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1 | CPAC.zip\Billing Interface for Fee Care | 03-056BillingInterface_RSD_v1.0_fully signed.docx | Thu Feb 9 15:02:56 2017 UTC |
2 | CPAC.zip\Billing Interface for Fee Care | 03-056BillingInterface_RSD_v1.0_fully signed.docx | Thu Feb 9 20:37:00 2017 UTC |
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1 | Department of Vetera ns Affairs | |
2 | ||
3 | ||
4 | ||
5 | ||
6 | Billing In terface fo r Fee Care | |
7 | ||
8 | ||
9 | Requiremen ts Specifi cation Doc ument | |
10 | ||
11 | ||
12 | ||
13 | ||
14 | ||
15 | ||
16 | ||
17 | ||
18 | ||
19 | September 2015 | |
20 | ||
21 | Version 1. 0 | |
22 | ||
23 | Revision H istory | |
24 | ||
25 | Date | |
26 | Version | |
27 | Descriptio n | |
28 | Author | |
29 | Reviewer | |
30 | Issue Date | |
31 | 07/24/2015 | |
32 | 0.01 | |
33 | Initial dr aft | |
34 | S. Ritter | |
35 | S. Ambrose | |
36 | 07/24/2015 | |
37 | 08/19/2015 | |
38 | 0.02 | |
39 | Updates to reflect V A Comments | |
40 | S. Ritter | |
41 | S. Ambrose | |
42 | 08/19/2015 | |
43 | 09/01/2015 | |
44 | 0.03 | |
45 | Incorporat ed VA Comm ents | |
46 | S. Ritter | |
47 | S. Ambrose | |
48 | 09/07/2015 | |
49 | 09/10/2015 | |
50 | 1.0 | |
51 | First Form al Iterati on | |
52 | C. Dunn | |
53 | ||
54 | ||
55 | ||
56 | Table of C ontents | |
57 | ||
58 | 1.Introduc tion ..... .......... .......... .......... .......... .......... .......... .......... .......... ... 1 | |
59 | 1.1. Purp ose ...... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .. 1 | |
60 | 1.2. Scop e ........ .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .... 1 | |
61 | 1.3. Refe rences ... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 4 | |
62 | 2.Overall Descriptio n ........ .......... .......... .......... .......... .......... .......... ........ 4 | |
63 | 2.1. Acce ssibility Specificat ions...... .......... .......... .......... .......... .......... .......... .......... 4 | |
64 | 2.2. Busi ness Rules Specifica tion ..... .......... .......... .......... .......... .......... .......... ........ 4 | |
65 | 2.3. Desi gn Constra ints Speci fication.. .......... .......... .......... .......... .......... .......... ..... 5 | |
66 | 2.4. Disa ster Recov ery Specif ication .. .......... .......... .......... .......... .......... .......... ...... 5 | |
67 | 2.5. Docu mentation Specificat ions...... .......... .......... .......... .......... .......... .......... ...... 5 | |
68 | 2.6. Func tional Spe cification s ........ .......... .......... .......... .......... .......... .......... .......... . 5 | |
69 | 2.6.1.Syst em Feature : New IB R ate Type o f FEE REIM B INS .... .......... .......... 6 | |
70 | 2.6.2.Syst em Feature : New AR C ategory of FEE REIMB INS and n ew | |
71 | Revenue So urce Codes in FMS Ta bles. .... .......... .......... .......... .......... .......... ........ 7 | |
72 | 2.6.3.Syst em Feature : System c apability to generat e reports in AR | |
73 | Package th at include New FEE R EIMB INS R ate Type. .......... .......... .......... ........ 7 | |
74 | 2.6.4.Syst em Feature : Create n ew fund of FEE REIMB INS in FM S tables. . 8 | |
75 | 2.7. Grap hical User Interface (GUI) Spe cification s ........ .......... .......... .......... ........ 8 | |
76 | 2.8. Mult i-division al Specifi cations... .......... .......... .......... .......... .......... .......... ......... 8 | |
77 | 2.9. Perf ormance Sp ecificatio ns........ .......... .......... .......... .......... .......... .......... ........ 8 | |
78 | 2.10.Quali ty Attribu tes Specif ication .. .......... .......... .......... .......... .......... .......... ....... 8 | |
79 | 2.11.Relia bility Spe cification s......... .......... .......... .......... .......... .......... .......... .......... .. 9 | |
80 | 2.12.Scope Integrati on........ .......... .......... .......... .......... .......... .......... .......... .......... ..... 9 | |
81 | 2.13.Secur ity Specif ications . .......... .......... .......... .......... .......... .......... .......... .......... .. 9 | |
82 | 2.14.Syste m Features ......... .......... .......... .......... .......... .......... .......... .......... .......... ..... 9 | |
83 | 2.15.Usabi lity Speci fications. .......... .......... .......... .......... .......... .......... .......... .......... .. 9 | |
84 | 3.Applicab le Standar ds ....... .......... .......... .......... .......... .......... .......... ..... 9 | |
85 | 4.Interfac es ....... .......... .......... .......... .......... .......... .......... .......... .......... ... 10 | |
86 | 4.1. Comm unications Interface s ........ .......... .......... .......... .......... .......... .......... ...... 10 | |
87 | 4.2. Hard ware Inter faces..... .......... .......... .......... .......... .......... .......... .......... .......... .. 11 | |
88 | 4.3. Soft ware Inter faces..... .......... .......... .......... .......... .......... .......... .......... .......... ... 11 | |
89 | 4.4. User Interface s ........ .......... .......... .......... .......... .......... .......... .......... .......... ....... 11 | |
90 | 5.Legal, C opyright, and Other Notices .. .......... .......... .......... .......... .... 11 | |
