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Global: ^IBA(355.3

Package: Integrated Billing

Global: ^IBA(355.3


Information

FileMan FileNo FileMan Filename Package
355.3 GROUP INSURANCE PLAN Integrated Billing

Description

Accessed By FileMan Db Calls, Total: 79

Package Total Routines
Integrated Billing 75 IBBFAPI    IBCEF    IBCEQ1A    IBCMDT2    IBCNAU    IBCNBAC    IBCNBAR    IBCNBCD
IBCNBCD1    IBCNBLP    IBCNBLP1    IBCNBMN    IBCNBU1    IBCNEDE2    IBCNEDE3    IBCNERPD
IBCNETST    IBCNEUT5    IBCNEUT7    IBCNGP1    IBCNICB    IBCNICB2    IBCNIUF    IBCNIUHL
IBCNOR1    IBCNOR4    IBCNRP    IBCNRP5    IBCNRPM1    IBCNRPM2    IBCNRPMT    IBCNRPS2
IBCNRRP3    IBCNS    IBCNS1    IBCNSC0    IBCNSC3    IBCNSJ    IBCNSJ14    IBCNSJ2
IBCNSJ4    IBCNSJ5    IBCNSJ53    IBCNSJ54    IBCNSM    IBCNSM3    IBCNSM31    IBCNSM5
IBCNSP1    IBCNSP11    IBCNSP3    IBCNSU    IBCNSU21    IBCNSUR    IBCNSUR1    IBCNSUR2
IBCNSUR4    IBCNSUX    IBCNSUX1    IBCOPP2    IBNCPDP3    IBNCPDS1    IBNCPEV    IBNCPEV1
IBOTR3    IBRFN4    IBTRH1A    IBTRH2    IBTRH8    IBTRHLO    IBY137PO    IBY280PO
IBY399P4    IBY778PR    IBYAPT    
Prosthetics 3 RMPR9DM3    RMPRBIL    RMPRPFFS    
Enrollment Application System 1 EASEZPVI    

Pointed To By FileMan Files, Total: 10

Package Total FileMan Files
E Claims Management Engine 5 BPS ASLEEP PAYERS(#9002313.15)[.01]    BPS INSURER DATA(#9002313.78)[.08]    BPS CLAIMS(#9002313.02)[1.04]    BPS TRANSACTION(#9002313.59)[#9002313.59902(.01)]    BPS LOG OF TRANSACTIONS(#9002313.57)[#9002313.57902(.01)]    
Integrated Billing 4 PLAN COVERAGE LIMITATIONS(#355.32)[.01]    ANNUAL BENEFITS(#355.4)[.02]    INSURANCE CLAIMS YEAR TO DATE(#355.5)[.01]    IB NCPDP EVENT LOG(#366.14)[#366.141(.303), #366.1412(.02)]    
Registration 1 PATIENT(#2)[#2.312(.18)]    

Pointer To FileMan Files, Total: 6

Package Total FileMan Files
Integrated Billing 4 INSURANCE COMPANY(#36)[.01]    PLAN(#366.03)[6.01]    TYPE OF PLAN(#355.1)[.09]    INSURANCE FILING TIME FRAME(#355.13)[.16]    
Kernel 1 NEW PERSON(#200)[1.02, 1.04, 1.06, 1.08]    
Registration 1 PATIENT(#2)[.1]    

Fields, Total: 31

Field # Name Loc Type Details
.01 INSURANCE COMPANY 0;1 POINTER TO INSURANCE COMPANY FILE (#36)
************************REQUIRED FIELD************************
INSURANCE COMPANY(#36)

