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Global: ^IBA(355.33

Package: Integrated Billing

Global: ^IBA(355.33


Information

FileMan FileNo FileMan Filename Package
355.33 INSURANCE VERIFICATION PROCESSOR Integrated Billing

Description

Accessed By FileMan Db Calls, Total: 37

Package Total Routines
Integrated Billing 36 IBCNBAC    IBCNBAR    IBCNBCD    IBCNBCD5    IBCNBED    IBCNBEE    IBCNBLA1    IBCNBLE
IBCNBLE1    IBCNBLP    IBCNBMI    IBCNBPG    IBCNBU1    IBCNEDE1    IBCNEDE7    IBCNEHL1
IBCNEHL5    IBCNEHL6    IBCNEHLQ    IBCNERTC    IBCNERTQ    IBCNERTU    IBCNETST    IBCNEUT2
IBCNEUT3    IBCNEUT4    IBCNEUT7    IBCNICB    IBCNICB2    IBCNOR2    IBCNRDV    IBCNSBL1
IBJPI2    IBRBUL    IBY659PO    IBY778PR    
Scheduling 1 SDESPATRPC    

Pointed To By FileMan Files, Total: 3

Package Total FileMan Files
Integrated Billing 3 IIV RESPONSE(#365)[.04]    IIV TRANSMISSION QUEUE(#365.1)[.05]    INTERFACILITY INSURANCE UPDATE(#365.19)[1.05, 2.03]    

Pointer To FileMan Files, Total: 10

Package Total FileMan Files
Integrated Billing 4 TYPE OF PLAN(#355.1)[40.09]    SOURCE OF INFORMATION(#355.12)[.03]    X12 271 SERVICE TYPE(#365.013)[80.01, 80.02, 80.03, 80.04, 80.05, 80.06, 80.07, 80.08, 80.09, 80.1, 80.11, 80.12, 80.13, 80.14, 80.15, 80.16, 80.17, 80.18, 80.19, 80.2]    IIV STATUS TABLE(#365.15)[.12]    
Kernel 3 INSTITUTION(#4)[.14]    STATE(#5)[21.05, 61.1, 62.05]
NEW PERSON(#200)[.02, .06, .11]
E Claims Management Engine 2 BPS NCPDP PATIENT RELATIONSHIP CODE(#9002313.19)[60.15]    BPS RESPONSES(#9002313.03)[.17]    
Registration 1 PATIENT(#2)[60.01]    

Fields, Total: 101

Field # Name Loc Type Details
.01 DATE ENTERED 0;1 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  SEP 09, 1998
  • HELP-PROMPT:  Enter the date this entry is added to the Insurance Buffer file.
  • DESCRIPTION:  
    This is the date this entry is added to the buffer file.
  • CROSS-REFERENCE:  355.33^B
    1)= S ^IBA(355.33,"B",$E(X,1,30),DA)=""
    2)= K ^IBA(355.33,"B",$E(X,1,30),DA)
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^.02
    1)= X ^DD(355.33,.01,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=DUZ X ^DD(355.33,.01,1,2,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$S('$D(^VA(200,+$P(Y(1),U,2),0)):"",1:$P(^(0),U,1))=""
    1.4)= S DIH=$S($D(^IBA(355.33,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,2)=DIV,DIH=355.33,DIG=.02 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= ENTERED BY=""
    CREATE VALUE)= S X=DUZ
    DELETE VALUE)= NO EFFECT
    FIELD)= ENTERED BY
    Set Entered By to the user who created the entry.
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^.04
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(355.33,.01,1,3,69.2) S X=X="" I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X=DIV S X="E" X ^DD(355.33,.01,1,3,1.4)
    1.4)= S DIH=$S($D(^IBA(355.33,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,4)=DIV,DIH=355.33,DIG=.04 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    69.2)= S Y(2)=$C(59)_$S($D(^DD(355.33,.04,0)):$P(^(0),U,3),1:""),Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,4)_":",2),$C(59),1)
    CREATE CONDITION)= STATUS=""
    CREATE VALUE)= S X="E"
    DELETE VALUE)= NO EFFECT
    FIELD)= STATUS
    Set initial Status to Entered.
  • CROSS-REFERENCE:  355.33^AEST^MUMPS
    1)= I $P($G(^IBA(355.33,DA,0)),U,4)'="" S ^IBA(355.33,"AEST",$P(^(0),U,4),X,DA)=""
    2)= I $P($G(^IBA(355.33,DA,0)),U,4)'="" K ^IBA(355.33,"AEST",$P(^(0),U,4),X,DA)
    Cross reference by Status and Date Entered.
  • CROSS-REFERENCE:  355.33^AFST^MUMPS
    1)= S ^IBA(355.33,"AFST","E",X,DA)=""
    2)= K ^IBA(355.33,"AFST","E",X,DA)
    Cross reference of all entries by action and date of action.
.02 ENTERED BY 0;2 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter the user that added this entry.
  • DESCRIPTION:  
    This is the user of the source package that entered this insurance entry.
  • NOTES:  TRIGGERED by the DATE ENTERED field of the INSURANCE VERIFICATION PROCESSOR File
.03 SOURCE OF INFORMATION 0;3 POINTER TO SOURCE OF INFORMATION FILE (#355.12) SOURCE OF INFORMATION(#355.12)

  • OUTPUT TRANSFORM:  S Y=$$GET1^DIQ(355.12,Y_",",.02,"E")
  • LAST EDITED:  OCT 31, 2006
  • HELP-PROMPT:  Enter the source by which this insurance information was obtained.
  • DESCRIPTION:  
    This is the source by which this insurance information was obtained.
.04 STATUS 0;4 SET
  • 'E' FOR ENTERED;
  • 'A' FOR ACCEPTED;
  • 'R' FOR REJECTED;

  • LAST EDITED:  SEP 22, 1999
  • HELP-PROMPT:  Enter the status of this entry.
  • DESCRIPTION:  This is the status of this insurance entry.
    E - Entered Locally but not yet processed
    A - Processed and Accepted, data moved to Insurance files
    R - Processed and Rejected, data Not moved to Insurance files
    When an entry is processed most of the data is deleted from the Insurance Buffer file. Entries with a status of Accepted or Rejected will only have stub entries in this file for reporting and tracking purposes.
  • NOTES:  TRIGGERED by the DATE ENTERED field of the INSURANCE VERIFICATION PROCESSOR File
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^.05
    1)= X ^DD(355.33,.04,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y X ^DD(355.33,.04,1,1,1.1) X ^DD(355.33,.04,1,1,1.4)
    1.1)= S X=DIV N %I,%H,% D NOW^%DTC S X=%
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(355.33,.04,1,1,69.3) S X=X="REJECTED",Y=X,X=Y(4),X=X!Y,Y=X,X=Y(2),X=X&Y
    1.4)= S DIH=$S($D(^IBA(355.33,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,5)=DIV,DIH=355.33,DIG=.05 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    69.2)= S Y(3)=$C(59)_$S($D(^DD(355.33,.04,0)):$P(^(0),U,3),1:""),Y(5)=$C(59)_$S($D(^DD(355.33,.04,0)):$P(^(0),U,3),1:""),Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"")
    69.3)= X ^DD(355.33,.04,1,1,69.2) S X=$P(Y(1),U,5)="",Y(2)=X S X=$P($P(Y(3),$C(59)_Y(0)_":",2),$C(59),1)="ACCEPTED",Y(4)=X S X=$P($P(Y(5),$C(59)_Y(0)_":",2),$C(59),1)
    CREATE CONDITION)= (DATE PROCESSED="")&(STATUS="ACCEPTED"!(STATUS="REJECTED"))
    CREATE VALUE)= NOW
    DELETE VALUE)= NO EFFECT
    FIELD)= DATE PROCESSED
    Set Date Processed when Status is changed.
  • CROSS-REFERENCE:  355.33^AEST1^MUMPS
    1)= I +$P($G(^IBA(355.33,DA,0)),U,1) S ^IBA(355.33,"AEST",X,+$P(^(0),U,1),DA)=""
    2)= I +$P($G(^IBA(355.33,DA,0)),U,1) K ^IBA(355.33,"AEST",X,+$P(^(0),U,1),DA)
    Cross reference by Status and Date Entered.
.05 DATE PROCESSED 0;5 DATE

