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1 | Purch Care Auth Compliance P3.zip | 08-020 PC Auth Compl RSD v1.1.docx | Mon Aug 7 13:15:46 2017 UTC |
2 | Purch Care Auth Compliance P3.zip | 08-020 PC Auth Compl RSD v1.1.docx | Mon Aug 7 19:59:26 2017 UTC |
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1 | Health Adm inistratio n Product Enhancemen ts (HAPE) | ||
2 | Electronic Data Inte rchange (E DI) | ||
3 | Purchased Care (PC) Enhancemen ts | ||
4 | |||
5 | Requiremen ts Specifi cation Doc ument | ||
6 | for | ||
7 | Purchased Care Autho rizations Compliance Phase 3 | ||
8 | |||
9 | |||
10 | |||
11 | July 2016 | ||
12 | Version 1. 1 | ||
13 | |||
14 | |||
15 | |||
16 | Revision H istory | ||
17 | Creation D ate | ||
18 | Version No . | ||
19 | Descriptio n/Comments | ||
20 | Author(s) | ||
21 | Reviewer(s ) | ||
22 | Review Typ e | ||
23 | Issue Date | ||
24 | 07/01/2016 | ||
25 | 1.1 | ||
26 | |||
27 | |||
28 | |||
29 | |||
30 | |||
31 | 08/24/2015 | ||
32 | 1.0 | ||
33 | VA COR acc epted docu ment effec tive Augus t 24, 2015 . Document has been baselined for releas e. | ||
34 | F. Perez | ||
35 | |||
36 | |||
37 | |||
38 | |||
39 | |||
40 | Table of C ontents | ||
41 | 1Introduct ion1 | ||
42 | 1.1Purpose 2 | ||
43 | 1.2Scope2 | ||
44 | 1.3Referen ces6 | ||
45 | 2Overall D escription 8 | ||
46 | 2.1Accessi bility Spe cification s9 | ||
47 | 2.2Busines s Rules Sp ecificatio n9 | ||
48 | 2.3Design Constraint s Specific ation9 | ||
49 | 2.4Disaste r Recovery Specifica tion10 | ||
50 | 2.5Documen tation Spe cification s10 | ||
51 | 2.6Functio nal Specif ications11 | ||
52 | 2.6.1VistA Fee Autho rization E nhancement s11 | ||
53 | 2.6.1.1Con sult ID Re quirements - Inpatie nt11 | ||
54 | 2.6.1.2Con sult ID Re quirements - Outpati ent12 | ||
55 | 2.6.1.310- 7078 Autho rizations - Admissio n Date13 | ||
56 | 2.6.1.4Act ive Author izations14 | ||
57 | 2.6.2Maste r Authoriz ations Req uirements1 4 | ||
58 | 2.6.2.1Aut horization Health Ca re Status Requiremen ts16 | ||
59 | 2.6.3Healt h Care Ser vices Requ irements17 | ||
60 | 2.6.3.1Aut horization Health Ca re Service s Lookup T able Requi rements17 | ||
61 | 2.6.3.2Aut horization Health Ca re Service s Delivery (HSD) Loo kup Table Requiremen ts19 | ||
62 | 2.6.3.3Mas ter Outpat ient 10-70 79 Authori zations Se rvices Req uirements1 9 | ||
63 | 2.6.3.4Mas ter Inpati ent 10-707 8 Authoriz ations Ser vices Requ irements21 | ||
64 | 2.6.3.5Aut horization s Services Entry Req uirements2 2 | ||
65 | 2.6.4Graph ical User Interface2 3 | ||
66 | 2.6.4.1278 Unsolicit ed Request /Response GUI25 | ||
67 | 2.6.5Accep t/Deny Req uirements3 1 | ||
68 | 2.6.6AAT R equirement s40 | ||
69 | 2.6.6.1AAT Code Look up Table R equirement s40 | ||
70 | 2.6.6.2AAT Event log ging Requi rements41 | ||
71 | 2.6.6.3AAT Queuing R equirement s42 | ||
72 | 2.6.6.4278 Category of Authori zation and UM Queuin g Requirem ents43 | ||
73 | 2.6.6.5AAT Receive A uthorizati on Request 43 | ||
74 | 2.6.7Other Requireme nts44 | ||
75 | 2.6.7.1278 PHI Sensi tive Patie nt Require ments44 | ||
76 | 2.6.7.2278 Authoriza tion track ing45 | ||
77 | 2.6.7.3Gen eral Requi rements45 | ||
78 | 2.6.8EDI R equirement s46 | ||
79 | 2.6.8.1Sta tion of Ju risdiction Requireme nt46 | ||
80 | 2.6.8.2EDI Reporting Requireme nts46 | ||
81 | 2.6.8.3278 EDI Compl iance47 | ||
82 | 2.7Graphic al User In terface (G UI) Specif ications47 | ||
83 | 2.8Multi-d ivisional Specificat ions49 | ||
84 | 2.9Perform ance Speci fications4 9 | ||
85 | 2.10Qualit y Attribut es Specifi cation50 | ||
86 | 2.11Reliab ility Spec ifications 50 | ||
87 | 2.12Scope Integratio n51 | ||
88 | 2.13Securi ty Specifi cations51 | ||
89 | 2.14System Features5 2 | ||
90 | 2.15Usabil ity Specif ications53 | ||
91 | 3Applicabl e Standard s53 | ||
92 | 4Interface s54 | ||
93 | 4.1Communi cations In terfaces54 | ||
94 | 4.2Hardwar e Interfac es54 | ||
95 | 4.3Softwar e Interfac es54 | ||
96 | 4.4User In terfaces54 | ||
97 | 5Legal, Co pyright, a nd Other N otices55 | ||
98 | 6Purchased Component s55 | ||
99 | 6.1Defect Source (TO P 5)55 | ||
100 | 7User Clas s Characte ristics55 | ||
101 | 8Estimatio n56 | ||
102 | 9Approval Signatures 58 | ||
103 | A.Appendix A – Use C ase Specif ication59 | ||
104 | B.Appendix B – Acron ym List an d Glossary 60 | ||
105 | C.Appendix C – Sampl e 10-7078 Authorizat ion63 | ||
106 | D.Appendix D – Sampl e 10-7079 Authorizat ion65 | ||
107 | E.Appendix E – Sampl e Code Tab les68 | ||
108 | |||
109 | |||
110 | List of Ta bles | ||
111 | Table 1 - Business T hemes, Epi cs, and Us er Narrati ves3 | ||
112 | Table 2 - Out of Sco pe – Opera ting Rule6 | ||
113 | Table 3 - Out of Sco pe – FBCS Changes6 | ||
114 | Table 4 - Inpatient Consult ID Requireme nts11 | ||
115 | Table 5 - Outpatient Consult I D Requirem ents12 | ||
116 | Table 6 - Authorizat ion Admiss ion Date R equirement s13 | ||
117 | Table 7 - Active Aut horization Requireme nts14 | ||
118 | Table 8 - Master Aut horization s Requirem ents14 | ||
119 | Table 9 - Master Aut horization Status Wo rkflow16 | ||
120 | Table 10 - Master Au thorizatio n Status R equirement s17 | ||
121 | Table 11 - Authoriza tion Servi ces (UM03) Requireme nts18 | ||
122 | Table 12 - HSD Looku p Table Re quirements 19 | ||
123 | Table 13 - Master 10 -7079 Auth orization Services R equirement s19 | ||
124 | Table 14 - Master In patient Se rvices Req uirements2 1 | ||
125 | Table 15 - HSD Entry Requireme nts22 | ||
126 | Table 16 - Routing Q ueue Defin itions23 | ||
127 | Table 17 - Queues GU I Requirem ents25 | ||
128 | Table 18 - Unsolicit ed 278 Req uest GUI R equirement s - Summar y27 | ||
129 | Table 19 - Unsolicit ed 278 GUI Requireme nts - Deta il29 | ||
130 | Table 20 - Authoriza tion Reque st Require ments31 | ||
131 | Table 21 - 278 Reque st Require ments31 | ||
132 | Table 22 - Create Re sponse Req uirements3 4 | ||
133 | Table 23 - 278 ACCEP T Response Requireme nts38 | ||
134 | Table 24 - Authoriza tion DENIE D Requirem ents39 | ||
135 | Table 25 - AAT – Loo kup Table Requiremen ts40 | ||
136 | Table 26 - AAT Event Logging R equirement s41 | ||
137 | Table 27 - Queue Cre ation Requ irements42 | ||
138 | Table 28 - Category/ Queuing Re quirements 43 | ||
139 | Table 29 - AAT Recei ve Authori zation Req uirements4 3 | ||
140 | Table 30 - 278 PHI R equirement s44 | ||
141 | Table 31 - Authoriza tion Track ing Requir ements45 | ||
142 | Table 32 - General R equirement s45 | ||
143 | Table 33 - Station of Jurisdi ction Requ irements46 | ||
144 | Table 34 - EDI Repor ting Requi rements46 | ||
145 | Table 35 - EDI Compl iance Requ irements47 | ||
146 | Table 36 - Performan ce Specifi cations49 | ||
147 | Table 37 - Quality S pecificati ons50 | ||
148 | Table 38 - Reliabili ty Specifi cations50 | ||
149 | Table 39 - Security Specificat ions51 | ||
150 | Table 40 - User Clas s Characte ristics56 | ||
151 | Table 41 - EDI Estim ation Poin ts57 | ||
152 | Table 42 - EDI PC Si ze Based E ffort Esti mation57 | ||
153 | Table 43 - EDI PC Si zed Based Duration E stimates57 | ||
154 | Table 44 - Glossary6 0 | ||
155 | Table 45 - Sample Co de Tables6 8 | ||
156 | |||
157 | |||
158 | List of Fi gures | ||
159 | Figure 1 - Queues GU I24 | ||
160 | Figure 2 - Unsolicit ed 278 Req uests GUI – Summary View26 | ||
161 | Figure 3 - Unsolicit ed 278 Req uests GUI – Detail V iew28 | ||
162 | Figure 4 - Unsolicit ed 278 Req uests GUI - Response View29 | ||
163 | |||
164 | |||
165 | Introducti on | ||
166 | The missio n of the D epartment of Veteran s Affairs (VA), Offi ce of Info rmation an d Technolo gy (OI&T), Health Ad ministrati on Product Enhanceme nts (HAPE) is to pro vide Infor mation Tec hnology (I T) product s and serv ices to th e Veterans Health Ad ministrati on (VHA) w hich in tu rn provide s benefits and servi ces to Vet erans of t he United States. In meeting t hese goals , OI&T str ives to pr ovide high quality, effective, and effic ient IT se rvices to those resp onsible fo r providin g care to the Vetera ns at the point of-c are as wel l as throu ghout all the points of the Ve terans’ he alth care in an effe ctive, tim ely and co mpassionat e manner. VA depends on Inform ation Mana gement/Inf ormation T echnology (IM/IT) sy stems to m eet missio n goals. | ||
167 | The Chief Business O ffice Purc hased Care (CBOPC) a ssesses th e impact o f healthca re regulat ory requir ements on VHA Electr onic Data Interchang e (EDI) he alth care claims pro cessing an d designs the use ca ses to ill ustrate th e reengine ered busin ess proces s flows as sociated w ith techno logy chang es. The of fice conti nuously mo nitors and participa tes in mee tings of i ndustry ED I standard s-setting organizati ons. As th e business process o wner and S ubject Mat ter Expert (SME) for industry health car e EDI mand ates, Purc hased Care (PC) defi nes Busine ss Needs ( BNs) that necessitat e VHA EDI health car e claims s ystem soft ware devel opment. Th e office d esigns the maintenan ce and ite rative upd ates to th e EDI ente rprise too l used to pay health care provi ders for s ervice con nected car e provided to Vetera ns and fam ily member s. PC deve lops partn erships wi th other F ederal age ncies and trading pa rtners to support ED I processi ng and ver ify compli ance; they test soft ware, trai n users on the use o f revised software, and provid e help des k support for end us ers. The E DI transac tions proc esses are utilized t o pay near ly $6B in projected claims ann ually. The developme nt work do ne under t he scope o f PC is in extricably linked to providing Veterans the medica l care the y have ear ned and de serve. | ||
168 | 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. | ||
169 | As part of the FY14 Authorizat ions proje ct, the ab ility to c reate a 27 8 Response when a co py of the master aut horization exists in the 278 r epository will be in troduced. This funct ionality w ill contin ue to be s upported i n FY15. | ||
170 | 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. | ||
171 | 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. | ||
172 | 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. | ||
173 | 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). | ||
174 | 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 and the units for the s ervice to be provide d. This ch ange is ne cessary to support t he 278 Res ponse reco rd. | ||
175 | Purpose | ||
176 | This Requi rements Sp ecificatio n Document (RSD) ana lyzes the BNs of the VHA CBOPC and speci fies the r equirement s for the PC Authori zations Co mpliance P hase 3 pro ject. | ||
177 | 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. | ||
178 | This RSD f or PC Auth orizations Complianc e Phase 3 project de tails the enhancemen t that wil l be made to the FY1 4 authoriz ation soft ware that will allow an author izations c lerk to se lect the s ervice to be provide d, enter q uantities and enter units as r elated to the select ed service . | ||
179 | Additional enhanceme nts will b uild on th e EDI 278 Request fo r Services Review in troduced i n FY14. It will also introduce new 278 p rocessing functional ity that w ill allow a provider to submit an unsoli cited 278 Request fo r Health C are Servic es Review, route the request t o the appr opriate VA MC, queue 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 a new G UI. Over t ime, these enhanceme nts should significa ntly reduc e manual m ethods (e. g., respon ding to te lephone ca lls to VAM Cs by usin g EDI 278 transactio ns for tre atment aut horization s and pre- certificat ions. | ||
180 | The docume nt is orga nized as f ollows: | ||
181 | Section 1: Presents background informati on on HAPE EDI PC an d PC Autho rizations Compliance Phase 3 | ||
182 | Section 2: Presents an analysi s of the c urrent and future st ate of the PC Author izations C ompliance Phase 3 an d the requ irements | ||
183 | Section 3: Presents applicable standards reference d for this RSD | ||
184 | Sections 4 through 9 : Contains additiona l sections required in RSDs, m ost of whi ch are not applicabl e to this RSD; refer to the in dividual s ections fo r details | ||
185 | Appendix A : Presents Use Case Specificat ion, which is not ap plicable t o this RSD | ||
186 | Appendix B : Contains a list of acronyms and terms applicable to this R SD | ||
187 | Scope | ||
188 | The scope of this do cument is to address the busin ess requir ements ide ntified in the Busin ess Requir ements Doc ument (BRD ) for the base perio d of devel opment. | ||
189 | The update d AET will be implem ented as p art of the FY14 auth orizations project a nd allow t he VA to p rovide a c opy of the existing master aut horization (10-7078 or 10-10-7 079) store d in the C omputer Da ta Warehou se (CDW) a s part of FY14 work. | ||
190 | This effor t involves significa nt enhance ments to t he existin g AAT proc ess. | ||
191 | AET enhanc ements inc lude: | ||
192 | Allow VA t o accept u nsolicited 278 Autho rization R equest fro m Provider s | ||
193 | Verify all providers listed in the Autho rization R equest are allowed t o perform services f or the VAM C | ||
194 | Route the unsolicite d 278 Auth orization Request to the appro priate VAM C | ||
195 | Allow admi nistration of lookup table dat a used to populate 2 78 respons es | ||
196 | Notify the EDI manag ement team if AET go es offline | ||
197 | Allow the EDI manage ment team to export summary da ta from th e 278 Repo sitory to generate n ecessary m anagement reports | ||
198 | Automatica lly route the 278 Au thorizatio n Request to specifi c queues b ased on pr edefined r outing cri teria | ||
199 | Allow loca l queue ma nagement o f unsolici ted 278 He alth Care Service Re views | ||
200 | Verify pat ient is in local VAM C Authoriz ations dat abase | ||
201 | Additional ly, this p roject wil l add the following enhancemen ts to the existing V eterans He alth Infor mation Sys tems and T echnology Architectu re (VistA) Fee syste ms: | ||
202 | Generate 1 0-7078 aut horization s services with quan tified del iverables for the se rvice (pro cedure) au thorized | ||
203 | Generate 1 0-7079 aut horization s services with quan tified del iverables for the se rvice (pro cedure) au thorized | ||
204 | Specify qu antifiable Health Ca re Service s Delivery (HSD) sch edules | ||
205 | Review the 278 Reque st utilizi ng a new G UI. | ||
206 | Generate t he appropr iate 278 R eponses to the Reque st either approving, rejecting or denyin g request for servic es | ||
207 | 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 | ||
208 | Print the CPRS Order number on the appro priate Aut horization paperwork | ||
209 | 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 | ||
210 | The BNs th at will be addressed are shown in the ne xt table. | ||
211 | Table 1 - Business T hemes, Epi cs, and Us er Narrati ves | ||
212 | Identifier | ||
213 | Descriptio n | ||
214 | Theme 001 | ||
215 | Addition o f new data points (A ligns to G oal 2) | ||
216 | Epic 001 | ||
217 | As Non-VA Care Autho rization t eam, I wan t to be ab le to inpu t a Consul t ID so I can connec t the cons ultation t o the auth orization. | ||
218 | User Narra tive 001 | ||
219 | As a Non-V A PC Autho rization C lerk, I wa nt to inpu t a Consul t ID that is associa ted with t he VistA F ee Authori zations so that I ca n validate authoriza tion entry complianc e prior to Veterans being auth orized to seek Non-V A Care for their med ical need. | ||
220 | User Narra tive 002 | ||
221 | As a Non-V A PC Autho rization C lerk, I wa nt to inpu t a Consul t ID that is associa ted with t he VistA F ee Authori zations so that I ca n validate the lengt h of time that elaps es prior t o Veterans being aut horized to seek Non- VA Care fo r their me dical need . | ||
222 | User Narra tive 003 | ||
223 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to pre -populate a Consult ID when av ailable fr om the Con sult/Reque st Trackin g package that is as sociated w ith the Vi stA Fee Au thorizatio ns so that I can val idate auth orization entry comp liance pri or to Vete rans being authorize d to seek Non-VA Car e for thei r medical need. | ||
224 | Epic 002 | ||
225 | As Non-VA PC Authori zation tea m, I want to be able to create appropria te authori zation out puts with a Consult ID so I ca n connect the consul tation to the author ization. | ||
226 | User Narra tive 005 | ||
227 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to pri nt a Consu lt ID that is associ ated with the Author ization on a 10-7078 so that I can match documenta tion to th e authoriz ation and consult. | ||
228 | User Narra tive 006 | ||
229 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to pri nt a Consu lt ID that is associ ated with the Author ization on a 10-7079 so that I can match documenta tion to th e authoriz ation and consult. | ||
230 | |||
231 | |||
232 | Theme 002 | ||
233 | Edit Admis sion Date for Author ization (A ligns to G oal 1) | ||
234 | Epic 003 | ||
235 | As Non-VA Care Autho rization t eam, I wan t to be ab le to inpu t a future date of s ervice so I can prea uthorize i npatient c are. | ||
236 | User Narra tive 008 | ||
237 | As a Non-V A PC Autho rization C lerk, I wa nt to inpu t a date o f admissio n on the a ssociated VistA Fee Authorizat ion so tha t I can va lidate aut horization complianc e when the Veteran i s authoriz ed to be a dmitted in the hospi tal for th eir medica l need. | ||
238 | User Narra tive 010 | ||
239 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to pre -populate a date of admission when it ha s been edi ted from t he associa ted VistA Fee Author ization to the Hospi tal Notifi cation so that I can update th e date of admission to match t he authori zation. | ||
240 | User Narra tive 012 | ||
241 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to pre -populate a date of admission when it ha s been edi ted from t he associa ted VistA Fee Author izations t o the Pati ent Treatm ent File ( PTF) so th at I can u pdate date of admiss ion to mat ch the aut horization . | ||
242 | Theme 003 | ||
243 | Multiple A uthorizati ons Create d (Aligns to Goal 1) | ||
244 | Epic 004 | ||
245 | As Non-VA Care Autho rization t eam, I wan t to be ab le to crea te multipl e authoriz ations so I can auth orize emer gency care . | ||
246 | User Narra tive 014 | ||
247 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to ide ntify inco mplete aut horization s so that I can proc ess an aut horization for payme nt. | ||
248 | Epic 005 | ||
249 | As Non-VA PC Authori zations te am, I want to be abl e to expor t a report with the number of authorizat ions compl eted per u ser for a selected t imeframe s o that I c an downloa d the data . | ||
250 | Epic 006 | ||
251 | As Non-VA PC Authori zations te am, I want to be abl e to expor t a report by the ty pe of serv ice for a selected t imeframe s o that I c an downloa d the data . | ||
252 | Theme 004 | ||
253 | Electronic ally Trans mit Accred ited Stand ards Commi ttee X12 ( ASC X12) 2 78 (Aligns to Goal 2 ) | ||
254 | Epic 007 | ||
255 | As Non-VA Care Autho rization t eam, I wan t to be ab le to elec tronically receive a n ASC X12 278 Reques t so that I can init iate the a uthorizati on process . | ||
256 | User Narra tive 015 | ||
257 | As a Non-V A PC Autho rization C lerk, I wa nt to view an ASC X1 2 278 Requ est so tha t I can ac cept an au thorizatio n of care. | ||
258 | User Narra tive 016 | ||
259 | As a Non-V A PC Autho rization C lerk, I wa nt to view an ASC X1 2 278 Requ est so tha t I can de ny an auth orization of care. | ||
260 | Epic 008 | ||
261 | As Non-VA Care Autho rization t eam, I wan t to be ab le to elec tronically receive a n ASC X12 278 Reques t so that I can init iate the a uthorizati on process . | ||
262 | User Narra tive 017 | ||
263 | As a Non-V A PC Autho rization C lerk, I wa nt to crea te an ASC X12 278 re sponse so that I can deny an a uthorizati on of care . | ||
264 | Theme 005 | ||
265 | Electronic ally Proce ss ASC X12 278 (Alig ns to Goal 2) | ||
266 | Epic 009 | ||
267 | As Non-VA Care Autho rization t eam, I wan t to be ab le to iden tify the c ategory of an ASC X1 2 278 Requ est so tha t I know t he type of service f or an auth orization. | ||
268 | User Narra tive 018 | ||
269 | As a Non-V A PC Autho rization C lerk, I wa nt to view a UM01 so that I ca n identify the categ ory of ser vice that is needed. | ||
270 | User Narra tive 019 | ||
271 | As a Non-V A PC Autho rization C lerk, I wa nt to view a UM02 so that I ca n identify the certi fication t ype that i s needed. | ||
272 | User Narra tive 020 | ||
273 | As a Non-V A PC Autho rization C lerk, I wa nt to view a UM03 so that I ca n identify the type of service that is n eeded. | ||
274 | User Narra tive 021 | ||
275 | As a Non-V A PC Autho rization C lerk, I wa nt to view a UM04 so that I ca n identify the healt h care ser vice locat ion that i s needed. | ||
276 | Epic 010 | ||
277 | As Non-VA Care Autho rization t eam, I wan t to be ab le access an ASC X12 278 Reque st in an i dentified processing queue so that I can group aut horization s based on a pre-def ined crite ria. | ||
278 | User Narra tive 022(A ) | ||
279 | As a Non-V A PC Autho rization C lerk, I wa nt to view an author ization th at is plac ed in a qu eue so tha t I can pr ocess an a uthorizati on request . | ||
280 | User Narra tive 022(B ) | ||
281 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to cre ate an aut omated res ponse base d on pre-d efined cri teria so t hat I can respond to an author ization re quest. | ||
282 | Epic 011 | ||
283 | As Non-VA Care Autho rization t eam, I wan t to be ab le to iden tify the f acility th at process ed an ASC X12 278 Re quest so t hat I can track what facility is respons ible for t he authori zation. | ||
284 | Theme 6 | ||
285 | Report on ASC X12 27 8 Transact ions (Alig ns to Goal 2) | ||
286 | Epic 012 | ||
287 | As EDI Tea m, I want to be able to export a report with pre-d efined ASC X12 278 d ata points so that I can downl oad the da ta. | ||
288 | Theme 07 | ||
289 | Implement Council fo r Affordab le Quality Healthcar e (CAQH) C ommittee o n Operatin g Rules fo r Informat ion Exchan ge (CORE) Operating Rules for ASC X12N 2 78 (Aligns to Goal 2 ) | ||
290 | Epic 13 | ||
291 | As Non-VA Care Autho rization t eam, I wan t to be ab le to proc ess an ASC X12 278 a ccording t o the auth orization operating rules to d emonstrate complianc e so that VHA can ce rtify that CBOPC is compliant. | ||
292 | Epic 14 | ||
293 | As Non-VA Care Autho rization t eam, I wan t to be ab le to proc ess an ASC X12 278 a ccording t o the stan dard trans actions fo rmat to de monstrate compliance so that V HA can cer tify that CBOPC is c ompliant. | ||
294 | Epic 15 | ||
295 | As Non-VA Care Autho rization t eam, I wan t to be ab le to proc ess an ASC X12 278 a ccording t o the proc essing con nectivity rule to de monstrate compliance so that V HA can cer tify that CBOPC is c ompliant. | ||
296 | Epic 16 | ||
297 | As Non-VA Care Autho rization t eam, I wan t to be ab le to proc ess an ASC X12 278 a ccording t o the syst em availab ility rule to demons trate comp liance so that VHA c an certify that CBOP C is compl iant. | ||
298 | Epic 17 | ||
299 | As Non-VA Care Autho rization t eam, I wan t to be ab le to proc ess an ASC X12 278 a ccording t o the syst em respons e rule to demonstrat e complian ce so that VHA can c ertify tha t CBOPC is compliant . | ||
300 | Epic 19 | ||
301 | As Non-VA Care Autho rization t eam, I wan t to be ab le to proc ess an ASC X12 278 a ccording t o the real time stan dard ackno wledgement s time fra me to demo nstrate co mpliance s o that VHA can certi fy that CB OPC is com pliant. | ||
302 | User Narra tive 24 | ||
303 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to res pond to th e request of a real time autho rization w ithin 20 s econds so that I can be in com pliance wi th operati ng rules. | ||
304 | Theme 8 | ||
305 | Notificati on of 278 Status (Al igns to Go al 2) | ||
306 | Epic 20 | ||
307 | As EDI Tea m, I want to be able to receiv e a notifi cation of ASC X12 27 8 system s tatus to d emonstrate complianc e so that I can noti fy provide rs of avai lability. | ||
308 | User Narra tive 25 | ||
309 | As an EDI Analyst, I want to r eceive a n otificatio n when the ASC X12 2 78 reposit ory is una vailable w ithin one hour of it being una vailable s o that I c an notify providers of availab ility of t he system. | ||
310 | User Narra tive 26 | ||
311 | As an EDI Analyst, I want to r eceive a n otificatio n when the ASC X12 2 78 reposit ory is sch eduled for non-routi ne downtim e at least one week prior to b eing unava ilable so that I can notify pr oviders of availabil ity of the system. | ||
312 | User Narra tive 27 | ||
313 | As an EDI Analyst, I want to p ublish CBO PC holiday schedule so that I can notify providers of availa bility of the system . | ||
314 | |||
315 | The follow ing BNs ar e out of s cope for t his projec t. At the time of th is RSD cre ation the Health Car e Clearing House (HC CH) does n ot support batch mod e processi ng for 278 transacti ons. | ||
316 | Table 2 - Out of Sco pe – Opera ting Rule | ||
317 | Identifier | ||
318 | Descriptio n | ||
319 | User Narra tive 23 | ||
320 | As a Non-V A PC Autho rization C lerk, I wa nt to resp ond to a r equest for authoriza tion withi n three bu siness day s for the batch proc essing mod e so that CBOPC can be in comp liance wit h the oper ating rule s. | ||
321 | Epic 18 | ||
322 | As Non-VA Care Autho rization t eam, I wan t to be ab le to proc ess an ASC X12 278 a ccording t o the batc h acknowle dgements f ormat to d emonstrate complianc e so that VHA can ce rtify that CBOPC is compliant. | ||
323 | |||
324 | The follow ing BNs ar e out of s cope for t his projec t. Changes to Fee Ba sis Claims System (F BCS) can o nly be mad e by the c ontractor who suppor ts the FBC S software . | ||
325 | Table 3 - Out of Sco pe – FBCS Changes | ||
326 | Identifier | ||
327 | Descriptio n | ||
328 | User Narra tive 004 | ||
329 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to pre -populate a Consult ID that is associate d with the consult d escription from CPRS to the as sociated F BCS Author izations s o that I c an validat e the leng th of time that elap ses prior to the Vet eran being authorize d to seek Non-VA Car e for thei r medical need. | ||
330 | User Narra tive 009 | ||
331 | As a Non-V A PC Autho rization C lerk, I wa nt to inpu t a date o f admissio n on the a ssociated FBCS Autho rization s o that I c an validat e authoriz ation comp liance whe n the Vete ran is aut horized to be admitt ed in the hospital f or their m edical nee d. | ||
332 | User Narra tive 011 | ||
333 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to pre -populate a date of admission when it ha s been edi ted from t he associa ted FBCS A uthorizati ons to the Hospital Notificati on so that I can upd ate date o f admissio n to match the autho rization. | ||
334 | User Narra tive 013 | ||
335 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to pre -populate a date of admission when it ha s been edi ted from t he associa ted FBCS A uthorizati ons to the PTF so th at I can u pdate date of admiss ion to mat ch the aut horization . | ||
336 | References | ||