  • LAST EDITED:  JAN 25, 1995
  • DESCRIPTION:  
    Select the insurance company that this policy is with.
  • CROSS-REFERENCE:  355.3^B
    1)= S ^IBA(355.3,"B",$E(X,1,30),DA)=""
    2)= K ^IBA(355.3,"B",$E(X,1,30),DA)
  • CROSS-REFERENCE:  ^^TRIGGER^355.3^1.01
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^IBA(355.3,D0,1)):^(1),1:"") S X=$P(Y(1),U,1)="" I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,1)):^(1),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y X ^DD(355.3,.01,1,2,1.1) X ^DD
    (355.3,.01,1,2,1.4)
    1.1)= S X=DIV N %I,%H,% D NOW^%DTC S X=%
    1.4)= S DIH=$S($D(^IBA(355.3,DIV(0),1)):^(1),1:""),DIV=X S $P(^(1),U,1)=DIV,DIH=355.3,DIG=1.01 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= #1.01=""
    CREATE VALUE)= NOW
    DELETE VALUE)= NO EFFECT
    FIELD)= #1.01
    Triggers the date/time entered when creating a new entry.
  • CROSS-REFERENCE:  ^^TRIGGER^355.3^1.02
    1)= X ^DD(355.3,.01,1,3,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,1)):^(1),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=DUZ X ^DD(355.3,.01,1,3,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^IBA(355.3,D0,1)):^(1),1:"") S X=$S('$D(^VA(200,+$P(Y(1),U,2),0)):"",1:$P(^(0),U,1))=""
    1.4)= S DIH=$S($D(^IBA(355.3,DIV(0),1)):^(1),1:""),DIV=X S $P(^(1),U,2)=DIV,DIH=355.3,DIG=1.02 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= #1.02=""
    CREATE VALUE)= S X=DUZ
    DELETE VALUE)= NO EFFECT
    FIELD)= #1.02
    Triggers the user who created this entry.
  • CROSS-REFERENCE:  355.3^AGNA1^MUMPS
    1)= I $P(^IBA(355.3,DA,0),U,3)]"" S ^IBA(355.3,"AGNA",X,$P(^(0),U,3),DA)=""
    2)= I $P(^IBA(355.3,DA,0),U,3)]"" K ^IBA(355.3,"AGNA",X,$P(^(0),U,3),DA)
    Cross reference of insurance companies and group names.
  • CROSS-REFERENCE:  355.3^AGNU1^MUMPS
    1)= I $P(^IBA(355.3,DA,0),U,4)]"" S ^IBA(355.3,"AGNU",X,$P(^(0),U,4),DA)=""
    2)= I $P(^IBA(355.3,DA,0),U,4)]"" K ^IBA(355.3,"AGNU",X,$P(^(0),U,4),DA)
    Cross reference of insurance companies and group numbers.
  • CROSS-REFERENCE:  355.3^ACCP2^MUMPS
    1)= I $P(^IBA(355.3,DA,0),"^",3)]"" N Y S Y=$$COMP^IBCNSJ($P(^IBA(355.3,DA,0),"^",3)) I $L(Y) S ^IBA(355.3,"ACCP",+X,Y,DA)=""
    2)= I $P(^IBA(355.3,DA,0),"^",3)]"" N Y S Y=$$COMP^IBCNSJ($P(^IBA(355.3,DA,0),"^",3)) I $L(Y) K ^IBA(355.3,"ACCP",+X,Y,DA)
    Compresses entries by eliminating punctuation marks and leading zeroes, and converting lowercase to uppercase.
  • CROSS-REFERENCE:  355.3^ACCP3^MUMPS
    1)= I $P(^IBA(355.3,DA,0),"^",4)]"" N Y S Y=$$COMP^IBCNSJ($P(^IBA(355.3,DA,0),"^",4)) I $L(Y) S ^IBA(355.3,"ACCP",+X,Y,DA)=""
    2)= I $P(^IBA(355.3,DA,0),"^",4)]"" N Y S Y=$$COMP^IBCNSJ($P(^IBA(355.3,DA,0),"^",4)) I $L(Y) K ^IBA(355.3,"ACCP",+X,Y,DA)
    Cross-reference of the Plan company and compressed plan number.
    The "ACCP1" cross-reference in field #.04 is the companion cross-reference.
.02 IS THIS A GROUP POLICY? 0;2 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  MAY 25, 1993
  • HELP-PROMPT:  If this is a group plan answer "YES" so that other patients may be associated with it. If this is an individual plan answer "NO" and only the current patient can have this policy.
  • DESCRIPTION:  Some policies are individual policies and are specific to a patient. Many policies are group plans that many patients may have. If this is a group plan, answer 'YES' so that other patients may be associated with this
    policy. If this is an individual plan then answer 'NO' and only this patient can be associated with this policy.
.03 *GROUP NAME 0;3 FREE TEXT

