Consult the latest CDW schematic diagrams to understand the tables in which your variables of interest are housed and the primary key and foreign keys needed to link each pair of tables. This table contains information on inpatient care. We crosswalked the ScrSSN to allow for comparison with SAS data. To access the menus on this page please perform the following steps. For example, to understand the ICD-9 codes associated with a particular inpatient encounter, one would have to link the [Fee]. For some VEN13N, however, there is more than one MDCAREID. The key that allows for this linkage is the FeeInpatInvoiceSID which is a primary key in the [Fee]. 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. Current Decision Matrix (10/21/2022) Internal use only. There are additional payments for direct medical education, capital-related costs, and other factors as appropriate. Users must ensure their use of this technology/standard is consistent with VA policies and standards, including, but not limited to, VA Handbooks 6102 and 6500; VA Directives 6004, 6513, and 6517; and National Institute of Standards and Technology (NIST) standards, including Federal Information Processing Standards (FIPS). It is not available for claims in which payment was based on a contract amount. As of April 2019, this guidebook is no longer being updated. SAS and SQL also have several geographic fields related to the vendor providing the non-VA care, such as the vendors city, county, state and zip code. These variables relate to the VA station at which the Fee Basis care requests and claims are input. Prescription information: Prescribing provider's name. We are grateful for their cogent work. At the time of writing (October 2015), only operations staff will have permission to access the SAS data at VINCI. Private health insurance coverage through a Veteran or Veteran's spouse is insurance provided by an employer, Veteran or other non-federal source, including Medicare supplemental plans. These rules are subject to change by statute or regulation. Veterans Access, Choice, and Accountability Act of 2014 (VACAA): The Choice Program and the Choice Card [presentation]. There are two types of keys: primary keys and foreign keys. Edward J. Hines, Jr. VA Hospital, Hines, Ill. 2007. The VEN13N is the vendor ID with a suffix; VEN13N is more detailed than VENDID and is thus recommended for use. The amount claimed (PAMTCL) appears in the inpatient (INPT) file alone; there is no claimed amount on the outpatient side. A valid receipt showing the amount paid for the prescription. The charge for an ambulance trip to a non-VA hospital may be paid through the Non-VA Medical Care program if the medical center determines that the hospital services meet the criteria for an unauthorized claim or a 38 U.S.C 1725 (Mill Bill) claim, or if the patient died while in route to the facility. This component provides a front end for recognizing claim data through optical character recognition (OCR) software. A summary of the payment guidelines can be found in Appendix I. There are delays in the processing of Fee Basis claims. In the outpatient data, one observation represents a single CPT code. [ICD] table, the latter of which contains a list of all possible ICD-9 codes. However, there are some outliers; some claims can take up to 8 years to process. 2. We gratefully acknowledge comments and contributions from Sharon Dally, Susan Schmitt and Paul Barnett. Important: The mailing address below only pertains to disability compensation claims. 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. For authorized care, the referral number listed on the Billing and Other Referral Information form. Questions about care and authorization should be directed to the referring VA Medical Center. This product is Class 2 or Class 3 VA-designed and built Local Software OR is a commercially-licensed software product purchased or leased that will run in a VA VISTA environment or integrate with Class 1 National VISTA Software. 1725 when remaining liability to the Veteran is not a copayment or similar payment. However, the VA may pay a rate higher than the Medicare Fee Schedule rate for care provided in highly rural areas, as long as this rate is determined to be fair and reasonable by VA. One can find more information on payment rates under the Veterans Choice Act in federal regulation 17.1500. 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. NNPO. The VA Fee Schedule is available at provider.vacommunitycare.com > Documents & Links. Last updated August 21, 2017 Researchers should use PatientICN to link patient data within CDW. (In SAS the admission date is denoted by the TREATDTF variable and the discharge date by the TREATDTO variable, in SQL the admission date is denoted by the AdmissionDate field and the discharge date is denoted by the DischargeDate field). Most importantly, they do not represent all care provided during the fiscal year. Multiple claims can be paid against a single authorization. Lump sum payments are not paid via FBCS. As with the SAS data, the important variables in the SQL data are the AmountPaid and the DisbursedAmount. New values may be added over time. Appendix D contains information on the primary and foreign keys needed to link the various SQL tables. 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. 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. Of note, SQL and SAS data contain similar, but not exactly the same, information. This is helpful in determining the location of care in inpatient claims in which MDCAREID is missing, and in outpatient claims for hospital-provided services. These clams contain charges and are known as claimed amounts (PAMTCL in SAS, ClaimedAmount in SQL). Training - Exposure - Experience (TEE) Tournament. To access the menus on this page please perform the following steps. FPOV values of 32 and 33 also indicate ED visits, but are only observed in the Ancillary file. However, previous HERC investigation confirmed these are partial payments made for a single encounter or procedure. [FeeTravelPayment] contain information on travel type and payment. 