============================================================================= Run Date: JUL 09, 2009 Designation: IB*2*384 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #379 Status: Released Compliance Date: AUG 09, 2009 ============================================================================= Associated patches: (v)BPS*1*7 install with patch `IB*2*384' (c)PSO*7*289 install with patch `IB*2*384' (v)IB*2*292 <<= must be installed BEFORE `IB*2*384' (v)IB*2*361 <<= must be installed BEFORE `IB*2*384' (v)IB*2*377 <<= must be installed BEFORE `IB*2*384' (v)IB*2*401 <<= must be installed BEFORE `IB*2*384' (v)IB*2*405 <<= must be installed BEFORE `IB*2*384' Subject: ePHARMACY ENHANCEMENTS Category: - Routine - Data Dictionary Description: ============ This patch has enhancements which extend the capabilities of the Veterans Health Information Systems and Technology Architecture (VistA) electronic pharmacy (ePharmacy) billing system. Below is a list of all the applications involved in this project along with their patch number: APPLICATION/VERSION PATCH -------------------------------------------------------------- CONSOLIDATED MAIL OUTPATIENT PHARMACY (CMOP) V. 2.0 PSX*2*65 PHARMACY DATA MANAGEMENT (PDM) V. 1.0 PSS*1*131 OUTPATIENT PHARMACY (OP) V. 7.0 PSO*7*289 INTEGRATED BILLING (IB) V. 2.0 IB*2*384 ELECTRONIC CLAIMS MANAGEMENT ENGINE (ECME) V. 1.0 BPS*1*7 The last three patches (PSO*7*289, IB*2*384 and BPS*1*7) will be released in the Kernel Installation and Distribution System (KIDS) multi-build distribution BPS PSO IB BUNDLE 3.0. Patches PSX*2*65 and PSS*1*131 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*65 and PSS*1*131 must be installed prior to the installation of the multi-build. For more specific instructions please refer to the installation steps provided in each of the patches. This patch modifies the Integrated Billing v2.0 application as described below: 1. Release of Information (ROI) Identifier ------------------------------------------- This patch adds functionally to support the new ROI Identifier "U" in the DEA SPECIAL HDLG (#3) field in the DRUG (#50) file to determine if a drug can be billed to a third party payer (insurance company). Prior to this patch a non-billable code ("0" (zero), "9", or "M") was added to all items that should not be billed to avoid disclosing sensitive diagnoses for the following diseases: HIV, drug abuse, alcohol abuse, or sickle cell anemia. With this patch drugs associated with sensitive diagnoses will have a "U" placed in their DEA SPECIAL HDLG field. The new ROI will be used to check if an ROI is on file for the patient, and therefore be billable. 2. New Claims Tracking ROI file -------------------------------- A new CLAIMS TRACKING ROI file(#356.25) documents whether an ROI is on file for a patient. The Claims Tracking ROI file is maintained manually and indicates if a claim can be sent to third party payers for the particular Drug, Patient, and Insurance Company for drugs containing the new DEA Special Handling. 3. No Signed Release (ROI) --------------------------- When submitted to IB for billing determination, if it is determined that an active ROI is not in the new CLAIMS TRACKING ROI file for a claim that has a DEA Special Handling field of "U", then the claim will be returned non-billable with a Non-Billable Reason of NO ACTIVE ROI ON FILE. 4. ROI Identifier on Screen 7 ------------------------------ When Autobiller creates a claim or if a claim is manually created and the DEA Special Handling field of the Drug has the "U" indicator, the Sensitive Flag will automatically be changed to YES on Screen 7 of the Billing Screen. 5. Prompt for ROI Tracking Data When Entering or Editing a Bill ---------------------------------------------------------------- When entering billing information using the menu option Enter/Edit Billing Information [IB EDIT BILLING INFO], if the drug has a DEA Special Handling field of "U" and no ROI Tracking data is on file for the drug, the user will be prompted to enter the data from screen seven of the billing edit screens when the user is indicating that ROI forms have been completed. 