  • INPUT TRANSFORM:  K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>20!($L(X)<2) X
  • LAST EDITED:  NOV 20, 2013
  • HELP-PROMPT:  Answer must be 2-20 characters in length.
  • DESCRIPTION:  If this is a group policy, enter the name of the group that this policy is associated with. This is the name that the insurance company uses to identify the plan. This will appear on the health claims forms in the
    appropriate blocks. It will also be used to help identify this policy so that other patients with the same plan can be associated with it.
    This field is scheduled for deletion in May 2015.
  • NOTES:  TRIGGERED by the GROUP NAME field of the GROUP INSURANCE PLAN File
  • CROSS-REFERENCE:  355.3^D
    1)= S ^IBA(355.3,"D",$E(X,1,30),DA)=""
    2)= K ^IBA(355.3,"D",$E(X,1,30),DA)
  • CROSS-REFERENCE:  355.3^AGNA^MUMPS
    1)= S:+^IBA(355.3,DA,0) ^IBA(355.3,"AGNA",+^(0),X,DA)=""
    2)= K ^IBA(355.3,"AGNA",+^IBA(355.3,DA,0),X,DA)
    Cross reference of insurance companies and group names.
  • CROSS-REFERENCE:  355.3^ACCP^MUMPS
    1)= N Y S Y=$$COMP^IBCNSJ(X) I $L(Y) S ^IBA(355.3,"ACCP",+^IBA(355.3,DA,0),Y,DA)=""
    2)= N Y S Y=$$COMP^IBCNSJ(X) I $L(Y) K ^IBA(355.3,"ACCP",+^IBA(355.3,DA,0),Y,DA)
    Compresses entries by eliminating punctuation marks and leading zeroes, and converting lowercase to uppercase.
  • CROSS-REFERENCE:  ^^TRIGGER^355.3^2.01
    1)= X ^DD(355.3,.03,1,4,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,2)):^(2),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X=DIV S X=$P(^IBA(355.3,DA,0),U,3) X ^DD(355.3,.03,1,4,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.3,DA,0),U,3)'=$E($P($G(^IBA(355.3,DA,2)),U),1,20))
    1.4)= S DIH=$G(^IBA(355.3,DIV(0),2)),DIV=X S $P(^(2),U,1)=DIV,DIH=355.3,DIG=2.01 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.3,DA,0),U,3)="") I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,2)):^(2),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" X ^DD(355.3,.03,1,4,2.4)
    2.4)= S DIH=$G(^IBA(355.3,DIV(0),2)),DIV=X S $P(^(2),U,1)=DIV,DIH=355.3,DIG=2.01 D ^DICR
    CREATE CONDITION)= S X=($P(^IBA(355.3,DA,0),U,3)'=$E($P($G(^IBA(355.3,DA,2)),U),1,20))
    CREATE VALUE)= S X=$P(^IBA(355.3,DA,0),U,3)
    DELETE CONDITION)= S X=($P(^IBA(355.3,DA,0),U,3)="")
    DELETE VALUE)= @
    FIELD)= GROUP NAME
    Triggers field 2.01 if first 20 chars of its value differ from the value in this field. Deletes field 2.01 if field .03 is deleted.
.04 *GROUP NUMBER 0;4 FREE TEXT

