HERC: Veterans Choice Program - TPA Monthly Data
Attention A T users. To access the menus on this page please perform the following steps. 1. Please switch auto forms mode to off. 2. Hit enter to expand a main menu option (Health, Benefits, etc). 3. To enter and activate the submenu links, hit the down arrow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links.
 

Veterans Choice Program - TPA Monthly Data

Menu
Menu

Veterans Access, Choice, and Accountability Act (VACAA) Tables: TPA_mntlyChoice table

The Veterans Access, Choice, and Accountability Act of 2014 (hereafter referred to as VACAA) was signed into law in August 2014 to expand the availability of medical services for eligible Veterans with community providers. VACAA data is currently contained within 25 tables. There is a diagram of how 25 the VACAA tables join on the BISL/CDW website at: https://vaww.cdw.va.gov/Regions/fr/R2DWProjects/SitePages/Table_Joins.aspx. There is additional information on the VACAA program eligibility at: https://vaww.cdw.va.gov/bisl/Database/Shared%20Documents/Extractor/Extraction%20-%20VACAA%20Veterans%20Choice%20Program%20Eligibility.htm%23_Toc474313120.

We focused on the VACAA TPA_mnthlyChoice table. The VACAA TPA_mnthlyChoice table includes all Veterans who have had at least one authorization created by the Contractor/Third Party Administrator (TriWest, HealthNet) and where the Contractor/Third Party Administrator (TPA) has reported to VA via the required monthly report. Below are some definitions and notes for select variables in the TPA_mnthlyChoice table.

Note: If the Veteran's appointment was scheduled and completed as originally scheduled, both dates (origapptdt and dtfrstcmpltdappt) would be the same (original appointment and 1st date appointment completed). If the dates were different then that would suggest the original appointment was rescheduled.

