| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | service provided(+) | 0;1 | POINTER | 81 | B | The Current Procedural Terminology Code (CPT Code) as specified on the vendors invoice identifying the service the vendor provided to the veteran. |
| .05 | ipac agreement | 3;6 | POINTER | 161.95 | IPAC | This is the pointer to the IPAC Agreement file that is associated with the invoice. |
| .055 | dod invoice number | 3;7 | FREE TEXT | DODI | The DoD invoice number that is associated with this VistA invoice. Note that one DoD invoice number may have more than one VistA invoice. | |
| 1 | amount claimed(+) | 0;2 | NUMERIC | The amount the vendor is billing us for this service provided. | ||
| 2 | amount paid(+) | 0;3 | NUMERIC | The amount that the VA is going to pay for this service provided, not to exceed the amount entered in the AMOUNT CLAIMED (#1) field. Users holding the "FBAASUPERVISOR" key may override this limit. | ||
| 3 | amount suspended | 0;4 | NUMERIC | The portion of the vendor's claimed amount that the VA will not pay for various reasons. This amount is usually the difference between the vendor's amount claimed and the amount paid. | ||
| 3.5 | date suspended | 0;11 | DATE-TIME | The date that this payment is suspended. | ||
| 4 | suspend code | 0;5 | POINTER | 161.27 | The code that identifies why the amount paid was less than the amount claimed. The valid list of codes are contained in the Fee Basis Suspension file. | |
| 5 | date finalized | 0;6 | DATE-TIME | AK | The date that this payment line item was finalized (Certified) by the Fee Supervisor. | |
| 6 | clerk(+) | 0;7 | POINTER | 200 | The Fee clerk who entered in the payment data. | |
| 7 | batch number | 0;8 | POINTER | 161.7 | AC | The batch number with which this payment was associated. If the batch file has been purged this may be blank. |
| 8 | obligation number(+) | 0;10 | FREE TEXT | The obligation number identifying which funds this payment will be paid with. | ||
| 12 | date paid | 0;14 | DATE-TIME | This is the date of the check, as issued by the treasury. This information will be passed back to DHCP from the Financial Management System (FMS) when the check is issued to the vendor. This field will use the check date beginning with version 3.5 of Fee Basis. Entries prior to version 3.5 are the date the system automatically entered when the payment line item was queued to be transmitted to the Austin Automation Center for payment. | ||
| 13 | date correct invoice received(+) | 0;15 | DATE-TIME | Date that the VA receives what it feels to be a complete/correct invoice. This date is very important since it is the date used by the Central Fee system in determining if interest should be paid because of untimely processing by VA. Requirements for the prompt payment act apply. | ||
| 14 | invoice number | 0;16 | NUMERIC | C | An automatically generated number associated with a vendor's bill. | |
| 15 | patient type code(+) | 0;17 | SET OF CODES | 00:SURGICAL 10:MEDICAL 60:HOME NURSING SERVICE 85:PSYCHIATRIC-CONTRACT 86:PSYCHIATRIC 95:NEUROLOGICAL-CONTACT 96:NEUROLOGICAL | The patient's type code (ie medical, surgical) related to this payment line item. This is based on the authorization that is selected during the payment process. | |
| 16 | purpose of visit(+) | 0;18 | POINTER | 161.82 | This identifies the purpose that the veteran received the service provided. This data is obtained from the authorization data for the patient, at the time of payment entry. | |
| 17 | treatment type code(+) | 0;19 | SET OF CODES | 1:SHORT TERM FEE STATUS 2:HOME NURSING SERVICE 3:I.D. CARD STATUS | The treatment type code this payment is related to. It is obtained from the authorization data for the patient which was selected at the time of payment entry. | |
| 18 | payment type code(+) | 0;20 | SET OF CODES | R:REIMBURSEMENT S:STATISTICAL V:VENDOR SR:STAT-REIMBURSEMENT | Identifies whether this is a payment to a vendor, a reimbursement to the veteran, a statistical payment which only updates veteran year-to-date amounts and results in NO payment and a statistical reimbursement which allows the user to update payment record with a reimbursement paid out of system. | |
