Changeset 623 for WorldVistAEHR/trunk/r/FEE_BASIS-FB/FBAA79A.m
- Timestamp:
- Dec 4, 2009, 12:11:15 AM (14 years ago)
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- 1 edited
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WorldVistAEHR/trunk/r/FEE_BASIS-FB/FBAA79A.m (modified) (1 diff)
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WorldVistAEHR/trunk/r/FEE_BASIS-FB/FBAA79A.m
r613 r623 1 FBAA79A ;AISC/GRR-PRINT 7079 CONTINUED ;1/12/98 2 ;;3.5;FEE BASIS;**12,103**;JAN 30, 1995;Build 19 3 ;;Per VHA Directive 2004-038, this routine should not be modified. 4 S DIWL=1,DIWF="WC120" K ^UTILITY($J,"W") 5 I $D(^FBAAA(DFN,1,FBK,2)) F FBRR=0:0 S FBRR=$O(^FBAAA(DFN,1,FBK,2,FBRR)) Q:FBRR'>0 S FBXX=^(FBRR,0),X=FBXX D ^DIWP 6 D ^DIWW:$D(FBXX) K FBXX 7 W !,?40,"FOR VA USE ONLY",!,UL 8 W !," (5) STATE CODE | (6) COUNTY CODE | (7) TYPE OF | (8) YEAR OF BIRTH | (9) WAR | (10) PURPOSE |",!,?16,"|",?34,"|",?37,"PATIENT",?48,"|",?68,"|",?78,"|",?93,"|" 9 W !,?7,FBI(5),?16,"|",?23,CC,?34,"|",?41,FBPATT,?48,"|",?58,YOB,?68,"|",?74,POS,?78,"|",?87,POV,?93,"|",!,UL 10 W !,"STATION OF JURISDICTION",?48,"|",?78,"|",?80," (11) CODE",?100,"| (12) SEX",!,?48,"|",?78,"|",?100,"|"," ",$S(SEX="F":"FEMALE",1:"MALE") 11 W !,"Veterans Administration",?48,"|",?78,"|",?100,"|",$E(UL,101,120) 12 W !,FBS(2),?48,"|",?78,"|",?80,$S(CODE=1:"SHORT TERM - 1",CODE=2:"HOME NURSING - 2",CODE=3:"ID CARD STATUS - 3",1:""),?100,"| (13) POW" 13 W:FBS(3)]"" !,FBS(3),?48,"|",?78,"|",?100,"|"," ",$S(POW="Y":"YES",1:"NO") 14 W !,FBS(4)," ",SSTCD," ",FBS(6),?48,"|",?78,"|",?100,"|" W:FBS(3)']"" " ",$S(POW="Y":"YES",1:"NO") W !,?48,$E(UL,49,120) 15 W !,?48,"| APPROVED BY (Name and Title)",?110,"(",$S($D(^VA(200,DUZ,0)):$P(^(0),"^",2),1:""),")",!,?48,"|" 16 W !,"TELEPHONE: ",FBS(7),?48,"|",?50,FBS(8),!,?48,"|",?50,FBS(9),!,UL 17 W !,?32,"Information On Veterans Administration Program",! 18 W !,"Acceptance of this request to render the prescribed services will constitute an agreement which is subject",!,"to the following: ",! 19 W !,?3,"I. SERVICES. If services are not initiated, please return this document to the Station of Jurisdiction with a brief" 20 W !,?5,"explanation. Unless approved by the VA, services are limited in type and extent to those shown.",! 21 W !,?3,"II. PERIOD OF VALIDITY. Service must be performed within the period of validity indicated.",!,?5,"If a longer time is needed, please request an extension.",! 22 W !,?3,"III. REPORTS. Clinical reports are required when an examination only has been requested. Please ",!,?5,"submit reports promptly to the Station Of Jurisdiction.",! 23 W !,?3,"IV. STATEMENT OF ACCOUNTS. Submit a Statement of Account in your usual manner. Your statement must",!,?5,"include: (1) Patient's Name; (2) Identification NO.; (3) Treatment (CPT) and Dates Rendered; and (4) Fees.",! 24 W !,?3,"V. FEES. Fees claimed may not exceed those made to the general public for like services.",! 25 W !,?3,"VI. PAYMENT. Payment by the VA for services rendered and approved is payment in full.",! 26 W !,?3,"VII. HOSPITALIZATION. When a need for hospital care is indicated, please call the Station of Jurisdiction",!,?5,"for assistance in admitting the veteran to a VA hospital.",! 27 W !,?3,"VIII. INQUIRIES. Additional information when required may be obtained by contacting the Station Of Jurisdiction.",! 