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Provider Screening Module for Medicare/Medicaid Provider Enrollment

Current build status: Build status

Contents:

  1. Introduction and Current Status
  2. Background
  3. Features and Functionality
  4. Project Resources and Organization of This Repository
  5. Participating in the PSM Project

SECTION 1: Introduction and Current Status

This is an open source Provider Screening Module (PSM) designed to work within a Medicare/Medicaid Information System (MMIS) environment to provide a portal for screening service providers as part of the provider enrollment process. It is released under the Apache-2.0 open source license.

This code is a work-in-progress and is not yet ready for production deployment. Please see INSTALL.md for details.

Development activity now takes place on the master branch, with short-lived development branches used for specific tasks. Code contribution guidelines are in CONTRIBUTING.md. Please feel free to file issue tickets in this repository to ask questions.

See the "Background" section for the provenance of this project.

We made some replay branches to clarify development history, and to help us organize legacy code for eventual landing or rearrangement on master. These replay branches show the history of the JBoss side (soon to be WildFly), the WebSphere side (which is divided into two subtrees in the original repository), and the documentation changes:

The point of the replay branches is to give us a clean, disentangled view of the changes that happened in each line of development. They all start off with a virtually empty commit (just a .gitignore file), and then each has the appropriate selected commits from upstream replayed in sequence. The replay commits get their own commit IDs, of course, and their author is always @slifty (Dan Schultz) because he did the replaying, but in the commit message for each replay commit he includes the corresponding original commit ID from upstream.


SECTION 2: Background

The NASA Center of Excellence for Collaborative Innovation (CoECI) through an Interagency Agreement with the Centers for Medicare and Medicaid Services (CMS) administered a crowd-sourced application development challenge for the Medicare and Medicaid Services, Center for Medicaid and CHIP Services (CMCS). The challenge was to build a multi-state, multi-program provider screening application capable of risk scoring, credentialing validation, identify authentication, and sanction checks, that lowered the burden on providers and reduced administrative and infrastructure expenses for states and federal programs.

The application was built using NASA's contract with Harvard Business School in association with the Institute of Quantitative Social Sciences and their subcontract with TopCoder. The Application Development Challenge was sponsored by CMS as part of the Partnership for Program Integrity Innovation program with the specific intent of developing an application to improve capabilities for streamlining operations and screening providers to reduce fraud and abuse.

The challenge was comprised of an omnibus of 120 contests launched between June 2012 and April 2013, to cover all phases of the software development life cycle. The code and documentation resulting from that challenge are hosted in an original repository code, from which this repository was cloned to continue the project. Work restarted in April 2017.

More information on the challenge can be found here: http://www.topcoder.com/cms/medicaid-enrollment-portal/


SECTION 3: Features and Functionality

As of 21 June 2017, the PSM offers the following functionality:

  1. Any user
  • Self-register and create a new account
  • Receive new password via email
  • Log in
  • View homepage
  • Log out
  • Receive password reminder via email
  • Change password in profile
  1. User at "System administrator" privilege level
  • View other user accounts
  • Edit other user accounts
  • Create other user accounts and send email notifications to new users
  • Delete other user accounts
  1. User at "service admin" privilege level
  • View list of provider types
  • View list of help topics
  • View, create, edit, and delete agreements & addendums
  • Change agreement and addendum assignments for provider types
  • View, create, edit, and delete service agents
  1. User at "provider" privilege level
  • Make a new enrollment
  • While creating an enrollment, save a draft and then come back to it later
  • View existing enrollments (draft, pending, approved, and denied)
  • Print enrollments or export as PDF
  1. User at "service agent" privilege level
  • View existing draft and pending enrollments
  • Create a new provider enrollment
  • While creating an enrollment, save a draft and then come back to it later
  1. System
  • Issue risk score for an enrollment
  • Record logs in standalone/log/
  • Record changes for auditing in database tables audit_details and audit_records

[Note: As the developer team conducts initial improvement work on the PSM in June 2017, we anticipate recovering many of the features listed in the original repository, such as identity verification, building provider profiles, and MITA integration.]


SECTION 4: Project Resources and Repository Organization

Please see INSTALL.md for the latest installation instructions.

See DESIGN.md for an overview of the PSM's architecture and design assumptions.

The psm-app subdirectory holds the source code to the PSM proper.

opentechstrategies.github.io is our GitHub Pages site, where we publish documentation for the PSM's web API.

The ext-sources-app subdirectory has been removed. It held the source code to the semi-separate middleware application that provided a service wrapper around external data sources. This will be replaced as discussed on the mailing list.

The team-notes directory has agendas and meeting notes from various team and sub-team meetings.

See also the section "Participating in the PSM Project" below.


SECTION 5: Participating in the PSM Project

We welcome questions and contributions. You can:

  • Post in the psm-dev discussion group at https://groups.google.com/forum/#!forum/psm-dev. The forum archives are public, and anyone can post. The posting guidelines are fairly loose -- as long as your question is about the PSM, it's on-topic.

  • File a new issue ticket at https://github.com/OpenTechStrategies/psm/issues.

  • Submit a pull request to the repository. Here's our guide for code contributors.

  • Use IRC to talk to us in real time. Most of the dedicated team hangs out in #OpenTechStrategies on the irc.freenode.net server network. If you don't have IRC client software, you can use the Freenode webchat interface in your browser.

  • We hold team meetings by conference call sometimes. The agendas and notes from these meetings can be found in team-notes/meetings/. The current core developers are all based in the U.S., and these meetings are arranged around U.S. time zones. Eventually, when the PSM project has regular participants beyond the current core team, we may change how we schedule real-time meetings. For now, however, we schedule meetings on an ad hoc basis and just put the agendas and notes here, so that they are visible along with all the other project resources.

Note that submitting issues or pull requests requires a GitHub account, which anyone can create (there is no charge).

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