English French Notes Complete/Exclude PRIMARY PROVIDER # SECONDARY PROVIDER # TERTIARY PROVIDER # MAILING ADDRESS STREET MAILING ADDRESS STREET2 MAILING ADDRESS STREET3 MAILING ADDRESS CITY MAILING ADDRESS STATE MAILING ADDRESS ZIP CODE NON-PTF ADMISSION HOUR ACCIDENT HOUR 1:PHYSICIAN REFERRAL;2:CLINIC REFERRAL;3:HMO REFERRAL;4:TRANSFER FROM HOSPITAL;5:TRANSFER FROM SKILLED NURSING FAC.;6:TRANSFER FROM OTHER HEALTH CARE FAC.;7:EMERGENCY ROOM;8:COURT/LAW ENFORCEMENT;9:INFO NOT AVAILABLE; 1:EMERGENCY;2:URGENT;3:ELECTIVE; SNF/SA CARE DGCR(399.1, DISCHARGE STATUS OCCURRENCE CODE CONDITION CODE PROCEDURE CODING METHOD 4:CPT-4;5:HCPCS (HCFA COMMON PROCEDURE CODING SYSTEM);9:ICD-9-CM; VALUE CODE START DATE OP VISITS DATE(S) Event date can no longer be edited...cancel and submit a new bill if necessary. MDX# LOCATION OF CARE 1:HOSPITAL - INPT OR OPT (INCLUDES CLINICS);2:SKILLED NURSING (NHCU);3:HOME HEALTH AGENCY;7:CLINIC (ONLY INDEPENDENT/SATELITE);8:SPEC. FACILITY HOSP/AMB SURG CTR; BILL CLASSIFICATION ** The 'BILL CLASSIFICATION' must be consistent with the 'LOCATION OF CARE.' TIMEFRAME OF BILL 1:ADMIT THRU DISCHARGE;2:INTERIM - 1ST CLAIM;3:INTERIM - CONTINUING CLAIM;4:INTERIM - LAST CLAIM;5:LATE CHARGES ONLY;6:ADJUSTMENT CLAIM;7:REPLACEMENT CLAIM;8:VOID/CANCEL PRIOR CLAIM;O:NON-PAY/ZERO CLAIM; COVERED DAYS NJ4,0 NON-COVERED DAYS CO-INSURANCE DAYS BILL CHARGE TYPE 1:INSTITUTIONAL;2:PROFESSIONAL; IS THIS A SENSITIVE RECORD? ASSIGNMENT OF BENEFITS Yy1 POWER OF ATTORNEY COMPLETED? STATEMENT COVERS FROM STATEMENT COVERS TO DISCHARGE BEDSECTION LENGTH OF STAY REVENUE CODE MR*P399.2' RNJ8,2 RNJ6,0X UNITS OF SERVICE RNJ9,2XI NON-COVERED CHARGE 1:INPT BS;2:OPT VST DT;3:RX;4:CPT;5:PROS;6:DRG;9:UNASSOCIATED; OFFSET AMOUNT OFFSET DESCRIPTION RNJ10,2 NJ11,2 PRIMARY PRIOR PAYMENT PRIOR PAYMENT(S) SECONDARY PRIOR PAYMENT TERTIARY PRIOR PAYMENT UB92 FORM LOCATOR 49 RX PROCEDURE AUTO ADDED CHARGE - NO CHANGE TO TYPE/COMPONENT BILL COMMENT FORM LOCATOR 2 FORM LOCATOR 9 FORM LOCATOR 27 FORM LOCATOR 45 FORM LOCATOR 92 FORM LOCATOR 93 TREATMENT AUTHORIZATION CODE UF3;4 PRIMARY INSURANCE ICN/DCN UF3;5 SECONDARY INSURANCE ICN/DCN UF3;6 TERTIARY INSURANCE ICN/DCN PRIMARY AUTHORIZATION CODE SECONDARY AUTHORIZATION CODE TERTIARY AUTHORIZATION CODE 1:REFERRING;2:OPERATING;3:RENDERING;4:ATTENDING;9:OTHER; UF3;1 UF3;2 FORM LOCATOR 11 UF3;3 FORM LOCATOR 31 UF3;7 FORM LOCATOR 56 UF31;2 FORM LOCATOR 78 MR*S PERFORMED BY Prov Specialty On File: Provider Specialty On File: PRIMARY PROV ID CARE UNIT IBA(355.96, TX;8 FORCE CLAIM TO PRINT 0:NO FORCED PRINT;1:FORCE LOCAL PRINT;2:FORCE CLEARINGHOUSE PRINT; NO FORCED PRINT SECONDRY PROV ID CARE UNIT TERTIARY PROV ID CARE UNIT PRIMARY INS CO ID NUMBER SECONDARY INS CO ID NUMBER TERTIARY INS CO ID NUMBER REFERRING PROVIDER STATE UNABLE TO WORK FROM UNABLE TO WORK TO FORM LOCATOR 37C NON-VA FACILITY NVA_FC NVA_FC-0 NON-VA CARE TYPE 1:FEE BASIS, NON-LAB;2:FEE BASIS, LAB;3:NON-FEE BASIS, NON-LAB;4:NON-FEE BASIS, LAB; NON-VA CARE ID # UF31;3 FORM LOC 19-UNSPECIFIED DATA DATE LAST SEEN SPECIAL PROGRAM INDICATOR UF2;2 PRINT FACILITY DATA IN BOX 32 REFERRING PROV STATE AUTHORIZE BILL GENERATION? REASON(S) DISAPPROVED-INITIAL DGCR(399.4, TX;6 REQUEST MRA NOW? TX;2 LAST ELECTRONIC EXTRACT DATE DATE LAST PRINTED MP399.4' Updating file 399.1 MCCR UTILITY with new occurrence codes... RZD FOR STATE ASSIGNMENT RZD FOR NATIONAL ASSIGNMENT Occurrence Codes added (#399.1) *** Code Added *** NO DIAGNOSTIC MEASURE REPORTS FOUND FOR OCT 2003. DIAGNOSTIC MEASURES DATA ALREADY SENT FOR OCT 2003. Setting status of UNBILLED REPORT for OCT 2003 to complete. Transmitting