Address. Below we describe the general types of information in both the SAS and SQL data. 3. All SAS prescription-related data is found in two files: the PHR file and the PHARMVEN file. The Fee Basis files primary purpose is to record VA payments to non-VA providers. Veterans Health Administration. actions by all authorized VA and law enforcement personnel. Veterans are not responsible for the remaining balance shown as patient responsibility on the explanation of benefits from their insurance carrier. Veterans Health Administration. For example: services provided at a hospital anticoagulation clinic are billable for facility charges only if the anticoagulation is considered incident to physician services and certain other conditions are met.8. It is also possible that researchers will find a slight difference in the observations that the SAS versus SQL data contain. The CDW SharePoint site has a document that lists the purchased care SQL tables, the fields of that they contain, and some sample SQL queries (VA intranet only: https://vaww.cdw.va.gov/metadata/Metadata%20Documents/Forms/AllItems.aspx). However, in Table 4, we present some comparisons to demonstrate the different between SAS and SQL data. [FeeInpatInvoice], and a foreign key in the [Fee].[FeeInpatInvoiceICDProcedure]. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, Outreach, Transition and Economic Development Home, Warrior Training Advancement Course (WARTAC), Staff Appraisal Reviewer (SAR) Information, How to Apply for Nonsupervised Automatic Authority, VALERI (VA Loan Electronic Reporting Interface). Prior to use of this technology, users should check with their supervisor, Information Security Officer (ISO), Facility Chief Information Officer (CIO), or local Office of Information and Technology (OI&T) representative to ensure that all actions are consistent with current VA policies and procedures prior to implementation. 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). Using the Non-VA Medical Care data for research requires a basic understanding of laws and regulations that govern it. The SAS data are stored at AITC. The FMS disbursed amount is the payment amount plus any interest payment. Last updated validated on Tuesday, January 3, 2023 [FeePharmacyInvoice] table contains information on vendor, amount claimed, and amount paid. 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. Some Fee Basis data will also appear in the non-VA medical SAS inpatient file (formerly called the Patient Treatment File). In SQL, the patient ID will be the PatientICN or PatientSID, and the admit date is the admission date.. This Technology is currently being evaluated, reviewed, and tested in controlled environments. VA systems are intended to be used by authorized VA network users for viewing and retrieving information only; except as otherwise explicitly authorized for official business and limited personal use under VA policy. One way to do this is to concatenate the vendor identifier, the patient identifier, and the visit date. [ SFeeVendor] table. In some cases, there is a one-to-one relationship between VEN13N and MDCAREID. NPI is available within the VA CDW SStaff table. 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. The PHR file contains information on the cost-related data associated with the prescription, while the PHARMVEN file contains information on the vendor associated with the prescription. Payment for these types of care falls under the Non-VA Medical Care program. Veterans Health Administration. Care provided in foreign countries other than the Philippines. Accessed October 16, 2015. Some important DIM tables that will be useful in analyzing Fee Basis data are FeePurposeOfVisit, FeeSpecialtyCode, FeeVendor, ICD, ICDProcedure Code, DRG, CPT, and CPT Category. 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. With the exception of supplying remittance advice supporting documentation for timely filing purposes, these processes do not apply to authorized care. Thus, one could not simply use the patient identifier and the admission and discharge dates to collapse these observations into one inpatient stay. The table can be linked to the [Dim]. a. FBCS is designed to be used in the Fee Basis Departments of the Veteran Affairs Medical Centers (VAMCs). Accessed October 16, 2015. There are also differences in the variables contained in the SAS versus SQL data. 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. 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. Other work by HERC researchers indicates that in the FY 2014 data, DXLSF and DX1 were identical 47% of the time. You can further refine by selecting records on or after November 4, 2014, when Choice was first enacted. The VEN13N is the vendor ID with a suffix; VEN13N is more detailed than VENDID and is thus recommended for use. 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]. The mileage is calculated using the fastest route. Researchers and analysts will have to take care to collapse observations properly if warranted, for example to determine the costs, procedures or diagnosis associated with a single stay or visit. The Fee Purpose of Visit Code (FPOV) has strong guidance from VA Fee Basis Office and thus may be a more accurate way of categorizing care. 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. Menlo Park, CA. