the outpatient data, one observation represents a single CPT code. 1. If a researcher decides to use FPOV, please note that an FPOV value of 52 indicates ED visit for persons whose care is covered under the Millennium Bill and should thus be included in evaluating ED care. There are a number of different variables that denote the category of care a Veteran received through Fee Basis (see Table 2) Appendices B and H present more details about the values these variables can take. Many private health insurance companies will apply VA health care charges towards satisfying a Veteran's annual deductible and maximum out of pocket expnse. Given these different patient identifiers, it is difficult to conduct exact comparisons between SAS and SQL data. A single inpatient encounter may generate zero, one, or multiple ancillary records, depending on the number of ancillary procedures and physician services received. Persons who wish to access data in the secure tables on CDW (denoted by a S prefix) must complete a Real SSN Access Request Form. This form must be signed by the IRB and Associate Chief of Staff for Research and submitted with the DART data request. Electronic 837 claim and 275 supporting documentation submissions can be completed through VAs contracted clearinghouse, Change Healthcare, or through another clearinghouse of your choice. Both the SAS and SQL Fee Basis are housed at VINCI; the SQL data is also found at the Corporate Data Warehouse (CDW). There is no information available in the SAS data that identifies the actual medication dispensed. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B. 2. This most likely reflects a low frequency of surgery rather than missing data. 3. The impact on inpatient and emergent care is unclear, however, as the definition of prosthetic in VA is so broad as to include items placed inside the body, such as internal fixation devices, coronary stents, and cardioverter defibrillators. [FeeTravelPayment] contain information on travel type and payment. The procedure code table has just as many records as there were procedures on the invoice. 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. 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. Thus, our recommendation is as follows: Use disbursed amount to calculate the cost of care, except in the case where disbursed amount is missing and the payment was not cancelled. VA is required by law to bill private health insurance carriers for medical care, supplies and prescriptions provided for treatment of Veterans' nonservice-connected conditions. Documentation in support of a claim may include: *NOTE: Documentation not required includes flowsheets and medication administration. Accessed October 27, 2015. MDCAREID is the Medicare OSCAR number, which is a hospital identifier. (In SAS the admission date is denoted by the TREATDTF variable and the discharge date by the TREATDTO variable, in SQL the admission date is denoted by the AdmissionDate field and the discharge date is denoted by the DischargeDate field). For these reasons, VA strongly encourages Veterans to consider important factors, risks and benefits before making any changes to their private health insurance. If you are in crisis or having thoughts of suicide,
This application queues critical claims data into the FBCS shared MS SQL database for further processing and reporting. For more information, please visit the Data Access Request Tracker (DART) Request Process page on the VHA Data Portal(VA intranet only: http://vaww.vhadataportal.med.va.gov/DataAccess/DARTRequestProcess.aspx#resources). 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. PatientIEN and PatientSID are found in the general Fee Basis tables. Thus, the mailing address of the vendor is not always the vendors actual location. For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/. Claims for Non-VA Emergency Care VA Directive 6402, Modifications to Standardized National Software, Document Storage Systems (DSS) DocManager, Microsoft Structured Query Language (SQL) Server, Optical Character Recognition (OCR) Module, Fidelity National Information Service (FIS) Compass. Note: A Veterans insurance coverage or lack of insurance coverage does not determine their eligibility for treatment at a VA health care facility. Researchers with VA intranet access can access these images by copying and pasting the URLs into their browser. 10. 1. 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. Claims Assistance | Veterans' Affairs - South Carolina For billing questions contact: Health Resource Center To access the menus on this page please perform the following steps. field. 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. In SAS, this variable is called DISTYP, or disposition type, and is located in the Inpatient and Ancillary tables. These include Fee purpose of visit (FPOV), place of service (PLSER), type of treatment (TRETYPE), HCFA payment type (HCFATYPE), and record type (TYPE). E-fax: Documentation sent via email to Veterans Affairs Medical Center (VAMC) fax machine. We give an example here that relates to FeeInpatInvoice table. VA's fee basis care program. [FeeVendor] table. SAS data are also available in CDW, but are currently limited to those VA employees with operational access. Inpatient procedures are captured by ICD-9 procedure codes (SURG9CD1-SURG9CD25) in the hospital claims file. Access; upload; download; change; or delete information on this system; Otherwise misuse this system are strictly prohibited. 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. Appendix H lists their current values. More detailed information about the vendor can be found in the SQL [Dim]. 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. Accesed October 16, 2015. If electronic capability is not available, providers can submit claims by mail or secure fax. In the SQL files, there is no separate ancillary file; rather, data regarding the physician cost of the inpatient stay is denoted in the [Fee]. 2. 1728. 3. Researchers will have to select observations from the SQL FeeServiceProvided table in order to ensure they are only evaluating outpatient data. This could indicate a transfer between facilities or a physician bill for an inpatient stay. http://www.mssny.org/Documents/Enews/Aug%208%202014/VA%20ProvidersGuide.pdf, http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. This component provides administration, reporting, and letter generation for all of the components of the Fee Basis Claims Systems (FBCS) via native Microsoft Structured Query Language (SQL) Server database communication drivers. 15. Note that the vendor may represent the hospital, a hospital chain or the entity billing on behalf of the provider. PatientIEN and PatientSID are unique to a patient within a facility, but not unique to a patient across VA facilities (e.g., a patient who had visited multiple VA facilities will have multiple PatientIENs and multiple PatientSIDs). This component distributes fee workload to particular users using the FBCS MS SQL database and the VistA Gateway. Electronic Data Interchange (EDI): Payer ID for medical claims is TWVACCN. For the purpose of this guidebook, we focus on Fee Basis files only. For example, a hospital stay may last from Jan 1, 2010 to Jan 10, 2010, and have another claim for treatment provided on Jan 5, 2010. It appears that starting in FY2016, Choice data is now bypassing FBCS and residing in the PIT.