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Global: ^FBAAI

Package: Fee Basis

Global: ^FBAAI


Information

FileMan FileNo FileMan Filename Package
162.5 FEE BASIS INVOICE Fee Basis

Description

Accessed By FileMan Db Calls, Total: 31

Package Total Routines
Fee Basis 30 FBAAIARC    FBAASCB0    FBAAV5    FBAAVR0    FBAAVR5    FBCHDI    FBCHDI2    FBCHDIN
FBCHEAP    FBCHEP    FBCHEP1    FBCHFA    FBCHFED    FBCHFR    FBCHRR    FBCHVP
FBFHLD9    FBMRASV1    FBNHEDPA    FBNHEP1    FBPAID    FBPAID3    FBPHON2    FBSVBR
FBSVPR    FBUCLET2    FBUCUTL    FBUTL136    FBUTL8    FBXIP19    
Clinical Case Registries 1 RORHL21    

Pointed To By FileMan Files, Total: 1

Package Total FileMan Files
Integrated Billing 1 IB-FB INTERFACE TRACKING(#360)[1.03]    

Pointer To FileMan Files, Total: 24

Package Total FileMan Files
Fee Basis 17 ADJUSTMENT REASON(#161.91)[#162.558(.01)]    ADJUSTMENT GROUP(#161.92)[#162.558(1)]    REMITTANCE REMARK(#161.93)[#162.559(.01)]    PRESENT ON ADMISSION(#161.94)[30.02, 31.02, 32.02, 33.02, 34.02, 35.02, 35.12, 35.22, 35.32, 35.42, 35.52, 35.62, 35.72, 35.82, 35.92, 36.02, 36.12, 36.22, 36.32, 36.42, 36.52, 36.62, 36.72, 36.82, 36.92]    FEE BASIS CHECK CANCELLATION REASON(#162.95)[50]    FEE BASIS UNAUTHORIZED CLAIMS(#162.7)[4]    VA FORM 10-7078(#162.4)[4]    FEE BASIS SUSPENSION(#161.27)[10]    FEE BASIS CONTRACT(#161.43)[60]    FEE BASIS BATCH(#161.7)[15, 20]    FEE BASIS PROGRAM(#161.8)[11]    FEE BASIS PURPOSE OF VISIT(#161.82)[21]    IPAC VENDOR AGREEMENT FILE(#161.95)[87]    FEE BASIS DISPOSITION CODE(#162.6)[6.5]    FEE BASIS PAYMENT METHODOLOGY(#163.98)[90]    FEE BASIS PATIENT(#161)[3]    FEE BASIS VENDOR(#161.2)[2]    
DRG Grouper 3 DRG(#80.2)[24]    ICD OPERATION/PROCEDURE(#80.1)[40, 41, 42, 43, 44, 44.06, 44.07, 44.08, 44.09, 44.1, 44.11, 44.12, 44.13, 44.14, 44.15, 44.16, 44.17, 44.18, 44.19, 44.2, 44.21, 44.22, 44.23, 44.24, 44.25]    ICD DIAGNOSIS(#80)[30, 31, 32, 33, 34, 35, 35.1, 35.2, 35.3, 35.4, 35.5, 35.6, 35.7, 35.8, 35.9, 36, 36.1, 36.2, 36.3, 36.4, 36.5, 36.6, 36.7, 36.8, 36.9, 39]    
Kernel 3 INSTITUTION(#4)[23]    STATE(#5)[82]    NEW PERSON(#200)[17]    
Integrated Billing 1 IB ATTACHMENT REPORT TYPE(#353.3)[#162.591(.02)]    

Fields, Total: 153

Field # Name Loc Type Details
.01 NUMBER 0;1 NUMBER
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:+X'=X!(X>99999999)!(X<1)!(X?.E1"."1N.N)!('$$CHKBI^FBAAUTL4(X)) X S:$D(X) DINUM=X
  • LAST EDITED:  JUL 22, 1994
  • HELP-PROMPT:  Type a Number between 1 and 99999999, 0 Decimal Digits
  • DESCRIPTION:  
    This field contains the internal entry number for the Fee Basis Invoice.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  162.5^B
    1)= S ^FBAAI("B",$E(X,1,30),DA)=""
    2)= K ^FBAAI("B",$E(X,1,30),DA)
1 INVOICE DATE RECEIVED 0;2 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="ETX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JAN 31, 2000
  • DESCRIPTION:  
    This field contains the date the correct invoice was received. It is used by Austin for the calculation of any applicable interest payments.
  • RECORD INDEXES:  AI (#75)
2 VENDOR 0;3 POINTER TO FEE BASIS VENDOR FILE (#161.2)
************************REQUIRED FIELD************************
FEE BASIS VENDOR(#161.2)

  • LAST EDITED:  JAN 31, 2000
  • DESCRIPTION:  
    Reference to the vendor file, this field contains the name of the vendor associated with this invoice.
  • CROSS-REFERENCE:  162.5^C
    1)= S ^FBAAI("C",$E(X,1,30),DA)=""
    2)= K ^FBAAI("C",$E(X,1,30),DA)
  • CROSS-REFERENCE:  162.5^AF^MUMPS
    1)= S ^FBAAI("AF",$E(X,1,30),9999999.9999-$P(^FBAAI(DA,0),U,2),DA)=""
    2)= K ^FBAAI("AF",$E(X,1,30),9999999.9999-$P(^FBAAI(DA,0),U,2),DA)
  • CROSS-REFERENCE:  162.5^AK1^MUMPS
    1)= S:$P(^FBAAI(DA,0),U,4) ^FBAAI("AK",$P(^(0),U,4),$E(X,1,30),DA)=""
    2)= K:$P(^FBAAI(DA,0),U,4) ^FBAAI("AK",$P(^(0),U,4),$E(X,1,30),DA)
    Update cross-reference on veteran field, which includes vendor. Used for displaying payment data by veteran.
  • RECORD INDEXES:  AA (#73), AI (#75)
3 VETERAN 0;4 POINTER TO FEE BASIS PATIENT FILE (#161)
************************REQUIRED FIELD************************
FEE BASIS PATIENT(#161)

