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Patch Subject: MEDICAL CARE COLLECTION FUND (MCCF) ENHANCEMENTS PROJECT - EPAYMENTS
Description:
============
*************************************************************************
NOTICE:
The patch bundle PRCA IB MCCF EDI 1.0 (IB*2.0*530/PRCA*4.5*303) must
be installed first, then install two standalone patches, IB*2.0*529
and PRCA*4.5*304. Patch IB*2.0*529 must be installed before installing
PRCA*4.5*304. Install all patches close together so that your site has
all of the features released as part of this enhancement.
*************************************************************************
The Medical ePayments Compliance (Phase 2, Iteration 2) project ensures
the Veterans Administrations (VA) compliance with Electronic Funds
Transfer (EFT) & Electronic Remittance Advice (ERA) Operating Rules, and
enables VA to more effectively use ERA data, resulting in better revenue
and cash flow management. It will provide the infrastructure foundation
for electronic exchange of claim payment information and promotes an
interoperable system and will reduce the time elapsed between receipt of
the Electronic Data Interchange (EDI) 835 Electronic Remittance Advice
Transaction and receipt of the Cash Concentration or Disbursement (CCD+)
transactions. It will ensure that trace numbers between payments and
remittances can be used by VA, reducing the level of open accounts
receivable, allow claim denials to be more quickly addressed, and
standardizes Electronic Funds Transfer (EFT) & ERA enrollment to reduce
workload burden on VA staff.
This patch contains changes to the ePayments (835 and EFT) program area
to ensure compliance. Specifically, enhancements to the Veterans
Health Information Systems and Technology Architecture (VistA) Third Party
EDI Lockbox module to increase timely and accurate processing of payments
for electronic pharmacy claims in compliance with Health Insurance
Portability and Accountability Act (HIPAA) and Veterans Health
Administration (VHA) Fiscal Accounting policies will also be required.
The ePayments system is used by Accounts Receivable (AR) staff to process
payments from third party payers for both medical and pharmacy claims. The
objectives of the requested ePayments software modifications are to
expedite accurate payments by enhancing the ePayments software to
streamline the user's ability to process the pharmacy 835 while:
Complying with HIPAA legislative requirements to meet patient needs and
secure Protected Health Information (PHI).
Conducting payment accounting in accordance with the Office of Management
and Budget (OMB) directives.
Systematically enforcing VHA Fiscal Accounting policy.
This patch implements the following:
- Auto-posting of Pharmacy ERA payments
- Auditing of Suspense item processing
- Allowing ERAs with data exceptions Auto-post after corrections
- Allows re-use of Deposit Ticket #'s for manually created deposit
tickets
- Allows the Medical Auto-decrease functionality to specify maximum
decrease amounts by Claims Adjustment Reason Codes (CARC)
- Add Medical and Pharmacy filters to several reports
Patch Components
================
Files & Fields Associated:
File Name (#) Field Name (#)
New/Modified/Deleted
------------- -----------------------------------
--------------------
AR SITE PARAMETER (#342)
MAX DAYS ENTRY SUSPENDED (#7.04) New
AUTO POST MEDICAL PAPER BILLS (#7.05) New
AUTO POST PHARMACY PAPER BILLS (#7.06) New
AR BATCH PAYMENT (#344)
RECEIPT # (#.01) Modified
ELECTRONIC REMITTANCE ADVICE (#344.4)
DATE POSTED TO SUSPENSE Modified
ELECTRONIC REMITTANCE ADVICE - ERA DETAIL SUB-FILE (#344.41)
CLAIM COMMENT New
