308 lines
12 KiB
Plaintext
308 lines
12 KiB
Plaintext
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English French Notes Complete/Exclude
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The 'AMOUNT PAID' has been altered on the Fee Payment Voucher Document
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in FMS for the following payments:
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>>> For detailed payment information use the appropriate payment output. <<<
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Payment has been cancelled for the following line items:
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>>> For detailed check information use the Check Display output. <<<
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Check Number:
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Date of Service:
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Invoice Number:
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From Date:
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To Date:
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for travel on
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Select Fee Vendor:
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FEE Program
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Patient ID:
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Vendor ID:
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FEE PROGRAM:
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('*' Reimb. to Patient '+' Cancel. Activity '#' Voided Payment)
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There are no payments on file for
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for specified date range:
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and selected Fee Program(s):
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and ALL Fee programs
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There are no outpatient payments on file for specified date range
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and selected Fee programs
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Primary Dx:
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Obl.#:
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FEE PROGRAM:
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CPT-MOD
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Voucher
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Rx:
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Pat. ID:
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Vendor:
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>>> ANCILLARY SERVICE PAYMENTS <<<
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SERVICE CONNECTED?
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Primary Service Facility
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Include (P)atient Co-pays / (I)nsurance / (B)oth
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Select type of recover to include
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P - include only recover from patient copays
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I - include only recover from insurance
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B - include both
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Include (M)eans Test Co-pays /(L)TC Co-pays /(B)oth
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Select services to include
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M - include only Means Test copays
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L - include only LTC copays
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MeansTest
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There are no potential cost recoveries on file
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for specified date range:
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and selected Primary Service Area(s):
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and ALL Primary Service Areas
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POTENTIAL COST RECOVERY REPORT
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Cost recover from insurance.
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Cost recover from means testing
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and insurance.
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Cost recover from LTC co-pay
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Cost recover from insurance,
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1010EC Missing for LTC Patient.
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Cost Recover from insurance and
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Potential Cost Recover from LTC co-pay.
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>>> Cost recover from
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means testing
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and insurance
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Payments for veteran
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There are no payments to this vendor for this patient.
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RX #
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'*' Reimb. to Patient '+' Cancel. Activity '#' Voided Payment
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>>>Amount paid altered to $
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>>>Check cancelled on:
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Press 'ENTER' to
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view next selection
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return to list
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No check found for this line item.
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Line item #
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number on file for this entry
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MERGE PAIRS EXCLUDED DUE TO BOTH HAVE FEE BASIS ID CARDS
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MERGE PAIR Patient records
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both have FB ID card numbers. Please cancel one of the IDs and resubmit the Merge Pair
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*** DUZ and DUZ(0) must be defined as a valid user to initialize. ***
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Routine XPDUTL, part of Kernel Tool Kit 7.2 was not found on
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your system. This must be installed prior to installing this
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version of Fee Basis.
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You must have Fee Basis Version 3.0 installed prior to installing version 3.5
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CONTRACT HOSPITAL
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NON-VA HOSPITAL
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Check your package file for the
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entry. Unable to determine version.
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Your version of the
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must be at least
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to install this version of FEE.
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Want to select patient from DHCP Patient File
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Enter LAST NAME
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Enter last name of patient. Answer must be 3 to 20 characters in length
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Enter FIRST INITIAL
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Enter MIDDLE INITIAL
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Patient ID Number
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Answer must contain 9 numbers. Pseudo-SSN not allowed
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Sex of Patient
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Want to select a vendor from DHCP Fee Basis Vendor file
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Vendor must have a Medicare ID number to send to the pricer.
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Select Vendor Name
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Enter Medicare ID Number
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State of Vendor
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Admitting Authority
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Disposition Code
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Is this a Patient Reimbursement
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Payment by Medicare or Other Federal Agency
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Must enter at least a primary diagnosis.
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Billed Charges
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Amount Claimed
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Obligation Number
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Case sent to pricer.