diagnostic measure reports for OCT 2003. Post-install complete. >>> Updating the IVM Center domain in the IB SITE PARAMETERS (#350.9) file... G.IVM REPORTS@IVM.VA.GOV IB OUTPUT MANAGEMENT REPORTS IB OUTPUT IVM BILLING ACTIVITY <<< Adding IB OUTPUT IVM BILLING ACTIVITY option to IB OUTPUT MANAGEMENT REPORTS menu... <<< Post init complete! <<< Adding new entry to BILL FORM TYPE for IB REPORTS! IB UNBILLED AMOUNTS This mail group will be automatically mailed the IB Unbilled Amounts report each month. You may add members at this time. <<< Mail Group ( ) CREATION FAILED !!! <<< Updating your IB Site Parameters 6.25///IB UNBILLED AMOUNTS;6.24///0 Patch PRCA*4*24 or PRCA*4.5*6 does not appear to be installed! Please install the appropriate patch and then re-run this initialization. IBCNS QUIT >>> Deleting protocol IBCNS QUIT as an item of IBCNSC INSURANCE CO... (It will be added back in momentarily) IBCNSJ PLAN LOOKUP IBCNSP POLICY MENU for protocol ' IBCNS EXPANDED POLICY^1^^80^5^17^1^1^Policy^IBCNSP POLICY MENU^Patient Policy Information^1 'IBCNS PLAN LOOKUP' List Template... IBCNS PLAN LOOKUP^1^^80^7^19^1^1^Plan^IBCNSJ PLAN LOOKUP^Insurance Plan Lookup^1^^1 IBCN INSURANCE MGMT MENU IBCN LIST PLANS BY INS CO >>> Adding IBCN LIST PLANS BY INS CO option to the IBCN INSURANCE MGMT MENU... >>> Building the 'ACCP' cross-reference for file #355.3 ... (I'll write a dot for every 100 entries processed) Note that group plan had the individual policy pointer removed. >>> Queuing off a job to clean up various insurance files... (You'll get a message when the job is completed) IB - PATCH IB*2*28 POST INIT - INSURANCE CLEAN-UP The job has been queued. The task number is Unable to queue this job. Please run FIX^IBYAPT1 at any time. Patch IB*2*28 Insurance Clean-up Completion The Insurance Files clean-up job has completed. Number of AGNA cross references in file #355.3 deleted: Number of AGNU cross references in file #355.3 deleted: Number of errant Annual Benefits in file #355.4 deleted: Number of errant Benefits Used in file #355.5 deleted: Number of errant Personal Riders in file #355.7 deleted: Number of Insurance Reviews in file #356.2 repointed: DUZ(0) must also be defined to run this initialization. >> ACCOUNTS RECEIVABLE CATEGORY (430.2) ' ' not found. Patch PRCA*4*15 or PRCA*4.5*1 does not appear to be installed! Please install the appropriate patch and then re-run this initialization. CHAMPVA REIMB. INS. DG CHAMPVA PER DIEM NEW DG CHAMPVA PER DIEM CANCEL DG CHAMPVA PER DIEM UPDATE >> RATE TYPE (399.3) ' >> ACTION TYPE (350.1) ' Required file entries are missing. You should determine why you do not have these entries before continuing. They should have been installed with the installation of IB v2.0. ' is not Inactive. ' already has a pointer to an ACCOUNTS RECEIVABLE CATEGORY (430.2). This RATE TYPE will be re-pointed to a new CATEGORY in this installation. RATE TYPE entries have changed since the release of IB 2.0. You should determine why these entries may have changed, and then inactivate the Rate Types again, before re-running the initialization. CHAMPVA PER DIEM >>> Initializing Billing Parameters for CHAMPVA Billing... >>> Unable to initialize your CHAMPVA billing parameters! Please call your ISC for assistance. >>> It appears as if you are re-running the initialization. The CHAMPVA Billing parameters were not updated. >> The two CHAMPVA RATE TYPES have been activated and linked to an ACCOUNTS RECEIVABLE CATEGORY... >> The Patient Billing CHAMPVA Action Types have been updated... >> Added new CHAMPVA Subsistence rate, effective 10/1/94... .01///IB CHAMPVA