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| 1 | ePharmacy_Bundle 12.zip | bps_1_0_p24_tm.docx | Wed Sep 12 15:14:00 2018 UTC |
| 2 | ePharmacy_Bundle 12.zip | bps_1_0_p24_tm.docx | Fri Sep 14 14:35:48 2018 UTC |
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| 1 | Department of Vetera ns Affairs | ||
| 2 | ELECTRONIC CLAIMS MA NAGEMENT E NGINE (ECM E) | ||
| 3 | |||
| 4 | TECHNICAL MANUAL/SEC URITY GUID E | ||
| 5 | |||
| 6 | |||
| 7 | |||
| 8 | Version 1. 0 | ||
| 9 | |||
| 10 | April 2006 | ||
| 11 | |||
| 12 | (Revised N ovember 20 18) | ||
| 13 | |||
| 14 | |||
| 15 | Department of Vetera ns Affairs | ||
| 16 | |||
| 17 | Office of Informatio n and Tech nology (OI T) | ||
| 18 | |||
| 19 | |||
| 20 | Revision H istory | ||
| 21 | |||
| 22 | Date | ||
| 23 | Changed pa ges | ||
| 24 | Descriptio n (Patch # if applic able) | ||
| 25 | Project Ma nager | ||
| 26 | Technical Writer | ||
| 27 | 11/2018 | ||
| 28 | 7, 16, 20, 21, 26, 2 7, 30, 79 | ||
| 29 | Update for patch BPS *1*24 | ||
| 30 | PII | ||
| 31 | PII | ||
| 32 | 7/2018 | ||
| 33 | 19, 20, 50 | ||
| 34 | Update for patch BPS *1*23 | ||
| 35 | PII | ||
| 36 | PII | ||
| 37 | 11/2017 | ||
| 38 | 10, 19, 48 | ||
| 39 | Update for patch BPS *1*22 | ||
| 40 | PII | ||
| 41 | PII | ||
| 42 | 3/2017 | ||
| 43 | 19 | ||
| 44 | Update for patch BPS *1*21 | ||
| 45 | PII | ||
| 46 | PII | ||
| 47 | 06/2016 | ||
| 48 | 7, 19, 21, 24, 25, 2 7, 28, 29, 34, 47, 4 8, 61, 71, 72, 76, 9 3 | ||
| 49 | Update for patch BPS *1*20 | ||
| 50 | PII | ||
| 51 | PII | ||
| 52 | 06/2015 | ||
| 53 | 7, 14,18, 24,26,29,7 2,75,76 | ||
| 54 | Update for patch BPS *1*19 | ||
| 55 | PII | ||
| 56 | PII | ||
| 57 | 02/2015 | ||
| 58 | 19,43, re formatted footers | ||
| 59 | Update for patch BPS *1.0*17 | ||
| 60 | PII | ||
| 61 | PII | ||
| 62 | 11/2013 | ||
| 63 | i,ii, iii, iv, v, 19 , 39, 40, 93 | ||
| 64 | Update for patch BPS *1.0*15 | ||
| 65 | PII | ||
| 66 | PII | ||
| 67 | 02/2012 | ||
| 68 | 1, 7, 13, 15, 16, 17 , 20, 22, 24, 25, 26 , 27, 28, 29, 30, 31 , 32, 36, 38, 39, 40 , 41, 42, 43, 44, 45 , 46, 47, 48, 49, 50 , 51, 52, 53, 54, 55 , 56, 57, 59, 65, 66 , 67, 68, 69, 71, 80 , 81, 88, 103 | ||
| 69 | Update for patch BPS *1.0*11 | ||
| 70 | PII | ||
| 71 | PII | ||
| 72 | 10/2011 | ||
| 73 | 1, 2, 7, 10, 11, 13 -17, 19, 2 1-29, 31, 33-43, 45, 46, 51, 5 7, 59, 61, 63, 67-68 , 71, 73-7 5, 77, 79, 85, 88, 9 0, 93, 95 | ||
| 74 | Updates fo r Build BP S*1.0*10, v D.0 | ||
| 75 | PII | ||
| 76 | PII | ||
| 77 | 11/2010 | ||
| 78 | |||
| 79 | Updates fo r patch BP S*1*9 (TRI CARE Activ e release) | ||
| 80 | PII | ||
| 81 | PII | ||
| 82 | 08/2010 | ||
| 83 | |||
| 84 | Updates fo r BPS*1*8 (Coordinat ion of Ben efits rele ase) | ||
| 85 | PII | ||
| 86 | PII | ||
| 87 | 07/2009 | ||
| 88 | |||
| 89 | ePHARMACY ENHANCEMEN TS patch BPS*1.0*7 | ||
| 90 | PII | ||
| 91 | PII | ||
| 92 | |||
| 93 | |||
| 94 | ePHARMACY TRICARE SU PPORT FRAM EWORK patc h BPS*1*6. | ||
| 95 | PII | ||
| 96 | PII | ||
| 97 | 10/2007 | ||
| 98 | |||
| 99 | ePHARMACY/ ECME ENHAN CEMENTS pa tch BPS*1* 5. | ||
| 100 | PII | ||
| 101 | PII | ||
| 102 | 12/2006 | ||
| 103 | |||
| 104 | RX NOT PRO CESSED FOR SITE MESS AGE patch BPS*1.0*4 | ||
| 105 | PII | ||
| 106 | PII | ||
| 107 | 02/2007 | ||
| 108 | |||
| 109 | Updated fo r NPI patc h BPS*1*2. | ||
| 110 | PII | ||
| 111 | PII | ||
| 112 | 08/2006 | ||
| 113 | |||
| 114 | Updated fo r interim patch BPS* 1*3. | ||
| 115 | PII | ||
| 116 | PII | ||
| 117 | 04/2006 | ||
| 118 | |||
| 119 | Initial re lease of t he Electro nic Claims Managemen t Engine ( ECME) Tech nical Manu al/Securit y Guide. | ||
| 120 | PII | ||
| 121 | PII | ||
| 122 | |||
| 123 | |||
| 124 | |||
| 125 | |||
| 126 | (This page included for two-si ded copyin g.) | ||
| 127 | |||
| 128 | Contents | ||
| 129 | Introducti on1 | ||
| 130 | Descriptio n of ECME Technical Guide1 | ||
| 131 | Orientatio n2 | ||
| 132 | List of Re lated Docu mentation4 | ||
| 133 | Technical Manual5 | ||
| 134 | 1ECME V. 1 .0 Menus7 | ||
| 135 | 2Implement ation and Maintenanc e9 | ||
| 136 | 2.1Site Pa rameters9 | ||
| 137 | 2.2Editing the Basic Pharmacy ECME Param eters9 | ||
| 138 | 2.3System Requiremen ts11 | ||
| 139 | 3Files13 | ||
| 140 | 4Routines1 9 | ||
| 141 | 4.1Descrip tions19 | ||
| 142 | 4.2Callabl e Routines 20 | ||
| 143 | 5Templates 21 | ||
| 144 | 5.1Print T emplates21 | ||
| 145 | 5.2Input T emplates21 | ||
| 146 | 5.3Sort Te mplates21 | ||
| 147 | 5.4List Te mplates21 | ||
| 148 | 6Exported Options23 | ||
| 149 | 6.1Stand-a lone Optio ns23 | ||
| 150 | 6.2Top-lev el Menus23 | ||
| 151 | 6.3Options 28 | ||
| 152 | 7Archiving and Purgi ng32 | ||
| 153 | 7.1Archivi ng32 | ||
| 154 | 7.2Purging 32 | ||
| 155 | 8Callable Routines/E ntry Point s/Applicat ion Progra mmer Inter faces (API s)34 | ||
| 156 | 8.1Callabl e Routines 34 | ||
| 157 | 8.2Applica tion Progr ammer Inte rfaces (AP I’s)34 | ||
| 158 | 8.3Entry P oints45 | ||
| 159 | 9Protocols 47 | ||
| 160 | 10External Relations 49 | ||
| 161 | 10.1Softwa re Require ments49 | ||
| 162 | 10.2Integr ation Agre ements (IN TEGRATION CONTROL RE GISTRATION S)49 | ||
| 163 | 11Internal Relations 51 | ||
| 164 | 12Package- Wide Varia bles53 | ||
| 165 | 12.1SACC E xemptions5 3 | ||
| 166 | 12.2Variab les53 | ||
| 167 | Security G uide55 | ||
| 168 | 13Security Managemen t57 | ||
| 169 | 14Mail Gro ups and Ma il Message s (Bulleti ns)59 | ||
| 170 | 15Remote S ystems61 | ||
| 171 | 16Archivin g and Purg ing63 | ||
| 172 | 16.1Archiv ing63 | ||
| 173 | 16.2Purgin g63 | ||
| 174 | 17Continge ncy Planni ng65 | ||
| 175 | 18Interfac ing67 | ||
| 176 | 19Electron ic Signatu res69 | ||
| 177 | 20Menus71 | ||
| 178 | 20.1Securi ty Keys0 | ||
| 179 | 21File Sec urity77 | ||
| 180 | 22Referenc es79 | ||
| 181 | 23Official Policies7 9 | ||
| 182 | A.Glossary 81 | ||
| 183 | B.Index99 | ||
| 184 | |||
| 185 | |||
| 186 | |||
| 187 | |||
| 188 | |||
| 189 | Introducti on | ||
| 190 | Descriptio n of ECME Technical Guide | ||
| 191 | The Electr onic Claim s Manageme nt Engine (ECME) Tec hnical Gui de describ es the tec hnical and security aspects of the ECME V. 1.0 app lication. Its intend ed audienc e includes Health Sy stems Desi gn & Devel opment (HS D&D) devel opers and members of the Pharm acy Automa ted Data P rocessing Applicatio n Coordina tor (ADPAC ) and Info rmation Re sources Ma nagement S ervice (IR MS) staff. Users can find ECME V. 1.0 do cumentatio n, includi ng any sub sequent ch ange pages affecting this guid e, on the Veterans H ealth Info rmation Sy stems and Technology Architect ure (VistA ) document ation libr ary at htt p:// URL . | ||
| 192 | |||
| 193 | The ECME V . 1.0 appl ication ge nerates el ectronic c laims in N ational Co uncil for Prescripti on Drug Pr ograms (NC PDP) in ve rsion D.0 format bas ed on the Outpatient Pharmacy V. 7.0 wor kflow. Cla ims will a lso be pro cessed in version D. 0. format until all payers swi tch to NCP DP version D.0.–D.9. | ||
| 194 | |||
| 195 | ECME V. 1. 0 performs the follo wing tasks : | ||
| 196 | |||
| 197 | It allows pharmacy u sers to su bmit, resu bmit, and reverse el ectronic c laims. | ||
| 198 | |||
| 199 | It provide s reports for end us ers and ma nagement o n claims s tatus, tra nsaction h istory, an d system c onfigurati on standin gs. | ||
| 200 | |||
| 201 | It allows Pharmacy A DPACs and IRMs to co nfigure EC ME to phar macy site specificat ions. | ||
| 202 | |||
| 203 | It allows users to s ubmit elig ibility ve rification transmiss ions for p harmacy in surance. | ||
| 204 | |||
| 205 | The ECME p ackage was originall y released in two ph ases, a do rmant phas e (release d on 10/20 /2004), an d an activ e phase. T he BPS 1.0 Master Bu ild was th e dormant phase, rel easing the ECME V. 1 .0 package (which oc cupies the BPS names pace) in a dormant s tate and e nhancing I ntegrated Billing (I B) V. 2, s o that the user can link pharm acy groups with insu rance grou p plans. I n addition , during t he dormant phase, ea ch site sh ould have already re gistered t heir pharm acy with t he Financi al Service s Center ( FSC). | ||
| 206 | |||
| 207 | The active phase all owed the E CME V. 1.0 package t o produce electronic claims. T hese chang es allowed the VistA software applicatio ns to tran smit outpa tient phar macy presc ription cl aims to pa yers elect ronically and to rec eive claim responses (which in clude Drug Utilizati on Respons es (DURs) and warnin gs) on a r eal-time b asis and i n accordan ce with He althcare I nsurance P ortability and Accou ntability Act (HIPAA ) Electron ic Data In terchange (EDI) tran sactions a nd NCPDP m andated fo rmat stand ards, spec ifically N CPDP Telec ommunicati on Standar d V. 5.1. A later re lease adde d the capa bility of sending cl aims in th e NCPDP Te lecommunic ation Stan dard V. D. 0. | ||
| 208 | |||
| 209 | ECME V. 1. 0 claims p rocessing begins whe n events w ithin Outp atient Pha rmacy V. 7 .0 meet sp ecific cri teria that indicate the system should ge nerate an electronic claim. To build a c laim throu gh ECME V. 1.0, the following must occur : | ||
| 210 | |||
| 211 | The patien t must be registered . | ||
| 212 | The patien t must hav e pharmacy insurance coverage. | ||
| 213 | The patien t must hav e a prescr iption for a non-ser vice conne cted condi tion and w ith a bill able drug. | ||
| 214 | |||
| 215 | Logic embe dded withi n ECME V. 1.0 manage s the crea tion of th e electron ic claim, which requ ires integ ration wit h Integrat ed Billing (IB) V. 2 .0, Pharma cy Data Ma nagement ( PDM) V. 1. 0, and the National Drug File (NDF) V. 4 .0. ECME V . 1.0 also generates claims du ring Conso lidated Ma il Outpati ent Pharma cy (CMOP) V. 2.0 pro cessing fo r prescrip tions that meet bill ing requir ements; th e prescrip tions are suspended for CMOP f ills. | ||
| 216 | |||
| 217 | The Vetera ns Health Administra tion (VHA) developed the ECME V. 1.0 sof tware in o rder to co mply with the Health Insurance Portabili ty and Acc ountabilit y Act of 1 996, which requires health car e provider s to trans mit outpat ient pharm acy prescr iption cla ims to pay ers electr onically i n the NCPD P format, and to rec eive respo nses on a real-time basis. ECM E V. 1.0 w as derived from the Pharmacy P oint of Sa le V. 1.0 (POS) appl ication de veloped by the India n Health S ervice (IH S). | ||
| 218 | |||
| 219 | Orientatio n | ||
| 220 | This guide consisten tly uses t he followi ng notatio n to enhan ce readabi lity. | ||
| 221 | |||
| 222 | Screen pro mpts are d enoted wit h quotatio n marks ar ound them. Example: t he “Press ENTER to c ontinue” p rompt will display n ext. | ||
| 223 | |||
| 224 | Menu optio ns are ita licized. E xample: Th e Payable Claims Rep ort option lists pay able elect ronic clai ms in bill ed and pai d amounts. | ||
| 225 | |||
| 226 | Responses in bold fa ce denote user input .Example: Select ECM E Option: RPT | ||
| 227 | |||
| 228 | <Enter> in dicates th e user mus t press th e Enter ke y (or Retu rn key on some keybo ards).Exam ple: Type Y for Yes or N for N o and pres s <Enter> | ||
| 229 | |||
| 230 | <Tab> indi cates the user must press the Tab key.Ex ample: Pre ss <Tab> t o move the cursor to the next field. | ||
| 231 | |||
| 232 | Note: Ind icates esp ecially im portant or helpful i nformation . | ||
| 233 | |||
| 234 | Options are locked with a pa rticular s ecurity ke y. The use r must hol d the part icular sec urity key to be able to perfor m the menu option.Ex ample: Th e user can not access the Pharm acy ECME M anager Men u options without th e BPS MANA GER key. | ||
| 235 | |||
| 236 | The page symbol ind icates a r eferral to a diagram . | ||
| 237 | |||
| 238 | ?, ??, ??? The user can enter one, two or three q uestion ma rks at any prompt to get onlin e help. On e question mark brie fly states what info rmation is appropria te for the prompt. T wo questio n marks pr ovide more detailed help, plus hidden ac tions, and three que stion mark s give the most deta iled help, including a list of possible answers, i f appropri ate. | ||
| 239 | |||
| 240 | Users can obtain onl ine help i n the foll owing ways . | ||
| 241 | |||
| 242 | Enter a qu estion mar k (?) for assistance in choosi ng actions at a prom pt. | ||
| 243 | Use the ke rnel routi ne, XINDEX , to produ ce detaile d listings of the ro utines. | ||
| 244 | Use VA Fil eMan to ge nerate lis tings of d ata dictio naries for the files . | ||
| 245 | |||
| 246 | |||
| 247 | List of Re lated Docu mentation | ||
| 248 | |||
| 249 | Electronic Claims Ma nagement E ngine V. 1 .0 User Ma nual | ||
| 250 | |||
| 251 | Outpatient Pharmacy V. 7.0 Tec hnical Man ual/Securi ty Guide C hange Page s | ||
| 252 | |||
| 253 | Outpatient Pharmacy V. 7.0 Use r Manual C hange Page s | ||
| 254 | |||
| 255 | HIPAA NCPD P Connecti on for EDI Pharmacy (Active Re lease) Ins tallation Guide | ||
| 256 | |||
| 257 | HIPAA NCPD P Connecti on for EDI Pharmacy (Active Re lease) Rel ease Notes | ||
| 258 | |||
| 259 | HIPAA NCPD P IB/AR Re lease Note s | ||
| 260 | |||
| 261 | PDM Techni cal Manual /Security Guide Chan ge Pages | ||
| 262 | |||
| 263 | PDM User's Manual Ch ange Pages | ||
| 264 | |||
| 265 | CMOP Techn ical Manua l Change P ages | ||
| 266 | |||
| 267 | CMOP User' s Manual C hange Page s | ||
| 268 | |||
| 269 | |||
| 270 | |||
| 271 | Technical Manual | ||
| 272 | (This page included for two-si ded copyin g.) | ||
| 273 | |||
| 274 | |||
| 275 | |||
| 276 | ECME V. 1.0 Men us | ||
| 277 | The comple te list of Electroni c Claims M anagement Engine (EC ME) V. 1.0 menu opti ons is sho wn below. The Claims Coordinat or needs t o access a ll ECME V. 1.0 optio ns. | ||
| 278 | |||
| 279 | |||
| 280 | To view th e complete ECME V. 1 .0 menu st ructure, t he user mu st hold th e BPSMENU, BPS USER, BPS MANAG ER, BPS MA STER, BPS REPORTS, a nd BPS SUP ERVISOR ke ys. | ||
| 281 | |||
| 282 | UClaims Da ta Entry S creen | ||
| 283 | |||
| 284 | COBECME Ph armacy COB . . . | ||
| 285 | SECPotenti al Seconda ry Rx Clai ms Report | ||
| 286 | TRIPotenti al Claims Report for Dual Elig ible | ||
| 287 | PROProcess Secondary /TRICARE R x to ECME | ||
| 288 | |||
| 289 | MGRPharmac y ECME Man ager Menu . . . | ||
| 290 | MNTECME tr ansaction maintenanc e options … | ||
| 291 | UNSView/Un strand Sub missions N ot Complet ed | ||
| 292 | ROCRe Open CLOSED/Re submit Cla im | ||
| 293 | SETPharmac y ECME Set up Menu .. . | ||
| 294 | BASEdit Ba sic ECME P arameters | ||
| 295 | PHAREdi t ECME Pha rmacy Data | ||
| 296 | REGRegi ster Pharm acy with A ustin Auto mation Cen ter | ||
| 297 | STATStatis tics Scree n | ||
| 298 | RPTPharmac y Electron ic Claims Reports . . . | ||
| 299 | CLAClaim R esults and Status . . . | ||
| 300 | PAYPayable Claims Re port | ||
| 301 | REJRejecte d Claims R eport | ||
| 302 | ECMPCOMP/E CME Activi ty Report | ||
| 303 | REVReversa l Claims R eport | ||
| 304 | NYRClaims Submitted, Not Yet R eleased | ||
| 305 | RECRecent Transactio ns | ||
| 306 | DAYTotals by Date | ||
| 307 | CLOClosed Claims Rep ort | ||
| 308 | NBSNon-Bil lable Stat us Report | ||
| 309 | SPASpendin g Account Report | ||
| 310 | OTHOther R eports . . . | ||
| 311 | CRI ECME Claims-Re sponse Inq uiry | ||
| 312 | PAYPayer S heet Detai l Report | ||
| 313 | PHARECME S etup – Pha rmacies Re port | ||
| 314 | TATTurn-ar ound time statistics | ||
| 315 | VERView eP harmacy Rx | ||
| 316 | OPROPECC P roductivit y Report | ||
| 317 | (This pag e included for two-s ided copyi ng.) | ||
| 318 | |||
| 319 | |||
| 320 | Implementa tion and M aintenance | ||
| 321 | Site Param eters | ||
| 322 | The site p arameters consist of the editi ng of the basic phar macy Elect ronic Clai ms Managem ent Engine (ECME) pa rameters a nd the ass ociation o f the outp atient sit es with th e ECME pha rmacy. | ||
| 323 | |||
| 324 | Editing th e Basic Ph armacy ECM E Paramete rs | ||
| 325 | The Edit B asic Pharm acy ECME P arameters option all ows the us er to dete rmine how long progr ess messag es will di splay on t he screen when claim s are bein g processe d in the f oreground. | ||
| 326 | |||
| 327 | To edit th is paramet er, use th e followin g menu pat h: | ||
| 328 | |||
| 329 | ECME Main Menu [BPSM ENU] (Lock ed: BPSMEN U) | ||
| 330 | Pharmacy E CME Manage r Menu [BP S MANAGER MENU] (Loc ked: BPS M ANAGER) | ||
| 331 | Pharmacy E CME Setup Menu [BPS SETUP MENU ] | ||
| 332 | Edit Basic Pharmacy ECME Param eters [BPS SETUP PAR T 1] (Lock ed: BPS | ||
| 333 | MASTER) | ||
| 334 | |||
| 335 | Example of Screen pr int | ||
| 336 | |||