6. Prevent Bill Authorization ------------------------------ If a bill has the Sensitive Diagnosis question answered YES and the ROI Form completed prompt answered as not YES, an error will display in the National Edits error listing when the user is attempting to complete the bill. Authorization of the bill will not be allowed in this case until those Fields are updated. 7. Submit Claim to ECME ROI Prompts ------------------------------------ When using the Claims Tracking option to Submit Claim to ECME and the Drug has a DEA Special Handling field of "U" and no ROI Tracking data is on file for the drug, the user will be prompted to enter the data related to the ROI. This will allow for automatic submission of future prescriptions for the same patient, Drug and Insurance Company as long as the ROI is active within the effective dates. Active status will be determined based on the effective dates. The maximum date range for the effective/expiration dates permitted within the ROI file is one year. 8. Claims Tracking Non-Billable Reasons List --------------------------------------------- The ECME selectable list of non-billable reasons, contained in the Claims Tracking Non-Billable Reasons List file(#356.8), has been expanded to Include the set of Service Connected/Environmental indicators. Additionally a new Reason Not Billable of NO PHARMACY COVERAGE is being added. This new RNB will be utilized whenever the ePharmacy or nightly Claims Tracking software determines not to bill in place of the old SERVICE NOT COVERED entry to be more specific. 9. Copayment Information in TPJI ---------------------------------- The TPJI display is updated to include Outpatient Medication Copayment information. This information will appear at the bottom of the current TPJI display. 10. NON COVERED DRUGS functionality ------------------------------------ This patch adds a functionally that would allow the site to stop sending claims for specific drugs and specific Group plans if they were rejected for specific reasons. Two new fields were added to the IB SITE PARMETER file (#350.9): - (#11.02) DRUG NONCOVERED RECHECK PERIOD to store the number of days to re-check the "NON COVERED DRUG BY PAYER" status. If this number is zero then the functionality is turned off at the site. By default this number is set to zero during installation of the patch. So if the site decides to use this functionality then this number needs to be set to positive value. - (#12) NON COVERED REJECT CODES multiple field to store Reject code(s) returned by the payer that should be treated as NON COVERED BY PLAN response. The code "70" will be pre-populated by the post-install. The new IB NDC NON COVERED BY PLAN file (366.16) was introduced in this patch to store the combination of drugs NDC and Group Plan ien, that was rejected by payers as non-covered by plan. The software prevents sending claims to payers for the Group Plan and NDC combination if it is found in this file and if the last date when the NDC was rejected is not older than the number of days in (#11.02) DRUG NONCOVERED RECHECK PERIOD of the IB SITE PARMETER file. If it is older then the claim will be sent to the payer as usual and if it is rejected again then the date in the file will be updated. The rejected claims will be marked in CLAIM TRACKING record with the new non-billable reason "NON COVERED DRUG PER PLAN". This new item was added to the CLAIMS TRACKING NON-BILLABLE REASONS file (#356.8) The new DRUGS NON COVERED REPORT was designed to display for users the current active and expired combinations of Non Covered Drugs and Group Plans. The new menu option [IB DRUGS NON COVERED REPORT] has been created to access this report from IB menu [IBCNR E-PHARMACY MENU]. The IB Site Parameters submenu of the menu option [IBJ MCCR SITE PARAMETERS] was modify to allow the user to edit the new two fields as well as another e-Pharmacy related field HIPAA NCPDP ACTIVE FLAG. These fields are placed in the section[12]: HIPPA NCPDP Active Flag : Active Drug Non Covered Recheck Period : 10 days(s) Non Covered Reject Codes : 70 Product/Service Not Covered These new fields had replaced the following obsolete fields in the section [12]: Rx Billing Port: Prim Billing Task: AWP