CLAIM COMMENT DATE New
CLAIM COMMENT USER New
RCDPE AUTO-PAY EXCLUSION (#344.6)
EXCLUDE RX CLAIM POSTING (#.08) New
PHARMACY AUTO-POST COMMENT (#3) New
RCDPE PARAMETER (#344.61)
AUTO-POST RX CLAIMS ENABLED (WorldVistA#1.01) New
AUTO-DECREASE RX ENABLED (WorldVistA#1.02) New
RCDPE CARC-RARC AUTO DEC (#344.62) New
RCDPE SUSPENSE AUDIT (#344.71) New
RCDPE AUTO-POST AUDIT (#344.72) New
RCDPE DM REPORT PARAMETERS (#344.9) New
RCDPE DM REPORT ARCHIVE (#344.91) New
Forms Associated:
New/Modified/
Form Name File Name (Number) Deleted
--------- ------------------ -------------
N/A
Mail Groups Associated:
New/Modified/
Mail Group Name Deleted
--------------- -------------
N/A
Options Associated:
New/Modified/
Option Name Type Deleted
----------- ---- -------------
Finance AR Manager Menu [PRCA menu Modified
MANAGER MENU]
Agent Cashier Menu [RCDP AGENT menu Modified
CASHIER MENU]
EDI Lockbox (ePayments) menu Modified
Reports Menu [RCDPE EDI
LOCKBOX REPORTS MENU]
EDI Diagnostic Measures menu New
Reports [RCDPE EDI NATIONAL
REPORTS]
EDI VOLUME STATISTICS Report run routine New
[RCDPE EDI VOLUME
STATISTICS]
EFT/ERA TRENDING Report run routine New
[RCDPE EFT-ERA TRENDING
REPORT]
ERA Status Change Audit Report run routine New
[RCDPE ERA STATUS CHNG AUD
REP]
Disable-Enable DM Background run routine New
Job/Reports [RCDPE NR
DISABLE/ENABLE]
EDI Diagnostic Measures menu New
Extracts Menu [RCDPE NR
EXTRACT MENU]
Manually Start DM Extract run routine New
[RCDPE NR MANUAL START]
Manually Transmit DM Extract run routine New
[RCDPE NR MANUAL TRANSMIT]
View/Print Extracted Reports run routine New
[RCDPE NR VIEW/PRINT
EXTRACTS]
Link Payment Tracking Report run routine New
[RCDPE SUSPENSE AUDIT
REPORT]
Parameter Definitions:
New/Modified/
Parameter Name Deleted
-------------- -------------
RCDPE APAR Modified
Protocols Associated:
New/Modified/
Protocol Name Deleted
------------- -------------
RCDP LINK PAYMENTS SUSPENSE REPORT Modified
RCDPE APAR CLAIM COMMENT New
RCDPE APAR EEOB REFRESH Modified
RCDPE APAR EEOB REVIEW Modified
RCDPE APAR RESEARCH Modified
RCDPE APAR SELECTED EEOB MENU Modified
RCDPE APAR SPLIT LINE Modified
RCDPE APAR VERIFY Modified
RCDPE APAR VIEW/PRINT EOB Modified
RCDPE APAR VIEW/PRINT ERA Modified
RCDPE EOB WL RECEIPT VIEW Modified
RCDPE EOB WL REVIEW Modified
RCDPE EOB WORKLIST CHANGE VIEW Modified
RCDPE EOB WORKLIST DIST ADJ Modified
RCDPE EOB WORKLIST MARK FOR AUTO POST New
RCDPE EOB WORKLIST MENU Modified
RCDPE EOB WORKLIST RECEIPT PROCESSING Modified
RCDPE EOB WORKLIST REFRESH Modified
RCDPE EOB WORKLIST SPLIT LINE Modified
RCDPE EOB WORKLIST VERIFY Modified
RCDPE MARK FOR AUTOPOST New
RCDPE VIEW/PRINT WORKLIST ERA Modified
RCDPE WORKLIST ERA LIST MENU Modified
RCDPE WORKLIST ERA MARK FOR AUTO POST New
Security Keys Associated:
New/Modified/
Security Key Name Deleted
----------------- -------------
N/A
List Templates:
New/Modified/
Template Name Type Deleted
------------- ---- -------------
RCDP DEPOSIT PROFILE List Modified
RCDP LINK PAYMENTS TO ACCOUNTS List Modified
RCDPE WORKLIST ERA LIST List Modified
Templates Associated:
New/Modified/
Template Name Type File Name (Number) Deleted
------------- ---- ------------------ -------------
RCMS EDI LOCKBOX Input AR SITE PARAMETER (#342) Modified
Additional Information:
-----------------------
N/A
New Service Requests (NSRs):
-----------------------------
20130518 - Medical ePayments Compliance (Phase 2, Iteration 2)
Patient Safety Issues (PSIs):
------------------------------
N/A
Remedy Ticket(s) & Overviews:
-----------------------------
1. INC1269592/INC1282993: EFTs posted to paper EOBs are not showing up
on reports and causing stale dated lockups.
