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1 | CPAC.zip\Fee-Revenue Service Connected Condition Decision | 20-001 Serv-ConnectDecision_SDD_v1.00.docx | Tue Feb 7 21:04:26 2017 UTC |
2 | CPAC.zip\Fee-Revenue Service Connected Condition Decision | 20-001 Serv-ConnectDecision_SDD_v1.00.docx | Fri Feb 10 20:50:00 2017 UTC |
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1 | Department of Vetera ns Affairs | |
2 | ||
3 | Fee-Revenu e Service Connected Condition Decision S ystem Desi gn Documen t | |
4 | ||
5 | ||
6 | ||
7 | FB*3.5*163 | |
8 | January 20 17 | |
9 | Version 1. 00 | |
10 | ||
11 | Revision H istory | |
12 | Date | |
13 | Version | |
14 | Descriptio n | |
15 | Author | |
16 | Reviewers | |
17 | Issue Date | |
18 | Formal Rev iew | |
19 | 01/03/2017 | |
20 | 1.00 | |
21 | Formatting changes, per PMO | |
22 | P. Wild | |
23 | K. Marr | |
24 | 01/04/2017 | |
25 | ||
26 | 12/21/2016 | |
27 | 0.11 | |
28 | Formatting changes, per PMO | |
29 | P.Wild | |
30 | K. Marr | |
31 | 12/22/2016 | |
32 | ||
33 | 08/25/2016 | |
34 | 0.10 | |
35 | Per AERB, added stat ement rega rding SFTP | |
36 | P. Wild | |
37 | ||
38 | ||
39 | ||
40 | 03/08/2016 | |
41 | 0.09 | |
42 | Modified t ool versio n numbers, per AERB | |
43 | P.Wild | |
44 | ||
45 | ||
46 | ||
47 | 02/01/2016 | |
48 | 0.08 | |
49 | Updates re flecting V A Comments | |
50 | B. Armstro ng | |
51 | S. Blair | |
52 | 02/11/2016 | |
53 | ||
54 | 12/21/2015 | |
55 | 0.07 | |
56 | Updates re flecting V A Comments | |
57 | B. Armstro ng | |
58 | S. Blair | |
59 | 12/29/2015 | |
60 | ||
61 | 12/08/2015 | |
62 | 0.06 | |
63 | Peer Revie w | |
64 | Added patc h #, descr iptive tex t to 5.1 – 5.3, 6.1. 6.2 | |
65 | P. Wild | |
66 | S. Blair | |
67 | 12/10/2015 | |
68 | ||
69 | 10/14/2015 | |
70 | 0.05 | |
71 | Added rout ine sectio n | |
72 | B. Armstro ng | |
73 | S. Blair | |
74 | ||
75 | ||
76 | 09/01/2015 | |
77 | 0.04 | |
78 | Updates re flecting V A Comments | |
79 | G. Howard | |
80 | B. Armstro ng | |
81 | S. Ambrose | |
82 | 09/03/2015 | |
83 | ||
84 | 08/14/2015 | |
85 | 0.03 | |
86 | Updates pe r Formal R eview | |
87 | G. Howard | |
88 | J. Treat | |
89 | S. Ambrose | |
90 | 08/14/2015 | |
91 | 08/24/2015 | |
92 | 07/24/2015 | |
93 | 0.02 | |
94 | Initial Dr aft | |
95 | M. Tsai | |
96 | G. Howard | |
97 | S. Ambrose | |
98 | 07/24/2015 | |
99 | 08/11/2015 | |
100 | 07/07/2015 | |
101 | 0.01 | |
102 | Sections 1 -4 for AER B Review R equest | |
103 | CPAC PMOSS | |
104 | ||
105 | ||
106 | ||
107 | ||
108 | Activity | |
109 | New Capabi lity (1) | |
110 | Feature En hancement (2) | |
111 | Field Depl oyment (A) | |
112 | Yes | |
113 | Yes | |
114 | Cloud/Web Deployment (B) | |
115 | No | |
116 | No | |
117 | Mobile App lication ( C) | |
118 | No | |
119 | No | |
120 | ||
121 | Table of C ontents | |
122 | 1.Introduc tion7 | |
123 | 1.1.Scope7 | |
124 | 1.2.User P rofiles7 | |
125 | 2.Backgrou nd8 | |
126 | 2.1.Overvi ew of the System8 | |
127 | 2.2.Overvi ew of the Business P rocess8 | |
128 | 2.3.Overvi ew of the Significan t Requirem ents9 | |
129 | 2.4.Overvi ew of Func tional Req uirements9 | |
130 | 2.4.1.Over view of Fu nctional W orkload/Pe rformance Requiremen ts10 | |
131 | 2.4.2.Over view of Op erational Requiremen ts10 | |
132 | 2.4.3.Over view of Te chnical Re quirements 10 | |
133 | 2.4.4.Over view of Se curity or Privacy Re quirements 10 | |
134 | 2.4.5.Over view of Sy stem Criti cality and High Avai lability R equirement s10 | |
135 | 2.4.6.Sing le Sign-on Requireme nts10 | |
136 | 2.4.7.Requ irement fo r Use of E nterprise Portals10 | |
137 | 2.4.8.Spec ial Device Requireme nts10 | |
138 | 3.Conceptu al Design1 0 | |
139 | 3.1.Concep tual Appli cation Des ign10 | |
140 | 3.1.1.Appl ication Co ntext10 | |
141 | 3.1.2.High -Level App lication D esign11 | |
142 | 3.1.3.Appl ication Lo cations14 | |
143 | 3.2.Concep tual Data Design14 | |
144 | 3.2.1.Proj ect Concep tual Data Model14 | |
145 | 3.2.2.Data base Infor mation14 | |
146 | 3.2.3.User Interface Data Mapp ing15 | |
147 | 3.3.Concep tual Infra structure Design15 | |
148 | 3.3.1.Syst em Critica lity and H igh Availa bility15 | |
149 | 3.3.2.Spec ial Techno logy16 | |
150 | 3.3.3.Tech nology Loc ations16 | |
151 | 3.3.4.Conc eptual Inf rastructur e Diagram1 6 | |
152 | 3.3.4.1.Lo cation of Environmen ts and Ext ernal Inte rfaces16 | |
153 | 3.3.4.2.Co nceptual P roduction String Dia gram16 | |
154 | 4.System A rchitectur e16 | |
155 | 4.1.Hardwa re Archite cture16 | |
156 | 4.2.Softwa re Archite cture16 | |
157 | 4.3.Networ k Architec ture18 | |
158 | 4.4.SOA/ES S19 | |
159 | 4.5.Enterp rise Archi tecture19 | |
160 | 5.Data Des ign19 | |
161 | 5.1.Databa se Managem ent System (DBMS) Fi les19 | |
162 | 5.2.Non-DB MS Files19 | |
163 | 5.3.Data V iew19 | |
164 | 6.Detailed Design20 | |
165 | 6.1.Hardwa re Detaile d Design20 | |
166 | 6.2.Softwa re Detaile d Design20 | |
167 | 6.2.1.Conc eptual Des ign20 | |
168 | 6.2.1.1.Pr oduct Pers pective20 | |
169 | 6.2.1.1.1. User Inter faces20 | |
170 | 6.2.1.1.2. Hardware I nterfaces2 0 | |
171 | 6.2.1.1.3. Software I nterfaces2 0 | |
172 | 6.2.1.1.4. Communicat ions Inter faces21 | |
173 | 6.2.1.1.5. Memory Con straints21 | |
174 | 6.2.1.1.6. Special Op erations21 | |
175 | 6.2.1.2.Pr oduct Feat ures21 | |
176 | 6.2.1.3.Us er Charact eristics21 | |
177 | 6.2.1.4.De pendencies and Const raints21 | |
178 | 6.2.2.Spec ific Requi rements21 | |
179 | 6.2.2.1.Da tabase Rep ository21 | |
180 | 6.2.2.2.Sy stem Featu res21 | |
181 | 6.2.2.3.De sign Eleme nt Tables2 1 | |
182 | 6.2.2.3.1. Routines ( Entry Poin ts)21 | |
183 | 6.2.2.3.1. 1.Fee-Reve nue SC Con dition Dec ision21 | |
184 | 6.2.2.3.2. Templates2 6 | |
185 | 6.2.2.3.3. Data Entri es Affecte d by the D esign26 | |
186 | 6.2.2.3.4. Unique Rec ord(s)26 | |
187 | 6.2.2.3.5. File or Gl obal Size Changes26 | |
188 | 6.2.2.3.6. Mail Group s26 | |
189 | 6.2.2.3.7. Security K eys26 | |
190 | 6.2.2.3.8. Options26 | |
191 | 6.2.2.3.9. Protocols2 7 | |
192 | 6.2.2.3.10 .RPC27 | |
193 | 6.2.2.3.11 .Constants Defined i n Interfac e27 | |
194 | 6.2.2.3.12 .Variables Defined i n Interfac e27 | |
195 | 6.2.2.3.13 .Types Def ined in In terface27 | |
196 | 6.2.2.3.14 .GUI27 | |
197 | 6.2.2.3.15 .GUI Class es27 | |
198 | 6.2.2.3.16 .Current F orm27 | |
199 | 6.2.2.3.17 .Modified Form27 | |
200 | 6.2.2.3.18 .Component s on Form2 7 | |
201 | 6.2.2.3.19 .Events27 | |
202 | 6.2.2.3.20 .Methods27 | |
203 | 6.2.2.3.21 .Special R eferences2 7 | |
204 | 6.2.2.3.22 .Class Eve nts27 | |
205 | 6.2.2.3.23 .Class Met hods27 | |
206 | 6.2.2.3.24 .Class Pro perties27 | |
207 | 6.2.2.3.25 .Uses Clau se28 | |
208 | 6.2.2.3.26 .Forms28 | |
