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VA Code in Flight Submission - Healthcare Claims 837 Compliance Phase 2 Iteration 1
Please use this identifier to cite or link to this publication: http://hdl.handle.net/10909/11067
Submitted by OI&T EPMO Lean Systems Engineering Open Source Coordination Office on 11-08-2016.
The HAPE EDI portfolio delivers IT products and services to CBO. This PC enhancement project is intended to deliver a range of updates, extensions, and modifications to various financial and administrative systems, processes, files, and reporting mechanisms, including:
• PC System Enhancements: Harris will modify vendor data storage and claims processing functionality so payments to small businesses are made in a timely manner per the Prompt Payment Act. Harris will develop reports to verify compliance and data integrity.
• Health Administration Center (HAC) EDI Claims System Enhancements: Harris will provide EDI functionality related to referral requests and authorizations in preparation for rules effective January 2016.
• Electronic Remittance Advice (ERA) 835 Compliance: To comply with CORE Level III Electronic Funds Transfer (EFT) standards, Harris will modify vendor file and vendor maintenance functionality, Veterans Health Information Systems and Technology Architecture (VistA) Fee, and Claims Processing and Eligibility (CP&E) for beneficiary-related transactions.
• Health Plan Identifier (HPID) Compliance: To comply with rules effective Fall 2016, Harris will modify claim transaction functionality related to incoming HPID validation and generation of outgoing EDI transactions to populate the VA HPID.
• Claims Attachments Compliance: Harris will create systems to manage the receipt, processing, and storage of claims attachments in preparation for rules effective January 2016.
• Healthcare Claims 837 Compliance: Harrris will review and modify the 837 transaction flow within VA systems.
• Caregiver Stipend Payments System (optional task): Harris will create a rules-based system to calculate stipend payments for caregivers, and create an interface to VA’s vendor database and maintenance process, CBOPC Veterans files, and Financial Management System (FMS) payment system.

Revision Notes

This revision makes available the in-flight code for Phase 2, Iteration 1 for EWV and CP&E.

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