Section_8_Bill_Scan_Data_Entry_Legacy_version_20140106.doc

Requirements Specification Document (LEGACY DRAFT)

Bill Scan - Data Entry (Section 8)

Central Bill Process

Bill Scan - Data Entry (PWS Section 8) Requirements Specification 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 Bill Scan – Data Entry – DFEC

81.1 Bill Scan – Data Entry Business Process Description - DFEC

81.1.1 Ensure that 98% of Scanned Images Are Not Identified as “Best Scan Possible”

81.1.2 Perform Required Validations

81.1.3 Identify and Return Deficient Bills

81.1.4 Assign Unique Identifier

81.1.5 Identify Bill Type

91.1.6 Transmit DFEC Attachment Images Submitted with Bills

91.1.7 RTP/RTC Bills Not Submitted on Approved Forms/Missing Required Data Elements

91.1.8 Foreign, Special Payment, and Panama Bills

91.1.9 Access Images and Display Claimant Number

91.1.10 Document Storage and Destruction

91.1.11 Create Bill Records/Capture Required Data Elements

111.2 Bill Scan – Data Entry Business Process Flows – DFEC

111.2.1

121.2.2 Non Bill/Correspondence Scan Flow

Bill Scan – Data Entry - DEEOIC

142.1 Bill Scan – Data Entry Business Process Description - DEEOIC

142.1.1

142.1.2

142.1.3

142.1.4

142.1.5

152.1.6 Transmit DEEOIC Attachment Images Submitted with Bills

152.1.7

172.1.8

172.1.9

172.1.10 Document Storage

172.1.11

182.2 Bill Scan – Data Entry Business Process Flows – DEEOIC

182.2.1

192.2.2

Bill Scan – Data Entry – DCMWC

213.1 Bill Scan – Data Entry Business Process Description - DCMWC

213.1.1

213.1.2

213.1.3

213.1.4

213.1.5

223.1.6 DCMWC Attachment Images with Bills

223.1.7

233.1.8

233.1.9

233.1.10 Document Storage and Destruction

233.1.11

253.2 Bill Scan – Data Entry Business Process Flows – DCMWC

253.2.1

263.2.2

Bill Scan – Data Entry Business Requirements

274.1 Functional Requirements

304.2 Business Rules

Bill Scan - Data Entry Supporting Functional Components

415.1 Initial Data Migration

415.2 Interfaces

425.3 Reports

425.4 Letters

Constraints

436.1 Assumptions

436.2 Dependencies

436.3 Issues/Open Items

Appendices

447.1 Terms & Definitions

467.2 CMS1500/OWCP1500 – Health Insurance Claim Form

467.2.1

597.3 UB04/UB92 – Uniform Billing Form

747.4 OWCP915 – Claimant Medical Reimbursement Form

777.5 OWCP915 – Claimant Drug/Pharmacy Reimbursement Form

797.6 OWCP957- Medical Travel Refund Request

867.7 ADA Dental Claim Form

957.8 NCPDP Universal Pharmacy Billing Form

987.9 NALC200 – Carrier Reimbursement Form

1017.10 Adjustment Request Form

1067.11 Foreign Bill & Special Payment Batch Header Sheets

1067.11.1 National Office Special Provider Payments

1077.11.2 National Office Claimant Foreign Bill Payments

1087.11.3 National Office Claimant Panama Bill Payments

1097.11.4 National Office Provider Foreign Bill Payments

1107.11.5 National Office Provider Panama Bill Payments

1 Bill Scan – Data Entry – DFEC

1.1 Bill Scan – Data Entry Business Process Description - DFEC

1.1.1 Ensure that 98% of Scanned Images Are Not Identified as “Best Scan Possible”

Both manual and automated processes are used to ensure that all images are usable for all downstream processing (manual and automated). The downstream processes are monitored for image related issues and any problems found are communicated back to the mailroom. All necessary steps are taken to ensure that images are of the best possible overall quality, including daily maintenance of the imaging equipment as well as periodic maintenance by trained factory technicians. Any bills or documents that are not of sufficient quality to provide a legible image are identified and returned to the submitter. Utilizing the techniques of individually adjusting the scan equipment and manually rescanning substandard images, as well as utilizing the RTP process for illegible documents as a last resort, ensures that 98% of all scanned images will not be categorized as "Best Scan Possible".

1.1.2 Perform Required Validations

All images must be accurate, viewable, and useful for automated processing. Quality control drives the ability to use automated software for data capture and document indexing. The following items are validated:

· The number of images matches the number of paper pages

· Images are properly rotated

· Blank pages are deleted

· The complete image is viewable, accurate, and legible

1.1.3 Identify and Return Deficient Bills

Using both manual and automated techniques, CBP will identify and return to the provider (RTP) or claimant (RTC) any bills or documents found to be illegible or not in condition to provide a useable image for downstream processing. CBP will use a government approved RTP/RTC letter with all required content.

