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VA Code in Flight Submission - Non VA Care Claims Processing Enhancements(docs and KIDS build GMRC*3.0*75)
Please use this identifier to cite or link to this publication: http://hdl.handle.net/10909/10986
Submitted by OI&T EPMO Lean Systems Engineering Open Source Coordination Office on 11-26-2014.
To address identified problems, the VHA Chief Business Office (CBO), for Purchased Care has developed a comprehensive set of requirements to outline a vision for the future state of the Purchased Care Program. In order to meet the long term business requirement, VA will need to execute full business process re-engineering, move to one claims processing system, and make the organizational changes necessary to support these program requirements. The CBO is managing multiple programmatic changes to meet both long-term needs as well as interim requirements in both care coordination and claims processing. Claims processing covers the efficient processing, payment or denial of health care claims submitted by Non-VA providers to include assurance that systems are in place to accurately adjudicate and pay claims.
In order to meet the long-term vision, the CBO has partnered with the Financial Services Center (FSC) in Austin, TX to develop a centralized HCP system. HCP will first be deployed to Indianapolis in Q2FY14, followed by incremental updates, and finally a complete national deployment by the end of 2015.
The current integration of multiple VistA functionalities for Non-VA claims processing and referral/authorization is not sufficient to assure that appropriate estimation and obligation information is current, transparent and available for decision making during Non-VA referral/authorization and claims processing.

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