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1 | Purch Care Auth Compliance P3.zip\arpsMaster\src\main\webapp\static\doc | ARPS_User_Guide.docx | Tue Aug 8 18:10:23 2017 UTC |
2 | Purch Care Auth Compliance P3.zip\arpsMaster\src\main\webapp\static\doc | ARPS_User_Guide.docx | Tue Aug 8 18:39:42 2017 UTC |
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1 | Health Adm inistratio n Product Enhancemen ts (HAPE) Electronic Data Inte rchange (E DI) | ||
2 | Purchased Care (PC) Enhancemen ts User Gu ide | ||
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5 | Purchased Care Autho rizations Compliance Authoriza tion Reque st Process ing System (ARPS) | ||
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13 | November 2 016 Depart ment of Ve terans Aff airs | ||
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41 | 11/03/2016 | ||
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209 | ons Compli ance v0.01 ii | ||
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258 | November 2 01 | ||
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313 | Table of C ontents | ||
314 | Introducti on1 | ||
315 | Purpose3 | ||
316 | Document O rientation 4 | ||
317 | Audience4 | ||
318 | Assumption s4 | ||
319 | Document C onventions 4 | ||
320 | Organizati on of the Manual4 | ||
321 | Disclaimer s4 | ||
322 | Software D isclaimer4 | ||
323 | Documentat ion Discla imer5 | ||
324 | References and Resou rces5 | ||
325 | Coordinati on5 | ||
326 | System Sum mary7 | ||
327 | System Con figuration 7 | ||
328 | Data Flows 7 | ||
329 | User Acces s Levels8 | ||
330 | Continuity of Operat ion8 | ||
331 | Getting St arted9 | ||
332 | Logging On 9 | ||
333 | System Men u9 | ||
334 | Changing U ser ID and Password1 1 | ||
335 | Exit Syste m11 | ||
336 | Caveats an d Exceptio ns11 | ||
337 | Using the Software12 | ||
338 | Troublesho oting18 | ||
339 | Special In structions for Error Correctio n18 | ||
340 | National S ervice Des k and Orga nizational Contacts1 8 | ||
341 | Acronyms a nd Abbrevi ations18 | ||
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351 | Purchased Care Autho rizations Compliance v0.01iiiN ovember 20 16 User Gu ide | ||
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358 | List of Ta bles | ||
359 | Table 1: A cronyms an d Definiti ons18 | ||
360 | List of Fi gures | ||
361 | Figure 1: Data Flow Diagram8 | ||
362 | Figure 2: ARPS Warni ng Notice9 | ||
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411 | Purchased Care Autho rizations Compliance v0.01ivNo vember 201 6 User Gui de | ||
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418 | Introducti on | ||
419 | The missio n of the D epartment of Veteran s Affairs (VA), Offi ce of Info rmation an d Technolo gy (OI&T), HAPE is t o provide informatio n technolo gy (IT) pr oducts and services to the Vet erans Heal th Adminis tration (V HA) who in turn prov ides benef its and se rvices to Veterans o f the Unit ed States. In meetin g these go als, OI&T strives to provide h igh qualit y, effecti ve, and ef ficient IT services to those r esponsible for provi ding care to the Vet erans at t he point o f-care as well as th roughout a ll the poi nts of the Veterans’ health ca re in an e ffective, timely and compassio nate manne r. VA depe nds on inf ormation m anagement/ informatio n technolo gy (IM/IT) systems t o meet mis sion goals . | ||
420 | The Chief Business O ffice (CBO ) PC asses ses the im pact of he althcare r egulatory requiremen ts on VHA EDI revenu e operatio ns and des igns the u se cases t o illustra te the ree ngineered business p rocess flo ws associa ted with t echnology changes. T he office continuous ly monitor s and part icipates i n meetings of indust ry EDI sta ndards-set ting organ izations. As the bus iness proc ess owner and subjec t matter e xpert (SME ) for indu stry healt h care EDI mandates, Purchased Care defi nes busine ss needs t hat necess itate reve nue system software developmen t. The off ice design s the main tenance an d iterativ e updates to the EDI enterpris e tool use d to pay h ealthcare providers for servic e connecte d care pro vided to V eterans. P urchased C are develo ps partner ships with other Fed eral agenc ies and tr ading part ners to su pport EDI processing and verif y complian ce; they t est softwa re, train users on t he use of revised so ftware, an d provide help desk support fo r end user s. The EDI transacti ons proces ses are ut ilized to pay nearly $6B in pr ojected cl aims annua lly. The d evelopment work done under the scope of Purchased Care is in extricably linked to providing Veterans the medica l care the y have ear ned and de serve. | ||
421 | The HAPE E DI portfol io deliver s IT produ cts and se rvices to CBO. This PC enhance ment proje ct is inte nded to de liver a ra nge of upd ates, exte nsions, an d modifica tions to v arious fin ancial and administr ative syst ems, proce sses, file s, and rep orting mec hanisms, i ncluding: | ||
422 | |||
423 | PC System Enhancemen ts: Harris will modi fy vendor data stora ge and cla ims proces sing funct ionality s o payments to small businesses are made in a timel y manner p er the Pro mpt Paymen t Act. Har ris will d evelop rep orts to ve rify compl iance and data integ rity. | ||
424 | Health Adm inistratio n Center ( HAC) EDI C laims Syst em Enhance ments: Har ris will p rovide EDI functiona lity relat ed to refe rral reque sts and au thorizatio ns in prep aration fo r rules ef fective Ja nuary 2016 . | ||
425 | Electronic Remittanc e Advice ( ERA) (835) Complianc e: To comp ly with CO RE Level I II Electro nic Funds Transfer ( EFT) stand ards, Harr is will mo dify vendo r file and vendor ma intenance functional ity, Veter ans Health Informati on Systems and Techn ology Arch itecture ( VistA) Fee , and Clai ms Process ing and El igibility (CP&E) for beneficia ry- relate d transact ions. | ||
