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Global: ^FB583

Package: Fee Basis

Global: ^FB583


Information

FileMan FileNo FileMan Filename Package
162.7 FEE BASIS UNAUTHORIZED CLAIMS Fee Basis

Description

Accessed By FileMan Db Calls, Total: 23

Package Total Routines
Fee Basis 23 FB35167P    FBAACLU    FBFPCI    FBMRASV1    FBPHON2    FBPMRG    FBUCAUD    FBUCDIS
FBUCED    FBUCED0    FBUCED1    FBUCEN    FBUCEN1    FBUCEX    FBUCLINK    FBUCMEA
FBUCOUT    FBUCPAY    FBUCUPD    FBUCUPD1    FBUCUTL8    FBXIP19    FBXIP27    

Pointed To By FileMan Files, Total: 6

Package Total FileMan Files
Fee Basis 6 FEE BASIS UNAUTHORIZED CLAIMS(#162.7)[20]    FEE BASIS PHARMACY INVOICE(#162.1)[#162.11(26)]    FEE BASIS UNAUTHORIZED CLAIMS PENDING INFO(#162.8)[.02]    FEE BASIS PATIENT(#161)[#161.01(.055)]    FEE BASIS PAYMENT(#162)[#162.03(27)]    FEE BASIS INVOICE(#162.5)[4]    

Pointer To FileMan Files, Total: 10

Package Total FileMan Files
Fee Basis 6 FEE BASIS UNAUTHORIZED CLAIMS DISPOSITIONS(#162.91)[10]    FEE BASIS UNAUTHORIZED CLAIMS STATUS(#162.92)[24, #162.701(.03)]    FEE BASIS UNAUTHORIZED DISAPPROVAL REASONS(#162.94)[#162.715(.01)]    FEE BASIS UNAUTHORIZED CLAIMS(#162.7)[20]    FEE BASIS PROGRAM(#161.8)[.5]    FEE BASIS VENDOR(#161.2)[1, 23]    
Kernel 2 INSTITUTION(#4)[6]    NEW PERSON(#200)[23, 27, #162.701(.02), #162.792(1), #162.793(4)]    
DRG Grouper 1 ICD DIAGNOSIS(#80)[5.1]    
Registration 1 PATIENT(#2)[2, 23]    

Fields, Total: 48

Field # Name Loc Type Details
.01 DATE CLAIM RECEIVED 0;1 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)=-DT D ^%DT K %DT S X=Y K:Y<1 X
  • LAST EDITED:  FEB 27, 2014
  • HELP-PROMPT:  Enter when an Unauthorized Claim, complete or incomplete, is received.
  • DESCRIPTION:  
    This is the Date that the valid 583 was accepted for processing. Usually the date the claim is being entered.
  • DELETE TEST:  .01,0)= D DEL^FBUCDD1(DA)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  162.7^B
    1)= S ^FB583("B",$E(X,1,30),DA)=""
    2)= K ^FB583("B",$E(X,1,30),DA)
  • CROSS-REFERENCE:  162.7^AID^MUMPS
    1)= S ^FB583("AID",-X,DA)=""
    2)= K ^FB583("AID",-X,DA)
    Sort entries by inverse date unauthorized claim received.
  • RECORD INDEXES:  AUD (#1210)
.5 FEE PROGRAM 0;2 POINTER TO FEE BASIS PROGRAM FILE (#161.8)
************************REQUIRED FIELD************************
FEE BASIS PROGRAM(#161.8)

  • INPUT TRANSFORM:  S DIC("S")="I +$P(^(0),U,3)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAR 29, 1994
  • HELP-PROMPT:  Enter the appropriate active fee program to which this claim pertains.
  • DESCRIPTION:  
    The appropriate fee program to which this unauthorized claim pertains. Only active fee programs can be selected.
  • SCREEN:  S DIC("S")="I +$P(^(0),U,3)"
  • EXPLANATION:  Only active fee programs can be selected.
  • CROSS-REFERENCE:  162.7^AA1^MUMPS
    1)= S:$P(^FB583(DA,0),U,13) ^FB583("AA",X,$P(^(0),U,13),DA)=""
    2)= K:$P(^FB583(DA,0),U,13) ^FB583("AA",X,$P(^(0),U,13),DA)
    Cross reference by fee program, authorization from date.
  • CROSS-REFERENCE:  162.7^AD1^MUMPS
    1)= S:$P(^FB583(DA,0),U,14) ^FB583("AD",X,$P(^(0),U,14),DA)=""
    2)= K:$P(^FB583(DA,0),U,14) ^FB583("AD",X,$P(^(0),U,14),DA)
    Cross reference by fee program and authorization to date.
1 VENDOR 0;3 POINTER TO FEE BASIS VENDOR FILE (#161.2)
************************REQUIRED FIELD************************
FEE BASIS VENDOR(#161.2)

