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Routine: IBCF2P

Package: Integrated Billing

Routine: IBCF2P


Information

IBCF2P ;ALB/ARH - PRINT HCFA 1500 12-90 FORM ; 17-JUL-93

Source Information

Source file <IBCF2P.m>

Entry Points

Name Comments DBIA/ICR reference
PRINT ; print the form, IBFLD required
LINE8 ; insured's ID number
LINE10 ; patient name, DOB, sex; insured's name ("SAME" if patient)
LINE12 ; patient's address (street); pt. rel to ins.; insured's address
LINE14 ; patient addr city, state code, marital status; insured's city, state
LINE16 ; patient zip code, phone; patient employment status; insured's zip code, phone
LINE18 ; other insured's name; insured's policy group
LINE20 ; other insured's policy number; condition related to employment?; insured's date of birth and sex
LINE22 ; other insured's DOB, sex; patient auto accident & place; insured's employer
LINE24 ; other insured's employer; patient other accident; insured's insurance plan name
LINE26 ; other insured's plan name; is there another benefit plan *488* add box 10d
LINE29 ; patient's signature; insured's signature (use PL 99-272, SECTION 1729 TITLE 38)
LINE32 ; date of current illness; date of similar illness; dates unable to work *488*
LINE34 ; name of referring physician; ID# referring physician; hospitalization dates related to services
LINE35 ; "not for SC" note line 1
LINE36 ; "not for SC" note line 2; outside lab (now defaults to "no" in IBEHCFA)
LINE37 ; diagnosis code indicator *488*
LINE38 ; diagnosis codes 1-4 ; field 22 (MEDICAID) left blank *488*
LINE39 ; diagnosis codes 5-8 *488*
LINE40 ; diagnosis codes 9-12; field 23 (prior authorization #) *488*
LINE44 ;lines 44,46,48,50,52,54 all the same
LINE56
LINE58
LINE69
LINE60
LINE61
END