426 | Health Pla n Identifi er (HPID) Compliance : To compl y with rul es effecti ve Fall 20 16, Harris will modi fy claim t ransaction functiona lity relat ed to inco ming HPID validation and gener ation of o utgoing ED I transact ions to po pulate the VA HPID. | ||
427 | Claims Att achments C ompliance: Harris wi ll create systems to manage th e receipt, processin g, and sto rage of cl aims attac hments in preparatio n for rule s effectiv e January 2016. | ||
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444 | |||
445 | Purchased Care Autho rizations Compliance v0.011Nov ember 2016 User Guid e | ||
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453 | Healthcare Claims 83 7 Complian ce: Harris will revi ew and mod ify the 83 7 transact ion | ||
454 | flow withi n VA syste ms. | ||
455 | |||
456 | Caregiver Stipend Pa yments Sys tem (optio nal task): Harris wi ll create a rules-ba sed | ||
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458 | system to calculate stipend pa yments for caregiver s, and cre ate an int erface to VA’s | ||
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465 | Comment [A 1]: Delete ?vendor da tabase and maintenan ce process , CBOPC Ve terans fil es, and Fi nancial Ma nagement S ystem (FMS ) payment system. | ||
466 | |||
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468 | The HAPE E DI portfol io deliver s IT produ cts and se rvices to CBO. This PC enhance ment | ||
469 | project is intended to deliver a range o f updates, extension s, and mod ifications to variou s financia l and admi nistrative systems, processes, files, an d reportin g mechanis ms. The PC | ||
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472 | g | ||
473 | Authorizat ions Compl iance proj ect will c reate proc esses and systems to receive i ncomin | ||
474 | |||
475 | requests f or Healthc are Claim services r eview (278 ) and prod uce corres ponding re sponse | ||
476 | |||
477 | transactio ns (278). Over time, this enha ncement sh ould signi ficantly r educe manu al methods | ||
478 | |||
479 | Comment [A 2]: Add? F rom the SD D(e.g., re sponding t o telephon e calls to VA Medica l Centers, or VAMCs) using EDI transacti ons for tr eatment au thorizatio ns and pre -certifica tions. | ||
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481 | |||
482 | The PC Aut horization s Complian ce project will crea te new pro cesses and systems t o receive incoming r equests fo r healthca re service s review ( 278) and p roduce cor responding response transactio ns (278). Over time, this enha ncement sh ould signi ficantly r educe manu al methods (e.g., re sponding t o telephon e calls to VA Medica l Centers (VAMCs) us ing EDI tr ansactions for treat ment autho rizations and pre-ce rtificatio ns. | ||
483 | |||
484 | As part of the FY14 Authorizat ions proje ct, the ab ility to c reate a 27 8 Response when a co py of | ||
485 | the master authoriza tion exist s in the 2 78 reposit ory will b e introduc ed. This f unctionali ty will | ||
486 | |||
487 | continue t o be suppo rted in FY 15. | ||
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490 | |||
491 | NOTE: The master aut horization is a gene ric term t o referenc e either t he 10-7078 or 10-707 9 authoriz ation crea ted and st ored in th e VistA Fe e system. Informatio n from thi s authoriz ation will be stored in the 27 8 Reposito ry and the 278 Respo nse will b e generate d from the informati on stored in the 278 Repositor y. | ||
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494 | In FY15, n ew functio nality wil l be intro duced that will allo w the VA t o process 278 Reques t where a copy of th e master a uthorizati on does no t exists i n the 278 Repository at the ti me that th e 278 Requ est is rec eived and a master a uthorizati on has to be created . In this document, these requ ests are r eferenced as unsolic ited 278 R equest. | ||
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497 | Additional enhanceme nts in thi s project will build on the ED I 278 Requ est for Se rvices Rev iew being introduced as part o f the FY14 Authoriza tions proj ect. The n ew 278 pro cessing fu nctionalit y will all ow a provi der to sub mit an uns olicited 2 78 Request for Healt h Care Ser vices. | ||
498 | |||
499 | |||
500 | First the Automated EDI Tool ( AET) will route the 278 Reques t to the a ppropriate VAMC and assign the request t o a queue based on t he service requested . These e nhancement s will all ow the aut horization clerk to to review the reques t based on the servi ce request ed and all ow authori zation cle rks to res pond to th ose reques ts utilizi ng two new Graphical User Inte rfaces (GU I). | ||
501 | |||
502 | |||
503 | In this pr oject, we will be mo difying ex isting aut horization processin g so that the author ization cl erk will b e able to select a s ervice to be provide d (from a lookup tab le) and en ter the qu antity | ||
504 | |||
505 | Purchased Care Autho rizations Compliance v0.012Nov ember 2016 User Guid e | ||
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517 | and the un its for th e service to be prov ided. This change is necessary to suppor t the 278 | ||
518 | |||
519 | Response r ecord. | ||
520 | |||
521 | Purpose | ||
522 | This Purch ase Care A uthorizati ons Compli ance User Guide prov ides end u sers with the inform ation need ed to util ize the en hancements to the AR PS, AET, a nd VistA F ee Basis. | ||
523 | The enhanc ements des cribed in the guide are: ARPS: | ||
524 | The abilit y to link the CPRS o rder with the master authoriza tion recor d | ||
525 | The abilit y to creat e and issu e a 10-707 8 prior to the Veter an receivi ng the ser vices | ||
526 | The abilit y to add q uantitativ e services for a Vet eran (impr oves suppo rt of 278 processing ) | ||
527 | The abilit y to recei ve unsolic ited 278 R equest fro m a provid er, routed to the ap propriate VAMC and v erify that the provi der is aut horized to conduct b usiness wi th VA | ||