Update Port: Sec Billing Task : TCP/IP Address : Prim AWP Upd Task: Task UCI/VOL : Sec AWP Upd Task : AWP Charge Set : Task Started : Prescriber ID : Task Last Ran : DEA vs Presc.ID: Shutdown Tasks? : Calc comp code : 11. SERVICE CONNECTED DETERMINATION CHANGE REPORT -------------------------------------------------- The Service Connected Determination Change Report [IB SC DETERMINATION CHANGE RPT] was added to the Patient Billing Reports Menu [IB OUTPUT PATIENT REPORT MENU]. This option creates a report with patients that have prescriptions and Service Connected determination changes for a specific time period to assist with determining if copays need to be reset. 12. INSUR^IBBAPI API modification -------------------------------- IB API INSUR^IBBAPI (ICR #4419) was modified to accept the new "E" flag for the IBSTAT parameter (INSURANCE STATUS FILTER) to provide a new functionality that allows to return e-Pharmacy billable insurance plans. This patch addresses the following New Service Request (NSR): ------------------------------------------------------------- There is no NSR associated with this patch. This patch addresses the following Remedy Ticket(s): ---------------------------------------------------- There are no Remedy Tickets associated with this patch. Components Sent With Patch -------------------------- The following is a list of the files included in this patch: UP SEND DATA DATE SEC. COMES SITE RSLV FILE # NAME DD CODE W/FILE DATA PTS ----------------------------------------------------------------------- 350.9 IB SITE PARAMETERS YES NO NO 356.25 CLAIMS TRACKING ROI YES NO NO 366.16 IB NDC NON COVERED BY PLAN YES NO NO 399 BILL/CLAIMS YES NO NO The following is a list of fields included in this patch: Field Name (Number) File Name (Number) Subfile Name (Number) ------------------- ------------------ DRUG NONCOVERED RECHECK PERIOD (11.02) IB SITE PARAMETERS (350.9) NON COVERED REJECT CODES (.01) NON COVERED REJECT CODES (sub-file) (350.912) R.O.I. FORM(S) COMPLETED? (157) BILL/CLAIMS (399) The following is a list of list templates included in this patch: Template Name ------------- IBNCR EXPANDED ROI SEND TO SITE IBNCR PATIENT RELEASE OF INFO SEND TO SITE The following is a list of options included in this patch: Option Name Type New/Modified ----------- ---- ------------ IB DRUGS NON COVERED REPORT RUN ROUTINE New IB OUTPUT PATIENT REPORT MENU RUN ROUTINE Modified IB SC DETERMINATION CHANGE RPT RUN ROUTINE New IBCNR E-PHARMACY MENU MENU Use as Link IBCNR RELEASE OF INFORMATION RUN ROUTINE New The following is a list of protocols included in this patch: Protocol Name ----------- IBNCR ADD ROI SEND TO SITE IBNCR EDIT ROI INFO SEND TO SITE IBNCR PATIENT ROI SEND TO SITE IBNCR ROI EXP MENU SEND TO SITE IBNCR VIEWEDIT ROI SEND TO SITE The following security key is exported with this patch: ------------------------------------------------------- IBCNR ROI -------- This key grants access to the option-- Patient Release of Information (ROI) [IBCNR RELEASE OF INFORMATION]. This option allows the tracking of Release of Information for sensitive diagnosis medications. The ROI Clerk and others holding this key will be allowed to add and edit ROI entries in the CLAIMS TRACKING ROI file(#356.25). Documentation Retrieval: ======================== Sites may retrieve documentation in one of the following ways: 1. The preferred method is to FTP the files from download.vista.med.va.gov, which will transmit the files from the first available FTP server. Use the appropriate FTP capability to retrieve the files and use BINARY format. 2. Sites may also elect to retrieve documentation directly from a specific server as follows: Albany ftp.fo-albany.med.va.gov Hines ftp.fo-hines.med.va.gov Salt Lake City ftp.fo-slc.med.va.gov 3. Documentation can also be retrieved from the VistA Documentation Library (VDL) on the Internet at the following address, http://www.va.gov/vdl. The documentation distribution includes: FILE NAME DESCRIPTION --------------------------------------------------------------------- ib_2_384_rn.pdf IB Release Notes Test Sites: =========== Heartland-West HCS Louisville, KY Saginaw, MI ================INSTALLATION INSTRUCTIONS ================= To avoid disruptions, these patches should be installed when users are not on the system and during non-peak hours. Of particular concern would be the items below. 