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Those with access to the VA intranet can find a list of SQL fields on the CDW MetaData site. _____________________________________________________________________________. Office of Media and Public Relations. VA can make payments to non-VA health care providers under many arrangements. VA Information Resource Center VHA Corporate Data Warehouse [webpage]. The new temporary end date is the maximum of the discharge date of the third observation and temporary end date from Step 2. Thus, one could not simply use the patient identifier and the admission and discharge dates to collapse these observations into one inpatient stay. From 1998 to 2014, approximately 50% of claims were paid within 30 days of VA receiving the invoice, and 95% of claims are paid in 200 days or less. [SpatientAddress] tables. Submit a corrected claim when you need to replace an entire claim previously submitted and processed. These data records cannot be linked to particular patient identifiers or encounters. Some VA medical centers purchase care from only one of the hospitals in the chain. For these reasons, the program does not pay for 100% of care that was otherwise eligible. The Fee Purpose of Visit (FPOV) and Health Care Financing Agency Payment Type (HCFATYPE) variables feature values pertaining to setting (inpatient, outpatient, home-based), specific items (e.g., supplies and diagnostics), and miscellaneous purposes.[1]. It appears that starting in FY2016, Choice data is now bypassing FBCS and residing in the PIT. On March 17, 2022, The U.S. Court of Appeals for the Federal Circuit issued a ruling that changes VAs ability to reimburse as secondary payer under 38 U.S.C.1725. You can find more information about eligibility on the VHA Office of Community Care website. SQL Fee Basis files themselves contain limited patient demographic variables, but can be linked to other SQL data. The veteran must wait over 30 days past their preferred appointment date or the date deemed medically necessary by their provider, b. 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). Reimbursements appear in the Travel Expenses (TVL) file. [XXX] tables.9,12 Tables under the DIM schema contain attributes that describe the records in the Fee tables. In SQL, the outpatient data are housed in the FeeServiceProvided table. For example, a technology approved with a decision for 12.6.4+ would cover any version that is greater than 12.6.4, but would not exceed the .6 decimal ie: 12.6.401 Address. Each patient should have only one ICN in the entire VA, regardless of the number of facilities at which he is seen. To enter and activate the submenu links, hit the down arrow. Go to CDW Home, click on CDW MetaData, then click on the link for Purchased Care. Business Product Management. Use Azure Rights Management Services (Azure RMS) for encrypted email. Therefore, it is not possible to do an exact comparison across the datasets. Claims for Non-VA Emergency Care SAS and SQL data are organized differently and contain different variables. 16. It is not necessarily the station at which the Veteran receives most VA care or the station which will pay for a particular Non-VA Medical Care service. For current information on Community Care data, please visit the page. However, not all data in the FeeServiceProvided table are outpatient data; some may pertain to inpatient stays. (Anything) - 7.(Anything). The travel payments data contains reimbursements for particular travel events (TVLAMT). 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. Prior to FY 2007, INTAMT has two implied decimal places. Inpatient care beyond the time when a patient is stabilized and can be transferred to a VA facility, except where a VA facility is not feasibly available. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. Each prescription record has a fill date and a patient identifier (either PatientICN or scrambled social security number). Data from FY1998 and FY1999 have a greater degree of discordance. For example, sta3n 589A5 will be found as 589. SQL Fee Basis data are stored in the form of multiple relational tables that must be linked, or in SQL parlance, joined, in order to create an analysis dataset. 1. If a Veteran has only Medicare Part A then VA may consider payment for ancillary and professional services usually covered under Part B. Electronic Data Interchange (EDI): Payer ID for medical claims is TWVACCN. Missing values of PAYCAT could be imputed by finding the corresponding inpatient stay in the INPT file. Other Health Insurance (OHI) and Explanation of Benefits (EOBs), Any other document type normally sent via paper in support of a Veteran unauthorized emergency claim. They do not represent all claims received during the year. In the SAS data, the provider component of the inpatient stay is captured in the ancillary file. The Act amends 38 U.S.C. To access the menus on this page please perform the following steps. 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 is specific to certain claims for Non-Service Connected emergency medical care under Title 38 USC 1725. Health Information Governance. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). (formerly known as VA Fee Basis or NonVA)-Community provider submits the claim and supporting documentation through their EDI provider services in . MDCAREID is not available in the outpatient SAS Fee Basis data, even though some outpatient services are provided in a hospital. 3. This rule applies even when the patient is incapable of making a call. VA Fee Basis Programs. Hit enter to expand a main menu option (Health, Benefits, etc). 7. 