308 lines
12 KiB
Plaintext
308 lines
12 KiB
Plaintext
English French Notes Complete/Exclude
|
|
TRANSMIT OVERDUE ABSENCE BULLETIN
|
|
Y - To search for inpatients overdue from AA, UA and PASS and transmit
|
|
bulletin to select mailgroup.
|
|
N - If you don't wish to search for overdue absences.
|
|
OVERDUE ABSENCES AS OF
|
|
...BACKGROUND SEARCH QUEUED!!
|
|
Select AMIS 334-341 MONTH/YEAR:
|
|
Results already exist for this month. Do you wish to recalculate
|
|
Enter 'YES' to recalculate monthly totals, or 'NO' to print.
|
|
Beginning
|
|
End
|
|
of month statistics are missing for ward
|
|
Ward not included in AMIS
|
|
AMIS
|
|
INTERMEDIATE MEDICINE
|
|
REHABILITATION MED
|
|
BLIND REHABILITATION
|
|
SPINAL CORD INJURY
|
|
FOR THIS SEGMENT FIELDS SHOULD BALANCE AS FOLLOWS:
|
|
Fields 009 and 010 prior period plus 001,002,003 current period
|
|
less fields 004 thru 008 current period must equal fields
|
|
009 and 010 current period.
|
|
*** This segment
|
|
has Not been Balanced
|
|
is Out of Balance
|
|
Press RETURN to continue or '^' to stop
|
|
Select AMIS 345-346 MONTH/YEAR:
|
|
NURSING HOME
|
|
less fields 005 thru 008 current period must equal fields
|
|
No admissions on file, will check scheduled admissions
|
|
Since an admission was not chosen, scheduled admissions for this patient will be checked
|
|
No scheduled admissions on file
|
|
This report requires 132 column output
|
|
NO ADDRESS ON FILE
|
|
PRINT THIRD PARTY REVIEW
|
|
YES - If you wish to print Third Party Review Sheet
|
|
NO - If you don't want to print Third Party Review Sheet
|
|
Beneficiary Travel Claim Information <Screen 1>
|
|
Claim Date:
|
|
PT ID:
|
|
Address:
|
|
SC%:
|
|
Other Elig.:
|
|
Disabilities:
|
|
Income:
|
|
Source of Income:
|
|
MEANS TEST
|
|
COPAY TEST
|
|
INCOME SCREENING
|
|
VA CHECK
|
|
No. of Dependents:
|
|
MT Status:
|
|
NOT APPLICABLE
|
|
MEANS TEST
|
|
BT Income:
|
|
NOT RECORDED
|
|
Certified Eligible:
|
|
Date Certified:
|
|
* * * NOTE * * PATIENT HAS BEEN CERTIFIED INELIGIBLE BASED ON INCOME
|
|
* * * * Discrepancy exists in incomes reported, please verify * * * *
|
|
VERSION 1.0 OF BENEFICIARY TRAVEL HAS NOT BEEN LOADED.
|
|
>> Environment check complete and okay.
|
|
Updating PACKAGE File...
|
|
No PACKAGE entry defined - Cannot update!
|
|
Updating PACKAGE file complete.
|
|
Re-indexing 'BB' cross-reference.
|
|
Beneficiary Travel
|
|
SHORT DESCRIPTION field complete.
|
|
DESCRIPTION field complete.
|
|
FILE field complete.
|
|
FIELD field complete.
|
|
VERSION 5.3 OF REGISTRATION HAS NOT BEEN LOADED.
|
|
BENEFICIARY TRAVEL
|
|
REGISTRATION PACKAGE HAS NOT BEEN FOUND
|
|
CONTACT - PIMS National VISTA Support Team for assistance!