209 | 6.2.2.3.27 .Functions 28 | |
210 | 6.2.2.3.28 .Dialog28 | |
211 | 6.2.2.3.29 .Help Fram e28 | |
212 | 6.2.2.3.30 .HL7 Appli cation Par ameter28 | |
213 | 6.2.2.3.31 .HL7 Logic al Link28 | |
214 | 6.2.2.3.32 .Commercia l Off-the- Shelf (COT S) Interfa ce28 | |
215 | 6.3.Networ k Detailed Design28 | |
216 | 6.4.Securi ty and Pri vacy28 | |
217 | 6.4.1.Secu rity28 | |
218 | 6.4.2.Priv acy28 | |
219 | 6.5.SOA/ES S Detailed Design28 | |
220 | 7.External System In terface De sign28 | |
221 | 8.Human-Ma chine Inte rface29 | |
222 | Attachment A – Appro val Signat ures30 | |
223 | Attachment B – Acron ym List31 | |
224 | Attachment C – Addit ional Info rmation33 | |
225 | A.1 Identi fication o f Technolo gy and Sta ndards33 | |
226 | A.2 Constr aining Pol icies, Dir ectives an d Procedur es33 | |
227 | A.3 RTM33 | |
228 | A.4 Packag ing and In stallation 33 | |
229 | A.5 Design Metrics33 | |
230 | Attachment D – Chang e Log34 | |
231 | ||
232 | ||
233 | List of Ta bles | |
234 | Table 1: S cope Inclu sions7 | |
235 | Table 2: P rimary and Secondary Users7 | |
236 | Table 3: F unctional Requiremen ts9 | |
237 | Table 4 Da tabase Inf ormation15 | |
238 | Table 5 : Grouping: Routines21 | |
239 | Table 6: A cronym Lis t31 | |
240 | ||
241 | List of Fi gures | |
242 | Figure 1: Fee Claim SC Determi nation App lication C ontext Dia gram11 | |
243 | Figure 2: Overview o f EDI X12 Messaging1 2 | |
244 | Figure 3: Overview o f Claims P rocessing and Eligib ility (CP& E) System and Interf aces13 | |
245 | Figure 4: Data Model 14 | |
246 | Figure 5 N etwork Arc hitecture1 8 | |
247 | Figure 6 E nterprise Architectu re19 | |
248 | ||
249 | ||
250 | ||
251 | Introducti on | |
252 | The propos ed enhance ment seeks modificat ions to th e Fee Basi s (FB) app lication’s Potential Cost Reco very Repor t (PCRR) t o ensure t hat all No n-VA Care billed lin e item cha rges are i ncluded, r egardless of respons es entered in the FB software by Fee Cle rks. The D epartment of Veteran s Affairs (VA) may o nly recoup the cost of paid Se rvices. By removing the report filtering that pert ains to th e Service Connected (SC) Condi tion and P otential C ost Recove ry data va lues, line item char ges previo usly exclu ded based on respons es to POTE NTIAL COST RECOVERY and SC CON DITION pro mpts in FB all Non-V A care bil led line i tem charge s will app ear on the PCRR, ena bling the Revenue St aff to opt imize cost recovery. | |
253 | Scope | |
254 | This secti on describ es the pro ject scope which inc ludes chan ges to the VistA FB applicatio n. The sco pe of this enhanceme nt is to a ddress req uirements described in the Req uirements Specificat ion Docume nt (RSD) a s elaborat ed from th e Business Requireme nts Docume nt (BRD); both are a vailable v ia Technic al Service s Project Repository (TSPR) he re: http:/ / DNS /warboard/ anotebk.as p?proj=178 7&Type=Act ive | |
255 | Table 1: S cope Inclu sions | |
256 | Includes | |
257 | Include bi lled line item charg es for Non -VA Care o n the PCRR | |
258 | Logic will be remove d from the existing PCRR that selects re port data based on P otential C ost Recove ry and/or SC Conditi on Yes/No responses in FB. | |
259 | There are no exclusi ons to rep ort. | |
260 | User Profi les | |
261 | User profi les are th e same as those for Integrated Billing ( IB) and FB ; addition al specifi cs for thi s project are elabor ated in Ta ble 2: | |
262 | Table 2: P rimary and Secondary Users | |
263 | Name | |
264 | Descriptio n | |
265 | Responsibi lities | |
266 | Primary Us ers | |
267 | VA Medical Center (V AMC) FB an d Revenue/ Medical C are Cost R ecovery (M CCR)) staf f | |
268 | Process au thorizatio ns and cla ims for Ve terans for Non-VA he althcare s ervices | |
269 | Secondary Users | |
270 | Chief Busi ness Offic e (CBO) Na tional Fee Program O ffice (NFP O) and Pur chased Car e (PC) Pro gram Offic e Staff; V eterans In tegrated S ervice Net work (VISN ) Staff, V A Central Office (VA CO) CBO St aff | |
271 | Monitor, t rack, tren d, analyze and repor t data on Non-VA car e | |
272 | Background | |
273 | Overview o f the Syst em | |
274 | The CBO PC Program O ffice is r equesting enhancemen ts to Vete rans Healt h Informat ion System s and Tech nology Arc hitecture (VistA) FB applicati on to alig n system f unction wi th revenue optimizat ion busine ss policie s. Current ly, respon ses provid ed by FB c lerks to c ertain FB prompts ca n affect t he ability of Revenu e staff to know whet her certai n claims a re cost re coverable. The reque sted enhan cements wi ll improve the abili ty of Reve nue staff to optimiz e revenue. | |
275 | Overview o f the Busi ness Proce ss | |
276 | Current Pr ogram Offi ce policy requires a ll invoice s submitte d for serv ices provi ded by Non -VA health care provi ders to be reviewed by VA Reve nue Staff to determi ne if ther e is a pot ential for cost reco very throu gh the VAM C’s MCCR P rogram. If a Veteran is treate d for a no n-SC injur y/illness by a Non-V A healthca re provide r, VA is a ble to bil l a Vetera n’s third party insu rer for co sts associ ated with those serv ices. Inco nsistencie s have bee n identifi ed in the current pr ocesses wh ich have a llowed cos t recovera ble claims to be mis sed and no t evaluate d by Reven ue Staff f or collect ion on com pensable s ervices. I t has been determine d that the root caus e of this problem re sides on t he Fee sid e of the c laims proc ess. Fee c lerks are required t o respond when promp ted, as to whether o r not a bi lled line item charg e is relat ed to a Ve teran’s SC injury/il lness or i s cost rec overable. PC Program Office St aff have i dentified business p ractices i n the Non- VA healthc are provid er claims process th at could b e inhibiti ng revenue optimizat ion. They include: | |
277 | Fee clerks are not d irected by policy or trained t o make app ropriate d ecisions a s to wheth er or not a billed l ine-item c harge is r elated to a Veteran’ s SC injur y/illness. | |
278 | If Fee cle rks indica te that a billed lin e item cha rge is for a conditi on related to a Vete ran’s SC i llness/inj ury, that charge is categorize d as non-c ost recove rable. Rev enue staff would not be provid ed an oppo rtunity to review th is line it em charge/ claim as i t will be excluded f rom the PC RR. This r eport list s all clai ms that ar e potentia lly cost r ecoverable by VA. Th e exclusio n of this informatio n on the P CRR preven ts Revenue Staff fro m having a ccess to i nformation on all No n-VA healt hcare clai ms and is in direct conflict w ith curren t CBO poli cy, which states tha t all Non- VA healthc are claims are to be presented to Revenu e Staff fo r proper e valuation to determi ne if they qualify a s cost-rec overable c laims. As a result, Revenue st aff would not be abl e to bill a Veteran’ s third pa rty insura nce carrie r for pote ntially co st-recover able servi ces. These instances could res ult in los s of poten tial reven ue, as VA would not be able to bill for services i t is legal ly permitt ed to cost -recover. | |
