Files > FEE BASIS UNAUTHORIZED CLAIMS

name

FEE BASIS UNAUTHORIZED CLAIMS

number

162.7

location

^FB583(

description

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.

Fields

#	Name	Location	Type	Details	Index	Description
.01	date claim received(+)	0;1	DATE-TIME		B	This is the Date that the valid 583 was accepted for processing. Usually the date the claim is being entered.
.5	fee program(+)	0;2	POINTER	161.8		The appropriate fee program to which this unauthorized claim pertains. Only active fee programs can be selected.
1	vendor(+)	0;3	POINTER	161.2	C	The vendor who provided the services being charged.
2	veteran(+)	0;4	POINTER	2	D	The name of the veteran who received the services being claimed.
3	treatment from date(+)	0;5	DATE-TIME			Date which treatment began for submitted unauthorized claim. Date cannot be in the future.
4	treatment to date(+)	0;6	DATE-TIME			Date which treatment ended for sumbitted unauthorized claim. Date cannot be in the future or be earlier than Treatment From date.
5	diagnosis	DX;1	FREE TEXT			Enter the diagnosis upon which services were rendered.
5.1	icd diagnosis	DX;2	POINTER	80		Patient's diagnosis for which this authorization is being issued. This field is only for ICD-10 and later.
6	primary service facility	0;7	POINTER	4		The name of the facility which will reimburse the COJ.
7	date valid claim received	0;8	DATE-TIME			Date complete (valid) unauthorized claim received for medical review.
8	amount claimed	0;9	NUMERIC			The dollar amount being claimed.
9	patient type code(+)	0;10	SET OF CODES	00:SURGICAL 10:MEDICAL 86:PSYCHIATRIC		The appropriate patient type code for services which were received.
10	disposition	0;11	POINTER	162.91		Only 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.
10.5	disposition remarks	4;0	WORD-PROCESSING			Special remarks regarding the initial disposition that should be included on a disposition letter to the claimant. (Optional)
10.6	appeal disposition remarks	A1;0	WORD-PROCESSING			Special remarks regarding the disposition of an appeal that should be included on a disposition letter to the claimant. (Optional)
10.7	cova disposition remarks	A2;0	WORD-PROCESSING			Special remarks regarding the disposition of a COVA appeal that should be included on a disposition letter to the claimant. (Optional)
11	date of disposition	0;12	DATE-TIME			The date the claim was dispositioned.
12	authorized from date	0;13	DATE-TIME			The beginning date from which fee services for unauthorized claim are authorized. Date cannot be in the future or before Treatment From date.
13	authorized to date	0;14	DATE-TIME			The 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.
14	amount approved	0;15	NUMERIC			The authorized amount for payment of an unauthorized claim.
15	reason for disapproval	D;0	MULTIPLE	162.715		Provides reason(s) why a claim was disapproved.
16	*dispositon description	1;0	WORD-PROCESSING			The description of the disposition. Replaced by the REASON FOR DISAPPROVAL field.
17	*reason for pending	2;0	WORD-PROCESSING			The reason the claim was pending. Replaced by the FEE BASIS UNAUTHORIZED REQUESTED INFORMATION file (# 162.93).
19	print letter?	0;16	BOOLEAN	1:YES	AL	If this field has a YES value, an unauthorized claim letter needs to be printed.
19.5	date letter sent	0;19	DATE-TIME		ALP	Date letter sent to submitter.
19.6	date req info sent	6;1	DATE-TIME			This 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.
20	master claim(+)	0;20	POINTER	162.7	AMC	Enter 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.
21	reopen claim date	0;21	DATE-TIME			Date dispositioned claim reopended for review.
22	date of original disposition	0;22	DATE-TIME			Date unauthorized claim was originally dispostioned. Used in determining expiration date in the case of appeal status'.
23	claim submitted by(+)	0;23	VARIABLE-POINTER	2, 161.2, 200		Identify 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.
24	status(+)	0;24	POINTER	162.92	AS	Select the appropriate status from FEE BASIS UNAUTHORIZED CLAIMS STATUS file. Status is automatically determined and stuffed, it should not be edited.
25	date of current status(+)	0;25	DATE-TIME			This field contains the date on which the current status was entered or updated.
26	expiration date of claim	0;26	DATE-TIME			The 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.
26.5	extensions	3;0	MULTIPLE	162.701
27	entered/last edited by	0;17	POINTER	200		The name of the person who entered the claim.
28	date entered/last edited	0;18	DATE-TIME			The date on which the unauthorized claim was entered.
29	discharge type		COMPUTED			Display DISCHARGE TYPE of related entry in authorization subfile.
30	authorization	0;27	NUMERIC			This field is set to the internal entry number of the appropriate authorization in file 161.
31	38 u.s.c. 1725	0;28	BOOLEAN	1:YES 0:NO		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.
32	fpps claim id	5;1	FREE TEXT			Enter the entire FPPS Claim ID as shown on the invoice document. (1-32 character text ID created by FPPS system).
50	notice of disagreement recv'd	A;1	DATE-TIME			Date Notice of Agreement (VAF 21-4138) received.
51	statement of the case issued	A;2	DATE-TIME			Date Statement of the Case was issued.
52	date substantive appeal recv'd	A;3	DATE-TIME			Date Substantive Appeal was received.
53	date appeal dispositioned	A;4	DATE-TIME			Date appeal decision rendered by Board of Veterans Appeal (BVA).
54	date appealed to cova	A;5	DATE-TIME			Date 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.
55	date cova appeal dispositioned	A;6	DATE-TIME			Date a decision to a COVA appeal rendered.
293	data audit	LOG2;0	MULTIPLE	162.793		The data audit multiple stores historical information for selected fields.