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| # | Location | File | Last Modified |
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| 1 | PSE_v22_PRCA4.5307.zip\PSE_v22_PRCA4.5307\PSE Patch PRCA_45_307 v22 CIF submission.zip | PSE RSD Phase 01 Incr01 v1.18.docx | Wed Feb 8 22:46:36 2017 UTC |
| 2 | PSE_v22_PRCA4.5307.zip\PSE_v22_PRCA4.5307\PSE Patch PRCA_45_307 v22 CIF submission.zip | PSE RSD Phase 01 Incr01 v1.18.docx | Tue Feb 28 05:15:19 2017 UTC |
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| 1 | Patient St atement En hancements (PSE) | |
| 2 | Discrepanc ies (Incre ment 1, Ph ase 1) | |
| 3 | Requiremen ts Specifi cation Doc ument | |
| 4 | ||
| 5 | ||
| 6 | ||
| 7 | December 2 016 | |
| 8 | Version 1. 18 | |
| 9 | ||
| 10 | Department of Vetera ns Affairs | |
| 11 | ||
| 12 | Revision H istory | |
| 13 | Note: The revision h istory cyc le begins once chang es or enha ncements a re request ed after t he Require ments Spec ification Document h as been ba se-lined. | |
| 14 | Date | |
| 15 | Version | |
| 16 | Descriptio n | |
| 17 | Author | |
| 18 | 12/12/2016 | |
| 19 | 1.18 | |
| 20 | Updated re quirement ACJ009 and ACJ008 to explicitl y state th at out of balance bi lls not in specific status wil l not be r emediated by the Aut o-Correcti on job. (C R #429994) | |
| 21 | ||
| 22 | Updated se ction 2.6. 1 and requ irements A CJ001, ACJ 010, ACR00 1 and remo ved requir ement ACJ0 07 to excl ude Missin g Amount D iscrepanci es fixes. (CR #43256 5) | |
| 23 | Ray Mattes on | |
| 24 | 11/29/2016 | |
| 25 | 1.17 | |
| 26 | Updated re quirement ACJ006 to exclude Re fund Revie ws from Au to-Correct ion. (CR # 425119) | |
| 27 | Ray Mattes on | |
| 28 | 10/31/2016 | |
| 29 | 1.16 | |
| 30 | Added requ irements A CJ014 and ACR014 to account fo r and repo rt on inde terminate bill discr epancies. (CR #38592 6) | |
| 31 | Ray Mattes on | |
| 32 | 10/20/2016 | |
| 33 | 1.15 | |
| 34 | Added user stories U S005, US00 6, and US0 07 to expl icitly sta te the tra nsaction d iscrepancy remediati on require ments. | |
| 35 | Ray Mattes on | |
| 36 | 10/3/2016 | |
| 37 | 1.14 | |
| 38 | Updated Au to-Correct ion flow d iagram in 2.61; upda ted Requir ements ACJ 007, ACJ00 8, ACJ009, ACR003 to update AR transacti on types t hat are co rrected. ( CR #386662 ) | |
| 39 | ||
| 40 | Added requ irements A CJ012 and ACJ013 to handle Aut o-Correcti on batch j ob failure reporting . (CR #385 933) | |
| 41 | ||
| 42 | Updated re quirement ACJ010 to explicitly state tha t out of b alance bil ls with mu ltiple dis crepancies will not be remedia ted by the Auto-Corr ection job . (CR #385 926) | |
| 43 | Ray Mattes on | |
| 44 | 8/1/2016 | |
| 45 | 1.13 | |
| 46 | Added Vist A AR Patie nt Stateme nt run dat e change f unctional requiremen ts. | |
| 47 | Ray Mattes on | |
| 48 | 05/27/2016 | |
| 49 | 1.12 | |
| 50 | Updated in troduction | |
| 51 | Shawnee Bl air | |
| 52 | 4/13/2016 | |
| 53 | 1.11 | |
| 54 | Updated AC J002 to re flect the initial sc hedule of the Auto-C orrection Job. | |
| 55 | Diana Coll ins | |
| 56 | 3/29/2016 | |
| 57 | 1.10 | |
| 58 | Updated se ction 2.6. 3 with cla rification of what “ If the Aut o-Correcti on job fai ls to laun ch or is u nable to c orrect the transacti on, HPS wi ll be noti fied” mean s, and “by producing an error in the Vis tA error l og file” w as added. | |
| 59 | Updated co ver sheet title. | |
| 60 | Updated AC R003 per d efect 2917 10 (Missin g or null transactio n discrepa ncies for decrease, increase, and paymen ts in part are marke d as OTHER ERROR.) | |
| 61 | Randy Maje wski | |
| 62 | 3/17/2016 | |
| 63 | 1.09 | |
| 64 | Update sec tion 2.6.3 “duplicat e flag” is now “inco mplete fla g (INCOMPL ETE TRANSA CTION FLAG . 433, 10) ”. | |
| 65 | Renumbered requireme nt ACR012 to ACR013 at the bot tom of tab le 2.6. | |
| 66 | Updated AC J003 per R TC task 29 0807, 2761 50. | |
| 67 | Randy Maje wski | |
| 68 | 3/9/2016 | |
| 69 | 1.08 | |
| 70 | Updated th e screen c aptures in Appendix A as follo ws: | |
| 71 | the Auto-C orrection Report to show the C ontinue pr ompt | |
| 72 | the Auto-C orrection Report to show the P atient Sta tement Aut o-Correcti on Program option | |
| 73 | Diana Coll ins | |
| 74 | 3/3/2016 | |
| 75 | 1.07 | |
| 76 | Added the new Securi ty Key Nam e to ACJ00 4. | |
| 77 | Diana Coll ins | |
| 78 | 2/4/2016 | |
| 79 | 1.06 | |
| 80 | Updated AC R003 to in clude the status of ‘Other’. | |
| 81 | VA confirm ed that a new securi ty key is needed; Up dated ACJ0 04 accordi ngly. | |
| 82 | Added requ irement AC J011. | |
| 83 | Added requ irement AC R012. | |
| 84 | Refreshed screen moc k-ups to s how the fo ur new Aut o-Correcti on Reasons . | |
| 85 | Added Over view of th e PSE proj ect phases . | |
| 86 | Diana Coll ins | |
| 87 | 10/30/2015 | |
| 88 | 1.05 | |
| 89 | Updated ve rbiage in sections 2 .6.1, 2.6. 2, and 2.6 .3 per Ray Pietrzak. | |
| 90 | Heather Ch atwin | |
| 91 | 10/18/2015 | |
| 92 | 1.04 | |
| 93 | Updates ma de per cus tomer revi ew. | |
| 94 | Updates in clude: | |
| 95 | Section 1. 2 added no te regardi ng root ca use analys is, and re moved refe rences of TBD. | |
| 96 | Section 1. 3: include d referenc e to BRD a nd include d PSE PWS. | |
| 97 | Section 2. 6: removed agile fig ures, and added subs ections 2. 6.1, 2.6.2 , and 2.6. 3 to cover business process of the Auto- Correction Job. Upda ted requir ement ACJ0 08. | |
| 98 | Section 2. 6.4 added and provid ed updated specifica tions to s how tracea bility to PWS requir ements. | |
| 99 | Section 2. 9: accepte d changes made to th e performa nce table, and inclu ded a sent ence indic ating the table was inserted f rom the BR D. | |
| 100 | Section 2. 12: remove d scope in tegration specificat ions as th ey are not applicabl e to Phase 1. | |
| 101 | Updated co ver page, and footer s. | |
| 102 | Heather Ch atwin | |
| 103 | 9/28/2015 | |
| 104 | 1.03 | |
| 105 | Removed re ference to My Health eVet (MHV) in sectio n 2.3. Des ign Constr aints Spec ification (Out of sc ope) | |
| 106 | The follow ing note w as added t o ACJ007, ACJ008, an d ACJ009: “This requ irement ma y be modif ied as wor k on the A uto-Correc tion conti nues.” | |
| 107 | Removed re ferences t o the uniq ue patient identifie r and stat ement form in sectio n 2.12.1. CCPC. | |
| 108 | Removed th e “To Be D etermined” statement from sect ion 2.15. Usability Specificat ions. | |
| 109 | Added Figu re 17 To B e PSE Auto -Correctio n Diagram. | |
| 110 | Tony Nixon | |
| 111 | ||
| 112 | 1.02 | |
| 113 | Removed RT C ID. | |
| 114 | Added requ irements f or the Aut o-Correcti on Job to resolve th e followin g discrepa ncies: | |
| 115 | Missing tr ansaction amount | |
| 116 | Duplicate transactio n | |
| 117 | Incomplete transacti on status | |
| 118 | Updates to Appendix A: | |
| 119 | Added Auto -Correctio n Report e xamples | |
| 120 | Added exam ples of th e followin g 3 discre pancies | |
| 121 | Missing tr ansaction amount | |
