Full_Reqs_Rpt

Document Sample
Full_Reqs_Rpt Powered By Docstoc
					Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
                                                                       Page i
_____________________________________________________________________________


TO:          Host sites, STC Beta site, SSMs, and CMS
FROM:        Christopher Sheridan
DATE:        June 28, 2007
SUBJECT:     R2007400 Full Requirements Document

The following release document is being transmitted today, Thursday, June 28,
2007, via NDM.

Important Notes:

           1. This document contains 21 CRs, 10 of them are Group 1, and the
              other 11 are Group 2 CRs. Included among the 21 CRs are three
              Research-Only CRs.

           2. The following CR has not completed a Requirements Walkthrough
              Meeting and while the requirements are felt to be complete, they
              are subject to further changes:

              00025545 5636 OCTOBER QUARTERLY UPDATE TO 2007 SNF CB.

           3. The following CR completed its Requirements Walkthrough Meeting,
              however, CMS has requested to stop development until they provide
              further direction.

              00025382 5490 - NEW NUMBER SERIES AND STATE CODES

           4. The CRs listed in Section II represent Research-Only efforts.
              There are no software deliverables for the October release with
              these CRs.

           5. Written comments/questions are due back to CMS and the CWF
              Maintainer (CSC), via e-mail, no later than 07/05/2007. Responses
              to those comments/questions will be returned to the CWF Community
              no later than 07/12/2007. As long as they are received by the
              appropriate date, any changes prompted by the responses will be
              incorporated, as needed, into the Pre-Release document, which will
              be transmitted on 07/17/2007 in preparation for the Pre-Release
              Conference call scheduled for 07/25/2007.

              Comments/Questions should be sent to the following email addresses:

              cpowel26@csc.com, vvuyyuru@csc.com, dkocovin@csc.com,
              kallen1@cms.hhs.gov, kwoytan@cms.hhs.gov, wolfsheimer@cms.hhs.gov,
              Vivian.Rogers@cms.hhs.gov and cpflaum@cms.hhs.gov.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
                                                                      Page ii
_____________________________________________________________________________


If you have any questions regarding this Release, please contact the Release
Coordinators, Chet Powell at (443) 436-6734 (primary contact) or Vinay Vuyyuru
at (443) 436-6719 (secondary contact).

Thank you.

This document includes:

I.   CHANGE REQUESTS ........................................................1

      1.     00025425   SATELLITE HICR AUDIT REPORT REQUIRES UPDATES.............1

      2.     00025364   5454-METHOD OF PAYMENT FOR EXTENDED STAY SERVICES UNDER
                         DEMO ..................................................10

      3.     00025374   EDIT HIC NUMBERS IN THE BATCH BUILDER...................18

      4.     00025382   5490 - NEW NUMBER SERIES AND STATE CODES................25

      5.     00025393   REQUESTING MODIFICATION TO EDIT 5608 TO ALLOW LOA CLAIM.40

      6.     00025402   AUTO ADJUST INDICATOR NOT IN HISTORY....................48

      7.     00025408   MODIFY A/B EDIT 7244 TO NOT READ HISTORY FOR TOB 21X....53

      8.     00025448   UPDATE CONTRACTOR NAME ON CONTR FOR MULTIPLE CONTRACTORS59

      9.     00025471   NPI PROJECT SUPPORT FOR THE OCTOBER 2007 RELEASE........65

      10. 00025472      5569-MODIFICATIONS TO NATIONAL COBA PROCESS.............70

      11. 00025478      ARCHIVE MAINTENANCE FOR RELEASE R2007400................88

      12. 00025479      R2007400 INSTALLATION INSTRUCTION - ONE-TIMER CONTROL CR98

      13. 00025480      EXTERNAL COPYBOOK CHANGES FOR R2007400.................104

      14. 00025481      DOCUMENTATION CHANGES FOR RELEASE R2007400.............109

      15. 00025484      5589-NEW CONTRACTOR NUMBER FOR JURISDICTION 3 ARIZONA PT A
                          .....................................................116

      16. 00025498      5601-TRANSITION MEDIGAP (CLAIM-BASED) PROCESS TO COBC..124


______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
                                                                     Page iii
_____________________________________________________________________________


      17. 00025534    MODIFY EDIT 6020 FOR PART B TO NO LONGER APPLY PT/OT LOGIC
                        .....................................................139

      18. 00025545    5636 OCTOBER QUARTERLY UPDATE TO 2007 SNF CB...........148

II.   ANALYSIS CHANGE REQUESTS .............................................159

      1.   00025378   5499-PRESENT ON ADMISSION INDICATOR SYSTEMS ANALYSIS...159

      2.   00025443   5561-CASE MIX REFINEMENT FOR HH PPS (ANALYSIS ONLY)....170

      3.   00025521   5611-CWF IUR ANALYSIS ONLY.............................180




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                        Page 1
____________________________________________________________________________


I.         CHANGE REQUESTS

      1.     00025425   SATELLITE HICR AUDIT REPORT REQUIRES UPDATES

     DATE ENTERED:      02/27/07

     TITLE:             SATELLITE HICR AUDIT REPORT REQUIRES UPDATES

     PROJECT CODE:      CM01

     PRIORITY:          2

     RELEASE LEVEL: R2007400

     GROUP LEVEL:       2

     HOST SITE ID:      CWFM2000

     STATUS ON CR:      WORK

     DOC. REQUIRED: N

     HOST EVAL:         N/A

     DOC RECEIVED:      N

     ADDENDUM INFO: NONE

     EST. CATEGORY:     3
     EST. HOURS:        0300
     ACT. HOURS:        0136
     CAT/CR EVAL:       N

     COMMENT:           N/A

     DESCRIPTION:
     ------------
     Issue is with the formatting of the report. The PRIOR
     and AFTER columns for the HICR transaction data are
     being displayed above the report heading and satellite
     number and address for all transactions that get populated
     to the report.


  This issue is not related to the plog 25270. This is an issue
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                        Page 2
____________________________________________________________________________

  with the Satellite HICR Audit report on all transactions and we
  will research this and assign it a CR number and let you know
  what the number is after we identify the problem.
  Thanks,
  Meredith


  Plog 25270 was to address some HICR reporting issues but we
  are still seeing some problems. I have ndm'd
  CWM.TEST.NDM.KS.REQRPT.DT022607 to CSC. In this file it can be
  seen that the 'PRIOR     AFTER' column heading line is not in
  the proper location. Also it appears that the 'action code:'
  value has not been initialized (it has a portion of the city from
  the prior line).

  Thanks,
  Greg Cenova
  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:          25425____________    WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                 _X_   Minor
  FUNCTION:    _________________                 ___   Major
  PROGRAM:     _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Rick Wolfsheimer
      Telephone:           410-786-6160
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Meredith Revier
      Telephone:           469-372-1022
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Gopal Kumar
       Telephone:          443-436-6733
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                        Page 3
____________________________________________________________________________


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  ( ) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  CWF must fix the formatting of the HICR Satellite Audit
  report for the HICR transactions displayed on this report.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                        Page 4
____________________________________________________________________________

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  CWF must make format changes to the HICR Satellite Audit report
  to display the data on the report correctly. The following is a
  list of formatting issues we have found on this report:

  1. Currently the Prior and After column headings are being displayed
     before the report heading, Satellite number and Satellite address.
     This formatting issue applies to all HICR transactions
     generated on the report.

  The following is how the report is currently displaying the
  column headings incorrectly:

           PRIOR                               AFTER
    S A T E L L I T E   H I C R    A U D I T   R E P O R T
    F O R W A R D   T O   S A T E L L I T E:   00900
  TRAILBLAZER HEALTH ENTERPRISES, LLC
  LBJ FREEWAY ATTN: JO BROOKS
  EXECUTIVE CENTER III
  DALLLAS                     TX 75243-1765
  CODE:     2
           247511108A
           R2003.3-HCBC
           00                                  00
           00                                  00
           2002327                             2002327
           2002327                             2002327
           0000000                             2003112
           00000140.00                         00000140.00

  2. On the HCHA transaction data the ACTION CODE field is being
     displayed as part of the CITY name in the address when the
     city name is more than 6 bytes long.


  REPORT DATE: 05/15/2007          S A T E L L I T E   H I C R   A U
     USERID: 0000001               F O R W A R D   T O   S A T E L L
     DATE/TIME: 03113150310
     TRANSID: HCHA          BLUE CROSS AND BLUE SHIELD OF UTAH
     HIC NUMBER: 247511124A    P.O. BOX 30270
                               SALT LAKE CITY            UT 84130-
       HH HISTORY REC - ACTION CODE:AKE C2 <======
       INTERMEDIARY NUMBER                00410
       PROVIDER NUMBER                    457057
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                        Page 5
____________________________________________________________________________

       FIRST SERVICE DATE                 2001023

  * Note: Action code '2' is mixed up with a part of city name
    (HH HISTORY REC - ACTION CODE:AKE C2). This is happening
    only when city name is more than 6 bytes length.

  3. The Satellite address needs to be formatted correctly. Currently
     it is intertwined with the DATE/TIME on the transaction.
     This format change applies to all HICR transactions generated
     on this report.

  REPORT DATE: 05/15/2007          S A T E L L I T E    H I C R   A U
     USERID: 0000001               F O R W A R D    T O   S A T E L L
     DATE/TIME: 03112162858TRAILBLAZER HEALTH ENTERPRISES, LLC
     TRANSID: HCBC          8330 LBJ FREEWAY ATTN: JO BROOKS
     HIC NUMBER: 247511108A    EXECUTIVE CENTER III
                               DALLAS                     TX 75243-17
       PTB SUMMARY REC - ACTION CODE:     2


  4. CWF must make corrections to the report heading. Currently
     it is displaying twice for every HICR transaction. This
     formatting change applies to all HICR transactions
     generated on this report.

  REPORT DATE: 05/15/2007                       H I C R   A U D I T
     USERID: 0000001
     DATE/TIME: 03112162858
     TRANSID: HCBC
     HIC NUMBER: 247511108A
                                          PRIOR
  REPORT DATE: 05/15/2007          S A T E L L I T E    H I C R   A U
     USERID: 0000001               F O R W A R D    T O   S A T E L L
     DATE/TIME: 03112162858TRAILBLAZER HEALTH ENTERPRISES, LLC
     TRANSID: HCBC          8330 LBJ FREEWAY ATTN: JO BROOKS
     HIC NUMBER: 247511108A    EXECUTIVE CENTER III
                               DALLAS                     TX 75243-17


  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                        Page 6
____________________________________________________________________________

  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  Generate the HICR Satellite Audit report.

  Response
  Verify the column headings for PRIOR and AFTER transaction
  data are now located above the actual HICR transaction data
  and not above the report heading, Satellite number and address.

  Event 1.2
  Generate the HICR Satellite Audit report.

  Response
  Verify the Action code field is correctly displaying with the
  data from the HICR HCHA transaction and is no longer a part of
  the Satellite address city name when the name is more than
  6 bytes long.

  Event 1.3
  Generate the HICR Satellite Audit report.

  Response
  Verify Satellite address is now listed separately from the
  DATE/TIME field on the report.

  Event 1.4
  Generate the HICR Satellite Audit report.

  Response
  Verify the report heading is only listed once for the HICR
  transactions listed on the report.


  ***.......This is the width of the Release Document.......***

  The Entity List includes only NEW acronyms and terminology
  that is currently not in use in CWF.

  Entity List: N/A
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                        Page 7
____________________________________________________________________________

       1.   Entity:
            Description:

  Areas Affected by the Problem.
    1. HICR Audit Report

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:       XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    rISK/DESIGN ISSUE:

  ok

  Rick Wolfsheimer
  Business Applications Management Group
  Division of Systems Operations
  Production Support Team
  Richard.Wolfsheimer@cms.hhs.gov
  410-786-6160


  -----Original Message-----
  From: MEREDITH.REVIER@trailblazerhealth.com
  mailto:MEREDITH.REVIER@trailblazerhealth.com
  Sent: Tuesday, May 22, 2007 10:37 AM
  To: Wolfsheimer, Richard E. (CMS/OIS)
  Cc: gkumar@csc.com; cpowel26@csc.com
  Subject: FW: CR25425 update to reqs
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                        Page 8
____________________________________________________________________________



  -----Original Message-----
  From: MEREDITH.REVIER
  Sent: Monday, May 21, 2007 1:46 PM
  To: richard.wolfsheimer@cms.hhs.com.tbhe
  Cc: gkumar@csc.com.tbhe; cpowel26@csc.com.tbhe
  Subject: CR25425 update to reqs


  Hi Rick,
  Gopal has found a couple more issues with the HICR satellite report. We
  have
  added them to the CR. Just an FYI.
  Thanks,
  Meredith Revier


  *******************************************************************



  Mere,

  I reviewed the CWF CR in Infoman and have decided no walkthrough is
  needed.



  *** Walkthru Waived ***



  Rick Wolfsheimer




  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                        Page 9
____________________________________________________________________________

  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 10
____________________________________________________________________________


  2.   00025364   5454-METHOD OF PAYMENT FOR EXTENDED STAY SERVICES UNDER DEMO

 DATE ENTERED:    01/16/07

 TITLE:           5454-METHOD OF PAYMENT FOR EXTENDED STAY SERVICES UNDER DEMO

 PROJECT CODE:    CM01

 PRIORITY:        1

 RELEASE LEVEL: R2007400

 GROUP LEVEL:     1

 HOST SITE ID:    CWFM2000

 STATUS ON CR:    WORK

 DOC. REQUIRED: N

 HOST EVAL:       N/A

 DOC RECEIVED:    N

 ADDENDUM INFO: NONE

 EST. CATEGORY:   3
 EST. HOURS:      0300
 ACT. HOURS:      0148
 CAT/CR EVAL:     N

 COMMENT:         N/A

  DESCRIPTION:
  ------------
   Section 434 of the Medicare Prescription Drug, Improvement,
  and Modernization Act of 2003 (MMA) established "The Frontier
  Extended Stay Clinic (FESC) Demonstration Project" to test the
  feasibility of providing extended stay services to remote frontier
  areas under Medicare payment and regulations. A FESC must be
  located in a community which is - (1) at least 75 miles away from
  the nearest acute care hospital or critical access hospital, or (2) is
  inaccessible by public road. FESCs are designed to address the needs
  of seriously or critically ill or injured patients who, due to adverse
  weather conditions or other reasons, cannot be transferred to acute
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 11
____________________________________________________________________________

  care hospitals, or patients who do not meet CMS inpatient hospital
  admission criteria and who need monitoring and observation for a
  limited period of time.

  Under regulations established for the demonstration, clinics
  participating under the FESC demonstration will be allowed to
  keep patients for extended stays in situations where weather or
  other circumstances prevent transfer. Extended stays up to 48
  hours are permitted for patients who do not meet CMS inpatient
  hospital admission criteria but who need monitoring and observation
  for a limited period of time. According to the regulations, there can
  be no more than 4 patients under this criterion at any one time at any
  single facility.

  According to Section 434, the FESC demonstration will last for
  three years.

  CMS is currently soliciting applications for the demonstration project.

  Clinics will be selected in early CY 2007.

  CWF REQ:

  CWF will need to modify consistency edit '0014' to allow
  new DEMO# '53' for Part A.

  CWF will need also ensure new DEMO# is carried in History
  and NCH.

  REQUIREMENTS:
  -------------
  m           DEFINITION AND ANALYSIS PHASES

  CR:          _25364___________   WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                _X_   Minor
  FUNCTION:    _________________                ___   Major
  PROGRAM:     _________________                ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                Vivian Rogers
      Telephone:          410-786-8142
      FAX, CMS:           410-786-0271
      Responsibilities:   REVIEW TECH DESIGN, APPROVE MODS

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 12
____________________________________________________________________________

  CWFM Participants:
  1. BUSINESS ANALYST:     Rita Crane
      Telephone:           469-372-2199
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Margarita Podyachev
       Telephone:          443-436-6608
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  Section 434 of the Medicate Prescription Drug, Improvement, and
  Modernization Act of 2003 (MMA) established "The Frontier Extended
  Stay Clinic (FESC) Demonstration Project" to test the feasibility
  of providing extended stay services to remote frontier areas
  under Medicare payment and regulations.

  Under regulations established for the demonstration, clinics
  participating under the FESC demonstration will be allowed
  to keep patients for extended stays in situations where weather
  or other circumstances prevent transfer.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 13
____________________________________________________________________________

  CWF will need to modify consistency edit '0014' to allow
  new Demo Number '53' for Part A.

  CWF will also need to ensure new Demo Number '53' is carried
  in the claim history and NCH.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  Modify consistency edit '0014' to allow new Demo Number '53'
  for Part A.

  Requirement 2
  Ensure that Demo Number '53' is carried on the Claim in
  history.

  Requirement 3
  Ensure that Demo Number '53' is carried on the Claim in
  NCH.

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 14
____________________________________________________________________________

  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  An HUIP record is received with Demo Number '53'.

  Response
  The record is accepted, and consistency edit '0014' is
  not set.

  Event 1.2
  An HUOP record is received with Demo Number '53'.

  Response
  The record is accepted, and consistency edit '0014' is
  not set.

  Event 1.3
  An HUIP record is received with a Demo Number other than
  '01', '04', '05', '06', '07', '08', '15', '30', '31', '38',
  '39', '40', '44', '45', '46', '48', '49', or '53'.

  Response
  The record is rejected, and consistency edit '0014' is
  set.

  Event 1.4
  An HUOP record is received with a Demo Number other than
  '01', '04', '05', '06', '07', '08', '15', '30', '31', '38',
  '39', '40', '44', '45', '46', '48', '49', or '53'.

  Response
  The record is rejected, and consistency edit '0014' is
  set.

  Event 2.1
  An HUIP record is received with Demo Number '53'.

  Response
  The record is accepted, and carried on the claim in history.

  Event 2.2
  An HUOP record is received with Demo Number '53'.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 15
____________________________________________________________________________


  Response
  The record is accepted, and carried on the claim in history.

  Event 3.1
  An HUIP record is received with Demo Number '53'.

  Response
  The record is accepted, and posted in NCH.

  Event 3.2
  An HUOP record is received with Demo Number '53'.

  Response
  The record is accepted, and posted in NCH.

  ***.......This is the width of the Release Document.......***

  The Entity List includes only NEW acronyms and terminology
  that is currently not in use in CWF.

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. Part A Consistency Module

  Solution Criteria: N/A

    EDITS AFFECTED:
  ***.......This is the width of the Release Document......***

  a. Error Code:    0014   ( )New (X)Modified ( )Deleted
  Disposition: ER

  Type of Record: HHA, Hospice, Hospital, OUTP, SNF

  Error Message:
  Demonstrative Numbers other than '01', '03', '04', '05',
  '06', '07', '08', '15', '30', '31', '37', '38', '39', '40',
  '44', '45', '46', '48', '49', '51' or '53' are invalid.

  Set Condition for edit '0014': Under Development

  Hospital
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 16
____________________________________________________________________________

  When the Demonstration Number is not equal to '01', '03', '04',
  '05', '06', '07', '08', '15', '30', '31', '38', '39',
  '40', '44', '45', '46', '48', '49', '53', spaces or low values,
  and the Action Code is equal to '1' or '3', set the '0014'
  error code.

  When the Demonstration Number is equal to '05', and the
  Action Code is equal to '1' or '3', and a valid CHOICES ID
  is not present, set the '0014' error code.

  SNF
  When the Demonstration Number is equal to '01', and the
  Action Code is equal to '1' or '3', and the RUGS Provider
  Indicator is not equal to '2', '3', '4', or the first two
  positions of the claim bill type are not equal to '21', set
  the '0014' error code.

  When the Demonstration Number is equal to '04' and the
  Action Code is equal to '1' or '3', and Condition Code 'W0'
  is not present, or the first two positions of the bill type
  are not equal to '18', '21', '28', or '51' set the '0014'
  error code.

  HHA, Hospice, OUTP
  When the Demonstration Number is equal to '05, and the
  Action Code is equal to '1' or '3', and a valid CHOICES ID
  is not present, set the '0014' error code.

  When the Demonstration Number on the claim is not equal to
  '05', '15', '30', '31', '37', '38', '40', '46', '48', '49',
  '51', '53', spaces or low values, and the Action Code is equal to
  '1' or '3', set the '0014' error code.

  When the Demonstration Number on the claim is equal to '44'
  and the Type of Bill is '32x' or '33x' (Home Health Claims)
  and the Action Code is equal to '1' or '3', bypass this
  edit.

  Trailer Information: '08'




  ***.......This is the width of the Release Document......***


______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 17
____________________________________________________________________________

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  Contractor:
  Author: Mazumdar, Siddhartha
  Date: 01/15/2007
  Subject: Re: CWF Comment

  The first 750 characters of the comment are the following:
  Language is included in the revised CR business requirements:
  Claims processed under the demonstration rules according to this
  CR will be tagged with a demonstration code =53. The demonstration
  code shall be part of the claim record sent to the national claims
  history file.



  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 18
____________________________________________________________________________


  3.   00025374   EDIT HIC NUMBERS IN THE BATCH BUILDER

 DATE ENTERED:    01/19/07

 TITLE:           EDIT HIC NUMBERS IN THE BATCH BUILDER

 PROJECT CODE:    CM01

 PRIORITY:        1

 RELEASE LEVEL: R2007400

 GROUP LEVEL:     2

 HOST SITE ID:    CWFM2000

 STATUS ON CR:    REQS

 DOC. REQUIRED: N

 HOST EVAL:       N/A

 DOC RECEIVED:    N

 ADDENDUM INFO: NONE

 EST. CATEGORY:   3
 EST. HOURS:      0300
 ACT. HOURS:      0298
 CAT/CR EVAL:     N

 COMMENT:         N/A

 DESCRIPTION:
 ------------
   CWF Host Sites have requested to create a CR to address the
 issue of editing HIC numbers in the batch builder rather than
 than waiting until the HISC starts.

 CWF Requirement:
 Modify the batch builder <program CABBSPCL> to convert the
 HIC number on the claim (if necessary) and validate that it
 is in an acceptable format, if not, generate a response with
 an appropriate consistency error code.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 19
____________________________________________________________________________

  The response records will get written to CABOTxx file for
  the site that is currently being processed.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:          25374____________    WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                 _X_   Minor
  FUNCTION:    _________________                 ___   Major
  PROGRAM:     _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 RICK WOLFSHEIMER
      Telephone:           410-786-6160
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     VICKI L SOMMERS
      Telephone:           469-372-7642
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       SRI ANNE
       Telephone:          443-436-6723
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *              blank line is found.                               *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *              after a colon. Try to format as it should appear *
  *              in the Release Document.                           *
  *******************************************************************


______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 20
____________________________________________________________________________

    IMPACT:
  (X) Host
  ( ) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  CWF Host Sites have requested to create a CR to address the
  issue of editing HIC numbers in the batch builder rather than
  than waiting until the HISC starts.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  Modify the batch builder <program CABBSPCL> to convert the
  HIC number on the claim (if necessary) and validate that it
  is in an acceptable format, if not, generate a response with
  an appropriate consistency error code.

  The response records will get written to CABOTxx file for
  the site that is currently being processed.

  ***.......This is the width of the Release Document.......***


______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 21
____________________________________________________________________________

  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  An HUIP, HUOP, HUHH or HUHC claim is being submitted with an
  invalid HIC number.

  Response
  The Claim transactions will get rejected with the consistency
  error code 'A002'.The response record will get written to the
  CABOTxx file.

  Event 1.2
  An HUBC, HUDC claim is being submitted with an invalid HIC
  number.

  Response
  The Claim transactions will get rejected with the consistency
  error code '0301'.The response record will get written to the
  CABOTxx file.

  Event 1.3
  An HUCM Transaction is being submitted with an invalid HIC
  number.

  Response
  HUCM transaction will get rejected with the consistency
  error code 'C100'. The response record will get written
  to the CABOTxx file.

  Event 1.4
  An HURD Transaction is being submitted with an invalid HIC
  number.

  Response
  HURD transaction will get rejected with the consistency
  error code 'RD02'. The response record will get written
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 22
____________________________________________________________________________

  to the CABOTxx file.

  Event 1.5
  An HUSP Transaction is being submitted with an invalid HIC
  number.

  Response
  HUSP transaction will get rejected with the consistency
  error code 'SP12'. The response record will get written
  to the CABOTxx file.

  Event 1.6
  An HUBO Transaction is being submitted with an invalid HIC
  number.

  Response
  HUBO transaction will get rejected with the consistency
  error code 'BO01'. The response record will get written
  to the CABOTxx file.

  ***.......This is the width of the Release Document.......***

  The Entity List includes only NEW acronyms and terminology
  that is currently not in use in CWF.