  • INPUT TRANSFORM:  S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  SEP 09, 1998
  • HELP-PROMPT:  Enter the date this entry is processed by insurance personnel.
  • DESCRIPTION:  
    This is the date authorized insurance personnel either accepted or rejected the information in this entry.
  • NOTES:  TRIGGERED by the STATUS field of the INSURANCE VERIFICATION PROCESSOR File
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^.06
    1)= X ^DD(355.33,.05,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X=DIV S X=DUZ X ^DD(355.33,.05,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$S('$D(^VA(200,+$P(Y(1),U,6),0)):"",1:$P(^(0),U,1))=""
    1.4)= S DIH=$S($D(^IBA(355.33,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,6)=DIV,DIH=355.33,DIG=.06 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= PROCESSED BY=""
    CREATE VALUE)= S X=DUZ
    DELETE VALUE)= NO EFFECT
    FIELD)= PROCESSED BY
    Set Processed By to the user who processed the entry.
  • CROSS-REFERENCE:  355.33^AFST1^MUMPS
    1)= I $P($G(^IBA(355.33,DA,0)),U,4)'="" S ^IBA(355.33,"AFST",$P(^(0),U,4),X,DA)=""
    2)= I $P($G(^IBA(355.33,DA,0)),U,4)'="" K ^IBA(355.33,"AFST",$P(^(0),U,4),X,DA)
    Cross reference of all entries by action and date of action.
.06 PROCESSED BY 0;6 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter the insurance user who processed this entry.
  • DESCRIPTION:  
    This is the insurance user who accepted or rejected this entry.
  • NOTES:  TRIGGERED by the DATE PROCESSED field of the INSURANCE VERIFICATION PROCESSOR File
.07 NEW COMPANY 0;7 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter Yes if this entry resulted in a new Insurance Company.
  • DESCRIPTION:  
    This flag indicates if this buffer entry resulted in a new Insurance Company being created. This will only be Yes if the buffer entry was accepted and a new Insurance Company entry was added to the Insurance Company File.
.08 NEW GROUP/PLAN 0;8 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter Yes if this entry resulted in a new Insurance Group/Plan.
  • DESCRIPTION:  
    This flag indicates if this buffer entry resulted in a new Group/Plan being created. This will only be Yes if the buffer entry was accepted and a new Group/Plan entry was added to the Group Insurance Plan file.
.09 NEW POLICY 0;9 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter Yes if this entry resulted in a new Insurance Policy for this patient.
  • DESCRIPTION:  
    This flag indicates if this buffer entry resulted in a new Patient Insurance Policy being created. This will only be Yes if the buffer entry was accepted and a new Policy entry was added for this patient.
.1 DATE VERIFIED 0;10 DATE

  • INPUT TRANSFORM:  S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  SEP 22, 1999
  • HELP-PROMPT:  This is the date the Buffer entry is verified by insurance personnel.
  • DESCRIPTION:  
    This is the date insurance personnel verified this insurance information is correct. This will only be used if the verification step was completed separately from the acceptance step of the process.
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^.11
    1)= X ^DD(355.33,.1,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,11),X=X S DIU=X K Y S X=DIV S X=DUZ X ^DD(355.33,.1,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$S('$D(^VA(200,+$P(Y(1),U,11),0)):"",1:$P(^(0),U,1))=""
    1.4)= S DIH=$S($D(^IBA(355.33,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,11)=DIV,DIH=355.33,DIG=.11 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= VERIFIED BY=""
    CREATE VALUE)= S X=DUZ
    DELETE VALUE)= NO EFFECT
    FIELD)= VERIFIED BY
    Set Verified By to the user who verified the entry.
  • CROSS-REFERENCE:  355.33^AFST2^MUMPS
    1)= S ^IBA(355.33,"AFST","V",X,DA)=""
    2)= K ^IBA(355.33,"AFST","V",X,DA)
    Cross reference of all entries by action and date of action.
.11 VERIFIED BY 0;11 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  AUG 04, 1998
  • HELP-PROMPT:  This is the insurance user who verified this insurance information.
  • DESCRIPTION:  
    This is the insurance user that verified this insurance information is correct. This should only be entered if the entry is verified before it is accepted.
  • NOTES:  TRIGGERED by the DATE VERIFIED field of the INSURANCE VERIFICATION PROCESSOR File
.12 IIV STATUS 0;12 POINTER TO IIV STATUS TABLE FILE (#365.15) IIV STATUS TABLE(#365.15)

  • LAST EDITED:  APR 14, 2003
  • HELP-PROMPT:  Enter the IIV status associated with this buffer entry.
  • DESCRIPTION:  This field is a pointer to the IIV STATUS TABLE file. This identifies the visual symbol that should appear in the IIV status column in the insurance buffer listing of entries. The symbols appear next to the patient name
    to indicate the current stage within the electronic verification process.
.13 OVERRIDE FRESHNESS FLAG 0;13 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  JUL 08, 2002
  • HELP-PROMPT:  Enter Yes to force an electronic transmission of this entry.
  • DESCRIPTION:  The presence of this flag will alert the Buffer extract process and also the process that electronically transmits the insurance verification request, that this buffer entry should get transmitted and sent to the Payer -
    bypassing the National Insurance Cache. This is regardless of the freshness date or of any other data elements. This flag trumps everything else in the electronic verification process.
.14 REMOTE LOCATION 0;14 POINTER TO INSTITUTION FILE (#4) INSTITUTION(#4)

  • LAST EDITED:  JUL 15, 2003
  • HELP-PROMPT:  Specify the facility where this insurance information came from.
  • DESCRIPTION:  
    This is the remote location from where this insurance information was gathered from. This field is optional and will only be completed if the information came from a remote facility.
.15 IIV PROCESSED DATE 0;15 DATE

  • INPUT TRANSFORM:  S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUL 22, 2003
  • HELP-PROMPT:  This is the date the response was received using eIIV.
  • DESCRIPTION:  
    This date/time field is automatically updated when a response is received using the electronic insurance eligibility communications via the IIV software.
.16 REAL TIME VERIFICATION 0;16 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  SEP 13, 2010
  • HELP-PROMPT:  Is the buffer entry verified by real time verification?
  • DESCRIPTION:  
    Flag that indicates if Real Time Verification processed and verified this insurance buffer entry.
  • TECHNICAL DESCR:  
    Real Time Verification flag is set to 1 for YES if the insurance buffer entry was successfully verified by Real Time Verification.
    SOURCE OF DATA: SET BY THE REAL TIME VERIFICATION PROCESS
  • NOTES:  TRIGGERED by the INSURANCE COMPANY NAME field of the INSURANCE VERIFICATION PROCESSOR File
    TRIGGERED by the *GROUP NAME field of the INSURANCE VERIFICATION PROCESSOR File
    TRIGGERED by the *GROUP NUMBER field of the INSURANCE VERIFICATION PROCESSOR File
    TRIGGERED by the PATIENT NAME field of the INSURANCE VERIFICATION PROCESSOR File
    TRIGGERED by the *SUBSCRIBER ID field of the INSURANCE VERIFICATION PROCESSOR File
    TRIGGERED by the INSURED'S DOB field of the INSURANCE VERIFICATION PROCESSOR File
    TRIGGERED by the PATIENT ID field of the INSURANCE VERIFICATION PROCESSOR File
    TRIGGERED by the GROUP NAME field of the INSURANCE VERIFICATION PROCESSOR File
    TRIGGERED by the GROUP NUMBER field of the INSURANCE VERIFICATION PROCESSOR File
    TRIGGERED by the SUBSCRIBER ID field of the INSURANCE VERIFICATION PROCESSOR File
.17 BPS RESPONSE 0;17 POINTER TO BPS RESPONSES FILE (#9002313.03) BPS RESPONSES(#9002313.03)

  • LAST EDITED:  NOV 15, 2010
  • HELP-PROMPT:  Enter the BPS RESPONSES entry linked with this buffer entry.
  • DESCRIPTION:  This is the payer's response to an Eligibility Inquiry. When an ePharmacy Eligibility Inquiry transaction is sent to the payer, the payer responds with an NCPDP Eligibility Response transaction through the ECME engine.
    This response is stored by default in the BPS RESPONSES file. When this happens an insurance buffer entry is also created. This field links the buffer entry with the BPS Response entry.
  • TECHNICAL DESCR:  
    This field will be automatically populated by the system when receiving Eligibility responses through the ECME engine. It is only valid for buffer entries that have a Source of Information of e-Pharmacy.
  • CROSS-REFERENCE:  355.33^E
    1)= S ^IBA(355.33,"E",$E(X,1,30),DA)=""
    2)= K ^IBA(355.33,"E",$E(X,1,30),DA)
.18 SERVICE DATE 0;18 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  MAY 07, 2013
  • HELP-PROMPT:  Enter the service date to be included in eIV inquiry.
  • DESCRIPTION:  
    Service date to be included in eIV inquiry.
20.01 INSURANCE COMPANY NAME 20;1 FREE TEXT