1. Do not install the patch when ECME claims are being generated by the BPS Nightly Background Job option [BPS NIGHTLY BACKGROUND JOB]. Wait for this job to finish or complete the installation before this job starts. 2. Do not install the patch when prescriptions are being transmitted to CMOP. Wait for the CMOP transmission to finish or complete the installation before the transmission starts. Check with Pharmacy Service or your pharmacy Automated Data Processing Application Coordinator (ADPAC) to find out when CMOP transmissions occur. 3. In addition, note that you will be prompted to disable the following options during the installation: Billing Clerk's Menu [IB BILLING CLERK MENU] Billing Supervisor Menu ... [IB BILLING SUPERVISOR MENU] Patient Insurance Menu ... [IBCN INSURANCE MGMT MENU] e-Pharmacy Menu ... [IBCNR E-PHARMACY MENU] ECME Billing Events Report option [IB ECME BILLING EVENTS] ECME [BPSMENU] ECME User Screen [BPS USER SCREEN] Rx (Prescriptions) [PSO RX] ePharmacy Menu [PSO EPHARMACY MENU] Suspense Functions [PSO PND] Install Time - Approximately 30 minutes 1. OBTAIN PATCHES -------------- Patches PSX*2*65 and PSS*1*131 will be sent to your system upon release from the National Patch Module. Obtain the host file BPS_1_7_PSO_IB.KID, which contains the following three patch installs: BPS*1.0*7 PSO*7.0*289 IB*2.0*384 Sites can retrieve VistA software from the following FTP addresses. The preferred method is to FTP the files from: download.vista.med.va.gov This will transmit the files from the first available FTP server. Sites may also elect to retrieve software directly from a specific server as follows: Albany ftp.fo-albany.med.va.gov Hines ftp.fo-hines.med.va.gov Salt Lake City ftp.fo-slc.med.va.gov The BPS_1_7_PSO_IB.KID host file is located in the anonymous.software directory. Use ASCII Mode when downloading the file. 2. LOAD TRANSPORT GLOBAL FOR STAND-ALONE PATCHES --------------------------------------------- For patches PSX*2*65 and PSS*1*131, choose the PackMan message containing each of these patches and invoke the INSTALL/CHECK MESSAGE PackMan option. 3. START UP KIDS ------------- Start up the Kernel Installation and Distribution System Menu option [XPD MAIN]: Edits and Distribution ... Utilities ... Installation ... Select Kernel Installation & Distribution System Option: INStallation --- Load a Distribution Print Transport Global Compare Transport Global to Current System Verify Checksums in Transport Global Install Package(s) Restart Install of Package(s) Unload a Distribution Backup a Transport Global Select Installation Option: 4. RUN OPTIONAL INSTALLATION OPTIONS FOR STAND-ALONE PATCHES --------------------------------------------------------- From the Installation menu, you may select to use the following options (when prompted for the INSTALL NAME, enter each of the stand-alone patches (PSX*2.0*65 and PSS*1.0*131)): a. Backup a Transport Global - This option will create a backup message of any routines exported with this patch. It will not backup any other changes such as Database Definitions (DD's) or templates. b. Compare Transport Global to Current System - This option will allow you to view all changes that will be made when this patch is installed. It compares all components of this patch (routines, DD's, templates, etc.). c. Verify Checksums in Transport Global - This option will allow you to ensure the integrity of the routines that are in the transport global. 5. INSTALL STAND-ALONE PATCHES --------------------------- This is the step to start the installation of this KIDS patch. This will need to be run for each of the stand-alone patches (PSX*2*65 and PSS*1*131). a. Choose the Install Package(s) option to start the patch install. b. When prompted for the "Select INSTALL NAME:", enter the patch name. c. When prompted "Want KIDS to INHIBIT LOGONs during the install? YES//" answer NO. d. When prompted "Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//" answer NO. e. When prompted, "Device: Home//" respond with the correct device. 