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1 | CPAC.zip\Fee-Revenue Enhancements | 21-001 RevenueEnhance_SDD_v1.00.docx | Wed Feb 8 18:55:56 2017 UTC |
2 | CPAC.zip\Fee-Revenue Enhancements | 21-001 RevenueEnhance_SDD_v1.00.docx | Fri Feb 10 15:53:07 2017 UTC |
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1 | Department of Vetera ns Affairs | |
2 | ||
3 | Fee-Revenu e Enhancem ents | |
4 | System Des ign Docume nt | |
5 | IB*2.0*554 | |
6 | FB*3.5*163 | |
7 | ||
8 | ||
9 | ||
10 | February 2 017 | |
11 | Version 1. 00 | |
12 | Revision H istory | |
13 | Date | |
14 | Version | |
15 | Descriptio n | |
16 | Author | |
17 | Reviewers | |
18 | Issue Date | |
19 | Formal Rev iew | |
20 | 02/08/2017 | |
21 | 1.00 | |
22 | Updated ba sed on VA feedback | |
23 | S. Ambrose | |
24 | ||
25 | 02/08/2017 | |
26 | ||
27 | 01/03/2017 | |
28 | 0.10 | |
29 | Formatting changes, per PMO | |
30 | P. Wild | |
31 | K. Marr | |
32 | 01/04/2017 | |
33 | ||
34 | 12/21/2016 | |
35 | 0.09 | |
36 | Formatting changes, per PMO | |
37 | P.Wild | |
38 | K. Marr | |
39 | 12/22/2016 | |
40 | ||
41 | 08/25/2016 | |
42 | 0.08 | |
43 | Per AERB, added stat ement rega rding SFTP | |
44 | P. Wild | |
45 | ||
46 | ||
47 | ||
48 | 03/08/2016 | |
49 | 0.07 | |
50 | Modified t ool versio n numbers, per AERB | |
51 | P.Wild | |
52 | ||
53 | ||
54 | ||
55 | 02/07/2016 | |
56 | 0.06 | |
57 | Updated pe r VA revie w comments | |
58 | P.Wild | |
59 | S. Blair | |
60 | ||
61 | ||
62 | 01/19/2016 | |
63 | 0.05 | |
64 | Updated Ta ble 2 Upda tes to Sec tions 5 & 6 | |
65 | P. Wild | |
66 | ||
67 | ||
68 | ||
69 | 10/20/2015 | |
70 | 0.04 | |
71 | Updates to Sections 5 & 6 | |
72 | P.Wild / R . DeWayne | |
73 | S. Blair | |
74 | ||
75 | ||
76 | 08/27/2015 | |
77 | 0.03 | |
78 | Updated ba sed on VA Comments | |
79 | ||
80 | Added Func tionality bullets in section 2 .3.1 | |
81 | ||
82 | Added diag rams in se ctions 3.1 .1., 3.1.2 , and 3.2. 1 | |
83 | S. Ritter | |
84 | S. Ambrose | |
85 | 09/03/2015 | |
86 | ||
87 | 08/14/2015 | |
88 | 0.02 | |
89 | Initial Dr aft | |
90 | R. DeWayne | |
91 | S. Ambrose | |
92 | 08/14/2015 | |
93 | 08/21/2015 | |
94 | 07/07/2015 | |
95 | 0.01 | |
96 | Sections 1 -4 for AER B Review R equest | |
97 | CPAC PMOSS | |
98 | S. Blair | |
99 | ||
100 | ||
101 | ||
102 | Activity | |
103 | New Capabi lity (1) | |
104 | Feature En hancement (2) | |
105 | Field Depl oyment (A) | |
106 | Yes | |
107 | Yes | |
108 | Cloud/Web Deployment (B) | |
109 | No | |
110 | No | |
111 | Mobile App lication ( C) | |
112 | No | |
113 | No | |
114 | ||
115 | Table of C ontents | |
116 | 1.Introduc tion1 | |
117 | 1.1.Scope1 | |
118 | 1.2.User P rofiles1 | |
119 | 2.Backgrou nd1 | |
120 | 2.1.Overvi ew of the System1 | |
121 | 2.2.Overvi ew of the Business P rocess2 | |
122 | 2.3.Overvi ew of the Significan t Requirem ents2 | |
123 | 2.3.1.Over view of Fu nctional R equirement s2 | |
124 | 2.3.2.Over view of Fu nctional W orkload/Pe rformance Requiremen ts7 | |
125 | 2.3.3.Over view of Op erational Requiremen ts7 | |
126 | 2.3.4.Over view of Te chnical Re quirements 7 | |
127 | 2.3.5.Over view of Se curity or Privacy Re quirements 7 | |
128 | 2.3.6.Over view of Sy stem Criti cality and High Avai lability R equirement s7 | |
129 | 2.3.7.Sing le Sign-on Requireme nts8 | |
130 | 2.3.8.Requ irement fo r Use of E nterprise Portals8 | |
131 | 2.3.9.Spec ial Device Requireme nts8 | |
132 | 3.Conceptu al Design8 | |
133 | 3.1.Concep tual Appli cation Des ign8 | |
134 | 3.1.1.Appl ication Co ntext8 | |
135 | 3.1.2.High -Level App lication D esign8 | |
136 | 3.1.3.Appl ication Lo cations10 | |
137 | 3.2.Concep tual Data Design11 | |
138 | 3.2.1.Proj ect Concep tual Data Model11 | |
139 | 3.2.2.Data base Infor mation11 | |
140 | 3.2.3.User Interface Data Mapp ing12 | |
141 | 3.3.Concep tual Infra structure Design12 | |
142 | 3.3.1.Syst em Critica lity and H igh Availa bility12 | |
143 | 3.3.2.Spec ial Techno logy12 | |
144 | 3.3.3.Tech nology Loc ations12 | |
145 | 3.3.4.Conc eptual Inf rastructur e Diagram1 3 | |
146 | 3.3.4.1.Lo cation of Environmen ts and Ext ernal Inte rfaces13 | |
147 | 3.3.4.2.Co nceptual P roduction String Dia gram13 | |
148 | 4.System A rchitectur e13 | |
149 | 4.1.Hardwa re Archite cture13 | |
150 | 4.2.Softwa re Archite cture13 | |
151 | 4.3.Networ k Architec ture15 | |
152 | 4.4.SOA/ES S16 | |
153 | 4.5.Enterp rise Archi tecture16 | |
154 | 5.Data Des ign16 | |
155 | 5.1.Databa se Managem ent System (DBMS) Fi les16 | |
156 | 5.2.Non-DB MS Files25 | |
157 | 5.3.Data V iew25 | |
158 | 6.Detailed Design26 | |
159 | 6.1.Hardwa re Detaile d Design26 | |
160 | 6.2.Softwa re Detaile d Design26 | |
161 | 6.2.1.Conc eptual Des ign26 | |
162 | 6.2.1.1.Pr oduct Pers pective26 | |
163 | 6.2.1.1.1. User Inter faces26 | |
164 | 6.2.1.1.2. Hardware I nterfaces2 6 | |
165 | 6.2.1.1.3. Software I nterfaces2 6 | |
166 | 6.2.1.1.4. Communicat ions Inter faces27 | |
167 | 6.2.1.1.5. Memory Con straints27 | |
168 | 6.2.1.1.6. Special Op erations27 | |
169 | 6.2.1.2.Pr oduct Feat ures27 | |
170 | 6.2.1.3.Us er Charact eristics27 | |
171 | 6.2.1.4.De pendencies and Const raints27 | |
172 | 6.2.2.Spec ific Requi rements27 | |
173 | 6.2.2.1.Da tabase Rep ository27 | |
174 | 6.2.2.2.Sy stem Featu res27 | |
175 | 6.2.2.3.Ni ghtly Proc ess #131 | |
176 | 6.2.2.4.Bi lling Work list31 | |
177 | 6.2.2.5.De sign Eleme nt Tables3 2 | |
178 | 6.2.2.5.1. Routines ( Entry Poin ts)32 | |
179 | 6.2.2.5.2. Templates7 9 | |
180 | 6.2.2.5.3. Bulletins7 9 | |
181 | 6.2.2.5.4. Data Entri es Affecte d by the D esign79 | |
182 | 6.2.2.5.5. Unique Rec ord(s)79 | |
183 | 6.2.2.5.6. File or Gl obal Size Changes80 | |
184 | 6.2.2.5.7. Mail Group s80 | |
185 | 6.2.2.5.8. Security K eys80 | |
186 | 6.2.2.5.9. Options – Note: Per VA Policy Analyst De cision (12 /2016), IB Billing W orklist Op tion is di sabled. Co de will re main in pa tch.80 | |
187 | 6.2.2.5.10 .Protocols 81 | |
188 | 6.2.2.5.11 .RPC82 | |
189 | 6.2.2.5.12 .Constants Defined i n Interfac e82 | |
190 | 6.2.2.5.13 .Variables Defined i n Interfac e82 | |
191 | 6.2.2.5.14 .Types Def ined in In terface82 | |
192 | 6.2.2.5.15 .GUI82 | |
193 | 6.2.2.5.16 .GUI Class es82 | |
194 | 6.2.2.5.17 .Current F orm82 | |
195 | 6.2.2.5.18 .Modified Form82 | |
196 | 6.2.2.5.19 .Component s on Form8 2 | |
197 | 6.2.2.5.20 .Events82 | |
198 | 6.2.2.5.21 .Methods82 | |
199 | 6.2.2.5.22 .Special R eferences8 3 | |
200 | 6.2.2.5.23 .Class Eve nts83 | |
201 | 6.2.2.5.24 .Class Met hods83 | |
202 | 6.2.2.5.25 .Class Pro perties83 | |
203 | 6.2.2.5.26 .Uses Clau se83 | |
204 | 6.2.2.5.27 .Forms83 | |
205 | 6.2.2.5.28 .Functions 83 | |
206 | 6.2.2.5.29 .Dialog83 | |
207 | 6.2.2.5.30 .Help Fram e83 | |
208 | 6.2.2.5.31 .HL7 Appli cation Par ameter83 | |
209 | 6.2.2.5.32 .HL7 Logic al Link83 | |
210 | 6.2.2.5.33 .Commercia l Off-the- Shelf (COT S) Interfa ce83 | |
211 | 6.3.Networ k Detailed Design83 | |
212 | 6.4.Securi ty and Pri vacy83 | |
213 | 6.4.1.Secu rity83 | |
214 | 6.4.2.Priv acy84 | |
215 | 6.5.SOA/ES S Detailed Design84 | |
216 | 7.External System In terface De sign84 | |
217 | 8.Human-Ma chine Inte rface84 | |
218 | Attachment A – Appro val Signat ures85 | |
219 | Attachment B – Acron yms86 | |
220 | Attachment C – Addit ional Info rmation88 | |
221 | A.1 Identi fication o f Technolo gy and Sta ndards88 | |
222 | A.2 Constr aining Pol icies, Dir ectives an d Procedur es88 | |
223 | A.3 RTM88 | |
224 | A.4 Packag ing and In stallation 88 | |
225 | A.5 Design Metrics88 | |
226 | Attachment D – Chang e Log89 | |
227 | ||
228 | ||
229 | List of Ta bles | |
230 | Table 1: P rimary and Secondary Users1 | |
231 | Table 2: F unctional Requiremen ts3 | |
232 | Table 3: D atabase In formation1 1 | |
233 | Table 4: F ileMan Dat abases16 | |
234 | Table 5: F unctional Requiremen ts (RSD) v s. Design Elements27 | |
235 | Table 6: ( Grouping): Routines3 2 | |
236 | Table 7: O ptions80 | |
237 | Table 8: A cronym Lis t86 | |
238 | ||
239 | List of Fi gures | |
240 | Figure 1: Fee Revenu e Enhancem ent Applic ation Cont ext Diagra m8 | |
241 | Figure 2: Overview o f EDI X12 Messaging9 | |
242 | Figure 3: Overview o f Claims P rocessing and Eligib ility (CP& E) System and Interf aces10 | |
243 | Figure 4: Data Model 11 | |
244 | Figure 5: Network Ar chitecture 15 | |
245 | Figure 6: Enterprise Architect ure16 | |
246 | ||
247 | ||
248 | Introducti on | |
249 | The Vetera ns Health Administra tion (VHA) Chief Bus iness Offi ce (CBO), Purchased Care Progr am Office affirms th at the cur rent Veter ans Health Informati on Systems and Techn ology Arch itecture ( VistA) doe s not supp ort the bu siness pro cesses for securing potential cost recov ery of bil lable Non- Department of Vetera ns Affairs (VA) epis odes of ca re in a ti mely and e fficient m anner. The y are seek ing enhanc ements to the VistA Fee Basis (FB) and I ntegrated Billing (I B)/Revenue software applicatio ns to auto mate the m ovement of billable Non-VA Car e (NVC) ca ses from V istA FB th rough the Revenue IB software product, t o include prioritiza tion of hi gh cost cl aims, auto mation of Veterans’ co-pay req uirements and decisi on support for asses sing clini cal review of cases. | |
250 | Scope | |
251 | The Fee-Re venue Enha ncements B usiness Re quirements Document (BRD) is a vailable v ia Technic al Service s Project Repository (TSPR) he re:
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|
252 | This enhan cement wil l modify v arious Vis tA applica tions, pri marily Vis tA FB and IB. The sc ope of the se enhance ments invo lves an in teraction between th e various modules th at would a utomate cu rrent manu al process es where V A Medical Centers’ ( VAMCs) sta ff are cre ating invo ices to bi ll Veteran s’ third p arty insur ance co-pa yments for cost reco verable se rvices pro vided for Non-VA hea lth care s ervices. | |
253 | User Profi les | |
254 | User profi les are el aborated i n Table 1: | |
255 | Table 1: P rimary and Secondary Users | |
256 | Name | |
257 | Descriptio n | |
258 | Responsibi lities | |
259 | Primary Us ers | |
260 | VAMC FB an d Revenue/ Medical C are Cost R ecovery (M CCR) staff | |
261 | Process NV C authoriz ations and claims fo r the Vete rans’ Non- VA healthc are servic es | |
262 | Secondary Users | |
263 | CBO Nation al Fee Pro gram Offic e (NFPO) a nd Purchas ed Care Pr ogram Offi ce Staff, Veterans I ntegrated Service Ne tworks (VI SN) Staff and VA Cen tral Offic e (VACO) C BO Staff | |
264 | Monitor, t rack, tren d, analyze and repor t data on the VA car e | |
265 | Background | |
266 | Overview o f the Syst em | |
267 | The VA, VH A is one o f the worl d’s larges t health c are delive ry organiz ations. As part of a n integrat ed strateg y to provi de Veteran s with tim ely access to qualit y health c are servic es, VA cli nics are a uthorized to pay for health ca re service s acquired from Non- VA health care provi ders. Thes e services may be ac quired by eligible V eterans fr om Non-VA health car e provider s when acc ess to ser vices is n ot availab le from VA . The VA i s legislat ively “man dated to a ppropriate ly reimbur se for hea lth care f or eligibl e benefici aries.” | |
268 | The VA man ages NVC a uthorizati on, claims processin g and reim bursement for servic es acquire d from Non -VA health care prov iders. The basic pro visions of and autho rity for t he NVC pro gram are p rovided by public la ws passed by Congres s. These l aws have b een codifi ed into th e United S tates Code and furth er clarifi ed in the Code of Fe deral Regu lations. V arious VA policies a nd directi ves have b een writte n to provi de additio nal interp retation. | |
269 | In general , while Ve terans see king healt h care at VA expense should ob tain such care at VA facilitie s, Non-VA facility c are, or th e use of F B, is gene rally only authorize d when app ropriate V A services and/or fa cilities a re not ava ilable or cannot be economical ly provide d to the V eteran due to geogra phical ina ccessibili ty. The us e of FB, o r Non-VA f acilities, is not co nsidered a permanent solution for Vetera n health c are needs. | |
270 | The VA Off ice of Ins pector Gen eral (OIG) recently reported t hat VHA is not optim izing reve nue intake via the M edical Car e Collecti on Fund (M CCF) billi ng of NVC claims cas es. The VH A CBO, Pur chased Car e Program Office is in agreeme nt and aff irms that the curren t VistA do es not sup port the b usiness pr ocesses fo r securing potential cost reco very of bi llable Non -VA episod es of care in a time ly and eff icient man ner. They are seekin g enhancem ents to th e VistA FB and IB/Re venue soft ware appli cations to automate the moveme nt of bill able Non-V A cases fr om VistA F B through the Revenu e IB softw are produc t, to incl ude priori tization o f high cos t claims, automation of Vetera ns’ Co-Pay requireme nts and de cision sup port for a ssessing c linical re view of ca ses. | |
271 | Overview o f the Busi ness Proce ss | |
272 | A high-lev el view of the curre nt (as-is) and futur e (to-be) Fee Revenu e Enhancem ent proces ses/workfl ows are av ailable vi a TSPR her e:
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273 | Overview o f the Sign ificant Re quirements | |
274 | The Fee-Re venue Enha ncements B RD, Requir ements Spe cification Document (RSD), and Requireme nts Tracea bility Mat rix (RTM) are availa ble via TS PR here:
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275 | Until docu ments are approved a nd posted to TSPR, t hey will b e made ava ilable upo n request from the p roject tea m. | |
276 | Overview o f Function al Require ments | |
277 | The Fee-Re venue Enha ncements p roject wil l execute the follow ing: | |
278 | Enhancemen t provides an intera ction from FB to IB to support the VHA R evenue Sta ff in Reve nue Pre-Ce rtificatio n. | |
279 | This enhan cement pro vides an i nteraction into FB t o support the VHA Re venue Staf f in the c reation/re vision of claims. | |
280 | This docum ent addres ses only t he Fee Rev enue enhan cement, on e of five enhancemen ts compris ing the ED I CPAC Rev enue Enhan cements Pr ogram. Det ails regar ding other enhanceme nts in the program a re describ ed in sepa rate RSDs. | |
281 | During req uirements elaboratio n for this enhanceme nt, the Bu siness Nee ds (BNs) a nd require ments were discussed from the perspectiv e of the B RD, includ ing the ch anges reco mmended in the BRD t o address the BNs. | |
282 | The revise d understa nding of t he BNs and goals has revealed that BNs 2 FRE-2.10 – FRE-2.20 are no lo nger neede d since th ey have be en address ed on othe r projects and don’t need to b e implemen ted. These revised B Ns will be reflected in the RS D. The RSD should be regarded as the sou rce for th e most rec ent BNs an d requirem ents based on requir ements ela boration. | |
283 | The BNs/re quirements are shown in Table 2. Table 2 also refl ects the o bsolescenc e of BN2 r equirement s FRE-2.10 – FRE-2.2 0 that are no longer needed on this Enha ncement. | |
284 | Table 2: F unctional Requiremen ts | |
285 | BN | |
286 | Owner Requ irement (O WNR) | |
287 | Number | |
288 | OWNR | |
289 | Priority* | |
290 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
291 | FRE-2.1 | |
292 | The system shall hav e the abil ity to rec ord the au thorizatio n and the correspond ing author ization mo dification data. | |
293 | High | |
294 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
295 | FRE-2.2 | |
296 | The system shall hav e the abil ity to tra nsmit the authorizat ion and th e correspo nding auth orization data to th e IB packa ge to supp ort Revenu e pre-cert ification. | |
297 | High | |
298 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
299 | FRE-2.3 | |
300 | The system shall hav e the abil ity to dis play the a uthorizati on and the correspon ding autho rization d ata in rea l-time to include an y authoriz ation upda tes. | |
301 | High | |
302 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
303 | FRE-2.4 | |
304 | The system shall hav e the abil ity to aut omatically alert/not ify specif ied Revenu e users of instances of author ized care for member s with ins urance. | |
305 | High | |
306 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
307 | FRE-2.5 | |
308 | The system shall hav e the abil ity to tra ck all tra nsmissions of author izations a nd authori zation upd ates to th e IB packa ge. | |
309 | High | |
310 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
311 | FRE-2.6 | |
312 | The system shall hav e the abil ity to tra nsmit all claim data received and proces sed to the IB packag e. | |
313 | High | |
314 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
