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Sub-Field: 365.192

Package: Integrated Billing

INTERFACILITY INSURANCE UPDATE(#365.19)-->365.192

Sub-Field: 365.192


Information

Parent File Name Number Package
INTERFACILITY INSURANCE UPDATE(#365.19) ORIGINATING VAMC 365.192 Integrated Billing

Details

Field # Name Loc Type Details
.01 ORIGINATING VAMC 0;1 POINTER TO INSTITUTION FILE (#4) INSTITUTION(#4)

  • LAST EDITED:  FEB 24, 2021
  • HELP-PROMPT:  Enter the VAMC from where you received the verified active policy.
  • DESCRIPTION:  
    This field identifies the VAMC where the verified active policy originated.
  • CROSS-REFERENCE:  365.192^B
    1)= S ^IBCN(365.19,DA(1),2.1,"B",$E(X,1,30),DA)=""
    2)= K ^IBCN(365.19,DA(1),2.1,"B",$E(X,1,30),DA)
.02 PATIENT ICN 0;2 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999999999)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  FEB 25, 2021
  • HELP-PROMPT:  Enter the Integration Control Number for the patient. A number between 1 and 999999999999.
  • DESCRIPTION:  
    This field identifies the Integration Control Number (ICN) of the patient associated with the received policy.
  • TECHNICAL DESCR:  
    This field is only used for those entries that were RECEIVED from another VAMC.
    SOURCE OF DATA: INTEGRATION CONTROL NUMBER(#2,991.01)
.03 INSURANCE COMPANY NAME 0;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
    MAXIMUM LENGTH: 30
  • LAST EDITED:  FEB 10, 2021
  • HELP-PROMPT:  Enter the Insurance Company Name (3-30 characters).
  • DESCRIPTION:  
    This field identifies the name of the insurance carrier associated with the received policy.
  • TECHNICAL DESCR:  
    This field is only used for those entries that were RECEIVED from another VAMC.
    SOURCE OF DATA: NAME(#36,.01)
.04 GROUP NAME 0;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<2) X
    MAXIMUM LENGTH: 80
  • LAST EDITED:  FEB 22, 2021
  • HELP-PROMPT:  Enter the Group Name (2-80 characters).
  • DESCRIPTION:  
    This field identifies the group name associated with the received policy. This is the name that the insurance company uses to identify the plan.
  • TECHNICAL DESCR:  
    This field is only used for those entries that were RECEIVED from another VAMC.
    SOURCE OF DATA: NEW GROUP NAME(#2.312,20)
.05 GROUP NUMBER 0;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>55!($L(X)<2) X
    MAXIMUM LENGTH: 55
  • LAST EDITED:  FEB 22, 2021
  • HELP-PROMPT:  Enter the Group Number (2-55 characters).
  • DESCRIPTION:  
    This field identifies the group number associated with the received policy. This is the group number/code that the insurance company uses to identify this plan.
  • TECHNICAL DESCR:  
    This field is only used for those entries that were RECEIVED from another VAMC.
    SOURCE OF DATA: NEW GROUP NUMBER(#2.312,21)
.06 BANKING IDENTIFICATION NUMBER 0;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
    MAXIMUM LENGTH: 10
  • LAST EDITED:  FEB 24, 2021
  • HELP-PROMPT:  Enter the Plan's Banking Identification Number (BIN) (1-10 characters).
  • DESCRIPTION:  
    This field identifies the Banking Identification Number (BIN) associated with the received policy. The BIN is used for NCPDP transmissions.
  • TECHNICAL DESCR:  
    This is only used for those entries that were RECEIVED from another VAMC.
    SOURCE OF DATA: GROUP PLAN(#2.312,.18) > GROUP INSURANCE PLAN(#355.3) > BANKING IDENTIFICATION NUMBER(#355.3,6.02)
.07 PROCESSOR CONTROL NUMBER (PCN) 0;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
    MAXIMUM LENGTH: 20
  • LAST EDITED:  FEB 24, 2021
  • HELP-PROMPT:  Enter the plan's Processor Control Number (PCN) (1-20 characters).
  • DESCRIPTION:  
    This field identifies the Processor Control Number (PCN) associated with the received policy. The PCN is used for NCPDP transmissions.
  • TECHNICAL DESCR:  
    This field is only used for those entries that were RECEIVED from another VAMC.
    SOURCE OF DATA: GROUP PLAN(#2.312,.18) > GROUP INSURANCE PLAN(#355.3) > PROCESSOR CONTROL NUMBER(#355.3,6.03)
.08 TYPE OF PLAN 0;8 POINTER TO TYPE OF PLAN FILE (#355.1) TYPE OF PLAN(#355.1)

  • LAST EDITED:  FEB 24, 2021
  • HELP-PROMPT:  Enter the Type of Plan that best describes this plan.
  • DESCRIPTION:  
    This field identifies the type of plan associated with the received policy. The type of policy is used to determine if reimbursement for claims from the insurance carrier is appropriate.
  • TECHNICAL DESCR:  
    This field is only used for those entries that were RECEIVED from another VAMC.
    SOURCE OF DATA: GROUP PLAN(#2.312,.18) > GROUP INSURANCE PLAN(#355.3) > TYPE OF PLAN(#355.3,.09)
.09 EFFECTIVE DATE OF POLICY 0;9 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  FEB 24, 2021
  • HELP-PROMPT:  Enter the effective date of this policy for the applicant.
  • DESCRIPTION:  
    This field identifies the effective date associated with the received policy. This is the date the policy went into effect for the applicant.
  • TECHNICAL DESCR:  
    This field is only used for those entries that were RECEIVED from another VAMC.
    SOURCE OF DATA: EFFECTIVE DATE OF POLICY(#2.312,8)
.1 PT. RELATIONSHIP - HIPAA 0;10 SET
  • '01' FOR SPOUSE;
  • '18' FOR SELF;
  • '19' FOR CHILD;
  • '20' FOR EMPLOYEE;
  • '29' FOR SIGNIFICANT OTHER;
  • '32' FOR MOTHER;
  • '33' FOR FATHER;
  • '39' FOR ORGAN DONOR;
  • '41' FOR INJURED PLAINTIFF;
  • '53' FOR LIFE PARTNER;
  • 'G8' FOR OTHER RELATIONSHIP;

