Global: ^IBA(364.9

FileMan FileNo	FileMan Filename	Package
364.9	ACC X12 ENCOUNTERS	Integrated Billing

Package	Total	Routines
Integrated Billing	20	IBACCRPT IBACCWL1 IBACCWLAIBILL IBACCWLAIREAS IBACCWLAIVIEW IBACCWLBILLVE IBACCWLEE IBACCWLPREV IBACCWLPURGE IBACCWLRURREV IBACCWLUTIL IBACCWLUTIL1 IBACCWLUTIL2 IBACCWLUTIL4 IBACCWLUTIL5 IBACCWLVE IBACCWLVS IBCE837ACC IBCE837ACC2A IBCE837ACC4

Package	Total	FileMan Files
Integrated Billing	5	BILL/CLAIMS(#399)[2.02] INSURANCE COMPANY(#36)[.17, .18, .19] ACC X12 CLAIM FAILURES(#364.91)[#364.95(.01), #364.97(.01)] ACC ACTIVITY CODES(#364.92)[#364.94(.03)] BILL FORM TYPE(#353)[.06]
Kernel	1	NEW PERSON(#200)[#364.94(.02)]
Registration	1	PATIENT(#2)[2.01]

Fields, Total: 43

Field #	Name	Loc	Type	Details
.01	DATE/TIME ENTERED	0;1	DATE	**********************REQUIRED FIELD********************** INPUT TRANSFORM: `S %DT="ETXR" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `OCT 23, 2025` HELP-PROMPT: `Enter the date and time the community care encounter was received in VistA.` DESCRIPTION: `This is the date and time the community care X12 837 claim encounter was received in VistA.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.` CROSS-REFERENCE: `364.9^B` `1)= S ^IBA(364.9,"B",$E(X,1,30),DA)=""` `2)= K ^IBA(364.9,"B",$E(X,1,30),DA)` `This cross reference of the DATE/TIME ENTERED field is used for lookup of automated community care encounters by date and time.`
.02	PATIENT LAST NAME	0;2	FREE TEXT	**********************REQUIRED FIELD********************** INPUT TRANSFORM: `K:$L(X)>60!($L(X)<1) X` `MAXIMUM LENGTH: 60` LAST EDITED: `FEB 02, 2026` HELP-PROMPT: `Enter the patient's last name.` DESCRIPTION: `This is the patient's last name as found in the community care X12 837 claim encounter data.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.` CROSS-REFERENCE: `364.9^G` `1)= S ^IBA(364.9,"G",$E(X,1,30),DA)=""` `2)= K ^IBA(364.9,"G",$E(X,1,30),DA)` `This cross reference of the PATIENT LAST NAME field is used for patient last name searching.`
.03	PATIENT FIRST NAME	0;3	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>35!($L(X)<1) X` `MAXIMUM LENGTH: 35` LAST EDITED: `FEB 02, 2026` HELP-PROMPT: `Enter the patient's first name.` DESCRIPTION: `This is the patient's first name as found in the community care X12 837 claim encounter data.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
.04	PATIENT MIDDLE NAME	0;4	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>25!($L(X)<1) X` `MAXIMUM LENGTH: 25` LAST EDITED: `FEB 26, 2026` HELP-PROMPT: `Enter the patient's middle name or initial.` DESCRIPTION: `This is the patient's middle name or initial as found in the community care X12 837 claim encounter data.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
.05	IN-PATIENT/OUT-PATIENT	0;5	SET	'I' FOR IN-PATIENT; 'O' FOR OUT-PATIENT; LAST EDITED: `DEC 18, 2024` HELP-PROMPT: `Enter I for in-patient or O for out-patient service.` DESCRIPTION: `This field indicates whether this encounter's medical service was performed as an in-patient or out-patient.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
.06	FORM TYPE	0;6	POINTER TO BILL FORM TYPE FILE (#353)	**********************REQUIRED FIELD********************** BILL FORM TYPE(#353) LAST EDITED: `DEC 18, 2024` HELP-PROMPT: `Enter the type of claim form the community care claim was received as.` DESCRIPTION: `This is the claim form type for which service was billed by community care. This field value will be either form type 2 (CMS-1500), form type 3 (UB-04) or form type 7 (J430D).` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
.07	PROVIDER	0;7	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>100!($L(X)<1) X` `MAXIMUM LENGTH: 100` LAST EDITED: `DEC 18, 2024` HELP-PROMPT: `Enter the provider for this encounter in the format of last name, first name.` DESCRIPTION: `This is the provider name found in the community care X12 837 claim encounter data.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