91 | 6.Purchase d Componen ts ....... .......... .......... .......... .......... .......... ......... 11 | |
92 | 6.1. Defe ct Source (TOP 5) .. .......... .......... .......... .......... .......... .......... .......... .......... . 11 | |
93 | 7.User Cla ss Charact eristics.. .......... .......... .......... .......... .......... .......... 11 | |
94 | ||
95 | 8.Estimati on ....... .......... .......... .......... .......... .......... .......... .......... .......... . 11 | |
96 | Attachment A – Appro val Signat ures ..... .......... .......... .......... .......... ....... 13 | |
97 | Attachment B – Acron ym List .. .......... .......... .......... .......... .......... .......... .. 14 | |
98 | Attachment C – Enter prise Requ irements . .......... .......... .......... .......... ... 16 | |
99 | ||
100 | List of Ta bles | |
101 | ||
102 | Table 1: S uccess Fac tors ..... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... . 1 | |
103 | Table 2: B illing Int erface for Fee Care BNs....... .......... .......... .......... .......... .......... .......... .......... .......... .......... 2 | |
104 | Table 3: A cronym Lis t......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 14 | |
105 | Table 4: E nterprise Requiremen ts ....... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ... 16 | |
106 | ||
107 | List of Fi gures | |
108 | ||
109 | Figure 1: Cumulative Probabili ty (“S-cur ve”) Chart ......... .......... .......... .......... .......... .......... .......... .......... . 12 | |
110 | ||
111 | 1. Introdu ction | |
112 | ||
113 | The Chief Business O ffice (CBO ) is reque sting syst em enhance ments to t he Veteran s Health I nformation Systems a nd Technol ogy Archit ecture (Vi stA) Integ rated Bill ing (IB), Accounts R eceivable (AR), and Fee Basis software m odules tha t would al low segreg ating all billing an d collecti on activit ies for No n-Departme nt of Vete rans Affai rs (VA), C are Third Party Insu rance carr iers’ reim bursement. | |
114 | ||
115 | Current Me dical Care Collectio ns Fund (M CCF) Third Party bil ling and c ollections applicati ons in the VistA inf ormation s ystem do n ot segrega te the Non -VA care c laims from those cla ims for se rvice rend ered at Ve terans Hea lth Admini stration ( VHA) healt hcare faci lities, wh ich makes it difficu lt to vali date the t hird party revenue g enerated t hrough the Non-VA ca re cost re covery eff orts. The current pr ocess is a resource intensive, manual pr ocess with no assura nce that a ll applica ble Non-VA charges h ave been b illed and collected. | |
116 | ||
117 | 1.1.Purpos e | |
118 | ||
119 | This Requi rements Sp ecificatio n Document (RSD) spe cifies the requireme nts for th e Billing Interface for Fee Ca re enhance ment of th e Electron ic Data In terchange (EDI) Cons olidated P atient Acc ount Cente r (CPAC) R evenue Enh ancements Program. T he intende d audience is the CB O Purchase d Care Pro gram Offic e, CPAC ke y stakehol ders inclu ding the C PAC Revenu e Systems Management (RSM) org anization, and the C PAC EDI Re venue Enha ncements d evelopment team. | |
120 | ||
121 | 1.2.Scope | |
122 | ||
123 | This docum ent addres ses the Bu siness Nee d (BN) and requireme nts propos ed in the Third Part y Billing Improvemen ts for Fee Care Busi ness Requi rements Do cument (BR D) dated M arch 2011, which out lines reco mmended ch anges to t he VistA I B, AR, and Fee Basis applicati ons. | |
124 | ||
125 | The succes s factors of the enh ancements proposed i n the BRD are shown in Table 1 . | |
126 | ||
127 | Table 1: S uccess Fac tors | |
128 | ||
129 | Success Fa ctors | |
130 | Measuremen t | |
131 | Third Part y insuranc e carriers are bille d and reim bursement is collect ed for eac h approved Non-VA ca re claim f or Veteran s with thi rd party | |
132 | insurance. Complete claim info rmation is captured in VistA a nd is clea rly identi fied as No n-VA care | |
133 | claims dat a. | |
134 | Identify b illed fee care so VA has metri cs and can validate how much h as been bi lled/colle cted for F ee Care – mechanism to track o n back end | |
135 | ||
136 | This docum ent addres ses only t he Billing Interface for Fee C are enhanc ement, one of five e nhancement s comprisi ng the EDI CPAC Reve nue Enhanc ements Pro gram. Deta ils regard ing other enhancemen ts in the program ar e describe d in separ ate RSDs. | |
137 | ||
138 | During req uirements elaboratio n for this enhanceme nt, the BN and requi rements we re discuss ed from th e perspect ive of the BRD, incl uding the changes re commended in the BRD to addres s the BN. | |
139 | ||
140 | The BNs/re quirements are shown in Table 2. | |
141 | ||
142 | Table 2: B illing Int erface for Fee Care BNs | |
143 | ||
144 | BN | |
145 | Owner Requ irement (O WNR) | |
146 | Number | |
147 | OWNR | |
148 | Ranking R= Required O =Optional | |
149 | BN 1: New IB Rate Ty pe of Fee Reimbursem ent Insura nce (FEE R EIMB INS). | |
150 | 1.1 | |
151 | System cap ability fo r option t o select F EE REIMB I NS Rate Ty pe in Vist A IB menu for all ap plicable I B Rate Typ e options. System sh all allow selection of FEE REI MB INS Typ e when bil ling for I npatient a nd Outpati ent Non-VA Care Clai ms. | |
