Payer Name: VA Fee Basis Program Department of …

1 Payer Name: VA Fee Basis Program Department of veterans affairs National Non-VA Medical Care Program Office Line(s) of Business 12115 (Medical and Hospital). 12116 (Dental). Payer Note: This Program is intended to be used by veterans when services need to be provided at a non-VA. VA medical center for various reasons. For more information on this Program please visit the Payer website listed below in Customer Service, Payer section. Payer ID 12115 & 12116. Products Member ID Number Required The Patient's/Subscriber's 9 digit digit numeric member ID. (Example : 123456789). Each Patient/Subscriber has a unique member ID and should be identified as SELF . The Patient is always the Subscriber Do not send veteran or parent information If the patient is a newborn than the ID will be 9 numeric +.

2 P'. Group Number Not Applicable NPI / Provider Number accepted NPI is accept Federal Tax ID Required - A 9 digit numeric Tax Identification Number (TIN), Employee Identification Number (EIN) or Social Security Number (SSN) of the facility or individual provider/group. Authorization Number Authorizations are required for some services. Authorization number on the claim when submitted electronically is optional, but is recommended for faster claims adjudication. Attachments Claims should be submitted electronically. If supporting documentation is required for claims VAFEE will request additional information. You can indicate that additional supporting documentation is available using the ASCX12 PWK segment. Attachments cannot be submitted electronically at this time.

3 ECOB Secondary claims are accepted electronically. Exclusions None Encounters Not applicable Customer Service, Payer For questions or concerns regarding claim routing, clearinghouse rejections or transactions responses contact: Your vendor. If you use software maintained by a company other than Emdeon to submit your claims electronically, call your vendor. Your vendor should contact Emdeon if further assistance needed. ON 24/7 - If you use an Emdeon product, you may have access to Emdeon's online support tool, ON 24/7, enabling you to obtain customer support online 24 hours a day, 7 days a week. Emdeon Client Solutions: option 3. If you use an Emdeon product to submit your claims or you are a contracted client, contact us directly at this phone number.

4 Emdeon Customer and Sales Support: Electronic Claims Resource Center: All other questions please contact your local VA Medical Center or the VA Medical Center facility where the service was rendered if different than your local facility. Emdeon Real-Time Eligibility, Claim Status, Health Care Service Review Inquiry and Transactions Request are available using Real-Time Payer ID VAFEE. Claim status is only available for electronic claims submitted through Emdeon. Timely Filing Limits Contact your local VA Medical Center Fee Basis office. Timely filing limitations vary and are dependent upon federal regulation. VA FEE will not accept Emdeon reports as proof of timely filing. ERA/EFT An Electronic Remittance Advice (835) is provided for all electronic compliant claims submitted to Emdeon.

5 835s are not returned on paper claims. To receive an Electronic Remittance Advice (835), contact your vendor directly. Providers/Vendors must complete and submit the Emdeon ERA Provider Setup from to receive 835s. Contact Emdeon at option 1 for assistance with enrollment. EFT payments are received separately from US Dept of the Treasury. To enroll for EFT, providers will need to fill out and submit to the Treasury Department an SF 3881 which can be found on the following link: or Providers may contact the Treasury for EFT enrollment at the following number:1-877-353-9791.