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Sub-Field: 399.0222

Package: Integrated Billing

BILL/CLAIMS(#399)-->399.0222

Sub-Field: 399.0222


Information

Parent File Name Number Package
BILL/CLAIMS(#399) PROVIDER 399.0222 Integrated Billing

Details

Field # Name Loc Type Details
.01 FUNCTION 0;1 SET
************************REQUIRED FIELD************************
  • '1' FOR REFERRING;
  • '2' FOR OPERATING;
  • '3' FOR RENDERING;
  • '4' FOR ATTENDING;
  • '5' FOR SUPERVISING;
  • '9' FOR OTHER OPERATING;
  • '6' FOR ASSISTANT SURGEON;

  • LAST EDITED:  OCT 05, 2017
  • HELP-PROMPT:  Select the function performed by a provider for this bill.
  • DESCRIPTION:  There are providers who performed specific functions for the services on this bill. These providers are needed to enable the V.A. to collect reimbursement when more than one provider function is involved in the
    billable episode (like an operating physician or referring provider). This data identifies the type of function that was performed by a provider. There can only be 1 provider recorded for each function on a claim.
  • SCREEN:  S DIC("S")="I $$PRVOK^IBCEU(+Y,$S($G(D0):D0,1:$G(DA)))"
  • EXPLANATION:  Function must match bill form type. Use '??' to see the function definitions.
  • EXECUTABLE HELP:  D PRVHELP^IBCEU5
  • PRE-LOOKUP:  S X=$$UP^XLFSTR(X)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  399.0222^B
    1)= S ^DGCR(399,DA(1),"PRV","B",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,DA(1),"PRV","B",$E(X,1,30),DA)
  • CROSS-REFERENCE:  ^^TRIGGER^399.0222^.04
    1)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=Y(0),X=X S X=X'=1 I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X="" X ^DD(399.0222,.01,1,2,1.4)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"PRV",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,4)=DIV,DIH=399.0222,DIG=.04 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X="" X ^DD(399.0222,.01,1,2,2.4)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"PRV",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,4)=DIV,DIH=399.0222,DIG=.04 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    3)= Do not delete
    CREATE CONDITION)= INTERNAL(PROVIDER FUNCTION)'=1
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= PROVIDER STATE
    This xref is used to delete the state field if the provider is not a referring provider function type.
  • CROSS-REFERENCE:  399.0222^C^MUMPS
    1)= S ^DGCR(399,DA(1),"PRV","C",$E($$EXTERNAL^DILFD(399.0222,.01,,X),1,30),DA)=""
    2)= K ^DGCR(399,DA(1),"PRV","C",$E($$EXTERNAL^DILFD(399.0222,.01,,X),1,30),DA)
  • CROSS-REFERENCE:  399.0222^CA^MUMPS
    1)= S ^DGCR(399,DA(1),"PRV","C",$$LOW^XLFSTR($E($$EXTERNAL^DILFD(399.0222,.01,,X),1,30)),DA)=""
    2)= K ^DGCR(399,DA(1),"PRV","C",$$LOW^XLFSTR($E($$EXTERNAL^DILFD(399.0222,.01,,X),1,30)),DA)
.02 PERFORMED BY 0;2 VARIABLE POINTER NEW PERSON(#200)  IB NON/OTHER VA BILLING PROVIDER(#355.93)  

