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Global: ^IBA(354

Package: Integrated Billing

Global: ^IBA(354

Information

FileMan FileNo	FileMan Filename	Package
354	BILLING PATIENT	Integrated Billing

Description

DO NOT EDIT THIS FILE. Under normal operation it is not necessary to edit the fields in this file directly. The option Manually Change Copay Exemption (Hardships) can be used to update and correct this entry by creating a new exemption. If many patient records have problems the option Print/Verify Patient Exemption Status can be used to correct the entries. The data in this file is updated each time a new (current) exemption is created for a patient. Exemptions are automatically created when changes in patient information change the exemption status or when an expired (older than 1 year) exemption is encountered when determining the exemption status for pharmacy. This file will contain specific information related to billing about individual patients. Current Status of the Medication Copayment Exemption will be kept in this file. Conceptually this is different than the BILLING EXEMPTIONS File which maintains the audit log and historical data related to billing exemptions. Per VHA Directive 10-93-142, this file definition should not be modified.

Accessed By FileMan Db Calls, Total: 12

Package	Total	Routines
Integrated Billing	10	IB20P385 IBARXEP IBARXEPL IBARXEPS IBARXEPV IBAUTL6 IBAUTL7 IBCNSBL IBCNSM2 IBXEXS
Registration	1	DG53632P
Scheduling	1	SDESPATRPC

Pointed To By FileMan Files, Total: 1

Package	Total	FileMan Files
Integrated Billing	1	BILLING EXEMPTIONS(#354.1)[.02]

Pointer To FileMan Files, Total: 2

Package	Total	FileMan Files
Integrated Billing	1	EXEMPTION REASON(#354.2)[.05]
Registration	1	PATIENT(#2)[.01]

