Of note, SQL and SAS data contain similar, but not exactly the same, information. We found SPECIALPROVCAT was missing in 93% of records. The data regarding the clinical encounter as well as the charge and payment for that encounter are populated into the VA Health Information Systems and Technology Architecture (VistA). The payment amount variables (AMOUNT and DISAMT) are missing (blank) in a small number of cases. Submit a claim void when you need to cancel a claim already submitted and processed. This guide was published in October 2015; the same month the United States switched from ICD-9 to ICD-10. These tables involve payments paid only through FBCS. This application completes the update of critical claims data into the FBCS shared MS SQL database for further processing and reporting. Here, ICDProcedureSID is a primary key in the [Dim]. 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. The Medicare hospital provider ID (MDCAREID) is entered by fee basis staff in order to calculate hospital reimbursement using the Medicare Pricer software. A foreign key is a key that uniquely identifies a record of another table. 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. There is another category of Fee Basis care that is considered unauthorized care. This is specific to certain claims for Non-Service Connected emergency medical care under Title 38 USC 1725. 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. 2. There is a lack of publicly available technical documentation and support may be limited to specific forums. Missingness can vary substantially by year and by file. Electronic Data Interchange (EDI): Payer ID for medical claims is 12115. In SQL, these variables can be found in the [Dim]. This improves claim accuracy and reduces the amount of time it takes for us to process claim determinations. MDCAREID is available in most inpatient SAS Fee Basis records. Please contact the referring VAMC for e-fax number. For the inpatient data, we compared observations with the same patient identifier, based on PaidDate in SQL and TRANSDAT in SAS. http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. SQL data must be linked from multiple tables in order to create an analysis dataset. However, a 7.4.x decision Veterans who meet certain criteria may be eligible for mileage reimbursement for travel to and from VA or Non-VA care. Basic demographic variables can be found in the [Patient]. Claims related to this care are considered authorized care. National Provider Identifier: Submit all that are applicable, including, but not limited to billing, rendering/servicing, and referring. 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. HERC did not investigate use of NPI for this guidebook. These inpatient tables have to be linked to FeeInpatInvoiceICDDiagnosis, FeeInpatInvoiceICDProcedure, FeeInitialTreatment and the appropriate DIM tables in order to understand the specific diagnoses and procedures associated with the inpatient observations in these tables. The Veterans Access, Choice, and Accountability Act (Veterans Choice Act), passed in 2014, expanded veterans access to non-VA care. VIReC. Last updated validated on Tuesday, January 3, 2023 Other work by HERC researchers indicates that in the FY 2014 data, DXLSF and DX1 were identical 47% of the time. It is not available for claims in which payment was based on a contract amount. Veterans Health Administration. 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. Through patient identifier and travel date (TravelPaymentDate), one can link these payments to inpatient and outpatient encounters. VA employees working on research studies cannot create their own crosswalk file as they do not have permission to use these files. 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). [SpatientAddress] tables. The invoice table would have to have a sufficient number of fields to accommodate the maximum number of procedures report on any invoice. In this situation, a given VA medical center has a preferred hospital from which it purchases care. The Veteran's full 9-digit social security number (SSN) may be used if the ICN is not available. To link an authorization to a claim, use the trifecta of what VistA would consider sta3n, PatientIEN, and AuthorizationIEN. VA-station related information includes STA3N, STA6A and STANUM in SAS and Sta3n and PrimaryServiceInstitution in SQL. The VA Fee Basis medical program provides payment authorization for eligible Veterans to obtain routine medical treatment services through non-VA health care providers. This is true for both the inpatient and outpatient data. To access the menus on this page please perform the following steps. A claim void must be identical to the original claim that it is intended to cancel. Smith MW, Su P, Phibbs CS. The deadline for claims submission is dependent upon which program the care has been authorized through or which program the emergency care will be considered under. Researchers wishing to work with SAS Fee Basis data can access them at the Austin Information Technology Center (AITC). 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. FBCS is an auditing system which provides instructional prompts designed to interface with the Veterans Information Systems and Technology Architecture (VistA) package to track, report, and analyze fee claim data. There is a CPT field in the inpatient files, but this is always missing; hospitals do not use CPT codes to bill. The Routing tool manages how Health Care Finance Administration (HCFA) and Uniform Billing (UB) claims will electronically flow through the FBCS program. 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. Note: The last extract occurred in December 2020. 15. 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. Appropriate access enforcement and physical security control must also be implemented. There are up to 25 ICD-9 diagnosis codes and 25 ICD-9 surgical procedure codes in the inpatient data. Get the latest updates on VA community care, including program changes, resources and more! March 2018: Due to the transition of the National Non-VA Medical Care Program Office to the VHA Office of Community Care and updates to the VINCI website, some documents may no longer be available. 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. At the time of writing, SAS data at CDW are available only to those persons with VA operations access. 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). Review the Filing Electronically section above to learn how to file a claim electronically. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. 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. This is in line with the way VHA Office of Productivity, Efficiency & Staffing (OPES) ascertains ED visit. 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. 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. Documentation in support of a claim may include: *NOTE: Documentation not required includes flowsheets and medication administration. Our review of the data suggests that pharmacy and ancillary claims take longer to process than inpatient or outpatient claims. Additionally, our health care providers make certain that Veterans' VA medical records remain updated by returning information about Veteran care and treatment to VA. business and limited personal use under VA policy. FBCS supports payment of claims via VistA. Researchers should use PatientICN to link patient data within CDW. However, investigation has confirmed these are partial payments made for a single encounter or procedure. To file a claim for services authorized by VA, follow instructions included in the Submitting Claims section of the referral. Fee Purpose of Visit (FPOV) Document [online; VA intranet only]. Fee Basis Services - VetsFirst More information can be found at the OPES website: http://opes.vssc.med.va.gov. Veterans applying for and using VA medical care must provide their health insurance information, including coverage provided under policies of their spouses. Available at: http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/. Any supporting documentation that VA is unable to link to a claim will be returned to sender to for additional information. Attention A T users. Please switch auto forms mode to off. Each year represents the year in which the claim was processed, not the year in which the service was rendered. If the Veteran has insurance, VA cannot pay even when the entire claim is less than the deductible. Available at: http://www.va.gov/opa/choiceact/documents/Choice-Program-Fact-Sheet-Final.pdf. This schema contains sensitive information such as SSNs, bank accounts, and the actual name of personnel. The SQL tables [Dim]. To find all care provided in a particular fiscal year requires searching by treatment date over several years of Non-VA Medical Care claims. Each patient should have only one ICN in the entire VA, regardless of the number of facilities at which he is seen. Providers cannot bill both VA and the patient or another insurer for the same encounter. Please switch auto forms mode to off. Box 30780, Tampa FL 33630-3780. VA intranet users can visit https://vaww.va.gov/communitycare/ (intranet only). April 08, 2014. This most likely reflects a low frequency of surgery rather than missing data. There are no references identified for this entry.