English French Notes Complete/Exclude WAITING SINCE MAIL MESSAGE # MINIMUM # OF DAYS MSGS WAITING TO BE FILED: Enter the minimum number of days a message has been waiting to be filed before it appears on this report REPORT OF EDI MSGS PENDING TOO LONG TO BE FILED TOTAL # OF MESSAGES WAITING OVER TO BE FILED: EDI MESSAGES WAITING TO BE FILED OVER MESSAGE TYPE IN CURRENT MESSAGE # STATUS SINCE DO YOU WANT TO INCLUDE A LIST OF BILLS WITH EACH BATCH?: Enter the first 10-digit batch number you want included on the report Start with BATCH #: Must enter a 10-digit batch # Enter the last 10-digit batch number you want included on the report Go to BATCH #: Enter the first date you want to include on the report Start with LAST TRANSMIT DATE: Must enter a valid date Enter the last date you want to include on the report Go to LAST TRANSMIT DATE: Select BATCH STATUS: EDI 837 BATCH DETAIL LIST Rejected?: Resubmit: Batch Type : Mail Msg: Received in Austin?: Status Date: Date Recorded: First Sent : Last Sent : Number Transmit Status Resubmit Batch # * = NOT RESUBMITTED Number Transmit Status Resubmit Batch # BATCH DETAIL LIST This report provides a list of claims held in a Ready for Extract status. Users can select all bills in a Ready for extract status or only those trapped due to the EDI Parameters being turned off. This report requires a 132 column printer. IB - EDI Claims in Waiting Transmission Status Your task number has been queued. There are no EDI records in a ready for extract status Total EDI Bills Total MRA Bills Total bills Your EDI site parameter setting is incomplete. Please contact your coordinator. Your site parameters are set to allow EDI transmissions There is no need to run this report. Trapped Claims Ready for Extract Inpt/ Inst/ Opt Prof Statement Date Do you want to print a list of: 1 - All bills in Ready for Extract status 2 - Bills trapped due to EDI paramater being turned off IB - EDI/MRA Claims in Rescue Process There are no records to print Claims in Rescue Process Stmt Date Ins Co. IB-HOLD IBCE ELEC REPORT DISP IBREP DISP IBREP DISP1 No reports available for dispositioning REPORT: RACUBOTH RUCH EDI RETURN MESSAGE ROUTER ERROR Return Message Code: Return Message Date: Message Time: Update Date: Update Time: Return Message File #(s): Mailman Message #: cannot be determined Msg Line: Return Message Text: ERROR+ S.IBCE MESSAGES SERVER *** NEW PAGE *** *** END OF PAGE *** I:G.IB EDI SUPERVISOR Status message received for batch PAYID= PAYER ID RETURNED IS DIFFERENT THAN PAYER ID ON FILE BILL # : PAYER : BILL TYPE : ID ON FILE : ID RETURNED: Please determine which id number is correct and correct the id in the insurance file for this payer, if needed ALREADY EXISTS - CAN'T HAVE BOTH ON ONE BILL IBA(355.93 N-CURRENT INS POLICY TYPE Another user has locked this record - try again later ONLY SELECT TO CLOSE THE TRANSMIT RECORDS IF YOU KNOW THESE ARE THE FINAL ELECTRONIC MESSAGES YOU WILL RECEIVE FOR ALL THE BILLS REFERENCED BY THESE MESSAGES DO YOU WANT TO AUTOMATICALLY CLOSE THE TRANSMIT RECORDS FOR ANY MESSAGES THAT AREN'T REJECTS?: DO YOU WANT TO SEE EACH MESSAGE BEFORE MARKING IT REVIEWED?: IF YOU OPT TO SEE EACH MESSAGE, YOU CAN CONTROL WHETHER OR NOT THE MESSAGE IS MARKED AS REVIEWED AND, FOR NON-REJECTS, WHETHER OR NOT TO CLOSE THE TRANSMIT RECORD FOR THE BILL OK TO MARK REVIEWED?: IF YOU ENTER YES, THIS MESSAGE WILL BE MARKED REVIEWED IF YOU ENTER NO, THIS MESSAGE WILL NOT BE ALTERED IF YOU ENTER AN ^, THIS MESSAGE WILL NOT BE ALTERED & NONE OF THE REMAINING MESSAGES WILL BE PROCESSED OK TO CLOSE THIS BILL'S TRANSMIT RECORD?: THIS IS A REJECTION ... ARE YOU SURE YOU WANT TO MARK IT REVIEWED?: MESSAGES FOLLOWING THIS ONE WILL BE PROCESSED CLAIM SENT TO PAYER CLAIM REJECTED Seq #: Bill number: LAST SELECTION PROCESSED N-PRIOR PAYMENTS PRINT CENTER N-PATIENT STATUS N-SOURCE OF ADMISSION N-OTH INSURANCE PRIOR PAYMENT N-EOB ENTRIES Adding occurrence code 24 and primary insurance rejection date to bill Adding value code for reporting of bill's prior payments N-CURR INSURED DEMOGRAPHICS N-OTH INSURED DEMOGRAPHICS Adding occurrence code ' insurance subscriber's date of birth N-DATE LAST SEEN Date Last Seen: N-REFERRING PROVIDER ID Homebound N-ASSIGN OF BENEFITS INDICATOR Nn0 Patient