============================================================================= Run Date: SEP 18, 2003 Designation: IB*2*184 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #209 Status: Released Compliance Date: OCT 07, 2003 ============================================================================= Associated patches: (v)IB*2*80 <<= must be installed BEFORE `IB*2*184' (v)IB*2*153 <<= must be installed BEFORE `IB*2*184' (v)IB*2*163 <<= must be installed BEFORE `IB*2*184' (v)IB*2*183 <<= must be installed BEFORE `IB*2*184' (v)IB*2*191 <<= must be installed BEFORE `IB*2*184' (v)IB*2*231 <<= must be installed BEFORE `IB*2*184' Subject: INSURANCE IDENTIFICATION & VERIFICATION Category: - Routine - Input Template - Data Dictionary - Other Description: ============ * NOTE: This patch must be installed by October 7, 2003, in order to meet * the HIPAA compliance date for use of the software by October 16, 2003. Interface Overview ------------------ The Insurance Identification and Verification project (IIV) implements automatic and electronic methods to identify and confirm insurance coverage for veterans. This is accomplished through a series of batch extracts from VistA that produce either insurance confirmation requests or insurance identification requests. These requests are transmitted out of VistA in HL7 format to the BusinessWare commercial application suite from Vitria. The BusinessWare server is a dedicated server in Austin, TX and provides the link or gateway between VistA and the outside world. BusinessWare aggregates and translates these messages into ANSI X12 format, sends them to WebMD, who sends them to the participating insurance companies. The insurance companies transmit their responses back to WebMD, who sends them back into BusinessWare. The ANSI X12 responses are then translated back into HL7 and routed to the originating VistA system. Functional Description ---------------------- The Insurance Identification and Verification project (IIV) provides an extension to the existing Vista Insurance Buffer functionality to enable electronic discovery and confirmation of third-party commercial health insurance coverage for registered VA patients. Each night a process is run, via TaskMan which compiles a batch of insurance eligibility inquiries based on activity within the system. Sources include unverified insurance information entered in the Insurance Buffer as well as patients that have scheduled appointments or have had past encounters, but have not had a recent verification of their insurance files. If a patient has no insurance information on record, inquiries may be made to the most commonly billed insurance companies for that specific site, in an attempt to discover previously unknown coverage. Sites are able to tailor the selection of patients for the nightly batch through a set of parameters that allow control of the volume of electronic inquiries made, which sources should be considered and date range parameters. Inquiries are then verified through an exchange of HIPAA-compliant electronic communications between the VistA system and a National Healthcare Insurance Cache server that is located at the AAC in Austin, Texas. This national datacenter receives the eligibility inquiry messages and issues a response by first checking its database for any fresh information that it may have on file, or if no current information is available it will forward the request to an electronic clearinghouse of insurance information. WebMD is currently contracted to handle the clearinghouse services. The clearinghouse, in