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Global: ^IBE(355.1

Package: Integrated Billing

Global: ^IBE(355.1


Information

FileMan FileNo FileMan Filename Package
355.1 TYPE OF PLAN Integrated Billing

Description

Accessed By FileMan Db Calls, Total: 14

Package Total Routines
Integrated Billing 12 IB20P413    IBBFAPI    IBCEMSRI    IBCNEUT5    IBCNOR4    IBCNRDV    IBCNSM    IBENDS
IBENDS1    IBY528PA    IBY778PO    IBYQNS    
Fee Basis 1 FBPCR    
Health Summary 1 GMTSDEM2    

Pointed To By FileMan Files, Total: 3

Package Total FileMan Files
Integrated Billing 3 GROUP INSURANCE PLAN(#355.3)[.09]    INSURANCE VERIFICATION PROCESSOR(#355.33)[40.09]    INTERFACILITY INSURANCE UPDATE(#365.19)[#365.192(.08)]    

Pointer To FileMan Files, Total: 1

Package Total FileMan Files
Integrated Billing 1 MASTER TYPE OF PLAN(#355.99)[15]    

Fields, Total: 7

Field # Name Loc Type Details
.01 NAME 0;1 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>70!($L(X)<3)!'(X'?1P.E) X
  • LAST EDITED:  MAY 06, 2015
  • HELP-PROMPT:  Enter the standard abbreviation. Answer must be 2-70 characters in length.
  • DESCRIPTION:  There are a number of different types of policies, some have very specific types of coverage while others cover a much broader range of care. This is the name of the type of policy. Select the name that best describes
    the type of policy. This is a list of standard types of policies.
    The type of policy may be dependent on the type of coverage provided by the insurance company and may affect the type of benefits that are available for the policy. This will be used in determining if the reimbursement
    from the insurance company is appropriate for this policy.
  • FIELD INDEX:  B (#851) REGULAR IR LOOKUP & SORTING
    Short Descr: "B" Regular Cross-Reference of .01 field
    Description: The "B" cross-reference has been updated to allow for a full 70-character lookup instead of being limited to the first 30 characters. This is done to prevent a potential lookup error by Fileman DBS calls.
    Set Logic: S ^IBE(355.1,"B",$E(X,1,70),DA)=""
    Kill Logic: K ^IBE(355.1,"B",$E(X,1,70),DA)
    Whole Kill: K ^IBE(355.1,"B")
    X(1): NAME (355.1,.01) (Subscr 1) (Len 70) (forwards)
.02 ABBREVIATION 0;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>12!($L(X)<2) X
  • LAST EDITED:  MAY 07, 2015
  • HELP-PROMPT:  Enter the standard abbreviation. Answer must be 2-12 characters in length.
  • DESCRIPTION:  
    Enter the standard abbreviation for this type of policy. The abbreviation will be used on standard displays of policy information where space is limited.
  • CROSS-REFERENCE:  355.1^D
    1)= S ^IBE(355.1,"D",$E(X,1,30),DA)=""
    2)= K ^IBE(355.1,"D",$E(X,1,30),DA)
    This cross-reference allows the Type of Plan to be found by the abbreviation.
.03 MAJOR CATEGORY 0;3 SET
  • '1' FOR MAJOR MEDICAL;
  • '2' FOR DENTAL;
  • '3' FOR HMO;
  • '4' FOR PPO;
  • '5' FOR MEDICARE;
  • '6' FOR MEDICAIDE;
  • '7' FOR CHAMPUS;
  • '8' FOR WORKMANS COMP;
  • '9' FOR INDEMNITY;
  • '10' FOR PRESCRIPTION;
  • '11' FOR MEDICARE SUPPLEMENTAL;
  • '12' FOR ALL OTHER;

  • LAST EDITED:  JAN 11, 1994
  • DESCRIPTION:  
    Each type of policy must be identified with a major category. It is the major category field that will be used to determine the type of policy internally by the computer.
    WRITE AUTHORITY: @
  • CROSS-REFERENCE:  355.1^C
    1)= S ^IBE(355.1,"C",$E(X,1,30),DA)=""
    2)= K ^IBE(355.1,"C",$E(X,1,30),DA)
.04 INACTIVE 0;4 SET
  • '1' FOR YES;

  • LAST EDITED:  AUG 11, 1997
  • HELP-PROMPT:  Enter Yes if this Type of Plan should be Inactivated.
  • DESCRIPTION:  
    An Inactive Type of Plan should no longer be used to define Plans.
10 DESCRIPTION 10;0 WORD-PROCESSING #355.11

  • DESCRIPTION:  
    Enter a one or two sentence description of the type of policy.
  • LAST EDITED:  JUN 03, 1993
14 EFFECTIVE DATE 14;0 DATE Multiple #355.14 355.14

  • DESCRIPTION:  The effective date multiple contains the date(s) on which the coverage amounts paid by a supplemental Type of Plan go into effect or change. The percentages paid are stored within this Effective Date multiple by Group
    Code and Reason Code. When these percentages change, a new effective date should be entered along with each Group and Reason Code for which this plan pays. If there is no effective date entry or the effective date is
    AFTER the claim service From date, the secondary balance due will be calculated as 100% of Patient Responsibility as indicated on the Medicare-equivalent Remittance Advice (MRA).
  • TECHNICAL DESCR:  If the Type of Plan assigned to the insurance plan on a claim, has an effective date on or before the claim service From date: (File#399 Field#151 FIELD NAME: STATEMENT COVERS FROM Global Location: U;1) the balance due
    for the secondary claim will be based on the patient responsibility multiplied by any percentages stored in the effective date multiple, plus excess charges if applicable. If there is no effective date entry or the
    effective date is AFTER the claim From service date, the secondary balance due will be calculated as 100% of Patient Responsibility as indicated on the Medicare-equivalent Remittance Advice.
  • INDEXED BY:  PART A PERCENTAGE & PART B PERCENTAGE & REASON CODE (AEDT)
15 MASTER TYPE OF PLAN 0;5 POINTER TO MASTER TYPE OF PLAN FILE (#355.99) MASTER TYPE OF PLAN(#355.99)

