ATTACHMENT C- PWS Attachments.pdf

ATTACHMENT A: Multiple Surveillance Activities (including Operational Support and Surveillance Document Summary)

Ideal Document Ideal Frequency Ideal Medium Submit To

Monthly Invoice Monthly; by the 10th of each month

Electronically as per

FAR/COR

direction

COR

Updated HIPAA X12 270/271 Payer List

Monthly; by the 10th of each month

Electronically in Microsoft 2016 or higher

COR &

eInsurance Project Team

Updated Insurance Coverage Discovery Payer List

Monthly; by the 10th of each month

Electronically in Microsoft 2016 or higher

COR &

eInsurance Project Team

New Payer Timeline Updated for bi-weekly meeting

Electronically in Microsoft 2016 or higher

FSC &

eInsurance Project Team

Requested Payers/New Payers List

Updated for bi-weekly meeting

Electronically in Microsoft 2016 or higher

FSC &

eInsurance Project Team

Master Payer List Report Monthly; by the 10th of each month

Electronically in Microsoft 2016 or higher eInsurance Project Team

Payer dictionaries & Payer companion guides

1 day after Contract Award & within 10 business days of any change by a payer

Electronically in Microsoft 2016 or higher

VA FSC

HIPAA Version 7030 or later Project Plan

90 days after final publication of government’s intent to adopt rules

Electronically in Microsoft 2016 or higher

COR, FSC

eInsurance

Project Team

Payer enrollment(s) Processed and updated as necessary due to payer changes and/or for repairs

Electronically in Microsoft 2016 or higher

FSC &

eInsurance Project Team

EICD Response Report Monthly; by the 10th of each month

Electronically in Microsoft 2016 or higher

COR, FSC

eInsurance Project Team

EICD Reconciliation Report Monthly; by the 10th of each month

Electronically in Microsoft 2016 or higher

COR, FSC

eInsurance Project Team

EICD Response Time Report Monthly; by the 10th of each month

Electronically in Microsoft 2016 or higher

COR, FSC

eInsurance Project Team

Ad-hoc Reports/Research Data

Typically, within 3 business days of error notification & data request for research

Electronically in Microsoft 2016 or higher

COR, FSC

eInsurance Project Team

Electronic notification of system-wide failures

Within 1 hour of failure if during normal business hours, by 9 am ET next day if during non-business hours

Electronically in Microsoft 2016 or higher

FSC &

eInsurance Project Team

Electronic notification of system-wide planned outage

24 hours or more before planned outage

Electronically in Microsoft 2016 or higher

FSC &

eInsurance Project Team

Electronic notification of Payer failure

Within 1 hour of 100% failure if during normal business hours, by 9 am ET next day if during non-business hours

Electronically in Microsoft 2016 or higher

FSC &

eInsurance Project Team

Electronic notification of planned Payer outage

24 hours or more before planned outage or as soon as Payer notification, whichever is first

Electronically in Microsoft 2016 or higher

FSC &

eInsurance Project Team

Electronic notification of planned service change

30 days before planned change

Electronically in Microsoft 2016 or higher

FSC &

eInsurance Project Team

Test Plan(s) & Test Result(s) 1 week before planned change is implemented

Electronically in Microsoft 2016 or higher

FSC &

eInsurance Project Team

Transactions in a test environment for future HIPAA version

TBD by HIPAA version 7030 or later published adoption and implementation schedule

Secure HIPAA transaction

VA FSC

ATTACHMENT B – ABBREVIATIONS

Acronym Meaning 270 EDI Health Care Eligibility/Benefit Inquiry 271 EDI Health Care Eligibility/Benefit Response 278 EDI Health Care Service Review Information 835 EDI Health Care Claim Payment/Advice Transaction Set 837 EDI Health Care Claim Transaction Set 997 EDI Functional Acknowledgement Transaction Set AITC Austin Information Technology Center ANSI American National Standards Institute ASC X12 Accredited Standards Committee X12 CAQH Council for Affordable Quality Healthcare CO Contracting Officer COR Contracting Officer Representative CORE Committee of Operating Rules and Information Exchange E-BUS eBusiness EDI Electronic Data Interchange EHN Accredited Healthcare Network EHNAC Electronic Healthcare Network Accreditation Commission EICD Electronic Insurance Coverage Discovery EIT Electronic and Information Technology FAR Federal Acquisition Regulation FIPS Federal Information Processing Standards FISMA Federal Information Security Management Act FSC Financial Services Center HCCH Health Care Clearing House HIPAA Health Insurance Portability and Accountability Act HITECH Health Information Technology for Economic and Clinical Health Act HNAP Healthcare Network Accreditation Program ID Identifiers IDIQ Indefinite Delivery Indefinite Quantity ISA – MOU Interconnection Security Agreement Memorandum of Understanding LAN Local Area Network

NACHA National Automated Clearinghouse Association NIST National Institute of Standards and Technology NPI National Payer Identifier OCC Office of Community Care PHI Protected Health Information PII Personally Identifiable Information PO Program Office POC Point of Contact

Acronym Meaning POP Period of Performance

PPACA Patient Protection and Affordable Care Act PWS Performance Work Statement

QASP Quality Assurance Surveillance Plan QCP Quality Control Program RO Revenue Operation RPO Recover Point Objective RT Real Time RTO Recovery Time Objective TIN Tax Payer Identification Number USC United States Code VA Veterans Administration VAMC Veterans Administration Medical Center VHA Veterans Health Administration VISTA Veterans Health Information Systems and Technology Architecture VPN Virtual Private Network WAN Wide Area Network

Health Care Clearing House (HCCH) HIPAA Insurance Identification and Verification

