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1 | Purch Care Auth Compliance P3.zip | 08-020 PC Auth Compl SDD v1.2.docx | Mon Aug 7 13:15:46 2017 UTC |
2 | Purch Care Auth Compliance P3.zip | 08-020 PC Auth Compl SDD v1.2.docx | Mon Aug 7 20:40:06 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 | System Des ign Docume nt (SDD) | ||
6 | for | ||
7 | Purchased Care Autho rizations Compliance Phase 3 I ncrement 1 | ||
8 | |||
9 | |||
10 | |||
11 | Department of Vetera ns Affairs | ||
12 | December 2 015 | ||
13 | Version 1. 2 | ||
14 | |||
15 | |||
16 | |||
17 | Revision H istory | ||
18 | Creation D ate | ||
19 | Version No . | ||
20 | Descriptio n/Comments | ||
21 | Author(s) | ||
22 | Reviewer(s ) | ||
23 | Review Typ e | ||
24 | Issue Date | ||
25 | 12/08/2015 | ||
26 | 1.2 | ||
27 | Changes re lated to A ERB feedba ck | ||
28 | Z. Bertram | ||
29 | F. Perez | ||
30 | TW Review | ||
31 | 12/09/2015 | ||
32 | 12/07/2015 | ||
33 | 1.1 | ||
34 | Replaced r eferences to AAT (th e EDI engi ne) with A ET (which it is bein g merged i nto) | ||
35 | Z. Bertram | ||
36 | F. Perez | ||
37 | TW Review | ||
38 | 12/08/2015 | ||
39 | 09/15/2015 | ||
40 | 1.0 | ||
41 | VA COR acc epted docu ment effec tive Septe mber 15, 2 015. Docum ent has be en baselin ed for rel ease. | ||
42 | F. Perez | ||
43 | |||
44 | |||
45 | 09/15/2015 | ||
46 | |||
47 | |||
48 | |||
49 | |||
50 | |||
51 | |||
52 | |||
53 | |||
54 | |||
55 | Table of C ontents | ||
56 | 1Introduct ion1 | ||
57 | 1.1Purpose of the SD D1 | ||
58 | 1.2Identif ication2 | ||
59 | 1.3Scope3 | ||
60 | 1.4Constra ining Poli cies, Dire ctives and Procedure s6 | ||
61 | 1.5User Ch aracterist ics7 | ||
62 | 1.5.1User Objectives 7 | ||
63 | 1.6Relatio nship to O ther Docum ents and P lans7 | ||
64 | 1.7Definit ions, Acro nyms, and Abbreviati ons8 | ||
65 | 1.7.1Acron yms8 | ||
66 | 1.7.2Defin itions10 | ||
67 | 1.8Referen ces10 | ||
68 | 2Backgroun d13 | ||
69 | 2.1Overvie w of the S ystem13 | ||
70 | 2.2Overvie w of the B usiness Pr ocess14 | ||
71 | 2.3Busines s Benefits 15 | ||
72 | 2.4Assumpt ions and C onstraints 15 | ||
73 | 2.4.1Desig n Assumpti ons15 | ||
74 | 2.4.2Desig n Constrai nts15 | ||
75 | 2.4.3Desig n Trade-of fs16 | ||
76 | 2.5Overvie w of the S ignificant Requireme nts16 | ||
77 | 2.5.1Overv iew of Sig nificant F unctional Requiremen ts16 | ||
78 | 2.5.2Overv iew of Fun ctional Wo rkload / P erformance Requireme nts16 | ||
79 | 2.5.3Overv iew of Ope rational R equirement s16 | ||
80 | 2.5.4Overv iew of the Technical Requireme nts17 | ||
81 | 2.5.5Overv iew of the Security or Privacy Requireme nts17 | ||
82 | 2.5.6Overv iew of Sys tem Critic ality and High Avail ability Re quirements 18 | ||
83 | 2.5.7Singl e Sign-on Requiremen t18 | ||
84 | 2.5.8Requi rement for Use of En terprise P ortals18 | ||
85 | 2.5.9Speci al Device Requiremen ts18 | ||
86 | 2.6Legacy System Ret irement18 | ||
87 | 3Conceptua l Design19 | ||
88 | 3.1Concept ual Applic ation Desi gn19 | ||
89 | 3.1.1Appli cation Con text19 | ||
90 | 3.1.2High- Level Appl ication De sign19 | ||
91 | 3.1.3Appli cation Loc ations20 | ||
92 | 3.2Concept ual Data D esign20 | ||
93 | 3.2.1Proje ct Concept ual Data M odel20 | ||
94 | 3.2.2Datab ase Inform ation20 | ||
95 | 3.2.3User Interface Data Mappi ng20 | ||
96 | 3.2.3.1App lication S creen Inte rface20 | ||
97 | 3.2.3.2App lication R eport Inte rface20 | ||
98 | 3.2.3.3Unm apped Data Element20 | ||
99 | 3.3Concept ual Infras tructure D esign20 | ||
100 | 3.3.1Syste m Critical ity and Hi gh Availab ility20 | ||
101 | 3.3.2Speci al Technol ogy20 | ||
102 | 3.3.3Techn ology Loca tions21 | ||
103 | 3.3.4Conce ptual Infr astructure Diagram21 | ||
104 | 3.3.4.1Loc ation of E nvironment s and Exte rnal Inter faces21 | ||
105 | 3.3.4.2Con ceptual Pr oduction S tring Diag ram21 | ||
106 | 4System Ar chitecture 22 | ||
107 | 4.1Hardwar e Architec ture22 | ||
108 | 4.2Softwar e Architec ture22 | ||
109 | 4.3Network Architect ure22 | ||
110 | 4.4Service Oriented Architectu re / ESS22 | ||
111 | 4.5Enterpr ise Archit ecture22 | ||
112 | 5Data Desi gn23 | ||
113 | 5.1DBMS Fi les23 | ||
114 | 5.2Non-DBM S Files24 | ||
115 | 5.3Data Vi ew24 | ||
116 | 6Detailed Design25 | ||
117 | 6.1Hardwar e Detailed Design25 | ||
118 | 6.2Softwar e Detailed Design25 | ||
119 | 6.2.1Conce ptual Desi gn25 | ||
120 | 6.2.1.1Pro duct Persp ective25 | ||
121 | 6.2.1.2Pro duct Featu res26 | ||
122 | 6.2.1.3Use r Characte ristics26 | ||
123 | 6.2.1.4Dep endencies and Constr aints26 | ||
124 | 6.2.2Speci fic Requir ements26 | ||
125 | 6.2.2.1Dat abase Repo sitory26 | ||
126 | 6.2.2.2Sys tem Featur es27 | ||
127 | 6.2.2.3Des ign Elemen t Tables53 | ||
128 | 6.3Network Detailed Design58 | ||
129 | 6.4Service Oriented Architectu re / ESS D etailed De sign58 | ||
130 | 7External System Int erface Des ign59 | ||
131 | 7.1Interfa ce Archite cture59 | ||
132 | 7.2Interfa ce Detaile d Design59 | ||
133 | 8Human-Mac hine Inter face60 | ||
134 | 8.1Interfa ce Design Rules60 | ||
135 | 8.2Inputs6 0 | ||
136 | 8.3Outputs 60 | ||
137 | 8.4Navigat ion Hierar chy60 | ||
138 | 9Security and Privac y61 | ||
139 | 9.1Securit y61 | ||
140 | 9.2Privacy 61 | ||
141 | Attachment A – Appro val Signat ures62 | ||
142 | A.Addition al Informa tion63 | ||
143 | A.1.RTM63 | ||
144 | A.2.Packag ing and In stallation 63 | ||
145 | A.3.Design Metrics63 | ||
146 | A.4.Acrony m List and Glossary6 3 | ||
147 | A.5.Requir ed Technic al Documen ts63 | ||
148 | |||
149 | |||
150 | List of Ta bles | ||
151 | Table 1 – Scope Incl usions3 | ||
152 | Table 2 – Scope Excl usions6 | ||
153 | Table 3 – EDI PC Doc umentation 7 | ||
154 | Table 4 – Acronyms a nd Abbrevi ations8 | ||
155 | Table 5 – Definition s10 | ||
156 | Table 6 – 278 Author ization Re quest Busi ness Proce ss Identif iers14 | ||
157 | Table 7 – Security R equirement s17 | ||
158 | Table 8 – Databases2 0 | ||
159 | Table 9 – 278_REQUES T23 | ||
160 | Table 10 – 7078_AUTH ORIZATION2 3 | ||
161 | Table 11 – Design El ements for Consult I Ds27 | ||
162 | Table 12 – Design El ements for Consult I Ds28 | ||
163 | Table 13 – Design El ements for Admission Date28 | ||
164 | Table 14 – Design El ements for Multiple Authorizat ions29 | ||
165 | Table 15 – Design El ements for Master Au thorizatio ns29 | ||
166 | Table 16 – Authoriza tion Statu s/Workflow 31 | ||
167 | Table 17 – Design El ements for Authoriza tion Statu s31 | ||
168 | Table 18 – Design El ements for Authoriza tion Expor t31 | ||
169 | Table 19 – Design El ements for HSD32 | ||
170 | Table 20 – Design El ements for Outpatien t Services 32 | ||
171 | Table 21 – Design El ements for Inpatient Services3 2 | ||
172 | Table 22 – Design El ements for Authoriza tion Servi ces Entry3 3 | ||
173 | Table 23 – Design El ements for Request Q ueues GUI3 4 | ||
174 | Table 24 – Design El ements for Request P rocessing GUI36 | ||
175 | Table 25 – Design El ements for Request P rocessing GUI37 | ||
176 | Table 26 – Design El ements for Code Look up Tables3 9 | ||
177 | Table 27 – Design El ements for Event Log ging40 | ||
178 | Table 28 – Design El ements for Request Q ueues41 | ||
179 | Table 29 – Design El ements for Authoriza tion Reque st Queuing 41 | ||
180 | Table 30 – Design El ements for Request R eception41 | ||
181 | Table 31 – Design El ements for Sensitive PHI Handl ing43 | ||
182 | Table 32 – Design El ements for Request a nd Respons e Tracking 43 | ||
183 | Table 33 – Design El ements for Request V alidation4 3 | ||
184 | Table 34 – Design El ements for Request V alidation4 5 | ||
185 | Table 35 – Design El ements for Request V alidation4 6 | ||
186 | Table 36 – Design El ements for Request V alidation4 6 | ||
187 | Table 37 – Design El ements for Request V alidation4 6 | ||
188 | Table 38 – Design El ements for Response Generation 47 | ||
189 | Table 39 – Design El ements for Response Generation 47 | ||
190 | Table 40 – Design El ements for Response Generation 48 | ||
191 | Table 41 – Design El ements for Response Generation 48 | ||
192 | Table 42 – Design El ements for Response Generation 49 | ||
193 | Table 43 – Design El ements for Response Generation 50 | ||
194 | Table 44 – Design El ements for Response Generation 50 | ||
195 | Table 45 – Design El ements for Vendor In formation5 1 | ||
196 | Table 46 – Design El ements for Reporting 51 | ||
197 | Table 47 – Design El ements for EDI Compl iance51 | ||
198 | Table 48 – Design El ements for Performan ce52 | ||
199 | Table 49 - Design El ements for Security5 2 | ||
200 | Table 50 – FBAA AUTH ORIZATION Template53 | ||
201 | |||
202 | List of Fi gures | ||
203 | Figure 1 – Authoriza tion Reque st Busines s Process Diagram14 | ||
204 | Figure 2 – Authoriza tion Reque st Concept ual Applic ation Desi gn19 | ||
205 | Figure 3 – Authoriza tion Reque st Design2 5 | ||
206 | Figure 4 – Queues GU I34 | ||
207 | Figure 5 – Unsolicit ed 278 Req uests GUI – Summary View35 | ||
208 | Figure 6 – Unsolicit ed 278 Req uest GUI – Detail Vi ew37 | ||
209 | |||
210 | Introducti on | ||
211 | 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. | ||
212 | 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) re venue oper ations and designs t he use cas es to illu strate the reenginee red busine ss process flows ass ociated wi th technol ogy change s. The off ice contin uously mon itors and participat es in meet ings of in dustry EDI standards -setting o rganizatio ns. As the business process ow ner and su bject matt er expert (SME) for industry h ealth care EDI manda tes, PC de fines busi ness needs that nece ssitate re venue syst em softwar e developm ent. The o ffice desi gns the ma intenance and iterat ive update s to the E DI enterpr ise tool u sed to pay healthcar e provider s for serv ice connec ted care p rovided to Veterans. PC develo ps partner ships with other Fed eral agenc ies and tr ading part ners to su pport EDI processing and verif y complian ce; they t est softwa re, train users on t he use of revised so ftware, an d provide help desk support fo r end user s. The EDI transacti ons proces ses are ut ilized to pay nearly $6B in pr ojected cl aims annua lly. The d evelopment work done under the scope of PC is inex tricably l inked to p roviding V eterans th e medical care they have earne d and dese rve. | ||
213 | The HAPE E DI portfol io deliver s IT produ cts and se rvices to CBO. This PC enhance ment proje ct is inte nded to de liver a ra nge of upd ates, exte nsions, an d modifica tions to v arious fin ancial and administr ative syst ems, proce sses, file s, and rep orting mec hanisms. T he PC Auth orizations Complianc e project will creat e processe s and syst ems to rec eive incom ing reques ts for Hea lthcare Cl aim servic es review (278) and produce co rrespondin g response transacti ons (278). Over time , this enh ancement s hould sign ificantly reduce man ual method s (e.g., r esponding to telepho ne calls t o VA Medic al Centers , or VAMCs ) using ED I transact ions for t reatment a uthorizati ons and pr e-certific ations. | ||
214 | Purpose of the SDD | ||
215 | This Syste m Design D ocument (S DD) transl ates the r equirement s listed i n the corr esponding Requiremen ts Specifi cation Doc ument (RSD ) into tec hnical des ign specif ications. It identif ies the sy stem archi tecture, a nd describ es hardwar e, softwar e, communi cation, an d interfac e componen ts for Inc rement 1 o f the the Authorizat ions Compl iance proj ect. | ||
216 | The intend ed audienc e of this document i ncludes th e Product Developmen t (PD), So ftware Qua lity Assur ance (SQA) , the CBO, and staff at the Of fice of OI &T at the Health Adm inistratio n Center ( HAC). | ||
217 | This SDD f or Authori zations Co mpliance d etails the necessary functiona lity for p rocessing provider r equests fo r authoriz ations and for more accurately defining authorized services on those a uthorizati ons. | ||
218 | This docum ent is org anized as follows: | ||
219 | Section 1: Presents introducti on, scope, definitio n and acro nyms, and references . | ||
220 | Section 2: Presents a conceptu al design and analys is of the External I nterfaces. | ||
221 | Section 3: Documents the speci fic techni cal and de sign requi rements fo r each sof tware elem ent releva nt to the PC Authori zations Co mpliance p roject. | ||
222 | Section 4: Presents details re garding th e system a rchitectur e. | ||
223 | Section 5: Presents details re garding da ta design, including database management system (D BMS) and d ata view. | ||
224 | Section 6: Discusses the syste m’s detail ed hardwar e and soft ware desig n as appli cable. | ||
225 | Section 7: Presents details of the exter nal interf ace design to the sy stem. | ||
226 | Section 8: Presents details of the inter face betwe en the use r and the PC system. | ||
227 | Section 9: Presents details of system se curity mec hanisms an d privacy design con sideration s at the a pplication level. | ||
228 | Attachment A: Docume nts the ap proval of this SDD b y VA OI&T personnel. | ||
229 | Identifica tion | ||
230 | The system s impacted by this p roject are Veterans Health Inf ormation S ystems and Technolog y Architec ture (Vist A) Fee Bas is and the Automated EDI Tool (AET). | ||
231 | 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. EDI PC wi ll use thi s guidance to fulfil l the perf ormance re quirements of this c ontract. | ||
232 | 44 U.S.C. § 3541, “F ederal Inf ormation S ecurity Ma nagement A ct (FISMA) of 2002” | ||
233 | Federal In formation Processing Standards (FIPS) Pu blication 140-2, “Se curity Req uirements For Crypto graphic Mo dules” | ||
234 | Software E ngineering Institute (SEI), So ftware Acq uisition-C apability Maturity M odeling (S A-CMM) Lev el 3 proce dures and processes | ||
235 | VA Directi ve 6102, “ Internet/I ntranet Se rvices,” J uly 15, 20 08 | ||
236 | 36 C.F.R. Part 1194 “Electroni c and IT A ccessibili ty Standar ds,” July 1, 2003 | ||
237 | Office of Management and Budge t (OMB) Ci rcular A-1 30, “Manag ement of F ederal Inf ormation R esources,” November 28, 2000 | ||
238 | 32 C.F.R. Part 199, “Civilian Health and Medical P rogram of the Unifor med Servic es (CHAMPU S)” | ||
239 | 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 | ||
240 | 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 | ||
241 | Homeland S ecurity Pr esidential Directive (12) (HSP D-12) | ||
242 | VA Directi ve 6500, “ Informatio n Security Program,” August 4, 2006 | ||
243 | VA Handboo k 6500, “I nformation Security Program,” September 18, 2007 | ||
244 | VA Handboo k, 6500.5, Incorpora ting Secur ity and Pr ivacy in S ystem Deve lopment Li fecycle. | ||
245 | VA Handboo k 6500.6, “Contract Security,” March 12, 2010 | ||
246 | Project Ma nagement A ccountabil ity System (PMAS) po rtal (refe rence Perf ormance Wo rk Stateme nt (PWS) R eferences - Technica l Library at https:/ DNS /) | ||
247 | 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. | ||
248 | Technical Reference Model (TRM ) (referen ce at http :// DNS /TRM /TRMHomePa ge.asp ) | ||
249 | National I nstitute S tandards a nd Technol ogy (NIST) Special P ublication s (SP) 800 -60 and 80 0-53 | ||
250 | Informatio n Technolo gy 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 | ||
251 | HIPAA of 1 996; Pub.L 104-191. | ||
252 | 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 | ||
253 | 5 Code of Federal Re gulations (CFR) 1315 , Final Ru le, Prompt Payment ( http:// DNS /prompt/re gulations. html) (for merly OMB Circular A -125), | ||
254 | The aim of this proj ect is to ensure tha t the EDI PC systems are compl iant with the Commit tee on Ope rating Rul es for Inf ormation E xchange (C ORE) Rules as publis hed by Cou ncil for A ffordable Quality He althcare ( CAQH), and found her e http://w ww.caqh.or g/CORE_ope rat_rules. php | ||
255 | VA M Progr amming Sta ndards and Conventio ns. Revise d 04/03/20 07 (http:/ DNS /TRM/files /SACC_2008 .pdf) | ||
256 | Scope | ||
257 | This docum ent addres ses the so ftware des ign that w ill satisf y the tech nical requ irements i n the PC A uthorizati ons Compli ance RSD, which the EDI PC pro ject team developed from the B usiness Re quirements Document (BRD). | ||
258 | Table 1 li sts the sc ope inclus ions for t he PC Auth orizations Complianc e project. | ||
259 | Table 1 – Scope Incl usions | ||
260 | Identifier | ||
261 | Descriptio n | ||
262 | Theme 001 | ||
263 | Addition o f new data points (A ligns to G oal 2) | ||
264 | Epic 001 | ||
265 | 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. | ||
266 | User Narra tive 001 | ||
267 | 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. | ||
268 | User Narra tive 002 | ||
269 | 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 . | ||
270 | User Narra tive 003 | ||
271 | 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. | ||
272 | Epic 002 | ||
273 | 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. | ||
274 | User Narra tive 005 | ||
275 | 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. | ||
276 | User Narra tive 006 | ||
277 | 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. | ||
278 | User Narra tive 007 | ||
279 | 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 Non-VA Provider A uthorizati on Notific ation Lett er so that I can mat ch documen tation to the author ization an d consult. | ||
