SAS data also contain an additional diagnosis variable that is not present in the SQL data -- DXLSF. JANESVILLE, WI 53547-4444. or Fax to: TOLL FREE: 844-531-7818 & 248-524-4260 (Utilized for Foreign Claimants) return to top. The data files in each fiscal year represent all claims processed in the FMS during the year. VINCI. TRM Proper Use Tab/Section. There may be multiple STA3Ns for a single inpatient stay. [FeeInpatInvoiceICDDiagnosis] with the [Dim]. To file a claim for services authorized by VA, follow instructions included in the Submitting Claims section of the referral. Claims processed after March 17, 2022, will be reviewed and aligned with the federal ruling which prohibits secondary payment on emergency care copayments and deductibles. The same cannot be said for DX2-DX25, however, as additional diagnosis codes are optional. The disbursed amount should be used to calculate the cost of care, except in the case where disbursed amount is missing. Health Information Governance. PatientIEN and PatientSID are found in the general Fee Basis tables. PLSER values overlap considerably with those of the Medicare Carrier Line Place of Service codes. These variables relate to the VA station at which the Fee Basis care requests and claims are input. We crosswalked the ScrSSN to allow for comparison with SAS data. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). 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. As noted above, in SAS, the patient identifier is the SCRSSN; this is unique to each patient across the entire VA. Unlike the inpatient data, there can be multiple records with the same invoice number. When evaluating the cost of care, use the disbursed amount. Please contact the referring VAMC for e-fax number. This care will be approved (or denied) by the local VA Fee Office; the Veteran is then free to seek non-VA care. To enter and activate the submenu links, hit the down arrow. Claims for Non-VA Emergency Care This component provides a front end for validation and/or correcting the data that was read from the claim via the OCR module. Those with access to the VA intranet can find a list of SQL fields on the CDW MetaData site. 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. VA Informatics and Computing Resource Center (VINCI). Sign up to receive the VA Provider Advisor newsletter. VINCI. SQL Fee Basis data are stored in CDW in multiple individual tables. It can be difficult to determine the provider and the location of the Non-VA care provider. 2. Electronic Data Interchange (EDI): Payer ID for medical and dental claims is VA CCN. 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. Starting in 2009, there are also a number of DXPOA variables in the SAS data, which indicate diagnoses that are present on admission. The UB-92 equivalent variables would be: facility (after merging in facility name from the FBCS_Facilities table), vistapatkey, and vistaauthkey, respectively. Please switch auto forms mode to off. This application is directly attached to TWAIN compliant scanners and works offline to VistA and the FBCS MS SQL databases. Request and Coordinate Care: Find more information about submitting documentation for authorized care. We are grateful for their cogent work. When a claim is linked to VistA, the variable Other_Hlth_ins_present is populated. Smith MW, Chow A. Non-VA Medical Care (Fee Basis) Data: A Guide for Researchers. VA is the primary and sole payer when VA issues an authorization. Claims related to this care are considered authorized care. In this chapter, we discuss general aspects of Fee Basis data. Researchers will have to select observations from the SQL FeeServiceProvided table in order to ensure they are only evaluating outpatient data. June 5, 2009. Researchers can look at the disposition variable as an indicator of transfer between VA and non-VA care. Fee Basis data will be most useful for studying conditions where contract care is common, such as home-based care and nursing care, and for determining typical non-VA charges for health care services (both charges and payments are reported) and comparing those to VA costs. Guidance can be found under "VHA Data Quality Program Reports. All access
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). Thus, unauthorized care is not unpaid care it is simply not PRE-authorized care. There are also variables pertaining to Veteran geographic information, particularly ZIP, HOMECNTY and HOMESTATE in the SAS data and County, Country, Province, and State in the SQL data. The invoice table would have to have a sufficient number of fields to accommodate the maximum number of procedures report on any invoice. 15. This report covers the audit of payments made through VA's Fee Basis Claims System (FBCS), encompassing claims paid via that payment process from November 1, 2014 through September 30, 2016. 