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. There are also differences in the variables contained in the SAS versus SQL data. 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. ____________________________________________________________________________. This application completes the update of critical claims data into the FBCS shared MS SQL database for further processing and reporting. Researchers wishing to work with SAS Fee Basis data can access them at the Austin Information Technology Center (AITC). In order to qualify for round trip mileage, an appointment must be scheduled. NPI and Medicare IDs have an M to M relationship. This guide serves as an addendum to any technical documentation supplied by the healthcare clearinghouse when establishing a trading partner agreement. 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. VA can also pay for hospice care for Veterans when the VA facility is unable to provide the needed care; this happens frequently, as VA provides only inpatient-based hospice care and many Veterans may wish to receive hospice at home or in the community. Accessed October 07, 2015. Seven refer explicitly to Veterans alone, while the remaining two are for diagnostic services or eligibility exams, neither of which constitutes treatment. Accessed October 16, 2015. ", Military service variables can be found in [PatSub],[PatientServicePeriod], [Patient]. Any variable that has an S prefix indicates secure data and requires special permission to access; researchers should be aware of this when submitting their IRB applications and their CDW DART data access requests. There are up to 25 ICD-9 diagnosis codes and 25 ICD-9 surgical procedure codes in the inpatient data. They appear in Table 6, where an X indicates that the variable appears in the file.10 Vendor type (TYPE), payment category (PAYCAT), treatment code (TRETYPE), and place of service (PLSER) all provide information on the type or setting of care. Available at:http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx. [1] The Health Care Financing Administration (HCFA) was renamed the Centers for Medicare and Medicaid Services. The two tables can be joined through FeePharmacyInvoiceSID. All tablesmentioned in the Fee Basis guidebookare storedin an Excel file. A claim for which the Veteran had coverage by a health plan as defined in statute. This amounts to approximately 1.7 million claims processed per month and approximately $5-8 billion per year. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Payments received from a Veterans private health insurance carrier are credited towards any applicable VA copayments, reducing all or part of the Veterans out-of-pocket expenses. For more information call 1-800-396-7929.Claims for Non-VA Emergency CareVeterans need to make sure any bills for non-VA emergency care of non-service connected conditions are submitted to the VA Medical Centers NVCC Office within 90 days. (refer to the Category tab under Runtime Dependencies), Users must ensure that Microsoft Structured Query Language (SQL) Server, Microsoft Internet Explorer (IE), and Microsoft Excel are implemented with VA-approved baselines. 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. Mark Smith and Adam Chow were the authors of the original HERC guidebook, upon which this document builds. 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. Inpatient care, regardless of patients health status, if VA was not notified within 72 hours of admission. (formerly known as VA Fee Basis or NonVA)-Community provider submits the claim and supporting documentation through their EDI provider services in . In this situation, a given VA medical center has a preferred hospital from which it purchases care. [Patient], [PatSub]. Please switch auto forms mode to off. [FeeInitialTreatment], [Fee]. The SQL prescription data are housed in the [Fee]. Available at: http://www.mssny.org/Documents/Enews/Aug%208%202014/VA%20ProvidersGuide.pdf, 6. Fee Basis Services. VA-station related information includes STA3N, STA6A and STANUM in SAS and Sta3n and PrimaryServiceInstitution in SQL. Make sure the services provided are within the scope of the authorization. Class 2 or Class 3 products must restrict their interfaces to Class 1 National Software to use of publicly-supported APIs ONLY. Persons looking to find the date of service should be advised that it will not be contained in the FeeServiceProvided table. SQL data contain the following vendor information: NPI, FeeVendorSID, FeeVendorIEN, NPI, VendorType and FeeSpecialtyCodeName. 2. Updated September 21, 2015. With few exceptions these variables will be of little interest to researchers. For more details, including rules for handling patients transferred during a stay, see federal regulation 38 CFR 17.55. 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]. Data in any of the any S tables require Staff Real SSN access. There are three routes for filing claims for authorized care which depend on your status in VAs network and how the care was authorized: All non-urgent and non-emergent care requires authorization from VA in advance. Veterans Health Administration. The Florida Department of Veterans' Affairs has Claims Examiners co-located with the VA Regional Office in Bay Pines, each VA Medical Center and many VA Outpatient Clinics. VENDID is the vendor ID. All persons working with these data should review this information before conducting any analyses. First, it includes both the payment amount and any interest that may apply. 