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.