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1 | CPEE_Build_6_Sprint_9 and 11.zip | CLIN0008AA_Build 6 Requirements Package_CPE_CCSE_v0.1.docx | Tue Feb 6 17:50:58 2018 UTC |
2 | CPEE_Build_6_Sprint_9 and 11.zip | CLIN0008AA_Build 6 Requirements Package_CPE_CCSE_v0.1.docx | Wed Feb 14 22:19:56 2018 UTC |
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1 | Community Care Syste m Enhancem ents (CCSE ) | |
2 | Claims Pro cessing & Eligibilit y (CP&E) | |
3 | Requiremen ts Package | |
4 | Build 6 | |
5 | CLIN 0008A A | |
6 | ||
7 | ||
8 | ||
9 | Department of Vetera ns Affairs | |
10 | Office of Informatio n and Tech nology (OI &T) | |
11 | December 2 017 | |
12 | Version 0. 1 | |
13 | ||
14 | ||
15 | Revision H istory | |
16 | Note: The revision h istory cyc le begins once chang es or enha ncements a re request ed after t he documen t has been baselined . | |
17 | Date | |
18 | Version | |
19 | Descriptio n | |
20 | Author | |
21 | 12/19/17 | |
22 | 0.1 | |
23 | Initial dr aft of Bui ld 6 Requi rements Pa ckage. | |
24 | Michael Sy nakiewicz | |
25 | ||
26 | ||
27 | Table of C ontents | |
28 | ||
29 | 1.Introduc tion1 | |
30 | 2.Purpose1 | |
31 | 3.Requirem ents Check list1 | |
32 | ||
33 | Introducti on | |
34 | ||
35 | The Depart ment of Ve terans Aff airs (VA) Community Care Syste m Enhancem ents (CCSE ) program is compris ed of Clai ms Process ing and El igibility (CP&E), Cl aims Compl iance Phas e 4 (CC4) and System Integrity (SI) proj ects. The program im pacts both systems w ithin the Office of Community Care (OCC) and syste ms located at the Ve terans Int egrated Se rvice Netw ork (VISN) level, in cluding Fe e Basis Cl aims Syste m (FBCS), and system s located at the Vet erans Admi nistration Medical C enter (VAM C) level, including Veterans I ntegrated Systems Te chnology A rchitectur e (VistA) Fee. | |
36 | ||
37 | Purpose | |
38 | ||
39 | The purpos e of this Requiremen ts Package is to pro vide the E pics, stak eholder ne eds, visua lizations, stories, and other sources of requireme nts inform ation for functional and non-f unctional requiremen ts. The pa ckage incl udes a che cklist ref erencing m ock-ups, v isual aids , and dyna mic wirefr ames as re quired to demonstrat e the navi gation, ta xonomy, me nus and de pendencies between f eatures in the user interface (UI) and a ll aspects of the pr esentation layer tha t interact with the user. | |
40 | ||
41 | Requiremen ts Checkli st | |
42 | ||
43 | The follow ing detail ed checkli st is deco mposed int o referenc ed require ments docu mentation. | |
44 | Item | |
45 | Applicable Yes/NA | |
46 | Reference | |
47 | Epics | |
48 | Yes | |
49 | Epic 5 – E DI Reopen | |
50 | Epic CC400 02 – 835 R eversal | |
51 | Stakeholde r Needs | |
52 | Yes | |
53 | Stakeholde r needs ar e captured in the el aborated U ser Storie s on Ratio nal | |
54 | Visualizat ions | |
55 | N/A | |
56 | ||
57 | Stories | |
58 | Yes | |
59 | User Story | |
60 | Rational R m# | |
61 | Requiremen t | |
62 | CPE005-100 | |
63 | 938899 | |
64 | As the R&R VE I want reason co de "Correc tion to a previously processed submissio n" to be s ent on an EOB whenev er a corre cted 837 i s processe d. | |
65 | CPE005-102 | |
66 | 938903 | |
67 | As the R&R VE I want reason co de "Paymen t for this claim/ser vice may h ave been p rovided in a previou s payment" to be sen t on an EO B whenever a correct ed 837 is processed. | |
68 | CPE005-103 | |
69 | 937663 | |
70 | As the VE I would li ke the sys tem to cre ate a Reve rsed Statu s that can be applie d to the O riginal PD I. | |
71 | CPE005-104 | |
72 | 938885 | |
73 | As the VE I would li ke the sys tem to app ly the Rev ersed Stat us to an O riginal PD I when the user has initiated a reversal . | |
74 | CPE005-107 | |
75 | 943751 | |
76 | As the VE I would li ke the sys tem to app ly a Rever sed Status to all Cl aims assoc iated with an Origin al PDI in which the user has i nitiated a Reversal. | |