  • LAST EDITED:  JAN 31, 2000
  • DESCRIPTION:  
    Reference the Fee Basis Patient file, this field contains the name of the veteran for which this invoice is established.
  • CROSS-REFERENCE:  162.5^D
    1)= S ^FBAAI("D",$E(X,1,30),DA)=""
    2)= K ^FBAAI("D",$E(X,1,30),DA)
  • CROSS-REFERENCE:  162.5^AG^MUMPS
    1)= S ^FBAAI("AG",$E(X,1,30),9999999.9999-$P(^FBAAI(DA,0),U,2),DA)=""
    2)= K ^FBAAI("AG",$E(X,1,30),9999999.9999-$P(^FBAAI(DA,0),U,2),DA)
  • CROSS-REFERENCE:  162.5^AK^MUMPS
    1)= S:$P(^FBAAI(DA,0),U,3) ^FBAAI("AK",$E(X,1,30),$P(^FBAAI(DA,0),U,3),DA)=""
    2)= K:$P(^FBAAI(DA,0),U,3) ^FBAAI("AK",$E(X,1,30),$P(^(0),U,3),DA)
    Cross-reference on veteran field to include vendor.
  • RECORD INDEXES:  AA (#73), AE (#74), AI (#75)
4 ASSOCIATED 7078/583 0;5 VARIABLE POINTER VA FORM 10-7078(#162.4)  FEE BASIS UNAUTHORIZED CLAIMS(#162.7)  

  • LAST EDITED:  OCT 11, 1990
  • DESCRIPTION:  
    This field contains the pointer to the appropriate 7078 or 583 file.
  • CROSS-REFERENCE:  162.5^AJ^MUMPS
    1)= S ^FBAAI("E",$E(X,1,30),DA)=""
    2)= K ^FBAAI("E",$E(X,1,30),DA)
5 TREATMENT FROM DATE 0;6 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="ETX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JAN 31, 2000
  • DESCRIPTION:  
    Information in this field indicates the starting date for this invoice. (i.e. the starting treatment date for which this billing covers).
  • RECORD INDEXES:  AA (#73)
6 TREATMENT TO DATE 0;7 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="ETX" D ^%DT S X=Y K:Y<1 X I $D(X),$P(^FBAAI(DA,0),U,6)>X K X W !,*7,"To Date cannot be before From date!",!
  • LAST EDITED:  JAN 29, 1991
  • DESCRIPTION:  
    Information in this field indicates the ending date for this invoice. (i.e. the ending treatment date this billing covers).
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
6.5 DISCHARGE TYPE CODE 0;21 POINTER TO FEE BASIS DISPOSITION CODE FILE (#162.6) FEE BASIS DISPOSITION CODE(#162.6)

  • LAST EDITED:  APR 16, 1990
  • DESCRIPTION:  
    This field contains the code pertaining to the type of discharge associated with this invoice.
6.6 BILLED CHARGES 0;22 NUMBER
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<.01) X
  • LAST EDITED:  NOV 17, 2008
  • HELP-PROMPT:  Type a Dollar Amount between .01 and 9999999.99, 2 Decimal Digits
  • DESCRIPTION:  
    This field contains cost information on the amount the VA was initially billed by the vendor for an inpatient stay.
6.7 PAYMENT BY MEDICARE/FED AGENCY 0;23 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  I $D(X) D YN^FBAAUTL3
  • OUTPUT TRANSFORM:  D OUTYN^FBAAUTL3
  • LAST EDITED:  MAR 18, 1994
  • HELP-PROMPT:  Answer 'Yes' or '1' for YES and 'No' or '0' for NO.
  • DESCRIPTION:  
    Answer 'Yes' if Medicare or some other federal agency has paid some of the bill for contract hospital.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
7 AMOUNT CLAIMED 0;8 NUMBER
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<.01) X I $D(X),$P(^FBAAI(DA,0),U,12)=6,$P(^(0),U,22)
  • LAST EDITED:  DEC 02, 2008
  • HELP-PROMPT:  Type a Dollar Amount between .01 and 9999999.99, 2 Decimal Digits
  • DESCRIPTION:  
    The portion of the billed charges that the vendor is requesting payment for from the VA. Usually the billed charges and the amount claimed will be the same.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
8 AMOUNT PAID 0;9 NUMBER
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<0) X I $D(X),$P(^FBAAI(DA,0),U,12)'=6,$P(^FBAAI(DA,0),U,8)
  • LAST EDITED:  DEC 02, 2008
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999.99, 2 Decimal Digits
  • DESCRIPTION:  
    The dollar amount that was actually paid to the vendor for the service provided.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
9 AMOUNT SUSPENDED 0;10 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<0) X
  • LAST EDITED:  NOV 17, 2008
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999.99, 2 Decimal Digits
  • DESCRIPTION:  
    The difference between the amount claimed and the amount paid.
10 SUSPEND CODE 0;11 POINTER TO FEE BASIS SUSPENSION FILE (#161.27) FEE BASIS SUSPENSION(#161.27)

