308 lines
12 KiB
Plaintext
308 lines
12 KiB
Plaintext
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English French Notes Complete/Exclude
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PRIMARY PROVIDER #
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SECONDARY PROVIDER #
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TERTIARY PROVIDER #
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MAILING ADDRESS STREET
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MAILING ADDRESS STREET2
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MAILING ADDRESS STREET3
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MAILING ADDRESS CITY
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MAILING ADDRESS STATE
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MAILING ADDRESS ZIP CODE
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NON-PTF ADMISSION HOUR
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ACCIDENT HOUR
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1:PHYSICIAN REFERRAL;2:CLINIC REFERRAL;3:HMO REFERRAL;4:TRANSFER FROM HOSPITAL;5:TRANSFER FROM SKILLED NURSING FAC.;6:TRANSFER FROM OTHER HEALTH CARE FAC.;7:EMERGENCY ROOM;8:COURT/LAW ENFORCEMENT;9:INFO NOT AVAILABLE;
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1:EMERGENCY;2:URGENT;3:ELECTIVE;
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SNF/SA CARE
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DGCR(399.1,
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DISCHARGE STATUS
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OCCURRENCE CODE
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CONDITION CODE
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PROCEDURE CODING METHOD
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4:CPT-4;5:HCPCS (HCFA COMMON PROCEDURE CODING SYSTEM);9:ICD-9-CM;
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VALUE CODE
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START DATE
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OP VISITS DATE(S)
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Event date can no longer be edited...cancel and submit a new bill if necessary.
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MDX#
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LOCATION OF CARE
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1:HOSPITAL - INPT OR OPT (INCLUDES CLINICS);2:SKILLED NURSING (NHCU);3:HOME HEALTH AGENCY;7:CLINIC (ONLY INDEPENDENT/SATELITE);8:SPEC. FACILITY HOSP/AMB SURG CTR;
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BILL CLASSIFICATION
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** The 'BILL CLASSIFICATION' must be consistent with the 'LOCATION OF CARE.'
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TIMEFRAME OF BILL
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1:ADMIT THRU DISCHARGE;2:INTERIM - 1ST CLAIM;3:INTERIM - CONTINUING CLAIM;4:INTERIM - LAST CLAIM;5:LATE CHARGES ONLY;6:ADJUSTMENT CLAIM;7:REPLACEMENT CLAIM;8:VOID/CANCEL PRIOR CLAIM;O:NON-PAY/ZERO CLAIM;
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COVERED DAYS
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NJ4,0
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NON-COVERED DAYS
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CO-INSURANCE DAYS
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BILL CHARGE TYPE
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1:INSTITUTIONAL;2:PROFESSIONAL;
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IS THIS A SENSITIVE RECORD?
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ASSIGNMENT OF BENEFITS
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Yy1
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POWER OF ATTORNEY COMPLETED?