152 | R | |
153 | BN 1: New IB Rate Ty pe of | |
154 | FEE REIMB INS. | |
155 | 1.2 | |
156 | System aut omatically assigns t he FEE REI MB INS Rat e Type whe n the Pati ent Treatm ent File ( PTF) indic ates NON-V A CARE. | |
157 | R | |
158 | BN 1: New IB Rate Ty pe of | |
159 | FEE REIMB INS. | |
160 | 1.3 | |
161 | System cap ability fo r data ent ry of foll owing Non- VA Care da ta element s (not an all-inclus ive list): | |
162 | Non-VA Di scharge Da te | |
163 | Non-VA Fa cility | |
164 | Non-VA Ca re Type | |
165 | Non-VA Ca re Provide r ID# | |
166 | Non-VA Fa cility Tax onomy | |
167 | R | |
168 | BN 1: New IB Rate Ty pe of | |
169 | FEE REIMB INS. | |
170 | 1.4 | |
171 | Associate FEE REIMB INS with | |
172 | Reasonable Charges. | |
173 | R | |
174 | BN 1: New IB Rate Ty pe of | |
175 | FEE REIMB INS. | |
176 | 1.5 | |
177 | System wil l automati cally asso ciate all FEE REIMB INS Rate T ype bills with Disch arge Bedse ction of “ 30 NON-VA CARE”. | |
178 | R | |
179 | BN 1: New IB Rate Ty pe of | |
180 | FEE REIMB INS. | |
181 | 1.7 | |
182 | System wil l also all ow e-billi ng of clai ms, the sa me as for the Rate T ype of REI MBURSABLE INS. | |
183 | R | |
184 | BN 1: New IB Rate Ty pe of | |
185 | FEE REIMB INS. | |
186 | 1.8 | |
187 | System cap ability fo r IB Outpu t Clerk Pr oductivity option/re port to in clude FEE REIMB INS insurance Rate Type for both s ummary and detailed reports. | |
188 | R | |
189 | BN 1: New IB Rate Ty pe of | |
190 | FEE REIMB INS. | |
191 | 1.9 | |
192 | Incorporat e the FEE REIMB INS Rate Type into other IB Report s /Menus t hat curren tly contai n the Reim bursable I ns Rate Ty pe. | |
193 | R | |
194 | ||
195 | ||
196 | BN | |
197 | Owner Requ irement (O WNR) | |
198 | Number | |
199 | OWNR | |
200 | Ranking R= Required O =Optional | |
201 | BN 2: New AR Categor y of FEE R EIMB INS a nd new Rev enue Sourc e Codes in Financial Managemen t System ( FMS) Table s. | |
202 | 2.1 | |
203 | Associate FEE REIMB INS Rate T ype in IB with new C ategory Ty pe in AR w ith the sa me title. | |
204 | R | |
205 | BN 2: New AR Categor y of FEE R EIMB INS a nd new Rev enue Sourc e Codes in FMS Table s. | |
206 | 2.2 | |
207 | Associate FEE REIMB INS Catego ry in | |
208 | AR with ne w Fund (if approved) or | |
209 | 528704, if not appro ved. | |
210 | R | |
211 | BN 2: New AR Categor y of FEE R EIMB INS a nd new Rev enue Sourc e Codes in FMS Table s. | |
212 | 2.3 | |
213 | Associate FEE REIMB INS Catego ry in AR w ith new Re venue Sour ce Code(s) in AR and Tables in FMS (poss ibly 1 for IPT, | |
214 | 1 for OPT, TBD). | |
215 | R | |
216 | BN 3: Syst em capabil ity to gen erate repo rts in AR Package th at include New FEE R EIMB INS R ate Type. | |
217 | 3.1 | |
218 | Enhance AR Third Par ty Follow Up Summary Report (I BJD) to in clude a se parate cat egory for Non-VA Car e data (FE E REIMB IN S) AR Cate gory. | |
219 | R | |
220 | BN 3: Syst em capabil ity to gen erate repo rts in AR Package th at include New FEE R EIMB INS R ate Type. | |
221 | 3.2 | |
222 | Enhance AR Third Par ty Detaile d Follow- Up Report to include a separat e category for New F EE REIMB I NS AR Cate gory for N on-VA Care data. | |
223 | R | |
224 | BN 3: Syst em capabil ity to gen erate repo rts in AR Package th at include New FEE R EIMB INS R ate Type. | |
225 | 3.3 | |
226 | Enhance In surance Pa yment Tren d Report t o include new FEE RE IMB INS AR Category for Non-VA Care data . | |
227 | R | |
228 | ||
229 | ||
230 | BN | |
231 | Owner Requ irement (O WNR) | |
232 | Number | |
233 | OWNR | |
234 | Ranking R= Required O =Optional | |
235 | BN 3: Syst em capabil ity to gen erate repo rts in AR Package th at include New FEE R EIMB INS R ate Type. | |
236 | 3.4 | |
237 | Incorporat e the FEE REIMB INS Category i nto other AR Reports /Menus tha t | |
238 | currently contain th e Category of | |
239 | REIMBURS. HEALTH INS . Bills. | |
240 | R | |
241 | BN 4: Crea te new fun d of FEE R EIMB INS i n FMS tabl es. | |
242 | 4.1 | |
243 | Associate new fund w ith new FE E REIMB IN S category type in A R. | |
244 | R | |
245 | BN 4: Crea te new fun d of FEE R EIMB INS i n FMS tabl es. | |
246 | 4.2 | |
247 | Associate new fund w ith new Re venue | |
248 | Source Cod es in AR. | |
249 | R | |
250 | BN 4: Crea te new fun d of FEE R EIMB INS i n FMS tabl es. | |
251 | 4.3 | |
252 | Associate new fund w ith new Re venue | |
253 | Source Cod es in FMS. | |
254 | R | |
255 | ||
256 | 1.3.Refere nces | |
257 | ||
258 | The follow ing docume ntation/hy perlinks c ontain inf ormation r elated to this RSD: | |
259 | ||
260 | Third Par ty Billing Improveme nts for Fe e Care BRD , March 20 11 | |
261 | Please re fer to App endix A of the BRD f or additio nal refere nces relev ant to thi s enhancem ent | |
262 | ||
263 | 2. Overall Descripti on | |
264 | ||
265 | 2.1.Access ibility Sp ecificatio ns | |
266 | ||
267 | This proje ct will ad here to al l applicab le require ments of S ection 508 of the Re habilitati on Act of | |
268 | 1973, as a mended (29 U.S.C. 79 4d). A 508 complianc e review w ill be con ducted in accordance with Proj ect Manage ment Accou ntability System (PM AS) standa rds. | |
269 | ||
270 | 2.2.Busine ss Rules S pecificati on | |