280 | Theme 002 | ||
281 | Edit Admis sion Date for Author ization (A ligns to G oal 1) | ||
282 | Epic 003 | ||
283 | 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. | ||
284 | User Narra tive 008 | ||
285 | 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. | ||
286 | User Narra tive 010 | ||
287 | 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. | ||
288 | User Narra tive 012 | ||
289 | 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 . | ||
290 | Theme 003 | ||
291 | Multiple A uthorizati ons Create d (Aligns to Goal 1) | ||
292 | Epic 004 | ||
293 | 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 . | ||
294 | User Narra tive 014 | ||
295 | 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. | ||
296 | Epic 005 | ||
297 | 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 . | ||
298 | Epic 006 | ||
299 | 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 . | ||
300 | Theme 004 | ||
301 | Electronic ally Trans mit Accred ited Stand ards Commi ttee X12 ( ASC X12) 2 78 (Aligns to Goal 2 ) | ||
302 | Epic 007 | ||
303 | 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 . | ||
304 | User Narra tive 015 | ||
305 | 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. | ||
306 | User Narra tive 016 | ||
307 | 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. | ||
308 | Epic 008 | ||
309 | 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 . | ||
310 | User Narra tive 017 | ||
311 | 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 . | ||
312 | Theme 005 | ||
313 | Electronic ally Proce ss ASC X12 278 (Alig ns to Goal 2) | ||
314 | Epic 009 | ||
315 | 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. | ||
316 | User Narra tive 018 | ||
317 | 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. | ||
318 | User Narra tive 019 | ||
319 | 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. | ||
320 | User Narra tive 020 | ||
321 | 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. | ||
322 | User Narra tive 021 | ||
323 | 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. | ||
324 | Epic 010 | ||
325 | 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. | ||
326 | User Narra tive 022 ( A) | ||
327 | 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 . | ||
328 | User Narra tive 022 ( B) | ||
329 | 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. | ||
330 | Epic 011 | ||
331 | 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. | ||
332 | Theme 006 | ||
333 | Report on ASC X12 27 8 Transact ions (Alig ns to Goal 2) | ||
334 | Epic 012 | ||
335 | 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. | ||
336 | Theme 007 | ||
337 | Implement CAQH CORE Operating Rules for ASC X12N 2 78 (Aligns to Goal 2 ) | ||
338 | Epic 013 | ||
339 | 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 Chief Bus iness Offi ce Purchas ed Care (C BOPC) is c ompliant. | ||
340 | Epic 014 | ||
341 | 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. | ||
342 | Epic 015 | ||
343 | 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. | ||
344 | Epic 016 | ||
345 | 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. | ||
346 | Epic 017 | ||
347 | 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 . | ||
348 | Epic 019 | ||
349 | 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. | ||
350 | User Narra tive 024 | ||
351 | 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. | ||
352 | Several Bu siness Nee ds were fo und to be out of the scope for this proj ect, for o ne of two reasons. T he needs m arked with “[Batch M ode]” were marked as such beca use the cu rrently co ntracted H ealth Care Clearing House (HCC H) doesn’t support b atch proce ssing for 278 author ization tr ansactions . The need s marked w ith “[FBCS ]” were ma rked as su ch because those nee ds require modificat ion to the Fee Basis Claims Sy stem (FBCS ), which c an only be made by t he contrac tor charge d with upd ating that system. T he needs m arked with “[AET Mon itor]” wer e marked a s such bec ause those needs are already m et by the existing A ET Monitor system. | ||
353 | Table 2 – Scope Excl usions | ||
354 | Identifier | ||
355 | Descriptio n | ||
356 | User Narra tive 023 | ||
357 | 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. [Batch Mode] | ||
358 | Epic 018 | ||
359 | 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. [Batch Mo de] | ||
360 | User Narra tive 004 | ||
361 | 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 Comp uterized P atient Rec ord System (CPRS) to the assoc iated FBCS Authoriza tions so t hat I can validate t he length of time th at elapses prior to the Vetera n being au thorized t o seek Non -VA Care f or their m edical nee d. [FBCS] | ||
362 | User Narra tive 009 | ||
363 | 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. [FBCS] | ||
364 | User Narra tive 011 | ||
365 | 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. [FBCS] | ||
366 | User Narra tive 013 | ||
367 | 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 . [FBCS] | ||
368 | Epic 020 | ||
369 | 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. [AET Monit or] | ||
370 | User Narra tive 025 | ||
371 | 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. [AET Moni tor] | ||
372 | User Narra tive 026 | ||
373 | 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. [ AET Monito r] | ||
374 | User Narra tive 027 | ||
375 | 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 . [AET Mon itor] | ||
376 | Constraini ng Policie s, Directi ves and Pr ocedures | ||
377 | This SDD i s constrai ned by the following policies, directive s, artifac ts, and pr ocedures. | ||
378 | Policies a nd Directi ves | ||
379 | PMAS Guide v4.0, (VA IQ 7023849 ) Assistan t Secretar y for Info rmation an d Technolo gy (005) R elease Mem orandum, d ated Septe mber 17, 2 010 | ||
380 | HAPE Progr am Office Procedures , Policies , Template s | ||
381 | System Eng ineering D esign Revi ew (SEDR) Process | ||
382 | One-VA TRM – Data, S ervice, Te chnical Fe deral Segm ent Archit ecture Met hodology ( FSAM) | ||
383 | PMAS Proje ct Documen tation Por tal | ||
384 | C&A Divisi on Webpage | ||
385 | ASC X12N/0 05010X215 Health Car e Services Review – Inquiry an d Response (278) | ||
386 | ASC X12N/0 05010X217 Health Car e Services Review – Request fo r Review a nd Respons e (278) | ||
387 | ProPath Ve rsion 23, PRP-2.3, C reate SDD | ||
388 | VA-generat ed Artifac ts | ||
389 | BRD | ||
390 | Project Ch arter | ||
391 | VA Standar d Procedur es | ||
392 | PMAS Readi ness Check list | ||
393 | VA Section 508 polic ies and pr ocedures 6 221 Access ible Elect ronic and IT, Direct ive/Handbo ok, publis hed by the VA’s Sect ion 508 PD Product A ssessment Competency Division (reference at http:/ / DNS /vapubs/vi ewPublicat ion.asp?Pu b_ID=435&F Type=2) | ||
394 | 508 compli ance testi ng certifi cations fo r each enh ancement t hat requir es any cha nge to the Graphical User Inte rface (GUI ) (http:/ DNS /Standards _Checklist .asp) | ||
395 | VA M Progr amming Sta ndards and Conventio ns. Revise d 04/03/20 07 (http:/ / DNS /TRM/files /SACC_2008 .pdf) | ||
396 | User Chara cteristics | ||
397 | This devel opment wil l mostly a ffect revi ew nurses and Non-VA Care cler ks respons ible for m anaging au thorizatio ns for Non -VA Care. | ||
398 | User Objec tives | ||
399 | The Author izations C ompliance developmen t will all ow Non-VA Care perso nnel to re spond to r equests fo r authoriz ations fro m Non-VA p roviders a nd to more accuratel y select a uthorized services. | ||
400 | Relationsh ip to Othe r Document s and Plan s | ||
401 | The SDD fo r PC Autho rizations Compliance is develo ped in con junction w ith other EDI PC doc uments, as shown in the follow ing tableT able 3. | ||
402 | Table 3 – EDI PC Doc umentation | ||
403 | Document T ype | ||
404 | Descriptio n | ||
405 | Performanc e Work Sta tement (PW S) | ||
406 | Defines wo rk activit ies, deliv erables, a nd the tim eline for the perfor mance of t he contrac ted work, including the SDD de velopment and delive ry. | ||
407 | RSD | ||
408 | System des ign is der ived from this docum ent, which details t he require ments. | ||
409 | Requiremen ts Traceab ility Matr ix (RTM) | ||
410 | Continuous ly confirm s and vali dates requ irements b y providin g backward traceabil ity. Also maps indiv idual test cases to each desig n element and requir ement, dem onstrating forward t raceabilit y. | ||
411 | Project Ma nagement P lan (PMP) | ||
412 | Describes the approa ch for man aging and monitoring the imple mentation of the pro ject. | ||
413 | Project Sc hedule | ||
414 | Details th e planned schedule t asks, mile stones, an d dates ne cessary to accomplis h on-time contractua l deliveri es. | ||
415 | Test Plan | ||
416 | Provides t he testing approach, including specifica tion of th e testing scope and objectives , and test ing strate gy and con duct. | ||
417 | Quality As surance Su rveillance Plan (QAS P) | ||
418 | VA-generat ed documen t that des cribes pro cesses tha t promote periodic i nspections of docume nts, proce sses, and the end pr oduct. | ||
419 | Configurat ion Manage ment Plan (CMP) | ||
420 | Provides t he defined Configura tion Manag ement (CM) and chang e control policies a nd guideli nes that a re applied throughou t the proj ect life c ycle to va lidate the integrity of system s and comp onents tha t are plac ed under i ts control . Addresse s configur ation iden tification , change p rocesses, configurat ion auditi ng, and st atus accou nting info rmation. | ||
421 | Definition s, Acronym s, and Abb reviations | ||
422 | Acronyms | ||
423 | The table below list s acronyms and abbre viations a pplicable to the Aut horization s Complian ce project . | ||
424 | Table 4 – Acronyms a nd Abbrevi ations | ||
425 | Term | ||
426 | Definition | ||
427 | AAT | ||
428 | Automated Authorizat ion Tool | ||
429 | AET | ||
430 | Automated EDI Tool | ||
431 | ANSI | ||
432 | American N ational St andards In stitute | ||
433 | ASC X12 | ||
434 | Accredited Standards Committee X12 | ||
435 | BRD | ||
436 | Business R equirement s Document | ||
437 | CAQH | ||
438 | Council fo r Affordab le Quality Healthcar e | ||
439 | CBO | ||
440 | Chief Busi ness Offic e | ||
441 | CBOPC | ||
442 | Chief Busi ness Offic e Purchase d Care | ||
443 | CDW | ||
444 | Corporate Data Wareh ouse | ||
445 | CFR | ||
446 | Code of Fe deral Regu lations | ||
447 | CHAMPUS | ||
448 | Civilian H ealth and Medical Pr ogram of t he Uniform ed Service s | ||
449 | CM | ||
450 | Configurat ion Manage ment | ||
451 | CMP | ||
452 | Configurat ion Manage ment Plan | ||
453 | CMS | ||
454 | Centers fo r Medicare & Medicai d Services | ||
455 | CORE® | ||
456 | Committee on Operati ng Rules f or Informa tion Excha nge | ||
457 | COTS | ||
458 | Commercial off-the-s helf | ||
459 | CPRS | ||
460 | Computeriz ed Patient Record Sy stem | ||
461 | CVS | ||
462 | Conformanc e Validati on Stateme nt | ||
463 | DBMS | ||
464 | Database M anagement System | ||
465 | EDI | ||
466 | Electronic Data Inte rchange | ||
467 | EFT | ||
468 | Electronic Funds Tra nsfer | ||
469 | EMF | ||
470 | Enterprise Managemen t Foundati on | ||
471 | ERD | ||
472 | Entity Rel ationship Diagram | ||
473 | ESS | ||
474 | Electronic Safety an d Security | ||
475 | FBCS | ||
476 | Fee Basis Claims Sys tem | ||
477 | FIPS | ||
478 | Federal In formation Processing Standards | ||
479 | FISMA | ||
480 | Federal In formation Security M anagement Act | ||
481 | FSAM | ||
482 | Federal Se gment Arch itecture M ethodology | ||
483 | GUI | ||
484 | Graphical User Inter face | ||
485 | HAC | ||
486 | Health Adm inistratio n Center | ||
487 | HAPE | ||
488 | Health Adm inistratio n Producti on Enhance ments | ||
489 | HCCH | ||
490 | Health Car e Clearing House | ||
491 | HIPAA | ||
492 | Health Ins urance Por tability a nd Account ability Ac t | ||
493 | HL7 | ||
494 | Health Lev el 7 | ||
495 | HSD | ||
496 | Healthcare Services Delivery | ||
497 | HSPD-12 | ||
498 | Homeland S ecurity Pr esidential Directive (12) | ||
499 | IM | ||
500 | Informatio n Manageme nt | ||
501 | IPT | ||
502 | Integrated Project T eam | ||
503 | IT | ||
504 | Informatio n Technolo gy | ||
505 | ITAM | ||
506 | Informatio n Technolo gy Asset M anagement | ||
507 | NIST | ||
508 | National I nstitute o f Standard s and Tech nology | ||
509 | NVCC | ||
510 | Non-VA Coo rdinated C are | ||
511 | OED | ||
512 | Office of Enterprise Developme nt | ||
513 | OI&T | ||
514 | Office of Informatio n and Tech nology | ||
515 | OMB | ||
516 | Office of Management and Budge t | ||
517 | PC | ||
518 | Purchased Care | ||
519 | PD | ||
520 | Product De velopment | ||
521 | PHI | ||
522 | Protected Health Inf ormation | ||
523 | PII | ||
524 | Personally Identifia ble Inform ation | ||
525 | PjM | ||
526 | Project Ma nager | ||
527 | PMAS | ||
528 | Project Ma nagement A ccountabil ity System | ||
529 | PMD | ||
530 | Policy Man agement De partment | ||
531 | PMP | ||
532 | Project Ma nagement P lan | ||
533 | PPACA | ||
534 | Patient Pr otection a nd Afforda ble Care A ct | ||
535 | PTF | ||
536 | Patient Tr eatment Fi le | ||
537 | PWS | ||
538 | Performanc e Work Sta tement | ||
539 | QASP | ||
540 | Quality As surance Su rveillance Plan | ||
541 | RPC | ||
542 | Remote Pro cedure Cal l | ||
543 | RSD | ||
544 | Requiremen ts Specifi cation Doc ument | ||
545 | RTM | ||
546 | Requiremen ts Traceab ility Matr ix | ||
547 | SA-CMM | ||
548 | Software A cquisition -Capabilit y Maturity Modeling | ||
549 | SDD | ||
550 | System Des ign Docume nt | ||
551 | SEDR | ||
552 | System Eng ineering D esign Revi ew | ||
553 | SEI | ||
554 | Software E ngineering Institute | ||
555 | SME | ||
556 | Subject Ma tter Exper t | ||
557 | SOA | ||
558 | Service Or iented Arc hitecture | ||
559 | SP | ||
560 | Special Pu blication | ||
561 | SQA | ||
562 | Software Q uality Ass urance | ||
563 | T4 | ||
564 | Transforma tion Twent y-One Tota l Technolo gy | ||
565 | TCP / IP | ||
566 | Transmissi on Control Protocol / Internet Protocol | ||
567 | TO | ||
568 | Task Order | ||
569 | TRM | ||
570 | Technical Reference Model | ||
571 | UAK | ||
572 | Unique Aut horization Key | ||
573 | UMO | ||
574 | Utilizatio n Manageme nt Organiz ation | ||
575 | VA | ||
576 | Department of Vetera ns Affairs | ||
577 | VAMC | ||
578 | VA Medical Center | ||
579 | VHA | ||
580 | Veterans H ealth Admi nistration | ||
581 | VISN | ||
582 | Veterans I ntegrated Service Ne tworks | ||
583 | VistA | ||
584 | Veterans H ealth Info rmation Sy stems and Technology Architect ure | ||
585 | VPN | ||
586 | Virtual Pr ivate Netw ork | ||
587 | Definition s | ||
588 | The table below list s terms an d definiti ons applic able to th e Authoriz ations Com pliance pr oject. | ||
589 | Table 5 – Definition s | ||
590 | Term | ||
591 | Definition | ||
592 | 278 Health Care Serv ices Revie w – Reques t for Revi ew | ||
593 | 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. | ||
594 | AAA | ||
595 | The standa rd segment used in X 12 message s to indic ate an err or. | ||
596 | ASC X12 | ||
597 | ASC X12 – is an Amer ican Natio nal Standa rds Instit ute (ANSI) -accredite d standard s developm ent organi zation and the entit y responsi ble for th e HIPAA tr ansaction standards for electr onic healt h care, el igibility, claims pr ocessing, claims sta tus, autho rizations and remitt ance trans actions na med by the Health In surance Ac countabili ty and Por tability A ct of 1996 . The VA i s currentl y operatin g to versi on 5010 st andards. | ||
598 | CORE | ||
599 | The CORE, is an mult i-stakehol der initia tive creat ed, organi zed and fa cilitated by CAQH th at is work ing to mak e it easie r for phys icians and hospitals to access eligibili ty, benefi ts and cla im informa tion for t heir patie nts at the point of care | ||
600 | HIPAA v. 5 010 | ||
601 | 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. | ||
602 | Master Aut horization | ||
603 | Term used when refer ring to 10 -7078 or 1 0-7079 aut horization s without regard to which type of author ization is reference d. | ||
604 | Payer | ||
605 | 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 | ||
606 | References | ||
607 | Authorizat ions Compl iance BRD - version 1.0, 5/14/ 15 (http:/ / DNS /pm/hape/i pt_5010/ED I_Portfoli o/Program% 20Level%20 Documentat ion/Forms/ AllItems.a spx?RootFo lder=%2Fpm %2Fhape%2F ipt%5F5010 %2FEDI%5FP ortfolio%2 FProgram%2 0Level%20D ocumentati on%2FPC%2F FY%202015% 2FBRD&Init ialTabId=R ibbon%2EDo cument&Vis ibilityCon text=WSSTa bPersisten ce) | ||
608 | Authorizat ions Compl iance RSD - version 1.0, 8/24/ 2015(http: // DNS /pm/hape/i pt_5010/ED I_Portfoli o/Program% 20Level%20 Documentat ion/Forms/ AllItems.a spx?RootFo lder=%2Fpm %2Fhape%2F ipt%5F5010 %2FEDI%5FP ortfolio%2 FProgram%2 0Level%20D ocumentati on%2FPC%2F FY%202015% 2FVendor%2 0Deliverab les%20%28V A%2D118%2D 11%2DD%2D1 009%29%2F0 002AC%20%2 D%20Purcha sed%20Care %20Authori zations%20 Compliance %20Phase%2 03%20Requi rements%20 Specificat ion%20Docu ment) | ||
609 | Authoriza tions Comp liance Ent ity Relati onship Dia gram (ERD) - version 0.01, Jul y 2015 (VA SharePoin t link pen ding) | ||
