As noted above, non-VA care may be authorized under the Non-VA Medical Care program when VA cannot offer needed care. 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. The prescriptions filled by fee-basis pharmacies are often small quantities of medication to meet the patients emergency or short-term needs while a CMOP prescription is being filled. To access the menus on this page please perform the following steps. For example, DISAMT=1000 in FY06 really indicates DISAMT=10.00. All SAS prescription-related data is found in two files: the PHR file and the PHARMVEN file. If electronic capability is not available, providers can submit claims by mail or secure fax. 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. For example, accessing FY2014 data on Dec 1, 2014 will likely result in fewer observations than when accessing FY 2014 data on Dec 1, 2015. 3. The OI&T Enterprise Program Management Office does not endorse nor support Class 2 and Class 3 products and does not support data usage or application programmer interfaces (APIs) between Class 1 National Software products and Class 2 or Class 3 products. Much Fee Basis care is pre-authorized prior to the Veteran obtaining care and is thus considered Authorized Care. Office of Information and Analytics. If the VA Fee Schedule does not include a rate for the covered service provided, reimbursement will be made at 100% of customary charges, as defined in the provider's VA CCN Payment Appendix. U.S. Department of Veterans Affairs. Each table has only one primary key field. Our office is located at 6940 O St, Suite 400 Lincoln NE 68510. SAS data are also available in CDW, but are currently limited to those VA employees with operational access. Users of the data should keep in mind that these data represent the physical location of the entity billing for care, which may or may not be the same as the providers location. Identifying Veterans in the CDW [online; VA intranet only]. VIReC. Visit the VHA Data Portal for further information on accessing restricted VSSC web reports. HERC investigation of Fee Files reveals certain data anomalies of which researchers should be aware. This application completes the update of critical claims data into the FBCS shared MS SQL database for further processing and reporting. Claims should be mailed to the following address: VA Eastern Kansas Health Care System Attn: Fee Basis Office 2200 SW Gage Blvd Topeka. In both the SAS and the SQL data, there are usually multiple observations per patient encounter. For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/. The payment category (PAYCAT) is missing for all records in the inpatient services (ANCIL) file. Austin Information Technology Center (AITC) is one of the VAs five national data centers. In the SAS data, the provider component of the inpatient stay is captured in the ancillary file. More information can be found at the OPES website: http://opes.vssc.med.va.gov. [FeePharmacyInvoice] table contains information on vendor, amount claimed, and amount paid. [Patient], [SPatient]. Values for Fee Purpose of Visit (FPOV), HCFA Payment Type (HCFATYPE), Treatment Code (TRETYPE), Place of Service (PLSER), and Vendor Type (TYPE) appear in Appendix B. Search VA Fee Basis Programs PayerID 12115 and find the complete info about VA Fee Basis Programs Insurance Type, LOB, ENR, RTE, RTS, ERA, SEC, Customer Service Number and more . The zip code accompanying the VEN13 variable denotes the zip code to which VA sent reimbursement, not the zip code where the service was rendered. If a researcher wishes to find the Medicare hospital provider ID, one approach is to use the vendor identification variables (VEN13N, VENDID) to locate the vendors name and location in the VEN file, and then to use this information to find the Medicare provider ID using publicly available files from CMS, the agency that oversees the Medicare program. Non-VA Medical Care data may be tabulated at the VHA Support Services Center (VSSC) (VA intranet only: http://vssc.med.va.gov/). PatientIEN and PatientSID are found in the general Fee Basis tables. We suggest using only the first 3 characters from sta3n for the merge. VA Informatics and Computing Resource Center (VINCI). Customer Engagement Portal - Veterans Affairs In this situation, a given VA medical center has a preferred hospital from which it purchases care. The base rate varies by level of ambulance service provided, locality of the Medicare carrier area, and Point of Pickup (POP) zip code classification: urban, rural, or "super rural." For pension claims, use the Pension Management Center (PMC) that serves your state. Therefore, to make a complete assessment of the payments for inpatient cases, researchers should evaluate the outpatient files along with the inpatient and ancillary files. 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). Accessed October 07, 2015. Table 1 in the Data Quality Analysis teams guide Linking Patient Data in the CDW Updateprovides a brief summary for each identifier (Available atthe VHA Data Portal. We believe that payments are then made from the claim data available from the Claims Reconciliation and Auditing: Program Integrity Tool (PIT) with lump sum/expedited payments being made on a weekly basis and retrospective review, as well as recoupment efforts for overpayments/duplicates. Go to CDW Home, click on CDW MetaData, then click on the link for Purchased Care. The Medicare Ambulance Fee Schedule consists of a base rate plus mileage. Please see Section 2.1.4. for HERC advice about how to collapse multiple observations to evaluate the length and cost of a single inpatient stay. