Veterans' Affairs Processing (VAP) quality checking 111-22190000

VAP quality checking selection reports

The selected work to be checked can be found on the Report Management and Distribution System (RMDS) reports. There are 9 reports that cover:

A - allied health claims
H - hospital claims
M - medical claims

Table 1: this table lists the available RMDS reports.

State	Report
SA	DVA VQCSAA QC SELECTION - Allied Health DVA VQCSAM QC SELECTION - Medical DVA VQCSAH QC SELECTION - Hospital
VIC	DVA VQCVCA QC SELECTION - Allied Health DVA VQCVCH QC SELECTION - Hospital DVA VQCVCM QC SELECTION - Medical
WA	DVA VQCWAA QC SELECTION - Allied Health DVA VQCWAH QC SELECTION - Hospital DVA VQCWAM QC SELECTION - Medical

Error-free status code

Table 2

Error-free status code

Definition

Processing Tip

V01

Error-free

Quality check did not detect errors

Document error status codes

Table 3

Error status code

Definition

Processing tip

V20

Critical

No documents to support payment/claim processed with incomplete information on documents.

It is an error when a claim has been processed:

without supporting documentation
where the documentation used was not an original copy

If documentation is recovered after quality checking is complete, the error code must not be reversed.

Note: LPS must confirm the service and try to retrieve the documents. Where confirmation of the service or retrieval of the documents cannot be achieved, escalate to the VAP Helpdesk.

Processing error status codes for below V60

Table 4

Error status codes

Definition

Processing tip

V39

Critical

File number rejected incorrectly

It is an error when the Service Officer has rejected a line/service due to the DVA file number not found in accordance with the business rules.

V40

Critical

Service line/s rejected in error

It is an error when:

a Service Officer has rejected item lines/services when not in accordance with the business rules

Note: when the rejection is due to the veteran's file number not found, see error code V39.

V41

Critical

Item paid in error

It is an error when:

a Service Officer has paid items when not in accordance with the business rules
an online claim has been paid when transmitted using incorrect channel
a Service Officer has paid items when not in accordance with Veterans' accepted disabilities

V42

Critical

Payee provider keyed incorrectly or not keyed

It is an error when the payee provider:

keyed does not match the supporting documentation
is not keyed

V43

Non-critical

Claim ID keyed incorrectly

It is an error when the claim ID keyed does not match supporting documentation when DVA stationery is used.

Note: it is not an error when an invalid claim ID is submitted and has been altered.

V44

Critical

Service provider keyed incorrectly

It is an error when the service provider keyed does not match supporting documentation.

V45

Critical

File number selected incorrectly

It is an error when the file number keyed or selected does not match the supporting documentation.

Note: it is not an error if the voucher does not contain a file number beneficiary identifier.

V46

Critical

Patient keyed or selected incorrectly

It is an error when the patient keyed or selected does not match supporting documentation.

V47

Critical

Item keyed incorrectly

It is an error when the item number keyed does not match the supporting documentation.

V48

Critical

Date of service keyed incorrectly

It is an error when the date of service does not match supporting documentation.

Note for allied only: it is not an error if a Service Officer changes the year of service to the current year, during January only, when the fee matches the current year.

V49

Critical

Benefit paid is incorrect

It is an error when the Service Officer has allowed payment of an incorrect amount due to manual calculations.

Note: DVA policy allows for a benefit to be paid above the provider’s charge without Service Officer intervention.

V50

Non-critical

Processing indicator (PI) keyed incorrectly

It is an error when the Service Officer has keyed the incorrect PI.

Note: only the highest PI code used is stored by the system.

V51

Critical

Reason code keyed incorrectly or not keyed

It is an error when an incorrect or invalid reason code is keyed, or not keyed when required.

Note: when the reason code is relating to the veteran’s details, see error code V53.