315 | FRE-2.7 | |
316 | The system shall hav e the abil ity to tra ck all tra nsmissions of claims and claim s updates to the IB package. | |
317 | High | |
318 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
319 | FRE-2.8 | |
320 | The system shall hav e the abil ity to ide ntify paid claims as sociated w ith a pati ent whose eligibilit y is copay required. | |
321 | High | |
322 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
323 | FRE-2.9 | |
324 | The system shall hav e the abil ity to int eract with the VistA IB Softwa re (bi-dir ectional) to send NV C payment data on pa id claims for first party (co- pay) and t hird party determina tion. | |
325 | High | |
326 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
327 | FRE-2.10 | |
328 | The system shall hav e the abil ity to rec eive cost recovery a nd recoupm ent detail updates f or NVC thi rd party a ccounts re ceivables from the I B package. | |
329 | Not Requir ed | |
330 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
331 | FRE-2.11 | |
332 | The system shall hav e a bi-dir ectional i nteraction with Fina ncial Mana gement Sys tem (FMS) to process recoupmen t data for NVC claim s with ove rpayments, duplicate payments and errone ous paymen ts. | |
333 | Not Requir ed | |
334 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
335 | FRE-2.12 | |
336 | The system shall hav e the abil ity to cre ate workfl ow for all issues th at must be resolved manually. | |
337 | Not Requir ed | |
338 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
339 | FRE-2.13 | |
340 | The system shall hav e the abil ity to man age all wo rkflow ite ms resulti ng from is sues. | |
341 | Not Requir ed | |
342 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
343 | FRE-2.14 | |
344 | The system shall hav e the abil ity to tra ck all wor kflow, inc luding dat e and time stamps fo r each wor kflow stag e througho ut the wor kflow life cycle for historica l and repo rting purp oses. | |
345 | Not Requir ed | |
346 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
347 | FRE-2.15 | |
348 | The system shall hav e the abil ity to esc alate/reas sign workf low items based on u ser specif ic permiss ions. | |
349 | Not Requir ed | |
350 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
351 | FRE-2.16 | |
352 | The system shall pro vide the c apability to query w orkflow re sults both in detail and in su mmary. | |
353 | Not Requir ed | |
354 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
355 | FRE-2.17 | |
356 | The system shall hav e the abil ity for au tomatic an d manual r eport gene ration. | |
357 | Not Requir ed | |
358 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
359 | FRE-2.18 | |
360 | The system shall hav e the abil ity for al l reports to be arch ived/store d in a dep ository fo r historic al purpose s to be ac cessed on demand by any user w ith the ap propriate permission s. | |
361 | Not Requir ed | |
362 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
363 | FRE-2.19 | |
364 | The system shall hav e the abil ity for de signated u sers to cr eate ad ho c reports. | |
365 | Not Requir ed | |
366 | BN 2: The system sha ll have th e ability to interac t with the VistA IB Software t o transmit authorize d care dat a at the t ime the ca re is auth orized and paid clai ms data, p ost NVC pa yment. | |
367 | FRE-2.20 | |
368 | The system shall hav e the abil ity to all ow all use rs with th e appropri ate permis sions to e xport data into othe r formats, such as A ccess data tables an d/or Excel workbooks for analy sis and ma nipulation . | |
369 | Not Requir ed | |
370 | Overview o f Function al Workloa d/Performa nce Requir ements | |
371 | Not applic able – thi s project is compose d of VistA FB and IB patches. There are no functio nal worklo ad/perform ance requi rements as sociated w ith this p roject. | |
372 | Overview o f Operatio nal Requir ements | |
373 | Not applic able – the re are no changes to existing operationa l requirem ents. | |
374 | Overview o f Technica l Requirem ents | |
375 | Not applic able – the re are no technical requiremen ts that dr ive the co nceptual d esign. | |
376 | Overview o f Security or Privac y Requirem ents | |
377 | All VA and VHA secur ity or pri vacy requi rements wi ll be adhe red to. Cr oss-cuttin g security requireme nts are co ntained in the VA En terprise R equirement s Reposito ry (ERR). Efforts th at involve the colle ction and maintenanc e of indiv idually id entifiable informati on must be covered b y a Privac y Act syst em of reco rds notice . | |
378 | Overview o f System C riticality and High Availabili ty Require ments | |
379 | The FB and IB system s are comp osed of mu ltiple Vis tA applica tions. Eac h of these applicati ons has it s own avai lability a nd downtim e requirem ents which will be V AMC depend ent. The F B and IB a pplication s do not i mpose any requiremen t beyond t he require ment alrea dy specifi ed by each of the ap plications . Any rela ted claim that canno t be submi tted due t o communic ation or o ther issue s will be queued and submitted when the systems ar e availabl e. | |
380 | Single Sig n-on Requi rements | |
381 | Not applic able – acc ess is con trolled by the VistA applicati on and the underlyin g operatin g system. This appli cation doe s not mand ate any ad ditional a ccess or s ign-on req uirements. | |
382 | Requiremen t for Use of Enterpr ise Portal s | |
383 | Not applic able – the re are no changes to the requi rements fo r use of e nterprise portals. | |
384 | Special De vice Requi rements | |
385 | Not applic able – no special de vices are required. | |
386 | Conceptual Design | |
387 | This proje ct is comp osed of Vi stA FB and IB patche s and ther e are no c onceptual design con sideration s. The act ual softwa re detaile d design i s presente d in Secti on 6.2.2 S pecific Re quirements . | |
388 | Conceptual Applicati on Design | |
389 | Not applic able – the re are no conceptual design co nsideratio ns. | |
390 | Applicatio n Context | |
391 | These enha ncements d o not requ ire any ch anges to t he applica tion conte xt. | |
392 | Figure 1 p rovides th e applicat ion contex t. | |
393 | Figure 1: Fee Revenu e Enhancem ent Applic ation Cont ext Diagra m | |
394 | ||
395 | High-Level Applicati on Design | |
396 | This proje ct does no t require any change s to the h igh-level conceptual applicati on design. | |
397 | For inform ational pu rposes and applicati on context , Figure 2 and Figur e 3 displa y the Elec tronic Dat a Intercha nge (EDI) X12 messag ing infras tructure f or Veteran s and bene ficiaries. | |
398 | Figure 2: Overview o f EDI X12 Messaging | |
399 | ||
400 | Figure 3: Overview o f Claims P rocessing and Eligib ility (CP& E) System and Interf aces | |
401 | ||
402 | Applicatio n Location s | |
403 | VistA is d eployed un iversally across VHA at more t han 1,500 sites of c are, inclu ding each Veterans A ffairs Med ical Cente r (VAMC), Community Based Outp atient Cli nic (CBOC) and Commu nity Livin g Center ( CLC), as w ell as at nearly 300 VA Vet Ce nters. The Fee Basis and Integ rated Bill ing applic ation modu les are lo cated with in the nat ionally re leased Vis tA applica tion. This will not change as a result o f this pro ject. | |
404 | Conceptual Data Desi gn | |
405 | Project Co nceptual D ata Model | |
406 | Figure 4 p rovides th e conceptu al data mo del for th is project . The Bill ing Workli st is a ne w addition to the co nceptual d ata model. Insurance Company b illing, pr eviously c ompleted m anually, w ill be aut omated as a result o f this pro ject. | |
407 | Figure 4: Data Model | |
408 | ||
409 | For a more detailed visual of the VistA data model , refer to the Entit y Relation ship Diagr am (ERD) a vailable v ia TSPR he re:
|
|
410 | Database I nformation | |
411 | The databa se being u tilized fo r this pro ject is Vi stA. Withi n the Vist A database , two soft ware modul es will be utilized – Fee Basi s and Inte grated Bil ling. | |
412 | Table 3: D atabase In formation | |
413 | Database N ame | |
414 | Descriptio n | |
415 | Type | |
416 | Steward | |
417 | VistA | |
418 | Veterans H ealth Info rmation Sy stems and Technology Architect ure | |
419 | I | |
420 | VA | |
421 | The VistA Fee Basis module, an d associat ed Massach usetts Gen eral Hospi tal Utilit y Multi-Pr ogramming System (Mu mps) datab ase, provi des for mo re efficie nt and acc urate oper ation of t he fee for service p rogram wit h reductio n of paper work, savi ngs in sta ff hours, minimizati on of erro rs, and by allowing medical fa cilities t o have gre ater contr ol over di sbursement of fee me dical, pha rmacy, and travel mo nies. | |
422 | The VistA Integrated Billing m odule, and associate d Mumps da tabase, al lows for t he capture , maintena nce, and s torage of insurance data inclu ding polic y informat ion and re lated bene fits. It p rovides th e ability to electro nically tr ansmit bil ls to paye rs with th e data req uired by H IPAA. It a lso provid es the abi lity to re ceive and store elec tronic 835 Health Ca re Claim P ayment/Adv ice. It in cludes the ability t o create p rinted bil ls which c an then be mailed to payers wh o are unab le to acce pt an elec tronic cla im. A Clai ms Trackin g feature is availab le to assi st utiliza tion revie w staff in tracking episodes o f care, co mpleting p re-certifi cations, c ompleting continued stay revie ws, and pr ocessing a ppeals and denials. An Automat ed Biller module pro vides a pr ocess that automatic ally creat es bills f or billabl e events w hich can t hen be fin ished and authorized by the bi lling staf f. The IB software a lso provid es many re porting fe atures tha t support the billin g staff by providing statistic s, trackin g and hist orical inf ormation. | |
423 | User Inter face Data Mapping | |
424 | VistA Fee Basis rece ives data from the F ee Basis C laims Syst em (FBCS), a Graphic al User In terface (G UI) system that send s authoriz ation and claim data to the Vi stA Fee Ba sis system . These fi elds are m apped in V istA, via Remote Pro cedure Cal ls (RPCs). There wil l be no ch anges to V istA Fee B asis inter face mappi ng for thi s project. | |
425 | The VistA Integrated Billing p ackage ele ctronicall y transmit bills to payers wit h the data required by HIPAA. It also pr ovides the ability t o receive and store electronic 835 Healt h Care Cla im Payment /Advice. T here will be no chan ges to Vis tA Integra ted Billin g interfac e mapping for this p roject. | |
426 | Conceptual Infrastru cture Desi gn | |
427 | System Cri ticality a nd High Av ailability | |
428 | No changes are expec ted to sys tem critic ality and high avail ability as a result of this pr oject. Rel iability a nd availab ility requ irements f or VistA a re managed by region al data ce nters. | |
429 | Special Te chnology | |
430 | VistA has historical ly been bu ilt on a c lient-serv er archite cture, whi ch ties to gether wor kstations and person al compute rs with us er interfa ces at VA facilities . No speci al technol ogies will be modifi ed as a re sult of th is project . | |
431 | Technology Locations | |
432 | All softwa re changes for this project wi ll be comp leted with in nationa lly releas ed VistA s oftware co de. Mumps routines ( programs) will be mo dified and added to the Fee Ba sis and In tegrated B illing sof tware. | |
433 | Conceptual Infrastru cture Diag ram | |
434 | Location o f Environm ents and E xternal In terfaces | |
435 | Please see Figure 2 and Figure 3. Modifi cations fo r this pro ject will be complet ed within the bounds of the Vi stA system , only. | |
436 | Conceptual Productio n String D iagram | |
437 | No concept ual produc tion strin g diagram exists for the VistA Fee Basis and Integ rated Bill ing module s. The sta ndard Vist A configur ation will be utiliz ed. | |
438 | System Arc hitecture | |
439 | This proje ct is comp osed of Vi stA patche s, which d o not requ ire any ch anges to t he VistA S ystem Arch itecture. However, b rief descr iptions of these ent ities will be provid ed below. | |
440 | Hardware A rchitectur e | |
441 | The FB and IB applic ations are part of t he VistA s uite of ap plications . The Vist A Monograp h states: | |
442 | “VistA is deployed u niversally across VH A at more than 1,500 sites of care, incl uding each VAMC, Com munity Bas ed Outpati ent Clinic (CBOC) an d Communit y Living C enter (CLC ), as well as at nea rly 300 VA Vet Cente rs. These locations will have a variety of hardwar e platform s but all meet a min imal stand ard requir ed to supp ort VistA. ” | |
443 | Software A rchitectur e | |
444 | The FB and IB system s are comp osed of mu ltiple Vis tA applica tions. The y also int eract with many othe r VistA st andard mod ules, such as Mailma n, Kernel, Health Le vel 7 (HL7 ), and Fil eMan. The entire Vis tA applica tion consi sts of 200 + modules. The VistA monograph includes this descr iption for VistA: | |
445 | “VistA is an integra ted Electr onic Healt h Record ( EHR) infor mation tec hnology sy stem with applicatio n packages that shar e a common data stor e and comm on interna l services . The data store and VistA ker nel are im plemented in the Mas sachusetts General H ospital Ut ility Mult i-Programm ing System (MUMPS) c omputer la nguage and the Compu terized Pa tient Reco rd System (CPRS) GUI is implem ented in D elphi. App lication c lients use a highly efficient proprietar y protocol to access data. Vis tA is high ly configu rable and customizab le, and in addition to appropr iate conne ctivity am ongst Vist A modules, VistA sup ports the integratio n of best- of-breed a pplication s at multi ple levels , includin g MUMPS Ap plication Programmin g Interfac e (API), R emote Proc edure Call (RPC), Me dical Doma in Web Ser vices (MDW S), HL7, a nd data ex change via Blue Butt on or eHea lth Exchan ges. VistA comprises nearly 20 0 distinct applicati ons/module s, 15,000 routines, and millio ns of line s of compu ter code. | |
446 | The backbo ne of VHA’ s clinical and admin istrative informatio n technolo gy capabil ity, VistA has histo rically be en built o n a client -server ar chitecture , which ti es togethe r workstat ions and p ersonal co mputers wi th GUIs at VA facili ties. The CPRS GUI i s as highl y customiz able and r uns on wor kstations, laptops, tablets (i ncluding i Pads) and smart phon es. VistA interopera tes with n umerous Co mmercial O ff-the-She lf (COTS) software a pplication s and with selected informatio n technolo gy systems of other federal ag encies and , increasi ngly, heal th informa tion excha nge networ ks. At the time of p ublication of this e dition of the Monogr aph, compr ehensive p roposed en hancements to VistA were in th e initial stages; re ferred to as “VistA Evolution” these enh ancements are will r eflect dev elopment a nd archite cture enha ncements t o allow gr eater inte raction wi th data an d greater efficiency for the V istA syste m.” | |
447 | Note that the change s required by this p roject are based in the MUMPS computer l anguage an d do not i mpact CPRS . | |
448 | Network Ar chitecture | |
449 | Figure 5: Network Ar chitecture | |
450 | ||
451 | Please see Figure 5, above, fo r a depict ion of net work archi tecture su rrounding Claims/Bil ling proce ssing. The network a rchitectur e is not i mpacted or modified by this pr oject. | |
452 | ** Please note: | |
453 | Per Elizab eth Congdo n (Manager , Health S ystems Pla tform, Ent erprise Sy stems Engi neering, V A OI&T Ser vice Deliv ery and En gineering) “VistA is using SFT P and has for quite a while”. | |
454 | SOA/ESS | |
455 | Not applic able – thi s project will not i mpact or m andate any additiona l requirem ent for Se rvice Orie nted Archi tecture (S OA)/Enterp rise Share d Services (ESS). | |
456 | Enterprise Architect ure | |
457 | Figure 6: Enterprise Architect ure | |
458 | ||
459 | Figure 6, above is a depiction of the Vi stA system ’s Enterpr ise Archit ecture. No modificat ions are t o me made to the exi sting syst em’s (Vist A’s) archi tecture, a s a result of this p roject. | |
460 | Data Desig n | |
461 | Database M anagement System (DB MS) Files | |
462 | This is a VistA Inte grated Bil ling patch . The data base manag ement syst em (DBMS) in use is VA FileMan . | |
463 | The VistA Integrated Billing p ackage use s the stan dard VA Fi leMan data dictionar ies (DDs) and files. This tabl e identifi es the VA FileMan da tabases wh ich are be ing modifi ed by this VistA Int egrated Bi lling proj ect. | |
464 | Table 4: F ileMan Dat abases | |
465 | Database | |
466 | File Numbe r | |
467 | FEE BASIS PATIENT FI LE - AUTHO RIZATION S UB-FILE (N ew Trigger ) | |