279 | The enhanc ements des cribed in the Fee-Re venue SC C ondition D ecision RS D and in t his System Design Do cument (SD D) address the short comings of the curre nt busines s process. | |
280 | A high-lev el view of the curre nt (as-is) and futur e (to-be) third-part y billing precertifi cation pro cesses/wor kflows are available via TSPR here: http :// DNS /warboard/ anotebk.as p?proj=178 7&Type=Act ive | |
281 | Overview o f the Sign ificant Re quirements | |
282 | The Fee-Re venue SC C ondition D ecision BR D, RSD, an d Requirem ents Trace ability Ma trix (RTM) are avail able via T SPR here: http:// DNS /warboard/ anotebk.as p?proj=178 7&Type=Act ive | |
283 | Until docu ments are approved a nd posted to TSPR, t hey will b e made ava ilable upo n request from the p roject tea m. | |
284 | Overview o f Function al Require ments | |
285 | The Fee-Re venue SC C ondition D ecision en hancement project wi ll execute the follo wing: | |
286 | Logic will be remove d from the existing PCRR that selects re port data based on P otential C ost Recove ry and/or SC Conditi on Yes/No responses in FB. | |
287 | Table 3: F unctional Requiremen ts | |
288 | Business N eed (BN) | |
289 | Owner Req. | |
290 | (OWNR) | |
291 | Number | |
292 | OWNR | |
293 | Functional Requireme nt | |
294 | Priority* | |
295 | BN 3: Incr ease oppor tunities f or Revenue Staff to evaluate p otential c ost recove rable case s on the V istA FB PC RR. | |
296 | 3.1 | |
297 | Provide th e ability to include billed li ne item ch arges for Non-VA Car e on the P CRR, inclu ding line item charg es previou sly exclud ed based o n response s to POTEN TIAL COST RECOVERY a nd SC COND ITION prom pts in FB. | |
298 | FRSC-3.1-0 1 | |
299 | The system shall inc lude all N on-VA Care Community Nursing H ome (CNH) billed lin e item cha rges on th e VistA Fe e Basis PC RR. | |
300 | ||
301 | FRSC-3.1-0 2 | |
302 | The system shall inc lude all N on-VA Care Civil Hos pital (CH) billed li ne item ch arges on t he VistA F ee Basis P CRR. | |
303 | ||
304 | FRSC-3.1-0 3 | |
305 | The system shall inc lude all N on-VA Care Outpatien t billed l ine item c harges on the VistA Fee Basis PCRR. | |
306 | ||
307 | FRSC-3.1-0 4 | |
308 | The system shall inc lude all N on-VA Care Pharmacy billed lin e item cha rges on th e VistA Fe e Basis PC RR. | |
309 | ||
310 | High | |
311 | Overview o f Function al Workloa d/Performa nce Requir ements | |
312 | Not applic able – the re are no functional workload/ performanc e requirem ents assoc iated with this enha ncement pr oject. | |
313 | Overview o f Operatio nal Requir ements | |
314 | Not applic able – the re are no changes to existing operationa l requirem ents. | |
315 | Overview o f Technica l Requirem ents | |
316 | Not applic able – the re are no technical requiremen ts that di ve the con ceptual de sign. | |
317 | Overview o f Security or Privac y Requirem ents | |
318 | All VA and Veterans Health Adm inistratio n (VHA) se curity or privacy re quirements will be a dhered to. Cross-cut ting secur ity requir ements are contained in the VA Enterpris e Requirem ents Repos itory (ERR ). Efforts that invo lve the co llection a nd mainten ance of in dividually identifia ble inform ation must be covere d by a Pri vacy Act s ystem of r ecords not ice. | |
319 | Overview o f System C riticality and High Availabili ty Require ments | |
320 | The VistA FB system is compose d of multi ple VistA applicatio ns. This a pplication has its o wn availab ility and downtime r equirement s which wi ll be VAMC dependent . The FB p atch does not impose any requi rement bey ond the re quirement already sp ecified by the appli cation. An y related claim that cannot be submitted due to co mmunicatio n or other issues wi ll be queu ed and sub mitted whe n the syst ems are av ailable. | |
321 | Single Sig n-on Requi rements | |
322 | Not applic able – the re are no changes to the exist ing single sign-on r equirement s. | |
323 | Requiremen t for Use of Enterpr ise Portal s | |
324 | Not applic able – the re are no changes to the requi rements fo r use of e nterprise portals. | |
325 | Special De vice Requi rements | |
326 | Not applic able – no special de vices are required. | |
327 | Conceptual Design | |
328 | This proje ct is comp osed of Vi stA FB pat ches and t here are n o conceptu al design considerat ions. The actual sof tware deta iled desig n is prese nted in Se ction 6.2. 2 Specific Requireme nts. | |
329 | Conceptual Applicati on Design | |
330 | Applicatio n Context | |
331 | VistA is d eployed un iversally across the VHA at mo re than 1, 500 sites of care, i ncluding e ach Vetera ns Affairs Medical C enter (VAM C), Commun ity Based Outpatient Clinic (C BOC) and C ommunity L iving Cent er (CLC), as well as at nearly 300 VA Ve t Centers. The FB an d IB appli cation mod ules are l ocated wit hin the na tionally r eleased Vi stA applic ation. Thi s will not change as a result of this pr oject. | |
332 | Figure 1: Fee Claim SC Determi nation App lication C ontext Dia gram | |
333 | High-Level Applicati on Design | |
334 | The databa se being u tilized fo r this pro ject is Vi stA. Withi n the Vist A database , two soft ware modul es will be utilized – Fee Basi s and Inte grated Bil ling. For informatio nal purpos es and app lication c ontext, Fi gure 2 and Figure 3 display th e Electron ic Data In terchange (EDI) X12 messaging infrastruc ture for V eterans an d benefici aries. How ever, this enhanceme nt does no t involve changes to the EDI i nfrastruct ure, nor d oes it dir ectly invo lve the ED I process. | |
335 | ||
336 | Figure 2: Overview o f EDI X12 Messaging | |
337 | ||
338 | Figure 3: Overview o f Claims P rocessing and Eligib ility (CP& E) System and Interf aces | |
339 | ||
340 | Applicatio n Location s | |
341 | VistA is d eployed un iversally across VHA at more t han 1,500 sites of c are, inclu ding each VAMC, CBOC , and CLC, as well a s at nearl y 300 VA V et Centers . The FB a nd IB appl ication mo dules are located wi thin the n ationally released V istA appli cation. Th is will no t change a s a result of this p roject. | |
342 | Conceptual Data Desi gn | |
343 | Project Co nceptual D ata Model | |