| 337 | Edit Pharm acy ECME c onfigurati on | ||
| 338 | |||
| 339 | ECME timeo ut? (0 to 30 seconds ) : 30// | ||
| 340 | Insurer As leep Inter val (0 to 29 minutes ): 10// | ||
| 341 | Insurer As leep Retri es (0 to 9 9): 10// | ||
| 342 | Default El igibility Pharmacy: | ||
| 343 | Associatin g the Outp atient Sit es with an ECME Phar macy | ||
| 344 | |||
| 345 | This optio n enables the pharma cy users t o submit t hird party claims. | ||
| 346 | |||
| 347 | To edit th is paramet er, use th e followin g menu pat h: | ||
| 348 | |||
| 349 | ECME Main Menu [BPS MENU] (Loc ked: BPSME NU) | ||
| 350 | Pharmacy E CME Manage r Menu [BP S MANAGER MENU] (Loc ked: BPS M ANAGER) | ||
| 351 | Edit Pharm acy ECME P harmacy Da ta [BPS S ETUP PHARM ACY] (Lock ed: BPS | ||
| 352 | MASTER) | ||
| 353 | |||
| 354 | The follow ing is a l ist of pro mpts relat ed to the Associatin g of Outpa tient Site s with an ECME Pharm acy option . | ||
| 355 | |||
| 356 | Select BPS PHARMACIE S NAME: E nter a BPS PHARMACIE S NAME, OR OUTPATIEN T SITE. By entering a question mark (?), the syste m will ret urn the av ailable BP S Pharmaci es. A new BPS Pharma cy can be entered an d the name must be 3 – 30 alph abetical c haracters (not numer ic and can not start with punct uation cha racter). | ||
| 357 | |||
| 358 | STATUS: Di splays the current s tatus (Act ive/Inacti ve). This is entered in the Re gister Pha rmacy with Austin Au tomation C enter opti on [BPS SE TUP REGIST ER PHARMAC Y] and is a read-onl y field on this scre en. | ||
| 359 | |||
| 360 | NCPDP #: D isplays th e Pharmacy NCPDP #. This is a number ass igned to y our pharma cy by the NCPDP and was former ly called NABP # (Na tional Ass ociation o f Boards o f Pharmacy number). This is en tered in t he Registe r Pharmacy with Aust in Automat ion Center option [B PS SETUP R EGISTER PH ARMACY] an d is a rea d-only fie ld on this screen. | ||
| 361 | |||
| 362 | NPI: Displ ays the Ph armacy Nat ional Prov ider Ident ifier (NPI ). This nu mber is as signed to your pharm acy by the Centers f or Medicar e and Medi caid Servi ces (CMS) and was re quested by the Centr al Busines s Office ( CBO). It i s automati cally dete rmined by linking an entry in BPS PHARMA CIES (#900 2313.56) t o an Outpa tient Site . | ||
| 363 | |||
| 364 | Select OUT PATIENT SI TE: You m ay enter a new OUTPA TIENT SITE , if you w ish. One o r more of the VISTA Pharmacy p ackage's O UTPATIENT SITE entri es (file # 59) must b e associat ed with an ECME Phar macy entry . | ||
| 365 | |||
| 366 | CMOP SWITC H: Enter O N to proce ss CMOP cl aims via E CME, OFF t o not proc ess CMOP c laims. Cho ose from 0 -CMOP OFF/ 1-CMOP ON. | ||
| 367 | |||
| 368 | AUTO-REVER SE PARAMET ER: ECME uses the A UTO-REVERS E site par ameter whe n determin ing whethe r non-rele ased presc ription cl aims (thos e that hav e a PAYABL E response ) are to b e automati cally REVE RSED. The AUTO-REVER SE site pa rameter is set for t he number of days th at ECME wi ll wait be fore the c laim is au tomaticall y REVERSED . ECME wil l allow th e user to enter a nu mber betwe en 3-10 an d ECME wil l wait the entered n umber of d ays before REVERSING the non-r eleased Rx with a pa yable resp onse retur ned by the payer. Th e suggeste d setting is 5. | ||
| 369 | |||
| 370 | DEFAULT DE A #: Many payers req uire the p rescriber' s Drug Enf orcement A dministrat ion (DEA) number as part of th e claim. I f your pha rmacy has a DEA # th at may be used in ca se a presc riber does not have this DEA # on file w ith you, e nter that default DE A # here. | ||
| 371 | |||
| 372 | |||
| 373 | Example Sc reen print | ||
| 374 | |||
| 375 | Select BPS PHARMACIE S NAME: DA YTON | ||
| 376 | |||
| 377 | NAME: DAYT ON | ||
| 378 | STATUS: AC TIVE | ||
| 379 | NCPDP #: 3 664085 | ||
| 380 | NPI: 12345 67895 | ||
| 381 | Select OUT PATIENT SI TE: DAYTON // <ENTER> | ||
| 382 | OUTPATIE NT SITE: D AYTON// <E NTER> | ||
| 383 | Select OUT PATIENT SI TE: <ENTER > | ||
| 384 | CMOP SWITC H: CMOP ON // <ENTER> | ||
| 385 | AUTO-REVER SE PARAMET ER: 10// < ENTER> | ||
| 386 | DEFAULT DE A #: XX111 11111// <E NTER> | ||
| 387 | |||
| 388 | System Req uirements | ||
| 389 | There are no specifi c hardware requireme nts for th e ECME V. 1.0 packag e. | ||
| 390 | |||
| 391 | Disk Space Requireme nts | ||
| 392 | |||
| 393 | Since this version i s distribu ted using KIDS, the transport global is automatica lly delete d after th e initial installati on. | ||
| 394 | |||
| 395 | There are less than 200 BPS* r outines, w hich occup y less tha n 1 MB of space. | ||
| 396 | Journaling Globals | ||
| 397 | |||
| 398 | The ECME V . 1.0 pack age uses t he namespa ce BPS. Al l BPS* glo bals shoul d be journ aled, if j ournaling is used. | ||
| 399 | |||
| 400 | |||
| 401 | |||
| 402 | (This page included for two-si ded copyin g). | ||
| 403 | |||
| 404 | Files | ||
| 405 | |||
| 406 | Number | ||
| 407 | Global | ||
| 408 | Location | ||
| 409 | Name | ||
| 410 | Brief Desc ription | ||
| 411 | 9002313.02 | ||
| 412 | ^BPSC( | ||
| 413 | BPS CLAIMS | ||
| 414 | Intermedia te form of transmiss ions. Fiel ds are sto red in for matted for m. Raw pac ket is als o stored. Most field s are in F ree Text f ormat to a ccommodate NCPDP Sta ndard form atting cri teria and required f ield lengt hs. Fields other tha n those wi th decimal s in the n umber corr elate dire ctly to th e field nu mbers supp lied in th e NCPDP Da ta Diction ary. | ||
| 415 | 9002313.03 | ||
| 416 | ^BPSR( | ||
| 417 | BPS RESPON SES | ||
| 418 | This file stores the response informatio n returned by the th ird-party payer. Mos t of the f ields have 'raw' NCP DP data so it is for matted per the NCPDP specifica tions. | ||
| 419 | 9002313.12 | ||
| 420 | ^BPS(90023 13.12, | ||
| 421 | BPS LOG | ||
| 422 | This is th e ECME log , which is used to s tore an au dit trail of ECME ac tivity. | ||
| 423 | There are currently two types of logs – one for tr ansactions and anoth er for pur ging. | ||
| 424 | 9002313.15 | ||
| 425 | ^BPS(90023 13.15, | ||
| 426 | BPS ASLEEP PAYERS | ||
| 427 | This file is used to store pay ers that a re asleep or should be ignored because t hey are as leep. Gene rally, the re should be few or no entries in this f ile unless there are payers th at are asl eep. | ||
| 428 | 9002313.19 | ||
| 429 | ^BPS(90023 13.19, | ||
| 430 | BPS NCPDP PATIENT RE LATIONSHIP CODE | ||
| 431 | Standard N CPDP Patie nt Relatio nship data to be use d in submi tting clai ms. The fi le and dat a should n ever be lo cally modi fied. | ||
| 432 | 9002313.2 | ||
| 433 | ^BPS(90023 13.2, | ||
| 434 | BPS NCPDP OTHER PAYE R AMT PAID QUAL | ||
| 435 | Static fil e to store the codes and descr iptions fo r NCPDP fi eld 342-HC (Other Pa yer Amount Paid Qual ifier). T hese codes are used for second ary electr onic claim transmiss ions to th ird party payers. N o local ch anges shou ld ever be made to t his file. | ||
| 436 | 9002313.21 | ||
| 437 | ^BPS(90023 13.21, | ||
| 438 | BPS NCPDP PROFESSION AL SERVICE CODE | ||
| 439 | Static fil e that is used to st ore the po ssible NCP DP PROFESS IONAL SERV ICE CODE v alues, whi ch are use d for over riding DUR rejects. This file is populat ed by the installati on and sho uld not be edited by sites. | ||
| 440 | 9002313.22 | ||
| 441 | ^BPS(90023 13.22, | ||
| 442 | BPS NCPDP RESULT OF SERVICE CO DE | ||
| 443 | Static fil e used to store the possible N CPDP RESUL T OF SERVI CE CODE va lues, whic h are used for overr iding DUR rejects. T his file i s populate d by the i nstallatio n and shou ld not be edited by sites. | ||
| 444 | 9002313.23 | ||
| 445 | ^BPS(90023 13.23, | ||
| 446 | BPS NCPDP REASON FO R SERVICE CODE | ||
| 447 | Static fil e that is used to st ore the po ssible NCP DP REASON FOR SERVIC E CODE val ues, which are used for overri ding DUR r ejects. Th is file is populated by the in stallation and shoul d not be e dited by s ites. | ||
| 448 | 9002313.24 | ||
| 449 | ^BPS(90023 13.24, | ||
| 450 | BPS NCPDP DAW CODE | ||
| 451 | Static fil e used to store NCPD P DAW (Dis pense As W ritten) co des, which are used for prescr iption ele ctronic cl aim transm ission to third part y payers. This file is populat ed by the installati on and sho uld not be edited by sites. | ||
| 452 | 9002313.25 | ||
| 453 | ^BPS(90023 13.25, | ||
| 454 | BPS NCPDP CLARIFICAT ION CODES | ||
| 455 | This file is used to store the possible NCPDP CLAR IFICATION CODE value s, which a re used fo r overridi ng DUR rej ects. No l ocal chang es should ever be ma de to this file. The data stor ed in this file are based on t he NCPDP s tandards a nd are nat ionally di stributed. | ||
| 456 | 9002313.26 | ||
| 457 | ^BPS(90023 13.26, | ||
| 458 | BPS NCPDP PRIOR AUTH ORIZATION TYPE CODE | ||
| 459 | This file comes with standard NCPDP prio r authoriz ation data to be use d in submi tting clai ms. The fi le and dat a should n ever be lo cally modi fied, edit ed or chan ged. | ||
| 460 | 9002313.27 | ||
| 461 | ^BPS(90023 13.27, | ||
| 462 | BPS NCPDP PATIENT RE SIDENCE CO DE | ||
| 463 | Standard N CPDP Patie nt Residen ce data us ed in subm itting cla ims. The f ile and da ta should never be l ocally mod ified. | ||
| 464 | 9002313.28 | ||
| 465 | ^BPS(90023 13.28, | ||
| 466 | BPS NCPDP PHARMACY S ERVICE TYP E | ||
| 467 | Standard N CPDP Pharm acy Servic e Type dat a used in submitting claims. T he file an d data sho uld never be locally modified. | ||
| 468 | 9002313.29 | ||
| 469 | ^BPS(90023 13.29, | ||
| 470 | BPS NCPDP DELAY REAS ON CODE | ||
| 471 | Standard N CPDP Delay Reason Co de data us ed in subm itting cla ims. The f ile and da ta should never be l ocally mod ified. | ||
| 472 | 9002313.31 | ||
| 473 | ^BPS(90023 13.31, | ||
| 474 | BPS CERTIF ICATION | ||
| 475 | This file holds data for devel opment use in certif ying softw are when r equired by clearingh ouses and payers. | ||
| 476 | 9002313.32 | ||
| 477 | ^BPS(90023 13.32, | ||
| 478 | BPS PAYER RESPONSE O VERRIDES | ||
| 479 | This file is used to store Pay er Respons e Override s. This fi le should not be pop ulated on production systems, only on te st systems . | ||
| 480 | 9002313.34 | ||
| 481 | ^BPS(90023 13.34, | ||
| 482 | BPS NCPDP PRESCRIBER PLACE OF SERVICE | ||
| 483 | This file is used to store the possible NCPDP PRES CRIBER PLA CE OF SERV ICE CODES, that can be sent wi th a claim . | ||
| 484 | 9002313.35 | ||
| 485 | ^BPS(90023 13.35, | ||
| 486 | BPS NCPDP BENEFIT ST AGE INDICA TOR | ||
| 487 | This file is used to store the possible NCPDP BENE FIT STAGE INDICATOR, that can be sent on a claim o r returned by the pa yer. | ||
| 488 | 9002313.36 | ||
| 489 | ^BPS(90023 13.36, | ||
| 490 | BPS NCPDP LTPAC DISP ENSE FREQU ENCY | ||
| 491 | This file is used to store the possible NCPDP LTPA C DISPENSE FREQUENCY , that can be sent o n a claim. | ||
| 492 | 9002313.37 | ||
| 493 | ^BPS(90023 13.37, | ||
| 494 | BPS NCPDP PATIENT PA Y COMPONEN T QUALIFIE R | ||
| 495 | This file is used to store the possible NCPDP PATI ENT PAY CO MPONENT QU ALIFIER, t hat can be returned by the pay er. | ||
| 496 | 9002313.38 | ||
| 497 | ^BPS(90023 13.38, | ||
| 498 | BPS NCPDP OTHER PAYE R PROGRAM TYPE | ||
| 499 | This file is used to store the possible NCPDP OTHE R PAYER AD JUDICATED PROGRAM TY PE, that c an be retu rned by th e payer. | ||
| 500 | 9002313.51 1 | ||
| 501 | ^BPS(90023 13.511, | ||
| 502 | BPS NCPDP OVERRIDE | ||
| 503 | Contains v alues for override o f specific NCPDP fie lds. | ||
| 504 | 9002313.56 | ||
| 505 | ^BPS(90023 13.56, | ||
| 506 | BPS PHARMA CIES | ||
| 507 | Pharmacy-s pecific da ta -- NCPD P #, NPI, default DE A #, etc. One BPS PH ARMACY has a list of one or mo re OUTPATI ENT SITES (file 59) | ||
| 508 | 9002313.57 | ||
| 509 | ^BPSTL( | ||
| 510 | BPS LOG OF TRANSACTI ONS | ||
| 511 | This file contains a copy of t he BPS Tra nsaction ( #9002313.5 9) record after it c ompletes ( reaches 99 %) and thu s, provide s a histor ical recor d of all c ompleted t ransaction s. | ||
| 512 | 9002313.58 | ||
| 513 | ^BPSECX("S ", | ||
| 514 | BPS STATIS TICS | ||
| 515 | Statistics ; displaye d by the B PS STATIST ICS SCREEN option. | ||
| 516 | 9002313.59 | ||
| 517 | ^BPST( | ||
| 518 | BPS TRANSA CTION | ||
| 519 | This file stores the most rece nt transac tions for an RX/Fill (Billing Request or Reversal) or Patien t/Policy ( Eligibilit y Verifica tion). Whe n complete (status 9 9), a copy of the re cord is pl aced in th e BPS Log of Transac tions file (#9002313 .57). | ||
| 520 | 9002313.77 | ||
| 521 | ^BPS(90023 13.77, | ||
| 522 | BPS REQUES TS | ||
| 523 | This file is used to store dat a for queu ed request s before t he ECME en gine un-qu eues them and during their pro cessing. T he data st ored in th is file ar e used to create a r ecord in B PS TRANSAC TION file (#9002313. 59) to bui ld a claim request o r reversal and send it to the insurer (p ayer). Gen erally the re should be few or no entries in this f ile unless there are stranded claims/rev ersal or r equests th at need to be un-str anded by t he user. | ||
| 524 | 9002313.78 | ||
| 525 | ^BPS(90023 13.78, | ||
| 526 | BPS INSURE R DATA | ||
| 527 | This file is used to store ins urers' det ails data returned b y the Inte grated Bil ling packa ge to be u sed by the ECME engi ne to buil d claim re quests and reversals and send them to in surers (pa yers). Gen erally the re should be few or no entries in this f ile unless there are stranded claims, re versal or requests t hat need t o be un-st randed by the user. | ||
| 528 | 9002313.83 | ||
| 529 | ^BPSF(9002 313.83, | ||
| 530 | BPS RESULT CATEGORY | ||
| 531 | A list of the possib le result categories , as retur ned by CAT EG^BPSOSUC (). This t able is ov erwritten by the ins tallation. | ||
| 532 | 9002313.89 | ||
| 533 | ^BPSF(9002 313.89, | ||
| 534 | BPS ERROR CODES | ||
| 535 | Obsolete. | ||
| 536 | 9002313.91 | ||
| 537 | ^BPSF(9002 313.91, | ||
| 538 | BPS NCPDP FIELD DEFS | ||
| 539 | The file o f NCPDP Da ta Diction ary fields which are combined into forma tted packe ts. Packag e installa tion updat es this fi le. | ||
| 540 | 9002313.92 | ||
| 541 | ^BPSF(9002 313.92, | ||
| 542 | BPS NCPDP FORMATS | ||
| 543 | Entries ar e commonly referred to as “pay er sheets” . These ar e the form ats for se nding clai ms. This f ile was in itially in stalled as part of t he dormant release a nd updates are sent by the AIT C via HL7. Never mod ify locall y, except in coopera tion with developmen t. | ||
| 544 | 9002313.93 | ||
| 545 | ^BPSF(9002 313.93, | ||
| 546 | BPS NCPDP REJECT COD ES | ||
| 547 | Rejection codes as d efined by NCPDP. Nev er edit th is file. I nstallatio n overwrit es this fi le, totall y. | ||
| 548 | 9002313.99 | ||
| 549 | ^BPS(90023 13.99, | ||
| 550 | BPS SETUP | ||
| 551 | ECME syste m paramete rs. Contai ns only on e entry ca lled MAIN SETUP ENTR Y with an IEN of 1. | ||
| 552 | |||
| 553 | |||
| 554 | Data Dicti onaries (D D) are par t of the o nline docu mentation for this s oftware ap plication. Use VA Fi leMan List File Attr ibutes [DI LIST] opti on, under the Data D ictionary Utilities [DI DDU] o ption, to print the DDs. | ||
| 555 | |||
| 556 | |||
| 557 | |||
| 558 | |||
| 559 | |||
| 560 | |||
| 561 | Routines | ||
| 562 | Descriptio ns | ||
| 563 | The follow ing is a l ist of rou tines expo rted by th e Electron ic Claims Management Engine (E CME) V. 1. 0 package. Each rout ine’s firs t line con tains a br ief descri ption of t he routine ’s functio n. Use the First Lin e Routine Print [XU FIRST LINE PRINT] op tion to pr int a list of just t he first l ine of eac h BPS* rou tine. | ||
| 564 | |||
| 565 | |||
| 566 | BPSBCKJ | ||
| 567 | BPSBUTL | ||
| 568 | BPSCMT | ||
| 569 | BPSCMT01 | ||
| 570 | BPSCT | ||
| 571 | BPSECA1 | ||
| 572 | BPSECA8 | ||
| 573 | BPSECFM | ||
| 574 | BPSECMC2 | ||
| 575 | BPSECMP2 | ||
| 576 | BPSECMPS | ||
| 577 | BPSECX0 | ||
| 578 | BPSECX1 | ||
| 579 | BPSELG | ||
| 580 | BPSFLD01 | ||
| 581 | BPSGRPL | ||
| 582 | BPSJACK | ||
| 583 | BPSJAREG | ||
| 584 | BPSJHLI | ||
| 585 | BPSJHLT | ||
| 586 | BPSJINIT | ||
| 587 | BPSJPHNM | ||
| 588 | BPSJPREG | ||
| 589 | BPSJUTL | ||
| 590 | BPSJUTL1 | ||
| 591 | BPSJVAL | ||
| 592 | BPSJVAL1 | ||
| 593 | BPSJVAL2 | ||
| 594 | BPSJZPR | ||
| 595 | BPSJZQR | ||
| 596 | BPSJZRP | ||
| 597 | BPSMHDR | ||
| 598 | BPSNCPD1 | ||
| 599 | BPSNCPD2 | ||
| 600 | BPSNCPD3 | ||
| 601 | BPSNCPD4 | ||
| 602 | BPSNCPD5 | ||
| 603 | BPSNCPD6 | ||
| 604 | BPSNCPD9 | ||
| 605 | BPSNCPDP | ||
| 606 | BPSNPI | ||
| 607 | BPSOPR | ||
| 608 | BPSOPR2 | ||
| 609 | BPSOPR3 | ||