  • INPUT TRANSFORM:  I $D(X) K:$L(X)>17!($L(X)<2) X
  • LAST EDITED:  APR 27, 2020
  • HELP-PROMPT:  Answer must be 2-17 characters in length.
  • DESCRIPTION:  If this is a group policy enter the number which identifies this policy, i.e. group number/code that the insurance company uses to identify this plan.
    This field is scheduled for deletion in May 2015.
  • TECHNICAL DESCR:  DEVELOPERS, as long as there is a cross-reference calling the EVENT^IVMPLOG tag associated with this field, contact the Enrollment System (ES) leadership if your patch modification will result in mass updates to this field
    upon installation.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the GROUP NUMBER field of the GROUP INSURANCE PLAN File
  • CROSS-REFERENCE:  355.3^E
    1)= S ^IBA(355.3,"E",$E(X,1,30),DA)=""
    2)= K ^IBA(355.3,"E",$E(X,1,30),DA)
  • CROSS-REFERENCE:  355.3^AGNU^MUMPS
    1)= S:+^IBA(355.3,DA,0) ^IBA(355.3,"AGNU",+^(0),X,DA)=""
    2)= K ^IBA(355.3,"AGNU",+^IBA(355.3,DA,0),X,DA)
    Cross reference of insurance companies and group names.
  • CROSS-REFERENCE:  355.3^ACCP1^MUMPS
    1)= N Y S Y=$$COMP^IBCNSJ(X) I $L(Y) S ^IBA(355.3,"ACCP",+^IBA(355.3,DA,0),Y,DA)=""
    2)= N Y S Y=$$COMP^IBCNSJ(X) I $L(Y) K ^IBA(355.3,"ACCP",+^IBA(355.3,DA,0),Y,DA)
    Compresses entries by eliminating punctuation marks and leading zeroes, and converting lowercase to uppercase.
  • CROSS-REFERENCE:  355.3^AENR04^MUMPS
    1)= D EVENT^IVMPLOG($P($G(^IBA(355.3,DA,0)),U,10))
    2)= D EVENT^IVMPLOG($P($G(^IBA(355.3,DA,0)),U,10))
    3)= DO NOT DELETE
    This cross-reference is used to notify HEC of changes that may affect enrollment.
  • CROSS-REFERENCE:  ^^TRIGGER^355.3^2.02
    1)= X ^DD(355.3,.04,1,5,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,2)):^(2),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=$P(^IBA(355.3,DA,0),U,4) X ^DD(355.3,.04,1,5,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.3,DA,0),U,4)'=$E($P($G(^IBA(355.3,DA,2)),U,2),1,17))
    1.4)= S DIH=$G(^IBA(355.3,DIV(0),2)),DIV=X S $P(^(2),U,2)=DIV,DIH=355.3,DIG=2.02 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.3,DA,0),U,4)="") I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,2)):^(2),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(355.3,.04,1,5,2.4)
    2.4)= S DIH=$G(^IBA(355.3,DIV(0),2)),DIV=X S $P(^(2),U,2)=DIV,DIH=355.3,DIG=2.02 D ^DICR
    CREATE CONDITION)= S X=($P(^IBA(355.3,DA,0),U,4)'=$E($P($G(^IBA(355.3,DA,2)),U,2),1,17))
    CREATE VALUE)= S X=$P(^IBA(355.3,DA,0),U,4)
    DELETE CONDITION)= S X=($P(^IBA(355.3,DA,0),U,4)="")
    DELETE VALUE)= @
    FIELD)= GROUP NUMBER
    Triggers field 2.02 if first 17 chars of its value differ from the value in this field. Deletes field 2.02 if field .04 is deleted.
.05 IS UTILIZATION REVIEW REQUIRED 0;5 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  FEB 23, 1993
  • HELP-PROMPT:  Answer "YES" if this policy requires Utilization Review for all billable cases. Otherwise, answer "NO".
  • DESCRIPTION:  Answer "YES" if Utilization Review is required by the insurance company for this policy. Answer "NO" if it is not required. The UR staff will automatically be required to follow-up on all billable cases where this field
    is answered "YES". If the field is answered "NO" then UR follow-up will be considered optional.
.06 IS PRE-CERTIFICATION REQUIRED? 0;6 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  FEB 23, 1993
  • HELP-PROMPT:  Answer "YES" if pre-certification is required by this policy. Otherwise answer "NO".
  • DESCRIPTION:  Answer "YES" if this policy requires Pre-certification of all non-emergent admissions. Answer "NO" if pre-certification is not required. If pre-certification is required but not obtained, follow-up will be required by
    the MCCR tracking module.
.07 EXCLUDE PRE-EXISTING CONDITION 0;7 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  JUL 02, 1993
  • HELP-PROMPT:  Answer "YES" if this policy excludes any pre existing conditions. Otherwise answer "NO".
  • DESCRIPTION:  Answer "YES" if the policy excludes any pre existing conditions. Answer "NO" if the policy covers any pre existing conditions. If a patient has pre-exisiting conditions that are not covered they should be entered in the
    patient policy comment field.
.08 BENEFITS ASSIGNABLE? 0;8 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  FEB 23, 1993
  • DESCRIPTION:  
    If this policy will allow assignment of benefits then answer YES, otherwise answer NO. Normally this field will be answered YES. However, it may be useful to track policies that do not allow for assignment of benefits.
.09 TYPE OF PLAN 0;9 POINTER TO TYPE OF PLAN FILE (#355.1) TYPE OF PLAN(#355.1)

