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| # | Location | File | Last Modified |
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| 1 | MCCF_EDI_TAS_IB_2.0_621.zip | TAS+eIns+US3502+SDD+v1.1.docx | Wed Sep 26 22:26:37 2018 UTC |
| 2 | MCCF_EDI_TAS_IB_2.0_621.zip | TAS+eIns+US3502+SDD+v1.1.docx | Wed Sep 26 23:16:19 2018 UTC |
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| 1 | MCCF EDI T AS EINSURA NCE US3502 | |
| 2 | System Des ign Docume nt | |
| 3 | IB*2.0*602 | |
| 4 | ||
| 5 | ||
| 6 | ||
| 7 | ||
| 8 | Department of Vetera ns Affairs | |
| 9 | January 20 18 | |
| 10 | Version 1. 1 | |
| 11 | User Story Number: U S3502 | |
| 12 | User Story Name: Upd ate eIV St atistical Report wit h EICD & M BI Data | |
| 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 | Insurance Verificati on User | |
| 21 | Review the summary n umber of t ransaction s generate d by Elect ronic Insu rance Cove rage Disco very and M BI Inquiry in the ex isting eIV Statistic al Report | |
| 22 | I can moni tor traffi c and resp onse time and identi fy connect ivity issu es. | |
| 23 | ||
| 24 | Report Sel ection: | |
| 25 | Option: [ IBCNE IIV STATISTICA L REPORT] “eIV Stati stical Rep ort” | |
| 26 | Routine: I BCNERP7 -- “eIV STAT ISTICAL RE PORT” | |
| 27 | No changes | |
| 28 | ||
| 29 | Report Com pile: | |
| 30 | Routine: I BCNERP8 – “eIV STATI STICAL REP ORT COMPIL E” | |
| 31 | Make sure any “new” counts are added to the compil e logic an d made ava ilable to the print | |
| 32 | Routine: I N ; Determ ine Incomi ng Data | |
| 33 | Remove any non-verif ied extrac t count va riable(s) | |
| 34 | If WHICH E XTRACT (#3 65.1,.10) = 3 skip t o next rec ord | |
| 35 | ||
| 36 | Adjust exi sting Buff er logic: when (WHIC H EXTRACT (#365.1,.1 0) = 1) an d (HL7 SUB SCRIBER ID FIELD (#3 65.1,.16) ‘= “MBIreq uest”) | |
| 37 | ||
| 38 | Add count for EICD r esponses | |
| 39 | When (WHIC H EXTRACT (#365.1,.1 0) = 4)and (QUERY (#3 65.1,.11)= (I)dentif ication fo r the requ ested date range of the report | |
| 40 | ||
| 41 | Add count for EICD-t riggered V erificatio n response s | |
| 42 | When (WHIC H EXTRACT (#365.1,.1 0) = 4)and (QUERY (#3 65.1,.11)= (V)erifica tion for t he request ed date ra nge of the report | |
| 43 | ||
| 44 | Add count for MBI re sponses | |
| 45 | When (WHIC H EXTRACT (#365.1,.1 0) = 1)and (HL7 SUBSC RIBER ID F IELD (#365 .1,.16) = “MBIreques t”) | |
| 46 | ||
| 47 | Routine: O UT ;Outgoi ng Data | |
| 48 | Remove any non-verif ied extrac t count va riable(s) | |
| 49 | If WHICH E XTRACT (#3 65.1,.10) = 3 skip t o next rec ord | |
| 50 | ||
| 51 | Adjust exi sting Buff er logic: when (WHIC H EXTRACT (#365.1,.1 0) = 1)and (HL7 SUBSC RIBER ID F IELD (#365 .1,.16) ‘= “MBIreque st) | |
| 52 | ||
| 53 | Add count for EICD q ueries | |
| 54 | When (WHIC H EXTRACT (#365.1,.1 0) = 4)and (QUERY (#3 65.1,.11)= (I)dentif ication) f or the req uested dat e range of the repor t | |
| 55 | ||
| 56 | Add count for EICD-t riggered V erificatio n queries | |
