Section_25_Management_Reporting_Legacy_version_20140106.doc

Requirements Specification Document (LEGACY DRAFT)

Management Reporting (Section 25)

Central Bill Process

Management Reporting (PWS Section 25)

Requirements Specifications Document

(LEGACY DRAFT)

Prepared for:

U.S. Department of Labor

Office of Worker’s Compensation Programs

Revision History:

SPECIAL NOTICE: This document is a legacy draft requirements specification document developed between 2011 and 2012. As outlined in the Performance Work Statement, the Contractor will be required to review this RSD and make appropriate updates wherever necessary. (Please refer to PWS R0052 for more details.)

Table of Contents Management Reporting – DFEC

61.1 Management Reporting Overview - DFEC

71.2 Management Reporting Business Process Description - DFEC

71.2.1 Management Reporting Tool

71.2.1.1 Tool Features/Capabilities

71.2.1.2 Types of Reports

71.2.1.3 Report Distribution

81.2.1.4 Report Training

81.2.1.5 DFEC Reports

81.3 Management Reporting Business Process Flow – DFEC

Management Reporting Overview – DEEOIC

92.1 Management Reporting – DEEOIC

102.2 Management Reporting Business Process Description - DEEOIC

102.2.1

102.2.1.1

102.2.1.2

102.2.1.3

112.2.1.4

112.2.1.5 DEEOIC Reports

112.3 Management Reporting Business Process Flow – DEEOIC

Management Reporting – DCMWC

123.1 Management Reporting – DCMWC

133.2 Management Reporting Business Process Description - DCMWC

133.2.1

133.2.1.1

133.2.1.2

133.2.1.3

143.2.1.4

143.2.1.5 DCMWC Reports

143.3 Management Reporting Business Process Flow – DCMWC

Management Reporting Requirements

154.1 Functional Requirements

174.2 Business Rules

Management Reporting Supporting Functional Components

195.1 Initial Data Migration

195.2 Interfaces

205.3 Reports

205.4 Letters

Constraints

216.1 Assumptions

216.2 Dependencies

216.3 Issues/Open Items

Appendices

227.1 Terms & Definitions

277.2 DFEC Standard and On-Demand Reports

507.3 DEEOIC Standard and On-Demand Reports

687.4 DCMWC Standard and On-Demand Reports

1 Management Reporting – DFEC

1.1 Management Reporting Overview - DFEC

The CBP management reporting solution will support fast, accurate and flexible reporting of CBP data to enable Government personnel to monitor and control CBP operations. Reporting is an important component of the overall CBP, as the reports and underlying data allow the Government to assess processing volumes and the Contractor’s performance and operational efficiency.

CBP reports will be implemented using a flexible web-based tool that is easily integrated with other CBP components and provides comprehensive reporting capabilities such as automated generation of scheduled reports and ad-hoc querying capabilities to generate on-demand reports. The reporting tool will provide users with the ability to generate various charts, including bar charts, pie charts and stacked charts. Authorized users will have the ability to define report format, such as inclusion/exclusion of headers, footers, columns/rows and data.

Reports will be available via the CBP portal, and upon operational cut-over, the most recent seven years of historical data will be available via the reporting tool. Data older than 7 years will be made available, upon request, within two business days.

Standard and on-demand reports will be displayed in a drop-down menu format. Users will have the ability to filter the display of data, such as hide/display columns or only display user-defined data elements or ranges of values. Reports can be exported to other programs in numerous formats such as .pdf, .doc, .xls. Two export options will be available—export of content which enables the export of the report exactly as shown (screen shot format), or export of data which enables the data to be loaded into another program such as Microsoft Excel or Access for manipulation by the user.

CBP reports will be customized to meet the requirements for each OWCP program. In addition to operational reports, the Contractor will develop performance reports that allow the Government to assess the Contractor’s performance against contract standards. The Contractor will provide consistent reporting on status and quality of operations and provide performance reports on all aspects of CBP operations. The Government will be notified in the event that operations are outside of DOL’s acceptable standards. Standardized (scheduled) reports will be distributed electronically in accordance with DOL’s reporting and security requirements for each program; on-demand reports will be available 24/7 to authorized users.