271 | ||
272 | There are no specifi c new busi ness rules applicabl e to this enhancemen t. | |
273 | ||
274 | A high-lev el view of the curre nt (as-is) and futur e (to-be) billing in terface fo r fee care processes /workflows are avail able via T echnical S ervices Pr oject Repo sitory (TS PR) here: http:// DNS /warboard/ anotebk.as p?proj=178 3&Type=Act ive | |
275 | ||
276 | 2.3.Design Constrain ts Specifi cation | |
277 | VA Standa rds and Co nventions for Massac husetts Ge neral Hosp ital Utili ty Multi- Programmin g System ( MUMPS) dev elopment | |
278 | VA Techni cal Refere nce Model (TRM) | |
279 | ||
280 | 2.4.Disast er Recover y Specific ation | |
281 | ||
282 | There are no new or specific d isaster re covery spe cification s for this project. The disast er recover y specific ations per taining to any VistA system is applicabl e to this project. | |
283 | ||
284 | 2.5.Docume ntation Sp ecificatio ns | |
285 | ||
286 | System doc umentation to be del ivered wil l be in ac cordance w ith PMAS a nd ProPath System | |
287 | Developmen t Processe s. | |
288 | ||
289 | Documentat ion to be delivered includes b ut is not limited to : | |
290 | ||
291 | Installat ion Guide | |
292 | User Guid e | |
293 | Technical Manual | |
294 | Security Guide | |
295 | Contingen cy Plan | |
296 | Disaster Recovery P lan (DRP) | |
297 | Deploymen t Plan | |
298 | Release N otes | |
299 | ||
300 | 2.6.Functi onal Speci fications | |
301 | ||
302 | The scope of this re quest is t o enhance VistA soft ware appli cations, I B, AR, Fee care modu les, and r elated bus iness prac tices to i mprove and ensure ac curate bil ling, coll ections, d ata captur e, and rep orting for all appro ved Non-VA care clai ms for ser vices rend ered by No n-VA healt h care pro viders. Th ese enhanc ements wou ld allow V HA to impr ove curren t processe s with mor e efficien t and effe ctive prac tices, the reby impro ving the l evel of sa tisfaction of our Ve terans. | |
303 | ||
304 | Major obje ctives of this reque st include : | |
305 | ||
306 | Capture a ll inpatie nt and out patient th ird party billing an d collecti ons data f or claims submitted in the Non -VA care c ost recove ry effort. | |
307 | Accurate segregatio n of Non-V A care bil ling and c ollections from othe r third pa rty financ ial inform ation. | |
308 | Increased monitorin g, trendin g, and rep orting act ivities on Non-VA Ca re Third P arty insur ance bille d and coll ected clai ms. | |
309 | ||
310 | 2.6.1.Syst em Feature : New IB R ate Type o f FEE REIM B INS | |
311 | ||
312 | Fun ctional Re quirement: FRBILL-1. 1-1 | |
313 | ||
314 | The system shall hav e the capa bility for the optio n to selec t FEE REIM B INS Rate Type in | |
315 | VistA IB m enu for al l applicab le IB Rate Type opti ons. | |
316 | ||
317 | Fun ctional Re quirement: FRBILL-1. 1-2 | |
318 | ||
319 | The system shall all ow selecti on of FEE REIMB INS Type when billing fo r Inpatien t and | |
320 | Outpatient Non-VA Ca re Claims. | |
321 | ||
322 | Note: If t here is a Non-VA Fac ility, but rate type doesn’t s how Fee Re imburse - error will show; | |
323 | if there i s no Non-V A facility , but Fee Reimbursem ent is rat e type - e rror will show. | |
324 | ||
325 | Fun ctional Re quirement: FRBILL-1. 2 | |
326 | ||
327 | The system shall aut omatically assign th e FEE REIM B INS Rate Type when the PTF i ndicates | |
328 | NON-VA CAR E. | |
329 | ||
330 | Fun ctional Re quirement: FRBILL-1. 3 - 01 | |
331 | ||
332 | The system shall pro vide the c apability to associa te Non-VA Discharge Date to th e new IB r ate type. | |
333 | ||
334 | Fun ctional Re quirement: FRBILL-1. 3 - 02 | |
335 | ||
336 | The system shall pro vide the c apability to associa te Non-VA Facility t o the new IB rate ty pe. | |
337 | ||
338 | Fun ctional Re quirement: FRBILL-1. 3 - 03 | |
339 | ||
340 | The system shall pro vide the c apability to associa te Non-VA Care Type to the new IB rate t ype. | |
341 | ||
342 | Fun ctional Re quirement: FRBILL-1. 3 - 04 | |
343 | ||
344 | The system shall pro vide the c apability to associa te Non-VA Care Provi der ID# to the new I B | |
345 | rate type. | |
346 | ||
347 | Fun ctional Re quirement: FRBILL-1. 3 – 05 | |
348 | ||
349 | The system shall pro vide the c apability to associa te Non-VA Facility T axonomy to the new I B | |
350 | rate type | |
351 | ||
352 | Fun ctional Re quirement: FRBILL-1. 4 | |
353 | ||
354 | The system shall ass ociate FEE REIMB INS with Reas onable Cha rges. | |
355 | ||
356 | Funct ional Requ irement: F RBILL-1.5 | |
357 | ||
358 | The system shall aut omatically associate all FEE R EIMB INS R ate Type b ills with Discharge | |
359 | Bedsection of “30 NO N-VA CARE” . | |
360 | ||
361 | Funct ional Requ irement: F RBILL-1.7 | |
362 | ||
363 | The system shall all ow e-billi ng of clai ms, the sa me as for the Rate T ype of REI MBURSABLE INS. | |
364 | ||
365 | Funct ional Requ irement: F RBILL-1.8 | |
366 | ||
367 | The system shall pro vide the c apability for IB Out put Clerk Productivi ty option/ report to include | |
368 | FEE REIMB INS insura nce Rate T ype for bo th summary and detai led report s. | |
369 | ||
370 | Funct ional Requ irement: F RBILL-1.9 | |
