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1 | C:\AraxisMergeCompare\Pri_un | CIF Submission_EDI_Mid_Build_9.xlsx | Wed Mar 27 18:59:15 2019 UTC |
2 | C:\AraxisMergeCompare\Pri_re | CIF Submission_EDI_Mid_Build_9.xlsx | Thu Mar 28 17:50:36 2019 UTC |
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1 | SHEET: Use r Stories | ||
2 | Project Ar ea,Rationa l,Summary, Descriptio n, | ||
3 | ARS (CM),8 20845,CCNN C-Reroutin g-01.03.02 : FPPS CC NNC Error Report,CCN NC-Rerouti ng-01.03.0 2: As the EDI team, I want to have a cl aim rerout ed to FSC/ CCNNC Clai m Report t hat contai ns details about the status of the claim (en-route , completi on, error) . | ||
4 | |||
5 | Acceptance Criteria: Verify t hat a FSC/ CCNNC Clai ms Report shows deta ils about routing st atus of er ror. | ||
6 | |||
7 | Verify tha t the HAC to FSC re- routed cla ims report contains values for REFD9 837 Claim Con trol Numbe r; eRepos Claim Key; FPPS Clai m ID; FPPS Implement ation Type Code; Inb ound 837 F ilename; O utbound 83 7 Filename ; PCN; Cl aim Receiv ed Date; a nd Claim S ent Date | ||
8 | |||
9 | , | ||
10 | ARS (CM),8 20825,CCNN C-Reroutin g-01.02.05 : EDI Gat eway Commu nicate Re- Route FPPS _Owner Loa d,CCNNC-Re routing-01 .02.05: As the EDI t eam, I wan t any inbo und claims identifie d as belon ging to a station in a CCNNC r egion to b e rerouted to CCNNC. | ||
11 | |||
12 | Acceptance Criteria: Verify t hat inboun d claims c an be rero uted to CC NNC on a n ightly sch eduled bas is. | ||
13 | |||
14 | , | ||
15 | ARS (CM),8 20824,CCNN C-Reroutin g-01.02.04 : EDI Gate way Commun icate Isol ated Rerou ted 837 Cl aim File t o FSC Erro rs,CCNNC-R erouting-0 1.02.04: As the EDI team, I w ant the ED I Gateway to display errors in an except ions windo w for isol ated re-ro uted 837 c laims to F SC errors. | ||
16 | |||
17 | Acceptance Criteria: Verify t hat the is olated re- routed cla ims errors are outpu t to a rep ort. | ||
18 | , | ||
19 | ARS (CM),8 19902,CCNN C-Reroutin g-01.02.03 : EDI Gate way Commun icate Isol ated Rerou ted 837 Cl aim File t o FSC,CCNN C-Reroutin g-01.02.03 : As the E DI team, I want the EDI Gatewa y to commu nicate the isolated X12 837 ba tch of FSC claims to FSC so th at FSC can retrieve and proces s the clai ms. | ||
20 | |||
21 | Acceptance Criteria: Verify t hat EDI Ga teway can communicat e an x12 8 37 batch o f rerouted claims to FSC. | ||
22 | , | ||
23 | EDI_Gatewa y (CM),913 761,CCNNC- Rerouting- 01.03: FSC CCNNC Rer outed Clai m Reports, CCNNC-Rero uting-01.0 3: As the EDI team, I want to have a set of report s on FSC c laim rerou ting activ ity so tha t I can be assured o f proper s ystem oper ation and be made aw are of iss ues requir ing manual resolutio ns., | ||
24 | EDI_Gatewa y (CM),913 759,CCNNC- Rerouting- 01.03.02: FPPS CCNNC Error Rep ort,CCNNC- Rerouting- 01.03.02: As the EDI team, I w ant to hav e a claim rerouted t o FSC/CCNN C Claim Re port that contains d etails abo ut the sta tus of the claim (en -route, co mpletion, error). | ||
25 | |||
26 | Acceptance Criteria: Verify t hat a FSC/ CCNNC Clai ms Report shows deta ils about routing st atus of er ror. | ||
27 | |||
28 | Verify tha t the HAC to FSC re- routed cla ims report contains values for REFD9 837 Claim Con trol Numbe r; eRepos Claim Key; FPPS Clai m ID; FPPS Implement ation Type Code; Inb ound 837 F ilename; O utbound 83 7 Filename ; FBCS Cla im ID; PCN ; Claim Re ceived Dat e; and Cla im Sent Da te, | ||
29 | EDI_Gatewa y (CM),913 758,CCNNC- Rerouting- 01.03.01: FPPS CCNNC Rerouted Claims Rep ort HAC to FSC,CCNNC -Rerouting -01.03.01: As the E DI team, I want to h ave a Clai m Rerouted to FSC/CC NNC Claim Report tha t contains details o f claims t hat have b een rerout ed and sen t to FSC f or process ing. It sh all be int ernal to H AC for bus iness awar eness. | ||
30 | |||
31 | Acceptance Criteria: Verify t hat the HA C to FSC r e-routed c laims repo rt contain s values f or REFD9 8 37 Claim C ontrol Num ber; eRepo s Claim Ke y; FPPS Cl aim ID; FP PS Impleme ntation Ty pe Code; I nbound 837 Filename; Outbound 837 Filena me; FBCS C laim ID; P CN; Claim Received D ate; and C laim Sent Date, | ||
32 | EDI_Gatewa y (CM),913 754,CCNNC- Rerouting- 01.02.06: Isolated R erouted Cl aims File, CCNNC-Rero uting-01.0 2.06: As t he EDI tea m, I need to retriev e specific claims fr om an exis ting x12 8 37 file ba sed on the claim tra ce number so that I can isolat e rerouted claim dat a. | ||
33 | |||
34 | Acceptance Criteria: Verify t hat an ST/ SE claim d ata set ca n be found using the claim tra ce number. , | ||
35 | EDI_Gatewa y (CM),913 750,CCNNC- Rerouting- 01.02.05: EDI Gatewa y Communic ate Rerout e FPPS_OWN ER Load,CC NNC-Rerout ing-01.02. 05: As the EDI team, I want an y inbound claims ide ntified as belonging to a stat ion in a C CNNC regio n to be re routed to CCNNC. | ||
36 | |||