1.2 Management Reporting Business Process Description - DFEC

1.2.1 Management Reporting Tool

The Contractor will integrate the reporting tool () with other CBP components to provide robust reporting capabilities that allow for the generation of standardized, scheduled reports in addition to on-demand, ad-hoc reports. The reporting tool will enable user to perform queries and data analysis on bill processing and performance data. When reports are generated, they will be based on the most current CBP production data. For ad-hoc/on-demand reports data will be pulled in real-time from the production CBP system enabling users to view the most current, up-to-date information. Other reports are based on parameters such as date ranges, and will include a snapshot of data for that particular date range (e.g., DFEC Authorizations in ‘F’ (Further Review) status).

1.2.1.1 Tool Features/Capabilities

CBP reporting functions will be subject to role-based security. Both Government and Contractor staff will only have access to reports and report information for which they have been approved. If a user’s security profile allows access to reports and information only for their respective District Office, the user will not be able to generate reports for other District Offices.

In addition to providing standard reporting capabilities, such as allowing users to save and print reports, the reporting tool will provide data visualization tools that enable users to understand underlying data. The tool will give users many options in the presentation of report data, such as generation of various charts, including bar charts, pie charts, stacked charts, side-by-side charts, three dimensional graphs and other graphical formats.

The presentation of CBP report data will be easily customized by users. Users will have the ability to define formatting such as inclusion/exclusion of headers/footers, columns/rows, and segregation/aggregation of data. Users will be able to define criteria for reports and generate either summary or detail information at the program, region, District Office, case, claimant/provider level.

1.2.1.2 Types of Reports

In addition to report frequency (standard/scheduled vs. on-demand/ad-hoc), CBP will support two basic categories of reports: CBP operations reporting on bill processing statistics (e.g., authorization reports, eligibility error reports, interest rate summary report) and CBP performance reporting (e.g., prior authorizations processed report, bill resolutions statistical report card). System monitoring, program analysis, service utilization analysis, management queries and bill processing performance reports will be provided to assist DOL in gauging the status of CBP operations.

1.2.1.3 Report Distribution

Scheduled reports will be made available electronically via the CBP portal so that users will have on-demand access to those reports. Electronic distribution of scheduled reports will be made to authorized users according to the DOL’s frequency and security requirements.

1.2.1.4 Report Training

As part of the Contractor’s training curriculum, users will receive training on CBP report functionality and features. All report functionality will be documented in CBP training/user manuals and additional quick-reference or report aids will be provided to CBP users.

1.2.1.5 DFEC Reports

Appendix 9.2 includes the list of 57 DFEC reports, along with their type and frequency (standard, on-demand or both) and a list of data elements to be included on each report. This table also includes additional reports requested in the respective PWS requirement documents.

1.3 Management Reporting Business Process Flow – DFEC

Not Applicable.

2 Management Reporting Overview – DEEOIC

2.1 Management Reporting – DEEOIC

The CBP management reporting solution will support fast, accurate and flexible reporting of CBP data to enable Government personnel to monitor and control CBP operations. Reporting is an important component of the overall CBP, as the reports and underlying data allow the Government to assess processing volumesand the Contractor’s performance and operational efficiency.

CBP reports will be implemented using a reporting tool, a flexible web-based tool that is easily integrated with other CBP components and provides comprehensive reporting capabilities such as automated generation of scheduled reports and ad-hoc querying capabilities to generate on-demand reports. The reporting tool will provide users with the ability to generate various charts, including bar charts, pie charts and stacked charts. Authorized users will have the ability to define report format, such as inclusion/exclusion of headers, footers, columns/rows and data.

Reports will be available via the CBP portal, and upon operational cut-over the most recent seven years of historical data will be available via the reporting tool. Data older than 7 years will be made available, upon request, within two business days.

Standard and on-demand reports will be displayed in a drop-down menu format. Users will have the ability to filter the display of data, such as hide/display columns or only display user-defined data elements or ranges of values. Reports will be exported to other programs in numerous formats such as .pdf, .doc, .xls. Two export options will be available—export of content which enables the export of the report exactly as shown (screen shot format), or export of data which enables the data to be loaded into another program such as Microsoft Excel or Access for manipulation by the user.