  • INPUT TRANSFORM:  S DIC("S")="I '$$SCREEN^XTID(355.99,.01,+Y_"","")" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  AUG 30, 2017
  • HELP-PROMPT:  Enter the Master Type of Plan (MTOP) PHDSC Source of Payment associated with the Type of Plan. NOTE: MTOP names are case sensitive.
  • DESCRIPTION:  
    This field points to the MASTER TYPE OF PLAN file (#355.99). This is a link to the national standard names for source of payment.
  • SCREEN:  S DIC("S")="I '$$SCREEN^XTID(355.99,.01,+Y_"","")"
  • EXPLANATION:  Only active Master Type of Plan entries may be selected.
  • CROSS-REFERENCE:  355.1^MTOP
    1)= S ^IBE(355.1,"MTOP",$E(X,1,30),DA)=""
    2)= K ^IBE(355.1,"MTOP",$E(X,1,30),DA)
    This cross references MASTER TYPE OF PLAN (#15) field entries.

Found Entries, Total: 63

NAME: ACCIDENT AND HEALTH INSURANCE    NAME: AVIATION TRIP INSURANCE    NAME: BLUE CROSS/BLUE SHIELD    NAME: CATASTROPHIC INSURANCE    NAME: TRICARE    NAME: COINSURANCE    NAME: COMPREHENSIVE MAJOR MEDICAL    NAME: DENTAL INSURANCE    
NAME: DUAL COVERAGE    NAME: HEALTH MAINTENANCE ORGANIZATION    NAME: INPATIENT (BASIC HOSPITAL)    NAME: INDIVIDUAL PRACTICE ASSOCATION (IPA)    NAME: KEY-MAN HEALTH INSURANCE    NAME: MAJOR MEDICAL EXPENSE INSURANCE    NAME: MANAGED CARE SYSTEM (MCS)    NAME: MEDICAID    
NAME: MEDI-CAL    NAME: MEDICAL EXPENSE (OPT/PROF)    NAME: MEDICARE (M)    NAME: MEDICARE/MEDICAID (MEDI-CAL)    NAME: MEDIGAP PLAN C    NAME: NO-FAULT INSURANCE    NAME: PREFERRED PROVIDER ORGANIZATION (PPO)    NAME: PREPAID GROUP PRACTICE PLAN    
NAME: QUALIFIED IMPAIRMENT INSURANCE    NAME: REGULAR MEDICAL EXPENSE INSURANCE    NAME: RETIREE    NAME: SPECIAL CLASS INSURANCE    NAME: SPECIAL RISK INSURANCE    NAME: SPECIFIED DISEASE INSURANCE    NAME: SURGICAL EXPENSE INSURANCE    NAME: WORKERS' COMPENSATION INSURANCE    
NAME: LABS, PROCEDURES, X-RAY, ETC. (ONLY)    NAME: INCOME PROTECTION (INDEMNITY)    NAME: PRESCRIPTION    NAME: MENTAL HEALTH    NAME: HOSPITAL-MEDICAL INSURANCE    NAME: TRICARE SUPPLEMENTAL    NAME: AUTOMOBILE    NAME: CARVE-OUT    
NAME: CHAMPVA    NAME: MEDICARE SECONDARY (NO B EXC)    NAME: POINT OF SERVICE    NAME: TORT FEASOR    NAME: MEDIGAP PLAN F    NAME: MEDIGAP PLAN A    NAME: MEDIGAP PLAN B    NAME: MEDIGAP PLAN D    
NAME: MEDIGAP PLAN G    NAME: MEDIGAP PLAN K    NAME: MEDIGAP PLAN L    NAME: MEDIGAP PLAN M    NAME: MEDIGAP PLAN N    NAME: MEDICARE SECONDARY (B EXC)    NAME: MEDICARE SUPPLEMENTAL    NAME: HIGH DEDUCTIBLE HEALTH PLAN    
NAME: HIGH DEDUCTIBLE HEALTH PLAN W/HEALTH SAVINGS ACCOUNT    NAME: HIGH DEDUCTIBLE HEALTH PLAN W/HEALTH REIMBURSEMENT ARRANGEMENT    NAME: HEALTH MAINTENANCE ORGANIZATION W/OUT OF NETWORK BENEFITS    NAME: EXCLUSIVE PROVIDER ORGANIZATION    NAME: MEDICARE ADVANTAGE    NAME: VISION    NAME: VA SPECIAL CLASS    

ICR, Total: 4

ICR LINK Subscribing Package(s) Fields Referenced Description
ICR #951
  • Income Verification Match
  • Health Summary
  • Order Entry Results Reporting
    		•  NAME (.01).
    Access: Direct Global Read & w/Fileman

    		 The NAME of the type of plan is directly read anddisplayed to the user when the entire IVM policy is displayed to the user forreview.
    ICR #1045
  • INCOME VERIFICATION NAT'L DB
    		•  NAME (.01).
    Access: Direct Global Read & w/Fileman

    		 Standard types of plans that an insurance company mayprovide.
    ICR #3595
  • Health Summary
  • Fee Basis
    		•  NAME (.01).
    Access: Read w/Fileman
    ICR #3828
  • Accounts Receivable
  • Insurance Capture Buffer
    		•  NAME (.01).
    Access: Direct Global Read & w/Fileman

    MAJOR CATEGORY (.03).
    Access: Direct Global Read & w/Fileman
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