4. EPMO Open Source Coordination Office Redaction File Detail Report

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4.1 Files compared

#	Location	File	Last Modified
1	eInsurance_Build_17_IB_2_601.zip	US116+(TAS+USIN-035)+Populate+HL7+with+Subscriber+DOB.docx	Wed Nov 8 18:21:21 2017 UTC
2	eInsurance_Build_17_IB_2_601.zip	US116+(TAS+USIN-035)+Populate+HL7+with+Subscriber+DOB.docx	Wed Dec 6 21:36:43 2017 UTC

4.2 Comparison summary

Description	Between Files 1 and 2
Description	Text Blocks	Lines
Unchanged	1	210
Changed	0	0
Inserted	0	0
Removed	0	0

4.3 Comparison options

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Character case	Differences in character case are significant
Line endings	Differences in line endings (`CR` and `LF` characters) are ignored
CR/LF characters	Not shown in the comparison detail

4.4 Active regular expressions

No regular expressions were active.

4.5 Comparison detail

	1	User Story Number: U S116 (USIN -035)
	2	User Story Name: Pop ulate HL7 with Subsc riber’s DO B Field
	3	Product Ba cklog ID: 68
	4	Backlog Pr iority: No t Defined
	5	Author: eI nsurance
	6	Background
	7	Insurance eligibilit y requests always us e the pati ent date o f birth (D OB) from r egistratio n when the patient i s the subs criber. S ubsequent auto-updat e also com pares the DOB provid ed by the insurer (o n the 271 response) with this Patient fi le date. If these d ates do no t match, a patient i nsurance f ile will n ever auto- update (be cause insu rance pers onnel cann ot change the regist ration rec ord) and o ften retur n rejected responses as payer cannot loc ate patien t.
	8
	9	This creat es a probl em verifyi ng a patie nt record when a Vet eran may h ave given inaccurate informati on to the military a bout their DOB. VA always use s the Vete ran’s DOB as provide d on milit ary record s in the r egistratio n file. I t is not a lways the most accur ate DOB, e specially when it co mes to Med icare enro llment. M edicare of ten has a different DOB than V A, and if a successf ul respons e cannot b e obtained , the buff er entry n ever auto- updates.
	10
	11	We want th e ability to use the DOB as en tered into the Patie nt Insuran ce Sub-Fil e to be tr ansmitted on the 270 inquiry i nstead. W e have mod ified “Sub scriber Na me” to beh ave in thi s way and want DOB b ehavior to match.
	12
	13	There is n o change t o or depen dency on t he Insuran ce Capture Buffer (I CB) applic ation, whi ch will co ntinue to use existi ng fields.
	14	There is n o requirem ent for ad ditional f ields to b e populate d for entr y clerks ( Company, S ubscriber ID and/or DOB).
	15	There is n o change t o the beha vior of th e Subscrib er Update (SU) actio n (path = Patient In surance [P I], View P olicy [VP] ).
	16	Story
	17	As an insu rance veri fier, I wa nt the 270 inquiry t o read the DOB from the Patien t Insuranc e Sub-File so that e ligibility inquiries will be s ent with t his subscr iber DOB a nd the sub sequent 27 1 response can be re turned (an d auto-upd ate occur) successfu lly.
	18	Conversati on
	19	This chang e involves the PID s egment and , when the patient r elationshi p to insur ed is not “self,” th e GT1 segm ent. No c hange to H L7 message but chang ing the da ta used to populate the DOB fi eld for su bscriber.
	20	Current Fu nctionalit y
	21	For Appoin tment Extr act:
	22	If patient relations hip to ins ured = sel f then pop ulate subs criber DOB in PID se gment from Patient f ile DATE O F BIRTH (# 2,.03).