371 | ||
372 | The system shall inc orporate t he FEE REI MB INS Rat e Type int o other IB Reports/M enus that currently contain th e Reimburs able INS R ate Type. | |
373 | ||
374 | 2.6.2.Syst em Feature : New AR C ategory of FEE REIMB INS and n ew Revenue Source Co des in FMS Tables. | |
375 | ||
376 | The system shall cre ate a new AR Categor y of FEE R EIMB INS a nd new Rev enue Sourc e | |
377 | Codes in F MS Tables. | |
378 | ||
379 | Fun ctional Re quirement: FRBILL-2. 1 | |
380 | ||
381 | The system shall ass ociate FEE REIMB INS Rate Type in IB wit h new Cate gory Type in AR | |
382 | with the s ame title. | |
383 | ||
384 | Fun ctional Re quirement: FRBILL-2. 2 | |
385 | ||
386 | The system shall ass ociate FEE REIMB INS Category in AR with new Fund (if approv ed) or | |
387 | 528704, if not appro ved. | |
388 | ||
389 | Fun ctional Re quirement: FRBILL-2. 3 | |
390 | ||
391 | The system shall ass ociate FEE REIMB INS Category in AR with new Reven ue Source Code(s) | |
392 | in AR and Tables in FMS. | |
393 | ||
394 | 2.6.3.Syst em Feature : System c apability to generat e reports in AR Pack age that i nclude New FEE REIMB INS Rate Type. | |
395 | ||
396 | The system shall pro vide the c apability to generat e reports in AR Pack age that i nclude New FEE REIMB INS Rate Type. | |
397 | ||
398 | Fun ctional Re quirement: FRBILL-3. 1 | |
399 | ||
400 | The system shall enh ance AR Th ird Party Follow up Summary Re port (IBJD ) to inclu de a separ ate catego ry for Non -VA Care d ata (FEE R EIMB INS) AR Categor y. | |
401 | ||
402 | Fun ctional Re quirement: FRBILL-3. 2 | |
403 | ||
404 | The system shall enh ance AR Th ird Party Detailed F ollow-Up R eport to i nclude a s eparate ca tegory for New FEE R EIMB INS A R Category for Non-V A Care dat a. | |
405 | ||
406 | Fun ctional Re quirement: FRBILL-3. 3 | |
407 | ||
408 | The system shall enh ance Insur ance Payme nt Trend R eport to i nclude new FEE REIMB INS AR Ca tegory for Non-VA Ca re data. | |
409 | ||
410 | Fun ctional Re quirement: FRBILL-3. 4 | |
411 | ||
412 | The system shall inc orporate t he FEE REI MB INS Cat egory into other AR Reports/Me nus that c urrently c ontain the Category of REIMBUR S. HEALTH INS. Bills . | |
413 | ||
414 | 2.6.4.Syst em Feature : Create n ew fund of FEE REIMB INS in FM S | |
415 | tables. | |
416 | ||
417 | The system shall cre ate a new fund of FE E REIMB IN S in FMS t ables. | |
418 | ||
419 | Fun ctional Re quirement: FRBILL- 4 .1 | |
420 | ||
421 | The system shall ass ociate the new fund with new F EE REIMB I NS categor y type in AR. | |
422 | ||
423 | Fun ctional Re quirement: FRBILL- 4 .2 | |
424 | ||
425 | The system shall ass ociate the new fund with new R evenue Sou rce Codes in AR. | |
426 | ||
427 | Fun ctional Re quirement: FRBILL- 4 .3 | |
428 | ||
429 | The system shall ass ociate the new fund with new R evenue Sou rce Codes in FMS. | |
430 | ||
431 | 2.7.Graphi cal User I nterface ( GUI) Speci fications | |
432 | ||
433 | This enhan cement doe s not invo lve a GUI. | |
434 | ||
435 | 2.8.Multi- divisional Specifica tions | |
436 | ||
437 | No new mul ti-divisio nal requir ements are being int roduced as part of t his enhanc ement. Thi s enhancem ent will u se existin g multi-di visional f unctionali ty and wil l continue to operat e in a mul ti-divisio n and/or m ulti-site environmen t. | |
438 | ||
439 | 2.9.Perfor mance Spec ifications | |
440 | ||
441 | No perform ance speci fications have been identified . | |
442 | ||
443 | It is impl ied that t his enhanc ement will not intro duce perfo rmance deg radation t o the exis ting syste m. | |
444 | ||
445 | 2.10. Qual ity Attrib utes Speci fication | |
446 | ||
447 | The softwa re associa ted with t his enhanc ement shal l be relea sed with z ero high o r medium i mpact defe cts. Test defect log s will be submitted after inte rnal Quali ty Assuran ce (QA) an d site tes ting for V A review. | |
448 | ||
449 | The MUMPS code devel oped for t his projec t will be compliant to all VA MUMPS Codi ng | |
450 | Standards and Conven tions. | |
451 | ||
452 | 2.11. Reli ability Sp ecificatio ns | |
453 | ||
454 | As specifi ed in the BRD, syste m availabi lity shoul d be 24 ho urs per da y, 365 day s per year except du ring perio ds of sche duled main tenance. | |
455 | ||
456 | 2.12. Scop e Integrat ion | |
457 | ||
458 | This enhan cement wil l be limit ed to chan ges to the VistA IB, AR, Fee B asis appli cations, a nd making a new fund available to the FM S. | |
459 | ||
460 | 2.13. Secu rity Speci fications | |
461 | ||
462 | There are no explici t security specifica tions for this enhan cement. | |
463 | ||
464 | All VA and VHA secur ity requir ements wil l be adher ed to. Cro ss-cutting security requiremen ts are con tained in the VA Ent erprise Re quirements Repositor y (ERR). E fforts tha t involve the collec tion and m aintenance of indivi dually ide ntifiable informatio n must be covered by a Privacy Act syste m of recor ds notice. | |
465 | ||
466 | 2.14. Syst em Feature s | |
467 | ||
468 | This enhan cement mod ifies an e xisting Vi stA applic ation. | |
469 | ||
470 | The System Features introduced by this p roject are detailed in Section 2.6. | |
471 | ||