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. resides on and transmits through computer systems and networks funded by the VA. Request and Coordinate Care: Find more information about submitting documentation for authorized care. For example, if a physician billed for a complete blood count and a venipuncture in the same day, there would be two records with the same invoice number, but different CPT codes and different claimed amounts. a. Accessed October 07, 2015. Appendices G and H, copied from the Non-VA Medical Care program website, describes in detail the types of records for which each Fee Purpose of Visit (FPOV) codes are assigned. This seeming complicated arrangement is an efficient way to store data. PatientICN is assigned by CDW. The VA payment (DISAMT) is typically less than or equal to the PAMT value, although in some cases VA will pay more than Medicare would pay. Fee Purpose of Visit is the recommended way to evaluate the category of the visit. One exception to this is when identifying emergency department (ED) visits. There is no separate payment for items such as oxygen or other supplies, the number of attendants, providing an EKG during the trip, etc. The Fee Basis files are stored in two formats: SAS and SQL. There may be multiple vendor IDs (VENDIDs) for a single inpatient stay. 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. Then, to see which ICD procedure codes were coded for this inpatient stay, one must link to the [Dim]. This component provides a front end for validation and/or correcting the data that was read from the claim via the OCR module. Details about the VA rules governing reimbursement can be found in Chapter 7 of this guidebook. We found SPECIALPROVCAT was missing in 93% of records. For home loan matters, contact a Regional Loan Center and for Veteran Readiness and Employment matters, contact your local regional office at their physical address. First, it includes both the payment amount and any interest that may apply. 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. VA can also pay for hospice care for Veterans when the VA facility is unable to provide the needed care; this happens frequently, as VA provides only inpatient-based hospice care and many Veterans may wish to receive hospice at home or in the community. UB-92 box 56 (ProviderNPI) represents the providers National Provider Identifier. 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. NPI is available within the VA CDW SStaff table. SAS data are housed in 8 ready-to-use datasets per fiscal year. All access More information can be found at the OPES website: http://opes.vssc.med.va.gov. This variable is defined as 1st Diagnosis Code. A comparison from FY 2009 to 2014 data reveals that DX1 in SAS corresponds to DX1 in SQL data, and up to 2008, DXLSF in SAS corresponds to DX1 in SQL (see Table 5). Researchers who have never before used CDW are encouraged to read the VA CDW First Time Users guide, available from the VIReC website (VAintranet only:http://vaww.virec.research.va.gov/CDW/Overview.htm). FBCS is moving to a centralized system in the near future, where there will be centralized rules and national policies with 3 distinct groups: CCN (network), CCRA (authorization), and CCRS (reimbursement system; an IBM product). 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. Some encounters have multiple procedures that are paid as a single encounter; other encounters have multiple procedures and there are separate payments for each procedure. There are nine situations in which Non-VA Medical Care is authorized. We suggest using only the first 3 characters from sta3n for the merge. In this situation, a given VA medical center has a preferred hospital from which it purchases care. It would seem logical to use the vendors location, found in the vendor files PHARVEN and VEN, to associate care with a particular station, but this should be approached with caution. Each year represents the year in which the claim was processed, not the year in which the service was rendered. Researchers with VA intranet access can access these sites by copying and pasting the URLs into their browser. There is also a host of non-emergency surgery provided through Fee Basis mechanisms that may be of interest to researchers. Business Product Management. If the Veteran went to the ED and was not admitted to the hospital, this would be considered outpatient care. Additionally, our health care providers make certain that Veterans' VA medical records remain updated by returning information about Veteran care and treatment to VA. 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. For more details, including rules for handling patients transferred during a stay, see federal regulation 38 CFR 17.55. The DSS Fee Basis Claims System (FBCS) is a web-based claim management system. For example, an interest payment of $14.21 would appear as 1421. INTAMT is part of DISAMT; it should not be added to them. 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. Researchers must consider whether a missing value means not applicable. For example, many inpatient (INPT) records lack a value for any of the surgery codes (SURG9CD1-SURG9CD5). Facility charges vs. ancillary charges: There are instances when there may be claims for facility charges with no corresponding ancillary provider charge. Each table has only one primary key field. The specific locations of the SAS payment variables and the SQL payment variables can be found in Chapters 4 and 5, respectively. It may duplicate the PatientIEN of another patient at another facility, and should not be used as an identifier. All information in this guidebook pertains to use of ICD-9 codes. In order to gain access to the AITC mainframe, VA system users must contact their local Customer User Provisioning System (CUPS) Points of Contact (POC) and submit a VA Form 9957 to create a Time Sharing Option (TSO) account. Before this time, data were entered by hand, and there was no easy way to tell whether the claim being entered was a duplicate one. [ICDProcedure] table and a foreign key in the [Fee]. Researchers wishing to work with SAS Fee Basis data can access them at the Austin Information Technology Center (AITC). NNPO. Box 537007Sacramento CA 95853-7007, CCN Region 5(Kodiak, Alaska, only)Submit to TriWest. However, there are best practices that all SQL-based analyses should follow. To access the menus on this page please perform the following