610 | Transforma tion Twent y-One Tota l Technolo gy (T4), P WS, Date: November 2 0, 2014, T AC-15-1682 2, Task Or der (TO) P WS 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 | ||
611 | 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. | ||
612 | 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. | ||
613 | CORE Level III Elect ronic Fund s Transfer (EFT) sta ndards. | ||
614 | 44 U.S.C. § 3541, “F ISMA of 20 02” | ||
615 | FIPS Publi cation 140 -2, “Secur ity Requir ements For Cryptogra phic Modul es” | ||
616 | SEI, SA-CM M Level 3 procedures and proce sses | ||
617 | VA Directi ve 6102, “ Internet/I ntranet Se rvices,” J uly 15, 20 08 | ||
618 | 36 C.F.R. Part 1194 “Electroni c and IT A ccessibili ty Standar ds,” July 1, 2003 | ||
619 | OMB Circul ar A-130, “Managemen t of Feder al Informa tion Resou rces,” Nov ember 28, 2000 | ||
620 | 32 C.F.R. Part 199, “CHAMPUS” | ||
621 | An Introdu ctory Reso urce Guide for Imple menting th e HIPAA Se curity Rul e, March 2 005 | ||
622 | 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 | ||
623 | Homeland S ecurity Pr esidential Directive (12) (HSP D-12) | ||
624 | VA Directi ve 6500, “ Informatio n Security Program,” August 4, 2006 | ||
625 | VA Handboo k 6500, “I nformation Security Program,” September 18, 2007 | ||
626 | VA Handboo k, 6500.5, Incorpora ting Secur ity and Pr ivacy in S ystem Deve lopment Li fecycle. | ||
627 | VA Handboo k 6500.6, “Contract Security,” March 12, 2010 | ||
628 | PMAS porta l (referen ce PWS Ref erences - Technical Library at https:// DNS /) | ||
629 | 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. | ||
630 | TRM (refer ence at ht tp:// DNS /TRM /files/SAC C_2008.pdf ) | ||
631 | NIST SP 80 0-60 and 8 00-53 | ||
632 | ITAM and E MF BR-0006 , version 002.1-1405 2008, date d 10/30/20 07 | ||
633 | HIPAA of 1 996; Pub.L 104-191. | ||
634 | PPACA, Pub . L. 111-1 48, 124 St at. 119, H .R. 3590, enacted Ma rch 23, 20 10 | ||
635 | 5 CFR 1315 , Final Ru le, Prompt Payment ( http:// DNS /prompt/re gulations. html) (for merly OMB Circular A -125), | ||
636 | 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 the CAQH, and found here: htt p://www.ca qh.org/COR E_operat_r ules.php. | ||
637 | VA M Progr amming Sta ndards and Conventio ns. Revise d 04/03/20 07 (http:/ / DNS /TRM/files /SACC_2008 .pdf) | ||
638 | ASC X12N/0 05010X215 Health Car e Services Review – Inquiry an d Response (278) | ||
639 | ASC X12N/0 05010X217 Health Car e Services Review – Request fo r Review a nd Respons e (278) | ||
640 | ProPath Ve rsion 23, PRP-2.3, C reate SDD | ||
641 | PMAS Readi ness Check list | ||
642 | VA Section 508 polic ies and pr ocedures 6 221 Access ible Elect ronic and IT, Direct ive/Handbo ok, publis hed by the VA’s Sect ion 508 PD Product A ssessment Competency Division (reference at http:/ / DNS /vapubs/vi ewPublicat ion.asp?Pu b_ID=435&F Type=2) | ||
643 | 508 compli ance testi ng certifi cations fo r each enh ancement t hat requir es any cha nge to the GUI (http :// DNS /Standards _Checklist .asp) | ||
644 | Background | ||
645 | Overview o f the Syst em | ||
646 | A number o f systems will be mo dified as part of th is project in order to allow N on-VA Care personnel to respon d to reque sts for au thorizatio n. | ||
647 | VistA Fee Basis is u sed to man age author izations a nd payment s for Non- VA Care. I t will be modified t o allow fo r more dis crete entr y of autho rized serv ices and b etter trac king of th e status o f authoriz ations. | ||
648 | The AET is a system for receiv ing EDI tr ansactions , includin g 278 tran sactions i nquiring a bout autho rizations or request ing a new authorizat ion. This project wi ll improve support f or those a uthorizati on request s, includi ng adding a new Auto mated Auth orization Tool (AAT) GUI for r esponding to those r equests. | ||
649 | The Automa ted Author ization To ol (AAT) G UI is a ne w system t hat will a llow revie w nurses o r clerks a t the vari ous VAMCs to respond to reques ts for new authoriza tions. | ||
650 | Overview o f the Busi ness Proce ss | ||
651 | |||
652 | Figure 1 – Authoriza tion Reque st Busines s Process Diagram | ||
653 | Table 6 – 278 Author ization Re quest Busi ness Proce ss Identif iers | ||
654 | Step | ||
655 | Process St ep | ||
656 | Automated/ Manual | ||
657 | Current or Future Pr ocess | ||
658 | Owner of P rocess | ||
659 | 1A | ||
660 | Authorizat ion comple ted by Non -VA Coordi nated Care (NVCC) st aff OR | ||
661 | Manual | ||
662 | Current | ||
663 | NVCC Staff | ||
664 | 1B | ||
665 | Completed Authorizat ion data p ulled from Corporate Data Ware house (CDW ) | ||
666 | Automated | ||
667 | New | ||
668 | NVCC Staff | ||
669 | 1C | ||
670 | AET stores a copy of Authoriza tion data in the 278 Repositor y | ||
671 | Automated | ||
672 | Current | ||
673 | CBOPC | ||
674 | 2A | ||
675 | Provider s ubmits 278 EDI Reque st to HCCH | ||
676 | Automated | ||
677 | Current | ||
678 | Provider | ||
679 | 2B | ||
680 | HCCH valid ates reque st | ||
681 | Automated | ||
682 | Current | ||
683 | HCCH | ||
684 | 3B | ||
685 | HCCH forwa rds valida ted 278 re quest to C BOPC OR | ||
686 | Automated | ||
687 | Current | ||
688 | HCCH | ||
689 | 4B | ||
690 | HCCH retur ns 278 req uest that fail valid ation to p rovider (A AA Error) | ||
691 | Automated | ||
692 | Current | ||
693 | HCCH | ||
694 | 5B | ||
695 | HCCH forwa rds valida ted 278 re quest to C BOPC AET | ||
696 | Automated | ||
697 | Current | ||
698 | HCCH | ||
699 | 6B | ||
700 | AET retrie ves 278 Au thorizatio n from 278 repositor y | ||
701 | Automated | ||
702 | Current | ||
703 | CBOPC | ||
704 | 7B | ||
705 | Request Fo und? | ||
706 | Automated | ||
707 | Current | ||
708 | CBOPC | ||
709 | 8A | ||
710 | YES - AET generates 278 Author ization Re sponse to HCCH | ||
711 | Automated | ||
712 | Current | ||
713 | CBOPC | ||
714 | 9B | ||
715 | AET sends response t o HCCH | ||
716 | Automated | ||
717 | Current | ||
718 | CBOPC | ||
719 | 10B | ||
720 | HCCH valid ates respo nse | ||
721 | Automated | ||
722 | Current | ||
723 | CBOPC | ||
724 | 11B | ||
725 | Provider r eceives re sponse fro m HCCH | ||
726 | Automated | ||
727 | Current | ||
728 | HCCH | ||
729 | 7C | ||
730 | NO - AET v alidates p rovider da ta | ||
731 | Automated | ||
732 | New | ||
733 | CBOPC | ||
734 | 7D | ||
735 | Allowed Pr ovider? | ||
736 | |||
737 | |||
738 | |||
739 | 7E | ||
740 | YES - AET routes 278 Request t o appropri ate queue | ||
741 | Automated | ||
742 | New | ||
743 | CBOPC | ||
744 | 8D | ||
745 | YES - AET generates 278 PENDIN G Response to HCCH | ||
746 | Automated | ||
747 | Current | ||
748 | CBOPC | ||
749 | 9B | ||
750 | YES – AET sends 278 Response | ||
751 | Automated | ||
752 | Current | ||
753 | CBOPC | ||
754 | 8B | ||
755 | NO – AET r outes requ est to DEN Y queue | ||
756 | Automated | ||
757 | New | ||
758 | CBOPC | ||
759 | 8C | ||
760 | NO – AET g enerates 2 78 DENY re sponse | ||
761 | Automated | ||
762 | New | ||
763 | CBOPC | ||
764 | 9B | ||
765 | NO – AET s ends 278 R esponse | ||
766 | Automated | ||
767 | Current | ||
768 | CBOPC | ||
769 | 7C | ||
770 | NO - AET r outes 278 Request to AAT | ||
771 | Automated | ||
772 | New | ||
773 | CBOPC | ||
774 | 7D | ||
775 | NO - AET v alidates p rovider da ta | ||
776 | Automated | ||
777 | New | ||
778 | CBOPC | ||
779 | 7E | ||
780 | NO - AET r outes 278 Request to appropria te queue | ||
781 | Automated | ||
782 | New | ||
783 | CBOPC | ||
784 | 8B | ||
785 | NO - AET g enerates 2 78 Error R esponse to HCCH | ||
786 | Automated | ||
787 | Current | ||
788 | CBOPC | ||
789 | 8C | ||
790 | YES - AET generates 278 Author ization Re sponse to HCCH | ||
791 | Automated | ||
792 | Current | ||
793 | CBOPC | ||
794 | Business B enefits | ||
795 | This devel opment wil l allow th e VA to fu lly partic ipate in e lectronic exchanges for author ization of Non-VA Ca re, potent ially savi ng costs o f printing and maili ng large a mounts of authorizat ion inform ation. In addition, this devel opment wil l bring th e NVCC pro gram into compliance with appl icable CAQ H CORE Ope rating Rul es pertain ing to aut horization s. | ||
796 | Assumption s and Cons traints | ||
797 | Design Ass umptions | ||
798 | There are no signifi cant assum ptions ass ociated wi th this pr oject. | ||
799 | Design Con straints | ||
800 | EDI PC has the follo wing const raints: | ||
801 | 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. | ||
802 | Developmen t of the a pplication s is const rained by the availa bility of programmin g resource s and VHA resources for advice and testi ng. | ||
803 | Timely acq uisition o f all new or allocat ed hardwar e resource s approved by the Go vernment f or project developme nt. | ||
804 | The VA Pol icy Manage ment Depar tment (PMD ) is respo nsible for designing the queue s routing criteria f or 278 aut horization requests received b y the AAT. Delay of these rul es will de lay the co ding neces sary to im plement th e rules. | ||
805 | Design Tra de-offs | ||
806 | No signifi cant trade -offs have been iden tified for this proj ect. | ||
807 | Overview o f the Sign ificant Re quirements | ||
808 | Overview o f Signific ant Functi onal Requi rements | ||
809 | The AET wi ll accept and store authorizat ion reques ts, allowi ng Non-VA providers to request authoriza tions elec tronically rather th an the cur rent phone -calls-and -paper pro cess. | ||
810 | A new AAT GUI will b e put into place tha t will all ow for the managemen t of queue s of incom ing author ization re quests. | ||
811 | VistA Fee Basis will also allo w discrete authorize d services to be sel ected for an authori zation, al lowing for more accu rate repor ting of se rvices to Non-VA pro viders. | ||
812 | Overview o f Function al Workloa d / Perfor mance Requ irements | ||
813 | In accorda nce with t he CORE Op erating Ru les, the A ET will ha ve a maxim um of 20 s econds to respond to real-time requests from provi ders for a n authoriz ation. Whe n a provid er request s an autho rization, the AET wi ll have a maximum of 20 second s to respo nd that th e review o f that req uest is in progress. The provi der will m ake one or more subs equent req uests with in the fol lowing thr ee days to retrieve the reques ted author ization. | ||
814 | Overview o f Operatio nal Requir ements | ||
815 | There are no changes to existi ng operati onal requi rements. | ||
816 | Overview o f the Tech nical Requ irements | ||
817 | Technical requiremen ts in this context r efers to t he non-fun ctional re quirements . With the exception of mainta ining exis ting techn ical capab ilities as noted in other subs ections of 2.5, ther e are no s uch requir ements. Overview o f the Secu rity or Pr ivacy Requ irements | ||
818 | Table 7 – Security R equirement s | ||
819 | Theme/Epic /Narrative | ||
820 | Requiremen t Number | ||
821 | Descriptio n | ||
822 | Epic 010 | ||
823 | FS-EP010-0 13 | ||
824 | An authori zed user s hall be ab le to assi gn a 278 R equest to a differen t queue. | ||
825 | Epic 010 | ||
826 | FS-EP010-0 26-002FS-E P010-027-0 02 | ||
827 | If the req uestor or vendor is identified that is n ot allowed to conduc t business with VA, AET shall write an e ntry to th e AET even t log iden tifying th e 278 Requ est, reque stor/vendo r and mess age indica ting reque stor/vendo r is unaut horized. | ||
828 | Epic 007 | ||
829 | FS-EP007-0 97 | ||
830 | The system shall be able to id entify a p rovider wh o has rest ricted acc ess to Pro tected Hea lth Inform ation (PHI ). | ||
831 | Epic 007 | ||
832 | FS-EP007-1 54 | ||
833 | 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”. | ||
834 | Epic 005 | ||
835 | FS-EP005-0 01 | ||
836 | FS-EP005-0 01-001 | ||
837 | FS-EP005-0 01-002 | ||
838 | FS-EP005-0 01-003 | ||
839 | FS-EP005-0 01-004 | ||
840 | An authori zed reques tor shall be able to export th e followin g data poi nts for CO MPLETE aut horization s: | ||
841 | User Id of user who completed the author ization | ||
842 | Total numb er of auth orizations in a COMP LETE state by user-i d | ||
843 | Start-date entered b y requesto r | ||
844 | End-date e ntered by requestor | ||
845 | User Narra tive 024 | ||
846 | PS-EP015-0 01 | ||
847 | All transa ctions bet ween AET a nd HCCH wi ll be over a secure communicat ions chann el. | ||
848 | Epic 007 | ||
849 | SS-EP007-0 01 | ||
850 | SS-EP007-0 01-001 | ||
851 | SS-EP007-0 01-002 | ||
852 | SS-EP007-0 01-003 | ||
853 | SS-EP007-0 01-004 | ||
854 | SS-EP007-0 01-005 | ||
855 | SS-EP007-0 01-006 | ||
856 | SS-EP007-0 01-007 | ||
857 | SS-EP007-0 01-008 | ||
858 | Users hold ing the Vi stA Fee Au thorizatio n key shal l be able to: | ||
859 | Add Servic es records to a mast er authori zation rec ord | ||
860 | View the 2 78 Request queues | ||
861 | Select a 2 78 Request from the 278 unsoli cited requ est queues | ||
862 | View the 2 78 Request | ||
863 | View 275 R epository records | ||
864 | Create 278 Response segments f or a 278 R equest | ||
865 | Assign a 2 78 Respons e HSD resp onse | ||
866 | Release a completed 278 to the AET proce ss | ||
867 | Epic 007 | ||
868 | SS-EP007-0 02SS-EP007 -002-001 | ||
869 | |||
870 | Users hold ing the Vi stA Fee Su pervisor k ey shall: | ||
871 | Have all t he capacit ies listed above | ||
872 | Epic 007 | ||
873 | SS-EP007-0 03SS-EP007 -003-001 | ||
874 | SS-EP007-0 03-002 | ||
875 | SS-EP007-0 03-003 | ||
876 | AET Admini strator sh all: | ||
877 | Be able to monitor t he connect ion betwee n AET and the HCCH | ||
878 | Be able to monitor t he connect ion betwee n AET and AAT | ||
879 | Be able to update su pporting 2 78 lookup tables | ||
880 | Epic 007 | ||
881 | SS-EP007-0 04SS-EP007 -004-001 | ||
882 | SS-EP007-0 04-002 | ||
883 | EDI Manage ment Team shall: | ||
884 | Have all t he capabil ities of t he AET Adm inistrator | ||
885 | Access the master au thorizatio n interfac e as neede d to monit or perform ance | ||
886 | Overview o f System C riticality and High Availabili ty Require ments | ||
887 | The existi ng availab ility and disaster r ecovery pl ans will b e sufficie nt for the affected systems. A s stated i n the BRD, the syste ms involve d are to b e availabl e no less than 86% o f the cale ndar week, and shoul d recover from any o utage with a mean ti me of 30 m inutes. Ad ditional d etails sho uld be ava ilable fro m the HAC and AITC C IOs, and t he technic al leaders hip at the various V istA insta nces. | ||
888 | Single Sig n-on Requi rement | ||
889 | There are no changes to the ex isting sin gle sign-o n requirem ents. | ||
890 | Requiremen t for Use of Enterpr ise Portal s | ||
891 | There are no changes to the re quirements for use o f enterpri se portals . | ||
892 | Special De vice Requi rements | ||
893 | No special devices a re require d. | ||
894 | Legacy Sys tem Retire ment | ||
895 | There are no legacy system ret irements p lanned for this set of changes . | ||
896 | Conceptual Design | ||
897 | Conceptual Applicati on Design | ||
898 | |||
899 | Figure 2 – Authoriza tion Reque st Concept ual Applic ation Desi gn | ||
900 | Applicatio n Context | ||
901 | This devel opment wil l suppleme nt existin g systems with a new workflow built on t op of an e xisting sy stem. A ne w AAT GUI will be ad ded to the AET that will allow for user processing of author ization re quests. Ch anges will be made i n VistA (a nd possibl y FBCS, de pending on the avail ability of developme nt resourc es from th e contract or charged with upda ting that system) to allow for more fine -grained e ntry of au thorized s ervices. T hese more discrete s ervices ar e necessar y for deli vering aut horization s via EDI transactio ns. | ||
902 | High-Level Applicati on Design | ||
903 | Currently, review nu rses and N on-VA Care clerks us e VistA Fe e Basis an d FBCS in order to c reate auth orizations for Non-V A Care. Re quests for authoriza tions are done via p hone calls from Non- VA provide rs. After this devel opment, No n-VA provi ders will be able to send elec tronic req uests for authorizat ions. Usin g the new AAT GUI, u sers will be able to see queue s of diffe rent kinds of reques ts (such a s emergenc y care or dental car e requests ) and deci de whether or not to authorize that care . While fi lling out the author ization th e way they would pre viously in VistA Fee Basis or FBCS, user s will be able to se lect an au thorized s ervice usi ng codes f rom a stan dardized a uthorized service lo okup table . These mo re discret e codes ar e necessar y for tran smitting a workable authorizat ion over E DI. | ||
904 | Applicatio n Location s | ||
905 | The VistA Fee Basis applicatio n is locat ed locally at variou s VAMCs or regionall y at integ rated Vete rans Integ rated Serv ice Networ ks (VISNs) supportin g more tha n one VAMC . The AET is hosted at the Au stin Infor mation Tec hnology Ce nter (AITC ). The HAC hosts the AET Monit or. | ||
906 | Conceptual Data Desi gn | ||
907 | Project Co nceptual D ata Model | ||
908 | Section 5. 1 details new additi ons to the data mode l for this project. | ||
909 | Database I nformation | ||
910 | Table 8 – Databases | ||
911 | Database N ame | ||
912 | Descriptio n | ||
913 | Type | ||
914 | Steward | ||
915 | VistA | ||
916 | Veterans H ealth Info rmation Sy stems and Technology Architect ure | ||