April 16, 2026

ATTACHMENT C – PROJECTED TRANSACTION VOLUMES

12/1/2026-11/30/2027 Quality

PWS 7.3.1

Real-time HIPAA 270/271 transaction for standard payers 2,885,224

PWS 7.3.2

Real-time HIPAA 270/271 transaction for participating payers 483,512

PWS 7.3.3

Real-time HIPAA 270/271 transaction for non-participating payers 110,099

PWS 7.5.1

Customized insurance coverage discovery transaction for found insurance per patient requested 123,678

PWS 7.5.2

Customized insurance coverage discovery transaction for not-found insurance per patient requested 4,035,407 12/1/2027-11/30/2028 Quality

PWS 7.3.1

Real-time HIPAA 270/271 transaction for standard payers 3,029,485

PWS 7.3.2

Real-time HIPAA 270/271 transaction for participating payers 507,688

PWS 7.3.3

Real-time HIPAA 270/271 transaction for non-participating payers 115,604

PWS 7.5.1

Customized insurance coverage discovery transaction for found insurance per patient requested 129,862

PWS 7.5.2

Customized insurance coverage discovery transaction for not-found insurance per patient requested 4,237,177 12/1/2028-11/30/2029 Quality

PWS 7.3.1

Real-time HIPAA 270/271 transaction for standard payers 3,180,959

PWS 7.3.2

Real-time HIPAA 270/271 transaction for participating payers 533,072

PWS 7.3.3

Real-time HIPAA 270/271 transaction for non-participating payers 121,384

PWS 7.5.1

Customized insurance coverage discovery transaction for found insurance per patient requested 136,355

PWS 7.5.2

Customized insurance coverage discovery transaction for not-found insurance per patient requested 4,449,036 12/1/2029-11/30/2030 Quality

PWS 7.3.1

Real-time HIPAA 270/271 transaction for standard payers 3,340,007

PWS 7.3.2

Real-time HIPAA 270/271 transaction for participating payers 559,726

PWS 7.3.3

Real-time HIPAA 270/271 transaction for non-participating payers 127,453

PWS 7.5.1

Customized insurance coverage discovery transaction for found insurance per patient requested 143,173

Health Care Clearing House (HCCH) HIPAA Insurance Identification and Verification

April 16, 2026

PWS 7.5.2

Customized insurance coverage discovery transaction for not-found insurance per patient requested 4,671,488 12/1/2030-11/30/2031 Quality

PWS 7.3.1

Real-time HIPAA 270/271 transaction for standard payers 3,507,007

PWS 7.3.2

Real-time HIPAA 270/271 transaction for participating payers 587,712

PWS 7.3.3

Real-time HIPAA 270/271 transaction for non-participating payers 133,826

PWS 7.5.1

Customized insurance coverage discovery transaction for found insurance per patient requested 150,331

PWS 7.5.2

Customized insurance coverage discovery transaction for not-found insurance per patient requested 4,905,062

*a historical 5% annual increase has been experienced for HIPAA 270/271 transactions.

Historical data for coverage discovery is not available.

ATTACHMENT D – MINIMUM ESSENTIAL PAYER CONNECTIONS

ESSENTIAL PAYER NAME ESSENTIAL PAYER NAME

ACS Benefit Services EPSI, Inc.

Allegiance Benefit Plan Management Equitable Life Casualty Insurance Company Ambetter Expert Benefit Solutions Americo Financial Life & Annuity FCE Benefit Administrators AmeriHealth First Medical Network Ameritas Group FirstCare AultCare Fox/Everett Automated Benefit Services Fringe Benefits Auxiant Gateway Health Plan Bankers Life & Casualty Geisinger Health Plans Careleon Behavioral Health GEMCare Best Choice Health Plan Gilsbar Blue Benefit Administrators of Mass Global Health BMC HealthNet Plan Gold Coast Health Plan Boon-Chapman Benefit Admin Group Health Northwest

Harken Health Bridgespan Health Choice Oklahoma Bright Health Health Cost Solutions Capitol Administrators Health New England Caprock Health Plan of Virginia CareMore Healthcare Management Administrators Carolina Care Plan, Inc. (CCP) HealthPlans Inc Cenpatico HealthScope Centene HealthTeam Advantage Cerner Health Plan Heartland National Life Insurance Company CHC – Coventry Health Plans Heritage Physician Network (Houston) Claims Management Service Inc Hometown Health Colonial Penn Life Hudson Health Plan Community Health Group iCare (Independent Care Health Plan) Community HealthFirst Medicare Advantage Independence Administrators ConnectiCare - Medicare Independent Health Consumers Life Insurers Administrative Corporation (IAC) Corporate Benefit Service Integrated Mental Health Services Covenant Administrators (TPA) Jai Medical Systems

Cox Health Plan Kemper Benefits CSI Life Insurance Company Key Healthy Partners Denver Health Medical Plan KeySolution Deseret Mutual (DMBA) Keystone Mercy Health Director's Guild Public Employee Benefit Authority Educators Mutual Insurance (EMI) Puritan Life Insurance Employee Benefit Services - Dental Regence Group Administration Lincoln Heritage Reserve National Insurance Company LoneStar TPA Royal Neighbors of America Loomis Company S and S Healthcare Strategies Louisiana Health Exchange SBLI USA Life Insurance Company, Inc.