  • LAST EDITED:  JAN 31, 2000
  • DESCRIPTION:  
    If an amount was suspended, the user is requested to indicate the reason for suspense from the selection of suspense codes.
  • RECORD INDEXES:  AI (#75)
11 FEE PROGRAM 0;12 POINTER TO FEE BASIS PROGRAM FILE (#161.8)
************************REQUIRED FIELD************************
FEE BASIS PROGRAM(#161.8)

  • DESCRIPTION:  
    This field contains the valid Fee Program associated with this Invoice as contained in the Fee Basis Program file (i.e. Contract Hospital or Community Nursing Home for an inpatient stay).
12 PAYMENT TYPE CODE 0;13 SET
  • 'R' FOR REIMBURSEMENT;
  • 'V' FOR VENDOR;
  • 'S' FOR STATISTICAL;
  • 'SR' FOR STAT-REIMBURSEMENT;

  • DESCRIPTION:  An entry of 'R' will indicate the invoice is for a reimbursement to the veteran for services that he/she has already paid. An entry of 'V' will indicate the invoice is for a payment directly to a vendor. An entry of 'S'
    will indicate the invoice was paid "out of system" to a vendor and allows the update of the payment history files. An entry of 'SR' will indicate a statistical reimbursement to a party other than the vendor.
13 REJECT STATUS FBREJ;1 SET
  • 'P' FOR REJECTED, PENDING ACTION;
  • 'C' FOR REJECTED, COMPLETED;

  • DESCRIPTION:  An entry in this field will indicate that the invoice has been rejected. An entry of 'P' will indicate the invoice has been rejected and it is awaiting action. An entry of 'C' will indicate the invoice has been rejected
    and action on it has been completed.
14 REJECT REASON FBREJ;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>40!($L(X)<2) X
  • HELP-PROMPT:  Answer must be 2-40 characters in length.
  • DESCRIPTION:  
    If the invoice has a status of rejected, the user will be prompted to enter a reason that the reject has occurred.
15 OLD BATCH NUMBER FBREJ;3 POINTER TO FEE BASIS BATCH FILE (#161.7) FEE BASIS BATCH(#161.7)

  • LAST EDITED:  JAN 31, 1989
  • DESCRIPTION:  
    This field is populated only if there is a reject pending. It will contain the batch number of the old batch associated with the invoice. This is to provide a link back to that batch if the user deletes the reject.
  • CROSS-REFERENCE:  162.5^AH^MUMPS
    1)= S ^FBAAI("AH",$E(X,1,30),DA)=""
    2)= K ^FBAAI("AH",$E(X,1,30),DA)
15.3 INTERFACE REJECT FBREJ;4 SET
  • '1' FOR YES;

  • LAST EDITED:  DEC 12, 2011
  • HELP-PROMPT:  Enter YES if the line item was rejected by Central Fee.
  • DESCRIPTION:  This field is populated by the FBAA BATCH SERVER and FBAA REJECT SERVER server options when a payment line item is rejected via the interface with Central Fee. This field is used to distinguish line items that were
    locally rejected from those that were rejected by a downstream system. This field is not populated for a local reject.
15.6 REJECT CODE FBREJC;0 Multiple #162.515 162.515

  • DESCRIPTION:  The REJECT CODE multiple is populated with one to four reject codes by the FBAA BATCH SERVER and FBAA REJECT SERVER server options when a line item is rejected via the interface with Central Fee. The REJECT CODE multiple
    is not used for local rejects. The reason for a local reject is entered into the REJECT REASON (#14) field.
16 VOID PAYMENT 0;14 SET
  • 'VP' FOR VOIDED PAYMENT;

  • DESCRIPTION:  
    Entry into this field is made when the user indicates the payment must be voided.
16.5 REASON FOR VOIDED PAYMENT R;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>75!($L(X)<3) X
  • LAST EDITED:  MAR 04, 1993
  • HELP-PROMPT:  Answer must be 3-75 characters in length.
  • DESCRIPTION:  
    This field is only populated if the Void Payment field is flagged for a void. The user is prompted to enter a reason the payment was voided.
17 SUPERVISOR WHO VOIDED 0;15 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  APR 05, 1990
  • DESCRIPTION:  
    This field is only populated when the Void Payment field is flagged for a void. The field is stuffed with the user who voided the payment (and in all instances, the user must be a supervisor).
18 DESCRIPTION OF SUSPENSION 1;0 WORD-PROCESSING #162.518

