| [604] | 1 | English French Notes Complete/Exclude
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| 2 | Vendor is listed as 'exempt from the pricer'.
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| 3 | Do you wish to keep this invoice exempt from the pricer
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| 4 | Medicare ID Number is needed for this Vendor!
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| 5 | Obligation number on batch does not match 1358.
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| 6 | Obligation number on batch must be
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| 7 | Invoice number
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| 8 | has already been entered for this authorization.
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| 9 | Use the Contract Hospital 'Invoice Edit' option if needed.
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| 10 | Want to add another invoice for this episode of care
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| 11 | Unable to create Non VA PTF Record.
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| 12 | This Invoice may not be added to Batch #
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| 13 | ***You may not add a
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| 14 | pricer exempt
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| 15 | invoice to a
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| 16 | Do you want to open a new batch at this time
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| 17 | You must Reopen the batch prior to editting the invoice.
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| 18 | to edit this invoice.
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| 19 | Batch has already been sent to Austin for payment.
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| 20 | Site Parameters must be entered prior
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| 21 | to using this option.
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| 22 | Is this the correct 7078
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| 23 | Disposition
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| 24 | Issuing Office
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| 25 | 1. Date of Issue
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| 26 | Name of Physician or Station
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| 27 | ID#:
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| 28 | 4. Veteran's Claim No.
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| 29 | 5. Authorization Valid
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| 30 | From
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| 31 | To
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| 32 | PART 1. - SERVICES AUTHORIZED
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| 33 | 6. Services shown below are authorized for the period indicated in Item 5 above.
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| 34 | (See Special Provisions below.)
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| 35 | 8. Fee Schedule or Contract
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| 36 | 10. Estimated Amount
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| 37 | 11. Fiscal Symbols
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| 38 | 12. Authorized by (Name and Title)
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| 39 | Approving Official for 7078
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| 40 | Enter <return> to accept the default or enter a name from 3 to 45 characters in length
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| 41 | Title of Approving Official
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| 42 | Enter <return> to accept the default title or enter a title from 3 to 45 characters in length
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| 43 | # of copies of 7078
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| 44 | 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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| 45 | USER:
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| 46 | REPORT OF CONTACT CONTINUED
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| 47 | For:
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| 48 | NOTIFICATION OF ADMISSION TO PRIVATE HOSPITAL
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| 49 | AUTHORIZATION FROM DATE/TIME:
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| 50 | DATE/TIME OF ADMISSION:
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| 51 | NAME of HOSPITAL:
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| 52 | ADDRESS:
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| 53 | PHYSICIAN'S NAME:
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| 54 | Not Entered
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| 55 | TENTATIVE DIAGNOSIS:
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| 56 | INSURANCE TYPE:
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| 57 | MODE of TRANSPORTATION:
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| 58 | APPROVED/DISAPPROVED
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| 59 | FEE BASIS SECTION
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| 60 | VA form 119C
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| 61 | Do you want this report for all PSAs
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| 62 | CIVIL HOSPITAL PSA REPORT
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| 63 | OUTPATIENT MEDICAL PSA REPORT
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| 64 | PHARMACY PSA REPORT
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| 65 | COMMUNITY N.H. PSA REPORT
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| 66 | County Code
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| 67 | Amount Paid
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| 68 | Total Dollars spent by PSA for the dates of
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| 69 | TOTAL AMOUNT PAID
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| 70 | TOTALS DOLLAR AMOUNT BY PSA FOR ALL SELECTED PROGRAMS
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| 71 | TOTAL AMOUNT
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| 72 | FEE PROGRAM
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| 73 | No payments found for this Fee Program.
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| 74 | This notification has a status of complete. Cannot edit.
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| 75 | Admission overlaps another request for this patient.
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| 76 | REPORT OF CONTACT INFORMATION
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| 77 | CANNOT ENTER ENTITLEMENT.
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| 78 | Do you want to determine Medical Entitlement now
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| 79 | Do you want to setup a 7078 now
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| 80 | There is an incomplete 7078 for this patient.
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| 81 | The reference number is
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| 82 | < NEW REQUEST DELETED >
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| 83 | This Authorization From Date exceeds the 72 hour notification period.
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| 84 | Do you want to continue ? No//
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| 85 | Entering an '^' is not allowed. Please answer 'Yes' or 'No'.
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| 86 | Authorized From Date must be equal to or greater than the Date of Admission
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| 87 | You must be a holder of the 'FBAASUPERVIVOR' key to reconsider a denied request.
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| 88 | No audit data on file.
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| 89 | Field changed:
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| 90 | Date of Change:
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| 91 | AUDIT on FEE NOTIFICATION ENTITLEMENT CHANGE
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| 92 | DATE/TIME of NOTIFICATION
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| 93 | FIELD CHANGED
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| 94 | No payments rejected!
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| 95 | Rejected!
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| 96 | CIVIL HOSPITAL REJECTED PAYMENT HISTORY
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| 97 | ('*' Represents Reimbursement to Patient
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| 98 | '#' Represents Voided Payment)
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| 99 | Inv Date
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| 100 | Susp
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| 101 | Invoice
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| 102 | Select Batch with Pricer Rejects:
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| 103 | No items rejected for this batch!
