[604] | 1 | English French Notes Complete/Exclude
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| 2 | WAITING SINCE
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| 3 | MAIL MESSAGE #
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| 4 | MINIMUM # OF DAYS MSGS WAITING TO BE FILED:
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| 5 | Enter the minimum number of days a message has been waiting to be filed
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| 6 | before it appears on this report
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| 7 | REPORT OF EDI MSGS PENDING TOO LONG TO BE FILED
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| 8 | TOTAL # OF MESSAGES WAITING OVER
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| 9 | TO BE FILED:
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| 10 | EDI MESSAGES WAITING TO BE FILED OVER
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| 11 | MESSAGE TYPE
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| 12 | IN CURRENT
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| 13 | MESSAGE #
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| 14 | STATUS SINCE
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| 15 | DO YOU WANT TO INCLUDE A LIST OF BILLS WITH EACH BATCH?:
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| 16 | Enter the first 10-digit batch number you want included on the report
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| 17 | Start with BATCH #:
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| 18 | Must enter a 10-digit batch #
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| 19 | Enter the last 10-digit batch number you want included on the report
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| 20 | Go to BATCH #:
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| 21 | Enter the first date you want to include on the report
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| 22 | Start with LAST TRANSMIT DATE:
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| 23 | Must enter a valid date
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| 24 | Enter the last date you want to include on the report
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| 25 | Go to LAST TRANSMIT DATE:
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| 26 | Select BATCH STATUS:
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| 27 | EDI 837 BATCH DETAIL LIST
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| 28 | Rejected?:
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| 29 | Resubmit:
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| 30 | Batch Type :
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| 31 | Mail Msg:
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| 32 | Received in Austin?:
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| 33 | Status Date:
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| 34 | Date Recorded:
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| 35 | First Sent :
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| 36 | Last Sent :
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| 37 | Number Transmit Status Resubmit Batch #
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| 38 | * = NOT RESUBMITTED
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| 39 | Number Transmit Status
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| 40 | Resubmit Batch #
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| 41 | BATCH DETAIL LIST
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| 42 | This report provides a list of claims held in a
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| 43 | Ready for Extract status. Users can select all bills
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| 44 | in a Ready for extract status or only those trapped due to
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| 45 | the EDI Parameters being turned off.
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| 46 | This report requires a 132 column printer.
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| 47 | IB - EDI Claims in Waiting Transmission Status
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| 48 | Your task number
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| 49 | has been queued.
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| 50 | There are no EDI records
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| 51 | in a ready for extract status
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| 52 | Total EDI Bills
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| 53 | Total MRA Bills
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| 54 | Total bills
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| 55 | Your EDI site parameter setting is incomplete.
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| 56 | Please contact your coordinator.
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| 57 | Your site parameters are set to allow EDI transmissions
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| 58 | There is no need to run this report.
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| 59 | Trapped
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| 60 | Claims Ready for Extract
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| 61 | Inpt/
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| 62 | Inst/
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| 63 | Opt
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| 64 | Prof
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| 65 | Statement Date
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| 66 | Do you want to print a list of:
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| 67 | 1 - All bills in Ready for Extract status
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| 68 | 2 - Bills trapped due to EDI paramater being turned off
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| 69 | IB - EDI/MRA Claims in Rescue Process
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| 70 | There are no records to print
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| 71 | Claims in Rescue Process
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| 72 | Stmt Date
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| 73 | Ins Co.
