============================================================================= Run Date: OCT 20, 2004 Designation: PRCA*4.5*202 Package : PRCA - ACCOUNTS RECEIVABLE Priority: Mandatory Version : 4.5 SEQ #193 Status: Released Compliance Date: NOV 20, 2004 ============================================================================= Associated patches: (v)PRCA*4.5*158<<= must be installed BEFORE `PRCA*4.5*202' (v)PRCA*4.5*196<<= must be installed BEFORE `PRCA*4.5*202' (v)IB*2*223 <<= must be installed BEFORE `PRCA*4.5*202' (v)PRCA*4.5*208<<= must be installed BEFORE `PRCA*4.5*202' Subject: NCPDP PHARMACY SUPPORT Category: - Routine - Data Dictionary - Informational Description: ============ PATCH OVERVIEW --------------- The Healthcare Insurance Portability and Accountability Act National Council for Prescription Drug Programs (HIPAA NCPDP) initiative, whose ultimate goal is to provide functionality allowing electronic transmission of Outpatient Pharmacy (OP) prescription claims to payers and the receipt of claim responses (including drug utilization review responses and warnings) on a real-time basis, is being developed and introduced in a phased implementation strategy. This deployment strategy was utilized due to the complexity of the functionality and the number of product line dependencies. The first release of this two part implementation is BPS*1.0, comprised of the new Electronic Claims Management Engine (ECME) package (in the BPS namespace), plus the patches PSS*1*81, IB*2.0*223, IB*2.0*251, and PRCA*4.5*202, which are listed here in order of installation. BPS*1.0 is a dormant release that only allows each site to perform preliminary setup work and to confirm that the software does not adversely affect other packages. There are two main areas addressed by BPS*1*0: a. Registration of the Pharmacy with the Vitria BusinessWare IE. b. The Insurance Matching of Group Plans with Pharmacy Plans Following the installation of BPS*1.0, each site must register their pharmacy with Vitria and match applicable insurance group plans using the insurance matching screens. These processes are detailed in the HIPAA NCPDP CONNECTION FOR EDI PHARMACY (Dormant Release) INSTALLATION GUIDE and the E-PHARMACY CLAIMS INSURANCE PROCESS document. Both of these documents are located on the anonymous directory. It is very important that the IRM or person installing the patch at each facility provide a copy of these documents to its ADPAC(s) and any other relevant staff who will be responsible for registering their pharmacy with Vitria and completing the insurance matching process. At a later date, additional HIPAA NCPDP patches will be released to activate all of the HIPAA NCPDP functionality. Until that time, sites will not be able to electronically submit claims utilizing this new functionality. The HIPAA NCPDP project was created in response to a Chief Business Office (CBO) request for modifications to several Veterans Health Information Systems and Technology Architecture (VistA) software applications in accordance with HIPAA Electronic Data Interchange (EDI) transactions and NCPDP mandated format standards, specifically the NCPDP Telecommunication Standard v.5.1. The specific functionality for this patch is listed below. Functional Description ----------------------- The patch PRCA*4.5*202 represents the Accounts Receivable portion of the NCPDP-Pharmacy Connection project. It modifies the EDI Lockbox functionality by adding the ability to manually process EOB related to NCPDP claims. The patch modifies Accounts Receivable (AR) users interface to make it possible to select bills by entering NCPDP Prescription/Service Reference Numbers. When working with "Receipt Processing" [RCDP RECEIPT PROCESSING] and "Link Payment to Account" [RCDP LINK PAYMENT TO ACCOUNT] menu options, users normally enter the Bill Number or the Patient Name corresponding to the processed payment. The users prompt to that input is: PATIENT NAME OR BILL NUMBER: Although the prompt is asking for a Patient Name or a Bill Number, there are some other types of data that may be entered to identify the corresponding bill. Previously the choices were: - Tricare Authorization Number; - Prescription Number. This patch adds one more type of data that can be entered to identify a Bill. The "ECME Number", the Prescription/Service Reference Number, indicated in the NCPDP Electronic Claim, can now be entered to identify the bill. The help text for the above user's prompt has been modified to provide a better explanation of the expected input: PATIENT NAME OR BILL NUMBER: ? Enter one of following: Patient Name, Bill No, Tricare Authorization No, ECME Rx Reference Number or Prescription Number. PATIENT NAME OR BILL NUMBER: If the users input is not a Bill Number and not a Patient Name, and is recognized as a Tricare Authorization Number, Prescription Number or a ECME Number, the subsequent user's prompt will be respectively: Is this TRICARE reference number - 123456? No// Is this prescription number - 123456? No// Is this ECME Rx reference number - 123456? No// Technical Description ---------------------- The patch modifies the procedure PNORBILL^RCDPURED, which is