Sec. 105. Department of Veterans Affairs electronic interface for processing of medical claims
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Not later than the implementation date specified in section 108(a), the Chief Information Officer of the Department of Veterans Affairs shall ensure that the information technology system used by the Department to receive, process, and pay claims under the VA Care in the Community Program established in section 1703A of title 38, United States Code, as added by section 102, and under Veterans Care Agreements established in section 1703B of such title, as added by section 103, includes the following:
A function through which a covered non-Department health care provider may submit all required data and supporting information required for claims reimbursement through electronic data interchanges. An ability to automatically adjudicate claims. A centralized claims database that is accessible nationwide. Integration with the relevant eligibility and authorization information technology systems of the Department. Ability for a covered non-Department health care provider to ascertain the status of a pending claim submitted by the provider, receive information regarding missing documentation or discrepancies that may impede claim processing timelines or result in rejection, and receive notification when such claim is accepted for reimbursement or rejected.
A claim review system similar to that used by the Centers for Medicare & Medicaid Services, as of the date of the enactment of this Act, including the use of contractors to perform audits through data analytics, to determine the appropriateness and accuracy of claims of providers and to ensure program integrity and oversight. The Chief Information Officer shall also ensure that the information technology system covered under subsection
(a)meets the following criteria: Such system shall be developed and implemented in compliance with all applicable laws, regulations and Federal Government standards regarding information security, privacy, and accessibility. Such system shall provide for the elicitation, analysis, and prioritization of functional and nonfunctional information security and privacy requirements for such system, including security and privacy services and architectural requirements relating to security and privacy based on a thorough risk assessment of all reasonably anticipated cyber and noncyber threats to the security and privacy of electronic protected health information made available through such interface. Such system shall provide for the elicitation, analysis, and prioritization of secure development requirements relating to such system. Such system shall provide assurance that the prioritized information security and privacy requirements of such system— are correctly implemented in the design and implementation of such system through the systems development lifecycle; and satisfy the information objectives of such system relating to security and privacy throughout the systems development lifecycle. The Chief Information Officer may enter into a contract for purposes of carrying out this section. In this section: The term electronic protected health information has the meaning given that term in section 160.103 of title 45, Code of Federal Regulations, as in effect on the date of the enactment of this Act. The term covered non-Department health care provider means— a network provider (as defined by section 1701(11) of title 38, United States Code, as added by section 102); a non-network provider with which the Secretary has entered into a Veterans Care Agreement under section 1703B of such title, as added by section 103; or any other non-Department eligible provider or non-Department health care provider that furnishes hospital care or medical services pursuant to chapter 17 of such title. The term secure development requirements means, with respect to the information technology system established under subsection (a), activities that are required to be completed during the system development lifecycle of such interface, such as secure coding principles and test methodologies. The term VA Care in the Community Program has the meaning given that term in section 1701(12) of title 38, United States Code, as added by section 102.