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Sub-Field: 399.0404

Package: Integrated Billing

BILL/CLAIMS(#399)-->399.0304-->399.0404

Sub-Field: 399.0404


Information

Parent File Name Number Package
399.0304 LINE PROVIDER 399.0404 Integrated Billing

Details

Field # Name Loc Type Details
.01 LINE FUNCTION 0;1 SET
  • '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:  MAR 01, 2017
  • HELP-PROMPT:  Select the function performed by a provider for this claim line.
  • DESCRIPTION:  There are providers who performed specific functions for the services on this claim line. 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 line.
  • SCREEN:  S DIC("S")="I $$LNPRVOK^IBCEU7(+Y,$G(DA(2)))"
  • EXPLANATION:  Function must match bill form type. Use '??' to see the function definitions.
  • EXECUTABLE HELP:  D LNPRVHLP^IBCEU7
  • CROSS-REFERENCE:  399.0404^B
    1)= S ^DGCR(399,DA(2),"CP",DA(1),"LNPRV","B",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,DA(2),"CP",DA(1),"LNPRV","B",$E(X,1,30),DA)
  • CROSS-REFERENCE:  ^^TRIGGER^399.0404^.04
    1)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(0)=X S X=Y(0),X=X S X=X'=1 I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X="" X ^DD(3
    99.0404,.01,1,2,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,4)=DIV,DIH=399.0404,DIG=.04 D ^DICR
    2)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X="" X ^DD(399.0404,.01,1,2,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,4)=DIV,DIH=399.0404,DIG=.04 D ^DICR
    3)= Do Not Delete
    CREATE CONDITION)= INTERNAL(LINE PROVIDER LINE FUNCTION)'=1
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= LINE PROVIDER STATE
    This xref is used to delete the state field if the provider is not a referring provider function type.
  • FIELD INDEX:  C (#178) REGULAR IR LOOKUP & SORTING
    Short Descr: External value of LINE FUNCTION field.
    Set Logic: S ^DGCR(399,DA(2),"CP",DA(1),"LNPRV","C",$E(X(2),1,30),DA)=""
    Kill Logic: K ^DGCR(399,DA(2),"CP",DA(1),"LNPRV","C",$E(X(2),1,30),DA)
    Whole Kill: K ^DGCR(399,DA(2),"CP",DA(1),"LNPRV","C")
    X(1): LINE FUNCTION (399.0404,.01) (Len 30) (forwards)
    X(2): Computed Code: S X=$$EXTERNAL^DILFD(399.0404,.01,,X(1))
    (Subscr 1) (Len 30)
.02 LINE PERFORMED BY 0;2 VARIABLE POINTER NEW PERSON(#200)  IB NON/OTHER VA BILLING PROVIDER(#355.93)  

