| 1 | English French Notes Complete/Exclude
|
|---|
| 2 | PRIMARY PROVIDER #
|
|---|
| 3 | SECONDARY PROVIDER #
|
|---|
| 4 | TERTIARY PROVIDER #
|
|---|
| 5 | MAILING ADDRESS STREET
|
|---|
| 6 | MAILING ADDRESS STREET2
|
|---|
| 7 | MAILING ADDRESS STREET3
|
|---|
| 8 | MAILING ADDRESS CITY
|
|---|
| 9 | MAILING ADDRESS STATE
|
|---|
| 10 | MAILING ADDRESS ZIP CODE
|
|---|
| 11 | NON-PTF ADMISSION HOUR
|
|---|
| 12 | ACCIDENT HOUR
|
|---|
| 13 | 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;
|
|---|
| 14 | 1:EMERGENCY;2:URGENT;3:ELECTIVE;
|
|---|
| 15 | SNF/SA CARE
|
|---|
| 16 | DGCR(399.1,
|
|---|
| 17 | DISCHARGE STATUS
|
|---|
| 18 | OCCURRENCE CODE
|
|---|
| 19 | CONDITION CODE
|
|---|
| 20 | PROCEDURE CODING METHOD
|
|---|
| 21 | 4:CPT-4;5:HCPCS (HCFA COMMON PROCEDURE CODING SYSTEM);9:ICD-9-CM;
|
|---|
| 22 | VALUE CODE
|
|---|
| 23 | START DATE
|
|---|
| 24 | OP VISITS DATE(S)
|
|---|
| 25 | Event date can no longer be edited...cancel and submit a new bill if necessary.
|
|---|
| 26 | MDX#
|
|---|
| 27 | LOCATION OF CARE
|
|---|
| 28 | 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;
|
|---|
| 29 | BILL CLASSIFICATION
|
|---|
| 30 | ** The 'BILL CLASSIFICATION' must be consistent with the 'LOCATION OF CARE.'
|
|---|
| 31 | TIMEFRAME OF BILL
|
|---|
| 32 | 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;
|
|---|
| 33 | COVERED DAYS
|
|---|
| 34 | NJ4,0
|
|---|
| 35 | NON-COVERED DAYS
|
|---|
| 36 | CO-INSURANCE DAYS
|
|---|
| 37 | BILL CHARGE TYPE
|
|---|
| 38 | 1:INSTITUTIONAL;2:PROFESSIONAL;
|
|---|
| 39 | IS THIS A SENSITIVE RECORD?
|
|---|
| 40 | ASSIGNMENT OF BENEFITS
|
|---|
| 41 | Yy1
|
|---|
| 42 | POWER OF ATTORNEY COMPLETED?
|
|---|
| 43 | STATEMENT COVERS FROM
|
|---|
| 44 | STATEMENT COVERS TO
|
|---|
| 45 | DISCHARGE BEDSECTION
|
|---|
| 46 | LENGTH OF STAY
|
|---|
| 47 | REVENUE CODE
|
|---|
| 48 | MR*P399.2'
|
|---|
| 49 | RNJ8,2
|
|---|
| 50 | RNJ6,0X
|
|---|
| 51 | UNITS OF SERVICE
|
|---|
| 52 | RNJ9,2XI
|
|---|
| 53 | NON-COVERED CHARGE
|
|---|
| 54 | 1:INPT BS;2:OPT VST DT;3:RX;4:CPT;5:PROS;6:DRG;9:UNASSOCIATED;
|
|---|
| 55 | OFFSET AMOUNT
|
|---|
| 56 | OFFSET DESCRIPTION
|
|---|
| 57 | RNJ10,2
|
|---|
| 58 | NJ11,2
|
|---|
| 59 | PRIMARY PRIOR PAYMENT
|
|---|
| 60 | PRIOR PAYMENT(S)
|
|---|
| 61 | SECONDARY PRIOR PAYMENT
|
|---|
| 62 | TERTIARY PRIOR PAYMENT
|
|---|
| 63 | UB92 FORM LOCATOR 49
|
|---|
| 64 | RX PROCEDURE
|
|---|
| 65 | AUTO ADDED CHARGE - NO CHANGE TO TYPE/COMPONENT
|
|---|
| 66 | BILL COMMENT
|
|---|
| 67 | FORM LOCATOR 2
|
|---|
| 68 | FORM LOCATOR 9
|
|---|
| 69 | FORM LOCATOR 27