| 122 | Duplicate transactio n | |
| 123 | Incomplete transacti on status | |
| 124 | Addition o f Appendix B: Manual Steps To Resolve An y Discrepa ncy. | |
| 125 | Tony Nixon | |
| 126 | 9/09/2015 | |
| 127 | 1.01 | |
| 128 | Interim dr aft; revie wed Append ix A (incl uded in te mplate) wi th HP PSE team and d etermined these requ irements w ere not ap plicable f or Phase I . removed appendix A from the interim ve rsion, but kept the appendix a s a place holder (if needed fo r the fina l). | |
| 129 | Removed se ction four as this s ection is not applic able to th e PSE proj ect. | |
| 130 | Updated co ver page, and table of content s to inclu de list of figures a nd list of tables. | |
| 131 | Heather Ch atwin | |
| 132 | Tony Nixon | |
| 133 | 8/26/2015 | |
| 134 | 1.00 | |
| 135 | Initial dr aft of PSE Phase I. | |
| 136 | Heather Ch atwin | |
| 137 | Tony Nixon | |
| 138 | ||
| 139 | Artifact R ationale | |
| 140 | The Requir ements Spe cification Document (RSD) reco rds the re sults of t he specifi cation gat hering pro cesses car ried out d uring the Requiremen ts phase. The RSD is generally written b y the func tional ana lyst(s) an d should p rovide the bulk of t he informa tion used to create the test p lan and te st scripts . It shoul d be updat ed for eac h incremen t. | |
| 141 | The level of detail contained in this RS D should b e consiste nt with th e size and scope of the projec t. It is n ot necessa ry to fill out any s ections of this docu ment that do not app ly to the project. T he resourc es necessa ry to crea te and mai ntain this document during the life cycl e of a lar ge project should be acknowled ged and cl early refl ected in p roject sch edules. Do not dupli cate data that is al ready defi ned in ano ther docum ent or a s ection in this docum ent; note in the sec tion where the infor mation can be found. | |
| 142 | ||
| 143 | Table of C ontents | |
| 144 | 1.Introduc tion7 | |
| 145 | 1.1.Purpos e7 | |
| 146 | 1.2.Scope7 | |
| 147 | 1.2.1.Out of Scope8 | |
| 148 | 1.3.Refere nces8 | |
| 149 | 2.Overall Descriptio n8 | |
| 150 | 2.1.Access ibility Sp ecificatio ns9 | |
| 151 | 2.2.Busine ss Rules S pecificati on9 | |
| 152 | 2.3.Design Constrain ts Specifi cation10 | |
| 153 | 2.4.Disast er Recover y Specific ation11 | |
| 154 | 2.5.Docume ntation Sp ecificatio ns11 | |
| 155 | 2.6.Functi onal Speci fications1 1 | |
| 156 | 2.6.1.To-B e Auto-Cor rection Jo b: Missing Transacti on Process 11 | |
| 157 | 2.6.2.To-B e Auto-Cor rection Jo b: Incompl ete Transa ction Proc ess13 | |
| 158 | 2.6.3.To B e Auto-Cor rection Jo b: Duplica te Transac tion Proce ss14 | |
| 159 | 2.6.4.To B e Schedule for VistA AR Patien t Statemen t Run Date s14 | |
| 160 | 2.6.5.Func tional Req uirements1 5 | |
| 161 | 2.7.Graphi cal User I nterface ( GUI) Speci fications2 1 | |
| 162 | 2.8.Multi- divisional Specifica tions21 | |
| 163 | 2.9.Perfor mance Spec ifications 21 | |
| 164 | 2.10.Quali ty Attribu tes Specif ication22 | |
| 165 | 2.11.Relia bility Spe cification s22 | |
| 166 | 2.12.Scope Integrati on22 | |
| 167 | 2.12.1.Sec urity Spec ifications 22 | |
| 168 | 2.13.Syste m Features 23 | |
| 169 | 2.14.Usabi lity Speci fications2 3 | |
| 170 | 3.Purchase d Componen ts23 | |
| 171 | 4.Approval Signature s24 | |
| 172 | ||
| 173 | List of Fi gures | |
| 174 | ||
| 175 | Figure 1: To-Be Auto -Correctio n Batch Pr ocess13 | |
| 176 | Figure 2: Auto-Corre ction Job and Report Menu Opti ons25 | |
| 177 | Figure 3: Notificati on to AR U ser when j ob is stil l actively running26 | |
| 178 | Figure 4: MailMan no tification when Auto -Correctio n job is s till activ ely runnin g26 | |
| 179 | Figure 5: Auto-Corre ction Repo rt Options 27 | |
| 180 | Figure 6: Auto-Corre ction Repo rt Option Selection Example27 | |
| 181 | Figure 7: Auto-Corre ction Repo rt: Sorted by Bill N umber27 | |
| 182 | Figure 8: Auto-Corre ction Repo rt: Sorted by Debtor Name28 | |
| 183 | Figure 9: Auto-Corre ction Repo rt: Sorted by Auto C orrection Date28 | |
| 184 | Figure 10: Auto-Corr ection Rep ort: Sorte d by Trans action Num ber28 | |
| 185 | Figure 11: Missing T ransaction Amount – Screen 129 | |
| 186 | Figure 12: Missing T ransaction Amount – Screen 230 | |
| 187 | Figure 13: Missing T ransaction Amount – Screen 331 | |
| 188 | Figure 14: Duplicate Transacti on – Scree n 131 | |
| 189 | Figure 15: Duplicate Transacti on – Scree n 232 | |
| 190 | Figure 16: Duplicate Transacti on – Scree n 333 | |
| 191 | Figure 17: Incomplet e Status – Screen 13 4 | |
| 192 | Figure 18: Incomplet e Status – Screen 23 5 | |
| 193 | Figure 19: Incomplet e Status-S creen 335 | |
| 194 | Figure 20: Patient S tatement D eficiency Resolution To-Be Pro cess Diagr am37 | |
| 195 | ||
| 196 | List of Ta bles | |
| 197 | Table 21: Access Lev els for Vi stA AR Pac kage9 | |
| 198 | Table 22: Patient St atement Ru les10 | |
| 199 | Table 23: To Be sche dule of Vi stA Patien t Statemen t run date s15 | |
| 200 | Table 24: Descriptio n of Requi rement Spe cification Table15 | |
| 201 | Table 25:A uto-Correc tion Job ( ACJ) Requi rements16 | |
| 202 | Table 26: Busines Ru les for Ba lancing Ac counts (BR )18 | |
| 203 | Table 27: Auto-Corre ction Repo rt (ACR) R equirement s18 | |
| 204 | Table 28: Patient St atement Ch ange Date Requiremen ts20 | |
| 205 | Table 29: Transactio n Discrepa ncy Root C ause Remed iation Req uirements2 1 | |
| 206 | Table 210: Perfomanc e Specific ations21 | |
| 207 | ||
| 208 | Introducti on | |
| 209 | The remedi ation of t he Veteran s Health I nformation Systems T echnology Architectu re (VistA) Accounts Receivable (AR) proc ess is req uired to p rovide a c onsolidate d and easi ly readabl e patient statement from multi ple treatm ent facili ties durin g a monthl y cycle. E nhancement s to the A R system w ill increa se Veteran satisfact ion by mit igating co ncerns rai sed by Vet erans Serv ice Organi zations (V SO) and in dividual V eterans, w ho have pr ovided fee dback to t he Departm ent of Vet erans Affa irs (VA) r egarding p oor custom er service and poor business p ractices. Future dev elopment a ctivities are depend ent on Pha se 1 and P hase 2 enh ancements, as these enhancemen ts will de ploy best practices in financi al and bus iness proc esses, and align wit h the VA i nitiative to build V eterans Re cord Manag ement (VRM ) capabili ty to enab le conveni ent and se amless int eractions. | |
| 210 | The PSE pr oject incl udes 3 dev elopment p hases acro ss 5 incre ments. Pha se 1 will remediate existing p ayment cyc le deficie ncies and include an Auto-Corr ection job . Phase 1 will be co ded and in itial SQA testing wi ll be perf ormed in I ncrement 1 . Phase 1 final Soft ware Quali ty Assuran ce (SQA), User Funct ionality T esting (UF T), Initia l Operabil ity Capabi lity (IOC) , and depl oyment wil l be in In crement 3. | |
| 211 | Phase 2 in cludes the creation of the con solidated billing st atement. P hase 2 wil l be coded and initi al SQA tes ting will be perform ed in Incr ement 2. P hase 2 fin al SQA, UF T, IOC, an d deployme nt will be in Increm ent 3. | |
