| [604] | 1 | English French Notes Complete/Exclude
|
|---|
| 2 | Review Status:
|
|---|
| 3 | Insurance Seq:
|
|---|
| 4 | Last Edited :
|
|---|
| 5 | Last Edit By :
|
|---|
| 6 | New Pat. Nm.:
|
|---|
| 7 | New Pat. Id :
|
|---|
| 8 | PAYER INFORMATION:
|
|---|
| 9 | Payer Name :
|
|---|
| 10 | Payer Id :
|
|---|
| 11 | ICN :
|
|---|
| 12 | Cross Ovr ID :
|
|---|
| 13 | Cross Ovr Nm:
|
|---|
| 14 | CLAIM LEVEL PAY STATUS:
|
|---|
| 15 | Tot Submitted Chrg:
|
|---|
| 16 | Covered Amt :
|
|---|
| 17 | Payer Paid Amt :
|
|---|
| 18 | Patient Resp. Amt :
|
|---|
| 19 | Discount Amt :
|
|---|
| 20 | Per Day Limit Amt :
|
|---|
| 21 | Tax Amt :
|
|---|
| 22 | Tot Before Tax Amt:
|
|---|
| 23 | Total Allowed Amt :
|
|---|
| 24 | Negative Reimb Amt:
|
|---|
| 25 | Discharge Fraction:
|
|---|
| 26 | DRG Code Used :
|
|---|
| 27 | DRG Weight Used :
|
|---|
| 28 | Reimburse Rate :
|
|---|
| 29 | HCPCS Pay Amt :
|
|---|
| 30 | Esrd Paid Amt :
|
|---|
| 31 | Non-Pay Prof Comp :
|
|---|
| 32 | CLAIM LEVEL ADJUSTMENTS:
|
|---|
| 33 | GROUP CODE:
|
|---|
| 34 | REASON CODE:
|
|---|
| 35 | REVIEW DATA:
|
|---|
| 36 | REVIEW DATE/TIME:
|
|---|
| 37 | **A/R CORRECTED PAYMENT DATA:
|
|---|
| 38 | TOTAL AMT PD:
|
|---|
| 39 | N-ALL INSURED PT RELATION
|
|---|
| 40 | Pt. Relation :
|
|---|
| 41 | N-ALL INSURED FULL NAMES
|
|---|
| 42 | Insured Name:
|
|---|
| 43 | N-ALL INSURANCE NUMBER
|
|---|
| 44 | Insured ID
|
|---|
| 45 | FLD NAME
|
|---|
| 46 | Invalid entry #
|
|---|
| 47 | Field not found!!
|
|---|
| 48 | N-STATEMENT COVERS FROM DATE
|
|---|
| 49 | DIC(81.3
|
|---|
| 50 | N-UB92 LOCATION OF CARE
|
|---|
| 51 | N-UB92 BILL CLASSIFICATION
|
|---|
| 52 | N-UB92 TIMEFRAME OF BILL
|
|---|
| 53 | LM-UB
|
|---|
| 54 | Warning:** REV CODE UNITS < #PROCEDURES, THEY MUST BE =
|
|---|
| 55 | Warning:** REV CODE UNITS > #PROCEDURES, THEY MUST BE=:
|
|---|
| 56 | Rx#
|
|---|
| 57 | RX:
|
|---|
| 58 | NDC:
|
|---|
| 59 | NOC:
|
|---|
| 60 | **** ERROR - NO PROC LINK TO REV CODE FOR DRUG: RX#:
|
|---|
| 61 | DX-E
|
|---|
| 62 | OFFSET AMOUNT:
|
|---|
| 63 | Prosthetic:
|
|---|
| 64 | RX-UB92
|
|---|
| 65 | PRESCRIPTION REFILLS:
|
|---|
| 66 | days supply
|
|---|
| 67 | NDC #:
|
|---|
| 68 | PROS-UB92
|
|---|
| 69 | PROSTHETIC REFILLS:
|
|---|
| 70 | NON-SERV
|
|---|
| 71 | FILE LOCKED ... TRY AGAIN LATER
|
|---|
| 72 | New Rule's TYPE OF RULE:
|
|---|
| 73 | YOU ARE ADDING A RULE THAT WILL ONLY ALLOW THE TRANSMISSION OF BILLS WHOSE
|
|---|
| 74 | FORM TYPE IS INCLUDED IN THIS RULE.