468 | 161.01 | |
469 | IB-FB INTE RFACE TRAC KING FILE (New File) Note: Thi s file all ows IB and FB to int eract with each othe r. | |
470 | 360 | |
471 | FEE BASIS PATIENT FI LE – AUTHO RIZATION S UB-FILE (# 161.01) – New Trigge r | |
472 | A new trig ger / cros s-referenc e (Field: FROM DATE, 161.01,.0 1) has bee n added so that each time a ne w or modif ied author ization is set in Vi stA, a new record wi ll log to the IB-FB INTERFACE TRACKING F ILE (#360) . | |
473 | Note: Trig ger code ( EVENT^IBFB UTIL) is d etailed in the Routi ne Table p ortion of this docum ent | |
474 | ||
475 | STANDARD D ATA DICTIO NARY #161. 01 -- AUTH ORIZATION SUB-FILE | |
476 | ||
477 | STORED IN ^FBAAA(D0, 1, | |
478 | ||
479 | DATA NAME GLOBAL DAT A | |
480 | ELEMENT TI TLE LOCATI ON TYPE | |
481 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
482 | ||
483 | 161.01,.01 FROM DATE 0;1 DATE | |
484 | ||
485 | INPUT TRA NSFORM: S %DT="EX" D ^%DT S X= Y K:Y<1 X | |
486 | LAST EDIT ED: OCT 05 , 2015 | |
487 | DESCRIPTI ON: The be ginning da te for whi ch the pat ient is | |
488 | authorize d to obtai n services from priv ate | |
489 | vendors. For every claim made by a vend or for | |
490 | this pati ent, this date will be checked to | |
491 | insure th at the dat e the serv ice was pr ovided | |
492 | was on or after thi s date. | |
493 | ||
494 | DELETE TE ST: .01,0) = I $$DELA ^FBUCDD1(. DA,1) | |
495 | ||
496 | NOTES: XX XX--CAN'T BE ALTERED EXCEPT BY PROGRAMME R | |
497 | ||
498 | CROSS-REF ERENCE: 16 1^AIC1^MUM PS | |
499 | 1)= S:$P( ^FBAAA(DA( 1),1,DA,0) ,U,20)]"" ^FBAAA(" | |
500 | AIC",DA(1 ),-X,$P(^F BAAA(DA(1) ,1,DA,0),U ,20),DA) | |
501 | ="" | |
502 | 2)= K:$P( ^FBAAA(DA( 1),1,DA,0) ,U,20)]"" ^FBAAA(" | |
503 | AIC",DA(1 ),-X,$P(^F BAAA(DA(1) ,1,DA,0),U ,20),DA) | |
504 | Cross-ref erence use d to ident ify potent ial | |
505 | billables using inv erse date. Used to s et | |
506 | "AIC" cro ss-referen ce on fiel d .097, PO TENTIAL | |
507 | COST RECO VERY CASE. | |
508 | ||
509 | CROSS-REF ERENCE: 16 1^ATST | |
510 | 1)= S ^FB AAA("ATST" ,$E(X,1,30 ),DA(1),DA )="" | |
511 | ||
512 | 2)= K ^FB AAA("ATST" ,$E(X,1,30 ),DA(1),DA ) | |
513 | ||
514 | CROSS-REF ERENCE: 16 1.01^B | |
515 | 1)= S ^FB AAA(DA(1), 1,"B",$E(X ,1,30),DA) ="" | |
516 | 2)= K ^FB AAA(DA(1), 1,"B",$E(X ,1,30),DA) | |
517 | ||
518 | CROSS-REF ERENCE: 16 1^AENR01^M UMPS | |
519 | 1)= D:'$D (DIU(0)) E VENT^IVMPL OG(DA(1)) | |
520 | 2)= D:'$D (DIU(0)) E VENT^IVMPL OG(DA(1)) | |
521 | Notify HE C of chang es to FEE Authorizat ion. | |
522 | ||
523 | CROSS-REF ERENCE: 16 1^AC^MUMPS | |
524 | 1)= D:'$D (DIU(0)) E VENT^IBFBU TIL(DA(1)) | |
525 | 2)= D:'$D (DIU(0)) E VENT^IBFBU TIL(DA(1)) | |
526 | Add new e ntry into file 360 o n new Auth orization | |
527 | ||
528 | RECORD IN DEXES: AMR A (#1327), AUD (#120 4) | |
529 | IB-FB INTE RFACE TRAC KING FILE (#360) – N ew File | |
530 | STANDARD D ATA DICTIO NARY #360 -- IB-FB I NTERFACE T RACKING FI LE | |
531 | STORED IN ^IBFB(360, | |
532 | ||
533 | DATA NAME GLOBAL DAT A | |
534 | ELEMENT TI TLE LOCATI ON TYPE | |
535 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------- | |
536 | DD ACCESS : | |
537 | RD ACCESS : | |
538 | WR ACCESS : | |
539 | DEL ACCES S: | |
540 | LAYGO ACC ESS: | |
541 | AUDIT ACC ESS: @ | |
542 | ||
543 | IDENTIFIED BY: PATIE NT (#.02), FB AUTHOR IZATION (# .03) | |
544 | NON-VA CA RE field ( #.33) of t he CLAIMS TRACKING F ile (#356) | |
545 | ||
546 | CROSS REFE RENCED BY: AUTH DELE TION DATE/ TIME (AC), CLAIM NUM BER(AD), E NTRY NUMBE R(B), PATI ENT(C) | |
547 | INDEXED BY : BI QUEUE (BI), REA DY TO BILL (BL), PAT IENT & FB AUTHORIZAT ION | |
548 | (D), INVO ICE NUMBER & FB PAYM ENT INDICA TOR (F), F R QUEUE (F R), | |
549 | IV QUEUE (IV), SC Q UEUE (SC), UR QUEUE (UR) | |
550 | ||
551 | 360,.01 EN TRY NUMBER 0;1 NUMBE R (Require d) | |
552 | INPUT TRA NSFORM: S: $D(X) DINU M=X | |
553 | LAST EDIT ED: DEC 15 , 2015 | |
554 | HELP-PROM PT: Enter an entry n umber. | |
555 | DESCRIPTI ON: This i s the inte rnal entry number to identify | |
556 | the link between cl aims/bills and Fee B asis | |
557 | payments and author izations. | |
558 | TECHNICAL DESCR: Ma nual cross reference s: | |
559 | ; ^IBFB(3 60,"DFN",D FN,DT,IEN, IBLOG)="" Log | |
560 | cross ref erence by Patient | |
561 | ; ^IBFB(3 60,"DT",DT ,DFN,IEN,I BLOG)="" L og | |
562 | cross ref erence by Date | |
563 | NOTES: XX XX--CAN'T BE ALTERED EXCEPT BY PROGRAMME R | |
564 | CROSS-REF ERENCE: 36 0^B | |
565 | 1)= S ^IB FB(360,"B" ,$E(X,1,30 ),DA)="" | |
566 | 2)= K ^IB FB(360,"B" ,$E(X,1,30 ),DA) | |
567 | ||
568 | 360,.02 PA TIENT 0;2 POINTER TO PATIENT F ILE (#2) | |
569 | LAST EDIT ED: DEC 03 , 2015 | |
570 | HELP-PROM PT: Enter a Patient name. | |
571 | DESCRIPTI ON: Patien t name to link autho rizations, payments | |
572 | and claim s/bills. | |
573 | CROSS-REF ERENCE: 36 0^C | |
574 | 1)= S ^IB FB(360,"C" ,$E(X,1,30 ),DA)="" | |
575 | 2)= K ^IB FB(360,"C" ,$E(X,1,30 ),DA) | |
576 | RECORD IN DEXES: D ( #1334) | |
577 | ||
578 | 360,.03 FB AUTHORIZA TION 0;3 N UMBER | |
579 | INPUT TRA NSFORM: K: +X'=X!(X>9 9999999)!( X<1)!(X?.E 1"."1.N) X | |
580 | LAST EDIT ED: DEC 03 , 2015 | |
581 | HELP-PROM PT: Enter a Patient Authorizat ion number . | |
582 | DESCRIPTI ON: Enter an Authori zation IEN to link | |
583 | authoriza tions, pay ments and claims/bil ls. | |
584 | TECHNICAL DESCR: Th is is the Authorizat ion number not a poi nter. | |
585 | It refere nces file 161.01 | |
586 | RECORD IN DEXES: D ( #1334) | |
587 | ||
588 | 360,.04 AU TH DELETIO N DATE/TIM E 0;4 DATE | |
589 | INPUT TRA NSFORM: S %DT="ET" D ^%DT S X= Y K:X<1 X | |
590 | LAST EDIT ED: DEC 03 , 2015 | |
591 | HELP-PROM PT: Enter the date/t ime the Au thorizatio n was | |
592 | deleted. | |
593 | DESCRIPTI ON: This i s the date that an A uthorizati on was | |
594 | deleted c ompletely. Used for tracking p urposes. | |
595 | TECHNICAL DESCR: We 're tracki ng in an A uthorizati on was del eted | |
596 | and there were poin ters to cl aims or bi lls | |
597 | present. | |
598 | CROSS-REF ERENCE: 36 0^AC | |
599 | 1)= S ^IB FB(360,"AC ",$E(X,1,3 0),DA)="" | |
600 | 2)= K ^IB FB(360,"AC ",$E(X,1,3 0),DA) | |
601 | Payment I D cross re ference us ed for lin king FB | |
602 | to IB. | |
603 | ||
604 | 360,.05 FB PAYMENT I NDICATOR 0 ;5 FREE TE XT | |
605 | INPUT TRA NSFORM: K: $L(X)>25!( $L(X)<1) X | |
606 | LAST EDIT ED: DEC 04 , 2015 | |
607 | HELP-PROM PT: Enter a payment indicator | |
608 | DESCRIPTI ON: Fee Ba sis Paymen t indicato r, formatt ed as | |
609 | following : Patient IEN;Vendor IEN;Initi al | |
610 | treatment date IEN; Service pr ovided IEN | |
611 | Example: " 100000;4 55;2;4" | |
612 | TECHNICAL DESCR: Th is represe nts a comp lex pointe r to the F B | |
613 | payment f ile (#162) . Where th e ID could be | |
614 | saved as (for examp le) "165;2 22;1;10". Patient | |
615 | pointer i s 165, ven dor pointe r is 222, Service | |
616 | date is 1 , service provided i s 10. Actu al | |
617 | pointer w ould be: ^ FBAAC(165, 1,222,1,1, 1,10). | |
618 | RECORD IN DEXES: F ( #1335) | |
619 | ||
620 | 360,1.01 C LAIM NUMBE R 1;1 POIN TER TO CLA IMS TRACKI NG FILE (# 356) | |
621 | LAST EDIT ED: DEC 16 , 2015 | |
622 | HELP-PROM PT: Enter a claim ID . | |
623 | DESCRIPTI ON: Enter a Claim ID to assist in linkin g fee basi s | |
624 | authoriza tions and payments t o claims i n file | |
625 | #356. | |
626 | TECHNICAL DESCR: We need a cl aim ID to assist in linking fe e | |
627 | basis aut horization s and thir d party cl aims to | |
628 | payments. Without t his field we lose th e | |
629 | ability t o link 3rd party cla ims to fee basis. | |
630 | CROSS-REF ERENCE: 36 0^AD | |
631 | 1)= S ^IB FB(360,"AD ",$E(X,1,3 0),DA)="" | |
632 | 2)= K ^IB FB(360,"AD ",$E(X,1,3 0),DA) | |
633 | ||
634 | 360,1.02 B ILL/CLAIMS 1;2 POINT ER TO BILL /CLAIMS FI LE (#399) | |
635 | LAST EDIT ED: DEC 03 , 2015 | |
636 | HELP-PROM PT: Enter an existin g Bill for the Patie nt. | |
637 | DESCRIPTI ON: We use this to l ink an exi sting entr y in file | |
638 | #399 to a n existing fee basis authoriza tion and | |
639 | payment. | |
640 | ||
641 | 360,1.03 I NVOICE NUM BER 1;3 PO INTER TO F EE BASIS I NVOICE FIL E (#162.5) | |
642 | LAST EDIT ED: DEC 03 , 2015 | |
643 | HELP-PROM PT: Enter a fee basi s invoice number. | |
644 | DESCRIPTI ON: We nee d to be ab le to link a fee bas is invoice | |
645 | to a clai m/bill and to an exi sting | |
646 | authoriza tion and p ayment. | |
647 | TECHNICAL DESCR: We need a In voice ID t o assist i n linking fee | |
648 | basis aut horization s and clai ms/bills t o | |
649 | payments. | |
650 | RECORD IN DEXES: F ( #1335) | |
651 | ||
652 | 360,1.04 I NTEGRATED BILLING AC TION 1;4 P OINTER TO INTEGRATED BILLING A CTION FILE (#350) | |
653 | LAST EDIT ED: DEC 03 , 2015 | |
654 | HELP-PROM PT: Enter a copaymen t associat ed with th e FB auth | |
655 | DESCRIPTI ON: Enter a first pa rty copay IEN to lin k to a FB | |
656 | Auth and payment. | |
657 | TECHNICAL DESCR: We need a Bi ll ID to a ssist in l inking fee | |
658 | basis aut horization s and firs t party cl aims to | |
659 | payments. Without t his field we lose th e | |
660 | ability t o link 1st party cla ims to fee basis | |
661 | Authoriza tions and payments. | |
662 | ||
663 | 360,2.01 I V QUEUE 2; 1 SET | |
664 | Insurance Verificat ion Precer t Queue | |
665 | 'IV' FOR IV QUEUE; | |
666 | 'XX' FOR REMOVED; | |
667 | LAST EDIT ED: DEC 15 , 2015 | |
668 | HELP-PROM PT: IV Pre cert Queue | |
669 | DESCRIPTI ON: This i s the Insu rance Veri fication | |
670 | Precertif ication Qu eue | |
671 | FIELD IND EX: IV (#1 337) REGUL AR IR LOOK UP & SORTI NG | |
672 | Short Des cr: IV QUE UE | |
673 | Set Logic : S ^IBFB( 360,"IV",$ E(X,1,240) ,DA)="" | |
674 | Kill Logi c: K ^IBFB (360,"IV", $E(X,1,240 ),DA) | |
675 | Whole Kil l: K ^IBFB (360,"IV") | |
676 | X(1): IV QUEUE (360 ,2.01) (Su bscr 1) (L en 240) | |
677 | (forwards ) | |
678 | ||
679 | 360,2.02 U R QUEUE 2; 2 SET | |
680 | RUR Prece rt Queue | |
681 | 'UR' FOR UR QUEUE; | |
682 | 'XX' FOR REMOVED; | |
683 | LAST EDIT ED: DEC 15 , 2015 | |
684 | HELP-PROM PT: UR Pre cert Queue | |
685 | DESCRIPTI ON: This i s the RUR Precertifi cation Que ue | |
686 | FIELD IND EX: UR (#1 339) REGUL AR IR LOOK UP & SORTI NG | |
687 | Short Des cr: UR QUE UE | |
688 | Set Logic : S ^IBFB( 360,"UR",$ E(X,1,240) ,DA)="" | |
689 | Kill Logi c: K ^IBFB (360,"UR", $E(X,1,240 ),DA) | |
690 | Whole Kil l: K ^IBFB (360,"UR") | |
691 | X(1): UR QUEUE (360 ,2.02) (Su bscr 1) (L en 240) | |
692 | (forwards ) | |
693 | ||
694 | 360,2.03 F R QUEUE 2; 3 SET | |
695 | Facility Revenue Bi lling Queu e | |
696 | 'FR' FOR FR QUEUE; | |
697 | 'XX' FOR REMOVED; | |
698 | LAST EDIT ED: DEC 15 , 2015 | |
699 | HELP-PROM PT: FR Bil ling Queue | |
700 | DESCRIPTI ON: This i s the Faci lity Reven ue Billing Queue | |
701 | FIELD IND EX: FR (#1 336) REGUL AR IR LOOK UP & SORTI NG | |
702 | Short Des cr: FR QUE UE | |
703 | Set Logic : S ^IBFB( 360,"FR",$ E(X,1,240) ,DA)="" | |
704 | Kill Logi c: K ^IBFB (360,"FR", $E(X,1,240 ),DA) | |
705 | Whole Kil l: K ^IBFB (360,"FR") | |
706 | X(1): FR QUEUE (360 ,2.03) (Su bscr 1) (L en 240) | |
707 | (forwards ) | |
708 | ||
709 | 360,2.04 S C QUEUE 2; 4 SET | |
710 | RUR Servi ce Connect ed Billing Queue | |
711 | 'SC' FOR SC QUEUE; | |
712 | 'XX' FOR REMOVED; | |
713 | LAST EDIT ED: DEC 15 , 2015 | |
714 | HELP-PROM PT: SC Bil ling Queue | |
715 | DESCRIPTI ON: This i s the RUR Service Co nnected Bi lling Queu e | |
716 | FIELD IND EX: SC (#1 338) REGUL AR IR LOOK UP & SORTI NG | |
717 | Short Des cr: SC QUE UE | |
718 | Set Logic : S ^IBFB( 360,"SC",$ E(X,1,240) ,DA)="" | |
719 | Kill Logi c: K ^IBFB (360,"SC", $E(X,1,240 ),DA) | |
720 | Whole Kil l: K ^IBFB (360,"SC") | |
721 | X(1): SC QUEUE (360 ,2.04) (Su bscr 1) (L en 240) | |
722 | (forwards ) | |
723 | ||
724 | 360,2.05 B I QUEUE 2; 5 SET | |
725 | Billing R eview Queu e | |
726 | 'BI' FOR BI QUEUE; | |
727 | 'XX' FOR REMOVED; | |
728 | LAST EDIT ED: DEC 15 , 2015 | |
729 | HELP-PROM PT: BI Bil ling Queue | |
730 | DESCRIPTI ON: This i s the Bill ing Review Queue | |
731 | FIELD IND EX: BI (#1 332) REGUL AR IR LOOK UP & SORTI NG | |
732 | Short Des cr: BI QUE UE | |
733 | Set Logic : S ^IBFB( 360,"BI",$ E(X,1,240) ,DA)="" | |
734 | Kill Logi c: K ^IBFB (360,"BI", $E(X,1,240 ),DA) | |
735 | Whole Kil l: K ^IBFB (360,"BI") | |
736 | X(1): BI QUEUE (360 ,2.05) (Su bscr 1) (L en 240) | |
737 | (forwards ) | |
738 | ||
739 | 360,3.01 N EXT REVIEW DT 3;1 DA TE | |
740 | Date of n ext RUR pr ecertifica tion revie w | |
741 | INPUT TRA NSFORM: S %DT="E" D ^%DT S X=Y K:X<1 X | |
742 | LAST EDIT ED: DEC 15 , 2015 | |
743 | HELP-PROM PT: (No ra nge limit on date) | |
744 | DESCRIPTI ON: This f ield holds the date of the nex t RUR | |
745 | precertif ication re view. If a date has been | |
746 | entered i n this fie ld, the au thorizatio n will | |
747 | not displ ay on the RUR precer tification work | |
748 | queue unt il the dat e specifie d. | |
749 | ||
750 | 360,3.02 1 ST OR 3RD PTY 3;2 NU MBER | |
751 | First Par ty Copay o r Third Pa rty Insura nce | |
752 | INPUT TRA NSFORM: K: +X'=X!(X>3 )!(X<1)!(X ?.E1"."1.N ) X | |
753 | LAST EDIT ED: DEC 15 , 2015 | |
754 | HELP-PROM PT: First party copa y or third party ins urance | |
755 | DESCRIPTI ON: This f ield indic ates if th e bill is for first | |
756 | party cop ay or thir d party in surance. | |
757 | TECHNICAL DESCR: Fi rst Party Copay = | |
758 | $P(^IBFB( 360,IEN,3) ,"^",2)=1 Third Part y | |
759 | Insurance = $P(^IBF B(360,IEN, 3),"^",2)= 3 | |
760 | ||
761 | 360,4 LOG 4;0 DATE M ultiple #3 60.04 | |
762 | (Add New Entry with out Asking ) | |
763 | ||
764 | 360.04,.01 DATE/TIME 0;1 DATE | |
765 | INPUT TRA NSFORM: S %DT="ESTR" D ^%DT S X=Y K:X<1 X | |
766 | LAST EDIT ED: NOV 05 , 2015 | |
767 | HELP-PROM PT: Enter the date/t ime of the change to the | |
768 | entries. | |
769 | DESCRIPTI ON: Used t o capture the change s to the e ntries in | |
770 | the file, by date a nd time of change. | |
771 | ||
772 | 360.04,.02 EVENT 0;2 FREE TEXT | |
773 | INPUT TRA NSFORM: K: $L(X)>45!( $L(X)<1) X | |
774 | LAST EDIT ED: NOV 05 , 2015 | |
775 | HELP-PROM PT: Enter the event that occur red that w e logged. | |
776 | DESCRIPTI ON: Used t o track wh at kind of event occ urred | |
777 | that we a re trackin g. | |
778 | ||
779 | 360.04,.03 USER 0;3 POINTER TO NEW PERSO N FILE (#2 00) | |
780 | LAST EDIT ED: NOV 05 , 2015 | |
781 | HELP-PROM PT: Enter the user t hat made t he change. | |
782 | ||
783 | FILES POI NTED TO FI ELDS | |
784 | BILL/CLAIM S (#399) B ILL/CLAIMS (#1.02) | |
785 | CLAIMS TRA CKING (#35 6) CLAIM N UMBER (#1. 01) | |
786 | FEE BASIS INVOICE (# 162.5) INV OICE NUMBE R (#1.03) | |
787 | INTEGRATED BILLING A CTION (#35 0) INTEGRA TED BILLIN G ACTION ( #1.04) | |
788 | NEW PERSON (#200) LO G:USER (#. 03) | |
789 | PATIENT (# 2) PATIENT (#.02) | |
790 | ||
791 | INDEX AND CROSS-REFE RENCE LIST -- FILE # 360 | |
792 | ||
793 | File #360 | |
794 | Record In dexes: | |
795 | D (#1334) RECORD RE GULAR IR L OOKUP & SO RTING | |
796 | Short Des cr: Lookup index | |
797 | Set Logic : S ^IBFB( 360,"D",X( 1),X(2),DA )="" | |
798 | Kill Logi c: K ^IBFB (360,"D",X (1),X(2),D A) | |
799 | Whole Kil l: K ^IBFB (360,"D") | |
800 | X(1): PAT IENT (360, .02) (Subs cr 1) (for wards) | |
801 | X(2): FB AUTHORIZAT ION (360,. 03) (Subsc r 2) (forw ards) | |
802 | ||
803 | F (#1335) RECORD RE GULAR IR L OOKUP & SO RTING | |
804 | Short Des cr: Cross reference by invoice and payme nt ID | |
805 | Set Logic : S ^IBFB( 360,"F",X( 1),$E(X(2) ,1,30),DA) ="" | |
806 | Kill Logi c: K ^IBFB (360,"F",X (1),$E(X(2 ),1,30),DA ) | |
807 | Whole Kil l: K ^IBFB (360,"F") | |
808 | X(1): INV OICE NUMBE R (360,1.0 3) (Subscr 1) (forwa rds) | |
809 | X(2): FB PAYMENT IN DICATOR (3 60,.05) (S ubscr 2) ( Len 30) | |
810 | (forwards ) | |
811 | INPUT TEMP LATE(S): | |
812 | PRINT TEMP LATE(S): | |
813 | SORT TEMPL ATE(S): | |
814 | FORM(S)/BL OCK(S): | |
815 | Non-DBMS F iles | |
816 | N/A. There are no no n-DBMS Fil es in use. | |
817 | Data View | |
818 | This proje ct is a Vi stA Integr ated Billi ng patch. We have an Entity Re lationship Diagram ( ERD) as on e of the d eliverable s with thi s project. | |
819 | For a more detailed visual of the VistA data model , refer to the ERD a vailable v ia TSPR he re: http:/ / DNS /warboard/ anotebk.as p?proj=178 6&Type=Act ive | |
820 | Detailed D esign | |
821 | Hardware D etailed De sign | |
822 | N/A. This project is a VistA I ntegrated Billing pa tch. There are no mo dification s to any e xisting ha rdware | |
823 | Software D etailed De sign | |
824 | Conceptual Design | |
