System of Records (SOR)
54VA17 - Health Administration Center Civilian Health and Medical Program Records-VA
System location:
Records are maintained at the Health Administration Center (HAC),
300 South Jackson Street, Denver, Colorado 80209.
Categories of individuals covered by the system:
Categories of individuals covered by the system include the
following:
- Dependents of veterans who seek health care under 38, U.S.C.
1781, 1802 and 1803, 1813 and Pub. L. 103-446, section 107.
- Veterans seeking health care services in a foreign country,
excluding services provided in Canada and the Philippines, under 38
U.S.C. 1724.
- Veterans receiving community fee for service benefits at VA
expense under Title 38, U.S.C 1703, 1725 and 1728.
- Health care providers treating individuals who receive care
under 38 U.S.C. 1724, 1781, 1803, 1813, and Pub.L. 103-446 section
107.
Categories of records in the system:
Records maintained in the system include medical benefit
application and eligibility information concerning the veteran and,
when applicable, their spouse and/or dependent(s), other health
insurance information, correspondence concerning individuals and
documents pertaining to claims for medical services, information
related to claims processing and third party liability recovery
actions taken by VA and/or TRICARE. The record may include the name,
address and other identifying information concerning health care
providers, services provided, amounts claimed and paid for health
care services, medical records, and treatment and payment dates.
Additional information may include veteran, spouse and/or dependent
identifying information (e.g., name, address, social security number,
VA claims file number, date of birth), and military service
information concerning the veteran sponsor (e.g., dates, branch and
character of service, medical information).
Authority for maintenance of the system:
Title 38, United States Code, sections 501(a) and 501(b), 1703,
1724, 1725, 1728 1781, 1802 and 1803, 1813, and Pub. L. 103-446
section 107.
Purpose(s):
Records may be used for purposes of establishing and monitoring
eligibility to receive VA benefits and processing medical claims for
payment for eligible beneficiaries and veterans.
Routine uses of records maintained in the system, including
categories of users and the purposes of such uses:
VA may disclose protected health information pursuant to the
following routine uses where required by law, or required or
permitted by 45 CFR parts 160 and 164.
- Eligibility and claim information from this system of records
may be disclosed verbally and in writing. For example, disclosure may
be made via correspondence, call service center or by interactive web
page, in response to an inquiry made by the claimant, claimant's
guardian, claimant's next of kin or person with whom the claimant has
a meaningful relationship, health care provider, trading partner or
contractor. Purposes of these disclosures are to assist the provider
or claimant in obtaining reimbursement for claimed medical services,
to facilitate billing processes, to verify beneficiary eligibility
for requested services, and to provide payment information regarding
claimed services. Eligibility or entitlement information disclosed
may include the name, authorization number (social security number),
effective dates of eligibility, reasons for any period of
ineligibility, and other health insurance information of the named
individual. Claim information disclosed may include payment
information such as payment identification number, date of payment,
date of service, amount billed, amount paid, name of payee, or
reasons for non-payment.
- Statistical and other data may be disclosed to Federal, state,
and local government agencies and national health organizations to
assist in the development of programs that will be beneficial to
health care recipients, to protect their rights under the law, and to
ensure that they are receiving all health benefits to which they are
entitled.
- VA may disclose on its own initiative any information in this
system, except the names and home addresses of veterans and their
dependents, which is relevant to a suspected or reasonably imminent
violation of law, whether civil, criminal or regulatory in nature and
whether arising by general or program statute or by regulation, rule
or order issued pursuant thereto, to a Federal, state, local, tribal,
or foreign agency charged with the responsibility of investigating or
prosecuting such violation, or charged with enforcing or implementing
the statute, regulation, rule or order. On its own initiative, VA may
also disclose the names and addresses of veterans and their
dependents to a Federal agency charged with the responsibility of
investigating or prosecuting civil, criminal or regulatory violations
of law, or charged with enforcing or implementing the statute,
regulation, rule or order issued pursuant thereto.
- A record from this system of records may be disclosed to a
Federal agency upon its request for use in the issuance of a security
clearance, the investigation of an employee, the letting of a
contract, or the issuance of a license, grant or other benefit by the
requesting agency, to the extent that the information is relevant and
necessary to the requesting Agency's decision on the matter.
- Disclosure may be made to a congressional office from the
record of an individual in response to an inquiry from the
congressional office made at the request of that individual.