337 | 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
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||
338 | 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. http:// DNS /pm/hape/i pt_5010/ED I_Portfoli o/Program% 20Level%20 Documentat ion/PC/FY% 202015/Tea m%20Admini stration/S 02_Purchas ed_Care_(P C)_Systems _Enhanceme nts_PWS_11 -20-2014,_ v5.0.docx | ||
339 | 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. | ||
340 | 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. | ||
341 | 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 | ||
342 | Non-VA Car e Version 6.2 Templa te | ||
343 | Real-Time X12 Standa rd Compani on Guide v ersion 1.0 , date Dec ember 2012 , Emdeon B usiness Se rvices | ||
344 | 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 /10-10-707 9 | ||
345 | Place of S ervice Cod es for Pro fessional Claims Dat abase (upd ated Novem ber 1, 201 2) | ||
346 | Fee Basis Technical Manual ver sion 3.5, Revised Ja nuary 2013 , VA – OI& T PD | ||
347 | Fee Basis User Manua l version 3.5, Revis ed Septemb er 2013, V A – OI&T P D | ||
348 | 44 U.S.C. § 3541, “F ederal Inf ormation S ecurity Ma nagement A ct (FISMA) of 2002” | ||
349 | Federal In formation Processing Standards (FIPS) Pu blication 140-2, “Se curity Req uirements For Crypto graphic Mo dules” | ||
350 | 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 | ||
351 | VA Directi ve 6102, “ Internet/I ntranet Se rvices,” J uly 15, 20 08 | ||
352 | 36 C.F.R. Part 1194 “Electroni c and IT A ccessibili ty Standar ds,” July 1, 2003 | ||
353 | Office of Management and Budge t (OMB) Ci rcular A-1 30, “Manag ement of F ederal Inf ormation R esources,” November 28, 2000 | ||
354 | 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 | ||
355 | 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 | ||
356 | Homeland S ecurity Pr esidential Directive (12) (HSP D-12) | ||
357 | VA Directi ve 6500, “ Informatio n Security Program,” August 4, 2006 | ||
358 | VA Handboo k 6500, “I nformation Security Program,” September 18, 2007 | ||
359 | VA Handboo k, 6500.5, Incorpora ting Secur ity and Pr ivacy in S ystem Deve lopment Li fecycle. | ||
360 | VA Handboo k 6500.6, “Contract Security,” March 12, 2010 | ||
361 | Program Ma nagement A ccountabil ity System (PMAS) po rtal (refe rence PWS References - Technic al Library at https: / DNS /) | ||
362 | 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. | ||
363 | Technical Reference Model (TRM ) (referen ce at http :// DNS /TRM/TRMHo mePage.asp ) | ||
364 | National I nstitute S tandards a nd Technol ogy (NIST) Special P ublication s SP 800-6 0 and 800- 53 | ||
365 | 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-E MF Concept ual link] | ||
366 | HIPAA of 1 996; Pub.L 104-191). | ||
367 | Patient Pr otection a nd Afforda ble Care A ct (PPACA) , Pub. L. 111-148, 1 24 Stat. 1 19, H.R. 3 590, enact ed March 2 3, 2010 | ||
368 | 5 CFR 1315 , Final Ru le, Prompt Payment ( http:// DNS /prompt/re gulations. html) (for merly OMB Circular A -125) | ||
369 | 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://w ww.caqh.or g/CORE_ope rat_rules. php | ||
370 | 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 | ||
371 | VA M Progr amming Sta ndards and Conventio ns. Revise d 04/03/20 07 (http:/ / DNS /TRM/files /SACC_2008 .pdf). | ||
372 | Overall De scription | ||
373 | This proje ct will en hance exis ting autho rization b y: | ||
374 | Capturing and displa ying the C PRS order number whe n a CPRS o rder exist s for the authorizat ion | ||
375 | Allowing a n authoriz ation cler k to creat e a master authoriza tion prior to the se rvices bei ng deliver ed | ||
376 | This proje ct also ex pands the AAT EDI 27 8 processi ng being i ntroduced as part of the Gover nment Fisc al Year (G FY) 14 HAC EDI Autho rizations project. A AT will: | ||
377 | Support th e generati on of a 27 8 EDI comp liant resp onse | ||
378 | Allow a us er, throug h a new GU I, to revi ew the 278 Request a nd either Accept or Deny a 278 Request. | ||
379 | Automatica lly route an unsolic ited 278 H ealth Care Service R equest to different queues bas ed on info rmation in the reque st (Inpati ent servic es, Outpat ient servi ces, Denta l services , etc.) an d allow a user to re view a 278 Request i n its assi gned queue and deter mine autho rization a ctions. | ||
380 | Notify the EDI Manag ement team if AET go es offline for an ex tended per iod of tim e | ||
381 | Meet CAQH Core Opera ting Rules | ||
382 | Export 278 Summary d ata to gen erate mana gement per formance r eports | ||
383 | Accessibil ity Specif ications | ||
384 | This proje ct will ad here to al l applicab le require ments of S ection 508 of the Re habilitati on Act of 1973, as a mended (29 U.S.C. 79 4d). The s tandards a re detaile d at http: // DNS /Standards _Checklist .asp. | ||
385 | Business R ules Speci fication | ||
386 | PC Authori zations ha s the foll owing busi ness rules : | ||
387 | Notify the EDI Manag ement team if AAT pr ocessing e ncounters unplanned downtime e xceeding 6 0 minutes | ||
388 | EDI manage ment team will make a schedule available to the HC CH and pro viders of planned do wntime | ||
389 | Core Opera ting Rules | ||
390 | A HIPAA co vered heal th plan or its agent must be a ble to sup port the H ealth Care Services Review – R equest and Response Processing Mode Rule | ||
391 | A HIPAA co vered enti ty or its agent must be able t o support the Phase IV CAQH CO RE 470 Con nectivity Rule Versi on 4.0.0. | ||
392 | Health Car e Services Review – Request an d Response System Av ailability Rule | ||
393 | Health Car e Services Review – Request an d Response Real Time Processin g Mode Res ponse Time 269 Requi rements | ||
394 | Health Car e Services Review – Request an d Response Real Time Acknowled gement Req uirements | ||
395 | Design Con straints S pecificati on | ||
396 | PC Authori zations ha s the foll owing cons traints: | ||
397 | The curren t authoriz ation form s have a p lace for l isting “se rvices not authorize d”. The ED I 278 stan dard does not suppor t this typ e of infor mation and it cannot be suppor ted as par t of the E DI 278 imp lementatio n. | ||
398 | The curren t authoriz ation form s have a m ulti-page “payment m ethodology ” narrativ e text tha t is not s upported b y the 278 EDI standa rd. This w ill not be included as part of the 278 E DI respons e. | ||
399 | Changes to FBCS are beyond the scope of this proje ct. FBCS w ill need t o be modif ied to sel ect the au thorizatio n data fro m the new fields in the master authoriza tion recor d. The fol lowing cha nges will need to be made: | ||
400 | Allow the authorizat ion clerk to populat e a servic e record f rom a look -up table added to V istA Fee ( UM03). | ||
401 | Allow the authorizat ion clerk to populat e the Heal th Care De livery inf ormation f rom look-u p tables a dded to Vi stA Fee (H SD01, HSD0 2, HSD03). | ||
402 | Allow the authorizat ion clerk to enter a n optional single fr ee form na rrative te xt message not to ex ceed 264 c haracters. | ||
403 | The soluti on will ne ed to meet CORE EDI standards. | ||
404 | The soluti on well ne ed to oper ate within the opera ting const raints and requireme nts provid ed by the HCCH. | ||
405 | The soluti on will ne ed to meet VA Enterp rise Stand ards for d evelopment language, security, 508 compl iance, web framework , applicat ion framew ork, and i ntegration with othe r VA syste ms. | ||
406 | It will al so be nece ssary to i ntroduce s everal new lookup ta bles in or der to sel ect and or der the se rvices to be provide d, and spe cify the q uantity an d frequenc y of the s ervices be ing ordere d. Develop ing some o f the data in these lookup tab les will r equire the assistanc e of Non-V A Coordina ted Care ( NVCC) Auth orization SMEs and P olicy Mana gement Dep artment (P MD) who ha s a strong working k nowledge o f services offered f or each ty pe of auth orization. | ||
407 | Disaster R ecovery Sp ecificatio n | ||
408 | The existi ng Disaste r Recovery Plan (DRP ) details the basics for disas ter recove ry as it r elates to the HAPE E DI PC port folio. | ||
409 | The existi ng DRP wil l need to be modifie d to incor porate the 278 AAT p rocessing into the p lan. The D RP will al so need to be modifi ed to supp ort recove ry of 278 Repository data and the HCCH m essaging i n the even t that AAT encounter s unplanne d interrup tion of se rvices. | ||
410 | The disast er recover y specific ations for the syste ms impacte d by this project ca n also be found in t he Agillia nce RiskVi sion Gover nance, Ris k, and Com pliance (G RC) tool m aintained by the Off ice of Cyb er Securit y (OCS). | ||
411 | Please con tact the a ssigned Sy stem Owner and/or In formation Security O fficer (IS O) for acc ess to the respectiv e RiskVisi on GRC ent ries for t he followi ng systems : | ||
412 | AET | ||
413 | VistA Fee | ||
414 | Documentat ion Specif ications | ||
415 | This docum ent covers modificat ions to th e identifi ed systems and speci fies relat ed technic al require ments for those modi fications. | ||
416 | In additio n to deliv ering soft ware code that satis fies the s pecificati ons in thi s document , the foll owing docu mentation is include d in the c ontractual deliverab le. The fi les contai ning these documents are separ ate from t he softwar e package: | ||
417 | Installati on Guide U pdate - Pr ovides the informati on necessa ry to inst all the so ftware wit h little o r no assis tance from the softw are develo pers or su pport staf f. | ||
418 | The AET in stallation guide wil l be updat ed to incl ude instal lation of the new AA T function ality | ||
419 | Installati on of the default AA T lookup t ables | ||
420 | Release No tes - Desc ribes chan ges to exi sting soft ware and n ew feature s and func tions crea ted as a r esult of t his remedi ation. | ||
421 | Security G uide Updat e - Identi fies and e xplains an y unique a nd/or atyp ical featu res and mi scellaneou s informat ion that m ay be of p articular interest t o ISOs. | ||
422 | Technical Manual - P rovides in formation that techn ical users require t o support the system . | ||
423 | Management and maint enance of the AAT ta bles | ||
424 | Technical specificat ions of th e AAT GUI | ||
425 | Users Guid e Update - Provides informatio n that end -users req uire to op erate the system. | ||
426 | AAT update s | ||
427 | New AAT qu eue manage ment | ||
428 | Functional Specifica tions | ||
429 | VistA Fee Authorizat ion Enhanc ements | ||
430 | Consult ID , from CPR S will be added to t he master authorizat ion and re lated sour ce documen ts when th e master a uthorizati on is base d on a CPR S order. | ||
431 | Consult ID Requireme nts - Inpa tient | ||
432 | Table 4 - Inpatient Consult ID Requireme nts | ||
433 | Identifier | ||
434 | Requiremen t Number | ||
435 | Descriptio n | ||
436 | Theme 001 | ||
437 | |||
438 | Addition o f new data points (A ligns to G oal 2) | ||
439 | Epic 001 | ||
440 | |||
441 | As Non-VA Care Autho rization t eam, I wan t to be ab le to inpu t a Consul t ID so I can connec t the cons ultation t o the auth orization. | ||
442 | User Narra tive 001 | ||
443 | |||
444 | As a Non-V A PC Autho rization C lerk, I wa nt to inpu t a Consul t ID that is associa ted with t he VistA F ee Authori zations so that I ca n validate authoriza tion entry complianc e prior to Veterans being auth orized to seek Non-V A Care for their med ical need. | ||
445 | |||
446 | FS-UN001-0 01 | ||
447 | When an in patient au thorizatio n is being generated as a resu lt of a co nsult orde r placed i n CPRS, th e system s hall store the Consu lt ID with the autho rization r ecord. | ||
448 | User Narra tive 002 | ||
449 | |||
450 | As a Non-V A PC Autho rization C lerk, I wa nt to inpu t a Consul t ID that is associa ted with t he VistA F ee Authori zations so that I ca n validate the lengt h of time that elaps es prior t o Veterans being aut horized to seek Non- VA Care fo r their me dical need . | ||
451 | |||
452 | FS-UN002-0 01 | ||
453 | When an in patient au thorizatio n is being generated as a resu lt of a co nsult orde r placed i n CPRS, th e Consult ID approva l date and time shal l be avail able as pa rt of a re quested da ta export. | ||
454 | Epic 002 | ||
455 | |||
456 | As Non-VA Care Autho rization t eam, I wan t to be ab le to crea te appropr iate autho rization o utputs wit h a Consul t ID so I can connec t the cons ultation t o the auth orization. | ||
457 | User Narra tive 005 | ||
458 | |||
459 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to pri nt a Consu lt ID that is associ ated with the Author ization on a 10-7078 so that I can match documenta tion to th e authoriz ation and consult. | ||
460 | |||
461 | FS-UN005-0 01 | ||
462 | When a Con sult ID is present i n the auth orization record, th e Consult ID shall b e displaye d on the a uthorizati on screen. | ||
463 | |||
464 | FS-UN005-0 02 | ||
465 | When a Con sult ID is present i n the auth orization record, th e Consult ID shall b e printed on a 10-70 78 paper a uthorizati on. | ||
466 | |||
467 | |||
468 | |||
469 | |||
470 | |||
471 | |||
472 | |||
473 | |||
474 | |||
475 | Consult ID Requireme nts - Outp atient | ||
476 | Table 5 - Outpatient Consult I D Requirem ents | ||
477 | Identifier | ||
478 | Requiremen t Number | ||
479 | Descriptio n | ||
480 | Theme 001 | ||
481 | |||
482 | Addition o f new data points (A ligns to G oal 2) | ||
483 | Epic 001 | ||
484 | |||
485 | As Non-VA Care Autho rization t eam, I wan t to be ab le to inpu t a Consul t ID so I can connec t the cons ultation t o the auth orization. | ||
486 | User Narra tive 003 | ||
487 | |||
488 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to pre -populate a Consult ID when av ailable fr om the Con sult/Reque st Trackin g package that is as sociated w ith the Vi stA Fee Au thorizatio ns so that I can val idate auth orization entry comp liance pri or to Vete rans being authorize d to seek Non-VA Car e for thei r medical need. | ||
489 | |||
490 | FS-UN003-0 01 | ||
491 | When an ou tpatient a uthorizati on is bein g generate d as a res ult of a c onsult ord er placed in CPRS, C onsult ID , system d ate and ti me shall b e availabl e as part of a reque sted data export. | ||
492 | |||
493 | FS-UN003-0 02 | ||
494 | When an ou tpatient a uthorizati on is bein g generate d as a res ult of a c onsult ord er placed in CPRS, t he system shall stor e the Cons ult ID app roval date and time with the a uthorizati on record. | ||
495 | Epic 002 | ||
496 | |||
497 | As Non-VA Care Autho rization t eam, I wan t to be ab le to crea te appropr iate autho rization o utputs wit h a Consul t ID so I can connec t the cons ultation t o the auth orization. | ||
498 | User Narra tive 006 | ||
499 | |||
500 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to pri nt a Consu lt ID that is associ ated with the Author ization on a 10-7079 so that I can match documenta tion to th e authoriz ation and consult. | ||
501 | |||
502 | FS-UN006-0 01 | ||
503 | When a Con sult ID is present i n the auth orization record, th e Consult ID shall b e displaye d on the 1 0-7079 aut horization screens. | ||
504 | |||
505 | FS-UN006-0 02 | ||
506 | When a Con sult ID is present i n the auth orization record, th e Consult ID shall b e printed on a 10-70 79 paper a uthorizati on. | ||
507 | |||
508 | |||
509 | |||
510 | |||
511 | |||
512 | |||
513 | |||
514 | |||
515 | |||
516 | 10-7078 Au thorizatio ns - Admis sion Date | ||
517 | Table 6 - Authorizat ion Admiss ion Date R equirement s | ||
518 | Identifier | ||
519 | Requiremen t Number | ||
520 | Descriptio n | ||
521 | Theme 002 | ||
522 | |||
523 | Edit Admis sion Date for Author ization (A ligns to G oal 1) | ||
524 | Epic 003 | ||
525 | |||
526 | As Non-VA Care Autho rization t eam, I wan t to be ab le to inpu t a future date of s ervice so I can prea uthorize i npatient c are. | ||
527 | |||
528 | FS-EP003-0 01 | ||
529 | A VistA Fe e user sha ll be allo wed to cre ate a 10-7 078 author ization wi th a Date of Service (FROM dat e) greater than the current sy stem date. | ||
530 | |||
531 | FS-EP003-0 02 | ||
532 | A VistA Fe e user sha ll be allo wed to cre ate a 10-7 078 author ization wi th a Date of Service (TO date) greater t han the cu rrent syst em date. | ||
533 | User Narra tive 008 | ||
534 | |||
535 | As a Non-V A PC Autho rization C lerk, I wa nt to inpu t a date o f admissio n on the a ssociated VistA Fee Authorizat ion so tha t I can va lidate aut horization complianc e when the Veteran i s authoriz ed to be a dmitted in the hospi tal for th eir medica l need. | ||
536 | |||
537 | FS-UN008-0 01 | ||
538 | During 10- 7078 autho rization c reation, a VistA Fee user shal l be allow ed to ente r a Date-o f-Admissio n includin g a future date of a dmission. | ||
539 | |||
540 | FS-UN008-0 02 | ||
541 | During 10- 7078 autho rization u pdate, a V istA Fee u ser shall be allowed to edit a Date-of-A dmission i ncluding a future da te of admi ssion. | ||
542 | User Narra tive 010 | ||
543 | |||
544 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to pre -populate a date of admission when it ha s been edi ted from t he associa ted VistA Fee Author ization to the Hospi tal Notifi cation so that I can update th e date of admission to match t he authori zation. | ||
545 | |||
546 | FS-UN010-0 01 | ||
547 | During Vis tA Fee 10- 7078 autho rization c reation, i f Date-of- Admission exists in the Hospit al Notific ation File (#162.2), the syste m shall au tomaticall y populate the 10-70 78 authori zation Dat e-of-Admis sion with the Date-o f-Admissio n from the Hospital Notificati on file. | ||
548 | |||
549 | FS-UN010-0 02 | ||
550 | If during VistA Fee entry/edit of the Ho spital Not ification file, the Date-of-Ad mission do es not mat ch the Dat e-of-Admis sion of th e 10-7078 authorizat ion record the syste m shall di splay a wa rning to t he user. | ||
551 | User Narra tive 012 | ||
552 | |||
553 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to pre -populate a date of admission when it ha s been edi ted from t he associa ted VistA Fee Author izations t o the PTF so that I can update date of a dmission t o match th e authoriz ation. | ||
554 | |||
555 | FS-UN012-0 01 | ||
556 | During Vis tA Fee 10- 7078 autho rization c reation, i f Date-of- Admission exists in the PTF, t he system shall auto matically populate t he -10-707 8 authoriz ation Date -of-Admiss ion with t he Date-of =Admission from the Hospital N otificatio n file. | ||
557 | |||
558 | FS-UN012-0 02 | ||
559 | If during VistA Fee entry/edit of the PT F, the Dat e-of-Admis sion does not match the Date-o f-Admissio n of the 1 0-7078 aut horization record th e system s hall displ ay a warni ng to the user. | ||
560 | Active Aut horization s | ||
561 | Table 7 - Active Aut horization Requireme nts | ||
562 | Identifier | ||
563 | Requiremen t Number | ||
564 | Descriptio n | ||
565 | Theme 003 | ||
566 | |||
567 | Multiple A uthorizati ons Create d (Aligns to Goal 1) | ||
568 | Epic 004 | ||
569 | |||
570 | As Non-VA Care Autho rization t eam, I wan t to be ab le to crea te multipl e authoriz ations so I can auth orize emer gency care . | ||
571 | User Narra tive 014 | ||
572 | |||
573 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to ide ntify inco mplete aut horization s so that I can proc ess an aut horization for payme nt. | ||
574 | |||
575 | FS-UN014-0 01 | ||
576 | When a 10- 7078 is re ady to be issued, a user shall be prompt ed to chan ge the aut horization status to “ACTIVE”. | ||
577 | |||
578 | FS-UN014-0 02 | ||
579 | When a 10- 7079 is re ady to be issued, a user shall be prompt ed to chan ge the aut horization status to “ACTIVE”. | ||
580 | Master Aut horization s Requirem ents | ||
581 | Table 8 - Master Aut horization s Requirem ents | ||
582 | Identifier | ||
583 | Requiremen t Number | ||
584 | Descriptio n | ||
585 | Theme 004 | ||
586 | |||
587 | Electronic ally Trans mit ASC X1 2 278 (Ali gns to Goa l 2) | ||
588 | Epic 008 | ||
589 | |||
590 | As Non-VA Care Autho rization t eam, I wan t to be ab le to elec tronically receive a n ASC X12 278 Reques t so that I can init iate the a uthorizati on process . | ||
591 | |||
592 | FS-EP008-0 01 | ||
593 | The follow ing data s hall be st ored as pa rt of the master aut horization record: | ||
594 | |||
595 | FS-EP008-0 01-001 | ||
596 | Up to two occurrence s of Patie nt Event T racking Nu mber | ||
597 | |||
598 | FS-EP008-0 01-002 | ||
599 | Authorizat ion-type ( 10-7078/10 -7079) | ||
600 | |||
601 | FS-EP008-0 01-003 | ||
602 | Category C ode (UM01) | ||
603 | |||
604 | FS-EP008-0 01-004 | ||
605 | DELETED | ||
606 | |||
607 | FS-EP008-0 01-005 | ||
608 | Certificat ion Type C ode (UM02) | ||
609 | |||
610 | FS-EP008-0 01-006 | ||
611 | Health Ser vices Type of Care A uthorized (UM03) | ||
612 | |||
613 | FS-EP008-0 01-007 | ||
614 | Service Lo cation (UM 04) | ||
615 | |||
616 | FS-EP008-0 01-008 | ||
617 | Related Ca use inform ation (UM0 5) | ||
618 | |||
619 | FS-EP008-0 01-009 | ||
620 | Level of S ervice Cod e (UM06) | ||
621 | |||
622 | FS-EP008-0 01-010 | ||
623 | Current Co ndition Co de UM07) | ||
624 | |||
625 | FS-EP008-0 01-011 | ||
626 | Prognosis Code (UM08 ) | ||
627 | |||
628 | FS-EP008-0 01-012 | ||
629 | Release of Informati on Code (U M09) | ||
630 | |||
631 | FS-EP008-0 01-013 | ||
632 | Delay Reas on Code (U M10) | ||
633 | |||
634 | FS-EP008-0 01-014 | ||
635 | Up to eigh t occurren ces of Pat ient Diagn osis Info (HI segmen t) | ||
636 | |||
637 | FS-EP008-0 01-015 | ||
638 | HSD Reques t Quantity (HSD02) | ||
639 | |||
640 | FS-EP008-0 01-016 | ||
641 | HSD Reques t Units Co de (HSD03) | ||
642 | |||
643 | FS-EP008-0 01-017 | ||
644 | HSD Reques t Quantity Qualifier (HSD01) | ||
645 | |||
646 | FS-EP008-0 01-018 | ||
647 | HSD Reques t Selectio n (HSD04) | ||
648 | |||
649 | FS-EP008-0 01-019 | ||
650 | HSD Reques t Time Per iod (HSD05 ) | ||
651 | |||
652 | FS-EP008-0 01-020 | ||
653 | HSD Reques t Periods (HSD06) | ||
654 | |||
655 | FS-EP008-0 01-021 | ||
656 | HSD Reques t Pattern Code (HSD0 7) | ||
657 | |||
658 | FS-EP008-0 01-022 | ||
659 | HSD Reques t Pattern Period (HS D08) | ||
660 | |||
661 | FS-EP008-0 01-023 | ||
662 | HSD Respon se Quantit y (HSD02) | ||
663 | |||
664 | FS-EP008-0 01-024 | ||
665 | HSD Respon se Units C ode (HSD03 ) | ||
666 | |||
667 | FS-EP008-0 01-025 | ||
668 | HSD Respon se Quantit y Qualifie r (HSD01) | ||
669 | |||
670 | FS-EP008-0 01-026 | ||
671 | DELETED | ||
672 | |||
673 | FS-EP008-0 01-027 | ||
674 | DELETED | ||
675 | |||
676 | FS-EP008-0 01-028 | ||
677 | DELETED | ||
678 | |||
679 | FS-EP008-0 01-029 | ||
680 | DELETED | ||
681 | |||
682 | FS-EP008-0 01-030 | ||
683 | DELETED | ||
684 | |||
685 | FS-EP008-0 01-031 | ||
686 | HCR Respon se Action Code (HCR0 1) | ||
687 | |||
688 | FS-EP008-0 01-032 | ||
689 | HCR Respon se Referen ce Identif ication (H CR02) | ||
690 | |||
691 | FS-EP008-0 01-033 | ||
692 | HCR Respon se Industr y Code (HC R03) | ||
693 | |||
694 | FS-EP008-0 01-034 | ||
695 | HCR Respon se Code (H CR04) | ||
696 | |||
697 | FS-EP008-0 01-035 | ||
698 | Accident D ate | ||
699 | |||
700 | FS-EP008-0 01-036 | ||
701 | Last Menst rual Perio d Date | ||
702 | |||
703 | FS-EP008-0 01-037 | ||
704 | Estimated Date of Bi rth | ||
705 | |||
706 | FS-EP008-0 01-038 | ||
707 | Onset Date | ||
708 | |||
709 | FS-EP008-0 01-039 | ||
710 | Event Date s | ||
711 | |||
712 | FS-EP008-0 01-040 | ||
713 | Admission Date | ||
714 | |||
715 | FS-EP008-0 01-041 | ||
716 | Discharge Date | ||
717 | |||
718 | FS-EP008-0 01-042 | ||
719 | CRC Reques t Ambulanc e Certific ation Info rmation | ||
720 | |||
721 | FS-EP008-0 01-043 | ||
722 | CRC Reques t Chiropra ctic Certi fication | ||
723 | |||
724 | FS-EP008-0 01-044 | ||
725 | CRC Reques t Durable Medical Eq uipment In formation | ||
726 | |||
727 | FS-EP008-0 01-045 | ||
728 | CRC Reques t Oxygen T herapy Cer tification Informati on | ||
729 | |||
730 | FS-EP008-0 01-046 | ||
731 | CRC Reques t Function al Limitat ion Inform ation | ||
732 | |||
733 | FS-EP008-0 01-047 | ||
734 | CRC Reques t Activiti es Permitt ed Informa tion | ||
735 | |||
736 | FS-EP008-0 01-048 | ||
737 | CRC Reques t Mental S tatus Info rmation | ||
738 | |||
739 | FS-EP008-0 01-049 | ||
740 | CL1 Reques t Institut ion Claim Code | ||
741 | |||
742 | FS-EP008-0 01-050 | ||
743 | CR1 Reques t Ambulanc e Transpor t Informat ion | ||
744 | |||
745 | FS-EP008-0 01-051 | ||
746 | CR2 Reques t Spinal M anipulatio n Informat ion | ||
747 | |||
748 | FS-EP008-0 01-052 | ||
749 | CR5 Reques t Home Oxy gen Therap y Informat ion | ||
750 | |||
751 | FS-EP008-0 01-053 | ||
752 | CR6 Reques t Home Hea lth Care I nformation | ||
753 | |||
754 | FS-EP008-0 01-054 | ||
755 | DELETED | ||
756 | |||
757 | FS-EP008-0 01-055 | ||
758 | DELETED | ||
759 | |||
760 | FS-EP008-0 01-056 | ||
761 | DELETED | ||
762 | |||
763 | FS-EP008-0 01-057 | ||
764 | DELETED | ||
765 | |||
766 | FS-EP008-0 01-058 | ||
767 | DELETED | ||
768 | |||
769 | FS-EP008-0 01-059 | ||
770 | DELETED | ||
771 | |||
772 | FS-EP008-0 01-060 | ||
773 | DELETED | ||
774 | |||
775 | FS-EP008-0 01-061 | ||
776 | DELETED | ||
777 | |||
778 | FS-EP008-0 01-062 | ||
779 | DELETED | ||
780 | |||
781 | FS-EP008-0 01-063 | ||
782 | DELETED | ||
783 | |||
784 | FS-EP008-0 01-064 | ||
785 | DELETED | ||
786 | |||
787 | FS-EP008-0 01-065 | ||
788 | DELETED | ||
789 | |||
790 | FS-EP008-0 01-066 | ||
791 | Up to 10 P aperwork R equest seg ments | ||
792 | |||
793 | FS-EP008-0 01-067 | ||
794 | DELETED | ||
795 | |||
796 | FS-EP008-0 01-068 | ||
797 | Message Te xt Request | ||
798 | |||
799 | FS-EP008-0 01-069 | ||
800 | Message Te xt Respons e | ||
801 | |||
802 | FS-EP008-0 01-070 | ||
803 | Up to 14 o ccurrences of Patien t Provider Request I nformation (2010EA) | ||
804 | |||
805 | FS-EP008-0 01-071 | ||
806 | DELETED | ||
807 | |||
808 | FS-EP008-0 01-072 | ||
809 | Up to 5 oc currences of Patient Event Tra nsport Inf ormation ( 2010EB) | ||
810 | |||
811 | FS-EP008-0 01-073 | ||
812 | Up to 3 oc currences of Patient Event Oth er UMO Nam e Informat ion (2010E C) | ||
813 | Authorizat ion Health Care Stat us Require ments | ||
814 | To track w hen an Aut horization is ready to be file d in the 2 78 Reposit ory, it wi ll be nece ssary to i ntroduce s everal new Status in dicators i n the mast er authori zation rec ord. | ||
815 | Table 9 - Master Aut horization Status Wo rkflow | ||
816 | Status | ||
817 | Current/Ne w | ||
818 | Workflow l evel | ||
819 | Meaning | ||
820 | INCOMPLETE (I) | ||
821 | Current | ||
822 | 1 | ||
823 | When a mas ter author ization is first cre ated, the Authorizat ion Status is set to INCOMPLET E. | ||
824 | ACTIVE (A) | ||
825 | New | ||
826 | 2 | ||
827 | When a mas ter author ization is ready to be issued, the autho rization c lerk sets the status to ACTIVE .AAT. | ||
828 | COMPLETE ( C) | ||
829 | Current | ||
830 | 3 | ||
831 | When all s ervices ha ve been pr ovided and a claim f iled again st the mas ter author ization, t he Authori zation Sta tus may be set to CO MPLETE. | ||
832 | CLOSED (X) | ||
833 | |||
834 | New | ||
835 | 4 | ||
836 | When all c laims have been file d against a master a uthorizati on and no further pr ocessing i s allowed, the maste r authoriz ation may be CLOSED. | ||
