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1 | CPEE_Build_6_Sprint_9 and 11.zip | CPE_005_Release Notes_01302018.docx | Tue Feb 6 17:50:58 2018 UTC |
2 | CPEE_Build_6_Sprint_9 and 11.zip | CPE_005_Release Notes_01302018.docx | Thu Feb 15 02:13:39 2018 UTC |
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1 | Claims Pro cessing & Eligibilit y System ( CP&E) | |
2 | Release No tes | |
3 | ||
4 | Patch CPE* 1.0*001 | |
5 | ||
6 | January 20 18 | |
7 | Department of Vetera ns Affairs | |
8 | Office of Informatio n and Tech nology (OI &T) | |
9 | ||
10 | ||
11 | Revision H istory | |
12 | Creation D ate | |
13 | Version No . | |
14 | Descriptio n/Comments | |
15 | Author(s) | |
16 | Reviewer(s ) | |
17 | Review Typ e | |
18 | Issue Date | |
19 | 01/25/2018 | |
20 | 0.1 | |
21 | Initial Dr aft | |
22 | Michael Sy nakiewicz | |
23 | Dennis Bri cker | |
24 | Peer Revie w | |
25 | 01/3/18 | |
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58 | Table of C ontents | |
59 | 1.Introduc tion1 | |
60 | 2.Purpose1 | |
61 | 3.Audience 1 | |
62 | 4.This Rel ease2 | |
63 | 4.1.New Fe atures and Functions Added2 | |
64 | 4.2.Enhanc ements and Modificat ions to Ex isting2 | |
65 | 4.3.Known Issues3 | |
66 | 5.Product Documentat ion3 | |
67 | ||
68 | ||
69 | Introducti on | |
70 | The Claims Processin g & Eligib ility (CP& E) project addresses improved functional ity to inc lude the f ollowing: initial cl aims proce ssing, ven dor select ion and tr avel claim s point of pickup su spense que ues claim review and clearing, modificat ions to do cument ide ntificatio n software and Optic al Charact er Recogni tion (OCR) capabilit ies, autom atic syste m imaging and storin g of templ ate letter s requesti ng additio nal inform ation. The overall o bjective f or this pr oject cent ers on inc reased pro ductivity, reduction of improp er payment s, and imp roved cust omer servi ce. The CP &E Project includes workstream s for Elec tronic Dat a Intercha nge (EDI) Claims Reo pen and Ve ndor Strea mlining. | |
71 | The EDI Cl aims Reope n process will allow the Healt h Claims R eimburseme nt group t o reopen E DI claims in the Cac he system and then p rocess tho se reopene d claims. The Office of Commun ity Care ( OCC) has r equested a modificat ion of sys tem functi onality an d business processes active in the CP&E system. Th is modific ation will allow for a Voucher Examiner (VE) to re open claim s, allowin g the VE t o re-adjud icate clai ms for whi ch the ser vice provi der has re quested re considerat ion withou t requirin g a print and scan o f the clai m as a wor k around. | |
72 | The Vendor Streamlin ing proces s is a man ual proces s carried out in the Image Pro cessing (I P) menu op tion by VE . Vendor S election i s importan t for seve ral reason s: | |
73 | Ensure tha t provider s who care for benef iciaries a re paid fo r their se rvices in timely man ner. | |
74 | Ensure the payment g oes to the correct v endor | |
75 | Verify pay -to provid er and ini tiate any correction s to the v endor | |
76 | Have new v endors or locations added to t he system, (and ther eby, be ve rified by the Vendor Queue tea m) | |
77 | Reduce fra udulent an d errant r emit-to cl aims | |
78 | Improve th e overall claims pro cessing sp eed and ac curacy | |
79 | The object ive of the vendor se lection pr ocess is t o search t he Vendor Look-Up Fi le in Vist A to locat e the vend or record that match es the Rem it-To (RT) informati on on the bill. This process e nsures acc urate CHAM PVA paymen t and deli very to th e proper b illing add ress. | |
