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VA Code in Flight Submission - EDI Insurance Verification Processor (RSD & SDD Only)
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Submitted by OIT EPMO EPMD ACOE Tools Operations Open Source Service on 08-19-2014.
Chief Business Office (CBO) eBusiness Solutions is sponsoring this request. In an ongoing effort to improve and increase revenue, eBusiness Solutions will implement best practices related to insurance capture and verification. The project will incorporate industry standard card scanning capabilities and a Windows Graphical User Interface (GUI) interface for VistA; to provide VHA insurance intake & verification clerks the electronic software system necessary to capture new insurance information for Veterans. This business process will be appointment driven and will implement a standard business process that captures and verifies insurance information and demographic data through paperless technology combined with VistA integration.
New GUI software is being requested to streamline and enhance existing data capture and processing abilities of Veterans Health Information Systems and Technology Architecture (VistA) Integrated Billing (IB) package. VHA is also in the process of updating its current Health Insurance Portability and Accountability Act of 1996 (HIPAA) transaction standards to the updated operating rules and Health Plan Identifier (HPID) requirements of the Patient Protection and Affordable Care Act of 2010 (PPACA). VHA must address business changes and software system impacts that will result from final rules published by the Department of Health and Human Services (HHS) to meet the administrative simplification mandates of PPACA section 1104. While this body of work will not specifically address any particular HIPAA or PPACA regulations, any GUI software developed will need to be cognizant of HIPAA and PPACA mandates now and in the future.

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