E CLAIMS MGMT ENGINE (198)    PACKAGE (9.4)

Name Value
NAME E CLAIMS MGMT ENGINE
PREFIX BPS
CURRENT VERSION 1.0
SHORT DESCRIPTION ELECTRONIC CLAIMS MGT
VERSION
  • 1.0
    DATE DISTRIBUTED:   2005-11-19 00:00:00
    PATCH APPLICATION HISTORY:
    • 1
      DATE APPLIED:   2006-05-25 00:00:00
      APPLIED BY:   USER,ONE
      DESCRIPTION:   
      PATCH OVERVIEW
      to the complexity of the functionality and the number of product line
      dependencies.
       
      This is the second part of the Electronic Claims Management Engine (ECME)
      package (in the BPS namespace), also known as the active build. It
      comprises of these patches: BPS*1*1, PSO*7*148, PSS*1*90, PSX*2*48 and
      IB*2*276.
       
      This build will introduce functionality supporting Point of Service
      Outpatient Pharmacy claim and billing processing by collecting billing and
       
      clinical information within the prescription fill workflow process.  This
      build will create real-time electronic claims and send claim data to
      adjudicating payers from the new VistA Electronic Claims Management Engine
      (ECME) via the VistA HL7 module (using the PSO NCPDP link) to the Vitria
      server at the FSC in Austin, TX in a HIPAA compliant (NCPDP V. 5.1)
      format. Vitria will then store and forward these transactions to WebMD for
      final submission to the payer on a real-time basis. Payer responses will
      be received and returned to VistA in the appropriate manner (i.e. - claim
      transactions sent to Integrated Billing (IB), Drug Utilization responses
      and warnings sent to the Outpatient Pharmacy V. 7.0 package and rejections
      The Healthcare Insurance Portability and Accountability Act National
      made available to the appropriate personnel for review and analysis).
       
      Within VistA, throughout this process, constant bi-directional
      communication via API's between Outpatient Pharmacy, Integrated Billing,
      and ECME will process and generate these claim and billing transactions at
      the appropriate trigger points within the standard VA process workflow.
      Council for Prescription Drug Programs (HIPAA NCPDP) initiative, whose
      ultimate goal is to provide functionality allowing electronic transmission
      of Outpatient Pharmacy (OP) prescription claims to payers and the receipt
      of claim responses (including drug utilization review responses and
      warnings) on a real-time basis, is being developed and introduced in a
      phased implementation strategy. This deployment strategy was utilized due
      
    • 10
      DATE APPLIED:   2011-11-02 12:02:43
      APPLIED BY:   USER,SEVENTEEN
      DESCRIPTION:   
      ePharmacy Phase 5 - NCPDP D.0
      
    • 12 SEQ #11
      DATE APPLIED:   2011-12-13 15:21:16
      APPLIED BY:   USER,SEVENTEEN
      DESCRIPTION:   
      Modify reversal process to get the reversal payer sheet from the pharmacy 
      plan.
      
    • 11
      DATE APPLIED:   2012-02-16 14:00:21
      APPLIED BY:   USER,SEVENTEEN
      DESCRIPTION:   
      ePharmacy Phase 6
      
    • 14 SEQ #13
      DATE APPLIED:   2013-03-19 11:20:12
      APPLIED BY:   USER,SEVENTEEN
      DESCRIPTION:   
      This patch fixes random subscript errors, allows users to select 
      a Drug Class Code as an option during the Payable Claims Report 
      [BPS RPT PAYABLE] and fixes issues while sorting in the ECME 
      User Screen [BPS USER SCREEN].
      
    • 15
      DATE APPLIED:   2014-01-06 16:16:55
      APPLIED BY:   USER,SEVENTEEN
      DESCRIPTION:   
      EPHARMACY OPERATING RULES
      
    • 18
      DATE APPLIED:   2015-02-09 12:43:22
      APPLIED BY:   USER,SEVENTEEN
    • 17
      DATE APPLIED:   2015-05-14 10:11:54
      APPLIED BY:   USER,SEVENTEEN
      DESCRIPTION:   
      ePayments ePharmacy Compliance
      BPS IB PRCA EPAYMENTS BUNDLE 1.0
      