|
|
Visits For:
|
|
* * * * ADMITTED ON THIS DATE * * * *
|
|
* * * * DISCHARGED ON THIS DATE * * * *
|
|
* * * * CURRENTLY AN INPATIENT * * * *
|
|
* * * INPATIENT STATUS * * *
|
|
Admitted On:
|
|
Ward Location:
|
|
Discharge Date:
|
|
Appointments:
|
|
NONE RECORDED FOR THIS DATE
|
|
PATIENT/DATE
|
|
Elig for Visit:
|
|
Appt Type:
|
|
Clinic Stop:
|
|
NO-SHOW
|
|
Past Claims: NONE RECORDED
|
|
Date/Time
|
|
Account
|
|
Deductible
|
|
Amt. Paid
|
|
Past Claims:
|
|
>> WARNING! No ACCOUNT TYPE for this claim, Please correct through Claim Enter/Edit!
|
|
Beneficiary Travel Claim Information <Display>
|
|
Depart From:
|
|
To:
|
|
Cert. Date:
|
|
Account:
|
|
REVIEW VISIT
|
|
Most Econ. Cost:
|
|
Attend/Payee:
|
|
Meals & Lodging:
|
|
One Way/
|
|
CoreFLS
|
|
Carrier
|
|
CoreFLS Carrier:
|
|
Carrier:
|
|
Ferry, Bridges, Etc.:
|
|
Round Trip:
|
|
ONE WAY
|
|
ROUND TRIP
|
|
Auth. Person:
|
|
Total Mileage Amount:
|
|
Mileage/
|
|
Applied Deductible:
|
|
One Way:
|
|
Amount Payable:
|
|
Remarks:
|
|
MILEAGE REMARKS:
|
|
;@9;9;S DGBTDE=X S:DGBTDE>DGBTTC DGBTDE=DGBTTC,DGBTFLAG=2 S:DGBTDE>DGBTDRM DGBTDE=DGBTDRM,DGBTFLAG=1
|
|
DEDUCTIBLE AMOUNT HAS BEEN CHANGED
|
|
DEDUCTIBLE AMOUNT CAN NOT EXCEED THE TOTAL COSTS FOR THIS CLAIM
|
|
DEDUCTIBLE FOR THIS CLAIM CAN NOT EXCEED THE AMOUNT REMAINING FOR THIS MONTH
|
|
This needs to be printed at 132 columns
|
|
, DESIGNEE OF CERTIFYING OFFICIAL
|
|
VA FORM 70-3542d
|
|
TASK #
|
|
| VOUCHER FOR CASH REIMBURSEMENT OF BENEFICIARY TRAVEL EXPENSES |
|
|
| 2. Name and Address of Issuing Health Care Facility
|
|
1. Patient Data Card Information
|
|
| 3. Fiscal Symbols
|
|
| 4. From (Place of Departure)
|
|
| 6. Miles Traveled
|
|
| 7. Authorized Mileage Rate:
|
|
| 8. Mileage Allowance (Item 6 X Item 7)
|
|
per mile
|
|
| 9. Meals & Lodging Costs |
|
|
| 11. Total (Sum of 8, 9, and 10)
|
|
| 12. Most Economical
|
|
| 13. Total (Sum of 9 and 12)
|
|
| 14. AMOUNT CLAIMED AND PAYABLE *
|
|
| Public Trans. Costs
|
|
APPLIED DEDUCTIBLE
|
|
| * The amount payable will be the amount entered in Item 11 or Item 13, whichever is less. Exception: If public transportation
|
|
| is not reasonably accessible or would be medically inadvisable, the amount payable will be the amount entered in item 11.
|
|
| I CERTIFY THAT THE CLAIMANT REPORTED FOR AN AUTHORIZED SERVICE ON THE DATE SHOWN. (Authority VA Regulation 6100 & PL 100-322)
|
|
| 15. Date/Time of Claim
|
|
| 16. Signature of Certifying Official
|
|
| I have neither obtained transportation at Government expense nor through the use of Government request, tickets, or tokens;
|
|
| and have not used any Government-owned conveyance or incurred any expenses which may be presented as charges against the
|
|
| Dept. of Veterans Affairs for transportation, meals, or lodging in connection with my authorized travel that is not herein
|
|
| claimed. I hereby claim the amount entered in Item 14 above. I certify that the claim is correct and just and that payment
|
|
| has not been received.
|
|
| I hereby acknowledge receipt, in cash or check to be mailed, of the amount in Item 14 above, in full payment of this claim.
