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VA Code in Flight Submission - EDI Medical ePayments Compliance Phase 2 (RSD & SDD Only)
Please use this identifier to cite or link to this publication: http://hdl.handle.net/10909/10933
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 the 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 electronic transactions and code sets and standard, unique identifiers 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 Medical ePayments Compliance (Phase 2, Iteration 2) project ensures VA’s compliance with Electronic Funds Transfer (EFT) & Electronic Remittance Advice (ERA) Operating Rules and enables VA to more effectively use ERA data, resulting in better revenue and cash flow management; provides the infrastructure foundation for electronic exchange of claim payment information and promotes an interoperable system; reduces the time elapsed between receipt of the 835 and receipt of the CCD+ transaction; ensures that trace numbers between payments and remittances can be used by VA, reducing the level of open accounts receivable and allowing claim denials to be more quickly addressed; and standardizes EFT & ERA enrollment, reducing workload burden on VA staff.

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