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Global: ^IBE(356.8

Package: Integrated Billing

Global: ^IBE(356.8

Information

FileMan FileNo	FileMan Filename	Package
356.8	CLAIMS TRACKING NON-BILLABLE REASONS	Integrated Billing

Description

This is a file of reasons that may be entered into the claims tracking module to specify why a potential claim isn't billable. Do NOT add, edit, or delete entries in this file without instructions from your ISC. Per VHA Directive 10-93-142, this file definition should not be modified.

Directly Accessed By Routines, Total: 50

Package	Total	Routines
Integrated Billing	45	IB20P123 IB20P132 IB20P159 IB20P247 IB20P276 IB20P339 IB20P384 IB20P486 IB20P510 IB20P587 IB20P673 IB20P686 IB20P786 IB20P791 IBCC1 IBCONS3 IBCOPV1 IBCU81 IBJDB21 IBJDB22 IBNCPBB IBNCPDP1 IBNCPDP4 IBNCPDPI IBNCPDPU IBNCPDR2 IBNCPDR4 IBPP IBPU2 IBRSUTL IBTOECT IBTOSA IBTOSUM2 IBTOUA IBTOUR3 IBTRED0 IBTRKR31 IBY155PO IBY399P1 IBY434PO IBY452PO IBYJPT IBYP458 ^IBE(356.8 ^IBE(399.6
E Claims Management Engine	5	BPSBUTL BPSECMP2 BPSOSU BPSRPT6 BPSSCRU6

Accessed By FileMan Db Calls, Total: 21

Package	Total	Routines
Integrated Billing	20	IB20P123 IB20P132 IB20P159 IB20P247 IB20P339 IB20P384 IB20P486 IB20P510 IB20P587 IB20P673 IB20P686 IB20P786 IB20P791 IBPU2 IBY155PO IBY399P1 IBY434PO IBY452PO IBYJPT IBYP458
E Claims Management Engine	1	BPSSCRCL

Pointed To By FileMan Files, Total: 4

Package	Total	FileMan Files
E Claims Management Engine	2	BPS REQUESTS(#9002313.77)[7.02] BPS CLAIMS(#9002313.02)[904]
Integrated Billing	2	IB NCPDP EVENT LOG(#366.14)[#366.141(.307)] CLAIMS TRACKING(#356)[.19]

Fields, Total: 6

Field #	Name	Loc	Type	Details
.001	NUMBER		NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>9999)!(X<1)!(X?.E1"."1N.N) X` LAST EDITED: `SEP 30, 1993` HELP-PROMPT: `Type a Number between 1 and 9999, 0 Decimal Digits` DESCRIPTION: `This is the number of the reason not billable. It is used for look-up purposes only.`
.01	NAME	0;1	FREE TEXT	**********************REQUIRED FIELD********************** INPUT TRANSFORM: `K:$L(X)>30!(X?.N)!($L(X)<3)!'(X'?1P.E) X` HELP-PROMPT: `NAME MUST BE 3-30 CHARACTERS, NOT NUMERIC OR STARTING WITH PUNCTUATION` DESCRIPTION: `Enter the name of the reason that a visit is not billable. This is the name that will appear on displays and outputs. If a claims tracking entry is assigned a reaon not billable then it will be considered to not be` `billable. Users may select whether visits that have a reason not billable assigned should appear on the patients with visits and insurance reports.` CROSS-REFERENCE: `356.8^B` `1)= S ^IBE(356.8,"B",$E(X,1,30),DA)=""` `2)= K ^IBE(356.8,"B",$E(X,1,30),DA)`
.02	ECME FLAG	0;2	SET	'0' FOR NO; '1' FOR YES; LAST EDITED: `FEB 24, 2005` HELP-PROMPT: `Enter 'Yes' if the record may be used as ECME Close Claim Reason.` DESCRIPTION: `This field is flagging the record to be used as ECME CLOSE CLAIM REASON. The default value is 'NO'. If the field is set to 'YES' the NON-BILLABLE REASON will appear as an option in the ECME CLOSE CLAIM SCREEN.`
.03	ECME PAPER FLAG	0;3	SET	'0' FOR NO; '1' FOR YES; LAST EDITED: `FEB 24, 2005` HELP-PROMPT: `Enter 'YES' if the closed ECME claim may be paper-billable.` DESCRIPTION: `This flag is related to NON-BILLABLE REASONs that are marked with ECME FLAG to be used as ECME CLOSE CLAIM REASON. If this field 'ECME PAPER FLAG' is set to 'YES', it indicates that the NON BILLABLE REASON may be` `potentially billable "on paper". When the ECME user (OPECC) is closing the e-Pharmacy claim and enters the NON BILLABLE REASON as a CLOSE CLAIM REASON, the additional prompt will be issued to the user - should the claim be` `billed "on paper"?`
.04	CODE	0;4	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>5!($L(X)<3) X` LAST EDITED: `OCT 21, 2008` HELP-PROMPT: `Answer must be 3-5 characters in length.` DESCRIPTION: `This code uniquely identifies a particular RNB by group and number. Format is Group_# where group sorts like RNBs into the following: BL-Billing, CV-Insurance Coverage, DC-Documentation, MC-Miscellaneous, MN-Medical` `Necessity, RX-Pharmacy, VA-VA Specific.` CROSS-REFERENCE: `356.8^C` `1)= S ^IBE(356.8,"C",$E(X,1,30),DA)=""` `2)= K ^IBE(356.8,"C",$E(X,1,30),DA)`
.05	INACTIVE	0;5	SET	'0' FOR ACTIVE; '1' FOR INACTIVE; LAST EDITED: `MAR 23, 2009` HELP-PROMPT: `Enter INACTIVE to Inactivate this Reason Not Billable.` DESCRIPTION: `This indicates if the RNB is inactive and should no longer be used.`