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| 74 | IB-HOLD
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| 75 | IBCE ELEC REPORT DISP
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| 76 | IBREP DISP
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| 77 | IBREP DISP1
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| 78 | No reports available for dispositioning
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| 79 | REPORT:
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| 80 | RACUBOTH RUCH
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| 81 | EDI RETURN MESSAGE ROUTER ERROR
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| 82 | Return Message Code:
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| 83 | Return Message Date:
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| 84 | Message Time:
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| 85 | Update Date:
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| 86 | Update Time:
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| 87 | Return Message File #(s):
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| 88 | Mailman Message #:
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| 89 | cannot be determined
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| 90 | Msg Line:
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| 91 | Return Message Text:
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| 92 | ERROR+
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| 93 | S.IBCE MESSAGES SERVER
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| 94 | *** NEW PAGE ***
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| 95 | *** END OF PAGE ***
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| 96 | I:G.IB EDI SUPERVISOR
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| 97 | Status message received for batch
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| 98 | PAYID=
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| 99 | PAYER ID RETURNED IS DIFFERENT THAN PAYER ID ON FILE
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| 100 | BILL # :
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| 101 | PAYER :
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| 102 | BILL TYPE :
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| 103 | ID ON FILE :
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| 104 | ID RETURNED:
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| 105 | Please determine which id number is correct and correct the id in the
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| 106 | insurance file for this payer, if needed
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| 107 | ALREADY EXISTS - CAN'T HAVE BOTH ON ONE BILL
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| 108 | IBA(355.93
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| 109 | N-CURRENT INS POLICY TYPE
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| 110 | Another user has locked this record - try again later
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| 111 | ONLY SELECT TO CLOSE THE TRANSMIT RECORDS IF YOU KNOW THESE ARE THE FINAL
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| 112 | ELECTRONIC MESSAGES YOU WILL RECEIVE FOR ALL THE BILLS REFERENCED BY
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| 113 | THESE MESSAGES
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| 114 | DO YOU WANT TO AUTOMATICALLY CLOSE THE TRANSMIT RECORDS FOR ANY MESSAGES
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| 115 | THAT AREN'T REJECTS?:
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| 116 | DO YOU WANT TO SEE EACH MESSAGE BEFORE MARKING IT REVIEWED?:
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| 117 | IF YOU OPT TO SEE EACH MESSAGE, YOU CAN CONTROL WHETHER OR NOT THE MESSAGE
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| 118 | IS MARKED AS REVIEWED
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| 119 | AND, FOR NON-REJECTS, WHETHER OR NOT TO CLOSE THE
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| 120 | TRANSMIT RECORD FOR THE BILL
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| 121 | OK TO MARK REVIEWED?:
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| 122 | IF YOU ENTER YES, THIS MESSAGE WILL BE MARKED REVIEWED
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| 123 | IF YOU ENTER NO, THIS MESSAGE WILL NOT BE ALTERED
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| 124 | IF YOU ENTER AN ^, THIS MESSAGE WILL NOT BE ALTERED & NONE OF THE
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| 125 | REMAINING MESSAGES WILL BE PROCESSED
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| 126 | OK TO CLOSE THIS BILL'S TRANSMIT RECORD?:
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| 127 | THIS IS A REJECTION ... ARE YOU SURE YOU WANT TO MARK IT REVIEWED?:
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| 128 | MESSAGES FOLLOWING THIS ONE WILL BE PROCESSED
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| 129 | CLAIM SENT TO PAYER
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| 130 | CLAIM REJECTED
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| 131 | Seq #:
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| 132 | Bill number:
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| 133 | LAST SELECTION PROCESSED
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| 134 | N-PRIOR PAYMENTS
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| 135 | PRINT CENTER
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| 136 | N-PATIENT STATUS
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| 137 | N-SOURCE OF ADMISSION
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| 138 | N-OTH INSURANCE PRIOR PAYMENT
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| 139 | N-EOB ENTRIES
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| 140 | Adding occurrence code 24 and primary insurance rejection date to bill
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| 141 | Adding value code
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| 142 | for reporting of bill's prior payments
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| 143 | N-CURR INSURED DEMOGRAPHICS
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| 144 | N-OTH INSURED DEMOGRAPHICS