|
|---|
| 75 | New Rule's TRANSMISSION TYPE:
|
|---|
| 76 | APPLY RULE ONLY TO BILLS THAT ARE (I)NSTITUTIONAL, (P)ROFESSIONAL, OR (B)OTH:
|
|---|
| 77 | ONLY TRANSMIT (I)NSTITUTIONAL, (P)ROFESSIONAL, OR (B)OTH:
|
|---|
| 78 | APPLY RULE ONLY TO BILLS THAT ARE (I)NPATIENT, (O)UTPATIENT, OR (B)OTH:
|
|---|
| 79 | THIS RULE WILL ONLY APPLY TO BILLS THAT MATCH ALL OF THE FOLLOWING CONDITIONS:
|
|---|
| 80 | BILL IS
|
|---|
| 81 | AN
|
|---|
| 82 | EITHER AN EDI OR MRA
|
|---|
| 83 | BILL AND IS ALSO
|
|---|
| 84 | AN INSTITUTIONAL^A PROFESSIONAL
|
|---|
| 85 | EITHER A PROFESSIONAL OR INSTITUTIONAL
|
|---|
| 86 | AND
|
|---|
| 87 | IS ALSO AN
|
|---|
| 88 | IS EITHER AN INPATIENT OR OUTPATIENT
|
|---|
| 89 | NOTE: RULE WILL BE IGNORED FOR ANY BILLS THAT DO NOT MATCH ALL THE CONDITIONS
|
|---|
| 90 | BILL IS AN MRA BILL
|
|---|
| 91 | AND IS ALSO
|
|---|
| 92 | AND ALSO HAS A NEXT INSURANCE THAT HAS BEEN INCLUDED IN THE
|
|---|
| 93 | 'INSURANCE COMPANIES INCLUDED' LIST FOR THIS RULE.
|
|---|
| 94 | NOTE: THIS RULE WILL BE IGNORED FOR ANY BILL THAT DOES NOT MATCH
|
|---|
| 95 | ALL OF THESE CONDITIONS.
|
|---|
| 96 | THE EFFECT OF THIS RULE WILL BE: IF A BILL MATCHES ALL OF THE ABOVE CONDITIONS,
|
|---|
| 97 | THE REQUEST AND RECEIPT OF AN MRA WILL NOT BE ALLOWED.
|
|---|
| 98 | IS THIS CORRECT?
|
|---|
| 99 | THE RULE WILL BE APPLIED AND THE BILL WILL NOT BE TRANSMITTED IF:
|
|---|
| 100 | - THE RULE APPLIES TO ALL INSURANCE COMPANIES
|
|---|
| 101 | - THE RULE 'APPLIES TO' ONLY SPECIFIC INSURANCE COMPANIES AND THE BILL'S
|
|---|
| 102 | INSURANCE COMPANY APPEARS ON THE RULE'S 'INCLUDE LIST'
|
|---|
| 103 | - THE RULE 'EXCLUDES' SPECIFIC INSURANCE COMPANIES AND THE BILL'S
|
|---|
| 104 | INSURANCE COMPANY DOES NOT APPEAR ON THE RULE'S 'EXCLUDE LIST'
|
|---|
| 105 | - THE RULE HAS NO BILL TYPE RESTRICTIONS OR APPLIES TO ALL BILL TYPES
|
|---|
| 106 | - THE RULE IS RESTRICTED TO CERTAIN BILL TYPES AND THE BILL'S BILL TYPE IS
|
|---|
| 107 | INCLUDED FOR THE RULE OR IS NOT EXCLUDED FOR THE RULE
|
|---|
| 108 | NEXT
|
|---|
| 109 | BILL TYPE
|
|---|
| 110 | TO EXCLUDE
|
|---|
| 111 | Enter the bill types to include/exclude. To include, enter the
|
|---|
| 112 | 3 digit bill type. To exclude, precede the 3 digit bill type with a minus (-)
|
|---|
| 113 | You may use 'X' as a wild card. Use XXX to include all bill types.