|
|---|
| 70 | FORM LOCATOR 45
|
|---|
| 71 | FORM LOCATOR 92
|
|---|
| 72 | FORM LOCATOR 93
|
|---|
| 73 | TREATMENT AUTHORIZATION CODE
|
|---|
| 74 | UF3;4
|
|---|
| 75 | PRIMARY INSURANCE ICN/DCN
|
|---|
| 76 | UF3;5
|
|---|
| 77 | SECONDARY INSURANCE ICN/DCN
|
|---|
| 78 | UF3;6
|
|---|
| 79 | TERTIARY INSURANCE ICN/DCN
|
|---|
| 80 | PRIMARY AUTHORIZATION CODE
|
|---|
| 81 | SECONDARY AUTHORIZATION CODE
|
|---|
| 82 | TERTIARY AUTHORIZATION CODE
|
|---|
| 83 | 1:REFERRING;2:OPERATING;3:RENDERING;4:ATTENDING;9:OTHER;
|
|---|
| 84 | UF3;1
|
|---|
| 85 | UF3;2
|
|---|
| 86 | FORM LOCATOR 11
|
|---|
| 87 | UF3;3
|
|---|
| 88 | FORM LOCATOR 31
|
|---|
| 89 | UF3;7
|
|---|
| 90 | FORM LOCATOR 56
|
|---|
| 91 | UF31;2
|
|---|
| 92 | FORM LOCATOR 78
|
|---|
| 93 | MR*S
|
|---|
| 94 | PERFORMED BY
|
|---|
| 95 | Prov Specialty On File:
|
|---|
| 96 | Provider Specialty On File:
|
|---|
| 97 | PRIMARY PROV ID CARE UNIT
|
|---|
| 98 | IBA(355.96,
|
|---|
| 99 | TX;8
|
|---|
| 100 | FORCE CLAIM TO PRINT
|
|---|
| 101 | 0:NO FORCED PRINT;1:FORCE LOCAL PRINT;2:FORCE CLEARINGHOUSE PRINT;
|
|---|
| 102 | NO FORCED PRINT
|
|---|
| 103 | SECONDRY PROV ID CARE UNIT
|
|---|
| 104 | TERTIARY PROV ID CARE UNIT
|
|---|
| 105 | PRIMARY INS CO ID NUMBER
|
|---|
| 106 | SECONDARY INS CO ID NUMBER
|
|---|
| 107 | TERTIARY INS CO ID NUMBER
|
|---|
| 108 | REFERRING PROVIDER STATE
|
|---|
| 109 | UNABLE TO WORK FROM
|
|---|
| 110 | UNABLE TO WORK TO
|
|---|
| 111 | FORM LOCATOR 37C
|
|---|
| 112 | NON-VA FACILITY
|
|---|
| 113 | NVA_FC
|
|---|
| 114 | NVA_FC-0
|
|---|
| 115 | NON-VA CARE TYPE
|
|---|
| 116 | 1:FEE BASIS, NON-LAB;2:FEE BASIS, LAB;3:NON-FEE BASIS, NON-LAB;4:NON-FEE BASIS, LAB;
|
|---|
| 117 | NON-VA CARE ID #
|
|---|
| 118 | UF31;3
|
|---|
| 119 | FORM LOC 19-UNSPECIFIED DATA
|
|---|
| 120 | DATE LAST SEEN
|
|---|
| 121 | SPECIAL PROGRAM INDICATOR
|
|---|
| 122 | UF2;2
|
|---|
| 123 | PRINT FACILITY DATA IN BOX 32
|
|---|
| 124 | REFERRING PROV STATE
|
|---|
| 125 | AUTHORIZE BILL GENERATION?
|
|---|
| 126 | REASON(S) DISAPPROVED-INITIAL
|
|---|
| 127 | DGCR(399.4,
|
|---|
| 128 | TX;6
|
|---|
| 129 | REQUEST MRA NOW?
|
|---|
| 130 | TX;2
|
|---|
| 131 | LAST ELECTRONIC EXTRACT DATE
|
|---|
| 132 | DATE LAST PRINTED
|
|---|
| 133 | MP399.4'
|
|---|
| 134 | Updating file 399.1 MCCR UTILITY with new occurrence codes...
|
|---|
| 135 | RZD FOR STATE ASSIGNMENT
|
|---|
| 136 | RZD FOR NATIONAL ASSIGNMENT
|
|---|
| 137 | Occurrence Codes added (#399.1)
|
|---|
| 138 | *** Code Added ***
|
|---|
| 139 | NO DIAGNOSTIC MEASURE REPORTS FOUND FOR OCT 2003.
