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1 | CPAC.zip\Copays on Hold - Medicare No Insurance | 22-003 Copays on Hold RSD v1.1 - fully signed.docx | Thu Feb 9 15:05:30 2017 UTC |
2 | CPAC.zip\Copays on Hold - Medicare No Insurance | 22-003 Copays on Hold RSD v1.1 - fully signed.docx | Fri Feb 10 15:07:07 2017 UTC |
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1 | Department of Vetera ns Affairs | |
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6 | Copays on Hold – Med icare/No I nsurance | |
7 | ||
8 | ||
9 | Requiremen ts Specifi cation Doc ument | |
10 | ||
11 | ||
12 | ||
13 | ||
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15 | ||
16 | ||
17 | ||
18 | ||
19 | September 2016 | |
20 | ||
21 | Version 1. 1 | |
22 | ||
23 | Revision H istory | |
24 | ||
25 | Date | |
26 | Version | |
27 | Descriptio n | |
28 | Author | |
29 | Reviewer | |
30 | Issue Date | |
31 | 06/09/2015 | |
32 | 0.01 | |
33 | Initial dr aft | |
34 | G. Howard | |
35 | S. Ambrose | |
36 | 07/10/2015 | |
37 | 08/10/2015 | |
38 | 0.02 | |
39 | Revised to include a dditional requiremen ts for Vis tA Held Ch arges Repo rt. | |
40 | G. Howard | |
41 | S. Ambrose | |
42 | 08/11/2015 | |
43 | 08/18/2015 | |
44 | 0.03 | |
45 | Formal rev iew update s | |
46 | C. Dunn | |
47 | ||
48 | ||
49 | 08/31/2015 | |
50 | 0.04 | |
51 | Applied re visions ba sed on VA review and feedback, to includ e: | |
52 | Changed “ patient” r eferences to “Vetera n”. | |
53 | Corrected /clarified Introduct ion and Sc ope sectio ns. | |
54 | Added det ail to | |
55 | References section. | |
56 | Clarified requireme nts for BN | |
57 | 2.2 | |
58 | Added col umn to | |
59 | Held Charg es report. | |
60 | G. Howard | |
61 | S. Ambrose | |
62 | 09/01/2015 | |
63 | 09/14/2015 | |
64 | 1.0 | |
65 | Applied re visions ba sed on VA review and feedback. Clarified wording f or require ments COH- 2.1-01, | |
66 | 2.2-01, 2. 2-02, 3.1. -01, 3.2- | |
67 | 15 and Bus iness Need s 2.1 and 2.2. | |
68 | G. Howard | |
69 | S. Ambrose | |
70 | 09/15/2015 | |
71 | 09/22/2016 | |
72 | 1.1 | |
73 | Updated Re quirement COH | |
74 | 3.2-11 as it was rem oved by cu stomer. | |
75 | S. Quigley | |
76 | ||
77 | 09/22/2016 | |
78 | ||
79 | Table of C ontents | |
80 | ||
81 | 1.Introduc tion ..... .......... .......... .......... .......... .......... .......... .......... .......... ... 1 | |
82 | 1.1. Purp ose ...... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .. 1 | |
83 | 1.2. Scop e ........ .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .... 1 | |
84 | 1.3. Refe rences ... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 5 | |
85 | 2.Overall Descriptio n ........ .......... .......... .......... .......... .......... .......... ........ 6 | |
86 | 2.1. Acce ssibility Specificat ions...... .......... .......... .......... .......... .......... .......... .......... 6 | |
87 | 2.2. Busi ness Rules Specifica tion ..... .......... .......... .......... .......... .......... .......... ........ 6 | |
88 | 2.3. Desi gn Constra ints Speci fication.. .......... .......... .......... .......... .......... .......... ..... 6 | |
89 | 2.4. Disa ster Recov ery Specif ication .. .......... .......... .......... .......... .......... .......... ...... 6 | |
90 | 2.5. Docu mentation Specificat ions...... .......... .......... .......... .......... .......... .......... ...... 6 | |
91 | 2.6. Func tional Spe cification s ........ .......... .......... .......... .......... .......... .......... .......... . 7 | |
92 | 2.6.1.Syst em Feature : Automati cally Rele ase Copay Charges .. .......... ......... 8 | |
93 | 2.6.2.Syst em Feature : Prohibit Copays fr om Being P laced on H old ...... ...... 8 | |
94 | 2.6.3.Vist A Held Cha rges Repor t ........ .......... .......... .......... .......... .......... .......... . 9 | |
95 | 2.7. Grap hical User Interface (GUI) Spe cification s ........ .......... .......... .......... ...... 12 | |
96 | 2.8. Mult i-division al Specifi cations... .......... .......... .......... .......... .......... .......... ....... 12 | |
97 | 2.9. Perf ormance Sp ecificatio ns........ .......... .......... .......... .......... .......... .......... ...... 12 | |
98 | 2.10.Quali ty Attribu tes Specif ication .. .......... .......... .......... .......... .......... .......... ..... 12 | |
99 | 2.11.Relia bility Spe cification s......... .......... .......... .......... .......... .......... .......... .......... 13 | |
100 | 2.12.Scope Integrati on........ .......... .......... .......... .......... .......... .......... .......... .......... ... 13 | |
101 | 2.13.Secur ity Specif ications . .......... .......... .......... .......... .......... .......... .......... .......... 13 | |
102 | 2.14.Syste m Features ......... .......... .......... .......... .......... .......... .......... .......... .......... ... 13 | |
103 | 2.15.Usabi lity Speci fications. .......... .......... .......... .......... .......... .......... .......... .......... 13 | |
104 | 3.Applicab le Standar ds ....... .......... .......... .......... .......... .......... .......... ... 13 | |
105 | 4.Interfac es ....... .......... .......... .......... .......... .......... .......... .......... .......... ... 14 | |
106 | 4.1. Comm unications Interface s ........ .......... .......... .......... .......... .......... .......... ...... 14 | |
107 | 4.2. Hard ware Inter faces..... .......... .......... .......... .......... .......... .......... .......... .......... .. 15 | |
108 | 4.3. Soft ware Inter faces..... .......... .......... .......... .......... .......... .......... .......... .......... ... 15 | |
109 | 4.4. User Interface s ........ .......... .......... .......... .......... .......... .......... .......... .......... ....... 15 | |
110 | 5.Legal, C opyright, and Other Notices .. .......... .......... .......... .......... .... 15 | |
111 | 6.Purchase d Componen ts ....... .......... .......... .......... .......... .......... ......... 15 | |
112 | 6.1. Defe ct Source (TOP 5) .. .......... .......... .......... .......... .......... .......... .......... .......... . 15 | |
113 | 7.User Cla ss Charact eristics.. .......... .......... .......... .......... .......... .......... 15 | |
114 | 8.Estimati on ....... .......... .......... .......... .......... .......... .......... .......... .......... . 15 | |
115 | Attachment A – Appro val Signat ures ..... .......... .......... .......... .......... ....... 17 | |
116 | Attachment B – Acron ym List an d Glossary ......... .......... .......... .......... . 18 | |
117 | ||
118 | Attachment C- Enterp rise Requi rements .. .......... .......... .......... .......... ..20 | |
119 | Attachment D- Types of Plans i n VistA .. .......... .......... .......... .......... .....22 | |