472 | 2.15. Usab ility Spec ifications | |
473 | ||
474 | The existi ng Fee Bas is interfa ce will be used for this enhan cement, in cluding ex isting usa bility spe cification s. The use r interfac e features of the ex isting Vis tA Fee Bas is Applica tion will not be mod ified, and therefore no perfor mance degr adation wi ll be intr oduced. | |
475 | ||
476 | Additional functiona lity will be describ ed from a user stand point in t he user gu ide. Train ing needed to begin using the new functi onality is expected to be mini mal. | |
477 | ||
478 | 3. Applica ble Standa rds | |
479 | ||
480 | Configurat ion Manage ment (CM) processes provide th e release and contro l of the s ystem, har dware, and software to which t his docume nt applies , includin g identifi cation num ber(s), ti tle(s), ab breviation (s), versi on number( s), and re lease numb er(s). | |
481 | ||
482 | Listed bel ow are VA reference and guidan ce documen tation and standards applicabl e to or ta ilored for the CPAC EDI Projec t. This gu idance is used to fu lfill the performanc e requirem ents of th is contrac t. | |
483 | ||
484 | 44 U.S.C. § 3541, “ Federal In formation Security M anagement Act (FISMA ) of 2002” | |
485 | Federal I nformation Processin g Standard s (FIPS) P ublication 140-2, “S ecurity | |
486 | Requiremen ts For Cry ptographic Modules” | |
487 | Software Engineerin g Institut e, Softwar e Acquisit ion-Capabi lity Matur ity Modeli ng (SA- CM M) Level 3 procedure s and proc esses | |
488 | VA Direct ive 6102, “Internet/ Intranet S ervices,” July 15, 2 008 | |
489 | 36 C.F.R. Part 1194 “Electron ic and Inf ormation T echnology (IT) Acces sibility | |
490 | Standards, ” July 1, 2003 | |
491 | ||
492 | Office of Managemen t and Budg et (OMB) C ircular A- 130, “Mana gement of Federal | |
493 | Informatio n Resource s,” Novemb er 28, 200 0 | |
494 | 32 C.F.R. Part 199, “Civilian Health an d Medical Program of the Unifo rmed Servi ces | |
495 | (CHAMPUS)” | |
496 | An Introd uctory Res ource Guid e for Impl ementing t he Health Insurance Portabilit y and | |
497 | Accountabi lity Act ( HIPAA) Sec urity Rule , March 20 05 | |
498 | Sections 504 and 50 8 of the R ehabilitat ion Act (2 9 U.S.C. § 794d), as amended b y the | |
499 | Workforce Investment Act of 19 98 (P.L. 1 05-220), A ugust 7, 1 998 | |
500 | Homeland Security P residentia l Directiv e (12) (HS PD-12) | |
501 | VA Direct ive 6500, “Informati on Securit y Program, ” August 4 , 2006 | |
502 | VA Handbo ok 6500, “ Informatio n Security Program,” September 18, 2007 | |
503 | VA Handbo ok, 6500.5 , Incorpor ating Secu rity and P rivacy in System Dev elopment | |
504 | Lifecycle. | |
505 | VA Handbo ok 6500.6, “Contract Security, ” March 12 , 2010 | |
506 | PMAS port al (refere nce Perfor mance Work Statement [PWS] Ref erences) – Technical | |
507 | Library | |
508 | Office of Enterpris e Developm ent (OED) ProPath Pr ocess Meth odology (r eference P WS Referen ces) –Tech nical Libr ary and Pr oPath Libr ary. Note: In the ev ent of a c onflict, O ED ProPath takes pre cedence ov er other p rocesses o r methodol ogies. | |
509 | TRM | |
510 | National Institute Standards and Techno logy (NIST ) Special Publicatio ns (SP) 80 0-60 and 8 00-53 | |
511 | IT Asset Management (ITAM) an d Enterpri se Managem ent Founda tion (EMF) BR-0006, version 00 2.1-140520 08, dated 10/30/2007 [Note inf ormational , Context, and ITAM- EMF Conce ptual link ] | |
512 | HIPAA of 1996; Pub. L 104-191. | |
513 | VA Sectio n 508 poli cies and p rocedures 6221 Acces sible Elec tronic and IT, Direc tive/Handb ook, publi shed by VA ’s Section 508 Produ ct Develop ment Produ ct Assessm ent Compet ency Divis ion | |
514 | VA M Prog ramming St andards an d Conventi ons. Revis ed 04/03/2 007 | |
515 | VA Sectio n 508 poli cies and p rocedures 6221 Acces sible Elec tronic and IT, Direc tive/Handb ook, publi shed by VA ’s Section 508 Produ ct Develop ment Produ ct Assessm ent Compet ency Divis ion (refer ence at ht tp:/ DNS .asp?Pub_I D=435&FTyp e=2) | |
516 | ||
517 | 4. Interfa ces | |
518 | ||
519 | 4.1.Commun ications I nterfaces | |
520 | ||
521 | No new com munication s interfac es are req uired for this enhan cement. | |
522 | ||
523 | 4.2.Hardwa re Interfa ces | |
524 | ||
525 | No new har dware inte rfaces are required for this e nhancement . | |
526 | ||
527 | 4.3.Softwa re Interfa ces | |
528 | ||
529 | No new sof tware inte rfaces are required for this e nhancement . | |
530 | ||
531 | 4.4.User I nterfaces | |
532 | ||
533 | This enhan cement wil l use the existing V istA IB, A R, and Fee Basis use r interfac e. No modi fications are specif ied for th ese user i nterfaces. | |
534 | ||
535 | 5. Legal, Copyright, and Other Notices | |
536 | ||
537 | This effor t is spons ored by an agency of the Unite d States G overnment. Neither t he United States Gov ernment no r any agen cy thereof , nor any of its sub contractor s, nor any of their employees, makes any warranty, express o r implied, or assume s any lega l liabilit y or respo nsibility for the ac curacy, co mpleteness , or usefu lness of a ny informa tion, appa ratus, pro duct, or p rocess dis closed, or represent s that its use would not infri nge on pri vately own ed rights. Reference | |
