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.