| 212 | Phase 3 in cludes mak ing the bi lling stat ements ava ilable on- line throu gh the My HealtheVet (MHV) por tal and fo r the gene ration of the Annual Patient P ayment Sum mary (APPS ) statemen t. Phase 3 will be c oded and i nitial SQA testing w ill be per formed in Increment 4. Phase 3 final SQA , UFT, IOC , and depl oyment wil l be in In crement 5. | |
| 213 | Purpose | |
| 214 | The purpos e of this RSD is to introduce the functi onal and t echnical r equirement s for Pati ent Statem ent Enhanc ements (PS E) for Pha se I. The intended a udience fo r this doc ument are PSE Office of Inform ation and Technology (OI&T), t he PSE Bus iness Requ irements O ffice, and other PSE stakehold ers. | |
| 215 | Scope | |
| 216 | This RSD f ocuses on the busine ss rules a nd require ments for Phase 1 de velopment. Items con sidered in scope for Phase 1 a re listed below: | |
| 217 | As-Is anal ysis of th e VistA AR Patient S tatement p rocess for deficienc y resoluti on and To- Be of the process wh ich includ es the res olved defe cts and au tomation. | |
| 218 | Root-cause analysis of the fol lowing 3 a ccount bal ance discr epancies w ithin the AR applica tion: | |
| 219 | Transactio n amount m issing | |
| 220 | Duplicate transactio n | |
| 221 | Incomplete status | |
| 222 | Note: Root cause ana lysis of I ncomplete Status is complete. Analysis c onfirmed t he incompl ete status flag (INC OMPLETE TR ANSACTION FLAG, 433, 10) is se t incorrec tly to ‘1’ by end us ers. The A uto-Correc tion Job w ill remedy this issu e by setti ng the inc omplete st atus to ‘0 ’ when an account is out of ba lance. The developme nt team co ntinues to work clos ely with t he busines s to deter mine scena rios that cause dupl icate tran sactions a nd missing transacti ons amount s. | |
| 223 | Requiremen t elaborat ion of Pha se I busin ess requir ements def ined in th e Patient Statement Enhancemen t (PSE) Pr oject Work Scope (PW S) documen t (section 5.5). | |
| 224 | Developmen t and inst allation o f an autom ated proce ss for the detection and track ing of dis crepancies that prev ent a pati ent statem ent from p rocessing. | |
| 225 | Developmen t of an au tomated pr ocess for remediatio n of discr epancies t hat preven t a patien t statemen t from pro cessing. | |
| 226 | Update the billing s tatement r un date fo r any VA s ites that build and transmit s tatement d ata to AIT C on or af ter the 26 th calenda r day of e ach month. | |
| 227 | Out of Sco pe | |
| 228 | The follow ing items are consid ered out o f scope fo r Phase I developmen t: | |
| 229 | Requiremen t analysis and elabo ration for Phase II and Phase III requir ements. | |
| 230 | References | |
| 231 | The follow ing docume nt was use d as refer ence mater ial for th is RSD: | |
| 232 | Patient St atement En hancements (PSE) Pro ject Work Scope, Sec tion 5.5. | |
| 233 | NSR 201007 16 (CCPC) Patient St atement En hancements and Conso lidation B RD-3-18-15 .http:// URL . DNS Active | |
| 234 | Overall De scription | |
| 235 | The Vetera ns Health Administra tion (VHA) Chief Bus iness Offi ce (CBO) i s requesti ng softwar e enhancem ents to re medy defic iencies id entified w ith patien t statemen ts. These requested enhancemen ts will re quire chan ges to the VistA AR package. | |
| 236 | The enhanc ement iden tifies Vis tA AR acco unt balanc e discrepa ncies and other know n discrepa ncies that interrupt the norma l patient statement printing p rocess and prevents successful completio n. Three t ypes of ma jor discre pancies ha ve been id entified t hrough a s earch of h elp desk t ickets sub mitted. Th e existing work-arou nd process requires submission of a Nati onal Remed y Ticket s ubmitted b y the fiel d to Produ ct Support . Product Support pe rsonnel ac cess the V istA AR pa ckage and complete t he onerous manual ad justments to the dat a in order to correc t the disc repancies on Veteran accounts before the Consolida ted Co-Pay ment Proce ssing Cent er (CCPC) patient st atements c an be sent . | |
| 237 | In additio n, and in preparatio n for PSE Phase 2 so ftware ins tallation, any site that curre ntly build s and tran smits stat ement data to AITC o n or after the 26th date of ea ch calenda r month, m ust be cha nged to tr ansmit sta tement dat a to a dat e earlier in the mon th. | |
| 238 | Accessibil ity Specif ications | |
| 239 | The PSE pr oject will adhere to all Secti on 508 req uirements, which inc lude compl iance with the appli cable requ irements i n the VHA Section 50 8 checklis ts (1194.2 1, 1194.22 , 1194.24, 1194.31, and 1194.4 1) located at 508 Re sources Li nk or as o therwise s pecified. Establishe d checkpoi nts will e nsure that accessibi lity is in corporated from the earliest p ossible de sign or ac quisition phase and successful ly impleme nted throu ghout the project. | |
| 240 | The table below defi nes the di fferent le vels of ac cess to th e VistA AR package. | |
| 241 | Table 21: Access Lev els for Vi stA AR Pac kage | |
| 242 | User Level | |
| 243 | Role | |
| 244 | Responsibi lities | |
| 245 | Access Lev el | |
| 246 | Primary | |
| 247 | VA Medical Center ag ent cashie rs | |
| 248 | Applying p ayments | |
| 249 | Effecting other vari ous change s to the A R record ( increases and decrea ses) | |
| 250 | Full Acces s | |
| 251 | Primary | |
| 252 | Customer S ervice Sta ff (facili ties and C onsolidate d Patient Account Ce nters [CPA C]) | |
| 253 | Effecting other vari ous change s to the A R record ( increases and decrea ses) | |
| 254 | Full Acces s | |
| 255 | Primary | |
| 256 | Health Res ource Cent er (HRC) S taff | |
| 257 | Effecting other vari ous change s to the A R record ( increases and decrea ses) | |
| 258 | Full Acces s | |
| 259 | Secondary | |
| 260 | Austin Inf ormation T echnology Center (AI TC) staff | |
| 261 | Receive st atement da ta in a fl at file | |
| 262 | Format dat a for stat ement mail ing | |
| 263 | Send data file to pr int contra ctor | |
| 264 | Full Acces s | |
| 265 | Secondary | |
| 266 | Administra tors | |
| 267 | Run FileMa n routines for repor ting purpo ses or ext racting in formation for other reasons. | |
| 268 | Full Acces s | |
| 269 | Business R ules Speci fication | |
| 270 | The table below iden tifies kno wn conditi ons that p revent the patient s tatement p rocess fro m completi ng. If a p atient sta tement mee ts one of the follow ing criter ia, the pa tient stat ement will not print . The AR u ser manual will be u pdated wit h the foll owing busi ness rules : | |
| 271 | Table 22: Patient St atement Ru les | |
| 272 | Event | |
| 273 | A patient statement will not p rint when the outsta nding bala nce of the AR bills and the Pa tient Stat ement bala nce are un equal. | |
| 274 | A patient statement will not p rint when the outsta nding amou nt of the account is in an unp rocessed s tatus (i.e ., Refund Review, Pe nding Calm Code). | |
