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Global: ^DGCR(399

Package: Integrated Billing

Global: ^DGCR(399


Information

FileMan FileNo FileMan Filename Package
399 BILL/CLAIMS Integrated Billing

Description

Accessed By FileMan Db Calls, Total: 211

Package Total Routines
Integrated Billing 189 IB20P191    IB20P411    IB20P564    IBACUS2    IBCA2    IBCAPP    IBCAPP2    IBCAPR
IBCAPR2    IBCB    IBCB1    IBCBB    IBCBB1    IBCBB13    IBCBB21    IBCC
IBCCC    IBCCC1    IBCCC2    IBCCC3    IBCCCB0    IBCCPT    IBCD3    IBCE837A
IBCE837K    IBCE837N    IBCECOB1    IBCECOB3    IBCEDC    IBCEF11    IBCEF12    IBCEF2
IBCEF21    IBCEF22    IBCEF73A    IBCEF74    IBCEF84    IBCEM03    IBCEM3    IBCEMQA
IBCEMSRI    IBCEMU1    IBCEOB2    IBCEOB3    IBCEP7B    IBCEP81    IBCEPTC2    IBCEPTC3
IBCERP3    IBCERP6    IBCESRV2    IBCEST    IBCEU2    IBCEU3    IBCEU4    IBCEXTR2
IBCEXTRP    IBCF23A    IBCF4    IBCISC    IBCNHPR1    IBCNQ    IBCNSMR0    IBCNSP2
IBCOPR    IBCRTN    IBCSC102    IBCSC10A    IBCSC10B    IBCSC10H    IBCSC4    IBCSC4D
IBCSC5    IBCSC5C    IBCSC7    IBCSC8    IBCSCE    IBCSCH2    IBCU62    IBCU71
IBCU72    IBCVC    IBEFSMUT    IBJTEP    IBJTEP1    IBJTPE    IBJTU2    IBNCPDP2
IBNCPDP3    IBNCPDP5    IBOCPD    IBOHLS1    IBPU2    IBRFIHL2    IBRFIWL    IBRFN4
IBTPRPT    IBTUBO1    IBTUBOA    IBVCB    IBVCB1    IBVCB2    IBXS1    IBXS2
IBXS3    IBXS36    IBXS39    IBXS4    IBXS41    IBXS42    IBXS43    IBXS44
IBXS5    IBXS51    IBXS52    IBXS53    IBXS54    IBXS6    IBXS63    IBXS64
IBXS7    IBXS71    IBXS74    IBXS77    IBXS8    IBXS81    IBXS9    IBXS91
IBXSA    IBXSA2    IBXSA21    IBXSA25    IBXSAH    IBXSAH1    IBXSAH5    IBXSC1
IBXSC2    IBXSC3    IBXSC31    IBXSC34    IBXSC35    IBXSC36    IBXSC39    IBXSC4
IBXSC41    IBXSC42    IBXSC43    IBXSC44    IBXSC5    IBXSC51    IBXSC52    IBXSC53
IBXSC54    IBXSC55    IBXSC6    IBXSC61    IBXSC67    IBXSC68    IBXSC7    IBXSC71
IBXSC712    IBXSC74    IBXSC78    IBXSC79    IBXSC8    IBXSC82    IBXSC821    IBXSC822
IBXSC824    IBXSC829    IBXSC8H    IBXSC8H1    IBXSC8H3    IBXSC8H4    IBXSC8H5    IBXST
IBXST1    IBXST5    IBXST6    IBXX19    IBY137PR    IBY232PO    IBY232PR    IBY288PO
IBY348PR    IBY349PR    IBY400PO    IBY400PR    IBYOPRE    
Accounts Receivable 20 PRCABJ2    PRCAMDA1    PRCAUDT    RCDPARC    RCDPEAD1    RCDPEAD3    RCDPEAPQ    RCDPEM4
RCDPEM5    RCDPEM8    RCDPEMAR    RCDPENR1    RCDPENR2    RCDPENR3    RCDPENR4    RCDPENR5
RCDPEWLD    RCHRFS2    RCVCR2    RCXFMSUR    
Automated Information Collection System 1 IBDFOSG2    
E Claims Management Engine 1 BPSKBERPT    

Pointed To By FileMan Files, Total: 20

Package Total FileMan Files
Integrated Billing 16 BILL/CLAIMS(#399)[.15, .17, 29, 30, 34, 125, 126, 127]    TRICARE PHARMACY TRANSACTIONS(#351.5)[.09]    CLAIMSMANAGER BILLS(#351.9)[.01]    IB AUTOMATED BILLING COMMENTS(#362.1)[.03]    IB BILL/CLAIMS DIAGNOSIS(#362.3)[.02]    IB BILL/CLAIMS PRESCRIPTION REFILL(#362.4)[.02]    IB BILL/CLAIMS PROSTHETICS(#362.5)[.02]    EDI TRANSMIT BILL(#364)[.01]    HEALTH CARE CLAIM RFAI (277)(#368)[111.01]    IB NCPDP EVENT LOG(#366.14)[#366.141(.301), #366.141(7.02)]    IB-FB INTERFACE TRACKING(#360)[1.02]    BILL STATUS MESSAGE(#361)[.01]    EXPLANATION OF BENEFITS(#361.1)[.01, #361.1101(.04), #361.11016(.01), #361.18(.03)]    EDI TEST CLAIM STATUS MESSAGE(#361.4)[.01]    CLAIMS TRACKING(#356)[.11]    CLAIMS TRACKING/BILL(#356.399)[.02]    
E Claims Management Engine 3 BPS REQUESTS(#9002313.77)[1.09]    BPS TRANSACTION(#9002313.59)[#9002313.59902(902.3)]    BPS LOG OF TRANSACTIONS(#9002313.57)[#9002313.57902(902.3)]    
Accounts Receivable 1 RCDPE FIRST PARTY CHARGE QUEUE(#344.74)[.02]    

Pointer To FileMan Files, Total: 34

Package Total FileMan Files
Integrated Billing 20 BILL/CLAIMS(#399)[.15, .17, 29, 30, 34, 125, 126, 127]    MCCR UTILITY(#399.1)[.25, 161, 162, #399.04(.01), #399.041(.01), #399.042(.05), #399.047(.01), #399.048(.01)]    REVENUE CODE(#399.2)[#399.042(.01)]    RATE TYPE(#399.3)[.07]    MCCR INCONSISTENT DATA ELEMENTS(#399.4)[#399.044(.01), #399.045(.01)]    INSURANCE COMPANY(#36)[101, 102, 103, 135]    IB NON/OTHER VA BILLING PROVIDER(#355.93)[232, #399.0222(.02), #399.0404(.02)]
IB INS CO PROVIDER ID CARE UNIT(#355.96)[#399.0222(.09), #399.0222(.1), #399.0222(.11), #399.0222(1.01), #399.0222(1.02), #399.0222(1.03)]    IB ALTERNATE PRIMARY ID TYPE(#355.98)[140, 142, 144]
IB BILL/CLAIMS DIAGNOSIS(#362.3)[#399.0304(10), #399.0304(11), #399.0304(12), #399.0304(13)]    IB ERROR(#350.8)[36]    BILL FORM TYPE(#353)[.19]    PLACE OF SERVICE(#353.1)[168, #399.0304(8)]    TYPE OF SERVICE(#353.2)[169, #399.0304(9)]    IB ATTACHMENT REPORT TYPE(#353.3)[285, #399.0304(71)]    TRANSPORT REASON CODE(#353.4)[288]    AMBULANCE CONDITION INDICATORS(#353.5)[#399.0292(.01)]    IB PROVIDER ID # TYPE(#355.97)[128, 129, 130, #399.0222(.12), #399.0222(.13), #399.0222(.14), #399.0404(.12), #399.0404(.13), #399.0404(.14)]    CMN FORM TYPES(#399.6)[#399.0304(24)]    X12 278 DENTAL NUMBERING SYSTEM(#356.022)[#399.30491(.01)]    
Kernel 4 INSTITUTION(#4)[111]    STATE(#5)[108, 274, 280, #399.0222(.04), #399.0404(.04), #399.041(.03)]    PERSON CLASS(#8932.1)[243, 244, 252, #399.0222(.15), #399.0404(.15)]    NEW PERSON(#200)[2, 5, 8, 11, 13, 15, 18, 32, 37, 475, 477, 479, #399.0222(.02), #399.0304(18), #399.0404(.02), #399.046(.02), #399.077(.02), #399.078(.02)]    
DRG Grouper 3 DRG(#80.2)[170]    ICD OPERATION/PROCEDURE(#80.1)[54, 55, 56, 304, #399.0304(.01)]    ICD DIAGNOSIS(#80)[65, 66, 67, 68, 215, 249, 250, 251, #399.0304(7)]    
Registration 3 MEDICAL CENTER DIVISION(#40.8)[.22, #399.0304(5), #399.042(.07)]
PTF(#45)[.08]    PATIENT(#2)[.02]    
CPT HCPCS Codes 2 CPT MODIFIER(#81.3)[#399.0304(14), #399.30416(.02)]    CPT(#81)[51, 52, 53, 57, 58, 59, 266, 267, 304, #399.0304(.01), #399.0304(24.204), #399.0304(24.219), #399.042(.06)]    
Scheduling 2 HOSPITAL LOCATION(#44)[#399.0304(6)]    OUTPATIENT ENCOUNTER(#409.68)[#399.0304(20)]    

Fields, Total: 259

Field # Name Loc Type Details
.01 BILL NUMBER 0;1 FREE TEXT

  • INPUT TRANSFORM:  K:X[""""!($A(X)=45) X I $D(X) K:X'?.ANP X I $D(X) K:$E(X)=" " X I $D(X) K:$L(X)>10!($L(X)<7) X
  • LAST EDITED:  JUL 14, 2010
  • HELP-PROMPT:  Enter the unique bill number for this billing episode [7-10 characters].
  • DESCRIPTION:  This is the unique bill number assigned to this billing episode. The bill numbers are determined from entries in the AR BILL NUMBER file. New bill numbers consist of 7 characters (Example: K000001). Bill numbers for
    bills that have been cancelled in Integrated Billing (IB) during the process of correcting errors in the original bill, consist of 10 characters, the original bill plus a hyphen and an incremental number (Example:
    K000001-01).
    UNEDITABLE
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  399^B
    1)= S ^DGCR(399,"B",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,"B",$E(X,1,30),DA)
  • CROSS-REFERENCE:  ^^TRIGGER^399^1
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,1)="" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^
    %DTC X ^DD(399,.01,1,3,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,1)=DIV,DIH=399,DIG=1 D ^DICR
    2)= Q
    CREATE CONDITION)= DATE ENTERED=""
    CREATE VALUE)= TODAY
    DELETE VALUE)= NO EFFECT
    FIELD)= #1
  • CROSS-REFERENCE:  ^^TRIGGER^399^2
    1)= X ^DD(399,.01,1,4,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=$S(($D(DUZ)#2):DUZ,1:"") X ^DD(399,.01,1,4,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,2),X=X S X=X=""
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,2)=DIV,DIH=399,DIG=2 D ^DICR
    2)= Q
    CREATE CONDITION)= INTERNAL(#2)=""
    CREATE VALUE)= S X=$S(($D(DUZ)#2):DUZ,1:"")
    DELETE VALUE)= NO EFFECT
    FIELD)= #2
  • CROSS-REFERENCE:  ^^TRIGGER^399^164
    1)= X ^DD(399,.01,1,5,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,14),X=X S DIU=X K Y S X=DIV S X=$S($D(^IBE(350.9,1,1)):$P(^(1),U,6),1:"") X ^DD(399,.01,1,5,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,14)=""
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"U")),DIV=X S $P(^("U"),U,14)=DIV,DIH=399,DIG=164 D ^DICR
    2)= Q
    CREATE CONDITION)= #164=""
    CREATE VALUE)= S X=$S($D(^IBE(350.9,1,1)):$P(^(1),U,6),1:"")
    DELETE VALUE)= NO EFFECT
    FIELD)= #164
    This will automatically store the default BC/BS PROVIDER # from the IB SITE PARAMETERS file into the BC/BS PROVIDER # field for this bill.
  • CROSS-REFERENCE:  ^^TRIGGER^399^.13
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,13),X=X S DIU=X K Y S X=DIV S X=1 S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,13)=DIV,DIH=399,DIG=.13 D ^DICR
    2)= Q
    CREATE VALUE)= S X=1
    DELETE VALUE)= NO EFFECT
    FIELD)= #.13
  • CROSS-REFERENCE:  ^^TRIGGER^399^.19
    1)= X ^DD(399,.01,1,7,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,19),X=X S DIU=X K Y S X=DIV S X=3 S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,19)=DIV,DIH=399,DIG=.19 D ^DICR
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($G(^IBE(353,+$P(Y(1),U,19),0)),U)=""
    2)= Q
    3)= DO NOT DELETE
    CREATE CONDITION)= FORM TYPE=""
    CREATE VALUE)= S X=3
    DELETE VALUE)= NO EFFECT
    FIELD)= FORM TYPE
    Sets the bill's form type to a 3 (UB) when the bill is created.
.02 PATIENT NAME 0;2 POINTER TO PATIENT FILE (#2)
************************REQUIRED FIELD************************
PATIENT(#2)

  • LAST EDITED:  FEB 12, 1997
  • HELP-PROMPT:  Enter the name of the patient for whom this bill is being generated.
  • DESCRIPTION:  
    This is the name of the patient for whom this bill is being generated.
    UNEDITABLE
  • CROSS-REFERENCE:  399^C
    1)= S ^DGCR(399,"C",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,"C",$E(X,1,30),DA)
  • RECORD INDEXES:  AE (#477)
.03 EVENT DATE 0;3 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="ETP",%DT(0)="-0" D ^%DT S X=Y K:Y<1 X I $D(X),'$D(IBNWBL) W !?4,"Event date can no longer be edited...cancel and submit a new bill if necessary." K X
  • LAST EDITED:  FEB 20, 1992
  • HELP-PROMPT:  Enter the date of admission for inpatient episodes of care. For outpatient visits, enter the date of the initial outpatient visit.
  • DESCRIPTION:  
    This is the date on which care was originated. For inpatient episodes of care, this is the admission date. For outpatient visits, this is the date of the initial outpatient visit.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  399^D
    1)= S ^DGCR(399,"D",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,"D",$E(X,1,30),DA)
  • CROSS-REFERENCE:  399^APDT^MUMPS
    1)= S IBN=$P(^DGCR(399,DA,0),"^",2) S:$D(IBN) ^DGCR(399,"APDT",IBN,DA,9999999-X)="" K IBN
    2)= S IBN=$P(^DGCR(399,DA,0),"^",2) I $D(IBN) K ^DGCR(399,"APDT",IBN,DA,9999999-X),IBN
    Cross-reference of bills by patient and event date.
  • CROSS-REFERENCE:  399^ABNDT^MUMPS
    1)= S ^DGCR(399,"ABNDT",DA,9999999-X)=""
    2)= K ^DGCR(399,"ABNDT",DA,9999999-X)
    Cross-reference of bills by inverse event date.
.04 LOCATION OF CARE 0;4 SET
************************REQUIRED FIELD************************
  • '1' FOR HOSPITAL (INCLUDES CLINIC) - INPT. OR OPT.;
  • '2' FOR SKILLED NURSING (NHCU);
  • '7' FOR CLINIC (WHEN INDEPENDENT OR SATELLITE);

  • LAST EDITED:  JAN 16, 2007
  • HELP-PROMPT:  Enter the code which identifies the type of facility at which care was administered.
  • DESCRIPTION:  
    This identifies the type of facility at which care was administered.
  • CROSS-REFERENCE:  ^^TRIGGER^399^.24
    1)= X ^DD(399,.04,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,24),X=X S DIU=X K Y S X=DIV S X=DIV,X=X S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,24)=DIV,DIH=399,DIG=.24 D ^DICR
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(399,.24,0)),U,3),Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,24)_":",2),$C(59))=""
    2)= Q
    3)= Do Not Delete
    CREATE CONDITION)= UB-04 LOCATION OF CARE=""
    CREATE VALUE)= INTERNAL(LOCATION OF CARE)
    DELETE VALUE)= NO EFFECT
    FIELD)= UB-04 LOCATION OF CARE
    This trigger forces the same initial value into the UB-04 LOCATION OF CARE field as the system-calculated LOCATION OF CARE field.
.05 BILL CLASSIFICATION 0;5 SET
************************REQUIRED FIELD************************
  • '1' FOR INPATIENT (MEDICARE PART A);
  • '2' FOR HUMANITARIAN EMERGENCY (INPT./MEDICARE PART B);
  • '3' FOR OUTPATIENT;
  • '4' FOR HUMANITARIAN EMERGENCY (OPT./ESRD);

  • LAST EDITED:  JUL 28, 2011
  • HELP-PROMPT:  Enter the code which designates inpatient or outpatient care.
  • DESCRIPTION:  
    This code identifies the care being billed for as inpatient or outpatient.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  399^ABT
    1)= S ^DGCR(399,"ABT",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,"ABT",$E(X,1,30),DA)
  • CROSS-REFERENCE:  ^^TRIGGER^399^.25
    1)= X ^DD(399,.05,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,25),X=X S DIU=X K Y S X=DIV S X=$$TRIG05^IBCU4(X,D0) S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,25)=DIV,DIH=399,DIG=.25 D ^
    DICR
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($G(^DGCR(399.1,+$P(Y(1),U,25),0)),U)=""
    2)= Q
    CREATE CONDITION)= UB-04 BILL CLASSIFICATION=""
    CREATE VALUE)= S X=$$TRIG05^IBCU4(X,D0)
    DELETE VALUE)= NO EFFECT
    FIELD)= UB-04 BILL CLASSIFICATION
  • CROSS-REFERENCE:  ^^TRIGGER^399^158
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(399,.05,1,3,69.3) S Y(7)=$G(X) S X=Y(0),X=X S X=X=3,Y=X,X=Y(6),X=X&Y I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X=DIV S X=3
    X ^DD(399,.05,1,3,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"U")),DIV=X S $P(^("U"),U,8)=DIV,DIH=399,DIG=158 D ^DICR
    2)= Q
    69.2)= S Y(2)=$C(59)_$P($G(^DD(399,158,0)),U,3),Y(5)=$S($D(^DGCR(399,D0,0)):^(0),1:""),Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"")
    69.3)= X ^DD(399,.05,1,3,69.2) S X=$P($P(Y(2),$C(59)_$P(Y(1),U,8)_":",2),$C(59))="",Y(3)=$G(X),Y(4)=$G(X) S X=$P(Y(5),U,27),X=X S X=X=1,Y=X,X=Y(3),X=X&Y,Y(6)=$G(X)
    CREATE CONDITION)= (#158="")&(INTERNAL(#.27)=1)&(INTERNAL(#.05)=3)
    CREATE VALUE)= S X=3
    DELETE VALUE)= NO EFFECT
    FIELD)= TYPE OF ADMISSION
    This trigger is designed to set the TYPE OF ADMISSION to "3 for ELECTIVE", if it is empty, when the BILL CHARGE TYPE field is equal to "1 for INSTITUTIONAL" and the BILL CLASSIFICATION field is equal to "3 for OUTPATIENT".
.06 TIMEFRAME OF BILL 0;6 SET
************************REQUIRED FIELD************************
  • '1' FOR ADMIT THRU DISCHARGE;
  • '2' FOR INTERIM - FIRST CLAIM;
  • '3' FOR INTERIM - CONTINUING CLAIM;
  • '4' FOR INTERIM - LAST CLAIM;
  • '5' FOR LATE CHARGES ONLY;
  • '6' FOR ADJUSTMENT PRIOR CLAIM;
  • '7' FOR REPLACEMENT PRIOR CLAIM;
  • '8' FOR VOID/CANCEL PRIOR CLAIM;
  • '0' FOR NON-PAY/ZERO CLAIM;

  • LAST EDITED:  JUN 27, 2017
  • HELP-PROMPT:  Enter the code which defines the frequency of this bill.
  • DESCRIPTION:  
    This code defines the frequency of this bill.
  • NOTES:  TRIGGERED by the UB-04 TIMEFRAME OF BILL field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^.26
    1)= X ^DD(399,.06,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,26),X=X S DIU=X K Y S X=DIV S X=DIV,X=X S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,26)=DIV,DIH=399,DIG=.26 D ^DICR
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(399,.26,0)),U,3),Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,26)_":",2),$C(59))=""
    2)= Q
    3)= Do not delete
    CREATE CONDITION)= UB-04 TIMEFRAME OF BILL=""
    CREATE VALUE)= INTERNAL(TIMEFRAME OF BILL)
    DELETE VALUE)= NO EFFECT
    FIELD)= UB-04 TIMEFRAME OF BILL
    This trigger forces the same initial value into the UB-04 TIMEFRAME OF BILL field as the system-calculated TIMEFRAME OF BILL field.
.07 RATE TYPE 0;7 POINTER TO RATE TYPE FILE (#399.3)
************************REQUIRED FIELD************************
RATE TYPE(#399.3)

  • INPUT TRANSFORM:  S DIC("S")="I '$P(^(0),U,3)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JUN 14, 2004
  • HELP-PROMPT:  Enter the code which identifies the type of bill.
  • DESCRIPTION:  
    This identifies the type of bill.
  • SCREEN:  S DIC("S")="I '$P(^(0),U,3)"
  • EXPLANATION:  to screen out Inactive Rate Types
  • CROSS-REFERENCE:  ^^TRIGGER^399^156
    1)= X ^DD(399,.07,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X=DIV S X=1 X ^DD(399,.07,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(399,.07,1,1,69.2) S X=$P($P(Y(102),$C(59)_$P(Y(101),U,5)_":",2),$C(59),1)["YES" S D0=I(0,0)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U")):^("U"),1:""),DIV=X S $P(^("U"),U,6)=DIV,DIH=399,DIG=156 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= X ^DD(399,.07,1,1,2.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X=DIV S X=0 X ^DD(399,.07,1,1,2.4)
    2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(399,.07,1,1,79.2) S Y(101)=$S($D(^DGCR(399.3,D0,0)):^(0),1:"") S X=$P($P(Y(102),$C(59)_$P(Y(101),U,5)_":",2),$C(59),1)'["YES" S D0=I(0,0)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U")):^("U"),1:""),DIV=X S $P(^("U"),U,6)=DIV,DIH=399,DIG=156 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    69.2)= S I(0,0)=$S($D(D0):D0,1:""),D0=Y(0) S:'$D(^DGCR(399.3,+D0,0)) D0=-1 S Y(102)=$C(59)_$S($D(^DD(399.3,.05,0)):$P(^(0),U,3),1:""),Y(101)=$S($D(^DGCR(399.3,D0,0)):^(0),1:"")
    79.2)= S I(0,0)=$S($D(D0):D0,1:""),Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:""),D0=$P(Y(1),U,7) S:'$D(^DGCR(399.3,+D0,0)) D0=-1 S Y(102)=$C(59)_$S($D(^DD(399.3,.05,0)):$P(^(0),U,3),1:"")
    CREATE CONDITION)= RATE TYPE:IS THIS A THIRD PARTY BILL?["YES"
    CREATE VALUE)= S X=1
    DELETE CONDITION)= RATE TYPE:IS THIS A THIRD PARTY BILL?'["YES"
    DELETE VALUE)= S X=0
    FIELD)= ASSIGNMENT OF BENEFITS
  • CROSS-REFERENCE:  ^^TRIGGER^399^.11
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,11),X=X S DIU=X K Y S X=DIV S X=$P(^DGCR(399.3,$P(^DGCR(399,DA,0),U,7),0),U,7) X ^DD(399,.07,1,2,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,11)=DIV,DIH=399,DIG=.11 D ^DICR
    2)= Q
    CREATE VALUE)= S X=$P(^DGCR(399.3,$P(^DGCR(399,DA,0),U,7),0),U,7)
    DELETE VALUE)= NO EFFECT
    FIELD)= WHO'S RESPONSIBLE
  • CROSS-REFERENCE:  399^AD
    1)= S ^DGCR(399,"AD",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,"AD",$E(X,1,30),DA)
.08 PTF ENTRY NUMBER 0;8 POINTER TO PTF FILE (#45)
************************REQUIRED FIELD************************
PTF(#45)

  • INPUT TRANSFORM:  D PTF^IBCU S DIC(0)="MN",DIC="^DGPT(",DIC("S")="I $D(IBDD1(+Y))" D ^DIC:X K DIC,IBDD1 S:$D(DIE) DIC=DIE S X=+Y K:Y<0 X
  • LAST EDITED:  SEP 02, 2008
  • HELP-PROMPT:  ENTER A PTF RECORD BELONGING TO THIS PATIENT ONLY!
  • DESCRIPTION:  
    This identifies PTF records belonging to this patient only.
  • SCREEN:  S DIC("S")="I $D(IBDD1(+Y))"
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^399^159
    1)= X ^DD(399,.08,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,9),X=X S DIU=X K Y S X=DIV S X=2 X ^DD(399,.08,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$S($D(^DD(399,159,0)):$P(^(0),U,3),1:""),Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,9)_":",2),$C(59),1)=""
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U")):^("U"),1:""),DIV=X S $P(^("U"),U,9)=DIV,DIH=399,DIG=159 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= #159=""
    CREATE VALUE)= S X=2
    DELETE VALUE)= NO EFFECT
    FIELD)= #159
  • CROSS-REFERENCE:  ^^TRIGGER^399^158
    1)= X ^DD(399,.08,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X=DIV S X=2 X ^DD(399,.08,1,2,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$S($D(^DD(399,158,0)):$P(^(0),U,3),1:""),Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,8)_":",2),$C(59),1)=""
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U")):^("U"),1:""),DIV=X S $P(^("U"),U,8)=DIV,DIH=399,DIG=158 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= #158=""
    CREATE VALUE)= S X=2
    DELETE VALUE)= NO EFFECT
    FIELD)= #158
  • CROSS-REFERENCE:  ^^TRIGGER^399^162
    1)= X ^DD(399,.08,1,4,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,12),X=X S DIU=X K Y S X=DIV D DIS^IBCU S X=X X ^DD(399,.08,1,4,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$S('$D(^DGCR(399.1,+$P(Y(1),U,12),0)):"",1:$P(^(0),U,1))=""
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U")):^("U"),1:""),DIV=X S $P(^("U"),U,12)=DIV,DIH=399,DIG=162 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,12),X=X S DIU=X K Y S X="" X ^DD(399,.08,1,4,2.4)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U")):^("U"),1:""),DIV=X S $P(^("U"),U,12)=DIV,DIH=399,DIG=162 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE CONDITION)= #162=""
    CREATE VALUE)= D DIS^IBCU S X=X
    DELETE VALUE)= @
    FIELD)= #162
    This sets the discharge status to the correct entry based upon the Disposition Field type in the PTF record.
  • CROSS-REFERENCE:  399^APTF
    1)= S ^DGCR(399,"APTF",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,"APTF",$E(X,1,30),DA)
    Cross reference of all PTF records with associated bills. To be used by PTF purge utilities.
  • CROSS-REFERENCE:  ^^TRIGGER^399^165
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X I $P(^DGCR(399,DA,0),U,5)<3 I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y S X=DIV S X=+$$LOS1^IBCU64(DA) X ^DD(399,.08,1,6,1.4)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U")):^("U"),1:""),DIV=X S $P(^("U"),U,15)=DIV,DIH=399,DIG=165 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= I $P(^DGCR(399,DA,0),U,5)<3
    CREATE VALUE)= S X=+$$LOS1^IBCU64(DA)
    DELETE VALUE)= NO EFFECT
    FIELD)= LENGTH OF STAY
    Sets Length of Stay based on PTF record and date range of bill. Inpatients only.
  • CROSS-REFERENCE:  ^^TRIGGER^399^170
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$PPSC^IBCU64(DA) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y S X=DIV S X=$$PPS^IBCU64(DA,X) X ^DD(399,.08,1,7,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"U1")),DIV=X S $P(^("U1"),U,15)=DIV,DIH=399,DIG=170 D ^DICR
    2)= Q
    CREATE CONDITION)= S X=$$PPSC^IBCU64(DA)
    CREATE VALUE)= S X=$$PPS^IBCU64(DA,X)
    DELETE VALUE)= NO EFFECT
    FIELD)= PPS
    This trigger will create a default PPS (DRG) value into the claim. The trigger condition ensures that the PPS field is currently blank and that the claim is an inpatient, UB type claim.
.09 PROCEDURE CODING METHOD 0;9 SET
  • '4' FOR CPT-4;
  • '5' FOR HCPCS (HCFA COMMON PROCEDURE CODING SYSTEM);
  • '9' FOR ICD;

  • INPUT TRANSFORM:  S:X=4 X=5
  • LAST EDITED:  JAN 28, 2014
  • HELP-PROMPT:  Enter the code which identifies the method for procedure coding on this bill.
  • DESCRIPTION:  
    This defines the outpatient procedure coding method utilized on this bill. If you select CPT-4, it will be changed to HCPCS automatically.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the FORM TYPE field of the BILL/CLAIMS File
.11 WHO'S RESPONSIBLE FOR BILL? 0;11 SET
************************REQUIRED FIELD************************
  • 'p' FOR PATIENT;
  • 'i' FOR INSURER;
  • 'o' FOR OTHER;