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. Batch Builder Program

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 23
____________________________________________________________________________

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************
  --- RECEIVED FROM CSC.CF00080 443-436-6734          07-06-19 12.26
    -> HCFACO.CF90870        RICK WOLFSHEIMER                469
    -> HCFACO.CF90508        CATHY PFLAUM                    469
    -> CMSCO.CF91252         VIVIAN ROGERS                   469
    -> CMSCO.CF90468         KATHY WOYTAN                    469
    -> CWFSW.CF90327         GREG CENOVA                     469
    -> CWFSE.CF90144         JANET JOHNSON                   0469
    -> CSC.CF00030           SRI ANNE                        469
    -> CSC.CF00054           ANIL KATRAGUNTA                 CSC
    -> CSC.CF00051           JERRY WEAVER                    CSC
    -> CSC.CF00014           VINAY VUYYURU                   469

  RICK:
  PER YOUR AGREEMENT IN THIS MORNING'S CALL, WE CONTACTED JANICE
  JOHNSON AND GREG CENOVA TO REITERATE THE INTENTION OF THIS CR AS
  PROVIDING THE REQUESTED CODING UPDATE, YET WE ARE UNABLE TO
  ENSURE THE ELIMINATION THE HISC ABEND. JANICE AND GREG
  UNDERSTOOD THIS AND BELIEVED THAT THIS REMAINS TO BE THE BEST
  APPROACH TO ADDRESS THE HISC ABEND.

  PLEASE LET ME KNOW IF YOU HAVE ANY QUESTIONS.
  THANK YOU,
  CHET
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 24
____________________________________________________________________________


  --- RECEIVED FROM CSC.CF00080 443-436-6734          07-06-18 15.09
    -> HCFACO.CF90870        RICK WOLFSHEIMER               469
    -> HCFACO.CF90508        CATHY PFLAUM                   469
    -> CMSCO.CF90468         KATHY WOYTAN                   469
    -> CSC.CF00030           SRI ANNE                       469
    -> CSC.CF00054           ANIL KATRAGUNTA                CSC
    -> CSC.CF00051           JERRY WEAVER                   CSC
    -> CSC.CF00014           VINAY VUYYURU                  469
  RICK:
  CR 25374 EDIT HIC NUMBERS IN THE BATCH BUILDER PROPOSES AN UPDATE
  TO THE CWF BATCH BUILDER IN AN EFFORT TO PREVENT AN ABEND FROM
  OCCURRING IN THE HISC PROCESS. IN THE EXAMPLES THAT HAVE BEEN
  PROVIDED TO CSC, WE UNDERSTAND THE PROPOSED FIX REQUEST, HOWEVER,
  WE ARE UNABLE TO REPRODUCE THE HISC ABEND THAT THE FIX IS
  INTENDED TO ELIMINATE. THIS ABEND IS UNIQUE TO A GW HOST'S
  SATELLITE FILE.

  PLEASE LET ME KNOW WHEN YOU WOULD BE AVAILABLE TO DISCUSS THE
  EXPECTATIONS OF THIS CR, SINCE IT WILL IMPACT THE CLAIMS BALANCING
  PROCESS OF THE HISC PROCESS AND MAY NOT ELIMINATE THE EXISTING
  HISC ABEND.

  THANK YOU,
  CHET




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 25
____________________________________________________________________________


   4.   00025382   5490 - NEW NUMBER SERIES AND STATE CODES

  DATE ENTERED:    01/25/07

  TITLE:           5490 - NEW NUMBER SERIES AND STATE CODES

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2007400

  GROUP LEVEL:     1

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    WORK

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   3
  EST. HOURS:      0300
  ACT. HOURS:      0216
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------

  1/25/07
  The National Provider Identifier will replace the Medicare/Medicaid
  Provider Number on all Medicare claims on May 23, 2007. The NPI will
  assume the Medicare/Medicaid Provider Number's role as a primary
  identifier. In order to avoid confusion with the NPI, the Medicare/
  Medicaid Provider Number (also known as the OSCAR Number, Medicare
  Identification Number, or Provider Number) has been renamed the
  CMS Certification Number (CCN). The CCN continues to serve a critical
  role in verifying that a provider has been Medicare certified and
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 26
____________________________________________________________________________

  for what types of services. This number is used throughout the
  various components of CMS, and maintaining this number is integral
  to CMS' business operations.

  A new provider type entitled Transplant Centers has been identified.
  The new CCN series assigned to this provider is 9800-9899.

  New states codes for   CCNS have also been assigned to the following
  states: California -   (75)
          Iowa       -   (76)
          Minnesota -    (77)
          Illinois   -   (78)


  A)
  CWF must modify consistency error codes '0401', and '0702'
  to include the new provider range 9800-9899 for Part A
  claims.


  B)
  CWF must add the new state codes to the COBC logic that
  utilizes the Provider and State Code as part of the
  inclusion and exclusion criteria. These new states codes
  will display with the existing indicators 'K', Part A
  Provider and State Code, and 'L' Part B State Code.

  This CR has a July 2007 implementation date.



  Yvonne Anderson
  CWMF Support Team

  469 -372-5420

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:          ______25382______    WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                 _x_   Minor
  FUNCTION:    _________________                 ___   Major
  PROGRAM:     _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 27
____________________________________________________________________________


  CMS Participants:
  1. Name:                 Kathy Woytan
      Telephone:           410-786-4982
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Yvonne Anderson
      Telephone:           469-372-5420
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Henry Alligood
       Telephone:          717-909-5120
       FAX,Baltimore,MD:   717-909=5150
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  (X) Satellite Part B
  (X) Hospice
  (X) Home Health
  (X) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  CMS has assigned new State Codes for California, Iowa, Minnesota
  and Illinois.

  CMS has identified a new Provider Type (9800-9899) entitled
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 28
____________________________________________________________________________

  transplant centers.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  CWF must accept the following new State Codes in the first two
  positions of the Provider Number on Part A claims and the first
  two positions of the BSI Number on Part B claims.

             75   -   California
             76   -   Iowa
             77   -   Minnesota
             78   -   Illinois

  Requirement 2
  CWF must continue to accept the existing State Codes in the
  first two positions of the Provider Number on Part A claims
  and the first two positions of the BSI Number on Part B claims
  for the following states:

             05, 55 - California
             16 - Iowa
             24 - Minnesota
             14 - Illinois

  Requirement 3
  CWF must add the new State Codes as valid values to the
  Inclusion/Exclusion processing used by COBC for Part A
  Crossover Indicator 'K'.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 29
____________________________________________________________________________


  Requirement 4
  CWF must add the new State Codes as valid values to the
  Inclusion/Exclusion processing used by COBC for Part B
  Crossover Indicator 'L'.

  Requirement 5
  CWF must modify consistency error code '0401' to add the new
  range of transplant center Provider Numbers '9800-9899'.

  The valid Type of Bill (s) for the transplant center Providers
  are 'xx'.

  Requirement 6
  CWF must modify consistency error code '0702' to add the new
  range of transplant center Provider Numbers '9800-9899'.

  The valid Type of Bill (s) for the transplant center Providers
  are 'xx'.

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  Submit an HUIP, HUOP, HUHH, or HUHC record that contains
  one of the new state codes '75', '76', '77', or '78' in
  the first two positions of the Provider Number field.

  Response
  The record is processed and accepted in CWF.

  Event 2.1
  Submit an HUIP, HUOP, HUHH or HUHC record that contains
  one of the existing states codes for a state that received
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 30
____________________________________________________________________________

  a new state code. The existing codes are '05', '14', '16',
  '24', or '55'. The existing codes will be in the first
  two positions of the Provider Number field.

  Response
  The record is processed and accepted in CWF.

  Event 3.1
  Submit an HUIP, HUOP, HUHH or HUHC record that contains
  one of the new state codes: '75', '76', '77', or '78'
  in the first two positions of the Provider Number. The
  Beneficiary's COIF File contains an inclusion for the new
  state code.

  Response
  The record is processed and crosses over. A '29' Trailer
  is generated. The detail of the record in HIMR displays
  Crossover Disposition Indicator 'A'.

  Event 3.2
  Submit an HUIP, HUOP, HUHH or HUHC record that contains
  one of the new state codes: '75', '76', '77', or '78'
  in the first two positions of the Provider Number. The
  Beneficiary's COIF File contains an inclusion for the new
  state code.

  Response
  The record is processed and does not cross over. A '29'
  Trailer is not generated. The detail of the record in
  HIMR displays a Crossover Disposition Indicator 'K'.

  Event 4.1
  Submit an HUBC or HUDC record that contains a BSI
  in the first two positions of the incoming record.
  The record contains one of the new state codes:
  '75', '76', '77', or '78'. The Beneficiary's COIF
  File contains an inclusion for the new state.

  Response
  The record is processed and crosses over. A '29' Trailer
  is generated. The detail of the record in HIMR displays
  Crossover Disposition Indicator 'A'.

  Event 4.2
  Submit an HUBC or HUDC record that contains a BSI
  in the first two positions of the incoming record.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 31
____________________________________________________________________________

  The record contains one of the new state codes:
  '75', '76', '77', or '78'. The Beneficiary's COIF
  File contains an exclusion for the new state.

  Response
  The record is processed and does not cross over. A '29'
  Trailer is not generated. The detail of the record in
  HIMR displays Crossover Disposition Indicator 'L'.

  Event 5.1
  Submit an HUIP, HUOP, HUHH or HUHC record that contains
  a Provider Number in the new range of transplant center
  Providers: '9800-9899' with a valid Type of Bill (xx)
  for the record type.

  Response
  The record is processed, error code '0401' is not set.

  Event 6.1
  Submit an HUIP, HUOP, HUHH, or HUHC record that contains
  a Provider Number in the new range of transplant center
  Providers: '9800-9899' with a valid Type of Bill (xx)
  for the record type.

  Response
  The record is processed, error code '0702' is not set.




  ***.......This is the width of the Release Document.......***

  The Entity List includes only NEW acronyms and terminology
  that is currently not in use in CWF.

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. Part A
    2. Part B/DMERC
    3. COIF File
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 32
____________________________________________________________________________


  Solution Criteria: N/A

    EDITS AFFECTED:
  ***.......This is the width of the Release Document......***

  a. Error Code:    0401   ( )New (X)Modified ( )Deleted
  Disposition:      ER

  Type of Record:   Hospital, OUTP, HHA, Hospice, SNF

  Error Message:
  The Type of Bill (TOB) is invalid, is
  inconsistent with the Provider Number,
  or the TOB Code present is not allowed
  for Revenue Code '0403'.

  Set Condition for edit '0401': Under Development

  (The following Bill Types are referenced in the CMS-IOM-manual
  section 100-04 chapter 25-completing and processing the UB-92.)

  Description
  Bill Type Code                      Provider Number Range
  --------------                      ---------------------
  11x Hospital Inpatient Part A              0001-0999
                                             000E-999E
                                             000F-999F
                                             1200-1299
                                             1300-1399
                                             2000-2299
                                             3025-3099
                                             3300-3399
                                             4000-4499
                                             M000-M999
                                             R000-R999
                                             S000-S999
                                             T000-T999
                                             V000-V999
  12x Hospital Inpatient Part B              Same as 11x
                                             W000-W999

  13x Hospital Outpatient                  Same as 11x
       (Except M000-M999, R000-R999,1300-1399) 1800-1989
                                                2300-2499
       14x Hospital Other Part B                Same as 11x
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 33
____________________________________________________________________________

       (Except M000-M999, R000-R999)            1800-1989

   18x Hospital Swing Bed                   U000-U999
                                            W000-W999
                                            Y000-Y999
                                            Z300-Z399
                                            1300-1399
   21x SNF Inpatient                        5000-6499
   22x SNF Inpatient Part B                 1800-1989
                                            5000-6499
                                            W000-W999
                                            Z300-Z399

   23x SNF Outpatient                       5000-6499
   24x SNF Outpatient (Other Part B)        5000-6499
   28x SNF Swing Bed                        5000-6499
                                            Y000-Y999
                                            Z300-Z399
                                            3100-3199
                                            7000-8499
                                            9000-9799
   33x Home Health                          1800-1989
                                            3100-3199
                                            7000-8499
                                            9000-9799
   34x Home Health (Part B Only)            1800-1989
                                            3100-3199
                                            7000-8499
                                            9000-9799
   41x Religious Non-medical Health Care    1990-1999
           Institution (RNHCI)

   43x Religious Non-medical Health Care    1990-1999
           Institution (RNHCI)
   51x Christian Science SNF                6990-6999
           (Term Date 06/30/2000)


   71x Rural Health Clinic                   3400-3499
                                             3976-3999
                                             8500-8999
    72x ESRD Clinic                          1200-1299
                                             2300-2999
                                             3300-3399
                                             3500-3799
    73x Federally Qualified Health Center    1000-1199
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 34
____________________________________________________________________________

                                            1800-1989
   74x Clinic OPT Valid prior to 1990 only 4500-4599
       Valid after 9/30/1991 thru 3/31/1997
                                            4600-4799
                                            4900-4999
       Valid anytime                        6500-6899
                                            6900-6989
   75x CORF                                 3200-3299
                                            4500-4599
                                            4800-4899
                                            6500-6989
   76x Community Mental Health Center       1400-1499
                                            4600-4799
                                            4900-4999

   81x Non-hospital based Hospice             1500-1799
                                              8500-8999
   72x ESRD Clinic                            1200-1299
                                              2300-2999
                                              3300-3399
                                              3500-3799
   73x Federally Qualified Health Center      1000-1199
                                              1800-1989
   74x Clinic OPT Valid prior to 1990 only    4500-4599
       Valid after 9/30/1991 thru 3/31/1997
                                              4600-4799
                                              4900-4999
       Valid anytime                          6500-6899
                                              6900-6989
   75x CORF                                   3200-3299
                                              4500-4599
                                              4800-4899
                                              6500-6989
   76x Community Mental Health Center         1400-1499
                                              4600-4799
                                              4900-4999

   81x Non-hospital based Hospice             1500-1799
   82x Hospital based Hospice                 1500-1799
   83x ASC payment limit same as 11x
               (except 1300-1399)
   85x Rural Primary Care Hospital (RPCH)    1300-1399
   89x Other Outpatient                      0001-0999
                                             1200-1399
                                             1400-1499
                                             1800-1989
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 35
____________________________________________________________________________

                                             2000-2299
                                             2300-2999
                                             3025-3099
                                             3100-3199
                                             3200-3299
                                             3300-3399
                                             3400-3499
                                             3500-3799
                                             3800-3999
                                             4000-4499
                                             4500-4599
                                             4600-4799
                                             4800-4899
                                             4900-4999
                                             6500-6899
                                             6900-6989
                                             7000-8499
                                             8500-8999
                                             9000-9499
                                             S001-S999
                                             T001-T999
                                             V001-V999
                                             W000-W999
                                             000E-999E
                                             000F-999F

  The documentation above defines the valid bill
  type/Provider Number combinations. When a match is not
  found, set the '0401' error code.

  Hospital, SNF
  When the first two positions of the Inpatient bill type do
  not equal '11', and the Inpatient Revenue Code is equal to
  '0403', set the '0401' error code.

  When the first two positions of the Inpatient bill type
  equals to '18' and Demonstration Number is equal to '31',
  bypass this edit.

  When the bill type is '43x' and Provider range '1990-1999',
  bypass this edit.

  OUTP, HHA, Hospice
  When the bill type is not numeric, set the '0401' error
  code.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 36
____________________________________________________________________________

  When the bill type is equal to '89X' and the Provider
  Number is equal to '031500', bypass this edit.

  Trailer Information: '08'


  b. Error Code:    0702   ( )New (X)Modified ( )Deleted
  Disposition:      ER

  Type of Record:   Hospital, OUTP, HHA, Hospice, SNF

  Error Message:
  The Provider Number is not consistent
  with the Type of Bill.

  Set Condition for edit '0702': Under Development

  When the bill type is '43x' and Provider range '1990-1999',
  bypass this edit.

  The following are valid Provider Number ranges for the
  associated Type of Bill:


  TOB                  Provider Number Range
  ---                  ---------------------
  All TOBs             xx0xxx
      (except 2xx, 18x and 51x)
      (TOB 51x Term date 06/30/2000)
                       xx1200 - xx1399
                       xx2000 - xx2299
                       xx3025 - xx3099
                       xx3300 - xx3399
                       xx4000 - xx4499
                       xxxxxE
                       xxxxxF
                       xxSxxx
                       xxTxxx
                       xxVxxx
       41x                 same as All TOBs
                                     xx1900 - xx1999
       2xx and 51x                   xx0999
              (Term date 06/30/2000)
              (except 21x)               xx5xxx
                                     xx6000 - xx6499

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 37
____________________________________________________________________________

                                  xxUxxx
                                  xxYxxx
                                  xxZ300 - xxZ399
              18x                 same as 2xx and 51x
                                  xxRxxx

 When the TOB is equal to '11A', '11D', '41A', '41B', or
 '41D', bypass this edit.

 When the TOB is equal to '18x' and Demonstration Number
 equal to '31' for an Inpatient claim, bypass this edit.

 Trailer Information: '08'




 ***.......This is the width of the Release Document......***

 ISSUE/ANSWERS:
 --------------
   RISK/DESIGN ISSUE:

 ***.......This is the width of the Risk/Issue Memo.....***

 **********************************************************
 * Key the RISK/DESIGN ISSUE between the title and the end*
 * line. The CR # and title will appear on daily memo     *
 * with CR-relate information: CMS, BA, SE, SME and CAT. *
 * Example from CR 16871. "John: I keyed answers to your *
 * questions. Please review. Thanks, Joe" or Example      *
 * from CR 17062: "This CR is being placed in CMS status *
 * awaiting CMS's answer concerning TOS 53".              *
 * When keying, only place information that should appear *
 * on the memo between the header and *** width *** line. *
 * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
 **********************************************************




 5/22/07 12:15PM



  Here is your answer.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 38
____________________________________________________________________________


  TOBs 11x, 12x, 13x, 14x, and 85x.

  Kathy Woytan
  Business Applications Management Group
  Division of Business Application Analysis
  Common Working File Group Team Lead
  Kathryn.Woytan@cms.hhs.gov
  410-786-4982


  -----Original Message-----
  From: YVONNE.ANDERSON@trailblazerhealth.com
  mailto:YVONNE.ANDERSON@trailblazerhealth.com
  Sent: Tuesday, May 22, 2007 8:45 AM
  To: Woytan, Kathryn A. (CMS/OIS)
  Cc: halligoo@csc.com
  Subject: 5490 - 25382

  Kathy,
  Would you check with CMS again to see if we have received any
  information
  from Cindie Murphy regarding the valid TOBS for the
  new transplant centers. The programmer is beginning to code this CR, and
  we do not have the valid TOBS. This was addressed prior to the walk-thru

  Yvonne Anderson
  CWFM Support Team
  469 372-5420



  -------------------------------
  Tue: 6/5/07 11:05AM
  Subject
  CMS CR 5490



  Yvonne, Henry and Chet,

  Please stop work on CMS CR 5490.

  I received the following information:

  It appears that the new provider number series is intended for internal
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 39
____________________________________________________________________________

 survey and certification purposes only, and will not be used for billing
 The transplant programs would be enrolled through their hospital s
 enrollment record; a separate record would not be created. The provider
 would have the option of setting up a separate NPI number for their
 transplant program, which may change that equation.

 Based on the above, we have been advised what CWF and FISS are coding ma
 not be what CMS intended. As soon as we have additional information I
 will let you know.


 Kathy Woytan
 Business Applications Management Group
 Division of Business Application Analysis
 Common Working File Group Team Lead
 Kathryn.Woytan@cms.hhs.gov
 410-786-4982




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 40
____________________________________________________________________________


   5.     00025393   REQUESTING MODIFICATION TO EDIT 5608 TO ALLOW LOA CLAIM

  DATE ENTERED:      02/06/07

  TITLE:             REQUESTING MODIFICATION TO EDIT 5608 TO ALLOW LOA CLAIM

  PROJECT CODE:      CM01

  PRIORITY:          2

  RELEASE LEVEL: R2007400

  GROUP LEVEL:       2

  HOST SITE ID:      CWFM2000

  STATUS ON CR:      WORK

  DOC. REQUIRED: N

  HOST EVAL:         N/A

  DOC RECEIVED:      N

  ADDENDUM INFO: NONE

  EST. CATEGORY:     3
  EST. HOURS:        0300
  ACT. HOURS:        0234
  CAT/CR EVAL:       N

  COMMENT:           N/A

  DESCRIPTION:
  ------------
  Satellite is requesting modification to Utilization edit 5608
  due to leave of absence claim overlapping SNF stay that
  has been split.
  ---------

  Liza:

  Thank you for your help! I did take a look at a few of our former
  rejects and the suggestion will not work as originally presented.   I
  think it will need to look if it's a SNF claim on history and the OC 74
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 41
____________________________________________________________________________

  is present for the DOS of the incoming claim:

  -If yes, then disregard the subsequent SNF claim DOS that are not
  applicable and do not assign 5608.
  -If no OC 74 for incoming claim DOS, then reject for 5608

  Please let me know if you would like some of these examples.

  Kathy

  -------


  We have a user getting a U5608 in production on an Inpatient SNF
  adjustment. The reason she is getting it as she has discovered
  is their is another claim from another contractor with dates of
  service that overlap her adjustment and the other claim does not
  have a occurrences span code 74 for leave of absence which she
  says it should have. She needs the other contractor to correct
  the already posted claim but how does she go about doing that, the
  other claim was posted by carrier 00190. The claim is for
  204147637A inpatient 07/18/02-07/25/02, SNF admit 07/18/02 thru
  08/03/02 SNF provider billed 07/18/02-07/31/02 with occurrence
  span code 74 for leave of absence for 07/24/02-07/24/02 however
  the provider from carrier 00190 did not bill the osc74 on the SNF
  dos 08/01/02-08/03/02.

  Here are the files for your review:

  CWF.TEST.T390360.SO.CWFBILLZ
  CWF.TEST.T390360.SO.C01.RPLYZ
  CWF.TEST.CWF.UTILMOVE.G1092V00

  I tracked this claim and it came in thru South but the bene is
  at Keystone so the first reply they got was a 52, I only sent you
  the reply from Keystone which in fact did give them a trailer 8
  with the U5608.
  Can you guys tell me what do tell this user as to how to get her
  adjustment to post?

  Thanks,
  Liza

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 42
____________________________________________________________________________


  CR:          25393____________    WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                 ___   Minor
  FUNCTION:    _________________                 _x_   Major
  PROGRAM:     _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Cathy Pflaum
      Telephone:           410-786-3016
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Rita Crane
      Telephone:           469-372-2199
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Ron Dodson
       Telephone:          443-436-6715
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  ( ) DMERC
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 43
____________________________________________________________________________

  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  Utilization edit '5608' is incorrectly set when an incoming
  '11x' Type of Bill hospital record for a leave of absence
  is received that is during an SNF stay in history that has
  been split. One SNF record reflects the leave of absence
  (74 Span Code) and the other history SNF record reflects a
  From and Thru Date that the incoming hospital claim does not
  fall within.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  Modify utilization edit '5608' when the incoming hospital/SNF
  record From and Thru Dates do not fall within the From and
  Thru Date of the history hospital/SNF, bypass this edit.

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 44
____________________________________________________________________________

  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  An HUIP '11x' Type of Bill record for a leave of absence
  is received with Dates of Service during an SNF stay in
  history that has been split.

  The incoming HUIP '11x' Type of Bill record From and Thru
  Dates are within the initial SNF From and Thru Dates in
  history that also reflects Span Code '74' for the leave
  of absence.

  The second SNF in history has the same Admit Date of the
  prior SNF stay, however, the incoming HUIP '11x' Type of
  Bill record From and Thru Dates are not within the From
  and Thru Date of the subsequent SNF record.

  Response
  The record is accepted, and utilization edit '5608' is
  not set.

  Event 1.2
  An incoming HUIP record or SNF record is received with
  Service Dates that fall between the Admit Date and Service
  From Date of a history claim. The Admit Date or Provider
  Number is not the same as the history record and the
  Patient Status is not '30'.

  Response
  The record is rejected, and utilization edit '5608' is set.

  ***.......This is the width of the Release Document.......***

  The Entity List includes only NEW acronyms and terminology
  that is currently not in use in CWF.

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. Utilization

  Solution Criteria: N/A
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 45
____________________________________________________________________________


    EDITS AFFECTED:
  ***.......This is the width of the Release Document......***

  a. Error Code:    5608   ( )New (X)Modified ( )Deleted
  Disposition: UR

  Type of Record: Hospital, SNF

  Error Message:
  An incoming Inpatient hospital or SNF claim has Service Dates
  that fall between the Admit Date and service From Date of a
  history claim. The Admission Date or Provider Number is not
  the same as the history claim and the patient status is not
  '30'.