917 | Create/Mod ify | ||
918 | VHA | ||
919 | PD_EDI | ||
920 | Automated Authorizat ion Tool | ||
921 | Create/Mod ify | ||
922 | HAC | ||
923 | User Inter face Data Mapping | ||
924 | Applicatio n Screen I nterface | ||
925 | Section 6. 2.2.2 desc ribes the new and ad ditional u ser interf ace screen s. | ||
926 | Applicatio n Report I nterface | ||
927 | No new rep orts will be develop ed for thi s project. | ||
928 | Unmapped D ata Elemen t | ||
929 | No unmappe d data ele ments will be added. | ||
930 | Conceptual Infrastru cture Desi gn | ||
931 | There will be no arc hitectural changes t o VistA Fe e Basis. A AT will be a new web -based GUI that will be used t o manage a uthorizati on request s that com e into the AET. | ||
932 | System Cri ticality a nd High Av ailability | ||
933 | All modifi cations ar e to exist ing system s. There i s no effec t on syste m critical ity. The e xisting av ailability and disas ter recove ry plans w ill be suf ficient fo r the affe cted syste ms. As sta ted in the BRD, the systems in volved are to be ava ilable no less than 86% of the calendar week, and should rec over from any outage with a me an time of 30 minute s. Additio nal detail s should b e availabl e from the HAC and A ITC CIOs, and the te chnical le adership a t the vari ous VistA instances. | ||
934 | Special Te chnology | ||
935 | No special technolog y is requi red for th is project . | ||
936 | Technology Locations | ||
937 | There is n o environm ent change for exist ing system s. The new AAT will be located at the De nver HAC. The AET wi ll continu e to be ho sted at AI TC, and th e VistA Fe e Basis ap plication continues to be loca ted at Vis tA sites t hroughout the countr y. | ||
938 | Conceptual Infrastru cture Diag ram | ||
939 | Location o f Environm ents and E xternal In terfaces | ||
940 | The VistA instances are locate d locally at various VAMCs or regionally at integr ated VISNs . The new AAT system will be l ocated at the HAC. T he existin g AET syst em will co ntinue to be hosted at AITC. | ||
941 | Conceptual Productio n String D iagram | ||
942 | The diagra m displaye d in Secti on 3.1 sho ws the int eractions of the dif ferent sys tems invol ved in thi s set of c hanges. | ||
943 | System Arc hitecture | ||
944 | VistA Fee Basis is h osted at t he VAMCs a nd regiona l VISNs on VA standa rd hardwar e and oper ating syst em softwar e and util izes the c urrent Int erSystems version of Caché, 20 14 (at the time of t his writin g). The AA T will be hosted at the HAC. | ||
945 | Hardware A rchitectur e | ||
946 | No hardwar e changes are requir ed for the changes t o VistA Fe e Basis or AET. The new AAT GU I will req uire a web server at the HAC t hat can ma nage web s ervices. T he existin g AET will see an in crease in activity a s Non-VA p roviders s tart to re quest auth orizations electroni cally inst ead of ove r the phon e, so care must be t aken to in sure the A ET has eno ugh storag e space to deal with the incre ased trans action vol ume. | ||
947 | Software A rchitectur e | ||
948 | VistA Fee Basis prov ides a cen tral locat ion for th e collecti on of fina ncial and medical da ta related to Fee Ba sis Non-VA claims an d authoriz ations. | ||
949 | The AET, a n EDI engi ne that cu rrently pr ocesses 27 0/271 elig ibility an d 278 auth orization transactio ns, will q ueue incom ing author ization re quests. Th e AAT will provide a new web-b ased GUI t hat allows users to manage tho se queues of incomin g requests . | ||
950 | |||
951 | Network Ar chitecture | ||
952 | This proje ct require s no chang es to the network ar chitecture . | ||
953 | Service Or iented Arc hitecture / ESS | ||
954 | There is n o change t o any exis ting Servi ce Oriente d Architec ture (SOA) . Addition al details about the existing SOA (if an y) should be availab le from th e HAC and AITC CIOs, and the t echnical l eadership at the var ious VistA instances . | ||
955 | Enterprise Architect ure | ||
956 | There is n o change t o existing enterpris e architec ture. No a dditional tools or t echnologie s will be added to t he existin g architec ture, and all existi ng such it ems are be lieved to be complia nt with th e Technica l Referenc e Manual ( TRM.) Addi tional det ails about the exist ing tools and techno logies bei ng used sh ould be av ailable fr om the HAC and AITC CIOs, and the techni cal leader ship at th e various VistA inst ances. | ||
957 | Data Desi gn | ||
958 | DBMS Files | ||
959 | The AET da tabase wil l keep rec ords of in coming aut horization requests in the exi sting tabl e for 278 requests. A new fiel d to track the statu s of autho rizations will be ad ded to the 7078_AUTH ORIZATION table to t rack the s tatus of a uthorizati ons, as we ll. | ||
960 | Table 9 – 278_REQUES T | ||
961 | Column | ||
962 | CDW Column | ||
963 | Type | ||
964 | Notes | ||
965 | AAT_REQUES T_ID | ||
966 | N/A | ||
967 | Numeric | ||
968 | Automatica lly assign ed to each request | ||
969 | HCCH_REQUE ST_ID | ||
970 | N/A | ||
971 | Numeric | ||
972 | From the i ncoming tr ansaction | ||
973 | REQUEST_RE CEIVED | ||
974 | N/A | ||
975 | Date/Time | ||
976 | When incom ing transa ction was received | ||
977 | REQUEST_TE XT | ||
978 | N/A | ||
979 | Text | ||
980 | The entire ty of the incoming m essage | ||
981 | PATIENT_SI D | ||
982 | SPatient.S Patient.Pa tientSID | ||
983 | Numeric | ||
984 | ID of Vete ran (or bl ank if no matching V eteran fou nd) | ||
985 | VENDOR_SID | ||
986 | Dim.FeeVen dor.FeeVen dorSID | ||
987 | Numeric | ||
988 | ID of inqu iring vend or (or bla nk if no m atching ve ndor found ) | ||
989 | DOS_START_ DATE | ||
990 | N/A | ||
991 | Date/Time | ||
992 | Beginning of date ra nge for re quested au thorizatio n | ||
993 | DOS_END_DA TE | ||
994 | N/A | ||
995 | Date/Time | ||
996 | End of dat e range fo r requeste d authoriz ation | ||
997 | SERVICE_TY PE_CODE | ||
998 | N/A | ||
999 | Alphanumer ic | ||
1000 | Type of se rvice requ ested | ||
1001 | QUEUE | ||
1002 | N/A | ||
1003 | Alphanumer ic | ||
1004 | Code repre senting wh ich queue this reque st has bee n placed i n (or blan k for a re quest that isn’t in a queue)E= Emergency, I=Inpatie nt, O=Outp atient, D= Dental, M= Multiple P roblem, V= Patient Pr oblem, P=P rovider Pr oblem, R=I ncoming Re quest | ||
1005 | Table 10 – 7078_AUTH ORIZATION | ||
1006 | Column | ||
1007 | CDW Column | ||
1008 | Type | ||
1009 | Notes | ||
1010 | 7078_AUTHO RIZATION_S ID | ||
1011 | Fee.FeeAut horization Request.Fe eAuthoriza tionReques tSID | ||
1012 | Numeric | ||
1013 | Unique ID for author ization | ||
1014 | SOURCE_STA TION | ||
1015 | Fee.FeeAut horization Request.St a3n | ||
1016 | Numeric | ||
1017 | Station nu mber of au thorizatio n source ( used for U nique Auth orization KEY [UAK]) | ||
1018 | 7078_AUTHO RIZATION_I EN | ||
1019 | Fee.FeeAut horization Request.Fe eAuthoriza tionReques tIEN | ||
1020 | Numeric | ||
1021 | Local IEN for source authoriza tion (used for UAK) | ||
1022 | PATIENT_SI D | ||
1023 | SPatient.S Patient.Pa tientSID | ||
1024 | Numeric | ||
1025 | Authorized Veteran | ||
1026 | PATIENT_IE N | ||
1027 | SPatient.S Patient.Pa tientIEN | ||
1028 | Numeric | ||
1029 | Local IEN for source patient ( used for U AK) | ||
1030 | VENDOR_SID | ||
1031 | Fee.FeeAut horization Request.Fe eVendorSID | ||
1032 | Numeric | ||
1033 | Authorized vendor | ||
1034 | ISSUED_DAT E | ||
1035 | Fee.FeeAut horization Request.Is sueDate | ||
1036 | Date/Time | ||
1037 | Date the 7 078 was is sued | ||
1038 | DOS_START_ DATE | ||
1039 | Fee.FeeAut horization Request.Au thorizatio nFromDate | ||
1040 | Date/Time | ||
1041 | Beginning of authori zed dates of service | ||
1042 | DOS_END_DA TE | ||
1043 | Fee.FeeAut horization Request.Au thorizatio nToDate | ||
1044 | Date/Time | ||
1045 | End of aut horized da te of serv ice. | ||
1046 | SERVICES | ||
1047 | Fee.FeeAut horization Remarks.Fe eAuthoriza tionRemark s | ||
1048 | Text | ||
1049 | First 264 characters (the limi t for the 278 transa ction) of the author ized servi ces | ||
1050 | STATUS | ||
1051 | Fee.FeeAut horization Request.St atus | ||
1052 | Alphanumer ic | ||
1053 | Code repre senting th e status o f the auth orization. | ||
1054 | I=Incomple te, A=Acti ve, C=Comp lete, X=Cl osed, DC=C anceled | ||
1055 | Non-DBMS F iles | ||
1056 | There are no new Non -DBMS file s or chang es to any existing N on-DBMS fi les. | ||
1057 | Data View | ||
1058 | Changes to the data view are d escribed i n Section 6.2.2.2. | ||
1059 | Detailed D esign | ||
1060 | Section 6. 2.2.2 deta ils the ch anges that will be m ade to the Non-VA Ca re authori zation pro cess. Thes e changes are reflec ted in the diagram b elow. | ||
1061 | |||
1062 | Figure 3 – Authoriza tion Reque st Design | ||
1063 | Hardware D etailed De sign | ||
1064 | See Sectio n 4.1 for informatio n on the h ardware re quirements . | ||
1065 | Software D etailed De sign | ||
1066 | Conceptual Design | ||
1067 | Product Pe rspective | ||
1068 | Currently, review nu rses and N on-VA Care clerks us e VistA Fe e Basis an d FBCS in order to c reate auth orizations for Non-V A Care. Re quests for authoriza tions are done via p hone calls from Non- VA provide rs. After this devel opment, No n-VA provi ders will be able to send elec tronic req uests for authorizat ions. Usin g the new AAT GUI, u sers will be able to see queue s of diffe rent kinds of reques ts (such a s emergenc y care or dental car e requests ) and deci de whether or not to authorize that care . While fi lling out the author ization th e way they would pre viously in VistA Fee Basis or FBCS, user s then wil l be able to select an authori zed servic e using st andard cod es. (This will only apply to F BCS if the contracto r charged with maint aining tha t system a llocates d evelopment resources to the re lated chan ges.) Thes e more dis crete code s are nece ssary for transmitti ng a worka ble author ization ov er EDI. | ||
1069 | |||
1070 | User Inter faces | ||
1071 | Existing u ser interf aces will not be cha nged. A ne w, web-bas ed user in terface wi ll be deve loped for AAT, and t hat interf ace is des cribed in detail in Sections 6 .2.2.2.12, 6.2.2.2.1 1, and 6.2 .2.2.12. | ||
1072 | Hardware I nterfaces | ||
1073 | There are no planned changes t o the exis ting hardw are interf aces. | ||
1074 | Software I nterfaces | ||
1075 | AAT will b e a new we b-based GU I that wil l be used to manage authorizat ion reques ts that co me into th e AAT. | ||
1076 | Communicat ions Inter faces | ||
1077 | All involv ed systems will use the existi ng VA Tran smission C ontrol Pro tocol / In ternet Pro tocol (TCP / IP) net work. | ||
1078 | Memory Con straints | ||
1079 | The change s describe d in this document d o not impa ct any exi sting memo ry constra ints. | ||
1080 | Special Op erations | ||
1081 | There will be no cha nges relat ed to spec ial operat ions. | ||
1082 | Product Fe atures | ||
1083 | The AET wi ll accept and store authorizat ion reques ts, allowi ng Non-VA providers to request authoriza tions elec tronically rather th an the cur rent phone -calls-and -paper pro cess. | ||
1084 | A new AAT GUI will b e put into place tha t will all ow for the managemen t of queue s of incom ing author ization re quests. | ||
1085 | VistA Fee Basis will allow dis crete auth orized ser vices to b e selected for an au thorizatio n, allowin g for more accurate reporting of service s to Non-V A provider s. | ||
1086 | User Chara cteristics | ||
1087 | This devel opment wil l mostly a ffect revi ew nurses and Non-VA Care cler ks respons ible for m anaging au thorizatio ns for Non -VA Care. | ||
1088 | Dependenci es and Con straints | ||
1089 | The PC Aut horization s Complian ce will be undertake n in paral lel with t he PC X12 Attachment s Complian ce project . Both pro jects invo lve change s to the A AT. Care w ill need t o be taken by both p rojects to not undo the work o f the othe r, or to d eliver a n onworking product be cause one project is complete and the ot her is not . | ||
1090 | Specific R equirement s | ||
1091 | Database R epository | ||
1092 | All enhanc ements aff ect the ex isting AAT , AET, and VistA dat abases. No new datab ases are n eeded. | ||
1093 | System Fea tures | ||
1094 | Consult ID on Inpati ent Author izations | ||
1095 | Table 11 – Design El ements for Consult I Ds | ||
1096 | Requiremen t Number | ||
1097 | Design Ele ment | ||
1098 | Descriptio n | ||
1099 | FS-UN001-0 01 | ||
1100 | SD-UN001-0 01 | ||
1101 | 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 in V istA. | ||
1102 | FS-UN002-0 01 | ||
1103 | SD-UN002-0 01 | ||
1104 | 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. | ||
1105 | FS-UN005-0 01 | ||
1106 | SD-UN005-0 01 | ||
1107 | 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 in VistA. | ||
1108 | FS-UN005-0 02 | ||
1109 | SD-UN005-0 02 | ||
1110 | 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. | ||
1111 | FS-UN007-0 01 | ||
1112 | SD-UN007-0 01 | ||
1113 | 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 letter screen in VistA. | ||
1114 | FS-UN007-0 02 | ||
1115 | SD-UN007-0 02 | ||
1116 | When a Con sult ID is present i n the auth orization record, th e Consult ID shall b e included as part o f the Pati ent Episod e loop wit hin the ED I 278 resp onses. | ||
1117 | |||
1118 | Consult ID on Outpat ient Autho rizations | ||
1119 | Table 12 – Design El ements for Consult I Ds | ||
1120 | Requiremen t Number | ||
1121 | Design Ele ment | ||
1122 | Descriptio n | ||
1123 | FS-UN003-0 01 | ||
1124 | SD-UN003-0 01 | ||
1125 | 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. | ||
1126 | FS-UN003-0 02 | ||
1127 | SD-UN003-0 02 | ||
1128 | 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 Consult ID approv al date an d time sha ll be avai lable as p art of a r equested d ata export . | ||
1129 | FS-UN006-0 01 | ||
1130 | SD-UN006-0 01 | ||
1131 | 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 i n VistA. | ||
1132 | FS-UN006-0 02 | ||
1133 | SD-UN006-0 02 | ||
1134 | 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. | ||
1135 | FS-UN007-0 04 | ||
1136 | SD-UN007-0 04 | ||
1137 | 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 letter screen in VistA. | ||
1138 | FS-UN007-0 05 | ||
1139 | SD-UN007-0 05 | ||
1140 | 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 letter. | ||
1141 | Admission Date on In patient Au thorizatio ns | ||
1142 | Table 13 – Design El ements for Admission Date | ||
1143 | Requiremen t Number | ||
1144 | Design Ele ment | ||
1145 | Descriptio n | ||
1146 | FS-EP003-0 01 | ||
1147 | SD-EP003-0 01 | ||
1148 | 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. | ||
1149 | FS-EP003-0 02 | ||
1150 | SD-EP003-0 02 | ||
1151 | 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. | ||
1152 | FS-UN008-0 01 | ||
1153 | SD-UN008-0 01 | ||
1154 | 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, includi ng a futur e date of admission. | ||
1155 | FS-UN008-0 02 | ||
1156 | SD-UN008-0 02 | ||
1157 | During 10- 7078 autho rization u pdate, a V istA Fee u ser shall be allowed to edit a Date-of-A dmission, including a future d ate of adm ission. | ||
1158 | FS-UN010-0 01 | ||
1159 | SD-UN010-0 01 | ||
1160 | 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. | ||
1161 | FS-UN010-0 02 | ||
1162 | SD-UN010-0 02 | ||
1163 | 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. | ||
1164 | FS-UN012-0 01 | ||
1165 | SD-UN012-0 01 | ||
1166 | 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. | ||
1167 | FS-UN012-0 02 | ||
1168 | SD-UN012-0 02 | ||
1169 | 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. | ||
1170 | Multiple A uthorizati ons | ||
1171 | Table 14 – Design El ements for Multiple Authorizat ions | ||
1172 | Requiremen t Number | ||
1173 | Design Ele ment | ||
1174 | Descriptio n | ||
1175 | FS-UN014-0 01 | ||
1176 | SD-UN014-0 01 | ||
1177 | 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”. | ||
1178 | FS-UN014-0 02 | ||
1179 | SD-UN014-0 02 | ||
1180 | 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”. | ||
1181 | Master Aut horization Data | ||
1182 | A number o f new data fields wi ll be stor ed in Vist A (and, th erefore CD W and AAT) relating to authori zation dat a. Due to the number of fields included and the ma ximum cell size Word places on tables, s everal tab le rows ha ve been de voted to t he design element co ntaining t he list of fields. H owever, th ey should be conside red as a s ingle desi gn element . | ||
1183 | Table 15 – Design El ements for Master Au thorizatio ns | ||
1184 | Requiremen t Number | ||
1185 | Design Ele ment | ||
1186 | Descriptio n | ||
1187 | FS-EP008-0 01 | ||
1188 | FS-EP008-0 01-001 | ||
1189 | FS-EP008-0 01-002 | ||
1190 | FS-EP008-0 01-003 | ||
1191 | FS-EP008-0 01-005 | ||
1192 | FS-EP008-0 01-006 | ||
1193 | FS-EP008-0 01-007 | ||
1194 | FS-EP008-0 01-008 | ||
1195 | FS-EP008-0 01-009 | ||
1196 | FS-EP008-0 01-010 | ||
1197 | SD-EP008-0 01 | ||
1198 | The follow ing data s hall be st ored as pa rt of the master aut horization record: | ||
1199 | Up to two occurrence s of Patie nt Event T racking Nu mber | ||
1200 | Authorizat ion-type ( 10-7078/10 -7079) | ||
1201 | Category C ode (UM01) | ||
1202 | Certificat ion Type C ode (UM02) | ||
