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Global: ^IBA(354.1

Package: Integrated Billing

Global: ^IBA(354.1

Information

FileMan FileNo	FileMan Filename	Package
354.1	BILLING EXEMPTIONS	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 entries 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. This file will hold the time sensitive data that is used to determine if a patient can be exluded from any type of billing for a period of time. The initial use of this file is for storing the time sensitive data related to whether or not a patient is exempt from pharmacy copay requirement due to income below the pension level. The file then maintains the audit trail of changes to exemptions and historical data about exemptions. The data in this file should be retained for approximately the current calendar year and the past calendar year. The ability to purge data in this file will be added at a future time. Per VHA Directive 10-93-142, this file definition should not be modified.

Directly Accessed By Routines, Total: 68

Package	Total	Routines
Integrated Billing	64	IB20E331 IB20E379 IB20E557 IB20E661 IB20E692 IB20E753 IB20E780 IB20P253 IB20P410 IB20P441 IB20P465 IB20P485 IB20P540 IB20P611 IB20P74P IB20P753 IBAMTED2 IBARXEI IBARXEU3 IBAUTL6 IBXEX3 ^IBE(399.6 IB20P379 IB20P661 IBARXEL IBARXEL1 IBARXEPS IBARXEU4 IBAUTL7 IBPEX IBXEX1 ^IBA(354.1 IB20E362 IB20E425 IB20E441 IB20E465 IB20E485 IB20E540 IB20E583 IB20E611 IB20E635 IB20E723 IB20P331 IB20P362 IB20P385 IB20P425 IB20P514 IB20P557 IB20P583 IB20P635 IB20P692 IB20P723 IB20P74E IB20P780 IBAERR3 IBAMTED1 IBARXEPV IBARXET IBARXEU IBARXEU0 IBARXEX IBXEX IBXEX2 IBXEXI
Registration	1	DGMTCOR

Accessed By FileMan Db Calls, Total: 10

Package	Total	Routines
Integrated Billing	10	IB20P385 IBAERR3 IBARXEL IBARXET IBARXEU4 IBAUTL6 IBAUTL7 IBPEX IBXEX IBXEXI

Pointer To FileMan Files, Total: 4

Package	Total	FileMan Files
Integrated Billing	3	BILLING PATIENT(#354)[.02] BILLING ALERTS(#354.4)[.09] EXEMPTION REASON(#354.2)[.05]
Kernel	1	NEW PERSON(#200)[.07]