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183 | Copays on Hold- Medi care/No I nsurance | |
184 | Requiremen ts Specifi cation Doc ument !V S eptember 2 016 | |
185 | ||
186 | List of Ta bles | |
187 | ||
188 | Table 1: G oals and I mpacts ... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ......... 2 | |
189 | Table 2: C opays on H old BNs .. .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ...... 3 | |
190 | Table 3: A cronym Lis t and Glos sary ..... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... . 18 | |
191 | Table 4: E nterprise Requiremen ts ....... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ... 20 | |
192 | Table 5: T ypes of Pl ans in Vis tA (As of 4-17-12) . .......... .......... .......... .......... .......... .......... .......... .......... ...... 22 | |
193 | ||
194 | ||
195 | List of Fi gures | |
196 | ||
197 | Figure 1: Cumulative Probabili ty (“S-cur ve”) Chart ......... .......... .......... .......... .......... .......... .......... .......... . 16 | |
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249 | ||
250 | Copays on Hold – Med icare/No I nsurance | |
251 | Requiremen ts Specifi cation Doc umentvSept ember 2016 | |
252 | ||
253 | 1. Introdu ction | |
254 | ||
255 | The Vetera ns Health Informatio n Systems and Techno logy Archi tecture (V istA) Inte grated Bil ling (IB) software a pplication automates the creat ion of thi rd party b illing for ms allowin g for the entry, edi ting, auth orizing, p rinting, a nd canceli ng of bill s. It also provides reports to identify billable e pisodes of care, pat ient and i nsurance i nquiries, and statis tical data . Part of this funct ionality i nvolves pr ocessing f irst party bills for medicatio ns or serv ices. Firs t party bi lls are cr eated when a Veteran incurs ch arges base d on the p atient’s p riority gr oup and/or income le vel for me dical serv ices rende red at a D epartment of Veteran s Affairs (VA) healt h care fac ility. The charges i ncurred ar e generall y copaymen ts for Vet erans who are treate d as an in patient, o utpatient, or in rec eipt of pr escription s.1 If the Veteran d oes not ha ve third p arty billa ble insura nce, copay charges a re release d to the V eteran and he/she re ceives a m onthly sta tement sho wing the c opay amoun ts due. If the Veter an does ha ve billabl e insuranc e, copay c harges are automatic ally put o n hold by the system (within t he 350 IB Action Fil e) for up to 90 days . This hol ding perio d allows t ime for VA to submit bills to the third party insu rance carr ier as wel l as time for the ca rrier to s ubmit paym ent(s) bac k to VA. R evenue per sonnel act ively revi ew | |
256 | Veteran co payments o n hold (“h eld charge s”) to ens ure third party paym ents are a pplied to offset | |
257 | the amount due from the Vetera n as well as release charges w here the s ervices ar e not cove red by the ir third p arty insur ance. Thes e core rev iews will not be imp acted by t he enhance ments in t his Requir ements Spe cification Document (RSD). | |
258 | ||
259 | Veterans a nd Active Duty perso nnel who p resent for care unde r their TR ICARE bene fit are no t subject to the Vet eran copay ments refe renced in this docum ent. Those beneficia ries are a ssessed a cost share based on third part y payments collected and indiv idual TRIC ARE policy coverage. Other Fir st Party b ills are m anually cr eated for TRICARE be neficiarie s when a c ost-share is due fro m submissi on of a cl aim for me dical serv ices to TR ICARE. | |
260 | ||
261 | 1.1.Purpos e | |
262 | ||
263 | This RSD s pecifies t he require ments for the Copays on Hold e nhancement of the El ectronic D ata Interc hange (EDI ) Consolid ated Patie nt Account Center (C PAC) Reven ue Enhance ments Prog ram. The i ntended au dience is the Chief Business O ffice (CBO ) 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. | |
264 | ||
265 | 1.2.Scope | |
266 | ||
267 | This docum ent addres ses the Bu siness Nee d (BN) and requireme nts propos ed in the Copays on Hold – Med icare/No I nsurance W ork Effort Unique Id entifying #20120204 Business R equirement s Document (BRD) dat ed July 20 12, which outlines r ecommended changes t o the Vist A IB appli cation. | |
268 | ||
269 | The goals, impacts, and outcom e measures of the en hancements proposed in the BRD are shown in Table 1. Note: d uring requ irements e laboration , VA stake holders an d subject matter exp erts exami ned the BN s, goals, and outcom es from th e BRD and applied cl arificatio ns and cor rections. | |
270 | ||
271 | ||
272 | ||
273 | 1 Series 1 601C: Reve nue for Ve teran Bene fits/Claim s – First Party Acco unts Recei vable | |
274 | ||
275 | Therefore, the BNs e xpressed i n this doc ument may differ sli ghtly from the origi nal BNs li sted in th e BRD refe renced abo ve. | |
276 | ||
277 | Table 1: G oals and I mpacts | |
278 | ||
279 | Goal/Objec tive and D esired | |
280 | Outcome | |
281 | Impact | |
282 | Measuremen t | |
283 | Automatica lly releas e copay | |
284 | charges fo r Veterans when all of the fol lowing cri teria have been | |
285 | determined /met: | |
286 | All outst anding Buf fer File e ntries cur rently ass igned to t he Veteran have been processed ; | |
287 | Veteran h as no othe r billable third par ty insuran ce for the copay dat e loaded i nto the in surance fi le. Note: “no | |
288 | other bill able third party ins urance” is indicated by a valu e of “No” in the “Wi ll Reimbur se” field in the ins urance com pany edito r as well as individ ual/group plan cover age limita tions. | |
289 | If the Ve teran only has TRICA RE or Civi lian Healt h and Medi cal Progra m of the V A (CHAMPVA ) in the P atient Ins urance (PI ) File and has no ot her billab le third p arty insur ance for t he copay d ate loaded into the insurance file. Note : “no othe r billable third par ty insuran ce” is ind icated by a value of “No” in t he “Will R eimburse” field in t he | |
290 | insurance company ed itor as we ll as indi vidual/gro up plan | |
291 | coverage l imitations . | |
292 | More effi cient use of VA reso urces by d iscontinui ng the man ual proces s of relea sing first party cop ayments. | |
293 | Adherence to the Ve terans Hea lth Admini stration ( VHA) Direc tive 2012- 005 Applic ation of T hird-Party Reimburse ment to Ve teran Copa yments (ht tp:// DNS / DNS ations/Vi ewPublicat ion.asp?pu b_ID=2480 ) that cop ays are he ld only fo r billable insurance reimburse ments. | |
294 | Less Vete ran confus ion due to extensive time laps e, resulti ng in less calls to Health | |
295 | Resource C enter (HRC ) and | |
296 | CPACs. | |
297 | Copay char ges will b e automati cally rele ased to Ve terans 100 % of the t ime when a ll buffer | |
298 | file entri es have be en process ed | |
299 | and no | |