Loyal Christian Benefit Association Kitsap Physician Services Magellan Behavioral Health Lifetime Benefit Solutions (RMSCO) MAMSI Health Plan Lifewise Health Plans Maricopa Care Advantage (Arizona) Select Health Plans MedCost Benefit Services SelectCare Health Plans Medigold Health Plans Sharp Health Plan MedStar Family Choice Shenandoah Life Insurance MedStar Health Plan SisCo Benefits MercyCare Health Plans Soundpath Health Metropolitan Health Plan (MHP) Spectrum Health Moda Health State Farm National Telecommunications Cooperative Association (NTCA)

Stewart C Miller and Co

NEHEN - Neighborhood Health Plans Sutter Select Neighborhood Health Partnership TexanPlus Health Plans Nova Healthcare Administrators Three Rivers Health Plans (Unison Health

Plan) Oscar Thrivent Paramount Health Underwriters Safety & Claims Partners National Health Plans of NC United Health Group - Optum Health

Behavioral Solutions Pennsylvania Health and Wellness United Health Group - UHCWest People First Univera Physicians Health Plans Universal American Physicians Plus Insurance University of Utah Health Plans Piedmont Wellstar HealthPlans University Physicians Care Advantage

(Arizona)

Pinnacle Claims Management Valley Care Program Prairie States Valley Health Plan Preferred Health System of Kansas Value Options Premier Health Washington National Presbyterian Health Plan WEA Trust Professional Benefits Administrators Wellsense

Note: List is subject to change as payers are added or removed

ATTACHMENT E – ADDITIONAL PAYER CONNECTIONS

ADDITIONAL PAYER NAME ADDITIONAL PAYER NAME

AARP HEALTH PLAN BCBS OF NEVADA

AETNA BCBS OF NEW HAMPSHIRE

AMERIBEN BCBS OF NEW JERSEY (HORIZON)

AMERICAN POSTAL WRKRS UNION

(APWU) BCBS OF NEW MEXICO

AMERIHEALTH ADMINISTRATORS BCBS OF NEW YORK (EMPIRE)

ASURIS NORTHWEST HEALTH BCBS OF NEW YORK (EXCELLUS)

AVERA HEALTH PLANS

BCBS OF NEW YORK

HEALTHNOW/WESTERN

AVMED BCBS OF NORTH CAROLINA

BANNER HEALTH PLANS BCBS OF NORTH DAKOTA

BCBS HAWAII - LOCAL BCBS OF OHIO

BCBS OF ALABAMA BCBS OF OKLAHOMA

BCBS OF ALASKA (PREMERA) BCBS OF OREGON (REGENCE)

BCBS OF ARIZONA BCBS OF PENNSYLVANIA (HIGHMARK)

BCBS OF ARKANSAS BCBS OF RHODE ISLAND

BCBS OF CENTRAL NEW YORK BCBS OF ROCHESTER AREA (NY)

BCBS OF COLORADO BCBS OF SOUTH CAROLINA

BCBS OF CONNECTICUT BCBS OF SOUTH DAKOTA

BCBS OF DELAWARE BCBS OF TENNESSEE

BCBS OF DIST OF COLUMBIA

(CAREFIRST) BCBS OF TEXAS

BCBS OF FLORIDA BCBS OF UTICA-WATERTOWN (NY)

BCBS OF GEORGIA BCBS OF VERMONT

BCBS OF HAWAII BCBS OF VIRGINIA

BCBS OF ILLINOIS BCBS OF WEST VIRGINIA

BCBS OF INDIANA BCBS OF WISCONSIN

BCBS OF IOWA BCBS OF WYOMING

BCBS OF KANSAS BCBS PUERTO RICO (TRIPLE-S)

BCBS OF KANSAS CITY BLUE CROSS OF CALIFORNIA

BCBS OF KENTUCKY BLUE CROSS OF IDAHO

BCBS OF LOUISIANA

BLUE CROSS OF PENNSYLVANIA

(CAPITAL)

BCBS OF MAINE

BLUE CROSS OF PENNSYLVANIA

(INDEPENDENCE)

BCBS OF MARYLAND (CAREFIRST) BLUE CROSS OF UTAH (REGENCE)

BCBS OF MASSACHUSETTS

BLUE CROSS OF WASHINGTON

(PREMERA)

BCBS OF MICHIGAN BLUE SHIELD OF CALIFORNIA

BCBS OF MINNESOTA BLUE SHIELD OF IDAHO

BCBS OF MISSISSIPPI

BLUE SHIELD OF NEW YORK

(NORTHEASTERN)

BCBS OF MISSOURI MHNET BEHAVIORAL HEALTH

BCBS OF MONTANA MMSI (MAYO)

BCBS OF NEBRASKA

MOLINA HEALTHCARE OF

CALIFORNIA

BLUE SHIELD OF WASHINGTON

(REGENCE) MUNICIPAL HEALTH BENEFIT FUND

BLUEGRASS FAMILY HEALTH MUTUAL HEALTH SERVICES

CAPITAL DISTRICT PHYSICIANS-

CDPHP MUTUAL OF OMAHA

CHAMPVA-SPINA BIFIDA- HAC MVP HEALTH CARE

CIGNA NALC - NATL ASSN OF LTR CARRIERS

CIGNA BEHAVIORAL HEALTH 1199 NATIONAL BENEFIT FUND

CORESOURCE (FMH) OPTIMA/SENTARA

CULINARY HEALTH FUND OPTUM HEALTH BEHAVIORAL (OHB)

DAKOTA CARE OXFORD HEALTH PLANS (UHC)

DESERET MUTUAL PACIFIC SOURCE HEALTH PLAN

EMBLEMHEALTH PAN-AMERICAN LIFE INSURANCE

GOLDEN RULE INSURANCE PARAMOUNT HEALTH

GOVT EMPLOYEES HSPTL ASSOC

(GEHA) PHYSICIANS MUTUAL INSURANCE CO

GREAT WEST HEALTHCARE PIEDMONT WELLSTAR HEALTH PLANS

GROUP HEALTH COOPERATIVE

GUNDERSEN LUTHERAN HEALTH

HARVARD PILGRIM HEALTH CARE

HEALTH NET

HEALTHGRAM TRICARE OVERSEAS

HEALTHPARTNERS (MN) TRICARE WEST

HEALTHSCOPE TUFTS HEALTH PLAN

HEALTHSPRING UMR (WAUSAU)

