============================================================================= Run Date: FEB 16, 2012 Designation: PSO*7*385 Package : PSO - OUTPATIENT PHARMACY Priority: Mandatory Version : 7 SEQ #328 Status: Released Compliance Date: MAR 17, 2012 ============================================================================= Associated patches: (v)PSO*7*174 <<= must be installed BEFORE `PSO*7*385' (v)PSO*7*200 <<= must be installed BEFORE `PSO*7*385' (v)PSO*7*279 <<= must be installed BEFORE `PSO*7*385' (v)PSO*7*317 <<= must be installed BEFORE `PSO*7*385' (v)PSO*7*326 <<= must be installed BEFORE `PSO*7*385' (v)PSO*7*353 <<= must be installed BEFORE `PSO*7*385' (v)PSO*7*357 <<= must be installed BEFORE `PSO*7*385' (v)PSO*7*359 <<= must be installed BEFORE `PSO*7*385' (v)PSO*7*366 <<= must be installed BEFORE `PSO*7*385' (v)PSO*7*373 <<= must be installed BEFORE `PSO*7*385' (v)PSO*7*387 <<= must be installed BEFORE `PSO*7*385' Subject: EPHARMACY PHASE 6 Category: - Routine - Data Dictionary - Other - Enhancement (Mandatory) Description: ============ This patch has enhancements that 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*385 INTEGRATED BILLING (IB) V. 2.0 IB*2*452 ELECTRONIC CLAIMS MANAGEMENT ENGINE (ECME) V. 1.0 BPS*1*11 CONSOLIDATED MAIL OUTPATIENT PHARMACY (CMOP) V. 2.0 PSX*2*73 The patches (PSO*7*385, IB*2*452, BPS*1*11, and PSX*2*73) are being released in the Kernel Installation and Distribution System (KIDS) multi-build distribution BPS PSO IB PSX BUNDLE 7.0. The purpose of this software package is to maintain compliance with legislative and federal mandates and to address and correct gaps and inefficiencies in the current electronic pharmacy billing processes. This will ultimately increase revenues collected by VA Medical Centers and outpatient pharmacies by reducing the volume of short pays and payment denials. All pharmacy claims for payers that are processed electronically are compliant with the current industry standards. This software adds support for the electronic billing of the Health Administration Center (HAC) CHAMPVA payer in order to provide an automated process and to prevent manual workarounds for CHAMPVA. This specific patch contains the following functionality: --------------------------------------------------------- 1. Renamed the PSO TRICARE security keys: PSO TRICARE to PSO TRICARE/CHAMPVA and PSO TRICARE MGR to PSO TRICARE/CHAMPVA MGR. The functionality requiring these keys have been adjusted to look for these new names. 2. The ability to process CHAMPVA prescriptions through the VistA Outpatient Pharmacy software for CHAMPVA eligible inpatients by bypassing ePharmacy claims generation has been added. For these prescriptions, an entry in the ECME Log section of the View Prescription log will be created with the new non-billable reason of "CHAMPVA INPATIENT/DISCHARGE". 3. An Override function has been added to allow continued processing of prescriptions for CHAMPVA eligible outpatients when a rejected response is received from the CHAMPVA payer/Pharmacy Benefits Manager (PBM). 4. An Override function has been added to allow continued processing of prescriptions for CHAMPVA eligible outpatients when a prescription is not ECME billable. 5. The PSO TRICARE AUDIT LOG file (#52.87) has been renamed to PSO AUDIT LOG in order to accommodate CHAMPVA audit data as well as TRICARE. A new ELIGIBILITY field has been added. 6. Renamed the TRICARE Bypass/Override Report [PSO TRICARE OVERRIDE REPORT] option to TRICARE CHAMPVA Bypass/Override Report [PSO TRI CVA OVERRIDE REPORT]. The TRICARE CHAMPVA Bypass/Override Report [PSO TRI CVA OVERRIDE REPORT] option was modified to: a. Display a new filter prompt for eligibility (CHAMPVA, TRICARE, or ALL). b. Add 'PARTIAL FILL' to the list of selectable report types. c. Depending on user input, add CHAMPVA and/or PARTIAL FILLS to the output of the report. 7. Local mail and CMOP suspense processing have been modified to: a. Put rejected CHAMPVA prescriptions Suspense to the Third Party Payer Rejects screen. b. Allow processing of CHAMPVA inpatient prescriptions. c. Allow processing of CHAMPVA prescriptions if they have been 'Ignored' by prior processing. 