Attachment A Provider Directory Tool.pdf

Level 1

Level 2

Level 3

List of Excluded Individuals and Ententies (LEIE)

An export file is downloaded from the LEIE website which is then uploaded monthly into

PPMS to exclude providers.

List is downloaded from an

OIG site.

List of Excluded Individuals and Ententies (LEIE)

An export file is downloaded from the LEIE website which is then uploaded monthly into

PPMS to exclude providers.

List is downloaded from an

OIG site.

Date Completed:

Community Care Network (CCN) Contractors*

PPMS, via DAS, submits the VA providers capable of writing prescriptions to the CCN contractors.

Community Care Network (CCN) Contractors*

PPMS, via DAS, submits the VA providers capable of writing prescriptions to the CCN contractors.

DAS (Data Access Services)*

PPMS receives external non-VA provider data through DAS.

DAS (Data Access Services)*

PPMS receives external non-VA provider data through DAS.

Drug Enforcement Agency (DEA) Database

PPMS matches the NPI and DEA Database for providers.

PPMS/PIE ensures the providers match according to NPI. PPMS then does a data enhancement of findings from the DEA

Database.

Drug Enforcement Agency (DEA) Database

PPMS matches the NPI and DEA Database for providers.

PPMS/PIE ensures the providers match according to NPI. PPMS then does a data enhancement of findings from the DEA

Database.

SAMS.gov (System for Award Management)

An exclusion record identifies parties excluded from receiving Federal contracts, certain subcontracts, and certain types of Federal financial and non Financial assistance and benefits. Exclusions are also referred to as suspensions and debarments. List comes from GSA and auto uploads into PPMS.

SAMS.gov (System for Award Management)

An exclusion record identifies parties excluded from receiving Federal contracts, certain subcontracts, and certain types of Federal financial and non Financial assistance and benefits. Exclusions are also referred to as suspensions and debarments. List comes from GSA and auto uploads into PPMS.

National Plan and Provider Enumeration System (NPPES)

NPI validation process (automated system).

National Plan and Provider Enumeration System (NPPES)

NPI validation process (automated system).

Indian Health Service/Indian Tribal Health/Urban Indian

Organizations (IHS/THP/UIO) ITU Organization Reimbursement

It is a manual upload.

Trigger is if an agreement is renewed, updated or a new agreement is created.

Currently 128 sovereign nations.

Indian Health Service/Indian Tribal Health/Urban Indian

Organizations (IHS/THP/UIO) ITU Organization Reimbursement

It is a manual upload.

Trigger is if an agreement is renewed, updated or a new agreement is created.

Currently 128 sovereign nations.

Local Contracts

Local Contracts are initiated by local VA facilities if they can't provide a service in their facility.

Local Contracts

Local Contracts are initiated by local VA facilities if they can't provide a service in their facility.

Department of Defense (DOD)

The IEN Data Management Team is contacted by DOD point of contact when updates are needed to DOD facilities/providers.

Department of Defense (DOD)

The IEN Data Management Team is contacted by DOD point of contact when updates are needed to DOD facilities/providers.

Bing Services

Validates addresses, geocodes and contact information. PPMS currently validates geocode addresses against the Bing

Services.

Bing Services

Validates addresses, geocodes and contact information. PPMS currently validates geocode addresses against the Bing

Services.

Centers for Medicare and Medicaid Services (CMS)

PPMS receives the National Plan and Provider

Enumeration System (NPPES) file for validation of the National Provider Identifier (NPI). This ensures the ten-digit numeric number is valid for NPPES.

Centers for Medicare and Medicaid Services (CMS)

PPMS receives the National Plan and Provider

Enumeration System (NPPES) file for validation of the National Provider Identifier (NPI). This ensures the ten-digit numeric number is valid for NPPES.

Identity Access Management

(IAM)

IAM provides access services including single sign on internal (SSOi), single sign on external (SSOe), Provisioning and Delegation, as well as identity services, including the VA MPI (Master Person Index). IAM validates users of the PPMS system and assists with connectivity and user access management.