1.1.4 Assign Unique Identifier

During the imaging process step, scanner operators using high-speed scanners will assign a Meta tag to each document and its attachments with a DCN. The DCN will be in a format acceptable to the Government but at a minimum will contain the date of receipt and unique identification number. Once scanned, the scanner places an imprint of the number on the back of the physical document as well as all of its attachments. The same number imprinted on the bill document is imprinted on all of its attachments, associating them as being part of that bill.

1.1.5 Identify Bill Type

All documents classified as bills will be assigned a bill type. Expected (but not limited to) bill types are OWCP/CMS 1500, OWCP/UB 04/UB92, OWCP 915/957, ADA Dental, NCPDP Pharmacy, NALC 200 Carrier Form and adjustments.

1.1.6 Transmit DFEC Attachment Images Submitted with Bills

All FECA bill documents and attachments will be routed to the appropriate workflow for data capture and bill processing activities. All DFEC correspondence submitted with a bill (medical records etc.) is processed as specified by DFEC requirements. At a high level, documents will be checked for presence and validity of an approved case number, routed to specified DO case numbers if unable to determine one, imaged, indexed(including but not limited to category and author date) and delivered to the appropriate DO for further processing within a monthly average of two business days. Image and index files will be compressed in a .zip file format prior to delivery. All bill documents and attachments will be routed to the appropriate workflow for processing. Authorizations will be imaged, indexed as category code "Medical and SOAF" with a subject code of "request for authorization", and also be routed to the appropriate capture workflow. Hardcopy documents will be stored for 90 days and then disposed of per Federal guidelines.

1.1.7 RTP/RTC Bills Not Submitted on Approved Forms/Missing Required Data Elements

Bills will typically be submitted on the following Government approved forms; CMS-1500, UB-04, UB-92, OWCP-915, OWCP-957, NCPDP Universal Billing Form, NALC-200 Carrier Reimbursement form, ADA Dental Form, and the Adjustment Request Form. All bills not submitted on a Government approved form will be returned to the provider (RTP) or Claimant (RTC). All bills or adjustment request that do not contain the required information as shown below will be returned to the Provider (RTP) and/or Claimant (RTC) based on submitted bill forms.

OWCP-1500

· Case Number missing/invalid or Case Number/name mismatch

· Signature or acceptable forms of a signature missing

· Diagnosis Codes Missing/Invalid

· Procedure Codes missing/invalid

· Missing Place of Service

· Line Item Charges missing/invalid

· Date of Service missing/invalid/or is a future date

· Missing Facility name/address

· No Active Provider Number on file or Provider number missing

· Physicians signature is missing

· Submitted provider number does not match tax id

UB-04/UB 92

· Case number missing/invalid or Case number/name mismatch

· Principle diagnosis code is missing/invalid

· Line Item Charges missing

· No Active Provider Number on file or Provider number missing

· Physicians signature is missing

· Type of bill missing/invalid

· Revenue Center Code (s) missing/invalid

· Medicare # missing for Provider type 01 on UB Bill Type 111

· Incorrect Form

· Submitted provider number does not match tax id

· Receipts/Proof of Payment Missing Pharmacy

· Case number missing/invalid or Case number/name mismatch

· Detail Line charges missing

· Date of Service missing/invalid or is a future date

· NCPDP missing/invalid

· Authorized pharmacy representative signature missing

· NDC missing

· Quantity missing

OWCP-957

· Case Number missing/invalid or Case Number/name mismatch

· Claimant Signature missing

· Travel Expense Missing

· Travel From/To Missing

· Date of Travel is missing

· Medical Facility/Pharmacy Address (missing in Block-E)

· Date Care Rendered (must be completed by physician) missing in block-H

· Physician Signature (missing in Block-H)

· ‘Treatment For’ or ‘Prompt Pay’ box must be checked (missing in Block-H)

OWCP-915 Medical

· Case Number missing/invalid or Case Number/name mismatch

· Claimant signature and date missing

· Procedure codes missing/invalid

· Amount Paid by the Claimant missing

· Date of Service missing

· Receipts/Proof of Payment missing

· Diagnosis missing OWCP-915 (Drug/Pharmacy)

