WCMBP_Section_J_Attachment_29_-_Sample_Incumbent_Artifact_Matrix_AMD_5.xlsx
XLSX spreadsheet 93 KB Posted
- Attached to
- Solicitation Notice for Workers' Compensation Medical Bill Processing (WCMBP) Federal contract opportunity
- Solicitation number
- DOL141RP21903
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WCMBP_Section_J_Attachment_29_-_Sample_Incumbent_Artifacts
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Sheet1
| Type | Arti # | Name | Definition/ Description | Frequency | Data Source(s)? | Priority ("1" Most Important to "5" Least Important) | Date Needed by Vendor | Required Format | Required Media | Date Received |
| Incumbent Artifact | IA - 1 | Copies of Remittance Advices | A template and actual RA with data for each bill type and transaction type (i.e. adjustments, voids, etc…) | Initial delivery and then recurring as updates are made. | Incumbent | MS Word | CD | |||
| Incumbent Artifact | IA - 2 | Copies of all notices and bulletins | The most current set of notices and bulletins authored by both incumbent and DOL. This is information posted to the current website, distributed to the provider and claimant community. This will be an ongoing delivery as we get closer to Operations, to ensure we have the most current information to communicate to stakeholders. | Initial delivery and then recurring as notices and bulletins are updated, or new ones created. | Incumbent | MS Word, PDF | CD | |||
| Incumbent Artifact | IA - 3 | Outgoing contractor closeout plan | Initial delivery and then recurring as updates are made. | Incumbent | MS Word | CD | ||||
| Incumbent Artifact | IA - 4 | Medical Bill Operations Manuals to include, but not limited to: | Documents redacted as appropriate (e.g. screen shots, etc.) | Initial delivery and then recurring as updates are made. | Incumbent | MS Word | CD | |||
| Incumbent Artifact | IA - 4a | Bill Processing | Initial delivery and then recurring as updates are made. | Incumbent | MS Word | CD | ||||
| Incumbent Artifact | IA - 4b | Bill Resolution/Adjustment | Initial delivery and then recurring as updates are made. | Incumbent | MS Word | CD | ||||
| Incumbent Artifact | IA - 4c | Provider Enrollment | Initial delivery and then recurring as updates are made. | Incumbent | MS Word | CD | ||||
| Incumbent Artifact | IA - 4d | Authorization | Initial delivery and then recurring as updates are made. | Incumbent | MS Word | CD | ||||
| Incumbent Artifact | IA - 4e | Call Center | Initial delivery and then recurring as updates are made. | Incumbent | MS Word | CD | ||||
| Incumbent Artifact | IA - 4f | Mailroom | Current processing manuals and examples of the many forms received by the central mailroom (i.e. congressional or senate inquiry, letters from Congress/Senate responding to questions/complaints from claimants, direct deposit forms, checks, Federal Health Benefit Election form, Workers' Compensation Medical Report form, etc...) | Initial delivery and then recurring as updates are made. | Incumbent | MS Word | CD | |||
| Incumbent Artifact | IA - g | Pharmacy Point of Sale | Initial delivery and then recurring as updates are made. | Incumbent | MS Word | CD | ||||
| Incumbent Artifact | IA - 4h | EDI | Initial delivery and then recurring as updates are made. | Incumbent | MS Word | CD | ||||
| Incumbent Artifact | IA - 5 | Edits/Audits documentation to include, but not limited to: | Initial delivery and then recurring as updates are made. | Incumbent | ||||||
| Incumbent Artifact | IA - 5a | Exception Control file, listing all edits for all programs and their disposition status by bill type | Most current listing. This will be an ongoing delivery as we get closer to Operations. | Initial delivery and then recurring as updates are made. | Incumbent | MS Excel | CD | |||
| Incumbent Artifact | IA - 5b | Posting criteria for all edits and audits | Most current listing. This will be an ongoing delivery as we get closer to Operations. | Initial delivery and then recurring as updates are made. | Incumbent | MS Excel | CD | |||
| Incumbent Artifact | IA - 5c | List of all EOBs and message text and the association to their respective edit | Initial delivery and then recurring as updates are made. | Incumbent | MS Excel | CD | ||||
| Incumbent Artifact | IA - 6 | List of all providers on review, excluded, under investigation, etc. | Initial delivery and then recurring as updates are made. | Incumbent | ||||||
| Incumbent Artifact | IA - 7 | List of all claimants on review, and the supporting documentation as to why | Initial delivery and then recurring as updates are made. | DOL? | ||||||