  • LAST EDITED:  SEP 24, 1997
  • HELP-PROMPT:  Enter the code which identifies the party responsible for payment of this bill.
  • DESCRIPTION:  
    This identifies the party responsible for payment of this bill.
    UNEDITABLE
  • NOTES:  TRIGGERED by the RATE TYPE field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^112
    1)= X ^DD(399,.11,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"M")):^("M"),1:"") S X=$P(Y(1),U,12),X=X S DIU=X K Y S X=DIV D EN1^IBCU5 X ^DD(399,.11,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=(X="i"&($S('$D(^DGCR(399,DA,"M")):1,'+^("M"):1,'$D(^DIC(36,+^("M"),0)):1,1:0)))
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"M")):^("M"),1:""),DIV=X S $P(^("M"),U,12)=DIV,DIH=399,DIG=112 D ^DICR
    2)= Q
    CREATE CONDITION)= S X=(X="i"&($S('$D(^DGCR(399,DA,"M")):1,'+^("M"):1,'$D(^DIC(36,+^("M"),0)):1,1:0)))
    CREATE VALUE)= D EN1^IBCU5
    DELETE VALUE)= NO EFFECT
    FIELD)= #112
  • CROSS-REFERENCE:  399^AML1^MUMPS
    1)= D EN^IBCU5
    2)= D DEL^IBCU5
    Loads/deletes the mailing address.
  • CROSS-REFERENCE:  399^AREV6^MUMPS
    1)= S DGRVRCAL=1
    2)= S DGRVRCAL=2
    Variable causes revenue codes and charges to be re-calculated on return to the enter/edit billing screens.
  • CROSS-REFERENCE:  ^^TRIGGER^399^.21
    1)= X ^DD(399,.11,1,4,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,21),X=X S DIU=X K Y X ^DD(399,.11,1,4,1.1) X ^DD(399,.11,1,4,1.4)
    1.1)= S X=DIV S X=DIV,X=X S X=X="i",Y(1)=X S X="P",Y(2)=X,Y(3)=X S X=DIV,X=X S X=X="p",Y(4)=X S X="A",Y(5)=X S X=1,Y(6)=X S X="",X=$S(Y(1):Y(2),Y(4):Y(5),Y(6):X)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$S($D(^DD(399,.21,0)):$P(^(0),U,3),1:""),Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,21)_":",2),$C(59),1)=""
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,21)=DIV,DIH=399,DIG=.21 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$S($P(^DGCR(399,DA,0),U,11)'="i":1,"PST"'[$P(^DGCR(399,DA,0),U,21):1,1:0) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,21),X=X S DIU=X K Y S X="" X ^DD(3
    99,.11,1,4,2.4)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,21)=DIV,DIH=399,DIG=.21 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE CONDITION)= CURRENT BILL PAYER SEQUENCE=""
    CREATE VALUE)= $S(INTERNAL(WHO'S RESPONSIBLE)="i":"P",INTERNAL(WHO'S RESPONSIBLE)="p":"A",1:"")
    DELETE CONDITION)= S X=$S($P(^DGCR(399,DA,0),U,11)'="i":1,"PST"'[$P(^DGCR(399,DA,0),U,21):1,1:0)
    DELETE VALUE)= @
    FIELD)= CURRENT BILL PAYER SEQUENCE
    If the Payer Sequence has not been set then set it based on Who's Responsible. When Who's responsible is changed/deleted then update the Payer Sequence if insurer is not reponsible or the payer sequence is not a valid
    sequence for an insurer.
.13 STATUS 0;13 SET
************************REQUIRED FIELD************************
  • '0' FOR CLOSED;
  • '1' FOR ENTERED/NOT REVIEWED;
  • '2' FOR REQUEST MRA;
  • '3' FOR AUTHORIZED;
  • '4' FOR PRNT/TX;
  • '5' FOR **NOT USED**;
  • '7' FOR CANCELLED;

  • LAST EDITED:  MAY 30, 2000
  • HELP-PROMPT:  Enter the code which defines whether or not billing record is editable.
  • DESCRIPTION:  This identifies the status of this billing record. That is, whether or not this record is open for editing. Current valid statuses are: 1=ENTERED/NOT REVIEWED, 2=REQUEST MRA, 3=AUTHORIZED, 4=PRNT/TX, 7=CANCELLED, 0=CLOSED
    Note that 5:TRANSMITTED is not currently valid Only ENTERED/NOT REVIEWED bills are editable.
  • NOTES:  TRIGGERED by the BILL NUMBER field of the BILL/CLAIMS File
    TRIGGERED by the DATE LAST PRINTED field of the BILL/CLAIMS File
    TRIGGERED by the DATE BILL CANCELLED field of the BILL/CLAIMS File
    TRIGGERED by the REQUEST AN MRA? field of the BILL/CLAIMS File
    TRIGGERED by the AUTHORIZE BILL GENERATION? field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^.14
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,14),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC X ^DD(399,.13,1,1,1.4)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,14)=DIV,DIH=399,DIG=.14 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE VALUE)= TODAY
    DELETE VALUE)= NO EFFECT
    FIELD)= #.14
  • CROSS-REFERENCE:  399^AOP^MUMPS
    1)= I X>0,X<3,$P(^DGCR(399,DA,0),U,2) S ^DGCR(399,"AOP",$P(^(0),U,2),DA)=""
    2)= I $P(^DGCR(399,DA,0),U,2) K ^DGCR(399,"AOP",$P(^(0),U,2),DA)
  • CROSS-REFERENCE:  399^AST^MUMPS
    1)= I +X=3 S ^DGCR(399,"AST",+X,DA)=""
    2)= K ^DGCR(399,"AST",+X,DA)
    Cross reference of all Authorized bills.
  • CROSS-REFERENCE:  ^^TRIGGER^399^24
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=Y(0),X=X S X=X=2 I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X=DIV S X="1N" X ^DD(399,.13,1,4,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,5)=DIV,DIH=399,DIG=24 D ^DICR
    2)= X ^DD(399,.13,1,4,2.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X=DIV S X="0" S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,5)=DIV,DIH=399,DIG=24 D ^DICR
    2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(399,.13,1,4,79.2) S Y=X,X=Y(2),X=X!Y,Y(4)=X,Y(5)=X S X=$P(Y(6),U,5),X=X S X=X,Y=X,X=Y(4),X=X&Y
    3)= DO NOT DELETE
    79.2)= S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:""),Y(6)=$S($D(^("TX")):^("TX"),1:"") S X=$P(Y(1),U,13),X=X S X=X=1,Y(2)=X,Y(3)=X S X=$P(Y(1),U,13),X=X S X=X=7
    CREATE CONDITION)= INTERNAL(STATUS)=2
    CREATE VALUE)= "1N"
    DELETE CONDITION)= (INTERNAL(STATUS)=1!(INTERNAL(STATUS)=7))&(INTERNAL(CLAIM MRA STATUS))
    DELETE VALUE)= "0"
    FIELD)= CLAIM MRA STATUS
    This trigger forces the CLAIM MRA STATUS field to be set to '1N' (MRA NEEDED/NOT YET REQUESTED) whenever the STATUS of the claim is set to 2 (REQUEST MRA). If the STATUS of the claim is changed to 1 (ENTERED/NOT REVIEWED)
    or 7 (CANCELLED) and the MRA CLAIM STATUS is currently '1N' or '1R',the MRA CLAIM STATUS field is set to 0 (NO MRA NEEDED).
.14 STATUS DATE 0;14 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  AUG 26, 2003
  • HELP-PROMPT:  Enter the date of last status change.
  • DESCRIPTION:  
    This is the date of the last status change.
  • NOTES:  TRIGGERED by the STATUS field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  399^AF^MUMPS
    1)= D BC^IBJVDEQ
    2)= Q
    This cross-reference sets the record into the nightly Data Extract queue if it meets the criteria.
.15 BILL COPIED FROM 0;15 POINTER TO BILL/CLAIMS FILE (#399) BILL/CLAIMS(#399)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),U,13)=7" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JAN 26, 1990
  • HELP-PROMPT:  Enter the bill that this bill was copied from.
  • DESCRIPTION:  
    If this bill was copied from another bill, then this will be the bill it was copied from. This field is automatically completed by the Copy and Cancel option.
  • SCREEN:  S DIC("S")="I $P(^(0),U,13)=7"
  • EXPLANATION:  BILL MUST BE CANCELLED TO COPY
.16 NON-VA DISCHARGE DATE 0;16 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  APR 20, 1990
  • HELP-PROMPT:  Enter the discharge date for this admission. It must be since the admission date and not in the future.
  • DESCRIPTION:  
    This is the discharge date for NON-VA Admissions when no associated PTF record exists. The date entered must be after the admission date and not into the future.
.17 PRIMARY BILL 0;17 POINTER TO BILL/CLAIMS FILE (#399) BILL/CLAIMS(#399)

  • LAST EDITED:  MAY 24, 1990
  • DESCRIPTION:  
    This is the initial bill that this episode is associated with. If an episode of care has more than one bill but multiple event dates, then this field can be used.
  • CROSS-REFERENCE:  399^AC
    1)= S ^DGCR(399,"AC",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,"AC",$E(X,1,30),DA)
.18 SC AT TIME OF CARE 0;18 FREE TEXT

  • INPUT TRANSFORM:  I $D(X) D YN^IBCU
  • OUTPUT TRANSFORM:  S Y=$S(Y:"YES",Y=0:"NO",1:"")
  • LAST EDITED:  SEP 13, 1991
  • HELP-PROMPT:  Was this patient Service Connected for any condition during the timeframe of this bill? Answer 'Yes' or 'No'.
  • DESCRIPTION:  Was this patient Service Connected for any condition at the time the care in the bill was rendered. This field is used to correctly assign Accounts Receivable AMIS segments to this bill if it is a Reimbursable Insurance
    bill. Answer 'Yes' or 'No'.
    The default for this field is the current value in the SC PATIENT field of the patient file. If this field is left blank, the default value will be used to determine the AMIS segment.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
.19 FORM TYPE 0;19 POINTER TO BILL FORM TYPE FILE (#353)
************************REQUIRED FIELD************************
BILL FORM TYPE(#353)

  • INPUT TRANSFORM:  S DIC("S")="I $$FTINPUT^IBCU9(Y)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  NOV 15, 2017
  • HELP-PROMPT:  Enter the type of claim form to be used.
  • DESCRIPTION:  
    Select the form type on which to print the bill.
  • TECHNICAL DESCR:  
    Critical that this field either be a 2, 3, or a 7.
  • SCREEN:  S DIC("S")="I $$FTINPUT^IBCU9(Y)"
  • EXPLANATION:  Must be a printable national form type.
  • NOTES:  TRIGGERED by the BILL NUMBER field of the BILL/CLAIMS File
    TRIGGERED by the BILL CHARGE TYPE field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^.09
    1)= X ^DD(399,.19,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,9),X=X S DIU=X K Y S X=DIV S X=5 S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,9)=DIV,DIH=399,DIG=.09 D ^DICR
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(399,.19,1,1,69.2) S X=$P($P(Y(3),$C(59)_$P(Y(2),U,9)_":",2),$C(59))="",Y=X,X=Y(1),X=X&Y
    2)= Q
    69.2)= S Y(3)=$C(59)_$P($G(^DD(399,.09,0)),U,3),Y(2)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($G(^IBE(353,+Y(0),0)),U)="CMS-1500",Y(1)=$G(X)
    CREATE CONDITION)= FORM TYPE="CMS-1500"&(PROCEDURE CODING METHOD="")
    CREATE VALUE)= S X=5
    DELETE VALUE)= NO EFFECT
    FIELD)= PROCEDURE CODING METHOD
    If the CMS-1500 claim form is used and no coding method defined, then set coding method to HCPCS
  • CROSS-REFERENCE:  399^AREV7^MUMPS
    1)= S DGRVRCAL=1
    2)= S DGRVRCAL=2
    3)= DO NOT DELETE
    Variable causes revenue codes and chrges to be re-calculated on return to the enter/edit billing screens.
  • CROSS-REFERENCE:  399^AH^MUMPS
    1)= D ALLID^IBCEP3(DA,.19,1)
    2)= D ALLID^IBCEP3(DA,.19,2)
    3)= Do not delete
    This cross reference determines if the change of form type requires the provider id's to be updated or deleted. If it does, the update/deletion is performed for the claim.
  • CROSS-REFERENCE:  ^^TRIGGER^399^140
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,1)=DIV,DIH=399,DIG=140 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE VALUE)= @
    FIELD)= PRIMARY PAYER-ALT ID TYPE
    This trigger removes PRIMARY PAYER-ALT ID TYPE when Form Type is changed since ID Type is dependent on FORM TYPE.
  • CROSS-REFERENCE:  399^AJ^MUMPS
    1)= D ATTREND^IBCU1(DA,"","")
    2)= D ATTREND^IBCU1(DA,"","")
    3)= Do Not Delete
    This Mumps cross reference is used to potentially trigger 6 other fields in file 399. The fields are triggered when the insurance companies in the claim have flags set to use the attending or rendering physicians as the
    billing provider secondary IDs. The flags in file 36 are field #4.06 (ATT/REND ID BILL SEC ID PROF) and field 4.08 (ATT/REND ID BILL SEC ID INST).
    The following fields are the ones being "triggered": #122 PRIMARY PROVIDER # #123 SECONDARY PROVIDER # #124 TERTIARY PROVIDER # #128 PRIMARY ID QUALIFER #129 SECONDARY ID QUALIFIER #130 TERTIARY ID QUALIFIER
  • CROSS-REFERENCE:  ^^TRIGGER^399^141
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,2)=DIV,DIH=399,DIG=141 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE VALUE)= @
    FIELD)= PRIMARY PAYER-ALT ID
    This trigger removes PRIMARY PAYER-ALT ID when Form Type is changed since ID is dependent on FORM TYPE.
  • CROSS-REFERENCE:  ^^TRIGGER^399^142
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,3)=DIV,DIH=399,DIG=142 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE VALUE)= @
    FIELD)= SECONDARY PAYER-ALT ID TYPE
    This trigger removes SECONDARY PAYER-ALT ID TYPE when Form Type is changed since ID Type is dependent on FORM TYPE.
  • CROSS-REFERENCE:  ^^TRIGGER^399^143
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,4)=DIV,DIH=399,DIG=143 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE VALUE)= @
    FIELD)= SECONDARY PAYER-ALT ID
    This trigger removes SECONDARY PAYER-ALT ID when Form Type is changed since ID is dependent on FORM TYPE.
  • CROSS-REFERENCE:  ^^TRIGGER^399^144
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,5)=DIV,DIH=399,DIG=144 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE VALUE)= @
    FIELD)= TERTIARY PAYER-ALT ID TYPE
    This trigger removes TERTIARY PAYER-ALT ID TYPE when Form Type is changed since ID Type is dependent on FORM TYPE.
  • CROSS-REFERENCE:  ^^TRIGGER^399^145
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,6)=DIV,DIH=399,DIG=145 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE VALUE)= @
    FIELD)= TERTIARY PAYER-ALT ID
    This trigger removes TERTIARY PAYER-ALT ID when Form Type is changed since ID is dependent on FORM TYPE.
  • FIELD INDEX:  AK (#984) MUMPS IR ACTION
    Short Descr: Update the line level providers for claim FORM TYPE change.
    Description: For Patch IB*2.0*432:
    The patch introduces line providers to the Bill/Claims process. Line providers (Sub-file 399.0404) are based on the claim FORM TYPE. So, when there is a change in claim FORM TYPE, then we want to update the line level
    providers to be in agreement with the claim FORM TYPE (see below for FORM TYPE and allowable line provider types). In the case when the FORM TYPE field is changed, then the line provider types are checked to see if any, or
    all, line providers need to be deleted from the claim.
    Logic:
    (1) IF $$LNPRVFT^IBCEU7(X,.IBLNPRV) is TRUE, then we have line providers
    in the IBLNPRV array to be deleted.
    Note: IBLNPRV array holds the procedure IENs (Sub-file 399.0304), and
    line provider IENs and .01 field (Sub-file 399.0404,.01) equal to the
    delete indicator "@" in FDA format
    (FDA_ROOT(FILE#,"IENS",FIELD#)="VALUE".
    (2) IF (1) TRUE, then we call FILE^DIE("E","IBLNPRV") to delete the line level providers in the IBLNPRV array.
    Allowable line provider types by FORM TYPE:
    Allowable line provider functions for UB04 (FORM TYPE = 3)
    Inpatient and UB04 Outpatient:
    - Rendering Provider(VAL=3).
    - Referring Provider(VAL=1).
    - Operating Physician(VAL=2).
    - Other Operating Physician(VAL=9).
    Allowable line provider functions for CMS 1500 (FORM TYPE = 2)
    Inpatient and CMS 1500 Outpatient:
    - Rendering Provider(VAL=3).
    - Referring Provider(VAL=1).
    - Supervising Provider(VAL=5).
    Set Logic: N IBLNPRV I $$LNPRVFT^IBCEU7(X,.IBLNPRV) D FILE^DIE("E","IBLNPRV") Q
    Kill Logic: Q
    X(1): FORM TYPE (399,.19) (Len 20) (forwards)
  • FIELD INDEX:  AL (#985) MUMPS IR ACTION
    Short Descr: Remove line level info from inpatient UBs.
    Description: For Patch IB*2.0*432:
    The patch introduces line providers and line level attachment information to the Bill/Claims process. Billers are prevented from entering this information for inpatient UBs. However, if the biller entered the information
    before changing the FORM TYPE to UB, the data may exist and needs to be cleaned up. The clean up routine removes following line level attachment information from the PROCEDURES sub-file (#399.0304): (#70) ATTACHMENT
    CONTROL NUMBER, (#71) ATTACHMENT REPORT TYPE and (#72) ATTACHMENT REPORT TRANS CODE. It also removes all line level provider information in the LINE PROVIDER sub-file (#399.0404).
    Set Logic: D REMOVE^IBCEU7(DA,X(1))
    Set Cond: S X=X(1)=3
    Kill Logic: Q
    X(1): FORM TYPE (399,.19) (Len 20) (forwards)
  • RECORD INDEXES:  ABP (#820)
.2 AUTO 0;20 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  AUG 24, 1995
  • HELP-PROMPT:  True if this bill was created by the auto biller.
  • DESCRIPTION:  
    True if this bill was created by the auto biller. Should only be set by the auto biller software, no manual entry.
  • CROSS-REFERENCE:  ^^TRIGGER^399^2
    1)= X ^DD(399,.2,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=.5 X ^DD(399,.2,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$C(59)_$S($D(^DD(399,.2,0)):$P(^(0),U,3),1:"") S X=$P($P(Y(1),$C(59)_Y(0)_":",2),$C(59),1)="YES"
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"S")):^("S"),1:""),DIV=X S $P(^("S"),U,2)=DIV,DIH=399,DIG=2 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= AUTO="YES"
    CREATE VALUE)= S X=.5
    DELETE VALUE)= NO EFFECT
    FIELD)= ENTERED/EDITED BY
.21 CURRENT BILL PAYER SEQUENCE 0;21 SET
  • 'P' FOR PRIMARY INSURANCE;
  • 'S' FOR SECONDARY INSURANCE;
  • 'T' FOR TERTIARY INSURANCE;
  • 'A' FOR PATIENT;

  • LAST EDITED:  APR 18, 2017
  • HELP-PROMPT:  Enter the entity currently responsible for paying this bill.
  • DESCRIPTION:  
    This field determines the entity currently responsible for paying this bill.
  • SCREEN:  S DIC("S")="I $S(X=""P"":$D(^DGCR(399,DA,""I1"")),X=""S"":$D(^DGCR(399,DA,""I2"")),X=""T"":$D(^DGCR(399,DA,""I3"")),1:1)"
  • EXPLANATION:  Primary/Secondary/Tertiary must have corresponding insurance co on bill.
  • NOTES:  TRIGGERED by the WHO'S RESPONSIBLE FOR BILL? field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^136
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=$$BPP^IBCNS2(DA) X ^DD(399,.21,1,1,1.4)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,2)=DIV,DIH=399,DIG=136 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(399,.21,1,1,2.4)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,2)=DIV,DIH=399,DIG=136 D ^DICR
    CREATE VALUE)= S X=$$BPP^IBCNS2(DA)
    DELETE VALUE)= @
    FIELD)= BILL PAYER POLICY
    Set the Bill Payer Policy to the Payer Policy corresponding to the Payer Sequence.
  • CROSS-REFERENCE:  ^^TRIGGER^399^24
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=('$$REQMRA^IBEFUNC(DA)&$$NEEDMRA^IBEFUNC(DA)) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X=DIV S X=0 X ^DD(399,.21,1,2,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,5)=DIV,DIH=399,DIG=24 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=('$$REQMRA^IBEFUNC(DA)&$$NEEDMRA^IBEFUNC(DA)) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" X ^DD(399,.21,1,2,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,5)=DIV,DIH=399,DIG=24 D ^DICR
    CREATE CONDITION)= ('$$REQMRA^IBEFUNC(DA)&$$NEEDMRA^IBEFUNC(DA))
    CREATE VALUE)= S X=0
    DELETE CONDITION)= ('$$REQMRA^IBEFUNC(DA)&$$NEEDMRA^IBEFUNC(DA))
    DELETE VALUE)= @
    FIELD)= CLAIM MRA STATUS
    When the payer sequence changes, this trigger will detect if an MRA is no longer needed, but the CLAIM MRA STATUS field still indicates than an MRA is still needed. In this case, the CLAIM MRA STATUS is updated to be 0 -
    NO MRA NEEDED.
  • CROSS-REFERENCE:  ^^TRIGGER^399^27
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$S($$WNRBILL^IBEFUNC(DA,X):1,1:0) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" X ^DD(399,.21,1,3,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,8)=DIV,DIH=399,DIG=27 D ^DICR
    2)= Q
    3)= Do not delete
    CREATE CONDITION)= S X=$S($$WNRBILL^IBEFUNC(DA,X):1,1:0)
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= FORCE CLAIM TO PRINT
    If the insurance for the payer sequence is MEDICARE WNR, the data in field FORCE CLAIM TO PRINT must be deleted as it is not valid to print an MRA request.
  • CROSS-REFERENCE:  ^^TRIGGER^399^27
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$CREATE^IBCEF84(DA) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X=DIV S X=1 X ^DD(399,.21,1,4,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,8)=DIV,DIH=399,DIG=27 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$DELETE^IBCEF84(DA) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" X ^DD(399,.21,1,4,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,8)=DIV,DIH=399,DIG=27 D ^DICR
    CREATE CONDITION)= S X=$$CREATE^IBCEF84(DA)
    CREATE VALUE)= S X=1
    DELETE CONDITION)= S X=$$DELETE^IBCEF84(DA)
    DELETE VALUE)= @
    FIELD)= FORCE CLAIM TO PRINT
    This trigger is designed to set the FORCE CLAIM TO PRINT field 27 equal to 1 for SECONDARY MEDICARE WNR claims if the carrier field PRINT SEC MED CLAIMS W/O MRA, 6.1 is set. If the current value of field 27, FORCE CLAIM
    TO PRINT is equal to 1, and field .21, CURRENT BILL PAYER SEQUENCE is changed to something other than "S", then the value in field 27, FORCE CLAIM TO PRINT, is deleted.
  • CROSS-REFERENCE:  ^^TRIGGER^399^125
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=Y(0),X=X S X=X="P" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" X ^DD(399,.21,1,5,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,5)=DIV,DIH=399,DIG=125 D ^DICR
    2)= Q
    CREATE CONDITION)= INTERNAL(CURRENT BILL PAYER SEQUENCE)="P"
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= PRIMARY BILL #
    This TRIGGER removes the PRIMARY BILL # when the CURRENT BILL PAYER SEQUENCE is set to "P"rimary to prevent COB information from subsequent claims being placed on the 837 claims transmission.
  • CROSS-REFERENCE:  ^^TRIGGER^399^126
    1)= X ^DD(399,.21,1,6,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,6)=DIV,DIH=399,DIG=126 D ^DICR
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=Y(0),X=X S X=X="P",Y(1)=$G(X),Y(2)=$G(X) S X=Y(0),X=X S X=X="S",Y=X,X=Y(1),X=X!Y
    2)= Q
    CREATE CONDITION)= INTERNAL(CURRENT BILL PAYER SEQUENCE)="P"!(INTERNAL(CURRENT BILL PAYER SEQUENCE)="S")
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= SECONDARY BILL #
    This TRIGGER removes the SECONDARY BILL # when the CURRENT BILL PAYER SEQUENCE is set to either "P"rimary or "S"econdary to prevent COB information from subsequent claims being placed on the 837 claims transmission.
  • CROSS-REFERENCE:  ^^TRIGGER^399^127
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,7)=DIV,DIH=399,DIG=127 D ^DICR
    2)= Q
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= TERTIARY BILL #
    This TRIGGER removes the TERTIARY BILL # when the CURRENT BILL PAYER SEQUENCE is set to either "P"rimary, "S"econdary or "T"ertiary to prevent COB information from subsequent claims being placed on the 837 claims
    transmission.
  • CROSS-REFERENCE:  ^^TRIGGER^399^218
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=Y(0),X=X S X=X="P" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X="" X ^DD(399,.21,1,8,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,4)=DIV,DIH=399,DIG=218 D ^DICR
    2)= Q
    CREATE CONDITION)= INTERNAL(CURRENT BILL PAYER SEQUENCE)="P"
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= PRIMARY PRIOR PAYMENT
    This TRIGGER removes the PRIMARY PRIOR PAYMENT when the CURRENT BILL PAYER SEQUENCE is set to "P"rimary to properly adjust the calculation of the OFFSET AMOUNT for subsequent claims being placed on the 837 claims
    tranmission.
  • CROSS-REFERENCE:  ^^TRIGGER^399^219
    1)= X ^DD(399,.21,1,9,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,5)=DIV,DIH=399,DIG=219 D ^DICR
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=Y(0),X=X S X=X="P",Y(1)=$G(X),Y(2)=$G(X) S X=Y(0),X=X S X=X="S",Y=X,X=Y(1),X=X!Y
    2)= Q
    CREATE CONDITION)= INTERNAL(CURRENT BILL PAYER SEQUENCE)="P"!(INTERNAL(CURRENT BILL PAYER SEQUENCE)="S")
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= SECONDARY PRIOR PAYMENT
    This TRIGGER removes the SECONDARY PRIOR PAYMENT when the CURRENT BILL PAYER SEQUENCE is set to "P"rimary or "S"econdary to properly adjust the calculation of the OFFSET AMOUNT for subsequent claims being placed on the 837
    claims transmission.
  • CROSS-REFERENCE:  ^^TRIGGER^399^220
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,6)=DIV,DIH=399,DIG=220 D ^DICR
    2)= Q
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= TERTIARY PRIOR PAYMENT
    This TRIGGER removes the TERTIARY PRIOR PAYMENT when the CURRENT BILL PAYER SEQUENCE is set to "P"rimary, "S"econdary or "T"ertiary to properly adjust the calculation of the OFFSET AMOUNT for subsequent claims being placed
    on the 837 claims transmission.
.22 DEFAULT DIVISION 0;22 POINTER TO MEDICAL CENTER DIVISION FILE (#40.8) MEDICAL CENTER DIVISION(#40.8)

  • LAST EDITED:  JUN 14, 2006
  • HELP-PROMPT:  Enter the default division that should be used in charge calculations.
  • DESCRIPTION:  
    For rates specific to a division, this division will be used to determine the charges for all CPT's that do not have a division specified.
  • CROSS-REFERENCE:  ^^TRIGGER^399^235
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$CLIAREQ^IBCEP8A(DA) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,13),X=X S DIU=X K Y S X=DIV S X=$$CLIA^IBCEP8A(DA) X ^DD(399,.22,1,7,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,13)=DIV,DIH=399,DIG=235 D ^DICR
    2)= Q
    CREATE CONDITION)= S X=$$CLIAREQ^IBCEP8A(DA)
    CREATE VALUE)= S X=$$CLIA^IBCEP8A(DA)
    DELETE VALUE)= NO EFFECT
    FIELD)= LAB CLIA NUMBER
    This trigger will set the LAB CLIA NUMBER field to the default CLIA# for the division when the division field is entered or changed. The trigger condition ensures that lab services are on the claim.
  • RECORD INDEXES:  ABP (#820)
.24 UB-04 LOCATION OF CARE 0;24 SET
************************REQUIRED FIELD************************
  • '1' FOR HOSPITAL - INPT OR OPT (INCLUDES CLINICS);
  • '2' FOR SKILLED NURSING (NHCU);
  • '3' FOR HOME HEALTH AGENCY;
  • '7' FOR CLINIC (ONLY INDEPENDENT/SATELITE);
  • '8' FOR SPEC. FACILITY HOSP/AMB SURG CTR;