344 | Not applic able – thi s project does not r equire any changes t o the conc eptual dat a model. F igure 4 pr ovides the data mode l. | |
345 | ||
346 | Figure 4: Data Model | |
347 | For a more detailed visual of the VistA data model , refer to the Entit y Relation ship Diagr am (ERD) a vailable v ia TSPR he re: | |
348 | http:// DNS /warboard/ anotebk.as p?proj=178 7&Type=Act ive | |
349 | Until the ERD is app roved and posted to TSPR, it w ill be mad e availabl e upon req uest from the projec t team. | |
350 | Database I nformation | |
351 | The databa se being u tilized fo r this pro ject is Vi stA. Withi n the Vist A database , two soft ware modul es will be utilized – Fee Basi s and Inte grated Bil ling. | |
352 | ||
353 | ||
354 | Table 4 Da tabase Inf ormation | |
355 | Database N ame | |
356 | Descriptio n | |
357 | Type | |
358 | Steward | |
359 | VistA | |
360 | Veterans H ealth Info rmation Sy stems and Technology Architect ure | |
361 | I | |
362 | VA | |
363 | The VistA FB module, and assoc iated Mass achusetts General Ho spital Uti lity Multi -Programmi ng System (Mumps) da tabase, pr ovides for more effi cient and accurate o peration o f the fee for servic e program with reduc tion of pa perwork, s avings in staff hour s, minimiz ation of e rrors, and by allowi ng medical facilitie s to have greater co ntrol over disbursem ent of fee medical, pharmacy, and travel monies. | |
364 | The VistA IB module, and assoc iated Mump s database , allows f or the cap ture, main tenance, a nd storage of insura nce data i ncluding p olicy info rmation an d related benefits. It provide s the abil ity to ele ctronicall y transmit bills to payers wit h the data required by HIPAA. It also pr ovides the ability t o receive and store electronic 835 Healt h Care Cla im Payment /Advice. I t includes the abili ty to crea te printed bills whi ch can the n be maile d to payer s who are unable to accept an electronic claim. A Claims Tra cking feat ure is ava ilable to assist uti lization r eview staf f in track ing episod es of care , completi ng pre-cer tification s, complet ing contin ued stay r eviews, an d processi ng appeals and denia ls. An Aut omated Bil ler module provides a process that autom atically c reates bil ls for bil lable even ts which c an then be finished and author ized by th e billing staff. The IB softwa re also pr ovides man y reportin g features that supp ort the bi lling staf f by provi ding stati stics, tra cking and historical informati on. | |
365 | User Inter face Data Mapping | |
366 | VistA FB r eceives da ta from th e Fee Basi s Claims S ystem (FBC S), a Grap hical User Interface (GUI) sys tem that s ends autho rization a nd claim d ata to the VistA Fee Basis sys tem. These fields ar e mapped i n VistA, v ia Remote Procedure Calls (RPC s). There will be no changes t o VistA Fe e Basis in terface ma pping for this proje ct. | |
367 | The VistA IB package electroni cally tran smit bills to payers with the data requi red by HIP AA. It als o provides the abili ty to rece ive and st ore electr onic 835 H ealth Care Claim Pay ment/Advic e. There w ill be no changes to VistA Int egrated Bi lling inte rface mapp ing for th is project . | |
368 | Conceptual Infrastru cture Desi gn | |
369 | System Cri ticality a nd High Av ailability | |
370 | No changes are expec ted to sys tem critic ality and high avail ability, a s a result of this p roject. Re liability and availa bility req uirements for VistA are manage d by regio nal data c enters. | |
371 | Special Te chnology | |
372 | VistA has historical ly been bu ilt on a c lient-serv er archite cture, whi ch ties to gether wor kstations and person al compute rs with us er interfa ces at VA facilities . No speci al technol ogies will be modifi ed as a re sult of th is project . | |
373 | Technology Locations | |
374 | All softwa re changes for this project wi ll be comp leted with in nationa lly releas ed VistA s oftware co de. Mumps routines ( programs) will be mo dified and added to the Fee Ba sis and In tegrated B illing sof tware. | |
375 | Conceptual Infrastru cture Diag ram | |
376 | Location o f Environm ents and E xternal In terfaces | |
377 | Please see Figure 2 and Figure 3. Modifi cations fo r this pro ject will be complet ed within the bounds of the Vi stA system , only. | |
378 | Conceptual Productio n String D iagram | |
379 | No concept ual produc tion strin g diagram exists for the VistA FB and IB modules. The standa rd VistA c onfigurati on will be utilized. | |
380 | System Arc hitecture | |
381 | This proje ct encompa sses enhan cements to the exist ing FB sys tem which does not r equire any changes t o the Vist A architec ture or ha rdware arc hitecture. | |
382 | Hardware A rchitectur e | |
383 | The FB app lication i s part of the VistA suite of a pplication s. The Vis tA Monogra ph states: | |
384 | “VistA is deployed u niversally across VH A at more than 1,500 sites of care, incl uding each VAMC, Com munity Bas ed Outpati ent Clinic (CBOC) an d Communit y Living C enter (CLC ), as well as at nea rly 300 VA Vet Cente rs. These locations will have a variety of hardwar e platform s but all meet a min imal stand ard requir ed to supp ort VistA. ” | |
385 | Software A rchitectur e | |
386 | The FB sys tem is com posed of m ultiple Vi stA applic ations. Th ey also in teract wit h many oth er VistA s tandard mo dules, suc h as Mailm an, Kernel , Health L evel 7 (HL 7), and Fi leMan. The entire Vi stA applic ation cons ists of 20 0+ modules . The Vist A monograp h includes this desc ription fo r VistA: | |
387 | “VistA is an integra ted Electr onic Healt h Record ( EHR) infor mation tec hnology sy stem with applicatio n packages that shar e a common data stor e and comm on interna l services . The data store and VistA ker nel are im plemented in the Mas sachusetts General H ospital Ut ility Mult i-Programm ing System (MUMPS) c omputer la nguage, an d the Comp uterized P atient Rec ord System (CPRS) Gr aphical Us er Interfa ce (GUI) i s implemen ted in Del phi. Appli cation cli ents use a highly-ef ficient pr oprietary protocol t o access d ata. VistA is highly configura ble and cu stomizable , and in a ddition to appropria te connect ivity amon gst VistA modules, V istA suppo rts the in tegration of best-of -breed app lications at multipl e levels, including MUMPS Appl ication Pr ogramming Interface (API), Rem ote Proced ure Call ( RPC), Medi cal Domain Web Servi ces (MDWS) , HL7, and data exch ange via B lue Button or eHealt h Exchange s. VistA c omprises n early 200 distinct a pplication s/modules, 15,000 ro utines, an d millions of lines of compute r code. | |
