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1 | CPEE_v1_Build_7.zip\CPEE_v1_Build_7\Build 7 Deliverables | CLIN_0008AA_Build 7 Requirements Package_CPE_CCSE_v0.1.docx | Tue Apr 24 15:18:42 2018 UTC |
2 | CPEE_v1_Build_7.zip\CPEE_v1_Build_7\Build 7 Deliverables | CLIN_0008AA_Build 7 Requirements Package_CPE_CCSE_v0.1.docx | Tue Apr 24 18:48:19 2018 UTC |
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1 | Community Care Syste m Enhancem ents (CCSE ) | |
2 | Claims Pro cessing & Eligibilit y (CP&E) | |
3 | ||
4 | Build 7 Re quirements Package | |
5 | ||
6 | ||
7 | ||
8 | Department of Vetera ns Affairs | |
9 | Office of Informatio n and Tech nology (OI &T) | |
10 | February 2 018 | |
11 | Version 0. 1 | |
12 | ||
13 | ||
14 | Revision H istory | |
15 | 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 . | |
16 | Date | |
17 | Version | |
18 | Descriptio n | |
19 | Author | |
20 | 2/28/2018 | |
21 | 0.1 | |
22 | Initial Dr aft for Bu ild 7 Requ irement | |
23 | Michael Sy nakiewicz | |
24 | ||
25 | ||
26 | Table of C ontents | |
27 | ||
28 | 1.Introduc tion1 | |
29 | 2.Purpose1 | |
30 | 3.Requirem ents Check list1 | |
31 | ||
32 | Introducti on | |
33 | ||
34 | 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. | |
35 | ||
36 | Purpose | |
37 | ||
38 | 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. | |
39 | ||
40 | Requiremen ts Checkli st | |
41 | ||
42 | The follow ing detail ed checkli st is deco mposed int o referenc ed require ments docu mentation. | |
43 | Item | |
44 | Applicable Yes/NA | |
45 | Reference | |
46 | Epics | |
47 | Yes | |
48 | Epic 5 – E DI Reopen | |
49 | Epic 1 – V endor Stre amlining | |
50 | CC4 – Reve rse Adjudi cated Clai ms | |
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 | CPE001-013 | |
63 | 958201 | |
64 | As the HCR Group I w ould like a report I can eithe r print or export to Excel fro m CP&E tha t displays the infor mation bas ed on the report spe cification s on dupli cate vendo r records that have been inact ivated. | |
65 | CPE001-018 | |
66 | 951231 | |
67 | As an HCR PA I want the label in the IP vendor scr een to be changed fr om "Remit- to Informa tion" to " Billing/Re mit-to Inf ormation". | |
68 | CPE001-019 | |
69 | 951234 | |
70 | As an HCR PA I want the system to displa y the prov ider's bil ling addre ss (Street Address, City, Stat e, and Zip Code) on the IP Ven dor search result sc reen in th e field th at is labe lled "BILL ING/REMIT- TO ADDRESS ", when th e billing address is present i n the Vend or File . | |
71 | CPE001-100 | |
72 | 972772 | |
73 | As a VE, I want the system to use the PL Zip in th e Prospect ive Paymen t System ( PPS) payme nt methodo logy in al l correspo nding Type s of Cover age for th e Coordina tion of Be nefit of P rimary, Se condary an d Tertiary for CHAMP VA\SB manu al and EDI Inpatient claims. | |
74 | CPE001-101 | |
75 | 972773 | |
76 | As a VE, I want the system to use the PL Zip in th e Low Volu me Mental Health (LV MH) paymen t methodol ogy in all correspon ding Types of Covera ge for the Coordinat ion of Ben efit of Pr imary, Sec ondary and Tertiary for CHAMPV A\SB manua l and EDI Inpatient claims. | |
77 | CPE001-102 | |
78 | 972774 | |
79 | As a VE, I want the system to use the PL Zip in th e High Vol ume Mental Health (H VMH) payme nt methodo logy claim s in all c orrespondi ng Types o f Coverage for the C oordinatio n of Benef it of Prim ary, Secon dary and T ertiary fo r CHAMPVA\ SB manual and EDI In patient. | |
80 | CPE001-103 | |
81 | 972775 | |