· Case Number missing/invalid or Case Number/name mismatch

· Claimant signature and date missing

· Amount paid by the claimant missing

· Date of Service/Dispense date missing

· NDC Missing

· Drug Quantity missing

· Receipts/Proof of payment missing

· Prescription number missing

Dental

· Case Number missing/invalid or Case Number/name mismatch

· Procedure codes missing/invalid

· Line Item Charges missing

· Date of Service missing/invalid/or is a future date

· Provider Identification number is missing/invalid

· Physicians signature is missing

· Submitted provider number does not match tax id

Non Standard Document

· Incorrect Form

1.1.8 Foreign, Special Payment, and Panama Bills

All bills and their associated attachments identified as Foreign (bills with services provided in a foreign country), Special Payment, and Panama bills will be imaged and forwarded to the National Office for currency conversion and/or payment. With the exception of Panama bills submitted by Providers, the National Office will pay the Foreign Bills, Special Payment Bills, and Claimant Panama Bills via manual check processing. These bills are then sent back to Contractor mailroom by the Fiscal Operations National Office Unit with specific Batch Header Sheets that identifies each type of special bill and the appropriate method for scanning and keying. The National Office will indicate on the bill the amount paid via manual check for proper recording into the payment system. Along with specific procedure codes (SPPAY, FORGN, PANAM, and PANAC), specific categories will be also be used for these bills to make retrieval of the scanned documents easier. Panama bills submitted by Providers (PANAM) will be keyed in affect pay mode and paid as billed directly through the CBP system based on the provider number submitted on the applicable batch header sheet. Foreign (FORGN), Special Payment (SPPAY), and Claimant Panama (PANAC) bills will be keyed as ‘history only’.

1.1.9 Access Images and Display Claimant Number

The case number will be displayed in the non printable margin of the top right corner on the displayed bill and attachment images. Bill images and their associated attachments will be searchable based on case number, provider number, DCN, Unique Identifier (TCN), Dates of services, and payment date.

1.1.10 Document Storage and Destruction

All FECA hardcopy Bill documents will be stored in the secure central storage facility for a period of 90 days Hardcopy documents can be accessed during these retention periods upon request. After the designated retention period, disposal and destruction of all documents will be performed per Government policies utilizing its designated document recycler.

1.1.11 Create Bill Records/Capture Required Data Elements

Please refer to the following appendices regarding data capture requirements:

NOTE: Currently, there is no Prompt Pay specific DOL form. Instead, they are submitted as follows and identified by a stamp of “Prompt Pay”. PWS Section 11 RSD (see Appendix 7.3) provides the details of the Mailroom processing checklist for Prompt Pay.

(Provider) Original provider’s invoice or CMS1500/OWCP1500

(Claimant Medical Reimbursement)

OWCP915

1.2 Bill Scan – Data Entry Business Process Flows – DFEC

The following diagram captures the DFEC Bill Scan - Data Entry Business Process flow.

1.2.1 Bill Scan - Data Entry

1.2.2 Non Bill/Correspondence Scan Flow

2 Bill Scan – Data Entry - DEEOIC

2.1 Bill Scan – Data Entry Business Process Description - DEEOIC

2.1.1 Ensure that 98% of Scanned Images Are Not Identified as “Best Scan Possible”

Both manual and automated processes are used to ensure that all images are usable for all downstream processing (manual and automated). The downstream processes are monitored for image related issues and any problems found are communicated back to the mailroom. All necessary steps are taken to ensure that images are of the best possible overall quality, including daily maintenance of the imaging equipment as well as periodic maintenance by trained factory technicians. Any bills or documents that are not of sufficient quality to provide a legible image are identified and returned to the submitter. Utilizing the techniques of individually adjusting the scan equipment and manually rescanning substandard images, as well as utilizing the RTP process for illegible documents as a last resort, ensures that 98% of all scanned images will not be categorized as "Best Scan Possible".

2.1.2 Perform Required Validations

All images must be accurate, viewable, and useful for automated processing. Quality control drives the ability to use automated software for data capture and document indexing. The following items are validated:

· The number of images matches the number of paper pages

· Images are properly rotated

· Blank pages are deleted

· The complete image is viewable, accurate, and legible

2.1.3 Identify and Return Deficient Bills

Using both manual and automated techniques, CBP will identify and return to the provider (RTP) or claimant (RTC) any bills or documents found to be illegible or not in condition to provide a useable image for downstream processing. CBP will use a government approved RTP/RTC letter with all required content.

2.1.4 Assign Unique Identifier

During the imaging process step, scanner operators using high-speed scanners will assign a Meta tag to each document and its attachments with a DCN. The DCN will be in a format acceptable to the Government but at a minimum will contain the date of receipt and unique identification number. Once scanned, the scanner places an imprint of the number on the back of the physical document as well as all of its attachments. The same number imprinted on the bill document is imprinted on all of its attachments, associating them as being part of that bill.

2.1.5 Identify Bill Type

All documents classified as bills will be assigned a bill type. Expected (but not limited to) bill types are OWCP/CMS 1500, OWCP/UB 04/UB92, OWCP 915/957, ADA Dental, NCPDP Pharmacy, NALC 200 Carrier Form and adjustments.

DEEOIC Prompt Pay bills will be identified as PPA-1 and PPA-2. PPA bills that have a Homegrown grown PPA procedure code as listed in the PPA specifics document provided to Contractor will be billed on a HCFA-1500 and will have the PPA date located in block 11. These bills will be processed within 21 days of the PPA date. Prompt Pay Travel will be billed on an OWCP 957- completed by the District Office, signed, dated by the CE and marked Prompt Pay. Diagnostic services related to a second opinion, or referee or expert referral will be billed separately, and can be billed on a HCFA-1500 or UB-04 approved by the DO and marked Prompt Pay, signed and dated by the CE. PPA Travel bills and PPA diagnostic services must be processed 21 days of receipt in Contractor’s mailroom.

