English French Notes Complete/Exclude The 'AMOUNT PAID' has been altered on the Fee Payment Voucher Document in FMS for the following payments: >>> For detailed payment information use the appropriate payment output. <<< Payment has been cancelled for the following line items: >>> For detailed check information use the Check Display output. <<< Check Number: Date of Service: Invoice Number: From Date: To Date: for travel on Select Fee Vendor: FEE Program Patient ID: Vendor ID: FEE PROGRAM: ('*' Reimb. to Patient '+' Cancel. Activity '#' Voided Payment) There are no payments on file for for specified date range: and selected Fee Program(s): and ALL Fee programs There are no outpatient payments on file for specified date range and selected Fee programs Primary Dx: Obl.#: FEE PROGRAM: CPT-MOD Voucher Rx: Pat. ID: Vendor: >>> ANCILLARY SERVICE PAYMENTS <<< SERVICE CONNECTED? Primary Service Facility Include (P)atient Co-pays / (I)nsurance / (B)oth Select type of recover to include P - include only recover from patient copays I - include only recover from insurance B - include both Include (M)eans Test Co-pays /(L)TC Co-pays /(B)oth Select services to include M - include only Means Test copays L - include only LTC copays MeansTest There are no potential cost recoveries on file for specified date range: and selected Primary Service Area(s): and ALL Primary Service Areas POTENTIAL COST RECOVERY REPORT Cost recover from insurance. Cost recover from means testing and insurance. Cost recover from LTC co-pay Cost recover from insurance, 1010EC Missing for LTC Patient. Cost Recover from insurance and Potential Cost Recover from LTC co-pay. >>> Cost recover from means testing and insurance Payments for veteran There are no payments to this vendor for this patient. RX # '*' Reimb. to Patient '+' Cancel. Activity '#' Voided Payment >>>Amount paid altered to $ >>>Check cancelled on: Press 'ENTER' to view next selection return to list No check found for this line item. Line item # number on file for this entry MERGE PAIRS EXCLUDED DUE TO BOTH HAVE FEE BASIS ID CARDS MERGE PAIR Patient records both have FB ID card numbers. Please cancel one of the IDs and resubmit the Merge Pair *** DUZ and DUZ(0) must be defined as a valid user to initialize. *** Routine XPDUTL, part of Kernel Tool Kit 7.2 was not found on your system. This must be installed prior to installing this version of Fee Basis. You must have Fee Basis Version 3.0 installed prior to installing version 3.5 CONTRACT HOSPITAL NON-VA HOSPITAL Check your package file for the entry. Unable to determine version. Your version of the must be at least to install this version of FEE. Want to select patient from DHCP Patient File Enter LAST NAME Enter last name of patient. Answer must be 3 to 20 characters in length Enter FIRST INITIAL Enter MIDDLE INITIAL Patient ID Number Answer must contain 9 numbers. Pseudo-SSN not allowed Sex of Patient Want to select a vendor from DHCP Fee Basis Vendor file Vendor must have a Medicare ID number to send to the pricer. Select Vendor Name Enter Medicare ID Number State of Vendor Admitting Authority Disposition Code Is this a Patient Reimbursement Payment by Medicare or Other Federal Agency Must enter at least a primary diagnosis. Billed Charges Amount Claimed Obligation Number Case sent to pricer. Starting Post Init FBPST35 Completed FBPST35 Post-Init FBPST35A has already been run. Beginning FBPST35A.... CONVERSION OF DENIALS FILES Now I will move any Medical Denial information you wish to keep into the Fee Basis Payment File (#162). I will then remove the Fee Basis Medical Denials file (#163) and the Fee Basis Pharmacy Denials file (#163.1). Do you want to keep any Medical Denials that are presently stored in the Fee Basis Medical Denials file (#163) Answering yes will move the denials to file #162, no will delete them You may elect to merge all of your Fee Basis Medical Denials. If you choose not to retain all denials, you will be prompted to select a STARTING DATE to retain denials. Denials from the starting date to the present date will be merged into file #162. Do you wish to retain all Medical Denials Select date to retain denials Beginning merge Deleting the Fee Basis Medical Denials file (#163)... Deleting the Fee Basis Pharmacy Denials file (#163.1)... Cleaning up DD nodes... Completed FBPST35A Unable to complete the FBPST35A Post-Init routine. To complete this process, run ^FBPST35A as soon as possible. Beginning FBPST35B .... CONVERSION OF FEE BASIS FEE SCHEDULE FILE (#163.99) Completed FBPST35B The following vendors with invalid ID's have been placed in delete status: FEE BASIS VENDOR CORRECTIONS CLEANUP FBTEXT( FBPST35C has previously run to completion! Beginning FBPST35C REMOVAL OF FIELDS PREVIOUSLY STARRED FOR DELETION. Do you want me to task this job in the background for you Answerring 'YES' will run the job in the background and send you a bulletin when completed. Answerring 'NO' will run the job now (no bulletin will be sent). Required response! Routine FBPST35 to remove obsolete fields has been tasked. Deleting any data remaining in the obsolete fields. Deleting field # from file # Completed FBPST35C Post initialization routine FBPST35C has run to completion. FEE BASIS POST-INIT COMPLETE Are you finished editing prescriptions on