  • LAST EDITED:  JAN 16, 2007
  • HELP-PROMPT:  Enter the appropriate UB-04 location of care
  • DESCRIPTION:  
    This field contains the code representing the location of care for a bill. This is the first digit of the 3-digit UB-04 type of bill.
  • NOTES:  TRIGGERED by the LOCATION OF CARE field of the BILL/CLAIMS File
.25 UB-04 BILL CLASSIFICATION 0;25 POINTER TO MCCR UTILITY FILE (#399.1)
************************REQUIRED FIELD************************
MCCR UTILITY(#399.1)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),U,23),$$TOBIN^IBCU4(Y,D0)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  JAN 16, 2007
  • HELP-PROMPT:  Enter the appropriate UB-04 bill classification
  • DESCRIPTION:  
    This field contains the code representing the bill classification for the bill. It is the second digit in the 3-digit UB-04 type of bill.
  • SCREEN:  S DIC("S")="I $P(^(0),U,23),$$TOBIN^IBCU4(Y,D0)"
  • EXPLANATION:  CLASSIFICATION MUST BE CONSISTENT WITH LOC OF CARE VALUE
  • NOTES:  TRIGGERED by the BILL CLASSIFICATION field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  399^AI^MUMPS
    1)= D ALLID^IBCEP3(DA,.25,1)
    2)= D ALLID^IBCEP3(DA,.25,2)
    3)= Do not delete
    This cross reference determines if the change of care type requires the provider id's to be updated or deleted. If it does, the update/deletion is performed for the claim.
.26 UB-04 TIMEFRAME OF BILL 0;26 SET
************************REQUIRED FIELD************************
  • '1' FOR ADMIT THRU DISCHARGE;
  • '2' FOR INTERIM - 1ST CLAIM;
  • '3' FOR INTERIM - CONTINUING CLAIM;
  • '4' FOR INTERIM - LAST CLAIM;
  • '5' FOR LATE CHARGES ONLY;
  • '6' FOR ADJUSTMENT CLAIM;
  • '7' FOR REPLACEMENT CLAIM;
  • '8' FOR VOID/CANCEL PRIOR CLAIM;
  • '0' FOR NON-PAY/ZERO CLAIM;

  • LAST EDITED:  JUN 27, 2017
  • HELP-PROMPT:  Enter the appropriate UB-04 timeframe of bill
  • DESCRIPTION:  
    This field contains the code representing the timeframe of the bill value for the bill. This is the 3rd digit of the 3-digit UB-04 type of bill.
  • NOTES:  TRIGGERED by the TIMEFRAME OF BILL field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^.06
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X=DIV S X=DIV,X=X S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,6)=DIV,DIH=399,DIG=.06 D ^DICR
    2)= Q
    CREATE VALUE)= INTERNAL(UB-04 TIMEFRAME OF BILL)
    DELETE VALUE)= NO EFFECT
    FIELD)= TIMEFRAME OF BILL
.27 BILL CHARGE TYPE 0;27 SET
  • '1' FOR INSTITUTIONAL;
  • '2' FOR PROFESSIONAL;

  • LAST EDITED:  JUL 28, 2011
  • HELP-PROMPT:  Enter the part of the service to the patient this bill covers.
  • DESCRIPTION:  
    The service to the patient may have two components, institutional/facility and professional. If this bill only has charges for one of these components then enter that component.
  • CROSS-REFERENCE:  ^^TRIGGER^399^.19
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,19),X=X S DIU=X K Y S X=DIV S X=$$FT^IBCU3(DA,1) X ^DD(399,.27,1,1,1.4)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,19)=DIV,DIH=399,DIG=.19 D ^DICR
    2)= Q
    CREATE VALUE)= S X=$$FT^IBCU3(DA,1)
    DELETE VALUE)= NO EFFECT
    FIELD)= FORM TYPE
    Sets the bill Form Type based on Insurance, Charge Type, and Site default.
  • CROSS-REFERENCE:  ^^TRIGGER^399^158
    1)= X ^DD(399,.27,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X=DIV S X=3 S DIH=$G(^DGCR(399,DIV(0),"U")),DIV=X S $P(^("U"),U,8)=DIV,DIH=399,DIG=158 D ^DICR
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(399,.27,1,2,69.3) S Y(6)=$G(X) S X=$P(Y(7),U,5),X=X S X=X=3,Y=X,X=Y(5),X=X&Y
    2)= Q
    69.2)= S Y(2)=$C(59)_$P($G(^DD(399,158,0)),U,3),Y(7)=$S($D(^DGCR(399,D0,0)):^(0),1:""),Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"")
    69.3)= X ^DD(399,.27,1,2,69.2) S X=$P($P(Y(2),$C(59)_$P(Y(1),U,8)_":",2),$C(59))="",Y(3)=$G(X),Y(4)=$G(X) S X=Y(0),X=X S X=X=1,Y=X,X=Y(3),X=X&Y,Y(5)=$G(X)
    CREATE CONDITION)= (#158="")&(INTERNAL(#.27)=1)&(INTERNAL(#.05)=3)
    CREATE VALUE)= S X=3
    DELETE VALUE)= NO EFFECT
    FIELD)= TYPE OF ADMISSION
    This trigger is designed to set the TYPE OF ADMISSION to "3 for ELECTIVE", if it is empty, when the BILL CHARGE TYPE field is equal to "1 for INSTITUTIONAL" and the BILL CLASSIFICATION field is equal to "3 for OUTPATIENT".
  • FIELD INDEX:  AM (#989) MUMPS IR ACTION
    Short Descr: Trigger to reset the Revenue Code MANUALLY EDITED flag.
    Description: This trigger is designed to remove the MANUALLY EDITED flag from all records in the REVENUE CODE multiple when the BILL CHARGE TYPE field is changed.
    Set Logic: D CMAEDALL^IBCU9(DA)
    Kill Logic: D CMAEDALL^IBCU9(DA)
    X(1): BILL CHARGE TYPE (399,.27) (Subscr 1) (forwards)
.28 INITIAL DATE OF SERVICE 0;28 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  AUG 31, 2021
  • HELP-PROMPT:  Please enter the initial date of service.
  • DESCRIPTION:  
    This field contains initial date of service.
1 DATE ENTERED S;1 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  MAY 21, 1992
  • HELP-PROMPT:  Enter the date on which this billing record was established.
  • DESCRIPTION:  
    This is the date on which this billing record was established.
    UNEDITABLE
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the BILL NUMBER field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  399^APD
    1)= S ^DGCR(399,"APD",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,"APD",$E(X,1,30),DA)
    Regular cross-reference used to speed up reports.
2 ENTERED/EDITED BY S;2 POINTER TO NEW PERSON FILE (#200)
************************REQUIRED FIELD************************
NEW PERSON(#200)

  • LAST EDITED:  SEP 21, 1990
  • HELP-PROMPT:  Enter the user who established this billing record.
  • DESCRIPTION:  
    This is the user who established this billing record.
    UNEDITABLE
  • NOTES:  TRIGGERED by the BILL NUMBER field of the BILL/CLAIMS File
    TRIGGERED by the AUTO field of the BILL/CLAIMS File
3 INITIAL REVIEW S;3 FREE TEXT

  • INPUT TRANSFORM:  I $D(X) D YN^IBCU
  • OUTPUT TRANSFORM:  S Y=$S(Y:"YES",Y=0:"NO",1:"")
  • LAST EDITED:  MAR 10, 1994
  • HELP-PROMPT:  Enter 'Yes' or '1' if the information in this record is accurate and complete or 'No' or '0' if the information is inaccurate or incomplete.
  • DESCRIPTION:  
    This allows the user to approve or disapprove the information contained in this billing record.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^399^4
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,4)="" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^
    %DTC X ^DD(399,3,1,1,1.4)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"S")):^("S"),1:""),DIV=X S $P(^("S"),U,4)=DIV,DIH=399,DIG=4 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= INITIAL REVIEW DATE=""
    CREATE VALUE)= TODAY
    DELETE VALUE)= NO EFFECT
    FIELD)= INITIAL REVIEW DATE
  • CROSS-REFERENCE:  ^^TRIGGER^399^5
    1)= X ^DD(399,3,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X=DIV S X=DUZ X ^DD(399,3,1,2,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$S('$D(^VA(200,+$P(Y(1),U,5),0)):"",1:$P(^(0),U,1))=""
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"S")):^("S"),1:""),DIV=X S $P(^("S"),U,5)=DIV,DIH=399,DIG=5 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= INITIAL REVIEWER=""
    CREATE VALUE)= S X=DUZ
    DELETE VALUE)= NO EFFECT
    FIELD)= INITIAL REVIEWER
4 INITIAL REVIEW DATE S;4 DATE

  • INPUT TRANSFORM:  S %DT="ETX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JAN 16, 1990
  • HELP-PROMPT:  Enter the date on which this billing record was first reviewed.
  • DESCRIPTION:  
    This is the date on which this record was initially reviewed.
  • NOTES:  TRIGGERED by the INITIAL REVIEW field of the BILL/CLAIMS File
5 INITIAL REVIEWER S;5 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  SEP 21, 1990
  • HELP-PROMPT:  Enter the user who first reviewed this billing record.
  • DESCRIPTION:  
    This is the user who performed the initial review on this billing record.
    UNEDITABLE
  • NOTES:  TRIGGERED by the INITIAL REVIEW field of the BILL/CLAIMS File
6 SECONDARY REVIEW S;6 FREE TEXT

  • INPUT TRANSFORM:  I $D(X) D YN^IBCU
  • OUTPUT TRANSFORM:  S Y=$S(Y:"YES",Y=0:"NO",1:"")
  • LAST EDITED:  JUL 24, 1998
  • HELP-PROMPT:  Enter 'Yes' or '1' if the information in this record is accurate and complete, or 'No' or '0' if the information is inaccurate or incomplete.
  • DESCRIPTION:  
    This allows the user to approve or disapprove the information contained in this billing record during the secondary review stage.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
7 MRA REQUESTED DATE S;7 DATE

  • INPUT TRANSFORM:  S %DT="ETX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  MAY 28, 2004
  • HELP-PROMPT:  Enter the date on which the last request for an MRA was performed.
  • DESCRIPTION:  
    This is the last date for which this record requested an MRA.
  • TECHNICAL DESCR:  
    This field used to contain the SECONDARY REVIEW DATE data, but is being recycled for requesting MRA date data.
    WRITE AUTHORITY: ^
  • NOTES:  TRIGGERED by the REQUEST AN MRA? field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  399^APM
    1)= S ^DGCR(399,"APM",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,"APM",$E(X,1,30),DA)
    Regular cross-reference on the date the MRA was requested. Used to speed up reports.
8 MRA REQUESTOR S;8 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JUL 24, 1998
  • HELP-PROMPT:  Enter the user who requested this bill be submitted to request an MRA
  • DESCRIPTION:  
    This is the user who requested this bill be submitted to request an MRA because MEDICARE WNR is the current insurance for the bill.
  • TECHNICAL DESCR:  
    This field used to contain the SECONDARY REVIEWER data, but is being recycled for who requested an MRA data.
  • NOTES:  TRIGGERED by the REQUEST AN MRA? field of the BILL/CLAIMS File
9 AUTHORIZE BILL GENERATION? S;9 FREE TEXT

  • INPUT TRANSFORM:  I $D(X) D YN^IBCU
  • OUTPUT TRANSFORM:  S Y=$S(Y:"YES",Y=0:"NO",1:"")
  • LAST EDITED:  JUN 20, 2003
  • HELP-PROMPT:  Enter 'Yes' or '1' if the billing record has been reviewed and is ready for authorization, or 'No' or '0' if the billing record is not ready to be authorized.
  • DESCRIPTION:  
    This allows the user to authorize the printing/transmitting of this bill.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^399^10
    1)= X ^DD(399,9,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,10),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC X ^DD(399,9,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,10)="",Y(2)=X,Y(3)=X,Y=Y(0) X:$D(^DD(399,9,2)) ^(2) S X=Y="YES",Y=X,X=Y(2),X=X&Y
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"S")):^("S"),1:""),DIV=X S $P(^("S"),U,10)=DIV,DIH=399,DIG=10 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= AUTHORIZATION DATE=""&(#9="YES")
    CREATE VALUE)= TODAY
    DELETE VALUE)= NO EFFECT
    FIELD)= AUTHORIZATION DATE
  • CROSS-REFERENCE:  ^^TRIGGER^399^11
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(399,9,1,2,69.2) S X=X="YES",Y=X,X=Y(2),X=X&Y I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,11),X=X S DIU=X K Y S X=DIV S X=DUZ X ^DD(399,9,1,2,1.4)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"S")):^("S"),1:""),DIV=X S $P(^("S"),U,11)=DIV,DIH=399,DIG=11 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    69.2)= S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$S('$D(^VA(200,+$P(Y(1),U,11),0)):"",1:$P(^(0),U,1))="",Y(2)=X,Y(3)=X,Y=Y(0) X:$D(^DD(399,9,2)) ^(2) S X=Y
    CREATE CONDITION)= AUTHORIZER=""&(#9="YES")
    CREATE VALUE)= S X=DUZ
    DELETE VALUE)= NO EFFECT
    FIELD)= AUTHORIZER
  • CROSS-REFERENCE:  ^^TRIGGER^399^.13
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y=Y(0) X:$D(^DD(399,9,2)) ^(2) S X=Y="YES" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,13),X=X S DIU=X K Y S X=DIV S X=3 X ^DD(399,9,1,3,1.4)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,13)=DIV,DIH=399,DIG=.13 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= #9="YES"
    CREATE VALUE)= S X=3
    DELETE VALUE)= NO EFFECT
    FIELD)= STATUS
  • CROSS-REFERENCE:  ^^TRIGGER^399^25
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$EXTERNAL^DIDU(399,9,"",Y(0))="YES" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X="" X ^DD(399,9,1,4,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,6)=DIV,DIH=399,DIG=25 D ^DICR
    2)= Q
    CREATE CONDITION)= #9="YES"
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= REQUEST
    If Authorize Bill Generation? (Fld #9) is answered with Yes, then the value in Request an MRA? (Fld #25) gets removed (set to null).
10 AUTHORIZATION DATE S;10 DATE

  • INPUT TRANSFORM:  S %DT="ETX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  AUG 24, 1995
  • HELP-PROMPT:  Enter date on which this billing record was authorized for generation.
  • DESCRIPTION:  
    This is the date on which this bill was authorized for printing.
    UNEDITABLE
  • NOTES:  TRIGGERED by the AUTHORIZE BILL GENERATION? field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  399^APD3
    1)= S ^DGCR(399,"APD3",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,"APD3",$E(X,1,30),DA)
    Regular cross-reference used to speed up reports.
11 AUTHORIZER S;11 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  SEP 21, 1990
  • HELP-PROMPT:  Enter user who authorized this bill for generation.
  • DESCRIPTION:  
    This is the user who authorized the generation of this bill.
    UNEDITABLE
  • NOTES:  TRIGGERED by the AUTHORIZE BILL GENERATION? field of the BILL/CLAIMS File
12 DATE FIRST PRINTED S;12 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="ETX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 18, 2004
  • HELP-PROMPT:  Enter date on which this bill was first generated.
  • DESCRIPTION:  
    This is the date on which the bill was first printed.
  • CROSS-REFERENCE:  ^^TRIGGER^399^14
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,14)="" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,14),X=X S DIU=X K Y S X=DIV N %I,%H,% D NO
    W^%DTC X ^DD(399,12,1,1,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,14)=DIV,DIH=399,DIG=14 D ^DICR
    2)= Q
    CREATE CONDITION)= #14=""
    CREATE VALUE)= TODAY
    DELETE VALUE)= NO EFFECT
    FIELD)= #14
  • CROSS-REFERENCE:  ^^TRIGGER^399^15
    1)= X ^DD(399,12,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y S X=DIV S X=DUZ S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,15)=DIV,DIH=399,DIG=15 D ^DICR
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P($G(^VA(200,+$P(Y(1),U,15),0)),U)=""
    2)= Q
    CREATE CONDITION)= #15=""
    CREATE VALUE)= S X=DUZ
    DELETE VALUE)= NO EFFECT
    FIELD)= #15
  • CROSS-REFERENCE:  ^^TRIGGER^399^13
    1)= X ^DD(399,12,1,3,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,13),X=X S DIU=X K Y S X=DIV S X=DUZ S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,13)=DIV,DIH=399,DIG=13 D ^DICR
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P($G(^VA(200,+$P(Y(1),U,13),0)),U)=""
    2)= Q
    CREATE CONDITION)= FIRST PRINTED BY=""
    CREATE VALUE)= S X=DUZ
    DELETE VALUE)= NO EFFECT
    FIELD)= FIRST PRINTED BY
  • CROSS-REFERENCE:  399^AP
    1)= S ^DGCR(399,"AP",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,"AP",$E(X,1,30),DA)
    Regular cross-reference to be used to speed up reports.
13 FIRST PRINTED BY S;13 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  SEP 21, 1990
  • HELP-PROMPT:  Enter user who first generated this bill.
  • DESCRIPTION:  
    This is the user who first generated this bill.
  • NOTES:  TRIGGERED by the DATE FIRST PRINTED field of the BILL/CLAIMS File
14 DATE LAST PRINTED S;14 DATE

  • INPUT TRANSFORM:  S %DT="ETX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 14, 2004
  • HELP-PROMPT:  Enter date on which this bill was last generated.
  • DESCRIPTION:  
    This is the date on which this bill was last printed.
  • NOTES:  TRIGGERED by the DATE FIRST PRINTED field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^.13
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,13),X=X S DIU=X K Y S X=DIV S X=4 S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,13)=DIV,DIH=399,DIG=.13 D ^DICR
    2)= Q
    CREATE VALUE)= S X=4
    DELETE VALUE)= NO EFFECT
    FIELD)= STATUS
  • CROSS-REFERENCE:  ^^TRIGGER^399^15
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y S X=DIV S X=DUZ S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,15)=DIV,DIH=399,DIG=15 D ^DICR
    2)= Q
    CREATE VALUE)= S X=DUZ
    DELETE VALUE)= NO EFFECT
    FIELD)= #15
15 LAST PRINTED BY S;15 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  SEP 21, 1990
  • HELP-PROMPT:  Enter user who generated this bill last.
  • DESCRIPTION:  
    This is the user who last printed this bill.
    UNEDITABLE
  • NOTES:  TRIGGERED by the DATE FIRST PRINTED field of the BILL/CLAIMS File
    TRIGGERED by the DATE LAST PRINTED field of the BILL/CLAIMS File
16 CANCEL BILL? S;16 FREE TEXT

  • INPUT TRANSFORM:  I $D(X) D YN^IBCU
  • OUTPUT TRANSFORM:  S Y=$S(Y:"YES",Y=0:"NO",1:"")
  • LAST EDITED:  APR 06, 2004
  • HELP-PROMPT:  Enter 'Yes' or '1' if you want this billing record to be cancelled, 'No' or '0' if you do not want this billing record to be cancelled.
  • DESCRIPTION:  
    This allows the user to cancel this bill.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^399^17
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$EXTERNAL^DIDU(399,16,"",Y(0))="YES" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,17),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC X ^DD(399,16,1,1,
    1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,17)=DIV,DIH=399,DIG=17 D ^DICR
    2)= Q
    CREATE CONDITION)= CANCEL BILL?="YES"
    CREATE VALUE)= TODAY
    DELETE VALUE)= NO EFFECT
    FIELD)= #17
  • CROSS-REFERENCE:  ^^TRIGGER^399^18
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$EXTERNAL^DIDU(399,16,"",Y(0))="YES" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,18),X=X S DIU=X K Y S X=DIV S X=DUZ X ^DD(399,16,1,2,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,18)=DIV,DIH=399,DIG=18 D ^DICR
    2)= Q
    CREATE CONDITION)= CANCEL BILL?="YES"
    CREATE VALUE)= S X=DUZ
    DELETE VALUE)= NO EFFECT
    FIELD)= #18
17 DATE BILL CANCELLED S;17 DATE

  • INPUT TRANSFORM:  S %DT="ETX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 14, 2004
  • HELP-PROMPT:  Enter date on which this bill was cancelled.
  • DESCRIPTION:  
    This is the date on which this billing record was cancelled.
    UNEDITABLE
  • NOTES:  TRIGGERED by the CANCEL BILL? field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^.13
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,16),X=X S X=X=1 I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,13),X=X S DIU=X K Y S X=DIV S X=7 X ^
    DD(399,17,1,1,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,13)=DIV,DIH=399,DIG=.13 D ^DICR
    2)= Q
    CREATE CONDITION)= INTERNAL(#16)=1
    CREATE VALUE)= S X=7
    DELETE VALUE)= NO EFFECT
    FIELD)= STATUS
18 BILL CANCELLED BY S;18 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  SEP 21, 1990
  • HELP-PROMPT:  Enter user who cancelled this bill.
  • DESCRIPTION:  
    This is the user who cancelled this bill.
    UNEDITABLE
  • NOTES:  TRIGGERED by the CANCEL BILL? field of the BILL/CLAIMS File
19 REASON CANCELLED S;19 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>100!($L(X)<3)!'(X?1A.ANP) X I '$D(X) X ^DD(399,19,9.3)
  • LAST EDITED:  JAN 21, 1992
  • HELP-PROMPT:  Enter the 3-100 character reason(s) why this bill was cancelled.
  • DESCRIPTION:  
    This is the reason(s) why this bill was cancelled. This entry is mandatory when cancelling a bill. Enter 3-100 characters, the first character must be an alphabetic character.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
20 LAST AUSTIN CONFIRM DATE TX;1 DATE

  • INPUT TRANSFORM:  S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  AUG 19, 1996
  • HELP-PROMPT:  Enter the date/time that this bill was confirmed by Austin as received.
  • DESCRIPTION:  
    This is the last date/time that Austin received the bill.
21 LAST ELECTRONIC EXTRACT DATE TX;2 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  APR 18, 2000
  • HELP-PROMPT:  Enter the date/time that this bill was last extracted for EDI transmission.
  • DESCRIPTION:  
    This is the last time this bill was extracted to be transmitted to Austin.
  • CROSS-REFERENCE:  399^ALEX
    1)= S ^DGCR(399,"ALEX",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,"ALEX",$E(X,1,30),DA)
    3)= Please do not delete
    This cross reference provides a way to easily find all bills extracted in a selected date range.
22 MRA RECORDED DATE TX;3 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  APR 21, 1999
  • HELP-PROMPT:  Enter the date the MRA was received for this bill
  • DESCRIPTION:  
    This is the date that the MRA was recorded as being received for this bill.
  • NOTES:  TRIGGERED by the CLAIM MRA STATUS field of the BILL/CLAIMS File
23 IS DUPLICATE? S;20 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  OCT 08, 2019
  • HELP-PROMPT:  Enter 'Yes' if this claim is a valid duplicate claim. Otherwise, enter 'No'.
  • DESCRIPTION:  
    If this claim is an EDI resubmission of a claim, then this field will be set to 'Yes'. If this field value is 'No' and FSC identifies this claim as a duplicate (already transmitted), then it will be ignored.
24 CLAIM MRA STATUS TX;5 SET
  • '0' FOR NO MRA NEEDED;
  • '1N' FOR MRA NEEDED/NOT YET REQUESTED;
  • '1R' FOR MRA REQUESTED;
  • 'C' FOR VALID MRA RECEIVED;
  • 'A' FOR MRA SKIPPED;

  • LAST EDITED:  OCT 03, 2000
  • HELP-PROMPT:  ENTER THE STATUS OF THE CLAIM FOR MRA
  • DESCRIPTION:  
    This field tracks the process of obtaining an MRA for a MEDICARE primary claim.
  • TECHNICAL DESCR:  If 'CLAIM MRA STATUS, there is no need to check for MRA status any further as either the MRA has been received or is not needed.
    This field is used to determine what can happen to this claim. If an MRA is needed, this field will prevent it from being sent to A/R and will protect it from any other action that would compromise its integrity until a
    formal bill can be created for it.
  • NOTES:  TRIGGERED by the STATUS field of the BILL/CLAIMS File
    TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
    TRIGGERED by the PRIMARY INSURANCE CARRIER field of the BILL/CLAIMS File
    TRIGGERED by the SECONDARY INSURANCE CARRIER field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^22
    1)= X ^DD(399,24,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV S X=DT X ^DD(399,24,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,3)="",Y(2)=X,Y(3)=X S X=Y(0),X=X S X=X="C",Y=X,X=Y(2),X=X&Y
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"TX")):^("TX"),1:""),DIV=X S $P(^("TX"),U,3)=DIV,DIH=399,DIG=22 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= MRA RECORDED DATE=""&(INTERNAL(CLAIM MRA STATUS)="C")
    CREATE VALUE)= S X=DT
    DELETE VALUE)= NO EFFECT
    FIELD)= MRA RECORDED DATE
25 REQUEST AN MRA? TX;6 FREE TEXT

  • INPUT TRANSFORM:  I $D(Y) D YN^IBCU
  • OUTPUT TRANSFORM:  S Y=$P("NO^YES",U,Y+1)
  • LAST EDITED:  JUL 25, 2003
  • HELP-PROMPT:  Enter 'Yes' (1) if the bill has been reviewed and is ready for submission to MEDICARE for an MRA, or 'No' (0) if the billing record is not ready to be submitted.
  • DESCRIPTION:  
    This field indicates that the bill is ready to send to MEDICARE for an MRA.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the AUTHORIZE BILL GENERATION? field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^.13
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=Y(0),X=X S X=X=1 I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,13),X=X S DIU=X K Y S X=DIV S X=2 X ^DD(399,25,1,1,1.4)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,13)=DIV,DIH=399,DIG=.13 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    3)= Do not delete
    CREATE CONDITION)= INTERNAL(REQUEST AN MRA)=1
    CREATE VALUE)= S X=2
    DELETE VALUE)= NO EFFECT
    FIELD)= STATUS
    This triggers the status of the bill to indicate an MRA is ready to be requested.
  • CROSS-REFERENCE:  ^^TRIGGER^399^8
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(399,25,1,2,69.2) S X=X S X=X="",Y=X,X=Y(2),X=X&Y I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X=DIV S X=DUZ X ^DD(399,25,1,2,1
    .4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,8)=DIV,DIH=399,DIG=8 D ^DICR
    2)= Q
    69.2)= S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:""),Y(4)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,13),X=X S X=X=2,Y(2)=$G(X),Y(3)=$G(X) S X=$P(Y(4),U,8)
    CREATE CONDITION)= (INTERNAL(#.13)=2)&(INTERNAL(#8)="")
    CREATE VALUE)= S X=DUZ
    DELETE VALUE)= NO EFFECT
    FIELD)= MRA REQUESTOR
  • CROSS-REFERENCE:  ^^TRIGGER^399^7
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(399,25,1,3,69.2) S X=X S X=X="",Y=X,X=Y(2),X=X&Y I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X=DIV S X=DT X ^DD(399,25,1,3,1.
    4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,7)=DIV,DIH=399,DIG=7 D ^DICR
    2)= Q
    69.2)= S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:""),Y(4)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,13),X=X S X=X=2,Y(2)=$G(X),Y(3)=$G(X) S X=$P(Y(4),U,7)
    CREATE CONDITION)= (INTERNAL(#.13)=2)&(INTERNAL(#7)="")
    CREATE VALUE)= S X=DT
    DELETE VALUE)= NO EFFECT
    FIELD)= MRA REQUESTED DATE
26 PRINTED VIA EDI? TX;7 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  JUL 12, 1999
  • HELP-PROMPT:  Enter 1 if this claim was printed at the EDI contractor
  • DESCRIPTION:  
    This field is the flag that says the bill was not transmitted electronically when the EDI contractor got the claim, but was printed at their print shop and mailed out.
27 FORCE CLAIM TO PRINT TX;8 SET
  • '0' FOR NO FORCED PRINT;
  • '1' FOR FORCE LOCAL PRINT;
  • '2' FOR *FORCE CLEARINGHOUSE PRINT;

  • LAST EDITED:  MAR 14, 2014
  • HELP-PROMPT:  Enter 0 to transmit the claim electronically to the payer. Enter 1 to print the claim locally.
  • DESCRIPTION:  
    This field determines whether a claim is transmitted electronically (0) or printed locally (1).
  • SCREEN:  S DIC("S")="I Y'=2"
  • EXPLANATION:  Print to Clearinghouse is no longer an available option.
  • NOTES:  TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
    TRIGGERED by the PRIMARY INSURANCE CARRIER field of the BILL/CLAIMS File
    TRIGGERED by the SECONDARY INSURANCE CARRIER field of the BILL/CLAIMS File
    TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
    TRIGGERED by the PRIMARY INSURANCE CARRIER field of the BILL/CLAIMS File
28 FORCE PRINT MRA SECONDARY TX;9 SET
  • '0' FOR NO FORCED PRINT;
  • '1' FOR MEDICARE SECONDARY FORCE LOCAL PRINT;

  • LAST EDITED:  SEP 16, 2004
  • HELP-PROMPT:  Enter a 1 to force print locally the subsequent MRA claim
  • DESCRIPTION:  Once the MRA is received from Medicare, the payer sequence on this claim will be incremented and this claim will become the subsequent MRA claim.
    If this field is set to FORCE LOCAL PRINT, then the subsequent MRA claim cannot be electronically transmitted and must be printed locally.
    If this field is set to NO FORCED PRINT (Default), then the subsequent MRA claim may be sent electronically to the next payer.
28.1 MRA REVIEW STATUS TX;10 SET
  • '0' FOR NOT BEING REVIEWED;
  • '1' FOR REVIEW IN PROCESS;

  • LAST EDITED:  AUG 20, 2010
  • HELP-PROMPT:  Enter code indicating whether this MRA claim is being reviewed.
  • DESCRIPTION:  
    Select code that indicates whether this claim is under review.
29 BILL CLONED TO S1;1 POINTER TO BILL/CLAIMS FILE (#399) BILL/CLAIMS(#399)

  • LAST EDITED:  JUL 12, 2005
  • HELP-PROMPT:  Select the Bill Number for which the new claim is being created.
  • DESCRIPTION:  
    This is the Bill Number for which the new claim is being created.
30 BILL CLONED FROM S1;2 POINTER TO BILL/CLAIMS FILE (#399) BILL/CLAIMS(#399)

  • LAST EDITED:  JUL 11, 2005
  • HELP-PROMPT:  Select the Bill Number from which this claim was cloned.
  • DESCRIPTION:  
    This is the bill number to which this claim is being cloned.
31 DATE BILL CLONED S1;3 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUL 11, 2005
  • HELP-PROMPT:  Enter the date this bill was cloned.
  • DESCRIPTION:  
    This is the date this bill was cloned.
32 BILL CLONED BY S1;4 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JUL 11, 2005
  • HELP-PROMPT:  Enter the name of the person who is cloning the claim.
  • DESCRIPTION:  
    This is the user who cloned the claim.
33 REASON CLONED S1;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  JUL 11, 2005
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the reason why the old claim was cloned to a new one.
34 AUTO PROCESSED FROM CLAIM S1;6 POINTER TO BILL/CLAIMS FILE (#399) BILL/CLAIMS(#399)

  • LAST EDITED:  OCT 14, 2010
  • HELP-PROMPT:  Select the claim which was used to auto-process the current claim.
  • DESCRIPTION:  
    This claim was used to create the current claim by the commercial insurance auto-processing routines. It is system generated and uneditable by the users.
35 AUTO PROCESS S1;7 SET
  • '1' FOR WORKLIST;
  • '2' FOR AUTO LOCAL PRINT;
  • '3' FOR AUTO EDI;
  • '4' FOR NO LONGER ON WORKLIST;

  • LAST EDITED:  OCT 14, 2010
  • HELP-PROMPT:  What is the result of the auto-processing of this claim?
  • DESCRIPTION:  The result of the commercial claim auto-processing. There are three possible outcomes of the auto-processing. The claim can automatically be sent electronically. The claim can automatically be printed locally. Finally,
    the claim can be added to the worklist.
    This claim will be changed to NO LONGER ON WORKLIST when this claim is 'worked' off either by removing, cloning, or processing the claim. This removes the claim from the active worklist but serves as an audit trail to
    show the result of the commercial claim auto-processing.
    This field is set by the system and should not be edited through Fileman.
  • CROSS-REFERENCE:  399^CAP
    1)= S ^DGCR(399,"CAP",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,"CAP",$E(X,1,30),DA)
    This is the cross reference used to build the COB Management worklist.
36 AUTO PROCESS REASON S1;8 POINTER TO IB ERROR FILE (#350.8) IB ERROR(#350.8)

  • LAST EDITED:  NOV 08, 2010
  • HELP-PROMPT:  Why was this claim not auto-processed?
  • DESCRIPTION:  
    This is the reason that the claim failed auto-processing and was put on the worklist. This is system generated. Do not edit through Fileman.
37 REMOVED FROM WORKLIST BY S1;9 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  OCT 14, 2010
  • HELP-PROMPT:  Select the user who removed the claim from the COB worklist.
  • DESCRIPTION:  
    This is the user who removed the Claim from the COB worklist. Set by the system automatically. Don't edit through Fileman.
37.1 ON TAS PCR? S1;10 SET (BOOLEAN Data Type)
  • Yes indicates this claim has been included on the TAS Printed Claims Report(PCR).

