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Global: ^IBCN(365.19

Package: Integrated Billing

Global: ^IBCN(365.19


Information

FileMan FileNo FileMan Filename Package
365.19 INTERFACILITY INSURANCE UPDATE Integrated Billing

Description

Accessed By FileMan Db Calls, Total: 4

Package Total Routines
Integrated Billing 4 IBCNIUHL    IBCNIUK    IBCNIUR1    IBY687PO    

Pointer To FileMan Files, Total: 5

Package Total FileMan Files
Integrated Billing 3 INSURANCE VERIFICATION PROCESSOR(#355.33)[1.05, 2.03]    TYPE OF PLAN(#355.1)[#365.192(.08)]    PAYER(#365.12)[1.02]    
Kernel 1 INSTITUTION(#4)[#365.191(.01), #365.192(.01)]    
Registration 1 PATIENT(#2)[.01]    

Fields, Total: 16

Field # Name Loc Type Details
.01 PATIENT NAME 0;1 POINTER TO PATIENT FILE (#2)
************************REQUIRED FIELD************************
PATIENT(#2)

  • LAST EDITED:  FEB 10, 2021
  • HELP-PROMPT:  Enter the patient name.
  • DESCRIPTION:  
    This is the patient whose insurance was recently verified as 'active'. This patient's verified active policy was either sent to a VAMC(s) or received from another VAMC.
  • CROSS-REFERENCE:  365.19^B
    1)= S ^IBCN(365.19,"B",$E(X,1,30),DA)=""
    2)= K ^IBCN(365.19,"B",$E(X,1,30),DA)
  • RECORD INDEXES:  D (#1709)
.02 DATE/TIME CREATED 0;2 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="ESTXR" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  FEB 24, 2021
  • HELP-PROMPT:  Enter the date and time that the entry was created.
  • DESCRIPTION:  
    This is the date/time that this entry was created in this file.
  • TECHNICAL DESCR:  The value of the DIRECTION (#365.19,.03) field has a bearing on the meaning of this field. If DIRECTION = SENDER, this is the date/time that the active policy, defined in this entry, was verified as an active policy. It
    does NOT mean that the policy was 'sent' at this time. If the DIRECTION = RECEIVER, then this is the date/time that the active policy was received from another VAMC.
  • RECORD INDEXES:  DIR (#1710)
.03 DIRECTION 0;3 SET
************************REQUIRED FIELD************************
  • 'S' FOR SENDER;
  • 'R' FOR RECEIVER;

  • LAST EDITED:  FEB 24, 2021
  • HELP-PROMPT:  Enter the direction of the data flow.
  • DESCRIPTION:  This is the data flow of this policy from the perspective of this VAMC. The direction is to be set to SENDER if this VAMC was sending/sharing the recently verified active policy with one or more VAMCs. Direction is to be
    set to RECEIVER if this VAMC received the recently verified active policy from another VAMC.
  • RECORD INDEXES:  DIR (#1710)
1.01 SENDER STATUS 1;1 SET
  • 'W' FOR WAITING;
  • 'P' FOR PARTIAL;
  • 'C' FOR COMPLETE;
  • 'F' FOR FAILED MISSING DATA;

  • LAST EDITED:  SEP 23, 2021
  • HELP-PROMPT:  Enter the status of the SENDER entry.
  • DESCRIPTION:  
    This is the overall status of the SENDER entry. It indicates whether the entry has finished sending the policy to all VAMCs that it intended to.
  • TECHNICAL DESCR:  This field is only used (and is required) when the DIRECTION (#365.19,.03) field is set to SENDER. WAITING indicates that the policy has NOT been shared with a VAMC yet. PARTIAL indicates that the policy has been sent to
    some of the VAMCs that Interfacility Insurance Update (IIU) intends to share it with; however, it has not successfully sent it to all VAMCs that it is intending to send to. COMPLETE indicates that IIU has finished sending
    the policy to all VAMCs that it is intending to. FAILED MISSING DATA indicates that not all of the IIU required fields are available; therefore, the policy will not be shared to other VAMCs.
  • CROSS-REFERENCE:  365.19^C
    1)= S ^IBCN(365.19,"C",$E(X,1,30),DA)=""
    2)= K ^IBCN(365.19,"C",$E(X,1,30),DA)
    This cross references the Sending Status of the entries.
1.02 PAYER 1;2 POINTER TO PAYER FILE (#365.12) PAYER(#365.12)