steps. Electronic Data Interchange (EDI) Interface. Office of Information and Analytics. A missing value of the primary diagnosis code should therefore be treated as truly missing. Unauthorized inpatient or outpatient claims must be submitted within 90 days from the date of care. Quality of Life and Veterans Affairs Appropriations Act of 2006 (Public Law 109-114),the FSC offers a wide range of financial and accounting products and services to both the VA and Other Government Agencies (OGA). There is very limited outpatient pharmacy data in the Fee files. To access the menus on this page please perform the following steps. Attention A T users. Many private health insurance companies will apply VA health care charges towards satisfying a Veteran's annual deductible and maximum out of pocket expnse. For some VEN13N, however, there is more than one MDCAREID. b. For The majority of claims, 99%, were processed within 2 years, with the exception of pharmacy data in FY 2004 and FY2008. More than 99% of claims for inpatient, ancillary and outpatient care are processed within 2 years. Non-VA Medical Care data may be tabulated at the VHA Support Services Center (VSSC) (VA intranet only: http://vssc.med.va.gov/). The alternative, putting the procedure code fields in the invoice table, would not be as efficient. There is no information available in the SAS data that identifies the actual medication dispensed. 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. [FeeServiceProvided], [Fee]. Chapter 6 provides information about how to access the Fee Basis data, while Chapter 7 provides information about the rules governing Fee Basis care. If it cannot be located in the PTF Main file or DSS NDE for inpatient care, search other inpatient files. Researchers will have to select observations from the SQL FeeServiceProvided table in order to ensure they are only evaluating outpatient data. The travel payment data contains reimbursements for particular travel events (TravelAmount). (refer to the Category tab under Runtime Dependencies), Users must ensure that Microsoft Structured Query Language (SQL) Server, Microsoft Internet Explorer (IE), and Microsoft Excel are implemented with VA-approved baselines. Please review the Where To Send Claims and the Where To Send Documentation sections below for mailing addresses and Electronic Data Interchange (EDI) details. All instances of deployment using this technology should be reviewed by the local ISO (Information Security Officer) to ensure compliance with. 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. Payment of ambulance transportation under 38 U.S.C. However, in Table 4, we present some comparisons to demonstrate the different between SAS and SQL data. For authorized care, the referral number listed on the Billing and Other Referral Information form. U.S. Department of Veterans Affairs. VINCI Data Description: Fee/Purchased Care [online; VA intranet only]. A claim void must be identical to the original claim that it is intended to cancel. Important: The mailing address below only pertains to disability compensation claims. A record is created only if there is a code on the invoice to be recorded. Below are some answers to general questions about linking the UB-92 form to the FBCS data. 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. There are 3 categories of geographic data: veteran-related information, vendor-related information and VA-station related information. 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. For example, DISAMT=1000 in FY06 really indicates DISAMT=10.00. To enter and activate the submenu links, hit the down arrow. This application is directly attached to TWAIN compliant scanners and works offline to VistA and the FBCS MS SQL databases. Fee Basis data can be broadly categorized into 4 classes: inpatient care, outpatient care, pharmacy, and travel data. VA systems are intended to be used by authorized VA network users for viewing and For example, there could be many NPIs associated with a VEN13N (e.g., a hospital employing multiple providers), or many VEN13Ns for a single provider (e.g., a surgeon with privileges at multiple hospitals). However, Veterans may be responsible for a VA copayment depending on their assigned Priority Group. Operating Systems Supported by the Technology. There are often multiple observations per inpatient stay and multiple observations per outpatient encounter. This technology can use a VA-preferred database. In SAS, the outpatient data are housed in the MED files. The 275 transaction process should not be utilized for the submission of any other documentation for authorized care. The VA pays for both emergency and non-emergency care through Fee Basis mechanisms. Veterans Access, Choice, and Accountability Act of 2014 (VACAA): The Choice Program and the Choice Card [presentation]. If a patient received care at another facility, that patient will be have a different PatientSID assigned for that facility. For emergency care of service connected conditions, there is a two-year limit to submit any bills. Note: The last extract occurred in December 2020. Starting in 2009, there are also a number of DXPOA variables in the SAS data, which indicate diagnoses that are present on admission. The status value R stands for re-routed, meaning the claim was re-routed to the Health Administration Center (HAC). If using payment amount, one would overestimate the cost of care. Bowel and Bladder Care. 1. Veterans Health Administration. 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. If the payment was made outside of FBCS, they wont show here. If the gap is 0 or 1, it is part of the same hospital stay and we then want to assess its discharge date. Note that the vendor may represent the hospital, a hospital chain or the entity billing on behalf of the provider. FBCS supports payment of claims via VistA. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). The data files in each fiscal year represent all claims processed in the FMS during the year. 