8. The Third Party Payer Rejects - Worklist [PSO REJECTS WORKLIST] and Third Party Payer Rejects - View/Process [PSO REJECTS VIEW/PROCESS] options have the following changes: a. There is a separate section for CHAMPVA Non DUR/RTS prescriptions. There is also a new hidden action CVA (Show/Hide CHAMPVA) that toggles whether this section of the screen is displayed. b. The Reject Information screen was modified to display the Banking Identification Number (BIN) instead of the Group Name of the Insurance Plan. c. A new hidden action called SDC (Suspense Date Calculation) has been created which calculates a new suspense date based on the Last Date of Service and Last Days Supply retrieved from the most recent ePharmacy claim. These two inputs and the final suspense date are editable by the user. d. A new hidden action called SMA (Submit Multiple Actions) was created, which allows a user to enter override values for the Submission Clarification Codes, the Prior Authorization values, and the DUR fields. e. For the OVR (Submit Override Codes) action, the data for the Reason for Service prompt is now always editable. Previously, it was only editable if there was no default value. f. Under certain circumstances, the maximum amount of Payer Addl Msg data was not always being displayed. This has been corrected. g. For a TRICARE and CHAMPVA non-billable prescription, the reason not billable returned by IB Billing Determination is displayed in the Payer Addl Msg field. h. The list of submission clarification codes that can be selected in the Submit Clarif. Code [CLA] action has been updated to reflect new values in the NCPDP standard. 9. For a TRICARE or CHAMPVA prescription that is not ECME billable, the Medication Profile has been modified to: a. Allow the use of the action DC (Discontinue Rx) without reversing a claim. b. When using the DC (Discontinue RX) action, the default for the Nature of Order prompt has been changed from SERVICE CORRECTION to REJECTED BY SERVICE. c. Allow the PR (Partial) for non-billable CHAMPVA/TRICARE prescriptions by allowing the user to override the non-billable condition. 10. The ePharmacy Date of Service calculation algorithm has been modified with this patch. The fill date is no longer considered an acceptable value for the date of service. The algorithm uses the release date if it exists. If the release date doesn't exist, then the system uses the current date. 11. ePharmacy replaces the TRICARE and TRI reference with a CHAMPVA and CVA reference when referring to a CHAMPVA prescription. 12. A new report now exists called "View ePharmacy Rx" that allows the user to view information for one prescription, combining information from Outpatient Pharmacy, Integrated Billing and ECME. This report will be available in many places within Outpatient Pharmacy. 13. For ECME billable prescriptions, an alert of "ePharmacy Rx - Obtain signature" will be displayed at the time of a window prescription release. 14. For ECME billable prescriptions, Outpatient Pharmacy sends an indicator to the Outpatient Pharmacy Automation Interface (OPAI) indicating that the prescription was submitted electronically through ECME. 15. The printer label prompt will no longer be presented to users for ePharmacy rejected TRICARE or ePharmacy rejected CHAMPVA prescription. 16. When a TRICARE or CHAMPVA prescription is missing an NDC, it will get the TRICARE/CHAMPVA Non-Billable Notification Screen so that they can be processed like other TRICARE/CHAMPVA non-billable prescription. 17. The Discontinue Prescription(s) [PSO C] option was modified to allow a label to print for a non-billable TRICARE or CHAMPVA prescription that is re-instated and ignored from the TRICARE/CHAMPVA Non-Billable notification screen. 