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STATEMENT COVERS FROM
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STATEMENT COVERS TO
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DISCHARGE BEDSECTION
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LENGTH OF STAY
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REVENUE CODE
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MR*P399.2'
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RNJ8,2
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RNJ6,0X
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UNITS OF SERVICE
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RNJ9,2XI
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NON-COVERED CHARGE
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1:INPT BS;2:OPT VST DT;3:RX;4:CPT;5:PROS;6:DRG;9:UNASSOCIATED;
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OFFSET AMOUNT
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OFFSET DESCRIPTION
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RNJ10,2
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NJ11,2
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PRIMARY PRIOR PAYMENT
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PRIOR PAYMENT(S)
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SECONDARY PRIOR PAYMENT
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TERTIARY PRIOR PAYMENT
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UB92 FORM LOCATOR 49
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RX PROCEDURE
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AUTO ADDED CHARGE - NO CHANGE TO TYPE/COMPONENT
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BILL COMMENT
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FORM LOCATOR 2
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FORM LOCATOR 9
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FORM LOCATOR 27
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FORM LOCATOR 45
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FORM LOCATOR 92
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FORM LOCATOR 93
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TREATMENT AUTHORIZATION CODE
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UF3;4
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PRIMARY INSURANCE ICN/DCN
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UF3;5
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SECONDARY INSURANCE ICN/DCN
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UF3;6
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TERTIARY INSURANCE ICN/DCN
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PRIMARY AUTHORIZATION CODE
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SECONDARY AUTHORIZATION CODE
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TERTIARY AUTHORIZATION CODE
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1:REFERRING;2:OPERATING;3:RENDERING;4:ATTENDING;9:OTHER;
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UF3;1
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UF3;2
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FORM LOCATOR 11
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UF3;3
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FORM LOCATOR 31
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UF3;7
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FORM LOCATOR 56
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UF31;2
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FORM LOCATOR 78
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MR*S
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PERFORMED BY
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Prov Specialty On File:
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Provider Specialty On File:
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PRIMARY PROV ID CARE UNIT
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IBA(355.96,
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TX;8
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FORCE CLAIM TO PRINT
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0:NO FORCED PRINT;1:FORCE LOCAL PRINT;2:FORCE CLEARINGHOUSE PRINT;
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NO FORCED PRINT
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SECONDRY PROV ID CARE UNIT
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TERTIARY PROV ID CARE UNIT
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PRIMARY INS CO ID NUMBER
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SECONDARY INS CO ID NUMBER
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TERTIARY INS CO ID NUMBER
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REFERRING PROVIDER STATE
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UNABLE TO WORK FROM
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UNABLE TO WORK TO
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FORM LOCATOR 37C
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NON-VA FACILITY
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NVA_FC
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NVA_FC-0
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NON-VA CARE TYPE
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1:FEE BASIS, NON-LAB;2:FEE BASIS, LAB;3:NON-FEE BASIS, NON-LAB;4:NON-FEE BASIS, LAB;
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NON-VA CARE ID #
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UF31;3
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FORM LOC 19-UNSPECIFIED DATA
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DATE LAST SEEN
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SPECIAL PROGRAM INDICATOR
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UF2;2
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PRINT FACILITY DATA IN BOX 32
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REFERRING PROV STATE
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AUTHORIZE BILL GENERATION?
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REASON(S) DISAPPROVED-INITIAL
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DGCR(399.4,
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TX;6
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REQUEST MRA NOW?
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TX;2
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LAST ELECTRONIC EXTRACT DATE
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DATE LAST PRINTED
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MP399.4'
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Updating file 399.1 MCCR UTILITY with new occurrence codes...
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RZD FOR STATE ASSIGNMENT
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RZD FOR NATIONAL ASSIGNMENT
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Occurrence Codes added (#399.1)
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*** Code Added ***
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NO DIAGNOSTIC MEASURE REPORTS FOUND FOR OCT 2003.
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DIAGNOSTIC MEASURES DATA ALREADY SENT FOR OCT 2003.
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Setting status of UNBILLED REPORT for OCT 2003 to complete.
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Transmitting diagnostic measure reports for OCT 2003.
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Post-install complete.
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>>> Updating the IVM Center domain in the IB SITE PARAMETERS (#350.9) file...
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G.IVM REPORTS@IVM.VA.GOV
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IB OUTPUT MANAGEMENT REPORTS
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IB OUTPUT IVM BILLING ACTIVITY
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<<< Adding IB OUTPUT IVM BILLING ACTIVITY option to IB OUTPUT MANAGEMENT
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REPORTS menu...
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<<< Post init complete!
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<<< Adding new entry to BILL FORM TYPE for IB REPORTS!
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IB UNBILLED AMOUNTS
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This mail group will be automatically mailed the IB Unbilled Amounts
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report each month.
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You may add members at this time.
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<<< Mail Group (
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) CREATION FAILED !!!
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<<< Updating your IB Site Parameters
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6.25///IB UNBILLED AMOUNTS;6.24///0
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Patch PRCA*4*24 or PRCA*4.5*6 does not appear to be installed! Please
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install the appropriate patch and then re-run this initialization.