300 | additional billable insurance for the da te of serv ice or pre scription fill date is active (including Veterans who only h ave TRICAR E and CHAM PVA). | |
301 | ||
302 | Table 2 re flects the BNs/requi rements fr om the BRD . | |
303 | ||
304 | Table 2: C opays on H old BNs | |
305 | ||
306 | ReqPro Tag | |
307 | BN | |
308 | Owner Requ irement (O WNR) | |
309 | Number | |
310 | OWNR | |
311 | Priority* | |
312 | NEED1555 | |
313 | BN 1: Adhe re to the Enterprise Level req uirements within the Requireme nts Manage ment Repos itory (RMR ) and as s pecificall y addresse d in Appen dix B of t his docume nt. | |
314 | NEED2227 | |
315 | BN 2: Prov ide the ab ility for the VistA IB softwar e applicat ion to aut omatically release c opay charg es for Vet erans, whe n appropri ate. | |
316 | OWNR10112 | |
317 | ||
318 | 2.1 | |
319 | Provide th e ability for the Vi stA IB sof tware appl ication to automatic ally relea se copay c harges whe n processi ng the Buf fer File a nd all of the follow ing criter ia have be en determi ned/met: | |
320 | All outsta nding Buff er File en tries curr ently assi gned to th e Veteran have been processed; | |
321 | Veteran ha s no other billable third part y insuranc e for the copay date loaded in to the ins urance fil e. Note: “ no other b illable th ird party insurance” is indica ted by a v alue of “N o” in the “Will Reim burse” fie ld in the insurance company ed itor as we ll as indi vidual/gro up plan co verage lim itations. | |
322 | High | |
323 | OWNR10113 | |
324 | ||
325 | 2.2 | |
326 | Provide th e ability to not pla ce copays on hold if the Veter an only ha s TRICARE or CHAMPVA insurance within th e VistA in surance fi le and has no other billable t hird party insurance for the c opay date loaded int o the insu rance file . Note: “n o other bi llable thi rd party i nsurance” is indicat ed by a va lue of “No ” in the “ Will Reimb urse” fiel d in the i nsurance c ompany edi tor as wel l as indiv idual/grou p plan cov erage limi tations. | |
327 | High | |
328 | ||
329 | ||
330 | ReqPro Tag | |
331 | BN | |
332 | Owner Requ irement (O WNR) | |
333 | Number | |
334 | OWNR | |
335 | Priority* | |
336 | ||
337 | ||
338 | 2.3 | |
339 | Provide th e ability to automat ically rel ease copay ment charg es when in surance fi le coverag e limitati ons for an y insuranc e active f or that da te of serv ice/fill d ate indica te “NO” co verage for that part icular typ e of servi ce. | |
340 | High | |
341 | ||
342 | BN 3: Prov ide enhanc ements to the VistA Held Charg es Report to address current | |
343 | CPAC proce sses and u se of the report. | |
344 | ||
345 | ||
346 | 3.1 | |
347 | System sha ll include a List Ma nager User Interface with avai lable Vist A fields c urrently r equired fo r effectiv e review o f held cop ayment cha rges: | |
348 | 1. Site/D ivision | |
349 | 2. Patien t Name | |
350 | 3. Patien t ID | |
351 | 4. Insura nce | |
352 | 5. Covera ge limitat ions | |
353 | 6. Covera ge effecti ve dates | |
354 | 7. Event type | |
355 | 8. Date o f service or fill da te | |
356 | 9. RX num ber when a pplicable | |
357 | 10. Amount on hold | |
358 | 11. Date c opay bille d | |
359 | 12. Third party clai m(s) numbe rs associa ted with p atient and date of s ervice | |
360 | 13. Curren t Status o f associat ed third p arty claim s identifi ed in Fiel d | |
361 | #12. | |
362 | 14. Date t hird party claims bi lled | |
363 | 15. Billed charges f or third p arty claim s | |
364 | 16. Number of days O n Hold | |
365 | High | |
366 | ||
367 | ||
368 | ReqPro Tag | |
369 | BN | |
370 | Owner Requ irement (O WNR) | |
371 | Number | |
372 | OWNR | |
373 | Priority* | |
374 | ||
375 | ||
376 | 3.2 | |
377 | System sha ll provide report pa rameters t hat allow customizat ion of dat a: | |
378 | 1. Timefr ame (based on date o f service/ fill date) | |
379 | 2. Site/D ivision | |
380 | 3. Patien t name and last 4 | |
381 | Social Sec urity Numb er | |
382 | (SSN) | |
383 | 4. Includ e insuranc e informat ion (y/n) | |
384 | 5. Includ e previous ly release d copay ch arges (y/n ) | |
385 | 6. Excel ready prin t to file | |
386 | High | |
387 | ||
388 | ||
389 | 3.3 | |
390 | System sha ll perform an intern al sort so file outp ut will gr oup copaym ent charge data by p atient eli minating d uplicate e ntries of patient na me and ins urance inf ormation. | |
391 | High | |
392 | ||
393 | ||
394 | 3.4 | |
395 | System sha ll only pu ll PI info rmation re levant to the oldest date of h eld charge s for a pa tient (dat e of servi ce). | |
396 | High | |
397 | ||
398 | This docum ent addres ses only t he Copays on Hold en hancement, one of fi ve enhance ments comp rising the EDI CPAC Revenue En hancements Program. Details re garding ot her enhanc ements in the progra m are desc ribed in s eparate RS Ds. | |
399 | ||
400 | 1.3.Refere nces | |
401 | ||
402 | The follow ing docume ntation co ntains inf ormation r elated to this RSD: | |
403 | ||
404 | Copays on Hold – Me dicare/No Insurance Work Effor t Unique I dentifying #20120204 | |
405 | BRD, July 2012 | |
406 | CHAMPVA P olicy Manu al, Chapte r 1 – Prog ram Admini stration h ttp:// DNS /reference s/policyma nuals/cham pva/defaul t.htm | |
407 | Financial Policies and Proced ures, Medi cal Care D ebts, Volu me XII - C hapter 5, June | |
408 | 2010 http: // DNS /finance/d ocs/VA-Fin ancialPoli cyVolumeXI IChapter05 .pdf | |
409 | General C ounsel Dec ision/Ruli ng (PRC03- 96) – Appl ication of Health In surance | |
410 | Payments t o Veterans ’ Copaymen t Obligati ons, 5/23/ 96 | |
411 | http:// DNS /ogc/docs/ 1996/Prc03 -96.doc | |
412 | ||
413 | Help Desk Inquiry, Case ID: H D000000039 0964, Ente red 3/30/1 0 http:// DNS\ pasdocs/su pportinfo/ 20120204 C opays on H old - Medi care No In surance.zi p | |
414 | New Servi ce Request (NSR) #20 120204 Cop ays On Hol d – Medica re/No Insu rance http :// DNS /nsrd/Tab_ GeneralInf oView.asp? RequestID= 20120204 | |
415 | Series 16 01C: Reven ue for Vet erans Bene fits/Claim s – First Party Acco unts Recei vable http :// DNS /cbo/apps/ policyguid es/infomap .asp?addre ss=VHA_PG_ 1601C.04.2 | |
416 | .A.1 | |
417 | Spreadshe et, Types of Plans ( VistA). Sh own in Att achment D – Types of Plans in VistA | |
418 | of this do cument. | |
419 | VA Handbo ok 6500 – Informatio n Security Program h ttp:/ DNS /vapubs/vi ewPublicat ion.asp?Pu b_ID=364&F Type=2 | |
420 | VHA Direc tive 2012- 005 Applic ation of T hird-Party Reimburse ment to Ve teran http :// DNS .asp?pub_I D=2480 | |
421 | 2. Overall Descripti on | |
422 | ||
423 | 2.1.Access ibility Sp ecificatio ns | |
424 | ||
425 | This proje ct will ad here to al l applicab le require ments of S ection 508 of the Re habilitati on Act of | |
426 | 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. | |
427 | ||
428 | 2.2.Busine ss Rules S pecificati on | |
429 | ||
430 | There are no specifi c business rules app licable to this enha ncement. | |