|
|
| 17. Signature of Payee
|
|
REMARKS:
|
|
ACCOUNT:
|
|
REVIEW VISIT
|
|
AUDIT BLOCK
|
|
AMOUNT PAID FOUND CORRECT
|
|
Auditor's Initials
|
|
VA Form 70-3542d
|
|
DO YOU WANT TO QUERY CoreFLS FOR A VENDOR
|
|
SITE_CODE
|
|
** COMMUNICATIONS SERVICE LIBRARY (CSL) PACKAGE NOT INSTALLED **
|
|
** CoreFLS national database query **
|
|
** LOCAL VENDOR (#392.31) File updated. **
|
|
Unsuccessful Query!
|
|
** CoreFLS Query **
|
|
**COREFLS Vendor interface is not active.
|
|
No Problems were found in the Distance Data.
|
|
Enter Departure City
|
|
Enter the name for the departure city
|
|
Name must be free text, 1-30 characters in length
|
|
FILE IN USE, PLEASE TRY AGAIN LATER
|
|
Enter another division for this departure city
|
|
Enter a 'Y'es to add or enter another division, or 'N'o to exit to the Departure City prompt
|
|
CITY OR TOWN
|
|
THE MILEAGE FOR THE SELECTED DIVISION WILL BE USED AS THE
|
|
DEFAULT MILEAGE FOR THIS DEPARTURE CITY.
|
|
Enter the CITY as the point of origin. The MILEAGE/ONE-WAY
|
|
is the distance from the CITY to the Medical Center Division.
|
|
INCOMPLETE INFORMATION WAS ENTERED, BOTH THE STATE AND ZIP CODE
|
|
ARE REQUIRED, RECORD DELETED
|
|
You can either correct these problems, or add a new departure city.
|
|
CORRECT PROBLEMS
|
|
***WARNING...MEDICAL CENTER DIVISION FILE IS NOT SET UP
|
|
>> ONE OR MORE ADDITIONAL INFORMATION FIELDS NEED TO BE COMPLETED
|
|
>> ONE OR MORE ZIP CODES ARE MISSING
|
|
>> ONE OR MORE DEFAULT MILEAGES ARE MISSING OR SET TO ZERO
|
|
WARNING...MEDICAL CENTER DIVISION FILE IS NOT SET UP
|
|
USE THE ADT PARAMETER OPTION FILE TO SET UP DIVISION
|
|
Select DIVISION:
|
|
***WARNING...BENE TRAVEL PARAMETERS HAVE NOT BEEN SET UP
|
|
USE THE BENEFICIARY TRAVEL PARAMETER RATES ENTER/EDIT OPTION TO PROPERLY INITIALIZE
|
|
Eligibility is missing from registration and is required to continue.
|
|
Continue processing claim
|
|
Sorry, enter 'Y'es or RETURN to continue procesing claim, 'N'o to exit
|
|
Complete claim for
|
|
SORRY, '^' NOT ALLOWED
|
|
ENTER 'Y'ES OR 'N'O
|
|
INSTITUTION HAS NOT BEEN DEFINED FOR
|
|
USE THE ADT PARAMETER OPTION TO UPDATE
|
|
INSTITUTION ADDRESS NOT ENTERED. PLEASE UPDATE USING THE INSTITUTION FILE ENTER/EDIT
|
|
Enter a 'P' to display Past CLAIM dates for editing.
|
|
Time is required when adding a new CLAIM.
|
|
Select TRAVEL CLAIM DATE/TIME
|
|
There are other claims on this date.
|
|
Select by number to edit or <RETURN> to add a new CLAIM.
|
|
Select 1
|
|
, or <RETURN> to add a new claim:
|
|
Select, by number, one of the displayed claim dates:
|
|
Are you sure you want to add a new claim
|
|
Enter 'YES' to add a new claim, or 'NO' not to add the claim.
|
|
There are no entries on file for this patient
|
|
Select CLAIM
|
|
Type '^' to exit date list, or <RETURN> to display more dates
|
|
Entering a '^' will exit the Past CLAIM list, entering <RETURN> will continue to scroll through past dates.