|
|---|
| 114 | If XXX is entered, the rest of the entries must be bill type exclusions.
|
|---|
| 115 | The current bill types entered for this rule are:
|
|---|
| 116 | ALL BILL TYPES INCLUDED - ONLY EXCLUSIONS ALLOWED NOW
|
|---|
| 117 | Warning ... this rule will not work unless you enter at least one bill type
|
|---|
| 118 | Timed out or '^' entered ... bill types not added
|
|---|
| 119 | INSURANCE CO OPTION:
|
|---|
| 120 | Select Insurance Co to
|
|---|
| 121 | clude for this rule:
|
|---|
| 122 | Entries deleted!
|
|---|
| 123 | Warning ... no insurance companies entered
|
|---|
| 124 | Cannot add this bill type restrictions because:
|
|---|
| 125 | In order to exclude, you must include at least one bill type including the
|
|---|
| 126 | excluded bill type first
|
|---|
| 127 | You already have 'XXX' (all bill types) - can only EXCLUDE bill types now
|
|---|
| 128 | You have already entered this bill type
|
|---|
| 129 | You have included and excluded the same bill type
|
|---|
| 130 | * WARNING - MAKING CHANGES TO THE TRANSMISSION *
|
|---|
| 131 | * RULES USING THIS OPTION CAN SERIOUSLY AFFECT THE *
|
|---|
| 132 | * SITE'S ABILITY TO BILL. BE EXTREMELY CAUTIOUS *
|
|---|
| 133 | * WHEN USING THIS OPTION. *
|
|---|
| 134 | IBCE RULES
|
|---|
| 135 | FORM TRANSMIT INSURANCE RULE
|
|---|
| 136 | # TYPE TYPE OPTION NUM SHORT DESCRIPTION
|
|---|
| 137 | ACTIVE DATE INACTIVE DATE
|
|---|
| 138 | IBCE-RULE
|
|---|
| 139 | IBCE-RULEDX
|
|---|
| 140 | EDI ONLY
|
|---|
| 141 | MRA ONLY
|
|---|
| 142 | BOTH EDI/MRA
|
|---|
| 143 | Rule #'s followed by an * are currently inactive
|
|---|
| 144 | Only currently active rules are displayed
|
|---|
| 145 | Transmission Rules Found
|
|---|
| 146 | RULE TYPE '
|
|---|
| 147 | ' DOES NOT ALLOW BILL TYPE RESTRICTIONS
|
|---|
| 148 | PRESS RETURN
|
|---|
| 149 | IBCE-BTDX
|
|---|
| 150 | Bill Type Restriction #
|
|---|
| 151 | IBCE-BT
|
|---|
| 152 | Warning ... no insurance companies chosen to
|
|---|
| 153 | @RULE NUMBER
|
|---|
| 154 | TRANSMISSION RULE(s) HAVE BEEN SUCCESSFULLY FILED
|
|---|
| 155 | NO TRANSMISSION RULES ADDED
|
|---|
| 156 | CANNOT BE AFTER RULE'S INACTIVE DATE OF
|
|---|
| 157 | CANNOT BE BEFORE RULE'S ACTIVE DATE OF
|
|---|
| 158 | MUST BE PRIOR TO BILL TYPE'S INACTIVE DATE OF
|
|---|
| 159 | MUST BE AFTER BILL TYPE'S ACTIVE DATE OF
|
|---|
| 160 | CHANGE WOULD INVALIDATE BILL TYPE RESTRICTION DATE
|
|---|
| 161 | IBCE RULE BT RESTRICT
|
|---|
| 162 | BILL TYPE RESTRICTIONS FOR RULE #
|
|---|
| 163 | Transmit type:
|
|---|
| 164 | EDI
|
|---|
| 165 | MRA
|
|---|
| 166 | Form Type :
|
|---|
| 167 | Ins Co Option:
|
|---|
| 168 | ALL
|
|---|
| 169 | Active Date :
|
|---|
| 170 | Inactive Date:
|
|---|
| 171 | No Bill Type Restrictions Found
|
|---|
| 172 | THE BILL TYPE RESTRICTION(S) WAS/WERE DELETED
|
|---|
| 173 | Bill type
|
|---|
| 174 | not deleted - deleting
|
|---|
| 175 | this restriction
|
|---|
| 176 | these restrictions
|
|---|
| 177 | would cause an inconsistency
|
|---|
| 178 | Press return:
|
|---|
| 179 | Missing Parameters
|
|---|
| 180 | No base file found for form
|
|---|
| 181 | No data found for required field
|
|---|
| 182 | Max # lines or occurrences exceeded (
|
|---|
| 183 | BILL-SEARCH
|
|---|
| 184 | FILEMAN FIELD:
|
|---|
| 185 | NOT A PRINTABLE FORM!!