| 610 | BPSOS | ||
| 611 | BPSOS03 | ||
| 612 | BPSOS2 | ||
| 613 | BPSOS2A | ||
| 614 | BPSOS2B | ||
| 615 | BPSOS2C | ||
| 616 | BPSOS57 | ||
| 617 | BPSOS6M | ||
| 618 | BPSOSC2 | ||
| 619 | BPSOSCA | ||
| 620 | BPSOSCB | ||
| 621 | BPSOSCC | ||
| 622 | BPSOSCD | ||
| 623 | BPSOSCE | ||
| 624 | BPSOSCF | ||
| 625 | BPSOSH2 | ||
| 626 | BPSOSHF | ||
| 627 | BPSOSHR | ||
| 628 | BPSOSIY | ||
| 629 | BPSOSIZ | ||
| 630 | BPSOSK | ||
| 631 | BPSOSL | ||
| 632 | BPSOSL1 | ||
| 633 | BPSOSO | ||
| 634 | BPSOSO1 | ||
| 635 | BPSOSO2 | ||
| 636 | BPSOSQ | ||
| 637 | BPSOSQ2 | ||
| 638 | BPSOSQ4 | ||
| 639 | BPSOSQA | ||
| 640 | BPSOSQC | ||
| 641 | BPSOSQF | ||
| 642 | BPSOSQG | ||
| 643 | BPSOSQL | ||
| 644 | BPSOSRB | ||
| 645 | BPSOSRX | ||
| 646 | BPSOSRX2 | ||
| 647 | BPSOSRX3 | ||
| 648 | BPSOSRX4 | ||
| 649 | BPSOSRX5 | ||
| 650 | BPSOSRX6 | ||
| 651 | BPSOSRX7 | ||
| 652 | BPSOSRX8 | ||
| 653 | BPSOSS8 | ||
| 654 | BPSOSSG | ||
| 655 | BPSOSU | ||
| 656 | BPSOSU1 | ||
| 657 | BPSOSU2 | ||
| 658 | BPSOSU3 | ||
| 659 | BPSOSU4 | ||
| 660 | BPSOSU5 | ||
| 661 | BPSOSU8 | ||
| 662 | BPSOSU9 | ||
| 663 | BPSOSUC | ||
| 664 | BPSOSUD | ||
| 665 | BPSOSUE | ||
| 666 | BPSPHAR | ||
| 667 | BPSPRRX | ||
| 668 | BPSPRRX1 | ||
| 669 | BPSPRRX2 | ||
| 670 | BPSPRRX3 | ||
| 671 | BPSPRRX4 | ||
| 672 | BPSPRRX5 | ||
| 673 | BPSPRRX6 | ||
| 674 | BPSPSOU1 | ||
| 675 | BPSRCRI | ||
| 676 | BPSRDT1 | ||
| 677 | BPSREOP | ||
| 678 | BPSREOP1 | ||
| 679 | BPSRES | ||
| 680 | BPSRES1 | ||
| 681 | BPSRPAY | ||
| 682 | BPSRPT0 | ||
| 683 | BPSRPT1 | ||
| 684 | BPSRPT2 | ||
| 685 | BPSRPT3 | ||
| 686 | BPSRPT3A | ||
| 687 | BPSRPT4 | ||
| 688 | BPSRPT5 | ||
| 689 | BPSRPT6 | ||
| 690 | BPSRPT7 | ||
| 691 | BPSRPT8 | ||
| 692 | BPSRPT9 | ||
| 693 | BPSRPT9A | ||
| 694 | BPSRSELG | ||
| 695 | BPSRSEV | ||
| 696 | BPSRSHLD | ||
| 697 | BPSRSINS | ||
| 698 | BPSRSM | ||
| 699 | BPSRSPRS | ||
| 700 | BPSRSRLC | ||
| 701 | BPSRSTPJ | ||
| 702 | BPSSCR | ||
| 703 | BPSSCR01 | ||
| 704 | BPSSCR02 | ||
| 705 | BPSSCR03 | ||
| 706 | BPSSCR04 | ||
| 707 | BPSSCR05 | ||
| 708 | BPSSCRCL | ||
| 709 | BPSSCRCU | ||
| 710 | BPSSCRCV | ||
| 711 | BPSSCRDS | ||
| 712 | BPSSCRDV | ||
| 713 | BPSSCRL1 | ||
| 714 | BPSSCRLG | ||
| 715 | BPSSCRN0 | ||
| 716 | BPSSCRPR | ||
| 717 | BPSSCRRJ | ||
| 718 | BPSSCRRS | ||
| 719 | BPSSCRRV | ||
| 720 | BPSSCRSL | ||
| 721 | BPSSCRU1 | ||
| 722 | BPSSCRU2 | ||
| 723 | BPSSCRU3 | ||
| 724 | BPSSCRU4 | ||
| 725 | BPSSCRU5 | ||
| 726 | BPSSCRU6 | ||
| 727 | BPSSCRUD | ||
| 728 | BPSSCRV1 | ||
| 729 | BPSSCRV2 | ||
| 730 | BPSTEST | ||
| 731 | BPSTEST1 | ||
| 732 | BPSTEST2 | ||
| 733 | BPSTSET | ||
| 734 | BPSTSET2 | ||
| 735 | BPSUSCR | ||
| 736 | BPSUSCR1 | ||
| 737 | BPSUSCR2 | ||
| 738 | BPSUSCR4 | ||
| 739 | BPSUTIL | ||
| 740 | BPSUTIL1 | ||
| 741 | BPSUTIL2 | ||
| 742 | BPSVRX | ||
| 743 | BPSVRX1 | ||
| 744 | BPSVRX2 | ||
| 745 | BPSVRX3 | ||
| 746 | BPSWRKLS | ||
| 747 | |||
| 748 | |||
| 749 | |||
| 750 | |||
| 751 | |||
| 752 | |||
| 753 | |||
| 754 | |||
| 755 | Callable R outines | ||
| 756 | Entry poin ts provide d by the E CME V. 1.0 package t o other so ftware pac kages can be found i n the Exte rnal Relat ionships s ection of this manua l. No othe r routines are desig nated as c allable fr om outside of this p ackage. | ||
| 757 | |||
| 758 | |||
| 759 | Templates | ||
| 760 | |||
| 761 | Print Temp lates | ||
| 762 | NAMEFILE | ||
| 763 | |||
| 764 | BPS TECH – FILESFILE (#1) | ||
| 765 | BPS TECH – OPTIONSOP TION (#19) | ||
| 766 | |||
| 767 | |||
| 768 | Input Temp lates | ||
| 769 | |||
| 770 | NAMEFILE | ||
| 771 | |||
| 772 | BPSJ PHARM ACY ENTER/ EDITBPS PH ARMACIES ( #9002313.5 6) | ||
| 773 | BPSJ SITE SETUPBPS S ETUP (#900 2313.99) | ||
| 774 | |||
| 775 | Sort Templ ates | ||
| 776 | NAMEFILE | ||
| 777 | |||
| 778 | BPS SETUP PHARMACIES BPS PHARMA CIES (# 90 02313.56) | ||
| 779 | |||
| 780 | |||
| 781 | List Templ ates | ||
| 782 | BPS LSTMN COMMENTS | ||
| 783 | BPS LSTMN DEVLOG | ||
| 784 | BPS LSTMN ECME REOPE N | ||
| 785 | BPS LSTMN ECME UNSTR AND | ||
| 786 | BPS LSTMN ECME USRSC R | ||
| 787 | BPS LSTMN LOG | ||
| 788 | BPS LSTMN RSCH MENU | ||
| 789 | BPS OPECC REJECT INF ORMATION | ||
| 790 | BPS STATIS TICS AND M ANAGEMENT | ||
| 791 | BPS VIEW E CME RX | ||
| 792 | |||
| 793 | Example: H ow to View List Temp lates usin g VA FileM an | ||
| 794 | |||
| 795 | Select VA FileMan Op tion: Inqu ire to Fil e Entries | ||
| 796 | |||
| 797 | OUTPUT FRO M WHAT FIL E: LIST TE MPLATE// | ||
| 798 | Select LIS T TEMPLATE NAME: BPS STATIS TICS AND M ANAGEMENT | ||
| 799 | ANOTHER ON E: | ||
| 800 | STANDARD C APTIONED O UTPUT? Yes // (Yes) | ||
| 801 | Include CO MPUTED fie lds: (N/Y /R/B): NO/ / - No re cord numbe r (IEN), n o Computed Fields | ||
| 802 | |||
| 803 | NAME: BPS STATISTICS AND MANAG EMENT TYPE OF LI ST: PROTOC OL RIGHT MARG IN: 80 | ||
| 804 | TOP MARG IN: 4 BOTTOM MAR GIN: 18 OK TO TRAN SPORT?: NO T OK | ||
| 805 | USE CURS OR CONTROL : YES PROTOCOL M ENU: BPS P ROTOCOL 2 SCREEN TIT LE: ECME S TATISTICS | ||
| 806 | ALLOWABL E NUMBER O F ACTIONS: 1 AUTOMATIC DEFAULTS: YES HIDDEN ACT ION MENU: VALM HIDDE N ACTIONS | ||
| 807 | ARRAY NA ME: ^TMP( "BPSOS2",$ J) EXIT CODE: D EXIT^BP SOS2 HEADER COD E: D HDR^B PSOS2 | ||
| 808 | HELP COD E: D HELP^ BPSOS2 ENTRY CODE : D INIT^B PSOS2 | ||
| 809 | |||
| 810 | Exported O ptions | ||
| 811 | Stand-alon e Options | ||
| 812 | All of the Electroni c Claims M anagement Engine (EC ME) V. 1.0 package o ptions are designed to be “sta nd-alone”, that is, they can b e accessed without f irst acces sing the t op-level m enu. All o f the opti ons can be placed on menus oth er than th eir origin al menu wi thout any additional editing; users will still be required t o hold the proper se curity key to gain a ccess to e ach partic ular optio n. | ||
| 813 | |||
| 814 | Top-level Menus | ||
| 815 | The ECME M ain Menu [ BPSMENU] o ption is t he top-lev el menu. I t contains one user option, pl us three B PS sub-men us. | ||
| 816 | |||
| 817 | ECME User Screen[BPS USER SCRE EN] | ||
| 818 | ECME Pharm acy COB[BP S COB MENU ] | ||
| 819 | Pharmacy E CME Manage r Menu[BPS MANAGER M ENU] | ||
| 820 | Pharmacy E lectronic Claims Rep orts[BPS M ENU RPT MA IN] | ||
| 821 | |||
| 822 | Key Assign ment | ||
| 823 | |||
| 824 | The ECME M ain Menu [ BPSMENU] a nd its mai n sub-menu s require users to p ossess par ticular Se curity Key s (file #1 9.1) for a ccess to t he options . The foll owing keys control t he ECME Ma in Menu an d its thre e main sub -menus. | ||
| 825 | |||
| 826 | KEYMenu | ||
| 827 | |||
| 828 | BPSMENUReq uired for the main E CME menu [ BPSMENU] | ||
| 829 | |||
| 830 | BPS USER R equired fo r the ECME User Scre en [BPS US ER SCREEN] and for t he option “Process S econdary/T RICARE Rx to ECME” [ BPS COB PR OCESS SECO ND TRICARE ] | ||
| 831 | |||
| 832 | BPS MANAGE R Required for these ECME opti ons: | ||
| 833 | Pharmacy E CME Manage r Menu [BP S MANAGER MENU] | ||
| 834 | Statistics Screen [B PS STATIST ICS SCREEN ] | ||
| 835 | ECME trans action mai ntenance o ptions [BP S MENU MAI NTENANCE] | ||
| 836 | View/Unstr and Submis sions Not Completed [BPS UNSTR AND SCREEN ] | ||
| 837 | Re Open CL OSED/Resub mit Claims [BPS REOP EN CLOSED CLAIMS] | ||
| 838 | |||
| 839 | BPS MASTER Required f or these E CME option s: | ||
| 840 | Pharmacy E CME Setup Menu [BPS SETUP MENU ] | ||
| 841 | Edit Basic ECME Para meters [BP S SETUP BA SIC PARAMS ] | ||
| 842 | Edit ECME Pharmacy D ata [BPS S ETUP PHARM ACY] | ||
| 843 | Register P harmacy wi th Austin Automation Center [B PS SETUP R EGISTER PH ARMACY] | ||
| 844 | |||
| 845 | BPS REPORT S Required for these ECME opti ons: | ||
| 846 | Pharmacy E lectronic Claims Rep orts [BPS MENU RPT M AIN] | ||
| 847 | Claim Resu lts and St atus [BPS MENU RPT C LAIM STATU S] | ||
| 848 | Recent Tra nsactions [BPS RPT R ECENT TRAN SACTIONS] | ||
| 849 | Closed Cla ims Report [BPS RPT CLOSED CLA IMS] | ||
| 850 | CMOP/ECME Activity R eport [BPS RPT CMOP/ ECME ACTIV ITY] | ||
| 851 | Claims Sub mitted, No t Yet Rele ased [BPS RPT NOT RE LEASED] | ||
| 852 | Payable Cl aims Repor t [BPS RPT PAYABLE] | ||
| 853 | Payer Shee t Detail R eport [BPS RPT PAYER SHEET DET AIL] | ||
| 854 | Rejected C laims Repo rt [BPS RP T REJECTIO N] | ||
| 855 | Reversal C laims Repo rt [BPS RP T REVERSAL ] | ||
| 856 | Totals by Date [BPS RPT TOTALS BY DAY] | ||
| 857 | Turn-aroun d time sta tistics [B PS RPT TUR NAROUND ST ATS] | ||
| 858 | ECME Setup – Pharmac ies Report [BPS RPT SETUP PHAR MACIES] | ||
| 859 | ECME Claim s-Response Inquiry [ BPS RPT CL AIMS RESPO NSE] | ||
| 860 | Spending A ccount Rep ort [BPS R PT SPENDIN G ACCOUNT] | ||
| 861 | Other Repo rts [BPS M ENU RPT OT HER] | ||
| 862 | Non-Billab le Status Report [BP S RPT NON- BILLABLE R EPORT] | ||
| 863 | |||
| 864 | BPS SUPERV ISORRequir ed for thi s ECME opt ion: | ||
| 865 | OPECC Prod uctivity R eport [BPS OPECC PRO DUCTIVITY REPORT] | ||
| 866 | |||
| 867 | |||
| 868 | |||
| 869 | Here is th e hierarch y of ECME Menu Optio ns and Sec urity Keys : | ||
| 870 | |||
| 871 | |||
| 872 | ECME (BPSM ENU) **LOC KED: BPSME NU** | ||
| 873 | | | ||
| 874 | | | ||
| 875 | ---------- ---------- ---------- ---------- ---------- ------U EC ME User Sc reen | ||
| 876 | [BPS USER SCRE EN] | ||
| 877 | **LO CKED: BPS USER** | ||
| 878 | |||
| 879 | --COB ECME Pharmacy ---------- ---------- ---------- ----SEC Po tential | ||
| 880 | COB [BPS COB Se condary Rx | ||
| 881 | MENU ] Cl aims Repor t | ||
| 882 | | [B PS COB RPT | ||
| 883 | | SE CONDARY | ||
| 884 | | CL AIMS] | ||
| 885 | | | ||
| 886 | |--------- ---------- ---------- ---------- ----TRI Po tential Cl aims | ||
| 887 | | Re port for D ual | ||
| 888 | | El igible [BP S | ||
| 889 | | PO TENTIAL CL AIMS | ||
| 890 | | RP T DUAL] | ||
| 891 | | | ||
| 892 | |--------- ---------- ---------- ---------- ----PRO Pr ocess | ||
| 893 | Se condary/TR ICAR | ||
| 894 | E Rx to ECME | ||
| 895 | [B PS COB PRO CESS | ||
| 896 | SE COND TRICA RE] | ||
| 897 | ** LOCKED: BP S USER** | ||
| 898 | |||
| 899 | |||
| 900 | --MGR Phar macy ECME --------MN T ECME tra nsaction - ----UNS Vi ew/Unstran d | ||
| 901 | Mana ger Menu maintena nce Su bmissions Not | ||
| 902 | [BPS MANAGER options [BPS Co mpleted [B PS | ||
| 903 | MENU ] MENU UN STRAND SCR EEN] | ||
| 904 | **LO CKED: BPS MAINTENA NCE] ** LOCKED: BP S MANAGER* * | ||
| 905 | MANA GER** **LOCKED : BPS | ||
| 906 | | MANAGER* * | ||
| 907 | | | | ||
| 908 | | |--- ---------- ----ROC Re Open CLOS ED/Resubmi t | ||
| 909 | | Cl aim [BPS | ||
| 910 | | RE OPEN CLOSE D | ||
| 911 | | CL AIM] | ||
| 912 | | ** LOCKED: BP S MANAGER* * | ||
| 913 | | | ||
| 914 | | | ||
| 915 | | | ||
| 916 | | | ||
| 917 | |--------- --------SE T Pharmacy ECME ---- ----BAS Ed it Basic E CME | ||
| 918 | | Setup Me nu [BPS Pa rameters [ BPS | ||
| 919 | | SETUP ME NU] SE TUP BASIC | ||
| 920 | | **LOCKED : BPS PA RAMS] | ||
| 921 | | MASTER** ** LOCKED: BP S MASTER** | ||
| 922 | | | | ||
| 923 | | |--- ---------- ---PHAR Ed it ECME | ||
| 924 | | | Ph armacy Dat a | ||
| 925 | | | [B PS SETUP | ||
| 926 | | | PH ARMACY] | ||
| 927 | | | ** LOCKED: BP S MASTER** | ||
| 928 | | | | ||
| 929 | | |--- ---------- ----REG Re gister | ||
| 930 | | Ph armacy wit h | ||
| 931 | | Au stin | ||
| 932 | | Au tomation | ||
| 933 | | Ce nter [BPS | ||
| 934 | | SE TUP REGIST ER | ||
| 935 | | PH ARMACY] | ||
| 936 | | ** LOCKED: BP S MASTER** | ||
| 937 | | | ||
| 938 | | | ||
| 939 | |--------- ---------- ---------- ---------- ---STAT St atistics | ||
| 940 | Sc reen [BPS | ||
| 941 | ST ATISTICS | ||
| 942 | SC REEN] | ||
| 943 | ** LOCKED: BP S MANAGER* * | ||
| 944 | |||
| 945 | |||
| 946 | --RPT Phar macy ----- --------CL A Claim Re sults ---- ----PAY Pa yable Clai ms | ||
| 947 | Elec tronic and Stat us [BPS Re port [BPS RPT | ||
| 948 | Clai ms Reports MENU RPT CLAIM PA YABLE] | ||
| 949 | [BPS MENU RPT STATUS] ** LOCKED: BP S REPORTS* * | ||
| 950 | MAIN ] **LOCKED : BPS REPO RTS** | ||
| 951 | **LO CKED: BPS REPORTS** | | ||
| 952 | | | ||
| 953 | | | | ||
| 954 | | |--- ---------- ----REJ Re jected Cla ims | ||
| 955 | | | Re port [BPS RPT | ||
| 956 | | | RE JECTION] | ||
| 957 | | | ** LOCKED: BP S REPORTS* * | ||
| 958 | | | | ||
| 959 | | |--- ---------- ---ECMP CM OP/ECME | ||
| 960 | | | Ac tivity Rep ort | ||
| 961 | | | [B PS RPT | ||
| 962 | | | CM OP/ECME | ||
| 963 | | | AC TIVITY] | ||
| 964 | | | ** LOCKED: BP S REPORTS* * | ||
| 965 | | | | ||
| 966 | | |--- ---------- ----REV Re versal Cla ims | ||
| 967 | | | Re port [BPS RPT | ||
| 968 | | | RE VERSAL] | ||
| 969 | | | ** LOCKED: BP S REPORTS* * | ||
| 970 | | | | ||
| 971 | | |--- ---------- ----NYR Cl aims | ||
| 972 | | | Su bmitted, N ot | ||
| 973 | | | Ye t Released | ||
| 974 | | | [B PS RPT NOT | ||
| 975 | | | RE LEASED] | ||
| 976 | | | ** LOCKED: BP S REPORTS* * | ||
| 977 | | | | ||
| 978 | | |--- ---------- ----REC Re cent | ||
| 979 | | | Tr ansactions | ||
| 980 | | | [B PS RPT REC ENT | ||
| 981 | | | TR ANSACTIONS ] | ||
| 982 | | | ** LOCKED: BP S REPORTS* * | ||
| 983 | | | | ||
| 984 | | |--- ---------- ----DAY To tals by Da te | ||
| 985 | | | [B PS RPT TOT ALS | ||
| 986 | | | BY DAY] | ||
| 987 | | | ** LOCKED: BP S REPORTS* * | ||
| 988 | | | | ||
| 989 | | |--- ---------- ----CLO Cl osed Claim s | ||
| 990 | | | Re port [BPS RPT | ||
| 991 | | | CL OSED CLAIM S] | ||
| 992 | | | ** LOCKED: BP S REPORTS* * | ||
| 993 | | | | ||
| 994 | | |--- ---------- ----NBS No n-Billable Status | ||
| 995 | | | Re port [BPS RPT | ||
| 996 | | | NO N-BILLABLE REPORT | ||
| 997 | | | ** LOCKED: BP S REPORTS* * | ||
| 998 | | | | ||
| 999 | | |--- ---------- ----SPA Sp ending Acc ount | ||
| 1000 | | Re port [BPS RPT | ||
| 1001 | | SP ENDING | ||
| 1002 | | AC COUNT] | ||
| 1003 | | ** LOCKED: BP S REPORTS* * | ||
| 1004 | | | ||
| 1005 | |--------- --------OT H Other Re ports ---- ----CRI EC ME | ||
| 1006 | [BPS MEN U RPT Cl aims-Respo nse | ||
| 1007 | OTHER] In quiry [BPS RPT | ||
| 1008 | **LOCKED : BPS CL AIMS RESPO NSE] | ||
| 1009 | REPORTS* * ** LOCKED: BP S REPORTS* * | ||
| 1010 | | | ||
| 1011 | |--- ---------- ----PAY Pa yer Sheet | ||
| 1012 | | De tail Repor t | ||
| 1013 | | [B PS RPT PAY ER | ||
| 1014 | | SH EET DETAIL ] | ||
| 1015 | | ** LOCKED: BP S REPORTS* * | ||
| 1016 | | | ||
| 1017 | |--- ---------- ---PHAR EC ME Setup - | ||
| 1018 | | Ph armacies | ||
| 1019 | | Re port [BPS RPT | ||
| 1020 | | SE TUP | ||
| 1021 | | PH ARMACIES] | ||
| 1022 | | ** LOCKED: BP S REPORTS* * | ||
| 1023 | | | ||
| 1024 | |--- ---------- ----TAT Tu rn-around time | ||
| 1025 | | st atistics [ BPS | ||
| 1026 | | RP T TURNAROU ND | ||
| 1027 | | ST ATS] | ||
| 1028 | | ** LOCKED: BP S REPORTS* * | ||
| 1029 | | | ||
| 1030 | |--- ---------- ----VER Vi ew ePharma cy | ||
| 1031 | | Rx [BPS RPT VIEW | ||
| 1032 | | EC ME RX] | ||
| 1033 | | | ||
| 1034 | |--- ---------- ----OPR OP ECC | ||
| 1035 | Pr oductivity | ||
| 1036 | Re port [BPS | ||
| 1037 | OP ECC | ||
| 1038 | PR ODUCTIVITY | ||
| 1039 | RE PORT] | ||
| 1040 | ** LOCKED: BP S | ||
| 1041 | SU PERVISOR** | ||
| 1042 | |||
| 1043 | |||
| 1044 | |||
| 1045 | |||
| 1046 | |||
| 1047 | |||
| 1048 | |||
| 1049 | |||
| 1050 | |||
| 1051 | |||
| 1052 | Menu Place ment | ||
| 1053 | |||
| 1054 | It is reco mmended th at the use r place th e ECME V. 1.0 main m enu and su b-menus on the Core Applicatio ns menu wh ere the ot her packag e menus ar e found. | ||
| 1055 | |||
| 1056 | Options | ||
| 1057 | |||
| 1058 | The follow ing option s are expo rted with the ECME V . 1.0 pack age. | ||
| 1059 | |||
| 1060 | Option Nam e | ||
| 1061 | Menu Text | ||
| 1062 | |||
| 1063 | |||
| 1064 | BPS MANAGE R MENU | ||
| 1065 | Pharmacy E CME Manage r Menu | ||
| 1066 | |||
| 1067 | |||
| 1068 | BPS MENU M AINTENANCE | ||
| 1069 | ECME trans action mai ntenance o ptions | ||
| 1070 | |||
| 1071 | |||
| 1072 | BPS MENU R PT CLAIM S TATUS | ||
| 1073 | Claim Resu lts and St atus | ||
| 1074 | |||
| 1075 | |||
| 1076 | BPS MENU R PT MAIN | ||
| 1077 | Pharmacy E lectronic Claims Rep orts | ||
| 1078 | |||
| 1079 | |||
| 1080 | BPS MENU R PT OTHER | ||
| 1081 | |||
| 1082 | BPS COB ME NU | ||
| 1083 | |||
| 1084 | BPS COB PR OCESS SECO ND TRICARE | ||
| 1085 | |||
| 1086 | BPS COB RP T SECONDAR Y CLAIMS | ||
| 1087 | |||
| 1088 | BPS POTENT IAL CLAIMS RPT DUAL | ||
| 1089 | Other Repo rts | ||
| 1090 | |||
| 1091 | ECME Pharm acy COB | ||
| 1092 | |||
| 1093 | Process Se condary/TR ICARE Rx t o ECME | ||
| 1094 | |||
| 1095 | Potential Secondary Rx Claims Report | ||