  • LAST EDITED:  OCT 03, 2022
  • HELP-PROMPT:  Enter 'Yes' to indicate this claim has been included on the TAS Printed Claims Report (PCR). Otherwise, enter 'No'.
  • DESCRIPTION:  
    Yes indicates this claim has been included on the TAS Printed Claims Report(PCR).
38 REMOVED FROM WORKLIST HOW UF32;4 SET
  • 'RM' FOR REMOVE ACTION;
  • 'PC' FOR PROCESS COB ACTION;
  • 'CL' FOR CLONE ACTION;
  • 'CA' FOR CANCELLED ACTION;
  • 'CR' FOR CORRECTED ACTION;

  • LAST EDITED:  MAR 18, 2011
  • HELP-PROMPT:  How was the claim removed from the COB worklist?
  • DESCRIPTION:  
    This is the action which removed this claim from the COB worklist. Set by the system automatically. Don't edit through Fileman.
39 REMOVED FROM WORKLIST DATE UF32;5 DATE

  • INPUT TRANSFORM:  S %DT="ESTX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  OCT 15, 2010
  • HELP-PROMPT:  Enter the date that this claim was removed from COB management worklist.
  • DESCRIPTION:  
    This is the date/time the claim was removed from the COB management worklist worklist. Set automatically. Don't edit through Fileman.
40 CONDITION CODE CC;0 POINTER Multiple #399.04 399.04

  • DESCRIPTION:  
    This identifies the condition(s) relating to this bill that may affect payer processing.
41 OCCURRENCE CODE OC;0 POINTER Multiple #399.041 399.041

  • DESCRIPTION:  
    This identifies the significant event(s) relating to this bill that may affect payer processing.
  • SCREEN:  S DIC("S")="I $D(^DGCR(399.1,+Y,0)) I $P(^DGCR(399.1,+Y,0),""^"",4)=1 X ^DD(399.041,9.1)"
  • EXPLANATION:  Valid MCCR Occurrence Codes only!
  • IDENTIFIED BY:  DATE(#.02)[R]
42 REVENUE CODE RC;0 POINTER Multiple #399.042 399.042

  • LAST EDITED:  MAR 31, 1999
  • DESCRIPTION:  
    This identifies specific accommodation(s), ancillary service(s) or billing calculation(s).
  • IDENTIFIED BY:  BEDSECTION(#.05)[R]
  • INDEXED BY:  REVENUE CODE & RX PROCEDURE (ADPR)
43 OP VISITS DATE(S) OP;0 DATE Multiple #399.043 399.043

  • DESCRIPTION:  
    This identifies the outpatient visit date(s) which are included on this bill.
44 REASON(S) DISAPPROVED-INITIAL D1;0 POINTER Multiple #399.044 399.044

  • DESCRIPTION:  
    This defines the reason(s) why this billing record was disapproved during the initial review phase.
45 REASON(S) DISAPPROVED-SECOND D2;0 POINTER Multiple #399.045 399.045

  • DESCRIPTION:  
    This defines the reason(s) why this billing record was disapproved during the secondary review phase.
46 RETURNED LOG DATE/TIME R;0 DATE Multiple #399.046 399.046

  • DESCRIPTION:  This field provides the audit trail of who edited a bill after is has been returned from being Audited for correction by the approving service. Data in this field is automatically entered by the system whenever a returned
    bill is edited and/or returned to fiscal.
47 VALUE CODE CV;0 POINTER Multiple #399.047 399.047

  • INDEXED BY:  VALUE CODE (AC)
48 OTHER CARE OT;0 POINTER Multiple #399.048 399.048

  • DESCRIPTION:  
    Allows definition of the type of care to be other than the standard inpatient or outpatient.
  • TECHNICAL DESCR:  
    Used to identify the charges applied to the dates of care.
51 *CPT PROCEDURE CODE (1) C;1 POINTER TO CPT FILE (#81) CPT(#81)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),""^"",1)?5N" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JAN 22, 1992
  • HELP-PROMPT:  CPT procedure codes may be selected if CPT is specified as the Procedure Coding Method for this bill.
  • DESCRIPTION:  This is a CPT outpatient procedure code.
    This field has been marked for deletion 11/4/91.
  • SCREEN:  S DIC("S")="I $P(^(0),""^"",1)?5N"
  • EXPLANATION:  Only CPT codes may be selected!!
52 *CPT PROCEDURE CODE (2) C;2 POINTER TO CPT FILE (#81) CPT(#81)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),""^"",1)?5N" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JAN 22, 1992
  • HELP-PROMPT:  CPT outpatient procedure codes may only be selected if CPT is specified as the Procedure Coding Method for this outpatient bill.
  • DESCRIPTION:  This is a CPT outpatient procedure code.
    This field has been marked for deletion on 11/4/91.
  • SCREEN:  S DIC("S")="I $P(^(0),""^"",1)?5N"
  • EXPLANATION:  Only CPT codes may be selected!!
53 *CPT PROCEDURE CODE (3) C;3 POINTER TO CPT FILE (#81) CPT(#81)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),""^"",1)?5N" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JAN 22, 1992
  • HELP-PROMPT:  CPT outpatient procedure codes may only be selected if CPT is specified as the Procedure Coding Method for this outpatient bill.
  • DESCRIPTION:  This is a CPT outpatient procedure code.
    This field has been marked for deletion on 11/4/91.
  • SCREEN:  S DIC("S")="I $P(^(0),""^"",1)?5N"
  • EXPLANATION:  Only CPT codes may be selected!!
54 *ICD PROCEDURE CODE (1) C;4 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  JAN 22, 1992
  • HELP-PROMPT:  Enter ICD procedure code associated with the outpatient episode of care.
  • DESCRIPTION:  This is an ICD outpatient procedure code.
    This field is marked for deletion on 11/4/91.
55 *ICD PROCEDURE CODE (2) C;5 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  JAN 22, 1992
  • HELP-PROMPT:  Enter ICD procedure code associated with this outpatient episode of care.
  • DESCRIPTION:  This is an ICD outpatient procedure code.
    This field is marked of deletion on 11/4/91.
56 *ICD PROCEDURE CODE (3) C;6 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  JAN 22, 1992
  • HELP-PROMPT:  Enter ICD procedure code associated with this outpatient episode of care.
  • DESCRIPTION:  This is an ICD outpatient procedure code.
    This field is marked for deletion on 11/4/91.
57 *HCFA PROCEDURE CODE (1) C;7 POINTER TO CPT FILE (#81) CPT(#81)

  • INPUT TRANSFORM:  S D="F" D IX^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JAN 22, 1992
  • HELP-PROMPT:  Enter HCFA procedure code associated with this outpatient episode of care.
  • DESCRIPTION:  This is a HCFA outpatient procedure code.
    This field is marked for deletion on 11/4/91.
  • SCREEN:  S DIC("S")="I $P(^(0),""^"",1)?1A.N"
  • EXPLANATION:  Only HCFA codes may be selected!!
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
58 *HCFA PROCEDURE CODE (2) C;8 POINTER TO CPT FILE (#81) CPT(#81)

  • INPUT TRANSFORM:  S D="F" D IX^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JAN 22, 1992
  • HELP-PROMPT:  Enter HCFA procedure code associated with this outpatient episode of care.
  • DESCRIPTION:  This is a HCFA outpatient procedure code.
    This field has been marked for deletion on 11/4/91.
  • SCREEN:  S DIC("S")="I $P(^(0),""^"",1)?1A.N"
  • EXPLANATION:  Only HCFA codes may be selected!!
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
59 *HCFA PROCEDURE CODE (3) C;9 POINTER TO CPT FILE (#81) CPT(#81)

  • INPUT TRANSFORM:  S D="F" D IX^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JAN 22, 1992
  • HELP-PROMPT:  Enter HCFA procedure code associated with this outpatient episode of care.
  • DESCRIPTION:  This is a HCFA outpatient procedure code.
    This field has been marked for deletion on 11/4/91.
  • SCREEN:  S DIC("S")="I $P(^(0),""^"",1)?1A.N"
  • EXPLANATION:  Only HCFA codes may be selected!!
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
60 OUTPATIENT DIAGNOSIS C;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>45!($L(X)<1)!'(X?1U.ANP) X
  • LAST EDITED:  JUN 13, 1990
  • HELP-PROMPT:  Answer must be 1-45 characters in length.
  • DESCRIPTION:  
    The outpatient diagnosis is selectable from the ICD DIAGNOSIS file.
    WRITE AUTHORITY: ^
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
61 *PROCDEDURE DATE (1) C;11 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y I $D(X) D DTMES^IBCU7
  • LAST EDITED:  NOV 04, 1991
  • HELP-PROMPT:  TYPE A DATE ON OR BEFORE TODAY
  • DESCRIPTION:  This is the date on which the first procedure associated with this billing episode occurred.
    This field has been marked for deletion on 11/4/91.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
62 *PROCEDURE DATE (2) C;12 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y I $D(X) D DTMES^IBCU7
  • LAST EDITED:  NOV 04, 1991
  • DESCRIPTION:  This is the date on which the second procedure associated with this billing episode occurred.
    This field has been marked for deletion on 11/4/91.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
63 *PROCEDURE DATE (3) C;13 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y I $D(X) D DTMES^IBCU7
  • LAST EDITED:  NOV 04, 1991
  • HELP-PROMPT:  TYPE A DATE ON OR BEFORE TODAY
  • DESCRIPTION:  This is the date on which the third procedure associated with this billing episode occurred.
    This field has been marked for deletion on 11/4/91.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
65 *ICD DIAGNOSIS CODE (2) C;15 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 10, 1993
  • HELP-PROMPT:  Enter the ICD diagnosis code which pertains to this billing episode.
  • DESCRIPTION:  
    This is the second ICD diagnosis code associated with this billing episode.
  • TECHNICAL DESCR:  
    Replaced by a diagnosis file (362.3) with IB v2.0. "*" for deletion on 11/10/93.
66 *ICD DIAGNOSIS CODE (3) C;16 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 10, 1993
  • HELP-PROMPT:  Enter the ICD diagnosis code which pertains to this billing episode.
  • DESCRIPTION:  
    This is the third ICD diagnosis code associated with this billing episode.
  • TECHNICAL DESCR:  
    Replaced by a diagnosis file (362.3) with IB v2.0. "*" for deletion on 11/10/93.
67 *ICD DIAGNOSIS CODE (4) C;17 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 10, 1993
  • HELP-PROMPT:  Enter the ICD diagnosis code which pertains to this billing episode.
  • DESCRIPTION:  
    This is the fourth ICD diagnosis code associated with this billing episode.
  • TECHNICAL DESCR:  
    Replaced by a diagnosis file (362.3) with IB v2.0. "*" for deletion on 11/10/93.
68 *ICD DIAGNOSIS CODE (5) C;18 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 10, 1993
  • HELP-PROMPT:  Enter the ICD diagnosis code which pertains to this billing episode.
  • DESCRIPTION:  
    This is the fifth ICD diagnosis code associated with this billing episode.
  • TECHNICAL DESCR:  
    Replaced by a diagnosis file (362.3) with IB v2.0. "*" for deletion on 11/10/93.
77 MRA REQUEST CLAIM COMMENTS TXC;0 DATE Multiple #399.077 399.077

  • LAST EDITED:  NOV 05, 2007
  • DESCRIPTION:  This multiple structure is available only for those claims in a status of 2 - REQUEST MRA. This will allow the users to enter comments either in TPJI or in the MRA worklist that pertain to this claim during the time the
    MRA request claim is sent to Medicare and before the MRA secondary claim is authorized to the secondary payer.
    Once entered, comments may not be edited or deleted by the users.
78 EOB CLAIM COMMENTS TXC2;0 DATE Multiple #399.078 399.078

  • DESCRIPTION:  This multiple structure is available only for those claims on the COB Management Worklist. This will allow the users to view comments either in TPJI or in the COB worklist.
    Once entered, comments may not be edited or deleted by the users.
92 BANDING DATE DEN;1 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 28, 2017
  • HELP-PROMPT:  Enter the date the patient's orthodontic appliances were placed.
  • DESCRIPTION:  
    This is the date the patient's orthodontic appliances were placed.
93 TREATMENT MONTHS COUNT DEN;2 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999999999999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 28, 2017
  • HELP-PROMPT:  Enter the estimated number of treatment months in whole numbers.
  • DESCRIPTION:  
    This is the estimated number of treatment months.
94 TREATMENT MONTHS REMAINING DEN;3 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999999999999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 28, 2017
  • HELP-PROMPT:  Enter the number of months remaining required for a transfer patient, in whole numbers.
  • DESCRIPTION:  
    This is the number of months remaining required for a transfer patient.
95 TREATMENT INDICATOR DEN;4 SET
  • '1' FOR YES;

  • LAST EDITED:  SEP 05, 2017
  • HELP-PROMPT:  Enter 'YES' if services reported on this claim are for orthodontic purposes. Otherwise, leave blank. REQUIRED when neither Treatment Months nor Treatment Months Remaining are present.
  • DESCRIPTION:  
    This field indicates that services reported on this claim are for orthodontic purposes. REQUIRED when neither Treatment Months nor Treatment Months Remaining are present.
96 TOOTH NUMBER DEN1;0 Multiple #399.096 399.096

  • LAST EDITED:  SEP 01, 2017
  • DESCRIPTION:  
    This is a multiple field defining the teeth that the dental services were related to.
  • IDENTIFIED BY:  STATUS CODE(#.02)
97 DENTAL CLAIM NOTE DEN2;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1) X
    MAXIMUM LENGTH: 80
  • LAST EDITED:  JUN 28, 2017
  • HELP-PROMPT:  Enter information that is needed to substantiate the medical treatment, 1 to 80 characters.
  • DESCRIPTION:  
    This is an 80 character free text field to allow for the entry of information that is needed to substantiate medical treatment.
101 PRIMARY INSURANCE CARRIER M;1 POINTER TO INSURANCE COMPANY FILE (#36)
************************REQUIRED FIELD************************
INSURANCE COMPANY(#36)

  • INPUT TRANSFORM:  D DD^IBCNS S DIC("S")="I $D(IBDD(+Y)),'$D(^DGCR(399,DA,""AIC"",+Y))" D ^DIC K DIC,IBDD S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  NOV 12, 2015
  • HELP-PROMPT:  Enter name of insurance carrier to which this bill is to be sent.
  • DESCRIPTION:  
    This is the name of the insurance carrier to which this bill is to be sent. This is from the entries in this patient's file of insurance companies.
  • TECHNICAL DESCR:  
    Only valid/active insurance companies for this patient can be choosen, as defined by DD^IBCNS. Company must not already be defined as a carrier (399,102-103) for this bill.
  • SCREEN:  S DIC("S")="I $D(IBDD(+Y)),'$D(^DGCR(399,DA,""AIC"",+Y))"
  • EXPLANATION:  Only valid insurance companies for this date of care.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the PRIMARY INSURANCE POLICY field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^122
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=$$PRVNUM^IBCU(DA,X,1) X ^DD(399,101,1,1,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,2)=DIV,DIH=399,DIG=122 D ^DICR
    2)= Q
    3)= Do Not Delete
    CREATE VALUE)= S X=$$PRVNUM^IBCU(DA,X,1)
    DELETE VALUE)= NO EFFECT
    FIELD)= PRIMARY PROVIDER #
    This trigger sets the Bill Primary Provider # based on the Form Type, using the Primary Insurance Companies Hospital or Professional Provider Number. Special case for Medicare Part A.
  • CROSS-REFERENCE:  ^^TRIGGER^399^24
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X I $$COBN^IBCEF(DA)=1 I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y X ^DD(399,101,1,2,1.1) X ^DD(399,101,1,2,1.4)
    1.1)= S X=DIV S X=$S($$REQMRA^IBEFUNC(DA):"1N",1:"")
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"TX")):^("TX"),1:""),DIV=X S $P(^("TX"),U,5)=DIV,DIH=399,DIG=24 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X I $$COBN^IBCEF(DA)=1 I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" X ^DD(399,101,1,2,2.4)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"TX")):^("TX"),1:""),DIV=X S $P(^("TX"),U,5)=DIV,DIH=399,DIG=24 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    3)= DO NOT DELETE
    CREATE CONDITION)= I $$COBN^IBCEF(DA)=1
    CREATE VALUE)= S X=$S($$REQMRA^IBEFUNC(DA):"1N",1:"")
    DELETE CONDITION)= I $$COBN^IBCEF(DA)=1
    DELETE VALUE)= @
    FIELD)= CLAIM MRA STATUS
    This triggers the CLAIM MRA STATUS to 'MRA NEEDED' (1N) if the primary insurance is the current insurance and the current insurance = MEDICARE WNR.
  • CROSS-REFERENCE:  ^^TRIGGER^399^27
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$S($$MCRWNR^IBEFUNC(X):$$COBN^IBCEF(DA)=1,1:0) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" X ^DD(399,101,1,3,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,8)=DIV,DIH=399,DIG=27 D ^DICR
    2)= Q
    3)= Do not delete
    CREATE CONDITION)= S X=$S($$MCRWNR^IBEFUNC(X):$$COBN^IBCEF(DA)=1,1:0)
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= FORCE CLAIM TO PRINT
    When the current insurance is the primary insurance and the primary insurance is MEDICARE WNR, delete the FORCE CLAIM TO PRINT field as it is not valid to print an MRA request.
  • CROSS-REFERENCE:  ^^TRIGGER^399^128
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,10),X=X S DIU=X K Y S X=DIV S X=$$PRVQUAL^IBCU(DA,X,1) X ^DD(399,101,1,4,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,10)=DIV,DIH=399,DIG=128 D ^DICR
    2)= Q
    CREATE VALUE)= S X=$$PRVQUAL^IBCU(DA,X,1)
    DELETE VALUE)= NO EFFECT
    FIELD)= PRIMARY ID QUALIFIER
  • CROSS-REFERENCE:  ^^TRIGGER^399^27
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$CREATE^IBCEF84(DA) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X=DIV S X=1 X ^DD(399,101,1,5,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,8)=DIV,DIH=399,DIG=27 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$DELETE^IBCEF84(DA) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" X ^DD(399,101,1,5,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,8)=DIV,DIH=399,DIG=27 D ^DICR
    CREATE CONDITION)= S X=$$CREATE^IBCEF84(DA)
    CREATE VALUE)= S X=1
    DELETE CONDITION)= S X=$$DELETE^IBCEF84(DA)
    DELETE VALUE)= @
    FIELD)= FORCE CLAIM TO PRINT
    This trigger is designed to set the FORCE CLAIM TO PRINT field 27 equal to 1 for SECONDARY MEDICARE WNR claims if the carrier field PRINT SEC MED CLAIMS W/O MRA, 6.1 is set. If the current value of field 27, FORCE CLAIM
    TO PRINT is equal to 1, and field 101, PRIMARY INSURANCE CARRIER is changed to a carrier where field 6.1, PRINT SEC MED CLAIMS W/O MRA is not set, then the value in field 27, FORCE CLAIM TO PRINT, is deleted.
  • CROSS-REFERENCE:  ^^TRIGGER^399^140
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,1)=DIV,DIH=399,DIG=140 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE VALUE)= @
    FIELD)= PRIMARY PAYER-ALT ID TYPE
    This trigger removes PRIMARY PAYER-ALT ID TYPE when PRIMARY INSURANCE CARRIER is changed since ID Type is dependent on INSURANCE CARRIER.
  • CROSS-REFERENCE:  ^^TRIGGER^399^141
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,2)=DIV,DIH=399,DIG=141 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE VALUE)= @
    FIELD)= PRIMARY PAYER-ALT ID
    This trigger removes PRIMARY PAYER-ALT ID when PRIMARY INSURANCE CARRIER is changed since ID is dependent on INSURANCE CARRIER.
  • RECORD INDEXES:  AE (#477), AUPDID (#139)
102 SECONDARY INSURANCE CARRIER M;2 POINTER TO INSURANCE COMPANY FILE (#36) INSURANCE COMPANY(#36)

  • INPUT TRANSFORM:  D ^DIC K DIC,IBDD S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  NOV 12, 2015
  • HELP-PROMPT:  Enter name of secondary insurance carrier from which the provider might expect some payment for this bill.
  • DESCRIPTION:  
    This is the name of the secondary insurance carrier from which the provider might expect some payment for this bill.
  • SCREEN:  S DIC("S")="I $D(IBDD(+Y)),'$D(^DGCR(399,DA,""AIC"",+Y))"
  • EXPLANATION:  Only valid insurance companies for this date of care.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the SECONDARY INSURANCE POLICY field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  399^AI2^MUMPS
    1)= Q
    2)= Q
  • CROSS-REFERENCE:  ^^TRIGGER^399^123
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV S X=$$PRVNUM^IBCU(DA,X,2) X ^DD(399,102,1,2,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,3)=DIV,DIH=399,DIG=123 D ^DICR
    2)= Q
    3)= Do Not Delete
    CREATE VALUE)= S X=$$PRVNUM^IBCU(DA,X,2)
    DELETE VALUE)= NO EFFECT
    FIELD)= SECONDARY PROVIDER
    This trigger sets the Bill Secondary Provider # based on the Form Type, using the Secondary Insurance Companies Hospital or Professional Provider Number. Special case for Medicare Part A.
  • CROSS-REFERENCE:  ^^TRIGGER^399^24
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X I $$COBN^IBCEF(DA)=2 I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y X ^DD(399,102,1,3,1.1) X ^DD(399,102,1,3,1.4)
    1.1)= S X=DIV S X=$S($$REQMRA^IBEFUNC(DA):"1N",1:"")
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"TX")):^("TX"),1:""),DIV=X S $P(^("TX"),U,5)=DIV,DIH=399,DIG=24 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X I $$COBN^IBCEF(DA)=2 I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" X ^DD(399,102,1,3,2.4)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"TX")):^("TX"),1:""),DIV=X S $P(^("TX"),U,5)=DIV,DIH=399,DIG=24 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    3)= DO NOT DELETE
    CREATE CONDITION)= I $$COBN^IBCEF(DA)=2
    CREATE VALUE)= S X=$S($$REQMRA^IBEFUNC(DA):"1N",1:"")
    DELETE CONDITION)= I $$COBN^IBCEF(DA)=2
    DELETE VALUE)= @
    FIELD)= CLAIM MRA STATUS
    This trigger forces the CLAIM MRA STATUS field to be set appropriately if the current insurance is the secondary insurance company and it will require an MRA request.
  • CROSS-REFERENCE:  ^^TRIGGER^399^27
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$S($$MCRWNR^IBEFUNC(X):$$COBN^IBCEF(DA)=2,1:0) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" X ^DD(399,102,1,4,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,8)=DIV,DIH=399,DIG=27 D ^DICR
    2)= Q
    3)= Do not delete
    CREATE CONDITION)= S X=$S($$MCRWNR^IBEFUNC(X):$$COBN^IBCEF(DA)=2,1:0)
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= FORCE CLAIM TO PRINT
    When the current insurance is the secondary insurance and the secondary insurance is MEDICARE WNR, delete the FORCE CLAIM TO PRINT field as it is not valid to print an MRA request.
  • CROSS-REFERENCE:  ^^TRIGGER^399^129
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,11),X=X S DIU=X K Y S X=DIV S X=$$PRVQUAL^IBCU(DA,X,2) X ^DD(399,102,1,5,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,11)=DIV,DIH=399,DIG=129 D ^DICR
    2)= Q
    CREATE VALUE)= S X=$$PRVQUAL^IBCU(DA,X,2)
    DELETE VALUE)= NO EFFECT
    FIELD)= SECONDARY ID QUALIFIER
  • CROSS-REFERENCE:  ^^TRIGGER^399^142
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,3)=DIV,DIH=399,DIG=142 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE VALUE)= @
    FIELD)= SECONDARY PAYER-ALT ID TYPE
    This trigger removes SECONDARY PAYER-ALT ID TYPE when SECONDARY INSURANCE CARRIER is changed since ID Type is dependent on INSURANCE CARRIER.
  • CROSS-REFERENCE:  ^^TRIGGER^399^143
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,4)=DIV,DIH=399,DIG=143 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE VALUE)= @
    FIELD)= SECONDARY PAYER-ALT ID
    This trigger removes SECONDARY PAYER-ALT ID when SECONDARY INSURANCE CARRIER is changed since ID is dependent on INSURANCE CARRIER.
  • RECORD INDEXES:  AE (#477), AUPDID (#139)
103 TERTIARY INSURANCE CARRIER M;3 POINTER TO INSURANCE COMPANY FILE (#36) INSURANCE COMPANY(#36)

  • INPUT TRANSFORM:  D ^DIC K DIC,IBDD S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  NOV 12, 2015
  • HELP-PROMPT:  Enter name of tertiary insurance carrier from which the provider might expect some payment for this bill.
  • DESCRIPTION:  
    This is the name of the tertiary insurance carrier from which the provider might expect some payment for this bill.
  • SCREEN:  S DIC("S")="I $D(IBDD(+Y)),'$D(^DGCR(399,DA,""AIC"",+Y))"
  • EXPLANATION:  Only valid insurance companies for this date of care.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the TERTIARY INSURANCE POLICY field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  399^AI3^MUMPS
    1)= Q
    2)= Q
  • CROSS-REFERENCE:  ^^TRIGGER^399^124
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X=DIV S X=$$PRVNUM^IBCU(DA,X,3) X ^DD(399,103,1,2,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,4)=DIV,DIH=399,DIG=124 D ^DICR
    2)= Q
    3)= Do Not Delete
    CREATE VALUE)= S X=$$PRVNUM^IBCU(DA,X,3)
    DELETE VALUE)= NO EFFECT
    FIELD)= TERTIARY PROVIDER
    This trigger sets the Bill Tertiary Provider # based on the Form Type, using the Tertiary Insurance Companies Hospital or Professional Provider Number. Special case for Medicare Part A.
  • CROSS-REFERENCE:  ^^TRIGGER^399^130
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,12),X=X S DIU=X K Y S X=DIV S X=$$PRVQUAL^IBCU(DA,X,3) X ^DD(399,103,1,3,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,12)=DIV,DIH=399,DIG=130 D ^DICR
    2)= Q
    CREATE VALUE)= S X=$$PRVQUAL^IBCU(DA,X,3)
    DELETE VALUE)= NO EFFECT
    FIELD)= TERTIARY ID QUALIFIER
  • CROSS-REFERENCE:  ^^TRIGGER^399^145
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,6)=DIV,DIH=399,DIG=145 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE VALUE)= @
    FIELD)= TERTIARY PAYER-ALT ID
    This trigger removes TERTIARY PAYER-ALT ID when TERTIARY INSURANCE CARRIER is changed since ID is dependent on INSURANCE CARRIER.
  • CROSS-REFERENCE:  ^^TRIGGER^399^144
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,5)=DIV,DIH=399,DIG=144 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE VALUE)= @
    FIELD)= TERTIARY PAYER-ALT ID TYPE
    This trigger removes TERTIARY PAYER-ALT ID TYPE when TERTIARY INSURANCE CARRIER is changed since ID Type is dependent on INSURANCE CARRIER.
  • RECORD INDEXES:  AE (#477), AUPDID (#139)
104 MAILING ADDRESS NAME M;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  MAY 23, 1988
  • HELP-PROMPT:  Enter the name or title of the person to which this bill is to be sent.
  • DESCRIPTION:  
    This is the name of the party to whom this bill is to be sent.
105 MAILING ADDRESS STREET M;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<3) X
  • LAST EDITED:  JAN 31, 1989
  • HELP-PROMPT:  Enter the 3-35 character street address to which this bill is to be mailed.
  • DESCRIPTION:  
    This is the street address to which this bill is to be sent.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
106 MAILING ADDRESS STREET2 M;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<3) X
  • HELP-PROMPT:  Enter the 3-35 character street address to which this bill is to be mailed.
  • DESCRIPTION:  
    This is the street address to which this bill is to be sent.
107 MAILING ADDRESS CITY M;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>25!($L(X)<2) X
  • LAST EDITED:  FEB 13, 1989
  • HELP-PROMPT:  Enter the 2-25 character city to which this bill is to be mailed.
  • DESCRIPTION:  
    This is the city to which this bill is to be sent.
108 MAILING ADDRESS STATE M;8 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  MAY 23, 1988
  • HELP-PROMPT:  Enter the state to which this bill is to be mailed.
  • DESCRIPTION:  
    This is the state to which this bill is to be sent.
109 MAILING ADDRESS ZIP CODE M;9 FREE TEXT