388 | The backbo ne of VHA’ s clinical and admin istrative informatio n technolo gy capabil ity, VistA has histo rically be en built o n a client -server ar chitecture , which ti es togethe r workstat ions and p ersonal co mputers wi th GUIs at VA facili ties. The CPRS GUI i s as highl y customiz able and r uns on wor kstations, laptops, tablets (i ncluding i Pads) and smart phon es. VistA interopera tes with n umerous co mmercial-o ff-the she lf softwar e applicat ions and w ith select ed informa tion techn ology syst ems of oth er federal agencies and, incre asingly, h ealth info rmation ex change net works. At the time o f publicat ion of thi s edition of the Mon ograph, co mprehensiv e proposed enhanceme nts to Vis tA were in the initi al stages; referred to as “Vis tA Evoluti on” these enhancemen ts are wil l reflect developmen t and arch itecture e nhancement s to allow greater i nteraction with data and great er efficie ncy for th e VistA sy stem.” | |
389 | Note that the change s required by this p roject are based in the MUMPS computer l anguage an d do not i mpact CPRS . | |
390 | Network Ar chitecture | |
391 | ||
392 | Figure 5 N etwork Arc hitecture | |
393 | Figure 5, above, dia grams netw ork archit ecture for the claim s processi ng and bil ling syste ms. Netwo rk archite cture is n ot impacte d or modif ied by thi s project. | |
394 | ** Please note: | |
395 | Per Elizab eth Congdo n (Manager , Health S ystems Pla tform, Ent erprise Sy stems Engi neering, V A OI&T Ser vice Deliv ery and En gineering) “VistA is using SFT P and has for quite a while”. | |
396 | ||
397 | SOA/ESS | |
398 | Not applic able – thi s project will not i mpact or m andate any additiona l requirem ent for Se rvice Orie nted Archi tecture (S OA)/Enterp rise Share d Services (ESS). | |
399 | Enterprise Architect ure | |
400 | ||
401 | Figure 6 E nterprise Architectu re | |
402 | The existi ng Enterpr ise Archit ecture wil l not be m odified fo r this pro ject. | |
403 | ||
404 | Data Desig n | |
405 | Database M anagement System (DB MS) Files | |
406 | This is a VistA FEE BASIS patc h (FB*3.5* 163). The database m anagement system (DB MS) in use is VA Fil eMan. | |
407 | The VistA FEE BASIS package us es the sta ndard VA F ileMan dat a dictiona ries (DDs) and files . No DD mo dification s are bein g made for this proj ect. | |
408 | Non-DBMS F iles | |
409 | There are no non-DBM S Files mo dified or added for this proje ct. | |
410 | Data View | |
411 | This proje ct is a Vi stA FEE BA SIS patch. The ERD i s one of t he deliver ables for this proje ct. Please see link in Section 3.2.1. | |
412 | Detailed D esign | |
413 | Blank sect ions have been kept for versio n control. | |
414 | Hardware D etailed De sign | |
415 | This proje ct is a Vi stA FEE BA SIS patch. There are no modifi cations to any exist ing hardwa re. | |
416 | Software D etailed De sign | |
417 | Conceptual Design | |
418 | Product Pe rspective | |
419 | The VistA FEE BASIS system inc ludes a PC RR that pr ovides inf ormation r egarding p aid non-VA care invo ices that may be cos t-recovera ble, due t o third-pa rty insura nce or fir st-party c o-pay. | |
420 | User Inter faces | |
421 | User Inter face with all FEE BA SIS applic ation soft ware is pe rformed th rough Vist A screens. VistA is a characte r-based ap plication accessible through t erminal em ulator sof tware resi dent on ne tworked co mputers. | |
422 | The FEE BA SIS applic ation is a character -based sys tem using VA FileMan as its da tabase man ager and C ache/M as the progra mming lang uage. This software applicatio n is part of the Vis tA suite o f applicat ions, whic h include additional clinical and financ ial applic ations. Th ere are no GUIs. | |
423 | Hardware I nterfaces | |
424 | VistA FEE BASIS rece ives data from the F BCS, a GUI system th at sends a uthorizati on and cla im data to the VistA FEE BASIS system. | |
425 | Communicat ions betwe en VistA s ites and H IPAA EDI S ervices pa ss through the Local Area Netw orks (LANs ) and acro ss the Dep artment of Veterans Affairs (V A) intrane t. The Ser vices comm unicate ov er the Aus tin Inform ation Tech nology Cen ter (AITC) LAN and t hrough the private f rame relay to the co mmunicatio ns clearin ghouse for this proj ect. The c learinghou se communi cates with the tradi ng partner processor s that are continual ly designa ted using previously negotiate d contract ual terms and condit ions. | |
426 | Software I nterfaces | |
427 | The follow ing softwa re must be installed prior to the releas e of this product. | |
428 | •InterSyst ems Mumps Version Ca che 2014.1 .3 Ad Hoc 14809 | |
429 | •VA FileMa n Version 22.0 | |
430 | •VistA Ker nel Versio n 8.0 | |
431 | •VistA Mai lMan Versi on 8.0 | |
432 | •VistA Fee Basis Ver sion 3.5 | |
433 | •Vista Int egrated Bi lling Vers ion 2.0 | |
434 | •Vista Acc ounts Rece ivable Ver sion 4.5 | |
435 | •VistA Reg istration Version 5. 3 | |
436 | Other tool s utilized during de velopment and testin g: | |
437 | •Rational Team Conce rt: Relea se 6.0 (VA Network-w ide versio n) | |
438 | Communicat ions Inter faces | |
439 | Memory Con straints | |
440 | N/A. There are no me mory const raints ass ociated wi th this pr oject. | |
441 | Special Op erations | |
442 | N/A. There are no sp ecial oper ations ass ociated wi th this pr oject. | |
443 | Product Fe atures | |
444 | Please see Section 1 .1 for a l ist of Sco pe Inclusi ons, Secti on 2.4 for an overvi ew of the significan t function al require ments, and Section 2 .3 for a l ink to the BRD / det ailed func tional req uirements. | |
445 | User Chara cteristics | |
446 | In general , the reso urces that shall wor k with FEE BASIS sof tware need to be kno wledgeable in the ar ea of FBCS , FEE BASI S and, to a lesser e xtent, Int egrated Bi lling. | |
447 | Dependenci es and Con straints | |
448 | N/A/ There are no de pendencies and const raints wit h this pro ject. | |
449 | Specific R equirement s | |
450 | Database R epository | |
451 | This proje ct is a Vi stA patch. The datab ase reposi tory is st andard Vis tA databas e using Fi leMan file s and fiel ds. Any mo dification s to this database r epository are detail ed in Sect ion 6.2.2. 2. | |
452 | System Fea tures | |
453 | The RTM de signator o n Table 5 identifies the speci fic functi onal requi rements as presented in the RS D for this project, with regar ds to each routine c hange. | |
454 | Design El ement Tabl es | |
455 | Routines ( Entry Poin ts) | |
456 | Fee-Revenu e SC Condi tion Decis ion | |
457 | Table 5 : Grouping: Routines | |
458 | Routines | |
459 | Activities | |
460 | Routine Na me | |
461 | FBPCR2 | |