  • INPUT TRANSFORM:  S X=$$UP^XLFSTR(X),X=$$TRIM^XLFSTR(X) K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  SEP 02, 2010
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    Enter the name of the Insurance Carrier that provides coverage for this patient.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  355.33^D
    1)= S ^IBA(355.33,"D",$E(X,1,30),DA)=""
    2)= K ^IBA(355.33,"D",$E(X,1,30),DA)
    Insurance Company Cross-reference.
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^.16
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=DIV,DIH=355.33,DIG=.16 D
    ^DICR
    2)= Q
    CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
    DELETE VALUE)= NO EFFECT
    FIELD)= REAL TIME
    Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time verification.
20.02 PHONE NUMBER 20;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Answer must be 7-20 characters in length.
  • DESCRIPTION:  
    Enter the phone number at which this insurance company can be reached.
20.03 BILLING PHONE NUMBER 20;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter the phone number of the billing office for this company. Answer must be 7-20 characters in length.
  • DESCRIPTION:  
    The insurance carriers phone number where inquires about patient billing should be made.
20.04 PRECERTIFICATION PHONE NUMBER 20;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter the phone number for pre-certification of care with the insurance company, if required. Answer must be 7-20 characters in length.
  • DESCRIPTION:  
    If this company requires pre-certification of insurance coverage to be completed prior to a patient being treated then enter the phone number of the pre-cert office.
20.05 REIMBURSE? 20;5 SET
  • 'Y' FOR WILL REIMBURSE;
  • '*' FOR WILL REIMBURSE IF TREATED UNDER VAR 6046(C) OR VAR 6060.2(A);
  • '**' FOR DEPENDS ON POLICY, CHECK WITH COMPANY;
  • 'N' FOR WILL NOT REIMBURSE;

  • LAST EDITED:  MAR 24, 1998
  • HELP-PROMPT:  Does this company reimburse the VA for care provided to it's policy holders?
  • DESCRIPTION:  
    Choose from the available list of choices the appropriate code denoting whether or not and under which circumstances this insurance carrier will reimburse the Dept of Veterans Affairs for care received.
21.01 STREET ADDRESS [LINE 1] 21;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<3) X
  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Answer must be 3-35 characters in length.
  • DESCRIPTION:  
    Enter the first line of the insurance company's mailing address street.
21.02 STREET ADDRESS [LINE 2] 21;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter the second line of the insurance company's mailing address street. Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    If the insurance company's mailing address street is longer than 1 line, enter the second line here.
21.03 STREET ADDRESS [LINE 3] 21;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter the third line of the insurance company's mailing address street. Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    If the insurance company's mailing address street is longer than 2 lines, enter the third line here.
21.04 CITY 21;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>25!($L(X)<2) X
  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Answer must be 2-25 characters in length.
  • DESCRIPTION:  
    This is the insurance company's mailing address city.
21.05 STATE 21;5 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter the company's mailing address state.
  • DESCRIPTION:  
    This is the insurance company's mailing address state.
21.06 ZIP CODE 21;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<5) X I $D(X) D ZIPIN^VAFADDR
  • OUTPUT TRANSFORM:  D ZIPOUT^VAFADDR
  • LAST EDITED:  FEB 10, 1998
  • HELP-PROMPT:  Enter either a 5 or 9 digit zip code.
  • DESCRIPTION:  
    This is the insurance company's mailing address zip code.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
40.01 IS THIS A GROUP POLICY? 40;1 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter Yes if other patients may be associated with this plan, otherwise enter No.
  • DESCRIPTION:  
    Some policies are individual policies and are specific to a patient. Many policies are group plans that cover many patients.
40.02 *GROUP NAME 40;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<2) X
  • LAST EDITED:  DEC 03, 2013
  • HELP-PROMPT:  Enter the name of the group this policy is associated with. Answer must be 2-20 characters in length.
  • DESCRIPTION:  This is the name that the insurance company uses to identify this plan.
    This field is scheduled for deletion in May 2015.
  • NOTES:  TRIGGERED by the GROUP NAME field of the INSURANCE VERIFICATION PROCESSOR File
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^.16
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=DIV,DIH=355.33,DIG=.16 D
    ^DICR
    2)= Q
    CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
    DELETE VALUE)= NO EFFECT
    FIELD)= REAL TIME
    Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time verification.
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^90.01
    1)= X ^DD(355.33,40.02,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,90)):^(90),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X=DIV S X=$P(^IBA(355.33,DA,40),U,2) X ^DD(355.33,40.02,1,2,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,40),U,2)'=$E($P($G(^IBA(355.33,DA,90)),U),1,20))
    1.4)= S DIH=$G(^IBA(355.33,DIV(0),90)),DIV=X S $P(^(90),U,1)=DIV,DIH=355.33,DIG=90.01 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,40),U,2)="") I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,90)):^(90),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" X ^DD(355.33,40.02,1,2,2.4)
    2.4)= S DIH=$G(^IBA(355.33,DIV(0),90)),DIV=X S $P(^(90),U,1)=DIV,DIH=355.33,DIG=90.01 D ^DICR
    CREATE CONDITION)= S X=($P(^IBA(355.33,DA,40),U,2)'=$E($P($G(^IBA(355.33,DA,90)),U),1,20))
    CREATE VALUE)= S X=$P(^IBA(355.33,DA,40),U,2)
    DELETE CONDITION)= S X=($P(^IBA(355.33,DA,40),U,2)="")
    DELETE VALUE)= @
    FIELD)= GROUP NAME
    Triggers field 90.01 if first 20 chars of its value differ from the value in this field. Deletes field 90.01 if field 40.02 is deleted.
40.03 *GROUP NUMBER 40;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>17!($L(X)<2) X
  • LAST EDITED:  DEC 03, 2013
  • HELP-PROMPT:  Enter the number that identifies this group/plan. Answer must be 2-17 characters in length.
  • DESCRIPTION:  This is the number or code which the insurance company uses to identify this plan.
    This field is scheduled for deletion in May 2015.
  • NOTES:  TRIGGERED by the GROUP NUMBER field of the INSURANCE VERIFICATION PROCESSOR File
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^.16
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=DIV,DIH=355.33,DIG=.16 D
    ^DICR
    2)= Q
    CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
    DELETE VALUE)= NO EFFECT
    FIELD)= REAL TIME
    Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time verification.
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^90.02
    1)= X ^DD(355.33,40.03,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,90)):^(90),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=$P(^IBA(355.33,DA,40),U,3) X ^DD(355.33,40.03,1,2,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,40),U,3)'=$E($P($G(^IBA(355.33,DA,90)),U,2),1,17))
    1.4)= S DIH=$G(^IBA(355.33,DIV(0),90)),DIV=X S $P(^(90),U,2)=DIV,DIH=355.33,DIG=90.02 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,40),U,3)="") I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,90)):^(90),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(355.33,40.03,1,2,2.4)
    2.4)= S DIH=$G(^IBA(355.33,DIV(0),90)),DIV=X S $P(^(90),U,2)=DIV,DIH=355.33,DIG=90.02 D ^DICR
    CREATE CONDITION)= S X=($P(^IBA(355.33,DA,40),U,3)'=$E($P($G(^IBA(355.33,DA,90)),U,2),1,17))
    CREATE VALUE)= S X=$P(^IBA(355.33,DA,40),U,3)
    DELETE CONDITION)= S X=($P(^IBA(355.33,DA,40),U,3)="")
    DELETE VALUE)= @
    FIELD)= GROUP NUMBER
    Triggers field 90.02 if first 17 chars of its value differ from the value in this field. Deletes field 90.02 if field 40.03 is deleted.
40.04 UTILITZATION REVIEW REQUIRED 40;4 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter Yes if this plan requires Utilization Review for all billable cases.
  • DESCRIPTION:  
    If this is answered Yes, then the UR staff will be required to follow-up on all billable cases. If this is answered No then UR follow-up will be considered optional.
40.05 PRECERTIFICATION REQUIRED 40;5 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter Yes if pre-certification is required by this plan.
  • DESCRIPTION:  
    Enter Yes if this plan requires all non-emergent admissions to be pre-certified.
40.06 AMBULATORY CARE CERTIFICATION 40;6 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter Yes if certification is required for ambulatory care.
  • DESCRIPTION:  
    Enter Yes if this plan requires certification of ambulatory procedures. This may include Ambulatory Surgeries, CAT Scans, MRI, non-invasive procedures, etc.
40.07 EXCLUDE PREEXISTING CONDITION 40;7 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter Yes if this plan excludes any pre-existing conditions.
  • DESCRIPTION:  
    Enter Yes if the plan does not cover any pre-existing conditions the patient may have, otherwise enter No.
40.08 BENEFITS ASSIGNABLE 40;8 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter Yes if this plan will allow assignment of benefits, otherwise enter No.
  • DESCRIPTION:  
    Enter Yes if assignment of benefits is allowed by this plan.
40.09 TYPE OF PLAN 40;9 POINTER TO TYPE OF PLAN FILE (#355.1) TYPE OF PLAN(#355.1)

  • INPUT TRANSFORM:  S DIC("S")="I '$P(^(0),U,4)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  FEB 11, 1998
  • HELP-PROMPT:  Enter the Type of Plan that best describes this plan.
  • DESCRIPTION:  
    Select the Type of Plan that best describes this plan. The Type of Plan may be used to determine if reimbursement for claims from the insurance carrier is appropriate.
  • SCREEN:  S DIC("S")="I '$P(^(0),U,4)"
  • EXPLANATION:  Active Types of Plans Only!
40.1 BANKING IDENTIFICATION NUMBER 40;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  APR 09, 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.
40.11 PROCESSOR CONTROL NUMBER (PCN) 40;11 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  APR 09, 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.
60.01 PATIENT NAME 60;1 POINTER TO PATIENT FILE (#2) PATIENT(#2)