  Set Condition for edit '5608': Under Development

  When an incoming hospital SNF claim has a Thru Date that is
  less than a hospital or SNF history claim's From Date and
  equal to, or greater than, the Admit Date (the history claim's
  Admit Date is less than its From Date) and the Admit Dates or
  Provider Numbers of both claims are not equal or the patient
  status of the incoming claim is not equal to '30', set the
  '5608' error code.

  When an incoming hospital or SNF history (this history claim
  will now re referred to as "the second history claim") is
  present that has a Thru Date that is less than the first
  history claim's From Date and equal to or greater than the
  Admit Date, and when the second history claim's Thru Date is
  less than or equal to the incoming claim's Admit Date or the
  second history claim's Admit Date and less than, or equal to
  the incoming claim's Thru Date, and when the incoming claim's

  When an incoming hospital or SNF history (this history claim
  will now re referred to as "the second history claim") is
  present that has a Thru Date that is less than the first
  history claim's From Date and equal to or greater than the
  Admit Date, and when the second history claim's Thru Date is
  less than or equal to the incoming claim's Admit Date or the
  second history claim's Admit Date and less than, or equal to
  the incoming claim's Thru Date, and when the incoming claim's
  date is equal to or, greater than, the second history claim's
  Occurrence Span Code '74' From Date and the incoming claim's
  Thru Date is equal to or less than the second history claim's
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 46
____________________________________________________________________________

  Occurrence Span Code '74' Thru Date, bypass this edit.

  When an incoming CANCEL ONLY (Action Code '4') claims or
  history claims that have a Cancel Date greater than zero,
  bypass this edit.

  When TOB is '11Z', bypass this edit.

  When an incoming hospital or SNF claim is an IME/GME claim
  with Condition codes '04' and '69' present and the Dates of
  Service fall between the Admit Date and Service From Date of
  history record, bypass this edit.

  Trailer Information: 06, 08


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  Vicki, Yes the edit will still work after the modification based on the
  requirements given here.

  Sri
  ______________________________________
  Sri
  I let the HOST know that I was having CSC review the requests to the edi
  and
  recieved the response below.
  Based on this will the modification still work and also ensure the edit
  sets
  when it should for the edit's conditions.
  Vic



  Thanks Vicki..

  I advised the user of your review by CSC and she sent me the following
  email,
  can you add this to your research for CSC?    Thanks..Liza
  -----------------------------------------

  Liza:
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 47
____________________________________________________________________________


  Thank you for your help! I did take a look at a few of our former
  rejects and the suggestion will not work as originally presented.   I
  think it will need to look if it's a SNF claim on history and the OC 74
  is present for the DOS of the incoming claim:

  -If yes, then disregard the subsequent SNF claim DOS that are not
  applicable and do not assign 5608.
  -If no OC 74 for incoming claim DOS, then reject for 5608

  Please let me know if you would like some of these examples.

  Kathy




  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 48
____________________________________________________________________________


   6.   00025402   AUTO ADJUST INDICATOR NOT IN HISTORY

  DATE ENTERED:    02/09/07

  TITLE:           AUTO ADJUST INDICATOR NOT IN HISTORY

  PROJECT CODE:    CM01

  PRIORITY:        2

  RELEASE LEVEL: R2007400

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    WORK

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   3
  EST. HOURS:      0300
  ACT. HOURS:      0170
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  When an Inpatient auto adjustment is done for
  overapplied deductible the auto adj indicator 1 is not
  display in HIMR in INPA.

  ********************************************************
    07-02-09 11.06
    -> CSC.CSCBA             Business Analysts
     -> CSC.RCSTAFF           Release coordinators

   Yes, it would appear that CR 24398, implemented with R2006.3, is
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 49
____________________________________________________________________________

   the cause. There are several other fields that I would question
   are being updated, or updated correctly. This goes back to
   restructuring the history table being passed between modules,
   along with removing Summary Inpatient History.

   The module is moving a '1' to a field, but that is not the field
   being returned, and the field being returned is never updated
   with the '1'.

   My opinion is a CR needs to be opened to address the problem,
   which is not a HIMR Display issue, it is inpatient history not
   having the correct values.

   THANKS - Heather

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:          ____25402________    WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                 _x_   Minor
  FUNCTION:    _________________                 ___   Major
  PROGRAM:     _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Rick Wolfsheimer
      Telephone:           410-786-6160
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Ofelia Castillo
      Telephone:           469-372-6492
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Dennis Wingert
       Telephone:          717-909-2226
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 50
____________________________________________________________________________

  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  When an Inpatient auto-adjustment is done for over-applied
  deductible the auto adjustment field in HIMR (INPA) is not being
  populated with the correct value.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 51
____________________________________________________________________________

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  CWF must ensure that the Inpatient history is populating
  the correct value in the auto adjustment field in HIMR (INPA)
  when an Inpatient auto adjustment is process.

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  Posted to history is an Inpatient record with Dates of Service
  in January with deductible.

  An incoming Inpatient record with Dates of Service in December
  is received.

  Response
  The Inpatient record is processed. The INPA display a '1' in
  the auto adjustment field in HIMR (INPA).

  ***.......This is the width of the Release Document.......***

  The Entity List includes only NEW acronyms and terminology
  that is currently not in use in CWF.

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. HIMR (INPA)

  Solution Criteria: N/A
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 52
____________________________________________________________________________


    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 53
____________________________________________________________________________


   7.   00025408   MODIFY A/B EDIT 7244 TO NOT READ HISTORY FOR TOB 21X

  DATE ENTERED:    02/15/07

  TITLE:           MODIFY A/B EDIT 7244 TO NOT READ HISTORY FOR TOB 21X

  PROJECT CODE:    CM01

  PRIORITY:        2

  RELEASE LEVEL: R2007400

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM2000

  STATUS ON CR:    WORK

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   2
  EST. HOURS:      0125
  ACT. HOURS:      0110
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  Based on CR16732 a new edit should be created to
  reject Part B for PT/OT/ST if the DOS overlap a hospital
  stay for TOB 11x and 12x.

  A/B Crossover edit 7244 is reading TOB 11x and 21x for HUIP
  and not TOB 12x for HUOP.

  Modify the edit to only read TOB 121x on HUIP and to read TOB
  12x on HUOP.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 54
____________________________________________________________________________

 We are working an issue TRACS 403212, where a claim is getting
 CR-7244, but the user believes it shouldn't.


 The problem is described by the satellite as
 based on CR 16732, the error code will only set
 for type of bill 11x or 12x. The history my
 claim is rejecting against is a TOB 21x.
 I did not find anything in infoman that indicated
 the TOB editing has been changed. The edit
 descriptor indicates PT/SLP or OT services cannot
 be paid by Part B during hospitalization.
 I don't think that would include SNF claims.
 Please verify if the editing has changed to
 include SNF history.


 My research shows that this edit is not set up to bypass the
 satellites' claim scenario, which leads me to believe the
 edit is setting correctly.

 How can this be corrected?

 We have NDM'ed some files to you for your review.

 Process #85823,   file CWM.TEST.NDM.NE.T403212.UTILMOVE
 Process #85824    file CWM.TEST.NDM.NE.T403212.CLAIMS
 Process #85825,   file CWM.TEST.NDM.C07.T403212.RESPONSE
 If you have any   questions, please let me know.

 Thanks,
 Dionne Thompson
 TrailBlazer Health Ent. LLC.
 CWF SW/MA/GW/KS/NE/SO Hosts
 469-372-0793

 REQUIREMENTS:
 -------------
             DEFINITION AND ANALYSIS PHASES

 CR:          ___25408_________    WORK TYPE:   ___   Incidental
 SUBSYSTEM:   _________________                 _x_   Minor
 FUNCTION:    _________________                 ___   Major
 PROGRAM:     _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 55
____________________________________________________________________________


  CMS Participants:
  1. Name:                 Cathy Pflaum
      Telephone:           410-786-3016
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Yvonne Anderson
      Telephone:           469-372-5420
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Shailan Mandayam
       Telephone:          443-436-6732
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  ( ) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  (X) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  A/B crossover error code '7244' is setting in error when a
  Part B record is submitted that has a From or Thru Date that
  is equal to, overlaps or within a From and Thru Date of an
  Inpatient record with a TOB '211'.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 56
____________________________________________________________________________


  Error code '7244' is applicable only for TOB '11x' for
  Inpatient and '12x' for Outpatient.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  Modify error code '7244' to reject when the TOB is either '11x'
  for Inpatient or '12x' for Outpatient.


  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  Submit an HUBC record that has a From or Thru Date that is
  equal, within or overlapping the From or Thru Date of an HUIP
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 57
____________________________________________________________________________

  record posted to history that contains a TOB '11x'.

  Response
  The incoming HUBC record is rejected with error code '7244'.

  Event 1.2
  Submit an HUBC record that has a From or Thru Date that is
  equal, within or overlapping the From or Thru Date of an HUOP
  record posted to history that contains a TOB '12x'.

  Response
  The incoming HUBC record is rejected with error code '7244'.



  ***.......This is the width of the Release Document.......***

  The Entity List includes only NEW acronyms and terminology
  that is currently not in use in CWF.

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. Part B

  Solution Criteria: N/A

    EDITS AFFECTED:
  ***.......This is the width of the Release Document......***


  a. Error Code:    7244   ( )New (X)Modified ( )Deleted
  Disposition:      CR

  Type of Record:   Pt. B Carrier

  Error Message:
  Physical, Occupational and Speech Therapy services
  cannot be paid by Part B during an Inpatient or
  Outpatient hospitalization.

  Set Condition for edit '7244': Under Development

  A Part B service for Physical Therapy (Type of Service 'W'),
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 58
____________________________________________________________________________

 Occupational Therapy (Type of Service 'U') or Speech Therapy
 (HCPCS codes in Category '70') has From/Thru Dates that are
 equal to, overlap or are within the From/Thru Dates on an
 Inpatient stay (11x) or an Outpatient Stay (12) in history.

 Trailer Information: '08', '13'



 ***.......This is the width of the Release Document......***

 ISSUE/ANSWERS:
 --------------
   RISK/DESIGN ISSUE:

 ***.......This is the width of the Risk/Issue Memo.....***

 **********************************************************
 * Key the RISK/DESIGN ISSUE between the title and the end*
 * line. The CR # and title will appear on daily memo     *
 * with CR-relate information: CMS, BA, SE, SME and CAT. *
 * Example from CR 16871. "John: I keyed answers to your *
 * questions. Please review. Thanks, Joe" or Example      *
 * from CR 17062: "This CR is being placed in CMS status *
 * awaiting CMS's answer concerning TOS 53".              *
 * When keying, only place information that should appear *
 * on the memo between the header and *** width *** line. *
 * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
 **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 59
____________________________________________________________________________


   8.   00025448   UPDATE CONTRACTOR NAME ON CONTR FOR MULTIPLE CONTRACTORS

  DATE ENTERED:    03/15/07

  TITLE:           UPDATE CONTRACTOR NAME ON CONTR FOR MULTIPLE CONTRACTORS

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2007400

  GROUP LEVEL:     2

  HOST SITE ID:    EMBCBS1000

  STATUS ON CR:    WORK

  DOC. REQUIRED: Y

  HOST EVAL:       VALIDATE

  DOC RECEIVED:    Y

  ADDENDUM INFO: NONE

  EST. CATEGORY:   1
  EST. HOURS:      0075
  ACT. HOURS:      0055
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  Please change the contractor name to National Government Services, Inc.
  for the following contractor ids:
  00130 AdminaStar Federal
  00131 AdminaStar Federal
  00160 AdminaStar Federal
  00180 Associated Hospital Service
  00181 Associated Hospital Service
  00270 Anthem Plans of New Hampshire
  00308 Empire Medicare Services
  00332 AdminaStar Federal
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 60
____________________________________________________________________________

  00450 United Government Services
  00452 United Government Services
  00453 United Government Services
  00454 United Government Services
  00630 AdminaStar Federal
  00660 AdminaStar Federal
  00803 Empire Medicare Services
  00805 Empire Medicare Services
  17003 AdminaStar Federal
  This name change is effective immediately for these contractors, so
  please make the changes as soon possible.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:          _25448___________    WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                 _X_   Minor
  FUNCTION:    _________________                 ___   Major
  PROGRAM:     _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Rick Wolfsheimer
      Telephone:           410-786-6160
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Karen Chaffin
      Telephone:           469-372-0645
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Gopal Kumar
       Telephone:          443-436-6733
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *              blank line is found.                               *
  * HEADINGS   - Start in column 2.                                 *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 61
____________________________________________________________________________

  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  (X) Satellite Part B
  (X) Hospice
  (X) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  CWF has received a request to have the name of the following
  contractors changed to National Government Services, Inc. :

  00130
  00131
  00160
  00180
  00181
  00270
  00308
  00332
  00450
  00452
  00453
  00454
  00630
  00660
  00803
  00805
  17003


  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 62
____________________________________________________________________________

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

    NEW BUSINESS REQUIREMENTS:

  Requirement 1
  CWF will update the Contractor name to National Government
  Services Inc. for the following contractor IDs:

  00130   AdminaStar Federal
  00131   AdminaStar Federal
  00160   AdminaStar Federal
  00180   Associated Hospital Service
  00181   Associated Hospital Service
  00270   Anthem Plans of New Hampshire
  00308   Empire Medicare Services
  00332   AdminaStar Federal
  00450   United Government Services
  00425   United Government Services
  00453   United Government Services
  00454   United Government Services
  00630   AdminaStar Federal
  00660   AdminaStar Federal
  00803   Empire Medicare Services
  00805   Empire Medicare Services
  17003   AdminaStar Federal


  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 63
____________________________________________________________________________

 * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
 *******************************************************************
   EVENT-RESPONSE LIST:
 ***.......This is the width of the Release Document.......***

 Event 1.1
 Access the CONT file in HIMR for the following Contractors:

 00130   AdminaStar Federal
 00131   AdminaStar Federal
 00160   AdminaStar Federal
 00180   Associated Hospital Service
 00181   Associated Hospital Service
 00270   Anthem Plans of New Hampshire
 00308   Empire Medicare Services
 00332   AdminaStar Federal
 00450   United Government Services
 00425   United Government Services
 00453   United Government Services
 00454   United Government Services
 00630   AdminaStar Federal
 00660   AdminaStar Federal
 00803   Empire Medicare Services
 00805   Empire Medicare Services
 17003   AdminaStar Federal

 Response
 The name has been changed to National Government Services, Inc.

 ***.......This is the width of the Release Document.......***

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List: N/A
   1. Entity:
       Description:

 Areas Affected by the Problem.
   1. Contractor Table

 Solution Criteria: N/A

   EDITS AFFECTED: None
 ***.......This is the width of the Release Document......***

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 64
____________________________________________________________________________

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 65
____________________________________________________________________________


   9.   00025471   NPI PROJECT SUPPORT FOR THE OCTOBER 2007 RELEASE

  DATE ENTERED:    04/02/07

  TITLE:           NPI PROJECT SUPPORT FOR THE OCTOBER 2007 RELEASE

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2007400

  GROUP LEVEL:     1

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    CONF

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   3
  EST. HOURS:      0300
  ACT. HOURS:      0250
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  NPI project support for CMS and Contractors through out
  the NPI project.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:         25471____________   WORK TYPE: ___ Incidental
  SUBSYSTEM: _________________                _X_ Minor
  FUNCTION:   _________________               ___ Major
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 66
____________________________________________________________________________

  PROGRAM:     _________________                ___ New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Kathy Woytan
      Telephone:           410-786-4982
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Karen Chaffin
      Telephone:           469-372-0645
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Chet Powell
       Telephone:          443-436-6734
       FAX,Baltimore,MD:   443-436-0819
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  ( ) Host
  ( ) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***



______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 67
____________________________________________________________________________



    REASON FOR CHANGE:

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

    NEW BUSINESS REQUIREMENTS:

  Requirement 1
  xxxx

  Requirement 2
  xxx

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  ******************************************************************
  * If you want the EVENT-RESPONSEs printed in the release document*
  * remove the word "None" and delete the delimiter line. Number *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.        *
  * NBR 1, Event would be 1.1, NBR 2,Events would be 2.1, 2.2, etc.*
  ******************************************************************
    EVENT-RESPONSE LIST: None
  ***.......This is the width of the Release Document.......***

  Event 1.1

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 68
____________________________________________________________________________

  Response
  ***.......This is the width of the Release Document.......***

  The Entity List includes only NEW acronyms and terminology
  that is currently not in use in CWF.

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1.

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 69
____________________________________________________________________________

 * When keying, only place information that should appear *
 * on the memo between the header and *** width *** line. *
 * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
 **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 70
____________________________________________________________________________


   10. 00025472    5569-MODIFICATIONS TO NATIONAL COBA PROCESS

  DATE ENTERED:    04/03/07

  TITLE:           5569-MODIFICATIONS TO NATIONAL COBA PROCESS

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2007400

  GROUP LEVEL:     1

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    REQS

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   4
  EST. HOURS:      0750
  ACT. HOURS:      0680
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------

  4/3/07

  1) CWF will create a new 1-byte field in the header of the
  HUIP, HUOP, HUHH and HUHC records that will contain a new
  Liability Indicator.

  2) CWF will modify the logic for Beneficiary Liability, or
  No-Beneficiary Liability Crossover Indicators G and F) to
  read the new Liability Indicator field.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 71
____________________________________________________________________________


  3) CWF will modify the logic for Adj. Beneficiary Liability, or
  Adj. No-Beneficiary Liability Crossover Indicators U and T) to
  read the new Liability Indicator field.

  4) CWF will display the new field will be displayed on the header
  of the record in HIMR, and HITF.

  5) CWF will create a new error code that will reject any values
  other than L or N submitted in the new Liability Indicator field
  for the Part A records.

  6) CWF shall no longer reject non-assigned claims with error
  code 5248, or send Trailer 36 when the Beneficiary has a
  COBA ID (70000-77999).

  7) CWF will return a Trailer 29 if the COBA ID range (70000-
  77999) does not have an exclusion marked for non-assigned
  claims.

  8) CWF will mark the claim with Crossover Indicator 'C' if
  COBA ID range (70000-77999) has an exclusion marked for non-
  assigned claims.

  9) CWF will no longer bypass TOB 329 and 339 from COBC
  processing for Part A adjustment fully denied claims.




  THESE REQUIREMENTS are being REMOVED PER RE-REVIEW OF 5569
  4/13/07.--Yvonne Anderson


  9) CWF will accept and process a new unsolicited Abort
  Crossover Transaction (ACT). The new transaction will
  be sent from the Host as an incoming and returned from
  CWF as a response.

  10) CWF will create and return a response for the new ACT
  transactions when all mandatory fields are not complete,
  or the data in the field is invalid.


  11) CWF will create new error codes for the new ACT trans-
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 72
____________________________________________________________________________

  action.

  12) CWF will post a new 'Z' Indicator along with a Date the
  transaction was aborted, on Page 3 of the detail for Part
  A records, and on Page 2 of the detail for Part B/DMERC
  records.

  Yvonne Anderson
  CWFM Support Team

  469 372-5420

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:            ____25472________   WORK TYPE:   ___   Incidental
  SUBSYSTEM:     _________________                ___   Minor
  FUNCTION:      _________________                _x_   Major
  PROGRAM:       _________________                ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                  Kathy Woytan
      Telephone:            410-786-4982
      FAX, CMS:             410-786-0271
      Responsibilities:     REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:      Yvonne Anderson
      Telephone:            469-372-5420
      FAX,Richardson,TX:    469-372-0284
      Responsibilities:     DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:        Batchu/Dolphus/Dodson
       Telephone:           443-436-6739, 6721, 6715
       FAX,Baltimore,MD:    443-436-3803
       Responsibilities:    ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                            TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *              blank line is found.                               *
  * HEADINGS   - Start in column 2.                                 *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 73
____________________________________________________________________________

  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  (X) Satellite Part B
  (X) Hospice
  (X) Home Health
  (X) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  Currently CWF reads one of three No-Pay Codes, 'B', 'N' and
  'R' that is submitted from each contractor for HUIP, HUOP,
  HUHH and HUHC records to determine when fully denied claims
  with or without Beneficiary liability should be excluded.
  CMS has determined that using the No-Pay Codes to determine
  the exclusion is not resulting in suppressing all of the
  fully denied Part A claims. Therefore, CMS is modifying the
  exclusion criteria used by CWF to include new fields that
  the contractors will use to specify Beneficiary Liability.

  CMS has also determined that CWF should no longer bypass
  Part A adjustment claims, fully (100%) paid when the Type
  of Bill is '329' or '339'.

  CMS has also determined CWF will no longer set error code
  '5248' when an HUDC record is submitted as non-assigned.
  With this change the Trailer '36' will also no longer be
  received.

  Instead CWF will return a Trailer '29' when an non-assigned
  HUDC claim is processed if there are no exclusions marked for
  non-assigned claims for Medicaid COBA IDs (70000-77999). If
  there is an exclusion marked for non-assigned HUDC records,
  for Medicaid COBA ID (70000-77999) CWF will not cross the
  claim over. A Trailer '29' will not be received, and a
  Crossover Disposition Indicator 'C' will be displayed on the
  detail of the record in HIMR.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 74
____________________________________________________________________________




 ***.......This is the width of the Release Document.......***

 Analyze Current Situation:

 Alternative Solutions: N/A

 Evaluation of Alternative Solutions: N/A

 Recommendation: N/A


 *******************************************************************
 * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
 * the release document. Numerically list statements that reflect *
 * the NEW BUSINESS REQUIREMENTS.                                  *
 *******************************************************************

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 CWF must create a new one-byte field in the header of the
 incoming HUIP, HUOP, HUHH or HUHC record that will contain
 a new 'LIAB IND'. The value 'L' will be submitted in this
 field when the Beneficiary is liable for any of the services
 on the record. (The claim must be fully denied).

 CABEHUIN Copybook
  Field Name       = HUIN-LIAB-IND
  Field Number     =
  Field Position =

 CABEHUON Copybook
  Field Name       = HUON-LIAB-IND
  Field Number     =
  Field Position =

 The layouts for these copybooks will be included
 with the external copybook CR 00025480.

  Requirement 2
  Incoming HUIP, HUOP, HUHH and HUHC records may also
  contain a value 'N' in the new 'LIAB IND' field. The
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 75
____________________________________________________________________________

  'N' will be used when the Beneficiary is NOT liable
  for all of the services on the record. (The claim
  must be fully denied).

  Requirement 3
  CWF will create a new consistency error code '0047' that
  will set when the 'LIAB IND' field contains a value not
  equal to 'L', 'N' or Space.

  The edit will be bypassed when:

   -The Action Code is equal to '4' (Cancel Only)

   -The Action Code is equal to '7' (History Bill).

   -The record does not contain a No-Pay Code.

  Requirement 4
  CWF will modify the COBC inclusion/exclusion logic for the 'F'
  (Original 100% Denied Claims with No Beneficiary Liability),
  'G' (Original 100% Denied claims with Beneficiary Liability),
  'T' (Adjustment Claim 100% Denied Claims with No Beneficiary
  Liability) and 'U' (Adjustment Claim 100% Denied with
  Beneficiary Liability) to no longer read the No-Pay Codes
  'B', 'N', and 'R', but to read the new 'LIAB IND' field
  on the incoming HUIP, HUOP, HUHH, and HUHC records.

  Requirement 5
  CWF must create and display a new one-byte field 'LIAB
  IND' in the header of the HUIP, HUOP, HUHH and HUHC
  record in HIMR that will store the 'L' or 'N' Indicator.

  Requirement 6
  CWF must create and display a new one-byte field 'LIAB
  IND' in the header of the HUIP, HUOP, HUHH and HUHC
  record in ITF that will store the 'L' or 'N' Indicator.

  Requirement 7
  CWF must display the Crossover Indicators 'F', 'G', 'T' and 'U'
  on page 3 of the detail line of the INPH, OUTH, HHAH and HOSH
  for Part A from data in the new 'LIAB IND' field.

  Requirement 8
  CWF must create a new one-byte field 'LIAB IND' in
  the header of the HUIP, HUOP, HUHH and HUHC record of the
  Claim History that will store the 'L' or 'N' Indicator.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 76
____________________________________________________________________________


  (Copybooks internal to CWF)

  Requirement 9
  CWF must create a new one-byte field 'LIAB IND' in the
  header of the HUIP, HUOP, HUHH and HUHC record for the
  CMSCLM file.

  CABEHUIP Copybook
   Field Name       = HUIP-LIAB-IND
   Field Number     =
   Field Position =

  CABEHUOP Copybook
   Field Name       = HUOP-LIAB-IND
   Field Number     =
   Field Position =

  The layouts for these copybooks will be included
  with the external copybook CR 00025480.

