============================================================================= Run Date: SEP 14, 2010 Designation: IB*2*411 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #401 Status: Released Compliance Date: OCT 15, 2010 ============================================================================= Associated patches: (v)IB*2*384 <<= must be installed BEFORE `IB*2*411' Subject: ePHARMACY COB SUPPORT Category: - Routine - Data Dictionary - Other 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 -------------------------------------------------------------- OUTPATIENT PHARMACY (OP) V. 7.0 PSO*7*290 INTEGRATED BILLING (IB) V. 2.0 IB*2*411 ELECTRONIC CLAIMS MANAGEMENT ENGINE (ECME) V. 1.0 BPS*1*8 The three patches (PSO*7*290, IB*2*411 and BPS*1*8) are being released in the Kernel Installation and Distribution System (KIDS) multi-build distribution BPS PSO IB BUNDLE 4.0. 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. Third Party Joint Inquiry (TPJI), Receipt Processing and Decrease Adjustment ------------------------------------------------- This patch modifies the lookup of ePharmacy transactions to display additional information to assist in the bill selection. When a lookup for a bill is done and multiple matches are found the insurance company name and a Coordination of Benefits (COB) indicator will now be displayed. Select one of the following: BILL RX DATE INSURANCE COB PATIENT ----------------------------------------------------------------------- 1 K60008Pe 100714 07/16/07 AETNA INSURANCE p IBPATIENT,ONE 2 K60008Qe 100714 07/16/07 BLUE CROSS OF WY s IBPATIENT,ONE 3 K60008Re 100714 07/16/07 NEW YORK LIFE IN IBPATIENT,ONE Select one of the bills by number: 2. Changes to support ePharmacy secondary billing ------------------------------------------------- Electronic Claims Management Engine package was modified to allow the user to submit an e-claim to secondary payers. IB software was modified to support secondary billing for e-Pharmacy claims, to create secondary bills for specific insurance plans and rate types. Note: the Claims Tracking system is not updated with the results of secondary billing except in cases where the primary payer rejects the claim, but the secondary payer pays. 3. Changes to IB ECME EVENTS report ----------------------------------- IB ECME EVENTS report was modified to capture, store and display RX COB (payer sequence) indicators. 4. BILLINFO^IBNCPDPI API modification ------------------------------------- In order to support a new secondary billing functionality for e-Pharmacy the IB Application Programmer Interface (API) BILLINFO^IBNCPDPI (ICR #4729) was modified to accept a new parameter to pass in the payer sequence to return information for a specific bill - primary or secondary. 5. RNB^IBNCPDPI API addition ---------------------------- In order to provide additional billing functionality for e-Pharmacy, the IB API RNB^IBNCPDPI (ICR# 4729) was created to provide information about whether or not the Claims Tracking episode for a specific Prescription and Fill is billable. 6. New APIs for e-Pharmacy -------------------------- In order to support a new secondary billing functionality for e-Pharmacy three new APIs were introduced (ICR # 5355) in this patch: ISBILL^IBNCPUT3 - to determine if there is a bill with a given bill #, BILINF^IBNCPUT3 - to get bill details from file #399, RXBILL^IBNCPUT3 - to find bill(s) for the specific RX/refill. 7. A new IB API to support ECME Potential Secondary Rx Claims Report -------------------------------------------------------------------- The COLLECT^IBOSRX API (ICR # 5361) was designed to collect IB data for ECME Potential Secondary Rx Claims Report. 8. The bill matching functionality ---------------------------------- The code responsible for bill matching was adjusted to correctly process bills with different payer sequence (primary and secondary bills). Also modifications have been made to unify the matching process and use 7 digit format with leading zeros for ECME number identifiers (BCID). The post-install routine will loop through all ECME number identifiers and make sure they are 7 characters long. 9. Removing non-standard cross-references ----------------------------------------- The software was modified so that the non-standard "AG" cross-references of the BILL/CLAIMS file (#399) are no longer used. The post-install routine will clean up the "AG" node of the file, removing part of the non-FileMan standard cross-references. 10. New Action in Patient Insurance Management ---------------------------------------------- A new ListManager action has been added to the Patient Insurance Management screen to allow the user to quickly identify which of the patient's insurance policies provide for pharmacy coverage as of a user specified prescription fill date. The name of the new action is "RX COB Determination". 