va fee basis program claims address va fee basis program claims address

Previously, VA could reimburse Veterans or pay non-VA hospitals directly only if a Veteran has no other health insurance. Persons interested in studying care provided under the Choice Act may wish to explore the VACAA tables or the FBCS tables at VA Corporate Data Warehouse (CDW). 2. 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. Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. [Patient], [Spatient]. PatientIEN and PatientSID are found in the general Fee Basis tables. According to the Health Administration Center Internet website, the proportion of claims processed within 30 days rose from under 40% in 2007 to over 97% by the end of 2008. Those options are: Utilize HealthShare Referral Manager (HSRM) for referrals, authorizations and documentation exchange. The outpatient pharmacy data includes medications dispensed in a pharmacy. Veterans should mail or fax correspondence pertaining to compensation claims to the below location. If billing electronically, please include "Other Payers Information" in Loop 2320, 2330A, 2330B, and 2430. Money collected by VA from private health insurance carriers is returned back to the VA medical center providing the care. There is another category of Fee Basis care that is considered unauthorized care. They do not represent all claims received during the year. In SAS, these data can be found in the Vendor file. resides on and transmits through computer systems and networks funded by the VA. All access or use constitutes understanding and acceptance that there is no reasonable Thus, the mailing address of the vendor is not always the vendors actual location. 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. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B. DSS Fee Basis Claims Systems (FBCS) - DigitalVA 1. VA patients who receive prescriptions from non-VA providers fill them from a VA pharmacy, often the VA Certified Mail Order Pharmacy (CMOP). In that case, use payment amount instead. For some years, there may be high rates of missingness of ICD-9 data in the Ancillary files. (refer to the Category tab under Runtime Dependencies), Veterans Affairs (VA) users must ensure VA sensitive data is properly protected in compliance with all VA regulations. Va Fee Basis Program Claims Address - filecloudbarcode One can evaluate which encounters were unauthorized by joining the FeeUnauthorizedClaim table through the FeeUnauthorizedClaimSID key. Researchers with VA intranet access can access these sites by copying and pasting the URLs into their browser. Missingness can vary substantially by year and by file. We view the patients insurance data in the VistA file if the claim is flagged as reimbursable in VistA and encompasses the dates on the claim. Include the claim, or a copy of the claim, on top of the supporting documentation that is mailed to the following address: Include a completed cover sheet with the supporting documentation that is mailed to the above address. Fee Basis data files contain information regarding both the care the Veteran received and the reimbursement of the care. 14. one episode of care, which can have multiple dates within the prescribed treatment, one provider, as identified by the Tax Identification Number (TIN), and. There are exceptions. 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. 12. 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). In SQL, these variables can be found in the [Dim]. It is also possible that researchers will find a slight difference in the observations that the SAS versus SQL data contain. Move on to the next patient ID, STA3N, VEN13N combination and repeat the entire process above. NPI and Medicare IDs have an M to M relationship. 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. Benefits Delivery at Discharge - Pre-Discharge - Veterans Affairs 15. Available at: http://vaww.virec.research.va.gov/CDW/Overview.htm. Table 9 lists a number of financial variables the SQL data contain. There is very limited outpatient pharmacy data in the Fee files. One can use the FeeInitialTreatmentSID variable in the FeeServiceProvided table to link to the Fee.FeeInitialTreatment table. All persons working with these data should review this information before conducting any analyses. 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. Q. 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. The Medicare Ambulance Fee Schedule consists of a base rate plus mileage. These geographic variables indicate the VA station paying for the service. [FeeInpatInvoiceICDProcedure] table. PracticeBridge. The prescription must be for a service-connected condition or must otherwise have specific approval. Appendix G lists all available FPOV codes and classifies them as inpatient or outpatient. Basic demographic variables can be found in the [Patient]. In addition, VA may place a Veteran in a private or state-run nursing home when a bed in a VA nursing home is unavailable or if the nursing home is distant from the patients residence. To enter and activate the submenu links, hit the down arrow. The key field indicates which invoice they appeared on. Reimbursement for Pharmacists Services in a Hospital-based, Pharmacist-managed Anticoagulation Clinic. For current information on Community Care data, please visit the page. Prescription-related data in the PHARVEN file contain only summary payments by month. The funds are used to provide the best care possible to our Veterans. 