English French Notes Complete/Exclude Review Status: Insurance Seq: Last Edited : Last Edit By : New Pat. Nm.: New Pat. Id : PAYER INFORMATION: Payer Name : Payer Id : ICN : Cross Ovr ID : Cross Ovr Nm: CLAIM LEVEL PAY STATUS: Tot Submitted Chrg: Covered Amt : Payer Paid Amt : Patient Resp. Amt : Discount Amt : Per Day Limit Amt : Tax Amt : Tot Before Tax Amt: Total Allowed Amt : Negative Reimb Amt: Discharge Fraction: DRG Code Used : DRG Weight Used : Reimburse Rate : HCPCS Pay Amt : Esrd Paid Amt : Non-Pay Prof Comp : CLAIM LEVEL ADJUSTMENTS: GROUP CODE: REASON CODE: REVIEW DATA: REVIEW DATE/TIME: **A/R CORRECTED PAYMENT DATA: TOTAL AMT PD: N-ALL INSURED PT RELATION Pt. Relation : N-ALL INSURED FULL NAMES Insured Name: N-ALL INSURANCE NUMBER Insured ID FLD NAME Invalid entry # Field not found!! N-STATEMENT COVERS FROM DATE DIC(81.3 N-UB92 LOCATION OF CARE N-UB92 BILL CLASSIFICATION N-UB92 TIMEFRAME OF BILL LM-UB Warning:** REV CODE UNITS < #PROCEDURES, THEY MUST BE = Warning:** REV CODE UNITS > #PROCEDURES, THEY MUST BE=: Rx# RX: NDC: NOC: **** ERROR - NO PROC LINK TO REV CODE FOR DRUG: RX#: DX-E OFFSET AMOUNT: Prosthetic: RX-UB92 PRESCRIPTION REFILLS: days supply NDC #: PROS-UB92 PROSTHETIC REFILLS: NON-SERV FILE LOCKED ... TRY AGAIN LATER New Rule's TYPE OF RULE: YOU ARE ADDING A RULE THAT WILL ONLY ALLOW THE TRANSMISSION OF BILLS WHOSE FORM TYPE IS INCLUDED IN THIS RULE. New Rule's TRANSMISSION TYPE: APPLY RULE ONLY TO BILLS THAT ARE (I)NSTITUTIONAL, (P)ROFESSIONAL, OR (B)OTH: ONLY TRANSMIT (I)NSTITUTIONAL, (P)ROFESSIONAL, OR (B)OTH: APPLY RULE ONLY TO BILLS THAT ARE (I)NPATIENT, (O)UTPATIENT, OR (B)OTH: THIS RULE WILL ONLY APPLY TO BILLS THAT MATCH ALL OF THE FOLLOWING CONDITIONS: BILL IS AN EITHER AN EDI OR MRA BILL AND IS ALSO AN INSTITUTIONAL^A PROFESSIONAL EITHER A PROFESSIONAL OR INSTITUTIONAL AND IS ALSO AN IS EITHER AN INPATIENT OR OUTPATIENT NOTE: RULE WILL BE IGNORED FOR ANY BILLS THAT DO NOT MATCH ALL THE CONDITIONS BILL IS AN MRA BILL AND IS ALSO AND ALSO HAS A NEXT INSURANCE THAT HAS BEEN INCLUDED IN THE 'INSURANCE COMPANIES INCLUDED' LIST FOR THIS RULE. NOTE: THIS RULE WILL BE IGNORED FOR ANY BILL THAT DOES NOT MATCH ALL OF THESE CONDITIONS. THE EFFECT OF THIS RULE WILL BE: IF A BILL MATCHES ALL OF THE ABOVE CONDITIONS, THE REQUEST AND RECEIPT OF AN MRA WILL NOT BE ALLOWED. IS THIS CORRECT? THE RULE WILL BE APPLIED AND THE BILL WILL NOT BE TRANSMITTED IF: - THE RULE APPLIES TO ALL INSURANCE COMPANIES - THE RULE 'APPLIES TO' ONLY SPECIFIC INSURANCE COMPANIES AND THE BILL'S INSURANCE COMPANY APPEARS ON THE RULE'S 'INCLUDE LIST' - THE RULE 'EXCLUDES' SPECIFIC INSURANCE COMPANIES AND THE BILL'S INSURANCE COMPANY DOES NOT APPEAR ON THE RULE'S 'EXCLUDE LIST' - THE RULE HAS NO BILL TYPE RESTRICTIONS OR APPLIES TO ALL BILL TYPES - THE RULE IS RESTRICTED TO CERTAIN BILL TYPES AND THE BILL'S BILL TYPE IS INCLUDED FOR THE RULE OR IS NOT EXCLUDED FOR THE RULE NEXT BILL TYPE TO EXCLUDE Enter the bill types to include/exclude. To include, enter the 3 digit bill type. To exclude, precede the 3 digit bill type with a minus (-) You may use 'X' as a wild card. Use XXX to include all bill types. If XXX is entered, the rest of the entries must be bill type exclusions. The current bill types entered for this rule are: ALL BILL TYPES INCLUDED - ONLY EXCLUSIONS ALLOWED NOW Warning ... this rule will not work unless you enter at least one bill type Timed out or '^' entered ... bill types not added INSURANCE CO OPTION: Select Insurance Co to clude for this rule: Entries deleted! Warning ... no insurance companies entered Cannot add this bill type restrictions because: In order to exclude, you must include at least one bill type including the excluded bill type first You already have 'XXX' (all bill types) - can only EXCLUDE bill types now You have already entered this bill type You have included and excluded the same bill type * WARNING - MAKING CHANGES TO THE TRANSMISSION * * RULES USING THIS OPTION CAN SERIOUSLY AFFECT THE * * SITE'S ABILITY TO BILL. BE EXTREMELY CAUTIOUS * * WHEN USING THIS OPTION. * IBCE RULES FORM TRANSMIT INSURANCE RULE # TYPE TYPE OPTION NUM SHORT DESCRIPTION ACTIVE DATE INACTIVE DATE IBCE-RULE IBCE-RULEDX EDI ONLY MRA ONLY BOTH EDI/MRA Rule #'s followed by an * are currently inactive Only currently active rules are displayed Transmission Rules Found RULE TYPE ' ' DOES NOT ALLOW BILL TYPE RESTRICTIONS PRESS RETURN