Patch 41 – PIT STOP

1. Patch 41 – PIT STOP

2. Agenda • Pre-requisite patches or requirements • Modifications of Patch 41 • Questions

3. Pre-Requisite Patches & Steps • Patch 39 “Improper Payments Patch” • Released Nationally on 7/11 • GUI only patch Fee Basis Claims System (FBCS) Patch 39 will assist users in proactively identifying and reducing potential improper payments by modifying existing functionality and behavior in key claims processing areas. FBCS will assist in identifying potential payments not in compliance with VHA policies and procedures by alerting claims processing clerks of potential payments to be made on behalf of ineligible beneficiaries and or of claims requiring a secondary review or action before payments may be made. FBCS will assist in detection of possible Timely Filing violations for Mill Bill and Unauthorized claims, potential Mill Bill payments where other health insurance exists, potential duplicate claims and lines and potential remaining authorized visits discrepancies before allowing users to review the presented details and supply justification reasons for further processing, if necessary. FBCS will also require a secondary supervisor review of high-dollar payments and previous timely filing violations before these claims may proceed for Payment.

4. Pre-Requisite Patches & Steps • Patch 29 “CPRS/FBCS Bidirectional” • NVCC Template Implementation (Consult templates for Non-VA Purchased Care using standardized format and questions) • Estimate National Release 8/20 • GUI and KIDS changes Fee Basis Claims System (FBCS) Patch 29 introduces functionality to increase the number of CPRS consults displayed within the FBCS Authorization module for Non-VA purchased care authorized service management, provide the ability to update the consult record via FBCS Authorization and collect, display and populate consult data elements to subsequent authorizations. FBCS Patch 29 will display pertinent fee consults via CPRS within the FBCS application to better assist in authorization management for non-va purchased care. FBCS Patch 29 will allow users to stay apprised of significant events of an eligible consult’s approval and scheduling process, allow for permission-based updates to the consults via the FBCS Authorization application and allow users to manage which consults they would like to continue to see listed within a work list of eligible consults. Equipped with the information via the consults the user will be able to create subsequent authorizations for the requested care.

5. Enhancements of Patch 41 Primary Purpose Enhancements to FBCS to provide flexibility in the use of the PIT Service and PIT workflow. These enhancements would allow VA and PIT management to specify whether the PIT Service and subsequent workflow should be enabled, where if disabled, would not require transmittal of scoring data or returned scoring results to proceed with claims adjudication. Key Areas of Change • FBCS shall create a PIT Service status flag in the database structure denoting whether the PIT Service is active. This flag can be enabled and disabled via IRMS/OI&T staff at the direction of CBOPC management. • When the FBCS PIT Service flag is set as enabled, FBCS shall continue to implement and enforce the PIT design and process

6. Enhancements of Patch 41 Key Areas of Change (continued) • When the FBCS PIT Service flag is disabled, FBCS shall no longer require claims to be scored and scoring results returned before making the claim available for further processing. • FBCS shall devise a script that may be run by IRMS/OI&T at the time the database PIT Service flag is disabled that will update the PIT Status of claims already sent for scoring but not yet returned so that they may be accessible by end users for further processing and payment without requiring returned score data. • The script shall append a claim history statement to affected records indicating they have been updated via this script.

7. Questions & Answers