HUMANA UNICARE

INTERNATIONAL MEDICAL CARD INC UNITED HEALTH CARE

JOHNS HOPKINS HEALTH PLAN UNITY HEALTH PLANS

JP FARLEY CORPORATION UPMC HEALTH PLAN (TRISTATE)

KAISER FDN HEALTHPLAN-

COLORADO USAA-MEDICARE SUPPLEMENTAL

KEY BENEFIT ADMINISTRATORS WEB-TPA

LIFEWISE HEALTHPLAN OF

WASHINGTON QUALCARE

MAGNACARE QUALCHOICE

MAIL HANDLERS BENEFIT PLAN ROCKY MOUNTAIN HEALTH PLAN

MEDBEN (NEWARK OH) SANFORD HEALTH PLAN

MEDICA SCOTT & WHITE HEALTH PLAN

MEDICAL MUTUAL OF OHIO (MMO) SECURITY HEALTH PLAN

SIERRA HEALTH SERVICES

SUMMACARE HEALTH PLAN UNICARE

TRICARE EAST UNITED HEALTH CARE

TRICARE FOR LIFE UNITY HEALTH PLANS

TRICARE OVERSEAS UPMC HEALTH PLAN (TRISTATE)

TRICARE WEST USAA-MEDICARE SUPPLEMENTAL

TUFTS HEALTH PLAN WEB-TPA

UMR (WAUSAU)

ATTACHMENT F – MASTER PAYER LIST REPORT

General Information:

Date report was generated Data date or range represented by report

Details:

Payer Name Payer ID assigned by HCCH Payer Activation Date (i.e. date payer went live) Payer Deactivation Date (i.e. date payer was disabled if applicable) Payer Status (par, non-par, standard, etc.)

Payer Status Change during the reporting period (i.e. yes/no) Date Payer Status Change occurred Payer Status from – to (i.e. payer changed from non-par to par) Participates in eIV (i.e. yes/no) Participates in EICD (i.e. yes/no)

ATTACHMENT G - EICD RESPONSE REPORT

Data date or range represented by report All data broken down by location (i.e. CPAC/VISN/Station, provided by VA) Total/ Total by CPAC /Total by VISN/Total by Station

Details:

Insurance search responses carrying found data transaction volume Insurance search responses not carrying found data transaction volume

ATTACHMENT H – EICD RECONCILIATION REPORT

Data date or range represented by report All data broken down by location (i.e. CPAC/VISN/Station, provided by VA) Total/ Total by CPAC /Total by VISN/Total by Station

Details:

Insurance search inquiries carrying found data transaction volume Insurance search responses carrying found data transaction volume Insurance search responses not carrying found data transaction volume Rate of insurance found Rate of insurance not found

ATTACHMENT I – EICD RESPONSE TIME REPORT

Data date or range represented by report All data broken down by location (i.e. CPAC/VISN/Station, provided by VA) Total/ Total by CPAC /Total by VISN/Total by Station

Details:

Insurance search inquiries carrying found data transaction volume Insurance search responses carrying found data transaction volume Rate of insurance found Found data provided on first VA expected date transaction volume Rate of data provided on first VA expected date transaction volume Found data provided on second VA expected date transaction volume Rate of data provided on second VA expected date transaction volume

ATTACHMENT J – MINIMUM ESSENTIAL PAYER CONNECTIONS FOR INSURANCE COVERAGE

DISCOVERY

ESSENTIAL PAYER NAME FOR

INSURANCE COVERAGE DISCOVERY

ESSENTIAL PAYER NAME FOR

INSURANCE COVERAGE DISCOVERY

AARP HEALTH PLAN BCBS OF NORTH CAROLINA

AETNA BCBS OF NORTH DAKOTA

AMERIBEN BCBS OF OHIO

AMERICAN POSTAL WRKRS UNION

(APWU) BCBS OF OKLAHOMA

AMERIHEALTH ADMINISTRATORS BCBS OF OREGON (REGENCE)

ASSOC DE MAESTROS PUERTO RICO BCBS OF PENNSYLVANIA (HIGHMARK)

ASURIS NORTHWEST HEALTH BCBS OF RHODE ISLAND

AULTCARE BCBS OF ROCHESTER AREA (NY)

AUXIANT BCBS OF SOUTH CAROLINA

AVERA HEALTH PLANS BCBS OF SOUTH DAKOTA

BCBS HAWAII BCBS OF TENNESSEE

BCBS OF ALABAMA BCBS OF TEXAS

BCBS OF ALASKA (PREMERA) BCBS OF UTICA-WATERTOWN (NY)

BCBS OF ARIZONA BCBS OF VERMONT

BCBS OF ARKANSAS BCBS OF VIRGINIA

BCBS OF CENTRAL NEW YORK BCBS OF WEST VIRGINIA

BCBS OF COLORADO BCBS OF WISCONSIN

BCBS OF CONNECTICUT BCBS OF WYOMING

BCBS OF DELAWARE BCBS PUERTO RICO (TRIPLE-S)

BCBS OF DIST OF COLUMBIA

(CAREFIRST) BENEFIT MANAGEMENT INC.

