Global: ^IBE(364.4

FileMan FileNo	FileMan Filename	Package
364.4	IB EDI TRANSMISSION RULE	Integrated Billing

Package	Total	Routines
Integrated Billing	11	IBCEF62 ^IBE(399.6 BILL TYPE RESTRICTIONS EXCLUDED INSURANCE COMPANY IBCEF4 IBCEF5 IBCEF6 IBCEF61 IBEFUNC INCLUDED INSURANCE COMPANY ^IBE(364.4

Package	Total	Routines
Integrated Billing	2	IBCEF5 IBCEF61

Package	Total	FileMan Files
Integrated Billing	1	INSURANCE COMPANY(#36)[#364.42(.01), #364.43(.01)]
Kernel	1	NEW PERSON(#200)[10.01, 10.03]

Fields, Total: 18

Field #	Name	Loc	Type	Details
.01	RULE NUMBER	0;1	NUMBER	**********************REQUIRED FIELD********************** INPUT TRANSFORM: `K:+X'=X!(X>999999)!(X<0)!(X?.E1"."1N.N) X I $D(X),X<99 N DIR,Y,IBX S IBX=X K X D EN^DDIOL("Use a # > 99 to protect local rules from national updates") S DIR(0)="YA",DIR("A")="OK to continue? " D ^DIR K DIR,X S:Y X=IBX` LAST EDITED: `APR 26, 1999` HELP-PROMPT: `Type a Number from 0-999999 (0-99 are reserved for national use. Use at your own risk!!)` DESCRIPTION: `This is the rule # given to identify this rule. Rules 1-99 are reserved for National EDI rules and are not editable.` NOTES: `XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER` CROSS-REFERENCE: `364.4^B` `1)= S ^IBE(364.4,"B",$E(X,1,30),DA)=""` `2)= K ^IBE(364.4,"B",$E(X,1,30),DA)` CROSS-REFERENCE: `^^TRIGGER^364.4^.04` `1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBE(364.4,D0,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X=DIV S X=3 X ^DD(364.4,.01,1,2,1.4)` `1.4)= S DIH=$S($D(^IBE(364.4,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,4)=DIV,DIH=364.4,DIG=.04 D ^DICR` `2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBE(364.4,D0,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X="" X ^DD(364.4,.01,1,2,2.4)` `2.4)= S DIH=$S($D(^IBE(364.4,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,4)=DIV,DIH=364.4,DIG=.04 D ^DICR` `3)= Do not delete` `CREATE VALUE)= S X=3` `DELETE VALUE)= @` `FIELD)= #.04` `This trigger is used to force a 3 into the TYPE OF CARE field because CO thinks it does not need it, but the field thinks it might. For now, the code will assume it is always a '3' (both inpt and outpt) and when/if they` `realize they need this field, it will be ready for their use.`
.02	EARLIEST ACTIVATE DATE	0;2	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X),'$$BTDTOK^IBCEF61(DA,"",1,X) K X` LAST EDITED: `MAY 03, 1999` HELP-PROMPT: `Enter a date here if this rule should be effective in the future. Must be less than entered expire date.` DESCRIPTION: `This is a date in the future when this rule will automatically be used.` NOTES: `XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER`
.03	TRANSMISSION TYPE	0;3	SET	**********************REQUIRED FIELD********************** '1' FOR EDI only; '2' FOR MRA only; '3' FOR Both EDI and MRA; LAST EDITED: `MAR 29, 2002` HELP-PROMPT: `Select the type of transmission this rule will apply to` DESCRIPTION: `This is the type of transmission that the rule will be executed for.` RECORD INDEXES: `AD (#138)`
.04	TYPE OF CARE	0;4	SET	**********************REQUIRED FIELD********************** '1' FOR OUTPATIENT only; '2' FOR INPATIENT only; '3' FOR Both INPT and OUTPT; LAST EDITED: `MAR 29, 2002` HELP-PROMPT: `Select the type of care this rule will apply to` DESCRIPTION: `This is the type of care that the rule will be executed for.` `WRITE AUTHORITY: ^` NOTES: `TRIGGERED by the RULE NUMBER field of the IB EDI TRANSMISSION RULE File` RECORD INDEXES: `AD (#138)`
.05	FORM TYPE	0;5	SET	**********************REQUIRED FIELD********************** '1' FOR INSTITUTIONAL (UB-04) only; '2' FOR PROFESSIONAL (CMS-1500 and J430D) only; '3' FOR Both INST (UB-04) and PROF (CMS-1500 and J430D); LAST EDITED: `APR 28, 2017` HELP-PROMPT: `Select the form type this rule will apply to` DESCRIPTION: `This is the form type that the rule will be executed for.` RECORD INDEXES: `AD (#138)`
.06	INACTIVE DATE	0;6	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X),'$$BTDTOK^IBCEF61(DA,"",2,X) K X` LAST EDITED: `MAR 29, 2002` HELP-PROMPT: `Enter the date when this edit will no longer be used to determine if a bill is transmittable. Must not be earlier than entered active date.` DESCRIPTION: `This is the date on which this edit will not longer be used to determine 'transmittable' for a bill.` NOTES: `XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER` RECORD INDEXES: `AD (#138)`
.07	INSURANCE COMPANY OPTION	0;7	SET	**********************REQUIRED FIELD********************** '1' FOR APPLY ONLY TO SPECIFIC COMPANIES; '2' FOR DO NOT APPLY TO SPECIFIC COMPANIES; '3' FOR APPLY TO ALL COMPANIES; LAST EDITED: `MAR 29, 2002` HELP-PROMPT: `Select the option to determine which insurance companies to apply this rule to.` DESCRIPTION: `This is the option to determine which insurance companies to apply this rule to. If 1 or 2 are chosen, the list of insurance companies to be included or excluded should be entered in the appropriate multiple within this` `file.` RECORD INDEXES: `AD (#138)`