turn, forwards the inquiry to the requested payer, ex. Aetna, Blue Cross/Blue Shield, etc. The payer issues a response message to confirm or deny coverage based on the information provided in the inquiry. The national cache database is updated with the results to potentially be used for future inquiries, and the response message is routed back to the VistA site and posted to the Insurance Buffer where authorized users can review and accept the returned information into the current insurance files through enhancements to the insurance buffer list options. One challenge inherent in this process results from the fact that each VA site is able to maintain a separate list of insurance companies. In order for the various VistA locales to be able to effectively request eligibility information for the various payers, a national VA insurance payer list has been established to provide a standard identification system for all payers that are participating in this process. Enhancements have been added to allow each VA site the ability to link the insurance companies in their own site's list to the appropriate payer in the national payer list. This standardizes the identification of the payer to which each inquiry should be directed. Additional features were also added to assist the users of the insurance buffer with IIV related tasks. A new feature named "Auto Match" has been added that allows the system to be "taught" rules for matching the user- entered insurance company names in the insurance buffer to existing entries in the site's insurance company file. Also, a new method has been added for accepting information from an insurance buffer entry into the patient's permanent insurance records that allows each data field change to be individually accepted or rejected. Another feature allows a user to select multiple buffer entries for the Process, Expand, and Reject entry actions, to ease the process of working with larger sets of buffer entries. Configuration Requirements -------------------------- As mentioned previously, there is a new IIV site parameter screen. It is accessed through the existing MCCR Site Parameters option. It is imperative that insurance supervisor staff review the IIV Installation Guide found on the FTP sites for detailed instructions on the set-up, use, and function of the IIV site parameters. These parameters will govern how IIV will function at your facility. TECHNICAL NOTES =============== This is the list of all new and updated items included in this patch. INPUT TEMPLATES: ---------------- Input Template Name File IBCNE GENERAL PARAMETER EDIT IB SITE PARAMETERS (#350.9) New IBEDIT INS CO1 INSURANCE COMPANY FILE (#36) Modified LIST TEMPLATES: --------------- IBCNB INSURANCE BUFFER ENTRY Modified IBCNE AUTO MATCH BUFFER LIST New IBCNE PAYER EXPAND LIST New IBCNE PAYER MAINT LIST New IBCNE REQUEST INS INQUIRY LIST New IBJP IIV SITE PARAMETERS New MAILGROUP: ---------- IBCNE IIV MESSAGE New SECURITY KEYS: -------------- IBCNE IIV AUTO MATCH New IBCNE IIV SUPERVISOR New OPTIONS: -------- Option Name Added to Menu IB PURGE MENU Modified IBCN INSURANCE MGMT MENU Modified IBCNE AUTO MATCH BUFFER IBCNE IIV MENU New IBCNE AUTO MATCH ENTER/EDIT IBCNE IIV MENU New IBCNE IIV BATCH PROCESS {TaskMan Only} New IBCNE IIV MENU IBCN INSURANCE MGMT MENU New IBCNE IIV PAYER LINK REPORT IBCNE IIV MENU New IBCNE IIV PAYER REPORT IBCNE IIV MENU New IBCNE IIV RESPONSE REPORT IBCNE IIV MENU New IBCNE IIV STATISTICAL REPORT IBCNE IIV MENU New IBCNE PAYER EDIT IBCNE PAYER MAINTENANCE MENU New IBCNE PAYER LINK IBCNE PAYER MAINTENANCE MENU New