1.0 Interconnectivity
Between The Contractor And Defense Health Agency-Great Lakes (DHA-GL)
(The SAS For Army, Air Force, Navy, Marine Corps, And Coast Guard)
1.1 Automated
Data Processing (ADP) Protocols
1.1.1 For those Government staff
who will remotely access the contractor’s system from the DHA-GL
location, the contractor shall provide access for entry and edit
of referrals into the contractor’s systems. The contractor shall
include a status code indicating that SAS review is required.
1.1.2 The contractor
shall submit a standard management report which provides the number
of deferred claims that SAS staff reviewed and processed during
each month. Details for reporting are identified in DD Form 1423,
Contract Data Requirements List (CDRL), located in Section J of
the applicable contract.
1.1.3 The contractor shall provide
the capability to edit the status and entry of a 16 digit disposition
code indicating if the referral was approved for civilian network
treatment (see
paragraph 1.2). This disposition code may
be used during the claims adjudication process.
1.1.4 The contractor
shall provide the logic to automatically approve the referral if
the SAS determination is not received within two work days of referral
entry.
1.1.5 The contractor shall provide the telecommunications,
hardware, and software necessary for data entry and report printing
from the SAS location. The contractor shall provide application
training and support to the SAS staff who utilize the contractor’s
referral system.
1.1.6 The contractor shall provide
a data dictionary of available data elements to be sent to the SAS
automated information system. The contractor shall send all care
referral records to the SAS in a tab delimited data flat file. The
method of transfer shall be File Transfer Protocol (FTP) or a secure, password-protected
e-mail attachment.
1.1.7 The contractor shall provide
the SAS with read-only access to their subcontractor’s claims history
database. The contractor shall provide the necessary training to
the SAS staff in order to access the claims history database.
1.2
SAS Referral
Data
1.2.1 The format of the referral number shall be
DMISYYJJJNNNS where:
1.2.1.1 DMIS =
the DMIS ID Code of the issuing facility (5203 = SAS);
1.2.1.2 YY =
the last two digits of the year in which the referral number was
issued;
1.2.1.3 JJJ = the Julian date on which
the referral number was issued;
1.2.1.4 NNN =
the Facility Sequence Number;
1.2.1.5 S =
Status (the type of provider)
• C = Civilian
Care (refer to
Chapter 16, Section 2, paragraph 5.3.1.2 for
referral requirements)
• M = Military
Care (medical Military Treatment Facility (MTF)/Enhanced Multi-Service Market
(eMSM) or clinic)
• V =
Department of Veterans Affairs (DVA)/Veterans
Health Administration (VHA) Care (DVA/VHA hospital
or medical facility)
• P = Care
rendered under the Department of Defense/Department of Veterans
Affairs (DoD/VA) Memorandum of Agreement (MOA) for “Referral of
Active Duty Military Personnel Who Sustain Spinal Cord Injury, Traumatic
Brain Injury, or Blindness to Veterans Affairs Medical Facilities
for Health Care and Rehabilitative Services” (refer to
Section 2, paragraph 3.1 for referral requirements).
1.2.2 The format
of the effective date is
YYYYMMDD where:
• YYYY =
the year in which the SAS referral is effective;
• MM =
the month in which the SAS referral is effective; and
• DD =
the day on which the SAS referral is effective. A retroactive authorization
is indicated by an effective date prior to the issue date.
1.2.3 The format
of the expiration date is
YYYYMMDD where:
• YYYY =
the year in which the SAS referral expires;
• MM =
the month in which the SAS referral expires; and
• DD =
the day on which the SAS referral expires.