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IBCNS QUIT
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>>> Deleting protocol IBCNS QUIT as an item of IBCNSC INSURANCE CO...
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(It will be added back in momentarily)
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IBCNSJ PLAN LOOKUP
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IBCNSP POLICY MENU
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for protocol '
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IBCNS EXPANDED POLICY^1^^80^5^17^1^1^Policy^IBCNSP POLICY MENU^Patient Policy Information^1
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'IBCNS PLAN LOOKUP' List Template...
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IBCNS PLAN LOOKUP^1^^80^7^19^1^1^Plan^IBCNSJ PLAN LOOKUP^Insurance Plan Lookup^1^^1
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IBCN INSURANCE MGMT MENU
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IBCN LIST PLANS BY INS CO
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>>> Adding IBCN LIST PLANS BY INS CO option to the IBCN INSURANCE MGMT MENU...
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>>> Building the 'ACCP' cross-reference for file #355.3 ...
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(I'll write a dot for every 100 entries processed)
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Note that
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group plan
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had the individual policy pointer removed.
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>>> Queuing off a job to clean up various insurance files...
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(You'll get a message when the job is completed)
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IB - PATCH IB*2*28 POST INIT - INSURANCE CLEAN-UP
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The job has been queued. The task number is
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Unable to queue this job. Please run FIX^IBYAPT1 at any time.
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Patch IB*2*28 Insurance Clean-up Completion
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The Insurance Files clean-up job has completed.
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Number of AGNA cross references in file #355.3 deleted:
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Number of AGNU cross references in file #355.3 deleted:
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Number of errant Annual Benefits in file #355.4 deleted:
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Number of errant Benefits Used in file #355.5 deleted:
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Number of errant Personal Riders in file #355.7 deleted:
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Number of Insurance Reviews in file #356.2 repointed:
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DUZ(0) must also be defined to run this initialization.
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>> ACCOUNTS RECEIVABLE CATEGORY (430.2) '
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' not found.
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Patch PRCA*4*15 or PRCA*4.5*1 does not appear to be installed! Please install
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the appropriate patch and then re-run this initialization.
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CHAMPVA REIMB. INS.
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DG CHAMPVA PER DIEM NEW
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DG CHAMPVA PER DIEM CANCEL
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DG CHAMPVA PER DIEM UPDATE
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>> RATE TYPE (399.3) '
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>> ACTION TYPE (350.1) '
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Required file entries are missing. You should determine why you do not
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have these entries before continuing. They should have been installed
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with the installation of IB v2.0.
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' is not Inactive.
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' already has a pointer
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to an ACCOUNTS RECEIVABLE CATEGORY (430.2).
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This RATE TYPE will be re-pointed to a new CATEGORY in this installation.
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RATE TYPE entries have changed since the release of IB 2.0. You should
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determine why these entries may have changed, and then inactivate
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the Rate Types again, before re-running the initialization.
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CHAMPVA PER DIEM
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>>> Initializing Billing Parameters for CHAMPVA Billing...
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>>> Unable to initialize your CHAMPVA billing parameters!
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Please call your ISC for assistance.
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>>> It appears as if you are re-running the initialization.
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The CHAMPVA Billing parameters were not updated.
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>> The two CHAMPVA RATE TYPES have been activated and linked to an
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ACCOUNTS RECEIVABLE CATEGORY...
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>> The Patient Billing CHAMPVA Action Types have been updated...
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>> Added new CHAMPVA Subsistence rate, effective 10/1/94...
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.01///IB CHAMPVA RATE/INSURER;.02///Rate Type and Primary Carrier's Type of Coverage do not both match CHAMPVA.
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>>> IB085 - CHAMPVA Rate/Insurer match error added to IB ERROR file.
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>>> Installing List Template...
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BILL#^49^8^Bill #
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>>> Adding the Reminder Letter into the IB FORM LETTER (#354.6) file...
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Unable to add the letter! Contact your supporting ISC for assistance.