37 | Acceptance Criteria: Verify t hat inboun d claims c an be rero uted to CC NNC on a n ightly sch eduled bas is., | ||
38 | EDI_Gatewa y (CM),913 748,CCNNC- Rerouting- 01.02.04: EDI Gatewa y Communic ate Isolat ed Reroute d 837 Clai m File to FSC Errors ,CCNNC-Rer outing-01. 02.04: As the EDI te am, I want the EDI G ateway to display er rors indic ators for isolated r e-routed 8 37 claims to FSC err ors. | ||
39 | |||
40 | Acceptance Criteria: Verify t hat the is olated re- routed cla ims errors are indic ated as su ch in the database., | ||
41 | EDI_Gatewa y (CM),913 747,CCNNC- Rerouting- 01.02.03: EDI Gatewa y Communic ate Isolat ed Reroute d 837 Clai m File to FSC,CCNNC- Rerouting- 01.02.03: As the EDI team, I w ant the ED I Gateway to communi cate the i solated X1 2 837 batc h of FSC c laims to F SC so that FSC can r etrieve an d process the claims . | ||
42 | |||
43 | Acceptance Criteria: Verify t hat EDI Ga teway can communicat e an x12 8 37 batch o f rerouted claims to FSC., | ||
44 | EDI_Gatewa y (CM),913 745,CCNNC- Rerouting- 01.02: EDI Gateway R eroute Cla im to FSC, CCNNC-Rero uting-01.0 2: As the EDI team, I want the EDI Gatew ay to prov ide origin al 837 cla im data to FSC when a claim ha s been rer outed so t hat FSC ca n properly process c laims that have been rerouted to them., | ||
45 | EDI_Gatewa y (CM),913 721,CCNNC- Rerouting- 01.02.02: EDI Gatewa y Isolate Original 8 37 Claim,C CNNC-Rerou ting-01.02 .02: As th e EDI team , I want t he EDI Gat eway to cr eate a new 837 batch file cont aining ori ginal and unmodified 837 claim data (ST- SE) so tha t it can c ommunicate a batch o f rerouted claims to FSC. | ||
46 | |||
47 | Acceptance Criteria: Verify t hat EDI Ga teway can create an x12 837 ba tch file c ontaining a subset o f 837 clai ms which h ave been r erouted to FSC and a re located in an x12 837 batch ., | ||
48 | EDI_Gatewa y (CM),913 719,CCNNC- Rerouting- 01.02.01: EDI Gatewa y Find Ori ginal 837 Batch,CCNN C-Reroutin g-01.02.01 : As the E DI team, I want the EDI Gatewa y to retri eve the or iginal bat ch file co ntaining a n 837 rero uted to FS C so that the EDI Ga teway can reroute a specific c laim from a claim ba tch to FSC in a corr esponding 837. | ||
49 | |||
50 | Acceptance Criteria: Verify t hat EDI Ga teway can find the o riginal X1 2 837 batc h file con taining a specific c laim using claim dat a in E_Rep ository., | ||
51 | EDI_Gatewa y (CM),913 717,CCNNC- Rerouting- 01.01.02: FPPS Rerou te Claim I ndicator,C CNNC-Rerou ting-01.01 .02: As th e EDI team , I want t o indicate to the ED I Gateway which clai ms will ne ed to be r erouted to FSC when the claim is assigne d to an FS C Managed VISN so th at the EDI Gateway c an properl y communic ate a rero uted claim to FSC. | ||
52 | |||
53 | Acceptance Criteria: Verify t hat FPPS n otifies ED I Gateway of claims which need to be rer outed to F SC., | ||
54 | EDI_Gatewa y (CM),913 714,CCNNC- Rerouting- 01.01.01: FPPS Stati on CCNNC I ndicator,C CNNC-Rerou ting-01.01 .01: As th e EDI team , I want t o be able to indicat e specific stations are locate d in VISNS which sho uld route claims to FSC for pa yment so t hat I can actively m anage the migration of VISNs t o have cla ims manage d by FSC. | ||
55 | |||
56 | Acceptance Criteria: Verify t hat a stat ion can be configure d in the F PPS Databa se as in a FSC Manag ed VISN., | ||
57 | EDI_Gatewa y (CM),913 710,CCNNC- Rerouting- 01.01: FPP S Reroute VISN Rules ,CCNNC-Rer outing-01. 01: As the EDI team, I want to be able t o configur e FPPS sta tions so t hat claims rerouted to specifi c VISNs wi ll engage logic to r eroute HAC claims to FSC., | ||
58 | EDI_Gatewa y (CM),913 702,SUBEPI C-01.05: 2 77CA to CS TAT Suppor t Systems, SUBEPIC-01 .05: As th e VA OCC, I want to be able to have a to ol that co ordinates receiving 277CA file s so that they are q ueued for processing and their receipt i s tracked. , | ||
59 | EDI_Gatewa y (CM),913 700,SUBEPI C-01.04: C A to CSTAT Reporting ,SUBEPIC-0 1.04: As t he VA OCC, I want to be able t o review l ogs and ru n reports on the 277 CA to CSTA T web serv ice so tha t I can be aware of performanc e and usag e of the w eb service ., | ||
60 | EDI_Gatewa y (CM),913 697,SUBEPI C-01.02: C A to CSTAT Storage a nd Generat ion,SUBEPI C-01.02: A s the VA O CC, I want to be abl e to recei ve 277CA C laim Statu s to be co nverted an d transmit ted to Cha nge Health care via a web servi ce so that external applicatio ns can coo rdinate cl aim status es with Ch ange Healt h as requi red., | ||
61 | EDI_Gatewa y (CM),913 696,STORY- 01.05.02: 277CA to C STAT MoveI t Pick Up Job,STORY- 01.05.02: As the VA OCC, I wan t a MoveIt job that will pick up incomin g 277CA fi les so tha t they can be pulled into the applicatio n for proc essing. | ||
62 | |||
63 | Acceptance Criteria: Verify th at a MoveI t job exis ts that pi cks up a f ile for in coming 277 CA files a nd trigger s the appl ication to process. | ||