IBCNE PAYER MAINTENANCE MENU IBCN INSURANCE MGMT MENU New IBCNE PURGE IIV DATA IB PURGE MENU New IBCNE REQUEST INQUIRY IBCNE IIV MENU New PROTOCOLS: ---------- IBCNB ENTRY RESPONSE REPORT New IBCNB ENTRY SCREEN MENU Modified IBCNB LIST CHECK NAMES New IBCNB LIST SCREEN MENU Modified IBCNE AUTO MATCH BUFFER EXIT New IBCNE AUTO MATCH BUFFER LINK New IBCNE AUTO MATCH BUFFER MENU New IBCNE AUTO MATCH BUFFER SELECT New IBCNE FAST EXIT New IBCNE IIV ID REQUEST New IBCNE IIV IN New IBCNE IIV MFN IN New IBCNE IIV MFN OUT New IBCNE IIV REGISTER New IBCNE IIV RESPONSE New IBCNE IIV RQI OUT New IBCNE IIV RQV OUT New IBCNE IIV TABLE New IBCNE IIV VER REQUEST New IBCNE PAYER EXIT New IBCNE PAYER EXPAND New IBCNE PAYER EXPAND MENU New IBCNE PAYER LINK New IBCNE PAYER MAINT MENU New IBCNE REVERIFY INSURANCE MENU New IBCNE SELECT INSURANCE New IBCNSC INS CO INPT CLAIMS Modified IBCNSC INS CO INQUIRY OFFICE Modified IBCNSC INS CO MAIN MAILING ADDRESS Modified IBCNSC INS CO PAYER New IBCNSC INS CO REMARKS Modified IBCNSC INS CO RX CLAIMS Modified IBCNSC INS CO SYNONYMS Modified IBCNSC INSURANCE CO Modified IBJ EXIT Attach to Menu IBJP AUTO BILLING SCREEN Modified IBJP CLAIMS TRACKING SCREEN Modified IBJP IB SITE PARAMETER SCREEN Modified IBJP IIV BATCH EXTRACT EDIT New IBJP IIV GENERAL EDIT New IBJP IIV MOST POPULAR EDIT New IBJP IIV PAT W/O INS New IBJP INS VER MENU New IBJP INS VER SCREEN New IBJP MCCR PARAMETERS MENU Modified VALM BLANK 1 Attach to Menu VALM PRINT LIST Attach to Menu HL7 APPLICATION PARAMETER: -------------------------- IIV EC New IIV VISTA New HL LOGICAL LINKS: ---------------- IIV EC New IIV SERVER New MODIFIED FILES/FIELDS: ---------------------- File/Field # File Field 2.312, 1.09 PATIENT FILE SOURCE OF INFORMATION 36, .128 INSURANCE COMPANY FILE ANOTHER CO. PROCESS CLAIMS? ANOTHER CO. PROCESS IP CLAIMS? 36, .168 INSURANCE COMPANY FILE ANOTHER CO. PROCESS CLAIMS? ANOTHER CO. PROCESS OP CLAIMS? 355.33, .03 INSURANCE BUFFER FILE SOURCE OF INFORMATION 355.33, 20.01 INSURANCE BUFFER FILE INSURANCE COMPANY NAME Note that the only change to fields (36, .128) and (36, .168) was the field Name. These names had been identical and have been changed to be more descriptive. NEW FILES/FIELDS: ----------------- 36, 3.1 INSURANCE COMPANY FILE PAYER 350.9, 51.01 IB SITE PARAMETERS FILE FRESHNESS DAYS 350.9, 51.02 IB SITE PARAMETERS FILE DAILY MAILMAN MSG 350.9, 51.03 IB SITE PARAMETERS FILE DAILY MSG TIME 350.9, 51.04 IB SITE PARAMETERS FILE MESSAGES MAILGROUP 350.9, 51.05 IB SITE PARAMETERS FILE TIMEOUT DAYS 350.9, 51.06 IB SITE PARAMETERS FILE NUMBER RETRIES 350.9, 51.07 IB SITE PARAMETERS FILE TIMEOUT MAILMAN MSG 350.9, 51.08 IB SITE PARAMETERS FILE INQUIRE INACTIVE INSURANCE 350.9, 51.09 IB SITE PARAMETERS FILE INQUIRE POPULAR INSUR CO. 350.9, 51.1 IB SITE PARAMETERS FILE NO. POPULAR INSUR CO. 350.9, 51.11 IB SITE PARAMETERS FILE POPULAR INSUR CO. FROM DATE 350.9, 51.12 IB SITE PARAMETERS FILE POPULAR INSUR CO. THRU DATE 350.9, 51.13 IB SITE PARAMETERS FILE HL7 RESPONSE PROCESSING 350.9, 51.14 IB SITE PARAMETERS FILE HL7 START TIME 350.9, 51.15 IB SITE PARAMETERS FILE HL7 MAXIMUM NUMBER 350.9, 51.16 IB SITE PARAMETERS FILE CONTACT PERSON 350.9, 51.17 IB SITE PARAMETERS FILE BATCH EXTRACTS 350.9002, .01 IB SITE PARAMETERS FILE BATCH EXTRACTS 350.9002, .02 IB SITE PARAMETERS FILE ACTIVE? 