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1 | NonVA_PIT_SDD.zip | NonVA_PIT_SDD.docx | Tue Jun 11 19:28:20 2019 UTC |
2 | NonVA_PIT_SDD.zip | NonVA_PIT_SDD.docx | Wed Jun 12 14:35:12 2019 UTC |
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1 | Non-VA Car e Program Integrity Tools | ||
2 | |||
3 | System Des ign Docume nt | ||
4 | |||
5 | Version 1. 19 | ||
6 | |||
7 | |||
8 | |||
9 | |||
10 | |||
11 | |||
12 | |||
13 | |||
14 | March 2019 | ||
15 | |||
16 | Revision H istory | ||
17 | The follow ing indica tes the ve rsioning p rocess tha t this doc ument has undergone: | ||
18 | |||
19 | Version Nu mber | ||
20 | Date | ||
21 | (mm/dd/yy) | ||
22 | Summary of Changes | ||
23 | Author | ||
24 | 1.0 | ||
25 | 6/15/2011 | ||
26 | Initial Do cument | ||
27 | Paul Ferna ndes / Bir en Desai | ||
28 | 1.1 | ||
29 | 10/14/2011 | ||
30 | Updated dr aft versio n to refle ct design approach | ||
31 | IBM Team | ||
32 | 1.2 | ||
33 | 11/2/2011 | ||
34 | Updated dr aft versio n addressi ng VA comm ents sent on | ||
35 | IBM Team | ||
36 | 1.3 | ||
37 | 12/22/2012 | ||
38 | Updated de tailed des ign sectio n includin g data mod els | ||
39 | IBM Team | ||
40 | 1.4 | ||
41 | 02/15/2012 | ||
42 | Multiple u pdates to the figure s and deta iled desig n section to reflect changes t o the scop e as well as provisi on of furt her detail s. | ||
43 | IBM Team | ||
44 | 1.5 | ||
45 | 3/8/2012 | ||
46 | Addressed VA comment s and prov ided furth er details to fill o ut Increme nt 1 docum entation. | ||
47 | IBM Team | ||
48 | 1.6 | ||
49 | 5/07/2012 | ||
50 | Updated ET L diagrams , enhanced reference s to all r elated des ign docume nts | ||
51 | IBM Team | ||
52 | 1.7 | ||
53 | 8/10/2012 | ||
54 | Responded to VA comm ents, list ed design assumption s & constr aints, add ed details on VA dir ectives | ||
55 | IBM Team | ||
56 | 1.8 | ||
57 | 11/5/2012 | ||
58 | Updated re ference to Data Mode l and Data dictionar y, updated reference s and link s to key d eliverable s | ||
59 | IBM Team | ||
60 | 1.9 | ||
61 | 1/28/2013 | ||
62 | Added comp liance sec tion and r esponded t o ASD ques tions in t he appendi ces | ||
63 | IBM Team | ||
64 | 1.10 | ||
65 | 10/30/2013 | ||
66 | Updated do cument to reflect CP &E DW and CDW implem entation. Updated a ll figures . | ||
67 | IBM Team | ||
68 | 1.11 | ||
69 | 11/01/2013 | ||
70 | Updated do cument to reflect th at the FBC S integrat ion, CP&E X12/EDI in tegration, as well a s scoring implementa tion were completed and deploy ed as part of the No n-VA Care Claims Pro cessing in crement fo r PIT. Als o updated document t o reflect that the C P&E DW and CDW ETL i ntegration to PIT wi ll occur d uring the Non-VA Car e PIT ICD Enhancemen tss increm ent. | ||
71 | IBM Team | ||
72 | 1.12 | ||
73 | 11/05/2013 | ||
74 | Additional edits to reflect wo rk complet ed during Non-VA Car e Claims P rocessing increment versus cur rent scope of enhanc ement work | ||
75 | IBM Team | ||
76 | 1.13 | ||
77 | 11/06/2013 | ||
78 | Constraine d scope of document to CP&E DW and CDW e nhancement work in p reparation for VA re view | ||
79 | IBM Team | ||
80 | 1.14 | ||
81 | 12/4/2013 | ||
82 | Updated gr aphics to reflect up coming imp lementatio n of predi ctive anal ytics tool ; added VA Auditor G roup as a user group | ||
83 | IBM Team | ||
84 | 1.15 | ||
85 | 12/24/2013 | ||
86 | Updated se ctions 1.6 .1, 1.7.1, 2, 2.2 – 2.3 in res ponse to C larke/Buck questions | ||
87 | IBM Team | ||
88 | 1.16 | ||
89 | 1/7/2014 | ||
90 | Corrected Sharepoint link, add ed detail on databas e size pro jection | ||
91 | IBM Team | ||
92 | 1.17 | ||
93 | 05/19/2014 | ||
94 | ICD Enhanc ements – 1 ) Updated for HCPS I nterface | ||
95 | |||
96 | EQuality/I BM | ||
97 | 1.18 | ||
98 | 04/23/2015 | ||
99 | Updated to include c hanges for PIT TSS I CD increme nt enhance ments | ||
100 | IBM | ||
101 | 1.19 | ||
102 | 02/28/2019 | ||
103 | Sowmya Rac haputi – U pdated PIT Architect ure Always ON SQL Clu ster | ||
104 | By Light | ||
105 | |||
106 | 03/22/2019 | ||
107 | Athar Ahma d – Review | ||
108 | By Light | ||
109 | |||
110 | |||
111 | Artifact R ationale | ||
112 | The System Design Do cument (SD D) is a du al-use doc ument that provides the concep tual desig n as well as the as- built desi gn. This d ocument wi ll be upda ted as the product i s built, t o reflect the as-bui lt product . | ||
113 | |||
114 | When to Co mplete Eac h Section of the SDD | ||
115 | Section | ||
116 | Completed On or Befo re PMAS Ph ase | ||
117 | Rationale | ||
118 | 1 – Introd uction | ||
119 | MS 0 Revie w; updated thereafte r | ||
120 | Conceptual design sh ould infor m evaluati on of inve stments | ||
121 | 2 – Backgr ound | ||
122 | MS 0 Revie w; updated thereafte r | ||
123 | Conceptual design sh ould infor m evaluati on of inve stments | ||
124 | 3 – Concep tual Desig n | ||
125 | MS 0 Revie w; updated thereafte r | ||
126 | Conceptual design sh ould infor m evaluati on of inve stments | ||
127 | 4 – System Architect ure | ||
128 | MS 0 Revie w; updated thereafte r | ||
129 | Conceptual design sh ould infor m evaluati on of inve stments | ||
130 | 5 – Data D esign | ||
131 | MS 1 Revie w; updated thereafte r | ||
132 | Design det ails shoul d be elabo rated upon during PM AS Plannin g phase an d prior to developme nt | ||
133 | 6 – Detail ed Design | ||
134 | MS 1 Revie w; updated thereafte r | ||
135 | Design det ails shoul d be elabo rated upon during PM AS Plannin g phase an d prior to developme nt | ||
136 | 7 – Extern al System Interface Design | ||
137 | MS 1 Revie w; updated thereafte r | ||
138 | Design det ails shoul d be elabo rated upon during PM AS Plannin g phase an d prior to developme nt | ||
139 | 8 – Human Machine In terfaces | ||
140 | MS 1 Revie w; updated thereafte r | ||
141 | Design det ails shoul d be elabo rated upon during PM AS Plannin g phase an d prior to developme nt | ||
142 | Attachment s | ||
143 | MS 1 Revie w; updated thereafte r | ||
144 | Design det ails shoul d be elabo rated upon during PM AS Plannin g phase an d prior to developme nt | ||
145 | A product’ s system d esign shou ld be defi ned concep tually pri or to the allocation of person nel and re sources th at occur a t project initiation . This giv es the ent erprise an opportuni ty to eval uate IT in vestments before pro ject teams are stood up and fu nding is a llocated. Sections 1 - 4, which discuss t he high-le vel design , should b e complete d prior to MS 0. All sections should be completed and update d before M S 1. Proje cts will n eed to add ress all S DD approva l constrai nts prior to the MS 2 review. In additio n, the SDD should re flect the as-built p roduct goi ng into th e MS 2 rev iew. | ||
146 | |||
147 | Activity | ||
148 | New Capabi lity (1) | ||
149 | Feature En hancement (2) | ||
150 | Field Depl oyment (A) | ||
151 | No | ||
152 | No | ||
153 | Cloud/Web Deployment (B) | ||
154 | No | ||
155 | No | ||
156 | Mobile App lication ( C) | ||
157 | No | ||
158 | No | ||
159 | Table of C ontents | ||
160 | 1.Introduc tion7 | ||
161 | 1.1Documen t Purpose7 | ||
162 | 1.2Project Scope7 | ||
163 | 1.3 User P rofiles7 | ||
164 | 1.3 Relati onship to other Arti facts8 | ||
165 | 1.4Methodo logy, Tool s, and Tec hniques9 | ||
166 | 1.5 Constr aining Pol icies, Dir ectives, a nd Procedu res9 | ||
167 | 1.5.1 Offi ce of Info rmation Se curity9 | ||
168 | 1.5.1.1 VA Certifica tion and A ccreditati on Process 10 | ||
169 | 1.5.2 Core Common Bu siness and Infrastru cture Serv ices10 | ||
170 | 2.Backgrou nd10 | ||
171 | 2.1Overvie w of Syste m:11 | ||
172 | 2.2Overvie w of the B usiness Pr ocess12 | ||
173 | 2.2.1ETL P rocess12 | ||
174 | 2.2.2 Repo rting and Dashboard1 4 | ||
175 | 2.2.3 Busi ness Benef its14 | ||
176 | 2.3 Overvi ew of the Significan t Requirem ents14 | ||
177 | 2.3.1Funct ional Requ irements14 | ||
178 | 2.3.2Workl oad and Pe rformance Requiremen ts14 | ||
179 | 2.3.3Opera tional Req uirements1 5 | ||
180 | 2.3.4Relia bility Spe cification s15 | ||
181 | 2.3.5Secur ity Specif ications15 | ||
182 | 3.Conceptu al Design1 5 | ||
183 | 3.1Concept ual Applic ation Desi gn15 | ||
184 | 3.1.1Appli cation Con text16 | ||
185 | 3.1.2High- Level Appl ication De sign17 | ||
186 | 3.1.3Appli cation Loc ations19 | ||
187 | 3.1.4Appli cation Use rs20 | ||
188 | 3.2 Concep tual Data Design21 | ||
189 | 3.2.1 Repo sitory Con ceptual Da ta Model21 | ||
190 | 3.2.2 Repo sitory Dat abase Info rmation21 | ||
191 | 3.3Concept ual Infras tructure D esign22 | ||
192 | 3.3.1 Syst em Critica lity and H igh Availa bility24 | ||
193 | 3.3.2Speci al Technol ogy24 | ||
194 | 3.3.3Techn ology Loca tions24 | ||
195 | 3.3.4Conce ptual Infr astructure Diagram24 | ||