V53

Non-critical

Veteran DVA details reason code/s keyed incorrectly or not keyed

It is an error when a reason code has:

not been keyed, when a change of name or file number has occurred
been keyed incorrectly

V54

Critical

LSPN or SCP or Equipment Number keyed incorrectly

It is an error when the LSPN or SCP or Equipment Number has been keyed incorrectly.

V55

Critical

Referring or requesting details keyed incorrectly

It is an error when the referring or requesting:

date
referral period
provider

have been keyed incorrectly.

Note: it is not an error where the system has automatically generated a referral line and reason code field SGN is displayed against a veteran's history.

V56

Critical

Service line/s not keyed

It is an error when service line/s on the voucher or claim form have not been keyed.

V57

Critical

Additional service line/s keyed

It is an error when additional service line/s have been keyed.

V58

Critical

Treatment location keyed incorrectly

It is an error when the treatment location keyed does not match the supporting documentation.

V59

Critical

Kilometres (KMs) travelled keyed incorrectly or not keyed

It is an error when the kilometres travelled keyed does not match the supporting documentation.

Processing error status codes V60 and above

Table 5

Error status codes

Definition

Processing tip

V60

Critical

'NO' field keyed incorrectly or not keyed

It is an error when the 'NO' field has not been keyed or has been keyed incorrectly for:

tooth number
radiotherapy fields
number of patients
bulking of prosthesis

V61

Non-critical

Charge keyed incorrectly

It is an error when the charge keyed does not match the supporting documentation, provided the correct benefit has been paid.

See also V49 if the benefit paid was incorrect.

V62

Critical

Admission or discharge dates keyed incorrectly

It is an error when the admission or discharge dates keyed do not match the supporting documentation.

V63

Non-critical

Claim processed under the incorrect source office code (SOC)

It is an error when a claim was paid under the incorrect SOC.

V64

Critical

Hospital procedure discount code keyed incorrectly or not keyed

It is an error when the incorrect hospital discount code has been keyed incorrectly or not keyed.

V65

Critical

Procedure theatre type applied incorrectly

It is an error when the incorrect procedure theatre type has been applied.

V66

Critical

Special Theatre Band keyed incorrectly or not keyed

It is an error when the Special Theatre Band has been keyed incorrectly or not keyed.

V67

Critical

Admission code keyed incorrectly

It is an error when the admission code does not match the supporting documentation.

V68

Non-critical

Separation code keyed incorrectly

It is an error when the separation code keyed does not match supporting documentation.

Note: it is not an error when a separation code cannot be determined and the Service Officer keys ‘z’.

V69

Critical

ICD 10 code keyed incorrectly or not keyed when required

It is an error when the ICD 10 code keyed does not match supporting documentation or is not keyed.

V70

Critical

Case Payment or Per Diem claim paid incorrectly

It is an error when a claim was paid as:

Case Payment instead of Per Diem
Per Diem instead of Case Payment

V71

Critical

Prosthetic handling charges paid incorrectly

It is an error when the prosthetic item handling charge paid is incorrect.

Examples

Financial impact of Veterans' Affair Processing (VAP) errors

Other examples of VAP financial impact

Error count example 1 - basic error count

Error count example 2 - online claim; non-critical error

Error count example 3 - manual claim; critical and non-critical errors

Error count example 4 - manual claim; multiple critical errors

Error count example 5 - errors at claim level

Financial impact of VAP errors

Errors identified in the VAP quality checking can have a financial impact where a benefit is affected and results in a resubmission or adjustment. The financial impact can be an under or overpayment.

If the error detected at quality checking results in an under or overpayment, the difference between the original benefit paid and the correct benefit paid becomes the amount used to calculate ’financial impact’, see the example below.

Table 6: this table provides an example of a financial impact calculation.