2.1.6 Transmit DEEOIC Attachment Images Submitted with Bills

All DEEOIC bill documents and attachments will be routed to the appropriate workflow for data capture and bill processing activities. Work queues with links to images associated with a given DCN (includes bill and all attachments) will be created for each District Office to facilitate document reviews. All DEEOIC correspondence submitted with a bill (medical records etc.) is processed as specified by DEEOIC requirements. At a high level, documents will first be checked for the presence and validity of an approved case number (SSN). If a valid case number is present, then documents will be imaged and indexed (including but not limited to category and author date) and then routed to the appropriate District Office within a monthly average of two business days. All bill documents and attachments will be routed to the appropriate workflow for processing. Authorizations will be imaged, indexed and routed to the appropriate capture workflow. Hardcopy documents will be stored for 2 years. After the two year retention period, DEEOIC hardcopy documents will be archived (boxed and shipped to FRC).

2.1.7 RTP/RTC Bills Not Submitted on Approved Forms/Missing Required Data Elements

Bills will typically be submitted on the following Government approved forms; CMS-1500, UB-04, UB-92, OWCP-915, OWCP-957, NCPDP Universal Billing Form, NALC-200 Carrier Reimbursement form, ADA Dental Form, and the Adjustment Request Form. All bills not submitted on a Government approved form will be returned to the provider (RTP) or Claimant (RTC). All bills or adjustment request that do not contain the required information as shown below will be returned to the Provider (RTP) and/or Claimant (RTC) based on submitted bill forms.

OWCP-1500

· Case Number missing/invalid or Case Number/name mismatch (should only be returned as RTC after the SSN lookup criteria has failed)

· Signature or acceptable forms of a signature missing

· Diagnosis Codes Missing/Invalid

· Procedure Codes missing/invalid

· Missing Place of Service

· Line Item Charges missing/invalid

· Date of Service missing/invalid/or is a future date

· Missing Facility name/address

· No Active Provider Number on file or Provider number missing

· Physicians signature is missing

· Submitted provider number does not match tax id

UB-04/UB 92

· Case number missing/invalid or Case number/name mismatch

· Principle diagnosis code is missing/invalid

· Line Item Charges missing

· No Active Provider Number on file or Provider number missing

· Physicians signature is missing

· Type of bill missing/invalid

· Revenue Center Code (s) missing/invalid

· Medicare # missing for Provider type 01 on UB Bill Type 111

· Incorrect Form

· Submitted provider number does not match tax id

· Receipts/Proof of Payment Missing (required only if the UB or 1500 is attached to the OWCP 915 for claimant reimbursement)

Pharmacy

· Case number missing/invalid or Case number/name mismatch

· Detail Line charges missing

· Date of Service missing/invalid or is a future date

· NCPDP missing/invalid

· Authorized pharmacy representative signature missing

· NDC missing

· Quantity missing

· Day Supply missing

OWCP-957

· Case Number missing/invalid or Case Number/name mismatch

· Claimant Signature missing

· Travel Expense Missing

· Travel From/To Missing

· Date of Travel is missing

· Medical Facility/Pharmacy Address (missing in Block-E)

· Date Care Rendered (must be completed by physician) missing in block-H

· Physician Signature (missing in Block-H)

· Diagnosis Code Missing

OWCP-915 Medical

· Case Number missing/invalid or Case Number/name mismatch should only be Returned as RTC after the SSN lookup criteria has failed)

· Claimant signature and date missing

· Procedure codes missing/invalid

· Amount Paid by the Claimant missing

· Date of Service missing

· Receipts/Proof of Payment missing

· Diagnosis missing OWCP-915 (Drug/Pharmacy)

· Case Number missing/invalid or Case Number/name mismatch

· Claimant signature and date missing

· Amount paid by the claimant missing

· Date of Service/Dispense date missing

· NDC Missing

· Drug Quantity missing

· Receipts/Proof of payment missing

· Prescription number missing

Dental

· Case Number missing/invalid or Case Number/name mismatch

· Procedure codes missing/invalid

· Line Item Charges missing

· Date of Service missing/invalid/or is a future date

· Provider Identification number is missing/invalid

· Physicians signature is missing

· Submitted provider number does not match tax id

Non Standard Document

· Incorrect Form

2.1.8 Foreign, Special Payment, and Panama Bills

All bills and their associated attachments identified as Foreign (bills with services provided in a foreign country), and Special Payment bills will be imaged and forwarded to the National Office for currency conversion and/or payment. The National Office will pay the Foreign Bills and Special Payment Bills via manual check processing. These bills are then sent back to Contractor mailroom by the National Office with specific Batch Header Sheets that identifies each type of special bill and the appropriate method for scanning and keying. The National Office will indicate on the bill the amount paid via manual check for proper recording into the payment system. Along with specific procedure codes (SPPAY, FORGN), specific categories will be also be used for these bills to make retrieval of the scanned documents easier. Foreign (FORGN) and Special Payment (SPPAY) bills will be keyed as ‘history only’.