  • LAST EDITED:  DEC 28, 2010
  • HELP-PROMPT:  Enter the name of the provider who performed the indicated function
  • DESCRIPTION:  
    Providers may be VA providers found in the VistA NEW PERSON file or NON-VA providers found in the IB NON VA BILLING PROVIDER file.
  • EXECUTABLE HELP:  
  • NOTES:  TRIGGERED by the PRIMARY INS CO ID NUMBER field of the PROVIDER sub-field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399.0222^.05
    1)= X ^DD(399.0222,.02,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" X ^DD(399.0222,.02,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$P(Y(1),U,5)="SLF000"
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"PRV",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,5)=DIV,DIH=399.0222,DIG=.05 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    3)= Do not delete
    CREATE CONDITION)= PRIMARY INS CO ID NUMBER="SLF000"
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= PRIMARY INS CO ID NUMBER
    This cross reference deletes any SLF000 id in the primary insurance id if a provider name is entered.
  • CROSS-REFERENCE:  ^^TRIGGER^399.0222^.03
    1)= X ^DD(399.0222,.02,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV S X=$$EXTCR^IBCEU5(X) X ^DD(399.0222,.02,1,2,1.4)
    1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S Y(2)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:""),Y=Y(0) X:$D(^DD(399.0222,.02,2)) ^(2) S X=Y'["*",Y(1)=X S X=$P(Y(2),U,3)="",Y=X,X=Y(1),X=X&Y
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"PRV",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,3)=DIV,DIH=399.0222,DIG=.03 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(399.0222,.02,1,2,2.4)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"PRV",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,3)=DIV,DIH=399.0222,DIG=.03 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    3)= Do not delete
    CREATE CONDITION)= CREDENTIALS=""
    CREATE VALUE)= S X=$$EXTCR^IBCEU5(X)
    DELETE VALUE)= @
    FIELD)= CREDENTIALS
    This trigger will force the CREDENTIALS field of the provider multiple to be set to the first 3 characters of the provider's degree if the credentials don't already exist.
  • CROSS-REFERENCE:  ^^TRIGGER^399.0222^.08
    1)= X ^DD(399.0222,.02,1,3,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X=DIV S X=$$SPEC^IBCEU(X,$P($G(^DGCR(399,D0,"U")),U)) X ^DD(399.0222,.02,1,3,1.4)
    1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$P(Y(1),U,8)=""
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"PRV",DIV(1),0)),DIV=X S $P(^(0),U,8)=DIV,DIH=399.0222,DIG=.08 D ^DICR
    2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" X ^DD(399.0222,.02,1,3,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"PRV",DIV(1),0)),DIV=X S $P(^(0),U,8)=DIV,DIH=399.0222,DIG=.08 D ^DICR
    3)= Do not delete
    CREATE CONDITION)= SPECIALTY=""
    CREATE VALUE)= S X=$$SPEC^IBCEU(X,$P($G(^DGCR(399,D0,"U")),U))
    DELETE VALUE)= @
    FIELD)= SPECIALTY
    This trigger will force the SPECIALTY field of the provider multiple to be set to the current specialty of the provider.
  • CROSS-REFERENCE:  ^^TRIGGER^399.0222^.05
    1)= Q
    2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" X ^DD(399.0222,.02,1,4,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"PRV",DIV(1),0)),DIV=X S $P(^(0),U,5)=DIV,DIH=399.0222,DIG=.05 D ^DICR
    3)= Do not delete
    CREATE VALUE)= NO EFFECT
    DELETE VALUE)= @
    FIELD)= PRIMARY INS CO ID NUMBER
    This xref deletes the PRIMARY INS CO ID NUMBER when the provider is changed.
  • CROSS-REFERENCE:  ^^TRIGGER^399.0222^.06
    1)= Q
    2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X="" X ^DD(399.0222,.02,1,5,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"PRV",DIV(1),0)),DIV=X S $P(^(0),U,6)=DIV,DIH=399.0222,DIG=.06 D ^DICR
    3)= Do not delete
    CREATE VALUE)= NO EFFECT
    DELETE VALUE)= @
    FIELD)= SECONDARY INS CO ID NUMBER
    This xref deletes the SECONDARY INS CO ID NUMBER when the provider is changed.
  • CROSS-REFERENCE:  ^^TRIGGER^399.0222^.07
    1)= Q
    2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(399.0222,.02,1,6,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"PRV",DIV(1),0)),DIV=X S $P(^(0),U,7)=DIV,DIH=399.0222,DIG=.07 D ^DICR
    3)= Do not delete
    CREATE VALUE)= NO EFFECT
    DELETE VALUE)= @
    FIELD)= TERTIARY INS CO ID NUMBER
    This xref deletes the TERTIARY INS CO ID NUMBER when the provider is changed.
  • CROSS-REFERENCE:  ^^TRIGGER^399.0222^.15
    1)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y X ^DD(399.0222,.02,1,7,1.1) X ^DD(399.0222,.02,1,7,1.4)
    1.1)= S X=DIV S X=$P($$GETTAX^IBCEF73A(X,$P(^DGCR(399,D0,0),U,3)),U,2)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"PRV",DIV(1),0)),DIV=X S $P(^(0),U,15)=DIV,DIH=399.0222,DIG=.15 D ^DICR
    2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y S X="" X ^DD(399.0222,.02,1,7,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"PRV",DIV(1),0)),DIV=X S $P(^(0),U,15)=DIV,DIH=399.0222,DIG=.15 D ^DICR
    3)= Do not delete
    CREATE VALUE)= S X=$P($$GETTAX^IBCEF73A(X,$P(^DGCR(399,D0,0),U,3)),U,2)
    DELETE VALUE)= @
    FIELD)= TAXONOMY
    This trigger updates the TAXONOMY field with the provider's taxonomy code if the event date of the claim is covered, otherwise, it will set the TAXONOMY field to null.
.03 CREDENTIALS 0;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • LAST EDITED:  APR 05, 2000
  • HELP-PROMPT:  Enter up to 3 digits to describe the providers credentials
  • DESCRIPTION:  
    This field should contain the 1-3 digit code for the provider's credentials as they apply to the services being billed for.
  • NOTES:  TRIGGERED by the PERFORMED BY field of the PROVIDER sub-field of the BILL/CLAIMS File
.04 STATE 0;4 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  MAY 16, 2002
  • HELP-PROMPT:  ENTER THE STATE FOR THE REFERRING PROVIDER
  • DESCRIPTION:  
    This is the state of the referring provider. This is only used for referring provider types
  • NOTES:  TRIGGERED by the FUNCTION field of the PROVIDER sub-field of the BILL/CLAIMS File
.05 PRIMARY INS CO ID NUMBER 0;5 FREE TEXT