528 | The abilit y to view the 278 Un solicited Request qu eues and s elect a 27 8 Request to process | ||
529 | The abilit y to see t he details of the 27 8 Request | ||
530 | The abilit y to gener ate a 278 Response A ET: | ||
531 | Allow VA t o accept u nsolicited 278 Autho rization R equest fro m Provider s | ||
532 | Verify all providers listed in the Autho rization R equest are allowed t o perform services f or the VAM C | ||
533 | Route the unsolicite d 278 Auth orization Request to the appro priate VAM C | ||
534 | Allow admi nistration of lookup table dat a used to populate 2 78 respons es | ||
535 | Notify the EDI manag ement team if AET go es offline | ||
536 | Allow the EDI manage ment team to export summary da ta from th e 278 Repo sitory to generate n ecessary m anagement reports | ||
537 | Automatica lly route the 278 Au thorizatio n Request to specifi c queues b ased on pr edefined r outing cri teria | ||
538 | Allow loca l queue ma nagement o f unsolici ted 278 He alth Care Service Re views | ||
539 | Verify pat ient is in local VAM C Authoriz ations dat abase Vist A Fee Basi s: | ||
540 | Generate 1 0-7078 aut horization s services with quan tified del iverables for the se rvice (pro cedure) au thorized | ||
541 | Generate 1 0-7079 aut horization s services with quan tified del iverables for the se rvice (pro cedure) au thorized | ||
542 | Comment [A 3]: Add? F rom the RS D | ||
543 | |||
544 | Comment [A 4]: Look f or doubles | ||
545 | |||
546 | |||
547 | Purchased Care Autho rizations Compliance v0.013Nov ember 2016 User Guid e | ||
548 | |||
549 | |||
550 | |||
551 | |||
552 | |||
553 | |||
554 | Specify qu antifiable Health Ca re Service s Delivery (HSD) sch edules | ||
555 | Review the 278 Reque st utilizi ng a new G UI | ||
556 | Generate t he appropr iate 278 R eponses to the Reque st either approving, rejecting or denyin g request for servic es | ||
557 | Capture th e Computer ized Patie nt Record System (CP RS) order number wit hin the ma ster autho rization f ile, when an Authori zation is created as a result of a CPRS order | ||
558 | Print the CPRS Order number on the appro priate Aut horization paperwork | ||
559 | Allow a us er to gene rate and i ssue a mas ter author ization pr ior to the services being prov ided to th e Veteran | ||
560 | Document O rientation | ||
561 | Audience | ||
562 | The intend ed audienc e of this document i ncludes th e Product Developmen t (PD), So ftware Qua lity Assur ance (SQA) , the Chie f Business Office (C BO), staff at the OI &T at the Health Adm inistratio n Center ( HAC) and t he staff w ho issue a uthorizati ons for No n-VA Care. | ||
563 | Assumption s | ||
564 | This guide was writt en with th e followin g assumed experience /skills of the audie nce: | ||
565 | User has b asic knowl edge of th e operatin g system ( such as th e use of c ommands, m enu option s, and nav igation to ols) | ||
566 | User has b een provid ed the app ropriate a ctive role s, menus, and securi ty keys re quired for the ARPS, AET, and VistA Fee Basis | ||
567 | User has v alidated a ccess to A RPS, AET, and VistA Fee Basis | ||
568 | User has c ompleted a ny prerequ isite trai ning | ||
569 | Document Convention s | ||
570 | System men us are dep icted grap hically as figures i n the docu ment. | ||
571 | Organizati on of the Manual | ||
572 | The organi zation of this manua l is drive n by proje ct-specifi c scenario s. The pro ject-speci fic scenar ios descri bed in thi s manual a re organiz ed in the following order: | ||
573 | ARPS Funct ionality | ||
574 | AET Enhanc ed Functio nality | ||
575 | VistA Fee Basis Enha nced Funct ionality | ||
576 | Disclaimer s | ||
577 | Software D isclaimer | ||
578 | This softw are was de veloped at the Depar tment of V eterans Af fairs (VA) by employ ees of the Federal G overnment in the cou rse of the ir officia l duties. Pursuant t o title 17 Section 1 05 of the | ||
579 | |||
580 | Purchased Care Autho rizations Compliance v0.014Nov ember 2016 User Guid e | ||
581 | |||
582 | |||
583 | |||
584 | |||
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586 | |||
587 | United Sta tes Code t his softwa re is not subject to copyright protectio n and is i n the publ ic domain. VA assume s no respo nsibility whatsoever for its u se by othe r parties, and makes no guaran tees, expr essed or i mplied, ab out its qu ality, rel iability, or any oth er charact eristic. W e would ap preciate a cknowledge ment if th e software is used. This softw are can be redistrib uted and/o r modified freely pr ovided tha t any deri vative wor ks bear so me notice that they are derive d from it, and any m odified ve rsions bea r some not ice that t hey have b een modifi ed. | ||
588 | Documentat ion Discl aimer | ||
589 | The appear ance of ex ternal hyp erlink ref erences in this manu al does no t constitu te endorse ment by th e Departme nt of Vete rans Affai rs (VA) of this Web site or th e informat ion, produ cts, or se rvices con tained the rein. The VA does no t exercise any edito rial contr ol over th e informat ion found at these l ocations. Such links are provi ded and ar e consiste nt with th e stated p urpose of the VA. | ||
590 | References and Resou rces | ||
591 | BRD PC Aut horization s Complian ce Phase 3 - EPS 01- 02-03-03-0 8-020 - Ne w Service Request (N SR) 201406 11 http:// DNS /pm/hape/i pt_5010/ED I_Portfoli o/Program% 20Level%20 D ocumentati on/PC/FY%2 02015/Team %20Adminis tration/S0 2_Purchase d_Care_(PC )_Systems_ Enhancemen ts_PWS_11- 20-2014,_v 5.0.docx ocumentat ion/PC/FY% 202015/BRD /08- 020%2 0PC%20Auth %20Compl%2 0BRD%20v1. 0.pdf | ||
592 | Transforma tion Twent y-One Tota l Technolo gy (T4), P erformance Work Stat ement (PWS ), Date: N ovember 20 , 2014, TA C-15-16822 , Task Ord er (TO) PW S Version Number: 5. 0.