  • EXPLANATION:  VistA provider must have a person class defined in NEW PERSON File (200).
    SCREEN ON FILE 355.93: S DIC("S")="I $$INDIVIDUAL^IBCU4($G(IBIFN),$P(^(0),U,2),$P($G(^DGCR(399,D0,""CP"",D1,""LNPRV"",D2,0)),U))"
  • EXPLANATION:  Non VA providers can be individuals or facilities. They can not be facility type on certain forms.
  • LAST EDITED:  MAR 16, 2022
  • HELP-PROMPT:  Select the provider who performed the indicated function.
  • DESCRIPTION:  
    Providers may be VA providers found in the VistA NEW PERSON file or NON-VA providers found in the IB NON VA BILLING PROVIDER file.
  • EXECUTABLE HELP:  D INDIVHELP^IBCU4
  • NOTES:  TRIGGERED by the PRIMARY INS CO ID NUMBER field of the LINE PROVIDER sub-field of the PROCEDURES sub-field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399.0404^.05
    1)= X ^DD(399.0404,.02,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" X ^DD(399.0404,.02,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,5)="SLF000"
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,5)=DIV,DIH=399.0404,DIG=.05 D ^DICR
    2)= Q
    3)= Do Not Delete
    CREATE CONDITION)= PRIMARY INS CO ID NUMBER="SLF000"
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= PRIMARY INS CO ID NUMBER
    This cross reference deletes any SLF000 id in the primary insurance id if a provider name is entered.
  • CROSS-REFERENCE:  ^^TRIGGER^399.0404^.03
    1)= X ^DD(399.0404,.02,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV S X=$$EXTCR^IBCEU5(X) X ^DD(399.0404,.02,1,2,1.4)
    1.3)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,3)=""
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,3)=DIV,DIH=399.0404,DIG=.03 D ^DICR
    2)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(399.0404,.02,1,2,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,3)=DIV,DIH=399.0404,DIG=.03 D ^DICR
    3)= Do not delete
    CREATE CONDITION)= CREDENTIALS=""
    CREATE VALUE)= S X=$$EXTCR^IBCEU5(X)
    DELETE VALUE)= @
    FIELD)= CREDENTIALS
    This trigger will force the CREDENTIALS field of the line provider multiple to be set to the first 3 characters of the provider's degree if the credentials don't already exist.
  • CROSS-REFERENCE:  ^^TRIGGER^399.0404^.08
    1)= X ^DD(399.0404,.02,1,3,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y X ^DD(399.0404,.02,1,3,1.1) X ^DD(399.0404,.02,1,3,1.4)
    1.1)= S X=DIV S X=$$SPEC^IBCEU(X,$P($G(^DGCR(399,D0,"U")),U))
    1.3)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,8)=""
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,8)=DIV,DIH=399.0404,DIG=.08 D ^DICR
    2)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" X ^DD(399.0404,.02,1,3,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,8)=DIV,DIH=399.0404,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 line provider multiple to be set to the current specialty of the provider.
  • CROSS-REFERENCE:  ^^TRIGGER^399.0404^.05
    1)= Q
    2)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" X ^DD(399.0404,.02,1,4,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,5)=DIV,DIH=399.0404,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^399.0404^.06
    1)= Q
    2)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X="" X ^DD(399.0404,.02,1,5,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,6)=DIV,DIH=399.0404,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^399.0404^.07
    1)= Q
    2)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(399.0404,.02,1,6,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,7)=DIV,DIH=399.0404,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^399.0404^.15
    1)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y X ^DD(399.0404,.02,1,7,1.1) X ^DD(399.0404,.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),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,15)=DIV,DIH=399.0404,DIG=.15 D ^DICR
    2)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y S X="" X ^DD(399.0404,.02,1,7,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,15)=DIV,DIH=399.0404,DIG=.15 D ^DICR
    3)= Do not delete
    CREATE VALUE)= S X=$P($$GETTAX^IBCEF73A(X,$P(^DGCR(399,D0,0),U,3)),U,2)
    DELETE VALUE)= @
    FIELD)= LINE TAXONOMY
    This trigger updates the LINE TAXONOMY field with the provider's taxonomy code if the event date of the claim is covered, otherwise, it will set the LINE TAXONOMY field to null.
.03 CREDENTIALS 0;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • LAST EDITED:  OCT 14, 2010
  • HELP-PROMPT:  Enter up to 3 digits to describe the provider's 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 LINE PERFORMED BY field of the LINE PROVIDER sub-field of the PROCEDURES sub-field of the BILL/CLAIMS File
.04 STATE 0;4 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  OCT 14, 2010
  • 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 LINE FUNCTION field of the LINE PROVIDER sub-field of the PROCEDURES sub-field of the BILL/CLAIMS File
    TRIGGERED by the LINE FUNCTION field of the LINE PROVIDER sub-field of the PROCEDURES sub-field of the BILL/CLAIMS File
.05 PRIMARY INS CO ID NUMBER 0;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  OCT 14, 2010
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    This is the primary insurance co specific provider's secondary id number.
  • NOTES:  TRIGGERED by the LINE PERFORMED BY field of the LINE PROVIDER sub-field of the PROCEDURES sub-field of the BILL/CLAIMS File
    TRIGGERED by the LINE PERFORMED BY field of the LINE PROVIDER sub-field of the PROCEDURES sub-field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399.0404^.02
    1)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(0)=X S X=Y(0)="SLF000" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(399.0
    404,.05,1,1,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,2)=DIV,DIH=399.0404,DIG=.02 D ^DICR
    2)= Q
    3)= Do not delete
    CREATE CONDITION)= PRIMARY INS CO ID NUMBER="SLF000"
    CREATE VALUE)= @
    DELETE VALUE)= NO EFFECT
    FIELD)= LINE PERFORMED BY
    This erases the provider name if the id is SLF000.
.06 SECONDARY INS CO ID NUMBER 0;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  OCT 14, 2010
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    This is the secondary ins company's specific secondary provider id number.
  • NOTES:  TRIGGERED by the LINE PERFORMED BY field of the LINE PROVIDER sub-field of the PROCEDURES sub-field of the BILL/CLAIMS File
.07 TERTIARY INS CO ID NUMBER 0;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  OCT 14, 2010
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    This is the tertiary ins company's specific secondary provider id number.
  • NOTES:  TRIGGERED by the LINE PERFORMED BY field of the LINE PROVIDER sub-field of the PROCEDURES sub-field of the BILL/CLAIMS File
.08 SPECIALTY 0;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<2) X
  • LAST EDITED:  SEP 14, 2010
  • 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 LINE PERFORMED BY field of the LINE PROVIDER sub-field of the PROCEDURES sub-field of the BILL/CLAIMS File
.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=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  SEP 14, 2010
  • 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.
.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=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  OCT 14, 2010
  • HELP-PROMPT:  Enter the type of id the secondary payer requires as a secondary id.
  • DESCRIPTION:  
    This is 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.
.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=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  SEP 14, 2010
  • 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.
.15 LINE TAXONOMY 0;15 POINTER TO PERSON CLASS FILE (#8932.1) PERSON CLASS(#8932.1)

  • LAST EDITED:  OCT 14, 2010
  • HELP-PROMPT:  Enter the Taxonomy Code associated with this entry.
  • DESCRIPTION:  
    This is the Taxonomy Code associated with this entry.
  • NOTES:  TRIGGERED by the LINE PERFORMED BY field of the LINE PROVIDER sub-field of the PROCEDURES sub-field of the BILL/CLAIMS File
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