CBP reports will be customized to meet the requirements for each OWCP program. In addition to operational reports, the Contractor will develope performance reports that allow the Government to assess the Contractor’s performance against contract standards. The Contractor will provide consistent reporting on status and quality of operations and provide performance reports on all aspects of CBP operations. The Government will be notified in the event that operations are outside of DOL’s acceptable standards. Standardized (scheduled) reports will be distributed electronically in accordance with DOL’s reporting and security requirements for each program; on-demand reports will be available 24/7 to authorized users.

2.2 Management Reporting Business Process Description - DEEOIC

2.2.1 Management Reporting Tool

The Contractor will integrate a reporting tool with other CBP components to provide robust reporting capabilities that allow for the generation of standardized, scheduled reports in addition to on-demand, ad-hoc reports. The reporting tool will enable users to perform queries and data analysis on bill processing and performance data. When reports are generated, they will be based on the most current CBP production data. For ad-hoc/on-demand reports data will be pulled in real-time from the production CBP system enabling users to view the most current, up-to-date information. Other reports will be based on parameters such as date ranges, and will include a snapshot of data for that particular date range.

2.2.1.1 Tool Features/Capabilities

CBP reporting functions will be subject to role-based security. Both Government and Contractor staff will only have access to reports and report information for which they have been approved. If a user’s security profile allows access to reports and information for their respective District Office, the user will not be able to generate reports for other District Offices.

In addition to providing standard reporting capabilities, such as allowing users to save and print reports, the reporting tool will provide data visualization tools that enable users to understand underlying data. The tool will give users many options in the presentation of report data, such as generation of various charts, including bar charts, pie charts, stacked charts, side-by-side charts, three dimensional graphs and other graphical formats.

The presentation of CBP report data will be easily customized by users. Users will have the ability to define formatting such as inclusion/exclusion of headers/footers, columns/rows, and segregation/aggregation of data. Users will be able to define criteria for reports and generate either summary or detail information at the program, region, District Office, case, claimant/provider level.

2.2.1.2 Types of Reports

In addition to report frequency (standard/scheduled vs. on-demand/ad-hoc), CBP will support two basic categories of reports: CBP operations reporting on bill processing statistics (e.g., authorization reports, eligibility error reports, interest rate summary report) and CBP performance reporting (e.g., prior authorizations processed report, bill resolutions statistical report card). System monitoring, program analysis, service utilization analysis, management queries and bill processing performance reports will be provided to assist DOL in gauging the status of CBP operations.

2.2.1.3 Report Distribution

Scheduled reports will be made available electronically via the CBP portal so that users will have on-demand access to those reports. Electronic distribution of scheduled reports will be made to authorized users according to the DOL’s frequency and security requirements.

2.2.1.4 Report Training

As part of the Contractor’s training curriculum, users will receive training on CBP report functionality and features. All report functionality will be documented in CBP training/user manuals and additional quick-reference or report aids will be provided to CBP users.

2.2.1.5 DEEOIC Reports

Appendix 9.3 includes the list of 53 DEEOIC reports, along with their type and frequency (standard, on-demand or both) and a list of data elements to be included on each report. This table also includes additional reports requested in the respective PWS requirement numbers.

2.3 Management Reporting Business Process Flow – DEEOIC

Not Applicable.

3 Management Reporting – DCMWC

3.1 Management Reporting – DCMWC

The CBP management reporting solution will support fast, accurate and flexible reporting of CBP data to enable Government personnel to monitor and control CBP operations. Reporting is an important component of the overall CBP, as the reports and underlying data will allow the Government to assess processing volumes, Contractor performance and operational efficiency.

CBP reports will be implemented using a reporting tool, a flexible web-based tool that is easily integrated with other CBP components and will provide comprehensive reporting capabilities such as automated generation of scheduled reports and ad-hoc querying capabilities to generate on-demand reports. The reporting tool tool will provide users with the ability to generate various charts, including bar charts, pie charts and stacked charts. Authorized users will have the ability to define report format, such as inclusion/exclusion of headers, footers, columns/rows and data.