| 275 | A patient statement will not p rint when it has an Open or Ac tive bill and unproc essed. | |
| 276 | A patient statement will not p rint when a prepayme nt bill is in Refund Review st atus. | |
| 277 | A patient statement will not p rint when it has a z ero balanc e and the site param eter “Supp ress Zero Balance” f ield is se t to “Yes” . | |
| 278 | A patient statement will not p rint when there is n o amount d ue and no new activi ty. | |
| 279 | A patient statement will not p rint when the accoun t has a cr edit balan ce and no new activi ty. | |
| 280 | A patient statement will not p rint when it has a c redit/prep ayment bal ance amoun t of less than $1.00 (one doll ar). | |
| 281 | A patient statement will not p rint when it only ha s interest and admin istrative charges. | |
| 282 | A patient statement will not p rint when the next s tatement d ate has no t yet occu rred. | |
| 283 | A patient statement will not p rint when the statem ent date i s unknown. | |
| 284 | A patient statement will not p rint when the third (3rd) lett er has alr eady print ed. | |
| 285 | Design Con straints S pecificati on | |
| 286 | PSE will a dhere to a ll technic al standar ds publish ed in VA H andbook 61 02, as wel l as all s ecurity st andards de scribed un der the Se ction 2.13 of this d ocument. F or develop ment, codi ng standar ds follow the Standa rds and Co nventions document. | |
| 287 | Technical Subject Ma tter Exper t (SME) sh ortage, du e to the c omplexity of the exi sting soft ware, and the partic ipation of experienc ed VistA A R applicat ion develo pers is es sential to the succe ssful desi gn and dev elopment o f the syst em. | |
| 288 | Any propos ed solutio n must mee t all VHA Security, Privacy, a nd Identit y Manageme nt require ments and Non-Functi onal requi rements ad dresses in this docu ment. | |
| 289 | Integrated testing e nvironment s that inc lude all u pstream an d downstre am applica tions, i.e ., Lockbox , must be available. | |
| 290 | Constraint s on funct ionality o f this ini tiative ex ist relate d to reven ue policie s and busi ness rules . | |
| 291 | Statements will not print if t he AR Debt or file is set to ‘U nknown’ or has an in valid entr y/incomple te address . Addresse s used for billing p urposes ar e stored i n the AR D ebtor file (#340). F irst Party (patient) debtor ad dresses ar e stored i n the Vist A Patient file (#2). | |
| 292 | Other cons traints wi ll be adde d as disco vered duri ng require ments elab oration. | |
| 293 | Disaster R ecovery Sp ecificatio n | |
| 294 | A continge ncy plan w ill addres s PSE disa ster recov ery needs. The emerg ency manag ement staf f of syste m sites wi ll coordin ate with d eveloping the contin gency plan and the f acility di rector or program ma nager will approve i t. The con tingency p lan will d efine the overall ob jectives a nd establi sh the fra mework, ro les, and r esponsibil ities of t he plan. T he plan wi ll address the scope , resource requireme nts, proce ssing prio rities, tr aining, te sting, pla n maintena nce, and b ackup requ irements o f the cont ingency re covery pla n. The con tingency p lan will i nclude rem ote sites. Activitie s involved in creati ng this pl an include conductin g an impac t analysis , identify ing preven tive measu res, devel oping a re covery str ategy, doc umenting t he disaste r plan, di stributing the plan to appropr iate indiv iduals, tr aining the staff, an d testing the plan. | |
| 295 | The PSE co ntingency plan will identify t he activit ies that a re necessa ry to exec ute tempor ary inform ation syst em process ing capabi lities, re pair damag e to the o riginal sy stem, and restore op erational capabiliti es at the original o r new faci lity. The informatio n system c ontingency recovery plan will also docum ent the fo llowing re sources re quired for supportin g critical functions . Recovery strategie s will inc lude the s equence of activitie s as well as detaile d procedur es for the technical recovery of operati ons until the system can be re constitute d | |
| 296 | Documentat ion Specif ications | |
| 297 | The PSE pr oject will conform t o the docu mentation specificat ions as ma ndated by Program Ma nagement A ccountabil ity System (PMAS), P roPath, an d the Inte grated Pro ject Team (IPT). | |
| 298 | Functional Specifica tions | |
| 299 | This secti on introdu ces the Vi stA AR sys tem proces ses, funct ional and non-functi onal requi rements th at support the Auto- Correction job (ACJ) and the A uto-Correc tion repor t (ACR) fo r the top three disc repancies: Incomplet e Transact ions, Miss ing Transa ctions, an d Duplicat e Transact ions. This section a lso introd uces the a djustment of the mon thly VistA AR patien t statemen t run date s. | |
| 300 | The diagra m in Figur e 1 illust rates the To-Be Auto -Correctio n Batch Jo b for Miss ing Amount Transacti on, Incomp lete Trans action, an d Duplicat e Transact ion discre pancies. | |
| 301 | NOTE: Mis sing Amoun t Transact ion discre pancies fi xes will b e a future enhanceme nt to the Auto-Corre ction Batc h Job. | |
| 302 | ||
| 303 | Figure 1: To-Be Auto -Correctio n Batch Pr ocess | |
| 304 | ||
| 305 | Missing T ransaction Amount Di screpancy Fixes | |
| 306 | Changes wi ll correct infrequen t erroneou s data com binations and transa ction sequ ences that result in missing t ransaction amounts i n the AR T RANSACTION file (#43 3). Revise d processi ng will de liver accu rate amoun ts in the file to en sure probl em-free pa tient stat ement prin ting. | |
| 307 | To-Be Auto -Correctio n Job: Inc omplete Tr ansaction Process | |
| 308 | Changes wi ll be made in the Vi stA AR mod ule to ens ure user-a djusted tr ansactions no longer result in “incomple te” status es (INCOMP LETE TRANS ACTION FLA G, 433, 10 ). Changes will rese t flags te mporarily set by use rs when pr ocessing i ncreases a nd decreas es to bala nce accoun ts. Revise d processi ng will de liver “com plete” sta tuses in F ileMan Fil e #433 to ensure pro blem-free patient st atement pr inting. | |
| 309 | When other unidentif ied proces sing condi tions resu lt in “inc omplete” s tatuses (I NCOMPLETE TRANSACTIO N FLAG, 43 3, 10), th e Auto-Cor rection pr ocess outl ined in Se ction 2.6. 5 will ame nd process ing result s to make the overal l account balance eq ual the Pa tient Stat ement bala nce. | |
| 310 | The Auto-C orrection Batch Job process fo r correcti ng incompl ete transa ctions is illustrate d in Figur e 1. When the Auto-C orrection Batch Prog ram determ ines the a ccount is out of bal ance due t o a single transacti on marked as incompl ete (INCOM PLETE TRAN SACTION FL AG, 433,10 ), in a A ctive or O pen bill a nd the AR transactio n is anyth ing other than a “CO MMENT TRAN SACTION”, the job co rrects the incomplet e flag wit hin the AR TRANSACTI ON file (# 433). | |
| 311 | To Be Auto -Correctio n Job: Dup licate Tra nsaction P rocess | |