| 19 | reject status | FBREJ;1 | SET OF CODES | P:REJECTED, PENDING C:REJECTED, COMPLETED | Identifies whether this line item has been rejected and is pending assignment to another batch. | |
| 20 | reject reason | FBREJ;2 | FREE TEXT | The reason this line item was rejected for payment. Normally, the Austin reject code is entered. | ||
| 21 | old batch number | FBREJ;3 | POINTER | 161.7 | AH | The batch number this line item was associated with before the line item was rejected. |
| 21.3 | interface reject | FBREJ;4 | BOOLEAN | 1:YES | This field is populated by the FBAA BATCH SERVER and FBAA REJECT SERVER server options when a payment line item is rejected via the interface with Central Fee. This field is used to distinguish line items that were locally rejected from those that were rejected by a downstream system. This field is not populated for a local reject. | |
| 21.6 | reject code | FBREJC;0 | MULTIPLE | 162.031 | The REJECT CODE multiple is populated with one to four reject codes by the FBAA BATCH SERVER and FBAA REJECT SERVER server options when a line item is rejected via the interface with Central Fee. The REJECT CODE multiple is not used for local rejects. The reason for a local reject is entered into the REJECT REASON (#20) field. | |
| 22 | description of suspension | 1;0 | WORD-PROCESSING | This field is used only when the suspend code entered is '4' meaning 'Other'. This allows the entering of the reason that the payment amount was not in full. This will be printed on the suspense letter. | ||
| 23 | fee program | 0;9 | POINTER | 161.8 | The Fee program that this line item is associated with (ie Outpatient Medical, Contract Hospital). | |
| 24 | void payment | 0;21 | SET OF CODES | VP:VOID | This field is set when a payment was made in error and the site has initiated a bill of collection to retrieve the dollars expended. The ability to void a payment is restricted to the holder of the FBAASUPERVISOR security key. | |
| 24.5 | reason for voided payment | R;1 | FREE TEXT | This field will allow the Fee Supervisor to store the reason why they had to void a payment. | ||
| 25 | supervisor | 0;22 | POINTER | 200 | This is the Fee Supervisor who cancelled(voided) the payment. | |
| 26 | primary service facility | 0;12 | POINTER | 4 | The VA Hospital responsible for the veterans care. | |
| 27 | associated 7078/583 | 0;13 | VARIABLE-POINTER | 162.4, 162.7 | AM | Contains the related 7078 or 583 if an unauthorized claim. |
| 28 | primary diagnosis | 0;23 | POINTER | 80 | This field contains the primary diagnosis of the patient for the service provided. | |
| 29 | va type of service | 0;24 | POINTER | 163.85 | The information recorded in this field will be sent with the payment record to the Austin DPC. It will allow the program office to do some comparisons between VA supplied services and those supplied by Fee Basis. | |
| 30 | place of service | 0;25 | POINTER | 353.1 | This field determines where the service was administered to the veteran. | |
| 31 | hcfa type of service | 0;26 | POINTER | 353.2 | This information will be used to determine payment amounts in the future. It is currently asked on the HCFA 1500 form. | |
| 32 | service connected condition? | 0;27 | FREE TEXT | Indicates whether the service provided was for a Service Connected condition. Answer 'Yes' if service provided was for a Service Connected condition, 'No' if eligible under NSC such as Aid and Attendance. | ||
| 33 | vendor invoice date(+) | 2;1 | DATE-TIME | This is the date that the vendor issued the invoice. | ||
| 34 | prompt pay type | 2;2 | SET OF CODES | 1:MONEY MANAGED | Field is set to 1 if the payment is subject to interest payments (prompt pay). Otherwise it remains blank. | |
| 35 | check number | 2;3 | FREE TEXT | Contains the check number as issued by the treasury. This field is updated after the check is issued, through a server option that records actual payment information for each Fee payment made. | ||
| 36 | cancellation date | 2;4 | DATE-TIME | This is the date the treasury cancelled the check. This field is updated through a server option that records cancellations of previously recorded payment data. | ||
| 37 | reason code | 2;5 | POINTER | 162.95 | This field contains a pointer to the Fee Basis Check Cancellation Reason file. It is populated through a server option that updates the payment record when the treasury cancels a check that was previously payed. | |
