RRB12R004 Exhibit1.pdf

Exhibit 1

Medical Exam and Consultative Opinion Ordering

The RRB contracts with two separate providers to: 1) schedule and provide results of medical exams ordered and 2) review the results of complex conditions to determine disability.

The following pages are provided to demonstrate to the proposer how the current FFS system accommodates medical exam and consultative opinion processing. Baseline FFS screens, modified screens showing the use of non-edited fields to store required data and 'keystroke emulation' screens depicting the actual view that staff uses when ordering and receiving are included. Payments are created by a nightly batch process after receivers are successfully accepted. The additional information required for 'ME' documents is passed to the medical exam vendor nightly to enable them to schedule exams and also provides data needed for various reports used to monitor the contract. The consultative opinions do not require additional data for the orders and no nightly file is created for that vendor. The opinion cost and all exam costs are defined in the vendor contracts by contract year and are updated in the RRB-created table each October 1st

The proposer is required to provide a solution that will allow staff, located both locally and in the field, to order/receive exams and opinions that are ordered for claimants and create the associated payments.

FFS BASELINE COMMODITY PURCHASE ORDER

FFS USER'S GUIDE - THE PURCHASING SUBSYSTEM

FFS RELEASE 52 (october, 7994)

COMMND: DOCID: PC ••

STATUS: BATID: SEC2:

COMMODITY PURCHASE ORDER DOCUMENT

PC DATE: ••••• , ACTION: • ACCTG PD:

VENDOR CODE: •••••••••• • TRANS TYPE: •• DOC TYPE:

NAME: •••••••••••••••••••••••••••••• DEL DATE:

ADDRESS: •••••••••••••••••••••••••••••• INSP/ACC DAYS:

••••••••••••••••• _............ NEG PYMT DAYS:

•••••••••••••••••••••••••••••• ENDING DATE:

CONTACT: •••••••••••••••••••••••••••••• END DATE DESC: ••••••••••••

COMMENTS: •••••••••••• NO OF OPTIONS: •• TEXT TYPE:

ALT PAYEE: ••••••••••• / ••••••••••••••••••••••••••••••

RCVR REQD: INV REQD: • BUYER: •• RELATED GBL: •••••••••••

BLANKET i: FOB: • SHIP VIA: ••••••• •.• •• • SHIP TO: ••••••••••••

PURCH METHOD: PRINT PO: • CONF ORDER: EFFECTIVE DATE: ••••••

RESP PERSON: WHOUSE CODE: •••• CONTRACT 11: .

DOC TOTAL: ••••••••••••••• ASSOC ORDER: •••••••••••••

BFYS: •••• FUND: •••••• REF REQ: INVITATION II: .. _ ..

DISCOUNT \: •••••. DISCOUNT DAYS:

DISCOUNT \: •••••• DISCOUNT DAYS:

DISCOUNT \: •••••• DISCOUNT DAYS:

COMMND: DOCID: PC ••

STATUS: BATID: • ••••• SEC2:

****************************** ACCOUNTING DATA ~**************.***************

REF BUDGET

LINE REF REQ .LN BFYS FUND ORG /SUB PROGRAM BOC/SUB RPTG

"Ai15UNT: I/D:. P/F: COST ORG/SUB: / •• JOBNb: DESCRIPTION: ••••••••••••••••••••.•••••••••

ASSOC ORDER: •• CLOSED BFYS: •• •• CLOSED FUND: .

****************************** COMMODITY DATA ••••••• *** ••••••••••••••••••••••

REF I I R P

LN REF REQ LN QTY D UNIT UNIT COST D C TOTAL COST F

COMMODITY ITEM: ••••••••••••• ~ ••• CATALOG II: ••••••.••••

DELIVERY BLDG/ROOM: •••• / •••••• TEXT TYPE:.. TEXT FLAG: •

DISC AMOUNT/PCT: / WAREHOUSE: ..

DESCRiPTION: ••••••••••••••••••••••••••••••••••••••••••••••••.•••••••••••

FFS BASELINE RECEIVER

FFS USER'S GUIDE - THE PURCHASING SUBSYSTEM

FFS RELEASE 52 (October, 7994)

COMMND: DOClO: RC •• STATUS: BATlO: •••••• SEc2:

H

RECEIVER DOCUMENT

RECEIPT DATE: •••• " ACCOUNTING PERIOD: •• •• BFY: •• •• ACTION: •

REF ORDER TRANS CODE/NUMBER: •• / ••••••••••• TRANS TYPE: ••

VENDOR CODE: •••••••••• • RECEIVED BY: ••••••••••••••••••••

NAME: ••••••••••••••••••••••••••••••

ADDRESS: ••••••••••••••••••••••••••••••

CARRIER CODE:

CARRIER NAME:

CARRIER NUMBER: I .... ., ..