196 | 3.3.4.1 Lo cation of Environmen ts and Ext ernal Inte rfaces24 | ||
197 | 3.3.4.2 Co nceptual P roduction String Dia gram26 | ||
198 | 4.System A rchitectur e28 | ||
199 | 4.1Hardwar e Architec ture29 | ||
200 | 4.2Softwar e Architec ture30 | ||
201 | 4.3Communi cations Ar chitecture 30 | ||
202 | 5.Data Des ign31 | ||
203 | 5.1Data Ma nagement S ystem File s31 | ||
204 | 5.2Non-Dat abase Mana gement Sys tem Files3 1 | ||
205 | 6.Detailed Design31 | ||
206 | 6.1Hardwar e Detailed Design31 | ||
207 | 6.2Softwar e Detailed Design32 | ||
208 | 6.3Communi cations De tailed Des ign33 | ||
209 | 7.External Interface Design33 | ||
210 | 8.Human-Ma chine inte rface33 | ||
211 | 9.System I ntegrity C ontrols33 | ||
212 | Appendix A 34 | ||
213 | 1.1Packagi ng and Ins tallation3 4 | ||
214 | Glossary o f Terms34 | ||
215 | Approval S ignatures3 6 | ||
216 | |||
217 | List of Ta bles | ||
218 | Table 1: P IT Primary User Grou ps8 | ||
219 | Table 2: P IT Adminis trator Use r Roles8 | ||
220 | Table 3: E TL Process 13 | ||
221 | Table 4: A pplication Context D escription 17 | ||
222 | Table 5: P IT Applica tion Desig n Steps18 | ||
223 | Table 6: P rogram Int egrity Too ls Compone nts19 | ||
224 | Table 7: A pplication Locations 20 | ||
225 | Table 8: A pplication Users21 | ||
226 | Table 9: D ata Reposi tory Key E lements22 | ||
227 | Table 10: Applicatio ns Using D ata Reposi tory22 | ||
228 | Table 11: Glossary o f Terms34 | ||
229 | |||
230 | List of Fi gures | ||
231 | Figure 1: Program In tegrity To ols - Over view11 | ||
232 | Figure 3: Program In tegrity To ols Contex t Diagram1 6 | ||
233 | Figure 4: Program In tegrity To ols Contex t – High-L evel Appli cation Des ign18 | ||
234 | Figure 5: Production Environme nt24 | ||
235 | Figure 6: AITC Deplo yment26 | ||
236 | |||
237 | |||
238 | Introducti on | ||
239 | The Non-VA Care Prog ram Integr ity Tools system, or PIT, is a comprehen sive set o f tools to detect Fr aud, Waste , and Abus e (FWA) fo r the Purc hased Care (PC) prog rams at th e Departme nt of Vete rans Affai rs (VA). The system was built , tested, and deploy ed to the VA product ion enviro nment in F all 2012, and has be en address ing the cl aim scorin g, central ization of claim dat a, and rel ated repor ting capab ility need s of PC pr ograms sin ce. The ex isting sol ution arch itecture i ncludes fo ur primary component s: | ||
240 | Program In tegrity Da ta Reposit ory | ||
241 | Claims Sco ring Tool | ||
242 | Reporting and analyt ics capabi lity | ||
243 | Data integ ration/Ext ract Trans form Load (ETL) serv ices that load claim data from source sy stems into the repos itory and posts clai m scoring results fo r use in p ayments. | ||
244 | Document P urpose | ||
245 | This docum ent is int ended for technical users resp onsible fo r managing security, deploying rules, ad ministerin g the data base, perf orming oth er adminis trative ta sks, etc, as well as for proje ct managem ent person nel respon sible for ensuring t he PIT ful fills proj ect requir ements. | ||
246 | This docum ent does n ot provide detailed explanatio ns of the individual ETL proce sses to be used for each sourc e system – instead, references are provi ded, where appropria te, to the specific non-VA Car e PIT ETL Design Doc ument. | ||
247 | Project Sc ope | ||
248 | The Progra m Integrit y Tools cu rrently re ceives non -VA Care c laims data from FBCS , CP&E and FSC score s each cla im for the risk of F WA, and st ores the c laim data in the PIT EDR, to al low report ing agains t the clai ms data. T he FBCS in tegration, CP&E inte gration, F SC integra tion and a s well as scoring co mponent we re complet ed. | ||
249 | In essence , while FB CS claims data is cu rrently be ing used f or pre-pay ment scori ng of clai ms, CDW pr ovides cor related pa yment data to identi fy and tra ck payment outflows on the ori ginal inco ming FBCS claims dat a. Simila rly, CP&E DW payment data prov ides insig ht on VA’s payments on the pre viously-sc ored CP&E X12 data i ntegrated into PIT. Together, CDW and CP &E DW prov ide import ant follow -up data o n VA PC’s payment ou tflows. FS C also pro vides pre- payment sc oring of c laims, whi ch are sco red. | ||
250 | 1.3User Pr ofiles | ||
251 | The Progra m Integrit y Tools wa s designed with the following primary us er groups in mind. D etails of different roles have been conf irmed with Program I ntegrity T ools stake holders. | ||
252 | Table 1: P IT Primary User Grou ps | ||
253 | Role | ||
254 | Responsibi lities | ||
255 | Business N eed from P IT | ||
256 | System Pro ficiency | ||
257 | Program In tegrity /I nformatics team memb ers | ||
258 | CBO Busine ss Analyst s responsi ble for ad dressing a nd reporti ng on FWA | ||
259 | Oversight and Report ing on FWA detection and preve ntion, as well as co mmunicatio n to Opera tions Mana ger | ||
260 | Multiple c ube-based data analy sis tools | ||
261 | AITC Syste m Administ rator | ||
262 | Manage con figuration of the PI T software in all en vironments | ||
263 | Manage con figuration of the PI T software in all en vironments | ||
264 | |||
265 | |||
266 | The table below list s the diff erent admi nistrator roles of t he Program Integrity Tools. De tails of l evel of su pport for each role were deter mined in c onsultatio n with Pro gram Integ rity Tools stakehold ers. | ||
267 | Table 2: P IT Adminis trator Use r Roles | ||
268 | Role | ||
269 | Tool | ||
270 | Descriptio n | ||
271 | Fraud and Abuse Mana gement Sys tem (FAMS) Admin | ||
272 | FAMS web a pp | ||
273 | FAMS datab ase | ||
274 | FAMS Admin istrative Utility | ||
275 | Maintenanc e of the s ystem that includes maintainin g reports, database commands, and sever jobs, as w ell as use rs. | ||
276 | WODM Archi tect | ||
277 | WebSphere WODM | ||
278 | Overall de ployment o rganizatio ns of rule s and maki ng sure th at the exe cution of rule sets is optimiz ed | ||
279 | WebSphere Business E vents (WBE ) Admin | ||
280 | IBM WebSph ere Busine ss Events | ||
281 | Administra tion of th e WBE syst em managem ent functi ons and ge neration o f system r eports | ||
282 | Database A dministrat or (DBA) | ||
283 | MS Structu red Query Language ( SQL) Serve r | ||
284 | Management of the da ta reposit ory. | ||
285 | Works with the devel opment tea ms to main tain consi stent data structure s. | ||
286 | InfoSphere Admin | ||
287 | IBM InfoSp here Data Stage | ||
288 | Management of the ET L script. Maintenanc e of the E TL jobs. | ||
289 | WebSphere Admin | ||
290 | IBM WebSph ere | ||
291 | Administra tion of th e WebSpher e system m anagement functions and genera tion of sy stem repor ts | ||
292 | |||
293 | 1.3 Relati onship to other Arti facts | ||
294 | The Progra m Integrit y Tools SD D is based on the bu siness nee ds of the customer/b usiness ow ner descri bed in the following documents . | ||
295 | Program In tegrity To ols Requir ement Spec ification Document ( RSD) | ||
296 | Program In tegrity To ols Progra m Manageme nt Plan (P MP) | ||
297 | 1.4Methodo logy, Tool s, and Tec hniques | ||
298 | This SDD w as created from the following template f rom VIP: s ystem_desi gn_documen t_ templat e.docx. Pe r the VIP recommenda tion, the technical details ha ve been dr afted out in this do cument via conceptua l designs. Technical writing a nd reviews then prov ide a clea n-up servi ce on the document f or ultimat e submissi on to VIP Review (as part of a packet of artifacts required to attain the Active state). From that review, ch anges will be implem ented to f urther ref ine the ac curacy of the docume nt’s techn ical conte nt. With t he input o f several program an d project peers, the document will be re ady for th e Formal R eview. Any feedback to come fr om this re view will be impleme nted as we ll. Any SD D change r equests ma de during the develo pment phas e are then addressed as needed and chang es capture d througho ut. | ||
299 | 1.5 Constr aining Pol icies, Dir ectives, a nd Procedu res | ||
300 | The Vetera ns Integra ted Proces s (VIP) Pr ocess is a Lean-Agil e framewor k that ser vices the interest o f Veterans through t he efficie nt streaml ining of a ctivities that occur within th e enterpri se. This d ocument co nforms to the Vetera ns Integra ted Proces s Methodol ogy templa te for the SDD and i s required in the pl anning pha se of a pr oject. | ||
301 | The Progra m Integrit y Tools sy stem will be in comp liance wit h relevant VA direct ive requir ements inc luding VA Directive 6513, whic h directs VA policy toward sec uring exte rnal conne ctions to the VA net work infra structure, as well a s VA Handb ook 6500.3 , relating to Certif ication & Accreditat ion requir ements. | ||
