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1 | CCRS.zip\CCRS\CCRS-BUSRULES-v1.5.3.zip\CCRS-BUSRULES-v1.5.3-436e6fff1115001d614ccd45b469ad60a9bdb27b\docs | Build_Plan.docx | Tue Apr 10 06:18:41 2018 UTC |
2 | CCRS.zip\CCRS\CCRS-BUSRULES-v1.5.3.zip\CCRS-BUSRULES-v1.5.3-436e6fff1115001d614ccd45b469ad60a9bdb27b\docs | Build_Plan.docx | Fri Jun 15 14:45:31 2018 UTC |
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1 | Community Care Reimb ursement S ystem (CCR S) | |
2 | Build 1 | |
3 | ||
4 | ||
5 | ||
6 | Department of Vetera ns Affairs (VA) | |
7 | Office of Informatio n and Tech nology (OI T) | |
8 | October 20 17 | |
9 | Version 4. 0 | |
10 | Document V ersion His tory | |
11 | Date | |
12 | Version | |
13 | Descriptio n | |
14 | Author | |
15 | 10/17/2017 | |
16 | 4.0 | |
17 | Updated to incorpora te sprints 001 and 0 02 | |
18 | CCRS Devel opment Tea m | |
19 | 10/10/2017 | |
20 | 3.0 | |
21 | Updated to accept ch anges and review goa ls | |
22 | CCRS Devel opment Tea m | |
23 | 9/29/2017 | |
24 | 2.0 | |
25 | Updated wi th Feedbac k and corr ections fr om OIT and Business Stakeholde rs | |
26 | CCRS Devel opment Tea m | |
27 | 9/27/2017 | |
28 | 1.0 | |
29 | Initial su bmission | |
30 | CCRS Devel opment Tea m | |
31 | Note: The revision h istory cyc le begins once chang es or enha ncements a re request ed after t he documen t has been baselined . | |
32 | ||
33 | Table of C ontents | |
34 | 1.Backgrou nd1 | |
35 | 2.Roadmap1 | |
36 | 3.Build Su mmary2 | |
37 | 4.Build 1 Goals2 | |
38 | 5.Build Ex ecution3 | |
39 | 6.Scrum Te ams3 | |
40 | 6.1.FTC Or ganization Chart3 | |
41 | 6.2.CCRS D evelopment Capacity4 | |
42 | 7.RM Busin ess Epics, Sub-Epics and User Stories4 | |
43 | 8.Assumpti ons and Co nstraints6 | |
44 | 9.Schedule 7 | |
45 | 10.Build 1 – Sprint 1 – CM Wor k Item Sto ries7 | |
46 | 10.1.Sprin t 1 Work P roducts7 | |
47 | 10.2.Sprin t 1 – Team 18 | |
48 | 10.3.Sprin t 1 – Team 28 | |
49 | 10.4.Sprin t 1 – Team 39 | |
50 | 10.5.Sprin t 1 – Team 410 | |
51 | 11.Build 1 – Sprint 2 – Work I tem Storie s11 | |
52 | 11.1.Sprin t 2 Work P roducts11 | |
53 | 11.2.Sprin t 2 – Team 112 | |
54 | 11.3.Sprin t 2 – Team 213 | |
55 | 11.4.Sprin t 2 – Team 313 | |
56 | 11.5.Sprin t 2 – Team 415 | |
57 | 12.Build 1 – Sprint 3 – Work I tem Storie s15 | |
58 | 13.Build 1 – Sprint 4 – Work I tem Storie s16 | |
59 | 14.Build 1 – Sprint 5 – Work I tem Storie s16 | |
60 | 15.Build 1 – Sprint 6 – Work I tem Storie s16 | |
61 | 16.End of Build 1 De monstrable Content17 | |
62 | 17.Appendi x – Accept ance Crite ria17 | |
63 | ||
64 | Background | |
65 | The VHA Of fice of Co mmunity Ca re (VHA CC ) requires an Inform ation Tech nology sol ution to h andle auto mated proc essing of invoices, from intak e to payme nt. This i ncludes th e verifica tion of pa yment accu racy of in voices sub mitted by the Commun ity Care N etwork (CC N) contrac tors. To a chieve the goal of b eing a tru sted and t imely busi ness partn er with th e Communit y Care Net work contr actors and their pro viders, VH A CC must implement a proven a dministrat ion and wo rkflow too l that pro vides auto mated deni als or pay ment, whil e also pro viding for rigorous post-payme nt busines s analytic s. The Com munity Car e Reimburs ement Syst em (CCRS) will be bu ilt to sup port both the VHA CC and the C CN contrac tors. | |
66 | The use of industry standard a utomation and analyt ics in CCR S greatly reduces im proper pay ments by e liminating human err or, standa rdizing bu siness rul es and pra ctices acr oss the en terprise, and provid es robust analytics for the id entificati on of 3rd party bill ing requir ements as well as Fr aud, Waste , and Abus e. CCRS wi ll employ automation to valida te Communi ty Care in voices (in cluding ph armacy) su bmitted by the contr acted Comm unity Care Networks. CCRS will enable ac curate rei mbursement payments to the CCN s for the submitted 837 Coordi nation of Benefits ( COB) invoi ces as wel l as facil itate audi t and reve nue recove ry activit ies (e.g., 3rd Party billing). | |
67 | Developmen t of CCRS as an invo ice valida tion and r eimburseme nt system will addre ss the req uirement t o validate invoices for reimbu rsement ra ther than adjudicate claims fo r payment. Further, CCRS will support ca se managem ent capabi lity throu gh a workf low system for post- payment pr ocesses. | |
68 | Roadmap | |
69 | The CCRS d evelopment for Build 1 will st art in Oct ober 2017 and will e nd in Janu ary 2018 w ith a targ et release date of M arch 2018. | |
70 | CCRS Build 1 | |
71 | eRepos w/ 837 generi c Interfac e (inbound ) -> Compl ete or Rej ect | |
72 | IAM/MVI In terface (i nbound) | |
73 | IPPS Repor ting Inter face Phase 1 (outbou nd) | |
74 | PPMS Inter face Phase 1 with Mo ck JSON (i nbound) | |
75 | CCR&A Inte rface via flat file (inbound) | |
76 | Business R ules for R eimburseme nt -> Pay or Deny Ph ase I | |
77 | *Note: PPM S and CCR& A interfac es will be developed in two ph ases subje ct to crit ical data element pr ioritizati on | |
78 | The figure below sho ws the cap ability th at we will build for Build 1. | |
79 | ||
80 | ||
81 | ||
82 | Build Summ ary | |
83 | CCRS Build 1 will fo cus on ini tial funct ionality t o support reimbursem ent, inclu ding the d evelopment of ETL ro utines to extract, t ransform a nd load 83 7 COB data into the CCRS datab ase. Reimb ursement b usiness ru les will b e develope d to asses s payment or denial. CCRS Buil d 1 will a lso delive r the firs t iteratio ns of the MVI/IAM, C CR&A, IPPS , and PPMS interface s that pro vide data required b y the reim bursement business r ules. | |
84 | Build 1 Go als | |
85 | This build plan incl udes the h igh level build goal s for CCRS Build 1 d evelopment : | |
86 | Implement the core d atabase sc hema to su pport inco ming 837 C OB and NCP DP invoice s | |
87 | Load stati c referenc e datasets into CCRS database | |
88 | Develop co de to extr act, trans form and l oad 837 CO B and NCPD P invoice data into the CCRS d atabase | |
89 | The follow ing compli ance Epics will be a ddressed i n this bui ld DEA.04. 02.03 DEA. 04.05.04 D EA.04.03.0 1 DEA.04.0 5.02 DEA.0 4.02.02 | |
90 | Developmen t will occ ur in the contractor environme nt for Bui ld 1. Team 3 (Interf aces) will also use the VA Dev and Test environmen ts to work with inte rface part ners | |
91 | CCRS VA de v and test environme nts will b e fully co nfigured b y the end of the bui ld | |
92 | Regression testing, SQA, and u ser accept ance testi ng will be conducted at the en d of the b uild | |
93 | Implement all 837 CO B and NCPD P ETL data completen ess valida tions | |
94 | Documented interface trigger d ates (the date when the interf ace must b e availabl e to the C CRS develo pment team ) and comm unicated C CRS schedu le with in terface te ams | |
95 | First iter ation of t he IAM/MVI Interface (inbound) , IPPS Rep orting Int erface (ou tbound), P PMS Interf ace with M ock JSON ( inbound), and CCR&A Interface via flat f ile (inbou nd) | |
96 | Implement additional schema to support a uthoritati ve data fr om service partners as their s chemas and services become ava ilable | |
97 | Identify a ll data el ements req uired by R evenue Ope rations fo r the work flow tool. Categoriz e and grou p data ele ments into logical g rouping in order to identify e ntity rela tionships | |
98 | Complete i nitial des ign and wi reframe of case mana gement use r interfac e and work flow user interface | |
99 | Develop an d create r eimburseme nt busines s rules (r eferral # on invoice , duplicat e, timely filing, da tes of ser vice, LEIE , provider CCN valid ation) for invoices | |
100 | Develop, r eview and document w orkflow ru les that c an be impl emented in the case management business model ODM rules | |
101 | ||
102 | Our intent ion is to develop th e proof of concept f or CCRS Bu ild 1 as p er the roa dmap outsi de of the VA environ ment. Reg ression te sting and proof of c oncept wil l be compl eted for B uild 1. | |
103 | Build Exec ution | |
