Attachment H- Eligibility Verification and Enrollment Data Exchange- Dental Network.docx

ELIGIBILITY VERIFICATION AND ENROLLMENT DATA EXCHANGE

These formats apply to both eligibility and enrollment data exchanges. There are three types of eligibility and enrollment data that will be provided to the Contractor:

· An initial load of copies of enrollment and eligibility data for all Veterans who are currently enrolled in the VA health system

· Enrollment and eligibility data updates

· Eligibility status responses to real time requests The Contractor will integrate with VA’s Data Access Service (DAS) for receipt of copies of eligibility and enrollment data.

Initial Load The initial load will consist of copies of Veteran records that are enrolled in the VA health system. These records will be designated as INIT (for initial).

Enrollment Updates Enrollment and eligibility updates will be sent for Veteran records whose enrollment and/or eligibility status changes. The Contractor will receive current information on an ongoing basis as follows:

· Updates for any newly enrolled Veteran

· Updates for Veterans whose physical address or contact information is changed (this could change a Veteran’s region and trigger a handoff between regional Contractors)

· Updates for Veterans demographic information

· Updates to Enrollment Status that result in a Veteran no longer enrolled in the Enrollment System, including deceased Veterans (Flag = NLE_ES (No Longer Enrolled in VA Enrollment System)) Eligibility Verification The Contractor can request verification of community care distance eligibility through VA DAS for Veterans who are actively seeking or receiving care in the community. The Contractor can request verification for Veterans who are authorized to receive care in the community for a specific episode of care after meeting time-eligibility criteria through an Electronic Data Exchange request.

Data to Be Processed Characteristics All data have the following characteristics:

· Verified to be ASCII – no Unicode

· One record per Veteran (will have Mailing Address (Permanent or Temporary), and residential address Record Data Dictionary Every copy of a record transmitted will follow this definition. Some fields may be NULL (no value).

Basic Information

"P" for Permanent Mailing Address "T" for Temporary Mailing Address “R” for Residential Address NULL if no address on file

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

Preferred Facility Name

Eligibility Information

"M" – eligible based on mileage “B” – basic eligibility (Eligible for Program, but not for services.)

“X” – no longer eligible “H” – eligible based on geographic burden

NLE_ES

Y or N or Null (no value)

Distance-Eligible Information (Present at all times even if the individual fields are empty)

Basic Record Structure

Sample record structure – Not Distance-Eligible 53009535^0000001006293853V438339000000^6876864947^123456789^LASTNAME^FIRSTNAME^MI^19500101^^F^^P^^123 Wonderful Rd^^^GAiNESVILLE^ME^34742^^USA^20100322100300^^^4042216089^^^^^402GA^Caribou VA Clinic^B

Sample record structure – Distance 53009535^0000001006293853V438339000000^6876864947^123456789^LASTNAME^FIRSTNAME^MI^19500101^^F^^P^^123 Wonderful Rd^^^GAiNESVILLE^ME^34742^^USA^20100322100300^^^4042216089^^^^^402GA^Caribou VA Clinic^M^7^508^ATLANTA VAMC Sample record structure –No Longer Enrolled in Enrollment System 53009535^0000001006293853V438339000000^6876864947^123456789^LASTNAME^FIRSTNAME^MI^19500101^^F^^P^^123 Wonderful Rd^^^GAiNESVILLE^ME^34742^^USA^20100322100300^ ^ ^ ^ ^ ^ ^ ^PF_NO^PF_NAME^VCE^NLE_ES^NLE_ES_DATE

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