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VA Code in Flight Submission - EDI Uniform Use of CARC/RARC (RSD & SDD Only)
Please use this identifier to cite or link to this publication: http://hdl.handle.net/10909/10932
Submitted by OI&T EPMO Lean Systems Engineering Open Source Coordination Office on 08-19-2014.
Changes to Veterans Health Information Systems and Technology Architecture (VistA) Accounts Receivable (AR), Integrated Billing (IB), Insurance Capture Buffer (ICB) and Kernel application software are being requested by the Veterans Health Administration (VHA) Chief Business Office (CBO) eBusiness Solutions to comply with legislative changes mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) as amended by Public Law (P.L.) 111-148, The Patient Protection and Affordable Care Act (PPACA), Section 1104. Provisions of PPACA, Section 1104 are listed in order of effective date in the following table.
In addition, the PPACA requires the establishment of a review committee to provide a report of recommendations for updating the transaction standards and operating rules to the Secretary of the Department of Health and Human Services (HHS) beginning on 01/01/2014 and continuing on a biennial basis.
VHA uses the following standard, unique identifiers and Electronic Data Interchange (EDI) transactions in support of its third-party revenue and collections operation:
 National Provider Identifier (NPI)
 270/271 Health Care Eligibility Benefit Inquiry and Response
 837 Health Care Claims – Institutional and Professional
 National Council Pharmacy Drug Program (NCPDP) Pharmacy Transactions
 835 Health Care Claim Payment/Advice
 EFT
The Uniform Use of CARC/RARC (835) Rule (Phase 2, Iteration 2) projects allow VA to more effectively obtain payment from patients, to more quickly generate secondary claims to other payers, and to reduce open accounts receivable through implementation of standard CARC/RARC usage.

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