.08	PROVIDER TYPE	0;8	SET	'DN' FOR REFERRING PROVIDER; 'P3' FOR PRIMARY CARE PROVIDER; '82' FOR RENDERING PROVIDER; 'DQ' FOR SUPERVISING PROVIDER; '71' FOR ATTENDING PROVIDER; '72' FOR OPERATING PHYSICIAN; LAST EDITED: `NOV 27, 2023` HELP-PROMPT: `Enter a valid provider type.` DESCRIPTION: `This is the provider type found in the community care X12 837 claim encounter data received from Payer EDI for the provider assigned to this encounter.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
.09	PROVIDER NPI	0;9	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>10!($L(X)<10) X` `MAXIMUM LENGTH: 10` LAST EDITED: `NOV 27, 2023` HELP-PROMPT: `Enter the provider's NPI.` DESCRIPTION: `This is the provider's NPI found in the community care X12 837 claim encounter data.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
.1	PATIENT DOB	0;10	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `NOV 27, 2023` HELP-PROMPT: `Enter the patient's date of birth.` DESCRIPTION: `This is the patient's date of birth as found in the community care X12 837 claim encounter data.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
.11	PATIENT SSN	0;11	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>9!($L(X)<9) X` `MAXIMUM LENGTH: 9` LAST EDITED: `DEC 23, 2024` HELP-PROMPT: `Enter the patient's 9 digit social security number.` DESCRIPTION: `This is the patient's social security number as found in the community care X12 837 claim encounter data.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
.12	SERVICE DATE	0;12	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `MAR 11, 2025` HELP-PROMPT: `Enter the date of service for this encounter.` DESCRIPTION: `This is the first service line's date of service found in the community care X12 837 claim encounter data.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
.13	CPT	0;13	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>10!($L(X)<1) X` `MAXIMUM LENGTH: 10` LAST EDITED: `DEC 18, 2024` HELP-PROMPT: `Enter a current procedural terminology (CPT) code for this encounter.` DESCRIPTION: `This is the first current procedural terminology (CPT) code found in the community care X12 837 claim encounter data.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
.14	PRIMARY DX	0;14	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>10!($L(X)<1) X` `MAXIMUM LENGTH: 10` LAST EDITED: `DEC 18, 2024` HELP-PROMPT: `Enter the primary diagnosis code for this encounter.` DESCRIPTION: `This is the primary diagnosis code found in the community care X12 837 claim encounter data.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
.15	X12 CLAIM NUMBER	0;15	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>30!($L(X)<3) X` `MAXIMUM LENGTH: 30` LAST EDITED: `DEC 18, 2024` HELP-PROMPT: `Enter the claim number for this external 837 claim.` DESCRIPTION: `This is the claim number assigned to the encounter by the clearinghouse.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.` `This is the value added network trace number (claim number) found in the X12 837 REF segment in loop 2300 where REF01 (reference identification qualifier) equals 'D9'.` CROSS-REFERENCE: `364.9^D` `1)= S ^IBA(364.9,"D",$E(X,1,30),DA)=""` `2)= K ^IBA(364.9,"D",$E(X,1,30),DA)` `This cross reference of the X12 CLAIM NUMBER field is used for Payer EDI encounter claim number searching.`