64 | Verify tha t the Move It job wil l search a location and pull f iles based on the na ming, spec ifically 8 37 claim B atch Files with the first char acter desi gnator of "C." | ||
65 | |||
66 | 837 claim batch file s | ||
67 | H<c>NNC.Y YYYMMDD.HH MMSS.837 | ||
68 | H<c> Ident ifier for claim type and sourc e | ||
69 | “H” is for HAC, "C" is for Cha nge Health (These in dicate non -suppresse d claims w ith no ass ociated CS TAT genera ted) | ||
70 | “P” or “I” for claim type | ||
71 | HP – prof essional c laims, 005 010X222A1 | ||
72 | HI – inst itutional claims, 00 5010X223A2 | ||
73 | NNC Progr am name | ||
74 | “NNC” for Non-Networ k Claims | ||
75 | YYYYMMDD date value | ||
76 | HHMMSS timesta mp | ||
77 | 837 static val ue | ||
78 | Examples f rom HAC | ||
79 | HPNNC.2018 0920.10334 5.837, | ||
80 | EDI_Gatewa y (CM),913 689,STORY- 01.05.01: Watcher Se rvice,STOR Y-01.05.01 : As the V A OCC, I w ant a serv ice that w ill watch for incomi ng 277CA f iles so th at they ca n be pulle d into the applicati on for pro cessing. | ||
81 | |||
82 | Acceptance Criteria: Verify th at a servi ce exists that watch es a file location f or incomin g 277CA fi les and tr iggers the applicati on to proc ess. | ||
83 | Verify tha t the watc her servic e archives 277CA fil es in a se parate fol der for tr acking pur poses., | ||
84 | EDI_Gatewa y (CM),913 687,STORY- 01.04.02: 277CA to C STAT Audit Log Repor t,STORY-01 .04.02: As the VA OC C, I want to be able to genera te reports on the 27 7CA to CST AT web ser vice so th at I can t rack usage and analy ze applica tion metri cs. | ||
85 | |||
86 | Acceptance Criteria: Verify th at reports on 277CA to CSTAT w eb service communica tions can be generat ed by regi stered web service u ser and da te/time sp an., | ||
87 | EDI_Gatewa y (CM),913 685,STORY- 01.04.01: 277CA to C STAT Data Logging,ST ORY-01.04. 01: As the VA OCC, I want to l og all tra nsmissions sent to t he 277CA t o CSTAT we b service and the re sults so t hat I can track and research p otential i ssues in u tilizing t he webserv ice. | ||
88 | |||
89 | Acceptance Criteria: Verify th at the 277 CA to CSTA T web serv ice commun ications a re logged into a dat abase. | ||
90 | , | ||
91 | EDI_Gatewa y (CM),913 684,STORY- 01.02.14: 277CA to C STAT STC S egment Gen eration,ST ORY-01.02. 14: As the VA OCC, I want the 277CA Clai m Status w eb service to commun icate rece ived and a cceptance transmissi ons to the 277CA to CSTAT conv ersation l ogic so th at I can c onvert tra nsmissions to the Ch ange Healt h propriet ary CSTAT format for CSTAT Cla im Status Record Det ails (STC Segments). | ||
92 | |||
93 | Acceptance Criteria: Verify th at the 277 CA Claim S tatus web service ca n communic ate receiv ed 277CA C laim Statu s transmis sions to t he 277CA t o CSTAT co nversion l ogic for C laim Statu s Record D etails (ST C Segments )., | ||
94 | EDI_Gatewa y (CM),913 669,STORY- 01.02.13: Multiple T ransaction Set Suppo rt,STORY-0 1.02.13: A s the VA O CC, I want the 277CA Claim Sta tus web se rvice to c ommunicate received and proces s multiple transmiss ions in a single bat ch file to the 277CA to CSTAT conversati on logic s o that I c an convert transmiss ions to th e Change H ealth prop rietary CS TAT format . | ||
95 | |||
96 | Acceptance Criteria: Verify th e 277CA Cl aim Status web servi ce generat es a singl e CSTAT co ntaining a ll claim s tatus tran sactions r eceived on a single 277CA, | ||
97 | EDI_Gatewa y (CM),913 666,STORY- 01.02.12: 277CA to C STAT CLM G eneration, STORY-01.0 2.12: As t he VA OCC, I want th e 277CA Cl aim Status web servi ce to comm unicate re ceived and acceptanc e transmis sions to t he 277CA t o CSTAT co nversation logic so that I can convert t ransmissio ns to the Change Hea lth propri etary CSTA T format f or Claim L evel Recor ds Detail. | ||
98 | |||
99 | Acceptance Criteria: Verify th at the 277 CA Claim S tatus web service ca n communic ate receiv ed 277CA C laim Statu s transmis sions to t he 277CA t o CSTAT co nversion l ogic for C laim Level Records D etail., | ||
100 | EDI_Gatewa y (CM),913 665,STORY- 01.02.11: 277CA Clai m Ingestio n to Datab ase,STORY- 01.02.11: As the VA OCC, I wan t the web services t o be able to process ECAMS dat a so that I can conv ert 277CA transmissi ons to the Change He alth propr ietary CST AT format for Claim Level Reco rds Detail . | ||
101 | |||
102 | Acceptance Criteria: Verify th at the bac kend can p rocess ECA MS data vi a web serv ices. | ||
103 | This shall include i nformation that popu lates the logging ta ble., | ||
104 | EDI_Gatewa y (CM),913 663,STORY- 01.02.10: 277CA to C STAT Conve rsion,STOR Y-01.02.10 : As the V A OCC, I w ant the mo dified 277 CA data so that I ca n convert the data t o the Chan ge Health proprietar y CSTAT fo rmat for C laim Level Records D etail. | ||
105 | |||
106 | Acceptance Criteria: Verify th at the 277 CA Claim S tatus data converts to CSTAT., | ||