  • LAST EDITED:  JUL 02, 1993
  • HELP-PROMPT:  Enter the vendor who provided the services being charged.
  • DESCRIPTION:  
    The vendor who provided the services being charged.
  • CROSS-REFERENCE:  162.7^C
    1)= S ^FB583("C",$E(X,1,30),DA)=""
    2)= K ^FB583("C",$E(X,1,30),DA)
  • CROSS-REFERENCE:  162.7^AVF^MUMPS
    1)= S:$P(^FB583(DA,0),U,5) ^FB583("AVF",X,$P(^(0),U,5),DA)=""
    2)= K:$P(^FB583(DA,0),U,5) ^FB583("AVF",X,$P(^(0),U,5),DA)
    Cross reference by vendor, treatment from date and record number.
  • CROSS-REFERENCE:  162.7^AVS^MUMPS
    1)= N FBZ S FBZ=$$FBZ^FBUCUTL(DA) S:$P(FBZ,U,24) ^FB583("AVS",X,$P(FBZ,U,24),DA)="" K FBZ
    2)= N FBZ S FBZ=$$FBZ^FBUCUTL(DA) K:$P(FBZ,U,24) ^FB583("AVS",X,$P(FBZ,U,24),DA) K FBZ
    Cross-reference used to group claims by vendor and status.
  • CROSS-REFERENCE:  162.7^AVMS^MUMPS
    1)= D MSIX^FBUCDD(X,DA,1,1,"AVMS")
    2)= D MSIX^FBUCDD(X,DA,1,2,"AVMS")
    This cross-reference sets/kill the 'AVMS' cross-reference. It is used to display the relationship between primary/secondary claims. Fields involved are: Vendor, Master Claim and Status, having the respective index of
    'AVMS', 'AVMS1' or 'AVMS2'. In order to re-set the 'AVMS' index you only need to re-index ONE of these fields.
2 VETERAN 0;4 POINTER TO PATIENT FILE (#2)
************************REQUIRED FIELD************************
PATIENT(#2)

  • LAST EDITED:  JUL 02, 1993
  • HELP-PROMPT:  Enter the veteran who received the services being claimed.
  • DESCRIPTION:  
    The name of the veteran who received the services being claimed.
  • CROSS-REFERENCE:  162.7^D
    1)= S ^FB583("D",$E(X,1,30),DA)=""
    2)= K ^FB583("D",$E(X,1,30),DA)
  • CROSS-REFERENCE:  162.7^APF^MUMPS
    1)= S:$P(^FB583(DA,0),U,5) ^FB583("APF",X,$P(^(0),U,5),DA)=""
    2)= K:$P(^FB583(DA,0),U,5) ^FB583("APF",X,$P(^(0),U,5),DA)
    Cross reference by patient, treatment from date, record number.
  • CROSS-REFERENCE:  162.7^APS^MUMPS
    1)= N FBZ S FBZ=$$FBZ^FBUCUTL(DA) S:$P(FBZ,U,24) ^FB583("APS",X,$P(FBZ,U,24),DA)="" K FBZ
    2)= N FBZ S FBZ=$$FBZ^FBUCUTL(DA) K:$P(FBZ,U,24) ^FB583("APS",X,$P(FBZ,U,24),DA) K FBZ
    Cross-reference used to group claims by veteran (patient) and status.
  • CROSS-REFERENCE:  162.7^APMS^MUMPS
    1)= D MSIX^FBUCDD(X,DA,2,1,"APMS")
    2)= D MSIX^FBUCDD(X,DA,2,2,"APMS")
    This cross-reference sets/kill the 'APMS' cross-reference. It is used to display the relationship between primary/secondary claims. Fields involved are: Patient, Master Claim and Status, having the respective index of
    'APMS', 'APMS1' or 'APMS2'. In order to re-set the 'APMS' index you only need to re-index ONE of these fields.
3 TREATMENT FROM DATE 0;5 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="EPX",%DT(0)=-DT D ^%DT K %DT(0) S X=Y K:Y<1 X
  • LAST EDITED:  MAY 05, 1993
  • HELP-PROMPT:  Enter the date treatment began for this particular Fee program and claim. Date can not be in the future.
  • DESCRIPTION:  
    Date which treatment began for submitted unauthorized claim. Date cannot be in the future.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  162.7^APF1^MUMPS
    1)= S:$P(^FB583(DA,0),U,4) ^FB583("APF",$P(^(0),U,4),X,DA)=""
    2)= K:$P(^FB583(DA,0),U,4) ^FB583("APF",$P(^(0),U,4),X,DA)
    Cross reference by patient, treatment from date and record number.
  • CROSS-REFERENCE:  162.7^AVF1^MUMPS
    1)= S:$P(^FB583(DA,0),U,3) ^FB583("AVF",$P(^(0),U,3),X,DA)=""
    2)= K:$P(^FB583(DA,0),U,3) ^FB583("AVF",$P(^(0),U,3),X,DA)
    Cross reference by vendor, treatment from date and record number.
4 TREATMENT TO DATE 0;6 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="EPX",%DT(0)=-DT D ^%DT K %DT(0) S X=Y Q:'$G(DA) S FBZZ=4 K:$$INPUT^FBUCDD(DA,X,Y,FBZZ) X K FBZZ
  • LAST EDITED:  SEP 16, 1993
  • HELP-PROMPT:  Enter the date treatment ended for this particular Fee program and claim. Date cannot be in the future. Treatment To Date cannot be earlier than Treatment From Date.
  • DESCRIPTION:  
    Date which treatment ended for sumbitted unauthorized claim. Date cannot be in the future or be earlier than Treatment From date.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
5 DIAGNOSIS DX;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>120!($L(X)<3) X
  • HELP-PROMPT:  Answer must be 3-120 characters in length.
  • DESCRIPTION:  
    Enter the diagnosis upon which services were rendered.
5.1 ICD DIAGNOSIS DX;2 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  MAR 26, 2012
  • HELP-PROMPT:  Select the Diagnosis.
  • DESCRIPTION:  
    Patient's diagnosis for which this authorization is being issued. This field is only for ICD-10 and later.
6 PRIMARY SERVICE FACILITY 0;7 POINTER TO INSTITUTION FILE (#4) INSTITUTION(#4)

