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Global: ^DIC(36

Package: Integrated Billing

Global: ^DIC(36


Information

FileMan FileNo FileMan Filename Package
36 INSURANCE COMPANY Integrated Billing

Description

Directly Accessed By Routines, Total: 327

Package Total Routines
Integrated Billing 308 ^IBA(355.95    IB20P191    IB20P244    IB20P279    IB20P297    IB20PT1    IB20PT81    IB20PT87
IB20PT88    IB20PT8A    IB20PT8B    IB20R244    IBACUS2    IBATLM3A    IBCAPP    IBCAPP2
IBCB11    IBCBB    IBCBB1    IBCCCB    IBCCCB0    IBCECOB    IBCECOB1    IBCECOB5
IBCECSA1    IBCECSA6    IBCEDC    IBCEDP    IBCEF2    IBCEF31    IBCEF4    IBCEF7
IBCEF72    IBCEF74    IBCEF75    IBCEF78    IBCEFG60    IBCEM4    IBCEMCA    IBCEMCL
IBCEMSR6    IBCEMSRI    IBCEMU3    IBCEOB2    IBCEP    IBCEP0    IBCEP0B    IBCEP1
IBCEP2    IBCEP2A    IBCEP3    IBCEP4    IBCEP5    IBCEP7    IBCEP7B    IBCEP9B
IBCEPA    IBCEPB    IBCEPC    IBCEPCID    IBCEPTC    IBCEPTC0    IBCEQ1    IBCEQ1A
IBCEQ2    IBCERP2    IBCERP6    IBCERP7    IBCERPN    IBCESRV2    IBCEST    IBCEXTR1
IBCF1    IBCF10    IBCF21    IBCF3    IBCF31    IBCFP1    IBCICME1    IBCIPAY
IBCIWK    IBCMDT    IBCNADD    IBCNAU1    IBCNBAA    IBCNBAC    IBCNBCD    IBCNBLP1
IBCNBMN    IBCNCH    IBCNCH3    IBCNEAMC    IBCNEAMI    IBCNEBF    IBCNEDST    IBCNEHL1
IBCNEHLU    IBCNEML    IBCNEPM    IBCNEPM1    IBCNEQU    IBCNERPC    IBCNERPD    IBCNERTC
IBCNES    IBCNEUT3    IBCNEUT4    IBCNEUT6    IBCNEUT8    IBCNGP    IBCNHUT2    IBCNICB
IBCNILK    IBCNOR1A    IBCNOR3    IBCNOR4    IBCNRP    IBCNRP5    IBCNRPM2    IBCNRPS2
IBCNRPSI    IBCNRRP2    IBCNRRP3    IBCNS    IBCNS1    IBCNS2    IBCNS3    IBCNSA
IBCNSBL1    IBCNSBL2    IBCNSC    IBCNSC0    IBCNSC01    IBCNSC1    IBCNSC2    IBCNSC3
IBCNSC4    IBCNSC41    IBCNSCD1    IBCNSCD3    IBCNSGE    IBCNSGM    IBCNSI    IBCNSJ12
IBCNSJ3    IBCNSJ4    IBCNSJ5    IBCNSJ53    IBCNSM    IBCNSM1    IBCNSM3    IBCNSM32
IBCNSM5    IBCNSMM1    IBCNSOK    IBCNSP0    IBCNSP2    IBCNSU31    IBCNSUX1    IBCONS2
IBCOPP    IBCORC1    IBCORC2    IBCORC3    IBCRBC1    IBCRBC11    IBCSCE    IBCU
IBCU3    IBCU5    IBECEA35    IBECUS2    IBECUS3    IBEFUNC    IBEFURT    IBJD1
IBJDF51    IBJDF61    IBJDF62    IBJDI4    IBJPS6    IBJTBA1    IBJTCA1    IBJTLA1
IBJTLB1    IBJTRA1    IBJTU3    IBJTU31    IBNCPDP5    IBNCPDPI    IBNCPDR    IBNCPDR5
IBNCPIV    IBOBL    IBOHLD2    IBOSCDC1    IBOUNP3    IBOUNP6    IBRBUL    IBRFN
IBRFN3    IBRFN4    IBT APPEAL INFO    IBT ASSIGN CASE    IBT AVERAGE BILL AMOUNTS (12M)    IBTOAT1    IBTOBI1    IBTOBI2
IBTOECT    IBTRC4    IBTRCD0    IBTRCD1    IBTUTL3    IBY371PO    IBY399P4    IBY416PO
IBY601PO    ^DGCR(399    ^IBT(356.2    IBOTR3    IBTUBO3    IBY280PR    IBY288PO    IBY516PR
IBY621PO    ^IBA(355.7    IBCNSM6    IBCNSMR    IBCNSMR0    IBCNSMR1    IBCNSMRE    IBCNSU
IBCNSU2    IBCNSUR1    IBCOMA1    IBCOMC1    IBCOMD1    IBCONS1    IBCRBG    IBCSC10
IBCSC3    IBCU41    IBFBWL2    IBJDF11    IBJDF12    IBJDI41    IBJDI5    IBJTBA
IBJTCA2    IBNCPDP1    IBNCPDR4    IBNCPDRA    IBNCPRR    IBNCPUT3    IBNOTVER1    IBOHLS1
IBOLK1    IBOSRX    IBOTR2    IBT INSURANCE INFO    IBT PRECERT INFO    IBTRC3    IBTRD    IBY137PO
IBY232PO    IBY232PR    IBY320PO    IBY400PR    IBY432PO    IBY519PO    IBY608PO    ^IBA(355.9
^IBA(364.7    ^IBE(399.6    IB20P240    IBBFAPI    IBCAPR1    IBCE837    IBCE837A    IBCEDS
IBCEMCA3    IBCEMMR    IBCEP2B    IBCNBU1    IBCNEDE3    IBCNERP8    IBCNHUT1    IBCNINSC
IBCNRPM1    IBCNRPMT    IBCNSC02    IBCNSCD    IBCNSCD2    IBCNSP    IBCNSU21    IBCOMDT
IBCOPP2    IBCU1    IBCU61    IBJDF52    IBJPC1    IBT QUICK EDIT    IBTRC    IBTRC2
IBY189PO    ^IBA(364.5    IBY348PO    IBYOPRE    
Accounts Receivable 10 PRCADR1    PRCASVC6    PRCATP5    RCAMADD    RCAMINS    RCDPEAA3    RCDPEAC    RCDPENRU
RCDPEV    RCXVDC3    
Registration 4 DGCRNS    DGINS    DGREG0    VAFHLIN1    
Automated Information Collection System 1 IBDFN6    
Consult Request Tracking 1 GMRCCCRA    
Kernel 1 XUSNPIXU    
Order Entry Results Reporting 1 ORDV07    
Outpatient Pharmacy 1 PSO427PS    

Accessed By FileMan Db Calls, Total: 128

Package Total Routines
Integrated Billing 116 IB20P191    IB20P240    IB20R244    IBBFAPI    IBCAPR    IBCAPR2    IBCBB13    IBCE837
IBCEF74    IBCEF74A    IBCEF84    IBCEMU3    IBCEP    IBCEP0    IBCEP0A    IBCEP0B
IBCEP2B    IBCEP3    IBCEP5D    IBCEP7B    IBCEP9    IBCEPB    IBCERP7    IBCEST
IBCMDT    IBCMDT2    IBCNAU    IBCNBAC    IBCNBAR    IBCNBCD    IBCNBMN    IBCNBU1
IBCNEBF    IBCNEDE2    IBCNEDE3    IBCNEDST    IBCNERP8    IBCNERPC    IBCNERPD    IBCNERPG
IBCNES    IBCNEUT7    IBCNGP    IBCNGP1    IBCNHPR1    IBCNHUT2    IBCNILK    IBCNINSC
IBCNIUF    IBCNOR1    IBCNOR1A    IBCNOR3    IBCNOR4    IBCNRDV    IBCNRP5    IBCNRP5P
IBCNRPSI    IBCNSC    IBCNSC0    IBCNSC01    IBCNSC1    IBCNSC3    IBCNSCD    IBCNSCD1
IBCNSCD3    IBCNSGE    IBCNSGM    IBCNSJ14    IBCNSU    IBCNSU21    IBCNSUR    IBCNSUR4
IBCNSUX    IBCOMDT    IBCOMDT1    IBCOPP    IBCOPR    IBCSC3    IBCU    IBFBWL5
IBJDF1    IBJPC1    IBNCPDP3    IBNCPDP6    IBNCPDPI    IBNCPEV    IBNCPEV3    IBRFIHL2
IBRFN4    IBRUTL    IBTRH1A    IBTRH2    IBTRH5    IBTRH6    IBTRH7    IBTRH8
IBTRHDE    IBTRHLO    IBTRHRC    IBY137PO    IBY189PO    IBY232PR    IBY280PR    IBY320PO
IBY348PR    IBY371PO    IBY399P4    IBY400PR    IBY432PO    IBY516PR    IBY521PO    IBY521PR
IBY547PO    IBY601PO    IBY608PO    IBY621PO    
Accounts Receivable 3 RCDPENR4    RCDPENRU    RCXVDC3    
Consult Request Tracking 2 GMRCCCR1    GMRCCCRA    
Enrollment Application System 2 EASEC100    EASEZPVI    
Outpatient Pharmacy 2 PSOPROD1    PSOPROD2    
DSS Extracts 1 ECXUTL2    
Health Summary 1 GMTSDEM2    
Registration 1 DGINS    

Pointed To By FileMan Files, Total: 28

Package Total FileMan Files
Integrated Billing 18 BILL/CLAIMS(#399)[101, 102, 103, 135]    INSURANCE COMPANY(#36)[.127, .139, .147, .157, .16, .167, .187, .197, 3.14, 5.02]    GROUP INSURANCE PLAN(#355.3)[.01]    IB BILLING PRACTITIONER ID(#355.9)[.02]    IB INSURANCE CO LEVEL BILLING PROV ID(#355.91)[.01]    FACILITY BILLING ID(#355.92)[.01]    IB PROVIDER ID CARE UNIT(#355.95)[.03]    IB INS CO PROVIDER ID CARE UNIT(#355.96)[.03]    EDI TRANSMISSION BATCH(#364.1)[.12]    IB FORM FIELD CONTENT(#364.7)[.05]    HEALTH CARE CLAIM RFAI (277)(#368)[101.01]    HPID/OEID TRANSMISSION QUEUE(#367.1)[.02]    IB SITE PARAMETERS(#350.9)[4.02, 4.06, #350.965(.01), #350.966(.01), #350.999(.01)]    IB EDI TRANSMISSION RULE(#364.4)[#364.42(.01), #364.43(.01)]    EXPLANATION OF BENEFITS(#361.1)[.02]    INSURANCE REVIEW(#356.2)[.08]    HCS REVIEW TRANSMISSION(#356.22)[#356.2215(.02)]    CLAIMS TRACKING ROI(#356.25)[.04]    
Accounts Receivable 3 ACCOUNTS RECEIVABLE(#430)[19, 19.1]    AR DEBTOR(#340)[.01]    ELECTRONIC REMITTANCE ADVICE(#344.4)[#344.41(.04)]    
E Claims Management Engine 3 BPS INSURER DATA(#9002313.78)[3.05]    BPS TRANSACTION(#9002313.59)[#9002313.59902(902.33)]    BPS LOG OF TRANSACTIONS(#9002313.57)[#9002313.57902(902.33)]    
DSS Extracts 2 PRESCRIPTION EXTRACT(#727.81)[48]    PROSTHETICS EXTRACT(#727.826)[45]    
PAID 1 APPLICANT(#453)[747.21]    
Registration 1 PATIENT(#2)[#2.101(25), #2.312(.01)]    

Pointer To FileMan Files, Total: 8

Package Total FileMan Files
Integrated Billing 7 REVENUE CODE(#399.2)[.09, .15]    INSURANCE COMPANY(#36)[.127, .139, .147, .157, .16, .167, .187, .197, 3.14, 5.02]    IB ALTERNATE PRIMARY ID TYPE(#355.98)[#36.015(.01), #36.016(.01)]    INSURANCE FILING TIME FRAME(#355.13)[.18]    TYPE OF INSURANCE COVERAGE(#355.2)[.13]    IB PROVIDER ID # TYPE(#355.97)[4.01, 4.02, 4.04, 4.1]    PAYER(#365.12)[3.1]    
Kernel 1 STATE(#5)[.115, .125, .145, .155, .165, .185, .195]