104 | During the build, sc rum teams will creat e, elabora te, develo p, and tes t CM Work Items in s upport of the RM Bus iness User Stories. The teams work in a cadence of two weeks per sprin t and ther e are six (6) sprint s in a bui ld. During sprint ex ecution, t he teams a lso conduc t agile ce remonies ( e.g., spri nt plannin g, daily s crums, spr int review ). The tea ms and the Product O wner plan for sprint s by movin g Work Ite m Stories from the b acklog int o the spri nt. | |
105 | Teams work at the ab ove cadenc e to build value tow ard the co mmitted go als for th e build. T hey comple te Work It em Stories in ranked order, ba sed on the priority establishe d in the C M backlog by the Pro duct Owner . The comp leted Work Item Stor ies in a S print will be marked as Done o nly they h ave passed all assoc iated QM t ests which incorpora te the acc eptance cr iteria. | |
106 | Defects fo und during sprints w ill be eva luated by the CCRS t eam and th e Product Owner, who will prio ritize thi s new Work Item with in the CM backlog. A t the end of the spr int, the C CRS team w ill demons trate work products during the sprint re view. | |
107 | Scrum Team s | |
108 | Developmen t capacity will be b ased on th e develope rs, busine ss analyst s, and tes ters assig ned to the each scru m team. A team’s cap acity is d etermined by its res ource comp osition. E ach resour ce in the scrum team is allott ed six (6) effective daily wor k hours, w ith the re maining tw o (2) hour s dedicate d to admin istrative tasks (e.g ., emails, meetings) . We also allocated an average of one (1 ) day per resource d edicated t o sprint c eremonies. | |
109 | FTC Organi zation Cha rt | |
110 | ETL Data I ntegration | |
111 | Team 1 | |
112 | Revenue Op erations | |
113 | Team 2 | |
114 | Interfaces | |
115 | Team 3 | |
116 | ODM Busine ss Rules | |
117 | Team 4 | |
118 | Chuck Tols on – Progr am Manager | |
119 | Jay Lahiri – Project Manager | |
120 | Aamir Syed – Revenue Operation s SME | |
121 | Neetika Si ngh – Seni or Configu ration Man ager | |
122 | Jose Urdan eta – Ente rprise Arc hitect / C SM | |
123 | Evelyn Cru z – Projec t Coordina tor | |
124 | Shadi Soli man | |
125 | Team I Lea d | |
126 | Meghan McG rane | |
127 | BA / Team II Lead | |
128 | Brendan Ho ar | |
129 | Team III L ead | |
130 | Jennifer L ucas | |
131 | BA / Team IV Lead | |
132 | Anil Kowat ra | |
133 | Sr. Develo per | |
134 | Nick Norri s | |
135 | Sr. Develo per | |
136 | Ron Celis | |
137 | Sr. Develo per | |
138 | Ken Phaupp | |
139 | Sr. Develo per | |
140 | Roman Shly apak | |
141 | Sr. Develo per | |
142 | Bala Gopal an | |
143 | Sr. Develo per | |
144 | William Wi lliams | |
145 | Sr. Develo per | |
146 | David Wei | |
147 | Sr. Develo per | |
148 | Vivien Pur ifoy-Do Sr . Business Analyst | |
149 | Angela Ru | |
150 | Business A nalyst | |
151 | Margaret W on | |
152 | Sr. Busine ss Analyst | |
153 | Sasha Anav iev | |
154 | Sr. Lead D eveloper | |
155 | Iqra Youni s | |
156 | Tester | |
157 | Mossammad Akter | |
158 | Tester | |
159 | Sam Khanla rbig | |
160 | Tester | |
161 | Latifa Joh nson | |
162 | Tester | |
163 | Denis Luko nin | |
164 | Developer | |
165 | Adam Newto n | |
166 | Developer | |
167 | Scott Baue r | |
168 | Training D eveloper / BA | |
169 | David Mull aney | |
170 | Developer | |
171 | CCRS Devel opment Cap acity | |
172 | Each devel opment res ource has the capaci ty to work six (6) h ours per d ay during each ten ( 10) busine ss day spr int, total ing 60 hou rs every t wo weeks. The equiva lent of on e day (six hours) wi ll be dedi cated to s print cere monies and therefore each reso urce in th e scrum te ams will h ave an est imated 54 hours of e ffective t ime in eac h sprint. | |
173 | Work Item Tasks perf ormed by t he teams a re aligned to Work I tem Storie s and Work Item Epic s in CM. T he Work It em Stories are also linked to RM Busines s User Sto ries. The sprint dev elopment c apacity is depicted below. | |
174 | Please not e that the capacity for each t eam, withi n a sprint , will var y dependin g upon pro ject prior ities and availabili ty of reso urces. The full capa city by te am is depi cted below ; this ref lects capa city in ev ery two-we ek cycle o r capacity by sprint . | |
175 | Team 1 | |
176 | Team 2 | |
177 | Team 3 | |
178 | Team 4 | |
179 | 324 (hours ) | |
180 | 324 (hours ) | |
181 | 324 (hours ) | |
182 | 324 (hours ) | |
183 | RM Busines s Epics, S ub-Epics a nd User St ories | |
184 | The follow ing table describes the Ration al (RM) Bu siness epi cs, Sub-Ep ics and Us er Stories that the CM Work It em Stories will be a dvancing d uring the entire Dev elopment B uild 1. Fu ll complet ion of CM Work Item Stories wi thin the s print allo ws the spr int to be reviewed, accepted a nd closed. The team will work to obtain acceptance of the wo rk product s and func tionality that is de veloped to advance t hese Busin ess User S tories. Pl ease note that the b usiness us er stories within RM were not scoped to be complet ed within one build. For examp le, many b usiness us er stories combine b oth reimbu rsement an d revenue operations requireme nts and th e business owner has instructe d us to pr ioritize t he deliver y of reimb ursement f unctionali ty. | |
185 | Team | |
186 | RM Epic / Sub-Epic | |
187 | Story# | |
188 | Rational | |
189 | Business U ser Story Descriptio n | |
190 | Team 1 & T eam 3 | |
191 | 001.001 | |
192 | ClaimsStor y001 | |
193 | RM: 912201 , QM: 1527 97 | |
194 | As a CCRS User, I ne ed the Sys tem to rec eive all i nvoices su bmitted 83 7I COB (In stitutiona l) reimbur sement cla ims direct ly from th e clearing house so t hat the Sy stem recei ves all cl aims that pass front end edits . | |
195 | Team 1 & T eam 3 | |
196 | 001.001 | |
197 | ClaimsStor y002 | |
198 | RM: 912202 , QM: 1528 12 | |
199 | As a CCRS User, I ne ed the Sys tem to rec eive all i nvoices su bmitted 83 7P COB (Pr ofessional ) reimburs ement clai ms directl y from the clearingh ouse so th at the Sys tem receiv es all cla ims that p ass front end edits. | |
200 | Team 1 & T eam 3 | |
201 | 001.001 | |
202 | ClaimsStor y003 | |
203 | RM: 912192 , QM: 1528 14 | |
204 | As a CCRS User, I ne ed the Sys tem to rec eive all i nvoices 83 7D COB (De ntal) reim bursement claims dir ectly from the clear inghouse s o that the System re ceives all claims th at pass fr ont end ed its. | |
205 | Team 1 | |
206 | 001.001 | |
207 | ClaimsStor y004 | |
208 | RM: 912200 , QM: 1528 26 | |
209 | As a CCRS User, I ne ed the Sys tem to tra nsform the 837 COBs into a con sumable cl aim invoic e into CCR S, so that the invoi ces can be evaluated . | |
210 | Team 1 & T eam 4 | |
211 | 001.001 | |
212 | ClaimsStor y005 | |
213 | RM: 912196 , QM: 1528 33 | |
214 | As a CCRS User, I ne ed the Sys tem to eva luate the claim invo ice to ens ure data c ompletenes s, so that only comp lete claim invoices are accept ed into CC RS. | |
215 | Team 1 | |
216 | 001.001 | |
217 | ClaimsStor y006 | |
218 | RM: 912191 , | |
219 | QM: 152835 | |
220 | As a CCRS User, I ne ed the Sys tem to rej ect claim invoices t hat failed data comp leteness e dits, so t hat we may store and communica te rejecti ons. | |
221 | Team 1 | |
222 | 001.001 | |
223 | ClaimsStor y007 | |
224 | RM: 912205 , | |
225 | QM: 152838 | |
226 | As a CCRS User, I ne ed the Sys tem to sto re all acc epted clai m invoices that pass ed data co mpleteness edits, so that we m ay process for reimb ursement. | |
227 | Team 2 | |
228 | 001.004 | |
229 | ClaimsStor y182 | |
230 | RM: 918560 | |
231 | QM: 153605 | |
232 | As Revenue Operation s, I need to be able to view a ll Communi ty Care Pr ogram clai ms in a st andard cla im viewer so that VH A Communit y Care sta ff view cl aims withi n the syst em in a si milar form at. | |
233 | Team 2 | |
234 | 001.004 | |
235 | ClaimsStor y180 | |
236 | RM: 918558 | |
237 | QM: 153600 | |
238 | As Revenue Operation s, I need to be able to route paid claim data to o ther Reven ue departm ents (Faci lity Reven ue (FR), I nsurance V erifiers ( IV), Reven ue Utiliza tion Revie w (RUR), a nd Billing ) so that we can fac ilitate VA Third Par ty Billing . | |
239 | Team 2 | |
240 | 001.004 | |
241 | ClaimsStor y044 | |
242 | RM: 918512 , | |
243 | QM: 153437 | |
244 | As Revenue Operation s, I need to identif y Veteran copayment eligibilit y requirem ent data, so that I can access the workl ist of app licable re venue reco very work items. | |