  Requirement 10
  Previously CWF implemented error code '5248' to set
  when an HUBC or HUDC record was submitted as non-assigned
  and the Beneficiary's COIF File contains a State Medicaid
  COBA ID (70000-77999). With this change the '5248' will
  no longer set for HUDC record.

  -CWF must no longer set consistency error code '5248' for
   HUDC records.

  -CWF must continue to set consistency error code '5248' for
   HUBC records.


  Requirement 11
  CWF shall modify the logic for State Medicaid COBA IDs
  (70000-77999) to generate a Trailer '29' for HUDC records
  when there are no exclusions marked for non-assigned claims.

  Requirement 12
  CWF shall continue to exclude non-assigned claims for State
  Medicaid COBA IDs (70000-77999) and post a Cross-over
  Disposition Indicator 'C' in HIMR when there is an
  exclusion marked for non-assigned claims. The HUDC record
  will not cross over, and a '29' Trailer will not be
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 77
____________________________________________________________________________

 generated.

 Requirement 13
 CWF will no longer bypass Type of Bill '329' and '339'
 for Part A Adjustment Claims that are fully (100%) paid,
 Crossover Indicator 'S'.

 Requirement 14
 CWF must no longer generate Trailer '36' for HUDC records.

 CWF must continue to generate Trailer '36' for HUBC records
 when consistency error code '5248' is set.


 ***.......This is the width of the Release Document.......***


 The Event-Response List provides a description of the way
 that the system should function AFTER the change.

 *******************************************************************
 * If you want the EVENT-RESPONSES printed in the release document *
 * remove the word "None" and delete the delimiter line. Number    *
 * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
 * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
 *******************************************************************
   EVENT-RESPONSE LIST:
 ***.......This is the width of the Release Document.......***

 Event 1.1
 An HUIP, HUOP, HUHH, or HUHC record is submitted with denied
 services. The Beneficiary is liable for the services. The new
 'LIAB IND' in the header of the record contains an 'L'.

 Response
 The incoming record is processed with the new 'LIAB IND'.

 Event 2.1
 An HUIP, HUOP, HUHH, or HUHC record is submitted with denied
 services. The Beneficiary is not liable for all the services.
 The new 'LIAB IND' in the header of the record contains an 'N'.

 Response
 The incoming record is processed with the new 'LIAB IND'.

  Event 3.1
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 78
____________________________________________________________________________

  An HUIP, HUOP, HUHH, or HUHC record is submitted with a value
  not equal to 'L', 'N' or space.

  Response
  The record is rejected, error code '0047' is set.

  Event 4.1
  An HUIP, HUOP, HUHH, or HUHC record is submitted that contains
  a No-Pay Code equal to 'B', 'N' or 'R'. The new 'LIAB IND'
  field is equal to 'N'. The Beneficiary has an exclusion marked
  on the COIF File for Original 100% Denied Claims With No
  Beneficiary Liability.

  Response
  The record is processed through CWF. The record is not crossed
  over. Trailer '29' is not generated. Page 3 of the detail of
  the record in HIMR displays an 'F'.

  Event 4.2
  An HUIP, HUOP, HUHH, or HUHC record is submitted with a No-Pay
  Code equal to 'B', 'N' or 'R'. The Beneficiary has an exclusion
  marked on the COIF File for Original 100% Denied Claims With
  No Beneficiary Liability. The new 'LIAB IND' field is blank.

  Response
  The record is processed through CWF. The record crossed over.
  Trailer '29' is generated. Page 3 of the detail of the record
  in HIMR display an 'A'.

  Event 4.3
  An HUIP, HUOP, HUHH, or HUHC record is submitted that contains
  a No-Pay Code equal to 'B', 'N' or 'R'. The new 'LIAB IND' field
  is equal to 'L'. The Beneficiary has an exclusion marked on the COIF
  File for Original 100% Denied Claims With Beneficiary Liability.

  Response
  The record is processed through CWF. The record is not
  crossed over. Trailer '29' is not generated. Page 3 of the
  detail of the record in HIMR displays a 'G'.

  Event 4.4
  An HUIP, HUOP, HUHH, or HUHC record is submitted that contains
  a No-Pay Code equal to 'B', 'N' or 'R'. The Beneficiary has an
  exclusion marked on the COIF File for Original 100% Denied
  Claims With Beneficiary Liability. The new 'LIAB IND' field
  is blank.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 79
____________________________________________________________________________


 Response
 The record is processed through CWF. The record crossed over.
 Trailer '29' is generated. Page 3 of the detail of the record
 in HIMR display an 'A'.

 Event 4.5
 An adjustment is submitted for an HUIP, HUOP, HUHH or HUHC
 record. The adjustment contains a No-Pay Code equal to 'B',
 'N', or 'R'. The adjustment claim contains an 'L' in the new
 'LIAB IND' field. The Beneficiary has an exclusion marked on the
 COIF File for Adjustment 100% Denied Claims with No Beneficiary
 Liability.

 Response
 The record is processed through CWF. The record is not
 crossed over. Trailer '29' is not generated. Page 3 of the
 detail of the record in HIMR displays a 'T'.

 Event 4.6
 An adjustment is submitted for an HUIP, HUOP, HUHH or HUHC
 record. The adjustment contains a No-Pay Code equal to 'B',
 'N', or 'R'. The Beneficiary has an exclusion marked on the
 COIF File for Adjustment 100% Denied Claims With No Beneficiary
 Liability. The new 'LAIB IND' field is blank.

 Response
 The record is processed through CWF. The record crossed over.
 Trailer '29' is generated. Page 3 of the detail of the record
 in HIMR display an 'A'.

 Event 4.7
 An adjustment is submitted for an HUIP, HUOP, HUHH or HUHC
 record. The adjustment contains a No-Pay Code equal to 'B',
 'N', or 'R'. The adjustment contains an 'N' in the new 'LIAB
 IND' field. The Beneficiary has an exclusion marked on the
 COIF File for Adjustment 100% Denied Claims with Beneficiary
 Liability.

 Response
 The record is processed through CWF. The record is not
 crossed over. Trailer '29' is not generated. Page 3 of the
 detail of the record in HIMR displays a 'U'.

  Event 5.1
  Review the header of an HUIP, HUOP, HUHH or HUHC record
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 80
____________________________________________________________________________

 in HIMR.

 Response
 The record contains a new one-byte 'LIAB IND' field.

 Event 6.1
 Review the header of an HUIP, HUOP, HUHH or HUHC record
 in ITF.

 Response
 The record contains a new one-byte 'LIAB IND' field.

 Event 7.1
 Submit an HUIP, HUOP, HUHH or HUHC record for a Beneficiary
 that has an exclusion marked on the COIF File for Liability
 or No Liability for an original claim.

 Response
 Page 3 of the record posted in HIMR displays a 'F' or
 'G' indicator.

 Event 7.2
 Submit an HUIP, HUOP, HUHH or HUHC record for a Beneficiary
 that has an exclusion marked on the COIF File for Liability
 or No Liability for an adjusted claim.

 Response
 Page 3 of the record posted in HIMR displays a 'T' or
 'U' indicator.

 Event 8.1
 Review the header of an HUIP, HUOP, HUHH or HUHC record
 of the Beneficiary's Claim History.

 Response
 The record contains a new one-byte 'LIAB IND' field.

 Event 9.1
 Review the header of an HUIP, HUOP, HUHH or HUHC record
 of the CMSCLM file.

 Response
 The record contains a new one-byte 'LIAB IND' field.

  Event 10.1
  Submit a non-assigned HUBC record for a Beneficiary
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 81
____________________________________________________________________________

 that has a COIF File with a COBA ID in the '70000-77999'
 range. The Date of Service on the incoming record is
 within the range of the Effective Date of the COBA ID.
 The COBA ID does contains an exclusion for non-assigned
 records.

 Response
 The record is rejected, error code '5248' is set.

 Event 10.2
 Submit a non-assigned HUDC record for a Beneficiary
 that has a COIF File with a COBA ID in the '70000-77999'
 range. The Date of Service on the incoming record is
 within the range of the Effective Date of the COBA ID.
 The COBA ID does contains an exclusion for non-assigned
 records.

 Response
 The record is processed, error code '5248' is not set.

 Event 11.1
 Submit a non-assigned HUDC record for a Beneficiary
 that has a COIF File with a COBA ID in the '70000-77999'
 range. The Date of Service on the incoming record are
 within the range of the Effective Date of the COBA ID.
 The COBA ID does not contain any inclusions/exclusions.

 Response
 The record is processed, and crossed over. Trailer '29'
 is generated. An 'A' is posted to the detail of the
 claim in history.

 Event 12.1
 Submit a non-assigned HUDC record for a Beneficiary
 that has a COIF File with a COBA ID in the '70000-77999'
 range. The Date of Service on the incoming record are
 within the range of the Effective Date of the COBA ID.
 The COBA ID contains an exclusion for non-assigned claims.

 Response
 The record is processed, and does not cross over. Trailer
 '29' is not generated. A 'C' is posted to the detail of
 the claim in history.

  Event 13.1
  Submit an adjustment for a HUHH record that contains a
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 82
____________________________________________________________________________

 Type of Bill Equal to '329' or '339'. The COIF File for
 the Beneficiary has an exclusion marked for Adjustment
 Claims fully 100% paid.

 Response
 The record is processed, and does not cross over. Trailer
 '29' is not generated. An 'S' is posted to the detail of
 the claim in history.

 Event 14.1
 Submit a non-assigned HUBC record for a Beneficiary that
 has a COIF File with a COBA ID in the '70000-77999' range.
 The Date of Service on the incoming record is within the
 range of the Effective Date of the COBA ID. The COIF
 File contains an exclusion for non-assigned claims.

 Response
 The record is rejected. Error code '5248' is set, and
 Trailer '36' is returned.

 Event 14.2
 Submit a non-assigned HUDC record for a Beneficiary
 that has a COIF File with a COBA ID in the '70000-77999'
 range. The Date of Service on the incoming record is
 within the range of the Effective Date of the COBA ID.
 The COIF File contains an exclusion for non-assigned claims.

 Response
 The record is processed. The CWF response file does not
 return a Trailer '36'.

 ***.......This is the width of the Release Document.......***

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List: N/A
   1. Entity:
       Description:

 Areas   Affected by the Problem.
   1.    Part A
   2.    Part B/DMERC
   3.    COIF File
   4.    Trailer '36'

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 83
____________________________________________________________________________

 Solution Criteria: N/A

   EDITS AFFECTED:
 ***.......This is the width of the Release Document......***

 a.   Error Code:   5248   ( )New (X)Modified ( )Deleted

 Disposition: UR

 Type of Record: Pt. B Carrier

 Error Message:
 A Part B claim is received with an Assignment
 Indicator other than 'A', and the COIF File
 indicates that the claim is during an active
 Medicaid insurance period.

 Set Condition for edit '5248': Under Development
 A Part B claim is received with an Assignment Indicator
 other than 'A' and the BOI Auxiliary File indicates
 the claim is during an active Medicaid insurance period.

 Trailer Information: '08', '36'


 b.   Error Code:   5248   ( )New ( )Modified (X)Deleted w/R2007400

 Disposition: UR

 Type of Record: DMEPOS

 Error Message:
 A Part B or DME claim is received with an
 Assignment Indicator other than 'A', and the
 COIF File indicates that the claim is during
 an active Medicaid insurance period.

 Set Condition for edit '5248': Under Development
 A Part B or DME claim is received with an Assignment
 Indicator other than 'A' and the BOI Auxiliary File indicates
 the claim is during an active Medicaid insurance period.

 Trailer Information: '08', '36'



______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 84
____________________________________________________________________________

  c.   Error Code:   0047   (X)New ( )Modified ( ) ( )Deleted

  Disposition: ER

  Type of Record: Hospital, OUTP, HHA, Hospice, SNF

  Error Message:
  An invalid value has been entered for the 'LIAB IND'
  field.

  Set Condition for edit '0047':      UNDER DEVELOPMENT

  Trailer Information: '08'




  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 85
____________________________________________________________________________


                                      12:36PM   Thur. May 10, 2007

  From: Brian.Pabst@cms.hhs.gov.tbhe
  To: Kathy.Woytan@cms.hhs.gov.tbhe; yvonne.anderson@trailblazerhealth



  Hello Kathy et al:    Thanks for the great walk-through this morning...



  As discussed, requirement 5569.4.1 (links to requirement 14 of
  CR#00025472 walk-through document) indicates that CWF shall exclude
  types of bills 329 and 339 when the trading partner wishes to exclude
  either "Original claims, fully paid, without deductible or co-insurance
  remaining" or "Adjustment claims, fully paid, without deductible or
  co-insurance remaining."   Given that CWF considers types of bills 329 &
  339 to be 'adjustment' claims, CWF would only be able to allow for
  exclusion of "Adjustment claims, fully paid w/out deductible or
  co-insurance remaining, " as per the COIF. This functionality is
  actually ied to requirement 13 within CR#00025472.   Business
  requirement #14 within CR00025472 thus becomes unnecessary.



  Thank you, Brian P.

  -------------------------------------------




  Here is what I received from Brian based on the meeting we had
  last week.



  Kathy Woytan
  Business Applications Management Group
  Division of Business Application Analysis
  Common Working File Group Team Lead
  Kathryn.Woytan@cms.hhs.gov
  410-786-4982

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 86
____________________________________________________________________________

 -----------------------------------
 As I recall, we discussed the fact that CWF would de-obligate the
 remaining 2 addt'l 10-byte segments within field 34 of the HUBC and HUDC
 claim transactions (header) & that CWF would display the claim-based
 Medigap COBA ID on the HIMR detailed history screens without a crossover
 disposition when the individual cannot be found on the COIF or when the
 Medigap insurer is in test mode with the COBC. Additionally, we are
 discontinuing trailer 37. I believe this covers the major points of the
 discussion for what a confirmatory note was required....



 Thank you, Brian R. Pabst--



 -------------------------------------



 From: Pabst, Brian R. (CMS/OFM)
 Sent: Wednesday, April 25, 2007 12:05 PM
 To: Woytan, Kathryn A. (CMS/OIS); Kettish, Donna E. (CMS/OFM)
 Cc: 'Yvonne.anderson@trailblazerhealth.com'
 Subject: Questions for 4/26/07 Mtg w/ CWF re CR 5601
 Importance: High



 Hi Kathy: In addition to the issues you've sent me, which I am
 attaching for others, I would like to also address the following
 points/issues at tomorrow's 9AM mtg re CR 5601:


 1)   Should contractors input the Medigap claim-based COBA ID as
 0000055000-0059999 or spaces within the 1st 10-byte iteration of field
 34 of the HUBC or HUDC claim transactions (header)? Based upon our
 preliminary conversation of this morning, you believed "yes."

  2)   As part of CWF's validation editing for correct number, will a
  separate edit be in place if the contractor happens to place an
  otherwise valid value for field 34 in the incorrect 10-byte iteration
  (i.e., 2nd or 3rd iteration)?   IF so, I need to address this in the
  CR....NOTE: To me, it would not make sense to return alert code 7704
  via trailer 21 for these situations, since the values are really valid
  just placed in the incorrect iterative segment? This would not, in my
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 87
____________________________________________________________________________

  opinion, go over big with the provider community, particularly if the
  provider did everything appropriately on the incoming claim.

  3)   Several commenters inquired whether the trailer 21 would be the
  same format as is used in Part A claims processing today. You believed
  yes.

  I am also attaching a finalized version of CR 5601 for use at tomorrow's
  mtg. This version now incorporates elements from the contractor
  comments, none of which would influence system hours.....



  I understand you'll coordinate call logistics for tomorrow & will send
  an appointment....Let me know if that needs to change.



  Thanks, BRP.




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 88
____________________________________________________________________________


   11. 00025478    ARCHIVE MAINTENANCE FOR RELEASE R2007400

  DATE ENTERED:    04/05/07

  TITLE:           ARCHIVE MAINTENANCE FOR RELEASE R2007400

  PROJECT CODE:    CM01

  PRIORITY:        2

  RELEASE LEVEL: R2007400

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    REQS

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   0
  EST. HOURS:      0025
  ACT. HOURS:      0000
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  ARCHIVE OBSOLETE CWF SOFTWARE CHANGES DUE TO MAINTENANCE CHANGES
  FOR RELEASE R2007400.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:         __________25478__   WORK TYPE: ___ Incidental
  SUBSYSTEM: _________________                _X_ Minor
  FUNCTION:   _________________               ___ Major
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 89
____________________________________________________________________________

  PROGRAM:     _________________                ___ New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Kathy Woytan
      Telephone:           410-786-4982
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Karen Chaffin
      Telephone:           469-372-0645
      FAX,Richardson,TX:   469-372-1022
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Chet Powell
       Telephone:          443-436-6734
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  (X) Satellite Part B
  ( ) RHHI
  ( ) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  This CR will record those CWFM configuration items that are
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 90
____________________________________________________________________________

  to be archived and/or restored with the R2007400 Release.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  Archive the following SOURCE modules:

   HOST:
   -----

      CR 000xxxxx (R2007400 Release)
         HIABCMSP
         CABBHIRD
         RRBXTRCT
         xxxxxxxx


      PR 000xxxxx (R200xx00 Release)
         xxxxxxxx
         xxxxxxxx

   SATL:
   -----

      CR 000xxxxx (R200xx00 Release)
         xxxxxxx
         xxxxxxx


______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 91
____________________________________________________________________________


     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


 Archive the following COPYBOOKS modules:

   HOST:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx

     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx

   SATL:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


 Archive the following CICSMAP modules:

   HOST:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


   SATL:
   -----

      CR 000xxxxx (R200xx00 Release)
         xxxxxxxx
         xxxxxxxx
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 92
____________________________________________________________________________



  Archive the following UTILITY modules:

   HOST:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx



     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

   SATL:
   -----

     CR 000xxxxx (R200xx00 Release)-
        xxxxxxxx
        xxxxxxxx



     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


  Archive the following JCL modules:

   HOST:
   -----

     CR 000xxxxx (R2003100 Release)
        CABMWC89

     CR 000xxxxx (R200XX00 Release)
        xxxxxxxx
        xxxxxxxx

      PR 000xxxxx (R200xx00 Release)
         xxxxxxxx
         xxxxxxxx
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 93
____________________________________________________________________________


   SATL:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


  Archive the following PROC modules:

   HOST:
   -----

     CR 000xxxxx (R2003100 Release)
        CAB$WC89

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

   SATL:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


  Archive the following IDCMCARD modules:

    HOST:
    -----
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 94
____________________________________________________________________________


     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

   SATL:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


  Archive the following CONTROL CARD modules:

   HOST:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

   SATL:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 95
____________________________________________________________________________


  Archive the following CICS RDO Entries:

   HOST:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

   SATL:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx




  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  ******************************************************************
  * If you want the EVENT-RESPONSEs printed in the release document*
  * remove the word "None" and delete the delimiter line. Number *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.        *
  * NBR 1, Event would be 1.1, NBR 2,Events would be 2.1, 2.2, etc.*
  ******************************************************************
    EVENT-RESPONSE LIST: None
  ***.......This is the width of the Release Document.......***

  Event 1.1
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 96
____________________________________________________________________________


 Response
 ***.......This is the width of the Release Document.......***

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List: N/A
   1. Entity:
       Description:

 Areas Affected by the Problem.
   1.

 Solution Criteria: N/A

   EDITS AFFECTED: None
 ***.......This is the width of the Release Document......***

 a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
 Disposition:

 Type of Record:

 Error Message:

 Set Condition for edit '####':

 Trailer Information:


 ***.......This is the width of the Release Document......***

 ISSUE/ANSWERS:
 --------------
   RISK/DESIGN ISSUE:

 ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 97
____________________________________________________________________________

  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************

  --- Received from CSC.CF00083 443-436-6732          07-06-18 12.07
    -> CSC.RCSTAFF           Release coordinators
    -> CWFSE.CF91081         LIZ JONES                      469
    -> CWFSE.CF90144         JANET JOHNSON                  0469
    -> CSC.CF00051           JERRY WEAVER                   CSC

  Hi Liz,

  Thanks for catching this issue. We will be archiving
  one proc and associated JCL with 2007400 (CR25478) Release.
  *.HOST.PROC ----> CAB$WC89
  *.HOST.JCL ----> CABMWC89

  Please let us know if you have any other questions/Concerns.

  Thanks
  Raju
  ------------------------------------------------------------------
  --- Received from CWFSE.CF91081 205-220-3696        06-08-24 14.41
    -> CWFSE.CF90144         JANET JOHNSON                  0469
    -> CWFSE.CF91081         LIZ JONES                      469
    -> CSC.CF00051           JERRY WEAVER                   CSC

  Jerry,

      In cleaning up some old JCL I noticed that CAB$WC89 is still
   listed as a current proc and is in the documentation. I do
   not believe Trailblazers nor Cahaba uses this PROC anymore.
   The program it executes CABPOMN is not even sent to us anymore.
   Can you look at archiving this process.
                                           Thanks,
                                           Liz Jones




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 98
____________________________________________________________________________


   12. 00025479    R2007400 INSTALLATION INSTRUCTION - ONE-TIMER CONTROL CR

  DATE ENTERED:    04/05/07

  TITLE:           R2007400 INSTALLATION INSTRUCTION - ONE-TIMER CONTROL CR

  PROJECT CODE:    CM01

  PRIORITY:        2

  RELEASE LEVEL: R2007400

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    REQS

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   0
  EST. HOURS:      0025
  ACT. HOURS:      0000
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  THIS CR WILL CONTAIN THE INSTALLATION INSTRUCTIONS FOR EACH INDIVIDUAL
  CR WITHIN RELEASE R2007400 THAT REQUIRES ANY SPECIAL INSTALLATION
  PROCEDURES. THE INDIVIDUAL CRS WILL REFERENCE THIS CR AS THE REPOSITORY
  FOR THE INSTRUCTIONS.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:         25479____________   WORK TYPE: ___ Incidental
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                       Page 99
____________________________________________________________________________

  SUBSYSTEM:   _________________                _x_ Minor
  FUNCTION:    _________________                ___ Major
  PROGRAM:     _________________                ___ New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Kathy Woytan
      Telephone:           410-786-4982
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Karen Chaffin
      Telephone:           469-372-0645
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Chet Powell
       Telephone:          443-436-6734
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  (X) Satellite Part B
  (X) RHHI
  (X) Home Health
  (X) DMERC
  ***.......This is the width of the Release Document.......***

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 100
____________________________________________________________________________

    REASON FOR CHANGE:
  This CR will track one-timers and Installation Instructions for
  the R2007400 Release. Host and Satellites should refer to the
  R2007400 Release Documentation Appendix A for information
  concerning interdependencies and timing of these jobs.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  One-Timer Job Name:
  Originating CR:     000xxxxx
  Run by Host/Satl:
  Files Prod/Test:
  Purpose of Job:




  Requirement 2
  One-Timer Job Name:
  Originating CR:
  Run by Host/Satl:
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 101
____________________________________________________________________________

  Files Prod/Test:
  Purpose of Job:


  Requirement 3
  One-Timer Job Name:
  Originating CR:
  Run by Host/Satl:
  Files Prod/Test:
  Purpose of Job:



  Requirement 4
  One-Timer Job Name:
  Originating CR:
  Run by Host/Satl:
  Files Prod/Test:
  Purpose of Job:


  Requirement 5
  One-Timer Job Name:
  Originating CR:
  Run by Host/Satl:
  Files Prod/Test:
  Purpose of Job:


  Requirement 6
  One-Timer Job Name:
  Originating CR:
  Run by Host/Satl:
  Files Prod/Test:
  Purpose of Job:


  Requirement 7
  One-Timer Job Name:
  Originating CR:
  Run by Host/Satl:
  Files Prod/Test:
  Purpose of Job:


  Requirement 8
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 102
____________________________________________________________________________

  One-Timer Job Name:
  Originating CR:
  Run by Host/Satl:
  Files Prod/Test:
  Purpose of Job:


  Requirement 9
  One-Timer Job Name:
  Originating CR:
  Run by Host/Satl:
  Files Prod/Test:
  Purpose of Job:


  Requirement 10
  One-Timer Job Name:
  Originating CR:
  Run by Host/Satl:
  Files Prod/Test:
  Purpose of Job:


  ***.......This is the width of the Release Document.......***
  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  ******************************************************************
  * If you want the EVENT-RESPONSEs printed in the release document*
  * remove the word "None" and delete the delimiter line. Number *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.        *
  * NBR 1, Event would be 1.1, NBR 2,Events would be 2.1, 2.2, etc.*
  ******************************************************************
    EVENT-RESPONSE LIST: None
  ***.......This is the width of the Release Document.......***

  Event 1.1

  Response
  ***.......This is the width of the Release Document.......***

  The Entity List includes only NEW acronyms and terminology
  that is currently not in use in CWF.