    • 19
      DATE APPLIED:   2016-02-11 17:16:37
      APPLIED BY:   USER,FIFTYFOUR
      DESCRIPTION:   
      HAPE EDI Revenue project - NCPDP Continuous Maintenance Standards
      
    • 20
      DATE APPLIED:   2016-08-29 12:56:24
      APPLIED BY:   USER,FIFTYFOUR
      DESCRIPTION:   
      MCCF ePharmacy Compliance Phase 3
      
    • 21 SEQ #19
      DATE APPLIED:   2017-08-02 13:25:31
      APPLIED BY:   USER,FIFTYFOUR
      DESCRIPTION:   
      MCCF EDI TAS ePharmacy Iteration 1
      
    • 3
      DATE APPLIED:   2006-09-23 00:00:00
      APPLIED BY:   USER,ONE
      DESCRIPTION:   
      This patch supports the National Council for Prescription Drug Programs 
      that will enable the user to reopen a closed Electronic Claims Management
      Engine (ECME) claim; updates to the Rx Activity Log; and permanent storage
      of Claims activity information as reported by the ECME Billing Events
      Report. 
      (NCPDP) standard which was adopted under the Healthcare Insurance
      Portability and Accountability Act (HIPAA) for pharmacy claims. This patch
      is one of six to be released.  Three patches will be released in a KIDS
      multi-build distribution containing: BPS*1*3, PSO*7*247, and IB*2*342.  
      Three patches will be released individually and they are: PRCA*4.5*247,
      PSX*2*62, and PSS*1*115.
       
      Enhancements included in the release of the six patches are a new option 
      
    • 22
      DATE APPLIED:   2017-11-27 13:48:54
      APPLIED BY:   USER,FIFTYFOUR
      DESCRIPTION:   
      MCCF EDI TAS EPHARMACY BUILD 2
      
    • 23
      DATE APPLIED:   2018-09-07 12:24:13
      APPLIED BY:   USER,FIFTYFOUR
      DESCRIPTION:   
      MCCF EDI TAS EPHARMACY BUILDS 3 & 4
      
    • 24
      DATE APPLIED:   2019-02-01 14:37:59
      APPLIED BY:   USER,FIFTYFOUR
      DESCRIPTION:   
      MCCF EDI TAS EPHARMACY BUILDS 5 & 6
      
    • 25 SEQ #23
      DATE APPLIED:   2019-04-02 14:26:22
      APPLIED BY:   USER,FIFTYFOUR
    • 26
      DATE APPLIED:   2020-04-10 16:08:07
      APPLIED BY:   USER,SEVENTY
      DESCRIPTION:   
      MCCF EDI TAS EPHARMACY BUILD 13
      
    • 27
      DATE APPLIED:   2020-12-08 08:27:24
      APPLIED BY:   USER,SEVENTEEN
    • 28b
      DATE APPLIED:   2021-05-19 00:00:00
      DESCRIPTION:   
      Backup of BPS PSO IB BUNDLE 16.0, BPS*1.0*28, PSO*7.0*560, IB*2
       
      Warning:  Installing this backup patch message will install older versions
      of routines and Build Components (options, protocols, templates, etc.).
      Please verify with the Development Team that it is safe to install.
      
    • 28
      DATE APPLIED:   2021-05-19 16:10:28
      APPLIED BY:   USER,SEVENTEEN
    • 4 SEQ #3
      DATE APPLIED:   2006-12-11 17:28:03
      APPLIED BY:   USER,ONE
      DESCRIPTION:   
      This patch modifies the Application Program Interface (API) that
      processes claims in E-Pharmacy to check for a valid user before it
      stores that information in the BPS Transaction File
      (#9002313.59).
      
    • 2 SEQ #4
      DATE APPLIED:   2007-06-29 19:01:04
      APPLIED BY:   USER,ONE
      DESCRIPTION:   
      The HIPPA NPI project supports the use of NPI within the Electronic 
      Claims Management Engine (ECME) application.
      