837 | CANCELLED (DC) | ||
838 | Current | ||
839 | 4 | ||
840 | A master a uthorizati on can be cancelled at either workflow l evel 1 or 2. | ||
841 | |||
842 | Table 10 - Master Au thorizatio n Status R equirement s | ||
843 | Identifier | ||
844 | Requiremen t Number | ||
845 | Descriptio n | ||
846 | Theme 003 | ||
847 | |||
848 | Multiple A uthorizati ons Create d (Aligns to Goal 1) | ||
849 | Epic 004 | ||
850 | |||
851 | As Non-VA Care Autho rization t eam, I wan t to be ab le to crea te multipl e authoriz ations so I can auth orize emer gency care . | ||
852 | User Narra tive 014 | ||
853 | |||
854 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to ide ntify inco mplete aut horization s so that I can proc ess an aut horization for payme nt. | ||
855 | |||
856 | FS-UN014-0 03 | ||
857 | On master authorizat ion creati on, the au thorizatio n status s hall be se t to: “I”, INCOMPLET E. | ||
858 | |||
859 | FS-UN014-0 04 | ||
860 | When a mas ter author ization is ready for release t o the prov ider, the authorizat ion status shall be set to “A” , ACTIVE b y an autho rization c lerk. | ||
861 | |||
862 | FS-UN014-0 05 | ||
863 | An authori zation cle rk shall b e allowed to change the Author ization st atus to a different equal or h igher work flow level supported value as long as th e workflow level is less than 4 | ||
864 | Health Car e Services Requireme nts | ||
865 | As a part of the 278 implement ation, it is necessa ry to chan ge how the master au thorizatio n (10-7078 and 10-70 79) entry of service s to be pr ovided to a Veteran are entere d and stor ed. In the current p rocess, th e authoriz ed service s are ente red as nar rative tex t (example : 12 shoul der rehab sessions, weekly). | ||
866 | The goal h ere is to allow auth orization clerks to generate n ew authori zations us ing existi ng applica tions and workflows with the o nly differ ence being that when it is tim e to enter authorize d services , the auth orization clerk will select a service to be provid ed from a drop-down menu, and also enter the quant ity and co nfirm the units used to delive r the serv ice. It wi ll be nece ssary to c hange the master aut horization forms to print the service an d delivery data from new data points in the VistA Fee record . This inc ludes the: | ||
867 | The 10-707 8 authoriz ation form | ||
868 | The 10-707 8 Provider authoriza tion lette r | ||
869 | The 10-707 8 Veteran authorizat ion letter | ||
870 | The 10-707 9 authoriz ation form | ||
871 | The 10-707 9 Provider authoriza tion lette r | ||
872 | The 10-707 9 Veteran authorizat ion letter | ||
873 | The tables in this s ection ref erence the ACS X12 2 78 standar ds regardi ng some of the conte nt to be p opulated i n these ta bles. Thes e lookup t ables will be used a s part of the master authoriza tion creat ion and up dates. The X278 stan dard is re ferenced t o ensure t hat the lo okup table data is c onsistent with the 2 78 EDI spe cification s. However , this inf ormation i s entered prior to t he 278 Res ponse proc ess. | ||
874 | Authorizat ion Health Care Serv ices Looku p Table Re quirements | ||
875 | In order t o support the change s to how s ervices ar e selected and enter ed for mas ter author izations, several ne w lookup t ables will be requir ed. | ||
876 | NOTE: Deve loping som e of the d ata in thi s services lookup ta bles will require th e assistan ce of NVCC Authoriza tion SME. The servic e that can be ordere d will be based on t he values defined fo r field UM 03 as defi ned in the 278 X12 T R3 standar d. | ||
877 | Table 11 - Authoriza tion Servi ces (UM03) Requireme nts | ||
878 | Identifier | ||
879 | Requiremen t Number | ||
880 | Descriptio n | ||
881 | Theme 004 | ||
882 | |||
883 | Electronic ally Trans mit ASC X1 2 278 (Ali gns to Goa l 2) | ||
884 | Epic 008 | ||
885 | |||
886 | As Non-VA Care Autho rization t eam, I wan t to be ab le to elec tronically receive a n ASC X12 278 Reques t so that I can init iate the a uthorizati on process . | ||
887 | |||
888 | FS-EP008-0 01 | ||
889 | DELETED | ||
890 | |||
891 | FS-EP008-0 02 | ||
892 | There shal l be one e ntry in th e table fo r each ser vice that can be sel ected for a master a uthorizati on (UM03). | ||
893 | |||
894 | FS-EP008-0 03 | ||
895 | DELETED | ||
896 | |||
897 | FS-EP008-0 04 | ||
898 | DELETED | ||
899 | |||
900 | FS-EP008-0 05 | ||
901 | DELETED | ||
902 | |||
903 | FS-EP008-0 06 | ||
904 | The Servic es table s hall conta in a descr iption for use by th e authoriz ation cler k to ensur e the corr ect servic e is being selected. | ||
905 | |||
906 | FS-EP008-0 07 | ||
907 | An authori zation cle rk shall b e allowed to search service ta ble by key word descr iption. | ||
908 | |||
909 | FS-EP008-0 08 | ||
910 | DELETED | ||
911 | |||
912 | FS-EP008-0 09 | ||
913 | DELETED | ||
914 | |||
915 | FS-EP008-0 10 | ||
916 | DELETED | ||
917 | |||
918 | FS-EP008-0 11 | ||
919 | DELETED | ||
920 | |||
921 | FS-EP008-0 12 | ||
922 | DELETED | ||
923 | |||
924 | FS-EP008-0 13 | ||
925 | DELETED | ||
926 | |||
927 | FS-EP008-0 14 | ||
928 | DELETED | ||
929 | |||
930 | FS-EP008-0 15 | ||
931 | DELETED | ||
932 | |||
933 | FS-EP008-0 16 | ||
934 | DELETED | ||
935 | |||
936 | FS-EP008-0 17 | ||
937 | DELETED | ||
938 | |||
939 | FS-EP008-0 18 | ||
940 | DELETED | ||
941 | |||
942 | FS-EP008-0 19 | ||
943 | DELETED | ||
944 | |||
945 | FS-EP008-0 20 | ||
946 | DELETED | ||
947 | |||
948 | FS-EP008-0 21 | ||
949 | DELETED | ||
950 | |||
951 | FS-EP008-0 22 | ||
952 | DELETED | ||
953 | |||
954 | FS-EP008-0 23 | ||
955 | DEELTED | ||
956 | |||
957 | FS-EP008-0 24 | ||
958 | DELETED | ||
959 | |||
960 | FS-EP008-0 25 | ||
961 | DELETED | ||
962 | |||
963 | FS-EP008-0 26 | ||
964 | DELETED | ||
965 | |||
966 | FS-EP008-0 27 | ||
967 | DELETED | ||
968 | |||
969 | Authorizat ion Health Care Serv ices Deliv ery (HSD) Lookup Tab le Require ments | ||
970 | In order t o support the change s to how H SD is sele cted and e ntered for master au thorizatio ns, new lo okup table s will be required. | ||
971 | Table 12 - HSD Looku p Table Re quirements | ||
972 | Identifier | ||
973 | Requiremen t Number | ||
974 | Descriptio n | ||
975 | Theme 004 | ||
976 | |||
977 | Electronic ally Trans mit ASC X1 2 278 (Ali gns to Goa l 2) | ||
978 | Epic 008 | ||
979 | |||
980 | As Non-VA Care Autho rization t eam, I wan t to be ab le to elec tronically receive a n ASC X12 278 Reques t so that I can init iate the a uthorizati on process . | ||
981 | |||
982 | FS-EP008-0 28 | ||
983 | A lookup t able shall be requir ed so an a uthorizati on clerk c an select a Quantity Qualifier as define d in the A SC X12 X21 7 standard s, (elemen t HSD01). | ||
984 | |||
985 | FS-EP008-0 29 | ||
986 | A lookup t able shall be requir ed so an a uthorizati on clerk c an select a Unit (Ba sis for Me asurement) code as d efined in the ASC X1 2 X217 sta ndards, (e lement HSD 03). | ||
987 | |||
988 | FS-EP008-0 30 | ||
989 | DELETED | ||
990 | |||
991 | FS-EP008-0 31 | ||
992 | DELETED | ||
993 | |||
994 | FS-EP008-0 32 | ||
995 | DELETED | ||
996 | Master Out patient 10 -7079 Auth orizations Services Requiremen ts | ||
997 | To support the creat ion of a 2 78 Respons e, the ser vices must be quanti fied. A us er will fi rst select a service to be pro vided, ent er the num ber of uni ts to be p rovided an d the unit of measur e to be de livered. S o, instead of enteri ng one lin e of narra tive text, the autho rization c lerk enter s three da ta element s, as per the exampl e below: | ||
998 | SERVICE: S houlder Re hab | ||
999 | QUANTITY: 12 | ||
1000 | UNIT of ME ASURE: Wee kly | ||
1001 | The requir ements bel ow, in con junction w ith the Se rvice entr y requirem ents will support th is change. | ||
1002 | Table 13 - Master 10 -7079 Auth orization Services R equirement s | ||
1003 | Identifier | ||
1004 | Requiremen t Number | ||
1005 | Descriptio n | ||
1006 | Theme 004 | ||
1007 | |||
1008 | Electronic ally Trans mit ASC X1 2 278 (Ali gns to Goa l 2) | ||
1009 | Epic 007 | ||
1010 | |||
1011 | As Non-VA Care Autho rization t eam, I wan t to be ab le to elec tronically receive a n ASC X12 278 Reques t so that I can init iate the a uthorizati on process . | ||
1012 | |||
1013 | FS-EP007-0 01 | ||
1014 | DELETED | ||
1015 | |||
1016 | FS-EP007-0 02 | ||
1017 | DELETED | ||
1018 | |||
1019 | FS-EP007-0 03 | ||
1020 | DELETED | ||
1021 | |||
1022 | FS-EP007-0 04 | ||
1023 | DELETED | ||
1024 | |||
1025 | FS-EP007-0 05 | ||
1026 | DELETED | ||
1027 | |||
1028 | FS-EP007-0 05-001 | ||
1029 | DELTED | ||
1030 | |||
1031 | FS-EP007-0 05-002 | ||
1032 | DELETED | ||
1033 | |||
1034 | FS-EP007-0 05-003 | ||
1035 | DELETED | ||
1036 | |||
1037 | FS-EP007-0 06 | ||
1038 | The 10-707 9 Authoriz ation form shall be modified t o: | ||
1039 | |||
1040 | FS-EP007-0 06-001 | ||
1041 | display th e services descripti on (UM03) | ||
1042 | |||
1043 | FS-EP007-0 06-002 | ||
1044 | display th e services quantity (HSD02) | ||
1045 | |||
1046 | FS-EP007-0 06-003 | ||
1047 | display th e services units (HS D01) | ||
1048 | |||
1049 | FS-EP007-0 06-004 | ||
1050 | display Me asurement Code (HSD0 3) | ||
1051 | |||
1052 | FS-EP007-0 06-005 | ||
1053 | DELETED | ||
1054 | |||
1055 | FS-EP007-0 06-006 | ||
1056 | DELETED | ||
1057 | |||
1058 | FS-EP007-0 06-007 | ||
1059 | DELETED | ||
1060 | |||
1061 | FS-EP007-0 06-008 | ||
1062 | DELETED | ||
1063 | |||
1064 | FS-EP007-0 06-009 | ||
1065 | DELETED | ||
1066 | |||
1067 | FS-EP007-0 07-001 | ||
1068 | DELETED | ||
1069 | |||
1070 | FS-EP007-0 07-002 | ||
1071 | DELETED | ||
1072 | |||
1073 | FS-EP007-0 07-003 | ||
1074 | DELETED | ||
1075 | |||
1076 | FS-EP007-0 07-004 | ||
1077 | DELETED | ||
1078 | |||
1079 | FS-EP007-0 07-005 | ||
1080 | DELETED | ||
1081 | |||
1082 | FS-EP007-0 07-006 | ||
1083 | DELETED | ||
1084 | |||
1085 | FS-EP007-0 07 | ||
1086 | If the Res ponse MSG – Message Text is pr esent, it shall be p rinted in the servic es area of the autho rization | ||
1087 | |||
1088 | FS-EP007-0 08 | ||
1089 | The revise d 10-7079 authorizat ion form s hall be pr intable. | ||
1090 | |||
1091 | FS-EP007-0 09 | ||
1092 | The 10-707 9 Authoriz ation lett er shall b e modified to: | ||
1093 | |||
1094 | FS-EP007-0 09-001 | ||
1095 | display th e services descripti on (UM03) | ||
1096 | |||
1097 | FS-EP007-0 09-002 | ||
1098 | display th e services quantity (HSD02) | ||
1099 | |||
1100 | FS-EP007-0 09-003 | ||
1101 | display th e services units (HS D01) | ||
1102 | |||
1103 | FS-EP007-0 09-004 | ||
1104 | display Me asurement Code (HSD0 3) | ||
1105 | |||
1106 | FS-EP007-0 09-005 | ||
1107 | DELETED | ||
1108 | |||
1109 | FS-EP007-0 09-006 | ||
1110 | DELETED | ||
1111 | |||
1112 | FS-EP007-0 09-007 | ||
1113 | DELETED | ||
1114 | |||
1115 | FS-EP007-0 09-008 | ||
1116 | DELETED | ||
1117 | |||
1118 | FS-EP007-0 09-009 | ||
1119 | DELETED | ||
1120 | |||
1121 | FS-EP007-0 10 | ||
1122 | If the Res ponse MSG – Message Text is pr esent in t he 278 res ponse, it shall be p rinted in the servic es area of the autho rization: | ||
1123 | |||
1124 | FS-EP007-0 10-001 | ||
1125 | DELETED | ||
1126 | |||
1127 | FS-EP007-0 10-002 | ||
1128 | DELETED | ||
1129 | |||
1130 | FS-EP007-0 10-003 | ||
1131 | DELETED | ||
1132 | |||
1133 | FS-EP007-0 10-004 | ||
1134 | DELETED | ||
1135 | |||
1136 | FS-EP007-0 10-005 | ||
1137 | DELETED | ||
1138 | |||
1139 | FS-EP007-0 10-006 | ||
1140 | DELETED | ||
1141 | |||
1142 | FS-EP007-0 10-007 | ||
1143 | DELETED | ||
1144 | |||
1145 | FS-EP007-0 11 | ||
1146 | The revise d 10-7079 authorizat ion letter shall be printable. | ||
1147 | Master Inp atient 10- 7078 Autho rizations Services R equirement s | ||
1148 | Table 14 - Master In patient Se rvices Req uirements | ||
1149 | Identifier | ||
1150 | Requiremen t Number | ||
1151 | Descriptio n | ||
1152 | Theme 004 | ||
1153 | |||
1154 | Electronic ally Trans mit ASC X1 2 278 (Ali gns to Goa l 2) | ||
1155 | Epic 007 | ||
1156 | |||
1157 | As Non-VA Care Autho rization t eam, I wan t to be ab le to elec tronically receive a n ASC X12 278 Reques t so that I can init iate the a uthorizati on process . | ||
1158 | |||
1159 | FS-EP007-0 11 | ||
1160 | DELETED | ||
1161 | |||
1162 | FS-EP007-0 12 | ||
1163 | DELETED | ||
1164 | |||
1165 | FS-EP007-0 13 | ||
1166 | DELETED | ||
1167 | |||
1168 | FS-EP007-0 14 | ||
1169 | DELETED | ||
1170 | |||
1171 | FS-EP007-0 15 | ||
1172 | DELETED | ||
1173 | |||
1174 | FS-EP007-0 15-001 | ||
1175 | DELETED | ||
1176 | |||
1177 | FS-EP007-0 15-002 | ||
1178 | DELETED | ||
1179 | |||
1180 | FS-EP007-0 16 | ||
1181 | The 10-707 9 Authoriz ation form shall be modified t o: | ||
1182 | |||
1183 | FS-EP007-0 16-001 | ||
1184 | display th e services descripti on (UM03) | ||
1185 | |||
1186 | FS-EP007-0 16-002 | ||
1187 | display th e services quantity (HSD02) | ||
1188 | |||
1189 | FS-EP007-0 16-003 | ||
1190 | display th e services units (HS D01) | ||
1191 | |||
1192 | FS-EP007-0 16-004 | ||
1193 | display Me asurement Code (HSD0 3) | ||
1194 | |||
1195 | FS-EP007-0 16-005 | ||
1196 | DELETED | ||
1197 | |||
1198 | FS-EP007-0 16-006 | ||
1199 | DELETED | ||
1200 | |||
1201 | FS-EP007-0 16-007 | ||
1202 | DELETED | ||
1203 | |||
1204 | FS-EP007-0 16-008 | ||
1205 | DELETED | ||
1206 | |||
1207 | FS-EP007-0 16-009 | ||
1208 | DELETED | ||
1209 | |||
1210 | FS-EP007-0 16-010 | ||
1211 | DELETED | ||
1212 | |||
1213 | FS-EP007-0 17 | ||
1214 | If the Res ponse MSG – Message Text segme nt is pr esent in t he 278 res ponse, it shall be p rinted in the servic es area of the autho rization: | ||
1215 | |||
1216 | FS-EP007-0 17-001 | ||
1217 | DELETED | ||
1218 | |||
1219 | FS-EP007-0 17-002 | ||
1220 | DELETED | ||
1221 | |||
1222 | FS-EP007-0 17-003 | ||
1223 | DELETED | ||
1224 | |||
1225 | FS-EP007-0 17-004 | ||
1226 | DELETED | ||
1227 | |||
1228 | FS-EP007-0 17-005 | ||
1229 | DELETED | ||
1230 | |||
1231 | FS-EP007-0 17-006 | ||
1232 | DELETED | ||
1233 | |||
1234 | FS-EP007-0 17-007 | ||
1235 | DELETED | ||
1236 | |||
1237 | FS-EP007-0 18 | ||
1238 | The revise d 10-7078 authorizat ion form s hall be pr intable. | ||
1239 | |||
1240 | FS-EP007-0 18 | ||
1241 | DELETED | ||
1242 | |||
1243 | FS-EP007-0 19 | ||
1244 | The 10-707 8 Authoriz ation form shall be modified t o: | ||
1245 | |||
1246 | FS-EP007-0 19-001 | ||
1247 | display th e services descripti on (UM03) | ||
1248 | |||
1249 | FS-EP007-0 19-002 | ||
1250 | display th e services quantity (HSD02) | ||
1251 | |||
1252 | FS-EP007-0 19-003 | ||
1253 | display th e services units (HS D01) | ||
1254 | |||
1255 | FS-EP007-0 19-004 | ||
1256 | display Me asurement Code (HSD0 3) | ||
1257 | |||
1258 | FS-EP007-0 19-005 | ||
1259 | DELETED | ||
1260 | |||
1261 | FS-EP007-0 19-006 | ||
1262 | DELETED | ||
1263 | |||
1264 | FS-EP007-0 19-007 | ||
1265 | DELETED | ||
1266 | |||
1267 | FS-EP007-0 19-008 | ||
1268 | DELETED | ||
1269 | |||
1270 | FS-EP007-0 19-009 | ||
1271 | DELETED | ||
1272 | |||
1273 | FS-EP007-0 19-010 | ||
1274 | DELETED | ||
1275 | |||
1276 | FS-EP007-0 20 | ||
1277 | If the Res ponse MSG – Message Text segme nt is pre sent in th e 278 resp onse, it s hall be pr inted in t he service s area of the author ization: | ||
1278 | |||
1279 | FS-EP007-0 20-001 | ||
1280 | DELETED | ||
1281 | |||
1282 | FS-EP007-0 20-002 | ||
1283 | DELETED | ||
1284 | |||
1285 | FS-EP007-0 20-003 | ||
1286 | DELETED | ||
1287 | |||
1288 | FS-EP007-0 20-004 | ||
1289 | DELETED | ||
1290 | |||
1291 | FS-EP007-0 20-005 | ||
1292 | DELETED | ||
1293 | |||
1294 | FS-EP007-0 20-006 | ||
1295 | DELETED | ||
1296 | |||
1297 | FS-EP007-0 20-007 | ||
1298 | DELETED | ||
1299 | |||
1300 | FS-EP007-0 21 | ||
1301 | The revise d 10-7078 authorizat ion letter shall be printable. | ||
1302 | Authorizat ions Servi ces Entry Requiremen ts | ||
1303 | To enter s ervices as an author ization is being cre ated or up dated, new data entr y function ality will be requir ed that al lows the a uthorizati on to sele ct a servi ce, enter a quantity and speci fy the uni ts for the services. To enter the author ized servi ce, the ex isting dat a function ality will need to b e changed to allow t he authori zation cle rk to sele ct a servi ce from a lookup tab le, enter a quantity and speci fy the uni ts for the service. | ||
1304 | Table 15 - HSD Entry Requireme nts | ||
1305 | Identifier | ||
1306 | Requiremen t Number | ||
1307 | Requiremen ts Descrip tion | ||
1308 | Theme 004 | ||
1309 | |||
1310 | Electronic ally Trans mit ASC X1 2 278 (Ali gns to Goa l 2) | ||
1311 | Epic 007 | ||
1312 | |||
1313 | As Non-VA Care Autho rization t eam, I wan t to be ab le to elec tronically receive a n ASC X12 278 Reques t so that I can init iate the a uthorizati on process . | ||
1314 | |||
1315 | FS-EP007-0 26 | ||
1316 | The entry functional ity shall allow the user to en ter one se t of HSD i nformation for each master aut horization . | ||
1317 | |||
1318 | FS-EP007-0 26-01 | ||
1319 | HSD quanti ty qualifi er (HSD01) | ||
1320 | |||
1321 | FS-EP007-0 26-01 | ||
1322 | HSD quanti ty (HSD02) | ||
1323 | |||
1324 | FS-EP007-0 26-02 | ||
1325 | HSD Units (HSD03) | ||
1326 | |||
1327 | FS-EP007-0 26-03 | ||
1328 | DELETED | ||
1329 | |||
1330 | FS-EP007-0 26-04 | ||
1331 | DELETED | ||
1332 | |||
1333 | FS-EP007-0 26-05 | ||
1334 | DELETED | ||
1335 | |||
1336 | FS-EP007-0 26-06 | ||
1337 | DELETED | ||
1338 | |||
1339 | FS-EP007-0 26-07 | ||
1340 | DELETED | ||
1341 | |||
1342 | FS-EP007-0 27 | ||
1343 | If HSD01 i s present, HSD02 sha ll be requ ired. | ||
1344 | Graphical User Inter face | ||
1345 | There will be two GU I’s requir ed to impl ement supp ort for th is new pro cessing. | ||
1346 | Queues GUI – a GUI t hat will: | ||
1347 | When unsol icited 278 Requests are receiv ed, they w ill be rou ted by to the VAMC t hat AAT de termines s ervices th e Veteran. The AAT w ill use th e same rou ting logic currently incorpora ted in the Automated Eligibili ty Tool (A ET). | ||
1348 | The AAT wi ll then ro ute the re quest to a specific queue, bas ed on the informatio n in the 2 78 Request and the r outing rul es provide d by the P MD. Possi ble queues are ident ified in t he next ta ble. | ||
1349 | Allow an a uthorizati on clerk t o view all of the un solicited 278 Reques ts by assi gned queue and selec t 278 Requ est to vie w in the 2 78 Request GUI. | ||
1350 | 278 Reques t GUI – a GUI that w ill allow a local us er to: | ||
1351 | View a sum mary of th e 278 Requ est for th e selected patient | ||
1352 | View each segment of the 278 R equest | ||
1353 | Generate a 278 Respo nse to the request b y either a ccepting o r denying the 278 re quest. | ||
1354 | Table 16 - Routing Q ueue Defin itions | ||
1355 | Queue Name | ||
1356 | Queue Proc essing Des cription | ||
1357 | Awaiting A ssignment queue | ||
1358 | This is a view of th e 278 Requ est waitin g to be as signed to one of the queues be low. In th eory this view shoul d always s how 0 or a low numbe r. If reco rds show a n accumula tion, this may be an indicator that the AAT is una ble to rou te the req uest. | ||
1359 | Patient Pr oblem queu e (High Pr iority) | ||
1360 | When a 278 Request h as been re ceived and validated the AAT p erforms a lookup on the local VistA Fee Patient fi le to veri fy that th e patient is on file . In most cases, the patient s hould exis t on the s ystem and processing will cont inue. Howe ver, if fo r some rea son the pa tient is n ot file, t he 278 Req uest will be routed to this qu eue and no further a ction will be taken by the AAT until the record is reviewed, the reaso n for the problem is identifie d and corr ected. The re are two possible reasons wh y a record may be in this queu e: | ||
1361 | The AAT ro uted the p atient to the wrong VAMC (Stat ion ID) | ||
1362 | The patien t is assig ned to the local VAM C but has never rece ived servi ces from t he VA faci lity | ||
1363 | Provider P roblem que ue | ||
1364 | (High Prio rity) | ||
1365 | This queue captures 278 Reques t when a p rovider id entified i n the 278 Request do es not exi st on the local Vist A Fee vend or file. S ince there can be mu ltiple pro viders ide ntified in the 278 R equest, ea ch provide r record w ill be ver ified. | ||
1366 | Emergency Services q ueue (High Priority) | ||
1367 | If a 278 R equest is received t hat is ide ntified as “Emergenc y” based o n informat ion in the 278 Reque st, it wil l be route d to this high prior ity queue for immedi ate action by an aut horization clerk. | ||
1368 | Mental Hea lth queue | ||
1369 | A 278 Requ est is rec eived and identified as requir ing servic es for men tal health care. | ||
1370 | Dental que ue | ||
1371 | A 278 Requ est is rec eived and identified as an Out patient ba sed on the informati on in the request, t he 278 is placed in this table . | ||
1372 | Inpatient queue | ||
1373 | A 278 Requ est is rec eived and identified as an Inp atient bas ed on the informatio n in the r equest, th e 278 is p laced in t his table. | ||
1374 | Outpatient queue | ||
1375 | A 278 Requ est is rec eived and identified as an Out patient ba sed on the informati on in the request, t he 278 is placed in this table . Also, th is is the default ca tch-all qu eue, meani ng that if as a resu lt of pass ing throug h the abov e routing checks and not meeti ng the cri teria, the 278 Reque st is plac ed in this queue. | ||
1376 | Accepted q ueue | ||
1377 | This is a reference queue only for an au thorizatio n clerk to be able t o review a 278 Reque st that wa s accepted . | ||
1378 | Denied que ue | ||
1379 | This is a reference queue only for an au thorizatio n clerk to be able t o review a 278 Reque st that wa s denied. | ||
1380 | |||
1381 | The figure below is an example of what t he 278 Que ues GUI mi ght look l ike. | ||
1382 | |||
1383 | Figure 1 - Queues GU I | ||
1384 | |||
1385 | Table 17 - Queues GU I Requirem ents | ||
1386 | Identifier | ||
1387 | Requiremen t Number | ||
1388 | Requiremen ts Descrip tion | ||
1389 | Theme 005 | ||
1390 | |||
1391 | Electronic ally Proce ss ASC X12 278 (Alig ns to Goal 2) | ||
1392 | Epic 010 | ||
1393 | |||
1394 | As Non-VA Care Autho rization t eam, I wan t to be ab le access an ASC X12 278 Reque sts in an identified processin g queue so that I ca n group au thorizatio ns based o n a pre-de fined crit eria. | ||
1395 | User Narra tive 022(A ) | ||
1396 | |||
1397 | As a Non-V A PC Autho rization C lerk, I wa nt to view an author ization th at is plac ed in a qu eue so tha t I can pr ocess an a uthorizati on request . | ||
1398 | |||
1399 | FS-UN022A- 001 | ||
1400 | The Queues GUI shall display a list of a ll queues. | ||
1401 | |||
1402 | FS-UN022A- 002 | ||
1403 | The Queues GUI shall display H igh Priori ty queues separately from norm al process ing queues . | ||
1404 | |||
1405 | FS-UN022A- 003 | ||
1406 | The Queues GUI shall display f or each qu eue, the n umber of r equest in the queue. | ||
1407 | |||
1408 | FS-UN022A- 004 | ||
1409 | The Queues GUI shall allow a u ser to sel ect a queu e and see a summary of all req uests in t he selecte d queue: | ||
1410 | |||
1411 | FS-UN022A- 004-01 | ||
1412 | Patient Na me | ||
1413 | |||
1414 | FS-UN022A- 004-02 | ||
1415 | Patient Id | ||
1416 | |||
1417 | FS-UN022A- 004-03 | ||
1418 | Patient Da te of Birt h | ||
1419 | |||
1420 | FS-UN022A- 004-04 | ||
1421 | Date added to queue | ||
1422 | |||
1423 | FS-UN022A- 004-05 | ||
1424 | Days in qu eue (calcu lated) | ||
1425 | |||
1426 | FS-UN022A- 004-06 | ||
1427 | Value in U M01 | ||
1428 | |||
1429 | FS-UN022A- 004-07 | ||
1430 | Value in U M02 | ||
1431 | |||
1432 | FS-UN022A- 004-08 | ||
1433 | Value in U M03 | ||
1434 | |||
1435 | FS-UN022A- 004-09 | ||
1436 | Date Range | ||
1437 | |||
1438 | FS-UN022A- 005 | ||
1439 | A user sha ll be able be able t o sort on any field in the det ailed queu ed list. | ||
1440 | |||
1441 | FS-UN022A- 006 | ||
1442 | A user sha ll be able to filter by any fi eld in the lists. | ||
1443 | |||
1444 | FS-UN022A- 007 | ||
1445 | A user sha ll be able to select any recor d in the q ueue to lo ad into th e 278 Navi gation GUI . | ||
1446 | |||
1447 | FS-UN022A- 008 | ||
1448 | The Queues GUI shall allow a u ser to sel ect a Requ est from t he queue. | ||
1449 | |||
1450 | FS-UN022A- 009 | ||
1451 | When a pat ient has b een select ed, the Qu eues GUI s hall open the 278 Re quest/Resp onse GUI i n a separa te view. | ||
1452 | |||
1453 | FS-UN022A- 010 | ||
1454 | Once an un solicited master aut horization has eithe r as Accep ted or Den ied, it sh all be ass igned to t he corresp onding ref erence que ue. | ||
1455 | |||
1456 | FS-UN022A- 011 | ||
1457 | A user sha ll only be allowed t o view the number of incoming 278 Reques ts awaitin g assignme nt. | ||
1458 | |||
1459 | 278 Unsoli cited Requ est/Respon se GUI | ||
1460 | 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. | ||
1461 | 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: | ||
1462 | View 1 – P atient dem ographics, populated from the 278 Reques t informat ion. | ||
1463 | 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. | ||
1464 | View 3 – 2 78 Request detailed view. This view allo ws a user to: | ||
1465 | 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. | ||
1466 | View assoc iated pape rwork resi ding in th e 275 repo sitory. | ||
1467 | View 4 – 2 78 Respons e This vi ew will al low a user : | ||
1468 | To ACCEPT a 278 Requ est and de signate in patient/ou tpatient a uthorizati on. This will prepo pulate the master au thorizatio n record w ith data f rom the 27 8 reqquest OR | ||
1469 | To DENY an authoriza tion and p rovide a r eason for the denial . | ||
1470 | |||
1471 | |||
1472 | Figure 2 - Unsolicit ed 278 Req uests GUI – Summary View | ||
1473 | |||
1474 | Table 18 - Unsolicit ed 278 Req uest GUI R equirement s - Summar y | ||
1475 | Identifier | ||
1476 | Requiremen t Number | ||
1477 | Requiremen ts Descrip tion | ||
1478 | Theme 004 | ||
1479 | |||
1480 | Electronic ally Trans mit ASC X1 2 278 (Ali gns to Goa l 2) | ||
1481 | Epic 007 | ||
1482 | |||
1483 | As Non-VA Care Autho rization t eam, I wan t to be ab le to elec tronically receive a n ASC X12 278 Reques t so that I can init iate the a uthorizati on process . | ||
1484 | User Narra tive 015 | ||
1485 | |||
1486 | As a Non-V A PC Autho rization C lerk, I wa nt to view an ASC X1 2 278 Requ est so tha t I can ac cept an au thorizatio n of care. | ||
1487 | User Narra tive 016 | ||
1488 | |||
1489 | As a Non-V A PC Autho rization C lerk, I wa nt to view an ASC X1 2 278 Requ est so tha t I can de ny an auth orization of care. | ||
1490 | |||
1491 | FS-UN015-0 01 | ||
1492 | The 278 Re quest/Resp onse GUI w ill be pop ulated wit h the pati ent author ization in formation from the 2 78 Request . The foll owing info rmation sh all be pop ulated: | ||
1493 | |||
1494 | FS-UN015-0 01-001 | ||
1495 | Patient Na me | ||
1496 | |||
1497 | FS-UN015-0 01-002 | ||
1498 | Patient ID | ||
1499 | |||
1500 | FS-UN015-0 01-003 | ||
1501 | DELETED | ||
1502 | |||
1503 | FS-UN015-0 01-004 | ||
1504 | Consult ID , if prese nt | ||
1505 | |||
1506 | FS-UN015-0 01-003 | ||
1507 | Authorizat ion Date | ||
1508 | |||
1509 | FS-UN015-0 01-004 | ||
1510 | Reference Number | ||
1511 | |||
1512 | FS-UN015-0 01-005 | ||
1513 | Authorizat ion FROM d ate | ||
1514 | |||
1515 | FS-UN015-0 01-006 | ||
1516 | Authorizat ion TO dat e | ||