|
|---|
| 186 | BILL DOES NOT EXIST
|
|---|
| 187 | DEPT VETERANS AFFAIRS
|
|---|
| 188 | VETERANS AFFAIRS,DEPT
|
|---|
| 189 | IBCE LOCAL FORMS LIST
|
|---|
| 190 | No Local Forms Currently On File
|
|---|
| 191 | Form Number:
|
|---|
| 192 | Base File :
|
|---|
| 193 | Format Type:
|
|---|
| 194 | Form Length:
|
|---|
| 195 | Associated With National Form:
|
|---|
| 196 | Entry Pre-processor :
|
|---|
| 197 | (defined for associated 'parent' form)
|
|---|
| 198 | Entry Post-processor:
|
|---|
| 199 | Form Pre-processor :
|
|---|
| 200 | Form Post-processor :
|
|---|
| 201 | Output Logic :
|
|---|
| 202 | (Use formatter default)
|
|---|
| 203 | Extract Logic :
|
|---|
| 204 | LOCAL FORM:
|
|---|
| 205 | Enter a new LOCAL FORM NAME:
|
|---|
| 206 | Enter the name that you want your new local form to be referenced by
|
|---|
| 207 | Enter form number (must be > 9999):
|
|---|
| 208 | Enter the internal entry number that will be assigned to this form
|
|---|
| 209 | Another user has taken this number ... please select a new one.
|
|---|
| 210 | MUST HAVE A BASE FILE!!
|
|---|
| 211 | MUST HAVE A FORMAT TYPE!!
|
|---|
| 212 | WANT TO ASSOCIATE THIS FORM WITH A NATIONAL FORM
|
|---|
| 213 | FORM NOT ASSOCIATED WITH ANY NATIONAL FORM
|
|---|
| 214 | WANT TO COPY ALL FIELDS FROM AN EXISTING FORM
|
|---|
| 215 | Select FORM TO COPY FROM:
|
|---|
| 216 | ARE YOU SURE YOU WANT TO MAKE THIS COPY
|
|---|
| 217 | This may take a little while ... please be patient while I build your new form
|
|---|
| 218 | Field copy completed -
|
|---|
| 219 | fields copied
|
|---|
| 220 | IBCE FORM FIELDS LIST
|
|---|
| 221 | Exit option entirely
|
|---|
| 222 | A form with this name already exists
|
|---|
| 223 | A form with this number already exists
|
|---|
| 224 | Select LOCAL DATA ELEMENT Name:
|
|---|
| 225 | ONLY NATIONAL FIELDS CAN BEGIN WITH 'N-'
|
|---|
| 226 | Are you sure you want to DELETE LOCAL FORM -
|
|---|
| 227 | If you choose to delete this form, the form's field content definitions will also be deleted
|
|---|
| 228 | No Fields Currently Defined For Form
|
|---|
| 229 | Bill Form:
|
|---|
| 230 | Associated With Nat. Form:
|
|---|
| 231 | Not Associated With A National Form
|
|---|
| 232 | OVERRIDE AN EXISTING FIELD
|
|---|
| 233 | Can Only Over-ride a NATIONAL form field
|
|---|
| 234 | Can't Over-ride a form field that is an over-ride itself
|
|---|
| 235 | Form field definition will not allow override
|
|---|
| 236 | Over-riding Form Field #
|
|---|
| 237 | IS THIS OK
|
|---|
| 238 | COPY OVER THE DATA ELEMENT AND OUTPUT FORMAT FROM THE ORIGINAL FLD
|
|---|
| 239 | MUST HAVE A PAGE/SEQ
|
|---|
| 240 | MUST HAVE A FIRST LINE #
|
|---|
| 241 | MUST HAVE A STARTING COLUMN
|
|---|
| 242 | Form field: (#
|
|---|
| 243 | is a NATIONAL form field
|
|---|
| 244 | EDIT A NATIONAL FIELD FROM
|
|---|
| 245 | FORM FIELD
|
|---|
| 246 | 'S CONTENT DEFINITION NOW
|
|---|
| 247 | ...Please define CONTENT of field...