| 1096 | |||
| 1097 | Potential Claims Rep ort for Du al Eligibl e | ||
| 1098 | |||
| 1099 | |||
| 1100 | BPS NIGHTL Y BACKGROU ND JOB | ||
| 1101 | BPS Nightl y Backgrou nd Job | ||
| 1102 | |||
| 1103 | |||
| 1104 | BPS REOPEN CLOSED CL AIM | ||
| 1105 | Re Open CL OSED/Resub mit Claim | ||
| 1106 | |||
| 1107 | |||
| 1108 | BPS RPT RE CENT TRANS ACTIONS | ||
| 1109 | Recent Tra nsactions | ||
| 1110 | |||
| 1111 | |||
| 1112 | BPS RPT CL OSED CLAIM S | ||
| 1113 | Closed Cla ims Report | ||
| 1114 | |||
| 1115 | |||
| 1116 | BPS RPT CM OP/ECME AC TIVITY | ||
| 1117 | CMOP/ECME Activity R eport | ||
| 1118 | |||
| 1119 | |||
| 1120 | BPS RPT NO T RELEASED | ||
| 1121 | Claims Sub mitted, No t Yet Rele ased | ||
| 1122 | |||
| 1123 | |||
| 1124 | BPS RPT PA YABLE | ||
| 1125 | Payable Cl aims Repor t | ||
| 1126 | |||
| 1127 | |||
| 1128 | BPS RPT PA YER SHEET DETAIL | ||
| 1129 | Payer Shee t Detail R eport | ||
| 1130 | |||
| 1131 | |||
| 1132 | BPS RPT RE JECTION | ||
| 1133 | Rejected C laims Repo rt | ||
| 1134 | |||
| 1135 | |||
| 1136 | BPS RPT RE VERSAL | ||
| 1137 | Reversal C laims Repo rt | ||
| 1138 | |||
| 1139 | |||
| 1140 | BPS RPT SE TUP PHARMA CIES | ||
| 1141 | ECME Setup - Pharmac ies Report | ||
| 1142 | |||
| 1143 | |||
| 1144 | BPS RPT TO TALS BY DA Y | ||
| 1145 | Totals by Date | ||
| 1146 | |||
| 1147 | |||
| 1148 | BPS RPT TU RNAROUND S TATS | ||
| 1149 | Turn-aroun d time sta tistics | ||
| 1150 | |||
| 1151 | |||
| 1152 | BPS SETUP MENU | ||
| 1153 | Pharmacy E CME Setup Menu | ||
| 1154 | |||
| 1155 | |||
| 1156 | BPS SETUP BASIC PARA MS | ||
| 1157 | Edit Basic Pharmacy ECME Param eters | ||
| 1158 | |||
| 1159 | |||
| 1160 | BPS SETUP PHARMACY | ||
| 1161 | Edit ECME Pharmacy D ata | ||
| 1162 | |||
| 1163 | |||
| 1164 | BPS SETUP REGISTER P HARMACY | ||
| 1165 | Register P harmacy wi th Austin Automation Center | ||
| 1166 | |||
| 1167 | |||
| 1168 | BPS STATIS TICS SCREE N | ||
| 1169 | Statistics Screen | ||
| 1170 | |||
| 1171 | |||
| 1172 | BPS UNSTRA ND SCREEN | ||
| 1173 | View/Unstr and Submis sions Not Completed | ||
| 1174 | |||
| 1175 | |||
| 1176 | BPS USER S CREEN | ||
| 1177 | ECME User Screen | ||
| 1178 | |||
| 1179 | |||
| 1180 | BPSMENU | ||
| 1181 | ECME | ||
| 1182 | |||
| 1183 | |||
| 1184 | BPS RPT CL AIMS RESPO NSE | ||
| 1185 | ECME Claim s-Response Inquiry | ||
| 1186 | |||
| 1187 | |||
| 1188 | BPS RPT NO N-BILLABLE REPORT | ||
| 1189 | Non-Billab le Status Report | ||
| 1190 | |||
| 1191 | |||
| 1192 | BPS RPT SP ENDING ACC OUNT | ||
| 1193 | Spending A ccount Rep ort | ||
| 1194 | |||
| 1195 | |||
| 1196 | BPS RPT VI EW ECME RX | ||
| 1197 | View ePhar macy Rx | ||
| 1198 | |||
| 1199 | BPS OPECC PRODUCTIVI TY REPORT | ||
| 1200 | OPECC Prod uctivity R eport | ||
| 1201 | |||
| 1202 | |||
| 1203 | |||
| 1204 | The follow ing extern al options are acces sed by the ECME V. 1 .0 package : | ||
| 1205 | |||
| 1206 | Option Nam e | ||
| 1207 | Menu Text | ||
| 1208 | Package | ||
| 1209 | |||
| 1210 | |||
| 1211 | |||
| 1212 | N/A | ||
| 1213 | |||
| 1214 | |||
| 1215 | |||
| 1216 | |||
| 1217 | |||
| 1218 | Example: H ow to View the Expor ted Option s Using VA FileMan | ||
| 1219 | |||
| 1220 | VA FileMan 22.0 | ||
| 1221 | |||
| 1222 | |||
| 1223 | Select OPT ION: 5 IN QUIRE TO F ILE ENTRIE S | ||
| 1224 | |||
| 1225 | OUTPUT FRO M WHAT FIL E: OPTION/ / <Enter> | ||
| 1226 | Select OPT ION NAME: BPSMENU ECME | ||
| 1227 | ANOTHER ON E: <Enter> | ||
| 1228 | STANDARD C APTIONED O UTPUT? Yes // <Enter> (Yes) | ||
| 1229 | Include CO MPUTED fie lds: (N/Y /R/B): NO/ / <Enter> - No recor d number ( IEN), no C omputed | ||
| 1230 | Fields | ||
| 1231 | |||
| 1232 | |||
| 1233 | DISPLAY AU DIT TRAIL? No// <Ent er> NO | ||
| 1234 | |||
| 1235 | |||
| 1236 | NAME: BPSM ENU MENU TEXT: ECME | ||
| 1237 | TYPE: me nu CREATOR: E CMEuser,On e | ||
| 1238 | LOCK: BP SMENU PACKAGE: I HS PHARMAC Y POINT OF SALE | ||
| 1239 | E ACTION PRESENT: YES HEADER PRE SENT?: YES | ||
| 1240 | DESCRIPTI ON: The main menu | ||
| 1241 | ITEM: BPS MANAGER ME NU SYNONYM: M GR | ||
| 1242 | DISPLAY ORDER: 2 | ||
| 1243 | ITEM: BPS USER SCREE N SYNONYM: U | ||
| 1244 | DISPLAY ORDER: 1 | ||
| 1245 | ITEM: BPS MENU RPT M AIN SYNONYM: R PT | ||
| 1246 | DISPLAY ORDER: 4 | ||
| 1247 | ENTRY AC TION: K BP SQUIT D IN IT^BPSMHDR I $G(BPSQ UIT) K BPS QUIT S XQU IT=1 | ||
| 1248 | HEADER: D HDR^BPSM HDR TIMESTAMP: 60116,628 62 | ||
| 1249 | TIMESTAM P OF PRIMA RY MENU: 6 0044,54655 | ||
| 1250 | UPPERCAS E MENU TEX T: ECME | ||
| 1251 | |||
| 1252 | |||
| 1253 | |||
| 1254 | Select OPT ION NAME: | ||
| 1255 | |||
| 1256 | |||
| 1257 | |||
| 1258 | |||
| 1259 | |||
| 1260 | Archiving and Purgin g | ||
| 1261 | Archiving | ||
| 1262 | At present , the Elec tronic Cla ims Manage ment Engin e (ECME) V . 1.0 pack age does n ot provide for the a rchiving o f its data . | ||
| 1263 | |||
| 1264 | Purging | ||
| 1265 | The BPS Ni ghtly Back ground Job , which sh ould be sc heduled to run night ly, will p urge data older than 365 days from the B PS LOG (#9 002313.12) file. | ||
| 1266 | (This page included for two-si ded copyin g.) | ||
| 1267 | |||
| 1268 | Callable R outines/En try Points /Applicati on Program mer Interf aces (APIs ) | ||
| 1269 | The only c alls into Electronic Claims Ma nagement E ngine (ECM E) V. 1.0 should be done by th e Pharmacy package i nterface a nd Claims Tracking. | ||
| 1270 | Callable R outines | ||
| 1271 | There are no routine s that are callable by the fir st routine line. Ple ase see th e API sect ion for ca llable ent ry points in the rou tines. | ||
| 1272 | |||
| 1273 | Applicatio n Programm er Interfa ces (API’s ) | ||
| 1274 | $$EN^BPSNC PDP | ||
| 1275 | |||
| 1276 | This API s ubmits a b illing req uest or re versal to ECME. The software u ses Integr ated Billi ng to dete rmine if t he claim i s ECME bil lable. If it is, the claim wil l be put o n a queue and proces sed. Use o f $$EN^BPS NCPDP is s upported b y Integrat ion Agreem ent #4415 and is onl y availabl e to Outpa tient Phar macy and I ntegrated Billing. | ||
| 1277 | |||
| 1278 | There are eighteen p arameters that can b e passed i nto this A PI. | ||
| 1279 | BRXIEN (re quired) – Prescripti on IEN, fi le #52 (re quired) | ||
| 1280 | BFILL (opt ional) – P rescriptio n Fill Num ber. If om itted, the first fil l is assum ed. | ||
| 1281 | DOS (optio nal) – Dat e of Servi ce. If omi tted, this will be c alculated to be the released d ate or the prescript ion and fi ll. If the prescript ion and fi ll has not been rele ased, it w ill be the current d ate. | ||
| 1282 | BWHERE (re quired) – Prescripti on Action string (op tional). A llowed val ues: | ||
| 1283 | AREV = Aut o-Reversal | ||
| 1284 | BB = Back Billing | ||
| 1285 | CRLB = CMO P/OPAI Rel ease & Reb ill | ||
| 1286 | CRLR = CMO P/OPAI Rel ease & Rev erse (succ essful rel ease) | ||
| 1287 | CRLX = CMO P/OPAI uns uccessful release & reverse | ||
| 1288 | CRRL = CMO P/OPAI Rel ease – Ori ginal clai m not paid , submit a nother cla im, no rev ersal | ||
| 1289 | DC = Disco ntinue – o nly revers e un-relea sed PAYABL E DC's, re lease date check sho uld be in calling ro utine. | ||
| 1290 | DE = Delet e | ||
| 1291 | ED = Edit (includes RX release with NDC edit) | ||
| 1292 | ERES = Res ubmit from ECME user screen | ||
| 1293 | ERWV = Res ubmit With out Revers al from EC ME user sc reen | ||
| 1294 | ERNB = Res ubmit of a TRI/CVA n on-billabl e entry fr om the ECM E user scr een | ||
| 1295 | EREV = Rev ersal from ECME user screen | ||
| 1296 | HLD = Put prescripti on on Hold | ||
| 1297 | OREV = Rev ersal from Outpatien t Pharmacy edit scre en | ||
| 1298 | RSNB = Res ubmit Non- Billable T RICARE & C HAMPVA fro m PSO Reje ct Info Sc reen | ||
| 1299 | OF = Origi nal Fill | ||
| 1300 | P2 = Ori ginal subm ission fro m PRO Opti on, no rev ersal | ||
| 1301 | P2S = Res ubmit from PRO Optio n | ||
| 1302 | PC = Pull CMOPs | ||
| 1303 | PE = Pull early from suspense | ||
| 1304 | PL = Pull local from suspense | ||
| 1305 | PP = Pull RX (PP) ac tion from Patient Pr escription Processin g option. | ||
| 1306 | RF = Refil l | ||
| 1307 | RN = Renew | ||
| 1308 | RRL = Rel ease – Ori ginal clai m not paid , submit a nother cla im, no rev ersal | ||
| 1309 | RS = Retur n-to-Stock | ||
| 1310 | BILLNDC (o ptional) – Valid NDC # with for mat 5-4-2 (optional) . If omitt ed, the ND C for the prescripti on/fill is assumed. | ||
| 1311 | REVREAS (o ptional) – Reversal Reason | ||
| 1312 | DURREC (op tional) – String of up to thre e sets of DUR info. Sets are d elimited w ith "~". E ach set co nsists of three "^" pieces: | ||
| 1313 | 1st piece – Professi onal Servi ce Code | ||
| 1314 | 2nd piece – Reason f or Service Code | ||
| 1315 | 3rd piece – Result o f Service Code | ||
| 1316 | BPOVRIEN ( optional) – Pointer to the BPS NCPDP OVE RRIDE file (#9002313 .511); onl y passed i f there ar e override s entered by a user via the Re submit wit h Edits (R ED) option | ||
| 1317 | BPSCLARF ( optional) – Submissi on Clarifi cation Cod e to be in cluded in the claim. | ||
| 1318 | BPSAUTH (o ptional) – String of Prior Aut horization info (opt ional) – T wo "^" pie ces: | ||
| 1319 | 1st piece – Prior Au thorizatio n Type Cod e | ||
| 1320 | 2nd piece – Prior Au thorizatio n Number | ||
| 1321 | BPCOBIND ( optional) – Coordina tion Of Be nefits (CO B) indicat or – 1- Pr imary, 2- Secondary. If omitte d, default s to 1. | ||
| 1322 | BPJOBFLG ( optional) – Backgrou nd/foregro und job fl ag: | ||
| 1323 | B – if cal led by un- queuing lo gic in bac kground | ||
| 1324 | F – if cal led by oth er (foregr ound) proc esses (def ault). | ||
| 1325 | BPREQIEN ( optional) – IEN of t he BPS REQ UEST entry to be unq ueued | ||
| 1326 | BPSCLOSE ( optional) – local ar ray used f or Close A fter Rever sal functi onality wh en the use r had chos en to clos e the clai m after su ccessful revers al. Used w ith BWHERE ="EREV" on ly. If cla im needs t o be close d then: | ||
| 1327 | BPSCLOSE(" CLOSE AFT REV")=1 | ||
| 1328 | BPSCLOSE(" CLOSE AFT REV REASON ")= IEN of file #356 .8 | ||
| 1329 | BPSCLOSE(" CLOSE AFT REV COMMEN T")= text of the com ment | ||
| 1330 | BPSPLAN (o ptional) – IEN of th e entry in the GROUP INSURANCE PLAN file (#355.3) | ||
| 1331 | BPSPRDAT ( optional) – Array, p assed by r eference, which cont ains prima ry claim d ata that i s needed t o submit a secondary claim. | ||
| 1332 | Format: B PSPRDAT(NC PDP field) | ||
| 1333 | BPSRTYPE ( optional) – Rate Typ e, IEN fil e #399.3 | ||
| 1334 | BPSDELAY ( optional) – Delay Re ason Code, IEN of BP S NCPDP DE LAY REASON CODE, fil e #9002313 .29 | ||
| 1335 | |||
| 1336 | |||
| 1337 | The output of this e xtrinsic f unction is a string in the for mat: | ||
| 1338 | |||
| 1339 | RESPONSE^M ESSAGE^ELI GIBILITY^C LAIMSTATUS ^COB^RXCOB ^INSURANCE | ||
| 1340 | |||
| 1341 | Where: | ||
| 1342 | |||
| 1343 | RESPONSE i ndicates: | ||
| 1344 | 0 – Submi tted throu gh ECME | ||
| 1345 | 1 – No su bmission t hrough ECM E | ||
| 1346 | 2 – IB no t billable | ||
| 1347 | 3 – Claim was close d, not sub mitted (RT S/Deletes) | ||
| 1348 | 4 – Unabl e to queue claim | ||
| 1349 | 5 – Incor rect infor mation sup plied to E CME | ||
| 1350 | 6 – Inact ive ECME – Primarily used for TRICARE an d CHAMPVA to indicat e it is ok to proces s the pres cription. | ||
| 1351 | 10 – Rever sal but no resubmit | ||
| 1352 | MESSAGE = Message as sociated w ith the re sponse (er ror/submit ted) | ||
| 1353 | ELIGIBILIT Y = V – Ve teran, T – TRICARE, C – CHAMPV A | ||
| 1354 | CLAIMSTATU S = claim status (nu ll or IN P ROGRESS/E PAYABLE/et c...) | ||
| 1355 | COB = Coo rdination Of Benefit indicator of the in surance as it is sto red in the PATIENT f ile: 1- pr imary, 2 – secondary , 3 – tert iary | ||
| 1356 | RXCOB = p ayer seque nce indica tor of the claim sen t to the p ayer as a result of this call: 1- primar y, 2 – sec ondary | ||
| 1357 | INSURANCE = Name of the insura nce compan y that was billed as a result of this ca ll | ||
| 1358 | |||
| 1359 | |||
| 1360 | Examples o f returned values: | ||
| 1361 | |||
| 1362 | “0^Pres cription X YZ success fully subm itted to E CME for cl aim genera tion.^V^E PAYABLE” | ||
| 1363 | “0^Reve rsing pres cription 1 00469.^V^E REVERSAL ACCEPTED” | ||
| 1364 | “1^ECME switch is not on fo r the site ^T^E REVER SAL ACCEPT ED | ||
| 1365 | “2^Null DEA Speci al Handlin g field^V^ ” | ||
| 1366 | “3^Clai m was not payable so it has be en closed. No ECME claim crea ted.^V^E R EJECTED” | ||
| 1367 | “4^Erro r: There i s a SCHEDU LED reques t without ACTIVATED requests, RXIEN=XYZ, REFILL=0^ V^IN PROGR ESS” | ||
| 1368 | “5^RX A ction para meter miss ing^V^E PA YABLE” | ||
| 1369 | |||
| 1370 | $$EN^BPSNC PD9 | ||
| 1371 | |||
| 1372 | This API s ubmits an eligibilit y verifica tion reque st to ECME . The soft ware uses Integrated Billing t o determin e if the r equest is ECME billa ble. If it is, the r equest wil l be put o n a queue and proces sed. Use o f $$EN^BPS NCPD9 is s upported b y Integrat ion Agreem ent # 5576 and is on ly availab le to Inte grated Bil ling. | ||
| 1373 | |||
| 1374 | Input Para meters: | ||
| 1375 | DFN (requi red) – Pat ient | ||
| 1376 | BPSARRY- A rray of va lues | ||
| 1377 | "PLAN" (re quired) – IEN to the GROUP INS URANCE PLA N file (#3 55.3) | ||
| 1378 | "DOS" (req uired) – D ate of Ser vice | ||
| 1379 | "IEN" (opt ional) – I EN to PRES CRIPTION f ile (#52) | ||
| 1380 | "FILL NUMB ER" (optio nal) – Fil l Number | ||
| 1381 | "REL CODE" (optional ) – Relati onship Cod e | ||
| 1382 | "PERSON CO DE" (optio nal) – Per son Code | ||
| 1383 | |||
| 1384 | Return Val ue – A str ing with t wo pieces | ||
| 1385 | Piece 1 – 0: Not sub mitted or 1: Submitt ed | ||
| 1386 | Piece 2 – Message wi th final d isposition (submitte d or reaso n not subm itted). | ||
| 1387 | |||
| 1388 | $$STATUS^B PSOSRX | ||
| 1389 | |||
| 1390 | This API s hows the s tatus or a claim sub mitted to ECME. Use of $$STATU S^BPSOSRX is support ed by Inte gration Ag reement #4 300 and is only avai lable to O utpatient Pharmacy. | ||
| 1391 | |||
| 1392 | Note: If t he claim h as already been proc essed and it is resu bmitted, a reversal will be do ne first, and then t he resubmi t will be done. Inte rvening ca lls to $$S TATUS may show progr ess of the reversal before the resubmitt ed claim i s processe d. | ||
| 1393 | |||
| 1394 | Input Para meters: | ||
| 1395 | KEY1 (requ ired) – Fi rst key of the reque st | ||
| 1396 | KEY2 (requ ired) – Se cond key o f the requ est | ||
| 1397 | QUE (optio nal) – Que ue check f lag, where : | ||
| 1398 | 0 – Do not check if a request is on the queue | ||
| 1399 | 1 (or null ) – Check if a reque st is on t he queue, defaults t o 1 | ||
| 1400 | Note: Exte rnal routi nes should either no t pass thi s paramete r or set i t to 1. Th e values o f 0 (zero) or null a re reserve d for inte rnal ECME processing . | ||
| 1401 | BPRQIEN (o ptional) – BPS REQUE STS ien, f ile #90023 13.77 | ||
| 1402 | BPCOB (opt ional) – T he payer s equence, w here '1' i ndicates P rimary and '2' indic ates Secon dary. If B PCOB is nu ll, then P rimary is assumed | ||
| 1403 | |||
| 1404 | Return Val ue: | ||
| 1405 | This funct ion will r eturn null if there is not ECM E record f or this re quest or a string in the forma t "RESULT^ LAST UPDAT E DATE/TIM E^DESCRIPT ION^STATUS %” | ||
| 1406 | |||
| 1407 | Where: | ||
| 1408 | RESULT – C urrent sta tus of the request. It can hav e one of t hree value s: | ||
| 1409 | “SCHEDULED ” for sche duled (not ACTIVATED ) requests . | ||
| 1410 | “IN PROGRE SS” for in complete r equest | ||
| 1411 | The final status for complete requests ( see below) . | ||
| 1412 | LAST UPDAT E DATE/TIM E – The Fi leMan date /time of t he last up date to th e status o f this req uest. | ||
| 1413 | DESCRIPTIO N is eithe r: | ||
| 1414 | Incomplete requests will be th e progress status (e .g., Waiti ng to Star t, Transmi tting, etc .). | ||
| 1415 | Completed requests w ill have e ither be: | ||
| 1416 | The reason that the ECME proce ss was abo rted if th e result i s E OTHER. | ||
| 1417 | If the res ult is not E OTHER, it will be similar t o the RESU LT. | ||
| 1418 | STATUS % – The compl etion perc entage. No te that 99 is consid ered compl ete. | ||
| 1419 | |||
| 1420 | The possib le final s tatus valu es for: | ||
| 1421 | Claim Bill ing Reques ts | ||
| 1422 | E PAYABLE, E REJECTE D, E CAPTU RED, E DUP LICATE, E UNSTRANDED , E OTHER | ||
| 1423 | Claim Reve rsals | ||
| 1424 | E REVERSAL ACCEPTED, E REVERSA L REJECTED , E REVERS AL UNSTRAN DED, E REV ERSAL OTHE R | ||
