308 lines
9.9 KiB
Plaintext
308 lines
9.9 KiB
Plaintext
English French Notes Complete/Exclude
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Vendor is listed as 'exempt from the pricer'.
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Do you wish to keep this invoice exempt from the pricer
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Medicare ID Number is needed for this Vendor!
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Obligation number on batch does not match 1358.
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Obligation number on batch must be
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Invoice number
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has already been entered for this authorization.
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Use the Contract Hospital 'Invoice Edit' option if needed.
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Want to add another invoice for this episode of care
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Unable to create Non VA PTF Record.
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This Invoice may not be added to Batch #
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***You may not add a
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pricer exempt
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invoice to a
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Do you want to open a new batch at this time
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You must Reopen the batch prior to editting the invoice.
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to edit this invoice.
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Batch has already been sent to Austin for payment.
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Site Parameters must be entered prior
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to using this option.
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Is this the correct 7078
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Disposition
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Issuing Office
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1. Date of Issue
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Name of Physician or Station
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ID#:
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4. Veteran's Claim No.
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5. Authorization Valid
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From
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To
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PART 1. - SERVICES AUTHORIZED
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6. Services shown below are authorized for the period indicated in Item 5 above.
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(See Special Provisions below.)
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8. Fee Schedule or Contract
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10. Estimated Amount
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11. Fiscal Symbols
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12. Authorized by (Name and Title)
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Approving Official for 7078
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Enter <return> to accept the default or enter a name from 3 to 45 characters in length
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Title of Approving Official
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Enter <return> to accept the default title or enter a title from 3 to 45 characters in length
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# of copies of 7078
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Select a number between 1 and 5. This number represents the number of copies of the 7078 you would like printed
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USER:
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REPORT OF CONTACT CONTINUED
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For:
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NOTIFICATION OF ADMISSION TO PRIVATE HOSPITAL
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AUTHORIZATION FROM DATE/TIME:
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DATE/TIME OF ADMISSION:
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NAME of HOSPITAL:
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ADDRESS:
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PHYSICIAN'S NAME:
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Not Entered
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TENTATIVE DIAGNOSIS:
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INSURANCE TYPE:
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MODE of TRANSPORTATION:
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APPROVED/DISAPPROVED
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FEE BASIS SECTION
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VA form 119C
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Do you want this report for all PSAs
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CIVIL HOSPITAL PSA REPORT
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OUTPATIENT MEDICAL PSA REPORT
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PHARMACY PSA REPORT
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COMMUNITY N.H. PSA REPORT
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County Code
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Amount Paid
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Total Dollars spent by PSA for the dates of
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TOTAL AMOUNT PAID
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TOTALS DOLLAR AMOUNT BY PSA FOR ALL SELECTED PROGRAMS
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TOTAL AMOUNT
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FEE PROGRAM
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No payments found for this Fee Program.
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This notification has a status of complete. Cannot edit.
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Admission overlaps another request for this patient.
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REPORT OF CONTACT INFORMATION
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CANNOT ENTER ENTITLEMENT.
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Do you want to determine Medical Entitlement now
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Do you want to setup a 7078 now
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There is an incomplete 7078 for this patient.
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The reference number is
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< NEW REQUEST DELETED >
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This Authorization From Date exceeds the 72 hour notification period.
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Do you want to continue ? No//
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Entering an '^' is not allowed. Please answer 'Yes' or 'No'.
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Authorized From Date must be equal to or greater than the Date of Admission
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You must be a holder of the 'FBAASUPERVIVOR' key to reconsider a denied request.
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No audit data on file.
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Field changed:
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Date of Change:
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AUDIT on FEE NOTIFICATION ENTITLEMENT CHANGE
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DATE/TIME of NOTIFICATION
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FIELD CHANGED
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No payments rejected!
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Rejected!