28 W !,?3,"IX. When submitting claims for payment you must include the NPI and Taxonomy Code of the rendering practitioner, and" 29 W !,?5,"the NPI and Taxonomy Code of your organization. If, under the HIPAA NPI Final Rule" 30 W !,?5,"[http://www.cms.hhs.gov/NationalProvIdentStand], your organization is an ""atypical"" provider furnishing services such as" 31 W !,?5,"taxi, home and vehicle modifications, insect control, habilitation, and respite services and is therefore ineligible" 32 W !,?5,"for an NPI, it is important that you indicate ""Ineligible for NPI"" on your claim form ." 33 W !,UL 34 W !?3,"VA Form 10-7079" 35 W ?85,"Date Printed: ",$$FMTE^XLFDT(DT),! 36 Q 1 FBAA79A ;AISC/GRR-PRINT 7079 CONTINUED ;1/12/98 2 ;;3.5;FEE BASIS;**12**;JAN 30, 1995 3 ;;Per VHA Directive 10-93-142, this routine should not be modified. 4 S DIWL=1,DIWF="WC120" K ^UTILITY($J,"W") 5 I $D(^FBAAA(DFN,1,FBK,2)) F FBRR=0:0 S FBRR=$O(^FBAAA(DFN,1,FBK,2,FBRR)) Q:FBRR'>0 S FBXX=^(FBRR,0),X=FBXX D ^DIWP 6 D ^DIWW:$D(FBXX) K FBXX 7 W !,?40,"FOR VA USE ONLY",!,UL 8 W !," (5) STATE CODE | (6) COUNTY CODE | (7) TYPE OF | (8) YEAR OF BIRTH | (9) WAR | (10) PURPOSE |",!,?16,"|",?34,"|",?37,"PATIENT",?48,"|",?68,"|",?78,"|",?93,"|" 9 W !,?7,FBI(5),?16,"|",?23,CC,?34,"|",?41,FBPATT,?48,"|",?58,YOB,?68,"|",?74,POS,?78,"|",?87,POV,?93,"|",!,UL 10 W !,"STATION OF JURISDICTION",?48,"|",?78,"|",?80," (11) CODE",?100,"| (12) SEX",!,?48,"|",?78,"|",?100,"|"," ",$S(SEX="F":"FEMALE",1:"MALE") 11 W !,"Veterans Administration",?48,"|",?78,"|",?100,"|",$E(UL,101,120) 12 W !,FBS(2),?48,"|",?78,"|",?80,$S(CODE=1:"SHORT TERM - 1",CODE=2:"HOME NURSING - 2",CODE=3:"ID CARD STATUS - 3",1:""),?100,"| (13) POW" 13 W:FBS(3)]"" !,FBS(3),?48,"|",?78,"|",?100,"|"," ",$S(POW="Y":"YES",1:"NO") 14 W !,FBS(4)," ",SSTCD," ",FBS(6),?48,"|",?78,"|",?100,"|" W:FBS(3)']"" " ",$S(POW="Y":"YES",1:"NO") W !,?48,$E(UL,49,120) 15 W !,?48,"| APPROVED BY (Name and Title)",?110,"(",$S($D(^VA(200,DUZ,0)):$P(^(0),"^",2),1:""),")",!,?48,"|" 16 W !,"TELEPHONE: ",FBS(7),?48,"|",?50,FBS(8),!,?48,"|",?50,FBS(9),!,UL 17 W !,?32,"Information On Veterans Administration Program",! 18 W !,"Acceptance of this request to render the prescribed services will constitute an agreement which is subject",!,"to the following: ",! 19 W !,?3,"I. SERVICES. If services are not initiated, please return this document to the Station of Jurisdiction with a brief" 20 W !,?5,"explanation. Unless approved by the VA, services are limited in type and extent to those shown.",! 21 W !,?3,"II. PERIOD OF VALIDITY. Service must be performed within the period of validity indicated.",!,?5,"If a longer time is needed, please request an extension.",! 22 W !,?3,"III. REPORTS. Clinical reports are required when an examination only has been requested. Please ",!,?5,"submit reports promptly to the Station Of Jurisdiction.",! 23 W !,?3,"IV. STATEMENT OF ACCOUNTS. Submit a Statement of Account in your usual manner. Your statement must",!,?5,"include: (1) Patient's Name; (2) Identification NO.; (3) Treatment (CPT) and Dates Rendered; and (4) Fees.",! 24 W !,?3,"V. FEES. Fees claimed may not exceed those made to the general public for like services.",! 25 W !,?3,"VI. PAYMENT. Payment by the VA for services rendered and approved is payment in full.",! 26 W !,?3,"VII. HOSPITALIZATION. When a need for hospital care is indicated, please call the Station of Jurisdiction",!,?5,"for assistance in admitting the veteran to a VA hospital.",! 27 W !,?3,"VIII. INQUIRIES. Additional information when required may be obtained by contacting the Station Of Jurisdiction.",!,UL 28 W !?3,"VA Form 10-7079" 29 W ?85,"Date Printed: ",$$FMTE^XLFDT(DT),! 30 Q
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