Identity Access Management

(IAM)

IAM provides access services including single sign on internal (SSOi), single sign on external (SSOe), Provisioning and Delegation, as well as identity services, including the VA MPI (Master Person Index). IAM validates users of the PPMS system and assists with connectivity and user access management.

Veteran Care Agreements (VCAs)

This is a manual process conducted by the

Integrated External Network (IEN) Data

Management Team to capture VCA agreements in PPMS. VA may enter into agreements with certain community providers to care for Veterans when they are not part of the VA contracted community care network.

Veteran Care Agreements (VCAs)

This is a manual process conducted by the

Integrated External Network (IEN) Data

Management Team to capture VCA agreements in PPMS. VA may enter into agreements with certain community providers to care for Veterans when they are not part of the VA contracted community care network.

National Dialysis Services Contract (NDSC)

This is a manual process that provides updates on Dialysis services facility information. There are 9 contractors that provide information to the IEN Data Management team.

National Dialysis Services Contract (NDSC)

This is a manual process that provides updates on Dialysis services facility information. There are 9 contractors that provide information to the IEN Data Management team.

Veteran Affairs Site Tracking

(VAST)

VSC provides data to VAST and CDW. Provides VA facility address and location. It also provides provider information and DoD provider availability information.

Veteran Affairs Site Tracking

(VAST)

VSC provides data to VAST and CDW. Provides VA facility address and location. It also provides provider information and DoD provider availability information.

DAS (Data Access Services)*

PPMS sends the response file and VA provider file through DAS to CCN.

DAS (Data Access Services)*

PPMS sends the response file and VA provider file through DAS to CCN.

Community Care Network (CCN) Contractors*

PPMS sends the provider file to the CCN Contractors through DAS.

Community Care Network (CCN) Contractors*

PPMS sends the provider file to the CCN Contractors through DAS.

CCRA (Community Care Referral and Authorization/ HSRM (HealthShare Referral

Manager)

HSRM consumes the master directory of community provider information from PPMS. HSRM Build 7.4 aligned the affiliation of the network selection in PPMS.

This provided a real time search and select from

DWS, versus previously, where it was a database update in HSRM.

CCRA (Community Care Referral and Authorization/ HSRM (HealthShare Referral

Manager)

HSRM consumes the master directory of community provider information from PPMS. HSRM Build 7.4 aligned the affiliation of the network selection in PPMS.

This provided a real time search and select from

DWS, versus previously, where it was a database update in HSRM.

eCAMS (Electronic Claims Adjudication Management

System) CCNNC

In the future, eCAMS will confirm with PPMS that a non-VA provider was active on the date of service, prior to payment.

eCAMS (Electronic Claims Adjudication Management

System) CCNNC

In the future, eCAMS will confirm with PPMS that a non-VA provider was active on the date of service, prior to payment.

CCRS (CC Reimbursement System)

CCRS consumes PPMS data through the data web services (DWS). CCRS receives reference data from DWS. CCRS checks to ensure the provider on the bill is active and not on the

LEIE. If the provider is in DWS, then they're not on the LEIE list.

CCRS (CC Reimbursement System)

CCRS consumes PPMS data through the data web services (DWS). CCRS receives reference data from DWS. CCRS checks to ensure the provider on the bill is active and not on the

LEIE. If the provider is in DWS, then they're not on the LEIE list.

VA.gov Provider Locator

Provider data from PPMS via API is critical to the

Va.gov- Provider Locator.

The Provider Locator allows

Veterans to search for a provider in their community that can meet their healthcare needs. PPMS will interface with the Provider Locator Tool to ensure that the providers offered to Veterans are eligible and active. Provider Locator uses the PPMS Data Web Services (DWS).

VA.gov Provider Locator

Provider data from PPMS via API is critical to the

Va.gov- Provider Locator.

The Provider Locator allows

Veterans to search for a provider in their community that can meet their healthcare needs. PPMS will interface with the Provider Locator Tool to ensure that the providers offered to Veterans are eligible and active. Provider Locator uses the PPMS Data Web Services (DWS).