538 | herein to any specif ic commerc ial produc t, process , or servi ce by trad e name, tr ademark, m anufacture r, or othe rwise does not neces sarily con stitute or imply its endorseme nt, recomm endation, or favorin g by the U nited Stat es Governm ent or any agency th ereof, or any of its subcontra ctors. The views and opinions of authors expressed herein do not neces sarily sta te or refl ect those of the Uni ted States Governmen t or any a gency ther eof. | |
539 | ||
540 | 6. Purchas ed Compone nts | |
541 | ||
542 | Not applic able. | |
543 | ||
544 | 6.1.Defect Source (T OP 5) | |
545 | ||
546 | Not applic able. | |
547 | ||
548 | 7. User Cl ass Charac teristics | |
549 | ||
550 | The modifi cations id entified i n this enh ancement a re primari ly used by VHA Fee B asis Admin istration Staff, IB Staff, AR Staff and secondary users; Vet erans Inte grated Ser vice Netwo rk (VISN) Staff, and CBO Staff . | |
551 | ||
552 | 8. Estimat ion | |
553 | ||
554 | TBD. | |
555 | ||
556 | Project So ftware Fun ctional Si ze and Siz e-Based | |
557 | Effort and Duration Estimate | |
558 | ||
559 | ||
560 | Applicatio n | |
561 | ||
562 | Item | |
563 | A | |
564 | B | |
565 | C | |
566 | D | |
567 | E | |
568 | Total | |
569 | Counted Fu nction | |
570 | Points | |
571 | ||
572 | ||
573 | ||
574 | ||
575 | ||
576 | TBD | |
577 | Estimated Scope | |
578 | Growth | |
579 | ||
580 | ||
581 | ||
582 | ||
583 | ||
584 | TBD | |
585 | Estimated Size at | |
586 | Release | |
587 | ||
588 | ||
589 | ||
590 | ||
591 | ||
592 | TBD | |
593 | ||
594 | Size-Based Effort Es timates | |
595 | Labor Hour s | |
596 | Probabilit y | |
597 | Low-Effort Estimate – With ind icated pro bability, project wi ll consume no more t han: | |
598 | TBD | |
599 | ||
600 | High-Effor t Estimate – With in dicated pr obability, project w ill consum e no more than: | |
601 | TBD | |
602 | ||
603 | ||
604 | Size-Based Duration Estimates | |
605 | Work Days | |
606 | Probabilit y | |
607 | Low-Durati on Estimat e – With i ndicated p robability , project will consu me no more than: | |
608 | TBD | |
609 | ||
610 | High-Durat ion Estima te – With indicated probabilit y, project will cons ume no mor e than: | |
611 | TBD | |
612 | ||
613 | ||
614 | ||
615 | ||
616 | ||
617 | ||
618 | ||
619 | TBD | |
620 | Figure 1: Cumulative Probabili ty (“S-cur ve”) Chart | |
621 | ||
622 | Attachment A – Appro val Signat ures | |
623 | ||
624 | ||
625 | ||
626 | ||
627 | ||
628 | ||
629 | Signed:Dat e: | |
630 | ||
631 | Greg Estes | |
632 | Business S ponsor | |
633 | ||
634 | ||
635 | ||
636 | ||
637 | ||
638 | ||
639 | Signed:Dat e: | |
640 | ||
641 | Charles Du nn | |
642 | CPAC Progr am Manager , Integrat ed Project Team (IPT ) Co-Chair | |
643 | ||
644 | ||
645 | ||
646 | ||
647 | ||
648 | ||
649 | Signed:Dat e: | |
650 | ||
651 | Ann Kliegl | |
652 | CPAC Proje ct Manager , IPT Co-C hair | |
653 | ||
654 | Attachment B – Acron ym List | |
655 | ||
656 | Table 3: A cronym Lis t | |
657 | ||
658 | Term | |
659 | Meaning | |
660 | AR | |
661 | Accounts R eceivable | |
662 | BN | |
663 | Business N eed | |
664 | BRD | |
665 | Business R equirement s Document | |
666 | CBO | |
667 | Chief Busi ness Offic e | |
668 | CCD | |
669 | Continuity of Care D ocument | |
670 | CHAMPUS | |
671 | Civilian H ealth and Medical Pr ogram of t he Uniform ed Service s | |
672 | CM | |
673 | Configurat ion Manage ment | |
674 | CPAC | |
675 | Consolidat ed Patient Account C enter | |
676 | DRP | |
677 | Disaster R ecovery Pl an | |
678 | EDES | |
679 | Emergency Department Encounter Summary | |
680 | EDI | |
681 | Electronic Data Inte rchange | |
682 | EMF | |
683 | Enterprise Managemen t Foundati on | |
684 | ERR | |
685 | Enterprise Requireme nts Reposi tory | |
686 | FEE REIMB INS | |
687 | Fee Reimbu rsement In surance | |
688 | FIPS | |
689 | Federal In formation Processing Standards | |
690 | FISMA | |
691 | Federal In formation Security M anagement Act | |
692 | FMS | |
693 | Financial Management System | |
694 | GUI | |
695 | Graphical User Inter face | |
696 | HIPAA | |
697 | Health Ins urance Por tability a nd Account ability Ac t | |
698 | HITSP | |
699 | Health IT Standards Panel | |
700 | HL7 | |
701 | Health Lev el Seven | |
702 | HSPD-12 | |
703 | Homeland S ecurity Pr esidential Directive (12) | |
704 | IB | |
705 | Integrated Billing | |
706 | IHE | |
707 | Integratin g the Heal thcare Ent erprise | |
708 | IPT | |
709 | Integrated Project T eam | |
710 | IT | |
711 | Informatio n Technolo gy | |
712 | ITAM | |
713 | IT Asset M anagement | |
714 | MCCF | |
715 | Medical Ca re Collect ions Fund | |
716 | MUMPS | |
717 | Massachuse tts Genera l Hospital Utility M ulti-Progr amming Sys tem | |
718 | ||
719 | ||
720 | Term | |
721 | Meaning | |
722 | NIST | |
723 | National I nstitute S tandards a nd Technol ogy | |
724 | OED | |
725 | Office of Enterprise Developme nt | |
726 | OI&T | |
727 | Office of Informatio n and Tech nology | |
728 | OMB | |
729 | Office of Management and Budge t | |
730 | OWNR | |
731 | Owner Requ irement | |
732 | PMAS | |
733 | Project Ma nagement A ccountabil ity System | |
734 | PTF | |
735 | Patient Tr eatment Fi le | |
736 | PWS | |
