1 | English French Notes Complete/Exclude
|
---|
2 | WAITING SINCE
|
---|
3 | MAIL MESSAGE #
|
---|
4 | MINIMUM # OF DAYS MSGS WAITING TO BE FILED:
|
---|
5 | Enter the minimum number of days a message has been waiting to be filed
|
---|
6 | before it appears on this report
|
---|
7 | REPORT OF EDI MSGS PENDING TOO LONG TO BE FILED
|
---|
8 | TOTAL # OF MESSAGES WAITING OVER
|
---|
9 | TO BE FILED:
|
---|
10 | EDI MESSAGES WAITING TO BE FILED OVER
|
---|
11 | MESSAGE TYPE
|
---|
12 | IN CURRENT
|
---|
13 | MESSAGE #
|
---|
14 | STATUS SINCE
|
---|
15 | DO YOU WANT TO INCLUDE A LIST OF BILLS WITH EACH BATCH?:
|
---|
16 | Enter the first 10-digit batch number you want included on the report
|
---|
17 | Start with BATCH #:
|
---|
18 | Must enter a 10-digit batch #
|
---|
19 | Enter the last 10-digit batch number you want included on the report
|
---|
20 | Go to BATCH #:
|
---|
21 | Enter the first date you want to include on the report
|
---|
22 | Start with LAST TRANSMIT DATE:
|
---|
23 | Must enter a valid date
|
---|
24 | Enter the last date you want to include on the report
|
---|
25 | Go to LAST TRANSMIT DATE:
|
---|
26 | Select BATCH STATUS:
|
---|
27 | EDI 837 BATCH DETAIL LIST
|
---|
28 | Rejected?:
|
---|
29 | Resubmit:
|
---|
30 | Batch Type :
|
---|
31 | Mail Msg:
|
---|
32 | Received in Austin?:
|
---|
33 | Status Date:
|
---|
34 | Date Recorded:
|
---|
35 | First Sent :
|
---|
36 | Last Sent :
|
---|
37 | Number Transmit Status Resubmit Batch #
|
---|
38 | * = NOT RESUBMITTED
|
---|
39 | Number Transmit Status
|
---|
40 | Resubmit Batch #
|
---|
41 | BATCH DETAIL LIST
|
---|
42 | This report provides a list of claims held in a
|
---|
43 | Ready for Extract status. Users can select all bills
|
---|
44 | in a Ready for extract status or only those trapped due to
|
---|
45 | the EDI Parameters being turned off.
|
---|
46 | This report requires a 132 column printer.
|
---|
47 | IB - EDI Claims in Waiting Transmission Status
|
---|
48 | Your task number
|
---|
49 | has been queued.
|
---|
50 | There are no EDI records
|
---|
51 | in a ready for extract status
|
---|
52 | Total EDI Bills
|
---|
53 | Total MRA Bills
|
---|
54 | Total bills
|
---|
55 | Your EDI site parameter setting is incomplete.
|
---|
56 | Please contact your coordinator.
|
---|
57 | Your site parameters are set to allow EDI transmissions
|
---|
58 | There is no need to run this report.
|
---|
59 | Trapped
|
---|
60 | Claims Ready for Extract
|
---|
61 | Inpt/
|
---|
62 | Inst/
|
---|
63 | Opt
|
---|
64 | Prof
|
---|
65 | Statement Date
|
---|
66 | Do you want to print a list of:
|
---|
67 | 1 - All bills in Ready for Extract status
|
---|
68 | 2 - Bills trapped due to EDI paramater being turned off
|
---|
69 | IB - EDI/MRA Claims in Rescue Process
|
---|
70 | There are no records to print
|
---|
71 | Claims in Rescue Process
|
---|
72 | Stmt Date
|
---|
73 | Ins Co.