  • INPUT TRANSFORM:  I $D(DA) N Z S Z=$G(^DGCR(399,DA(1),"PRV",DA,0)) S:X="/ID" X=$$RECALC^IBCEP2A(.DA,1,$P(Z,U,5)) K:$L(X)>15!'$L(X) X I $D(X),$P(Z,U,2)="",$S($$INPAT^IBCEF(DA(1),1):1,1:X'="SLF000") K X
  • LAST EDITED:  MAY 08, 2006
  • HELP-PROMPT:  Enter the # the primary ins co uses for the provider. If outpatient and self-referred, use SLF000.
  • DESCRIPTION:  
    This is the primary insurance co specific provider's secondary id number.
  • EXECUTABLE HELP:  D INSPAR^IBCEP2A(DA(1),1)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the PERFORMED BY field of the PROVIDER sub-field of the BILL/CLAIMS File
    TRIGGERED by the PERFORMED BY field of the PROVIDER sub-field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399.0222^.02
    1)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=Y(0)="SLF000" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(399.0222,.05,1,1,1.4)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"PRV",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,2)=DIV,DIH=399.0222,DIG=.02 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= Q
    3)= Do not delete
    CREATE CONDITION)= PRIMARY INS CO ID NUMBER="SLF000"
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= PERFORMED BY
    This erases the provider name if the id is SLF000.
  • CROSS-REFERENCE:  399.0222^AC^MUMPS
    1)= D ATTREND^IBCU1(DA(1),DA,.05)
    2)= D ATTREND^IBCU1(DA(1),DA,.05)
    3)= Do Not Delete
    This Mumps cross reference is used to trigger #122 PRIMARY PROVIDER #. The field is triggered when the primary insurance company in the claim has flags set to use the attending or rendering physicians as the billing
    provider secondary IDs. The flags in file 36 are field #4.06 (ATT/REND ID BILL SEC ID PROF) and field 4.08 (ATT/REND ID BILL SEC ID INST).
.06 SECONDARY INS CO ID NUMBER 0;6 FREE TEXT

  • INPUT TRANSFORM:  I $D(DA) N Z S Z=$G(^DGCR(399,DA(1),"PRV",DA,0)) S:X="/ID" X=$$RECALC^IBCEP2A(.DA,2,$P(Z,U,6)) K:$L(X)>15!'$L(X) X I $D(X),$P(Z,U,2)="",$S($$INPAT^IBCEF(DA(1),1):1,1:X'="SLF000") K X
  • LAST EDITED:  MAY 08, 2006
  • HELP-PROMPT:  Enter the # the secondary ins co uses for the provider. If outpatient and self-referred, use SLF000.
  • DESCRIPTION:  
    This is the secondary ins company's specific secondary provider id number.
  • EXECUTABLE HELP:  D INSPAR^IBCEP2A(DA(1),2)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the PERFORMED BY field of the PROVIDER sub-field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  399.0222^AD^MUMPS
    1)= D ATTREND^IBCU1(DA(1),DA,.06)
    2)= D ATTREND^IBCU1(DA(1),DA,.06)
    3)= Do Not Delete
    This Mumps cross reference is used to trigger #123 SECONDARY PROVIDER #. The field is triggered when the secondary insurance company in the claim has flags set to use the attending or rendering physicians as the billing
    provider secondary IDs. The flags in file 36 are field #4.06 (ATT/REND ID BILL SEC ID PROF) and field 4.08 (ATT/REND ID BILL SEC ID INST).
.07 TERTIARY INS CO ID NUMBER 0;7 FREE TEXT