107 | EDI_Gatewa y (CM),913 644,STORY- 01.02.09: 277CA to C STAT Heade r Record D etail and Trailer Re cord Detai ls,STORY-0 1.02.09: A s the VA O CC, I want the 277CA Claim Sta tus web se rvice to c ommunicate received and accept ance trans missions t o the 277C A to CSTAT conversat ion logic so that I can conver t transmis sions to t he Change Health pro prietary C STAT forma t for Head er Record Detail and Trailer R ecord Deta ils. | ||
108 | |||
109 | Acceptance Criteria: Verify th at the 277 CA Claim S tatus web service ca n communic ate receiv ed 277CA C laim Statu s transmis sions to t he 277CA t o CSTAT co nversion l ogic for H eader Reco rd Detail and Traile r Record D etails., | ||
110 | EDI_Gatewa y (CM),913 643,STORY- 01.02.08: 277CA to C STAT Claim Status Re cord Detai ls,STORY-0 1.02.08: A s the VA O CC, I want the 277CA Claim Sta tus web se rvice to c ommunicate received and accept ance trans missions t o the 277C A to CSTAT conversat ion logic so that I can conver t transmis sions to t he Change Health pro prietary C STAT forma t for Clai m Status R ecord Deta ils. | ||
111 | |||
112 | Acceptance Criteria: Verify th at the 277 CA Claim S tatus web service ca n communic ate receiv ed 277CA C laim Statu s transmis sions to t he 277CA t o CSTAT co nversion l ogic for C laim Statu s Record D etails., | ||
113 | EDI_Gatewa y (CM),913 639,STORY- 01.02.07: 277CA to C STAT Claim Line Leve l Records Detail,STO RY-01.02.0 7: As the VA OCC, I want the d atabase to store dat a so that I can late r convert 277CA tran smissions to the Cha nge Health proprieta ry CSTAT f ormat for Claim Line Level Rec ords Detai l. | ||
114 | |||
115 | Acceptance Criteria: Verify th at the dat abase can store data to prepar e for the 277CA to C STAT conve rsion logi c for Clai m Line Lev el Records Detail., | ||
116 | EDI_Gatewa y (CM),913 637,STORY- 01.02.06: 277CA to C STAT Claim Level Rec ord Detail ,STORY-01. 02.06: As the VA OCC , I want t he databas e to store data so t hat I can later conv ert 277CA transmissi ons to the Change He alth propr ietary CST AT format for Claim Level Reco rds Detail . | ||
117 | |||
118 | Acceptance Criteria: Verify th at the dat abase can store data to prepar e for the 277CA to C STAT conve rsion logi c for Clai m Level Re cords Deta il., | ||
119 | EDI_Gatewa y (CM),909 429,5010Re p-14.01.81 : Loop 233 0A N4 Post al Code Si tuational Rule,5010R ep-14.01.8 1: Loop 23 30A N4 Pos tal Code S ituational Rule | ||
120 | |||
121 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N403 Pos tal Code i s blank (O CC only ac cepts US b ased claim s)., | ||
122 | EDI_Gatewa y (CM),909 428,5010Re p-14.01.60 : Loop 201 0AB N4 Sta te Code Si tuational Rule,5010R ep-14.01.6 0: Loop 20 10AB N4 St ate Code S ituational Rule | ||
123 | |||
124 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N402 Sta te Code is blank (OC C only acc epts US ba sed claims )., | ||
125 | EDI_Gatewa y (CM),909 425,5010Re p-14.01.70 : Loop 201 0BA N4 Pos tal Code L ength Situ ational Ru le,5010Rep -14.01.70: Loop 2010 BA N4 Post al Code Le ngth Situa tional Rul e | ||
126 | |||
127 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N403 Pos tal Code i s less tha n 9 digits (OCC only accepts U S based cl aims)., | ||
128 | EDI_Gatewa y (CM),909 423,5010Re p-14.01.63 : Loop 201 0AB N4 Cou ntry Subdi vision Cod e Situatio nal Rule,5 010Rep-14. 01.63: Loo p 2010AB N 4 Country Subdivisio n Code Sit uational R ule | ||
129 | |||
130 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N407 Cou ntry Subdi vision is not blank (OCC only accepts US based cla ims)., | ||
131 | EDI_Gatewa y (CM),909 422,5010Re p-14.01.67 : Loop 201 0AC N4 Cou ntry Subdi vision Cod e Situatio nal Rule,5 010Rep-14. 01.67: Loo p 2010AC N 4 Country Subdivisio n Code Sit uational R ule | ||
132 | |||
133 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N407 Cou ntry Subdi vision is not blank (OCC only accepts US based cla ims)., | ||
134 | EDI_Gatewa y (CM),909 421,5010Re p-14.01.68 : Loop 201 0BA N4 Sta te Code Si tuational Rule,5010R ep-14.01.6 8: Loop 20 10BA N4 St ate Code S ituational Rule | ||
135 | |||
136 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N402 Sta te Code is blank (OC C only acc epts US ba sed claims )., | ||
137 | EDI_Gatewa y (CM),909 420,5010Re p-14.01.56 : Loop 201 0AA N4 Sta te Code Si tuational Rule,5010R ep-14.01.5 6: Loop 20 10AA N4 St ate Code S ituational Rule | ||
138 | |||
139 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N402 Sta te Code is blank (OC C only acc epts US ba sed claims )., | ||
140 | EDI_Gatewa y (CM),909 416,5010Re p-14.01.59 : Loop 201 0AA N4 Cou ntry Subdi vision Cod e Situatio nal Rule,5 010Rep-14. 01.59: Loo p 2010AA N 4 Country Subdivisio n Code Sit uational R ule | ||
141 | |||
142 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N407 Cou ntry Subdi vision is not blank (OCC only accepts US based cla ims)., | ||