| 1425 | Eligibilit y Verifica tion | ||
| 1426 | E ELIGIBIL ITY ACCEPT ED, E ELIG IBILITY RE JECTED, E ELIGIBILIT Y UNSTRAND ED, E REVE RSAL OTHER | ||
| 1427 | Any submis sion type | ||
| 1428 | CORRUPT | ||
| 1429 | |||
| 1430 | $$NABP^BPS BUTL | ||
| 1431 | This extri nsic funct ion return s the Serv ice Provid er ID for the most r ecent NCPD P claim fo r the pres cription a nd fill. U se of $$NA BP^BPSBUTL is suppor ted by Int egration A greement # 4719. | ||
| 1432 | |||
| 1433 | Input Para meters: | ||
| 1434 | RXP (requi red) – IEN in the PR ESCRIPTION file #52 | ||
| 1435 | BFILL (opt ional) – T he fill nu mber. If B FILL is om itted, the first fil l is assum ed. | ||
| 1436 | |||
| 1437 | Return Val ue: | ||
| 1438 | Returns th e value of the Servi ce Provide r ID field (201-B1) for the la test NCPDP claim. Th is field w ill have t he NPI num ber. | ||
| 1439 | |||
| 1440 | $$CLAIM^BP SBUTL | ||
| 1441 | This extri nsic funct ion API is used to r etrieve th e most rec ent ECME t ransaction , claim, a nd respons e informat ion relate d to a spe cific pres cription a nd fill. U se of $$CL AIM^BPSBUT L is suppo rted by In tegration Agreement #4719. | ||
| 1442 | |||
| 1443 | Input Para meters: | ||
| 1444 | RXI (requi red) – Pre scription IEN (Point er to the PRESCRIPTI ON File (# 52)) | ||
| 1445 | RXR (optio nal) – Fil l Number ( 0 for Orig inal, 1 fo r 1st refi ll, 2 for the 2nd re fill, etc. ). Default to the or iginal fil l (0), if not passed in. | ||
| 1446 | COB (optio nal) – COB Indicator (1: Prima ry, 2: Sec ondary, 3: Tertiary) . Defaults to primar y (1) if n ot passed in. | ||
| 1447 | |||
| 1448 | Return Val ue. A foll owing stri ng with th e followin g pieces: | ||
| 1449 | 1 – BPS TR ANSACTION file (#900 2313.59) p ointer | ||
| 1450 | 2 – BPS CL AIMS file (#9002313. 02) pointe r for the most recen t billing request. | ||
| 1451 | 3 – BPS RE SPONSES fi le (#90023 13.03) poi nter assoc iated with the billi ng request returned in piece 2 . | ||
| 1452 | 4 – BPS CL AIMS file (#9002313. 02) pointe r for the reversal c laim, if i t is the m ost recent claim | ||
| 1453 | 5 – BPS RE SPONSES fi le (#90023 13.03) poi nter assoc iated with the rever sal claim returned i n piece 4. | ||
| 1454 | 6 – Prescr iption/Ser vice Refer ence Numbe r (ECME Nu mber) of t he most re cent claim . | ||
| 1455 | |||
| 1456 | $$DIVNCPDP ^BPSBUTL | ||
| 1457 | This extri nsic funct ion API re turns the NCPDP and NPI number s for a sp ecific out patient si te. Use of $$DIVNCPD P^BPSBUTL is support ed by Inte gration Ag reement #4 719. | ||
| 1458 | |||
| 1459 | |||
| 1460 | |||
| 1461 | |||
| 1462 | Input Para meters: | ||
| 1463 | BPSDIV (re quired) – Pointer to the Outpa tient Site file, #59 . | ||
| 1464 | |||
| 1465 | Return Val ue: | ||
| 1466 | Returns th e NCPDP an d NPI numb ers associ ated with the Outpat ient Site. Returns N ULL if the Outpatien t Site is not passed in, or if the Outpa tient Site is not li nked to a BPS Pharma cy. | ||
| 1467 | |||
| 1468 | $$ADDCOMM^ BPSBUTL | ||
| 1469 | This extri nsic funct ion API is used to p ass commen ts that wi ll be stor ed in the BPS TRANSA CTION file (#9002313 .59) and d isplayed i n the ECME User Scre en. Use of $$ADDCOMM ^BPSBUTL i s supporte d by Integ ration Agr eement #47 19. | ||
| 1470 | |||
| 1471 | Input Para meters: | ||
| 1472 | BPRX (requ ired) – Po inter to t he PRESCRI PTION File (#52)). | ||
| 1473 | BPREF (opt ional) – F ill Number (0 for Or iginal, 1 for 1st re fill, 2 fo r the 2nd refill, et c.). If no t passed i n, it will default t o the orig inal fill. | ||
| 1474 | BPRCMNT (r equired) – Comment t o be added . | ||
| 1475 | BPBKG (opt ional) – I ndicates i f the API was called by a back ground pro cess. | ||
| 1476 | |||
| 1477 | If this pa rameter va lue is 1, then the c omment is stored in BPS TRANSA CTION (#90 02313.59) file with POSTMASTER as the us er enterin g the comm ent. | ||
| 1478 | |||
| 1479 | Return Val ue: | ||
| 1480 | Returns 1 if the com ments were added suc cessfully. | ||
| 1481 | Returns -1 if the co mments wer e not adde d successf ully. | ||
| 1482 | |||
| 1483 | $$AMT^BPSB UTL | ||
| 1484 | This API r eturns the Gross Amo unt Due fo r the give n Rx, Fill and COB. | ||
| 1485 | |||
| 1486 | Input Para meters: | ||
| 1487 | RX (requir ed) - This is a poin ter to the Prescript ion file # 52. | ||
| 1488 | RFILL (opt ional) - T his is the fill numb er of the prescripti on. Defaul ts to orig inal fill if not pas sed. | ||
| 1489 | COB (optio nal) - Thi s is the C OB payer s equence nu mber of th e ECME bil l. Default s to 1 (pr imary) if not passed . | ||
| 1490 | |||
| 1491 | Return Val ues: | ||
| 1492 | $$AMT (opt ional) - T he functio n value is the value of the Gr oss Amount Due field (#902.15) from the #9002313.5 9902 subfi le of the BPS Transa ction file . | ||
| 1493 | |||
| 1494 | $$NFLDT^BP SBUTL | ||
| 1495 | This API r eturns the Next Avai lable Fill Date from BPS RESPO NSES File #9002313.0 3. | ||
| 1496 | |||
| 1497 | Input Para meters: | ||
| 1498 | RX (requir ed) - Poin ter to the Prescript ion file # 52. | ||
| 1499 | RFILL (req uired) - T his is the fill numb er of the prescripti on. | ||
| 1500 | COB (optio nal) - Thi s is the C OB payer s equence nu mber of th e original bill. Def aults to 1 (primary) if not pa ssed. | ||
| 1501 | |||
| 1502 | Return Val ues: | ||
| 1503 | $$NFLDT Ne xt Availab le Fill Da te. | ||
| 1504 | |||
| 1505 | $$BBILL^BP SBUTL | ||
| 1506 | Back Bill indicator from BPS C LAIMS file #9002313. 02. Return s 1 if RX ACTION cod e of "BB", "P2”, or "P2S" is f ound. Othe rwise retu rns 0. | ||
| 1507 | |||
| 1508 | Input Para meters: | ||
| 1509 | RX (option al) - This is a poin ter to the Prescript ion file # 52. | ||
| 1510 | RFILL (opt ional) - F ill/refill number. D efaults to 0 (origin al fill) i f not pass ed. | ||
| 1511 | COB (optio nal) - Thi s is the C OB payer s equence nu mber of th e original bill. Def aults to 1 (primary) if not pa ssed. | ||
| 1512 | |||
| 1513 | Return Val ues: | ||
| 1514 | $$BBILL - Back Bill Indicator: 1 - Back Bill 0 - N ot a Back Bill | ||
| 1515 | |||
| 1516 | $$ELIG ^BP SBUTL | ||
| 1517 | This API r eturns the Eligibili ty for the given Rx, Fill and COB. | ||
| 1518 | |||
| 1519 | Input Para meters: | ||
| 1520 | RX (requir ed) - This is the po inter to t he Prescri ption file #52. | ||
| 1521 | RFILL (opt ional) - F ill/Refill number. D efaults to 0 (origin al fill) i f not pass ed. | ||
| 1522 | COB (optio nal) - Thi s is the C OB payer s equence nu mber of th e ECME bil l. Default s to 1 (pr imary) if not passed . | ||
| 1523 | |||
| 1524 | Return Val ues: | ||
| 1525 | $$ELIG The function value is t he value o f the Gros s Amount D ue field ( #901.04) f rom the BP S Transact ion file # 9002313.59 . | ||
| 1526 | IBSEND^BPS ECMP2 | ||
| 1527 | This API i s called b y Outpatie nt Pharmac y and the API will t hen compil e the info rmation ne eded to cr eate a BIL LING event in Integr ated Billi ng. Use of IBSEND^BP SECMP2 is supported by Integra tion Agree ment #4411 and is on ly availab le to Outp atient Pha rmacy. | ||
| 1528 | |||
| 1529 | |||
| 1530 | |||
| 1531 | |||
| 1532 | |||
| 1533 | Input Para meters: | ||
| 1534 | CLAIMIEN ( required) – IEN from BPS CLAIM S, #900231 3.02. | ||
| 1535 | RESPIEN (r equired) – IEN from BPS Respon se (requir ed). | ||
| 1536 | EVENT (opt ional) – T his is use d by PSO t o create s pecific ev ents (BILL ). | ||
| 1537 | USER (opti onal/requi red) – Use r who is c reating th e event. T his is req uired when EVENT is sent. | ||
| 1538 | |||
| 1539 | Return Val ue: | ||
| 1540 | None | ||
| 1541 | |||
| 1542 | $$ECMEON^B PSUTIL | ||
| 1543 | This extri nsic funct ion API in dicates wh ether the ECME switc h is on fo r an Outpa tient Site (file #59 ). Use of $$ECMEON^B PSUTIL is supported by Integra tion Agree ment #4410 and is on ly availab le to Outp atient Pha rmacy and CMOP. | ||
| 1544 | |||
| 1545 | Input Para meters: | ||
| 1546 | Site (requ ired) – Po inter to O utpatient Site, file #59. | ||
| 1547 | |||
| 1548 | Return Val ue: | ||
| 1549 | Returns 1 if the ECM E switch i s on for t he outpati ent site, or 0 (zero ) if the E CME switch is off. | ||
| 1550 | |||
| 1551 | $$CMOPON^B PSUTIL | ||
| 1552 | This extri nsic funct ion API in dicates wh ether the CMOP switc h is on fo r an Outpa tient Site (file #59 ). Use of $$CMOPON^B PSUTIL is supported by Integra tion Agree ment #4410 and is on ly availab le to Outp atient Pha rmacy and CMOP. | ||
| 1553 | |||
| 1554 | Input Para meters: | ||
| 1555 | Site (requ ired) – Po inter to O utpatient Site file, #59. | ||
| 1556 | |||
| 1557 | Return Val ue: | ||
| 1558 | Returns 1 if the CMO P switch i s on for t he outpati ent site a nd 0 (zero ) if the C MOP switch is off. | ||
| 1559 | |||
| 1560 | $$BPSPLN^B PSUTIL | ||
| 1561 | This extri nsic funct ion return s the insu rance PLAN NAME fiel d (#902.24 ) value fr om the BPS TRANSACTI ON file (# 9002313.59 ). Use of $$BPSLN^BP SUTIL is s upported b y Integrat ion Agreem ent #4410 and is onl y availabl e to Outpa tient Phar macy and C MOP. | ||
| 1562 | |||
| 1563 | Input Para meters: | ||
| 1564 | RXI (requi red) – IEN of the PR ESCRIPTION file (#52 ) | ||
| 1565 | RXR (optio nal) – Fil l Number. Defaults t o original fill (0) if not pas sed in. | ||
| 1566 | |||
| 1567 | Return Val ue: | ||
| 1568 | The insura nce PLAN N AME field (#902.24) value for the relate d entry in the BPS T RANSACTION file. | ||
| 1569 | |||
| 1570 | $$CLMECME^ BPSUTIL2 | ||
| 1571 | This extri nsic funct ion return s the late st date of service f or the pre scription fill that matches th e date of service re turned by the payer. It uses t he BPS LOG OF TRANSA CTIONS fil e (#900231 3.57) to f ind the da te. The re turned dat e is used to automat ically mat ch electro nic paymen ts to clai ms. Use of $$CLMECME ^BPSUTIL2 is support ed by Inte gration Ag reement #6 028 and is only avai lable to t he Integra ted Billin g (IB) app lication. | ||
| 1572 | |||
| 1573 | Input Para meters: | ||
| 1574 | ECME (requ ired) – Th e ECME num ber of the prescript ion for wh ich a bill is sought . | ||
| 1575 | RCDATE (op tional) – The date o f service returned b y the paye r with the payment d ata. | ||
| 1576 | |||
| 1577 | |||
| 1578 | Return Val ue: | ||
| 1579 | The altern ate date o f service returned b ased on cl aim data i n BPS LOG OF TRANSAC TIONS file (#9002313 .57). This date is t he closest date of s ervice for the fill that match es the pay er-provide d date of service. | ||
| 1580 | |||
| 1581 | $$VALECME^ BPSUTIL2 | ||
| 1582 | This extri nsic funct ion return s whether an ECME nu mber is va lid or not .. Use of $$VALECME^ BPSUTIL2 i s supporte d by Integ ration Agr eement #61 39 and is available to the Acc ounts Rece ivable and Integrate d Billing (IB) appli cations. | ||
| 1583 | |||
| 1584 | Input Para meters: | ||
| 1585 | ECMENUM (r equired) – The ECME number to be validat ed. | ||
| 1586 | |||
| 1587 | Return Val ue: | ||
| 1588 | |||
| 1589 | 0 – Indica tes the EC ME number passed in is INVALID | ||
| 1590 | |||
| 1591 | 1 – Indica tes the EC ME number passed in is VALID | ||
| 1592 | $$DUR1^BPS NCPD3 | ||
| 1593 | This API r eturns an array of d ata to Out patient Ph armacy, wh ich is use d to popul ate the re ject multi ple of the Prescript ion file a nd is disp layed in t he Reject Informatio n Screen o f the Thir d Party Pa yer Reject s – Workli st and Thi rd Party P ayer Rejec ts – View/ Process op tions. Pri marily, it is data f rom the BP S Response file but also inclu des some B PS Claims and BPS Tr ansaction data. The use of DUR 1^BPSNCPD3 is suppor ted by Int egration A greement # 4560 and i s only ava ilable to Outpatient Pharmacy. | ||
| 1594 | |||
| 1595 | |||
| 1596 | Input Para meters: | ||
| 1597 | BRXIEN (re quired) – IEN of the PRESCRIPT ION file ( #52) | ||
| 1598 | BFILL (req uired) – F ill Number | ||
| 1599 | BPRXCOB (o ptional) – Coordinat ion of Ben efits indi cator (1-P rimary, 2- Secondary) . If not p assed in, primary is assumed. | ||
| 1600 | |||
| 1601 | Return Val ues: | ||
| 1602 | DUR (passe d by refer ence) – Ar ray of dat a, which p rimarily c omes from the BPS Re sponse fil e but also includes data from BPS Claims and BPS T ransaction . | ||
| 1603 | ERROR (pas sed by ref erence) – Array of d ata that i s only ret urned if t he data co uld not be gathered. | ||
| 1604 | |||
| 1605 | $$DURESP^B PSNCPD3 | ||
| 1606 | This API r eturns an array of d ata to Out patient Ph armacy, wh ich is a s ubset of t he data re turned by DUR1. It i s data fro m the BPS Response f ile that i s primaril y used to populate t he display of the Ad ditional R eject Info rmation sc reen in th e Third Pa rty Payer Rejects – Worklist a nd Third P arty Payer Rejects – View/Proc ess option s. The use of DURESP ^BPSNCPD3 is support ed by Inte gration Ag reement #4 560 and is only avai lable to O utpatient Pharmacy. | ||
| 1607 | |||
| 1608 | |||
| 1609 | Input Para meters: | ||
| 1610 | DURIEN (re quired) – IEN of the BPS RESPO NSE file ( #9002313.0 3). | ||
| 1611 | BPRXCOB (o ptional) – Coordinat ion of Ben efits indi cator (1-P rimary, 2- Secondary) . If not p assed in, primary is assumed. | ||
| 1612 | |||
| 1613 | Return Val ues: | ||
| 1614 | DUR (passe d by refer ence) – Ar ray of dat a, which c omes from the BPS Re sponse fil e. | ||
| 1615 | |||
| 1616 | Entry Poin ts | ||
| 1617 | Please see the API s ection for callable entry poin ts. | ||
| 1618 | |||
| 1619 | (This page included for two-si ded copyin g.) | ||
| 1620 | |||
| 1621 | |||
| 1622 | Protocols | ||
| 1623 | |||
| 1624 | BPS ECMECL 1 NTE | ||
| 1625 | BPS ECMESV 1 NTE | ||
| 1626 | BPS OPECC REJECT INF O MEDICATI ON PROFILE | ||
| 1627 | BPS OPECC REJECT INF O PATIENT INFORMATIO N | ||
| 1628 | BPS OPECC REJECT INF O VIEW RX | ||
| 1629 | BPS OPECC REJECT MEN U | ||
| 1630 | BPS OPECC REJECT VIE W ECME RX | ||
| 1631 | BPS P1 EXI T | ||
| 1632 | BPS P2 CON TINUOUS | ||
| 1633 | BPS P2 UPD ATE | ||
| 1634 | BPS P2 ZER O | ||
| 1635 | BPS PROTOC OL 2 | ||
| 1636 | BPS PRTCL CMT ADD | ||
| 1637 | BPS PRTCL CMT ADD PH ARM | ||
| 1638 | BPS PRTCL CMT EXIT | ||
| 1639 | BPS PRTCL CMT MENU | ||
| 1640 | BPS PRTCL ECME INFO REPORT | ||
| 1641 | BPS PRTCL ECME USRSC R | ||
| 1642 | BPS PRTCL IBCNR EDIT PLAN | ||
| 1643 | BPS PRTCL IBCNR GROU P PLAN MAT CH | ||
| 1644 | BPS PRTCL IBCNR PLAN MATCH | ||
| 1645 | BPS PRTCL LOG MENU | ||
| 1646 | BPS PRTCL REOPEN | ||
| 1647 | BPS PRTCL REOPEN EXI T | ||
| 1648 | BPS PRTCL REOPEN MEN U | ||
| 1649 | BPS PRTCL RSCH CLAIM TRACKING | ||
| 1650 | BPS PRTCL RSCH ELIG INQ | ||
| 1651 | BPS PRTCL RSCH EXIT | ||
| 1652 | BPS PRTCL RSCH GRPL | ||
| 1653 | BPS PRTCL RSCH HIDDE N ACTIONS | ||
| 1654 | BPS PRTCL RSCH IB EV ENT REPORT | ||
| 1655 | BPS PRTCL RSCH MENU | ||
| 1656 | BPS PRTCL RSCH ON HO LD COPAY | ||
| 1657 | BPS PRTCL RSCH RELEA SE COPAY | ||
| 1658 | BPS PRTCL RSCH TPJI | ||
| 1659 | BPS PRTCL RSCH VIEW ELIGIBILIT Y | ||
| 1660 | BPS PRTCL RSCH VIEW INSURANCE | ||
| 1661 | BPS PRTCL RSCH VIEW PRESCRIPTI ON | ||
| 1662 | BPS PRTCL UNSTRAND | ||
| 1663 | BPS PRTCL UNSTRAND A LL | ||
| 1664 | BPS PRTCL UNSTRAND E XIT | ||
| 1665 | BPS PRTCL UNSTRAND P RINT | ||
| 1666 | BPS PRTCL UNSTRAND S ELECT | ||
| 1667 | BPS PRTCL USRSCR CHA NGE VIEW | ||
| 1668 | BPS PRTCL USRSCR CLA IM LOG | ||
| 1669 | BPS PRTCL USRSCR CLO SE | ||
| 1670 | BPS PRTCL USRSCR COM MENT | ||
| 1671 | BPS PRTCL USRSCR CON TINUOUS | ||
| 1672 | BPS PRTCL USRSCR DEV ELOPER LOG | ||
| 1673 | BPS PRTCL USRSCR EXI T | ||
| 1674 | BPS PRTCL USRSCR HID DEN ACTION S | ||
| 1675 | BPS PRTCL USRSCR OPE CC REJECT INFORMATIO N | ||
| 1676 | BPS PRTCL USRSCR OPE N/CLOSE NO N-BILLABLE ENTRY | ||
| 1677 | BPS PRTCL USRSCR PHA RM WRKLST | ||
| 1678 | BPS PRTCL USRSCR REO PEN CLOSED CLAIMS | ||
| 1679 | BPS PRTCL USRSCR RES EARCH MENU | ||
| 1680 | BPS PRTCL USRSCR RES UB NO REVE RSE | ||
| 1681 | BPS PRTCL USRSCR RES UBMIT | ||
| 1682 | BPS PRTCL USRSCR RES UBMIT EDIT S | ||
| 1683 | BPS PRTCL USRSCR REV ERSE | ||
| 1684 | BPS PRTCL USRSCR SOR TLIST | ||
| 1685 | BPS PRTCL USRSCR UPD ATE | ||
| 1686 | BPS VALM D OWN A LINE | ||
| 1687 | BPS VALM F IRST SCREE N | ||
| 1688 | BPS VALM G OTO PAGE | ||
| 1689 | BPS VALM L AST SCREEN | ||
| 1690 | BPS VALM N EXT SCREEN | ||
| 1691 | BPS VALM P REVIOUS SC REEN | ||
| 1692 | BPS VALM P RINT SCREE N | ||
| 1693 | BPS VALM U P ONE LINE | ||
| 1694 | BPS VIEW E CME RX MEN U | ||
| 1695 | BPS VRX NA V BILL LIS T | ||
| 1696 | BPS VRX NA V BILLING EVENTS RPT | ||