    • 5
      DATE APPLIED:   2007-12-12 21:48:59
      APPLIED BY:   USER,ONE
      DESCRIPTION:   
      This patch has enhancements which extend the capabilities of the Veterans
         ELECTRONIC CLAIMS MANAGEMENT ENGINE (ECME) V. 1.0    BPS*1*5
         PHARMACY DATA MANAGEMENT (PDM) V. 1.0                PSS*1*127
         CONSOLIDATED MAIL OUTPATIENT PHARMACY (CMOP) V. 2.0  PSX*2*63
       
      The first three patches (BPS*1*5, IB*2*363,and PSO*7*260) will be
      released in the Kernel Installation and Distribution System (KIDS)
      multi-build distribution BPS PSO IB BUNDLE 2.0.  Patches PSX*2*63 and
      PSS*1*127 will be released as stand-alone patches.  Since there is an
      implementation dependency between the multi-build distribution and the
      stand-alone patches, PSX*2*63 and PSS*1*127 must be installed prior to
      Health Information Systems and Technology Architecture (VistA) electronic
      the installation of the multi-build.  For more specific instructions
      please refer to the installation steps provided in each of the patches.
      pharmacy (ePharmacy) system.  Below is a list of all the applications
      involved in this project along with their patch number:
        
         APPLICATION/VERSION                                  PATCH
         --------------------------------------------------------------
         OUTPATIENT PHARMACY (OP) V. 7.0                      PSO*7*260
         INTEGRATED BILLING (IB) V. 2.0                       IB*2*363
      
    • 6 SEQ #6
      DATE APPLIED:   2009-04-21 16:22:35
      APPLIED BY:   USER,SEVENTEEN
    • 7
      DATE APPLIED:   2009-07-14 09:12:31
      APPLIED BY:   USER,SEVENTEEN
      DESCRIPTION:   
      E-PHARMACY ENHANCEMENTS
      
    • 8
      DATE APPLIED:   2010-09-15 09:21:46
      APPLIED BY:   USER,SEVENTEEN
    • 9
      DATE APPLIED:   2010-12-16 16:42:30
      APPLIED BY:   USER,SEVENTEEN
    DATE INSTALLED AT THIS SITE:   2004-10-29 00:00:00
    INSTALLED BY:   USER,ONE
    DESCRIPTION OF ENHANCEMENTS:   
    Description:
    of claim responses (including drug utilization review responses and 
    Routine Summary: 
    ================
    The second line now reads as follows: 
     
        <TAB>;;1.0;IHS Pharmacy Point of Sale; **[patch list]**; Jun 2004
     
     CHECK^XTSUMBLD results: 
     
    Routine        Checksum Value  
    =======        ============== 
    warnings) on a real-time basis, is being developed and introduced in a 
    BPSECA1         6485606
    BPSECA2         1682902
    BPSECA4         6220829
    BPSECA5         4789118
    BPSECA7          711596
    BPSECA8         3062006
    BPSECA9         4929109
    BPSECFM         2542538
    BPSECP0         1231669
    BPSECP1         8373351
    phased implementation strategy. This deployment strategy was utilized due 
    BPSECP2         4648149
    BPSECP3         8882441
    BPSECR0         1379515
    BPSECR1         1717840
    BPSECR2         3480905
    BPSECX0          754266
    BPSECX1         4278553
    BPSECX4          569954
    BPSECZ3         4496980
    BPSECZA         4449840
    to the complexity of the functionality and the number of product line 
    BPSER1A         3879379
    BPSER2A         5013615
    BPSER3A         3060197
    BPSER4A         4098816
    BPSES00         1681063
    BPSJACK        10839099
    BPSJAREG        3471785
    BPSJHLI         1245414
    BPSJHLT        11644295
    BPSJINI1        6280511
    dependencies.
    BPSJINIT        7809002
    BPSJPHNM        7830674
    BPSJPREG        3683655
    BPSJUTL         2750894
    BPSJUTL1        3176342
    BPSJVAL         3292489
    BPSJVAL1        9341066
    BPSJVAL2        7321923
    BPSJXI1         1888198
    BPSJZPR        10852903
     