  Entity List: N/A
    1. Entity:
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 103
____________________________________________________________________________

        Description:

  Areas Affected by the Problem.
    1.

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 104
____________________________________________________________________________


   13. 00025480    EXTERNAL COPYBOOK CHANGES FOR R2007400

  DATE ENTERED:    04/05/07

  TITLE:           EXTERNAL COPYBOOK CHANGES FOR R2007400

  PROJECT CODE:    CM01

  PRIORITY:        2

  RELEASE LEVEL: R2007400

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    REQS

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   0
  EST. HOURS:      0025
  ACT. HOURS:      0000
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  This CR will serve as the repository for all copybook changes that are
  made as a result of Release R2007400.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:         25480____________   WORK TYPE: ___ Incidental
  SUBSYSTEM: _________________                _x_ Minor
  FUNCTION:   _________________               ___ Major
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 105
____________________________________________________________________________

  PROGRAM:     _________________                ___ New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Kathy Woytan
      Telephone:           410-786-4982
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Karen Chaffin
      Telephone:           469-372-0645
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Chet Powell
       Telephone:          443-436-6734
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *              blank line is found.                               *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *              after a colon. Try to format as it should appear *
  *              in the Release Document.                           *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  (X) Satellite Part B
  (X) RHHI
  (X) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  Make external copybook updates that are associated with the
  CRs contained in the R2007400 Release, and communicate them
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 106
____________________________________________________________________________

  to the Standard System Maintainers.
  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

   Requirement 1

   Copybook Name: xxxxxxxx

  These changes are associated with CRs 000xxxxx, 000xxxxx:


   Requirement 2

   Copybook Name: xxxxxxxx

  These changes are associated with CRs 000xxxxx, 000xxxxx:



  Requirement 3

  Copybook Name: xxxxxxxx

  These changes are associated with CR 000xxxxx:



  Requirement 4

  Copybook Name: xxxxxxxx
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 107
____________________________________________________________________________


  These changes are associated with CR 000xxxxx:



  Requirement 6

  Copybook Name: xxxxxxxx

  These changes are associated with CR 000xxxxx:


  Requirement 7

  Copybook Name: xxxxxxxx

  These changes are associated with CR 000xxxxx:


  Requirement 8

  Copybook Name: xxxxxxxx

  These changes are associated with CR 000xxxxx:

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  ******************************************************************
  * If you want the EVENT-RESPONSEs printed in the release document*
  * remove the word "None" and delete the delimiter line. Number *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.        *
  * NBR 1, Event would be 1.1, NBR 2,Events would be 2.1, 2.2, etc.*
  ******************************************************************
    EVENT-RESPONSE LIST: None
  ***.......This is the width of the Release Document.......***

  Event 1.1

  Response
  ***.......This is the width of the Release Document.......***

  The Entity List includes only NEW acronyms and terminology
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 108
____________________________________________________________________________

  that is currently not in use in CWF.

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1.

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:

  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 109
____________________________________________________________________________


   14. 00025481    DOCUMENTATION CHANGES FOR RELEASE R2007400

  DATE ENTERED:    04/05/07

  TITLE:           DOCUMENTATION CHANGES FOR RELEASE R2007400

  PROJECT CODE:    CM01

  PRIORITY:        2

  RELEASE LEVEL: R2007400

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    REQS

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   0
  EST. HOURS:      0025
  ACT. HOURS:      0000
  CAT/CR EVAL:     N

  COMMENT:         3

  DESCRIPTION:
  ------------
  THIS CR DESCRIBES CHANGES TO DOCUMENTATION RESULTING FROM THE
  CWFM RELEASE.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:         25481____________   WORK TYPE: ___ Incidental
  SUBSYSTEM: _________________                ___ Minor
  FUNCTION:   _________________               _X_ Major
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 110
____________________________________________________________________________

  PROGRAM:     _________________                ___ New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Kathy Woytan
      Telephone:           410-786-4982
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Karen Chaffin
      Telephone:           469-372-0645
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Kocovinos
       Telephone:          443-436-6706
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  (X) Satellite Part B
  (X) RHHI
  (X) Home Health
  (X) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  Make documentation updates that are not associated with a CR in the
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 111
____________________________________________________________________________

  R2007400 release and communicate them to the users.

    NEW BUSINESS REQUIREMENTS:
  The documentation updates that are not associated with a CR in the
  R2007400 release are listed below:

  1.   DOCUMENTATION UPDATE REQUESTED:
       ASSOCIATED CR:
       ASSOCIATED DOC ONLY:
       ASSOCIATED RELEASE:
       REQUESTED DATE:
       REQUESTED BY: Kocovinos
       PHONE NUMBER: 443-436-6706
       LOCATION OF CHANGE(S):

       DESCRIPTION OF CHANGE(S):
       Fix all grammar, punctuation, upper/lower case
       issues throughout the documentation.


  2.   DOCUMENTATION UPDATE REQUESTED:
       ASSOCIATED CR:
       ASSOCIATED DOC ONLY:
       ASSOCIATED RELEASE:
       REQUESTED DATE:
       REQUESTED BY:
       PHONE NUMBER:
       LOCATION OF CHANGE(S):

       DESCRIPTION OF CHANGE(S):




  3.   DOCUMENTATION UPDATE REQUESTED:
       ASSOCIATED PR:
       ASSOCIATED DOC ONLY:
       ASSOCIATED RELEASE:
       REQUESTED DATE:
       REQUESTED BY:
       PHONE NUMBER:
       LOCATION OF CHANGE(S):

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 112
____________________________________________________________________________

       DESCRIPTION OF CHANGE(S):




  4.   DOCUMENTATION UPDATE REQUESTED:
       ASSOCIATED CR:
       ASSOCIATED DOC ONLY:
       ASSOCIATED RELEASE:
       REQUESTED DATE:
       REQUESTED BY:
       PHONE NUMBER:
       LOCATION OF CHANGE(S):

       DESCRIPTION OF CHANGE(S):




  5.   DOCUMENTATION UPDATE REQUESTED:
       ASSOCIATED PROB:
       ASSOCIATED DOC ONLY:
       ASSOCIATED RELEASE:
       REQUESTED DATE:
       REQUESTED BY:
       PHONE NUMBER:
       LOCATION OF CHANGE(S):

       DESCRIPTION OF CHANGE(S):




  6.   DOCUMENTATION UPDATE REQUESTED:
       ASSOCIATED CR:
       ASSOCIATED DOC ONLY:
       ASSOCIATED RELEASE:
       REQUESTED DATE:
       REQUESTED BY:
       PHONE NUMBER:
       LOCATION OF CHANGE(S):

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 113
____________________________________________________________________________

       DESCRIPTION OF CHANGE(S):


  7.   DOCUMENTATION UPDATE REQUESTED:
       ASSOCIATED CR:
       ASSOCIATED DOC ONLY:
       ASSOCIATED RELEASE:
       REQUESTED DATE:
       REQUESTED BY:
       PHONE NUMBER:
       LOCATION OF CHANGE(S):

       DESCRIPTION OF CHANGE(S):



  8.   DOCUMENTATION UPDATE REQUESTED:
       ASSOCIATED CR:
       ASSOCIATED DOC ONLY:
       ASSOCIATED RELEASE:
       REQUESTED DATE:
       REQUESTED BY:
       PHONE NUMBER:
       LOCATION OF CHANGE(S):

       DESCRIPTION OF CHANGE(S):


  9.   DOCUMENTATION UPDATE REQUESTED:
       ASSOCIATED CR:
       ASSOCIATED DOC ONLY:
       ASSOCIATED RELEASE:
       REQUESTED DATE:
       REQUESTED BY:
       PHONE NUMBER:
       LOCATION OF CHANGE(S):

       DESCRIPTION OF CHANGE(S):




  10. DOCUMENTATION UPDATE REQUESTED:
      ASSOCIATED PROB:
      ASSOCIATED DOC ONLY:
      ASSOCIATED RELEASE:
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 114
____________________________________________________________________________

     REQUESTED DATE:
     REQUESTED BY:
     PHONE NUMBER:
     LOCATION OF CHANGE(S):

     DESCRIPTION OF CHANGE(S):


  11. DOCUMENTATION UPDATE REQUESTED:
      ASSOCIATED CR:
      ASSOCIATED DOC ONLY:
      ASSOCIATED RELEASE:
      REQUESTED DATE:
      REQUESTED BY:
      PHONE NUMBER:
      LOCATION OF CHANGE(S):

     DESCRIPTION OF CHANGE(S):




  12. DOCUMENTATION UPDATE REQUESTED:
      ASSOCIATED CR:
      ASSOCIATED DOC ONLY:
      ASSOCIATED RELEASE:
      REQUESTED DATE:
      REQUESTED BY:
      PHONE NUMBER:
      LOCATION OF CHANGE(S):

     DESCRIPTION OF CHANGE(S):




  13. DOCUMENTATION UPDATE REQUESTED:
      ASSOCIATED CR:
      ASSOCIATED DOC ONLY:
      ASSOCIATED RELEASE:
      REQUESTED DATE:
      REQUESTED BY:
      PHONE NUMBER:
      LOCATION OF CHANGE(S):
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 115
____________________________________________________________________________


      DESCRIPTION OF CHANGE(S):



  ***.......This is the width of the Release Document......***
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

   EDITS AFFECTED:

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 116
____________________________________________________________________________


   15. 00025484    5589-NEW CONTRACTOR NUMBER FOR JURISDICTION 3 ARIZONA PT A

  DATE ENTERED:    04/06/07

  TITLE:           5589-NEW CONTRACTOR NUMBER FOR JURISDICTION 3 ARIZONA PT A

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2007400

  GROUP LEVEL:     1

  HOST SITE ID:    CWFM2000

  STATUS ON CR:    WORK

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   2
  EST. HOURS:      0125
  ACT. HOURS:      0108
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  The purpose of this change request is to notify all interested
  parties that the Centers for Medicare & Medicaid Services
  (CMS) has a need to assign a new contractor workload number
  for the Jurisdiction 3 Arizona Part A Workload. Currently the
  Arizona Part A workload is identified by contractor number 03001.
  CMS is changing the Arizona Part A number to 03101 so that 03001
  can be used as global number for the entire Part A of Jurisdiction 3.
  The global number for the entire Part B of Jurisdiction 3 will be 03002.
  The global number for all of Jurisdiction 3 will be 03000.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 117
____________________________________________________________________________

  CWF shall be modified to reflect the new contractor number,
  03101 for the Arizona Part A Workload.

  CWF REQS are:
  1) Add new A/B MAC 03101 to the CONTRACTOR Table.
  2) A crosswalk will be required for old Contractor '00030'
     and '03001' to the new Contactor '03101'.
  3) Update the edit indicator with an X on the CONT file
     for 03001 and next to the x indicate 03101

  4) Update the edit indicator with an X on the CONT file
     for 00030 where 03001 is indicated and replace with
     03101 next to the X.

  5) UTLJTRAN update for COBCAUX file for 03001 to update to be
     03101.


  CWF should not be receiving claims under 03001 for
  the Global Contractor.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:          _25484___________    WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                 _X_   Minor
  FUNCTION:    _________________                 ___   Major
  PROGRAM:     _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Kathy Woytan
      Telephone:           410-786-4982
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Karen Chaffin
      Telephone:           469-372-0645
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.  PROG ANALYST:      Sri Anne
      Telephone:         443-436-6723
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 118
____________________________________________________________________________

     FAX,Baltimore,MD:   443-436-3803
     Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                         TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  The purpose of this change request is to notify all interested
  parties that the Centers for Medicare & Medicaid Services (CMS)
  has a need to assign a new contractor workload number for the
  Jurisdiction 3 Arizona Part A Workload. Currently the Arizona
  Part A workload is identified by contractor number 03001. CMS is
  changing the Arizona Part A number to 03101 so that 03001 can
  be used as global number for the entire Part A of Jurisdiction
  3. The global number for the entire Part B of Jurisdiction 3
  will be 03002. The global number for all of Jurisdiction 3 will
  be 03000.

  CWF shall be modified to reflect the new contractor number
  03101 for the Arizona Part A workload.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 119
____________________________________________________________________________


  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  CWF will add new A/B MAC Contractor number '03101' to the
  Contractor table with the following name and address:

  Noridian Mutual Insurance Company
  D.B.A. Noridian Admin Srvc, LLC
  901 40th Street South, Suite 1
  Fargo, ND 58103

  Requirement 2
  A crosswalk will be required for Old Contractor '00030' and
  '03001' to the new Contractor '03101'.

  Requirement 3
  CWF will update the edit indicator with an X on the CONT file
  for '03001', and next to the X, indicate '03101'.

  Requirement 4
  CWF will update the edit indicator with an X on the CONT file
  for '00030' where '03001' is indicated and replace with '03101'
  next to the X.

  Requirement 5
  Run the one-time utility UTLJTRAN to update the Contractor
  transition on the COBCAUX file for '03001' to apply to new
  Contractor '03101'.

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 120
____________________________________________________________________________


  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  Access the CONT file in HIMR for new Contractor '03101'.

  Response
  Contractor '03101' has been added with the following name
  and address:

  Noridian Mutual Insurance Company
  D.B.A. Noridian Admin Srvc, LLC
  901 40th Street South, Suite 1
  Fargo, ND 58103

  Event 2.1
  An adjustment is submitted by Contractor '03101', on or after
  10/01/2007 to adjust a claim that was originally processed by
  either Contractors '00030' or '03001'.

  Response
  The adjustment does not set error code '6010'.

  Event 3.1
  Access the CONT file in HIMR for Contractor '03001'.

  Response
  The Edit Indicator field shows an 'X' with new contractor
  '03101' next to it. Any IUR generated for Contractor '03001'
  after 10/01/2007 will be forwarded to '03101'.

  Event 4.1
  Access the CONT file in HIMR for Contractor '00030'.

  Response
  The Edit Indicator field shows old contractor '03001' has
  been replaced with new contractor '03101' and an 'X' is
  shown next to it.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 121
____________________________________________________________________________

  Event 5.1
  Enter an HUSP transaction to update an MSP Auxiliary file.
  The beneficiary has Contractor '03001' on the COBCAUX file.

  Response
  An HUSC is generated to the new Contractor '03101' for
  Contractor '03001'.

  ***.......This is the width of the Release Document.......***

  The Entity List includes only NEW acronyms and terminology
  that is currently not in use in CWF.

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. Contractor Table
    2. COBCAUX file

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:
  Contractor:
  Author: Marshall, Ken
  Date: 04/11/2007
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 122
____________________________________________________________________________

  Subject: Re: CWF comments

  The first 750 characters of the comment are the following:
  After October 1, 2007, Noridian Mutual Insurance Company will be 03001.
  Their address is 901 40th Street South, Suite 1, Fargo, ND 58103


  Contractor:
  Author: SOMMERS, VICKI
  Date: 04/10/2007
  Subject: CWF comments

  The first 750 characters of the comment are the following:
  CWF will not be using the Global Contractor 03001 based on response from
  CMS on 4/10/07 however, we will need to update the Contractor Table in C
  Please indicate the name and address we should apply for Contractor 0300
  since Arizona is posted at this time. Do we continue to use this name an
  address in CWF?
  ------------------

  Contractor:
  Author: Marshall, Ken
  Date: 04/10/2007
  Subject: Re: Add'l comment due to CMS Response for CWF

  The first 750 characters of the comment are the following:
  Cynthia Kulow told us that the MACs will be using the individual contrac
  number when communicating with CWF. The global number won't be the one
  that CWF receives. It will be used only for
  A/B MAC reporting to CMS for workload purposes.

  Contractor:
  Author: SOMMERS, VICKI
  Date: 04/06/2007
  Subject: Add'l comment due to CMS Response for CWF

  The first 750 characters of the comment are the following: Since CMS (Ke
  indicated that the entire Part A jurisdiction 3 can use 03001 and Part B
  03002, then the CR REQS will need to be updated. 1) To require a new con
  number to
  be created for Part B and also need to know the name and address for the
  2) Who will be responsible for receiving the replies including IURS to w
  contractor from the CWF HOST for the Global number? 3) If the Part A Glo
   is used in CWF
  what will be the name and address. 4) Who is responsible for receiving t
  including IURs and Reports to the contractor from the CWF HOST? 5) Do w
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 123
____________________________________________________________________________

  crosswalk to all the existing contractors for the new Global contractors
  an Early Involvement call for this CMS CR.



  Contractor:
  Author: Marshall, Ken
  Date: 04/06/2007
  Subject: Re: CWF Comments

  The first 750 characters of the comment are the following:
  03001 can be used as the global number for the entire Part A jurisdictio
  if needed and the global number for entire Part B jurisdiction can be
  03002.




  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 124
____________________________________________________________________________


   16. 00025498    5601-TRANSITION MEDIGAP (CLAIM-BASED) PROCESS TO COBC

  DATE ENTERED:    04/13/07

  TITLE:           5601-TRANSITION MEDIGAP (CLAIM-BASED) PROCESS TO COBC

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2007400

  GROUP LEVEL:     1

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    WORK

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   4
  EST. HOURS:      0750
  ACT. HOURS:      0670
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------

  4/13/2007

  1)CWF must read field 34 on incoming HUBC and HUDC records to
    verify the 5-digit number is within the claim-based Medigap
    range of COBA IDs 0000055000-0000059999, or space.

  2) If the incoming HUBC or HUDC record processes and receives
     an '01 response, CWF must return alert code '7704' along with
     Trailer '21' when the value in field 34 is not in the claim-
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 125
____________________________________________________________________________

    based Medigap COBA IDs range 0000055000-0000059999, or the
    field does not contain a space.

 2a)-(4/19/2007)
   Add new crossover disposition indicator logic for 'Z' and
   'AA'.


 3) If the field does contain a valid value of 0000055000-0000059999
    CWF must read the COIF File to determine if there is selection
    criteria for eligibility-based trading partners (COBA IDs
    30000-54999) and claim-based Medigap trading partners (COBA
    IDs 0000055000-0000059999). If CWF determines COBA IDs exist for
    both and that both will crossover, the Trailer '29' will be
    modified to suppress the data for the claim-based Medigap
    (COBA IDs 0000055000-0000054999).

 4) CWF will continue to display the Crossover Disposition
    Indicator 'A' when the claim meets the crossover criteria
    for the eligibility-based ID in the detail of the record
    in HIMR.

 5) CWF will display a Crossover Disposition Indicator 'AA'
    when the data is suppressed for the claim-based Medigap
    COBA IDs (0000055000-0000054999).


 6) CWF will modify the sort criteria for Trailer '29' as
    follows:

    A)30000-54999
    B)55000-59999
    C)00000-29999
    D)60000-69999
    E)80000-89999
    F)70000-79999

 Yvonne Anderson
 CWFM Support Team

 469-372-5420

 REQUIREMENTS:
 -------------
             DEFINITION AND ANALYSIS PHASES

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 126
____________________________________________________________________________

 CR:          _____25498_______   WORK TYPE:   ___   Incidental
 SUBSYSTEM:   _________________                ___   Minor
 FUNCTION:    _________________                _x_   Major
 PROGRAM:     _________________                ___   New Subsystem

 DEFINITION PHASE ORGANIZATION

 CMS Participants:
 1. Name:                 Kathy Woytan
     Telephone:           410-786-4982
     FAX, CMS:            410-786-0271
     Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

 CWFM Participants:
 1. BUSINESS ANALYST:     Yvonne Anderson
     Telephone:           469-372-5420
     FAX,Richardson,TX:   469-372-0284
     Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

 2.   PROG ANALYST:       Henry Alligood/Frye/Bromley
      Telephone:          717-909-5120/5124/5121
      FAX,Baltimore,MD:   717-909-5150
      Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                          TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  (X) Satellite Part B
  (X) Hospice
  (X) Home Health
  (X) DMERC
  ***.......This is the width of the Release Document.......***
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 127
____________________________________________________________________________


    REASON FOR CHANGE:
  At present, Part B contractors and DMACs maintain a variety
  of claim formats and connectivity options in support of the
  Medigap claim-based crossover process. Effective with the
  transitioning of the Medigap claim-based crossover process
  to the Coordination of Benefits Contractor (COBC) on 10/01/2007
  CMS will only support the HIPAA ANSI X-12N 837 professional
  COB claim format and NCPDP.

  The changes outlined in this CR for CWF will ensure that CMS
  fulfills its requirements for being able to accept the HIPAA
  ANSI X-12N 837 COBC claim transaction.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  CWF will read field '34', CROSSOVER ID, on incoming HUBC
  and HUDC records for the purpose of conducting a validity
  check.

  CWF will verify whether the data in field '34' CROSSOVER ID,
  contains a valid Medigap Claim-Based ID (0000055000 to
  0000059999) or a Space.

  Requirement 2
  If the incoming HUBC or HUDC record does not contain a valid
  Medigap Claim-Based ID (0000055000 to 0000059999) or space,
  in field '34', CROSSOVER ID, and the record receives an '01'
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 128
____________________________________________________________________________

  disposition, CWF will return the new alert code '7704' along
  with the Trailer '21'.

  21.    Alert Trailer
   a.    Trailer Code
   b.    Alert Code
   c.    Filler

  Requirement 3
  CWF must create a new Crossover Disposition Indicator 'Z' (Invalid
  Medigap Claim-Based Crossover ID included on claim). The 'Z'
  indicator will be displayed when an invalid Medigap Claim-Based
  COBA ID has been submitted.

  Requirement 4
  CWF will display the new 'Z' indicator and invalid COBA ID that
  was submitted on the claim on Page 2 of the detail of the Part
  B and DMERC claims in HIMR.


  PTBH                           PART B CLAIM HISTORY                PAGE    2
  HIC xxxxxxxxxx                       LOCAL HOST               DOB xx/xx/xxxx
  CORR xxxxxxxxxx        NAME xxxxx.xxxxxx                      DOD
  MSP 3 REP 2
                         INP 0000 OUT 0000 HOS 0000 PTB 0001 DME 0000 HHA 000

            ELIGIBILITY BASED CROSSOVER
              ID IND        ID IND        ID IND         ID   IND         ID   IND
            NO ELIGIBILITY BASED DATA TO DISPLAY


        >>> CLAIM BASED CROSSOVER ID:
             ????? Z

  -------------------------------------------------------


   DMEH                           DMEPOS CLAIM HISTORY                   PAGE    2
   HIC xxxxxxxxxx                       LOCAL HOST                  DOB 09/24/1912
   CORR xxxxxxxxxx        NAME xxxxx.xxxxxx                         DOD
   CMN 1 REP 2
                          INP 0000 OUT 0000 HOS 0000 PTB 0000 DME 0001 HHA 00

          ELIGIBILITY BASED CROSSOVER
            ID IND        ID IND        ID IND        ID IND        ID IN
          NO ELIGIBILITY BASED DATA TO DISPLAY
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 129
____________________________________________________________________________



     >>> CLAIM BASED CROSSOVER ID:
           ????? Z

  Requirement 5
  If the incoming HUBC or HUDC record contains a valid Medigap
  Claim-Based ID (0000055000 to 0000059999) CWF will interrogate
  the BOI file for any other Eligibility COBA IDs (30000 to 54999).

  If eligibility COBA IDs are present on the BOI Auxiliary file,
  CWF will then interrogate the COIF File for any inclusions or
  exclusions that apply.

  NOTE: If CWF does not find a corresponding COIF File the
        Medigap claim-based COBA ID will be posted without an
        indicator.

       If CWF finds a corresponding COIF File, but the
       T/P Indicator is equal to T (Test), the Medigap
       claim-based COBA ID will be posted without an
       indicator.

       If the Test/Production Indicator is equal to 'T' for
       an Eligibility-Based COBA ID, CWF will continue to
       not display a crossover disposition indicator on
       the detail of the claim in HIMR.

  Requirement 6
  If CWF determines the claim should be crossed over for both a
  production Medigap Eligibility-Based COBA ID (30000-54999) and
  for a production Medigap Claim-Based COBA ID (0000055000 to
  0000059999) the Trailer '29' will only reflect the COBA ID
  for the production Medigap eligibility-based COBA ID (30000-
  54999). The data for the claim-based COBA ID (0000055000 to
  0000059999) will not be displayed in the Trailer '29'.

  Requirement 7
  CWF must create a new Crossover Disposition Indicator 'AA'
  (Beneficiary identified on Medigap eligibility file; duplicate
  Medigap Claim-Based crossover voided).

  CWF will only display the 'AA' for a production Medigap
  Claim-Based COBA ID (0000055000 to 0000059999).

  Requirement 8
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 130
____________________________________________________________________________

 CWF will display the new Crossover Disposition Indicator 'AA'
 along with the production Medigap Claim-Based COBA ID on Page
 2 of the detail of the Part B and DMERC claims in HIMR.