Fields, Total: 140

Field # Name Loc Type Details
.01 NAME 0;1 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3)!'(X'?1P.E)!(X'?.ANP) X
  • LAST EDITED:  APR 08, 2015
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  Enter the name of the insurance carrier which at least one patient seen at your facility has. This information must be updated using the 'Insurance Company Entry/Edit' option, NOT using VA FileMan. Editing of this data
    through a filemanager option could cause negative impacts on the MAS and IB software modules in addition to other DHCP modules.
  • AUDIT:  YES, ALWAYS
  • DELETE TEST:  1,0)= I 1 W !!,"You must use the 'Delete Company' action to delete a company... "
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  36^B
    1)= S ^DIC(36,"B",$E(X,1,30),DA)=""
    2)= K ^DIC(36,"B",$E(X,1,30),DA)
  • CROSS-REFERENCE:  ^^TRIGGER^36^4.04
    1)= X ^DD(36,.01,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,4)):^(4),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X=DIV S X="22" S DIH=$G(^DIC(36,DIV(0),4)),DIV=X S $P(^(4),U,4)=DIV,DIH=36,DIG=4.04 D ^DICR
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DIC(36,D0,4)):^(4),1:"") S X=$P($G(^IBE(355.97,+$P(Y(1),U,4),0)),U)=""
    2)= Q
    CREATE CONDITION)= #4.04=""
    CREATE VALUE)= "22"
    DELETE VALUE)= NO EFFECT
    FIELD)= #4.04
  • CROSS-REFERENCE:  ^^TRIGGER^36^4.05
    1)= X ^DD(36,.01,1,3,1.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,4)):^(4),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X=DIV S X="0" S DIH=$G(^DIC(36,DIV(0),4)),DIV=X S $P(^(4),U,5)=DIV,DIH=36,DIG=4.05 D ^DICR
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(36,4.05,0)),U,3),Y(1)=$S($D(^DIC(36,D0,4)):^(4),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,5)_":",2),$C(59))=""
    2)= Q
    CREATE CONDITION)= REF PROV SEC ID REQ ON CLAIMS=""
    CREATE VALUE)= "0"
    DELETE VALUE)= NO EFFECT
    FIELD)= REF PROV SEC ID REQ ON CLAIMS
  • CROSS-REFERENCE:  ^^TRIGGER^36^4.06
    1)= X ^DD(36,.01,1,4,1.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,4)):^(4),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X=DIV S X="0" S DIH=$G(^DIC(36,DIV(0),4)),DIV=X S $P(^(4),U,6)=DIV,DIH=36,DIG=4.06 D ^DICR
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(36,4.06,0)),U,3),Y(1)=$S($D(^DIC(36,D0,4)):^(4),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,6)_":",2),$C(59))=""
    2)= Q
    CREATE CONDITION)= #4.06=""
    CREATE VALUE)= "0"
    DELETE VALUE)= NO EFFECT
    FIELD)= ATT/REND ID BILL SEC ID PROF
  • CROSS-REFERENCE:  ^^TRIGGER^36^4.07
    1)= X ^DD(36,.01,1,5,1.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,4)):^(4),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X=DIV S X="1" S DIH=$G(^DIC(36,DIV(0),4)),DIV=X S $P(^(4),U,7)=DIV,DIH=36,DIG=4.07 D ^DICR
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(36,4.07,0)),U,3),Y(1)=$S($D(^DIC(36,D0,4)):^(4),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,7)_":",2),$C(59))=""
    2)= Q
    CREATE CONDITION)= SEND LAB OR FAC IDS FOR VAMC=""
    CREATE VALUE)= "1"
    DELETE VALUE)= NO EFFECT
    FIELD)= SEND LAB OR FAC IDS FOR VAMC
  • CROSS-REFERENCE:  ^^TRIGGER^36^4.08
    1)= X ^DD(36,.01,1,6,1.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,4)):^(4),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X=DIV S X="0" S DIH=$G(^DIC(36,DIV(0),4)),DIV=X S $P(^(4),U,8)=DIV,DIH=36,DIG=4.08 D ^DICR
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(36,4.08,0)),U,3),Y(1)=$S($D(^DIC(36,D0,4)):^(4),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,8)_":",2),$C(59))=""
    2)= Q
    CREATE CONDITION)= #4.08=""
    CREATE VALUE)= "0"
    DELETE VALUE)= NO EFFECT
    FIELD)= ATT/REND ID BILL SEC ID INST
.05 INACTIVE 0;5 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  APR 08, 2015
  • HELP-PROMPT:  Enter 'Yes" if this company is inactive and should no longer be allowed for selection.
  • DESCRIPTION:  
    If this insurance company is no longer active in your area, enter INACTIVE here. This will disallow users from selecting this insurance company entry.
  • AUDIT:  YES, ALWAYS
  • DELETE TEST:  1,0)= I $D(DGINS)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
.06 ALLOW MULTIPLE BEDSECTIONS 0;6 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  NOV 17, 2005
  • HELP-PROMPT:  Enter whether or not this Insurance Company will accept multiple bedsections on a claim form. If left blank a NO is assumed.
  • DESCRIPTION:  This field determines whether this insurance company will accept multiple bedsections on one claim form. If answered 'YES' then selection of the PRIMARY INSURANCE CARRIER in MCCR will trigger revenue codes for all
    bedsections within the STATEMENT COVERS FROM and STATEMENT COVERS TO dates. If this is answered 'NO' or left blank then only the first bedsection in the date range will be used.
.07 DIFFERENT REVENUE CODES TO USE 0;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>40!($L(X)<3) X I $D(X) X "F DGII=1:1:10 S DGINX=$P(X,"","",DGII) Q:DGINX="""" I DGINX'?3N."":""3N K X Q" K DGII,DGINX
  • LAST EDITED:  NOV 17, 2005
  • HELP-PROMPT:  Answer must be 3-40 characters in length. Enter the 3 digit rev code that is being replaced followed by a ':' followed by the rev code to be used for this Ins Company. (old RC:new RC,old RC:new RC)
  • DESCRIPTION:  This field is used to replace standard revenue codes used on a bill with revenue codes requested by an insurance company.
    The standard revenue codes are those codes found in the Charge Master and are used for most bills.
    Enter the standard revenue code to be replaced followed by ':' followed by the revenue code the insurance company requires:
    500:510 will result in revenue code 500 being replaced
    by 510 on this insurance company bills
    Separate multiple revenue code replacement sets by a comma:
    101:240,500:510
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
.08 ONE OPT. VISIT ON BILL ONLY 0;8 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  NOV 17, 2005
  • HELP-PROMPT:  Enter whether or not claom form's to this Insurance Company should allow only 1 outpatient visit per bill.
  • DESCRIPTION:  If this field is answered 'YES' then only one outpatient visit will be allowed per claim form for this Insurance Company.
    If it is unanswered or answered 'NO' then multiple (up to 10) outpatient bills will be allowed per claim form.
.09 AMBULATORY SURG. REV. CODE 0;9 POINTER TO REVENUE CODE FILE (#399.2) REVENUE CODE(#399.2)

  • 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:  NOV 20, 1991
  • HELP-PROMPT:  Enter the default revenue code for ambulatory surgical codes. This will automatically be used when creating a bill.
  • DESCRIPTION:  
    This is the Revenue Code that will automatically be generated for this insurance company if a billable Ambulatory Surgical Code is listed as a procedure in this this bill.
  • SCREEN:  S DIC("S")="I $P(^(0),U,3)"
  • EXPLANATION:  Only Activated Revenue Codes can be selected!
.1 ATTENDING PHYSICIAN ID. 0;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>22!($L(X)<3) X
  • LAST EDITED:  MAR 21, 2001
  • HELP-PROMPT:  Answer must be 3-22 characters in length.
  • DESCRIPTION:  
    This field is no longer used. Provider id's now come from the 355.9 files.
.11 *HOSPITAL PROVIDER NUMBER 0;11 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  JAN 16, 2007
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  An identifier assigned to the facility by the insurance company. It will be printed in form locator 51 of the UB-92 of bills for this insurance company.
    This field is marked for deletion and can be deleted 11/23/2008.
  • TECHNICAL DESCR:  Printed in form locator 51 of the UB-92
    This field is marked for deletion and can be deleted 11/23/2008.
.111 STREET ADDRESS [LINE 1] .11;1 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<3) X
  • LAST EDITED:  APR 01, 2015
  • HELP-PROMPT:  Enter the first line of this company's street address with 3-35 characters.
  • DESCRIPTION:  
    Enter the first line of this company's street address with 3-35 characters.
  • AUDIT:  YES, ALWAYS
  • DELETE TEST:  1,0)= I $D(DGINS)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^36^.112
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.11)):^(.11),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(36,.111,1,1,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.11)):^(.11),1:""),DIV=X S $P(^(.11),U,2)=DIV,DIH=36,DIG=.112 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.11)):^(.11),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(36,.111,1,1,2.4)
    2.4)= S DIH=$S($D(^DIC(36,DIV(0),.11)):^(.11),1:""),DIV=X S $P(^(.11),U,2)=DIV,DIH=36,DIG=.112 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= STREET ADDRESS [LINE 2]
    When changing or deleting STREET ADDRESS [LINE 1] delete STREET ADDRESS [LINE 2].
  • CROSS-REFERENCE:  ^^TRIGGER^36^.113
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.11)):^(.11),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.111,1,2,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.11)):^(.11),1:""),DIV=X S $P(^(.11),U,3)=DIV,DIH=36,DIG=.113 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.11)):^(.11),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.111,1,2,2.4)
    2.4)= S DIH=$S($D(^DIC(36,DIV(0),.11)):^(.11),1:""),DIV=X S $P(^(.11),U,3)=DIV,DIH=36,DIG=.113 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= STREET ADDRESS [LINE 3]
    When changing or deleting STREET ADDRESS [LINE 1] delete STREET ADDRESS [LINE 3].
.112 STREET ADDRESS [LINE 2] .11;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(DA),.111) X
  • LAST EDITED:  APR 01, 2015
  • HELP-PROMPT:  If the Street Address is longer than one line, enter a second line between 3-30 characters. It can not be the same as Line 1.
  • DESCRIPTION:  
    If the Street Address is longer than one line, enter a second line between 3-30 characters. It can not be the same as Line 1.
  • AUDIT:  YES, ALWAYS
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the STREET ADDRESS [LINE 1] field of the INSURANCE COMPANY File
  • CROSS-REFERENCE:  ^^TRIGGER^36^.113
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.11)):^(.11),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.112,1,1,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.11)):^(.11),1:""),DIV=X S $P(^(.11),U,3)=DIV,DIH=36,DIG=.113 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.11)):^(.11),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.112,1,1,2.4)
    2.4)= S DIH=$S($D(^DIC(36,DIV(0),.11)):^(.11),1:""),DIV=X S $P(^(.11),U,3)=DIV,DIH=36,DIG=.113 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= STREET ADDRESS [LINE 3]
    When changing or deleting STREET ADDRESS [LINE 2] delete STREET ADDRESS [LINE 3].
.113 STREET ADDRESS [LINE 3] .11;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(DA),.111,.112) X
  • LAST EDITED:  APR 03, 2023
  • HELP-PROMPT:  If the Street Address is longer than two lines, enter a third line between 3-30 characters. It can not be the same as Line 1 or Line 2.
  • DESCRIPTION:  
    If the Street Address is longer than two lines, enter a third line between 3-30 characters. It can not be the same as Line 1 or Line 2.
  • AUDIT:  YES, ALWAYS
  • DELETE TEST:  1,0)= I $D(DGINS)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the STREET ADDRESS [LINE 2] field of the INSURANCE COMPANY File
    TRIGGERED by the STREET ADDRESS [LINE 1] field of the INSURANCE COMPANY File
.114 CITY .11;4 FREE TEXT

  • INPUT TRANSFORM:  K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>25!($L(X)<2) X
  • LAST EDITED:  FEB 26, 1993
  • HELP-PROMPT:  Enter the city in which this company is located with 2-25 characters. If the space provided is not sufficient, abbreviate the city to the best of your ability.
  • DESCRIPTION:  
    Enter the city of the mailing address for this insurance carrier.
  • DELETE TEST:  1,0)= I $D(DGINS)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
.115 STATE .11;5 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  MAR 12, 1993
  • DESCRIPTION:  
    Enter the state of the mailing address for this insurance carrier.
  • DELETE TEST:  1,0)= I $D(DGINS)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
.116 ZIP CODE .11;6 FREE TEXT

  • INPUT TRANSFORM:  K:($L(X)>10!($L(X)<9)) X I $D(X) K:'$$ZIPCHK9^IBCNSU(X) X I $D(X) D ZIPIN^VAFADDR
    MAXIMUM LENGTH: 10
  • OUTPUT TRANSFORM:  D ZIPOUT^VAFADDR
  • LAST EDITED:  MAR 22, 2017
  • HELP-PROMPT:  Answer must be nine (999999999) or ten characters (99999-9999) in length. The last 4 cannot be '0000' or '9999'.
  • DESCRIPTION:  
    This is the ZIP code for the payer's main mailing address. Enter a 9 or 10 character ZIP code.
  • DELETE TEST:  1,0)= I $D(DGINS)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
.117 BILLING COMPANY NAME .11;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  JUL 15, 1993
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    Enter the name of the insurance carrier's billing company.
.119 FAX NUMBER .11;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  NOV 23, 1993
  • HELP-PROMPT:  Enter the fax number of the company with 7 - 20 characters, ex. 415-444-6555.
  • DESCRIPTION:  
    Enter the fax number of this insurance carrier.
.12 FILING TIME FRAME 0;12 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  FEB 01, 1994
  • HELP-PROMPT:  Enter maximum amount of time from date of service that the insurance company allows for submitting claims. Answer must be 3-30 characters in length.
  • DESCRIPTION:  Enter the maximum amount of time from the date of service that the insurance company allows for submitting claims. Examples: 60 days, 90 days, 6 months, 1 year, 18 months; March 30 following year of service, June 1
    following year of service.
.121 CLAIMS (INPT) STREET ADDRESS 1 .12;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3)!'$G(IBCNS) X
  • LAST EDITED:  JUN 19, 2007
  • HELP-PROMPT:  If the inpatient claims process address of this company is different from its main address, enter Line 1 of the inpatient claims street address. Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    If the inpatient claims process address of this company is different from its main address, enter Line 1 of the inpatient claims street address. Answer must be 3-30 characters in length.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^36^.122
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.12)):^(.12),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(36,.121,1,1,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.12)):^(.12),1:""),DIV=X S $P(^(.12),U,2)=DIV,DIH=36,DIG=.122 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.12)):^(.12),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(36,.121,1,1,2.4)
    2.4)= S DIH=$S($D(^DIC(36,DIV(0),.12)):^(.12),1:""),DIV=X S $P(^(.12),U,2)=DIV,DIH=36,DIG=.122 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= CLAIMS (INPT) STREET ADDRESS 2
    When changing or deleting CLAIMS (INPT) STREET ADDRESS 1 delete CLAIMS (INPT) STREET ADDRESS 2.
  • CROSS-REFERENCE:  ^^TRIGGER^36^.123
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.12)):^(.12),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.121,1,2,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.12)):^(.12),1:""),DIV=X S $P(^(.12),U,3)=DIV,DIH=36,DIG=.123 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.12)):^(.12),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.121,1,2,2.4)
    2.4)= S DIH=$S($D(^DIC(36,DIV(0),.12)):^(.12),1:""),DIV=X S $P(^(.12),U,3)=DIV,DIH=36,DIG=.123 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= CLAIMS (INPT) STREET ADDRESS 3
    When changing or deleting CLAIMS (INPT) STREET ADDRESS 1 delete CLAIMS STREET ADDRESS [LINE 3].
.122 CLAIMS (INPT) STREET ADDRESS 2 .12;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.121) X
  • LAST EDITED:  JUN 19, 2007
  • HELP-PROMPT:  If the Inpatient Claims Process Address is longer than one line, enter a second line between 3-30 characters. It can not be the same as Line 1.
  • DESCRIPTION:  
    If the Inpatient Claims Process Address is longer than one line, enter a second line between 3-30 characters. It can not be the same as Line 1.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the CLAIMS (INPT) STREET ADDRESS 1 field of the INSURANCE COMPANY File
  • CROSS-REFERENCE:  ^^TRIGGER^36^.123
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.12)):^(.12),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.122,1,1,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.12)):^(.12),1:""),DIV=X S $P(^(.12),U,3)=DIV,DIH=36,DIG=.123 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.12)):^(.12),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.122,1,1,2.4)
    2.4)= S DIH=$S($D(^DIC(36,DIV(0),.12)):^(.12),1:""),DIV=X S $P(^(.12),U,3)=DIV,DIH=36,DIG=.123 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= CLAIMS (INPT) STREET ADDRESS 3
    When changing or deleting CLAIMS (INPT) STREET ADDRESS 2 delete CLAIMS (INPT) STREET ADDRESS 3.
.123 CLAIMS (INPT) STREET ADDRESS 3 .12;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.121,.122) X
  • LAST EDITED:  JUN 19, 2007
  • HELP-PROMPT:  If the Inpatient Claims Process Address is longer than two lines, enter a third line between 3-30 characters. It can not be the same as Line 1 or Line 2.
  • DESCRIPTION:  
    If the Inpatient Claims Process Address is longer than two lines, enter a third line between 3-30 characters. It can not be the same as Line 1 or Line 2.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the CLAIMS (INPT) STREET ADDRESS 1 field of the INSURANCE COMPANY File
    TRIGGERED by the CLAIMS (INPT) STREET ADDRESS 2 field of the INSURANCE COMPANY File
.124 CLAIMS (INPT) PROCESS CITY .12;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>25!($L(X)<2) X
  • LAST EDITED:  JUL 15, 1993
  • HELP-PROMPT:  If the inpatient claims process address of this company is different from its main address, enter city of the inpatient claims process address. Answer must be 2-25 characters in length.
  • DESCRIPTION:  
    Enter the city in which this insurance company's inpatient claims office is located.
.125 CLAIMS (INPT) PROCESS STATE .12;5 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  OCT 07, 1993
  • HELP-PROMPT:  If the inpatient claims process address of this company is different from its main address, enter state of the inpatient claims process address.
  • DESCRIPTION:  
    Enter the state in which this insurance company's inpatient claims office is located. Enter state even if it is the same as the state of the company's main address.
.126 CLAIMS (INPT) PROCESS ZIP .12;6 FREE TEXT