BCBS OF FLORIDA BLUE CROSS OF CALIFORNIA

BCBS OF GEORGIA BLUE CROSS OF IDAHO

BCBS OF HAWAII

BLUE CROSS OF PENNSYLVANIA

(CAPITAL)

BCBS OF ILLINOIS

BLUE CROSS OF PENNSYLVANIA

(INDEPENDENCE)

BCBS OF INDIANA BLUE CROSS OF UTAH (REGENCE)

BCBS OF IOWA

BLUE CROSS OF WASHINGTON

(PREMERA)

BCBS OF KANSAS BLUE SHIELD OF CALIFORNIA

ESSENTIAL PAYER NAME FOR

INSURANCE COVERAGE DISCOVERY

BCBS OF KANSAS CITY BLUE SHIELD OF IDAHO

BCBS OF KENTUCKY

BLUE SHIELD OF NEW YORK

(NORTHEASTERN)

BCBS OF LOUISIANA

BLUE SHIELD OF WASHINGTON

(REGENCE)

BCBS OF MAINE BOON-CHAPMAN BENEFIT ADMIN

BCBS OF MARYLAND (CAREFIRST) CAPITAL DISTRICT PHYSICIANS-CDPHP

BCBS OF MASSACHUSETTS CIGNA

BCBS OF MICHIGAN CONNECTICARE

BCBS OF MINNESOTA CORESOURCE (FMH)

BCBS OF MISSISSIPPI CORESOURCE (LITTLE ROCK)

BCBS OF MISSOURI CORESOURCE (MD PA IL NC IN)

BCBS OF MONTANA CORESOURCE (OH)

BCBS OF NEBRASKA COUNTRY LIFE INSURANCE CO

BCBS OF NEVADA

BCBS OF NEW HAMPSHIRE

BCBS OF NEW JERSEY (HORIZON)

BCBS OF NEW MEXICO

BCBS OF NEW YORK (EMPIRE)

BCBS OF NEW YORK (EXCELLUS)

BCBS OF NEW YORK

HEALTHNOW/WESTERN

MEDBEN

MEDICA

MEDICAL CARD SYSTEM

MEDICAL MUTUAL OF OHIO

MED-PAY

MODA HEALTH

MUNICIPAL HEALTH BENEFIT FUND

MUTUAL OF OMAHA

MVP HEALTH CARE

NALC - NATL ASSN OF LTR CARRIERS

CULINARY HEALTH FUND NBF 1199 NATIONAL BENEFIT FUND

DAKOTA CARE NETWORK HEALTH PLAN

DEAN HEALTH PLAN OPTIMA/SENTARA

DESERET MUTUAL OXFORD HEALTH PLANS (UHC)

EBMS PACIFIC SOURCE HEALTH PLAN

ESSENTIAL PAYER NAME FOR

INSURANCE COVERAGE DISCOVERY

EMBLEMHEALTH PAN-AMERICAN LIFE INSURANCE

FIRSTCARE PARAMOUNT HEALTH

GEISINGER HEALTH PLAN PHYSICIANS MUTUAL INSURANCE CO

GILSBAR PREFERRED ONE

GOLDEN RULE INSURANCE PRIORITY HEALTH

GOVT EMPLOYEES HSPTL ASSOC (GEHA) PROVIDENCE HEALTH PLAN

HEALTH ALLIANCE MEDICAL PLANS

(HAP-MI)

PUBLIC EMPLOYEES HEALTH PLAN

(PEHP)

HEALTH ALLIANCE MEDICAL PLANS (IL) QUALCARE

HEALTH CHOICE QUALCHOICE

HEALTH NET ROCKY MOUNTAIN HEALTH PLAN

HEALTH PLAN OF UPPER OHIO VALLEY SANFORD HEALTH PLAN

HEALTHCARE MANAGEMENT

ADMINISTRATORS SCOTT & WHITE HEALTH PLAN

HEALTHCOMP ADMINISTRATORS SECURE HEALTH PLANS OF GEORGIA

HEALTHPARTNERS SECURITY HEALTH PLAN

HEALTHSCOPE SELECT HEALTH UTAH

HOMETOWN HEALTH PLAN SIERRA HEALTH SERVICES

HUMANA SISCO BENEFITS

INDEPENDENT HEALTH STATE FARM

INTERNATIONAL MEDICAL CARD INC SUMMACARE HEALTH PLAN

JOHNS HOPKINS HEALTH PLAN TUFTS HEALTH PLAN

KAISER FDN HEALTHPLAN- COLORADO UMR (WAUSAU)

KAISER FDN HEALTHPLAN- HAWAII UNICARE

KAISER FDN HEALTHPLAN- MID-

ATLANTIC UNIFIED LIFE INSURANCE COMPANY

KAISER FDN HEALTHPLAN- NORTHWEST

UNION PACIFIC RAILROAD EMP HLTH

SYS

KAISER FDN HEALTHPLAN- OHIO

UNITED AMERICAN INSURANCE

COMPANY

KAISER PERMANENTE OF GEORGIA UNITED HEALTH CARE

KAISER PERMANENTE OF N CALIFORNIA UNITY HEALTH PLANS

KAISER PERMANENTE OF S CALIFORNIA UPMC HEALTH PLAN (TRISTATE)

KEY BENEFIT ADMINISTRATORS VIVA HEALTH INC

LIFETIME BENEFIT SERVICES (RMSCO) WEA TRUST

LIFEWISE HEALTHPLAN OF

WASHINGTON WEB-TPA

ESSENTIAL PAYER NAME FOR

INSURANCE COVERAGE DISCOVERY

LOOMIS COMPANY KITSAP PHYSICIAN SERVICES

MAGNACARE

ATTACHMENT K – ADDITIONAL PAYER CONNECTIONS FOR INSURANCE COVERAGE

DISCOVERY

ADDITIONAL PAYER NAMES FOR

ADDITIONAL PAYER NAMES FOR

INSURANCE COVERAGE DISCOVERY

ACS BENEFIT SERVICES MEDIMPACT

ALLIANCE BEHAVIORAL HEALTH MEDPARTNERS

ALLSTATE MEGALIFE (OKLAHOMA CITY)

MERITAIN HEALTH-AGENCY SERVICES

AMERICAN HERITAGE MHNET

ARGUS MID-AMERICAN BENEFITS, INC.