 PTBH                        PART B CLAIM HISTORY                 PAGE    2
 HIC xxxxxxxxxx                    LOCAL HOST                DOB xx/xx/xxxx
 CORR xxxxxxxxxx     NAME xxxxx.xxxxxx                       DOD
 MSP 3 REP 2
                      INP 0000 OUT 0000 HOS 0000 PTB 0001 DME 0000 HHA 000

        ELIGIBILITY BASED CROSSOVER
          ID IND        ID IND         ID    IND     ID    IND          ID    IND
        32411 A


    >>> CLAIM BASED CROSSOVER ID:
        55611 AA

 -------------------------------------------------------


  DMEH                        DMEPOS CLAIM HISTORY                    PAGE    2
  HIC xxxxxxxxxx                    LOCAL HOST                   DOB 09/24/1912
  CORR xxxxxxxxxx     NAME xxxxx.xxxxxx                          DOD
  CMN 1 REP 2

             INP 0000 OUT 0000 HOS 0000 PTB 0000 DME 0001 HHA 00

         ELIGIBILITY BASED CROSSOVER
           ID IND        ID IND         ID    IND     ID    IND          ID    IN
         32411 A


    >>> CLAIM BASED CROSSOVER ID:
         55611 AA


  Requirement 9
  If CWF determines there are no production Medigap Eligibility
  COBA IDs (30000-54999), and there are also no exclusions for the
  Medigap Claim-Based COBA IDs (0000055000 to 0000059999), the
  claim will be crossed over for the production Medigap Claim-
  Based COBA ID (0000055000 to 0000059999). A '29' Trailer will
  be generated. The Crossover Disposition 'A' will be displayed
  in the Claim-Based Segment on Page 2 of the HUBC or HUDC record.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 131
____________________________________________________________________________



  PTBH                        PART B CLAIM HISTORY                 PAGE    2
  HIC xxxxxxxxxx                    LOCAL HOST                DOB xx/xx/xxxx
  CORR xxxxxxxxxx     NAME xxxxx.xxxxxx                       DOD
  MSP 3 REP 2
                      INP 0000 OUT 0000 HOS 0000 PTB 0001 DME 0000 HHA 000

         ELIGIBILITY BASED CROSSOVER
           ID IND        ID IND         ID   IND      ID    IND          ID   IND



     >>> CLAIM BASED CROSSOVER ID:
         59219 A

  -------------------------------------------------------


   DMEH                        DMEPOS CLAIM HISTORY                    PAGE    2
   HIC xxxxxxxxxx                    LOCAL HOST                   DOB 09/24/1912
   CORR xxxxxxxxxx     NAME xxxxx.xxxxxx                          DOD
   CMN 1 REP 2

              INP 0000 OUT 0000 HOS 0000 PTB 0000 DME 0001 HHA 00

          ELIGIBILITY BASED CROSSOVER
           ID IND        ID IND         ID   IND      ID    IND          ID   IND



     >>> CLAIM BASED CROSSOVER ID:
         59219 A

  -------------------------------------------------------


  Requirement 10
  Due to the new COBA Medigap Claim-Based crossover process,
  CWF must modify the sort criteria for the COBA IDs as
  follows:

   1) Medigap Eligibility file based (30000-54999)
   2) Medigap Claim-Based (55000-59999)
   3) Supplemental (00001-29999)
   4) TRICARE for Life (60000-69999)
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 132
____________________________________________________________________________

   5) Other Insurer (80000-89999) and
   6) Medicaid (70000-79999)


  Requirement 11
  Currently all Part A and Part B/DME claims contain 3
  occurrences of the Claim Based Crossover IDs.

  For Part B/DME, this shall be reduced to 1 occurrence
  and the remaining converted to filler.

  For Part A claims, the area that contains the 3 unused
  occurrences will be converted to filler.

  External copybooks affected: CABEHUIN, CABEHUIP, CABEHUON,
  CABEHUOP, CABEHUBC, CABEHIBC.

  These layouts will be included with external copybook
  CR 00025480.

  Requirement 12
  CWF must modify Page 2 of the HUBC and HUDC record in HIMR
  to remove the two (2) unused occurrences of the Claim
  Based Crossover IDs.

  Requirement 13
  CWF must modify Page 3 of the HUIP, HUOP, HUHH and HUHC
  in HIMR record to remove the three (3) unused occurrences
  of the Claim Based Crossover IDs.

  Requirement 14
  CWF must modify the CWF Internal Testing Facility screen
  for HUBC and HUDC records to remove the two (2) unused
  occurrences of the Claim- Based Crossover IDs.

  Requirement 15
  CWF must modify the CWF Internal Testing Facility screen
  for HUIP, HUOP, HUHH and HUHC records to remove the three
  (3) unused occurrences of the Claim Based Crossover IDs.

  Requirement 16
  CWF implemented Trailer '37' in a previous release to be
  used in conjunction with the claim-based crossover process.
  CMS has advised CWF the Trailer '37' will not be necessary.

  CWF is deactivating Trailer '37'. The CUTELX37 in the
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 133
____________________________________________________________________________

  copybook is being archived.


  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  Submit an HUBC or HUDC record that contains a value in the
  CROSSOVER ID field '34'.

  Response
  CWF verifies the validity of the data searching for a Medigap
  claim-based COBA ID in the range of (0000055000 to 0000059999)
  or a space.

  Event 1.2
  Submit an HUBC record that contains a space in the CROSSOVER
  ID field '34'.

  Response
  CWF verifies the validity of the data searching for a Medigap
  claim-based COBA ID in the range of (0000055000 to 0000059999)
  or a space.

  Event 1.3
  Submit an HUDC record that contains a space in the CROSSOVER
  ID field '34'.

  Response
  CWF verifies the validity of the data searching for a Medigap
  claim-based COBA ID in the range of (0000055000 to 0000059999)
  or a space.

  Event 2.1
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 134
____________________________________________________________________________

  Submit an HUBC or HUDC record that contains a Medigap claim-
  based value in field '34'. The record receives an '01'
  response. The COBA ID in field '34' is not in the range
  (0000055000 to 0000059999).

  Response
  The record receives a '7704' alert, and a Trailer '21'.

  Event 3.1
  Review the CWF Crossover Logic Flow and the CMS Crossover
  Disposition Indicator list.

  Response
  A new Crossover Disposition Indicator 'Z' has been added
  to the lists.

  Event 4.1
  Submit an HUBC or HUDC record that contains an invalid
  Medigap Claim-Based COBA ID in the range (0000055000 to
  0000059999). The claim receives an '01'.

  Response
  Page '2' of the PTBH screen in HIMR displays the new 'Z'
  COBA Indicator and the invalid Medigap Claim-Based ID.

  Event 5.1
  Submit an HUBC or HUDC record that contains a valid
  Medigap Claim-Based COBA ID in the range (0000055000 to
  000005999 ). There is not a COIF File for the Beneficiary.

  Response
  The record receives an '01' and processes in CWF. The
  Medigap Claim-Based COBA ID is posted to the detail of
  the record without a Crossover Disposition Indicator.

  Event 5.2
  Submit an HUBC or HUDC record that contains a valid
  Medigap Claim-Based COBA ID in the range (0000055000 to
  0000059999). The BOI contains other COBA IDs. The COIF
  File contains a 'T' T/P indicator. There are no exclusions
  on the COIF File.

  Response
  The record receives an '01' and processes in CWF. The
  Medigap Claim-Based COBA ID is posted to the detail of
  the record without a Crossover Disposition Indicator.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 135
____________________________________________________________________________


  Event 6.1
  Submit an HUBC or HUDC record that contains a valid
  Medigap Claim-Based COBA ID in the range (0000055000 to
  0000059999). There are also valid Eligibility COBA IDs
  (30000-54999) on the COIF File. There are no exclusions
  on the COIF File. The COIF File contains a 'P' T/P indicator.

  Response
  The record receives an '01' and processes in CWF. The
  record crosses over and the Trailer '29' displays only
  the data for the Eligibility COBA ID. The data is not
  displayed for the Medigap Claim-Based COBA ID (0000055000
  to 0000059999).

  Event 7.1
  Review the CWF Crossover Logic Flow and the CMS Crossover
  Disposition Indicator list.

  Response
  A new Crossover Disposition Indicator 'AA' has been added
  to the lists.

  Event 8.1
  Review an HUBC or HUDC record for a Beneficiary that contains
  a Medigap Claim-Based COBA ID in the range (0000055000
  to 0000059999). There are also valid Eligibility COBA IDs
  (30000-54999) on the COIF File. There are no exclusions
  on the COIF File. The COIF File contains a 'P' T/P indicator

  Response
  Page 2 of the record contains the COBA ID for the Eligibility
  COBA ID (30000-54999) with an 'A' Crossover Disposition Indicator,
  along with an 'AA' Crossover Disposition Indicator for
  Medigap Claim-Based COBA ID in the range (0000055000 to
  0000059999).

  Event 9.1
  Review an HUBC or HUDC record for a Beneficiary that contains
  a Medigap Claim-Based COBA ID in the range (0000055000
  to 0000059999). There are no Eligibility COBA IDs on the
  (30000-54999) on the COIF File. There are no exclusions
  on the COIF File contains a 'P' T/P indicator.

  Response
  The record is crossed over. The claim receives a Trailer '29'.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 136
____________________________________________________________________________

  Page 2 of the record contains the COBA ID for the Medigap
  COBA ID (0000055000-0000059999) with an 'A' Crossover
  Disposition Indicator in the Claim Based Crossover ID field.

  Event 10.1
  Submit an HUBC or HUDC record that contains COBA IDs for Medigap
  Eligibility File Based, Medigap Claim Based, Supplemental,
  TRICARE, Other Insurance and Medicaid.

  Response
  The COBA IDs on the Trailer '29' are sorted correctly based
  on the new sort hierarchy.

  Event 11.1
  Review copybooks CABEHUBC and CABEHIBC.

  Response
  The Part B/DMERC records contain filler for the two
  unused Crossover ID fields.

  Event 11.2
  Review copybooks CABEHUIN, CABEHUIP, CABEHUON and CABEHUOP.

  Response
  The Part A records contain filler for the three unused
  Crossover IDs.

  Review 12.1
  Review Page 2 of an HUBC or HUDC record in HIMR.

  Response
  The two unused Crossover ID fields on the Part B/DMERC
  records have been removed.

  Review 13.1
  Review Page 3 of an HUIP, HUOP, HUHH or HUHC record in HIMR.

  Response
  The three unused Crossover ID fields on the Part A records
  have been removed.

  Review 14.1
  Review an HUBC or HUDC record in ITF.

  Response
  The two unused Crossover ID fields on the Part B/DMERC
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 137
____________________________________________________________________________

 records have been removed.


 Review 15.1
 Review an HUIP, HUOP, HUHH or HUHC record in ITF.

 Response
 The three unused Crossover ID fields on the Part A records
 have been removed.

 Event 16.1
 Review copybook CUTELX37.

 Response
 The data for Trailer '37' has been removed.




 ***.......This is the width of the Release Document.......***

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List: N/A
   1. Entity:
       Description:

 Areas Affected by the Problem.
   1.
   2.

 Solution Criteria: N/A

   EDITS AFFECTED:
 ***.......This is the width of the Release Document......***

 a.   Error Code:   7704   (X)New ( )Modified ( )Deleted

 Disposition:   A/B Alert Code

 Type of Record: Pt. B Carrier, DMEPOS

 Error Message:
 The Medigap Claim-Based COBA ID submitted is invalid.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 138
____________________________________________________________________________

  Set Condition:   Under Development

  Trailer: '01', '21'


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 139
____________________________________________________________________________


   17. 00025534    MODIFY EDIT 6020 FOR PART B TO NO LONGER APPLY PT/OT LOGIC

  DATE ENTERED:    05/02/07

  TITLE:           MODIFY EDIT 6020 FOR PART B TO NO LONGER APPLY PT/OT LOGIC

  PROJECT CODE:    CM01

  PRIORITY:        2

  RELEASE LEVEL: R2007400

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM2000

  STATUS ON CR:    WORK

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   4
  EST. HOURS:      0750
  ACT. HOURS:      0400
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------

  Per CMS go ahead and create a CWF CR however, if the
  volume is low the workaround will be to apply
  the pt/ot amount being adjusted or canceled to the
  Bene's Pt/Ot limitation amount thru HICR. Once the
  update is done the adjustment/cancel can be released.

  This impacts a situation where the overapplied amount for
  pt/ot that has the edit in the override field was
  canceled and the amount was reduced from the $1740.00
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 140
____________________________________________________________________________

 causing the next adjustment/cancel for Part B to set
 the 6020 edit since amount on claim is more than the
 amount posted on the BENE's file.

 CWF should modify edit 6020 to no longer apply logic
 for pt/ot limitations on Part B adjustments or cancels
 due to the fact overapplied amounts are affected.
 Vicki Sommers
 ------------

 Paula has reported incorrect PT/OT amounts shown on HIMR,
 amounts do not equal pt/ot amt on posted claims for 2006.
 Also IUR's have been received and adjustments have been made to
 recoup monies prev paid on PT/OT claims. Adjustments are
 receiving 6020 in error. According to Paula, they have a
 significant volume for the 6020 setting in error.

 Can you take a look at this, please?

 Example for 6020A, shows only $43.67 applied to the PT limitation
 However, when you look at the claims, the correct amount should
 be $1215.47 for 2006. ADJ due to Home Health IUR.

 CWM.TEST.NDM.SO.KD6020A.UTILMOVE
 CWM.TEST.NDM.SO.KD6020A.CLAIMS
 CWM.TEST.NDM.so.kd6020a.RESPONSE

 Second example shows invalid amount in pt and ot field on himr.
 Claim is being adjusted to recoup money due to a MCIUR.
 Claim receiving 6020 also.
 CWM.TEST.NDM.SO.KD6020b.UTILMOVE
 CWM.TEST.NDM.SO.KD6020B.CLAIMS
 CWM.TEST.NDM.SO.KD6020B.RESPONSE


 I checked Infoman, but could not find anything recent for this
 error code.

 Thank you,
 Kathleen
 469-372-7016

 REQUIREMENTS:
 -------------
             DEFINITION AND ANALYSIS PHASES

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 141
____________________________________________________________________________

  CR:          ______25534______    WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                 _ _   Minor
  FUNCTION:    _________________                 _X_   Major
  PROGRAM:     _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Cathy Pflaum
      Telephone:           410-786-3016
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Vicki Sommers
      Telephone:           469-372-7642
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Heather Byram
       Telephone:          717-909-2228
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  ( ) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  (X) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 142
____________________________________________________________________________


    REASON FOR CHANGE:
  Physical and Occupational Therapy claims where the
  override field is present due to the over-applied amount
  is causing subsequent cancels or adjustments that are
  to deny the PT/OT amount is reducing the PT/OT amount for
  the year. When the PT/OT amount present on the Beneficiary
  Master Record is less than the PT/OT amount on the next
  cancel/adjustment for Part B causes edit '6020' to set.
  Once the edit '6020' is bypassed, CWF is calculating a
  negative amount to post to the Beneficiary's Master Record
  for PT/OT for the year.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  CWF must modify edit '6020' to no longer apply the logic for
  Physical and Occupational Therapy limitation on Part B
  adjustment or cancels.

  Requirement 2
  CWF should not calculate a negative amount in the PT or OT
  limitation amount on the Beneficiary's Master Record for a
  Part B record. Currently CWF does not calculate a negative
  amount for Outpatient when the over applied amount is
  canceled or adjusted as non covered in CWF. The same
  process should apply to Part B when over applied amount is
  canceled or adjusted to deny for PT or OT. The limitation
  amount should reset back to zero and not a negative amount.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 143
____________________________________________________________________________


  NOTE: This problem occurs once the edit '6020' is bypassed.

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  Submit a Part B adjustment (Entry Code 5) or Cancel (Entry
  Code 3) where the PT/OT limitations is impacted and the Bene's
  total PT/OT limitation on the Master Record is less than the
  amount on the claim in history being adjusted/cancel.

  Response
  The incoming Part B adjustment does not set '6020'.

  Event 2.1
  Submit a Part B record that will be accepted with the over
  applied limitation amount for PT or OT.
  The Beneficiary already has previously processed Part B
  records with the allowed amount for PT or OT. Submit cancels
  or adjustments as denied on all the Part B records with
  PT or OT.

  Response
  The Amount Applied for PTHPY or OTHPY indicates zero and not
  a negative amount on the Beneficiary Master Record.

  ***.......This is the width of the Release Document.......***

  The Entity List includes only NEW acronyms and terminology
  that is currently not in use in CWF.

  Entity List: N/A
    1. Entity:
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 144
____________________________________________________________________________

        Description:

  Areas Affected by the Problem.
    1. Utilization module
    2. PT OT Limitation Amount on Beneficiary Master Record.

  Solution Criteria: N/A

    EDITS AFFECTED:
  ***.......This is the width of the Release Document......***

  a. Error Code:    6020    ( )New (X)Modified ( )Deleted
  Disposition: UR

  Type of Record: Pt. B Carrier

  Error Message:
  Adjustment Claim - insufficient expenses in the Beneficiary
  Master Trailer for full credit (Entry Code equals 3 or 5).

  Set Condition for edit '6020': Under Development

  When the claim Entry Code is equal to '3' or '5', and one
  of the following is true:

     Submitted medical expenses are less than '0';
     Submitted psychiatric expenses are less than '0';
     Submitted physical therapy expenses are less than '0';
     Submitted occupational therapy expenses are less than
     0'; Submitted blood deductible is less than '0',
     set the '6020' error code.

  For VA Pt. B claims with Entry Code 3 (Cancel) or 5
  (Adjustment), bypass this edit.

  When the history date of accretion is less than the
  Beneficiary date of accretion, and the history cash
  deductible is less than or equal to '0', bypass this edit.

  When the history date of accretion is less than the
  Beneficiary date of accretion, and the history cash
  deductible is less than or equal to '0', bypass this edit.


  Trailer Information: 08

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 145
____________________________________________________________________________


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:


  Vicki,

  Open a CR to modify 6020 to no longer set for PT/OT. This CR will
  not be a priority since the volume is low and there is a work around.

  Until the CR is assigned instruct the contractor to contact the
  HICR staff for resolution.

  Any questions let me know.

  Cathy

  Cathy or Rick
  We have received a requests on an issue involving PT/OT limitations
  where the Part B adjustments is returning UR 6020.
  6020 is Adjustment Claim - insufficient expenses in the Beneficiary
  Master Trailer for full credit (Entry Code equals 3 or 5).
  The total PT limitation after the four Part B claims for 2006 were
  processed was $1667.33.
  An Outpatient claim for $1244.47 for PT was processed and the FI applied
  the 8022 edit (over applied PT limitations ) in the override field so t
  amount actually applied for PT was $2911.80 to the PT limitation. Howeve
  the BENB only posts the limitation amount of $1740.00 for 2006.
  The FI then submitted a Cancel on the Outpatient record with the PT
  amount of $1244.47 which reduced the BENE's limitation amount from the
  $1740.00 to be $495.53 on the BENB. (Note the Outpatient cancel was the
  record with the 8022 in the override field).
  Then a Part B record with a PT amount of $451.86 was cancelled which
  reduced the BENE's limitation amount to be $43.67.
  Another Part B record submitted an adjustment to noncover the PT amount
  of $381.75 and is setting the edit 6020 since the amount
  is more than what is posted on the PT limitation on the BENB which is
  $43.67.
  The issue where amounts that are overridden with the edit and the
  overapplied amount is not posted to the limitations and then canceled or
  adjusted to be noncovered have always backed out the amount in the poste
  limitations. We now have a situation where the amount being canceled is
  than the amount posted on the BENB and is causing the edit 6020 to set.
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 146
____________________________________________________________________________

  The following suggestions should be considered:
  1) Modify 6020 to no longer set for pt/ot and only set for medical
  expenses (cash deductible) and psychiatric
  2) If the edit 8022 or 8024 are posted in the override field, CWF should
  not back out from the BENE's PT/OT limitation. This will require system
  change and may have part of the charges that should be included in the
  limitation amount.
  3) Have contractors send requests to the HICR Staff in Texas to update
  the PT/OT limitation to be the amount from the claim returning 6020.

  Since this situation has not been addressed before and hopefully impacts
  a small volume , the best suggestion maybe #3 unless the volume
  is highly impacted, then modify 6020 from #1. Currently CWF does not
  set edit 6020 on Outpatient for the above condition and would allow the
  cancel or adjustment to noncover to process for PT/OT limitations.

  Let me know what you feel would be the best solution for this problem
  reported by a Part B satellite.

  Vicki
  ************************
  From: VICKI.SOMMERS
  Sent: Wednesday, May 02, 2007 3:19 PM
  To: KATHLEEN.DOGGETT
  Subject: RE: PT/OT with error code 6020

  Kathleen
  Since the impact is more than one claim, CMS wants us to assign the CR t
  Hopefully this will get done soon.
  Start looking for this sometime in May if no issues.

  Tks
  Vicki

   -----Original Message-----
  From: KATHLEEN.DOGGETT
  Sent: Wednesday, May 02, 2007 12:21 PM
  To: VICKI.SOMMERS
  Cc: KATHLEEN.DOGGETT
  Subject: FW: PT/OT with error code 6020

  Vicki,
  According to Paula's area, they have 60 adj pending for 6020 for pt/ot.
  Would this be considered high volume? Should they send all of these for

  Thank you,
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 147
____________________________________________________________________________

  Kathleen

  CONFIDENTIALITY NOTICE: This e-mail message, including any attachments,

   -----Original Message-----
  From: Keene.PaulaPaula.Keene@fcso.com.TBHE
  Sent: Wednesday, May 02, 2007 11:25 AM
  To: KATHLEEN.DOGGETT
  Cc: Davis.CassondraCassondra.Davis@fcso.com.TBHE

  Subject: PT/OT with error code 6020

  Based on the volumes below and the amount of work that would be required
  to send these for manual correction, do you think this would be
  considered a high volume or not?

  How do you want us to proceed?

   ______________________________________________
   From: Davis, Cassondra
   Sent: Wednesday, May 02, 2007 12:21 PM
   To: Keene, Paula
   Subject: Volumes for STR 13260

   We have at least 60 adjustments pending currently with error code
   6020.

   Sondra Davis
   Financial Services Operations
   Ext. 16425


  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 148
____________________________________________________________________________


   18. 00025545    5636 OCTOBER QUARTERLY UPDATE TO 2007 SNF CB

  DATE ENTERED:    05/08/07

  TITLE:           5636 OCTOBER QUARTERLY UPDATE TO 2007 SNF CB

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2007400

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    REQS

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   3
  EST. HOURS:      0300
  ACT. HOURS:      0139
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  October Quarterly Update to 2007 SNF CB

  2007 File 1
  Part B Q1003 Effective prior to 1/1/2007

  2007 File 1
  Part B Q1001 and Q1002 prior to 6/30/2005


  Part A
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 149
____________________________________________________________________________

  Remove mammography HCPCS code 77055 and 77056 retroactive 1/1/2007
  Edit 7252 must be modify to remove the above HCPCS codes.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:          ______25545______    WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                 _x_   Minor
  FUNCTION:    _________________                 ___   Major
  PROGRAM:     _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Vivian Rogers
      Telephone:           410-786-8142
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Ofelia Castillo
      Telephone:           469-372-6492
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Jackie Dolphus
       Telephone:          443-436-6721
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *              blank line is found.                               *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *              after a colon. Try to format as it should appear *
  *              in the Release Document.                           *
  *******************************************************************
    IMPACT:
  (X) Host
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 150
____________________________________________________________________________

  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  (X) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  (X) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  October quarterly updates for FIs and Carrier for SNF
  Consolidated Billing.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  CWF must modify A/B Crossover edit '7252' to remove the
  following mammography diagnostic HCPCS code(s):
  '77055' and '77056'.

  Requirement 2
  CWF must modify the informational unsolicited process for
  A/B Crossover edit '7252' to remove the following mammography
  diagnostic HCPCS code(s):
  '77055' and '77056'.

  Requirement 3
  CWF must add the following HCPCS code(s) to the Physician
  Services (Category 75) file in CABCHCCB copybook.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 151
____________________________________________________________________________

  'Q1003' for Dates of Service prior to 01/01/2007
  'Q1001' and 'Q1002' for Dates of Service prior to 05/18/2005

  Requirement 4
  CWF will ensure that the A/B Crossover edits '7260' and '7261'
  for SNF CB works according to SNF guidelines.

  Requirement 5
  CWF will ensure that the informational unsolicited process
  for SNF CB works according to SNF guidelines for A/B
  Crossover edits '7260' and '7261'.


  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  Posted to history is a SNF Inpatient Part A claim with
  Dates of Service on or after 01/01/2007.