.16	STATUS	0;16	SET	'0' FOR OPEN; '1' FOR IN PROGRESS; '2' FOR CLOSED; '3' FOR PURGED; LAST EDITED: `AUG 27, 2025` HELP-PROMPT: `Enter the processing status of the community care encounter.` DESCRIPTION: `This is the current status of the community care encounter.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It is initially populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI. This` `status field is then updated by the VistA software based on user actions performed while working the encounters off of a worklist.` CROSS-REFERENCE: `364.9^AD` `1)= S ^IBA(364.9,"AD",$E(X,1,30),DA)=""` `2)= K ^IBA(364.9,"AD",$E(X,1,30),DA)` `This cross reference is used to sort the automated community care encounter entries by STATUS.` CROSS-REFERENCE: `^^TRIGGER^364.9^.22` `1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(364.9,D0,0)):^(0),1:"") S X=$P(Y(1),U,22),X=X S DIU=X K Y S X=DIV S X=$$NOW^XLFDT S DIH=$G(^IBA(364.9,DIV(0),0)),DIV=X S $P(^(0),U,22)=DIV,DIH=364.9,DIG=.22 D ^DICR` `2)= Q` `CREATE VALUE)= S X=$$NOW^XLFDT` `DELETE VALUE)= NO EFFECT` `FIELD)= STATUS DATE CHANGED` `The STATUS DATE CHANGED field is triggered every time the STATUS is changed.` CROSS-REFERENCE: `^^TRIGGER^364.9^.21` `1)= X ^DD(364.9,.16,1,3,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(364.9,D0,0)):^(0),1:"") S X=$P(Y(1),U,21),X=X S DIU=X K Y S X=DIV S X=1 S DIH=$G(^IBA(364.9,DIV(0),0)),DIV=X S $P(^(0),U,21)=DIV,DIH=364.9,DIG=.21 D ^DICR` `1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$C(59)_$P($G(^DD(364.9,.16,0)),U,3) S X=$P($P(Y(1),$C(59)_Y(0)_":",2),$C(59))'="PURGED"` `2)= Q` `CREATE CONDITION)= STATUS'="PURGED"` `CREATE VALUE)= S X=1` `DELETE VALUE)= NO EFFECT` `FIELD)= READY` `This trigger is used to force the community care encounter data to be extracted for power bi external reporting.` CROSS-REFERENCE: `^^TRIGGER^364.9^3.01` `1)= X ^DD(364.9,.16,1,4,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(364.9,D0,3)):^(3),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" S DIH=$G(^IBA(364.9,DIV(0),3)),DIV=X S $P(^(3),U,1)=DIV,DIH=364.9,DIG=3.01 D ^DICR` `1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$C(59)_$P($G(^DD(364.9,.16,0)),U,3) S X=$P($P(Y(1),$C(59)_Y(0)_":",2),$C(59))="CLOSED"` `2)= Q` `CREATE CONDITION)= STATUS="CLOSED"` `CREATE VALUE)= @` `DELETE VALUE)= NO EFFECT` `FIELD)= ASSIGNED TO GROUP` `Once the STATUS is CLOSED, it is no longer assigned to any group.`
.17	PRIMARY INS	0;17	POINTER TO INSURANCE COMPANY FILE (#36)	INSURANCE COMPANY(#36) LAST EDITED: `DEC 18, 2024` HELP-PROMPT: `Enter the primary insurance company to be used for the VistA claim.` DESCRIPTION: `This is the primary insurance company to be used when creating the initial VistA claim.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
.18	SECONDARY INS	0;18	POINTER TO INSURANCE COMPANY FILE (#36)	INSURANCE COMPANY(#36) LAST EDITED: `DEC 18, 2024` HELP-PROMPT: `Enter the secondary insurance company to be used for the VistA claim.` DESCRIPTION: `This is the secondary insurance company to be used when creating the initial VistA claim.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
.19	TERTIARY INS	0;19	POINTER TO INSURANCE COMPANY FILE (#36)	INSURANCE COMPANY(#36) LAST EDITED: `DEC 18, 2024` HELP-PROMPT: `Enter the tertiary insurance company to be used for the VistA claim.` DESCRIPTION: `This is the tertiary insurance company to be used when creating the initial VistA claim.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
.2	SITE NUMBER	0;20	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>7!($L(X)<3) X` `MAXIMUM LENGTH: 7` LAST EDITED: `DEC 18, 2024` HELP-PROMPT: `Enter the VistA site(station) number concatenated with an optional two character division code. Example: 123AB.` DESCRIPTION: `This value is the numeric VistA site (station) number, optionally concatenated with a two character division code. Example: 123AB.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming community care X12 837 encounters VistA receives from Payer EDI.`