  • LAST EDITED:  FEB 24, 2021
  • HELP-PROMPT:  Enter the Payer for this entry.
  • DESCRIPTION:  
    This is the Payer with whom this policy is associated.
  • TECHNICAL DESCR:  
    This field is only used for those entries that were SENT to another VAMC.
1.03 INSUR RECORD IEN 1;3 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999)!(X<1)!(X?.E1"."1.N) X
  • LAST EDITED:  FEB 25, 2021
  • HELP-PROMPT:  Enter the IEN of the insurance record sent. Type a number between 1 and 999, 0 decimal digits.
  • DESCRIPTION:  
    This field is the IEN of the insurance record which Interfacility Insurance Update (IIU) uses to pull policy information to send to another VAMC.
  • TECHNICAL DESCR:  This field is only used for those entries that were SENT to another VAMC. This field is the IEN of the insurance record on the INSURANCE TYPE subfile (#2.312) of the PATIENT file (#2) for the policy that we want to send
    to other VAMCs via an HL7 message. This can NOT be a pointer field.
    SOURCE OF DATA: PATIENT (#2) Insurance Type subfile (#2.312)
  • RECORD INDEXES:  D (#1709)
1.04 EIV AUTO-UPDATE 1;4 SET (BOOLEAN Data Type)
  • This field indicates whether or not the active policy was verified via eIV's AUTO UPDATE process (no touch process).

  • LAST EDITED:  FEB 24, 2021
  • HELP-PROMPT:  Enter "YES" if this entry was auto updated or "NO" if it was not.
  • DESCRIPTION:  
    This field indicates whether or not the active policy was verified via eIV's AUTO UPDATE process (no touch process).
  • TECHNICAL DESCR:  
    This field is only used for those entries that were SENT to another VAMC. If the field is null, treat it as a "NO" value for reports or processing.
    SOURCE OF DATA: EIV AUTO-UPDATE(#365,.13)
1.05 SENDER BUFFER 1;5 POINTER TO INSURANCE VERIFICATION PROCESSOR FILE (#355.33) INSURANCE VERIFICATION PROCESSOR(#355.33)

  • LAST EDITED:  FEB 24, 2021
  • HELP-PROMPT:  Enter the insurance buffer entry number or leave blank if auto updated.
  • DESCRIPTION:  
    This field points to the buffer record that was verified as active insurance if the eIV AUTO-UPDATE (#365.19,1.04) field is "NO".
  • TECHNICAL DESCR:  
    This field is only used for those entries that were SENT to another VAMC.
1.06 SENDER SUBSCRIBER ID 1;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<3) X
    MAXIMUM LENGTH: 80
  • LAST EDITED:  FEB 25, 2021
  • HELP-PROMPT:  Enter the Subscriber ID that was sent to the receiving VAMC (3-80 characters).
  • DESCRIPTION:  
    This field is used by reports to display the Subscriber ID that was sent as part of the verified active policy.
  • TECHNICAL DESCR:  
    This field is used only for those entries that were SENT to another VAMC.
    SOURCE OF DATA: SUBSCRIBER ID(#2.312,7.02)
1.07 SEND COORDINATION OF BENEFITS 1;7 SET
  • '1' FOR Primary;
  • '2' FOR Secondary;
  • '3' FOR Tertiary;

  • LAST EDITED:  FEB 24, 2021
  • HELP-PROMPT:  Enter the Coordination of Benefits sent to the receiving VAMC.
  • DESCRIPTION:  
    This field is used by reports to display the Coordination of Benefits (COB) that was sent as part of the verified active policy.
  • TECHNICAL DESCR:  
    This field is only used for those entries that were SENT to another VAMC.
    SOURCE OF DATA: COORDINATION OF BENEFITS(#2.312,.2)
1.08 ICB PROCESSED BUFFER 1;8 SET (BOOLEAN Data Type)
  • The buffer entry in the INSURANCE VERIFICATION PROCESSOR file #355.33 was processed by the COTS ICB product.