1517 | |||
1518 | FS-UN015-0 01-007 | ||
1519 | 278 Reques t date | ||
1520 | |||
1521 | FS-UN015-0 01-008 | ||
1522 | 278 assign ed queue | ||
1523 | |||
1524 | FS-UN015-0 02 | ||
1525 | The 278 Na vigation V iew shall: | ||
1526 | |||
1527 | FS-UN015-0 02-001 | ||
1528 | Display re quest sect ions Reque stor Info, Patient I nfo, optio nal Depend ent Info, Episode of Care Info and Servi ce Info. | ||
1529 | |||
1530 | FS-UN015-0 02-002 | ||
1531 | Allow a us er to sele ct any ava ilable of the displa yed sectio ns and pop ulate the 278 Reques t View wit h the deta il informa tion | ||
1532 | |||
1533 | FS-UN015-0 02-003 | ||
1534 | Allow the user to ex pand/colla pse a sect ion view | ||
1535 | |||
1536 | FS-UN015-0 02-004 | ||
1537 | If a secti on is not present in the 278 R equest, th e user sha ll not be able to se lect it | ||
1538 | |||
1539 | FS-UN015-0 02-005 | ||
1540 | If a secti on is not present in the 278 R equest, th e segment shall indi cate that it is unav ailable | ||
1541 | |||
1542 | FS-UN015-0 02-006 | ||
1543 | If a secti on has mul tiple occu rrences of a data el ement, the re shall b e a numeri c indicato r on the n umber of o ccurrences | ||
1544 | |||
1545 | |||
1546 | |||
1547 | Figure 3 - Unsolicit ed 278 Req uests GUI – Detail V iew | ||
1548 | |||
1549 | This view will allow the user to review all the in formation in the 278 Request. | ||
1550 | |||
1551 | |||
1552 | |||
1553 | |||
1554 | Figure 4 - Unsolicit ed 278 Req uests GUI - Response View | ||
1555 | |||
1556 | Table 19 - Unsolicit ed 278 GUI Requireme nts - Deta il | ||
1557 | Identifier | ||
1558 | Requiremen t Number | ||
1559 | Requiremen ts Descrip tion | ||
1560 | Theme 004 | ||
1561 | |||
1562 | Electronic ally Trans mit ASC X1 2 278 (Ali gns to Goa l 2) | ||
1563 | Epic 007 | ||
1564 | |||
1565 | As Non-VA Care Autho rization t eam, I wan t to be ab le to elec tronically receive a n ASC X12 278 Reques t so that I can init iate the a uthorizati on process . | ||
1566 | User Narra tive 015 | ||
1567 | |||
1568 | As a Non-V A PC Autho rization C lerk, I wa nt to view an ASC X1 2 278 Requ est so tha t I can ac cept an au thorizatio n of care. | ||
1569 | |||
1570 | FS-UN015-0 03 | ||
1571 | The HL ele ment HL se gment data shall not be viewab le. | ||
1572 | |||
1573 | FS-UN015-0 04 | ||
1574 | An NVCC us er shall b e able to view the d ata in a 2 78 Request , translat ed to huma n viewable form: | ||
1575 | |||
1576 | FS-UN015-0 04-001 | ||
1577 | View the i nformation in the re quired 201 0B REQUEST OR request loop. | ||
1578 | |||
1579 | FS-UN015-0 04-002 | ||
1580 | View the i nformation in the re quired 201 0C SUBSCRI BER reques t loop. | ||
1581 | |||
1582 | FS-UN015-0 04-003 | ||
1583 | If present , view the informati on in the 2010D DEPE NDENT requ est loop. | ||
1584 | |||
1585 | FS-UN015-0 04-004 | ||
1586 | View the i nformation in the re quired 200 0E PATIENT request l oop. | ||
1587 | |||
1588 | FS-UN015-0 04-005 | ||
1589 | View the i nformation in the si tuational 2010EA PAT IENT EVENT PROVIDER NAME reque st loop. | ||
1590 | |||
1591 | FS-UN015-0 04-006 | ||
1592 | View the i nformation in the si tuational 2010EB PAT IENT EVENT TRANSPORT request l oop. | ||
1593 | |||
1594 | FS-UN015-0 04-007 | ||
1595 | View the i nformation in the si tuational 2010EC PAT IENT EVENT OTHER UMO NAME requ est loop. | ||
1596 | |||
1597 | FS-UN015-0 04-008 | ||
1598 | If present , view the informati on in the 2000F SERV ICE reques t loop. | ||
1599 | |||
1600 | FS-UN015-0 04-009 | ||
1601 | If present , view the informati on in the 2010F SERV ICE PROVID ER request loop. | ||
1602 | |||
1603 | FS-UN015-0 05 | ||
1604 | There shal l be a sum mary scree n of all 2 78 Request loops: | ||
1605 | |||
1606 | FS-UN015-0 05-001 | ||
1607 | For each l oop, the l oop data s hall be di splayed. | ||
1608 | |||
1609 | FS-UN015-0 05-002 | ||
1610 | If data is present i n a loop, there shal l be an in dicator se t so a use r can dete rmine what informati on needs t o be revie wed. | ||
1611 | |||
1612 | FS-UN015-0 06 | ||
1613 | The user s hall be ab le to view a summary of repeat ing segmen ts: | ||
1614 | |||
1615 | FS-UN015-0 06-001 | ||
1616 | The user s hall be ab le to see the number of occurr ences in t he segment . | ||
1617 | |||
1618 | FS-UN015-0 06-002 | ||
1619 | The user s hall be ab le to see summary de tail of ea ch segment . | ||
1620 | |||
1621 | FS-UN015-0 06-003 | ||
1622 | The user s hall be ab le to view an in ind ividual su mmary reco rd from th e repeatin g segment summary sc reen. | ||
1623 | |||
1624 | FS-UN015-0 06-004 | ||
1625 | Display al l populate d elements in the 27 8 Request for the se lected 278 loop. | ||
1626 | |||
1627 | FS-UN015-0 06-005 | ||
1628 | If a segme nt/element has multi ple occurr ences, all occurrenc es shall b e displaye d. | ||
1629 | |||
1630 | FS-UN015-0 06-006 | ||
1631 | The user s hall not b e allowed to change any of the data in t he 278 Req uest View (Read Only ). | ||
1632 | |||
1633 | FS-UN015-0 06-007 | ||
1634 | If electro nic attach ments were submitted to the 27 5 Attachme nts Reposi tory as pa rt of the 278 Reques t, the use r shall be able to v iew the li st of atta chment(s). | ||
1635 | |||
1636 | FS-UN015-0 06-008 | ||
1637 | The user s hall be ab le to view the attac hment(s) s tored in t he 275 Rep ository. | ||
1638 | |||
1639 | FS-UN015-0 11 | ||
1640 | If the aut horization clerk cli cks on the ACCEPT bu tton, the following shall occu r:: | ||
1641 | |||
1642 | FS-UN015-0 11-001 | ||
1643 | The user s hall be re quired to select the authoriza tion as ei ther an IN PATIENT or OUTPATIEN T authoriz ation | ||
1644 | |||
1645 | FS-UN015-0 11-002 | ||
1646 | A master a uthorizati on record shall be p opulated w ith the in formation from the 2 78 request . | ||
1647 | |||
1648 | FS-UN015-0 11-003 | ||
1649 | The HCR01 field in t he master authorizat ion shall be populat ed with “A 1” | ||
1650 | |||
1651 | FS-UN016-0 01 | ||
1652 | If the aut horization clerk cli cks on the DENY butt on, the us er shall b e required to select reason fo r the deni al from th e GUI (HCR 03) | ||
1653 | Theme 005 | ||
1654 | |||
1655 | Electronic ally Proce ss ASC X12 278 (Alig ns to Goal 2) | ||
1656 | Epic 009 | ||
1657 | |||
1658 | As Non-VA Care Autho rization t eam, I wan t to be ab le to iden tify the c ategory of an ASC X1 2 278 Requ est so tha t I know t he type of service f or an auth orization. | ||
1659 | User Narra tive 018 | ||
1660 | |||
1661 | As a Non-V A PC Autho rization C lerk, I wa nt to view a UM01 so that I ca n identify the categ ory of ser vice that is needed. | ||
1662 | User Narra tive 019 | ||
1663 | |||
1664 | As a Non-V A PC Autho rization C lerk, I wa nt to view a UM02 so that I ca n identify the certi fication t ype that i s needed. | ||
1665 | User Narra tive 020 | ||
1666 | |||
1667 | As a Non-V A PC Autho rization C lerk, I wa nt to view a UM03 so that I ca n identify the type of service that is n eeded. | ||
1668 | User Narra tive 021 | ||
1669 | |||
1670 | As a Non-V A PC Autho rization C lerk, I wa nt to view a UM04 so that I ca n identify the healt h care ser vice locat ion that i s needed. | ||
1671 | |||
1672 | FS-UN018-0 01 | ||
1673 | UM01 shall be viewab le in the GUI | ||
1674 | |||
1675 | FS-UN019-0 01 | ||
1676 | UM02 shall be viewab le in the GUI | ||
1677 | |||
1678 | FS-UN020-0 03 | ||
1679 | UM03 shall be viewab le in the GUI | ||
1680 | |||
1681 | FS-UN021-0 01 | ||
1682 | UM04 shall be viewab le in the GUI | ||
1683 | Accept/Den y Requirem ents | ||
1684 | 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. | ||
1685 | Authorizat ion respon ses will b e returned in the Pa tient Even t loop. | ||
1686 | Table 20 - Authoriza tion Reque st Require ments | ||
1687 | Identifier | ||
1688 | Requiremen t Number | ||
1689 | Requiremen ts Descrip tion | ||
1690 | Theme 004 | ||
1691 | |||
1692 | Electronic ally Trans mit ASC X1 2 278 (Ali gns to Goa l 2) | ||
1693 | Epic 007 | ||
1694 | |||
1695 | As Non-VA Care Autho rization t eam, I wan t to be ab le to elec tronically receive a n ASC X12 278 Reques t so that I can init iate the a uthorizati on process . | ||
1696 | User Narra tive 015 | ||
1697 | |||
1698 | As a Non-V A PC Autho rization C lerk, I wa nt to view an ASC X1 2 278 Requ est so tha t I can ac cept an au thorizatio n of care. | ||
1699 | |||
1700 | FS-UN015-0 07 | ||
1701 | DELETED | ||
1702 | |||
1703 | FS-UN015-0 08 | ||
1704 | A user sha ll be able to view e ach segmen t of data stored as part of th e 278 requ est. | ||
1705 | |||
1706 | FS-UN015-0 09 | ||
1707 | A user sha ll not be able to ch ange store d request data. | ||
1708 | |||
1709 | FS-UN015-0 10 | ||
1710 | A user sha ll not be allowed to delete st ored reque st informa tion. | ||
1711 | |||
1712 | Table 21 - 278 Reque st Require ments | ||
1713 | Identifier | ||
1714 | Requiremen t Number | ||
1715 | Requiremen t Descript ion | ||
1716 | Theme 004 | ||
1717 | |||
1718 | Electronic ally Trans mit ASC X1 2 278 (Ali gns to Goa l 2) | ||
1719 | Epic 007 | ||
1720 | |||
1721 | As Non-VA Care Autho rization t eam, I wan t to be ab le to elec tronically receive a n ASC X12 278 Reques t so that I can init iate the a uthorizati on process . | ||
1722 | |||
1723 | |||
1724 | Patient Le vel Event Loop | ||
1725 | |||
1726 | FS-EP007-1 14 | ||
1727 | A UM segme nt shall b e required in a 278 Patient Ev ent Loop R equest. | ||
1728 | |||
1729 | FS-EP007-1 14-001 | ||
1730 | UM01 = AR shall be s upported | ||
1731 | |||
1732 | FS-EP007-1 14-002 | ||
1733 | UM01 = HS shall be s upported | ||
1734 | |||
1735 | FS-EP007-1 14-003 | ||
1736 | UM01 = IN shall not be support ed | ||
1737 | |||
1738 | FS-EP007-1 14-004 | ||
1739 | UM01 = SC shall not be support ed | ||
1740 | |||
1741 | FS-EP007-1 14-005 | ||
1742 | UM02 = 1 s hall be su pported | ||
1743 | |||
1744 | FS-EP007-1 14-006 | ||
1745 | UM02 = 2 s hall be su pported | ||
1746 | |||
1747 | FS-EP007-1 14-007 | ||
1748 | UM02 = 3 s hall be su pported | ||
1749 | |||
1750 | FS-EP007-1 14-008 | ||
1751 | UM02 = 4 s hall be su pported | ||
1752 | |||
1753 | FS-EP007-1 14-009 | ||
1754 | UM02 = I s hall be su pported | ||
1755 | |||
1756 | FS-EP007-1 14-010 | ||
1757 | UM02 = N s hall be su pported | ||
1758 | |||
1759 | FS-EP007-1 14-011 | ||
1760 | UM02 = R s hall be su pported | ||
1761 | |||
1762 | FS-EP007-1 14-012 | ||
1763 | UM02 = S s hall be su pported | ||
1764 | |||
1765 | FS-EP007-1 14-013 | ||
1766 | UM03 shall be valida ted agains t the UM03 lookup ta ble | ||
1767 | |||
1768 | FS-EP007-1 14-014 | ||
1769 | If Present , UM04 sha ll be supp orted | ||
1770 | |||
1771 | FS-EP007-1 14-015 | ||
1772 | If present , UM06 sha ll be supp orted | ||
1773 | |||
1774 | FS-EP007-1 14-016 | ||
1775 | REF segmen ts, if pre sent, shal l be suppo rted | ||
1776 | |||
1777 | FS-EP007-1 15 | ||
1778 | 278 Reques t Date seg ments, if present sh all be sto red as par t of the m aster auth orization record. Th is include s date typ e and date . | ||
1779 | |||
1780 | FS-EP007-1 15-001 | ||
1781 | DTP01 = 43 9, Acciden t date | ||
1782 | |||
1783 | FS-EP007-1 15-002 | ||
1784 | DTP01 = 48 4, Last Me nstrual Pe riod | ||
1785 | |||
1786 | FS-EP007-1 15-003 | ||
1787 | DTP01 = AB C, Estimat ed Date of Birth | ||
1788 | |||
1789 | FS-EP007-1 15-004 | ||
1790 | DTP01 = 43 1, Onset o f Current Symptoms o r Illness | ||
1791 | |||
1792 | FS-EP007-1 15-005 | ||
1793 | DTP01 = AA H, Event D ate | ||
1794 | |||
1795 | FS-EP007-1 15-006 | ||
1796 | DTP01 = 43 5, Admissi on Date | ||
1797 | |||
1798 | FS-EP007-1 15-007 | ||
1799 | Admission date shall be requir ed if UM01 = AR | ||
1800 | |||
1801 | FS-EP007-1 15-008 | ||
1802 | DTP01 = 09 6, Dischar ge date | ||
1803 | |||
1804 | FS-EP007-1 15-009 | ||
1805 | Discharge date shall only be p rovided if UM01 = “A R” | ||
1806 | |||
1807 | FS-EP007-1 15-010 | ||
1808 | Any DTP el ements sub mitted as part of th e 278 Requ est shall be returne d in the 2 78 Respons e | ||
1809 | |||
1810 | FS-EP007-1 16 | ||
1811 | Patient Di agnosis (H I) if subm itted as p art of the 278 Reque st shall b e stored i n the mast er authori zation rec ord. | ||
1812 | |||
1813 | FS-EP007-1 17 | ||
1814 | There syst em shall b e able to store up 1 2 occurren ces of the HI compos ite data. | ||
1815 | |||
1816 | FS-EP007-1 18 | ||
1817 | If present , HSD shal l be store d in the m aster auth orization record. | ||
1818 | |||
1819 | FS-EP007-1 19 | ||
1820 | If present , CRC segm ent(s) sha ll be supp orted: | ||
1821 | |||
1822 | FS-EP007-1 19-001 | ||
1823 | CR03 eleme nts shall be validat ed based o n the valu e in CR01 | ||
1824 | |||
1825 | FS-EP007-1 19-002 | ||
1826 | CR04 eleme nts shall be validat ed against CR03 look up table v alues base d on the v alue in CR 01 | ||
1827 | |||
1828 | FS-EP007-1 19-003 | ||
1829 | CR05 eleme nts shall be validat ed against CR03 look up table v alues base d on the v alue in CR 01 | ||
1830 | |||
1831 | FS-EP007-1 19-004 | ||
1832 | CR06 eleme nts shall be validat ed against CR03 look up table v alues base d on the v alue in CR 01 | ||
1833 | |||
1834 | FS-EP007-1 20 | ||
1835 | If CL1 pre sent, CL1 shall be v alidated a gainst CL1 lookup ta bles. | ||
1836 | |||
1837 | FS-EP007-1 21 | ||
1838 | If CR1 pre sent, CR1 shall be v alidated a gainst CR1 lookup ta bles. | ||
1839 | |||
1840 | FS-EP007-1 22 | ||
1841 | If CR2 pre sent, CR2 shall be v alidated a gainst CR2 lookup ta bles. | ||
1842 | |||
1843 | FS-EP007-1 23 | ||
1844 | If CR5 pre sent, CR5 shall be v alidated a gainst CR5 lookup ta bles. | ||
1845 | |||
1846 | FS-EP007-1 24 | ||
1847 | The system shall sup port up to 10 occurr ences of t he PWK seg ment. | ||
1848 | |||
1849 | FS-EP007-1 25 | ||
1850 | If PWK seg ment is pr esent and PWK02 = “E L”, the 27 5 attachme nt reposit ory shall be checked for recei pt of atta chment bas ed on the value in P WK06, | ||
1851 | |||
1852 | FS-EP007-1 26 | ||
1853 | If the att achment is not avail able, AAT shall repo rt a 278 R esponse er ror. | ||
1854 | |||
1855 | FS-EP007-1 27 | ||
1856 | If MSG tex t segment is present , the mess age text s hall be st ored in th e master a uthorizati on record. | ||
1857 | |||
1858 | |||
1859 | Loop 2010E A | ||
1860 | |||
1861 | FS-EP007-1 28 | ||
1862 | The system shall sup port up to 14 occurr ences of t he 2010EA loop. | ||
1863 | |||
1864 | FS-EP007-1 29 | ||
1865 | Each provi der shall be validat ed against the VistA Fee Provi der file. | ||
1866 | |||
1867 | FS-EP007-1 30 | ||
1868 | Each provi der record shall be stored as part of th e master a uthorizati on record. | ||
1869 | |||
1870 | FS-EP007-1 31 | ||
1871 | If REF seg ment is pr esent, sys tem shall try to ver ify the pr ovided ide ntificatio n informat ion. | ||
1872 | |||
1873 | FS-EP007-1 32 | ||
1874 | If PER seg ment prese nt, PER in formation shall be s tored as p art of the master au thorizatio n record. | ||
1875 | |||
1876 | FS-EP007-1 33 | ||
1877 | If PRV seg ment prese nt, PRV in formation shall be s tored as p art of the master au thorizatio n record. | ||
1878 | |||
1879 | FS-EP007-1 34 | ||
1880 | If present , PRV data shall be validated against co de lookup tables. | ||
1881 | |||
1882 | |||
1883 | Loop 2010E B | ||
1884 | |||
1885 | FS-EP007-1 35 | ||
1886 | If present , the syst em shall s upport up to 5 occur rences of the 2010EB loop. | ||
1887 | |||
1888 | FS-EP007-1 36 | ||
1889 | If present , there sh all be at least two occurrence s of the l oop. | ||
1890 | |||
1891 | FS-EP007-1 37 | ||
1892 | 1st occurr ence shall represent the pick- up locatio n | ||
1893 | |||
1894 | FS-EP007-1 38 | ||
1895 | 2nd occurr ence shall represent the drop- off locati on | ||
1896 | |||
1897 | |||
1898 | Loop 2010E C | ||
1899 | |||
1900 | FS-EP007-1 39 | ||
1901 | If present , the syst em shall s upport up to three o ccurrences of the 20 10EC loop. | ||
1902 | |||
1903 | |||
1904 | Loop 2000F | ||
1905 | |||
1906 | FS-EP007-1 40 | ||
1907 | The system shall sup port up to two occur rences of the Trace Reassociat ion Number (TRN) seg ment, if p resent in the 2000E Request lo op. | ||
1908 | |||
1909 | FS-EP007-1 41 | ||
1910 | If present , the REF segment sh all be sup ported in the 2000E Request lo op. | ||
1911 | |||
1912 | FS-EP007-1 42 | ||
1913 | If present , DTP segm ents shall be suppor ted in the 2000E Req uest loop. | ||
1914 | |||
1915 | FS-EP007-1 43 | ||
1916 | If present , SV1 segm ent shall be support ed in the 2000F Requ est loop. | ||
1917 | |||
1918 | FS-EP007-1 44 | ||
1919 | If present , SV2 segm ent shall be support ed in the 2000F Requ est loop. | ||
1920 | |||
1921 | FS-EP007-1 45 | ||
1922 | If present , SV3 segm ent shall be support ed in the 2000F Requ est loop. | ||
1923 | |||
1924 | FS-EP007-1 46 | ||
1925 | If present , TOO segm ent shall be support ed in the 2000F Requ est loop. | ||
1926 | |||
1927 | FS-EP007-1 47 | ||
1928 | If present , HSD segm ent shall be support ed in the 2000F Requ est loop. | ||
1929 | |||
1930 | FS-EP007-1 48 | ||
1931 | The system shall sup port up to 10 occurr ences of t he PWK seg ment. | ||
1932 | |||
1933 | FS-EP007-1 49 | ||
1934 | If PWK seg ment is pr esent and PWK02 = “E L”, the 27 5 attachme nt reposit ory shall be checked for recei pt of atta chment bas ed on the value in P WK06, | ||
1935 | |||
1936 | FS-EP007-1 50 | ||
1937 | If the att achment is not avail able, AAT shall repo rt a 278 R esponse er ror. | ||
1938 | |||
1939 | FS-EP007-1 51 | ||
1940 | If MSG tex t segment is present , the mess age text s hall be st ored in th e master a uthorizati on record. | ||
1941 | |||
1942 | A 278 resp onse is re quired for either an accepte o r denied 2 78’s. The requiremen ts in the next table are commo n to both responses. | ||
1943 | Table 22 - Create Re sponse Req uirements | ||
1944 | Identifier | ||
1945 | Requiremen t Number | ||
1946 | Requiremen t Descript ion | ||
1947 | Theme 004 | ||
1948 | |||
1949 | Electronic ally Trans mit ASC X1 2 278 (Ali gns to Goa l 2) | ||
1950 | Epic 008 | ||
1951 | |||
1952 | As Non-VA Care Autho rization t eam, I wan t to be ab le to elec tronically receive a n ASC X12 278 Reques t so that I can init iate the a uthorizati on process . | ||
1953 | User Narra tive 017 | ||
1954 | |||
1955 | As a Non-V A PC Autho rization C lerk, I wa nt to crea te an ASC X12 278 re sponse so that I can deny an a uthorizati on of care . | ||
1956 | NOTE: | ||
1957 | |||
1958 | There is n ot a User Narrative for ACCEPT and initi ally this User Narra tive was u sed. Chan ging requi rement now will have a signifi cant impac t on the s upporting SDD and RT M, so the RSD will m aintain th is numberi ng. | ||
1959 | The inform ation in t his table will be u sed to pop ulate both the 278 A CCEPT or D ENY record . | ||
1960 | |||
1961 | FS-UN017-0 10 | ||
1962 | DELETED | ||
1963 | |||
1964 | FS-UN017-0 13 | ||
1965 | Every mast er authori zation sha ll have on e Service (UM03) rec ord in the response. | ||
1966 | |||
1967 | FS-UN017-0 01 | ||
1968 | All 278 Re sponse sha ll be deli vered in a Patient E vent Loop. | ||
1969 | |||
1970 | FS-UN017-0 02 | ||
1971 | Service Le vel 278 Re sponse sha ll not be supported. | ||
1972 | |||
1973 | |||
1974 | Loop 2010A | ||
1975 | |||
1976 | FS-UN017-0 03 | ||
1977 | Loop 2010A shall be required i n a 278 Re sponse. | ||
1978 | |||
1979 | FS-UN017-0 04 | ||
1980 | Loop 2010A segment N M1 shall b e populate d as follo ws: | ||
1981 | |||
1982 | FS-UN017-0 04-001 | ||
1983 | Loop 2010A NM101 sha ll be popu lated with “PR”. | ||
1984 | |||
1985 | FS-UN017-0 04-002 | ||
1986 | Loop 2010A NM102 sha ll be popu lated with “2”. | ||
1987 | |||
1988 | FS-UN017-0 04-003 | ||
1989 | Loop 2010A NM103 sha ll be popu lated with the Stati on of Juri sdiction V AMC Name | ||
1990 | |||
1991 | FS-UN017-0 04-004 | ||
1992 | Loop 2010A NM108 sha ll be popu lated with the “PI”. | ||
1993 | |||
1994 | FS-UN017-0 04-005 | ||
1995 | Loop 2010A NM109 sha ll be popu lated with “12115”. | ||
1996 | |||
1997 | FS-UN017-0 05 | ||
1998 | Loop 2010A PER segme nt shall b e populate d as follo ws: | ||
1999 | |||
2000 | FS-UN017-0 05-001 | ||
2001 | Loop 2010A element P ER01 “IC” | ||
2002 | |||
2003 | FS-UN017-0 05-002 | ||
2004 | Loop 2010A element P ER02, Name of VAMC c ontact wil l be popul ated with a generic VAMC provi ded staff name as de fined by t he local V AMC. | ||
2005 | |||
2006 | FS-UN017-0 05-003 | ||
2007 | Loop 2010A element P ER03, “EM” | ||
2008 | |||
2009 | FS-UN017-0 05-004 | ||
2010 | Loop 2010A element P ER04, Emai l address of VAMC st aff approv ing the au thorizatio n will be populated with the l ocal VAMC defined ge neral emai l address. | ||
2011 | |||
2012 | FS-UN017-0 05-005 | ||
2013 | Loop 2010A element P ER05, “TE” | ||
2014 | |||
2015 | FS-UN017-0 05-006 | ||
2016 | Loop 2010A element P ER06, Phon e Number o f VAMC sta ff will be populated with the local VAMC defined g eneral pho ne number of the VAM C approvin g the auth orization | ||
2017 | |||
2018 | FS-UN017-0 05-007 | ||
2019 | Loop 2010A element P ER07, “FX” | ||
2020 | |||
2021 | FS-UN017-0 05-008 | ||
2022 | Loop 2010A element P ER08 will be populat ed with th e local VA MC defined general, Fax Number of VAMC a pproving t he authori zation | ||
2023 | |||
2024 | |||
2025 | Loop 2010B | ||
2026 | |||
2027 | FS-UN017-0 06 | ||
2028 | Loop 2010B shall be required i n a 278 Re sponse. | ||
2029 | |||
2030 | FS-UN017-0 07 | ||
2031 | Loop 2010B segment s hall be po pulated wi th the inf ormation f rom the 20 10B Reques t loop. | ||
2032 | |||
2033 | |||
2034 | Loop 2010C /2010D | ||
2035 | |||
2036 | FS-UN017-0 11 | ||
2037 | Loop 2010C shall be required i n a 278 Re sponse. | ||
2038 | |||
2039 | FS-UN017-0 12 | ||
2040 | If the 201 0D loop ex ists in th e 278 Requ est, the 2 010C Respo nse loop s hall be po pulated wi th the val ues from t he 278 201 0D Request loop and informatio n from the veteran p atient rec ord. | ||
2041 | |||
2042 | FS-UN017-0 13 | ||
2043 | DELETED | ||
2044 | |||
2045 | FS-UN017-0 14 | ||
2046 | If the 201 0D loop do es NOT exi st in the 278 Reques t, the 201 0C Respons e loop sha ll be popu lated acco rding to t he require ments in t he PATIENT RESPONSE INFORMATIO N. | ||
2047 | |||
2048 | FS-UN017-0 15 | ||
2049 | PATIENT RE SPONSE INF ORMATION | ||
2050 | |||
2051 | FS-UN017-0 16 | ||
2052 | NM1 shall be require d: | ||
2053 | |||
2054 | FS-UN017-0 16-001 | ||
2055 | NM101 = “I L” | ||
2056 | |||
2057 | FS-UN017-0 16-002 | ||
2058 | NM102 = “1 ” | ||
2059 | |||
2060 | FS-UN017-0 16-003 | ||
2061 | NM103 = La st Name of the Patie nt from th e Patient file | ||
2062 | |||
2063 | FS-UN017-0 16-004 | ||
2064 | NM104 = Fi rst Name o f the Pati ent from t he Patient file | ||
2065 | |||
2066 | FS-UN017-0 16-005 | ||
2067 | NM105 = Mi ddle Name of the Pat ient from the Patien t file | ||
2068 | |||
2069 | FS-UN017-0 16-006 | ||
2070 | If exist, NM106 shal l be popul ated with the value from the 2 78 2010B R equest loo p, element NM106 | ||
2071 | |||
2072 | FS-UN017-0 16=007 | ||
2073 | If exist, NM107 shal l be popul ated with the value from the 2 78 2010B R equest loo p, element NM107 | ||
2074 | |||
2075 | FS-UN017-0 16-008 | ||
2076 | NM108 = “M I” | ||
2077 | |||
2078 | FS-UN017-0 16-009 | ||
2079 | NM109 = Pa tient SSN | ||
2080 | |||
2081 | FS-UN017-0 17 | ||
2082 | The REF el ement shal l be retur ned in the Patient L oop Respon se: | ||
2083 | |||
2084 | FS-UN017-0 17-001 | ||
2085 | The REF el ement shal l not exce ed 9 occur rences | ||
2086 | |||
2087 | FS-UN017-0 17-002 | ||
2088 | If REF ele ments are present in the 278 R equest, th ey shall b e returned in the 20 10B Respon se. | ||
2089 | |||
2090 | FS-UN017-0 17-003 | ||
2091 | The author ization cl erk shall not be all owed to ch ange exist ing REF el ements | ||
2092 | |||
2093 | FS-UN017-0 18 | ||
2094 | NM3 shall be require d: | ||
2095 | |||
2096 | FS-UN017-0 18-001 | ||
2097 | N301 shall be popula ted with t he patient street ad dress | ||
2098 | |||
2099 | FS-UN017-0 18-002 | ||
2100 | If patient has an ad ditional a ddress lin e, N302 sh all be pop ulated. | ||
2101 | |||
2102 | FS-UN017-0 19 | ||
2103 | NM4 shall be require d: | ||
2104 | |||
2105 | FS-UN017-0 19-001 | ||
2106 | N401 shall be popula ted with C ity from p atient fil e | ||
2107 | |||
2108 | FS-UN017-0 19-002 | ||
2109 | N402 shall be popula ted with S tate patie nt file | ||
2110 | |||
2111 | FS-UN017-0 19-003 | ||
2112 | N403 shall be popula ted with Z ip from th e patient file | ||
2113 | |||
2114 | FS-UN017-0 19-004 | ||
2115 | N404 shall be popula ted with C ountry cod e | ||
2116 | |||
2117 | FS-UN017-0 20 | ||
2118 | DMG shall be populat ed as foll ows: | ||
2119 | |||
2120 | FS-UN017-0 20-001 | ||
2121 | DMG01 = “D 8” | ||
2122 | |||
2123 | FS-UN017-0 20-002 | ||
2124 | DMG02 = Pa tients Dat e of Birth | ||
2125 | |||
2126 | FS-UN017-0 20-003 | ||
2127 | DMG03 = Pa tient gend er (F, U, M) | ||
2128 | |||
2129 | FS-UN017-0 21 | ||
2130 | The INS se gment shal l not be r equired in the respo nse. | ||
2131 | |||
2132 | |||
2133 | Loop 2000E | ||
2134 | |||
2135 | FS-UN017-0 22 | ||
2136 | Loop 2000E , element TRN shall be populat ed with th e value fr om the 278 2010B Req uest loop, if presen t in the 2 78 2000E R equest loo p. | ||
2137 | |||
2138 | FS-UN017-0 23 | ||
2139 | DELETED | ||
2140 | |||
2141 | FS-UN017-0 23-001 | ||
2142 | DELETED | ||
2143 | |||
2144 | FS-UN017-0 23-002 | ||
2145 | DELETED | ||
2146 | |||
2147 | FS-UN017-0 23-003 | ||
2148 | DELETED | ||
2149 | |||
2150 | FS-UN017-0 23-004 | ||
2151 | DELETED | ||
2152 | |||
2153 | FS-UN017-0 23-005 | ||
2154 | DELETED | ||
2155 | |||
2156 | FS-UN017-0 24 | ||
2157 | DELETED | ||
2158 | |||
2159 | FS-UN017-0 24-001 | ||
2160 | DELETED | ||
2161 | |||
2162 | FS-UN017-0 24-002 | ||
2163 | DELETED | ||
2164 | |||
2165 | FS-UN017-0 24-003 | ||
2166 | DELETED | ||
2167 | |||
2168 | FS-UN017-0 24-004 | ||
2169 | DELETED | ||
2170 | |||
2171 | FS-UN017-0 25 | ||
2172 | If present , the REF shall be p opulated i n the 278 2000E Resp onse based on the va lue in the 278 reque st REF seg ments. | ||
2173 | |||
2174 | FS-UN017-0 26 | ||
2175 | 2000E – DT P segments shall be optional. | ||
2176 | |||
2177 | FS-UN017-0 26-001 | ||
2178 | 2000E – DT P segments if presen t, shall n ot exceed 9 occurren ces. | ||
2179 | |||
2180 | FS-UN017-0 26-002 | ||
2181 | 2000E – DT P segments if presen t in the 2 78 2000E R equest loo p shall ha ve the sam e values p opulated i n the 278 Response l oop. | ||
2182 | |||
2183 | FS-UN017-0 27 | ||
2184 | HI shall b e populate d in the 2 78 2000E R esponse ba sed on the values in the maste r authoriz ation reco rd. | ||
2185 | |||
2186 | FS-UN017-0 28 | ||
2187 | DELETED | ||
2188 | |||
2189 | FS-UN017-0 29 | ||
2190 | DELETED | ||
2191 | |||
2192 | FS-UN017-0 30 | ||
2193 | DELETED | ||
2194 | |||
2195 | FS-UN017-0 31 | ||
2196 | DELETED | ||
2197 | |||
2198 | FS-UN017-0 32 | ||
2199 | DELETED | ||
2200 | |||
2201 | FS-UN017-0 33 | ||
2202 | DELETED | ||
2203 | |||
2204 | FS-UN017-0 34 | ||
2205 | DELETED | ||
2206 | |||
2207 | FS-UN017-0 35 | ||
2208 | DELETED | ||
2209 | |||
2210 | FS-UN017-0 36 | ||
2211 | For FY15,I f present in the 278 request, the Loop 2 010EA shal l not be p opulated i n the 278 2000E Resp onse. | ||
2212 | |||
2213 | FS-UN017-0 37 | ||