| Incumbent Artifact | IA - 8 | Complete history of Data Files and format for Conversion to include, but not limited to: | Recurring - frequency to be further defined in the Data Migration Plan. | Incumbent | ||||||
| Incumbent Artifact | IA - 8a | Bill history to include all medical and pharmacy bills and related information | Incumbent | ASCII | ||||||
| Incumbent Artifact | IA - 8b | Provider files | Incumbent | ASCII | ||||||
| Incumbent Artifact | IA - 8c | Eligibility files | Incumbent | ASCII | ||||||
| Incumbent Artifact | IA - 8d | Authorization files | Incumbent | |||||||
| Incumbent Artifact | IA - 8e | Reference files to include: | Incumbent | |||||||
| Incumbent Artifact | IA - 8.e.1 | Procedure (containing HCPCS, CPT, Homegrown, RCC, ICD-9, ICD-10, Diagnosis, Surgical Codes, DRG | Incumbent | ASCII | ||||||
| Incumbent Artifact | IA - 8.e.2 | DCMWC I/O Logic tables for both Inpatient and Outpatient | Incumbent | |||||||
| Incumbent Artifact | IA - 8.e.3 | Utilization Review files | Incumbent | |||||||
| Incumbent Artifact | IA - 8f | Fee Schedule file | Incumbent | |||||||
| Incumbent Artifact | IA - 8g | Payment/Financial files to include: | Incumbent | |||||||
| Incumbent Artifact | IA - 8.g.1 | Recoupment files | Incumbent | |||||||
| Incumbent Artifact | IA - 8.g.2 | Liens and IRS Levies | Incumbent | |||||||
| Incumbent Artifact | IA - 8.g.3 | Credit balances | Incumbent | |||||||
| Incumbent Artifact | IA - 8.g.4 | Check/EFT files | Incumbent | |||||||
| Incumbent Artifact | IA - 8.g.5 | Accounts Receivable files | Incumbent | |||||||
| Incumbent Artifact | IA - 8.g.6 | Overpayment files | Incumbent | |||||||
| Incumbent Artifact | IA - 8h | Correspondence files | Incumbent | |||||||
| Incumbent Artifact | IA - 9 | File formats for all data files and interface files | Pre-extraction for now so we can begin data analysis and understand the structure. Will need a post extraction format for conversion purposes, which we will request at a later date. | Initial delivery and then recurring as updates are made. | Incumbent | MS Word | CD | |||
| Incumbent Artifact | IA - 10 | Name, telephone number, address, EIN of provider | All providers, active, inactive, excluded. (Master Provider File). | One time | Incumbent | MS Excel | CD | |||
| Incumbent Artifact | IA - 11 | Training manuals and materials | This will be an ongoing delivery as we get closer to Operations to make sure we have a smooth transition on training. | Initial delivery and then recurring as updates are made. | Incumbent | MS Word, MS PPT | CD | |||
| Incumbent Artifact | IA - 12 | List of all outstanding Change Requests | This is to request any new CRs from <date> forward. | Initial delivery and then recurring as updates are made. | Incumbent | MS Word or MS Excel | CD | |||
| Incumbent Artifact | IA - 13 | Copies of all CBP reports and letters | All report and letter templates, includeing examples of each. The timeframe for this request is <date> - <date>. | Initial delivery and then recurring as updates are made. | Incumbent | MS Word | CD | |||
| Incumbent Artifact | IA - 14 | Treatment Suites Source Code and Data | For the Treatment Suite Code, please check out the entire project as an eclipse project and put it in a zip file. For the Treatment Suites data, please create a fixed length flat file in ascii format, and provide the file format, so we can recognize the data elements. |
Regarding Treatment Suites, we have a few questions that need to be answered in order for us to ensure we line up the right software. If there is technical documentation for the application that addresses all of this, that would be great to have.
1. What is the application server and version (i.e. WebSphere, JBoss, WebLogic)?
2. Are there any specific property files for the application server?
3. What is the data access layer - IBATIS, Hibernate, JDBC)
4. What version of Struts (i.e. 1.1, 1.2)?
5. Is the application running on Unix or Windows?
6. Please provide a copy of the Build.xml file so we understand the build process Initial delivery and then recurring as updates are made. Incumbent For the Treatment Suite Code, please check out the entire project as an eclipse project and put it in a zip file. For the Treatment Suites data, please create a fixed length flat file in ascii format, and provide the file format, so we can recognize the data elements. CD
This is an example list
Sheet2
| Data Files |
| Bill History |
| Authorization |
| Eligibility |
| Provider |
| Reference (to include all service codes, edit files, exception control files, eob files) |
| Fee Schedule files |
| Utilization Review files |
Sheet3 image1.png image2.png
File details come from the government source that posted it. Updated .