6. LOAD TRANSPORT GLOBAL FOR MULTI-BUILD ------------------------------------- After the installation of the stand-alone patches is complete, return to the Installation menu. From the Installation menu, select the Load a Distribution option. When prompted for "Enter a Host File:", enter the full directory path where you saved the host file BPS_1_7_PSO_IB.KID (e.g., SYS$SYSDEVICE:[ANONYMOUS]BPS_1_7_PSO_IB.KID). When prompted for "OK to continue with Load? NO//", enter "YES." The following will display: Loading Distribution... BPS PSO IB BUNDLE 3.0 BPS*1.0*7 PSO*7.0*289 IB*2.0*384 Use INSTALL NAME: BPS PSO IB BUNDLE 3.0 to install this Distribution. 7. RUN OPTIONAL INSTALLATION OPTIONS FOR MULTI-BUILD ------------------------------------------------- From the Installation menu, you may select to use the following options (when prompted for the INSTALL NAME, enter BPS PSO IB BUNDLE 3.0): a. Backup a Transport Global - This option will create a backup message of any routines exported with this patch. It will not backup any other changes such as DD's or templates. b. Compare Transport Global to Current System - This option will allow you to view all changes that will be made when this patch is installed. It compares all components of this patch (routines, DD's, templates, etc.). c. Verify Checksums in Transport Global - This option will allow you to ensure the integrity of the routines that are in the transport global. 8. INSTALL MULTI-BUILD ------------------- This is the step to start the installation of this KIDS patch. This will need to be run for the BPS PSO IB BUNDLE 3.0. a. Choose the Install Package(s) option to start the patch install. b. When prompted for the "Select INSTALL NAME:", enter BPS PSO IB BUNDLE 3.0. c. For the PSO*7*289 patch when prompted "Incoming Mail Groups: Enter the Coordinator for Mail Group 'PSO REJECTS BACKGROUND MESSAGE':", enter the User ID of the person who will serve as the coordinator for this new mail group. d. For the BPS*1*7 patch, when prompted "Want KIDS to Rebuild Menu Trees Upon Completion of Install? YES//" enter YES unless your system does this in a nightly TaskMan process. e. For the PSO*7*289 patch, when prompted "Want KIDS to Rebuild Menu Trees Upon Completion of Install? YES//" enter YES unless your system does this in a nightly TaskMan process. f. For the IB*2*384 patch, when prompted "Want KIDS to Rebuild Menu Trees Upon Completion of Install? YES//" enter YES unless your system does this in a nightly TaskMan process. g. When prompted "Want KIDS to INHIBIT LOGONs during the install? YES//" enter NO. h. When prompted "Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//" enter YES. i. When prompted "Enter options you wish to mark as 'Out Of Order':" enter the following options: Billing Clerk's Menu [IB BILLING CLERK MENU] Billing Supervisor Menu ... [IB BILLING SUPERVISOR MENU] Patient Insurance Menu ... [IBCN INSURANCE MGMT MENU] e-Pharmacy Menu ... [IBCNR E-PHARMACY MENU] ECME Billing Events Report option [IB ECME BILLING EVENTS] ECME [BPSMENU] ECME User Screen [BPS USER SCREEN] Rx (Prescriptions) [PSO RX] ePharmacy Menu [PSO EPHARMACY MENU] Suspense Functions [PSO PND] j. When prompted "Enter protocols you wish to mark as 'Out Of Order':" enter . k. When prompted "Delay Install (Minutes): (0-60): 0//" enter an appropriate number of minutes to delay the installation in order to give users enough time to exit the disabled options before the installation starts. l. When prompted "Device: Home//" respond with the correct device. The IB post-install routine delivered with IB*2*384 will do the tasks listed below. The time required to accomplish this task is less than 10 minutes. The post-install routine IB20P384 is being left on the system after the install. The routine will be deleted with a future patch. 1. Edit the Service Connection and Environmental Indicators in the Claims Tracking Non-Billable Reasons file (#356.8) so that they are ECME selectable when closing a claim and providing a non-billable reason. 2. Add a new entry, "IB328 ROI FORM REQUIRED FOR SENSITIVE RECORD to the IB Error file (#350.8). 