| 38 | cancellation activity | 2;6 | SET OF CODES | R:WILL BE REPLACED C:WILL BE REISSUED X:WILL NOT BE REISSUED | This field is populated when a cancellation is recorded for the payment referenced. This field will always remain populated, to indicate that there was cancellation activity on this payment at one time. New payments will replace the cancellation date and reason code fields, but the cancellation activity flag will not be overwritten. This flag will allow the user to know that previous cancellation activity existed, and to review the cancellation history output for further information. | |
| 40 | disbursed amount | 2;8 | NUMERIC | This is the dollar amount paid by the treasury, less any interest paid. | ||
| 41 | interest amount | 2;9 | NUMERIC | The interest amount paid on this line item by the treasury. | ||
| 42 | site of service zip code(+) | 2;10 | FREE TEXT | Zip Code of the location where the service was actually performed. | ||
| 43 | anesthesia time (minutes) | 2;11 | NUMERIC | Enter time billed for an anesthesia service in minutes. The bill may specify anesthesia units which will need to be converted to minutes. | ||
| 44 | fee schedule amount | 2;12 | NUMERIC | This is the dollar amount obtained from a fee schedule for the service provided. | ||
| 45 | fee schedule | 2;13 | SET OF CODES | F:VA FEE SCHEDULE R:RBRVS FEE SCHEDULE | Specifies which fee schedule was used to obtain the fee schedule amount for this service provided. | |
| 46 | cpt modifier | M;0 | MULTIPLE | 162.06 | ||
| 47 | units paid(+) | 2;14 | NUMERIC | Units of service being paid for this line item if any payment is being made for the line item. If payment disapproved for the line item then enter the units of service that were billed. | ||
| 48 | revenue code | 2;15 | POINTER | 399.2 | Revenue code is a 3-digit code associated with itemized charges on a UB92 billing invoice. A revenue code should be entered if a CPT/HCPCS code was not specified for the line item. If both revenue code and a CPT/HCPCS code have been entered for a line item, the revenue code will be considered the more accurate description of the service. | |
| 49 | patient account number | 2;16 | FREE TEXT | Please enter the Patient control number. This could be either the Patient Identification Number or Patient Account Number from the vendor's invoice. | ||
| 50 | fpps claim id | 3;1 | FREE TEXT | Enter the entire FPPS Claim ID as shown on the invoice document. (1-32 character text ID created by FPPS system). | ||
| 51 | fpps line item | 3;2 | FREE TEXT | Enter the line item sequence number associated with this charge. Each charge on the FPPS invoice document will have a line item sequence number associated with it. A line item can be entered individually or a group of charges from multiple lines can be entered. If all line items in a group are in numerical sequence, you may enter the first line item sequence number followed by a hyphen and the last line item sequence number. If the grouped charges are not in sequential order, each line item must be entered individually, followed by a comma. | ||
| 52 | adjustment | 7;0 | MULTIPLE | 162.07 | ||
| 53 | remittance remark | 8;0 | MULTIPLE | 162.08 | ||
| 54 | contract | 3;8 | POINTER | 161.43 | ACN | If the payment is for contracted services, the contract number can be specified in this field. The selected contract must be active and applicable to the vendor being paid. |
| 55 | routing number | 2;17 | FREE TEXT | Enter the financial routing number information that was returned with the payment from Central Fee for Electronic Fund Transfer (EFT) entries. This information will be forwarded to FPPS so that the vendor can be notified of the payment. This field must be 9 characters, including any leading zeros. Note: The Central Fee nightly update will automatically set this field if the data is included in their message. | ||
| 56 | account number | 2;18 | FREE TEXT | Enter the financial account number information that was returned with the payment from Central Fee for Electronic Fund Transfer (EFT) entries. This information will be forwarded to FPPS so that the vendor can be notified of the payment. This field must be 1-17 characters, including any leading zeros. Note: The Central Fee nightly update will automatically set this field if the data is included in their message. | ||
