308 lines
10 KiB
Plaintext
308 lines
10 KiB
Plaintext
English French Notes Complete/Exclude
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Review Status:
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Insurance Seq:
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Last Edited :
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Last Edit By :
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New Pat. Nm.:
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New Pat. Id :
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PAYER INFORMATION:
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Payer Name :
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Payer Id :
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ICN :
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Cross Ovr ID :
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Cross Ovr Nm:
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CLAIM LEVEL PAY STATUS:
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Tot Submitted Chrg:
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Covered Amt :
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Payer Paid Amt :
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Patient Resp. Amt :
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Discount Amt :
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Per Day Limit Amt :
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Tax Amt :
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Tot Before Tax Amt:
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Total Allowed Amt :
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Negative Reimb Amt:
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Discharge Fraction:
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DRG Code Used :
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DRG Weight Used :
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Reimburse Rate :
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HCPCS Pay Amt :
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Esrd Paid Amt :
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Non-Pay Prof Comp :
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CLAIM LEVEL ADJUSTMENTS:
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GROUP CODE:
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REASON CODE:
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REVIEW DATA:
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REVIEW DATE/TIME:
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**A/R CORRECTED PAYMENT DATA:
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TOTAL AMT PD:
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N-ALL INSURED PT RELATION
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Pt. Relation :
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N-ALL INSURED FULL NAMES
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Insured Name:
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N-ALL INSURANCE NUMBER
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Insured ID
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FLD NAME
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Invalid entry #
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Field not found!!
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N-STATEMENT COVERS FROM DATE
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DIC(81.3
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N-UB92 LOCATION OF CARE
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N-UB92 BILL CLASSIFICATION
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N-UB92 TIMEFRAME OF BILL
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LM-UB
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Warning:** REV CODE UNITS < #PROCEDURES, THEY MUST BE =
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Warning:** REV CODE UNITS > #PROCEDURES, THEY MUST BE=:
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Rx#
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RX:
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NDC:
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NOC:
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**** ERROR - NO PROC LINK TO REV CODE FOR DRUG: RX#:
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DX-E
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OFFSET AMOUNT:
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Prosthetic:
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RX-UB92
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PRESCRIPTION REFILLS:
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days supply
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NDC #:
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PROS-UB92
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PROSTHETIC REFILLS:
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NON-SERV
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FILE LOCKED ... TRY AGAIN LATER
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New Rule's TYPE OF RULE:
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YOU ARE ADDING A RULE THAT WILL ONLY ALLOW THE TRANSMISSION OF BILLS WHOSE
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FORM TYPE IS INCLUDED IN THIS RULE.
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New Rule's TRANSMISSION TYPE:
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APPLY RULE ONLY TO BILLS THAT ARE (I)NSTITUTIONAL, (P)ROFESSIONAL, OR (B)OTH:
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ONLY TRANSMIT (I)NSTITUTIONAL, (P)ROFESSIONAL, OR (B)OTH:
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APPLY RULE ONLY TO BILLS THAT ARE (I)NPATIENT, (O)UTPATIENT, OR (B)OTH:
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THIS RULE WILL ONLY APPLY TO BILLS THAT MATCH ALL OF THE FOLLOWING CONDITIONS:
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BILL IS
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AN
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EITHER AN EDI OR MRA
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BILL AND IS ALSO
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AN INSTITUTIONAL^A PROFESSIONAL
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EITHER A PROFESSIONAL OR INSTITUTIONAL
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AND
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IS ALSO AN
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IS EITHER AN INPATIENT OR OUTPATIENT
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NOTE: RULE WILL BE IGNORED FOR ANY BILLS THAT DO NOT MATCH ALL THE CONDITIONS
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BILL IS AN MRA BILL
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AND IS ALSO
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AND ALSO HAS A NEXT INSURANCE THAT HAS BEEN INCLUDED IN THE
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'INSURANCE COMPANIES INCLUDED' LIST FOR THIS RULE.
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NOTE: THIS RULE WILL BE IGNORED FOR ANY BILL THAT DOES NOT MATCH
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ALL OF THESE CONDITIONS.
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THE EFFECT OF THIS RULE WILL BE: IF A BILL MATCHES ALL OF THE ABOVE CONDITIONS,
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THE REQUEST AND RECEIPT OF AN MRA WILL NOT BE ALLOWED.