Reports will be available via the CBP portal, and upon operational cut-over, the most recent seven years of historical data will be available via the reporting tool. Data older than 7 years will be made available, upon request, within two business days.

Standard and on-demand reports will be displayed in a drop-down menu format. Users will have the ability to filter the display of data, such as hide/display columns or only display user-defined data elements or ranges of values. Reportswill be exported to other programs in numerous formats such as .pdf, .doc, .xls. Two export options will be available—export of content which enables the export of the report exactly as shown (screen shot format), or export of data which enables the data to be loaded into another program such as Microsoft Excel or Access for manipulation by the user.

CBP reports will be customized to meet the requirements for each OWCP program. In addition to operational reports, the Contractor will develop performance reports that allow the Government to assess the Contractor’s performance against contract standards. The Contractor will provide consistent reporting on status and quality of operations and provide performance reports on all aspects of CBP operations. The Government will be notified in the event that operational metrics are outside of DOL’s acceptable standards. Standardized (scheduled) reports will be distributed electronically in accordance with DOL’s reporting and security requirements for each program; on-demand reports will be available 24/7 to authorized users.

3.2 Management Reporting Business Process Description - DCMWC

3.2.1 Management Reporting Tool

The Contractor will integrate a reporting tool with other CBP components to provide robust reporting capabilities that allow for the generation of standardized, scheduled reports in addition to on-demand, ad-hoc reports. The reporting tool will enable users to perform queries and data analysis on bill processing and performance data. When reports are generated, they will be based on the most current CBP production data. For ad-hoc/on-demand reports data will be pulled in real-time from the production CBP system enabling users to view the most current, up-to-date information. Other reports will be based on parameters such as date ranges, and will include a snapshot of data for that particular date range.

3.2.1.1 Tool Features/Capabilities

CBP reporting functions will be subject to role-based security. Both Government and Contractor staff will only have access to reports and report information for which they have been approved. If a user’s security profile allows access to reports and information for their respective District Office, the user will not be able to generate reports for other District Offices.

In addition to providing standard reporting capabilities, such as allowing users to save and print reports, the reporting tool will provide data visualization tools that enable users to understand the underlying data. The tool will give users many options in the presentation of report data, such as generation of various charts, including bar charts, pie charts, stacked charts, side-by-side charts, three dimensional graphs and other graphical formats.

The presentation of CBP report data will be easily customized by users. Users will have the ability to define formatting such as inclusion/exclusion of headers/footers, columns/rows, and segregation/aggregation of data. Users will be able to define criteria for reports and generate either summary or detail information at the program, region, District Office, case, claimant/provider level.

3.2.1.2 Types of Reports

In addition to report frequency (standard/scheduled vs. on-demand/ad-hoc), CBP will support two basic categories of reports: CBP operations reporting on bill processing statistics (e.g., authorization reports, eligibility error reports, interest rate summary report) and CBP performance reporting (e.g., prior authorizations processed report, bill resolutions statistical report card). System monitoring, program analysis, service utilization analysis, management queries and bill processing performance reports will be provided to assist DOL in gauging the status of CBP operations.

3.2.1.3 Report Distribution

Scheduled reports will be made available electronically via the CBP portal so that users will have on-demand access to those reports. Electronic distribution of scheduled reports will be made to authorized users according to the DOL’s frequency and security requirements.

3.2.1.4 Report Training

As part of the Contractor’s training curriculum, users will receive training on CBP report functionality and features. All report functionality will be documented in CBP training/user manuals and additional quick-reference or report aids will be provided to CBP users.

3.2.1.5 DCMWC Reports

Appendix 9.4 includes the list of 93 DCMWC reports, along with their type and frequency (standard, on-demand or both) and a list of data elements to be included on each report. This table also includes additional reports requested in the respective PWS requirement numbers.

3.3 Management Reporting Business Process Flow – DCMWC

Not Applicable.

4 Management Reporting Requirements

The following section documents the functional requirements and business rules needed to implement the requirements outlined in Section 25 – Management Reporting of the PWS. For requirements traceability purposes, IDs have been assigned to each functional requirement and business rule. The first two characters of each ID represent the related Program number, (B1 (Core/DFEC), B2 (DEEOIC), B3 (DCMWC), followed by PWS Section, followed by a 3 digit sequentially assigned number within each Build/PWS Section. The Program column indicates whether the requirement/rule is Core (i.e., applies to all programs) or if it is DFEC, DEEOIC, and/or DCMWC specific.

