The U.S. Department of Veterans Affairs (VA) aims to provide eligible Veterans the care they need at the right time, from the right provider, in the right place. Normally, VA must authorize care outside the VA healthcare system before it occurs, using a web-based Community Care Referral and Authorization tool.
Veterans requiring emergency room care do not need to request prior authorization but must notify VA within 72 hours. This allows providers to submit claims, and VA to coordinate and determine eligibility for follow up care.Â
The Emergency Care Authorization Tool (ECAT), built to quickly address a surge in emergency room care during the COVID-19 pandemic, needed to be replaced with a sustainable, long-term solution. Under the original system, a provider or Veteran submitted a form via email or fax that was then entered into a SharePoint site and transmitted into VA’s claims processing system. The entire process was slow, labor intensive, and costly, requiring hundreds of employees.
VA sought a modernized, user-friendly system that offered workflow-based case management and the ability to process these authorizations at scale. Ultimately, the solution needed to ensure Veterans receive the follow-up care they need quickly and seamlessly.
Cognosante developed and deployed two modernized portals to automate the receipt and adjudication of emergency care notifications: the Emergency Care Reporting (ECR) Submission Portal and the ECR Administrative Portal.
The ECR Submission Portal is a public-facing web portal that allows Veterans, caregivers, health providers, and VA clinical staff to submit emergency care notifications after a Veteran receives care. Hosted in AWS GovCloud with CCRA system components, the Submission Portal uses automation to minimize administrative burdens and presents a unified architecture promoting sustainability and additional modernization over time.
The ECR Administrative Portal allows VA voucher examiners, clinicians, and revenue operations team members to receive emergency care notifications and perform care coordination.
For more complex cases, the Administrative Portal automatically sends the request for clinician review. Once the emergency notification is adjudicated, the system automatically sends the notification message to one or more downstream systems so that the claim can be paid.
The entire ECR solution was developed using a DevSecOps Modern Software Factory approach to optimize security and scalability, improve efficiency, and minimize development and sustainment costs.
The architecture gives VA the ability to modify workflows as new processes are introduced and helps information flow efficiently through the system, enabling easier, safer, faster completion of tasks. The design further supports VA’s goal of improving the customer experience for Veterans and community providers through automatic generation of emails, faxes, and contact center call-back tracking.Â
The new ECR system allowed VA to sunset the antiquated SharePoint-based ECAT process and reassign over 200 FTEs to other duties, resulting in significant labor cost savings. To date, over 4 million emergency care authorizations have been processed through the ECR submission portal for more than 1.5 million Veterans. The system is processing over 135,000 authorizations per month, and claims are being paid faster.Â
Learn more about how Cognosante is helping government organizations deliver services, bridging intentions to outcomes through improved customer experiences.Â