|
---|
74 | IB-HOLD
|
---|
75 | IBCE ELEC REPORT DISP
|
---|
76 | IBREP DISP
|
---|
77 | IBREP DISP1
|
---|
78 | No reports available for dispositioning
|
---|
79 | REPORT:
|
---|
80 | RACUBOTH RUCH
|
---|
81 | EDI RETURN MESSAGE ROUTER ERROR
|
---|
82 | Return Message Code:
|
---|
83 | Return Message Date:
|
---|
84 | Message Time:
|
---|
85 | Update Date:
|
---|
86 | Update Time:
|
---|
87 | Return Message File #(s):
|
---|
88 | Mailman Message #:
|
---|
89 | cannot be determined
|
---|
90 | Msg Line:
|
---|
91 | Return Message Text:
|
---|
92 | ERROR+
|
---|
93 | S.IBCE MESSAGES SERVER
|
---|
94 | *** NEW PAGE ***
|
---|
95 | *** END OF PAGE ***
|
---|
96 | I:G.IB EDI SUPERVISOR
|
---|
97 | Status message received for batch
|
---|
98 | PAYID=
|
---|
99 | PAYER ID RETURNED IS DIFFERENT THAN PAYER ID ON FILE
|
---|
100 | BILL # :
|
---|
101 | PAYER :
|
---|
102 | BILL TYPE :
|
---|
103 | ID ON FILE :
|
---|
104 | ID RETURNED:
|
---|
105 | Please determine which id number is correct and correct the id in the
|
---|
106 | insurance file for this payer, if needed
|
---|
107 | ALREADY EXISTS - CAN'T HAVE BOTH ON ONE BILL
|
---|
108 | IBA(355.93
|
---|
109 | N-CURRENT INS POLICY TYPE
|
---|
110 | Another user has locked this record - try again later
|
---|
111 | ONLY SELECT TO CLOSE THE TRANSMIT RECORDS IF YOU KNOW THESE ARE THE FINAL
|
---|
112 | ELECTRONIC MESSAGES YOU WILL RECEIVE FOR ALL THE BILLS REFERENCED BY
|
---|
113 | THESE MESSAGES
|
---|
114 | DO YOU WANT TO AUTOMATICALLY CLOSE THE TRANSMIT RECORDS FOR ANY MESSAGES
|
---|
115 | THAT AREN'T REJECTS?:
|
---|
116 | DO YOU WANT TO SEE EACH MESSAGE BEFORE MARKING IT REVIEWED?:
|
---|
117 | IF YOU OPT TO SEE EACH MESSAGE, YOU CAN CONTROL WHETHER OR NOT THE MESSAGE
|
---|
118 | IS MARKED AS REVIEWED
|
---|
119 | AND, FOR NON-REJECTS, WHETHER OR NOT TO CLOSE THE
|
---|
120 | TRANSMIT RECORD FOR THE BILL
|
---|
121 | OK TO MARK REVIEWED?:
|
---|
122 | IF YOU ENTER YES, THIS MESSAGE WILL BE MARKED REVIEWED
|
---|
123 | IF YOU ENTER NO, THIS MESSAGE WILL NOT BE ALTERED
|
---|
124 | IF YOU ENTER AN ^, THIS MESSAGE WILL NOT BE ALTERED & NONE OF THE
|
---|
125 | REMAINING MESSAGES WILL BE PROCESSED
|
---|
126 | OK TO CLOSE THIS BILL'S TRANSMIT RECORD?:
|
---|
127 | THIS IS A REJECTION ... ARE YOU SURE YOU WANT TO MARK IT REVIEWED?:
|
---|
128 | MESSAGES FOLLOWING THIS ONE WILL BE PROCESSED
|
---|
129 | CLAIM SENT TO PAYER
|
---|
130 | CLAIM REJECTED
|
---|
131 | Seq #:
|
---|
132 | Bill number:
|
---|
133 | LAST SELECTION PROCESSED
|
---|
134 | N-PRIOR PAYMENTS
|
---|
135 | PRINT CENTER
|
---|
136 | N-PATIENT STATUS
|
---|
137 | N-SOURCE OF ADMISSION
|
---|
138 | N-OTH INSURANCE PRIOR PAYMENT
|
---|
139 | N-EOB ENTRIES
|
---|
140 | Adding occurrence code 24 and primary insurance rejection date to bill
|
---|
141 | Adding value code
|
---|
142 | for reporting of bill's prior payments
|
---|
143 | N-CURR INSURED DEMOGRAPHICS
|
---|
144 | N-OTH INSURED DEMOGRAPHICS
|
---|
145 | Adding occurrence code '
|
---|
146 | insurance subscriber's date of birth
|
---|
147 | N-DATE LAST SEEN
|
---|
148 | Date Last Seen:
|
---|
149 | N-REFERRING PROVIDER ID
|
---|
150 | Homebound
|
---|
151 | N-ASSIGN OF BENEFITS INDICATOR
|
---|
152 | Nn0
|
---|
153 | Patient refuses to assign benefits
|
---|
154 | NOC Drug:
|
---|
155 | Testing for hearing aid
|
---|
156 | Attending physician,not hospice employee
|
---|
157 | Last Xray:
|
---|
158 | Level of Sublux:
|
---|
159 | N-SPECIAL PROGRAM
|
---|
160 | Medicare demonstration project for lung volume reduction surgery study
|
---|
161 | N-HCFA 1500 BOX 19 RAW DATA
|
---|
162 | N-BILL REMARKS