Found Entries, Total: 128

NAME: NOT INSURED	NAME: SC TREATMENT	NAME: AGENT ORANGE	NAME: IONIZING RADIATION	NAME: SOUTHWEST ASIA	NAME: SERVICE NOT COVERED	NAME: COVERAGE CANCELED	NAME: NEEDS SC DETERMINATION
NAME: NON-BILLABLE APPOINTMENT TYPE	NAME: INVALID PRESCRIPTION ENTRY	NAME: REFILL ON VISIT DATE	NAME: PRESCRIPTION DELETED	NAME: PRESCRIPTION NOT RELEASED	NAME: DRUG NOT BILLABLE	NAME: HMO POLICY	NAME: REFUSES TO SIGN RELEASE (ROI)
NAME: NON-BILLABLE STOP CODE	NAME: RESEARCH VISIT	NAME: BILL PURGED	NAME: NON-BILLABLE CLINIC	NAME: MILITARY SEXUAL TRAUMA	NAME: CREDENTIALING ISSUE	NAME: INSUFFICIENT DOCUMENTATION	NAME: NO DOCUMENTATION
NAME: NON-BILLABLE PROVIDER (RESID.)	NAME: NON-BILLABLE PROVIDER (OTHER)	NAME: OTHER COMPLIANCE	NAME: OUT OF NETWORK (PPO)	NAME: HEAD/NECK CANCER	NAME: COMBAT VETERAN	NAME: MRA REC'D. NO SEC RESP EXISTS	NAME: MRA REC'D. SEC NOT BILLED
NAME: 90 DAY RX FILL NOT COVERED	NAME: NOT A CONTRACTED PROVIDER	NAME: INVALID MULTIPLES PER DAY SUPP	NAME: REFILL TOO SOON	NAME: INVALID NDC FROM CMOP	NAME: PROJECT 112/SHAD	NAME: NON COVERED DRUG PER PLAN	NAME: FILING TIMEFRAME NOT MET
NAME: GLOBAL SURGERY	NAME: CHARGES SPLIT	NAME: PRE-CERT NOT OBTAINED	NAME: DUPLICATE ENCOUNTER	NAME: MEDICARE REPLACEMENT POLICY	NAME: COVERED BY MEDICARE AT 100%	NAME: BENEFITS MAXED	NAME: C&P EXAM/REGISTRY EXAM
NAME: TELEPHONE ENCOUNTER	NAME: NO TX PROVIDED/ADVICE ONLY	NAME: ROI NOT OBTAINED	NAME: UNSIGNED DOCUMENT	NAME: CONCURRENT CARE	NAME: 72 HOUR RULE	NAME: CUSTODIAL/RESIDENTIAL CARE	NAME: OBSERVATION-OP BILLED
NAME: BILLED INSTITUTIONAL ONLY	NAME: BILLED PROFESSIONAL ONLY	NAME: NO OUTPATIENT COVERAGE	NAME: NO INPATIENT COVERAGE	NAME: NO PHARMACY COVERAGE	NAME: NO DENTAL COVERAGE	NAME: NO MENTAL HEALTH COVERAGE	NAME: NO LTC COVERAGE
NAME: MED NEC-DX NOT COVERED	NAME: MED NEC-CPT NOT COVERED	NAME: MED NEC-LCD EDIT	NAME: MED NEC-OTHER	NAME: MEDICARE EXCLUDED SERVICE	NAME: RESIDENT SUPERVISION NOT MET	NAME: ANCILLARY PROVIDER AT CBOC	NAME: NON-COVERED PROVIDER
NAME: NO DIAGNOSIS/SYMPTOMS IN NOTE	NAME: NO CHIEF COMPLAINT	NAME: NOTE NOT WRITTEN TIMELY	NAME: NO PHYSICIAN ORDER	NAME: NO PLAN OF CARE	NAME: STUDENT NOTE ONLY	NAME: ALL BILLABLE CPT CODES BILLED	NAME: NO INPT PROF FEES BILLED
NAME: REPETITIVE SERVICES	NAME: PENDING CODE SET UPDATE	NAME: PENDING RC CHARGE UPDATE	NAME: NPI/TAXONOMY/PPN ISSUES	NAME: RX DUR REJECT	NAME: RX PRIOR AUTH NOT OBTAINED	NAME: RX MEDICARE PART D	NAME: RX DISCOUNT CARD
NAME: DATE OF BIRTH MISMATCH	NAME: NEW PT/NO HX	NAME: NEW PT/NO EXAM	NAME: NEW PT/NO COMPLEXITY	NAME: EST PT/NO HX/NO EXAM	NAME: EST PT/NO HX/NO COMPLEXITY	NAME: EST PT/NO EXAM/NO COMPLEXITY	NAME: NO VISION COVERAGE
NAME: TRICARE INPATIENT/DISCHARGE	NAME: CHAMPVA INPATIENT/DISCHARGE	NAME: INPATIENT RX AUTO-REVERSAL	NAME: CAMP LEJEUNE TREATMENT	NAME: APPT CANCELLED/PT NOT SEEN	NAME: SEEN BY PROVIDER ON SAME DAY	NAME: NON-BILLABLE DME/PROSTHETIC	NAME: NON-BILLABLE PROCEDURE
NAME: EMPLOYEE HEALTH	NAME: ENCOUNTER DURING INPT STAY	NAME: NO PROSTHETIC COVERAGE	NAME: NON-COVERED DIAGNOSIS	NAME: NON-COVERED ROUTINE CARE	NAME: HDHP PLAN NOT BILLED	NAME: NOT RELATED TO WC/TORT/NF	NAME: TRICARE PT SEEN AS VETERAN
NAME: COMBINED CHARGES	NAME: UNBUNDLED SERVICE	NAME: CHAMPVA PT SEEN AS VETERAN	NAME: LOD NOT OBTAINED	NAME: BILLING LIMITATIONS	NAME: NO COVERAGE	NAME: POLICY LIMITATIONS	NAME: DOCUMENTATION DOES NOT SUPPORT
NAME: NON-BILLABLE SERVICE	NAME: MEDICAL NECESSITY	NAME: RX LIMITATIONS	NAME: MISSING NDC	NAME: RX BILLED PAPER CLAIM	NAME: PACT ACT 103	NAME: DOD PROVIDER TX DOD PT AT VA	NAME: OTHER

