English French Notes Complete/Exclude , was opened for invoices unable to post to 1358. Adjust 1358 and take action on new batch. Print Denials only Do you want to print letters for ALL Fee Basis programs Select PROGRAM to print letter for Do you want to choose another Program Do you want to choose a different letter for each of the PROGRAMS you have selected Select letter to print for Inpatient Payments Outpatient Payments Pharmacy Payments CH Notification/Denials Select Patient (or RETURN to select all): Select Vendor (or RETURN to select all): RX DATE REASON FOR SUSPENSION For All Suspension codes 'Yes' to print suspension letters for all suspension codes, 'No' to select specific codes. There are no suspension letters found that meet the criteria you have CPT- No suspension codes selected! **** REPORT OF FEE SCHEDULE **** For Fiscal Year Total # Date Compiled Date Range There is no data on file for fiscal year Site parameters must be entered before using the Fee system! You have no open Batches!! You currently have the following Batches Open Batch Obligation Opened There is no FEE ID Card information on file for this patient! Are you sure you want to terminate this ID Card ;.7TERMINATION REASON~;S NIDR=X UNKNOWN OPTION REQUEST QUEUED Fee Basis Site Parameters must be entered to proceed batches left before the BATCH PURGE routine needs to be run. Contact your IRM Service! January^February^March^April^May^June^July^August^September^October^November^December Date of Service cannot be later than Invoice Date! Date of Service Authorization period. Unable to determine Station Number. Check Fee Site Parameters or Station Number in the Institution File. Transmission header must exist in FEE BASIS SITE PARAMETER file before you can proceed. Please enter 'Yes' or 'No'. PATIENT HAS NO AUTHORIZATIONS Veteran does NOT have an Authorization for the Fee Program being used !! Is this the correct Authorization period (Y/N) Authorization period There is already an existing admission for this authorization! That transfer type NOT consistent with last transfer type! A 'Transfer From' type transaction can only follow a 'Transfer To' type! Authorization type selected inconsistent with option being used This Obligation number does not exist in the IFCAP file! Queueing has been initiated by another user and is now in progress! Date entered overlaps existing contract dates! Select FROM DATE: Select TO DATE: There already is an active CNH authorization on file. Use the 'Edit CNH Authorization' option. DATE entered overlaps a previous Authorization! Is this the correct vendor Want to review fee pharmacy payment history Re-compile FB input templates Recompilation of Fee Basis Input Templates FB VENDOR UPDATE FBAA AUTHORIZATION NOT A VALID ENTRY! CPT code not valid! CPT Modifier not valid! STATION NUMBER-OBLIGATION NUMBER inappropriate for Business Type. Deleting... Group OO can't be used with other groups. Deleting OO... Group S must be specified with group RV. Adding S... There are no transactions requiring transmission This option will transmit all Batches and MRA's ready to be transmitted to Austin The following Batches will be transmitted: FEE BASIS MESSAGE # FEE NON-VA HOSP TO PRICER MESSAGE # Not approved in Austin yet. CANNOT BE TRANSMITTED!!! Want to edit data *** VENDOR DEMOGRAPHICS *** ==> FLAGGED FOR DELETION <== ==> AWAITING AUSTIN APPROVAL <== ID Number: Address [2]: Type: Participation Code: ZIP: Medicare ID Number: Chain: Fax: Pricer Exempt: Yes Type (FPDS): Group (FPDS): Austin Name: Last Change Last Change Non-Fee User Station TO Austin: FROM Austin: The following data must be entered when adding a new vendor: Entering an '^' at this point will delete vendor! Current Vendor information is pending Austin processing. Changing Vendor information at this time may jeopardize the processing of the existing Master Record Adjustment! Do you wish to continue editing this Vendor Unable to setup MRA transaction. Trying again. .... Vendor deleted >>> CNH INFORMATION <<< Total Beds: Inspected/Accredited: Inspected by VA Accredited by JCAH Inspect. & Accred. Contract #: Medicare/Medicaid: Not Cert. for either Cert. for Medicare Cert. for Medicaid Cert. for both Effect. DT: Last Assessment: End Date: RATE Unable to access vendor record. Trying again. Cannot add contract information to this vendor until change has been approved by Austin. You cannot change contract numbers or effective dates on a contract that has rates associated with it. Contract information reset Enter Nursing Home Rate Enter an amount between .01 and 9999999.99 There are too many rates loaded for that contract! Please remove obsolete rates. Rate already exists for that contract! Vendor selected is not a Community Nursing Home. Current vendor information is pending Austin processing. Use the Display/Edit Vendor option if changes need to be made. Vendor has been deleted. Vendor is being accessed by another user. Select Medical Vendor: NOT PAID ** VENDOR LOOK-UP ** REV.CODE PATIENT ACCOUNT NO. INVOICE # REMIT REMARK DATE PAID Sorry,you must be a supervisor to use this option. Pt.ID ('*' Reimb. to Patient '#' Voided Payment) SVC DATE Which payment item(s) would you like to Cancel the void on the payment(s) Void payment for You must adjust control point accordingly through