  • INPUT TRANSFORM:  K:($L(X)>10!($L(X)<9)) X I $D(X) K:'$$ZIPCHK9^IBCNSU(X) X I $D(X) D ZIPIN^VAFADDR
    MAXIMUM LENGTH: 10
  • OUTPUT TRANSFORM:  D ZIPOUT^VAFADDR
  • LAST EDITED:  MAR 22, 2017
  • HELP-PROMPT:  Answer must be nine (999999999) or ten characters (99999-9999) in length. The last 4 cannot be '0000' or '9999'.
  • DESCRIPTION:  
    This is the ZIP code for the address of the inpatient claims processing location when it differs from the payer's main mailing address. Enter a 9 or 10 character ZIP code.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
.127 CLAIMS (INPT) COMPANY NAME .12;7 POINTER TO INSURANCE COMPANY FILE (#36) INSURANCE COMPANY(#36)

  • INPUT TRANSFORM:  S DIC(0)=DIC(0)_"F",DIC("S")="I '$P(^(0),U,5),'$P($G(^(.12)),U,7),(Y'=DA)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  OCT 05, 1993
  • DESCRIPTION:  You can only select a company that processes claims. The company specified in this field must be an active insurance company, not the same company as the entry being edited, and must not have another company specified as
    handling Inpatient Claims for it.
  • SCREEN:  S DIC("S")="I '$P(^(0),U,5),'$P($G(^(.12)),U,7),(Y'=DA)"
  • EXPLANATION:  Select a company that processes inpatient claims for this company. Must be active, not this company, and process its own inpatient claims.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the ANOTHER CO. PROCESS IP CLAIMS? field of the INSURANCE COMPANY File
.128 ANOTHER CO. PROCESS IP CLAIMS? .12;8 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  APR 10, 2003
  • DESCRIPTION:  
    Enter "Yes" if another insurance company processes Inpatient Claims.
  • CROSS-REFERENCE:  ^^TRIGGER^36^.127
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X='$P($G(^DIC(36,DA,.12)),"^",8) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,.12)):^(.12),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(36,.128,1,1,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.12)):^(.12),1:""),DIV=X S $P(^(.12),U,7)=DIV,DIH=36,DIG=.127 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= S X='$P($G(^DIC(36,DA,.12)),"^",8)
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= #.127
    Enter "Yes" if another insurance company processes Inpatient Claims.
.129 CLAIMS (INPT) FAX .12;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  NOV 22, 1993
  • HELP-PROMPT:  Enter the fax number of the inpatient claims office with 7-20 characters, e.g. 444-8888, 614-333-9999.
  • DESCRIPTION:  
    Enter the fax number of this insurance carrier's inpatient claims office.
.13 TYPE OF COVERAGE 0;13 POINTER TO TYPE OF INSURANCE COVERAGE FILE (#355.2) TYPE OF INSURANCE COVERAGE(#355.2)

  • LAST EDITED:  NOV 17, 2005
  • DESCRIPTION:  If this insurance carrier provides only one type of coverage then select the entry that best describes this carriers type of coverage. If this carrier provides more than one type of coverage then select HEALTH INSURANCE.
    The default answer if left unanswered is Health Insurance.
    This is useful information when contacting carriers, when creating claims for reimbursement, and when estimating if the payment received is appropriate.
    If this field is answered it may affect choices that can be selected when entering policy or benefit information.
.131 PHONE NUMBER .13;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  FEB 26, 1993
  • HELP-PROMPT:  Enter the telephone number of the company with 7 - 20 characters, ex. 777-8888, 415 111 2222 x123.
  • DESCRIPTION:  
    Enter the phone number at which this insurance carrier can be reached.
  • DELETE TEST:  1,0)= I $D(DGINS)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
.1311 CLAIMS (RX) PHONE NUMBER .13;11 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  JAN 04, 1994
  • HELP-PROMPT:  Enter the telephone number of the prescription claims office with 7 - 20 characters, ex. 777-8888, 415 111 2222x123.
  • DESCRIPTION:  
    Enter the phone number at which the prescription claims office of this insurance carrier can be reached.
.132 BILLING PHONE NUMBER .13;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  MAY 04, 1990
  • HELP-PROMPT:  Enter the telephone number of the billing office for this company. Answer must be 7-20 characters in length.
  • DESCRIPTION:  
    Enter the phone number of the insurance carrier where inquiries about patient billing should be made.
.133 PRECERTIFICATION PHONE NUMBER .13;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  MAY 04, 1990
  • HELP-PROMPT:  Enter the phone number for getting Precertification of insurance if this company requires it. Answer must be 7-20 characters in length.
  • DESCRIPTION:  
    If precertification is required prior to a patient being treated, enter the number of the insurance carrier to which this request can be made.
.1331 PRECERTIFICATION PORTAL .13;12 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1)!'(X'["/>") X
    MAXIMUM LENGTH: 80
  • LAST EDITED:  JUN 18, 2024
  • HELP-PROMPT:  Answer must be between 1 and 80 characters and it cannot contain "/>".
  • DESCRIPTION:  
    If precertification is required prior to a patient being treated, enter the website of the insurance carrier to which this request can be made. Answer cannot contain "/>".
  • TECHNICAL DESCR:  
    Introduced with IB*2*794
.134 VERIFICATION PHONE NUMBER .13;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  MAR 29, 1993
  • HELP-PROMPT:  Enter the phone number for getting verification of insurance. Answer must be 7-20 characters in length.
  • DESCRIPTION:  
    Enter the phone number of the insurance carrier to which a Verification request can be made.
.135 CLAIMS (INPT) PHONE NUMBER .13;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  JUL 15, 1993
  • HELP-PROMPT:  Enter the telephone number of the inpatient claims office with 7-20 characters, e.g. 777-8888, 415 111 2222 x123.
  • DESCRIPTION:  
    Enter the telephone number at which this insurance carrier's inpatient claims office can be reached.
.136 CLAIMS (OPT) PHONE NUMBER .13;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  JUL 15, 1993
  • HELP-PROMPT:  Enter the telephone number of the outpatient claims office with 7 - 20 characters, ex. 777-8888, 415 111 2222 x123.
  • DESCRIPTION:  
    Enter the phone number at which the outpatient claims office of this insurance carrier can be reached.
.137 APPEALS PHONE NUMBER .13;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  JUL 15, 1993
  • HELP-PROMPT:  Enter the telephone number of the appeals office with 7 - 20 characters, ex. 777-8888, 415 111 2222 x123.
  • DESCRIPTION:  
    Enter the telephone number at which the appeals office of this insurance carrier can be reached.
.138 INQUIRY PHONE NUMBER .13;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  JUL 15, 1993
  • HELP-PROMPT:  Enter the telephone number of the inquiry office with 7 - 20 characters, ex. 777-8888, 415 111 222 x123.
  • DESCRIPTION:  
    Enter the telephone number at which the inquiry office of this insurance carrier can be reached.
.139 PRECERT COMPANY NAME .13;9 POINTER TO INSURANCE COMPANY FILE (#36) INSURANCE COMPANY(#36)

  • INPUT TRANSFORM:  S DIC(0)=DIC(0)_"F",DIC("S")="I '$P(^(0),U,5),'$P($G(^(.13)),U,9),(Y'=DA)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  OCT 06, 1993
  • DESCRIPTION:  
    You can only select a company that processes Precerts. The company specified in this field must be an active insurance company, not the same company specified as handling Precerts for it.
  • SCREEN:  S DIC("S")="I '$P(^(0),U,5),'$P($G(^(.13)),U,9),(Y'=DA)"
  • EXPLANATION:  Select a company that processes precerts for this company. Must be active, not this company, and process its own precerts.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the ANOTHER CO. PROCESS PRECERTS? field of the INSURANCE COMPANY File
.141 APPEALS ADDRESS ST. [LINE 1] .14;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3)!'$G(IBCNS) X
  • LAST EDITED:  JUN 19, 2007
  • HELP-PROMPT:  If the appeals address of this company is different from its main address, enter Line 1 of the appeals street address. Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    If the appeals address of this company is different from its main address, enter Line 1 of the appeals street address. Answer must be 3-30 characters in length.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^36^.142
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.14)):^(.14),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(36,.141,1,1,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.14)):^(.14),1:""),DIV=X S $P(^(.14),U,2)=DIV,DIH=36,DIG=.142 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.14)):^(.14),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(36,.141,1,1,2.4)
    2.4)= S DIH=$S($D(^DIC(36,DIV(0),.14)):^(.14),1:""),DIV=X S $P(^(.14),U,2)=DIV,DIH=36,DIG=.142 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= APPEALS ADDRESS ST. [LINE 2]
    When changing or deleting APPEALS ADDRESS ST. [LINE 1] delete APPEALS ADDRESS ST. [LINE 2].
  • CROSS-REFERENCE:  ^^TRIGGER^36^.143
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.14)):^(.14),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.141,1,2,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.14)):^(.14),1:""),DIV=X S $P(^(.14),U,3)=DIV,DIH=36,DIG=.143 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.14)):^(.14),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.141,1,2,2.4)
    2.4)= S DIH=$S($D(^DIC(36,DIV(0),.14)):^(.14),1:""),DIV=X S $P(^(.14),U,3)=DIV,DIH=36,DIG=.143 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= APPEALS ADDRESS ST. [LINE 3]
    When changing or deleting APPEALS ADDRESS ST. [LINE 1] delete APPEALS ADDRESS ST. [LINE 3].
.142 APPEALS ADDRESS ST. [LINE 2] .14;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.141) X
  • LAST EDITED:  JUN 19, 2007
  • HELP-PROMPT:  If the Appeals Address is longer than one line, enter a second line between 3-30 characters. It can not be the same as Line 1.
  • DESCRIPTION:  
    If the Appeals Address is longer than one line, enter a second line between 3-30 characters. It can not be the same as Line 1.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the APPEALS ADDRESS ST. [LINE 1] field of the INSURANCE COMPANY File
  • CROSS-REFERENCE:  ^^TRIGGER^36^.143
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.14)):^(.14),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.142,1,1,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.14)):^(.14),1:""),DIV=X S $P(^(.14),U,3)=DIV,DIH=36,DIG=.143 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.14)):^(.14),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.142,1,1,2.4)
    2.4)= S DIH=$S($D(^DIC(36,DIV(0),.14)):^(.14),1:""),DIV=X S $P(^(.14),U,3)=DIV,DIH=36,DIG=.143 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= APPEALS ADDRESS ST. [LINE 3]
    When changing or deleting APPEALS ADDRESS ST. [LINE 2] delete APPEALS ADDRESS ST. [LINE 3].
.143 APPEALS ADDRESS ST. [LINE 3] .14;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.141,.142) X
  • LAST EDITED:  JUN 19, 2007
  • HELP-PROMPT:  If the Appeals Address is longer than two lines, enter a third line between 3-30 characters. It can not be the same as Line 1 or Line 2.
  • DESCRIPTION:  
    If the Appeals Address is longer than two lines, enter a third line between 3-30 characters. It can not be the same as Line 1 or Line 2.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the APPEALS ADDRESS ST. [LINE 2] field of the INSURANCE COMPANY File
    TRIGGERED by the APPEALS ADDRESS ST. [LINE 1] field of the INSURANCE COMPANY File
.144 APPEALS ADDRESS CITY .14;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>25!($L(X)<2) X
  • LAST EDITED:  FEB 25, 1993
  • HELP-PROMPT:  If the appeals address of this company is different from its main address, enter city of the appeals address. Answer must be 2-25 characters in length.
  • DESCRIPTION:  
    Enter the city in which the appeals office of this insurance company is located.
.145 APPEALS ADDRESS STATE .14;5 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  OCT 07, 1993
  • HELP-PROMPT:  If the appeals address of this company is different from its main address, enter state of the appeals address.
  • DESCRIPTION:  
    Enter the state in which the appeals office of this insurance company is located. Enter state even if it is the same as the state of the company's main address.
.146 APPEALS ADDRESS ZIP .14;6 FREE TEXT

  • INPUT TRANSFORM:  K:($L(X)>10!($L(X)<9)) X I $D(X) K:'$$ZIPCHK9^IBCNSU(X) X I $D(X) D ZIPIN^VAFADDR
    MAXIMUM LENGTH: 10
  • OUTPUT TRANSFORM:  D ZIPOUT^VAFADDR
  • LAST EDITED:  MAR 22, 2017
  • HELP-PROMPT:  Answer must be nine (999999999) or ten characters (99999-9999) in length. The last 4 cannot be '0000' or '9999'.
  • DESCRIPTION:  
    This is the ZIP code for the address of the appeals processing location when it differs from the payer's main mailing address. Enter a 9 or 10 character ZIP code.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
.147 APPEALS COMPANY NAME .14;7 POINTER TO INSURANCE COMPANY FILE (#36) INSURANCE COMPANY(#36)

  • INPUT TRANSFORM:  S DIC(0)=DIC(0)_"F",DIC("S")="I '$P(^(0),U,5),'$P($G(^(.14)),U,7),(Y'=DA)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  OCT 06, 1993
  • DESCRIPTION:  You can only select a company that processes Appeals. The company specified in this field must be an active insurance company, not the same company as the entry being edited, and must not have another company specified as
    handling Appeals for it.
  • SCREEN:  S DIC("S")="I '$P(^(0),U,5),'$P($G(^(.14)),U,7),(Y'=DA)"
  • EXPLANATION:  Select a company that processes inpatient claims for this company. Must be active, not this company, and process its own inpatient claims.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the ANOTHER CO. PROCESS APPEALS? field of the INSURANCE COMPANY File
.148 ANOTHER CO. PROCESS APPEALS? .14;8 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  OCT 07, 1993
  • DESCRIPTION:  
    Enter "Yes" if another insurance company processes appeals.
  • CROSS-REFERENCE:  ^^TRIGGER^36^.147
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X='$P($G(^DIC(36,DA,.14)),"^",8) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,.14)):^(.14),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(36,.148,1,1,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.14)):^(.14),1:""),DIV=X S $P(^(.14),U,7)=DIV,DIH=36,DIG=.147 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= S X='$P($G(^DIC(36,DA,.14)),"^",8)
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= #.147
.149 APPEALS FAX .14;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  NOV 22, 1993
  • HELP-PROMPT:  Enter the fax number of this insurance carrier's appeals office with 7 - 20 characters, ex. 444-8888, 614-333-9999.
  • DESCRIPTION:  
    Enter the fax number of the appeals office of this insurance carrier.
.15 PRESCRIPTION REFILL REV. CODE 0;15 POINTER TO REVENUE CODE FILE (#399.2) REVENUE CODE(#399.2)