.21	READY FOR POWER BI EXTRACT?	0;21	SET (BOOLEAN Data Type)	This field indicates when an entry needs to be extracted for Power BI reporting. LAST EDITED: `JAN 30, 2024` HELP-PROMPT: `Enter a 1 if this entry needs to be extracted for Power BI reporting.` DESCRIPTION: `This field indicates when an entry needs to be extracted for Power BI reporting.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.` NOTES: `TRIGGERED by the CLAIM NUMBER field of the ACC X12 ENCOUNTERS File` `TRIGGERED by the AUTHORIZED? field of the ACC X12 ENCOUNTERS File` `TRIGGERED by the STATUS field of the ACC X12 ENCOUNTERS File` CROSS-REFERENCE: `364.9^E^MUMPS` `1)= I X S ^IBA(364.9,"E",X,DA)=""` `2)= K ^IBA(364.9,"E",X,DA)` `This index is used to determine if X12 entry needs to be exported for Power BI reporting.`
.22	STATUS DATE CHANGED	0;22	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `DEC 19, 2024` HELP-PROMPT: `Enter the date the STATUS was changed.` DESCRIPTION: `This is the date the STATUS field was last changed.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It is initially populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI. This` `status date changed field is updated each time the STATUS field is changed based on user actions performed while working the encounters off of a worklist.` NOTES: `TRIGGERED by the STATUS field of the ACC X12 ENCOUNTERS File`
.23	DAYS ON A WORKLIST		COMPUTED	MUMPS CODE: `S Y(364.9,.23,1)=$S($D(^IBA(364.9,D0,0)):^(0),1:"") N %I,%H,% D NOW^%DTC S X=X,X1=X,X2=$P(Y(364.9,.23,1),U,1),X="" D:X2 ^%DTC:X1` ALGORITHM: `TODAY-DATE/TIME ENTERED` LAST EDITED: `DEC 18, 2024` HELP-PROMPT: `Enter Standard MUMPS code` DESCRIPTION: `This computed field displays the number of days from the date an encounter was imported in field (#.01) DATE/TIME ENTERED to today's date (DT).` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It is a computed field based on length of time on a given worklist.`
.24	SITE NUMBER IN JSON	0;24	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>7!($L(X)<3) X` `MAXIMUM LENGTH: 7` LAST EDITED: `DEC 18, 2024` HELP-PROMPT: `Enter the VistA site(station) number concatenated with an optional two character division code that was received in the original X12 encounter.` DESCRIPTION: `This value is the original numeric site (station) number, optionally concatenated with a two character division code. Example: 123AB.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming community care X12 837 encounters VistA receives from Payer EDI.`
.25	SERVICE FACILITY	0;25	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>60!($L(X)<1) X` `MAXIMUM LENGTH: 60` LAST EDITED: `DEC 18, 2024` HELP-PROMPT: `Enter the service facility for this encounter.` DESCRIPTION: `This is the service facility name found in the community care X12 837 claim encounter data.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
.26	SERVICE FACILITY NPI	0;26	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>10!($L(X)<10) X` `MAXIMUM LENGTH: 10` LAST EDITED: `DEC 18, 2024` HELP-PROMPT: `Enter the service facility's national provider id (NPI).` DESCRIPTION: `This is the service facility's national provider id (NPI) found in the community care X12 837 claim encounter data.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
.27	PAID AMOUNT	0;27	NUMBER	INPUT TRANSFORM: `S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999999)!(X<0) X` LAST EDITED: `DEC 18, 2024` HELP-PROMPT: `Enter the dollar amount of the amount paid by VA for this community care encounter.` DESCRIPTION: `This is the amount the VA paid on this community care encounter.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
.28	CHARGE AMOUNT	0;28	NUMBER	INPUT TRANSFORM: `S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999999)!(X<0) X` LAST EDITED: `DEC 18, 2024` HELP-PROMPT: `Enter the dollar amount of the original charges on the community care claim.` DESCRIPTION: `This is the original community care claim charge amount found in the community care X12 837 claim encounter data.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