  • DESCRIPTION:  
    This field is only populated when there is a dollar amount that has been suspended. The user is prompted to enter a description of the suspension in word-processing format.
  • LAST EDITED:  JAN 17, 1991
19 DATE FINALIZED 0;16 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 11, 1990
  • DESCRIPTION:  
    This field contains the date the invoice was vouchered by Fiscal.
  • CROSS-REFERENCE:  162.5^AP^MUMPS
    1)= S:$P(^FBAAI(DA,0),U,20)]"" ^FBAAI("AP",$P(^FBAAI(DA,0),U,20),9999999-$E(X,1,30),DA)=""
    2)= K:$P(^FBAAI(DA,0),U,20)]"" ^FBAAI("AP",$P(^FBAAI(DA,0),U,20),9999999-$E(X,1,30),DA)
  • CROSS-REFERENCE:  162.5^AD
    1)= S ^FBAAI("AD",$E(X,1,30),DA)=""
    2)= K ^FBAAI("AD",$E(X,1,30),DA)
20 BATCH NUMBER 0;17 POINTER TO FEE BASIS BATCH FILE (#161.7) FEE BASIS BATCH(#161.7)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),U,3)=""B9""&($P(^(0),U,5)=DUZ)&($P(^(""ST""),U,1)=""O"")" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JAN 31, 2000
  • DESCRIPTION:  
    This field contains the batch number associated with this invoice. (The batch number that the invoice resides in).
  • SCREEN:  S DIC("S")="I $P(^(0),U,3)=""B9""&($P(^(0),U,5)=DUZ)&($P(^(""ST""),U,1)=""O"")"
  • EXPLANATION:  ONLY BATCHES WITH A STATUS OF 'OPEN'
  • CROSS-REFERENCE:  162.5^AC^MUMPS
    1)= S ^FBAAI("AC",$E(X,1,30),DA)=""
    2)= K ^FBAAI("AC",$E(X,1,30),DA)
  • RECORD INDEXES:  AE (#74)
21 PURPOSE OF VISIT 0;18 POINTER TO FEE BASIS PURPOSE OF VISIT FILE (#161.82) FEE BASIS PURPOSE OF VISIT(#161.82)

  • INPUT TRANSFORM:  S DIC("S")="I $S('$G(^(""I"")):1,DT'>^(""I""):1,1:0)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  FEB 05, 1993
  • DESCRIPTION:  
    Contains the valid Purpose of Visit code as defined in the Fee Basis Purpose of Visit file.
  • SCREEN:  S DIC("S")="I $S('$G(^(""I"")):1,DT'>^(""I""):1,1:0)"
  • EXPLANATION:  An inactive Purpose of Visit Code may not be selected.
22 PATIENT TYPE CODE 0;19 SET
  • '00' FOR SURGICAL;
  • '10' FOR MEDICAL;
  • '60' FOR HOME NURSING SERVICE;
  • '85' FOR PSYCHIATRIC-CONTRACT;
  • '86' FOR PSYCHIATRIC;
  • '95' FOR NEUROLOGICAL-CONTRACT;
  • '96' FOR NEUROLOGICAL;

  • LAST EDITED:  APR 25, 1989
  • DESCRIPTION:  
    This field requires the entry of the type of treatment being provided to the patient (i.e. Surgical, Medical, Home Nursing Service, etc.)
23 PRIMARY SERVICE FACILITY 0;20 POINTER TO INSTITUTION FILE (#4) INSTITUTION(#4)

  • LAST EDITED:  JUN 04, 1990
  • DESCRIPTION:  
    The VA Hospital responsible for that Veterans care.
24 DISCHARGE DRG 0;24 POINTER TO DRG FILE (#80.2) DRG(#80.2)

  • LAST EDITED:  JAN 11, 1993
  • DESCRIPTION:  
    This field should contain the discharge DRG that is returned from the Austin Pricer System.
  • TECHNICAL DESCR:  
    This field is a pointer to the DRG file, however it is the grouped DRG as calculated by the Austin Pricer system.
24.5 DRG WEIGHT 2;12 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999.9999)!(X<0)!(X?.E1"."5N.N) X
  • LAST EDITED:  SEP 22, 2003
  • HELP-PROMPT:  Type a Number between 0 and 999.9999, 4 Decimal Digits
  • DESCRIPTION:  
    Enter the DRG weight as reported by the Austin Pricer.
25 RESUBMISSION 0;25 SET
  • '1' FOR YES;

  • LAST EDITED:  MAR 04, 1993
  • DESCRIPTION:  
    Entry into this field indicates that this invoice is a resubmission. Failure to annotate an invoice in such a manner would cause Austin to reject the payment as duplicate.
26 NVH PRICER AMOUNT 0;26 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<.01) X
  • LAST EDITED:  NOV 17, 2008
  • HELP-PROMPT:  Type a Dollar Amount between .01 and 9999999.99, 2 Decimal Digits
  • DESCRIPTION:  
    The amount for this payment as determined by the Austin Pricer.
30 ICD1 DX;1 POINTER TO ICD DIAGNOSIS FILE (#80)
************************REQUIRED FIELD************************
ICD DIAGNOSIS(#80)