  • LAST EDITED:  SEP 02, 2010
  • HELP-PROMPT:  Enter the patient covered by this insurance.
  • DESCRIPTION:  
    This is the patient covered by this insurance policy.
  • CROSS-REFERENCE:  355.33^C
    1)= S ^IBA(355.33,"C",$E(X,1,30),DA)=""
    2)= K ^IBA(355.33,"C",$E(X,1,30),DA)
    Patient Cross-reference.
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^.16
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=DIV,DIH=355.33,DIG=.16 D
    ^DICR
    2)= Q
    CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
    DELETE VALUE)= NO EFFECT
    FIELD)= REAL TIME
    Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time verification.
60.02 EFFECTIVE DATE 60;2 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X),$P($G(^IBA(355.33,DA,60)),U,3)'="",X>$P(^IBA(355.33,DA,60),U,3) K X
  • LAST EDITED:  OCT 17, 1998
  • HELP-PROMPT:  The effective date of the policy for this patient, must not be greater than the expiration date.
  • DESCRIPTION:  
    This is the date this policy went into effect for this patient.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  355.33^AI^MUMPS
    1)= Q
    2)= Q
    Cross reference to force filing of data so input transform will work.
60.03 EXPIRATION DATE 60;3 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X),X<$P($G(^IBA(355.33,DA,60)),U,2) K X
  • LAST EDITED:  FEB 17, 1998
  • HELP-PROMPT:  Enter the date this policy expires for this patient, date must not be before policy effective date.
  • DESCRIPTION:  
    If this insurance policy coverage expires for this patient on a specified date, enter that date, otherwise leave this blank.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
60.04 *SUBSCRIBER ID 60;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<3) X
  • LAST EDITED:  DEC 03, 2013
  • HELP-PROMPT:  Answer must be 3-20 characters in length.
  • DESCRIPTION:  Enter the Subscriber's Primary ID number. This number is assigned by the payer and can be found on the subscriber's insurance card.
    This field is scheduled for deletion in May 2015.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the SUBSCRIBER ID field of the INSURANCE VERIFICATION PROCESSOR File
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^.16
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=DIV,DIH=355.33,DIG=.16 D
    ^DICR
    2)= Q
    CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
    DELETE VALUE)= NO EFFECT
    FIELD)= REAL TIME
    Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time verification.
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^90.03
    1)= X ^DD(355.33,60.04,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,90)):^(90),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV S X=$P(^IBA(355.33,DA,60),U,4) X ^DD(355.33,60.04,1,2,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,60),U,4)'=$E($P($G(^IBA(355.33,DA,90)),U,3),1,20))
    1.4)= S DIH=$G(^IBA(355.33,DIV(0),90)),DIV=X S $P(^(90),U,3)=DIV,DIH=355.33,DIG=90.03 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,60),U,4)="") I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,90)):^(90),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(355.33,60.04,1,2,2.4)
    2.4)= S DIH=$G(^IBA(355.33,DIV(0),90)),DIV=X S $P(^(90),U,3)=DIV,DIH=355.33,DIG=90.03 D ^DICR
    CREATE CONDITION)= S X=($P(^IBA(355.33,DA,60),U,4)'=$E($P($G(^IBA(355.33,DA,90)),U,3),1,20))
    CREATE VALUE)= S X=$P(^IBA(355.33,DA,60),U,4)
    DELETE CONDITION)= S X=($P(^IBA(355.33,DA,60),U,4)="")
    DELETE VALUE)= @
    FIELD)= SUBSCRIBER ID
    Triggers field 90.03 if first 20 chars of its value differ from the value in this field. Deletes field 90.03 if field 60.04 is deleted.
60.05 WHOSE INSURANCE 60;5 SET
  • 'v' FOR VETERAN;
  • 's' FOR SPOUSE;
  • 'o' FOR OTHER;
  • 'p' FOR PATIENT;

  • LAST EDITED:  OCT 18, 2005
  • HELP-PROMPT:  Enter who holds the insurance policy (the insured).
  • DESCRIPTION:  
    Enter 'v' if this insurance policy is held by the veteran, 's' if the veterans spouse holds the policy, or 'o' if anyone else is the policy holder.
  • TECHNICAL DESCR:  
    'p' for PATIENT may be entered if the VistA system is non-VA. 'v' is excluded if the VistA system is non-VA.
  • SCREEN:  S DIC("S")="I ($G(DUZ(""AG""))'=""V""&(""pso""[Y))!($G(DUZ(""AG""))=""V""&(""vso""[Y))"
  • EXPLANATION:  Exclude VA from selecting 'p' for Patient.
  • NOTES:  TRIGGERED by the PT. RELATIONSHIP TO INSURED field of the INSURANCE VERIFICATION PROCESSOR File
60.06 PT. RELATIONSHIP TO INSURED 60;6 SET
  • '01' FOR PATIENT;
  • '02' FOR SPOUSE;
  • '03' FOR NATURAL CHILD;
  • '08' FOR EMPLOYEE;
  • '09' FOR DO NOT USE;
  • '11' FOR ORGAN DONOR;
  • '15' FOR INJURED PLANTIFF;
  • '18' FOR DO NOT USE;
  • '32' FOR MOTHER;
  • '33' FOR FATHER;
  • '34' FOR SIGNIFICANT OTHER;
  • '35' FOR LIFE PARTNER;
  • '36' FOR OTHER RELATIONSHIP;

  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Enter the code for the patient's relationship to the insured (or policy holder).
  • DESCRIPTION:  
    Enter the code which best describes the patient's relationship to the person who holds this policy (or insured).
  • SCREEN:  S DIC("S")="I X'=""09"",X'=""18"""
  • EXPLANATION:  Cannot use 09 or 18 anymore
  • NOTES:  TRIGGERED by the PT. RELATIONSHIP - HIPAA field of the INSURANCE VERIFICATION PROCESSOR File
  • CROSS-REFERENCE:  355.33^AI1^MUMPS
    1)= Q
    2)= Q
    Cross reference to force filing of data so input transform will work.
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^60.14
    1)= X ^DD(355.33,60.06,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,60)):^(60),1:"") S X=$P(Y(1),U,14),X=X S DIU=X K Y S X=DIV S X=$$PRELCNV^IBCNSP1($P(^IBA(355.33,DA,60),U,6),1) X ^DD(355.33,60.06,1,2,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 N Z S Z=$$PRELCNV^IBCNSP1($P(^IBA(355.33,D0,60),U,6),1),X=(Z'=""&(Z'=$P(^IBA(355.33,D0,60),U,14)))
    1.4)= S DIH=$G(^IBA(355.33,DIV(0),60)),DIV=X S $P(^(60),U,14)=DIV,DIH=355.33,DIG=60.14 D ^DICR
    2)= Q
    CREATE CONDITION)= N Z S Z=$$PRELCNV^IBCNSP1($P(^IBA(355.33,D0,60),U,6),1),X=(Z'=""&(Z'=$P(^IBA(355.33,D0,60),U,14)))
    CREATE VALUE)= S X=$$PRELCNV^IBCNSP1($P(^IBA(355.33,DA,60),U,6),1)
    DELETE VALUE)= NO EFFECT
    FIELD)= #60.14
    Triggers field 60.14 if its value differs from value in this field.
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^60.05
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,60)):^(60),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X=DIV S X=$S(+X=1:$S($G(DUZ("AG"))="V":"v",1:"p"),+X=2:"s",1:"o") X ^DD(355.33,60.06,1,3,1.4)
    1.4)= S DIH=$G(^IBA(355.33,DIV(0),60)),DIV=X S $P(^(60),U,5)=DIV,DIH=355.33,DIG=60.05 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,60)):^(60),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" S DIH=$G(^IBA(355.33,DIV(0),60)),DIV=X S $P(^(60),U,5)=DIV,DIH=355.33,DIG=60.05 D ^DICR
    CREATE VALUE)= S X=$S(+X=1:$S($G(DUZ("AG"))="V":"v",1:"p"),+X=2:"s",1:"o")
    DELETE VALUE)= @
    FIELD)= #60.05
    This trigger will set the WHOSE INSURANCE field (60.05). WHOSE INSURANCE will no longer be asked on user interface screens.
60.07 *NAME OF INSURED 60;7 FREE TEXT