462 | Enhancemen t Category | |
463 | New | |
464 | Modify | |
465 | Delete | |
466 | No Change | |
467 | RTM | |
468 | RSD FRSC-3 .1-01, FRS C-3.1-02, FRSC-3.1-0 3, FRSC-3. 1-04 | |
469 | Related Op tions | |
470 | POTENTIAL COST RECOV ERY REPORT | |
471 | ||
472 | Related Ro utines | |
473 | Routines “ Called By” | |
474 | Routines “ Called” | |
475 | ||
476 | ||
477 | $$GET1^DIQ , ^DIR, $$ ADJLRA^FBA AFA, $$RRL ^FBAAFR, $ $DATX^FBAA UTL, $$CPT ^FBAAUTL4, $$MODL^FB AAUTL4, $$ DT2FMDT^FB CSV1, $$IC D9^FBCSV1, $$ICD9P^F BCSV1, $$C ATC^FBPCR, HDR^FBPCR , VET^FBPC R, $$FILTE R^FBPCR4, $$INSURED^ FBPCR4 | |
478 | ||
479 | Routines | |
480 | Activities | |
481 | Data Dicti onary (DD) Reference s | |
482 | ^FBAA(161. 27, ^FBAA( 161.7, ^FB ACC(, ^FBA AC(“AK”, ^ FBAAV(, ^T MP($J | |
483 | Related Pr otocols | |
484 | NONE | |
485 | Related In tegration Control Re gistration s (ICRs) | |
486 | NONE | |
487 | Data Passi ng | |
488 | Input | |
489 | Output Re ference | |
490 | Both | |
491 | Global Re ference | |
492 | Local | |
493 | Input Attr ibute Name and Defin ition | |
494 | Name: NONE | |
495 | Definition : NONE | |
496 | Output Att ribute Nam e and Defi nition | |
497 | Name: NONE | |
498 | Definition : NONE | |
499 | ||
500 | ||
501 | ||
502 | Current Lo gic (Chang es are Hig hlighted) | |
503 | SET ;set v ariables - also entr y point fr om FBPCR67 | |
504 | N FBPCR,F BX | |
505 | S Y=$G(^F BAAC(J,1,K ,1,L,1,M,0 )) Q:'+$P( Y,U,9)!($G (^FBAAC(J, 1,K,1,L,1, M,"FBREJ") )]"") | |
506 | S FBY=$G( ^FBAAC(J,1 ,K,1,L,1,M ,2)),FBDAT 003=$G(^FB AAC(J,1,K, 1,L,1,M,3) ) ; FB*3.5 *122 | |
507 | S FBDAT00 4=$G(^FBAA C(J,1,K,1, L,1,M,4)), FBDAT005=$ G(^FBAAC(J ,1,K,1,L,1 ,M,5)) ; F B*3.5*133 | |
508 | S FBVNAME =$E($P($G( ^FBAAV(K,0 )),U),1,23 ),FBVID=$S (FBVNAME]" ":$P(^(0), U,2)_"/"_$ S($P($G(^( 3)),U,2)]" ":$P(^(3), U,2),1:"** ********") ,1:"") | |
509 | S FBP=+$P (Y,U,9),FB SC=$P(Y,U, 27),FBPDX= +$P(Y,U,23 ),FBPSF=+$ P(Y,U,12) | |
510 | S ^TMP($J ,"FB",FBPS F)=$G(^FBA AC(J,1,K,1 ,L,4)) ; F B*3.5*122 | |
511 | S FBSC=$S (FBSC="Y": "YES",FBSC ="N":"NO", 1:"-") | |
512 | S T=$P(Y, U,5),D2=$P (Y,U,6),FB DOS=D2,D2= $$DATX^FBA AUTL(D2),F BCP=$P(Y,U ,18),FBCP= $S(FBCP=1: "(C&P)",1: "") | |
513 | Q:FBCP]"" !('FBPSV&( '$D(FBPSV( FBPSF)))) S FBPCR=+$ G(^FBAAC(J ,1,K,1,L,0 )),FBCATC= $$CATC^FBP CR(DFN,FBP CR,+$P(Y,U ,18)),FBIN S=$S(FBSC[ "N":$$INSU RED^FBPCR4 (DFN,FBPCR ),1:0) Q:' FBCATC&'FB INS | |
514 | S FBAACPT C=$$CPT^FB AAUTL4($P( Y,U)) | |
515 | S FBOB=$P (Y,U,10) | |
516 | I T]"" S T=$P($G(^F BAA(161.27 ,+T,0)),U) | |
517 | S FBTYPE= $P(Y,U,20) ,FBVP=$P(Y ,U,21),FBI N=$P(Y,U,1 6),FBBN=$P (Y,U,8),FB BN=$S(FBBN ']"":"",$D (^FBAA(161 .7,FBBN,0) ):$P(^(0), U),1:""),F BBN=$S(FBB N="":"",1: $E("00000" ,$L(FBBN)+ 1,5)_FBBN) | |
518 | S FBVEN=F BVNAME_";" _FBVID,FBP AT=FBPNAME _";"_DFN | |
519 | S FBMODLE =$$MODL^FB AAUTL4("^F BAAC("_J_" ,1,"_K_",1 ,"_L_",1," _M_",""M"" )","E") | |
520 | I T]"" S T=$P($G(^F BAA(161.27 ,+T,0)),U) ;suspend code | |
521 | S TAMT=$F N($P(Y,U,4 ),"",2) ;s uspend amo unt | |
522 | S FBUNITS =$P(FBY,U, 14) ;units paid | |
523 | S FBCSID= $P(FBY,U,1 6) ;patien t account number | |
524 | S FBX=$$A DJLRA^FBAA FA(M_","_L _","_K_"," _J_",") | |
525 | S FBADJLR =$P(FBX,U) ;adjustme nt codes | |
526 | S FBADJLA =$P(FBX,U, 2) ;adjust ment amoun ts | |
527 | S FBRRMKL =$$RRL^FBA AFR(M_","_ L_","_K_", "_J_",") ; remit rema rks | |
528 | ;output f ormat | |
529 | S A1=$J($ P(Y,U,2),6 ,2),A2=$J( $P(Y,U,3), 6,2),A3=$J (A3,6,2),F BIN=$J(FBI N,7) | |
530 | S FBDT1=$ S(FBVP="VP ":"#",1:"" )_$S(FBTYP E="R":"*", 1:" ")_FBD T | |
531 | Q | |
532 | ||
533 | ||
534 | ||
535 | Modified L ogic (Chan ges are Hi ghlighted) | |
536 | SET ;set v ariables - also entr y point fr om FBPCR67 | |
537 | N FBPCR,F BX | |
538 | S Y=$G(^F BAAC(J,1,K ,1,L,1,M,0 )) Q:'+$P( Y,U,9)!($G (^FBAAC(J, 1,K,1,L,1, M,"FBREJ") )]"") | |
539 | S FBY=$G( ^FBAAC(J,1 ,K,1,L,1,M ,2)),FBDAT 003=$G(^FB AAC(J,1,K, 1,L,1,M,3) ) ; FB*3.5 *122 | |
540 | S FBDAT00 4=$G(^FBAA C(J,1,K,1, L,1,M,4)), FBDAT005=$ G(^FBAAC(J ,1,K,1,L,1 ,M,5)) ; F B*3.5*133 | |
541 | S FBVNAME =$E($P($G( ^FBAAV(K,0 )),U),1,23 ),FBVID=$S (FBVNAME]" ":$P(^(0), U,2)_"/"_$ S($P($G(^( 3)),U,2)]" ":$P(^(3), U,2),1:"** ********") ,1:"") | |
542 | S FBP=+$P (Y,U,9),FB SC=$P(Y,U, 27),FBPDX= +$P(Y,U,23 ),FBPSF=+$ P(Y,U,12) | |
543 | S ^TMP($J ,"FB",FBPS F)=$G(^FBA AC(J,1,K,1 ,L,4)) ; F B*3.5*122 | |
544 | S FBSC=$S (FBSC="Y": "YES",FBSC ="N":"NO", 1:"-") | |
545 | S T=$P(Y, U,5),D2=$P (Y,U,6),FB DOS=D2,D2= $$DATX^FBA AUTL(D2),F BCP=$P(Y,U ,18),FBCP= $S(FBCP=1: "(C&P)",1: "") | |
546 | ; FB*3.5* 163 - baa start | |
547 | ;Q:FBCP]" "!('FBPSV& ('$D(FBPSV (FBPSF)))) S FBPCR=+ $G(^FBAAC( J,1,K,1,L, 0)),FBCATC =$$CATC^FB PCR(DFN,FB PCR,+$P(Y, U,18)),FBI NS=$S(FBSC ["N":$$INS URED^FBPCR 4(DFN,FBPC R),1:0) Q: 'FBCATC&'F BINS | |
548 | Q:FBCP]"" !('FBPSV&( '$D(FBPSV( FBPSF)))) | |
549 | S FBPCR=+ $G(^FBAAC( J,1,K,1,L, 0)),FBCATC =$$CATC^FB PCR(DFN,FB PCR,+$P(Y, U,18)),FBI NS=$$INSUR ED^FBPCR4( DFN,FBPCR) | |
550 | Q:'FBCATC &'FBINS | |
551 | ; FB*3.5* 163 - baa end | |
552 | S FBAACPT C=$$CPT^FB AAUTL4($P( Y,U)) | |
553 | S FBOB=$P (Y,U,10) | |
554 | I T]"" S T=$P($G(^F BAA(161.27 ,+T,0)),U) | |
555 | S FBTYPE= $P(Y,U,20) ,FBVP=$P(Y ,U,21),FBI N=$P(Y,U,1 6),FBBN=$P (Y,U,8),FB BN=$S(FBBN ']"":"",$D (^FBAA(161 .7,FBBN,0) ):$P(^(0), U),1:""),F BBN=$S(FBB N="":"",1: $E("00000" ,$L(FBBN)+ 1,5)_FBBN) | |
556 | S FBVEN=F BVNAME_";" _FBVID,FBP AT=FBPNAME _";"_DFN | |
557 | S FBMODLE =$$MODL^FB AAUTL4("^F BAAC("_J_" ,1,"_K_",1 ,"_L_",1," _M_",""M"" )","E") | |
558 | I T]"" S T=$P($G(^F BAA(161.27 ,+T,0)),U) ;suspend code | |
559 | S TAMT=$F N($P(Y,U,4 ),"",2) ;s uspend amo unt | |
560 | S FBUNITS =$P(FBY,U, 14) ;units paid | |
561 | S FBCSID= $P(FBY,U,1 6) ;patien t account number | |
562 | S FBX=$$A DJLRA^FBAA FA(M_","_L _","_K_"," _J_",") | |
563 | S FBADJLR =$P(FBX,U) ;adjustme nt codes | |
564 | S FBADJLA =$P(FBX,U, 2) ;adjust ment amoun ts | |
565 | S FBRRMKL =$$RRL^FBA AFR(M_","_ L_","_K_", "_J_",") ; remit rema rks | |
566 | ;output f ormat | |
567 | S A1=$J($ P(Y,U,2),6 ,2),A2=$J( $P(Y,U,3), 6,2),A3=$J (A3,6,2),F BIN=$J(FBI N,7) | |
568 | S FBDT1=$ S(FBVP="VP ":"#",1:"" )_$S(FBTYP E="R":"*", 1:" ")_FBD T | |
569 | Q | |
570 | ||
571 | Routines | |
572 | Activities | |
573 | Routine Na me | |
574 | FBPCR3 | |
575 | Enhancemen t Category | |
576 | New | |
577 | Modify | |
578 | Delete | |
579 | No Change | |
580 | RTM | |
581 | RSD 3.1 | |
582 | Related Op tions | |
583 | POTENTIAL COST RECOV ERY REPORT | |
584 | ||
585 | Related Ro utines | |
586 | Routines “ Called By” | |
587 | Routines “ Called” | |
588 | ||
589 | ^FBPCR | |