|
|---|
| 140 | DIAGNOSTIC MEASURES DATA ALREADY SENT FOR OCT 2003.
|
|---|
| 141 | Setting status of UNBILLED REPORT for OCT 2003 to complete.
|
|---|
| 142 | Transmitting diagnostic measure reports for OCT 2003.
|
|---|
| 143 | Post-install complete.
|
|---|
| 144 | >>> Updating the IVM Center domain in the IB SITE PARAMETERS (#350.9) file...
|
|---|
| 145 | G.IVM REPORTS@IVM.VA.GOV
|
|---|
| 146 | IB OUTPUT MANAGEMENT REPORTS
|
|---|
| 147 | IB OUTPUT IVM BILLING ACTIVITY
|
|---|
| 148 | <<< Adding IB OUTPUT IVM BILLING ACTIVITY option to IB OUTPUT MANAGEMENT
|
|---|
| 149 | REPORTS menu...
|
|---|
| 150 | <<< Post init complete!
|
|---|
| 151 | <<< Adding new entry to BILL FORM TYPE for IB REPORTS!
|
|---|
| 152 | IB UNBILLED AMOUNTS
|
|---|
| 153 | This mail group will be automatically mailed the IB Unbilled Amounts
|
|---|
| 154 | report each month.
|
|---|
| 155 | You may add members at this time.
|
|---|
| 156 | <<< Mail Group (
|
|---|
| 157 | ) CREATION FAILED !!!
|
|---|
| 158 | <<< Updating your IB Site Parameters
|
|---|
| 159 | 6.25///IB UNBILLED AMOUNTS;6.24///0
|
|---|
| 160 | Patch PRCA*4*24 or PRCA*4.5*6 does not appear to be installed! Please
|
|---|
| 161 | install the appropriate patch and then re-run this initialization.
|
|---|
| 162 | IBCNS QUIT
|
|---|
| 163 | >>> Deleting protocol IBCNS QUIT as an item of IBCNSC INSURANCE CO...
|
|---|
| 164 | (It will be added back in momentarily)
|
|---|
| 165 | IBCNSJ PLAN LOOKUP
|
|---|
| 166 | IBCNSP POLICY MENU
|
|---|
| 167 | for protocol '
|
|---|
| 168 | IBCNS EXPANDED POLICY^1^^80^5^17^1^1^Policy^IBCNSP POLICY MENU^Patient Policy Information^1
|
|---|
| 169 | 'IBCNS PLAN LOOKUP' List Template...
|
|---|
| 170 | IBCNS PLAN LOOKUP^1^^80^7^19^1^1^Plan^IBCNSJ PLAN LOOKUP^Insurance Plan Lookup^1^^1
|
|---|
| 171 | IBCN INSURANCE MGMT MENU
|
|---|
| 172 | IBCN LIST PLANS BY INS CO
|
|---|
| 173 | >>> Adding IBCN LIST PLANS BY INS CO option to the IBCN INSURANCE MGMT MENU...
|
|---|
| 174 | >>> Building the 'ACCP' cross-reference for file #355.3 ...
|
|---|
| 175 | (I'll write a dot for every 100 entries processed)
|
|---|
| 176 | Note that
|
|---|
| 177 | group plan
|
|---|
| 178 | had the individual policy pointer removed.
|
|---|
| 179 | >>> Queuing off a job to clean up various insurance files...
|
|---|
| 180 | (You'll get a message when the job is completed)
|
|---|
| 181 | IB - PATCH IB*2*28 POST INIT - INSURANCE CLEAN-UP
|
|---|
| 182 | The job has been queued. The task number is
|
|---|
| 183 | Unable to queue this job. Please run FIX^IBYAPT1 at any time.
|
|---|
| 184 | Patch IB*2*28 Insurance Clean-up Completion
|
|---|
| 185 | The Insurance Files clean-up job has completed.
|
|---|
| 186 | Number of AGNA cross references in file #355.3 deleted:
|
|---|
| 187 | Number of AGNU cross references in file #355.3 deleted:
|
|---|
| 188 | Number of errant Annual Benefits in file #355.4 deleted:
|
|---|
| 189 | Number of errant Benefits Used in file #355.5 deleted:
|
|---|
| 190 | Number of errant Personal Riders in file #355.7 deleted:
|
|---|
| 191 | Number of Insurance Reviews in file #356.2 repointed:
|
|---|
| 192 | DUZ(0) must also be defined to run this initialization.
|
|---|
| 193 | >> ACCOUNTS RECEIVABLE CATEGORY (430.2) '
|
|---|
| 194 | ' not found.