| 57 | When (WHIC H EXTRACT (#365.1,.1 0) = 4)and (QUERY (#3 65.1,.11)= (V)erific ation) for the reque sted date range of t he report | |
| 58 | ||
| 59 | Add count for MBI qu eries | |
| 60 | When (WHIC H EXTRACT (#365.1,.1 0) = 1)and (HL7 SUBSC RIBER ID F IELD (#365 .1,.16) = “MBIreques t”) | |
| 61 | ||
| 62 | Routine: C UR ; Curre nt Status - stats - timeframe independen t | |
| 63 | Add count for pendin g Insuranc e Buffer q ueries | |
| 64 | When (WHIC H EXTRACT (#365.1,.1 0) = 1)and (HL7 SUBSC RIBER ID F IELD (#365 .1,.16) ‘= “MBIreque st) | |
| 65 | ||
| 66 | Add count for pendin g Appointm ent querie s | |
| 67 | When WHICH EXTRACT ( #365.1,.10 ) = 2 | |
| 68 | ||
| 69 | Add count for pendin g EICD que ries | |
| 70 | When (WHIC H EXTRACT (#365.1,.1 0) = 4)and (QUERY (#3 65.1,.11)= (I)dentifi cation) | |
| 71 | ||
| 72 | Add count for pendin g EICD-tri ggered Ver ification queries | |
| 73 | When (WHIC H EXTRACT (#365.1,.1 0) = 4)and (QUERY (#3 65.1,.11)= (V)erifica tion) | |
| 74 | ||
| 75 | Add count for pendin g MBI quer ies | |
| 76 | When (WHIC H EXTRACT (#365.1,.1 0) = 1)and (HL7 SUBSC RIBER ID F IELD (#365 .1,.16) = “MBIreques t”) | |
| 77 | ||
| 78 | Add count for Receiv ed MBI IDs (%) | |
| 79 | Update PIE CE $S to a dd ‘%’ an d populate report pr operly | |
| 80 | ||
| 81 | Report Pri nt: | |
| 82 | Routine: I BCNERP9 – “eIV STATI STICAL REP ORT PRINT” | |
| 83 | Make sure any “new” counts are received from the c ompile log ic and pri nted in th e report | |
| 84 | Remove the “Non-veri fied Insur ance” line item unde r both Inq uiries Sen t and Resp onses Rece ived secti ons. | |
| 85 | Remove “# of * entri es (User V erified Po licy)” fou nd under U ser Action Required | |
| 86 | eIV Statis tical Repo rt – popu late the l ine items in red (th anks Rebec ca) with d ata provid ed from th e compile (see the report sam ple below ) | |
| 87 | Comment ou t line #15 9, “. S LI NECT=LINEC T+1” | |
| 88 | Change lin e #160, “I IBOUT="E" S DISPDAT A(LINECT)= $S(TYPE="O UT":"Inqui ries Sent" ,1:"Respon ses Receiv ed")_U_+$P (RPTDATA,U ,1)” to | |
| 89 | “I IBOUT=" E" S DISPD ATA(LINECT )= S DISPD ATA(LINECT )_$S(TYPE= "OUT":" (I nquiries S ent)",1:"( Responses Received)" )_U_+$P(RP TDATA,U,1) ” | |
| 90 | Change lin e #161 “I IBOUT="R" S DISPDATA (LINECT)=$ $FO^IBCNEU T1($S(TYPE ="OUT":"In quiries Se nt:",1:"Re sponses Re ceived:"), 36)_$$FO^I BCNEUT1(+$ P(RPTDATA, U,1),9,"R" )” | |
| 91 | To | |
| 92 | “I IBOUT=" R" S DISPD ATA(LINECT )=DISPDATA (LINECT)_$ $FO^IBCNEU T1($S(TYPE ="OUT":"(I nquiri es Sent) :",1:" (Re sponses Re ceived): " ),36)_$$FO ^IBCNEUT1( +$P(RPTDAT A,U,1),9," R")” | |
| 93 | Line, #162 Change “ . F CT=1:1 :3 D” | |
| 94 | To | |
| 95 | . F CT=1:1 :5 D | |
| 96 | Line, #163 Change “. . S TYPE= " "_$S(CT= 1:"Insuran ce Buffer" ,CT=2:"App ointment", 1:"Non-ver ified Insu rance")” | |
| 97 | To | |
| 98 | . . S TYPE =" "_$S(CT =1:"Insura nce Buffer ",CT=2:"Ap pointment" ,CT=3:” El ectronic I nsurance C overage Di scovery (E ICD”,CT=4: ” EICD-Tri ggered eIn surance Ve rification ”,1:”MBI I nquiry”) | |