    BPSJZQR         1211753
    BPSJZRP         6572546
    BPSMHDR         5172150
    BPSOS02          922003
    BPSOS03         4762173
    BPSOS2          5794835
    BPSOS2A         3438805
    BPSOS2B        12833055
    BPSOS2C         5657589
    BPSOS2D         1377421
    The first release of this two part implementation is BPS*1*0, comprised of
    BPSOS2E         1432527
    BPSOS2F            2190
    BPSOS6A         1692241
    BPSOS6E         2202299
    BPSOS6F          975863
    BPSOS6G          583939
    BPSOS6H         4134763
    BPSOS6I        15473221
    BPSOS6K         1898226
    BPSOS6L         1105023
    the new Electronic Claims Management Engine (ECME) package (in the BPS 
    BPSOS6N        16897666
    BPSOS96          776535
    BPSOS97          696242
    BPSOSA          2151744
    BPSOSAA         2532955
    BPSOSAB         9179518
    BPSOSAD          613947
    BPSOSAM        11538762
    BPSOSAN         1994745
    BPSOSAO         1873331
    namespace), plus the patches PSS*1*81, IB*2.0*223, IB*2.0*251, and 
    BPSOSAP         2403666
    BPSOSAQ          735144
    BPSOSAR         8262363
    BPSOSAS         1745519
    BPSOSAW         5124351
    BPSOSAY         1379312
    BPSOSAZ         1186543
    BPSOSB           959796
    BPSOSB0          113802
    BPSOSB1            2139
    PRCA*4.5*202, which are listed here in order of installation. BPS*1*0 is a
    BPSOSB2            2146
    BPSOSB4            2160
    BPSOSB5            2167
    BPSOSBA          101168
    BPSOSBC          617661
    BPSOSBD         2674634
    BPSOSBE            2279
    BPSOSBI            2307
    BPSOSBL          101245
    BPSOSBP          484897
    ===========
    dormant release that only allows each site to perform preliminary setup 
    BPSOSBQ          485350
    BPSOSBT          485371
    BPSOSBU            2391
    BPSOSBW         4604870
    BPSOSC1         2746444
    BPSOSC2        10781985
    BPSOSC3         2261922
    BPSOSCA         4059491
    BPSOSCF        10660104
    BPSOSD1            2151
    work and to confirm that the software does not adversely affect other 
    BPSOSEC         3788978
    BPSOSFD        13905233
    BPSOSH2         6439291
    BPSOSH4         7279183
    BPSOSH5         4709954
    BPSOSH6         6286709
    BPSOSH7         9955590
    BPSOSHF         3902159
    BPSOSHR         4748980
    BPSOSHU          358514
    packages.
    BPSOSI          6988972
    BPSOSI7         2207252
    BPSOSI8         7983989
    BPSOSIB         1520498
    BPSOSIO         1817298
    BPSOSIP          124772
    BPSOSIW         2934848
    BPSOSIY        13182481
    BPSOSIZ         9743963
    BPSOSJ1         2985572
     
    BPSOSK          5983189
    BPSOSK2         1179461
    BPSOSL          7117465
    BPSOSL1         2520334
    BPSOSM          2149792
    BPSOSM1        10236213
    BPSOSMA         2958187
    BPSOSMB         3244227
    BPSOSMC         5914845
    BPSOSMZ         1902484
    There are two main areas addressed by BPS*1*0:
    BPSOSN0            2010
    BPSOSN4          844510
    BPSOSN7          289249
    BPSOSO1         1391042
    BPSOSO2         6339508
    BPSOSO3            2231
    BPSOSO4            2238
    BPSOSO5            2245
    BPSOSQ1         2227577
    BPSOSQ2         8749786
     
    BPSOSQ3        10336941
    BPSOSQ4         8580589
    BPSOSQF         2968761
    BPSOSQG         5287867
    BPSOSQH          957180
    BPSOSQJ         6618401
    BPSOSQL        10953965
    BPSOSQS         8333856
    BPSOSR1         6141326
    BPSOSR2          579087
    a. Registration of the Pharmacy with the Vitria BusinessWare IE.
    BPSOSR4         4195196
    BPSOSRB         8237522
    BPSOSS2         2327741
    BPSOSS3          670477
    BPSOSS6          214430
    BPSOSS7           67706
    BPSOSS8         7915679
    BPSOSS9         1158213
    BPSOSSG        11401688
    BPSOSU1         2630136
    b. The Insurance Matching of Group Plans with Pharmacy Plans
    BPSOSU2         1004112
    BPSOSU3          877677
    BPSOSU4         4710582
    BPSOSU5          764934
    BPSOSU7         2698763
    BPSOSU8         3768830
    BPSOSU9         1857421
    BPSOSUA         8511603
    BPSOSUB         3172501
    BPSOSUC         1896200
     
    BPSOSUD         6705940
    BPSOSUE         4667712
    BPSOSX          6863167
    BPSOSXA            2383
    BPSOSXE         1952199
    BPSRDT         12823556
    BPSUTIL          464990
     
     
    Documentation Retrieval:
    Following the installation of BPS*1*0, each site must register their 
    ========================
     
    The ECME documentation is available on the ANONYMOUS.SOFTWARE directory
    at one of the following Office of Information (OI) Field Offices.
     