  • INPUT TRANSFORM:  N Z1 S Z1=$G(^IBA(355.33,DA,60)) S:$P(Z1,U,6)="01"&X X=$P($G(^DPT(+Z1,0)),U,1) K:$L(X)>30!($L(X)<2) X
  • LAST EDITED:  NOV 20, 2013
  • HELP-PROMPT:  Enter the name of the person who holds the policy. Answer must be 2-30 characters in length.
  • DESCRIPTION:  Enter the name of the individual for which this policy was issued. If the Patients Relationship to the Insured is 'Patient' then this name will default to the patients name via input transform.
    This field is scheduled for deletion in May 2015.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the NAME OF INSURED field of the INSURANCE VERIFICATION PROCESSOR File
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^91.01
    1)= X ^DD(355.33,60.07,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,91)):^(91),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X=DIV S X=$P(^IBA(355.33,DA,60),U,7) X ^DD(355.33,60.07,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,60),U,7)'=$E($P($G(^IBA(355.33,DA,91)),U),1,30))
    1.4)= S DIH=$G(^IBA(355.33,DIV(0),91)),DIV=X S $P(^(91),U,1)=DIV,DIH=355.33,DIG=91.01 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,60),U,7)="") I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,91)):^(91),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" X ^DD(355.33,60.07,1,1,2.4)
    2.4)= S DIH=$G(^IBA(355.33,DIV(0),91)),DIV=X S $P(^(91),U,1)=DIV,DIH=355.33,DIG=91.01 D ^DICR
    CREATE CONDITION)= S X=($P(^IBA(355.33,DA,60),U,7)'=$E($P($G(^IBA(355.33,DA,91)),U),1,30))
    CREATE VALUE)= S X=$P(^IBA(355.33,DA,60),U,7)
    DELETE CONDITION)= S X=($P(^IBA(355.33,DA,60),U,7)="")
    DELETE VALUE)= @
    FIELD)= NAME OF INSURED
    Triggers field 91.01 if first 30 chars of its value differ from the value in this field. Deletes field 91.01 if field 60.07 is deleted.
60.08 INSURED'S DOB 60;8 DATE

  • INPUT TRANSFORM:  S %DT="EXP" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  SEP 13, 2010
  • HELP-PROMPT:  Enter the Date of Birth of the policy holder. This is only needed if the patient is not the insured.
  • DESCRIPTION:  
    This is the policy holder's (insured's) Date of Birth. This is not needed if the patient is not the policy holder since the patient's DOB is stored elsewhere.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^.16
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=DIV,DIH=355.33,DIG=.16 D
    ^DICR
    2)= Q
    CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
    DELETE VALUE)= NO EFFECT
    FIELD)= REAL TIME
    Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time verification.
60.09 INSURED'S SSN 60;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>13!($L(X)<9) X S:$D(X) X=$TR(X,"-","")
  • OUTPUT TRANSFORM:  S Y=$E(Y,1,3)_"-"_$E(Y,4,5)_"-"_$E(Y,6,9)
  • LAST EDITED:  FEB 10, 1998
  • HELP-PROMPT:  If the insured is not the patient enter the insured's SSN. Answer must be 9-13 characters in length.
  • DESCRIPTION:  
    This is the policy holders (insured's) social security number. This only needs to be entered if it is different than the Subscriber Id number and the insured is not the patient.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
60.1 PRIMARY CARE PROVIDER 60;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  FEB 10, 1998
  • HELP-PROMPT:  If referral is required for VA reimbursement, enter the non-VA provider that referred this patient to the VA. Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the patient's Primary Care Provider within their managed care network that referred the patient to the VA. In some cases if the patients PC Provider refers the patient to the VA their HMO will reimburse.
60.11 PRIMARY PROVIDER PHONE 60;11 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  FEB 10, 1998
  • HELP-PROMPT:  The phone number of the Primary Care Provider that referred the patient to the VA. Answer must be 7-20 characters in length.
  • DESCRIPTION:  
    This is the phone number of the patients non-VA primary care provider that may refer the patient to the VA for care.
60.12 COORDINATION OF BENEFITS 60;12 SET
  • '1' FOR PRIMARY;
  • '2' FOR SECONDARY;
  • '3' FOR TERTIARY;

  • LAST EDITED:  AUG 03, 1998
  • HELP-PROMPT:  Enter the code that best relates where in the payment sequence this policy should be placed.
  • DESCRIPTION:  
    Enter '1' if this is the patient's primary insurance policy. Enter '2' if this policy is secondary to (billed after) the primary policy. Enter '3' if this policy is tertiary or billed after the secondary policy.
60.13 INSURED'S SEX 60;13 SET
  • 'F' FOR FEMALE;
  • 'M' FOR MALE;

  • LAST EDITED:  OCT 02, 2006
  • HELP-PROMPT:  Enter the sex (M or F) of the policy holder.
  • DESCRIPTION:  This field is used in insurance billing to help verify the policy coverage when the bill is submitted to the carrier. If the patient is the policy holder, this value should match the patient's sex. If the patient's
    spouse or other relative is the policy holder, the appropriate value should be determined and entered.
60.14 PT. RELATIONSHIP - HIPAA 60;14 SET
  • '01' FOR SPOUSE;
  • '18' FOR SELF;
  • '19' FOR CHILD;
  • '20' FOR EMPLOYEE;
  • '29' FOR SIGNIFICANT OTHER;
  • '32' FOR MOTHER;
  • '33' FOR FATHER;
  • '39' FOR ORGAN DONOR;
  • '41' FOR INJURED PLAINTIFF;
  • '53' FOR LIFE PARTNER;
  • 'G8' FOR OTHER RELATIONSHIP;

  • LAST EDITED:  MAY 13, 2013
  • HELP-PROMPT:  Enter the HIPAA code which indicates the patient's relationship to the injured party.
  • DESCRIPTION:  Select the HIPAA relationship code that describes the relationship this patient has to the holder of this insurance policy. If the policy belongs to the patient enter '18' for SELF. If the policy belongs to the spouse
    enter '01' for SPOUSE, etc.
  • NOTES:  TRIGGERED by the PT. RELATIONSHIP TO INSURED field of the INSURANCE VERIFICATION PROCESSOR File
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^60.06
    1)= X ^DD(355.33,60.14,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,60)):^(60),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X=DIV S X=$$PRELCNV^IBCNSP1($P(^IBA(355.33,DA,60),U,14),0) X ^DD(355.33,60.14,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 N Z S Z=$$PRELCNV^IBCNSP1($P(^IBA(355.33,D0,60),U,14),0),X=(Z'=""&(Z'=$P(^IBA(355.33,D0,60),U,6)))
    1.4)= S DIH=$G(^IBA(355.33,DIV(0),60)),DIV=X S $P(^(60),U,6)=DIV,DIH=355.33,DIG=60.06 D ^DICR
    2)= Q
    CREATE CONDITION)= N Z S Z=$$PRELCNV^IBCNSP1($P(^IBA(355.33,D0,60),U,14),0),X=(Z'=""&(Z'=$P(^IBA(355.33,D0,60),U,6)))
    CREATE VALUE)= S X=$$PRELCNV^IBCNSP1($P(^IBA(355.33,DA,60),U,14),0)
    DELETE VALUE)= NO EFFECT
    FIELD)= PT. RELATIONSHIP TO INSURED
    Triggers field 60.06 if its value differs from value in this field.
60.15 PHARMACY RELATIONSHIP CODE 60;15 POINTER TO BPS NCPDP PATIENT RELATIONSHIP CODE FILE (#9002313.19) BPS NCPDP PATIENT RELATIONSHIP CODE(#9002313.19)

  • LAST EDITED:  JUN 21, 2011
  • HELP-PROMPT:  Select the relationship of the patient to the cardholder.
  • DESCRIPTION:  This is the relationship of the patient to the cardholder.
    Code Description
    ---- -----------
    0 Not Specified
    1 Cardholder - The individual that is enrolled in and receives
    benefits from a health plan
    2 Spouse - Patient is the husband/wife/partner of the cardholder
    3 Child - Patient is a child of the cardholder
    4 Other - Relationship to cardholder is not precise
  • TECHNICAL DESCR:  
    This field is NCPDP field 306-C6 - Patient Relationship Code
60.16 PHARMACY PERSON CODE 60;16 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • LAST EDITED:  JUN 21, 2011
  • HELP-PROMPT:  Answer must be 1-3 characters in length.
  • DESCRIPTION:  This is the code that is assigned by the payer to identify the patient. The payer may use a unique person code to identify each specific person on the pharmacy insurance policy. This code may also describe the patient's
    relationship to the cardholder.
    Enrollment Standard Examples:
    001 = Cardholder
    002 = Spouse
    003 - 999 = Dependents and Others (including second spouses, etc.)
  • TECHNICAL DESCR:  
    This is NCPDP field 303-C3 - Person Code
61.01 ESGHP? 61;1 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  FEB 10, 1998
  • HELP-PROMPT:  Enter Yes if this policy is part of an Employer Sponsored Group Health Plan.
  • DESCRIPTION:  
    Enter Yes if this policy is part of a plan that is sponsored or provided by the insured's (policy holder's) current or past employer.
61.02 SPONSORING EMPLOYER NAME 61;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter the name of the employer that sponsors this policy. Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    If this is an Employer Sponsored Group Health Plan then enter the name of the employer that sponsors the plan.
61.03 EMPLOYMENT STATUS 61;3 SET
  • '1' FOR FULL TIME;
  • '2' FOR PART TIME;
  • '3' FOR NOT EMPLOYED;
  • '4' FOR SELF EMPLOYED;
  • '5' FOR RETIRED;
  • '6' FOR ACTIVE MILITARY;
  • '9' FOR UNKNOWN;