2214 | For FY15, If present in the 27 8 request, the Loop 2010EB sha ll not be populated in the 278 2000E Res ponse. | ||
2215 | |||
2216 | FS-UN018-0 01 | ||
2217 | DELETED | ||
2218 | |||
2219 | FS-UN018-0 02 | ||
2220 | DELETED | ||
2221 | |||
2222 | FS-UN019-0 01 | ||
2223 | DELETED | ||
2224 | |||
2225 | FS-UN019-0 02 | ||
2226 | DELETED | ||
2227 | |||
2228 | FS-UN020-0 01 | ||
2229 | DELETED | ||
2230 | |||
2231 | FS-UN020-0 21 | ||
2232 | DELETED | ||
2233 | |||
2234 | FS-UN017-0 39 | ||
2235 | DELETED | ||
2236 | |||
2237 | FS-UN017-0 40 | ||
2238 | DELETED | ||
2239 | |||
2240 | FS-UN017-0 41 | ||
2241 | DELETED | ||
2242 | |||
2243 | FS-UN017-0 42 | ||
2244 | DELETED | ||
2245 | |||
2246 | FS-UN017-0 43 | ||
2247 | DELETED | ||
2248 | |||
2249 | FS-UN017-0 44 | ||
2250 | DELETED | ||
2251 | |||
2252 | FS-UN017-0 45 | ||
2253 | DELETED | ||
2254 | |||
2255 | FS-UN017-0 46 | ||
2256 | DELETED | ||
2257 | |||
2258 | FS-UN017-0 47 | ||
2259 | DELETED | ||
2260 | |||
2261 | FS-UN017-0 48 | ||
2262 | For FY15, the PWK se gment shal l not be s upported i n 2000E lo op | ||
2263 | |||
2264 | FS-UN017-0 48-001 | ||
2265 | DELETED | ||
2266 | |||
2267 | FS-UN017-0 49 | ||
2268 | A user sha ll be allo wed to ent er up to 2 64 charact ers of fre e text in the 2000E service lo op respons e. | ||
2269 | |||
2270 | |||
2271 | Loop 2010E A | ||
2272 | |||
2273 | FS-UN017-0 50 | ||
2274 | The 2010EA response loop shall not be su pported in FY15. | ||
2275 | |||
2276 | FS-UN017-0 51 | ||
2277 | DELETED | ||
2278 | |||
2279 | FS-UN017-0 52 | ||
2280 | DELETED | ||
2281 | |||
2282 | FS-UN017-0 53 | ||
2283 | DELETED | ||
2284 | |||
2285 | FS-UN017-0 54 | ||
2286 | DELETED | ||
2287 | |||
2288 | FS-UN017-0 55 | ||
2289 | DELETED | ||
2290 | |||
2291 | FS-UN017-0 56 | ||
2292 | DELETED | ||
2293 | |||
2294 | FS-UN017-0 57 | ||
2295 | PRV segmen t shall no t be requi red in the 2010EB Re sponse. | ||
2296 | |||
2297 | |||
2298 | Loop 2000F | ||
2299 | |||
2300 | FS-UN017-0 38 | ||
2301 | If F loop data is pr esent as p art of the 278 Reque st, it sha ll not be returned a s part of the 278 Re sponse. | ||
2302 | |||
2303 | Table 23 - 278 ACCEP T Response Requireme nts | ||
2304 | Identifier | ||
2305 | Requiremen t Number | ||
2306 | Requiremen t Descript ion | ||
2307 | Theme 005 | ||
2308 | |||
2309 | Electronic ally Proce ss ASC X12 278 (Alig ns to Goal 2) | ||
2310 | Epic 010 | ||
2311 | |||
2312 | As Non-VA Care Autho rization t eam, I wan t to be ab le access an ASC X12 278 Reque sts in an identified processin g queue so that I ca n group au thorizatio ns based o n a pre-de fined crit eria. | ||
2313 | User Narra tive 022 ( B) | ||
2314 | |||
2315 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to cre ate an aut omated res ponse base d on pre-d efined cri teria so t hat I can respond to an author ization re quest. | ||
2316 | |||
2317 | FS-UN022B- 001 | ||
2318 | The HCR se gment shal l be requi red in the 2000E Res ponse loop : | ||
2319 | |||
2320 | FS-UN022B- 001-001 | ||
2321 | DELETED | ||
2322 | |||
2323 | FS-UN022B- 001-002 | ||
2324 | DELETED | ||
2325 | |||
2326 | FS-UN022B- 001-003 | ||
2327 | DELETED | ||
2328 | |||
2329 | FS-UN022B- 001-004 | ||
2330 | DELETED | ||
2331 | |||
2332 | FS-UN022B- 001-005 | ||
2333 | DELETED | ||
2334 | |||
2335 | FS-UN022B- 001-006 | ||
2336 | DELETED | ||
2337 | |||
2338 | FS-UN022B- 001-007 | ||
2339 | DELETED | ||
2340 | |||
2341 | FS-UN022B- 001-008 | ||
2342 | DELETED | ||
2343 | |||
2344 | FS-UN022B- 001-009 | ||
2345 | DELETED | ||
2346 | |||
2347 | FS-UN022B- 001-010 | ||
2348 | DELETED | ||
2349 | |||
2350 | FS-UN022B- 002 | ||
2351 | HCR01 shal l be popul ated with the value from the m aster auth orization record. | ||
2352 | |||
2353 | FS-UN022B- 002-001 | ||
2354 | DELETED | ||
2355 | |||
2356 | FS-UN022B- 003 | ||
2357 | HCR02 shal l be popul ated with the master authoriza tion Uniqu e-Authoriz ation-Key. | ||
2358 | |||
2359 | FS-UN022B- 003-001 | ||
2360 | DELETED | ||
2361 | |||
2362 | FS-UN022B- 003-002 | ||
2363 | DELETED | ||
2364 | |||
2365 | FS-UN022B- 003-003 | ||
2366 | DELETED | ||
2367 | |||
2368 | FS-UN022B- 004 | ||
2369 | MSG respon se segment if popula ted as par t of the m aster auth orization, shall be populated in the 278 response . | ||
2370 | |||
2371 | FS-UN022B- 004-001 | ||
2372 | DELETED | ||
2373 | |||
2374 | FS-UN022B- 004-002 | ||
2375 | DELETED | ||
2376 | |||
2377 | FS-UN022B- 004-003 | ||
2378 | DELETED | ||
2379 | |||
2380 | FS-UN022B- 005 | ||
2381 | UM03 278 response s hall be po pulated wi th the UM0 3 response value fro m the mast er authori zation rec ord. | ||
2382 | |||
2383 | FS-UN022B- 005-001 | ||
2384 | DELETED | ||
2385 | |||
2386 | FS-UN022B- 005-002 | ||
2387 | DELETED | ||
2388 | |||
2389 | FS-UN022B- 005-003 | ||
2390 | DELETED | ||
2391 | |||
2392 | FS-UN022B- 005-004 | ||
2393 | DELETED | ||
2394 | |||
2395 | FS-UN022B- 006 | ||
2396 | The HSD se gment shal l be popul ated from the data i n the mast er authori zation HSD response data eleme nts. | ||
2397 | |||
2398 | FS-UN022B- 006-001 | ||
2399 | DELETED | ||
2400 | |||
2401 | FS-UN022B- 006-002 | ||
2402 | DELETED | ||
2403 | |||
2404 | FS-UN022B- 006-003 | ||
2405 | DELETED | ||
2406 | |||
2407 | FS-UN022B- 006-004 | ||
2408 | DELETED | ||
2409 | |||
2410 | FS-UN022B- 007 | ||
2411 | The 278 Re quest reco rd shall b e moved to the 278 A CCEPTED re ference qu eue | ||
2412 | |||
2413 | FS-UN022B- 007-001 | ||
2414 | DELETED | ||
2415 | |||
2416 | FS-UN022B- 007-002 | ||
2417 | DELETED | ||
2418 | |||
2419 | FS-UN022B- 007-003 | ||
2420 | DELETED | ||
2421 | |||
2422 | FS-UN016-0 01 | ||
2423 | DELETED | ||
2424 | |||
2425 | FS-UN016-0 01-001 | ||
2426 | DELETED | ||
2427 | |||
2428 | FS-UN016-0 01-002 | ||
2429 | DELETED | ||
2430 | |||
2431 | FS-UN016-0 01-003 | ||
2432 | DELETED | ||
2433 | |||
2434 | FS-UN016-0 01-004 | ||
2435 | DELETED | ||
2436 | |||
2437 | FS-UN016-0 01-005 | ||
2438 | DELETED | ||
2439 | |||
2440 | FS-UN016-0 01-006 | ||
2441 | DELETED | ||
2442 | |||
2443 | FS-UN016-0 01-007 | ||
2444 | DELETED | ||
2445 | |||
2446 | FS-UN016-0 02 | ||
2447 | DELETED | ||
2448 | |||
2449 | FS-UN016-0 03 | ||
2450 | DELETED | ||
2451 | |||
2452 | FS-UN016-0 04 | ||
2453 | DELETED | ||
2454 | |||
2455 | FS-UN016-0 05 | ||
2456 | DELETED | ||
2457 | |||
2458 | 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. | ||
2459 | 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 . | ||
2460 | Table 24 - Authoriza tion DENIE D Requirem ents | ||
2461 | Identifier | ||
2462 | Requiremen t Number | ||
2463 | Requiremen ts Descrip tion | ||
2464 | Theme 004 | ||
2465 | |||
2466 | Electronic ally Trans mit ASC X1 2 278 (Ali gns to Goa l 2) | ||
2467 | Epic 007 | ||
2468 | |||
2469 | As Non-VA Care Autho rization t eam, I wan t to be ab le to elec tronically receive a n ASC X12 278 Reques t so that I can init iate the a uthorizati on process . | ||
2470 | User Narra tive 017 | ||
2471 | |||
2472 | As a Non-V A PC Autho rization C lerk, I wa nt to crea te an ASC X12 278 re sponse so that I can deny an a uthorizati on of care . | ||
2473 | |||
2474 | FS-UN017-0 08 | ||
2475 | The AAT sh all write a 278 resp onse recor d to the 2 78 Reposit ory: | ||
2476 | |||
2477 | FS-UN017-0 08-001 | ||
2478 | Existing 2 78 Patient episode r equest seg ment data shall be u sed to pop ulate corr esponding 278 respon se segment s in the m aster auth orization. | ||
2479 | |||
2480 | FS-UN017-0 08-002 | ||
2481 | HCR01 shal l be set t o “A2”. | ||
2482 | |||
2483 | FS-UN017-0 08-003 | ||
2484 | HCR02 shal l not be s et. | ||
2485 | |||
2486 | FS-UN017-0 08-004 | ||
2487 | HCR03 shal l be set b ased on th e reason c ode entere d via the 278 GUI. | ||
2488 | |||
2489 | FS-UN017-0 08-005 | ||
2490 | DELETED | ||
2491 | |||
2492 | FS-UN017-0 08-006 | ||
2493 | DELETED | ||
2494 | |||
2495 | FS-UN017-0 08-007 | ||
2496 | DELETED | ||
2497 | |||
2498 | FS-UN017-0 09 | ||
2499 | If a 278 R equest is received a nd a DENIE D 278 Resp onse recor d exist in the 278 R epository, AAT shall return a DENIED 278 response based on t he data in the 278 R esponse re cord | ||
2500 | |||
2501 | FS-UN017-0 09-001 | ||
2502 | DELETED | ||
2503 | |||
2504 | FS-UN017-0 09-002 | ||
2505 | DELETED | ||
2506 | |||
2507 | FS-UN017-0 09-003 | ||
2508 | DELETED | ||
2509 | |||
2510 | FS-UN017-0 10 | ||
2511 | The 278 re cord shall be assign ed to the 278 Denied reference queue. | ||
2512 | AAT Requir ements | ||
2513 | 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. | ||
2514 | (For the p urposes of this docu ment, the assumption is the AA A code tab les were c reated in FY14). | ||
2515 | AAT Code L ookup Tabl e Requirem ents | ||
2516 | Table 25 - AAT – Loo kup Table Requiremen ts | ||
2517 | Identifier | ||
2518 | Requiremen t Number | ||
2519 | Requiremen ts Descrip tion | ||
2520 | Theme 004 | ||
2521 | |||
2522 | Electronic ally Trans mit ASC X1 2 278 (Ali gns to Goa l 2) | ||
2523 | Epic 007 | ||
2524 | |||
2525 | As Non-VA Care Autho rization t eam, I wan t to be ab le to elec tronically receive a n ASC X12 278 Reques t so that I can init iate the a uthorizati on process . | ||
2526 | |||
2527 | FS-EP007-0 33 | ||
2528 | Element NM 101 shall require a lookup tab le. | ||
2529 | |||
2530 | FS-EP007-0 34 | ||
2531 | Element NM 102 shall require a lookup tab le. | ||
2532 | |||
2533 | FS-EP007-0 35 | ||
2534 | Element NM 108 shall require a lookup tab le. | ||
2535 | |||
2536 | FS-EP007-0 36 | ||
2537 | Element PE R03 shall require a lookup tab le. | ||
2538 | |||
2539 | FS-EP007-0 37 | ||
2540 | Element PE R07 shall require a lookup tab le. | ||
2541 | |||
2542 | FS-EP007-0 38 | ||
2543 | Element RE F01 shall require a lookup tab le. | ||
2544 | |||
2545 | FS-EP007-0 39 | ||
2546 | Element PR V01 shall require a lookup tab le. | ||
2547 | |||
2548 | FS-EP007-0 40 | ||
2549 | Element N4 03 shall r equire a l ookup tabl e. | ||
2550 | |||
2551 | FS-EP007-0 41 | ||
2552 | Element N4 02 shall r equire a l ookup tabl e. | ||
2553 | |||
2554 | FS-EP007-0 42 | ||
2555 | Element N4 07 shall r equire a l ookup tabl e. | ||
2556 | |||
2557 | FS-EP007-0 43 | ||
2558 | Element DM G01 shall require a lookup tab le. | ||
2559 | |||
2560 | FS-EP007-0 44 | ||
2561 | Element DM G03 shall require a lookup tab le. | ||
2562 | |||
2563 | FS-EP007-0 45 | ||
2564 | DELETED | ||
2565 | |||
2566 | FS-EP007-0 46 | ||
2567 | DELETED | ||
2568 | |||
2569 | FS-EP007-0 47 | ||
2570 | DELETED | ||
2571 | |||
2572 | FS-EP007-0 48 | ||
2573 | Element TR N01 shall require a lookup tab le. | ||
2574 | |||
2575 | FS-EP007-0 49 | ||
2576 | Element UM 01 shall r equire a l ookup tabl e. | ||
2577 | |||
2578 | FS-EP007-0 50 | ||
2579 | Element UM 02 shall r equire a l ookup tabl e. | ||
2580 | |||
2581 | FS-EP007-0 51 | ||
2582 | Element UM 03 shall r equire a l ookup tabl e. | ||
2583 | |||
2584 | FS-EP007-0 52 | ||
2585 | Element UM 03 shall i ndicate if the servi ce is supp orted for each recor d in the U M03 lookup table. | ||
2586 | |||
2587 | FS-EP007-0 53 | ||
2588 | DELETED | ||
2589 | |||
2590 | FS-EP007-0 54 | ||
2591 | DELETED | ||
2592 | |||
2593 | FS-EP007-0 55 | ||
2594 | Element HC R01 shall require a lookup tab le. | ||
2595 | |||
2596 | FS-EP007-0 56 | ||
2597 | Element HC R03 shall require a lookup tab le. | ||
2598 | |||
2599 | FS-EP007-0 57 | ||
2600 | Element DT P01 shall require a lookup tab le. | ||
2601 | |||
2602 | FS-EP007-0 58 | ||
2603 | Element DT P02 shall require a lookup tab le. | ||
2604 | |||
2605 | FS-EP007-0 59 | ||
2606 | Element HI 0X-1 shall require a lookup ta ble. | ||
2607 | |||
2608 | FS-EP007-0 60 | ||
2609 | Element HI 0X -2 shal l require a lookup t able. | ||
2610 | |||
2611 | FS-EP007-0 61 | ||
2612 | Element HI 0X -3 shal l require a lookup t able. | ||
2613 | |||
2614 | |||
2615 | Note: The HI0X has e ntries lab eled 1 thr ough 12 an d within t he 12 occu rrences th ere are 3 lookup tab les shared by the sa me element s. | ||
2616 | |||
2617 | FS-EP007-0 62 | ||
2618 | Element CL 101 shall require a lookup tab le. | ||
2619 | |||
2620 | FS-EP007-0 63 | ||
2621 | Element CL 102 shall require a lookup tab le. | ||
2622 | |||
2623 | FS-EP007-0 64 | ||
2624 | Element CL 103 shall require a lookup tab le. | ||
2625 | |||
2626 | FS-EP007-0 65 | ||
2627 | Element CR 103 shall require a lookup tab le. | ||
2628 | |||
2629 | FS-EP007-0 66 | ||
2630 | Element CR 105 shall require a lookup tab le. | ||
2631 | |||
2632 | FS-EP007-0 67 | ||
2633 | Element CR 203 shall require a lookup tab le. | ||
2634 | |||
2635 | FS-EP007-0 68 | ||
2636 | Element CR 503 shall require a lookup tab le. | ||
2637 | |||
2638 | FS-EP007-0 69 | ||
2639 | Element CR 504 shall require a lookup tab le. | ||
2640 | |||
2641 | FS-EP007-0 70 | ||
2642 | Element CR 517 shall require a lookup tab le. | ||
2643 | |||
2644 | FS-EP007-0 71 | ||
2645 | Element CR 518 shall require a lookup tab le. | ||
2646 | |||
2647 | FS-EP007-0 72 | ||
2648 | Element CR 601 shall require a lookup tab le. | ||
2649 | |||
2650 | FS-EP007-0 73 | ||
2651 | Element CR 603 shall require a lookup tab le. | ||
2652 | |||
2653 | FS-EP007-0 74 | ||
2654 | Element CR 607 shall require a lookup tab le. | ||
2655 | |||
2656 | FS-EP007-0 75 | ||
2657 | Element CR 608 shall require a lookup tab le. | ||
2658 | |||
2659 | FS-EP007-0 76 | ||
2660 | Element PW K01 shall require a lookup tab le. | ||
2661 | |||
2662 | FS-EP007-0 77 | ||
2663 | Element PW K02 shall require a lookup tab le. | ||
2664 | |||
2665 | AAT Event logging Re quirements | ||
2666 | Table 26 - AAT Event Logging R equirement s | ||
2667 | Identifier | ||
2668 | Requiremen t Number | ||
2669 | Requiremen t Descript ion | ||
2670 | |||
2671 | FS-EP007-0 90 | ||
2672 | For each a ction that AAT perfo rms, the f ollowing i nformation shall be written to the AAT e vent log: | ||
2673 | |||
2674 | FS-EP007-0 90-001 | ||
2675 | Actor init iating the event | ||
2676 | |||
2677 | FS-EP007-0 90-002 | ||
2678 | Date/time of the eve nt | ||
2679 | |||
2680 | FS-EP007-0 90-003 | ||
2681 | Action bei ng execute d | ||
2682 | |||
2683 | FS-EP007-0 90-004 | ||
2684 | Result of executed a ction | ||
2685 | |||
2686 | FS-EP007-0 90-005 | ||
2687 | 278 Reques t-ID | ||
2688 | |||
2689 | FS-EP007-0 91 | ||
2690 | An authori zed user s hall be ab le to sear ch the AAT log by: | ||
2691 | |||
2692 | FS-EP007-0 91-001 | ||
2693 | 278 Provid er Request identifie r | ||
2694 | |||
2695 | FS-EP007-0 91-002 | ||
2696 | Patient ID | ||
2697 | |||
2698 | FS-EP007-0 91-003 | ||
2699 | Patient Na me | ||
2700 | |||
2701 | FS-EP007-0 91-004 | ||
2702 | 278 Reques t date | ||
2703 | |||
2704 | FS-EP007-0 91-005 | ||
2705 | Actor init iating the event | ||
2706 | |||
2707 | FS-EP007-0 92 | ||
2708 | An authori zed user s hall be ab le to view only the records ev ent loggin g records based on t he search performed. | ||
2709 | AAT Queuin g Requirem ents | ||
2710 | All incomi ng unsolic ited 278 R equests sh all be rou ted to que ues based on criteri a in the U M data seg ment. | ||
2711 | Table 27 - Queue Cre ation Requ irements | ||
2712 | Identifier | ||
2713 | Requiremen t Number | ||
2714 | Requiremen t Descript ion | ||
2715 | Theme 005 | ||
2716 | |||
2717 | Electronic ally Proce ss ASC X12 278 (Alig ns to Goal 2) | ||
2718 | Epic 010 | ||
2719 | |||
2720 | As Non-VA Care Autho rization t eam, I wan t to be ab le access an ASC X12 278 Reque sts in an identified processin g queue so that I ca n group au thorizatio ns based o n a pre-de fined crit eria. | ||
2721 | |||
2722 | FS-EP010-0 01 | ||
2723 | There shal l be an “I ncoming Re quest” que ue. | ||
2724 | |||
2725 | FS-EP010-0 02 | ||
2726 | There shal l be a “Pa tient Prob lem” queue . | ||
2727 | |||
2728 | FS-EP010-0 03 | ||
2729 | There shal l be a “Pr ovider Pro blem” queu e. | ||
2730 | |||
2731 | FS-EP010-0 04 | ||
2732 | There shal l be an “E mergency R equest” qu eue. | ||
2733 | |||
2734 | FS-EP010-0 05 | ||
2735 | There shal l be a Men tal Health queue. | ||
2736 | |||
2737 | FS-EP010-0 06 | ||
2738 | There shal l be an “I npatient R equest” qu eue. | ||
2739 | |||
2740 | FS-EP010-0 07 | ||
2741 | There shal l be an “O utpatient Request qu eue. | ||
2742 | |||
2743 | FS-EP010-0 08 | ||
2744 | There shal l be a “De ntal Reque st queue. | ||
2745 | |||
2746 | FS-EP010-0 09 | ||
2747 | There shal l be a Men tal Health Request q ueue. | ||
2748 | |||
2749 | FS-EP010-0 10 | ||
2750 | There shal l be a Rej ected Requ est queue. | ||
2751 | |||
2752 | FS-EP010-0 11 | ||
2753 | There shal l be a Del eted Reque st queue. | ||
2754 | |||
2755 | FS-EP010-0 12 | ||
2756 | An authori zation sha ll only be assigned to a singl e queue. | ||
2757 | |||
2758 | FS-EP010-0 13 | ||
2759 | An authori zed user s hall be ab le to assi gn a 278 R equest to a differen t queue. | ||
2760 | |||
2761 | FS-EP010-0 19 | ||
2762 | A user sha ll be able to see a summary of each queu e and the total numb er of reco rds in eac h queue. | ||
2763 | 278 Catego ry of Auth orization and UM Que uing Requi rements | ||
2764 | Table 28 - Category/ Queuing Re quirements | ||
2765 | Identifier | ||
2766 | Requiremen t Number | ||
2767 | Requiremen t Descript ion | ||
2768 | Theme 005 | ||
2769 | |||
2770 | Electronic ally Proce ss ASC X12 278 (Alig ns to Goal 2) | ||
2771 | Epic 009 | ||
2772 | |||
2773 | As Non-VA Care Autho rization t eam, I wan t to be ab le to iden tify the c ategory of an ASC X1 2 278 Requ est so tha t I know t he type of service f or an auth orization. | ||
2774 | User Narra tive 018 | ||
2775 | |||
2776 | As a Non-V A PC Autho rization C lerk, I wa nt to view a UM01 so that I ca n identify the categ ory of ser vice that is needed. | ||
2777 | User Narra tive 019 | ||
2778 | |||
2779 | As a Non-V A PC Autho rization C lerk, I wa nt to view a UM02 so that I ca n identify the certi fication t ype that i s needed. | ||
2780 | User Narra tive 020 | ||
2781 | |||
2782 | As a Non-V A PC Autho rization C lerk, I wa nt to view a UM03 so that I ca n identify the type of service that is n eeded. | ||
2783 | User Narra tive 021 | ||
2784 | |||
2785 | As a Non-V A PC Autho rization C lerk, I wa nt to view a UM04 so that I ca n identify the healt h care ser vice locat ion that i s needed. | ||
2786 | |||
2787 | |||
2788 | EMERGENCY ROUTING RU LES | ||
2789 | |||
2790 | FS-UN020-0 01 | ||
2791 | If 278 Req uest loop element UM 03 = “86” AAT shall route the 278 Reques t to the H igh Priori ty “Emerge ncy Reques t” queue. | ||
2792 | |||
2793 | FS-UN021-0 01 | ||
2794 | The AAT sh all route 278 Reques t based on routing r ules devel oped by th e VA PMD. | ||
2795 | |||
2796 | FS-EP009-0 097 | ||
2797 | By default , all othe r 278 Requ est shall be routed to the “Ou tpatient R equest” qu eue. | ||
2798 | AAT Receiv e Authoriz ation Requ est | ||
2799 | Table 29 - AAT Recei ve Authori zation Req uirements | ||
2800 | Identifier | ||
2801 | Requiremen t Number | ||
2802 | Requiremen t Descript ion | ||
2803 | Theme 005 | ||
2804 | |||
2805 | Electronic ally Proce ss ASC X12 278 (Alig ns to Goal 2) | ||
2806 | Epic 010 | ||
2807 | |||
2808 | As Non-VA Care Autho rization t eam, I wan t to be ab le access an ASC X12 278 Reque sts in an identified processin g queue so that I ca n group au thorizatio ns based o n a pre-de fined crit eria. | ||
2809 | |||
2810 | FS-EP010-0 26 | ||
2811 | AAT shall validate t he provide rs: | ||
2812 | |||
2813 | FS-EP010-0 26-001 | ||
2814 | Verify tha t the prov ider submi tting the 278 Reques t is allow ed to cond uct busine ss with th e VMA. | ||
2815 | |||
2816 | FS-EP010-0 26-002 | ||
2817 | If the req uestor is identified that is n ot allowed to conduc t business with VA, AAT shall write an e ntry to th e AAT even t log iden tifying th e 278 Requ est, vendo r and mess age indica ting vendo r is unaut horized. | ||
2818 | |||
2819 | FS-EP010-0 26-003 | ||
2820 | Send a 278 AAA Denie d Error Re sponse | ||
2821 | |||
2822 | FS-EP010-0 27 | ||
2823 | If loop 20 10EA is pr esent, AAT shall: | ||
2824 | |||
2825 | FS-EP010-0 27-001 | ||
2826 | Verify tha t each pro vider in t he 2010EA loop is al lowed to c onduct bus iness with VA. | ||
2827 | |||
2828 | FS-EP010-0 27-002 | ||
2829 | If a provi der is ide ntified th at is not allowed to conduct b usiness wi th VA, AAT shall wri te an entr y to the A AT event l og identif ying the 2 78 Request , vendor a nd message indicatin g vendor i s unauthor ized. | ||
2830 | |||
2831 | FS-EP010-0 27-003 | ||
2832 | Send a 278 AAA Denie d Error Re sponse | ||
2833 | |||
2834 | FS-EP010-0 28 | ||
2835 | If loop 20 10FA is pr esent, AAT shall: | ||
2836 | |||
2837 | FS-EP010-0 28-001 | ||
2838 | Verify tha t each pro vider in t he 2010FA loop is al lowed to c onduct bus iness with VA. | ||
2839 | |||
2840 | FS-EP010-0 28-002 | ||
2841 | If a provi der is ide ntified th at is not allowed to conduct b usiness wi th VA, AAT shall wri te an entr y to the A AT event l og identif ying the 2 78 Request , vendor a nd message indicatin g vendor i s unauthor ized. | ||
2842 | |||
2843 | FS-EP010-0 28-003 | ||
2844 | Send a 278 AAA Denie d Error Re sponse | ||
2845 | |||
2846 | FS-EP010-0 29 | ||
2847 | AAT shall route the 278 Reques t to the l ocal VMA “ Incoming R equest” qu eue for pr ocessing. | ||
2848 | |||
2849 | FS-EP010-0 25 | ||
2850 | AAT shall process a request fr om the “In coming Req uest” queu e: | ||
2851 | |||
2852 | FS-EP010-0 25-001 | ||
2853 | Verify tha t the pati ent identi fied in th e 278 is a patient o n the VMA VistA Fee Patient fi le. | ||
2854 | |||
2855 | FS-EP010-0 25-002 | ||
2856 | If the pat ient is no t found on the VMA p atient fil e, AAT sha ll write a n event to the AAT e vent file. | ||
2857 | |||
2858 | FS-EP010-0 25-003 | ||
2859 | If the pat ient is no t found on the VMA p atient fil e, AAT sha ll route t he 278 Req uest to th e “Patient Not Found ” queue af ter valida ting provi ders. | ||
2860 | |||
2861 | FS-EP010-0 24 | ||
2862 | If a provi der does n ot exists on the pro vider file , the 278 Request sh all be rou ted to the VMA local “Provider Problem” queue. | ||
2863 | |||
2864 | NOTE: | ||
2865 | FS-EP010-0 14 through EP-010-02 2 assigned new UN nu mbering | ||
2866 | Other Requ irements | ||
2867 | 278 PHI Se nsitive Pa tient Requ irements | ||
2868 | Table 30 - 278 PHI R equirement s | ||
2869 | Identifier | ||
2870 | Requiremen t Number | ||
2871 | Requiremen t Descript ion | ||
2872 | Theme 004 | ||
2873 | |||
2874 | Electronic ally Trans mit ASC X1 2 278 (Ali gns to Goa l 2) | ||
2875 | Epic 007 | ||
2876 | |||
2877 | As Non-VA Care Autho rization t eam, I wan t to be ab le to elec tronically receive a n ASC X12 278 Reques t so that I can init iate the a uthorizati on process . | ||
2878 | |||
2879 | FS-EP007-0 96 | ||
2880 | The system shall be able to id entify whi ch 278 seg ments cont ain PHI ba sed on tab le driven criteria d eveloped b y the VA P MD. | ||
2881 | |||
2882 | FS-EP007-0 97 | ||
2883 | The system shall be able to id entify a p rovider wh o has rest ricted acc ess to PHI informati on. | ||
2884 | |||
2885 | FS-EP007-0 98 | ||
2886 | The system shall be able to id entify a 2 78 Request as PHI-se nsitive. | ||
2887 | |||
2888 | FS-EP007-0 99 | ||
2889 | The defaul t setting for PHI-Se nsitive sh all be “NO ” for the 278 Reques t. | ||
2890 | |||
2891 | FS-EP007-1 00 | ||
2892 | DELETED | ||
2893 | |||
2894 | FS-EP007-1 01 | ||
2895 | DELETED | ||
2896 | |||
2897 | FS-EP007-1 02 | ||
2898 | DELETED | ||
2899 | |||
2900 | FS-EP007-1 03 | ||
2901 | DELETED | ||
2902 | |||
2903 | FS-EP007-1 04 | ||
2904 | DELETED | ||
2905 | |||
2906 | FS-EP007-1 05 | ||
2907 | DELETED | ||
2908 | |||
2909 | FS-EP007-1 06 | ||
2910 | DELETED | ||
2911 | |||
2912 | FS-EP007-1 07 | ||
2913 | DELETED | ||
2914 | |||
2915 | FS-EP007-1 08 | ||
2916 | DELETED | ||
2917 | |||
2918 | FS-EP007-1 08-001 | ||
2919 | DELETED | ||
2920 | |||
2921 | FS-EP007-1 08-002 | ||
2922 | DELETED | ||
2923 | |||
2924 | FS-EP007-1 08-003 | ||
2925 | DELETED | ||
2926 | |||
2927 | FS-EP007-1 08-004 | ||
2928 | DELETED | ||
2929 | |||
2930 | FS-EP007-1 08-005 | ||
2931 | DELETED | ||
2932 | |||
2933 | FS-EP007-1 08-006 | ||
2934 | DELETED | ||
2935 | |||
2936 | FS-EP007-1 08-007 | ||
2937 | DELETED | ||
2938 | 278 Author ization tr acking | ||
2939 | Table 31 - Authoriza tion Track ing Requir ements | ||
2940 | Identifier | ||
2941 | Requiremen t Number | ||
2942 | Requiremen t Descript ion | ||
2943 | Theme 004 | ||
2944 | |||
2945 | Electronic ally Trans mit ASC X1 2 278 (Ali gns to Goa l 2) | ||
2946 | Epic 007 | ||
2947 | |||
2948 | As Non-VA Care Autho rization t eam, I wan t to be ab le to elec tronically receive a n ASC X12 278 Reques t so that I can init iate the a uthorizati on process . | ||
2949 | |||
2950 | FS-EP007-1 09 | ||
2951 | A provider may submi t or resub mit a 278 Request fo r a single authoriza tion. | ||
2952 | |||
2953 | FS-EP007-1 10 | ||
2954 | Each reque st and cor responding response shall be u niquely id entified b y a single identifie r. | ||
2955 | |||
2956 | FS-EP007-1 11 | ||
2957 | Each reque st and cor responding response shall be s tored in p ersistent storage. | ||
2958 | |||
2959 | FS-EP007-1 12 | ||
2960 | Date/time of each re quest shal l be store d. | ||
2961 | |||
2962 | FS-EP007-1 13 | ||
2963 | A user sha ll be able to view a uthorizati on request /response history | ||
2964 | General Re quirements | ||
2965 | Table 32 - General R equirement s | ||
2966 | Identifier | ||
2967 | Requiremen t Number | ||
2968 | Requiremen t Descript ion | ||
2969 | Theme 004 | ||
2970 | |||
2971 | Electronic ally Trans mit ASC X1 2 278 (Ali gns to Goa l 2) | ||
2972 | Epic 007 | ||
2973 | |||
2974 | As Non-VA Care Autho rization t eam, I wan t to be ab le to elec tronically receive a n ASC X12 278 Reques t so that I can init iate the a uthorizati on process . | ||
2975 | |||
2976 | FS-EP007-1 52 | ||
2977 | The local VAMC provi der (vendo r) file sh all be abl e to ident ify a reco rd as an o rganizatio n or an in dividual. | ||
2978 | |||
2979 | FS-EP007-1 53 | ||
2980 | The local VAMC provi der (vendo r) file sh all be abl e to ident ify a prov ider as PH I-restrict ed. | ||
2981 | |||
2982 | FS-EP007-1 54 | ||
2983 | A provider identifie d as PHI-r estricted shall not have acces s to patie nt medical informati on where t he PHI-sen sitive fla g is set t o “Y”. | ||
2984 | EDI Requir ements | ||
2985 | Station of Jurisdict ion Requir ement | ||
2986 | Table 33 - Station of Jurisdi ction Requ irements | ||
2987 | Identifier | ||
2988 | Requiremen t Number | ||
2989 | Descriptio n | ||
2990 | Theme 005 | ||
2991 | |||
2992 | Electronic ally Proce ss ASC X12 278 (Alig ns to Goal 2) | ||
2993 | Epic 011 | ||
2994 | |||
2995 | As Non-VA Care Autho rization t eam, I wan t to be ab le to iden tify the f acility th at process ed an ASC X12 278 Re quest so t hat I can track what facility is respons ible for t he authori zation. | ||
2996 | |||
2997 | FS-EP011-0 01 | ||
2998 | Station-of -Jurisdict ion shall be availab le as part of the da ta export when reque sted as pa rt of the export par ameters. | ||
2999 | EDI Report ing Requir ements | ||
3000 | Table 34 - EDI Repor ting Requi rements | ||
3001 | Identifier | ||
3002 | Requiremen t Number | ||
3003 | Requiremen t Descript ion | ||
3004 | Theme 003 | ||
3005 | |||
3006 | Multiple A uthorizati ons Create d (Aligns to Goal 1) | ||
3007 | Epic 005 | ||