ASR HEALTH BENEFITS

AVMED

BANNER HEALTH PLANS

CARELEON BEHAVIORAL HEALTH

BEHAVIORAL HEALTH SYSTEMS, INC

BLUEGRASS FAMILY HEALTH

CAREMARK

CATAMARAN

CDS GROUP HEALTH

EVERNORTH BEHAVIORAL HEALTH

CONSUMERS COUNTY MUTUAL

INSURANCE COMPANY

EXPRESS SCRIPTS OPTUM HEALTH BEHAVIORAL (OHB)

GROUP HEALTH COOPERATIVE OPTUM RX

GROUP PENSION ADMINISTRATORS

(GPA) PHYSICIANS CARE HEALTH PLANS

GUNDERSEN LUTHERAN HEALTH

PIEDMONT COMMUNITY HEALTH

PLANS

HARVARD PILGRIM HEALTH CARE PLANNED ADMINISTRATORS INC

HEALTHGRAM INC. POMCO

HEALTHLINK PRESBYTERIAN HEALTH PLAN

HEALTHPLUS OF MICHIGAN PRIME THERAPEUTICS

HEALTHSMART PROVIDERS CARE NETWORK

HEALTHSPRING RELIANCE STANDARD LIFE INS CO

JP FARLEY CORPORATION SAGAMORE HEALTH NETWORK

ADDITIONAL PAYER NAMES FOR

ADDITIONAL PAYER NAMES FOR

INSURANCE COVERAGE DISCOVERY

KITSAP PHYSICIAN SERVICES

SOUTHEASTERN INDIANA HEALTH

(SIHO)

MAGELLAN BEHAVIORAL HEALTH

TRUSTEED PLANS SERIVCE

CORPORATION

UNITED MEDICAL RESOURCES (UMR) TRUSTMARK

MEDCO

UNIFIED GROUP SERVICES HEALTH

PLANS

MEDCOST BENEFIT SERVICES VALUE OPTIONS

ATTACHMENT L – INSURANCE COVERAGE DISCOVERY INTERFACE

Contractor receives a message from VA indicating to search for insurance for this patient;

formatted as:

Segment ID Sample

HEADER

ISA ISA*00* *00* *ZZ**<TBD> *ZZ*<TBD>

*171212*1534*^*00501*100100100*0*P*:~

GS GS*HS*<TBD>*<TBD>*20171212*1534*100100100*X*005010X279A1~

ST ST*270*100100100*005010X279A1~

BHT BHT*0022*13*539-539887766554*20171212*153400~

Loop ID 2000A – INFORAMTION SOURCE LEVEL

HL HL*1**20*1~

Loop ID 2100A – INFORAMTION SOURCE NAME

NM1 NM1*PR*2*ELECTRONIC COVERAGE DISCOVERY*****PI*<TBD>~

Loop ID 2000B – INFORMATION RECEIVER LEVEL

HL HL*2*1*21*1~

Loop ID 2100B – INFORMATION RECEIVER NAME

NM1 NM1*1P*2*CINCINNATI VAMC*****XX*1234567890~

Loop ID 2000C – SUBSCRIBER LEVEL

HL HL*3*2*22*0~

TRN TRN*1*100100100*9ECTRACE ~

Loop ID 2100C – SUBSCRIBER NAME

NM1 NM1*IL*1*LAST*FIRST*<M>***MI*100200300~

ID Sample

N3 N3*1001 VA BLVD~

N4 N4*CINCINNATI*OH*45201~

DMG DMG*D8*19450101*M~

DTP DTP*291*D8*20171212~

Loop ID 2110C – SUBSCRIBER ELIGIBILITY OR BENEFIT INQUIRY

EQ EQ*30~

TRAILER

SE*13*100100100~

GE*1*100100100~

IEA*1*100100100~

*where <TBD> indicates VA originating facility

Contractor sends a message to VA confirming receipt of initial patient demographics for insurance search; formatted as:

Segment ID Sample

HEADER

ST ST*271*100100101*005010X279A1~

BHT BHT*0022*11*539-539887766554*20171212*153400~

LOOP ID 2000A—INFORAMTION SOURCE LEVEL

HL HL*1**20*1~

LOOP ID - 2100A INFORAMTION SOURCE NAME

NM1 NM1*PR*2*ELECTRONIC COVERAGE DISCOVERY*****PI*<TBD>~

LOOP ID - 2000B INFORMATION RECEIVER LEVEL

HL HL*2*1*21*1~

LOOP ID - 2100B INFORMATION RECEIVER NAME

NM1 NM1*1P*2*CINCINNATI VAMC*****XX*1234567890~

LOOP ID - 2000C SUBSCRIBER LEVEL

HL HL*3*2*22*0~

TRN TRN*2*100100100*9ECTRACE ~

LOOP ID - 2100C SUBSCRIBER NAME

NM1 NM1*IL*1*LAST*FIRST*M***MI*100200300~

N3 N3*1001 VA BLVD~

N4 N4*CINCINNATI*OH*45201~

AAA AAA*Y**63*W~

DMG DMG*D8*19450101*M~

DTP DTP*291*D8*20171212~

TRAILER

SE SE*13*100100101~

*where <TBD> indicates VA originating facility **where AAA*Y**63*W~ is mutually defined as please wait X number of days to submit status check one and can be reformatted to mutually agreeable 2100X/AAA response.

Contractor shall receive a message from VA after X time interval, requesting if search results are available (aka: status check) . The status check message would be a retransmission of the original 270 except for the date/time stamp, which reflect current date and time.

