English French Notes Complete/Exclude to specify the CPT codes to be included on the report. If the Range method is chosen, you will asked for one or more ranges of CPT codes. (e.g. from 11000 to 11999) If the Individual method is chosen, you will be asked to select one or more specific CPT codes. Start of CPT Range # End of CPT Range # Start can't be after the End Note: Additional data printed if device supports 130+ characters for Payments with Finalized Dates from and all CPT Codes and CPT Codes: No payments found that match criteria. REPORT TOTALS COST/SAVINGS FROM RBRVS FEE SCHEDULE CPT CODE- Total Occurrences Payments at RBRVS Estimated Payments if RBRVS was not used Est. Savings 75th Percentile Usual & Customary* from RBRVS Patient has been deleted from the Patient file, cannot create transaction! Delete MRA has been created! CPT Modifier(s): Sorry,only the clerk who entered the payment or a supervisor can edit this payment. Sorry, only the Supervisor can edit a payment once the batch has been released. Sorry,you cannot edit a payment once the batch has been Finalized. Exit ('^') allowed now FPPS CLAIM ID was changed. Updating lines on invoice... FPPS LINE ITEM must be entered for each line on the invoice. SVC DATE: REV. CODE: AMT CLAIMED: Select Fee Patient: No payments for this patient! TRAVEL PAYMENTS: Check #: Paid: Vendor ID: MEDICAL PAYMENT HISTORY ('*' Reimb. to Patient '+' Cancel. Activity '#' Voided Payment) (paid symbol: 'R' RBRVS 'F' 75th percentile 'C' contract 'M' Mill Bill Svc Date Rev.Code Units Patient Account No. Amt Claimed Amt Paid Adj Code Adj Amount Remit Remark VoucherDt You must be a Fee supervisor to use this option. Select Invoice number: Select Prescription # : Payment not voided! Payment already voided! Is this the prescription you want to Cancel the void on Void Answer 'Yes' if you want to Void this prescription. Patient also has Inpatient Report(s) of Contact with the following date(s): Fee site parameters must be initialized!! Are you sure you want to enter a new invoice Invoice # assigned is: Vendor is flagged for Austin deletion! Want to edit Vendor data Date Correct Invoice Received: Vendor Invoice Date: Pharmacy Invoice #: DATE PRESCRIPTION FILLED: Date Prescription Filled is prior to later than authorization period!! Select PRESCRIPTION NUMBER Prescription referred to Pharmacy Service for determination. Since you didn't enter any line items has been Deleted!! Invoice No.: Invoice Total: $ Want to enter another Invoice Incomplete prescription entry. Deleted. No prescriptions currently in this invoice. Vendor Name: Patient I.D. Fill Date There already is a prescription number entered, from this vendor, for that fill date. The invoice number is Do you want to continue a previously entered Invoice Want to list previously entered line items This prescription number already exsists in this invoice. Do you wish to enter this prescription again You do not have access to the Fee Invoice File, contact your IRM Service. Rejected Invoice Number: Date Received: Invoice Date: Patient Account #: AMT CLAIMED AMT PAID BATCH NO. VOUCHER DATE Other Suspension Description AMT CLAIMED ADJ AMT REMIT RMK Please enter a whole number! Alpha characters and puctuation are invalid Answer must be numeric Select Batch for this Invoice: Invoice Closed out!! Batch selected established by another user, choose another. Batch selected is NOT a Pharmacy type batch, choose another. Batch selected not in Open status, choose another. Batch has reached maximum allowable payment entries! Now openning another batch for you. That Batch already has maximum allowable payment items! Invoice Totals: $ New Batch to closeout invoice is: Select Pharmacy Vendor: ** PHARMACY VENDOR LOOK-UP ** ID #: Chain #: Strength Claimed Date Finalized Are you sure you want to create a ' Add Change Reinstate ' type MRA for this patient MRA deleted. Transaction Created! Old Card Pt.ID Change Date There are no Fee Basis prescriptions Pending Pharmacy review Fee Prescription(s) Pending Pharmacy review Want to review some now No more prescriptions pending review! >> PATIENT REIMBURSEMENT << Prescription #: Fill Date: Is Prescription for an Authorized Condition A 'No' answer will deny payment. Was a Generic Drug issued to patient A 'No' answer alerts FEE to pay the generic equivalent, if one exists. Enter VA Generic Drug equivalent Match the drug entered by FEE to an entry in the VA Drug file. Is this an emergency medication A 'No' answer will DENY payment. Optional Pharmacy Remarks >>> PRESCRIPTION REVIEW <<< Rx for Authorized condition: Emergency Medication: Generic Drug Issued: Generic Drug Name: Current list of Adjustments: Code: Group: Current list of