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Global: ^IBFB(360

Package: Integrated Billing

Global: ^IBFB(360


Information

FileMan FileNo FileMan Filename Package
360 IB-FB INTERFACE TRACKING Integrated Billing

Description

Accessed By FileMan Db Calls, Total: 5

Package Total Routines
Integrated Billing 5 IBFBNP1    IBFBUTIL    IBFBWL1    IBFBWL2    IBFBWL5    

Pointer To FileMan Files, Total: 6

Package Total FileMan Files
Integrated Billing 3 BILL/CLAIMS(#399)[1.02]    INTEGRATED BILLING ACTION(#350)[1.04]    CLAIMS TRACKING(#356)[1.01]    
Fee Basis 1 FEE BASIS INVOICE(#162.5)[1.03]    
Kernel 1 NEW PERSON(#200)[#360.04(.03)]    
Registration 1 PATIENT(#2)[.02]    

Fields, Total: 17

Field # Name Loc Type Details
.01 ENTRY NUMBER 0;1 NUMBER
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999)!(X<0)!(X?.E1"."1N.N) X S:$D(X) DINUM=X
  • LAST EDITED:  FEB 17, 2016
  • HELP-PROMPT:  Enter an entry number, between 1 - 9999999
  • DESCRIPTION:  
    This is the internal entry number to identify the link between claims/bills and Fee Basis payments and authorizations.
  • TECHNICAL DESCR:  Manual cross references:
    ; ^IBFB(360,"DFN",DFN,DT,IEN,IBLOG)="" Log cross reference by Patient
    ; ^IBFB(360,"DT",DT,DFN,IEN,IBLOG)="" Log cross reference by Date
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  360^B
    1)= S ^IBFB(360,"B",$E(X,1,30),DA)=""
    2)= K ^IBFB(360,"B",$E(X,1,30),DA)
.02 PATIENT 0;2 POINTER TO PATIENT FILE (#2) PATIENT(#2)

  • LAST EDITED:  FEB 17, 2016
  • HELP-PROMPT:  Enter a Patient name.
  • DESCRIPTION:  
    Patient name to link authorizations, payments and claims/bills.
  • CROSS-REFERENCE:  360^C
    1)= S ^IBFB(360,"C",$E(X,1,30),DA)=""
    2)= K ^IBFB(360,"C",$E(X,1,30),DA)
    This cross reference is used to easily track entries made by a particular user. User and entry number.
  • RECORD INDEXES:  D (#1428), F (#1429)
.03 FB AUTHORIZATION 0;3 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999999)!(X<1)!(X?.E1"."1.N) X
  • LAST EDITED:  FEB 17, 2016
  • HELP-PROMPT:  Enter a Patient Authorization number, between 1 - 99999999
  • DESCRIPTION:  
    Enter an Authorization IEN to link authorizations, payments and claims/bills.
  • TECHNICAL DESCR:  
    This is the Authorization number not a pointer. It references file 161.01
  • RECORD INDEXES:  D (#1428)
.04 AUTH DELETION DATE/TIME 0;4 DATE

  • INPUT TRANSFORM:  S %DT="ETR" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  FEB 17, 2016
  • HELP-PROMPT:  Enter the date/time the Authorization was deleted.
  • DESCRIPTION:  
    This is the date that an Authorization was deleted completely. Used for tracking purposes.
  • TECHNICAL DESCR:  
    We're tracking in an Authorization was deleted and there were pointers to claims or bills present.
  • CROSS-REFERENCE:  360^AC
    1)= S ^IBFB(360,"AC",$E(X,1,30),DA)=""
    2)= K ^IBFB(360,"AC",$E(X,1,30),DA)
    Payment ID cross reference used for linking FB to IB.
.05 INITIAL TREATMENT DATE 0;5 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  FEB 17, 2016
  • HELP-PROMPT:  Enter date of Initial Treatment.
  • DESCRIPTION:  
    This is the date of the initial Non-VA Care treatment was provided.
1.01 CLAIMS TRACKING ENTRY NUMBER 1;1 POINTER TO CLAIMS TRACKING FILE (#356) CLAIMS TRACKING(#356)