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593 | ASC X12N/0 05010X215 Health Car e Services Review – Inquiry an d Response (278), Da te May 200 6, ASC X12 Standards for EDI T echnical R eport Type 3. | ||
594 | ASC X12N/0 05010X217 Health Car e Services Review – Request fo r Review a nd Respons e (278), D ate May 20 06, ASC X1 2 Standard s for EDI Technical Report Typ e 3. | ||
595 | Phase IV C AQH CORE 4 52 Health Care Servi ces Review - Request for Revie w and Resp onse (278) Infrastru cture Rule version 4 .0.0 - Dra ft for Rul es Work Gr oup Ballot - March 2 015 | ||
596 | Non-VA Car e Version 6.2 Templa te | ||
597 | Real-Time X12 Standa rd Compani on Guide v ersion 1.0 , date Dec ember 2012 , Emdeon B usiness Se rvices | ||
598 | |||
599 | |||
600 | |||
601 | |||
602 | Purchased Care Autho rizations Compliance v0.015Nov ember 2016 User Guid e | ||
603 | |||
604 | |||
605 | |||
606 | |||
607 | |||
608 | |||
609 | National N on-VA Medi cal Care P rogram Off ice (NNPO) Non-VA Me dical Care Coordinat ion Author ization Fa ct Sheet f or Pre-aut horized Ca re - VA Fo rm 10-7078 /10- 10-70 79 | ||
610 | Place of S ervice Cod es for Pro fessional Claims Dat abase (upd ated Novem ber 1, 201 2) | ||
611 | Fee Basis Technical Manual ver sion 3.5, Revised Ja nuary 2013 , VA – OI& T PD | ||
612 | Fee Basis User Manua l version 3.5, Revis ed Septemb er 2013, V A – OI&T P D | ||
613 | 44 U.S.C. § 3541, “F ederal Inf ormation S ecurity Ma nagement A ct (FISMA) of 2002” | ||
614 | Federal In formation Processing Standards (FIPS) Pu blication 140-2, “Se curity Req uirements For Crypto graphic Mo dules” | ||
615 | Software E ngineering Institute (SEI), So ftware Acq uisition-C apability Maturity M odeling In tegration (SA-CMMI) Level 3 pr ocedures a nd process es | ||
616 | VA Directi ve 6102, “ Internet/I ntranet Se rvices,” J uly 15, 20 08 | ||
617 | 36 C.F.R. Part 1194 “Electroni c and IT A ccessibili ty Standar ds,” July 1, 2003 | ||
618 | Office of Management and Budge t (OMB) Ci rcular A-1 30, “Manag ement of F ederal Inf ormation R esources,” November 28, 2000 | ||
619 | An Introdu ctory Reso urce Guide for Imple menting th e Health I nsurance P ortability and Accou ntability Act (HIPAA ) Security Rule, Mar ch 2005 | ||
620 | Sections 5 04 and 508 of the Re habilitati on Act (29 U.S.C. § 794d), as amended by the Workf orce Inves tment Act of 1998 (P .L. 105-22 0), August 7, 1998 | ||
621 | Homeland S ecurity Pr esidential Directive (12) (HSP D-12) | ||
622 | VA Directi ve 6500, “ Informatio n Security Program,” August 4, 2006 | ||
623 | VA Handboo k 6500, “I nformation Security Program,” September 18, 2007 | ||
624 | VA Handboo k, 6500.5, Incorpora ting Secur ity and Pr ivacy in S ystem Deve lopment Li fecycle. | ||
625 | VA Handboo k 6500.6, “Contract Security,” March 12, 2010 | ||
626 | Program Ma nagement A ccountabil ity System (PMAS) po rtal (refe rence PWS References | ||
627 | - Technica l Library at https:/ / DNS /) | ||
628 | Office of Enterprise Developme nt (OED) P roPath Pro cess Metho dology (re ference PW S Referenc es -Techni cal Librar y and ProP ath Librar y links at https:// DNS /). Note: In the eve nt of a co nflict, OE D ProPath takes prec edence ove r other pr ocesses or methodolo gies. | ||
629 | Technical Reference Model (TRM ) (referen ce at http: DNS /TRM/TRMHo mePage.asp ) | ||
630 | National I nstitute S tandards a nd Technol ogy (NIST) Special P ublication s SP 800-6 0 and 800- 53 | ||
631 | |||
632 | |||
633 | Purchased Care Autho rizations Compliance v0.016Nov ember 2016 User Guid e | ||
634 | |||
635 | |||
636 | |||
637 | |||
638 | |||
639 | |||
640 | IT Asset M anagement (ITAM) and Enterpris e Manageme nt Foundat ion (EMF) BR-0006, v ersion 002 .1-1405200 8, dated 1 0/30/2007 [Note info rmational, Context, and ITAM- EMF Concep tual link] | ||
641 | HIPAA of 1996; Pub. L 104-191) . | ||
642 | Patient Pr otection a nd Afforda ble Care A ct (PPACA) , Pub. L. 111-148, 1 24 Stat. 1 19, | ||
643 | H.R. 3590, enacted M arch 23, 2 010 | ||
644 | 5 CFR 1315 , Final Ru le, Prompt Payment ( http:// DNS /prompt/re gulations. html) (for merly OMB Circular A -125) | ||
645 | The aim of this proj ect is to verify tha t the EDI PC systems are compl iant with the CORE R ules as pu blished by CAQH, and found her e http:// www.caqh.o rg/CORE_op erat_rules .php | ||
646 | VA Section 508 polic ies and pr ocedures 6 221 Access ible Elect ronic and IT, Direct ive/Handbo ok, publis hed by VA’ s Section 508 PD Pro duct Asses sment Comp etency Div ision | ||
647 | VA M Progr amming Sta ndards and Conventio ns. Revise d 04/03/20 07 (http:/ / DNS /TRM/files /SACC_2008 .pdf). | ||
648 | Coordinati on | ||
649 | This is an enhanceme nt to new and existi ng softwar e; no coor dination i s required to access any new f unctionali ty. | ||
650 | |||
651 | System Sum mary | ||
