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| # | Location | File | Last Modified |
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| 1 | MCCF_EDI_TAS_IB_2.0_621.zip | TAS+eIns+US3513+SDD+v1.0.docx | Wed Sep 26 22:34:57 2018 UTC |
| 2 | MCCF_EDI_TAS_IB_2.0_621.zip | TAS+eIns+US3513+SDD+v1.0.docx | Wed Sep 26 23:21:23 2018 UTC |
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| 1 | MCCF EDI T AS EINSURA NCE US3513 | |
| 2 | System Des ign Docume nt | |
| 3 | IB*2.0*602 | |
| 4 | ||
| 5 | ||
| 6 | ||
| 7 | ||
| 8 | Department of Vetera ns Affairs | |
| 9 | December 2 017 | |
| 10 | Version 1. 0 | |
| 11 | User Story Number: U S3513 | |
| 12 | User Story Name: Ele ctronic In surance Co verage Dis covery: Re quest (Inb ound Messa ge) | |
| 13 | ||
| 14 | Epic Taxon omy | |
| 15 | eBiz Com pliance Port Upd ate Increase No Touch TAS Apps | |
| 16 | Story: | |
| 17 | As a... | |
| 18 | I want to. .. | |
| 19 | So that... | |
| 20 | Consumer o f Electron ic Insuran ce Coverag e Discover y (EICD) f unctionali ty | |
| 21 | Receive an d process (in VistA) the EICD Response s ent by Fin ancial Ser vices Cent er (FSC) a fter FSC r eceives th e EICD Res ponse from TransUnio n (TU) | |
| 22 | Found insu rance for a patient can be ver ified for eligibilit y benefits and persi sted in th e patient’ s insuranc e file. | |
| 23 | Assumption s: | |
| 24 | The below design ass umes that FSC (and u ltimately Transunion ) will sen d the foll owing data (we are n ot capturi ng any oth er data) f or the ins urance fou nd: the V A Payer ID , , group ID, subscr iber ID, m ember ID, subscriber SSN, subs criber DOB | |
| 25 | ||
| 26 | At this ti me, the eI V Response Report wi ll not dis play the i nsurance i nformation for the A 1 response s with thi s current design. A new user story will be needed – for a f uture rele ase – to u pdate the eIV Respon se Report if that in formation is desired on the re port. | |
| 27 | ||
| 28 | The eIV pu rge file l ogic will need to up dated to i nclude the new file #365.16 – possible f uture stor y. | |
| 29 | Design: | |
| 30 | Note : “TQ ” is a ref erence to file #365. 1 (IIV TRA NSMISSION QUEUE) | |
| 31 | Edit exist ing file I IV TRANSMI SSION QUEU E #365.1 | |
| 32 | Add new fi eld .21 E IV INS DIS COVERY RES ULTS IEN (Number c orrespondi ng to the #365.16 no de “INS-A2 ” multiple ) | |
| 33 | ||
| 34 | Edit exist ing file I IV RESPONS E #365 | |
| 35 | Add new fi eld pointe r or logic al pointer to the EI V INSURANC E DISCOVER Y RESULTS #365.16 | |
| 36 | ||
| 37 | ||
| 38 | ||
| 39 | ||
| 40 | ||
| 41 | ||
| 42 | A new file will be c reated to store inbo und messag e informat ion for A1 responses and provi de a ‘cros swalk’ of sorts | |
| 43 | Name #365. 16 EIV INS URANCE DIS COVERY RES ULTS | |
| 44 | Global ^IB CN(365.16 | |
| 45 | ^IBCN(365. 16,IEN,0)= A1 TQ Poin ter ^ A1 D T Created ^ A1 EICD Payer ^ A1 EC Trace Number ^ A 1 Response Pointer | |
| 46 | ||
| 47 | ^IBCN(365. 16,IEN,”IN S-A2”)= In surance in fo discove red (MULTI PLE) | |
| 48 | ||
| 49 | ^IBCN(365. 16,IEN,”IN S-A2”,DA,0 )= A2 TQ P ointer ^ A 2 DT Creat ed ^ PAYER (VA NATIO NAL ID) ^ GROUP ID ^ SUBSCRIBE R ID ^ MEM BER ID^ SU BSCRIBER S SN ^ SUBSC RIBER DOB | |
| 50 | ||