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. business and limited personal use under VA policy. FPOV values of 32 and 33 also indicate ED visits, but are only observed in the Ancillary file. 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. For example, sta3n 589A5 will be found as 589. PDF Frequently Asked Questions for Providers - Logistics Health Such care is called Non-VA Medical Care, or Fee Basis care. While VA always encourages providers to submit claims electronically, on and after May 1, 2020, it is important that all documentation submitted in support of a claim comply with one of the two paper submission processes described. 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. Updated September 21, 2015. Box 537007Sacramento CA 95853-7007, CCN Region 5(Kodiak, Alaska, only)Submit to TriWest. If the gap is 0 or 1, it is part of the same hospital stay and we then want to assess its discharge date. For example, if the Veteran had an Emergency Department (ED) visit and then was admitted to the hospital, this would be considered inpatient care. However, we conducted some comparisons for inpatient data. VA Informatics and Computing Resource Center (VINCI). The CDW is a relational database organized into a collection of data domains implemented on the Microsoft SQL server in VINCI. If you have additional questions about the form or your portal account access, please contact the Provider Services Solution (PRSS) help desk at 888-829-5373. VINCI. If the payment was made outside of FBCS, they wont show here. 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. 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. [ICD9] tables. Please visit Emergency Care Claims to learn more. The Medicare hospital provider ID (MDCAREID) is entered by fee basis staff in order to calculate hospital reimbursement using the Medicare Pricer software. If the Veteran has insurance, VA cannot pay even when the entire claim is less than the deductible. Researchers will need to link to the Patient and SPatient domains to access this geographic information in the SQL data. 3. 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. 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. Mark Smith and Adam Chow were the authors of the original HERC guidebook, upon which this document builds. 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. The SQL tables [Dim]. VSSC provides numerous relevant web reports, data resources, and analytics support, including summary data by facility and VISN and national summary data. Some VA medical centers purchase care from only one of the hospitals in the chain. Actual processing time has varied considerably over the years. Review the Corrections and Voids page for more information. the rates paid by the United States to Medicare providers). HERC researchers found that claims for the professional component of hospital stays also appeared in the file of claims for outpatient services. If notification was not made to VA and you wish to have claims considered for payment, please submit claims and supporting documentation to VA as listed in the "Where to Send Claims" dropdown below. Last updated validated on Tuesday, January 3, 2023 We recommend researchers use the FeePurposeOfVisit codes (FPOV) codes to eliminate observations related to non-outpatient care before beginning analyses. [FeeInitialTreatment], [Fee]. The Department of Veterans Affairs has implemented centralized mail processing (CM) for compensation claims to reduce incoming paper handling and shipping requirements. Hit enter to expand a main menu option (Health, Benefits, etc). More detailed information about the vendor can be found in the SQL [Dim]. VA medical centers may purchase prosthetics and related items, such as clothing specialized for prosthetic limbs, and then dispense them through VA facilities. There are substantial differences in quantity of inpatient diagnosis and procedure data available in SAS versus SQL. The mileage is calculated using the fastest route. VINCI Data Description: Dimension [online; VA intranet only]. 1725 when remaining liability to the Veteran is not a copayment or similar payment. 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. For education claims, refer to the appropriate Regional Processing Office. While NPI is available in SQL data, it does require special permissions to access, as it is located in the [Sstaff]. There are nine situations in which Non-VA Medical Care is authorized. Care provided in foreign countries other than the Philippines. In particular, CDW also recommends Patient SIDs with a value of less than 1 be deleted. As a single encounter may have more than one CPT code, users may have to aggregate multiple observations in order to evaluate the care received on a particular day. Emergency claims covered under the Veterans Millennium Care and Benefits Act, Public Law 106-117); see 29 CFR 17.120 and 38 CFR 17.1004. 