737 | Performanc e Work Sta tement | |
738 | QA | |
739 | Quality As surance | |
740 | RMR | |
741 | Requiremen ts Managem ent Reposi tory | |
742 | RSD | |
743 | Requiremen ts Specifi cation Doc ument | |
744 | RSM | |
745 | Revenue Sy stems Mana gement | |
746 | SA-CMM | |
747 | Software A cquisition -Capabilit y Maturity Modeling | |
748 | SDS | |
749 | Standard D ata Servic es | |
750 | SP | |
751 | Special Pu blications | |
752 | TRM | |
753 | Technical Reference Model | |
754 | TSPR | |
755 | Technical Services P roject Rep ository | |
756 | VA | |
757 | Department of Vetera ns Affairs | |
758 | VETS | |
759 | VA Enterpr ise Termin ology Serv ices | |
760 | VHA | |
761 | Veterans H ealth Admi nistration | |
762 | VISN | |
763 | Veterans I ntegrated Service Ne twork | |
764 | VistA | |
765 | Veterans H ealth Info rmation Sy stems and Technology Architect ure | |
766 | ||
767 | Attachment C – Enter prise Requ irements | |
768 | ||
769 | Below is a subset of Enterpris e-level Re quirements that are of particu lar intere st to the business c ommunity. These requ irements M UST be add ressed wit hin each p roject res ulting fro m this wor k effort. If Office of Informa tion and T echnology (OI&T) can not addres s these En terprise- level requ irements, the Busine ss Owners responsibl e for each area MUST be engage d in any w aiver disc ussions pr ior to any decisions being mad e. This se ction is n ot meant t o be a com prehensive list of a ll Enterpr ise-level requiremen ts that ma y apply to this work effort an d should n ot preclud e the tech nical comm unity from reviewing all Enter prise-leve l requirem ents, and identifyin g others t hat should apply to this work effort as well. | |
770 | ||
771 | Enterprise -level req uirements are contai ned in the VA Requir ements Man agement Re pository ( RMR). Cont act the RM R Team to gain acces s to the R MR and to obtain the comprehen sive alloc ation of E nterprise- level requ irements f or the pro ject devel opment ite ration at PI I
|
|
772 | ||
773 | Table 4: E nterprise Requiremen ts | |
774 | ||
775 | ReqPro | |
776 | Tag | |
777 | Requiremen t | |
778 | Type | |
779 | Descriptio n | |
780 | ENTR99 | |
781 | Security | |
782 | All VA sec urity requ irements w ill be adh ered to. B ased on FI PS 199 and NIST SP 8 00-60, rec ommended S ecurity Ca tegorizati on is High . | |
783 | ||
784 | ||
785 | The Securi ty Categor ization wi ll drive t he initial set of mi nimal secu rity contr ols requir ed for the informati on system. Minimum s ecurity co ntrol requ irements a re address ed in NIST SP 800-53 and VA Ha ndbook 650 0, Appendi x D. | |
786 | ENTR10 | |
787 | Privacy | |
788 | All VA Pri vacy requi rements wi ll be adhe red to. Ef forts that involve t he collect ion and ma intenance of individ ually iden tifiable i nformation must be c overed by a Privacy Act system of record s notice. | |
789 | ENTR95 | |
790 | 508 Compli ance | |
791 | All Sectio n 508 requ irements w ill be adh ered to. C ompliance with Secti on 508 wil l be deter mined by f ully meeti ng the app licable re quirements as set fo rth in the VHA Secti on 508 che cklists (1 194.21, 11 94.22, 119 4.24, | |
792 | 1194.31 an d 1194.41) located a t: | |
793 | http:/ DNS /508/resou rces_508.h tml or as otherwise specified. Checkpoin ts will be establish ed to ensu re that ac cessibilit y is incor porated fr om the ear liest poss ible desig n or acqui sition pha se and suc cessfully implemente d througho ut the pro ject. | |
794 | ENTR7 | |
795 | Executive Order | |
796 | All execut ive order requiremen ts will be adhered t o. | |
797 | ||
798 | ||
799 | ReqPro | |
800 | Tag | |
801 | Requiremen t | |
802 | Type | |
803 | Descriptio n | |
804 | ENTR8 | |
805 | Identity | |
806 | Management | |
807 | All Enterp rise Ident ity Manage ment requi rements wi ll be adhe red to. Th ese requir ements are applicabl e to any a pplication that adds , updates, or perfor ms lookups on person s. | |
808 | ENTR103 | |
809 | Terminolog y | |
810 | Services | |
811 | Applicatio n/services shall ref erence the Standard Data Servi ces (SDS) as the aut horitative source to access no n- clinica l referenc e terminol ogy. | |
812 | ENTR104 | |
813 | Terminolog y | |
814 | Services | |
815 | Applicatio n/Services shall use the VA En terprise T erminology Services (VETS) as the author itative so urce to ac cess clini cal refere nce termin ology. | |
816 | ENTR105 | |
817 | Terminolog y | |
818 | Services | |
819 | Applicatio ns recordi ng the ass essments a nd care de livered in response to an Emer gency Depa rtment vis it shall c onform to standards defined by the VHA-e ndorsed ve rsion of C 28 – Heal th IT Stan dards Pane l (HITSP) Emergency Care Summa ry Documen t Using In tegrating the Health care Enter prise (IHE ) Emergenc y Departme nt Encount er Summary (EDES) Co mponent. | |
820 | ENTR106 | |
821 | Terminolog y | |
822 | Services | |
823 | Applicatio ns exchang ing data s ummarizing a patient ’s medical status sh all confor m to stand ards defin ed by the VHA-endors ed version of C 32 – HITSP Sum mary Docum ents Using Health Le vel Seven (HL7) Cont inuity of Care Docum ent (CCD) Component. |
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