350.9002, .03 IB SITE PARAMETERS FILE SELECTION CRITERIA #1 350.9002, .04 IB SITE PARAMETERS FILE SELECTION CRITERIA #2 350.9002, .05 IB SITE PARAMETERS FILE MAXIMUM EXTRACT NUMBER 350.9002, .06 IB SITE PARAMETERS FILE SUPPRESS BUFFER CREATION 350.9, 51.18 IB SITE PARAMETERS FILE POPULAR INSUR CO. 350.9003, .01 IB SITE PARAMETERS FILE POPULAR INSUR CO. 350.9, 51.19 IB SITE PARAMETERS FILE HL7 STOP TIME 350.9, 51.2 IB SITE PARAMETERS FILE FAILURE MAILMAN MSG 350.9, 51.21 IB SITE PARAMETERS FILE MOST POPULAR COMPILE DATE 350.9, 51.22 IB SITE PARAMETERS FILE REGISTRATION COMPLETE 350.9, 51.23 IB SITE PARAMETERS FILE INQUIRE SECONDARY INSURANCES 355.33, .12 INSURANCE BUFFER FILE IIV STATUS 355.33, .13 INSURANCE BUFFER FILE OVERRIDE FRESHNESS FLAG 355.33, .15 INSURANCE BUFFER FILE IIV PROCESSED DATE NEW FILES: ---------- There is one new global associated with this patch: ^IBCN File # 365 IIV RESPONSE File # 365.011 X12 271 ELIGIBILITY/BENEFIT File # 365.012 X12 271 COVERAGE LEVEL File # 365.013 X12 271 SERVICE TYPE File # 365.014 X12 271 INSURANCE TYPE File # 365.015 X12 271 TIME PERIOD QUALIFIER File # 365.016 X12 271 QUANTITY QUALIFIER File # 365.017 X12 271 ERROR CONDITION File # 365.018 X12 271 ERROR ACTION File # 365.021 X12 271 CONTACT QUALIFIER File # 365.1 IIV TRANSMISSION QUEUE File # 365.11 IIV AUTO MATCH File # 365.12 PAYER File # 365.13 PAYER APPLICATION File # 365.14 IIV TRANSMISSION STATUS File # 365.15 IIV STATUS TABLE ROUTINES: -------- The following is a list of the routines included in this patch. The second line of each of these routines now looks like: ;;2.0;INTEGRATED BILLING;**[PATCH LIST,]184**;21-MAR-94 CHECK^XTSUMBLD results Routine Before Patch After Patch Patch List ======== ============ =========== ========== IBCNBAA 21019876 21901940 82,184 IBCNBAC n/a 18723108 184 IBCNBEE 13272224 14782528 82,184 IBCNBES 2323101 2685785 82,184 IBCNBLA 5493170 15241547 82,149,153,184 IBCNBLA1 21092683 23506808 82,133,149,184 IBCNBLA2 n/a 5176526 184 IBCNBLE 21281443 22141419 82,231,184 IBCNBLE1 n/a 6922418 184 IBCNBLL 17085018 19957600 82,149,153,183,184 IBCNBME 6565520 6680059 82,103,184 IBCNBMI 9858887 11550799 82,184 IBCNBU1 9913314 10486397 82,184 IBCNBUH 14305005 17093150 82,184 IBCNEAMC n/a 10245849 184 IBCNEAME n/a 3767427 184 IBCNEAMI n/a 7411483 184 IBCNEBF n/a 5706943 184 IBCNEDE n/a 9887929 184 IBCNEDE1 n/a 10761837 184 IBCNEDE2 n/a 10647827 184 IBCNEDE3 n/a 10362656 184 IBCNEDE4 n/a 13573751 184 IBCNEDE5 n/a 5992585 184 IBCNEDE6 n/a 6495408 184 IBCNEDEP n/a 12382940 184 IBCNEDEQ n/a 4747398 184 IBCNEHLD n/a 1692434 184 IBCNEHLI n/a 2887592 184 IBCNEHLK n/a 613776 184 IBCNEHLM n/a 7750955 184 IBCNEHLO n/a 427667 184 IBCNEHLP n/a 12005373 184 IBCNEHLQ n/a 6108212 184 IBCNEHLR n/a 5870016 184 IBCNEHLS n/a 10219415 184 IBCNEHLT n/a 10149370 184 IBCNEHLU n/a 585851 184 IBCNEKIT n/a 14071154 184 IBCNEPM n/a 5418407 184 IBCNEPM1 n/a 5357056 184 IBCNEPM2 n/a 2949269 184 IBCNEPST n/a 8289186 184 IBCNEPY n/a 7102097 184 IBCNEQU n/a 16729366 184 IBCNERP0 n/a 2444128 184 IBCNERP1 n/a 14325613 184 IBCNERP2 n/a 11795436 184 IBCNERP3 n/a 22215991 184 IBCNERP4 n/a 3829469 184 IBCNERP5 n/a 13494627 184 IBCNERP6 n/a 15688371 184 IBCNERP7 n/a 6625943 184 IBCNERP8 n/a 7869197 184 IBCNERP9 n/a 14841537 184 IBCNERPA n/a 2345475 184 IBCNERPB n/a 10087135 184 IBCNERPC n/a 11387237 184 IBCNERPD n/a 13567885 184 IBCNEUT1 n/a 6240817 184 IBCNEUT2 n/a 1104226 184 IBCNEUT3 n/a 18241549 184 IBCNEUT4 n/a 16507451 184 IBCNEUT5 n/a 8653372 184 IBCNEUT6 n/a 6191472 184 IBCNEUT7 n/a 1478397 184 IBCNEUT8 n/a 2301127 184 IBCNSC 7684873 7873005 46,137,184 IBCNSC01 9707762 14639853 52,137,191,184 IBCNSMM 5879124 5879124 103,133,184 IBJPI n/a 20494012 184 IBJPI2 n/a 16202092 184 IBJPM 3464070 4070106 39,137,184 Total number of routines modified: 15 Total number of new routines: 58 Total number of