IFCAP! Cancel Voided payment for Vendor has no Payment data for this Patient! There are no finalized payments for this vendor that have been voided. that may be voided. Sorry, only Supervisor can Finalize batch! Rejected items from batch Want to reject the entire Batch 'Yes' will flag all payment items in batch as rejected, 'No' will prompt for rejection of specific line items. Want to reject any line items Do you want to Finalize Batch as Correct Batch has NOT been Finalized! Batch has been Finalized! Batch is still Open! Supervisor has not Released Batch yet! Batch has not been Transmitted yet! Payment already rejected! Want all line items rejected for this patient Reject which line item You already rejected that one!! Are you sure you want to reject item number: Enter reason for rejecting Required Response!! Item rejected. Want to reject another Reason for rejecting Reject all line items for this patient Are you sure you want to reject line item number: Item Rejected! Want to reject another You just did that one! Item rejected, want to reject another Reason for Rejecting Enter Authorization Number Enter the Authorization Number that appears on the 7079 Enter numerics followed by a dash followed by numerics. Invalid Authorization Number There already is a 7078 set up for this request. The number is AUTHORIZATION TO DATE: Authorization To Date must be after Authorization From Date! DATE OF DISCHARGE: Date of Discharge must not be earlier than the Authorization To Date! ADMITTING AUTHORITY BEDSECTION/TREATING SPECIALTY: ...deleting 7078. Use 'Set-up a 7078' after adjusting 1358. The reference number did not get set up with the IFCAP software. Contact your package coordinator. Obligation number selected is invalid or you are not a control point user in the IFCAP package! Try again DISCHARGE TYPE: Is this Correct ....Posting to 1358 Select one of the following: '00' FOR SURGICAL '10' FOR MEDICAL '86' FOR PSYCHIATRY Estimated amount Enter the reason for pending disposition or an '^' to exit This is a required response. Enter an '^' to exit. Unable to create Non-VA PTF Record. Non-VA PTF Record Created. AUTHORIZATION AND INVOICE FOR MEDICAL AND HOSPITAL SERVICES SPECIAL PROVISIONS: Acceptance of this authorization to render service is governed by the following: 1. ACCEPTANCE OF THIS AUTHORIZATION AND PROVIDING OF SUCH TREATMENT OR SERVICES SUBJECTS YOU, THE PROVIDER OF CARE, TO THE PROVISIONS OF PUBLIC LAW 93-579, THE PRIVACY ACT OF 1974, TO THE EXTENT OF THE RECORDS PERTAINING TO THE VA AUTHORIZED TREATMENT OR SERVICES OF THIS VETERAN. 2. Fees or rates listed represent maximum allowance for services specified. In no event should charges be made to the VA in excess of usual and customary charges to the general public for similar services. 3. Payment by the VA is payment in full for authorized services rendered. 4. Unless otherwise approved by the VA, services are limited in type and extent to those shown on this authorization. If services are not initiated for any reason, return a copy of the authorization to the issuing office with a brief explanation. 5. A copy of the Operative Report will be forwarded to the Authorizing station within one week following any major 6. A copy of the hospital summary will be forwarded to the authorizing station within ten work days following the release of the patient from the hospital. All questions relating to this authorization should be referred to the issuing VA Office VA Form 10-7078 NON-VA HOSPITAL ACTIVITY REPORTS This option will calculate the Activity Report. Enter Month and Year: Do not specify day of month Not future dates ACTIVITY REPORT For the month of: DAYS OF UNAUTH CARE Must delete all movements associated with this authorization before canceling. There is already an invoice entered for this hospitalization. Cannot delete! There already are ancillary services entered against this authorization. Cannot delete! Are you sure you want to cancel Authorization cancelled. Now updating 1358. Unable to affect 1358 adjustment. Use appropriate IFCAP options. 1358 Not available for posting. Authorization has been cancelled Unable to delete PTF record. Select Veteran: AUTHORIZATION TO DATE DATE OF DISCHARGE BEDSECTION/TREATING: Payment already exists for this disposition, editing of dates not allowed! Date of Discharge must now be edited to be equal to or later than the Authorization To Date. ;5ADMITTING AUTHORITY~ This is a mandatory response. Entering an '^' is not allowed! Choose Report Type No payments found within specified timeframe! ** Indicates an Ancillary Payment MILL BILL (1725) NON-MILL BILL UNAUTHORIZED CLAIMS COST REPORT FOR CIVIL HOSPITAL DT CLAIM REC ASSOC 7078 FINAL DRG TREATING SPECIALTY: AVE. AMT. PAID TOTAL CASES: AVERAGE AMOUNT PAID: AVERAGE LOS: TOTAL ANCILLARY PAYMENTS: Are you sure you want to delete this Request ...request deleted Associated 7078: Batch #: Date Finalized: Rejects Pending! Reject reason: Select Invoice to delete: Sure you want to delete this invoice Would you like to reject any invoices from the pricer 70% of Pricer Amount = Enter a reason for rejecting payment from Austin Pricer Are you sure you want to reject this item Reject another No 7078 on file for this authorization. #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### ####################