  • INPUT TRANSFORM:  S:$E(X,6)="-" X=$TR(X,"-") K:$L(X)>9!($L(X)<5)!'(X?5N!(X?9N)) X
  • LAST EDITED:  MAY 10, 1999
  • HELP-PROMPT:  Enter the 5-digit or 9-digit zip code to which this bill is to be sent.
  • DESCRIPTION:  
    This is the 5-digit or 9-digit zip code to which this bill is to be sent.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
110 *PATIENT SHORT MAILING ADDRESS M;10 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>47!($L(X)<1) X
  • LAST EDITED:  FEB 07, 2007
  • HELP-PROMPT:  Answer with the 1-47 character short form of the patient mailing address. This is all the information run together with a maximum of 47 characters.
  • DESCRIPTION:  This is the 1-47 character patient mailing address that will print in block 11 on the UB-82 form and block 13 on the UB-92. The computer will try to calculate this. If the length of all the patient address fields is
    longer than 47 characters you will need to abbreviate this in order to get it to print in this block.
    This field is marked for deletion and can be deleted 11/23/2008.
111 RESPONSIBLE INSTITUTION M;11 POINTER TO INSTITUTION FILE (#4)
************************REQUIRED FIELD************************
INSTITUTION(#4)

  • LAST EDITED:  MAY 15, 1990
  • HELP-PROMPT:  Enter name of the institution or organization responsible for payment of this bill.
  • DESCRIPTION:  
    This is the name of the institution or organization responsible for payment of this bill.
  • CROSS-REFERENCE:  399^AML^MUMPS
    1)= D MAILIN^IBCU5
    2)= D DEL^IBCU5
    Sets/deletes mailing address.
  • CROSS-REFERENCE:  399^AREV5^MUMPS
    1)= S DGRVRCAL=1
    2)= S DGRVRCAL=2
    Variable causes revenue codes and chrges to be re-calculated on return to the enter/edit billing screens.
112 PRIMARY INSURANCE POLICY M;12 FREE TEXT

  • INPUT TRANSFORM:  K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>20!($L(X)<1) X D:$D(X) DD^IBCNS2(X,DA,1)
  • OUTPUT TRANSFORM:  S Y=$$TRANS^IBCNS2($G(DA,D0),Y)
  • LAST EDITED:  SEP 03, 2014
  • HELP-PROMPT:  Select this patient's insurance policy that is the primary policy to be billed. Enter the name of the Ins. Company or its internal entry number.
  • DESCRIPTION:  
    The policy to be billed for this episode of care.
  • EXECUTABLE HELP:  D DDHELP^IBCNS2(DA,1)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the WHO'S RESPONSIBLE FOR BILL? field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^101
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M")):^("M"),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y X ^DD(399,112,1,1,1.1) X ^DD(399,112,1,1,1.4)
    1.1)= S X=DIV S X=+$$INSCO^IBCNS2(DA,$P(^DGCR(399,DA,"M"),U,12))
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"M")):^("M"),1:""),DIV=X S $P(^("M"),U,1)=DIV,DIH=399,DIG=101 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M")):^("M"),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" X ^DD(399,112,1,1,2.4)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"M")):^("M"),1:""),DIV=X S $P(^("M"),U,1)=DIV,DIH=399,DIG=101 D ^DICR
    CREATE VALUE)= S X=+$$INSCO^IBCNS2(DA,$P(^DGCR(399,DA,"M"),U,12))
    DELETE VALUE)= @
    FIELD)= #101
  • CROSS-REFERENCE:  399^AI11^MUMPS
    1)= D IX^IBCNS2(DA,"I1")
    2)= D KIX^IBCNS2(DA,"I1")
    Sets "I1" x-ref and "aic" x-ref for bill/claims file. These indexes previously were set by field #101.
  • CROSS-REFERENCE:  ^^TRIGGER^399^136
    1)= X ^DD(399,112,1,3,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=$$BPP^IBCNS2(DA,1) X ^DD(399,112,1,3,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$S($D(^DD(399,.21,0)):$P(^(0),U,3),1:""),Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,21)_":",2),$C(59),1)="PRIMARY INSURANCE"
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,2)=DIV,DIH=399,DIG=136 D ^DICR
    2)= X ^DD(399,112,1,3,2.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(399,112,1,3,2.4)
    2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$S($D(^DD(399,.21,0)):$P(^(0),U,3),1:""),Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,21)_":",2),$C(59),1)="PRIMARY INSURANCE"
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,2)=DIV,DIH=399,DIG=136 D ^DICR
    CREATE CONDITION)= CURRENT BILL PAYER SEQUENCE="PRIMARY INSURANCE"
    CREATE VALUE)= S X=$$BPP^IBCNS2(DA,1)
    DELETE CONDITION)= CURRENT BILL PAYER SEQUENCE="PRIMARY INSURANCE"
    DELETE VALUE)= @
    FIELD)= BILL PAYER POLICY
    If this is a Primary Bill then set Bill Payer to the Primary Payer.
  • CROSS-REFERENCE:  ^^TRIGGER^399^163
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,13),X=X S DIU=X K Y S X=DIV S X=$$AUTH^IBCNS4(D0,X) S DIH=$G(^DGCR(399,DIV(0),"U")),DIV=X S $P(^("U"),U,13)=DIV,DIH=399,DIG=163 D
    ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,13),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"U")),DIV=X S $P(^("U"),U,13)=DIV,DIH=399,DIG=163 D ^DICR
    CREATE VALUE)= S X=$$AUTH^IBCNS4(D0,X)
    DELETE VALUE)= @
    FIELD)= TREATMENT AUTH
  • CROSS-REFERENCE:  ^^TRIGGER^399^253
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"UF32")):^("UF32"),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X=DIV S X=$$REF^IBCNS4(D0,X) X ^DD(399,112,1,5,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"UF32")),DIV=X S $P(^("UF32"),U,1)=DIV,DIH=399,DIG=253 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"UF32")):^("UF32"),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"UF32")),DIV=X S $P(^("UF32"),U,1)=DIV,DIH=399,DIG=253 D ^DICR
    CREATE VALUE)= S X=$$REF^IBCNS4(D0,X)
    DELETE VALUE)= @
    FIELD)= PRIMARY REF
  • RECORD INDEXES:  AUPDID (#139)
113 SECONDARY INSURANCE POLICY M;13 FREE TEXT

  • INPUT TRANSFORM:  K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>20!($L(X)<1) X D:$D(X) DD^IBCNS2(X,DA,2)
  • OUTPUT TRANSFORM:  S Y=$$TRANS^IBCNS2($G(DA,D0),Y)
  • LAST EDITED:  SEP 03, 2014
  • HELP-PROMPT:  Select this patient's insurance policy that is the secondary policy to be billed. Enter the name of the Ins. Company or its internal entry number.
  • DESCRIPTION:  
    The secondary policy to be billed for this episode of care.
  • EXECUTABLE HELP:  D DDHELP^IBCNS2(DA,2)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^399^102
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M")):^("M"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y X ^DD(399,113,1,1,1.1) X ^DD(399,113,1,1,1.4)
    1.1)= S X=DIV S X=+$$INSCO^IBCNS2(DA,+$P(^DGCR(399,DA,"M"),U,13))
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"M")):^("M"),1:""),DIV=X S $P(^("M"),U,2)=DIV,DIH=399,DIG=102 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M")):^("M"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(399,113,1,1,2.4)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"M")):^("M"),1:""),DIV=X S $P(^("M"),U,2)=DIV,DIH=399,DIG=102 D ^DICR
    CREATE VALUE)= S X=+$$INSCO^IBCNS2(DA,+$P(^DGCR(399,DA,"M"),U,13))
    DELETE VALUE)= @
    FIELD)= SECONDARY INSURANCE CARRIER
  • CROSS-REFERENCE:  399^AI21^MUMPS
    1)= D IX^IBCNS2(DA,"I2")
    2)= D KIX^IBCNS2(DA,"I2")
    Sets "I2" x-ref and "aic" x-ref for bill/claims file. These indexes previously were set by field #102.
  • CROSS-REFERENCE:  ^^TRIGGER^399^136
    1)= X ^DD(399,113,1,3,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=$$BPP^IBCNS2(DA,1) X ^DD(399,113,1,3,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$S($D(^DD(399,.21,0)):$P(^(0),U,3),1:""),Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,21)_":",2),$C(59),1)="SECONDARY INSURANCE"
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,2)=DIV,DIH=399,DIG=136 D ^DICR
    2)= X ^DD(399,113,1,3,2.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(399,113,1,3,2.4)
    2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$S($D(^DD(399,.21,0)):$P(^(0),U,3),1:""),Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,21)_":",2),$C(59),1)="SECONDARY INSURANCE"
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,2)=DIV,DIH=399,DIG=136 D ^DICR
    CREATE CONDITION)= CURRENT BILL PAYER SEQUENCE="SECONDARY INSURANCE"
    CREATE VALUE)= S X=$$BPP^IBCNS2(DA,1)
    DELETE CONDITION)= CURRENT BILL PAYER SEQUENCE="SECONDARY INSURANCE"
    DELETE VALUE)= @
    FIELD)= BILL PAYER POLICY
    If this is a Secondary Bill then set the Bill Payer to the Secondary Payer.
  • CROSS-REFERENCE:  ^^TRIGGER^399^230
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X=DIV S X=$$AUTH^IBCNS4(D0,X) S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,8)=DIV,DIH=399,DIG=230
    D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,8)=DIV,DIH=399,DIG=230 D ^DICR
    CREATE VALUE)= S X=$$AUTH^IBCNS4(D0,X)
    DELETE VALUE)= @
    FIELD)= SECONDARY AUTH
  • CROSS-REFERENCE:  ^^TRIGGER^399^254
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"UF32")):^("UF32"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=$$REF^IBCNS4(D0,X) X ^DD(399,113,1,5,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"UF32")),DIV=X S $P(^("UF32"),U,2)=DIV,DIH=399,DIG=254 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"UF32")):^("UF32"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"UF32")),DIV=X S $P(^("UF32"),U,2)=DIV,DIH=399,DIG=254 D ^DICR
    CREATE VALUE)= S X=$$REF^IBCNS4(D0,X)
    DELETE VALUE)= @
    FIELD)= SECONDARY REF
  • RECORD INDEXES:  AUPDID (#139)
114 TERTIARY INSURANCE POLICY M;14 FREE TEXT

  • INPUT TRANSFORM:  K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>20!($L(X)<1) X D:$D(X) DD^IBCNS2(X,DA,3)
  • OUTPUT TRANSFORM:  S Y=$$TRANS^IBCNS2($G(DA,D0),Y)
  • LAST EDITED:  SEP 03, 2014
  • HELP-PROMPT:  Select this patient's insurance policy that is the tertiary policy to be billed. Enter the name of the Ins. Company or its internal entry number.
  • DESCRIPTION:  
    The tertiary policy to be billed for this episode of care.
  • EXECUTABLE HELP:  D DDHELP^IBCNS2(DA,3)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^399^103
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M")):^("M"),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y X ^DD(399,114,1,1,1.1) X ^DD(399,114,1,1,1.4)
    1.1)= S X=DIV S X=+$$INSCO^IBCNS2(DA,+$P(^DGCR(399,DA,"M"),U,14))
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"M")):^("M"),1:""),DIV=X S $P(^("M"),U,3)=DIV,DIH=399,DIG=103 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M")):^("M"),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(399,114,1,1,2.4)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"M")):^("M"),1:""),DIV=X S $P(^("M"),U,3)=DIV,DIH=399,DIG=103 D ^DICR
    CREATE VALUE)= S X=+$$INSCO^IBCNS2(DA,+$P(^DGCR(399,DA,"M"),U,14))
    DELETE VALUE)= @
    FIELD)= TERTIARY INSURANCE CARRIER
  • CROSS-REFERENCE:  399^AI31^MUMPS
    1)= D IX^IBCNS2(DA,"I3")
    2)= D KIX^IBCNS2(DA,"I3")
    Sets "I3" x-ref and "aic" x-ref for bill/claims file. These indexes previously were set by field #103.
  • CROSS-REFERENCE:  ^^TRIGGER^399^136
    1)= X ^DD(399,114,1,3,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=$$BPP^IBCNS2(DA) X ^DD(399,114,1,3,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$S($D(^DD(399,.21,0)):$P(^(0),U,3),1:""),Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,21)_":",2),$C(59),1)="TERTIARY INSURANCE"
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,2)=DIV,DIH=399,DIG=136 D ^DICR
    2)= X ^DD(399,114,1,3,2.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(399,114,1,3,2.4)
    2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$S($D(^DD(399,.21,0)):$P(^(0),U,3),1:""),Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,21)_":",2),$C(59),1)="TERTIARY INSURANCE"
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,2)=DIV,DIH=399,DIG=136 D ^DICR
    CREATE CONDITION)= CURRENT BILL PAYER SEQUENCE="TERTIARY INSURANCE"
    CREATE VALUE)= S X=$$BPP^IBCNS2(DA)
    DELETE CONDITION)= CURRENT BILL PAYER SEQUENCE="TERTIARY INSURANCE"
    DELETE VALUE)= @
    FIELD)= BILL PAYER POLICY
    If this is a Tertiary Bill then set the Bill Payer to the Tertiary Payer.
  • CROSS-REFERENCE:  ^^TRIGGER^399^231
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,9),X=X S DIU=X K Y S X=DIV S X=$$AUTH^IBCNS4(D0,X) S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,9)=DIV,DIH=399,DIG=231
    D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,9),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,9)=DIV,DIH=399,DIG=231 D ^DICR
    CREATE VALUE)= S X=$$AUTH^IBCNS4(D0,X)
    DELETE VALUE)= @
    FIELD)= TERTIARY AUTH
  • CROSS-REFERENCE:  ^^TRIGGER^399^255
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"UF32")):^("UF32"),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV S X=$$REF^IBCNS4(D0,X) X ^DD(399,114,1,5,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"UF32")),DIV=X S $P(^("UF32"),U,3)=DIV,DIH=399,DIG=255 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"UF32")):^("UF32"),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"UF32")),DIV=X S $P(^("UF32"),U,3)=DIV,DIH=399,DIG=255 D ^DICR
    CREATE VALUE)= S X=$$REF^IBCNS4(D0,X)
    DELETE VALUE)= @
    FIELD)= TERTIARY REF
  • RECORD INDEXES:  AUPDID (#139)
121 MAILING ADDRESS STREET3 M1;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<3) X
  • LAST EDITED:  JAN 10, 1989
  • HELP-PROMPT:  Enter the 3-35 character street address to which this bill is to be sent.
  • DESCRIPTION:  
    This is the street address to which this bill is to be sent.
122 PRIMARY PROVIDER # M1;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>13!($L(X)<3)!($TR(X," ")="") X
  • LAST EDITED:  MAR 06, 2009
  • HELP-PROMPT:  Answer must be 3-13 characters in length.
  • DESCRIPTION:  
    This is the number assigned to the provider by the primary payer. Printed in Form Locator 57 for the Primary Insurance Carrier on the UB-04.
  • TECHNICAL DESCR:  This field is set via the "ABP" new-style MUMPS x-refs from the following fields in the BILL/CLAIMS file (#399) and in the IB BILL/CLAIMS PRESCRIPTION REFILL file (#362.4):
    399,.22 - DEFAULT DIVISION
    399,232 - NON-VA FACILITY
    399,136 - BILL PAYER POLICY
    399,.19 - FORM TYPE 362.4,.02 - BILL NUMBER
    Whenever these fields are edited, the billing provider may change and this may also change the billing provider secondary IDs and Qualifiers for all payers on the claim.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the PRIMARY INSURANCE CARRIER field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^128
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,2)="" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,10),X=X S DIU=X K Y S X="" X ^DD(399,12
    2,1,1,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,10)=DIV,DIH=399,DIG=128 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE CONDITION)= PRIMARY PROVIDER #=""
    DELETE VALUE)= @
    FIELD)= PRIMARY ID QUALIFIER
    This trigger will delete the PRIMARY ID QUALIFIER when the PRIMARY PROVIDER # is deleted
123 SECONDARY PROVIDER # M1;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>13!($L(X)<3)!($TR(X," ")="") X
  • LAST EDITED:  MAR 06, 2009
  • HELP-PROMPT:  Answer must be 3-13 characters in length.
  • DESCRIPTION:  
    This is the number assigned to the provider by the secondary payer. Printed in Form Locator 57 for the Secondary Insurance Carrier on the UB-04.
  • TECHNICAL DESCR:  This field is set via the "ABP" new-style MUMPS x-refs from the following fields in the BILL/CLAIMS file (#399) and in the IB BILL/CLAIMS PRESCRIPTION REFILL file (#362.4):
    399,.22 - DEFAULT DIVISION
    399,232 - NON-VA FACILITY
    399,136 - BILL PAYER POLICY
    399,.19 - FORM TYPE 362.4,.02 - BILL NUMBER
    Whenever these fields are edited, the billing provider may change and this may also change the billing provider secondary IDs and Qualifiers for all payers on the claim.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the SECONDARY INSURANCE CARRIER field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^129
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,3)="" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,11),X=X S DIU=X K Y S X="" X ^DD(399,12
    3,1,1,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,11)=DIV,DIH=399,DIG=129 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE CONDITION)= SECONDARY PROVIDER #=""
    DELETE VALUE)= @
    FIELD)= SECONDARY ID QUALIFIER
    This trigger will delete the SECONDARY ID QUALIFIER when the SECONDARY PROVIDER # is deleted
124 TERTIARY PROVIDER # M1;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>13!($L(X)<3)!($TR(X," ")="") X
  • LAST EDITED:  MAR 06, 2009
  • HELP-PROMPT:  Answer must be 3-13 characters in length.
  • DESCRIPTION:  
    This is the number assigned to the provider by the tertiary payer. Printed in Form Locator 57 for the Tertiary Insurance Carrier on the UB-04.
  • TECHNICAL DESCR:  This field is set via the "ABP" new-style MUMPS x-refs from the following fields in the BILL/CLAIMS file (#399) and in the IB BILL/CLAIMS PRESCRIPTION REFILL file (#362.4):
    399,.22 - DEFAULT DIVISION
    399,232 - NON-VA FACILITY
    399,136 - BILL PAYER POLICY
    399,.19 - FORM TYPE 362.4,.02 - BILL NUMBER
    Whenever these fields are edited, the billing provider may change and this may also change the billing provider secondary IDs and Qualifiers for all payers on the claim.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the TERTIARY INSURANCE CARRIER field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^130
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,4)="" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,12),X=X S DIU=X K Y S X="" X ^DD(399,12
    4,1,1,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,12)=DIV,DIH=399,DIG=130 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE CONDITION)= TERTIARY PROVIDER #=""
    DELETE VALUE)= @
    FIELD)= TERTIARY ID QUALIFIER
    This trigger will delete the TERTIARY ID QUALIFIER when the TERTIARY PROVIDER # is deleted
125 PRIMARY BILL # M1;5 POINTER TO BILL/CLAIMS FILE (#399) BILL/CLAIMS(#399)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),U,21)=""P""" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  AUG 21, 1997
  • HELP-PROMPT:  Enter the Primary Bill in the series for this episode of care.
  • DESCRIPTION:  
    This is the bill to the Primary Payer for the episode(s) on this bill.
  • SCREEN:  S DIC("S")="I $P(^(0),U,21)=""P"""
  • EXPLANATION:  Primary Bills Only!
  • NOTES:  TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
126 SECONDARY BILL # M1;6 POINTER TO BILL/CLAIMS FILE (#399) BILL/CLAIMS(#399)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),U,21)=""S""" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  AUG 21, 1997
  • HELP-PROMPT:  Enter the Secondary Bill in the series for this episode of care.
  • DESCRIPTION:  
    This is the bill to the Secondary Payer for the episode(s) on this bill.
  • SCREEN:  S DIC("S")="I $P(^(0),U,21)=""S"""
  • EXPLANATION:  Secondary Bills Only!
  • NOTES:  TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
127 TERTIARY BILL # M1;7 POINTER TO BILL/CLAIMS FILE (#399) BILL/CLAIMS(#399)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),U,21)=""T""" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  AUG 21, 1997
  • HELP-PROMPT:  Enter the Tertiary Bill in the series for this episode of care.
  • DESCRIPTION:  
    This is the bill to the Tertiary Payer for the episode(s) on this bill.
  • SCREEN:  S DIC("S")="I $P(^(0),U,21)=""T"""
  • EXPLANATION:  Tertiary Bills Only!
  • NOTES:  TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
128 PRIMARY ID QUALIFIER M1;10 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97) IB PROVIDER ID # TYPE(#355.97)

  • INPUT TRANSFORM:  S DIC("S")="I $$BPS^IBCEPU(Y)!($$EPT^IBCEPU(Y))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAR 06, 2009
  • HELP-PROMPT:  Enter the Qualifier for the Primary Insurance ID #
  • DESCRIPTION:  
    This is the qualifier for PRIMARY PROVIDER #.
  • TECHNICAL DESCR:  This field is set via the "ABP" new-style MUMPS x-refs from the following fields in the BILL/CLAIMS file (#399) and in the IB BILL/CLAIMS PRESCRIPTION REFILL file (#362.4):
    399,.22 - DEFAULT DIVISION
    399,232 - NON-VA FACILITY
    399,136 - BILL PAYER POLICY
    399,.19 - FORM TYPE 362.4,.02 - BILL NUMBER
    Whenever these fields are edited, the billing provider may change and this may also change the billing provider secondary IDs and Qualifiers for all payers on the claim.
  • SCREEN:  S DIC("S")="I $$BPS^IBCEPU(Y)!($$EPT^IBCEPU(Y))"
  • EXPLANATION:  Only Billing Provider Secondary IDs allowed
  • NOTES:  TRIGGERED by the PRIMARY INSURANCE CARRIER field of the BILL/CLAIMS File
    TRIGGERED by the PRIMARY PROVIDER # field of the BILL/CLAIMS File
129 SECONDARY ID QUALIFIER M1;11 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97) IB PROVIDER ID # TYPE(#355.97)

  • INPUT TRANSFORM:  S DIC("S")="I $$BPS^IBCEPU(Y)!($$EPT^IBCEPU(Y))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAR 06, 2009
  • HELP-PROMPT:  Enter the Qualifier for the Secondary Insurance ID #
  • DESCRIPTION:  
    This is the qualifier for the SECONDARY PROVIDER #.
  • TECHNICAL DESCR:  This field is set via the "ABP" new-style MUMPS x-refs from the following fields in the BILL/CLAIMS file (#399) and in the IB BILL/CLAIMS PRESCRIPTION REFILL file (#362.4):
    399,.22 - DEFAULT DIVISION
    399,232 - NON-VA FACILITY
    399,136 - BILL PAYER POLICY
    399,.19 - FORM TYPE 362.4,.02 - BILL NUMBER
    Whenever these fields are edited, the billing provider may change and this may also change the billing provider secondary IDs and Qualifiers for all payers on the claim.
  • SCREEN:  S DIC("S")="I $$BPS^IBCEPU(Y)!($$EPT^IBCEPU(Y))"
  • EXPLANATION:  Only Billing Provider Secondary IDs allowed
  • NOTES:  TRIGGERED by the SECONDARY INSURANCE CARRIER field of the BILL/CLAIMS File
    TRIGGERED by the SECONDARY PROVIDER # field of the BILL/CLAIMS File
130 TERTIARY ID QUALIFIER M1;12 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97) IB PROVIDER ID # TYPE(#355.97)

  • INPUT TRANSFORM:  S DIC("S")="I $$BPS^IBCEPU(Y)!($$EPT^IBCEPU(Y))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAR 06, 2009
  • HELP-PROMPT:  Enter the Qualifier for the Tertiary Insurance ID #
  • DESCRIPTION:  
    This is the qualifier for the TERTIARY PROVIDER #.
  • TECHNICAL DESCR:  This field is set via the "ABP" new-style MUMPS x-refs from the following fields in the BILL/CLAIMS file (#399) and in the IB BILL/CLAIMS PRESCRIPTION REFILL file (#362.4):
    399,.22 - DEFAULT DIVISION
    399,232 - NON-VA FACILITY
    399,136 - BILL PAYER POLICY
    399,.19 - FORM TYPE 362.4,.02 - BILL NUMBER
    Whenever these fields are edited, the billing provider may change and this may also change the billing provider secondary IDs and Qualifiers for all payers on the claim.
  • SCREEN:  S DIC("S")="I $$BPS^IBCEPU(Y)!($$EPT^IBCEPU(Y))"
  • EXPLANATION:  Only Billing Provider Secondary IDs allowed
  • NOTES:  TRIGGERED by the TERTIARY INSURANCE CARRIER field of the BILL/CLAIMS File
    TRIGGERED by the TERTIARY PROVIDER # field of the BILL/CLAIMS File
135 BILL PAYER CARRIER MP;1 POINTER TO INSURANCE COMPANY FILE (#36) INSURANCE COMPANY(#36)

  • INPUT TRANSFORM:  S DIC("S")="I $D(^DGCR(399,DA,""AIC"",+Y))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAR 05, 1999
  • HELP-PROMPT:  Select the Insurance Carrier responsible for this bill.
  • DESCRIPTION:  
    This is the Insurance Carrier responsible for the bill. This may only be set to the Carrier assigned as Primary, Secondary, or Tertiary carrier that corresponds to the Payer Sequence.
  • SCREEN:  S DIC("S")="I $D(^DGCR(399,DA,""AIC"",+Y))"
  • EXPLANATION:  Only Insurance Companies already assigned to this bill!
  • NOTES:  TRIGGERED by the BILL PAYER POLICY field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  399^AML2^MUMPS
    1)= D MAILA^IBCU5
    2)= D DEL^IBCU5
    Sets Mailing Address to the address of the Bill Payer.
  • CROSS-REFERENCE:  399^AREV4^MUMPS
    1)= S DGRVRCAL=1
    2)= S DGRVRCAL=2
    This variable causes the bills charges to be recalculated.
136 BILL PAYER POLICY MP;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X K:$G(X)'=$$BPP^IBCNS2(DA) X
  • OUTPUT TRANSFORM:  S Y=$$TRANS^IBCNS2($G(DA,D0),Y)
  • LAST EDITED:  JAN 31, 2003
  • HELP-PROMPT:  Select the policy responsible for this bill.
  • DESCRIPTION:  
    This is the policy responsible for this bill. This may only be set to the policy assigned as Primary, Secondary, or Tertiary policy that corresponds to the Payer Sequence.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
    TRIGGERED by the PRIMARY INSURANCE POLICY field of the BILL/CLAIMS File
    TRIGGERED by the SECONDARY INSURANCE POLICY field of the BILL/CLAIMS File
    TRIGGERED by the TERTIARY INSURANCE POLICY field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^135
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X='$$WNRBILL^IBEFUNC(DA) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y X ^DD(399,136,1,1,1.1) X ^DD(399,136,1,1,1.4)
    1.1)= S X=DIV S X=+$$INSCO^IBCNS2(DA,+$P(^DGCR(399,DA,"MP"),U,2))
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,1)=DIV,DIH=399,DIG=135 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" X ^DD(399,136,1,1,2.4)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,1)=DIV,DIH=399,DIG=135 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE CONDITION)= S X='$$WNRBILL^IBEFUNC(DA)
    CREATE VALUE)= S X=+$$INSCO^IBCNS2(DA,+$P(^DGCR(399,DA,"MP"),U,2))
    DELETE VALUE)= @
    FIELD)= BILL PAYER CARRIER
    Sets the BILL PAYER CARRIER to the Bill Payer Policy Insurance Company if insurance is not Medicare - will not reimburse.
  • RECORD INDEXES:  ABP (#820)
140 PRIMARY PAYER-ALT ID TYPE M2;1 POINTER TO IB ALTERNATE PRIMARY ID TYPE FILE (#355.98) IB ALTERNATE PRIMARY ID TYPE(#355.98)