|
---|
163 | DISPLAY THE FULL HCFA 1500 BOX 19?:
|
---|
164 | Bill:
|
---|
165 | VARIABLE TO DISPLAY (IBXDATA):
|
---|
166 | BAD VARIABLE NAME
|
---|
167 | *** NO DATA TO DISPLAY
|
---|
168 | Remember to run this for flds that set up pre-requisite data (if any) first
|
---|
169 | Form Field:
|
---|
170 | N-SPECIALTY CODE
|
---|
171 | N-ALL PROVIDERS
|
---|
172 | PRV-82
|
---|
173 | DEPT OF VETERANS AFFAIRS
|
---|
174 | SELECT 1-
|
---|
175 | Enter your selection for procedure from 1 to
|
---|
176 | There were more than
|
---|
177 | matches found. Please try again with more specific input
|
---|
178 | N-ATT/REND PROVIDER ID
|
---|
179 | WANT TO CHANGE THE
|
---|
180 | PROVIDER'S FUNCTION TO
|
---|
181 | IF YOU ANSWER YES HERE, YOU WILL MAKE THE PROVIDER FUNCTIONS CONSISTENT
|
---|
182 | WITH THE FORM TYPE OF THE BILL
|
---|
183 | FUNCTION DOES NOT BELONG ON THIS BILL TYPE & MUST BE DELETED
|
---|
184 | This bill is
|
---|
185 | The valid provider functions for this bill are:
|
---|
186 | - ALREADY ON BILL
|
---|
187 | - NOT ON BILL
|
---|
188 | Select Rx for this charge:
|
---|
189 | Enter an Rx# for this revenue code
|
---|
190 | The Rx must not already have an associated revenue code
|
---|
191 | PROCEDURE #
|
---|
192 | HAS BEEN ASSOCIATED WITH THIS MANUAL CHARGE
|
---|
193 | Respond YES if this revenue code charge specifically references the data for
|
---|
194 | a particular procedure that was manually entered on the previous screen.
|
---|
195 | For outpatient UB92 bills, associating a manual revenue code charge with
|
---|
196 | a procedure is the only way to print a modifier in box 44
|
---|
197 | SHOULD A PROCEDURE ENTRY BE ASSOCIATED WITH THIS CHARGE?:
|
---|
198 | Respond YES if you no longer want this revenue code charge to reference a
|
---|
199 | specific manually entered procedure
|
---|
200 | DELETE THE EXISTING PROCEDURE ASSOCIATION?:
|
---|
201 | SELECT A PROCEDURE ENTRY:
|
---|
202 | Enter a manually-added CPT procedure to associate with this charge
|
---|
203 | IBCE EXTR STATUS MANAGEMENT
|
---|
204 | Claims in need of rescue process
|
---|
205 | This function is not necessary.
|
---|
206 | No records trapped in a Ready for Extract status found
|
---|
207 | Authorizing bill...
|
---|
208 | This option will display the EDI extract data for a bill.
|
---|
209 | There is no entry in the EDI Transmit Bill file for this bill number.
|
---|
210 | There is no batch # for this bill. It has not been transmitted.
|
---|
211 | INCLUDE FIELDS WITH NO DATA?:
|
---|
212 | Transmitted Bill Extract Data
|
---|
213 | Your task number
|
---|
214 | Inpt
|
---|
215 | Oupt
|
---|
216 | (NO DATA - RECORD NOT SENT)
|
---|
217 | EDI Transmitted Bill Extract Data
|
---|
218 | UB-82
|
---|
219 | FOLLOW-UP AR FORM
|
---|
220 | BILL ADDENDUM FOR
|
---|
221 | BILL FORM TYPE NOT COMPLETE FOR
|
---|
222 | QUEUEING OF
|
---|
223 | DG*
|
---|
224 | *** COPY OF ORIGINAL BILL ***
|
---|
225 | *** SECOND NOTICE ***
|
---|
226 | *** THIRD NOTICE ***
|
---|
227 | MEDICARE ESRD
|
---|
228 | IB-RC
|
---|
229 | Dept. Veterans Affairs
|
---|
230 | Bill Type:
|
---|
231 | INPATIENT CARE
|
---|
232 | ADDITIONAL PROCEDURE CODES:
|
---|
233 | LESS
|
---|
234 | OP VISIT DATE(S) BILLED
|
---|
235 | MISSING INPUT VARIABLES
|
---|
236 | BILL NON-EXISTANT
|
---|
237 | BILL CANCELLED
|
---|
238 | BILL STATUS INAPPROPRIATE
|
---|
239 | For your information, even though the patient may be otherwise eligible
|
---|
240 | for Medicare, no payment may be made under Medicare to any Federal provider
|
---|
241 | of medical care or services and may not be used as a reason for non-payment.