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. Up to FY2008 data, DXLSF is labeled as 1st Diagnosis Code. In FY2009 and on, DXLSF is labeled as the Admitting or Primary Diagnosis Code. In FY 2009 and later SAS data, there is also another variable, DX1, which is not present in SAS data prior to FY2009. To learn more, please visit the Provider Training section on the MES website . They do not represent all claims received during the year. Multiple SAS datasets have VENID and VEN13N. Unscheduled trips may be reimbursed for the return mileage only. Data Quality Analysis Team. VA calculates PAMT from CMS pricer software on the basis of DRG and length of stay. Hospice also appears to be billed monthly, with longest length of stay for a single hospice invoice of 31 days. Questions about non-VA care claims may be directed to the Fee Basis Unit between the hours of 8:00 a.m. Email Address Required. However, one also needs to exercise caution with DRG; there are 2 different sets of DRGs used over time. There are two important variables to consider if evaluating the cost (VA reimbursement) of Fee Basis Care: the payment amount (AMOUNT in SAS, PaidAmount in SQL) or the Financial Management System (FMS) disbursed amount (DISAMT in SAS, DisbursedAmount in SQL). Researchers should use PatientICN to link patient data within CDW. There are up to 25 ICD-9 diagnosis codes and 25 ICD-9 surgical procedure codes in the inpatient data. [ SFeeVendor] table. 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. 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. VA Claims Representation; RESOURCES. Once the process is exhausted for a particular patient, STA3N and VEN13N combination, we calculate length of stay as the difference between the admission date of the first record and the temporary end date.. HERC did not investigate use of NPI for this guidebook. No, only one type of care can be covered by a single authorization. VSSC web reports are organized into nine domains: Business Operations, Capital & Planning, Clinical Care, Customer Service, Quality & Performance, Resource Management, Special Focus, Systems Redesign, and Workload. It is available in the PHARVEN and VEN files, albeit with a high degree of missingness. VINCI Data Description: Dimension [online; VA intranet only]. However, we conducted some comparisons for inpatient data. Veterans Access, Choice, And Accountability Act of 2014: Title I: Choice Program and Health Care Collaboration [online]. All SAS prescription-related data is found in two files: the PHR file and the PHARMVEN file. Community provider mails the paper claims and documentation to the new mailing address of VA's central claims intake location. However, 99% of inpatient hospital invoices were associated with a length of stay of 33 days or less. VA can make payments to non-VA health care providers under many arrangements. In both the SAS and the SQL data, there are usually multiple observations per patient encounter. Table 8 denotes on which CDW servers Fee Basis data are housed. Persons looking to classify Veterans military service are encouraged to read the Data Quality Analysis Teams guidance on Identifying Veterans in the CDW(VA intranet only:http://vaww.vhadataportal.med.va.gov/Portals/0/DataQualityProgram/Reports/Identifying_Veterans_in_CDW.pdf).14. Data Quality Program. Electronic Data Interchange (EDI) Interface. The Routing tool manages how Health Care Finance Administration (HCFA) and Uniform Billing (UB) claims will electronically flow through the FBCS program. 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. _____________________________________________________________________________. To understand what procedures were performed during an inpatient stay in the [Fee]. FBCS is designed to be used in the Fee Basis Departments of the Veteran Affairs Medical Centers (VAMCs). 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. The National Provider Identifier (NPI) is a unique 10-digit identification number issued by the Centers for Medicare and Medicaid Services to all health care providers in the United States. 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. CLAIM.MD | Payer Information | VA Fee Basis Programs Payer Information VA Fee Basis Programs Payer ID: 12115 This insurance is also known as: Veterans Administration Need to submit transactions to this insurance carrier? Accessed October 16, 2015. Care for dependent children, except newborns, in situations where VA pays for the mothers obstetric care during the same stay. [XXX] tables, but also the [DIM]. 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. American Society of Health-System Pharmacy (ASHP). We encourage readers to seek out the latest guidance before conducting analyses, as CDW Data Quality Analysis team may have updates to this information. 4. [XXX] tables.9,12 Tables under the DIM schema contain attributes that describe the records in the Fee tables. This technology can integrate with and alter database technologies. Patient type can take one of seven values: surgical; medical; home nursing; psych contract; psychiatric, neuro contract; or neurological. Patient identifiers are also different across SAS and SQL data. The Implementer of this technology has the responsibility to ensure the version deployed is 508-compliant. Each prescription record has a fill date and a patient identifier (either PatientICN or scrambled social security number). Please visit Provider Education and Training for upcoming events. 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. VIReC. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. 3. As noted in Chapter 2, the important variables capturing cost of care are AMOUNT and DISAMT. There is limited information on the providers associated with Fee Basis care. 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. Access; upload; download; change; or delete information on this system; Otherwise misuse this system are strictly prohibited. More information about can be found on their website: https://www.va.gov/communitycare/. (formerly known as VA Fee Basis or NonVA)-Community provider submits the claim and supporting documentation through their EDI provider services in . There is no information available in the SAS data that identifies the actual medication dispensed. (2) Additionally, a Veteran must also meet at least one of the following criteria. 