143 | EDI_Gatewa y (CM),909 415,5010Re p-14.01.87 : Loop 233 0B N4 Coun try Subdiv ision Code Situation al Rule,50 10Rep-14.0 1.87: Loop 2330B N4 Country Su bdivision Code Situa tional Rul e | ||
144 | |||
145 | AC: Verify that Heal thshare re jects the X12 837 He althcare t ransaction , in a com pliant 999 , if the N 407 Countr y Code Sub division c ode is not null and N404 is nu ll (State verificati on takes p lace in CS TAT proces s)., | ||
146 | EDI_Gatewa y (CM),909 414,5010Re p-14.01.85 : Loop 233 0B N4 Post al Code Si tuational Rule,5010R ep-14.01.8 5: Loop 23 30B N4 Pos tal Code S ituational Rule | ||
147 | |||
148 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N403 Pos tal Code i s blank (O CC only ac cepts US b ased claim s)., | ||
149 | EDI_Gatewa y (CM),909 413,5010Re p-14.01.76 : Loop 201 0CA N4 Sta te Code Si tuational Rule,5010R ep-14.01.7 6: Loop 20 10CA N4 St ate Code S ituational Rule | ||
150 | |||
151 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N402 Sta te Code is blank (OC C only acc epts US ba sed claims )., | ||
152 | EDI_Gatewa y (CM),909 412,5010Re p-14.01.84 : Loop 233 0B N4 Stat e Code Sit uational R ule,5010Re p-14.01.84 : Loop 233 0B N4 Stat e Code Sit uational R ule | ||
153 | |||
154 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N402 Sta te Code is blank (OC C only acc epts US ba sed claims )., | ||
155 | EDI_Gatewa y (CM),909 411,5010Re p-14.01.82 : Loop 233 0A N4 Post al Code Le ngth Situa tional Rul e,5010Rep- 14.01.82: Loop 2330A N4 Postal Code Leng th Situati onal Rule | ||
156 | |||
157 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N403 Pos tal Code i s less tha n 9 digits (OCC only accepts U S based cl aims)., | ||
158 | EDI_Gatewa y (CM),909 410,5010Re p-14.01.64 : Loop 201 0AC N4 Sta te Code Si tuational Rule,5010R ep-14.01.6 4: Loop 20 10AC N4 St ate Code S ituational Rule | ||
159 | |||
160 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N402 Sta te Code is blank (OC C only acc epts US ba sed claims )., | ||
161 | EDI_Gatewa y (CM),909 407,5010Re p-14.01.83 : Loop 233 0A N4 Coun try Subdiv ision Code Situation al Rule,50 10Rep-14.0 1.83: Loop 2330A N4 Country Su bdivision Code Situa tional Rul e | ||
162 | |||
163 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N407 Cou ntry Subdi vision is not blank (OCC only accepts US based cla ims)., | ||
164 | EDI_Gatewa y (CM),909 405,5010Re p-14.01.73 : Loop 201 0BB N4 Pos tal Code S ituational Rule,5010 Rep-14.01. 73: Loop 2 010BB N4 P ostal Code Situation al Rule | ||
165 | |||
166 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N403 Pos tal Code i s blank (O CC only ac cepts US b ased claim s)., | ||
167 | EDI_Gatewa y (CM),909 404,5010Re p-14.01.57 : Loop 201 0AA N4 Pos tal Code S ituational Rule,5010 Rep-14.01. 57: Loop 2 010AA N4 P ostal Code Situation al Rule | ||
168 | |||
169 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N403 Pos tal Code i s blank (O CC only ac cepts US b ased claim s)., | ||
170 | EDI_Gatewa y (CM),909 402,5010Re p-14.01.79 : Loop 201 0CA N4 Cou ntry Subdi vision Cod e Situatio nal Rule,5 010Rep-14. 01.79: Loo p 2010CA N 4 Country Subdivisio n Code Sit uational R ule | ||
171 | |||
172 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N407 Cou ntry Subdi vision is not blank (OCC only accepts US based cla ims)., | ||
173 | EDI_Gatewa y (CM),909 401,5010Re p-14.01.58 : Loop 201 0AA N4 Pos tal Code L ength Situ ational Ru le,5010Rep -14.01.58: Loop 2010 AA N4 Post al Code Le ngth Situa tional Rul e | ||
174 | |||
175 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N403 Pos tal Code i s less tha n 9 digits (OCC only accepts U S based cl aims)., | ||
176 | EDI_Gatewa y (CM),909 399,5010Re p-14.01.71 : Loop 201 0BA N4 Cou ntry Subdi vision Cod e Situatio nal Rule,5 010Rep-14. 01.71: Loo p 2010BA N 4 Country Subdivisio n Code Sit uational R ule | ||
177 | |||
178 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N407 Cou ntry Subdi vision is not blank (OCC only accepts US based cla ims)., | ||
179 | EDI_Gatewa y (CM),909 397,5010Re p-14.01.66 : Loop 201 0AC N4 Pos tal Code L ength Situ ational Ru le,5010Rep -14.01.66: Loop 2010 AC N4 Post al Code Le ngth Situa tional Rul e | ||
180 | |||
181 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N403 Pos tal Code i s less tha n 9 digits (OCC only accepts U S based cl aims)., | ||
182 | EDI_Gatewa y (CM),909 393,5010Re p-14.01.80 : Loop 233 0A N4 Stat e Code Sit uational R ule,5010Re p-14.01.80 : Loop 233 0A N4 Stat e Code Sit uational R ule | ||
183 | |||
184 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N402 Sta te Code is blank (OC C only acc epts US ba sed claims )., | ||
185 | EDI_Gatewa y (CM),909 391,5010Re p-14.01.77 : Loop 201 0CA N4 Pos tal Code S ituational Rule,5010 Rep-14.01. 77: Loop 2 010CA N4 P ostal Code Situation al Rule | ||
186 | |||