CLEAR ALL: • DOCUMENT TOTAL: ••••••••••••••• COMMENTS: ••••••••••••

COMMND: DOCID: RC ••

STATUS": BATID: • ••••• SEc2:

************************ ACCOUNTING LINE DATA **************************

LINE NUMBER: ••• REF ACCOUNTING LINE NUMBER: TRANSACTION TYPE: ••

BUDGET FYS: •• •• FUND: BUDGET ORG/SUB: ••••••• /

PROGRAM: ••••••••• BOC/SUB: •••• / COST ORG/SUB: ••••••• /

JOB NUMBER: •••••••• RPTG CAT:

CLOSED BFYS: ., •• CLOSED FUND:

AMOUNT: .•••••••••••• ••• I/O: P/F:

OUTS REF AMT: ••••••••••••••• DESC: ••••••••••••••••••••••••••••••

************************ COMMODITY LINE DATA ***************************

LINE NO: ••• ORDER LINE: ••• PRIOR QTY NOT RECEIVED: •••••••.• P /F:

COMMODITY CODE: •••••••••••••• ••• QUANTITY RECEIVED: ••••••••• I/O:

SPECIAL COND: •• UNIT: •••• QUANTITY ACCEPTED: •••••••.• I/O:

CATALOG NUMBER: ••••••••••• LOC SEQ:. LOC NUMBER: •••••••••

DESCRIPTION: •••••••••••••••••••••••••••••• SHELF LIFE: •••••

FA NUMBER: ••••••••••••••• FA TYPE:

BETTERMENT NUMBER: •• TOTAL COST: •••••••••••••••

MEDICAL EXAM HEADER/LINE SCREENS

Modified FFS baseline commodity purchase order (PC) document

COMMND: DOClD: ME 1600 000111222AA OS/24/12 10:20:1

STATUS: SCHED BATID: SEC2:

MEDICAL EXAM ORDER

TYPE REQ: 01 ACTION: E

EE NAME: THURSTON / HOWELL

BENE NAME: LOVIE /HOWELL

REASON CD: 23

DESIG UNIT: DOMO

FO#: 111

AUTHORIZED ORDERER: PAT

TOTAL AMOUNT: 45.00 DEL DATE: 062212

COMMND: DOClD: ME 1600000111222AA OS/24/12 10:17:33

STATUS: SCHED BATID: SEC2: 001-001 OF 002

******************************** EXAM DATA *********************************

EXAM NUMBER: 016 EXAM AMOUNT: 45.00

DELETE EXAM IND:

'Sold' fields are entered.

MEDICAL EXAM HEADER/LINE SCREENS

COMMNO: DOCID: ME 1600 000111222AA OS/24/1210:20:1

STATUS: SCHED BATID: SEQ:

MEDICAL EXAM ORDER

TYPE REQ: 01 INVITATION # (01,02,03) ACTION: E

EE NAME: THURSTON I HOWEll CONTACT (split 11/19 of 30)

BENE NAME: LOVIE /HOWEU RELATED GLBL/COMMENTS

REASON CD: 23 CONTRACT NUMBER (numeric, if 2nd 1 or 2 - no bene name)

DESIG UNIT: DOMO END DATE DESC (BDMO, BHA, BUSI)

FO#: 111 SHIP TO (valid on 'SHIP' table)

AUTHORIZED ORDERER: PAT RESP PERSON (required)

TOTAL AMOUNT: 45.00 DEL DATE: 0622 12 TYPE REQ 01 = 29 days TYPE REQ 02 = 36 days ship-addr-code:-vla defaulted In COBOL editor (copy of FFS ssor). Delivery date is calculated and cannot be entered.

COMMND: DOClD: ME 1600000111222AA OS/24/12 10:17:33

STATUS: SCHED BATID: SEC2: 001-001 OF 002

******************************** E~DATA *****************************.***

EXAM NUMBER: 016 LINE NUMBER EXAM AMOUNT: 45.00 LINE AMOUNT

able

ACTION: A TABLEID: PTEX USERID: GEND

PURCHASING TEXT DATA ENTRY TABLE

KEY IS PO 10, COMM LINE, TEXT LINE

PO 10: ME 000111222AA COMM UNE: 000

TEXT

TEXT LINE

01- 312-555-3333 0010

02- street address 0015

03- city 0020

04- st zip 0025

05- J DEPP; G CLOONEY (prevIous doctors) 0030 06- complaint (i.e., back prob) 0035

07- complaint line 2 if needed 0040

08- AARON BOWLING 0045

09 0050

10- 008=99/99/99 0055

ACTION: R TABLEID: MEXC USERID: GEND

MEDICAL EXAM COST REFERENCE TABLE

KEY IS MEDICAL EXAM NUMBER

NUMBER EXAM COST DESCRIPTION

000 25.00 CONSULTING OPINION

001 3.00 DERMATOLOGIST EXAMINATION

003 21.00 OTOLARYNGOLOGY (EAR EXAM)

005 23.00 OTOLARYNGOLOGY (EAR/CALORIC)

007 16.00 OPTHALMOLOGY (EYE EXAM)

011 6.00 I.Q. EXAM

012 10.00 NEUROLOGIST EXAMINATION

013 4.00 PSYCHIATRIC EXAM

cr.

