Attachment N DAS Interface Control Document ICD Template.docx

TEMPLATE

Office of Information and Technology

Authorization Interface Control Document (ICD) Community Care Referral and Authorization (CCRA) Managed Services and Standard Integration Partner (SIP)

[DATE] | [Version XX]

U.S. DEPARTMENT OF VETERANS AFFAIRS (VA) FOR INTERNAL USE ONLY

Office of Information and Technology

Table of Contents

FOR INTERNAL USE ONLY

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 4

Table of Exhibits

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 5

Disclaimer The ICD is an IT document which details the connection between VA systems and related information. It is not intended to be used for contractual purposes and does not commit VA to any financial obligations or contract modifications.

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 6

Introduction Community Care Referral and Authorization (CCRA) is an enterprise-wide system in support of community care used by community care staff to generate referrals and authorizations for Veterans receiving care in the community. Clinical and Department of Veterans Affairs (VA) community care staff located at VA medical centers (VAMCs), outpatient clinics, community-based outpatient clinics (CBOCs), and Veterans Integrated Service Network (VISN) offices use this solution to enhance Veteran access to care. The HealthShare Referral Manager (HSRM) application is an integral component of both the CCRA system and community care information technology (IT) architecture that allows Veterans to receive care from community providers.

HSRM allowed VA to transition from a largely manual process to a more streamlined process that generates standardized referrals and authorizations according to clinical and business rules. HSRM supports clinical and administrative processes that:

» Seamlessly provide eligible Veterans with prompt referrals to a community provider of their choice » Provide community providers with referrals and authorizations consistent with industry standards » Decrease the administrative burden on VA clinical and community care staff members by establishing clinical and business pathways that reflect best practices, consistent outcomes, and reduced turnaround times, along with a solution that automates those pathways » Facilitate communication between community care staff, third-party administrators (TPAs), and community providers via a unified platform that enables the secure exchange of medical information Referral information will need to be provided to a Standard Integration Partner (SIP). SIPs include Choice/Patient-Centered Community Care (PCCC) networks and Community Care Networks (CCNs). These documents are sent from the HealthShare Information Exchange (HSIE) through the Data Access Service (DAS) and eventually to a PCCC vendor as a JavaScript Object Notation (JSON) file contained in the body of a Hypertext Transfer Protocol (HTTP) POST message. HSIE will be referred to herein as HSRM. This ICD focuses on the connections between HSRM and DAS, and the messages exchanged between the two systems.

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 7

Purpose This document presents the software interface requirements between HSRM and a SIP in the CCRA solution. DAS acts as a proxy between HSRM and any SIP. The purpose of this ICD is to specify interface requirements to be met by the participating system. It describes the concept of operations for the interface, defines the message structure and protocols which govern the interchange of data, and identifies the communication paths along which the data is expected to flow.

Scope This ICD specifies the interface between HSRM and a SIP. Upon formal approval for each participating system, this ICD shall be incorporated into the requirements baseline for the approving system.

Included in this document are details on the functional, performance, operational, and design requirements for the interface and a description of the file parameters and record layouts for the data exchanged between the two systems. This data is used in conjunction with other datasets to create HSRM datasets. It is intended for all parties requiring such information, including software developers, system designers, and testers responsible for implementing the interface.

System Identification The interface between HSRM, DAS, and a SIP is described herein. In this interface, HSRM sends a notification to the DAS system, which forwards the information to the SIP as notification that a new referral document is available.

System 1: HSRM

Exhibit 1: HSRM System Details

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 8

Points of Contact » [VA POC 1 Name, Email, Phone Number] » [VA POC 2 Name, Email, Phone Number] » [VA POC 3 Name, Email, Phone Number]

System 2: DAS

Exhibit 2: DAS System Details

partner application and DRS

System 3: SIP

Exhibit 3: SIP Details

Operational Agreement This ICD provides the specifications for an interface between HSRM, DAS, and a SIP regarding referral data. The Fast Healthcare Interoperability Resources (FHIR) message

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 9

requirements are defined by the DAS system. The JSON body of that message, containing the referral data, is constructed to match the formatting agreed upon between HSRM and the SIP.