|
|---|
| 195 | Patch PRCA*4*15 or PRCA*4.5*1 does not appear to be installed! Please install
|
|---|
| 196 | the appropriate patch and then re-run this initialization.
|
|---|
| 197 | CHAMPVA REIMB. INS.
|
|---|
| 198 | DG CHAMPVA PER DIEM NEW
|
|---|
| 199 | DG CHAMPVA PER DIEM CANCEL
|
|---|
| 200 | DG CHAMPVA PER DIEM UPDATE
|
|---|
| 201 | >> RATE TYPE (399.3) '
|
|---|
| 202 | >> ACTION TYPE (350.1) '
|
|---|
| 203 | Required file entries are missing. You should determine why you do not
|
|---|
| 204 | have these entries before continuing. They should have been installed
|
|---|
| 205 | with the installation of IB v2.0.
|
|---|
| 206 | ' is not Inactive.
|
|---|
| 207 | ' already has a pointer
|
|---|
| 208 | to an ACCOUNTS RECEIVABLE CATEGORY (430.2).
|
|---|
| 209 | This RATE TYPE will be re-pointed to a new CATEGORY in this installation.
|
|---|
| 210 | RATE TYPE entries have changed since the release of IB 2.0. You should
|
|---|
| 211 | determine why these entries may have changed, and then inactivate
|
|---|
| 212 | the Rate Types again, before re-running the initialization.
|
|---|
| 213 | CHAMPVA PER DIEM
|
|---|
| 214 | >>> Initializing Billing Parameters for CHAMPVA Billing...
|
|---|
| 215 | >>> Unable to initialize your CHAMPVA billing parameters!
|
|---|
| 216 | Please call your ISC for assistance.
|
|---|
| 217 | >>> It appears as if you are re-running the initialization.
|
|---|
| 218 | The CHAMPVA Billing parameters were not updated.
|
|---|
| 219 | >> The two CHAMPVA RATE TYPES have been activated and linked to an
|
|---|
| 220 | ACCOUNTS RECEIVABLE CATEGORY...
|
|---|
| 221 | >> The Patient Billing CHAMPVA Action Types have been updated...
|
|---|
| 222 | >> Added new CHAMPVA Subsistence rate, effective 10/1/94...
|
|---|
| 223 | .01///IB CHAMPVA RATE/INSURER;.02///Rate Type and Primary Carrier's Type of Coverage do not both match CHAMPVA.
|
|---|
| 224 | >>> IB085 - CHAMPVA Rate/Insurer match error added to IB ERROR file.
|
|---|
| 225 | >>> Installing List Template...
|
|---|
| 226 | BILL#^49^8^Bill #
|
|---|
| 227 | >>> Adding the Reminder Letter into the IB FORM LETTER (#354.6) file...
|
|---|
| 228 | Unable to add the letter! Contact your supporting ISC for assistance.
|
|---|
| 229 | Income Test Reminder Letter^2^15
|
|---|
| 230 | The VA is required by law to charge veterans who receive medications
|
|---|
| 231 | on an outpatient basis for the treatment of nonservice-connected
|
|---|
| 232 | conditions, a copayment of $2.00 for each 30-day (or less) supply
|
|---|
| 233 | of medication provided. Based on the income information requested
|
|---|
| 234 | each year, some veterans may be exempt from the copayment.
|
|---|
| 235 | Our records indicate that your medication copayment exemption
|
|---|
| 236 | status will expire on |VAR(
|
|---|
| 237 | <enter a third paragraph which provides instructions to the veteran>
|
|---|
| 238 | <enter a signature title if desired>
|
|---|
| 239 | Department of Veterans Affairs Medical Center
|
|---|
| 240 | <enter the facility street here>
|
|---|
| 241 | <enter the facility city/state/zip here>
|
|---|
| 242 | IB RX EXEMPTION MENU
|
|---|
| 243 | IB RX REPRINT REMINDER
|
|---|
| 244 | >>> Adding IB RX REPRINT REMINDER option to the IB RX EXEMPTION MENU...
|
|---|
| 245 | APD3 cross reference already exists - not rebuilt
|
|---|
| 246 | >>> Building the 'APD3' cross-reference for file #399 ...
|
|---|
| 247 | (I'll write a dot for every 500 entries processed)
|
|---|
| 248 | Begin:
|
|---|
| 249 | End:
|
|---|
| 250 | entries processed in
|
|---|
| 251 | >>> Correcting the spelling of the entry 'ADMISSION TO CIRCUMENT SLOWNESS'
|
|---|
| 252 | (code 3.03) in file #356.4 ...