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. It is the patient identifier that uniquely defines a patient across all facilities. In the SAS data, the patient identifier is the scrambled social security number (SCRSSN). VIReC. Health Information Governance. The Department of Veterans Affairs (VA) often pays providers in the community to provide care to Veterans when it is unable to provide such care itself (e.g., due to a lack of resources or delays in providing care), or when it is infeasible to do so (e.g., emergency care). Fee Basis data files contain information regarding both the care the Veteran received and the reimbursement of the care. Attention A T users. Available at: http://vaww.vhadataportal.med.va.gov/Portals/0/DataQualityProgram/Reports/Identifying_Veterans_in_CDW.pdf. Users interested in learning the rules in force at a particular point in time should contact the VHA Office of Community Care. PMS-DRG was effective in FY 2008; prior to this time CMS-DRGs were used. The vendor identity can be found through the FeeVendorSID or the FeeVendorIEN variables in SQL. We recommend researchers use the FeePurposeOfVisit codes (FPOV) codes to eliminate observations related to non-outpatient care before beginning analyses. Microsoft Internet Explorer, a dependency of this technology, is in End of Life status and must no longer be used. VA Technical Reference Model v 23.1 DSS Fee Basis Claims Systems (FBCS) General Decision Reference Component Category Analysis Vendor Release Information The Vendor Release table provides the known releases for the TRM Technology, obtained from the vendor (or from the release source). If the provider declines VA payment then it may be able to charge the patient a greater total amount. In SAS, the outpatient data are housed in the MED files. Chief Business Office. The amount of interest paid on the claim, if any, appears as the variable INTAMT. 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." All access In VA datasets, the MDCAREID does not have an accompanying address, but one can use other non-VA datasets (e.g., Hospital Compare) and determine the address of the hospitals physical location through the common MDCAREID variable. This care will be approved (or denied) by the local VA Fee Office; the Veteran is then free to seek non-VA care. 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. This FPOV variable broadly categorizes the reason for the encounter, such as hospice or respite care. 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. E-fax: Documentation sent via email to Veterans Affairs Medical Center (VAMC) fax machine. Compare the admission date of the third observation to the temporary end date from above. Appendix D contains information on the primary and foreign keys needed to link the various SQL tables. Office of Information and Analytics. Procedures are identified by CPT code (CPT1) in the non-hospital inpatient services (the ancillary file) and in the outpatient procedures file. A claims scrubber software program is run to ensure completeness and to locate possible errors. To locate the facility at which the Veteran usually receives VA care, the VA Information Resource Center (VIReC) recommends consulting the preferred facility indicator in the VHA Enrollment Database.7. Health plans include private health insurance, Medicare, Medicaid, and other forms of insurance that will pay for medical treatment arising from the patients injury or illness (e.g., automobile insurance following a car accident). Download the tables here. If the payment was made outside of FBCS, they wont show here. The Veteran's full 9-digit social security number (SSN) may be used if the ICN is not available. All tablesmentioned in the Fee Basis guidebookare storedin an Excel file. Claims for Non-VA Emergency Care In particular, CDW also recommends Patient SIDs with a value of less than 1 be deleted. Users must ensure that Microsoft .NET Framework, Microsoft Structured Query Language (SQL) Server, and Microsoft Excel are implemented with VA-approved baselines. This seeming complicated arrangement is an efficient way to store data. The Vendor Release table provides the known releases for the. Most commonly, authorized care refers to medical or dental care that was approved and arranged by VA to be completed in the community. 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. If you are in crisis or having thoughts of suicide, National Provider Identifier: Submit all that are applicable, including, but not limited to billing, rendering/servicing, and referring. We tried to link the UB-92 form to identify Choice authorizations; however, we found few records and decided to use obligation number. [ModeOfTransportation] and [Fee]. Attention A T users. More information can be found at the OPES website: http://opes.vssc.med.va.gov. 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. Make sure the services provided are within the scope of the authorization. U.S. Department of Veterans Affairs. All information in this guidebook pertains to use of ICD-9 codes. 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. The second record would have an admission date of Jan 5, 2010 and a discharge date of Jan 5, 2010. 