825 | Product Pe rspective | |
826 | The VistA Integrated Billing s ystem is a software package th at is bein g modified to intera ct and sha re data wi th the Vis tA Fee Bas is system. Data from NVC autho rizations will be tr acked and made avail able to th e Integrat ed Billing system. | |
827 | User Inter faces | |
828 | User Inter face with all Integr ated Billi ng applica tion softw are is per formed thr ough exist ing and ne w VistA sc reens. Vis tA is a ch aracter-ba sed applic ation acce ssible thr ough termi nal emulat or softwar e resident on networ ked comput ers. | |
829 | The Integr ated Billi ng applica tion is a character- based syst em using V A FileMan as its dat abase mana ger and Ca che/M as t he program ming langu age. This software a pplication is part o f the Vist A suite of applicati ons, which include a dditional clinical a nd financi al applica tions. The re are no GUIs. | |
830 | Hardware I nterfaces | |
831 | Communicat ions betwe en VistA s ites and H IPAA EDI S ervices pa ss through the Local Area Netw orks (LANs ) and acro ss the VA intranet. The Servic es communi cate over the Austin Informati on Technol ogy Center (AITC) LA N and thro ugh the pr ivate fram e relay to the commu nications clearingho use for th is project . The clea ringhouse communicat es with th e trading partner pr ocessors t hat are co ntinually designated using pre viously ne gotiated c ontractual terms and condition s. | |
832 | Software I nterfaces | |
833 | The follow ing softwa re must be installed prior to the releas e of this product. | |
834 | InterSyste ms Mumps V ersion Cac he 2014.1. 3 Ad Hoc 1 4809 | |
835 | VA FileMan Version 2 2.0 | |
836 | VistA Kern el Version 8.0 | |
837 | VistA Mail Man Versio n 8.0 | |
838 | VistA Fee Basis Vers ion 3.5 | |
839 | Vista Inte grated Bil ling Versi on 2.0 | |
840 | Vista Acco unts Recei vable Vers ion 4.5 | |
841 | VistA Regi stration V ersion 5.3 | |
842 | Other tool s utilized during de velopment and testin g: | |
843 | Rational T eam Concer t: Release 6.0 (VA N etwork-wid e version) | |
844 | Communicat ions Inter faces | |
845 | Memory Con straints | |
846 | N/A. There are no me mory const raints ass ociated wi th this pr oject. | |
847 | Special Op erations | |
848 | N/A. There are no sp ecial oper ations ass ociated wi th this pr oject. | |
849 | Product Fe atures | |
850 | Please see Section 1 .1 for a l ist of Sco pe Inclusi ons, Secti on 2.3 for an overvi ew of the significan t function al require ments, and Section 6 .2.2 for a list of a ll of the functional requireme nts. | |
851 | User Chara cteristics | |
852 | In general , the reso urces that shall wor k with Int egrated Bi lling soft ware need to be know ledgeable in the are a of Integ rated Bill ing and, t o a lesser extent, F ee Basis. | |
853 | Dependenci es and Con straints | |
854 | N/A. There are no de pendencies and const raints wit h this pro ject. | |
855 | Specific R equirement s | |
856 | Database R epository | |
857 | This proje ct is a Vi stA patch. The datab ase reposi tory is st andard Vis tA databas e using Fi leMan file s and fiel ds. Any mo dification s to this database r epository are detail ed in Sect ion 6.2.2. 2. | |
858 | System Fea tures | |
859 | The follow ing sub-se ctions of this SDD m atch the s pecific fu nctional r equirement s as prese nted in th e RSD for this proje ct. | |
860 | This table attempts to demonst rate how f unctional requiremen ts from th e Fee-Reve nue Enhanc ements RSD relate to the desig n: | |
861 | Table 5: F unctional Requiremen ts (RSD) v s. Design Elements | |
862 | Requiremen t | |
863 | RSD Functi onal Req I tem # | |
864 | Design Ele ments | |
865 | The system shall hav e the abil ity to rec ord the au thorizatio n and the correspond ing author ization mo dification data in a new VistA file that will allo w the IB s ystem to " point" to the author ization da ta in Fee Basis syst em at the time the a uthorizati on is crea ted. | |
866 | FRFEE-2.1 | |
867 | New trigge r in the F EE BASIS P ATIENT FIL E (#161) w ill log ne w FB auth pointer in to IB-FB I nterface T racking fi le | |
868 | The system shall pro vide the a bility to record aut horization and autho rization m odificatio n data in the IB sys tem that i ncludes: | |
869 | Ordering P hysicianDi agnosis/Pr ocedureDOS Non-VA Loc ationAll A ctive Insu ranceLast Date Insur ance Verif iedType of Service ( NVC)Servic e Connecte d/Special Auth Elig | |
870 | FRFEE-2.1- 01 – FRFEE -2.1-08 | |
871 | New trigge r in the F EE BASIS P ATIENT FIL E (#161) w ill log ne w FB auth pointer in to IB-FB I nterface T racking fi le | |
872 | The system shall hav e the abil ity to int erface (in teract wit h) authori zation and the corre sponding a uthorizati on data to the IB pa ckage to s upport Rev enue pre-c ertificati on. | |
873 | FRFEE-2.2 | |
874 | Nightly Pr ocess #1 w ill identi fy paid in voices and log them in the new IB-FB Int erface Tra cking File These new entries / paid invo ices will display on the main screen of the Facili ty Revenue Queue – B illing Wor klist | |
875 | The system shall pro vide the a bility to transmit a uthorizati on and aut horization modificat ion data t o the IB s ystem that includes: Ordering P hysician | |
876 | Diagnosis/ Procedure | |
877 | DOS | |
878 | Non-VA Loc ation | |
879 | All Active Insurance | |
880 | Last Date Insurance Verified | |
881 | Type of Se rvice (NVC ) | |
882 | Service Co nnected/Sp ecial Auth Elig | |
883 | FRFEE-2.2. 01 - 2.2-0 8 | |
884 | Nightly Pr ocess #1 w ill identi fy paid in voices and log them in the new IB-FB Int erface Tra cking File / Facilit y Revenue Billing Wo rklist Que ue | |
885 | These new entries wi ll display on the ma in screen of the Fac ility Reve nue Queue – Billing Worklist | |
886 | The system shall hav e the abil ity to dis play the a uthorizati on and the correspon ding autho rization d ata (Fee B asis Claim s System [ FBCS] data elements available in VistA F ee) in rea l-time to include an y authoriz ation upda tes in a n ew IB Work list. | |
887 | FRFEE-2.3 | |
888 | Billing Wo rklist and related s creens | |
889 | The system shall pro vide the a bility to display au thorizatio n and auth orization data in IB system vi a Worklist that incl udes the n ame of the ordering physician (NPI #, Ta xonomy Cod e, Last Na me, First Name MI). | |
890 | FRFEE-2.3- 01 | |
891 | Billing Wo rklist - A ction EE – Expand | |
892 | The system shall pro vide the a bility to display au thorizatio n and auth orization data in IB system vi a Worklist that incl udes the D iagnosis/P rocedure f or service s authoriz ed in free text with unlimited character s. | |
893 | FRFEE-2.3- 02 | |
894 | Billing Wo rklist - A ction EE – Expand | |
895 | The system shall pro vide the a bility to display au thorizatio n and auth orization data in IB system vi a Worklist that incl udes the s cheduled d ate of ser vice which include d ate ranges (MM/DD/YY ). | |
896 | FRFEE-2.3- 03 | |
897 | Main Billi ng Worklis t Screen ( DOS Start) Billing Wo rklist - W orklist Ac tion EE – Expand | |
898 | The system shall pro vide the a bility to display au thorizatio n and auth orization data in IB system vi a Worklist that incl udes the n ame of Non -VA locati on (if ava ilable). | |
899 | FRFEE-2.3- 04 | |
900 | Billing Wo rklist - A ction EE - Expand | |
901 | The system shall pro vide the a bility to display au thorizatio n and auth orization data in IB system vi a Worklist that incl udes the b illable in surance in formation on file. | |
902 | FRFEE-2.3- 05 | |
903 | Billing Wo rklist - A ction EE - Expand | |
904 | The system shall pro vide the a bility to display au thorizatio n and auth orization data in IB system vi a Worklist that incl udes the l ast date o f billable insurance verified (MM/DD/YY) . | |
905 | FRFEE-2.3- 06 | |
906 | Billing Wo rklist - A ction EE – Expand | |
907 | The system shall pro vide the a bility to display au thorizatio n and auth orization data in IB system vi a Worklist that incl udes the t ype of ser vice (Now referred t o as NVC – Type of N on-VA Care ). | |
908 | FRFEE-2.3- 07 | |
909 | Main Billi ng Worklis t Screen | |
910 | Billing Wo rklist - A ction EE – Expand | |
911 | The system shall pro vide the a bility to display au thorizatio n and auth orization data in IB system vi a Worklist that incl udes the e xisting sp ecial auth ority and/ or service connected condition s in free text (if a pplicable) . | |
912 | FRFEE-2.3- 08 | |
913 | Billing Wo rklist - A ction EE - Expand | |
914 | The system shall hav e the abil ity to aut omatically alert/not ify specif ied Revenu e users of instances of author ized care for member s with bil lable insu rance usin g a new IB Worklist that has o n demand r efresh cap abilities. | |
915 | FRFEE-2.4 | |
916 | Billing Wo rklist - A ction EE – Expand | |
917 | The system shall hav e the abil ity to tra ck each tr ansmission of author izations a nd authori zation upd ates to th e IB packa ge using t he IB Work list. | |
918 | FRFEE-2.5 | |
919 | Billing Wo rklist - A ction HI – HistoryNe w Report O ption: IB NVC BILLIN G WORKLIST REPORT | |
920 | The system shall pro vide an in terface so once paym ent has be en approve d/issued ( output of VistA Fee Basis), it would cre ate/revise a revisio n of the p aid Non-VA care clai m and push into IB. | |
921 | FRFEE-2.6 | |
922 | Billing Qu eue / Bill ing Workli st - Actio n WA (Comp lete) – Wo rklist Act ions (plac es in auto -bill queu e) | |
923 | Nightly Pr ocess #2 | |
924 | The system shall pro vide the a bility to track deli very of pa id Non-VA care claim s and clai ms updates from Vist A Fee Basi s to the I B package. | |
925 | FRFEE-2.7 | |
926 | IB-FB Inte rface Trac king File, Nightly P rocess #1 | |
927 | The system shall pro vide the a bility to identify u npaid/paid Non-VA ca re claims with the a ppropriate copay eli gibility s tatus, suc h as membe r "co-pay required" in the new IB Workli st. | |
928 | FRFEE-2.8 | |
929 | Billing Wo rklist Act ion EE – E xpand | |
930 | The system shall pro vide the a bility to interface (interact with) Fee Basis with the VistA IB Softwa re (bi-dir ectional) to send NV C payment data on pa id Non-VA claims for first par ty (co-pay ) and thir d party de terminatio n via the new IB wor klist. | |
931 | FRFEE-2.9 | |
932 | IB-FB Inte rface Trac king File, Nightly P rocess #2 | |
933 | The system shall pro vide the a bility to enter time frame para meters whe n generati ng the IB Worklist b ased on pa id date an d date of service. | |
934 | FRFEE-2.10 | |
935 | New Report Option: I B NVC BILL ING WORKLI ST REPORT | |
936 | Nightly Pr ocess #1 | |
937 | The existi ng Means T est Nightl y Compilat ion Job (^ IBAMTC) ca lls the Cl aims Track er - Auto- Enroller ( ^IBTRKR) w hile proce ssing. A n ew process (^IBFBNP1 ) will be added to t he Claims Tracker – Auto-Enrol l jobstrea m. This pr ocess will loop thro ugh newly paid NVC i nvoices an d add them to the IB -FB Interf ace Tracki ng File (# 360) / Fac ility Reve nue Queue of the Bil ling Workl ist. The i nvoices wi ll be furt her catego rized by f irst-party copay and third-par ty insuran ce. This n ew nightly process w ill also t ie NVC Aut horization s and NVC Invoice IE Ns togethe r (in the IB-FB Inte rface Trac king File (#360)) fo r downstre am process ing. | |
938 | Billing W orklist | |
939 | Note: Per VA Policy Analyst de cision (12 /2016), th e IB Billi ng Worklis t Option h as been di sabled, bu t the code will rema in in the patch. | |
940 | This enhan cement see ks to assi st the VAM Cs in admi nistering timely bil ling to fi rst-party copay and third part y payers b y notifyin g appropri ate staff as soon as Non-VA Ca re invoice s are paid . | |
941 | The system shall not ify Facili ty Revenue personnel , Revenue Utilizatio n Review ( RUR) Nurse s (Service Connected and Speci al Authori ty Eligibi lity Revie wers) and Billing pe rsonnel vi a a workli st, when a Non-VA Ca re invoice is paid o n the Vist A NVC “sid e”. | |
942 | IB Billing Worklist process wi ll be as f ollows: | |
943 | Non-VA Car e invoice is paid by VA. | |
944 | Nightly Pr ocess #1 r uns and pl aces invoi ce on the Facility R evenue Que ue of the Billing Wo rklist (FR Queue). | |
945 | The invoic es will be further s eparated i nto First Party and Third Part y Sub-Queu es for the remaining worklist tasks. | |
946 | Facility R evenue per sonnel wil l review t he invoice , using Bi lling Work list link to Claims Tracking t o assist w ith their task of de termining if the NVC invoice s hould be r emoved fro m the work list or pr oceed with RUR-SC an d/or Billi ng Worklis t review. | |
947 | Facility R evenue per sonnel wil l deem the ir review of the inv oice “Comp lete” or e lect to “R emove” the item from the billi ng process , via Work list Actio n. | |
948 | If “Remove ” action i s undertak en by Faci lity Reven ue personn el, invoic e is logge d in the I B-FB Inter face Track ing File ( #360) hist orical log ging secti on (to be used for r eporting) and remove d from the Facility Revenue Qu eue and th e overall Billing Wo rklist. | |
949 | If “Comple te” action is select ed by Faci lity Reven ue personn el, invoic e is logge d, removed from the Facility R evenue Que ue and dis played on the RUR – SC/SA Queu e of the B illing Wor klist (SC Queue) if the Vetera n has SC/S A eligibil ity or the Billing Q ueue of th e Billing Worklist ( BI Queue) if the Vet eran does not have S C/SA eligi bility. | |
950 | An RUR Nur se will re view the i nvoice for Service C onnected a nd Special Authority care/trea tment via Worklist l inks to Cl aims Track ing. | |
951 | The RUR Nu rse may de em that bi lling can proceed (n o Service Connected or Special Authority Eligibili ty) by usi ng Worklis t Action “ Complete”. If the RU R Nurse de ems that c are/treatm ent was Se rvice Conn ected or S pecial Aut hority, th ey will el ect to “Re move” the invoice fr om the RUR – SC/SA Q ueue and t he overall Billing W orklist. | |
952 | If “Comple te” option was selec ted by the RUR Nurse , the invo ice is rec orded in a log file (with an o ptional RU R status m essage), r emoved fro m the RUR- SC/SA Queu e, and pla ced in the Billing Q ueue. | |
953 | If “Remove ” option w as selecte d by the R UR Nurse, the invoic e is recor ded in a l og file (w ith option al RUR sta tus messag e), remove d from RUR -SC/SA que ue and rem oved from the Billin g Worklist . | |
954 | Billing pe rsonnel wi ll review invoices o n the Bill ing Queue of the Bil ling Workl ist (BI Qu eue). | |
955 | Billing pe rsonnel wi ll do a fi nal review of any in voices tha t have pro gressed to their que ue – They may opt to use Workl ist links to Claims Tracking t o assist w ith their task of de termining whether or not the i nvoice sho uld procee d with NVC billing. | |
956 | If Billing personnel deem that the invoi ce review is “Comple te”, a bil l will be created. T he bill wi ll be acce ssible fro m the “Ent er/Edit Bi lling Info rmation” V istA Optio n. | |
957 | If Billing personnel deem that they shou ld “Remove ” the invo ice from t he billing process, the invoic e will be logged wit h an appro priate mes sage and r emoved fro m the Bill ing Queue of the Bil ling Workl ist. | |
958 | Please Not e: The Fac ility Reve nue / RUR- SC/SA / Bi lling Work list proce ss is a me thod of tr acking and handling workflow. It was des igned to n otify and assist the three dep artments ( Facility R evenue, RU R-SC/SA an d Billing) with thei r daily ta sks. The q ueuing pro cess will always pro gress from Facility Revenue to Billing, UNLESS an invoice is removed b y one of t he departm ents (deem ed not bil lable). If the final review by Billing d eems that the invoic e should i ndeed be b illed (to either fir st party c opay or th ird party insurance) , a bill w ill be cre ated. | |
959 | There is a Worklist History Ac tion that will provi de a means to view W orklist au thorizatio n actions, as well a s date/tim e and user . A report was writt en to disp lay past w orklist ac tivities f rom the wo rklist log . The Vist A Option f or the new report is : IB NVC B ILLING WOR KLIST REPO RT | |
960 | Design El ement Tabl es | |
961 | Routines ( Entry Poin ts) | |
962 | Table 6: ( Grouping): Routines | |
963 | Routines | |
964 | Activities | |
965 | Routine Na me | |
966 | ^IBFBUTIL – IB FB Ut ilitiesNot e: This ro utine cont ains the “ Trigger” c ode that l ogs new Vi stA author izations i nto the IB -FB Interf ace Tracki ng File (# 360), as w ell as som e other IB FB utilit ies. | |
967 | Enhancemen t Category | |
968 | New | |
969 | Modify | |
970 | Delete | |
971 | No Change | |
972 | RTM | |