| 312 | Changes wi ll be made in the Vi stA AR mod ule to ens ure duplic ate transa ctions do not result when spec ific autom atic decre ases are p rocessed. Changes wi ll elimina te the sec ond transa ction with a unique internal i dentificat ion so tha t duplicat es are no longer wri tten to th e AR TRANS ACTION fil e (#433). Revised pr ocessing w ill delive r accurate amounts i n the file to ensure problem-f ree patien t statemen t printing . | |
| 313 | ||
| 314 | When other unidentif ied proces sing condi tions resu lt in dupl icate tran sactions f or Decreas e Adjustme nt transac tions, the Auto-Corr ection pro cess outli ned in Sec tion 2.6.5 will amen d processi ng results to make t he overall account b alance equ al the Pat ient State ment balan ce. | |
| 315 | ||
| 316 | The Auto-C orrection Batch Job process fo r correcti ng duplica te transac tions is i llustrated in Figure 1. When t he auto-co rrect job determines an accoun t is out o f balance in the AR TRANSACTIO N file (#4 33) due to a single duplicate Decrease A djustment transactio n for an O pen, Activ e, or Canc ellation b ill, the A uto-Correc tion job c orrects th e duplicat e discrepa ncy by set ting the i ncomplete flag on th e duplicat e transact ion. | |
| 317 | To Be Sch edule for VistA AR P atient Sta tement Run Dates | |
| 318 | All VistA AR sites w ill need t o create a nd transmi t to AITC all Patien t Statemen t data bef ore the 26 th calenda r day of t he month i mmediately prior to the operat ional depl oyment of the consol idated bil ling state ment funct ionality i mplementat ion (i.e. PSE Phase 2). The ne ed to move all site patient bi lling proc essing to before the 26th day of the mon th is to a ccommodate the first month in which the new PSE ‘c onsolidate d patient billing st atement’ p rocesses a re impleme nted. Seve nteen Vist A sites ha ve been id entified ( see Table 23) that c urrently h ave a Pati ent Statem ent date o n or after the 26th of the mon th. | |
| 319 | Moving the Patient S tatement R un date fo r these 17 sites wil l ensure a window at the end o f the imme diate prio r month in which all statement data has been proce ssed for b illing bef ore the ne w consolid ated Patie nt Stateme nt process es are imp lemented ( i.e., PSE Phase 2). | |
| 320 | The adjust ed Patient Statement run date schedule f or the 17 VistA AR s ites is in dicated in Table 23. | |
| 321 | ||
| 322 | Table 23: To Be sche dule of Vi stA Patien t Statemen t run date s | |
| 323 | Station # | |
| 324 | Station na me | |
| 325 | Current bu ild Date | |
| 326 | Current Pa tient Stat ement Date | |
| 327 | New build Date | |
| 328 | New Patien t Statemen t Date | |
| 329 | 438 | |
| 330 | SIOUX FALL S,SD | |
| 331 | 24 | |
| 332 | 26 | |
| 333 | 19 | |
| 334 | 21 | |
| 335 | 501 | |
| 336 | ALBUQUERQU E,NM | |
| 337 | 24 | |
| 338 | 26 | |
| 339 | 19 | |
| 340 | 21 | |
| 341 | 504 | |
| 342 | AMARILLO,T X | |
| 343 | 24 | |
| 344 | 26 | |
| 345 | 19 | |
| 346 | 21 | |
| 347 | 542 | |
| 348 | COATESVILL E,PA | |
| 349 | 24 | |
| 350 | 26 | |
| 351 | 19 | |
| 352 | 21 | |
| 353 | 562 | |
| 354 | ERIE,PA | |
| 355 | 24 | |
| 356 | 26 | |
| 357 | 19 | |
| 358 | 21 | |
| 359 | 568 | |
| 360 | FORT MEADE ,SD | |
| 361 | 24 | |
| 362 | 26 | |
| 363 | 19 | |
| 364 | 21 | |
| 365 | 649 | |
| 366 | PRESCOTT,A Z | |
| 367 | 24 | |
| 368 | 26 | |
| 369 | 19 | |
| 370 | 21 | |
| 371 | 656 | |
| 372 | ST. CLOUD, MN | |
| 373 | 24 | |
| 374 | 26 | |
| 375 | 19 | |
| 376 | 21 | |
| 377 | 688 | |
| 378 | WASHINGTON ,DC | |
| 379 | 24 | |
| 380 | 26 | |
| 381 | 19 | |
| 382 | 21 | |
| 383 | 756 | |
| 384 | EL PASO,TX | |
| 385 | 24 | |
| 386 | 26 | |
| 387 | 19 | |
| 388 | 21 | |
| 389 | 565 | |
| 390 | FAYETTEVIL LE,NC | |
| 391 | 26 | |
| 392 | 28 | |
| 393 | 20 | |
| 394 | 22 | |
| 395 | 621 | |
| 396 | MOUNTAIN H OME,TN | |
| 397 | 26 | |
| 398 | 28 | |
| 399 | 20 | |
| 400 | 22 | |
| 401 | 658 | |
| 402 | SALEM,VA | |
| 403 | 26 | |
| 404 | 28 | |
| 405 | 20 | |
| 406 | 22 | |
| 407 | 664 | |
| 408 | SAN DIEGO, CA | |
| 409 | 26 | |
| 410 | 28 | |
| 411 | 20 | |
| 412 | 22 | |
| 413 | 671 | |
| 414 | SAN ANTONI O,TX | |
| 415 | 26 | |
| 416 | 28 | |
| 417 | 20 | |
| 418 | 22 | |
| 419 | 689 | |
| 420 | WEST HAVEN ,CT | |
| 421 | 26 | |
| 422 | 28 | |
| 423 | 20 | |
| 424 | 22 | |
| 425 | 740 | |
| 426 | TEXAS VALL EY COASTAL ,TX | |
| 427 | 26 | |
| 428 | 28 | |
| 429 | 20 | |
| 430 | 22 | |
| 431 | Functiona l Requirem ents | |
| 432 | This secti on identif ies the fe atures and functiona l requirem ents for t he PSE pro ject – Pha se 1. For traceabili ty across project ar tifacts an d the rati onal tools , the foll owing tabl e structur e along wi th a brief descripti on of the fields is identified below. Ta bles are o rganized b y feature: Auto-Corr ection Job , Auto-Cor rection Re port, and Statement Run Date C hanges. | |
| 433 | Table 24: Descriptio n of Requi rement Spe cification Table | |
| 434 | Req. Type | |
| 435 | Requireme nt Type De scription | |
| 436 | Req. ID | |
| 437 | This is th e BN, PWS, RSD, or U ser Story (US) uniqu e identifi er. RSD id entifiers begin with an acrony m of ACJ ( Auto-Corre ction Job) , or ACR ( Auto-Corre ction Repo rt). | |
| 438 | Primary Te xt | |
| 439 | This is th e requirem ent or use r story te xt. | |
| 440 | Priority | |
| 441 | This is th e priority of the re quirement as indicat ed in the PWS. | |
| 442 | Table 25: Auto-Corre ction Job (ACJ) Requ irements | |
| 443 | Req. ID | |
| 444 | Primary Te xt | |
| 445 | Priority | |
| 446 | BN1 | |
| 447 | Manage Vis tA A/R dis crepancies . | |
| 448 | ||
| 449 | BN 1.1 | |
| 450 | The system shall det ect discre pancies th at prevent the patie nt stateme nt process es from su ccessful c ompletion. | |
| 451 | High | |
| 452 | US001 | |
| 453 | As a user, I want th e Accounts Receivabl e applicat ion to det ect and co rrect acco unt balanc e discrepa ncies as p art of nor mal operat ions, so t hat I do n ot have to perform t he task ma nually. | |
| 454 | ||
| 455 | ACJ001 | |
| 456 | The AR app lication s hall execu te Auto-Co rrection f unctionali ty that de tects and remediates the follo wing 2 typ es of disc repancies: | |
| 457 | Duplicate transactio n | |
| 458 | Incomplete Transacti on status | |
| 459 | High | |
| 460 | BN 1.4 | |
| 461 | The system shall cor rect the d iscrepancy as part o f normal o perations. | |
| 462 | ||
| 463 | ACJ002 | |
| 464 | The Auto-C orrection functional ity shall be a taske d job that runs in t he backgro und of the Accounts Receivable applicati on. The jo b will be initially scheduled to run eve ry Wednesd ay at 1:00 AM local time, befo re the CCP C job runs . | |
| 465 | Note: The scheduling may chang e based on how long the job ru ns during site testi ng. | |
| 466 | High | |
| 467 | BN 1.6 | |
| 468 | The system shall cre ate and ex ecute tran sactions r equired to correct F irst Pary AR transac tion discr epancies. | |
| 469 | High | |
| 470 | ACJ003 | |