431 | ||
432 | 2.3.Design Constrain ts Specifi cation | |
433 | VA Standa rds and Co nventions for Massac husetts Ge neral Hosp ital Utili ty Multi- Programmin g System ( MUMPS) dev elopment | |
434 | VA Techni cal Refere nce Model (TRM) | |
435 | ||
436 | 2.4.Disast er Recover y Specific ation | |
437 | ||
438 | 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. | |
439 | ||
440 | 2.5.Docume ntation Sp ecificatio ns | |
441 | ||
442 | System doc umentation to be del ivered wil l be in ac cordance w ith PMAS a nd ProPath System | |
443 | Developmen t Processe s. | |
444 | ||
445 | Documentat ion to be delivered includes b ut is not limited to : | |
446 | ||
447 | Installat ion Guide | |
448 | User Guid e | |
449 | Technical Manual | |
450 | Security Guide | |
451 | ||
452 | Contingen cy Plan | |
453 | Disaster Recovery P lan (DRP) | |
454 | Deploymen t Plan | |
455 | Release N otes | |
456 | ||
457 | 2.6.Functi onal Speci fications | |
458 | ||
459 | The VistA IB softwar e applicat ion automa tes the cr eation of third part y billing forms allo wing for t he entry, editing, a uthorizing , printing , and canc eling of b ills. It a lso provid es reports to identi fy billabl e episodes of care, Veteran an d insuranc e inquirie s, and sta tistical d ata. Part of | |
460 | this funct ionality i nvolves pr ocessing f irst party bills for medicatio ns or serv ices. Firs t party bi lls are cr eated when a Veteran incurs ch arges base d on the V eteran’s p riority gr oup and/or income le vel for me dical serv ices rende red at a V A health c are facili ty. The ch arges incu rred are g enerally c opayments for Vetera ns who are treated a s an inpat ient, outp atient, or in receip t of presc riptions.2 If the Ve teran does not have third part y billable insurance , copay ch arges are released t o the Vete ran; and h e/she rece ives a mon thly state ment showi ng the cop ay amounts | |
461 | due. If th e Veteran does have billable i nsurance, copay char ges are au tomaticall y put on h old by the system (w ithin the 350 IB Act ion File) for up to 90 days. T his holdin g period a llows time for VA to submit bi lls to the third par ty insuran ce carrier as well a s time for the carri er to subm it payment (s) back t o VA. | |
462 | ||
463 | The Buffer File was created to provide a temporary holding f ile for ne wly identi fied healt h insuranc e policies until suc h time tha t the poli cy informa tion could be verifi ed and pla ced into t he PI File for billi ng. When t he Buffer File was d esigned in the 1990s , all copa ys were au tomaticall y placed o n hold whe n any entr y was made in the Bu ffer File or if the Veteran ha d active i nsurance i n the Vist A PI File. Since the buffer wa s only use d to colle ct billabl e insuranc e and/or M edicare fo r those Ve terans wit h insuranc e, the hol d copay fe ature was not a prob lem. Sites could man age the co pays on ho ld for tho se limited number of entries i n the Buff er File th at may hav e erroneou sly been c reated. Th is became a problem when the I nsurance C apture Buf fer (ICB) was releas ed to the field with instructi ons to act ually crea te buffer entries fo r ‘No Insu rance’ and ‘Patient Refused’. Collecting and verif ying all M edicare in formation from the | |
464 | Buffer Fil e, regardl ess of whe ther the V eteran has any billa ble insura nce or not , compound ed the pro blem. This has resul ted in inc reased man hours to manually r elease cop ay charges from leng thy ‘Held Charges Re ports’. If the repor t is not w orked on a regular b asis, the system wil l auto-rel ease the c harges in 90 days. V HA has man dated that copays ar e held onl y for bill able insur ance reimb ursements. Additiona lly, Veter ans can be come confu sed due to the long wait from the time s ervice was rendered to the tim e they rec eive a bil l. This ha s increase d the volu me of call s that are being mad e by the V eteran to HRC and CP ACs for ex planations associate d with the delay. | |
465 | ||
466 | To remedy this situa tion, the VistA IB s oftware ap plication must be up dated to a utomatical ly release copay cha rges after the insur ance verif ication st aff has co mpleted pr ocessing o f each ind ividual bu ffer file entry for a specific Veteran. | |
467 | ||
468 | ||
469 | ||
470 | ||
471 | 2 Series 1 601C: Reve nue for Ve teran Bene fits/Claim s – First Party Acco unts Recei vable | |
472 | ||
473 | The VistA Held Charg es Report will be re worked ext ensively a nd convert ed to List Manager f ormat. The List Mana ger format will allo w the user to intera ct with th e report t o facilita te the exa mination o f data. Li st Manager actions w ill be cre ated that will provi de the use r with the capabilit y to relea se the cop ay charges directly from the L ist Manage r report s creen, and also the capability to export the repor t to Excel format. N ew report filtering selections will be p rovided to further c ustomize t he report generation . | |
474 | ||
475 | 2.6.1.Syst em Feature : Automati cally Rele ase Copay Charges | |
476 | ||
477 | BN 2: Prov ide the ab ility for the VistA IB softwar e applicat ion to aut omatically release c opay charg es for Vet erans, whe n appropri ate. | |
478 | ||
479 | BN 2.1: Pr ovide the ability fo r the Vist A IB softw are applic ation to a utomatical ly release copay cha rges when processing the Buffe r File and all of th e followin g criteria have been determine d/met: 1) All outsta nding Buff er File en tries curr ently assi gned to th e Veteran have been processed; 2) Vetera n has no o ther billa ble third party insu rance for the copay date loade d into the insurance file. Not e: “no oth er billabl e third pa rty insura nce” is in dicated by a value o f “No” in the “Will Reimburse” field in the insura nce compan y editor a s well as individual /group pla n coverage limitatio ns. | |
480 | ||
481 | 2.6.1.1.Fu nctional R equirement : COH-2.1- 01 | |
482 | ||
483 | The system shall aut omatically release c opay charg es for a V eteran dur ing Buffer File proc essing whe n both of the follow ing condit ions are m et: all ou tstanding Buffer Fil e entries assigned t o the Vete ran have b een proces sed, and t he Veteran has no ot her billab le third p arty insur ance for t he copay d ate loaded into the insurance file. Note : “no othe r billable third par ty insuran ce” is ind icated by a value of “No” in t he “Will R eimburse” field in t he insuran ce company editor as well as i ndividual/ group plan coverage limitation s. | |
484 | ||
485 | ||
486 | ||
487 | BN 2.3: Pr ovide the ability to automatic ally relea se copayme nt charges when insu rance file coverage limitation s for any insurance active for that date of servic e/fill dat e indicate “NO” cove rage for t hat partic ular type of service . | |
488 | ||