652 | AET is a w eb-based s ystem used for recei ving EDI t ransaction s, includi ng 278 tra nsactions inquiring about auth orizations or reques ting a new authoriza tion. This project w ill improv e support for those authorizat ion reques ts, includ ing adding a new ARP S GUI for responding to those requests. | ||
653 | ARPS GUI i s a new we b-based sy stem that will allow review nu rses or cl erks at th e various VAMCs to r espond to requests f or new aut horization s. | ||
654 | VistA Fee Basis is a web-based system us ed to mana ge authori zations an d payments for Non-V A Care. It will be m odified to allow for more disc rete entry of author ized servi ces and be tter track ing of the status of authoriza tions. | ||
655 | System Con figuration | ||
656 | System con figuration was not i n scope fo r the Purc hased Care Authoriza tions Comp liance pro ject. | ||
657 | Data Flows | ||
658 | The follow ing workfl ow process defines h ow Non-VA care perso nnel can r espond to requests f or authori zations. | ||
659 | |||
660 | |||
661 | |||
662 | Purchased Care Autho rizations Compliance v0.017Nov ember 2016 User Guid e | ||
663 | |||
664 | |||
665 | |||
666 | |||
667 | |||
668 | |||
669 | The proces s begins w hen unsoli cited 278 Requests a re receive d. Unsolic ited 278 R equests wi ll be rout ed by to t he VAMC th at ARPS de termines s ervices th e Veteran. The ARPS will use t he same ro uting logi c currentl y incorpor ated in th e Automate d Eligibil ity Tool ( AET). | ||
670 | The ARPS w ill route the reques t to a spe cific queu e, based o n the info rmation in the 278 R equest and the routi ng rules p rovided by the PMD. The author ization cl erk will t hen be abl e to view all of the unsolicit ed 278 Req uests by a ssigned qu eue and se lect 278 R equest to view in th e 278 Requ est GUI. A 278 Respo nse will b e generate d to the r equest by an authori zation cle rk either accepting or denying the 278 r equest. | ||
671 | Figure 1: Data Flow Diagram | ||
672 | |||
673 | |||
674 | User Acces s Levels | ||
675 | The user a nd group l evel acces s to the A ET and Vis tA Fee Bas is did not change fo r the enha ncements d escribed i n this man ual. | ||
676 | The user a ccess to A RPS will b e coordina ted by a H AC adminis trator. | ||
677 | Continuity of Operat ion | ||
678 | |||
679 | Comment [A 5]: Add so mething ab out ARPS?T he existin g Disaster Recovery Plan did n ot change for AET an d VistA Fe e Basis. | ||
680 | |||
681 | |||
682 | |||
683 | |||
684 | |||
685 | Purchased Care Autho rizations Compliance v0.018Nov ember 2016 User Guid e | ||
686 | |||
687 | |||
688 | |||
689 | |||
690 | |||
691 | |||
692 | Getting St arted | ||
693 | Logging On | ||
694 | Use existi ng login p rocedures to access the system . | ||
695 | The ARPS a pplication can be ac cessed thr ough the u sers web b rowser by simply pas ting the U RL link ( DNS /) into th e navigati on bar. | ||
696 | The screen below is the first one the us er will en counter. U sers must accept the Warning n otice to a ccess ARPS . | ||
697 | Figure 2: ARPS Warni ng Notice | ||
698 | |||
699 | |||
700 | |||
701 | |||
702 | |||
703 | |||
704 | |||
705 | |||
706 | |||
707 | |||
708 | |||
709 | |||
710 | |||
711 | S ys tem M enu | ||
712 | ARPS | ||
713 | The system menu firs t encounte red is the Search 27 8 Requests screen. T he Search 278 Reques ts screen shows summ ary inform ation for all record s in the s elected qu eue. On th e left sid e of the s creen is t he 278 Req uests sele ction scre en. The us er can nav igate to d ifferent t ypes of 27 8 requests by clicki ng on a hy perlink. I ts current default i s the Emer gency Requ est screen but the i nstruction s are the same for a ll other q ueues. | ||
714 | |||
715 | |||
716 | |||
717 | |||
718 | |||
719 | |||
720 | |||
721 | |||
722 | |||
723 | |||
724 | |||
725 | |||
726 | |||
727 | |||
728 | Purchased Care Autho rizations Compliance v0.019Nov ember 2016 User Guid e | ||
729 | |||
730 | |||
731 | |||
732 | |||
733 | |||
734 | |||
735 | Figure 3: Search 278 Requests Screen | ||
736 | |||
737 | |||
738 | Viewing 27 8 Requests | ||
739 | To view th e request, a user ca n click a record fro m the Sear ch 278 Req uests scre en. After selecting a record f rom the se arch scree n: | ||
740 | Patient Au thorizatio n request (header in fo) displa ys | ||
741 | All detail ed Authori zation Req uest infor mation dis plays on s creen (scr oll to see the data) | ||
742 | Left Navig ation – na vigate to different parts of t he Authori zation Req uest: | ||
743 | Patient In formation | ||
744 | Provider I nformation | ||
745 | Dependent informatio n (if pres ent) | ||
746 | Care Reque sted infor mation | ||
747 | Services R equested | ||
748 | Action | ||
749 | Deny/Accep t Authoriz ation | ||
750 | Change que ue | ||
751 | Change Sta tion | ||
752 | Audit log (of all ac tions take n on speci fic patien t record) | ||