2.1.9 Access Images and Display Claimant Number

The case number will be displayed in the non printable margin of the top right corner on the displayed bill and attachment images. Bill images and their associated attachments will be searchable based on case number, provider number, DCN, Unique Identifier (TCN), Dates of services, and payment date.

2.1.10 Document Storage

All DEEOIC hardcopy Bill documents will be stored in the secure central storage facility for a period of 2 years. Hardcopy documents can be accessed during these retention periods upon request. After the designated retention period, Contractor will transfer the documents to the Federal Records Center (FRC) for final storage.

2.1.11 Create Bill Records/Capture Required Data Elements

Please refer to the following appendices regarding data capture requirements:

NOTE: Currently, there is no Prompt Pay specific DOL form. Instead, they are submitted and identified by a stamp of “Prompt Pay”.

2.2 Bill Scan – Data Entry Business Process Flows – DEEOIC

2.2.1 Bill Scan - Data Entry

2.2.2 Non Bill/Correspondence Scan Flow

3 Bill Scan – Data Entry – DCMWC

3.1 Bill Scan – Data Entry Business Process Description - DCMWC

3.1.1 Ensure that 98% of Scanned Images Are Not Identified as “Best Scan Possible”

Both manual and automated processes are used to ensure that all images are usable for all downstream processing (manual and automated). The downstream processes are monitored for image related issues and any problems found are communicated back to the mailroom. All necessary steps are taken to ensure that images are of the best possible overall quality, including daily maintenance of the imaging equipment as well as periodic maintenance by trained factory technicians. Any bills or documents that are not of sufficient quality to provide a legible image are identified and returned to the submitter. Utilizing the techniques of individually adjusting the scan equipment and manually rescanning substandard images, as well as utilizing the RTP process for illegible documents as a last resort, ensures that 98% of all scanned images will not be categorized as "Best Scan Possible".

3.1.2 Perform Required Validations

All images must be accurate, viewable, and useful for automated processing. Quality control drives the ability to use automated software for data capture and document indexing. The following items are validated:

· The number of images matches the number of paper pages

· Images are properly rotated

· Blank pages are deleted

· The complete image is viewable, accurate, and legible

3.1.3 Identify and Return Deficient Bills

Using both manual and automated techniques, CBP will identify and return to the provider (RTP) or claimant (RTC) any bills or documents found to be illegible or not in condition to provide a useable image for downstream processing. CBP will use a government approved RTP/RTC letter with all required content.

3.1.4 Assign Unique Identifier

During the imaging process step, scanner operators using high-speed scanners will assign a Meta tag to each document and its attachments with a DCN. The DCN will be in a format acceptable to the Government but at a minimum will contain the date of receipt and unique identification number. Once scanned, the scanner places an imprint of the number on the back of the physical document as well as all of its attachments. The same number imprinted on the bill document is imprinted on all of its attachments, associating them as being part of that bill.

3.1.5 Identify Bill Type

All documents classified as bills will be assigned a bill type. Expected (but not limited to) bill types are OWCP/CMS 1500, OWCP/UB 04/UB92, OWCP 915/957, and NCPDP Pharmacy.

DCMWC Prompt Pay bills will be identified as PPA. PPA bills that have a determination PPA procedure code as listed in the PPA specifics document provided to Contractor will be billed on a HCFA-1500 and will have the PPA date located in block 11. These bills will be processed within 21 days of the PPA date. Prompt Pay Travel will be billed on an OWCP 957- completed by the District Office, signed, dated by the CE and marked Prompt Pay. PPA Travel bills must be processed 21 days of receipt in Contractor’s mailroom.

3.1.6 DCMWC Attachment Images with Bills

All DCMWC bill documents and attachments will be routed to the appropriate workflow for data capture and bill processing activities. Work queues with links to images associated with a given DCN (includes bill and all attachments) will be created for each District Office to facilitate document reviews. All DCMWC correspondence submitted with a bill (medical records etc.) is processed as specified by DCMWC requirements. Attachment images for DCMWC will not be queued for transmission to the Government as medical records to the District Office. The attachment images for DCMWC will remain with the submitted bills and stored in the image retrieval system. At a high level, documents will first be checked for the presence and validity of an approved case number (SSN). All bill documents and attachments will be routed to the appropriate workflow for processing. . Hardcopy documents will be stored for 90 days. After the 90-day retention period, DCMWC hardcopy documents will be destroyed per DOL policies utilizing its designated document recycler 3N Document Destruction, Inc.

