| DESCRIPTION OF ENHANCEMENTS |
PATCH OVERVIEW
introduced in a phased implementation strategy. This deployment strategy
schedule adjustment is entered. These are optional and will be sent in
the NCPDP transmission.
7. To assist with the posting of payments, the API used to look
up bills to post payments in the Accounts Receivable package has
been updated to allow for input of the ECME number.
Technical Description
---------------------
was utilized due to the complexity of the functionality and the number of
IB20P223 is an environment check to ensure that the site has 4 national
rate types defined. If the rate types are not defined, a site will need
to defined them prior to install. The 4 rate types are:
CHAMPUS (or TRICARE)
CHAMPUS REIMB. INS. (or TRICARE REIMB. INS.)
CHAMPVA
CHAMPVA REIMB. INS.
If your site does not have the exact spelling as shown above, you should
contact EVS for assistance. Your site may have them defined but the
names may have been changed.
product line dependencies.
This routine also has a post install that will add two reasons not
billable. They are:
HEAD/NECK CANCER
COMBAT VETERAN
IBCRCC has an optional parameter in the RATECHG line tag of FEE. If this
parameter is passed by reference, the API will return any Administrative
Fee and Dispensing Fee amounts for the Rate Schedule.
IBCREE has been modified to capture the Administrative Fee and Dispensing
Fee, if appropriate. The Rate Schedule adjustment must have an amount
added in the calculation of the adjustment for the fee questions to be
asked.
IBCRU3 has been modified to add a new entry point to look up the event
pointer based on a rate type.
IBJTCA1 is included to add enhancements to the Third Party Joint Inquiry
to display new information that relates to ECME claims.
The first release of this two part implementation is BPS*1*0, comprised
IBNCPDP is the main API routine to be used by Outpatient Pharmacy. All
new APIs will be supported with this routine.
IBNCPDP1 will handle the initial call by Outpatient Pharmacy. This
routine will load the prescription information to Claims Tracking, look
up insurance information, verify active pharmacy coverage and return the
necessary billing information so that a NCPDP claim can be produced.
IBNCPDP2 will handle all response information sent from Outpatient
of the new Electronic Claims Management Engine (ECME) package (in the BPS
Pharmacy. This routine will create bills, authorize bills, audit bills,
adjust bills, cancel bills and ensure that the claims are updated in
Claims Tracking.
IBNCPDP3 will handle Average Wholesale Pricing updates.
IBNCPCPU will be a utility routine for all the NCPDP billing needs in IB.
IBRFN has been updated to allow for input of an ECME number when posting
payments in the Accounts Receivable package. The API for AR will now
namespace), plus the patches PSS*1*81, IB*2.0*223, IB*2.0*251, and
return the type of lookup found.
IBRUTL is being included to suppress the third party billing bulletin when
a first party bill goes on hold for third party billing and the bill has
already been billed using the ECME software.
IBTUTL1 has been modified to accept an additional optional parameter in
the REFILL line tag for the EARLIEST AUTOBILL DATE. If the new parameter
is specified in the call, that date will be used instead of the existing
functionality.
PRCA*4.5*202, which are listed here in order of installation. BPS*1*0 is
COMPONENTS SENT WITH PATCH
--------------------------
The following is a list of the routine(s) included in this patch.
The second line of each of these routine(s) will look like:
<tab>;;2.0;INTEGRATED BILLING;**[patch list]**;21-MAR-94
CHECK^XTSUMBLD results
a dormant release that only allows each site to perform preliminary setup
Routine Before Patch After Patch Patch List
------- ------------ ----------- ----------
* IB20P223 N/A 2185163 223
IBCRCC 7424137 7476482 52,80,106,138,245,223
IBCREE 20456836 21593159 52,106,115,223
IBCRU3 5450420 6652039 52,106,223
IBJTCA1 16164807 16640403 39,80,106,137,223
IBNCPDP N/A 355298 223
IBNCPDP1 N/A 13353250 223
work and to confirm that the software does not adversely affect other
IBNCPDP2 N/A 16386559 223
IBNCPDP3 N/A 758252 223
IBNCPDPU N/A 8111193 223
IBRFN 4021093 6787815 52,130,183,223
IBRUTL 3925983 4993649 70,82,132,142,176,179,202,223
IBTUTL1 5460777 6092014 13,223
Total number of routines - 13
---------------
packages.
* NOTE: THIS ROUTINE WILL BE AUTOMATICALLY DELETED AFTER INSTALL.
Data Dictionary Changes:
UP SEND DATA USER
DATE SEC. COMES SITE RSLV OVER
FILE # NAME DD CODE W/FILE DATA PTS RIDE
------------------------------------------------------------------------------
361.1 EXPLANATION OF BENEFITS YES NO NO NO
Partial DD: subDD: 361.1 fld: .14
DATA SCREEN:
363 RATE SCHEDULE YES NO NO NO
Partial DD: subDD: 363 fld: 1.01
fld: 1.02
DATA SCREEN:
There are two main areas addressed by BPS*1*0:
399 BILL/CLAIMS YES NO NO NO
Partial DD: subDD: 399 fld: 460
fld: 461
DATA SCREEN:
SOFTWARE AND DOCUMENTATION RETRIEVAL
====================================
The software for this patch is being distributed in host file
BPS_1_0.KID. The host file will contain seven KIDS builds.