302 | The VIP ma ndates tha t all new VA IT proj ects/progr ams uses a n incremen tal develo pment appr oach, requ iring freq uent deliv ery milest ones that deliver ne w capabili ties for b usiness sp onsors to test and a ccept func tionality. Implemen ted by the Assistant Secretary for IT, V IP is a VA -wide IT p roject eff ort to bet ter empowe r the OIT Project Ma nagers and teams to meet their mission: delivering world-cla ss IT prod ucts that meet busin ess needs on time an d within b udget. | ||
303 | Claims and Clinical data fetch ed from th e source s ystems may contain P rotected H ealth Info rmation (P HI) and El ectronic P rotected H ealth Info rmation (E PHI) that is subject to protec tion under the regul ations iss ued by the Departmen t of Healt h and Huma n Services , as manda ted by the Health In surance Po rtability and Accoun tability A ct of 1996 (HIPAA); 45 CFR Par ts 160 and 164, Subp arts A and E, the St andards fo r Privacy of Individ ually Iden tifiable H ealth Info rmation (“ Privacy Ru le”); and 45 CFR Par ts 160 and 164, Subp arts A and C, the Se curity Sta ndard (“Se curity Rul e”). Purs uant to th e Privacy and Securi ty Rules, the system shall be architecte d to prote ct PHI and EPHI. | ||
304 | 1.5.1 Offi ce of Info rmation Se curity | ||
305 | The Progra m Integrit y Tool (PI T) applica tion is ho sted at th e Austin I nformation Technolog y Center ( AITC) and the manage ment and d evelopment teams for PIT have collaborat ed with th e AITC man agement te am on all informatio n security matters. A Service Level Agre ement was devised an d signed a sserting t hat the pr oject woul d adopt al l required security protocol a s mandated by VA. Th e Pre-Prod uction and Productio n Environm ents for P IT both cu rrently ha ve a Autho rity to Op erate (ATO ). The PIT team has coordinate d with the Office of Cyber Sec urity on C ertificati on and Acc reditation (C&A) and has follo wed all ap plicable p rocesses. This invol ved runnin g vulnerab ility scan s on three (3) level s: (1) dat abases (2) operating system, a nd (3) web applicati on and rem ediating i dentified “critical” and “high ” vulnerab ilities to procure t he ATO. As per VA gu idelines, all securi ty documen tation has been post ed to the SMART data base. The ATO served as a nece ssary prec ursor to a n active P roduction Environmen t being av ailable fo r project use. In an effort to remain co mpliant wi th C&A reg ulations, the AITC t eam runs v ulnerabili ty scans o n a regula r basis to remediate all vulne rabilities (Critical /High/Medi um/Low) as they seek to ultima tely obtai n a (pendi ng) full A uthority t o Operate (ATO). Thi s document conform t o Veterans Integrate d Process Methodolog y template s. | ||
306 | 1.5.1.1 VA Certifica tion and A ccreditati on Process | ||
307 | The PIT O& M project had obtain ed a Autho rity to Op erate (ATO ) from the VA Office of Cyber Security. The Offic e of Cyber Security approved t he project ’s C&A req uest, conc luded that the Progr am Integri ty Tools w as in comp liance wit h relevant VA direct ive requir ements inc luding VA Directive 6513, whic h directs VA policy toward sec uring exte rnal conne ctions to the VA net work infra structure, as well a s VA Handb ook 6500.3 , relating to Certif ication & Accreditat ion requir ements. | ||
308 | 1.5.2 Core Common Bu siness and Infrastru cture Serv ices | ||
309 | There are two Core C ommon Busi ness and I nfrastruct ure Standa rds which have been published, the Relea se Archite cture and Identity a nd Access Management . The Pro gram Integ rity Tools adheres t o the Ente rprise Tec hnical Arc hitecture Compliance Guidance, signed Au gust 2012, and align s with the OneVA EA Global Pri nciples, i ncluding: Mission Al ignment, D ata Visibi lity and A ccessibili ty, Data I nteroperab ility, Inf rastructur e Interope rability, Informatio n Security , Enterpri se Service s. | ||
310 | Further, P rogram Int egrity Too ls (PIT) a dheres to all establ ished and accepted V A guidelin es for ide ntity and access man agement fo r all user s. The app lication i s hosted a t the Aust in Informa tion Techn ology Cent er (AITC) and the AI TC Program Manager i s responsi ble for is suing and regulating access to the AITC environmen t via VA 9 957 forms, which req uires spon sorship fr om the Chi ef Busines s Office ( CBO). A pr erequisite for appli cants is a valid VA account in the VHAMA STER domai n, thus re quiring al l users to go throug h the appl icable VA screening processes and regula tions. Upo n receivin g a valid VA ID, the PIT User’ s access r equest mus t be appro ved by the VA Projec t Manager. After gai ning entry to the AI TC environ ment, the user then works with the devel opment tea m and VA M anagement to gain ac cess and p riority wi thin the c omponents of the PIT applicati on. Becaus e PIT is m eant to be utilized as a means to reduce fraud, wa ste, and a buse withi n VA Purch ased Care, only indi viduals wh o already have certi fied train ing to eva luate heal thcare cla ims from N on-VA prov iders will be using this tool. This tran slates to a select g roup of le ss than 30 individua ls in the Program In tegrity De partment o f the VHA Chief Busi ness Offic e Purchase d Care gro up. Their level(s) o f access a nd priorit y are esta blished th rough the Department of Progra m Integrit y in their Office of Human Res ources Man agement (O HRM) appro ved Positi on Descrip tions for appointmen ts of publ ic trust. These staf f members are specif ically hir ed into fe deral care er positio ns to perf orm the ty pe of func tions asso ciated wit h this acc ess. These VA employ ees curren tly have r ights to v iew Person ally Ident ifiable In formation (PII) and Personal H ealth Info rmation (P HI) and th ere will b e no chang e in the t ype(s) of data they will be re viewing, w ith the De partment o f Program Integrity maintainin g and mana ging the l ist of app roved user s. | ||
311 | |||
312 | Background | ||
313 | FBCS is cu rrently co mprised of 35 FBCS s tations, s erving in total appr oximately ~150 fee s tations. C laims proc essing dat a also exi sts within the centr alized Rep ository at the CP&E serving ot her Purcha sed Care P rograms in cluding CH AMPVA, Spi na Bifida, Children of Women V ietnam Vet erans (CWV V), Foreig n Medical Program. F or both of these sou rces, the integratio n to PIT w as complet ed during the Non-VA Care Clai ms Process ing increm ent, and h as been wo rking in p roduction since the Fall of 20 12. Proce ssed pre-p aid claims received from Finan cial Servi ce Center (VACS) sou rce was in tegrated t o PIT wher e the clai ms are sco red for fr aud, waste and abuse analysis. | ||
314 | |||
315 | PIT Operat ions & Mai ntenance r equires to measure p erformance metrics o f Servers, Databases and Repor ts. As par t of the P IT mainten ance, few of the cri tical task s are perf ormed: | ||
316 | To improve Server Pe rformance: Load bala nce of the Servers i s performe d with the other pro duction se rvers. | ||
317 | To improve ETL Perfo rmance: Im plement lo gic in ETL that elim inates dup lication o f provider data in P ITEDR. | ||
318 | To improve Claims Sc oring Tool Performan ce: Perfor mance tuni ng of Scor ing querie s is execu ted. | ||
319 | To improve PITEDR Da tabase Per formance: Archiving 6 years pr ior data, removing u nsed table s, indexes and schem a objects | ||
320 | To Improve Reporting and analy tics capab ility: Opt imize quer ies used i n Reports, enabling data marts for frequ ent report requests which give snapshots of requir ed data fo r specific analysis. | ||
321 | The claims processin g data con tains Pers onally Ide ntifiable Informatio n (PII) an d Personal Health In formation (PHI), and as such r equires st rict secur ity requir ements. | ||
322 | Overview o f System: | ||
323 | The follow ing figure depicts t he overvie w of the P rogram Int egrity Too ls and its purpose. | ||
324 | Figure 1: Program In tegrity To ols - Over view | ||
325 | |||
326 | The Progra m Integrit y Tools is comprised of multip le compone nts, as sh own above in Figure 1: | ||
327 | The PIT da ta reposit ory is bei ng fed (fr om FBCS, C P&E X12, F SC and NCP DP D.0) cl aims data through th e drop zon e. | ||
328 | The claims scoring t ool implem ented duri ng the ini tial Non-V A Care Cla ims Proces sing incre ment assig ns scores based on t he risk of fraud/was te and abu se on a pr e-payment basis. | ||
329 | The ETL pu shes claim scores to the drop zone where the FBCS, FSC and CP &E systems retrieve and proces s them acc ordingly ( note: CP&E is not cu rrently se tup to aut omatically process r eturned in formation from PIT). | ||