973 | FRFEE-2.1, FRFEE-2.1 -01 throug h FRFEE-2. 1-08 | |
974 | Related Op tions | |
975 | IB BILLING WORKLIST | |
976 | ||
977 | Related Ro utines | |
978 | Routines “ Called By” | |
979 | Routines “ Called” | |
980 | ||
981 | DEMOS^IBFB WL1BLD^IBF BWL2 | |
982 | N/A | |
983 | ||
984 | Routines | |
985 | Activities | |
986 | Data Dicti onary (DD) Reference s | |
987 | FEE BASIS PATIENT FI LE AUTHORI ZATION SUB FILE (#16 1.01) | |
988 | IB-FB INTE RFACE TRAC KING FIL E (#360)FEE BASIS PROG RAM FILE ( #161.8)FEE BASIS PAY MENT FILE (#162) | |
989 | FEE BASIS PHARMACY I NVOICE FIL E (#162.1) | |
990 | FEE BASIS INVOICE FI LE (#162.5 ) | |
991 | Related Pr otocols | |
992 | None | |
993 | Related In tegration Control Re gistration s (ICRs) | |
994 | In process | |
995 | Data Passi ng | |
996 | Input | |
997 | Output Re ference | |
998 | Both | |
999 | Global Re ference | |
1000 | Local | |
1001 | Input Attr ibute Name and Defin ition | |
1002 | Name: None | |
1003 | Definition : None | |
1004 | Output Att ribute Nam e and Defi nition | |
1005 | Name: None | |
1006 | Definition : None | |
1007 | ||
1008 | Current Lo gic | |
1009 | New Routin e | |
1010 | ||
1011 | Modified L ogic (Chan ges are hi ghlighted) | |
1012 | IBFBUTIL ; ALB/RED - API for ED I-CPAC (IB *2.0*554) ;10/01/15 | |
1013 | ;;2.0;INT EGRATED BI LLING;**55 4**;OCT 15 , 2015;Bui ld 3 | |
1014 | ;Per VA D irective 6 402, this routine sh ould not b e modified . | |
1015 | ; | |
1016 | ; Integra tion Agree ments | |
1017 | ; 10000 N OW^%DTC | |
1018 | ; 2053 UP DATE^DIE | |
1019 | ; | |
1020 | Q ; Routi ne cannot be called directly | |
1021 | ; | |
1022 | ;Special note: We a re creatin g and usin g a few ne w global n odes in fi l. | |
1023 | ; If they are defin ed in FM w e lose con trol over them, and a re-index . | |
1024 | ; They on ly exist a s temporar y flags fo r our work list func tionality. | |
1025 | ; | |
1026 | ; ^IBFB(3 60,"DFN",D FN,DT,IEN, IBLOG)="" Log cross reference by Patient | |
1027 | ; ^IBFB(3 60,"DT",DT ,DFN,IEN,I BLOG)="" L og cross r eference b y Date | |
1028 | ; | |
1029 | EVENT(DFN) ; IB*2.0* 554 | |
1030 | ;Input: D FN | |
1031 | ;Output: none | |
1032 | N DIKIEN, AUTH,IENS, IBFBDT,FDA ,IBIENS,IB EVENT,IBLO G,IBMOD,DE LFLG,IENRO ON | |
1033 | S (IEN,DI KIEN,IENS) =0 | |
1034 | S DELFLG= $G(D) ;Kil l entry fl ag | |
1035 | I $G(DA)' ="",DA'=DF N S AUTH=D A | |
1036 | I $G(AUTH )="",$G(D1 )'="" S AU TH=D1 | |
1037 | S DK=$G(D K) | |
1038 | I 'DK,$G( DIVAL)="" S:$G(DIVAL UE)'="" DI VAL=DIVALU E ;(From D ate verif) | |
1039 | Q:'$G(DFN ) | |
1040 | Q:'$G(AUT H) | |
1041 | S IBFBDT= $$NOW^XLFD T() ;Used for date/t ime | |
1042 | ;Add entr y into IBF B TRACKING file (#36 0) | |
1043 | S IBIENS= "+1,",IENS =$P(^IBFB( 360,0),U,3 )+1 | |
1044 | ;For dele ted Auth's remove a few entrie s and set a delete d ate | |
1045 | I DELFLG D | |
1046 | . K FDA | |
1047 | . S DIKIE N=$O(^IBFB (360,"D",D FN,AUTH,0) ) Q:DIKIEN ="" | |
1048 | . S FDA(3 60,DIKIEN_ ",",.03)=" @",FDA(360 ,DIKIEN_", ",.04)=IBF BDT ;If Au s | |
1049 | . K ^IBFB (360,"IV", DIKIEN) | |
1050 | ;Add/edit | |
1051 | I 'DELFLG D | |
1052 | . K FDA | |
1053 | . S FDA(3 60,IBIENS, .01)=IENS, FDA(360,IB IENS,.02)= DFN,FDA(36 0,IBIENS,. 0T | |
1054 | . S IENRO OT="" ; Ad ding new e ntry) | |
1055 | I 'DELFLG D UPDATE^ DIE("","FD A","IENROO T") | |
1056 | I DELFLG D UPDATE^D IE("","FDA ") | |
1057 | S IEN=+$G (IENROOT(1 )) | |
1058 | I 'IEN,$G (DIKIEN)'= "" S IEN=$ G(DIKIEN) | |
1059 | Q:'IEN | |
1060 | D ;SET LOG FILE ENTR IES | |
1061 | . K FDA N IENROOT S IENROOT="" | |
1062 | . S FDA(36 0.04,"+1," _IEN_",",. 01)=IBFBDT ,FDA(360.0 4,"+1,"_IE N_",",.03) Z | |
1063 | . S IBMOD= 0,IBLOG=$P ($G(^IBFB( 360,IENS,4 ,0)),U,3) | |
1064 | . I IBLOG' ="" S IBMO D=1 | |
1065 | . S IBEVEN T=$S(DELFL G:"Auth de leted",IBM OD=0:"Auth log-IV qu eue",1:"Au ) | |
1066 | . S FDA(36 0.04,"+1," _IEN_",",. 02)=IBEVEN T | |
1067 | . D UPDATE ^DIE("","F DA","IENRO OT") | |
1068 | ;LOG ENTRY AND CROSS REFERENCE S | |
1069 | I 'DELFLG S IEN=IENR OOT(1) D | |
1070 | . ;Set IEN in IV fie ld/cross-r eference | |
1071 | . K FDA | |
1072 | . S FDA(36 0,IEN_",", 2.01)="IV" | |
1073 | . D UPDATE ^DIE("","F DA") | |
1074 | ; These ca nnot easil y be set i n FM, we d on't have a date and we can't N | |
1075 | S LOGIEN=0 ,LOGIEN=$P (^IBFB(360 ,IEN,4,0), U,3) | |
1076 | S ^IBFB(36 0,"DFN",DF N,IBFBDT,I EN,LOGIEN) ="",^IBFB( 360,"DT",I BFBDT,DFN, " | |
1077 | Q | |
1078 | ; | |
1079 | GETAUTH(IE NS,AUTHARR ) ; API to call Auth orization Data | |
1080 | D GETS^DIQ (161.01,IE NS,".01;.0 2;.021;.03 ;.04;.055; .06;.065;. 07;.08;.08 ) | |
1081 | Q | |
1082 | ; | |
1083 | GETST(IEN) ; Get Sta rt Date us ing Invoic e | |
1084 | N IBFLDS,I BINIEN,IBI NLN1,IBFPN O1 | |
1085 | S IBINV=$$ GET1^DIQ(3 60,IEN_"," ,1.03,"I") ; Invoice # | |
1086 | S IBFPNO=$ $GET1^DIQ( 161.01,IBI EN_",",.03 ,"I") ; NV C IEN (Typ e) on FEE) | |
1087 | ; For Bill ing Workli st Only, N VC may hav e changed -- Check F ee Basis P ) | |
1088 | I IBINV'=" " D | |
1089 | . S IBINIE N=$O(^FBAA C("C",IBIN V,DFN,"")) | |
1090 | . S IBINLN 1=$O(^FBAA C("C",IBIN V,DFN,IBIN IEN,"")) | |
1091 | . S IBINLN 2=$O(^FBAA C("C",IBIN V,DFN,IBIN IEN,IBINLN 1,"")) | |
1092 | . S IBFPNO 1=$$GET1^D IQ(162.03, IBINLN2_", "_IBINLN1_ ","_IBINIE N_","_DFN_ ) | |
1093 | . S IBFPNO T=$$GET1^D IQ(162.03, IBINLN2_", "_IBINLN1_ ","_IBINIE N_","_DFN_ ) | |
1094 | . I $G(IBF PNOT)'="" S IBFP=IBF PNOT | |
1095 | . S IBST=$ $GET1^DIQ( 162.02,IBI NLN1_","_I BINIEN_"," _DFN_","," .01","I") e | |
1096 | . I IBST=" ",IBFPNO=3 D | |
1097 | .. S IBRX= 0 | |
1098 | .. F S IBR X=$O(^FBAA (162.1,IBI NV,"RX",IB RX)) Q:IBR X="" D | |
1099 | ... S IBST =$$GET1^DI Q(162.11,I BRX_","_IB INV,2,"I") ; Fill Da te | |
1100 | Q | |
1101 | ; | |
1102 | GETPAY(IEN ) ; Get NV C Payment Data using Invoice | |
1103 | N IBFLDS,I BINIEN,IBI NLN1,IBINL N2,IBFPNO1 | |
1104 | S IBINV=$$ GET1^DIQ(3 60,IEN_"," ,1.03,"I") ; Invoice # | |
1105 | S IBFPNO=$ $GET1^DIQ( 161.01,IBI EN_",",.03 ,"I") ; NV C IEN (Typ e) on FEE) | |
1106 | ; For Bill ing Workli st Only, N VC may hav e changed -- Check F ee Basis P ) | |
1107 | I IBINV'=" " D | |
1108 | . S IBINIE N="" | |
1109 | . S IBINIE N=$O(^FBAA C("C",IBIN V,DFN,IBIN IEN)) Q:IB INIEN="" D | |
1110 | .. S IBINL N1="" | |
1111 | .. S IBINL N1=$O(^FBA AC("C",IBI NV,DFN,IBI NIEN,IBINL N1)) Q:IBI NLN1="" D | |
1112 | ... S IBIN LN2="" | |
1113 | ... S IBIN LN2=$O(^FB AAC("C",IB INV,DFN,IB INIEN,IBIN LN1,IBINLN 2)) Q:IBIN D | |
1114 | .... S IBF PNO1=$$GET 1^DIQ(162. 03,IBINLN2 _","_IBINL N1_","_IBI NIEN_","_D ) | |
1115 | .... I $G( IBFPNO1)'= "" S IBFPN O=IBFPNO1 | |
1116 | .... S IBF LDS="2;63; 64;65" | |
1117 | .... D GET S^DIQ(162. 03,IBINLN2 _","_IBINL N1_","_IBI NIEN_","_D FN_",",IBF | |
1118 | Q | |
1119 | ; | |
1120 | CHKBILL(IB IN) ;Check for prior bill | |
1121 | N IBINV,I BFBDT,IBCL M,IBFBAU | |
1122 | S IBINV=$ TR(IBIN," ","") | |
1123 | S IBFBDT= "" | |
1124 | F S IBFBD T=$O(^IBFB (360,"DFN" ,DFN,IBFBD T)) Q:IBFB DT="" D | |
1125 | . S IBFBA U="" | |
1126 | . F S IBF BAU=$O(^IB FB(360,"DF N",DFN,IBF BDT,IBFBAU )) Q:IBFBA U="" D | |
1127 | .. I $P($ G(^IBFB(36 0,IBFBAU,1 )),U,3)=IB INV D | |
1128 | ... S IBC LM=$$GET1^ DIQ(360,IB FBAU_",",1 .01,"I") | |
1129 | ... I IBC LM'="" S F BINAU=$$PR ECRT^IBTRC 1(IBCLM,18 ) | |
1130 | ... S FBB ILL=$$GET1 ^DIQ(360,I BFBAU_",", 1.02,"I") | |
1131 | ... I FBB ILL'="" S FBSKIP=1 | |
1132 | Q | |
1133 | ; | |
1134 | GETDTS(IBI EN) ;Get B egin and E nd Dates f rom Author ization | |
1135 | S IBST=$$ GET1^DIQ(1 61.01,IBIE N_",",.01, "I") | |
1136 | S IBEND=$ $GET1^DIQ( 161.01,IBI EN_",",.02 ,"I") | |
1137 | Q | |
1138 | ; | |
1139 | ||
1140 | ||
1141 | Routines | |
1142 | Activities | |
1143 | Routine Na me | |
1144 | ^IBFBNP1 – FB to IB Interactio n Nightly Process #1 | |
1145 | ||
1146 | This proce ss loops t hrough pai d invoices from NVC providers and | |
1147 | sets up th e IB Billi ng Worklis t – Facili ty Revenue Queue for first par ty and thi rd party s ervices. | |
1148 | ||
1149 | Enhancemen t Category | |
1150 | New | |
1151 | Modify | |
1152 | Delete | |
1153 | No Change | |
1154 | RTM | |
1155 | FRFEE-2.2, FRFEE-2.2 .01 - 2.2- 08, FRFEE- 2.7 | |
1156 | Related Op tions | |
1157 | IB MT NIGH T COMP – N ote: Due t o VA Polic y Analyst Decision 1 2/2016, th e nightly process wi ll not be run via ca ll from ^I BCD. | |
1158 | ||
1159 | Routines | |
1160 | Activities | |
1161 | Data Dicti onary (DD) Reference s | |
1162 | IB-FB INTE RFACE TRAC KING FILE (#360)INTE GRATED BIL LING ACTIO N FILE (#3 50) | |
1163 | IB SITE PA RAMETERS ( #350.9) | |
1164 | VA FORM 10 -7078 FILE (#162.4) | |
1165 | FEE BASIS PAYMENT FI LE (#162) | |
1166 | ||
1167 | Related Pr otocols | |
1168 | None | |
1169 | Related In tegration Control Re gistration s (ICRs) | |
1170 | In process | |
1171 | Data Passi ng | |
1172 | Input | |
1173 | Output Re ference | |
1174 | Both | |
1175 | Global Re ference | |
1176 | Local | |
1177 | Input Attr ibute Name and Defin ition | |
1178 | Name: None | |
1179 | Definition : None | |
1180 | Output Att ribute Nam e and Defi nition | |
1181 | Name: None | |
1182 | Definition : None | |
1183 | ||
1184 | Current Lo gic | |
1185 | New Routin e | |
1186 | ||
1187 | Modified L ogic (Chan ges are hi ghlighted) | |
1188 | IBFBNP1 ;A LB/RED- ED I-CPAC bui ld 1st and 3rd party copayment s ;10/01/1 5 | |
1189 | ;;2.0;INTE GRATED BIL LING;**554 **;OCT 15, 2015;Buil d 3 | |
1190 | ;;Per VA D irective 6 402, this routine sh ould not b e modified . | |
1191 | ; | |
1192 | ; Integrat ion Agreem ents | |
1193 | ; 10000 NO W^%DTC | |
1194 | ; 2053 UPD ATE^DIE | |
1195 | ; 2171 - $ $STA^XUAF4 | |
1196 | ; $$CATC^F BPCR | |
1197 | ; MKARRLTC ^FBPCR4 | |
1198 | ; FPINPT^I BEFURF | |
1199 | ; FPOPV^IB EFURF | |
1200 | ; $$INSURE D^IBCNS1 | |
1201 | ; | |
1202 | Q | |
1203 | NRUN(IBSTD T) ; main entry poin t - nightl y run job to look at existing FB paymen0 | |
1204 | ;Start by looking fo r recent F B payments | |
1205 | ; Input is start dat e (FM form at), defau lts to tod ay-1 | |
1206 | ; | |
1207 | N IBVEN,IB SERVDT,IBC ATC,IBSITE ,IBMTC,FBA RRLTC,IBDT PD,IBDUZ,I BREC,IBREC L | |
1208 | N IBBILL,I BCLAIM,IBF BDT,IBIENS ,IBLOG,IEN ROOT,IENS, IBSERV,FRS TPRT,IBFBI Y | |
1209 | S IBSTDT=$ G(IBSTDT)\ 1 | |
1210 | I IBSTDT'? 7N S IBSTD T="" | |
1211 | S FBARRLTC ="" D MKAR RLTC^FBPCR 4 ;build a rray neede d later fo r POV in y | |
1212 | S (IBCATC, IBMTC,FRST PRT)=0 ;(C AT C FLAG and IBMTC = Determin e if patie | |
1213 | ; | |
1214 | D SITE^FBA ACO S IBSI TE=$P(FBSI TE(1),U,3) | |
1215 | ;S IBN=$$P T^IBEFUNC( IBDFN) D U TIL^IBCA3, UTIL^IBOA3 2 ; check for allJ | |
1216 | I IBSTDT=" " S IBSTDT =$P(^IBE(3 50.9,1,0), U,6)\1 ; s et to last tn | |
1217 | F S IBSTDT =$O(^FBAAC ("AK",IBST DT)) Q:'IB STDT D PAY MT | |
1218 | Q | |
1219 | PAYMT ; | |
1220 | N IBAUTH,I BPOV,IBINV | |
1221 | S (DFN,IBP OV,IBINV,I BDOS,IBCAR ETY)=0 F S DFN=$O(^F BAAC("AK", IBSTDT,DFD | |
1222 | . S IBVEN= 0 F S IBVE N=$O(^FBAA C("AK",IBS TDT,DFN,IB VEN)) Q:'I BVEN D | |
1223 | .. S IBSER VDT=0 F S IBSERVDT=$ O(^FBAAC(" AK",IBSTDT ,DFN,IBVEN ,IBSERVDTD | |
1224 | ... S IBSE RV=0 F S I BSERV=$O(^ FBAAC("AK" ,IBSTDT,DF N,IBVEN,IB SERVDT,IBD | |
1225 | .... ; Set the tempo rary payme nt array t o service date and t he zero no V | |
1226 | .... Q:$G( ^FBAAC(DFN ,1,IBVEN,1 ,IBSERVDT, 1,IBSERV,0 ))="" ; qu d | |
1227 | .... Q:$G( ^FBAAC(DFN ,1,IBVEN,1 ,IBSERVDT, 1,IBSERV," FBREJ"))]" " ;paymend | |
1228 | .... S IBD TPD=$$GET1 ^DIQ(162.0 3,IBSERV_" ,"_IBSERVD T_","_IBVE N_","_DFN_ ) | |
1229 | .... Q:'IB DTPD ; qui t if the d ate paid i s NULL/Emp ty | |
1230 | .... S IBD OS=$$GET1^ DIQ(162.02 ,IBSERVDT_ ","_IBVEN_ ","_DFN_", ",.01,"I") | |
1231 | .... S IBA UTH=$$GET1 ^DIQ(162.0 3,IBSERV_" ,"_IBSERVD T_","_IBVE N_","_DFN_ 4 | |
1232 | .... S IBT YP=$$GET1^ DIQ(162.03 ,IBSERV_", "_IBSERVDT _","_IBVEN _","_DFN_" e | |
1233 | .... S IBI NV=$$GET1^ DIQ(162.03 ,IBSERV_", "_IBSERVDT _","_IBVEN _","_DFN_" ) | |
1234 | .... Q:'IB INV ;Quit if there i s no Invoi ce for thi s record | |
1235 | .... S IBC ARETY=$$GE T1^DIQ(162 .03,IBSERV _","_IBSER VDT_","_IB VEN_","_DF 8 | |
1236 | .... I "^2 ^3^6^7^"'[ IBCARETY Q ;Fee Prog ram catego ries | |
1237 | .... S IBP OV=$$GET1^ DIQ(162.03 ,IBSERV_", "_IBSERVDT _","_IBVEN _","_DFN_" ) | |
1238 | .... Q:'IB POV | |
1239 | .... S IBC ATC=$$CATC ^FBPCR(DFN ,IBDOS,IBP OV) ;deter mine 3rd p arty copas | |
1240 | .... S IBF BINS=$$INS URED^IBCNS 1(DFN,IBDO S) ; Check for activ e insurane | |
1241 | .... D ADM IT,CHKOTPT ,FILE | |
1242 | Q | |
1243 | ; | |
1244 | ADMIT ; ch eck for in patient 1s t party bi lls | |
1245 | Q:$G(IBAD MDT)="" | |
1246 | S IBBILL= 0 | |
1247 | K ^TMP("I BRBF",$J) ; kill of temp globa l before c all | |
1248 | D FPINPT^ IBEFURF(DF N,IBADMDT) | |
1249 | S IBBILL= $O(^TMP("I BRBF",$J," FP",0)) | |
1250 | K ^TMP("I BRBF",$J) | |
1251 | Q | |
1252 | ; | |
1253 | ; | |
1254 | FILE ; che ck payment against f ile #360 | |
1255 | ; | |
1256 | N FDA,IBE DIT,IBRECZ ,IBOAUTH,I BOCLM,IBOB ILL,IBFLAG | |
1257 | S (IBOAUT H,IBEDIT,I BREC,IBFLA G,IENS,IBC LAIM)=0,IB BILL=$G(IB BILL) | |
1258 | I $G(IBAU TH)="" S I BAUTH="0" | |
1259 | ; check t o see if t he patient has that invoice, i d | |
1260 | I IBINV,$ D(^IBFB(36 0,"F",DFN, IBINV)) S IBREC=$O(^ IBFB(360," F",DFN,IBI Nd | |
1261 | ; | |
1262 | ; check t o see if t here is a record exi sting with y | |
1263 | I 'IBAUTH ,$D(^IBFB( 360,"C",DF N)) D | |
1264 | . S IBREC Z=0 ; set a temporar y record n umber to c heck again st f | |
1265 | . F S IBR ECZ=$O(^IB FB(360,"C" ,DFN,IBREC Z)) Q:IBRE CZ="" D | |
1266 | .. S IBOC LM=$P($G(^ IBFB(360,I BRECZ,1)), U) ;Claim IEN exists for this d | |
1267 | .. S IBOB ILL=$P($G( ^IBFB(360, IBRECZ,1)) ,U,4) ; Bi ll IEN exi sts for th d | |
1268 | .. I IBOC LM!IBOBILL S IBREC=I BRECZ,IBRE CZ="a" Q ; Found a re cord to ed t | |
1269 | .. Q | |
1270 | ; | |
1271 | I ('FRSTP RT&'IBFBIN S)!('IBCAT C&'IBFBINS ) Q ; Quit if no ins urance any | |
1272 | ; | |
1273 | ||
1274 | ; edit an existing record | |
1275 | I IBREC D | |
1276 | . K FDA | |
1277 | . S IBCLA IM=+$$GET1 ^DIQ(360,I BREC_",",1 .01,"I") | |
1278 | . ; D STU B ;check/c reate stub record in file #356 | |
1279 | . I $$GET 1^DIQ(360, IBREC_",", 1.03,"I")= "" S FDA(3 60,IBREC_" ,",1.03)=$ Gr | |
1280 | . I $$GET 1^DIQ(360, IBREC_",", .05,"I")=" " S FDA(36 0,IBREC_", ",.05)=IBD Oe | |
1281 | . I IBBIL L,$$GET1^D IQ(360,IBR EC_",",1.0 4,"I")="" S FDA(360, IBREC_",", 1n | |
1282 | . I IBCLA IM,$$GET1^ DIQ(360,IB REC_",",1. 01,"I")'=I BCLAIM S F DA(360,IBR Er | |
1283 | . I $$GET 1^DIQ(360, IBREC_",", 2.03,"I")= "" S FDA(3 60,IBREC_" ,",2.03)=" Fe | |
1284 | . Q:'$D(F DA) | |
1285 | . S IBFLA G=1 ; flag used for log file | |
1286 | . D UPDAT E^DIE(""," FDA") | |
1287 | . I 'IBCA TC S IBBIL L=$$GET1^D IQ(360,IBR EC_",",1.0 4,"I") I I BBILL D SE TT | |
1288 | .; | |
1289 | ; | |
1290 | ; | |
1291 | I 'IBREC D | |
1292 | . K FDA,I ENROOT | |
1293 | . S IBFLA G=1 ; flag used for log file | |
1294 | . S IBIEN S="+1,",IE NS=$P(^IBF B(360,0),U ,3)+1 | |
1295 | . S FDA(3 60,IBIENS, .01)=IENS, FDA(360,IB IENS,.02)= $G(DFN),FD A(360,IBIE N) | |
1296 | . S FDA(3 60,IBIENS, 1.03)=$G(I BINV),FDA( 360,IBIENS ,.05)=IBDO S ;Invoice e | |
1297 | . I IBBIL L S FDA(36 0,IBIENS,1 .04)=IBBIL L ;1st Par ty Co-pay - Admissio n | |
1298 | . I OTPTB IL S FDA(3 60,IBIENS, 1.04)=OTPT BIL ;1st P arty Co-pa y - outpt | |
1299 | . S FDA(3 60,IBIENS, 2.03)="FR" ;Set faci lity reven ue worklis t queue | |
1300 | . S (IENR OOT,IENROO T(1))="" ; adding ne w entry) | |
1301 | . D UPDAT E^DIE(""," FDA","IENR OOT") | |
1302 | . I IENRO OT(1)'="" S IBREC=IE NROOT(1) | |
1303 | . ; D STU B K FDA | |
1304 | . S FDA(3 60,IBREC_" ,",1.01)=I BCLAIM | |
1305 | . D UPDAT E^DIE(""," FDA") | |
1306 | I IBREC,' FRSTPRT D | |
1307 | . Q:$P($G (^IBFB(360 ,IBREC,3)) ,U,2)=3 | |
1308 | . K FDA | |
1309 | . S IBFLA G=1 ; flag used for log file | |
1310 | . S FDA(3 60,IBREC_" ,",3.02)=3 | |
1311 | . D UPDAT E^DIE(""," FDA") | |
1312 | ; | |
1313 | I FRSTPRT D | |
1314 | . Q:$P($G (^IBFB(360 ,IBREC,3)) ,U,2)=1 | |
1315 | . K FDA | |
1316 | . S IENRO OT="",IBFL AG=1 ; fla g used for log file | |
1317 | . S FDA(3 60,IBREC_" ,",3.02)=1 | |
1318 | . D UPDAT E^DIE(""," FDA","IENR OOT") | |
1319 | ; | |
1320 | I IBBILL! (OTPTBIL) D ; set po inter for Inpt or ou tpt y | |
1321 | . I IBBIL L Q:$P(^IB (IBBILL,0) ,U,23)=IBR EC ; exist s and vali d | |
1322 | . I OTPTB IL Q:$P(^I B(OTPTBIL, 0),U,23)=I BREC | |
1323 | . K FDA | |
1324 | . S IBFLA G=1 ; flag used for log file | |
1325 | . S FDA(3 50,IBBILL_ ",",.23)=I BREC ; set Non-Va Ca re value t o the p0 | |
1326 | . D UPDAT E^DIE(""," FDA") | |
1327 | ; | |
1328 | LOG ; set log (audit ) file ent ries | |