|
|---|
| 248 | Definition of Form Field: (#
|
|---|
| 249 | Defining content of form field: (#
|
|---|
| 250 | Select a DATA ELEMENT:
|
|---|
| 251 | FORM FIELD #:
|
|---|
| 252 | YOU CANNOT
|
|---|
| 253 | A NATIONALLY ASSOCIATED LOCAL FORM
|
|---|
| 254 | - REDEFINE THE FIELD'S CONTENT BY USING A LOCAL FORM FIELD TO OVERRIDE
|
|---|
| 255 | DELETE NATIONAL FIELDS FROM
|
|---|
| 256 | Can't delete this field until all fields associated with it are deleted
|
|---|
| 257 | If you delete this form field, its content definition will
|
|---|
| 258 | also be deleted
|
|---|
| 259 | Form Field #
|
|---|
| 260 | The following problem
|
|---|
| 261 | exist for this definition:
|
|---|
| 262 | * DATA ELEMENT
|
|---|
| 263 | OR SCREEN PROMPT
|
|---|
| 264 | FOR FIELD IS MISSING - NO DATA WILL BE OUTPUT
|
|---|
| 265 | * MORE THAN ONE OVERRIDE FLD DEFINITION EXISTS FOR THE ASSOC FIELD FOR:
|
|---|
| 266 | INS CO:
|
|---|
| 267 | BILL TYPE:
|
|---|
| 268 | WANT TO RE-EDIT THIS RECORD NOW?
|
|---|
| 269 | Form Field:
|
|---|
| 270 | First Line:
|
|---|
| 271 | Col/Pc:
|
|---|
| 272 | Pad:
|
|---|
| 273 | Bill Type:
|
|---|
| 274 | Data Element:
|
|---|
| 275 | Scrn Prompt:
|
|---|
| 276 | Edit Status:
|
|---|
| 277 | Fileman Fld:
|
|---|
| 278 | Constant Val:
|
|---|
| 279 | Extract Code:
|
|---|
| 280 | Format Code:
|
|---|
| 281 | National/Loc:
|
|---|
| 282 | Base File:
|
|---|
| 283 | OUTPUT FORMATTER - FORM:
|
|---|
| 284 | OUTPUT FORMATTER:
|
|---|
| 285 | Output Device:
|
|---|
| 286 | PRINT FORM:
|
|---|
| 287 | Do you want to queue this transmission
|
|---|
| 288 | Do you want to run this job without queuing it now
|
|---|
| 289 | Please enter the date and time to execute this job...
|
|---|
| 290 | <RET> or '^' to QUIT or 1-
|
|---|
| 291 | to EDIT:
|
|---|
| 292 | delimiters. The elements that are editable are assigned a group number
|
|---|
| 293 | enclosed in brackets
|
|---|
| 294 | while those without group numbers are not.
|
|---|
| 295 | PRESS <RETURN> KEY to RETURN to SCREEN
|
|---|
| 296 | Send transmission to your mailbox
|
|---|
| 297 | Enter a mail queue name:
|
|---|
| 298 | This is the mailman queue where the formatted test record should be sent
|
|---|
| 299 | Message
|
|---|
| 300 | is no longer in return message file
|
|---|
| 301 | This message has already been scheduled for update. Task # is:
|
|---|
| 302 | Message status (
|
|---|
| 303 | #################### #################### ####################
|
|---|
| 304 | #################### #################### ####################
|
|---|
| 305 | #################### #################### ####################
|
|---|
| 306 | #################### #################### ####################
|
|---|
| 307 | #################### #################### ####################
|
|---|
