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(			
<enter a third paragraph which provides instructions to the veteran>			
<enter a signature title if desired>			
Department of Veterans Affairs Medical Center			
<enter the facility street here>			
<enter the facility city/state/zip here>			
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...			
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