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| 104 | Select New Batch Number:
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| 105 | Want to re-initiate this payment
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| 106 | Want to edit payment now
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| 107 | This Batch is exempt from the Pricer!!!
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| 108 | Please use the 'Release a Batch' option to forward this batch for payment.
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| 109 | DISCHARGE DATE
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| 110 | AMOUNT CLAIMED
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| 111 | AMOUNT SUSPENDED
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| 112 | Answer 'Yes' to print suspension letters for all suspension
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| 113 | codes, otherwise answer 'No' to select specific codes.
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| 114 | NOTIFICATION DATE
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| 115 | no inpatients pending disposition.
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| 116 | PENDING 7078's
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| 117 | ('++' indicates LOS > 10 days)
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| 118 | Total Requests:
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| 119 | # of Requests Denied:
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| 120 | # of Requests Pending:
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| 121 | CONTRACT HOSPITAL REQUEST STATISTICS
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| 122 | ('+' Request Pending)
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| 123 | ('!' Request Denied)
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| 124 | No invoices on line for this vendor.
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| 125 | PAYMENT HISTORY
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| 126 | INVOICE DISPLAY
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| 127 | Patient Control Number
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| 128 | ('*'Reimbursement to Veteran '+' Cancellation Activity) '#' Voided Payment)
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| 129 | Fr Date
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| 130 | To Date Claimed Paid
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| 131 | Sus Code
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| 132 | Dt. Rec.
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| 133 | Inv. Date
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| 134 | FPPS Claim ID
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| 135 | FPPS Line Item
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| 136 | To Date
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| 137 | Cov.Days
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| 138 | Sorry, you must be a supervisor to use this option.
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| 139 | Vendor has no
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| 140 | finalized payments
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| 141 | to VOID
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| 142 | for this patient under the
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| 143 | COMMUNITY NURSING HOME
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| 144 | the payment(s)
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| 145 | ('*' Represents Reimbursement to Patient)
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| 146 | ('#' Represents a Voided Payment)
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| 147 | FROM DATE
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| 148 | TO DATE
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| 149 | Cancel Voided
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| 150 | payment for
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| 151 | Select Check Number
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| 152 | There is no record of that check number.
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| 153 | VENDOR:
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| 154 | VENDOR ID:
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| 155 | Patient ID:
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| 156 | PAYMENT HISTORY FOR CHECK #
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| 157 | FEE PROGRAM:
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| 158 | ('*' Reimbursement to Patient '#' Voided Payment '+' Cancellation Activity)
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| 159 | Travel Dt
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| 160 | Fill Dt
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| 161 | Inpatient type is not identified.
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| 162 | ****CENSUS DATE SELECTION****
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| 163 | Census DATE:
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| 164 | Display Address for Vendors
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| 165 | FEE BASIS
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| 166 | VENDOR NAME
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| 167 | VENDOR ID
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| 168 | VETERAN ID
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| 169 | AUTH FROM
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| 170 | Invalid Code
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| 171 | Code is inactive
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| 172 | ICD O/P Code inactive ...
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| 173 | Invalid ICD O/P Code
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| 174 | Invalid ICD O/P Code
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| 175 | on date of service (
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| 176 | ICD Dx Code inactive ...
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| 177 | Invalid ICD Dx Code
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| 178 | Invalid ICD Dx Code
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| 179 | ICD Dx Code
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| 180 | FROM DATE
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| 181 | FEE ID CARD NUMBER
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| 182 | You cannot assign that number because it already has been assigned!
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| 183 | FEE ID CARD ISSUE DATE
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| 184 | FEE ID CARD EXPIRATION DATE
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| 185 | REASON FOR CARD NUMBER CHANGE
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| 186 | You are only allowed to edit an outpatient authorization using this option.
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| 187 | From Date cannot be later than the To Date!
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| 188 | To Date cannot be earlier than From Date!
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| 189 | RP161.8'
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| 190 | FBAA(161.8,
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| 191 | RP4'
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| 192 | PRIMARY SERVICE FACILITY
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| 193 | PURPOSE OF VISIT CODE
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| 194 | FBAA(161.82,
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| 195 | MST POV can't be selected because veteran's MST status is not YES.