4.1 Functional Requirements

PWS

Req # Functional

Req ID

R0824

R0831

R0839

R0840

B2-25-BR001

B3-25-BR001 B1-25-BR002

Core

R0828

R0841

R0842

B2-25-BR001

B3-25-BR001

Core

R0830

R0834

R0835

R0836

R0837

R0838

R0829

R0832

R0834

R0836

R0826

R0827

R0833

R0825

R0844

4.2 Business Rules

· Should report information covering system monitoring, program analysis, service utilization analysis, management queries, and bill processing performance.

· Should provide consistent reporting on the status and quality of operations.

· Should record performance data in every area of operations.

· Should notify and report operations that are outside DOL acceptable standards of operation.

· Should provide DOL with the insight and transparency to measure Contractor’s performance against the performance standards set forth in the contract and enable the Contractor to make recommendations on Management Reporting improvements.

· Should have the capability to be requested through the report system, the version history of changes made in the dispositions, verbiage, processing instructions of the edits and audits, as well as the version histories for changes made to EOB messages.

Core

· Should allow authorized users to alter the presentation of report data by selecting user-defined criteria such as summary, detail, date ranges, program, region, District Office, case number, provider number, etc. The data warehouse stores all data that is used to generate reports. As a result, the data used to generate a specific report (s) will be made available as part of the ad-hoc functionality. DOL will use the ad-hoc functionality to create the specific reports they need for the time period needed, and for the data needed.

· Should allow for user-defined formatting of reports (e.g., headers, footers, columns, and rows, segregation/aggregation of data)

· Should provide the capability to generate bar charts, pie charts, stacked charts, side-by-side charts, three dimensional graphs, and other graphical presentation formats Core

· DOL and Contractor staff should only have access to the report information for which they are approved (e.g., a user from one program or District Office should not be able to access report data from another program or District Office).

· The ability to save and print reports should be subject to Federal and Department security policies.

· The ability to alter the presentation of report data by selecting user-defined criteria should only be available to authorized users.

Core

· Reports should be available for the most recent seven (7) years of historical data.

· Access to archive information older than seven (7) years should be made available within two days of DOL request.

· Standard reports should provide the information in a standard format as scheduled.

· On demand reports should provide the requester with the capability to create and identify specific information that they need for the report based on need through the report system.

· On demand and ad-hoc reports should provide authorized users the ability to request monthly, weekly, or quarterly periods, for specific provider (s), claimant (s), procedures, pay dates, date of services, or as a cumulationof these specifics.

Core

5 Management Reporting Supporting Functional Components

The following functional components serve as inputs or outputs to the Management Reporting process.

5.1 Initial Data Migration

The following table identifies the initial data migration required by the Management Reporting process. Specific details (i.e., file layout, business rules, etc.) of each data migration will be outlined under a separate document, Detailed Design Specifications. For requirements traceability purposes, Initial Data Migration IDs have been assigned to each Initial Data Migration requirement. The first two digits represent the PWS Section, followed by a system component identifier (IDM01=DFEC; IDM02=DEEOIC; IDM03=DCMWC; IDM99=Misc/Global), followed by a 3 digit sequentially assigned number within each PWS Section and system identifier.

Data Migration

ID

Source

System Target

System Description

5.2 Interfaces

The following table identifies the interfaces required by the Management Reporting process. Specific details (i.e., file layout, business rules, etc.) of each interface will be outlined under a separate document, Detailed Design Specifications. For requirements traceability purposes, Interface IDs have been assigned to each interface requirement. The first two digits represent the PWS Section, followed by a system component identifier (INTF01=DFEC; INTF02=DEEOIC; INTF03=DCMWC; INTF99=Misc/Global), followed by a 3 digit sequentially assigned number.

Future State Interface ID was updated in the table below after B1 RSD was baselined to include the ‘global’ numeric indicator.