ICR, Total: 1

ICR LINK	Subscribing Package(s)	Fields Referenced	Description
ICR #4710	E Claims Management Engine	NAME (.01). Access: Direct Global Read & w/Fileman ECME PAPER FLAG (.03). Access: Direct Global Read & w/Fileman ECME FLAG (.02). Access: Direct Global Read & w/Fileman	direct read

Global Variables Directly Accessed

Name	Line Occurrences (* Changed, ! Killed)
^IBE(356.8 - [#356.8]	.01(XREF 1S), .01(XREF 1K), .04(XREF 1S), .04(XREF 1K)

Naked Globals

Name	Field # of Occurrence
^(0	ID.04+1

Local Variables

Legend:

>>	Not killed explicitly
*	Changed
!	Killed
~	Newed

Name	Field # of Occurrence
>> DA	.01(XREF 1S), .01(XREF 1K), .04(XREF 1S), .04(XREF 1K)
>> DIC	ID.05+1
U	ID.04+1
X	.001+1!, .01+1!, .01(XREF 1S), .01(XREF 1K), .04+1!, .04(XREF 1S), .04(XREF 1K)

Info | Desc | Directly Accessed By Routines | Accessed By FileMan Db Calls | Pointed To By FileMan Files | Fields | ICR | Found Entries | Global Variables Directly Accessed | Naked Globals | Local Variables | All