Inactive

As part of an integrated strategy to provide Veterans with timely access to quality healthcare, Department of Veterans Affairs (VA), Veteran's Health Administration (VHA) healthcare facilities are aut... As part of an integrated strategy to provide Veterans with timely access to quality healthcare, Department of Veterans Affairs (VA), Veteran's Health Administration (VHA) healthcare facilities are authorized to pay for healthcare services acquired from non-VA healthcare providers. VA manages the authorization, claims processing and reimbursement for services acquired from non-VA health care providers through the Purchased Care Program. VA used the Fee Base Claim System (FBCS) to manage and process Fee claims in an electronic environment which improved the ability to keep track of claims in-process and enabled identification of duplicate and non-compliant claims. However, VA retired the FBCS software and other systems are used to authorize and pay claims. Certain types of claims will still need to be priced that cannot be completed in the Electronic Claims Adjudication Management System (eCAMS). The eCAMS cannot process historical claims because it does not have the original claims (frequency code 7s) information. VA requires a separate system that that can price claims with a frequency code 7. Additionally, there will be mandatory periodic audits on claims processing for historical claims, which will require a review of the prices paid to non-VA health care providers compared to Centers for Medicare and Medicaid Services (CMS) allowable rates on the Government s fee schedule for the applicable year, in which the claim was adjudicated (the scope of these audits may review up to seven years in the past).