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All information in this guidebook pertains to use of ICD-9 codes. 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). We are the third-party administrator for the VA CCN for Regions 1, 2 and 3, encompassing 36 states, Puerto Rico, the U.S. Virgin Islands and the District of Columbia. SQL Fee data are available through the VA Corporate Data Warehouse (CDW)/VA Informatics and Computing Infrastructure (VINCI). Care provided under contract is eligible for interest payments. or use of this system constitutes user understanding and acceptance of these terms The disbursed amount should be used to calculate the cost of care, except in the case where disbursed amount is missing. A summary of the payment guidelines can be found in Appendix I. For more detailed information, researchers should visit the VHA Office of Community Care website. 12. (refer to the Category tab under Runtime Dependencies), Users must ensure that Microsoft Structured Query Language (SQL) Server is implemented with VA-approved baselines. You can use NPI to link providers in VA and Medicare. URLs are not live because they are VA intranet only. The VA Fee Basis medical program provides payment authorization for eligible Veterans to obtain routine medical treatment services through non-VA health care providers. Inpatient stays in both SAS and SQL Fee Basis data can denote hospital stays, nursing home stays, or hospice stays. Both ancillary and outpatient files have one record per CPT code. The 275 transaction process should not be utilized for the submission of any other documentation for authorized care. Non-VA Payment Methodology Matrix [online; VA intranet only]. Presence of this software on the One-VA TRM does not equate to designation as a Class 1 National Software product and MUST NOT be assumed to comply with all VA programming standards, namespacing and interface control agreement standards, data management standards, documentation standards, information assurance standards, security standards and 508 compliance standards. There are exceptions. VA systems are intended to be used by authorized VA network users for viewing and This technology has not been assessed by the Section 508 Office. This seeming complicated arrangement is an efficient way to store data. Previously, VA could reimburse Veterans or pay non-VA hospitals directly only if a Veteran has no other health insurance. Attention A T users. Summary data are also available through the VHA Support Services Center (VSSC) website on the VA intranet. 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. 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. No new extracts will occur. They do not represent all claims received during the year. The travel payments data contains reimbursements for particular travel events (TVLAMT). As of July 2015, the current mileage reimbursement rate is 41.5 cents per mile. Information from this system For these reasons, the program does not pay for 100% of care that was otherwise eligible. In the outpatient data, each record represents a different procedure, as assessed through the Current Procedural Terminology (CPT) code. The unique patient identifier by which to conduct SQL-based Fee Basis analyses is PatientICN. As a Class 2 or Class 3 product, it MUST NOT be assumed to having been released into production through all OI&T product release and sustainment process controls for project management; requirements, development and testing management; and configuration, change, and release management necessary to satisfy OI&T process and product compliance. 1. It can be difficult to determine the provider and the location of the Non-VA care provider. Note: The last extract occurred in December 2020. Identify Choice records by using tax ID and specialprovcat= CHOICE. 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. VA will arrange for transportation for them or will reimburse expenses on the basis of vouchers submitted. 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. 1725 or 38 U.S.C. Austin Information Technology Center (AITC) is one of the VAs five national data centers. 