  • INPUT TRANSFORM:  S DIC("S")="I '$P(^(0),U,4)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JUL 11, 2022
  • HELP-PROMPT:  Enter the type of policy that best describes this policy.
  • DESCRIPTION:  Select the type of plan that best describes this plan. The type of policy will be used to determine if reimbursement for claims from the insurance carrier is appropriate. It will also be used to determine what other
    fields and displays are appropriate for this plan. If unknown or unsure, pick the more general type of plan.
  • SCREEN:  S DIC("S")="I '$P(^(0),U,4)"
  • EXPLANATION:  Active Types of Plans Only!
  • AUDIT:  YES, ALWAYS
  • CROSS-REFERENCE:  ^^TRIGGER^355.3^.14
    1)= X ^DD(355.3,.09,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,0)):^(0),1:"") S X=$P(Y(1),U,14),X=X S DIU=X K Y S X="" X ^DD(355.3,.09,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(355.3,.09,1,1,69.4) S X=X S Y=X,X=Y(107),X=X S X=X[Y,X=$S(Y(103):Y(105),Y(106):X) S D0=I(0,0)
    1.4)= S DIH=$S($D(^IBA(355.3,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,14)=DIV,DIH=355.3,DIG=.14 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= X ^DD(355.3,.09,1,1,2.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,0)):^(0),1:"") S X=$P(Y(1),U,14),X=X S DIU=X K Y S X="" X ^DD(355.3,.09,1,1,2.4)
    2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(355.3,.09,1,1,79.4) S X=X S Y=X,X=Y(107),X=X S X=X[Y,X=$S(Y(103):Y(105),Y(106):X) S D0=I(0,0)
    2.4)= S DIH=$S($D(^IBA(355.3,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,14)=DIV,DIH=355.3,DIG=.14 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    3)= Do not delete
    69.2)= S I(0,0)=$S($D(D0):D0,1:""),Y(2)=$S($D(^IBA(355.3,D0,0)):^(0),1:""),D0=Y(0) S:'$D(^IBE(355.1,+D0,0)) D0=-1 S Y(102)=$C(59)_$S($D(^DD(355.1,.03,0)):$P(^(0),U,3),1:"")
    69.3)= X ^DD(355.3,.09,1,1,69.2) S Y(101)=$S($D(^IBE(355.1,D0,0)):^(0),1:"") S X=$P($P(Y(102),$C(59)_$P(Y(101),U,3)_":",2),$C(59),1)="MEDICARE",Y(103)=X S X="ABC"
    69.4)= X ^DD(355.3,.09,1,1,69.3) S Y(104)=X S X=$P(Y(2),U,14),X=X S Y=X,X=Y(104),X=X S X=X'[Y,Y(105)=X S X=1,Y(106)=X S X="ABC",Y(107)=X S X=$P(Y(2),U,14)
    79.2)= S I(0,0)=$S($D(D0):D0,1:""),Y(1)=$S($D(^IBA(355.3,D0,0)):^(0),1:""),D0=$P(Y(1),U,9) S:'$D(^IBE(355.1,+D0,0)) D0=-1 S Y(102)=$C(59)_$S($D(^DD(355.1,.03,0)):$P(^(0),U,3),1:"")
    79.3)= X ^DD(355.3,.09,1,1,79.2) S Y(101)=$S($D(^IBE(355.1,D0,0)):^(0),1:"") S X=$P($P(Y(102),$C(59)_$P(Y(101),U,3)_":",2),$C(59),1)="MEDICARE",Y(103)=X S X="ABC"
    79.4)= X ^DD(355.3,.09,1,1,79.3) S Y(104)=X S X=$P(Y(1),U,14),X=X S Y=X,X=Y(104),X=X S X=X'[Y,Y(105)=X S X=1,Y(106)=X S X="ABC",Y(107)=X S X=$P(Y(1),U,14)
    CREATE CONDITION)= $S(TYPE OF PLAN:MAJOR CATEGORY="MEDICARE":"ABC"'[INTERNAL(PLAN CATEGORY),1:"ABC"[INTERNAL(PLAN CATEGORY))
    CREATE VALUE)= @
    DELETE CONDITION)= $S(TYPE OF PLAN:MAJOR CATEGORY="MEDICARE":"ABC"'[INTERNAL(PLAN CATEGORY),1:"ABC"[INTERNAL(PLAN CATEGORY))
    DELETE VALUE)= @
    FIELD)= PLAN CATEGORY
    This trigger makes sure that if the type of plan has a MEDICARE major category, the PLAN CATEGORY is either null or is A, B, or C. Also, if the type of plan does not have a MEDICARE major category, that the PLAN CATEGORY
    field is deleted.
.1 INDIVIDUAL POLICY PATIENT 0;10 POINTER TO PATIENT FILE (#2) PATIENT(#2)

  • LAST EDITED:  JUN 01, 1993
  • DESCRIPTION:  This is the patient associated with this policy if this is an individual policy.
    If this is an individual policy, the system will store the patient in this field. Only one patient may be associated with an individual policy. Many patients can be associated with a group policy.
.11 INACTIVE 0;11 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  NOV 02, 1994
  • HELP-PROMPT:  ENTER 'YES' IF THIS PLAN IS INACTIVE AND SHOULD NO LONGER BE ALLOWED FOR SELECTION.
  • DESCRIPTION:  
    If this plan is no longer active in your area, enter INACTIVE here. This will disallow users from selecting this entry.
.12 AMBULATORY CARE CERTIFICATION 0;12 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  AUG 13, 1997
  • HELP-PROMPT:  Answer "YES" if certification is required by this plan for ambulatory care.
  • DESCRIPTION:  
    Answer "YES" if this plan requires certification of ambulatory procedures. This may include Ambulatory surgeries, CAT scans, MRI, non-invasive procedures, etc.
.13 PLAN FILING TIME FRAME 0;13 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  SEP 03, 1997
  • HELP-PROMPT:  Enter maximum amount of time from date of service that this Plan allows for submitting a claim. Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the maximum amount of time from the date of service to submission of the claim allowed by this Insurance Plan. Examples: 60 days, 90 days, 6 months, 1 year, March 30 following year of service.
.14 PLAN CATEGORY 0;14 SET
  • 'A' FOR MEDICARE PART A;
  • 'B' FOR MEDICARE PART B;
  • 'C' FOR MEDICARE OTHER;