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IS THIS CORRECT?
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THE RULE WILL BE APPLIED AND THE BILL WILL NOT BE TRANSMITTED IF:
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- THE RULE APPLIES TO ALL INSURANCE COMPANIES
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- THE RULE 'APPLIES TO' ONLY SPECIFIC INSURANCE COMPANIES AND THE BILL'S
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INSURANCE COMPANY APPEARS ON THE RULE'S 'INCLUDE LIST'
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- THE RULE 'EXCLUDES' SPECIFIC INSURANCE COMPANIES AND THE BILL'S
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INSURANCE COMPANY DOES NOT APPEAR ON THE RULE'S 'EXCLUDE LIST'
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- THE RULE HAS NO BILL TYPE RESTRICTIONS OR APPLIES TO ALL BILL TYPES
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- THE RULE IS RESTRICTED TO CERTAIN BILL TYPES AND THE BILL'S BILL TYPE IS
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INCLUDED FOR THE RULE OR IS NOT EXCLUDED FOR THE RULE
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NEXT
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BILL TYPE
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TO EXCLUDE
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Enter the bill types to include/exclude. To include, enter the
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3 digit bill type. To exclude, precede the 3 digit bill type with a minus (-)
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You may use 'X' as a wild card. Use XXX to include all bill types.
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If XXX is entered, the rest of the entries must be bill type exclusions.
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The current bill types entered for this rule are:
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ALL BILL TYPES INCLUDED - ONLY EXCLUSIONS ALLOWED NOW
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Warning ... this rule will not work unless you enter at least one bill type
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Timed out or '^' entered ... bill types not added
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INSURANCE CO OPTION:
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Select Insurance Co to
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clude for this rule:
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Entries deleted!
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Warning ... no insurance companies entered
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Cannot add this bill type restrictions because:
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In order to exclude, you must include at least one bill type including the
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excluded bill type first
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You already have 'XXX' (all bill types) - can only EXCLUDE bill types now
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You have already entered this bill type
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You have included and excluded the same bill type
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* WARNING - MAKING CHANGES TO THE TRANSMISSION *
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* RULES USING THIS OPTION CAN SERIOUSLY AFFECT THE *
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* SITE'S ABILITY TO BILL. BE EXTREMELY CAUTIOUS *
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* WHEN USING THIS OPTION. *
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IBCE RULES
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FORM TRANSMIT INSURANCE RULE
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# TYPE TYPE OPTION NUM SHORT DESCRIPTION
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ACTIVE DATE INACTIVE DATE
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IBCE-RULE
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IBCE-RULEDX
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EDI ONLY
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MRA ONLY
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BOTH EDI/MRA
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Rule #'s followed by an * are currently inactive
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Only currently active rules are displayed
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Transmission Rules Found
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RULE TYPE '
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' DOES NOT ALLOW BILL TYPE RESTRICTIONS
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PRESS RETURN
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IBCE-BTDX
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Bill Type Restriction #
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IBCE-BT
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Warning ... no insurance companies chosen to
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@RULE NUMBER
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TRANSMISSION RULE(s) HAVE BEEN SUCCESSFULLY FILED
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NO TRANSMISSION RULES ADDED
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CANNOT BE AFTER RULE'S INACTIVE DATE OF
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CANNOT BE BEFORE RULE'S ACTIVE DATE OF
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MUST BE PRIOR TO BILL TYPE'S INACTIVE DATE OF
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MUST BE AFTER BILL TYPE'S ACTIVE DATE OF
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CHANGE WOULD INVALIDATE BILL TYPE RESTRICTION DATE
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IBCE RULE BT RESTRICT
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BILL TYPE RESTRICTIONS FOR RULE #
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Transmit type:
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EDI
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MRA
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Form Type :
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Ins Co Option:
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ALL
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Active Date :
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Inactive Date:
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No Bill Type Restrictions Found
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THE BILL TYPE RESTRICTION(S) WAS/WERE DELETED
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Bill type
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not deleted - deleting
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this restriction
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these restrictions
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would cause an inconsistency
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Press return:
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Missing Parameters
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No base file found for form
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No data found for required field
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Max # lines or occurrences exceeded (
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BILL-SEARCH
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FILEMAN FIELD:
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NOT A PRINTABLE FORM!!