|
|
Select a Past CLAIM date by number, or enter 'N' for NOW.
|
|
INVALID ENTRY!
|
|
Time is required when adding a new CLAIM date.
|
|
If there is more than one claim per date, select by number to edit.
|
|
Please wait, Checking Mileage ...
|
|
DEFAULT MILEAGE USED
|
|
Module has not been properly initialized - to continue you should first complete
|
|
the parameters
|
|
Beneficiary Travel Claim Information <Enter/Edit>
|
|
Another user is editing this entry.
|
|
Select ELIGIBILITY
|
|
SORRY, '^' NOT ALLOWED!!
|
|
ELIGIBILITY REQUIRED.
|
|
Choose by NUMBER the primary eligibility or other entitled eligibilities
|
|
Choose 1-
|
|
Enter choice from those displayed
|
|
Select ELIGIBILITY:
|
|
Select ACCOUNT:
|
|
ACCOUNT IS REQUIRED!!
|
|
;9;S DGBTDE=X S:DGBTDE>DGBTTC DGBTDE=DGBTTC,DGBTFlAG=2 S:DGBTDE>DGBTDRM DGBTDE=DGBTDRM,DGBTFLAG=1
|
|
Primary and other entitled eligibilities for patient:
|
|
Last Certification:
|
|
Eligible:
|
|
Amount Certified:
|
|
'A'DD A NEW DATE, 'E'DIT EXISTING OR 'Q'UIT:
|
|
ENTER A - to 'A'dd a new certification date
|
|
E - to 'E'dit an existing entry for this patient
|
|
Select CERTIFICATION DATE:
|
|
There is already a certification for
|
|
Only one certification per date is necessary.
|
|
REPORTED MEANS TEST INCOME:
|
|
There are no computer entries on file for this patient.
|
|
Enter the date of annual certification.
|
|
Time is required when adding a new certification date.
|
|
Future dates are not allowed.
|
|
New travel rates are determined each fiscal year. The rates should be
|
|
entered each year with the effective date of Oct 1.
|
|
Changing values for the current or past fiscal years could result in changes
|
|
to the claims already entered.
|
|
Select EFFECTIVE DATE
|
|
ACCOUNT TYPES are determined by Fiscal Service and have a direct impact
|
|
on the type of questions asked in the Beneficiary Travel CLAIM ENTER/EDIT
|
|
DO NOT add to this file unless so instructed by Fiscal Service.
|
|
Select ACCOUNT
|
|
You are about to enter/edit Bene Travel account types. Although
|
|
this process is now decentralized, changes and additions should be
|
|
made with extreme care.
|
|
Would you like to Enter/Edit another ACCOUNT
|
|
ENTER DEDUCTIBLE AMOUNT/
|
|
Type a dollar amount between 0 and
|
|
with up to 2 decimal places.
|
|
-- Deductible exceeds limit.
|
|
The effective date must start on the fiscal year, Oct 1.
|
|
<I>nformation, <D>isplay claim, <E>dit claim,
|
|
<P>rint form,
|
|
Quit
|
|
Do you want to delete this claim
|
|
This claim is incomplete and is now being deleted.....
|
|
You may choose from the following:
|
|
<I>nformation - to view the two informational screens
|
|
<D>isplay - to view this claim
|
|
<E>d it - to change this claim
|
|
<P>rint - to print form 70-3542d (132 columns)
|
|
<Q>uit - to exit from this option
|
|
ADD:
|
|
PH:
|
|
NO:
|
|
FAX:
|
|
****THIS VENDOR IS INACTIVE
|
|
INTERN'L
|
|
Enter beginning date:
|
|
Enter ending date:
|
|
The ending date cannot be before the beginning date
|
|
Future dates are not allowed
|
|
Sort output by:
|
|
Select one from the above list
|
|
Sort Bene Travel claims by one of the following:
|
|
A for Account
|
|
C for Carrier
|
|
#################### #################### ####################
|
|
#################### #################### ####################
|
|
#################### #################### ####################
|
|
#################### #################### ####################
|
|
#################### #################### ####################
|