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Income Test Reminder Letter^2^15
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The VA is required by law to charge veterans who receive medications
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on an outpatient basis for the treatment of nonservice-connected
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conditions, a copayment of $2.00 for each 30-day (or less) supply
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of medication provided. Based on the income information requested
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each year, some veterans may be exempt from the copayment.
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Our records indicate that your medication copayment exemption
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status will expire on |VAR(
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<enter a third paragraph which provides instructions to the veteran>
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<enter a signature title if desired>
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Department of Veterans Affairs Medical Center
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<enter the facility street here>
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<enter the facility city/state/zip here>
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IB RX EXEMPTION MENU
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IB RX REPRINT REMINDER
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>>> Adding IB RX REPRINT REMINDER option to the IB RX EXEMPTION MENU...
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APD3 cross reference already exists - not rebuilt
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>>> Building the 'APD3' cross-reference for file #399 ...
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(I'll write a dot for every 500 entries processed)
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Begin:
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End:
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entries processed in
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>>> Correcting the spelling of the entry 'ADMISSION TO CIRCUMENT SLOWNESS'
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(code 3.03) in file #356.4 ...
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This entry is not cross-referenced correctly!
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Please contact IRMFO Customer Service staff for assistance.
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This entry could not be found!
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.01////ADMISSION TO CIRCUMVENT SLOWNESS
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>>> I need to queue a job to clean up the 'Name of Insured' fields in
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the PATIENT (#2) and BILL/CLAIMS (#399) files...
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IB - CORRECT 'NAME OF INSURED' VALUES
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Please note that you will receive a mail message when this job has completed.
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Job Completion - Correct 'Name of Insured' Fields
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INTEGRATED BILLING
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The job to correct the 'Name of Insured' fields in files #2 and #399
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has completed.
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Number of policies corrected in file #2:
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Number of bills corrected in file #399:
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Patch IB*2*6 does not appear to be installed! Please
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install this patch and then re-run this initialization.
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Patch IB*2*8 does not appear to be installed! Please
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Patch IB*2*13 does not appear to be installed! Please
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Patch IB*2*23 does not appear to be installed! Please
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Patch IB*2*40 does not appear to be installed! Please
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Patch IB*2*45 does not appear to be installed! Please
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IBCNSP ADD COMMENT
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IBCNSP EDIT ALL
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IBCNSJ CHANGE PLAN
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>>> Deleting protocol
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as an item of
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(It will be re-added in a moment)
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IBCNSC PLAN LIST
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IBCNSC PLAN DETAIL
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>>> Rebuilding ^XUTL for protocol '
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>>> Adding records to INSURANCE RIDERS file for new limitation categories...
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INPATIENT COVERAGE
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OUTPATIENT COVERAGE
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PRESCRIPTION COVERAGE
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>>> Updating PLAN LIMITATION CATEGORY file with insurance rider info...
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'IBCNS INS CO PLAN DETAIL' List Template ...
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IBCNS INS CO PLAN DETAIL^1^^80^5^17^1^1^Plan^IBCNSC PLAN DETAIL^View/Edit Plan
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'IBCNS PLAN LIST' List Template ...
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IBCNS PLAN LIST^1^^80^6^19^1^1^Plan^IBCNSC PLAN LIST^Insurance Plan List^1^^1
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Post-Install Complete
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*** REASON NOT BILLABLE of 'NON-BILLABLE CLINIC' already exists in FILE #356.8, new entry NOT added.
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<<< Adding new REASON NOT BILLABLE of 'NON-BILLABLE CLINIC' to file #356.8
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**** Unable to add new entry to FILE #356.8, contact Field Support ****
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<<< Updating entries in NON-BILLABLE CLINIC STOP CODES (#352.3) file
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<<< Adding TP Non-billable Stops to NON-BILLABLE CLINIC STOP CODES (#352.3) file
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*** Could not add entry
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IB*2*148 Post-Install Complete
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>> Inactivating Charges for Inactive CPT codes, Please Wait...
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Charges Inactivated.
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>> Removing Charges Sets that have no Charges Assigned...
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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