Remittance Remarks: Optional Pharmacy Remarks: Want to edit prior to release Want to review another Prescription Enter Invoice number you wish to make a determination on. Must be an invoice which is 'Pending Determination' status. Someone is editing that invoice now! Select Suspense Code Suspension Description Suspension description is required for a suspense code of 'OTHER'. Patient has no Pharmacy payment history. FPPS Line Item: PHARMACY PAYMENT HISTORY Pt ID: ID # Chain # Date Certified Paid None on File Telephone Personal VA Office SSN # >> REPORT OF CONTACT << Name of Veteran Telephone No. of Vet. Date of Contact Address of Veteran Type of Contact Person Contacted Telephone Number of Person Contacted Brief statement of information requested and given Division or Section Executed by(signature and title) VA form 119 There are no Reports of Contact on line for this patient. Fee Purge is not running! Total Payment Line Items to be Purged: Number of Line Items Purged as of now: Not Transmitted FEE BASIS VENDORS AWAITING AUSTIN APPROVAL DATE TRANSMITTED TO AUSTIN There are no venders awaiting Austin approval. Batch has been Re-opened! Rejects deleted from batch Sorry, only Supervisor can Delete reject flag! No items rejected in this batch! Want line items listed Want to delete rejection codes for the entire Batch Want to delete rejection code for any line items Invalid entry, must enter a number between 1 and or an '^' to exit! No payments in this batch for that patient! Delete Reject flag for all items for this patient Delete reject for which line item You already deleted that one!! Are you sure you want to delete reject for item number Item Deleted. Want to delete another If you answer 'Yes' to this question, all payment items in this batch will be flagged as rejected! If you answer 'No', you will be asked if you want to reject specific line items! Delete reject flag for which line item You already did that one !! Are you sure you want to delete the reject on item number Are you sure you want to delete reject code for all rejected items in this batch Reject codes for all items have been deleted! There is a problem with your 1358. Unable to delete reject flag! No payments rejected in this batch for that patient! You just deleted that one!! Delete Reject code for all items for this patient Delete reject code for which line item Reject code deleted! No 7078 on file for invoice . Could not determine 1358. No Rejects Pending! Batch Number: Voucher Date: Voucherer: Reject Reason: Old Batch #: REJECTS PENDING ACTION Re-transmit MRA's for which date: No MRA's were transmitted on that date! Re-Transmitting Want to print this Report of Contact Select Batch with Rejects: Select New Batch number: Want to re-initiate all rejected items in the Batch 'Yes' will re-initiate all rejected payment items for this batch, 'No' will prompt for re-initiation of specific line items Want to re-initiate any line items Re-initiate which line item You already did that one!! Are you sure you want to re-initiate line item number Item Re-initiated. Want to re-initiate another FYI: Invoice was split since entire invoice did not move to the new batch. Re-initiated lines are being assigned a new invoice number of Enter the batch number to which the rejected items you re-initiate will be assigned to. It must be an open batch and assigned to you. The obligation number from the batch with rejects is not the same as the new batch selected ! Re-Initiate which line item New Batch for Rejects is: Are you sure you want to re-initiate all line items in this batch All rejected items have been re-initiated! All rejected items (except for voided payments) have been re-initiated! New Batch selected does not have enough room to fit the rejects pending from batch has a status of VOID. Please delete the VOID before re-initiating this rejected payment. You just did that one!! Line Re-initiated. Are you sure you want to re-initiate item number: Reject code deleted. This report produces a 132 character output. There are no batches Pending Release! Try releasing batch at another time. Batch needs to be released to Pricer first. Release of batch Sorry, only Supervisor can Release batch! Do you want to Release Batch as Correct Batch has NOT been Released! Batch has been Released! This batch CANNOT be released. Check your 1358. 1358 not available for posting! No invoices found for this batch. Unable to release. FB7078( No associated 7078 for invoice . Unable to release batch. Unable to locate reference number on 1358. Run Post Commitments for Obligation option. STA #-OBLIGATION #-REF # A new batch, number #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### ####################