invoice AUTH. NOT ADDED AUTH IS AUSTIN DELETED. USE THE REINSTATE OPTION TO CHANGE IT. (No Editing) OK to DELETE the ERROR. STATE HOME not found in FEE BASIS PROGRAM (#161.8) file. Unable to process State Home authorization. Please contact IRM. ERROR ADDING TO #161 ANOTHER USER IS EDITING THIS PATIENT & PROGRAM. PLEASE TRY AGAIN LATER. Enter FROM DATE: Enter TO DATE: The specified dates conflict with other authorization(s). Please specify different dates for this authorization or remove the conflcit by first editing the other authorization(s). Conflict with FROM DATE PURPOSE OF VISIT **Austin Deleted** - Use Reinstate to reuse this From Date For ALL Purpose of Visits? Y/N Select one or more Purpose of Visits Active Authorizations Report No active authorizations found during period. for POV: TOTAL DAY(S) FOR POV WITHIN REPORT PERIOD: ACTIVE AUTHORIZATIONS by POV, Vendor, Patient TRANSFER TO VA VA(200 Disposition to Cancel/Withdrawn. Use the Delete Unauthorized Claim option. Select a printer device name. NOTE: This is not a pointer field, the exact name must be entered. Printer name: Location: TREATMENT FROM: TREATMENT TO: Cannot delete Authorization because payments already exist! Cannot delete Authorization because a 7078/583 entry has already been established! No data on file. Select the claim which you would like to display < PENDING INFORMATION > < PAYMENTS ON FILE > < ASSOCIATED CLAIMS > Fee Program ASSOCIATED INVOICES Do you wish to edit Do you wish to display return address POTENTIAL DUPLICATES No. Current extension date is Confirm entry of as the new extension date for the claim New extension date is equal to existing extension date. No change made. .02////^S X=DUZ;.03///INCOMPLETE UNAUTHORIZED CLAIM;.04///^S X=FBEXTD ERROR ADDING EXTENSION Vendor information is required for disposition. Patient Type Code is required for disposition. Shall other claims be updated to same veteran & treat. from/to dates Shall all other claims be updated to the disposition & auth. from/to dates Shall all other claims be updated to the auth. from/to dates Shall disapproval reason apply to all other claims Are you sure you wish to delete Shall all of these claims be deleted Deleting claim and associated claims not dispositioned ... Select VETERAN Select FEE VENDOR Is this claim being considered under Millennium Act 38 U.S.C. 1725 (Y/N) Is the unauthorized claim complete for the FEE PROGRAM Checking for potential duplicates... Checking eligibility... Patient is not a veteran. Are you sure you wish to enter a new unauthorized claim ... Deleting incomplete record. An unauthorized claim is considered complete (or valid) if all the necessary information has been received. A claim can never be considered complete if it is missing form 10-583 or form 10-583 is incomplete. Some examples of other items which are needed are: Copies of actual bills Original paid receipt Itemized invoice/UB82 Medical records or signature for release Diagnostic/Procedure code(s) Enter Y(es) if complete, N(o) if incomplete. Enter Y(es) if all required information has been submitted, N(o) if the claim is incomplete. The disposition for the selected claim is At least one other claim in this group has been dispositioned. The existing disposition(s) in the group follow: Would you like this claim to be dispositioned Would you like to change the disposition to another The claim cannot be dispositioned. Patient Type Code is required to disposition the claim. Do you want to specify the Patient Type Code for the claim No Patient Type for master claim. No Patient Type for secondary claim. Master claim doesn't have any Patient Type Code Do you want to enter Patient Type Code for the master claim Master claim has Patient Type Code : Do you want to use the same Patient Type for the secondary claim Unauthorized Claims Dispositioned to 'ABANDONED' Treatment Select the date range within which an unauthorized claim will expire. Unauthorized Mill Bill (1725) NON-Mill Bill Claims Due to Expire between No claims will expire within selected date range. AUTO PRINT UNAUTH CLAIM LETTER Do you wish to reprint letters for a date range Select Yes to reprint letters for a date range; No to reprint a specific letter. Should the expiration date be updated Answer Yes to update the expiration date based upon today's printout, No to only reprint the letter but not change the date when the information is due. Queue to print on: REPRINT UNAUTH CLAIM LETTERS FBARY( BATCH UNAUTH CLAIM LETTERS Enter NUMBER OF COPIES for each letter Print all types of letters Enter YES to print all types of letters. Enter NO to just print letters of one specific type. VENDOR: VETERAN: In Reply Refer To: Reason(s) for not approving SIGNED STATEMENT FROM CLAIMANT REGARDING: EPISODE OF CARE: Authorized from: Authorized to: Amount approved: Itemized list follows: *Reason(s) for Suspension (4) Other. Specific reason immediately follows item. Discharge Date Amt Approved Suspend* Reason for Suspension: Service Date RX Date Drug Name: This claim has other claims associated with it and, therefore, can not be associated to another. Select the unauthorized claim to which this one should be associated: This option will allow you to disassociate a claim. #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### ####################