187 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N403 Pos tal Code i s blank (O CC only ac cepts US b ased claim s)., | ||
188 | EDI_Gatewa y (CM),909 389,5010Re p-14.01.74 : Loop 201 0BB N4 Pos tal Code L ength Situ ational Ru le,5010Rep -14.01.74: Loop 2010 BB N4 Post al Code Le ngth Situa tional Rul e | ||
189 | |||
190 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N403 Pos tal Code i s less tha n 9 digits (OCC only accepts U S based cl aims)., | ||
191 | EDI_Gatewa y (CM),909 388,5010Re p-14.01.78 : Loop 201 0CA N4 Pos tal Code L ength Situ ational Ru le,5010Rep -14.01.78: Loop 2010 CA N4 Post al Code Le ngth Situa tional Rul e | ||
192 | |||
193 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N403 Pos tal Code i s less tha n 9 digits (OCC only accepts U S based cl aims)., | ||
194 | EDI_Gatewa y (CM),909 386,5010Re p-14.01.65 : Loop 201 0AC N4 Pos tal Code S ituational Rule,5010 Rep-14.01. 65: Loop 2 010AC N4 P ostal Code Situation al Rule | ||
195 | |||
196 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N403 Pos tal Code i s blank (O CC only ac cepts US b ased claim s)., | ||
197 | EDI_Gatewa y (CM),909 385,5010Re p-14.01.86 : Loop 233 0B N4 Post al Code Le ngth Situa tional Rul e,5010Rep- 14.01.86: Loop 2330B N4 Postal Code Leng th Situati onal Rule | ||
198 | |||
199 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N403 Pos tal Code i s less tha n 9 digits (OCC only accepts U S based cl aims)., | ||
200 | EDI_Gatewa y (CM),909 384,5010Re p-14.01.69 : Loop 201 0BA N4 Pos tal Code S ituational Rule,5010 Rep-14.01. 69: Loop 2 010BA N4 P ostal Code Situation al Rule | ||
201 | |||
202 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N403 Pos tal Code i s blank (O CC only ac cepts US b ased claim s)., | ||
203 | EDI_Gatewa y (CM),909 383,5010Re p-14.01.75 : Loop 201 0BB N4 Cou ntry Subdi vision Cod e Situatio nal Rule,5 010Rep-14. 01.75: Loo p 2010BB N 4 Country Subdivisio n Code Sit uational R ule | ||
204 | |||
205 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N407 Cou ntry Subdi vision is not blank (OCC only accepts US based cla ims)., | ||
206 | EDI_Gatewa y (CM),909 377,5010Re p-14.01.62 : Loop 201 0AB N4 Pos tal Code L ength Situ ational Ru le,5010Rep -14.01.62: Loop 2010 AB N4 Post al Code Le ngth Situa tional Rul e | ||
207 | |||
208 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N403 Pos tal Code i s less tha n 9 digits (OCC only accepts U S based cl aims)., | ||
209 | EDI_Gatewa y (CM),909 375,5010Re p-14.01.61 : Loop 201 0AB N4 Pos tal Code S ituational Rule,5010 Rep-14.01. 61: Loop 2 010AB N4 P ostal Code Situation al Rule | ||
210 | |||
211 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N403 Pos tal Code i s blank (O CC only ac cepts US b ased claim s)., | ||
212 | EDI_Gatewa y (CM),909 372,5010Re p-14.01.72 : Loop 201 0BB N4 Sta te Code Si tuational Rule,5010R ep-14.01.7 2: Loop 20 10BB N4 St ate Code S ituational Rule | ||
213 | |||
214 | AC: Verify that Heal thshare re jects X12 837 Health care Claim files if a N402 Sta te Code is blank (OC C only acc epts US ba sed claims )., | ||
215 | EDI_Gatewa y (CM),906 965,5010Re p-01.03: R eplace X12 999 Data Translatio ns,5010Rep -01.03: As the EDI t eam, I wan t to use H ealthShare to create ASC X12 9 99 files f rom the E_ Repository Oracle Da tabase so that this file can b e communic ated to th e Healthca re Clearin g House., | ||
216 | EDI_Gatewa y (CM),904 748,5010Re p-01.03.07 : 999 Loop 2110 (AK2 /IK3/IK4 I mplementat ion Data) from E_Rep os,5010Rep -01.03.07: As the ED I team, I want to ha ve HealthS hare retri eve the Lo op 2110 (A K2/IK3/IK4 Implement ation Data Element N ote) segme nts of out bound 999 files from E_Reposit ory so tha t an accur ate 999 fi le can be generated from data in E_Repos itory. | ||
217 | |||
218 | Acceptance Criteria: Verify th at the con tents of E _Repositor y intended for the 9 99 Loop 21 10 (AK2/IK 3/IK4 Impl ementation Data Elem ent Note - IK4, CTX - For All Repeats of Loop 2100 ) are retr ieved and used to ge nerate a 9 99, | ||
219 | EDI_Gatewa y (CM),904 746,5010Re p-01.03.01 : 999 ISA/ IEA from E _Repos,501 0Rep-01.03 .01: As th e EDI team , I want t o have Hea lthShare r etrieve th e ISA/IEA segments o f outbound 999 files from E_Re pository s o that an accurate 9 99 file ca n be gener ated from data in E_ Repository . | ||
220 | |||
221 | Acceptance Criteria: Verify th at the con tents of E _Repositor y intended for the 9 99 ISA/IEA are retri eved and u sed to gen erate a 99 9, | ||
222 | EDI_Gatewa y (CM),904 736,5010Re p-01.03.02 : 999 GS/G E from E_R epos,5010R ep-01.03.0 2: As the EDI team, I want to have Healt hShare ret rieve the GS/GE segm ents of ou tbound 999 files fro m E_Reposi tory so th at an accu rate 999 f ile can be generated from data in E_Repo sitory. | ||
223 | |||
224 | Acceptance Criteria: Verify th at the con tents of E _Repositor y intended for the 9 99 GS/GE a re retriev ed and use d to gener ate a 999, | ||