Standards and References » FHIR Resource “DocumentReference” to post HTTP data – http://hl7.org/fhir/DSTU2/documentreference.html » FHIR Resource “OperationOutcome” to post HTTP data – http://hl7.org/fhir/DSTU2/operationoutcome.html

Interface Definition Both HSRM and DAS have a web service to consume messages as a representational state transfer (REST)-ful Hypertext Transfer Protocol Secure (HTTPS) POST. The body of these messages follows standards defined by FHIR documents. Details about the standards and versioning are defined in Standards and References.

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 10

System Overview Exhibit 4: System Interconnection Overview

Note: In Exhibit 4, the VA system is HSRM and the TPA is a SIP.

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 11

Interface Overview

1. HSRM sends an FHIR Document Reference resource to DAS via RESTful HTTPS POST in the DAS.Operation.FHIRDocumentationNotification operation. The content.attachment.url element shall contain the Uniform Resource Locator (URL) pointing to the location of the payload data in the HSRM. The content type of the request to DAS must be application/json+fhir.

a. If DAS is unreachable, a Transmission Control Protocol/Internet Protocol (TCP/IP) error will be logged, and an alert will be generated for the CCRA support distribution list.

2. DAS sends a synchronous HTTPS response back to the DAS.Operation.FHIRDocumentationNotification in HSRM containing an FHIR operation outcome to specify a success or failure.

a. If any response other than an HTTP 201 is received, an alert is raised.

3. DAS transmits the Document Reference resource received from HSRM to a SIP system via RESTful HTTPS POST.

4. DAS receives a synchronous HTTPS response from the SIP system.

5. For synchronous HTTPS response from the SIP system, whether it is a success or a failure, DAS sends an FHIR Operation Outcome via asynchronous RESTful HTTPS POST to the HSRM service, DAS.Service.DASRESTService. The content type of HTTPS POST data shall be application/json+fhir.

a. Any failures will generate an alert message.

Note: The failure scenarios include DAS having connectivity issues with a SIP system, a SIP system service being down, etc. Details about the handling of this scenario are defined in Connectivity Errors.

6. DAS receives a synchronous HTTPS response from the DAS.Service.DASRESTService in HSRM.

7. The SIP system sends a query message to DAS using the URL value of content.attachment.url element to retrieve binary/attachment data. The content type of the request to DAS must be application/json+fhir.

8. DAS sends a synchronous HTTPS response to DAS.Service.DASRESTService service in HSRM; the HTTPS response is not actual binary data but an HTTPS acknowledgement with a status code from DAS to accept or reject the GET query, indicating that the message was received and processed by DAS.

9. DAS sends a query message to DAS.Service.DASRESTService service in HSRM via RESTful HTTPS POST to retrieve the payload.

a. Successful retrieval is listed in the service log.

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b. Failure to retrieve a document will generate an alert message.

10. DAS sends an FHIR Operation Outcome resource to the SIP system via RESTful HTTPS POST. The content type of the HTTPS POST request to the SIP must be application/json+fhir.

11. DAS receives a synchronous HTTPS response from the SIP system.

12. DAS receives the payload data in the HTTPS response from the DAS.Service.DASRESTService in HSRM.

13. DAS posts the payload to the SIP system.

14. DAS receives a synchronous HTTPS response from the SIP system indicating whether they can receive the request.

15. For synchronous HTTPS response from the SIP contractor, whether it is a success or a failure, DAS sends an FHIR operation outcome via asynchronous RESTful HTTPS POST to DAS.Service.DASRESTService service in HSRM. Details about the failure are defined in Required Fields.

16. DAS receives a synchronous HTTPS 200 response from that service indicating that the DAS message was received by HSRM.

Note: Steps 3 – 8, 10 – 11, and 13 – 15 are not owned by CCRA and the SIP must work with DAS to resolve connectivity issues.

HSRM may receive the following errors messages:

Step 1: Network Connection Failed Step 2: Bad Integration Control Number (ICN) Operations Users do not directly interact with the interfaces. The messages triggered out of HSRM are either in response to a request from DAS or are sent from HSRM notifying HSRM that there is a new referral document available.

Data Transfer As in step 12 in Interface Overview, payloads from CCRA are retrieved by DAS and subsequently delivered to the SIP by DAS.

Transaction Types All transactions will contain a payload based on FHIR standards. The content type of the request must be application/json+fhir due to a requirement from the DAS system.

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 13

Data Exchanges DAS.Service.DASRESTService This service is to be consumed by the DAS system.