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. 1725 when remaining liability to the Veteran is not a copayment or similar payment. [ICD] table, the latter of which contains a list of all possible ICD-9 codes. A missing value of the primary diagnosis code should therefore be treated as truly missing. 988 (Press 1). For these reasons, VA strongly encourages Veterans to consider important factors, risks and benefits before making any changes to their private health insurance. National Non-VA Medical Care Program Office (NNPO). VA Palo Alto, Health Economics Resource Center; October 2013. Then, to see which ICD procedure codes were coded for this inpatient stay, one must link to the [Dim]. 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. The temporary end date is the maximum of these two values. 1. Submit a corrected claim when you need to replace an entire claim previously submitted and processed. 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]. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. SQL data must be linked from multiple tables in order to create an analysis dataset. Box 108851Florence SC29502-8851, Delta Dental of CaliforniaVA Community Care NetworkP.O. Here, ICDProcedureSID is a primary key in the [Dim]. 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. 21. There are multiple methods by which community providers may electronically provide VA with the required medical documentation for care coordination purposes. MDCAREID is available in most inpatient SAS Fee Basis records. The vendor identity can be found through the FeeVendorSID or the FeeVendorIEN variables in SQL. Medical specialty type (SPECCODE) is a provider-specific variable and indicates the specialty type of the provider rendering the service. 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. SAS versus SQL data differ in three main ways: Appendix A lists all variables in the SAS files. [FeePrescription] table contains rich information on the type of drug prescribed and dispensed, including the drug name, manufacturer, strength, quantity, date filled and charge and disbursed (payment) amount. 14. If that analyst examines VEN13N and STA6A (in inpatient Fee Basis data, this field represents the VA hospital arranging care), there is often only one MDCAREID. For additional information or assistance regarding Section 508, please contact the Section 508 Office at Section508@va.gov. to) monitoring; recording; copying; auditing; inspecting; investigating; restricting
At the time of writing (October 2015), only operations staff will have permission to access the SAS data at VINCI. To access the menus on this page please perform the following steps. VA Directive 6402, Modifications to Standardized National Software, Document Storage Systems (DSS) DocManager, Microsoft Structured Query Language (SQL) Server, Optical Character Recognition (OCR) Module, Fidelity National Information Service (FIS) Compass. Pre-2007, DISAMT and INTAMT each have two implied decimal places a value of 1000 would indicate $10.00. ______________________________________________________________________________. Fee Basis: 214-857-1397 C & P. VA Claims Representation; RESOURCES. One exception to this is when identifying emergency department (ED) visits. 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). 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. Accessed October 16, 2015. Download the tables here. Researchers can do this using the FeePurposeOfVisit (FPOV) code.11 We recommend this approach over using another variable, such as the Fee Program. Cunningham, K. VA implements the first of several Veterans Choice Program eligibility expansions. 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. 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. If using payment amount, one would overestimate the cost of care. SQL Fee Basis files themselves contain limited patient demographic variables, but can be linked to other SQL data. The Act amends 38 U.S.C. There are very limited data in both the SAS and the SQL Fee Basis data regarding the provider associated with care; the closest one can get to this information is to denote the vendor associated with the encounter (detailed more in sections 4.11 and 5.10). Basic demographic variables can be found in the [Patient]. 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. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. At the time of writing, version 4.2 is the most current version. The Choice Act represents one of the largest shifts in the organization and financing of healthcare in the Department of Veterans Affairs (VA) in recent years. In the outpatient data, one observation represents a single CPT code. [LocalDrug] table through LocalDrugSID to see whether there was the generic equivalent found in the VA drug file that was dispensed to the patient. Fee Basis data live in both SAS and SQL format. If the payment was made outside of FBCS, they wont show here. 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). Primary keys are denoted by (PK) and foreign keys are denoted by (FK). 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 payment category (PAYCAT) is missing for all records in the inpatient services (ANCIL) file. Hit enter to expand a main menu option (Health, Benefits, etc).
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