77 | CPE005-108 | |
78 | 943755 | |
79 | As the VEI I would l ike the sy stem to ap ply a Void ed Status to all Cla ims associ ated with an Origina l PDI with a FC8 whe n the user initiates Claim Sor t. | |
80 | CPE005-109 | |
81 | 953758 | |
82 | As the VE I would li ke the sys tem to dis play Rever sed claim status dat a on the P PR. | |
83 | CPE005-110 | |
84 | 943760 | |
85 | As the VE I would li ke the sys tem to dis play Voide d claim st atus data on the PPR . | |
86 | CPE005-111 | |
87 | 943762 | |
88 | As the R&R VE I want the syste m to verif y that no associated claims fo r the Orig inal PDI n umber ente red for va lidation o n the Docu ment ID Sc reen have a Reversed status wh en I selec t to reope n an EDI s ubmission. | |
89 | CPE005-113 | |
90 | 943767 | |
91 | As the R&R VE I want the syste m to verif y that no associated claims fo r the Orig inal PDI n umber ente red for va lidation o n the Docu ment ID Sc reen have a Reversed status wh en I selec t to reope n a Manual EDI submi ssion. | |
92 | CPE005-115 | |
93 | 945019 | |
94 | As the R&R VE I want a new rea son code t hat states "Claim(s) reversal notificati on, update d EOB(s) w ill follow " to be cr eated in C P&E. | |
95 | CPE005-116 | |
96 | 945031 | |
97 | As the R&R VE I want reason co de "Claim( s) reversa l notifica tion, upda ted EOB(s) will foll ow" to be sent on an EOB when a user ini tiates a r eversal. | |
98 | CPE005-117 | |
99 | 945034 | |
100 | As the R&R VE I want the syste m to check to ensure the Origi nal PDI en tered on t he Documen t ID scree n for vali dation has associate d claims w hen I sele ct to reop en a Manua l EDI. | |
101 | CPE005-119 | |
102 | 945039 | |
103 | As the R&R VE I want the syste m to autol oad the Cu rrent PDI into the R ead Only C urrent PDI field on the Docume nt ID scre en based o n the Rese t PDI for Processing (RPP) sub routine i n CP&E [CH MRESET] wh en I selec t to reope n a Manual EDI. | |
104 | CPE005-121 | |
105 | 945426 | |
106 | As the R&R VE when I reopen a Manual EDI I want th e system t o autoload onto all applicable screens t he Origina l PDI info rmation fr om the 837 transacti on when I save the n umber I en tered on t he Documen t ID scree n for vali dation. | |
107 | CPE005-122 | |
108 | 947784 | |
109 | As the R&R VE when I reopen a Manual EDI I want th e system t o verify t he benefic iary on th e Original PDI I hav e entered for valida tion match es the ben eficiary o n the Curr ent PDI th at I have assigned t o myself. | |
110 | CC40002-00 1 | |
111 | 943475 | |
112 | As All Cla ims Proces sing Staff , I need t o create a Reversed 835 Stagin g File by negating a ll payment s on the o riginal 83 5 so that I can crea te an X12 835 that m atches the ASC X12 s pecificati on for rev ersal. | |
113 | CC40002-00 2 | |
114 | 957608 | |
115 | As All Cla ims Proces sing Staff , I need t o create a Reversed 835 Stagin g File by flagging t he CLP02 s egment as Code 22 so that I ca n create a n X12 835 that match es the ASC X12 speci fication f or reversa l. | |
116 | CC40002-00 3 | |
117 | 957609 | |
118 | As All Cla ims Proces sing Staff , I need t o create a Reversed 835 Stagin g File by removing t he patient responsib ility loca ted in the CLP05 seg ment so th at I can c reate an X 12 835 tha t matches the ASC X1 2 specific ation for reversal. | |
119 | ||
120 | Other Requ irements I nformation | |
121 | N/A | |
122 | ||
123 | Mock-Ups | |
124 | N/A | |
125 | Included i n the User Stories | |
126 | Visual Aid s | |
127 | N/A | |
128 | ||
129 | Dynamic Wi reframes | |
130 | N/A | |
131 | Printed In dividual R eport | |
132 | Edit Claim Data | |
133 | Reversed/V oid Status | |
134 | Reason Cod e | |
135 | Modify Doc ument ID S creen – PD I | |
136 | PDI Paymen t | |
137 |
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