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. Fee Basis data files contain information regarding both the care the Veteran received and the reimbursement of the care. VSSC provides numerous relevant web reports, data resources, and analytics support, including summary data by facility and VISN and national summary data. At the time of writing, SAS data at CDW are available only to those persons with VA operations access. Researchers should pay special attention to reducing duplicates in the pre-2008 data. Additionally, we found 0.94% of records were approved Choice claims (e.g., records where SPECIALPROVCAT= CHOICE and STATUS= A (approved)). However, not all dates on the claim are approved. INTIND and INTAMT are not always concordant. The vendor identity can be found through the VENDID or VEN13N variables in SAS. Technology must remain patched and operated in accordance with Federal and Department security policies and guidelines in order to mitigate known and future security vulnerabilities. 3. There are multiple methods by which community providers may electronically provide VA with the required medical documentation for care coordination purposes. In SAS, data are stored in variables, observations and datasets. The prescription must be for a service-connected condition or must otherwise have specific approval. See 38 USC 1725 and 1728.). 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. 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. Through the CCN, Veterans have access to regional networks of high-performing, licensed health care . More information about can be found on their website: https://www.va.gov/communitycare/. 8. Note that some physicians use the same ID number as the hospital. Mark Smith and Adam Chow were the authors of the original HERC guidebook, upon which this document builds. October 1, 2015. [FeeInpatInvoice], [Fee]. 17. Non-VA providers submit claims for reimbursement to VA. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. This rare event most likely indicates a transfer. The electronic 275 transaction process may be utilized to supply Remittance Advice documentation for timely filing purposes. [Spatient], and [Spatient]. The Non-VA Medical Care program covers the full range of medical and dental care, with these exceptions: Although VA utilization files contain many non-Veterans, Non-VA Medical Care files do not. Unscheduled trips may be reimbursed for the return mileage only. 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. [PatientRace] tables. One can use the FeeInitialTreatmentSID variable in the FeeServiceProvided table to link to the Fee.FeeInitialTreatment table. 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. CDW Data Quality Analysis Team has particular recommendations for excluding observations before beginning analyses on your cohort.13 Corporate Data Warehouse (CDW) contains dummy data as well as test patients that will need to be removed from tables before conducting analyses. In both SAS and SQL data, outpatient data are organized in long format, with one record per CPT code. 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). VA Form 10-583, Claim for Payment of Cost of Unauthorized Medical Services. In this chapter, we discuss general aspects of Fee Basis data. As of April 2019, this guidebook is no longer being updated. 1. For dual pension and compensation claims, use the mailing address below for compensation claims. Fee Purpose of Visit (FPOV) Document [online; VA intranet only]. These variables relate to the VA station at which the Fee Basis care requests and claims are input. Most ED visits will be identified through FPOV values of 32 or 33. 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. The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. A subsequent report will contain the results of an audit conducted to assess It is not available for claims in which payment was based on a contract amount. Basic demographic variables can be found in the [Patient]. In SQL, the patient ID will be the PatientICN or PatientSID, and the admit date is the admission date.. NNPO. Chief Business Office. The process for filing a claim for services rendered to a Veteran in the community varies depending upon whether or not the services were referred by VA and by the entity through which the services were authorizedVA or one of the VA Third Party Administrators (TriWest Healthcare Alliance or Optum United Health Care). No new extracts will occur. If the provider declines VA payment then it may be able to charge the patient a greater total amount. is ok, 12.6.5 is ok, 12.6.9 is ok, however 12.7.0 or 13.0 is not. As noted above, in SAS, the patient identifier is the SCRSSN; this is unique to each patient across the entire VA. [Patient], [PatSub]. When a claim is linked to VistA, the variable Other_Hlth_ins_present is populated. Any variable that has an S prefix indicates secure data and requires special permission to access; researchers should be aware of this when submitting their IRB applications and their CDW DART data access requests. 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. Box 202117Florence SC 29502, Logistics Health, Inc.ATTN: VA CCN Claims328 Front St. S.La Crosse WI 54601, Secure Fax: 608-793-2143(Specify VA CCN on fax). 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. 1-800-273-8255 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. VA Informatics and Computing Resource Center (VINCI). Users must ensure their use of this technology/standard is consistent with VA policies and standards, including, but not limited to, VA Handbooks 6102 and 6500; VA Directives 6004, 6513, and 6517; and National Institute of Standards and Technology (NIST) standards, including Federal Information Processing Standards (FIPS). In this way, records that are missing MDCAREID can be given a MDCAREID based on the value of VEN13N and STA6A in the record. 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 is the patient identifier that uniquely defines a patient across all facilities. 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.