English French Notes Complete/Exclude INSURED'S ADDRESS STREET PATIENT ADDRESS CITY INSURED'S ADDRESS CITY PT ZIP CODE INS ZIP CODE OTHER INSURED'S NAME INSURED'S POLICY GROUP OTHER POLICY NUMBER INSURED'S EMPLOYER OTHER'S EMPLOYER INSURANCE PLAN NAME OTHER'S INSURANCE PLAN REFERRING PHYSICIAN PHYSICIAN ID BC/BS# FEDERAL TAX ID PAT ACCT# AGENT CASHIER (999) 999-9999 CITY, STATE ZIP PRINT UB-92 BILL NO SOMETHING OP VISIT DATE(S) BILLED: ADDITIONAL DIAGNOSIS CODES: PROSTHETIC ITEMS: PRINT TEST BILL *** UB-92 TEST PATTERN *** BN XXX TAX# XXXX PT SHORT ADDRESS RESPONSIBLE PARTY'S NAME REV CODE description Name of Payer 1 Provider # Name of Payer 2 Name of Payer 3 Insured's Name 1 Insurance # Group Name Insured's Name 2 Insured's Name 3 Treatment Auth. Cd Employer Name Employer Location Dx Cd ADMT DX Attending Phys. ID# Other Phys. ID# Patient ID#: xxx-xx-xxxx Bill Type: xxx xxxxxx UB 92 TEST PATTERN Provider Representative DATE Transmittable Bill can NOT be printed until transmitted This is a Transmittable Bill that has already been transmitted WANT TO PRINT THIS BILL ADDENDUM ANYWAY OUTPUT DEVICE: DAYS SUPPLY: REFILL DATE DAYS SUPPLY NDC # ***TASK STOPPED BY USER*** Default printer in billing not defined for the , none will print! There are no Authorized but not Printed bills to print! Z:ZIP;I:INSURANCE COMPANY NAME;P:PATIENT NAME; This option prints all non-transmittable bills with a Status of Authorized in the order requested. The printed bills may be sorted by: Zip Code, Insurance Company Name, and Patient name. First Sort Bills By Enter the field that the bills should be sorted on within . Press return if the order already entered is sufficient. Then Sort Bills By Begin printing bills Enter 'Y'es to begin printing of all authorized non-transmittable bills. ... bills not printed! BATCH PRINT AUTHORIZED THIRD PARTY BILLS BATCH PRINTING The following bill(s) were not printed due to errors indicated. PRINT BILL ERRORS One or more bills were not printed. Check your mail for details NOT ADDED TO FILE 351.9 Select ClaimsManager Bill: IBCI CLAIMSMANAGER ASSIGN *** RECORD IS LOCKED *** Another user is currently editing this bill. IBCI CLAIMSMANAGER WK BROWSE IBCI CLAIMSMANAGER CLERK WK ClaimsManager Error Report There are no errors currently recorded in the ClaimsManager file. There is no data to report. IBCICME ERROR CODES ALL Error Codes in the ClaimsManager File Please Select the Error Codes to include This response must be a list or range. For example, 1,3,5 or 2-4,8 If you include #1, then all codes will be included regardless of what you enter here. SELECTED ERRCODES ALL ERRCODES DISPLAY ERROR TEXT Do you want to see the ClaimsManager Error Messages for these bills Enter YES if you would like to see the full description of the error including all lines of error message text. Enter NO if you do not want to see this information. ERROR DISPLAY TYPE 1:Display all ClaimsManager Errors for a Bill; 2:Display all Bills for a ClaimsManager Error Code Select the Error Display Type The answer to this question will determine how the Bills and Errors are displayed on the report. Select option 1 if you want to display all of the ClaimsManager errors for each bill that appears on the report. These errors will appear together with the bill. Select option 2 if you want to break this report out by ClaimsManager error code. In this case, you will see separate sections for each error code and all bills in which a particular error code is present. Remember that the bills and errors are still subject to the other selection and sort criteria that you enter. RPTSPECS( ~~~ NO INSURANCE ~~~ Terminal Digit Dollar Impact Bill Number Total # Claims Total # Errors ClaimsManager Detailed Error Report sort by Page : Detailed Report BILL NO. ERROR CODES CM STATUS ClaimsManager Audit Error Report for Summary Report CM Error Message: ClaimsManager Status Report Do you want to exit out of this option entirely Enter YES to immediately exit out of this option. Enter NO to return to the previous question. Select Date Range by Please enter the type of date on which you would like to report. The Event Date is the date on which the services were performed. The Entered Date is the date on which the bill was Entered into VistA. Enter the beginning Enter the ending 1:All ClaimsManager Statuses; 2:One Specific ClaimsManager Status; 3:Any ClaimsManager Status (Bill is still Editable) Select the ClaimsManager Status Option Option 1 - All ClaimsManager Statuses - indicates that all bills will be included on the report regardless of ClaimsManager Option 2 - One Specific ClaimsManager Status - will allow you to choose a ClaimsManager status and only bills with this specific status will be included on the report. Option 3 - Any ClaimsManager Status (Bill is still Editable) - will only select those bills that are still open for editing in the IB Enter/Edit Billing Information option. Please choose a ClaimsManager Status Do you want to see ClaimsManager comments associated with these bills Enter YES if you would like to see the comments which are stored in the ClaimsManager file (#351.9) for each bill on this report. Enter NO if you do not want to see these comments. Do you want to include one specific Assigned to person or All? Please enter 1 or A Enter '1' to indicate that you only want to include one specific Assigned to person on this report. You will then be asked to select this person. Enter 'A' to indicate that you