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CIVIL HOSPITAL REJECTED PAYMENT HISTORY
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('*' Represents Reimbursement to Patient
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'#' Represents Voided Payment)
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Inv Date
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Susp
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Invoice
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Select Batch with Pricer Rejects:
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No items rejected for this batch!
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Select New Batch Number:
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Want to re-initiate this payment
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Want to edit payment now
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This Batch is exempt from the Pricer!!!
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Please use the 'Release a Batch' option to forward this batch for payment.
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DISCHARGE DATE
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AMOUNT CLAIMED
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AMOUNT SUSPENDED
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Answer 'Yes' to print suspension letters for all suspension
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codes, otherwise answer 'No' to select specific codes.
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NOTIFICATION DATE
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no inpatients pending disposition.
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PENDING 7078's
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('++' indicates LOS > 10 days)
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Total Requests:
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# of Requests Denied:
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# of Requests Pending:
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CONTRACT HOSPITAL REQUEST STATISTICS
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('+' Request Pending)
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('!' Request Denied)
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No invoices on line for this vendor.
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PAYMENT HISTORY
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INVOICE DISPLAY
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Patient Control Number
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('*'Reimbursement to Veteran '+' Cancellation Activity) '#' Voided Payment)
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Fr Date
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To Date Claimed Paid
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Sus Code
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Dt. Rec.
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Inv. Date
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FPPS Claim ID
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FPPS Line Item
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To Date
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Cov.Days
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Sorry, you must be a supervisor to use this option.
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Vendor has no
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finalized payments
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to VOID
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for this patient under the
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COMMUNITY NURSING HOME
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the payment(s)
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('*' Represents Reimbursement to Patient)
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('#' Represents a Voided Payment)
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FROM DATE
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TO DATE
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Cancel Voided
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payment for
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Select Check Number
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There is no record of that check number.
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VENDOR:
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VENDOR ID:
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Patient ID:
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PAYMENT HISTORY FOR CHECK #
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FEE PROGRAM:
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('*' Reimbursement to Patient '#' Voided Payment '+' Cancellation Activity)
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Travel Dt
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Fill Dt
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Inpatient type is not identified.
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****CENSUS DATE SELECTION****
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Census DATE:
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Display Address for Vendors
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FEE BASIS
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VENDOR NAME
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VENDOR ID
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VETERAN ID
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AUTH FROM
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Invalid Code
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Code is inactive
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ICD O/P Code inactive ...
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Invalid ICD O/P Code
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Invalid ICD O/P Code
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on date of service (
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ICD Dx Code inactive ...
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Invalid ICD Dx Code
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Invalid ICD Dx Code
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ICD Dx Code
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FROM DATE
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FEE ID CARD NUMBER
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You cannot assign that number because it already has been assigned!
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FEE ID CARD ISSUE DATE
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FEE ID CARD EXPIRATION DATE
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REASON FOR CARD NUMBER CHANGE
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You are only allowed to edit an outpatient authorization using this option.
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From Date cannot be later than the To Date!
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To Date cannot be earlier than From Date!
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RP161.8'
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FBAA(161.8,
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RP4'
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PRIMARY SERVICE FACILITY
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PURPOSE OF VISIT CODE
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FBAA(161.82,
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MST POV can't be selected because veteran's MST status is not YES.