.29	PAYER CLAIM CONTROL NUMBER	0;29	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>50!($L(X)<1) X` `MAXIMUM LENGTH: 50` LAST EDITED: `JAN 28, 2025` HELP-PROMPT: `Enter the payer claim control number assigned to this community care encounter.` DESCRIPTION: `This is the payer claim control number assigned to this encounter when the VA paid the community care claim.`
.3	SECONDARY DX	0;30	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>225!($L(X)<1) X` `MAXIMUM LENGTH: 225` LAST EDITED: `JAN 29, 2025` HELP-PROMPT: `Enter the secondary diagnosis code(s), separated by a comma, for this community care encounter.` DESCRIPTION: `These are the secondary diagnosis codes received on the community care encounter.`
.31	EXEMPT FROM SC/SA	0;31	SET (BOOLEAN Data Type)	should be 'No'. LAST EDITED: `FEB 26, 2026` HELP-PROMPT: `Enter 'Yes' if this encounter should be considered non-service connected. Otherwise, enter 'No'.` DESCRIPTION: `If the patient on this encounter is set up as service connected but the actual service on this encounter is billable, then this field should be set to 'Yes' in order for the encounter to be billed. Otherwise, the value` `should be 'No'.`
1.01	SEGMENT	1;0	Multiple #364.9001	364.9001 DESCRIPTION: `These are the original X12 segments received in the community care X12 837 claim encounter data.` TECHNICAL DESCR: `This multiple is not intended for end user entering or editing. They will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
2.01	PATIENT	2;1	POINTER TO PATIENT FILE (#2)	PATIENT(#2) LAST EDITED: `DEC 19, 2024` HELP-PROMPT: `Enter the patient this community care encounter is for.` DESCRIPTION: `This is the patient found from information in the community care X12 837 claim encounter data.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.` CROSS-REFERENCE: `364.9^F` `1)= S ^IBA(364.9,"F",$E(X,1,30),DA)=""` `2)= K ^IBA(364.9,"F",$E(X,1,30),DA)` `This cross reference is used for sorting the encounter file entries by patient.`
2.02	CLAIM NUMBER	2;2	POINTER TO BILL/CLAIMS FILE (#399)	BILL/CLAIMS(#399) LAST EDITED: `DEC 19, 2024` HELP-PROMPT: `Enter the VistA claim number which was generated for this community care encounter.` DESCRIPTION: `This is the link to the BILL/CLAIMS file for the VistA claim which was auto-created from the community care X12 837 claim encounter data.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.` CROSS-REFERENCE: `^^TRIGGER^364.9^.21` `1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(364.9,D0,0)):^(0),1:"") S X=$P(Y(1),U,21),X=X S DIU=X K Y S X=DIV S X=1 S DIH=$G(^IBA(364.9,DIV(0),0)),DIV=X S $P(^(0),U,21)=DIV,DIH=364.9,DIG=.21 D ^DICR` `2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(364.9,D0,0)):^(0),1:"") S X=$P(Y(1),U,21),X=X S DIU=X K Y S X=DIV S X=0 S DIH=$G(^IBA(364.9,DIV(0),0)),DIV=X S $P(^(0),U,21)=DIV,DIH=364.9,DIG=.21 D ^DICR` `CREATE VALUE)= S X=1` `DELETE VALUE)= S X=0` `FIELD)= READY` CROSS-REFERENCE: `364.9^C` `1)= S ^IBA(364.9,"C",$E(X,1,30),DA)=""` `2)= K ^IBA(364.9,"C",$E(X,1,30),DA)` `This cross reference is used to lookup a community care encounter by the associated VistA claim number.`
2.03	AUTHORIZED?	2;3	SET (BOOLEAN Data Type)	This value will be 1 (Yes) if the VistA claim was able to be auto-authorized. LAST EDITED: `JAN 30, 2024` HELP-PROMPT: `Enter 1 (Yes) if this VistA claim was auto-authorized.` DESCRIPTION: `This value will be 1 (Yes) if the VistA claim was able to be auto-authorized.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.` CROSS-REFERENCE: `^^TRIGGER^364.9^.21` `1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(364.9,D0,0)):^(0),1:"") S X=$P(Y(1),U,21),X=X S DIU=X K Y S X=DIV S X=1 S DIH=$G(^IBA(364.9,DIV(0),0)),DIV=X S $P(^(0),U,21)=DIV,DIH=364.9,DIG=.21 D ^DICR` `2)= Q` `CREATE VALUE)= S X=1` `DELETE VALUE)= NO EFFECT` `FIELD)= READ` `This trigger sets the READY FOR POWER BI EXTRACT? field when the VistA claim is successfully authorized for submission to the payer.`