245 | Team 2 | |
246 | 001.005 | |
247 | ClaimsStor y157 | |
248 | RM: 918544 , | |
249 | QM: 153582 | |
250 | As a Reven ue Operati ons staff, I need to view all line level claim dat a within t he CCRS Re pository, so that I can determ ine VA cos t recovery opportuni ties for T hird Party billable health ins urance | |
251 | Team 3 | |
252 | ||
253 | 001.001 | |
254 | ClaimsStor y191 | |
255 | RM: 912190 , QM: 1528 16 | |
256 | As a CCRS User, I ne ed the Sys tem to rec eive all i nvoices Ph armacy for m NCPDP D. 0 reimburs ement clai ms directl y from the clearingh ouse so th at the Sys tem receiv es all cla ims that p ass front end edits. | |
257 | Team 3 | |
258 | 001.001 | |
259 | ClaimsStor y023 | |
260 | RM: 912209 , QM: 1530 93 | |
261 | As a CCRS User, I ne ed the Sys tem to aut omatically match inv oices to e xisting re ferrals wi thin CCRS, so only m atched inv oices are processed. | |
262 | Team 3 | |
263 | 001.002 | |
264 | ClaimsStor y015 | |
265 | RM: 912189 , QM: 1529 71 | |
266 | As a CCRS User, I ne ed the Sys tem to aut omatically identify the patien t on the r eimburseme nt invoice claims us ing the Un ique Ident ifier so t hat I can validate t he patient ’s active membership for payme nt approva l. | |
267 | Team 4 | |
268 | 001.003 | |
269 | ClaimsStor y029 | |
270 | RM: 912199 , | |
271 | QM: 153098 | |
272 | As a CCRS User, I ne ed the Sys tem to aut omatically identify the duplic ate reimbu rsement in voice clai ms using t he unique combinatio n of claim line data so that I can valid ate the re imbursemen t claim us ing this c ombination for front end proces sing claim rejection . | |
273 | Team 4 | |
274 | 001.002 | |
275 | ClaimsStor y010 | |
276 | RM: 912211 | |
277 | QM: 152957 | |
278 | As a CCRS User, I ne ed the Sys tem to aut omatically process O utpatient invoices t o validate invoices by applyin g correspo nding edit ing rules so that th e system p rocesses w ith the pr oper appro val/denial completio n and assi gnment to correspond ing workfl ow as need ed. | |
279 | Team 4 | |
280 | 001.002 | |
281 | ClaimsStor y192 | |
282 | RM: 912214 | |
283 | QM: 153086 | |
284 | As a CCRS User, I ne ed the Sys tem to aut omatically process D ental invo ices so th at the inv oice is va lidated by applying the corres ponding ed iting rule s so that it's rerou ted to the correspon ding workf low queue for approv al/denial completion . | |
285 | Team 4 | |
286 | 001.002 | |
287 | ClaimsStor y011 | |
288 | RM: 912207 | |
289 | QM: 152959 | |
290 | As a CCRS User, I ne ed the Sys tem to aut omatically process I npatient i nvoices to validate invoices b y applying correspon ding editi ng rules s o that the system pr ocesses wi th the pro per approv al/denial completion and assig nment to c orrespondi ng workflo w as neede d. | |
291 | Team 4 | |
292 | 001.002 | |
293 | ClaimsStor y013 | |
294 | RM: 912206 | |
295 | QM: 152963 | |
296 | As a CCRS User, I ne ed the Sys tem to aut omatically process P harmacy in voices so that the i nvoice is validated by applyin g the corr esponding editing ru les so tha t it's rer outed to t he corresp onding wor kflow queu e for appr oval/denia l completi on. **Nati onal Counc il for Pre scription Drug Progr ams, (NCPD P)** | |
297 | Please not e that RM Business U ser Storie s may exte nd over mu ltiple spr ints and/o r builds. However, C M Work Ite m Stories and Tasks are expect ed to be c ompleted i n a single sprint. T he details of Work I tem Storie s to be co mpleted in this spri nt are lis ted in Sec tion 8 (Sc hedule). | |
298 | Assumption s and Cons traints | |
299 | The CCRS D evelopment Team will use mock artifacts (e.g., ser vices, dat a, files, drop zone, reporting ) while aw aiting rep resentativ e CCN invo ices. | |
300 | The CCRS D evelopment Team requ ires VA in tranet acc ess and el evated pri vileges in order to perform de velopment and testin g in the V A environm ent. | |
301 | The CCRS d evelopment team has a requirem ent to hav e elevated access ap proved in higher lev el environ ments (Pre prod, Prod ) before c onfigurati ons and in stallation s can be c ompleted f or code pr omotion in support t o UAT and end-to-end testing | |
302 | The CCRS D evelopment team requ ires ERepo s connecti vity with AITC serve r CCRS dro p zones to simulate 837 COB tr ansmission s to compl ete RM use r stories | |
303 | The CCRS D evelopment team requ ires estab lishment o f the CCNs and repre sentative samples of all contr actor 837 COBs in or der to com plete RM u ser storie s | |
304 | The CCRS D evelopment team requ ires IBM C FM softwar e to be do wnloaded b y VA staff and made available on VA deve lopment se rvers to b e able to complete R M user sto ries | |
305 | The CCRS D evelopment team requ ires that data from the eight pilot site s (four VA MCs and fo ur clinics ) be repre sentative of all fou r CCNs acr oss 837 CO B and NCPD P claim in voice type s prior to be able t o complete RM user s tories | |
306 | The CCRS D evelopment team requ ires deliv ery of rep resentativ e 837/NCPD P data fro m the CCN to eRepos to CCRS pr ior to com pleting RM user stor ies | |
307 | The CCRS D evelopment team requ ires autho ritative r eferral, p rovider an d invoice data prior to be abl e to compl ete RM use r stories | |
308 | The CCRS D evelopment team requ ires agree ment from our interf ace partne rs on dev/ test sched ule by Oct ober 17th for the fo llowing in terfaces: MVI/IAM, P PMS, CCR&A , IPPS. | |
309 | Schedule | |
310 | The follow ing table records th e week by week sched ule for Bu ild 1. Ple ase notice some spri nts will b e short in capacity due to hol idays. | |
311 | Developmen t Build 1 | |
312 | Week | |
313 | Start | |
314 | Week | |
315 | End | |
316 | Days in | |
317 | Week | |
318 | Contract | |
319 | Week | |
320 | Sprint | |
321 | Number | |
322 | 10/17/2017 | |
323 | 10/20/2017 | |
324 | 4 | |
325 | Week 21 | |
326 | Sprint 1 | |
327 | 10/23/2017 | |
328 | 10/30/2017 | |
329 | 5 | |
330 | Week 22 | |
331 | Sprint 1 | |
332 | 10/31/2017 | |
333 | 11/3/2017 | |
334 | 4 | |
335 | Week 23 | |
336 | Sprint 2 | |
337 | 11/6/2017 | |
338 | 11/13/2017 | |
339 | 5 | |
340 | Week 24 | |
341 | Sprint 2 | |
342 | 11/14/2017 | |
343 | 11/17/2017 | |
344 | 4 | |
345 | Week 25 | |
346 | Sprint 3 | |
347 | 11/20/2017 | |
348 | 11/27/2017 | |
349 | 5 | |
350 | Week 26 | |
351 | Sprint 3 | |
352 | 11/28/2017 | |
353 | 12/1/2017 | |
354 | 4 | |
355 | Week 27 | |
356 | Sprint 4 | |
357 | 12/4/2017 | |
358 | 12/11/2017 | |
359 | 5 | |
360 | Week 28 | |
361 | Sprint 4 | |
362 | 12/12/2017 | |
363 | 12/15/2017 | |
364 | 4 | |
365 | Week 29 | |
366 | Sprint 5 | |
367 | 12/18/2017 | |
368 | 12/25/2017 | |
369 | 5 | |
370 | Week 30 | |
371 | Sprint 5 | |
372 | 12/26/2017 | |
373 | 12/29/2017 | |
374 | 4 | |
375 | Week 31 | |
376 | Sprint 6 | |
377 | 1/8/2018 | |
378 | 1/12/2018 | |
379 | 5 | |
380 | Week 32 | |
381 | Sprint 6 | |
382 | Build 1 – Sprint 1 – CM Work I tem Storie s | |
383 | The follow ing tables record Ra tional CM Work Item Stories to be comple ted in Bui ld 1. | |
384 | Sprint 1 W ork Produc ts | |
385 | Team | |
386 | Work Produ cts | |
387 | Team 1 | |
388 | 837I ETL d ata comple teness val idations r equirement s document ation | |
389 | Test claim s data for ETL 837I load | |
390 | Test cases and test scripts fo r validati on of 837I data load | |
391 | Team 2 | |
392 | Documented and categ orized dat a elements and sourc es for Rev enue Opera tions | |
393 | Documented logical g roupings o f data ele ments | |
394 | Diagram of entity re lationship s | |
395 | Elaborate requiremen ts, Revenu e Operatio ns busines s rules, a nd accepta nce criter ia in meet ing minute s | |
396 | Team 3 | |
397 | DB Schema for CCR&A (new versi on) | |
398 | IAD for CC RA (new ve rsion) | |
399 | IAD for IA M/MVI (new version) | |
400 | Meeting no tes (IAM/M VI) | |
401 | Meeting no tes (CCRA) | |
402 | Meeting no tes (PPMS) | |
403 | Interfaces Dependenc ies/Schedu le Integra tion docum ent update d | |
404 | Team 4 | |
405 | Prototype business r ule code f or minimum acceptanc e criteria for outpa tient invo ices | |
406 | ||
407 | Sprint 1 – Team 1 | |
408 | Task Name | |
409 | Duration | |
410 | Start | |
411 | Finish | |
