English	French	Notes	Complete/Exclude
 Form Locator 			
 Tx Auth. Code  : 			
 Bill Remark       : 			
Pri: 			
 Tx Auth. Code(s)  : 			
 Admitting Dx      : 			
 Admission Source  : 			
(OLD PROV DATA) 			
 Form Locator 2    : 			
 Form Locator 11   : 			
 Form Locator 31   : 			
 Form Locator 56   : 			
 Form Locator 78   : 			
 Force To Print?   : 			
NOT TRANSMITTABLE			
 Provider ID Maint  : (Edit Provider ID information)			
 Unable To Work From: 			
Unable To Work To  : 			
 Admitting Dx       : 			
ICN/DCN(s)         : 			
Tx Auth. Code(s)   : 			
(OLD BOX 31 DATA) 			
 Non-VA Facility    : 			
 Form Locator 19    : 			
Homebound          : 			
Date Last Seen     : 			
Spec Prog Indicator: 			
 Print Main Facility Box 32: 			
Force To Print?    : 			
  **Warning** Credentials differ from those found in NEW PERSON or IB NON VA			
BILLING PROVIDER file (			
Changes will print local, but only credentials on file transmit			
Primary^Secondary^Tertiary			
 ins co requires care unit 			
 for this claim			
No local screen has been defined for this form type			
Bill must have insurance co or resp institution to use this screen			
No local data fields are needed for this bill type/insurance company			
DR(1,399,			
DR(2,2)			
DR(2,2,			
of data,			
 '^N' to jump to screen #N (see			
  Special help screens:			
Enter '?SC' to view SC Status and Rated Disabilities.			
Enter '?INS' to view the patients insurance policies.			
Enter '?PRV' to view provider specific information.			
Enter '?PRC' to view all procedures on the bill and related data.			
Enter '?CHG' to view all items on the bill with potential charges.			
Enter '?CPT' to view all charges for selected CPT codes and bill type.			
Enter '?HCFA' to view how block 24 will print on a HCFA 1500.			
Enter '?INC' to execute the edits & view the bill inconsistencies.			
Enter '?CLA' to view the ClaimsManager options.			
PRESS <RETURN> KEY			
 to RETURN to SCREEN 			
DATA GROUPS ON PARAMETER SCREEN			
 to RETURN to PARAMETER SCREEN			
Patient Employer Name, Address^Spouse Employer Name, Address			
Payer Information^Provider Numbers^Mailing Address			
Admission Information^Discharge Information^Diagnosis Code(s)^Coding Method, Inpt Proc Code(s)^Occurrence Code(s)^Condition Code(s)^Value Code(s)			
Event Date^Outpatient Diagnosis^Outpatient Visits^Coding Method, Opt. Pro. Code(s)^Occurrence Code(s)^Condtion Code(s)			
Bill Type, Covered/Non-Covered Days^R.O.I., Assignment of Benefits^Statement Covers Period^Bedsection, Length of Stay^Revenue Code(s), Offset, Total^Rate Schedule(s)^Prior Payments/Claims			
Bill Remark^Form Locator 2^Form Locator 9^Form Locator 27^Form Locator 45^Form Locator 92^Form Locator 93^Tx Auth. Code			
Locally defined fields			
Bill Remark, ICN/DCN's, Tx Auth. Code, Admit Diagnosis/Source^Providers^Form Locator 2 and 11^Form Locator 31^Form Locator 56, 57, and 78^Force to Print			
Period Unable to Work^Admit Dx, ICN/DCN, Tx/Prior Auth. Code^Providers^Non-VA Facility^Form Locator 19^Force to Print			
Fed Tax #, BC/BS #, MAS Svc Pointer^Bill Signer, Billing Supervisor^Security Parameters, Outpatient CPT parameters ^Remarks, Mailgroups^Agent Cashier Address/Phone			
Demographic^Employment^Payer^Inpatient Event^Outpatient Event^Inpatient Billing - General^Outpatient Billing - General^Billing - Specific^Locally Defined			
Example of diagnoses, procedures and charges printing on the HCFA 1500			
BOX 19 DATA: 			
This is a display of provider specific information.			
Select PROVIDER NAME: 			
 Signature Name: 			
Signature Title: 			
None Active on 			
   Person Class: 			
  PROVIDER TYPE: 			
RC Provider Group: 			
SC Status and Rated Disabilities for 			
 SC At Time Of Care: 			
DO YOU WISH TO ADD/EDIT INSURANCE COMPANY DATA FOR THIS PATIENT			
YES - And I'll prompt you so that you may add insurance data to the PATIENT			
file for this patient.			
NO  - To bypass this editing of the PATIENT file.			