  • HELP-PROMPT:  Enter the facility which is responsible for reimbursing the COJ.
  • DESCRIPTION:  
    The name of the facility which will reimburse the COJ.
7 DATE VALID CLAIM RECEIVED 0;8 DATE

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)=-DT D ^%DT K %DT S X=Y S FBZZ=7 K:$$INPUT^FBUCDD(DA,X,Y,FBZZ) X K FBZZ
  • LAST EDITED:  FEB 27, 2014
  • HELP-PROMPT:  Enter date valid claim was received. Valid claim includes all supporting information/documentation.
  • DESCRIPTION:  
    Date complete (valid) unauthorized claim received for medical review.
  • TECHNICAL DESCR:  
    This field is automatically updated in the update routine.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • RECORD INDEXES:  AUD (#1210)
8 AMOUNT CLAIMED 0;9 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<0) X
  • LAST EDITED:  JAN 08, 2009
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999.99, 2 Decimal Digits
  • DESCRIPTION:  
    The dollar amount being claimed.
9 PATIENT TYPE CODE 0;10 SET
************************REQUIRED FIELD************************
  • '00' FOR SURGICAL;
  • '10' FOR MEDICAL;
  • '86' FOR PSYCHIATRIC;

  • LAST EDITED:  SEP 12, 1990
  • HELP-PROMPT:  Enter the appropriate patient type code for services received.
  • DESCRIPTION:  
    The appropriate patient type code for services which were received.
10 DISPOSITION 0;11 POINTER TO FEE BASIS UNAUTHORIZED CLAIMS DISPOSITIONS FILE (#162.91) FEE BASIS UNAUTHORIZED CLAIMS DISPOSITIONS(#162.91)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),U,2)" D ^DIC K DIC S DIC=DIE,X=+Y S FBZZ=10 K:$$INPUT^FBUCDD(DA,X,Y,FBZZ) X K FBZZ
  • LAST EDITED:  FEB 27, 2014
  • HELP-PROMPT:  Select the appropriate disposition reason. An approved, approved to stabilization or disapproved disposition requires a Complete status.
  • DESCRIPTION:  Only active dispositions can be selected. If the disposition has been approved, or approved to stabilization and payments made, then the disposition can not be changed unless the FBAASUPERVISOR key is held. An approved,
    approved to stabilization, or disapproved disposition requires a Complete status.
  • TECHNICAL DESCR:  If date valid claim received is null, then only reason for disposition
    should be for cancelled/withdrawn or abandoned. If a disposition is not approved, and there are payments made against
    the claim, the user may change the value only if s/he holds the
    supervisor security key.
    When the status or disposition changes, a letter needs to be printed. Once printed, the expiration date is calculated. The number of days is derived from the status.
  • SCREEN:  S DIC("S")="I $P(^(0),U,2)"
  • EXPLANATION:  Allow selection of active dispositions.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  162.7^AC^MUMPS
    1)= S ^FB583("AC",$E(X,1,30),DA)=""
    2)= K ^FB583("AC",$E(X,1,30),DA)
  • RECORD INDEXES:  AUD (#1210)
10.5 DISPOSITION REMARKS 4;0 WORD-PROCESSING #162.702

  • LAST EDITED:  NOV 15, 2001
  • DESCRIPTION:  
    Special remarks regarding the initial disposition that should be included on a disposition letter to the claimant. (Optional)
  • LAST EDITED:  NOV 15, 2001
  • DESCRIPTION:  
    Special remarks regarding the initial disposition that should be included on a disposition letter to the claimant. (Optional)
10.6 APPEAL DISPOSITION REMARKS A1;0 WORD-PROCESSING #162.703

  • DESCRIPTION:  
    Special remarks regarding the disposition of an appeal that should be included on a disposition letter to the claimant. (Optional)
  • LAST EDITED:  NOV 15, 2001
  • DESCRIPTION:  
    Special remarks regarding the disposition of an appeal that should be included on a disposition letter to the claimant. (Optional)
10.7 COVA DISPOSITION REMARKS A2;0 WORD-PROCESSING #162.704

  • LAST EDITED:  AUG 16, 2002
  • DESCRIPTION:  
    Special remarks regarding the disposition of a COVA appeal that should be included on a disposition letter to the claimant. (Optional)
  • LAST EDITED:  AUG 16, 2002
  • DESCRIPTION:  
    Special remarks regarding the disposition of a COVA appeal that should be included on a disposition letter to the claimant. (Optional)
11 DATE OF DISPOSITION 0;12 DATE

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)=-DT D ^%DT K %DT S X=Y K:Y<1 X
  • LAST EDITED:  FEB 27, 2014
  • HELP-PROMPT:  Enter date claim dispositioned.
  • DESCRIPTION:  
    The date the claim was dispositioned.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • RECORD INDEXES:  AUD (#1210)
12 AUTHORIZED FROM DATE 0;13 DATE