1725 when remaining liability to the Veteran is not a copayment or similar payment. To find all care provided in a particular fiscal year requires searching by treatment date over several years of Non-VA Medical Care claims. This could indicate a transfer between facilities or a physician bill for an inpatient stay. Training - Exposure - Experience (TEE) Tournament, Observational Medical Outcomes Partnership (OMOP), Personnel & Accounting Integrated System (PAID), Decision Analysis: Decision Trees, Simulation Models, Sensitivity Analyses, Measuring the Cost of a Program or Practice: Microcosting, List of VA Economists and Researchers with Health Economic Interests. Customer Engagement Portal - Veterans Affairs Multiple SQL tables contain these variables. U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. VA Claims Representation; RESOURCES. When there is no available rate in the Medicare Fee Schedule, the VA will follow the payment guidelines for Non-VA Medical Care. [FeeInitialTreatment], [Fee]. Office of Information and Analytics. For additional information or assistance regarding Section 508, please contact the Section 508 Office at Section508@va.gov. To file a claim for services authorized by VA, follow instructions included in the Submitting Claims section of the referral. VA has set a goal of processing all clean claims within 30 days. Medication dosage/strength. There is a strong, but imperfect, concordance, between the observations housed in the SAS and SQL data. VA calculates PAMT from CMS pricer software on the basis of DRG and length of stay. TriWest VA CCN ClaimsP.O. Providers are not required to accept VA payment in all cases. Non-VA providers submit claims for reimbursement to VA. 5. https://vaww.cdw.va.gov/metadata/Reports/ERDiagramsOfViews/Purchased%20Care%20Authorized_5638.jpg, https://vaww.cdw.va.gov/metadata/Reports/ERDiagramsOfViews/Purchased%20Care%20Unauthorized_242.jpg, https://vaww.cdw.va.gov/metadata/Reports/ERDiagramsOfViews/Purchased%20Care%20Service_5480.jpg. 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. Thus, one could not simply use the patient identifier and the admission and discharge dates to collapse these observations into one inpatient stay. There may be many providers that use the same vendor for billing. VIReC. The DSS Fee Basis Claims System (FBCS) is a web-based claim management system. The Act amends 38 U.S.C. The vendor and the provider may or may not be the same entities. Unscheduled trips may be reimbursed for the return mileage only. A claim for which the Veteran had coverage by a health plan as defined in statute. See 38 USC 1725 and 1728.). UB-92 box 56 (ProviderNPI) represents the providers National Provider Identifier. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. There may be multiple STA3Ns for a single inpatient stay. The VHA Office of Community Care is the contact for all VA community care programs. Records that relate PatientSID to PatientICN are found two tables: Patient.Patient and SPatient.Spatient. Thus, in SQL the total cost of an inpatient stay would be determined by evaluating the DisbursedAmount in the [Fee]. This technology is not portable as it runs only on Windows operating systems. In general, we recommend using the disbursed amount to capture the cost of care, for two reasons. 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. Persons looking to find the date of service should be advised that it will not be contained in the FeeServiceProvided table. Veterans Choice Program - Fee Basis Claims System in CDW - Veterans Affairs This is true for both the inpatient and outpatient data. There are substantial differences in quantity of inpatient diagnosis and procedure data available in SAS versus SQL. If it cannot be located in the PTF Main file or DSS NDE for inpatient care, search other inpatient files. Another approach is to search other fee claims submitted by the same vendor to see if a Medicare hospital ID was assigned to those claims. The VEN13N is the vendor ID with a suffix; VEN13N is more detailed than VENDID and is thus recommended for use. With few exceptions these variables will be of little interest to researchers. While Unauthorized care is considered a separate domain, the data pertaining to Unauthorized care are stored alongside the Authorized care data in the FeeInpatInvoice table and the FeeServiceProvided table. One may therefore assume that all patients receiving treatment through the Non-VA Medical Care program are Veterans. FBCS is where weve spent the bulk of our time investigating. This is in line with the way VHA Office of Productivity, Efficiency & Staffing (OPES) ascertains ED visit. Chapter 4 offers detailed information SAS Fee Basis data; Chapter 5 provides detailed information about SQL Fee Basis data. Guidance can be found under "VHA Data Quality Program Reports. For dual pension and compensation claims, use the mailing address below for compensation claims. Persons working with the SAS data should keep in mind that prior to FY 2007, the disbursed amount (DISAMT) had an implied decimal point whereas the payment amount (AMOUNT) did not. Accessed October 16, 2015. For some VEN13N, however, there is more than one MDCAREID. The vendor identity can be found through the FeeVendorSID or the FeeVendorIEN variables in SQL. At the time of writing (October 2015), only operations staff will have permission to access the SAS data at VINCI.