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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

Accessed By FileMan Db Calls, Total: 20

Package Total Routines
Integrated Billing 19 IB20P123    IB20P132    IB20P159    IB20P247    IB20P339    IB20P384    IB20P486    IB20P510
IB20P587    IB20P673    IB20P686    IB20P786    IB20P791    IBPU2    IBY399P1    IBY434PO
IBY452PO    IBYJPT    IBYP458    
E Claims Management Engine 1 BPSSCRCL    

Pointed To By FileMan Files, Total: 5

Package Total FileMan Files
E Claims Management Engine 3 BPS REQUESTS(#9002313.77)[7.02]    BPS AUTO CLOSE REJECT CODE(#9002313.94)[.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
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