  • 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:  NOV 17, 2005
  • HELP-PROMPT:  Enter revenue code to be used for Rx refills.
  • DESCRIPTION:  
    This is the Revenue Code that will automatically be generated for this insurance company if a prescription refill is listed on this bill.
  • SCREEN:  S DIC("S")="I $P(^(0),U,3)"
  • EXPLANATION:  This is the Revenue Code that will automatically be generated for this insurance company if a prescription refill is listed on this bill.
.151 INQUIRY ADDRESS ST. [LINE 1] .15;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3)!'$G(IBCNS) X
  • LAST EDITED:  JUN 19, 2007
  • HELP-PROMPT:  If the inquiry address of this company is different from its main address, enter Line 1 of the inquiry street address. Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    If the inquiry address of this company is different from its main address, enter Line 1 of the inquiry street address. Answer must be 3-30 characters in length.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^36^.152
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.15)):^(.15),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(36,.151,1,1,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.15)):^(.15),1:""),DIV=X S $P(^(.15),U,2)=DIV,DIH=36,DIG=.152 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.15)):^(.15),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(36,.151,1,1,2.4)
    2.4)= S DIH=$S($D(^DIC(36,DIV(0),.15)):^(.15),1:""),DIV=X S $P(^(.15),U,2)=DIV,DIH=36,DIG=.152 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= INQUIRY ADDRESS ST. [LINE 2]
    When changing or deleting INQUIRY ADDRESS ST. [LINE 1] delete INQUIRY ADDRESS ST. [LINE 2].
  • CROSS-REFERENCE:  ^^TRIGGER^36^.153
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.15)):^(.15),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.151,1,2,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.15)):^(.15),1:""),DIV=X S $P(^(.15),U,3)=DIV,DIH=36,DIG=.153 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.15)):^(.15),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.151,1,2,2.4)
    2.4)= S DIH=$S($D(^DIC(36,DIV(0),.15)):^(.15),1:""),DIV=X S $P(^(.15),U,3)=DIV,DIH=36,DIG=.153 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= INQUIRY ADDRESS ST. [LINE 3]
    When changing or deleting INQUIRY ADDRESS ST. [LINE 1] delete INQUIRY ADDRESS ST. [LINE 3].
.152 INQUIRY ADDRESS ST. [LINE 2] .15;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.151) X
  • LAST EDITED:  JUN 19, 2007
  • HELP-PROMPT:  If the Inquiry Address is longer than one line, enter a second line between 3-30 characters. It can not be the same as Line 1.
  • DESCRIPTION:  
    If the Inquiry Address is longer than one line, enter a second line between 3-30 characters. It can not be the same as Line 1.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the INQUIRY ADDRESS ST. [LINE 1] field of the INSURANCE COMPANY File
  • CROSS-REFERENCE:  ^^TRIGGER^36^.153
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.15)):^(.15),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.152,1,1,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.15)):^(.15),1:""),DIV=X S $P(^(.15),U,3)=DIV,DIH=36,DIG=.153 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.15)):^(.15),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.152,1,1,2.4)
    2.4)= S DIH=$S($D(^DIC(36,DIV(0),.15)):^(.15),1:""),DIV=X S $P(^(.15),U,3)=DIV,DIH=36,DIG=.153 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= INQUIRY ADDRESS ST. [LINE 3]
    When changing or deleting INQUIRY ADDRESS ST. [LINE 2] delete INQUIRY ADDRESS ST. [LINE 3].
.153 INQUIRY ADDRESS ST. [LINE 3] .15;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.151,.152) X
  • LAST EDITED:  JUN 19, 2007
  • HELP-PROMPT:  If the Inquiry Address is longer than two lines, enter a third line between 3-30 characters. It can not be the same as Line 1 or Line 2.
  • DESCRIPTION:  
    If the Inquiry Address is longer than two lines, enter a third line between 3-30 characters. It can not be the same as Line 1 or Line 2.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the INQUIRY ADDRESS ST. [LINE 1] field of the INSURANCE COMPANY File
    TRIGGERED by the INQUIRY ADDRESS ST. [LINE 2] field of the INSURANCE COMPANY File
.154 INQUIRY ADDRESS CITY .15;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>25!($L(X)<2) X
  • LAST EDITED:  FEB 25, 1993
  • HELP-PROMPT:  If the inquiry address of this company is different from its main address, enter city of the inquiry address. Answer must be 2-25 characters in length.
  • DESCRIPTION:  
    Enter the city in which this insurance company's inquiry address office is located.
.155 INQUIRY ADDRESS STATE .15;5 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  FEB 25, 1993
  • HELP-PROMPT:  If the inquiry address of this company is different from its main address, enter state of the inquiry address.
  • DESCRIPTION:  
    Enter the state in which this insurance company's inquiry address office is located. Enter state even if it is the same as the state of the company's main address.
.156 INQUIRY ADDRESS ZIP CODE .15;6 FREE TEXT

  • INPUT TRANSFORM:  K:($L(X)>10!($L(X)<9)) X I $D(X) K:'$$ZIPCHK9^IBCNSU(X) X I $D(X) D ZIPIN^VAFADDR
    MAXIMUM LENGTH: 10
  • OUTPUT TRANSFORM:  D ZIPOUT^VAFADDR
  • LAST EDITED:  MAR 22, 2017
  • HELP-PROMPT:  Answer must be nine (999999999) or ten characters (99999-9999) in length. The last 4 cannot be '0000' or '9999'.
  • DESCRIPTION:  
    This is the ZIP code for the address of the inquiry processing location when it differs from the payer's main mailing address. Enter a 9 or 10 character ZIP code.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
.157 INQUIRY COMPANY NAME .15;7 POINTER TO INSURANCE COMPANY FILE (#36) INSURANCE COMPANY(#36)

  • INPUT TRANSFORM:  S DIC(0)=DIC(0)_"F",DIC("S")="I '$P(^(0),U,5),'$P($G(^(.15)),U,7),(Y'=DA)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  OCT 08, 1993
  • DESCRIPTION:  You can only select a company that processes Inquiries. The company specified in this field must be an active insurance company, not the same company as the entry being edited, and must not have another company specified
    as handling Inquiries for it.
  • SCREEN:  S DIC("S")="I '$P(^(0),U,5),'$P($G(^(.15)),U,7),(Y'=DA)"
  • EXPLANATION:  Select a company that processes inquiries for this company. Must be active, not this company, and process its own inquiries.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the ANOTHER CO. PROCESS INQUIRIES? field of the INSURANCE COMPANY File
.158 ANOTHER CO. PROCESS INQUIRIES? .15;8 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  OCT 07, 1993
  • DESCRIPTION:  
    Enter "Yes" if another insurance company processes Inquiries.
  • CROSS-REFERENCE:  ^^TRIGGER^36^.157
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X='$P($G(^DIC(36,DA,.15)),"^",8) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,.15)):^(.15),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(36,.158,1,1,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.15)):^(.15),1:""),DIV=X S $P(^(.15),U,7)=DIV,DIH=36,DIG=.157 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= S X='$P($G(^DIC(36,DA,.15)),"^",8)
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= #.157
.159 INQUIRY FAX .15;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  NOV 22, 1993
  • HELP-PROMPT:  Enter the fax number of this insurance carrier's inquiries office with 7 - 20 characters, ex. 444-8888, 614-333-9999.
  • DESCRIPTION:  
    Enter the fax number of the inquiries office of this insurance carrier.
.16 REPOINT PATIENTS TO 0;16 POINTER TO INSURANCE COMPANY FILE (#36) INSURANCE COMPANY(#36)

  • LAST EDITED:  FEB 28, 1994
  • DESCRIPTION:  
    If an insurance company has been inactivated and the patients repointed to another company then this is the company that they are assigned.
  • TECHNICAL DESCR:  
    This field will be maintained by the computer. Do not manually enter/edit.
    WRITE AUTHORITY: ^
.161 CLAIMS (OPT) STREET ADDRESS 1 .16;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<3)!'$G(IBCNS) X
  • LAST EDITED:  JUN 19, 2007
  • HELP-PROMPT:  If the outpatient claims process address of this company is different from its main address, enter Line 1 of the outpatient claims street address. Answer must be 3-35 characters in length.
  • DESCRIPTION:  
    If the outpatient claims process address of this company is different from its main address, enter Line 1 of the outpatient claims street address. Answer must be 3-35 characters in length.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^36^.162
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.16)):^(.16),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(36,.161,1,1,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.16)):^(.16),1:""),DIV=X S $P(^(.16),U,2)=DIV,DIH=36,DIG=.162 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.16)):^(.16),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(36,.161,1,1,2.4)
    2.4)= S DIH=$S($D(^DIC(36,DIV(0),.16)):^(.16),1:""),DIV=X S $P(^(.16),U,2)=DIV,DIH=36,DIG=.162 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= #.162
    When changing or deleting CLAIMS (OPT) STREET ADDRESS 1 delete CLAIMS (OPT) STREET ADDRESS 2.
  • CROSS-REFERENCE:  ^^TRIGGER^36^.163
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.16)):^(.16),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.161,1,2,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.16)):^(.16),1:""),DIV=X S $P(^(.16),U,3)=DIV,DIH=36,DIG=.163 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.16)):^(.16),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.161,1,2,2.4)
    2.4)= S DIH=$S($D(^DIC(36,DIV(0),.16)):^(.16),1:""),DIV=X S $P(^(.16),U,3)=DIV,DIH=36,DIG=.163 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= #.163
    When changing or deleting CLAIMS (OPT) STREET ADDRESS 1 delete CLAIMS (OPT) STREET ADDRESS 3.
.162 CLAIMS (OPT) STREET ADDRESS 2 .16;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.161) X
  • LAST EDITED:  SEP 28, 2007
  • HELP-PROMPT:  If the Outpatient Claims Process Address is longer than one line, enter a second line between 3-35 characters. It can not be the same as Line 1.
  • DESCRIPTION:  
    If the Outpatient Claims Process Address is longer than one line, enter a second line between 3-35 characters. It can not be the same as Line 1.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the CLAIMS (OPT) STREET ADDRESS 1 field of the INSURANCE COMPANY File
  • CROSS-REFERENCE:  ^^TRIGGER^36^.163
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.16)):^(.16),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.162,1,1,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.16)):^(.16),1:""),DIV=X S $P(^(.16),U,3)=DIV,DIH=36,DIG=.163 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.16)):^(.16),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.162,1,1,2.4)
    2.4)= S DIH=$S($D(^DIC(36,DIV(0),.16)):^(.16),1:""),DIV=X S $P(^(.16),U,3)=DIV,DIH=36,DIG=.163 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= #.163
    When changing or deleting CLAIMS (OPT) STREET ADDRESS 2 delete CLAIMS (OPT) STREET ADDRESS 3.
.163 CLAIMS (OPT) STREET ADDRESS 3 .16;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.161,.162) X
  • LAST EDITED:  JUN 19, 2007
  • HELP-PROMPT:  If the Outpatient Claims Process Address is longer than two lines, enter a third line between 3-35 characters. It can not be the same as Line 1 or Line 2.
  • DESCRIPTION:  
    If the Outpatient Claims Process Address is longer than two lines, enter a third line between 3-35 characters. It can not be the same as Line 1 or Line 2.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the CLAIMS (OPT) STREET ADDRESS 1 field of the INSURANCE COMPANY File
    TRIGGERED by the CLAIMS (OPT) STREET ADDRESS 2 field of the INSURANCE COMPANY File
.164 CLAIMS (OPT) PROCESS CITY .16;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>25!($L(X)<2) X
  • LAST EDITED:  JUL 15, 1993
  • HELP-PROMPT:  If the outpatient claims process address of this company is different from its main address, enter city of the outpatient claims process address. Answer must be 2-25 characters in length.
  • DESCRIPTION:  
    Enter the city in which this insurance company's outpatient claims office is located.
.165 CLAIMS (OPT) PROCESS STATE .16;5 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  JUL 15, 1993
  • HELP-PROMPT:  If the outpatient claims process address of this company is different from its main address, enter state of the outpatient claims address.
  • DESCRIPTION:  
    Enter the state in which this insurance company's outpatient claims office is located. Enter state even if it is the same as the state of the company's main address.
.166 CLAIMS (OPT) PROCESS ZIP .16;6 FREE TEXT

  • INPUT TRANSFORM:  K:($L(X)>10!($L(X)<9)) X I $D(X) K:'$$ZIPCHK9^IBCNSU(X) X I $D(X) D ZIPIN^VAFADDR
    MAXIMUM LENGTH: 10
  • OUTPUT TRANSFORM:  D ZIPOUT^VAFADDR
  • LAST EDITED:  MAR 22, 2017
  • HELP-PROMPT:  Answer must be nine (999999999) or ten characters (99999-9999) in length. The last 4 cannot be '0000' or '9999'.
  • DESCRIPTION:  
    This is the ZIP code for the address of the outpatient claims processing location when it differs from the payer's main mailing address. Enter a 9 or 10 character ZIP code.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
.167 CLAIMS (OPT) COMPANY NAME .16;7 POINTER TO INSURANCE COMPANY FILE (#36) INSURANCE COMPANY(#36)

  • INPUT TRANSFORM:  S DIC(0)=DIC(0)_"F",DIC("S")="I '$P(^(0),U,5),'$P($G(^(.16)),U,7),Y'=DA" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  OCT 01, 1993
  • DESCRIPTION:  You can only select a company that processes claims. The company specified in this field must be an active insurance company, not the same company as the entry being edited, and must not have another company specified as
    handling Outpatient Claims for it.
  • SCREEN:  S DIC("S")="I '$P(^(0),U,5),'$P($G(^(.16)),U,7),Y'=DA"
  • EXPLANATION:  Select an active Insurance Company that will process Outpatient Claims for this company. It may not be this company or have another company process outpatient claims for it.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the ANOTHER CO. PROCESS OP CLAIMS? field of the INSURANCE COMPANY File
.168 ANOTHER CO. PROCESS OP CLAIMS? .16;8 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  APR 10, 2003
  • DESCRIPTION:  
    Enter "Yes" if another insurance company processes Outpatient Claims.
  • CROSS-REFERENCE:  ^^TRIGGER^36^.167
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X='$P($G(^DIC(36,DA,.16)),"^",8) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,.16)):^(.16),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(36,.168,1,1,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.16)):^(.16),1:""),DIV=X S $P(^(.16),U,7)=DIV,DIH=36,DIG=.167 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= S X='$P($G(^DIC(36,DA,.16)),"^",8)
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= #.167
.169 CLAIMS (OPT) FAX .16;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  NOV 22, 1993
  • HELP-PROMPT:  Enter the fax number of the outpatient claims office with 7 - 20 characters, ex. 444-8888, 614-333-9999.
  • DESCRIPTION:  
    Enter the fax number of the outpatient claims office of this insurance carrier.
.17 PROFESSIONAL PROVIDER NUMBER 0;17 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  SEP 05, 2006
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    An identifier for professional (CMS-1500) bills assigned by the insurance company. This field is a counterpart to the Hospital Provider Number.
.178 ANOTHER CO. PROCESS PRECERTS? .17;8 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  OCT 07, 1993
  • DESCRIPTION:  
    Enter "Yes" if another insurance company processes precerts.
  • CROSS-REFERENCE:  ^^TRIGGER^36^.139
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X='$P($G(^DIC(36,DA,.17)),"^",8) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,.13)):^(.13),1:"") S X=$P(Y(1),U,9),X=X S DIU=X K Y S X="" X ^DD(36,.178,1,1,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.13)):^(.13),1:""),DIV=X S $P(^(.13),U,9)=DIV,DIH=36,DIG=.139 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= S X='$P($G(^DIC(36,DA,.17)),"^",8)
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= #.139
.18 STANDARD FTF 0;18 POINTER TO INSURANCE FILING TIME FRAME FILE (#355.13) INSURANCE FILING TIME FRAME(#355.13)