  • INPUT TRANSFORM:  S DIC("S")="I $$ACIDS^IBCU(DA,1,+Y)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  NOV 19, 2015
  • HELP-PROMPT:  Enter an Alternate Payer ID Type.
  • DESCRIPTION:  
    This is the Alternate Inst Primary Payer ID Type which is used to identify an Alternate Inst Primary Payer ID for this payer.
  • SCREEN:  S DIC("S")="I $$ACIDS^IBCU(DA,1,+Y)"
  • EXPLANATION:  Only allow ID types set up in Insurance Company Editor.
  • NOTES:  TRIGGERED by the PRIMARY INSURANCE CARRIER field of the BILL/CLAIMS File
    TRIGGERED by the FORM TYPE field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^141
    1)= X ^DD(399,140,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=$$ACIDD^IBCU(DA,1,X) X ^DD(399,140,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,2)=""
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,2)=DIV,DIH=399,DIG=141 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,2)=DIV,DIH=399,DIG=141 D ^DICR
    CREATE CONDITION)= #141=""
    CREATE VALUE)= S X=$$ACIDD^IBCU(DA,1,X)
    DELETE VALUE)= @
    FIELD)= #141
    Trigger the default Alternate ID for this INSURANCE COMPANY and this FORM TYPE.
141 PRIMARY PAYER-ALT ID M2;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1)!($$UP^XLFSTR(X)["PRNT") X
  • LAST EDITED:  NOV 19, 2015
  • HELP-PROMPT:  Answer must be 1-30 characters in length and not contain PRNT.
  • DESCRIPTION:  
    This is the Alternate Inst Prim Payer ID which is used to route claims to an alternate administration contractor for certain claims.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the PRIMARY PAYER-ALT ID TYPE field of the BILL/CLAIMS File
    TRIGGERED by the PRIMARY INSURANCE CARRIER field of the BILL/CLAIMS File
    TRIGGERED by the FORM TYPE field of the BILL/CLAIMS File
142 SECONDARY PAYER-ALT ID TYPE M2;3 POINTER TO IB ALTERNATE PRIMARY ID TYPE FILE (#355.98) IB ALTERNATE PRIMARY ID TYPE(#355.98)

  • INPUT TRANSFORM:  S DIC("S")="I $$ACIDS^IBCU(DA,2,+Y)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  NOV 19, 2015
  • HELP-PROMPT:  Enter an Alternate Payer ID Type.
  • DESCRIPTION:  
    This is the Alternate Inst Primary Payer ID Type which is used to identify an Alternate Inst Primary Payer ID for this payer.
  • SCREEN:  S DIC("S")="I $$ACIDS^IBCU(DA,2,+Y)"
  • EXPLANATION:  Only allow ID types set up in Insurance Company Editor.
  • NOTES:  TRIGGERED by the SECONDARY INSURANCE CARRIER field of the BILL/CLAIMS File
    TRIGGERED by the FORM TYPE field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^143
    1)= X ^DD(399,142,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X=DIV S X=$$ACIDD^IBCU(DA,2,X) X ^DD(399,142,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,4)=""
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,4)=DIV,DIH=399,DIG=143 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,4)=DIV,DIH=399,DIG=143 D ^DICR
    CREATE CONDITION)= #143=""
    CREATE VALUE)= S X=$$ACIDD^IBCU(DA,2,X)
    DELETE VALUE)= @
    FIELD)= #143
    Trigger the default Alternate ID for this INSURANCE COMPANY and this FORM TYPE.
143 SECONDARY PAYER-ALT ID M2;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1)!($$UP^XLFSTR(X)["PRNT") X
  • LAST EDITED:  NOV 19, 2015
  • HELP-PROMPT:  Answer must be 1-30 characters in length and not contain PRNT.
  • DESCRIPTION:  
    This is the Alternate Inst Prim Payer ID which is used to route claims to an alternate administration contractor for certain claims.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the SECONDARY PAYER-ALT ID TYPE field of the BILL/CLAIMS File
    TRIGGERED by the SECONDARY INSURANCE CARRIER field of the BILL/CLAIMS File
    TRIGGERED by the FORM TYPE field of the BILL/CLAIMS File
144 TERTIARY PAYER-ALT ID TYPE M2;5 POINTER TO IB ALTERNATE PRIMARY ID TYPE FILE (#355.98) IB ALTERNATE PRIMARY ID TYPE(#355.98)

  • INPUT TRANSFORM:  S DIC("S")="I $$ACIDS^IBCU(DA,3,+Y)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  NOV 19, 2015
  • HELP-PROMPT:  Enter an Alternate Payer ID Type.
  • DESCRIPTION:  
    This is the Alternate Inst Primary Payer ID Type which is used to identify an Alternate Inst Primary Payer ID for this payer.
  • SCREEN:  S DIC("S")="I $$ACIDS^IBCU(DA,3,+Y)"
  • EXPLANATION:  Only allow ID types set up in Insurance Company Editor.
  • NOTES:  TRIGGERED by the TERTIARY INSURANCE CARRIER field of the BILL/CLAIMS File
    TRIGGERED by the FORM TYPE field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^145
    1)= X ^DD(399,144,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X=DIV S X=$$ACIDD^IBCU(DA,3,X) X ^DD(399,144,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,6)=""
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,6)=DIV,DIH=399,DIG=145 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,6)=DIV,DIH=399,DIG=145 D ^DICR
    CREATE CONDITION)= #145=""
    CREATE VALUE)= S X=$$ACIDD^IBCU(DA,3,X)
    DELETE VALUE)= @
    FIELD)= #145
    Trigger the default Alternate ID for this INSURANCE COMPANY and this FORM TYPE.
145 TERTIARY PAYER-ALT ID M2;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1)!($$UP^XLFSTR(X)["PRNT") X
  • LAST EDITED:  NOV 19, 2015
  • HELP-PROMPT:  Answer must be 1-30 characters in length and not contain PRNT.
  • DESCRIPTION:  
    This is the Alternate Inst Prim Payer ID which is used to route claims to an alternate administration contractor for certain claims.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the TERTIARY PAYER-ALT ID TYPE field of the BILL/CLAIMS File
    TRIGGERED by the TERTIARY INSURANCE CARRIER field of the BILL/CLAIMS File
    TRIGGERED by the FORM TYPE field of the BILL/CLAIMS File
151 STATEMENT COVERS FROM U;1 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="ETP" D ^%DT S X=Y K:Y<1 X I $D(X) D DDAT^IBCU4 K IB00
  • LAST EDITED:  OCT 23, 2001
  • HELP-PROMPT:  Enter the beginning service date of the period included on this bill.
  • DESCRIPTION:  
    This is the beginning service date of the period covered by this bill. The date range for inpatient interim bills should not be overlapped.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^399^165
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X I $P(^DGCR(399,DA,0),U,5)<3 I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y S X=DIV S X=$$LOS1^IBCU64(DA) X ^DD(399,151,1,1,1.4)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U")):^("U"),1:""),DIV=X S $P(^("U"),U,15)=DIV,DIH=399,DIG=165 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= I $P(^DGCR(399,DA,0),U,5)<3
    CREATE VALUE)= S X=$$LOS1^IBCU64(DA)
    DELETE VALUE)= NO EFFECT
    FIELD)= LENGTH OF STAY
    Sets Length of Stay based on PTF record and date range of bill. Inpatient only.
  • CROSS-REFERENCE:  399^AREV2^MUMPS
    1)= S DGRVRCAL=1
    2)= S DGRVRCAL=2
    Variable causes revenue codes and charges to be re-calculated on return to the enter/edit billing screens.
  • CROSS-REFERENCE:  ^^TRIGGER^399^201
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X I +$G(^DGCR(399,DA,"U1"))=0 I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X=DIV S X=0 X ^DD(399,151,1,3,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"U1")),DIV=X S $P(^("U1"),U,1)=DIV,DIH=399,DIG=201 D ^DICR
    2)= Q
    CREATE CONDITION)= I +$G(^DGCR(399,DA,"U1"))=0
    CREATE VALUE)= S X=0
    DELETE VALUE)= NO EFFECT
    FIELD)= TOTAL CHARGE
  • CROSS-REFERENCE:  399^APDS^MUMPS
    1)= S:$P(^DGCR(399,DA,0),"^",2) ^DGCR(399,"APDS",$P(^(0),U,2),-X,DA)=""
    2)= K:$P(^DGCR(399,DA,0),"^",2) ^DGCR(399,"APDS",$P(^(0),U,2),-X,DA)
    Patients and bills by inverse Statement From Date.
152 STATEMENT COVERS TO U;2 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="ETP" D ^%DT S X=Y K:Y<1 X I $D(X) D DDAT1^IBCU4 K IB00
  • LAST EDITED:  OCT 18, 1993
  • HELP-PROMPT:  Enter the ending service date of period covered by this bill.
  • DESCRIPTION:  
    This is the ending service date of the period covered by this bill. The date range for inpatient interim bills should not be overlapped.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^399^165
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X I $P(^DGCR(399,DA,0),U,5)<3 I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y S X=DIV S X=$$LOS1^IBCU64(DA) X ^DD(399,152,1,1,1.4)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U")):^("U"),1:""),DIV=X S $P(^("U"),U,15)=DIV,DIH=399,DIG=165 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= I $P(^DGCR(399,DA,0),U,5)<3
    CREATE VALUE)= S X=$$LOS1^IBCU64(DA)
    DELETE VALUE)= NO EFFECT
    FIELD)= LENGTH OF STAY
    Sets Length of Stay based on PTF record and date range of bill. (Inpatient only.)
  • CROSS-REFERENCE:  399^AREV3^MUMPS
    1)= S DGRVRCAL=1
    2)= S DGRVRCAL=2
    Variable causes revenue codes and chrges to be re-calculated on return to the enter/edit billing screens.
153 POWER OF ATTORNEY COMPLETED? U;3 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  I $D(X) D YN^IBCU
  • OUTPUT TRANSFORM:  S Y=$S(Y:"YES",Y=0:"NO",1:"")
  • LAST EDITED:  JUN 07, 1988
  • HELP-PROMPT:  Enter 'Yes' or '1' if Power of Attorney has been completed, 'No' or '0' if Power of Attorney has not been completed.
  • DESCRIPTION:  
    This identifies whether or not the power of attorney forms (if necessary) have been signed.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
154 WHOSE EMPLOYMENT INFO.? U;4 SET
************************REQUIRED FIELD************************
  • 'p' FOR PATIENT;
  • 's' FOR SPOUSE;

  • LAST EDITED:  MAY 23, 1988
  • HELP-PROMPT:  Enter the code which indicates whether the employment information given applies to the patient or to the patient's spouse.
  • DESCRIPTION:  
    This indicates whether the employment information give applies to the patient or to the patient's spouse.
155 IS THIS A SENSITIVE RECORD? U;5 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  I $D(X) D YN^IBCU
  • OUTPUT TRANSFORM:  S Y=$S(Y:"YES",Y=0:"NO",1:"")
  • LAST EDITED:  JUN 07, 1988
  • HELP-PROMPT:  Enter 'Yes' or '1' if this record contains sensitive information pertaining to, but not limited to, drugs, alcohol, and/or sickle cell anemia, 'No' or '0' if it does not.
  • DESCRIPTION:  
    This indicates whether or not this record contains information pertaining to, but not limited to, drugs, alcohol, or sickle cell anemia, and if so, allows the user to identify this record as "sensitive".
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
156 ASSIGNMENT OF BENEFITS U;6 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  I $D(X) D YN^IBCU I $D(X) X:X=0 ^DD(399,156,9.3) K IBRATY
  • OUTPUT TRANSFORM:  S Y=$S(Y="":"","Yy1"[Y:"YES","Nn0"[Y:"NO",1:"")
  • LAST EDITED:  SEP 21, 1999
  • HELP-PROMPT:  Enter the code which indicates whether or not a third party is authorized to pay the provider for services covered by this bill.
  • DESCRIPTION:  
    This indicates whether or not a third party is authorized to pay the provider for services covered by this bill.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the RATE TYPE field of the BILL/CLAIMS File
157 R.O.I. FORM(S) COMPLETED? U;7 FREE TEXT

  • INPUT TRANSFORM:  I $D(X) D YN^IBCU S:$G(X)=1 X=$$ROI399^IBNCPDR4($G(DA))
  • OUTPUT TRANSFORM:  S Y=$S(Y:"YES",Y=0:"NO",1:"")
  • LAST EDITED:  OCT 22, 2008
  • HELP-PROMPT:  Enter 'Yes' or '1' if Release Of Information form(s) are completed, 'No' or '0' if Release Of Information form(s) are not completed.
  • DESCRIPTION:  
    This allows the user to indicate if the Release of Information forms (if necessary) have been signed.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
158 TYPE OF ADMISSION U;8 SET
  • '1' FOR EMERGENCY;
  • '2' FOR URGENT;
  • '3' FOR ELECTIVE;
  • '4' FOR NEWBORN;
  • '5' FOR TRAUMA;
  • '9' FOR INFORMATION NOT AVAILABLE;

  • LAST EDITED:  NOV 13, 2008
  • HELP-PROMPT:  Enter a code indicating the priority/type of this admission.
  • DESCRIPTION:  
    Enter the Priority/Type of this admission.
  • NOTES:  TRIGGERED by the PTF ENTRY NUMBER field of the BILL/CLAIMS File
    TRIGGERED by the BILL CLASSIFICATION field of the BILL/CLAIMS File
    TRIGGERED by the BILL CHARGE TYPE field of the BILL/CLAIMS File
159 SOURCE OF ADMISSION U;9 SET
  • '1' FOR PHYSICIAN REFERRAL;
  • '2' FOR CLINIC REFERRAL;
  • '3' FOR HMO REFERRAL;
  • '4' FOR TRANSFER FROM HOSPITAL;
  • '5' FOR TRANSFER FROM SKILLED NURSING FAC.;
  • '6' FOR TRANSFER FROM OTHER HEALTH CARE FAC.;
  • '7' FOR EMERGENCY ROOM;
  • '8' FOR COURT/LAW ENFORCEMENT;
  • '9' FOR INFO NOT AVAILABLE;

  • LAST EDITED:  APR 03, 1989
  • HELP-PROMPT:  Enter the code which indicates the source of this admission.
  • DESCRIPTION:  
    This indicates the source of this admission or how an outpatient came to be treated at the facility.
  • NOTES:  TRIGGERED by the PTF ENTRY NUMBER field of the BILL/CLAIMS File
159.5 NON-PTF ADMISSION HOUR U;20 FREE TEXT

  • INPUT TRANSFORM:  D NOPTF^IBCU
  • OUTPUT TRANSFORM:  S Y=$S(Y=0:"12AM",Y<12:Y_"AM",Y=12:"12PM",Y=99:Y,1:(Y-12)_"PM")
  • LAST EDITED:  FEB 22, 2000
  • HELP-PROMPT:  Type an hour from 0-23 or you may enter 1-12 with AM/PM. Use 99 if hr is unknown.
  • DESCRIPTION:  
    This is the actual hour the patient was admitted for non-PTF related bills.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
160 ACCIDENT HOUR U;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1)!(X=99) X
  • LAST EDITED:  FEB 22, 2000
  • HELP-PROMPT:  Enter the hour at which an accident took place if this bill is related to an accident.
  • DESCRIPTION:  
    This indicates the hour at which an accident occurred if this episode of care is related to an accident.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
161 DISCHARGE BEDSECTION U;11 POINTER TO MCCR UTILITY FILE (#399.1) MCCR UTILITY(#399.1)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^DGCR(399.1,+Y,0),""^"",5)=1" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JUN 14, 2004
  • HELP-PROMPT:  Enter the bedsection from which this patient was discharged.
  • DESCRIPTION:  
    This is the bedsection from which this patient was discharged.
  • SCREEN:  S DIC("S")="I $P(^DGCR(399.1,+Y,0),""^"",5)=1"
  • EXPLANATION:  Valid MCCR Bedsections only!
  • CROSS-REFERENCE:  ^^TRIGGER^399^162
    1)= X ^DD(399,161,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,12),X=X S DIU=X K Y S X=DIV D DIS^IBCU S X=X S DIH=$G(^DGCR(399,DIV(0),"U")),DIV=X S $P(^("U"),U,12)=DIV,DIH=399,DIG=162 D ^
    DICR
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P($G(^DGCR(399.1,+$P(Y(1),U,12),0)),U)=""
    2)= Q
    CREATE CONDITION)= #162=""
    CREATE VALUE)= D DIS^IBCU S X=X
    DELETE VALUE)= NO EFFECT
    FIELD)= #162
    Sets the Discharge Status field to the correct status based upon the Disposition Type field in the PTF Record.
162 DISCHARGE STATUS U;12 POINTER TO MCCR UTILITY FILE (#399.1) MCCR UTILITY(#399.1)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^DGCR(399.1,+Y,0),""^"",6)=1" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  AUG 31, 1988
  • HELP-PROMPT:  Enter the code which indicates patient status as of statement covers through date.
  • DESCRIPTION:  
    This is the patient status as of the statement covers through date.
  • SCREEN:  S DIC("S")="I $P(^DGCR(399.1,+Y,0),""^"",6)=1"
  • EXPLANATION:  Valid MCCR Discharge Statuses only!
  • NOTES:  TRIGGERED by the PTF ENTRY NUMBER field of the BILL/CLAIMS File
    TRIGGERED by the DISCHARGE BEDSECTION field of the BILL/CLAIMS File
163 TREATMENT AUTHORIZATION CODE U;13 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<1) X
    MAXIMUM LENGTH: 50
  • LAST EDITED:  APR 27, 2017
  • HELP-PROMPT:  Answer must be 1-50 characters in length.
  • DESCRIPTION:  This indicates that the treatment covered by this bill has been authorized by the primary payer.
    On the CMS-1500 this is box 23, PRIOR AUTHORIZATION NUMBER. On the UB-04, this is reported in FL63.
  • NOTES:  TRIGGERED by the PRIMARY INSURANCE POLICY field of the BILL/CLAIMS File
164 BC/BS PROVIDER # U;14 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>13!($L(X)<3)!'(X?.ANP) X
  • LAST EDITED:  AUG 19, 1991
  • HELP-PROMPT:  Enter the Blue Cross/Shield provider number for this particular billing episode.
  • DESCRIPTION:  
    This is the Blue Cross/Blue Shield Provider Number for this billing episode.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the BILL NUMBER field of the BILL/CLAIMS File
165 LENGTH OF STAY U;15 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>6!($L(X)<1)!'(X?.N) X
  • LAST EDITED:  MAR 15, 2001
  • HELP-PROMPT:  Enter the length of stay for this inpatient episode excluding pass, AA and UA days.
  • DESCRIPTION:  
    This defines the length of stay in days for this inpatient episode excluding pass, AA, and UA days.
  • TECHNICAL DESCR:  If no PTF defined then uses the Statement From and To dates for LOS. Excludes pass, AA, UA days but includes days in non-billable bedsections. Notice that the number of units of service under revenue code only includes
    billable bedsections so the number of units may not add up to the length of stay if the patient was in a non-billable bedsection for awhile. LOS of a stay where admit day=discharge day is 1. LOS of a stay where admit
    date+1=discharge date also has an LOS of 1. The discharge date is not charged. Therefore, on continuous first and interum bills the LOS is the date range inclusive of the last day on the bill, all other bills exclude the
    last day (with exception of admit=discharge day).
  • NOTES:  TRIGGERED by the PTF ENTRY NUMBER field of the BILL/CLAIMS File
    TRIGGERED by the STATEMENT COVERS FROM field of the BILL/CLAIMS File
    TRIGGERED by the STATEMENT COVERS TO field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^216
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P($G(^DGCR(399,DA,"U2")),U,2)=""&$$INPAT^IBCEF(DA,1)) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=DIV X ^DD(399,1
    65,1,1,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,2)=DIV,DIH=399,DIG=216 D ^DICR
    2)= Q
    3)= Do not delete
    CREATE CONDITION)= S X=($P($G(^DGCR(399,DA,"U2")),U,2)=""&$$INPAT^IBCEF(DA,1))
    CREATE VALUE)= LENGTH OF STAY
    DELETE VALUE)= NO EFFECT
    FIELD)= COVERED DAYS
    This cross reference populates the covered days field with the length of stay if the bill is for an inpatient episode and there is not already a value entered for covered days on this bill.
  • CROSS-REFERENCE:  ^^TRIGGER^399^217
    1)= X ^DD(399,165,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV N Z S X=$$LOS1^IBCU64(DA,.Z),X=+$G(Z) X ^DD(399,165,1,2,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P($G(^DGCR(399,DA,"U2")),U,3)=""&$$INPAT^IBCEF(DA,1))
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,3)=DIV,DIH=399,DIG=217 D ^DICR
    2)= Q
    3)= Do not delete
    CREATE CONDITION)= S X=($P($G(^DGCR(399,DA,"U2")),U,3)=""&$$INPAT^IBCEF(DA,1))
    CREATE VALUE)= N Z S X=$$LOS1^IBCU64(DA,.Z),X=+$G(Z)
    DELETE VALUE)= NO EFFECT
    FIELD)= NON-COVERED DAYS
    This cross reference populates the non-covered days field with the # of leave/pass days if the bill is for an inpatient episode and there is not already a value entered for non-covered days on this bill.
166 UNABLE TO WORK FROM U;16 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  SEP 21, 2006
  • HELP-PROMPT:  Enter the beginning date the patient became unable to work due to current condition.
  • DESCRIPTION:  
    Enter the beginning date for the period of time that the patient could not work due to the condition for which this claim is being submitted. Printed on the CMS-1500.
167 UNABLE TO WORK TO U;17 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  SEP 21, 2006
  • HELP-PROMPT:  Enter the ending date of the time that the patient was unable to work due to current condition.
  • DESCRIPTION:  
    This is the ending date of the period of time during which the patient was unable to work due to the condition for which this claim is being submitted. Used on the CMS-1500.
168 *PLACE OF SERVICE U;18 POINTER TO PLACE OF SERVICE FILE (#353.1) PLACE OF SERVICE(#353.1)

  • LAST EDITED:  JUN 11, 1993
  • HELP-PROMPT:  Enter the code corresponding to the Place of Service of patient care.
  • DESCRIPTION:  
    This indicates the Place of Service, used on the HCFA 1500. Not used after IB v1.5, replaced by PLACE OF SERVICE (304,8) associated with a specific procedure. Marked for deletion 6/11/93.
169 *TYPE OF SERVICE U;19 POINTER TO TYPE OF SERVICE FILE (#353.2) TYPE OF SERVICE(#353.2)

  • LAST EDITED:  JUN 11, 1993
  • HELP-PROMPT:  Enter the appropriate Type of Service code for this visit.
  • DESCRIPTION:  
    Code indicating the Type of Service preformed. Used on the HCFA 1500. Not used after IB v1.5, replaced by TYPE OF SERVICE (304,9) associated with a specific procedure. Marked for deletion 6/11/93.
170 PPS U1;15 POINTER TO DRG FILE (#80.2) DRG(#80.2)

  • LAST EDITED:  NOV 04, 2008
  • HELP-PROMPT:  Enter one DRG from the PTF or enter one from the DRG file.
  • DESCRIPTION:  
    Accept the default Discharge DRG as the PPS value or enter another DRG from the PTF file or from the DRG file.
  • NOTES:  TRIGGERED by the PTF ENTRY NUMBER field of the BILL/CLAIMS File
201 TOTAL CHARGES U1;1 NUMBER