Fields, Total: 16

Field #	Name	Loc	Type	Details
.01	EFFECTIVE DATE	0;1	DATE	**********************REQUIRED FIELD********************** INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `APR 07, 1993` DESCRIPTION: `Enter the effective date of the exemption.` `Patients will be given 1 year of exemption from the Medication Copayment requirement from this effective date. For patients who's exemption is based on income data, every effort will be made to keep this effective date` `consistent with the Means Test Date of Test or the Copayment Income Test Date of Test.` DELETE TEST: `1,0)= I 1 W !,"Deleting entries not allowed"` `UNEDITABLE` CROSS-REFERENCE: `354.1^B` `1)= S ^IBA(354.1,"B",$E(X,1,30),DA)=""` `2)= K ^IBA(354.1,"B",$E(X,1,30),DA)` CROSS-REFERENCE: `354.1^ACY^MUMPS` `1)= I $P(^IBA(354.1,DA,0),"^",2),$P(^(0),U,3),$P(^(0),U,10) S ^IBA(354.1,"ACY",+$P(^(0),"^",3),+$P(^(0),"^",2),$E(X,1,3),DA)=""` `2)= K ^IBA(354.1,"ACY",+$P(^IBA(354.1,DA,0),"^",3),+$P(^(0),U,2),$E(X,1,3),DA)` `Cross-reference of all ACTIVE entries for a patient for an effective date. For Pharmacy Co-pay income exemption this equates to calendar year (CY).` CROSS-REFERENCE: `354.1^AIVDT^MUMPS` `1)= N IBX S IBX=^IBA(354.1,DA,0) I $P(IBX,U,2),$P(IBX,U,3),$P(IBX,U,4)'="",$P(IBX,U,10) S ^IBA(354.1,"AIVDT",+$P(IBX,U,3),+$P(IBX,U,2),-($P(IBX,U)),DA)=""` `2)= K ^IBA(354.1,"AIVDT",+$P(^IBA(354.1,DA,0),U,3),+$P(^(0),U,2),-X,DA)` `Inverse date cross reference of all exemption entries for a patient.` CROSS-REFERENCE: `354.1^APIDT1^MUMPS` `1)= I $P(^IBA(354.1,DA,0),U,2),$P(^(0),U,3) S ^IBA(354.1,"APIDT",+$P(^(0),U,2),+$P(^(0),U,3),-X,DA)=""` `2)= K ^IBA(354.1,"APIDT",+$P(^IBA(354.1,DA,0),U,2),+$P(^(0),U,3),-X,DA)` `Cross reference of all exemptions by patient, by type and by inverse date.`
.02	PATIENT	0;2	POINTER TO BILLING PATIENT FILE (#354)	**********************REQUIRED FIELD********************** BILLING PATIENT(#354) LAST EDITED: `FEB 04, 1993` DESCRIPTION: `This is the patient that this Billing Exemption Entry is for. The Patient must be in the Billing Patient File. The Current Status for an exemption will be automatically stored in the Billing Patient file.` `UNEDITABLE` CROSS-REFERENCE: `354.1^AP` `1)= S ^IBA(354.1,"AP",$E(X,1,30),DA)=""` `2)= K ^IBA(354.1,"AP",$E(X,1,30),DA)` `Cross-reference of Patient.` CROSS-REFERENCE: `354.1^AIVDT2^MUMPS` `1)= N IBX S IBX=^IBA(354.1,DA,0) I $P(IBX,U,2),$P(IBX,U,3),$P(IBX,U,4)'="",$P(IBX,U,10) S ^IBA(354.1,"AIVDT",+$P(IBX,U,3),+$P(IBX,U,2),-($P(IBX,U)),DA)=""` `2)= K ^IBA(354.1,"AIVDT",+$P(^IBA(354.1,DA,0),"^",3),+X,-($P(^(0),U)),DA)` CROSS-REFERENCE: `354.1^C` `1)= S ^IBA(354.1,"C",$E(X,1,30),DA)=""` `2)= K ^IBA(354.1,"C",$E(X,1,30),DA)` `Cross-reference of all ACTIVE entries for a patient by calendar year (CY). This equates to $e(effective date,1,3).` CROSS-REFERENCE: `354.1^APIDT^MUMPS` `1)= I $P(^IBA(354.1,DA,0),U,3),+^(0) S ^IBA(354.1,"APIDT",X,+$P(^(0),U,3),-($P(^(0),U)),DA)=""` `2)= K ^IBA(354.1,"APIDT",+X,+$P(^IBA(354.1,DA,0),U,3),-($P(^(0),U)),DA)` `Cross-reference of all records by patient, by type, by inverse date.` CROSS-REFERENCE: `354.1^ACAN1^MUMPS` `1)= I $P(^IBA(354.1,DA,0),"^",14) S ^IBA(354.1,"ACAN",X,-$P(^(0),"^",14),DA)=""` `2)= K ^IBA(354.1,"ACAN",X,-$P(^IBA(354.1,DA,0),"^",14),DA)` `3)= DO NOT DELETE` `This cross-reference is set whenever bills are retroactively canceled due to the medication copayment exemption patch. It is used to prevent canceling charges in AR a second time. This is necessary because the direct` `link between IB and AR is not maintained for this functionality as it is necessary to remove admin and interest charges that may have accumulated.`
.03	TYPE	0;3	SET	**********************REQUIRED FIELD********************** '1' FOR COPAY INCOME EXEMPTION; LAST EDITED: `FEB 04, 1993` DESCRIPTION: `This is the type of exemption that this entry is for. Each type of exemption will have its own record.` TECHNICAL DESCR: `Currently there is only one type of record. Pharmacy Copay Exemptions based on income.` `UNEDITABLE` CROSS-REFERENCE: `354.1^AIVDT3^MUMPS` `1)= N IBX S IBX=^IBA(354.1,DA,0) I $P(IBX,U,2),$P(IBX,U,3),$P(IBX,U,4)'="",$P(IBX,U,10) S ^IBA(354.1,"AIVDT",+$P(IBX,U,3),+$P(IBX,U,2),-($P(IBX,U)),DA)=""` `2)= K ^IBA(354.1,"AIVDT",+X,+$P(^IBA(354.1,DA,0),U,2),-($P(^(0),U)),DA)` `Inverse date cross reference of all exemptions for a patient for a type of exemption.` CROSS-REFERENCE: `354.1^APIDT2^MUMPS` `1)= I $P(^IBA(354.1,DA,0),U,2),+^(0) S ^IBA(354.1,"APIDT",+$P(^(0),U,2),+X,-($P(^(0),U)),DA)=""` `2)= K ^IBA(354.1,"APIDT",+$P(^IBA(354.1,DA,0),U,2),+X,-($P(^(0),U)),DA)` `Cross-reference of all records by patient, by type, by inverse date.` CROSS-REFERENCE: `354.1^ACY3^MUMPS` `1)= I $P(^IBA(354.1,DA,0),U,2),+^(0) S ^IBA(354.1,"ACY",+X,+$P(^(0),U,2),+$E($P(^(0),U),1,3),DA)=""` `2)= K ^IBA(354.1,"ACY",+X,+$P(^IBA(354.1,DA,0),U,2),+$E($P(^(0),U),1,3),DA)` `Cross reference of all active entries for a patient by inverse date.`
