308 lines
12 KiB
Plaintext
308 lines
12 KiB
Plaintext
English French Notes Complete/Exclude
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Form Locator
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Tx Auth. Code :
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Bill Remark :
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Pri:
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Tx Auth. Code(s) :
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Admitting Dx :
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Admission Source :
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(OLD PROV DATA)
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Form Locator 2 :
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Form Locator 11 :
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Form Locator 31 :
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Form Locator 56 :
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Form Locator 78 :
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Force To Print? :
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NOT TRANSMITTABLE
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Provider ID Maint : (Edit Provider ID information)
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Unable To Work From:
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Unable To Work To :
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Admitting Dx :
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ICN/DCN(s) :
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Tx Auth. Code(s) :
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(OLD BOX 31 DATA)
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Non-VA Facility :
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Form Locator 19 :
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Homebound :
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Date Last Seen :
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Spec Prog Indicator:
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Print Main Facility Box 32:
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Force To Print? :
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**Warning** Credentials differ from those found in NEW PERSON or IB NON VA
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BILLING PROVIDER file (
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Changes will print local, but only credentials on file transmit
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Primary^Secondary^Tertiary
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ins co requires care unit
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for this claim
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No local screen has been defined for this form type
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Bill must have insurance co or resp institution to use this screen
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No local data fields are needed for this bill type/insurance company
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DR(1,399,
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DR(2,2)
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DR(2,2,
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of data,
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'^N' to jump to screen #N (see
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Special help screens:
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Enter '?SC' to view SC Status and Rated Disabilities.
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Enter '?INS' to view the patients insurance policies.
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Enter '?PRV' to view provider specific information.
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Enter '?PRC' to view all procedures on the bill and related data.
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Enter '?CHG' to view all items on the bill with potential charges.
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Enter '?CPT' to view all charges for selected CPT codes and bill type.
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Enter '?HCFA' to view how block 24 will print on a HCFA 1500.
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Enter '?INC' to execute the edits & view the bill inconsistencies.
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Enter '?CLA' to view the ClaimsManager options.
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PRESS <RETURN> KEY
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to RETURN to SCREEN
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DATA GROUPS ON PARAMETER SCREEN
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to RETURN to PARAMETER SCREEN
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Patient Employer Name, Address^Spouse Employer Name, Address
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Payer Information^Provider Numbers^Mailing Address
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Admission Information^Discharge Information^Diagnosis Code(s)^Coding Method, Inpt Proc Code(s)^Occurrence Code(s)^Condition Code(s)^Value Code(s)
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Event Date^Outpatient Diagnosis^Outpatient Visits^Coding Method, Opt. Pro. Code(s)^Occurrence Code(s)^Condtion Code(s)
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Bill Type, Covered/Non-Covered Days^R.O.I., Assignment of Benefits^Statement Covers Period^Bedsection, Length of Stay^Revenue Code(s), Offset, Total^Rate Schedule(s)^Prior Payments/Claims
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Bill Remark^Form Locator 2^Form Locator 9^Form Locator 27^Form Locator 45^Form Locator 92^Form Locator 93^Tx Auth. Code
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Locally defined fields
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Bill Remark, ICN/DCN's, Tx Auth. Code, Admit Diagnosis/Source^Providers^Form Locator 2 and 11^Form Locator 31^Form Locator 56, 57, and 78^Force to Print
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Period Unable to Work^Admit Dx, ICN/DCN, Tx/Prior Auth. Code^Providers^Non-VA Facility^Form Locator 19^Force to Print
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Fed Tax #, BC/BS #, MAS Svc Pointer^Bill Signer, Billing Supervisor^Security Parameters, Outpatient CPT parameters ^Remarks, Mailgroups^Agent Cashier Address/Phone
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Demographic^Employment^Payer^Inpatient Event^Outpatient Event^Inpatient Billing - General^Outpatient Billing - General^Billing - Specific^Locally Defined
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Example of diagnoses, procedures and charges printing on the HCFA 1500
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BOX 19 DATA:
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This is a display of provider specific information.
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Select PROVIDER NAME:
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Signature Name:
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Signature Title:
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None Active on
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Person Class:
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PROVIDER TYPE:
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RC Provider Group:
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SC Status and Rated Disabilities for
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SC At Time Of Care:
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DO YOU WISH TO ADD/EDIT INSURANCE COMPANY DATA FOR THIS PATIENT
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YES - And I'll prompt you so that you may add insurance data to the PATIENT
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file for this patient.
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NO - To bypass this editing of the PATIENT file.