.08	SHORT DESCRIPTION	0;8	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>40!($L(X)<1) X` LAST EDITED: `APR 29, 1999` HELP-PROMPT: `Answer must be 1-40 characters in length.` DESCRIPTION: `This is a short description of the rule used for identification purposes on lookup.`
.1	BILL TYPE RESTRICTIONS	BTYP;0	Multiple #364.41	364.41 LAST EDITED: `APR 29, 1999`
.11	TYPE OF RULE	0;11	SET	**********************REQUIRED FIELD********************** '0' FOR LIMIT TO FORM TYPE; '1' FOR LIMIT TO SOME BILL TYPES; '2' FOR MRA REQUEST RESTRICTIONS; '9' FOR LOCALLY DEFINED; LAST EDITED: `JAN 16, 2007` HELP-PROMPT: `Select the 'type' of rule this is.` DESCRIPTION: `This flag puts the rule into a 'type' category for conflict checking. It is also a flag that can indicate this rule needs to be executed to determine if an MRA request is valid for the MEDIGAP insurance that is next in` `line for COB or if the claim should be directly shuttled to the MEDIGAP carrier.` `TYPE OF RULE = 0 (LIMIT TO FORM TYPES) is used to further limit the transmission of PROFESSIONAL (CMS-1500) or INSTITUTIONAL (UB-04) form types. If you pick one form type, no bills of the other form type will be` `transmitted for: a) the insurance companies you selected to include OR b) the insurance companies not entered on the excluded list OR c) any insurance co if all insurance companies are selected.` `TYPE OF RULE = 1 (LIMIT TO SOME BILL TYPES) is used to further limit the transmission of the UB-04 equivalent of bill type (111,131,etc). These rules can be used to restrict transmissions to specific bill types or to` `allow all bill types except those specified (these are entered preceeded by a dash). A 'wild card' character of X can be used to indicate that a character in that position is included (ie 11X will allow 111,112,113,etc)` `The rule will not allow transmission of bills matching the EDI/MRA and PROF/INST parameters and insurance co restrictions (see rule 0 above) unless they match the allowed bill types and do not match any of the excluded` `bill types.` `TYPE OF RULE = 9 (LOCAL EDITS) are local edits. If this type of rule is used, the code entered for the edit must return a truth value of 1 if the bill should be transmitted or 0 if the bill should not be transmitted. The` `variable IBIFN is the internal entry # of the bill (file 399), the IB(x) array contains the value of fields #.03,.04,.05,.07,.11 for the rule where 'x' is the field #. IBDA is the ien of the rule (file 364.4).` CROSS-REFERENCE: `364.4^AC` `1)= S ^IBE(364.4,"AC",$E(X,1,30),DA)=""` `2)= K ^IBE(364.4,"AC",$E(X,1,30),DA)` `3)= Please don't delete` `This xref allows a check on all rules of the same type for conflict checking purposes.` RECORD INDEXES: `AD (#138)`
1	RULE CODE	1;E1,245	MUMPS	INPUT TRANSFORM: `K:$L(X)>245 X D:$D(X) ^DIM` LAST EDITED: `APR 19, 1999` HELP-PROMPT: `This is Standard MUMPS code that will be executed to enforce this rule.` DESCRIPTION: `This is the MUMPS call that will execute the edit's logic and will set $T to 1 for edit passed or to 0 for edit failed. You can assume the following variables are available:` `IBIFN = ien of the bill in file 399` `IB(.03) = Current value of the bill's transmission type` `IB(.05) = Current value of the bill's form type` `IB(.07) = Current value of the bill's insurance option` `WRITE AUTHORITY: @`
2	EXCLUDED INSURANCE COMPANY	2;0	POINTER Multiple #364.42	364.42
3	INCLUDED INSURANCE COMPANY	3;0	POINTER Multiple #364.43	364.43
4	RULE DESCRIPTION	4;0	WORD-PROCESSING #364.44	LAST EDITED: `APR 16, 1999` HELP-PROMPT: `Enter text here to provide a broader description of the transmission rule.` DESCRIPTION: `This is a broader description of the transmission rule.`
10.01	RULE ADDED BY	10;1	POINTER TO NEW PERSON FILE (#200)	NEW PERSON(#200) LAST EDITED: `APR 27, 1999` HELP-PROMPT: `Enter the name of the person who entered this rule` DESCRIPTION: `This is the person responsible for adding this rule to this file.`
10.02	RULE ADDED DATE	10;2	DATE	INPUT TRANSFORM: `S %DT="ETXR" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `APR 27, 1999` HELP-PROMPT: `Enter the date this rule was first added to the file.` DESCRIPTION: `This is the date this rule entry was first added to this file.`
10.03	RULE LAST EDITED BY	10;3	POINTER TO NEW PERSON FILE (#200)	NEW PERSON(#200) LAST EDITED: `APR 27, 1999` HELP-PROMPT: `Enter the name of the person who last edited this rule entry.` DESCRIPTION: `This is the name of the person who last edited this rule entry.`
10.04	RULE LAST EDITED DATE	10;4	DATE	INPUT TRANSFORM: `S %DT="ETXR" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `APR 27, 1999` HELP-PROMPT: `Enter the date this rule was last edited.` DESCRIPTION: `This is the last date this rule was edited.`