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 ----------------------------------------------------------------------- 366.14 IB NCPDP EVENT LOG Y N N The following is a list of fields included in this patch: Field Name (Number) File Name (Number) Subfile Name (Number) ------------------------------- --------------------------- IB NCPDP EVENT LOG (366.14) RX COB (7.01) subfile - EVENT (366.141) PRIMARY BILL (7.02) PRIOR PAYMENT (7.03) RATE TYPE SELECTED BY USER (7.04) The following is a list of protocols included in this patch: Protocol Name --------------------------- IBCNSM RX COB DETERMINATION IBCNSM PATIENT INSURANCE 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. 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_p411_rn.pdf IB Release Notes Test Sites: =========== Phoenix Loma Linda Tennessee Valley Kansas City Post Installation Overview -------------------------- The IB post-install routine delivered with IB*2*411 will schedule a job to run in 3 days which removes invalid cross references. The three days allows additional processing time to eliminate any remaining dependencies on the old cross references. It is important that the post install routine IB20P411 NOT be deleted prior to the running of the background tasked job. At the completion of the background tasked job, the installer will receive a MailMan message indicating the post install routine may be removed from the site's system. ================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: Patient Insurance Info View/Edit [IBCN PATIENT INSURANCE] ECME [BPSMENU] Third Party Joint Inquiry [IBJ THIRD PARTY JOINT INQUIRY] ECME Billing Events Report [IB ECME BILLING EVENTS] Install Time - Approximately 10 minutes 1. OBTAIN PATCHES -------------- Obtain the host file BPS_1_8_PSO_IB.KID, which contains the following three patch installs: BPS*1.0*8 PSO*7.0*290 IB*2.0*411 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_8_PSO_IB.KID host file is located in the anonymous.software directory. Use ASCII Mode when downloading the file. 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. 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_8_PSO_IB.KID (e.g., SYS$SYSDEVICE:[ANONYMOUS]BPS_1_8_PSO_IB.KID). When prompted for "OK to continue with Load? NO//", enter "YES." The following will display: Loading Distribution... BPS PSO IB BUNDLE 4.0 BPS*1.0*8 PSO*7.0*290 IB*2.0*411 Use INSTALL NAME: BPS PSO IB BUNDLE 4.0 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 4.0): 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 4.0. 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 4.0. c. For the BPS*1*8 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. d. For the PSO*7*290 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 IB*2*411 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. When prompted "Want KIDS to INHIBIT LOGONs during the install? YES//" enter NO. g. When prompted "Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//" enter YES. h. When prompted "Enter options you wish to mark as 'Out Of Order':" enter the following options: Patient Insurance Info View/Edit [IBCN PATIENT INSURANCE] ECME [BPSMENU] Third Party Joint Inquiry [IBJ THIRD PARTY JOINT INQUIRY] ECME Billing Events Report [IB ECME BILLING EVENTS] i. When prompted "Enter protocols you wish to mark as 'Out Of Order':" enter the following protocol: IBCNSM PATIENT INSURANCE j. 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. k. When prompted "Device: Home//" respond with the correct device. The second line of each of the following routines now looks like: ;;2.0;INTEGRATED BILLING;**[Patch List]**;21-MAR-94;Build 29 Routine Information: ==================== The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: IB20P411 Before: n/a After: B8564049 **411** Routine Name: IBNCPDP Before: B5165020 After: B5373340 **223,276,363,383,384,411** Routine Name: IBNCPDP1 Before: B62284917 After: B86393869 **223,276,339,363,383,405,384,411** Routine Name: IBNCPDP2 Before: B58655489 After: B63574984 **223,276,342,347,363,383,405, 384,411** Routine Name: IBNCPDP3 Before: B30631647 After: B32452413 **223,276,342,363,383,384,411** Routine Name: IBNCPDP4 Before: B49164947 After: B55992890 **276,342,405,384,411** Routine Name: IBNCPDP5 Before: n/a After: B76631396 **411** Routine Name: IBNCPDP6 Before: B12692205 After: B13230978 **383,384,411** Routine Name: IBNCPDPI Before: B7116772 After: B13118799 **276,383,384,411** Routine Name: IBNCPDS1 Before: n/a After: B11093951 **411** Routine Name: IBNCPEV Before: B85988869 After: B84818902 **342,363,383,384,411** Routine Name: IBNCPEV1 Before: B46001454 After: B46733979 **342,339,363,411** Routine Name: IBNCPLOG Before: B61812598 After: B64598922 **342,339,363,383,411** Routine Name: IBNCPUT3 Before: n/a After: B15411272 **411** Routine Name: IBOSRX Before: n/a After: B12228419 **411** Routine Name: IBRFN Before: B49715724 After: B52599969 **52,130,183,223,309,276,347,411** Routine list of preceding patches: 384 ============================================================================= User Information: Entered By : ZEIGLER,EDWARD L Date Entered : DEC 04, 2008 Completed By: TORRANCE,LORI Date Completed: SEP 14, 2010 Released By : BOTTINI,STEVE Date Released : SEP 14, 2010 ============================================================================= Packman Mail Message: ===================== No routines included