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Routine: IBCF3TP

Package: Integrated Billing

Routine: IBCF3TP


Information

IBCF3TP ;ALB/BGA - TEST PATTERN UB92 FORM ; 12-AUG-93

Source Information

Source file <IBCF3TP.m>

Entry Points

Name Comments DBIA/ICR reference
ZIS
ENP ;
5
11
19
32
43
48
56
61
END

Interaction Calls

Name Line Occurrences
Function Call: WRITE
  • Prompt: "##SR",?34,"*** UB-92 TEST PATTERN ***"
  • Line Location: ENP+1
Function Call: WRITE
  • Prompt: !,"AGENT CASHIER"
  • Line Location: ENP+2
Function Call: WRITE
  • Prompt: !,"AGENT CASHIER STREET",?57,"BN XXX ",?77,"XXX"
  • Line Location: ENP+3
Function Call: WRITE
  • Prompt: !,"CITY STATE ZIP"
  • Line Location: ENP+4
Function Call: WRITE
  • Prompt: !,"PHONE #",?26,"TAX# XXXX",?37,"5/1/93",?44,"5/4/93"
  • Line Location: 5+0
Function Call: WRITE
  • Prompt: !
  • Line Location: 5+1
Function Call: WRITE
  • Prompt: !,"PATIENT NAME",?31,"PT SHORT ADDRESS"
  • Line Location: 5+2
Function Call: WRITE
  • Prompt: !
  • Line Location: 5+3
Function Call: WRITE
  • Prompt: !,"DOB",?9,"X",?12,"X",?14,"DATE",?21,"HR",?25,"X",?28,"X",?30,"DR",?33,"ST",?36,"000-00-0000"
  • Line Location: 5+4
Function Call: WRITE
  • Prompt: ?IBI,"CC"
  • Line Location: 5+4
Function Call: WRITE
  • Prompt: !!
  • Line Location: 5+5
Function Call: WRITE
  • Prompt: ?IBI,"OC",?(IBI+3),"DATE"
  • Line Location: 11+0
Function Call: WRITE
  • Prompt: !!,"RESPONSIBLE PARTY'S NAME"
  • Line Location: 11+1
Function Call: WRITE
  • Prompt: !,"STREET ADDRESS 1",!,"STREET ADDRESS 2",!,"STREET ADDRESS 3",!,"CITY STATE ZIP"
  • Line Location: 11+2
Function Call: WRITE
  • Prompt: !
  • Line Location: 11+3
Function Call: WRITE
  • Prompt: !,"CD1",?5,"REV CODE description",?48,"xx",?57,"xxxx.xx"
  • Line Location: 19+0
Function Call: WRITE
  • Prompt: !,"CD2",?5,"REV CODE description",?48,"xx",?57,"xxxx.xx"
  • Line Location: 19+1
Function Call: WRITE
  • Prompt: !,"CD3",?5,"REV CODE description",?48,"xx",?57,"xxxx.xx"
  • Line Location: 19+2
Function Call: WRITE
  • Prompt: !,?5,"Subtotal",?57,"xxxx.xx"
  • Line Location: 19+3
Function Call: WRITE
  • Prompt: !!,?5,"Total",?57,"xxxx.xx"
  • Line Location: 19+4
Function Call: WRITE
  • Prompt: !!!!!!!!!
  • Line Location: 19+5
Function Call: WRITE
  • Prompt: !,"For your information, even though the patient may be otherwise eligible"
  • Line Location: 32+0
Function Call: WRITE
  • Prompt: !,"for Medicare, no payment may be made under Medicare to any Federal provider"
  • Line Location: 32+1
Function Call: WRITE
  • Prompt: !,"of medical care or services and may not be used as a reason for non-payment."
  • Line Location: 32+2
Function Call: WRITE
  • Prompt: !,"Please make your check payable to the Department of Veterans Affairs and"
  • Line Location: 32+3
Function Call: WRITE
  • Prompt: !,"send to the address listed above."
  • Line Location: 32+4
Function Call: WRITE
  • Prompt: !
  • Line Location: 32+5
Function Call: WRITE
  • Prompt: !,"The undersigned certifies that treatment rendered is not for a"
  • Line Location: 32+6
Function Call: WRITE
  • Prompt: !,"service connected disability."
  • Line Location: 32+7
Function Call: WRITE
  • Prompt: !
  • Line Location: 32+8
Function Call: WRITE
  • Prompt: !,"Name of Payer 1",?26,"Provider #",?40,"x",?43,"x"
  • Line Location: 43+0
Function Call: WRITE
  • Prompt: !,"Name of Payer 2",?26,"Provider #",?40,"x",?43,"x"
  • Line Location: 43+1
Function Call: WRITE
  • Prompt: !,"Name of Payer 3",?26,"Provider #",?40,"x",?43,"x"
  • Line Location: 43+2
Function Call: WRITE
  • Prompt: !!
  • Line Location: 43+3
Function Call: WRITE
  • Prompt: !,"Insured's Name 1",?26,"x",?29,"Insurance #",?49,"Group Name",?64,"Group #"
  • Line Location: 48+0
Function Call: WRITE
  • Prompt: !,"Insured's Name 2",?26,"x",?29,"Insurance #",?49,"Group Name",?64,"Group #"
  • Line Location: 48+1
Function Call: WRITE
  • Prompt: !,"Insured's Name 3",?26,"x",?29,"Insurance #",?49,"Group Name",?64,"Group #"
  • Line Location: 48+2
Function Call: WRITE
  • Prompt: !
  • Line Location: 48+3
Function Call: WRITE
  • Prompt: !,"Treatment Auth. Cd",?19,"x",?21,"Employer Name",?47,"Employer Location"
  • Line Location: 48+4
Function Call: WRITE
  • Prompt: !,?19,"x",?21,"Employer Name",?47,"Employer Location"
  • Line Location: 48+5
Function Call: WRITE
  • Prompt: !,?19,"x",?21,"Employer Name",?47,"Employer Location"
  • Line Location: 48+6
Function Call: WRITE
  • Prompt: !
  • Line Location: 48+7
Function Call: WRITE
  • Prompt: !,"PDX"
  • Line Location: 56+0
Function Call: WRITE
  • Prompt: ?IBI,"Dx Cd"
  • Line Location: 56+0
Function Call: WRITE
  • Prompt: ?64,"ADMT DX",!!
  • Line Location: 56+1
Function Call: WRITE
  • Prompt: ?IBI,"P-code",?(IBI+8),"mmddyy"
  • Line Location: 56+2
Function Call: WRITE
  • Prompt: ?52,"Attending Phys. ID#",!!
  • Line Location: 56+3
Function Call: WRITE
  • Prompt: ?IBI,"P-code",?(IBI+8),"mmddyy"
  • Line Location: 56+4
Function Call: WRITE
  • Prompt: ?52,"Other Phys. ID#"
  • Line Location: 56+5
Function Call: WRITE
  • Prompt: !,?7,"Patient ID#: xxx-xx-xxxx"
  • Line Location: 61+0
Function Call: WRITE
  • Prompt: !,"Bill Type: xxx xxxxxx"
  • Line Location: 61+1
Function Call: WRITE
  • Prompt: !,"UB 92 TEST PATTERN",?52,"Provider Representative DATE"
  • Line Location: 61+2
Function Call: WRITE
  • Prompt: !,"*** comment ***"
  • Line Location: 61+3
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