va fee basis program claims address

Medical specialty type (SPECCODE) is a provider-specific variable and indicates the specialty type of the provider rendering the service. [FeeInpatInvoice] table, one must first link that table to the [Fee]. VA Information Resource Center VHA Corporate Data Warehouse [webpage]. Research requests for data from CDW/VINCI must be submitted via the Data Access Request Tracker (DART) application. When evaluating the cost of care, use the disbursed amount. Data Quality Program. 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). Records that relate PatientSID to PatientICN are found two tables: Patient.Patient and SPatient.Spatient. U.S. Department of Veterans Affairs. Electronic Services Available (EDI): Professional/1. Five additional variables Financial Management System (FMS) transaction number, line number, date, batch number, and release date reflect processing of payments through the FMS. There are delays in the processing of Fee Basis claims. Use of this technology is strictly controlled and not available for use within the general population. Our office is located at 6940 O St, Suite 400 Lincoln NE 68510. PDF Office of Inspector General - Oversight.gov Appendix D contains information on the primary and foreign keys needed to link the various SQL tables. A missing value of the primary diagnosis code should therefore be treated as truly missing. Please switch auto forms mode to off. 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). While not required to process a claim for authorized services, medical documentation must be submitted to the authorizing VA medical facility as soon as possible after care has been provided. 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. ", Military service variables can be found in [PatSub],[PatientServicePeriod], [Patient]. 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. 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. It may duplicate the PatientIEN of another patient at another facility, and should not be used as an identifier. The vendor represents the entity billing for the non-VA care, while the provider represents the person who was involved in care provision. All instances of deployment using this technology should be reviewed by the local ISSO (Information System Security Officer) to ensure compliance with. Patient identifiers are also different across SAS and SQL data. Institutional Aspects of the Non-VA Medical Care System, https://www.va.gov/health-care/get-reimbursed-for-travel-pay/, http://www.va.gov/opa/choiceact/documents/Choice-Program-Fact-Sheet-Final.pdf. First, it includes both the payment amount and any interest that may apply. FPOV values of 32 and 33 also indicate ED visits, but are only observed in the Ancillary file. More information about can be found on their website: https://www.va.gov/communitycare/. Veteran's ICN can be found on the VA issued HSRM referral. In SAS, the inpatient (INPT) file includes PAMT, the Medicare prospective payment that would apply to the stay. PMS-DRG was effective in FY 2008; prior to this time CMS-DRGs were used. Users interested in learning the rules in force at a particular point in time should contact the VHA Office of Community Care. For EDI 837, Referral Number is Loop = 2300, Segment = REF*9F, Position = REF02 or Prior Authorization. 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 . Through patient ID (SCRSSN) and travel date (TVLDTE) one can link these payments to inpatient and outpatient encounters. 1-800-273-8255 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. There is no official data dictionary for the SAS Fee Basis data. April 14, 2014. (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. This improves our claims processing efficiency. 16. Researchers can look at the disposition variable as an indicator of transfer between VA and non-VA care. The key that allows for this linkage is the FeeInpatInvoiceSID which is a primary key in the [Fee]. As of July 2015, the current mileage reimbursement rate is 41.5 cents per mile. These tables involve payments paid only through FBCS. Veterans Crisis Line: U.S. Department of Veterans Affairs. Those options are: Utilize HealthShare Referral Manager (HSRM) for referrals, authorizations and documentation exchange. The new temporary end date is the maximum of the discharge date of the third observation and temporary end date from Step 2. [XXX] tables, but also the [DIM]. These geographic variables indicate the VA station paying for the service. NPI and Medicare IDs have an M to M relationship. 3. The generosity of the coverage is immaterial; if it covers any part of the providers bill, then VA may not pay anything. We tried to link the UB-92 form to identify Choice authorizations; however, we found few records and decided to use obligation number. Assistance with claims is free and covers all state and federal veterans' programs. Unauthorized care can be of an inpatient or outpatient nature. Please switch auto forms mode to off. VINCI. Review the Filing Electronically section above to learn how to file a claim electronically. Inpatient data are housed in the FeeInpatInvoice table as well as the FeeServiceProvided table, although the latter does not contain only inpatient data. [FeeVendor] table. 