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. Prior to the passage of this law on May 1, 2010, VA did not cover the cost of health care provided to dependent children, including newborns in situations where VA pays for the mothers obstetric care during the same stay. In particular, CDW also recommends Patient SIDs with a value of less than 1 be deleted. Of note, SQL and SAS data contain similar, but not exactly the same, information. Primary keys are denoted by (PK) and foreign keys are denoted by (FK). Use of this technology is strictly controlled and not available for use within the general population. This guide serves as an addendum to any technical documentation supplied by the healthcare clearinghouse when establishing a trading partner agreement. Outpatient prescriptions beyond a 10-day supply. Hit enter to expand a main menu option (Health, Benefits, etc). The Fee Basis files primary purpose is to record VA payments to non-VA providers. The Caregivers and Veterans Omnibus Health Services Act of 2010 (Public Law 111-163) authorizes VA to provide post-delivery and routine care to a newborn child of qualifying women Veterans receiving VA maternity care for up to seven days following the birth. There is very limited outpatient pharmacy data in the Fee files. There are also a number of other financial variables denoted in SAS (see Table 7). 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. Non-emergency care must be approved before the Veteran seeks care in the community.3 For traditional Non-VA care, a Veterans VA provider will submit a request at the local VA facility for Veteran care provided by Fee Basis. Veterans Choice Program (VCP) Overview [online]. 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. 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. Five additional variables Financial Management System (FMS) transaction number, line number, date, batch number, and release date reflect processing of payments through the FMS. 1. Most of these fields would be empty. 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. Another approach is to search other fee claims submitted by the same vendor to see if a Medicare hospital ID was assigned to those claims. 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. Each observation in the SAS and SQL data has an accompanying vendor ID. Box 30780, Tampa FL 33630-3780. Four FPOV (Fee Purpose of Visit) codes can be used to identify payment for unauthorized claims. This guidebook is intended to help researchers understand and use the National Fee Basis files, which come in both SQL and SAS formats. visit VeteransCrisisLine.net for more resources. In general, persons on active duty in the U.S. military are excluded even if they are transitioning to VA care. Defining a cohort is an activity that is different for each project and depends on the research question at hand. 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. Community provider mails the paper claims and documentation to the new mailing address of VA's central claims intake location. Researchers can look at the disposition variable as an indicator of transfer between VA and non-VA care. All observations for this particular patient ID, STA3N and VEN13N where the admission date comes on or after the admission date of the first record AND the discharge date comes on or before the temporary end date are considered to be part of the same inpatient stay. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). HERC Veterans Choice Program - Fee Basis Claims System in CDW Fee Basis Claims System (FBCS) in the VA Corporate Data Warehouse All Choice claims are processed by VISN 15. 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. The 275 transaction process should not be utilized for the submission of any other documentation for authorized care. The Fee Basis VA program allows Veterans to be seen by a community provider. Beware of VISNS 4, 15, and 23, as they have their own integrated system. VA medical centers may purchase prosthetics and related items, such as clothing specialized for prosthetic limbs, and then dispense them through VA facilities. These correspond to fields, rows and tables in a relational database. However, we conducted some comparisons for inpatient data. As of July 2015, the current mileage reimbursement rate is 41.5 cents per mile. The FPOV variable can be found in both the SAS and SQL data. 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. Accessed October 27, 2015. 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. 5. field. Previously, VA could reimburse Veterans or pay non-VA hospitals directly only if a Veteran has no other health insurance. NPI and Medicare IDs have an M to M relationship. In some cases, there is a one-to-one relationship between VEN13N and MDCAREID. At the time of writing, SAS data at CDW are available only to those persons with VA operations access. Appendix E includes a list of SQL fields related to the type of care a patient receives. If FIPS 140-2 encryption at the application level is not technically possible, FIPS 140-2 compliant full disk encryption (FOE) must be implemented on the hard drive where the DBMS resides. The SAS data are stored at AITC. 