330 | Overview o f the Busi ness Proce ss | ||
331 | The Progra m Integrit y Tools ha s three ma jor proces ses: | ||
332 | Extracting , Transfor ming and L oading Cla ims | ||
333 | Pre-Paymen t Scoring | ||
334 | Reporting | ||
335 | The pre-pa yment scor ing and re porting pr ocesses ha ve already been impl emented in the Non-V A Care Cla ims Proces sing Proje ct. The f ollowing s ections de pict the F BCS, VACS, CP&E EDI, CP&E DW, and CDW in terfaces c urrent sta te. | ||
336 | 2.2.1ETL P rocess | ||
337 | The ETL pr ocess move s data in batch proc esses betw een the dr op zone an d the data repositor y (for FBC S, CP&E X1 2, CP&E DW and VACS data); for CDW, the ETL utiliz es an open -database connectivi ty link to directly integrate data into the Data R epository. InfoSpher e Data Sta ge is the technology used for transformi ng and loa ding claim s related data into the Data R epository. Business rules for data trans formation are establ ished and managed in the Data Stage. The ETL jobs run as ser vices to l oad claims -related d ata into t he Data Re pository o perating e nvironment . | ||
338 | The transf ormation p rocess imp lements bu siness rul es that de fine data aggregatio ns and the relations hips betwe en the var ious entit ies in the data. | ||
339 | The loadin g process inserts an d commits the desire d attribut e into the target ta bles. The data repo sitory col lects data elements at the low est detail s of the c laim in or der to pre sent diffe rent level s of aggre gation req uired by t he scoring solution and the BI reporting tools. Fi gure 2 sho ws the pro cess flow diagram of extractin g, transfo rming and loading of claim dat a and clai m scores f rom the cl aims syste ms to and from the c entral rep ository. | ||
340 | Figure 2: ETL Proces s | ||
341 | |||
342 | |||
343 | The follow ing table lists the overview o f the busi ness proce sses from the figure s above. | ||
344 | Table 3: E TL Process | ||
345 | Owner | ||
346 | Descriptio n | ||
347 | Program In tegrity Ma nagement | ||
348 | Receive FB CS claims data feeds and store raw data feeds for audit and scoring pu rposes. | ||
349 | Program In tegrity Ma nagement | ||
350 | Receive VA CS claim d ata feeds and store data for s coring pur poses. | ||
351 | Program In tegrity Ma nagement | ||
352 | Extract Co rporate Da ta Warehou se payment data and store data for audit purposes. | ||
353 | Program In tegrity Ma nagement | ||
354 | Receive CP &E claims data feeds and store raw data feeds for audit and scoring pu rposes. | ||
355 | Program In tegrity Ma nagement | ||
356 | Extract CP &E Data Wa rehouse pa yment data feeds and store dat a for audi t purposes . | ||
357 | Program In tegrity Ma nagement | ||
358 | Conform th e source d ata; valid ate data f ormats; tr ansform da ta from CP &E DW and CDW and lo ad them to Central P IT Reposit ory | ||
359 | 2.2.2 Repo rting and Dashboard | ||
360 | PIT provid es access to data fr om across multiple s ource syst ems. The data model enables a report-au thor to de sign and i mplement c ross-funct ional repo rts to mee t the info rmation ne eds of bus iness user s and clai m processi ng clerks. In addi tion, the data repos itory allo ws users t o interrog ate data a nd build a d-hoc repo rts and qu eries. | ||
361 | The Micros oft BI Rep orting Too l has been selected by VA to b e the tool set for bu ilding bus iness inte lligence a nd analyti cs for Pro gram Integ rity users . Microsof t BI will provide th e VA with the capabi lity to de velop reus able stand ard report s - report s availabl e to users on-demand or when r un on sche dule. Use rs will al so have th e ability to develop ad-hoc qu eries/repo rts where they have greater co ntrol over content a nd layout. Addition ally, user s will hav e the abil ity to cre ate metric s and filt ers. | ||
362 | User acces s to repor ting is ba sed on his /her autho rization l evel. This character ization di stinguishe s users pr imarily by their exp ected soph istication in the us e of repor ting appli cations. The design and compl exity of r eporting-a pplication use depen ds on the role perfo rmed. Ana lysts, for example, are expect ed to typi cally be t he most so phisticate d users. | ||
363 | 2.2.3 Busi ness Benef its | ||
364 | The Proram Integrity Tools ben efits the IT Acquisi tions asso ciated wit h the Heal thcare Eff iciency In itiativ (T -15) and t he role th at the CBO has been assigned t o play in that initi ative. Th e Program Integrity Tools sati sfies the OIG findin gs and pro vides a me ans to add ress the c oncerns ra ised in th at finding . PIT imp roves the organizati on’s abili ty to comp ly with th e Improper Payments Eliminatio n and Reco very Act ( IPERA) and to reduce improper payments b efore they occur. | ||
365 | 2.3 Overvi ew of the Significan t Requirem ents | ||
366 | 2.3.1Funct ional Requ irements | ||
367 | All busine ss and tec hnical req uirements, from init ial requir ements eli citation t hrough the elaborati on process , will be captured i n a Busine ss Require ments Docu ment (BRD) . Business Needs are further d efined by requiremen ts that ar e structur ed as foll ows: | ||
368 | An EPIC ov erarching major requ irment | ||
369 | To Busines s User Sto ry that de scribe the high-leve l business requireme nt from th e user’s p erspective | ||
370 | To Develop ment User Story on h ow the req uirement w ould be im plemented. | ||
371 | To the Tas ks needed to support the requi rement. | ||
372 | 2.3.2Workl oad and Pe rformance Requiremen ts | ||
373 | The follow ing table identifies the impor tant perfo rmance and workload requiremen t that is currently in place. This proje ct will no t have any impact on existing system req uirements. | ||
374 | Reporting tool shall support a minimum o f 100 simu ltaneous u sers perfo rming writ e and read transacti ons during the estim ated peak usage hour s of 8 a.m .-10 p.m., EST (duri ng weekday s). | ||
375 | The operat ion of any single PI T componen t shall mi nimally af fect the p erformance , availabi lity, or s peed of an y other PI T componen ts. | ||
376 | 2.3.3Opera tional Req uirements | ||
377 | The follow ing list i dentifies the operat ional requ irements t hat are cu rrently in place and drive the system de sign. This project w ill not ha ve any imp act on exi sting syst em require ments. Mon itoring an d solution of agreed /identifie d critical systems a re under I T support 24 x 7 x 3 65. | ||
378 | PIT shall provide th e capabili ty to sche dule large transacti on functio ns during non-busine ss hours. | ||
379 | The ETL To ol shall b e capable of perform ing its du ties (extr act/transf orm/load) within the periodic cycle esta blished fo r synchron ization wi th the ext ernal syst ems. | ||
380 | Reporting Tool shall be availa ble 99.99% of time f rom 6 a.m. EST, to 1 0 p.m. EST , Monday t hrough Fri day. | ||
381 | The Scorin g Tool sha ll be avai lable 99.9 9% of the time, 24-h ours per d ay, Monday through F riday. Hol idays and weekends a re exclude d because no Veteran s Integrat ed Service Network ( VISN) is w orking ove rtime. | ||
382 | The Reposi tory shall be availa ble 24-hou rs per day , Monday t hrough Fri day. Holid ays and we ekends may be exclud ed on a sc heduled ba sis provid ed that no VISN is w orking wee kends. | ||
383 | 2.3.4Relia bility Spe cification s | ||
384 | The follow ing summar ize requir ements for Reliabili ty Specifi cations th at are cur rently in place. Thi s project will not h ave any im pact on ex isting sys tem requir ements. | ||
385 | Availabili ty is 99.9 % during d efined wor k hours of 6 a.m. ES T, to 2 a. m. EST. | ||
386 | System wil l fully re cover from an outage within 1 business d ay. | ||
387 | One-hundre d percent (100%) con tinuous ba ck-up data will be r estored wh en outage is recover ed. | ||
388 | Maintenanc e periods are non-wo rking hour s after 10 p.m., EST , weekdays . All main tenance pe riods woul d come wit h a minimu m of 72-ho urs advanc ed notice to all use rs. | ||
389 | Real-time monitoring and solut ion of agr eed/identi fied criti cal system s are unde r IT suppo rt 24 x 7 x 365. | ||
390 | 2.3.5Secur ity Specif ications | ||
391 | The Federa l Informat ion Proces sing Stand ard 199 (F IPS-199), Standards for Securi ty Categor ization of Federal I nformation and Infor mation Sys tems, defi nes the se curity cat egories, s ecurity ob jectives, and impact levels to which Nat ional Inst itute of S tandards a nd Technol ogy (NIST) Special P ublication (SP) 800- 60 Volume 1 Revision 1, maps i nformation types. A FIPS 199 a nalysis wa s complete d with a d etermined security c ategorizat ion of Mod erate impa ct. | ||