  • LAST EDITED:  JUL 11, 2022
  • HELP-PROMPT:  Enter the maximum standard filing time frame for this insurance company.
  • DESCRIPTION:  
    This is the standard filing time frame for the insurance company. It may be automatically applied to dates of service.
  • AUDIT:  YES, ALWAYS
  • CROSS-REFERENCE:  ^^TRIGGER^36^.19
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,0)):^(0),1:"") S X=$P(Y(1),U,19),X=X S DIU=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),0)),DIV=X S $P(^(0),U,19)=DIV,DIH=36,DIG=.19 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,0)):^(0),1:"") S X=$P(Y(1),U,19),X=X S DIU=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),0)),DIV=X S $P(^(0),U,19)=DIV,DIH=36,DIG=.19 D ^DICR
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= STANDARD FTF VALUE
    When changing or deleting Standard Filing Time Frame delete the corresponding Value.
.181 CLAIMS (RX) STREET ADDRESS 1 .18;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3)!'$G(IBCNS) X
  • LAST EDITED:  JUN 19, 2007
  • HELP-PROMPT:  If the prescription claims address of this company is different from its main address, enter Line 1 of the prescription claims address. Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    If the prescription claims address of this company is different from its main address, enter Line 1 of the prescription claims address. Answer must be 3-30 characters in length.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^36^.182
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.18)):^(.18),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(36,.181,1,1,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.18)):^(.18),1:""),DIV=X S $P(^(.18),U,2)=DIV,DIH=36,DIG=.182 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.18)):^(.18),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(36,.181,1,1,2.4)
    2.4)= S DIH=$S($D(^DIC(36,DIV(0),.18)):^(.18),1:""),DIV=X S $P(^(.18),U,2)=DIV,DIH=36,DIG=.182 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= #.182
    When changing or deleting CLAIMS (RX) STREET 1 delete CLAIMS (RX) STREET ADDRESS 1.
  • CROSS-REFERENCE:  ^^TRIGGER^36^.183
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.18)):^(.18),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.181,1,2,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.18)):^(.18),1:""),DIV=X S $P(^(.18),U,3)=DIV,DIH=36,DIG=.183 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.18)):^(.18),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.181,1,2,2.4)
    2.4)= S DIH=$S($D(^DIC(36,DIV(0),.18)):^(.18),1:""),DIV=X S $P(^(.18),U,3)=DIV,DIH=36,DIG=.183 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= #.183
    When changing or deleting CLAIMS (RX) STREET ADDRESS 1 delete CLAIMS (RX) STREET ADDRESS 2.
.182 CLAIMS (RX) STREET ADDRESS 2 .18;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.181) X
  • LAST EDITED:  JUN 19, 2007
  • HELP-PROMPT:  If the Prescription Claims Address is longer than one line, enter a second line between 3-30 characters. It can not be the same as Line 1.
  • DESCRIPTION:  
    If the Prescription Claims Address is longer than one line, enter a second line between 3-30 characters. It can not be the same as Line 1.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the CLAIMS (RX) STREET ADDRESS 1 field of the INSURANCE COMPANY File
  • CROSS-REFERENCE:  ^^TRIGGER^36^.183
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.18)):^(.18),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.182,1,1,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.18)):^(.18),1:""),DIV=X S $P(^(.18),U,3)=DIV,DIH=36,DIG=.183 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.18)):^(.18),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,.182,1,1,2.4)
    2.4)= S DIH=$S($D(^DIC(36,DIV(0),.18)):^(.18),1:""),DIV=X S $P(^(.18),U,3)=DIV,DIH=36,DIG=.183 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= #.183
.183 CLAIMS (RX) STREET ADDRESS 3 .18;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.181,.182) X
  • LAST EDITED:  JUN 19, 2007
  • HELP-PROMPT:  If the Prescription Claims Address is longer than two lines, enter a third line between 3-30 characters. It can not be the same as Line 1 or Line 2.
  • DESCRIPTION:  
    If the Prescription Claims Address is longer than two lines, enter a third line between 3-30 characters. It can not be the same as Line 1 or Line 2.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the CLAIMS (RX) STREET ADDRESS 1 field of the INSURANCE COMPANY File
    TRIGGERED by the CLAIMS (RX) STREET ADDRESS 2 field of the INSURANCE COMPANY File
.184 CLAIMS (RX) CITY .18;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>25!($L(X)<2) X
  • LAST EDITED:  JAN 03, 1994
  • HELP-PROMPT:  If the prescription claims office address of this company is different from its main address, enter city of the prescription claims address. Answer must be 2-25 characters in length.
  • DESCRIPTION:  
    Enter the city in which this insurance company's prescription claims office is located.
.185 CLAIMS (RX) STATE .18;5 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  JAN 22, 2013
  • HELP-PROMPT:  If the prescription claims office address of this company is different from its main address, enter state of the prescription claims office.
  • DESCRIPTION:  
    Enter the state in which this insurance company's prescription claims office is located. Enter state even if it is the same as the state of the company's main address.
.186 CLAIMS (RX) ZIP .18;6 FREE TEXT

  • INPUT TRANSFORM:  K:($L(X)>10!($L(X)<9)) X I $D(X) K:'$$ZIPCHK9^IBCNSU(X) X I $D(X) D ZIPIN^VAFADDR
    MAXIMUM LENGTH: 10
  • OUTPUT TRANSFORM:  D ZIPOUT^VAFADDR
  • LAST EDITED:  MAR 22, 2017
  • HELP-PROMPT:  Answer must be nine (999999999) or ten characters (99999-9999) in length. The last 4 cannot be '0000' or '9999'.
  • DESCRIPTION:  
    This is the ZIP code for the address of the prescription claims processing location when it differs from the payer's main mailing address. Enter a 9 or 10 character ZIP code.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
.187 CLAIMS (RX) COMPANY NAME .18;7 POINTER TO INSURANCE COMPANY FILE (#36) INSURANCE COMPANY(#36)

  • INPUT TRANSFORM:  S DIC(0)=DIC(0)_"F",DIC("S")="I '$P(^(0),U,5),'$P($G(^(.18)),U,7),(Y'=DA)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JAN 04, 1994
  • DESCRIPTION:  You can only select a company that processes Prescriptions. The company specified in this field must be an active insurance company, not the same company as the entry being edited, and must not have another company
    specified as handling Prescriptions for it.
  • SCREEN:  S DIC("S")="I '$P(^(0),U,5),'$P($G(^(.18)),U,7),(Y'=DA)"
  • EXPLANATION:  Select a company that processes prescription claims for this company. Must be active, not this company, and process its own prescription claims.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the ANOTHER CO. PROCESS RX CLAIMS? field of the INSURANCE COMPANY File
.188 ANOTHER CO. PROCESS RX CLAIMS? .18;8 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  JAN 04, 1994
  • DESCRIPTION:  
    Enter "Yes" if another insurance company processes prescription claims.
  • CROSS-REFERENCE:  ^^TRIGGER^36^.187
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X='$P($G(^DIC(36,DA,.18)),"^",8) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,.18)):^(.18),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(36,.188,1,1,1.4)
    1.4)= S DIH=$S($D(^DIC(36,DIV(0),.18)):^(.18),1:""),DIV=X S $P(^(.18),U,7)=DIV,DIH=36,DIG=.187 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= S X='$P($G(^DIC(36,DA,.18)),"^",8)
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= #.187
    Enter "Yes" if another insurance company processes prescription claims.
.189 CLAIMS (RX) FAX .18;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  JAN 03, 1994
  • HELP-PROMPT:  Enter the fax number of the prescription claims office with 7-20 characters, ex. 444-8888, 614-333-9999.
  • DESCRIPTION:  
    Enter the fax number of the prescription claims office of this insurance carrier.
.19 STANDARD FTF VALUE 0;19 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999)!(X<0)!(X?.E1"."2N.N) X
  • LAST EDITED:  JUL 11, 2022
  • HELP-PROMPT:  Type a Number between 0 and 999999, 1 Decimal Digit
  • DESCRIPTION:  
    Enter the value corresponding to the Standard Filing Time Frame. For example, for the time frame of Days, enter the number of days.
  • AUDIT:  YES, ALWAYS
  • NOTES:  TRIGGERED by the STANDARD FTF field of the INSURANCE COMPANY File
.191 CLAIMS (DENTAL) STREET ADDR 1 .19;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3)!'$G(IBCNS) X
    MAXIMUM LENGTH: 30
  • LAST EDITED:  AUG 29, 2018
  • HELP-PROMPT:  If the Dental claims process address of this company is different from its main address, enter Line 1 of the Dental claims street address. Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    If the Dental claims process address of this company is different from its main address, enter Line 1 of the Dental claims street address. Answer must be 3-30 characters in length.
  • AUDIT:  YES, ALWAYS
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^36^.192
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.19)):^(.19),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),.19)),DIV=X S $P(^(.19),U,2)=DIV,DIH=36,DIG=.192 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.19)):^(.19),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),.19)),DIV=X S $P(^(.19),U,2)=DIV,DIH=36,DIG=.192 D ^DICR
    3)= When changing or deleting CLAIMS (DENTAL) STREET ADDR 1 delete CLAIMS (DENTAL) STREET ADDR 2.
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= CLAIMS (DENTAL) STREET ADDR 2
    When changing or deleting CLAIMS (DENTAL) STREET ADDR 1 delete CLAIMS (DENTAL) STREET ADDR 2.
.1911 CLAIMS (DENTAL) PHONE NUMBER .19;11 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
    MAXIMUM LENGTH: 20
  • LAST EDITED:  AUG 29, 2018
  • HELP-PROMPT:  Enter the telephone number of the Dental claims office with 7-20 characters, e.g. 777-8888, 415 111 2222 x123.
  • DESCRIPTION:  
    Enter the telephone number at which this insurance carrier's Dental claims office can be reached.
  • AUDIT:  YES, ALWAYS
.192 CLAIMS (DENTAL) STREET ADDR 2 .19;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.191) X
    MAXIMUM LENGTH: 30
  • LAST EDITED:  AUG 29, 2018
  • HELP-PROMPT:  If the Dental Claims Process Address is longer than one line, enter a second line between 3-30 characters. The response can not be the same as Line 1.
  • DESCRIPTION:  
    If the Dental Claims Process Address is longer than one line, enter a second line between 3-30 characters. The response can not be the same as line 1.
  • AUDIT:  YES, ALWAYS
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the CLAIMS (DENTAL) STREET ADDR 1 field of the INSURANCE COMPANY File
.193 BLANK .19;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
    MAXIMUM LENGTH: 30
  • LAST EDITED:  AUG 29, 2018
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    This is a place holder for a 3rd address line, if needed.
  • AUDIT:  YES, ALWAYS
.194 CLAIMS (DENTAL) PROCESS CITY .19;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>25!($L(X)<2) X
    MAXIMUM LENGTH: 25
  • LAST EDITED:  AUG 29, 2018
  • HELP-PROMPT:  If the Dental claims process address of this company is different from its main address, enter city of the Dental claims process address. Answer must be 2-25 characters in length.
  • DESCRIPTION:  
    Enter the state in which this insurance company's Dental claims office is located. Enter state even if it is the same as the state of the company's main address.
  • AUDIT:  YES, ALWAYS
.195 CLAIMS (DENTAL) PROCESS STATE .19;5 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  AUG 29, 2018
  • HELP-PROMPT:  If the Dental claims process address of this company is different from its main address, enter state of the Dental claims process address.
  • DESCRIPTION:  
    Enter the state in which this insurance company's Dental claims office is located. Enter state even if it is the same as the state of the company's main address.
  • AUDIT:  YES, ALWAYS
.196 CLAIMS (DENTAL) PROCESS ZIP .19;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<9) X I $D(X) K:'$$ZIPCHK9^IBCNSU(X) X I $D(X) D ZIPIN^VAFADDR
    MAXIMUM LENGTH: 10
  • OUTPUT TRANSFORM:  D ZIPOUT^VAFADDR
  • LAST EDITED:  AUG 29, 2018
  • HELP-PROMPT:  Answer must be nine (999999999) or ten characters (99999-9999) in length. The last 4 cannot be '0000' or '9999'.
  • DESCRIPTION:  
    This is the ZIP code for the address of the Dental claims processing location when it differs from the payer's main mailing address. Enter a 9 or 10 character ZIP code.
  • AUDIT:  YES, ALWAYS
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
.197 CLAIMS (DENTAL) COMPANY NAME .19;7 POINTER TO INSURANCE COMPANY FILE (#36) INSURANCE COMPANY(#36)

  • INPUT TRANSFORM:  S DIC(0)=DIC(0)_"F",DIC("S")="I '$P(^(0),U,5),'$P($G(^(.19)),U,7),Y'=DA" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  AUG 29, 2018
  • HELP-PROMPT:  Select a company that processes Dental claims for this company.
  • DESCRIPTION:  You can only select a company that processes claims. The company specified in this field must be an active insurance company, not the same company as the entry being edited, and must not have another company specified as
    handling Dental Claims for it.
  • SCREEN:  S DIC("S")="I '$P(^(0),U,5),'$P($G(^(.19)),U,7),Y'=DA"
  • EXPLANATION:  This company must be active, not the same company, and process its own Dental claims.
  • AUDIT:  YES, ALWAYS
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the ANOTHER CO. PROC DENT CLAIMS? field of the INSURANCE COMPANY File
.198 ANOTHER CO. PROC DENT CLAIMS? .19;8 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  AUG 29, 2018
  • HELP-PROMPT:  Enter 'Yes' if another insurance company processes Dental Claims.
  • DESCRIPTION:  
    If another insurance company processes Dental Claims for this company, enter 'YES'. Otherwise, enter 'NO'.
  • AUDIT:  YES, ALWAYS
  • CROSS-REFERENCE:  ^^TRIGGER^36^.197
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X='$P($G(^DIC(36,DA,.19)),"^",8) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,.19)):^(.19),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(36,.198,1,1,1.4)
    1.4)= S DIH=$G(^DIC(36,DIV(0),.19)),DIV=X S $P(^(.19),U,7)=DIV,DIH=36,DIG=.197 D ^DICR
    2)= Q
    CREATE CONDITION)= S X='$P($G(^DIC(36,DA,.19)),"^",8)
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= CLAIMS (DENTAL) COMPANY NAME
    If another company processes Dental Claims for this company, the field CLAIMS (DENTAL) COMPANY NAME is triggered for entry.
.199 CLAIMS (DENTAL) FAX .19;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
    MAXIMUM LENGTH: 20
  • LAST EDITED:  AUG 29, 2018
  • HELP-PROMPT:  Enter the fax number of the inpatient claims office with 7-20 characters, e.g. 444-8888, 614-333-9999.
  • DESCRIPTION:  
    Enter the fax number of this insurance carrier's Dental claims office.
  • AUDIT:  YES, ALWAYS
1 REIMBURSE? 0;2 SET
************************REQUIRED FIELD************************
  • 'Y' FOR WILL REIMBURSE;
  • '*' FOR WILL REIMBURSE IF TREATED UNDER VAR 6046(C) OR VAR 6060.2(A);
  • '**' FOR DEPENDS ON POLICY, CHECK WITH COMPANY;
  • 'N' FOR WILL NOT REIMBURSE;

  • LAST EDITED:  APR 08, 2015
  • HELP-PROMPT:  Enter the proper reimbursement code.
  • DESCRIPTION:  
    Choose from the available list of choices the appropriate code denoting whether or not and under which circumstances this insurance carrier will reimburse the Dept of Veterans Affairs for care received.
  • AUDIT:  YES, ALWAYS
  • DELETE TEST:  1,0)= I $D(DGINS)
2 SIGNATURE REQUIRED ON BILL? 0;3 SET
************************REQUIRED FIELD************************
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  DEC 22, 1991
  • HELP-PROMPT:  Enter 'Yes' if a bill sent to this insurance carrier requires a manual signature or 'No' if it does not.
  • DESCRIPTION:  
    Enter a yes or no in this field denoting whether a signature is required on a bill before being submitted to the insurance carrier.
  • DELETE TEST:  1,0)= I $D(DGINS)
3.01 TRANSMIT ELECTRONICALLY 3;1 SET
************************REQUIRED FIELD************************
  • '1' FOR YES-LIVE;
  • '2' FOR YES-TEST;