IBCE-BTDX Bill Type Restriction # IBCE-BT Warning ... no insurance companies chosen to @RULE NUMBER TRANSMISSION RULE(s) HAVE BEEN SUCCESSFULLY FILED NO TRANSMISSION RULES ADDED CANNOT BE AFTER RULE'S INACTIVE DATE OF CANNOT BE BEFORE RULE'S ACTIVE DATE OF MUST BE PRIOR TO BILL TYPE'S INACTIVE DATE OF MUST BE AFTER BILL TYPE'S ACTIVE DATE OF CHANGE WOULD INVALIDATE BILL TYPE RESTRICTION DATE IBCE RULE BT RESTRICT BILL TYPE RESTRICTIONS FOR RULE # Transmit type: EDI MRA Form Type : Ins Co Option: ALL Active Date : Inactive Date: No Bill Type Restrictions Found THE BILL TYPE RESTRICTION(S) WAS/WERE DELETED Bill type not deleted - deleting this restriction these restrictions would cause an inconsistency Press return: Missing Parameters No base file found for form No data found for required field Max # lines or occurrences exceeded ( BILL-SEARCH FILEMAN FIELD: NOT A PRINTABLE FORM!! BILL DOES NOT EXIST DEPT VETERANS AFFAIRS VETERANS AFFAIRS,DEPT IBCE LOCAL FORMS LIST No Local Forms Currently On File Form Number: Base File : Format Type: Form Length: Associated With National Form: Entry Pre-processor : (defined for associated 'parent' form) Entry Post-processor: Form Pre-processor : Form Post-processor : Output Logic : (Use formatter default) Extract Logic : LOCAL FORM: Enter a new LOCAL FORM NAME: Enter the name that you want your new local form to be referenced by Enter form number (must be > 9999): Enter the internal entry number that will be assigned to this form Another user has taken this number ... please select a new one. MUST HAVE A BASE FILE!! MUST HAVE A FORMAT TYPE!! WANT TO ASSOCIATE THIS FORM WITH A NATIONAL FORM FORM NOT ASSOCIATED WITH ANY NATIONAL FORM WANT TO COPY ALL FIELDS FROM AN EXISTING FORM Select FORM TO COPY FROM: ARE YOU SURE YOU WANT TO MAKE THIS COPY This may take a little while ... please be patient while I build your new form Field copy completed - fields copied IBCE FORM FIELDS LIST Exit option entirely A form with this name already exists A form with this number already exists Select LOCAL DATA ELEMENT Name: ONLY NATIONAL FIELDS CAN BEGIN WITH 'N-' Are you sure you want to DELETE LOCAL FORM - If you choose to delete this form, the form's field content definitions will also be deleted No Fields Currently Defined For Form Bill Form: Associated With Nat. Form: Not Associated With A National Form OVERRIDE AN EXISTING FIELD Can Only Over-ride a NATIONAL form field Can't Over-ride a form field that is an over-ride itself Form field definition will not allow override Over-riding Form Field # IS THIS OK COPY OVER THE DATA ELEMENT AND OUTPUT FORMAT FROM THE ORIGINAL FLD MUST HAVE A PAGE/SEQ MUST HAVE A FIRST LINE # MUST HAVE A STARTING COLUMN Form field: (# is a NATIONAL form field EDIT A NATIONAL FIELD FROM FORM FIELD 'S CONTENT DEFINITION NOW ...Please define CONTENT of field... Definition of Form Field: (# Defining content of form field: (# Select a DATA ELEMENT: FORM FIELD #: YOU CANNOT A NATIONALLY ASSOCIATED LOCAL FORM - REDEFINE THE FIELD'S CONTENT BY USING A LOCAL FORM FIELD TO OVERRIDE DELETE NATIONAL FIELDS FROM Can't delete this field until all fields associated with it are deleted If you delete this form field, its content definition will also be deleted Form Field # The following problem exist for this definition: * DATA ELEMENT OR SCREEN PROMPT FOR FIELD IS MISSING - NO DATA WILL BE OUTPUT * MORE THAN ONE OVERRIDE FLD DEFINITION EXISTS FOR THE ASSOC FIELD FOR: INS CO: BILL TYPE: WANT TO RE-EDIT THIS RECORD NOW? Form Field: First Line: Col/Pc: Pad: Bill Type: Data Element: Scrn Prompt: Edit Status: Fileman Fld: Constant Val: Extract Code: Format Code: National/Loc: Base File: OUTPUT FORMATTER - FORM: OUTPUT FORMATTER: Output Device: PRINT FORM: Do you want to queue this transmission Do you want to run this job without queuing it now Please enter the date and time to execute this job... or '^' to QUIT or 1- to EDIT: delimiters. The elements that are editable are assigned a group number enclosed in brackets while those without group numbers are not. PRESS KEY to RETURN to SCREEN Send transmission to your mailbox Enter a mail queue name: This is the mailman queue where the formatted test record should be sent Message is no longer in return message file This message has already been scheduled for update. Task # is: Message status ( #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### ####################