  An incoming Outpatient claim (22x) is received with HCPCS
  code(s) '77055' and '77056' and the detail line item Date
  of service is within the Admission and Discharge Date of
  the posted SNF Inpatient Part A claim in history.

  Response
  The incoming Outpatient record is rejected, and error code
  '7252' is set.

  Event 2.1
  Posted to history is an Outpatient claim (22x) with
  HCPCS code '77055' and '77056'. The detail line item Date
  of Service is on or after 01/01/2007 and is within the
  Admission and Discharge Date of the incoming SNF claim.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 152
____________________________________________________________________________


  An incoming SNF Inpatient Part A claim (21x) is received
  with Dates of Service on, or after 01/01/2007.

  Response
  The incoming SNF Inpatient Part A claim is processed. An
  informational unsolicited response is generated for the
  Outpatient claim for A/B Crossover edit '7252'. Trailer
  '24', along with '31' is returned.

  Event 3.1
  Verify that HCPCS code(s) 'Q1001', 'Q1002', and 'Q1003'
  are displayed in the CABCHCCB copybook.

  Response
  The HCPCS code(s) are displayed in the CABCHCCB copybook.

  Event 4.1
  Posted to history is a SNF Inpatient Part A claim (21x)
  with Dates of Service prior to 01/01/2007.

  An incoming Part B claim is received with a non-therapy
  HCPCS code (Q1003) and the detail From or Thru Date
  overlaps the posted SNF Inpatient Part A claim in history.

  Response
  The incoming Part B claim is processed, and error code
  '7260' is not set.

  Event 4.2
  Posted to history is a SNF Inpatient Part A claim (21x)
  with Dates of Service prior to 05/18/2005.

  An incoming Part B claim is received with a non-therapy
  HCPCS code (Q1001 and Q1002) and the detail From or Thru
  Date overlaps the posted SNF Inpatient Part A claim in
  history.

  Response
  The incoming Part B claim is processed, and error code
  '7260' is not set.

  Event 4.3
  Posted to history is a SNF Inpatient Part A claim (21x)
  with Dates of Service prior to 01/01/2007.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 153
____________________________________________________________________________

  An incoming Part B claim is received with a non-therapy
  HCPCS code (Q1003) and the detail From or Thru Date is
  within the posted SNF Inpatient Part A claim in history.

  Response
  The incoming Part B claim is processed, and error code
  '7261' is not set.

  Event 4.4
  Posted to history is a SNF Inpatient Part A claim (21x)
  with Dates of Service prior to 05/18/2005.

  An incoming Part B claim is received with a non-therapy
  HCPCS Code (Q1001 and Q1002) and the detail From or Thru
  Date is within the posted SNF Inpatient Part A claim in
  history.

  Response
  The incoming Part B claim is processed, and error code
  '7261' is not set.

  Event 5.1
  Posted to history is a Part B claim with a non-therapy
  HCPCS code (Q1003). The detail From or Thru Date is
  prior to 01/01/2007 and overlaps the Admission and
  Discharge Date of the incoming SNF claim.

  An incoming SNF Inpatient Part A claim (21x) is received
  with Dates of Service prior to 01/01/2007.

  Response
  The incoming SNF Inpatient Part A claim (21x) is processed,
  and no informational unsolicited response is generated for
  the Part B claim for A/B Crossover edit '7260'.

  Event 5.2
  Posted to history is a Part B claim with a non-therapy
  HCPCS code (Q1001 and Q1002). The detail From or Thru Date
  is prior to 05/18/2005 and overlaps the Admission and
  Discharge Date of the incoming SNF claim.

  An incoming SNF Inpatient Part A claim (21x) is received
  with Dates of Service prior to 05/18/2005.

  Response
  The incoming SNF Inpatient Part A claim (21x) is processed,
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 154
____________________________________________________________________________

  and no informational unsolicited response is generated for
  the Part B claim for A/B Crossover edit '7260'.

  Event 5.3
  Posted to history is a Part B claim with a non-therapy
  HCPCS code (Q1003). The detail From or Thru Date is
  prior to 01/01/2007 and is within the Admission and
  Discharge Date of the incoming SNF claim.

  An incoming SNF Inpatient Part A claim (21x) is received
  with Dates of Service prior to 01/01/2007.

  Response
  The incoming SNF Inpatient Part A claim (21x) is processed,
  and no informational unsolicited response is generated for
  the Part B claim for A/B Crossover edit '7261'.

  Event 5.4
  Posted to history is a Part B claim with a non-therapy
  HCPCS code (Q1001 and Q1002). The detail From or Thru Date
  is prior to 05/18/2005 and is within the Admission and
  Discharge Date of the incoming SNF claim.

  An incoming SNF Inpatient Part A claim (21x) is received
  with Dates of Service prior to 05/18/2005.

  Response
  The incoming SNF Inpatient Part A claim (21x) is processed,
  and no informational unsolicited response is generated for
  the Part B claim for A/B Crossover edit '7261'.

  ***.......This is the width of the Release Document.......***

  The Entity List includes only NEW acronyms and terminology
  that is currently not in use in CWF.

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. A/B Crossover module
    2. Informational unsolicited process

  Solution Criteria: N/A

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 155
____________________________________________________________________________

    EDITS AFFECTED:
  ***.......This is the width of the Release Document......***

  a. Error Code:    7252   ( )New (X)Modified ( )Deleted
  Disposition: CR

  Type of Record: OUTP

  Error Message:
  For an Outpatient claim the detail line item Date of
  Service is within the Admission and Discharge Date of a SNF
  Inpatient Part A claim (21x) for non-therapy services.

  Set Condition for edit '7252': Under development


  Trailer Information: 08, 13, 31




  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:
  *******************************************************
   -----Original Message-----
  From: Rogers.Vivian.A.CMS/OISVivian.Rogers@CMS.hhs.gov.TBHE
  Sent: Wednesday, June 20, 2007 4:53 AM
  To: OFELIA.CASTILLO
  Subject: CMS CR 5636 - 25545

  Ofelia,

  You can use the date of May 18, 2005 in your requirements for HCPCS
  Q1001 and Q1002.
  Hope this helps,

  Vivian Rogers
  Business Applications Management Group
  Division of Business Application Analysis
  Common Working File
  Vivian.Rogers@cms.hhs.gov
  phone:410-786-8142
  ***********************************************************
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 156
____________________________________________________________________________

   -----Original Message-----
  From: Rogers.Vivian.A.CMS/OISVivian.Rogers@CMS.hhs.gov.TBHE
  Sent: Tuesday, June 19, 2007 11:39 AM
  To: OFELIA.CASTILLO
  Subject: RE: CMS 5636 CWF 25545

  Just to keep you in the loop I've put the question out to policy. I
  want to make sure they agree. As soon as I get an answer I will send
  you an email.


  Vivian Rogers
  Business Applications Management Group
  Division of Business Application Analysis
  Common Working File
  Vivian.Rogers@cms.hhs.gov
  phone:410-786-8142

  -----Original Message-----
  From: OFELIA.CASTILLO@trailblazerhealth.com
  mailto:OFELIA.CASTILLO@trailblazerhealth.com
  Sent: Tuesday, June 19, 2007 10:55 AM
  To: Rogers, Vivian A. (CMS/OIS); Woytan, Kathryn A. (CMS/OIS)
  Cc: OFELIA.CASTILLO@trailblazerhealth.com; jdolphus@cms.com;
  cpowel26@csc.com; vvuyyuru@csc.com
  Subject: CMS 5636 CWF 25545

  Hi! Vivian,

  The change request for 5636 indicates that HCPCS code Q1001 and Q1002
  should
  be for dates of service prior to June 30, 2005. However, we had CR 24221
  (CR
  3901) that requested that CWF put a term date of May 18, 2005.

  In my requirements is it okay to put for dates of service prior to
  May 18, 2005 for HCPCS code Q1001 and Q1002.

  If you have any question please let me know.
  Ofelia Castillo
  Business Analyst II
  CWFM Support
  TrailBlazer Health Inc
  8330 LBJ Freeway
  Dallas, Tx 75243
  Office: 469-372-6492
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 157
____________________________________________________________________________

  Fax: 469-372-0284
  ***********************************************************
   -----Original Message-----
  From: echimp@cms.hhs.gov.TBHE
  Sent: Monday, May 21, 2007 2:30 PM
  To: michael.satrom@cms.hhs.gov.TBHE; jsumrall@trispan.com.TBHE; donna.sa
  Subject: CR #5636 Comment 'CR#5636 (October Quarterly Update to 2007 Ann

  A new comment has been posted to CR #5636's POC review forum:

    Contractor:
    Author: Billingsley, April
   Date: 05/21/2007
   Subject: Re: CWF Comment

     The first 750 characters of the comment are the following: Thank you
  for your comment. Category 75 is being addressed in BRs 5636.1 and
   and 5636.2.
    Go to eChimp 2.0 for more comment details, or to offer feedback. Plea

     Best regards,
   DCOM
   https://echimp.cmsnet

  *********************************************************
  Contractor:
  Author: SOMMERS, VICKI
  Date: 05/08/2007
  Subject: CWF Comment

  The first 750 characters of the comment are the following:
  The following comment is from Ofeila Castillo:
  What sub-category should be updated for REQ xxxx.1 that is
  addressing HCPCS Q1003 and sub-category for xxxx.2 for
  HCPCS Q1001 and Q1002?



  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Change Requests                                                      Page 158
____________________________________________________________________________

  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************

  TOTAL RECORDS: 18




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 159
____________________________________________________________________________


II.        ANALYSIS CHANGE REQUESTS

      1.     00025378   5499-PRESENT ON ADMISSION INDICATOR SYSTEMS ANALYSIS

  DATE ENTERED:         01/24/07

  TITLE:                5499-PRESENT ON ADMISSION INDICATOR SYSTEMS ANALYSIS

  PROJECT CODE:         CM01

  PRIORITY:             1

  RELEASE LEVEL: R2007400

  GROUP LEVEL:          1

  HOST SITE ID:         CWFM2000

  STATUS ON CR:         RESE

  DOC. REQUIRED: N

  HOST EVAL:            N/A

  DOC RECEIVED:         N

  ADDENDUM INFO: NONE

  EST. CATEGORY:        2
  EST. HOURS:           0125
  ACT. HOURS:           0100
  CAT/CR EVAL:          N

  COMMENT:              N/A

  DESCRIPTION:
  ------------
  In order to group diagnoses into the proper DRG, CMS
  needs to capture a Present On Admission (POA) indicator
  for all claims involving inpatient admissions to general acute
  care hospitals. Use the UB-04 Data Specifications Manual
  and the ICD-9-CM Official Guidelines for Coding and Reporting
  to facilitate the assignment of the Present on Admission (POA)
  indicator for each diagnosis and external cause of injury code
  reported on claim forms (UB-04 and 837 Institutional).
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 160
____________________________________________________________________________

  CMS required that these POA indicator be reported on all claims
  for inpatient admissions to general acute care hospitals with
  discharge dates on or after January 1, 2008. Critical
  Access Hospitals, Maryland Waiver Hospitals, LTCH, Cancer
  Hospitals and Children's Inpatient Facilities are exempt
  from this requirement.

  These guidelines are not intended to replace any guidelines
  in the main body of the ICD-9-CM Official Guidelines for
  Coding and Reporting. The POA guidelines are not intended
  to provide guidance on when a condition should be coded,
  but rather, how to apply the POA indicator to the final set of
  diagnosis codes that have been assigned in accordance with
  Sections I, II, and III of the official coding guidelines. Subsequent
  to the assignment of the ICD-9-CM codes, the POA indicator
  should then be assigned to those conditions that have been coded.
  As stated in the Introduction to the ICD-9-CM Official Guidelines
  for Coding and Reporting, a joint effort between the healthcare
  provider and the coder is essential to achieve complete and
  accurate documentation, code assignment, and reporting of
  diagnoses and procedures. The importance of consistent, complete
  documentation in the medical record cannot be overemphasized.
  Medical record documentation from any provider involved in the
  care and treatment of the patient may be used to support the
  determination of whether a condition was present on admission or not.
  In the context of the official coding guidelines, the term "provider"
  means a physician or any qualified healthcare practitioner who is
  legally accountable for establishing the patient's diagnosis.

  This CR contains all relevant information on POA
  claims processing so that all appropriate systems
  modifications can be made with a complete
  understanding of the total project requirements.
  Although the purpose of this CR is to enable systems
  planning and design, some business requirements must
  be addressed now, while others are applicable on
  January 1, 2008.

  Effective January 1, 2008, on UB-04 paper claims the
  POA is the eighth digit of FL 67, Principal Diagnosis
  and the eighth digit of each of the secondary diagnosis
  fields FL 67 A-Q.

  Effective January 1, 2008, claims submitted electronically
  via 837, 4010A1 format, shall use segment K3 in the 2300
  loop, data element K301. The data element shall contain
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 161
____________________________________________________________________________

  the letters "POA", followed by a single POA indicator for
  every diagnosis reported on the claim. The POA indicator
  for the principal diagnosis should be the first indicator after
  "POA". POA indicators for secondary diagnoses would follow
  next, if applicable. The last POA indicator for principal and,
  if applicable, other diagnoses shall be followed by the letter
  "Z" to indicate the end of POA indicators for principal and, if
  applicable, other diagnoses or the letter "X" to indicate the
  end of POA indicators for principal and, if applicable, other
  diagnoses in special data processing situations that may be
  identified by CMS in the future.

  Effective October 1, 2007, CWF/NCH must create a new field
  to capture and store at least nine POAs and one end of POA
  indicator.


  CWF REQs:
  1)Create the new POA one byte indicator that will be carried
  10 times in the HEADER for the transmit record going to CWF.
  First one will be for the principal diagnosis, two thru nine
  for Other and ten for External cause of injury code.

  2)Create the new POA one byte indicators that will be carried
    to NCH for HUIP.

  3)Create the new POA one byte indicators that will be carried
    on the ITF screen for HUIP

  4)Create the new POA one byte indicators that will be carried
    on the claim history for HUIP.

  5)Create the new POA one byte indicators that will be displayed
    on the INPH in HIMR.


  Per CMS the new field is for Inpatient Only.
  Validation of the new field will be done front end and will
  not be required by CWF.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:         _25378___________   WORK TYPE: ___ Incidental
  SUBSYSTEM: _________________                ___ Minor
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 162
____________________________________________________________________________

  FUNCTION:    _________________                 _X_ Major
  PROGRAM:     _________________                 ___ New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                  Kathy Woytan
      Telephone:            410-786-4982
      FAX, CMS:             410-786-0271
      Responsibilities:     REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:      Meredith Revier
      Telephone:            469-372-1022
      FAX,Richardson,TX:    469-372-0284
      Responsibilities:     DEFINITION, ANALYSIS, SYSTEM TESTING

       BUSINESS ANALYST:    Vicki Sommers
       Telephone:           469-372-7642
       FAX,Richardson,TX:   469-372-0284
       Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:        Heather Byram
       Telephone:           717-909-5122
       FAX,Baltimore,MD:    443-436-3803
       Responsibilities:    ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                            TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *              blank line is found.                               *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *              after a colon. Try to format as it should appear *
  *              in the Release Document.                           *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 163
____________________________________________________________________________

 ( ) Home Health
 ( ) DMERC
 ***.......This is the width of the Release Document.......***

   REASON FOR CHANGE:
 ***Note: This is an ANALYSIS Only effort and does not contain
           any software updates.***

 Date Prepared: 5-07-07

 Release: R2007.4

 CWF CR #: 25378

 CMS CR #: 5499

 Early Involvement Call Needed? Yes, conducted May 1, 2007 3pm.

 Title: Present on Admission Indicator Systems Analysis

 Business Analyst: Meredith Revier
                   Vicki Sommers

 CMS Contact: Kathy Woytan

 Programmer: Heather Byram

 CR Description:
 Beginning 01/01/2008, CMS will begin accepting Present on
 Admission (POA) indicators on acute care hospital claims, in
 compliance with Section 5001(c) of Public Law 109-171.

 In order to group diagnoses into the proper DRG, CWF will need
 to capture a Present On Admission (POA) indicator for all
 claims involving inpatient admissions to general acute care
 hospitals. CWF will need to carry 10 POA indicators, one for
 principal diagnosis, two through nine for the secondary and
 other diagnoses (8 total), and the tenth for the end of POA
 which will ultimately allow CMS to exempt a claim from the
 DRG reduction process.

 CWF is not required to validate these fields, so no consistency edits
  will be created at this time.

 Type of Claim/Transaction Affected: Part A Inpatient-HUIP

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 164
____________________________________________________________________________

  Software Functions Affected:
   Inpatient Claims sent to NCH
   Inpatient Claims
   Inpatient Claims History
   HIMR Inpatient Claims History Detail
   ITF Inpatient Claims Entry

  Edits Affected:    None

  Trailers/Responses Affected: None

  Auxiliary Files Affected: None

  HCPCS Affected: None

  IUR Affected: None


  New Process to Apply:
  Beginning 01/01/2008, CWF will begin accepting Present on
  Admission (POA) indicators on acute care hospital claims, in
  compliance with Section 5001(c) of Public Law 109-171.


  Analysis:
  CWF will need to make the following modifications
  to accept, transmit and display the new 10, one byte
  Present on Admission indicator fields on inpatient
  acute care hospital claims.

  1. CWF will add the 10, one byte, Present on Admission (POA)
     indicator fields to the header portion of the inpatient claim
     transmit record (HUIP) submitted by Acute Care Hospitals
     (XX0001-XX0999) starting 01/01/2008 and after.


      The fields will stand for the following:

      POA1   for principle diagnosis
      POA2   for secondary diagnosis
      POA3   thru POA9 other diagnoses
      POAE   for Exemption

      This field will be added to CABEHUIN copybook.

  2. CWF will add the 10, one byte, new Present on Admission (POA)
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 165
____________________________________________________________________________

       indicator fields to the NCH record for inpatient claims (HUIP)
       starting 01/01/2008 and after.

      This field will be added to CABEHUIP copybook.


  3. CWF will add the 10, one byte, new Present on Admission (POA)
       indicator fields to the ITF screens for inpatient claims (HIIP)
       starting 01/01/02008 and after.

      This field will be added to CICSMAP HIIPM04.

  4. CWF will add the 10, one byte, new Present on Admission (POA)
       indicator fields to the INPH HIMR screen for inpatient
       claims (HUIP) starting 01/01/02008 and after.

       This field will be added to CICSMAP HMRMIP4.


  5. CWF will add the 10, one byte, new Present on Admission (POA)
     indicator fields to the inpatient claim history on the
     beneficiary record starting 01/01/2008 and after.

       This field will be added to CIOCINP copybook.




  Issues to be Addressed:
  The PM needs to have some rewording done to change the last POA
  indicator description from External Cause of Injury to End of POA.



  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 166
____________________________________________________________________________

  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

     NEW BUSINESS REQUIREMENTS: None

   Requirement 1
   xxxx

   Requirement 2
   xxx
  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST: NONE
  ***.......This is the width of the Release Document.......***

  Event 1.1

  Response
  ***.......This is the width of the Release Document.......***

  The Entity List includes only NEW acronyms and terminology
  that is currently not in use in CWF.

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1.

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 167
____________________________________________________________________________


  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:
  5499 will be an ANALYSIS ONLY CR for CWF in the October Release.   It is
  anticipated at this time that another CR will be written for the
  implementation for the January 2008 release.

  Kathy Woytan
  Business Applications Management Group
  Division of Business Application Analysis
  Common Working File Group Team Lead
  Kathryn.Woytan@cms.hhs.gov
  410-786-4982



  Meredith and Heather,
  Please read below... this changes the reqs still needs
   to be 10 POA Indicators but the last one can still be
   POAE for 'exempt' and not enternal cause of injury

  Also add below response to issues and answers in
  the CR
  Vicki
  **********************************************************
  A new comment has been posted to CR #5499's
  POC review forum:

  Contractor:
  Author: Barranco, Stuart
  Date: 04/27/2007
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 168
____________________________________________________________________________

  Subject: Re: CWF Comments

  The first 750 characters of the comment
  are the following: CWF must capure at
  least nine POA indicators, one for Principal
  DX and 8 for Other Dx. Additionally, CWF must
  capture a one byte 'end of POA' indicator which will
  ultimately allow CMS to exempt a claim from the DRG
  reduction process when CMS deems it to be an unavoidable
  or exceptionable situation.
  CMS does not require 'external cause of injury' coding
  so no POA for 'external cause of injury' needs to be
  captured on the CMS claim record.

  Go to eChimp 2.0 for more comment details, or to offer
  feedback. Please do not reply back to this message.

  Best regards,
  DCOM
  https://echimp.cmsnet


  *******************************************************************
  Contractor:
  Author: Barranco, Stuart
  Date: 02/27/2007
  Subject: Re: CWF Comments

  The first 750 characters of the comment are the following:
  CWF and/or NCH does not need to expand all 9 of the Dx fields if
  it adds a single inpatient only field that is capable of carrying
  the K3 segment. There is no need to validate the entries in
  this field since that is being done on the front end by the Grouper
  software unless CWF has a need to re Group the claim to validate the
  DRG.




  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 169
____________________________________________________________________________

  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 170
____________________________________________________________________________


   2.   00025443   5561-CASE MIX REFINEMENT FOR HH PPS (ANALYSIS ONLY)

  DATE ENTERED:    03/13/07

  TITLE:           5561-CASE MIX REFINEMENT FOR HH PPS (ANALYSIS ONLY)

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2007400

  GROUP LEVEL:     1

  HOST SITE ID:    CWFM2000

  STATUS ON CR:    RESE

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   2
  EST. HOURS:      0125
  ACT. HOURS:      0080
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  The requirements described in this confidential Change Request
  reflect the operational changes that would be necessary to implement
  the HH PPS refinements as they are currently planned.   These
  requirements will be subject to change based on any changes to the
  HH PPS case mix refinement final rule. However, in order to be prepared
  to meet the aggressive timeline to implement HH PPS refinements in
  January 2008, shared systems shall perform analysis of these requirement
  for the October 2007 systems release. All actual changes to the shared
  systems will be made in the January 2008 release.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 171
____________________________________________________________________________

  The proposed changes below apply only to HH PPS claim types
  (types of bill 32x and 33x).

  Effective Date:   Episodes beginning on or after January 1, 2008

  Medicare systems shall accept the new HIPPS codes
  described in attachment one.

  Medicare systems shall ensure that the provider submitted
  HIPPS code accurately reflects the position of the episode
  within a sequence of adjacent HH episodes.

  Medicare systems shall define a sequence of adjacent episodes
  as episodes with no more than 60 days between each episode
  end date and the next episode start date.

  Medicare systems shall ensure that claims submitted with HIPPS
  containing 1 or 2 in the 1st position represent the first or second
  episode in a sequence.

  Medicare systems shall identify for re-coding claims with HIPPS
  codes misrepresenting first or second episodes

  Medicare systems shall ensure that claims submitted with HIPPS
  containing 3 or 4 in the 1st position represent the third or greater
  episode in a sequence.

  Medicare systems shall identify for re-coding claims with HIPPS
  codes misrepresenting third or greater episodes.

  Medicare systems shall adjust previously paid episodes when the
  receipt of earlier dated episodes changes their position in a sequence
  of episodes.

  Medicare systems shall read the HH episode history when a new
  episode is received and identify any HIPPS codes that represent
  an incorrect position in the sequence.

  Medicare systems shall initiate an automatic adjustment of any
  previously paid episodes identified in above requirement.

  Medicare systems shall revise any edits that use HH HIPPS code
  ranges to use the HIPPS codes in attachment one, as appropriate.

  Medicare systems shall disable any edits and unsolicited response
  processes that validate inpatient stays in the 14 days prior to an
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 172
____________________________________________________________________________

  episode, for episodes beginning on or after January 1, 2008.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:          _____25443_______     WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                  ___   Minor
  FUNCTION:    _________________                  _x_   Major
  PROGRAM:     _________________                  ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                  Kathy Woytan
      Telephone:            410-786-4982
      FAX, CMS:             410-786-0271
      Responsibilities:     REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:      Vicki Sommers
      Telephone:            469-372-7642
      FAX,Richardson,TX:    469-372-0284
      Responsibilities:     DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   BUSINESS ANALYST:    Ofelia Castillo
       Telephone:           469-372-6492
       FAX,Richardson,TX:   469-372-0284
       Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  3.   PROG ANALYST:
       Telephone:           443-436-____
       FAX,Baltimore,MD:    443-436-3803
       Responsibilities:    ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                            TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *              blank line is found.                               *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *              after a colon. Try to format as it should appear *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 173
____________________________________________________________________________

  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  ( ) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  (X) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

    NEW BUSINESS REQUIREMENTS:
  *** Note: This is an ANALYSIS Only effort and does not contain
            any software updates. ***

  Dated 6/6/07
  Release R2007400
  CWF CR #: 25443
  CMS CR #: 5561

  Early Involvement Call Needed? Ongoing

  Title: Case Mix Refinement for the Home Health Prospective
  Payment System (Analysis)

  Business Analyst: Vicki Sommers and Ofelia Castillo

  CMS Contact: Kathy Woytan

  Programmer:

  CR Description:
  The requirements described in this confidential Change request
  reflect the operational changes that would be necessary to
  implement the HH PPS refinements as they are currently planned.
  These requirements will be subject to change based on any changes
  to the HHPPS case mix refinement final rule. However, in order
  to be prepared to meet the aggressive timeline to implement
  HHPPS refinements in January 2008, shared systems shall perform
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 174
____________________________________________________________________________

  analysis of these requirements for the October 2007 systems
  release. All actual changes to the shared systems will be
  made in the January 2008 release.