489 | 2.6.1.2.Fu nctional R equirement : COH-2.3- 01 | |
490 | ||
491 | The system shall aut omatically release c opay charg es for a V eteran whe n insuranc e file cov erage limi tations fo r the date of servic e/fill dat e indicate that ther e is no co verage for that part icular | |
492 | type of se rvice. Thi s applies to any ins urance act ive for th e date of service/fi ll date be ing evalua ted. | |
493 | ||
494 | 2.6.2.Syst em Feature : Prohibit Copays fr om Being P laced on H old | |
495 | ||
496 | BN 2: Prov ide the ab ility for the VistA IB softwar e applicat ion to aut omatically release c opay charg es for Vet erans, whe n appropri ate. | |
497 | ||
498 | BN 2.2: Pr ovide the ability to not place copays on hold if t he Veteran only has TRICARE or CHAMPVA i nsurance w ithin the VistA insu rance file and has n o other bi llable thi rd party i nsurance f or the cop ay date lo aded into the insura nce file. Note: “no other bill able third party | |
499 | ||
500 | insurance” is indica ted by a v alue of “N o” in the “Will Reim burse” fie ld in the | |
501 | insurance company ed itor as we ll as indi vidual/gro up plan co verage lim itations. | |
502 | ||
503 | 2.6.2.1.Fu nctional R equirement : COH-2.2- 01 | |
504 | ||
505 | The system shall pro hibit copa ys from be ing placed on hold i f the Vete ran has TR ICARE insu rance with in the Vis tA insuran ce file an d no other billable third part y insuranc e for the copay date loaded in to the ins urance fil e. Note: “ no other b illable th ird party insurance” is indica ted by | |
506 | a value of “No” in t he “Will R eimburse” field in t he insuran ce company editor as well as i ndividual/ group plan coverage limitation s. | |
507 | ||
508 | 2.6.2.2.Fu nctional R equirement : COH-2.2- 02 | |
509 | ||
510 | The system shall pro hibit copa ys from be ing placed on hold i f the Vete ran has CH AMPVA insu rance with in the Vis tA insuran ce file an d no other billable third part y insuranc e for the copay date loaded in to the ins urance fil e. Note: “ no other b illable th ird party insurance” is indica ted by | |
511 | a value of “No” in t he “Will R eimburse” field in t he insuran ce company editor as well as i ndividual/ group plan coverage limitation s. | |
512 | ||
513 | 2.6.3.Vist A Held Cha rges Repor t | |
514 | ||
515 | BN 3: Prov ide enhanc ements to the VistA Held Charg es Report to address current C PAC | |
516 | processes and use of the repor t. | |
517 | ||
518 | BN3.1: Sys tem shall include av ailable Vi stA fields currently required for effect ive review of held c opayment c harges: Si te/Divisio n, Patient Name, Pat ient ID, I nsurance, Coverage l imitations , Coverage effective dates, Ev ent type, Date of se rvice or f ill date, RX number when appli cable, Amo unt on hol d, Date co pay billed , Third pa rty claim( s) numbers associate d with pat ient and d ate of ser vice, Date third par ty claims billed, Bi lled charg es for thi rd party c laims, Num ber of Day s On Hold. | |
519 | ||
520 | 2.6.3.1.Fu nctional R equirement : COH-3.1- 01 | |
521 | ||
522 | The system shall pro vide the c apability to produce the VistA Held Char ges report containin g the foll owing fiel ds: | |
523 | ||
524 | Site/Divi sion | |
525 | ||
526 | Patient N ame | |
527 | ||
528 | Patient I D | |
529 | ||
530 | Insurance | |
531 | ||
532 | Coverage limitation s | |
533 | ||
534 | Coverage effective dates | |
535 | ||
536 | Event typ e | |
537 | ||
538 | Date of s ervice or fill date | |
539 | ||
540 | RX number when appl icable | |
541 | ||
542 | Amount on hold | |
543 | ||
544 | Date copa y billed | |
545 | ||
546 | Third par ty claim(s ) numbers associated with pati ent and da te of serv ice | |
547 | ||
548 | Current S tatus of a ssociated third part y claims | |
549 | ||
550 | Date thir d party cl aims bille d | |
551 | ||
552 | Billed ch arges for third part y claims | |
553 | ||
554 | Number of Days on H old | |
555 | ||
556 | ||
557 | ||
558 | BN 3.2 Sys tem shall provide re port param eters that allow cus tomization of data: Timeframe (based on date of se rvice/fill date), Si te/Divisio n, Patient name, Inc lude insur ance infor mation (y/ n), Includ e previous ly release d copay ch arges (y/n ), Excel r eady print to file. | |
559 | ||
560 | 2.6.3.2.Fu nctional R equirement COH-3.2-0 1 | |
561 | ||
562 | The system shall pro vide the c apability to generat e the Vist A Held Cha rges repor t for a Da te of | |
563 | Service/Fi ll Date as defined b y the user . | |
564 | ||
565 | 2.6.3.3.Fu nctional R equirement COH-3.2-0 2 | |
566 | ||
567 | The system shall pro vide the c apability to generat e the Vist A Held Cha rges repor t for a ra nge of | |
568 | Dates of S ervice/Fil l Dates as defined b y the user . | |
569 | ||
570 | 2.6.3.4.Fu nctional R equirement COH-3.2-0 3 | |
571 | ||
572 | The system shall pro vide the c apability to generat e the Vist A Held Cha rges repor t for all Dates of S ervice/Fil l Dates. | |
573 | ||
574 | 2.6.3.5.Fu nctional R equirement COH-3.2-0 4 | |
575 | ||
576 | The system shall pro vide the c apability to generat e the Vist A Held Cha rges repor t for a Si te | |
577 | (Division within Sit e) as defi ned by the user. | |
578 | ||
579 | 2.6.3.6.Fu nctional R equirement COH-3.2-0 5 | |
580 | ||
581 | The system shall pro vide the c apability to generat e the Vist A Held Cha rges repor t for more than one Site (Divi sion withi n Site) as defined b y the user . | |
582 | ||
583 | 2.6.3.7.Fu nctional R equirement COH-3.2-0 6 | |
584 | ||
585 | The system shall pro vide the c apability for the us er to gene rate the V istA Held Charges re port for a ll Sites ( including Division w ithin Site ). | |
586 | ||
587 | 2.6.3.8.Fu nctional R equirement COH-3.2-0 7 | |
588 | ||
589 | The system shall pro vide the c apability to generat e the Vist A Held Cha rges repor t for a Ve teran as d efined by the user. | |
590 | ||
591 | 2.6.3.9.Fu nctional R equirement COH-3.2-0 8 | |
592 | ||
593 | The system shall pro vide the c apability to generat e the Vist A Held Cha rges repor t for more than one Veteran as defined b y the user . | |
594 | ||
595 | 2.6.3.10. Functiona l Requirem ent COH-3. 2-09 | |
596 | ||
597 | The system shall pro vide the c apability for the us er to gene rate the V istA Held Charges re port for a ll Veteran s. | |
598 | ||
599 | 2.6.3.11. Functiona l Requirem ent COH-3. 2-10 | |
600 | ||
601 | The system shall pro vide the c apability for the us er to choo se whether insurance informati on is incl uded on th e VistA He ld Charges report. I nsurance i nformation includes Insurance, Coverage Limitation s, and Cov erage Effe ctive Date s. | |
602 | ||
603 | 2.6.3.12. Functiona l Requirem ent COH-3. 2-11 | |
604 | ||
605 | The system shall pro vide the c apability for the us er to choo se whether Previousl y Released | |