Endpoints

Exhibit 5: Endpoints

Response Exhibit 6 shows the endpoint, reason, and response.

Exhibit 6: Response

Endpoint HTTP Status Code

Reason

Response

Notes

/Document/: DocumentId

Success Extensible Markup Language (JSON) representation of the referral document returned in the body of the response

Document ID recorded in service log

/Document/: DocumentId

Content Not Found

No body returned » Specified document not available to be returned » Document ID recorded in service log

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 14

DAS.Operation.FHIRDocumentationNotification This service creates and sends a message, including custom headers defined by DAS requirements and an FHIR document reference as the body, to DAS through HTTPS POST. It also records the HTTP response from DAS in the logs.

Precedence and Criticality HSRM allows for a single referral post in real time or for batching all referrals created, updated, or cancelled within a specified interval. The batch interval can be updated with a configuration change upon agreement of CCRA, VA, and the SIP.

Communication Methods When “apply” or “update” is selected by a user in HSRM, or when the Computerized Patient Record System (CPRS) triggers a change to a referral, the referral number is triggered for processing. When the processing window is closed, a single file containing any referrals created or updated during that time is generated and DAS is notified that the file is ready.

The FHIR operation outcome is sent from DAS to HSRM asynchronously once the SIP has confirmed receipt of the FHIR document reference so that the data stream containing the JSON representation of the referral document can be sent.

DAS sends a request to HSRM for the data stream once the SIP has sent the request to DAS. The stream is returned as part of the HTTPS response from HSRM. Details about the data exchange are defined in Interface Overview.

Performance Requirements The SIP will receive the referral document within 30 seconds after HSRM sends the message to DAS.

Security Transfers between HSRM and DAS are protected by two-way Secure Sockets Layer (SSL) within the HTTPS application layer protocol. This protocol requires certificates that identify the host computers running the external partner’s applications and the DAS application.

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 15

Certificates must be public certificates of authority (Cas) signed for this interface. Certificates will use Transport Layer Security (TLS) version 1.2 or newer. External partners are responsible for obtaining and keeping their certificates up to date based on the lifetime of each certificate.

The certificates for external partners’ host computers and the DAS computers must be securely exchanged. Reference Exhibit 2 for contact information. DAS requires a copy of each external partner’s certificate and any other certificates needed to establish a chain of trust to the signing CA. Each external partner’s host computer requires a copy of the DAS computer certificate and other certificates needed to establish a chain of trust to the signing CA.

Information transmitted includes Veteran personally identifiable information (PII) and protected health information (PHI), which must be encrypted while in transit and at rest. Directives or policies that govern the protection of the data include but are not limited to National Institute of Standards and Technology (NIST) documents, VA Directive 6500, VA Handbook 6500 (or successors), and NIST Special Publication 800 series.

Interface Requirements HSRM sends a DocumentReference FHIR resource in the HTTP body via RESTful HTTP POST with required HTTP headers as listed in Interface Overview. It also processes an OperationOutcome FHIR resource when sent from DAS as the HTTP body.

Message/File Requirements This section documents the message requirements by describing the data protocol, communication method, and security requirements.

DAS.Message.FHIRDocumentNotificationRequest An object containing the data is used to generate the message being sent to DAS as notification that new documents are available.

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 16

Exhibit 7: Data Elements

Communication Methods The interface from HSRM to DAS, as well as DAS to HSRM, are both RESTful web services over HTTPS using FHIR messaging.

Interface Initiation A real-time trigger in HSRM notifies HSRM of any new or updated referrals based on actions taken by the end user to update a referral status or create or cancel an appointment. HSRM then forwards these downstream to DAS.

If a SIP has referrals batched and no referrals are contained within the interval, the message will be empty. A count of referrals, or “ReferralCount,” is added to the batch file so that the batch can be audited against the actual count of records received to ensure there are no errors causing the empty batch.

» Note: The scope of this ICD does not cover availability requirements outside the control of the interfacing systems (e.g., network availability).

Required Fields This section outlines the fields required by downstream systems.

Required Fields A SIP must receive basic referral information needed to process a request. Exhibit 8 contains required fields.