Voucher 1
Patient	James
Item	110
DOS keyed	01/07/2023
Provider	99999X
Charge	$230.00
Benefit paid	$226.50
Scenario	File number for James selected for quality checking. Account states in-patient but keyed as out-patient. Original benefit paid (outpatient) - $226.50 Correct benefit should be (inpatient) - $230.00 James was underpaid $3.50
Voucher 2
Patient	Harry
Item	110
DOS Keyed	01/08/2023
Provider	99999X
Charge	$226.50
Benefit paid	$199.95
Scenario	File number for Harry selected for quality checking. Account states the date of service is 01/07/2023 not 01/08/2023. Original benefit paid - $199.95 Correct benefit should be - $226.50 Harry was underpaid $26.55
Financial impact to be recorded against claims	$30.05 Note: the financial impact for the claim is the 2 patients added together – that is: $3.50 + $26.55

Other examples of VAP financial impact

Table 7: this table provides a list of examples of financial impacts.

Note: this list is not exhaustive and is updated regularly with new examples.

Situation	Implication	Under or overpayment	Financial impact
Item line rejected in error	Item rejected is part of a composite or multiple procedure and would result in an amendment.	Underpayment	Yes
Item line rejected in error	Item rejected is not part of a composite or multiple procedure and therefore would not be adjusted. Note: this line of data must be re-entered.	Underpayment	Yes
Item line rejected in error	Item rejected is part of a time restriction or body site assessment which would result in re-processing the rejected item using a processing indicator, and possibly a reason code, to enable payment according to the business rule.	Underpayment	Yes
Item line rejected in error	Item rejected because a VNSI search was incomplete but quality checker was able to locate the correct Veteran’s file number.	Underpayment	Yes
Item paid in error	Item paid when it should have been rejected.	Overpayment	Yes
Patient keyed or selected incorrectly Benefit not affected	File fix required - for history purposes only.	Nil	No
Patient keyed or selected incorrectly Benefit affected	File fix required. If the correct patient history contains a previously paid service which is restrictive to the service being claimed or if the correct patient has a different level of eligibility to the patient keyed it could result in a financial impact.	Under or overpayment	Yes
Item not keyed	Item missed is part of a composite or multiple procedure and would result in an amendment.	Underpayment	Yes
Item not keyed	Item missed is not part of a composite or multiple procedure and therefore would not be adjusted. Note: this line of data must be re-entered.	Underpayment	Yes
Item paid at incorrect rate (for example, in-hospital should be out-of- hospital or vice versa)	File fix and adjustment or recovery required.	Under or overpayment	Yes
Incorrect benefit paid due to incorrect manual calculation	Amendment or overpayment recovery required.	Under or overpayment	Yes
Incorrect referral/request details Benefit not affected	No adjustment required.	Nil	No
Incorrect referral/request details Benefit affected	File fix required.	Under or overpayment	Yes
Incorrect charge keyed Benefit not affected	No adjustment required.	Nil	No
Incorrect charge keyed Benefit affected	Amendment or overpayment recovery required.	Under or overpayment	Yes
Date of service keyed incorrectly Benefit affected	File fix and/or amendment required when the correct date of service results in a different payment of benefit due to the VAP Schedule changes and amendments conducted annually.	Under or overpayment	Yes
Date of service keyed Incorrectly Benefit not affected	File fix required - for history purposes only.	Nil	No
No documents to support payment	No adjustment required – at the time of quality checking no documents are available to support payment.	Overpayment	Yes
Item number paid where there is already one on history (duplicate)	Overpayment recovery required – under $100 money cannot be recovered.	Overpayment	Yes
Item not keyed but should have been rejected	Key the item and reject as normal.	Nil	No
Item keyed incorrectly	Amendment or overpayment recovery required.	Under or overpayment	Yes
Claim header/form not signed	No adjustment required.	Nil	No
Incorrect Claim ID keyed	No adjustment required.	Nil	No
Incorrect payee provider Note: if the service provider and payee provider are the same, this would apply	Overpayment recovery will be required	Overpayment	Yes
Incorrect Service Provider Benefit not affected	File fix required.	Nil	No
Incorrect Service Provider Benefit affected	If the correct provider has a previously paid service which is restrictive to the service being claimed it could result in a financial impact.	Under or overpayment	Yes
Claim processed under wrong source office code	No adjustment required.	Nil	No

Error count example 1 - basic error count

Table 8: this table provides a generic example of how to record quality checking results in the Veterans' Affairs Processing (VAP) Quality Reporting form.