Name	Line Occurrences (* Changed, ! Killed)
^DD(364.4	.01(XREF 2S), .01(XREF 2K)
^IBE(364.4 - [#364.4]	IXADSL+1*, IXADKL+1!, IXADKEIC+1!, .01(XREF 1S), .01(XREF 1K), .01(XREF 2S), .01(XREF 2n1.4), .01(XREF 2K), .01(XREF 2n2.4), .11(XREF 1S) , .11(XREF 1K)

>>	Not killed explicitly
*	Changed
!	Killed
~	Newed

Name	Field # of Occurrence
>> %DT	.02+1, .06+1, 10.02+1, 10.04+1
>> D0	.01(XREF 2S), .01(XREF 2K)
>> DA	IXADSL+1, IXADKL+1, .01(XREF 1S), .01(XREF 1K), .01(XREF 2S), .01(XREF 2K), .02+1, .06+1, .11(XREF 1S), .11(XREF 1K)
>> DIG	.01(XREF 2n1.4), .01(XREF 2n2.4)
>> DIH	.01(XREF 2n1.4), .01(XREF 2n2.4)
DIR	.01+1~!
DIR("A"	.01+1*
DIR(0	.01+1*
>> DIU	.01(XREF 2S), .01(XREF 2K)
DIV	.01(XREF 2S), .01(XREF 2n1.4), .01(XREF 2K), .01(XREF 2n2.4)
DIV(0	.01(XREF 2S), .01(XREF 2n1.4), .01(XREF 2K), .01(XREF 2n2.4)
IBX	.01+1~*
U	ID.08+1, .01(XREF 2S), .01(XREF 2n1.4), .01(XREF 2K), .01(XREF 2n2.4)
X	IXADSCC+1, IXADKCC+1, .01+1!, .01(XREF 1S), .01(XREF 1K), .01(XREF 2S), .01(XREF 2n1.4), .01(XREF 2K), .01(XREF 2n2.4), .02+1! , .06+1!, .08+1!, .11(XREF 1S), .11(XREF 1K), 1+1!, 10.02+1!, 10.04+1*!
>> X1(1	IXADKL+1, IXADKCC+1
>> X1(2	IXADKL+1, IXADKCC+1
>> X1(3	IXADKL+1, IXADKCC+1
>> X1(4	IXADKL+1, IXADKCC+1
>> X1(6	IXADKL+1
>> X2(1	IXADSL+1, IXADSCC+1
>> X2(2	IXADSL+1, IXADSCC+1
>> X2(3	IXADSL+1, IXADSCC+1
>> X2(4	IXADSL+1, IXADSCC+1
>> X2(5	IXADSL+1
>> X2(6	IXADSL+1
Y	.01+1~, .01(XREF 2S), .01(XREF 2K), .02+1, .06+1, 10.02+1, 10.04+1
Y(1	.01(XREF 2S), .01(XREF 2K)

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Package: Integrated Billing

Global: ^IBE(364.4

Information

Description

Directly Accessed By Routines, Total: 11

Accessed By FileMan Db Calls, Total: 2

Pointer To FileMan Files, Total: 2

Fields, Total: 18

External References

Global Variables Directly Accessed

Naked Globals

Local Variables

Legend:

Name	Field # of Occurrence
^%DT	.02+1, .06+1, 10.02+1, 10.04+1
EN^DDIOL	.01+1
^DICR	.01(XREF 2n1.4), .01(XREF 2n2.4)
^DIM	1+1
^DIR	.01+1
$$BTDTOK^IBCEF61	.02+1, .06+1