If you updated insurance information for any policy which is already specified			
as either a PRIMARY, SECONDARY or TERIARY for this billing episode, you will			
need to press the <RETURN> key through the following prompts in order to insure			
that these new values are properly stored.  If you fail to do so, i.e.,			
enter an up-arrow, the new values will not be stored as part of this billing			
If a procedure is linked as a prescription to a rev code, it cannot be deleted			
 - Enter the alphanumeric designation of your choice from			
the display (e.g. 'A1') to input one of the codes shown			
above into this billing record.			
 - Enter the name or code number of an 			
ICD DIAGNOSIS 			
not displayed above to input a 			
in the PTF record into this billing record, or '??' for 			
a list of all 			
CODES.			
 - Enter <RETURN> to accept the default 			
DIAGNOSIS 			
PROCEDURE 			
'^' to abort.			
No Codes Entered!			
Procedures Assigned to this Bill			
NO ENTRY FOUND^			
 to EDIT,			
 '^N' for screen N, or '^' to QUIT: 			
SAVE THE VALUE OF $T			
 [NOT REQUIRED]			
 W Z Q			
IOINHI;IOINLOW;IOINORM			
HELP SCREEN			
SCREEN <			
Inpat			
Outpat			
CITY/STATE UNKNOWN			
Patient has no ACTIVE PTF RECORDS for this event date.			
A 'PTF NUMBER' is required for inpatient billing records.			
Select the appropriate billing record from the above listing by number.			
This patient is only 			
 years old!!			
This patient is a MALE!! Condition code 18 applies only to FEMALES!!			
Choose only ACTIVE Revenue Codes!!			
Only ACTIVE Revenue Codes may be selected!!			
NOT A VALID CHOICE!			
LEFT AGAINST MEDICAL ADVICE			
DISCHARGED TO ANOTHER SHORT-TERM GENERAL HOSPITAL			
NO BLUE CROSS/SHIELD PROVIDER NUMBERS IDENTIFIED TO SELECT FROM!			
OR 			
ENTER BLUE CROSS/SHIELD PROVIDER # (BETWEEN 3-13 CHARACTERS)			
Revenue Code Listing			
Non-Cov			
Link Missing			
Current modifier			
Exceeds 'Total Charges' for this bill.			
Edit revenue codes/from-to dates if appropriate.			
START WITH DATE ENTERED: 			
GO TO DATE ENTERED: 			
bill IFN ^ bill date (stm to) ^ bill rate group			
) exists for Rx # 			
 and refill date 			
Cannot precede the 'EVENT DATE'!			
Cannot bill for future treatment!			
Can't be greater than date of specified Procedures!			
'Start Date' must be specified first!			
Cannot preceed the 'Start Date'!			
Must be in same fiscal year!			
Must be in same calendar year!			
Can't be less than date of specified Procedures!			
No 'Start Date' on file...can't enter OP visit dates...			
No 'End Date' on file...can't enter OP visit dates...			
Can't enter a visit date prior to 'Start Date'...			
Can't enter a visit date later than 'End Date'...			
Can Not Precede Bill Start Date!			
Can not be after Bill End Date!			
) exists for visit date (			
MR.			
MS.			
MRS.			
IB-BS			
IB-ASC			
IB-PTF			
Removing old Revenue Codes.			
Editing			
Updating Revenue Codes			
REV. CODE			
) exists overlapping this date range.			
Site param does not allow entry of non-PTF procedures			
SINCE THE PROCEDURE CODING METHOD HAS BEEN CHANGED, DO YOU WANT TO DELETE ALL			
PROCEDURE CODES IN THIS BILL			
If you answer 'Yes', all procedure codes will be DELETED from this bill.			
Procedure Entry:			
Select PROCEDURE DATE			
   Select PROCEDURE: 			
Warning:  Procedure code is inactive on this date			
The Procedure code is inactive on 			
Please select another Procedure.			
Date must be within STATEMENT COVERS FROM and STATEMENT COVERS TO period.			
Enter a date between 			
EDIT HCFA 1500 SPECIAL PROGRAM FIELDS and BOX 19?: 			
Respond YES only if you need to add/edit data for chiropratic visits,			
EPSDT care, or if billing for HOSPICE and attending is not a hospice employee.			
OK to add CPT codes to Visits file			
Adding Procedures to PCE...			
IB DATA			
  Procedures in 			
were added okay.			
were not added - error code is 			
Bill has no ICD DIAGNOSIS.			
<<<ASSOCIATED ICD-9 DIAGNOSIS>>>			
There are no diagnoses associated with this bill.			