- Disclosure may be made to National Archives and Records
Administration (NARA), and the General Services Administration (GSA)
in records management inspections conducted under authority of title
44 United States Code.
- Any relevant information in this system of records may be
disclosed to attorneys, insurance companies, employers, and to
courts, boards, or commissions; such disclosures may be made only to
the extent necessary to aid VA in preparation, presentation, and
prosecution of claims authorized under Federal, state, or local laws,
and regulations promulgated hereunder.
- Any information in this system of records may be disclosed to
the United States Department of Justice or United States Attorneys in
order to prosecute or defend litigation involving or pertaining to
the United States, or in which the United States has an interest.
- Any information in this system of records may be disclosed to
a Federal agency or party to an administrative proceeding being
conducted by a Federal agency, in order for VA to respond to and
comply with the issuance of an order by that Federal agency requiring
production of the information.
- Any information in this system of records may be disclosed to
a state or municipal grand jury, a state or municipal court or a
party in litigation, or to a state or municipal administrative agency
functioning in a quasi-judicial capacity or a party to a proceeding
being conducted by such agency, provided that any disclosure of
claimant information made under this routine use must comply with the
provisions of 38 CFR 1.511.
- Any information concerning the claimant's indebtedness to the
United States by virtue of a person's participation in a benefits
program administered by VA, including personal information obtained
from other Federal agencies through computer matching programs, may
be disclosed to any third party, except consumer reporting agencies,
in connection with any proceeding for the collection of any amount
owed to the United States. Purposes of these disclosures may be to
assist VA in collection of costs of services provided individuals not
entitled to such services and to initiate legal actions for
prosecuting individuals who willfully or fraudulently obtain Title 38
benefits without entitlement. This disclosure is consistent with 38
U.S.C. 5701(b)(6).
- Any relevant information from this system of records may be
disclosed to TRICARE, the Department of Defense (DoD) and the Defense
Eligibility Enrollment Reporting System (DEERS) to the extent
necessary to determine eligibility for the Civilian Health and
Medical Program of the Department of Veterans Affairs (CHAMPVA) or
TRICARE benefits, to develop and process CHAMPVA or TRICARE claims,
and to develop cost-recovery actions for claims involving individuals
not eligible for the services or claims involving potential third-
party liability.
- The name and address of a veteran or dependent, and other
information as is reasonably necessary to identify such individual,
may be disclosed to a consumer reporting agency for the purpose of
locating the individual or obtaining a consumer report to determine
the ability of the individual to repay an indebtedness to the United
States by virtue of the individual's participation in a benefits
program administered by VA, provided that the requirements of 38
U.S.C. 5701(g)(2) have been met.
- The name and address of a veteran or dependent, and other
information as is reasonably necessary to identify such individual,
including personal information obtained from other Federal agencies
through computer matching programs, and any information concerning
the individual's indebtedness to the United States by virtue of the
individual's participation in a benefits program administered by VA,
may be disclosed to a consumer reporting agency for purposes of
assisting in the collection of such indebtedness, provided that the
requirements of 38 U.S.C. 5701(g)(4) have been met.
- In response to an inquiry about a named individual from a
member of the general public, disclosure of information may be made
from this system of records to report the amount of VA monetary
benefits being received by the individual. This disclosure is
consistent with 38 U.S.C. 5701(c)(1).
- The name and address of a veteran or dependent may be
disclosed to another Federal agency or to a contractor of that
agency, at the written request of the head of that agency or designee
of the head of that agency, for the purpose of conducting government
research necessary to accomplish a statutory purpose of that agency.
- Any information in this system of records relevant to a claim
of a veteran or dependent, such as the name, address, the basis and
nature of a claim, amount of benefit payment information, medical
information and military service and active duty separation
information may be disclosed at the request of the claimant to
accredited service organizations, VA approved claim agents and
attorneys acting under a declaration of representation, so that these
individuals can aid claimants in the preparation, presentation and
prosecution of claims under the laws in the development and
presentation of claims for benefits administered by VA. The name and
address of a claimant will not, however, be disclosed to these
individuals under this routine use if the claimant has not requested
the assistance of the accredited service organization, claims agent
or an attorney.
- Any information in this system, including medical
information, the basis and nature of claim, the amount of benefits
and personal information may be disclosed to a VA Federal fiduciary
or a guardian ad litem in relation to his or her representation of a
claimant only to the extent necessary to fulfill the duties of the VA
Federal fiduciary or the guardian ad litem.
- The individual's name, address, social security number and
the amount (excluding interest) of any indebtedness which is waived
under 38 U.S.C. 3102, compromised under 4 CFR part 103, otherwise
forgiven, or for which the applicable statute of limitations for
enforcing collection has expired, may be disclosed to the Treasury
Department, Internal Revenue Service, as a report of income under 26
U.S.C. 61(a)(12).