  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter the insured's (policy holder's) employment status with the employer that sponsors this plan.
  • DESCRIPTION:  
    If this plan is an Employer Sponsored Group Health Plan then enter the policy holders employment status with the sponsoring employer.
61.04 RETIREMENT DATE 61;4 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter the date the insured retired from the employer that sponsors this plan.
  • DESCRIPTION:  
    If this plan is an Employer Sponsored Group Health Plan then enter the date the insured retired from the employer that sponsors the plan.
61.05 SEND BILL TO EMPLOYER 61;5 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter Yes if the insurance claims should be mailed to the employer for pre-processing.
  • DESCRIPTION:  If this is an Employer Sponsored Group Health Plan and the sponsoring employer requires claims against the policy be sent first to them for pre-processing, rather than the insurance company, then enter Yes. You will then
    be able to enter an address that these bills should be sent to. If the employer does not require this then the bills will be sent directly to the insurance company.
61.06 EMPLOYER CLAIMS STREET LINE 1 61;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter the first line of the street address of the employers claims office if the employer pre-processes insurance claims. Answer must be 3-30 characters in length.
  • DESCRIPTION:  Enter the first line of the street address of the sponsoring employers claims office if this is an Employer Sponsored Group Health Plan and the sponsoring employer requires claims against the policy be sent to them for
    pre-processing.
61.07 EMPLOYER CLAIMS STREET LINE 2 61;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter the second line of the street address of the employers claims office if the employer pre-processes insurance claims. Answer must be 3-30 characters in length.
  • DESCRIPTION:  Enter the second line of the street address of the sponsoring employers claims office if this is an Employer Sponsored Group Health Plan and the sponsoring employer requires claims against the policy be sent to them for
    pre-processing.
61.08 EMPLOYER CLAIMS STREET LINE 3 61;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter the third line of the street address of the employers claims office if the employer pre-processes insurance claims. Answer must be 3-30 characters in length.
  • DESCRIPTION:  Enter the third line of the street address of the sponsoring employers claims office if this is an Employer Sponsored Group Health Plan and the sponsoring employer requires claims against the policy be sent to them for
    pre-processing.
61.09 EMPLOYER CLAIMS CITY 61;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<3) X
  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter the city of the employers claims office if the employer pre-processes insurance claims. Answer must be 3-20 characters in length.
  • DESCRIPTION:  
    Enter the city of the sponsoring employers claims office if this is an Employer Sponsored Group Health Plan and the sponsoring employer requires claims against the policy be sent to them for pre-processing.
61.1 EMPLOYER CLAIMS STATE 61;10 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter the state of the employers claims office address if the employer pre-processes insurance claims. Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    Enter the State of the sponsoring employers claims office if this is an Employer Sponsored Group Health Plan and the sponsoring employer requires claims against the policy be sent to them for pre-processing.
61.11 EMPLOYER CLAIMS ZIP CODE 61;11 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<5) X D:$D(X) ZIPIN^VAFADDR
  • LAST EDITED:  MAR 17, 1998
  • HELP-PROMPT:  Enter the zip code of the employers claims office if the employer pre-processes insurance claims. Answer must be 5 or 9 digits in length.
  • DESCRIPTION:  
    Enter the zip code of the sponsoring employers claims office if this is an Employer Sponsored Group Health Plan and the sponsoring employer requires claims against the policy be sent to them for pre-processing.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
61.12 EMPLOYER CLAIMS PHONE NUMBER 61;12 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<7) X
  • LAST EDITED:  FEB 09, 1998
  • HELP-PROMPT:  Enter the phone number of the employers claims office if the employer pre-processes insurance claims. Answer must be 7-15 characters in length.
  • DESCRIPTION:  
    Enter the phone number of the sponsoring employers claims office if this is an Employer Sponsored Group Health Plan and the sponsoring employer requires claims against the policy be sent to them for pre-processing.
62.01 PATIENT ID 62;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  NOV 14, 2011
  • HELP-PROMPT:  Answer must be 1-30 characters in length
  • DESCRIPTION:  
    This is the patient's primary ID number for this insurance company. Enter this field when the patient and the subscriber are different and the patient has a unique ID number.
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^.16
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=DIV,DIH=355.33,DIG=.16 D
    ^DICR
    2)= Q
    CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
    DELETE VALUE)= NO EFFECT
    FIELD)= REAL TIME VERIFICATION
    Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time verification.
62.02 SUBSCRIBER ADDRESS LINE 1 62;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>55!($L(X)<1) X
  • LAST EDITED:  OCT 08, 2009
  • HELP-PROMPT:  Answer must be 1-55 characters in length.
  • DESCRIPTION:  
    Subscriber address, line 1.
62.03 SUBSCRIBER ADDRESS LINE 2 62;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>55!($L(X)<1) X
  • LAST EDITED:  OCT 08, 2009
  • HELP-PROMPT:  Answer must be 1-55 characters in length.
  • DESCRIPTION:  
    Subscriber address, line 2.
62.04 SUBSCRIBER ADDRESS CITY 62;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  OCT 08, 2009
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    Subscriber address, city.
62.05 SUBSCRIBER ADDRESS STATE 62;5 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  OCT 08, 2009
  • HELP-PROMPT:  Please select state.
  • DESCRIPTION:  
    Subscriber address, state.
62.06 SUBSCRIBER ADDRESS ZIP 62;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  OCT 08, 2009
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    Subscriber address, zip code.
62.07 SUBSCRIBER ADDRESS COUNTRY 62;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<2) X
  • LAST EDITED:  SEP 16, 2010
  • HELP-PROMPT:  Answer must be 2-3 characters in length.
  • DESCRIPTION:  
    Subscriber address, country code.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, PID.11.6.
62.08 SUBSCRIBER ADDRESS SUBDIVISION 62;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • LAST EDITED:  SEP 16, 2010
  • HELP-PROMPT:  Answer must be 1-3 characters in length.
  • DESCRIPTION:  
    Subscriber address, country subdivision code.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, PID.11.8.
62.09 SUBSCRIBER PHONE 62;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  APR 02, 2015
  • HELP-PROMPT:  Enter the subscriber's phone number. The entry must be 7-20 characters in length.
  • DESCRIPTION:  
    This field contains the phone number of the policyholder.
80.01 INQ SERVICE TYPE CODE 1 80;1 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    First Service Type Code to be sent with eIV insurance inquiry.
80.02 INQ SERVICE TYPE CODE 2 80;2 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    Second Service Type Code to be sent with eIV Insurance Inquiry.
80.03 INQ SERVICE TYPE CODE 3 80;3 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    Third Service Type Code to be sent with eIV Insurance Inquiry.
80.04 INQ SERVICE TYPE CODE 4 80;4 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    Fourth Service Type Code to be sent with eIV Insurance Inquiry.
80.05 INQ SERVICE TYPE CODE 5 80;5 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    Fifth Service Type Code to be sent with eIV Insurance Inquiry.
80.06 INQ SERVICE TYPE CODE 6 80;6 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    Sixth Service Type Code to be sent with eIV Insurance Inquiry.
80.07 INQ SERVICE TYPE CODE 7 80;7 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    Seventh Service Type Code to be sent with eIV Insurance Inquiry.
80.08 INQ SERVICE TYPE CODE 8 80;8 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    Eighth Service Type Code to be sent with eIV Insurance Inquiry.
80.09 INQ SERVICE TYPE CODE 9 80;9 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    Ninth Service Type Code to be sent with eIV Insurance Inquiry.
80.1 INQ SERVICE TYPE CODE 10 80;10 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    Tenth Service Type Code to be sent with eIV Insurance Inquiry.
80.11 INQ SERVICE TYPE CODE 11 80;11 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    Eleventh Service Type Code to be sent with eIV Insurance Inquiry.
80.12 INQ SERVICE TYPE CODE 12 80;12 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    Twelfth Service Type Code to be sent with eIV Insurance Inquiry.
80.13 INQ SERVICE TYPE CODE 13 80;13 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    Thirteenth Service Type Code to be sent with eIV Insurance Inquiry.
80.14 INQ SERVICE TYPE CODE 14 80;14 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    Fourteenth Service Type Code to be sent with eIV Insurance Inquiry.
80.15 INQ SERVICE TYPE CODE 15 80;15 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    Fifteenth Service Type Code to be sent with eIV Insurance Inquiry.
80.16 INQ SERVICE TYPE CODE 16 80;16 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    Sixteenth Service Type Code to be sent with eIV Insurance Inquiry.
80.17 INQ SERVICE TYPE CODE 17 80;17 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    Seventeenth Service Type Code to be sent with eIV Insurance Inquiry.
80.18 INQ SERVICE TYPE CODE 18 80;18 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    Eighteenth Service Type Code to be sent with eIV Insurance Inquiry.
80.19 INQ SERVICE TYPE CODE 19 80;19 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 12, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    Nineteenth Service Type Code to be sent with eIV Insurance Inquiry.
80.2 INQ SERVICE TYPE CODE 20 80;20 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  AUG 22, 2010
  • HELP-PROMPT:  Enter service type code to be sent with eIV insurance inquiry.
  • DESCRIPTION:  
    Twentieth Service Type Code to be sent with eIV Insurance Inquiry.
90.01 GROUP NAME 90;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<2)!'$$LENCHK^IBCNEUT1(X,20,0) X
  • LAST EDITED:  DEC 03, 2013
  • HELP-PROMPT:  Answer must be 2-20 characters in length.
  • DESCRIPTION:  
    This is the name that the insurance company uses to identify this plan.
  • TECHNICAL DESCR:  
    Replaces field 40.02. Length of this field is temporarily limited to 20 characters.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the *GROUP NAME field of the INSURANCE VERIFICATION PROCESSOR File
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^40.02
    1)= X ^DD(355.33,90.01,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,40)):^(40),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=$E($P(^IBA(355.33,DA,90),U),1,20) X ^DD(355.33,90.01,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P($G(^IBA(355.33,DA,40)),U,2)'=$E($P(^IBA(355.33,DA,90),U),1,20))
    1.4)= S DIH=$G(^IBA(355.33,DIV(0),40)),DIV=X S $P(^(40),U,2)=DIV,DIH=355.33,DIG=40.02 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,90),U)="") I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,40)):^(40),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(355.33,90.01,1,1,2.4)
    2.4)= S DIH=$G(^IBA(355.33,DIV(0),40)),DIV=X S $P(^(40),U,2)=DIV,DIH=355.33,DIG=40.02 D ^DICR
    CREATE CONDITION)= S X=($P($G(^IBA(355.33,DA,40)),U,2)'=$E($P(^IBA(355.33,DA,90),U),1,20))
    CREATE VALUE)= S X=$E($P(^IBA(355.33,DA,90),U),1,20)
    DELETE CONDITION)= S X=($P(^IBA(355.33,DA,90),U)="")
    DELETE VALUE)= @
    FIELD)= *GROUP NAME
    Triggers field 40.02 if its value differs from first 20 chars of the value in this field. Deletes field 40.02 if field 90.01 is deleted.
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^.16
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=DIV,DIH=355.33,DIG=.16 D
    ^DICR
    2)= Q
    CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
    DELETE VALUE)= NO EFFECT
    FIELD)= REAL TIME
    Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time verification.
90.02 GROUP NUMBER 90;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>55!($L(X)<2)!'$$LENCHK^IBCNEUT1(X,17,0) X
  • LAST EDITED:  DEC 03, 2013
  • HELP-PROMPT:  Answer must be 2-17 characters in length.
  • DESCRIPTION:  
    This is the number or code which the insurance company uses to identify this plan.
  • TECHNICAL DESCR:  
    Replaces field 40.03. Length of this field is temporarily limited to 17 characters.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the *GROUP NUMBER field of the INSURANCE VERIFICATION PROCESSOR File
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^40.03
    1)= X ^DD(355.33,90.02,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,40)):^(40),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV S X=$E($P(^IBA(355.33,DA,90),U,2),1,17) X ^DD(355.33,90.02,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P($G(^IBA(355.33,DA,40)),U,3)'=$E($P(^IBA(355.33,DA,90),U,2),1,17))
    1.4)= S DIH=$G(^IBA(355.33,DIV(0),40)),DIV=X S $P(^(40),U,3)=DIV,DIH=355.33,DIG=40.03 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,90),U,2)="") I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,40)):^(40),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(355.33,90.02,1,1,2.4)
    2.4)= S DIH=$G(^IBA(355.33,DIV(0),40)),DIV=X S $P(^(40),U,3)=DIV,DIH=355.33,DIG=40.03 D ^DICR
    CREATE CONDITION)= S X=($P($G(^IBA(355.33,DA,40)),U,3)'=$E($P(^IBA(355.33,DA,90),U,2),1,17))
    CREATE VALUE)= S X=$E($P(^IBA(355.33,DA,90),U,2),1,17)
    DELETE CONDITION)= S X=($P(^IBA(355.33,DA,90),U,2)="")
    DELETE VALUE)= @
    FIELD)= *GROUP NUMBER
    Triggers field 40.03 if its value differs from first 17 chars of the value in this field. Deletes field 40.03 if field 90.02 is deleted.
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^.16
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=DIV,DIH=355.33,DIG=.16 D
    ^DICR
    2)= Q
    CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
    DELETE VALUE)= NO EFFECT
    FIELD)= REAL TIME
    Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time verification.
90.03 SUBSCRIBER ID 90;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<3)!'$$LENCHK^IBCNEUT1(X,20,0) X
  • LAST EDITED:  DEC 03, 2013
  • HELP-PROMPT:  Answer must be 3-20 characters in length.
  • DESCRIPTION:  
    Enter the Subscriber's Primary ID number. This number is assigned by the payer and can be found on the subscriber's insurance card.
  • TECHNICAL DESCR:  
    Replaces field 60.04. Length of this field is temporarily limited to 20 characters.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the *SUBSCRIBER ID field of the INSURANCE VERIFICATION PROCESSOR File
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^60.04
    1)= X ^DD(355.33,90.03,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,60)):^(60),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X=DIV S X=$E($P(^IBA(355.33,DA,90),U,3),1,20) X ^DD(355.33,90.03,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P($G(^IBA(355.33,DA,60)),U,4)'=$E($P(^IBA(355.33,DA,90),U,3),1,20))
    1.4)= S DIH=$G(^IBA(355.33,DIV(0),60)),DIV=X S $P(^(60),U,4)=DIV,DIH=355.33,DIG=60.04 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,90),U,3)="") I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,60)):^(60),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X="" X ^DD(355.33,90.03,1,1,2.4)
    2.4)= S DIH=$G(^IBA(355.33,DIV(0),60)),DIV=X S $P(^(60),U,4)=DIV,DIH=355.33,DIG=60.04 D ^DICR
    CREATE CONDITION)= S X=($P($G(^IBA(355.33,DA,60)),U,4)'=$E($P(^IBA(355.33,DA,90),U,3),1,20))
    CREATE VALUE)= S X=$E($P(^IBA(355.33,DA,90),U,3),1,20)
    DELETE CONDITION)= S X=($P(^IBA(355.33,DA,90),U,3)="")
    DELETE VALUE)= @
    FIELD)= *SUBSCRIBER ID
    Triggers field 60.04 if its value differs from first 20 chars of the value in this field. Deletes field 60.04 if field 90.03 is deleted.
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^.16
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=DIV,DIH=355.33,DIG=.16 D
    ^DICR
    2)= Q
    CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
    DELETE VALUE)= NO EFFECT
    FIELD)= REAL TIME
    Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time verification.
91.01 NAME OF INSURED 91;1 FREE TEXT