    Sites may retrieve documentation in one of the following ways:
     
    (1) The preferred method is to FTP the files from
        download.vista.domain.ext, which will transmit the files from the
        first available FTP server.
     
    pharmacy with Vitria and match applicable insurance group plans using the 
     
    (2) Sites may also elect to retrieve documentation directly from a
        specific server as follows:
     
        Albany          ftp.fo-albany.domain.ext
        Hines           ftp.fo-hines.domain.ext
        Salt Lake City  ftp.fo-slc.domain.ext 
     
    The documentation distribution includes:
     
    insurance matching screens. These processes are detailed in the HIPAA 
       FILE NAME                        DESCRIPTION
       BPS_1_0_IG.PDF                   HIPAA NCPDP CONNECTION FOR EDI 
                                        PHARMACY (DORMANT RELEASE)
                                        INSTALLATION GUIDE 
       BPS_1_0_RN.PDF                   HIPAA NCPDP CONNECTION FOR EDI
                                        PHARMACY (DORMANT RELEASE)
                                        RELEASE NOTES
       IB_2_251_TM.PDF                  INTEGRATED BILLING IB*2.0*251 
                                        (e-PHARMACY) TECHNICAL MANUAL
       IB_2_251_UM.PDF                  e-PHARMACY CLAIMS INSURANCE PROCESS
    NCPDP CONNECTION FOR EDI PHARMACY INSTALLATION GUIDE and the E-PHARMACY 
                                        USER MANUAL
     
    (3) Documentation can also be retrieved from VISTA Documentation Library
    (VDL) on the Internet at the following address, http://www.domain.ext/vdl.
     
    Installation Instructions:
    ==========================  
     
    The software for this patch is being distributed via a host file.  The 
    host file will contain the following package and builds:
    CLAIMS INSURANCE PROCESS document. Both of these documents are located on
     
           Host file name BPS_1_0.KID
     
                   Package:
                           BPS_1
     
                   Builds:
                           PSS*1.0*81 
                           IB*2.0*223
                           IB*2.0*251
    the anonymous directory. It is very important that the IRM or person
                           PRCA*4.5*202
     
    Sites may retrieve the software directly by using FTP from the 
    ANONYMOUS.SOFTWARE directory at the following OI Field Offices:
     
           Albany:         ftp.fo-albany.domain.ext
           Hines:          ftp.fo-hines.domain.ext
           Salt Lake City: ftp.fo-slc.domain.ext
     
    Do not install this patch while Pharmacy Data Management users are using 
    installing the patch at each facility provide a copy of these documents to
    the software. Installation will take no longer than 15 minutes. There are
    no scheduling restrictions or recommendations.
     
    Installation Steps
     
     1. Use VA FileMan to add the new domain, EPHARMACY.VITRIA-EDI.AAC.DOMAIN.EXT,
        to the DOMAIN file (#4.2). The installation instructions are included
        in the patch description for the XM*DBA*160 patch. This domain must be
        in place before the installation of the IB*2*251 patch that is
        included in the BPS 1.0 Master Build.
    its ADPAC(s) and any other relevant staff who will be responsible for
     
     2. Download the KIDS file BPS_1_0.KID via FTP. This file needs to be 
        retrieved in ASCII format.
     
     3. Review mapped sets for the PSS*, IB*, and PRCA* namespaces.  If the 
        routines are mapped, they should be removed from the mapped set at
        this time.
     
     4. From the Kernel Installation & Distribution System menu, select the 
        Installation menu.
    registering their pharmacy with Vitria and completing the insurance 
     
     5. From this menu, select the Load a Distribution option. When prompted 
        for a file name, enter the directory name where you FTPd the build, 
        followed by BPS_1_0. In our example, the file name is
        USER$:[ANONYMOUS]BPS_1_0.KID. Determine the location where you stored
        your build to decide the correct file name entry.
     
