Therefore, on the outpatient side as well one must aggregate multiple records to get a full picture of the outpatient encounter. VINCI. Include the authorization number on the claim form for all non-emergent care. Internal use only. MDCAREID is the Medicare OSCAR number, which is a hospital identifier. More information on the proper use of the TRM can be found on the Box 537007Sacramento CA 95853-7007, CCN Region 5(Kodiak, Alaska, only)Submit to TriWest. Researchers will need to decide whether they will use the SAS or the SQL data and apply for appropriate IRB approval for use. If electronic capability is not available, providers can submit claims by mail or secure fax. Chapter 6 provides information about how to access the Fee Basis data, while Chapter 7 provides information about the rules governing Fee Basis care. Move on to the next patient ID, STA3N, VEN13N combination and repeat the entire process above. Users of the data should keep in mind that these data represent the physical location of the entity billing for care, which may or may not be the same as the providers location. 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.. VA must be capable of linking submitted supporting documentation to a corresponding claim. Electronic Data Interchange (EDI) Interface. Quality of Life and Veterans Affairs Appropriations Act of 2006 (Public Law 109-114),the FSC offers a wide range of financial and accounting products and services to both the VA and Other Government Agencies (OGA). The vendor represents the entity billing for the non-VA care, while the provider represents the person who was involved in care provision. In most cases, if you don't sign up for Part B when you are first eligible, you'll have to pay a late enrollment penalty. 1725 when remaining liability to the Veteran is not a copayment or similar payment. Class 2 or Class 3 products must restrict their interfaces to Class 1 National Software to use of publicly-supported APIs ONLY. Chapter 1 presents an overview of Fee Basis data in general; Chapter 2 presents an overview of the variables in the Fee Basis data; and Chapter 3 describes how SAS versus SQL forms of Fee Basis data differ. To access the menus on this page please perform the following steps. Veteran's ICN can be found on the VA issued HSRM referral. This component is a service that communicates with the Program Integrity Tool (PIT) which scores claims and sends results to FBCS. It will often times not be possible to determine the reason for an outpatient visit, as there will be multiple observations/CPT codes that denote a single visit. This technologysupports advanced data encryption methods and role-based access control. Medication dosage/strength. When MDCAREID is not available, it is possible to assign MCCAREID based on the relationship between VEN13N and STA6A. Appropriate access enforcement and physical security control must also be implemented. Accessed October 27, 2015. There are multiple potential identifiers for provider/vendor in the SAS data: the VENDID, VEN13N, MDCAREID, SPECCODE and NPI. 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. However, we conducted some comparisons for inpatient data. The Veteran's full 9-digit social security number (SSN) may be used if the ICN is not available. NPI is available within the VA CDW SStaff table. Appendices G and H, copied from the Non-VA Medical Care program website, describes in detail the types of records for which each Fee Purpose of Visit (FPOV) codes are assigned. This act expands the non-VA care veterans were able to receive before the act was passed. 2. 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 Veterans Emergency Care Fairness Act (Public Law 111-137), signed February 1, 2010, authorizes VA as a secondary payer to third party liability insurance not related to health insurance. There are a number of different variables that denote the category of care a Veteran received through Fee Basis (see Table 2) Appendices B and H present more details about the values these variables can take. To enter and activate the submenu links, hit the down arrow. VA Informatics and Computing Resource Center (VINCI). The Fee Basis files primary purpose is to record VA payments to non-VA providers. Information from this system have hearing loss. If the Veteran has insurance, VA cannot pay even when the entire claim is less than the deductible. ", Military service variables can be found in [PatSub],[PatientServicePeriod], [Patient]. 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. These correspond to fields, rows and tables in a relational database. Attention A T users. FSGLI: Family Servicemembers Group Life Insurance, Schedule of Payments for Traumatic Losses, S-DVI: Service-Disabled Veterans Life Insurance, Beneficiary Financial Counseling and Online Will, Lesbian Gay, Bisexual & Transgender Veterans, Pension Management Center (PMC) that serves your state, Claims Adjudication Procedures Manual/Live Manual, Link to subscribe to receive email notice of changes to the Live Manual. To find all care provided in a particular fiscal year requires searching by treatment date over several years of Non-VA Medical Care claims. Dental claims must be filed via 837 EDI transaction or using the most current. 