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. For more information call 1-800-396-7929. These correspond to fields, rows and tables in a relational database. Research requests for data from CDW/VINCI must be submitted via the Data Access Request Tracker (DART) application. If, however, VA is authorized to pay for only certain days in an inpatient stay, then the provider may bill the patient for the remaining days. The Fee Basis files' primary purpose is to record VA payments to non-VA providers. The discussion below pertains to both SAS and SQL data. Review the Corrections and Voids page for more information. Documentation in support of a claim may include: *NOTE: Documentation not required includes flowsheets and medication administration. U.S. Department of Veterans Affairs. However, not all data in the FeeServiceProvided table are outpatient data; some may pertain to inpatient stays. There are substantial differences in quantity of inpatient diagnosis and procedure data available in SAS versus SQL. Non-VA Medical Care data are available in SAS form at the Austin Information Technology Center (AITC) and in SAS form and SQL form through the VA Corporate Data Warehouse (CDW)/VA Informatics and Computing Infrastructure (VINCI). Veterans are not responsible for the remaining balance shown as patient responsibility on the explanation of benefits from their insurance carrier. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Accessed October 16, 2015. Chief Business Office. Office of Media and Public Relations. SQL Fee Basis files themselves contain limited patient demographic variables, but can be linked to other SQL data. For billing questions contact: Health Resource Center 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. U.S. Department of Veterans Affairs. Previously, VA could reimburse Veterans or pay non-VA hospitals directly only if a Veteran has no other health insurance. Missingness can vary substantially by year and by file. 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. All access FBCS supports payment of claims via VistA. A Non-VA Medical Care claim is defined by four elements: The remainder of section 7.4 details payment rules as of early 2015. A missing value of the primary diagnosis code should therefore be treated as truly missing. In SAS, the outpatient data are housed in the MED files. 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/. In SQL, there are multiple patient identifiers, with the most useful being the PatientICN. Available at: http://vaww.virec.research.va.gov/CDW/Overview.htm. and constitutes unconditional consent to review and action including (but not limited VA may reconsider and provide retroactive reimbursements for emergency treatment that was provided prior to the date of enactment (July 19, 2001), if documentation sufficiently demonstrates the original denial was because the Veteran received partial third party payment. Researchers will need to link to the Patient and SPatient domains to access this geographic information in the SQL data. VA evaluates these claims and decides how much to reimburse these providers for care. April 14, 2014. For Such care is called Non-VA Medical Care, or Fee Basis care. This Technology is currently being evaluated, reviewed, and tested in controlled environments. The definition of the DXLSF variable changes depending on the year of analysis. 3. The prescription must be for a service-connected condition or must otherwise have specific approval. Veterans who meet certain criteria may be eligible for mileage reimbursement for travel to and from VA or Non-VA care. 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. 1. 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). Compare the admission date of the third observation to the temporary end date from above. Linking Patient Data in the CDW Update [online; VA intranet only]. The second record would have an admission date of Jan 5, 2010 and a discharge date of Jan 5, 2010. In general, we recommend using the disbursed amount to capture the cost of care, for two reasons. 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. Address. VA Form 10-583, Claim for Payment of Cost of Unauthorized Medical Services. VA evaluates these claims and decides how much to reimburse these providers for care. [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. To learn more, please visit the Provider Training section on the MES website . For current information on Community Care data, please visit the page. Below we describe the general types of information in both the SAS and SQL data. VA Palo Alto, Health Economics Resource Center; October 2013. Race and ethnicity are found in the [PatientEthnicity], [PatSub]. Accessed October 16, 2015. 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). Use the column 'estimated cost' and it is available in the CDW FBCS data. Thus, one could not simply use the patient identifier and the admission and discharge dates to collapse these observations into one inpatient stay. The amount of interest paid on the claim, if any, appears as the variable INTAMT. A subsequent report will contain the results of an audit conducted to assess The data that is not available is the data element that indicates if it was generated by FBCS or manually entered by the user in FBCS. SAS and SQL data are very similar, but not exact copies of each other. If electronic capability is not available, providers can submit claims by mail. VINCI. Most files contain the invoice date, obligation number; check number and date, several variables pertaining to check cancellation and denials of payment, and the DHCP internal control number. There may be multiple STA3Ns for a single inpatient stay. This improves our claims processing efficiency. VA Informatics and Computing Resource Center (VINCI). One can use the FeeInitialTreatmentSID variable in the FeeServiceProvided table to link to the Fee.FeeInitialTreatment table. It is also possible that researchers will find a slight difference in the observations that the SAS versus SQL data contain. All access or use constitutes understanding and acceptance that there is no reasonable 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). Outpatient prescriptions beyond a 10-day supply. 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. There are exceptions. Community providers have three options that allow for that linkage: Submit the claim electronically via 837 transaction and the supporting documentation via 275 transaction. These vendors are presumably hospital chains. 