.04	STATUS	0;4	SET	**********************REQUIRED FIELD********************** '1' FOR EXEMPT; '0' FOR NON-EXEMPT; LAST EDITED: `FEB 04, 1993` DESCRIPTION: `This is the Exemption Status of this record. Enter whether the patient is exempt or not exempt from the TYPE of billing of this record. Generally this data element will be entered by the system.` `UNEDITABLE` CROSS-REFERENCE: `354.1^AS` `1)= S ^IBA(354.1,"AS",$E(X,1,30),DA)=""` `2)= K ^IBA(354.1,"AS",$E(X,1,30),DA)` `Cross-reference of Status.`
.05	EXEMPTION REASON	0;5	POINTER TO EXEMPTION REASON FILE (#354.2)	**********************REQUIRED FIELD********************** EXEMPTION REASON(#354.2) LAST EDITED: `FEB 04, 1993` DESCRIPTION: `Enter the reason that the patient is exempt or not exempt from this type of billing. Entry of this field will automatically update the STATUS of this exemption record to the STATUS of the Exemption Reason. For exmple, an` `exemption reason of "In Receipt of Pension" will automatically trigger a STATUS of Exempt for the Pharmacy Copay Income Exemption.` `UNEDITABLE` CROSS-REFERENCE: `354.1^AR` `1)= S ^IBA(354.1,"AR",$E(X,1,30),DA)=""` `2)= K ^IBA(354.1,"AR",$E(X,1,30),DA)` `Cross-reference of Exemption Reasons.`
.06	HOW ADDED	0;6	SET	'1' FOR SYSTEM; '2' FOR MANUAL; LAST EDITED: `DEC 09, 1992` DESCRIPTION: `This field indicates whether this record was automatically added by the system or manually entered by a user.` `This field will always be entered by the system.` TECHNICAL DESCR: `This field is updated to manual whenever a user creates an entry that does not appear to be consistent with the data returned from MAS or when adding a hardship exemption. Whenever this field is set to manual an` `electronic signature should be required and a bulletin or alert sent to an appropriate group.`
.07	USER ADDING ENTRY	0;7	POINTER TO NEW PERSON FILE (#200)	NEW PERSON(#200) LAST EDITED: `FEB 04, 1993` DESCRIPTION: `This is the user who was responsible for adding this entry. If the entry was SYSTEM added then the user would be the signed on user when the exemption was created. This may be a user who edited the patient record or who` `entered a prescription or a user who corrected an exemption. All changes except Hardship exemptions will be considered SYSTEM added. If the entry was Manually added then this is the user who entered the Hardship` `exemption.` `UNEDITABLE`
.08	DATE/TIME ADDED	0;8	DATE	**********************REQUIRED FIELD********************** INPUT TRANSFORM: `S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `FEB 04, 1993` DESCRIPTION: `This is the date and time this entry was added.` `The date time added will be different from the effective date in many cases, where the entry is based on actual income data and where there are changes to an exemption status. When the exemption is based upon the fact` `that the patient is recieving pension, etc. the effective date and the date added may be the same.` `UNEDITABLE`
.09	ALERT	0;9	POINTER TO BILLING ALERTS FILE (#354.4)	BILLING ALERTS(#354.4) LAST EDITED: `FEB 04, 1993` DESCRIPTION: `Future use.` CROSS-REFERENCE: `354.1^ALERT` `1)= S ^IBA(354.1,"ALERT",$E(X,1,30),DA)=""` `2)= K ^IBA(354.1,"ALERT",$E(X,1,30),DA)` `This is an index of alerted exemptions.`