  • INPUT TRANSFORM:  K:'$$EDIKEY^IBCNSC X
  • LAST EDITED:  AUG 29, 2018
  • HELP-PROMPT:  Enter 1 to bill electronically 2 to only transmit for testing
  • DESCRIPTION:  
    This field determines whether an electronic claim to this insurance company is sent as a test or a production claim.
  • AUDIT:  YES, ALWAYS
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
3.02 EDI ID NUMBER - PROF 3;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1)!($$UP^XLFSTR(X)["PRNT") X I $D(X) K:'$$EDIKEY^IBCNSC X
  • LAST EDITED:  FEB 18, 2020
  • HELP-PROMPT:  Answer must be 1-30 characters. PRNT values are not allowed.
  • DESCRIPTION:  
    This is the ID number used to identify the Payer on professional claim transmissions. PRNT values are not valid Payer IDs.
  • AUDIT:  YES, ALWAYS
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  36^AEP
    1)= S ^DIC(36,"AEP",$E(X,1,30),DA)=""
    2)= K ^DIC(36,"AEP",$E(X,1,30),DA)
    This cross-reference allows users to lookup an Insurance Company entry by Primary EDI # within the RCB option only.
3.03 BIN NUMBER 3;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<2) X
  • LAST EDITED:  AUG 14, 1996
  • HELP-PROMPT:  Answer must be 2-15 characters in length.
  • DESCRIPTION:  This field is used for facilities who are billing CHAMPUS prescription charges electronically to the CHAMPUS fiscal intermediary. The Bin number identifies this company as the CHAMPUS FI to the electronic billing system
    so that the claim is correctly routed to the FI.
3.04 EDI ID NUMBER - INST 3;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1)!($$UP^XLFSTR(X)["PRNT") X I $D(X) K:'$$EDIKEY^IBCNSC X
  • LAST EDITED:  FEB 18, 2020
  • HELP-PROMPT:  Answer must be 1-30 characters. PRNT values are not allowed.
  • DESCRIPTION:  
    This is the ID number used to identify the Payer on institutional claim transmissions. PRNT values are not valid Payer IDs.
  • AUDIT:  YES, ALWAYS
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  36^AEI
    1)= S ^DIC(36,"AEI",$E(X,1,30),DA)=""
    2)= K ^DIC(36,"AEI",$E(X,1,30),DA)
    This cross-reference allows users to lookup an Insurance Company entry by Primary EDI # within the RCB option only.
3.05 LAST EXTRACT DATE FOR TEST 3;5 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 02, 1997
  • HELP-PROMPT:  Enter the date that bills for this insurance company were last extracted for transmission.
  • DESCRIPTION:  
    The last date that bills for this insurance company were extracted. This date is used to reset the counter for the # of test bills submitted.
3.06 MAX NUMBER TEST BILLS PER DAY 3;6 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>10000)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 02, 1997
  • HELP-PROMPT:  Type a Number between 1 and 10000, 0 Decimal Digits
  • DESCRIPTION:  
    This field is used to indicate the maximum number of test bills to send per day to this insurance company.
3.07 NUMBER TEST BILLS FOR LAST DT 3;7 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>10000)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 02, 1997
  • HELP-PROMPT:  Type a Number between 1 and 10000, 0 Decimal Digits
  • DESCRIPTION:  
    This is the number of test bills that were sent on the last date when test bills were sent electronically for this insurance company.
3.09 ELECTRONIC INSURANCE TYPE 3;9 SET
  • '1' FOR HMO;
  • '2' FOR COMMERCIAL;
  • '3' FOR MEDICARE;
  • '4' FOR MEDICAID;
  • '5' FOR GROUP POLICY;
  • '9' FOR OTHER;

  • INPUT TRANSFORM:  K:'$$EDIKEY^IBCNSC X
  • LAST EDITED:  OCT 23, 2006
  • HELP-PROMPT:  ENTER THE TYPE OF INSURANCE FOR ELECTRONIC TRANSMISSION PURPOSES
  • DESCRIPTION:  This field contains the code to be used in the electronic transmission of claims to identify the type of insurance company the claim is for. The default, if this field is blank, is Group Policy. If you select GROUP
    POLICY, this will force a check in the GROUP insurance box of the CMS 1500/BOX 1.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
3.1 PAYER 3;10 POINTER TO PAYER FILE (#365.12) PAYER(#365.12)

  • INPUT TRANSFORM:  S DIC("S")="I $P($G(^(0)),U,1)'=""~NO PAYER"",$$ACTAPP^IBCNEUT5(Y)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  APR 01, 2015
  • HELP-PROMPT:  Please choose an entry in the Payer File.
  • DESCRIPTION:  This field points to an entry in the Payer File (#365.12). This field is not required, but it allows the insurance company entry to be able to conduct business electronically by linking the insurance company with a payer
    for various electronic applications.
  • SCREEN:  S DIC("S")="I $P($G(^(0)),U,1)'=""~NO PAYER"",$$ACTAPP^IBCNEUT5(Y)"
  • EXPLANATION:  Only valid payers may be selected.
  • AUDIT:  YES, ALWAYS
  • CROSS-REFERENCE:  36^AC
    1)= S ^DIC(36,"AC",$E(X,1,30),DA)=""
    2)= K ^DIC(36,"AC",$E(X,1,30),DA)
    This cross-reference is used to find insurance companies pointing to a specific payer.
3.13 INS COMPANY LINK TYPE 3;13 SET
  • 'P' FOR PARENT;
  • 'C' FOR CHILD;

  • INPUT TRANSFORM:  K:$D(^DIC(36,"APC",DA))&(X'="P") X K:'$$EDIKEY^IBCNSC X
  • LAST EDITED:  MAY 04, 2006
  • DESCRIPTION:  This field indicates if the insurance company is identified as a Parent insurance company or a Child insurance company. This linkage between parent insurance companies and children insurance companies allows for easier
    maintenance of billing provider secondary ID's.
    If this insurance company is currently defined as a Parent insurance company and there are Children insurance companies associated with it, then this field cannot be changed. You must first disassociate the Children from
    the Parent.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the INS COMPANY LINK PARENT field of the INSURANCE COMPANY File
  • CROSS-REFERENCE:  ^^TRIGGER^36^3.14
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DIC(36,D0,3)):^(3),1:"") S X=$P(Y(1),U,13),X=X S X=X'="C" I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,3)):^(3),1:"") S X=$P(Y(1),U,14),X=X S DIU=X K Y S X="" X ^DD(36,3.13,1
    ,1,2.4)
    2.4)= S DIH=$G(^DIC(36,DIV(0),3)),DIV=X S $P(^(3),U,14)=DIV,DIH=36,DIG=3.14 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE CONDITION)= INTERNAL(INS COMPANY LINK TYPE)'="C"
    DELETE VALUE)= @
    FIELD)= INS COMPANY LINK PARENT
3.14 INS COMPANY LINK PARENT 3;14 POINTER TO INSURANCE COMPANY FILE (#36) INSURANCE COMPANY(#36)

  • INPUT TRANSFORM:  S DIC("S")="I $P($G(^DIC(36,Y,3)),U,13)=""P"",$P($G(^DIC(36,DA,3)),U,13)=""C""" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X K:'$$EDIKEY^IBCNSC X
  • LAST EDITED:  MAY 04, 2006
  • DESCRIPTION:  
    This field identifies the parent insurance company link for maintenance of billing provider secondary ID's. This field is only valid for insurance companies identified as children.
  • SCREEN:  S DIC("S")="I $P($G(^DIC(36,Y,3)),U,13)=""P"",$P($G(^DIC(36,DA,3)),U,13)=""C"""
  • EXPLANATION:  Only parent insurance companies may be selected.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the INS COMPANY LINK TYPE field of the INSURANCE COMPANY File
  • CROSS-REFERENCE:  36^APC
    1)= S ^DIC(36,"APC",$E(X,1,30),DA)=""
    2)= K ^DIC(36,"APC",$E(X,1,30),DA)
    Cross reference by Parent insurance company.
  • CROSS-REFERENCE:  ^^TRIGGER^36^3.13
    1)= X ^DD(36,3.14,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,3)):^(3),1:"") S X=$P(Y(1),U,13),X=X S DIU=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),3)),DIV=X S $P(^(3),U,13)=DIV,DIH=36,DIG=3.13 D ^DICR
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(3)=$S($D(^DIC(36,D0,3)):^(3),1:"") S X=Y(0),X=X S X=X="",Y(1)=$G(X),Y(2)=$G(X) S X=$P(Y(3),U,13),X=X S X=X="C",Y=X,X=Y(1),X=X&Y
    2)= X ^DD(36,3.14,1,2,2.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,3)):^(3),1:"") S X=$P(Y(1),U,13),X=X S DIU=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),3)),DIV=X S $P(^(3),U,13)=DIV,DIH=36,DIG=3.13 D ^DICR
    2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DIC(36,D0,3)):^(3),1:"") S X=$P(Y(1),U,14),X=X S X=X="",Y(2)=$G(X),Y(3)=$G(X) S X=$P(Y(1),U,13),X=X S X=X="C",Y=X,X=Y(2),X=X&Y
    CREATE CONDITION)= INTERNAL(INS COMPANY LINK PARENT)=""&(INTERNAL(INS COMPANY LINK TYPE)="C")
    CREATE VALUE)= @
    DELETE CONDITION)= INTERNAL(INS COMPANY LINK PARENT)=""&(INTERNAL(INS COMPANY LINK TYPE)="C")
    DELETE VALUE)= @
    FIELD)= INS COMPANY LINK TYPE
3.15 EDI ID NUMBER - DENTAL 3;15 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1)!($$UP^XLFSTR(X)["PRNT") X
    MAXIMUM LENGTH: 30
  • LAST EDITED:  AUG 29, 2018
  • HELP-PROMPT:  Answer must be 1-30 characters in length. PRNT values are not allowed.
  • DESCRIPTION:  
    This is the ID number used to identify the Payer on Dental claim transmissions. PRNT values are not valid Payer IDs.
  • AUDIT:  YES, ALWAYS
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  36^AED
    1)= S ^DIC(36,"AED",$E(X,1,30),DA)=""
    2)= K ^DIC(36,"AED",$E(X,1,30),DA)
    This cross-reference allows users to lookup an Insurance Company entry by Dental EDI # within the RCB option only.
4.01 PERF PROV SECOND ID TYPE 1500 4;1 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97) IB PROVIDER ID # TYPE(#355.97)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),U,3)'=""1A"",$P(^(0),U,3)'=""TJ"",$$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  SEP 05, 2006
  • HELP-PROMPT:  Enter the type of performing provider id # the insurance co requires on its CMS-1500 bills
  • DESCRIPTION:  This is the type of performing provider secondary id # that the insurance company expects on CMS-1500 bills received from the V.A. When the payer-specific provider id is extracted, this field is used to determine where to
    get the default data from if another secondary id is not entered for the claim.
  • SCREEN:  S DIC("S")="I $P(^(0),U,3)'=""1A"",$P(^(0),U,3)'=""TJ"",$$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))"
  • EXPLANATION:  Must be valid id type for performing provider id
4.02 PERF PROV SECOND ID TYPE UB 4;2 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97) IB PROVIDER ID # TYPE(#355.97)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),U,3)'=""TJ"",$$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  JAN 16, 2007
  • HELP-PROMPT:  Enter the type of performing provider id # the insurance co requires on its UB-04 bills
  • DESCRIPTION:  This is the type of performing provider id # that the insurance company expects on UB-04 bills received from the V.A. When the payer-specific provider id is extracted, this field is used to determine where to get the data
    from.
  • SCREEN:  S DIC("S")="I $P(^(0),U,3)'=""TJ"",$$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))"
  • EXPLANATION:  Must be valid id type for performing provider id.
4.03 SECONDARY ID REQUIREMENTS 4;3 SET
  • '0' FOR NONE REQUIRED;
  • '1' FOR CMS-1500 REQUIRED;
  • '2' FOR UB-04 REQUIRED;
  • '3' FOR BOTH UB-04 AND CMS-1500 REQUIRED;

  • LAST EDITED:  JAN 16, 2007
  • HELP-PROMPT:  Enter the code to specify the secondary performing provider id requirement for this ins co by form type
  • DESCRIPTION:  
    This field is used to identify if the insurance company requires the performing provider secondary id on the UB-04, the CMS-1500 or both.
4.04 REF PROV SEC ID DEF CMS-1500 4;4 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97) IB PROVIDER ID # TYPE(#355.97)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),U,3)'=""1A"",$$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  SEP 05, 2006
  • HELP-PROMPT:  Enter the referring providers secondary ID type to be used on outgoing claims
  • DESCRIPTION:  
    This is the default qualifier for a referring provider if there is a referring provider and the form type is CMS-1500.
  • SCREEN:  S DIC("S")="I $P(^(0),U,3)'=""1A"",$$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))"
  • EXPLANATION:  Must be an allowable ID for a person
  • NOTES:  TRIGGERED by the NAME field of the INSURANCE COMPANY File
4.05 REF PROV SEC ID REQ ON CLAIMS 4;5 SET
  • '1' FOR CMS-1500;
  • '0' FOR NONE;