Exhibit 8: Required Fields

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 17

Ordering Officer Name

Patient’s Social Security Number (SSN)

Referral Last Update Date

Referral Last Update Time

Referring Provider

CCRA will always post referrals in a JSON format with a referral number (e.g., VA000000001) and ICN. The ICN, patient address, and demographics may be updated by VA. CCRA registers an interest with the Master Patient Index (MPI). MPI is VA’s source of truth for patient information. The current patient information as recorded in the Patient Details screen will be sent to the downstream partner when the referral is created, updated, or cancelled.

When there are payload errors (e.g., a missing ICN), the SIP rejects the referral; however, DAS may or may not notify HSRM based on the connection established by the SIP and DAS.

If batch processing is used, a message may not be sent back to DAS in real time and the referral is triaged first by the SIP. VA and the SIP may not be able to resend the referral, and the payload errors may need to be resolved collaboratively by VA and the SIP.

HSRM is not the owner of Standardized Episode of Care (SEOC) content. HSRM uploads SEOCs nightly and will make available the latest version immediately to end users creating consults. The SIP will need to reach out to the VA SEOC team if the SEOC ID received in the payload has not been provided to the SIP.

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HSRM does not own provider data and cannot guarantee that a treating provider tax ID will always be available. If it is not available, the SIP must work with VA to load that information into the Provider Profile Management System (PPMS) so that it can be sent with the referral. HSRM only consumes tax IDs for Type 2 providers with one tax ID in PPMS currently. VA and CCRA are discussing potential enhancements for the future.

Connectivity Errors If the connection between HSRM and DAS is down, HSRM will try to send the message three times over the course of 15 seconds. If a connection cannot be established, the interface will stop, and messages will queue. In order to resume sending these messages, DAS must contact the HSRM point of contact and confirm the system is back online and request that CCRA can proceed with the queue.

DAS’s retry logic is configurable. If the connection between DAS and the SIP is down, DAS will resend up to 3 times over 5 minutes. If the connection cannot be established at this point, DAS will need to manage the delivery of these messages to the SIP.

If the SIP cannot communicate with DAS or is receiving error messages (other than 200 response), it is their responsibility to retrieve this data properly. The SIP will contact HSRM’s point of contact to ensure the messages can be retrieved.

Monitoring of these queues and error logs will be a manual process.

Support Contacts

Exhibit 9: Contact List

DAS

OITPDDASSustainmentTeam@va.gov

[VA Escalation Point Name, Contact Information]

[Contractor Organization]

[Contractor Initial Contact Name, Position Title, Email]

[Contractor Escalation Contact Name, Position Title, Email]

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 19

Interface Control The real-time referral process in HSRM, triggered by HSRM for new or updated referrals with a status other than initial or suspended, sends referrals downstream to System and Information Integrity (SI) through the DAS architecture.

Data Elements HSRM Build 6.0 CCRA Data Elements Available to SIP A list of data elements, including the data type, data element requirements in creating the JSON, and element maximum length, are included in .

JSON Schema The JSON schema provides information on the properties of the JSON, including the data element name, data element description and type, and maximum length within a formatted JSON message. The current JSON schema can be found in Appendix C.

Note: The schema represents a single real-time referral post of all elements. If the referral post is received via batch, the schema does not include the batch headers. The batch headers are included in the sample batch JSON in .

Note: This schema represents a single real-time referral post. During the initial release, Optum will be receiving batch referrals hourly that will contain the element’s batch and referrals.

Sample Batch JSON A sample JSON batch file is included in of this document.

Sample Empty Batch JSON

“Batch”: { “ReferralCount”: 0, CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 20

“BatchDate”: “03\/07\/2019 12:30:39”

» Note: The above JSON sample does not include cancelled appointment information.

HSRM Build 6.1 CCRA Data Elements Introduced in Build 6.1 Treating Facility Address Line 1 and Address Line 2 were being sent as two separate fields and were no longer concatenated in Address Line 1.

CCRA Data Elements Removed in Build 6.1 The Combat Veteran Indicator was removed from the schema.

HSRM Build 7.0 There were no changes to the schema in Build 7.0.

HSRM Build 7.4 A CareType object was added that contains the CareTypeCode and CareTypeDesc as an array.

HSRM Build 7.5 The LevelOfCareCode, LevelOfCareDesc, and Seockey are sent in the main referral body. SEOC object was removed.