.1	ACTIVE	0;10	SET	**********************REQUIRED FIELD********************** '1' FOR ACTIVE; '0' FOR INACTIVE; LAST EDITED: `FEB 04, 1993` DESCRIPTION: `Only 1 record for an effective date can be active at a time. When it is necessary to change a patient's exemption status the user will be asked if this is the currently active record. If yes, then all other records for` `the effective date will be inactivated automatically.` SCREEN: `S DIC("S")="I $$ACTIVE^IBARXEU(X)"` EXPLANATION: `Only 1 entry for a patient for an effective date can be active at one time` CROSS-REFERENCE: `354.1^AA` `1)= S ^IBA(354.1,"AA",$E(X,1,30),DA)=""` `2)= K ^IBA(354.1,"AA",$E(X,1,30),DA)` `Cross-reference of Active Records.` CROSS-REFERENCE: `354.1^AIVDT1^MUMPS` `1)= N IBX S IBX=^IBA(354.1,DA,0) I +X,$P(IBX,U,2),$P(IBX,U,3),$P(IBX,U,4)'="" S ^IBA(354.1,"AIVDT",+$P(IBX,U,3),+$P(IBX,U,2),-($P(IBX,U)),DA)=""` `2)= N IBX S IBX=^IBA(354.1,DA,0) K ^IBA(354.1,"AIVDT",+$P(IBX,U,3),+$P(IBX,U,2),-($P(IBX,U)),DA)` `If this is the active record, patient has been entered, type has been entered, status has been entered; set up an inverse cross reference.` `^iba(354.1,"aivdt",type,patient,inverse effective date,da)=""` CROSS-REFERENCE: `354.1^ACY2^MUMPS` `1)= I X,+$P(^IBA(354.1,DA,0),U,2),+$P(^(0),U,3),+^(0) S ^IBA(354.1,"ACY",+$P(^(0),U,3),+$P(^(0),U,2),+$E($P(^(0),U),1,3),DA)=""` `2)= K ^IBA(354.1,"ACY",+$P(^IBA(354.1,DA,0),U,3),+$P(^(0),U,2),+$E($P(^(0),U),1,3),DA)` `Cross-reference of all ACTIVE entries for a patient by calendar year (CY). This equates to $e(effective date,1,3).`
.11	ELECTRONIC SIGNATURE	0;11	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>20!($L(X)<6) X` OUTPUT TRANSFORM: `S Y(0)=Y S Y=""` LAST EDITED: `APR 22, 1993` HELP-PROMPT: `Answer must be 6-20 characters in length.` DESCRIPTION: `Enter your Electronic Signature. This field will be required whenever a user trys to create an exemption that is different from the exemption computed by the system. This would be required in order to create a hardship` `exemption.`
.12	SECOND ELECTRONIC SIGNATURE	0;12	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>40!($L(X)<3) X` LAST EDITED: `APR 22, 1993` HELP-PROMPT: `Answer must be 3-40 characters in length.` DESCRIPTION: `A second electronic signature for hardship exemptions will be implemented in a future release.`
.13	RETRO CANCEL BILLS START DATE	0;13	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:3991231X) X` LAST EDITED: `DEC 09, 1992` HELP-PROMPT: `TYPE A DATE BETWEEN 1/29/1992 AND 12/31/2099` DESCRIPTION: `If this exemption requires retroactively canceling prior charges, this is the beginning date for the retroactive cancellation. This must be tracked to prevent duplicate retroactive cancellations of the same charges.`
.14	RETRO CANCEL BILLS END DATE	0;14	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:3991231X) X` LAST EDITED: `JAN 13, 1993` HELP-PROMPT: `TYPE A DATE BETWEEN 1/29/1992 AND 12/31/2099` DESCRIPTION: `If this exemption requires retroactively canceling prior charges, this is the ending date for the retroactive cancellation. This must be tracked to prevent duplicate retroactive cancellations of the same charges.` CROSS-REFERENCE: `354.1^ACAN^MUMPS` `1)= I $P(^IBA(354.1,DA,0),"^",2) S ^IBA(354.1,"ACAN",$P(^(0),"^",2),-X,DA)=""` `2)= K ^IBA(354.1,"ACAN",$P(^IBA(354.1,DA,0),"^",2),-X,DA)` `3)= DO NOT DELETE` `This cross-reference is set whenever bills are retroactively canceled due to the medication copayment exemption patch. It is used to prevent canceling charges in AR for the same period. This is necessary because the` `direct link between IB and AR is not maintained for this functionality as it is necessary to remove admin and interest charges that may have accumulated.`
.15	PRIOR YEAR THRESHOLDS	0;15	DATE	INPUT TRANSFORM: `S %DT="E" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `JAN 26, 1993` DESCRIPTION: `This field will contain the date of the threshold used to calculate exemptions based on income only if the date of the threshold was over 1 year in the past. This will be used by the add threshold option to list and` `recompute these exemptions when new thresholds are entered.` CROSS-REFERENCE: `354.1^APRIOR` `1)= S ^IBA(354.1,"APRIOR",$E(X,1,30),DA)=""` `2)= K ^IBA(354.1,"APRIOR",$E(X,1,30),DA)` `This is a cross reference of all active exemptions created with prior year thresholds. It will be used when entering new thresholds to identfy patient exemptions in need of updating. It will be deleted by the IB` `INACTIVATE EXEMPTION TEMPLATE when creating a new exemption for this date.`
.16	REMINDER LETTER DATE	0;16	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `MAR 27, 1995` DESCRIPTION: `This field is used to indicate the date on which the income test reminder letter was printed, based on this exemption. This field is updated during the nightly background job which prints the letters. If this exemption` `is encountered after a letter has already been printed (based on this exemption) another letter will not be printed.`