1203 | Service Lo cation (UM 04) | ||
1204 | Health Ser vices Deli very Quant ity Qualif ier (HSD01 ) | ||
1205 | Related Ca use inform ation (UM0 5) | ||
1206 | Level of S ervice Cod e (UM06) | ||
1207 | Current Co ndition Co de (UM07) | ||
1208 | FS-EP008-0 01-011 | ||
1209 | FS-EP008-0 01-012 | ||
1210 | FS-EP008-0 01-013 | ||
1211 | FS-EP008-0 01-014 | ||
1212 | FS-EP008-0 01-015 | ||
1213 | FS-EP008-0 01-016 | ||
1214 | FS-EP008-0 01-017 | ||
1215 | FS-EP008-0 01-018 | ||
1216 | FS-EP008-0 01-019 | ||
1217 | FS-EP008-0 01-020 | ||
1218 | FS-EP008-0 01-021 | ||
1219 | FS-EP008-0 01-022 | ||
1220 | FS-EP008-0 01-023 | ||
1221 | FS-EP008-0 01-024 | ||
1222 | FS-EP008-0 01-025 | ||
1223 | FS-EP008-0 01-031 | ||
1224 | FS-EP008-0 01-032 | ||
1225 | FS-EP008-0 01-033 | ||
1226 | FS-EP008-0 01-034 | ||
1227 | |||
1228 | Prognosis Code (UM08 ) | ||
1229 | Release of Informati on Code (U M09) | ||
1230 | Delay Reas on Code (U M10) | ||
1231 | Up to eigh t occurren ces of Pat ient Diagn osis Info (HI segmen t) | ||
1232 | HSD Reques t Quantity (HSD02) | ||
1233 | HSD Reques t Units Co de (HSD03) | ||
1234 | HSD Reques t Quantity Qualifier (HSD01) | ||
1235 | HSD Reques t Selectio n (HSD04) | ||
1236 | HSD Reques t Time Per iod (HSD05 ) | ||
1237 | HSD Reques t Periods (HSD06) | ||
1238 | HSD Reques t Pattern Code (HSD0 7) | ||
1239 | HSD Reques t Pattern Period (HS D08) | ||
1240 | HSD Respon se Quantit y (HSD02) | ||
1241 | HSD Respon se Units C ode (HSD03 ) | ||
1242 | HSD Respon se Quantit y Qualifie r (HSD01) | ||
1243 | HCR Respon se Action Code (HCR0 1) | ||
1244 | HCR Respon se Referen ce Identif ication (H CR02) | ||
1245 | HCR Respon se Industr y Code (HC R03) | ||
1246 | HCR Respon se Code (H CR04) | ||
1247 | FS-EP008-0 01-035 | ||
1248 | FS-EP008-0 01-036 | ||
1249 | FS-EP008-0 01-037 | ||
1250 | FS-EP008-0 01-038 | ||
1251 | FS-EP008-0 01-039 | ||
1252 | FS-EP008-0 01-040 | ||
1253 | FS-EP008-0 01-041 | ||
1254 | FS-EP008-0 01-042 | ||
1255 | FS-EP008-0 01-043 | ||
1256 | FS-EP008-0 01-044 | ||
1257 | FS-EP008-0 01-045 | ||
1258 | FS-EP008-0 01-046 | ||
1259 | FS-EP008-0 01-047 | ||
1260 | FS-EP008-0 01-048 | ||
1261 | FS-EP008-0 01-049 | ||
1262 | FS-EP008-0 01-050 | ||
1263 | FS-EP008-0 01-051 | ||
1264 | FS-EP008-0 01-052 | ||
1265 | FS-EP008-0 01-053 | ||
1266 | |||
1267 | Accident D ate | ||
1268 | Last Menst rual Perio d Date | ||
1269 | Estimated Date of Bi rth | ||
1270 | Onset Date | ||
1271 | Event Date s | ||
1272 | Admission Date | ||
1273 | Discharge Date | ||
1274 | CRC Reques t Ambulanc e Certific ation Info rmation | ||
1275 | CRC Reques t Chiropra ctic Certi fication | ||
1276 | CRC Reques t Durable Medical Eq uipment In formation | ||
1277 | CRC Reques t Oxygen T herapy Cer tification Informati on | ||
1278 | CRC Reques t Function al Limitat ion Inform ation | ||
1279 | CRC Reques t Activiti es Permitt ed Informa tion | ||
1280 | CRC Reques t Mental S tatus Info rmation | ||
1281 | CL1 Reques t Institut ion Claim Code | ||
1282 | CR1 Reques t Ambulanc e Transpor t Informat ion | ||
1283 | CR2 Reques t Spinal M anipulatio n Informat ion | ||
1284 | CR5 Reques t Home Oxy gen Therap y Informat ion | ||
1285 | CR6 Reques t Home Hea lth Care I nformation | ||
1286 | FS-EP008-0 01-066 | ||
1287 | FS-EP008-0 01-068 | ||
1288 | FS-EP008-0 01-069 | ||
1289 | FS-EP008-0 01-070 | ||
1290 | FS-EP008-0 01-072 | ||
1291 | FS-EP008-0 01-073 | ||
1292 | |||
1293 | Up to 10 P aperwork R equest seg ments | ||
1294 | Message Te xt Request | ||
1295 | Message T ext Respon se | ||
1296 | Up to 14 o ccurrences of Patien t Provider Request I nformation (2010EA) | ||
1297 | Up to 5 oc currences of Patient Event Tra nsport Inf ormation ( 2010EB) | ||
1298 | Up to 3 oc currences of Patient Event Oth er Utiliza tion Manag ement Orga nization ( UMO) Name Informatio n (2010EC) | ||
1299 | Authorizat ion Status | ||
1300 | New values for the s tatus of a n authoriz ation will be added allowing t he system to track w here in th e authoriz ation work flow a giv en authori zation fal ls, and wh ether it i s ready to be used i n response to an aut horization query. | ||
1301 | Table 16 – Authoriza tion Statu s/Workflow | ||
1302 | Status | ||
1303 | Current/Ne w | ||
1304 | Workflow l evel | ||
1305 | Meaning | ||
1306 | Incomplete (I) | ||
1307 | Current | ||
1308 | 1 | ||
1309 | When a mas ter author ization is first cre ated, the Authorizat ion Status is set to INCOMPLET E. | ||
1310 | Active (A) | ||
1311 | New | ||
1312 | 2 | ||
1313 | When a mas ter author ization is ready to be issued, the autho rization c lerk sets the status to ACTIVE . | ||
1314 | Reject (R) | ||
1315 | New | ||
1316 | 2 | ||
1317 | A master a uthorizati on receive d via a 27 8 request that has b een return ed for cor rection by the provi der, Once corrected, the autho rization m ay be set to ACTIVE. | ||
1318 | Complete ( C) | ||
1319 | Current | ||
1320 | 3 | ||
1321 | 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. | ||
1322 | Denied (D) | ||
1323 | New | ||
1324 | 4 | ||
1325 | A master a uthorizati on receive d via a 27 8 request that has b een denied by the VA and no fu rther acti on is allo wed. | ||
1326 | Closed (X) | ||
1327 | |||
1328 | New | ||
1329 | 4 | ||
1330 | 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. | ||
1331 | Cancelled (DC) | ||
1332 | Current | ||
1333 | 4 | ||
1334 | A master a uthorizati on can be cancelled at either workflow l evel 1 or 2. | ||
1335 | Table 17 – Design El ements for Authoriza tion Statu s | ||
1336 | Requiremen t Number | ||
1337 | Design Ele ment | ||
1338 | Descriptio n | ||
1339 | FS-UN014-0 03 | ||
1340 | SD-UN014-0 03 | ||
1341 | On master authorizat ion creati on, the au thorizatio n status i n VistA sh all be set to “I”, I NCOMPLETE. | ||
1342 | FS-UN014-0 04 | ||
1343 | SD-UN014-0 04 | ||
1344 | 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 in Vi stA. | ||
1345 | FS-UN014-0 05 | ||
1346 | SD-UN014-0 05 | ||
1347 | 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. | ||
1348 | Authorizat ion Export | ||
1349 | Table 18 – Design El ements for Authoriza tion Expor t | ||
1350 | Requiremen t Number | ||
1351 | Design Ele ment | ||
1352 | Descriptio n | ||
1353 | FS-EP011-0 01 | ||
1354 | SD-EP011-0 01 | ||
1355 | Station-of -Jurisdict ion shall be availab le as part of the da ta export from CDW w hen reques ted as par t of the e xport para meters. | ||
1356 | |||
1357 | Healthcare Services Delivery ( HSD) Looku p Table | ||
1358 | Table 19 – Design El ements for HSD | ||
1359 | Requiremen t Number | ||
1360 | Design Ele ment | ||
1361 | Descriptio n | ||
1362 | FS-EP008-0 28 | ||
1363 | SD-EP008-0 28 | ||
1364 | A lookup t able shall be requir ed in Vist A Fee Basi s so an au thorizatio n clerk ca n select a Quantity Qualifier as defined in the AS C X12 X217 standards , (element HSD01). | ||
1365 | FS-EP008-0 29 | ||
1366 | SD-EP008-0 29 | ||
1367 | 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). | ||
1368 | Outpatient Authoriza tion Servi ces | ||
1369 | Table 20 – Design El ements for Outpatien t Services | ||
1370 | Requiremen t Number | ||
1371 | Design Ele ment | ||
1372 | Descriptio n | ||
1373 | FS-EP007-0 06 | ||
1374 | FS-EP007-0 06-001 | ||
1375 | FS-EP007-0 06-002 | ||
1376 | FS-EP007-0 06-003 | ||
1377 | FS-EP007-0 06-004 | ||
1378 | SD-EP007-0 06 | ||
1379 | The 10-707 9 Authoriz ation form generated in VistA Fee shall be modifie d to: | ||
1380 | display th e services descripti on (UM03) | ||
1381 | display th e services quantity (HSD02) | ||
1382 | display th e services units (HS D01) | ||
1383 | display th e measurem ent code ( HSD03) | ||
1384 | FS-EP007-0 07 | ||
1385 | |||
1386 | SD-EP007-0 07 | ||
1387 | If the Res ponse MSG – Message Text is pr esent, it shall be p rinted in the servic es area of the autho rization. | ||
1388 | FS-EP007-0 08 | ||
1389 | SD-EP007-0 08 | ||
1390 | The revise d 10-7079 authorizat ion form s hall be pr intable. | ||
1391 | FS-EP007-0 09 | ||
1392 | FS-EP007-0 09-001 | ||
1393 | FS-EP007-0 09-002 | ||
1394 | FS-EP007-0 09-003 | ||
1395 | FS-EP007-0 09-004 | ||
1396 | |||
1397 | SD-EP007-0 09 | ||
1398 | The 10-707 9 Authoriz ation lett er generat ed in Vist A Fee shal l be modif ied to: | ||
1399 | display th e services descripti on (UM03) | ||
1400 | display th e services quantity (HSD02) | ||
1401 | display th e services units (HS D01) | ||
1402 | display Me asurement Code (HSD0 3) | ||
1403 | FS-EP007-0 10 | ||
1404 | |||
1405 | |||
1406 | SD-EP007-0 10 | ||
1407 | 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 | ||
1408 | FS-EP007-0 11 | ||
1409 | SD-EP007-0 11 | ||
1410 | The revise d 10-7079 authorizat ion letter shall be printable. | ||
1411 | Inpatient Authorizat ion Servic es | ||
1412 | Table 21 – Design El ements for Inpatient Services | ||
1413 | Requiremen t Number | ||
1414 | Design Ele ment | ||
1415 | Descriptio n | ||
1416 | FS-EP007-0 16 | ||
1417 | FS-EP007-0 16-001 | ||
1418 | FS-EP007-0 16-002 | ||
1419 | FS-EP007-0 16-003 | ||
1420 | FS-EP007-0 16-004 | ||
1421 | |||
1422 | SD-EP007-0 16 | ||
1423 | The 10-707 8 Authoriz ation form generated in VistA Fee shall be modifie d to: | ||
1424 | display th e services descripti on (UM03) | ||
1425 | display th e services quantity (HSD02) | ||
1426 | display th e services units (HS D01) | ||
1427 | display Me asurement Code (HSD0 3) | ||
1428 | FS-EP007-0 17 | ||
1429 | SD-EP007-0 17 | ||
1430 | 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. | ||
1431 | FS-EP007-0 18 | ||
1432 | SD-EP007-0 18 | ||
1433 | The revise d 10-7078 authorizat ion form s hall be pr intable. | ||
1434 | FS-EP007-0 19 | ||
1435 | FS-EP007-0 19-001 | ||
1436 | FS-EP007-0 19-002 | ||
1437 | FS-EP007-0 19-003 | ||
1438 | FS-EP007-0 19-004 | ||
1439 | SD-EP007-0 19 | ||
1440 | The 10-707 8 Authoriz ation lett er generat ed in Vist A Fee shal l be modif ied to: | ||
1441 | display th e services descripti on (UM03) | ||
1442 | display th e services quantity (HSD02) | ||
1443 | display th e services units (HS D01) | ||
1444 | display Me asurement Code (HSD0 3) | ||
1445 | FS-EP007-0 20 | ||
1446 | SD-EP007-0 20 | ||
1447 | 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. | ||
1448 | FS-EP007-0 21 | ||
1449 | SD-EP007-0 21 | ||
1450 | The revise d 10-7078 authorizat ion letter shall be printable. | ||
1451 | Authorizat ion Servic es Entry | ||
1452 | VistA Fee Basis will have addi tional fie lds added to the wor kflow to c reate a ne w authoriz ation in o rder to ca pture new data eleme nts necess ary for cr eating a u seful auth orization transactio n. | ||
1453 | Table 22 – Design El ements for Authoriza tion Servi ces Entry | ||
1454 | Requiremen t Number | ||
1455 | Design Ele ment | ||
1456 | Descriptio n | ||
1457 | FS-EP007-0 26 | ||
1458 | FS-EP007-0 26-01 | ||
1459 | FS-EP007-0 26-02 | ||
1460 | FS-EP007-0 26-03 | ||
1461 | SD-EP007-0 26 | ||
1462 | The entry functional ity shall allow the user to en ter the on e set of H SD informa tion for e ach master authoriza tion: | ||
1463 | HSD quanti ty qualifi er (HSD01) | ||
1464 | HSD quanti ty (HSD02) | ||
1465 | HSD Units (HSD03) | ||
1466 | FS-EP007-0 26-027 | ||
1467 | SD-EP007-0 26-027 | ||
1468 | If the HSD Quantity Qualifier is present , the HSD Quantity w ill be req uired. | ||
1469 | |||
1470 | Authorizat ion Reques t Queues G UI | ||
1471 | |||
1472 | Figure 4 – Queues GU I | ||
1473 | Table 23 – Design El ements for Request Q ueues GUI | ||
1474 | Requiremen t Number | ||
1475 | Design Ele ment | ||
1476 | Descriptio n | ||
1477 | FS-UN022A- 001 | ||
1478 | SD-UN022A- 001 | ||
1479 | The Queues GUI shall display a list of a ll queues. | ||
1480 | FS-UN022A- 002 | ||
1481 | SD-UN022A- 002 | ||
1482 | The Queues GUI shall display H igh Priori ty queues separately from norm al process ing queues . | ||
1483 | FS-UN022A- 003 | ||
1484 | SD-UN022A- 003 | ||
1485 | The Queues GUI shall display f or each qu eue, the n umber of r equest in the queue. | ||
1486 | FS-UN022A- 004 | ||
1487 | FS-UN022A- 004-001 | ||
1488 | FS-UN022A- 004-002 | ||
1489 | FS-UN022A- 004-003 | ||
1490 | FS-UN022A- 004-004 | ||
1491 | FS-UN022A- 004-005 | ||
1492 | FS-UN022A- 004-006 | ||
1493 | FS-UN022A- 004-007 | ||
1494 | FS-UN022A- 004-008 | ||
1495 | FS-UN022A- 004-009 | ||
1496 | SD-UN022A- 004 | ||
1497 | 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: | ||
1498 | Patient Na me | ||
1499 | Patient Id | ||
1500 | Patient Da te of Birt h | ||
1501 | Date added to queue | ||
1502 | Days in qu eue (calcu lated) | ||
1503 | Value in U M01 | ||
1504 | Value in U M02 | ||
1505 | Value in U M03 | ||
1506 | Date range | ||
1507 | FS-UN022A- 008 | ||
1508 | SD-UN022A- 008 | ||
1509 | The Queues GUI shall allow a u ser to sel ect a requ est from t he queue. | ||
1510 | FS-UN022A- 009 | ||
1511 | SD-UN022A- 009 | ||
1512 | 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. | ||
1513 | FS-UN022A- 010 | ||
1514 | |||
1515 | SD-UN022A- 010 | ||
1516 | Once an un solicited master aut horization has the s tatus chan ged from I NCOMPLETE (I), it sh all no lon ger be ass igned to a queue. | ||
1517 | FS-UN022A- 011 | ||
1518 | SD-UN022A- 011 | ||
1519 | A user sha ll only be allowed t o view the number of incoming 278 Reques ts. | ||
1520 | |||
1521 | |||
1522 | Authorizat ion Reques t Processi ng GUI – S ummary | ||
1523 | |||
1524 | Figure 5 – Unsolicit ed 278 Req uests GUI – Summary View | ||
1525 | |||
1526 | Table 24 – Design El ements for Request P rocessing GUI | ||
1527 | Requiremen t Number | ||
1528 | Design Ele ment | ||
1529 | Descriptio n | ||
1530 | FS-UN015-0 01 | ||
1531 | FS-UN015-0 01-001 | ||
1532 | FS-UN015-0 01-002 | ||
1533 | FS-UN015-0 01-003 | ||
1534 | FS-UN015-0 01-004 | ||
1535 | FS-UN015-0 01-005 | ||
1536 | FS-UN015-0 01-006 | ||
1537 | FS-UN015-0 01-007 | ||
1538 | FS-UN015-0 01-008 | ||
1539 | |||
1540 | SD-UN015-0 01 | ||
1541 | 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: | ||
1542 | • Patient Name | ||
1543 | • Patient ID | ||
1544 | • Authoriz ation Date | ||
1545 | • Referenc e Number | ||
1546 | • Authoriz ation FROM date | ||
1547 | • Authoriz ation TO d ate | ||
1548 | • 278 Requ est date | ||
1549 | • 278 assi gned queue | ||
1550 | FS-UN015-0 02 | ||
1551 | FS-UN015-0 02-001 | ||
1552 | FS-UN015-0 02-002 | ||
1553 | FS-UN015-0 02-003 | ||
1554 | FS-UN015-0 02-004 | ||
1555 | FS-UN015-0 02-005 | ||
1556 | FS-UN015-0 02-006 | ||
1557 | SD-UN015-0 02 | ||
1558 | The 278 Na vigation V iew shall: | ||
1559 | • Display request se ctions,Req uestor Inf o, Patient Info, opt ional Depe ndent Info , Episode of Care In fo and Ser vice Info. | ||
1560 | • Allow a user to se lect any a vailable o f the disp layed sect ions and p opulate th e 278 Requ est View w ith the de tail infor mation and populate the 278 Re quest View | ||
1561 | • Allow th e user to expand/col lapse a se ction view | ||
1562 | • If a sec tion is no t present in the 278 Request, the user s hall not b e able to select it | ||
1563 | • If a sec tion is no t present in the 278 Request, the segmen t shall in dicate tha t it is un available | ||
1564 | • If a sec tion has m ultiple oc currences of data el ements, th ere shall be a numer ic indicat or on the number of occurrence s | ||
1565 | |||
1566 | Authorizat ion Reques t Processi ng GUI – D etails | ||
1567 | |||
1568 | Figure 6 – Unsolicit ed 278 Req uest GUI – Detail Vi ew | ||
1569 | Table 25 – Design El ements for Request P rocessing GUI | ||
1570 | Requiremen t Number | ||
1571 | Design Ele ment | ||
1572 | Descriptio n | ||
1573 | FS-UN015-0 03 | ||
1574 | SD-UN015-0 03 | ||
1575 | The HL ele ment data shall not be viewabl e. | ||
1576 | FS-UN015-0 04 | ||
1577 | FS-UN015-0 04-001 | ||
1578 | FS-UN015-0 04-002 | ||
1579 | FS-UN015-0 04-003 | ||
1580 | FS-UN015-0 04-004 | ||
1581 | FS-UN015-0 04-005 | ||
1582 | FS-UN015-0 04-006 | ||
1583 | FS-UN015-0 04-007 | ||
1584 | FS-UN015-0 04-008 | ||
1585 | FS-UN015-0 04-009 | ||
1586 | SD-UN015-0 04 | ||
1587 | An NVCC us er shall b e able to view the d ata in a 2 78 Request : | ||
1588 | View the i nformation in the re quired 201 0B REQUEST OR request loop. | ||
1589 | View the i nformation in the re quired 201 0C SUBSCRI BER reques t loop. | ||
1590 | If present , view the informati on in the 2010D DEPE NDENT requ est loop. | ||
1591 | View the i nformation in the re quired 200 0E PATIENT request l oop. | ||
1592 | View the i nformation in the si tuational 2010EA PAT IENT EVENT PROVIDER NAME reque st loop. | ||
1593 | View the i nformation in the si tuational 2010EB PAT IENT EVENT TRANSPORT request l oop. | ||
1594 | View the i nformation in the si tuational 2010EC PAT IENT EVENT OTHER UMO NAME requ est loop. | ||
1595 | If present , view the informati on in the 2000F SERV ICE reques t loop. | ||
1596 | If present , view the informati on in the 2010F SERV ICE PROVID ER request loop. | ||
1597 | View the i nformation in the si tuational 2010EA PAT IENT EVENT PROVIDER NAME reque st loop. | ||
1598 | View the i nformation in the si tuational 2010EB PAT IENT EVENT TRANSPORT request l oop. | ||
1599 | View the i nformation in the si tuational 2010EC PAT IENT EVENT OTHER UMO NAME requ est loop. | ||
1600 | If present , view the informati on in the 2000F SERV ICE reques t loop. | ||