606 | Copay char ges are in cluded on the VistA Held Charg es report. **This R equirement was | |
607 | ||
608 | Removal of | |
609 | removed by the custo mer (see a ttachment) .COH-3.2-1 1 per Ann | |
610 | ||
611 | 2.6.3.13. Functiona l Requirem ent COH-3. 2-12 | |
612 | ||
613 | The system shall gen erate the VistA Held Charges r eport in L ist Manage r format. | |
614 | ||
615 | 2.6.3.14. Functiona l Requirem ent COH-3. 2-13 | |
616 | ||
617 | The system shall pro vide a Lis t Manager action to export the VistA Hel d Charges report in Excel form at. | |
618 | ||
619 | 2.6.3.15. Functiona l Requirem ent COH-3. 2-14 | |
620 | ||
621 | The system shall pro vide a Lis t Manager action to release he ld co-pay charges fo r a select ed line it em on the VistA Held Charges r eport. | |
622 | ||
623 | 2.6.3.16. Functiona l Requirem ent COH-3. 2-15 | |
624 | ||
625 | The system shall lim it the abi lity to re lease held co-pay ch arges from the VistA Held Char ges report List Mana ger screen by mainta ining the existing r equirement of the us er to poss ess the IB AUTHORIZE security key to acc ess this o ption. | |
626 | ||
627 | ||
628 | ||
629 | BN 3.3: Sy stem shall perform a n internal sort so f ile output will grou p copaymen t charge d ata by | |
630 | Veteran el iminating duplicate entries of patient n ame and in surance in formation. | |
631 | ||
632 | 2.6.3.17. Functiona l Requirem ent COH-3. 3-01 | |
633 | ||
634 | The system shall gro up data by patient o n the Vist A Held Cha rges repor t, with ea ch copayme nt appeari ng as a se parate lin e item wit hin each p atient. | |
635 | ||
636 | (Note: pre sently the report gr oups data by payment s, causing the same patient to appear in multiple locations on the rep ort.) | |
637 | ||
638 | 2.6.3.18. Functiona l Requirem ent COH-3. 3-02 | |
639 | ||
640 | The system shall inc lude only charges ha ving on “o n hold” st atus on th e VistA He ld Charges | |
641 | report. | |
642 | ||
643 | 2.6.3.19. Functiona l Requirem ent COH-3. 3-03 | |
644 | ||
645 | The system shall gen erate the Patient ID on the Vi stA Held C harges rep ort as the first let ter of the last name /last four digits of the Veter an’s SSN. For exampl e, a Veter an whose l ast name b egins with the lette r ‘B’ and whose SSN ends with 1234 will appear on the report as B1234. | |
646 | ||
647 | ||
648 | ||
649 | BN 3.4: Sy stem shall only pull PI inform ation rele vant to th e oldest d ate of hel d charges for a | |
650 | Veteran (d ate of ser vice). | |
651 | ||
652 | 2.6.3.20. Functiona l Requirem ent COH-3. 4-01 | |
653 | ||
654 | The system shall inc lude only the insura nce inform ation (as listed in requiremen t COH-3.2- 10) that w as active at the tim e of the e pisode of care relat ing to the held copa y charges on the Vis tA Held Ch arges Repo rt. | |
655 | ||
656 | 2.7.Graphi cal User I nterface ( GUI) Speci fications | |
657 | ||
658 | This enhan cement doe s not invo lve a GUI. | |
659 | ||
660 | 2.8.Multi- divisional Specifica tions | |
661 | ||
662 | 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. The Vis tA Held Ch arges Repo rt will re flect 5 di git divisi on number within sit e. | |
663 | ||
664 | 2.9.Perfor mance Spec ifications | |
665 | ||
666 | No perform ance speci fications have been identified . | |
667 | ||
668 | It is impl ied that t his enhanc ement will not intro duce perfo rmance deg radation t o the exis ting syste m. | |
669 | ||
670 | 2.10. Qual ity Attrib utes Speci fication | |
671 | ||
672 | 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. | |
673 | ||
674 | The MUMPS code devel oped for t his projec t will be compliant to all VA MUMPS Codi ng | |
675 | Standards and Conven tions. | |
676 | ||
677 | 2.11. Reli ability Sp ecificatio ns | |
678 | ||
679 | System ava ilability should be 24 hours p er day, 36 5 days per year exce pt during periods of scheduled maintenan ce. | |
680 | ||
681 | 2.12. Scop e Integrat ion | |
682 | ||
683 | This enhan cement wil l be limit ed to chan ges to the VistA IB applicatio n only. | |
684 | ||
685 | 2.13. Secu rity Speci fications | |
686 | ||
687 | There are no explici t security specifica tions for this enhan cement. | |
688 | ||
689 | 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. | |
690 | ||
691 | 2.14. Syst em Feature s | |
692 | ||
693 | This enhan cement mod ifies an e xisting Vi stA applic ation. | |
694 | ||
695 | The System Features introduced by this p roject are detailed in Section Error! Re ference so urce not f ound.. | |
696 | ||
697 | 2.15. Usab ility Spec ifications | |
698 | ||
699 | The existi ng IB user interface will be u sed for th is enhance ment, incl uding exis ting usabi lity speci fications. The user interface features o f the exis ting VistA IB applic ation will not be mo dified, an d therefor e no perfo rmance deg radation w ill be int roduced. | |
700 | ||
701 | 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. | |
702 | ||
703 | 3. Applica ble Standa rds | |
704 | ||
705 | 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). | |
706 | ||
707 | 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. | |
708 | ||
709 | 44 U.S.C. § 3541, “ Federal In formation Security M anagement Act (FISMA ) of 2002” | |
710 | Federal I nformation Processin g Standard s (FIPS) P ublication 140-2, “S ecurity | |
711 | Requiremen ts For Cry ptographic Modules” | |
712 | 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 | |
713 | VA Direct ive 6102, “Internet/ Intranet S ervices,” July 15, 2 008 | |
714 | 36 C.F.R. Part 1194 “Electron ic and Inf ormation T echnology (IT) Acces sibility | |
715 | Standards, ” July 1, 2003 | |
716 | ||
717 | Office of Managemen t and Budg et (OMB) C ircular A- 130, “Mana gement of Federal | |
718 | Informatio n Resource s,” Novemb er 28, 200 0 | |
719 | 32 C.F.R. Part 199, “Civilian Health an d Medical Program of the Unifo rmed Servi ces | |
720 | (CHAMPUS)” | |
721 | An Introd uctory Res ource Guid e for Impl ementing t he Health Insurance Portabilit y and | |
722 | Accountabi lity Act ( HIPAA) Sec urity Rule , March 20 05 | |
723 | Sections 504 and 50 8 of the R ehabilitat ion Act (2 9 U.S.C. § 794d), as amended b y the | |
724 | Workforce Investment Act of 19 98 (P.L. 1 05-220), A ugust 7, 1 998 | |
725 | Homeland Security P residentia l Directiv e (12) (HS PD-12) | |
726 | VA Direct ive 6500, “Informati on Securit y Program, ” August 4 , 2006 | |
727 | VA Handbo ok 6500, “ Informatio n Security Program,” September 18, 2007 | |
728 | VA Handbo ok, 6500.5 , Incorpor ating Secu rity and P rivacy in System Dev elopment | |
729 | Lifecycle. | |
730 | VA Handbo ok 6500.6, “Contract Security, ” March 12 , 2010 | |
731 | PMAS port al (refere nce Perfor mance Work Statement (PWS) Ref erences – Technical | |
732 | Library | |