- The name of a veteran or dependent, other information as is
reasonably necessary to identify such individual, and any other
information concerning the individual's indebtedness by virtue of a
person's participation in a benefits program administered by VA, may
be disclosed to the Treasury Department, Internal Revenue Service,
for the collection of Title 38, U.S.C. benefit overpayments, overdue
indebtedness, and/or costs of services provided to an individual not
entitled to such services, by the withholding of all or a portion of
the person's Federal income tax refund.
- The name, date of birth and social security number of a
veteran, spouse or dependent, and other identifying information as is
reasonably necessary may be disclosed to Social Security
Administration and Centers for Medicare & Medicaid Services,
Department of Health and Human Services, for the purpose of
validating social security numbers and Medicare information.
- The name and address of any health care provider in this
system of records who has received payment for claimed services in
behalf of a veteran and beneficiary may be disclosed in response to
an inquiry from a member of the general public.
- Relevant information from this system of records may be
disclosed to individuals, organizations, private or public agencies,
etc., with whom VA has a contract or agreement to perform such
services as VA may deem practicable for the purposes of laws
administered by VA in order for the contractor or subcontractor to
perform the services of the contract or agreement.
- Relevant information from this system of records may be
disclosed to an accrediting Quality Review and Peer Review
Organization in connection with the review of claims or other review
activities associated with VA Health Administration Center
accreditation to professionally accepted claims processing standards.
Policies and practices for storing, retrieving, accessing,
retaining and disposing of records in the system:
Storage:
Records are stored electronically, in paper folders, magnetic
discs, and magnetic tape. Paper documents may be scanned/digitized
and stored for viewing electronically.
Retrievability:
Paper records are retrieved by name or VA claims file number or
social security number of the veteran sponsor. Computer records are
retrieved by name or social security number of the veteran sponsor,
spouse, and/or dependent, or VA claims file number of the veteran
sponsor.
Safeguards:
Working spaces and record storage areas at the HAC are secured
during all business and non-business hours. All entrance doors
require an electronic pass card for entry. The HAC Security Officer
issues electronic pass cards. HAC staff control visitor entry by door
release and escort. The building is equipped with an intrusion alarm
system monitored by HAC security staff during business hours and by a
security service vendor during non-business hours. Records are stored
in an electronic controlled storage filing area. Records in work
areas are stored in locked file cabinets or locked rooms. Access to
record storage areas is restricted to VA employees on a ``need-to-
know'' basis. Access to the computer room is generally limited by
appropriate locking devices and restricted to authorized VA employees
and vendor personnel. Automated Data Processing (ADP) peripheral
devices are generally placed in secure areas or are otherwise
protected. Authorized VA employees may access information in the
computer system by a series of individually unique passwords/codes.
Retention and disposal:
Records are maintained and disposed of in accordance with record
disposition authority approved by the Archivist of the United States.
Paper records that are scanned and digitized for viewing
electronically are destroyed after they have been scanned onto
optical disks, and the electronic copy determined to be an accurate
and complete copy of the paper record scanned.
System manager(s) and address:
Director, Business Office (16), Department of Veterans Affairs,
Veterans Health Administration, VA Central Office, 810 Vermont
Avenue, NW., Washington, DC 20420. Official Maintaining the System:
Director, Health Administration Center, Department of Veterans
Affairs, PO Box 65020, Denver, CO 80206-9020.
Notification procedure:
Any individual who wishes to determine whether a record is being
maintained in this system under his or her name or other personal
identifier, or wants to determine the contents of such record, should
submit a written request to Director, VA Health Administration
Center, PO Box 65020, Denver, Colorado 80206-9020, or apply in person
to the Director, VA Health Administration Center, 300 South Jackson
Street, Denver, Colorado 80209. Inquiries should include the veteran
sponsor's full name and social security and VA claims file numbers,
and the spouse or dependent's name, social security number and return
address.
Record access procedures:
An individual who seeks access to records maintained under his or
her name in this system may write or visit the Director, VA Health
Administration Center.
Contesting record procedures:
(See Record Access Procedures above.)
Record source categories:
The veteran sponsor, spouse and/or dependent, military service
departments, private medical facilities and health care
professionals, electronic trading partners, contractors, DoD,
TRICARE, DEERS, other Federal agencies, VA Regional Offices, Veterans
Benefits Administration (VBA) automated record systems, and VA
Medical Centers.
Back to Index
[back to top]
|