36C10G20R0014-040.docx

Enrollment System Core (ESC) Interface Control Document Version 1.16

Enrollment System Core to Community Care Network October 2019 Department of Veterans Affairs Office of Enterprise Development Management, Enrollment and Financial Systems (MEFS)

Feb 2010 Health Eligibility Case Management System 2 Enrollment System Redesign to VA/DOD Identity Repository (CDW) Interface Control Document October 2019 Enrollment System Core i Enrollment System Core to Community Care Network Interface Control Document Revision History

Update Address: STATE, ZIP, ZIP4; Residential Address: R_STATE, R_ZIP, R_ZIP4 field lengths in Eligibility file layout Update Insurance Company Address: STATE, ZIP field lengths in OHI file layout Change data type for ZIP and ZIP4 fields Ruth Orem

Updated Insurance Company Address: ST1, ST2, ST3, CITY field lengths in OHI file layout Updated signature block on Approvals page Ruth Orem

Table of Contents

Table of Figures

Table 1: Server Connectivity in Various Environments 8

October 2019 Enrollment System Core ii Enrollment System Core to Community Care Network Interface Control Document

1. Introduction One of the requirements of the Community Care Program is to improve support to Veterans through automated Community Care eligibility determinations and interfacing with Planning Systems Support Group (PSSG), Corporate Data Warehouse (CDW), VHA Support Service Center (VSSC) and Community Care Network (CCN). Enrollment System (ES) is identified as the system to request Geocoding/drive distance and Title 38/Care Request/Urgent Care information and to make the Community Care eligibility determinations based on that data. A new interface is to be established between ESC and the CCN to send Community Care eligibility information to the CCN and receive Other Health Insurance (OHI) information from the CCN for Veterans who are eligible to receive Community Care services

1.1. Purpose

The purpose of this document is to describe the system components that enable the daily send of data to Community Care Networks.

1.2. Scope

This Interface Control Document (ICD) specifies the interface between the Veterans Health Administration (VHA), ESC and the CCN. Upon formal approval for each participating system, this ICD shall be incorporated into the requirements baseline for each system. This document provides details on the functional, performance, operational and design requirements for the interface. It is intended for all parties requiring such information, including software developers, system designers, Infrastructure support staff and testers responsible for implementing the interface. The Department of Veterans Affairs (VA) Data Access Services (DAS) team will provide the interface between ES and the CCN.

1.3. System Identification

1.3.1. Enrollment System Core

Identification number

1.3.2. Community Care Network

Identification number

Version number

Data Access Services

Identification number

1.4. Operational Agreement

This ICD provides the specification for an interface between ESC and the CCN regarding enrollment and eligibility data and health insurance information for Veterans. The Project Manager for the DAS team is responsible for notifying the VHA ESC Points of Contact of any potential or planned changes to data feeds, once these changes are known, in order to minimize adverse impacts to VHA.

All VHA ESC users and developers are expected to protect Community Care data in accordance with the Privacy Act and Trade Secrets Act guidelines. The following considerations will be made when conducting interfacing operations with the CCN:

VHA ESC users and developers agrees not to misuse or disclose Personally Identifiable Information (PII) other than as permitted or required by this Agreement or as Required by Law.

VHA ESC users and developers agrees to use appropriate safeguards to prevent use or disclosure of the personal information other than as provided for by this Agreement.

VHA ESC users and developers agrees to mitigate, to the extent practicable, any harmful effect that is known to the Users of a misuse or disclosure of PII by any Business Partner in violation of the requirements of this Agreement.

VHA ESC users and developers agrees to report to the Integrated Ethics Program Officer (IPEO) any misuse or disclosure of the PII not provided for by this Agreement of which it becomes aware; thereby triggering the Austin Information Technology Center (AITC) to trigger their incident response procedures, which includes notifying all stakeholders.

VHA ESC users and developers agrees to ensure that any agent, including a subcontractor to whom it provides Protected Information received from the CCN, agrees to the same restrictions and conditions that apply through this Agreement to ESC with respect to such information.

Modifications to the ICD can be requested by both of the systems. Once agreed by the project managers of the respective teams, the document will be modified by the ESC project team and a copy will be sent to the CCN team for approval. The document will be placed under version control in the Rational Team Concert (RTC) ESC repository.