1601 | If present , view the informati on in the 2010F SERV ICE PROVID ER request loop. | ||
1602 | FS-UN015-0 05 | ||
1603 | FS-UN015-0 05-001 | ||
1604 | FS-UN015-0 05-002 | ||
1605 | SD-UN015-0 05 | ||
1606 | There shal l be a sum mary scree n of all 2 78 Request loops: | ||
1607 | For each l oop, the l oop data s hall be di splayed. | ||
1608 | If data is present i n a loop t here shall be an ind icator set so a user can deter mine what informatio n needs to be review ed. | ||
1609 | FS-UN015-0 06 | ||
1610 | FS-UN015-0 06-001 | ||
1611 | FS-UN015-0 06-002 | ||
1612 | FS-UN015-0 06-003 | ||
1613 | FS-UN015-0 06-004 | ||
1614 | FS-UN015-0 06-005 | ||
1615 | FS-UN015-0 06-006 | ||
1616 | FS-UN015-0 06-007 | ||
1617 | FS-UN015-0 06-008 | ||
1618 | SD-UN015-0 06 | ||
1619 | The user s hall be ab le to view a summary of repeat ing segmen ts: | ||
1620 | The user s hall be ab le to see the number of occurr ences in t he segment . | ||
1621 | The user s hall be ab le to see summary de tail of ea ch segment . | ||
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 | Display al l populate d elements in the 27 8 Request for the se lected 278 loop. | ||
1624 | If a segme nt/element has multi ple occurr ences, all currents shall be d isplayed. | ||
1625 | The user s hall not b e allowed to change any of the data in t he 278 Req uest View (Read Only ). | ||
1626 | 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). | ||
1627 | The user s hall be ab le to view the attac hment(s) s tored in t he 275 Rep ository. | ||
1628 | FS-UN015-0 08 | ||
1629 | SD-UN015-0 08 | ||
1630 | A user sha ll be able to view e ach segmen t of data stored as part of th e 278 requ est. | ||
1631 | FS-UN015-0 09 | ||
1632 | SD-UN015-0 09 | ||
1633 | A user sha ll not be able to ch ange store d request data. | ||
1634 | FS-UN015-0 10 | ||
1635 | SD-UN015-0 10 | ||
1636 | A user sha ll not be allowed to delete st ored reque st informa tion. | ||
1637 | FS-UN015-0 11 | ||
1638 | FS-UN015-0 11-001 | ||
1639 | FS-UN015-0 11-002 | ||
1640 | FS-UN015-0 11-003 | ||
1641 | SD-UN015-0 11 | ||
1642 | If the aut horization clerk cli cks on the ACCEPT bu tton, the following shall occu r: | ||
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 | The HCR01 field in t he master authorizat ion shall be populat ed with “A 1” | ||
1645 | FS-UN016-0 01 | ||
1646 | |||
1647 | SD-UN016-0 01 | ||
1648 | 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) | ||
1649 | FS-UN017-0 10 | ||
1650 | SD-UN017-0 10 | ||
1651 | Upon denia l, the 278 record sh all be ass igned to t he 278 Den ied queue. | ||
1652 | FS-UN018-0 01 | ||
1653 | SD-UN018-0 01 | ||
1654 | UM01 shall be viewab le in the GUI. | ||
1655 | FS-UN019-0 01 | ||
1656 | SD-UN019-0 01 | ||
1657 | UM02 shall be viewab le in the GUI. | ||
1658 | FS-UN020-0 03 | ||
1659 | SD-UN020-0 03 | ||
1660 | UM03 shall be viewab le in the GUI. | ||
1661 | FS-UN021-0 02 | ||
1662 | SD-UN021-0 02 | ||
1663 | UM04 shall be viewab le in the GUI. | ||
1664 | Request Pr ocessing C ode Lookup Tables | ||
1665 | Table 26 – Design El ements for Code Look up Tables | ||
1666 | Requiremen t Number | ||
1667 | Design Ele ment | ||
1668 | Descriptio n | ||
1669 | FS-EP007-0 33FS-EP007 -034 | ||
1670 | FS-EP007-0 35 | ||
1671 | FS-EP007-0 36 | ||
1672 | FS-EP007-0 37 | ||
1673 | FS-EP007-0 38 | ||
1674 | FS-EP007-0 39 | ||
1675 | FS-EP007-0 40 | ||
1676 | FS-EP007-0 41 | ||
1677 | FS-EP007-0 42 | ||
1678 | FS-EP007-0 43 | ||
1679 | FS-EP007-0 44 | ||
1680 | FS-EP007-0 48 | ||
1681 | FS-EP007-0 49 | ||
1682 | FS-EP007-0 50 | ||
1683 | FS-EP007-0 51 | ||
1684 | FS-EP007-0 53 | ||
1685 | FS-EP007-0 54 | ||
1686 | FS-EP007-0 55 | ||
1687 | FS-EP007-0 56 | ||
1688 | FS-EP007-0 57 | ||
1689 | FS-EP007-0 58 | ||
1690 | FS-EP007-0 59 | ||
1691 | FS-EP007-0 60 | ||
1692 | FS-EP007-0 61 | ||
1693 | FS-EP007-0 62 | ||
1694 | FS-EP007-0 63 | ||
1695 | FS-EP007-0 64 | ||
1696 | FS-EP007-0 65 | ||
1697 | FS-EP007-0 66 | ||
1698 | FS-EP007-0 67 | ||
1699 | FS-EP007-0 68 | ||
1700 | FS-EP007-0 69 | ||
1701 | FS-EP007-0 70 | ||
1702 | FS-EP007-0 71 | ||
1703 | FS-EP007-0 72 | ||
1704 | FS-EP007-0 73 | ||
1705 | FS-EP007-0 74 | ||
1706 | FS-EP007-0 75 | ||
1707 | FS-EP007-0 76 | ||
1708 | FS-EP007-0 77 | ||
1709 | SD-EP007-0 33 | ||
1710 | The follow ing elemen ts require lookup ta bles: | ||
1711 | NM101 | ||
1712 | NM102 | ||
1713 | NM108 | ||
1714 | PER03 | ||
1715 | PER07 | ||
1716 | REF01 | ||
1717 | PRV01 | ||
1718 | N403 | ||
1719 | N407 | ||
1720 | DMG01 | ||
1721 | DMG03 | ||
1722 | TRN01 | ||
1723 | UM01 | ||
1724 | UM02 | ||
1725 | UM03 | ||
1726 | UM04 | ||
1727 | UM06 | ||
1728 | HCR01 | ||
1729 | HCR03 | ||
1730 | DTP01 | ||
1731 | DTP02 | ||
1732 | HI0X-1 | ||
1733 | HI0X-2 | ||
1734 | HI0X-3 | ||
1735 | CL101 | ||
1736 | CL102 | ||
1737 | CL103 | ||
1738 | CR103 | ||
1739 | CR105 | ||
1740 | CR203 | ||
1741 | CR503 | ||
1742 | CR504 | ||
1743 | CR517 | ||
1744 | CR518 | ||
1745 | CR601 | ||
1746 | CR603 | ||
1747 | CR607 | ||
1748 | CR608 | ||
1749 | PWK01 | ||
1750 | PWK02 | ||
1751 | Note: Elem ent UM03 s hall indic ate if the service i s supporte d for each record in the UM03 lookup tab le. | ||
1752 | 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. | ||
1753 | Request Pr ocessing E vent Loggi ng | ||
1754 | Table 27 – Design El ements for Event Log ging | ||
1755 | Requiremen t Number | ||
1756 | Design Ele ment | ||
1757 | Descriptio n | ||
1758 | FS-EP007-0 90 | ||
1759 | FS-EP007-0 90-001 | ||
1760 | FS-EP007-0 90-002 | ||
1761 | FS-EP007-0 90-003 | ||
1762 | FS-EP007-0 90-004 | ||
1763 | FS-EP007-0 90-005 | ||
1764 | SD-EP007-0 90 | ||
1765 | For each a ction that AAT perfo rms, the f ollowing i nformation shall be written to the AAT e vent log: | ||
1766 | Actor init iating the event | ||
1767 | Date/time of the eve nt | ||
1768 | Action bei ng execute d | ||
1769 | Result of executed a ction | ||
1770 | 278 Reques t-ID | ||
1771 | FS-EP007-0 91 | ||
1772 | FS-EP007-0 91-001 | ||
1773 | FS-EP007-0 91-002 | ||
1774 | FS-EP007-0 91-003 | ||
1775 | FS-EP007-0 91-004 | ||
1776 | FS-EP007-0 91-005 | ||
1777 | SD-EP007-0 91 | ||
1778 | An authori zed user s hall be ab le to sear ch the AAT log by:• | ||
1779 | 278 Provid er Request identifie r | ||
1780 | Patient ID | ||
1781 | Patient Na me | ||
1782 | 278 Reques t date | ||
1783 | Actor init iating the event | ||
1784 | FS-EP007-0 92 | ||
1785 | SD-EP007-0 92 | ||
1786 | 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. | ||
1787 | Request Pr ocessing Q ueues | ||
1788 | All incomi ng 278 aut horization requests shall be r outed to q ueues base d on crite ria in the UM data s egment. Th e queues s hall have the follow ing “Categ ory of Req uest” valu es. | ||
1789 | Table 28 – Design El ements for Request Q ueues | ||
1790 | Requiremen t Number | ||
1791 | Design Ele ment | ||
1792 | Descriptio n | ||
1793 | FS-EP010-0 01 | ||
1794 | SD-EP010-0 01 | ||
1795 | There shal l be an “I ncoming Re quest” que ue. | ||
1796 | FS-EP010-0 02 | ||
1797 | SD-EP010-0 02 | ||
1798 | There shal l be a “Pa tient Prob lem” queue . | ||
1799 | FS-EP010-0 03 | ||
1800 | SD-EP010-0 03 | ||
1801 | There shal l be a “Pr ovider Pro blem” queu e. | ||
1802 | FS-EP010-0 04 | ||
1803 | SD-EP010-0 04 | ||
1804 | There shal l be an “E mergency R equest” qu eue. | ||
1805 | FS-EP010-0 05 | ||
1806 | SD-EP010-0 05 | ||
1807 | There shal l be a “Me ntal Healt h” queue. | ||
1808 | FS-EP010-0 06 | ||
1809 | SD-EP010-0 06 | ||
1810 | There shal l be an “I npatient R equest” qu eue. | ||
1811 | FS-EP010-0 07 | ||
1812 | SD-EP010-0 07 | ||
1813 | There shal l be an “O utpatient Request” q ueue. | ||
1814 | FS-EP010-0 08 | ||
1815 | SD-EP010-0 08 | ||
1816 | There shal l be a “De ntal Reque st” queue. | ||
1817 | FS-EP010-0 11 | ||
1818 | SD-EP010-0 11 | ||
1819 | There shal l be a “De nied Reque st” queue. | ||
1820 | FS-EP010-0 12 | ||
1821 | SD-EP010-0 12 | ||
1822 | An authori zation sha ll only be assigned to a singl e queue. | ||
1823 | FS-EP010-0 13 | ||
1824 | SD-EP010-0 18 | ||
1825 | An authori zed user s hall be ab le to assi gn a 278 R equest to a differen t queue. | ||
1826 | FS-EP010-0 19 | ||
1827 | SD-EP010-0 19 | ||
1828 | 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. | ||
1829 | FS-UN022A- 005 | ||
1830 | SD-UN022A- 005 | ||
1831 | A user sha ll be able to sort o n any fiel d in the d etailed qu eued list. | ||
1832 | FS-UN022A- 006 | ||
1833 | SD-UN022A- 006 | ||
1834 | A user sha ll be able to filter by any fi eld in the lists. | ||
1835 | FS-UN022A- 007 | ||
1836 | SD-UN022A- 007 | ||
1837 | 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 . | ||
1838 | Authorizat ion Reques t Queuing Rules | ||
1839 | Table 29 – Design El ements for Authoriza tion Reque st Queuing | ||
1840 | Requiremen t Number | ||
1841 | Design Ele ment | ||
1842 | Descriptio n | ||
1843 | FS-UN021-0 01 | ||
1844 | SD-UN021-0 01 | ||
1845 | The AET sh all route 278 Reques t based on routing r ules to be developed by the VA Policy Ma nagement D epartment (PMD). Onc e the PMD has devise d the rule s, this do cument wil l be updat ed. | ||
1846 | FS-EP009-0 09 | ||
1847 | SD-EP009-0 09 | ||
1848 | By default , all othe r 278 Requ est shall be routed to the “Ou tpatient R equest” qu eue. | ||
1849 | Authorizat ion Reques t Receptio n and Queu ing | ||
1850 | Table 30 – Design El ements for Request R eception | ||
1851 | Requiremen t Number | ||
1852 | Design Ele ment | ||
1853 | Descriptio n | ||
1854 | FS-EP010-0 29 | ||
1855 | SD-EP010-0 29 | ||
1856 | AET shall route the 278 Reques t to the l ocal VAMC “Incoming Request” q ueue for p rocessing. | ||
1857 | FS-EP010-0 25 | ||
1858 | FS-EP010-0 25-001 | ||
1859 | FS-EP010-0 25-002 | ||
1860 | FS-EP010-0 25-003 | ||
1861 | SD-EP010-0 25 | ||
1862 | After perf orming the provider validation explained in SD-EP0 10-026, AE T shall pe rform the following checks on a request from the “ Incoming R equest” qu eue: | ||
1863 | Verify tha t the pati ent identi fied in th e 278 is a patient o n the VAMC VistA Fee Patient f ile. | ||
1864 | If the pat ient is no t found in the patie nt file, A ET shall w rite an ev ent to the AET event file. | ||
1865 | If the pat ient is no t found in the patie nt file, A ET shall r oute the 2 78 Request to the “P atient Not Found” qu eue after validating providers . | ||
1866 | FS-EP010-0 26 | ||
1867 | FS-EP010-0 26-001 | ||
1868 | FS-EP010-0 26-002 | ||
1869 | FS-EP010-0 26-003 | ||
1870 | SD-EP010-0 26 | ||
1871 | AET shall validate t he provide rs: | ||
1872 | Verify tha t the prov ider submi tting the 278 Reques t is allow ed to cond uct busine ss with th e VA. | ||
1873 | If the req uestor is identified that is n ot allowed to conduc t business with VA, AET shall write an e ntry to th e AET even t log iden tifying th e 278 Requ est, vendo r and mess age indica ting vendo r is unaut horized. | ||
1874 | Send a 278 AAA Denie d Error Re sponse | ||
1875 | FS-EP010-0 27 | ||
1876 | FS-EP010-0 27-001 | ||
1877 | FS-EP010-0 27-002 | ||
1878 | FS-EP010-0 27-003 | ||
1879 | SD-EP010-0 27 | ||
1880 | If loop 20 10EA is pr esent, AET shall: | ||
1881 | Verify tha t each pro vider in t he 2010EA loop is al lowed to c onduct bus iness with VA. | ||
1882 | If a provi der is ide ntified th at is not allowed to conduct b usiness wi th VA, AET shall wri te an entr y to the A ET event l og identif ying the 2 78 Request , vendor a nd message indicatin g vendor i s unauthor ized. | ||
1883 | Send a 278 AAA Denie d error re sponse | ||
1884 | FS-EP010-0 28 | ||
1885 | FS-EP010-0 28-001 | ||
1886 | FS-EP010-0 28-002 | ||
1887 | FS-EP010-0 28-003 | ||
1888 | SD-EP010-0 28 | ||
1889 | If loop 20 10FA is pr esent, AET shall: | ||
1890 | Verify tha t each pro vider in t he 2010FA loop is al lowed to c onduct bus iness with VA. | ||
1891 | If a provi der is ide ntified th at is not allowed to conduct b usiness wi th VA, AET shall wri te an entr y to the A ET event l og identif ying the 2 78 Request , vendor a nd message indicatin g vendor i s unauthor ized. | ||
1892 | Send a 278 AAA Denie d error re sponse | ||
1893 | Sensitive PHI Handli ng | ||
1894 | Table 31 – Design El ements for Sensitive PHI Handl ing | ||
1895 | Requiremen t Number | ||
1896 | Design Ele ment | ||
1897 | Descriptio n | ||
1898 | FS-EP007-0 96 | ||
1899 | SD-EP007-0 96 | ||
1900 | 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. | ||
1901 | |||
1902 | FS-EP007-0 97 | ||
1903 | SD-EP007-0 97 | ||
1904 | The AET sh all be abl e to ident ify a prov ider who h as restric ted access to PHI in formation. | ||
1905 | FS-EP007-0 98 | ||
1906 | SD-EP007-0 98 | ||
1907 | The AET sh all be abl e to ident ify a 278 Request as PHI-sensi tive. | ||
1908 | FS-EP007-0 99 | ||
1909 | SD-EP007-0 99 | ||
1910 | The defaul t setting for PHI-Se nsitive sh all be “NO ” for the 278 Reques t. | ||
1911 | Request an d Response Tracking | ||
1912 | Table 32 – Design El ements for Request a nd Respons e Tracking | ||
1913 | Requiremen t Number | ||
1914 | Design Ele ment | ||
1915 | Descriptio n | ||
1916 | FS-EP007-1 09 | ||
1917 | SD-EP007-1 09 | ||
1918 | A provider may submi t or resub mit a 278 Request fo r a single authoriza tion. | ||
1919 | FS-EP007-1 10 | ||
1920 | SD-EP007-1 10 | ||
1921 | Each reque st and cor responding response shall be u niquely id entified b y a single identifie r. | ||
1922 | FS-EP007-1 11 | ||
1923 | SD-EP007-1 11 | ||
1924 | Each reque st and cor responding response shall be s tored in p ersistent storage in AET. | ||
1925 | FS-EP007-1 12 | ||
1926 | SD-EP007-1 12 | ||
1927 | Date/time of each re quest shal l be store d. | ||
1928 | FS-EP007-1 13 | ||
1929 | SD-EP007-1 13 | ||
1930 | A user sha ll be able to view a uthorizati on request /response history in AAT GUI | ||
1931 | Request Va lidation – 2000E Pat ient Event Level Loo p | ||
1932 | Table 33 – Design El ements for Request V alidation | ||
1933 | Requiremen t Number | ||
1934 | Design Ele ment | ||
1935 | Descriptio n | ||
1936 | FS-EP007-1 14 | ||
1937 | FS-EP007-1 14-001 | ||
1938 | FS-EP007-1 14-002 | ||
1939 | FS-EP007-1 14-003 | ||
1940 | FS-EP007-1 14-004 | ||
1941 | FS-EP007-1 14-005 | ||
1942 | FS-EP007-1 14-006 | ||
1943 | FS-EP007-1 14-007 | ||
1944 | FS-EP007-1 14-008 | ||
1945 | FS-EP007-1 14-009 | ||
1946 | FS-EP007-1 14-010 | ||
1947 | FS-EP007-1 14-011 | ||
1948 | FS-EP007-1 14-012 | ||
1949 | FS-EP007-1 14-013 | ||
1950 | FS-EP007-1 14-014 | ||
1951 | FS-EP007-1 14-015 | ||
1952 | FS-EP007-1 14-016 | ||
1953 | SD-EP007-1 14 | ||
1954 | A UM segme nt shall b e required in a 278 Patient Ev ent Loop R equest. | ||
1955 | UM01 = AR shall be s upported | ||
1956 | UM01 = HS shall be s upported | ||
1957 | UM01 = IN shall not be support ed | ||
1958 | UM01 = SC shall not be support ed | ||
1959 | UM02 = 1 s hall be su pported | ||
1960 | UM02 = 2 s hall be su pported | ||
1961 | UM02 = 3 s hall be su pported | ||
1962 | UM02 = 4 s hall be su pported | ||
1963 | UM02 = I s hall be su pported | ||
1964 | UM02 = N s hall be su pported | ||
1965 | UM02 = R s hall be su pported | ||
1966 | UM02 = S s hall be su pported | ||
1967 | UM03 shall be valida ted agains t the UM03 lookup ta ble | ||
1968 | If Present , UM04 sha ll be supp orted | ||
1969 | If present , UM06 sha ll be supp orted | ||
1970 | REF segmen ts, if pre sent, shal l be suppo rted | ||
1971 | FS-EP007-1 15 | ||
1972 | FS-EP007-1 15-001 | ||
1973 | FS-EP007-1 15-002 | ||
1974 | FS-EP007-1 15-003 | ||
1975 | FS-EP007-1 15-004 | ||
1976 | FS-EP007-1 15-005 | ||
1977 | FS-EP007-1 15-006 | ||
1978 | FS-EP007-1 15-007 | ||
1979 | FS-EP007-1 15-008 | ||
1980 | FS-EP007-1 15-009 | ||
1981 | FS-EP007-1 15-010 | ||
1982 | SD-EP007-1 15 | ||
1983 | 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 . | ||
1984 | DTP01 = 43 9, Acciden t date | ||
1985 | DTP01 = 48 4, Last Me nstrual Pe riod | ||
1986 | DTP01 = AB C, Estimat ed Date of Birth | ||
1987 | DTP01 = 43 1, Onset o f Current Symptoms o r Illness | ||
1988 | DTP01 = AA H, Event D ate | ||
1989 | DTP01 = 43 5, Admissi on Date | ||
1990 | Admission date shall be requir ed if UM01 = AR | ||
1991 | DTP01 = 09 6, Dischar ge date | ||
1992 | Any DTP el ements sub mitted as part of th e 278 Requ est shall be returne d in the 2 78 Respons e unless t he respons e is an au thorizatio n | ||
1993 | FS-EP007-1 16 | ||
1994 | SD-EP007-1 16 | ||
1995 | 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. | ||
1996 | FS-EP007-1 17 | ||
1997 | SD-EP007-1 17 | ||
1998 | The system shall be able to st ore up 12 occurrence s of the H I composit e data. | ||
1999 | FS-EP007-1 18 | ||
2000 | SD-EP007-1 18 | ||
2001 | If present , Health S ervices De livery (HS D) shall b e stored i n the mast er authori zation rec ord. | ||
2002 | FS-EP007-1 19 | ||
2003 | FS-EP007-1 19-001 | ||
2004 | FS-EP007-1 19-002 | ||
2005 | FS-EP007-1 19-003 | ||
2006 | FS-EP007-1 19-004 | ||
2007 | SD-EP007-1 19 | ||
2008 | If present , CRC segm ent(s) sha ll be supp orted: | ||
2009 | CR03 eleme nts shall be validat ed based o n the valu e in CR01 | ||
2010 | CR04 eleme nts shall be validat ed against CR03 look up table v alues base d on the v alue in CR 01 | ||
2011 | CR05 eleme nts shall be validat ed against CR03 look up table v alues base d on the v alue in CR 01 | ||