  • LAST EDITED:  SEP 17, 2021
  • HELP-PROMPT:  Enter "YES" if this entry was processed by ICB or "NO" if it was not.
  • DESCRIPTION:  
    The buffer entry in the INSURANCE VERIFICATION PROCESSOR file #355.33 was processed by the COTS ICB product.
  • TECHNICAL DESCR:  
    This field is only used for those entries that were SENT to another VAMC. If the field is null, treat it as a "NO" value for processing.
1.1 DESTINATION VAMC 1.1;0 POINTER Multiple #365.191 365.191

  • DESCRIPTION:  
    Track the VAMCs that this patient visited, thus where this verified active policy should be SENT.
  • TECHNICAL DESCR:  
    This multiple is only used for those entries when the DIRECTION (#365.19,.03) field equals "SENDER".
2.01 RECEIVER STATUS 2;1 SET
  • 'S' FOR SAVED TO BUFFER;
  • 'V' FOR VISITED TOO LONG AGO;
  • 'R' FOR RECEIVE IIU DATA IS OFF;
  • 'D' FOR DUPLICATE;
  • 'I' FOR IIU ENABLED IS OFF;
  • 'E' FOR ERROR SAVING TO IIU;
  • 'B' FOR ERROR SAVING TO BUFFER;

  • LAST EDITED:  APR 21, 2021
  • HELP-PROMPT:  Enter the status of the incoming data (received policy).
  • DESCRIPTION:  
    This is the overall status of the received entry. It indicates whether or not the policy that was received from another VAMC was saved to the INSURANCE VERIFICATION PROCESSOR (#355.33) file as a buffer entry.
  • TECHNICAL DESCR:  This field is only used (and is required) when the DIRECTION (#365.19,.03) field equals RECEIVER. This field will indicate the filing status of the entry; whether it was saved to the INSURANCE VERIFICATION PROCESSOR
    (#355.33) file or rejected.
  • CROSS-REFERENCE:  ^^TRIGGER^365.19^2.02
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBCN(365.19,D0,2)):^(2),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S X=% X ^DD(365.19,2.01,1,1,1.4)
    1.4)= S DIH=$G(^IBCN(365.19,DIV(0),2)),DIV=X S $P(^(2),U,2)=DIV,DIH=365.19,DIG=2.02 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBCN(365.19,D0,2)):^(2),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S X=% X ^DD(365.19,2.01,1,1,2.4)
    2.4)= S DIH=$G(^IBCN(365.19,DIV(0),2)),DIV=X S $P(^(2),U,2)=DIV,DIH=365.19,DIG=2.02 D ^DICR
    3)= DO NOT DELETE
    CREATE VALUE)= NOW
    DELETE VALUE)= NOW
    FIELD)= RECEIVER STATUS DATE/TIME
    NOREINDEX)= 1
    This trigger will set the RECEIVER STATUS DATE/TIME (#2.02) to the current date/time whenever any change/deletion is made to the RECEIVER STATUS (#2.01) field.
2.02 RECEIVER STATUS DATE/TIME 2;2 DATE

  • INPUT TRANSFORM:  S %DT="ESTX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  FEB 10, 2021
  • HELP-PROMPT:  Enter the date and time of the RECEIVER STATUS.
  • DESCRIPTION:  
    This field indicates the date/time that this policy was received from another VAMC.
  • TECHNICAL DESCR:  
    This field is only used for those entries that were RECEIVED from another VAMC.
    WRITE AUTHORITY: ^
  • NOTES:  TRIGGERED by the RECEIVER STATUS field of the INTERFACILITY INSURANCE UPDATE File
2.03 RECEIVER BUFFER 2;3 POINTER TO INSURANCE VERIFICATION PROCESSOR FILE (#355.33) INSURANCE VERIFICATION PROCESSOR(#355.33)

  • LAST EDITED:  FEB 24, 2021
  • HELP-PROMPT:  Enter the Buffer Entry number
  • DESCRIPTION:  
    This is the entry in the INSURANCE VERIFICATION PROCESSOR (#355.33) of where this policy was saved for user processing.
  • TECHNICAL DESCR:  
    This field is only used for those entries that were RECEIVED from another VAMC. This is only populated if the RECEIVER STATUS(#365.19, 2.01) field equals "SAVED TO BUFFER". It is required in this instance.
2.1 ORIGINATING VAMC 2.1;0 POINTER Multiple #365.192 365.192

  • TECHNICAL DESCR:  
    This multiple contains the policy information that was RECEIVED from another VAMC.
Info |  Desc |  Accessed By FileMan Db Calls |  Pointer To FileMan Files |  Fields