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Starting Post Init FBPST35
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Completed FBPST35
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Post-Init FBPST35A has already been run.
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Beginning FBPST35A....
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CONVERSION OF DENIALS FILES
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Now I will move any Medical Denial information you wish to keep into the
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Fee Basis Payment File (#162). I will then remove the Fee Basis Medical
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Denials file (#163) and the Fee Basis Pharmacy Denials file (#163.1).
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Do you want to keep any Medical Denials that are presently stored in the
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Fee Basis Medical Denials file (#163)
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Answering yes will move the denials to file #162, no will delete them
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You may elect to merge all of your Fee Basis Medical Denials. If you
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choose not to retain all denials, you will be prompted to select a
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STARTING DATE to retain denials. Denials from the starting date to the
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present date will be merged into file #162.
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Do you wish to retain all Medical Denials
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Select date to retain denials
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Beginning merge
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Deleting the Fee Basis Medical Denials file (#163)...
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Deleting the Fee Basis Pharmacy Denials file (#163.1)...
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Cleaning up DD nodes...
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Completed FBPST35A
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Unable to complete the FBPST35A Post-Init routine. To complete this
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process, run ^FBPST35A as soon as possible.
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Beginning FBPST35B ....
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CONVERSION OF FEE BASIS FEE SCHEDULE FILE (#163.99)
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Completed FBPST35B
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The following vendors with invalid ID's have been placed in delete status:
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FEE BASIS VENDOR CORRECTIONS CLEANUP
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FBTEXT(
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FBPST35C has previously run to completion!
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Beginning FBPST35C
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REMOVAL OF FIELDS PREVIOUSLY STARRED FOR DELETION.
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Do you want me to task this job in the background for you
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Answerring 'YES' will run the job in the background and send you a bulletin
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when completed. Answerring 'NO' will run the job now (no
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bulletin will be sent).
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Required response!
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Routine FBPST35 to remove obsolete fields has been tasked.
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Deleting any data remaining in the obsolete fields.
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Deleting field #
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from file #
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Completed FBPST35C
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Post initialization routine FBPST35C has run to completion.
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FEE BASIS POST-INIT COMPLETE
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Are you finished editing prescriptions on invoice
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AUTH. NOT ADDED
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AUTH IS AUSTIN DELETED. USE THE REINSTATE OPTION TO CHANGE IT.
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(No Editing)
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OK to DELETE the
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ERROR. STATE HOME not found in FEE BASIS PROGRAM (#161.8) file.
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Unable to process State Home authorization. Please contact IRM.
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ERROR ADDING TO #161
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ANOTHER USER IS EDITING THIS PATIENT & PROGRAM. PLEASE TRY AGAIN LATER.
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Enter FROM DATE:
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Enter TO DATE:
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The specified dates conflict with other authorization(s).
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Please specify different dates for this authorization or
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remove the conflcit by first editing the other authorization(s).
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Conflict with FROM DATE
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PURPOSE OF VISIT
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**Austin Deleted** - Use Reinstate to reuse this From Date
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For ALL Purpose of Visits? Y/N
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Select one or more Purpose of Visits
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Active Authorizations Report
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No active authorizations found during period.
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for POV:
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TOTAL DAY(S) FOR POV WITHIN REPORT PERIOD:
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ACTIVE AUTHORIZATIONS by POV, Vendor, Patient
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TRANSFER TO VA
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VA(200
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Disposition to Cancel/Withdrawn.
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Use the Delete Unauthorized Claim option.
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Select a printer device name.
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NOTE: This is not a pointer field, the exact name must be entered.
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Printer name:
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Location:
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TREATMENT FROM:
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TREATMENT TO:
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Cannot delete Authorization because payments already exist!
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Cannot delete Authorization because a 7078/583 entry has already been established!
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No data on file.
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Select the claim which you would like to display
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< PENDING INFORMATION >
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< PAYMENTS ON FILE >
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< ASSOCIATED CLAIMS >
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Fee Program
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ASSOCIATED INVOICES
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Do you wish to edit
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Do you wish to display return address
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POTENTIAL DUPLICATES
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No.