Details	Quality checking results	Trans. selected for check	Error applied	Trans. with errors	Trans. with critical errors
Header	No error found	1	N/A	0	0
Six patients without Service Officer intervention	Do not check these as there was no Service Officer intervention	0	N/A	0	0
Patient: Jenny Item 24 24/06/23 Item km 25	Service Officer overrode the restriction on the item 24 (restrictive with item 721 on history) using PI 42 and there was no justification	1	V41 (critical) x1	1	1
Patient: Victor Item 36 25/06/23	No error found	1	N/A	0	0
Patient: George Item 30071 25/06/23 Item 30071 25/06/23	Paperwork indicated separate sites and the anatomical sites and the Service Officer allowed the automatic restriction to stand	1	V40 (critical) x1	1	1
Patient: Harry Item 36 25/06/23 Item 721 25/06/23	No error found	1	N/A	0	0
Patient: Anita Item 23 24/06/23 Item 23 25/06/23	No error found	1	N/A	0	0
Patient: Vicki Item 23 24/06/14 Item 23 25/06/14	No error found	1	N/A	0	0

In this example the following details are recorded in the Veterans' Affairs Processing (VAP) Quality Reporting form:

No. of Tran in claim - 13
No. of Trans selected for checking - 7 (only those with intervention)
Trans with Critical Error - 2 (only those with critical errors are included on the form)

Also:

2 Transactions with Errors have been identified

Processing Errors to be recorded in reporting form – V41 x 1, v40 x 1

Error count example 2 - online claim; non-critical error

Table 9: this table provides examples of how to record quality checking results in the Veterans' Affairs Processing (VAP) Quality Reporting form for an online claim containing a header plus 2 patients; both had Service Officer intervention.

Details	Quality checking results	Trans. selected for check	Error applied	Trans. with errors	Trans. with critical errors
Header	Do not check the header as there is no Service Officer intervention	0	N/A	0	0
Patient: Harry Item 36 25/06/23 Item 721 25/06/23	Provider submitted incorrect DVA number for the veteran. The Service Officer found the number and updated accordingly but did not key the reason code 249 to advise the provider	1	V53 (non-critical) x1	1	0
Patient: Patricia Item 23 15/02/23 Item 23 16/02/23	No error found	1	N/A	0	0

In this example the following details are recorded in the Veterans' Affairs Processing (VAP) Quality Reporting form:

No. of Tran in claim - 2
No. of Trans selected for checking - 2 (only those with intervention)
Trans with Critical Error - 0 (only those with critical errors)

Also:
1 Transaction with an Error has been identified

Processing Errors to be recorded in reporting form - V53 x 1

Error count example 3 - manual claim; critical and non-critical errors

Table 10: this table provides examples of how to record quality checking results in the Veterans' Affairs Processing (VAP) Quality Reporting form for a manual claim containing a header plus 5 patients.

Details	Quality checking results	Trans. selected for check	Error applied	Trans. with errors	Trans. with critical errors
Header	No errors found	1	N/A	0	0
Patient: Jenny Item 30071 25/02/23 Item 30071 26/02/23	Service Officer keyed: DOS as 25/01/23 rather than 25/02/23 DOS as 26/01/23 rather than 26/02/23 30071 25/01/23 with charge of $50.00, voucher states $60.00	1	V48 (critical) x1 V61 (non-critical) x1	1	1
Patient: Elizabeth Item 23 15/02/23 Item 23 16/02/23	No errors found	1	N/A	0	0
Patient: Harry Item 36 25/06/23 Item 721 25/06/23	The file number supplied for Harry was incorrect. The Service Officer found the correct file number and plaid the claim but did not use RSN 249 - 'Note veteran's correct file number'	1	V53 (non-critical) x1	1	0
Patient: George Item 36 25/06/23	Voucher rejected with RSN 376 (file number not found). Quality checker found the file number	1	V40 (critical) x1	1	1
Patient: Barry Item 23 15/02/23 Item 23 16/02/23	No errors found	1	N/A	0	0