 *** Please select procedure diagnoses by number to left of diagnosis code ***			
Current Values:  			
Dx 			
Associated Diagnosis (			
Please enter one of the following billing diagnoses by number at left of code:			
You may also enter '^' to exit, '@' to delete a procedure diagnosis, or			
<CR> to accept a current value or skip a prompt.			
RC-OPT FAC			
RC-PHYSICI			
Modifier 26 			
Deleted from			
Added to			
 CPT procedures.			
Modifier TC Deleted from all Procedures (			
 Procedures Deleted (			
Modifier 26 Procedures Added (			
CPT-CLN			
 replaced by 			
CANCEL WITHOUT EXAM			
ADMIT THRU DISCHARGE			
FIRST CLAIM			
CONTINUING CLAIM			
LAST CLAIM			
LATE CHARGE(S)			
ZERO CLAIM			
Deleting old synonym for the Purge Conversion Log action..........			
IBDFC PURGE CONVERSION LOG			
Cleaning up corrupt second piece of global ^IBE(357,IFN,2,0)			
AICS 3.0 Installation Requirements:			
>>> Environment check failed.  Installation will not be allowed.			
>>> Environment is Ok			
>>> Checking Environment:			
    Can not proceed.  XPDABORT is inappropriately defined.			
    Environment checks OK			
>>> Checking PACKAGE File Entries:			
    Checking for required patch 			
not found!!			
>>> Checking BUILD File Entries:			
Missing Required Package File Entry (Package/Patch): 			
 ...Ok - in Package File			
DG SELECT ICD-9 DIAGNOSIS CODE			
PX INPUT EXAMS			
PX INPUT VISIT CLASSIFICATION			
>>> Now Attempting to automatically update Tool Kit forms and Tool Kit Blocks.			
    Moving Block '			
' from import/export to Tool Kit			
    Moving Form '			
' from import export utility to AICS			
>>> Tool Kit Forms and Blocks are already installed.			
>>>   Tool Kit Forms sent (4): 			
>>> Tool Kit Blocks sent (28): 			
CLINICAL LEXICON ENTRY^P757.01'^LEX(757.01,^2;2^Q			
CLINICAL LEXICON^P757.01'^LEX(757.01,^2;2^Q			
>>> AICS Data Dictionaries updated to use Lexicon Utility version 2.0			
>>> Form Specs being deleted and recreated for scanning.			
INPUT DIAGNOSIS CODE (ICD9)			
DIAGNOSIS/PROBLEM			
DIAGNOSIS/PROBLEM^1^13^14^2^^^			
>>> Updating Package Interface Entry for INPUT DIAGNOSIS CODE (ICD9)			
INPUT PROVIDER			
PX INPUT PATIENT ACTIVE PROBLE			
>>> Deleting Fields *'d for Deletion in Package Interface file (357.6)			
IBD RESOURCE			
>>> Adding Resouce Device 'IBD RESOURCE' for scanning.			
1////IBD RESOURCE;.02////NA;2///RESOURCE			
LIST OF FORMS READY FOR IMPORT OR EXPORT			
(** there are 			
 toolkit blocks in the work space **)			
This form was created with version 			
Export Notes For 			
This action requires PROGRAMMER ACCESS!			
The work space must be cleared before the INITS are run. Is that okay?			
In order for you to import forms from another site the other site must have			
prepared and sent you inits created using the import/export facility.			
What is the name of the init routine that contains the forms that you want to			
That routine does not exist!			
Using the DIFROM action requires PROGRAMMER ACCESS!			
There is nothing in the work space to export!			
LIST OF TOOLKIT BLOCKS READY FOR IMPORT OR EXPORT			
 forms in the work space **)			
What type of block do you want to export?			
NOW CHOOSE THE BLOCK TO COPY!			
New Toolkit Block Name: 			
Enter a unique name for the toolkit block up to 30 characters			
There is already a toolkit block with that name! The name should be unique.			
Moving Form '			
' to import export utility			
Moving Block '			
' from form '			
' to utility			
IBDE CLN			
>>> Now checking the PACKAGE INTERFACE file for inappropriate data qualifiers.			
IBD(357.98,			
 >> WARNING: The following interfaces use the PROBLEM node to transmit data			
    Package Interface 			
    Contact Customer Support for assistance updating the package interface file.			
 >> Summary of the Package Interface Check:			
    No required changes were found.			
    A total of 			
 removed from Package Interface Entries.			
    The PCE DIM data fields for 			
 Package Interface			
 Allowable Qualifier			
    The Package Interface 			
       an invalid qualifier of 			
       a duplicate qualifier of 			
       a bad qualifier of 			
 not deleted, PCE DIM NODE='PROBLEM'			
       The PCE Device Interface Data Updated.			
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