3008 | |||
3009 | As Non-VA PC Authori zations te am, I want to be abl e to expor t a report with the number of authorizat ions compl eted per u ser for a selected t imeframe s o that I c an downloa d the data . | ||
3010 | |||
3011 | FS-EP005-0 01 | ||
3012 | An authori zed reques tor shall be able to export th e followin g data poi nts for CO MPLETE aut horization s: | ||
3013 | |||
3014 | FS-EP005-0 01-001 | ||
3015 | User Id of user who completed the author ization | ||
3016 | |||
3017 | FS-EP005-0 01-002 | ||
3018 | Total numb er of auth orizations in a COMP LETE state by user-i d | ||
3019 | |||
3020 | FS-EP005-0 01-003 | ||
3021 | Start-date entered b y requesto r | ||
3022 | |||
3023 | FS-EP005-0 01-004 | ||
3024 | End-date e ntered by requestor | ||
3025 | |||
3026 | FS-EP005-0 02 | ||
3027 | The reques tor shall be require d to enter a request start-dat e. | ||
3028 | |||
3029 | FS-EP005-0 03 | ||
3030 | The system shall def ault the r equest end -date to t he current system da te. | ||
3031 | |||
3032 | FS-EP005-0 04 | ||
3033 | The reques tor shall be allowed to enter a differen t request end-date. | ||
3034 | |||
3035 | FS-EP006-0 01 | ||
3036 | The reques tor shall be require d to selec t either 1 0-7078 or 10-7079 au thorizatio ns for the export. | ||
3037 | |||
3038 | FS-EP005-0 05 | ||
3039 | By default , the syst em shall e xport all users and total numb er of auth orizations completed . | ||
3040 | |||
3041 | FS-EP005-0 06 | ||
3042 | The system shall sor t the data by user-i d, ascendi ng. | ||
3043 | Epic 006 | ||
3044 | |||
3045 | As Non-VA PC Authori zations te am, I want to be abl e to expor t a report by the ty pe of serv ice for a selected t imeframe s o that I c an downloa d the data . | ||
3046 | |||
3047 | FS-EP006-0 02 | ||
3048 | The reques tor shall be require d to selec t either 1 0-7078 or 10-7079 au thorizatio ns for the export. | ||
3049 | Theme 06 | ||
3050 | |||
3051 | Report on ASC X12 27 8 Transact ions (Alig ns to Goal 2) | ||
3052 | Epic 012 | ||
3053 | |||
3054 | As EDI Tea m, I want to be able to export a report with pre-d efined ASC X12 278 d ata points so that I can downl oad the da ta. | ||
3055 | |||
3056 | FS-EP012-0 01 | ||
3057 | The reques tor shall be able to select th e file for mat for th e exported report. | ||
3058 | |||
3059 | FS-EP012-0 02 | ||
3060 | The reques tor shall be able to select th e storage location f or the exp orted file . | ||
3061 | 278 EDI Co mpliance | ||
3062 | Table 35 - EDI Compl iance Requ irements | ||
3063 | Identifier | ||
3064 | Requiremen t Number | ||
3065 | Requiremen t Descript ion | ||
3066 | Theme 07 | ||
3067 | |||
3068 | Implement CAQH CORE Operating Rules for ASC X12N 2 78 (Aligns to Goal 2 ) | ||
3069 | Epic 13 | ||
3070 | |||
3071 | As Non-VA Care Autho rization t eam, I wan t to be ab le to proc ess an ASC X12 278 a ccording t o the auth orization operating rules to d emonstrate complianc e so that VHA can ce rtify that CBOPC is compliant. | ||
3072 | Epic 14 | ||
3073 | |||
3074 | As Non-VA Care Autho rization t eam, I wan t to be ab le to proc ess an ASC X12 278 a ccording t o the stan dard trans actions fo rmat to de monstrate compliance so that V HA can cer tify that CBOPC is c ompliant. | ||
3075 | |||
3076 | FS-EP013-0 01 | ||
3077 | EDI compli ance intro duced in F Y14 shall be continu ed: | ||
3078 | |||
3079 | FS-EP013-0 01-001 | ||
3080 | A 278 Requ est shall be validat ed for EDI complianc e | ||
3081 | |||
3082 | FS-EP014-0 01 | ||
3083 | A 278 Resp onse shall be EDI co mpliant | ||
3084 | |||
3085 | FS-EP014-0 02 | ||
3086 | AAA Error reporting as introdu ced in FY1 4 shall be expanded. | ||
3087 | Graphical User Inter face (GUI) Specifica tions | ||
3088 | GUI Requir ements are listed in the follo wing Funct ional Requ irements: | ||
3089 | Figure 2 - Unsolicit ed 278 Req uests GUI – Summary View | ||
3090 | Table 17 - Queues GU I Requirem ents | ||
3091 | |||
3092 | Figure 3 - Unsolicit ed 278 Req uests GUI – Detail V iew | ||
3093 | Table 18 - Unsolicit ed 278 Req uest GUI R equirement s - Summar y | ||
3094 | |||
3095 | |||
3096 | Figure 4 - Unsolicit ed 278 Req uests GUI - Response View | ||
3097 | Table 19 - Unsolicit ed 278 GUI Requireme nts - Deta il | ||
3098 | Multi-divi sional Spe cification s | ||
3099 | There will not be an y changes required t o handle M ulti-Divis ional Spec ifications for the 2 78 Respons e processi ng since t he master authorizat ion system already h andles any specific Multi-Divi sional Spe cification requireme nts. | ||
3100 | Performanc e Specific ations | ||
3101 | Table 36 - Performan ce Specifi cations | ||
3102 | Identifier | ||
3103 | Requiremen t Number | ||
3104 | Requiremen t Descript ion | ||
3105 | Theme 07 | ||
3106 | |||
3107 | Implement CAQH CORE Operating Rules for ASC X12N 2 78 (Aligns to Goal 2 ) | ||
3108 | Epic 15 | ||
3109 | |||
3110 | As Non-VA Care Autho rization t eam, I wan t to be ab le to proc ess an ASC X12 278 a ccording t o the proc essing con nectivity rule to de monstrate compliance so that V HA can cer tify that CBOPC is c ompliant. | ||
3111 | Epic 17 | ||
3112 | |||
3113 | As Non-VA Care Autho rization t eam, I wan t to be ab le to proc ess an ASC X12 278 a ccording t o the syst em respons e rule to demonstrat e complian ce so that VHA can c ertify tha t CBOPC is compliant . | ||
3114 | Epic 19 | ||
3115 | |||
3116 | As Non-VA Care Autho rization t eam, I wan t to be ab le to proc ess an ASC X12 278 a ccording t o the real time stan dard ackno wledgement s time fra me to demo nstrate co mpliance s o that VHA can certi fy that CB OPC is com pliant. | ||
3117 | User Narra tive 24 | ||
3118 | |||
3119 | As a Non-V A PC Autho rization C lerk, I wa nt the sys tem to res pond to th e request of a real time autho rization w ithin 20 s econds so that I can be in com pliance wi th operati ng rules. | ||
3120 | |||
3121 | PS-EP017-0 01 | ||
3122 | AAT shall complete t he entire 278 transa ction (req uest/respo nse) withi n the Cent ers for Me dicare & M edicaid Se rvices (CM S) specifi ed maximum 20 second response time durin g system u ptime. | ||
3123 | |||
3124 | PS- EP017- 002 | ||
3125 | AAT shall not need t o provide a response during sc heduled sy stem down time. | ||
3126 | |||
3127 | PS- EP017- 003 | ||
3128 | AAT shall be able to support m ultiple us ers withou t degradat ion in res ponse time . | ||
3129 | |||
3130 | PS- EP017- 004 | ||
3131 | AAT Servic es GUI sha ll be able to suppor t multiple users wit hout degra dation in response t ime. | ||
3132 | |||
3133 | PS- EP017- 005 | ||
3134 | AAT Queues GUI shall be able t o support multiple u sers witho ut degrada tion in re sponse tim e. | ||
3135 | |||
3136 | PS- EP017- 006 | ||
3137 | AAT 278 Re view/Reque st GUI sha ll be able to suppor t multiple users wit hout degra dation in response t ime. | ||
3138 | |||
3139 | PS-UN024-0 01 | ||
3140 | 278 Reques t/Response transacti ons shall only be su pported in Real-time mode. | ||
3141 | |||
3142 | PS-EP015-0 01 | ||
3143 | All transa ctions bet ween AAT a nd HCCH wi ll be over a secure communicat ions chann el. | ||
3144 | Quality At tributes S pecificati on | ||
3145 | The AAT ge nerated 27 8 Response will conf orm to the EDI stand ards. | ||
3146 | The Massac husetts Ge neral Hosp ital Utili ty Multi-P rogramming System (M UMPS) code developed for this project wi ll be comp liant with all VA MU MPS Coding Standards and Conve ntions. | ||
3147 | Table 37 - Quality S pecificati ons | ||
3148 | Identifier | ||
3149 | Requiremen t Number | ||
3150 | Requiremen t Descript ion | ||
3151 | Theme 07 | ||
3152 | |||
3153 | Implement CAQH CORE Operating Rules for ASC X12N 2 78 (Aligns to Goal 2 ) | ||
3154 | Epic 16 | ||
3155 | |||
3156 | As Non-VA Care Autho rization t eam, I wan t to be ab le to proc ess an ASC X12 278 a ccording t o the syst em availab ility rule to demons trate comp liance so that VHA c an certify that CBOP C is compl iant. | ||
3157 | |||
3158 | QAS-EP016- 001 | ||
3159 | AAT will b e availabl e at least 86% of th e time dur ing a norm al work we ek, | ||
3160 | Reliabilit y Specific ations | ||
3161 | Table 38 - Reliabili ty Specifi cations | ||
3162 | Identifier | ||
3163 | Requiremen t Number | ||
3164 | Requiremen t Descript ion | ||
3165 | Theme 8 | ||
3166 | |||
3167 | Notificati on of 278 Status (Al igns to Go al 2) | ||
3168 | Epic 20 | ||
3169 | |||
3170 | As EDI Tea m, I want to be able to receiv e a notifi cation of ASC X12 27 8 system s tatus to d emonstrate complianc e so that I can noti fy provide rs of avai lability. | ||
3171 | User Narra tive 25 | ||
3172 | |||
3173 | As an EDI Analyst, I want to r eceive a n otificatio n when the ASC X12 2 78 reposit ory is una vailable w ithin one hour of it being una vailable s o that I c an notify providers of availab ility of t he system. | ||
3174 | User Narra tive 26 | ||
3175 | |||
3176 | As an EDI Analyst, I want to r eceive a n otificatio n when the ASC X12 2 78 reposit ory is sch eduled for non-routi ne downtim e at least one week prior to b eing unava ilable so that I can notify pr oviders of availabil ity of the system. | ||
3177 | User Narra tive 27 | ||
3178 | |||
3179 | As an EDI Analyst, I want to p ublish CBO PC holiday schedule so that I can notify providers of availa bility of the system . | ||
3180 | |||
3181 | RS-UN025-0 01 | ||
3182 | AAT shall maintain a Heartbeat between A AT and the HCCH: | ||
3183 | |||
3184 | RS-UN025-0 01-001 | ||
3185 | The Heartb eat WARNIN G value sh all be con figurable by the EDI Response Team | ||
3186 | |||
3187 | RS-UN025-0 01-002 | ||
3188 | The Heartb eat CRITIC AL value s hall be co nfigurable by the ED I Response Team | ||
3189 | |||
3190 | RS-UN025-0 01-003 | ||
3191 | The Critic al Heartbe at repeat frequent s hall be co nfigurable by the ED I Response team. | ||
3192 | |||
3193 | RS-UN025-0 01-004 | ||
3194 | If the Hea rtbeat fai ls for mor e than the configure d WARNING minutes, a warning e mail shall be sent t o the EDI Response t eam | ||
3195 | |||
3196 | RS-UN025-0 01-005 | ||
3197 | If the Hea rtbeat fai ls for mor e than the configure d WARNING minutes, a warning e mail shall be sent t o the EDI Response t eam | ||
3198 | |||
3199 | RS-UN025-0 01-006 | ||
3200 | The Heartb eat CRITIC AL email m essage sha ll be sent at a freq uency spec ified in t he Heartbe at frequen cy value u ntil the H eartbeat i s restored . | ||
3201 | |||
3202 | RS-UN026-0 01 | ||
3203 | The EDI Ma nagement T eam will b e responsi ble for ma naging sch eduled and unschedul ed downtim e. | ||
3204 | |||
3205 | RS-UN027-0 01 | ||
3206 | The EDI Ma nagement T eam will b e responsi ble for ma intaining a calendar of schedu led down t ime. | ||
3207 | Scope Inte gration | ||
3208 | The integr ation betw een the ma ster autho rization s ystems (10 -7078/10-7 079) shoul d already exist. | ||
3209 | The other new functi onality be ing introd uced will be within the existi ng VistA F ee systems and no ne w Integrat ion should be requir ed to othe r systems. | ||
3210 | Security S pecificati ons | ||
3211 | Table 39 - Security Specificat ions | ||
3212 | Identifier | ||
3213 | Requiremen t Number | ||
3214 | Requiremen t Descript ion | ||
3215 | Theme 004 | ||
3216 | |||
3217 | Electronic ally Trans mit ASC X1 2 278 (Ali gns to Goa l 2) | ||
3218 | Epic 007 | ||
3219 | |||
3220 | As Non-VA Care Autho rization t eam, I wan t to be ab le to elec tronically receive a n ASC X12 278 Reques t so that I can init iate the a uthorizati on process . | ||
3221 | |||
3222 | SS-EP007-0 01 | ||
3223 | Users hold ing the Vi stA Fee Au thorizatio n key shal l be able to: | ||
3224 | |||
3225 | SS-EP007-0 01-001 | ||
3226 | Add Servic es records to a mast er authori zation rec ord | ||
3227 | |||
3228 | SS-EP007-0 01-002 | ||
3229 | View the 2 78 Request queues | ||
3230 | |||
3231 | SS-EP007-0 01-003 | ||
3232 | Select a 2 78 Request from the 278 unsoli cited requ est queues | ||
3233 | |||
3234 | SS-EP007-0 01-004 | ||
3235 | View the 2 78 Request | ||
3236 | |||
3237 | SS-EP007-0 01-005 | ||
3238 | View 275 R epository records | ||
3239 | |||
3240 | SS-EP007-0 01-006 | ||
3241 | Create 278 Response segments f or a 278 R equest | ||
3242 | |||
3243 | SS-EP007-0 01-007 | ||
3244 | Assign a 2 78 Respons e HSD resp onse | ||
3245 | |||
3246 | SS-EP007-0 01-008 | ||
3247 | Release a completed 278 to the AAT proce ss | ||
3248 | |||
3249 | SS-EP007-0 02 | ||
3250 | Users hold ing the Vi stA Fee Su pervisor k ey shall: | ||
3251 | |||
3252 | SS-EP007-0 02-001 | ||
3253 | Have all t he capacit ies listed above | ||
3254 | |||
3255 | SS-EP007-0 03 | ||
3256 | AAT Admini strator sh all: | ||
3257 | |||
3258 | SS-EP007-0 03-001 | ||
3259 | Be able to monitor t he connect ion betwee n AAT and the HCCH | ||
3260 | |||
3261 | SS-EP007-0 03-002 | ||
3262 | Be able to monitor t he connect ion betwee n AAT and each insta nce of AAT | ||
3263 | |||
3264 | SS-EP007-0 03-003 | ||
3265 | Be able to update su pporting 2 78 lookup tables | ||
3266 | |||
3267 | SS-EP007-0 04 | ||
3268 | EDI Manage ment Team shall: | ||
3269 | |||
3270 | SS-EP007-0 04-001 | ||
3271 | Have all t he capabil ities of t he AAT Adm inistrator | ||
3272 | |||
3273 | SS-EP007-0 04-002 | ||
3274 | Access the master au thorizatio n interfac e as neede d to monit or perform ance. | ||
3275 | |||
3276 | SS-EP007-0 04-003 | ||
3277 | Run data e xtracts fo r report g eneration. | ||
3278 | |||
3279 | 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. A Privacy Impact As sessment ( PIA) will be perform ed if requ ired. | ||
3280 | System Fea tures | ||
3281 | The follow ing system features are introd uced: | ||
3282 | The abilit y to link the CPRS o rder with the master authoriza tion recor d. | ||
3283 | The abilit y to creat e and issu e a 10-707 8 prior to the Veter an receivi ng the ser vices. | ||
3284 | The abilit y to add q uantitativ e services for a Vet eran (impr oves suppo rt of 278 processing ) | ||
3285 | 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 | ||
3286 | The abilit y to view the 278 Un solicited Request qu eues and s elect a 27 8 Request to process | ||
3287 | The abilit y to see t he details of the 27 8 Request | ||
3288 | The abilit y to gener ate a 278 Response | ||
3289 | Usability Specificat ions | ||
3290 | The NVCC s taff that coordinate care betw een provid ers and pa tients wil l need to be trained on the re vised auth orization workflow s o that the y allow pr oviders to elect to initiate a 278 REQUE ST transac tion and a re given a ll the nec essary inf ormation. | ||
3291 | The VistA Fee Basis clerks and superviso rs will ne ed trainin g to use t he enhance ments deve loped thro ugh this p roject. | ||
3292 | VistA Fee Basis uses a Roll-an d-scroll i nterface. This proje ct will us e the exis ting Roll- and-scroll interface and will not modify the user interface features o f the Fee Basis Appl ication. | ||
3293 | Applicable Standards | ||
3294 | 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). | ||
3295 | Listed bel ow are VA reference and guidan ce documen tation and standards applicabl e to or ta ilored for the EDI P C Project. This guid ance is us ed to fulf ill the pe rformance requiremen ts of this contract. | ||
3296 | 44 U.S.C. § 3541, “F ISMA of 20 02” | ||
3297 | FIPS Publi cation 140 -2, “Secur ity Requir ements For Cryptogra phic Modul es” | ||
3298 | SEI, SA-CM MI Level 3 procedure s and proc esses | ||
3299 | VA Directi ve 6102, “ Internet/I ntranet Se rvices,” J uly 15, 20 08 | ||
3300 | 36 C.F.R. Part 1194 “Electroni c and IT A ccessibili ty Standar ds,” July 1, 2003 | ||
3301 | OMB Circul ar A-130, “Managemen t of Feder al Informa tion Resou rces,” Nov ember 28, 2000 | ||
3302 | 32 C.F.R. Part 199, “Civilian Health and Medical P rogram of the Unifor med Servic es (CHAMPU S)” | ||
3303 | An Introdu ctory Reso urce Guide for Imple menting th e HIPAA Se curity Rul e, March 2 005 | ||
3304 | 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 | ||
3305 | HSPD-12 | ||
3306 | VA Directi ve 6500, “ Informatio n Security Program,” August 4, 2006 | ||
3307 | VA Handboo k 6500, “I nformation Security Program,” September 18, 2007 | ||
3308 | VA Handboo k, 6500.5, Incorpora ting Secur ity and Pr ivacy in S ystem Deve lopment Li fecycle. | ||
3309 | VA Handboo k 6500.6, “Contract Security,” March 12, 2010 | ||
3310 | PMAS porta l (referen ce PWS Ref erences - Technical Library at https:// DNS /) | ||
3311 | OED ProPat h Process Methodolog y (referen ce PWS Ref erences -T echnical L ibrary and ProPath L ibrary lin ks at http s:// DNS /). Note: In the eve nt of a co nflict, OE D ProPath takes prec edence ove r other pr ocesses or methodolo gies. | ||
3312 | TRM (refer ence at ht tp:// DNS /TRM/TRMHo mePage.asp ) | ||
3313 | NIST Speci al Publica tions SP 8 00-60 and 800-53 | ||
3314 | ITAM and E MF BR-0006 , version 002.1-1405 2008, date d 10/30/20 07 [Note i nformation al, Contex t, and ITA M-EMF Conc eptual lin k] | ||
3315 | HIPAA of 1 996; Pub.L 104-191). | ||
3316 | PPACA, Pub . L. 111-1 48, 124 St at. 119, H .R. 3590, enacted Ma rch 23, 20 10 | ||
3317 | OMB Circul ar A-125, "Prompt Pa yment." Pr ompt Payme nt Act Pro mpt Paymen t final ru le (5 CFR Part 1315, September 29, 1999) requires Executive department s and agen cies to pa y commerci al obligat ions withi n certain time perio ds and to pay intere st penalti es when pa yments are late (htt p:// DNS /prompt/re gulations. html and h ttp://www. ucop.edu/r aohome/cgm emos/82-36 .html) | ||
3318 | CFR 1315, Final Rule , Prompt P ayment (ht tp:// DNS /prompt/re gulations. html) (for merly OMB Circular A -125) | ||
3319 | The aim of this proj ect is to ensure tha t the EDI PC systems are compl iant with the CORE R ules as pu blished by CAQH, and found her e http://w ww.caqh.or g/CORE_ope rat_rules. php | ||
3320 | 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 | ||
3321 | VA M Progr amming Sta ndards and Conventio ns. Revise d 04/03/20 07 http:// DNS /VAStandar dPage.asp? tid=7404 | ||
3322 | ASC X12N/5 010X217 He alth Care Services R eview – Re quest for Review and Response (278) | ||
3323 | ASC X12N/5 010X215 He alth Care Services R eview – In quiry and Response ( 278) | ||
3324 | Interfaces | ||
3325 | Communicat ions Inter faces | ||
3326 | The interf ace betwee n AAT and the HCCH w ill contin ue to be u sed. New f unctionali ty will be added to the interf ace in the form of a Heartbeat monitor s o the EDI Response t eam can be notified in the eve nt that AA T and the HCCH lose connectivi ty for an extended p eriod of t ime. | ||
3327 | Hardware I nterfaces | ||
3328 | No new har dware inte rfaces are required. | ||
3329 | Software I nterfaces | ||
3330 | Existing V istA Fee i nterfaces will be mo dified to allow user s to enter services to be prov ided to th e Veteran via the ne w Services GUI. | ||
3331 | User Inter faces | ||
3332 | Existing V istA Fee i nterfaces will be ma intained a nd modifie d as neede d to suppo rt the new GUI’s and functiona lity being introduce d with thi s software release. These incl ude: | ||
3333 | A new Queu es Managem ent GUI th at will al low a user to view u nsolicited 278 Reque st receive d. Also al low the us er to sele ct a 278 R equest fro m the assi gned queue . | ||
3334 | A new 278 Request/Re sponse GUI that allo ws a user to view a selected 2 78 Request and Respo nd to it a fter a mas ter author ization re cord has b een create d. | ||
3335 | Legal, Cop yright, an d Other No tices | ||
3336 | This effor t is spons ored by an agency of the Unite d States G overnment. Neither t he United States Gov ernment no r any agen cy thereof , nor the contractor nor any o f its subc ontractors , nor any of their e mployees, makes any warranty, express or implied, or assumes any legal liability or respon sibility f or the acc uracy, com pleteness, or useful ness of an y informat ion, appar atus, prod uct, or pr ocess disc losed, or represents that its use would not infrin ge on priv ately owne d rights. Reference herein to any specif ic commerc ial produc t, process , or servi ce by trad e name, tr ademark, m anufacture r, or othe rwise does not neces sarily con stitute or imply its endorseme nt, recomm endation, or favorin g by the U nited Stat es Governm ent or any agency th ereof, or the contra ctor or an y of its s ubcontract ors. The v iews and o pinions of authors e xpressed h erein do n ot necessa rily state or reflec t those of the Unite d States G overnment or any age ncy thereo f. | ||
3337 | Purchased Components | ||
3338 | Not Applic able as th e contract or is not purchasing any new c omponents or softwar e. | ||
3339 | Defect Sou rce (TOP 5 ) | ||
3340 | Not Applic able as th e contract or is not purchasing any new c omponents or softwar e. | ||
3341 | User Class Character istics | ||
3342 | There are three exis ting user classes an d one new user class in the im plementati on of the new functi onality. | ||
3343 | Table 40 - User Clas s Characte ristics | ||
3344 | User Class | ||
3345 | Characteri stics | ||
3346 | Authorizat ion Clerk (user) | ||
3347 | This is th e existing user who is already trained i n the crea tion/updat ing of mas ter author ization. T hey are al ready prof icient in the use of the exist ing author ization in terfaces a nd will be trained o n the new interfaces . | ||
3348 | AAT Admini strator | ||
3349 | This is a new role a nd the use r will hav e the expe rtise of t he master authorizat ion system and will be respons ible for d ay to day management of the 27 8 Queues i nterface t o ensure t hat 278 Re quest do n ot remain in the que ue for exc essive per iods. | ||
3350 | This perso n will als o be respo nsible for maintaini ng the loc al Code (l ookup) tab les used b y the new interfaces . | ||
3351 | AAT EDI Ma nagement T eam | ||
3352 | This is an existing group that will be r esponsible for suppo rting and responding to AAT co nnectivity , AAT conn ectivity i ssues and EDI compli ance issue s. | ||
3353 | |||
3354 | They will monitor bo th the AAT /HCCH conn ection and the AAT/A AT connect ivity. | ||
3355 | Estimation | ||
3356 | Estimation points wi ll be requ ested upon approval of this RS D. | ||
3357 | |||
3358 | |||
3359 | Project So ftware Fun ctional Si ze and Siz e-Based Ef fort and D uration Es timate | ||
3360 | Applicatio n | ||
3361 | |||
3362 | Table 41 - EDI Estim ation Poin ts | ||
3363 | Item | ||
3364 | A | ||
3365 | B | ||
3366 | C | ||
3367 | D | ||
3368 | E | ||
3369 | Total | ||
3370 | Counted Fu nction Poi nts | ||
3371 | TBD | ||
3372 | TBD | ||
3373 | TBD | ||
3374 | TBD | ||
3375 | TBD | ||
3376 | TBD | ||
3377 | Estimated Scope Grow th | ||
3378 | TBD | ||
3379 | TBD | ||
3380 | TBD | ||
3381 | TBD | ||
3382 | TBD | ||
3383 | TBD | ||
3384 | Estimated Size at Re lease | ||
3385 | TBD | ||
3386 | TBD | ||
3387 | TBD | ||
3388 | TBD | ||
3389 | TBD | ||
3390 | TBD | ||
3391 | |||
3392 | Table 42 - EDI PC Si ze Based E ffort Esti mation | ||
3393 | Size-Based Effort Es timates | ||
3394 | Labor Hour s | ||
3395 | Probabilit y | ||
3396 | Low-Effort Estimate – With ind icated pro bability, project wi ll consume no more t han: | ||
3397 | TBD | ||
3398 | TBD | ||
3399 | High-Effor t Estimate – With in dicated pr obability, project w ill consum e no more than: | ||
3400 | TBD | ||
3401 | TBD | ||
3402 | |||
3403 | Table 43 - EDI PC Si zed Based Duration E stimates | ||
3404 | Size-Based Duration Estimates | ||
3405 | Work Days | ||
3406 | Probabilit y | ||
3407 | Low-Durati on Estimat e – With i ndicated p robability , project will consu me no more than: | ||
3408 | TBD | ||
3409 | TBD | ||
3410 | High-Durat ion Estima te -- With indicated probabili ty, projec t will con sume no mo re than: | ||
3411 | TBD | ||
3412 | TBD | ||
3413 | |||
3414 | |||
3415 | Approval S ignatures | ||
3416 | |||
3417 | |||
3418 | __________ __________ __________ __________ __________ ________ | ||
3419 | Signed:Dat e:Robert H uffmanVA B usiness Sp onsor and Integrated Project T eam (IPT) Co-ChairEl ectronic D ata Interc hange | ||
3420 | |||
3421 | |||
3422 | __________ __________ __________ __________ __________ ________Si gned:Date: Christan G ovichVA IT Program M anager (PM ) and Inte grated Pro ject Team (IPT) Co-C hairElectr onic Data Interchang e | ||
3423 | |||
3424 | |||
3425 | __________ __________ __________ __________ __________ ________Si gned:Date: William Kr immelVA Pr oject Mana ger (PjM)E lectronic Data Inter change | ||
3426 | |||
3427 | |||
3428 | |||
3429 | Appendix A – Use Cas e Specific ation | ||
3430 | The projec t has chos en not to employ use cases to express th e project' s requirem ents. | ||
3431 | Appendix B – Acronym List and Glossary | ||
3432 | In additio n to the a cronyms de fined belo w in Table 44, the O I&T Master Glossary can be fou nd athttp: // DNS /process/O IT%20Maste r%20Glossa ry/Home.as px | ||
3433 | Table 44 - Glossary | ||
3434 | Term | ||
3435 | Meaning | ||
3436 | 10-7078 au thorizatio n | ||
3437 | VA issued inpatient authorizat ion for me dical serv ices | ||
3438 | 10-7079 au thorizatio n | ||
3439 | VA issued outpatient authoriza tion for m edical ser vices | ||
3440 | 275 Attach ment | ||
3441 | ASC X12 27 5 Addition al Informa tion to Su pport a He alth Care Services R eview - Pr ovider use s the 275 EDI transa ctions to send reque sted infor mation abo ut a healt h care cla im or serv ices revie w. | ||
3442 | 276/277 He alth Care Claim Stat us Request and Respo nse | ||
3443 | A transact ion set fo r health c are claims , used to inquire ab out and re ceive info rmation ab out the pr ocessing s tatus of a claim | ||
3444 | 278 Health Care Serv ices Revie w | ||
3445 | An EDI tra nsaction t hat allows an author ized tradi ng partner to reques t and rece ive a resp onse on se rvices bei ng provide d for a pa tient. | ||
3446 | (Note: For GFY14, th is involve s receivin g an EDI c ompliant c opy of the existing master aut horization .) | ||
3447 | 835 Health Care Clai m Payment/ Remittance | ||
3448 | A transact ion set fo r health c are claim payment ad vice (or r emittance advice) - referred t o as a Rem ittance ad vice | ||
3449 | 837 Health Care Clai m Payment/ Advice | ||
3450 | A transact ion set fo r health c are claim payment ad vice (or r emittance advice) - referred t o as a Rem ittance ad vice | ||
3451 | AAA | ||
3452 | EDI error segments f or reporti ng errors encountere d during p rocessing | ||
3453 | AAT | ||
3454 | Automated Authorizat ion Tool = The compo nent of th e AAT that resides i n AITC and processes incoming 278 Health Care Serv ice Reques t, stores authorizat ions in th e 278 repo sitory and delivers 278 Respon ses to the HCCH. | ||
3455 | AAT GUI | ||
3456 | The interf ace that a llows a us er to view queued 27 8 EDI Requ est transa ctions, en ter/update services to be prov ided and d eliver the completed authoriza tion to AA T. | ||
3457 | AET | ||
3458 | Automated Eligibilit y Tool | ||
3459 | ANSI | ||
3460 | American N ational St andards In stitute | ||
3461 | ASC X12 | ||
3462 | The Accred ited Stand ards Commi ttee X12 – is an Ame rican Nati onal Stand ards Insti tute (ANSI )-accredit ed standar ds develop ment organ ization an d the enti ty respons ible for t he HIPAA t ransaction standards for elect ronic heal th care, e ligibility , claims p rocessing, claims st atus, auth orizations and remit tance tran sactions n amed by th e Health I nsurance A ccountabil ity and Po rtability Act of 199 6. The VA is current ly operati ng to vers ion 5010 s tandards. | ||