1329 | N FDA,IBE VENT,IBMOD ,IBDUZ | |
1330 | Q:'IBFLAG ;No chang es were ma de | |
1331 | D NOW^%DT C S IBFBDT =% | |
1332 | S IBMOD=0 ,IBDUZ=$G( DUZ) I $G( IBDUZ)="" S IBDUZ=". 5" ; Set u ser to pos ) | |
1333 | S FDA(360 .04,"+1,"_ IBREC_",", .01)=IBFBD T,FDA(360. 04,"+1,"_I BREC_",",. 0) | |
1334 | S IBMOD=0 ,IBLOG=$P( $G(^IBFB(3 60,IBREC,4 ,0)),U,3)+ 1 | |
1335 | I IBLOG=" " S IBMOD= 1 | |
1336 | S IBEVENT =$S(IBMOD= 0:"Auth lo g-FR queue ",1:"Auth mod-FR que ue"),FDA(3 6T | |
1337 | D UPDATE^ DIE("","FD A") | |
1338 | Q | |
1339 | ; | |
1340 | STUB ; loo k for thir d party cl aim pointe r in file #356 | |
1341 | ; | |
1342 | K IENROOT | |
1343 | I IBCLAIM ,$$GET1^DI Q(360,IBRE C_",",1.03 ,"I")'=IBI NV S IBCLA IM=0 ;1 in m | |
1344 | I IBCLAIM ,$D(^IBFB( 360,"AD",I BCLAIM)),$ O(^IBFB(36 0,"AD",IBC LAIM,0))'= Id | |
1345 | I 'IBCLAI M!($$GET1^ DIQ(356,IB CLAIM_",", .33,"I")=" ") D Q ; i n) | |
1346 | . K FDC,Z IENS,ZIEN | |
1347 | . I 'IBCL AIM S ZIEN S="+1,",ZI EN=$P(^IBT (356,0),U, 3)+1,IENRO OT="" D | |
1348 | .. S FDC( 356,ZIENS, .01)=IBSIT E_ZIEN,FDC (356,ZIENS ,.02)=DFN ;IEN and P t | |
1349 | .. S FDC( 356,ZIENS, .06)=IBDOS ,FDC(356,Z IENS,.2)=1 ;Date of service an e | |
1350 | . ;Edit a n existing claim wit h no point er | |
1351 | . I IBCLA IM S ZIENS =IBCLAIM_" ," | |
1352 | . S FDC(3 56,ZIENS,. 33)=IBREC ;Link back to file # 360 (IB-FB INTERFACE ) | |
1353 | . I IBCAR ETY D | |
1354 | .. I IBCA RETY=2 S F DC(356,ZIE NS,.18)=6 Q ;Outpati ent | |
1355 | .. I IBCA RETY=3 S F DC(356,ZIE NS,.18)=8 Q ;Pharmac y | |
1356 | .. I IBCA RETY=6!(IB CARETY=7) S FDC(356, ZIENS,.18) =7 Q ;Inpa tient | |
1357 | . I IBCLA IM D UPDAT E^DIE(""," FDC") ;edi t | |
1358 | . I 'IBCL AIM D | |
1359 | .. D UPDA TE^DIE("", "FDC","IEN ROOT") | |
1360 | .. I IENR OOT(1)'="" S IBCLAIM =IENROOT(1 ) ;New | |
1361 | Q | |
1362 | ; | |
1363 | SETOTPT ; Look for f irst party claim poi nter in fi le #360 to an exist Bill IEN | |
1364 | N FDA | |
1365 | ; | |
1366 | Q:'$D(^IB (IBBILL,0) ) ; invali d pointer to file #3 50 or t | |
1367 | Q:$P(^IB( IBBILL,0), U,23)=IBRE C ; pointe r is prese nt and val id | |
1368 | S FDA(350 ,IBBILL_", ",.23)=IBR EC ; set N on-Va Care value to the poi0 | |
1369 | D UPDATE^ DIE("","FD A") | |
1370 | Q | |
1371 | ; | |
1372 | CHKOTPT ; check for Outpatient 1st party bills | |
1373 | K ^TMP("I BRBF",$J) ; kill of temp globa l before c all | |
1374 | S (FRSTPR T,OTPTBIL) =0 | |
1375 | D FPOPV^I BEFURF(DFN ,IBDOS) Q: '$D(^TMP(" IBRBF",$J) ) | |
1376 | S OTPTBIL =$O(^TMP(" IBRBF",$J, "FP",0)),F RSTPRT=1 ; set outpt 1st party g | |
1377 | K ^TMP("I BRBF",$J) | |
1378 | ; | |
1379 | ;END OF I BFBNP1 | |
1380 | ||
1381 | Routines | |
1382 | Activities | |
1383 | Routine Na me | |
1384 | ^IBFBWL – Main Prece rt and Bil ling Workl ist Routin e(Note: So me section s of this routine ar e used by the Billin g Worklist only.) | |
1385 | Enhancemen t Category | |
1386 | New | |
1387 | Modify | |
1388 | Delete | |
1389 | No Change | |
1390 | RTM | |
1391 | FRFEE-2.2, FRFEE-2.3 , FRFEE-2. 4,FRFEE-2. 3-03, FRFE E-2.3-07 | |
1392 | Related Op tions | |
1393 | IB BILLING WORKLIST | |
1394 | ||
1395 | Related Ro utines | |
1396 | Routines “ Called By” | |
1397 | , | |
1398 | ||
1399 | Called by VistA Opti on -IB BIL LING WORKL IST | |
1400 | ||
1401 | Subroutine s Called b y ListMan Actions - EXPAND LIN KCT – Link to CTACTI ONSHISTORY | |
1402 | ||
1403 | 1. BLDWL^I BFBWL1 (Bi lling Work list only – NSR #201 10303)2. B LDWL^IBFBW L5 (Precer t Worklist only – NS R #2008101 0) | |
1404 | 3. Refresh Action ca lls GETAUT ,BLDWL in ^IBFBWL1/^ IBFBWL5 to rebuild l ists | |
1405 | ||
1406 | ||
1407 | ||
1408 | ||
1409 | ||
1410 | Routines | |
1411 | Activities | |
1412 | Data Dicti onary (DD) Reference s | |
1413 | INSTITUTIO N FILE (#4 ) PATIENT FILE (#2) FEE BASIS PATIENT AU THORIZATIO N SUBFILE (#161.01) CLAIMS TRA CKING FILE (#356) | |
1414 | Related Pr otocols | |
1415 | List | |
1416 | IB BILLING WORKLIST | |
1417 | ||
1418 | Menu Proto col | |
1419 | IB BILLING WORKLIST MENU | |
1420 | ||
1421 | Action Pro tocols | |
1422 | IB BILLING WORKLIST REFRESH - REFRESH^IB FBWL | |
1423 | IB BILLING WORKLIST EXPAND - E XPAND^IBFB WL | |
1424 | IB BILLING WORKLIST CLAIMS TRA CKING – LI NKCT^IBFBW L | |
1425 | IB BILLING WORKLIST ACTIONS – ACTIONS^IB FBWL | |
1426 | IB BILLING WORKLIST HISTORY – HISTORY^IB FBWL | |
1427 | ||
1428 | Related In tegration Control Re gistration s (ICRs) | |
1429 | Yes - in p rocess | |
1430 | Data Passi ng | |
1431 | Input | |
1432 | Output Re ference | |
1433 | Both | |
1434 | Global Re ference | |
1435 | Local | |
1436 | Input Attr ibute Name and Defin ition | |
1437 | Name: None | |
1438 | Definition : None | |
1439 | Output Att ribute Nam e and Defi nition | |
1440 | Name: None | |
1441 | Definition : None | |
1442 | ||
1443 | Current Lo gic | |
1444 | New Routin e | |
1445 | ||
1446 | Modified L ogic (Chan ges are hi ghlighted) | |
1447 | IBFBWL ;AL B/PAW-IB B ILLING Wor klist ; 30 -SEP-2015 | |
1448 | ;;2.0;INT EGRATED BI LLING;**55 4**;21-MAR -94;Build 3 | |
1449 | ;;Per VA Directive 6402, this routine s hould not be modifie d. | |
1450 | EN ; -- Ma in entry p oint for I B BILLING WORKLIST T his is the entry poi nt for the billing w orklist | |
1451 | N FILTERS ,IBGRP,IBD IVS,IBWLTY P | |
1452 | S IBWLTYP ="B" | |
1453 | I '$$FILT ER(.FILTER S) Q | |
1454 | S IBGRP=$ P($G(FILTE RS(0)),U,1 ) | |
1455 | K XQORS,V ALMEVL | |
1456 | D EN^VALM ("IB BILLI NG WORKLIS T") | |
1457 | Q | |
1458 | ; | |
1459 | EN2 ; -- M ain entry point for IB NVC PRE CERT WORKL IST This i s the entr y point fo r precert | |
1460 | N FILTERS ,IBGRP,IBD IVS,IBWLTY P | |
1461 | S IBWLTYP ="P" | |
1462 | I '$$FILT ER(.FILTER S) Q | |
1463 | S IBGRP=$ P($G(FILTE RS(0)),U,1 ) | |
1464 | K XQORS,V ALMEVL | |
1465 | D EN^VALM ("IB NVC P RECERT WOR KLIST") | |
1466 | Q | |
1467 | ; | |
1468 | INIT ; Ini tialize va riables fo r IB BILLI NG WORKLIS T Initiali zation for billing w orklist | |
1469 | D KILLGLB | |
1470 | D GETAUT^ IBFBWL1(IB GRP) Calls ^IBFBWL1 to build m ain billin g worklist screen | |
1471 | I '$D(^TM P("IBFBWL" ,$J)) D Q | |
1472 | . W !!,*7 ,"There ar e no new c ost recove rable invo ices on fi le." | |
1473 | . S DIR(0 )="E" | |
1474 | . D ^DIR | |
1475 | . S VALMQ UIT=1 | |
1476 | . D EXIT | |
1477 | S IBWLTYP ="B" | |
1478 | D BLDWL^I BFBWL1 | |
1479 | Q | |
1480 | ; | |
1481 | INIT2 ; In itialize v ariables f or IB NVC Precert Wo rklist | |
1482 | D KILLGLB | |
1483 | D GETAUT^ IBFBWL5(IB GRP) | |
1484 | I '$D(^TM P("IBFBWL" ,$J)) D Q | |
1485 | . W !!,*7 ,"There ar e no new a uthorizati ons on fil e." | |
1486 | . S DIR(0 )="E" | |
1487 | . D ^DIR | |
1488 | . S VALMQ UIT=1 | |
1489 | . D EXIT | |
1490 | S IBWLTYP ="P" | |
1491 | D BLDWL^I BFBWL5 | |
1492 | Q | |
1493 | ; | |
1494 | HDR ; Set header for IB BILLIN G Worklist | |
1495 | N IBDIVS, IBFST,IBIE N,IBXX,IBY | |
1496 | D CHKFILT | |
1497 | I IBWLTYP ="B" D | |
1498 | . S VALMH DR(1)=$S(I BY=1:"Faci lity Reven ue Review" ,IBY=2:"RU R SC/SA",I BY=3:"Bill ing") | |
1499 | . S VALMH DR(1)=VALM HDR(1)_" ( "_$S($P(FI LTERS(0),U ,4)=1:"Fir st Party C opay",1:"T hird Party ")_")" | |
1500 | I IBWLTYP ="P" D | |
1501 | . S VALMH DR(1)=$S(I BY=1:"Insu rance Veri fication", IBY=2:"RUR Pre-certi fication") | |
1502 | S VALMHDR (2)="Selec ted Divisi on(s): "_I BDIVS | |
1503 | Q | |
1504 | ; | |
1505 | HDR2 ; Set header fo r IB NVC P recert Wor klist | |
1506 | N IBDIVS, IBFST,IBIE N,IBXX,IBY | |
1507 | D CHKFILT | |
1508 | S VALMHDR (1)=$S(IBY =1:"Insura nce Verifi cation",IB Y=2:"RUR P re-certifi cation") | |
1509 | S VALMHDR (2)="Selec ted Divisi on(s): "_I BDIVS | |
1510 | Q | |
1511 | ; | |
1512 | FILTER(FIL TERS) ; Se t up filte rs | |
1513 | ; Sets an array of filters to determine which ent ries to in clude in d isplay | |
1514 | ; Input: None | |
1515 | ; Output: | |
1516 | ; Returns : 0 if the user ente red '^' or timed out , 1 otherw ise | |
1517 | ; If Bill ing - FILT ERS(0) = f ee basis g roup (1=Fa cility Rev enue, 2=RU R | |
1518 | SC/SA, 3=B illing)^ 0 (all) 1 ( selected) institutio ns ^ 0 (al l) 1 (sele cted) pati ents ^ 1(F irst Party Copay) 2 (Third Par ty) | |
1519 | ; If Prec ert - FILT ERS(0) = f ee basis g roup (1=in surance ve rification , | |
1520 | 2=RUR)^ 0 (all) 1 (s elected) i nstitution s ^ 0 (all ) 1 (selec ted) patie nts | |
1521 | ; FILTERS (1) = inst ien ^ ins t ien ^ et c... | |
1522 | ; FILTERS (2) = pat ien ^ pat ien ^ etc. .. | |
1523 | N DIR,DIR OUT,DIRUT, DTOUT,DUOU T,IBXX,X,X X,Y | |
1524 | K FILTERS | |
1525 | ; | |
1526 | ; Billing Departmen t | |
1527 | I IBWLTYP ="B" D | |
1528 | . S DIR(0 )="S",DIR( "A")="Sele ct (F)acil ity Revenu e, (R)UR S C/SA or (B )lling" | |
1529 | . S DIR(" ?",1)="Ent er 'F' for Facility Revenue, ' R' for RUR SC/SA" | |
1530 | . S DIR(" ?")="or 'B ' to for B illing." | |
1531 | . S $P(DI R(0),U,2)= "F:Facilit y Revenue; R:RUR SC/S A;B:Billin g" | |
1532 | . W ! D ^ DIR K DIR | |
1533 | . I $G(DI RUT) Q | |
1534 | . S X=$$U P^XLFSTR(X ) | |
1535 | . S FILTE RS(0)=$S(Y ="F":1,Y=" R":2,Y="B" :3,1:0) | |
1536 | ; | |
1537 | ; Pre-cer tification Departmen t | |
1538 | I IBWLTYP ="P" D | |
1539 | . S DIR(0 )="S",DIR( "A")="Sele ct (I)nsur ance Verif ication or (R)UR Pre -certifica tion" | |
1540 | . S DIR(" ?",1)="Ent er 'I' for insurance verificat ion author izations." | |
1541 | . S DIR(" ?")="Enter 'R' for R UR authori zations." | |
1542 | . S $P(DI R(0),U,2)= "I:Insuran ce Verific ation;R:RU R Pre-cert ification" | |
1543 | . W ! D ^ DIR K DIR | |
1544 | . I $G(DI RUT) Q | |
1545 | . S X=$$U P^XLFSTR(X ) | |
1546 | . S FILTE RS(0)=$S(Y ="I":1,Y=" R":2,1:0) | |
1547 | ; | |
1548 | ||
1549 | ; First P arty Copay or Third Party | |
1550 | I IBWLTYP ="B" D | |
1551 | . S DIR(0 )="S",DIR( "A")="Sele ct (F)irst Party Cop ay or (T)h ird Party Insurance" | |
1552 | . S $P(DI R(0),U,2)= "F:First P arty Copay ;T:Third P arty Insur ance" | |
1553 | . S DIR(" ?",1)="Ent er 'F' for First Par ty Copay." | |
1554 | . S DIR(" ?")="Enter 'T' for T hird Party Insurance ." | |
1555 | . S $P(DI R(0),U,2)= "F:First P arty Copay ;T:Third P arty Insur ance" | |
1556 | . W ! D ^ DIR K DIR | |
1557 | . I $G(DI RUT) Q | |
1558 | . S X=$$U P^XLFSTR(X ) | |
1559 | . S $P(FI LTERS(0),U ,4)=$S(Y=" F":1,Y="T" :3,1:0) | |
1560 | ; | |
1561 | I $G(DIRU T) Q 0 | |
1562 | ; | |
1563 | ; Site (D ivision) F ilter | |
1564 | S DIR(0)= "S",DIR("A ")="Select (A)ll or ( S)elected Division(s ):",DIR("B ")="All" | |
1565 | S DIR("?" ,1)="Enter 'A' for A LL Divisio ns." | |
1566 | S DIR("?" )="Enter ' S' to view entries f or selecte d Division (s)." | |
1567 | S $P(DIR( 0),U,2)="A :All Divis ions;S:Sel ected Divi sions" | |
1568 | W ! D ^DI R K DIR | |
1569 | I $G(DIRU T) Q 0 | |
1570 | S X=$$UP^ XLFSTR(X) | |
1571 | S $P(FILT ERS(0),U,2 )=$S(Y="A" :0,1:1) | |
1572 | ; | |
1573 | ; Set Div ision Filt er | |
1574 | I $P(FILT ERS(0),U,2 )=1 D ASKD IV(.FILTER S) | |
1575 | ; | |
1576 | ; Patient Filter | |
1577 | S DIR(0)= "S",DIR("A ")="Select (A)ll or ( S)elected Patient(s) :",DIR("B" )="All" | |
1578 | S DIR("?" ,1)="Enter 'A' to se lect ALL P atients." | |
1579 | S DIR("?" )="Enter ' S' to view entries f or selecte d Patients ." | |
1580 | S $P(DIR( 0),U,2)="A :All Patie nts;S:Sele cted Patie nts" | |
1581 | W ! D ^DI R K DIR | |
1582 | I $G(DIRU T) Q 0 | |
1583 | S X=$$UP^ XLFSTR(X) | |
1584 | S $P(FILT ERS(0),U,3 )=$S(Y="A" :0,1:1) | |
1585 | ; Set Pat ient / Vet eran filte r | |
1586 | I $P(FILT ERS(0),U,3 )=1 D ASKP AT(.FILTER S) | |
1587 | D SHOWFIL T(.FILTERS ) | |
1588 | Q 1 | |
1589 | ; | |
1590 | ASKDIV(FIL TERS) ; Se ts a list of Divisio ns to be d isplayed i n the Bill ing Workli st | |
1591 | ; Input: FILTERS - Current Ar ray of fil ter settin gs | |
1592 | ; Output: FILTERS - Updated A rray of fi lter setti ngs | |
1593 | N DIC,DIR ,DIRUT,DIV S,DUOUT,FI RST,IBIENS ,IBIENS2,I BXX,IEN,N, X,Y | |
1594 | S DIC=4,D IC(0)="AE" ,FIRST=1 | |
1595 | F D Q:+IE N<1 | |
1596 | . D ONEDI V(.DIC,.IE N,.FIRST) ; One Divi sion promp t | |
1597 | . Q:+IEN< 1 | |
1598 | . S IBIEN S($P(IEN,U ,2))=$P(IE N,U,7) | |
1599 | . S IBIEN S2($P(IEN, U,1))=$P(I EN,U,2) | |
1600 | I '$D(IBI ENS) S FIL TERS(1)="" Q | |
1601 | ; | |
1602 | ; Set the filter no de respons es in alph abetical o rder | |
1603 | S IBXX="" | |
1604 | F S IBXX= $O(IBIENS2 (IBXX)) Q: IBXX="" D | |
1605 | . S FILTE RS(1,IBXX) ="" | |
1606 | Q | |
1607 | ; | |
1608 | ONEDIV(DIC ,IEN,FIRST ) ; Prompt s the user for a Div ision | |
1609 | ; Input: DIC - Vari able/Array of settin gs needed for ^DIC c all | |
1610 | ; FIRST - Set to 1 initially and then 0 for subse quent call s | |
1611 | ; Output: FIRST - S et to 0 | |
1612 | ; IEN - I EN of the selected D ivision | |
1613 | ; null of no select ion was ma de | |
1614 | S DIC("A" )=$S(FIRST :"Select a Division: ",1:"Sele ct Another Division: ") | |
1615 | D ^DIC | |
1616 | S FIRST=0 ,IEN=Y | |
1617 | Q | |
1618 | ; | |
1619 | ||
1620 | ASKPAT(FIL TERS) ; Se ts a list of patient s | |
1621 | ; Input: FILTERS - Current Ar ray of fil ter settin gs | |
1622 | ; Output: FILTERS - Updated A rray of fi lter setti ngs | |
1623 | N DIC,DIR ,DIRUT,DIV S,DUOUT,FI RST,IBIENS ,IBIENS2,I BN,IBXX,IE N,X,Y | |
1624 | S DIC=2,D IC(0)="AE" ,FIRST=1 | |
1625 | F D Q:+IE N<1 | |
1626 | . D ONEPA T(.DIC,.IE N,.FIRST) ; One pati ent | |
1627 | . Q:+IEN< 1 | |
1628 | . S IBIEN S($P(IEN,U ,2))=$P(IE N,U,1) | |
1629 | . S IBIEN S2($P(IEN, U,1))=$P(I EN,U,2) | |
1630 | I '$D(IBI ENS) S FIL TERS(2)="" Q | |
1631 | ; | |
1632 | ; Set the filter no de respons es in alph abetical o rder | |
1633 | S IBXX="" | |
1634 | F D Q:IBX X="" | |
1635 | . S IBXX= $O(IBIENS( IBXX)) | |
1636 | . Q:IBXX= "" | |
1637 | . S IBN=I BIENS(IBXX ) | |
1638 | . S FILTE RS(2,IBN)= "" | |
1639 | Q | |
1640 | ; | |
1641 | ONEPAT(DIC ,IEN,FIRST ) ; Prompt s the user for a Pat ient | |
1642 | ; Input: DIC - Vari able/Array of settin gs needed for ^DIC c all | |
1643 | ; FIRST - Set to 1 initially and then 0 for subse quent call s | |
1644 | ; Output: FIRST - S et to 0 | |
1645 | ; IEN - I EN of the Patient | |
1646 | ; null of no select ion was ma de | |
1647 | S DIC("A" )=$S(FIRST :"Select P atient: ", 1:"Select Another Pa tient: ") | |
1648 | D ^DIC | |
1649 | S FIRST=0 ,IEN=Y | |
1650 | Q | |
1651 | ; | |
1652 | SHOWFILT(F ILTERS) ; Display | |
1653 | ; Display s the curr ently sele cted filte r selectio ns for the | |
1654 | ; Billing and NVC P recert Wor klist disp lay | |
1655 | ; Input: FILTERS() - Array of filter se ttings. Se e FILTERS for a deta iled | |
1656 | ; explana tion of th e FILTERS array | |
1657 | ; Output: Current F ilter sett ings are d isplayed | |
1658 | ; | |
1659 | N DIR,DIR OUT,DIRUT, DTOUT,DUOU T,IEN,LEN, IBXX,IBY,I BZ | |
1660 | I IBWLTYP ="B" D | |
1661 | . W !!!," Type of Re view: " | |
1662 | . S IBY=$ P(FILTERS( 0),U,1) | |
1663 | . W $S(IB Y=1:"Facil ity Revenu e",IBY=2:" RUR SC",IB Y=3:"Billi ng",1:"") | |
1664 | . S IBZ=$ P(FILTERS( 0),U,4) W " ("_$S(IB Z=1:"First Party Cop ay",1:"Thi rd Party") _")" | |
1665 | I IBWLTYP ="P" D | |
1666 | . W !!!," Pre-certif ication De partment: " | |
1667 | . S IBY=$ P(FILTERS( 0),U,1) | |
1668 | . W $S(IB Y=1:"Insur ance Verif ication",I BY=2:"RUR" ,1:"") | |
1669 | ; | |
1670 | W !,"Show All Divis ions or Se lected Div isions: " | |
1671 | W $S($P(F ILTERS(0), U,2)=0:"Al l",1:"Sele cted") | |
1672 | ; | |
1673 | ; Divisio n list (if any) | |
1674 | I ($P(FIL TERS(0),U, 2)=1) D | |
1675 | . W !,"Di visions to Display: " | |
1676 | . S LEN=2 0,IEN=0 | |
1677 | . F S IEN =$O(FILTER S(1,IEN)) Q:IEN="" D | |
1678 | . . S IBX X=$$GET1^D IQ(4,IEN_" ,",.01) | |
1679 | . . S LEN =LEN+$L(IB XX) | |
1680 | . . I LEN +2<80 D Q | |
1681 | . . . W I BXX | |
1682 | . . . I $ O(FILTERS( 1,IEN))'=" " D | |
1683 | . . . . S LEN=LEN+2 | |
1684 | . . . . W ", " | |
1685 | . . S LEN =20 | |
1686 | . . W !," ",IBXX | |
1687 | ; | |
1688 | W !,"All P atients or Selected Patients: " | |
1689 | W $S($P(F ILTERS(0), U,3)=0:"Al l",1:"Sele cted") | |
1690 | ; Patient Inclusion list (if any) | |
1691 | I ($P(FIL TERS(0),U, 3)=1) D | |
1692 | . W !,"Pa tients to Display: " | |
1693 | . S LEN=2 0,IEN=0 | |
1694 | . F S IEN =$O(FILTER S(2,IEN)) Q:IEN="" D | |
1695 | . . S IBX X=$$GET1^D IQ(2,IEN_" ,",.01) | |
1696 | . . S LEN =LEN+$L(IB XX) | |
1697 | . . I LEN +2<80 D Q | |
1698 | . . . W I BXX | |
1699 | . . . I $ O(FILTERS( 2,IEN))'=" " D | |
1700 | . . . . S LEN=LEN+2 | |
1701 | . . . . W ", " | |
1702 | . . S LEN =20 | |
1703 | . . W !," ",IBXX | |
1704 | ; | |
1705 | K DIR | |
1706 | D PAUSE^V ALM1 | |
1707 | Q | |
1708 | ; | |
1709 | EXPAND ; E xpand Item (EE) | |
1710 | D FULL^VA LM1 | |
1711 | N I,J,DFN ,IBFBA,IBX X,VALMY,EC NT,IBAUTH, IBNAME | |