  • LAST EDITED:  JUL 30, 1998
  • HELP-PROMPT:  Select the specific type of Category this MEDICARE plan covers.
  • DESCRIPTION:  
    If the Type of Plan's Major Category is MEDICARE, this field should contain the specific type of coverage that this plan represents.
  • SCREEN:  S DIC("S")="I $$CATOK^IBCEMRA(Y)"
  • EXPLANATION:  Type of plan Major Category must equal MEDICARE
  • NOTES:  TRIGGERED by the TYPE OF PLAN field of the GROUP INSURANCE PLAN File
.15 ELECTRONIC PLAN TYPE 0;15 SET
  • '16' FOR HMO MEDICARE;
  • 'MX' FOR MEDICARE A or B;
  • 'TV' FOR TITLE V;
  • 'MC' FOR MEDICAID;
  • 'BL' FOR BC/BS;
  • 'CH' FOR TRICARE;
  • '15' FOR INDEMNITY;
  • 'CI' FOR COMMERCIAL;
  • 'HM' FOR HMO;
  • 'DS' FOR DISABILITY;
  • '12' FOR PPO;
  • '13' FOR POS;
  • 'ZZ' FOR OTHER;
  • 'FI' FOR FEP - Do not use for BC/BS;
  • '17' FOR DENTAL;

  • LAST EDITED:  MAY 22, 2014
  • HELP-PROMPT:  Enter the appropriate type of plan to be used for electronic billing.
  • DESCRIPTION:  
    This field contains the X12 data to identify the source of pay type.
  • TECHNICAL DESCR:  
    This field must be consistent with the ELECTRONIC TYPE OF INSURANCE (#3.09) field in the INSURANCE COMPANY (#36) file.
.16 PLAN STANDARD FTF 0;16 POINTER TO INSURANCE FILING TIME FRAME FILE (#355.13) INSURANCE FILING TIME FRAME(#355.13)

  • LAST EDITED:  APR 02, 2015
  • HELP-PROMPT:  Enter the maximum standard filing time frame for this plan.
  • DESCRIPTION:  
    This is the standard filing time frame for the insurance plan. It may be automatically applied to dates of service.
  • AUDIT:  YES, ALWAYS
  • CROSS-REFERENCE:  ^^TRIGGER^355.3^.17
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.3,D0,0)):^(0),1:"") S X=$P(Y(1),U,17),X=X S DIU=X K Y S X="" S DIH=$G(^IBA(355.3,DIV(0),0)),DIV=X S $P(^(0),U,17)=DIV,DIH=355.3,DIG=.17 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.3,D0,0)):^(0),1:"") S X=$P(Y(1),U,17),X=X S DIU=X K Y S X="" S DIH=$G(^IBA(355.3,DIV(0),0)),DIV=X S $P(^(0),U,17)=DIV,DIH=355.3,DIG=.17 D ^DICR
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= PLAN STANDARD FTF VALUE
    When changing or deleting Standard Filing Time Frame delete the corresponding Value.
.17 PLAN STANDARD FTF VALUE 0;17 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999)!(X<0)!(X?.E1"."2N.N) X
  • LAST EDITED:  APR 02, 2015
  • HELP-PROMPT:  Type a Number between 0 and 999999, 1 Decimal Digit
  • DESCRIPTION:  
    Enter the value corresponding to the Standard Filing Time Frame. For example, for the time frame of Days, enter the number of days.
  • AUDIT:  YES, ALWAYS
  • NOTES:  TRIGGERED by the PLAN STANDARD FTF field of the GROUP INSURANCE PLAN File
1.01 DATE ENTERED 1;1 DATE

  • INPUT TRANSFORM:  S %DT="ESTX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  NOV 02, 1993
  • DESCRIPTION:  
    This is the date that this policy was entered. It is triggered by the creation of this entry.
  • NOTES:  TRIGGERED by the INSURANCE COMPANY field of the GROUP INSURANCE PLAN File
1.02 ENTERED BY 1;2 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JUN 03, 1993
  • DESCRIPTION:  
    This is the user who created this entry. It is automatically triggered by the creation of this entry.
  • NOTES:  TRIGGERED by the INSURANCE COMPANY field of the GROUP INSURANCE PLAN File
1.03 DATE LAST VERIFIED 1;3 DATE

  • INPUT TRANSFORM:  S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 03, 1993
  • DESCRIPTION:  This is the date that this policy was last verified. A policy is verified by selecting the Verify Policy Action on the Patient Insurance Management screen. Generally this is the last time that somebody contacted the
    insurance company and verified that policy information is correct.
1.04 VERIFIED BY 1;4 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JUN 03, 1993
  • DESCRIPTION:  
    This is the user who last verified that the policy information is correct.
1.05 DATE LAST EDITED 1;5 DATE