  • INPUT TRANSFORM:  I $D(DA) N Z S Z=$G(^DGCR(399,DA(1),"PRV",DA,0)) S:X="/ID" X=$$RECALC^IBCEP2A(.DA,3,$P(Z,U,7)) K:$L(X)>15!'$L(X) X I $D(X),$P(Z,U,2)="",$S($$INPAT^IBCEF(DA(1),1):1,1:X'="SLF000") K X
  • LAST EDITED:  MAY 08, 2006
  • HELP-PROMPT:  Enter the # the tertiary ins co uses for the provider. If outpatient and self-referred, use SLF000.
  • DESCRIPTION:  
    This is the tertiary ins company's specific secondary provider id number.
  • EXECUTABLE HELP:  D INSPAR^IBCEP2A(DA(1),3)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the PERFORMED BY field of the PROVIDER sub-field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  399.0222^AE^MUMPS
    1)= D ATTREND^IBCU1(DA(1),DA,.07)
    2)= D ATTREND^IBCU1(DA(1),DA,.07)
    3)= Do Not Delete
    This Mumps cross reference is used to trigger #124 TERTIARY PROVIDER #. The field is triggered when the tertiary insurance company in the claim has flags set to use the attending or rendering physicians as the billing
    provider secondary IDs. The flags in file 36 are field #4.06 (ATT/REND ID BILL SEC ID PROF) and field 4.08 (ATT/REND ID BILL SEC ID INST).
.08 SPECIALTY 0;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<2) X
  • LAST EDITED:  APR 11, 2000
  • HELP-PROMPT:  Enter the 2 digit specialty code designation
  • DESCRIPTION:  
    This field contains the specialty code for the provider if the provider is not resident in VistA's NEW PERSON file.
  • NOTES:  TRIGGERED by the PERFORMED BY field of the PROVIDER sub-field of the BILL/CLAIMS File
.09 DELETE 2006 .09 0;9 POINTER TO IB INS CO PROVIDER ID CARE UNIT FILE (#355.96)
************************REQUIRED FIELD************************
IB INS CO PROVIDER ID CARE UNIT(#355.96)

  • INPUT TRANSFORM:  S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,1,1)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAY 21, 2004
  • HELP-PROMPT:  Enter the care unit that applies to this bill for the primary insurance co's performing provider id
  • DESCRIPTION:  The primary insurance company requires a specific care unit value to identify the correct id for the performing provider. You must enter a care unit value here so a valid id can be determined. This care unit must be
    valid for the insurance co, form type, care type and provider type required by the insurance co.
  • SCREEN:  S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,1,1)"
  • EXPLANATION:  Must be a valid care unit for the ins co, care type, form type and performing prov id type
  • EXECUTABLE HELP:  D CAREID^IBCEP1("PERF",1,DA(1))
  • FIELD INDEX:  AUPDID1 (#140) MUMPS ACTION
    Short Descr: UPDATE PRIMARY PROVIDER ID WHEN DATA FIELDS CHANGE AT PROVIDER LEVEL OF FILE
    Description: This cross reference maintains the integrity of the rendering or attending provider id whenever the primary insurance company care unit is added, deleted or changed on the claim. If a valid provider number can be
    determined by the new value of the care unit, this id # is placed in the primary id field. If no valid id can be determined for the provider, the primary id field for the provider is deleted.
    Set Logic: D:X1(1)'=X2(1) SETID^IBCEP3(DA(1),1)
    Kill Logic: D:X1(1)'=X2(1)&(X(1)'="") DELID^IBCEP3(DA(1),1,1)
    Whole Kill: Q
    X(1): DELETE 2006 .09 (399.0222,.09) (forwards)
.1 DELETE 2006 .1 0;10 POINTER TO IB INS CO PROVIDER ID CARE UNIT FILE (#355.96)
************************REQUIRED FIELD************************
IB INS CO PROVIDER ID CARE UNIT(#355.96)