2012 | CR06 eleme nts shall be validat ed against CR03 look up table v alues base d on the v alue in CR 01 | ||
2013 | FS-EP007-1 20 | ||
2014 | SD-EP007-1 20 | ||
2015 | If CL1 pre sent, CL1 shall be v alidated a gainst CL1 lookup ta bles. | ||
2016 | FS-EP007-1 21 | ||
2017 | SD-EP007-1 21 | ||
2018 | If CR1 pre sent, CR1 shall be v alidated a gainst CR1 lookup ta bles. | ||
2019 | FS-EP007-1 22 | ||
2020 | SD-EP007-1 22 | ||
2021 | If CR2 pre sent, CR2 shall be v alidated a gainst CR2 lookup ta bles. | ||
2022 | FS-EP007-1 23 | ||
2023 | SD-EP007-1 23 | ||
2024 | If CR5 pre sent, CR5 shall be v alidated a gainst CR5 lookup ta bles. | ||
2025 | FS-EP007-1 24 | ||
2026 | SD-EP007-1 24 | ||
2027 | The system shall sup port up to 10 occurr ences of t he PWK seg ment. | ||
2028 | FS-EP007-1 25 | ||
2029 | SD-EP007-1 25 | ||
2030 | 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, | ||
2031 | FS-EP007-1 26 | ||
2032 | SD-EP007-1 26 | ||
2033 | If the att achment is not avail able, AAT GUI shall report a 2 78 Respons e error. | ||
2034 | FS-EP007-1 27 | ||
2035 | SD-EP007-1 27 | ||
2036 | If MSG tex t segment is present , the mess age text s hall be st ored in th e master a uthorizati on record. | ||
2037 | FS-EP007-1 40 | ||
2038 | SD-EP007-1 40 | ||
2039 | The system shall sup port up to two occur rences of the TRN se gment, if present in the 2000E Request l oop. | ||
2040 | FS-EP007-1 41 | ||
2041 | SD-EP007-1 41 | ||
2042 | If present , the REF segment sh all be sup ported in the 2000E Request lo op. | ||
2043 | FS-EP007-1 42 | ||
2044 | SD-EP007-1 42 | ||
2045 | If present , DTP segm ents shall be suppor ted in the 2000E Req uest loop. | ||
2046 | Request Va lidation – 2010EA Pa tient Even t Provider Name Loop | ||
2047 | Table 34 – Design El ements for Request V alidation | ||
2048 | Requiremen t Number | ||
2049 | Design Ele ment | ||
2050 | Descriptio n | ||
2051 | FS-EP007-1 28 | ||
2052 | SD-EP007-1 28 | ||
2053 | The system shall sup port up to 14 occurr ences of t he 2010EA loop. | ||
2054 | FS-EP007-1 29 | ||
2055 | SD-EP007-1 29 | ||
2056 | Each provi der shall be validat ed against the VistA Fee Provi der file. | ||
2057 | FS-EP007-1 30 | ||
2058 | SD-EP007-1 30 | ||
2059 | Each provi der record shall be stored as part of th e master a uthorizati on record. | ||
2060 | FS-EP007-1 31 | ||
2061 | SD-EP007-1 31 | ||
2062 | If REF seg ment is pr esent, sys tem shall try to ver ify the pr ovided ide ntificatio n informat ion. | ||
2063 | FS-EP007-1 32 | ||
2064 | SD-EP007-1 32 | ||
2065 | If PER seg ment prese nt, PER in formation shall be s tored as p art of the master au thorizatio n record. | ||
2066 | FS-EP007-1 33 | ||
2067 | SD-EP007-1 33 | ||
2068 | If PRV seg ment prese nt, PRV in formation shall be s tored as p art of the master au thorizatio n record. | ||
2069 | FS-EP007-1 34 | ||
2070 | SD-EP007-1 34 | ||
2071 | If present , PRV data shall be validated against co de lookup tables. | ||
2072 | |||
2073 | Request Va lidation – 2010EB Pa tient Even t Transpor t Informat ion Loop | ||
2074 | Table 35 – Design El ements for Request V alidation | ||
2075 | Requiremen t Number | ||
2076 | Design Ele ment | ||
2077 | Descriptio n | ||
2078 | FS-EP007-1 35 | ||
2079 | SD-EP007-1 35 | ||
2080 | If present , the syst em shall s upport up to 5 occur rences of the 2010EB loop. | ||
2081 | FS-EP007-1 36 | ||
2082 | FS-EP007-1 37 | ||
2083 | FS-EP007-1 38 | ||
2084 | SD-EP007-1 36 | ||
2085 | If present , there sh all be at least two occurrence s of the l oop. | ||
2086 | 1st occurr ence shall represent the pick- up locatio n | ||
2087 | 2nd occurr ence shall represent the drop- off locati on | ||
2088 | Request Va lidation – 2010EC Pa tient Even t Other UM O Name Loo p | ||
2089 | Table 36 – Design El ements for Request V alidation | ||
2090 | Requiremen t Number | ||
2091 | Design Ele ment | ||
2092 | Descriptio n | ||
2093 | FS-EP007-1 39 | ||
2094 | SD-EP007-1 39 | ||
2095 | If present , the syst em shall s upport up to three o ccurrences of the 20 10EC loop. | ||
2096 | Request Va lidation – 2000F Ser vice Level Loop | ||
2097 | Table 37 – Design El ements for Request V alidation | ||
2098 | Requiremen t Number | ||
2099 | Design Ele ment | ||
2100 | Descriptio n | ||
2101 | FS-EP007-1 43 | ||
2102 | SD-EP007-1 43 | ||
2103 | If present , SV1 segm ent shall be support ed in the 2000F Requ est loop. | ||
2104 | FS-EP007-1 44 | ||
2105 | SD-EP007-1 44 | ||
2106 | If present , SV2 segm ent shall be support ed in the 2000F Requ est loop. | ||
2107 | FS-EP007-1 45 | ||
2108 | SD-EP007-1 45 | ||
2109 | If present , SV3 segm ent shall be support ed in the 2000F Requ est loop. | ||
2110 | FS-EP007-1 46 | ||
2111 | SD-EP007-1 46 | ||
2112 | If present , TOO segm ent shall be support ed in the 2000F Requ est loop. | ||
2113 | FS-EP007-1 47 | ||
2114 | SD-EP007-1 47 | ||
2115 | If present , HSD segm ent shall be support ed in the 2000F Requ est loop. | ||
2116 | FS-EP007-1 48 | ||
2117 | SD-EP007-1 48 | ||
2118 | The system shall sup port up to 10 occurr ences of t he PWK seg ment. | ||
2119 | FS-EP007-1 49 | ||
2120 | SD-EP007-1 49 | ||
2121 | 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, | ||
2122 | FS-EP007-1 50 | ||
2123 | SD-EP007-1 50 | ||
2124 | If the att achment is not avail able, AAT shall repo rt a 278 R esponse er ror. | ||
2125 | FS-EP007-1 51 | ||
2126 | SD-EP007-1 51 | ||
2127 | If MSG tex t segment is present , the mess age text s hall be st ored in th e master a uthorizati on record. | ||
2128 | Response G eneration | ||
2129 | Table 38 – Design El ements for Response Generation | ||
2130 | Requiremen t Number | ||
2131 | Design Ele ment | ||
2132 | Descriptio n | ||
2133 | FS-UN017-0 01 | ||
2134 | SD-UN017-0 01 | ||
2135 | All 278 Re sponse sha ll be deli vered in a Patient E vent Loop. | ||
2136 | FS-UN017-0 02 | ||
2137 | SD-UN017-0 02 | ||
2138 | Service Le vel 278 Re sponse sha ll not be supported. | ||
2139 | FS-UN017-0 08 | ||
2140 | FS-UN017-0 08-001 | ||
2141 | FS-UN017-0 08-002 | ||
2142 | FS-UN017-0 08-003 | ||
2143 | FS-UN017-0 08-004 | ||
2144 | SD-UN017-0 08 | ||
2145 | |||
2146 | The AET sh all write a 278 resp onse recor d to the 2 78 Reposit ory: | ||
2147 | 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. | ||
2148 | HCR01 shal l be set b ased on th e action c ode entere d via the AAT GUI. | ||
2149 | HCR02 shal l not be s et. | ||
2150 | HCR03 shal l be set b ased on th e reason c ode entere d via the AAT GUI. | ||
2151 | FS-UN017-0 09 | ||
2152 | SD-UN017-0 09 | ||
2153 | If a 278 r equest is received a nd a DENIE D 278 resp onse recor d exists i n the 278 Repository , AET shal l return a DENIED 27 8 response based on the data i n the 278 Response r ecord. | ||
2154 | Response G eneration – 2010A UM O Organiza tion Name Loop | ||
2155 | Table 39 – Design El ements for Response Generation | ||
2156 | Requiremen t Number | ||
2157 | Design Ele ment | ||
2158 | Descriptio n | ||
2159 | FS-UN017-0 03 | ||
2160 | SD-UN017-0 03 | ||
2161 | Loop 2010A shall be required i n a 278 Re sponse. | ||
2162 | FS-UN017-0 04 | ||
2163 | FS-UN017-0 04-001 | ||
2164 | FS-UN017-0 04-002 | ||
2165 | FS-UN017-0 04-003 | ||
2166 | FS-UN017-0 04-004 | ||
2167 | FS-UN017-0 04-005 | ||
2168 | SD-UN017-0 04 | ||
2169 | Loop 2010A segment N M1 shall b e populate d as follo ws: | ||
2170 | Loop 2010A NM101 sha ll be popu lated with “PR”. | ||
2171 | Loop 2010A NM102 sha ll be popu lated with “2”. | ||
2172 | Loop 2010A NM103 sha ll be popu lated with the Stati on of Juri sdiction V AMC Name | ||
2173 | Loop 2010A NM108 sha ll be popu lated with the “PI”. | ||
2174 | Loop 2010A NM109 sha ll be popu lated with “12115”. | ||
2175 | FS-UN017-0 05 | ||
2176 | FS-UN017-0 05-001 | ||
2177 | FS-UN017-0 05-002 | ||
2178 | FS-UN017-0 05-003 | ||
2179 | FS-UN017-0 05-004 | ||
2180 | FS-UN017-0 05-005 | ||
2181 | FS-UN017-0 05-006 | ||
2182 | FS-UN017-0 05-007 | ||
2183 | FS-UN017-0 05-008 | ||
2184 | SD-UN017-0 05 | ||
2185 | Loop 2010A PER segme nt shall b e populate d as follo ws: | ||
2186 | Loop 2010A element P ER01 “IC” | ||
2187 | 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. | ||
2188 | Loop 2010A element P ER03, “EM” | ||
2189 | 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. | ||
2190 | Loop 2010A element P ER03, “TE” | ||
2191 | 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 | ||
2192 | Loop 2010A element P ER05, “FX” | ||
2193 | 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 | ||
2194 | Response G eneration – 2010B Re quester Na me Loop | ||
2195 | Table 40 – Design El ements for Response Generation | ||
2196 | Requiremen t Number | ||
2197 | Design Ele ment | ||
2198 | Descriptio n | ||
2199 | FS-UN017-0 06 | ||
2200 | SD-UN017-0 06 | ||
2201 | Loop 2010B shall be required i n a 278 Re sponse. | ||
2202 | FS-UN017-0 07 | ||
2203 | SD-UN017-0 07 | ||
2204 | Loop 2010B segment s hall be po pulated as with the informatio n from the 2010B Req uest loop. | ||
2205 | Response G eneration – 2010C Su bscriber N ame and 20 10D Depend ent Name L oops | ||
2206 | Table 41 – Design El ements for Response Generation | ||
2207 | Requiremen t Number | ||
2208 | Design Ele ment | ||
2209 | Descriptio n | ||
2210 | FS-UN017-0 11 | ||
2211 | SD-UN017-0 11 | ||
2212 | Loop 2010C shall be required i n a 278 Re sponse. | ||
2213 | FS-UN017-0 12 | ||
2214 | SD-UN017-0 12 | ||
2215 | 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. | ||
2216 | FS-UN017-0 13 | ||
2217 | SD-UN017-0 13 | ||
2218 | Every mast er authori zation sha ll have on e Service (UM03) rec ord in the response. | ||
2219 | FS-UN017-0 14 | ||
2220 | SD-UN017-0 14 | ||
2221 | 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. | ||
2222 | FS-UN017-0 16 | ||
2223 | FS-UN017-0 16-001 | ||
2224 | FS-UN017-0 16-002 | ||
2225 | FS-UN017-0 16-003 | ||
2226 | FS-UN017-0 16-004 | ||
2227 | FS-UN017-0 16-005 | ||
2228 | FS-UN017-0 16-006 | ||
2229 | FS-UN017-0 16-007 | ||
2230 | FS-UN017-0 16-008 | ||
2231 | FS-UN017-0 16-009 | ||
2232 | SD-UN017-0 16 | ||
2233 | NM1 shall be require d: | ||
2234 | NM101 = “I L” | ||
2235 | NM102 = “1 ” | ||
2236 | NM103 = La st Name of the Patie nt from th e Patient file | ||
2237 | NM104 = Fi rst Name o f the Pati ent from t he Patient file | ||
2238 | NM105 = Mi ddle Name of the Pat ient from the Patien t file | ||
2239 | If exist, NM106 shal l be popul ated with the value from the 2 78 2010B R equest loo p, element NM106 | ||
2240 | If exist, NM107 shal l be popul ated with the value from the 2 78 2010B R equest loo p, element NM107 | ||
2241 | NM108 = “M I” | ||
2242 | NM109 = VA assigned Patient | ||
2243 | FS-UN017-0 17 | ||
2244 | FS-UN017-0 17-001 | ||
2245 | FS-UN017-0 17-002 | ||
2246 | FS-UN017-0 17-003 | ||
2247 | SD-UN017-0 17 | ||
2248 | The REF el ement shal l be retur ned in the Patient L oop Respon se: | ||
2249 | The REF el ement shal l not exce ed 9 occur rences | ||
2250 | If REF ele ments are present in the 278 R equest, th ey shall b e returned in the 20 10B Respon se. | ||
2251 | The author ization cl erk shall not be all owed to ch ange exist ing REF el ements | ||
2252 | FS-UN017-0 18 | ||
2253 | FS-UN017-0 18-001 | ||
2254 | FS-UN017-0 18-002 | ||
2255 | SD-UN017-0 18 | ||
2256 | NM3 shall be require d: | ||
2257 | N301 shall be popula ted with t he patient street ad dress | ||
2258 | If patient has an ad ditional a ddress lin e, N302 sh all be pop ulated. | ||
2259 | FS-UN017-0 19 | ||
2260 | FS-UN017-0 19-001 | ||
2261 | FS-UN017-0 19-002 | ||
2262 | FS-UN017-0 19-003 | ||
2263 | FS-UN017-0 19-004 | ||
2264 | SD-UN017-0 19 | ||
2265 | NM4 shall be require d: | ||
2266 | N401 shall be popula ted with C ity from p atient fil e | ||
2267 | N402 shall be popula ted with S tate patie nt file | ||
2268 | N403 shall be popula ted with Z ip from th e patient file | ||
2269 | N404 shall be popula ted with C ountry cod e | ||
2270 | FS-UN017-0 20 | ||
2271 | FS-UN017-0 20-001 | ||
2272 | FS-UN017-0 20-002 | ||
2273 | FS-UN017-0 20-003 | ||
2274 | SD-UN017-0 20 | ||
2275 | DMG shall be populat ed as foll ows: | ||
2276 | DMG01 = “D 8” | ||
2277 | DMG02 = Pa tients Dat e of Birth | ||
2278 | DMG03 = Pa tient gend er (F, U, M) | ||
2279 | FS-UN017-0 21 | ||
2280 | SD-UN017-0 21 | ||
2281 | The INS se gment shal l not be r equired in the respo nse. | ||
2282 | Response G eneration – 2000E Pa tient Even t Level Lo op | ||
2283 | Table 42 – Design El ements for Response Generation | ||
2284 | Requiremen t Number | ||
2285 | Design Ele ment | ||
2286 | Descriptio n | ||
2287 | FS-UN017-0 22 | ||
2288 | SD-UN017-0 22 | ||
2289 | 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. | ||
2290 | FS-UN017-0 25 | ||
2291 | SD-UN017-0 25 | ||
2292 | REF shall be populat ed in the 278 2000E Response. | ||
2293 | FS-UN017-0 26 | ||
2294 | FS-UN017-0 26-001 | ||
2295 | FS-UN017-0 26-002 | ||
2296 | SD-UN017-0 26 | ||
2297 | 2000E – DT P segments shall be optional. | ||
2298 | 2000E – DT P segments if presen t, shall n ot exceed 9 occurren ces. | ||
2299 | 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. | ||
2300 | FS-UN017-0 27 | ||
2301 | SD-UN017-0 27 | ||
2302 | 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. | ||
2303 | FS-UN017-0 36 | ||
2304 | SD-UN017-0 36 | ||
2305 | If present in the 27 8 request, the Loop 2010EA sha ll not be populated in the 278 2000E Res ponse. | ||
2306 | FS-UN017-0 37 | ||
2307 | SD-UN017-0 37 | ||
2308 | If present in the 27 8 request, the Loop 2010EB sha ll not be populated in the 278 2000E Res ponse. | ||
2309 | FS-UN017-0 48 | ||
2310 | FS-UN017-0 48-001 | ||
2311 | SD-UN017-0 48 | ||
2312 | The PWK se gment shal l be suppo rted in 20 00E loop w ith 1 exce ption: | ||
2313 | PWK02 “EL” shall not be suppor ted in FY1 5. | ||
2314 | FS-UN017-0 49 | ||
2315 | SD-UN017-0 49 | ||
2316 | A user sha ll be allo wed to ent er up to 2 64 charact ers of fre e text per 2000E MSG segment. | ||
2317 | FS-UN022B- 001 | ||
2318 | SD-UN022B- 001 | ||
2319 | The HCR se gment shal l be requi red in the 2000E Res ponse loop . | ||
2320 | FS-UN022B- 002 | ||
2321 | SD-UN022B- 002 | ||
2322 | |||
2323 | HCR01 shal l be popul ated with the value from the m aster auth orization record. | ||
2324 | FS-UN022B- 003 | ||
2325 | |||
2326 | SD-UN022B- 003 | ||
2327 | HCR02 shal l be popul ated with the master authoriza tion UAK, unless the request h as been de nied.. | ||
2328 | FS-UN022B- 004 | ||
2329 | |||
2330 | SD-UN022B- 004 | ||
2331 | MSG respon se segment if popula ted as par t of the m aster auth orization, shall be populated in the 278 response . | ||
2332 | FS-UN022B- 005 | ||
2333 | |||
2334 | SD-UN022B- 005 | ||
2335 | UM03 278 r esponse sh all be pop ulated wit h the UM03 response value from the maste r authoriz ation reco rd. | ||
2336 | FS-UN022B- 006 | ||
2337 | |||
2338 | SD-UN022B- 006 | ||
2339 | The HSD se gment shal l be popul ated from the data i n the mast er authori zation HSD response data eleme nts. | ||
2340 | Response G eneration – 2000F Se rvice Leve l Loop | ||
2341 | Table 43 – Design El ements for Response Generation | ||
2342 | Requiremen t Number | ||
2343 | Design Ele ment | ||
2344 | Descriptio n | ||
2345 | FS-UN017-0 38 | ||
2346 | SD-UN017-0 38 | ||
2347 | If 2000F l oop data i s present as part of the 278 R equest, it shall not be return ed as part of the 27 8 Response . | ||
2348 | FS-UN022B- 007 | ||
2349 | |||
2350 | SD-UN022B- 007 | ||
2351 | The 278 Re quest reco rd shall b e moved to the 278 A CCEPTED re ference qu eue. | ||
2352 | Response G eneration – 2010FA S ervice Pro vider Name Loop | ||
2353 | Table 44 – Design El ements for Response Generation | ||
2354 | Requiremen t Number | ||
2355 | Design Ele ment | ||
2356 | Descriptio n | ||
2357 | FS-UN017-0 50 | ||
2358 | SD-UN017-0 50 | ||
2359 | The 2010EA response loop shall not be su pported in FY15. | ||
2360 | Vendor Inf ormation | ||
2361 | Table 45 – Design El ements for Vendor In formation | ||
2362 | Requiremen t Number | ||
2363 | Design Ele ment | ||
2364 | Descriptio n | ||
2365 | FS-EP007-1 52 | ||
2366 | SD-EP007-1 52 | ||
2367 | 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. | ||
2368 | FS-EP007-1 53 | ||
2369 | SD-EP007-1 53 | ||
2370 | The local VAMC provi der (vendo r) file sh all be abl e to ident ify a prov ider as PH I-restrict ed. | ||
2371 | FS-EP007-1 54 | ||
2372 | SD-EP007-1 54 | ||
2373 | 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”. | ||
2374 | Reporting | ||
2375 | Table 46 – Design El ements for Reporting | ||
2376 | Requiremen t Number | ||
2377 | Design Ele ment | ||
2378 | Descriptio n | ||
2379 | FS-EP005-0 01 | ||
2380 | FS-EP005-0 01-001 | ||
2381 | FS-EP005-0 01-002 | ||
2382 | FS-EP005-0 01-003 | ||
2383 | FS-EP005-0 01-004 | ||
2384 | SD-EP005-0 01 | ||
2385 | An authori zed reques tor shall be able to export th e followin g data poi nts from C DW for COM PLETE auth orizations : | ||
2386 | User Id of user who completed the author ization | ||
2387 | Total numb er of auth orizations in a COMP LETE state by user-i d | ||
2388 | Start-date entered b y requesto r | ||
2389 | End-date e ntered by requestor | ||
2390 | FS-EP005-0 02 | ||
2391 | SD-EP005-0 02 | ||
2392 | The reques tor shall be require d to enter a request start-dat e. | ||
2393 | FS-EP005-0 03 | ||
2394 | SD-EP005-0 03 | ||