3463 | Authorizat ion | ||
3464 | A approval to perfor m medical services f or a patie nt | ||
3465 | Authorizat ion-Id | ||
3466 | Identifier assigned by the Vis tA System generating the Autho rization. | ||
3467 | BN | ||
3468 | Business N eed | ||
3469 | BRD | ||
3470 | Business R equirement s Document | ||
3471 | CAQH | ||
3472 | Council fo r Affordab le Quality Healthcar e | ||
3473 | CBO | ||
3474 | Chief Busi ness Offic e | ||
3475 | CBOPC | ||
3476 | Chief Busi ness Offic e Purchase d Care | ||
3477 | CHAMPUS | ||
3478 | Civilian H ealth and Medical Pr ogram of t he Uniform ed Service s | ||
3479 | CM | ||
3480 | Configurat ion Manage ment | ||
3481 | CMS | ||
3482 | Centers fo r Medicare & Medicai d Services | ||
3483 | CORE® | ||
3484 | The Commit tee on Ope rating Rul es for Inf ormation E xchange (C ORE®), is an multi-s takeholder initiativ e created, organized and facil itated by CAQH that is working to make i t easier f or physici ans and ho spitals to access el igibility, benefits and claim informatio n for thei r patients at the po int of car e. | ||
3485 | CPRS | ||
3486 | Computeriz ed Patient Record Sy stem | ||
3487 | CRD | ||
3488 | Chronic Re nal Diseas e | ||
3489 | Data eleme nt | ||
3490 | An EDI ter m that def ines the i ndividual components of an EDI segment | ||
3491 | DRP | ||
3492 | Disaster R ecovery Pl an | ||
3493 | EDI | ||
3494 | Electronic Data Inte rchange | ||
3495 | Emdeon | ||
3496 | Current VA Health Ca re Clearin g House | ||
3497 | EMF | ||
3498 | Enterprise Managemen t Foundati on | ||
3499 | ERR | ||
3500 | Enterprise Requireme nts Reposi tory | ||
3501 | FBCS | ||
3502 | Fee Basis Claims Sys tem | ||
3503 | FIPS | ||
3504 | Federal In formation Processing Standards | ||
3505 | FISMA | ||
3506 | Federal In formation Security M anagement Act | ||
3507 | GFY | ||
3508 | Government Fiscal Ye ar | ||
3509 | GRC | ||
3510 | Governance , Risk, an d Complian ce | ||
3511 | GUI | ||
3512 | Graphical User Inter face | ||
3513 | HAC | ||
3514 | Health Adm inistratio n Center | ||
3515 | HAPE | ||
3516 | Health Adm inistratio n Product Enhancemen ts | ||
3517 | HCCH | ||
3518 | Health Car e Clearing House | ||
3519 | HIC | ||
3520 | Health Ins urance Cla im | ||
3521 | HIN | ||
3522 | Health Ind ustry Numb er | ||
3523 | HIPAA | ||
3524 | Health Ins urance Por tability a nd Account ability Ac t | ||
3525 | HIPAA v. 5 010 | ||
3526 | HIPAA vers ion 5010 i s the newe st set of standards related to the elect ronic tran smission o f specific health ca re transac tions such as Health Care Clai ms, Eligib ility Inqu iry/Respon se, and He alth Care Claim Remi ttance Adv ice. | ||
3527 | HSD | ||
3528 | Health Car e Services Delivery | ||
3529 | HSPD-12 | ||
3530 | Homeland S ecurity Pr esidential Directive (12) | ||
3531 | IM | ||
3532 | Informatio n Manageme nt | ||
3533 | IPT | ||
3534 | Integrated Project T eam | ||
3535 | ISO | ||
3536 | Informatio n Security Officer | ||
3537 | IT | ||
3538 | Informatio n Technolo gy | ||
3539 | ITAM | ||
3540 | IT Asset M anagement | ||
3541 | Master Aut horization | ||
3542 | The curren t VistA Fe e authoriz ation (10- 7078 or 10 -7079), | ||
3543 | MUMPS | ||
3544 | Massachuse tts Genera l Hospital Utility M ulti-Progr amming Sys tem | ||
3545 | NAIC | ||
3546 | National A ssociation of Insura nce Commis sioners Co mpany Code | ||
3547 | NIST | ||
3548 | National I nstitute S tandards a nd Technol ogy | ||
3549 | NNPO | ||
3550 | National N on-VA Medi cal Care P rogram Off ice | ||
3551 | NSR | ||
3552 | New Servic e Request | ||
3553 | NVCC | ||
3554 | Non-VA Coo rdinated C are | ||
3555 | OCS | ||
3556 | Office of Cyber Secu rity | ||
3557 | OED | ||
3558 | Office of Enterprise Developme nt | ||
3559 | OI&T | ||
3560 | Office of Informatio n and Tech nology | ||
3561 | OMB | ||
3562 | Office of Management and Budge t | ||
3563 | Patient | ||
3564 | An individ ual receiv ing medica l services | ||
3565 | Patient-Id | ||
3566 | Unique pat ient ident ifier | ||
3567 | Payer | ||
3568 | An insuran ce company , fiscal i ntermediar y, Governm ent agency , other ag ency, or i ndividual responsibl e for the payment of health ca re claims. | ||
3569 | PC | ||
3570 | Purchased Care | ||
3571 | PD | ||
3572 | Product De velopment | ||
3573 | PHI | ||
3574 | Protected Health Inf ormation | ||
3575 | PIA | ||
3576 | Privacy Im pact Asses sment | ||
3577 | PjM | ||
3578 | Project Ma nager | ||
3579 | PM | ||
3580 | Program Ma nager | ||
3581 | PMAS | ||
3582 | Program Ma nagement A ccountabil ity System | ||
3583 | PPACA | ||
3584 | Patient Pr otection a nd Afforda ble Care A ct | ||
3585 | Provider | ||
3586 | A physicia n or medic al service s organiza tion who p rovided se rvices to a patient | ||
3587 | PTF | ||
3588 | Patient Tr eatment Fi le | ||
3589 | PWS | ||
3590 | Performanc e Work Sta tement | ||
3591 | RSD | ||
3592 | Requiremen ts Specifi cation Doc ument | ||
3593 | SA-CMMI | ||
3594 | Software A cquisition -Capabilit y Maturity Modeling Integratio n | ||
3595 | Segment | ||
3596 | A EDI term used to d efine a se t of data elements t hat make u p a syntac tically co rrect mess age string | ||
3597 | SEI | ||
3598 | Software E ngineering Institute | ||
3599 | Separation character | ||
3600 | An EDI ter m that def ines how d ata elemen ts will be separated in an EDI data segm ent | ||
3601 | SME | ||
3602 | Subject Ma tter Exper t | ||
3603 | SQA | ||
3604 | Software Q uality Ass urance | ||
3605 | Station-ID | ||
3606 | Unique ide ntifier as signed to each VistA system | ||
3607 | Subscriber | ||
3608 | An infidel who maint ains the i nsurance c overage | ||
3609 | T4 | ||
3610 | Transforma tion Twent y-One Tota l Technolo gy | ||
3611 | Terminatio n Characte r | ||
3612 | An EDI ter m that den otes the e nd of an E DI data se gment | ||
3613 | TO | ||
3614 | Task Order | ||
3615 | TRM | ||
3616 | Technical Reference Model | ||
3617 | TRN | ||
3618 | Trace Reas sociation Number | ||
3619 | UAK | ||
3620 | Unique-Aut horization -Key – Uni que Author ization Id entifier c onsisting of the | ||
3621 | Station-ID +Patient-I D+Autoriza tion-ID | ||
3622 | UMO | ||
3623 | An organiz ation that approves services t o be provi ded to a s ubscriber | ||
3624 | VA | ||
3625 | Department of Vetera ns Affairs | ||
3626 | VAMC | ||
3627 | VA Medical Center | ||
3628 | VHA | ||
3629 | Veterans H ealth Admi nistration | ||
3630 | VistA | ||
3631 | Veterans H ealth Info rmation Sy stems and Technology Architect ure | ||
3632 | VistA Fee | ||
3633 | A sub-syst em within VistA used to genera te and man age author izations f or Veteran s seeking care at a Non-VA fac ility. | ||
3634 | |||
3635 | |||
3636 | Appendix C – Sample 10-7078 Au thorizatio n | ||
3637 | |||
3638 | |||
3639 | |||
3640 | |||
3641 | |||
3642 | |||
3643 | Appendix D – Sample 10-7079 Au thorizatio n | ||
3644 | |||
3645 | |||
3646 | |||
3647 | |||
3648 | |||
3649 | |||
3650 | |||
3651 | |||
3652 | Appendix E – Sample Code Table s | ||
3653 | These are sample cod e tables o nly. Much of the con tent was t aken from the 278 TR 3 document s, but the y are not complete. Complete a nd actual code table s will be created an d populate d as neede d during d esign and developmen t. | ||
3654 | |||
3655 | KEY: | ||
3656 | ACTION = “ A” = Accep t value | ||
3657 | ACTION = F – Fatal e rror – gen erate erro r message | ||
3658 | ACTION = N OT – Not U sed | ||
3659 | ACTION = B lank – To be determi ned during developme nt | ||
3660 | Table 45 - Sample Co de Tables | ||
3661 | Loop | ||
3662 | Seg ID | ||
3663 | CODE | ||
3664 | Descriptio n | ||
3665 | RQST | ||
3666 | Action | ||
3667 | RSPNAction | ||
3668 | Exception/ Notes | ||
3669 | 2000A | ||
3670 | HL03 | ||
3671 | 20 | ||
3672 | Informatio n Source | ||
3673 | A | ||
3674 | A | ||
3675 | |||
3676 | 2000A | ||
3677 | HL04 | ||
3678 | 0 | ||
3679 | No Subordi nate HL Se gments in this Hiera rchical St ructure | ||
3680 | W | ||
3681 | NOT | ||
3682 | |||
3683 | 2000A | ||
3684 | HL04 | ||
3685 | 1 | ||
3686 | Additional Subordina te HL Data Segment i n this Hie rarchical Structure | ||
3687 | A | ||
3688 | A | ||
3689 | |||
3690 | 2000A | ||
3691 | NM101 | ||
3692 | PR | ||
3693 | Payer | ||
3694 | A | ||
3695 | A | ||
3696 | |||
3697 | 2000A | ||
3698 | NM101 | ||
3699 | X3 | ||
3700 | Utilizatio n Manageme nt Organiz ation | ||
3701 | W | ||
3702 | W | ||
3703 | |||
3704 | 2000A | ||
3705 | NM101 | ||
3706 | 2B | ||
3707 | Third Part y Administ rator | ||
3708 | F | ||
3709 | F | ||
3710 | |||
3711 | 2000A | ||
3712 | NM101 | ||
3713 | 36 | ||
3714 | Employer | ||
3715 | F | ||
3716 | F | ||
3717 | |||
3718 | 2000A | ||
3719 | NM102 | ||
3720 | 1 | ||
3721 | Person | ||
3722 | F | ||
3723 | F | ||
3724 | |||
3725 | 2000A | ||
3726 | NM102 | ||
3727 | 2 | ||
3728 | Non-Person Entity | ||
3729 | A | ||
3730 | A | ||
3731 | |||
3732 | 2000A | ||
3733 | NM108 | ||
3734 | PI | ||
3735 | Payer Iden tification | ||
3736 | A | ||
3737 | A | ||
3738 | |||
3739 | 2000A | ||
3740 | NM108 | ||
3741 | 24 | ||
3742 | Employer I dentificat ion Number | ||
3743 | F | ||
3744 | F | ||
3745 | |||
3746 | 2000A | ||
3747 | NM108 | ||
3748 | 34 | ||
3749 | Social Sec urity Numb er | ||
3750 | F | ||
3751 | F | ||
3752 | |||
3753 | 2000A | ||
3754 | NM108 | ||
3755 | 46 | ||
3756 | Electronic Transmitt er Identif ication Nu mber | ||
3757 | A | ||
3758 | A | ||
3759 | |||
3760 | 2000B | ||
3761 | HL04 | ||
3762 | 1 | ||
3763 | Additional Subordina te HL data segment | ||
3764 | A | ||
3765 | A | ||
3766 | |||
3767 | 2000C | ||
3768 | HL04 | ||
3769 | 0 | ||
3770 | No Subordi nate HL Se gment in T his Hierar chical Str ucture | ||
3771 | F | ||
3772 | F | ||
3773 | |||
3774 | 2000C | ||
3775 | HL04 | ||
3776 | 1 | ||
3777 | Additional Subordina te HL Data Segment i n This Hie rarchical Structure | ||
3778 | A | ||
3779 | A | ||
3780 | |||
3781 | 2000C | ||
3782 | INS08 | ||
3783 | AO | ||
3784 | Active Mil itary – Ov erseas | ||
3785 | A | ||
3786 | |||
3787 | |||
3788 | 2000C | ||
3789 | INS08 | ||
3790 | AU | ||
3791 | Active Mil itary – US A | ||
3792 | A | ||
3793 | |||
3794 | |||
3795 | 2000C | ||
3796 | INS08 | ||
3797 | DI | ||
3798 | Deceased | ||
3799 | A | ||
3800 | |||
3801 | |||
3802 | 2000C | ||
3803 | INS08 | ||
3804 | PV | ||
3805 | Previous | ||
3806 | A | ||
3807 | |||
3808 | |||
3809 | 2000C | ||
3810 | INS08 | ||
3811 | RU | ||
3812 | Retired Mi litary – U SA | ||
3813 | A | ||
3814 | |||
3815 | |||
3816 | 2000D | ||
3817 | HL04 | ||
3818 | 0 | ||
3819 | No Subordi nate HL Se gment in T his Hierar chical Str ucture | ||
3820 | F | ||
3821 | F | ||
3822 | |||
3823 | 2000D | ||
3824 | HL04 | ||
3825 | 1 | ||
3826 | Additional Subordina te HL Data Segment i n This Hie rarchical Structure | ||
3827 | A | ||
3828 | A | ||
3829 | |||
3830 | 2000D | ||
3831 | INS02 | ||
3832 | G8 | ||
3833 | Other Rela tionship | ||
3834 | A | ||
3835 | |||
3836 | |||
3837 | 2000D | ||
3838 | INS02 | ||
3839 | 01 | ||
3840 | Spouse | ||
3841 | A | ||
3842 | |||
3843 | |||
3844 | 2000D | ||
3845 | INS02 | ||
3846 | 19 | ||
3847 | Child | ||
3848 | A | ||
3849 | |||
3850 | |||
3851 | 2000E | ||
3852 | DTP01 | ||
3853 | ABC | ||
3854 | Estimated Date of Bi rth | ||
3855 | X217 | ||
3856 | |||
3857 | D8 – Certi fication r elated to estimated delivery d ate | ||
3858 | 2000E | ||
3859 | DTP01 | ||
3860 | AAH | ||
3861 | Event Date | ||
3862 | A | ||
3863 | BOTH | ||
3864 | A | ||
3865 | D8, RD8; f UM01=AR, Admit Date | ||
3866 | 2000E | ||
3867 | DTP01 | ||
3868 | 007 | ||
3869 | Certificat ion Effect ive Date | ||
3870 | W | ||
3871 | X215 | ||
3872 | W | ||
3873 | |||
3874 | 2000E | ||
3875 | DTP01 | ||
3876 | 036 | ||
3877 | Certificat ion Expira tion Date | ||
3878 | W | ||
3879 | X215 | ||
3880 | W | ||
3881 | |||
3882 | 2000E | ||
3883 | DTP01 | ||
3884 | 096 | ||
3885 | Discharge Date | ||
3886 | W | ||
3887 | BOTH | ||
3888 | W | ||
3889 | D8 | ||
3890 | 2000E | ||
3891 | DTP01 | ||
3892 | 102 | ||
3893 | Certificat ion Date | ||
3894 | W | ||
3895 | X215 | ||
3896 | W | ||
3897 | |||
3898 | 2000E | ||
3899 | DTP01 | ||
3900 | 431 | ||
3901 | Onset of C urrent Sym ptoms or I llness Dat e | ||
3902 | X217 | ||
3903 | |||
3904 | D8 – Onset of patien ts conditi on is diff erent from diagnosis data (not accident or pregnan cy related ) | ||
3905 | 2000E | ||
3906 | DTP01 | ||
3907 | 435 | ||
3908 | Admission Date | ||
3909 | W | ||
3910 | BOTH | ||
3911 | W | ||
3912 | D8, RD8 | ||
3913 | 2000E | ||
3914 | DTP01 | ||
3915 | 439 | ||
3916 | Accident D ate | ||
3917 | W | ||
3918 | BOTH | ||
3919 | W | ||
3920 | D8 | ||
3921 | 2000E | ||
3922 | DTP01 | ||
3923 | 484 | ||
3924 | Last Menst rual Perio d Date | ||
3925 | X217 | ||
3926 | |||
3927 | D8 -Requir ed when th e Certific ation is p regnancy r elated | ||
3928 | 2000E | ||
3929 | DTP01 | ||
3930 | 881 | ||
3931 | Request Da te | ||
3932 | W | ||
3933 | X215 | ||
3934 | W | ||
3935 | |||
3936 | 2000E | ||
3937 | DTP02 | ||
3938 | D8 | ||
3939 | Single Dat e | ||
3940 | A | ||
3941 | A | ||
3942 | CCYYMMDD | ||
3943 | 2000E | ||
3944 | DTP02 | ||
3945 | RD8 | ||
3946 | Data Range | ||
3947 | A | ||
3948 | A | ||
3949 | CCYYMMDD-C CYYMMDD | ||
3950 | 2000E | ||
3951 | HAD07 | ||
3952 | 2 | ||
3953 | 2nd Week o f the Mont h | ||
3954 | NOT | ||
3955 | A | ||
3956 | |||
3957 | 2000E | ||
3958 | HAD07 | ||
3959 | 3 | ||
3960 | 3rd Week o f Month | ||
3961 | NOT | ||
3962 | A | ||
3963 | |||
3964 | 2000E | ||
3965 | HAD07 | ||
3966 | 5 | ||
3967 | 5th Week o f Month | ||
3968 | NOT | ||
3969 | A | ||
3970 | |||
3971 | 2000E | ||
3972 | HCR01 | ||
3973 | A1 | ||
3974 | Certified in Total | ||
3975 | A | ||
3976 | A | ||
3977 | |||
3978 | 2000E | ||
3979 | HCR01 | ||
3980 | A2 | ||
3981 | Certified – partial | ||
3982 | A | ||
3983 | A | ||
3984 | |||
3985 | 2000E | ||
3986 | HCR01 | ||
3987 | A3 | ||
3988 | Not Certif ied | ||
3989 | A | ||
3990 | A | ||
3991 | |||
3992 | 2000E | ||
3993 | HCR01 | ||
3994 | A4 | ||
3995 | Pended | ||
3996 | A | ||
3997 | A | ||
3998 | |||
3999 | 2000E | ||
4000 | HCR01 | ||
4001 | A6 | ||
4002 | Modified | ||
4003 | A | ||
4004 | A | ||
4005 | |||
4006 | 2000E | ||
4007 | HCR01 | ||
4008 | C | ||
4009 | Cancelled | ||
4010 | A | ||
4011 | A | ||
4012 | |||
4013 | 2000E | ||
4014 | HCR01 | ||
4015 | CT | ||
4016 | Contact Pa yer | ||
4017 | A | ||
4018 | A | ||
4019 | |||
4020 | 2000E | ||
4021 | HCR01 | ||
4022 | NA | ||
4023 | No Action Required | ||
4024 | NOT | ||
4025 | A | ||
4026 | |||
4027 | 2000E | ||
4028 | HCR01 | ||
4029 | 51 | ||
4030 | Complete | ||
4031 | Default | ||
4032 | A | ||
4033 | |||
4034 | 2000E | ||
4035 | HCR01 | ||
4036 | 71 | ||
4037 | Term Expir ed | ||
4038 | A | ||
4039 | A | ||
4040 | |||
4041 | 2000E | ||
4042 | HL04 | ||
4043 | 0 | ||
4044 | No Subordi nate HL Se gment in T his Hierar chical Str ucture | ||
4045 | A | ||
4046 | A | ||
4047 | |||
4048 | 2000E | ||
4049 | HL04 | ||
4050 | 1 | ||
4051 | Additional Subordina te HL Data Segment i n This Hie rarchical Structure | ||
4052 | W | ||
4053 | W | ||
4054 | |||
4055 | 2000E | ||
4056 | HSD01 | ||
4057 | DY | ||
4058 | Days | ||
4059 | NOT | ||
4060 | A | ||
4061 | |||
4062 | 2000E | ||
4063 | HSD01 | ||
4064 | FL | ||
4065 | Units | ||
4066 | NOT | ||
4067 | A | ||
4068 | |||
4069 | 2000E | ||
4070 | HSD01 | ||
4071 | HS | ||
4072 | Hours | ||
4073 | NOT | ||
4074 | A | ||
4075 | |||
4076 | 2000E | ||
4077 | HSD01 | ||
4078 | MN | ||
4079 | Month | ||
4080 | NOT | ||
4081 | A | ||
4082 | |||
4083 | 2000E | ||
4084 | HSD01 | ||
4085 | VS | ||
4086 | Visits | ||
4087 | NOT | ||
4088 | A | ||
4089 | |||
4090 | 2000E | ||
4091 | HSD02 | ||
4092 | DA | ||
4093 | Days | ||
4094 | NOT | ||
4095 | A | ||
4096 | |||
4097 | 2000E | ||
4098 | HSD02 | ||
4099 | MO | ||
4100 | Months | ||
4101 | NOT | ||
4102 | A | ||
4103 | |||
4104 | 2000E | ||
4105 | HSD02 | ||
4106 | WK | ||
4107 | Week | ||
4108 | NOT | ||
4109 | A | ||
4110 | |||
4111 | 2000E | ||
4112 | HSD05 | ||
4113 | 6 | ||
4114 | Hour | ||
4115 | NOT | ||
4116 | A | ||
4117 | |||
4118 | 2000E | ||
4119 | HSD05 | ||
4120 | 6 | ||
4121 | Hour | ||
4122 | NOT | ||
4123 | A | ||
4124 | |||
4125 | 2000E | ||
4126 | HSD05 | ||
4127 | 7 | ||
4128 | Day | ||
4129 | NOT | ||
4130 | A | ||
4131 | |||
4132 | 2000E | ||
4133 | HSD05 | ||
4134 | 21 | ||
4135 | Years | ||
4136 | NOT | ||
4137 | A | ||
4138 | |||
4139 | 2000E | ||
4140 | HSD05 | ||
4141 | 26 | ||
4142 | Episode | ||
4143 | NOT | ||
4144 | A | ||
4145 | |||
4146 | 2000E | ||
4147 | HSD05 | ||
4148 | 27 | ||
4149 | Visit | ||
4150 | NOT | ||
4151 | A | ||
4152 | |||
4153 | 2000E | ||
4154 | HSD05 | ||
4155 | 29 | ||
4156 | Remaining | ||
4157 | NOT | ||
4158 | A | ||
4159 | |||
4160 | 2000E | ||
4161 | HSD05 | ||
4162 | 34 | ||
4163 | Month | ||
4164 | NOT | ||
4165 | A | ||
4166 | |||
4167 | 2000E | ||
4168 | HSD05 | ||
4169 | 35 | ||
4170 | Week | ||
4171 | NOT | ||
4172 | A | ||
4173 | |||
4174 | 2000E | ||
4175 | HSD07 | ||
4176 | A | ||
4177 | Monday thr ough Frida y | ||
4178 | NOT | ||
4179 | A | ||
4180 | |||
4181 | 2000E | ||
4182 | HSD07 | ||
4183 | B | ||
4184 | Monday thr ough Satur day | ||
4185 | NOT | ||
4186 | A | ||
4187 | |||
4188 | 2000E | ||
4189 | HSD07 | ||
4190 | C | ||
4191 | Monday thr ough Sunda y | ||
4192 | NOT | ||
4193 | A | ||
4194 | |||
4195 | 2000E | ||
4196 | HSD07 | ||
4197 | D | ||
4198 | Monday | ||
4199 | NOT | ||
4200 | A | ||
4201 | |||
4202 | 2000E | ||
4203 | HSD07 | ||
4204 | E | ||
4205 | Tuesday | ||
4206 | NOT | ||
4207 | A | ||
4208 | |||
4209 | 2000E | ||
4210 | HSD07 | ||
4211 | F | ||
4212 | Wednesday | ||
4213 | NOT | ||
4214 | A | ||
4215 | |||
4216 | 2000E | ||
4217 | HSD07 | ||
4218 | G | ||
4219 | Thursday | ||
4220 | NOT | ||
4221 | A | ||
4222 | |||
4223 | 2000E | ||
4224 | HSD07 | ||
4225 | H | ||
4226 | Friday | ||
4227 | NOT | ||
4228 | A | ||
4229 | |||
4230 | 2000E | ||
4231 | HSD07 | ||
4232 | J | ||
4233 | Saturday | ||
4234 | NOT | ||
4235 | A | ||
4236 | |||
4237 | 2000E | ||
4238 | HSD07 | ||
4239 | K | ||
4240 | Sunday | ||
4241 | NOT | ||
4242 | A | ||
4243 | |||
4244 | 2000E | ||
4245 | HSD07 | ||
4246 | L | ||
4247 | Monday thr ough Thurs day | ||
4248 | NOT | ||
4249 | A | ||
4250 | |||
4251 | 2000E | ||
4252 | HSD07 | ||
4253 | M | ||
4254 | Immediatel y | ||
4255 | NOT | ||
4256 | A | ||
4257 | |||
4258 | 2000E | ||
4259 | HSD07 | ||
4260 | N | ||
4261 | As directe d | ||
4262 | NOT | ||
4263 | A | ||
4264 | |||
4265 | 2000E | ||
4266 | HSD07 | ||
4267 | O | ||
4268 | Daily – Mo nday throu gh Friday | ||
4269 | NOT | ||
4270 | A | ||
4271 | |||
4272 | 2000E | ||
4273 | HSD07 | ||
4274 | P | ||
4275 | ½ Monday, ½ Thursday | ||
4276 | NOT | ||
4277 | A | ||
4278 | |||
4279 | 2000E | ||
4280 | HSD07 | ||
4281 | Q | ||
4282 | ½ Tuesday, ½ Thursda y | ||
4283 | NOT | ||
4284 | A | ||
4285 | |||
4286 | 2000E | ||
4287 | HSD07 | ||
4288 | R | ||
4289 | ½ Wednesda y, ½ Frida y | ||
4290 | NOT | ||
4291 | A | ||
4292 | |||
4293 | 2000E | ||
4294 | HSD07 | ||
4295 | SA | ||
4296 | Sunday, Mo nday, Thur sday, Frid ay, Saturd ay | ||
4297 | NOT | ||
4298 | A | ||
4299 | |||
4300 | 2000E | ||
4301 | HSD07 | ||
4302 | SB | ||
4303 | Tuesday th rough Satu rday | ||
4304 | NOT | ||
4305 | A | ||
4306 | |||
4307 | 2000E | ||
4308 | HSD07 | ||
4309 | SC | ||
4310 | Sunday, We dnesday, T hursday, F riday, Sat urday | ||
4311 | NOT | ||
4312 | A | ||
4313 | |||
4314 | 2000E | ||
4315 | HSD07 | ||
4316 | SD | ||
4317 | Monday, We dnesday, T hursday, F riday, Sat urday | ||
4318 | NOT | ||
4319 | A | ||
4320 | |||
4321 | 2000E | ||
4322 | HSD07 | ||
4323 | SG | ||
4324 | Tuesday th rough Frid ay | ||
4325 | NOT | ||
4326 | A | ||
4327 | |||
4328 | 2000E | ||
4329 | HSD07 | ||
4330 | SL | ||
4331 | Monday, Tu esday, Thu rsday | ||
4332 | NOT | ||
4333 | A | ||
4334 | |||
4335 | 2000E | ||
4336 | HSD07 | ||
4337 | SP | ||
4338 | Monday, Tu esday, Fri day | ||
4339 | NOT | ||
4340 | A | ||
4341 | |||
4342 | 2000E | ||
4343 | HSD07 | ||
4344 | SX | ||
4345 | Wednesday and Thursd ay | ||
4346 | NOT | ||
4347 | A | ||
4348 | |||
4349 | 2000E | ||
4350 | HSD07 | ||
4351 | SY | ||
4352 | Monday, We dnesday, T hursday | ||
4353 | NOT | ||
4354 | A | ||
4355 | |||
4356 | 2000E | ||
4357 | HSD07 | ||
4358 | T | ||
4359 | ½ Tuesday, ½ Friday | ||
4360 | NOT | ||
4361 | A | ||
4362 | |||
4363 | 2000E | ||
4364 | HSD07 | ||
4365 | U | ||
4366 | ½ Monday, ½ Wednesda y | ||
4367 | NOT | ||
4368 | A | ||
4369 | |||
4370 | 2000E | ||
4371 | HSD07 | ||
4372 | V | ||
4373 | 1/3 Monday , 1/3 Wedn esday, 1/3 Friday | ||
4374 | NOT | ||
4375 | A | ||
4376 | |||
4377 | 2000E | ||
4378 | HSD07 | ||
4379 | W | ||
4380 | Whenever N ecessary | ||
4381 | NOT | ||
4382 | A | ||
4383 | |||
4384 | 2000E | ||
4385 | HSD07 | ||
4386 | WE | ||
4387 | Weekend | ||
4388 | NOT | ||
4389 | A | ||
4390 | |||
4391 | 2000E | ||
4392 | HSD07 | ||
4393 | X | ||
4394 | ½ by Wedne sday, Bala nce by Fri day | ||
4395 | NOT | ||
4396 | A | ||
4397 | |||
4398 | 2000E | ||
4399 | HSD07 | ||
4400 | Y | ||
4401 | None | ||
4402 | NOT | ||
4403 | A | ||
4404 | Also used to Cancel or Overrid e previous instructi ons | ||
4405 | 2000E | ||
4406 | HSD07 | ||
4407 | 1 | ||
4408 | 1st Week o f the Mont h | ||
4409 | NOT | ||
4410 | A | ||
4411 | |||
4412 | 2000E | ||
4413 | HSD07 | ||
4414 | 4 | ||
4415 | 4th Week o f Month | ||
4416 | NOT | ||
4417 | A | ||
4418 | |||
4419 | 2000E | ||
4420 | HSD07 | ||
4421 | 6 | ||
4422 | 1st and 3r d Week of the Month | ||
4423 | NOT | ||
4424 | A | ||
4425 | |||
4426 | 2000E | ||
4427 | HSD07 | ||
4428 | 7 | ||
4429 | 2nd and 4t h Week of the Month | ||
4430 | NOT | ||
4431 | A | ||
4432 | |||
4433 | 2000E | ||
4434 | HSD07 | ||
4435 | 8 | ||
4436 | 1st Workin g Day of P eriod | ||
4437 | NOT | ||
4438 | A | ||
4439 | |||
4440 | 2000E | ||
4441 | HSD07 | ||
4442 | 9 | ||
4443 | Last Worki ng Day of the Month | ||
4444 | NOT | ||
4445 | A | ||
4446 | |||
4447 | 2000E | ||
4448 | HSD08 | ||
4449 | A | ||
4450 | 1st Shift (Normal Wo rking Hour s) | ||
4451 | NOT | ||
4452 | A | ||
4453 | |||
4454 | 2000E | ||
4455 | HSD08 | ||
4456 | B | ||
4457 | 2nd Shift | ||
4458 | NOT | ||
4459 | A | ||
4460 | |||
4461 | 2000E | ||
4462 | HSD08 | ||
4463 | C | ||
4464 | 3rd Shift | ||
4465 | NOT | ||
4466 | A | ||
4467 | |||
4468 | 2000E | ||
4469 | HSD08 | ||
4470 | D | ||
4471 | A.M. | ||
4472 | NOT | ||
4473 | A | ||
4474 | |||
4475 | 2000E | ||
4476 | HSD08 | ||
4477 | E | ||
4478 | P.M. | ||
4479 | NOT | ||
4480 | A | ||
4481 | |||
4482 | 2000E | ||
4483 | HSD08 | ||
4484 | F | ||
4485 | As Directe d | ||
4486 | NOT | ||
4487 | A | ||
4488 | |||
4489 | 2000E | ||
4490 | HSD08 | ||
4491 | G | ||
4492 | Any Shift | ||
4493 | NOT | ||
4494 | A | ||
4495 | |||
4496 | 2000E | ||
4497 | HSD08 | ||
4498 | Y | ||
4499 | None | ||
4500 | NOT | ||
4501 | A | ||
4502 | Also used to Cancel or Overrid e previous instructi ons | ||
4503 | 2000E | ||
4504 | REF01 | ||
4505 | BB | ||
4506 | Authorizat ion Number | ||
4507 | A | ||
4508 | A | ||
4509 | |||
4510 | 2000E | ||
4511 | REF01 | ||
4512 | NT | ||
4513 | Administra tor’s Refe rence Numb er | ||
4514 | A | ||
4515 | A | ||
4516 | |||
4517 | 2000E | ||
4518 | UM01 | ||
4519 | AR | ||
4520 | Admission Review | ||
4521 | F | ||
4522 | F | ||
4523 | |||
4524 | 2000E | ||
4525 | UM01 | ||
4526 | HS | ||
4527 | Health Ser vices Revi ew | ||
4528 | A | ||
4529 | A | ||
4530 | |||
4531 | 2000E | ||
4532 | UM01 | ||
4533 | IN | ||
4534 | Individual | ||
4535 | F | ||
4536 | F | ||
4537 | |||
4538 | 2000E | ||
4539 | UM01 | ||
4540 | SC | ||
4541 | Specialty Care Revie w | ||
4542 | F | ||
4543 | F | ||
4544 | |||
4545 | 2000E | ||
4546 | UM02 | ||
4547 | I | ||
4548 | Initial | ||
4549 | A | ||
4550 | A | ||
4551 | |||
4552 | 2000E | ||
4553 | UM02 | ||
4554 | N | ||
4555 | Reconsider | ||
4556 | F | ||
4557 | F | ||
4558 | |||
4559 | 2000E | ||
4560 | UM02 | ||
4561 | R | ||
4562 | Renewal | ||
4563 | R | ||
4564 | R | ||
4565 | |||
4566 | 2000E | ||
4567 | UM02 | ||
4568 | S | ||
4569 | Revised | ||
4570 | W | ||
4571 | W | ||
4572 | |||
4573 | 2000E | ||
4574 | UM02 | ||
4575 | 1 | ||
4576 | Appeal – I mmediate | ||
4577 | F | ||
4578 | F | ||
4579 | |||
4580 | 2000E | ||
4581 | UM02 | ||
4582 | 2 | ||
4583 | Appeal – S tandard | ||
4584 | F | ||
4585 | F | ||
4586 | |||
4587 | 2000E | ||
4588 | UM02 | ||
4589 | 3 | ||
4590 | Cancel | ||
4591 | F | ||
4592 | F | ||
4593 | |||
4594 | 2000E | ||
4595 | UM02 | ||
4596 | 4 | ||
4597 | Extension | ||
4598 | F | ||
4599 | F | ||
4600 | |||
4601 | 2000E | ||
4602 | UM03 | ||
4603 | A4 | ||
4604 | Psychiatri c | ||
4605 | |||
4606 | |||
4607 | |||
4608 | 2000E | ||
4609 | UM03 | ||
4610 | A6 | ||
4611 | Psychother apy | ||
4612 | |||
4613 | |||
4614 | |||
4615 | 2000E | ||
4616 | UM03 | ||
4617 | A9 | ||
4618 | Rehabilita tion | ||
4619 | |||
4620 | |||
4621 | |||
4622 | 2000E | ||
4623 | UM03 | ||
4624 | AD | ||
4625 | Occupation al Therapy | ||
4626 | |||
4627 | |||
4628 | |||
4629 | 2000E | ||
4630 | UM03 | ||
4631 | AE | ||
4632 | Physical M edicine | ||
4633 | |||
4634 | |||
4635 | |||
4636 | 2000E | ||
4637 | UM03 | ||
4638 | AF | ||
4639 | Speech The rapy | ||
4640 | |||
4641 | |||
4642 | |||
4643 | 2000E | ||
4644 | UM03 | ||
4645 | AG | ||
4646 | Skilled Nu rsing Care | ||
4647 | |||
4648 | |||
4649 | |||
4650 | 2000E | ||
4651 | UM03 | ||
4652 | AI | ||
4653 | Substance Abuse | ||
4654 | |||
4655 | |||
4656 | |||
4657 | 2000E | ||
4658 | UM03 | ||
4659 | AJ | ||
4660 | Alcoholism | ||
4661 | |||
4662 | |||
4663 | |||
4664 | 2000E | ||
4665 | UM03 | ||
4666 | AK | ||
4667 | Drug Addic tion | ||
4668 | |||
4669 | |||
4670 | |||
4671 | 2000E | ||
4672 | UM03 | ||
4673 | AL | ||
4674 | Vision (Op tometry) | ||
4675 | |||
4676 | |||
4677 | |||
4678 | 2000E | ||
4679 | UM03 | ||
4680 | AR | ||
4681 | Experiment al Drug Th erapy | ||
4682 | |||
4683 | |||
4684 | |||
4685 | 2000E | ||
4686 | UM03 | ||
4687 | B1 | ||
4688 | Burn Care | ||
4689 | |||
4690 | |||
4691 | |||
4692 | 2000E | ||
4693 | UM03 | ||
4694 | BB | ||
4695 | Partial Ho spitalizat ion (Psych iatric) | ||
4696 | |||
4697 | |||
4698 | |||
4699 | 2000E | ||
4700 | UM03 | ||
4701 | BC | ||
4702 | Day Care ( Psychiatri c) | ||
4703 | |||
4704 | |||
4705 | |||
4706 | 2000E | ||
4707 | UM03 | ||
4708 | BD | ||
4709 | Cognitive Therapy | ||
4710 | |||
4711 | |||
4712 | |||
4713 | 2000E | ||
4714 | UM03 | ||
4715 | BE | ||
4716 | Massage Th erapy | ||
4717 | |||
4718 | |||
4719 | |||
4720 | 2000E | ||
4721 | UM03 | ||
4722 | BG | ||
4723 | Cardiac Re habilitati on | ||
4724 | |||
4725 | |||
4726 | |||
4727 | 2000E | ||
4728 | UM03 | ||
4729 | BL | ||
4730 | Cardiac | ||
4731 | |||
4732 | |||
4733 | |||
4734 | 2000E | ||
4735 | UM03 | ||
4736 | BN | ||
4737 | Gastrointe stinal | ||
4738 | |||
4739 | |||
4740 | |||
4741 | 2000E | ||
4742 | UM03 | ||
4743 | BP | ||
4744 | Endocrine | ||
4745 | |||
4746 | |||
4747 | |||
4748 | 2000E | ||
4749 | UM03 | ||
4750 | BQ | ||
4751 | Neurology | ||
4752 | |||
4753 | |||
4754 | |||
4755 | 2000E | ||
4756 | UM03 | ||
4757 | BS | ||
4758 | Invasive P rocedures | ||
4759 | |||
4760 | |||
4761 | |||
4762 | 2000E | ||
4763 | UM03 | ||
4764 | BY | ||
4765 | Physician Visit – Of fice: Sick | ||