3.1.7 RTP/RTC Bills Not Submitted on Approved Forms/Missing Required Data Elements

Bills will typically be submitted on the following Government approved forms; CMS-1500, UB-04, UB-92, OWCP-915, OWCP-957, and NCPDP Universal Billing Form. All non-PPA bills not submitted on a Government approved form will be returned to the provider (RTP) or Claimant (RTC). All bills or adjustment request that do not contain the required information as shown below will be returned to the Provider (RTP) and/or Claimant (RTC) based on submitted bill forms.

Claimant-submitted bills not received on Government-approved forms (OWCP 915 or 957), unless marked as Prompt Pay, will be returned as RTC. If claimants submit their charges on a HCFA-1500 or UB-04, the bills will be routed to the Bill Development workflow queue to be prepared for processing. The Bill Development analyst must look at the assignment locator to ensure it is properly filled out, and to verify who paid the bill. The analyst must also review all attachments to the bill to verify whether it is claimant- or provider-paid, and process accordingly.

OWCP-1500

· Signature or acceptable forms of a signature missing (Block 12/13)

· Diagnosis Codes Missing/Invalid (Block 21)

· Procedure Codes missing/invalid (Block 24D)

· Missing Place of Service (Block 24B)

· Line Item Charges missing/invalid (Block 24F)

· Date of Service missing/invalid/or is a future date (Block 24A)

· Diagnosis code pointer missing (Block 24E)

UB-04/UB 92

· Type of bill code missing (Block 4)

· Statement Covers Period (Block 6)

· Principle diagnosis code is missing/invalid or Diagnoses are handwritten (Block 67)

· Line Item Charges missing or invalid (Block 47)

· Admission date missing/invalid/future (Block 12)

· Revenue Center Code (s) missing/invalid (Block 42) Pharmacy

· NDC missing

· Quantity missing

· Prescription number missing

· Date of dispense missing

· Provider’s NABP number missing

· Amount billed missing

· Patient’s signature missing

OWCP-957

· Date travel missing (Block 5a, 6a)

· One-way/round trip missing (Block 5b, 6b)

· Travel From/To missing (Block 5c&d, 6c&d)

· No provider (5e, 6e)

· Mileage missing (Block 5g, 6g)

· Claimant Signature/Date missing (Block 7)

· Receipts/proof of payment missing (Block 5f, 6f)

· Physician signature missing (Block 5h, 6h)

· Date care rendered (Block 5h, 6h)

· Diagnosis code missing/invalid (Block 5h and 6h)

OWCP-915 Medical

· Amount paid by claimant missing

· Claimant signature/date missing

· Date(s) of service/purchase missing

· Receipts/proof of payment missing or information missing on receipts

· Prescription number missing

· Drug quantity missing

· 11 digit NDC number missing

Non Standard Document

· Incorrect Form

3.1.8 Foreign, Special Payment, and Panama Bills

All bills and their associated attachments identified as Foreign (bills with services provided in a foreign country), and Special Payment bills will be imaged and forwarded to the National Office for currency conversion and/or payment.

3.1.9 Access Images and Display Claimant Number

The case number will be displayed in the non printable margin of the top right corner on the displayed bill and attachment images. Bill images and their associated attachments will be searchable based on SSN, provider number, DCN, Unique Identifier (TCN), Dates of services, and payment date.

3.1.10 Document Storage and Destruction

All DCMWC hardcopy Bill documents will be stored in the secure central storage facility for a period of 90 days. Hardcopy documents can be accessed during these retention periods upon request. After the designated retention period, Contractor will dispose of and destroy all DCMWC hardcopy bill documents after this 90-day storage period per DOL policies utilizing its designated document recycler.

3.1.11 Create Bill Records/Capture Required Data Elements

Please refer to the following appendices regarding data capture requirements:

NOTE: Currently, there is no Prompt Pay specific DOL form. Instead, they are submitted and identified by a stamp of “Prompt Pay”.

3.2 Bill Scan – Data Entry Business Process Flows – DCMWC

3.2.1 Bill Scan - Data Entry

3.2.2 Non Bill/Correspondence Scan Flow

4 Bill Scan – Data Entry Business Requirements

The following section documents the functional requirements and business rules needed to implement the requirements outlined in Section 8 – Bill Scan/Data Entry 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 build 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.

1011-1012

4.1 Functional Requirements

PWS

Req # Functional

Req ID

R0314

R0315

R0316

R0317

R0318

R0341

R0347

R1010

R1011

R1012

R0015

B2-08-BR001

B3-08-BR001

B1-08-BR002

B2-08-BR002

B3-08-BR002

B1-08-BR003

B3-08-BR003

Core

R0319

R0320

R0322

R0323

R0324

B2-08-BR004

B3-08-BR004

Core

R0321

R0329

R0342

R0347

B1-08-BR005

Core

The Scan Control Number (SCN) is a unique number that identifies the imaged page. The scanner prints this number on the paper document for manual paper identification. The SCN is also stored with the image document for electronic identification and retrieval purposes. A unique SCN is printed on each page of multiple page documents. Duplicate SCN’s are not allowed.