753 | |||
754 | |||
755 | |||
756 | |||
757 | |||
758 | |||
759 | |||
760 | |||
761 | Purchased Care Autho rizations Compliance v0.0110No vember 201 6 User Gui de | ||
762 | |||
763 | |||
764 | |||
765 | |||
766 | |||
767 | |||
768 | Figure 4: Viewing a 278 Reques t | ||
769 | |||
770 | |||
771 | |||
772 | |||
773 | 3.2.2.AET | ||
774 | |||
775 | Comment [A 6]: Includ e?3.2.3.Vi stA Fee Ba sis | ||
776 | Changing U ser ID and Password | ||
777 | The ARPS H AC adminis trator wil l add user s to the a pplication . User IDs and passw ords are n ot used to access AR PS. Access and right s are base d on the r ights give n when add ed as a us er to ARPS by the HA C administ rator. | ||
778 | Use existi ng procedu res for ch anging use r IDs and passwords in AET and VistA Fee Basis. | ||
779 | Exit Syste m | ||
780 | Close the web browse r to exit the ARPS s ystem. | ||
781 | Use existi ng procedu res to log off and ex it the sys tem for AE T and Vist A Fee Basi s. | ||
782 | Caveats an d Exceptio ns | ||
783 | Not Applic able. | ||
784 | |||
785 | |||
786 | |||
787 | |||
788 | |||
789 | |||
790 | |||
791 | Purchased Care Autho rizations Compliance v0.0111No vember 201 6 User Gui de | ||
792 | |||
793 | |||
794 | |||
795 | |||
796 | |||
797 | |||
798 | Using the Software | ||
799 | ARPS Funct ionality | ||
800 | Search 278 Requests | ||
801 | The follow ing table contains i nstruction s for sear ching 278 Requests. | ||
802 | Table 1: A uthorizati on Request Search | ||
803 | |||
804 | Action | ||
805 | Descriptio n | ||
806 | Introducti on | ||
807 | The purpos e of the A RPS Search 278 Reque sts screen is to all ow the use r to searc h for 278 Requests b y several key identi fiers. | ||
808 | Accessing the Search screen | ||
809 | The Search 278 Reque sts screen is the fi rst screen the user may see wh en enterin g ARPS. | ||
810 | Selecting Search Cri teria | ||
811 | Once the S earch 278 Requests d isplays th e criteria to search for 278 R equests in cludes: | ||
812 | Name | ||
813 | ID | ||
814 | DOB | ||
815 | Requester | ||
816 | Service | ||
817 | Request Da te | ||
818 | Queue Days (more tha n 30 days – red, les s than 30 days – gre en) | ||
819 | Displaying the Searc h Results | ||
820 | After the desired cr iteria has been inpu t click En ter. The q uery resul ts are the n displaye d. | ||
821 | Search cri teria can be entered for an in dividual f ield or mu ltiple fie lds to inc rease accu racy of re sults. | ||
822 | |||
823 | |||
824 | |||
825 | |||
826 | |||
827 | |||
828 | |||
829 | |||
830 | |||
831 | |||
832 | |||
833 | |||
834 | |||
835 | |||
836 | |||
837 | Purchased Care Autho rizations Compliance v0.0112No vember 201 6 User Gui de | ||
838 | |||
839 | |||
840 | |||
841 | |||
842 | |||
843 | |||
844 | Figure 5: Search 278 Requests example (N ame) | ||
845 | |||
846 | |||
847 | |||
848 | |||
849 | |||
850 | |||
851 | |||
852 | |||
853 | |||
854 | |||
855 | |||
856 | |||
857 | |||
858 | |||
859 | |||
860 | |||
861 | |||
862 | |||
863 | |||
864 | |||
865 | |||
866 | |||
867 | Figure 6: Search 278 Requests example (m ultiple fi elds) | ||
868 | |||
869 | |||
870 | |||
871 | |||
872 | |||
873 | |||
874 | |||
875 | |||
876 | |||
877 | |||
878 | |||
879 | |||
880 | |||
881 | |||
882 | |||
883 | |||
884 | |||
885 | |||
886 | |||
887 | |||
888 | |||
889 | |||
890 | Viewing 27 8 Requests | ||
891 | The follow ing table contains i nstruction s for view ing 278 Re quests. | ||
892 | Table 2: V iew 278 Re quests | ||
893 | |||
894 | Action | ||
895 | Descriptio n | ||
896 | Introducti on | ||
897 | A 278 Requ est can be viewed in ARPS. | ||
898 | |||
899 | |||
900 | Purchased Care Autho rizations Compliance v0.0113No vember 201 6 User Gui de | ||
901 | |||
902 | |||
903 | |||
904 | |||
905 | |||
906 | |||
907 | Action | ||
908 | Descriptio n | ||
909 | Accessing the 278 Re quest | ||
910 | A Request exists in ARPS if it is found matching s earch crit eria. | ||
911 | Displaying the Reque st | ||
912 | The user m ust click on the pat ients name they woul d like to view. A ne w browser window wil l open to display th e Request. | ||
913 | Viewing th e Authoriz ation Requ est | ||
914 | The naviga tion locat ed on the left side of the scr een allows the user to navigat e to diffe rent parts of the Au thorizatio n Request: | ||
915 | Patient In formation | ||
916 | Subscriber | ||
917 | Provider I nformation | ||
918 | Requester | ||
919 | Dependent informatio n (if pres ent) | ||
920 | Care Reque sted infor mation | ||
921 | Services R equested | ||
922 | Action | ||
923 | Deny/Accep t Authoriz ation | ||
924 | Change que ue | ||
925 | Change Sta tion | ||
926 | Audit log (of all ac tions take n on speci fic patien t record) | ||
927 | |||
928 | |||
929 | |||
930 | |||
931 | |||
932 | |||
933 | |||
934 | |||
935 | |||
936 | |||
937 | |||
938 | |||
939 | |||
940 | |||
941 | |||
942 | |||