HSRM Release 8.0 Added two new program authorities and expired one:

» 59 Beneficiary Travel – Non-Urgent » 58 Beneficiary Travel – Urgent Expired Program Authority 40 Beneficiary Travel

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 21

HSRM Release 9.0 New optional task (CLIN) codes were added for Region 4 as a change request. The existing optional task (CLIN) codes will continue to be used for regions 1 – 3 and descriptions will be modified.

Exhibit 10: Optional Task Codes

HSRM Release 10.0 Added new program authority codes for Beneficiary Travel and Department of Defense (DoD):

» 100 FY21 Beneficiary Travel 2119 BT Eligible » 101 FY21 Beneficiary Travel 2129 Interfacility » 55 DoD Sharing – Air Force – 8111 » 54 DoD Sharing – Army – 8111 » 57 DoD Sharing – DC Facility – 8111 » 56 DoD Sharing – Navy – 8111 HSRM Release 11.0

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 22

Added a new field, AppointmentCreateDateTime, to the list of available fields. Added new program authority codes for Caregiver Program:

» 110 Caregiver Respite – 1720G-8210 » 112 Caregiver Non-VA Oversight – 1720G-8210 Added new network code for Community Care Region 5 – 36C10G21D0001.

HSRM Release 11.4 Added new optional task (CLIN) code for regions 1 – 3 as a change request.

Exhibit 11: Optional Task Codes

Optional Tasks

CLIN #X012AD

Regions 1 – 3 Optional COVID Appointment Scheduling and Care Coordination Services

HSRM Release 13.0 Added new program authorities:

» 60 FY22 Beneficiary Travel 2119 BT Eligible » 110 FY21 Caregiver Respite 1720G-8210 » 112 FY21 Caregiver Non-VA Oversight 1720G-8210 » 113 FY22 Caregiver Respite 1720G-8210 » 114 FY22 Caregiver Non-VA Oversight 1720G-8210 » 120 Emergent Suicide Care (Compact Act) – 1720J HSRM Release 14.0 Two new questions were added to the HSRM UI:

» Referral Details screen: Did the Veteran specifically ask to be scheduled with this provider or location? Yes/No » Record Appointment screen: Did the Veteran self-schedule their appointment or independently request this specific appointment date? Yes/No

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 23

Added new Veteran appointment preference code to JSON:

» WLYesNo1 and ApptYesNo1 » Both are of type: websys.StandardTypeDataType(StandardTypeName = “YESNO”) HSRM Release 14.0 – Out of Cycle Updated Referral Return Reason Codes to include only those listed in Exhibit 12.

Exhibit 12: Referral Return Reason Codes

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 24

Referral Receipt

HSRM Release 17.0 – Out of Cycle

» 62 FY23 Beneficiary Travel 2119 BT Eligible » 63 FY23 Beneficiary Travel 2129 Interfacility » 116 FY23 Caregiver Non-VA Oversight – 1720G-8210 » 115 FY23 Caregiver Respite – 1720G-8210 End dated program authorities:

» 100 FY21 Beneficiary Travel 2119 BT Eligible » 114 FY22 Caregiver Non-VA Oversight – 1720G-8210 » 113 FY22 Caregiver Respite – 1720G-8210 HSRM Releases 18.0 and 19.0 Added the following new Gender Identity fields to JSON:

» Preferred Name

· String » Birth Sex » Gender Identity » Gender Pronoun » Gender Pronoun Description

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 25

Exhibit 13: Birth Sex Code and Description

Exhibit 14: Gender Identity Code and Description

Exhibit 15: Gender Pronoun and Description

HSRM Release 22.0 The Patient First Name field will not be required in HSRM. This allows referrals to be passed downstream if the first name is missing.

HSRM Release 22.0 – Out of Cycle

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 26

» 64 FY24 Beneficiary Travel 2119 BT Eligible » 117 Caregiver Respite 1720G-8210 End dated program authorities:

» 115 FY23 Caregiver Respite - 1720G-8210 » 116 FY23 Caregiver Non-VA Oversight - 1720G-8210 » 60 FY22 Bene Travel Program Authority » 62 FY23 Beneficiary Travel 2119 BT Eligible HSRM Release 23.0 » Additional referral information, such as Patient Preferences, can be received from upstream systems and captured in HSRM as consult factors. These consult factors will be a part of the downstream JSON payload if there are values to be sent (e.g., VSP- Veteran Scheduling Preference: Community Provider Schedules).