called from the Data Dictionary of the file #344 (sub-file #344.01). It calls the IB procedure REC^IBRFN, which was also modified by this project (patch IB*2.0*223) to support ECME Numbers. To provide a more clear users interface, the IB procedure REC^IBRFN will be returning a flag - the second formal parameter by reference, indicating, how the users input was recognized: Tricare Authorization Number, Prescription Number, or the ECME Number. The consequent users prompt will indicate that. Routine RCDPESR1 modifies the EDI LockBox AR functionality to add capability of matching ECME number to IB bill automatically. ROUTINES SENT WITH PATCH ------------------------ The following is a list of the routines included in this patch. The second line of each of these routines now looks like: ;;4.5;Accounts Receivable;**[patch list]**;Mar 20, 1995 CHECK^XTSUMBLD results Routine Before Patch After Patch Patch List ------- ------------ ----------- ---------- PRCASVC3 1629668 1748043 158,202 RCDPESR1 14056917 14225614 173,214,208,202 RCDPURED 8549824 9425617 114,169,174,196,202 Total number of routines - 3 DATA DICTIONARIES SUMMARY ------------------------- The following is a list of the DD changes included in this patch. File # Field # Name ---------- ------- ------------------------------ 344 AR BATCH PAYMENT 344.01 TRANSACTION (sub-file) .09 PATIENT NAME OR BILL NUMBER Total number of modified files - 1 Test Sites: =========== NEW YORK HARBOR HCS NORTH TEXAS HCS ANN ARBOR, MI BATTLE CREEK, MI DETROIT, MI IRON MOUNTAIN, MI SOFTWARE AND DOCUMENTATION RETRIEVAL ==================================== The software for this patch is being distributed in host file BPS_1_0.KID. The host file will contain four patches and one package release. The builds contained in the BPS 1.0 multi-package distribution are: Package Patches/Package ------- ---------------------- ECME BPS*1.0 Pharmacy Data Management PSS*1.0*81 Integrated Billing IB*2.0*223, IB*2.0*251 Accounts Receivable PRCA*4.5*202 Please refer to the 'Software and Documentation Retrieval' section of the BPS*1.0 build description for instructions on how to acquire the patch software and documentation. INSTALLATION INSTRUCTIONS ========================== 1. Use VA FileMan to add the new domain, EPHARMACY.VITRIA-EDI.AAC.VA.GOV, to the DOMAIN file (#4.2). The installation instructions are included in the patch description for the XM*DBA*160 patch. This domain must be in place before the installation of the IB*2*251 patch that is included in the BPS 1.0 Master Build. 2. Download the KIDS file BPS_1_0.KID via FTP. This file needs to be retrieved in ASCII format. 3. Review mapped sets for the PSS*, IB*, and PRCA*namespaces. If the routines are mapped, they should be removed from the mapped set at this time. 4. From the Kernel Installation & Distribution System menu, select the Installation menu. 5. From this menu, select the Load a Distribution option. When prompted for a file name, enter the directory name where you FTPd the build, followed by BPS_1_0. In our example, the file name is USER$:[ANONYMOUS]BPS_1_0.KID. Determine the location where you stored your build to decide the correct file name entry. 6. At the "Want to Continue with Load? YES//" prompt, enter YES. 7. At the "Want to RUN the Environment Check Routine: YES//" prompt, answer YES. 8. From this menu, the installer may select to use the following options: (When prompted for INSTALL NAME, enter BPS 1.0) a. Backup a Transport Global - This option will create a backup message of any routines exported with the patch. It will NOT backup any other changes such as DDs or templates. b. Compare Transport Global to Current System - This option will allow you to view all changes that will be made when the patch is installed. It compares all components of the patch (routines, DDs, templates, etc.). c. Verify Checksums in Transport Global - This option will ensure the integrity of the routines that are in the transport global. 9. At the "Select Installation Option:" prompt, enter 6 Install Package(s) 10. At the "Select INSTALL NAME:" prompt, enter BPS 1.0. 11. When prompted, "Want KIDS to Rebuild Menu Trees Upon Completion of Install? YES//" respond NO. 12. When prompted, "Want KIDS to INHIBIT LOGONs during the install? YES//" respond NO. 13. When prompted, "Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//" respond NO. 14. When prompted, "Device:Home//" respond with the correct device and DO NOT queue this to P-Message. 15. If routines were unmapped as part of step 3, they should be returned to the mapped set once the installation has run to completion. Routine Information: ==================== Routine Name: - RCDPURED Routine Checksum: Routine Name: - PRCASVC3 Routine Checksum: Routine Name: - RCDPESR1 Routine Checksum: ============================================================================= User Information: Entered By : TUSEYEV,ANDREY Date Entered : JUL 25, 2003 Completed By: TORRANCE,LORI Date Completed: OCT 18, 2004 Released By : BOTTINI,STEVE Date Released : OCT 20, 2004 ============================================================================= Packman Mail Message: ===================== No routines included