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| 145 | Adding occurrence code '
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| 146 | insurance subscriber's date of birth
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| 147 | N-DATE LAST SEEN
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| 148 | Date Last Seen:
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| 149 | N-REFERRING PROVIDER ID
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| 150 | Homebound
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| 151 | N-ASSIGN OF BENEFITS INDICATOR
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| 152 | Nn0
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| 153 | Patient refuses to assign benefits
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| 154 | NOC Drug:
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| 155 | Testing for hearing aid
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| 156 | Attending physician,not hospice employee
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| 157 | Last Xray:
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| 158 | Level of Sublux:
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| 159 | N-SPECIAL PROGRAM
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| 160 | Medicare demonstration project for lung volume reduction surgery study
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| 161 | N-HCFA 1500 BOX 19 RAW DATA
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| 162 | N-BILL REMARKS
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| 163 | DISPLAY THE FULL HCFA 1500 BOX 19?:
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| 164 | Bill:
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| 165 | VARIABLE TO DISPLAY (IBXDATA):
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| 166 | BAD VARIABLE NAME
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| 167 | *** NO DATA TO DISPLAY
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| 168 | Remember to run this for flds that set up pre-requisite data (if any) first
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| 169 | Form Field:
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| 170 | N-SPECIALTY CODE
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| 171 | N-ALL PROVIDERS
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| 172 | PRV-82
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| 173 | DEPT OF VETERANS AFFAIRS
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| 174 | SELECT 1-
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| 175 | Enter your selection for procedure from 1 to
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| 176 | There were more than
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| 177 | matches found. Please try again with more specific input
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| 178 | N-ATT/REND PROVIDER ID
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| 179 | WANT TO CHANGE THE
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| 180 | PROVIDER'S FUNCTION TO
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| 181 | IF YOU ANSWER YES HERE, YOU WILL MAKE THE PROVIDER FUNCTIONS CONSISTENT
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| 182 | WITH THE FORM TYPE OF THE BILL
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| 183 | FUNCTION DOES NOT BELONG ON THIS BILL TYPE & MUST BE DELETED
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| 184 | This bill is
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| 185 | The valid provider functions for this bill are:
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| 186 | - ALREADY ON BILL
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| 187 | - NOT ON BILL
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| 188 | Select Rx for this charge:
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| 189 | Enter an Rx# for this revenue code
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| 190 | The Rx must not already have an associated revenue code
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| 191 | PROCEDURE #
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| 192 | HAS BEEN ASSOCIATED WITH THIS MANUAL CHARGE
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| 193 | Respond YES if this revenue code charge specifically references the data for
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| 194 | a particular procedure that was manually entered on the previous screen.
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| 195 | For outpatient UB92 bills, associating a manual revenue code charge with
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| 196 | a procedure is the only way to print a modifier in box 44
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| 197 | SHOULD A PROCEDURE ENTRY BE ASSOCIATED WITH THIS CHARGE?:
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| 198 | Respond YES if you no longer want this revenue code charge to reference a
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| 199 | specific manually entered procedure
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| 200 | DELETE THE EXISTING PROCEDURE ASSOCIATION?:
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| 201 | SELECT A PROCEDURE ENTRY:
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| 202 | Enter a manually-added CPT procedure to associate with this charge
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| 203 | IBCE EXTR STATUS MANAGEMENT
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| 204 | Claims in need of rescue process
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| 205 | This function is not necessary.
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| 206 | No records trapped in a Ready for Extract status found
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| 207 | Authorizing bill...
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| 208 | This option will display the EDI extract data for a bill.
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| 209 | There is no entry in the EDI Transmit Bill file for this bill number.
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| 210 | There is no batch # for this bill. It has not been transmitted.