18. Corrected an issue where labels were printing for rejected TRICARE or CHAMPVA prescriptions when editing a prescription field that did not result in the generation of a new NCPDP claim. Patch Components ================ Files & Fields Associated: File Name (Number) Field Name (Number) New/Modified/Deleted ------------------ ------------------- -------------------- PRESCRIPTION (#52) BILLING ELIGIBILITY INDICATOR (#85) Modified BILLING ELIGIBILITY INDICATOR (#85) of the REFILL sub-file (#52.1) Modified BIN (#29) of the REJECT INFO sub-file (#52.25) New EPHARMACY SITE PARAMETERS (52.86) ALLOW ALL REJECTS (#1) Modified PSO AUDIT LOG (52.87) *** FULL DD BEING SENT *** Modified Forms Associated: Form Name File # New/Modified/Deleted --------- ------ -------------------- N/A Mail Groups Associated: Mail Group Name New/Modified/Deleted --------------- -------------------- N/A Options Associated: Option Name Type New/Modified/Deleted ----------- ---- -------------------- BPS RPT VIEW ECME RX run routine New PSO EPHARMACY MENU menu Modified PSO TRICARE OVERRIDE REPORT run routine Modified Protocols Associated: Protocol Name New/Modified/Deleted ------------- -------------------- PSO HIDDEN ACTIONS #1 Modified PSO PMP HIDDEN ACTIONS MENU #2 Modified PSO PMP VIEW ECME RX New PSO REJECT DISPLAY HIDDEN MENU Modified PSO REJECT DISPLAY SMA New PSO REJECT DISPLAY SUSPENSE DATE Modified PSO REJECT SUSPENSE DT CALC New PSO REJECT VIEW ECME RX New PSO REJECTS CHAMPVA ON/OFF New PSO REJECTS HIDDEN ACTIONS #1 Modified PSO REJECTS TRICARE ON/OFF Modified Security Keys Associated: Security Key Name New/Modified/Deleted ---------------------- -------------------- PSO TRICARE Modified PSO TRICARE MGR Modified Templates Associated: Template Name Type File Name (Number) New/Modified/Deleted ------------- ---- ------------------ -------------------- N/A Additional Information: New Service Requests (NSRs) ---------------------------- Request Name: ePharmacy Claims Phase 6 (FY10) Request ID: 20090215 Patient Safety Issues (PSIs) ----------------------------- N/A Remedy Ticket(s) & Overview --------------------------- N/A Test Sites: ---------- Birmingham Loma Linda Phoenix Richmond Documentation Retrieval Instructions ------------------------------------ Updated documentation describing the new functionality introduced by this patch is available. The preferred method is to FTP the files from ftp://download.vista.med.va.gov. This transmits 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 Documentation can also be found on the VA Software Documentation Library at: http://www.va.gov/vdl/ Title File Name FTP Mode ------------------------------------------------------------------------- PSO Patch Release Notes PSO_7_P385_RN.PDF Binary Manager User Manual PSO_7_MAN_UM_R0212.PDF Binary Manager User Manual change pages PSO_7_P385_MAN_UM_CP.PDF Binary Pharmacist User Manual PSO_7_PHAR_UM_R0212.PDF Binary Pharmacist User Manual change pages PSO_7_P385_PHAR_UM_CP.PDF Binary Technician User Manual PSO_7_TECH_UM_R0212.PDF Binary Technician User Manual change pages PSO_7_P385_TECH_UM_CP.PDF Binary Technical Manual/Security Guide PSO_7_TM_R0212.PDF Binary Technical Manual/Security Guide change pages PSO_7_P385_TM_CP.PDF Binary Patch Installation: Pre/Post Installation Overview ------------------------------ There is a post-install routine associated with this patch named PSO7P385. The purpose of the post install routine is as follows: 1. Populate the ELIGIBILITY field (#18) of the PSO AUDIT LOG file (#52.87). This functionality loops through each entry in the PSO AUDIT LOG file. Depending on the size of this file, some time should be allocated for this process to complete. 2. Rename the PSO TRICARE security keys: PSO TRICARE to PSO TRICARE/CHAMPVA and PSO TRICARE MGR to PSO TRICARE/CHAMPVA MGR. 3. Remove cached hidden menu pointers allowing modified protocols to display correctly. 4. Update the BIN number on the PRESCRIPTION reject multiple. This functionality loops through the REJDAT index on the PRESCRIPTION file (#52). Depending on the size of this index, some time should be allocated for this process to complete. 5. Rename the TRICARE Bypass/Override Report [PSO TRICARE OVERRIDE REPORT] option to TRICARE CHAMPVA Bypass/Override Report [PSO TRI CVA OVERRIDE REPORT]. The post-install routine is automatically deleted by the system if allowed by your Kernel site parameters configuration. You may delete routine PSO7P385 if the installation was successful and it is not automatically deleted by KIDS. Installation Instructions ------------------------- This patch should take up to 20 minutes to install. DO NOT QUEUE the installation of this patch. To avoid disruptions, these patches should be installed during non-peak hours when there is minimal activity on the system. Avoid times when ECME claims are being transmitted. Of particular concern would be the options below. 