refuses to assign benefits NOC Drug: Testing for hearing aid Attending physician,not hospice employee Last Xray: Level of Sublux: N-SPECIAL PROGRAM Medicare demonstration project for lung volume reduction surgery study N-HCFA 1500 BOX 19 RAW DATA N-BILL REMARKS DISPLAY THE FULL HCFA 1500 BOX 19?: Bill: VARIABLE TO DISPLAY (IBXDATA): BAD VARIABLE NAME *** NO DATA TO DISPLAY Remember to run this for flds that set up pre-requisite data (if any) first Form Field: N-SPECIALTY CODE N-ALL PROVIDERS PRV-82 DEPT OF VETERANS AFFAIRS SELECT 1- Enter your selection for procedure from 1 to There were more than matches found. Please try again with more specific input N-ATT/REND PROVIDER ID WANT TO CHANGE THE PROVIDER'S FUNCTION TO IF YOU ANSWER YES HERE, YOU WILL MAKE THE PROVIDER FUNCTIONS CONSISTENT WITH THE FORM TYPE OF THE BILL FUNCTION DOES NOT BELONG ON THIS BILL TYPE & MUST BE DELETED This bill is The valid provider functions for this bill are: - ALREADY ON BILL - NOT ON BILL Select Rx for this charge: Enter an Rx# for this revenue code The Rx must not already have an associated revenue code PROCEDURE # HAS BEEN ASSOCIATED WITH THIS MANUAL CHARGE Respond YES if this revenue code charge specifically references the data for a particular procedure that was manually entered on the previous screen. For outpatient UB92 bills, associating a manual revenue code charge with a procedure is the only way to print a modifier in box 44 SHOULD A PROCEDURE ENTRY BE ASSOCIATED WITH THIS CHARGE?: Respond YES if you no longer want this revenue code charge to reference a specific manually entered procedure DELETE THE EXISTING PROCEDURE ASSOCIATION?: SELECT A PROCEDURE ENTRY: Enter a manually-added CPT procedure to associate with this charge IBCE EXTR STATUS MANAGEMENT Claims in need of rescue process This function is not necessary. No records trapped in a Ready for Extract status found Authorizing bill... This option will display the EDI extract data for a bill. There is no entry in the EDI Transmit Bill file for this bill number. There is no batch # for this bill. It has not been transmitted. INCLUDE FIELDS WITH NO DATA?: Transmitted Bill Extract Data Your task number Inpt Oupt (NO DATA - RECORD NOT SENT) EDI Transmitted Bill Extract Data UB-82 FOLLOW-UP AR FORM BILL ADDENDUM FOR BILL FORM TYPE NOT COMPLETE FOR QUEUEING OF DG* *** COPY OF ORIGINAL BILL *** *** SECOND NOTICE *** *** THIRD NOTICE *** MEDICARE ESRD IB-RC Dept. Veterans Affairs Bill Type: INPATIENT CARE ADDITIONAL PROCEDURE CODES: LESS OP VISIT DATE(S) BILLED MISSING INPUT VARIABLES BILL NON-EXISTANT BILL CANCELLED BILL STATUS INAPPROPRIATE For your information, even though the patient may be otherwise eligible for Medicare, no payment may be made under Medicare to any Federal provider of medical care or services and may not be used as a reason for non-payment. Please make your check payable to the Department of Veterans Affairs and send to the address listed above. The undersigned certifies that treatment rendered is not for a service connected disability. IBCF1TP-1 IB - TEST UB-82 PRINT IBCF1TP-2 *** UB-82 TEST PATTERN *** AGENT CASHIER AGENT CASHIER STREET CITY STATE ZIP PHONE # BC/BS # FED TAX # PATIENT ADDRESS PT DOB ADM DT MAILING ADDRESS NAME STREET ADDRESS 1 STREET ADDRESS 3 000 DAYS MEDICAL CARE REV CODE PAYER INSURED NAME POLICY # GROUP NAME GROUP # EMPLOYER NAME CITY STATE ZIP PRINCIPAL DIAGNOSIS PRINCIPAL PROCEDURE TX. AUTH. XXXX XXXXXXX UB-82 TEST PATTERN **TEST PATTERN** UB-82 SIGNER NAME UB-82 SIGNER TITLE PRINT HCFA1500 N-PRINT BILL SUBMIT STATUS ONSET OF SYMPTOMS/ILLNESS PUBLIC LAW 99-272/SECTION 1729 TITLE 38 PUBLIC LAW 99-272 Dept. Of Veterans Affairs THE UNDERSIGNED CERTIFIES TREATMENT IS NOT FOR A SERVICE-CONNECTED CONDITION proc^division^basc flag^bedsection^rev code^unit chrg^Rx seq # proc^division^basc flag^dx^pos^tos^modifier^unit chrg^Rx seq # proc^division^basc^dx^pos^tos^modifier(s)^unit chrg^purchased chg AUX-X not for SC IBCF2TP-1 IB - TEST HCFA 1500 PRINT IBCF2TP-2 INSURANCE CARRIER NAME CARRIER ADDRESS LINE 1 CARRIER ADDRESS LINE 2 CARRIER ADDRESS LINE 3 CARRIER CITY, STATE ZIP SUBSCRIBER ID# MM DD YY INSURED'S NAME PATIENT ADDRESS STREET #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### ####################