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Routine: FBCH78A

Package: Fee Basis

Routine: FBCH78A


Information

FBCH78A ;AISC/DMK-PRINT 7078 CONTINUED FROM FBCHP78 ;06FEB89

Source Information

Source file <FBCH78A.m>

Entry Points

Name Comments DBIA/ICR reference
HED
BOT
FISCAL ;SETS THE FISCAL SYMBOL BLOCK FOR 7078
CONT(X,Y) ;get contract for CNH authorization

Interaction Calls

Name Line Occurrences
Function Call: WRITE
  • Prompt: UL,!,?5,"Department of Veterans Affairs",?58,"AUTHORIZATION AND INVOICE FOR MEDICAL AND HOSPITAL SERVICES",!,UL,!
  • Line Location: HED+0
Function Call: WRITE
  • Prompt: !,"SPECIAL PROVISIONS: Acceptance of this authorization to render service is governed by the following:",!!
  • Line Location: BOT+0
Function Call: WRITE
  • Prompt: "1. ACCEPTANCE OF THIS AUTHORIZATION AND PROVIDING OF SUCH TREATMENT OR SERVICES SUBJECTS YOU, THE PROVIDER OF CARE, TO",!,?3,"THE PROVISIONS OF PUBLIC LAW 93-579, THE PRIVACY ACT OF 1974, TO THE EXTENT OF THE RECORDS "
  • Line Location: BOT+1
Function Call: WRITE
  • Prompt: "PERTAINING TO THE VA",!,?3,"AUTHORIZED TREATMENT OR SERVICES OF THIS VETERAN.",!
  • Line Location: BOT+2
Function Call: WRITE
  • Prompt: !,"2. Fees or rates listed represent maximum allowance for services specified. In no event should charges be made to the",!,?3,"VA in excess of usual and customary charges to the general public for similar services.",!
  • Line Location: BOT+3
Function Call: WRITE
  • Prompt: !,"3. Payment by the VA is payment in full for authorized services rendered.",!
  • Line Location: BOT+4
Function Call: WRITE
  • Prompt: !,"4. Unless otherwise approved by the VA, services are limited in type and extent to those shown on this authorization.",!,?3,"If services are not initiated for any reason, return a copy of the authorization to the issuing ",!
  • Line Location: BOT+5
Function Call: WRITE
  • Prompt: ?3,"office with a brief explanation.",!
  • Line Location: BOT+6
Function Call: WRITE
  • Prompt: !,"5. A copy of the Operative Report will be forwarded to the Authorizing station within one week following any major",!,?3,"surgery.",!
  • Line Location: BOT+7
Function Call: WRITE
  • Prompt: !,"6. A copy of the hospital summary will be forwarded to the authorizing station within ten work days following the ",!,?3,"release of the patient from the hospital.",!
  • Line Location: BOT+8
Function Call: WRITE
  • Prompt: !,"7. When submitting claims for payment you must include the NPI and Taxonomy Code of the rendering practitioner,"
  • Line Location: BOT+9
Function Call: WRITE
  • Prompt: !,?3,"and the NPI and Taxonomy Code of your organization. If, under the HIPAA NPI Final Rule"
  • Line Location: BOT+10
Function Call: WRITE
  • Prompt: !,?3,"[http://www.cms.hhs.gov/NationalProvIdentStand], your organization is an ""atypical"" provider furnishing services such"
  • Line Location: BOT+11
Function Call: WRITE
  • Prompt: !,?3,"as taxi, home and vehicle modifications, insect control, habilitation, and respite services and is therefore"
  • Line Location: BOT+12
Function Call: WRITE
  • Prompt: !,?3,"ineligible for an NPI, it is important that you indicate ""Ineligible for NPI"" on your claim form.",!
  • Line Location: BOT+13
Function Call: WRITE
  • Prompt: UL,!,?16,"All questions relating to this authorization should be referred to the issuing VA Office",!,UL,!,"VA Form 10-7078"
  • Line Location: BOT+14
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