1. BPS NIGHTLY BACKGROUND JOB [BPS NIGHTLY BACKGROUND JOB] Do not install the patch when ECME claims are being generated by the BPS Nightly Background Job option. Wait for this job to finish or complete the installation before this job starts. 2. Scheduled CS Transmission [PSXR SCHEDULED CS TRANS] and Scheduled Non-CS Transmission [PSXR SCHEDULED NON-CS TRANS] Do not install the patch when prescriptions are being transmitted to CMOP. Wait for the CMOP transmissions to finish or complete the installation before the transmissions start. Both the CS (Controlled Substances) and the non-CS CMOP transmission options should be checked. Check with Pharmacy Service or your Pharmacy ADPAC to find out when CMOP transmissions occur. ***** IMPORTANT INSTALLATION NOTES ***** This patch bundle is changing the name of File #52.87. The current name of this file is 'PSO TRICARE AUDIT LOG'. The new name of this file is 'PSO AUDIT LOG'. During the patch installation you will see the following information presented to the screen: 52.87 PSO AUDIT LOG *BUT YOU ALREADY HAVE 'PSO TRICARE AUDIT LOG' AS FILE #52.87! Shall I write over your PSO TRICARE AUDIT LOG File? YES// Please accept the default answer of YES to this question. You will also be prompted to enter the coordinator for the new BPS CHAMPVA mail group. Prior to installation, please contact your Medical Care Cost Recovery (MCCR) business department (Facility Revenue Manager) to determine who will be the coordinator for this new mail group. The users in this mail group will receive bulletins related to the processing of CHAMPVA electronic claims. After the patch is installed, members can be added to the mail group by using the Mail Group Edit [XMEDITMG] option. Pre-Installation Instructions ----------------------------- 1. OBTAIN PATCHES -------------- Obtain the host file BPS_1_11_PSO_IB_PSX.KID, which contains the following patches: BPS*1.0*11 PSO*7.0*385 IB*2.0*452 PSX*2.0*73 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_11_PSO_IB_PSX.KID host file is located in the anonymous.software directory. Use ASCII Mode when downloading the file. 2. 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: 3. LOAD TRANSPORT GLOBAL FOR MULTI-BUILD ------------------------------------- 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_11_PSO_IB_PSX.KID (e.g., SYS$SYSDEVICE:[ANONYMOUS]BPS_1_11_PSO_IB_PSX.KID). When prompted for "OK to continue with Load? NO//", enter "YES." The following will display: Loading Distribution... BPS PSO IB PSX BUNDLE 7.0 BPS*1.0*11 PSO*7.0*385 IB*2.0*452 PSX*2.0*73 Use INSTALL NAME: BPS PSO IB PSX BUNDLE 7.0 to install this Distribution. 4. 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 PSX BUNDLE 7.0): 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. 5. 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 PSX BUNDLE 7.0. a. Choose the Install Package(s) option to start the patch install. b. When prompted for the "Select INSTALL NAME:", enter BPS PSO IB PSX BUNDLE 7.0. c. When prompted to "Enter the Coordinator for Mail Group 'BPS CHAMPVA':", please respond with the appropriate person. d. When prompted "Shall I write over your PSO TRICARE AUDIT LOG File? YES//", please accept the default of YES in order to change the name of this file as instructed above. e. 