| 471 | The AR app lication s hall inclu de a VistA menu opti on to exec ute the Au to-Correct ion job, s o that it can be run on demand . There sh all be a u ser prompt indicatin g "Request ed Time To Run: NOW/ " so the u ser can ru n the job immediatel y (NOW) or queue the job to ru n at a fut ure date a nd time. | |
| 472 | High | |
| 473 | ACJ004 | |
| 474 | The AR app lication s hall provi de a new s ecurity ke y to run t he Auto-Co rrection j ob by an o ption. The new secur ity key na me will be PRCA AUTO CRCT PGM. | |
| 475 | High | |
| 476 | ACJ005 | |
| 477 | The Auto-C orrection job shall run after patch inst allation, so that au to-correct ion of dis crepancies begins im mediately. | |
| 478 | High | |
| 479 | ACJ006 | |
| 480 | The Auto-C orrection job shall execute Bu siness Rul es for Bal ancing Acc ounts to d etermine i f an accou nt is in b alance. I f an accou nt include s a bill t hat is cur rently in Refund Rev iew, the account is excluded from the A uto-Correc tion job p rocessing. | |
| 481 | ||
| 482 | See Table 26: Busine s Rules fo r Balancin g Accounts (BR) | |
| 483 | High | |
| 484 | ACJ008 | |
| 485 | ||
| 486 | If a dupli cate “DECR EASE ADJUS TMENT” tra nsaction e xists for an ‘Acitve , ‘Open’, or “Cancel lation’ bi ll in the AR TRANSAC TION file (#433) cau sing a pat ient’s acc ount to be out-of-ba lance, the n the Auto -Correctio n Job shal l correct the out-of -balance c ondition b y setting the INCOMP LETE TRANS ACTION FLA G field (# 10) to a v alue of 1 on the dup licate tra nsaction r ecord. | |
| 487 | ||
| 488 | Note: If a transacti on in AR f ile (#433) contains data that is identic al to that of a prev ious trans action, ex cept for t he transac tion numbe r, then th e transact ion is a d uplicate. | |
| 489 | See Append ix A - Dup licate Tra nsaction e xample | |
| 490 | High | |
| 491 | ACJ009 | |
| 492 | ||
| 493 | If a trans action in the AR TRA NSACTION f ile (#433) has the I NCOMPLETE TRANSACTIO N FLAG fie ld (#10) s et to 1 fo r any tran saction ty pe other t han a “COM MENT TRANS ACTION” fo r a bill t hat is cur rently ‘Ac tive’ or ‘ Open’, and causes a patient’s account to be out-of -balance, then the A uto-Correc tion Job s hall corre ct the out -of-balanc e conditio n by repla cing the v alue of 1 with a val ue of 0 in the INCOM PLETE TRAN SACTION FL AG field o n the inco mplete tra nsaction r ecord. | |
| 494 | See Append ix A - Inc omplete St atus examp le | |
| 495 | High | |
| 496 | ACJ010 | |
| 497 | The Auto-C orrection job shall execute bu siness rul es based o n Manual S teps To Re solve Any Discrepanc y to remed iate the f ollowing 2 types of discrepanc ies: | |
| 498 | Duplicate transactio n | |
| 499 | Incomplete status | |
| 500 | ||
| 501 | If multipl e discrepa ncies exis t within a n out-of-b alance bil l, the Aut o-Correcti on job doe s not atte mpt to bal ance the b ill but in stead mark s all tran saction re cords that have a di screpancy with a rea son of “No t Fixable” . | |
| 502 | See Append ix B – Man ual Steps To Resolve Any Discr epancy | |
| 503 | High | |
| 504 | ACJ014 | |
| 505 | When an AR billing a ccount is out of bal ance and t he exact t ransaction s within a bill that cause the out of ba lance disc repancy is indetermi nate, the Auto-Corre ction job does not a ttempt to balance th e statemen t but inst ead marks the first transactio n record i n the bill as “Not F ixable”. | |
| 506 | Note: This “indeterm inate” out -of-balanc e bill wil l be repor ted on wit hin the Au to-Correct ion report . See Requ irement AC R014. | |
| 507 | High | |
| 508 | ACJ011 | |
| 509 | The Auto-C orrection job shall send a Mai lman Notif ication to the ‘PRCA CPS’ Mail group when the job h as complet ed. | |
| 510 | High | |
| 511 | ACJ012 | |
| 512 | When an au thorized A R User ini tiates the Auto-Corr ection job from the VistA menu option, b ut the job is still actively r unning or failed to complete f rom the la st time it was ran, the system shall inf orm the AR user and send a Mai lman Notif ication to the ‘PRCA CPS’ Mail group that the job d id not yet complete from the l ast run of the proce ss. The AR user will be provid ed the cho ice to sta rt another Auto-Corr ection pro cess or qu it from st arting the job again . | |
| 513 | High | |
| 514 | ACJ013 | |
| 515 | When the A uto-Correc tion job i s started from VistA TaskMan, but the jo b is still actively running or failed to complete from the l ast time i t was ran, the syste m shall se nd a Mailm an Notific ation to t he ‘PRCACP S’ Mail gr oup that j ob did not yet compl ete from t he last ru n of the p rocess. | |
| 516 | High | |
| 517 | Table 26: Busines Ru les for Ba lancing Ac counts (BR ) | |
| 518 | Req. ID | |
| 519 | Primary Te xt | |
| 520 | Priority | |
| 521 | BR001 | |
| 522 | All transa ctions mus t add up t o the Curr ent Balanc e. | |
| 523 | High | |
| 524 | BR002 | |
| 525 | The balanc e for all bills must add up to Current B alance. | |
| 526 | High | |
| 527 | BR003 | |
| 528 | All transa ctions for a bill mu st add up to the Bil l Balance. | |
| 529 | High | |
| 530 | BR004 | |
| 531 | All transa ctions bef ore the la st stateme nt must ad d up to th e Last Sta tement Bal ance. | |
| 532 | High | |
| 533 | BR005 | |
| 534 | All transa ctions aft er the las t statemen t must add up to the New Activ ate Total. | |
| 535 | High | |
| 536 | BR006 | |
| 537 | The Last s tatement B alance + t he New Act ivate Tota l = Curren t Balance. | |
| 538 | High | |
| 539 | Table 27: Auto-Corre ction Repo rt (ACR) R equirement s | |
| 540 | Req. ID | |
| 541 | Primary Te xt | |
| 542 | Priority | |
| 543 | PWS 1.2 | |
| 544 | The system shall tra ck identif ied discre pancies. | |
| 545 | High | |
| 546 | US002 | |
| 547 | As a VistA user, I w ant to tra ck the 2 m ajor types of accoun t balance discrepanc ies in the Accounts Receivable applicati on, so tha t the corr ect patien t statemen t data are transmitt ed to the AITC. | |
| 548 | High | |
| 549 | ACR001 | |
| 550 | The AR app lication s hall creat e an Auto- Correction report th at tracks the follow ing 2 type s of balan ce discrep ancies: | |
| 551 | Duplicate transactio n | |
| 552 | Incomplete status | |
| 553 | High | |
| 554 | BN 1.3 | |
| 555 | Ensure tha t the proc ess to cre ate the ‘S tatement D iscrepancy Listing’ remains an d any enha ncements a re perform ed to this report. | |
| 556 | High | |
| 557 | ACR002 | |
| 558 | The Auto-C orrection Report sha ll list th e discrepa ncy detail s that wer e remediat ed by the Auto-corre ction job and displa y a reason for auto- correction . | |
| 559 | High | |
| 560 | US003 | |
| 561 | As a VistA user, I w ant the Vi stA System to identi fy and cat alog accou nt balance discrepan cies that could not be remedia ted by the Auto-Corr ection Job with an e xplanation so that t he found d iscrepanci es can be viewed and manually corrected. | |
| 562 | High | |
| 563 | BN 1.5 | |
