[Federal Register Volume 84, Number 131 (Tuesday, July 9, 2019)]
[Proposed Rules]
[Pages 32670-32671]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-14527]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17


Notice of Request for Information on Information and 
Documentation Required for Clean Claims for Care and Services

AGENCY: Department of Veterans Affairs.

ACTION: Request for information.

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SUMMARY: The Department of Veterans Affairs (VA) is requesting 
information from the public to inform VA's determination regarding the 
information and documentation that VA will require certain health care 
entities and providers to submit with certain claims for payment for 
hospital care, medical services, or extended care services. 
Specifically, VA is requesting input regarding what information and 
documentation VA should require non-Federal health care entities and 
providers to submit with certain claims for payment for hospital care, 
medical services, or extended care services furnished under chapter 17 
of title 38, United States Code (U.S.C.) in order for such claims to 
constitute ``clean claims'' under section 1703D of title 38 U.S.C.

DATES: Comments must be received on or before August 8, 2019.

ADDRESSES: Written comments may be submitted through http://www.regulations.gov; by mail or hand delivery to the Director, Office 
of Regulation Policy and Management (00REG), Department of Veterans 
Affairs, 810 Vermont Avenue NW, Room 1064, Washington, DC 20420; or by 
fax to (202) 273-9026. Comments should indicate that they are submitted 
in response to ``Notice of Request for Information on Information and 
Documentation Required for Clean Claims for Care and Services.'' Copies 
of comments received will be available for public inspection in the 
Office of Regulation Policy and Management, Room 1064, between the 
hours of 8:00 a.m. and 4:30 p.m., Monday through Friday (except Federal 
holidays). Please call (202) 461-4902 (this is not a toll-free number) 
for an appointment. During the comment period, comments may also be 
viewed online through the Federal Docket Management System at 
www.regulations.gov.

FOR FURTHER INFORMATION CONTACT: Joseph Duran, Office of Community Care 
(10D), Veterans Health Administration (VHA), Department of Veterans 
Affairs, Ptarmigan at Cherry Creek, Denver, CO 80209; 
[email protected], (303) 370-1637 (this is not a toll-free number).

SUPPLEMENTARY INFORMATION: The John S. McCain III, Daniel K. Akaka, and 
Samuel R. Johnson VA Maintaining Internal Systems and Strengthening 
Integrated Outside Networks Act of 2018 (commonly called MISSION Act, 
Pub. L. 115-182), created new section 1703D of title 38 U.S.C. 
concerning claims for payment for hospital care, medical services, and 
extended care services furnished by non-Federal entities and providers 
under chapter 17 of title 38 U.S.C. Section 1703D(f)(1) requires VA to 
provide to all non-Federal health care entities and providers 
participating in a program to furnish such care or services a list of 
information and documentation that VA requires to establish a clean 
claim under section 1703D. Section 1703D(f)(2) requires VA to consult 
with entities in the health care industry, in the public and private 
sectors, to determine the information and documentation that VA will 
include in that list. This notice identifies some of the information 
and documentation that VA proposes including in that list and solicits 
feedback from the public (in particular entities in the health care 
industry), to determine if these requirements regarding information and 
documentation are appropriate. This notice also requests input 
regarding any other information and/or documentation requirements that 
entities in the health care industry recommend VA include in that list. 
Responses to this notice will support VA's determination of which 
information and documentation will be required for a claim to be 
considered clean under section 1703D.
    This notice is a request for information only. Commenters are 
encouraged to provide complete, but concise, responses to the specific 
requests and statements outlined below. VA may choose to contact 
individual commenters, and such communications would serve to further 
clarify their written comments.
    Request for Information: VA requests information that will assist 
in developing a list of information and documentation, as mandated by 
section 1703D(f)(1), that will be required to establish a clean claim 
under section 1703D. The information and documentation identified on 
that list will be that which is necessary for accurate adjudication of 
the claim, to include data elements that, at a minimum: Accurately 
identify the patient; accurately identify the entity or provider that 
furnished the care and/or services; and accurately identify the care 
and services furnished. VA's specific requests for information follow:
    1. VA requests information related to the statements below:
    A. VA proposes that entities and providers must submit paper claims 
for institutional (facility) charges on the Centers for Medicare and 
Medicaid Services (CMS)--1450 Form; Form Title: UB-04 Uniform Bill.
    B. VA proposes that entities and providers must submit paper claims 
for non-institutional (professional) charges on the CMS-1500 Form; Form 
Title: Health Insurance Claim Form.
    C. VA proposes that entities and providers must submit electronic 
claims for institutional (facility) charges in the American National 
Standards Institute (ANSI) Accredited Standards Committee (ASC) X12N 
837I (Institutional) format, the electronic claim version of CMS-1450.
    D. VA proposes that entities and providers must submit electronic 
claims for non-institutional (professional)

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charges in the ANSI ASC X12N 837P (Professional) format, the electronic 
claim version of CMS-1500.
    E. VA proposes that claims must contain the correct member 
identifier, which, at this time, is the veteran's or beneficiary's 
Social Security Number.
    F. In 2019, VA will have Electronic Data Interchange (EDI) ASC 
X12N/005010X210 Patient Information (275) transaction attachment 
capabilities with the implementation of an X12 275 solution. However, a 
recent Council for Affordable Quality Healthcare (CAQH) report, ``A 
Report of Healthcare Industry Adoption of Electronic Business 
Transactions and Cost Savings'', indicated that there is very little 
adoption of the 275 electronic administrative transaction type 
throughout the health care industry (https://www.caqh.org/sites/default/files/explorations/index/report/2018-index-report.pdf). VA is 
interested in understanding the barriers to and timelines for wider 275 
transaction adoption to consider potential complications to broad 
implementation of an EDI claim submission mandate.
    2. In addition to information regarding the specific statements 
above, VA also requests any other information and/or documentation that 
entities and providers in the health care industry recommend VA include 
on the list.

Signing Authority

    The Secretary of Veterans Affairs, or designee, approved this 
document and authorized the undersigned to sign and submit the document 
to the Office of the Federal Register for publication electronically as 
an official document of the Department of Veterans Affairs. Robert L. 
Wilkie, Secretary, Department of Veterans Affairs, approved this 
document on June 26, 2019, for publication.

    Dated: July 3, 2019.
Luvenia Potts,
Program Specialist, Office of Regulation Policy & Management, Office of 
the Secretary, Department of Veterans Affairs.
[FR Doc. 2019-14527 Filed 7-8-19; 8:45 am]
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