| 1 | English French  Notes   Complete/Exclude
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| 2 |  Form Locator                   
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| 3 |  Tx Auth. Code  :                       
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| 4 |  Bill Remark       :                    
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| 5 | Pri:                    
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| 6 |  Tx Auth. Code(s)  :                    
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| 7 |  Admitting Dx      :                    
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| 8 |  Admission Source  :                    
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| 9 | (OLD PROV DATA)                         
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| 10 |  Form Locator 2    :                    
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| 11 |  Form Locator 11   :                    
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| 12 |  Form Locator 31   :                    
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| 13 |  Form Locator 56   :                    
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| 14 |  Form Locator 78   :                    
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| 15 |  Force To Print?   :                    
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| 16 | NOT TRANSMITTABLE                       
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| 17 |  Provider ID Maint  : (Edit Provider ID information)                    
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| 18 |  Unable To Work From:                   
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| 19 | Unable To Work To  :                    
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| 20 |  Admitting Dx       :                   
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| 21 | ICN/DCN(s)         :                    
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| 22 | Tx Auth. Code(s)   :                    
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| 23 | (OLD BOX 31 DATA)                       
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| 24 |  Non-VA Facility    :                   
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| 25 |  Form Locator 19    :                   
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| 26 | Homebound          :                    
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| 27 | Date Last Seen     :                    
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| 28 | Spec Prog Indicator:                    
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| 29 |  Print Main Facility Box 32:                    
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| 30 | Force To Print?    :                    
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| 31 |   **Warning** Credentials differ from those found in NEW PERSON or IB NON VA                    
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| 32 | BILLING PROVIDER file (                 
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| 33 | Changes will print local, but only credentials on file transmit                 
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| 34 | Primary^Secondary^Tertiary                      
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| 35 |  ins co requires care unit                      
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| 36 |  for this claim                 
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| 37 | No local screen has been defined for this form type                     
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| 38 | Bill must have insurance co or resp institution to use this screen                      
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| 39 | No local data fields are needed for this bill type/insurance company                    
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| 40 | DR(1,399,                       
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| 41 | DR(2,2)                 
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| 42 | DR(2,2,                 
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| 43 | of data,                        
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| 44 |  '^N' to jump to screen #N (see                 
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| 45 |   Special help screens:                 
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| 46 | Enter '?SC' to view SC Status and Rated Disabilities.                   
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| 47 | Enter '?INS' to view the patients insurance policies.                   
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| 48 | Enter '?PRV' to view provider specific information.                     
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| 49 | Enter '?PRC' to view all procedures on the bill and related data.                       
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| 50 | Enter '?CHG' to view all items on the bill with potential charges.                      
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| 51 | Enter '?CPT' to view all charges for selected CPT codes and bill type.                  
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| 52 | Enter '?HCFA' to view how block 24 will print on a HCFA 1500.                   
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| 53 | Enter '?INC' to execute the edits & view the bill inconsistencies.                      
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| 54 | Enter '?CLA' to view the ClaimsManager options.                 
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| 55 | PRESS <RETURN> KEY                      
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| 56 |  to RETURN to SCREEN                    
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| 57 | DATA GROUPS ON PARAMETER SCREEN                 
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| 58 |  to RETURN to PARAMETER SCREEN                  
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| 59 | Patient Employer Name, Address^Spouse Employer Name, Address                    
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| 60 | Payer Information^Provider Numbers^Mailing Address                      
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| 61 | Admission Information^Discharge Information^Diagnosis Code(s)^Coding Method, Inpt Proc Code(s)^Occurrence Code(s)^Condition Code(s)^Value Code(s)                       
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| 62 | Event Date^Outpatient Diagnosis^Outpatient Visits^Coding Method, Opt. Pro. Code(s)^Occurrence Code(s)^Condtion Code(s)                  
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| 63 | Bill Type, Covered/Non-Covered Days^R.O.I., Assignment of Benefits^Statement Covers Period^Bedsection, Length of Stay^Revenue Code(s), Offset, Total^Rate Schedule(s)^Prior Payments/Claims                     
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| 64 | Bill Remark^Form Locator 2^Form Locator 9^Form Locator 27^Form Locator 45^Form Locator 92^Form Locator 93^Tx Auth. Code                 
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| 65 | Locally defined fields                  
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| 66 | Bill Remark, ICN/DCN's, Tx Auth. Code, Admit Diagnosis/Source^Providers^Form Locator 2 and 11^Form Locator 31^Form Locator 56, 57, and 78^Force to Print                        
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| 67 | Period Unable to Work^Admit Dx, ICN/DCN, Tx/Prior Auth. Code^Providers^Non-VA Facility^Form Locator 19^Force to Print                   
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| 68 | Fed Tax #, BC/BS #, MAS Svc Pointer^Bill Signer, Billing Supervisor^Security Parameters, Outpatient CPT parameters ^Remarks, Mailgroups^Agent Cashier Address/Phone                     
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| 69 | Demographic^Employment^Payer^Inpatient Event^Outpatient Event^Inpatient Billing - General^Outpatient Billing - General^Billing - Specific^Locally Defined                       
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| 70 | Example of diagnoses, procedures and charges printing on the HCFA 1500                  
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| 71 | BOX 19 DATA:                    
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| 72 | This is a display of provider specific information.                     