| 99 | After line #231, “I TYPE="PYR" D G DATA X” Add | |
| 100 | . S LINECT =LINECT+1 | |
| 101 | . S DISPDA TA(LINECT) =" Payer A ctivity (D uring Repo rt Date Ra nge)” | |
| 102 | . S LINECT =LINECT+1 | |
| 103 | . S DISPDA TA(LINECT) =DASHES | |
| 104 | ||
| 105 | ** specifi cally for the excel version of the repor t ** | |
| 106 | ||
| 107 | The Excel output wil l require modificati on | |
| 108 | The excel output wil l not have blank lin es in betw een the di fferent se ctions or subsection s | |
| 109 | Remove the “Non-veri fied Insur ance” line item unde r both Inq uiries Sen t and Resp onses Rece ived secti ons. | |
| 110 | eIV Statis tical Repo rt – popu late the l ine items in red wit h data pro vided from the compi le (genera lly, follo w the prin ted report items sho w in the e xcel sampl e below) | |
| 111 | ||
| 112 | ||
| 113 | ||
| 114 | Example of the updat ed report: (report m ode) | |
| 115 | ||
| 116 | eIV Statis tical Repo rt Nov 09, 2017@ 10:50:13 Page: 1 | |
| 117 | Report Tim eframe: 11 /09/2016 1 2:00 - 11/ 09/2017 12 :00 | |
| 118 | ||
| 119 | Outgoing D ata (Inqui ries Sent) : 1 9 | |
| 120 | ========== ==== | |
| 121 | Insurance Buffer 1 9 | |
| 122 | Appointmen t 0 | |
| 123 | Electronic Insurance Coverage Discovery (EICD) # | |
| 124 | EICD-Trigg ered eInsu rance Veri fication # | |
| 125 | MBI Inquir y # | |
| 126 | ||
| 127 | Incoming D ata (Respo nses Recei ved): 1 9 | |
| 128 | ========== ==== | |
| 129 | Insurance Buffer 1 9 | |
| 130 | Appointmen t 0 | |
| 131 | Electronic Insurance Coverage Discovery (EICD) # | |
| 132 | EICD-Trigg ered eInsu rance Veri fication # | |
| 133 | MBI Respon se # | |
| 134 | ||
| 135 | Current St atus | |
| 136 | ========== ==== | |
| 137 | Responses Pending: 4 2 | |
| 138 | Insurance Buffer # | |
| 139 | Appointmen t # | |
| 140 | Electronic Insurance Coverage Discovery (EICD) # | |
| 141 | EICD-Trigg ered eInsu rance Veri fication # | |
| 142 | MBI Inquir y # | |
| 143 | Queued Inq uiries: 1 3 | |
| 144 | Deferred I nquiries: 0 | |
| 145 | Insurance Companies w/o Nation al ID: 70 6 | |
| 146 | eIV Payers Disabled Locally: 3 8 | |
| 147 | ||
| 148 | Insurance Buffer Ent ries: 68 2 | |
| 149 | User Ac tion Requi red: 221 | |
| 150 | # of + entries (Payer in dicated Ac tive polic y) 144 | |
| 151 | # of $ entries (Escalate d, Active policy) 0 | |
| 152 | # of % entries (MBI valu e received ) 0 | |
| 153 | # of - entries (Payer in dicated In active pol icy) 33 | |
| 154 | # of # entries (Policy s tatus unde termined) 19 | |
| 155 | # of ! entries (eIV need s user ass istance fo r entry) 9 | |
| 156 | Entrie s Awaiting Processin g: 461 | |
| 157 | # of ? entries (eIV is w aiting for a respons e) 28 | |
| 158 | # of blank ent ries (yet to be proc essed or a ccepted) 433 | |
| 159 | ||
| 160 | Payer Acti vity (Duri ng Report Date Range ) | |
| 161 | ========== ==== | |
| 162 | New eIV Pa yers recei ved: | |
| 163 | Aetna Cigna | |
| 164 | ||
| 165 | National P ayers = AC TIVE flag changes at FSC: | |