| 51 | ||
| 52 | Create new protocol as follows : | |
| 53 | NAME: IBCN E eIV RQI IN ITEM T EXT: eIV I DENTIFICAT ION CLIENT TYPE: ev ent driver DESCRIPT ION: This protocol i s for Iden tification messages SENDING APPLICATIO N: IIV VIS TA TRANSA CTION MESS AGE TYPE: RQP EVEN T TYPE: I0 4 ACCEPT ACK CODE: AL APPLIC ATION ACK TYPE: NE VERSION ID : 2.4 RES PONSE PROC ESSING ROU TINE: D ^I BCNEHLI S UBSCRIBERS : IBCNE EI V ID RESPO NSE | |
| 54 | Edit routi ne: IBCNEH LI | |
| 55 | Add a new line after 38, “I E VENT=”RQP^ IO4” S TA G="EICD",I BPRTCL=“IB CNE eIV RQ P IN” | |
| 56 | Edit line tag RSP to now call EN^IBCNEHL 1(2) inste ad of the current ca ll. | |
| 57 | Add line t ag EICD ; A1 Respons e | |
| 58 | Add line “ D EN^IBCNE HL1(1) Q” | |
| 59 | ||
| 60 | Edit routi ne: IBCNEH L1 | |
| 61 | Add a “Q” before lin e tag EN | |
| 62 | Edit Line tag EN, ch ange it to EN(EVENTY P) | |
| 63 | EVENTYP=1 > A1 Resp onse (RPI^ IO4) | |
| 64 | EVENTYP=2 > Normal 270 (RPI^I O1) | |
| 65 | For lines 63 & 66 wh ere it cal ls tags GT 1 & IN1 of IBNCEHL2 | |
| 66 | Only call these orig inal tags if the EVE NTYP=2 and the rest of the exi sting if s tatement i s right | |
| 67 | Call new t ag EICDGT1 and EICDI N1 in IBCN EHL7 if EV ENTPY=1 in stead | |
| 68 | Add line r ight above line 119 which says “S AUTO=$ $AUTOUPD(R IEN)” | |
| 69 | If EVENTYP =1 call ne w tag SAVE A1^IBCNEHL 7 | |
| 70 | Edit Line tag FIL, t o pass the variable EVENTYP to IBCNEHL6 | |
| 71 | ||
| 72 | ||
| 73 | Edit routi ne: FIL^IB CNEHL6 | |
| 74 | Change lin e tag FIL to receive variable EVENTYP | |
| 75 | After line #55, add line “I $G (EVENTYP)= 1 D EN^IBC NEHL7 Q” | |
| 76 | ||
| 77 | Create a n ew routine : IBCNEHL7 | |
| 78 | Create new tags EICD GT1 & EICD IN1 | |
| 79 | Grab data from the c orrespondi ng segment (EICDGT1 processes GT1s etc.) and save the data t o an array as we nee d to gathe r it all b efore savi ng to cros s referenc e | |
| 80 | If an IN1 has no cor responding GT1 then the SUBSCR IBER ID an d MEMBER I D are the same and t hey come f rom the IN 1 | |
| 81 | If an IN1 has a corr esponding GT1 then t he MEMBER ID is pull ed from th e IN1 and the SUBSCR IBER ID is pulled fr om the GT1 | |
| 82 | Create new tag SAVEA 1 | |
| 83 | Loop throu gh array g athered in EICDGT1 & EICDIN1 a nd save to EIV INSUR ANCE DISCO VERY RESUL TS file #3 65.16 | |
| 84 | Within tag EN, proce ss the inc oming A1 t hat was sa ved | |
| 85 | Using the IIV Transm ission Que ue ien var iable, loo p through the EIV IN SURANCE DI SCOVERY RE SULTS file #365.16 | |
| 86 | If payer i s both loc ally and n ationally active …. Create A2 TQ entry a nd send it out the d oor, then get next i tem in the loop | |
| 87 | Create a T Q entry #3 65.1 by ca lling a ta g “SET” ( ( you are mimicking what all t he other e xtracts an d real tim e do)) | |
| 88 | If subscri ber ID = “ ” in #365. 16 set su bscriber I D = MEMBER ID on fil e | |
| 89 | Payer – ge t from #36 5.16 | |
| 90 | Set freshn ess date = today – t he freshne ss date #3 50.9 | |
| 91 | S DATA1 = DFN of pat ient^payer ien^1^^su bscriber I D^FRESHNES S DATE^^PA TIENT ID | |
| 92 | S DATA2=4^ ”V”^today date | |
| 93 | S DATA5= t he pointer to “contr act servic es”^EIV IN S DISCOVER Y RESULTS IEN (#365. 1, .21) | |