The builds contained in the BPS 1.0 multi-package distribution are:
Package Patches
------- ----------------------
ECME BPS*1.0*1
Pharmacy Data Management PSS*1.0*81
Integrated Billing IB*2.0*223, IB*2.0*251
Accounts Receivable PRCA*4.5*202
a. Registration of the Pharmacy with the Vitria BusinessWare IE.
Please refer to the 'Software and Documentation Retrieval' section of the
BPS*1.0*1 patch description for instructions on how to acquire the patch
software and documentation.
INSTALLATION INSTRUCTIONS
==========================
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
b. The Insurance Matching of Group Plans with Pharmacy Plans
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.
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.
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.
Following the installation of BPS*1*0, each site must register their
6. At the "Want to Continue with Load? YES//" prompt, enter YES.
7. At the "Want to RUN the Environment Check Routine: YES//" prompt,
answer YES.
8. From this menu, the installer may select to use the following options:
(When prompted for INSTALL NAME, enter BPS 1.0)
pharmacy with Vitria and match applicable insurance group plans using the
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
insurance matching screens. These processes are detailed in the HIPAA
integrity of the routines that are in the transport global.
9. At the "Select Installation Option:" prompt, enter 6 Install Package(s)
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?
NCPDP CONNECTION FOR EDI PHARMACY INSTALLATION GUIDE and the MATCH GROUP
YES//" respond NO.
13. When prompted, "Want to DISABLE Scheduled Options, Menu Options, and
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.
PLANS WITH PHARMACY PLANS document. Both of these documents are located
on the anonymous directory. It is very important that the IRM or person
installing the patch at each facility provide a copy of these documents
to its ADPAC(s) and any other relevant staff who will be responsible for
registering their pharmacy with Vitria and completing the insurance
matching process.
At a later date, additional HIPAA NCPDP patches will be released to
activate all of the HIPAA NCPDP functionality. Until that time, sites
The Healthcare Insurance Portability and Accountability Act National
will 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.
Council for Prescription Drug Programs (HIPAA NCPDP) initiative, whose
The specific functionality for this patch is listed below.
Functional Description
----------------------
This patch adds the necessary enhancements to the Integrated Billing
package to support NCPDP (National Council for Prescription Drug Programs)
billing of pharmacy claims via the Outpatient Pharmacy package.
The features are:
ultimate goal is to provide functionality allowing electronic
1. When a patient is issued medication via Outpatient Pharmacy,
Outpatient Pharmacy will check with Integrated Billing (IB) to determine
if the prescription is NCPDP billable to a third party payer. The patient
must have active, reimbursable insurance that covers prescriptions as
specified in the patient's group policy coverage limitations. The
prescription must not be for OTC or research medications and must not be
related to SC (Service Connected), AO (Agent Orange), IR (Ionizing
Radiation), EC (Environmental Contaminants), HNC (Head/Neck Cancer), CV
(Combat Veteran), or MST (Military Sexual Trauma).
transmission of Outpatient Pharmacy (OP) prescription claims to payers
2. A check will be done to see if the site's Claims Tracking module is
turned on for prescriptions. When it is, the appropriate information
will be entered into that module in IB. To ensure that the Autobiller
does not bill the prescription on a paper claim until the electronic
transmission can be processed, the EARLIEST AUTOBILL DATE will be set for
60 days into the future. If the claim is not processed or resolved in
pharmacy within 60 days, then a paper claim will be automatically
generated.
and the receipt of claim responses (including drug utilization review
3. If the bill for the prescription is approved by the third party
insurance carrier for payment, Outpatient Pharmacy will make a second
call to IB. At that time, IB will create a bill in the BILL/CLAIMS
(#399) file for the amount of the total charge. The bill will be
automatically authorized and passed to Accounts Receivable (AR). IB will
have AR automatically audit the receivable and post a decrease adjustment
so that the amount of the outstanding receivable will be equal to the
amount of payment expected from the payer.
4. If a prescription bill is rejected, Outpatient Pharmacy will make a
responses and warnings) on a real-time basis, is being developed and
second call to IB. Assuming Claims Tracking is active for prescriptions,
IB will check to make sure the prescription is in Claims Tracking. The
Claims Tracking entry will be picked up by the Autobiller to ensure
proper follow-up is done.
5. If a prescription bill is reversed in Outpatient Pharmacy, both the
bill and receivable will be cancelled.
6. To support claims other than Reimbursable Insurance for Veterans, IB
will ask for both the Administrative Fee and Dispensing Fee when a rate
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