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| 211 | INCLUDE FIELDS WITH NO DATA?:
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| 212 | Transmitted Bill Extract Data
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| 213 | Your task number
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| 214 | Inpt
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| 215 | Oupt
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| 216 | (NO DATA - RECORD NOT SENT)
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| 217 | EDI Transmitted Bill Extract Data
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| 218 | UB-82
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| 219 | FOLLOW-UP AR FORM
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| 220 | BILL ADDENDUM FOR
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| 221 | BILL FORM TYPE NOT COMPLETE FOR
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| 222 | QUEUEING OF
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| 223 | DG*
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| 224 | *** COPY OF ORIGINAL BILL ***
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| 225 | *** SECOND NOTICE ***
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| 226 | *** THIRD NOTICE ***
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| 227 | MEDICARE ESRD
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| 228 | IB-RC
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| 229 | Dept. Veterans Affairs
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| 230 | Bill Type:
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| 231 | INPATIENT CARE
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| 232 | ADDITIONAL PROCEDURE CODES:
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| 233 | LESS
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| 234 | OP VISIT DATE(S) BILLED
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| 235 | MISSING INPUT VARIABLES
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| 236 | BILL NON-EXISTANT
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| 237 | BILL CANCELLED
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| 238 | BILL STATUS INAPPROPRIATE
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| 239 | For your information, even though the patient may be otherwise eligible
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| 240 | for Medicare, no payment may be made under Medicare to any Federal provider
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| 241 | of medical care or services and may not be used as a reason for non-payment.
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| 242 | Please make your check payable to the Department of Veterans Affairs and
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| 243 | send to the address listed above.
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| 244 | The undersigned certifies that treatment rendered is not for a
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| 245 | service connected disability.
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| 246 | IBCF1TP-1
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| 247 | IB - TEST UB-82 PRINT
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| 248 | IBCF1TP-2
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| 249 | *** UB-82 TEST PATTERN ***
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| 250 | AGENT CASHIER
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| 251 | AGENT CASHIER STREET
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| 252 | CITY STATE ZIP
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| 253 | PHONE #
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| 254 | BC/BS #
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| 255 | FED TAX #
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| 256 | PATIENT ADDRESS
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| 257 | PT DOB
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| 258 | ADM DT
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| 259 | MAILING ADDRESS NAME
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| 260 | STREET ADDRESS 1
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| 261 | STREET ADDRESS 3
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| 262 | 000 DAYS MEDICAL CARE
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| 263 | REV CODE
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| 264 | PAYER
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| 265 | INSURED NAME
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| 266 | POLICY #
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| 267 | GROUP NAME
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| 268 | GROUP #
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| 269 | EMPLOYER NAME
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| 270 | CITY STATE ZIP
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| 271 | PRINCIPAL DIAGNOSIS
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| 272 | PRINCIPAL PROCEDURE
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| 273 | TX. AUTH.
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| 274 | XXXX XXXXXXX
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| 275 | UB-82 TEST PATTERN
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| 276 | **TEST PATTERN**
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| 277 | UB-82 SIGNER NAME
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| 278 | UB-82 SIGNER TITLE
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| 279 | PRINT HCFA1500
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| 280 | N-PRINT BILL SUBMIT STATUS
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| 281 | ONSET OF SYMPTOMS/ILLNESS
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| 282 | PUBLIC LAW 99-272/SECTION 1729 TITLE 38
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| 283 | PUBLIC LAW 99-272
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| 284 | Dept. Of Veterans Affairs
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| 285 | THE UNDERSIGNED CERTIFIES TREATMENT IS NOT FOR A SERVICE-CONNECTED CONDITION
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| 286 | proc^division^basc flag^bedsection^rev code^unit chrg^Rx seq #
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| 287 | proc^division^basc flag^dx^pos^tos^modifier^unit chrg^Rx seq #
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| 288 | proc^division^basc^dx^pos^tos^modifier(s)^unit chrg^purchased chg
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| 289 | AUX-X
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| 290 | not for SC
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| 291 | IBCF2TP-1
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| 292 | IB - TEST HCFA 1500 PRINT
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| 293 | IBCF2TP-2
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| 294 | INSURANCE CARRIER NAME
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| 295 | CARRIER ADDRESS LINE 1
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| 296 | CARRIER ADDRESS LINE 2
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| 297 | CARRIER ADDRESS LINE 3
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| 298 | CARRIER CITY, STATE ZIP
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| 299 | SUBSCRIBER ID#
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| 300 | MM DD YY
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| 301 | INSURED'S NAME
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| 302 | PATIENT ADDRESS STREET
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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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