82 | As a VE, I want the system to use the PL Zip in th e Medicare Hospice P er Diem Ra tes paymen t methodol ogy for Ho spice Gene ral Inpati ent Care i n all corr esponding Types of C overage fo r the Coor dination o f Benefit of Primary , Secondar y and Tert iary for C HAMPVA\SB manual and EDI Inpat ient claim s. | |
83 | CPE001-104 | |
84 | 972776 | |
85 | As a VE, I want the system to use the PL Zip in th e Medicare Hospice P er Diem Ra tes paymen t methodol ogy for Ho spice Inpa tient Resp ite Care i n all corr esponding Types of C overage fo r the Coor dination o f Benefit of Primary , Secondar y and Tert iary for C HAMPVA\SB manual and EDI Inpat ient claim s. | |
86 | CPE001-105 | |
87 | 972777 | |
88 | As a VE, I want the system to use the PL Zip in th e Medicare SNF Price r payment methodolog y for Skil led Nursin g Facility (SNF) in all corres ponding Ty pes of Cov erage for the Coordi nation of Benefit of Primary, Secondary and Tertia ry for CHA MPVA\SB ma nual and E DI Inpatie nt claims. | |
89 | CPE001-106 | |
90 | 972778 | |
91 | As a VE, I want the system to use the PL Zip in th e DRG paym ent method ology for Substance Use Disord er Rehabil itation Fa cility (SU DRF) in al l correspo nding Type s of Cover age for th e Coordina tion of Be nefit of P rimary, Se condary an d Tertiary for CHAMP VA\SB manu al and EDI Inpatient claims. | |
92 | CPE001-107 | |
93 | 972779 | |
94 | As a VE, I want the system to use the PL Zip in th e Half Day Per Diem payment me thodology for Partia l Hospital ization pr ogram clai ms in all correspond ing Types of Coverag e for the Coordinati on of Bene fit of Pri mary, Seco ndary and Tertiary f or CHAMPVA \SB manual and EDI I npatient. | |
95 | CPE001-108 | |
96 | 972780 | |
97 | As a VE, I want the system to use the PL Zip in th e Full Day Per Diem payment me thodology for Partia l Hospital ization pr ogram clai ms in all correspond ing Types of Coverag e for the Coordinati on of Bene fit of Pri mary, Seco ndary and Tertiary f or CHAMPVA \SB\CWVV m anual and EDI Inpati ent. | |
98 | CPE001-109 | |
99 | 972781 | |
100 | As a VE, I want the system to use the PL Zip in th e CMAC pay ment metho dology for Facility and Profes sional Fee services in all cor responding Types of Coverage f or the Coo rdination of Benefit of Primar y, Seconda ry and Ter tiary for CHAMPVA\SB manual an d EDI Outp atient cla ims. | |
101 | CPE001-110 | |
102 | 972782 | |
103 | As a VE, I want the system to use the PL Zip in th e CMAC pay ment metho dology for Mental He alth in al l correspo nding Type s of Cover age for th e Coordina tion of Be nefit of P rimary, Se condary an d Tertiary for CHAMP VA\SB manu al and EDI Outpatien t claims. | |
104 | CPE001-111 | |
105 | 972783 | |
106 | As a VE, I want the system to use the PL Zip in th e CMAC pay ment metho dology for ASC Profe ssional Fe e services claims in all corre sponding T ypes of Co verage for the Coord ination of Benefit o f Primary, Secondary and Terti ary for CH AMPVA\SB m anual and EDI Outpat ient. | |
107 | CPE001-112 | |
108 | 972784 | |
109 | As a VE, I want the system to use the PL Zip in th e PPS paym ent method ology for ASC Hospit al Based F acility in all corre sponding T ypes of Co verage for the Coord ination of Benefit o f Primary, Secondary and Terti ary for CH AMPVA\SB m anual and EDI Outpat ient claim s. | |
110 | CPE001-113 | |
111 | 972785 | |
112 | As a VE, I want the system to use the PL Zip in th e PPS paym ent method ology for ASC Freest anding Fac ility in a ll corresp onding Typ es of Cove rage for t he Coordin ation of B enefit of Primary, S econdary a nd Tertiar y for CHAM PVA\SB man ual and ED I Outpatie nt claims. | |
113 | CPE001-114 | |