392 | Conceptual Design | ||
393 | Conceptual Applicati on Design | ||
394 | This secti on provide s a brief overview o f the cont ext within which the Program I ntegrity T ools exist s. The lev el 0 diagr am include s one obje ct for the Program I ntegrity T ools (PIT) that is t he subject of this d esign, and one objec t for each external system wit h which th e Program Integrity Tools inte rfaces. Th e level 1 diagram de composes t he PIT int o multiple sub-compo nents and depicts in terfaces i n more det ails. | ||
395 | Applicatio n Context | ||
396 | The follow ing figure shows the users and external systems th at will in teract wit h the Prog ram Integr ity Tools. | ||
397 | Figure 3: Program In tegrity To ols Contex t Diagram | ||
398 | |||
399 | Table 4: A pplication Context D escription | ||
400 | Object ID | ||
401 | Name | ||
402 | Descriptio n | ||
403 | Interface | ||
404 | Interface System | ||
405 | 1 | ||
406 | FBCS | ||
407 | Fee Basis Claims Sof tware resi des locall y | ||
408 | Drop Zone (using fla t file for mat) | ||
409 | FBCS | ||
410 | 2 | ||
411 | CP&E | ||
412 | Cache base d Claims P rocessing and Eligib ility syst em for han dling of C HAMPVA, Sp ina Bifida , CWVV and Foreign M edical Pro gram claim s. | ||
413 | Drop Zone (using ANS I X12 form at) | ||
414 | CP&E | ||
415 | 3 | ||
416 | CP&E DW | ||
417 | Claims Pro cessing an d Eligibil ity Data W arehouse | ||
418 | Drop Zone (using fla t file for mat) | ||
419 | CP&E DW | ||
420 | 4 | ||
421 | VACS | ||
422 | Pre-paid c laims rece ived from Financial Service Ce nter | ||
423 | Drop zone (using fla t file for mat) | ||
424 | VACS (FSC) | ||
425 | 4 | ||
426 | CDW | ||
427 | Corporate Data Wareh ouse | ||
428 | ODBC conne ction | ||
429 | CDW | ||
430 | 5 | ||
431 | Claim Cler k | ||
432 | CBO Claim processing staff | ||
433 | GUI | ||
434 | FBCS | ||
435 | 6 | ||
436 | Program In tegrity To ols | ||
437 | Suite of P rogram Int egrity Too ls | ||
438 | GUI/SQL/HT TP/ANSI X1 2 | ||
439 | Program In tegrity To ols | ||
440 | 7 | ||
441 | Program In tegrity To ols BI | ||
442 | PIT Busine ss Intelli gence Suit e | ||
443 | Internal t o PIT | ||
444 | Microsoft Report Bui lder | ||
445 | 8 | ||
446 | PI Manager | ||
447 | Program In tegrity ma nager to m anage the operation of Program Integrity Tools | ||
448 | HTTP/GUI | ||
449 | Program In tegrity To ols | ||
450 | High-Level Applicati on Design | ||
451 | Figure 4: Program In tegrity To ols Contex t – High-L evel Appli cation Des ign | ||
452 | |||
453 | |||
454 | |||
455 | Table 5: P IT Applica tion Desig n Steps | ||
456 | Step | ||
457 | Details | ||
458 | 1 | ||
459 | Initial VA source sy stems (FBC S, VACS, C P&E EDI) p rovide cla ims data t o the Drop Zone in f lat-file f ormat. CDW data extr acted to t he PIT dir ectly. | ||
460 | 2 | ||
461 | ETL proces ses claim data from the Drop Z one and lo ads it int o the PIT Data Repos itory | ||
462 | 3 | ||
463 | PIT Data R epository integrates and stand ardizes cl aim data t o allow fo r a compre hensive vi ew | ||
464 | 4 | ||
465 | Claims Sco ring Tool assigns sc ores based on the ri sk of frau d, waste a nd abuse f or pre-pay ment proce ssing | ||
466 | 5 | ||
467 | ETL pushes the assig ned scores to the Dr op Zone (f or FBCS, V ACS, and C P&E EDI da ta only) w here FBCS retrieve/p rocess Sco redClaims files acco rdingly | ||
468 | 6 | ||
469 | Dashboard and Report ing tool m onitor the claim dat a and acco mmodate en d-user bro wsing and analysis. End-users interact w ith Dashbo ard and Re porting to ols to pro duce stand ardized re ports and engage in other quer ying, repo rting, and business intelligen ce extract ions | ||
470 | 7 | ||
471 | PI team an d Claims C lerks revi ew PIT-gen erated sco res as par t of final payment p rocess | ||
472 | |||
473 | Table 6: P rogram Int egrity Too ls Compone nts | ||
474 | Objects | ||
475 | Name | ||
476 | ID | ||
477 | Descriptio n | ||
478 | Service or Legacy Co de | ||
479 | External I nterface N ame | ||
480 | External I nterface I D | ||
481 | Internal I nterface N ame | ||
482 | Internal I nterface I D | ||
483 | SDP Sectio ns 1&2 | ||
484 | Claim Scor ing | ||
485 | 4 | ||
486 | To generat e the scor e decision based on the claims data and business r ules defin ed in the repository | ||
487 | Legacy Cod e | ||
488 | n/a | ||
489 | n/a | ||
490 | Repository | ||
491 | 5 | ||
492 | n/a | ||
493 | Internal D ata Stores | ||
494 | Name | ||
495 | ID | ||
496 | Data Store d | ||
497 | Steward | ||
498 | Access | ||
499 | Repository | ||
500 | 3 | ||
501 | Claims Dat a and Tran saction Da ta | ||
502 | Program In tegrity Ma nagement | ||
503 | Access the claims da ta and bus iness rule s defined in the rep ository | ||
504 | Create aud it logs to store the transacti on | ||
505 | Objects | ||
506 | Name | ||
507 | ID | ||
508 | Descriptio n | ||
509 | Service or Legacy Co de | ||
510 | External I nterface N ame | ||
511 | External I nterface I D | ||
512 | Internal I nterface N ame | ||
513 | Internal I nterface I D | ||
514 | SDP Sectio ns 1&2 | ||
515 | Dashboard and Report ing | ||
516 | 6 | ||
517 | To allow b usiness ow ner to mon itor the C laim proce ssing indi cator stor ed in the central Re pository | ||
518 | Legacy Cod e | ||
519 | No Externa l Interfac e | ||
520 | n/a | ||
521 | Repository | ||
522 | 5 | ||
523 | n/a | ||
524 | Internal D ata Stores | ||
525 | Name | ||
526 | ID | ||
527 | Data Store d | ||
528 | Steward | ||
529 | Access | ||
530 | Repository | ||
531 | 3 | ||
532 | Claims Dat a and Tran saction Da ta | ||
533 | Program In tegrity Ma nagement | ||
534 | Access the claims da ta and Tra nsaction d ata to dis play in ta ble and gr aph format | ||
535 | Internal D ata Stores | ||
536 | Name | ||
537 | ID | ||
538 | Data Store d | ||
539 | Steward | ||
540 | Access | ||
541 | Repository | ||
542 | 3 | ||
543 | Claims Dat a | ||
544 | Program In tegrity Ma nagement | ||
545 | Access the post-paym ent claims data to r un the pre dictive an alytics mo del to fin d FWA patt erns (Futu re) | ||
546 | |||
547 | Objects | ||
548 | Name | ||
549 | ID | ||
550 | Descriptio n | ||
551 | Service or Legacy Co de | ||
552 | External I nterface N ame | ||
553 | External I nterface I D | ||
554 | Internal I nterface N ame | ||
555 | Internal I nterface I D | ||
556 | SDP Sectio ns 1&2 | ||
557 | ETL Tool | ||
558 | 2 | ||
559 | To extract , transfor m and load the sourc e data fro m the drop zone into the repos itory. And load the claims sco re from th e reposito ry to the drop zone. | ||
560 | Legacy Cod e | ||
561 | n/a | ||
562 | n/a | ||
563 | Repository | ||
564 | 5 | ||
565 | n/a | ||
566 | Internal D ata Stores | ||
567 | Name | ||
568 | ID | ||
569 | Data Store d | ||
570 | Steward | ||
571 | Access | ||
572 | Repository | ||
573 | 3 | ||
574 | Raw Data, Relational Data (if any), Dime nsional Da ta | ||
575 | Program In tegrity Ma nagement | ||
576 | Create the staging a rea to sto re the raw dataset e xtracted f rom the dr op zone | ||
577 | Create/upd ate confor med and tr ansformed data into the reposi tory which can be th en used by other com ponent of Program In tegrity To ols | ||
578 | Load the c laims scor e from the repositor y to the d rop zone | ||
579 | Objects | ||
580 | Name | ||
581 | ID | ||
582 | Descriptio n | ||
583 | Service or Legacy Co de | ||
584 | External I nterface N ame | ||
585 | External I nterface I D | ||
586 | Internal I nterface N ame | ||
587 | Internal I nterface I D | ||
588 | SDP Sectio ns 1&2 | ||
589 | FBCS, | ||
590 | FSC,CP&E E DI, | ||
591 | CDW | ||
592 | 1 | ||
593 | The source system to extract c laim data into the d rop zone o r directly to the PI TEDR | ||
594 | n/a | ||
595 | n/a | ||
596 | n/a | ||
597 | |||
598 | n/a | ||
599 | n/a | ||
600 | Internal D ata Stores | ||
601 | Internal V A System R epository | ||
602 | 3 | ||
603 | Raw Data, Relational Data (if any), Dime nsional Da ta | ||
604 | VA Source System | ||
605 | Source sys tem to loa d claim da ta into th e drop zon e | ||
606 | Source sys tem to loa d claims’ score from the drop zone | ||
607 | |||
608 | Applicatio n Location s | ||
609 | The Progra m Integrit y Tools co mponents h as been de ployed in a central location w hich can b e accessed from all the local VAMC as we ll as from anywhere within the VA networ k. The Pr ogram Inte grity Tool s suite is hosted at AITC. | ||
610 | |||
611 | Table 7: A pplication Locations | ||
612 | Applicatio n Componen t | ||
613 | Descriptio n | ||
614 | Location a t Which Co mponent is Run | ||
615 | Type | ||
616 | Scoring To ol | ||