Problem:
--------
When processing EFTs with paper EOBs, EFTs are not marked as posted in
VistA. Consequently, they are still showing up on reports and causing
stale dated lockups.
Resolution:
-----------
After investigating, this was determined to be a training issue as users
at some sites were not properly closing receipts after the EFT was posted
to a paper EOB. No programming changes were needed.
2. INC1289740: Auto-Posting of ERA line items does not always work.
Problem:
--------
During auto-posting of (ERA) line items that were marked for
auto-posting, if the payment amount was greater than the claim balance,
processing of ERA line items stopped and the remainder of the line items
did not process. In addition, the line items did not go back on the
Auto-Post Awaiting Resolution (APAR) worklist.
Resolution:
-----------
Any ERA line items with a payment amount less than the claim balance will
post. Any line items that cannot be posted due the payment amount being
greater than the claim balance will be sent to the APAR worklist.
3. INC1289572/IR277545: Receipt processing issues
Problem:
--------
This was actually two separate problems related to receipts:
3a. When an ERA has more than one receipt number, the APAR Header
displays the incorrect receipt numbers.
3b. When a user utilizes the Split/Edit action from the APAR worklist to
put dollars into Suspense and enters a comment, the comment is not
displayed on the Receipt Profile or the 215 Report.
Resolution:
-----------
3a. The APAR header was fixed to display the correct receipt numbers when
there are multiple receipt numbers on an ERA.
3b. There was conditional logic that was used when transferring comments
to the ERA detail lines. This conditional logic was removed and all
comments are now transferred Subsequently, the comments will be
displayed on the Receipt Profile and the 215 Report.
4. INC1289748: The Auto-Post report does not correctly display split
payments.
Problem:
--------
The Auto-Post report does not correctly display split payments, including
suspense payments. In addition, the receipt number does not always
display correctly.
Resolution:
-----------
The Auto-Post report now displays all payments, including split payments
and suspense payments. The receipt number is now correctly displayed.
Test Sites:
-----------
Alexandria VA Health Care System (Alexandria, LA)-Station 502
Huntington VA Medical Center (Huntington, WV)-Station 581
South Texas Veterans Health Care System (San Antonio, TX)-Station 671
Software and Documentation Retrieval Instructions:
----------------------------------------------------
Software being released as a host file and/or documentation describing
the new functionality introduced by this patch are available.
The preferred method is to retrieve files from download.vista.domain.ext.
This transmits the files from the first available server. Sites may
also elect to retrieve files directly from a specific server.
Sites may retrieve the software and/or documentation directly using Secure
File Transfer Protocol (SFTP) from the ANONYMOUS.SOFTWARE directory at
the following OI Field Offices:
Albany: domain.ext
Hines: domain.ext
Salt Lake City: domain.ext
Documentation can also be found on the VA Software Documentation Library
at: http://www4.domain.ext/vdl/
File Description File Name FTP Mode
--------------------------------------------------------------------
ACCOUNTS RECEIVABLES Technical Manual/ PRCA_4_5_TM_R0516.PDF (binary)
Security Manual
ACCOUNTS RECEIVABLES Release Notes/ PRCA_4_5_P304_RN.PDF (binary)
Installation Guide
EPAYMENTS USER MANUAL (EDI LOCKBOX) EPAYMENTS_USER_ (binary)
MANUAL_R0516.PDF
Patch Installation:
Pre/Post Installation Overview
------------------------------
Note:
The patch bundle PRCA IB MCCF EDI 1.0 (IB*2.0*530/PRCA*4.5*303) must
be installed first, then install two standalone patches, IB*2.0*529
and PRCA*4.5*304. Patch IB*2.0*529 must be installed before installing
PRCA*4.5*304. Install all patches close together so that your site has
all of the features released as part of this enhancement
There is a post installation routine which will initially prevent your
site from auto-auditing medical and pharmacy bills, and auto-posting and
auto-decreasing pharmacy ERAs.
After the post-install is complete you can safely remove the routine
RC45P304.
Use default answers for KIDS load/install questions.
Patch-Files: http://code.osehra.org/VistA.git/tree/b0ced814/Packages/Accounts+Receivable/Patches/PRCA_4.5_304- Loading branch information
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