This file contains unauthorized claim information for active fee programs. Sites have the ability to either track only complete claims or incomplete claims, depending upon the value in the site parameter field. A claim is considered complete once all information is received in order to make a determination (dispostion). Per VHA Directive 10-93-142, this file definition should not be modified.
.01date claim received(+)0;1DATE-TIMEBThis is the Date that the valid 583 was accepted for processing. Usually the date the claim is being entered.
.5fee program(+)0;2POINTER161.8The appropriate fee program to which this unauthorized claim pertains. Only active fee programs can be selected.
1vendor(+)0;3POINTER161.2CThe vendor who provided the services being charged.
2veteran(+)0;4POINTER2DThe name of the veteran who received the services being claimed.
3treatment from date(+)0;5DATE-TIMEDate which treatment began for submitted unauthorized claim. Date cannot be in the future.
4treatment to date(+)0;6DATE-TIMEDate which treatment ended for sumbitted unauthorized claim. Date cannot be in the future or be earlier than Treatment From date.
5diagnosisDX;1FREE TEXTEnter the diagnosis upon which services were rendered.
5.1icd diagnosisDX;2POINTER80Patient's diagnosis for which this authorization is being issued. This field is only for ICD-10 and later.
6primary service facility0;7POINTER4The name of the facility which will reimburse the COJ.
7date valid claim received0;8DATE-TIMEDate complete (valid) unauthorized claim received for medical review.
8amount claimed0;9NUMERICThe dollar amount being claimed.
9patient type code(+)0;10SET OF CODES00:SURGICAL
The appropriate patient type code for services which were received.
10disposition0;11POINTER162.91Only active dispositions can be selected. If the disposition has been approved, or approved to stabilization and payments made, then the disposition can not be changed unless the FBAASUPERVISOR key is held. An approved, approved to stabilization, or disapproved disposition requires a Complete status.
10.5disposition remarks4;0WORD-PROCESSINGSpecial remarks regarding the initial disposition that should be included on a disposition letter to the claimant. (Optional)
10.6appeal disposition remarksA1;0WORD-PROCESSINGSpecial remarks regarding the disposition of an appeal that should be included on a disposition letter to the claimant. (Optional)
10.7cova disposition remarksA2;0WORD-PROCESSINGSpecial remarks regarding the disposition of a COVA appeal that should be included on a disposition letter to the claimant. (Optional)
11date of disposition0;12DATE-TIMEThe date the claim was dispositioned.
12authorized from date0;13DATE-TIMEThe beginning date from which fee services for unauthorized claim are authorized. Date cannot be in the future or before Treatment From date.
13authorized to date0;14DATE-TIMEThe ending date which fee services are authorized. Date cannot be in the future or before the Authorized From date. Authorized To date cannot be greater than Treatment To date.
14amount approved0;15NUMERICThe authorized amount for payment of an unauthorized claim.
15reason for disapprovalD;0MULTIPLE162.715Provides reason(s) why a claim was disapproved.
16*dispositon description1;0WORD-PROCESSINGThe description of the disposition. Replaced by the REASON FOR DISAPPROVAL field.
17*reason for pending2;0WORD-PROCESSINGThe reason the claim was pending. Replaced by the FEE BASIS UNAUTHORIZED REQUESTED INFORMATION file (# 162.93).
19print letter?0;16BOOLEAN1:YES
ALIf this field has a YES value, an unauthorized claim letter needs to be printed.
19.5date letter sent0;19DATE-TIMEALPDate letter sent to submitter.
19.6date req info sent6;1DATE-TIMEThis field contains the most recent date a request for additional information letter was sent for the claim. This field is automatically populated by the software.
20master claim(+)0;20POINTER162.7AMCEnter the claim to which this claim is related. It may be related to itself. Select only those records containing the same veteran which have no disposition.
21reopen claim date0;21DATE-TIMEDate dispositioned claim reopended for review.
22date of original disposition0;22DATE-TIMEDate unauthorized claim was originally dispostioned. Used in determining expiration date in the case of appeal status'.
23claim submitted by(+)0;23VARIABLE-POINTER2, 161.2, 200Identify the submitter of the unauthorized claim. The submitter may differ from the vendor or veteran involved with the claim. If the submitter is a vendor, must be same value as entered in the VENDOR field; if veteran, must be same as VETERAN field.
24status(+)0;24POINTER162.92ASSelect the appropriate status from FEE BASIS UNAUTHORIZED CLAIMS STATUS file. Status is automatically determined and stuffed, it should not be edited.
25date of current status(+)0;25DATE-TIMEThis field contains the date on which the current status was entered or updated.
26expiration date of claim0;26DATE-TIMEThe date by which a response should be received before the claim expires. If the expiration date arrives with no response, then the appropriate action may need to be taken (action varies with status of claim). No further processing should be allowed. (If awaiting information, claim should be dispositioned to abandoned; if already dispostioned, appeal or BVA appeal can not be entered.) This field is automatically updated.
27entered/last edited by0;17POINTER200The name of the person who entered the claim.
28date entered/last edited0;18DATE-TIMEThe date on which the unauthorized claim was entered.
29discharge typeCOMPUTEDDisplay DISCHARGE TYPE of related entry in authorization subfile.
30authorization0;27NUMERICThis field is set to the internal entry number of the appropriate authorization in file 161.
3138 u.s.c. 17250;28BOOLEAN1:YES
If this field has a YES value, the software will treat this claim as an emergency care claim that is being considered under the provisions of the Millennium Act 38 U.S.C. 1725.
32fpps claim id5;1FREE TEXTEnter the entire FPPS Claim ID as shown on the invoice document. (1-32 character text ID created by FPPS system).
50notice of disagreement recv'dA;1DATE-TIMEDate Notice of Agreement (VAF 21-4138) received.
51statement of the case issuedA;2DATE-TIMEDate Statement of the Case was issued.
52date substantive appeal recv'dA;3DATE-TIMEDate Substantive Appeal was received.
53date appeal dispositionedA;4DATE-TIMEDate appeal decision rendered by Board of Veterans Appeal (BVA).
54date appealed to covaA;5DATE-TIMEDate Board of Veterans Appeal decision was appealed to Court of Veteran Affairs (COVA). A timely appeal must be within 120 days of the BVA decision.
55date cova appeal dispositionedA;6DATE-TIMEDate a decision to a COVA appeal rendered.
293data auditLOG2;0MULTIPLE162.793The data audit multiple stores historical information for selected fields.

Referenced by 3 types

  1. FEE BASIS INVOICE (162.5) -- associated 7078/583
  2. FEE BASIS UNAUTHORIZED CLAIMS (162.7) -- master claim
  3. FEE BASIS UNAUTHORIZED CLAIMS PENDING INFO (162.8) -- unauthorized claim