  • INPUT TRANSFORM:  S %DT="EPX",%DT(0)=-DT D ^%DT K %DT(0) S X=Y Q:'$D(DA) S FBZZ=12 K:$$INPUT^FBUCDD(DA,X,Y,FBZZ) X K FBZZ
  • LAST EDITED:  MAY 05, 1993
  • HELP-PROMPT:  Enter the beginning date which fee services are authorized. Date cannot be in the future. Date cannot be before Treatment From date or after Treatment To date.
  • DESCRIPTION:  
    The beginning date from which fee services for unauthorized claim are authorized. Date cannot be in the future or before Treatment From date.
  • EXECUTABLE HELP:  W !?5,"Treatment From: ",$$DATX^FBAAUTL(+$P(^FB583(DA,0),U,5))," Treatment To: ",$$DATX^FBAAUTL(+$P(^FB583(DA,0),U,6)),!
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  162.7^AA^MUMPS
    1)= S:$P(^FB583(DA,0),U,2) ^FB583("AA",$P(^(0),U,2),X,DA)=""
    2)= K:$P(^FB583(DA,0),U,2) ^FB583("AA",$P(^(0),U,2),X,DA)
    Cross refernece by fee program and authorization from date.
13 AUTHORIZED TO DATE 0;14 DATE

  • INPUT TRANSFORM:  S %DT="EPX",%DT(0)=-DT D ^%DT K %DT(0) S X=Y Q:'$D(DA) S FBZZ=13 K:$$INPUT^FBUCDD(DA,X,Y,FBZZ) X K FBZZ
  • LAST EDITED:  MAY 05, 1993
  • HELP-PROMPT:  Enter the date treatment authorized to. Date cannot be in the future or earlier than the Authorized From Date. Authorized To date cannot be after Treatment To date.
  • DESCRIPTION:  
    The ending date which fee services are authorized. Date cannot be in the future or before the Authorized From date. Authorized To date cannot be greater than Treatment To date.
  • EXECUTABLE HELP:  W !?5,"Treatment From: ",$$DATX^FBAAUTL(+$P(^FB583(DA,0),U,5))," Treatment To: ",$$DATX^FBAAUTL(+$P(^FB583(DA,0),U,6)),!
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  162.7^AD^MUMPS
    1)= S:$P(^FB583(DA,0),U,2) ^FB583("AD",$P(^(0),U,2),X,DA)=""
    2)= K:$P(^FB583(DA,0),U,2) ^FB583("AD",$P(^(0),U,2),X,DA)
    Cross reference by fee programs, authorization to date.
14 AMOUNT APPROVED 0;15 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<.01) X
  • LAST EDITED:  JAN 08, 2009
  • HELP-PROMPT:  Type a Dollar Amount between .01 and 9999999.99, 2 Decimal Digits
  • DESCRIPTION:  
    The authorized amount for payment of an unauthorized claim.
15 REASON FOR DISAPPROVAL D;0 POINTER Multiple #162.715 162.715

  • DESCRIPTION:  
    Provides reason(s) why a claim was disapproved.
  • TECHNICAL DESCR:  
    Only completed if disposition is DISAPPROVED.
  • SCREEN:  S DIC("S")="I $P(^(0),U,2),$P(^FB583(DA,0),U,11)>1"
  • EXPLANATION:  Allow selection of active disapproval reason(s) for claim with a dispostion of other than APPROVED.
16 *DISPOSITON DESCRIPTION 1;0 WORD-PROCESSING #162.716

  • LAST EDITED:  MAY 11, 1993
  • DESCRIPTION:  
    The description of the disposition. Replaced by the REASON FOR DISAPPROVAL field.
17 *REASON FOR PENDING 2;0 WORD-PROCESSING #162.717

  • LAST EDITED:  MAY 11, 1993
  • DESCRIPTION:  
    The reason the claim was pending. Replaced by the FEE BASIS UNAUTHORIZED REQUESTED INFORMATION file (# 162.93).
  • LAST EDITED:  AUG 22, 1990
19 PRINT LETTER? 0;16 SET
  • '1' FOR YES;

  • LAST EDITED:  APR 05, 1993
  • HELP-PROMPT:  Enter YES if letter needs to be printed.
  • DESCRIPTION:  
    If this field has a YES value, an unauthorized claim letter needs to be printed.
  • TECHNICAL DESCR:  
    When the status or disposition changes, a letter needs to be printed. Once printed, the expiration date is calculated. The number of days is derived from the status. This field is automatically updated.
  • CROSS-REFERENCE:  162.7^AL
    1)= S ^FB583("AL",$E(X,1,30),DA)=""
    2)= K ^FB583("AL",$E(X,1,30),DA)
    Cross-reference is used to determine which claims need a letter printed.
19.5 DATE LETTER SENT 0;19 DATE

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)=-DT D ^%DT K %DT S X=Y K:Y<1 X
  • LAST EDITED:  FEB 04, 2014
  • HELP-PROMPT:  Enter the date the follow-up or disposition letter was sent to submitter. Date can not be in the future.
  • DESCRIPTION:  
    Date letter sent to submitter.
  • TECHNICAL DESCR:  
    When the status or disposition changes, a letter needs to be printed. Once printed, the expiration date is calculated. The number of days is derived from the status. This field is automatically updated.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  162.7^ALP
    1)= S ^FB583("ALP",$E(X,1,30),DA)=""
    2)= K ^FB583("ALP",$E(X,1,30),DA)
    Cross-reference is used to determine if a letter has been printed. It may be used to reprint letters.
  • FIELD INDEX:  AILT (#1152) MUMPS ACTION
    Short Descr: Trigger letter date for request information letter.
    Description: This cross-reference copies the new value of the DATE LETTER SENT field to the DATE REQ INFO SENT field when the status of the claim is INCOMPLETE UNAUTHORIZED CLAIM. The DATE LETTER SENT field contains the date for both
    the request for information letter and the disposition letter. This trigger populates the DATE REQ INFO SENT field so the date of the request for information letter is retained.
    Set Logic: D LTRDT^FBUCAUD(1)
    Set Cond: S X=$S(X1(1)=X2(1):0,1:1)
    Kill Logic: D LTRDT^FBUCAUD(0)
    Kill Cond: S X=$S(X1(1)=X2(1):0,1:1)
    X(1): DATE LETTER SENT (162.7,19.5) (forwards)
19.6 DATE REQ INFO SENT 6;1 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  FEB 27, 2014
  • HELP-PROMPT:  Enter date a request for additional information letter was sent.
  • DESCRIPTION:  
    This field contains the most recent date a request for additional information letter was sent for the claim. This field is automatically populated by the software.
  • TECHNICAL DESCR:  
    The DATE REQ INFO LETTER field was added by patch FB*3.5*151 and does not reflect actions taken prior to patch installation
    WRITE AUTHORITY: ^
    UNEDITABLE
  • RECORD INDEXES:  AUD (#1210)
20 MASTER CLAIM 0;20 POINTER TO FEE BASIS UNAUTHORIZED CLAIMS FILE (#162.7)
************************REQUIRED FIELD************************
FEE BASIS UNAUTHORIZED CLAIMS(#162.7)