  • LAST EDITED:  MAY 29, 1990
  • DESCRIPTION:  
    The first valid ICD code associated with this payment.
30.02 POA1 POA;1 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD1 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD1 field.
31 ICD2 DX;2 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • DESCRIPTION:  
    The second valid ICD code (if one exists) associated with this payment.
31.02 POA2 POA;2 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD2 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD2 field.
32 ICD3 DX;3 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • DESCRIPTION:  
    The third valid ICD code (if one exists) associated with this payment.
32.02 POA3 POA;3 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD3 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD3 field.
33 ICD4 DX;4 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • DESCRIPTION:  
    The fourth valid ICD code (if one exists) associated with this payment.
33.02 POA4 POA;4 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD4 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD4 field.
34 ICD5 DX;5 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • DESCRIPTION:  
    The fifth valid ICD code (if one exists) associated with this payment.
34.02 POA5 POA;5 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD5 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD5 field.
35 ICD6 DX;6 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The sixth valid ICD code (if one exists) associated with this payment.
35.02 POA6 POA;6 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD6 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD6 field.
35.1 ICD7 DX;7 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The seventh valid ICD code (if one exists) associated with this payment.
35.12 POA7 POA;7 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD7 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD7 field.
35.2 ICD8 DX;8 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The eighth valid ICD code (if one exists) associated with this payment.
35.22 POA8 POA;8 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD8 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD8 field.
35.3 ICD9 DX;9 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The ninth valid ICD code (if one exists) associated with this payment.
35.32 POA9 POA;9 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD9 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD9 field.
35.4 ICD10 DX;10 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The tenth valid ICD code (if one exists) associated with this payment.
35.42 POA10 POA;10 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD10 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD10 field.
35.5 ICD11 DX;11 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The eleventh valid ICD code (if one exists) associated with this payment.
35.52 POA11 POA;11 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD11 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD11 field.
35.6 ICD12 DX;12 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The twelfth valid ICD code (if one exists) associated with this payment.
35.62 POA12 POA;12 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD12 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD12 field.
35.7 ICD13 DX;13 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The thirteenth valid ICD code (if one exists) associated with this payment.
35.72 POA13 POA;13 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD13 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD13 field.
35.8 ICD14 DX;14 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The fourteenth valid ICD code (if one exists) associated with this payment.
35.82 POA14 POA;14 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD14 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD14 field.
35.9 ICD15 DX;15 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The fifteenth valid ICD code (if one exists) associated with this payment.
35.92 POA15 POA;15 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD15 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD15 field.
36 ICD16 DX;16 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The sixteenth valid ICD code (if one exists) associated with this payment.
36.02 POA16 POA;16 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD16 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD16 field.
36.1 ICD17 DX;17 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The seventeenth valid ICD code (if one exists) associated with this payment.
36.12 POA17 POA;17 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD17 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD17 field.
36.2 ICD18 DX;18 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The eighteenth valid ICD code (if one exists) associated with this payment.
36.22 POA18 POA;18 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD18 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD18 field.
36.3 ICD19 DX;19 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The nineteenth valid ICD code (if one exists) associated with this payment.
36.32 POA19 POA;19 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD19 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD19 field.
36.4 ICD20 DX;20 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The twentieth valid ICD code (if one exists) associated with this payment.
36.42 POA20 POA;20 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD20 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD20 field.
36.5 ICD21 DX;21 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The twenty-first valid ICD code (if one exists) associated with this payment.
36.52 POA21 POA;21 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD21 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD21 field.
36.6 ICD22 DX;22 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The twenty-second valid ICD code (if one exists) associated with this payment.
36.62 POA22 POA;22 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD22 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD22 field.
36.7 ICD23 DX;23 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The twenty-third valid ICD code (if one exists) associated with this payment.
36.72 POA23 POA;23 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD23 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD23 field.
36.8 ICD24 DX;24 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The twenty-fourth valid ICD code (if one exists) associated with this payment.
36.82 POA24 POA;24 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD24 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD24 field.
36.9 ICD25 DX;25 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • DESCRIPTION:  
    The twenty-fifth valid ICD code (if one exists) associated with this payment.
36.92 POA25 POA;25 POINTER TO PRESENT ON ADMISSION FILE (#161.94) PRESENT ON ADMISSION(#161.94)

  • LAST EDITED:  NOV 20, 2008
  • HELP-PROMPT:  Enter the present on admission indicator for the ICD25 diagnosis.
  • DESCRIPTION:  
    This field contains the present on admission (POA) indicator for the diagnosis in the ICD25 field.
39 ADMITTING DIAGNOSIS 5;9 POINTER TO ICD DIAGNOSIS FILE (#80)
************************REQUIRED FIELD************************
ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 19, 2008
  • HELP-PROMPT:  Enter the admitting diagnosis for this claim.
  • DESCRIPTION:  
    This is the admitting diagnosis code from the claim.
40 PROC1 PROC;1 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • DESCRIPTION:  
    The first valid procedure code (if one exists) associated with this payment.
41 PROC2 PROC;2 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • DESCRIPTION:  
    The second valid procedure code (if one exists) associated with this payment.
42 PROC3 PROC;3 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • DESCRIPTION:  
    The third valid procedure code (if one exists) associated with this payment.
43 PROC4 PROC;4 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • DESCRIPTION:  
    The fourth valid procedure code (if one exists) associated with this payment.
44 PROC5 PROC;5 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • DESCRIPTION:  
    The fifth valid procedure code (if one exists) associated with this payment.
44.06 PROC6 PROC;6 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The sixth valid procedure code (if one exists) associated with this payment.
44.07 PROC7 PROC;7 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The seventh valid procedure code (if one exists) associated with this payment.
44.08 PROC8 PROC;8 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The eighth valid procedure code (if one exists) associated with this payment.
44.09 PROC9 PROC;9 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The ninth valid procedure code (if one exists) associated with this payment.
44.1 PROC10 PROC;10 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The tenth valid procedure code (if one exists) associated with this payment.
44.11 PROC11 PROC;11 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The eleventh valid procedure code (if one exists) associated with this payment.
44.12 PROC12 PROC;12 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The twelfth valid procedure code (if one exists) associated with this payment.
44.13 PROC13 PROC;13 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The thirteenth valid procedure code (if one exists) associated with this payment.
44.14 PROC14 PROC;14 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The fourteenth valid procedure code (if one exists) associated with this payment.
44.15 PROC15 PROC;15 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The fifteenth valid procedure code (if one exists) associated with this payment.
44.16 PROC16 PROC;16 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The sixteenth valid procedure code (if one exists) associated with this payment.
44.17 PROC17 PROC;17 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The seventeenth valid procedure code (if one exists) associated with this payment.
44.18 PROC18 PROC;18 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The eighteenth valid procedure code (if one exists) associated with this payment.
44.19 PROC19 PROC;19 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The nineteenth valid procedure code (if one exists) associated with this payment.
44.2 PROC20 PROC;20 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The twentieth valid procedure code (if one exists) associated with this payment.
44.21 PROC21 PROC;21 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The twenty-first valid procedure code (if one exists) associated with this payment.
44.22 PROC22 PROC;22 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The twenty-second valid procedure code (if one exists) associated with this payment.
44.23 PROC23 PROC;23 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The twenty-third valid procedure code (if one exists) associated with this payment.
44.24 PROC24 PROC;24 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The twenty-fourth valid procedure code (if one exists) associated with this payment.
44.25 PROC25 PROC;25 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1) ICD OPERATION/PROCEDURE(#80.1)