3.01	ASSIGNED TO GROUP	3;1	SET	'FRT' FOR FACILITY REVENUE TECHNICIANS; 'RUR' FOR REVENUE UTILIZATION REVIEW; 'IV' FOR INSURANCE VERIFICATION; 'BILL' FOR BILLING; 'PTF' FOR FACILITY REVENUE TECHNICIANS PTF; LAST EDITED: `DEC 18, 2024` HELP-PROMPT: `Enter the group of users this claim should be assigned to.` DESCRIPTION: `This is the current workgroup this claim is assigned to. When a claim is reassigned, this field is updated with the workgroup it was reassigned to.` NOTES: `TRIGGERED by the REASSIGNED TO GROUP field of the PREVIOUS ACTIVITY sub-field of the ACC X12 ENCOUNTERS File` `TRIGGERED by the STATUS field of the ACC X12 ENCOUNTERS File` CROSS-REFERENCE: `364.9^AC` `1)= S ^IBA(364.9,"AC",$E(X,1,30),DA)=""` `2)= K ^IBA(364.9,"AC",$E(X,1,30),DA)` `This cross reference is used as the main lookup to create the List Manager work lists for each workgroup.`
3.02	INITIAL ASSIGNED GROUP	3;2	SET	'FRT' FOR FACILITY REVENUE TECHNICIANS; 'RUR' FOR REVENUE UTILIZATION REVIEW; 'IV' FOR INSURANCE VERIFICATION; 'BILL' FOR BILLING; 'PTF' FOR FACILITY REVENUE TECHNICIANS PTF; LAST EDITED: `DEC 18, 2024` HELP-PROMPT: `Enter the group this encounter is assigned to when initially imported.` DESCRIPTION: `This is the first user group this encounter was assigned to upon import into VistA.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.`
3.03	DATE ASSIGNED	3;3	DATE	INPUT TRANSFORM: `S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `DEC 19, 2024` HELP-PROMPT: `Enter the date this encounter was assigned to a workgroup.` DESCRIPTION: `This is the date when the encounter is assigned to a particular work group in the #3.01 ASSIGNED TO GROUP field.` TECHNICAL DESCR: `This field is not intended for end user entering or editing. It is initially populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI. Each` `time the encounter gets assigned to a group, this field is updated.`
3.04	DAYS ON GROUP WORKLIST		COMPUTED	MUMPS CODE: `S X=$$DAYSONWRKGRP^IBACCWLUTIL1(D0)` ALGORITHM: `S X=$$DAYSONWRKGRP^IBACCWLUTIL1(D0)` LAST EDITED: `DEC 19, 2024` DESCRIPTION: `This computed field displays the number of days from the date an encounter is assigned to a group in field (#3.03) DATE ASSIGNED until today's date (DT).`
4	PREVIOUS ACTIVITY	4;0	DATE Multiple #364.94	364.94 LAST EDITED: `NOV 16, 2023` DESCRIPTION: `This multiple contains a record of all activity performed by workgroup users on a community care encounter.` TECHNICAL DESCR: `This multiple field is not intended for end user entering or editing.`
5	REASONS NOT AUTOBILLED	5;0	POINTER Multiple #364.95	364.95 DESCRIPTION: `These are the reasons the VistA claim was not 'auto-generated' or the reasons the VistA claim was not 'auto-billed'.` TECHNICAL DESCR: `This multiple field is not intended for end user entering or editing.`
6	SERVICE LINE NUMBER	6;0	Multiple #364.96	364.96 DESCRIPTION: `This is the service line level payment information received on the incoming community care encounter.` TECHNICAL DESCR: `This multiple field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer` `EDI.`
7	INITIAL REASON NOT AUTOBILLED	7;0	POINTER Multiple #364.97	364.97 DESCRIPTION: `These are the initial reasons the VistA claim was not 'auto-generated' or the initial reasons the VistA claim was not 'auto-billed'.` TECHNICAL DESCR: `This multiple field is not intended for end user entering or editing.`

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Package: Integrated Billing

Global: ^IBA(364.9

Information

Description

Accessed By FileMan Db Calls, Total: 20

Pointer To FileMan Files, Total: 7

Fields, Total: 43