  • INPUT TRANSFORM:  S DIC("S")="S FBZ=^FB583(DA,0) I $P(^FB583(+Y,0),U,4)=$P(FBZ,U,4),'+$P(^FB583(+Y,0),U,11) K FBZ" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAY 21, 1993
  • HELP-PROMPT:  Enter the existing claim which this claim relates to. If there is none, relate it to itself.
  • DESCRIPTION:  
    Enter the claim to which this claim is related. It may be related to itself. Select only those records containing the same veteran which have no disposition.
  • TECHNICAL DESCR:  Automatically set upon entry of claim. If claim submission involves different fee programs for the same episode of care, claims entered after the first for that episode of care will point to the first. The first one
    becomes the 'master'. Used for displaying claims.
  • SCREEN:  S DIC("S")="S FBZ=^FB583(DA,0) I $P(^FB583(+Y,0),U,4)=$P(FBZ,U,4),'+$P(^FB583(+Y,0),U,11) K FBZ"
  • EXPLANATION:  Select only those records containing the same veteran, having no dispostion.
  • CROSS-REFERENCE:  162.7^AMS^MUMPS
    1)= S:X'=DA ^FB583("AMS",X,DA)=""
    2)= K:X'=DA ^FB583("AMS",X,DA)
    Cross-reference secondary claims...those claims which point to another.
  • CROSS-REFERENCE:  162.7^AMP^MUMPS
    1)= S:X=DA ^FB583("AMP",X,DA)=""
    2)= K:X=DA ^FB583("AMP",X,DA)
    Cross reference primary claims...those master claims which point to themselves.
  • CROSS-REFERENCE:  162.7^AMC
    1)= S ^FB583("AMC",$E(X,1,30),DA)=""
    2)= K ^FB583("AMC",$E(X,1,30),DA)
    Cross-reference claims by master number for sorting.
  • CROSS-REFERENCE:  162.7^APMS1^MUMPS
    1)= D MSIX^FBUCDD(X,DA,20,1,"APMS")
    2)= D MSIX^FBUCDD(X,DA,20,2,"APMS")
    This cross-reference sets/kill the 'APMS' cross-reference. It is used to display the relationship between primary/secondary claims. Fields involved are: Patient, Master Claim and Status, having the respective index of
    'APMS', 'APMS1' or 'APMS2'. In order to re-set the 'APMS' index you only need to re-index ONE of these fields.
  • CROSS-REFERENCE:  162.7^AVMS1^MUMPS
    1)= D MSIX^FBUCDD(X,DA,20,1,"AVMS")
    2)= D MSIX^FBUCDD(X,DA,20,2,"AVMS")
    This cross-reference sets/kill the 'AVMS' cross-reference. It is used to display the relationship between primary/secondary claims. Fields involved are: Vendor, Master Claim and Status, having the respective index of
    'AVMS', 'AVMS1' or 'AVMS2'. In order to re-set the 'AVMS' index you only need to re-index ONE of these fields.
  • CROSS-REFERENCE:  162.7^AOMS1^MUMPS
    1)= D MSIX^FBUCDD(X,DA,20,1,"AOMS")
    2)= D MSIX^FBUCDD(X,DA,20,2,"AOMS")
    This cross-reference sets/kill the 'AOMS' cross-reference. It is used to display the relationship between primary/secondary claims. Fields involved are: Submitter, Master Claim and Status, having the respective index of
    'AOMS', 'AOMS1' or 'AOMS2'. In order to re-set the 'AOMS' index you only need to re-index ONE of these fields.
21 REOPEN CLAIM DATE 0;21 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  FEB 27, 2014
  • HELP-PROMPT:  Enter date dispositioned claim reopened (not appealed) for review.
  • DESCRIPTION:  
    Date dispositioned claim reopended for review.
  • TECHNICAL DESCR:  Automatically updated when claim is reopened.
    (Edit template will stuff if action type is REOpen.)
  • RECORD INDEXES:  AUD (#1210)
22 DATE OF ORIGINAL DISPOSITION 0;22 DATE

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)=-DT D ^%DT K %DT S X=Y K:Y<1 X
  • LAST EDITED:  OCT 15, 1993
  • HELP-PROMPT:  Enter date unauthorized claim was originally dispositioned.
  • DESCRIPTION:  
    Date unauthorized claim was originally dispostioned. Used in determining expiration date in the case of appeal status'.
  • TECHNICAL DESCR:  
    Automatically updated when status is determined.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
23 CLAIM SUBMITTED BY 0;23 VARIABLE POINTER
************************REQUIRED FIELD************************
PATIENT(#2)  FEE BASIS VENDOR(#161.2)  NEW PERSON(#200)  

