1.0 Interconnectivity Between The
Contractor And Defense Health Agency-Great Lakes (DHA-GL) (The SAS
For Army, Air Force, Navy, Marine Corps,
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 contractor
shall use File Transfer Protocol (FTP) or a secure,
password-protected email 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
contractor
shall use DMISYYJJJNNNS for
the referral number format 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 (Market/Military Treatment
Facility (MTF)
• 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.