943 | |||
944 | |||
945 | |||
946 | |||
947 | |||
948 | |||
949 | |||
950 | Purchased Care Autho rizations Compliance v0.0114No vember 201 6 User Gui de | ||
951 | |||
952 | |||
953 | |||
954 | |||
955 | |||
956 | |||
957 | Figure 7: Displaying the Reque st | ||
958 | |||
959 | |||
960 | Figure 8: Viewing th e Authoriz ation Requ est | ||
961 | |||
962 | |||
963 | |||
964 | |||
965 | |||
966 | |||
967 | |||
968 | |||
969 | |||
970 | |||
971 | |||
972 | |||
973 | |||
974 | |||
975 | |||
976 | |||
977 | |||
978 | |||
979 | |||
980 | |||
981 | |||
982 | |||
983 | |||
984 | Purchased Care Autho rizations Compliance v0.0115No vember 201 6 User Gui de | ||
985 | |||
986 | |||
987 | |||
988 | |||
989 | |||
990 | |||
991 | |||
992 | |||
993 | Comment [A 7]: Put a tableAccep t/Deny Re quirements | ||
994 | |||
995 | |||
996 | An authori zation in a queue ha s two poss ible dispo sitions. T hey can be accepted or denied. Informati on from 27 8 request will be av ailable to the autho rization c lerk for r eview and further pr ocessing. | ||
997 | Authorizat ion respon ses will b e returned in the Pa tient Even t loop. | ||
998 | |||
999 | |||
1000 | A 278 resp onse is re quired for either an accepted or denied 278’s. The requireme nts in the next tabl e are comm on to both responses . | ||
1001 | |||
1002 | |||
1003 | A denied r esponse wi ll be used when the NVCC staff determine s that the services are not co vered by t he VA. | ||
1004 | |||
1005 | |||
1006 | In both ca ses, the 2 78 Request is moved to the app ropriate r eference q ueue so NV CC staff h ave access to the or iginal 278 Request a nd Respons e informat ion in the event the provider or patient follow up with a ph one call o r email to resolve t he problem . | ||
1007 | Figure 9: Accept/Den y Requirem ents Scree n | ||
1008 | |||
1009 | |||
1010 | |||
1011 | |||
1012 | |||
1013 | |||
1014 | |||
1015 | |||
1016 | Purchased Care Autho rizations Compliance v0.0116No vember 201 6 User Gui de | ||
1017 | |||
1018 | |||
1019 | |||
1020 | |||
1021 | |||
1022 | |||
1023 | Figure 10: | ||
1024 | |||
1025 | |||
1026 | Comment [A 8]: Audit info suppo sed to sho w up on ac tion page? | ||
1027 | |||
1028 | |||
1029 | |||
1030 | |||
1031 | |||
1032 | |||
1033 | |||
1034 | |||
1035 | |||
1036 | |||
1037 | |||
1038 | |||
1039 | |||
1040 | |||
1041 | |||
1042 | Figure 11: | ||
1043 | |||
1044 | |||
1045 | |||
1046 | |||
1047 | |||
1048 | |||
1049 | |||
1050 | |||
1051 | |||
1052 | |||
1053 | |||
1054 | |||
1055 | |||
1056 | |||
1057 | |||
1058 | Purchased Care Autho rizations Compliance v0.0117No vember 201 6 User Gui de | ||
1059 | |||
1060 | |||
1061 | |||
1062 | |||
1063 | |||
1064 | |||
1065 | Figure 12: | ||
1066 | |||
1067 | |||
1068 | |||
1069 | |||
1070 | |||
1071 | |||
1072 | |||
1073 | |||
1074 | |||
1075 | |||
1076 | |||
1077 | |||
1078 | |||
1079 | |||
1080 | |||
1081 | |||
1082 | |||
1083 | |||
1084 | |||
1085 | |||
1086 | |||
1087 | |||
1088 | Troublesho oting | ||
1089 | There are no known p roblems an ticipated or otherwi se. For as sistance w ith proble ms with th e system, the user s hould foll ow existin g procedur es for hel p. | ||
1090 | Special In structions for Error Correctio n | ||
1091 | There are no special instructi ons for er ror eorrec tion assoc iated with the new f unctionali ty in the ARPS, AET, and VistA Fee Basis . | ||
1092 | National S ervice Des k and Orga nizational Contacts | ||
1093 | The ARPS s ystem is o wned and i mplemented by the HA C OIT. | ||
1094 | Users shou ld continu e to refer ence exist ing points of contac t for info rmation an d troubles hooting pu rposes in place for AET and Vi stA Fee Ba sis. | ||
1095 | As this is an existi ng system, no furthe r coordina tion betwe en organiz ations is required. | ||
1096 | |||
1097 | Acronyms a nd Abbrevi ations | ||
1098 | Table 3: A cronyms an d Definiti ons | ||
1099 | |||
1100 | Acronym | ||
1101 | Definition | ||
1102 | ARPS | ||
1103 | Authorizat ion Reques t Processi ng System | ||
1104 | CBO | ||
1105 | Chief Busi ness Offic e | ||
1106 | EDI | ||
1107 | Electronic Data Inte rchange | ||
1108 | HAPE | ||
1109 | Health Adm inistratio n Product Enhancemen ts | ||
1110 | IM | ||
1111 | Informatio n Manageme nt | ||
1112 | |||
1113 | Purchased Care Autho rizations Compliance v0.0118No vember 201 6 User Gui de | ||
1114 | |||
1115 | |||
1116 | |||
1117 | |||
1118 | |||
1119 | |||
1120 | Acronym | ||
1121 | Definition | ||
1122 | |||
1123 | IT | ||
1124 | Informatio n Technolo gy | ||
1125 | |||
1126 | OI&T | ||
1127 | Office of Informatio n and Tech nology | ||
1128 | |||
1129 | PC | ||
1130 | Purchased Care | ||
1131 | |||
1132 | SME | ||
1133 | Subject Ma tter Exper t | ||
1134 | |||
1135 | VA | ||
1136 | Department of Vetera ns Affairs | ||
1137 | |||
1138 | VHA | ||
1139 | Veterans H ealth Admi nistration | ||
1140 | |||
1141 | |||
1142 | |||
1143 | |||