617 | Pre-paymen t FWA scor ing tool | ||
618 | AITC | ||
619 | Business L ogic / Dat a Logic / Interface Code | ||
620 | ETL Tool | ||
621 | Extraction , Transfor mation and Loading o f Claims d ata to Cen tral Repos itory | ||
622 | AITC | ||
623 | Business L ogic / Dat a Logic / Interface Code | ||
624 | Data Repos itory | ||
625 | Central da ta reposit ory | ||
626 | AITC | ||
627 | Data Logic | ||
628 | Reporting Tool | ||
629 | Dashboard and report ing Tool | ||
630 | AITC | ||
631 | Presentati on Logic | ||
632 | Applicatio n Users | ||
633 | The follow ing table lists the Program In tegrity To ols users: | ||
634 | Table 8: A pplication Users | ||
635 | Applicatio n Componen t | ||
636 | Location | ||
637 | User | ||
638 | Scoring To ol | ||
639 | AITC | ||
640 | For the sc ored Claim s, the CBO Claims Cl erk is an Operationa l Customer For managi ng the bus iness rule s, the fol lowing rol es apply:B usiness Ru le Analyst | ||
641 | FAMS: Prof iling (to build mode ls and pro files) | ||
642 | ILOG JRule s (to defi ne the voc abulary, w rite and o rganize bu siness log ic into bu siness rul es and ins pect execu tion trace s) | ||
643 | Business R ule Develo per | ||
644 | FAMS: Valu e Set Gene ration Use r (to setu p the data load requ ired for p rofiling) | ||
645 | ILOG JRule s (impleme ntation fo r the busi ness rule vocabulary , debug an d tune rul e executio n) | ||
646 | ETL Tool | ||
647 | AITC | ||
648 | Power User s to maint ain and up date ETL r outines | ||
649 | Data Repos itory | ||
650 | AITC | ||
651 | Power User s to maint ain, upda te, extrac t data req uests | ||
652 | Reporting Tool | ||
653 | Throughout VA | ||
654 | Business O wner as Ma nagement C ustomer Ge neral | ||
655 | Run some s tandard re ports on a n ad hoc b asis. Not required t o build ne w reports – consumer of standa rd reports | ||
656 | Analyst | ||
657 | Detailed i nformation requireme nts; may i nclude seg ments of d ata corres ponding to business transactio ns based o n a period of time | ||
658 | Builds new reports t o meet inf ormation n eeds | ||
659 | Typically possesses a good und erstanding and knowl edge of wh ere the da ta resides and how t he data is structure d | ||
660 | Management | ||
661 | Consumes s ummarized informatio n at inter mediate le vel across business entities | ||
662 | Limited an alytics an d drill-do wn capabil ities | ||
663 | Executive | ||
664 | Consumes h ighly summ arized inf ormation ( Dashboard) with limi ted/ causa l drill-do wn capabil ities | ||
665 | Focuses on trend ana lysis for predefined business entities o ver a long period of time | ||
666 | 3.2 Concep tual Data Design | ||
667 | 3.2.1 Repo sitory Con ceptual Da ta Model | ||
668 | The object ive of the conceptua l data des ign is to define ste ps to asse mble a blu eprint to capture, a bstract, a nd identif y the layo ut of the VA Data Re pository. The data m odel is re fined thro ugh the li fecycle of a project with incr easing lev els of det ail from h igh level conceptual to a more detail lo gical and physical d esign. By Light use s the data modeling process to facilitat e communic ation and understand ing of dat a requirem ents betwe en the By Light deve lopment te am and VA business u sers. In a ddition, t he data mo del is use d by By Li ght to man age the me tadata and to provid e input to the physi cal data r epository. | ||
669 | The concep tual model identifie s the majo r business entities and lays t he groundw ork for th e Program Integrity Tool data repository data mode l. In this multidime nsional sc hema entit ies are de scribed as dimension s and fact s. Dimens ion tables are sets of related attribute s that are used to g roup or co nstrain fa ct-based i nformation when repo rting. Di mensions a re compani ons to a f act table. The dime nsion tabl es contain the textu al descrip tors of th e business . Common dimensions in the PI T data rep ository in clude: tim e, claim, provider a nd locatio n. The PI T data rep ository co nsists of several fa ct tables representi ng differe nt subject areas. A surrogate key uniqu ely identi fies each row in the fact tabl e. The PIT Repositor y consists of collec tions of s tar schema s aligned to multipl e fact tab les and co nforming d imensions tied to th e user rep orting req uirements and FAMS s coring too l applicat ion. | ||
670 | Please ref er to the Non-VA Car e Program Integrity Tools – En terprise D ata Archit ecture doc ument for detailed c onceptual, logical a nd physica l diagrams describin g the PIT data model . | ||
671 | 3.2.2 Repo sitory Dat abase Info rmation | ||
672 | The Progra m Integrit y Tools re pository c urrently i s deployed into prod uction and serves as the enter prise-wide repositor y providin g a multi- dimensiona l view to all Purcha sed Care c laims and payment da ta. The in tent of th e reposito ry is to h ouse data currently housed in multiple s ystems wit hin the VA . This cen tral repos itory cont ains suffi cient data necessary to facili tate multi ple goals including the develo pment of a robust Fr aud/Waste/ Abuse (FWA ) program, decreasin g improper payments, utilizing industry standard h ealth care claims to ols and pr oviding a broad view of paymen ts across VHA Progra ms. | ||
673 | The reposi tory resid es on a MS SQL Serve r DBMS. | ||
674 | Table 9: D ata Reposi tory Key E lements | ||
675 | Key Elemen t | ||
676 | Tools and Technologi es | ||
677 | DBMS | ||
678 | SQL Server 2012 R2 | ||
679 | Data Integ ration | ||
680 | InfoSphere Data Stag e 11.5 | ||
681 | Data Acces s | ||
682 | Services: JDBC, ODBC | ||
683 | In/Outboun d data fee d: flat fi les | ||
684 | Reporting | ||
685 | SSRS - SQL Server Re porting Se rvices | ||
686 | 3.2.2.1 Da tabase Int erfaces | ||
687 | The PIT da ta reposit ory curren tly interf aces with the follow ing applic ations: | ||
688 | Data integ ration lay er, which consists o f InfoSphe re Data St age. | ||
689 | PIT Fraud and FAMS a pplication | ||
690 | PIT Report ing Tool | ||
691 | |||
692 | Including external i nterfaces: | ||
693 | Table 10: Applicatio ns Using D ata Reposi tory | ||
694 | System Nam e | ||
695 | Location | ||
696 | Interface Methods | ||
697 | FAMS | ||
698 | AITC | ||
699 | JDBC | ||
700 | MS Busines s Intellig ence | ||
701 | AITC | ||
702 | .Net/ODBC | ||
703 | FBCS | ||
704 | VA VISN | ||
705 | File Trans fer | ||
706 | VACS | ||
707 | FSC | ||
708 | Simple Fil e Transfer Protocol | ||
709 | CP&E | ||
710 | HAC | ||
711 | File Trans fer | ||
712 | CDW | ||
713 | AITC | ||
714 | ODBC | ||
715 | InfoSphere DataStage | ||
716 | AITC | ||
717 | JDBC | ||
718 | |||
719 | 3.3Concept ual Infras tructure D esign | ||
720 | This secti on describ es a very high level overview of the con ceptual in frastructu re of the production environme nt: | ||
721 | Figure 5: Production Environme nt | ||
722 | |||
723 | |||
724 | |||
725 | |||
726 | 3.3.1 Syst em Critica lity and H igh Availa bility | ||
727 | The Progra m Integrit y Tools ad apted the infrastruc ture and m onitoring capability provided by the hos ting envir onment, wh ich is AIT C. As suc h, system criticalit y and avai lability i s related to consist ent availa bility of AITC’s env ironment. | ||
728 | Consistent , accurate ly-transmi tted feeds from VA s ource syst ems are es sential fo r PIT to p rocess and score cla ims as wel l as produ ce compreh ensive rep orting inf ormation f or involve d users. The failur e of these feeds wil l inhibit the Scorin g Model’s ability to score rel ated data and provid e reportin g informat ion, but w ill only i nhibit the Model’s f unctioning for speci fic failed feeds. P IT will st ill be abl e to proce ss and sto re claims for all wo rking feed s, which w ill allow for higher total ava ilability. | ||
729 | PIT will a lso ensure high avai lability b y adhering to genera l design g uidelines like decou pling comp onents. I n addition , computin g resource s will not be shared between a pplication s. Aside from key i nterdepend encies bet ween appli cations (i .e. the Re porting To ol’s depen dency on t he accurat e function ality of t he PIT Dat a Reposito ry), the f unctioning and opera tion of on e segment of PIT wil l not affe ct the spe ed or avai lability o f other to ols. Final ly, the PI T Data Rep ository wi ll be avai lable 24 h ours per d ay, Monday to Friday . | ||
730 | Please ref er to the Non-VA Car e Program Integrity Tools – Sy stem Archi tecture De sign for t he AITC fo r further details on PIT’s rel iance on A ITC. | ||
731 | 3.3.2Speci al Technol ogy | ||
732 | Not applic able. | ||
733 | 3.3.3Techn ology Loca tions | ||
734 | The PIT ap plication is current ly hosted at AITC. Non-VA Car e Program Integrity Tools - Sy stem Archi tecture De sign for A ITC | ||