  • INPUT TRANSFORM:  Q:'$G(DA) N FBZZ S FBZZ=23 K:$$INPUT^FBUCDD(DA,X,Y,FBZZ) X K FBZZ
  • LAST EDITED:  SEP 10, 1993
  • HELP-PROMPT:  Identify the submitter of the Unauthorized Claim. If the submitter is a vendor, must be same value as entered in the VENDOR field; if veteran, must be same as VETERAN field.
  • DESCRIPTION:  Identify the submitter of the unauthorized claim. The submitter may differ from the vendor or veteran involved with the claim.
    If the submitter is a vendor, must be same value as entered in the VENDOR field; if veteran, must be same as VETERAN field.
  • TECHNICAL DESCR:  
    The address for correspondence is determined from this field. If there is no entry, the default is the veteran's address.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  162.7^AOS1^MUMPS
    1)= N FBZ S FBZ=$$FBZ^FBUCUTL(DA) S:$P(FBZ,U,24)&(X["VA(200") ^FB583("AOS",+X,$P(FBZ,U,24),DA)="" K FBZ
    2)= N FBZ S FBZ=$$FBZ^FBUCUTL(DA) S:$P(FBZ,U,24)&(X["VA(200") ^FB583("AOS",+X,$P(FBZ,U,24),DA)="" K FBZ
    Cross-reference used to group claims by other party (new persons) and status.
  • CROSS-REFERENCE:  162.7^AOMS^MUMPS
    1)= D:X["VA(200" MSIX^FBUCDD(X,DA,23,1,"AOMS")
    2)= D:X["VA(200" MSIX^FBUCDD(X,DA,23,2,"AOMS")
    This cross-reference sets/kill the 'AOMS' cross-reference. It is used to display the relationship between primary/secondary claims. Fields involved are: Submitter, Master Claim and Status, having the respective index of
    'AOMS', 'AOMS1' or 'AOMS2'. In order to re-set the 'AOMS' index you only need to re-index ONE of these fields.
24 STATUS 0;24 POINTER TO FEE BASIS UNAUTHORIZED CLAIMS STATUS FILE (#162.92)
************************REQUIRED FIELD************************
FEE BASIS UNAUTHORIZED CLAIMS STATUS(#162.92)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),U,2)" D ^DIC K DIC S DIC=DIE,X=+Y S FBZZ=24 K:$$INPUT^FBUCDD(DA,X,Y,FBZZ) X K FBZZ
  • LAST EDITED:  FEB 27, 2014
  • HELP-PROMPT:  Select an active status for this unauthorized claim.
  • DESCRIPTION:  
    Select the appropriate status from FEE BASIS UNAUTHORIZED CLAIMS STATUS file. Status is automatically determined and stuffed, it should not be edited.
  • TECHNICAL DESCR:  Only active status' can be selected. If valid claim received, status should be greater than informal or returned. If claim is dipositioned, status should only be dispositioned. If claim has not been
    dispositioned, status should not be dispositioned.
    Status is automatically determined, based on the status order field in 162.92. When the status or disposition changes, a letter needs to be printed. Once printed, the expiration date is calculated.
    The number of days is derived from the status. This field is automatically updated.
  • SCREEN:  S DIC("S")="I $P(^(0),U,2)"
  • EXPLANATION:  Allow selection of active status.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  162.7^ASD^MUMPS
    1)= S:$P(^FB583(DA,0),U,25) ^FB583("ASD",X,$P(^(0),U,25),DA)=""
    2)= K:$P(^FB583(DA,0),U,25) ^FB583("ASD",X,$P(^(0),U,25),DA)
    Cross reference by status, status date and record number.
  • CROSS-REFERENCE:  162.7^APMS2^MUMPS
    1)= D MSIX^FBUCDD(X,DA,24,1,"APMS")
    2)= D MSIX^FBUCDD(X,DA,24,2,"APMS")
    This cross-reference sets/kill the 'APMS' cross-reference. It is used to display the relationship between primary/secondary claims. Fields involved are: Patient, Master Claim and Status, having the respective index of
    'APMS', 'APMS1' or 'APMS2'. In order to re-set the 'APMS' index you only need to re-index ONE of these fields.
  • CROSS-REFERENCE:  162.7^AES^MUMPS
    1)= N FBZ S FBZ=$$FBZ^FBUCUTL(DA) S:$P(FBZ,U,26) ^FB583("AES",$$ORDER^FBUCUTL(+X),-$P(FBZ,U,26),DA)="" K FBZ
    2)= N FBZ S FBZ=$$FBZ^FBUCUTL(DA) K:$P(FBZ,U,26) ^FB583("AES",$$ORDER^FBUCUTL(+X),-$P(FBZ,U,26),DA) K FBZ
    Cross-reference by status order and inverse expiration date.
  • CROSS-REFERENCE:  162.7^APS1^MUMPS
    1)= N FBZ S FBZ=$$FBZ^FBUCUTL(DA) S:$P(FBZ,U,4) ^FB583("APS",$P(FBZ,U,4),X,DA)="" K FBZ