The format of the SCN is as follows:

YYJJJ S EEEEE SSSSS

Where

· YYJJJ = Receipt date YY(year) and JJJ (Julian)

· SCANID = Unique number to identify the scanner the document was scanned on

· ENVELOPE ID = Count or ID maintained per Julian date count resets at a start of a Julian

· SSSSS = Sequence Number tracked in ScanSequence Table

The scanner assigns and imprints an SCN, which is unique for each piece of paper. The DCN is annotated later, and is the same for the document and all of its attachments. As a result, a bill will have one DCN/TCN, but could have multiple SCNs associated with it, depending on the number of individual pieces of paper that are part of that bill. The SCN is an internal identifier.

B1-08-BR006

B2-08-BR006

B3-08-BR006

Core

R0326

R0327

R0331

B2-08-BR007

B3-08-BR007

Core

R0328

R0329

R0335

R0336

R0345

B1-08-BR010

DFEC

R0328

R0329

R0335

R0336

R0345

B2-08-BR010

DEEOIC

R0328

R0329

R0335

R0336

R0345

B3-08-BR010

DCMWC

R0332

R0333

B2-08-BR011

B3-08-BR011

Core

R0334

R0340

R0341

R0343

R0344

R0346

B2-08-BR010

B3-08-BR010

B1-08-BR012

B3-08-BR012

B1-08-BR013

B1-08-BR014

B2-08-BR014

B3-08-BR014

Core

R0338

R0339

DFEC

R0338

R0339

DEEOIC

R0338

R0339

DCMWC

B2-08-BR001

B3-08-BR001

B1-08-BR003

B1-08-BR008

B2-08-BR008

B3-08-BR008

Core

4.2 Business Rules

· Documents stored as images should be viewable within 2 business days of receipt.

· 98% of scanned medical bills and iFECS images, as reported on a monthly basis, are not identified as “Best Scan Possible”.

· An accuracy level of 99.5 percent for bill data entry in key fields and 98 percent accuracy for all other fields should be maintained. Accuracy rates will be assessed based on random, daily sampling of at least 2 percent of the documents processed.

DFEC

B2-08-BR001

· Documents stored as images should be viewable within 2 business days of receipt.

· 98% of scanned medical bills as reported on a monthly basis are not identified as “Best Scan Possible”.

· An accuracy level of 99.5 percent for bill data entry in key fields and 98 percent accuracy for all other fields should be maintained. Accuracy rates will be assessed based on random, daily sampling of at least 2 percent of the documents processed.

DEEOIC

B3-08-BR001

· Documents stored as images should be viewable within 2 business days of receipt.

· 98% of scanned medical bills as reported on a monthly basis are not identified as “Best Scan Possible”.

· An accuracy level of 99.5 percent for bill data entry in key fields and 98 percent accuracy for all other fields should be maintained. Accuracy rates will be assessed based on random, daily sampling of at least 2 percent of the documents processed.

DCMWC

· List of DFEC required data elements provided by DOL should be captured using automated forms processing software. (See B1-08-BR013 for details)

DFEC

· List of DEEOIC required data elements provided by DOL should be captured using automated forms processing software. (See B1-08-BR013 for details)

DEEOIC

· List of DCMWC required data elements provided by DOL should be captured using automated forms processing software. (See B1-08-BR013 for details)

DCMWC

B1-08-BR003

· Envelopes returned by USPS should be processed as documents and both sides should be scanned if both sides have information.

Core

· Ensure 98% of scanned medical bills and iFECS images , as reported on a monthly basis, are not identified as “Best Scan Possible” through use of the following techniques:

· Individually adjust the scan equipment

· Manually re-scan substandard images, imaging errors, and documents with missing pages

· Use the RTP/RTC process for illegible documents

· Include a message indicating “Best Scan Possible” as an annotation in a notes field if an acceptable image quality cannot be obtained

DFEC

· Ensure 98% of scanned medical bills as reported on a monthly basis, are not identified as “Best Scan Possible” through use of the following techniques:

· Individually adjust the scan equipment

· Manually re-scan substandard images, imaging errors, and documents with missing pages

· Use the RTP/RTC process for illegible documents

· Include a message indicating “Best Scan Possible” as an annotation in a notes field if an acceptable image quality cannot be obtained

DEEOIC

· Ensure 98% of scanned medical bills as reported on a monthly basis, are not identified as “Best Scan Possible” through use of the following techniques:

· Individually adjust the scan equipment

· Manually re-scan substandard images, imaging errors, and documents with missing pages

· Use the RTP/RTC process for illegible documents

· Include a message indicating “Best Scan Possible” as an annotation in a notes field if an acceptable image quality cannot be obtained

DCMWC

· The number of image pages matches the number of paper pages.

· Images are properly rotated.

· Blank pages have been dropped.

· The complete image is viewable.