Table 1. TPA.mnthlyChoice table

TPA.mnthlyChoice table
Variable Description
accptddt Accepted date
appntdexcptns Defines exception on why appointment was rescheduled -- Selected from drop down list.
areatype Defined Geographical Location Area Type -- Selected from drop down list.
authcreatedt The date the TPA created an authorization for the requested care.
authstatus Authorization status (takes on values of "accepted", "returned", etc.).
caresc Indicator to identify care and if its related to Veteran's eligibility status of NSC vs SC -- Selected from drop down list.
caretype Defines type of care, what type of care was rendered -- Selected from drop down list.
catofcare Defines Categories of Care -- Selected from drop down list. The Third Party Administrators/Contractors (TriWest, HealthNet) were provided with a list of ‘Categories of Care’ (those in the Fee Basis Claims System, FBCS) so they would match those categories already in the VA Community Care data. There is no method of ensuring categories of care are correctly assigned, except through a manual audit process, as VA provides a VA Progress Note 10-0386 form with this information contained within it. There is no way to extract data within a progress note for validity of the correct category of care used.
choiceelig Identifier to categorize the type of Vet Choice Veteran based on eligibility. Categories are: 30 day, 30 day & 40 mile, 40 mile, & Hardship (which are Vet who live within the 40 mile radius, but have a hardship in traveling to VA due to geographic location) -- Selected from drop down list.
clin Contract Line Item Number.
clinneeddt Date clinical need was determined. NOTE: This only applies to 30 Day Veteran. Should be provided by the VAMC.
cmpfrstapptexptn Reason for reschedule if the original appointment date and date of first appointment completed are different.
cntrctr Derived Column: "TriWest" for TriWest data ETL; "HealthNet" for HealthNet data ETL.
cntrctrauthno Contractor's unique authorization number. Take the most recent one and coalesce missing data otherwise.
commutemiles Commute distance in miles.
commutetime Commute time.
commutetype Defines Commute Standard Type; defines the methodology for applying the appropriate commute time -- Selected from drop down list.
daystoappnt The number of business days between the Accepted Date and Appointed Date. The appointed date is the date the patient was contacted to schedule the appointment. -- Selected from drop down list.
daystofrstdcrtrn The number of days between the 1st appointment date completed and the Medical Documentation of 1st appointment returned to the VA Medical Center -- Selected from drop down list.
daystolstdocrtrn The number of days between the last appointment date and the Medical Documentation of the last appointment returned to the VA Medical Center -- Selected from drop down list.
daystoothermeddocrtrnd Days to other medical documentation requirement returned. The number of days between the 'Other Service Type' date of service and the return of the medical documentation from the 'Other Service Type' appointment.
daystosched The number of calendar days between the Appointed Date and the Appointment Date -- Selected from drop down list.
dt207lttrsnt The date the 207 letter was sent to the Veteran. NOTE: Also defined through 'Date Letter Sent'.
dtappntd Date patient was contacted for appointment scheduling. If NULL, assume appointment not yet made.
dtfrstcmpltdappt Date of the first appointment being complete. Actual first appointment date completed. If NULL, we may take the original completion date. If NULL, the Contractor has not received medical documentation to confirm the appointment was completed, so it may not be appropriate to consider the appointment was completed.
dtofmeddocrtrn_othermeddoc Date medical documentation for the 'Other Service Type' appointment was returned to the VA Medical Center.
dtofsvc_othermeddoc Date of service for other medical doctor.
dtrtrnd Date authorization was returned by the Contractor to the VA
dtvetoptin Date Veteran provided oral or written notification to opt in or out of the Choice Program.
eocenddt Date of the last appointment to complete episode of care.
eocstartdt Date of the initial appontment to start the episode of care.
frstmeddocrtrndt Date medical documentation of the 1st appointment was returned to the VA Medical Center.
fy Fiscal year.
imprtdt Derived Column: Date & time the data was imported into the database.
inptapptdocrtrndt Date of inpatient appointment medical documentation returned date.
inptdischgdt Date in which the patient discharged from inpatient hospitalization status.
inptmeddocrtrn The number of days between the Date of Discharge and the Date Medical Documentation was returned to the VA Medical Center -- Selected from drop down list.
lstapptdt Date of the last appointment of that episode of care.
lstmeddocrtrndt Date medical documentation for the last appointment was returned to the VA Medical Center.
mnthofrpt Last day of weekly reporting period. Weekly reporting period runs from Saturday thru Friday. Example: WkOfRpt='2015-07-24' for reporting period of 7/18 thru 7/24.
ohi Tracking whether the patient has active other health insurance (excluding Medicare and TRICARE) -- Selected from drop down list.
ohiname Name of the other health insurance (ex. AARP, Aetna, BlueCross BlueShield, etc.).
origapptdt Original date of the patient's appointment.
othermeddocctgry Other medical documentation requirement category. Indicator signifying the type of medical documentation other than routine medical care, where the performance metric has a specific allotted time for return. Refer -- Drop down menu provides specific types.
parentstaid Parent station ID.
provaddress Rendering provider's address.
provname Name of the provider actually providing the care to the patient.
provnpi Rendering Provider's NPI (National Provider Identifier).
provpart Indicator of provider’s participation in the network or out of the network -- Selected from drop down list.
provspec Provider specialty.
region Defines Geographical Area -- Selected from drop down list.
retroauth The value 'Retro Auth' indicates that the authorization was created by the contractor after the care had been provided. This field was exclusively reported by TriWest in reports for March and April 2015.
rptmnth Derived Column: Calendar month taken from WkOfRpt value.
rqrmnt207 The contractual requirement of contacting the Veteran. 207 Requirement.
rqstdt The date care was requested by the Veteran or Vendor. For 40 mile Veterans, the Veteran calls to request services. For 30 day Veterans, the VAMC submits a VA Form 10-0386.
rsnfrrtrn Defines Reasons for returning the authorization -- Selected from drop down list.
staid Assigned number that identifies each VA Medical Center.
urgappntnghr Urgent appointing (hr/min) If marked as Urgent Status, appointment hr/mins are required.
urgstatus Urgent status.
vamcname VA Medical Center who issued authorization to authorize care.
vetaddress Veteran's address.
vetcity City in which Veteran resides.
vetname Veteran's First and Last Name.
vetprefdt Date Veteran preferred to receive care. NOTE: This only applies to the 40 mile Veteran.
vetsc Indicator to identify Veteran's eligibility status of NSC vs SC.
vetssn Full 9 digit SSN.
vetstate State in which Veteran resides.
vetzip Zip in which Veteran resides.
visn VISN (Veteran’s Integrated Service Network).

Last updated: September 6, 2018