412 | ||
413 | Sprint 1 | |
414 | 10 Days | |
415 | Tues 10/17 /2017 | |
416 | Mon 10/30/ 2017 | |
417 | ||
418 | Team | |
419 | CM Work It em Story D escription | |
420 | CM Work It em Epic | |
421 | CM Work It em Sub Epi c | |
422 | CM Work It em Story | |
423 | CM Work It em Story P oints | |
424 | Total CM | |
425 | Work Item | |
426 | Task(s) | |
427 | Hours | |
428 | RM Busines s User Sto ry | |
429 | (traceabil ity) | |
430 | Team 1 | |
431 | S1-CS001-E TL-Develop 837I COB Data Compl eteness Va lidations | |
432 | 587828 | |
433 | 588310 | |
434 | 594128 | |
435 | 5 | |
436 | 32 | |
437 | 912201: Cl aimsStory0 01 | |
438 | ||
439 | S1-CS001-E TL-Develop 837I COB Data Mappi ngs | |
440 | 587828 | |
441 | 588311 | |
442 | 594130 | |
443 | 5 | |
444 | 88 | |
445 | 912201: Cl aimsStory0 01 | |
446 | ||
447 | S1-CS001-E TL-Databas e updates to support 837I COB ETL | |
448 | 587828 | |
449 | 588314 | |
450 | 594136 | |
451 | 5 | |
452 | 96 | |
453 | 912201: Cl aimsStory0 01 | |
454 | ||
455 | S1-CS001-C ode Develo pment Hard ening | |
456 | 587828 | |
457 | 588314 | |
458 | 594140 | |
459 | 5 | |
460 | 112 | |
461 | 912201: Cl aimsStory0 01 | |
462 | Sprint Mil estone / C eremony | |
463 | Hours | |
464 | Participan ts | |
465 | Date | |
466 | ||
467 | Sprint Kic koff / Pla nning | |
468 | 4 hours | |
469 | FTC + VA | |
470 | Tues (1st) | |
471 | ||
472 | Sprint Dai ly Scrum, Rational U pdates | |
473 | 1 hour | |
474 | FTC + VA | |
475 | Daily | |
476 | ||
477 | Scheduled Backlog Gr ooming | |
478 | 1 hour | |
479 | FTC + VA | |
480 | Mon | |
481 | ||
482 | Sprint Rev iew and De monstratio n | |
483 | 1 hour | |
484 | FTC + VA | |
485 | Mon (3rd) | |
486 | ||
487 | Sprint 1 – Team 2 | |
488 | Task Name | |
489 | Duration | |
490 | Start | |
491 | Finish | |
492 | ||
493 | Sprint 1 | |
494 | 10 Days | |
495 | Tues 10/17 /2017 | |
496 | Mon 10/30/ 2017 | |
497 | ||
498 | Team | |
499 | CM Work It em Story D escription | |
500 | CM Work It em Epic | |
501 | CM Work It em Sub Epi c | |
502 | CM Work It em Story | |
503 | CM Work It em Story P oints | |
504 | Total CM | |
505 | Work Item | |
506 | Task(s) | |
507 | Hours | |
508 | RM Busines s User Sto ry | |
509 | (traceabil ity) | |
510 | Team 2 | |
511 | S2- Docume nt data el ements and sources f or cases r eviewed by Revenue O perations | |
512 | 587928 | |
513 | 605304 | |
514 | 605226 | |
515 | 5 | |
516 | 60 | |
517 | 918544: Cl aimsStory1 57 | |
518 | ||
519 | S2- Valida te identif ied data e lements wi th Revenue Operation s | |
520 | 587928 | |
521 | 605304 | |
522 | 605227 | |
523 | 2 | |
524 | 30 | |
525 | 918544: Cl aimsStory1 57 | |
526 | ||
527 | S2- Perfor m technica l review o f the CCRS Data Repo sitory | |
528 | 587928 | |
529 | 605304 | |
530 | 605230 | |
531 | 5 | |
532 | 60 | |
533 | 918544: Cl aimsStory1 57 | |
534 | ||
535 | S2- Valida te all ide ntified da ta element s against CCRS Data Repository | |
536 | 587928 | |
537 | 605116 | |
538 | 605233 | |
539 | 1 | |
540 | 24 | |
541 | 918544: Cl aimsStory1 57 | |
542 | ||
543 | S2- Catego rize data elements i nto requir ed, option al and int o logical groups | |
544 | 587928 | |
545 | 605116 | |
546 | 605240 | |
547 | 5 | |
548 | 60 | |
549 | 918544: Cl aimsStory1 57 | |
550 | ||
551 | S2- Elabor ate requir ements, wo rkflow rul es, and ac ceptance c riteria | |
552 | 587954 | |
553 | 605241 | |
554 | 605293 | |
555 | 3 | |
556 | 45 | |
557 | 918512: Cl aimsStory0 44 | |
558 | ||
559 | S2-Build 1 Sprint 1 CCRS Busin ess Analys is and Pro ject Suppo rt | |
560 | 593805 | |
561 | 604638 | |
562 | 605215 | |
563 | 3 | |
564 | 45 | |
565 | -- | |
566 | Sprint Mil estone / C eremony | |
567 | Hours | |
568 | Participan ts | |
569 | Date | |
570 | ||
571 | Sprint Kic koff / Pla nning | |
572 | 4 hours | |
573 | FTC + VA | |
574 | Tues (1st) | |
575 | ||
576 | Sprint Dai ly Scrum, Rational U pdates | |
577 | 1 hour | |
578 | FTC + VA | |
579 | Daily | |
580 | ||
581 | Scheduled Backlog Gr ooming | |
582 | 1 hour | |
583 | FTC + VA | |
584 | Mon | |
585 | ||
586 | Sprint Rev iew and De monstratio n | |
587 | 1 hour | |
588 | FTC + VA | |
589 | Mon (3rd) | |
590 | ||
591 | Sprint 1 – Team 3 | |
592 | Task Name | |
593 | Duration | |
594 | Start | |
595 | Finish | |
596 | ||
597 | Sprint 1 | |
598 | 10 Days | |
599 | Tues 10/17 /2017 | |
600 | Mon 10/30/ 2017 | |
601 | ||
602 | Team | |
603 | CM Work It em Story D escription | |
604 | CM Work It em Epic | |
605 | CM Work It em Sub Epi c | |
606 | CM Work It em Story | |
607 | CM Work It em Story P oints | |
608 | Total CM | |
609 | Work Item | |
610 | Task(s) | |
611 | Hours | |
612 | RM Busines s User Sto ry | |
613 | (traceabil ity) | |
614 | Team 3 | |
615 | S3-IAM/MVI -11-Docume nting Stak eholder re view | |
616 | 587892 | |
617 | 592249 | |
618 | 592268 | |
619 | 1 | |
620 | 13.5 | |
621 | 912189: Cl aimsStory0 15 | |
622 | ||
623 | S3-PPMS-02 -Coordinat ing with E nterprise Architect | |
624 | 587828 | |
625 | 592252 | |
626 | 592297 | |
627 | 2 | |
628 | 27 | |
629 | 912201: Cl aimsStory0 01 | |
630 | ||
631 | S3-IAM/MVI -14-Design DB Schema | |
632 | 587892 | |
633 | 592249 | |
634 | 592271 | |
635 | 3 | |
636 | 40.5 | |
637 | 912189: Cl aimsStory0 15 | |
638 | ||
639 | S3-IAM/MVI -12-Coordi nating wit h RO | |
640 | 587892 | |
641 | 592249 | |
642 | 592269 | |
643 | 1 | |
644 | 13.5 | |
645 | 912189: Cl aimsStory0 15 | |
646 | ||
647 | S3-IAM/MVI -13-Docume ntation RO review | |
648 | 587892 | |
649 | 592249 | |
650 | 592270 | |
651 | 1 | |
652 | 13.5 | |
653 | 912189: Cl aimsStory0 15 | |
654 | ||
655 | S3-CCRA1-1 2-Coordina ting with RO | |
656 | 587916 | |
657 | 589145 | |
658 | 592344 | |
659 | 1 | |
660 | 13.5 | |
661 | 912209: Cl aimsStory0 23 | |
662 | ||
663 | S3-CCRA1-1 1-Document ing Stakeh older revi ew | |
664 | 587916 | |
665 | 589145 | |
666 | 592343 | |
667 | 1 | |
668 | 13.5 | |
669 | 912209: Cl aimsStory0 23 | |
670 | ||
671 | S3-CCRA1-1 3-Document ation RO r eview | |
672 | 587916 | |
673 | 589145 | |
674 | 592345 | |
675 | 1 | |
676 | 13.5 | |
677 | 912209: Cl aimsStory0 23 | |
678 | ||
679 | S3-IAM/MVI -36-SP1-Te st Executi on and Log ging | |
680 | 587892 | |
681 | 592251 | |
682 | 592293 | |
683 | 1 | |
684 | 13.5 | |
685 | 912189: Cl aimsStory0 15 | |
686 | ||
687 | S3-PPMS-36 -SP1-Test Execution and Loggin g | |
688 | 587828 | |
689 | 592256 | |
690 | 592331 | |
691 | 1 | |
692 | 13.5 | |
693 | 912201: Cl aimsStory0 01 | |
694 | ||
695 | S3-IAM/MVI -34-SP1-Te st Case De velopment | |
696 | 587892 | |
697 | 592251 | |
698 | 592291 | |
699 | 1 | |
700 | 13.5 | |
701 | 912189: Cl aimsStory0 15 | |
702 | ||
703 | S3-PPMS-34 -SP1-Test Case Devel opment | |
704 | 587828 | |
705 | 592256 | |
706 | 592329 | |
707 | 1 | |
708 | 13.5 | |
709 | 912201: Cl aimsStory0 01 | |
710 | ||
711 | S3-IAM/MVI -35-SP1-Te st Script Developmen t | |
712 | 587892 | |
713 | 592251 | |
714 | 592292 | |
715 | 1 | |
716 | 13.5 | |
717 | 912189: Cl aimsStory0 15 | |
718 | ||
719 | S3-PPMS-35 -SP1-Test Script Dev elopment | |
720 | 587828 | |
721 | 592256 | |
722 | 592330 | |
723 | 1 | |
724 | 13.5 | |
725 | 912201: Cl aimsStory0 01 | |
726 | ||
727 | S3-PPMS-11 -Documenti ng Stakeho lder revie w | |
728 | 587828 | |
729 | 592255 | |
730 | 592306 | |
731 | 1 | |
732 | 13.5 | |
733 | 912201: Cl aimsStory0 01912202: ClaimsStor y002912192 : ClaimsSt ory0039121 90: Claims Story191 | |
734 | ||
735 | S3-PPMS-12 -Coordinat ing with R O | |
736 | 587828 | |
737 | 592252 | |
738 | 592307 | |
739 | 1 | |
740 | 13.5 | |
741 | 912201: Cl aimsStory0 01 | |
742 | ||
743 | S3-PPMS-13 -Documenta tion RO re view | |
744 | 587828 | |
745 | 592255 | |
746 | 592308 | |
747 | 1 | |
748 | 13.5 | |
749 | 912201: Cl aimsStory0 01 | |
750 | ||
751 | S3-CCRA1-3 4-SP1-Test Case Deve lopment | |
752 | 587916 | |
753 | 592295 | |
754 | 592366 | |
755 | 1 | |
756 | 13.5 | |
757 | 912209: Cl aimsStory0 23 | |
758 | ||
759 | S3-CCRA1-3 5-SP1-Test Script De velopment | |
760 | 587916 | |
761 | 592295 | |
762 | 592367 | |
763 | 1 | |
764 | 13.5 | |
765 | 912209: Cl aimsStory0 23 | |
766 | ||
767 | S3-CCRA1-3 6-SP1-Test Execution and Loggi ng | |
768 | 587916 | |
769 | 592295 | |
770 | 592368 | |
771 | 1 | |
772 | 13.5 | |
773 | 912209: Cl aimsStory0 23 | |
774 | ||