  • INPUT TRANSFORM:  S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,1,2)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAY 21, 2004
  • HELP-PROMPT:  Enter the care unit that applies to this bill for the secondary insurance co's performing provider id
  • DESCRIPTION:  If the secondary insurance company requires a specific care unit specification to identify the correct id for the performing provider, this is the exact data value related to this claim that will allow the system to
    perform this match.
  • SCREEN:  S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,1,2)"
  • EXPLANATION:  Must be a valid care unit for the ins co, care type, form type and performing prov id type
  • EXECUTABLE HELP:  D CAREID^IBCEP1("PERF",2,DA(1))
  • FIELD INDEX:  AUPDID2 (#141) MUMPS ACTION
    Short Descr: UPDATE SECONDARY PROVIDER ID WHEN DATA FIELDS CHANGE AT PROVIDER LEVEL OF FILE
    Description: This cross reference maintains the integrity of the rendering or attending provider id whenever the secondary insurance company care unit is added, deleted or changed on the claim. If a valid provider number can be
    determined by the new value of the care unit, this id # is placed in the secondary id field. If no valid id can be determined for the provider, the secondary id field for the provider is deleted.
    Set Logic: D:X1(1)'=X2(1) SETID^IBCEP3(DA(1),2)
    Kill Logic: D:X1(1)'=X2(1) DELID^IBCEP3(DA(1),2,1)
    Whole Kill: Q
    X(1): DELETE 2006 .1 (399.0222,.1) (forwards)
    Transform (Display):
.11 DELETE 2006 .11 0;11 POINTER TO IB INS CO PROVIDER ID CARE UNIT FILE (#355.96)
************************REQUIRED FIELD************************
IB INS CO PROVIDER ID CARE UNIT(#355.96)

  • INPUT TRANSFORM:  S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,1,3)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAY 21, 2004
  • HELP-PROMPT:  Enter the care unit that applies to this bill for the tertiary insurance's performing provider id
  • DESCRIPTION:  If the tertiary insurance company requires a specific care unit specification to identify the correct id for the performing provider, this is the exact data value related to this claim that will allow the system to
    perform this match.
  • SCREEN:  S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,1,3)"
  • EXPLANATION:  Must be a valid care unit for the ins co, care type, form type and performing prov id type
  • EXECUTABLE HELP:  D CAREID^IBCEP1("PERF",3,DA(1))
  • FIELD INDEX:  AUPDID3 (#142) MUMPS ACTION
    Short Descr: UPDATE TERTIARY PROVIDER ID WHEN DATA FIELDS CHANGE AT PROVIDER LEVEL OF FILE
    Description: This cross reference maintains the integrity of the rendering or attending provider id whenever the tertiary insurance company care unit is added, deleted or changed on the claim. If a valid provider number can be
    determined by the new value of the care unit, this id # is placed in the tertiary id field. If no valid id can be determined for the provider, the tertiary id field for the provider is deleted.
    Set Logic: D:X1(1)'=X2(1) SETID^IBCEP3(DA(1),3)
    Kill Logic: D:X1(1)'=X2(1) DELID^IBCEP3(DA(1),3,1)
    Whole Kill: Q
    X(1): DELETE 2006 .11 (399.0222,.11) (forwards)
    Transform (Display):
.12 PRIM INS PROVIDER ID TYPE 0;12 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97) IB PROVIDER ID # TYPE(#355.97)

  • INPUT TRANSFORM:  S DIC("S")="I $$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAY 08, 2006
  • HELP-PROMPT:  Enter the type of id the primary payer requires as a secondary id.
  • DESCRIPTION:  
    This is the type of id the primary payer uses as a secondary id.
  • SCREEN:  S DIC("S")="I $$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))"
  • EXPLANATION:  Must be valid for transmission.
  • CROSS-REFERENCE:  399.0222^AF^MUMPS
    1)= D ATTREND^IBCU1(DA(1),DA,.12)
    2)= D ATTREND^IBCU1(DA(1),DA,.12)
    3)= Do Not Delete
    This Mumps cross reference is used to trigger #128 PRIMARY ID QUALIFIER. The field is triggered when the primary insurance company in the claim has flags set to use the attending or rendering physicians as the billing
    provider secondary IDs. The flags in file 36 are field #4.06 (ATT/REND ID BILL SEC ID PROF) and field 4.08 (ATT/REND ID BILL SEC ID INST).
.13 SEC INS PROVIDER ID TYPE 0;13 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97) IB PROVIDER ID # TYPE(#355.97)