  • INPUT TRANSFORM:  N Z1 S Z1=$G(^IBA(355.33,DA,60)) S:$P(Z1,U,6)="01"&X X=$P($G(^DPT(+Z1,0)),U,1) K:$L(X)>130!($L(X)<2)!'$$LENCHK^IBCNEUT1(X,30,0) X
  • LAST EDITED:  NOV 20, 2013
  • HELP-PROMPT:  Enter the name of the person who holds the policy. Answer must be 2-30 characters in length.
  • DESCRIPTION:  
    This is the name of the individual for which this policy was issued. If the Patient Relationship to the Insured is 'Patient' then this name will default to the patient name via input transform.
  • TECHNICAL DESCR:  
    Replaces field 60.07. Length of this field is temporarily limited to 30 characters.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the *NAME OF INSURED field of the INSURANCE VERIFICATION PROCESSOR File
  • CROSS-REFERENCE:  ^^TRIGGER^355.33^60.07
    1)= X ^DD(355.33,91.01,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,60)):^(60),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X=DIV S X=$E($P(^IBA(355.33,DA,91),U),1,30) X ^DD(355.33,91.01,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P($G(^IBA(355.33,DA,60)),U,7)'=$E($P(^IBA(355.33,DA,91),U),1,30))
    1.4)= S DIH=$G(^IBA(355.33,DIV(0),60)),DIV=X S $P(^(60),U,7)=DIV,DIH=355.33,DIG=60.07 D ^DICR
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,91),U)="") I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,60)):^(60),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(355.33,91.01,1,1,2.4)
    2.4)= S DIH=$G(^IBA(355.33,DIV(0),60)),DIV=X S $P(^(60),U,7)=DIV,DIH=355.33,DIG=60.07 D ^DICR
    CREATE CONDITION)= S X=($P($G(^IBA(355.33,DA,60)),U,7)'=$E($P(^IBA(355.33,DA,91),U),1,30))
    CREATE VALUE)= S X=$E($P(^IBA(355.33,DA,91),U),1,30)
    DELETE CONDITION)= S X=($P(^IBA(355.33,DA,91),U)="")
    DELETE VALUE)= @
    FIELD)= *NAME OF INSURED
    Triggers field 60.07 if its value differs from first 30 chars of the value in this field. Deletes field 60.07 if field 91.01 is deleted.