External References

Name	Field # of Occurrence
^%DT	.01+1, .08+1, .13+1, .14+1, .15+1, .16+1
Y^DIQ	ID.02+1

Global Variables Directly Accessed

Name	Line Occurrences (* Changed, ! Killed)
^DD(354	ID.02+1
^IBA(354 - [#354]	ID.02+1
^IBA(354.1 - [#354.1]	.01(XREF 1S), .01(XREF 1K), .01(XREF 2S), .01(XREF 2K), .01(XREF 3S), .01(XREF 3K), .01(XREF 4S), .01(XREF 4K), .02(XREF 1S), .02(XREF 1K) , .02(XREF 2S), .02(XREF 2K), .02(XREF 3S), .02(XREF 3K), .02(XREF 4S), .02(XREF 4K), .02(XREF 5S), .02(XREF 5K), .03(XREF 1S), .03(XREF 1K) , .03(XREF 2S), .03(XREF 2K), .03(XREF 3S), .03(XREF 3K), .04(XREF 1S), .04(XREF 1K), .05(XREF 1S), .05(XREF 1K), .09(XREF 1S), .09(XREF 1K) , .1(XREF 1S), .1(XREF 1K), .1(XREF 2S), .1(XREF 2K), .1(XREF 3S), .1(XREF 3K), .14(XREF 1S), .14(XREF 1K), .15(XREF 1S), .15(XREF 1K)