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| 196 | PATIENT TYPE CODE
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| 197 | 00:SURGICAL;10:MEDICAL;60:HOME NURSING SERVICE;85:PSYCHIATRIC-CONTRACT;86:PSYCHIATRIC;95:NEUROLOGICAL-CONTRACT;96:NEUROLOGICAL;
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| 198 | TREATMENT TYPE CODE
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| 199 | 1:SHORT TERM FEE STATUS;2:HOME NURSING SERVICES;3:I.D. CARD STATUS;4:STATE HOME;
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| 200 | DX LINE 1
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| 201 | DX LINE 2
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| 202 | DX LINE 3
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| 203 | AUTHORIZATION REMARKS^W^^0;1^Q
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| 204 | TYPE OF CARE
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| 205 | 1:C&P;2:OPT NSC;3:OPT SC;
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| 206 | ACCIDENT RELATED (Y/N)
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| 207 | POTENTIAL COST RECOVERY CASE
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| 208 | PRINT AUTHORIZATION (Y/N)
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| 209 | ID NUMBER
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| 210 | STREET ADDRESS
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| 211 | RP5'
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| 212 | TYPE OF VENDOR
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| 213 | 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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| 214 | SPECIALTY CODE
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| 215 | FBAA(161.6,
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| 216 | RP161.81'
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| 217 | PART CODE
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| 218 | FBAA(161.81,
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| 219 | RNJ4,0XO
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| 220 | STREET ADDRESS 2
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| 221 | MEDICARE ID NUMBER
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| 222 | MAIL ROUTE CODE
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| 223 | PHONE NUMBER
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| 224 | BUSINESS TYPE (FPDS)
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| 225 | 1:SMALL BUSINESS;2:LARGE BUSINESS;3:OUTSIDE U.S.;4:OTHER ENTITIES;
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| 226 | AMS;1
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| 227 | AUSTIN NAME FIELD
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| 228 | AMS;2
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| 229 | PRICER EXEMPT
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| 230 | AMS;3
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| 231 | AMS;4
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| 232 | FMS VENDOR TYPE
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| 233 | C:commercial;I:individual;F:federal;
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| 234 | AMS;5
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| 235 | PROVIDER CODE
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| 236 | B:both;V:vendor only;P:provider only;
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| 237 | AMS;6
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| 238 | TAX ID/SSN FLAG
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| 239 | T:TAX ID NUMBER;S:SSN NUMBER;
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| 240 | 1010EC missing
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| 241 | ALL LINES DO NOT HAVE SAME CANCEL STATUS
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| 242 | DAYS) = Covered Days
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| 243 | When an invoice is transmitted to FPPS via the HL7 package, a copy of the HL7
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| 244 | message text is saved in the FPPS QUEUED INVOICES (#163.5) file.
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| 245 | This option purges the message text for invoices transmitted prior to a
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| 246 | specified date. Messages that have not been accepted by the VistA Interface
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| 247 | Engine will not be purged unless there is a later message for the same
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| 248 | invoice number that has been accepted.
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| 249 | Purge text of messages transmitted prior to
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| 250 | The purge date must be at least 30 days ago.
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| 251 | This response must be a date. Enter '^' to quit.
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| 252 | FB FPPS Message Text Purge
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| 253 | For Messages Transmitted Prior To
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| 254 | Starting Purge...
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| 255 | Purge Completed.
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| 256 | The message text was purged from
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| 257 | in file 163.5.
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| 258 | FPPS Message Text Purge
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| 259 | FB FEE TO FPPS EVENT
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| 260 | INVALID TRANSACTION TYPE
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| 261 | MISSING INVOICE NUMBER
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| 262 | MISSING FPPS CLAIM ID
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| 263 | MISSING INVOICE DATE
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| 264 | MISSING CANCELLATION DATE
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| 265 | MISSING FPPS LINE ITEM
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| 266 | MISSING CHECK NUMBER
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| 267 | This option transmits HL7 messages to FPPS for EDI invoices.
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| 268 | Select Transmission Option
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| 269 | Enter I to transmit a single invoice or A to transmit
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| 270 | all pending invoices. If I is entered then you will be
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| 271 | asked to select the invoice.
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| 272 | Transmit all pending invoices now
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| 273 | Starting Process...
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| 274 | Error: Unable to initialize HL variables.
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| 275 | Checking for acknowledgements...
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| 276 | Transmitting Pending Invoices...
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| 277 | Process complete. Sending Summary Message to G.FEE...
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| 278 | ERROR: Couldn't initialize HL variables!
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| 279 | Error, invalid data for invoice
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| 280 | in file 163.5
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| 281 | transmit invoice
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| 282 | Error adding entry to file 163.5. Can't re-transmit invoice.
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| 283 | Invoice has been transmitted to the HL7 package.
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| 284 | Problems prevented transmission of the invoice.
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| 285 | Couldn't Lock Entry
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| 286 | in File 163.5.
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| 287 | Couldn't determine invoice # for entry
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| 288 | Invalid File # for entry
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| 289 | HL ERR:
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| 290 | Process Started.
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| 291 | Check transmitted messages for acknowledgement...
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| 292 | previously transmitted messages w/o ack.
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| 293 | of these were accepted.
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| 294 | of these were rejected.
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| 295 | of these still waiting for ack.
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| 296 | Transmit pending invoices...
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| 297 | not transmitted due to exception.
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| 298 | Process Complete.
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| 299 | Process (task) stopped due to user request.
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| 300 | List of Exceptions during Transmit of Pending Invoices
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| 301 | List of Invoices Waiting for Acknowledgement
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| 302 | List of Rejected Invoices that have not been reported.
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| 303 | #################### #################### ####################
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| 304 | #################### #################### ####################
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| 305 | #################### #################### ####################
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| 306 | #################### #################### ####################
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| 307 | #################### #################### ####################
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