733 | Office of Enterpris e Developm ent (OED) ProPath Pr ocess Meth odology (r eference P WS Referen ces –Techn ical Libra ry and Pro Path Libra ry. Note: In the eve nt of a co nflict, OE D ProPath takes prec edence ove r other pr ocesses or methodolo gies. | |
734 | TRM | |
735 | National Institute Standards and Techno logy (NIST ) Special Publicatio ns (SP) 80 0-60 and 8 00-53 | |
736 | 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 ] | |
737 | HIPAA of 1996; Pub. L 104-191. | |
738 | 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 | |
739 | VA M Prog ramming St andards an d Conventi ons. Revis ed 04/03/2 007 | |
740 | 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 /vapubs/vi ewPublicat ion.asp?Pu b_ID=435&F Type=2) | |
741 | ||
742 | 4. Interfa ces | |
743 | ||
744 | 4.1.Commun ications I nterfaces | |
745 | ||
746 | No new com munication s interfac es are req uired for this enhan cement. | |
747 | ||
748 | 4.2.Hardwa re Interfa ces | |
749 | ||
750 | No new har dware inte rfaces are required for this e nhancement . | |
751 | ||
752 | 4.3.Softwa re Interfa ces | |
753 | ||
754 | No new sof tware inte rfaces are required for this e nhancement . | |
755 | ||
756 | 4.4.User I nterfaces | |
757 | ||
758 | This enhan cement wil l use the existing V istA Fee B asis user interface. No modifi cations ar e specifie d for the user inter face. | |
759 | ||
760 | 5. Legal, Copyright, and Other Notices | |
761 | ||
762 | This effor t is spons ored by an agency of the Unite d States G overnment. Neither t he United States | |
763 | Government nor any a gency ther eof, nor H arris Corp oration no r any of i ts subcont ractors, n or any of their empl oyees, mak es any war ranty, exp ress or im plied, or assumes an y legal li ability or responsib ility for the accura cy, comple teness, or usefulnes s of any i nformation , apparatu s, product , or proce ss disclos ed, or rep resents th at its use would not infringe on private ly owned r ights. Ref erence her ein to any specific commercial product, process, o r service by trade n ame, trade mark, manu facturer, or otherwi se does no t necessar ily consti tute or im ply its en dorsement, recommend ation, or favoring b y the Unit ed States Government or any ag ency there of, or Har ris Corpor ation or a ny of its subcontrac tors. The views and opinions o f authors expressed herein do not necess arily stat e or refle ct those o f the Unit ed States Government or any ag ency there of. | |
764 | ||
765 | 6. Purchas ed Compone nts | |
766 | ||
767 | Not applic able. | |
768 | ||
769 | 6.1.Defect Source (T OP 5) | |
770 | ||
771 | Not applic able. | |
772 | ||
773 | 7. User Cl ass Charac teristics | |
774 | ||
775 | The enhanc ements des cribed in this docum ent will b e used by Billers, F irst Party Accounts | |
776 | Management , HRC Firs t Party Ca ll Center, and Reven ue Supervi sors. | |
777 | ||
778 | 8. Estimat ion | |
779 | ||
780 | TBD. | |
781 | ||
782 | Project So ftware Fun ctional Si ze and Siz e-Based | |
783 | Effort and Duration Estimate | |
784 | ||
785 | ||
786 | Applicatio n | |
787 | ||
788 | Item | |
789 | A | |
790 | B | |
791 | C | |
792 | D | |
793 | E | |
794 | Total | |
795 | Counted Fu nction | |
796 | Points | |
797 | ||
798 | ||
799 | ||
800 | ||
801 | ||
802 | ||
803 | Estimated Scope | |
804 | Growth | |
805 | ||
806 | ||
807 | ||
808 | ||
809 | ||
810 | ||
811 | Estimated Size at | |
812 | Release | |
813 | ||
814 | ||
815 | ||
816 | ||
817 | ||
818 | ||
819 | ||
820 | Size-Based Effort Es timates | |
821 | Labor Hour s | |
822 | Probabilit y | |
823 | Low-Effort Estimate – With ind icated pro bability, project wi ll consume no more t han: | |
824 | ||
825 | ||
826 | High-Effor t Estimate – With in dicated pr obability, project w ill consum e no more than: | |
827 | ||
828 | ||
829 | ||
830 | Size-Based Duration Estimates | |
831 | Work Days | |
832 | Probabilit y | |
833 | Low-Durati on Estimat e – With i ndicated p robability , project will consu me no more than: | |
834 | ||
835 | ||
836 | High-Durat ion Estima te – With indicated probabilit y, project will cons ume no mor e than: | |
837 | ||
838 | ||
839 | ||
840 | ||
841 | ||
842 | ||
843 | ||
844 | ||
845 | TBD | |
846 | Figure 1: Cumulative Probabili ty (“S-cur ve”) Chart | |
847 | ||
848 | Attachment A – Appro val Signat ures | |
849 | ||
850 | ||
851 | ||
852 | ||
853 | ||
854 | ||
855 | Signed:Dat e: | |
856 | ||
857 | Greg Estes | |
858 | Business S ponsor | |
859 | ||
860 | ||
861 | ||
862 | ||
863 | ||
864 | ||
865 | Signed:Dat e: | |
866 | ||
867 | Charles Du nn | |
868 | CPAC Progr am Manager , Integrat ed Project Team (IPT ) Co-Chair | |
869 | ||
870 | ||
871 | ||
872 | ||
873 | ||
874 | ||
875 | Signed:Dat e: | |
876 | ||
877 | Ann Kliegl | |
878 | CPAC Proje ct Manager , IPT Co-C hair | |
879 | ||
880 | Attachment B – Acron ym List an d Glossary | |
881 | ||
882 | Table 3: A cronym Lis t and Glos sary | |
883 | ||
884 | Term | |
885 | Meaning | |
886 | BN | |
887 | Business N eed | |
888 | BRD | |
889 | Business R equirement s Document | |
890 | CBO | |
891 | Chief Busi ness Offic e | |
892 | CCD | |
893 | Continuity of Care D ocument | |
894 | CHAMPUS | |
895 | Civilian H ealth and Medical Pr ogram of t he Uniform ed Service s | |
896 | CHAMPVA | |
897 | Civilian H ealth and Medical Pr ogram of t he VA | |
898 | CM | |
899 | Configurat ion Manage ment | |
900 | CPAC | |
901 | Consolidat ed Patient Account C enter | |
902 | DRP | |
903 | Disaster R ecovery Pl an | |
904 | EDES | |
905 | Emergency Department Encounter Summary | |
906 | EDI | |
907 | Electronic Data Inte rchange | |
908 | EMF | |
909 | Enterprise Managemen t Foundati on | |
910 | ERR | |
911 | Enterprise Requireme nts Reposi tory | |
912 | FIPS | |
913 | Federal In formation Processing Standards | |
914 | FISMA | |
915 | Federal In formation Security M anagement Act | |
916 | GUI | |
917 | Graphical User Inter face | |
918 | HIPAA | |
919 | Health Ins urance Por tability a nd Account ability Ac t | |
920 | HITSP | |
921 | Health IT Standards Panel | |
922 | HL7 | |
923 | Health Lev el Seven | |
924 | HRC | |
925 | Health Res ource Cent er | |
926 | HSPD-12 | |
927 | Homeland S ecurity Pr esidential Directive (12) | |
928 | IB | |
929 | Integrated Billing | |
930 | ICB | |
931 | Insurance Capture Bu ffer | |
932 | IHE | |
933 | Integratin g the Heal thcare Ent erprise | |
934 | IPT | |
935 | Integrated Project T eam | |
936 | IT | |
937 | Informatio n Technolo gy | |
938 | ITAM | |
939 | IT Asset M anagement | |
940 | MUMPS | |
941 | Massachuse tts Genera l Hospital Utility M ulti-Progr amming | |
942 | System | |
943 | NIST | |
944 | National I nstitute S tandards a nd Technol ogy | |
945 | ||
946 | ||
947 | Term | |
948 | Meaning | |
949 | NSR | |
950 | New Servic e Request | |
951 | OED | |
952 | Office of Enterprise Developme nt | |
953 | OI&T | |