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. Available at: http://vaww.vhadataportal.med.va.gov/Portals/0/DataQualityProgram/Reports/Identifying_Veterans_in_CDW.pdf. Unlike the inpatient data, there can be multiple records with the same invoice number. [FeeInpatInvoiceICDProcedure] table. Each year represents the year in which the claim was processed, not the year in which the service was rendered. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. DART is a workflow application that guides users through the request by collecting the appropriate documents, distributing documentation to reviewers, and assisting in communication between requestors and reviewers. 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]. 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. Chief Business Office. Users interested in learning the rules in force at a particular point in time should contact the VHA Office of Community Care. VINCI Data Description: Dimension [online; VA intranet only]. Get the latest updates on VA community care, including program changes, resources and more! 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. The SAS Fee Basis data are organized by fiscal year. VHA Office of FinanceP.O. The temporary end date is the maximum of these two values. One can use the FeeInitialTreatmentSID variable in the FeeServiceProvided table to link to the Fee.FeeInitialTreatment table. resides on and transmits through computer systems and networks funded by the VA. In SQL, these variables can be found in the [Dim]. 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. They appear in Table 6, where an X indicates that the variable appears in the file.10 Vendor type (TYPE), payment category (PAYCAT), treatment code (TRETYPE), and place of service (PLSER) all provide information on the type or setting of care. These tables involve payments paid only through FBCS. With few exceptions these variables will be of little interest to researchers. Below are some answers to general questions about the FBCS tables. 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/. 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. VA Informatics and Computing Resource Center (VINCI). To enter and activate the submenu links, hit the down arrow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. To access the menus on this page please perform the following steps. 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. The vendor identity can be found through the VENDID or VEN13N variables in SAS. The mileage fee varies by type of ambulance service: ground, fixed wing, or rotary wing, POP zip code classification, and loaded mileage. In SAS, this variable is called DISTYP, or disposition type, and is located in the Inpatient and Ancillary tables. 1. 1. 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. Ready. Money collected by VA from private health insurance carriers is returned back to the VA medical center providing the care. A Fee table will contain a record for an ICD-9 code, whereas a DIM table will contain the possible values of that ICD-9 code. As a Class 2 or Class 3 product, it MUST NOT be assumed to having been released into production through all OI&T product release and sustainment process controls for project management; requirements, development and testing management; and configuration, change, and release management necessary to satisfy OI&T process and product compliance. If a patient received care at another facility, that patient will be have a different PatientSID assigned for that facility. There is limited information on the providers associated with Fee Basis care. 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. Community Care Network Region 5 (authorized), Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, Indian Health Service/Tribal Health Program, CHAMPVA In-house Treatment Initiative (CITI), Indian Health Services/Tribal Health/Urban Indian, Spina Bifida Health Care Benefits Program, Veterans Health Information Exchange Program, Durable Medical Equipment/ Pharmacy Requirements, War Related Illness & Injury Study Center, Clinical Trainees (Academic Affiliations), Medical Document Submission Requirements for Care Coordination, Azure Rights Management Services (Azure RMS), Call TTY if you In SQL, the outpatient data are housed in the FeeServiceProvided table. VA will arrange for transportation for them or will reimburse expenses on the basis of vouchers submitted. Attention A T users. SQL Fee Basis files themselves contain limited patient demographic variables, but can be linked to other SQL data. U.S. Department of Veterans Affairs. 7. To enter and activate the submenu links, hit the down arrow. HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. Please switch auto forms mode to off. 