  • LAST EDITED:  NOV 20, 2008
  • DESCRIPTION:  
    The twenty-fifth valid procedure code (if one exists) associated with this payment.
45 DATE PAID 2;1 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  MAR 15, 1994
  • HELP-PROMPT:  This is the date of the check, as issued by the treasury.
  • DESCRIPTION:  This is the date of the check, as issued by the treasury. This information will be passed back to DHCP from the Financial Management System (FMS) when the check is issued to the vendor. This field will use the check date
    beginning with version 3.5 of Fee Basis.
46 VENDOR INVOICE DATE 2;2 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:Y<1 X I X>$P(^FBAAI(DA,0),U,2) W !,*7,"Vendor Invoice Date cannot be later than the Date Correct Invoice Received" K X
  • LAST EDITED:  APR 15, 1994
  • HELP-PROMPT:  Enter the date the vendor issued the invoice.
  • DESCRIPTION:  
    This is the date that the vendor issued the invoice.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
47 PROMPT PAY TYPE 2;3 SET
  • '1' FOR MONEY MANAGED;

  • LAST EDITED:  MAR 18, 1994
  • HELP-PROMPT:  Set equal to 1 if payment is subject to interest payments.
  • DESCRIPTION:  
    Field is set to 1 if the payment is subject to interest payments (prompt pay).
48 CHECK NUMBER 2;4 FREE TEXT

  • INPUT TRANSFORM:  K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>8!($L(X)<1)!'(X?.AN) X
  • LAST EDITED:  APR 25, 1994
  • HELP-PROMPT:  Answer must be 1-8 characters in length.
  • DESCRIPTION:  
    Contains the check number as issued by the treasury. This field is updated after the check is issued, through a server option that records actual payment information for each Fee payment made.
  • CROSS-REFERENCE:  162.5^ACK^MUMPS
    1)= S ^FBAAI("ACK",$E(X,1,30),DA)=""
    2)= K ^FBAAI("ACK",X,DA)
    This cross-reference is used to find payment line items for specific check numbers.
49 CANCELLATION DATE 2;5 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  MAR 15, 1994
  • HELP-PROMPT:  The date the check was cancelled by the treasury.
  • DESCRIPTION:  
    This is the date the treasury cancelled the check. This field is updated through a server option that records cancellations of previously recorded payment data.
50 REASON CODE 2;6 POINTER TO FEE BASIS CHECK CANCELLATION REASON FILE (#162.95) FEE BASIS CHECK CANCELLATION REASON(#162.95)

  • LAST EDITED:  MAR 15, 1994
  • HELP-PROMPT:  Enter the reason the check was cancelled.
  • DESCRIPTION:  
    This field contains a pointer to the Fee Basis Check Cancellation Reason file. It is populated through a server option that updates the payment record when the treasury cancels a check that was previously payed.
51 CANCELLATION ACTIVITY 2;7 SET
  • 'R' FOR WILL BE REPLACED;
  • 'C' FOR WILL BE REISSUED;
  • 'X' FOR WILL NOT BE REISSUED;

  • LAST EDITED:  APR 26, 1994
  • HELP-PROMPT:  Field will contain cancellation code if there has been cancellation activity on this payment.
  • DESCRIPTION:  This field is populated when a cancellation is recorded for the payment referenced. This field will always remain populated, to indicate that there was cancellation activity on this payment at one time. New payments will
    replace the cancellation date and reason code fields, but the cancellation activity flag will not be overwritten. This flag will allow the user to know that previous cancellation activity existed, and to review the
    cancellation history output for further information.
52 DISBURSED AMOUNT 2;8 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<0) X
  • LAST EDITED:  NOV 19, 2008
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999.99, 2 Decimal Digits
  • DESCRIPTION:  
    This is the dollar amount paid by the treasury, less any interest paid.
53 INTEREST AMOUNT 2;9 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
  • LAST EDITED:  APR 21, 1994
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
  • DESCRIPTION:  
    The interest amount paid on this line item by the treasury.
54 COVERED DAYS 2;10 NUMBER
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:+X'=X!(X>99999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUL 07, 2003
  • HELP-PROMPT:  Type a Number between 0 and 99999, 0 Decimal Digits
  • DESCRIPTION:  
    This is the number of total number of Inpatient days that the Fee Staff has determined will be paid. Enter number of inpatient days to be paid.
55 PATIENT CONTROL NUMBER 2;11 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  JUN 17, 2003
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    Please enter the Patient control number. This could be either the Patient Identification Number or Patient Account Number from the vendor's invoice.
56 FPPS CLAIM ID 3;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>32!($L(X)<1)!'(X?1.32N) X
  • LAST EDITED:  JUN 18, 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 (#301) REGULAR IR SORTING ONLY
    Short Descr: Cross-reference on FPPS CLAIM ID.
    Description: Regular cross-reference on the FPPS CLAIM ID.
    Set Logic: S ^FBAAI("AFC",$E(X,1,32),DA)=""
    Kill Logic: K ^FBAAI("AFC",$E(X,1,32),DA)
    Whole Kill: K ^FBAAI("AFC")
    X(1): FPPS CLAIM ID (162.5,56) (Subscr 1) (Len 32) (forwards)
57 FPPS LINE ITEM 3;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>40!($L(X)<1) X
  • LAST EDITED:  JUN 17, 2003
  • HELP-PROMPT:  This response must be a number or a list or range or ALL, e.g., 1,3,5 or 2-4,8.
  • DESCRIPTION:  Enter the line item sequence number associated with this charge. Each charge on the FPPS invoice document will have a line item sequence number associated with it. A line item can be entered individually or a group of
    charges from multiple lines can be entered. If all line items in a group are in numerical sequence, you may enter the first line item sequence number followed by a hyphen and the last line item sequence number. If the
    grouped charges are not in sequential order, each line item must be entered individually, followed by a comma.
58 ADJUSTMENT 8;0 POINTER Multiple #162.558 162.558
59 REMITTANCE REMARK 9;0 POINTER Multiple #162.559 162.559
60 CONTRACT 5;8 POINTER TO FEE BASIS CONTRACT FILE (#161.43) FEE BASIS CONTRACT(#161.43)