954 | Office of Informatio n and Tech nology | |
955 | OMB | |
956 | Office of Management and Budge t | |
957 | OWNR | |
958 | Owner Requ irement | |
959 | PI | |
960 | Patient In surance | |
961 | PMAS | |
962 | Project Ma nagement A ccountabil ity System | |
963 | PWS | |
964 | Performanc e Work Sta tement | |
965 | QA | |
966 | Quality As surance | |
967 | RMR | |
968 | Requiremen ts Managem ent Reposi tory | |
969 | RSD | |
970 | Requiremen ts Specifi cation Doc ument | |
971 | RSM | |
972 | Revenue Sy stems Mana gement | |
973 | SA-CMM | |
974 | Software A cquisition -Capabilit y Maturity Modeling | |
975 | SDS | |
976 | Standard D ata Servic es | |
977 | SP | |
978 | Special Pu blications | |
979 | SSN | |
980 | Social Sec urity Numb er | |
981 | TRM | |
982 | Technical Reference Model | |
983 | VA | |
984 | Department of Vetera ns Affairs | |
985 | VETS | |
986 | VA Enterpr ise Termin ology Serv ices | |
987 | VHA | |
988 | Veterans H ealth Admi nistration | |
989 | VistA | |
990 | Veterans H ealth Info rmation Sy stems and Technology | |
991 | Architectu re | |
992 | ||
993 | Attachment C – Enter prise Requ irements | |
994 | ||
995 | 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. | |
996 | ||
997 | Enterprise -level req uirements are contai ned in the VA RMR. C ontact the RMR Team to gain ac cess to th e RMR and to obtain the compre hensive al location o f Enterpri se-level r equirement s for the project de velopment iteration at PI I
|
|
998 | ||
999 | Table 4: E nterprise Requiremen ts | |
1000 | ||
1001 | ReqPro | |
1002 | Tag | |
1003 | Requiremen t | |
1004 | Type | |
1005 | Descriptio n | |
1006 | ENTR99 | |
1007 | Security | |
1008 | 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 . | |
1009 | 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. | |
1010 | ENTR10 | |
1011 | Privacy | |
1012 | 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. | |
1013 | ENTR95 | |
1014 | 508 | |
1015 | Compliance | |
1016 | 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, 1194 .31 and 11 94.41) loc ated at: h ttp:// DNS /508/resou rces_508.h tml
|
|
1017 | ENTR7 | |
1018 | Executive | |
1019 | Order | |
1020 | All execut ive order requiremen ts will be adhered t o. | |
1021 | ENTR8 | |
1022 | Identity | |
1023 | Management | |
1024 | 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. | |
1025 | ||
1026 | ||
1027 | ReqPro | |
1028 | Tag | |
1029 | Requiremen t | |
1030 | Type | |
1031 | Descriptio n | |
1032 | ENTR103 | |
1033 | Terminolog y | |
1034 | Services | |
1035 | Applicatio n/services shall ref erence the Standard Data Servi ces (SDS) as the aut horitative source to access no n-clinical reference terminolo gy. | |
1036 | ENTR104 | |
1037 | Terminolog y | |
1038 | Services | |
1039 | 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. | |
1040 | ENTR105 | |
1041 | Terminolog y | |
1042 | Services | |
1043 | 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. | |
1044 | ENTR106 | |
1045 | Terminolog y | |
1046 | Services | |
1047 | 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. | |
1048 | ||
1049 | Attachment D – Types of Plans in VistA | |
1050 | ||
1051 | Table 5: T ypes of Pl ans in Vis tA (As of 4-17-12) | |
1052 | ||
1053 | # | |
1054 | TYPE OF PL AN | |
1055 | CATEGORY | |
1056 | 1 | |
1057 | ACCIDENT A ND HEALTH INSURANCE | |
1058 | MAJOR MEDI CAL | |
1059 | 2 | |
1060 | AUTOMOBILE | |
1061 | MAJOR MEDI CAL | |
1062 | 3 | |
1063 | CARVE-OUT | |
1064 | MAJOR MEDI CAL | |
1065 | 4 | |
1066 | CATASTROPH IC INSURAN CE | |
1067 | MAJOR MEDI CAL | |
1068 | 5 | |
1069 | CHAMPVA | |
1070 | MAJOR MEDI CAL | |
1071 | 6 | |
1072 | COMPREHENS IVE MAJOR MEDICAL | |
1073 | MAJOR MEDI CAL | |
1074 | 7 | |
1075 | DENTAL INS URANCE | |
1076 | DENTAL | |
1077 | 8 | |
1078 | HEALTH MAI NTENANCE O RGANIZ | |
1079 | MAJOR MEDI CAL | |
1080 | 9 | |
1081 | INCOME PRO TECTION (I NDEMNITY) | |
1082 | INDEMNITY | |
1083 | 10 | |
1084 | INDIVIDUAL PRACTICE ASSOCATION (IPA) | |
1085 | MAJOR MEDI CAL | |
1086 | 11 | |
1087 | INPATIENT (BASIC HOS PITAL) | |
1088 | MAJOR MEDI CAL | |
1089 | 12 | |
1090 | LABS, PROC EDURES, X- RAY, ETC. (ONLY) | |
1091 | ALL OTHER | |
1092 | 13 | |
1093 | MANAGED CA RE SYSTEM (MCS) | |
1094 | MAJOR MEDI CAL | |
1095 | 14 | |
1096 | MEDI-CAL | |
1097 | MEDICAIDE | |
1098 | 15 | |
1099 | MEDICAID | |
1100 | MEDICAIDE | |
1101 | 16 | |
1102 | MEDICAL EX PENSE (OPT /PROF) | |
1103 | MAJOR MEDI CAL | |
1104 | 17 | |
1105 | MEDICARE ( M) | |
1106 | MEDICARE | |
1107 | 18 | |
1108 | MEDICARE S ECONDARY ( B EXC) | |
1109 | MAJOR MEDI CAL | |
1110 | 19 | |
1111 | MEDICARE S ECONDARY ( NO B EXC) | |
1112 | MAJOR MEDI CAL | |
1113 | 20 | |
1114 | MEDICARE S UPPLEMENTA L | |
1115 | MAJOR MEDI CAL | |
1116 | 21 | |
1117 | MEDICARE/M EDICAID (M EDI-CAL) | |
1118 | MEDICARE | |
1119 | 22 | |
1120 | MEDIGAP PL AN A | |
1121 | MEDICARE S UPPLEMENTA L | |
1122 | 23 | |
1123 | MEDIGAP PL AN B | |
1124 | MEDICARE S UPPLEMENTA L | |
1125 | 24 | |
1126 | MEDIGAP PL AN C | |
1127 | MEDICARE S UPPLEMENTA L | |
1128 | 25 | |
1129 | MEDIGAP PL AN D | |
1130 | MEDICARE S UPPLEMENTA L | |
1131 | 26 | |
1132 | MEDIGAP PL AN F | |
1133 | MEDICARE S UPPLEMENTA L | |
1134 | 27 | |
1135 | MEDIGAP PL AN G | |
1136 | MEDICARE S UPPLEMENTA L | |
1137 | 28 | |
1138 | MEDIGAP PL AN K | |
1139 | MEDICARE S UPPLEMENTA L | |
1140 | 29 | |
1141 | MEDIGAP PL AN L | |
1142 | MEDICARE S UPPLEMENTA L | |
1143 | 30 | |
1144 | MEDIGAP PL AN M | |
1145 | MEDICARE S UPPLEMENTA L | |
1146 | ||
1147 | ||
1148 | # | |
1149 | TYPE OF PL AN | |
1150 | CATEGORY | |
1151 | 31 | |
1152 | MEDIGAP PL AN N | |
1153 | MEDICARE S UPPLEMENTA L | |
1154 | 32 | |
1155 | MENTAL HEA LTH | |
1156 | ALL OTHER | |
1157 | 33 | |
1158 | NO-FAULT I NSURANCE | |
1159 | MAJOR MEDI CAL | |
1160 | ||
1161 | ||
1162 | 34 | |
1163 | ||
1164 | ||
1165 | POINT OF S ERVICE | |
1166 | HEALTH MAI NTENANCE O RGANIZATIO N (HMO) | |
1167 | ||
1168 | ||
1169 | 35 | |
1170 | PREFERRED PROVIDER O RGANIZATIO N (PPO) | |
1171 | ||
1172 | ||
1173 | PPO | |
1174 | 36 | |
1175 | PREPAID GR OUP PRACTI CE PLAN | |
1176 | HMO | |
1177 | 37 | |
1178 | PRESCRIPTI ON | |
1179 | PRESCRIPTI ON | |
1180 | 38 | |
1181 | RETIREE | |
1182 | MAJOR MEDI CAL | |
1183 | 39 | |
1184 | SPECIAL CL ASS INSURA NCE | |
1185 | MAJOR MEDI CAL | |
1186 | 40 | |
1187 | SPECIAL RI SK INSURAN CE | |
1188 | MAJOR MEDI CAL | |
1189 | 41 | |
1190 | SPECIFIED DISEASE IN SURANCE | |
1191 | MAJOR MEDI CAL | |
1192 | 42 | |
1193 | SURGICAL E XPENSE INS URANCE | |
1194 | MAJOR MEDI CAL | |
1195 | 43 | |
1196 | TORT FEASO R | |
1197 | ALL OTHER | |
1198 | 44 | |
1199 | TRICARE | |
1200 | CHAMPUS | |
1201 | 45 | |
1202 | TRICARE SU PPLEMENTAL | |
1203 | MAJOR MEDI CAL | |
1204 | 46 | |
1205 | WORKERS' C OMPENSATIO N INSURANC E | |
1206 | WORKMANS C OMP |
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