80 | ||
81 | ||
82 | Purpose | |
83 | These rele ase notes cover the changes to the Claim s Processi ng and Eli gibility d eliverable s and rele ase inform ation. | |
84 | Audience | |
85 | This docum ent target s users an d administ rators of Claims Pro cessing an d Eligibil ity and ap plies to t he changes made for this relea se only. | |
86 | This Relea se | |
87 | The follow ing sectio ns provide a summary of the ne w features and funct ions added , enhancem ents and m odificatio ns to the existing s oftware, a nd any kno wn issue f or Claims Processing and Eligi bility. | |
88 | New Featur es and Fun ctions Add ed | |
89 | The follow ing are th e new feat ures and f unctions a dded to Cl aims Proce ssing Enha ncements w ith in thi s release. | |
90 | Compare th e entered Tax ID to the Tax ID from the 837 file ( CPE001-014 ). If dif ferent pro vide a Pop Up error f or the use r to revie w the ente red Tax ID (CPE001-0 15). Resp ond to the user’s re sponse to the PopUp (CPE001-01 6). | |
91 | Enhancemen ts and Mod ifications to Existi ng | |
92 | The follow ing are th e enhancem ents and m odificatio ns to Elec tronic Dat a Intercha nge (EDI) Reopen rel ease with CM ID. | |
93 | 639003: Cr eate Rever sed Status for Origi nal Progra m Document Identifie r (PDI) | |
94 | 639004: Ap ply Revers ed Status to Origina l PDI | |
95 | 639008: Ap ply Voided Status to Claims | |
96 | 639011: Ve rify No Re versed Sta tus on Ass ociated Cl aims | |
97 | 649993: Ma nual EDI D isplay Err or Message Reversed Status on Associated Claims | |
98 | 656142: Ve rify No Vo ided Statu s on Origi nal PDI | |
99 | 656144: Vo ided Statu s on Origi nal PDI Er ror Messag e | |
100 | 639012: Ve rify No Re versed Sta tus on Ass ociated Cl aims | |
101 | 649990: Di splay Erro r Message Reversed S tatus on A ssociated Claims | |
102 | 639015: Ma nual EDI O riginal PD I Attached Claims | |
103 | 649249: Ma nual EDI O riginal PD I Attached Claims Er ror Messag e | |
104 | 639016: Ma nual EDI A utoload Cu rrent PDI | |
105 | 639017: M anual EDI Autoload O riginal PD I Informat ion | |
106 | 639018: M anual EDI Verify Ben eficiary M atch | |
107 | 649223: Ma nual EDI B eneficiary Match Err or Message | |
108 | 639019: Ma nual EDI V erify No V oided Stat us on Orig inal PDI | |
109 | 644917: Ma nual EDI V oided Stat us on Orig inal PDI E rror Messa ge | |
110 | 638572: In voke New R eason Code for Corre cted 837 | |
111 | 639009: Di splay Reve rsed Claim Status on Post Proc essing Rep ort (PPR) | |
112 | 639010: Di splay Void ed Claim S tatus on P PR | |
113 | 651326: In activate E xisting Du plicate Ve ndor Recor ds | |
114 | 651520: Co mpare Tax ID | |
115 | 651514: Di splay Erro r Message | |
116 | 651523: Re act to Use r Response to Error Message | |
117 | 651510: Mo dify Remit -to Addres s Label | |
118 | 639001: In voke New R eason Code Previous Payment | |
119 | ||
120 | Known Issu es | |
121 | There is n ot an Auth ority To O perate(ATO ) in place for CP&E and no pro duction re lease can move forwa rd until A TO is in p lace. | |
122 | Product Do cumentatio n | |
123 | The follow ing docume nts apply to this re lease: | |
124 | Community Care Syste m Enhancem ents CP&E User Guide | |
125 | Community Care Syste m Enhancem ents CP&E Deployment , Installa tion, Back out and Ro llback Gui de | |
126 | Community Care Syste m Enhancem ents CP&E Requiremen ts Traceab ility Matr ix |
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