2395 | The system shall def ault the r equest end -date to t he current system da te. | ||
2396 | FS-EP005-0 04 | ||
2397 | SD-EP005-0 04 | ||
2398 | The reques tor shall be allowed to enter a differen t request end-date. | ||
2399 | FS-EP005-0 05 | ||
2400 | SD-EP005-0 05 | ||
2401 | By default , the syst em shall e xport all users and total numb er of auth orizations completed . | ||
2402 | FS-EP005-0 06 | ||
2403 | SD-EP005-0 06 | ||
2404 | The system shall sor t the data by user-i d, ascendi ng. | ||
2405 | FS-EP006-0 02 | ||
2406 | SD-EP006-0 02 | ||
2407 | The reques tor shall be require d to selec t either 1 0-7078 or 10-7079 au thorizatio ns for the export. | ||
2408 | FS-EP012-0 01 | ||
2409 | SD-EP012-0 01 | ||
2410 | The reques tor shall be able to select th e file for mat for th e exported report. | ||
2411 | FS-EP012-0 02 | ||
2412 | SD-EP012-0 02 | ||
2413 | The reques tor shall be able to select th e storage location f or the exp orted file . | ||
2414 | EDI Compli ance | ||
2415 | Table 47 – Design El ements for EDI Compl iance | ||
2416 | Requiremen t Number | ||
2417 | Design Ele ment | ||
2418 | Descriptio n | ||
2419 | FS-EP013-0 01 | ||
2420 | FS-EP013-0 01-001 | ||
2421 | FS-EP014-0 01 | ||
2422 | SD-EP013-0 01 | ||
2423 | EDI compli ance intro duced in F Y14 shall be continu ed: | ||
2424 | A 278 Requ est shall be validat ed for EDI complianc e | ||
2425 | A 278 Resp onse shall be EDI co mpliant | ||
2426 | FS-EP014-0 02 | ||
2427 | SD-EP014-0 02 | ||
2428 | AAA (the s tandard se gment used in X12 me ssages to report err ors) Error reporting as introd uced in th e FY14 HAC EDI Claim s Systems Enhancemen t project shall be c ontinued. | ||
2429 | QAS-EP016- 001 | ||
2430 | SD-EP016-0 01 | ||
2431 | AET will b e availabl e at least 86% of th e time dur ing a norm al work we ek. | ||
2432 | Performanc e | ||
2433 | Table 48 – Design El ements for Performan ce | ||
2434 | Requiremen t Number | ||
2435 | Design Ele ment | ||
2436 | Descriptio n | ||
2437 | PS-EP017-0 01 | ||
2438 | SD-EP017-0 01 | ||
2439 | AET shall complete t he entire 278 transa ction (req uest / res ponse) wit hin the Ce nters for Medicare & Medicaid Services ( CMS) speci fied maxim um 20 seco nd respons e time dur ing system uptime. | ||
2440 | PS-EP017-0 02 | ||
2441 | SD-EP017-0 02 | ||
2442 | AET shall not need t o provide a response during sc heduled sy stem down time. | ||
2443 | PS- EP017- 003 | ||
2444 | SD- EP017- 003 | ||
2445 | AAT GUI sh all be abl e to suppo rt multipl e users wi thout degr adation in response time. | ||
2446 | PS- EP017- 004 | ||
2447 | SD- EP017- 004 | ||
2448 | AAT GUI Se rvices GUI shall be able to su pport mult iple users without d egradation in respon se time. | ||
2449 | PS- EP017- 005 | ||
2450 | SD- EP017- 005 | ||
2451 | AAT GUI Qu eues GUI s hall be ab le to supp ort multip le users w ithout deg radation i n response time. | ||
2452 | PS- EP017- 006 | ||
2453 | SD- EP017- 006 | ||
2454 | AAT GUI 27 8 Review / Request G UI shall b e able to support mu ltiple use rs without degradati on in resp onse time. | ||
2455 | PS-UN024-0 01 | ||
2456 | SD-UN024-0 01 | ||
2457 | 278 Reques t/Response transacti ons shall only be su pported in Real-time mode. | ||
2458 | PS-EP015-0 01 | ||
2459 | SD-EP015-0 01 | ||
2460 | All transa ctions bet ween AET a nd HCCH wi ll be over a secure communicat ions chann el. | ||
2461 | Security | ||
2462 | Table 49 - Design El ements for Security | ||
2463 | Requiremen t Number | ||
2464 | Design Ele ment | ||
2465 | Descriptio n | ||
2466 | SS-EP007-0 01 | ||
2467 | SS-EP007-0 01-001 | ||
2468 | SS-EP007-0 01-002 | ||
2469 | SS-EP007-0 01-003 | ||
2470 | SS-EP007-0 01-004 | ||
2471 | SS-EP007-0 01-005 | ||
2472 | SS-EP007-0 01-006 | ||
2473 | SS-EP007-0 01-007 | ||
2474 | SS-EP007-0 01-008 | ||
2475 | SD-EP007-0 01S | ||
2476 | Users hold ing the Vi stA Fee Au thorizatio n key shal l be able to: | ||
2477 | Add Servic es records to a mast er authori zation rec ord | ||
2478 | View the 2 78 Request queues | ||
2479 | Select a 2 78 Request from the 278 unsoli cited requ est queues | ||
2480 | View the 2 78 Request | ||
2481 | View 275 R epository records | ||
2482 | Create 278 Response segments f or a 278 R equest | ||
2483 | Assign a 2 78 Respons e HSD resp onse | ||
2484 | Release a completed 278 to the AET proce ss | ||
2485 | SS-EP007-0 02 | ||
2486 | SS-EP007-0 02-001 | ||
2487 | |||
2488 | SD-EP007-0 02S | ||
2489 | Users hold ing the Vi stA Fee Su pervisor k ey shall: | ||
2490 | Have all t he capacit ies listed above | ||
2491 | SS-EP007-0 03 | ||
2492 | SS-EP007-0 03-001 | ||
2493 | SS-EP007-0 03-003 | ||
2494 | SD-EP007-0 03S | ||
2495 | AAT Admini strator sh all: | ||
2496 | Be able to monitor t he connect ion betwee n AET and the HCCH | ||
2497 | Be able to update su pporting 2 78 lookup tables | ||
2498 | SS-EP007-0 04 | ||
2499 | SS-EP007-0 04-001 | ||
2500 | SS-EP007-0 04-002 | ||
2501 | SD-EP007-0 04S | ||
2502 | EDI Manage ment Team shall: | ||
2503 | Have all t he capabil ities of t he AET Adm inistrator | ||
2504 | Access the master au thorizatio n interfac e as neede d to monit or perform ance | ||
2505 | Design Ele ment Table s | ||
2506 | Routines ( Entry Poin ts) | ||
2507 | There are no new or modified r outines. | ||
2508 | Templates | ||
2509 | Table 50 – FBAA AUTH ORIZATION Template | ||
2510 | Templates | ||
2511 | Instructio ns | ||
2512 | Template N ame | ||
2513 | FBAA AUTHO RIZATION | ||
2514 | Enhancemen t Category | ||
2515 | Modify | ||
2516 | RSD Tracea bility | ||
2517 | |||
2518 | Template T ype | ||
2519 | Input | ||
2520 | Related Op tions | ||
2521 | |||
2522 | Related Ro utines | ||
2523 | |||
2524 | Data Dicti onary Refe rences | ||
2525 | 162.4 | ||
2526 | Global Ref erences | ||
2527 | |||
2528 | |||
2529 | |||
2530 | AUTHORIZAT ION | ||
2531 | S FBAOL D=^FBAAA(D A(1),1,DA, 0),FBAALT= $S($P(FBAO LD,"^",13) =2:"Y",$P( FBAOLD,"^" ,13)=3:"Y" ,1:""),FBP RG=$P(FBAO LD,"^",3) | ||
2532 | I FBPRG ,FBPRG'=2 W !!,*7,"Y ou are onl y allowed to edit an outpatien t authoriz ation usin g this opt ion.",!! S Y="" | ||
2533 | @1 | ||
2534 | FROM DA TE | ||
2535 | S FBTOD T=X | ||
2536 | S DOB=$ P(^DPT(DFN ,0),"^",3) | ||
2537 | D NOW^% DTC | ||
2538 | S NOW=X | ||
2539 | S X=FBT ODT | ||
2540 | I $$FMD IFF^XLFDT( NOW,DOB,1) <365 S Y=" @3" | ||
2541 | I $P(FB AOLD,U,2)' ]"" S Y="@ 2" | ||
2542 | I FBTOD T'>$P(FBAO LD,U,2) S Y="@2" | ||
2543 | FROM DA TE////^S X =+FBAOLD | ||
2544 | W !,*7, "From Date cannot be later tha n the To D ate!" | ||
2545 | S Y="@1 " | ||
2546 | @2 | ||
2547 | S:'$D(F BAADDYS) F BAADDYS=0 S X1=FBTOD T,X2=FBAAD DYS D C^%D TC S FBAAX =X | ||
2548 | S FBD1= DA | ||
2549 | TO DATE //^S X=$E( FBAAX,4,5) _"-"_$E(FB AAX,6,7)_" -"_($E(FBA AX,1,3)+17 00) | ||
2550 | S FBFRD T=DE(19) | ||
2551 | I $$FMD IFF^XLFDT( NOW,DOB,1) <365 S Y=" @6" | ||
2552 | @7 | ||
2553 | I $P(^F BAAA(DA(1) ,1,DA,0)," ^",7)]"" K DIE("NO^" ) | ||
2554 | FEE PRO GRAM////^S X=$S(FBPR G:FBPRG,1: 2) | ||
2555 | S FBTYP E=$S(FBPRG :FBPRG,1:2 ) | ||
2556 | 101;T | ||
2557 | REFERRI NG PROVIDE R | ||
2558 | I $G(X) W !,"REFE RRING PROV IDER NPI: ",$$REFNPI ^FBCH78(X) | ||
2559 | S Y="@4 " | ||
2560 | @3 | ||
2561 | I FBTOD T'<DOB&(FB TODT'>$$FM ADD^XLFDT( DOB,7)) S Y="@2" | ||
2562 | W !,*7, "This is a Newborn, From Date must be be tween DOB and DOB+7" | ||
2563 | S Y="@1 " | ||
2564 | @6 | ||
2565 | I FBFRD T'<DOB&(FB FRDT'>$$FM ADD^XLFDT( DOB,7)) S Y="@7" | ||
2566 | W !,*7, "This is a Newborn, TO Date mu st be betw een DOB an d DOB+7" | ||
2567 | S Y="@2 " | ||
2568 | @4 | ||
2569 | PURPOSE OF VISIT CODE | ||
2570 | S:$$EXT PV^FBAAUTL 5(X)'=55 Y ="@5" | ||
2571 | S:$P($$ GETSTAT^DG MSTAPI(DA( 1)),U,2)=" Y" Y="@5" | ||
2572 | S DIE(" NO^")="" | ||
2573 | W !,$C( 7),"MST PO V can't be selected because ve teran's MS T status i s not YES. " | ||
2574 | S Y="@4 " | ||
2575 | @5 | ||
2576 | PATIENT TYPE CODE | ||
2577 | TREATME NT TYPE CO DE | ||
2578 | S FBAAT T=X | ||
2579 | S FBAAL T=$S(X=2:" Y",X=3:"Y" ,1:"") | ||
2580 | K DIE(" NO^") | ||
2581 | S ICDSY S=10,IMPDA TE=$$IMPDA TE^FBCSV1( "10D") | ||
2582 | S EDATE =+FBAOLD | ||
2583 | S:EDATE <IMPDATE I CDSYS=9 | ||
2584 | I ICDSY S=10,FBAAT T=3 S Y="@ 10" | ||
2585 | S:ICDSY S=9 Y="@9" | ||
2586 | S FBDFN =DFN | ||
2587 | @8 | ||
2588 | S XX1=- 1 S XX1=$$ ASKICD10^F BASF(" IC D DIAGNOSI S","") | ||
2589 | I XX1<0 W !," ICD Diagn osis is re quired" S Y="@8" | ||
2590 | ICD DIA GNOSIS//// ^S X=XX1 | ||
2591 | S Y="@1 0" | ||
2592 | @9 | ||
2593 | DX LINE 1 | ||
2594 | S:X="" Y=.021 | ||
2595 | DX LINE 2 | ||
2596 | S:X="" Y=.021 | ||
2597 | DX LINE 3 | ||
2598 | @10 | ||
2599 | ; New fiel ds for aut horized se rvice will be added. | ||
2600 | AUTHORI ZATION REM ARKS | ||
2601 | TYPE OF CARE | ||
2602 | S:'$D(F BAAASKV) F BAAASKV="N " | ||
2603 | S:FBAAA SKV'="y" Y =100 | ||
2604 | VENDOR | ||
2605 | CLERK// //^S X=DUZ | ||
2606 | W !! | ||
2607 | ACCIDEN T RELATED (Y/N) | ||
2608 | POTENTI AL COST RE COVERY CAS E//^S X="N O" | ||
2609 | PRINT A UTHORIZATI ON (Y/N)// ^S X="YES" | ||
2610 | S FBAAP 79=$S(X["Y ":"Y",1:"" ) | ||
2611 | I X["Y" S Y="" | ||
2612 | PRINT A UTHORIZATI ON (Y/N)// /^S X="@" | ||
2613 | I '$D(FBAA TT) S Y="" | ||
2614 | I FBAATT'= 3 S Y="" | ||
2615 | S HID=$S($ D(^FBAAA(D A,4)):$P(^ (4),"^"),1 :"") | ||
2616 | FEE ID CAR D NUMBER | ||
2617 | S NID=X | ||
2618 | FEE ID CAR D ISSUE DA TE//^S X=" TODAY" | ||
2619 | S Y=$S(HID ="":"",HID =NID:"",NI D="":.65,1 :.7) | ||
2620 | FEE ID CAR D EXPIRATI ON DATE | ||
2621 | REASON FOR CARD NUMB ER CHANGE | ||
2622 | S NIDR=X | ||
2623 | Templates | ||
2624 | Descriptio n | ||
2625 | Template N ame | ||
2626 | FBAA AUTHO RIZATION | ||
2627 | Enhancemen t Category | ||
2628 | New | ||
2629 | Modify | ||
2630 | Delete | ||
2631 | No Change | ||
2632 | RSD | ||
2633 | |||
2634 | Template T ype | ||
2635 | Sort | ||
2636 | Input | ||
2637 | |||
2638 | Other | ||
2639 | Related Op tions | ||
2640 | |||
2641 | |||
2642 | Related Ro utines | ||
2643 | Routines “ Called By” | ||
2644 | Routines “ Called” | ||
2645 | |||
2646 | |||
2647 | |||
2648 | Bulletins | ||
2649 | There are no new or modified b ulletins. | ||
2650 | Data Entri es Affecte d by the D esign | ||
2651 | There are no new or modified d ata entrie s. | ||
2652 | Unique Rec ord(s) | ||
2653 | There are no new uni que record s or modif ications t o existing unique re cords. | ||
2654 | File or Gl obal Size Changes | ||
2655 | There shou ld be no s ignificant change in global si zes, new d ata is bei ng stored outside of VistA. | ||
2656 | Mail Group s | ||
2657 | There are no new or modified m ail groups . | ||
2658 | Security K eys | ||
2659 | There are no new or modified s ecurity ke ys. | ||
2660 | Options | ||
2661 | There are no new or modified o ptions. | ||
2662 | |||
2663 | Protocols | ||
2664 | There are no new or modified p rotocols. | ||
2665 | |||
2666 | Remote Pro cedure Cal l (RPC) | ||
2667 | There are no new or modified R PCs. | ||
2668 | Constants Defined in Interface | ||
2669 | There are no new or modified c onstants. | ||
2670 | Variables Defined in Interface | ||
2671 | There are no new or modified v ariables. | ||
2672 | Types Defi ned in Int erface | ||
2673 | There are no new or modified t ypes. | ||
2674 | GUI | ||
2675 | There are no new or modified C PRS-style GUIs. Desi gns for th e web-base d GUI elem ents of AA T are cont ained in S ections 6. 2.2.2.12, 6.2.2.2.11 , and 6.2. 2.2.12. | ||
2676 | GUI Classe s | ||
2677 | There are no new or modified C PRS-style GUI classe s. | ||
2678 | Current Fo rm | ||
2679 | There are no new or modified f orms. | ||
2680 | Modified F orm | ||
2681 | There are no new or modified f orms. | ||
2682 | Components on Form | ||
2683 | There are no new or modified c omponents. | ||
2684 | Events | ||
2685 | There are no new or modified e vents. | ||
2686 | Methods | ||
2687 | There are no new or modified m ethods. | ||
2688 | Special Re ferences | ||
2689 | There are no new or modified s pecial ref erences. | ||
2690 | Class Even ts | ||
2691 | There are no new or modified c lass event s. | ||
2692 | Class Meth ods | ||
2693 | There are no new or modified c lass metho ds. | ||
2694 | Class Prop erties | ||
2695 | There are no new or modified c lass prope rties. | ||
2696 | Uses Claus e | ||
2697 | There are no new or modified u se clauses . | ||
2698 | Forms | ||
2699 | There are no new or modified f orms. | ||
2700 | Functions | ||
2701 | There are no new or modified f unctions. | ||
2702 | Dialog | ||
2703 | There are no new or modified d ialogs. | ||
2704 | Help Frame | ||
2705 | There are no new or modified h elp frames . | ||
2706 | HL7 Applic ation Para meter | ||
2707 | There are no new or modified H ealth Leve l 7 (HL7) applicatio n paramete rs. | ||
2708 | HL7 Logica l Link | ||
2709 | There are no new or modified H L7 logical links. | ||
2710 | COTS Inter face | ||
2711 | There are no new or modified C ommercial off-the-sh elf (COTS) interface s. | ||
2712 | Network De tailed Des ign | ||
2713 | All system s involved in this d evelopment will use the existi ng VA netw ork. | ||
2714 | Service Or iented Arc hitecture / ESS Deta iled Desig n | ||
2715 | There are no new or modified s hared serv ices. | ||
2716 | External S ystem Inte rface Desi gn | ||
2717 | Interface Architectu re | ||
2718 | All involv ed systems will use the existi ng VA TCP/ IP network . | ||
2719 | Interface Detailed D esign | ||
2720 | The AET wi ll have a TCP/IP-bas ed interfa ce with a secure Vir tual Priva te Network (VPN) con nection to the HCCH that will use the AS C X12 278 standard t o respond to queries sent by t he HCCH. A very thor ough descr iption of the transa ction form at for the 278 is in cluded in the PC Aut horization s Complian ce RSD. | ||
2721 | For a full list of e lements in cluded in the 278 re sponse, co nsult the PC Authori zations Co mpliance R SD. | ||
2722 | Human-Mach ine Interf ace | ||
2723 | Interface Design Rul es | ||
2724 | Interface design rul es will re main uncha nged for e xisting sy stems. Car e will be taken to f ollow exis ting desig n rules in the new A AT GUI. | ||
2725 | Inputs | ||
2726 | Refer to S ections 6. 2.2.2.12, 6.2.2.2.11 , and 6.2. 2.2.12 for informati on on the new user i nterface f or the AAT . | ||
2727 | Outputs | ||
2728 | This devel opment doe s not incl ude any ne w outputs. Current a uthorizati on outputs will be e nhanced wi th Consult IDs. Refe r to Secti on 6.2.2.2 for more details. | ||
2729 | Navigation Hierarchy | ||
2730 | Refer to S ections 6. 2.2.2.12, 6.2.2.2.11 , and 6.2. 2.2.12 for informati on on the new user i nterface f or the AAT . | ||
2731 | Security a nd Privacy | ||
2732 | Security | ||
2733 | Existing s ystems wil l continue to use ex isting sec urity cont rols. All affected s ystems (na mely VistA ) include files of a uthorized users, and which fea tures they are allow ed to use, and that will not b e changed. The new A AT GUI wil l also kee p a record of the ac cess each user has a nd will on ly allow a ccess to a dministrat ive functi ons to tho se with th e proper s ecurity ke ys. | ||
2734 | Privacy | ||
2735 | PHI and Pe rsonally I dentifiabl e Informat ion (PII) will be se cured in t he appropr iate datab ases with controls t o ensure t hat only t hose with a need to access the data will be able t o do so. I n addition , provider s can be m arked so t hat they w on’t recei ve authori zation tra nsactions if those t ransaction s contain sensitive PHI. | ||
2736 | |||
2737 | |||
2738 | Attachment A – Appro val Signat ures | ||
2739 | This secti on is used to docume nt the app roval of t he SDD. Th e review s hould be c onducted f ace to fac e where si gnatures c an be obta ined ‘live ’ during t he review. If unable to conduc t a face-t o-face mee ting then it should be held vi a LiveMeet ing and co ncurrence captured d uring the meeting. T he Scribe should add /es/name by each po sition cit ed. Exampl e provided below. | ||
2740 | The Busine ss Sponsor and Proje ct Manager (PjM) are required to sign. | ||
2741 | |||
2742 | |||
2743 | __________ __________ __________ __________ __________ __________ __________ ________ | ||
2744 | Signed:Dat e: | ||
2745 | Robert Huf fman VA Business Sponsor an d Integrat ed Project Team (IPT ) Co-Chair Electronic Data Inte rchange | ||
2746 | |||
2747 | |||
2748 | __________ __________ __________ __________ __________ __________ __________ ________ | ||
2749 | Signed:Dat e: | ||
2750 | William Kr immelVA Pj MElectroni c Data Int erchange | ||
2751 | |||
2752 | Additional Informati on | ||
2753 | RTM | ||
2754 | The PC Aut horization s Complian ce RTM acc ompanies t his SDD. | ||
2755 | Packaging and Instal lation | ||
2756 | There are no special considera tions for software p ackaging a nd install ation. | ||
2757 | Design Met rics | ||
2758 | No unusual metrics w ere captur ed during the design process. | ||
2759 | Acronym Li st and Glo ssary | ||
2760 | Sections 1 .7.1 and 1 .7.2 provi de the def initions, acronyms, and abbrev iations wi thin this SDD. | ||
2761 | Required T echnical D ocuments | ||
2762 | The Confor mance Vali dation Sta tement (CV S) will be submitted for evide nce of Sec tion 508 c ompliance at the app ropriate t ime. |
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