Contractor sends a message to VA indicating results are not ready; formatted as:

ID Sample

HEADER

ST ST*271*100100101*005010X279A1~

BHT BHT*0022*11*539-539887766554*20171212*153400~

LOOP ID 2000A—INFORAMTION SOURCE LEVEL

HL HL*1**20*1~

LOOP ID - 2100A INFORAMTION SOURCE NAME

NM1 NM1*PR*2*ELECTRONIC COVERAGE DISCOVERY*****PI*<TBD>~

LOOP ID - 2000B INFORMATION RECEIVER LEVEL

HL HL*2*1*21*1~

LOOP ID - 2100B INFORMATION RECEIVER NAME

NM1 NM1*1P*2*CINCINNATI VAMC*****XX*1234567890~

LOOP ID - 2000C SUBSCRIBER LEVEL

HL HL*3*2*22*0~

TRN TRN*2*100100100*9ECTRACE ~

LOOP ID - 2100C SUBSCRIBER NAME

NM1 NM1*IL*1*LAST*FIRST*M***MI*100200300~

N3 N3*1001 VA BLVD~

N4 N4*CINCINNATI*OH*45201~

AAA AAA*Y**63*X~

DMG DMG*D8*19450101*M~

DTP DTP*291*D8*20171212~

TRAILER

SE SE*13*100100101~

*where <TBD> indicates VA originating facility **where AAA*Y**63*X~ is mutually defined as please wait X number of days to -re-submit status check two and can be reformatted to mutually agreeable 2100X/AAA response.

Contractor sends a message to VA indicating results are ready, 1 policy found; formatted as:

ID Value Sample Header

ST ST*271*100100101*005010X279A1~

BHT

BHT*0022*11*539-

539887766554*20171212*153400~

Loop ID 2000A—INFORAMATION SOURCE LEVEL

HL HL*1**20*1~

LOOP ID - 2100A INFORMATION SOURCE NAME 1

NM1

NM1*PR*2*ELECTRONIC COVERAGE

DISCOVERY*****PI*<TBD>~

LOOP ID - 2000B INFORMATION RECEIVER LEVEL

HL HL*2*1*21*1~

LOOP ID - 2100B INFORMATION RECEIVER NAME

NM1

NM1*1P*2*CINCINNATI

VAMC*****XX*1234567890~

LOOP ID - 2000C SUBSCRIBER LEVEL

HL HL*3*2*22*0~

TRN TRN*2*100100100*9ECTRACE ~

LOOP ID - 2100C SUBSCRIBER NAME

NM1

NM1*IL*1*LAST*FIRST*M***MI*100200300~

N3 N3*1001 VA BLVD~

N4 N4*CINCINNATI*OH*45201~

DMG DMG*D8*19450101*M~

DTP DTP*291*D8*20171212~

LOOP ID - 2110C SUBSCRIBER ELIGIBILITY OR BENEFIT INFORMATION

<2110C EB*R is expected to repeat for each policy found> EB EB*R**30**Plan name (if available)~

LOOP ID - 2115C SUBSCRIBER ELIGIBILITY OR BENEFIT ADDITIONAL

INFORMATION – NOT USED

<2110C LS is expected to repeat for each EB*R, but only one per EB*R>

LS LS*2120~

LOOP ID - 2120C SUBSCRIBER BENEFIT RELATED ENTITY NAME

<2120C is expected to repeat for each payer/policy combination, thus creating 2 2120C loops per policy found> NM1 NM1*PR*2*Payer Name******PI*123456~

ID Value Sample

REF

REF 01 Reference Identification Qualifier M7 - M7 Medical Assistance Category

REF 02 Reference Identification

1 - Medical 2 - Pharmacy 3 - Mental Health 4 - Other

REF 03 Description Medical, Pharmacy, Mental Health, Other

PER

PRV

NM1

NM101 Entity Identifier Code IL -Insured or Subscriber

NM102 Entity Type Qualifier 1 - Person Entity

NM103 Name Last or Organization Name Subscriber Name

NM104-NM107 Subscriber Name Information

NM108 - Identification Code Qualifier MI - Member Identification Number

NM109 Identification Code Member Policy Number

N3 Optional on dependent policy N4 Optional on dependent policy

REF

REF 01 Reference Identification Qualifier 6P

REF 02 Reference Identification Group Number

REF

REF 01 Reference Identification Qualifier SY

REF 02 Reference Identification SSN

DMG DOB

PER

PRV

ID Value Sample NM1 For Dependent policies only

NM101 Entity Identifier Code 03 - dependent

NM102 Entity Type Qualifier 1 - Person Entity

NM103 Name Last or Organization Name Dependent Name

NM104-NM107 Dependent Name Information

NM108 - Identification Code Qualifier MI - Member Identification Number

NM109 Identification Code Member Policy Number

N3 N4

REF

REF 01 Reference Identification Qualifier 6P

REF 02 Reference Identification Group Number

REF

REF 01 Reference Identification Qualifier SY

REF 02 Reference Identification SSN

DMG

DMG02 - Subscriber

DOB DOB

PER

PRV

LE

LOOP ID - 2120D DEPENDENT BENEFIT RELATED ENTITY NAME – NOT USED

SE SE*13*100100101~

*where <TBD> indicates VA originating facility **Policy found message is a customized X12 271 message, with each found insurance returned using one EB*R and a single 2120 loop under it. At a high level, each patient and policy information would be structured as follows:

EB*R**30**plan name (if available)~

LS~

1st NM1 for the payer, with REF*M7 for type of policy (values 1 - Medical, 2 - , …) 2nd NM1 and related N3, N4, REF*6P, REF*SY, DMG segments for the subscriber 3rd NM1 optional for the dependent + related N3, N4, REF*6P, REF*SY, DMG segments

LE~

EB*R**30**plan name (if available)~ if another policy found etc.