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Current extension date is
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Confirm entry of
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as the new extension date for the claim
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New extension date is equal to existing extension date. No change made.
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.02////^S X=DUZ;.03///INCOMPLETE UNAUTHORIZED CLAIM;.04///^S X=FBEXTD
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ERROR ADDING EXTENSION
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Vendor information is required for disposition.
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Patient Type Code is required for disposition.
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Shall other claims be updated to same veteran & treat. from/to dates
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Shall all other claims be updated to the disposition
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& auth. from/to dates
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Shall all other claims be updated to the auth. from/to dates
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Shall disapproval reason apply to all other claims
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Are you sure you wish to delete
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Shall all of these claims be deleted
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Deleting claim
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and associated claims not dispositioned ...
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Select VETERAN
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Select FEE VENDOR
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Is this claim being considered under Millennium Act 38 U.S.C. 1725 (Y/N)
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Is the unauthorized claim complete for the FEE PROGRAM
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Checking for potential duplicates...
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Checking eligibility...
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Patient is not a veteran.
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Are you sure you wish to enter a new unauthorized claim
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... Deleting incomplete record.
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An unauthorized claim is considered complete (or valid)
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if all the necessary information has been received.
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A claim can never be considered complete if it is missing
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form 10-583 or form 10-583 is incomplete.
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Some examples of other items which are needed are:
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Copies of actual bills
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Original paid receipt
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Itemized invoice/UB82
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Medical records or signature for release
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Diagnostic/Procedure code(s)
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Enter Y(es) if complete, N(o) if incomplete.
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Enter Y(es) if all required information has been submitted,
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N(o) if the claim is incomplete.
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The disposition for the selected claim is
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At least one other claim in this group has been dispositioned.
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The existing disposition(s) in the group follow:
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Would you like this claim to be dispositioned
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Would you like to change the disposition
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to another
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The claim cannot be dispositioned.
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Patient Type Code is required to disposition the claim.
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Do you want to specify the Patient Type Code for the claim
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No Patient Type for master claim.
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No Patient Type for secondary claim.
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Master claim doesn't have any Patient Type Code
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Do you want to enter Patient Type Code for the master claim
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Master claim has Patient Type Code :
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Do you want to use the same Patient Type for the secondary claim
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Unauthorized Claims Dispositioned to 'ABANDONED'
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Treatment
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Select the date range within which an unauthorized claim will expire.
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Unauthorized
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Mill Bill (1725)
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NON-Mill Bill
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Claims Due to Expire between
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No claims will expire within selected date range.
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AUTO PRINT UNAUTH CLAIM LETTER
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Do you wish to reprint letters for a date range
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Select Yes to reprint letters for a date range; No to reprint a specific letter.
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Should the expiration date be updated
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Answer Yes to update the expiration date based upon today's printout, No to only reprint the letter but not change the date when the information is due.
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Queue to print on:
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REPRINT UNAUTH CLAIM LETTERS
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FBARY(
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BATCH UNAUTH CLAIM LETTERS
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Enter NUMBER OF COPIES for each letter
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Print all types of letters
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Enter YES to print all types of letters. Enter NO to
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just print letters of one specific type.
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VENDOR:
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VETERAN:
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In Reply Refer To:
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Reason(s) for not approving
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SIGNED STATEMENT FROM CLAIMANT
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REGARDING:
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EPISODE OF CARE:
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Authorized from:
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Authorized to:
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Amount approved:
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Itemized list follows:
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*Reason(s) for Suspension
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(4) Other. Specific reason immediately follows item.
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Discharge Date
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Amt Approved
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Suspend*
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Reason for Suspension:
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Service Date
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RX Date
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Drug Name:
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This claim has other claims associated with it
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and, therefore, can not be associated to another.
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Select the unauthorized claim to which this one should be associated:
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This option will allow you to disassociate a claim.
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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