A person who served in active military and was discharged or released under conditions other than dishonorable.
What is a veteran?
100
A document that is initiated by the VA Provider to begin the Non-VA Care referral process?
What is a Referral or Consult?
100
USC 1725
What is the authority for Mill Bill?
100
Patient's home phone number, current address, insurance information
What are the patient's demographics? Very important to update!
100
Request from Veteran for Reconsideration or Notice of Disagreement
What is the notification a veteran uses if he/she does not agree with a VA decision regarding non-VA care?
200
A category of military personnel that may be eligible if they were called to active duty (for other than training purposes) and served the full period to which they were called.
What are Reservist or National Guard?
200
Name some of the inappropriate reasons for Non-VA referrals
What is: 1. service NOT included in Uniform Benefits Package; 2. veteran does not own a vehicle or does not like to drive; 3. care not medically necessary; 4. veteran does not want to wait to see VA provider; 5. VA services are provided in-house or at another VA.
200
USC 1728
What is the authority for Unauthorized claims?
200
Two ways Veteran is notified if Non-VA appointment is scheduled LESS than 14 days
What is contact the patient by telephone AND send an appointment letter?
200
Established method to track patient medical information released to non-VA providers.
What is Accounting of Disclosure?
300
Name two categories that are not eligible for VA or Non-VA care.
What is Humanitarian, collateral, non-Veteran, non-Veteran sharing agreement, Rejected Prioirty Group 8, Fugitive Felon, ineligible?
300
Stat, Urgent, Routine
What are the three types of referrals?
300
One of the requirements necessary to consider a claim under USC 1728 (Unauthorized).
What are:
1. Veteran 100% service-connected P&T; or unemployable; or service-connected for the condition that warrants care.
2. VA not feasibly available;
3. Medical emergency
300
A listing of all facility and national negotiated contracts or agreements for non-VA care.
What is the Contract Repository?
300
EOC
What is an Episode of Care?
400
Priority group of a veteran that is not eligible for VA services. Does not meet date or means test requirements.
What is Priority Group 8 e and 8 g? (Priority Group 8 e is 0% SC and can only be seen for SC condition)
400
ACP
What is Alternate Care Plan?
400
Claim is initially received, reviewed, and approved or denied.
What is administrative eligibilty review?
400
VAF 10-7078 and VAF 10-7079
What are the authorization forms used for pre-authorized non-VA care? 7078 = non-VA inpatient care; 7079 = non-VA outpatient care.
400
BVA
What is the Board of Veterans' Appeals?
500
Priority Group of Veterans with VA rated service-connected disabilities of 50% or more disabling; veterans determined by VA to be unemployable due to service-connected conditions
What is Priority Group 1?
500
VA in-house care available?
Sharing Agreements available?
Care at another VA available?
What is determining availability of services prior to using Non-VA referral/consult?
500
Point of stability is determined; medical necessity determined; VA bed availability determined
What is the clinical review process?
500
Action taken to close consult - Episode of Care (EOC).
What is clinical documentation received and scanned?
500
Appeals Folder
What is prepared to hold all written documentation provided by the veteran (or others)?