  • LAST EDITED:  OCT 23, 2001
  • HELP-PROMPT:  Enter the total amount of the revenue code charges for this bill in dollars.
  • DESCRIPTION:  
    This is the total amount of the revenue code charges for this bill.
    WRITE AUTHORITY: ^
    UNEDITABLE
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the STATEMENT COVERS FROM field of the BILL/CLAIMS File
202 OFFSET AMOUNT U1;2 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999)!(X<0) X
  • LAST EDITED:  APR 18, 2017
  • HELP-PROMPT:  Enter the dollar amount between 0 and 99999.99 that is to be subtracted from the total charges on this bill. Offset includes, but is not limited to, co-payments and deductibles.
  • DESCRIPTION:  
    This is the dollar amount which is to be subtracted from the total charges on this bill. Offset includes, but is not limited to, co-payments, credits, and deductibles.
  • NOTES:  TRIGGERED by the PRIMARY PRIOR PAYMENT field of the BILL/CLAIMS File
    TRIGGERED by the SECONDARY PRIOR PAYMENT field of the BILL/CLAIMS File
    TRIGGERED by the TERTIARY PRIOR PAYMENT field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^203
    1)= Q
    2)= X ^DD(399,202,1,1,2.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"U1")),DIV=X S $P(^("U1"),U,3)=DIV,DIH=399,DIG=203 D ^DICR
    2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,2)="",Y(2)=$G(X) S X=$P(Y(1),U,2)=0,Y=X,X=Y(2),X=X!Y
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"U1")),DIV=X S $P(^("U1"),U,3)=DIV,DIH=399,DIG=203 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE CONDITION)= OFFSET AMOUNT=""!(OFFSET AMOUNT=0)
    DELETE VALUE)= @
    FIELD)= #203
    When the OFFSET AMOUNT is deleted or is equal to ZERO, remove the OFFSET DESCRIPTION.
203 OFFSET DESCRIPTION U1;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>24!($L(X)<3) X
  • LAST EDITED:  MAR 17, 1994
  • HELP-PROMPT:  Enter reason for Offset Amount. Offset Description may include, but is not limited to, deductibles, copayments, credits, etc.
  • DESCRIPTION:  
    This defines the reason for offset amount. Maximum length is 24 characters.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the OFFSET AMOUNT field of the BILL/CLAIMS File
    TRIGGERED by the PRIMARY PRIOR PAYMENT field of the BILL/CLAIMS File
    TRIGGERED by the SECONDARY PRIOR PAYMENT field of the BILL/CLAIMS File
    TRIGGERED by the TERTIARY PRIOR PAYMENT field of the BILL/CLAIMS File
204 *UB82 FORM LOCATOR 2 U1;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<2) X
  • LAST EDITED:  JAN 16, 2007
  • HELP-PROMPT:  Enter the information (2-30 characters) which is to appear in form locator 2 on the UB-82 form.
  • DESCRIPTION:  This allows the user to enter information which will appear in form locator 2 on the UB-82 form.
    This field is marked for deletion and can be deleted 11/23/2008.
  • TECHNICAL DESCR:  The name (LABEL) of this field has been changed from: FORM LOCATOR 2 to: UB82 FORM LOCATOR 2 to distinguish it from field #450.
    This field is marked for deletion and can be deleted 11/23/2008.
205 *FORM LOCATOR 9 U1;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>7!($L(X)<2) X
  • LAST EDITED:  JAN 16, 2007
  • HELP-PROMPT:  Enter the information (2-7 characters) which will appear in form locator 9 on the UB-82 form.
  • DESCRIPTION:  This allows the user to enter information which will appear in form locator 9 on the UB-82 form.
    This field is marked for deletion and can be deleted 11/23/2008.
  • TECHNICAL DESCR:  Was temporarily used to hold Admitting DX for the UB-92 (FL 76), but was replaced by FL 215.
    This field is marked for deletion and can be deleted 11/23/2008.
206 *FORM LOCATOR 27 U1;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<2) X
  • LAST EDITED:  JAN 16, 2007
  • HELP-PROMPT:  Enter the information (2-8 characters) which is to appear in form locator 27 on the UB-82 form.
  • DESCRIPTION:  This allows the user to enter information will will appear in form locator 27 on the UB-82 form.
    This field is marked for deletion and can be deleted 11/23/2008.
207 *FORM LOCATOR 45 U1;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>17!($L(X)<2) X
  • LAST EDITED:  JAN 16, 2007
  • HELP-PROMPT:  Enter the information (2-17 characters) which will appear in form locator 45 on the UB-82 form.
  • DESCRIPTION:  This allows the user to enter information which will appear in form locator 45 on the UB-82 form.
    This field is marked for deletion and can be deleted 11/23/2008.
208 *BILL COMMENT U1;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<2) X
  • LAST EDITED:  FEB 09, 2007
  • HELP-PROMPT:  Answer must be 2-35 characters in length
  • DESCRIPTION:  
    This field is not used after IB patch 349. The new remarks field for FL-80 on the UB-04 is BILL REMARKS (field#402).
209 *FISCAL YEAR 1 U1;9 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<2)!'(X?.N) X
  • LAST EDITED:  MAY 22, 2001
  • HELP-PROMPT:  Enter the 2 digit fiscal year associated with this bill.
  • DESCRIPTION:  
    This defines the first fiscal year with which this bill is associated. OBSOLETE AS OF PATCH IB*2*137 -- 2001
210 *FY 1 CHARGES U1;10 NUMBER
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
  • LAST EDITED:  MAY 22, 2001
  • HELP-PROMPT:  Enter the charges incurred during the first fiscal year associated with this bill.
  • DESCRIPTION:  
    These are the charges incurred during the first fiscal year associated with this bill. OBSOLETE AS OF PATCH IB*2*137 -- 2001
211 *FISCAL YEAR 2 U1;11 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<2)!'(X?.N) X
  • LAST EDITED:  MAY 22, 2001
  • HELP-PROMPT:  Enter the 2 digit second fiscal year associated with this bill.
  • DESCRIPTION:  
    This is the second fiscal year with which this bill is associated. OBSOLETE AS OF PATCH IB*2*137 -- 2001
  • TECHNICAL DESCR:  
    Beginning with 1.5 bills can no longer span fical years, so this is no longer needed.
212 *FY 2 CHARGES U1;12 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
  • LAST EDITED:  MAY 22, 2001
  • HELP-PROMPT:  Enter the charges incurred during the second fiscal year associated with this bill.
  • DESCRIPTION:  
    These are the charges incurred during the second fiscal year associated with this bill. OBSOLETE AS OF PATCH IB*2*137 -- 2001
    WRITE AUTHORITY: ^
213 *FORM LOCATOR 92 U1;13 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>32!($L(X)<3) X
  • LAST EDITED:  JAN 16, 2007
  • HELP-PROMPT:  Answer must be 3-32 characters in length.
  • DESCRIPTION:  This is the Attending Physician ID (UPIN) and is printed on the UB-82 in form locator 92 and form locator 82 on the UB-92. This field will be loaded with the ATTENDING PHYSICIAN ID code required by the primary insurer, if
    that insurer has a code defined.
    This field is marked for deletion and can be deleted 11/23/2008.
  • TECHNICAL DESCR:  This field may be null or a value the billing clerk inserted while editing on screen 8 or a value that the primary insurer requires to print in form locator 92 of the UB-82 or FL 82 of the UB-92. If the field is null then
    the print routines print the string 'Dept. of Veterans Affairs' in form locator 82/92.
    This field is marked for deletion and can be deleted 11/23/2008.
214 *FORM LOCATOR 93 U1;14 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>32!($L(X)<3) X
  • LAST EDITED:  MAY 11, 1999
  • HELP-PROMPT:  Answer must be 3-32 characters in length.
  • DESCRIPTION:  Enter the 'Other Physician ID'. The name and/or number of the licensed physician other than the attending physician or what the primary insurer requires in this field on the form. Will print in form locator 93 on the
    UB-82 and form locator 83 on the UB-92.
  • TECHNICAL DESCR:  
    This field will be deleted 18 months from 1-1-2000.
215 ADMITTING DIAGNOSIS U2;1 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • INPUT TRANSFORM:  S ICDVDT=$$BDATE^IBACSV(+$G(DA)),DIC("S")="I $$ICD9ACT^IBACSV(+Y,ICDVDT)",DIC("W")="D EN^DDIOL("" ""_$P($$ICD9^IBACSV(+Y,ICDVDT),U,3),,""?0"")" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  JAN 16, 2007
  • HELP-PROMPT:  Enter the code for the admitting diagnosis.
  • DESCRIPTION:  The ICD-9 diagnosis code provided at the time of admission as stated by the physician.
    The admitting diagnosis code will be printed in Form Locator 69 on the UB-04.
  • SCREEN:  S ICDVDT=$$BDATE^IBACSV(+$G(DA)),DIC("S")="I $$ICD9ACT^IBACSV(+Y,ICDVDT)",DIC("W")="D EN^DDIOL("" ""_$P($$ICD9^IBACSV(+Y,ICDVDT),U,3),,""?0"")"
  • EXPLANATION:  Only codes active for the date of service may be selected.
  • NOTES:  TRIGGERED by the ORDER field of the IB BILL/CLAIMS DIAGNOSIS File
216 COVERED DAYS U2;2 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  JAN 17, 2007
  • HELP-PROMPT:  Type a number between 0 and 999, 0 Decimal Digits
  • DESCRIPTION:  
    The number of days covered by the primary payer, as qualified by the payer organization.
  • NOTES:  TRIGGERED by the LENGTH OF STAY field of the BILL/CLAIMS File
217 NON-COVERED DAYS U2;3 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  JAN 17, 2007
  • HELP-PROMPT:  Type a Number between 0 and 9999, 0 Decimal Digits
  • DESCRIPTION:  
    Days of care not covered by the primary payer.
  • NOTES:  TRIGGERED by the LENGTH OF STAY field of the BILL/CLAIMS File
218 PRIMARY PRIOR PAYMENT U2;4 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<0) X
  • LAST EDITED:  AUG 21, 1997
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 99999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is the amount the primary insurance has already paid on this bill.
  • NOTES:  TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^202
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=DIU+DIV X ^DD(399,218,1,1,1.4)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U1")):^("U1"),1:""),DIV=X S $P(^("U1"),U,2)=DIV,DIH=399,DIG=202 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=DIU-X X ^DD(399,218,1,1,2.4)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U1")):^("U1"),1:""),DIV=X S $P(^("U1"),U,2)=DIV,DIH=399,DIG=202 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= OFFSET AMOUNT+PRIMARY PRIOR PAYMENT
    DELETE VALUE)= OFFSET AMOUNT-OLD PRIMARY PRIOR PAYMENT
    FIELD)= OFFSET AMOUNT
    Adds Primary Prior Payment to the Offset Amount.
  • CROSS-REFERENCE:  ^^TRIGGER^399^203
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV S X="PRIOR PAYMENT(S)" X ^DD(399,218,1,2,1.4)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U1")):^("U1"),1:""),DIV=X S $P(^("U1"),U,3)=DIV,DIH=399,DIG=203 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE VALUE)= "PRIOR PAYMENT(S)"
    DELETE VALUE)= NO EFFECT
    FIELD)= OFFSET DESCRIPTION
    Sets Offset Description if a Primary Prior Payment is entered.
219 SECONDARY PRIOR PAYMENT U2;5 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<0) X
  • LAST EDITED:  AUG 21, 1997
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 99999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is the amount the secondary insurance has already paid on this bill.
  • NOTES:  TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^202
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=DIU+DIV X ^DD(399,219,1,1,1.4)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U1")):^("U1"),1:""),DIV=X S $P(^("U1"),U,2)=DIV,DIH=399,DIG=202 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=DIU-X X ^DD(399,219,1,1,2.4)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U1")):^("U1"),1:""),DIV=X S $P(^("U1"),U,2)=DIV,DIH=399,DIG=202 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= OFFSET AMOUNT+SECONDARY PRIOR PAYMENT
    DELETE VALUE)= OFFSET AMOUNT-OLD SECONDARY PRIOR PAYMENT
    FIELD)= OFFSET AMOUNT
    Adds the Secondary Prior Payment to the Offset Amount.
  • CROSS-REFERENCE:  ^^TRIGGER^399^203
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV S X="PRIOR PAYMENT(S)" X ^DD(399,219,1,2,1.4)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U1")):^("U1"),1:""),DIV=X S $P(^("U1"),U,3)=DIV,DIH=399,DIG=203 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE VALUE)= "PRIOR PAYMENT(S)"
    DELETE VALUE)= NO EFFECT
    FIELD)= OFFSET DESCRIPTION
    Sets Offset Description if a Secondary Prior Payment is entered.
220 TERTIARY PRIOR PAYMENT U2;6 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<0) X
  • LAST EDITED:  AUG 21, 1997
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 99999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is the amount the tertiary insurance has already paid on this bill.
  • NOTES:  TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399^202
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=DIU+DIV X ^DD(399,220,1,1,1.4)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U1")):^("U1"),1:""),DIV=X S $P(^("U1"),U,2)=DIV,DIH=399,DIG=202 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=DIU-X X ^DD(399,220,1,1,2.4)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U1")):^("U1"),1:""),DIV=X S $P(^("U1"),U,2)=DIV,DIH=399,DIG=202 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= OFFSET AMOUNT+TERTIARY PRIOR PAYMENT
    DELETE VALUE)= OFFSET AMOUNT-OLD TERTIARY PRIOR PAYMENT
    FIELD)= OFFSET AMOUNT
    Adds the Tertiary Prior Payments to the Offset Amount.
  • CROSS-REFERENCE:  ^^TRIGGER^399^203
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV S X="PRIOR PAYMENT(S)" X ^DD(399,220,1,2,1.4)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U1")):^("U1"),1:""),DIV=X S $P(^("U1"),U,3)=DIV,DIH=399,DIG=203 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE VALUE)= "PRIOR PAYMENT(S)"
    DELETE VALUE)= NO EFFECT
    FIELD)= OFFSET DESCRIPTION
    Sets the Offset Description if a Tertiary Prior Payment is entered.
221 CO-INSURANCE DAYS U2;7 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  JAN 17, 2007
  • HELP-PROMPT:  Type a number between 0 and 999, 0 Decimal Digits
  • DESCRIPTION:  
    This is the # of days.
222 PROVIDER PRV;0 SET Multiple #399.0222 399.0222

  • LAST EDITED:  APR 26, 2001
  • SCREEN:  S DIC("S")="I $$PRVOK^IBCEU(+Y,$S($D(D0):D0,1:$G(DA)))"
  • EXPLANATION:  Rendering is for prof only. Operating/Attending are for inst only.
  • IDENTIFIED BY:  PERFORMED BY(#.02)
  • INDEXED BY:  DELETE 2006 .09 (AUPDID1), DELETE 2006 .1 (AUPDID2), DELETE 2006 .11 (AUPDID3)
230 SECONDARY AUTHORIZATION CODE U2;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<1) X
    MAXIMUM LENGTH: 50
  • LAST EDITED:  APR 27, 2017
  • HELP-PROMPT:  Answer must be 1-50 characters in length.
  • DESCRIPTION:  This indicates that the treatment covered by this bill has been authorized by the secondary payer.
    On the CMS-1500 this is box 23, PRIOR AUTHORIZATION NUMBER. On the UB-04, this is reported in FL63.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the SECONDARY INSURANCE POLICY field of the BILL/CLAIMS File
231 TERTIARY AUTHORIZATION CODE U2;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<1) X
    MAXIMUM LENGTH: 50
  • LAST EDITED:  APR 27, 2017
  • HELP-PROMPT:  Answer must be 1-50 characters in length.
  • DESCRIPTION:  This indicates that the treatment covered by this bill has been authorized by the tertiary payer.
    On the CMS-1500 this is box 23, PRIOR AUTHORIZATION NUMBER. On the UB-04, this is reported in FL63.
  • NOTES:  TRIGGERED by the TERTIARY INSURANCE POLICY field of the BILL/CLAIMS File
232 NON-VA FACILITY U2;10 POINTER TO IB NON/OTHER VA BILLING PROVIDER FILE (#355.93) IB NON/OTHER VA BILLING PROVIDER(#355.93)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),U,2)=1" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  SEP 16, 2010
  • HELP-PROMPT:  Enter the non-VA/other VA facility where care was given.
  • DESCRIPTION:  
    The is the name of the non-VA or outside VA facility where the services were rendered.
  • SCREEN:  S DIC("S")="I $P(^(0),U,2)=1"
  • EXPLANATION:  Must be a facility provider type entry.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^399^234
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,12),X=X S DIU=X K Y X ^DD(399,232,1,1,1.1) X ^DD(399,232,1,1,1.4)
    1.1)= S X=DIV S I(0,0)=$S($D(D0):D0,1:""),D0=DIV S:'$D(^IBA(355.93,+D0,0)) D0=-1 S Y(101)=$S($D(^IBA(355.93,D0,0)):^(0),1:"") S X=$P(Y(101),U,9) S D0=I(0,0)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U2")):^("U2"),1:""),DIV=X S $P(^("U2"),U,12)=DIV,DIH=399,DIG=234 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,12),X=X S DIU=X K Y S X="" X ^DD(399,232,1,1,2.4)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U2")):^("U2"),1:""),DIV=X S $P(^("U2"),U,12)=DIV,DIH=399,DIG=234 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= NON-VA FACILITY:FACILITY DEFAULT ID NUMBER
    DELETE VALUE)= @
    FIELD)= NON-VA CARE ID #
  • CROSS-REFERENCE:  ^^TRIGGER^399^233
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,11),X=X S DIU=X K Y S X="" X ^DD(399,232,1,2,2.4)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U2")):^("U2"),1:""),DIV=X S $P(^("U2"),U,11)=DIV,DIH=399,DIG=233 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    3)= Do not delete
    CREATE VALUE)= NO EFFECT
    DELETE VALUE)= @
    FIELD)= NON-VA CARE TYPE
    This cross reference deletes the NON-VA CARE TYPE field when the NON-VA Facility value is deleted.
  • CROSS-REFERENCE:  ^^TRIGGER^399^235
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$CLIAREQ^IBCEP8A(DA) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,13),X=X S DIU=X K Y S X=DIV S X=$$CLIA^IBCEP8A(DA) X ^DD(399,232,1,3,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,13)=DIV,DIH=399,DIG=235 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$CLIAREQ^IBCEP8A(DA) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,13),X=X S DIU=X K Y S X=DIV S X=$$CLIA^IBCEP8A(DA) X ^DD(399,232,1,3,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,13)=DIV,DIH=399,DIG=235 D ^DICR
    CREATE CONDITION)= S X=$$CLIAREQ^IBCEP8A(DA)
    CREATE VALUE)= S X=$$CLIA^IBCEP8A(DA)
    DELETE CONDITION)= S X=$$CLIAREQ^IBCEP8A(DA)
    DELETE VALUE)= S X=$$CLIA^IBCEP8A(DA)
    FIELD)= LAB CLIA NUMBER
    This trigger will set the LAB CLIA NUMBER field to the default CLIA# for the facility - either VA facility or non-VA facility. The trigger condition ensures that lab services are on the claim.
  • CROSS-REFERENCE:  ^^TRIGGER^399^244
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U3")):^("U3"),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV S X=$P($$TAXGET^IBCEP81(X),U,2) X ^DD(399,232,1,4,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"U3")),DIV=X S $P(^("U3"),U,3)=DIV,DIH=399,DIG=244 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U3")):^("U3"),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"U3")),DIV=X S $P(^("U3"),U,3)=DIV,DIH=399,DIG=244 D ^DICR
    3)= Do not delete
    CREATE VALUE)= S X=$P($$TAXGET^IBCEP81(X),U,2)
    DELETE VALUE)= @
    FIELD)= #244
    This xref updates the NON-VA FACILITY TAXONOMY field with the non-VA facility's default taxonomy.
  • RECORD INDEXES:  ABP (#820)
233 NON-VA CARE TYPE U2;11 SET
  • '1' FOR FEE BASIS, NON-LAB;
  • '2' FOR FEE BASIS, LAB;
  • '3' FOR NON-FEE BASIS, NON-LAB;
  • '4' FOR NON-FEE BASIS, LAB;

  • LAST EDITED:  AUG 25, 1999
  • HELP-PROMPT:  Enter the type of outside care that was provided
  • DESCRIPTION:  
    This is the code that identifies if the care given was fee basis lab, fee basis non-lab, or non-fee basis care.
  • NOTES:  TRIGGERED by the NON-VA FACILITY field of the BILL/CLAIMS File
234 NON-VA CARE ID # U2;12 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  JUL 22, 1999
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    This is the id number to be reported on the bill for the non-VA facility where care was provided. For a lab, this should be the CLIA #
  • NOTES:  TRIGGERED by the NON-VA FACILITY field of the BILL/CLAIMS File
235 LAB CLIA NUMBER U2;13 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  DEC 28, 2005
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  Enter the CLIA number for the VA Division if the service was performed by the VA. Enter the CLIA number for the Other Facility if the service was performed by a non-VA facility.
    You can define a CLIA number as a secondary ID for a non-VA Facility through Provider ID Maint. If you enter a CLIA number here that is not defined in Provider ID Maint (non-VA) or the Institution file (VA), it will be
    sent with this claim only.
  • NOTES:  TRIGGERED by the NON-VA FACILITY field of the BILL/CLAIMS File
    TRIGGERED by the DEFAULT DIVISION field of the BILL/CLAIMS File
236 HOMEBOUND U2;14 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  JAN 29, 2014
  • HELP-PROMPT:  Enter yes if patient was homebound for purchased labs.
  • DESCRIPTION:  
    This is to indicate that the patient is homebound or institutionalized. Refer to MEDICARE regulations on when to use this field.
237 DATE LAST SEEN U2;15 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JAN 29, 2014
  • HELP-PROMPT:  Enter the last date the patient was seen if care was provided by an outside provider of PT/OT or routine foot care.
  • DESCRIPTION:  
    This is the date a patient was last seen. Refer to MEDICARE regulations on when to use this field.
238 SPECIAL PROGRAM INDICATOR U2;16 SET
  • '01' FOR EPSDT/CHAP;
  • '02' FOR Phys Handicapped Children Program;
  • '03' FOR Special Fed Funding;
  • '05' FOR Disability;
  • '07' FOR Induced Abortion - Danger to Life;
  • '08' FOR Induced Abortion - Rape or Incest;
  • '09' FOR 2nd Opinion/Surgery;

  • LAST EDITED:  JAN 29, 2014
  • HELP-PROMPT:  Enter the code indicating the Special Program under which the patient services were rendered.
  • DESCRIPTION:  
    This is the Special Program with which a claim is associated. Refer to MEDICARE regulations to decide when to use this field.
239 PRIMARY EMC ID CARE UNIT U2;17 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  NOV 09, 2000
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    This is the data value needed to allow the system to match the attending/rendering provider with the correct EMC id # for the primary ins co.
  • EXECUTABLE HELP:  D CAREID^IBCEP1("EMC",1,DA)
240 SECONDARY EMC ID CARE UNIT U2;18 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  NOV 09, 2000
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    This is the data value needed to allow the system to match the attending/rendering provider with the correct EMC id # for the secondary ins co.
  • EXECUTABLE HELP:  D CAREID^IBCEP1("EMC",2,DA)
241 TERTIARY EMC ID CARE UNIT U2;19 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  NOV 09, 2000
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    This is the data value needed to allow the system to match the attending/rendering provider with the correct EMC id # for the tertiary ins co.
  • EXECUTABLE HELP:  D CAREID^IBCEP1("EMC",3,DA)
242 MAMMOGRAPHY CERT NUMBER U3;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  DEC 28, 2005
  • HELP-PROMPT:  Answer must be 1-15 characters in length
  • DESCRIPTION:  Enter the Mammography Certification number for the VAMC if the service was performed by the VA. Enter the Mammography Certification number for the Other Facility if the service was performed by a non-VA facility.
    You can define a Mammography Certification number for a non-VA Facility through Provider ID Maint. If you enter a Mammography Certification number here that is not defined in Provider ID Maint (non-VA) or the Institution
    file (VA), it will be sent with this claim only.
243 SERVICE FACILITY TAXONOMY U3;2 POINTER TO PERSON CLASS FILE (#8932.1) PERSON CLASS(#8932.1)

  • INPUT TRANSFORM:  S DIC("S")="I $P($G(^(90002)),U,2)=""N""" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  MAR 06, 2009
  • HELP-PROMPT:  Enter the Taxonomy Code associated with the Service Facility.
  • DESCRIPTION:  
    This field contains the organizational taxonomy code for the Service Facility. You may override the default taxonomy code here.
  • TECHNICAL DESCR:  This field is set via the "ABP" new-style MUMPS x-refs from the following fields in the BILL/CLAIMS file (#399) and in the IB BILL/CLAIMS PRESCRIPTION REFILL file (#362.4):
    399,.22 - DEFAULT DIVISION
    399,232 - NON-VA FACILITY
    399,136 - BILL PAYER POLICY
    399,.19 - FORM TYPE 362.4,.02 - BILL NUMBER
    Whenever these fields are edited, the service facility may change and thus a new default service facility taxonomy code is filed.
  • SCREEN:  S DIC("S")="I $P($G(^(90002)),U,2)=""N"""
  • EXPLANATION:  Only entries for 'Non-Individuals' may be selected.
244 NON-VA FACILITY TAXONOMY U3;3 POINTER TO PERSON CLASS FILE (#8932.1) PERSON CLASS(#8932.1)

  • INPUT TRANSFORM:  S DIC("S")="I $P($G(^(90002)),U,2)=""N""" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JUN 13, 2006
  • HELP-PROMPT:  Enter the Taxonomy Code associated with this Non-VA Facility.
  • SCREEN:  S DIC("S")="I $P($G(^(90002)),U,2)=""N"""
  • EXPLANATION:  Only entries for 'Non-Individuals' may be selected.
  • NOTES:  TRIGGERED by the NON-VA FACILITY field of the BILL/CLAIMS File
245 LAST XRAY DATE U3;4 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X) D CHDAT^IBCU4
  • LAST EDITED:  JUN 19, 2007
  • HELP-PROMPT:  Enter the last date the patient had an Xray (for chiropractic only).
  • DESCRIPTION:  
    If an Xray was used to demonstrate a subluxation of the spine, enter the date of the last Xray. If an Xray date is entered, it will automatically print on CMS-1500.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
246 DATE OF INITIAL TREATMENT U3;5 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X) D CHDAT^IBCU4
  • LAST EDITED:  JUN 19, 2007
  • HELP-PROMPT:  Enter the date on which the chiropractic treatment began.
  • DESCRIPTION:  
    Date on which these treatments were started.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
247 DATE OF ACUTE MANIFESTATION U3;6 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X) D CHDAT^IBCU4
  • LAST EDITED:  JUN 19, 2007
  • HELP-PROMPT:  Enter the date on which the acute chiropractic condition began.
  • DESCRIPTION:  
    If the Patient's Condition Code equals Acute Condition or Acute Manifestation of a Chronic Condition, you must enter the date on which the acute condition started.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
248 PATIENT CONDITION CODE U3;7 SET
  • 'A' FOR Acute Condition;
  • 'C' FOR Chronic Condition;
  • 'D' FOR Non-acute Condition;
  • 'E' FOR Non-Life Threatening;
  • 'F' FOR Routine;
  • 'G' FOR Symptomatic;
  • 'M' FOR Acute Manifestation of a Chronic Condition;

  • LAST EDITED:  MAY 24, 2007
  • HELP-PROMPT:  Enter a code describing the chiropractic condition.
  • DESCRIPTION:  
    Enter one of the following required codes;
249 PRV DIAGNOSIS (1) U3;8 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 03, 2008
  • HELP-PROMPT:  Please enter the first "Patient reason for visit" diagnosis.
  • DESCRIPTION:  
    This is the first PRV diagnosis.
250 PRV DIAGNOSIS (2) U3;9 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 03, 2008
  • HELP-PROMPT:  Please enter the second "Patient reason for visit" diagnosis.
  • DESCRIPTION:  
    This is the second PRV diagnosis.
251 PRV DIAGNOSIS (3) U3;10 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 03, 2008
  • HELP-PROMPT:  Please enter the third "Patient reason for visit" diagnosis.
  • DESCRIPTION:  
    This is the third PRV diagnosis.
252 BILLING PROVIDER TAXONOMY U3;11 POINTER TO PERSON CLASS FILE (#8932.1) PERSON CLASS(#8932.1)

  • INPUT TRANSFORM:  S DIC("S")="I $P($G(^(90002)),U,2)=""N""" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  MAR 06, 2009
  • HELP-PROMPT:  Enter the Taxonomy Code associated with the Billing Provider.
  • DESCRIPTION:  
    This field contains the organizational taxonomy code for the Billing Provider. You may override the default taxonomy code here.
  • TECHNICAL DESCR:  This field is set via the "ABP" new-style MUMPS x-refs from the following fields in the BILL/CLAIMS file (#399) and in the IB BILL/CLAIMS PRESCRIPTION REFILL file (#362.4):
    399,.22 - DEFAULT DIVISION
    399,232 - NON-VA FACILITY
    399,136 - BILL PAYER POLICY
    399,.19 - FORM TYPE 362.4,.02 - BILL NUMBER
    Whenever these fields are edited, the billing provider may change and thus a new default billing provider taxonomy code is filed.
  • SCREEN:  S DIC("S")="I $P($G(^(90002)),U,2)=""N"""
  • EXPLANATION:  Only entries for 'Non-Individuals' may be selected.
253 PRIMARY REFERRAL NUMBER UF32;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<1) X
    MAXIMUM LENGTH: 50
  • LAST EDITED:  APR 27, 2017
  • HELP-PROMPT:  Answer must be 1-50 characters in length.
  • DESCRIPTION:  
    This is the primary referral number assigned to the insurance.
  • NOTES:  TRIGGERED by the PRIMARY INSURANCE POLICY field of the BILL/CLAIMS File
254 SECONDARY REFERRAL NUMBER UF32;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<1) X
    MAXIMUM LENGTH: 50
  • LAST EDITED:  APR 27, 2017
  • HELP-PROMPT:  Answer must be 1-50 characters in length.
  • DESCRIPTION:  
    This is the secondary referral number assigned to the insurance.
  • NOTES:  TRIGGERED by the SECONDARY INSURANCE POLICY field of the BILL/CLAIMS File
255 TERTIARY REFERRAL NUMBER UF32;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<1) X
    MAXIMUM LENGTH: 50
  • LAST EDITED:  APR 27, 2017
  • HELP-PROMPT:  Answer must be 1-50 characters in length.
  • DESCRIPTION:  
    This is the tertiary referral number assigned to the insurance.
  • NOTES:  TRIGGERED by the TERTIARY INSURANCE POLICY field of the BILL/CLAIMS File
260 COB TOTAL NON-COVERED AMOUNT U4;1 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999999999999)!(X<0) X
  • LAST EDITED:  OCT 19, 2010
  • HELP-PROMPT:  Type a dollar amount between 0 and 999999999999999, 2 decimal digits.
  • DESCRIPTION:  
    This is a dollar amount that must equal the Total Claim Charge Amount. Required when the current payer allows providers to bypass claim submission to the otherwise prior payer (example: Medicare secondary with no MRA).
261 PROPERTY/CASUALTY CLAIM NUMBER U4;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<1)!($TR(X," ")="")!($E(X)=" ") X
    MAXIMUM LENGTH: 50
  • LAST EDITED:  APR 27, 2017
  • HELP-PROMPT:  Answer must be 1-50 characters in length, not all spaces, no leading spaces.
  • DESCRIPTION:  
    This is a payer-assigned claim number for a property and casualty claim.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
262 PROP/CAS DATE OF 1ST CONTACT U4;3 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  OCT 19, 2010
  • HELP-PROMPT:  Enter the date of first contact, if applicable.
  • DESCRIPTION:  
    This is the date the patient first consulted the service provider for this property and casualty related condition. Required when state mandated.
263 DISABILITY START DATE U4;4 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:DT$P($G(^DGCR(399,DA,"U4")),U,5) K X
  • LAST EDITED:  OCT 19, 2010
  • HELP-PROMPT:  Enter the Disability start date. Cannot be a future date or after Disability end date.
  • DESCRIPTION:  
    This is the Disability start date. Cannot be a future date, and cannot be after Disability end date.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
264 DISABILITY END DATE U4;5 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:DT
  • LAST EDITED:  OCT 19, 2010
  • HELP-PROMPT:  Enter the Disability End Date. Cannot be before disability start date.
  • DESCRIPTION:  
    This is the Disability stop date. Future dates are not allowed and stop date cannot be before start date.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
266 PRIMARY SURGICAL PROC CODE U4;7 POINTER TO CPT FILE (#81) CPT(#81)

  • LAST EDITED:  AUG 11, 2010
  • HELP-PROMPT:  Select a primary HCPCS surgical code, if applicable.
  • DESCRIPTION:  
    This is a primary HCPCS surgical code when anesthesiology services are being billed and the payment of the claim is dependent on provision of surgical codes.
267 SECONDARY SURGICAL PROC CODE U4;8 POINTER TO CPT FILE (#81) CPT(#81)