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? NO//", enter NO. h. When prompted "Device: HOME//", respond with the correct device but do not queue this install. Post-Installation Instructions ------------------------------ N/A Routine Information: ==================== The second line of each of these routines now looks like: ;;7.0;OUTPATIENT PHARMACY;**[Patch List]**;DEC 1997;Build 27 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: PSO7P385 Before: n/a After: B23278834 **385** Routine Name: PSOBING1 Before: B55083995 After: B55582853 **5,28,56,135,244,268,357,385** Routine Name: PSOBINGO Before: B63802606 After: B65579784 **12,28,56,125,152,232,268,275, 326,385** Routine Name: PSOBORP0 Before: B11739758 After: B12711131 **358,385** Routine Name: PSOBORP1 Before:B107834737 After:B123593134 **358,385** Routine Name: PSOBORP2 Before: B20686173 After: B22629424 **358,385** Routine Name: PSOBORP3 Before:B185906920 After:B198582062 **358,359,385** Routine Name: PSOBPSSP Before: B8034354 After: B8096414 **289,385** Routine Name: PSOBPSU1 Before: B53744697 After: B62482822 **148,260,281,287,303,289,290, 358,359,385** Routine Name: PSOBPSU2 Before: B55533133 After: B56178581 **260,287,289,341,290,358,359,385** Routine Name: PSOBPSUT Before: B54958775 After: B56402434 **148,247,260,281,287,289,358,385** Routine Name: PSOCAN4 Before: B43086462 After: B47636509 **20,24,27,63,88,117,131,259, 268,225,358,385** Routine Name: PSOCSRL Before: B36552360 After: B37870006 **27,71,118,148,247,373,385** Routine Name: PSODISP Before: B55029655 After: B55745559 **15,71,131,156,185,148,247,200,385** Routine Name: PSODISP3 Before: B12357588 After: B12794425 **15,13,148,385** Routine Name: PSODISPS Before: B34175351 After: B37722132 **15,13,9,27,67,71,156,118,148, 247,200,385** Routine Name: PSOHLD Before: B56416497 After: B56482932 **1,16,21,24,27,32,55,82,114, 130,166,148,268,281,298,358, 353,385** Routine Name: PSOHLDS4 Before: B15529014 After: B16602666 **156,255,279,385** Routine Name: PSOHLSG1 Before: B61076664 After: B61791564 **10,26,30,56,70,139,152,385** Routine Name: PSONDCUT Before: B54609363 After: B54824511 **148,287,317,289,385** Routine Name: PSONDCV Before: B50952716 After: B51345733 **289,385** Routine Name: PSOORED2 Before: B74670919 After: B74745433 **2,51,46,78,102,114,117,133, 159,148,247,260,281,289,276, 358,251,385** Routine Name: PSOORED7 Before: B23964642 After: B24029981 **148,247,281,289,358,385** Routine Name: PSOORUT1 Before: B77945893 After: B77790582 **1,14,30,46,132,148,233,274, 225,305,289,251,387,385** Routine Name: PSOR52 Before: B34697297 After: B34622214 **10,22,27,181,148,201,260,281, 358,385** Routine Name: PSOREJP0 Before: B74165131 After: B77667131 **148,260,287,289,385** Routine Name: PSOREJP1 Before: B78046825 After:B160842921 **148,247,260,281,287,289,290, 358,359,385** Routine Name: PSOREJP2 Before: B86681161 After:B107773405 **148,247,260,287,289,358,385** Routine Name: PSOREJP3 Before:B107041706 After:B113373176 **260,287,289,290,358,359,385** Routine Name: PSOREJU1 Before: B77096006 After: B85284158 **148,247,260,287,289,358,359,385** Routine Name: PSOREJU2 Before: B49130506 After: B50124980 **148,260,287,341,290,358,359,385** Routine Name: PSOREJU3 Before: B68707597 After: B77858521 **287,290,358,359,385** Routine Name: PSOREJU4 Before: B31952299 After: B31675253 **289,290,358,359,385** Routine Name: PSOREJUT Before: B53275324 After: B76046787 **148,247,260,287,289,290,358, 359,385** Routine Name: PSORXED Before: B69656078 After: B72082911 **2,16,21,26,56,71,125,201,246, 289,298,366,385** Routine Name: PSORXL1 Before: B52372204 After: B52040688 **36,46,148,260,274,287,289, 358,251,385** Routine Name: PSORXPA1 Before: B26228658 After: B35082205 **11,27,56,77,130,152,181,174, 287,385** Routine Name: PSORXVW Before: B67653959 After: B70052400 **14,35,46,96,103,88,117,131, 146,156,185,210,148,233,260, 264,281,359,385** Routine Name: PSOSUPOE Before: B65674762 After: B74892149 **8,21,27,34,130,148,281,287, 289,358,385** Routine Name: PSOSUPRX Before: B46405696 After: B47540087 **8,36,130,185,148,287,358,385** Routine Name: PSOTRI Before: B15159690 After: B17975834 **358,385** Routine list of preceding patches: 200, 279, 326, 353, 357, 359, 366, 373 387 ============================================================================= User Information: Entered By : TOMLIN,BRIAN Date Entered : MAR 02, 2011 Completed By: CONQUEST,KENNETH Date Completed: FEB 15, 2012 Released By : MENEGUZZO,KIMBERLY Date Released : FEB 16, 2012 ============================================================================= Packman Mail Message: ===================== No routines included