Contractor sends a message to VA indicating Contractor could not find any policies for patient;

formatted as:

Segment ID Sample

HEADER

ST ST*271*100100101*005010X279A1~

BHT BHT*0022*11*539-539887766554*20171212*153400~

LOOP ID 2000A—INFORAMTION SOURCE LEVEL

HL HL*1**20*1~

LOOP ID - 2100A INFORAMTION SOURCE NAME

NM1 NM1*PR*2*ELECTRONIC COVERAGE DISCOVERY*****PI*<TBD>**~

LOOP ID - 2000B INFORMATION RECEIVER LEVEL

HL HL*2*1*21*1~

LOOP ID - 2100B INFORMATION RECEIVER NAME

NM1 NM1*1P*2*CINCINNATI VAMC*****XX*1234567890~

LOOP ID - 2000C SUBSCRIBER LEVEL

HL HL*3*2*22*0~

TRN TRN*2*100100100*9ECTRACE ~

LOOP ID - 2100C SUBSCRIBER NAME

NM1 NM1*IL*1*LAST*FIRST*M***MI*100200300~

N3 N3*1001 VA BLVD~

N4 N4*CINCINNATI*OH*45201~

AAA AAA*Y**75*S~

DMG DMG*D8*19450101*M~

DTP DTP*291*D8*20171212~

TRAILER

SE SE*13*100100101~

*where <TBD> indicates VA originating facility **where AAA*Y**75*S~ is mutually defined as no insurance has been found.

ATTACHMENT M – ACCREDITATION REQUIREMENTS

The Federal Information Security Modernization Act (FISMA) of 2014 requires all Federal agencies to comply with the standards and guidelines developed by the National Institute for Standards and Technology (NIST). VA Directive 6500: VA Cybersecurity Program establishes a VA cybersecurity program to protect and defend VA information and information technology.

VA Office Information and Technology (OIT) describes these operational requirements in VA Handbook 6500: Risk Management Framework for VA Information Systems and subsequent chapters.

Additionally, HIPAA covered entities are bound by the provisions found in the HIPAA Privacy and Security rules (45 CFR Parts 160 & 45 CFR 164); the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and the Patient Protection and Affordable Care Act (PPACA) of 2010. These mandates specifically reference the NIST SP 800-53, NIST SP 800-66 standards and include penalties for failure to comply and/or data breaches.

Electronic Healthcare Network Association Commission Healthcare Network Accreditation Program Electronic Health Network (EHNAC HNAP-EHN) certification is the primary EHNAC accreditation program indicating that a company/organization who operates an electronic health network performing claims clearinghouse or EDI gateway functions exceeds industry-established standards and comply with HIPAA regulations. HNAP assesses security infrastructure and data integrity measures including disaster recovery; business continuity; contingency plans; and intrusion detection and response. The program also evaluates transaction processing efficiency;

ability to comply with generally-accepted, industry-standard data formats; and audit trail capabilities. (https://www.ehnac.org/healthcare-network/) In addition, the State of Maryland and the State of New Jersey both require electronic healthcare transactions originating in those states to be processed by an EHNAC HNAP-EHN accredited clearinghouse.

The Deputy Assistant Secretary for Information Security has concurred with acceptance of the EHNAC HNAP-EHN certification of a HIPAA covered entity as meeting VA OIT A&A requirements without further review (memo dated September 2, 2016).

All HIPAA covered entities are required by Federal law to adopt the Phase I and II CAQH- CORE Eligibility & Claim Status Operating rules by January 1, 2013 as per Section 1104 of Public Law 111-148: Patient Protection and Affordable Care Act (PPACA). The Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CAQH-CORE) provides independent verification that an organization operates in agreement with the operating rules and the underlying standards. CORE certification means an entity has demonstrated that its IT system or product, is operating in conformance with the applicable requirements. (https://www.caqh.org/core/core-certification) https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1254 https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1255 https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1255 https://www.ecfr.gov/cgi-bin/text-idx?SID=468e4828bbf692d3831d08fa1f62e5e1&mc=true&node=pt45.1.160&rgn=div5 https://www.ecfr.gov/cgi-bin/text-idx?SID=2f7087288a4dd976a54db6bf5cf0c304&mc=true&node=pt45.1.164&rgn=div5 https://www.hhs.gov/hipaa/for-professionals/special-topics/hitech-act-enforcement-interim-final-rule/index.html https://www.hhs.gov/hipaa/for-professionals/special-topics/hitech-act-enforcement-interim-final-rule/index.html http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/content-detail.html http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/content-detail.html https://www.ehnac.org/healthcare-network/ http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/content-detail.html https://www.caqh.org/core/core-certification

To reasonably assure that a clearinghouse organization can receive and send a properly formatted HIPAA compliant electronic transaction from VA and back to VA in a production environment;

VA would need to conduct a lengthy and extensive testing phase with the awardee prior to activation of live services to ensure transaction interoperability and non-compliance issues were resolved. By requiring our clearinghouse entity to have CAQH CORE certification, the awardee is already attesting to being industry and HIPAA complaint by passing the rigorous CAQH CORE testing protocols and gaining certification. VA is also a CAQH CORE certified provider organization. For the purposes of the CAQH CORE certification, a CAQH CORE Endorsement pledge does not constitute a CAQH CORE certification.

The Offeror shall be evaluated to determine the following accreditation requirements have been met or tangible evidence is provided to document the requirements will be met no later than November 1, 2026. For the purposes of accreditation, all organizations participating in the contract are required to obtain and maintain both certifications, no exceptions will be granted. A prime contractor who teams with a sub-contractor, where only the sub-contractor carries the accreditation(s) will receive a Red/Unacceptable rating. A prime contractor who carries one certificate who teams with a sub-contractor who carries the opposite certificate will receive a Red/Unacceptable rating.