4766 | |||
4767 | |||
4768 | |||
4769 | 2000E | ||
4770 | UM03 | ||
4771 | BZ | ||
4772 | Physician Visit – Of fice: Well | ||
4773 | |||
4774 | |||
4775 | |||
4776 | 2000E | ||
4777 | UM03 | ||
4778 | C1 | ||
4779 | Coronary C are | ||
4780 | |||
4781 | |||
4782 | |||
4783 | 2000E | ||
4784 | UM03 | ||
4785 | CQ | ||
4786 | Case Manag ement | ||
4787 | |||
4788 | |||
4789 | |||
4790 | 2000E | ||
4791 | UM03 | ||
4792 | GY | ||
4793 | Allergy | ||
4794 | |||
4795 | |||
4796 | |||
4797 | 2000E | ||
4798 | UM03 | ||
4799 | IC | ||
4800 | Intensive Care | ||
4801 | |||
4802 | |||
4803 | |||
4804 | 2000E | ||
4805 | UM03 | ||
4806 | MH | ||
4807 | Mental Hea lth | ||
4808 | |||
4809 | |||
4810 | |||
4811 | 2000E | ||
4812 | UM03 | ||
4813 | NI | ||
4814 | Neonatal I ntensive C are | ||
4815 | |||
4816 | |||
4817 | |||
4818 | 2000E | ||
4819 | UM03 | ||
4820 | ON | ||
4821 | Oncology | ||
4822 | |||
4823 | |||
4824 | |||
4825 | 2000E | ||
4826 | UM03 | ||
4827 | PT | ||
4828 | Physical T herapy | ||
4829 | |||
4830 | |||
4831 | |||
4832 | 2000E | ||
4833 | UM03 | ||
4834 | PU | ||
4835 | Pulmonary | ||
4836 | |||
4837 | |||
4838 | |||
4839 | 2000E | ||
4840 | UM03 | ||
4841 | RN | ||
4842 | Renal | ||
4843 | |||
4844 | |||
4845 | |||
4846 | 2000E | ||
4847 | UM03 | ||
4848 | RT | ||
4849 | Residentia l Psychiat ric Treatm ent | ||
4850 | |||
4851 | |||
4852 | |||
4853 | 2000E | ||
4854 | UM03 | ||
4855 | TC | ||
4856 | Transition al Care | ||
4857 | |||
4858 | |||
4859 | |||
4860 | 2000E | ||
4861 | UM03 | ||
4862 | TN | ||
4863 | Transition al Nursery Care | ||
4864 | |||
4865 | |||
4866 | |||
4867 | 2000E | ||
4868 | UM03 | ||
4869 | 1 | ||
4870 | Medical Ca re | ||
4871 | A | ||
4872 | A | ||
4873 | |||
4874 | 2000E | ||
4875 | UM03 | ||
4876 | 2 | ||
4877 | Surgical | ||
4878 | |||
4879 | |||
4880 | |||
4881 | 2000E | ||
4882 | UM03 | ||
4883 | 3 | ||
4884 | Consultati on | ||
4885 | |||
4886 | |||
4887 | |||
4888 | 2000E | ||
4889 | UM03 | ||
4890 | 4 | ||
4891 | Diagnostic X-Ray | ||
4892 | |||
4893 | |||
4894 | |||
4895 | 2000E | ||
4896 | UM03 | ||
4897 | 5 | ||
4898 | Diagnostic Lab | ||
4899 | |||
4900 | |||
4901 | |||
4902 | 2000E | ||
4903 | UM03 | ||
4904 | 6 | ||
4905 | Radiation Therapy | ||
4906 | |||
4907 | |||
4908 | |||
4909 | 2000E | ||
4910 | UM03 | ||
4911 | 7 | ||
4912 | Anesthesia | ||
4913 | |||
4914 | |||
4915 | |||
4916 | 2000E | ||
4917 | UM03 | ||
4918 | 8 | ||
4919 | Surgical A ssistance | ||
4920 | |||
4921 | |||
4922 | |||
4923 | 2000E | ||
4924 | UM03 | ||
4925 | 11 | ||
4926 | Used Durab le Medical Equipment | ||
4927 | |||
4928 | |||
4929 | |||
4930 | 2000E | ||
4931 | UM03 | ||
4932 | 12 | ||
4933 | Durable Me dical Equi pment Purc hase | ||
4934 | |||
4935 | |||
4936 | |||
4937 | 2000E | ||
4938 | UM03 | ||
4939 | 14 | ||
4940 | Rental Sup plies in H ome | ||
4941 | |||
4942 | |||
4943 | |||
4944 | 2000E | ||
4945 | UM03 | ||
4946 | 15 | ||
4947 | Alternate Method Dia lysis | ||
4948 | |||
4949 | |||
4950 | |||
4951 | 2000E | ||
4952 | UM03 | ||
4953 | 16 | ||
4954 | Chronic Re nal Diseas e (CRD) Eq uipment | ||
4955 | |||
4956 | |||
4957 | |||
4958 | 2000E | ||
4959 | UM03 | ||
4960 | 17 | ||
4961 | Pre-Admiss ion Testin g | ||
4962 | |||
4963 | |||
4964 | |||
4965 | 2000E | ||
4966 | UM03 | ||
4967 | 18 | ||
4968 | Durable Me dical Equi pment Rent al | ||
4969 | |||
4970 | |||
4971 | |||
4972 | 2000E | ||
4973 | UM03 | ||
4974 | 20 | ||
4975 | Second Sur gical Opin ion | ||
4976 | |||
4977 | |||
4978 | |||
4979 | 2000E | ||
4980 | UM03 | ||
4981 | 21 | ||
4982 | Third Surg ical Opini on | ||
4983 | |||
4984 | |||
4985 | |||
4986 | 2000E | ||
4987 | UM03 | ||
4988 | 23 | ||
4989 | Diagnostic Dental | ||
4990 | |||
4991 | |||
4992 | |||
4993 | 2000E | ||
4994 | UM03 | ||
4995 | 24 | ||
4996 | Periodonti cs | ||
4997 | |||
4998 | |||
4999 | |||
5000 | 2000E | ||
5001 | UM03 | ||
5002 | 25 | ||
5003 | Restorativ e (Dental) | ||
5004 | |||
5005 | |||
5006 | |||
5007 | 2000E | ||
5008 | UM03 | ||
5009 | 26 | ||
5010 | Endodontic s | ||
5011 | |||
5012 | |||
5013 | |||
5014 | 2000E | ||
5015 | UM03 | ||
5016 | 27 | ||
5017 | Maxillofac ial Prosth etics | ||
5018 | |||
5019 | |||
5020 | |||
5021 | 2000E | ||
5022 | UM03 | ||
5023 | 28 | ||
5024 | Adjunctive Dental | ||
5025 | |||
5026 | |||
5027 | |||
5028 | 2000E | ||
5029 | UM03 | ||
5030 | 33 | ||
5031 | Chiropract ic | ||
5032 | |||
5033 | |||
5034 | |||
5035 | 2000E | ||
5036 | UM03 | ||
5037 | 35 | ||
5038 | Dental Car e | ||
5039 | |||
5040 | |||
5041 | |||
5042 | 2000E | ||
5043 | UM03 | ||
5044 | 36 | ||
5045 | Dental Cro wns | ||
5046 | |||
5047 | |||
5048 | |||
5049 | 2000E | ||
5050 | UM03 | ||
5051 | 37 | ||
5052 | Dental Acc ident | ||
5053 | |||
5054 | |||
5055 | |||
5056 | 2000E | ||
5057 | UM03 | ||
5058 | 38 | ||
5059 | Orthodonti cs | ||
5060 | |||
5061 | |||
5062 | |||
5063 | 2000E | ||
5064 | UM03 | ||
5065 | 39 | ||
5066 | Prosthodon tics | ||
5067 | |||
5068 | |||
5069 | |||
5070 | 2000E | ||
5071 | UM03 | ||
5072 | 40 | ||
5073 | Oral Surge ry | ||
5074 | |||
5075 | |||
5076 | |||
5077 | 2000E | ||
5078 | UM03 | ||
5079 | 42 | ||
5080 | Home Healt h Care | ||
5081 | |||
5082 | |||
5083 | |||
5084 | 2000E | ||
5085 | UM03 | ||
5086 | 44 | ||
5087 | Home Healt h Visits | ||
5088 | |||
5089 | |||
5090 | |||
5091 | 2000E | ||
5092 | UM03 | ||
5093 | 45 | ||
5094 | Hospice | ||
5095 | |||
5096 | |||
5097 | |||
5098 | 2000E | ||
5099 | UM03 | ||
5100 | 46 | ||
5101 | Respite Ca re | ||
5102 | |||
5103 | |||
5104 | |||
5105 | 2000E | ||
5106 | UM03 | ||
5107 | 54 | ||
5108 | Long Term Care | ||
5109 | |||
5110 | |||
5111 | |||
5112 | 2000E | ||
5113 | UM03 | ||
5114 | 56 | ||
5115 | Medically Related Tr ansportati on | ||
5116 | |||
5117 | |||
5118 | |||
5119 | 2000E | ||
5120 | UM03 | ||
5121 | 61 | ||
5122 | In-vitro F ertilizati on | ||
5123 | |||
5124 | |||
5125 | |||
5126 | 2000E | ||
5127 | UM03 | ||
5128 | 62 | ||
5129 | MRI/CAT Sc an | ||
5130 | |||
5131 | |||
5132 | |||
5133 | 2000E | ||
5134 | UM03 | ||
5135 | 63 | ||
5136 | Donor Proc edure | ||
5137 | |||
5138 | |||
5139 | |||
5140 | 2000E | ||
5141 | UM03 | ||
5142 | 64 | ||
5143 | Acupunctur e | ||
5144 | |||
5145 | |||
5146 | |||
5147 | 2000E | ||
5148 | UM03 | ||
5149 | 65 | ||
5150 | Newborn Ca re | ||
5151 | |||
5152 | |||
5153 | |||
5154 | 2000E | ||
5155 | UM03 | ||
5156 | 66 | ||
5157 | Pathology | ||
5158 | |||
5159 | |||
5160 | |||
5161 | 2000E | ||
5162 | UM03 | ||
5163 | 67 | ||
5164 | Smoking Ce ssation | ||
5165 | |||
5166 | |||
5167 | |||
5168 | 2000E | ||
5169 | UM03 | ||
5170 | 68 | ||
5171 | Well Baby Care | ||
5172 | |||
5173 | |||
5174 | |||
5175 | 2000E | ||
5176 | UM03 | ||
5177 | 69 | ||
5178 | Maternity | ||
5179 | |||
5180 | |||
5181 | |||
5182 | 2000E | ||
5183 | UM03 | ||
5184 | 70 | ||
5185 | Transplant s | ||
5186 | |||
5187 | |||
5188 | |||
5189 | 2000E | ||
5190 | UM03 | ||
5191 | 71 | ||
5192 | Audiology Exams | ||
5193 | |||
5194 | |||
5195 | |||
5196 | 2000E | ||
5197 | UM03 | ||
5198 | 72 | ||
5199 | Inhalation Therapy | ||
5200 | |||
5201 | |||
5202 | |||
5203 | 2000E | ||
5204 | UM03 | ||
5205 | 73 | ||
5206 | Diagnostic Medical | ||
5207 | |||
5208 | |||
5209 | |||
5210 | 2000E | ||
5211 | UM03 | ||
5212 | 74 | ||
5213 | Private Du ty Nursing | ||
5214 | |||
5215 | |||
5216 | |||
5217 | 2000E | ||
5218 | UM03 | ||
5219 | 75 | ||
5220 | Prosthetic Device | ||
5221 | |||
5222 | |||
5223 | |||
5224 | 2000E | ||
5225 | UM03 | ||
5226 | 76 | ||
5227 | Dialysis | ||
5228 | |||
5229 | |||
5230 | |||
5231 | 2000E | ||
5232 | UM03 | ||
5233 | 77 | ||
5234 | Ontologica l Exam | ||
5235 | |||
5236 | |||
5237 | |||
5238 | 2000E | ||
5239 | UM03 | ||
5240 | 78 | ||
5241 | Chemothera py | ||
5242 | |||
5243 | |||
5244 | |||
5245 | 2000E | ||
5246 | UM03 | ||
5247 | 79 | ||
5248 | Allergy Te sting | ||
5249 | |||
5250 | |||
5251 | |||
5252 | 2000E | ||
5253 | UM03 | ||
5254 | 80 | ||
5255 | Immunizati on | ||
5256 | |||
5257 | |||
5258 | |||
5259 | 2000E | ||
5260 | UM03 | ||
5261 | 82 | ||
5262 | Family Pla nning | ||
5263 | |||
5264 | |||
5265 | |||
5266 | 2000E | ||
5267 | UM03 | ||
5268 | 83 | ||
5269 | Infertilit y | ||
5270 | |||
5271 | |||
5272 | |||
5273 | 2000E | ||
5274 | UM03 | ||
5275 | 84 | ||
5276 | Abortion | ||
5277 | |||
5278 | |||
5279 | |||
5280 | 2000E | ||
5281 | UM03 | ||
5282 | 85 | ||
5283 | AIDS | ||
5284 | |||
5285 | |||
5286 | |||
5287 | 2000E | ||
5288 | UM03 | ||
5289 | 86 | ||
5290 | Emergency Services | ||
5291 | |||
5292 | |||
5293 | |||
5294 | 2000E | ||
5295 | UM03 | ||
5296 | 87 | ||
5297 | Cancer | ||
5298 | |||
5299 | |||
5300 | |||
5301 | 2000E | ||
5302 | UM03 | ||
5303 | 88 | ||
5304 | Pharmacy | ||
5305 | |||
5306 | |||
5307 | |||
5308 | 2000E | ||
5309 | UM03 | ||
5310 | 93 | ||
5311 | Podiatry | ||
5312 | |||
5313 | |||
5314 | |||
5315 | 2000E | ||
5316 | UM06 | ||
5317 | E | ||
5318 | Elective | ||
5319 | |||
5320 | |||
5321 | |||
5322 | 2000E | ||
5323 | UM06 | ||
5324 | U | ||
5325 | Urgent | ||
5326 | |||
5327 | |||
5328 | |||
5329 | 2000E | ||
5330 | UM06 | ||
5331 | 03 | ||
5332 | Emergency | ||
5333 | |||
5334 | |||
5335 | |||
5336 | 2000E | ||
5337 | UM07 | ||
5338 | E | ||
5339 | Excellent | ||
5340 | |||
5341 | |||
5342 | |||
5343 | 2000E | ||
5344 | UM07 | ||
5345 | F | ||
5346 | Fair | ||
5347 | |||
5348 | |||
5349 | |||
5350 | 2000E | ||
5351 | UM07 | ||
5352 | G | ||
5353 | Good | ||
5354 | |||
5355 | |||
5356 | |||
5357 | 2000E | ||
5358 | UM07 | ||
5359 | P | ||
5360 | Poor | ||
5361 | |||
5362 | |||
5363 | |||
5364 | 2000E | ||
5365 | UM07 | ||
5366 | 1 | ||
5367 | Acute | ||
5368 | |||
5369 | |||
5370 | |||
5371 | 2000E | ||
5372 | UM07 | ||
5373 | 2 | ||
5374 | Stable | ||
5375 | |||
5376 | |||
5377 | |||
5378 | 2000E | ||
5379 | UM07 | ||
5380 | 3 | ||
5381 | Chronic | ||
5382 | |||
5383 | |||
5384 | |||
5385 | 2000E | ||
5386 | UM07 | ||
5387 | 4 | ||
5388 | Systemic | ||
5389 | |||
5390 | |||
5391 | |||
5392 | 2000E | ||
5393 | UM07 | ||
5394 | 5 | ||
5395 | Localized | ||
5396 | |||
5397 | |||
5398 | |||
5399 | 2000E | ||
5400 | UM07 | ||
5401 | 6 | ||
5402 | Mild Disea se | ||
5403 | |||
5404 | |||
5405 | |||
5406 | 2000E | ||
5407 | UM07 | ||
5408 | 7 | ||
5409 | Normal, He althy | ||
5410 | |||
5411 | |||
5412 | |||
5413 | 2000E | ||
5414 | UM07 | ||
5415 | 8 | ||
5416 | Severe Sys temic Dise ase | ||
5417 | |||
5418 | |||
5419 | |||
5420 | 2000E | ||
5421 | UM07 | ||
5422 | 9 | ||
5423 | Severe Sys temic Dise ase that i s a Consta nt Threat to Life | ||
5424 | |||
5425 | |||
5426 | |||
5427 | 2000E | ||
5428 | UM08 | ||
5429 | 1 | ||
5430 | Poor | ||
5431 | |||
5432 | |||
5433 | |||
5434 | 2000E | ||
5435 | UM08 | ||
5436 | 2 | ||
5437 | Guarded | ||
5438 | |||
5439 | |||
5440 | |||
5441 | 2000E | ||
5442 | UM08 | ||
5443 | 3 | ||
5444 | Fair | ||
5445 | |||
5446 | |||
5447 | |||
5448 | 2000E | ||
5449 | UM08 | ||
5450 | 4 | ||
5451 | Good | ||
5452 | |||
5453 | |||
5454 | |||
5455 | 2000E | ||
5456 | UM08 | ||
5457 | 5 | ||
5458 | Very Good | ||
5459 | |||
5460 | |||
5461 | |||
5462 | 2000E | ||
5463 | UM08 | ||
5464 | 6 | ||
5465 | Excellent | ||
5466 | |||
5467 | |||
5468 | |||
5469 | 2000E | ||
5470 | UM08 | ||
5471 | 7 | ||
5472 | Less than 6 months t o Live | ||
5473 | |||
5474 | |||
5475 | |||
5476 | 2000E | ||
5477 | UM08 | ||
5478 | 8 | ||
5479 | Terminal | ||
5480 | |||
5481 | |||
5482 | |||
5483 | 2000E | ||
5484 | UM09 | ||
5485 | M | ||
5486 | The Provid er has Lim ited or Re stricted A bility to Release Da ta Related to a Clai m | ||
5487 | |||
5488 | |||
5489 | |||
5490 | 2000E | ||
5491 | UM09 | ||
5492 | Y | ||
5493 | Yes, Provi der has a Signed Sta tement Per mitting Re lease of M edical Bil ling Data Related to a Claim | ||
5494 | |||
5495 | |||
5496 | |||
5497 | 2000E | ||
5498 | UM10 | ||
5499 | 1 | ||
5500 | Proof of E ligibility Unknown o r Unavaila ble | ||
5501 | |||
5502 | |||
5503 | |||
5504 | 2000E | ||
5505 | UM10 | ||
5506 | 2 | ||
5507 | Litigation | ||
5508 | |||
5509 | |||
5510 | |||
5511 | 2000E | ||
5512 | UM10 | ||
5513 | 3 | ||
5514 | Authorizat ion Delays | ||
5515 | |||
5516 | |||
5517 | |||
5518 | 2000E | ||
5519 | UM10 | ||
5520 | 4 | ||
5521 | Delay in C ertifying Provider | ||
5522 | |||
5523 | |||
5524 | |||
5525 | 2000E | ||
5526 | UM10 | ||
5527 | 7 | ||
5528 | Third Part y Processi ng Delay | ||
5529 | |||
5530 | |||
5531 | |||
5532 | 2000E | ||
5533 | UM10 | ||
5534 | 8 | ||
5535 | Delay in E ligibility Determina tion | ||
5536 | |||
5537 | |||
5538 | |||
5539 | 2000E | ||
5540 | UM10 | ||
5541 | 10 | ||
5542 | Administra tion Delay in the Pr ior Approv al Process | ||
5543 | |||
5544 | |||
5545 | |||
5546 | 2000E | ||
5547 | UM10 | ||
5548 | 11 | ||
5549 | Other | ||
5550 | |||
5551 | |||
5552 | |||
5553 | 2000E | ||
5554 | UM10 | ||
5555 | 15 | ||
5556 | Natural Di saster | ||
5557 | |||
5558 | |||
5559 | |||
5560 | 2000E | ||
5561 | UM10 | ||
5562 | 16 | ||
5563 | Lack of In formation | ||
5564 | |||
5565 | |||
5566 | |||
5567 | 2000E | ||
5568 | UM10 | ||
5569 | 17 | ||
5570 | No Respons e to Initi al Request | ||
5571 | |||
5572 | |||
5573 | |||
5574 | 2010A | ||
5575 | NM101 | ||
5576 | 1P | ||
5577 | Provider | ||
5578 | F | ||
5579 | F | ||
5580 | |||
5581 | 2010A | ||
5582 | NM108 | ||
5583 | XV | ||
5584 | CMS Plan I D | ||
5585 | F | ||
5586 | F | ||
5587 | |||
5588 | 2010A | ||
5589 | NM108 | ||
5590 | XX | ||
5591 | CMS Nation al Provide r ID | ||
5592 | A | ||
5593 | A | ||
5594 | |||
5595 | 2010B | ||
5596 | NM101 | ||
5597 | FA | ||
5598 | Facility | ||
5599 | A | ||
5600 | A | ||
5601 | |||
5602 | 2010B | ||
5603 | NM101 | ||
5604 | PR | ||
5605 | Payer | ||
5606 | F | ||
5607 | F | ||
5608 | |||
5609 | 2010B | ||
5610 | NM101 | ||
5611 | X3 | ||
5612 | Utilizatio n Manageme nt Organiz ation | ||
5613 | F | ||
5614 | F | ||
5615 | |||
5616 | 2010B | ||
5617 | NM101 | ||
5618 | 1P | ||
5619 | Provider | ||
5620 | A | ||
5621 | A | ||
5622 | |||
5623 | 2010B | ||
5624 | NM101 | ||
5625 | 2A | ||
5626 | Federal, S tate, Coun ty or City Facility | ||
5627 | A | ||
5628 | A | ||
5629 | |||
5630 | 2010B | ||
5631 | NM101 | ||
5632 | 2B | ||
5633 | Third Part y Administ rator | ||
5634 | F | ||
5635 | F | ||
5636 | |||
5637 | 2010B | ||
5638 | NM101 | ||
5639 | 36 | ||
5640 | Employer | ||
5641 | F | ||
5642 | F | ||
5643 | |||
5644 | 2010B | ||
5645 | NM102 | ||
5646 | 1 | ||
5647 | Person | ||
5648 | A | ||
5649 | A | ||
5650 | |||
5651 | 2010B | ||
5652 | NM102 | ||
5653 | 2 | ||
5654 | Non-Person Entity | ||
5655 | A | ||
5656 | A | ||
5657 | |||
5658 | 2010B | ||
5659 | NM108 | ||
5660 | PI | ||
5661 | Payer Iden tification | ||
5662 | A | ||
5663 | A | ||
5664 | |||
5665 | 2010B | ||
5666 | NM108 | ||
5667 | XV | ||
5668 | CMS Plan I D | ||
5669 | A | ||
5670 | A | ||
5671 | |||
5672 | 2010B | ||
5673 | NM108 | ||
5674 | XX | ||
5675 | CMS Nation al Provide r ID | ||
5676 | A | ||
5677 | A | ||
5678 | |||
5679 | 2010B | ||
5680 | NM108 | ||
5681 | 24 | ||
5682 | Employer I dentificat ion Number | ||
5683 | A | ||
5684 | A | ||
5685 | |||
5686 | 2010B | ||
5687 | NM108 | ||
5688 | 34 | ||
5689 | Social Sec urity Numb er | ||
5690 | A | ||
5691 | A | ||
5692 | |||
5693 | 2010B | ||
5694 | NM108 | ||
5695 | 46 | ||
5696 | Electronic Transmitt er Identif ication Nu mber | ||
5697 | A | ||
5698 | A | ||
5699 | |||
5700 | 2010B | ||
5701 | REF01 | ||
5702 | EI | ||
5703 | Employer I dentificat ion Number | ||
5704 | A | ||
5705 | A | ||
5706 | Not used i f NM108=24 | ||
5707 | 2010B | ||
5708 | REF01 | ||
5709 | G5 | ||
5710 | Provider S ite Number | ||
5711 | A | ||
5712 | A | ||
5713 | |||
5714 | 2010B | ||
5715 | REF01 | ||
5716 | N5 | ||
5717 | Provider P lan Networ k Identifi cation Num ber | ||
5718 | A | ||
5719 | A | ||
5720 | |||
5721 | 2010B | ||
5722 | REF01 | ||
5723 | N7 | ||
5724 | Facility N etwork Ide ntificatio n Number | ||
5725 | A | ||
5726 | A | ||
5727 | |||
5728 | 2010B | ||
5729 | REF01 | ||
5730 | SY | ||
5731 | Social Sec urity Numb er | ||
5732 | A | ||
5733 | A | ||
5734 | If 2000B/N M108 = 34 Action = W | ||
5735 | 2010B | ||
5736 | REF01 | ||
5737 | TJ | ||
5738 | Federal Ta xpayer Ide ntificatio n Number | ||
5739 | A | ||
5740 | A | ||
5741 | |||
5742 | 2010B | ||
5743 | REF01 | ||
5744 | ZH | ||
5745 | Carrier As signed Ref erence Num ber (Use f or provide r ID assig ned by VA [UMO] | ||
5746 | A | ||
5747 | A | ||
5748 | |||
5749 | 2010B | ||
5750 | REF01 | ||
5751 | 1G | ||
5752 | Provider U PIN Number | ||
5753 | A | ||
5754 | A | ||
5755 | |||
5756 | 2010B | ||
5757 | REF01 | ||
5758 | 1J | ||
5759 | Facility I D Number | ||
5760 | A | ||
5761 | A | ||
5762 | |||
5763 | 2010C | ||
5764 | NM108 | ||
5765 | II | ||
5766 | Standard U nique Heal th Identif ier for ea ch individ ual in the United St ates | ||
5767 | W | ||
5768 | W | ||
5769 | |||
5770 | 2010C | ||
5771 | NM108 | ||
5772 | MI | ||
5773 | Member Ide ntificatio n Number | ||
5774 | A | ||
5775 | A | ||
5776 | |||
5777 | 2010C | ||
5778 | REF01 | ||
5779 | DP | ||
5780 | Department Number | ||
5781 | A | ||
5782 | A | ||
5783 | |||
5784 | 2010C | ||
5785 | REF01 | ||
5786 | EJ | ||
5787 | Patient Ac count Numb er | ||
5788 | A | ||
5789 | A | ||
5790 | W if 2000D loop exis ts | ||
5791 | 2010C | ||
5792 | REF01 | ||
5793 | F6 | ||
5794 | Health Ins urance Cla im (HIC) N umber | ||
5795 | A | ||
5796 | A | ||
5797 | |||
5798 | 2010C | ||
5799 | REF01 | ||
5800 | HJ | ||
5801 | Identity C ard Number | ||
5802 | A | ||
5803 | A | ||
5804 | |||
5805 | 2010C | ||
5806 | REF01 | ||
5807 | IG | ||
5808 | Insurance Policy Num ber | ||
5809 | A | ||
5810 | A | ||
5811 | |||
5812 | 2010C | ||
5813 | REF01 | ||
5814 | N6 | ||
5815 | Plan Netwo rk Identif ication Nu mber | ||
5816 | A | ||
5817 | A | ||
5818 | |||
5819 | 2010C | ||
5820 | REF01 | ||
5821 | NQ | ||
5822 | Medicaid R ecipient I dentificat ion Number | ||
5823 | A | ||
5824 | A | ||
5825 | |||
5826 | 2010C | ||
5827 | REF01 | ||
5828 | SY | ||
5829 | Social Sec urity Numb er | ||
5830 | A | ||
5831 | A | ||
5832 | |||
5833 | 2010C | ||
5834 | REF01 | ||
5835 | 1L | ||
5836 | Group or P olicy Numb er | ||
5837 | A | ||
5838 | A | ||
5839 | |||
5840 | 2010C | ||
5841 | REF01 | ||
5842 | 3L | ||
5843 | Branch Ide ntifier | ||
5844 | A | ||
5845 | A | ||
5846 | |||
5847 | 2010C | ||
5848 | REF01 | ||
5849 | 6P | ||
5850 | Group Numb er | ||
5851 | A | ||
5852 | A | ||
5853 | |||
5854 | 2010D | ||
5855 | REF01 | ||
5856 | EJ | ||
5857 | Patient Ac count Numb er | ||
5858 | A | ||
5859 | A | ||
5860 | |||
5861 | 2010D | ||
5862 | REF01 | ||
5863 | SY | ||
5864 | Social Sec urity Numb er | ||
5865 | A | ||
5866 | A | ||
5867 | |||
5868 | 2010D | ||
5869 | REF01 | ||
5870 | 28 | ||
5871 | Employee I dentificat ion Number | ||
5872 | A | ||
5873 | A | ||
5874 | |||
5875 | ANY | ||
5876 | PER03 | ||
5877 | EM | ||
5878 | Electronic Mail | ||
5879 | NOT | ||
5880 | A | ||
5881 | |||
5882 | ANY | ||
5883 | PER03 | ||
5884 | FX | ||
5885 | Facsimile | ||
5886 | NOT | ||
5887 | A | ||
5888 | |||
5889 | ANY | ||
5890 | PER03 | ||
5891 | TE | ||
5892 | Telephone | ||
5893 | NOT | ||
5894 | A | ||
5895 | |||
5896 | ANY | ||
5897 | PER03 | ||
5898 | UR | ||
5899 | Uniform Re source Loc ator | ||
5900 | NOT | ||
5901 | A | ||
5902 | Cannot con tain any E DI defined character s separato rs | ||
5903 | ANY | ||
5904 | PER05 | ||
5905 | EM | ||
5906 | Electronic Mail | ||
5907 | NOT | ||
5908 | A | ||
5909 | |||
5910 | ANY | ||
5911 | PER05 | ||
5912 | EX | ||
5913 | Telephone Extension | ||
5914 | NOT | ||
5915 | A | ||
5916 | |||
5917 | ANY | ||
5918 | PER05 | ||
5919 | FX | ||
5920 | Facsimile | ||
5921 | NOT | ||
5922 | A | ||
5923 | |||
5924 | ANY | ||
5925 | PER05 | ||
5926 | TE | ||
5927 | Telephone | ||
5928 | NOT | ||
5929 | A | ||
5930 | |||
5931 | ANY | ||
5932 | PER05 | ||
5933 | UR | ||
5934 | Uniform Re source Loc ator | ||
5935 | NOT | ||
5936 | A | ||
5937 | Cannot con tain any E DI defined character s separato rs | ||
5938 | ANY | ||
5939 | PER07 | ||
5940 | EM | ||
5941 | Electronic Mail | ||
5942 | NOT | ||
5943 | A | ||
5944 | |||
5945 | ANY | ||
5946 | PER07 | ||
5947 | EX | ||
5948 | Telephone Extension | ||
5949 | NOT | ||
5950 | A | ||
5951 | |||
5952 | ANY | ||
5953 | PER07 | ||
5954 | FX | ||
5955 | Facsimile | ||
5956 | NOT | ||
5957 | A | ||
5958 | |||
5959 | ANY | ||
5960 | PER07 | ||
5961 | TE | ||
5962 | Telephone | ||
5963 | NOT | ||
5964 | A | ||
5965 | |||
5966 | ANY | ||
5967 | PER07 | ||
5968 | UR | ||
5969 | Uniform Re source Loc ator | ||
5970 | NOT | ||
5971 | A | ||
5972 | Cannot con tain any E DI defined character s separato rs | ||
5973 | ANY | ||
5974 | PRV01 | ||
5975 | AD | ||
5976 | Admitting | ||
5977 | A | ||
5978 | A | ||
5979 | |||
5980 | ANY | ||
5981 | PRV01 | ||
5982 | AS | ||
5983 | Assistant Surgeon | ||
5984 | A | ||
5985 | A | ||
5986 | |||
5987 | ANY | ||
5988 | PRV01 | ||
5989 | AT | ||
5990 | Attending | ||
5991 | A | ||
5992 | A | ||
5993 | |||
5994 | ANY | ||
5995 | PRV01 | ||
5996 | CO | ||
5997 | Consulting | ||
5998 | A | ||
5999 | Default | ||
6000 | |||
6001 | ANY | ||
6002 | PRV01 | ||
6003 | CV | ||
6004 | Covering | ||
6005 | A | ||
6006 | A | ||
6007 | |||
6008 | ANY | ||
6009 | PRV01 | ||
6010 | OP | ||
6011 | Operating | ||
6012 | A | ||
6013 | A | ||
6014 | |||
6015 | ANY | ||
6016 | PRV01 | ||
6017 | OR | ||
6018 | Ordering | ||
6019 | A | ||
6020 | A | ||
6021 | |||
6022 | ANY | ||
6023 | PRV01 | ||
6024 | OT | ||
6025 | Other Phys ician | ||
6026 | A | ||
6027 | A | ||
6028 | |||
6029 | ANY | ||
6030 | PRV01 | ||
6031 | PC | ||
6032 | Primary Ca re Physici an | ||
6033 | A | ||
6034 | A | ||
6035 | |||
6036 | ANY | ||
6037 | PRV01 | ||
6038 | PE | ||
6039 | Performing | ||
6040 | A | ||
6041 | A | ||
6042 | |||
6043 | ANY | ||
6044 | PRV01 | ||
6045 | RF | ||
6046 | Referring | ||
6047 | A | ||
6048 | A | ||
6049 | |||
6050 | ANY | ||
6051 | PRV02 | ||
6052 | PXC | ||
6053 | Health Car e Provider Taxonomy Code | ||
6054 | A | ||
6055 | Default | ||
6056 | |||
6057 | BHT | ||
6058 | BHT01 | ||
6059 | 0007 | ||
6060 | Informatio n Source, Informatio n Receiver , Subscrib er, Depend ent, Event , Services | ||
6061 | A | ||
6062 | A | ||
6063 | |||
6064 | BHT | ||
6065 | BHT02 | ||
6066 | 28 | ||
6067 | Query | ||
6068 | A | ||
6069 | A | ||
6070 | |||
6071 | BHT | ||
6072 | BHT02 | ||
6073 | 49 | ||
6074 | Original – No Respon se Necessa ry | ||
6075 | E | ||
6076 | A | ||
6077 | |||
6078 | BHT | ||
6079 | BHT02 | ||
6080 | 51 | ||
6081 | Historical Inquiry | ||
6082 | W | ||
6083 | W | ||
6084 | |||
6085 | BHT | ||
6086 | BHT02 | ||
6087 | 52 | ||
6088 | Response t o Historic al Query | ||
6089 | E | ||
6090 | NOT | ||
6091 | |||
6092 | BHT | ||
6093 | BHT06 | ||
6094 | RD | ||
6095 | Return Det ail | ||
6096 | A | ||
6097 | NOT | ||
6098 | |||
6099 | BHT | ||
6100 | BHT06 | ||
6101 | ZW | ||
6102 | Sort and S egregate D etail | ||
6103 | W | ||
6104 | NOT | ||
6105 | |||
6106 | BHT | ||
6107 | BHT06 | ||
6108 | RD | ||
6109 | Returns De tail | ||
6110 | NOT | ||
6111 | NOT | ||
6112 | |||
6113 | BHT | ||
6114 | BHT06 | ||
6115 | RS | ||
6116 | Response – Additiona l Response Available | ||
6117 | NOT | ||
6118 | NOT | ||
6119 | |||
6120 | BHT | ||
6121 | BHT06 | ||
6122 | 18 | ||
6123 | Response – No Furthe r Updates to Follow | ||
6124 | W | ||
6125 | A | ||
6126 | |||
6127 | GS | ||
6128 | GS08 | ||
6129 | 005010X215 | ||
6130 | Standards Identifier | ||
6131 | A | ||
6132 | A | ||
6133 | |||
6134 | GS | ||
6135 | GS08 | ||
6136 | 005010X217 | ||
6137 | Standards Identifier | ||
6138 | A | ||
6139 | A | ||
6140 | |||
6141 | ISA | ||
6142 | ISA01 | ||
6143 | 00 | ||
6144 | No Authori zation Inf ormation i s ISA02 | ||
6145 | A | ||
6146 | A | ||
6147 | |||
6148 | ISA | ||
6149 | ISA01 | ||
6150 | 03 | ||
6151 | Additional Data Info rmation | ||
6152 | A | ||
6153 | A | ||
6154 | ISA02 cont ains data | ||
6155 | ISA | ||
6156 | ISA03 | ||
6157 | 00 | ||
6158 | No Securit y Informat ion is ISA 04 | ||
6159 | A | ||
6160 | A | ||
6161 | |||
6162 | ISA | ||
6163 | ISA03 | ||
6164 | 01 | ||
6165 | Password | ||
6166 | A | ||
6167 | A | ||
6168 | |||
6169 | ISA | ||
6170 | ISA05 | ||
6171 | ZZ | ||
6172 | Mutually d efined | ||
6173 | A | ||
6174 | A | ||
6175 | |||
6176 | ISA | ||
6177 | ISA05 | ||
6178 | 01 | ||
6179 | Duns (Dun & Bradstre et) | ||
6180 | A | ||
6181 | A | ||
6182 | |||
6183 | ISA | ||
6184 | ISA05 | ||
6185 | 14 | ||
6186 | DUNS Plus Suffix | ||
6187 | A | ||
6188 | A | ||
6189 | |||
6190 | ISA | ||
6191 | ISA05 | ||
6192 | 20 | ||
6193 | Health Ind ustry Numb er (HIN) | ||
6194 | A | ||
6195 | A | ||
6196 | |||
6197 | ISA | ||
6198 | ISA05 | ||
6199 | 27 | ||
6200 | Carrier Id entificati on Number (HCFA) | ||
6201 | A | ||
6202 | A | ||
6203 | |||
6204 | ISA | ||
6205 | ISA05 | ||
6206 | 28 | ||
6207 | Fiscal Int ermediary Identifica tion Numbe r (HCFA) | ||
6208 | A | ||
6209 | A | ||
6210 | |||
6211 | ISA | ||
6212 | ISA05 | ||
6213 | 30 | ||
6214 | U. S. Fede ral Tax Id entificati on Number | ||
6215 | A | ||
6216 | A | ||
6217 | |||
6218 | ISA | ||
6219 | ISA05 | ||
6220 | 33 | ||
6221 | National A ssociation of Insura nce Commis sioners Co mpany Code (NAIC) | ||
6222 | A | ||
6223 | A | ||
6224 | |||
6225 | ISA | ||
6226 | ISA07 | ||
6227 | ZZ | ||
6228 | Mutually d efined | ||
6229 | A | ||
6230 | A | ||
6231 | |||
6232 | ISA | ||
6233 | ISA07 | ||
6234 | 01 | ||
6235 | Duns (Dun & Bradstre et) | ||
6236 | A | ||
6237 | A | ||
6238 | |||
6239 | ISA | ||
6240 | ISA07 | ||
6241 | 14 | ||
6242 | DUNS Plus Suffix | ||
6243 | A | ||
6244 | A | ||
6245 | |||
6246 | ISA | ||
6247 | ISA07 | ||
6248 | 20 | ||
6249 | HIN | ||
6250 | A | ||
6251 | A | ||
6252 | |||
6253 | ISA | ||
6254 | ISA07 | ||
6255 | 27 | ||
6256 | Carrier Id entificati on Number (HCFA) | ||
6257 | A | ||
6258 | A | ||
6259 | |||
6260 | ISA | ||
6261 | ISA07 | ||
6262 | 28 | ||
6263 | Fiscal Int ermediary Identifica tion Numbe r (HCFA) | ||
6264 | A | ||
6265 | A | ||
6266 | |||
6267 | ISA | ||
6268 | ISA07 | ||
6269 | 30 | ||
6270 | U. S. Fede ral Tax Id entificati on Number | ||
6271 | A | ||
6272 | A | ||
6273 | |||
6274 | ISA | ||
6275 | ISA07 | ||
6276 | 33 | ||
6277 | NAIC | ||
6278 | A | ||
6279 | A | ||
6280 | |||
6281 | ISA | ||
6282 | ISA12 | ||
6283 | 00501 | ||
6284 | Standards Approved f or Publica tion by AS C X12 | ||
6285 | A | ||
6286 | A | ||
6287 | |||
6288 | ISA | ||
6289 | ISA14 | ||
6290 | 0 | ||
6291 | No Interch ange Ackno wledgement Requested | ||
6292 | A | ||
6293 | A | ||
6294 | |||
6295 | ISA | ||
6296 | ISA14 | ||
6297 | 1 | ||
6298 | Interchang e Acknowle dgement Re quested (T A1) | ||
6299 | A | ||
6300 | A | ||
6301 | |||
6302 | ISA | ||
6303 | ISA15 | ||
6304 | P | ||
6305 | Production Data | ||
6306 | A | ||
6307 | A | ||
6308 | |||
6309 | ISA | ||
6310 | ISA15 | ||
6311 | T | ||
6312 | Test Data | ||
6313 | A | ||
6314 | A | ||
6315 | |||
6316 | ST | ||
6317 | ST01 | ||
6318 | 278 | ||
6319 | Health Car e Services EDI ID | ||
6320 | A | ||
6321 | A | ||
6322 | |||
6323 | ST | ||
6324 | ST03 | ||
6325 | 005010X215 | ||
6326 | Health Car e Services EDI Stand ard ID for 215 Inqui ry | ||
6327 | A | ||
6328 | A | ||
6329 | |||
6330 | ST | ||
6331 | ST03 | ||
6332 | 005010X217 | ||
6333 | Health Car e Services EDI Stand ard ID for 217 Reque st | ||
6334 | A | ||
6335 | A | ||
6336 | |||
6337 | |||
6338 |
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