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. To understand what procedures were performed during an inpatient stay in the [Fee]. VA will arrange for transportation for them or will reimburse expenses on the basis of vouchers submitted. [SPatient] and[PatSub] tables. [FeeVendor] table. 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. would cover any version of 7.4. If the Veteran has insurance, VA cannot pay even when the entire claim is less than the deductible. Some web reports contain PHI and access to these is restricted. Detailed instructions and documentation required for DART data requests can be found on the VHA Data Portal intranet website at http://vaww.vhadataportal.med.va.gov/DataAccess/DARTRequestProcess.aspx. Below are some answers to general questions about linking the UB-92 form to the FBCS data. resides on and transmits through computer systems and networks funded by the VA. These tables involve payments paid only through FBCS. When MDCAREID is not available, it is possible to assign MCCAREID based on the relationship between VEN13N and STA6A. VA intranet only: http://vaww.vhadataportal.med.va.gov/Resources/DataReports.aspx). There are also a number of other financial variables denoted in SAS (see Table 7). Reimbursement for Pharmacists Services in a Hospital-based, Pharmacist-managed Anticoagulation Clinic. The VA pays for both emergency and non-emergency care through Fee Basis mechanisms. Attention A T users. SAS and SQL contain different variables to identify the provider and/or vendor associated with the care. SAS data have limited patient demographic data. October 1, 2015. Thus, in SQL the total cost of an inpatient stay would be determined by evaluating the DisbursedAmount in the [Fee]. Our office is located at 6940 O St, Suite 400 Lincoln NE 68510. 7. Please visit Emergency Care Claims to learn more. [FeePharmacyInvoice] and the [Fee]. Starting in 2009, there are also a number of DXPOA variables in the SAS data, which indicate diagnoses that are present on admission. Federal law puts prosthetics into a special payment category that mandates full financial support from VA. As implemented in VA policy, it requires that VA facilities provide all necessary prosthetics, orthotics, and assistive devices (prosthetics) needed by patients. visit VeteransCrisisLine.net for more resources. The Medicare hospital provider ID (MDCAREID) is entered by fee basis staff in order to calculate hospital reimbursement using the Medicare Pricer software. It may duplicate the PatientIEN of another patient at another facility, and should not be used as an identifier. We give an example here that relates to FeeInpatInvoice table. There is a deductible of $3 per trip up to a limit of $18 per month. VA Claims Representation; RESOURCES. 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. 1. 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. Contact: 1-877-353-9791; Email Customer Engagement; Customer Engagement Portal Login. If the provider declines VA payment then it may be able to charge the patient a greater total amount. In particular, CDW also recommends Patient SIDs with a value of less than 1 be deleted. 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. or use of this system constitutes user understanding and acceptance of these terms We suggest using only the first 3 characters from sta3n for the merge. Ready. If you are in crisis or having thoughts of suicide, Box 14830Albany, NY 12212. Get the latest updates on VA community care, including program changes, resources and more! Money collected by VA from private health insurance carriers is returned back to the VA medical center providing the care. You are strongly encouraged to electronically submit claims and required supporting documentation. Therefore, on the outpatient side as well one must aggregate multiple records to get a full picture of the outpatient encounter. For more information, including information on deductibles and special transports, visit: https://www.va.gov/health-care/get-reimbursed-for-travel-pay/. 9.2. This application reads, creates, edits authorization data in VistA, and copies critical information into the central SQL database for off-line VistA applications to consume. To file a claim for services authorized by VA, follow instructions included in the Submitting Claims section of the referral. As noted in Chapter 2, the important variables capturing cost of care are AMOUNT and DISAMT. 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. With additional permissions, researchers can also access City, Postal Code, Street Address, and Zip. The VA Fee Basis medical program provides payment authorization for eligible Veterans to obtain routine medical treatment services through non-VA health care providers. 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." 1. Community provider mails the paper claims and documentation to the new mailing address of VA's central claims intake location. Veterans Crisis Line: SQL data contain both SCRSSN and SSN, but these data reside in the SPatient table at CDW, and cannot be accessed by researchers without the CDW data manager and IRB approval. Austin Information Technology Center (AITC) is one of the VAs five national data centers. 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. Researchers should pay special attention to reducing duplicates in the pre-2008 data. SQL Fee Basis data are stored in CDW in multiple individual tables. 6. Table 3 lists their file names and gives a general description of their contents.10. [FeePrescription] tables. In both the SAS and the SQL data, there are usually multiple observations per patient encounter. If the claims and records do not conform to the minimum requirements for conversion to the 837 or 275 electronic formats, they are rejected and sent back for correction. The Vendor Release table provides the known releases for the. Name of the medication. Researchers can look at the disposition variable as an indicator of transfer between VA and non-VA care. Many veterans now have access to Non-VA medical care through the new Veterans Access, Choice, and Accountability Act (VACAA, or Choice Act). The vendor identity can be found through the FeeVendorSID or the FeeVendorIEN variables in SQL.