2. Interface Definition The interface between ESC and the CCN is a data sharing interface. ESC will construct a file of Veteran data and send that file to the CCN. ESC will send the Community Care eligibility data to the CCN on a daily basis including holidays. ESC will store the Community Care eligibility send information in ADR to be used by ES users to determine whether or not a Veteran’s information has been sent to the CCN.

ES Places, Retrieves and Processes CCN Files CCN Places, Retrieves and Processes ES Files

DAS

ADR

Figure 1: ESC-CCN interface 2.1.

System Overview The systems involved in the interface are ESC, DAS, and the CCN.

ESC is an automated system used by staff across VHA to work more efficiently and determine patient eligibility in a timelier manner. Messaging with the Department of Veterans Affairs Medical Center (VAMC) allows updates to the enterprise Enrollment System to be shared with the field staff. It is one component of the "system of systems" needed to implement the MyHealtheVet Registration, Eligibility and Enrollment (REE) environment.

Its two main functions are:

Expert System Based on information obtained from sites, Veterans Benefit Administration (VBA) and HEC staff determine and communicate verified medical benefits Eligibility and Enrollment (E&E) information for all Veterans and beneficiaries.

Work Flow (Case Management) For every exception where the expert system process cannot make a determination, "cases" are created for human intervention. HEC staff uses ESC to manage these "cases" to completion so that verified E&E can be determined.

Data Access Services: The VA’s DAS is a national group that provides interface services between VA internal applications and external entities. The DAS’s objective is to provide interface services to support teams with a need to interface with an entity external to VA. For details of the DAS service interface and interoperability, see DAS Data Routing Service ICD, currently version 1.6.8 January 2019.

Community Care Networks: The Community Care Networks provide outreach to Veterans related to the Community Care Program.

Interface Overview As explained in the introduction paragraph, this interface will be focused on ES sending Community Care information to the Community Care Network, and receiving Veterans Other Health Insurance (OHI) information from the Community Care Network.

Figure 2 explains the overall context for the information exchange between the various entities.

Figure 2: Overall Context for Community Care Network information exchangeES Community Care Network

ADR

DAS

Health Insurance Data

CC

Eligibility Data

ESC will create the daily files to be sent to the CCN.

2.2. Operations

As described in the earlier section, the interface is asynchronous and ESC will apply consistency checks and business rules to information returned from the interface.

2.3. Data Transfer

Frequency – One-time Record seeding. This is an initial load of copies of enrollment and eligibility data for all Veterans who are currently enrolled in the VA health system.

Frequency – Daily. Updates for any newly enrolled Veteran; updates demographic and contact information changes; updates for identity changes; updates to administrative community care eligibility.

Frequency – Daily. Receipt of Person Query (PRQ) as needed; Receipt of OHI Schedule – Daily, estimated at 5 AM CST, however it can vary. This includes holidays.

From the ESC Linux server, ESC will connect to the DAS server to place and receive files.

The diagram below shows the ESC-DAS-CCN system architecture. The table that follows the diagram lists the servers for each entity in each environment.

Figure 3: ESC-CCN Interface System Architecture

Name

Table 1: Server Connectivity in Various Environments

2.4. Transaction Types

Hypertext Transfer Protocol Secure (HTTPS).

2.5. Data Exchanges

Text file.

2.6. Precedence and Criticality

The data provider of the Veteran Community Care Eligibility (VCE) information is the ES team. The data consumer of the VCE data is the Community Care Network. The data provider of the Other Health Insurance (OHI) information is the Community Care Network. The data consumer of OHI is the ES team. This interface is exclusively developed for ESC Community Care Network initiative. The interface is developed for ESC version 5.6, with a target date for user Acceptance testing in April, 2019.

2.7. Communications Methods

HTTPS.

2.8. Performance Requirements

Not applicable.

2.9. Security

The interface will use secured connections between ESC servers and DAS servers, and CCN servers and DAS servers.

3. Interface Requirements Eligibility File File Naming Convention Eligibility file naming convention is CCN_<date>_<count>.txt Date format is YYYYMMDD Count is number of records in file Example: CCN_20190315_9531.txt File Layout File layout of the eligibility file that ESC will send to the CCN via DAS.