deleted routines: 0 Total number of routines: 73 INSTALLATION NOTES ================== There is one new global associated with this patch: ^IBCN The new IBCN global needs to be created prior to installation. Using the appropriate global management utility, create IBCN and assign the following global access privileges: System = RWD (or RWP), World = RWD (or RWP), Group = RWD (or RWP), and UCI = RWD (or RWP). This may require assistance from a System Manager. IBCN will contain data for three new files in this patch: IIV RESPONSE (#365) IIV TRANSMISSION QUEUE (#365.1) IIV AUTO MATCH (#365.11) The IIV AUTO MATCH file (#365.11) is not expected to be large. However, both the IIV RESPONSE file (#365) and the IIV TRANSMISSION QUEUE file (#365.1) may grow to become quite large depending on how the facility sets up and activates the batch extracts in the IIV Site Parameters option. The post-installation program, IBCNEPST, performs several tasks. 1. Sets up the IIV specific process user, INTERFACE,IB IIV, in the New Person file (#200). 2. Compiles the Most Popular Insurance Companies list by looping through the Bill/Claims file (#399) for the last year and finds the top ten insurance companies that bills were sent to. 3. Sets up the No Payer entry in the new Payer file (#365.12) 4. If a new install, defines the Batch Extract stub entries. The user must then follow the Post-Installation instructions to configure the Batch Extracts parameters. LOCATION OF KIDS FILE AND DOCUMENTATION FOR THIS PATCH ------------------------------------------------------ The following files are included for this patch: File Name Description --------- ----------- IB_2_184.KID Software Patch IB_2_184_IM.PDF Installation Guide IB_2_184_TM.PDF Technical Manual IB_2_184_UM.PDF User Manual These files are available on the OI Field Office anonymous.Software directories listed below. Use the appropriate FTP capability to retrieve the files. IB_2_184.KID needs to be downloaded in the ASCII format. The remaining files that end in .PDF need to be downloaded in the BINARY format. OI FIELD OFFICE FTP ADDRESS DIRECTORY =============== ============== =========== ALBANY ftp.fo-albany.med.va.gov anonymous.software HINES ftp.fo-hines.med.va.gov anonymous.software SALT LAKE ftp.fo-slc.med.va.gov anonymous.software FIRST AVAILABLE SERVER download.vista.med.va.gov anonymous.software ======================= INSTALLATION INSTRUCTIONS ======================= Installation of this patch is mandatory at all sites. This patch should be installed after normal business hours, when all Integrated Billing Users are logged off the system. The Post-Installation routine queues a background process to calculate the most frequently billed ("popular") insurance companies for the facility for the previous one year period. The PROCESS INSURANCE BUFFER [IBCN INSURANCE BUFFER PROCESS] option needs to be placed out of order during installation of this patch. Install Time - less than 10 minutes in the foreground. The aforementioned background process which runs immediately can take up to 45 minutes to complete. The installation of this patch and configuration of this functionality is more involved than the usual patch. Therefore the installation instructions are not included here in the patch description. Instead the install steps have been included in the Installation guide along with the functional configuration steps. * IMPORTANT - Refer to the Installation Guide for specific instructions - PRE-INSTALLATION CHECKLIST, INSTALLATION INSTRUCTIONS, POST-INSTALLATION CONFIGURATION, IIV SITE REGISTRATION AND