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Sub-Field: 364.95

Package: Integrated Billing

ACC X12 ENCOUNTERS(#364.9)-->364.95

Sub-Field: 364.95


Information

Parent File Name Number Package
ACC X12 ENCOUNTERS(#364.9) REASONS NOT AUTOBILLED 364.95 Integrated Billing

Details

Field # Name Loc Type Details
.01 REASON NOT AUTOBILLED 0;1 POINTER TO ACC X12 CLAIM FAILURES FILE (#364.91) ACC X12 CLAIM FAILURES(#364.91)

  • LAST EDITED:  DEC 19, 2024
  • HELP-PROMPT:  Enter the reason code an X12 ACC claim could not be auto-billed.
  • DESCRIPTION:  
    This REASON NOT AUTOBILLED code represents a reason the VistA claim was either not 'auto-generated' or not 'auto-billed'.
  • TECHNICAL DESCR:  
    This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.
  • CROSS-REFERENCE:  364.95^B
    1)= S ^IBA(364.9,DA(1),5,"B",$E(X,1,30),DA)=""
    2)= K ^IBA(364.9,DA(1),5,"B",$E(X,1,30),DA)
    This cross reference is used to search for specific failure reason codes within a given automated community care encounter.
.02 REASON NOTE 0;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<1) X
    MAXIMUM LENGTH: 50
  • LAST EDITED:  NOV 28, 2023
  • HELP-PROMPT:  Enter a short note that is helpful to describe the reason code.
  • DESCRIPTION:  
    This is a short note indicating further information why claim failed either 'auto-generation' or 'auto-billing'.
  • TECHNICAL DESCR:  
    This field is not intended for end user entering or editing. It will only be populated by the remote procedure that is handling the incoming automated community care X12 837 encounters VistA receives from Payer EDI.
.03 WORKLIST 0;3 SET
  • 'FRT' FOR FACILITY REVENUE TECHNICIANS;
  • 'RUR' FOR REVENUE UTILIZATION REVIEW;
  • 'IV' FOR INSURANCE VERIFICATION;
  • 'BILL' FOR BILLING;
  • 'PTF' FOR FACILITY REVENUE TECHNICIANS PTF;

  • LAST EDITED:  JAN 29, 2025
  • HELP-PROMPT:  Enter the worklist this failure reason should display on.
  • DESCRIPTION:  
    This is the worklist where this failure reason will display.
.04 PROVIDER NPI 0;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
    MAXIMUM LENGTH: 10
  • LAST EDITED:  FEB 26, 2026
  • HELP-PROMPT:  Enter the provider's 10 digit NPI.
  • DESCRIPTION:  
    This is the provider NPI that was received in the community care encounter. This NPI, if present, was not found in the VistA database.
  • CROSS-REFERENCE:  364.9^ANPI
    1)= S ^IBA(364.9,"ANPI",$E(X,1,30),DA(1),DA)=""
    2)= K ^IBA(364.9,"ANPI",$E(X,1,30),DA(1),DA)
    This cross reference is used to identify an NPI for a provider or facility that was not found in the VistA database.
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