308 lines
9.7 KiB
Plaintext
308 lines
9.7 KiB
Plaintext
English French Notes Complete/Exclude
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WAITING SINCE
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MAIL MESSAGE #
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MINIMUM # OF DAYS MSGS WAITING TO BE FILED:
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Enter the minimum number of days a message has been waiting to be filed
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before it appears on this report
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REPORT OF EDI MSGS PENDING TOO LONG TO BE FILED
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TOTAL # OF MESSAGES WAITING OVER
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TO BE FILED:
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EDI MESSAGES WAITING TO BE FILED OVER
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MESSAGE TYPE
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IN CURRENT
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MESSAGE #
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STATUS SINCE
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DO YOU WANT TO INCLUDE A LIST OF BILLS WITH EACH BATCH?:
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Enter the first 10-digit batch number you want included on the report
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Start with BATCH #:
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Must enter a 10-digit batch #
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Enter the last 10-digit batch number you want included on the report
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Go to BATCH #:
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Enter the first date you want to include on the report
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Start with LAST TRANSMIT DATE:
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Must enter a valid date
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Enter the last date you want to include on the report
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Go to LAST TRANSMIT DATE:
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Select BATCH STATUS:
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EDI 837 BATCH DETAIL LIST
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Rejected?:
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Resubmit:
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Batch Type :
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Mail Msg:
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Received in Austin?:
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Status Date:
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Date Recorded:
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First Sent :
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Last Sent :
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Number Transmit Status Resubmit Batch #
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* = NOT RESUBMITTED
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Number Transmit Status
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Resubmit Batch #
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BATCH DETAIL LIST
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This report provides a list of claims held in a
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Ready for Extract status. Users can select all bills
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in a Ready for extract status or only those trapped due to
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the EDI Parameters being turned off.
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This report requires a 132 column printer.
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IB - EDI Claims in Waiting Transmission Status
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Your task number
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has been queued.
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There are no EDI records
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in a ready for extract status
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Total EDI Bills
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Total MRA Bills
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Total bills
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Your EDI site parameter setting is incomplete.
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Please contact your coordinator.
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Your site parameters are set to allow EDI transmissions
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There is no need to run this report.
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Trapped
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Claims Ready for Extract
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Inpt/
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Inst/
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Opt
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Prof
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Statement Date
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Do you want to print a list of:
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1 - All bills in Ready for Extract status
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2 - Bills trapped due to EDI paramater being turned off
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IB - EDI/MRA Claims in Rescue Process
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There are no records to print
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Claims in Rescue Process
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Stmt Date
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Ins Co.
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IB-HOLD
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IBCE ELEC REPORT DISP
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IBREP DISP
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IBREP DISP1
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No reports available for dispositioning
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REPORT:
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RACUBOTH RUCH
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EDI RETURN MESSAGE ROUTER ERROR
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Return Message Code:
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Return Message Date:
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Message Time:
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Update Date:
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Update Time:
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Return Message File #(s):
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Mailman Message #:
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cannot be determined
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Msg Line:
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Return Message Text:
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ERROR+
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S.IBCE MESSAGES SERVER
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*** NEW PAGE ***
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*** END OF PAGE ***
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I:G.IB EDI SUPERVISOR
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Status message received for batch
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PAYID=
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PAYER ID RETURNED IS DIFFERENT THAN PAYER ID ON FILE
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BILL # :
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PAYER :
