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Global: ^IBA(355.32

Package: Integrated Billing

Global: ^IBA(355.32

Information

FileMan FileNo	FileMan Filename	Package
355.32	PLAN COVERAGE LIMITATIONS	Integrated Billing

Description

This file contains the detail by plan and effective date of the categories that may be restricted for insurance coverage.

Accessed By FileMan Db Calls, Total: 8

Pointer To FileMan Files, Total: 3

Fields, Total: 9

Field #	Name	Loc	Type	Details
.01	PLAN	0;1	POINTER TO GROUP INSURANCE PLAN FILE (#355.3)	**********************REQUIRED FIELD********************** GROUP INSURANCE PLAN(#355.3) LAST EDITED: `AUG 16, 1995` HELP-PROMPT: `Enter the plan that this limitation applies to.` DESCRIPTION: `The plan that this limitation will apply to.` NOTES: `XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER` CROSS-REFERENCE: `355.32^B` `1)= S ^IBA(355.32,"B",$E(X,1,30),DA)=""` `2)= K ^IBA(355.32,"B",$E(X,1,30),DA)` CROSS-REFERENCE: `355.32^APCD^MUMPS` `1)= I $P($G(^IBA(355.32,DA,0)),U,2)'="",$P(^(0),U,3)'="" S ^IBA(355.32,"APCD",$E(X,1,30),$P(^IBA(355.32,DA,0),U,2),-$P(^IBA(355.32,DA,0),U,3),DA)=""` `2)= I $P($G(^IBA(355.32,DA,0)),U,2)'="",$P(^(0),U,3)'="" K ^IBA(355.32,DA,"APCD",$E(X,1,30),$P(^IBA(355.32,DA,0),U,2),-$P(^IBA(355.32,DA,0),U,3),DA)` `3)= DO NOT DELETE` `Multiple xref on plan, coverage, and -effective date` CROSS-REFERENCE: `^^TRIGGER^355.32^1.01` `1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^IBA(355.32,D0,1)):^(1),1:"") S X=$P(Y(1),U,1)="" I X S X=DIV S Y(1)=$S($D(^IBA(355.32,D0,1)):^(1),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y X ^DD(355.32,.01,1,3,1.1) X` `^DD(355.32,.01,1,3,1.4)` `1.1)= S X=DIV N %I,%H,% D NOW^%DTC S X=%` `1.4)= S DIH=$S($D(^IBA(355.32,DIV(0),1)):^(1),1:""),DIV=X S $P(^(1),U,1)=DIV,DIH=355.32,DIG=1.01 D ^DICR:$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^355.32^1.02` `1)= X ^DD(355.32,.01,1,4,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.32,D0,1)):^(1),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=DUZ X ^DD(355.32,.01,1,4,1.4)` `1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^IBA(355.32,D0,1)):^(1),1:"") S X=$S('$D(^VA(200,+$P(Y(1),U,2),0)):"",1:$P(^(0),U,1))=""` `1.4)= S DIH=$S($D(^IBA(355.32,DIV(0),1)):^(1),1:""),DIV=X S $P(^(1),U,2)=DIV,DIH=355.32,DIG=1.02 D ^DICR:$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.`
.02	COVERAGE CATEGORY	0;2	POINTER TO PLAN LIMITATION CATEGORY FILE (#355.31)	**********************REQUIRED FIELD********************** PLAN LIMITATION CATEGORY(#355.31) LAST EDITED: `AUG 08, 1995` HELP-PROMPT: `Enter the type of coverage that will be limited.` DESCRIPTION: `The type of coverage that the insurance company plan has reimbursement limits on.` CROSS-REFERENCE: `355.32^APCD1^MUMPS` `1)= I $P($G(^IBA(355.32,DA,0)),U)'="",$P(^(0),U,3)'="" S ^IBA(355.32,"APCD",$P(^IBA(355.32,DA,0),U),$E(X,1,30),-$P(^IBA(355.32,DA,0),U,3),DA)=""` `2)= I $P($G(^IBA(355.32,DA,0)),U)'="",$P(^(0),U,3)'="" K ^IBA(355.32,"APCD",$P(^IBA(355.32,DA,0),U),$E(X,1,30),-$P(^IBA(355.32,DA,0),U,3),DA)` `3)= DO NOT DELETE` `Multiple xref on plan, coverage, and -effective date`
