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Global: ^IBE(364.4

Package: Integrated Billing

Global: ^IBE(364.4


Information

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

Description

Accessed By FileMan Db Calls, Total: 2

Package Total Routines
Integrated Billing 2 IBCEF5    IBCEF61    

Pointer To FileMan Files, Total: 2

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.
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