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). The Act amends 38 U.S.C. Most importantly, they do not represent all care provided during the fiscal year. In SAS data, there is also a primary service area variable (HOMEPSA) that indicates the station to which the Veterans residence is assigned based on geography. E-fax: Documentation sent via email to Veterans Affairs Medical Center (VAMC) fax machine. This technology integrates with Veterans Information Systems and Technology Architecture (VistA) through Massachusetts General Hospital Utility Multi-Programming System (MUMPS) or a Structured Query Language (SQL) database system on the backend. Office of Information and Analytics. This can become complicated by the fact that not all encounters relating to the same inpatient stay will have the same admission and discharge dates. You can submit a corrected claim or void (cancel) a claim you have already submitted to VA for processing, either electronically or in paper. The Department of Veterans Affairs' (VA) fee basis care spending increased from about $3.04 billion in fiscal year 2008 to about $4.48 billion in fiscal year 2012. We detail differences amongst the SAS and SQL Fee Basis data in the guidebook below. A Non-VA Medical Care claim is defined by four elements: The remainder of section 7.4 details payment rules as of early 2015. All instances of deployment using this technology should be reviewed by the local ISO (Information Security Officer) to ensure compliance with. In the outpatient data, each record represents a different procedure, as assessed through the Current Procedural Terminology (CPT) code. Beware of VISNS 4, 15, and 23, as they have their own integrated system. For billing questions contact: Health Resource Center Payment of ambulance transportation under 38 U.S.C. (Available at the VHA Data Portal. Payer ID for dental claims is CDCA1. The specific locations of the SAS payment variables and the SQL payment variables can be found in Chapters 4 and 5, respectively. [FeeInpatInvoice] and [Fee]. Fee Basis Services - VetsFirst Health - Veterans Affairs Electronic Data Interchange (EDI): Payer ID for medical and dental claims is VA CCN. Researchers will need to link to the Patient and SPatient domains to access this geographic information in the SQL data. The amount of interest paid on the claim, if any, appears as the variable INTAMT. Veterans should mail or fax correspondence pertaining to compensation claims to the below location. Given these different patient identifiers, it is difficult to conduct exact comparisons between SAS and SQL data. For example, the meaning of DRG001 is not the same in FY05 vs FY15. Accessed October 16, 2015. The VHA Office of Community Care is the contact for all VA community care programs. [ SFeeVendor] table. 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. 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. YESThis insurance is also known as: Veterans Administration. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). Get Help from Our VA Disability Claim Appeals Lawyers Today. The invoice table would have to have a sufficient number of fields to accommodate the maximum number of procedures report on any invoice. Mark Smith and Adam Chow were the authors of the original HERC guidebook, upon which this document builds. In SQL, these variables can be found in the [Dim]. 11. Researchers wishing to work with SAS Fee Basis data can access them at the Austin Information Technology Center (AITC). With the exception of supplying remittance advice supporting documentation for timely filing purposes, these processes do not apply to authorized care. Get the latest updates on VA community care, including program changes, resources and more! All Choice claims are processed by VISN 15. This application queues critical claims data into the FBCS shared MS SQL database for further processing and reporting. is ok, 12.6.5 is ok, 12.6.9 is ok, however 12.7.0 or 13.0 is not. All information in this guidebook pertains to use of ICD-9 codes. 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. 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. 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: When a claim has reached terminal status (A, P, D, R), the field ImportedDTStamp on the UB-92/HCFA tables represents the date it was processed. It appears that starting in FY2016, Choice data is now bypassing FBCS and residing in the PIT. Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. No, only one type of care can be covered by a single authorization. Both ancillary and outpatient files have one record per CPT code. VA employees working on research studies cannot create their own crosswalk file as they do not have permission to use these files. VA intranet users can visit https://vaww.va.gov/communitycare/ (intranet only). To enter and activate the submenu links, hit the down arrow. 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. Chief Business Office. A foreign key is a key that uniquely identifies a record of another table. TRM Proper Use Tab/Section. 15. Billing & Insurance - New York/New Jersey VA Health Care Network The discussion below pertains to both SAS and SQL data. 1. The two tables can be joined through FeePharmacyInvoiceSID. 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. Chapter 4 offers detailed information SAS Fee Basis data; Chapter 5 provides detailed information about SQL Fee Basis data. Researchers should use PatientICN to link patient data within CDW. Information from this system Note: records with status= R can have missing values for the variables vistapatkey and vistaauthkey, depending on whether or not these were linked before rejecting as a re-route to HAC. The process of linking can be complex; analysts should take care to reduce errors during this process. Find out More This application completes the update of critical claims data into the FBCS shared MS SQL database for further processing and reporting. Per the May 5th, 2015 memorandum from the VA Chief Information Security Officer (CISO) FIPS 140-2 Validate Full Disk Encryption (FOE) for Data at Rest in Database Management Systems (DBMS) and in accordance with Federal requirements and VA policy, database management must use Federal Information Processing Standards (FIPS) 140-2 compliant encryption to protect the confidentiality and integrity of VA information at rest at the application level. Accessed October 27, 2015. We found SPECIALPROVCAT was missing in 93% of records. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420.