Requirements for Processing VA Institutional and Professional

1.1 - Requirements for Processing VA Institutional and Professional Claims (Rev. 4023, Issued: 04-20-18, Effective: 07- 20-18, Implementation: 07-20- 18) Veterans typically see more than one physician at a VA facility on a given day. The A/B MAC (B)-defined provider number will contain a “V” in the first position and specialty codes. Including specialty codes permits the VA to have multiple provider numbers to accommodate various professional services furnished at a given facility on the same day for the same beneficiary-veteran. CWF will edit to ensure that only claims having all three of the following conditions will be processed according to the special VA claims adjudication procedures of this project: 1. A demo number of 31 is present; 2. A V is present in the first position of the A/B MAC (B) defined provider number field (HUBC Field 83 Provider Number, Positions 440-449); and 3. The VA A/B MAC (B) number is present If only two of these conditions are present, then CWF will reject the claim. If only the demo code of 31 is present, CWF will also reject the claim. The VA will use the ASC X12 837 professional claim format for A/B MAC (B) equivalent claims. To process VA claims from various localities, the VA A/B MAC (A) and (B) has established a database for the Medicare physician fee schedule to include pricing information for all of the States. The VA will use the following bill types for A/B MAC (A) equivalent claims: 11x, (Hospital Inpatient, Part A), 12x (Hospital Inpatient, Part B), 13x (Hospital Outpatient), 14x (Hospital Other, Part B), 18x (Hospital Swing Beds), 21x (SNF inpatient), and 23x (SNF outpatient). These claims are submitted using the ASC X12 837 institutional claim format. The SNF VA provider numbering scheme is as follows: a 2 digit numeric state code, followed by a “5”, followed by a 1 digit one up number, followed by with a “V”, ending with a single position alpha numeric.