114 | 972786 | |
115 | As a VE, I want the system to use the PL Zip in th e CMAC Ane sthesia Ra te payment methodolo gy in all correspond ing Types of Coverag e for the Coordinati on of Bene fit of Pri mary, Seco ndary and Tertiary f or Anesthe sia for CH AMPVA\SB m anual and EDI Outpat ient claim s. | |
116 | CPE001-115 | |
117 | 972787 | |
118 | As a VE, I want the system to use the PL Zip in th e Medicare Hospice P er Diem Ra tes paymen t methodol ogy for Ho spice Rout ine Home C are in all correspon ding Types of Covera ge for the Coordinat ion of Ben efit of Pr imary, Sec ondary and Tertiary for CHAMPV A\SB manua l and EDI Outpatient claims. | |
119 | CPE001-116 | |
120 | 972788 | |
121 | As a VE, I want the system to use the PL Zip in th e Medicare Hospice P er Diem Ra tes paymen t methodol ogy in all correspon ding Types of Covera ge for the Coordinat ion of Ben efit of Pr imary, Sec ondary and Tertiary for Hospic e Continuo us Home Ca re for CHA MPVA\SB ma nual and E DI Outpati ent claims . | |
122 | CPE001-117 | |
123 | 972789 | |
124 | As a VE, I want the system to use the PL Zip in th e CMAC Inj ectable Ra te payment methodolo gy for Inj ectable Dr ugs in all correspon ding Types of Covera ge for the Coordinat ion of Ben efit of Pr imary, Sec ondary and Tertiary for CHAMPV A\SB manua l and EDI Outpatient claims. | |
125 | CPE001-118 | |
126 | 972790 | |
127 | As a VE, I want the system to use the PL Zip in th e CMAC Inj ectable Ra te payment methodolo gy for Hom e Infusion J-code wi th NDC cla ims in all correspon ding Types of Covera ge for the Coordinat ion of Ben efit of Pr imary, Sec ondary and Tertiary for CHAMPV A\SB manua l and EDI Outpatient . | |
128 | CPE001-119 | |
129 | 972791 | |
130 | As a VE, I want the system to use the PL Zip in th e CMAC pay ment metho dology for Multiple Surgery in all corre sponding T ypes of Co verage for the Coord ination of Benefit o f Primary, Secondary and Terti ary for CH AMPVA\SB m anual and EDI Outpat ient claim s. | |
131 | CPE001-120 | |
132 | 972792 | |
133 | As a VE, I want the system to use the PL Zip in th e CMAC pay ment metho dology for Multiple Surgery Fi ngers or T oes in all correspon ding Types of Covera ge for the Coordinat ion of Ben efit of Pr imary, Sec ondary and Tertiary for CHAMPV A\SB manua l and EDI Outpatient claims. | |
134 | CPE001-121 | |
135 | 972793 | |
136 | As a VE, I want the system to use the PL Zip in th e CMAC pay ment metho dology for Assistant -At-Surger y in all c orrespondi ng Types o f Coverage for the C oordinatio n of Benef it of Prim ary, Secon dary and T ertiary fo r CHAMPVA\ SB manual and EDI Ou tpatient c laims. | |
137 | CPE001-122 | |
138 | 972794 | |
139 | As a VE, I want the system to use the PL Zip in th e CMAC pay ment metho dology for Other tha n Assistan t-At-Surge ry in all correspond ing Types of Coverag e for the Coordinati on of Bene fit of Pri mary, Seco ndary and Tertiary f or CHAMPVA \SB manual and EDI O utpatient claims. | |
140 | CPE001-123 | |
141 | 972795 | |
142 | As a VE, I want the system to use the PL Zip in th e CMAC pay ment metho dology in all corres ponding Ty pes of Cov erage for the Coordi nation of Benefit of Primary, Secondary and Tertia ry for CHA MPVA\SB ED I Manual a nd EDI cla ims with a Type of S ervice of Dental. | |
143 | ||
144 | Other Requ irements I nformation | |
145 | N/A | |
146 | ||
147 | Mock-Ups | |
148 | N/A | |
149 | Included i n the User Stories | |
150 | Visual Aid s | |
151 | N/A | |
152 | ||
153 | Dynamic Wi reframes | |
154 | N/A | |
155 |
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