775 | S3-CCRA1-0 2-Coordina ting with Enterprise Architect | |
776 | 587916 | |
777 | 589144 | |
778 | 592333 | |
779 | 1 | |
780 | 13.5 | |
781 | 912209: Cl aimsStory0 23 | |
782 | Sprint Mil estone / C eremony | |
783 | Hours | |
784 | Participan ts | |
785 | Date | |
786 | ||
787 | Sprint Kic koff / Pla nning | |
788 | 4 hours | |
789 | FTC + VA | |
790 | Mon (1st) | |
791 | ||
792 | Sprint Dai ly Scrum, Rational U pdates | |
793 | 1 hour | |
794 | FTC + VA | |
795 | Daily | |
796 | ||
797 | Scheduled Backlog Gr ooming | |
798 | 1 hour | |
799 | FTC + VA | |
800 | Mon | |
801 | ||
802 | Sprint Rev iew and De monstratio n | |
803 | 1 hour | |
804 | FTC + VA | |
805 | Mon (3rd) | |
806 | ||
807 | Sprint 1 – Team 4 | |
808 | Task Name | |
809 | Duration | |
810 | Start | |
811 | Finish | |
812 | ||
813 | Sprint 1 | |
814 | 10 Days | |
815 | Tues 10/17 /2017 | |
816 | Mon 10/30/ 2017 | |
817 | ||
818 | Team | |
819 | CM Work It em Story D escription | |
820 | CM Work It em Epic | |
821 | CM Work It em Sub Epi c | |
822 | CM Work It em Story | |
823 | CM Work It em Story P oints | |
824 | Total CM | |
825 | Work Item | |
826 | Task(s) | |
827 | Hours | |
828 | RM Busines s User Sto ry | |
829 | (traceabil ity) | |
830 | Team 4 | |
831 | S4-Build 1 Sprint 1 CCRS Busin ess Analys is and Pro ject Suppo rt | |
832 | 593805 | |
833 | 593811 | |
834 | 607236 | |
835 | 5 | |
836 | 69 | |
837 | - | |
838 | ||
839 | S4-Develop test case s and scri pts for Bu ild 1 Spri nt 1 | |
840 | 593805 | |
841 | 593811 | |
842 | 607207 | |
843 | 3 | |
844 | 43 | |
845 | - | |
846 | ||
847 | S4-CS010-D evelop and Design Ru les Specs, Object Mo del, and D AO | |
848 | 587860 | |
849 | 597314 | |
850 | 597343 | |
851 | 2 | |
852 | 43 | |
853 | 912211 | |
854 | ||
855 | S4-CS010-I mplement E ngines | |
856 | 587860 | |
857 | 597314 | |
858 | 597325 | |
859 | 2 | |
860 | 43 | |
861 | 912211 | |
862 | ||
863 | S4-CS010-F inalize/Se t up Devel opment Env ironment | |
864 | 587860 | |
865 | 597314 | |
866 | 597320 | |
867 | 2 | |
868 | 25 | |
869 | 912211 | |
870 | ||
871 | S4-CS010 C ode Busine ss Rules f or Dates o f Service | |
872 | 587860 | |
873 | 592731 | |
874 | 592749 | |
875 | 1 | |
876 | 19 | |
877 | 912211 | |
878 | ||
879 | S4-CS010-C ode Busine ss Rules f or Duplica tes | |
880 | 587860 | |
881 | 592731 | |
882 | 592738 | |
883 | 2 | |
884 | 30 | |
885 | 912211 | |
886 | ||
887 | S4-Elabora te Require ments for Minimum Ac ceptance C riteria | |
888 | 587860 | |
889 | 592717 | |
890 | 592700 | |
891 | 1 | |
892 | 21 | |
893 | 912211 | |
894 | ||
895 | S4-CS005-E laborate R equirement s for PPMS Queries | |
896 | 587842 | |
897 | 592690 | |
898 | 592694 | |
899 | 1 | |
900 | 3 | |
901 | 912196 | |
902 | ||
903 | S4-Build 1 Sprint 1 Resolve Im pediments | |
904 | 593805 | |
905 | 593811 | |
906 | 607428 | |
907 | 1 | |
908 | 28 | |
909 | - | |
910 | Sprint Mil estone / C eremony | |
911 | Hours | |
912 | Participan ts | |
913 | Date | |
914 | ||
915 | Sprint Kic koff / Pla nning | |
916 | 4 hours | |
917 | FTC + VA | |
918 | Mon (1st) | |
919 | ||
920 | Sprint Dai ly Scrum, Rational U pdates | |
921 | 1 hour | |
922 | FTC + VA | |
923 | Daily | |
924 | ||
925 | Scheduled Backlog Gr ooming | |
926 | 1 hour | |
927 | FTC + VA | |
928 | Mon | |
929 | ||
930 | /Sprint Re view and D emonstrati on | |
931 | 1 hour | |
932 | FTC + VA | |
933 | Fri (2nd) | |
934 | ||
935 | Build 1 – Sprint 2 – Work Item Stories | |
936 | Sprint 2 W ork Produc ts | |
937 | Team | |
938 | Work Produ cts | |
939 | Team 1 | |
940 | 837D ETL d ata comple teness val idations r equirement s document ation | |
941 | Test claim s data for ETL 837D load | |
942 | Test cases and test scripts fo r validati on of 837D data load | |
943 | Team 2 | |
944 | Documented workflow actions, r outing rul es, and ex ceptions f or each Re venue Oper ations rev iew type | |
945 | Documented cross cla im-type ma pping and defined da ta element relations hips | |
946 | Team 3 | |
947 | DB Schema for PPMS | |
948 | IAD for IA M/MVI (new version) | |
949 | IAD for PP MS (new ve rsion) | |
950 | Meeting no tes (IAM/M VI) | |
951 | Meeting no tes (CCRA) | |
952 | Meeting no tes (PPMS) | |
953 | Interfaces Dependenc ies/Schedu le Integra tion docum ent update d | |
954 | Team 4 | |
955 | Prototype business r ule code f or minimum acceptanc e criteria for inpat ient invoi ces | |
956 | Sprint 2 – Team 1 | |
957 | Task Name | |
958 | Duration | |
959 | Start | |
960 | Finish | |
961 | ||
962 | Sprint 2 | |
963 | 10 Days | |
964 | Tues 10/31 /2017 | |
965 | Mon | |
966 | 11/13/2017 | |
967 | ||
968 | Team | |
969 | CM Work It em Story D escription | |
970 | CM Work It em Epic | |
971 | CM Work It em Sub Epi c | |
972 | CM Work It em Story | |
973 | CM Work It em Story P oints | |
974 | Total CM | |
975 | Work Item | |
976 | Task(s) | |
977 | Hours | |
978 | RM Busines s User Sto ry | |
979 | (traceabil ity) | |
980 | Team 1 | |
981 | S1-CS003-E TL-Develop 837D COB Data Compl eteness Va lidations | |
982 | 587836 | |
983 | 588687 | |
984 | 594142 | |
985 | 5 | |
986 | 32 | |
987 | 912192: Cl aimsStory0 03 | |
988 | ||
989 | S1-CS003-E TL-Develop 837D COB Data Mappi ngs | |
990 | 587836 | |
991 | 588688 | |
992 | 594144 | |
993 | 5 | |
994 | 88 | |
995 | 912192: Cl aimsStory0 03 | |
996 | ||
997 | S1-CS003-E TL-Databas e updates to support 837D COB ETL | |
998 | 587836 | |
999 | 588691 | |
1000 | 594146 | |
1001 | 5 | |
1002 | 96 | |
1003 | 912192: Cl aimsStory0 03 | |
1004 | ||
1005 | S1-CS003-C ode Develo pment Hard ening | |
1006 | 587836 | |
1007 | 588691 | |
1008 | 594147 | |
1009 | 5 | |
1010 | 112 | |
1011 | 912192: Cl aimsStory0 03 | |
1012 | Sprint Mil estone / C eremony | |
1013 | Hours | |
1014 | Participan ts | |
1015 | Date | |
1016 | ||
1017 | Sprint Kic koff / Pla nning | |
1018 | 4 hours | |
1019 | FTC + VA | |
1020 | Tues (1st) | |
1021 | ||
1022 | Sprint Dai ly Scrum, Rational U pdates | |
1023 | 1 hour | |
1024 | FTC + VA | |
1025 | Daily | |
1026 | ||
1027 | Scheduled Backlog Gr ooming | |
1028 | 1 hour | |
1029 | FTC + VA | |
1030 | Mon | |
1031 | ||
1032 | Sprint Rev iew and De monstratio n | |
1033 | 1 hour | |
1034 | FTC + VA | |
1035 | Mon (3rd) | |
1036 | ||
1037 | Sprint 2 – Team 2 | |
1038 | Task Name | |
1039 | Duration | |
1040 | Start | |
1041 | Finish | |
1042 | ||
1043 | Sprint 2 | |
1044 | 10 Days | |
1045 | Tues 10/31 /2017 | |
1046 | Mon | |
1047 | 11/13/2017 | |
1048 | ||
1049 | Team | |
1050 | CM Work It em Story D escription | |
1051 | CM Work It em Epic | |
1052 | CM Work It em Sub Epi c | |
1053 | CM Work It em Story | |
1054 | CM Work It em Story P oints | |
1055 | Total CM | |
1056 | Work Item | |
1057 | Task(s) | |
1058 | Hours | |
1059 | RM Busines s User Sto ry | |
1060 | (traceabil ity) | |
1061 | Team 2 | |
1062 | S2- Identi fy workflo w routing rules and dispositio ns codes | |
1063 | 587979 | |
1064 | 605266 | |
1065 | 605269 | |
1066 | 5 | |
1067 | 62 | |
1068 | 918558: | |
1069 | ClaimsStor y180 | |
1070 | ||
1071 | S2- Identi fy excepti ons to wor kflow rout ing rules and dispos itions cod es | |
1072 | 587979 | |
1073 | 605266 | |
1074 | 605270 | |
1075 | 5 | |
1076 | 62 | |
1077 | 918558: | |
1078 | ClaimsStor y180 | |
1079 | ||
1080 | S2- Docume nt claim a ctions, ro uting, and exception s | |
1081 | 587979 | |
1082 | 605266 | |
1083 | 605271 | |
1084 | 3 | |
1085 | 46 | |
1086 | 918558: | |
1087 | ClaimsStor y180 | |
1088 | ||
1089 | S2- Comple te cross c laim-type mapping an d define d ata elemen t relation ships | |
1090 | 587989 | |
1091 | 605289 | |
1092 | 605290 | |
1093 | 5 | |
1094 | 62 | |
1095 | 918560: | |
1096 | ClaimsStor y182 | |
1097 | ||
1098 | S2- Elabor ate requir ements, wo rkflow rul es, and ac ceptance c riteria | |
1099 | 587954 | |
1100 | 604638 | |
1101 | 605258 | |
1102 | 3 | |
1103 | 46 | |
1104 | 918512: Cl aimsStory0 44 | |
1105 | ||
1106 | S2-Build 1 Sprint 2 CCRS Busin ess Analys is and Pro ject Suppo rt | |
1107 | 593805 | |
1108 | 604638 | |
1109 | 605291 | |
1110 | 3 | |
1111 | 46 | |
1112 | -- | |
1113 | Sprint Mil estone / C eremony | |
1114 | Hours | |
1115 | Participan ts | |
1116 | Date | |
1117 | ||
1118 | Sprint Kic koff / Pla nning | |
1119 | 4 hours | |
1120 | FTC + VA | |
1121 | Tues (1st) | |