735 | 3.3.4Conce ptual Infr astructure Diagram | ||
736 | 3.3.4.1 Lo cation of Environmen ts and Ext ernal Inte rfaces | ||
737 | The follow ing is the conceptua l infrastr ucture dia gram of th e Program Integrity Tools depl oyed withi n the AITC facility. | ||
738 | Figure 6: AITC Deplo yment | ||
739 | |||
740 | |||
741 | 3.3.4.2 Co nceptual P roduction String Dia gram | ||
742 | The follow ing figure shows a g raphical c onfigurati on of a si ngle produ ction stri ng of the Program In tegrity To ols. | ||
743 | Figure 7: PIT Concep tual Produ ction | ||
744 | |||
745 | |||
746 | |||
747 | System Arc hitecture | ||
748 | |||
749 | |||
750 | Hardware A rchitectur e | ||
751 | |||
752 | Table 1 1: AITC De velopment Environmen t Configur ations | ||
753 | Old Serve r | ||
754 | Newly Upgr aded Serve r | ||
755 | Purpose | ||
756 | IP Address | ||
757 | CPU | ||
758 | RAM | ||
759 | GB | ||
760 | OS | ||
761 | GB | ||
762 | APP | ||
763 | GB | ||
764 | DATA | ||
765 | GB | ||
766 | LOG | ||
767 | GB | ||
768 | TEMP | ||
769 | GB | ||
770 | DNS | ||
771 | DNS | ||
772 | Rules App Server | ||
773 | IP | ||
774 | 2 (3) | ||
775 | 6 | ||
776 | 80 | ||
777 | 200 | ||
778 | |||
779 | |||
780 | |||
781 | DNS | ||
782 | DNS | ||
783 | Data Stage Applicati on Server | ||
784 | IP | ||
785 | 2 | ||
786 | 28 | ||
787 | 80 | ||
788 | 39 | ||
789 | 159 | ||
790 | 29 | ||
791 | 19 | ||
792 | DNS | ||
793 | DNS | ||
794 | DataStage Applicatio n Server | ||
795 | IP | ||
796 | 2 | ||
797 | 8 | ||
798 | 80 | ||
799 | 220 | ||
800 | |||
801 | |||
802 | |||
803 | Table 12: AITC Test Environmen t Configur ation Deta ils | ||
804 | Server | ||
805 | Newly Upgr aed Server | ||
806 | Purpose | ||
807 | IP Address | ||
808 | CPU | ||
809 | RAM | ||
810 | GB | ||
811 | OS | ||
812 | GB | ||
813 | APP | ||
814 | GB | ||
815 | DATA | ||
816 | GB | ||
817 | LOG | ||
818 | GB | ||
819 | TEMP | ||
820 | GB | ||
821 | DNS | ||
822 | DNS | ||
823 | |||
824 | SharePoint / BI Appl ication Se rver | ||
825 | IP | ||
826 | 2 | ||
827 | 8 | ||
828 | 100 | ||
829 | 150 | ||
830 | |||
831 | |||
832 | |||
833 | DNS | ||
834 | DNS | ||
835 | Rules App Server | ||
836 | IP | ||
837 | 2 | ||
838 | 6 | ||
839 | 80 | ||
840 | 200 | ||
841 | |||
842 | |||
843 | |||
844 | DNS | ||
845 | DNS | ||
846 | FAMS Appli cation Ser ver | ||
847 | IP | ||
848 | 2 | ||
849 | 6 | ||
850 | 70 | ||
851 | 80 | ||
852 | |||
853 | |||
854 | |||
855 | Table 13: AITC Pre-P roduction Environmen t Configur ations | ||
856 | Server | ||
857 | Newly Upgr aded | ||
858 | Server | ||
859 | Purpose | ||
860 | IP Address | ||
861 | CPU | ||
862 | RAM | ||
863 | GB | ||
864 | OS | ||
865 | GB | ||
866 | APP | ||
867 | GB | ||
868 | DATA | ||
869 | GB | ||
870 | LOG | ||
871 | GB | ||
872 | TEMP | ||
873 | GB | ||
874 | DNS | ||
875 | DNS | ||
876 | Rules App Server | ||
877 | IP | ||
878 | 6 | ||
879 | 12 | ||
880 | 80 | ||
881 | 200 | ||
882 | |||
883 | |||
884 | |||
885 | DNS | ||
886 | DNS | ||
887 | Rules App Server | ||
888 | IP | ||
889 | 6 | ||
890 | 12 | ||
891 | 80 | ||
892 | 200 | ||
893 | |||
894 | |||
895 | |||
896 | DNS | ||
897 | DNS | ||
898 | DataStage Applicatio n Server | ||
899 | IP | ||
900 | 6 | ||
901 | 12 | ||
902 | 80 | ||
903 | 200 | ||
904 | |||
905 | |||
906 | |||
907 | DNS | ||
908 | DNS | ||
909 | DataStage Applicatio n Server | ||
910 | IP | ||
911 | 6 | ||
912 | 12 | ||
913 | 80 | ||
914 | 200 | ||
915 | |||
916 | |||
917 | |||
918 | DNS | ||
919 | DNS | ||
920 | FAMS Appli cation Ser ver | ||
921 | IP | ||
922 | 4 | ||
923 | 12 | ||
924 | 64 | ||
925 | 100 | ||
926 | |||
927 | |||
928 | |||
929 | DNS | ||
930 | DNS | ||
931 | Database | ||
932 | IP | ||
933 | 8 | ||
934 | 64 | ||
935 | 100 | ||
936 | 244 | ||
937 | (E)2000 | ||
938 | (F)1400 | ||
939 | (G)800 | ||
940 | 254 | ||
941 | 530 | ||
942 | DNS | ||
943 | DNS | ||
944 | SharePoint / BI Appl ication Se rver | ||
945 | IP | ||
946 | 6 | ||
947 | 16 | ||
948 | 80 | ||
949 | 260 | ||
950 | |||
951 | |||
952 | |||
953 | Table 14: AITC Produ ction Envi ronment Co nfiguratio ns | ||
954 | Server | ||
955 | Newly Upgr aded Serve r | ||
956 | Purpose | ||
957 | IP Address | ||
958 | CPU | ||
959 | RAM | ||
960 | GB | ||
961 | OS | ||
962 | GB | ||
963 | APP | ||
964 | GB | ||
965 | DATA | ||
966 | GB | ||
967 | LOG | ||
968 | GB | ||
969 | TEMP | ||
970 | GB | ||
971 | DNS | ||
972 | DNS | ||
973 | Rules App Server | ||
974 | IP | ||
975 | 4 | ||
976 | 12 | ||
977 | 80 | ||
978 | 50 | ||
979 | |||
980 | |||
981 | |||
982 | DNS | ||
983 | DNS | ||
984 | Rules App Server | ||
985 | IP | ||
986 | 4 | ||
987 | 12 | ||
988 | 80 | ||
989 | 90 | ||
990 | |||
991 | |||
992 | |||
993 | DNS | ||
994 | DNS | ||
995 | Datastage Applicatio n Server | ||
996 | IP | ||
997 | 8 | ||
998 | 16 | ||
999 | 100 | ||
1000 | 700 | ||
1001 | |||
1002 | |||
1003 | |||
1004 | DNS | ||
1005 | DNS | ||
1006 | Datastage Applicatio n Server | ||
1007 | IP | ||
1008 | 8 | ||
1009 | 16 | ||
1010 | 80 | ||
1011 | 400 | ||
1012 | |||
1013 | |||
1014 | |||
1015 | DNS | ||
1016 | DNS | ||
1017 | FAMS Appli cation Ser ver | ||
1018 | IP | ||
1019 | 4 | ||
1020 | 12 | ||
1021 | 60 | ||
1022 | 50 | ||
1023 | |||
1024 | |||
1025 | |||
1026 | DNS | ||
1027 | DNS | ||
1028 | SharePoint /BI Applic ation Serv er | ||
1029 | IP | ||
1030 | 4 | ||
1031 | 12 | ||
1032 | 60 | ||
1033 | 260 | ||
1034 | |||
1035 | |||
1036 | |||
1037 | DNS | ||
1038 | |||
1039 | |||
1040 | IP | ||
1041 | 8 | ||
1042 | 68 | ||
1043 | 80 | ||
1044 | 544 | ||
1045 | (E)2000 | ||
1046 | (F)2000 | ||
1047 | (G)773 | ||
1048 | 488 | ||
1049 | 400 | ||
1050 | DNS | ||
1051 | |||
1052 | |||
1053 | IP | ||
1054 | 8 | ||
1055 | 68 | ||
1056 | 80 | ||
1057 | 544 | ||
1058 | (E)2000 | ||
1059 | (F)2000 | ||
1060 | (G)773 | ||
1061 | 488 | ||
1062 | 400 | ||
1063 | DNS | ||
1064 | |||
1065 | |||
1066 | IP | ||
1067 | 8 | ||
1068 | 68 | ||
1069 | 80 | ||
1070 | 544 | ||
1071 | (E)2000 | ||
1072 | (F)2000 | ||
1073 | (G)773 | ||
1074 | 488 | ||
1075 | 400 | ||
1076 | |||
1077 | Software A rchitectur e | ||
1078 | Please ref erence the up-to-dat e versions of the fo llowing do cuments, p ublished s eparately, for detai ls on the Software A rchitectur e: | ||
1079 | Non-VA Car e Program Integrity Tools - En terprise D ata Archit ecture | ||
1080 | Non-VA Car e Program Integrity Tools - FB CS ETL Des ign Docume nt | ||
1081 | Non-VA Car e Program Integrity Tools - CP &E ETL Des ign Docume nt | ||
1082 | Non-VA Car e Program Integrity Tools - CD W ETL Desi gn Documen t | ||
1083 | Non-VA Car e Program Integrity Tools - Re pository U ser Guide | ||
1084 | |||
1085 | Communicat ions Archi tecture | ||
1086 | Table 14: Default Po rts | ||
1087 | Component | ||
1088 | Default Po rt Numbers | ||
1089 | IBM Inform ation Serv er Web-bas ed clients | ||
1090 | 9080 | ||
1091 | IBM Inform ation Serv er Web-bas ed clients - HTTPS | ||
1092 | 9443 | ||
1093 | WebSphere Applicatio n Server A dministrat ive consol e | ||
1094 | 9060 | ||
1095 | WebSphere Applicatio n Server A dministrat ive consol e (HTTPS) | ||
1096 | 9043 | ||
1097 | IBM Inform ation Serv er service s (RMI/IIO P) | ||
1098 | 2809, 9100 , 9401–940 3 | ||
1099 | IBM WebSph ere Inform ation Serv ices Direc tor servic es with JM S bindings | ||
1100 | 7276, 7286 , 5558, 55 78 | ||
1101 | SQL Server database | ||
1102 | 1433 | ||
1103 | IBM Inform ation Serv er ASB age nt | ||
1104 | 31531, and a random port numbe r greater than 1024* | ||
1105 | IBM Inform ation Serv er logging agent | ||
1106 | 31533 | ||
1107 | IBM WebSph ere DataSt age and Qu alityStage services | ||
1108 | 31538 | ||
1109 | Parallel j ob monitor s | ||
1110 | 13400 (por t 1) and 1 3401 (port 2) | ||
1111 | Parallel e ngine (APT _PM_STARTU P_PORT) | ||
1112 | multiple p orts, uses a port nu mber of 10 000 or gre ater | ||
1113 | Parallel e ngine remo te process startup ( rsh/ssh, m ultiple no des only) | ||
1114 | 22514 | ||
1115 | Parallel e ngine (APT _PLAYER_CO NNECTION_P ORT, multi ple nodes only) | ||
1116 | multiple p orts, uses a port nu mber of 11 000 or gre ater | ||
1117 | |||
1118 | Please see section 4 in the No n-VA Care Program In tegrity To ols - Syst em Archite cture Desi gn for AIT C document . | ||
1119 | Data Desig n | ||
1120 | Not applic able – the PIT’s Dat a Design w ill remain the same for the En hancement effort as it was for the origi nal develo pment of t he PIT. | ||
1121 | Data Manag ement Syst em Files | ||