Interaction Calls

Name Line Occurrences
Function Call: WRITE
  • Prompt: !,?IBADDM,$G(IBFLD(0,IBI))
  • Line Location: PRINT+2
Function Call: WRITE
  • Prompt: !!,?49,$E(IBFLD("1A"),1,28)
  • Line Location: LINE8+1
Function Call: WRITE
  • Prompt: !!,$E(IBFLD(2),1,28),?30,IBFLD("3D"),?($S(IBFLD("3X")="M":41,1:46)),"X",?49,$E(IBFLD(4),1,28)
  • Line Location: LINE10+1
Function Call: WRITE
  • Prompt: !!,$E(IBFLD(5,1),1,28),?($S(+IBFLD(6)=1:32,+IBFLD(6)=2:37,+IBFLD(6)=3:41,1:46)),"X",?49,$E(IBFLD(7),1,28)
  • Line Location: LINE12+1
Function Call: WRITE
  • Prompt: !!,$E(IBFLD(5,2),1,24),?25,IBFLD("5S"),?($S(IBFLD("8M")="S":34,IBFLD("8M")="M":40,1:46)),"X",?49
  • Line Location: LINE14+1
Function Call: WRITE
  • Prompt: !!,$E(IBFLD(5,3),1,12),?14,IBFLD("5T"),?34,$S(IBFLD("8E")="E":"X",1:""),?49
  • Line Location: LINE16+1
Function Call: WRITE
  • Prompt: !!,$E(IBFLD(9),1,28),?49,$E(IBFLD(11),1,28)
  • Line Location: LINE18+1
Function Call: WRITE
  • Prompt: !!,$E(IBFLD("9A"),1,28),?($S(+IBFLD("10A"):34,1:40)),"X"
  • Line Location: LINE20+1
Function Call: WRITE
  • Prompt: ?($S(IBFLD("11AX")="M":67,1:74)),"X"
  • Line Location: LINE20+2
Function Call: WRITE
  • Prompt: ?($S(IBFLD("9BX")="M":17,1:23)),"X"
  • Line Location: LINE22+1
Function Call: WRITE
  • Prompt: ?($S(+IBFLD("10B"):34,1:40)),"X",?44,IBFLD("10BS"),?49,$E(IBFLD("11B"),1,28)
  • Line Location: LINE22+2
Function Call: WRITE
  • Prompt: !!,?($S(+IBFLD("10C"):34,1:40)),"X",?49,$E(IBFLD("11C"),1,28)
  • Line Location: LINE24+3
Function Call: WRITE
  • Prompt: !!,$E(IBFLD("9D"),1,28),?30,IBFLD("10D"),?($S(+IBFLD("11D"):51,1:56)),"X"
  • Line Location: LINE26+1
Function Call: WRITE
  • Prompt: !!!,?3,IBFLD(12),?56,IBFLD(13)
  • Line Location: LINE29+1
Function Call: WRITE
  • Prompt: !!!,?1,IBFLD(14),?14,IBFLD(14.1),?26,IBFLD(15.1),?36,IBFLD(15),?53,IBFLD("16A"),?67,IBFLD("16B")
  • Line Location: LINE32+1
Function Call: WRITE
  • Prompt: !!,?53,IBFLD("18A"),?67,IBFLD("18B")
  • Line Location: LINE34+1
Function Call: WRITE
  • Prompt: !,?14,$E(IBFLD(19),1,31)_"-"
  • Line Location: LINE35+1
Function Call: WRITE
  • Prompt: !,$E(IBFLD(19),32,83),?56,"X"
  • Line Location: LINE36+1
Function Call: WRITE
  • Prompt: !,?40,IBFLD("21A")
  • Line Location: LINE37+1
Function Call: WRITE
  • Prompt: !,?2,IBFLD(21,1),?15,IBFLD(21,2),?28,IBFLD(21,3),?40,IBFLD(21,4)
  • Line Location: LINE38+1
Function Call: WRITE
  • Prompt: !,?2,IBFLD(21,5),?15,IBFLD(21,6),?28,IBFLD(21,7),?40,IBFLD(21,7)
  • Line Location: LINE39+1
Function Call: WRITE
  • Prompt: !,?2,IBFLD(21,9),?15,IBFLD(21,10),?28,IBFLD(21,11),?40,IBFLD(21,12),?49,IBFLD(23)
  • Line Location: LINE40+1
Function Call: WRITE
  • Prompt: !!
  • Line Location: LINE44+1
Function Call: WRITE
  • Prompt: !
  • Line Location: LINE44+2
Function Call: WRITE
  • Prompt: ?25,$E(IBFLD(24,IBI_"A"),1,15)
  • Line Location: LINE44+2
Function Call: WRITE
  • Prompt: !
  • Line Location: LINE44+3
Function Call: WRITE
  • Prompt: $P(IBFLD(24,IBI),U,1),?9,$P(IBFLD(24,IBI),U,2),?18,$P(IBFLD(24,IBI),U,3),?21,$P(IBFLD(24,IBI),U,4),?25,$E($P(IBFLD(24,IBI),U,5),1,15)
  • Line Location: LINE44+4
Function Call: WRITE
  • Prompt: ?32,$P($$MOD^ICPTMOD(+$P(IBFLD(24,IBI),U,9),"I",DT),U,2)
  • Line Location: LINE44+5
Function Call: WRITE
  • Prompt: ?41,$P(IBFLD(24,IBI),U,6),?48,$S(+$P(IBFLD(24,IBI),U,7):$J($P(IBFLD(24,IBI),U,7),9,2),1:""),?57,$J($P(IBFLD(24,IBI),U,8),3)
  • Line Location: LINE44+6
Function Call: WRITE
  • Prompt: !!,IBFLD(25),?18,"X",?22,IBFLD(26),?49,$J(IBFLD(28),10,2)
  • Line Location: LINE56+0
Function Call: WRITE
  • Prompt: !!,?22,$E(IBFLD(32,1),1,26),?49,$E(IBFLD(33,1),1,26)
  • Line Location: LINE58+0
Function Call: WRITE
  • Prompt: !,$E(IBFLD(31),1,21),?22,$E(IBFLD(32,2),1,26),?49,$E(IBFLD(33,2),1,26)
  • Line Location: LINE69+0
Function Call: WRITE
  • Prompt: !,$E(IBFLD(31),22,42)
  • Line Location: LINE60+0
Function Call: WRITE
  • Prompt: ", "_IBFLD(32,"X")
  • Line Location: LINE60+1
Function Call: WRITE
  • Prompt: ", "_IBFLD(33,"X")
  • Line Location: LINE60+2
Function Call: WRITE
  • Prompt: !,$E(IBFLD(31),43,63),?49,IBFLD(33,4)
  • Line Location: LINE61+0
Function Call: WRITE
  • Prompt: @IOF,!,?IBADDM,"PAGE ",IBPAGE,!!!!!!!,?49,IBFLD("1A"),!!,IBFLD(2)
  • Line Location: LINE61+4
Function Call: WRITE
  • Prompt: !
  • Line Location: LINE61+5
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