Naked Globals

Name	Field # of Occurrence
^(0	ID.02+1, .01(XREF 2S), .01(XREF 2K), .01(XREF 3K), .01(XREF 4S), .01(XREF 4K), .02(XREF 2K), .02(XREF 4S), .02(XREF 4K), .02(XREF 5S) , .03(XREF 1K), .03(XREF 2S), .03(XREF 2K), .03(XREF 3S), .03(XREF 3K), .1(XREF 3S), .1(XREF 3K), .14(XREF 1S)

Local Variables

Legend:

>>	Not killed explicitly
*	Changed
!	Killed
~	Newed

Name	Field # of Occurrence
>> %DT	.01+1, .08+1, .13+1, .14+1, .15+1, .16+1
%I	ID.02+1*!
>> C	ID.02+1*
>> DA	.01(XREF 1S), .01(XREF 1K), .01(XREF 2S), .01(XREF 2K), .01(XREF 3S), .01(XREF 3K), .01(XREF 4S), .01(XREF 4K), .02(XREF 1S), .02(XREF 1K) , .02(XREF 2S), .02(XREF 2K), .02(XREF 3S), .02(XREF 3K), .02(XREF 4S), .02(XREF 4K), .02(XREF 5S), .02(XREF 5K), .03(XREF 1S), .03(XREF 1K) , .03(XREF 2S), .03(XREF 2K), .03(XREF 3S), .03(XREF 3K), .04(XREF 1S), .04(XREF 1K), .05(XREF 1S), .05(XREF 1K), .09(XREF 1S), .09(XREF 1K) , .1(XREF 1S), .1(XREF 1K), .1(XREF 2S), .1(XREF 2K), .1(XREF 3S), .1(XREF 3K), .14(XREF 1S), .14(XREF 1K), .15(XREF 1S), .15(XREF 1K)
>> DIC	ID.02+1, ID.04+1, ID.1+1
>> DIC("S"	.1SCR+1*
IBX	.01(XREF 3S), .02(XREF 2S), .03(XREF 1S), .1(XREF 2S), .1(XREF 2K)
U	ID.02+1, .01(XREF 2S), .01(XREF 2K), .01(XREF 3S), .01(XREF 3K), .01(XREF 4S), .01(XREF 4K), .02(XREF 2S), .02(XREF 2K), .02(XREF 4S) , .02(XREF 4K), .03(XREF 1S), .03(XREF 1K), .03(XREF 2S), .03(XREF 2K), .03(XREF 3S), .03(XREF 3K), .1(XREF 2S), .1(XREF 2K), .1(XREF 3S) , .1(XREF 3K)
X	.01+1!, .01(XREF 1S), .01(XREF 1K), .01(XREF 2S), .01(XREF 2K), .01(XREF 3K), .01(XREF 4S), .01(XREF 4K), .02(XREF 1S), .02(XREF 1K) , .02(XREF 2K), .02(XREF 3S), .02(XREF 3K), .02(XREF 4S), .02(XREF 4K), .02(XREF 5S), .02(XREF 5K), .03(XREF 1K), .03(XREF 2S), .03(XREF 2K) , .03(XREF 3S), .03(XREF 3K), .04(XREF 1S), .04(XREF 1K), .05(XREF 1S), .05(XREF 1K), .08+1!, .09(XREF 1S), .09(XREF 1K), .1(XREF 1S) , .1(XREF 1K), .1(XREF 2S), .1(XREF 3S), .11+1!, .12+1!, .13+1!, .14+1!, .14(XREF 1S), .14(XREF 1K), .15+1! , .15(XREF 1S), .15(XREF 1K), .16+1!
>> Y	ID.02+1, .01+1, .08+1, .11OT+1, .13+1, .14+1, .15+1, .16+1
>> Y(0	.11OT+1*

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