  • LAST EDITED:  SEP 01, 2016
  • HELP-PROMPT:  Enter a claim ID.
  • DESCRIPTION:  
    Enter a Claim ID to assist in linking NVC authorizations and payments to claims in file #356.
  • TECHNICAL DESCR:  
    We need a claim ID to assist in linking NVC authorizations and third party claims to payments. Without this field we lose the ability to link 3rd party claims to fee basis.
  • CROSS-REFERENCE:  360^AD
    1)= S ^IBFB(360,"AD",$E(X,1,30),DA)=""
    2)= K ^IBFB(360,"AD",$E(X,1,30),DA)
    Used to be able to quickly lookup an entry based on the pointer to file #356 (Claim).
1.02 BILL/CLAIMS 1;2 POINTER TO BILL/CLAIMS FILE (#399) BILL/CLAIMS(#399)

  • LAST EDITED:  DEC 03, 2015
  • HELP-PROMPT:  Enter an existing Bill for the Patient.
  • DESCRIPTION:  
    We use this to link an existing entry in file #399 to an existing fee basis authorization and payment.
1.03 INVOICE NUMBER 1;3 POINTER TO FEE BASIS INVOICE FILE (#162.5) FEE BASIS INVOICE(#162.5)

  • LAST EDITED:  SEP 01, 2016
  • HELP-PROMPT:  Enter a fee basis invoice number.
  • DESCRIPTION:  
    This field is a pointer to the Inpatient Payment File and a soft pointer to the Outpatient Payment File.
  • TECHNICAL DESCR:  
    We need a Invoice ID to assist in linking NVC authorizations and claims/bills to payments.
  • RECORD INDEXES:  F (#1429)
1.04 INTEGRATED BILLING ACTION 1;4 POINTER TO INTEGRATED BILLING ACTION FILE (#350) INTEGRATED BILLING ACTION(#350)

  • LAST EDITED:  DEC 03, 2015
  • HELP-PROMPT:  Enter a copayment associated with the FB auth
  • DESCRIPTION:  
    Enter a first party copay IEN to link to a FB Auth and payment.
  • TECHNICAL DESCR:  
    We need a Bill ID to assist in linking NVC authorizations and first party claims to payments. Without this field we lose the ability to link 1st party claims to fee basis Authorizations and payments.
2.01 IV QUEUE 2;1 SET
  • 'IV' FOR IV QUEUE;
  • 'XX' FOR REMOVED;

  • LAST EDITED:  FEB 17, 2016
  • HELP-PROMPT:  Select from an IV Precert Queue type
  • DESCRIPTION:  
    This is the Insurance Verification Precertification Queue
  • FIELD INDEX:  IV (#1431) REGULAR IR LOOKUP & SORTING
    Short Descr: IV QUEUE
    Description: Used for Insurance Verification to be able to track the entries that need Insurance verification in the Worklist.
    Set Logic: S ^IBFB(360,"IV",$E(X,1,240),DA)=""
    Kill Logic: K ^IBFB(360,"IV",$E(X,1,240),DA)
    Whole Kill: K ^IBFB(360,"IV")
    X(1): IV QUEUE (360,2.01) (Subscr 1) (Len 240) (forwards)
2.02 UR QUEUE 2;2 SET
  • 'UR' FOR UR QUEUE;
  • 'XX' FOR REMOVED;

  • LAST EDITED:  FEB 17, 2016
  • HELP-PROMPT:  Select from an UR Precert Queue entry
  • DESCRIPTION:  
    This is the RUR Precertification Queue
  • FIELD INDEX:  UR (#1433) REGULAR IR LOOKUP & SORTING
    Short Descr: UR QUEUE
    Description: Used to track entries that need Utilization review completed.
    Set Logic: S ^IBFB(360,"UR",$E(X,1,240),DA)=""
    Kill Logic: K ^IBFB(360,"UR",$E(X,1,240),DA)
    Whole Kill: K ^IBFB(360,"UR")
    X(1): UR QUEUE (360,2.02) (Subscr 1) (Len 240) (forwards)
2.03 FR QUEUE 2;3 SET
  • 'FR' FOR FR QUEUE;
  • 'XX' FOR REMOVED;