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| 73 | Select PROVIDER NAME:                   
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| 74 |  Signature Name:                        
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| 75 | Signature Title:                        
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| 76 | None Active on                  
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| 77 |    Person Class:                        
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| 78 |   PROVIDER TYPE:                        
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| 79 | RC Provider Group:                      
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| 80 | SC Status and Rated Disabilities for                    
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| 81 |  SC At Time Of Care:                    
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| 82 | DO YOU WISH TO ADD/EDIT INSURANCE COMPANY DATA FOR THIS PATIENT                 
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| 83 | YES - And I'll prompt you so that you may add insurance data to the PATIENT                     
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| 84 | file for this patient.                  
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| 85 | NO  - To bypass this editing of the PATIENT file.                       
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| 86 | If you updated insurance information for any policy which is already specified                  
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| 87 | as either a PRIMARY, SECONDARY or TERIARY for this billing episode, you will                    
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| 88 | need to press the <RETURN> key through the following prompts in order to insure                 
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| 89 | that these new values are properly stored.  If you fail to do so, i.e.,                 
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| 90 | enter an up-arrow, the new values will not be stored as part of this billing                    
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| 91 | If a procedure is linked as a prescription to a rev code, it cannot be deleted                  
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| 92 |  - Enter the alphanumeric designation of your choice from                       
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| 93 | the display (e.g. 'A1') to input one of the codes shown                 
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| 94 | above into this billing record.                 
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| 95 |  - Enter the name or code number of an                  
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| 96 | ICD DIAGNOSIS                   
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| 97 | not displayed above to input a                  
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| 98 | in the PTF record into this billing record, or '??' for                         
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| 99 | a list of all                   
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| 100 | CODES.                  
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| 101 |  - Enter <RETURN> to accept the default                         
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| 102 | DIAGNOSIS                       
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| 103 | PROCEDURE                       
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| 104 | '^' to abort.                   
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| 105 | No Codes Entered!                       
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| 106 | Procedures Assigned to this Bill                        
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| 107 | NO ENTRY FOUND^                 
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| 108 |  to EDIT,                       
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| 109 |  '^N' for screen N, or '^' to QUIT:                     
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| 110 | SAVE THE VALUE OF $T                    
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| 111 |  [NOT REQUIRED]                 
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| 112 |  W Z Q                  
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| 113 | IOINHI;IOINLOW;IOINORM                  
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| 114 | HELP SCREEN                     
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| 115 | SCREEN <                        
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| 116 | Inpat                   
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| 117 | Outpat                  
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| 118 | CITY/STATE UNKNOWN                      
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| 119 | Patient has no ACTIVE PTF RECORDS for this event date.                  
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| 120 | A 'PTF NUMBER' is required for inpatient billing records.                       
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| 121 | Select the appropriate billing record from the above listing by number.                 
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| 122 | This patient is only                    
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| 123 |  years old!!                    
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| 124 | This patient is a MALE!! Condition code 18 applies only to FEMALES!!                    
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| 125 | Choose only ACTIVE Revenue Codes!!                      
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| 126 | Only ACTIVE Revenue Codes may be selected!!                     
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| 127 | NOT A VALID CHOICE!                     
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| 128 | LEFT AGAINST MEDICAL ADVICE                     
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| 129 | DISCHARGED TO ANOTHER SHORT-TERM GENERAL HOSPITAL                       
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| 130 | NO BLUE CROSS/SHIELD PROVIDER NUMBERS IDENTIFIED TO SELECT FROM!                        
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| 131 | OR                      
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| 132 | ENTER BLUE CROSS/SHIELD PROVIDER # (BETWEEN 3-13 CHARACTERS)                    
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| 133 | Revenue Code Listing                    
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| 134 | Non-Cov                 
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| 135 | Link Missing                    
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| 136 | Current modifier                        
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| 137 | Exceeds 'Total Charges' for this bill.                  
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| 138 | Edit revenue codes/from-to dates if appropriate.                        
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| 139 | START WITH DATE ENTERED:                        
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| 140 | GO TO DATE ENTERED:                     
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| 141 | bill IFN ^ bill date (stm to) ^ bill rate group                 
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| 142 | ) exists for Rx #                       
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| 143 |  and refill date                        
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| 144 | Cannot precede the 'EVENT DATE'!                        