» Added new Optional Task Extension field to HSRM user interface (UI). This Extend/Continue Appointment Scheduling Efforts field will be sent to TPAs as “ExtendApptTime” in the JSON file.

Exhibit 16: Patient Preference Consult Factors

· Veteran provided list of local network providers

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 27

VSP-Veteran scheduling preference: <option> PSS-Scheduling support: Veteran referred to VA.gov

· Veteran self-schedules

· Veteran referred to VA.gov

VSP-Veteran scheduling preference: <option> PSS-Scheduling support: Veteran declined support, provider identified

· Veteran self-schedules

· Veteran declined support, network provider identified

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 28

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 29

HSRM Release – Precertification Out of Cycle Additional precertification information, such as Precertification ID and associated attributes, can be received from upstream system VA Precertification Portal (VAPP). These data attributes will be sent downstream when available as part of the existing downstream JSON payload.

» Precertification ID » Procedure Code » Date of Service (Date that procedure in SEOC is being rendered) » Rendering Provider NPI » Rendering Facility NPI » Date of Request (Date that Precert was created) HSRM Release 24.0 Added new a patient preference consult factor which will be a part of the downstream JSON payload if there are values to be sent – Veterans’ Preference for Provider Gender (VPG).

Exhibit 17: Patient Preference Consult Factors (Additions)

HSRM Release 26.0 – Out of Cycle Added new program authority:

» 66 FY25 Beneficiary Travel 2119 BT Eligible

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 30

HSRM Release 27.0 Dental Request for Services (RFS) Data These data attributes will be sent downstream when available as part of the existing downstream JSON payload:

Dental Services Array » Diagnosis » Evaluation Code » Dental Care Plan » RFS Decision » Date Notified » Date Received » Date Sent For Scanning » Date Scanned » Date Submitted » Urgency » Annotated » Provider Notified » Reviewed » Details » Comments Dental Service Items Array » Arch Code » Code » Description » Approval Status » Surface Code » Tooth

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Appendix A: Acronyms and Abbreviations Exhibit 18: Acronyms and Abbreviations

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CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 33

Appendix B: Available Data Elements Exhibit 19: Available Data Elements

Build 11.0

CCRA Object Reference

Referral Properties

Parent Object

Patient Properties

Parent Object for Patient

ICN – The patient’s Integration Control Number

String

Required

CCRA.Referral.Patient.ICN

Birth Sex – The patient’s gender

String

Optional

CCRA.Referral.Patient.Gend er

Gender Identity – The patient’s self-identified gender

String

Optional

CCRA.Referral.Patient.Gend er Identity

Preferred Name – The patient’s preferred name

String

Optional

CCRA.Referral.Patient.Prefe rredName

Gender Pronoun Desc – The patient’s gender pronoun description

String

Optional

CCRA.Referral.Patient.Gend erPronounDesc

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 34

Build 11.0

CCRA Object Reference

Home Address

Parent Object for Home Address

Address1 – The patient's home address

– street line 1

String

Optional

32k CCRA.Referral.Patient.Hom eAddress.Addresss1

Address2 – The patient's home address

– street line 2

String

Optional

32k CCRA.Referral.Patient.Hom eAddress.Address2

ZipCode – The patient’s home address – zip code

String

Optional

32k CCRA.Referral.Patient.Hom eAddress.ZipCode

TelephoneHome – The patient’s home telephone number

String

Optional

CCRA.Referral.Patient.Telep honeHome

TelephoneBusiness – The patient's work telephone number

String

Optional

CCRA.Referral.Patient.Telep honeBusiness

TelephoneMobile – The patient's cell phone number

String

Optional

CCRA.Referral.Patient.Telep honeMobile

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 35

Build 11.0

CCRA Object Reference

PreferredContactMetho d – The patient's preferred method of contact (phone, email, mail)

String

Optional

Diagnosis – Current diagnosis of the patient's condition

String

Optional

CCRA.Referral.Diagnosis

DiagnosisCode – The International Classification of Diseases code for the patient's diagnosis

String

MedicalNecessity – The reason the service has been requested

Optional

32k CCRA.Referral.MedicalNece ssity

PayorStatus – The payer status of the Veteran either VA – Primary or VA – Secondary