     6. At the "Want to Continue with Load? YES//" prompt, enter YES.
     
     7. At the "Want to RUN the Environment Check Routine: YES//" prompt, 
    matching process.
        answer YES.
     
     8. From this menu, the installer may select to use the following options:
     
    (When prompted for INSTALL NAME, enter BPS 1.0)
     
        a. Backup a Transport Global - This option will create a backup 
        message of any routines exported with the patch. It will NOT backup
        any other changes such as DDs or templates.
     
     
        b. Compare Transport Global to Current System - This option will allow
        you to view all changes that will be made when the patch is installed.
        It compares all components of the patch (routines, DDs, templates,
        etc.).
     
        c. Verify Checksums in Transport Global - This option will ensure the 
        integrity of the routines that are in the transport global.
     
     9. At the "Select Installation Option:" prompt, enter 6 Install 
        Package(s)
    PATCH OVERVIEW
    At a later date, additional HIPAA NCPDP patches will be released to 
     
    10. At the "Select INSTALL NAME:" prompt, enter BPS 1.0.
     
    11. When prompted, "Want KIDS to Rebuild Menu Trees Upon Completion of 
        Install? YES//" respond NO.
     
    12. When prompted, "Want KIDS to INHIBIT LOGONs during the install? YES//"
        respond NO.
     
    13. When prompted, "Want to DISABLE Scheduled Options, Menu Options, and 
    activate all of the HIPAA NCPDP functionality. Until that time, sites will
        Protocols? YES//" respond NO.
     
    14. When prompted, "Device:Home//" respond with the correct device and DO 
        NOT queue this to P-Message.
     
    15. If routines were unmapped as part of step 3, they should be returned 
        to the mapped set once the installation has run to completion.
    not be able to electronically submit claims utilizing this new 
    functionality.
     
    The HIPAA NCPDP project was created in response to a Chief Business Office
    (CBO) request for modifications to several Veterans Health Information 
    Systems and Technology Architecture (VistA) software applications in 
    accordance with HIPAA Electronic Data Interchange (EDI) transactions and 
    NCPDP mandated format standards, specifically the NCPDP Telecommunication 
     
    Standard v.5.1.
     
    The specific functionality for this patch is listed below.
     
    (1)  A user interface has been developed to facilitate entry and filing
         Registration and Point of Contact information for each specific
         Application (Site) and Pharmacies at a site.
     
    (2)  An HL7 interface is included that will create and send HL7 messages
         containing the Application and Pharmacy Registration data to Vitria.
    The Healthcare Insurance Portability and Accountability Act National 
         This data notifies Vitria that the site will soon be sending 
         electronic third party pharmacy claims. 
     
    (3)  An additional HL7 interface is included which receives messages from
         Vitria containing the most up to date Payer Sheet data, and files the
         data into the appropriate Vista table. This interface will run 
         continously, and will keep the site updated with the most recent
         changes and additions to the third party Payer sheets.
     
    New Globals:
    Council for Prescription Drug Programs (HIPAA NCPDP) initiative, whose 
    ============
     
    The following globals will be created when installing this build.
     
    ^BPS            -       MOSTLY STATIC
    ^BPSC           -       VERY DYNAMIC - WILL CONTINUALLY GROW
    ^BPSCOMB        -       STATIC - CURRENTLY NOT USED BY THE VA
    ^BPSECP         -       DYNAMIC - DOESNT GROW
    ^BPSECX         -       DYAMIC - DOESNT GROW A LOT
    ^BPSEI          -       STATIC - CURRENTLY NOT USED BY THE VA
    ultimate goal is to provide functionality allowing electronic transmission
    ^BPSF           -       STATIC - DOESNT GROW
    ^BPSR           -       DYNAMIC - GROWS CONTINUALLY
    ^BPST           -       DYNAMIC - GROWS
    ^BPSTL          -       DYNAMIC - GROWS
     
     
    Associated NOISs:
    =================
    N/A
     
    of Outpatient Pharmacy (OP) prescription claims to payers and the receipt 
     
    Test Sites:
    ===========
    NEW YORK HARBOR HCS
    NORTH TEXAS HCS
    ANN ARBOR, MI       
    BATTLE CREEK, MI     
    DETROIT, MI
    IRON MOUNTAIN, MI