| 564 | The system shall ide ntify and catalog an y discrepa ncies not corrected for viewin g and manu al correct ive action . | |
| 565 | ||
| 566 | ACR003 | |
| 567 | The Auto-C orrection Report sha ll list th e discrepa ncy detail s that cou ld not be remediated by the Au to-Correct ion job an d display “Not Fixab le” as the reason wh y the disc repancy (o r discrepa ncies) cou ld not be resolved t hrough the auto corr ection bat ch process . | |
| 568 | High | |
| 569 | BN 1.7 | |
| 570 | The system shall rec ord all va lues assoc iated to t he discrep ancy for u se in root cause ana lysis (aud iting). | |
| 571 | ||
| 572 | ACR012 | |
| 573 | The Auto-C orrection report sha ll record audit valu es associa ted with r emediating the discr epancy. | |
| 574 | ||
| 575 | BN 1.8 | |
| 576 | Provide a Post Initi alization Utility th at shall r ecord all balance di screpancie s that req uire manua l remediat ion as wel l as discr epancies t hat were b alanced au tomaticall y to an ou tcome repo rt. The ab ility to r un the rep ort via an option mu st be prov ided. | |
| 577 | ||
| 578 | ACR004 | |
| 579 | The Auto-C orrection Report sha ll display only the last 4 dig its of the Social Se curity Num ber (SSN). | |
| 580 | High | |
| 581 | ACR005 | |
| 582 | The AR app lication s hall promp t the user to enter a FROM and TO date f or the Aut o-Correcti on Report. | |
| 583 | High | |
| 584 | ACR006 | |
| 585 | The Auto-C orrection Report sha ll provide a default FROM date value of “T-7”. | |
| 586 | High | |
| 587 | ACR007 | |
| 588 | The Auto-C orrection Report sha ll provide a default TO date v alue of “T ”. | |
| 589 | High | |
| 590 | ACR008 | |
| 591 | The AR app lication s hall promp t the user to sort t he Auto-Co rrection R eport by t he followi ng paramet ers: | |
| 592 | Bill numbe r | |
| 593 | Debtor nam e | |
| 594 | Transactio n number | |
| 595 | Auto Corre ction Date | |
| 596 | See Append ix A – Aut o-Correcti on Report | |
| 597 | High | |
| 598 | ACR009 | |
| 599 | The Auto-C orrection report sha ll display the follo wing infor mation wit h correspo nding head ers: | |
| 600 | BILL NO. | |
| 601 | DEBTOR | |
| 602 | SSN | |
| 603 | TRANS NUM | |
| 604 | AUTO-CORCT DATE | |
| 605 | AUTO-CORCT REASON | |
| 606 | See Append ix A – Aut o-Correcti on Report | |
| 607 | High | |
| 608 | ACR010 | |
| 609 | The Auto-C orrection report mai n header s hall read: | |
| 610 | “BILLS THA T HAVE BEE N AUTO-COR RECTED” | |
| 611 | See Append ix A – Aut o-Correcti on Report | |
| 612 | High | |
| 613 | ACR011 | |
| 614 | The Auto-C orrection report wil l have the following menu path : | |
| 615 | ||
| 616 | Clerk’s AR Menu: | |
| 617 | Account Ma nagement | |
| 618 | Auto-Corre ct Patient Discrepan cy Report | |
| 619 | See Append ix A – Aut o-Correcti on Report | |
| 620 | High | |
| 621 | ACR013 | |
| 622 | The Auto-C orrection Report sha ll pause a nd display a “Contin ue” prompt at the en d of the r eport page if the re port needs to span t o another screen on the VistA user inter face. | |
| 623 | Note: The output of the Auto- Correction Repot def aults to d isplay on the user’s screen, b ut can be queued to a network printer or to VistA MailMan. | |
| 624 | High | |
| 625 | ACR014 | |
| 626 | When the A uto-Correc tion job f inds a bil l that is out-of-bal ance, but the exact transactio n (or tran sactions) that are t he cause o f the disc repancy wi thin the b ill cannot be determ ined, the Auto-Corre ction Repo rt will in clude the bill numbe r in the r eport, dis play the r eason as “ Not Fixabl e” and lea ve the tra nsaction n umber blan k for the out-of-bal ance bill. | |
| 627 | High | |
| 628 | Table 28: Patient St atement Ch ange Date Requiremen ts | |
| 629 | Req. ID | |
| 630 | Primary Te xt | |
| 631 | Priority | |
| 632 | BN3 | |
| 633 | Consolidat e patient statement( s) within a single b illing cyc le | |
| 634 | High | |
| 635 | BN 3.3 | |
| 636 | The system shall gen erate a co nsolidated statement combining all activ e outstand ing accoun t charges (regardles s of the V A facility ) based on the Veter an's billi ng cycle. | |
| 637 | High | |
| 638 | US004 | |
| 639 | As a VistA user, I w ant my Vis tA site to build and transmit patient bi lling stat ement file s that are sent to A ITC prior to the 26t h of each month so t hat when c onsolidate d patient statement functional ity is imp lemented t here is a window at the end of the prior month whe n all stat ement data has been processed for billin g. | |
| 640 | ||
| 641 | Refer to T able 23 fo r the 17 S tation num bers to be modified for statem ent run da tes. | |
| 642 | High | |
| 643 | Table 29: Transactio n Discrepa ncy Root C ause Remed iation Req uirements | |
| 644 | Req. ID | |
| 645 | Primary Te xt | |
| 646 | Priority | |
| 647 | US005 | |
| 648 | As a VistA user, I w ant the Vi stA AR sys tem to rem ediate the identifie d root cau se of crea ting dupli cate trans action dis crepancies in First Party bill ing so tha t the Vete ran’s mont hly billin g statemen ts are not delayed i n the norm al monthly printing process. | |
| 649 | High | |
| 650 | US006 | |
| 651 | As a VistA user, I w ant the Vi stA AR sys tem to rem ediate the identifie d root cau se of crea ting Missi ng (NULL) transactio n amount d iscrepanci es in Firs t Party bi lling so t hat the Ve teran’s mo nthly bill ing statem ents are n ot delayed in the no rmal month ly printin g process. | |
| 652 | High | |
| 653 | US007 | |
| 654 | As a VistA user, I w ant the Vi stA AR sys tem to rem ediate the identifie d root cau se of crea ting Incom plete tran saction di screpancie s in First Party bil ling so th at the Vet eran’s mon thly billi ng stateme nts are no t delayed in the nor mal monthl y printing process. | |
| 655 | High | |
| 656 | ||
| 657 | Graphical User Inter face (GUI) Specifica tions | |
| 658 | Not appli cable. | |
| 659 | Multi-divi sional Spe cification s | |
| 660 | No new mu lti-divisi onal speci fications are being introduced in PSE Ph ase 1. | |
| 661 | Performanc e Specific ations | |
| 662 | The follow ing specif ications w ere provid ed in the NSR 201007 16 (CCPC) Patient St atement En hancements and Conso lidation B RD-3-18-15 :http:// URL . DNS Active | |
| 663 | Table 210: Performan ce Specifi cations | |
| 664 | If this is a system modificati on, how ma ny users d oes the cu rrent syst em support ? | |
| 665 | The curren t system i s used by Customer S ervice Rep resentativ es and CPA C Staff in the suppo rt of Vete ran. | |
| 666 | In the cur rent syste m: | |
| 667 | Accounts r eceivable data is up loaded to the VistA AR package for charg es for Vet eran medic al care fo r each Vet eran who r eceives ca re. | |
| 668 | Customer s ervice rep resentativ es access the VistA AR module when a Vet eran calls in with a question about thei r account. The estim ated numbe r of custo mer servic e represen tatives us ing the Vi stA AR mod ule is 1,2 00. | |