590 | ^DIR, $$DA TX^FBAAUTL , $$CATC^F BPCR, HDR^ FBPCR, VET ^FBPCR, KI LL^FBPCR2, $$FILTER^ FBPCR4, $$ INSURED^FB PCR4, $$AD JLRA^FBRXF A, $$RRL^F BRXFR | |
591 | ||
592 | Routines | |
593 | Activities | |
594 | Data Dicti onary (DD) Reference s | |
595 | ^FBAA(161. 27, ^FBAA( 161.7, ^FB AA(162.1, ^FBAAA(, ^ FBAAA(“AIC ”, ^FBAAV( , ^TMP($J | |
596 | Related Pr otocols | |
597 | NONE | |
598 | Related In tegration Control Re gistration s (ICRs) | |
599 | NONE | |
600 | Data Passi ng | |
601 | Input | |
602 | Output Re ference | |
603 | Both | |
604 | Global Re ference | |
605 | Local | |
606 | Input Attr ibute Name and Defin ition | |
607 | Name: NONE | |
608 | Definition : NONE | |
609 | Output Att ribute Nam e and Defi nition | |
610 | Name: NONE | |
611 | Definition : NONE | |
612 | ||
613 | Current Lo gic (Chang es are Hig hlighted) | |
614 | INSCK(FBDT ,FBDA1,FBP I) ;possib le cost re covery fcn call | |
615 | ;Passed v ariables: fbdt=fill date or tr eatment fr om date | |
616 | ; fbda1=i en if fee patient fi le, patien t ien | |
617 | ; fbpi=fe e program | |
618 | ;Output v ariables: fbins=1 if possible recovery, 0 if no | |
619 | S FBINS=0 ,FBDT=FBDT +.1,FBDT=+ $O(^FBAAA( "AIC",FBDA 1,-FBDT)) | |
620 | I FBDT S FBINS=$O(^ FBAAA("AIC ",FBDA1,FB DT,0)) I F BINS="Y" D | |
621 | .N FBDA S FBDA=+$O( ^FBAAA("AI C",FBDA1,F BDT,FBINS, 0)) | |
622 | .I $P($G( ^FBAAA(FBD A1,1,FBDA, 0)),U,3)'= FBPI S FBI NS=0 | |
623 | Q $S(FBIN S="Y":1,1: 0) | |
624 | ||
625 | Modified L ogic (Chan ges are Hi ghlighted) | |
626 | ;FB*3.5*16 3 - modifi ed to proc ess yes or no Potent ial Cost R ecovery va lue. | |
627 | INSCK(FBDT ,FBDA1,FBP I) ;possib le cost re covery fcn call | |
628 | ;Passed v ariables: fbdt=fill date or tr eatment fr om date | |
629 | ; fbda1=i en if fee patient fi le, patien t ien | |
630 | ; fbpi=fe e program | |
631 | ;Output v ariables: fbins=1 if possible recovery, 0 if no | |
632 | N FBOUT,C KFBPI | |
633 | S FBINS=0 ,FBDT=FBDT +.1,FBDT=+ $O(^FBAAA( "AIC",FBDA 1,-FBDT)), FBOUT=0 | |
634 | ;FB*3.5*16 3 START | |
635 | I FBDT S FBINS=$O(^ FBAAA("AIC ",FBDA1,FB DT,0)) I F BINS="Y"!( FBINS="N") D | |
636 | .N FBDA S FBDA=+$O( ^FBAAA("AI C",FBDA1,F BDT,FBINS, 0)) | |
637 | .S CKFBPI =$P($G(^FB AAA(FBDA1, 1,FBDA,0)) ,U,3) | |
638 | .I CKFBPI =6,FBPI=67 S FBOUT=1 | |
639 | .I CKFBPI =7,FBPI=67 S FBOUT=1 | |
640 | .I CKFBPI =67,FBPI=6 7 S FBOUT= 1 | |
641 | .I CKFBPI =3,FBPI=3 S FBOUT=1 | |
642 | Q FBOUT ; FB*3.5*163 END | |
643 | Templates | |
644 | No Templat es changed . | |
645 | Data Entri es Affecte d by the D esign | |
646 | No data En tries affe cted by th e Design. | |
647 | Unique Rec ord(s) | |
648 | No Unique Records ch anged. | |
649 | File or Gl obal Size Changes | |
650 | No File or Global si ze changes . | |
651 | Mail Group s | |
652 | No Mail Gr oups chang es. | |
653 | Security K eys | |
654 | No Securit y Keys cha nged. | |
655 | ||
656 | Options | |
657 | No Options changed. | |
658 | ||
659 | Protocols | |
660 | No Protoco ls changed . | |
661 | ||
662 | RPC | |
663 | No RPC cha nges. | |
664 | Constants Defined in Interface | |
665 | No Constan ts Defined in Interf ace. | |
666 | Variables Defined in Interface | |
667 | No Variabl es Defined in Interf ace. | |
668 | Types Defi ned in Int erface | |
669 | No Types d efined in Interface. | |
670 | GUI | |
671 | No GUI cha nges. | |
672 | GUI Classe s | |
673 | No GUI Cla ss changes . | |
674 | Current Fo rm | |
675 | No changes . | |
676 | Modified F orm | |
677 | No changes . | |
678 | Components on Form | |
679 | No changes . | |
680 | Events | |
681 | No Changes . | |
682 | Methods | |
683 | No Changes . | |
684 | Special Re ferences | |
685 | No changes . | |
686 | Class Even ts | |
687 | No changes . | |
688 | Class Meth ods | |
689 | No changes . | |
690 | Class Prop erties | |
691 | No changes . | |
692 | Uses Claus e | |
693 | No changes . | |
694 | Forms | |
695 | No changes . | |
696 | ||
697 | Functions | |
698 | No changes . | |
699 | ||
700 | Dialog | |
701 | No changes . | |
702 | Help Frame | |
703 | No changes . | |
704 | ||
705 | HL7 Applic ation Para meter | |
706 | No changes . | |
707 | ||
708 | ||
709 | ||
710 | ||
711 | HL7 Logica l Link | |
712 | No changes . | |
713 | ||
714 | Commercial Off-the-S helf (COTS ) Interfac e | |
715 | No changes . | |
716 | Network De tailed Des ign | |
717 | There are no network topology changes re lated to t his projec t. | |
718 | Security a nd Privacy | |
719 | This proje ct does no t add any additional security or privacy design co nsideratio ns. | |
720 | Security | |
721 | Security a nd Privacy are contr olled by t he VistA a pplication and the u nderlying operating system. Th is applica tion does not mandat e any addi tional sec urity or p rivacy req uirements. | |
722 | Privacy | |
723 | Security a nd Privacy are contr olled by t he VistA a pplication and the u nderlying operating system. Th is applica tion does not mandat e any addi tional sec urity or p rivacy req uirements. | |
724 | SOA/ESS De tailed Des ign | |
725 | Not applic able – ref erence Sec tion 4.4. | |
726 | External S ystem Inte rface Desi gn | |
727 | Not applic able – the re is no e xternal sy stem invol ved with t his projec t. | |
728 | Human-Mach ine Interf ace | |
729 | Not applic able – thi s project does not c hange the human-mach ine interf ace, which is done v ia the Vis tA user op tions. | |
730 | Attachment A – Appro val Signat ures | |
731 | The signat ure below is an ackn owledgemen t that the signatory understan ds the pur pose and c ontent of this docum ent. By si gning this document, you agree to this a s the SDD to begin w ork on the project d escribed w ithin, and commitmen t of the n ecessary r esources. | |
732 | ||
733 | ||
734 | ||
735 | __________ __________ __________ __________ __________ __________ __________ ______ | |
736 | Charles Du nn | |
737 | Office of Informatio n & Techno logy (OI&T ) Project Manager (P jM),Date | |
738 | Integrated Project T eam (IPT) Co-Chair | |
739 | ||
740 | ||
741 | ||
742 | __________ __________ __________ __________ __________ __________ __________ ______ | |
743 | Greg Estes | |
744 | Business S ponsorDate | |
745 | ||
746 | ||
747 | ||
748 | __________ __________ __________ __________ __________ __________ __________ ______ | |
749 | Ann Kliegl | |
750 | VHA PjM, I PT Co-Chai rDate | |
751 | ||
752 | ||
753 | Attachment B – Acron ym List | |
754 | Table 6: A cronym Lis t | |
755 | Term | |
756 | Definition | |
757 | AITC | |
758 | Austin Inf ormation T echnology Center | |
759 | API | |
760 | Applicatio n Programm ing Interf ace | |
761 | BN | |
762 | Business N eed | |
763 | BRD | |