    2)= N FBZ S FBZ=$$FBZ^FBUCUTL(DA) K:$P(FBZ,U,4) ^FB583("APS",$P(FBZ,U,4),X,DA) K FBZ
    Cross-reference used to group claims by veteran (patient) and status.
  • CROSS-REFERENCE:  162.7^AVS1^MUMPS
    1)= N FBZ S FBZ=$$FBZ^FBUCUTL(DA) S:$P(FBZ,U,3) ^FB583("AVS",$P(FBZ,U,3),X,DA)="" K FBZ
    2)= N FBZ S FBZ=$$FBZ^FBUCUTL(DA) K:$P(FBZ,U,3) ^FB583("AVS",$P(FBZ,U,3),X,DA) K FBZ
    Cross-reference used to group claims by vendor and status.
  • CROSS-REFERENCE:  162.7^AS
    1)= S ^FB583("AS",$E(X,1,30),DA)=""
    2)= K ^FB583("AS",$E(X,1,30),DA)
    Cross-refernece claims by status.
  • CROSS-REFERENCE:  162.7^AOS^MUMPS
    1)= N FBZ S FBZ=$$FBZ^FBUCUTL(DA) S:$P(FBZ,U,23)["VA(200" ^FB583("AOS",+$P(FBZ,U,23),X,DA)="" K FBZ
    2)= N FBZ S FBZ=$$FBZ^FBUCUTL(DA) K:$P(FBZ,U,23)["VA(200" ^FB583("AOS",+$P(FBZ,U,23),X,DA) K FBZ
    Cross-reference used to group claims by other party (new persons) and status.
  • CROSS-REFERENCE:  162.7^AVMS2^MUMPS
    1)= D MSIX^FBUCDD(X,DA,24,1,"AVMS")
    2)= D MSIX^FBUCDD(X,DA,24,2,"AVMS")
    This cross-reference sets/kill the 'AVMS' cross-reference. It is used to display the relationship between primary/secondary claims. Fields involved are: Vendor, Master Claim and Status, having the respective index of
    'AVMS', 'AVMS1' or 'AVMS2'. In order to re-set the 'AVMS' index you only need to re-index ONE of these fields.
  • CROSS-REFERENCE:  162.7^AOMS2^MUMPS
    1)= D MSIX^FBUCDD(X,DA,24,1,"AOMS")
    2)= D MSIX^FBUCDD(X,DA,24,2,"AOMS")
    This cross-reference sets/kill the 'AOMS' cross-reference. It is used to display the relationship between primary/secondary claims. Fields involved are: Submitter, Master Claim and Status, having the respective index of
    'AOMS', 'AOMS1' or 'AOMS2'. In order to re-set the 'AOMS' index you only need to re-index ONE of these fields.
  • RECORD INDEXES:  AUD (#1210)
25 DATE OF CURRENT STATUS 0;25 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)=-DT D ^%DT K %DT S X=Y K:Y<1 X
  • LAST EDITED:  OCT 15, 1993
  • HELP-PROMPT:  Enter the date on which the current status was updated.
  • DESCRIPTION:  
    This field contains the date on which the current status was entered or updated.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  162.7^ASD1^MUMPS
    1)= S:$P(^FB583(DA,0),U,24) ^FB583("ASD",$P(^(0),U,24),X,DA)=""
    2)= K:$P(^FB583(DA,0),U,24) ^FB583("ASD",$P(^(0),U,24),X,DA)
    Cross reference by status, status date and record number.
26 EXPIRATION DATE OF CLAIM 0;26 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUL 06, 1993
  • HELP-PROMPT:  Enter the date, if applicable, by which a response should be received.
  • DESCRIPTION:  The date by which a response should be received before the claim expires. If the expiration date arrives with no response, then the appropriate action may need to be taken (action varies with status of claim). No further
    processing should be allowed. (If awaiting information, claim should be dispositioned to abandoned; if already dispostioned, appeal or BVA appeal can not be entered.) This field is automatically updated.
  • TECHNICAL DESCR:  
    When the status or disposition changes, a letter needs to be printed. Once printed, the expiration date is calculated. The number of days is derived from the status. This field is automatically updated.
  • CROSS-REFERENCE:  162.7^AES1^MUMPS
    1)= N FBZ S FBZ=$$FBZ^FBUCUTL(DA) S:$P(FBZ,U,24) ^FB583("AES",$$ORDER^FBUCUTL(+$P(FBZ,U,24)),-X,DA)="" K FBZ
    2)= N FBZ S FBZ=$$FBZ^FBUCUTL(DA) K:$P(FBZ,U,24) ^FB583("AES",$$ORDER^FBUCUTL(+$P(FBZ,U,24)),-X,DA) K FBZ
    Cross-reference by status order and inverse expiration date.
26.5 EXTENSIONS 3;0 DATE Multiple #162.701 162.701
27 ENTERED/LAST EDITED BY 0;17 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JUL 31, 1993
  • HELP-PROMPT:  Enter the person who entered the claim.
  • DESCRIPTION:  
    The name of the person who entered the claim.
28 DATE ENTERED/LAST EDITED 0;18 DATE