| 1697 | BPS VRX NA V CRI | ||
| 1698 | BPS VRX NA V DG ELIG STATUS | ||
| 1699 | BPS VRX NA V DG ELIG VERIFICATI ON | ||
| 1700 | BPS VRX NA V ECME CLA IM LOG | ||
| 1701 | BPS VRX NA V INS POL | ||
| 1702 | BPS VRX NA V MED PROF ILE | ||
| 1703 | BPS VRX NA V PRINT RE PORT | ||
| 1704 | BPS VRX NA V TPJI AR ACCT PROFI LE | ||
| 1705 | BPS VRX NA V TPJI AR COMMENT HI STORY | ||
| 1706 | BPS VRX NA V TPJI CLA IM INFORMA TION | ||
| 1707 | BPS VRX NA V TPJI ECM E RX INFO | ||
| 1708 | BPS VRX NA V VIEWRX | ||
| 1709 | BPSJ MFN R EGISTER1 | ||
| 1710 | BPSJ PAYER INPUT | ||
| 1711 | BPSJ PAYER RESPONSE | ||
| 1712 | BPSJ REGIS TER | ||
| 1713 | |||
| 1714 | |||
| 1715 | Exte rnal Relat ions | ||
| 1716 | Software R equirement s | ||
| 1717 | The follow ing softwa re package s must be installed prior to E CME V. 1.0 installat ion. | ||
| 1718 | |||
| 1719 | Health Lev el Seven ( HL7) V. 1. 6 | ||
| 1720 | Integrated Billing ( IB) V. 2.0 | ||
| 1721 | Kernel V. 8.0 | ||
| 1722 | MailMan V. 8.0 | ||
| 1723 | National D rug File ( NDF) V. 4. 0 | ||
| 1724 | Outpatient Pharmacy V. 7.0 | ||
| 1725 | Pharmacy D ata Manage ment V. 1. 0 | ||
| 1726 | VA FileMan V. 22.0 | ||
| 1727 | Visit Trac king V. 2. 0 | ||
| 1728 | Consolidat ed Mail Ou tpatient P harmacy (C MOP) V. 2. 0 | ||
| 1729 | |||
| 1730 | |||
| 1731 | If the sit e plans to utilize t he CMOP fu nctionalit y, then CM OP V. 2.0 must also be install ed. | ||
| 1732 | |||
| 1733 | Integrati on Agreeme nts (INTEG RATION CON TROL REGIS TRATIONS) | ||
| 1734 | E Claims M anagement Engine V1. 0 has Data Base Inte gration Co ntrol regi strations (ICR) with the packa ges listed above, in addition to Registr ation (DG) and Sched uling (SD) . For comp lete infor mation reg arding the ICRs for E Claims M anagement Engine V1. 0, please refer to t he INTEGRA TION CONTR OL REGISTR ATIONS [DB A IA ISC] option und er the DBA [DBA] opt ion on FOR UM. | ||
| 1735 | (This page included for two-si ded copyin g.) | ||
| 1736 | |||
| 1737 | Inter nal Relati ons | ||
| 1738 | All of the ECME V. 1 .0 package options a re designe d to stand -alone. | ||
| 1739 | |||
| 1740 | (This page included for two-si ded copyin g.) | ||
| 1741 | |||
| 1742 | Pack age-Wide V ariables | ||
| 1743 | SACC Exem ptions | ||
| 1744 | There are no SACC ex emptions f or this pa ckage. | ||
| 1745 | Variables | ||
| 1746 | The follow ing is a l ist of the more impo rtant name space vari ables by t he ECME V. 1.0 packa ge. These variables are listed here for support pu rposes onl y and can change fro m version to version . | ||
| 1747 | |||
| 1748 | BPS array variables | ||
| 1749 | |||
| 1750 | The BPS ar ray contai ns all the informati on needed to build a claim. Th is informa tion comes primarily from two sources, I B/Insuranc e and Phar macy data. | ||
| 1751 | |||
| 1752 | |||
| 1753 | (This pag e included for two-s ided copyi ng.) | ||
| 1754 | |||
| 1755 | Security G uide | ||
| 1756 | |||
| 1757 | (This page included for two-si ded copyin g.) | ||
| 1758 | |||
| 1759 | Secur ity Manage ment | ||
| 1760 | This packa ge does no t impose a ny additio nal legal requiremen ts on the user, nor does it re lieve the user of an y legal re quirements . No addit ional secu rity measu res are to be applie d other th an those i mplemented through M enu Manage r and the package ro utines. No additiona l licenses are neces sary to ru n the soft ware. Conf identialit y of staff and patie nt data an d the moni toring of this confi dentiality are no di fferent th an with an y other pa per refere nce. | ||
| 1761 | |||
| 1762 | (This page included for two-si ded copyin g.) | ||
| 1763 | |||
| 1764 | |||
| 1765 | Mail Groups and Mail Mess ages (Bull etins) | ||
| 1766 | There are three mail groups in ECME. | ||
| 1767 | The mail g roup BPS O PECC shoul d contain members wh o will mon itor the E CME proces s. | ||
| 1768 | The mail g roup BPS T RICARE sho uld contai n members who will m onitor the TRI CARE proce ss. | ||
| 1769 | The mail g roup BPS C HAMPVA sho uld contai n members who will m onitor the CHA MPVA proce ss | ||
| 1770 | There are seven Mail Man messag es (bullet ins) sent by ECME. | ||
| 1771 | If an ECME transacti on is miss ing the in surance in formation necessary to process the claim , an email bulletin will be se nt to the BPS OPECC mail group before th e claim pr ocessing t erminates. | ||
| 1772 | The Auto-R eversal Pr ocess will send an e mail to th e BPS OPEC C mail gro up with a list of EC ME claims that were auto-rever sed. | ||
| 1773 | The VA SIT E CONTACT in the BPS SETUP tab le will be notified of any dif ficulties encountere d during t he registr ation proc ess. | ||
| 1774 | If a Veter an RX/fill cannot be queued fo r processi ng, an ema il is sent to the BP S OPECC ma il group. | ||
| 1775 | If a TRICA RE RX/fill cannot be queued fo r processi ng, an ema il is sent to the BP S TRICARE mail group . | ||
| 1776 | If a CHAMP VA RX/fill cannot be queued fo r processi ng, an ema il is sent to the BP S CHAMPVA mail group | ||
| 1777 | If a prima ry claim i s closed b y an Rx Re turn to St ock, an Rx Delete, o r an Inpat ient Auto Reversal a nd there i s an open secondary claim, a b ulletin wi ll be sent to the BP S OPECC ma il group s o that the y can manu ally rever se (if nee ded) and c lose the s econdary c laim. | ||
| 1778 | (This page included for two-si ded copyin g.) | ||
| 1779 | |||
| 1780 | Remot e Systems | ||
| 1781 | ECME trans mits presc ription cl aims and e ligibility verificat ion reques ts to thir d-party pa yers via t he Austin Informatio n Technolo gy Center (AITC) and the clear inghouse E mdeon via HL7. The c laims mess ages sent and receiv ed must co mply with the NCPDP V. D.0 Tel ecommunica tions Stan dard. The data on t he claims transactio ns are con trolled by fields de fined on t he payer s heets, whi ch are cre ated by th e third-pa rty payer. Generally , the data may inclu de patient , insuranc e, provide r, and pre scription data. The payer resp onse will include wh ether the claim was paid or re jected and possibly drug utili zation res ponse (DUR ) informat ion. The n umber of t ransaction s will var y dependin g on the f requency o f prescrip tions crea ted at a s ite and ho w many of those clai ms can be third-part y billed. The data i s not encr ypted betw een VistA and the AI TC, which is inside the VA fir ewall. | ||
| 1782 | ECME trans mits regis tration da ta to the AITC via H L7. The re gistration data incl udes the s ite data ( site numbe r, site co ntacts, an d site con tact means ) and phar macy data (pharmacy contacts a nd contact means, NC PDP, pharm acy DEA, a nd lead ph armacist d ata). The AITC retur ns acknowl edgement m essages fo r each reg istration message it receives. There is a nightly job, which , if sched uled prope rly, will register t he site an d pharmacy once ever y day. The data is a lso sent i f the user requests it via the Register Pharmacy w ith AITC o ption [BPS SETUP REG ISTER PHAM ACY]. The data is no t encrypte d between VistA and the AITC, which is i nside the VA firewal l. | ||
| 1783 | ECME recei ves payer sheet tabl e updates from the A ITC via HL 7. The pay er sheet d ata is sto red in the BPS NCPDP FORMATS t able (#900 2313.92). VistA will return ac knowledgem ent messag es for eve ry table u pdate it r eceives. C urrently, the AITC u pdates the ir databas e about on ce a week and any up dates will then be s ent to the VistA sit es. The da ta is not encrypted between Vi stA and th e AITC, wh ich is ins ide the VA firewall. | ||
| 1784 | (This page included for two-si ded copyin g.) | ||
| 1785 | |||
| 1786 | Archi ving and P urging | ||
| 1787 | Archiving | ||
| 1788 | At present , the ECME V. 1.0 pa ckage does not provi de for the archiving of its da ta. | ||
| 1789 | Purging | ||
| 1790 | The BPS Ni ghtly Back ground Job , which sh ould be sc heduled to run night ly, will p urge data older than 365 days from the B PS LOG (#9 002313.12) file. | ||
| 1791 | (This page included for two-si ded copyin g.) | ||
| 1792 | |||
| 1793 | Contin gency Plan ning | ||
| 1794 | If a syste m failure occurs, ch eck for st randed sub missions v ia the Vie w/Unstrand Submissio ns Not Com pleted opt ion [BPS U NSTRAND SC REEN]. If any strand ed submiss ions are f ound, unst rand them and reproc ess them v ia the ECM E User Scr een option . Note tha t requests stranded in a 'Tran smitting' state most likely in dicate tha t there is a problem with HL7 processing at the si te or at t he AITC. I f there is an HL7 pr oblem and it is reso lved, the submission s will tra nsmit norm ally and n o other ef fort is ne eded. Only in the ev ent that i t is verif ied that t here is no t an HL7 p roblem, th en submiss ions in th is state s hould be u nstranded. | ||
| 1795 | (This page included for two-si ded copyin g.) | ||
| 1796 | |||
| 1797 | Interf acing | ||
| 1798 | There are no special ized produ cts embedd ed within or require d by the E CME packag e. | ||
| 1799 | (This page included for two-si ded copyin g.) | ||
| 1800 | |||
| 1801 | Elect ronic Sign atures | ||
| 1802 | There are no electro nic signat ures requi red by the ECME pack age. | ||
| 1803 | (This pag e included for two-s ided copyi ng.) | ||
| 1804 | |||
| 1805 | Menus | ||
| 1806 | [BPSMENU] | ||
| 1807 | |||
| 1808 | The comple te list of ECME V. 1 .0 menu op tions is s hown below . The Clai ms Coordin ator needs to access all ECME V. 1.0 opt ions. | ||
| 1809 | |||
| 1810 | |||
| 1811 | To view th e complete ECME V. 1 .0 menu st ructure, t he user mu st hold th e BPSMENU, BPS USER, BPS MANAG ER, BPS MA STER, BPS REPORTS, a nd BPS SUP ERVISOR ke ys. | ||
| 1812 | |||
| 1813 | Option Nam e | ||
| 1814 | Menu Text | ||
| 1815 | |||
| 1816 | |||
| 1817 | BPS MANAGE R MENU | ||
| 1818 | Pharmacy E CME Manage r Menu | ||
| 1819 | |||
| 1820 | |||
| 1821 | BPS STATS SCREEN | ||
| 1822 | Statistics Screen | ||
| 1823 | |||
| 1824 | |||
| 1825 | BPS MENU M AINTENANCE | ||
| 1826 | ECME trans action mai ntenance o ptions | ||
| 1827 | |||
| 1828 | |||
| 1829 | BPS MENU R PT CLAIM S TATUS | ||
| 1830 | Claim Resu lts and St atus | ||
| 1831 | |||
| 1832 | |||
| 1833 | BPS MENU R PT MAIN | ||
| 1834 | Pharmacy E lectronic Claims Rep orts | ||
| 1835 | |||
| 1836 | |||
| 1837 | BPS MENU R PT OTHER | ||
| 1838 | |||
| 1839 | BPS COB ME NU | ||
| 1840 | |||
| 1841 | BPS COB PR OCESS SECO ND TRICARE | ||
| 1842 | |||
| 1843 | |||
| 1844 | BPS COB RP T SECONDAR Y CLAIMS | ||
| 1845 | |||
| 1846 | BPS POTENT IAL CLAIMS RPT DUAL | ||
| 1847 | |||
| 1848 | |||
| 1849 | Other Repo rts | ||
| 1850 | |||
| 1851 | ECME Pharm acy COB | ||
| 1852 | |||
| 1853 | Process Se condary/TR ICARE Rx t o ECME | ||
| 1854 | |||
| 1855 | Potential Secondary Rx Claims Report | ||
| 1856 | |||
| 1857 | Potential Claims Rep ort for Du al Eligibl e | ||
| 1858 | |||
| 1859 | |||
| 1860 | |||
| 1861 | |||
| 1862 | BPS NIGHTL Y BACKGROU ND JOB | ||
| 1863 | BPS Nightl y Backgrou nd Job | ||
| 1864 | |||
| 1865 | |||
| 1866 | BPS RPT RE CENT TRANS ACTIONS | ||
| 1867 | Recent Tra nsactions | ||
| 1868 | |||
| 1869 | |||
| 1870 | BPS RPT CL OSED CLAIM S | ||
| 1871 | Closed Cla ims Report | ||
| 1872 | |||
| 1873 | |||
| 1874 | BPS RPT CM OP/ECME AC TIVITY | ||
| 1875 | CMOP/ECME Activity R eport | ||
| 1876 | |||
| 1877 | |||
| 1878 | BPS RPT ER RONEOUS RE V | ||
| 1879 | List Possi ble Errone ous Revers als | ||
| 1880 | |||
| 1881 | |||
| 1882 | BPS RPT NO T RELEASED | ||
| 1883 | Claims Sub mitted, No t Yet Rele ased | ||
| 1884 | |||
| 1885 | |||
| 1886 | BPS RPT PA YABLE | ||
| 1887 | Payable Cl aims Repor t | ||
| 1888 | |||
| 1889 | |||
| 1890 | BPS RPT PA YER SHEET DETAIL | ||
| 1891 | Payer Shee t Detail R eport | ||
| 1892 | |||
| 1893 | |||
| 1894 | BPS RPT RE JECTION | ||
| 1895 | Rejected C laims Repo rt | ||
| 1896 | |||
| 1897 | |||
| 1898 | BPS RPT RE VERSAL | ||
| 1899 | Reversal C laims Repo rt | ||
| 1900 | |||
| 1901 | |||
| 1902 | BPS RPT TO TALS BY DA Y | ||
| 1903 | Totals by Date | ||
| 1904 | |||
| 1905 | |||
| 1906 | BPS SETUP MENU | ||
| 1907 | Pharmacy E CME Setup Menu | ||
| 1908 | |||
| 1909 | |||
| 1910 | BPS SETUP BASIC PARA MS | ||
| 1911 | Edit Basic Pharmacy ECME Param eters | ||
| 1912 | |||
| 1913 | |||
| 1914 | BPS RPT SE TUP PHARMA CIES | ||
| 1915 | ECME Setup – Pharmac ies Report | ||
| 1916 | |||
| 1917 | |||
| 1918 | BPS SETUP PHARMACY | ||
| 1919 | Edit Pharm acy ECME P harmacy Da ta | ||
| 1920 | |||
| 1921 | |||
| 1922 | BPS SETUP REGISTER P HARMACY | ||
| 1923 | Register P harmacy wi th Austin Automation Center | ||
| 1924 | |||
| 1925 | |||
| 1926 | BPS RPT TU RNAROUND S TATS | ||
| 1927 | Turn-aroun d time sta tistics | ||
| 1928 | |||
| 1929 | |||
| 1930 | BPS UNSTRA ND SCREEN | ||
| 1931 | View/Unstr and Submis sions Not Completed | ||
| 1932 | |||
| 1933 | |||
| 1934 | BPS USER S CREEN | ||
| 1935 | Claims Dat a Entry Sc reen | ||
| 1936 | |||
| 1937 | |||
| 1938 | BPSMENU | ||
| 1939 | ECME | ||
| 1940 | |||
| 1941 | |||
| 1942 | BPS RPT CL AIMS RESPO NSE | ||
| 1943 | ECME Claim s-Response Inquiry | ||
| 1944 | |||
| 1945 | |||
| 1946 | BPS RPT NO N-BILLABLE REPORT | ||
| 1947 | Non-Billab le Status Report | ||
| 1948 | |||
| 1949 | |||
| 1950 | BPS RPT SP ENDING ACC OUNT | ||
| 1951 | Spending A ccount Rep ort | ||
| 1952 | BPS RPT VI EW ECME RX | ||
| 1953 | View ePhar macy Rx | ||
| 1954 | BPS OPECC PRODUCTIVI TY REPORT | ||
| 1955 | OPECC Prod uctivity R eport | ||
| 1956 | |||
| 1957 | |||
| 1958 | Example: H ow to View the Expor ted Option s Using VA FileMan | ||
| 1959 | |||
| 1960 | |||
| 1961 | VA FileMan 22.0 | ||
| 1962 | |||
| 1963 | |||
| 1964 | Select OPT ION: 5 IN QUIRE TO F ILE ENTRIE S | ||
| 1965 | |||
| 1966 | OUTPUT FRO M WHAT FIL E: OPTION/ / <Enter> | ||
| 1967 | Select OPT ION NAME: BPSMENU ECME | ||
| 1968 | ANOTHER ON E: <Enter> | ||
| 1969 | STANDARD C APTIONED O UTPUT? Yes // <Enter> (Yes) | ||
| 1970 | Include CO MPUTED fie lds: (N/Y /R/B): NO/ / <Enter> - No recor d number ( IEN), no C omputed | ||
| 1971 | Fields | ||
| 1972 | DISPLAY AU DIT TRAIL? No// <Ent er> NO | ||
| 1973 | |||
| 1974 | NAME: BPSM ENU MENU TEXT: ECME | ||
| 1975 | TYPE: me nu CREATOR: E CMEuser,On e | ||
| 1976 | LOCK: BP SMENU PACKAGE: I HS PHARMAC Y POINT OF SALE | ||
| 1977 | E ACTION PRESENT: YES HEADER PRE SENT?: YES | ||
| 1978 | DESCRIPTI ON: The main menu | ||
| 1979 | ITEM: BPS MANAGER ME NU SYNONYM: M GR | ||
| 1980 | DISPLAY ORDER: 2 | ||
| 1981 | ITEM: BPS USER SCREE N SYNONYM: U | ||
| 1982 | DISPLAY ORDER: 1 | ||
| 1983 | ITEM: BPS MENU RPT M AIN SYNONYM: R PT | ||
| 1984 | DISPLAY ORDER: 4 | ||
| 1985 | ENTRY AC TION: K BP SQUIT D IN IT^BPSMHDR I $G(BPSQ UIT) K BPS QUIT S XQU IT=1 | ||
| 1986 | HEADER: D HDR^BPSM HDR TIMESTAMP: 60116,628 62 | ||
| 1987 | TIMESTAM P OF PRIMA RY MENU: 6 0044,54655 | ||
| 1988 | UPPERCAS E MENU TEX T: ECME | ||
| 1989 | |||
| 1990 | (This page included for two-si ded copyin g.) | ||
| 1991 | |||
| 1992 | Security K eys | ||
| 1993 | BPSMENU Re quired for accessing the main ECME menu [BPSMENU] | ||
| 1994 | |||
| 1995 | BPS USER Required f or accessi ng the ECM E User’s S creen [BPS USER SCRE EN] | ||
| 1996 | Required f or accessi ng the opt ion Proces s Secondar y/TRICARE Rx to ECME [BPS COB PROCESS SE COND TRICA RE] | ||
| 1997 | |||
| 1998 | BPS MANAGE R Required for acces sing the f ollowing E CME option s: | ||
| 1999 | Pharmacy E CME Manage r Menu [BP S MANAGER MENU] | ||
| 2000 | Statistics Screen [B PS STATIST ICS SCREEN ] | ||
| 2001 | ECME trans action mai ntenance o ptions [BP S MENU MAI NTENANCE] | ||
| 2002 | View/Unstr and Submis sions Not Completed [BPS UNSTR AND SCREEN ] | ||
| 2003 | Re Open CL OSED/Resub mit Claims [BPS REOP EN CLOSED CLAIMS] | ||
| 2004 | |||
| 2005 | BPS MASTER Required f or accessi ng the fol lowing ECM E options: | ||
| 2006 | Pharmacy E CME Setup Menu [BPS SETUP MENU ] | ||
| 2007 | Edit Basic Pharmacy ECME Param eters [BPS SETUP BAS IC PARAMS] | ||
| 2008 | Edit ECME Pharmacy D ata [BPS S ETUP PHARM ACY] | ||
| 2009 | Register P harmacy wi th Austin Automation Center [B PS SETUP R EGISTER PH ARMACY] | ||
| 2010 | |||
| 2011 | BPS REPORT S Required for acces sing the f ollowing E CME option s: | ||
| 2012 | Pharmacy E lectronic Claims Rep orts [BPS MENU RPT M AIN] | ||
| 2013 | Claim Resu lts and St atus [BPS MENU RPT C LAIM STATU S] | ||
| 2014 | Recent Tra nsactions [BPS RPT R ECENT TRAN SACTIONS] | ||
| 2015 | Closed Cla ims Report [BPS RPT CLOSED CLA IMS] | ||
| 2016 | CMOP/ECME Activity R eport [BPS RPT CMOP/ ECME ACTIV ITY] | ||