String

Optional

CCRA.Referral.PayorStatus

PrimaryCareProviderNPI

– The NPI for the primary care provider

String

Optional

CCRA.Referral.PrimaryCare ProviderNPI

PrimaryCareProviderNa me – The name of the Veteran's primary care provider

String

TreatingProvider – The care provider who will be providing the requested service

String

Optional

CCRA.Referral.TreatingProv ider

TreatingProviderNPI – The care provider's NPI for the provider that will be providing the requested service

String

Optional

CCRA.Referral.TreatingProv iderNPI

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 36

Build 11.0

CCRA Object Reference

Referral Category – Whether the service requested is inpatient or outpatient

String

Optional

32k

CCRA.Referral.ReferralCate gory

ReferralDate – The date when the referral was raised

String

Optional

CCRA.Referral.ReferralDate

ReferralExpirationDate – The date when this referral expires

String

Optional

32k CCRA.Referral.ReferralExpir ationDate

ReferralLastUpdatedDat e – The date the referral was last updated

String

Optional

32k CCRA.Referral.ReferralLastU pdateDate

ReferralLastUpdatedDat eTime – The date and time the referral was last updated

String

Optional

CCRA.Referral.ReferralLastU pdateDateTime

ReferralNumber – The unique, system – (HSRM) generated number for the referral

String

Optional

CCRA.Referral.ReferralNum ber

ReferralConsultId – Consult ID (from Veterans Health Informa tion Systems and Technology Architecture (VistA))

CCRA.Referral.ConsultID

ReferringFacility – The hospital that originated the referral

String

Optional

CCRA.Referral.ReferringFaci lity

ReferringProvider – The provider at the referring hospital that originated the referral

String

Optional

CCRA.Referral.ReferringPro vider

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 37

Build 11.0

CCRA Object Reference

ReferralReturnReason – The reason for the referral’s return

String

Optional

CCRA.Referral.ReferralRetur nReason

ReferralReturnReasonC ode – The reason code for the referral’s return

String

Optional

CCRA.Referral.ReferralRetur nReasonCode

ReferringSpecialty - The specialty at the referring hospital that originated the referral

String

Optional

CCRA.Referral.ReferringSpe cialty

SourceofReferral – How and where the referral was entered into HSRM

String

Optional

CCRA.Referral.SourceOfRef erral

TreatingFacility – The treating facility to which this referral has been allocated

String

Optional

CCRA.Referral.TreatingFacili ty

Treating Specialty – The specialty at the treating facility that will provide this service

String

Optional

CCRA.Referral.TreatingSpec ialty

CoPayment Status

Parent Object for CoPayment status

PriorityEnrollmentGroup

- Priority Enrollment Group – from Enrollment System (ES)

String

Optional

32k CCRA.Referral.CoPaymentS tatus.PriorityEnrollmentGro up

CurrentMeansTest – Current Means Test – from ES

String

Optional

32k CCRA.Referral.CoPaymentS tatus.CurrentMeansTest

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 38

Build 11.0

CCRA Object Reference

AgentOrangeExposureI ndicator – Agent Orange Exposure Indicator from ES

String

Optional

CCRA.Referral.CoPaymentS tatus.AgentOrangeExposur eIndicator

CombatVeteranEndDate

– Combat Veteran End Date from ES

String

Optional

CCRA.Referral.CoPaymentS tatus.CombatVeteranEndD ate

Project112SHADIndicat or – Project 112 SHAD Indicator from ES

String

Optional

CCRA.Referral.CoPaymentS tatus.Project112SHADIndic ator

SouthwestAsiaIndicator

– Southwest Asian Indicator from ES

String

Optional

CCRA.Referral.CoPaymentS tatus.SoutwestAsiaIndicator

IonizingRadiationIndicat or – Ionizing Radiation Indicator from ES

String

Optional

CCRA.Referral.CoPaymentS tatus.IonizingRadiationIndi cator

CampLejeuneIndicator – Camp Lejeune Indicator from ES

String

Optional

CCRA.Referral.CoPaymentS tatus.CampLejeuneIndicato r

Network – The CCN network to which this referral has been forwarded or “Not Allocated”

String

Optional

CCRA.Referral.Network

NetworkCode – The Network Code to which this referral has been forwarded or “Not Allocated”