  • LAST EDITED:  AUG 11, 2010
  • HELP-PROMPT:  Select a secondary HCPCS surgical code, if applicable.
  • DESCRIPTION:  
    This is a secondary HCPCS surgical code when anesthesiology services are being billed and the payment of the claim is dependent on provision of surgical codes.
268 PROPERTY/CASUALTY CONTACT NAME U4;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>60!($L(X)<1) X
  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Answer must be 1-60 characters in length.
  • DESCRIPTION:  
    This is the name of the person to be contacted regarding this Property and Casualty claim if different from the Patient/Subscriber.
269 PROP/CAS COMMUNICATION NUMBER U4;10 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  AUG 27, 2010
  • HELP-PROMPT:  Type a number between 0 and 9999999999, 0 decimal digits.
  • DESCRIPTION:  
    Enter the area code and phone number for the person to be contacted regarding this Property and Casualty claim.
269.1 PROP/CAS EXTENSION NUMBER U4;11 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999999)!(X<1)!(X?.E1"."1.N) X
  • LAST EDITED:  FEB 10, 2011
  • HELP-PROMPT:  Type a number between 1 and 9999999999, 0 decimal digits.
  • DESCRIPTION:  
    This is the extension number for the person to be contacted regarding this Property and Casualty claim.
271 AMBULANCE P/U ADDRESS 1 U5;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>55!($L(X)<1) X
    MAXIMUM LENGTH: 55
  • LAST EDITED:  APR 27, 2017
  • HELP-PROMPT:  Answer must be 1-55 characters in length.
  • DESCRIPTION:  
    This is line one of the street address where the patient was picked up. Required for ambulance transportation.
272 AMBULANCE P/U ADDRESS 2 U5;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>55!($L(X)<1) X
    MAXIMUM LENGTH: 55
  • LAST EDITED:  APR 27, 2017
  • HELP-PROMPT:  Answer must be 1-55 characters in length.
  • DESCRIPTION:  
    This is line two of the address where the patient was picked up.
273 AMBULANCE P/U CITY U5;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUL 25, 2010
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    This is the City where the patient was picked up. Required for ambulance transportation.
274 AMBULANCE P/U STATE U5;5 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  JUL 25, 2010
  • HELP-PROMPT:  Enter the Ambulance P/U State.
  • DESCRIPTION:  
    This is the State where the patient was picked up. Required for ambulance transportation.
275 AMBULANCE P/U ZIP U5;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  JUL 25, 2010
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    This is the Zip code of the location where the patient was picked up. Required for ambulance transportation.
276 AMBULANCE D/O LOCATION U6;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>60!($L(X)<1) X
  • LAST EDITED:  AUG 05, 2010
  • HELP-PROMPT:  Answer must be 1-60 characters in length.
  • DESCRIPTION:  
    This is the name of the location where the patient was dropped off, if it is known.
277 AMBULANCE D/O ADDRESS 1 U6;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>55!($L(X)<1) X
    MAXIMUM LENGTH: 55
  • LAST EDITED:  APR 27, 2017
  • HELP-PROMPT:  Answer must be 1-55 characters in length.
  • DESCRIPTION:  
    This is line one of the street address where the patient was dropped off. Required for ambulance transportation.
278 AMBULANCE D/O ADDRESS 2 U6;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>55!($L(X)<1) X
    MAXIMUM LENGTH: 55
  • LAST EDITED:  APR 27, 2017
  • HELP-PROMPT:  Answer must be 1-55 characters in length.
  • DESCRIPTION:  
    This is line two of the address where the patient was dropped off.
279 AMBULANCE D/O CITY U6;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  AUG 05, 2010
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    This is the City where the patient was dropped off. Required for ambulance transportation.
280 AMBULANCE D/O STATE U6;5 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  AUG 05, 2010
  • HELP-PROMPT:  Enter the Ambulance D/O State.
  • DESCRIPTION:  
    This is the State where the patient was dropped off. Required for ambulance transportation.
281 AMBULANCE D/O ZIP U6;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  AUG 05, 2010
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    This is the Zip code of the location where the patient was dropped off. Required for ambulance transportation.
282 ASSUMED CARE DATE U4;13 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:DT$P($G(^DGCR(399,DA,"U4")),U,14) K X
  • LAST EDITED:  OCT 19, 2010
  • HELP-PROMPT:  Enter the date the provider assumed care. Cannot be a future date or greater than the Relinquished Care Date.
  • DESCRIPTION:  
    This is the date on which the provider on this claim assumed the post-operative care associated with this claim. Cannot be a future date or greater than the relinquished care date.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
283 RELINQUISHED CARE DATE U4;14 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:DT
  • LAST EDITED:  OCT 19, 2010
  • HELP-PROMPT:  Enter the date the provider relinquished care. Cannot be a future date or before the assumed care date.
  • DESCRIPTION:  
    This is the date on which the provider on this claim relinquished the post-operative care associated with this claim.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
284 ATTACHMENT CONTROL NUMBER U8;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  AUG 16, 2010
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    This is an Attachment Control Number (alphanumeric) that can be used to identify the documentation that will provide additional information for this claim. This applies to the entire claim.
285 ATTACHMENT REPORT TYPE U8;2 POINTER TO IB ATTACHMENT REPORT TYPE FILE (#353.3) IB ATTACHMENT REPORT TYPE(#353.3)

  • INPUT TRANSFORM:  S DIC("S")="I $$RTYPOK^IBCEU(X,DA)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  APR 06, 2017
  • HELP-PROMPT:  Select an Attachment Report Type.
  • DESCRIPTION:  
    This is a Report Type to describe the type of documentation that will provide additional information for this claim. This applies to the entire claim.
  • SCREEN:  S DIC("S")="I $$RTYPOK^IBCEU(X,DA)"
  • EXPLANATION:  Form types have different valid Attachment Report Types
286 ATTACHMENT REPORT TRANS CODE U8;3 SET
  • 'AA' FOR Available on Request at Provider Site;
  • 'BM' FOR By Mail;
  • 'EL' FOR Electronically Only;
  • 'EM' FOR E-Mail;
  • 'FT' FOR File Transfer;
  • 'FX' FOR By Fax;

  • LAST EDITED:  AUG 16, 2010
  • HELP-PROMPT:  Choose a code for the Attachment Transmission Method.
  • DESCRIPTION:  
    This is the code for the Attachment Transmission Method. This applies to the entire claim.
287 PATIENT WEIGHT (LB) U7;1 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>1000)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUL 28, 2011
  • HELP-PROMPT:  Enter a whole number for the patient's weight (1-1000 Pounds).
  • DESCRIPTION:  
    This is a whole number for the patient's weight.
288 TRANSPORT REASON CODE U7;2 POINTER TO TRANSPORT REASON CODE FILE (#353.4) TRANSPORT REASON CODE(#353.4)

  • LAST EDITED:  JUL 28, 2011
  • HELP-PROMPT:  Select the code indicating the reason for transport.
  • DESCRIPTION:  
    This is the code indicating the reason for transport.
289 AMBULANCE TRANSPORT DISTANCE U7;3 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>10000)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  JUL 28, 2011
  • HELP-PROMPT:  Enter a whole number for the distance traveled during transport (0-10000 Miles).
  • DESCRIPTION:  
    This is a whole number for the distance traveled during transport.
290 ROUND TRIP PURPOSE DESCRIPTION U7;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1) X
  • LAST EDITED:  JUL 28, 2011
  • HELP-PROMPT:  Enter a free text explanation of the purpose of the R/T service (1-80 characters).
  • DESCRIPTION:  
    This is a free text explanation of the purpose of the R/T service.
291 STRETCHER PURPOSE DESCRIPTION U7;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1) X
  • LAST EDITED:  JUL 28, 2011
  • HELP-PROMPT:  Enter a free text explanation of why a stretcher was used (1-80 characters).
  • DESCRIPTION:  
    This is a free text explanation of why a stretcher was used.
292 AMBULANCE CONDITION INDICATOR U9;0 POINTER Multiple #399.0292 399.0292

  • DESCRIPTION:  
    This allows up to five patient condition indicators to describe the patient during ambulance pickup, transport, and drop off.
301 PRIMARY NODE I1;E1,240 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>240!($L(X)<1) X
  • LAST EDITED:  JAN 29, 1990
  • HELP-PROMPT:  This is the information pertaining to the primary insurance carrier associated with this bill.
  • DESCRIPTION:  
    This is the information pertaining to the primary insurance carrier which is associated with this bill.
  • TECHNICAL DESCR:  Set by trigger on Primary Insurance Carrier (399,101) and at UPDT^IBSCSE. This node is a duplicate of the insurance's node in the patient file. ^DGCR(399,IBIFN,"I1")=^DPT(DFN,.312,X)
    where +^DPT(DFN,.312,X)=(399,101) primary insurer
302 SECONDARY NODE I2;E1,240 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>240!($L(X)<1) X
  • LAST EDITED:  JAN 29, 1990
  • HELP-PROMPT:  This is the information pertaining to the secondary insurance carrier which is associated with this bill.
  • DESCRIPTION:  
    This is the information pertaining to the secondary insurance carrier which is associated with this bill.
  • TECHNICAL DESCR:  Set by trigger on Secondary Insurance Carrier (399,102) and by UPDT^IBCSCE. This node is a duplicate of the insurance's node in the patient file. ^DGCR(399,IBIFN,"I2")=^DPT(DFN,.312,X)
    where +^DPT(DFN,.312,X)=(399,102) secondary insurer for bill
303 TERTIARY NODE I3;E1,240 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>240!($L(X)<1) X
  • LAST EDITED:  JAN 29, 1990
  • HELP-PROMPT:  This is the information pertaining to the tertiary insurance carrier associated with this bill.
  • DESCRIPTION:  
    This is the information pertaining to the tertiary insurance carrier associated with this bill.
304 PROCEDURES CP;0 VARIABLE POINTER Multiple #399.0304 399.0304

  • LAST EDITED:  NOV 01, 1991
  • DESCRIPTION:  
    These are ICD or CPT procedures that are associated with this bill.
  • TECHNICAL DESCR:  
  • IDENTIFIED BY:  
    "WRITE": D DISPID^IBCSC4D
  • INDEXED BY:  DIVISION (AC), PROCEDURES (AD)
371 PRIMARY NODE 7 I17;E1,240 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>240!($L(X)<1) X
  • LAST EDITED:  MAY 29, 2014
  • HELP-PROMPT:  This is addl. information pertaining to the primary insurance carrier associated with this bill. Value must be 1 to 240 characters in length.
  • DESCRIPTION:  
    This is addl. information pertaining to the primary insurance carrier associated with this bill. It is equal to the 7 node of the INSURANCE TYPE sub-file of the PATIENT file.
  • TECHNICAL DESCR:  This node is set by a trigger on PRIMARY INSURANCE CARRIER (399,101) and at UPDT^IBSCSE. This node is a duplicate of the 7 node of the INSURANCE TYPE sub-file of the PATIENT file.
    ^DGCR(399,IBIFN,"I17")=^DPT(DFN,.312,X,7)
372 SECONDARY NODE 7 I27;E1,240 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>240!($L(X)<1) X
  • LAST EDITED:  MAY 29, 2014
  • HELP-PROMPT:  This is addl. information pertaining to the secondary insurance carrier associated with this bill. Value must be 1 to 240 characters in length.
  • DESCRIPTION:  
    This is addl. information pertaining to the secondary insurance carrier associated with this bill. It is equal to the 7 node of the INSURANCE TYPE sub-file of the PATIENT file.
  • TECHNICAL DESCR:  This node is set by a trigger on SECONDARY INSURANCE CARRIER (399,102) and by UPDT^IBSCSE. This node is a duplicate of the 7 node of the INSURANCE TYPE sub-file of the PATIENT file.
    ^DGCR(399,IBIFN,"I27")=^DPT(DFN,.312,X,7)
373 TERTIARY NODE 7 I37;E1,240 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>240!($L(X)<1) X
  • LAST EDITED:  MAY 28, 2014
  • HELP-PROMPT:  This is addl. information pertaining to the tertiary insurance carrier associated with this bill. Value must be 1 to 240 characters in length.
  • DESCRIPTION:  
    This is addl. information pertaining to the tertiary insurance carrier associated with this bill. It is equal to the 7 node of the INSURANCE TYPE sub-file of the PATIENT file.
  • TECHNICAL DESCR:  This node is set by a trigger on TERTIARY INSURANCE CARRIER (399,103) and by UPDT^IBSCSE. This node is a duplicate of the 7 node of the INSURANCE TYPE sub-file of the PATIENT file.
    ^DGCR(399,IBIFN,"I37")=^DPT(DFN,.312,X,7)
400 BLOCK 31 UF2;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>63!($L(X)<3) X
  • LAST EDITED:  SEP 08, 2006
  • HELP-PROMPT:  Answer must be 3-63 characters in length.
  • DESCRIPTION:  Entry will be printed in block 31 of the CMS-1500. This block is 3 lines of 21 characters each.
    Set up for the physicians name and number.
402 BILL REMARKS UF2;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1) X
  • LAST EDITED:  AUG 08, 2007
  • HELP-PROMPT:  Answer must be 1-80 characters in length
  • DESCRIPTION:  Enter up to 80 characters of free text which will print in FL-80.
    FL-80 on the UB-04 claim form is a 4-line box. Line 1 can hold a maximum of 19 characters after a mandatory 5 character indentation. Lines 2-4 can hold a maximum of 24 characters each.
    The display of these remarks on billing screen 8 is exactly how the remarks will appear on the printed claim form.
  • TECHNICAL DESCR:  
    This field is also transmitted via EDI in the UB1 segment, piece 21.
453 FORM LOCATOR 64A UF3;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<3) X
  • LAST EDITED:  SEP 23, 2010
  • HELP-PROMPT:  Answer must be 3-50 characters in length.
  • DESCRIPTION:  
    Form Locator 64A on the UB-04. This field is nationally reserved on adjustment/replacement type bills for the Internal Control Number (ICN)/Document Control Number (DCN) assigned to the original bill by the primary payer.
454 FORM LOCATOR 64B UF3;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<3) X
  • LAST EDITED:  SEP 23, 2010
  • HELP-PROMPT:  Answer must be 3-50 characters in length.
  • DESCRIPTION:  Form Locator 64B on the UB-04. This field is nationally reserved on adjustment/replacement type bills for the Internal Control Number (ICN)/Document Control Number (DCN) assigned to the original bill by the secondary
    payer.
455 FORM LOCATOR 64C UF3;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<3) X
  • LAST EDITED:  SEP 23, 2010
  • HELP-PROMPT:  Answer must be 3-50 characters in length.
  • DESCRIPTION:  Form Locator 64C on the UB-04. This field is nationally reserved on adjustment/replacement type bills for the Internal Control Number (ICN)/Document Control Number (DCN) assigned to the original bill by the tertiary
    payer.
457 *FORM LOCATOR 57 UF31;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>27!($L(X)<3) X
  • LAST EDITED:  JAN 17, 2007
  • HELP-PROMPT:  Answer must be 3-27 characters in length.
  • DESCRIPTION:  Unlabled Form Locator 57 on the UB-92.
    This field is marked for deletion and can be deleted 11/23/2008.
458 *FORM LOCATOR 78 UF31;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>5!($L(X)<3) X
  • LAST EDITED:  JAN 17, 2007
  • HELP-PROMPT:  Answer must be 3-5 characters in length.
  • DESCRIPTION:  Printed in Form Locator 78 on the UB-92. If more than 3 characters are entered this will be printed on two lines.
    This field is marked for deletion and can be deleted 11/23/2008.
  • TECHNICAL DESCR:  Unlabled Form Locator 78 on the UB-92. On the form the block is two lines of 2 and 3 characters, with the upper line optional. Therefore, if string is longer than 3 characters it must be split and printed on both lines.
    This field is marked for deletion and can be deleted 11/23/2008.
459 FORM LOC 19-UNSPECIFIED DATA UF31;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1) X
  • LAST EDITED:  FEB 25, 2014
  • HELP-PROMPT:  Answer must be 1-80 characters in length. Only 71 Characters will print.
  • DESCRIPTION:  This is an 71 character free text field that will print in Box 19 of the CMS-1500. Use this field to enter additional Payer required IDs in the format of: QualifierID number<3 spaces>QualifierID
    number.
  • TECHNICAL DESCR:  This returns the Paperwork Attachment
    Information in the following format:
    PWKNNFX12348907CHEY<3 Spaces>Next set if more than one on claim PWK is the qualifier for data, followed by the appropriate Report Type Code, the appropriate Transmission Type Code, then the Attachment Control Number.
    Do not enter spaces between qualifiers and data.
460 ECME NUMBER M1;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  DEC 02, 2024
  • HELP-PROMPT:  Enter the ECME reference number for this bill.
  • DESCRIPTION:  
    This is the reference number back to the ECME transaction to identify bills created electronically by the ECME/Pharmacy NCPDP process.
  • CROSS-REFERENCE:  399^AG
    1)= S ^DGCR(399,"AG",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,"AG",$E(X,1,30),DA)
  • CROSS-REFERENCE:  399^AECME^MUMPS
    1)= S ^DGCR(399,"AECME",$E(X,1,30),DA)=""
    2)= Q
    3)= DO NOT DELETE
    NOREINDEX)= 1
    Index AECME is used by ePayments to look up a claim by ECME number. The index may contain more than one submission date and time for an ECME number, which is needed for ePayments. Entries are set but not killed. Re-index
    is not allowed.
461 ECME APPROVAL M1;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  SEP 16, 2003
  • HELP-PROMPT:  Enter the ECME approval number.
  • DESCRIPTION:  
    This is the approval for payment received from the FI for ECME electronically processed claims.
471 PRIMARY INSURANCE HPID M1;13 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999999)!(X<1000000000)!(X?.E1"."1N.N)!$$HOD^IBCNHUT1(X) X
  • LAST EDITED:  JUN 30, 2014
  • HELP-PROMPT:  Enter a valid HPID. Must be 10 digits, all numeric, no decimal.
  • DESCRIPTION:  
    This field is the HPID to be sent for the primary insurer on this claim.
  • TECHNICAL DESCR:  
    This field is the HPID to be sent for the primary insurer on this claim.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^399^474
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S X=% X ^DD(399,471,1,1,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"MP")),DIV=X S $P(^("MP"),U,3)=DIV,DIH=399,DIG=474 D ^DICR
    2)= Q
    CREATE VALUE)= NOW
    DELETE VALUE)= NO EFFECT
    FIELD)= PRIMARY HPID EDIT
    When the PRIMARY INSURANCE HPID field is changed, update the PRIMARY HPID EDIT DATE/TIME Field (#474) with the current date and time.
  • CROSS-REFERENCE:  ^^TRIGGER^399^475
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X=DIV S X=$S(($D(DUZ)#2):DUZ,1:"") X ^DD(399,471,1,2,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"MP")),DIV=X S $P(^("MP"),U,4)=DIV,DIH=399,DIG=475 D ^DICR
    2)= Q
    CREATE VALUE)= S X=$S(($D(DUZ)#2):DUZ,1:"")
    DELETE VALUE)= NO EFFECT
    FIELD)= PRIMARY HPID CH
    When the PRIMARY INSURANCE HPID field is changed, update the PRIMARY HPID CHANGES MADE BY Field (#475) with the ID of the user making the change.
472 SECONDARY INSURANCE HPID M1;14 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999999)!(X<1000000000)!(X?.E1"."1N.N)!$$HOD^IBCNHUT1(X) X
  • LAST EDITED:  JUN 30, 2014
  • HELP-PROMPT:  Enter a valid HPID. Must be 10 digits, all numeric, no decimal.
  • DESCRIPTION:  
    This field is the HPID to be sent for the secondary insurer on this claim.
  • TECHNICAL DESCR:  
    This field is the HPID to be sent for the secondary insurer on this claim.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^399^476
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S X=% X ^DD(399,472,1,1,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"MP")),DIV=X S $P(^("MP"),U,5)=DIV,DIH=399,DIG=476 D ^DICR
    2)= Q
    CREATE VALUE)= NOW
    DELETE VALUE)= NO EFFECT
    FIELD)= SECONDARY HPID ED
    When the SECONDARY INSURANCE HPID field is changed, update the SECONDARY HPID EDIT DATE/TIME Field (#476) with the current date and time.
  • CROSS-REFERENCE:  ^^TRIGGER^399^477
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X=DIV S X=$S(($D(DUZ)#2):DUZ,1:"") X ^DD(399,472,1,2,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"MP")),DIV=X S $P(^("MP"),U,6)=DIV,DIH=399,DIG=477 D ^DICR
    2)= Q
    CREATE VALUE)= S X=$S(($D(DUZ)#2):DUZ,1:"")
    DELETE VALUE)= NO EFFECT
    FIELD)= SECONDARY HPID C
    When the SECONDARY INSURANCE HPID field is changed, update the SECONDARY HPID CHANGES MADE BY Field (#477) with the ID of the user making the change.
473 TERTIARY INSURANCE HPID M1;15 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999999)!(X<1000000000)!(X?.E1"."1N.N)!$$HOD^IBCNHUT1(X) X
  • LAST EDITED:  JUN 30, 2014
  • HELP-PROMPT:  Enter a valid HPID. Must be 10 digits, all numeric, no decimal.
  • DESCRIPTION:  
    This field is the HPID to be sent for the tertiary insurer on this claim.
  • TECHNICAL DESCR:  
    This field is the HPID to be sent for the tertiary insurer on this claim.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^399^478
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S X=% X ^DD(399,473,1,1,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"MP")),DIV=X S $P(^("MP"),U,7)=DIV,DIH=399,DIG=478 D ^DICR
    2)= Q
    CREATE VALUE)= NOW
    DELETE VALUE)= NO EFFECT
    FIELD)= TERTIARY HPID ED
    When the TERTIARY INSURANCE HPID field is changed, update the TERTIARY HPID EDIT DATE/TIME Field (#478) with the current date and time.
  • CROSS-REFERENCE:  ^^TRIGGER^399^479
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X=DIV S X=$S(($D(DUZ)#2):DUZ,1:"") X ^DD(399,473,1,2,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"MP")),DIV=X S $P(^("MP"),U,8)=DIV,DIH=399,DIG=479 D ^DICR
    2)= Q
    CREATE VALUE)= S X=$S(($D(DUZ)#2):DUZ,1:"")
    DELETE VALUE)= NO EFFECT
    FIELD)= TERTIARY HPID C
    When the TERTIARY INSURANCE HPID field is changed, update the TERTIARY HPID CHANGES MADE BY Field (#479) with the ID of the user making the change.
474 PRIMARY HPID EDIT DATE/TIME MP;3 DATE

  • INPUT TRANSFORM:  S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  DEC 15, 2014
  • HELP-PROMPT:  Enter the date/time the PRIMARY INSURANCE HPID Field (#471) was updated.
  • DESCRIPTION:  
    This is the date/time the PRIMARY INSURANCE HPID Field (#471) was updated. It is triggered by Field #471.
    WRITE AUTHORITY: ^
  • NOTES:  TRIGGERED by the PRIMARY INSURANCE HPID field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  399^E
    1)= S ^DGCR(399,"E",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,"E",$E(X,1,30),DA)
    This index will be used to look up the claim by the date the PRIMARY INSURANCE HPID Field (#471) was last edited.
475 PRIMARY HPID CHANGES MADE BY MP;4 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JAN 15, 2015
  • HELP-PROMPT:  Enter the user who last edited the PRIMARY INSURANCE HPID (Field #471).
  • DESCRIPTION:  
    This is the user who last edited the PRIMARY INSURANCE HPID Field (#471). It is triggered by Field #471.
    WRITE AUTHORITY: ^
  • NOTES:  TRIGGERED by the PRIMARY INSURANCE HPID field of the BILL/CLAIMS File
476 SECONDARY HPID EDIT DATE/TIME MP;5 DATE

  • INPUT TRANSFORM:  S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  DEC 15, 2014
  • HELP-PROMPT:  Enter the date/time the SECONDARY INSURANCE HPID Field (#472) was updated.
  • DESCRIPTION:  
    This is the date/time the SECONDARY INSURANCE HPID Field (#472) was updated. It is triggered by Field #472.
    WRITE AUTHORITY: ^
  • NOTES:  TRIGGERED by the SECONDARY INSURANCE HPID field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  399^F
    1)= S ^DGCR(399,"F",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,"F",$E(X,1,30),DA)
    This index will be used to look up the claim by the date the SECONDARY INSURANCE HPID Field (#472) was last edited.
477 SECONDARY HPID CHANGES MADE BY MP;6 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  NOV 25, 2014
  • HELP-PROMPT:  Enter the user who last edited the SECONDARY INSURANCE HPID Field (#472).
  • DESCRIPTION:  
    This is the user who last edited the SECONDARY INSURANCE HPID Field (#472). It is triggered by Field #472.
  • NOTES:  TRIGGERED by the SECONDARY INSURANCE HPID field of the BILL/CLAIMS File
478 TERTIARY HPID EDIT DATE/TIME MP;7 DATE

  • INPUT TRANSFORM:  S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  DEC 15, 2014
  • HELP-PROMPT:  Enter the date/time the TERTIARY INSURANCE HPID Field (#473) was updated.
  • DESCRIPTION:  
    This is the date/time the TERTIARY INSURANCE HPID Field (#473) was updated. It is triggered by Field #473.
    WRITE AUTHORITY: ^
  • NOTES:  TRIGGERED by the TERTIARY INSURANCE HPID field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  399^G
    1)= S ^DGCR(399,"G",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,"G",$E(X,1,30),DA)
    This index will be used to look up the claim by the date the TERTIARY INSURANCE HPID Field (#473) was last edited.
479 TERTIARY HPID CHANGES MADE BY MP;8 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JAN 15, 2015
  • HELP-PROMPT:  Enter the user who last edited the TERTIARY INSURANCE HPID Field (#473).
  • DESCRIPTION:  
    This is the user who last edited the TERTIARY INSURANCE HPID Field (#473). It is triggered by Field #473.
    WRITE AUTHORITY: ^
  • NOTES:  TRIGGERED by the TERTIARY INSURANCE HPID field of the BILL/CLAIMS File

ICR, Total: 4

ICR LINK Subscribing Package(s) Fields Referenced Description
ICR #1992
  • Automated Information Collection System
  • Accounts Receivable
    		•  BILL NUMBER (.01).
    Access: Direct Global Read & w/Fileman

    DATE ENTERED (1).
    Access: Direct Global Read & w/Fileman

    DATE FIRST PRINTED (12).
    Access: Direct Global Read & w/Fileman

    DATE BILL CANCELLED (17).
    Access: Direct Global Read & w/Fileman

    OP VISITS DATE(S) (43).
    Access: Direct Global Read & w/Fileman

    TOTAL CHARGES (201).
    Access: Direct Global Read & w/Fileman
    ICR #2281
  • Scheduling
    		•  STATEMENT COVERS FROM (151).
    Access: Direct Global Read & w/Fileman

    STATEMENT COVERS TO (152).
    Access: Direct Global Read & w/Fileman

    		 'C' xref.
    ICR #3820
  • Accounts Receivable
    		•  BILL CHARGE TYPE (.27).
    Access: Direct Global Read & w/Fileman

    DEFAULT DIVISION (.22).
    Access: Direct Global Read & w/Fileman

    RATE TYPE (.07).
    Access: Direct Global Read & w/Fileman

    SC AT TIME OF CARESC (.18).
    Access: Direct Global Read & w/Fileman

    AUTO (.2).
    Access: Direct Global Read & w/Fileman

    CURRENT BILL PAYER SEQUENCE (.21).
    Access: Direct Global Read & w/Fileman

    EVENT DATE (.03).
    Access: Direct Global Read & w/Fileman

    LOCATION OF CARE (.04).
    Access: Direct Global Read & w/Fileman

    BILL CLASSIFICATION (.05).
    Access: Direct Global Read & w/Fileman

    TIMEFRAME OF BILL (.06).
    Access: Direct Global Read & w/Fileman

    PROCEDURE CODING METHOD (.09).
    Access: Direct Global Read & w/Fileman

    STATUS (.13).
    Access: Direct Global Read & w/Fileman

    STATUS DATE (.14).
    Access: Direct Global Read & w/Fileman

    UB92 LOCATION OF CARE (.24).
    Access: Direct Global Read & w/Fileman

    UB92 BILL CLASSIFICATION (.25).
    Access: Direct Global Read & w/Fileman

    UB92 TIMEFRAME OF BILL (.26).
    Access: Direct Global Read & w/Fileman

    BILL NUMBER (.01).
    Access: Direct Global Read & w/Fileman

    PATIENT NAME (.02).
    Access: Direct Global Read & w/Fileman

    STATEMENT COVERS FROM (151).
    Access: Direct Global Read & w/Fileman

    STATEMENT COVERS TO (152).
    Access: Direct Global Read & w/Fileman

    IS THIS A SENSITIVE RECORD (155).
    Access: Direct Global Read & w/Fileman

    ASSIGNMENT OF BENEFITS (156).
    Access: Direct Global Read & w/Fileman

    TREATMENT AUTHORIZATION (163).
    Access: Direct Global Read & w/Fileman

    OFFSET AMOUNT (202).
    Access: Direct Global Read & w/Fileman

    ADMITTING DIAGNOSIS (215).
    Access: Direct Global Read & w/Fileman

    COVERED DAYS (216).
    Access: Direct Global Read & w/Fileman

    NON-COVERED DAYS (217).
    Access: Direct Global Read & w/Fileman

    PRIMARY PRIOR PAYMENT (218).
    Access: Direct Global Read & w/Fileman

    SECONDARY PRIOR PAYMENT (219).
    Access: Direct Global Read & w/Fileman

    TERTIARY PRIOR PAYMENT (220).
    Access: Direct Global Read & w/Fileman

    AUTHORIZATION DATE (10).
    Access: Direct Global Read & w/Fileman

    DATE FIRST PRINTED (12).
    Access: Direct Global Read & w/Fileman

    BILL PAYER CARRIER (135).
    Access: Direct Global Read & w/Fileman

    PRIMARY PROVIDER (122).
    Access: Direct Global Read & w/Fileman

    SECONDARY PROVIDER (123).
    Access: Direct Global Read & w/Fileman

    TERTIARY PROVIDER (124).
    Access: Direct Global Read & w/Fileman

    WHO'S RESPONSIBLE FOR BILL? (.11).
    Access: Direct Global Read & w/Fileman

    VALUE CODE (.01).
    Access: Direct Global Read & w/Fileman

    VALUE (.02).
    Access: Direct Global Read & w/Fileman

    REVENUE CODE (.01).
    Access: Direct Global Read & w/Fileman

    CHARGES (.02).
    Access: Direct Global Read & w/Fileman

    UNITS OF SERVICE (.03).
    Access: Direct Global Read & w/Fileman

    TOTAL (.04).
    Access: Direct Global Read & w/Fileman

    BEDSECTION (.05).
    Access: Direct Global Read & w/Fileman

    NON-COVERED DAYS (.09).
    Access: Direct Global Read & w/Fileman

    TYPE (.1).
    Access: Direct Global Read & w/Fileman

    ITEM (.11).
    Access: Direct Global Read & w/Fileman

    OP VISIT DATE (.01).
    Access: Direct Global Read & w/Fileman

    OCCURENCE CODE (.01).
    Access: Direct Global Read & w/Fileman

    (DGCR(399,D0,CV).
    Access:

    ICR #7217
  • Accounts Receivable
    		•  PTF ENTRY NUMBER (.08).
    Access: Read w/Fileman

    PRIMARY BILL (.17).
    Access: Read w/Fileman

    BILL CANCELLED BY (18).
    Access: Read w/Fileman

    REASON CANCELLED (19).
    Access: Read w/Fileman
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