In this example the following details are recorded in the Veterans' Affairs Processing (VAP) Quality Reporting form:

No. of Tran in claim - 6
No. of Trans selected for checking - 6
Trans with Critical Error - 2 (only those with critical errors)

Also:
3 Transactions with Errors have been identified

Processing Errors to be recorded in reporting form - V48 x 1, V61 x 1, V51 x 1, V40 x 1

Note: if the same error is found multiple times within the claim for the same patient then only one error applies. In the example above for Jenny there are 2 dates of service keyed incorrectly for the same patient. V48 - date of service keyed incorrectly, only applies once. However if the same error applied with different patients within the same claim, then the error code would be recorded multiple times.

Error count example 4 - manual claim; multiple critical errors

Table 11: this table provides examples of how to record quality checking results in the Veterans' Affairs Processing (VAP) Quality Reporting form for a manual claim containing a header plus 3 patients.

Details	Quality checking results	Trans. selected for check	Error applied	Trans. with errors	Trans. with critical errors
Header	Service Officer did not key the payee provider Service Officer keyed the service provider as 123456y rather than 123546y	1	V42 (critical) x1, V44 (critical) x1	1	1
Patient: Harriet Item 23 15/02/23 Item 23 16/02/23	No errors found	1	N/A	0	0
Patient: Larry Item 24/1 24/06/23 Item km 25	No errors found	1	N/A	0	0
Patient: Joseph Item 36 25/06/23	No errors found	1	N/A	0	0

In this example the following details are recorded in the Veterans' Affairs Processing (VAP) Quality Reporting form:

No. of Tran in claim - 4
No. of Trans selected for checking - 4
Trans with Critical Error - 1 (the information keyed in the header is an error in the header, not the other vouchers, therefore it is one transaction in error)

Also:

1 Transaction with Errors has been identified

Processing Errors to be recorded in reporting form – V42 x 1, V44 x 1

Error count example 5 - errors at claim level

Table 12: this table provides examples of how to record quality checking results in the Veterans' Affairs Processing (VAP) Quality Reporting form for a manual claim containing a header plus 2 patients, both had Service Officer intervention.

Details	Quality checking results	Trans. selected for check	Error applied	Trans. with errors	Trans. with critical errors
Header	The claim is not found in the Service Officer's batch	1	V20 (critical) x 1 (no paperwork to support action taken)	1	1
Patient: Harry	No analysis possible	1	N/A	0	0
Patient: Patricia	No analysis possible	1	N/A	0	0

In this example the following details are recorded in the Veterans' Affairs Processing (VAP) Quality Reporting form:

No. of Tran in claim - 3
No. of Trans selected for checking - 3
Trans with Critical Error - 1 (the error is on the whole claim which is identified at header level only, do not mark all 3 as errors)

Also:

1 Transaction with Errors has been identified

Processing Errors to be recorded in reporting form - V20 x 1

Forms (staff)

Veterans' Affairs Processing (VAP) Quality reporting form

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Intranet links

Enterprise Quality Framework

Contact details

Health Service Delivery Division – Quality, Performance and Technical Support

VAP Helpdesk

Operational Information

Veterans' Affairs Processing (VAP) quality checking 111-22190000

VAP quality checking selection reports

Error-free status code

Document error status codes

Processing error status codes for below V60

Processing error status codes V60 and above

Examples

Financial impact of VAP errors

Other examples of VAP financial impact

Error count example 1 - basic error count

Error count example 2 - online claim; non-critical error

Error count example 3 - manual claim; critical and non-critical errors

Error count example 4 - manual claim; multiple critical errors

Error count example 5 - errors at claim level

Forms (staff)

Intranet links

Contact details