The Veterans Health Administration (VHA) is home to the United States’ largest integrated health care system.  VA Health Care is committed to supporting its trading partners in achieving the full benefits of Electronic Data Interchange (EDI) Health Care processes.  As a health care payer and provider, VHA maintains compliance with regulatory mandates established by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). 

VA met the original January 1, 2012 mandatory compliance deadline for HIPAA 5010/National Council for Prescription Drug Programs (NCPDP) D.0 conversion by designing software and systems with the ability to maintain legacy (Version 4010/NCPDP 5.1) and contemporary (Version 5010/NCPDP D.0) maps to aid its trading partners in meeting compliance under either standard.  VA is pleased to announce that as of July 2, 2012 all insurance Payer Identifiers (IDs) are now pointed to the Version 5010 transaction maps within the payer switch operated at its payer EDI gateway.  All Payer IDs are now blocked from using the legacy, Version 4010 transaction map.  What this means is that VA is now operating exclusively within the Version 5010 standard for communicating electronic health care information with insurance payers and other health care trading partners.  Converting to 5010-only mapping of Payer IDs is an additional, significant milestone achievement for VA and demonstrates VA’s ability to meet ever-changing regulatory requirements within the health care industry.

Currently, VA Health Care is working toward completion of software system upgrades to comply with The Patient Protection and Affordable Care Act of 2010 (PPACA).  Improvements to our system will include:

• Further implementation of technology that uses Optical Character Reader (OCR) hardware and software to read, translate, and store readable patient health insurance identification cards and Veteran Identification Cards (VIC) in VHA’s Revenue System.
• Standardization of processes that will enable VHA to obtain health care financial responsibility data at the time of care.
• Implementation of methods that will identify patient financial liability at the time of care.
• Improvement of EDI Revenue System storage, display, and expansion of buffer file capabilities to meet health care EDI standards.
• Implementation of the process for utilizing electronic Pharmacy External Code List (ECL) updates.
• Additional solutions to seamlessly meet compliance with National Council for Prescription Drug Programs (NCPDP) D.0
• Further implementation of 837 transaction submissions.

Contact Us

We welcome your contact; to find out more specifics about VA’s on-going efforts to maintain compliance with new EDI standards and operating rules, email us at: VAEDITransactionsSupport@va.gov or dial our EDI Transactions Hotline at: 202.461.1550.