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. 16. It is available in the PHARVEN and VEN files, albeit with a high degree of missingness. SQL Fee Basis files themselves contain limited patient demographic variables, but can be linked to other SQL data. Community provider mails the paper claims and documentation to the new mailing address of VA's central claims intake location. Hit enter to expand a main menu option (Health, Benefits, etc). Driving distance between a veterans residence and their closest VA facility is over 40 miles, c. The veteran must travel by boat or plane to access the VA facility closest to their home (excluding Guam, American Samoa, or the Republic of the Philippines), d. The veteran faces an excessive burden in traveling to a VA, including a body of water or geologic formation that cannot be crossed by road. Fee Basis tables, however, only list PatientSID and do not list PatientICN. 1. Veterans whose income exceed the established VA Income Thresholds as well as those who choose not to complete the financial assessment must agree to pay required copays to become eligible for VA health care services. Some web reports contain PHI and access to these is restricted. FBCS Upload leverages LEADTOOLS Professional Optical Character Recognition (OCR) and is included in the FBCS workstation install package. Defining a cohort is an activity that is different for each project and depends on the research question at hand. Thus, the mailing address of the vendor is not always the vendors actual location. Visit the VHA Data Portal for further information on accessing restricted VSSC web reports. Researchers will need to link to the Patient and SPatient domains to access this geographic information in the SQL data. With the exception of supplying remittance advice supporting documentation for timely filing purposes, these processes do not apply to authorized care. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). 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: Researchers can read more information about accessing CDW on the VHA Data Portal (http://vaww.vhadataportal.med.va.gov/DataSources/CDW.aspx; VA intranet only). 10. Claims related to this care are considered authorized care. However, there is one situation in which the payment amount will be more accurate than the disbursed amount: when the disbursed amount is missing, and the payment was not cancelled, one should use the payment amount to capture the cost of care. Please switch auto forms mode to off. Multiple SAS datasets have VENID and VEN13N. Many URLs are not live because they are VA intranet only. Domains represent logically or conceptually related sets of data tables. For example, an interest payment of $14.21 would appear as 1421. INTAMT is part of DISAMT; it should not be added to them. All access or use constitutes understanding and acceptance that there is no reasonable Emergent care patient liabilities not tied to copayments or deductibles will continue to be considered for secondary payment by VA. For additional questions, contact VA by phone, tollfree, at (877) 881-7618. Veterans Health Administration. To link an authorization to a claim, use the trifecta of what VistA would consider sta3n, PatientIEN, and AuthorizationIEN. This application queues critical claims data into the FBCS shared MS SQL database for further processing and reporting. A Non-VA Medical Care claim is defined by four elements: The remainder of section 7.4 details payment rules as of early 2015. In the SAS data prior to FY 2007, the disbursed amount (DISAMT) had an implied decimal point whereas the payment amount (AMOUNT) did not. National Institute of Standards and Technology (NIST) standards. [Patient], [Spatient]. VINCI Data Description: Fee/Purchased Care [online; VA intranet only]. The vendor and the provider may or may not be the same entities. If a Veteran has only Medicare Part A then VA may consider payment for ancillary and professional services usually covered under Part B. Accessed October 16, 2015. 1. The majority of claims, 99%, were processed within 2 years, with the exception of pharmacy data in FY 2004 and FY2008. Outpatient prescriptions beyond a 10-day supply. U.S. Department of Veterans Affairs. 13. At the time of writing (October 2015), only operations staff will have permission to access the SAS data at VINCI. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. 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). VA is required by law to bill private health insurance carriers for medical care, supplies and prescriptions provided for treatment of Veterans' nonservice-connected conditions. Request and Coordinate Care: Find more information about submitting documentation for authorized care. There are multiple methods by which community providers may electronically provide VA with the required medical documentation for care coordination purposes. Of note, SQL and SAS data contain similar, but not exactly the same, information.