|
|---|
| 253 | This entry is not cross-referenced correctly!
|
|---|
| 254 | Please contact IRMFO Customer Service staff for assistance.
|
|---|
| 255 | This entry could not be found!
|
|---|
| 256 | .01////ADMISSION TO CIRCUMVENT SLOWNESS
|
|---|
| 257 | >>> I need to queue a job to clean up the 'Name of Insured' fields in
|
|---|
| 258 | the PATIENT (#2) and BILL/CLAIMS (#399) files...
|
|---|
| 259 | IB - CORRECT 'NAME OF INSURED' VALUES
|
|---|
| 260 | Please note that you will receive a mail message when this job has completed.
|
|---|
| 261 | Job Completion - Correct 'Name of Insured' Fields
|
|---|
| 262 | INTEGRATED BILLING
|
|---|
| 263 | The job to correct the 'Name of Insured' fields in files #2 and #399
|
|---|
| 264 | has completed.
|
|---|
| 265 | Number of policies corrected in file #2:
|
|---|
| 266 | Number of bills corrected in file #399:
|
|---|
| 267 | Patch IB*2*6 does not appear to be installed! Please
|
|---|
| 268 | install this patch and then re-run this initialization.
|
|---|
| 269 | Patch IB*2*8 does not appear to be installed! Please
|
|---|
| 270 | Patch IB*2*13 does not appear to be installed! Please
|
|---|
| 271 | Patch IB*2*23 does not appear to be installed! Please
|
|---|
| 272 | Patch IB*2*40 does not appear to be installed! Please
|
|---|
| 273 | Patch IB*2*45 does not appear to be installed! Please
|
|---|
| 274 | IBCNSP ADD COMMENT
|
|---|
| 275 | IBCNSP EDIT ALL
|
|---|
| 276 | IBCNSJ CHANGE PLAN
|
|---|
| 277 | >>> Deleting protocol
|
|---|
| 278 | as an item of
|
|---|
| 279 | (It will be re-added in a moment)
|
|---|
| 280 | IBCNSC PLAN LIST
|
|---|
| 281 | IBCNSC PLAN DETAIL
|
|---|
| 282 | >>> Rebuilding ^XUTL for protocol '
|
|---|
| 283 | >>> Adding records to INSURANCE RIDERS file for new limitation categories...
|
|---|
| 284 | INPATIENT COVERAGE
|
|---|
| 285 | OUTPATIENT COVERAGE
|
|---|
| 286 | PRESCRIPTION COVERAGE
|
|---|
| 287 | >>> Updating PLAN LIMITATION CATEGORY file with insurance rider info...
|
|---|
| 288 | 'IBCNS INS CO PLAN DETAIL' List Template ...
|
|---|
| 289 | IBCNS INS CO PLAN DETAIL^1^^80^5^17^1^1^Plan^IBCNSC PLAN DETAIL^View/Edit Plan
|
|---|
| 290 | 'IBCNS PLAN LIST' List Template ...
|
|---|
| 291 | IBCNS PLAN LIST^1^^80^6^19^1^1^Plan^IBCNSC PLAN LIST^Insurance Plan List^1^^1
|
|---|
| 292 | Post-Install Complete
|
|---|
| 293 | *** REASON NOT BILLABLE of 'NON-BILLABLE CLINIC' already exists in FILE #356.8, new entry NOT added.
|
|---|
| 294 | <<< Adding new REASON NOT BILLABLE of 'NON-BILLABLE CLINIC' to file #356.8
|
|---|
| 295 | **** Unable to add new entry to FILE #356.8, contact Field Support ****
|
|---|
| 296 | <<< Updating entries in NON-BILLABLE CLINIC STOP CODES (#352.3) file
|
|---|
| 297 | <<< Adding TP Non-billable Stops to NON-BILLABLE CLINIC STOP CODES (#352.3) file
|
|---|
| 298 | *** Could not add entry
|
|---|
| 299 | IB*2*148 Post-Install Complete
|
|---|
| 300 | >> Inactivating Charges for Inactive CPT codes, Please Wait...
|
|---|
| 301 | Charges Inactivated.
|
|---|
| 302 | >> Removing Charges Sets that have no Charges Assigned...
|
|---|
| 303 | #################### #################### ####################
|
|---|
| 304 | #################### #################### ####################
|
|---|
| 305 | #################### #################### ####################
|
|---|
| 306 | #################### #################### ####################
|
|---|
| 307 | #################### #################### ####################
|
|---|