Consulting Opinion cost is stored as number 000).

ABBREVIATED NIGHTLY FILE EXAMPLE:

"000111222AA"," 120525","PAT ","BOMO ","LOVIE ","HOWELL ","street address ","city ","st","zip ","312-555-3333 "," " " ","FO ","01 ","23","COMPLAINT

","J DEPP, G CLOONEY ","016","020"," "," "," ","DOB=99/99/99

MEDICAL EXAM RECEIVER HEADER/LINES

Modified FFS baseline Receiver (RC) document

COMMND: DOClD: RM 2500 0OOl11222AA OS/24/12 12:43

STATUS: SCHED BATID: SEC2:

MEDICAL PAYMENT

DATE RECEIVED: 052112

DATE ACCEPTED: 052312

REF ORDER TRANS CODE/NUMBER: ME / 000lU222AA ACTION: E

PAYMENT AUTHORIZED BY: PAT

CLEAR ALL: DOCUMENT TOTAl: 45.00

COMMND: DOCID: RM 2500000111222AA OS/24/12 12:47:19

STATUS: SCHED BATID: SEC2: 001-001 OF 001

************************ EXAM PAYMENT **************************

EXAM NUMBER: 016 COST: 45.00

DELETE RECEIVER IND:

VALUE CODE: AX

B01 ',,; e en ~ ed

MEDICAL EXAM RECEIVER HEADER/LINES

COMMND: DOClD: RM 2500 000111222AA OS/24/12 12:43

STATUS: SCHEU BATI0: SEC2:

MEDICAL PAYMENT

DATE RECEIVED: 052112 RECEIVED BY (positions 15-20)

DATE ACCEPTED: 052312 RECEIVED BY (positions 9-14)

REF ORDER TRANS CODE/NUMBER: ME / 000111222AA ACTION: E

PAYMENT AUTHORIZED BY: PAT RECEIVED BY (positions 1-8)

CLEAR ALL: DOCUMENT TOTAL: 45.00

COMMND: DOCID: RM 2500 000111222AA OS/24/12 12:47:39

STATUS: SCHED BAnD: SEC2: 001-001 OF 001

************************ EXAM PAYMENT ******.*******************

EXAM NUMBER: 016 LINE NUMBER COST: 45.00 LINE AMOUNT

DElETE RECEIVER IND:

l VALUE CODE:

CONSULTING OPINION SCREEN

COMMND:

STATUS: SCHED

H-

DOClD: CO 2500 000111222AA

BATID: SEQ:

CONSULTANT OPINION

OS/24/12 13:00:13

001-001 OF 001

DATE DUE: 060112 MODIFY/CANCEL: E

TYPE REQ: 01

OPINION TYPE: P

EXAMINER NAME: PAT

DOCUMENT TOTAL: 25.00

LINE NO: 001

Id'items

COMMND:

STATUS: SCHED

H-

DOClD: CO 2500 0OOl11222AA

BATIO: SEC2:

CONSULTANT OPINION

OS/24/1213:00:13

001-001 OF 001

DATE DUE: 060112 MODIFY/CANCEl: E

TYPE REQ: 01 INVITATION NUMBER (01,02)

OPINION TYPE: P CONTRACT NUMBER (P, M, B)

EXAMINER NAME: PAT RESP PERSON (required)

DOCUMENT TOTAL: 25.00

CONSULTING OPINION RECEIVER SCREEN

COMMND: DOClD: MR 2500 OOOll1222AA OS/24/12 13:20:19

STATUS: SCHED BAnD: SEQ: 001-001 OF 001

CONSULTANT OPINION RECEIVER

DATE RECEIVED: 0522 U

DATE ACCEPTED: 0524 12 MODIFY/CANCEL: E

PAYMENT AUTHORIZED BY: PAT DOCUMENT TOTAL: 25.00

VALUE CODE: IG

'Bold' items are entered

COMMND: DOClD: MR 2500000111222AA OS/24/12 13:20:19

STATUS: SCHED BATID: SEQ: 001-001 OF 001

CONSULTANT OPINION RECEIVER

DATE RECEIVED: 052212 RECEIVED BY (positions 1-8)

DATE ACCEPTED: 052412 RECEIVED BY (positions 15-20) MODIFY/CANCEL: E

PAYMENT AUTHORIZED BY: PAT RECEIVED BY (positions 9-14) DOCUMENT TOTAl: 25.00 e accounting trans esday, Oct 18, 2011 09:51 AM esday, Oc118, 2011 09:51 AM

I,Oc118,2011 09:54AM sday, Oct 18, 2011 09:55 AM