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. [XXX] tables.9,12 Tables under the DIM schema contain attributes that describe the records in the Fee tables. Previous work conducted for the HERC 2008 Fee Basis guidebook found that the cost of inpatient pharmacy was included in the inpatient records of the SAS INPT file. Contractor Announces Plan To Fix Non-VA Fee Basis Claims After a claim is submitted electronically it must be entered manually into a Non-VA Medical Care approval system. As noted above, there are differences in the patient identifier and the date variables in the SAS versus SQL data; both data sources do not contain the same variables regarding patient identifier or date the claim was paid. Available at: http://www.va.gov/opa/choiceact/documents/FactSheets/Veterans_Choice_Program_Eligibility_Details_August_1_Removal.pdf.. 3. Va Fee Basis Program Claims Address - pijonajalin.weebly.com VIReC Research User Guide: VHA Medical SAS Outpatient Datasets FY2006. Payer ID for dental claims is CDCA1. 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. have hearing loss. For example, the meaning of DRG001 is not the same in FY05 vs FY15. Payments received from a Veterans private health insurance carrier are credited towards any applicable VA copayments, reducing all or part of the Veterans out-of-pocket expenses. Non-VA Medical Care consumes a significant portion of VA spending; indeed, contract costs (i.e., the cost of all things purchased from non-VA health care providers) accounted for approximately 11% of VA expenditures in fiscal year 2014. However, a 7.4.x decision Name of the medication. Hit enter to expand a main menu option (Health, Benefits, etc). 2. Customer Call Center: 877-881-76188:05 a.m. to 6:45 p.m. Eastern TimeMondayFriday, Sign up for the Provider Advisor newsletter, Veterans Crisis Line: [FeeInpatInvoice], and a foreign key in the [Fee].[FeeInpatInvoiceICDProcedure]. HERC: Fee Basis Data: A Guide for Researchers - Veterans Affairs 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. To access the menus on this page please perform the following steps. 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. Compare the discharge date of the first observation to the admission date of the next (second) observation. VA employees working on operations studies can build their own crosswalk file as they have permission to use these file. How to create a secondary claims in eclinicalworks electronically; . However, investigation has confirmed these are partial payments made for a single encounter or procedure. More information about provider reimbursement can be found in the document Working with the Veterans Health Administration: A Guide for Providers (available on the VHA Office of Community Care website, on the Provider Resources page).5. This application is directly attached to TWAIN compliant scanners and works offline to VistA and the FBCS MS SQL databases. VA Health Care: Management and Oversight of Fee Basis Care Need 1725 when remaining liability to the Veteran is not a copayment or similar payment. The VA pays for both emergency and non-emergency care through Fee Basis mechanisms. VA has adopted a policy of processing payments for certain EDI claims outside of FBCS (Choice/PCCC) by rerouting the EDI claims back to the HAC, causing them to reach terminal status in FBCS and triggering a transition to the PIT repository. Information from this system resides on and transmits through computer systems and networks funded by the VA. The procedure code table has just as many records as there were procedures on the invoice. Therefore, to make a complete assessment of the payments for inpatient cases, researchers should evaluate the outpatient files along with the inpatient and ancillary files. SQL inpatient data contain up to 5 diagnoses and 5 procedure codes, while SAS inpatient data contain up to 25 diagnosis codes and up to 25 procedure codes. Please switch auto forms mode to off. Persons looking to classify Veterans military service are encouraged to read the Data Quality Analysis Teams guidance on Identifying Veterans in the CDW(VA intranet only:http://vaww.vhadataportal.med.va.gov/Portals/0/DataQualityProgram/Reports/Identifying_Veterans_in_CDW.pdf).14. Table 3 lists their file names and gives a general description of their contents.10. One way to do this is to concatenate the vendor identifier, the patient identifier, and the visit date. If disbursed amount is missing (but not $0), use payment amount instead. For current information on Community Care data, please visit the page. Those with access to the VA intranet can find a list of SQL fields on the CDW MetaData site. VA employees working on research studies cannot create their own crosswalk file as they do not have permission to use these files. To access the menus on this page please perform the following steps. Our review of the data suggests that pharmacy and ancillary claims take longer to process than inpatient or outpatient claims. Researchers evaluating care over time may want to use the DRG variable. However, there is one situation in which the payment amount will be more accurate than the disbursed amount: when the disbursed amount is missing, and the payment was not cancelled, one should use the payment amount to capture the cost of care. The same cannot be said for DX2-DX25, however, as additional diagnosis codes are optional. Download the tables here. Questions about non-VA care claims may be directed to the Fee Basis Unit between the hours of 8:00 a.m. Email Address Required. 3. . Chapter 6 contains more information about how to access these data. Health Information Governance. SQL tables require linking before conducting any data analyses. [PatientRace] tables. At the time of this writing, the NPI number was often missing from fee basis claims. 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.