  • INPUT TRANSFORM:  S DIC("S")="I $$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAY 08, 2006
  • HELP-PROMPT:  Enter the type of id the secondary payer requires as a secondary id.
  • SCREEN:  S DIC("S")="I $$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))"
  • EXPLANATION:  Must be valid for transmission.
  • CROSS-REFERENCE:  399.0222^AG^MUMPS
    1)= D ATTREND^IBCU1(DA(1),DA,.13)
    2)= D ATTREND^IBCU1(DA(1),DA,.13)
    3)= Do Not Delete
    This Mumps cross reference is used to trigger #129 SECONDARY ID QUALIFIER. The field is triggered when the secondary insurance company in the claim has flags set to use the attending or rendering physicians as the
    billing provider secondary IDs. The flags in file 36 are field #4.06 (ATT/REND ID BILL SEC ID PROF) and field 4.08 (ATT/REND ID BILL SEC ID INST).
.14 TERT INS PROVIDER ID TYPE 0;14 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97) IB PROVIDER ID # TYPE(#355.97)

  • INPUT TRANSFORM:  S DIC("S")="I $$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAY 08, 2006
  • HELP-PROMPT:  Enter the type of id the tertiary payer requires as a secondary id.
  • DESCRIPTION:  
    This is the type of id the tertiary payer uses as a secondary id.
  • SCREEN:  S DIC("S")="I $$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))"
  • EXPLANATION:  Must be valid for transmission.
  • CROSS-REFERENCE:  399.0222^AH^MUMPS
    1)= D ATTREND^IBCU1(DA(1),DA,.14)
    2)= D ATTREND^IBCU1(DA(1),DA,.14)
    3)= Do Not Delete
    This Mumps cross reference is used to trigger #130 TERTIARY ID QUALIFIER. The field is triggered when the tertiary insurance company in the claim has flags set to use the attending or rendering physicians as the billing
    provider secondary IDs. The flags in file 36 are field #4.06 (ATT/REND ID BILL SEC ID PROF) and field 4.08 (ATT/REND ID BILL SEC ID INST).
.15 TAXONOMY 0;15 POINTER TO PERSON CLASS FILE (#8932.1) PERSON CLASS(#8932.1)

  • LAST EDITED:  JUN 13, 2006
  • HELP-PROMPT:  Enter the Taxonomy Code associated with this entry.
  • NOTES:  TRIGGERED by the PERFORMED BY field of the PROVIDER sub-field of the BILL/CLAIMS File
1.01 DELETE 2006 1.01 1;1 POINTER TO IB INS CO PROVIDER ID CARE UNIT FILE (#355.96) IB INS CO PROVIDER ID CARE UNIT(#355.96)

  • INPUT TRANSFORM:  S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,2,1)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAY 21, 2004
  • HELP-PROMPT:  Enter the care unit that applies to this bill for the EMC id for the primary insurance
  • DESCRIPTION:  
    This is the exact data you need to use to allow the system to match the provider with the correct EMC id # for the primary insurance co based on this piece of data and relating directly to this claim.
  • SCREEN:  S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,2,1)"
  • EXPLANATION:  Must be a valid care unit for the ins co, care type, form type and EMC id type
  • EXECUTABLE HELP:  D CAREID^IBCEP1("EMC",1,DA(1))
1.02 DELETE 2006 1.02 1;2 POINTER TO IB INS CO PROVIDER ID CARE UNIT FILE (#355.96) IB INS CO PROVIDER ID CARE UNIT(#355.96)

  • INPUT TRANSFORM:  S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,2,2)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAY 21, 2004
  • HELP-PROMPT:  Enter the care unit that applies to this bill for the EMC id for the secondary insurance
  • DESCRIPTION:  
    This is the exact data you need to use to allow the system to match the provider with the correct EMC id # for the secondary insurance co based on this piece of data and relating directly to this claim.
  • SCREEN:  S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,2,2)"
  • EXPLANATION:  Must be a valid care unit for the ins co, care type, form type and EMC id type
  • EXECUTABLE HELP:  D CAREID^IBCEP1("EMC",2,DA(1))
1.03 DELETE 2006 1.03 1;3 POINTER TO IB INS CO PROVIDER ID CARE UNIT FILE (#355.96) IB INS CO PROVIDER ID CARE UNIT(#355.96)

  • INPUT TRANSFORM:  S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,2,3)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAY 21, 2004
  • HELP-PROMPT:  Enter the care unit that applies to this bill for the EMC id for the tertiary insurance
  • DESCRIPTION:  
    This is the exact data you need to use to allow the system to match the provider with the correct EMC id # for the tertiary insurance co based on this piece of data and relating directly to this claim.
  • SCREEN:  S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,2,3)"
  • EXPLANATION:  Must be a valid care unit for the ins co, care type, form type and EMC id type
  • EXECUTABLE HELP:  D CAREID^IBCEP1("EMC",3,DA(1))
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