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If you updated insurance information for any policy which is already specified
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as either a PRIMARY, SECONDARY or TERIARY for this billing episode, you will
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need to press the <RETURN> key through the following prompts in order to insure
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that these new values are properly stored. If you fail to do so, i.e.,
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enter an up-arrow, the new values will not be stored as part of this billing
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If a procedure is linked as a prescription to a rev code, it cannot be deleted
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- Enter the alphanumeric designation of your choice from
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the display (e.g. 'A1') to input one of the codes shown
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above into this billing record.
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- Enter the name or code number of an
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ICD DIAGNOSIS
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not displayed above to input a
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in the PTF record into this billing record, or '??' for
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a list of all
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CODES.
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- Enter <RETURN> to accept the default
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DIAGNOSIS
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PROCEDURE
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'^' to abort.
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No Codes Entered!
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Procedures Assigned to this Bill
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NO ENTRY FOUND^
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to EDIT,
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'^N' for screen N, or '^' to QUIT:
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SAVE THE VALUE OF $T
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[NOT REQUIRED]
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W Z Q
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IOINHI;IOINLOW;IOINORM
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HELP SCREEN
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SCREEN <
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Inpat
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Outpat
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CITY/STATE UNKNOWN
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Patient has no ACTIVE PTF RECORDS for this event date.
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A 'PTF NUMBER' is required for inpatient billing records.
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Select the appropriate billing record from the above listing by number.
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This patient is only
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years old!!
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This patient is a MALE!! Condition code 18 applies only to FEMALES!!
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Choose only ACTIVE Revenue Codes!!
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Only ACTIVE Revenue Codes may be selected!!
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NOT A VALID CHOICE!
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LEFT AGAINST MEDICAL ADVICE
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DISCHARGED TO ANOTHER SHORT-TERM GENERAL HOSPITAL
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NO BLUE CROSS/SHIELD PROVIDER NUMBERS IDENTIFIED TO SELECT FROM!
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OR
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ENTER BLUE CROSS/SHIELD PROVIDER # (BETWEEN 3-13 CHARACTERS)
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Revenue Code Listing
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Non-Cov
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Link Missing
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Current modifier
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Exceeds 'Total Charges' for this bill.
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Edit revenue codes/from-to dates if appropriate.
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START WITH DATE ENTERED:
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GO TO DATE ENTERED:
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bill IFN ^ bill date (stm to) ^ bill rate group
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) exists for Rx #
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and refill date
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Cannot precede the 'EVENT DATE'!
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Cannot bill for future treatment!
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Can't be greater than date of specified Procedures!
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'Start Date' must be specified first!
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Cannot preceed the 'Start Date'!
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Must be in same fiscal year!
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Must be in same calendar year!
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Can't be less than date of specified Procedures!
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No 'Start Date' on file...can't enter OP visit dates...
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No 'End Date' on file...can't enter OP visit dates...
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Can't enter a visit date prior to 'Start Date'...
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Can't enter a visit date later than 'End Date'...
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Can Not Precede Bill Start Date!
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Can not be after Bill End Date!
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) exists for visit date (
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MR.
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MS.
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MRS.
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IB-BS
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IB-ASC
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IB-PTF
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Removing old Revenue Codes.
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Editing
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Updating Revenue Codes
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REV. CODE
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) exists overlapping this date range.
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Site param does not allow entry of non-PTF procedures
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SINCE THE PROCEDURE CODING METHOD HAS BEEN CHANGED, DO YOU WANT TO DELETE ALL
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PROCEDURE CODES IN THIS BILL
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If you answer 'Yes', all procedure codes will be DELETED from this bill.
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Procedure Entry:
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Select PROCEDURE DATE
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Select PROCEDURE:
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Warning: Procedure code is inactive on this date
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The Procedure code is inactive on
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Please select another Procedure.
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Date must be within STATEMENT COVERS FROM and STATEMENT COVERS TO period.
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Enter a date between
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EDIT HCFA 1500 SPECIAL PROGRAM FIELDS and BOX 19?:
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Respond YES only if you need to add/edit data for chiropratic visits,
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EPSDT care, or if billing for HOSPICE and attending is not a hospice employee.
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OK to add CPT codes to Visits file
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Adding Procedures to PCE...
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IB DATA
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Procedures in
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were added okay.
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were not added - error code is
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Bill has no ICD DIAGNOSIS.
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<<<ASSOCIATED ICD-9 DIAGNOSIS>>>
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There are no diagnoses associated with this bill.