PIE (Provider Integration Engine)

PPMS provides external provider data to PIE to go into VistA.

PIE (Provider Integration Engine)

PPMS provides external provider data to PIE to go into VistA.

CDW (Corporate Data Warehouse)

CDW receives Non-VA provider information from PIE. The PIE Database is in CDW. PIE pulls files from CDW to determine which

VA providers are authorized to write in orders. PIE uses several tables in CDW.

Using those tables, PIE sends those providers to PPMS via IWS (Integrated

Webservices).

CDW (Corporate Data Warehouse)

CDW receives Non-VA provider information from PIE. The PIE Database is in CDW. PIE pulls files from CDW to determine which

VA providers are authorized to write in orders. PIE uses several tables in CDW.

Using those tables, PIE sends those providers to PPMS via IWS (Integrated

Webservices).

VistA

Updates to the Vista New Person File.

VistA

Updates to the Vista New Person File.

VA Online Scheduling (VAOS)

PPMS has current provider selection in VAOS.

VA Online Scheduling (VAOS)

PPMS has current provider selection in VAOS.

CommCare CRM

CommCare would like to get Provider Information by calling PPMS with an NPI number - CR067

CommCare CRM

CommCare would like to get Provider Information by calling PPMS with an NPI number - CR067

External Provider Scheduling

(EPS)

The system sources provider information from CDW and then the team manually cross-checks with PPMS to ensure they have accurate provider information.

External Provider Scheduling

(EPS)

The system sources provider information from CDW and then the team manually cross-checks with PPMS to ensure they have accurate provider information.

Cerner (Oracle Health / Federal Health)

The PPMS data transfer consists of an extract and weekly file transfer to Cerner for IOC.

Cerner (Oracle Health / Federal Health)

The PPMS data transfer consists of an extract and weekly file transfer to Cerner for IOC.

Centralization of Authorized Emergency Care (CAEC) /

Emergency Care Reporting Tool (ECR)

Network or Non--Network Facility determinations are made utilizing PPMS which tracks in network providers for Community Care as well as mileage and the nearest

VAMC.

Centralization of Authorized Emergency Care (CAEC) /

Emergency Care Reporting Tool (ECR)

Network or Non--Network Facility determinations are made utilizing PPMS which tracks in network providers for Community Care as well as mileage and the nearest

VAMC.

VA Health Connect

Connect through VISTA to obtain PPMS information.

VA Health Connect

Connect through VISTA to obtain PPMS information.

Master Person Index (MPI)

PIE sends CCN providers via 1301 addition (API) to VA MPI. This information is ultimately captured in the file 200 (new person file) and VistA and CPRS.

Master Person Index (MPI)

PIE sends CCN providers via 1301 addition (API) to VA MPI. This information is ultimately captured in the file 200 (new person file) and VistA and CPRS.

Level 4

Authorization and Eligibility Tool (AET)

AET will do a pull from DWS, which has an NPI Tax ID crosswalk.

Authorization and Eligibility Tool (AET)

AET will do a pull from DWS, which has an NPI Tax ID crosswalk.

Community Provider Locator

(CPL)

Community Care Provider mapping tools.

Community Provider Locator

(CPL)

Community Care Provider mapping tools.

PIE (Provider Integration Engine)

PIE (Provider Integration Engine): PIE is a feature of PPMS. PIE provides the VA Provider data to PPMS in support of providing the VA Provider Profile to the

Community Care Network.

PIE integrates with upstream dependencies to get information into and out of PPMS. It delivers the VA Provider File automatically from system to system. The VA Provider File is needed for written prescriptions to be filled at community pharmacies.

PIE (Provider Integration Engine)

PIE (Provider Integration Engine): PIE is a feature of PPMS. PIE provides the VA Provider data to PPMS in support of providing the VA Provider Profile to the

Community Care Network.

PIE integrates with upstream dependencies to get information into and out of PPMS. It delivers the VA Provider File automatically from system to system. The VA Provider File is needed for written prescriptions to be filled at community pharmacies.

Originating Initiative