The mission of the Department of Veterans Affairs (VA), Office of Information and Technology (OIT), Health Administration Product Enhancements (HAPE) is to provide information technology (IT) products and services to the Veterans Health Administration (VHA) which in turn provides benefits and services to Veterans of the United States. In meeting these goals, OI&T strives to provide high quality, effective, and efficient IT services to those responsible for providing care to the Veterans at the point of-care as well as throughout all the points of the Veterans’ health care in an effective, timely and compassionate manner. VA depends on information management/information technology (IM/IT) systems to meet mission goals.
The Chief Business Office Purchased Care (CBOPC) assesses the impact of healthcare regulatory requirements on VHA Electronic Data Interchange (EDI) revenue operations and designs the use cases to illustrate the reengineered business process flows associated with technology changes. The office continuously monitors and participates in meetings of industry EDI standards-setting organizations. As the business process owner and subject matter expert (SME) for industry health care EDI mandates, PC defines business needs that necessitate revenue system software development. The office designs the maintenance and iterative updates to the EDI enterprise tool used to pay healthcare providers for service connected care provided to Veterans. PC develops partnerships with other Federal agencies and trading partners to support EDI processing and verify compliance; they test software, train users on the use of revised software, and provide help desk support for end users. The EDI transactions processes are utilized to pay nearly $6B in projected claims annually. The development work done under the scope of PC is inextricably linked to providing Veterans the medical care they have earned and deserve.
The HAPE EDI portfolio delivers IT products and services to CBO. This PC enhancement project is intended to deliver a range of updates, extensions, and modifications to various financial and administrative systems, processes, files, and reporting mechanisms. The PC Authorizations Compliance project will create processes and systems to receive incoming requests for Healthcare Claim services review (278) and produce corresponding response transactions (278). Over time, this enhancement should significantly reduce manual methods (e.g., responding to telephone calls to VA Medical Centers, or VAMCs) using EDI transactions for treatment authorizations and pre-certifications.