225 | EDI_Gatewa y (CM),904 735,5010Re p-01.03.04 : 999 AK1/ AK9 (Funct ional Grou p Response Header an d Footer) from E_Rep os,5010Rep -01.03.04: As the ED I team, I want to ha ve HealthS hare retri eve the AK 1/AK9 (Fun ctional Gr oup Respon se Header and Footer ) segments of outbou nd 999 fil es from E_ Repository so that a n accurate 999 file can be gen erated fro m data in E_Reposito ry. | ||
226 | |||
227 | Acceptance Criteria: Verify th at the con tents of E _Repositor y intended for the 9 99 AK1/AK9 (Function al Group R esponse He ader and F ooter) are retrieved and used to generat e a 999, | ||
228 | EDI_Gatewa y (CM),904 734,5010Re p-01.03.03 : 999 ST/S E from E_R epos,5010R ep-01.03.0 3: As the EDI team, I want to have Healt hShare ret rieve the ST/SE segm ents of ou tbound 999 files fro m E_Reposi tory so th at an accu rate 999 f ile can be generated from data in E_Repo sitory. | ||
229 | |||
230 | Acceptance Criteria: Verify th at the con tents of E _Repositor y intended for the 9 99 ST/SE a re retriev ed and use d to gener ate a 999, | ||
231 | EDI_Gatewa y (CM),904 732,5010Re p-01.03.05 : 999 Loop 2000 (Tra nsaction S et Respons e Header) from E_Rep os,5010Rep -01.03.05: As the ED I team, I want to ha ve HealthS hare retri eve the Lo op 2000 (T ransaction Set Respo nse Header ) segments of outbou nd 999 fil es from E_ Repository so that a n accurate 999 file can be gen erated fro m data in E_Reposito ry. | ||
232 | |||
233 | Acceptance Criteria: Verify th at the con tents of E _Repositor y intended for the 9 99 Loop 20 00 (Transa ction Set Response H eader - AK 2, IK5 - F or All Rep eats) are retrieved and used t o generate a 999, | ||
234 | EDI_Gatewa y (CM),904 723,5010Re p-01.03.06 : 999 Loop 2100 (Tra nsaction S et Respons e Header) from E_Rep os,5010Rep -01.03.06: As the ED I team, I want to ha ve HealthS hare retri eve the Lo op 2100 (A K2/IK3 Err or Identif ication) s egments of outbound 999 files from E_Rep ository so that an a ccurate 99 9 file can be genera ted from d ata in E_R epository. | ||
235 | |||
236 | Acceptance Criteria: Verify th at the con tents of E _Repositor y intended for the 9 99 Loop 21 00 (AK2/IK 3 Error Id entificati on - IK3, CTX (Segme nt Context ), CTX (Bu siness Uni t Identifi er) - For All Repeat s of Loop 2000) are retrieved and used t o generate a 999, | ||
237 | EDI_Gatewa y (CM),892 198,5010Re p-22.02: R eplace EMD EON_ARCHIV E_MXCO_999 .BAT Scrip ts,5010Rep -22.02: As the EDI t eam, I wan t to repli cate the s teps taken by the EM DEON_ARCHI VE_MXCO_99 9.BAT scri pts so tha t I can re place and maintain t he EDI pro duction sy stem., | ||
238 | EDI_Gatewa y (CM),892 197,5010Re p-22.02.01 : Replace EMDEON_SEN D_MXCO_999 .BAT Funct ionality,5 010Rep-22. 02.01: As the EDI te am, I want to replic ate the fu nctionalit y executed in the EM DEON_SEND_ MXCO_999.B AT batch f ile so tha t I can re place and maintain t he EDI pro duction sy stem., | ||
239 | EDI_Gatewa y (CM),892 194,5010Re p-22.01.03 : Replace EMDEON999O .bat Funct ionality,5 010Rep-22. 01.03: As the EDI te am, I want to replic ate the fu nctionalit y executed in the EM DEON999O.b at batch f ile so tha t I can re place and maintain t he EDI pro duction sy stem., | ||
240 | EDI_Gatewa y (CM),892 193,5010Re p-22.01.02 : Replace 999_archiv e.bat Func tionality, 5010Rep-22 .01.02: As the EDI t eam, I wan t to repli cate the f unctionali ty execute d in the 9 99_archive .bat batch file so t hat I can replace an d maintain the EDI p roduction system. | ||
241 | |||
242 | AS IS: | ||
243 | Copies all files wit h names 99 9*.x12 fro m the EMDE ON\OUT fol der to the EMDEON\OU T\Archive folder and logs the outcome to the \scri pts\LOG\EM DEON_999ou t_ftprecor d.txt file . | ||
244 | |||
245 | TO BE: | ||
246 | Kicked off by 22.01. 01 | ||
247 | Archive ou tbound 999 files. | ||
248 | Execute 22 .01.03 | ||
249 | |||
250 | Acceptance Criteria: Verify th at HealthS hare archi ves all ou tbound 999 files des tined for ChangeHeal th to an a rchive fol der and re cords the archival i n the EMDE ON_999out_ ftprecord. txt log. | ||
251 | , | ||
252 | EDI_Gatewa y (CM),892 189,5010Re p-22.01.01 : Replace RENAME_999 .bat Funct ionality,5 010Rep-22. 01.01: As the EDI te am, I want to replic ate the fu nctionalit y executed in the RE NAME_999.b at batch f ile so tha t I can re place and maintain t he EDI pro duction sy stem. | ||
253 | |||
254 | AS IS: | ||
255 | |||
256 | Find out w hat gov.va .med.hac.e di.utils.R ename999 d oes. | ||
257 | Add Run ID Stamp to X12 999 Ba tch (Of al l claims n ot just go od/bad) Fi le Name | ||
258 | |||
259 | TO BE: | ||
260 | Kicked off by 21.01. 01 | ||
261 | Implement Creation o f 999 batc h file (al l incoming 837s acce pted) with a Run ID stamp in t he file na me. | ||
262 | Place in t he EMDEON\ OUT\Folder . | ||
263 | Executes 2 2.01.02 | ||
264 | |||