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| 145 | Cannot bill for future treatment!                       
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| 146 | Can't be greater than date of specified Procedures!                     
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| 147 | 'Start Date' must be specified first!                   
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| 148 | Cannot preceed the 'Start Date'!                        
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| 149 | Must be in same fiscal year!                    
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| 150 | Must be in same calendar year!                  
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| 151 | Can't be less than date of specified Procedures!                        
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| 152 | No 'Start Date' on file...can't enter OP visit dates...                 
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| 153 | No 'End Date' on file...can't enter OP visit dates...                   
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| 154 | Can't enter a visit date prior to 'Start Date'...                       
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| 155 | Can't enter a visit date later than 'End Date'...                       
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| 156 | Can Not Precede Bill Start Date!                        
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| 157 | Can not be after Bill End Date!                 
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| 158 | ) exists for visit date (                       
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| 159 | MR.                     
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| 160 | MS.                     
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| 161 | MRS.                    
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| 162 | IB-BS                   
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| 163 | IB-ASC                  
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| 164 | IB-PTF                  
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| 165 | Removing old Revenue Codes.                     
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| 166 | Editing                 
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| 167 | Updating Revenue Codes                  
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| 168 | REV. CODE                       
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| 169 | ) exists overlapping this date range.                   
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| 170 | Site param does not allow entry of non-PTF procedures                   
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| 171 | SINCE THE PROCEDURE CODING METHOD HAS BEEN CHANGED, DO YOU WANT TO DELETE ALL                   
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| 172 | PROCEDURE CODES IN THIS BILL                    
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| 173 | If you answer 'Yes', all procedure codes will be DELETED from this bill.                        
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| 174 | Procedure Entry:                        
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| 175 | Select PROCEDURE DATE                   
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| 176 |    Select PROCEDURE:                    
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| 177 | Warning:  Procedure code is inactive on this date                       
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| 178 | The Procedure code is inactive on                       
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| 179 | Please select another Procedure.                        
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| 180 | Date must be within STATEMENT COVERS FROM and STATEMENT COVERS TO period.                       
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| 181 | Enter a date between                    
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| 182 | EDIT HCFA 1500 SPECIAL PROGRAM FIELDS and BOX 19?:                      
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| 183 | Respond YES only if you need to add/edit data for chiropratic visits,                   
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| 184 | EPSDT care, or if billing for HOSPICE and attending is not a hospice employee.                  
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| 185 | OK to add CPT codes to Visits file                      
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| 186 | Adding Procedures to PCE...                     
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| 187 | IB DATA                 
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| 188 |   Procedures in                         
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| 189 | were added okay.                        
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| 190 | were not added - error code is                  
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| 191 | Bill has no ICD DIAGNOSIS.                      
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| 192 | <<<ASSOCIATED ICD-9 DIAGNOSIS>>>                        
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| 193 | There are no diagnoses associated with this bill.                       
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| 194 |  *** Please select procedure diagnoses by number to left of diagnosis code ***                  
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| 195 | Current Values:                         
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| 196 | Dx                      
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| 197 | Associated Diagnosis (                  
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| 198 | Please enter one of the following billing diagnoses by number at left of code:                  
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| 199 | You may also enter '^' to exit, '@' to delete a procedure diagnosis, or                 
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| 200 | <CR> to accept a current value or skip a prompt.                        
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| 201 | RC-OPT FAC                      
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| 202 | RC-PHYSICI                      
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| 203 | Modifier 26                     
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| 204 | Deleted from                    
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| 205 | Added to                        
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| 206 |  CPT procedures.                        
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| 207 | Modifier TC Deleted from all Procedures (                       
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| 208 |  Procedures Deleted (                   
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| 209 | Modifier 26 Procedures Added (                  
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| 210 | CPT-CLN                 
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| 211 |  replaced by                    
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| 212 | CANCEL WITHOUT EXAM                     
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| 213 | ADMIT THRU DISCHARGE                    
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| 214 | FIRST CLAIM                     
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| 215 | CONTINUING CLAIM                        
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| 216 | LAST CLAIM                      
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| 217 | LATE CHARGE(S)                  
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| 218 | ZERO CLAIM                      
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| 219 | Deleting old synonym for the Purge Conversion Log action..........                      
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| 220 | IBDFC PURGE CONVERSION LOG                      
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| 221 | Cleaning up corrupt second piece of global ^IBE(357,IFN,2,0)                    
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| 222 | AICS 3.0 Installation Requirements:                     
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| 223 | >>> Environment check failed.  Installation will not be allowed.                        
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| 224 | >>> Environment is Ok                   
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| 225 | >>> Checking Environment:                       
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| 226 |     Can not proceed.  XPDABORT is inappropriately defined.                      