	23	If patient relations hip to ins ured ≠ sel f then pop ulate pati ent DOB in PID segme nt from Pa tient file DATE OF B IRTH (#2,. 03) and su bscriber D OB in GT1 segment fr om Patient Insurance Sub-File INSURED DO B (#2.312, 3.01).
	24	For Buffer Extract ( real time inquiry):
	25	If patient relations hip to ins ured = sel f then pop ulate subs criber DOB in PID se gment from Patient f ile DATE O F BIRTH (# 2,.03).
	26	If patient relations hip to ins ured ≠ sel f then pop ulate pati ent DOB in PID segme nt from Pa tient file DATE OF B IRTH (#2,. 03) and su bscriber D OB in GT1 segment fr om the buf fer’s INSU RED DOB (# 355.33,60. 08)
	27	For Electr onic Inqui ry (on dem and, funct ionally eq uivalent t o Appointm ent Extrac t):
	28	If patient relations hip to ins ured = sel f then pop ulate subs criber DOB in PID se gment from Patient f ile DATE O F BIRTH (# 2,.03).
	29	If patient relations hip to ins ured ≠ sel f then pop ulate pati ent DOB in PID segme nt from Pa tient file DATE OF B IRTH (#2,. 03) and su bscriber D OB in GT1 segment fr om Patient Insurance Sub-File INSURED DO B (#2.312, 3.01).
	30	Future Fun ctionality
	31	For Appoin tment Extr act:
	32	If patient relations hip to ins ured = sel f then pop ulate subs criber DOB in PID se gment from Patient I nsurance S ub-File IN SURED DOB (#2.312,3. 01).
	33	If patient relations hip to ins ured = sel f and Pati ent Insura nce Sub-fi le INSURED DOB 2,.31 2,301 is b lank, then populate subscriber DOB in PI D segment from Patie nt file DA TE OF BIRT H (#2,.03) .
	34	Note: curr ent functi onality; d o not chan ge) If pat ient relat ionship to insured ≠ self then populate patient DO B in PID s egment fro m Patient file DATE OF BIRTH ( #2,.03) an d subscrib er DOB in GT1 segmen t from Pat ient Insur ance Sub-F ile INSURE D DOB (#2. 312,3.01).
	35	For Buffer Extract ( real time inquiry):
	36	If patient relations hip to ins ured = sel f then pop ulate subs criber DOB in PID se gment from buffer’s INSURED DO B (#355.33 ,60.08).
	37	If patient relations hip to ins ured = sel f and buff er’s INSUR ED DOB (#3 55.33,60.0 8) is blan k, then po pulate sub scriber DO B in PID s egment fro m Patient Insurance Sub-File I NSURED DOB (#2.312,3 .01).
	38	If patient relations hip to ins ured = sel f and both buffer’s INSURED DO B (#355.33 ,60.08) an d Patient Insurance Sub-File I NSURED DOB (#2.312,3 .01) are b lank, then populate subscriber DOB in PI D segment from Patie nt file DA TE OF BIRT H (#2,.03) .
	39	Note: curr ent functi onality; d o not chan ge) If pat ient relat ionship to insured ≠ self then populate patient DO B in PID s egment fro m Patient file DATE OF BIRTH ( #2,.03) an d populate subscribe r DOB in G T1 segment from buff er’s INSUR ED DOB (#3 55.33,60.0 8).
	40
	41	For Electr onic Inqui ry (on dem and, funct ionally eq uivalent t o Appointm ent Extrac t):
	42	If patient relations hip to ins ured = sel f then pop ulate subs criber DOB in PID se gment from Patient I nsurance S ub-File IN SURED DOB (#2.312,3. 01).
	43	If patient relations hip to ins ured = sel f and Pati ent Insura nce Sub-fi le INSURED DOB (#2.3 12,301) is blank, th en populat e subscrib er DOB in PID segmen t from Pat ient file DATE OF BI RTH (#2,.0 3).
	44	Note: curr ent functi onality; d o not chan ge) If pat ient relat ionship to insured ≠ self then populate patient DO B in PID s egment fro m Patient file DATE OF BIRTH ( #2,.03) an d subscrib er DOB in GT1 segmen t from Pat ient Insur ance Sub-F ile INSURE D DOB (#2. 312,3.01).
	45
	46	Developer note: Chec ked the in bound fili ng of DOB from Payer (to rule out the po tential re quirement to change the compar ison field s from aut o-update c ode). Resu lt of chec k per Deve lopment Le ad is that auto-upda te behavio r does not need to b e modified .