.03	EFFECTIVE DATE	0;3	DATE	**********************REQUIRED FIELD********************** INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `JUL 27, 1995` HELP-PROMPT: `Enter the date that this limitation is effective.` DESCRIPTION: `The date on which the type of coverage for this limitation becomes limited for insurance billing purposes.` NOTES: `XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER` CROSS-REFERENCE: `355.32^APCD2^MUMPS` `1)= I $P($G(^IBA(355.32,DA,0)),U)'="",$P(^(0),U,2)'="" S ^IBA(355.32,"APCD",$P(^IBA(355.32,DA,0),U),$P(^IBA(355.32,DA,0),U,2),-$E(X,1,30),DA)=""` `2)= I $P($G(^IBA(355.32,DA,0)),U)'="",$P(^(0),U,2)'="" K ^IBA(355.32,"APCD",$P(^IBA(355.32,DA,0),U),$P(^IBA(355.32,DA,0),U,2),-$E(X,1,30),DA)` `3)= DO NOT DELETE` `Multiple xref on plan, coverage, and -effective date`
.04	COVERAGE STATUS	0;4	SET	**********************REQUIRED FIELD********************** '0' FOR NOT COVERED; '1' FOR COVERED; '2' FOR CONDITIONAL COVERAGE; LAST EDITED: `AUG 29, 1995` HELP-PROMPT: `The status of this coverage for this plan as of the effective date.` DESCRIPTION: `This is the status of the coverage associated with this record on the effective date associated with this record.`
1.01	DATE ENTERED	1;1	DATE	INPUT TRANSFORM: `S %DT="ETX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `AUG 16, 1995` DESCRIPTION: `This is the date this limitation was entered. It is triggered by the creation of this entry.` NOTES: `TRIGGERED by the PLAN field of the PLAN COVERAGE LIMITATIONS File`
1.02	ENTERED BY	1;2	POINTER TO NEW PERSON FILE (#200)	NEW PERSON(#200) LAST EDITED: `AUG 16, 1995` DESCRIPTION: `This is the user who created this entry. It is automatically triggered by the creation of this entry.` NOTES: `TRIGGERED by the PLAN field of the PLAN COVERAGE LIMITATIONS File`
1.03	DATE LAST EDITED	1;3	DATE	INPUT TRANSFORM: `S %DT="ETX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `AUG 16, 1995` DESCRIPTION: `This is the date this limitation was last edited. It is automatically updated any time the limitation is edited using one of the options provided.`
1.04	LAST EDITED BY	1;4	POINTER TO NEW PERSON FILE (#200)	NEW PERSON(#200) LAST EDITED: `JAN 12, 2024` HELP-PROMPT: `Enter the name of the person who last edited the entry.` DESCRIPTION: `This is the user who last edited this limitation. It is automatically updated any time a person edits this limitation using one of the options provided.` FIELD INDEX: `LAST (#1736) MUMPS LOOKUP & SORTING` `Short Descr: Multiple xref on PLAN, -DATE LAST EDITED, and LAST EDITED BY` `Description: Multiple xref on PLAN (#.01), -DATE LAST EDITIED (#1.03), and LAST EDITED BY (#1.04).` `Re-Indexing is not allowed due to possible corruption in the field. If a site has certain corrupted records this cross reference will not be rebuilt during a Re-Index. Cross reference was introduced with IB2.0763. If` `the cross reference needs to be rebuilt, use code to check that all field are NOT null then call the re-index function in FileMan for one entry. (Refer to NEWINDX^IBY771PO).` `Set Logic: S ^IBA(355.32,"LAST",X(3),-X(2),X,DA)=""` `Kill Logic: K ^IBA(355.32,"LAST",X(3),-X(2),X,DA)` `Whole Kill: K ^IBA(355.32,"LAST")` `X(1): LAST EDITED BY (355.32,1.04) (Subscr 1) (forwards)` `X(2): Computed Code: S X=$P($G(^IBA(355.32,DA,1)),U,3)` `X(3): Computed Code: S X=$P($G(^IBA(355.32,DA,0)),U)` `NO RE-INDEXING ALLOWED!`
2	LIMITATION COMMENT	2;0	Multiple #355.321	355.321

ICR, Total: 2

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