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)=-DT D ^%DT K %DT S X=Y K:Y<1 X
  • LAST EDITED:  OCT 15, 1993
  • HELP-PROMPT:  Enter the date on which the claim was entered.
  • DESCRIPTION:  
    The date on which the unauthorized claim was entered.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
29 DISCHARGE TYPE COMPUTED

  • MUMPS CODE:  S X=$$DISCHTYP^FBUCDD(D0)
  • ALGORITHM:  S X=$$DISCHTYP^FBUCDD(D0)
  • LAST EDITED:  NOV 20, 1995
  • DESCRIPTION:  
    Display DISCHARGE TYPE of related entry in authorization subfile.
  • TECHNICAL DESCR:  
    Fee Basis Patient file (161), Authorization sub-file (161.01), Discharge Type field (.06) is referenced is entry is found in the field's 'AG' cross-reference. The value of the set is displayed.
30 AUTHORIZATION 0;27 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUL 20, 1993
  • HELP-PROMPT:  Enter the authorization to which this unauthorized claim is related.
  • DESCRIPTION:  
    This field is set to the internal entry number of the appropriate authorization in file 161.
31 38 U.S.C. 1725 0;28 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  JUN 21, 2001
  • HELP-PROMPT:  Enter YES if claim is being considered under Millennium Act 38 U.S.C. 1725.
  • DESCRIPTION:  
    If this field has a YES value, the software will treat this claim as an emergency care claim that is being considered under the provisions of the Millennium Act 38 U.S.C. 1725.
32 FPPS CLAIM ID 5;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>32!($L(X)<1)!'(X?1(1"1",1"2",1"3",1"4",1"5",1"6",1"7",1"8",1"9").31N) X
  • LAST EDITED:  JUN 26, 2003
  • HELP-PROMPT:  Enter a non-zero number from 1 to 32 digits long, 0 decimal digits.
  • DESCRIPTION:  
    Enter the entire FPPS Claim ID as shown on the invoice document. (1-32 character text ID created by FPPS system).
  • FIELD INDEX:  AFC (#302) REGULAR IR SORTING ONLY
    Short Descr: Cross-reference on FPPS CLAIM ID.
    Description: This is a regular cross-reference on the FPPS CLAIM ID (1-32 characters long).
    Set Logic: S ^FB583("AFC",$E(X,1,32),DA)=""
    Kill Logic: K ^FB583("AFC",$E(X,1,32),DA)
    Whole Kill: K ^FB583("AFC")
    X(1): FPPS CLAIM ID (162.7,32) (Subscr 1) (Len 32) (forwards)
50 NOTICE OF DISAGREEMENT RECV'D A;1 DATE

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)=-DT D ^%DT K %DT S X=Y K:Y<1 X
  • LAST EDITED:  FEB 27, 2014
  • HELP-PROMPT:  Enter date Notice of Agreement (VAF 21-4138) was received.
  • DESCRIPTION:  
    Date Notice of Agreement (VAF 21-4138) received.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • RECORD INDEXES:  AUD (#1210)
51 STATEMENT OF THE CASE ISSUED A;2 DATE

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)=-DT D ^%DT K %DT S X=Y K:Y<1 X
  • LAST EDITED:  FEB 27, 2014
  • HELP-PROMPT:  Enter date Statement of the Case was issued.
  • DESCRIPTION:  
    Date Statement of the Case was issued.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • RECORD INDEXES:  AUD (#1210)
52 DATE SUBSTANTIVE APPEAL RECV'D A;3 DATE

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)=-DT D ^%DT K %DT S X=Y K:Y<1 X
  • LAST EDITED:  FEB 27, 2014
  • HELP-PROMPT:  Enter date Substantive Appeal (VAF 1-9) was received.
  • DESCRIPTION:  
    Date Substantive Appeal was received.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • RECORD INDEXES:  AUD (#1210)
53 DATE APPEAL DISPOSITIONED A;4 DATE

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)=-DT D ^%DT K %DT S X=Y K:Y<1 X
  • LAST EDITED:  FEB 27, 2014
  • HELP-PROMPT:  Enter date BVA decided appeal.
  • DESCRIPTION:  
    Date appeal decision rendered by Board of Veterans Appeal (BVA).
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • RECORD INDEXES:  AUD (#1210)
54 DATE APPEALED TO COVA A;5 DATE

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)=-DT D ^%DT K %DT S X=Y K:Y<1 X
  • LAST EDITED:  FEB 27, 2014
  • HELP-PROMPT:  Enter date BVA decision was appealed to Court of Veteran Affairs (COVA).
  • DESCRIPTION:  
    Date Board of Veterans Appeal decision was appealed to Court of Veteran Affairs (COVA). A timely appeal must be within 120 days of the BVA decision.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • RECORD INDEXES:  AUD (#1210)
55 DATE COVA APPEAL DISPOSITIONED A;6 DATE

  • INPUT TRANSFORM:  S %DT="EX",%DT(0)=-DT D ^%DT K %DT S X=Y K:Y<1 X
  • LAST EDITED:  FEB 27, 2014
  • HELP-PROMPT:  Enter date a dispositon to a COVA appeal made.
  • DESCRIPTION:  
    Date a decision to a COVA appeal rendered.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • RECORD INDEXES:  AUD (#1210)
292 USER AUDIT LOG1;0 DATE Multiple #162.792 162.792

  • DESCRIPTION:  
    The user audit tracks users that enter or edit the unauthorized claim.
  • TECHNICAL DESCR:  The USER AUDIT multiple was added by patch FB*3.5*154 and does not reflect actions taken prior to patch installation with one exception. During the install the patch attempts to create one entry in the multiple for each
    pre-existing claim using data from the DATE ENTERED/LAST EDITED (#28) and ENTERED/LAST EDITED BY (#27) fields.
  • INDEXED BY:  EDITED BY (AU)
293 DATA AUDIT LOG2;0 DATE Multiple #162.793 162.793

  • DESCRIPTION:  
    The data audit multiple stores historical information for selected fields.
  • TECHNICAL DESCR:  
    The AUD index tracks changes to selected fields and populates the DATA AUDIT multiple. The multiple was added by patch FB*3.5*151 and does not reflect actions taken prior to patch installation.
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