	47	Detailed L isting of Acceptance Criteria
	48	Requiremen t ID
	49	Descriptio n
	50	External D ependency (Y/N)
	51	USIN-035.0 1
	52	For Appoin tment Extr act:
	53	Eligibilit y Inquiry for insure d as self populates subscriber DOB in PI D segment using Pati ent insura nce Sub-Fi le INSURED DOB (#2.3 12,301) if available ; else pop ulates usi ng Patient file DATE OF BIRTH (#2,.03).
	54	N
	55	USIN-035.0 2
	56	For Appoin tment Extr act:
	57	(Existing Functional ity) Eligi bility Inq uiry for i nsured not self popu lates pati ent DOB in PID segme nt using P atient fil e DATE OF BIRTH (#2, .03) and s ubscriber DOB in GT1 segment u sing Patie nt Insuran ce Sub-Fil e INSURED DOB (#2.31 2,3.01).
	58	N
	59	USIN-035.0 3
	60	For Buffer Extract:
	61	Eligibilit y Inquiry for insure d as self populates subscriber DOB in PI D segment using buff er’s INSUR ED DOB (#3 55.33,60.0 8) if avai lable; els e populate s subscrib er DOB usi ng Patient Insurance Sub-File INSURED DO B (#2.312, 3.01), if available; else popu lates subs criber DOB using Pat ient File DATE OF BI RTH, (#2,. 03).
	62	N
	63	USIN-035.0 4
	64	For Buffer Extract:
	65	(Existing Functional ity) Eligi bility Inq uiry for i nsured not self popu lates pati ent DOB in PID segme nt using P atient fil e DATE OF BIRTH (#2, .03) and p opulates s ubscriber DOB in GT1 segment u sing buffe r’s INSURE D DOB (#35 5.33,60.08 ).
	66	N
	67	USIN-035.0 5
	68	For Electr onic Inqui ry:
	69	Eligibilit y Inquiry for insure d as self populates subscriber DOB in PI D segment using Pati ent insura nce Sub-Fi le INSURED DOB (#2.3 12,301) if available ; else pop ulates usi ng Patient file DATE OF BIRTH (#2,.03).
	70	N
	71	USIN-035.0 6
	72	For Electr onic Inqui ry:
	73	Eligibilit y Inquiry for insure d not self populates patient D OB in PID segment us ing Patien t file DAT E OF BIRTH (#2,.03) and subscr iber DOB i n GT1 segm ent using Patient In surance Su b-File INS URED DOB ( #2.312,3.0 1).
	74	N
	75	Testing No tes:
	76	Test with different values for patient r elationshi p to insur ed.
	77	Test with different date of bi rth scenar ios:
	78	Patient fi le (regist ration) DA TE OF BIRT H (#2,.03) matches P atient Ins urance Sub -File INSU RED DOB (# 2.312,3.01 ).
	79	Patient fi le (regist ration) DA TE OF BIRT H (#2,.03) does not match Pati ent Insura nce SubFil e INSURED DOB (#2.31 2,3.01).
	80	Insurance Sub-File I NSURED DOB (#2.312,3 .01) is (p opulated/b lank).
	81	Buffer’s I NSURED DOB (#355.33, 60.08) is (populated /blank).
	82	Test using Appointme nt Extract and Buffe r Extract and Electr onic Inqui ry.
	83	Test using a Subscri ber with D OB differe nt from Pa tient DOB.
	84	Need FSC t o assist w ith testin g by monit oring the HL7 messag es they re ceive.
	85	Review all three of Appointmen t Extract, Buffer Ex tract, and Electroni c Insuranc e Inquiry and verify that all match requ irements.
	86	Review exi sting func tionality for popula ting Name of Subscri ber (name of insured ). Existin g Name of Subscriber behavior should mat ch the pro posed solu tion for D OB.
	87	Risks
	88	Continuing to send o nly non-ed itable DOB will cont inue to pr oduce elig ibility tr ansaction rejects th at will pr event auto -update.
	89	Assumption s:
	90	None defin ed.
	91	Approval S ignatures
	92
	93	Revision H istory
	94	Date
	95	Version
	96	Descriptio n
	97	Author
	98	10/13/2016
	99	v0.01
	100	Original
	101	eInsurance
	102	08/02/2017
	103	V0.02
	104	Revision
	105	eInsurance