1122 | ||
1123 | Sprint Dai ly Scrum, Rational U pdates | |
1124 | 1 hour | |
1125 | FTC + VA | |
1126 | Daily | |
1127 | ||
1128 | Scheduled Backlog Gr ooming | |
1129 | 1 hour | |
1130 | FTC + VA | |
1131 | Mon | |
1132 | ||
1133 | Sprint Rev iew and De monstratio n | |
1134 | 1 hour | |
1135 | FTC + VA | |
1136 | Mon (3rd) | |
1137 | ||
1138 | Sprint 2 – Team 3 | |
1139 | Task Name | |
1140 | Duration | |
1141 | Start | |
1142 | Finish | |
1143 | ||
1144 | Sprint 2 | |
1145 | 10 Days | |
1146 | Tues 10/31 /2017 | |
1147 | Mon | |
1148 | 11/13/2017 | |
1149 | ||
1150 | Team | |
1151 | CM Work It em Story D escription | |
1152 | CM Work It em Epic | |
1153 | CM Work It em Sub Epi c | |
1154 | CM Work It em Story | |
1155 | CM Work It em Story P oints | |
1156 | Total CM | |
1157 | Work Item | |
1158 | Task(s) | |
1159 | Hours | |
1160 | RM Busines s User Sto ry | |
1161 | (traceabil ity) | |
1162 | Team 3 | |
1163 | S3-IAM/MVI -39-SP2-Te st Executi on and Log ging | |
1164 | 587892 | |
1165 | 592251 | |
1166 | 605804 | |
1167 | 1 | |
1168 | 13.5 | |
1169 | 912189: Cl aimsStory0 15 | |
1170 | ||
1171 | S3-CCRA1-3 9-SP2-Test Execution and Loggi ng | |
1172 | 587916 | |
1173 | 592295 | |
1174 | 605895 | |
1175 | 1 | |
1176 | 13.5 | |
1177 | 912209: Cl aimsStory0 23 | |
1178 | ||
1179 | S3-PPMS-03 -Initial c ontact, ki ck-off mee ting and i nitial for ms w/ Inte rface Part ner | |
1180 | 587828 | |
1181 | 592252 | |
1182 | 592298 | |
1183 | 0.5 | |
1184 | 6.75 | |
1185 | 912201: Cl aimsStory0 01 | |
1186 | ||
1187 | S3-IAM/MVI -15-Docume ntation CC RS->Interf ace ICD or Interface ->CCRS ICD | |
1188 | 587892 | |
1189 | 592249 | |
1190 | 592272 | |
1191 | 2 | |
1192 | 27 | |
1193 | 912189: Cl aimsStory0 15 | |
1194 | ||
1195 | S3-IAM/MVI -16-Record ing and Re viewing In ternal Mee ting Notes | |
1196 | 587892 | |
1197 | 592249 | |
1198 | 592273 | |
1199 | 0.5 | |
1200 | 6.75 | |
1201 | 912189: Cl aimsStory0 15 | |
1202 | ||
1203 | S3-PPMS-17 -Developme nt (pseudo -code/flow ) | |
1204 | 587828 | |
1205 | 592255 | |
1206 | 592312 | |
1207 | 2 | |
1208 | 27 | |
1209 | 912201: Cl aimsStory0 01 | |
1210 | ||
1211 | S3-IAM/MVI -37-SP2-Te st Case De velopment | |
1212 | 587892 | |
1213 | 592251 | |
1214 | 605791 | |
1215 | 1 | |
1216 | 13.5 | |
1217 | 912189: Cl aimsStory0 15 | |
1218 | ||
1219 | S3-CCRA1-1 5-Document ation CCRS ->Interfac e ICD or I nterface-> CCRS ICD | |
1220 | 587916 | |
1221 | 589145 | |
1222 | 592347 | |
1223 | 2 | |
1224 | 27 | |
1225 | 912209: Cl aimsStory0 23 | |
1226 | ||
1227 | S3-CCRA1-1 4-ReDesign DB Schema after rec eiving upd ated schem a from CCR A | |
1228 | 587916 | |
1229 | 589145 | |
1230 | 592346 | |
1231 | 1 | |
1232 | 13.5 | |
1233 | 912209: Cl aimsStory0 23 | |
1234 | ||
1235 | S3-CCRA1-3 7-SP2-Test Case Deve lopment | |
1236 | 587916 | |
1237 | 592295 | |
1238 | 605891 | |
1239 | 1 | |
1240 | 13.5 | |
1241 | 912209: Cl aimsStory0 23 | |
1242 | ||
1243 | S3-PPMS-38 -SP2-Test Script Dev elopment | |
1244 | 587828 | |
1245 | 592256 | |
1246 | 605842 | |
1247 | 1 | |
1248 | 13.5 | |
1249 | 912201: Cl aimsStory0 01 | |
1250 | ||
1251 | S3-IAM/MVI -17-Develo pment (pse udo-code/f low) | |
1252 | 587892 | |
1253 | 592250 | |
1254 | 592274 | |
1255 | 2 | |
1256 | 27 | |
1257 | 912189: Cl aimsStory0 15 | |
1258 | ||
1259 | S3-IAM/MVI -38-SP2-Te st Script Developmen t | |
1260 | 587892 | |
1261 | 592251 | |
1262 | 605801 | |
1263 | 1 | |
1264 | 13.5 | |
1265 | 912189: Cl aimsStory0 15 | |
1266 | ||
1267 | S3-CCRA1-3 8-SP2-Test Script De velopment | |
1268 | 587916 | |
1269 | 592295 | |
1270 | 605893 | |
1271 | 1 | |
1272 | 13.5 | |
1273 | 912209: Cl aimsStory0 23 | |
1274 | ||
1275 | S3-PPMS-14 -Design DB Schema | |
1276 | 587828 | |
1277 | 592255 | |
1278 | 592309 | |
1279 | 2 | |
1280 | 27 | |
1281 | 912201: Cl aimsStory0 01 | |
1282 | ||
1283 | S3-PPMS-09 -Coordinat ing with C CRS Intern al Teams | |
1284 | 587828 | |
1285 | 592252 | |
1286 | 592304 | |
1287 | 0.5 | |
1288 | 6.75 | |
1289 | 912201: Cl aimsStory0 01 | |
1290 | ||
1291 | S3-PPMS-15 -Documenta tion CCRS- >Interface ICD or In terface->C CRS ICD | |
1292 | 587828 | |
1293 | 592255 | |
1294 | 592310 | |
1295 | 2 | |
1296 | 27 | |
1297 | 912201: Cl aimsStory0 01 | |
1298 | ||
1299 | S3-PPMS-39 -SP2-Test Execution and Loggin g | |
1300 | 587828 | |
1301 | 592256 | |
1302 | 605844 | |
1303 | 1 | |
1304 | 13.5 | |
1305 | 912201: Cl aimsStory0 01 | |
1306 | ||
1307 | S3-CCRA1-1 6-Recordin g and Revi ewing Inte rnal Meeti ng Notes | |
1308 | 587916 | |
1309 | 589145 | |
1310 | 592348 | |
1311 | 0.5 | |
1312 | 6.75 | |
1313 | 912209: Cl aimsStory0 23 | |
1314 | ||
1315 | S3-PPMS-37 -SP2-Test Case Devel opment | |
1316 | 587828 | |
1317 | 592256 | |
1318 | 605839 | |
1319 | 1 | |
1320 | 13.5 | |
1321 | 912201: Cl aimsStory0 01 | |
1322 | Sprint Mil estone / C eremony | |
1323 | Hours | |
1324 | Participan ts | |
1325 | Date | |
1326 | ||
1327 | Sprint Kic koff / Pla nning | |
1328 | 4 hours | |
1329 | FTC + VA | |
1330 | Mon (1st) | |
1331 | ||
1332 | Sprint Dai ly Scrum, Rational U pdates | |
1333 | 1 hour | |
1334 | FTC + VA | |
1335 | Daily | |
1336 | ||
1337 | Scheduled Backlog Gr ooming | |
1338 | 1 hour | |
1339 | FTC + VA | |
1340 | Mon | |
1341 | ||
1342 | Sprint Rev iew and De monstratio n | |
1343 | 1 hour | |
1344 | FTC + VA | |
1345 | Mon (3rd) | |
1346 | ||
1347 | Sprint 2 – Team 4 | |
1348 | Task Name | |
1349 | Duration | |
1350 | Start | |
1351 | Finish | |
1352 | ||
1353 | Sprint 2 | |
1354 | 10 Days | |
1355 | Tues 10/31 /2017 | |
1356 | Mon | |
1357 | 11/13/2017 | |
1358 | ||
1359 | Team | |
1360 | CM Work It em Story D escription | |
1361 | CM Work It em Epic | |
1362 | CM Work It em Sub Epi c | |
1363 | CM Work It em Story | |
1364 | CM Work It em Story P oints | |
1365 | Total CM | |
1366 | Work Item | |
1367 | Task(s) | |
1368 | Hours | |
1369 | RM Busines s User Sto ry | |
1370 | (traceabil ity) | |
1371 | Team 4 | |
1372 | S4-CS010 - Code busi ness rules for timel y filing | |
1373 | 587863 | |
1374 | 592731 | |
1375 | 592744 | |
1376 | 5 | |
1377 | 50 | |
1378 | 912211 | |
1379 | ||
1380 | S4-CS010 - Code busi ness rules for refer ral number | |
1381 | 587863 | |
1382 | 592731 | |
1383 | 592739 | |
1384 | 2 | |
1385 | 40 | |
1386 | 912211 | |
1387 | ||
1388 | S4-CS010 - Code busi ness rules for scope of episod e | |
1389 | 587863 | |
1390 | 592731 | |
1391 | 592752 | |
1392 | 2 | |
1393 | 94 | |
1394 | 912211 | |
1395 | ||
1396 | S4-Build 1 Sprint 2 CCRS Busin ess Analys is and Pro ject Suppo rt | |
1397 | 593805 | |
1398 | #593811 | |
1399 | 593842 | |
1400 | 5 | |
1401 | 54 | |
1402 | -- | |
1403 | ||
1404 | S4-CS005-E laborate R equirement s for PPMS queries | |
1405 | 587842 | |
1406 | 592690 | |
1407 | 592692 | |
1408 | 3 | |
1409 | 43 | |
1410 | 912916 | |
1411 | ||
1412 | S4-Develop test case s and scri pts for Bu ild 1 Spri nt 2 | |
1413 | 593805 | |
1414 | 593811 | |
1415 | 607455 | |
1416 | 3 | |
1417 | 43 | |
1418 | - | |
1419 | Sprint Mil estone / C eremony | |
1420 | Hours | |
1421 | Participan ts | |
1422 | Date | |
1423 | ||
1424 | Sprint Kic koff / Pla nning | |
1425 | 4 hours | |
1426 | FTC + VA | |
1427 | Mon (1st) | |
1428 | ||
1429 | Sprint Dai ly Scrum, Rational U pdates | |
1430 | 1 hour | |
1431 | FTC + VA | |
1432 | Daily | |
1433 | ||
1434 | Scheduled Backlog Gr ooming | |
1435 | 1 hour | |
1436 | FTC + VA | |
1437 | Mon | |
1438 | ||
1439 | Sprint Rev iew and De monstratio n | |
1440 | 1 hour | |
1441 | FTC + VA | |
1442 | Fri (2nd) | |
1443 | ||
1444 | Build 1 – Sprint 3 – Work Item Stories | |
1445 | Task Name | |
1446 | Duration | |
1447 | Start | |
1448 | Finish | |
1449 | ||
1450 | Sprint 3 | |
1451 | 10 Days | |
1452 | Mon | |
1453 | 11/14/2017 | |
1454 | Tues | |
1455 | 11/27/2017 | |
1456 | ||
1457 | Team | |
1458 | CM Work It em Story D escription | |
1459 | CM Work It em Epic | |
1460 | CM Work It em Sub Epi c | |
1461 | CM Work It em Story | |
1462 | CM Work It em Story P oints | |
1463 | Total CM | |
1464 | Work Item | |
1465 | Task(s) | |
1466 | Hours | |
1467 | RM Busines s User Sto ry | |
1468 | (traceabil ity) | |
1469 | Team 1 | |
1470 | ||
1471 | ||
1472 | ||
1473 | ||
1474 | 24 | |
1475 | 324 | |
1476 | ||
1477 | Team 2 | |
1478 | ||
1479 | ||
1480 | ||