| 669 | Once a mon th, billin g data is sent from each of th e 100+ Vis tA systems for each Veteran wh o has incu rred charg es at that site. The statement s are then created, printed an d sent out . Many Vet erans get bills from more than one site. Approxima tely 2 mil lion state ments are mailed eac h month. | |
| 670 | How many u sers will the new sy stem (or s ystem modi fication) support? | |
| 671 | The number of curren t system u sers will be the sam e for the modified s ystem. | |
| 672 | What is th e predicte d annual g rowth in t he number of system users? | |
| 673 | It is esti mated that the trans action vol ume may gr ow an addi tional 5-1 0% in the first year , but the number of users will not grow. | |
| 674 | Actual dat a provided for the n umber of U nique SSN / First Pa rty Collec tions (Pre scription, Inpatient /Outpatien t, and Lon g Term Car e) by Fisc al Year (F Y): Approx imately 20 0K get mul tiple stat ements per month. | |
| 675 | Quality At tributes S pecificati on | |
| 676 | Quality at tribute sp ecificatio ns will en hance the supportabi lity, main tainabilit y, portabi lity, test ability, a nd reusabi lity of th e PSE proj ect. This includes a pplicable coding sta ndards, na ming conve ntions, cl ass librar ies, maint enance acc ess, and m aintenance utilities . The qual ity attrib utes speci fications are achiev ed by the accepted d esign of t he Patient Statement enhanceme nts. | |
| 677 | Reliabilit y Specific ations | |
| 678 | VistA AR s hould be a vailable 2 4 hours pe r day, 365 days per year, exce pt during periods of scheduled maintenan ce. | |
| 679 | Scope Inte gration | |
| 680 | Additional scope spe cification s and inte gration ar e not appl icable to Phase I de velopment. | |
| 681 | Security S pecificati ons | |
| 682 | VA require s that app lication e nhancement s address standards, procedure s, and tec hnical asp ects of th e solution required for achiev ing system certifica tion and a ccreditati on. These should add ress contr ols listed in Federa l Informat ion Proces sing Stand ards (FIPS ) PUB 200, Minimum S ecurity Re quirements for Feder al Informa tion and I nformation Systems. Additional security specificat ions inclu de: | |
| 683 | Compliance with stan dards and regulatory requireme nts publis hed in VA Handbook a nd Directi ve 6500: V eterans Af fairs Dire ctives > V A Handbook and Direc tive 6500. | |
| 684 | Compliance with FIPS PUB 140-2 , Security Requireme nts for Cr yptographi c Modules, and for a ll voice a nd data tr affic encr yption: Co mputer Sec urity Divi sion > Pub lications > Federal Informatio n Processi ng Standar ds > FIPS PUB 140-2. | |
| 685 | Additional ly, due to patient s afety cons iderations , data pro tection me asures suc h as backu p interval s and redu ndancy sha ll be cons istent wit h systems categorize d as criti cal. | |
| 686 | System Fea tures | |
| 687 | Refer to S ection 2.6 .5 for the details o f all incl uded funct ionality. | |
| 688 | Usability Specificat ions | |
| 689 | There are no enhance ments bein g made to the VistA applicatio n during P hase 1 tha t affect h ow the sys tem is acc essed or o perated by users. PS E shall ut ilize As-I s componen ts and exi sting func tionality for user a ccess, sec urity and usability. | |
| 690 | Purchased Components | |
| 691 | The PSE p roject doe s not have purchased component s for Phas e 1. | |
| 692 | ||
| 693 | ||
| 694 | Approval S ignatures | |
| 695 | ||
| 696 | REVIEW DAT E: <date> | |
| 697 | SCRIBE: <n ame> | |
| 698 | ||
| 699 | Signed: __ __________ __________ __________ __________ __________ __________ __________ ______ | |
| 700 | Integrated Project T eam (IPT) ChairDate | |
| 701 | ||
| 702 | ||
| 703 | __________ __________ __________ __________ __________ __________ __________ ________ | |
| 704 | Business S ponsorDate | |
| 705 | ||
| 706 | __________ __________ __________ __________ __________ __________ __________ ________ | |
| 707 | IT Program ManagerDa te | |
| 708 | ||
| 709 | ||
| 710 | __________ __________ __________ __________ __________ __________ __________ ________ | |
| 711 | Project Ma nagerDate | |
| 712 | ||
| 713 | ||
| 714 | ||
| 715 | Appendix A : Discrepa ncy Exampl es | |
| 716 | Appendix A provides examples o f the new menu optio ns, report s and sort ing capabi lities, an d MailMan Notificati ons. | |
| 717 | ||
| 718 | Figure 2: Auto-Corre ction Job and Report Menu Opti ons | |
| 719 | ||
| 720 | ||
| 721 | Figure 3: Notificati on to AR U ser when j ob is stil l actively running | |
| 722 | ||
| 723 | ||
| 724 | Figure 4: MailMan no tification when Auto -Correctio n job is s till activ ely runnin g | |
| 725 | ||
| 726 | ||
| 727 | Figure 5: Auto-Corre ction Repo rt Options | |
| 728 | ||
| 729 | Figure 6: Auto-Corre ction Repo rt Option Selection Example | |
| 730 | ||
| 731 | Figure 7: Auto-Corre ction Repo rt: Sorted by Bill N umber | |
| 732 | ||
| 733 | ||
| 734 | Figure 8: Auto-Corre ction Repo rt: Sorted by Debtor Name | |
| 735 | ||
| 736 | Figure 9: Auto-Corre ction Repo rt: Sorted by Auto C orrection Date | |
| 737 | ||
| 738 | Figure 10: Auto-Corr ection Rep ort: Sorte d by Trans action Num ber | |
| 739 | ||
| 740 | Figure 11: Missing T ransaction Amount – Screen 1 | |
| 741 | ||
| 742 | Figure 12: Missing T ransaction Amount – Screen 2 | |
| 743 | ||
| 744 | Figure 13: Missing T ransaction Amount – Screen 3 | |
| 745 | ||
| 746 | ||
| 747 | Figure 14: Duplicate Transacti on – Scree n 1 | |
| 748 | ||
| 749 | ||
| 750 | Figure 15: Duplicate Transacti on – Scree n 2 | |
| 751 | ||
| 752 | ||
| 753 | Figure 16: Duplicate Transacti on – Scree n 3 | |
| 754 | ||
| 755 | ||
| 756 | ||
| 757 | Figure 17: Incomplet e Status – Screen 1 | |
| 758 | ||
| 759 | ||
| 760 | ||
| 761 | Figure 18: Incomplet e Status – Screen 2 | |
| 762 | ||
| 763 | ||
| 764 | Figure 19: Incomplet e Status-S creen 3 | |
| 765 | ||
| 766 | Appendix B – Manual Steps to R esolve Any Discrepan cy | |
| 767 | ||
| 768 | Check Pati ent Accoun t Balance. | |
| 769 | Run Transa ction Pati ent Statem ent Histor y. | |
| 770 | Discrepanc ies occur since last statement ? Statemen t printed in previou s month. | |
| 771 | Look for t he amount that is ou t of balan ce. | |
| 772 | Look at th e type of transactio n. | |
| 773 | Look at th e Bill Tra nsactions. | |
| 774 | Reconcile the new ac tivity. | |
| 775 | Reconcile the statem ent data. | |
| 776 | Preform th e correcti ons. | |
| 777 | For duplic ate transa ctions, se t the INCO MPLETE TRA NSACTION F LAG in fil e 433,10. | |
| 778 | For a miss ing transa ction amou nt, set th e Transact ion amount if in fil e 433. | |
| 779 | For INCOMP LETE TRANS ACTION FLA G that are causing t he discrep ancy, remo ve the fla g in file 433,10. | |
| 780 | Verify by Check Pati ent accoun t Balance. | |
| 781 | ||
| 782 | Appendix C – TO BE D iagram for Auto-Corr ection | |
| 783 | ||
| 784 | ||
| 785 | Figure 20: Patient S tatement D eficiency Resolution To-Be Pro cess Diagr am | |
| 786 |
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