764 | Business R equirement s Document | |
765 | CBO | |
766 | Chief Busi ness Offic e | |
767 | CBOC | |
768 | Community Based Outp atient Cli nic | |
769 | CH | |
770 | Civil Hosp ital | |
771 | CLC | |
772 | Community Living Cen ter | |
773 | CNH | |
774 | Community Nursing Ho me | |
775 | COTS | |
776 | Commercial Off-the-S helf | |
777 | CP&E | |
778 | Claims Pro cessing an d Eligibil ity | |
779 | CPRS | |
780 | Computeriz ed Patient Record Sy stem | |
781 | DBMS | |
782 | Database M anagement System | |
783 | DD | |
784 | Data Dicti onary | |
785 | EDI | |
786 | Electronic Data Inte rchange | |
787 | EHR | |
788 | Electronic Health Re cord | |
789 | ERD | |
790 | Entity Rel ationship Diagram | |
791 | ERR | |
792 | VA Enterpr ise Requir ements Rep ository | |
793 | ESS | |
794 | Enterprise Shared Se rvices | |
795 | FB | |
796 | Fee Basis | |
797 | FBCS | |
798 | Fee Basis Claims Sys tem | |
799 | GUI | |
800 | Graphical User Inter face | |
801 | HL7 | |
802 | Health Lev el 7 | |
803 | IB | |
804 | Integrated Billing | |
805 | IPT | |
806 | Integrated Project T eam | |
807 | LAN | |
808 | Local Area Network | |
809 | MCCR | |
810 | Medical Ca re Cost Re covery | |
811 | MDWS | |
812 | Medical Do main Web S ervices | |
813 | MUMPS | |
814 | Massachuse tts Genera l Hospital Utility M ulti-Progr amming Sys tem | |
815 | NFPO | |
816 | National F ee Program Office | |
817 | OI&T | |
818 | Office of Informatio n & Techno logy | |
819 | OWNR | |
820 | Owner Requ irement | |
821 | PC | |
822 | Purchased Care | |
823 | PCRR | |
824 | Potential Cost Recov ery Report | |
825 | PjM | |
826 | Project Ma nager | |
827 | RPC | |
828 | Remote Pro cedure Cal l | |
829 | RSD | |
830 | Requiremen ts Specifi cation Doc ument | |
831 | RTM | |
832 | Requiremen ts Traceab ility Matr ix | |
833 | SC | |
834 | Service Co nnected | |
835 | SDD | |
836 | System Des ign Docume nt | |
837 | SOA | |
838 | Service Or iented Arc hitecture | |
839 | TSPR | |
840 | Technical Services P roject Rep ository | |
841 | VA | |
842 | Department of Vetera ns Affairs | |
843 | VACO | |
844 | VA Central Office | |
845 | VAMC | |
846 | VA Medical Center | |
847 | VHA | |
848 | Veterans H ealth Admi nistration | |
849 | VISN | |
850 | Veterans I ntegrated Service Ne twork | |
851 | VistA | |
852 | Veterans H ealth Info rmation Sy stems and Technology Architect ure | |
853 | ||
854 | ||
855 | Attachment C – Addit ional Info rmation | |
856 | This secti on and its sub-secti ons are to be determ ined. Blan k sections have been kept for version co ntrol. | |
857 | A.1 Identi fication o f Technolo gy and Sta ndards | |
858 | A.2 Constr aining Pol icies, Dir ectives an d Procedur es | |
859 | A.3 RTM | |
860 | The Fee-Re venue SC C ondition D ecision RT M is avail able via T SPR here: http:// DNS /warboard/ anotebk.as p?proj=178 7&Type=Act ive | |
861 | A.4 Packag ing and In stallation | |
862 | A.5 Design Metrics | |
863 | ||
864 | Attachment D – Chang e Log | |
865 | Version | |
866 | Change | |
867 | Notes | |
868 | Status/Res olution | |
869 | 0.02 | |
870 | Replace em bedded dia grams with links to master/lat est file l ocation (T SPR) globa lly | |
871 | Avoids blu rriness an d/or versi on control issues | |
872 | Completed in v0.02 t racked cha nges retur ned to ven dor | |
873 | 0.02 | |
874 | Update acr onyms glob ally | |
875 | ||
876 | ||
877 | 0.02 | |
878 | Section 2. 3.1: add i n function al require ments tabl e for cons istency wi th other S DDs | |
879 | ||
880 | ||
881 | 0.02 | |
882 | Sections 2 .3.6, 3, 3 .1, 3.2.2, 3.2.3, 3. 3.1, 3.3.2 , 3.3.3, 4 .1, 4.2, u pdated for consisten cy with ot her SDDs | |
883 | ||
884 | Completed in v0.02 t racked cha nges retur ned to ven dor | |
885 | 0.03 | |
886 | Globally: Verbiage u pdated to match acro ss all 5 S DDs | |
887 | ||
888 | ||
889 | 0.03 | |
890 | Globally: Ensure acr onyms are defined at first men tion; upda te Acronym s table ac cordingly | |
891 | ||
892 | ||
893 | 0.03 | |
894 | Globally: 508 images – add alt ernative t ext | |
895 | ||
896 | ||
897 | 0.03 | |
898 | Section 1. 1: Removed Purpose ( only SDD t his was pr esent in) | |
899 | Updated ou tline for consistenc y | |
900 | ||
901 | 0.03 | |
902 | Section 2. 2: Review against RS D introduc tion verbi age | |
903 | Believe ne gative con notation w as removed | |
904 | ||
905 | 0.03 | |
906 | Table 2: r emoved REQ PRO colum n as wasn’ t populate d | |
907 | Replace if necessary to match BRD conten t | |
908 | ||
909 | ||
910 | Template R evision Hi story | |
911 | Date | |
912 | Version | |
913 | Descriptio n | |
914 | Author | |
915 | June 2015 | |
916 | 2.10 | |
917 | Changed He ading 1 de fault sett ing to eli minate pag e break be fore | |
918 | Process Ma nagement | |
919 | May 2015 | |
920 | 2.9 | |
921 | Edited for Section 5 08 conform ance and r emediated with Commo n Look Off ice tool | |
922 | Process Ma nagement | |
923 | February 2 015 | |
924 | 2.8 | |
925 | Incorporat es revisio ns from PM AS Reform Lockdown; namely rem oving requ irements f or informa tion that can be obt ained from other PMA S authorit ative sour ces. | |
926 | Andrew Sla wter, Offi ce of Tech nology Str ategies | |
927 | September 2014 | |
928 | 2.7 | |
929 | Adds Enter prise Shar ed Service s terms an d requires AERB Comp liance Cer tificate a ttachment. | |
930 | Process Ma nagement | |
931 | August 201 4 | |
932 | 2.6 | |
933 | Signature block upda te authori zed by AER B CR_01893 4 | |
934 | Process Ma nagement | |
935 | March 2014 | |
936 | 2.5 | |
937 | Section 50 8 repairs to new ver sion appro ved by AER B Chair ap proved | |
938 | Process Ma nagement | |
939 | August 201 3 | |
940 | 2.3 | |
941 | Replaced t he Service Architect ure sub-se ction with new sub-s ections fo r consumed and provi ded servic es. Also a pplied mis cellaneous feedback from VA te am. | |
942 | ASD Enterp rise Share d Services (ESS) Wor k Group | |
943 | June 2013 | |
944 | 1.3 | |
945 | Upgraded t o MS Offic e 2007-201 0 format | |
946 | Process Ma nagement | |
947 | June 2013 | |
948 | 1.2 | |
949 | Address in consistenc ies in Sec tion 3, Co nceptual D esign, Cor rect headi ngs | |
950 | Process Ma nagement | |
951 | March 2013 | |
952 | 1.1 | |
953 | Formatted to documen tation sta ndards and edited fo r Section 508 confor mance | |
954 | Process Ma nagement | |
955 | January 20 13 | |
956 | 1.0 | |
957 | Initial Do cument | |
958 | PMAS Busin ess Office | |
959 | ||
960 | See TOGAF® 9.1, Part III: ADM Guidelines & Techniq ues, Gap A nalysis on TOGAF web site at ht tp://pubs. opengroup. org/archit ecture/tog af9-doc/ar ch/chap27. html |
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