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