  • LAST EDITED:  JUL 09, 2009
  • HELP-PROMPT:  If applicable, select the contract.
  • DESCRIPTION:  
    If the payment is for contracted services, the contract number can be specified in this field. The selected contract must be active and applicable to the vendor being paid.
  • TECHNICAL DESCR:  
    In some cases this field will be automatically populated by the software based on the associated authorization. In other cases, the user will be prompted for a value.
  • CROSS-REFERENCE:  162.5^ACN
    1)= S ^FBAAI("ACN",$E(X,1,30),DA)=""
    2)= K ^FBAAI("ACN",$E(X,1,30),DA)
    This is an index of contracts entered for invoices. The index will be used to prevent deletion of entries from the FEE BASIS CONTRACT file that are referenced (pointed to) by an invoice.
61 ROUTING NUMBER 2;13 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>9!($L(X)<9) X
  • LAST EDITED:  MAY 13, 2011
  • HELP-PROMPT:  Answer must be 9 characters in length.
  • DESCRIPTION:  Enter the financial routing number information that was returned with the payment from Central Fee for Electronic Fund Transfer (EFT) entries. This information will be forwarded to FPPS so that the vendor can be notified
    of the payment. This field must be 9 characters, including any leading zeros. Note: The Central Fee nightly update will automatically set this field if the data is included in their message.
62 ACCOUNT NUMBER 2;14 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>17!($L(X)<1) X
  • LAST EDITED:  MAY 13, 2011
  • HELP-PROMPT:  Answer must be 1-17 characters in length.
  • DESCRIPTION:  Enter the financial account number information that was returned with the payment from Central Fee for Electronic Fund Transfer (EFT) entries. This information will be forwarded to FPPS so that the vendor can be notified
    of the payment. This field must be 1-17 characters, including any leading zeros. Note: The Central Fee nightly update will automatically set this field if the data is included in their message.
63 FINANCIAL INSTITUTION 2;15 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  MAY 13, 2011
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  Enter the financial institution name that was returned with the payment from Central Fee for Electronic Fund Transfer (EFT) entries. This information will be forwarded to FPPS so that the vendor can be notified of the
    payment. Note: The Central Fee nightly update will automatically set this field if the data is included in their message.
64 ATTENDING PROV NAME 4;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  APR 22, 2011
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    Enter the Attending Provider's name found in the claim information.
65 ATTENDING PROV NPI 4;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • LAST EDITED:  APR 22, 2011
  • HELP-PROMPT:  Answer must be 10 characters in length.
  • DESCRIPTION:  
    Enter the Attending Provider's National Provider Identifier (NPI) found in the claim information. This value must be 10 characters, including any leading zeros.
66 ATTENDING PROV TAXONOMY CODE 4;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • LAST EDITED:  APR 22, 2011
  • HELP-PROMPT:  Answer must be 10 characters in length.
  • DESCRIPTION:  
    Enter the Attending Provider's Taxonomy code found in the claim information. This value must be 10 characters, including any leading zeros.
67 OPERATING PROV NAME 4;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  APR 22, 2011
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    Enter the Operating Provider's name found in the claim information.
68 OPERATING PROV NPI 4;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • LAST EDITED:  APR 22, 2011
  • HELP-PROMPT:  Answer must be 10 characters in length.
  • DESCRIPTION:  
    Enter the Operating Provider's National Provider Identifier (NPI) found in the claim information. This value must be 10 characters, including any leading zeros.
69 RENDERING PROV NAME 4;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  APR 29, 2011
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    Enter the Rendering Provider's name found in the claim information.
70 RENDERING PROV NPI 4;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • LAST EDITED:  APR 22, 2011
  • HELP-PROMPT:  Answer must be 10 characters in length.
  • DESCRIPTION:  
    Enter the Rendering Provider's National Provider Identifier (NPI) found in the claim information. This value must be 10 characters, including any leading zeros.
71 RENDERING PROV TAXONOMY CODE 4;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • LAST EDITED:  APR 22, 2011
  • HELP-PROMPT:  Answer must be 10 characters in length.
  • DESCRIPTION:  
    Enter the Rendering Provider's Taxonomy code found in the claim information. This value must be 10 characters, including any leading zeros.
72 SERVICING PROV NAME 4;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  APR 22, 2011
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    Enter the Servicing Provider's name found in the claim information.
73 SERVICING PROV NPI 4;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • LAST EDITED:  APR 22, 2011
  • HELP-PROMPT:  Answer must be 10 characters in length.
  • DESCRIPTION:  
    Enter the Servicing Provider's National Provider Identifier (NPI) found in the claim information. This value must be 10 characters, including any leading zeros.
74 REFERRING PROV NAME 4;11 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  APR 22, 2011
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    Enter the Referring Provider's name found in the claim information.
75 REFERRING PROV NPI 4;12 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • LAST EDITED:  APR 22, 2011
  • HELP-PROMPT:  Answer must be 10 characters in length.
  • DESCRIPTION:  
    Enter the Referring Provider's National Provider Identifier (NPI) found in the claim information. This value must be 10 characters, including any leading zeros.
79 LINE ITEM RENDERING PROV RPROV;0 Multiple #162.579 162.579