1712 | D EN^VALM 2($G(XQORN OD(0))) | |
1713 | I $D(VALM Y) S IBXX= 0 F S IBXX =$O(VALMY( IBXX)) Q:' IBXX D | |
1714 | . K ^TMP( "IBFBWE",$ J) | |
1715 | . S ECNT= $G(^TMP("I BFBWLX",$J ,IBXX)) | |
1716 | . S DFN=$ P(ECNT,U,1 ),IBNAME=$ P(ECNT,U,2 ),IBAUTH=$ P(ECNT,U,3 ),IBFBA=$P (ECNT,U,4) | |
1717 | . S ^TMP( "IBFBWE",$ J)=DFN_U_I BNAME_U_IB AUTH_U_IBF BA | |
1718 | . D EN^VA LM("IB BIL LING WORKL IST EXPAND ") | |
1719 | . Q | |
1720 | K ^TMP("I BFBWE",$J) | |
1721 | S VALMBCK ="R" | |
1722 | Q | |
1723 | ; | |
1724 | LINKCT ; C laims Trac king (CT) | |
1725 | I IBWLTYP ="P",IBGRP =1 D Q Not called in Billing W orklist | |
1726 | . W !," T his action not avail able for I V queue." | |
1727 | . D PAUSE ^VALM1 | |
1728 | . K ^TMP( $J,"IBCLMT RK") | |
1729 | . S VALMB CK="R" | |
1730 | D FULL^VA LM1 | |
1731 | K ^TMP($J ,"IBCLMTRK ") | |
1732 | N I,J,CTD T,CTIEN,CT LN1,CTUSR, DFN,ECNT,G OTPAT,IBFB A,IBAUTH,I BEND,IBNAM E,IBST,IBX X,VALMY | |
1733 | D EN^VALM 2($G(XQORN OD(0))) | |
1734 | I $D(VALM Y) S IBXX= 0 F S IBXX =$O(VALMY( IBXX)) Q:' IBXX D | |
1735 | . S ECNT= $G(^TMP("I BFBWLX",$J ,IBXX)) | |
1736 | . S DFN=$ P(ECNT,U,1 ),IBNAME=$ P(ECNT,U,2 ),IBAUTH=$ P(ECNT,U,3 ),IBFBA=$P (ECNT,U,4) GOTPAT=1 | |
1737 | . D GETDT S^IBFBUTIL (IBIEN) | |
1738 | . I IBEND ="" S IBEN D="3991231 " | |
1739 | . S ^TMP( $J,"IBCLMT RK")=DFN_U _IBST_U_IB END_U_IBAU TH_U_IBFBA | |
1740 | . D EN^VA LM("IBT CL AIMS TRACK ING EDITOR ") | |
1741 | I IBWLTYP ="P",$D(D0 ) D Not ca lled in Bi lling Work list | |
1742 | . S CTIEN =D0 | |
1743 | . I '$D(^ IBT(356,CT IEN)) Q | |
1744 | . S CTLN1 =^IBT(356, CTIEN,1) | |
1745 | . S CTDT= $P($P(CTLN 1,U,1),"." ,1) | |
1746 | . S CTUSR =$P(CTLN1, U,2) | |
1747 | . I $G(DU Z)=CTUSR,D T=CTDT D | |
1748 | .. N Y,X | |
1749 | .. W !! | |
1750 | .. S DIR( "A")="Link last Clai ms Trackin g entry to current a uth for "_ IBNAME_"? " | |
1751 | .. S DIR( "?")="Plea se answer Yes or No. " | |
1752 | .. S DIR( "B")="YES" ,DIR(0)="Y A^^" | |
1753 | .. D ^DIR K DIR | |
1754 | .. I Y(0) '="YES" Q | |
1755 | .. S CTTM P=^TMP($J, "IBCLMTRK" ) | |
1756 | .. S DFN= $P(CTTMP,U ,1) | |
1757 | .. S IBAU TH=$P(CTTM P,U,4) | |
1758 | .. S IBXX ="" | |
1759 | .. S IBXX =$O(^IBFB( 360,"D",DF N,IBAUTH,I BXX)) | |
1760 | .. S $P(^ IBFB(360,I BXX,1),U,1 )=CTIEN | |
1761 | K ^TMP($J ,"IBCLMTRK ") | |
1762 | S VALMBCK ="R" | |
1763 | Q | |
1764 | ; | |
1765 | ACTIONS ; Worklist A ction (WA) | |
1766 | D FULL^VA LM1 | |
1767 | N I,J,DFN ,IBFBA,IBX X,VALMY,EC NT,IBAUTH, IBNAME | |
1768 | D EN^VALM 2($G(XQORN OD(0))) | |
1769 | I $D(VALM Y) S IBXX= 0 F S IBXX =$O(VALMY( IBXX)) Q:' IBXX D | |
1770 | . K ^TMP( "IBFBWA",$ J) | |
1771 | . S ECNT= $G(^TMP("I BFBWLX",$J ,IBXX)) | |
1772 | . S DFN=$ P(ECNT,U,1 ),IBNAME=$ P(ECNT,U,2 ),IBAUTH=$ P(ECNT,U,3 ),IBFBA=$P (ECNT,U,4) | |
1773 | . S ^TMP( "IBFBWA",$ J)=DFN_U_I BNAME_U_IB AUTH_U_IBF BA | |
1774 | . I IBWLT YP="B" D B illing Wor klist code | |
1775 | .. D EN^V ALM("IB BI LLING WORK LIST ACTIO NS") | |
1776 | . I IBWLT YP="P" D | |
1777 | .. I IBGR P=1 D EN^V ALM("IB NV C PRECERT WORKLIST I V") | |
1778 | .. I IBGR P=2 D EN^V ALM("IB NV C PRECERT WORKLIST R UR") | |
1779 | K ^TMP("I BFBWA",$J) | |
1780 | K ^TMP("V ALMAR",$J) | |
1781 | I IBWLTYP ="B" D BLD WL^IBFBWL1 | |
1782 | I IBWLTYP ="P" D BLD WL^IBFBWL5 | |
1783 | S VALMBCK ="R" | |
1784 | Q | |
1785 | ; | |
1786 | HISTORY ; Worklist H istory (HI ) | |
1787 | D FULL^VA LM1 | |
1788 | N I,J,DFN ,ECNT,IBA, IBAUTH,IBB ,IBHDT,IBH LG,IBHUSR, IBNAME,IBN AME,IBY,IB X,IBXX,VAL MY | |
1789 | D EN^VALM 2($G(XQORN OD(0))) | |
1790 | I $D(VALM Y) S IBXX= 0 F S IBXX =$O(VALMY( IBXX)) Q:' IBXX D | |
1791 | . K ^TMP( "IBFBWH",$ J) | |
1792 | . S ECNT= $G(^TMP("I BFBWLX",$J ,IBXX)) | |
1793 | . S DFN=$ P(ECNT,U,1 ),IBNAME=$ P(ECNT,U,2 ),IBAUTH=$ P(ECNT,U,3 ),IBFBA=$P (ECNT,U,4) | |
1794 | . I IBFBA ’=”” S IBY =IBFBA | |
1795 | . I IBFBA =”” D | |
1796 | .. S IBX= "" F S IBX =$O(^IBFB( 360,"C",DF N,IBX)) Q: IBX="" D | |
1797 | ... I $P( ^IBFB(360, IBX,0),U,3 )=IBAUTH S IBY=IBX | |
1798 | . S IBA=0 F S IBA=$ O(^IBFB(36 0,IBY,4,IB A)) Q:IBA= "" D | |
1799 | .. S IBHD T=$$FDATE^ VALM1($P(^ IBFB(360,I BY,4,IBA,0 ),U,1)) | |
1800 | .. S IBHL G=$P(^IBFB (360,IBY,4 ,IBA,0),U, 2) | |
1801 | .. S IBHU SR=$P(^IBF B(360,IBY, 4,IBA,0),U ,3) | |
1802 | .. S ^TMP ("IBFBWH", $J,IBA)=IB HDT_U_IBHL G_U_IBHUSR | |
1803 | . D EN^VA LM("IB BIL LING WORKL IST HISTOR Y") | |
1804 | . Q | |
1805 | K ^TMP("I BFBWH",$J) | |
1806 | S VALMBCK ="R" | |
1807 | Q | |
1808 | ; | |
1809 | REFRESH ; Special Ma in Screen List Refre sh Special refresh c ode was ne eded to re display li st | |
1810 | K ^TMP("I BFBWL",$J) | |
1811 | I IBWLTYP ="B" D | |
1812 | . D GETAU T^IBFBWL1( IBGRP) | |
1813 | . D BLDWL ^IBFBWL1 | |
1814 | I IBWLTYP ="P" D | |
1815 | . D GETAU T^IBFBWL5( IBGRP) | |
1816 | . D BLDWL ^IBFBWL5 | |
1817 | S VALMBCK ="R" | |
1818 | Q | |
1819 | ; | |
1820 | KILLGLB ; Kill Workl ist Global s | |
1821 | K ^TMP("I BFBWL",$J) | |
1822 | K ^TMP("I BFBWLX",$J ) | |
1823 | K ^TMP("I BFBWA",$J) | |
1824 | K ^TMP("I BFBWE",$J) | |
1825 | K ^TMP("I BFBWH",$J) | |
1826 | K ^TMP("V ALMAR",$J) | |
1827 | K ^TMP("X QORS",$J) | |
1828 | D CLEAR^V ALM1 | |
1829 | Q | |
1830 | ; | |
1831 | CHKFILT ; Check Filt ers | |
1832 | I $P($G(F ILTERS(0)) ,U,2)=0 S IBDIVS="Al l" | |
1833 | I $P($G(F ILTERS(0)) ,U,2)'=0 D | |
1834 | . S IBIEN =0,IBFST=1 | |
1835 | . F S IBI EN=$O(FILT ERS(1,IBIE N)) Q:IBIE N="" D | |
1836 | .. S IBXX =$E($$GET1 ^DIQ(4,IBI EN_",",.01 ),1,15) | |
1837 | .. I IBFS T S IBFST= 0,IBDIVS=I BXX Q | |
1838 | .. S IBDI VS=IBDIVS_ ","_IBXX | |
1839 | S IBY=$P( FILTERS(0) ,U,1) | |
1840 | Q | |
1841 | ; | |
1842 | HELP ; -- help code | |
1843 | S X="?" D DISP^XQOR M1 W !! | |
1844 | Q | |
1845 | ; | |
1846 | EXIT ; -- exit code | |
1847 | D KILLGLB | |
1848 | D CLEAN^V ALM10 | |
1849 | D ^%ZISC | |
1850 | Q | |
1851 | ||
1852 | Routines | |
1853 | Activities | |
1854 | Routine Na me | |
1855 | ^IBFBWL1 – Loop and create mai n Precert Worklist p age | |
1856 | (Note: ^IB FBWL5 is N OT used fo r the Bill ing Workli st. It is used to cr eate the m ain IB NVC Precert W orklist pa ge, only, NSR #20081 010) | |
1857 | Enhancemen t Category | |
1858 | New | |
1859 | Modify | |
1860 | Delete | |
1861 | No Change | |
1862 | RTM | |
1863 | FRFEE-2.2, FRFEE-2.3 , FRFEE-2. 4,FRFEE-2. 3-03, FRFE E-2.3-07 | |
1864 | Related Op tions | |
1865 | IB BILLING WORKLIST | |
1866 | ||
1867 | Related Ro utines | |
1868 | Routines “ Called By” | |
1869 | Routines “ Called” | |
1870 | ||
1871 | ^IBFBWL | |
1872 | ||
1873 | ||
1874 | ||
1875 | Routines | |
1876 | Activities | |
1877 | Data Dicti onary (DD) Reference s | |
1878 | FEE BASIS PATIENT AU THORIZATIO N SUBFILE (#161.01) | |
1879 | IB-FB INTE RFACE TRAC KING FILE (#360) | |
1880 | INSURANCE COMPANY FI LE (#36) | |
1881 | FEE BASIS CONTRACT F ILE (#161. 43) | |
1882 | Related Pr otocols | |
1883 | List | |
1884 | IB BILLING WORKLIST | |
1885 | ||
1886 | Menu Proto col | |
1887 | IB BILLING WORKLIST MENU | |
1888 | ||
1889 | Action Pro tocols | |
1890 | IB BILLING WORKLIST REFRESH - REFRESH^IB FBWL | |
1891 | IB BILLING WORKLIST EXPAND - E XPAND^IBFB WL | |
1892 | IB BILLING WORKLIST CLAIMS TRA CKING – LI NKCT^IBFBW L | |
1893 | IB BILLING WORKLIST ACTIONS – ACTIONS^IB FBWL | |
1894 | IB BILLING WORKLIST HISTORY – HISTORY^IB FBWL | |
1895 | Related In tegration Control Re gistration s (ICRs) | |
1896 | Yes – in p rocess | |
1897 | Data Passi ng | |
1898 | Input | |
1899 | Output Re ference | |
1900 | Both | |
1901 | Global Re ference | |
1902 | Local | |
1903 | Input Attr ibute Name and Defin ition | |
1904 | Name: None | |
1905 | Definition : None | |
1906 | Output Att ribute Nam e and Defi nition | |
1907 | Name: None | |
1908 | Definition : None | |
1909 | ||
1910 | Current Lo gic | |
1911 | New Routin e | |
1912 | ||
1913 | Modified L ogic (Chan ges are hi ghlighted) | |
1914 | IBFBWL1 ;A LB/PAW-IB Billing Wo rklist Mai n ; 30-SEP -2015 | |
1915 | ;;2.0;INT EGRATED BI LLING;**55 4**;21-MAR -94;Build 3 | |
1916 | ;;Per VA Directive 6402, this routine s hould not be modifie d. | |
1917 | ;; | |
1918 | ; | |
1919 | GETAUT(IBG RP) ; Obta in new inv oices, bas ed upon re view group | |
1920 | ;required input IBG RP = 1 (FR ) or 2 (SC ) or 3 (BI ) | |
1921 | ;output ^ TMP("IBFBW L",$J), co ntaining a uths for g roup queue | |
1922 | N IBA | |
1923 | S IBA="" | |
1924 | I IBGRP=1 D LOOP1 F acility Re venue Queu e | |
1925 | I IBGRP=2 D LOOP2 R UR-SC Queu e | |
1926 | I IBGRP=3 D LOOP3 B illing Que ue | |
1927 | Q | |
1928 | ; | |
1929 | LOOP1 ; Lo op to crea te Fee Rev enue Workl ist | |
1930 | F S IBA=$ O(^IBFB(36 0,"FR","FR ",IBA)) Q: IBA="" D | |
1931 | . D BLDTM P | |
1932 | Q | |
1933 | ; | |
1934 | LOOP2 ; Lo op to crea te RUR SC/ SA Worklis t | |
1935 | F S IBA=$ O(^IBFB(36 0,"SC","SC ",IBA)) Q: IBA="" D | |
1936 | . D BLDTM P | |
1937 | Q | |
1938 | ; | |
1939 | LOOP3 ; Lo op to crea te Billing Worklist | |
1940 | F S IBA=$ O(^IBFB(36 0,"BI","BI ",IBA)) Q: IBA="" D | |
1941 | . D BLDTM P | |
1942 | Q | |
1943 | ; | |
1944 | BLDTMP ; B uild ^TMP( "IBFBWL",$ J) | |
1945 | N DFN,IBA UTH,IBFPTP ,IBDIV,IBD OB,IBIEN,I BNAME,IBSS N,IBFP,IBS T,IBEND | |
1946 | I '$D(^IB FB(360,IBA )) Q | |
1947 | S DFN=$$G ET1^DIQ(36 0,IBA_",", .02,"I") | |
1948 | S IBAUTH= $$GET1^DIQ (360,IBA_" ,",.03) | |
1949 | S IBIEN=I BAUTH_","_ DFN_"," | |
1950 | S IBDIV=$ $GET1^DIQ( 161.01,IBI EN,101,"I" ) | |
1951 | I IBDIV'= "",$D(FILT ERS(1)) I '$D(FILTER S(1,IBDIV) ) Q ; If f iltering b y select d ivisions | |
1952 | I IBDIV=" ",$D(FILTE RS(1)) Q ; Filtering by divisi on, but no division on auth | |
1953 | I $D(FILT ERS(2)) I '$D(FILTER S(2,DFN)) Q ; If fil tering by select pat ients | |
1954 | S IBFPTP= $$GET1^DIQ (360,IBA_" ,",3.02) | |
1955 | I $P(FILT ERS(0),U,4 )=1,IBFPTP '=1 Q ; If filtering by first party | |
1956 | I $P(FILT ERS(0),U,4 )=3,IBFPTP =1 Q ; If filtering by first p arty | |
1957 | D DEMOS | |
1958 | Q | |
1959 | ; | |
1960 | DEMOS ; De mographics | |
1961 | N IBFP,IB INV,IBSSN, IBST,IBSTK ,IBSTL,IBS SX,IBSSLE, IBSSLS,VA, VADM,VAERR | |
1962 | D DEM^VAD PT | |
1963 | I VAERR K VADM | |
1964 | S IBNAME= $G(VADM(1) ) S:IBNAME ="" IBNAME =" " | |
1965 | S IBDOB=$ P($G(VADM( 3)),U,1) | |
1966 | S IBSSX=$ P($G(VADM( 2)),U,1),I BSSLE=$L(I BSSX),IBSS LS=6 I $E( IBSSX,IBSS LE)="P" S IBSSLS=5 | |
1967 | S IBSSN=$ E(IBNAME,1 )_$E(IBSSX ,IBSSLS,IB SSLE) | |
1968 | S IBFP=$$ GET1^DIQ(1 61.01,IBIE N_",",.03) ; NVC | |
1969 | I IBFP="" S IBFP="U NK" | |
1970 | S IBST="" | |
1971 | D GETST^I BFBUTIL(IB A) | |
1972 | I IBST="" S IBST="U NK" | |
1973 | ; Sort by DOS (prim ary), Type (secondar y) | |
1974 | S ^TMP("I BFBWL",$J, IBST,IBFP, IBNAME,DFN ,IBAUTH,IB A)=IBNAME_ U_IBDOB_U_ IBSSN_ | |
1975 | U_IBFP_U_I BST_U_IBIN V | |
1976 | Q | |
1977 | ; | |
1978 | BLDWL ; Bu ild Work L ist Screen | |
1979 | ; build d isplay lin es | |
1980 | K ^TMP("I BFBWLX",$J ) | |
1981 | N DFN,IBA UTH,IBFP,I BNAME,IBST ,IBXX,FIRS T,LINE,VCN T | |
1982 | S (VALMCN T,FIRST,VC NT,CNT)=0 | |
1983 | S IBST="" | |
1984 | F S IBST= $O(^TMP("I BFBWL",$J, IBST)) Q:I BST="" D | |
1985 | . S IBFP= "" | |
1986 | . F S IBF P=$O(^TMP( "IBFBWL",$ J,IBST,IBF P)) Q:IBFP ="" D | |
1987 | .. S IBNA ME="" | |
1988 | .. F S IB NAME=$O(^T MP("IBFBWL ",$J,IBST, IBFP,IBNAM E)) Q:IBNA ME="" D | |
1989 | ... S FIR ST=1 | |
1990 | ... S DFN ="" | |
1991 | ... F S D FN=$O(^TMP ("IBFBWL", $J,IBST,IB FP,IBNAME, DFN)) Q:DF N="" D | |
1992 | .... S IB AUTH="" | |
1993 | .... F S IBAUTH=$O( ^TMP("IBFB WL",$J,IBS T,IBFP,IBN AME,DFN,IB AUTH)) Q:I BAUTH="" D | |
1994 | ….. S IBA =”” | |
1995 | ….. F S I BG=$O(^TMP (“IBFBWL”, $J,IBST,IB FP,IBNAME, DFN,IBAUTH ,IBA)) Q:I BA=”” D | |
1996 | ...... S VCNT=VCNT+ 1 | |
1997 | ...... S LINE=$$SET L("",VCNT, "",1,4) ;l ine# | |
1998 | ...... S IBXX=^TMP( "IBFBWL",$ J,IBST,IBF P,IBNAME,D FN,IBAUTH, IBA) | |
1999 | …... S IB NAME=$P(IB XX,U) | |
2000 | …... S LI NE=$$SETL( LINE,IBNAM E,"",5,23) | |
2001 | ...... S LINE=$$SET L(LINE,$$F DATE^VALM1 ($P(IBXX,U ,2)),"",28 ,8) | |
2002 | …... S LI NE=$$SETL( LINE,$P(IB XX,U,3),"" ,37,5) | |
2003 | ...... S LINE=$$SET L(LINE,$P( IBXX,U,4), "",43,10) | |
2004 | …... I $P (IBXX,U,5) '="UNK" S LINE=$$SET L(LINE,$$F DATE^VALM1 ($P(IBXX,U ,5)),"",54 ,8) | |
2005 | ...... E S LINE=$$S ETL(LINE," ","",54,8) | |
2006 | …... S LI NE=$$SETL( LINE,$P(IB XX,U,6),"" ,63,16) | |
2007 | ...... S VALMCNT=VA LMCNT+1 | |
2008 | …... D SE T^VALM10(V ALMCNT,LIN E,VCNT) | |
2009 | ...... S ^TMP("IBFB WLX",$J,VC NT)=DFN_U_ IBNAME_U_I BAUTH_U_IB A | |
2010 | Q | |
2011 | ; | |
2012 | SETL(LINE, DATA,LABEL ,COL,LNG) ; Creates a line of data to be set into the body | |
2013 | ; of the worklist | |
2014 | ; Input: LINE - Cur rent line being crea ted | |
2015 | ; DATA - Informatio n to be ad ded to the end of th e current line | |
2016 | ; LABEL - Label to describe t he informa tion being added | |
2017 | ; COL - C olumn posi tion in li ne to add informatio n add | |
2018 | ; LNG - M aximum len gth of dat a informat ion to inc lude on th e line | |
2019 | ; Returns : Line upd ated with added info rmation | |
2020 | S LINE=LI NE_$J("",( COL-$L(LAB EL)-$L(LIN E)))_LABEL _$E(DATA,1 ,LNG) | |
2021 | Q LINE | |
2022 | ||
2023 | Routines | |
2024 | Activities | |
2025 | Routine Na me | |
2026 | ^IBFBWL2 – Expand Wo rklist Ite m | |
2027 | (Note: The Billing W orklist sh ares this routine wi th the Pre cert Workl ist. Many fields dis play on th e Billing Worklist o nly.) | |
2028 | ||
2029 | Enhancemen t Category | |
2030 | New | |
2031 | Modify | |
2032 | Delete | |
2033 | No Change | |
2034 | RTM | |
2035 | FRFEE-2.3- 01 through FRFEE-2.3 -08, FBFEE -2.4,FRFEE -2.8 | |
2036 | Related Op tions | |
2037 | IB BILLING WORKLIST | |
2038 | ||
2039 | Related Ro utines | |
2040 | Routines “ Called By” | |
2041 | Routines “ Called” | |
2042 | ||
2043 | ||
2044 | Called fro m IB BILLI NG WORKLIS T Action “ EE” – EXPA ND^IBFBWL | |
2045 | GETAUTH^IB FBUTIL | |
2046 | GETPAY^IBF BUTIL | |
2047 | CL^IBACV ( special au th elig) | |
2048 | CVEDT^IBAC V (combat vet elig)A LL^IBCNS1D AT1^IBOUTL | |
2049 | ||
2050 | ||
2051 | Routines | |
2052 | Activities | |
2053 | Data Dicti onary (DD) Reference s | |
2054 | PATIENT FI LE (#2) | |
2055 | IB-FB INTE RFACE TRAC KING FILE (#360) | |
2056 | FEE BASIS VENDOR FIL E (#161.2) | |
2057 | NEW PERSON FILE (#20 0) | |
2058 | DISABILITY CONDITION FILE (#31 ) | |
2059 | INSURANCE COMPANY FI LE (#36) | |
2060 | FEE BASIS PATIENT FI LE AUTHORI ZATION SUB FILE (#161 .01) | |
2061 | Related Pr otocols | |
2062 | Lists | |
2063 | IB BILLING WORKLIST MENU | |
2064 | IB BILLING WORKLIST EXPAND - E XPAND^IBFB WL | |
2065 | ||
2066 | Correspond ing Menu ( Protocol) | |
2067 | IB BILLING WORKLIST EXPAND MEN U PROTOCOL | |
2068 | Action Pro tocols | |
2069 | IB BILLING WORKLIST EXPAND REF RESH – REF RESH^IBFBW L2 | |
2070 | Related In tegration Control Re gistration s (ICRs) | |
2071 | Yes – in p rocess | |
2072 | Data Passi ng | |
2073 | Input | |
2074 | Output Re ference | |
2075 | Both | |
2076 | Global Re ference | |
2077 | Local | |
2078 | Input Attr ibute Name and Defin ition | |
2079 | Name: None | |
2080 | Definition : None | |
2081 | Output Att ribute Nam e and Defi nition | |
2082 | Name: None | |
2083 | Definition : None | |
2084 | ||
2085 | Current Lo gic | |
2086 | New Routin e | |
2087 | ||
2088 | Modified L ogic (Chan ges are hi ghlighted) | |
2089 | IBFBWL2 ;A LB/PAW-IB BILLING Wo rklist Exp and Item ; 30-SEP-20 15 | |
2090 | ;;2.0;INT EGRATED BI LLING;**55 4**;21-MAR -94;Build 3 | |
2091 | ;;Per VA Directive 6402, this routine s hould not be modifie d. | |
2092 | ;; | |
2093 | EN ; -- ma in entry p oint for B ILLING WOR KLIST EXPA ND | |
2094 | D EN^VALM ("IB PRECE RT WORKLIS T EXPAND") | |
2095 | Q | |
2096 | ; | |
2097 | HDR ; -- h eader code | |
2098 | S VALM("T ITLE")=" E xpanded NV C" | |
2099 | Q | |
2100 | ; | |
2101 | INIT ; -- init varia bles and l ist array | |
2102 | ; input - ^TMP("IBF BWE",$J)=D FN^IBNAME^ IBAUTH | |
2103 | ; output - Expanded worklist screen | |
2104 | I '$D(^TM P("IBFBWE" ,$J)) Q | |
2105 | N CNT,DFN ,ECNT,IBFB A,IBNAME,I BAUTH,IBST ,LINE,VAEL | |
2106 | S ECNT=$G (^TMP("IBF BWE",$J)) | |
2107 | S DFN=$P( ECNT,U,1), IBNAME=$P( ECNT,U,2), IBAUTH=$P( ECNT,U,3), IBFBA=$P(E C) | |
2108 | D BLD | |
2109 | D GETSC | |
2110 | D GETSTA | |
2111 | D GETINS | |
2112 | D BLDEXP | |
2113 | S VALMBCK ="R" | |
2114 | Q | |
2115 | ; | |
2116 | BLD ; buil d data to display | |
2117 | N IBARRAY ,IB7078,IB CP,IBIEN,I BDX1,IBDX2 ,IBDX3,IBE ND,IBENDX, IBFILL,IBF PI | |
2118 | N IBPUR,I BREF,IBREF A,IBREM,IB REM1,IBREM ARK,IBRET, IBSS,IBSTX ,IBTAX,IBV NE | |
2119 | N IBSSLS, IBVTAX,IBX ,IBXX,VA | |
2120 | S CNT=0 | |