| 57 | financial institution | 2;19 | FREE TEXT | Enter the financial institution name that was returned with the payment from Central Fee for Electronic Fund Transfer (EFT) entries. This information will be forwarded to FPPS so that the vendor can be notified of the payment. Note: The Central Fee nightly update will automatically set this field if the data is included in their message. | ||
| 58 | attending prov name | 4;1 | FREE TEXT | Enter the Attending Provider's name found in the claim information. | ||
| 59 | attending prov npi | 4;2 | FREE TEXT | Enter the Attending Provider's National Provider Identifier (NPI) found in the claim information. This value must be 10 characters, including any leading zeros. | ||
| 60 | attending prov taxonomy code | 4;3 | FREE TEXT | Enter the Attending Provider's Taxonomy code found in the claim information. This value must be 10 characters, including any leading zeros. | ||
| 61 | operating prov name | 4;4 | FREE TEXT | Enter the Operating Provider's name found in the claim information. | ||
| 62 | operating prov npi | 4;5 | FREE TEXT | Enter the Operating Provider's National Provider Identifier (NPI) found in the claim information. This value must be 10 characters, including any leading zeros. | ||
| 63 | rendering prov name | 4;6 | FREE TEXT | Enter the Rendering Provider's name found in the claim information. | ||
| 64 | rendering prov npi | 4;7 | FREE TEXT | Enter the Rendering Provider's National Provider Identifier (NPI) found in the claim information. This value must be 10 characters, including any leading zeros. | ||
| 65 | rendering prov taxonomy code | 4;8 | FREE TEXT | Enter the Rendering Provider's Taxonomy code found in the claim information. This value must be 10 characters, including any leading zeros. | ||
| 66 | servicing prov name | 4;9 | FREE TEXT | Enter the Servicing Provider's name found in the claim information. | ||
| 67 | servicing prov npi | 4;10 | FREE TEXT | Enter the Servicing Provider's National Provider Identifier (NPI) found in the claim information. This value must be 10 characters, including any leading zeros. | ||
| 68 | referring prov name | 4;11 | FREE TEXT | Enter the Referring Provider's name found in the claim information. | ||
| 69 | referring prov npi | 4;12 | FREE TEXT | Enter the Referring Provider's National Provider Identifier (NPI) found in the claim information. This value must be 10 characters, including ay leading zeros. | ||
| 73 | li rendering prov name | 3;3 | FREE TEXT | Enter the associated line item Rendering Provider's name found in the line item level claim information. Note: This field is only necessary if the line item Rendering Provider is different than the claim Rendering Provider. | ||
| 74 | li rendering prov npi | 3;4 | FREE TEXT | Enter the associated line item Rendering Provider's name found in the line item level claim information. This value must be 10 characters, including any leading zeros. Note: This field is only necessary if the line item Rendering Provider is different than the claim Rendering Provider. | ||
| 75 | li rendering prov taxonomy | 3;5 | FREE TEXT | Enter the associated line item Rendering Provider's Taxonomy code found in the line item level of the claim information. This value must be 10 characters, including any leading zeros. Note: This field is only necessary if the line item Rendering Provider is different than the claim Rendering Provider. | ||
| 76 | servicing facility address | 5;1 | FREE TEXT | Enter the Servicing Facility street address found in the claim information. | ||
| 77 | servicing facility city | 5;2 | FREE TEXT | Enter the Servicing Facility city found in the claim information. | ||
| 78 | servicing facility state | 5;3 | POINTER | 5 | Enter the Servicing Facility state found in the claim information. | |
| 79 | servicing facility zip | 5;4 | FREE TEXT | Enter the Servicing Facility zip code, in either the 5 digit format (e.g. 12345) or 9 digit format (e.g. 12345.6789 or 123456789). | ||
| 81 | unique claim identifier | 5;5 | FREE TEXT | This field contains a unique identifier for tracking claims. Fee5010 Project. |
Error: Invalid Global File Type: 162.03