  • LAST EDITED:  OCT 12, 2006
  • HELP-PROMPT:  Enter 1 if this qualifier is required on CMS-1500 claims that have a referring provider
  • DESCRIPTION:  
    Set this field to CMS-1500 if the default ID for a Referring Provider is REQUIRED on a claim.
  • NOTES:  TRIGGERED by the NAME field of the INSURANCE COMPANY File
4.06 ATT/REND ID BILL SEC ID PROF 4;6 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  SEP 05, 2006
  • HELP-PROMPT:  Enter 1 if att/rend ID should be used as Billing Provider's secondary ID for CMS-1500 claims
  • DESCRIPTION:  
    This flag is set for insurance companies that wish to have the attending/rendering provider secondary ID used as a billing provider secondary ID. This applies to CMS-1500 claims.
  • NOTES:  TRIGGERED by the NAME field of the INSURANCE COMPANY File
4.07 *SEND LAB OR FAC IDS FOR VAMC 4;7 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  JUL 25, 2014
  • HELP-PROMPT:  Enter a 1 (YES) if Lab or Facility IDs should be sent for procedures performed at VAMC
  • DESCRIPTION:  This flag determines whether to send the lab/facility IDs and facility data when services are performed at the VAMC. Some payers will not accept the same data in both the Billing Provider and the Service Facility loops.
    This flag only affects electronic claims and is only valid when one of the "Always use main VAMC as Billing Provider" fields (4.11 or 4.12) is set to "Yes". MRD;IB*2.0*516 - This field has been marked for deletion and can
    be deleted after 3/15/2018.
  • NOTES:  TRIGGERED by the NAME field of the INSURANCE COMPANY File
4.08 ATT/REND ID BILL SEC ID INST 4;8 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  MAY 04, 2006
  • HELP-PROMPT:  Enter 1 if att/rend ID should be used as Billing Provider's secondary ID for UB claims
  • DESCRIPTION:  
    This flag is set for insurance companies that wish to have the attending/rendering provider secondary ID used as a billing provider secondary ID. This applies to UB claims.
  • NOTES:  TRIGGERED by the NAME field of the INSURANCE COMPANY File
4.09 PERF PROV CARE UNIT PROMPT 4;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  MAY 07, 2001
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  This is the name of the specific care unit this insurance company needs on each claim to determine the correct performing provider id #. For example, if specialty code is the care unit that the provider id # is based on,
    you would enter SPECIALTY CODE here and, on each claim, enter the actual specialty code in the PROVIDER ID CARE UNIT field for the performing provider.
  • TECHNICAL DESCR:  
    This data will appear in the executable help for the PROVIDER ID CARE UNIT field.
4.1 DELETE 2006 4.1 4;10 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97) IB PROVIDER ID # TYPE(#355.97)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),U,2)'>4,$P(^(0),U,6)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAY 19, 2004
  • HELP-PROMPT:  Enter the provider id type to use if the id from the performing prov source is not found
  • DESCRIPTION:  
    This is the alternate provider id type to use to find the performing provider's id when the default id as defined by the performing provider id type cannot be found.
  • SCREEN:  S DIC("S")="I $P(^(0),U,2)'>4,$P(^(0),U,6)"
  • EXPLANATION:  Must be a valid type for performing provider and have no minimum source level or have source 1-4
4.11 *USE VAMC AS BILL PROV ON 1500 4;11 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  JUL 23, 2014
  • HELP-PROMPT:  Enter a 1 (YES) if main VAMC should always be used as billing provider for CMS-1500.
  • DESCRIPTION:  Setting this parameter to YES will cause the following to occur: the system will no longer determine the Billing Provider based upon the location of care; the Billing Provider on a professional claim will be the VAMC; the
    Division on the claim will print/transmit as the Service Facility. MRD;IB*2.0*516 - This field has been marked for deletion and can be deleted after 3/15/2018.
4.12 *USE VAMC AS BILL PROV ON UB04 4;12 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  JUL 23, 2014
  • HELP-PROMPT:  Enter a 1 (YES) if main VAMC should always be used as billing provider for UB-04.
  • DESCRIPTION:  Setting this parameter to YES will cause the following to occur: the system will no longer determine the Billing Provider based upon the location of care; the Billing Provider on an institutional claim will be the VAMC;
    the Division on the claim will transmit as the Service Facility. MRD;IB*2.0*516 - This field has been marked for deletion and can be deleted after 3/15/2018.
4.13 *USE BILL PROV VAMC ADDRESS 4;13 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  JUL 25, 2014
  • HELP-PROMPT:  Enter a 1 (YES) if name and address of billing provider (VAMC) should be taken from INSTITUTION file.
  • DESCRIPTION:  When this parameter is set to YES, the Billing Provider on a claim will be the VAMC but the name and address will be the name and street address from the institution file. When this parameter is set to NO, the Billing
    Provider on a claim will be the VAMC but the name and address will be the name and address of the VAMC's Pay-to Provider. MRD;IB*2.0*516 - This field has been marked for deletion and can be deleted after 3/15/2018.
5.01 SCHEDULED FOR DELETION 5;1 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  AUG 04, 1995
  • DESCRIPTION:  This field will be used if a company is scheduled for deletion. Setting this field to 'Yes' will set a cross-reference which will allow quick retrieval of this company when the deletion clean-up background job begins to
    run. That job will delete the entire insurance company entry.
  • TECHNICAL DESCR:  This field is used to flag insurance companies which will be deleted during a background process which should run within the same day that this field is set to 'Yes.' The Insurance Company Editor will not allow selection
    of companies where this field has been set to 'Yes.'
  • CROSS-REFERENCE:  36^ADEL^MUMPS
    1)= I X=1 S ^DIC(36,"ADEL",DA)=""
    2)= K ^DIC(36,"ADEL",DA)
    This cross-reference contains a list of all entries which have been flagged for deletion.
5.02 REPOINT DELETED COMPANY TO 5;2 POINTER TO INSURANCE COMPANY FILE (#36) INSURANCE COMPANY(#36)

  • LAST EDITED:  AUG 04, 1995
  • DESCRIPTION:  
    When an Insurance Company is deleted, it may be necessary to repoint billing activity associated with that company to another company. This field stored the pointer to that company.
  • TECHNICAL DESCR:  The pointer to the company to which all billing activity needs to be repointed is used during the tasked insurance company deletion clean-up job. Thus, it is stored with the company when the company is flagged for
    deletion.
6.01 EDI INST SECONDARY ID QUAL(1) 6;1 SET
  • '2U' FOR PAYER ID #;
  • 'FY' FOR CLAIM OFFICE #;
  • 'NF' FOR NAIC CODE;
  • 'TJ' FOR FED TAXPAYER #;

  • INPUT TRANSFORM:  K:$$DUPQUAL^IBCNSC($G(IBCNS),X,6.03) X Q
  • LAST EDITED:  JUL 30, 2007
  • HELP-PROMPT:  Enter the qualifier for this secondary Payer ID. You can not use the same qualifier multiple times for institutional payer IDs.
  • DESCRIPTION:  
    Enter a secondary payer ID qualifier if provided by the payer.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the EDI INST SECONDARY ID(1) field of the INSURANCE COMPANY File
  • CROSS-REFERENCE:  ^^TRIGGER^36^6.02
    1)= Q
    2)= X ^DD(36,6.01,1,1,2.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),6)),DIV=X S $P(^(6),U,2)=DIV,DIH=36,DIG=6.02 D ^DICR
    2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(36,6.01,0)),U,3),Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,1)_":",2),$C(59))=""
    CREATE VALUE)= NO EFFECT
    DELETE CONDITION)= #6.01=""
    DELETE VALUE)= @
    FIELD)= #6.02
6.02 EDI INST SECONDARY ID(1) 6;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUN 26, 2007
  • HELP-PROMPT:  Answer must be 1-30 characters in length
  • DESCRIPTION:  
    Enter a secondary payer ID number if provided by the payer.
  • NOTES:  TRIGGERED by the EDI INST SECONDARY ID QUAL(1) field of the INSURANCE COMPANY File
  • CROSS-REFERENCE:  ^^TRIGGER^36^6.01
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,2)="" I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" X ^DD(36,6.02,1,1,2.4)
    2.4)= S DIH=$G(^DIC(36,DIV(0),6)),DIV=X S $P(^(6),U,1)=DIV,DIH=36,DIG=6.01 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE CONDITION)= #6.02=""
    DELETE VALUE)= @
    FIELD)= #6.01
6.03 EDI INST SECONDARY ID QUAL(2) 6;3 SET
  • '2U' FOR PAYER ID #;
  • 'FY' FOR CLAIM OFFICE #;
  • 'NF' FOR NAIC CODE;
  • 'TJ' FOR FED TAXPAYER #;

  • INPUT TRANSFORM:  K:$$DUPQUAL^IBCNSC($G(IBCNS),X,6.01) X Q
  • LAST EDITED:  JUL 30, 2007
  • HELP-PROMPT:  Enter the qualifier for this secondary Payer ID. You can not use the same qualifier multiple times for institutional payer IDs.
  • DESCRIPTION:  
    Enter a secondary payer ID qualifier if provided by the payer.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the EDI INST SECONDARY ID(2) field of the INSURANCE COMPANY File
  • CROSS-REFERENCE:  ^^TRIGGER^36^6.04
    1)= Q
    2)= X ^DD(36,6.03,1,1,2.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),6)),DIV=X S $P(^(6),U,4)=DIV,DIH=36,DIG=6.04 D ^DICR
    2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(36,6.03,0)),U,3),Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,3)_":",2),$C(59))=""
    CREATE VALUE)= NO EFFECT
    DELETE CONDITION)= #6.03=""
    DELETE VALUE)= @
    FIELD)= #6.04
6.04 EDI INST SECONDARY ID(2) 6;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUN 26, 2007
  • HELP-PROMPT:  Answer must be 1-30 characters in length
  • DESCRIPTION:  
    Enter a secondary payer ID number if provided by the payer.
  • NOTES:  TRIGGERED by the EDI INST SECONDARY ID QUAL(2) field of the INSURANCE COMPANY File
  • CROSS-REFERENCE:  ^^TRIGGER^36^6.03
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,4)="" I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(36,6.04,1,1,2.4)
    2.4)= S DIH=$G(^DIC(36,DIV(0),6)),DIV=X S $P(^(6),U,3)=DIV,DIH=36,DIG=6.03 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE CONDITION)= #6.04=""
    DELETE VALUE)= @
    FIELD)= #6.03
6.05 EDI PROF SECONDARY ID QUAL(1) 6;5 SET
  • '2U' FOR PAYER ID #;
  • 'FY' FOR CLAIM OFFICE #;
  • 'NF' FOR NAIC CODE;
  • 'TJ' FOR FED TAXPAYER #;

  • INPUT TRANSFORM:  K:$$DUPQUAL^IBCNSC($G(IBCNS),X,6.07) X Q
  • LAST EDITED:  JUL 30, 2007
  • HELP-PROMPT:  Enter the qualifier for this secondary Payer ID. You can not use the same qualifier multiple times for professional payer IDs.
  • DESCRIPTION:  
    Enter a secondary payer ID qualifier if provided by the payer.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the EDI PROF SECONDARY ID(1) field of the INSURANCE COMPANY File
  • CROSS-REFERENCE:  ^^TRIGGER^36^6.06
    1)= Q
    2)= X ^DD(36,6.05,1,1,2.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),6)),DIV=X S $P(^(6),U,6)=DIV,DIH=36,DIG=6.06 D ^DICR
    2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(36,6.05,0)),U,3),Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,5)_":",2),$C(59))=""
    CREATE VALUE)= NO EFFECT
    DELETE CONDITION)= #6.05=""
    DELETE VALUE)= @
    FIELD)= #6.06
6.06 EDI PROF SECONDARY ID(1) 6;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUN 26, 2007
  • HELP-PROMPT:  Answer must be 1-30 characters in length
  • DESCRIPTION:  
    Enter a secondary payer ID number if provided by the payer.
  • NOTES:  TRIGGERED by the EDI PROF SECONDARY ID QUAL(1) field of the INSURANCE COMPANY File
  • CROSS-REFERENCE:  ^^TRIGGER^36^6.05
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,6)="" I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" X ^DD(36,6.06,1,1,2.4)
    2.4)= S DIH=$G(^DIC(36,DIV(0),6)),DIV=X S $P(^(6),U,5)=DIV,DIH=36,DIG=6.05 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE CONDITION)= #6.06=""
    DELETE VALUE)= @
    FIELD)= #6.05
6.07 EDI PROF SECONDARY ID QUAL(2) 6;7 SET
  • '2U' FOR PAYER ID #;
  • 'FY' FOR CLAIM OFFICE #;
  • 'NF' FOR NAIC CODE;
  • 'TJ' FOR FED TAXPAYER #;

  • INPUT TRANSFORM:  K:$$DUPQUAL^IBCNSC($G(IBCNS),X,6.05) X Q
  • LAST EDITED:  JUL 30, 2007
  • HELP-PROMPT:  Enter the qualifier for this secondary Payer ID. You can not use the same qualifier multiple times for professional payer IDs.
  • DESCRIPTION:  
    Enter a secondary payer ID qualifier if provided by the payer.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the EDI PROF SECONDARY ID(2) field of the INSURANCE COMPANY File
  • CROSS-REFERENCE:  ^^TRIGGER^36^6.08
    1)= Q
    2)= X ^DD(36,6.07,1,1,2.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),6)),DIV=X S $P(^(6),U,8)=DIV,DIH=36,DIG=6.08 D ^DICR
    2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(36,6.07,0)),U,3),Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,7)_":",2),$C(59))=""
    CREATE VALUE)= NO EFFECT
    DELETE CONDITION)= #6.07=""
    DELETE VALUE)= @
    FIELD)= #6.08
6.08 EDI PROF SECONDARY ID(2) 6;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUN 26, 2007
  • HELP-PROMPT:  Answer must be 1-30 characters in length
  • DESCRIPTION:  
    Enter a secondary payer ID number if provided by the payer.
  • NOTES:  TRIGGERED by the EDI PROF SECONDARY ID QUAL(2) field of the INSURANCE COMPANY File
  • CROSS-REFERENCE:  ^^TRIGGER^36^6.07
    1)= Q
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,8)="" I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(36,6.08,1,1,2.4)
    2.4)= S DIH=$G(^DIC(36,DIV(0),6)),DIV=X S $P(^(6),U,7)=DIV,DIH=36,DIG=6.07 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE CONDITION)= #6.08=""
    DELETE VALUE)= @
    FIELD)= #6.07
6.09 PRINT SEC/TERT AUTO CLAIMS? 6;9 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  AUG 11, 2010
  • HELP-PROMPT:  Enter YES if automatically-processed secondary or tertiary claims to this payer must be printed locally.
  • DESCRIPTION:  
    YES means that automatically-processed secondary or tertiary claims to this payer must be printed locally.
6.1 PRINT SEC MED CLAIMS W/O MRA? 6;10 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  OCT 12, 2010
  • HELP-PROMPT:  Enter YES if secondary Medicare claims to this payer which have not been transmitted to Medicare and for which no MRA has been received, must be printed locally.
  • DESCRIPTION:  
    YES means that secondary Medicare claims to this payer which have not been transmitted to Medicare and for which no MRA has been received, must be printed locally.
7.01 EDI - UMO (278) ID 7;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<2) X
  • LAST EDITED:  NOV 23, 2015
  • HELP-PROMPT:  Answer must be 2-80 characters in length.
  • DESCRIPTION:  
    This is the Utilization Management Organization identifier which will be sent in the 278 transaction with the qualifier of PI.
8.01 HPID/OEID 8;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  NOV 10, 2014
  • HELP-PROMPT:  Answer must be 1-10 digits in length.
  • DESCRIPTION:  The HPID/OEID is a 10-digit, all-numeric identifier following the ISO Standard 7812 format with a Luhn check-digit as the tenth digit. The start digit of the HPID/OEID signals whether the identifier has been provided to a
    health plan and not to an "other entity". If the start digit is a seven (7) then it is an HPID and identifies a health plan, a six (6) indicates an "other entity" (OEID). The OEID serves as the identifier for entities that
    are not health plans, healthcare providers, or individuals (persons) who are not eligible for the HPID or National Provider Identifier (NPI),yet they need to be identified in standard transactions and for other lawful
    purposes.
  • CROSS-REFERENCE:  36^AHOD
    1)= S ^DIC(36,"AHOD",$E(X,1,30),DA)=""
    2)= K ^DIC(36,"AHOD",$E(X,1,30),DA)
    This non look-up cross-reference will be used by routine IBCNHUT1 to internally locate an Insurance Company using the HPID/OEID (Health Plan or Other Entity Identifier).
8.02 CHP/SHP 8;2 SET
  • 'C' FOR Controlling Health Plan (CHP);
  • 'S' FOR Subhealth Plan (SHP);