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BILL TYPE :
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ID ON FILE :
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ID RETURNED:
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Please determine which id number is correct and correct the id in the
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insurance file for this payer, if needed
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ALREADY EXISTS - CAN'T HAVE BOTH ON ONE BILL
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IBA(355.93
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N-CURRENT INS POLICY TYPE
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Another user has locked this record - try again later
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ONLY SELECT TO CLOSE THE TRANSMIT RECORDS IF YOU KNOW THESE ARE THE FINAL
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ELECTRONIC MESSAGES YOU WILL RECEIVE FOR ALL THE BILLS REFERENCED BY
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THESE MESSAGES
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DO YOU WANT TO AUTOMATICALLY CLOSE THE TRANSMIT RECORDS FOR ANY MESSAGES
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THAT AREN'T REJECTS?:
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DO YOU WANT TO SEE EACH MESSAGE BEFORE MARKING IT REVIEWED?:
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IF YOU OPT TO SEE EACH MESSAGE, YOU CAN CONTROL WHETHER OR NOT THE MESSAGE
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IS MARKED AS REVIEWED
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AND, FOR NON-REJECTS, WHETHER OR NOT TO CLOSE THE
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TRANSMIT RECORD FOR THE BILL
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OK TO MARK REVIEWED?:
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IF YOU ENTER YES, THIS MESSAGE WILL BE MARKED REVIEWED
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IF YOU ENTER NO, THIS MESSAGE WILL NOT BE ALTERED
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IF YOU ENTER AN ^, THIS MESSAGE WILL NOT BE ALTERED & NONE OF THE
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REMAINING MESSAGES WILL BE PROCESSED
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OK TO CLOSE THIS BILL'S TRANSMIT RECORD?:
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THIS IS A REJECTION ... ARE YOU SURE YOU WANT TO MARK IT REVIEWED?:
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MESSAGES FOLLOWING THIS ONE WILL BE PROCESSED
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CLAIM SENT TO PAYER
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CLAIM REJECTED
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Seq #:
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Bill number:
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LAST SELECTION PROCESSED
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N-PRIOR PAYMENTS
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PRINT CENTER
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N-PATIENT STATUS
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N-SOURCE OF ADMISSION
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N-OTH INSURANCE PRIOR PAYMENT
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N-EOB ENTRIES
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Adding occurrence code 24 and primary insurance rejection date to bill
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Adding value code
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for reporting of bill's prior payments
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N-CURR INSURED DEMOGRAPHICS
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N-OTH INSURED DEMOGRAPHICS
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Adding occurrence code '
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insurance subscriber's date of birth
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N-DATE LAST SEEN
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Date Last Seen:
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N-REFERRING PROVIDER ID
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Homebound
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N-ASSIGN OF BENEFITS INDICATOR
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Nn0
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Patient refuses to assign benefits
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NOC Drug:
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Testing for hearing aid
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Attending physician,not hospice employee
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Last Xray:
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Level of Sublux:
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N-SPECIAL PROGRAM
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Medicare demonstration project for lung volume reduction surgery study
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N-HCFA 1500 BOX 19 RAW DATA
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N-BILL REMARKS
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DISPLAY THE FULL HCFA 1500 BOX 19?:
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Bill:
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VARIABLE TO DISPLAY (IBXDATA):
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BAD VARIABLE NAME
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*** NO DATA TO DISPLAY
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Remember to run this for flds that set up pre-requisite data (if any) first
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Form Field:
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N-SPECIALTY CODE
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N-ALL PROVIDERS
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PRV-82
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DEPT OF VETERANS AFFAIRS
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SELECT 1-
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Enter your selection for procedure from 1 to
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There were more than
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matches found. Please try again with more specific input
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N-ATT/REND PROVIDER ID
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WANT TO CHANGE THE
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PROVIDER'S FUNCTION TO
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IF YOU ANSWER YES HERE, YOU WILL MAKE THE PROVIDER FUNCTIONS CONSISTENT
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WITH THE FORM TYPE OF THE BILL
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FUNCTION DOES NOT BELONG ON THIS BILL TYPE & MUST BE DELETED
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This bill is
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The valid provider functions for this bill are:
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- ALREADY ON BILL
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- NOT ON BILL
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Select Rx for this charge:
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Enter an Rx# for this revenue code
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The Rx must not already have an associated revenue code
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PROCEDURE #
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HAS BEEN ASSOCIATED WITH THIS MANUAL CHARGE
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Respond YES if this revenue code charge specifically references the data for
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a particular procedure that was manually entered on the previous screen.