POST-REGISTRATION INSTRUCTIONS. Routine Information: ==================== Routine Name: - IBCNBAA Routine Checksum: Routine Name: - IBCNBAC Routine Checksum: Routine Name: - IBCNBEE Routine Checksum: Routine Name: - IBCNBES Routine Checksum: Routine Name: - IBCNBLA Routine Checksum: Routine Name: - IBCNBLA1 Routine Checksum: Routine Name: - IBCNBLA2 Routine Checksum: Routine Name: - IBCNBLE Routine Checksum: Routine Name: - IBCNBLE1 Routine Checksum: Routine Name: - IBCNBLL Routine Checksum: Routine Name: - IBCNBME Routine Checksum: Routine Name: - IBCNBMI Routine Checksum: Routine Name: - IBCNBU1 Routine Checksum: Routine Name: - IBCNBUH Routine Checksum: Routine Name: - IBCNEAMC Routine Checksum: Routine Name: - IBCNEAME Routine Checksum: Routine Name: - IBCNEAMI Routine Checksum: Routine Name: - IBCNEBF Routine Checksum: Routine Name: - IBCNEDE Routine Checksum: Routine Name: - IBCNEDE1 Routine Checksum: Routine Name: - IBCNEDE2 Routine Checksum: Routine Name: - IBCNEDE3 Routine Checksum: Routine Name: - IBCNEDE4 Routine Checksum: Routine Name: - IBCNEDE5 Routine Checksum: Routine Name: - IBCNEDE6 Routine Checksum: Routine Name: - IBCNEDEP Routine Checksum: Routine Name: - IBCNEDEQ Routine Checksum: Routine Name: - IBCNEHLD Routine Checksum: Routine Name: - IBCNEHLI Routine Checksum: Routine Name: - IBCNEHLK Routine Checksum: Routine Name: - IBCNEHLM Routine Checksum: Routine Name: - IBCNEHLO Routine Checksum: Routine Name: - IBCNEHLP Routine Checksum: Routine Name: - IBCNEHLQ Routine Checksum: Routine Name: - IBCNEHLR Routine Checksum: Routine Name: - IBCNEHLS Routine Checksum: Routine Name: - IBCNEHLT Routine Checksum: Routine Name: - IBCNEHLU Routine Checksum: Routine Name: - IBCNEKIT Routine Checksum: Routine Name: - IBCNEPM Routine Checksum: Routine Name: - IBCNEPM1 Routine Checksum: Routine Name: - IBCNEPM2 Routine Checksum: Routine Name: - IBCNEPST Routine Checksum: Routine Name: - IBCNEPY Routine Checksum: Routine Name: - IBCNEQU Routine Checksum: Routine Name: - IBCNERP0 Routine Checksum: Routine Name: - IBCNERP1 Routine Checksum: Routine Name: - IBCNERP2 Routine Checksum: Routine Name: - IBCNERP3 Routine Checksum: Routine Name: - IBCNERP4 Routine Checksum: Routine Name: - IBCNERP5 Routine Checksum: Routine Name: - IBCNERP6 Routine Checksum: Routine Name: - IBCNERP7 Routine Checksum: Routine Name: - IBCNERP8 Routine Checksum: Routine Name: - IBCNERP9 Routine Checksum: Routine Name: - IBCNERPA Routine Checksum: Routine Name: - IBCNERPB Routine Checksum: Routine Name: - IBCNERPC Routine Checksum: Routine Name: - IBCNERPD Routine Checksum: Routine Name: - IBCNEUT1 Routine Checksum: Routine Name: - IBCNEUT2 Routine Checksum: Routine Name: - IBCNEUT3 Routine Checksum: Routine Name: - IBCNEUT4 Routine Checksum: Routine Name: - IBCNEUT5 Routine Checksum: Routine Name: - IBCNEUT6 Routine Checksum: Routine Name: - IBCNEUT7 Routine Checksum: Routine Name: - IBCNEUT8 Routine Checksum: Routine Name: - IBCNSC Routine Checksum: Routine Name: - IBCNSC01 Routine Checksum: Routine Name: - IBCNSMM Routine Checksum: Routine Name: - IBJPI Routine Checksum: Routine Name: - IBJPI2 Routine Checksum: Routine Name: - IBJPM Routine Checksum: ============================================================================= User Information: Entered By : HARRIS,JANET Date Entered : JUL 15, 2002 Completed By: KUREK,STANLEY M Date Completed: SEP 18, 2003 Released By : GANUS,MAUNETTE Date Released : SEP 18, 2003 ============================================================================= Packman Mail Message: ===================== No routines included