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BILL DOES NOT EXIST
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DEPT VETERANS AFFAIRS
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VETERANS AFFAIRS,DEPT
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IBCE LOCAL FORMS LIST
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No Local Forms Currently On File
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Form Number:
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Base File :
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Format Type:
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Form Length:
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Associated With National Form:
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Entry Pre-processor :
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(defined for associated 'parent' form)
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Entry Post-processor:
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Form Pre-processor :
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Form Post-processor :
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Output Logic :
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(Use formatter default)
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Extract Logic :
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LOCAL FORM:
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Enter a new LOCAL FORM NAME:
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Enter the name that you want your new local form to be referenced by
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Enter form number (must be > 9999):
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Enter the internal entry number that will be assigned to this form
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Another user has taken this number ... please select a new one.
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MUST HAVE A BASE FILE!!
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MUST HAVE A FORMAT TYPE!!
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WANT TO ASSOCIATE THIS FORM WITH A NATIONAL FORM
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FORM NOT ASSOCIATED WITH ANY NATIONAL FORM
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WANT TO COPY ALL FIELDS FROM AN EXISTING FORM
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Select FORM TO COPY FROM:
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ARE YOU SURE YOU WANT TO MAKE THIS COPY
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This may take a little while ... please be patient while I build your new form
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Field copy completed -
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fields copied
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IBCE FORM FIELDS LIST
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Exit option entirely
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A form with this name already exists
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A form with this number already exists
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Select LOCAL DATA ELEMENT Name:
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ONLY NATIONAL FIELDS CAN BEGIN WITH 'N-'
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Are you sure you want to DELETE LOCAL FORM -
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If you choose to delete this form, the form's field content definitions will also be deleted
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No Fields Currently Defined For Form
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Bill Form:
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Associated With Nat. Form:
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Not Associated With A National Form
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OVERRIDE AN EXISTING FIELD
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Can Only Over-ride a NATIONAL form field
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Can't Over-ride a form field that is an over-ride itself
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Form field definition will not allow override
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Over-riding Form Field #
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IS THIS OK
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COPY OVER THE DATA ELEMENT AND OUTPUT FORMAT FROM THE ORIGINAL FLD
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MUST HAVE A PAGE/SEQ
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MUST HAVE A FIRST LINE #
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MUST HAVE A STARTING COLUMN
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Form field: (#
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is a NATIONAL form field
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EDIT A NATIONAL FIELD FROM
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FORM FIELD
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'S CONTENT DEFINITION NOW
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...Please define CONTENT of field...
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Definition of Form Field: (#
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Defining content of form field: (#
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Select a DATA ELEMENT:
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FORM FIELD #:
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YOU CANNOT
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A NATIONALLY ASSOCIATED LOCAL FORM
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- REDEFINE THE FIELD'S CONTENT BY USING A LOCAL FORM FIELD TO OVERRIDE
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DELETE NATIONAL FIELDS FROM
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Can't delete this field until all fields associated with it are deleted
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If you delete this form field, its content definition will
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also be deleted
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Form Field #
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The following problem
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exist for this definition:
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* DATA ELEMENT
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OR SCREEN PROMPT
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FOR FIELD IS MISSING - NO DATA WILL BE OUTPUT
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* MORE THAN ONE OVERRIDE FLD DEFINITION EXISTS FOR THE ASSOC FIELD FOR:
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INS CO:
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BILL TYPE:
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WANT TO RE-EDIT THIS RECORD NOW?
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Form Field:
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First Line:
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Col/Pc:
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Pad:
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Bill Type:
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Data Element:
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Scrn Prompt:
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Edit Status:
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Fileman Fld:
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Constant Val:
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Extract Code:
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Format Code:
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National/Loc:
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Base File:
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OUTPUT FORMATTER - FORM:
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OUTPUT FORMATTER:
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Output Device:
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PRINT FORM:
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Do you want to queue this transmission
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Do you want to run this job without queuing it now
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Please enter the date and time to execute this job...
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<RET> or '^' to QUIT or 1-
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to EDIT:
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delimiters. The elements that are editable are assigned a group number
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enclosed in brackets
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while those without group numbers are not.
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PRESS <RETURN> KEY to RETURN to SCREEN
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Send transmission to your mailbox
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Enter a mail queue name:
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This is the mailman queue where the formatted test record should be sent
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Message
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is no longer in return message file
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This message has already been scheduled for update. Task # is:
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Message status (
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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