| 2017 | Claims Sub mitted, No t Yet Rele ased [BPS RPT NOT RE LEASED] | ||
| 2018 | Payable Cl aims Repor t [BPS RPT PAYABLE] | ||
| 2019 | Payer Shee t Detail R eport [BPS RPT PAYER SHEET DET AIL] | ||
| 2020 | Rejected C laims Repo rt [BPS RP T REJECTIO N] | ||
| 2021 | Reversal C laims Repo rt [BPS RP T REVERSAL ] | ||
| 2022 | Totals by Date [BPS RPT TOTALS BY DAY] | ||
| 2023 | Turn-aroun d time sta tistics [B PS RPT TUR NAROUND ST ATS] | ||
| 2024 | ECME Setup – Pharmac ies Report [BPS RPT SETUP PHAR MACIES] | ||
| 2025 | Spending A ccount Rep ort [BPS R PT SPENDIN G ACCOUNT] | ||
| 2026 | ECME Claim s-Response Inquiry [ BPS RPT CL AIMS RESPO NSE] | ||
| 2027 | Non-Billab le Status Report [BP S RPT NON- BILLABLE R EPORT] | ||
| 2028 | |||
| 2029 | |||
| 2030 | BPS SUPERV ISORRequir ed for thi s ECME opt ion: | ||
| 2031 | OPECC Prod uctivity R eport [BPS OPECC PRO DUCTIVITY REPORT] | ||
| 2032 | File Security | ||
| 2033 | All ECME V . 1.0 rela ted files – BPS CLAI MS file (# 9002313.02 ) through BPS SETUP file (#900 2313.99) – have Audi t (AUDIT), Data Dict ionary (DD ), Delete (DEL), Lea rn As You Go (LAYGO) , and Writ e (WR) acc ess codes of “@” and Read (RD) access co des of “Pp ”. | ||
| 2034 | |||
| 2035 | (This page included for two-si ded copyin g.) | ||
| 2036 | |||
| 2037 | Refer ences | ||
| 2038 | |||
| 2039 | VA Softwar e Document Library | ||
| 2040 | http://URL | ||
| 2041 | |||
| 2042 | VA Softwar e Document Library – Electroni c Claims M anagement Engine (EC ME) | ||
| 2043 | http://URL | ||
| 2044 | |||
| 2045 | NCPDP HIPA A Transact ions docum entation | ||
| 2046 | http://www .ncpdp.org /news_hipa a_trans_cu rrent.aspx | ||
| 2047 | |||
| 2048 | HIPAA NCPD P Connecti on for EDI Pharmacy (Active Re lease) | ||
| 2049 | http://URL | ||
| 2050 | |||
| 2051 | NCPDP Basi c Guide to Standards | ||
| 2052 | http://www .ncpdp.org /pdf/Basic _guide_to_ standards. pdf | ||
| 2053 | |||
| 2054 | Offic ial Polici es | ||
| 2055 | ECME softw are is sub ject to VH A directiv e 2004-038 which for bids the l ocal modif ication of Class I s oftware. | ||
| 2056 | |||
| 2057 | |||
| 2058 | (This page included for two-si ded copyin g.) | ||
| 2059 | |||
| 2060 | Glossary | ||
| 2061 | |||
| 2062 | Accredited Standards Committee (ASC)An o rganizatio n that has been accr edited by American N ational St andards In stitute (A NSI) for t he develop ment of Am erican Nat ional Stan dards. | ||
| 2063 | |||
| 2064 | |||
| 2065 | Administra tive Code SetsCode s ets that c haracteriz e a genera l business situation rather th an a medic al conditi on or serv ice. | ||
| 2066 | |||
| 2067 | |||
| 2068 | Administra tive Simpl ification (A/S)Title II, Subti tle F, of HIPAA, whi ch gives t he Departm ent Of Hea lth And Hu man Servic es (DHHS) the author ity to man date the u se of stan dards for the electr onic excha nge of hea lth care d ata; to sp ecify what medical a nd adminis trative co de sets sh ould be us ed within those stan dards; to require th e use of n ational id entificati on systems for healt h care pat ients, pro viders, pa yers (or p lans), and employers (or spons ors); and to specify the types of measur es require d to prote ct the sec urity and privacy of personall y identifi able healt h care inf ormation. | ||
| 2069 | |||
| 2070 | AITCAustin Informati on Technol ogy Center , formerly known as the Austin Automatio n Center ( AAC). | ||
| 2071 | |||
| 2072 | American N ational St andards (A NS)Standar ds develop ed and app roved by o rganizatio ns accredi ted by ANS I. | ||
| 2073 | |||
| 2074 | |||
| 2075 | American N ational St andards In stituteAn organizati on that ac credits va rious | ||
| 2076 | (ANSI)stan dards-sett ing commit tees, and monitors t heir compl iance with the open rule-makin g process that they must follo w to quali fy for ANS I accredit ation. | ||
| 2077 | |||
| 2078 | |||
| 2079 | American S ociety for Testing a nd A stand ards group that has published general | ||
| 2080 | Materials (ASTM)gui delines fo r the deve lopment of standards , includin g those fo r health c are identi fiers. | ||
| 2081 | |||
| 2082 | |||
| 2083 | American M edical Ass ociation ( AMA) A pro fessional associatio n that rep resents th e voice of the Ameri can medica l professi on and con stitutes t he partner ship of ph ysicians a nd their p rofessiona l associat ions dedic ated to pr omoting th e art and science of medicine and the be tterment o f public h ealth. | ||
| 2084 | |||
| 2085 | |||
| 2086 | Back DoorS ystem acce ss via the roll and scroll, ch aracter an d Mumps ba sed VistA applicatio n. | ||
| 2087 | |||
| 2088 | |||
| 2089 | Blue Cross and Blue Shield Ass ociation A n associat ion that r epresents the common | ||
| 2090 | (BCBSA)int erest of B lue Cross and Blue S hield heal th plans. The BCBSA maintains the Claim Adjustment Reason Co des code s et. | ||
| 2091 | |||
| 2092 | |||
| 2093 | Business M odelA mode l of a bus iness orga nization o r process. | ||
| 2094 | |||
| 2095 | |||
| 2096 | CHAMPVA Pa tientA CHA MPVA patie nt is a pa tient that has CHAMP VA coverag e only. Th e CHAMPVA insurance will be bi lled for t he prescri ption. Gen erally, if the CHAMP VA insuran ce rejects the claim , then the medicatio n will NOT be releas ed to the patient. | ||
| 2097 | |||
| 2098 | |||
| 2099 | Clean Clai mAn insura nce claim that has n o defect, impropriet y (includi ng any lac k of any s ubstantial documenta tion) or p articular circumstan ce requiri ng special treatment that prev ents timel y payment from being made. | ||
| 2100 | |||
| 2101 | |||
| 2102 | Clearingho use For he alth care, an organi zation tha t | ||
| 2103 | (or Health Care Clea ringhouse) translates health ca re data to or from a standard format. | ||
| 2104 | |||
| 2105 | |||
| 2106 | Centers fo r Medicare & Medicai dCenters f or Medicar e & Medica id Service s, | ||
| 2107 | Services ( CMS)former ly Health Care Finan cing Admin istration (HCFA). Th e administ ration wit hin HHS th at is resp onsible fo r the nati onal admin istration of the Med icaid and Medicare p rograms. | ||
| 2108 | |||
| 2109 | |||
| 2110 | CMS-1450CM S’s name f or the ins titutional uniform c laim form, or UB-04. | ||
| 2111 | |||
| 2112 | |||
| 2113 | CMS-1500CM S’s name f or the pro fessional uniform cl aim form. | ||
| 2114 | |||
| 2115 | |||
| 2116 | Coordinati on of Bene fits (COB) A provisio n that is intended t o avoid cl aims payme nt delays and duplic ation of b enefits wh en a perso n is cover ed by two or more pl ans provid ing benefi ts or serv ices for m edical, de ntal or ot her care o r treatmen t. | ||
| 2117 | |||
| 2118 | |||
| 2119 | Code SetUn der HIPAA "codes use d to encod e data ele ments, tab les of ter ms, medica l concepts , diagnost ic codes, or medical procedure s. A code set includ es the cod es and des criptors o f the code s." [45 CF R 162.103] | ||
| 2120 | |||
| 2121 | |||
| 2122 | Covered En tityUnder HIPAA, a h ealth plan , healthca re clearin ghouse or health car e provider who trans mits infor mation in electronic form in c onnection with a tra nsaction c overed by this subch apter 160. 103 of 45 CFR. | ||
| 2123 | |||
| 2124 | |||
| 2125 | Current Pr ocedural T erminology A procedur e code set maintaine d and copy righted by the AMA a nd that ha s been sel ected for use under HIPAA for non-instit utional an d non-dent al profess ional tran sactions. | ||
| 2126 | |||
| 2127 | |||
| 2128 | Data Dicti onary (DD) A document or system that char acterizes the data c ontent of a system. | ||
| 2129 | |||
| 2130 | |||
| 2131 | Data Eleme ntUnder HI PAA, this is "…the s mallest na med unit o f informat ion in a t ransaction ." [45 CFR 162.103] | ||
| 2132 | |||
| 2133 | |||
| 2134 | Data Mappi ngThe proc ess of mat ching one set of dat a elements or indivi dual code values to their clos est equiva lents in a nother set of them. | ||
| 2135 | |||
| 2136 | |||
| 2137 | Data Model A conceptu al model o f the info rmation ne eded to su pport a bu siness fun ction or p rocess. | ||
| 2138 | |||
| 2139 | |||
| 2140 | Data SetUn der HIPAA, this is " …a semanti cally mean ingful uni t of infor mation exc hanged bet ween two p arties to a transact ion." [45 CFR 162.10 3] | ||
| 2141 | |||
| 2142 | |||
| 2143 | Designated Code SetA medical o r administ rative cod e set, whi ch DHHS ha s designat ed for use in one or more of t he HIPAA s tandards. | ||
| 2144 | |||
| 2145 | |||
| 2146 | Designated Data Cont ent Commit teeAn orga nization, which DHHS has | ||
| 2147 | or Designa ted DCCdes ignated fo r oversigh t of the b usiness da ta content of one or more of t he HIPAA-m andated tr ansaction standards. | ||
| 2148 | |||
| 2149 | |||
| 2150 | Designated StandardA standard that DHHS has design ated for u se under t he authori ty provide d by HIPAA . | ||
| 2151 | |||
| 2152 | |||
| 2153 | Department of Health and Human Per the w ebsite add ress provi ded below, | ||
| 2154 | Services ( DHHS) or ( HHS)'The D epartment of Health And Human Services i s the Unit ed States government 's princip al agency for protec ting the h ealth of a ll America ns and pro viding ess ential hum an service s, especia lly for th ose who ar e least ab le to help themselve s.' The we bsite is a vailable a t <http:// www.os.dhh s.gov/>. | ||
| 2155 | |||
| 2156 | |||
| 2157 | DismissedT he ECME fu nction of removing ( not physic ally delet ing) patie nt entries and/or pr escription s from vie wing on th e Claims D ata Entry Screen. | ||
| 2158 | |||
| 2159 | |||
| 2160 | Electronic Commerce (EComm)The exchange of busines s informat ion by ele ctronic me ans. | ||
| 2161 | |||
| 2162 | |||
| 2163 | Electronic Data Inte rchange (E DI)The tra nsfer of d ata betwee n differen t companie s using ne tworks, su ch as the Internet. As more an d more com panies are connected to the In ternet, ED I is becom ing increa singly imp ortant as an industr y standard for compa nies to bu y, sell, a nd trade i nformation . ANSI has approved a set of E DI standar ds known a s the X12 standards. | ||
| 2164 | |||
| 2165 | |||
| 2166 | FinishTerm used for completing orders fr om Order E ntry/Resul ts Reporti ng V. 3.0. | ||
| 2167 | |||
| 2168 | |||
| 2169 | ‘Finish’ a Prescript ionThis pr ocess with in VistA O utpatient Pharmacy V . 7.0 wher e a pharma cy prescri ption orde r has been reviewed by either a pharmacy technicia n or pharm acist and is the fir st step in processin g a prescr iption in Pharmacy. If perform ed by a ph armacist w ith the ap propriate security k ey, the pr escription can be ‘V erified’ a s well. Se e ‘Verify a Prescrip tion’ for more infor mation. | ||
| 2170 | |||
| 2171 | |||
| 2172 | Flat FileT his term u sually ref ers to a f ile that c onsists of a series of plain t ext record s. | ||
| 2173 | |||
| 2174 | |||
| 2175 | Front Door System acc ess via th e Delphi, Graphical User Inter face (GUI) based Vis tA applica tion. | ||
| 2176 | |||
| 2177 | |||
| 2178 | Graphical User Inter face (GUI) A graphica l method o f controll ing how a user inter acts with a computer to perfor m various tasks. | ||
| 2179 | |||
| 2180 | HCFA Commo n Procedur al Coding A medical code set t hat identi fies healt h care | ||
| 2181 | System (HC PCS)proced ures, equi pment, and supplies for claim submission purposes. It is mai ntained by Health Ca re Financi ng Adminis tration (H CFA), and has been s elected fo r use in t he HIPAA t ransaction s. HCPCS L evel I con tain numer ic CPT-4 c odes, whic h are main tained by the AMA. H CPCS Level II contai ns alphanu meric code s used to identify v arious ite ms and ser vices that are not i ncluded in the CPT-4 code set. These are maintaine d by HCFA, BCBSA, an d Health I nsurance A ssociation of Americ a (HIAA). HCPCS Leve l III cont ains alpha numeric co des that a re assigne d by Medic aid State agencies t o identify additiona l items an d services not inclu ded in lev els I and II. These are usuall y called " local code s”, and mu st have "W ", "X", "Y ", or "Z" in the fir st positio n. They ar e not name d as HIPAA standard codes. HCP CS Procedu re Modifie r Codes ca n be used with all t hree level s, with th e WA-ZY ra nge used f or locally assigned procedure modifiers. | ||
| 2182 | |||
| 2183 | |||
| 2184 | Health Car e Clearing houseUnder HIPAA, th is is "… a public or private e ntity that does eith er of the following: (1) proce sses or fa cilitates the proces sing of in formation received f rom anothe r entity i n a nonsta ndard form at or cont aining non standard d ata conten t into sta ndard data elements or a stand ard transa ction, or (2) receiv es a stand ard transa ction from another e ntity and processes or facilit ates the p rocessing of [that] informatio n into non standard f ormat or n onstandard data cont ent for a receiving entity." [ 45 CFR 160 .103] | ||
| 2185 | |||
| 2186 | |||
| 2187 | Health Car e Provider Under HIPA A, this is "…a provi der of ser vices as d efined in the sectio n 1861(u) of the [So cial Secur ity] Act, 42 USC 139 5x(u), a p rovider of medical o r other he alth servi ces as def ined in se ction 1861 (s) of the Act, 42 U SC 1395(s) , and any other pers on or orga nization w ho furnish es, bills, or is pai d for heal th care in the norma l course o f business ." [45 CFR 160.103] | ||
| 2188 | |||
| 2189 | |||
| 2190 | Health Inf ormationUn der HIPAA this is "… any infor mation, wh ether oral or record ed in any form or me dium that (a) is cre ated or re ceived by a health c are provid er, health plan, pub lic health authority , employer , life ins urer, scho ol or univ ersity, or health ca re clearin ghouse; an d (b) rela ted to the past, pre sent or fu ture physi cal or men tal health or condit ion of an individual , the prov ision of h ealth care to an ind ividual, o r the past , present or future payment fo r the prov ision of h ealth care to an ind ividual." [45 CFR 16 0.103] | ||
| 2191 | |||
| 2192 | |||
| 2193 | Health Ins urance Ass ociation o f An indus try associ ation that represent s the | ||
| 2194 | America ( HIAA)inter ests of co mmercial h ealth care insurers. The HIAA participat es in the maintenanc e of some code sets, including HCPCS Lev el II code s. | ||
| 2195 | |||
| 2196 | Health Ins urance Por tability a ndA Federa l law that makes a n umber of | ||
| 2197 | Accountabi lity Act o f 1996 (HI PAA)change s that hav e the goal of allowi ng persons to qualif y immediat ely for co mparable h ealth insu rance cove rage when they chang e their em ployment r elationshi ps. Title II, Subtit le F, of H IPAA gives HHS the a uthority t o mandate the use of standards for the e lectronic exchange o f health c are data; to specify what medi cal and ad ministrati ve code se ts should be used wi thin those standards ; to requi re the use of nation al identif ication sy stems for health car e patients , provider s, payers (or plans) , and empl oyers (or sponsors); and to sp ecify the types of m easures re quired to protect th e security and priva cy of pers onally ide ntifiable health car e informat ion. Also known as t he Kennedy -Kassebaum Bill, the Kassebaum -Kennedy B ill, K2, o r Public L aw 104-191 . | ||
| 2198 | |||
| 2199 | |||
| 2200 | Health Pla nUnder HIP AA this is "…an indi vidual or group plan that prov ides, or p ay the cos t of, medi cal care”. [45 CFR 1 60.103] | ||
| 2201 | |||
| 2202 | |||
| 2203 | Healthcare Financial Managemen t An organ ization fo r the impr ovement | ||
| 2204 | Associatio n (HFMA)of the finan cial manag ement of h ealthcare- related or ganization s. The HFM A sponsors some HIPA A educatio nal semina rs. | ||
| 2205 | |||
| 2206 | |||
| 2207 | Health Lev el Seven ( HL7)An ANS I-accredit ed group t hat define s standard s for the cross-plat form excha nge of inf ormation w ithin a he alth care organizati on. HL7 is responsib le for spe cifying th e Level Se ven Open S ystem Inte rconnectio n (OSI) st andards fo r the heal th industr y. Some HL 7 standard s will be encapsulat ed in the X12 standa rds used f or transmi tting clai m attachme nts. | ||
| 2208 | |||
| 2209 | |||
| 2210 | HIPAA Data Dictionar yA data di ctionary t hat define s and cros s- | ||
| 2211 | or HIPAA D Dreference s the cont ents of al l X12 tran sactions i ncluded in the HIPAA mandate. It is main tained by X12N/TG3. | ||
| 2212 | |||
| 2213 | |||
| 2214 | Implementa tion Guide (IG)A doc ument expl aining the proper us e of a sta ndard for a specific business purpose. T he X12N HI PAA IGs ar e the prim ary refere nce docume nts used b y those im plementing the assoc iated tran sactions, and are in corporated into the HIPAA regu lations by reference . | ||