  • LAST EDITED:  JUN 19, 2014
  • HELP-PROMPT:  Enter the type of plan; Controlling Health Plan (CHP) or a Sub-health Plan.
  • DESCRIPTION:  Define whether this health plan is a Controlling Health Plan (CHP) or a Sub-health Plan (SHP). CHP is a health plan that controls its own business activities, actions, or policies. A plan can have 0 to many sub-health
    plans associated to it. SHP is a health plan whose business activities, actions, or policies are directed by a CHP.
8.03 PARENT CHP (HPID) 8;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  JUN 19, 2014
  • HELP-PROMPT:  Answer must be 1-10 digits in length.
  • DESCRIPTION:  
    Only enter data IF this insurance company entry is NOT the parent CHP for this HPID/OEID. This would be the HPID of the parent Insurance Company.
8.04 NIF ID 8;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  NOV 10, 2014
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  This is the internal identifier of the correlated entry in the FSC NIF. The NIF ID associates the new HPID/OEID data element with their correlated entry in the NIF (National Insurance File) so that there will be a linkage
    between VA/VistA and the FSC's NIF.
  • CROSS-REFERENCE:  36^ANIF
    1)= S ^DIC(36,"ANIF",$E(X,1,30),DA)=""
    2)= K ^DIC(36,"ANIF",$E(X,1,30),DA)
    This non look-up cross-reference will be used by routine IBCNHUT1 to internally locate an Insurance Company using the NIF ID (National Insurance File Identifier).
10 SYNONYM 10;0 Multiple #36.03 36.03
11 REMARKS 11;0 WORD-PROCESSING #36.011

  • LAST EDITED:  NOV 09, 1993
  • DESCRIPTION:  
    You may enter unlimited free text comments about this insurance company. It may be helpful to date ongoing comments and identify the source of the comments.
  • LAST EDITED:  NOV 09, 1993
  • HELP-PROMPT:  You may enter comments about this insurance company.
13 PLAN TYPES NO BILL PRV SEC ID 13;0 SET Multiple #36.013 36.013

  • DESCRIPTION:  
    Enter all the Electronic plan types which will suppress Billing Provider Secondary and Additional IDs from being sent.
15 ALTERNATE INST PAYER ID TYPE 15;0 POINTER Multiple #36.015 36.015

  • DESCRIPTION:  This ID Type designates the type of claims which are processed by a different Administration Contractor than normal claims. It determines which Alternate Institutional Payer Primary ID will be transmitted.
    In order for an Alternate ID to be added to the Bill/Claims, it has to be in this sub-file.
16 ALTERNATE PROF PAYER ID TYPE 16;0 POINTER Multiple #36.016 36.016

  • DESCRIPTION:  This ID Type designates the type of claims which are processed by a different Administration Contractor than normal claims. It determines which Alternate Professional Payer Primary ID will be transmitted.
    In order for an Alternate ID to be added to the Bill/Claims, it has to be in this sub-file.
17 277EDI ID NUMBER 17;0 Multiple #36.017 36.017

  • DESCRIPTION:  
    This is the ID information needed to capture data for reporting purposes from processing 277stat transactions.

ICR, Total: 13

ICR LINK Subscribing Package(s) Fields Referenced Description
ICR #61
  • Social Work
    		•  NAME (.01).
    Access: Read w/Fileman
    ICR #612
  • Prosthetics
    		•  NAME (.01).
    Access: Read w/Fileman
    ICR #645
  • Automated Information Collection System
    		•  NAME (.01).
    Access: Read w/Fileman
    ICR #766
  • Patient Data Exchange
    		•
    ICR #794
  • Mental Health
  • Health Summary
  • Order Entry Results Reporting
    		•  NAME (.01).
    Access: Read w/Fileman
    ICR #949
  • Income Verification Match
    		•  NAME (.01).
    Access: Write w/Fileman

    STREET ADDRESS [LINE 1] (.111).
    Access: Write w/Fileman

    STREET ADDRESS [LINE 2] (.112).
    Access: Write w/Fileman

    CITY (.114).
    Access: Write w/Fileman

    STATE (.115).
    Access: Write w/Fileman

    ZIP CODE (.116).
    Access: Write w/Fileman

    PHONE NUMBER (.131).
    Access: Write w/Fileman

    		 Update of the insurance company address.
    ICR #3596
  • Health Summary
  • Order Entry Results Reporting
    		•  NAME (.01).
    Access: Read w/Fileman
    ICR #3642
  • M DATA EXTRACTOR
    		•
    ICR #4391
  • Accounts Receivable
    		•  INSURANCE COMPANY (.01).
    Access: Direct Global Read & w/Fileman

    INSURANCE COMPANY (.01).
    Access: Pointed to

    INSURANCE COMPANY (.01).
    Access: Read w/Fileman

    STREET ADDRESS [LINE 1] (.111).
    Access: Direct Global Read & w/Fileman

    STREET ADDRESS [LINE 2] (.112).
    Access: Direct Global Read & w/Fileman

    STREET ADDRESS [LINE 3] (.113).
    Access: Direct Global Read & w/Fileman

    CITY (.114).
    Access: Direct Global Read & w/Fileman

    STATE (.115).
    Access: Direct Global Read & w/Fileman

    ZIP CODE (.116).
    Access: Direct Global Read & w/Fileman
    ICR #4971
  • Kernel
    		•  NAME (.01).
    Access: Direct Global Read & w/Fileman

    TYPE OF COVERAGE (.13).
    Access: Direct Global Read & w/Fileman
    ICR #5292
  • Insurance Capture Buffer
    		•
    ICR #6142
  • Outpatient Pharmacy
    		•  NAME (.01).
    Access: Read w/Fileman
    ICR #7303
  • Lighthouse
    		•  NAME (.01).
    Access: Both R/W w/Fileman

    INACTIVE (.05).
    Access: Read w/Fileman

    ALLOW MULTIPLE BEDSECTIONS (.06).
    Access: Both R/W w/Fileman

    DIFFERENT REVENUE CODES TO USE (.07).
    Access: Both R/W w/Fileman

    ONE OPT. VISIT ON BILL ONLY (.08).
    Access: Both R/W w/Fileman

    FILING TIME FRAME (.12).
    Access: Both R/W w/Fileman

    TYPE OF COVERAGE (.13).
    Access: Both R/W w/Fileman

    PRESCRIPTION REFILL REV.CODE (.15).
    Access: Both R/W w/Fileman

    PROFESSIONAL PROVIDER NUMBER (.17).
    Access: Both R/W w/Fileman

    STANDARD FTF (.18).
    Access: Both R/W w/Fileman

    STANDARD FTF VALUE (.19).
    Access: Both R/W w/Fileman

    REIMBURSE (1).
    Access: Direct Global R/W & w/Fileman

    REIMBURSE (2).
    Access: Both R/W w/Fileman

    AMBULATORY SURG. REV. CODE (.09).
    Access: Both R/W w/Fileman

    ATTENDING PHYSICIAN ID. (.1).
    Access: Both R/W w/Fileman

    STREET ADDRESS [LINE 1] (.111).
    Access: Direct Global R/W & w/Fileman

    STREET ADDRESS [LINE 2] (.112).
    Access: Both R/W w/Fileman

    STREET ADDRESS [LINE 3] (.113).
    Access: Both R/W w/Fileman

    CITY (.114).
    Access: Direct Global R/W & w/Fileman

    STATE (.115).
    Access: Both R/W w/Fileman

    ZIP CODE (.116).
    Access: Both R/W w/Fileman

    BILLING COMPANY NAME (.117).
    Access: Both R/W w/Fileman

    FAX NUMBER (.119).
    Access: Both R/W w/Fileman

    CLAIMS (INPT) STREET ADDRESS 1 (.121).
    Access: Both R/W w/Fileman

    CLAIMS (INPT) STREET ADDRESS 2 (.122).
    Access: Both R/W w/Fileman

    CLAIMS (INPT) STREET ADDRESS 3 (.123).
    Access: Both R/W w/Fileman

    CLAIMS (INPT) PROCESS CITY (.124).
    Access: Both R/W w/Fileman

    CLAIMS (INPT) PROCESS STATE (.125).
    Access: Both R/W w/Fileman

    CLAIMS (INPT) PROCESS ZIP (.126).
    Access: Both R/W w/Fileman

    CLAIMS (INPT) COMPANY NAME (.127).
    Access: Both R/W w/Fileman

    ANOTHER CO. PROCESS IP CLAIMS (.128).
    Access: Both R/W w/Fileman

    CLAIMS (INPT) FAX (.129).
    Access: Both R/W w/Fileman

    PHONE NUMBER (.131).
    Access: Direct Global R/W & w/Fileman

    BILLING PHONE NUMBER (.132).
    Access: Direct Global R/W & w/Fileman

    CLAIMS (RX) PHONE NUMBER (.1311).
    Access: Both R/W w/Fileman

    PRECERTIFICATION PHONE NUMBER (.133).
    Access: Direct Global R/W & w/Fileman

    VERIFICATION PHONE NUMBER (.134).
    Access: Both R/W w/Fileman

    CLAIMS (INPT) PHONE NUMBER (.135).
    Access: Both R/W w/Fileman

    CLAIMS (OPT) PHONE NUMBER (.136).
    Access: Both R/W w/Fileman

    APPEALS PHONE NUMBER (.137).
    Access: Both R/W w/Fileman

    INQUIRY PHONE NUMBER (.138).
    Access: Both R/W w/Fileman

    PRECERT COMPANY NAME (.139).
    Access: Both R/W w/Fileman

    APPEALS ADDRESS ST. [LINE 1] (.141).
    Access: Both R/W w/Fileman

    APPEALS ADDRESS ST. [LINE 2] (.142).
    Access: Both R/W w/Fileman

    APPEALS ADDRESS ST. [LINE 3] (.143).
    Access: Both R/W w/Fileman

    APPEALS ADDRESS CITY (.144).
    Access: Both R/W w/Fileman

    APPEALS ADDRESS STATE (.145).
    Access: Both R/W w/Fileman

    APPEALS ADDRESS ZIP (.146).
    Access: Both R/W w/Fileman

    APPEALS COMPANY NAME (.147).
    Access: Both R/W w/Fileman

    ANOTHER CO. PROCESS APPEALS (.148).
    Access: Both R/W w/Fileman

    APPEALS FAX (.149).
    Access: Both R/W w/Fileman

    INQUIRY ADDRESS ST. [LINE 1] (.151).
    Access: Both R/W w/Fileman

    INQUIRY ADDRESS ST. [LINE 2] (.152).
    Access: Both R/W w/Fileman

    INQUIRY ADDRESS ST. [LINE 3] (.153).
    Access: Both R/W w/Fileman

    INQUIRY ADDRESS CITY (.154).
    Access: Both R/W w/Fileman

    INQUIRY ADDRESS STATE (.155).
    Access: Both R/W w/Fileman

    INQUIRY ADDRESS ZIP CODE (.156).
    Access: Both R/W w/Fileman

    INQUIRY COMPANY NAME (.157).
    Access: Both R/W w/Fileman

    ANOTHER CO. PROCESS INQUIRIES (.158).
    Access: Both R/W w/Fileman

    INQUIRY FAX (.159).
    Access: Both R/W w/Fileman

    CLAIMS (OPT) STREET ADDRESS 1 (.161).
    Access: Both R/W w/Fileman

    CLAIMS (OPT) STREET ADDRESS 2 (.162).
    Access: Both R/W w/Fileman

    CLAIMS (OPT) STREET ADDRESS 3 (.163).
    Access: Both R/W w/Fileman

    CLAIMS (OPT) PROCESS CITY (.164).
    Access: Both R/W w/Fileman

    CLAIMS (OPT) PROCESS STATE (.165).
    Access: Both R/W w/Fileman

    CLAIMS (OPT) PROCESS ZIP (.166).
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    CLAIMS (OPT) COMPANY NAME (.167).
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    ANOTHER CO. PROCESS OP CLAIMS (.168).
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    CLAIMS (OPT) FAX (.169).
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    ANOTHER CO. PROCESS PRECERTS (.178).
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    CLAIMS (RX) STREET ADDRESS 1 (.181).
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    CLAIMS (RX) STREET ADDRESS 2 (.182).
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    CLAIMS (RX) STREET ADDRESS 3 (.183).
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    CLAIMS (RX) CITY (.184).
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    CLAIMS (RX) STATE (.185).
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    CLAIMS (RX) ZIP (.186).
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    CLAIMS (RX) COMPANY NAME (.187).
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    ANOTHER CO. PROCESS RX CLAIMS (.188).
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    CLAIMS (RX) FAX (.189).
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    CLAIMS (DENTAL) STREET ADDR 1 (.191).
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    CLAIMS (DENTAL) PHONE NUMBER (.1911).
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    CLAIMS (DENTAL) STREET ADDR 2 (.192).
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    CLAIMS (DENTAL) PROCESS CITY (.194).
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    CLAIMS (DENTAL) PROCESS STATE (.195).
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    CLAIMS (DENTAL) PROCESS ZIP (.196).
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    CLAIMS (DENTAL) COMPANY NAME (.197).
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    ANOTHER CO. PROC DENT CLAIMS (.198).
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    CLAIMS (DENTAL) FAX (.199).
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    TRANSMIT ELECTRONICALLY (3.01).
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    EDI ID NUMBER - PROF (3.02).
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    BIN NUMBER (3.03).
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    EDI ID NUMBER - INST (3.04).
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    LAST EXTRACT DATE FOR TEST (3.05).
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    MAX NUMBER TEST BILLS PER DAY (3.06).
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    NUMBER TEST BILLS FOR LAST DT (3.07).
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    ELECTRONIC INSURANCE TYPE (3.09).
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    PAYER (3.1).
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    INS COMPANY LINK TYPE (3.13).
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    INS COMPANY LINK PARENT (3.14).
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    EDI ID NUMBER - DENTAL (3.15).
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    PERF PROV SECOND ID TYPE 1500 (4.01).
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    PERF PROV SECOND ID TYPE UB (4.02).
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    SECONDARY ID REQUIREMENTS (4.03).
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    REF PROV SEC ID DEF CMS-1500 (4.04).
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    REF PROV SEC ID REQ ON CLAIMS (4.05).
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    ATT/REND ID BILL SEC ID PROF (4.06).
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    ATT/REND ID BILL SEC ID INST (4.08).
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    PERF PROV CARE UNIT PROMPT (4.09).
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    EDI INST SECONDARY ID QUAL(1) (6.01).
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    EDI INST SECONDARY ID(1) (6.02).
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    EDI INST SECONDARY ID QUAL(2) (6.03).
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    EDI INST SECONDARY ID(2) (6.04).
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    EDI PROF SECONDARY ID QUAL(1) (6.05).
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    EDI PROF SECONDARY ID(1) (6.06).
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    EDI PROF SECONDARY ID QUAL(2) (6.07).
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    EDI PROF SECONDARY ID(2) (6.08).
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    PRINT SEC/TERT AUTO CLAIMS (6.09).
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    PRINT SEC MED CLAIMS W/O MRA (6.1).
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    EDI - UMO (278) ID (7.01).
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    HPID/OEID (8.01).
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    CHP/SHP (8.02).
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    PARENT CHP (HPID) (8.03).
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    NIF ID (8.04).
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    SYNONYM (.01).
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    PLAN TYPES NO BILL PRV SEC ID (.01).
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    277EDI ID NUMBER (.01).
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    277DATE EDI ID NUMBER (.02).
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    277EDI TYPE (.03).
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    277EDI ID NUMBER ON FILE (.04).
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    COLLECTIONS DOLLAR LIMIT (580950.01).
    Access: Both R/W w/Fileman

    		 SYNONYM (Multiple-36.03)PLAN TYPES NO BILL PRV SEC ID (Multiple-36.013)277EDI ID NUMBER (Multiple-36.017)
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