265 | Acceptance Criteria: An accept ed 999 is created fo r all inbo und 837 tr ansactions . | ||
266 | |||
267 | Reference: | ||
268 | All incomi ng claims will be re ported as accepted b y 999. | ||
269 | , | ||
270 | EDI_Gatewa y (CM),892 186,5010Re p-22.01: R eplace 4f_ 999_SEND_E MDEON Scri pts,5010Re p-22.01: A s the EDI team, I wa nt to repl icate the steps take n by the 4 f_999_SEND _EMDEON sc ripts so t hat I can replace an d maintain the EDI p roduction system., | ||
271 | EDI_Gatewa y (CM),892 183,5010Re p-21.01.01 : Replace VA_837_MAI N_eTRANS_R EPOS_LOADE R.py Funct ionality,5 010Rep-21. 01.01: As the EDI te am, I want to replic ate the fu nctionalit y executed in the VA _837_MAIN_ eTRANS_REP OS_LOADER. py batch f ile so tha t I can re place and maintain t he EDI pro duction sy stem., | ||
272 | EDI_Gatewa y (CM),892 179,5010Re p-21.01: R eplace 4d_ CPS_eTRANS _REPOS_LOA D Scripts, 5010Rep-21 .01: As th e EDI team , I want t o replicat e the step s taken by the 4d_CP S_eTRANS_R EPOS_LOAD scripts so that I ca n replace and mainta in the EDI productio n system., | ||
273 | EDI_Gatewa y (CM),892 174,5010Re p-20.01.04 : Replace COUNT_837_ EMDEON.py Functional ity,5010Re p-20.01.04 : As the E DI team, I want to r eplicate t he functio nality exe cuted in t he COUNT_8 37_EMDEON. py batch f ile so tha t I can re place and maintain t he EDI pro duction sy stem., | ||
274 | EDI_Gatewa y (CM),892 172,5010Re p-20.01.03 : Replace VA_INBOUND _SCHEDULED .py Functi onality,50 10Rep-20.0 1.03: As t he EDI tea m, I want to replica te the fun ctionality executed in the VA_ INBOUND_SC HEDULED.py batch fil e so that I can repl ace and ma intain the EDI produ ction syst em., | ||
275 | EDI_Gatewa y (CM),892 167,5010Re p-20.01.02 : Replace VA_CMS_INB OUND_SCHED ULED.py Fu nctionalit y,5010Rep- 20.01.02: As the EDI team, I w ant to rep licate the functiona lity execu ted in the VA_CMS_IN BOUND_SCHE DULED.py b atch file so that I can replac e and main tain the E DI product ion system ., | ||
276 | EDI_Gatewa y (CM),892 166,5010Re p-20.01.01 : Replace CHANGE_COB _DELIMITER .bat Funct ionality,5 010Rep-20. 01.01: As the EDI te am, I want to replic ate the fu nctionalit y executed in the CH ANGE_COB_D ELIMITER.b at batch f ile so tha t I can re place and maintain t he EDI pro duction sy stem., | ||
277 | EDI_Gatewa y (CM),892 164,5010Re p-20.01: R eplace 4b_ INBOUND_CO MPLIANCE_E MDEON Scri pts,5010Re p-20.01: A s the EDI team, I wa nt to repl icate the steps take n by the 4 b_INBOUND_ COMPLIANCE _EMDEON sc ripts so t hat I can replace an d maintain the EDI p roduction system., | ||
278 | EDI_Gatewa y (CM),892 161,5010Re p-19.02: R eplace 4a_ GET_MXCO_C LAIMS_EMDE ON Script, 5010Rep-19 .02: As th e EDI team , I want t o replicat e the step s taken by the 4a_GE T_MXCO_CLA IMS_EMDEON script so that I ca n replace and mainta in the EDI productio n system., | ||
279 | EDI_Gatewa y (CM),892 158,5010Re p-19.01: R eplace 4a_ GET_CLAIMS _EMDEON Sc ript,5010R ep-19.01: As the EDI team, I w ant to rep licate the steps tak en by the 4a_GET_CLA IMS_EMDEON script so that I ca n replace and mainta in the EDI productio n system., | ||
280 | EDI_Gatewa y (CM),892 155,5010Re p-19.02.01 : Replace EMDEON_GET _MXCO_CLAI MS.BAT Fun ctionality ,5010Rep-1 9.02.01: A s the EDI team, I wa nt to repl icate the functional ity execut ed in the EMDEON_GET _MXCO_CLAI MS.BAT bat ch file so that I ca n replace and mainta in the EDI productio n system., | ||
281 | EDI_Gatewa y (CM),892 153,5010Re p-19.01.04 : Replace VA_DUPLICA TE_CLAIM_C HECKER.py Functional ity,5010Re p-19.01.04 : As the E DI team, I want to r eplicate t he functio nality exe cuted in t he VA_DUPL ICATE_CLAI M_CHECKER. py batch f ile so tha t I can re place and maintain t he EDI pro duction sy stem., | ||
282 | EDI_Gatewa y (CM),892 152,5010Re p-19.01.03 : Replace EMDEONCLMI NRENAME.ba t Function ality,5010 Rep-19.01. 03: As the EDI team, I want to replicate the funct ionality e xecuted in the EMDEO NCLMINRENA ME.BAT bat ch file so that I ca n replace and mainta in the EDI productio n system., | ||
283 | EDI_Gatewa y (CM),892 150,5010Re p-19.01.01 : Replace EMDEONREPO RTS.bat Fu nctionalit y,5010Rep- 19.01.01: As the EDI team, I w ant to rep licate the functiona lity execu ted in the EMDEONREP ORTS.BAT b atch file so that I can replac e and main tain the E DI product ion system ., | ||
284 | EDI_Gatewa y (CM),892 147,5010Re p-19.01.02 : Replace EMDEONCLAI M.bat Func tionality, 5010Rep-19 .01.02: As the EDI t eam, I wan t to repli cate the f unctionali ty execute d in the E MDEONCLAIM .BAT batch file so t hat I can replace an d maintain the EDI p roduction system., | ||
285 | |||
286 | |||
287 | |||
288 | |||
289 | |||
290 | |||
291 | |||
292 | |||
293 | |||
294 | |||
295 | |||
296 | |||
297 | |||
298 | |||
299 | |||
300 | |||
301 | |||
302 | |||
303 |
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