3. Add a new entry, "NON COVERED DRUG PER PLAN" to the Claims Tracking Non-Billable Reasons file (#356.8). 4. New #350.9 fields are being populated for NON-COVERED DRUGS functionality. 5. Input template IB SCREEN7 is being recompiled. 6. Add a new entry, "NO PHARMACY COVERAGE" to the Claims Tracking Non-Billable Reasons file (#356.8). Routine Information: ==================== The second line of each of these routines now looks like: ;;2.0;INTEGRATED BILLING;**[Patch List]**;21-MAR-94;Build 36 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: IB20P384 Before: n/a After: B34256888 **384** Routine Name: IBBDOC Before: B671934 After: B683097 **267,260,286,361,384** Routine Name: IBBFAPI Before: B38433259 After: B42412028 **267,297,249,317,361,384** Routine Name: IBCBB1 Before: B67930710 After: B72688329 **27,52,80,93,106,51,151,148, 153,137,232,280,155,320,343, 349,363,371,395,384** Routine Name: IBCBB11 Before: B20828500 After: B25129928 **51,343,363,371,395,392,401,384** Routine Name: IBCD2 Before: B26849473 After: B27925323 **4,55,91,106,384** Routine Name: IBCD3 Before: B31420103 After: B31598371 **14,55,52,91,106,125,51,148, 160,137,210,245,260,405,384** Routine Name: IBCU Before: B57362986 After: B57580772 **52,106,51,191,232,323,320,384** Routine Name: IBJPS Before: B5270103 After: B5156185 **39,52,70,115,143,51,137,161, 155,320,348,349,377,384** Routine Name: IBJPS1 Before: B14719996 After: B15675647 **39,52,70,115,153,137,161,384** Routine Name: IBJPS2 Before: B47271248 After: B41372585 **39,52,115,143,51,137,161,155, 320,348,349,377,384** Routine Name: IBJTCA1 Before: B38260395 After: B47734103 **39,80,106,137,223,276,363,384** Routine Name: IBNCDNC Before: n/a After: B7190363 **384** Routine Name: IBNCDNC1 Before: n/a After: B21625955 **384** Routine Name: IBNCPBB Before: B97718741 After: B87491341 **276,347,384** Routine Name: IBNCPBB1 Before: n/a After: B4732084 **384** Routine Name: IBNCPDP Before: B1881095 After: B5165020 **223,276,363,383,384** Routine Name: IBNCPDP1 Before: B67595010 After: B62284917 **223,276,339,363,383,405,384** Routine Name: IBNCPDP2 Before: B55687303 After: B58655489 **223,276,342,347,363,383,405,384** Routine Name: IBNCPDP3 Before: B30635379 After: B30631647 **223,276,342,363,383,384** Routine Name: IBNCPDP4 Before: B49170045 After: B49164947 **276,342,405,384** Routine Name: IBNCPDP6 Before: B11789689 After: B12692205 **383,384** Routine Name: IBNCPDPC Before: B5379430 After: B5201665 **276,339,363,384** Routine Name: IBNCPDPE Before: B17542658 After: B17129560 **276,342,347,363,384** Routine Name: IBNCPDPH Before: B26701868 After: B26345635 **276,347,384** Routine Name: IBNCPDPI Before: B8589835 After: B7116772 **276,383,384** Routine Name: IBNCPDPL Before: B771797 After: B647455 **276,384** Routine Name: IBNCPDPR Before: B27008499 After: B26651365 **276,347,384** Routine Name: IBNCPDPU Before: B69246173 After: B71731167 **223,276,347,383,405,384** Routine Name: IBNCPDR Before: n/a After: B7723137 **384** Routine Name: IBNCPDR1 Before: n/a After: B4262134 **384** Routine Name: IBNCPDR2 Before: n/a After: B8736079 **384** Routine Name: IBNCPDR4 Before: n/a After: B32682440 **384** Routine Name: IBNCPDR5 Before: n/a After: B9016417 **384** Routine Name: IBNCPEV Before: B84966832 After: B85988869 **342,363,383,384** Routine Name: IBNCPNB Before: B29299329 After: B37701881 **276,342,384** Routine Name: IBNCPUT1 Before: B20040520 After: B20040520 **342,363,384** Routine Name: IBOSCDC Before: n/a After: B46124524 **384** Routine Name: IBOSCDC1 Before: n/a After: B17599955 **384** Routine Name: IBTRKR3 Before: B50230305 After: B54376358 **13,43,121,160,247,275,260, 309,336,312,339,347,405,384** Routine Name: IBTUTL1 Before: B59418416 After: B60382231 **13,223,249,292,384** Routine list of preceding patches: 292, 361, 377, 401, 405 ============================================================================= User Information: Entered By : ZEIGLER,EDWARD L Date Entered : OCT 25, 2007 Completed By: LYNCH,MARY F. Date Completed: JUL 06, 2009 Released By : BOTTINI,STEVE Date Released : JUL 09, 2009 ============================================================================= Packman Mail Message: ===================== No routines included