want to include all Assigned to people on this report. You will then be asked if you want to sort by the Assigned to person. Invalid response ... Please enter '1' or 'A' Do you want the primary sort by the Assigned To person Enter YES if you would like the bills on this report primarily sorted by the Assigned To person. If a bill is not assigned to anyone, then the word Enter NO if you would like to choose a different primary sort. Enter the Assigned to person to include: 1:Terminal Digit; 2:Insurance Company Name; 3:Patient Last Name; 4:Total Charges; 5:Bill Number Please enter the sort criteria Please enter the report type The Detailed report will show the breakout of bills & a summary based on the criteria that you selected. The Summary report will show the total amount of bills based on the criteria that you selected. *** This report is 132 characters wide *** IBCI ClaimsManager Status Report IBCI ClaimsManager Error Report ClaimsManager Status Report sort by ClaimsManager Bill Totals by ClaimsManager Status ClaimsManager Worksheet Report ClaimsManager does not have a Claims Worksheet on file for this Claim. Claim No: Not on File Please verify that you entered the correct patient. Another user is currently using this option. ClaimsManager is not working right now. IBCI CLAIMSMANAGER SKIP LIST Welcome to ClaimsManager Bill Processing This ListMan will display all skipped bills for processing PR/TX PT_NAME EVENT_DATE No Skipped Claims to Send to ClaimsManager. You may select one or more claims, or a range. You may choose a single bill, a list of bills (i.e. 2,5,9,12), a range of bills (i.e. 3-8), or any combination of these (i.e. 1,3,5,8-12). Only the bills you select here will be sent to ClaimsManager. The following bills were sent to ClaimsManager from the Multiple Claim Send option. ClaimsManager did not find any errors with them. These bills have passed both the IB edit checks and the ClaimsManager edit checks. They are ready to be authorized. Please review the bills for which you are responsible (if any) and take the appropriate action. BILL# PATIENT NAME PID DATE CHARGES USER NAME ClaimsManager Clean Claims There are no claims to send ... Sending claims ... please wait. 'Send All Bills to ClaimsManager' will send all claims listed to ClaimsManager for processing. 'Send All Non Auth Bills to ClaimsManager' will send only Non-Authorized claims to ClaimsManager for processing. 'Select Bills to send to ClaimsManager' allows individual and multiple selection of claims before sending claims to ClaimsManager for processing. IBCI CLAIMSMANAGER MGR WK Coder: Line: Error Level: ClaimsManager Error: No ERRORS defined for claim EVENT DATE: No Errors found by ClaimsManager. Are you sure you want to Override the errors of this bill Are you sure you want to Exit the ClaimsManager Interface process IBCINPT.DAT This option is responsible for creating the NPT file (New Patient History) for the ClaimsManager application from Ingenix. A 3 year history is needed so this option will extract claims data This process may take several minutes. Do you wish to proceed The file that will be created is called You may specify a valid directory location (path) for this file. After this file has been created, it needs to be accessible to the ClaimsManager application. This can be done either through network connections or by manually moving it to the ClaimsManager server. FOr Please enter the directory location (path) for Enter the location where the file should be created. Enter the full path specification up to, but not including, the filename. This includes any trailing slashes or brackets. If the operating system allows shortcuts, you can use them. Examples of valid paths include: VMS USER$:[SCRATCH] is not a valid directory location or path. Please press for more assistance. The full file specification including path and filename is: OK to begin The compile process has completed successfully. The number of bills that were reviewed is The number of records that will be in the NPT file is All that's left to do is to copy these records into the NPT file. The NPT file creation process is complete! IBCIPAY.DAT for the ClaimsManager application from Ingenix. This is a listing of the Insurance Companies that are currently stored in VistA. please wait There are records in the Payor File. The Payor File creation process is complete! VistA-ClaimsManager Interface Options ClaimsManager is only available for HCFA 1500 claims. The form type of the bill you're editing The charge type of this bill is Select option or press RETURN to continue The VistA-ClaimsManager Interface is not currently working. This bill is no longer editable. The ClaimsManager interface Test Send functionality is not available for this bill. ClaimsManager found with this bill. Press RETURN to view the error There was a communications failure: Please report these errors to your system manager. This bill was NOT successfully analyzed by ClaimsManager. There are no errors recorded in the file. Times sent to ClaimsManager: Last sent date/time: Last sent by: Date/time Entered: Date/time Last Edited: Assigned to: Biller: TEST- Sending to ClaimsManager No Errors found by ClaimsManager Communications Error - Not Sent to ClaimsManager There are no line items associated with this claim. ClaimsManager cannot process without line items. Please enter the line item data and resend. ... 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