| 2215 | |||
| 2216 | |||
| 2217 | Implementa tion Speci ficationUn der HIPAA, this is " … the spec ific instr uctions fo r implemen ting a sta ndard”. [4 5 CFR 160. 103] | ||
| 2218 | |||
| 2219 | |||
| 2220 | Informatio n ModelA c onceptual model of t he informa tion neede d to suppo rt a busin ess functi on or proc ess. | ||
| 2221 | |||
| 2222 | |||
| 2223 | Internatio nal Classi fication o f Diseases A medical code set maintained by the | ||
| 2224 | (ICD)World Health Or ganization (WHO). Th e primary purpose of this code set is to classify causes of death. A U nited Stat es (US) ex tension of this codi ng system, maintaine d by the N ational Ce nter for H ealth Stat istics (NC HS) within the Cente rs for Dis ease Contr ol (CDC), is used to identify morbidity factors, o r diagnose s. The ICD -9-CM (Rev ision 9 Cl inical Mod ification) codes hav e been sel ected for use in the HIPAA tra nsactions. | ||
| 2225 | |||
| 2226 | |||
| 2227 | Internatio nal Standa rds Organi zationAn o rganizatio n that coo rdinates t he | ||
| 2228 | (ISO) or I nternation al Organiz ation deve lopment an d adoption of numero us | ||
| 2229 | for Standa rdization internatio nal standa rds. | ||
| 2230 | |||
| 2231 | |||
| 2232 | Joint Comm ission on Accreditat ion In the future, t he JCAHO m ay play a role in | ||
| 2233 | of Healthc are Organi zations (J CAHO)certi fying thes e organiza tions comp liance wit h the HIPA A A/S requ irements. | ||
| 2234 | J-CodesPre viously HC PCS Level II has con tained a s et of code s with a h igh-order value of " J" to iden tify some drugs and some other items. Th e final HI PAA transa ctions and code set rule state s that any J-codes i dentifying drugs wil l be dropp ed from th e HCPCS an d NDC code s will be used to id entify all drug prod ucts. | ||
| 2235 | |||
| 2236 | |||
| 2237 | Maintain o r Maintena nceUnder H IPAA, this is "…acti vities nec essary to support th e use of a standard adopted by the Secre tary, incl uding tech nical corr ections to an implem entation s pecificati on, and en hancements or expans ion of a c ode set. T his term e xcludes th e activiti es related to the ad option of a new stan dard or im plementati on specifi cation, or modificat ion to an adopted st andard or implementa tion speci fication." [45 CFR 1 62.103] | ||
| 2238 | |||
| 2239 | |||
| 2240 | Maximum De fined Data SetUnder HIPAA, thi s is "… al l of the r equired da ta element s for a pa rticular s tandard ba sed on a s pecific im plementati on specifi cation." [ 45 CFR 162 .103]. A f ramework u nder HIPAA whereby a n entity c reating a transactio n is free to include whatever data any r eceiver mi ght want o r need. Th e recipien t of a max imum data set is fre e to ignor e any port ion of the data not needed to conduct th eir part o f the asso ciated bus iness tran saction, u nless the nonessenti al data is needed fo r coordina tion of be nefits. | ||
| 2241 | |||
| 2242 | |||
| 2243 | Medical Co de SetsCod es that ch aracterize a medical condition or treatm ent. The c ode sets a re usually maintaine d by profe ssional so cieties an d public h ealth orga nizations. | ||
| 2244 | |||
| 2245 | |||
| 2246 | |||
| 2247 | Memorandum of Unders tanding (M OU)A docum ent provid ing a gene ral descri ption of t he kinds o f responsi bilities t hat are to be assume d by two o r more par ties in th eir pursui t of some goal(s). I nformation that is m ore specif ic may be provided i n an assoc iated Stat ement Of W ork (SOW). | ||
| 2248 | |||
| 2249 | |||
| 2250 | Modify or Modificati onUnder HI PAA, refer s to "a ch ange adopt ed by the Secretary, through r egulation, to a stan dard or an implement ation spec ification. " [45 CFR 160.102] | ||
| 2251 | |||
| 2252 | |||
| 2253 | NABP #Nati onal Assoc iation of Boards of Pharmacy n umber. Thi s term is obsolete; it has bee n supersed ed by the NCPDP numb er. | ||
| 2254 | |||
| 2255 | |||
| 2256 | National C enter for Health Sta tisticsAn administra tion of HH S and CDC that | ||
| 2257 | (NCHS)over sees ICD c oding. | ||
| 2258 | |||
| 2259 | |||
| 2260 | National C ouncil for Prescript ion DrugAn ANSI-accr edited gro up that ma intains | ||
| 2261 | Programs ( NCPDP)a nu mber of st andard for mats for u se by the retail pha rmacy indu stry, some of which are includ ed in the HIPAA mand ates. | ||
| 2262 | |||
| 2263 | |||
| 2264 | National D rug Code ( NDC)A medi cal code s et that ha s been sel ected for use in the HIPAA tra nsactions. | ||
| 2265 | |||
| 2266 | |||
| 2267 | National E mployer ID A system f or uniquel y identify ing all sp onsors of health car e benefits . | ||
| 2268 | |||
| 2269 | |||
| 2270 | National P atient IDA system fo r uniquely identifyi ng all rec ipients of health ca re service s. | ||
| 2271 | |||
| 2272 | |||
| 2273 | National P ayer IDA s ystem for uniquely i dentifying all organ izations t hat pays f or health care servi ces. Also known as H ealth Plan ID or Pla n ID. | ||
| 2274 | |||
| 2275 | |||
| 2276 | National P rovider Fi le (NPF)Th e database envisione d for use in maintai ning a nat ional prov ider regis try. | ||
| 2277 | |||
| 2278 | |||
| 2279 | National P rovider ID A system f or uniquel y identify ing all pr oviders of health ca re service s, supplie s, and equ ipment. | ||
| 2280 | |||
| 2281 | |||
| 2282 | National P rovider Re gistryThe organizati on envisio ned for as signing th e National Provider IDs. | ||
| 2283 | |||
| 2284 | |||
| 2285 | National P rovider Sy stem (NPS) The admini strative s ystem envi sioned for supportin g a nation al provide r registry . | ||
| 2286 | |||
| 2287 | |||
| 2288 | National S tandard Fo rmat (NSF) Genericall y, this ap plies to a ny nationa l standard format, b ut it is o ften used in a more limited wa y to desig nate the P rofessiona l EMC NSF, a 320-byt e flat fil e record f ormat used to submit professio nal claims . | ||
| 2289 | |||
| 2290 | |||
| 2291 | National U niform Bil ling Commi tteeThe co mmittee es tablished by the Ame rican | ||
| 2292 | (NUBC)Hosp ital Assoc iation (AH A) to deve lop a sing le billing form and standard d ata set th at could b e used nat ionwide by instituti onal provi ders and p ayers for handling h ealth care claims. | ||
| 2293 | |||
| 2294 | |||
| 2295 | NCPDP Batc h Standard An NCPDP s tandard de signed for use by lo w-volume d ispensers of pharmac euticals, such as nu rsing home s. Version 1.0 of th is standar d has been mandated under HIPA A. | ||
| 2296 | |||
| 2297 | |||
| 2298 | NCPDP Tele communicat ion Standa rdsAn NCPD P standard designed for use by high-volu me dispens ers of pha rmaceutica ls, such a s retail p harmacies. Version D .0 is one of the tra nsaction s tandards u nder HIPAA . | ||
| 2299 | |||
| 2300 | |||
| 2301 | Non-Formul ary DrugsT he medicat ions, whic h are defi ned as com mercially available drug produ cts not in cluded in the VA Nat ional Form ulary. | ||
| 2302 | |||
| 2303 | |||
| 2304 | Notice of Intent (NO I)A docume nt that de scribes a subject ar ea for whi ch the Fed eral Gover nment is c onsidering developin g regulati ons. It ma y describe what the government considers to be the relevant considerat ions and i nvite comm ents from interested parties. These comm ents can t hen be use d in devel oping a No tice of Pr oposed Rul emaking (N PRM) or a final regu lation. | ||
| 2305 | |||
| 2306 | |||
| 2307 | Notice of Proposed R ulemaking (NPRM)A do cument tha t describe s and expl ains regul ations tha t the Fede ral Govern ment propo ses to ado pt at some future da te, and in vites inte rested par ties to su bmit comme nts relate d to them. These com ments can then be us ed in deve loping the final rul es. | ||
| 2308 | |||
| 2309 | |||
| 2310 | Office of Management & Budget (OMB)A Fed eral Gover nment agen cy that ha s a major role in re viewing pr oposed Fed eral regul ations. | ||
| 2311 | |||
| 2312 | |||
| 2313 | Open Syste m Intercon nection (O SI)A multi -layer ISO data comm unications standard. Level Sev en of this standard is industr y-specific , and HL7 is respons ible for s pecifying the level seven OSI standards for the he alth indus try. | ||
| 2314 | |||
| 2315 | |||
| 2316 | Orderable ItemAn Ord erable Ite m name and dosage fo rm that ha s no stren gth attach ed to it ( e.g., Acet aminophen) . The name with a st rength att ached is t he Dispens e Drug nam e (e.g., A cetaminoph en 325mg). | ||
| 2317 | |||
| 2318 | |||
| 2319 | PayerIn he alth care, an entity that assu mes the ri sk of payi ng for med ical treat ments. Thi s can be a n uninsure d patient, a self-in sured empl oyer, or a health ca re plan or Health Ma intenance Organizati on (HMO). | ||
| 2320 | |||
| 2321 | |||
| 2322 | PAYERIDHCF A’s term f or their N ational Pa yer ID ini tiative. | ||
| 2323 | |||
| 2324 | |||
| 2325 | Payer Shee tEntries i n BPS NCPD P FORMATS (#9002313. 92) are co mmonly ref erred to a s "payer s heets". | ||
| 2326 | |||
| 2327 | |||
| 2328 | Placeholde rsPhysical and/or lo gical data elements that are r eferenced and placed within a data struc ture that have a dat a definiti on but may or may no t currentl y exist wi thin the s ystem. The value of these data elements are not cu rrently ma intained b y the soft ware but a re establi shed for f uture iter ations of system dev elopment r elated to Billing Aw are. | ||
| 2329 | |||
| 2330 | |||
| 2331 | Potentiall y Billable EventA se rvice, whi ch has all required data eleme nts associ ated with it. These data eleme nts are co llected in the VistA Clinical Applicatio n. | ||
| 2332 | |||
| 2333 | |||
| 2334 | Profession al Compone ntCharges for physic ian servic es. Exampl es include physician who reads the Elect rocardiogr am (EKG) a nd an Emer gency Room physician who provi des treatm ent. | ||
| 2335 | |||
| 2336 | |||
| 2337 | Provider T axonomy Co desA code set for id entifying the provid er type an d area of specializa tion for a ll health care provi ders. A gi ven provid er can hav e several Provider T axonomy Co des. The B CBSA maint ains this code set. | ||
| 2338 | |||
| 2339 | |||
| 2340 | SecretaryU nder HIPAA , this ref ers to the Secretary of the US Departmen t of Healt h and Huma n Services or his/he r designat ed represe ntatives. [45 CFR 16 0.103]. | ||
| 2341 | |||
| 2342 | |||
| 2343 | SegmentUnd er HIPAA, this is "… a group of related d ata elemen ts in a tr ansaction” . [45 CFR 162.103] | ||
| 2344 | |||
| 2345 | |||
| 2346 | ServiceMed ical care and items such as me dical diag nosis and treatment, drugs and biologica ls, suppli es, applia nces, and equipment, medical s ocial serv ices, and use of hos pital Regi onal Prima ry Care Ho spital (RP CH) or Ski lled Nursi ng Facilit y (SNF) fa cilities. | ||
| 2347 | |||
| 2348 | |||
| 2349 | StandardUn der HIPAA, this is " … a prescr ibed set o f rules, c onditions, or requir ements des cribing th e followin g informat ion for pr oducts, sy stems, ser vices or p ractices ( 1) Classif ication of component s, (2) Spe cification of Materi als, perfo rmance or operations , (3) Deli neation of procedure s. [45 CFR 160.103] | ||
| 2350 | |||
| 2351 | |||
| 2352 | Standard S etting Org anization (SSO)Under HIPAA, th is is "…an organizat ion accred ited by AN SI that de velops and maintains standards for infor mation tra nsactions or data el ements, or any other standard that is ne cessary fo r, or will facilitat e the impl ementation of this p art." [45 CFR 160.10 3] | ||
| 2353 | |||
| 2354 | |||
| 2355 | Standard T ransaction Under HIPA A, this is "… a tran saction th at complie s with the applicabl e standard adopted u nder this part." [45 CFR 162.1 03] | ||
| 2356 | |||
| 2357 | |||
| 2358 | Statement of Work (S OW)A docum ent descri bing the s pecific ta sks and me thodologie s that wil l be follo wed to sat isfy the r equirement s of an as sociated c ontract or MOU. | ||
| 2359 | |||
| 2360 | |||
| 2361 | Third Part y Administ rator (TPA )An entity that proc esses heal th care cl aims and p erforms re lated busi ness funct ions for a health pl an. | ||
| 2362 | |||
| 2363 | |||
| 2364 | Third (3rd ) Party Cl aimsHealth care insu rance clai ms submitt ed to an e ntity for reimbursem ent of hea lth care b ills. | ||
| 2365 | |||
| 2366 | |||
| 2367 | Transactio nUnder HIP AA, this i s "…the ex change of informatio n between two partie s to carry out finan cial or ad ministrati ve activit ies relate d to healt h care." [ 45 CFR 160 .103] | ||
| 2368 | |||
| 2369 | |||
| 2370 | TRICARE Pa tientA TRI CARE patie nt is a pa tient that has TRICA RE coverag e. The TRI CARE insur ance will be billed for the pr escription . Generall y, if the TRICARE in surance re jects the claim, the n the medi cation wil l NOT be r eleased to the patie nt. | ||
| 2371 | |||
| 2372 | |||
| 2373 | UB-04A uni form insti tutional c laim form developed by the Nat ional Unif orm Billin g Committe e (NUBC) t hat has be en in use since 1993 . | ||
| 2374 | |||
| 2375 | |||
| 2376 | Unstructur ed DataThi s term usu ally refer s to data that is re presented as free-fo rm text, a s an image , etc., wh ere it is not practi cal to pre dict exact ly what da ta will ap pear where . | ||
| 2377 | |||
| 2378 | |||
| 2379 | ‘Verify’ a Prescript ionAfter a prescript ion order has been ‘ Finished’ the prescr iption mus t be ‘Veri fied’ by a n authoriz ed VistA u ser, throu gh the adm inistratio n of the s ystem secu rity key S OP. This i s a critic al step in the proce ss of gene rating an electronic claim. | ||
| 2380 | |||
| 2381 | |||
| 2382 | Veterans H ealth Info rmation Sy stems Acro nym for Ve terans Hea lth Inform ation | ||
| 2383 | and Techn ology Arch itecture ( VistA)Syst ems and Te chnology A rchitectur e, the new name for Decentrali zed Hospit al Compute r Program (DHCP). | ||
| 2384 | |||
| 2385 | |||
| 2386 | Workgroup for Electr onic DataA health ca re industr y group th at lobbied | ||
| 2387 | Interchang e (WEDI)fo r HIPAA A/ S, and tha t has a fo rmal consu ltative ro le under t he HIPAA l egislation . | ||
| 2388 | |||
| 2389 | |||
| 2390 | |||
| 2391 | |||
| 2392 | |||
| 2393 | |||
| 2394 | Index | ||
| 2395 | |||
| 2396 | |||
| 2397 | $$ADDCOMM^ BPSBUTL, 4 0 | ||
| 2398 | $$AMT^BPSB UTL, 40 | ||
| 2399 | $$BBILL^BP SBUTL, 41 | ||
| 2400 | $$BPSPLN^B PSUTIL, 43 | ||
| 2401 | $$CLAIM^BP SBUTL, 39 | ||
| 2402 | $$CMOPON^B PSUTIL, 42 | ||
| 2403 | $$DIVNCPDP ^BPSBUTL, 40 | ||
| 2404 | $$DURESP^B PSNCPD3, 4 4 | ||
| 2405 | $$ECMEON^B PSUTIL, 42 | ||
| 2406 | $$ELIG ^BP SBUTL, 41 | ||
| 2407 | $$EN^BPSNC PDP, 34, 3 7 | ||
| 2408 | $$NABP^BPS BUTL, 39 | ||
| 2409 | $$NFLDT^BP SBUTL, 41 | ||
| 2410 | $$STATUS^B PSOSRX, 37 | ||
| 2411 | $$STATUS^B PSOSRX(RXI ,RXR,QUE , BPRQIEN,BP COB), 37 | ||
| 2412 | Archiving, 32, 63 | ||
| 2413 | Associatin g the Outp atient Sit es with an ECME Phar macy, 9 | ||
| 2414 | BPS MANAGE R, 23 | ||
| 2415 | BPS MASTER , 24 | ||
| 2416 | BPS REPORT S, 24 | ||
| 2417 | BPS USER, 23 | ||
| 2418 | BPSMENU, 2 3 | ||
| 2419 | Contingenc y Planning , 65 | ||
| 2420 | Descriptio ns, 19 | ||
| 2421 | Disk Space Requireme nts, 11 | ||
| 2422 | ECME Menu Structure, 7 | ||
| 2423 | Electronic Signature s, 69 | ||
| 2424 | File Secur ity, 77 | ||
| 2425 | Files, 13 | ||
| 2426 | IBSEND^BPS ECMP2, 42 | ||
| 2427 | Index, 99 | ||
| 2428 | Input Temp lates, 21 | ||
| 2429 | Installati on, 9 | ||
| 2430 | Integratio n Agreemen ts, 49 | ||
| 2431 | Interfacin g, 67 | ||
| 2432 | Internal R elations, 51 | ||
| 2433 | Introducti on, 1 | ||
| 2434 | Journaling Globals, 11 | ||
| 2435 | Key Assign ment, 23 | ||
| 2436 | List Templ ates, 21 | ||
| 2437 | Mail Group s and Aler ts, 59 | ||
| 2438 | Mapping, 8 4 | ||
| 2439 | Menu Optio ns, 2 | ||
| 2440 | Menu Optio ns and Sec urity Keys , 24 | ||
| 2441 | Menus, 71 | ||
| 2442 | Official P olicies, 7 9 | ||
| 2443 | Options, 2 8 | ||
| 2444 | Orientatio n, 2 | ||
| 2445 | Pharmacy P OS User Me nu, 9 | ||
| 2446 | Print Temp lates, 21 | ||
| 2447 | prompts, 9 | ||
| 2448 | Purging, 3 2, 63 | ||
| 2449 | References , 79 | ||
| 2450 | Related Do cumentatio n, 4 | ||
| 2451 | Remote Sys tems, 61 | ||
| 2452 | Routines, 19, 20, 34 | ||
| 2453 | SACC Exemp tions, 53 | ||
| 2454 | Screen pro mpts, 2 | ||
| 2455 | Security K eys, 0 | ||
| 2456 | Security M anagement, 57 | ||
| 2457 | Site Param eters, 9 | ||
| 2458 | Software R equirement s, 49 | ||
| 2459 | Sort Templ ates, 21 | ||
| 2460 | Stand-alon e Options, 23 | ||
| 2461 | System Req uirements, 11 | ||
| 2462 | Top-level Menus, 23 | ||
| 2463 | Variables, 53 | ||
| 2464 | |||
| 2465 | |||
| 2466 |
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