String

Optional

CCRA.Referral.NetworkCod e

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 39

Build 11.0

CCRA Object Reference

CLINCode – The CLIN (Contract Line-Item Number) Code

String

Optional

CCRA.Referral.CLINCode

CLINDesc – The CLIN (Contract Line-Item Number) Description

String

Optional

CCRA.Referral.CLINDesc

PaymentAuthorityCode

– The Payment Authority Code

String

Optional

CCRA.Referral.PaymentAut horityCode

PaymentAuthorityDesc

– The Payment Authority Description

String

Optional

CCRA.Referral.PaymentAut horityDesc

Service-Connected Information

Service- Connected Array

ServiceConnectedPerce ntage – Service Connect Percentage from ES

Integer

Optional

CCRA.Referral.ServiceConn ectedInfo.ServiceConnecte dPercentage

ServiceConnected – Service-Connected Indicator From ES

String

Optional

CCRA.Referral.ServiceConn ectedInfo.ServiceConnecte d

ServiceConnectedCondi tion – Service Connect Description

String

Optional

CCRA.Referral.ServiceConn ectedInfo.ServiceConnecte dCondition

Military Sexual Trauma

Parent Object for Military Sexual Trauma

DeterminationFacility – For Military Sexual Trauma

Optional

32k CCRA.Referral.MilitarySexu alTrauma.DeterminationFac ility

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 40

Build 11.0

CCRA Object Reference

StatusChangeDate – For Military Sexual Trauma

String

Optional

CCRA.Referral.MilitarySexu alTrauma.StatusChangeDat e

Nose Throat Radium Info

Parent Object for Nose Throat Radium

DeterminationFacility - Name of Determination Facility – from ES

String

Optional

32k CCRA.Referral.NoseThroatR adiumInfo.DeterminationFa cility

ReceivingTreatment - Is Veteran receiving treatment – from ES

String

Optional

32k CCRA.Referral.NoseThroatR adiumInfo.ReceivingTreatm ent

VerificationDate - Verification Date – from ES

String

Optional

CCRA.Referral.NoseThroatR adiumInfo.VerificationDate

VerificationFacility – The Verification facility

String

Optional

32k CCRA.Referral.NoseThroatR adiumInfo.VerificationFacili ty

VerificationMethod – Verification Method – from ES

String

Optional

CCRA.Referral.NoseThroatR adiumInfo.VerificationMeth od

Eligibility Status

Parent Object for Eligibility Status

PermanentAndTotalDisa bled – Permanent and Total Disabled – from ES

String

MeansTestStatus – Means Test Status – from ES

Optional

32k CCRA.Referral.EligibilityStat us.MeansTestStatus

MeansTestDeterminedS tatus - Means Test Determined Status – from ES

String

Optional

CCRA.Referral.EligibilityStat us.MeansTestDeterminedSt atus

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 41

Build 11.0

CCRA Object Reference

LTCTestStatus – Long- term care (LTC) Test Status – from ES

String

Optional

32k CCRA.Referral.EligibilityStat us.LTCTestStatus

LTCTestDeterminedStat us – LTC Test Determined Status – from ES

String

Optional

32k CCRA.Referral.EligibilityStat us.LTCTestDeterminedStatu s

PharmacyCoPayTestStat us – Pharmacy CoPay Test Status – from ES

String

Optional

32k CCRA.Referral.EligibilityStat us.PharmacyCoPayTestStat us

PharmacyCoPayTestDet erminedStatus – Pharmacy CoPay Test Determined Status – from ES

String

Optional

32k

CCRA.Referral.EligibilityStat us.PharmacyCoPayTestDet erminedStatus

Transaction History

Transaction History Array

TransactionDate – Transaction Date YYYY- MM-DD

Optional

CCRA.Referral.TransactionH istory.TransactionDate

TransactionDateTime – Transaction Date YYYY- MM-DD HH:MM:SS

String

Optional

CCRA.Referral.TransactionH istory.TransactionDateTime

EffectiveDate – Transaction Effective Date YYYY-MM-DD

String

Optional

CCRA.Referral.TransactionH istory.EffectiveDate

EffectiveDateTime – Transaction Effective Date YYYY-MM-DD HH:MM:SS

String

Optional

CCRA.Referral.TransactionH istory.EffectiveDateTime

CCRA [CONTRACTOR ORGANIZATION] ICD – [DATE] 42

Build 11.0

CCRA Object Reference

Other Health Insurance (OHI)

OHI Array

CCRA.Referral.Other…