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. U.S. Department of Veterans Affairs. PLSER values overlap considerably with those of the Medicare Carrier Line Place of Service codes. There may be multiple STA3Ns for a single inpatient stay. For care received under the Choice Act, Veterans will work with the third party administrators of the Choice program to find an eligible provider in their area.4. Please review the Where To Send Claims and the Where To Send Documentation sections below for mailing addresses and Electronic Data Interchange (EDI) details. Non-VA providers submit claims for reimbursement to VA. For more information call 1-800-396-7929. Fee Basis providers vary in how frequently they submit an invoice for Fee Basis care. This is true for both the inpatient and the outpatient data, albeit for different reasons. If the patient is transferred from a non-VA to a VA hospital, the non-VA component of this care will be captured through Fee Basis, while the VA component of this care will be in the VA inpatient datasets. For education claims, refer to the appropriate Regional Processing Office. Thus the variable INTIND (interest indicator) equals 1 if the claim is eligible for interest and 0 otherwise. MDCAREID is not available in the outpatient SAS Fee Basis data, even though some outpatient services are provided in a hospital. In SQL, there are multiple patient identifiers, with the most useful being the PatientICN. For EDI 837, Referral Number is Loop = 2300, Segment = REF*9F, Position = REF02 or Prior Authorization. Previously, VA could reimburse Veterans or pay non-VA hospitals directly only if a Veteran has no other health insurance. This rule applies even when the patient is incapable of making a call. The local VA facilities put claims through a claim scrubber that checks to see if the claim was authorized and evaluates any errors or inconsistencies in the data. SQL Fee Basis data are stored in CDW in multiple individual tables. Using SQL data will allow the researcher to link to other rich data found in CDW, such as the Health Factors data. Such care is called Non-VA Medical Care, or Fee Basis care. _________________________________________________________________. TriWest VA CCN ClaimsP.O. In SAS, these data can be found in the Vendor file. Use of this technology is strictly controlled and not available for use within the general population. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. Then, to see which ICD procedure codes were coded for this inpatient stay, one must link to the [Dim]. *From the date the Veteran was discharged from the facility that furnished the emergency treatment; the date of death, but only if the death occurred during transportation to a facility for emergency treatment or if the death occurred during the stay in the facility that included the provision of the emergency treatment; or the date the Veteran exhausted, without success, action to obtain payment or reimbursement for treatment from a third party. Unlike the other patient identifiers in SQL such as PatientIEN or PatientSID, PatientICN is supposed to be unique to each patient across VA. VINCI. 2. However, previous HERC investigation confirmed these are partial payments made for a single encounter or procedure. visit VeteransCrisisLine.net for more resources. Generally, VA does not bill Medicare or Medicaid for reimbursement; however, VA does bill other types of health insurance including Medicare Supplemental plans for covered services. Providers who continue to elect to submit paper claims and paper documentation to support claims for unauthorized emergency care should be aware of the following: VHA Office of Integrated Veteran Care P.O. In SQL, the outpatient data are housed in the FeeServiceProvided table. For billing questions contact: Health Resource Center U.S. Department of Veterans Affairs. This schema contains sensitive information such as SSNs, bank accounts, and the actual name of personnel. There is no separate payment for items such as oxygen or other supplies, the number of attendants, providing an EKG during the trip, etc. 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 . Veterans who meet certain criteria may be eligible for mileage reimbursement for travel to and from VA or Non-VA care. Matching outpatient prosthetics order records in the VA National Prosthetics Patient Database (NPPD) to health care utilization databases. However, one also needs to exercise caution with DRG; there are 2 different sets of DRGs used over time. Clinical variables in SAS format include ICD-9 diagnosis codes, ICD-9 surgical codes, CPT codes and CPT modifier codes, DRG codes and Present on Admission codes. Missing values of PAYCAT could be imputed by finding the corresponding inpatient stay in the INPT file. Additionally, our health care providers make certain that Veterans' VA medical records remain updated by returning information about Veteran care and treatment to VA. Electronic Data Interchange (EDI): Payer ID for medical and dental claims is VA CCN. the rates paid by the United States to Medicare providers). Electronic Services Available (EDI): Professional/1. A primary key is a key that is unique for each record. Researchers will thus need permissions to allow the CDW data manager to obtain SCRSSN or SSN to PatientICN crosswalk to allow for the necessary data linkages. The 275 transaction process should not be utilized for the submission of any other documentation for authorized care. The FeeSpecialtyCodeName contains information on the specialty of the provider seen, such as oncology, chiropractic, pathology, neurosurgery, etc., but is missing much data. To access the menus on this page please perform the following steps. Use Azure Rights Management Services (Azure RMS) for encrypted email. 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. [Patient], [Spatient]. However, there are data available regarding the category of visit. The values of Adjustment Codes 1 and 2 (ADJCD1 and ADJCD2) explain the reason for non-payment.
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