1122 | Informatio n on the d atabase de sign has b een docume nted in de tail in th e Non-VA C are Progra m Integrit y Tools - Enterprise Data Arch itecture d ocument. Please ref er to that document for inform ation on P IT’s logic al and phy sical desi gn, includ ing entity relations hip diagra ms and det ails on th e logical model, an enterprise data bus matrix, an d more. | ||
1123 | Non-Databa se Managem ent System Files | ||
1124 | Non-DBMS f iles are r eceived fr om four di fferent so urce syste ms in the course of normal PIT operation s, and fil es from ea ch source system are handled d ifferently by the PI T ETL proc ess. Plea se refer t o the Non- VA Care Pr ogram Inte grity Tool s – Claims Scoring T ool Interf ace Contro l Document for infor mation on the intera ctions bet ween these source sy stems and the PIT, a nd please refer to i ndividual systems’ E TL design documents for specif ic details on the wa ys files a re handled by the PI T ETL (Non -VA Care P rogram Int egrity Too ls – FBCS ETL Design document, Non-VA Ca re Program Integrity Tools – C P&E (X12 8 37 and CP& E DW) ETL Design doc ument, Non -VA Care P rogram Int egrity Too ls – CDW E TL Design Document). | ||
1125 | |||
1126 | Detailed D esign | ||
1127 | Individual ETL desig n document s specify detailed d esign spec ifications for each process of the PIT. Please re ference th ese docume nts as nee ded. | ||
1128 | Hardware D etailed De sign | ||
1129 | The core h ardware de sign was n ot modifie d for the Program In tegrity To ols. Howev er, additi onal datab ase storag e space wa s added to PITEDR (P rogram Int egrity Too ls Enterpr ise Data R epository) . Also, pr oduction S ervers wer e migrated to new se rvers and latest sof wares were being ins talled and configure d. Below s creenshots indicate the curren t database size in p re-prod/pr od: | ||
1130 | Pre-prod d atabase si ze: | ||
1131 | |||
1132 | Prod datab ase size: | ||
1133 | |||
1134 | Software D etailed De sign | ||
1135 | The Claim Scoring To ol, PIT re pository, ETL tool, and Report ing tool w ill update d in this increment of work to support t he Tasks l isted in S ection 1. Please ref er to the following documents for detail s on the s pecific ET L, Scoring , Reposito ry, and Re porting de sign chang es: | ||
1136 | Repository | ||
1137 | Non-VA Car e Program Integrity Tools – Da ta Model | ||
1138 | Non-VA Car e Program Integrity Tools – Da ta Diction ary | ||
1139 | ETL | ||
1140 | Interfaces | ||
1141 | Non-VA Car e Program Integrity Tools – In terface Co ntrol Docu ment | ||
1142 | FBCS Field s | ||
1143 | Non-VA Car e Program Integrity Tools – FB CS UB file specifica tion | ||
1144 | Non-VA Car e Program Integrity Tools – FB CS HCFA fi le specifi cation | ||
1145 | Non-VA Car e Program Integrity Tools – FB CS UB mapp ings | ||
1146 | Non-VA Car e Program Integrity Tools – FB CS HCFA ma ppings | ||
1147 | Scoring To ol | ||
1148 | Non-VA Car e Program Integrity Tools – Sc oring Poli cy | ||
1149 | Communicat ions Detai led Design | ||
1150 | Please ref er to sect ion 4 of t he Non-VA Care Progr am Integri ty Tools - System Ar chitecture Design fo r AITC doc ument and the Non-VA Care Prog ram Integr ity Tools – Claims S coring Too l Interfac e Control Document f or informa tion on da ta exchang e/format b etween com ponents. | ||
1151 | 7.External Interface Design | ||
1152 | Please ref er to the Non-VA Car e Program Integrity Tools - Cl aim Scorin g Tool Int erface Con trol Docum ent for de tails on t he interfa ce between the PIT a nd externa l VA sourc e systems. | ||
1153 | 8.Human-Ma chine inte rface | ||
1154 | Please ref er to the following documentat ion for de tails on t he interfa ces betwee n human en d-users an d the PIT system, in cluding st ep-by-step walkthrou ghs for in teracting with the P IT: | ||
1155 | Non-VA Car e Program Integrity Tools - Sc oring Tool User Manu al | ||
1156 | Non-VA Car e Program Integrity Tools - Re pository U ser Guide | ||
1157 | 9.System I ntegrity C ontrols | ||
1158 | Please ref er to the Program In tegrity To ols Operat ions Manua l for info rmation on configura tion and r elease man agement, s ystem inte grity cont rols, and maintenanc e informat ion. This source is the up-to -date refe rence docu ment for a ll related topics. | ||
1159 | Appendix A | ||
1160 | Packaging and Instal lation | ||
1161 | Please ref er to the Non-VA Car e Program Integrity Tools - Co mprehensiv e Server U ser Manual (Volumes I and II) for detail s on softw are packag ing and in stallation . | ||
1162 | Glossary o f Terms | ||
1163 | Table 11: Glossary o f Terms | ||
1164 | Term | ||
1165 | Meaning | ||
1166 | ACR | ||
1167 | Artifact C entral Rep ository | ||
1168 | AITC | ||
1169 | Austin Inf ormation T echnology Center | ||
1170 | BI | ||
1171 | Business I ntelligenc e | ||
1172 | BRD | ||
1173 | Business R equirement s Document | ||
1174 | C&A | ||
1175 | Certificat ion and Ac creditatio n | ||
1176 | CBO | ||
1177 | Chief Busi ness Offic e | ||
1178 | CHAMPVA | ||
1179 | Civilian H ealth and Medical Pr ogram of t he VA | ||
1180 | CDW | ||
1181 | Corporate Data Wareh ouse | ||
1182 | CLRA | ||
1183 | Claim Line Risk Asse ssment | ||
1184 | COTS | ||
1185 | Commercial Off-The-S helf | ||
1186 | CP&E | ||
1187 | Claim Proc essing and Eligibili ty System | ||
1188 | DBMS | ||
1189 | Database M anagement System | ||
1190 | EDI | ||
1191 | Electronic Data Inte rchange | ||
1192 | ETL | ||
1193 | Extract, T ransform a nd Load | ||
1194 | FAMS | ||
1195 | Fraud and Abuse Mana gement Sys tem | ||
1196 | FBCS | ||
1197 | Fee Basis Claims Sof tware | ||
1198 | FWA | ||
1199 | Fraud/Wast e/Abuse | ||
1200 | HAC | ||
1201 | Health Adm inistratio n Center | ||
1202 | HCE | ||
1203 | Health Car e Efficien cy | ||
1204 | HCP | ||
1205 | Heath Clai ms Process ing | ||
1206 | HIPAA | ||
1207 | Health Ins urance Por tability a nd Account ability Ac t of 1996 | ||
1208 | ICD-9 | ||
1209 | Internatio nal Classi fication o f Diseases Version 9 | ||
1210 | ICD-10 | ||
1211 | Internatio nal Classi fication o f Diseases Version 1 0 | ||
1212 | IPERA | ||
1213 | Improper P ayments El imination and Recove ry Act | ||
1214 | IT | ||
1215 | Informatio n Technolo gy | ||
1216 | IM/IT | ||
1217 | Informatio n Manageme nt/Informa tion Techn ology | ||
1218 | MOSS | ||
1219 | Microsoft Office Sha rePoint Se rver | ||
1220 | MS | ||
1221 | Microsoft | ||
1222 | NCPDP | ||
1223 | National C ouncil for Prescript ion Drug P rograms | ||
1224 | OIT | ||
1225 | Office of Informatio n & Techno logy | ||
1226 | PCBL | ||
1227 | Purchased Care Busin ess Line | ||
1228 | PD | ||
1229 | Product De velopment | ||
1230 | PHI | ||
1231 | Protected Health Inf ormation | ||
1232 | PII | ||
1233 | Personally Identifia ble Inform ation | ||
1234 | PIT | ||
1235 | Program In tegrity To ols | ||
1236 | PITEDR | ||
1237 | Program In tegrity To ols Enterp rise Data Repository | ||
1238 | PMAS | ||
1239 | Project Ma nagement A ccountabil ity System | ||
1240 | PMP | ||
1241 | Program Ma nagement P lan | ||
1242 | RDBMS | ||
1243 | Relational Database Management System | ||
1244 | RSD | ||
1245 | Requiremen t Specific ation Docu ment | ||
1246 | SAS | ||
1247 | Statistica l Analysis System In stitute | ||
1248 | SDD | ||
1249 | System Des ign Docume nt | ||
1250 | SQL | ||
1251 | Structured Query Lan guage | ||
1252 | VA | ||
1253 | Department of Vetera ns Affairs | ||
1254 | VAMC | ||
1255 | Veterans A ffairs Med ical Cente r | ||
1256 | VHA | ||
1257 | Veterans H ealth Admi nistration | ||
1258 | VISN | ||
1259 | Veterans I ntegrated Service Ne twork | ||
1260 | VistA | ||
1261 | Veterans H ealth Info rmation Sy stems and Technology Architect ure | ||
1262 | WBE | ||
1263 | WebSphere Business E vents | ||
1264 | |||
1265 | |||
1266 | Approval S ignatures | ||
1267 | This secti on is used to docume nt the app roval of S ystem Desi gn Documen t. The Cha ir of the governing Integrated Project T eam (IPT), Business Sponsor, I T Program Manager, P roject Man ager, and the member s of the T echnical a nd Enterpr ise Archit ectural Re view Team are requir ed to sign . Please a nnotate si gnature bl ocks accor dingly. | ||
1268 | |||
1269 | |||
1270 | __________ __________ __________ __________ __________ ________ | ||
1271 | Signed:Dat e: | ||
1272 | Gilbert (T ony) Canal es | ||
1273 | |||
1274 | __________ __________ __________ __________ __________ ________ | ||
1275 | Signed:Dat e: | ||
1276 | Elizabeth Tyler | ||
1277 | |||
1278 | |||
1279 | __________ __________ __________ __________ __________ ________ | ||
1280 | Signed:Dat e: | ||
1281 | Enterprise Architect ure | ||
1282 | |||
1283 | |||
1284 | __________ __________ __________ __________ __________ ________ | ||
1285 | Signed:Dat e: | ||
1286 | Service De livery &En gineering |
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