1144 | |||
1145 | |||
1146 | |||
1147 | |||
1148 | |||
1149 | |||
1150 | |||
1151 | |||
1152 | |||
1153 | |||
1154 | |||
1155 | |||
1156 | |||
1157 | |||
1158 | |||
1159 | |||
1160 | |||
1161 | |||
1162 | |||
1163 | |||
1164 | |||
1165 | |||
1166 | |||
1167 | |||
1168 | |||
1169 | |||
1170 | |||
1171 | |||
1172 | The figure below is a concept of what th e 278 Requ est/Respon se GUI mig ht look li ke. The fi nal design may chang e based on feedback from the c ustomer an d the fina l design c reated by the develo pers. | ||
1173 | |||
1174 | |||
1175 | Purchased Care Autho rizations Compliance v0.0119No vember 201 6 User Gui de | ||
1176 | |||
1177 | |||
1178 | |||
1179 | |||
1180 | |||
1181 | |||
1182 | When a use r selects a Request from one o f the 278 Unsolicite d Request queues, th e 278 Requ est/Respon se GUI wil l be popul ated. Unde r the curr ent concep t, there w ill be fou r views av ailable in the GUI: | ||
1183 | View 1 – P atient dem ographics, populated from the 278 Reques t informat ion. | ||
1184 | View 2 – 2 78 Request Navigatio n View – t his provid es summary informati on about t he request . For exam ple if a s egment is present an d the numb er of occu rrences if a segment repeats. | ||
1185 | View 3 – 2 78 Request detailed view. This view allo ws a user to: | ||
1186 | Select an available segment fr om the 278 Navigatio n View and the detai led inform ation rece ived in th e section 278 Reques t will dis play. | ||
1187 | View assoc iated pape rwork resi ding in th e 275 repo sitory. | ||
1188 | View 4 – 2 78 Respons e This vi ew will al low a user : | ||
1189 | To ACCEPT a 278 Requ est and de signate in patient/ou tpatient a uthorizati on. This w ill prepop ulate the master aut horization record wi th data fr om the 278 reqquest OR | ||
1190 | To DENY an authoriza tion and p rovide a r eason for the denial . | ||
1191 | |||
1192 | |||
1193 | |||
1194 | |||
1195 | |||
1196 | |||
1197 | |||
1198 | |||
1199 | |||
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1219 | |||
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1224 | |||
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1226 | |||
1227 | |||
1228 | Figure 13 - Unsolici ted 278 Re quests GUI – Summary View | ||
1229 | |||
1230 | |||
1231 | |||
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1233 | |||
1234 | |||
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1245 | Purchased Care Autho rizations Compliance v0.0121No vember 201 6 User Gui de | ||
1246 | |||
1247 | |||
1248 | |||
1249 | |||
1250 | |||
1251 | |||
1252 | |||
1253 | |||
1254 | |||
1255 | Figure 14 - Unsolici ted 278 Re quests GUI – Detail View | ||
1256 | |||
1257 | |||
1258 | This view will allow the user to review all the in formation in the 278 Request. | ||
1259 | |||
1260 | |||
1261 | |||
1262 | |||
1263 | |||
1264 | |||
1265 | |||
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1273 | Purchased Care Autho rizations Compliance v0.0122No vember 201 6 User Gui de | ||
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1276 | |||
1277 | |||
1278 | |||
1279 | |||
1280 | |||
1281 | |||
1282 | |||
1283 | |||
1284 | Figure 15 - Unsolici ted 278 Re quests GUI - Respons e View | ||
1285 | |||
1286 | |||
1287 | 6.1.Accept /Deny Requ irements | ||
1288 | An authori zation in a queue ha s two poss ible dispo sitions. T hey can be acceptedo r denied. Informatio n from 278 request w ill be ava ilable to the author ization cl erk for re view and f urther pro cessing. | ||
1289 | Authorizat ion respon ses will b e returned in the Pa tient Even t loop. | ||
1290 | |||
1291 | |||
1292 | |||
1293 | A 278 resp onse is re quired for either an accepted or denied 278’s. The requireme nts in the next tabl e are comm on to both responses . | ||
1294 | |||
1295 | |||
1296 | A denied r esponse wi ll be used when the NVCC staff determine s that the services are not co vered by t he VA. | ||
1297 | In both ca ses, the 2 78 Request is moved to the app ropriate r eference q ueue so NV CC staff h ave access to the or iginal 278 Request a nd Respons e informat ion in the event the provider or patient follow up with a ph one call o r email to resolve t he problem . | ||
1298 | |||
1299 | |||
1300 | |||
1301 | |||
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1304 | |||
1305 | |||
1306 | |||
1307 | |||
1308 | |||
1309 | |||
1310 | |||
1311 | 1.1.1 AAT Requiremen ts | ||
1312 | To enforce 278 respo nse data, new lookup tables wi ll be requ ired. The data requi red to pop ulate thes e tables i s defined in the ASC X12 278 X 215 and X2 17 standar ds. | ||
1313 | (For the p urposes of this docu ment, the assumption is the AA A code tab les were c reated in FY14). | ||
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1353 | Purchased Care Autho rizations Compliance v0.0124No vember 201 6 User Gui de |
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