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For outpatient UB92 bills, associating a manual revenue code charge with
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a procedure is the only way to print a modifier in box 44
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SHOULD A PROCEDURE ENTRY BE ASSOCIATED WITH THIS CHARGE?:
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Respond YES if you no longer want this revenue code charge to reference a
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specific manually entered procedure
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DELETE THE EXISTING PROCEDURE ASSOCIATION?:
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SELECT A PROCEDURE ENTRY:
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Enter a manually-added CPT procedure to associate with this charge
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IBCE EXTR STATUS MANAGEMENT
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Claims in need of rescue process
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This function is not necessary.
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No records trapped in a Ready for Extract status found
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Authorizing bill...
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This option will display the EDI extract data for a bill.
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There is no entry in the EDI Transmit Bill file for this bill number.
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There is no batch # for this bill. It has not been transmitted.
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INCLUDE FIELDS WITH NO DATA?:
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Transmitted Bill Extract Data
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Your task number
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Inpt
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Oupt
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(NO DATA - RECORD NOT SENT)
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EDI Transmitted Bill Extract Data
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UB-82
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FOLLOW-UP AR FORM
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BILL ADDENDUM FOR
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BILL FORM TYPE NOT COMPLETE FOR
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QUEUEING OF
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DG*
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*** COPY OF ORIGINAL BILL ***
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*** SECOND NOTICE ***
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*** THIRD NOTICE ***
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MEDICARE ESRD
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IB-RC
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Dept. Veterans Affairs
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Bill Type:
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INPATIENT CARE
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ADDITIONAL PROCEDURE CODES:
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LESS
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OP VISIT DATE(S) BILLED
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MISSING INPUT VARIABLES
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BILL NON-EXISTANT
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BILL CANCELLED
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BILL STATUS INAPPROPRIATE
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For your information, even though the patient may be otherwise eligible
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for Medicare, no payment may be made under Medicare to any Federal provider
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of medical care or services and may not be used as a reason for non-payment.
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Please make your check payable to the Department of Veterans Affairs and
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send to the address listed above.
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The undersigned certifies that treatment rendered is not for a
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service connected disability.
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IBCF1TP-1
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IB - TEST UB-82 PRINT
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IBCF1TP-2
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*** UB-82 TEST PATTERN ***
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AGENT CASHIER
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AGENT CASHIER STREET
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CITY STATE ZIP
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PHONE #
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BC/BS #
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FED TAX #
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PATIENT ADDRESS
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PT DOB
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ADM DT
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MAILING ADDRESS NAME
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STREET ADDRESS 1
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STREET ADDRESS 3
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000 DAYS MEDICAL CARE
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REV CODE
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PAYER
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INSURED NAME
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POLICY #
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GROUP NAME
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GROUP #
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EMPLOYER NAME
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CITY STATE ZIP
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PRINCIPAL DIAGNOSIS
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PRINCIPAL PROCEDURE
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TX. AUTH.
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XXXX XXXXXXX
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UB-82 TEST PATTERN
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**TEST PATTERN**
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UB-82 SIGNER NAME
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UB-82 SIGNER TITLE
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PRINT HCFA1500
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N-PRINT BILL SUBMIT STATUS
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ONSET OF SYMPTOMS/ILLNESS
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PUBLIC LAW 99-272/SECTION 1729 TITLE 38
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PUBLIC LAW 99-272
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Dept. Of Veterans Affairs
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THE UNDERSIGNED CERTIFIES TREATMENT IS NOT FOR A SERVICE-CONNECTED CONDITION
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proc^division^basc flag^bedsection^rev code^unit chrg^Rx seq #
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proc^division^basc flag^dx^pos^tos^modifier^unit chrg^Rx seq #
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proc^division^basc^dx^pos^tos^modifier(s)^unit chrg^purchased chg
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AUX-X
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not for SC
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IBCF2TP-1
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IB - TEST HCFA 1500 PRINT
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IBCF2TP-2
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INSURANCE CARRIER NAME
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CARRIER ADDRESS LINE 1
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CARRIER ADDRESS LINE 2
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CARRIER ADDRESS LINE 3
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CARRIER CITY, STATE ZIP
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SUBSCRIBER ID#
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MM DD YY
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INSURED'S NAME
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PATIENT ADDRESS STREET
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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