RATE/INSURER;.02///Rate Type and Primary Carrier's Type of Coverage do not both match CHAMPVA. >>> IB085 - CHAMPVA Rate/Insurer match error added to IB ERROR file. >>> Installing List Template... BILL#^49^8^Bill # >>> Adding the Reminder Letter into the IB FORM LETTER (#354.6) file... Unable to add the letter! Contact your supporting ISC for assistance. Income Test Reminder Letter^2^15 The VA is required by law to charge veterans who receive medications on an outpatient basis for the treatment of nonservice-connected conditions, a copayment of $2.00 for each 30-day (or less) supply of medication provided. Based on the income information requested each year, some veterans may be exempt from the copayment. Our records indicate that your medication copayment exemption status will expire on |VAR( Department of Veterans Affairs Medical Center IB RX EXEMPTION MENU IB RX REPRINT REMINDER >>> Adding IB RX REPRINT REMINDER option to the IB RX EXEMPTION MENU... APD3 cross reference already exists - not rebuilt >>> Building the 'APD3' cross-reference for file #399 ... (I'll write a dot for every 500 entries processed) Begin: End: entries processed in >>> Correcting the spelling of the entry 'ADMISSION TO CIRCUMENT SLOWNESS' (code 3.03) in file #356.4 ... This entry is not cross-referenced correctly! Please contact IRMFO Customer Service staff for assistance. This entry could not be found! .01////ADMISSION TO CIRCUMVENT SLOWNESS >>> I need to queue a job to clean up the 'Name of Insured' fields in the PATIENT (#2) and BILL/CLAIMS (#399) files... IB - CORRECT 'NAME OF INSURED' VALUES Please note that you will receive a mail message when this job has completed. Job Completion - Correct 'Name of Insured' Fields INTEGRATED BILLING The job to correct the 'Name of Insured' fields in files #2 and #399 has completed. Number of policies corrected in file #2: Number of bills corrected in file #399: Patch IB*2*6 does not appear to be installed! Please install this patch and then re-run this initialization. Patch IB*2*8 does not appear to be installed! Please Patch IB*2*13 does not appear to be installed! Please Patch IB*2*23 does not appear to be installed! Please Patch IB*2*40 does not appear to be installed! Please Patch IB*2*45 does not appear to be installed! Please IBCNSP ADD COMMENT IBCNSP EDIT ALL IBCNSJ CHANGE PLAN >>> Deleting protocol as an item of (It will be re-added in a moment) IBCNSC PLAN LIST IBCNSC PLAN DETAIL >>> Rebuilding ^XUTL for protocol ' >>> Adding records to INSURANCE RIDERS file for new limitation categories... INPATIENT COVERAGE OUTPATIENT COVERAGE PRESCRIPTION COVERAGE >>> Updating PLAN LIMITATION CATEGORY file with insurance rider info... 'IBCNS INS CO PLAN DETAIL' List Template ... IBCNS INS CO PLAN DETAIL^1^^80^5^17^1^1^Plan^IBCNSC PLAN DETAIL^View/Edit Plan 'IBCNS PLAN LIST' List Template ... IBCNS PLAN LIST^1^^80^6^19^1^1^Plan^IBCNSC PLAN LIST^Insurance Plan List^1^^1 Post-Install Complete *** REASON NOT BILLABLE of 'NON-BILLABLE CLINIC' already exists in FILE #356.8, new entry NOT added. <<< Adding new REASON NOT BILLABLE of 'NON-BILLABLE CLINIC' to file #356.8 **** Unable to add new entry to FILE #356.8, contact Field Support **** <<< Updating entries in NON-BILLABLE CLINIC STOP CODES (#352.3) file <<< Adding TP Non-billable Stops to NON-BILLABLE CLINIC STOP CODES (#352.3) file *** Could not add entry IB*2*148 Post-Install Complete >> Inactivating Charges for Inactive CPT codes, Please Wait... Charges Inactivated. >> Removing Charges Sets that have no Charges Assigned... #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### ####################