|
---|
242 | Please make your check payable to the Department of Veterans Affairs and
|
---|
243 | send to the address listed above.
|
---|
244 | The undersigned certifies that treatment rendered is not for a
|
---|
245 | service connected disability.
|
---|
246 | IBCF1TP-1
|
---|
247 | IB - TEST UB-82 PRINT
|
---|
248 | IBCF1TP-2
|
---|
249 | *** UB-82 TEST PATTERN ***
|
---|
250 | AGENT CASHIER
|
---|
251 | AGENT CASHIER STREET
|
---|
252 | CITY STATE ZIP
|
---|
253 | PHONE #
|
---|
254 | BC/BS #
|
---|
255 | FED TAX #
|
---|
256 | PATIENT ADDRESS
|
---|
257 | PT DOB
|
---|
258 | ADM DT
|
---|
259 | MAILING ADDRESS NAME
|
---|
260 | STREET ADDRESS 1
|
---|
261 | STREET ADDRESS 3
|
---|
262 | 000 DAYS MEDICAL CARE
|
---|
263 | REV CODE
|
---|
264 | PAYER
|
---|
265 | INSURED NAME
|
---|
266 | POLICY #
|
---|
267 | GROUP NAME
|
---|
268 | GROUP #
|
---|
269 | EMPLOYER NAME
|
---|
270 | CITY STATE ZIP
|
---|
271 | PRINCIPAL DIAGNOSIS
|
---|
272 | PRINCIPAL PROCEDURE
|
---|
273 | TX. AUTH.
|
---|
274 | XXXX XXXXXXX
|
---|
275 | UB-82 TEST PATTERN
|
---|
276 | **TEST PATTERN**
|
---|
277 | UB-82 SIGNER NAME
|
---|
278 | UB-82 SIGNER TITLE
|
---|
279 | PRINT HCFA1500
|
---|
280 | N-PRINT BILL SUBMIT STATUS
|
---|
281 | ONSET OF SYMPTOMS/ILLNESS
|
---|
282 | PUBLIC LAW 99-272/SECTION 1729 TITLE 38
|
---|
283 | PUBLIC LAW 99-272
|
---|
284 | Dept. Of Veterans Affairs
|
---|
285 | THE UNDERSIGNED CERTIFIES TREATMENT IS NOT FOR A SERVICE-CONNECTED CONDITION
|
---|
286 | proc^division^basc flag^bedsection^rev code^unit chrg^Rx seq #
|
---|
287 | proc^division^basc flag^dx^pos^tos^modifier^unit chrg^Rx seq #
|
---|
288 | proc^division^basc^dx^pos^tos^modifier(s)^unit chrg^purchased chg
|
---|
289 | AUX-X
|
---|
290 | not for SC
|
---|
291 | IBCF2TP-1
|
---|
292 | IB - TEST HCFA 1500 PRINT
|
---|
293 | IBCF2TP-2
|
---|
294 | INSURANCE CARRIER NAME
|
---|
295 | CARRIER ADDRESS LINE 1
|
---|
296 | CARRIER ADDRESS LINE 2
|
---|
297 | CARRIER ADDRESS LINE 3
|
---|
298 | CARRIER CITY, STATE ZIP
|
---|
299 | SUBSCRIBER ID#
|
---|
300 | MM DD YY
|
---|
301 | INSURED'S NAME
|
---|
302 | PATIENT ADDRESS STREET
|
---|
303 | #################### #################### ####################
|
---|
304 | #################### #################### ####################
|
---|
305 | #################### #################### ####################
|
---|
306 | #################### #################### ####################
|
---|
307 | #################### #################### ####################
|
---|