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| 227 |     Environment checks OK                       
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| 228 | >>> Checking PACKAGE File Entries:                      
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| 229 |     Checking for required patch                         
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| 230 | not found!!                     
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| 231 | >>> Checking BUILD File Entries:                        
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| 232 | Missing Required Package File Entry (Package/Patch):                    
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| 233 |  ...Ok - in Package File                        
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| 234 | DG SELECT ICD-9 DIAGNOSIS CODE                  
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| 235 | PX INPUT EXAMS                  
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| 236 | PX INPUT VISIT CLASSIFICATION                   
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| 237 | >>> Now Attempting to automatically update Tool Kit forms and Tool Kit Blocks.                  
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| 238 |     Moving Block '                      
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| 239 | ' from import/export to Tool Kit                        
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| 240 |     Moving Form '                       
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| 241 | ' from import export utility to AICS                    
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| 242 | >>> Tool Kit Forms and Blocks are already installed.                    
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| 243 | >>>   Tool Kit Forms sent (4):                  
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| 244 | >>> Tool Kit Blocks sent (28):                  
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| 245 | CLINICAL LEXICON ENTRY^P757.01'^LEX(757.01,^2;2^Q                       
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| 246 | CLINICAL LEXICON^P757.01'^LEX(757.01,^2;2^Q                     
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| 247 | >>> AICS Data Dictionaries updated to use Lexicon Utility version 2.0                   
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| 248 | >>> Form Specs being deleted and recreated for scanning.                        
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| 249 | INPUT DIAGNOSIS CODE (ICD9)                     
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| 250 | DIAGNOSIS/PROBLEM                       
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| 251 | DIAGNOSIS/PROBLEM^1^13^14^2^^^                  
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| 252 | >>> Updating Package Interface Entry for INPUT DIAGNOSIS CODE (ICD9)                    
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| 253 | INPUT PROVIDER                  
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| 254 | PX INPUT PATIENT ACTIVE PROBLE                  
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| 255 | >>> Deleting Fields *'d for Deletion in Package Interface file (357.6)                  
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| 256 | IBD RESOURCE                    
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| 257 | >>> Adding Resouce Device 'IBD RESOURCE' for scanning.                  
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| 258 | 1////IBD RESOURCE;.02////NA;2///RESOURCE                        
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| 259 | LIST OF FORMS READY FOR IMPORT OR EXPORT                        
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| 260 | (** there are                   
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| 261 |  toolkit blocks in the work space **)                   
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| 262 | This form was created with version                      
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| 263 | Export Notes For                        
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| 264 | This action requires PROGRAMMER ACCESS!                 
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| 265 | The work space must be cleared before the INITS are run. Is that okay?                  
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| 266 | In order for you to import forms from another site the other site must have                     
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| 267 | prepared and sent you inits created using the import/export facility.                   
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| 268 | What is the name of the init routine that contains the forms that you want to                   
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| 269 | That routine does not exist!                    
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| 270 | Using the DIFROM action requires PROGRAMMER ACCESS!                     
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| 271 | There is nothing in the work space to export!                   
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| 272 | LIST OF TOOLKIT BLOCKS READY FOR IMPORT OR EXPORT                       
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| 273 |  forms in the work space **)                    
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| 274 | What type of block do you want to export?                       
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| 275 | NOW CHOOSE THE BLOCK TO COPY!                   
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| 276 | New Toolkit Block Name:                         
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| 277 | Enter a unique name for the toolkit block up to 30 characters                   
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| 278 | There is already a toolkit block with that name! The name should be unique.                     
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| 279 | Moving Form '                   
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| 280 | ' to import export utility                      
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| 281 | Moving Block '                  
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| 282 | ' from form '                   
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| 283 | ' to utility                    
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| 284 | IBDE CLN                        
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| 285 | >>> Now checking the PACKAGE INTERFACE file for inappropriate data qualifiers.                  
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| 286 | IBD(357.98,                     
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| 287 |  >> WARNING: The following interfaces use the PROBLEM node to transmit data                     
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| 288 |     Package Interface                   
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| 289 |     Contact Customer Support for assistance updating the package interface file.                        
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| 290 |  >> Summary of the Package Interface Check:                     
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| 291 |     No required changes were found.                     
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| 292 |     A total of                  
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| 293 |  removed from Package Interface Entries.                        
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| 294 |     The PCE DIM data fields for                         
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| 295 |  Package Interface                      
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| 296 |  Allowable Qualifier                    
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| 297 |     The Package Interface                       
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| 298 |        an invalid qualifier of                  
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| 299 |        a duplicate qualifier of                         
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| 300 |        a bad qualifier of                       
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| 301 |  not deleted, PCE DIM NODE='PROBLEM'                    
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| 302 |        The PCE Device Interface Data Updated.                   
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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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