1481 | ||
1482 | 24 | |
1483 | 324 | |
1484 | ||
1485 | Team 3 | |
1486 | ||
1487 | ||
1488 | ||
1489 | ||
1490 | 24 | |
1491 | 324 | |
1492 | ||
1493 | Team 4 | |
1494 | ||
1495 | ||
1496 | ||
1497 | ||
1498 | 24 | |
1499 | 324 | |
1500 | ||
1501 | Sprint Mil estone / C eremony | |
1502 | Hours | |
1503 | Participan ts | |
1504 | Date | |
1505 | ||
1506 | Sprint Kic koff / Pla nning | |
1507 | 4 hours | |
1508 | FTC + VA | |
1509 | Tues (1st) | |
1510 | ||
1511 | Sprint Dai ly Scrum, Rational U pdates | |
1512 | 1 hour | |
1513 | FTC + VA | |
1514 | Daily | |
1515 | ||
1516 | Scheduled Backlog Gr ooming | |
1517 | 1 hour | |
1518 | FTC + VA | |
1519 | Mon | |
1520 | ||
1521 | Sprint Rev iew and De monstratio n | |
1522 | 1 hour | |
1523 | FTC + VA | |
1524 | Mon (3rd) | |
1525 | ||
1526 | Build 1 – Sprint 4 – Work Item Stories | |
1527 | Task Name | |
1528 | Duration | |
1529 | Start | |
1530 | Finish | |
1531 | ||
1532 | Sprint 4 | |
1533 | 10 Days | |
1534 | Mon 11/28/ 2017 | |
1535 | Fri 12/11/ 2017 | |
1536 | ||
1537 | Team | |
1538 | CM Work It em Story D escription | |
1539 | CM Work It em Epic | |
1540 | CM Work It em Sub Epi c | |
1541 | CM Work It em Story | |
1542 | CM Work It em Story P oints | |
1543 | Total CM | |
1544 | Work Item | |
1545 | Task(s) | |
1546 | Hours | |
1547 | RM Busines s User Sto ry | |
1548 | (traceabil ity) | |
1549 | Team 1 | |
1550 | ||
1551 | ||
1552 | ||
1553 | ||
1554 | 24 | |
1555 | 324 | |
1556 | ||
1557 | Team 2 | |
1558 | ||
1559 | ||
1560 | ||
1561 | ||
1562 | 24 | |
1563 | 324 | |
1564 | ||
1565 | Team 3 | |
1566 | ||
1567 | ||
1568 | ||
1569 | ||
1570 | 24 | |
1571 | 324 | |
1572 | ||
1573 | Team 4 | |
1574 | ||
1575 | ||
1576 | ||
1577 | ||
1578 | 24 | |
1579 | 324 | |
1580 | ||
1581 | Sprint Mil estone / C eremony | |
1582 | Hours | |
1583 | Participan ts | |
1584 | Date | |
1585 | ||
1586 | Sprint Kic koff / Pla nning | |
1587 | 4 hours | |
1588 | FTC + VA | |
1589 | Tues (1st) | |
1590 | ||
1591 | Sprint Dai ly Scrum, Rational U pdates | |
1592 | 1 hour | |
1593 | FTC + VA | |
1594 | Daily | |
1595 | ||
1596 | Scheduled Backlog Gr ooming | |
1597 | 1 hour | |
1598 | FTC + VA | |
1599 | Mon | |
1600 | ||
1601 | Sprint Rev iew and De monstratio n | |
1602 | 1 hour | |
1603 | FTC + VA | |
1604 | Mon (3rd) | |
1605 | ||
1606 | Build 1 – Sprint 5 – Work Item Stories | |
1607 | Task Name | |
1608 | Duration | |
1609 | Start | |
1610 | Finish | |
1611 | ||
1612 | Sprint 5 | |
1613 | 10 Days | |
1614 | Mon 12/12/ 2017 | |
1615 | Fri | |
1616 | 12/25/2017 | |
1617 | ||
1618 | Team | |
1619 | CM Work It em Story D escription | |
1620 | CM Work It em Epic | |
1621 | CM Work It em Sub Epi c | |
1622 | CM Work It em Story | |
1623 | CM Work It em Story P oints | |
1624 | Total CM | |
1625 | Work Item | |
1626 | Task(s) | |
1627 | Hours | |
1628 | RM Busines s User Sto ry | |
1629 | (traceabil ity) | |
1630 | Team 1 | |
1631 | ||
1632 | ||
1633 | ||
1634 | ||
1635 | 24 | |
1636 | 324 | |
1637 | ||
1638 | Team 2 | |
1639 | ||
1640 | ||
1641 | ||
1642 | ||
1643 | 24 | |
1644 | 324 | |
1645 | ||
1646 | Team 3 | |
1647 | ||
1648 | ||
1649 | ||
1650 | ||
1651 | 24 | |
1652 | 324 | |
1653 | ||
1654 | Team 4 | |
1655 | ||
1656 | ||
1657 | ||
1658 | ||
1659 | 24 | |
1660 | 324 | |
1661 | ||
1662 | Sprint Mil estone / C eremony | |
1663 | Hours | |
1664 | Participan ts | |
1665 | Date | |
1666 | ||
1667 | Sprint Kic koff / Pla nning | |
1668 | 4 hours | |
1669 | FTC + VA | |
1670 | Tues (1st) | |
1671 | ||
1672 | Sprint Dai ly Scrum, Rational U pdates | |
1673 | 1 hour | |
1674 | FTC + VA | |
1675 | Daily | |
1676 | ||
1677 | Scheduled Backlog Gr ooming | |
1678 | 1 hour | |
1679 | FTC + VA | |
1680 | Mon | |
1681 | ||
1682 | Sprint Rev iew and De monstratio n | |
1683 | 1 hour | |
1684 | FTC + VA | |
1685 | Mon (3rd) | |
1686 | ||
1687 | Build 1 – Sprint 6 – Work Item Stories | |
1688 | Task Name | |
1689 | Duration | |
1690 | Start | |
1691 | Finish | |
1692 | ||
1693 | Sprint 6 | |
1694 | 10 Days | |
1695 | Mon 12/26/ 2017 | |
1696 | Fri 1/12/2 018 | |
1697 | ||
1698 | Team | |
1699 | CM Work It em Story D escription | |
1700 | CM Work It em Epic | |
1701 | CM Work It em Sub Epi c | |
1702 | CM Work It em Story | |
1703 | CM Work It em Story P oints | |
1704 | Total CM | |
1705 | Work Item | |
1706 | Task(s) | |
1707 | Hours | |
1708 | RM Busines s User Sto ry | |
1709 | (traceabil ity) | |
1710 | Team 1 | |
1711 | ||
1712 | ||
1713 | ||
1714 | ||
1715 | 24 | |
1716 | 324 | |
1717 | ||
1718 | Team 2 | |
1719 | ||
1720 | ||
1721 | ||
1722 | ||
1723 | 24 | |
1724 | 324 | |
1725 | ||
1726 | Team 3 | |
1727 | ||
1728 | ||
1729 | ||
1730 | ||
1731 | 24 | |
1732 | 324 | |
1733 | ||
1734 | Team 4 | |
1735 | ||
1736 | ||
1737 | ||
1738 | ||
1739 | 24 | |
1740 | 324 | |
1741 | ||
1742 | Sprint Mil estone / C eremony | |
1743 | Hours | |
1744 | Participan ts | |
1745 | Date | |
1746 | ||
1747 | Sprint Kic koff / Pla nning | |
1748 | 4 hours | |
1749 | FTC + VA | |
1750 | Tues (1st) | |
1751 | ||
1752 | Sprint Dai ly Scrum, Rational U pdates | |
1753 | 1 hour | |
1754 | FTC + VA | |
1755 | Daily | |
1756 | ||
1757 | Scheduled Backlog Gr ooming | |
1758 | 1 hour | |
1759 | FTC + VA | |
1760 | Mon | |
1761 | ||
1762 | Sprint Rev iew and De monstratio n | |
1763 | 1 hour | |
1764 | FTC + VA | |
1765 | Mon (3rd) | |
1766 | ||
1767 | End of Bui ld 1 Demon strable Co ntent | |
1768 | Team 1 dem onstrates initial ET L data loa ds of repr esentative 837 COB a nd NCPDP i nvoice dat a. | |
1769 | Team 1 dem onstrates 837 COB an d NCPDP ET L CCRS dat a complete ness valid ations. | |
1770 | Team 1 dem onstrates static ref erence dat a tables. | |
1771 | Team 1 dem onstrates the core C CRS data m odel. | |
1772 | Team 2 dem onstrates data eleme nts and bu siness obj ect mappin g. | |
1773 | Team 2 dem onstrates mock-up of case mana gement use r interfac e. | |
1774 | Team 2 dem onstrates documented workflow, actions, and routin g rules. | |
1775 | Team 3 dem onstrates final ICDs for IAM/M VI, CCR&A, and PPMS. | |
1776 | Team 3 dem onstrates working co de for IAM /MVI and P hase 1 of CCR&A, PPM S, and IPP S. | |
1777 | Team 4 dem onstrates a collecti on of proo f of conce pt busines s rules. | |
1778 | ||
1779 | Appendix – Acceptanc e Criteria | |
1780 | Each Work Item Story ’s interna l acceptan ce criteri a is fully verified by the ass ociated QM Test Case | |
1781 | Source cod e, compile d code and supportin g document s are chec ked into t he project ’s Rationa l reposito ry | |
1782 | ||
1783 | RM Busines s User Sto ry | |
1784 | Rational I Ds for RM Business U ser Story | |
1785 | Acceptance Criteria | |
1786 | ClaimsStor y001 | |
1787 | RM: 912201 | |
1788 | QM: 152197 | |
1789 | •System re ceives 837 I (Institu tional) di rectly fro m clearing house | |
1790 | •Submissio n will inc lude all r equired re imbursemen t claims d ata | |
1791 | •All reimb ursement c laims will include t he require d referral number | |
1792 | ClaimsStor y002 | |
1793 | RM: 912202 | |
1794 | QM: 152812 | |
1795 | • System r eceives 83 7P (Profes sional) di rectly fro m clearing house | |
1796 | • Submissi on will in clude all required r eimburseme nt claims data | |
1797 | • All reim bursement claims wil l include the requir ed referra l number | |
1798 | ClaimsStor y003 | |
1799 | RM: 912192 , QM: 1528 14 | |
1800 | • System r eceives 83 7D (Dental ) directly from clea ringhouse | |
1801 | • Submissi on will in clude all required r eimburseme nt claims data | |
1802 | • All reim bursement claims wil l include the requir ed referra l number | |
1803 | ClaimsStor y004 | |
1804 | RM: 912200 , QM: 1528 26 | |
1805 | • System t ransforms 837 COB in to a consu mable clai m invoice | |
1806 | • Submissi on will in clude all COB claims data | |
1807 | • All COB claims dat a is accep ted, store d and view able in th e CCRS Rep ository | |
1808 | ClaimsStor y005 | |
1809 | RM: 912196 , QM: 1528 33 | |
1810 | • Submissi on include s all requ ired reimb ursement c laims data | |
1811 | • Submissi on accepts all requi red reimbu rsement cl aims data, user can view and v alidate da ta fields from sourc e system a nd CCRS | |
1812 | ClaimsStor y006 | |
1813 | RM: 912191 , | |
1814 | QM: 152835 | |