Future State

Interface ID Source

System Target

System

5.3 Reports

The following table identifies the reports required by the Management Reporting process. Specific details (i.e., report templates, data elements, business rules, etc.) of each report will be outlined under a separate document, Detailed Design Specifications. For requirements traceability purposes, Report IDs have been assigned to each report requirement. The first two digits represent the PWS Section, followed by a system component identifier (RPT01=DFEC; RPT02=DEEOIC; RPT03=DCMWC; RPT99=Misc/Global), followed by a 3 digit sequentially assigned number within each PWS Section and system identifier.

Future State

Report ID Current State

Report ID

Refer to Appendices 7.2, 7.3, and 7.4

5.4 Letters

The following table identifies the letters required by the Management Reporting process. Specific details (e.g., letter templates, data elements, business rules, etc.) of each letter will be outlined under a separate document, Detailed Design Specifications. For requirements traceability purposes, Letter IDs have been assigned to each letter requirement. The first two digits represent the PWS Section, followed by a system component identifier (LTR01=DFEC; LTR02=DEEOIC; LTR03=DCMWC; LTR99=Misc/Global), followed by a 3 digit sequentially assigned number within each PWS Section and system identifier.

**NOTE: All Letters will be distributed electronically or through the Central Mailroom. Each respective letter will be listed in its respective RSD (e.g., DOL Prior Authorization Letter will be captured in the Authorization RSD).

Future State

Letter ID Current State

Letter ID

6 Constraints

6.1 Assumptions

· N/A

6.2 Dependencies

· N/A

6.3 Issues/Open Items

Section Issue/

Resolution

Resolved

7 Appendices

7.1 Terms & Definitions

Approved (A)

Pending (P)

Denied (D)

Further medical review (F)

Program administered by the Division of Coal Mine Workers’ Compensation (DCMWC) that provides compensation benefits to eligible coal miners and their families and medical benefits to eligible coal miners in the event of total disability or death due to pneumoconiosis. These benefits are financed through direct Federal appropriations, earmarked tax revenues, and legislatively mandated private sector liability insurance arrangements.

A medical bill processing operation that processes bills for three OWCP programs: FECA under DFEC; BLBA under DCMWC; EEOICPA under DEEOIC and using one centralized process, but with customized business rules for each program.

A United States federal agency under the Department of Health and Human Services that works to protect public health and safety by providing information to enhance health decisions, and it promotes health through partnerships with state health departments and other organizations. The CDC focus national attention on developing and applying disease prevention and control (especially infectious diseases and food borne pathogens and other microbial infections), environmental health, occupational safety and health, health promotion, injury prevention and education activities designed to improve the health of the people of the United States.

Codes defined by the AMA (American Medical Association)

Administers The Black Lung Benefits Act (BLBA) and provides compensation benefits to eligible coal miners and their families and medical benefits to eligible coal miners in the event of total disability or death due to pneumoconiosis. These benefits are financed through direct Federal appropriations, earmarked tax revenues, and legislatively mandated private sector liability insurance arrangements.

Provides benefits to employees or survivors of employees of the Department of Energy (DOE), its Contractors, and subcontractors, companies that provided beryllium to DOE and atomic weapons employers who suffer from a radiation-related cancer, beryllium-related disease, chronic silicosis, or exposures to other toxic substances resulting in occupational illnesses. The program also covers certain uranium workers who suffer from radiation-related illnesses as a result of their work in producing or testing nuclear weapons.

Act/program that provides wage replacement and medical benefits to civilian employees of the Federal Government who were injured at work and to certain designated groups.

Note: Based on the approach taken in identifying CBP Functional Requirements as requested by DOL, Functional Requirements, in the context of Section 4.1 of this document, cover both system and operational requirements.

Codes maintained by the AMA to identify procedures or services delivered by healthcare providers. It also includes codes for supplies, products, prosthetics, and ambulance services, etc.

A set of valid Procedure/Diagnosis codes defined by CMS (Center for Medicare & Medicaid Services).

Universal standard codes for pharmaceuticals used by humans.

Disability compensation programs, administered under the Department of Labor (DOL), which mitigate, through the provision of wage replacement and cash benefits, medical treatment, vocational rehabilitation, and other benefits, the financial burden on certain workers, or their dependents or survivors, resulting from work-related injury, disease, or death.