  • DESCRIPTION:  This multiple stores Rendering Provider information that is specific to a line item on the claim. A record should only be added to this multiple if the Rendering Provider for a line item is different from the Rendering
    Provider at the claim level. Example, if the PROC1 code is entered and has a different Rendering Provider than the claim Rendering Provider (field #70) the multiple will store the different data. Line item #1 would be
    referencing PROC1; Line Item #5 would reference PROC5.
80 SERVICING FACILITY ADDRESS 5;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>60!($L(X)<1) X
  • LAST EDITED:  JUN 16, 2011
  • HELP-PROMPT:  Answer must be 1-60 characters in length.
  • DESCRIPTION:  
    Enter the Servicing Facility street address found in the claim information.
81 SERVICING FACILITY CITY 5;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  JUN 16, 2011
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    Enter the Servicing Facility city found in the claim information.
82 SERVICING FACILITY STATE 5;3 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  JUN 16, 2011
  • DESCRIPTION:  
    Enter the Servicing Facility state found in the claim information.
83 SERVICING FACILITY ZIP 5;4 FREE TEXT

  • INPUT TRANSFORM:  K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>20!($L(X)<5) X I $D(X) D ZIPIN^VAFADDR
  • OUTPUT TRANSFORM:  D ZIPOUT^VAFADDR
  • LAST EDITED:  JUN 16, 2011
  • HELP-PROMPT:  Answer with either 5 digit or 9 digit zip code.
  • DESCRIPTION:  
    Enter the Servicing Facility zip code, in either the 5 digit format (e.g. 12345) or 9 digit format (e.g. 12345-6789 or 123456789).
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
85 UNIQUE CLAIM IDENTIFIER 5;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>28!($L(X)<1) X
  • LAST EDITED:  MAY 29, 2012
  • HELP-PROMPT:  Answer must be 1-28 characters in length.
  • DESCRIPTION:  
    This field contains a unique identifier for tracking claims. Fee5010 Project.
86 DoD INVOICE NUMBER 5;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>22!($L(X)<3) X
  • LAST EDITED:  JAN 30, 2014
  • HELP-PROMPT:  Answer must be 3-22 characters in length.
  • DESCRIPTION:  
    The DoD invoice number that is associated with the invoice. Note that if the invoice vendor is not a federal vendor then this field is null.
  • CROSS-REFERENCE:  162.5^DODI
    1)= S ^FBAAI("DODI",$E(X,1,30),DA)=""
    2)= K ^FBAAI("DODI",$E(X,1,30),DA)
    This is the cross reference for the DoD invoice number
87 IPAC VENDOR AGREEMENT 5;10 POINTER TO IPAC VENDOR AGREEMENT FILE FILE (#161.95) IPAC VENDOR AGREEMENT FILE(#161.95)

  • LAST EDITED:  MAR 05, 2014
  • HELP-PROMPT:  Enter the IPAC agreement associated with this invoice.
  • DESCRIPTION:  
    The IPAC Agreement record that is associated with this invoice. Note that if the invoice vendor is not a federal vendor this is field is null.
  • CROSS-REFERENCE:  162.5^IPAC
    1)= S ^FBAAI("IPAC",$E(X,1,30),DA)=""
    2)= K ^FBAAI("IPAC",$E(X,1,30),DA)
    This cross reference is used to identify invoices associated with IPAC.
88 AUTHORIZATION NUMBER 7;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 27, 2015
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This field holds the authorization numbers transmitted from FBCS.
89 CLAIM LEVEL ALLOWED AMOUNT 7;2 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<0) X
  • LAST EDITED:  SEP 10, 2015
  • HELP-PROMPT:  Type a dollar amount between 0 and 9999999.99, 2 decimal digits.
  • DESCRIPTION:  
    This field is for internal use only. FBCS will populate the value, if available, for claims sent to VistA from FBCS.
90 PAYMENT METHODOLOGY 2;16 POINTER TO FEE BASIS PAYMENT METHODOLOGY FILE (#163.98) FEE BASIS PAYMENT METHODOLOGY(#163.98)

  • LAST EDITED:  FEB 04, 2016
  • HELP-PROMPT:  Enter a valid Fee Basis Payment methodology
  • DESCRIPTION:  
    The values in this field come from FBCS and represents the actual payment methodology used in FBCS to adjudicate the claim.
91 ATTACHMENT ID 10;0 Multiple #162.591 162.591
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