  • INPUT TRANSFORM:  S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 03, 1993
  • DESCRIPTION:  
    This is the date that this policy was last edited. It is automatically updated any time a policy is editing using one of the options provided.
1.06 LAST EDITED BY 1;6 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JUN 03, 1993
  • DESCRIPTION:  
    This is the user who last edited this policy. It is automatically updated everytime a policy is edited using one of the options.
1.07 DATE LAST MATCHED 1;7 DATE

  • INPUT TRANSFORM:  S %DT="ESTX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  JUL 05, 2018
  • HELP-PROMPT:  (No range limit on date)
  • DESCRIPTION:  
    This is the date the policy was last matched.
1.08 LAST MATCHED BY 1;8 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JUL 05, 2018
  • DESCRIPTION:  
    This is the user who last matched the policy.
2.01 GROUP NAME 2;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<2)!'$$LENCHK^IBCNEUT1(X,20,0) X
  • LAST EDITED:  APR 02, 2015
  • HELP-PROMPT:  Answer must be 2-20 characters in length.
  • DESCRIPTION:  If this is a group policy, enter the name of the group that this policy is associated with. This is the name that the insurance company uses to identify the plan. This will appear on the health claims forms in the
    appropriate blocks. It will also be used to help identify this policy so that other patients with the same plan can be associated with it.
  • TECHNICAL DESCR:  
    Replaces field .03. Length of this field is temporarily limited to 20 characters.
  • AUDIT:  YES, ALWAYS
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the *GROUP NAME field of the GROUP INSURANCE PLAN File
  • CROSS-REFERENCE:  ^^TRIGGER^355.3^.03
    1)= X ^DD(355.3,2.01,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,0)):^(0),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV S X=$E($P(^IBA(355.3,DA,2),U),1,20) X ^DD(355.3,2.01,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.3,DA,0),U,3)'=$E($P(^IBA(355.3,DA,2),U),1,20))
    1.4)= S DIH=$G(^IBA(355.3,DIV(0),0)),DIV=X S $P(^(0),U,3)=DIV,DIH=355.3,DIG=.03 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.3,DA,2),U)="") I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,0)):^(0),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(355.3,2.01,1,1,2.4)
    2.4)= S DIH=$G(^IBA(355.3,DIV(0),0)),DIV=X S $P(^(0),U,3)=DIV,DIH=355.3,DIG=.03 D ^DICR
    CREATE CONDITION)= S X=($P(^IBA(355.3,DA,0),U,3)'=$E($P(^IBA(355.3,DA,2),U),1,20))
    CREATE VALUE)= S X=$E($P(^IBA(355.3,DA,2),U),1,20)
    DELETE CONDITION)= S X=($P(^IBA(355.3,DA,2),U)="")
    DELETE VALUE)= @
    FIELD)= *GROUP NAME
    Triggers field .03 if its value differs from first 20 chars of the value in this field. Deletes field .03 if field 2.01 is deleted.
2.02 GROUP NUMBER 2;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>55!($L(X)<2)!'$$LENCHK^IBCNEUT1(X,17,0) X
  • LAST EDITED:  APR 27, 2020
  • HELP-PROMPT:  Answer must be 2-17 characters in length.
  • DESCRIPTION:  
    If this is a group policy enter the number which identifies this policy, i.e. group number/code that the insurance company uses to identify this plan.
  • TECHNICAL DESCR:  DEVELOPERS, as long as there is a trigger to another field which has a cross-reference calling the EVENT^IVMPLOG tag, contact the Enrollment System (ES) leadership if your patch modification will result in mass updates to
    this field upon installation.
    Replaces field .04. Length of this field is temporarily limited to 17 characters.
  • AUDIT:  YES, ALWAYS
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the *GROUP NUMBER field of the GROUP INSURANCE PLAN File
  • CROSS-REFERENCE:  ^^TRIGGER^355.3^.04
    1)= X ^DD(355.3,2.02,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X=DIV S X=$E($P(^IBA(355.3,DA,2),U,2),1,17) X ^DD(355.3,2.02,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.3,DA,0),U,4)'=$E($P(^IBA(355.3,DA,2),U,2),1,17))
    1.4)= S DIH=$G(^IBA(355.3,DIV(0),0)),DIV=X S $P(^(0),U,4)=DIV,DIH=355.3,DIG=.04 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.3,DA,2),U,2)="") I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X="" X ^DD(355.3,2.02,1,1,2.4)
    2.4)= S DIH=$G(^IBA(355.3,DIV(0),0)),DIV=X S $P(^(0),U,4)=DIV,DIH=355.3,DIG=.04 D ^DICR
    CREATE CONDITION)= S X=($P(^IBA(355.3,DA,0),U,4)'=$E($P(^IBA(355.3,DA,2),U,2),1,17))
    CREATE VALUE)= S X=$E($P(^IBA(355.3,DA,2),U,2),1,17)
    DELETE CONDITION)= S X=($P(^IBA(355.3,DA,2),U,2)="")
    DELETE VALUE)= @
    FIELD)= *GROUP NUMBER
    Triggers field .04 if its value differs from first 17 chars of the value in this field. Deletes field .04 if field 2.02 is deleted.
6.01 PLAN ID 6;1 POINTER TO PLAN FILE (#366.03) PLAN(#366.03)