Basic Information

"P" - Permanent Mailing Address "T" - Temporary Mailing Address NULL if no address on file

“U” - Undeliverable “H” - Homeless “N” - Address not found “O” - Other NULL (no value) if no BAI.

Priority Group Information

Format: YYYYMMDD

Eligibility Information

· Combination of Eligibility Code and Effective Date - “|” delimited. Effective Date format is YYYYMMDD. Example: G|20190606.

· May have multiple VCE values separated by commas.

Allowable values:

“G|YYYYMMDD” – Grandfathered “H|YYYYMMDD” – Hardship “N|YYYYMMDD” – State No Full-Service VA “U|YYYYMMDD” – Urgent Care “B|YYYYMMDD” – Basic - qualifies for Community Care Program “X|YYYYMMDD” – No longer eligible

NLE_ES

“Y” – Yes “N” – No Null (no value)

Residential Address

Basic Record Structure PERID^ICN^EDIPI^SSN^LN^FN^MN^DOB^DOD^GENDER^SUF^ADDR_TYPE^BAI^ST1^ST2^ST3^CITY^STATE^ZIP^ZIP4^COUNTRY^ADT^PFA^PCF^HPN^CPN^TSTART^TEND^APN^EMAIL^PF_NO^PF_NAME^PRI_GRP^ENR_EFF_DATE^VCE^NLE_ES^NLE_ES_DATE^R_ST1^R_ST2^R_ST3^R_CITY^R_STATE^R_ZIP^R_ZIP4^R_COUNTRY^R_ADT^R_PFA^R_PCF Sample Record 53009535^0000001006293853V438339000000^6876864947^123456789^LASTNAME^FIRSTNAME^MI^19500101^^F^^P^^123 Wonderful Rd^^^GAINESVILLE^ME^34742^^USA^20100322100300^^^4042216089^^^^^^402GA^Caribou VA Clinic^7^20171001^G|20190606,U|20190707^N^^123 Wonderful Rd^^^GAINESVILLE^ME^34742^^USA^20100322100300^^

ESC will send eligibility files to the CCN when a record has been seeded and whenever an eligibility has become activated or in response to a Person Query (PRQ) request from a CCN.

Other Health Insurance (OHI)

File layout of the Other Health Insurance (OHI) file that ESC will receive from the CCN

Basic Information

Insurance Company Information

Sample Record

54321234567^000000123456780V12345000000^1234567890^BEASLEY^JAMES^LEE^JR^19500101^2345676543^AETNA^151 FARMINGTON AVE^^^HARTFORD^CT^06516^PREFERREDGROUP^A345987^PH2028442525^MARGARET BEASLEY^SPOUSE^19520615^20100301^20170731^860-273-0123^960-975-3110

ESC will receive OHI files from the CCN upon arrival of the file.

Person Query (PRQ) File layout of the Person Query file that ESC will receive from CCN.

Basic Information

Sample Record 0000001006293853V438339000000

4. Interface Verification Interface verification will be performed as described below.

ES-DAS Interface Sample data files will be created by the ESC development team for integration testing purposes. The ESC development team will place the files on the appropriate DAS server. This testing will verify integration between the ESC and the DAS servers (i.e., that files may be transferred correctly and securely).

DAS-CCN Interface Sample data files will be created by the ES development team for integration testing purposes. The ES development team will place the files on the appropriate DAS server. The CCN development team will perform a test where the team retrieves the files from the appropriate DAS server. This testing will verify integration between the CCN and the DAS server (i.e., that files may be transferred correctly and securely).

ES-CCN

Sample data files for CC Eligibility and OHI will be created by the ESC development team and placed on the appropriate DAS server for retrieval by the CCN for CC Eligibility, and for retrieval by ESC for OHI. The DAS will pass through the files. The CCN development team will analyze the data and format of both files, and execute appropriate business rules.

5. Interface Control N/A Data Elements See the Interface Requirements section in this document for details.

Approvals

Tyrone Brown Project Manager, Enrollment System Community Care Enterprise Health Benefits Determination (EHBD)

TBD

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