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. Fee Basis providers vary in how frequently they submit an invoice for Fee Basis care. Again, date of service is not available in the FeeServiceProvided table. 21. Through patient identifier and travel date (TravelPaymentDate), one can link these payments to inpatient and outpatient encounters. To access the menus on this page please perform the following steps. We continue on this process until we find a gap greater than 1 day or we have evaluated all observations with that patient ID, STA3N and VEN13N. PatientIEN is assigned by the facility. If a claim is filed for an eligible episode of care, VA must pay the whole amount according to the payment rules noted above. In both the SAS and the SQL data, there are usually multiple observations per patient encounter. Attention A T users. FBCS Upload leverages LEADTOOLS Professional Optical Character Recognition (OCR) and is included in the FBCS workstation install package. 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 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. Many classes of Veterans are eligible for travel payments. The travel payments data contains reimbursements for particular travel events (TVLAMT). The disbursed amount should be used to calculate the cost of care, except in the case where disbursed amount is missing. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. 9. For example, DISAMT=1000 in FY06 really indicates DISAMT=10.00. Domains generally indicate the application in the VistA electronic health record system from which most of the data elements come (e.g., Vital Signs or Mental Health Assessment).6. Unauthorized inpatient or outpatient claims must be submitted within 90 days from the date of care. b. MDCAREID is the Medicare OSCAR number, which is a hospital identifier. VA evaluates these claims and decides how much to reimburse these providers for care. This guide serves as an addendum to any technical documentation supplied by the healthcare clearinghouse when establishing a trading partner agreement. One may therefore assume that all patients receiving treatment through the Non-VA Medical Care program are Veterans. Each year represents the year in which the claim was processed, not the year in which the service was rendered. Then, to see which ICD procedure codes were coded for this inpatient stay, one must link to the [Dim]. Attention A T users. Providers are not required to accept VA payment in all cases. The amount claimed (PAMTCL) appears in the inpatient (INPT) file alone; there is no claimed amount on the outpatient side. U.S. Department of Veterans Affairs. HERC: Identifying Providers in VA Administrative Data - Veterans Affairs 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. 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. 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. Non-VA providers submit claims for reimbursement to VA. 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: Starting in 2009, there are also a number of DXPOA variables in the SAS data, which indicate diagnoses that are present on admission. To enter and activate the submenu links, hit the down arrow. The Routing tool manages how Health Care Finance Administration (HCFA) and Uniform Billing (UB) claims will electronically flow through the FBCS program. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). File a Claim for Veteran Care - Community Care - Veterans Affairs To access the menus on this page please perform the following steps. Lump sum payments are not paid via FBCS. It is only relevant for claims linked to VistA patients. Non-VA providers submit claims for reimbursement to VA. 4. Users must ensure sensitive data is properly protected in compliance with all VA regulations. There may be many providers that use the same vendor for billing. 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. Community providers have three options that allow for that linkage: Submit the claim electronically via 837 transaction and the supporting documentation via 275 transaction. INTIND and INTAMT are not always concordant. Two domains in which researchers can find reports on Non-VA Care are Resource Management and Workload. 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. Given the stronger guidance from the Fee Office regarding use of the FPOV code, we recommend using the FPOV code to discern which observations are ancillary care, as the FeeProgram may not be as reliable. SAS and SQL data are organized differently and contain different variables. 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. [SpatientAddress] tables. YESElectronic Remittance (ERA)YESICD- 1. At the time of this writing, the NPI number was often missing from fee basis claims. 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/. VA Palo Alto, Health Economics Resource Center;November 2015. While all non-VA providers must submit a claim to VA in order to be reimbursed for care, the claim filing deadline depends on the type of claim.