· The complete image is accurate and legible enough to be used for processing.

· Documents should be checked for presence and validity of an approved case number.

· Random sampling of at least 2% of documents processed should be taken and daily accuracy report provided.

Core

· Multi-page images should have the same identifier for all pages so as to associate the bill with all of its attachments.

· Identifiers on either side of the hardcopy page will be acceptable to DOL.

· Identifiers should not obscure any information on the page.

· See Section 6 (DFEC Imaging) Business Rule #B1-06-BR006 for additional rules on DCN (Document Control Number)

DFEC

· Multi-page images should have the same identifier for all pages so as to associate the bill with all of its attachments.

· Identifiers on either side of the hardcopy page will be acceptable to DOL.

· Identifiers should not obscure any information on the page.

DEEOIC

· Multi-page images should have the same identifier for all pages so as to associate the bill with all of its attachments.

· Identifiers on either side of the hardcopy page will be acceptable to DOL.

· Identifiers should not obscure any information on the page.

DCMWC

· CMS 1500/OWCP 1500

· UB04/UB92 Inpatient, Outpatient

· OWCP 915 Claimant Reimbursement (Medical)

· OWCP 915 Claimant Reimbursement (Drug/Pharmacy)

· OWCP 957 Travel Form

· ADA Dental Form

· NCPDP Universal Pharmacy Billing Form

· NALC 200 Carrier Reimbursement Form

· PPA (PPA2) Bills for Vocational Rehabilitation Testing, Home Modifications, School Tuition, etc.

· PPA1 (SECOP, CONSLT, IMPAR, NOSHO, etc)

· Adjustment Request Form NOTE#1: Currently, there is no specific form for PPA1 and PPA2. These may be submitted via 1500, 915 or invoice with stamp of “Prompt Pay”.

NOTE#2: The OWCP 915 will not be treated as a separate bill type. The contents of the 915 will take the form of one of the existing CBP bill types: Professional, Inpatient, Outpatient, Dental, Travel, Pharmacy, and Prompt Pay. The majority of the time, the 915 will be translated to a Professional or Pharmacy bill type.

DFEC

· CMS 1500/OWCP 1500

· UB04/UB92 Inpatient, Outpatient

· OWCP 915 Claimant Reimbursement (Medical)

· OWCP 915 Claimant Reimbursement (Drug/Pharmacy)

· OWCP 957 Travel Form

· ADA Dental Form

· NCPDP Universal Pharmacy Billing Form

· NALC 200 Carrier Reimbursement Form

· PPA2: Non-DMC (e.g., Impairment, Second Opinion, File Review)

· PPA1: DMC (e.g., Impairment, Second Opinion, File Review)

· Adjustment Request Form

NOTE#1: Currently, there is no specific form for PPA1 and PPA2. PPA2 are prompt pay bills that are non-interest bearing. PPA2 approved services will be billed on a HCFA, UB, OWCP 957 or OWCP 915.

NOTE#2: The OWCP 915 will not be treated as a separate bill type. The contents of the 915 will take the form of one of the existing CBP bill types: Professional, Inpatient, Outpatient, Dental, Travel, Pharmacy, and Prompt Pay. The majority of the time, the 915 will be translated to a Professional or Pharmacy bill type.

DEEOIC

· CMS 1500/OWCP 1500

· UB04/UB92 Inpatient, Outpatient

· OWCP 915 Claimant Reimbursement (Medical)

· OWCP 915 Claimant Reimbursement (Drug/Pharmacy)

· OWCP 957 Travel Form

· NCPDP Universal Pharmacy Billing Form

· PPA

NOTE#1: Currently, there is no specific form for PPA bills. PPA approved services will be billed on a HCFA, OWCP 957 or OWCP 915.

NOTE#2: The OWCP 915 will not be treated as a separate bill type. The contents of the 915 will take the form of one of the existing CBP bill types: Professional, Inpatient, Outpatient, Travel, Pharmacy, and Prompt Pay. The majority of the time, the 915 will be translated to a Professional or Pharmacy bill type.

DCMWC

· Documents with invalid or missing case number should be delivered to the appropriate DO for further processing within a monthly average of two business days.

· Image and index files should be compressed in a .zip file format prior to delivery.

· All DFEC bill documents and attachments should be routed to the appropriate workflow for data capture and bill processing activities.

· Authorizations should be imaged, indexed as category code "Medical and SOAF" with a subject code of "request for authorization", and also be routed to the appropriate capture workflow.

· All bill/adjustments images should be accessible by the Government at any time during or after the processing of the bill.

· Indexed data files should be provided to the DFEC according to Section 6: DFEC Document Imaging.

DFEC

· All DEEOIC bill documents and attachments should be routed to the appropriate workflow for data capture and bill processing activities.

· All bill/adjustments images should be accessible by the Government at any time during or after the processing of the bill.

DEEOIC

· Any documentation associated with an adjustment request gets scanned, and…