| 166 | No info rmation av ailable | |
| 167 | ||
| 168 | Nationally Active Pa yers – TRU STED flag changes at FSC: | |
| 169 | No info rmation av ailable | |
| 170 | * ** END OF REPORT *** | |
| 171 | ||
| 172 | ||
| 173 | Example of the updat ed report: (excel mo de) | |
| 174 | ||
| 175 | eIV Statis tical Repo rt Dec 05, 2017@ 12:09:33 Page: 1 | |
| 176 | Repo rt Timefra me: 08/27/ 2017 08:00 - 12/05/2 017 12:09 | |
| 177 | OUTGOING DATA (Inqu iries Sent )^127 | |
| 178 | Insuran ce Buffer^ 127 | |
| 179 | Appoint ment^0 | |
| 180 | Electro nic Insura nce Covera ge Discove ry (EICD)^ # | |
| 181 | EICD-Tr iggered eI nsurance V erificatio n^# | |
| 182 | MBI Inq uiry^# | |
| 183 | INCOMING D ATA (Respo nses Recei ved)^114 | |
| 184 | Insuran ce Buffer^ 114 | |
| 185 | Appoint ment^0 | |
| 186 | Electro nic Insura nce Covera ge Discove ry (EICD)^ # | |
| 187 | EICD-Tr iggered eI nsurance V erificatio n^# | |
| 188 | MBI Res ponse^# | |
| 189 | CURRENT ST ATUS | |
| 190 | Responses Pending^0 | |
| 191 | Insuran ce Buffer^ # | |
| 192 | Appoint ment^# | |
| 193 | Electro nic Insura nce Covera ge Discove ry (EICD)^ # | |
| 194 | EICD-Tr iggered eI nsurance V erificatio n^# | |
| 195 | MBI Inq uiry^# | |
| 196 | Queued In quiries^22 | |
| 197 | Deferred Inquiries: ^0 | |
| 198 | Insurance Companies w/o Natio nal ID^704 | |
| 199 | eIV Payer s Disabled Locally^3 7 | |
| 200 | Insurance Buffer En tries: ^38 9 | |
| 201 | User Acti on Require d^156 | |
| 202 | # of + entries (Payer in dicated Ac tive polic y)^144 | |
| 203 | # of $ entries (Escalate d, Active policy)^0 | |
| 204 | # of % entries (MBI valu e received )^0 | |
| 205 | # of - entries (Payer in dicated In active pol icy)^33 | |
| 206 | # of # entries (Policy s tatus unde termined)^ 19 | |
| 207 | # of ! entries (eIV need s user ass istance fo r entry)^9 | |
| 208 | Entries Aw aiting Pro cessing^23 3 | |
| 209 | # of ? entries (eIV is w aiting for a respons e)^0 | |
| 210 | # of blank ent ries (yet to be proc essed or a ccepted)^2 33 | |
| 211 | Payer Acti vity (Duri ng Report Date Range ) | |
| 212 | New eIV Pa yers recei ved: | |
| 213 | Aetna | |
| 214 | Cigna | |
| 215 | National P ayers = AC TIVE flag changes at FSC: | |
| 216 | No info rmation av ailable | |
| 217 | Nationally Active Pa yers – TRU STED flag changes at FSC: | |
| 218 | No info rmation av ailable | |
| 219 | * ** END OF REPORT *** | |
| 220 | ||
| 221 | Revision H istory | |
| 222 | Date | |
| 223 | Version | |
| 224 | Descriptio n | |
| 225 | Author | |
| 226 | 01/23/2018 | |
| 227 | 1.1 | |
| 228 | Updated SD D to resyn ch with up dated user story tha t was appr oved aroun d Jan. 201 8. The fo rmat of th e report c hanged. A dded blank lines and changed a round a fe w titles t o the diff erent subs ections. | |
| 229 | W. Darlene / N. Henr y | |
| 230 | 12/1/2017 | |
| 231 | 1.0 | |
| 232 | Initial dr aft – adde d addition al calcula tions to t he all sec tions of t he existin g report. | |
| 233 | Z. Tim | |
| 234 |
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