Fields, Total: 6

Field #	Name	Loc	Type	Details
.01	PATIENT NAME	0;1	POINTER TO PATIENT FILE (#2)	**********************REQUIRED FIELD********************** PATIENT(#2) INPUT TRANSFORM: `S DINUM=X` LAST EDITED: `JAN 21, 1993` HELP-PROMPT: `Enter the name of the patient as it appears in the patient file or enter the SSN or last four.` DESCRIPTION: `This is the name of the patient as it appears in the patient file.` TECHNICAL DESCR: `This field is the pointer to the PATIENT file. It will use the same internal entry number in this file as in the PATIENT file.` DELETE TEST: `1,0)= I 1 W !,"Deleting entries not allowed"` NOTES: `XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER` CROSS-REFERENCE: `354^B` `1)= S ^IBA(354,"B",$E(X,1,30),DA)=""` `2)= K ^IBA(354,"B",$E(X,1,30),DA)`
.03	COPAY EXEMPTION STATUS DATE	0;3	DATE	**********************REQUIRED FIELD********************** INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X K:X'=$P(^IBA(354,DA,0),U,3) X` LAST EDITED: `FEB 10, 1993` HELP-PROMPT: `Enter the date of the current income exemption.` DESCRIPTION: `DO NOT EDIT THIS FIELD. It is maintained by the Copay Exemption Software.` `This is the date that this patients Medication Copay Income Exemption Status was last updated. If this date is not in the current calendar year this patient will be flagged as needing to have his status updated.` TECHNICAL DESCR: `This field will be updated by the Copay Exemption software every time a new current exemption is added. It should not be edited.` `Programmers must 4 slash stuff data into this field to bypass the input transform.` `WRITE AUTHORITY: ^` NOTES: `XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER` `TRIGGERED by the COPAY INCOME EXEMPTION STATUS field of the BILLING PATIENT File` CROSS-REFERENCE: `354^AD` `1)= S ^IBA(354,"AD",$E(X,1,30),DA)=""` `2)= K ^IBA(354,"AD",$E(X,1,30),DA)`
.04	COPAY INCOME EXEMPTION STATUS	0;4	SET	**********************REQUIRED FIELD********************** '1' FOR EXEMPT; '0' FOR NON-EXEMPT; LAST EDITED: `SEP 13, 2005` HELP-PROMPT: `Enter whether this patient is currently exempt from pharmacy copay due to the income exemption.` DESCRIPTION: `DO NOT EDIT THIS FIELD. It is maintained by the Copay Exemption Software.` `This is the patients current Medication Copay Income Exemption Status. It is updated whenever an entry in the Billing Exemptions file is made.` `If a patient's income is less than the pension level, effective 10/29/92 the patient is exempt from paying the Medication Copayment. If a patient is receiving a VA Pension, or is receiving Aid and Attendence or House` `Bound benefits, or his income for the previous year is less than the pension level, he is exempt.` TECHNICAL DESCR: `This field will be updated by the Copay Exemption software every time a new current exemption is added. It should not be edited.` `Programmers must 4 slash stuff data into this field to bypass the input transform.` SCREEN: `S DIC("S")="I $P(^IBA(354,DA,0),U,4)=Y!($G(IBJOB)>10)"` EXPLANATION: `This field can only be edited/updated by the Copay Exemption software.` `WRITE AUTHORITY: ^` CROSS-REFERENCE: `354^AEX` `1)= S ^IBA(354,"AEX",$E(X,1,30),DA)=""` `2)= K ^IBA(354,"AEX",$E(X,1,30),DA)` `This is a regular cross-reference of the Pharmacy Copay Income Exemption Status of patients for their most recent status.` CROSS-REFERENCE: `^^TRIGGER^354^.03` `1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(354,D0,0)):^(0),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV S X=DT S DIH=$G(^IBA(354,DIV(0),0)),DIV=X S $P(^(0),U,3)=DIV,DIH=354,DIG=.03 D ^DICR` `2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(354,D0,0)):^(0),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" S DIH=$G(^IBA(354,DIV(0),0)),DIV=X S $P(^(0),U,3)=DIV,DIH=354,DIG=.03 D ^DICR` `CREATE VALUE)= S X=DT` `DELETE VALUE)= @` `FIELD)= #.03` CROSS-REFERENCE: `354^AENR04^MUMPS` `1)= D E354^DGRTRIG(DA)` `2)= D E354^DGRTRIG(DA)` `3)= DO NOT DELETE` `This cross-reference is used to notify HEC of changes that may affect enrollment.`
.05	COPAY EXEMPTION REASON	0;5	POINTER TO EXEMPTION REASON FILE (#354.2)	**********************REQUIRED FIELD********************** EXEMPTION REASON(#354.2) INPUT TRANSFORM: `S DIC("S")="I Y=$P(^IBA(354,DA,0),U,5)!($G(IBJOB)>10)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X` LAST EDITED: `FEB 10, 1993` DESCRIPTION: `DO NOT EDIT THIS FIELD. It is maintained by the Copay Exemption Software.` `This is the exemption reason for the current copay exemption. It will be entered by the system.` TECHNICAL DESCR: `This field will be updated by the Copay Exemption software every time a new current exemption is added. It should not be edited.` `Programmers must 4 slash stuff data into this field to bypass the input transform.` SCREEN: `S DIC("S")="I Y=$P(^IBA(354,DA,0),U,5)!($G(IBJOB)>10)"` EXPLANATION: `This field can only be edited/updated by the Copay Exemption software.` `WRITE AUTHORITY: ^` CROSS-REFERENCE: `354^AC` `1)= S ^IBA(354,"AC",$E(X,1,30),DA)=""` `2)= K ^IBA(354,"AC",$E(X,1,30),DA)`
50	EVER HAD IVM INSURANCE?	IVM;1	SET	'0' FOR NO; '1' FOR YES; LAST EDITED: `APR 21, 1994` HELP-PROMPT: `If patient has ever had insurance identified by IVM, type "YES"; otherwise, "NO".` DESCRIPTION: `This field flags patients who have ever had at least one insurance policy that was identified by the IVM Center.` CROSS-REFERENCE: `354^AIVM^MUMPS` `1)= I X=1 S ^IBA(354,"AIVM",DA)=""` `2)= K ^IBA(354,"AIVM",DA)` `This cross-reference flags patients who have (or have ever had) insurance identified by IVM.`
60	NO COVERAGE VERIFICATION DATE	60;1	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `OCT 08, 1998` HELP-PROMPT: `Enter the date verification was made that the patient has no insurance coverage.` DESCRIPTION: `This field contains the date that verification was made that this patient does not have any type of insurance coverage. When a policy is entered for a patient, this field will be deleted.` CROSS-REFERENCE: `354^AVDT` `1)= S ^IBA(354,"AVDT",$E(X,1,30),DA)=""` `2)= K ^IBA(354,"AVDT",$E(X,1,30),DA)` `3)= Do not delete.` `This cross-reference is used to list the date patients were verified that they have no insurance coverage.`

ICR, Total: 2

ICR LINK	Subscribing Package(s)	Fields Referenced	Description
ICR #5296	Insurance Capture Buffer
ICR #6115	VA Point of Service	COPAY INCOME EXEMPTION (.04). Access: Read w/Fileman

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