  • LAST EDITED:  NOV 10, 2003
  • HELP-PROMPT:  Enter the Group Insurance Plan's Plan ID.
  • DESCRIPTION:  
    The Group Insurance Plan's Plan ID.
6.02 BANKING IDENTIFICATION NUMBER 6;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  APR 08, 2004
  • HELP-PROMPT:  Enter the Plan's Banking Identification Number (BIN). Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    The Plan's Banking Identification Number (BIN). Used for NCPDP transmissions.
6.03 PROCESSOR CONTROL NUMBER (PCN) 6;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  APR 08, 2004
  • HELP-PROMPT:  Enter the Plan's Processor Control Number (PCN). Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    The Plan's Processor Control Number (PCN). Used for NCPDP transmissions.
11 COMMENTS 11;0 WORD-PROCESSING #355.311

  • DESCRIPTION:  
    Enter comments that are specific to this group plan. Do not enter comments about a specific patient or patient care here.
  • LAST EDITED:  NOV 09, 1993
  • HELP-PROMPT:  Enter comments specific to this Group Plan. These comments will pertain to multiple patients who have this same group plan.

ICR, Total: 4

ICR LINK Subscribing Package(s) Fields Referenced Description
ICR #952
  • Income Verification Match
    		•  IS PRE-CERTIFICATION REQUIRED? (.06).
    Access: Write w/Fileman

    TYPE OF PLAN (.09).
    Access: Write w/Fileman
    ICR #3823
  • Accounts Receivable
  • Prosthetics
    		•  GROUP NAME (.03).
    Access: Direct Global Read & w/Fileman

    GROUP NUMBER (.04).
    Access: Direct Global Read & w/Fileman

    TYPE OF PLAN (.09).
    Access: Direct Global Read & w/Fileman
    ICR #5293
  • Insurance Capture Buffer
    		•
    ICR #7304
  • Lighthouse
    		•  INSURANCE COMPANY (.01).
    Access: Both R/W w/Fileman

    IS THIS A GROUP POLICY (.02).
    Access: Both R/W w/Fileman

    IS UTILIZATION REVIEW REQUIRED (.05).
    Access: Both R/W w/Fileman

    IS PRE-CERTIFICATION REQUIRED? (.06).
    Access: Both R/W w/Fileman

    BENEFITS ASSIGNABLE? (.08).
    Access: Both R/W w/Fileman

    TYPE OF PLAN (.09).
    Access: Both R/W w/Fileman

    INDIVIDUAL POLICY PATIENT (.1).
    Access: Both R/W w/Fileman

    INACTIVE (.11).
    Access: Read w/Fileman

    AMBULATORY CARE CERTIFICATION (.12).
    Access: Both R/W w/Fileman

    PLAN FILING TIME FRAME (.13).
    Access: Both R/W w/Fileman

    PLAN CATEGORY (.14).
    Access: Both R/W w/Fileman

    ELECTRONIC PLAN TYPE (.15).
    Access: Both R/W w/Fileman

    PLAN STANDARD FTF (.16).
    Access: Both R/W w/Fileman

    PLAN STANDARD FTF VALUE (.17).
    Access: Both R/W w/Fileman

    DATE LAST VERIFIED (1.03).
    Access: Write w/Fileman

    VERIFIED BY (1.04).
    Access: Write w/Fileman

    DATE LAST EDITED (1.05).
    Access: Write w/Fileman

    LAST EDITED BY (1.06).
    Access: Write w/Fileman

    GROUP NAME (2.01).
    Access: Both R/W w/Fileman

    GROUP NUMBER (2.02).
    Access: Both R/W w/Fileman

    PLAN ID (6.01).
    Access: Both R/W w/Fileman

    BANKING IDENTIFICATION NUMBER (6.02).
    Access: Both R/W w/Fileman

    PROCESSOR CONTROL NUMBER (6.03).
    Access: Both R/W w/Fileman

    COMMENTS (.01).
    Access: Both R/W w/Fileman
    Info |  Desc |  Accessed By FileMan Db Calls |  Pointed To By FileMan Files |  Pointer To FileMan Files |  Fields |  ICR  | All