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*** Please select procedure diagnoses by number to left of diagnosis code ***
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Current Values:
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Dx
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Associated Diagnosis (
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Please enter one of the following billing diagnoses by number at left of code:
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You may also enter '^' to exit, '@' to delete a procedure diagnosis, or
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<CR> to accept a current value or skip a prompt.
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RC-OPT FAC
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RC-PHYSICI
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Modifier 26
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Deleted from
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Added to
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CPT procedures.
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Modifier TC Deleted from all Procedures (
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Procedures Deleted (
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Modifier 26 Procedures Added (
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CPT-CLN
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replaced by
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CANCEL WITHOUT EXAM
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ADMIT THRU DISCHARGE
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FIRST CLAIM
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CONTINUING CLAIM
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LAST CLAIM
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LATE CHARGE(S)
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ZERO CLAIM
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Deleting old synonym for the Purge Conversion Log action..........
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IBDFC PURGE CONVERSION LOG
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Cleaning up corrupt second piece of global ^IBE(357,IFN,2,0)
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AICS 3.0 Installation Requirements:
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>>> Environment check failed. Installation will not be allowed.
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>>> Environment is Ok
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>>> Checking Environment:
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Can not proceed. XPDABORT is inappropriately defined.
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Environment checks OK
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>>> Checking PACKAGE File Entries:
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Checking for required patch
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not found!!
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>>> Checking BUILD File Entries:
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Missing Required Package File Entry (Package/Patch):
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...Ok - in Package File
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DG SELECT ICD-9 DIAGNOSIS CODE
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PX INPUT EXAMS
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PX INPUT VISIT CLASSIFICATION
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>>> Now Attempting to automatically update Tool Kit forms and Tool Kit Blocks.
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Moving Block '
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' from import/export to Tool Kit
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Moving Form '
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' from import export utility to AICS
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>>> Tool Kit Forms and Blocks are already installed.
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>>> Tool Kit Forms sent (4):
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>>> Tool Kit Blocks sent (28):
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CLINICAL LEXICON ENTRY^P757.01'^LEX(757.01,^2;2^Q
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CLINICAL LEXICON^P757.01'^LEX(757.01,^2;2^Q
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>>> AICS Data Dictionaries updated to use Lexicon Utility version 2.0
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>>> Form Specs being deleted and recreated for scanning.
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INPUT DIAGNOSIS CODE (ICD9)
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DIAGNOSIS/PROBLEM
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DIAGNOSIS/PROBLEM^1^13^14^2^^^
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>>> Updating Package Interface Entry for INPUT DIAGNOSIS CODE (ICD9)
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INPUT PROVIDER
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PX INPUT PATIENT ACTIVE PROBLE
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>>> Deleting Fields *'d for Deletion in Package Interface file (357.6)
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IBD RESOURCE
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>>> Adding Resouce Device 'IBD RESOURCE' for scanning.
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1////IBD RESOURCE;.02////NA;2///RESOURCE
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LIST OF FORMS READY FOR IMPORT OR EXPORT
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(** there are
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toolkit blocks in the work space **)
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This form was created with version
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Export Notes For
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This action requires PROGRAMMER ACCESS!
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The work space must be cleared before the INITS are run. Is that okay?
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In order for you to import forms from another site the other site must have
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prepared and sent you inits created using the import/export facility.
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What is the name of the init routine that contains the forms that you want to
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That routine does not exist!
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Using the DIFROM action requires PROGRAMMER ACCESS!
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There is nothing in the work space to export!
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LIST OF TOOLKIT BLOCKS READY FOR IMPORT OR EXPORT
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forms in the work space **)
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What type of block do you want to export?
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NOW CHOOSE THE BLOCK TO COPY!
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New Toolkit Block Name:
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Enter a unique name for the toolkit block up to 30 characters
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There is already a toolkit block with that name! The name should be unique.
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Moving Form '
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' to import export utility
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Moving Block '
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' from form '
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' to utility
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IBDE CLN
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>>> Now checking the PACKAGE INTERFACE file for inappropriate data qualifiers.
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IBD(357.98,
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>> WARNING: The following interfaces use the PROBLEM node to transmit data
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Package Interface
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Contact Customer Support for assistance updating the package interface file.
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>> Summary of the Package Interface Check:
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No required changes were found.
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A total of
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removed from Package Interface Entries.
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The PCE DIM data fields for
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Package Interface
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Allowable Qualifier
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The Package Interface
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an invalid qualifier of
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a duplicate qualifier of
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a bad qualifier of
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not deleted, PCE DIM NODE='PROBLEM'
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The PCE Device Interface Data Updated.
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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