Codes used to identify facility charges such as operating room, private room, recovery room, inpatient or outpatient, supplies, and other charges.

7.2 DFEC Standard and On-Demand Reports

This list was obtained from the individual PWS Section RSDs, which was compiled from Action 824-b provided by DOL and the reports requested in the respective PWS requirement number indicated.

Future State

Report ID Current State

Report ID

Section 5 – Central Mailroom

Quarterly (On Demand) OWCP Provider Welcome Letter Mailing Report

Data Elements:

Provider Number

OWCP Program Enrollment ID

Provider Name

Date Welcome Letter Mailed

Provider Status (New Provider, Re-enrolled Provider)

Daily counts of all mail received for each program, broken down by PO Box as well as 3rd party courier.

Section 6 – DFEC Imaging

(On Demand)

Document Imaging (IFECs) Daily Summary

Data Elements:

Process Date

Decision Documents #

Fiscal Documents #

Forms Documents #

Incoming Correspondence#

Medical Documents #

Misc. Documents #

Nurse Documents #

Outgoing Correspondence #

Rehab Documents #

Prior Authorizations Documents #

Non-Scan Documents #

Multi-Documents #

Single Documents

On Demand) Document Imaging (IFECs XMIT) Monthly Summary Report

Data Elements:

File Name

Transmission Date

Document Count

Page Count

XMIT Time

Data Acknowledge (Y or N)

District Office ID

6-RPT01_003

Daily count of documents processed (DCN's), number of pages scanned, number of images and the number of images deleted

6-RPT01_004

Real-time batch status (Summary & Detail)

6-RPT01_005

Backlog/Reconciliation Report (Summary & Detail)

6-RPT01_006

Turnaround Report – Snapshot of batch status (Summary & Detail)

6-RPT01_007

Quality Report (Summary & Detail)

6-RPT01_008

Reject Report (Summary & Detail)

Section 7 - Claimant Bill Development

Summary & detail report of all returned bills by DOL program, the bill form, reason for return (RTC code) and count

Section 8 – Bill Scan/Data Entry

8-RPT01_001

Daily

Weekly

Monthly

PWS-08_R0346

Instances of forms field validation not satisfying Government validation criteria.

8-RPT01_002

Bill data entry accuracy report

Section 9 – Bill Processing

Data Elements:

District Office

Bill Type

Case Number

TCN

Provider Number

First Date of Service

Last Date of Service

Date Paid

Billed Amount

Paid Amount

Bill Status (Paid/Denied)

Bill Age

Data Elements:

District Office

Bill Type

Case Number

TCN

Provider Number

First Date of Service

Last Date of Service

Billed Amount

Allowed Amount

Bill Status (Suspended)

Bill Age

Current Location bill suspended

9-RPT01_003

Data Elements:

District Office

Bill Type

Case Number

TCN

Provider Number

First Date of Service

Last Date of Service

Date Paid

Billed Amount

Paid Amount

Bill Status (Paid/Denied)

Bill Age

9-RPT01_004

Data Elements:

District Office

Bill Type

Case Number

TCN

Provider Number

First Date of Service

Last Date of Service

Billed Amount

Allowed Amount

Bill Status (Suspended)

Bill Age

Current Location bill suspended

9-RPT01_005

Data Elements:

District Office

Bill Type

Case Number

TCN

Provider Number

First Date of Service

Last Date of Service

Date Paid

Billed Amount

Paid Amount

Bill Status (Paid/Denied)

Bill Age

9-RPT01_006

Data Elements:

District Office

Bill Type

Case Number

TCN

Provider Number

First Date of Service

Last Date of Service

Billed Amount

Allowed Amount

Bill Status (Suspended)

Bill Age

Current Location bill suspended

Data Elements:

Pay Center

Claimant Examiner (CE) ID

Current Suspense Location

TCN

Bill Type

Case Number

Provider Number

From Date of Service

To Date of Service

# of Days bill in current location

# of Bill Age Days

Suspended Bill Edits/Audits

9-RPT01_008

Procedure Code “FORGN”

Data Elements:

Provider # 609449700

Case Number

First Date of Service

Last Date of Service

Billed Amount (should equal amount paid by National Office; will represent the amount to be keyed by the Contractor as referenced on the History Bills) Paid Amount (should equal amount paid by National Office; will represent the amount to be keyed by the Contractor as referenced on the History Bills)

9-RPT01_009

Procedure Code “FORGN”

Data Elements:

Provider #999999991

Case Number

First Date of Service

Last Date of Service

Billed Amount (should equal amount paid by National Office; will represent the amount to be keyed by the Contractor as referenced on the History Bills) Paid Amount (should equal amount paid by National Office; will represent the amount to be keyed by the Contractor as referenced on the History Bills)

9-RPT01_010

Procedure Code “PANAM”

Data Elements:

Provider # (as referenced on the bill Block #33)

Case Number

First Date of Service

Last Date of Service

Billed Amount

Allowed Amount

Current Location bill suspended

9-RPT01_011

Weekly/

Monthly

(Standard) Adjudicated Panama Bills (Provider)

Procedure Code “PANAM”

Data Elements:

Provider # (as referenced on the bill Block #33)

Case Number

First Date of Service

Last Date of Service

Billed Amount

Paid Amount

Date Paid

9-RPT01_013

Weekly/

Monthly

(Standard) Paid Panama Bills (Claimant) History Only Procedure Code “PANAC”

Data Elements:

Provider # 999999991

Case Number

First Date of Service

Last Date of Service

Billed Amount (should equal amount paid by National Office; will represent the amount to be keyed by the Contractor as referenced on the History Bills) Paid Amount (should equal amount paid by National Office; will represent the amount to be keyed by the Contractor as referenced on the History Bills) Date Paid

9-RPT01_014

Weekly/

Monthly

(Standard) Adjudicated Special Payment Bills (Provider) History Only

Procedure Code “SPPAY”

Data Elements:

Provider # (as referenced on the bill Block #33)

Case Number

First Date of Service

Last Date of Service

Billed Amount (should equal amount paid by National Office; will represent the amount to be keyed by the Contractor as referenced on the History Bills) Paid Amount (should equal amount paid by National Office; will represent the amount to be keyed by the Contractor as referenced on the History Bills) Date Paid

Data Elements:

Case Number

TCN and Line Number

District Office

30-day Date Range (as entered by DOL representative by the DOL representative in District Office) Pay Center

Billed Diagnostic Procedure Code

Begin Date of Service

End Date of Service

Billed Amount

Payment Amount

9-RPT01_016

Monthly (Standard)

10th of every month Bill Support Statistical Report Card

Data Elements:

Number of Incoming Bills

Number of Adjudicated Bills

Number of Approved Bills

Total $ amount of approved charges

Total number of incoming bills denied

Total $ amount of denied charges

Total number of incoming bills in suspense

Top 5 edits suspended

Top 5 edits Denied

9-RPT01_017

Bill Processing Errors Audit Report

Report will include the identification of those caused by the Contractor, the Provider or DOL. The reason codes attached in the adjustment process will be the source of how the responsibility for the errors is classified.

Section 10 – Third Party Liability

10-RPT01_001

Data Elements:

District Office TPL Indicator – (Y) or (N) Date Indicator Turned On Date Indicator Turned Off Case Number Number of Bills Denied (While TPL Indicator = ‘Y’) Number of Bills Paid (While TPL Indicator = ‘N’) Total Amount of Denied Bills Total Amount of Paid Bills This report should provide data for only those claimants who were placed in a TPL status, as well as provide information of when the TPL was turned off by the District Office and based on the information delivered in the eligibility file update.

Section 11 – Prompt Pay

Data Elements:

TCN

Control Number

Case Number

Provider Number

First Date of Service

Last Date of Service

Procedure Code (COPTN)

Billed Amount

Paid Amount

Billed Date

Date Paid

Data Elements:

District Office

TCN

Member Case Number

Provider Number

Date of Service

Date PPA Bill Received

Bill Type PPA1/PPA2

Amount Billed

Returned Date

Bill Age

Quarterly (On Demand) DFEC Paid PPA Interest Rate Summary Report

Data Elements:

District Office

Bill Type (PPA1)

Case Number

Provider Number

D…