ICR, Total: 4

ICR LINK Subscribing Package(s) Fields Referenced Description
ICR #4785
  • Registration
    		•  (ALL).
    Access: Direct Global Read & w/Fileman

    GROUP NAME (90.01).
    Access: Direct Global Read & w/Fileman

    GROUP NUMBER (90.02).
    Access: Direct Global Read & w/Fileman

    SUBSCRIBER ID (90.03).
    Access: Direct Global Read & w/Fileman

    NAME OF INSURED (91.01).
    Access: Direct Global Read & w/Fileman
    ICR #5294
  • Insurance Capture Buffer
    		•
    ICR #6891
  • Mobile Scheduling Applications Suite
    		•  DATE ENTERED (.01).
    Access: Both R/W w/Fileman

    ENTERED BY (.02).
    Access: Both R/W w/Fileman

    SOURCE OF INFORMATION (.03).
    Access: Both R/W w/Fileman

    STATUS (.04).
    Access: Both R/W w/Fileman

    OVERRIDE FRESHNESS FLAG (.13).
    Access: Both R/W w/Fileman

    SERVICE DATE (.18).
    Access: Both R/W w/Fileman

    PATIENT NAME (60.01).
    Access: Both R/W w/Fileman

    *SUBSCRIBER ID (60.04).
    Access: Both R/W w/Fileman

    *NAME OF INSURED (60.07).
    Access: Both R/W w/Fileman

    PT. RELATIONSHIP - HIPAA (60.14).
    Access: Both R/W w/Fileman

    INSURED'S DOB (60.08).
    Access: Both R/W w/Fileman

    WHOSE INSURANCE (60.05).
    Access: Both R/W w/Fileman

    INSURANCE COMPANY NAME (20.01).
    Access: Both R/W w/Fileman

    PHONE NUMBER (20.02).
    Access: Both R/W w/Fileman

    PRECERTIFICATION PHONE NUMBER (20.04).
    Access: Both R/W w/Fileman

    BILLING PHONE NUMBER (20.03).
    Access: Both R/W w/Fileman

    STREET ADDRESS [LINE 1] (21.01).
    Access: Both R/W w/Fileman

    STREET ADDRESS [LINE 2] (21.02).
    Access: Both R/W w/Fileman

    CITY (21.04).
    Access: Both R/W w/Fileman

    STATE (21.05).
    Access: Both R/W w/Fileman

    ZIP CODE (21.06).
    Access: Both R/W w/Fileman

    INQ SERVICE TYPE CODE 1 (80.01).
    Access: Both R/W w/Fileman

    TYPE OF PLAN (40.09).
    Access: Both R/W w/Fileman

    BANKING IDENTIFICATION NUMBER (40.1).
    Access: Both R/W w/Fileman

    PROCESSOR CONTROL NUMBER (PCN) (40.11).
    Access: Both R/W w/Fileman

    SUBSCRIBER ADDRESS COUNTRY (62.07).
    Access: Both R/W w/Fileman

    SUBSCRIBER ADDRESS LINE 1 (62.02).
    Access: Both R/W w/Fileman

    SUBSCRIBER ADDRESS LINE 2 (62.03).
    Access: Both R/W w/Fileman

    SUBSCRIBER ADDRESS CITY (62.04).
    Access: Both R/W w/Fileman

    SUBSCRIBER ADDRESS STATE (62.05).
    Access: Both R/W w/Fileman

    SUBSCRIBER ADDRESS ZIP (62.06).
    Access: Both R/W w/Fileman

    SUBSCRIBER PHONE (62.09).
    Access: Both R/W w/Fileman

    GROUP NAME (90.01).
    Access: Both R/W w/Fileman

    GROUP NUMBER (90.02).
    Access: Both R/W w/Fileman

    SUBSCRIBER ID (90.03).
    Access: Both R/W w/Fileman
    ICR #7318
  • Lighthouse
    		•  DATE ENTERED (.01).
    Access: LAYGO

    ENTERED BY (.02).
    Access: Both R/W w/Fileman

    SOURCE OF INFORMATION (.03).
    Access: Both R/W w/Fileman

    STATUS (.04).
    Access: Both R/W w/Fileman

    OVERRIDE FRESHNESS (.13).
    Access: Both R/W w/Fileman

    SERVICE DATE (.18).
    Access: Both R/W w/Fileman

    INSURANCE COMPANY NAME (20.01).
    Access: Both R/W w/Fileman

    PHONE NUMBER (20.02).
    Access: Both R/W w/Fileman

    BILLING PHONE NUMBER (20.03).
    Access: Both R/W w/Fileman

    PRECERTIFICATION PHONE NUMBER (20.04).
    Access: Both R/W w/Fileman

    REIMBURSE? (20.05).
    Access: Both R/W w/Fileman

    STREET ADDRESS [LINE 1] (21.01).
    Access: Both R/W w/Fileman

    STREET ADDRESS [LINE 2] (21.02).
    Access: Both R/W w/Fileman

    STREET ADDRESS [LINE 3] (21.03).
    Access: Both R/W w/Fileman

    CITY (21.04).
    Access: Both R/W w/Fileman

    STATE (21.05).
    Access: Both R/W w/Fileman

    ZIP CODE (21.06).
    Access: Both R/W w/Fileman

    IS THIS A GROUP POLICY? (40.01).
    Access: Both R/W w/Fileman

    UTILIZATION REVIEW REQUIRED (40.04).
    Access: Both R/W w/Fileman

    PRECERTIFICATION REQUIRED (40.05).
    Access: Both R/W w/Fileman

    AMBULATORY CARE CERTIFICATION (40.06).
    Access: Both R/W w/Fileman

    TYPE OF PLAN (40.09).
    Access: Both R/W w/Fileman

    BANKING IDENTIFICATION NUMBER (40.1).
    Access: Both R/W w/Fileman

    PROCESSOR CONTROL NUMBER (40.11).
    Access: Both R/W w/Fileman

    PATIENT NAME (60.01).
    Access: Both R/W w/Fileman

    EFFECTIVE DATE (60.02).
    Access: Both R/W w/Fileman

    EXPIRATION DATE (60.03).
    Access: Both R/W w/Fileman

    WHOSE INSURANCE (60.05).
    Access: Both R/W w/Fileman

    INSURED'S DOB (60.08).
    Access: Both R/W w/Fileman

    INSURED'S SSN (60.09).
    Access: Both R/W w/Fileman

    PRIMARY CARE PROVIDER (60.1).
    Access: Both R/W w/Fileman

    PRIMARY PROVIDER PHONE (60.11).
    Access: Both R/W w/Fileman

    COORDINATION OF BENEFITS (60.12).
    Access: Both R/W w/Fileman

    INSURED'S SEX (60.13).
    Access: Both R/W w/Fileman

    PT. RELATIONSHIP - HIPAA (60.14).
    Access: Both R/W w/Fileman

    PHARMACY RELATIONSHIP CODE (60.15).
    Access: Both R/W w/Fileman

    PHARMACY PERSON CODE (60.16).
    Access: Both R/W w/Fileman

    PATIENT ID (62.01).
    Access: Both R/W w/Fileman

    SUBSCRIBER ADDRESS LINE 1 (62.02).
    Access: Both R/W w/Fileman

    SUBSCRIBER ADDRESS LINE 2 (62.03).
    Access: Both R/W w/Fileman

    SUBSCRIBER ADDRESS CITY (62.04).
    Access: Both R/W w/Fileman

    SUBSCRIBER ACCESS STATE (62.05).
    Access: Both R/W w/Fileman

    SUBSCRIBER ADDRESS ZIP (62.06).
    Access: Both R/W w/Fileman

    SUBSCRIBER ADDRESS SUBDIVISION (62.08).
    Access: Both R/W w/Fileman

    SUBSCRIBER PHONE (62.09).
    Access: Both R/W w/Fileman

    INQ SERVICE TYPE CODE 1 (80.01).
    Access: Both R/W w/Fileman

    GROUP NAME (90.01).
    Access: Both R/W w/Fileman

    GROUP NUMBER (90.02).
    Access: Both R/W w/Fileman

    SUBSCRIBER ID (90.03).
    Access: Both R/W w/Fileman

    NAME OF INSURED (91.01).
    Access: Both R/W w/Fileman

    EXCLUDE PREEXISTING CONDITION (40.07).
    Access: Both R/W w/Fileman

    BENEFITS ASSIGNABLE (40.08).
    Access: Both R/W w/Fileman

    SUBSCRIBER ADDRESS COUNTRY (62.07).
    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