1815 | • When all claim inv oices matc h all mini mum accept ance crite ria (Refer ral # on i nvoice, Du plicate, T imely fili ng, Dates of Service , Scope of episode), accept t he claim i nvoice dat a | |
1816 | • When cla im invoice data is i ncomplete, the syste m will rej ect that t ransmissio n and comm unicate re jection re ason | |
1817 | • Only com plete clai m invoice data will be stored in the CCR S Reposito ry | |
1818 | ClaimsStor y010 | |
1819 | RM: 912211 | |
1820 | QM: 152957 | |
1821 | • Invoice matches al l minimum acceptance criteria (Referral # on invoi ce, Duplic ate, Timel y filing, Dates of S ervice, Sc ope of epi sode) | |
1822 | • System p rocesses 1 00% of rei mbursement invoices that are n ot assigne d to a wor kflow queu e due to b usiness an d editing rules | |
1823 | • Complete invoice r eimburseme nt within 7 days or receipt by CCRS. | |
1824 | • System m ust assign reimburse ment invoi ce to the correspond ing workfl ow | |
1825 | • System w ill transm it alert t o work gro up of new work item in the wor kflow queu e | |
1826 | ClaimsStor y007 | |
1827 | RM: 912205 , | |
1828 | QM: 152838 | |
1829 | • Only com plete clai m data wil l be passe d, then it will be s tored in t he CCRS Re pository | |
1830 | ClaimsStor y014 | |
1831 | RM: 912181 | |
1832 | QM: 152964 | |
1833 | • Invoice matches al l minimum acceptance criteria (Referral # on invoi ce, Duplic ate, Timel y filing, Dates of S ervice, Sc ope of epi sode) | |
1834 | • System p rocesses 1 00% of rei mbursement invoices that are n ot assigne d to a wor kflow queu e due to b usiness an d editing rules | |
1835 | • Complete invoice r eimburseme nt within 7 days or receipt by CCRS. | |
1836 | • Pharmacy invoices will be pr ocessed us ing NCPDP data inter change sta ndards for the pharm acy servic es | |
1837 | • System m ust assign reimburse ment invoi ce to the correspond ing workfl ow | |
1838 | • System w ill transm it alert t o work gro up of new work item in the wor kflow queu e | |
1839 | ClaimsStor y012 | |
1840 | RM: 912197 | |
1841 | QM: 152960 | |
1842 | • Invoice matches al l minimum acceptance criteria (Referral # on invoi ce, Duplic ate, Timel y filing, Dates of S ervice, Sc ope of epi sode) | |
1843 | • System p rocesses 1 00% of rei mbursement invoices that are n ot assigne d to a wor kflow queu e due to b usiness an d editing rules | |
1844 | • Complete invoice r eimburseme nt within 7 days or receipt by CCRS. | |
1845 | • Pharmacy invoices will be pr ocessed us ing NCPDP data inter change sta ndards for the pharm acy servic es | |
1846 | • System m ust assign reimburse ment invoi ce to the correspond ing workfl ow | |
1847 | • System w ill transm it alert t o work gro up of new work item in the wor kflow queu e | |
1848 | ClaimsStor y044 | |
1849 | RM: 918522 , | |
1850 | QM: 153437 | |
1851 | • When RO accesses b ackend rep ository, V eteran cop ayment eli gibility, they can c omplete th e review o f the work item | |
1852 | ClaimsStor y157 | |
1853 | RM: 918516 , | |
1854 | QM: 153582 | |
1855 | • When Rev enue Opera tions Staf f accesses the CCRS backend re pository,, user can view all l ine level claim data to analyz e data | |
1856 | ClaimsStor y182 | |
1857 | RM: 918560 | |
1858 | QM: 153605 | |
1859 | • When a F acility Re venue (FR) accesses the CCRS R epository, user can review all line leve l claim da ta receive d to facil itate reco very of VA Third Par ty Billing | |
1860 | • When an Insurance Verifiers (IV) acces ses the CC RS Reposit ory, user can review all line level clai m data rec eived to f acilitate recovery o f VA Third Party Bil ling | |
1861 | • When a R evenue Uti lization R eview (RUR ) accesses the CCRS Repository , user can review al l line lev el claim d ata receiv ed to faci litate rec overy of V A Third Pa rty Billin g | |
1862 | • When a B iller acce sses the C CRS Reposi tory, user can revie w all line level cla im data re ceived to facilitate recovery of VA Thir d Party Bi lling | |
1863 | ClaimsStor y180 | |
1864 | RM: 918558 | |
1865 | QM: 153600 | |
1866 | • When the CCRS user accesses the CCRS R epository, the user can view m ultiple fi eld search selection s | |
1867 | • When the CCRS user accesses the CCRS R epository, the user can fill a single or multiple field sear ch selecti ons to fil ter all th e line lev el claim d ata result s | |
1868 | • When the CCRS user accesses the CCRS R epository, the user can select to search the repos itory by v arious Vet eran uniqu e identifi er (SSN or Name) | |
1869 | • When the CCRS user accesses the CCRS R epository, the user can select to search the repos itory by E DIPI | |
1870 | • When the CCRS user accesses the CCRS R epository, the user can select to search the repos itory by D OS range | |
1871 | • When the CCRS user accesses the CCRS R epository, the user can select to search the repos itory by P rovider NP I or TIN | |
1872 | • When the CCRS user accesses the CCRS R epository, the user can select to search the repos itory by c laim type | |
1873 | • When the CCRS user accesses the CCRS R epository, the user can select to search the repos itory by S tation ID | |
1874 | ClaimsStor y191 | |
1875 | RM: 912190 , QM: 1528 16 | |
1876 | • System r eceives NC PDP D.0 di rectly fro m clearing house | |
1877 | • Submissi on will in clude all required r eimburseme nt claims data | |
1878 | • All reim bursement claims wil l include the requir ed referra l number | |
1879 | ClaimStory 023 | |
1880 | RM: 912209 , QM: 1530 93 | |
1881 | • When the system re ceives the reimburse ment invoi ce it need s to be ma tched to e xisting re ferral | |
1882 | • When the system ma tched the invoice wi th referra l it is pr ocessed an d the syst em shows t he payment approved | |
1883 | ClaimsStor y192 | |
1884 | RM: 912214 | |
1885 | QM: 153086 | |
1886 | • Invoice matches al l minimum acceptance criteria (Referral # on invoi ce, Duplic ate, Timel y filing, Dates of S ervice, Sc ope of epi sode) | |
1887 | • System p rocesses 1 00% of rei mbursement invoices that are n ot assigne d to a wor kflow queu e due to b usiness an d editing rules | |
1888 | • Complete invoice r eimburseme nt within 7 days or receipt by CCRS. | |
1889 | • Pharmacy invoices will be pr ocessed us ing NCPDP data inter change sta ndards for the pharm acy servic es | |
1890 | • System m ust assign reimburse ment invoi ce to the correspond ing workfl ow | |
1891 | • System w ill transm it alert t o work gro up of new work item in the wor kflow queu e | |
1892 | ClaimsStor y029 | |
1893 | RM: 912199 , | |
1894 | QM: 153098 | |
1895 | • The syst em will de tect dupli cate claim s utilizin g the clai m unique i dentifier and preven t payment of duplica tes | |
1896 | • When the system de termines t he reimbur sement cla im submiss ion claim line match es any oth er claim l ines based on unique combinati on of the following: | |
1897 | - Uniqu e Identifi er | |
1898 | - Provi der Id | |
1899 | - Patie nt Id | |
1900 | - Servi ce Date Fr om | |
1901 | - Servi ce Date To (optional ) | |
1902 | - Place Of Servic e | |
1903 | - Proce dure Code | |
1904 | - Proce dure Modif ier(s) (op tional) | |
1905 | - Bille d Amount | |
1906 | • When the matching related cl aim line(s ) has been paid and shows an a llowed amo unt >0, th en the cla im will be flagged a s a duplic ate • When ther e is more than one c laim modif ier, then it will be flagged a s a duplic ate when a ll modifie rs match | |
1907 | • When the matching related cl aim line(s ) has a Cl aim Status which is NOT in {'R ejected', 'Denied'} | |
1908 | • When the matching claim line s are not part of th e same cla im, then i t will be flagged as a duplica te | |
1909 | • When bot h the matc hing relat ed claim l ine(s) and the claim line(s) s how a prev ious Pay F lag set to 'Yes' | |
1910 | ClaimsStor y015 | |
1911 | RM: 912189 , QM: 1529 71 | |
1912 | • The vali dated clai m invoice will trans mit the un ique ident ifier and correspond ing patien ts active membership | |
1913 | • If the c laim invoi ce has an member wit h an activ e membersh ip, claim will show accepted a nd validat ed | |
1914 | • If the p atients me mbership i s inactive , the clai m invoice should not be valida ted into C CRS |
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