  Type of Claim/Transaction Affected: HUHH

  Software Functions Affected:

  Edits Affected: A/B Crossover edits 7273 and 7274 will be
  disabled for episodes beginning 1/1/2008 and after.

  Trailers/Responses Affected: N/A

  Auxiliary Files Affected: N/A

  HCPCS Affected: N/A

  IUR Affected: N/A

  New Process to Apply:
  Create two new Utilization edits to ensure the correct
  HIPPS Code is present for the Early Episode and Late Episode.
  This will include creating logic for the two new codes
  for the IUR process also for HUHH. No new trailers will
  be created for this project. IUR will return trailer
  24 and 23. The Utilization edit will return trailer 08
  and 23.

  Analysis:
  CWF will read the HIPPS Code on the incoming Final Claim
  or LUPA Final for Date of Service 01/01/2008 and later to
  determine if applies to the correct episode. The Early
  Episode represents the 1st and 2nd Episode and the Late
  Episode represents the 3rd and later.
  CWF will also need to apply the informational Unsolicited
  Response process to the HUHH record for the above new
  process.


  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 175
____________________________________________________________________________

  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST: None
  ***.......This is the width of the Release Document.......***

  Event 1.1

  Response
  ***.......This is the width of the Release Document.......***

  The Entity List includes only NEW acronyms and terminology
  that is currently not in use in CWF.

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1.

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 176
____________________________________________________________________________

 Scenario 1
 Early Episodes 1st and 2nd (position #1 of the HIPPS Code is 1, 2, or 3)
 are posted to the HHEH file.
 The Final Claim in the first episode is cancelled and the first episode
 removed from HHEH file.
 The next Final Claim or Final Lupa is received as a Late Episode (3rd
 or later) and CWF should reject with a new error code due to the incorre
 position of the episode.
 *Should CWF expect in sequence processing?
 First Episode's Start Date is 1/1/08 and End Date 3/1/08
 Second Episode's Start Date is 3/2/08 and End Date 4/30/08
 Incoming Final Claim has Start Date of 5/1/2008

 WG: This scenario looks good to me. CWF should not expect in
 sequence processing per se, just enforce that episodes coded as early
 are early and coded as late are late, because this makes a payment
 difference.


 Scenario 2
 Early Episodes 1st and 2nd (position #1 of the HIPPS Code is 1, 2, or 3)
  are posted to the HHEH file.
 The Final Claim in the first episode is cancelled however, the first epi
  is NOT removed from HHEH file.
 The next Final Claim or Final Lupa is received as a Late Episode (3rd
 or later) and CWF should not reject the claim since first two episodes
 are still posted even though one of the claims were cancelled.
 First Episode's Start Date is 1/1/08 and End Date 3/1/08
 Second Episode's Start Date is 3/2/08 and End Date 4/30/08
 Incoming Final Claim has Start Date of 5/1/2008

 WG: Correct

 Scenario 3
 Early Episodes 1st and 2nd (position #1 of the HIPPS Code is 1, 2, or 3)
 are posted to the HHEH file.
 The Final Claim in the first or second is cancelled and the Episode is
 removed from the HHEH file.
 If the next Final Claim is received as Late Episode however, the Start
 Date is not the next subsequent claim (gap) should CWF reject due to
  incorrect position of the episode?
 -Should CWF expect in sequence processing between the Early episodes
 and Late Episodes?

  WG: CWF should reject this late episode, because history at the time of
  receipt says it should be early.    CWF should process on the history at
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 177
____________________________________________________________________________

  face value and not try to infer sequence from any gaps.

  Scenario 4
  Early Episodes 1st and 2nd are not posted on the HHEH File.
  The Final Claim is received as a Late Episode should CWF reject and
  expect in sequence processing and not accept Late Episode unless Early
  Episodes both 1st and 2nd are posted?

  WG: CWF should reject this claim because it says it is late and the
  history says that it is early.

  Scenario 5
  Early Episode 1st and 2nd are posted to the HHEH file.
  A Final claim is received with a Start Date that is before the first
  or second episode posted and has the correct HIPPS Code present.
  The claim is accepted and an IUR is generated on the Second Episode's
  Claim since this should be a Late Episode.

  WG: Correct


  Question
  1) If an Episode starts prior to 1/1/2008 but overlaps 1/1/2008 is this
  considered the 1st Early Episode?
  Same logic would apply for out of sequence of Episode 2 or 3 also.

  WG:   Not certain about this.   Need to confer with policy staff.

  2) CWF should not take reject or generate IUR due to a RAP and only the
  Final Claim or LUPA Final, is this correct?

  WG: Correct.


  3) Should CWF create two different reject codes one when HIPPS
  Code is for later Episodes and should be Early and one when HIPPS
  Code is for Early and should be for later Episode or one for both?

  WG: I believe 2 rejects will be needed to facilitate FISS knowing when
  populate the re-coding indicator that is added to the Pricer input recor
  attachment 2 of the CR.   But this should be confirmed with the FISS
  maintainer.


  NOTE:
  CWF is suggesting that action is taken to generate the IUR or
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 178
____________________________________________________________________________

  reject, if the cancel submitted removes the episode from the
 Beneficiary file. CWF would not take action if the cancel only
 removes the DOEBA and DOLBA and does not remove the episode.

 WG:   Agree.



 -------------------------------------------



 This is ok with the CWF maintainer.


 _____________________________________________
 From: Gehne, Wilfried K. (CMS/CMM)
 Sent: Tuesday, March 13, 2007 3:29 PM
 To: Atkins, Nicole V. (CMS/CMM); YOUNG, YVONNE D. (CMS/CMM); Kerr, Jason
 D. (CMS/CMM); Tucker, Wendy S. (CMS/CMM); Johnson, Kathy A. (CMS/OIS);
 Woytan, Kathryn A. (CMS/OIS); Kulow, Cynthia (CMS/OIS); Amendola, Tammy
 M. (CMS/OIS); Biggs, Marlene M. (CMS/OIS); SALLOUM-BYRAM, ROSE M.
 (CMS/OIS); CMS C4-20-02
 Subject: RE: Early Involvement Call for CR 5561 "Case Mix Refinement for
 the Home Health Prospective Payment System (Analysis Only)

 Our plan is to have discussion of this CR, including the maintainers, at
 our 3/22 RHHI call and to have continuous discussions about this project
 through that call from now until January.   In light of that, is a
 separate early involvement call necessary?    If it is, can we do a
 different day since Yvonne is out of the office next Monday?

 Wil Gehne
 CMS Division of Institutional Claims Processing
 Phone: (410) 786-6148
 Fax: (410) 786-0330 (Shared, send w/cover)




  Subject: CWF Comments
  POC Review Level: 1
  Posted by: SOMMERS, VICKI
  Posted: 03/12/2007 16:35
  Comments:
  SOMMERS, VICKI
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 179
____________________________________________________________________________

  CWF is requesting an Early Involvement call to explain this process for
  codes before analysis can be done to determine what changes are required
  According to REQ 5561.6 CWF will that the HIPPS code accurately reflects
  of the episode within a sequence of adjacent HH episode. Please explain
  if this means CWF will edit if the HIPPS code does not match the episode
  Does REQ 5561.7 require CWF to adjust records that have already posted?
  CWF revise existing edits in REQ 5561.8 or only apply these edit up to 1
  Does CMS want CWF to continue to apply edit in 5561.12 for Dates of Serv
  to 1/1/2008 and not disable the edits beginning 1/1/2008?



  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 180
____________________________________________________________________________


   3.   00025521   5611-CWF IUR ANALYSIS ONLY

  DATE ENTERED:    04/25/07

  TITLE:           5611-CWF IUR ANALYSIS ONLY

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2007400

  GROUP LEVEL:     1

  HOST SITE ID:    CWFM2000

  STATUS ON CR:    RESE

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   2
  EST. HOURS:      0125
  ACT. HOURS:      0080
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  All Shared System Maintainers are requested to conduct
  analysis regarding the Common Working File Informational
  Unsolicited Response process.

  The Informational Unsolicited Response process identifies a
  claim that needs to be adjusted by the Medicare contractor. Common
  Working File does not cancel the claim but returns information in
  Trailer 24. Upon receipt of the Informational Unsolicited Response
  the shared system software reads the trailer for each claim and either
  a manual or automated adjustment is performed. The Medicare
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 181
____________________________________________________________________________

  contractor initiates overpayment recovery procedures to retract
  Part A and Part B payment and generates an adjustment to update
  or cancel the claim on Common Working File and contractor history.

  There are several types of Informational Unsolicited Responses,
  for example: Home Health Consolidated Billing; SNF Consolidated
  Billing; Managed Care; CAPS; and VA Demo. Each type is marked
  with a unique transaction identifier in Common Working File claims
  history and on the trailer.

  CMS is requesting each system maintainer to analyze the current
  Informational Unsolicited Response process and recommend
  improvements. The improvements can be for either the shared
  system maintainer or the Common Working File. Possible suggestions
  for improvements could be additional automation, an audit trail on
  CWF HIMR when the IUR was produced, or generate an IUR for
  scenarios when monies should not have been taken back from providers.

  The Shared System Maintainers shall analyze the needs of CMS and
  Propose improvements to the CWF Informational Unsolicited
  Response process to make proper overpayment adjustments.

  CWF REQS:
  The Shared System Maintainers shall conduct analysis on how
  best to improve the CWF IUR process.

  The Shared System Maintainer shall provide a written analysis
  document clearly and an hourly estimate clearly defining
  the required system changes.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:          ____25521________   WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                ___   Minor
  FUNCTION:    _________________                _X_   Major
  PROGRAM:     _________________                ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:               Kathy Woytan
      Telephone:         410-786-4982
      FAX, CMS:          410-786-0271
      Responsibilities: REVIEW TECH DESIGN, APPROVE MODS
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 182
____________________________________________________________________________


 CWFM Participants:
 1. BUSINESS ANALYST:         Vicki Sommers
     Telephone:               469-372-7642
     FAX,Richardson,TX:       469-372-0284
     Responsibilities:        DEFINITION, ANALYSIS, SYSTEM TESTING

 2.     PROG ANALYST:         Sri Anne
        Telephone:            443-436-6723
        FAX,Baltimore,MD:     443-436-3803
        Responsibilities:     ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                              TESTING


 *******************************************************************
 * PARAGRAPHS - Start in column 1. The paragraph will end when a *
 *               blank line is found.                              *
 * HEADINGS   - Start in column 2.                                 *
 * FREE-FORMAT- Start in column 3.                                 *
 * Use upper and Lower case.                                       *
 *                                                                 *
 * EDITING    - Please allow 2 spaces after a period and 2 spaces *
 *               after a colon. Try to format as it should appear *
 *               in the Release Document.                          *
 *******************************************************************
   IMPACT:
 (X) Host
 (X) Satellite Part A Inpatient
 (X) Satellite Part A Outpatient
 (X) Satellite Part B
 (X) Hospice
 (X) Home Health
 (X) DMERC
 ***.......This is the width of the Release Document.......***

      REASON FOR CHANGE:

 ***NOTE: This is an ANALYSIS Only effort and does not contain any
          software updates. ***


 Date Prepared:     5/25/07

 Release: R2007400

  CWF CR #: 25521
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 183
____________________________________________________________________________


  CMS CR #: 5611

  Early Involvement Call Needed? Yes

  Title: Common Working File Informational Unsolicited Response-Analysis
         Only
  Business Analyst: Vicki Sommers

  CMS Contact: Kathy Woytan

  Programmer: Sri Anne

  CR Description:
  CMS is requesting each system maintainer to analyze the current Informat
  improvements. The improvements can be for either the shared
  system maintainer or the Common Working File.

  Type of Claim/Transaction Affected: All detail records in
  History for Inpatient/SNF, Outpatient, Home, Health, Hospice,
  Part B, and DME.

  Software Functions Affected:

  1) Beneficiary Claim History Record:
  Create a total of five UNSOL IND fields and five new fields for
  the Date of Generation of the IUR.

  2) New Process to replace L1001/L1002 Hardcopy Report:
  Eliminate the L1001/L1002 hardcopy reports for Inpatient/SNF due
  to Trailer 15 and 20 where claims are auto adjusted or auto
  cancelled and apply to the Unsolicited Response process.

  Eliminate the L1002 hardcopy reports for Inpatient/SNF and
  Hospice due to XREF Merges where claims are auto cancelled
  and apply to the Unsolicited Response process.

  3) CABBUMP:
  Due to CABBUMP Phase 2 - Streamline CWF Unsolicited Processing
  (CR24702) the following will be affected:
  A) Repetitious logic exists for processing unsolicited claims
  in CWF utilization modules.
  B) Consolidate and streamline unsolicited processing logic.
  Detail Informational Unsolicited processing description can be
  located in CWF USER Documentation Volumes:
  DESCLVL2 and PROGDTL.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 184
____________________________________________________________________________

  C) Transactions Affected:
  URs-Unsolicited Responses
  IURs-Informational Unsolicited Responses

  HIMR:
  The detailed history screens in HIMR to be modified
  to display five UNSOL IND fields and addition to the
  Date of Generation (DOG).

  Edits Affected: N/A

  Trailers/Responses Affected:
  Apply Trailer 15 and 20 logic to Unsolicited Response for
  HUIP and HUHC.

  Auxiliary Files Affected: N/A

  HCPCS Affected: N/A

  IUR Affected:
  Apply new Unsolicited Response for HUIP and HUHC.

  Analysis:
  CWF currently only carries one UNSOL IND field and if
  another type of IUR is generated, the existing Indicator
  is overlaid. Also CWF does not indicate the Date the IUR
  was generated.

  New Process to Apply:
  #1 CWF should allow up to five UNSOL IND fields on a
  claim in history with five new fields for the Date of
  Generation (DOG) displayed by each UNSOL Indicator.
  This will require new fields to be created on the claim
  in history for a Beneficiary's Master Record and HIMR.
  See attached Estimate for #1

  Analysis and Requirements:
  1. Analyze all detail records in History for Inpatient/SNF,
  Outpatient, Home, Health, Hospice, Part B, and DME that
  will be affected.
  2. Analyze all the detailed history screens in HIMR to be
  modified to display five Unsol Ind/Date of Generation
  Fields

  Development and Unit Testing:
  1. Modify the History Layouts for Inpatient/SNF, Outpatient,
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 185
____________________________________________________________________________

  Home, Health, Hospice, Part B, and DME to add five Unsol Ind
  and Date of generation Fields.
 2. Modify the detailed history screens in HIMR to display five
 Unsol Ind/Date of Generation fields. Move the fields around in
  HIMR screens
 To make room for five fields on the Header Page
 3. Modify all the programs to Populate all the five Unsol Ind/Date
 of generation Fields. Recompile all the affected program due to
 copy book changes

 System Testing:
 1. Extensive Testing required for sampling all the possible
 scenarios.
 -----------

 #2 Eliminate L1001/L1002 reports to remove logic to
 generate L1001/L1002 hardcopy reports and add logic
 to the Unsolicited Response to generate
 for auto adjustment (L1001) and auto cancel L1002)
 due claims processing and XREF Merge on Inpatient/
 SNF/Hospice.

 Analysis and Requirements:
 1. Analyze all the programs where the L1001/L1002
 reports being produced for the claims that are auto
 canceled or auto adjusted.
 2. Analyze the Unsolicited Programs to include the
 auto cancel and auto adjust logic for Inpatient/SNF/
 Hospice.

 Development and Unit Testing:
 1. Remove logic for L1001/L1002 hardcopy reports.
 2. Add logic to Unsolicited Response module to generate
 due to L1001 (Trailer 15) and L1002 (Trailer 20) due to
 auto adjustments and auto cancels.
 3. Add logic to Unsolicited Response module to generate
  due to L1002 (Auto Cancel) due to XREF Merges on Inpatient
 /SNF/Hospice.

 System Testing:
 1. Extensive Testing required for sampling all the possible
 scenarios
 ------------

  #3 CABBUMP PHASE 2 - Streamline CWF Unsolicited Processing
  Analysis and Requirements:
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 186
____________________________________________________________________________

  1. Modify program HHEHUSPL and HHBPUSPL as follows:

  These programs currently create Home Health Benefit periods
  and Home Health Episodes for home health claims, as well as,
  create URs for claims in history that overlaps
  the Home Health periods.

  -   Create common Interface area copybook for referencing
      the Unsolicited processing for Home Health Claims.

  -   Restructure and Streamline programs.

  - Process all IURs and URs for Part A and B utilization in
  new module-HIABUNSOL.

  2. Modify program HIMCHUSC as follows:

  This program currently generates unsolicited responses-(HUSC)
  for COBC contractors.

  - Restructure and Streamline program.

  3. Modify program HHEHUSPL and HHBPUSPL as follows:

  These programs currently create Home Health Benefit periods
  and Home Health Episodes for home health claims, as well as,
  create URs for claims in history that overlaps
  the Home Health periods.

  -   Create common Interface area copybook for referencing

      the Unsolicited processing for Home Health Claims.

  -   Restructure and Streamline programs.

  -   Process all URs for Home Health Claims
      in new module-HABUNSOL.


  4. Modify program HUBCCUT, HUIPCUT and HUOPCUT, CWF
  Inpatient, Outpatient and Part B Driver modules,
  as follows:

  -   Create common Interface area copybook for referencing
      the Unsolicited processing for HUBCCUT, HUIPCUT and HUOPCUT.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 187
____________________________________________________________________________

  -   Process all unsolicited response records for CEPP
      in new module-HABUNSOL.

  Development and Unit Testing:
  1. Streamline CWF Unsolicited Processing
     a. Repetitious logic exists for processing unsolicited claims
        in CWF utilization modules.
     b. Consolidate and streamline unsolicited processing logic.

  System Testing:
  1. Extensive Testing required for sampling all the possible scenarios
  ------------


  #4 CMS may want to consider reissuing an IUR that was
  previously generated (possible after 12 months) if an
  adjustment or new claim or reprocessed transaction (HHMO)
  is submitted that reads history to identify condition
  that would generate the IUR and found the same UNSOL IND
  was already set however, the DOG (Date of Generation)
  of the previous UNSOL IND has been more than 12 months.
  See attached Estimate for #1 and #2.

  Analysis and Requirements:
  1. Analyze all detail records in History for Inpatient/SNF,
  Outpatient, Home, Health, Hospice, Part B, and DME that will
  be affected.
  2. Analyze all the detailed history screens in HIMR to be
  modified to display five Unsol Ind/Date of Generation Fields

  Development and Unit Testing:
  1. Modify the History Layouts for Inpatient/SNF, Outpatient,
  Home Health, Hospice, Part B, and DME to add five Unsol Ind
  and Date of generation Fields.
  2. Modify the detailed history screens in HIMR to display five
  Unsol Ind/Date of Generation fields. Move the fields around in
  HIMR screens
  To make room for five fields on the Header Page
  3. Modify all the programs to Populate all the five Unsol Ind/Date
  of generation Fields. Recompile all the affected program due to
  copy book changes
  4. Create a second IUR that was previously generated (possible
  after 12 months) if an adjustment or new claim or reprocessed transactio
  condition that would generate the IUR and found the same UNSOL
  IND was already set however, the DOG (Date of Generation) of
  the previous UNSOL IND has been more than 12 months.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 188
____________________________________________________________________________


  System Testing:
  1. Extensive Testing required for sampling all the possible
  scenarios
  ----------


  Attachment A is a current list of IURs generated by CWF
  Attachment B is possible overlays.

  CWF should review all suggestions from the other Shared Maintainers
  and Satellites to determine what other modifications can be made
  to the IUR process for CWF.

  Issues to be Addressed: N/A

  Attachment A
  LIST OF IURS

  1.   IUR for Home Health Consolidated Billing impacts
       HUOP/HUBC/HUDC UNSOL IND is A

  2.   IUR for Centers/Provider Partnership impacts HUBC
       UNSOL IND is B and C

  3.   IUR for SNF Consolidated Billing impacts HUOP/HUBC/HUDC
       UNSOL IND is D

  4.   IUR for IHS/Tribal Hospital concurrent Outpatient stays
        impacts HUOP UNSOL IND is E

  5.   IUR for Radiology/Pathology impacts HUBC
       UNSOL IND are F, G, H, I, and J

  6.   IUR for HHMO Overlay impacts HUIP/HUOP/HUBC/HUDC
       UNSOL IND is M

  7.   IUR for incorrect Patient Status on IPPS impacts HUIP
       UNSOL IND is N

  8.   IUR for LTCH impacts HUOP
       UNSOL IND is O

  9.   IUR for HIS/Tribal Hospital concurrent Inpatient stay impacts
       HUOP UNSOL IND is P

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 189
____________________________________________________________________________

  10. IUR for VADS impacts HUOP/HUBC
      UNSOL IND is Q

  11. IUR for CAPS impacts HUBC
      UNSOL IND are R and S

  12. IUR for IRF and Proper Transfer Code impacts HUIP
      UNSOL IND is T

  13. IUR for VA DEMO impacts HUOP and HUBC
      UNSOL IND is V

  14. IUR for Part B Ambulance during Inpatient Stay impacts HUBC
      UNSOL IND is X

  -----------



  ATTACHMENT B
  POSSIBLE OVERLAYS


  1.   IUR for Home Health Consolidated Billing impacts
       HUOP/HUBC/HUDC
       The UNSOL IND is A and can be overlaid with M

  2.   IUR for Centers/Provider Partnership impacts HUBC
       The UNSOL IND are B and C and can be overlaid with M

  3.   IUR for SNF Consolidated Billing impacts HUOP/HUBC/HUDC
       The UNSOL IND is D and can be overlaid with M

  4.   IUR for IHS/Tribal Hospital concurrent Outpatient stays
        impacts HUOP The UNSOL IND is E and can be overlaid with M

  5.   IUR for Radiology/Pathology impacts HUBC
       The UNSOL IND are F, G, H, I, and J and can be overlaid with M

  6.   IUR for HHMO Overlay impacts HUIP/HUOP/HUBC/HUDC
       The UNSOL IND is M and can be overlaid with M

  7.   IUR for incorrect Patient Status on IPPS impacts HUIP
       The UNSOL IND is N and can be overlaid with M

  8. IUR for LTCH impacts HUOP
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 190
____________________________________________________________________________

       The UNSOL IND is O and can be overlaid with M

  9.   IUR for HIS/Tribal Hospital concurrent Inpatient stay
        impacts HUOP The UNSOL IND is P and can be overlaid with M

  10. IUR for VADS impacts HUOP/HUBC
      The UNSOL IND is Q and can be overlaid with M

  11. IUR for CAPS impacts HUBC
      The UNSOL IND are R and S and can be overlaid with A, D, or M

  12. IUR for IRF and Proper Transfer Code impacts HUIP
      The UNSOL IND is T and can be overlaid with M

  13. IUR for VA DEMO impacts HUOP and HUBC
      The UNSOL IND is V and can be overlaid with M

  14. IUR for Part B Ambulance during Inpatient Stay impacts HUBC
      The UNSOL IND is X and can be overlaid with M


  NOTE: Above situations could have exceptions to the rule and apply
  a) override of an edit allowing claim to process
  b) cancel claim that allows another claim to process
  c) more than one type of stay during the dates of service of the claim
     receiving an IUR




  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 191
____________________________________________________________________________

  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

    NEW BUSINESS REQUIREMENTS:

  Requirement 1
  xxxx

  Requirement 2
  xxx

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST: None
  ***.......This is the width of the Release Document.......***

  Event 1.1

  Response
  ***.......This is the width of the Release Document.......***

  The Entity List includes only NEW acronyms and terminology
  that is currently not in use in CWF.

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1.

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2007400
Full Requirements Document                                      June 28, 2007
Analysis Change Requests                                             Page 192
____________________________________________________________________________

  a. Error Code:     XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************

  TOTAL RECORDS: 3




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:7
posted:5/12/2011
language:English
pages:195