  • LAST EDITED:  FEB 22, 2021
  • HELP-PROMPT:  Select the HIPAA relationship code that describes the relationship this patient has to the holder of this insurance policy.
  • DESCRIPTION:  
    This field identifies the HIPAA Patient Relationship associated with the received policy. This describes the patient's relationship to the person who holds this policy (or insured).
  • TECHNICAL DESCR:  
    This field is only used for those entries that were RECEIVED from another VAMC.
    SOURCE OF DATA: PT. RELATIONSHIP - HIPAA(#2.312,4.03)
1.01 PATIENT ID 1;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
    MAXIMUM LENGTH: 30
  • LAST EDITED:  FEB 22, 2021
  • HELP-PROMPT:  Enter the patient's primary ID number (member number) (1-30 characters).
  • DESCRIPTION:  This field identifies the Patient Identifier (aka member number) associated with the received policy. This is the patient's primary ID number for this insurance company. Enter this field when the patient and the
    subscriber are different and the patient has been given a unique ID number.
  • TECHNICAL DESCR:  
    This field is only used for those entries that were RECEIVED from another VAMC.
    SOURCE OF DATA: PATIENT ID(#2.312,5.01)
1.02 NAME OF INSURED 1;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>130!($L(X)<2) X
    MAXIMUM LENGTH: 130
  • LAST EDITED:  FEB 24, 2021
  • HELP-PROMPT:  Enter the name of the individual for which this policy was issued (2-130 characters).
  • DESCRIPTION:  
    This field identifies the name of the insured (aka subscriber's or policy holder's name) associated with the received policy. This the name of the individual for which this insurance policy was issued.
  • TECHNICAL DESCR:  
    This field is only used for those entries that were RECEIVED from another VAMC.
    SOURCE OF DATA: NAME OF INSURED(#2.312,7.01)
1.03 SUBSCRIBER ID 1;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1) X
    MAXIMUM LENGTH: 80
  • LAST EDITED:  FEB 24, 2021
  • HELP-PROMPT:  Enter the subscriber's primary ID number (1-80 characters).
  • DESCRIPTION:  This field is the subscriber's identifier (aka policy holder's identifier) associated with the received policy. This is the primary number that was assigned by the payer and can be found on the subscriber's insurance
    card.
  • TECHNICAL DESCR:  
    This field is only used for those entries that were RECEIVED from another VAMC.
    SOURCE OF DATA: SUBSCRIBER ID(#2.312,7.02)
1.04 INSURED'S DOB 1;4 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  FEB 24, 2021
  • HELP-PROMPT:  Enter the Date of Birth of the policy holder.
  • DESCRIPTION:  
    This field identifies the date of birth of the insured (aka subscriber or policy holder) associated with the received policy.
  • TECHNICAL DESCR:  
    This field is only used for those entries that were RECEIVED from another VAMC.
    SOURCE OF DATA: INSURED'S DOB(#2.312,3.01)
1.05 COORDINATION OF BENEFITS 1;5 SET
  • '1' FOR PRIMARY;
  • '2' FOR SECONDARY;
  • '3' FOR TERTIARY;

  • LAST EDITED:  FEB 22, 2021
  • HELP-PROMPT:  Enter the code that best relates where in the payment sequence this policy should be placed.
  • DESCRIPTION:  This field identifies the coordination of benefits associated with the received policy. Enter '1' if this is the patient's primary insurance policy. Enter '2' if this policy is secondary to (billed after) the primary
    policy. Enter '3' if this policy is tertiary or billed after the secondary policy.
  • TECHNICAL DESCR:  
    This field is only used for those entries that were RECEIVED from another VAMC.
    SOURCE OF DATA: COORDINATION OF BENEFITS(#2.312,.2)
1.06 WHOSE INSURANCE 1;6 SET
  • 'v' FOR VETERAN;
  • 's' FOR SPOUSE;
  • 'o' FOR OTHER;

  • LAST EDITED:  FEB 24, 2021
  • HELP-PROMPT:  Enter who holds the insurance policy (the insured).
  • DESCRIPTION:  This field identifies the holder of the received policy. Enter 'v' if this insurance policy is held by the veteran (applicant), 's' if the veteran is married and the spouse holds the policy, or 'o' if someone other than
    the veteran or his/her spouse hold the policy, i.e., employer.
  • TECHNICAL DESCR:  
    This field is only used for those entries that were RECEIVED from another VAMC.
    SOURCE OF DATA: WHOSE INSURANCE(#2.312,6)
1.07 PAYER'S VA NATIONAL ID 1;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
    MAXIMUM LENGTH: 10
  • LAST EDITED:  FEB 22, 2021
  • HELP-PROMPT:  Enter the payer's VA National ID (1-10 characters).
  • DESCRIPTION:  
    This field identifies the payer associated with the received policy. This identifier is used to uniquely identify the insurance payers.
  • TECHNICAL DESCR:  
    This field is only used for those entries that were RECEIVED from another VAMC. The identifier is assigned by the Eligibility Communicator which is controlled by the Financial Service Center (FSC).
    SOURCE OF DATA: VA NATIONAL ID(#365.12,.02)
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