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PATIENT TYPE CODE
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00:SURGICAL;10:MEDICAL;60:HOME NURSING SERVICE;85:PSYCHIATRIC-CONTRACT;86:PSYCHIATRIC;95:NEUROLOGICAL-CONTRACT;96:NEUROLOGICAL;
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TREATMENT TYPE CODE
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1:SHORT TERM FEE STATUS;2:HOME NURSING SERVICES;3:I.D. CARD STATUS;4:STATE HOME;
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DX LINE 1
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DX LINE 2
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DX LINE 3
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AUTHORIZATION REMARKS^W^^0;1^Q
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TYPE OF CARE
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1:C&P;2:OPT NSC;3:OPT SC;
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ACCIDENT RELATED (Y/N)
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POTENTIAL COST RECOVERY CASE
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PRINT AUTHORIZATION (Y/N)
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ID NUMBER
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STREET ADDRESS
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RP5'
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TYPE OF VENDOR
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1:PUBLIC HOSPITAL;2:PHYSICIAN;3:PHARMACY;4:PROSTHETICS;5:TRAVEL;6:RADIOLOGY;7:LABORATORY;8:OTHER;9:PRIVATE HOSPITAL;10:FEDERAL HOSPITAL;
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SPECIALTY CODE
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FBAA(161.6,
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RP161.81'
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PART CODE
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FBAA(161.81,
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RNJ4,0XO
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STREET ADDRESS 2
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MEDICARE ID NUMBER
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MAIL ROUTE CODE
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PHONE NUMBER
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BUSINESS TYPE (FPDS)
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1:SMALL BUSINESS;2:LARGE BUSINESS;3:OUTSIDE U.S.;4:OTHER ENTITIES;
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AMS;1
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AUSTIN NAME FIELD
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AMS;2
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PRICER EXEMPT
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AMS;3
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AMS;4
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FMS VENDOR TYPE
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C:commercial;I:individual;F:federal;
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AMS;5
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PROVIDER CODE
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B:both;V:vendor only;P:provider only;
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AMS;6
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TAX ID/SSN FLAG
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T:TAX ID NUMBER;S:SSN NUMBER;
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1010EC missing
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ALL LINES DO NOT HAVE SAME CANCEL STATUS
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DAYS) = Covered Days
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When an invoice is transmitted to FPPS via the HL7 package, a copy of the HL7
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message text is saved in the FPPS QUEUED INVOICES (#163.5) file.
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This option purges the message text for invoices transmitted prior to a
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specified date. Messages that have not been accepted by the VistA Interface
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Engine will not be purged unless there is a later message for the same
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invoice number that has been accepted.
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Purge text of messages transmitted prior to
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The purge date must be at least 30 days ago.
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This response must be a date. Enter '^' to quit.
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FB FPPS Message Text Purge
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For Messages Transmitted Prior To
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Starting Purge...
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Purge Completed.
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The message text was purged from
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in file 163.5.
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FPPS Message Text Purge
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FB FEE TO FPPS EVENT
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INVALID TRANSACTION TYPE
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MISSING INVOICE NUMBER
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MISSING FPPS CLAIM ID
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MISSING INVOICE DATE
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MISSING CANCELLATION DATE
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MISSING FPPS LINE ITEM
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MISSING CHECK NUMBER
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This option transmits HL7 messages to FPPS for EDI invoices.
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Select Transmission Option
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Enter I to transmit a single invoice or A to transmit
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all pending invoices. If I is entered then you will be
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asked to select the invoice.
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Transmit all pending invoices now
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Starting Process...
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Error: Unable to initialize HL variables.
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Checking for acknowledgements...
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Transmitting Pending Invoices...
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Process complete. Sending Summary Message to G.FEE...
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ERROR: Couldn't initialize HL variables!
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Error, invalid data for invoice
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in file 163.5
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transmit invoice
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Error adding entry to file 163.5. Can't re-transmit invoice.
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Invoice has been transmitted to the HL7 package.
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Problems prevented transmission of the invoice.
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Couldn't Lock Entry
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in File 163.5.
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Couldn't determine invoice # for entry
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Invalid File # for entry
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HL ERR:
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Process Started.
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Check transmitted messages for acknowledgement...
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previously transmitted messages w/o ack.
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of these were accepted.
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of these were rejected.
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of these still waiting for ack.
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Transmit pending invoices...
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not transmitted due to exception.
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Process Complete.
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Process (task) stopped due to user request.
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List of Exceptions during Transmit of Pending Invoices
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List of Invoices Waiting for Acknowledgement
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List of Rejected Invoices that have not been reported.
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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