  • LAST EDITED:  FEB 17, 2016
  • HELP-PROMPT:  Select from an FR Billing Queue entry
  • DESCRIPTION:  
    This is the Facility Revenue Billing Queue
  • FIELD INDEX:  FR (#1430) REGULAR IR LOOKUP & SORTING
    Short Descr: FR QUEUE
    Description: Used to track entries that need Facility Revenue reviews completed.
    Set Logic: S ^IBFB(360,"FR",$E(X,1,240),DA)=""
    Kill Logic: K ^IBFB(360,"FR",$E(X,1,240),DA)
    Whole Kill: K ^IBFB(360,"FR")
    X(1): FR QUEUE (360,2.03) (Subscr 1) (Len 240) (forwards)
2.04 SC QUEUE 2;4 SET
  • 'SC' FOR SC QUEUE;
  • 'XX' FOR REMOVED;

  • LAST EDITED:  FEB 17, 2016
  • HELP-PROMPT:  Select from an SC Billing Queue entry
  • DESCRIPTION:  
    This is the RUR Service Connected Billing Queue
  • FIELD INDEX:  SC (#1432) REGULAR IR LOOKUP & SORTING
    Short Descr: SC QUEUE
    Description: Used to notate if this entry is - Service Connected / Special Authority Eligibility entries.
    Set Logic: S ^IBFB(360,"SC",$E(X,1,240),DA)=""
    Kill Logic: K ^IBFB(360,"SC",$E(X,1,240),DA)
    Whole Kill: K ^IBFB(360,"SC")
    X(1): SC QUEUE (360,2.04) (Subscr 1) (Len 240) (forwards)
2.05 BI QUEUE 2;5 SET
  • 'BI' FOR BI QUEUE;
  • 'XX' FOR REMOVED;

  • LAST EDITED:  FEB 17, 2016
  • HELP-PROMPT:  Select from a BI Billing Queue entry
  • DESCRIPTION:  
    This is the Billing Review Queue
  • FIELD INDEX:  BI (#1427) REGULAR IR LOOKUP & SORTING
    Short Descr: BI QUEUE
    Description: Used to track claims that are ready to be billed after all verifications are completed.
    Set Logic: S ^IBFB(360,"BI",$E(X,1,240),DA)=""
    Kill Logic: K ^IBFB(360,"BI",$E(X,1,240),DA)
    Whole Kill: K ^IBFB(360,"BI")
    X(1): BI QUEUE (360,2.05) (Subscr 1) (Len 240) (forwards)
3.01 NEXT REVIEW DT 3;1 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  FEB 17, 2016
  • HELP-PROMPT:  Enter a date for the next review.
  • DESCRIPTION:  
    This field holds the date of the next RUR precertification review. If a date has been entered in this field, the authorization will not display on the RUR precertification work queue until the date specified.
3.02 1ST OR 3RD PTY 3;2 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>3)!(X<1)!(X?.E1"."1.N) X
  • LAST EDITED:  FEB 17, 2016
  • HELP-PROMPT:  First party copay or third party insurance, number between 1-3
  • DESCRIPTION:  
    This field indicates if the bill is for first party copay or third party insurance.
  • TECHNICAL DESCR:  
    First Party Copay = $P(^IBFB(360,IEN,3),"^",2)=1 Third Party Insurance = $P(^IBFB(360,IEN,3),"^",2)=3
4 LOG 4;0 DATE Multiple #360.04 360.04

  • DESCRIPTION:  
    This is an audit field to track entries and changes made to the file for auditing purposes.
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