| 94 | *** now ca ll S TQIEN A2=$$SETTQ ^IBCNEDE7( DATA1,DATA 2,,,DATA5) | |
| 95 | Now you ha ve the TQ ien for th e A2 … us e that to save to EI V INSURANC E DISCOVER Y RESULTS file #365. 16 | |
| 96 | Load and S end HL7 Me ssage | |
| 97 | S RESPONS E=$$PROCSE ND^IBCNERT Q(TQIENA2) ; watch your varia bles | |
| 98 | Look at cl eanup ENDT RIG^IBCNER TQ for wha t array ma y need to be cleaned up | |
| 99 | If payer i s NOT both locally a nd nationa lly active …. Create buffer en try and th en skip to next item in the lo op | |
| 100 | ;write a b uffer entr y | |
| 101 | ;Patient f ields, nam e, dob and ssn will be populat ed automat ically | |
| 102 | K IBBUF | |
| 103 | S IBBUF(.0 2)=DUZ ; Entered By ((* NEW DUZ but t hen pass i n the valu e for the eiv interf ace user”) ) | |
| 104 | S IBBUF(.1 2)= “” ; n eed to det ermine the appropria te buffer symbol (bu ffer can’t handle pa yer name) – some ana lysis/test ing needed during co ding | |
| 105 | S IBBUF(.1 8)=DT | |
| 106 | S IBBUF(20 .01)=payer ien | |
| 107 | S IBBUF(60 .01)=DFN ; Patient I EN | |
| 108 | S IBBUF(60 .02)=EFFEC TIVE DATE | |
| 109 | S IBBUF(60 .06)= set to self if member id and subsc riber id a re same; o therwise s et to <TBD > | |
| 110 | S IBBUF(62 .01)=MEMBE R ID | |
| 111 | S IBBUF(80 .01)=30 | |
| 112 | S IBBUF(90 .02)=GROUP NUMBER | |
| 113 | S IBBUF(90 .03)=subsc riber ID | |
| 114 | ; the foll owing call in-turn, calls EDIT STF^IBCNBE S which wi ll make su re to file subscribe r ID last, automatic ally | |
| 115 | S IBFDA=$$ ADDSTF^IBC NBES($$FIN D1^DIC(355 .12,,,"CON TRACT SERV ICES","C") ,DFN,.IBBU F) | |
| 116 | ||
| 117 | ||
| 118 | Edit routi ne: IBCNEH LQ | |
| 119 | Modify NTE – 3rd occ urrence (l ine 176) | |
| 120 | from ”$S($ $MBICHK^IB CNEUT7(BUF F):"MBI",1 :"ELI")” | |
| 121 | to Wher e if MBI s et to ‘MBI ’, if EXT= 4 and Quer y=”I” set to “OHI”, otherwise “ELI” | |
| 122 | Change lin e 90 (with in GT1 tag ) from “I EXT'=1 D” to “I EXT =2 D” | |
| 123 | Within GT1 tag write new secti on for IF EXT=4 …. b uild the G T1 using t he data fr om the EIV INSURANCE DISCOVERY RESULTS f ile #365.1 6. * Note the field EIV INS D ISCOVERY R ESULTS IEN field (#3 65.1,.21) will indic ate which subfile on #365.16 t o use. | |
| 124 | Change lin e 145 (wit hin IN1 ta g) from “I EXT'=1 D” to “I EX T=2 D” | |
| 125 | Within IN1 tag write new secti on for IF EXT=4 …. b uild the I N1 using t he data fr om the EIV INSURANCE DISCOVERY RESULTS f ile #365.1 6. * Note the field EIV INS D ISCOVERY R ESULTS IEN field (#3 65.1,.21) will indic ate which subfile on #365.16 t o use. | |
| 126 | ||
| 127 | ||
| 128 | Edit routi ne: PROC^I BCNEDEP | |
| 129 | Add logic for NTE oc currences for 4 and 5 - make sure you a ddress all scenarios | |
| 130 | 4th occurr ence – bla nk when Qu ery = “I” ; expired in surances f or the pas t year | |
| 131 | 5th occurr ence – bla nk unless it is EXT= 4 & Query = “V” ; Trace # fr om the ass ociated A1 | |
| 132 | ||
| 133 | ||
| 134 | Edit routi ne: SETTQ^ IBCNEDE7 | |
| 135 | Make it so the 2nd p iece of DA TA5 is to be saved t o EIV INS DISCOVERY RESULTS IE N (#365.1, .21) |
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