2121 | D ELIG^VA DPT | |
2122 | S IBSSX=$ $GET1^DIQ( 2,DFN_",", .09,"I"),I BSSLE=$L(I BSSX),IBSS LS=6 I $E( I5 | |
2123 | S IBSS=$E (IBNAME,1) _$E(IBSSX, IBSSLS,IBS SLE) | |
2124 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="PATIEN T " | |
2125 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="SSN X | |
2126 | S IBIEN=I BAUTH_","_ DFN_"," | |
2127 | D GETAUTH ^IBFBUTIL( IBIEN,"IBA RRAY") ; C all API fo r Authoriz ation Sub- s | |
2128 | I IBWLTYP ="P" D | |
2129 | . S IBST= $G(IBARRAY (161.01,IB IEN,.01,"I ")) | |
2130 | . S IBEND =$G(IBARRA Y(161.01,I BIEN,.02," I")) | |
2131 | . S IBSTX =$G(IBARRA Y(161.01,I BIEN,.01," E")) | |
2132 | . S IBEND X=$G(IBARR AY(161.01, IBIEN,.02, "E")) | |
2133 | . S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)="AUTH DOS RANGE X | |
2134 | I IBWLTYP ="B" D | |
2135 | . S (IBST ,IBINV)="" | |
2136 | . I IBFBA '="" S IBX X=IBFBA | |
2137 | . I IBFBA ="" D | |
2138 | .. S IBX= "" F S IBX =$O(^IBFB( 360,"C",DF N,IBX)) Q: IBX="" D | |
2139 | ... I $$G ET1^DIQ(36 0,IBX_",", .03)=IBAUT H S IBXX=I BX | |
2140 | . D GETST ^IBFBUTIL( IBXX) | |
2141 | . D GETPA Y^IBFBUTIL (IBXX) | |
2142 | . I IBST' ="" S IBST X=$$FDATE^ VALM1(IBST ) | |
2143 | . S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)="INVO ICE NVC ) | |
2144 | . S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)="INVO ICE# V | |
2145 | . I IBFPN O=2!(IBFPN O=3) S CNT =CNT+1,^TM P("IBFBWE" ,$J,IBNAME ,DFN,IBAUT H) | |
2146 | . I IBFPN O=6!(IBFPN O=7) S CNT =CNT+1,^TM P("IBFBWE" ,$J,IBNAME ,DFN,IBAUT H) | |
2147 | . ; I IBF PNO=3 S CN T=CNT+1,^T MP("IBFBWE ",$J,IBNAM E,DFN,IBAU TH,CNT)="V E) | |
2148 | . I $G(IB INV)'="" D | |
2149 | .. S IBPA YX="" | |
2150 | .. F S IB PAYX=$O(IB RET(162.03 ,IBPAYX)) Q:IBPAYX=" " D | |
2151 | ... S CNT =CNT+1,^TM P("IBFBWE" ,$J,IBNAME ,DFN,IBAUT H,CNT)=" S ERVICE CPT ) | |
2152 | ... I $D( IBRET(162. 03,IBPAYX, 2,"I")) S IBINVPD=$F N(IBRET(16 2.03,IBPAY X) | |
2153 | ... S CNT =CNT+1,^TM P("IBFBWE" ,$J,IBNAME ,DFN,IBAUT H,CNT)=" A MOUNT PAID ) | |
2154 | ... S CNT =CNT+1,^TM P("IBFBWE" ,$J,IBNAME ,DFN,IBAUT H,CNT)=" R ENDERING P ) | |
2155 | ... S CNT =CNT+1,^TM P("IBFBWE" ,$J,IBNAME ,DFN,IBAUT H,CNT)=" R ENDERING N ) | |
2156 | ... S CNT =CNT+1,^TM P("IBFBWE" ,$J,IBNAME ,DFN,IBAUT H,CNT)=" R ENDERING T ) | |
2157 | S IBFP=$G( IBARRAY(16 1.01,IBIEN ,.03,"E")) | |
2158 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="AUTHOR IZATION NV CP | |
2159 | S IBPUR=$ G(IBARRAY( 161.01,IBI EN,.07,"E" )) | |
2160 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="PURPOS E OF VISIT R | |
2161 | S IBVND=$ G(IBARRAY( 161.01,IBI EN,.04,"E" )) | |
2162 | S IBVNDA= $G(IBARRAY (161.01,IB IEN,.04,"I ")) | |
2163 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="NON-VA LOCATION D | |
2164 | S IBVNPI= "" | |
2165 | I IBVNDA' ="" S IBVN PI=$$GET1^ DIQ(161.2, IBVNDA_"," ,41.01) | |
2166 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)=" NPI# I | |
2167 | S IBVTAX= "" | |
2168 | I IBVNDA' ="" S IBVT AX=$$GET1^ DIQ(161.2, IBVNDA_"," ,42) | |
2169 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)=" TAXON OMY X | |
2170 | S IB7078= $G(IBARRAY (161.01,IB IEN,.055," E")) | |
2171 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="ASSOC 7078/583 8 | |
2172 | S IBREF=$ G(IBARRAY( 161.01,IBI EN,104,"E" )) | |
2173 | S IBREFA= $G(IBARRAY (161.01,IB IEN,104,"I ")) | |
2174 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="ORDERI NG PHYSICI AF | |
2175 | S IBNPI=" " | |
2176 | I IBREFA' ="" S IBNP I=$$GET1^D IQ(200,IBR EFA_",",41 .99) | |
2177 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)=" NPI# I | |
2178 | ; Placeho lder if VA starts to use Taxon omy for VA physician s | |
2179 | S IBTAX=" " | |
2180 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)=" TAXON OMY X | |
2181 | S IBMT=$P ($G(VAEL(9 )),U,2) | |
2182 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="MEANS TEST STATU ST | |
2183 | D DISP^IB ARXEU(DFN, IBST,1,"") | |
2184 | S IBCP=$P ($G(X),U,2 ) | |
2185 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="MED CO PAY EXEMP SP | |
2186 | S IBDX1=$ G(IBARRAY( 161.01,IBI EN,.08,"E" )) | |
2187 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="DIAGNO SIS 1 1 | |
2188 | S IBDX2=$ G(IBARRAY( 161.01,IBI EN,.085,"E ")) | |
2189 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="DIAGNO SIS 2 2 | |
2190 | S IBDX3=$ G(IBARRAY( 161.01,IBI EN,.086,"E ")) | |
2191 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="DIAGNO SIS 3 3 | |
2192 | S IBICDDX =$G(IBARRA Y(161.01,I BIEN,.087, "E")) | |
2193 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="ICD DI AGNOSIS X | |
2194 | I '$D(IBA RRAY(161.0 1,IBIEN,.0 21)) S CNT =CNT+1,^TM P("IBFBWE" ,$J,IBNAME ," | |
2195 | S IBREM=" ",IBREM1=1 | |
2196 | F S IBREM =$O(IBARRA Y(161.01,I BIEN,.021, IBREM)) Q: IBREM=""!( IBREM="E") D | |
2197 | . S IBREM ARK=IBARRA Y(161.01,I BIEN,.021, IBREM) | |
2198 | . I IBREM 1 S CNT=CN T+1,^TMP(" IBFBWE",$J ,IBNAME,DF N,IBAUTH,C NT)="AUTH R0 | |
2199 | . E S CNT =CNT+1,^TM P("IBFBWE" ,$J,IBNAME ,DFN,IBAUT H,CNT)=" K | |
2200 | Q | |
2201 | ; | |
2202 | BLDEXP ; B uild expan d screen | |
2203 | D FULL^VA LM1 | |
2204 | N IBXX | |
2205 | S DFN=$P( ECNT,U,1), IBNAME=$P( ECNT,U,2), IBAUTH=$P( ECNT,U,3) | |
2206 | S VALMCNT =0 | |
2207 | S IBXX="" | |
2208 | F S IBXX= $O(^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,IB XX)) Q:+IB XX=0 D | |
2209 | . S LINE= ^TMP("IBFB WE",$J,IBN AME,DFN,IB AUTH,IBXX) | |
2210 | . S VALMC NT=VALMCNT +1 | |
2211 | . D SET^V ALM10(VALM CNT,LINE," ") | |
2212 | S VALMCNT =VALMCNT+1 | |
2213 | Q | |
2214 | ; | |
2215 | GETSC ; Ge t SC and S TA | |
2216 | N IBD,IBI ,IBX,IBY,I BSC,IBSC1, FIRST | |
2217 | S FIRST=1 | |
2218 | I VAEL(3) =0 S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)="SERV IQ | |
2219 | S IBSC="S ERVICE CON NECTED : " _$P(VAEL(3 ),U,2)_"%" | |
2220 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)=IBSC | |
2221 | I '$O(^DP T(DFN,.372 ,0)) S CNT =CNT+1,^TM P("IBFBWE" ,$J,IBNAME ,DFN,IBAUT HQ | |
2222 | S IBI=0 F S IBI=$O( ^DPT(DFN,. 372,IBI)) Q:'IBI D | |
2223 | . S IBX=$ G(^DPT(DFN ,.372,IBI, 0)),IBY=$G (^DIC(31,+ IBX,0)) | |
2224 | . S IBD=$ S($P(IBY,U ,4)="":$P( IBY,U,1),1 :$P(IBY,U, 4))_" ("_$ P(IBX,U,2) _" | |
2225 | . I FIRST S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="RATED DQ | |
2226 | . S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)=" D | |
2227 | Q | |
2228 | ; | |
2229 | GETSTA ; G et Special Authority Eligibili ty | |
2230 | N IBY,FIR ST,FOUND,I BADT,IBARR | |
2231 | S IBADT=I BST | |
2232 | S FOUND=0 | |
2233 | S FIRST=1 | |
2234 | D CL^IBAC V(DFN,IBAD T,"",.IBAR R) | |
2235 | I $D(IBAR R(3)) S IB Y="SC TREA TMENT" D G ETSTA1 | |
2236 | I $D(IBAR R(7)),+$$C VEDT^IBACV (DFN,IBDAT ) S IBY="C OMBAT VETE RAN" D GET S1 | |
2237 | I $D(IBAR R(1)) S IB Y="AGENT O RANGE" D G ETSTA1 | |
2238 | I $D(IBAR R(2)) S IB Y="IONIZIN G RADIATIO N" D GETST A1 | |
2239 | I $D(IBAR R(4)) S IB Y="SOUTHWE ST ASIA" D GETSTA1 | |
2240 | I $D(IBAR R(8)) S IB Y="PROJECT 112/SHAD" D GETSTA1 | |
2241 | I $D(IBAR R(5)) S IB Y="MILITAR Y SEXUAL T RAUMA" D G ETSTA1 | |
2242 | I $D(IBAR R(6)) S IB Y="HEAD/NE CK CANCER" D GETSTA1 | |
2243 | I 'FOUND S CNT=CNT+ 1,^TMP("IB FBWE",$J,I BNAME,DFN, IBAUTH,CNT )="STA | |
2244 | Q | |
2245 | ; | |
2246 | GETSTA1 ; Set in ^TM P("IBFBWE" ,$J) | |
2247 | I FIRST S CNT=CNT+1 ,^TMP("IBF BWE",$J,IB NAME,DFN,I BAUTH,CNT) ="SPEC AUT H | |
2248 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)=" Y | |
2249 | Q | |
2250 | ; | |
2251 | GETINS ; G et insuran ce informa tion | |
2252 | N EXDTCK, IBEFF,IBEX P,IBGRP,IB INSCO,IBIN S0,IBINS1, IBINS7,IBS UB,IBVERBY ,S | |
2253 | D ALL^IBC NS1(DFN,"I BINS") | |
2254 | S (IBX,IB INSYES)=0 | |
2255 | I '$D(IBI NS) S CNT= CNT+1,^TMP ("IBFBWE", $J,IBNAME, DFN,IBAUTH ,CNT)="INS UQ | |
2256 | F S IBX=$ O(IBINS(IB X)) Q:'IBX D | |
2257 | . S IBINS 0=IBINS(IB X,0) | |
2258 | . S IBINS 1=IBINS(IB X,1) | |
2259 | . S IBINS 7=$G(IBINS (IBX,7)) | |
2260 | . S IBINS CO=$P(^DIC (36,+IBINS 0,0),U,1) | |
2261 | . S IBSUB =$P(IBINS7 ,U,1) | |
2262 | . S IBGRP =$P(IBINS0 ,U,3) | |
2263 | . S EXDTC K=+$P(IBIN S0,U,4) | |
2264 | . I EXDTC K,EXDTCK<I BST Q ; if insurance expired b efore the from date t | |
2265 | . S IBINS YES=1 | |
2266 | . S IBEFF =$$DAT1^IB OUTL($P(IB INS0,U,8)) | |
2267 | . S IBEXP =$$DAT1^IB OUTL($P(IB INS0,U,4)) | |
2268 | . S IBVER DT=$P($G(I BINS1),U,3 ) | |
2269 | . S IBVER BY=$P($G(I BINS1),U,4 ) | |
2270 | . I IBVER DT'="" S I BVERDT=$$F DATE^VALM1 (IBVERDT) | |
2271 | . I IBVER BY'="" S I BVERBY="BY "_$$GET1^ DIQ(200,IB VERBY_", " ,.01) | |
2272 | . S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)="INSU RANCE O | |
2273 | . S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)=" SUB SCRIBER B | |
2274 | . S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)=" GRO UP P | |
2275 | . S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)=" EFF DATE F | |
2276 | . S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)=" EXP DATE P | |
2277 | . S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)=" DT LAST VERIY | |
2278 | I IBINSYE S=0 S CNT= CNT+1,^TMP ("IBFBWE", $J,IBNAME, DFN,IBAUTH ,CNT)="INS U" | |
2279 | Q | |
2280 | ; | |
2281 | REFRESH ; Special Ex pand Scree n Refresh | |
2282 | K ^TMP("I BFBWE",$J) | |
2283 | D BLD | |
2284 | D GETSC | |
2285 | D GETSTA | |
2286 | D GETINS | |
2287 | D BLDEXP | |
2288 | S VALMBCK ="R" | |
2289 | Q | |
2290 | ; | |
2291 | HELP ; -- help code | |
2292 | S X="?" D DISP^XQOR M1 W !! | |
2293 | Q | |
2294 | ; | |
2295 | EXIT ; -- exit code | |
2296 | K ^TMP("I BFBWE",$J) | |
2297 | D ^%ZISC | |
2298 | S VALMBCK ="R" Q | |
2299 | Q | |
2300 | ||
2301 | Routines | |
2302 | Activities | |
2303 | Routine Na me | |
2304 | ^IBFBWL3 - Billing W orklist Ac tions(Note : ^IBFBWL6 is not us ed for the Billing W orklist. I t is for I B NVC Prec ert Workli st Actions , only – N SR #200810 10. | |
2305 | Enhancemen t Category | |
2306 | New | |
2307 | Modify | |
2308 | Delete | |
2309 | No Change | |
2310 | RTM | |
2311 | FRFEE-2.6 | |
2312 | Related Op tions | |
2313 | IB BILLING WORKLIST | |
2314 | ||
2315 | Related Ro utines | |
2316 | Routines “ Called By” | |
2317 | Routines “ Called” | |
2318 | ||
2319 | ||
2320 | Called by IB BILLING WORKIST A ction “WA” – ACTIONS ^IBFBWL | |
2321 | Standard L istMan rou tines | |
2322 | ^DIQ^DIE % DTCDIM^IBY MTC | |
2323 | ||
2324 | Routines | |
2325 | Activities | |
2326 | Data Dicti onary (DD) Reference s | |
2327 | PATIENT FI LE (#2) | |
2328 | Related Pr otocols | |
2329 | Lists | |
2330 | IB BILLING WORKLIST MENU | |
2331 | IB BILLING WORKLIST ACTIONS – ACTIONS^IB FBWL | |
2332 | ||
2333 | Correspond ing Menu ( Protocol) | |
2334 | IB BILLING WORKLIST ACTION MEN U | |
2335 | ||
2336 | Action Pro tocols | |
2337 | IB BILLING WORKLIST COMPLETE | |
2338 | IB BILLING WORKLIST REMOVE | |
2339 | ||
2340 | ||
2341 | Related In tegration Control Re gistration s (ICRs) | |
2342 | Yes – in p rocess | |
2343 | Data Passi ng | |
2344 | Input | |
2345 | Output Re ference | |
2346 | Both | |
2347 | Global Re ference | |
2348 | Local | |
2349 | Input Attr ibute Name and Defin ition | |
2350 | Name: None | |
2351 | Definition : None | |
2352 | Output Att ribute Nam e and Defi nition | |
2353 | Name: None | |
2354 | Definition : None | |
2355 | ||
2356 | Current Lo gic | |
2357 | New Routin e | |
2358 | ||
2359 | Modified L ogic (Chan ges are hi ghlighted) | |
2360 | IBFBWL3 ;A LB/PAW-IB BILLING Wo rklist Act ions ; 30- SEP-2015 | |
2361 | ;;2.0;INT EGRATED BI LLING;**55 4**;21-MAR -94;Build 3 | |
2362 | ;;Per VA Directive 6402, this routine s hould not be modifie d. | |
2363 | ;; | |
2364 | EN ; -- ma in entry p oint for I B BILLING WORKLIST A CTIONS | |
2365 | ; add cod e to do fi lters here | |
2366 | ; | |
2367 | D EN^VALM ("IB BILLI NG WORKLIS T ACTIONS" ) | |
2368 | Q | |
2369 | ; | |
2370 | HDR ; -- h eader code | |
2371 | ; | |
2372 | N IBSS,IB SSX,IBSSLE ,IBSSLS | |
2373 | S VALM("T ITLE")=" W orklist Ac tions" | |
2374 | S IBSSX=$ $GET1^DIQ( 2,DFN,.09, "I"),IBSSL E=$L(IBSSX ),IBSSLS=6 I $E(IBSS X5 | |
2375 | S IBSS=$E (IBNAME,1) _$E(IBSSX, IBSSLS,IBS SLE) | |
2376 | S VALMHDR (2)=" PATI ENT: "_IBN AME_" (ID: "_IBSS_") " | |
2377 | Q | |
2378 | ; | |
2379 | INIT ; -- init varia bles and l ist array | |
2380 | ; input - ^TMP("IBF BWA",$J)=D FN^IBNAME^ IBAUTH | |
2381 | ; output - none | |
2382 | N DFN,ECN T,IBAUTH,I BFBA,IBNAM E | |
2383 | I '$D(^TM P("IBFBWA" ,$J)) Q | |
2384 | S ECNT=$G (^TMP("IBF BWA",$J)) | |
2385 | S DFN=$P( ECNT,U,1), IBNAME=$P( ECNT,U,2), IBAUTH=$P( ECNT,U,3), IBFBA=$P(E C) | |
2386 | D BLD | |
2387 | Q | |
2388 | ; | |
2389 | BLD ; Buil d data to display | |
2390 | N IBGRPX, VALMY | |
2391 | D FULL^VA LM1 | |
2392 | S IBGRPX= $S(IBGRP=1 :"Facility Revenue R eview",IBG RP=2:"RUR SC/SA Revi e) | |
2393 | D SET^VAL M10(1,""," ") | |
2394 | D SET^VAL M10(2," Av ailable Ac tions:") | |
2395 | D SET^VAL M10(3,""," ") | |
2396 | D SET^VAL M10(4," En ter 1 to C OMPLETE th e "_IBGRPX _" process .") | |
2397 | D SET^VAL M10(5," En ter 2 to R EMOVE an i tem from t he worklis t.") | |
2398 | I IBGRP=2 D RURRC^I BFBWL6 | |
2399 | Q | |
2400 | ; | |
2401 | DONE ; Rev iew is com plete (for IBGRP) | |
2402 | N IBEVENT ,IBIEN,IBS CSA,IENROO T,FDA | |
2403 | S IENROOT ="" | |
2404 | D FIND | |
2405 | I IBGRP=2 D RURRC^I BFBWL6 ; A dditional prompt for RUR reaso n codes | |
2406 | I IBGRP=1 D | |
2407 | . D SCSA ; Determin e if Servi ce Connect ed or Spec ial Treatm ent Author s | |
2408 | . S FDA(3 60,IBIEN_" ,",2.03)=" XX" | |
2409 | . D UPDAT E^DIE(""," FDA","IENR OOT") | |
2410 | . I IBSCS A D ; If S C/STA move to RUR-SC queue | |
2411 | .. S FDA( 360,IBIEN_ ",",2.04)= "SC" | |
2412 | . I 'IBSC SA D ; If no SC/STA move to bi lling queu e | |
2413 | .. S FDA( 360,IBIEN_ ",",2.05)= "BI" | |
2414 | . D UPDAT E^DIE(""," FDA","IENR OOT") | |
2415 | I IBGRP=2 D | |
2416 | . S FDA(3 60,IBIEN_" ,",2.04)=" XX" | |
2417 | . D UPDAT E^DIE(""," FDA","IENR OOT") | |
2418 | . S FDA(3 60,IBIEN_" ,",2.05)=" BI" | |
2419 | . D UPDAT E^DIE(""," FDA","IENR OOT") | |
2420 | I IBGRP=3 D | |
2421 | . S FDA(3 60,IBIEN_" ,",2.05)=" XX" | |
2422 | . D UPDAT E^DIE(""," FDA","IENR OOT") | |
2423 | . D BILLI NG | |
2424 | D RESET | |
2425 | I IBGRP=2 D RURRCPR ^IBFBWL6 | |
2426 | S IBEVENT =$S(IBGRP= 1:"Fac Rev ",IBGRP=2: "RUR-SC/SA ",1:"Billi ng")_"-Com p) | |
2427 | D LOGUPD | |
2428 | S IBGRPX= $S(IBGRP=1 :"Facility Revenue R eview",IBG RP=2:"RUR SC/SA Revi e) | |
2429 | W !," Ite m for "_IB NAME_" has completed "_IBGRPX_ "." | |
2430 | D PAUSE^V ALM1 | |
2431 | S VALMBCK ="R" | |
2432 | Q | |
2433 | ; | |
2434 | REM ; Remo ve Item fr om Worklis t (log IBG RP) | |
2435 | N IBEVENT ,IBIEN,IEN ROOT | |
2436 | S IENROOT ="" | |
2437 | D FIND | |
2438 | I IBGRP=2 D RURRC^I BFBWL6 ; A dditional prompt for RUR reaso n codes | |
2439 | I IBGRP=1 D | |
2440 | . S FDA(3 60,IBIEN_" ,",2.03)=" XX" | |
2441 | . D UPDAT E^DIE(""," FDA","IENR OOT") | |
2442 | I IBGRP=2 D | |
2443 | . S FDA(3 60,IBIEN_" ,",2.04)=" XX" | |
2444 | . D UPDAT E^DIE(""," FDA","IENR OOT") | |
2445 | I IBGRP=3 D | |
2446 | . S FDA(3 60,IBIEN_" ,",2.05)=" XX" | |
2447 | . D UPDAT E^DIE(""," FDA","IENR OOT") | |
2448 | D RESET | |
2449 | S IBEVENT =$S(IBGRP= 1:"Fac Rev ",IBGRP=2: "RUR-SC/SA ",1:"Billi ng")_"-Ite m" | |
2450 | D LOGUPD | |
2451 | W !," Ite m for "_IB NAME_" has been remo ved from t he worklis t." | |
2452 | W !," Ple ase update Claims Tr acking wit h Non-bill able Reaso n, if need e" | |
2453 | D PAUSE^V ALM1 | |
2454 | S VALMBCK ="R" | |
2455 | Q | |
2456 | ; | |
2457 | ||
2458 | FIND ; Fin d Auth Mat ch | |
2459 | I IBFBA'= "" S IBIEN =IBFBA Q | |
2460 | N IBX | |
2461 | S IBX="" F S IBX=$O (^IBFB(360 ,"C",DFN,I BX)) Q:IBX ="" D | |
2462 | . I $P(^I BFB(360,IB X,0),U,3)= IBAUTH S I BIEN=IBX | |
2463 | Q | |
2464 | ; | |
2465 | LOGUPD ; U pdate Log | |
2466 | N FDA,IBD T,IBLOG | |
2467 | S IBDT=$$ NOW^XLFDT( ) | |
2468 | S FDA(360 .04,"+1,"_ IBIEN_",", .01)=IBDT, FDA(360.04 ,"+1,"_IBI EN_",",.03 )Z | |
2469 | S IBLOG=$ P($G(^IBFB (360,IBIEN ,4,0)),U,3 ) | |
2470 | S IBLOG=I BLOG+1 | |
2471 | S FDA(360 .04,"+1,"_ IBIEN_",", .02)=IBEVE NT | |
2472 | D UPDATE^ DIE("","FD A") | |
2473 | S ^IBFB(3 60,"DFN",D FN,DT,IBIE N,IBLOG)=" " | |
2474 | S ^IBFB(3 60,"DT",DT ,DFN,IBIEN ,IBLOG)="" | |
2475 | Q | |
2476 | ; | |
2477 | SCSA ; Det ermine Ser vice Conne cted or Sp ecial Auth ority Elig ibility St atus | |
2478 | N IBARR,I BSC,IBSTA, VAEL | |
2479 | S (IBSC,I BSCSA,IBST A)=1 | |
2480 | D ELIG^VA DPT | |
2481 | I VAEL(3) =0 S IBSC= 0 | |
2482 | D GETST^I BFBUTIL(IB IEN) | |
2483 | D CL^IBAC V(DFN,IBST ,"",.IBARR ) | |
2484 | I '$D(IBA RR) S IBST A=0 | |
2485 | I 'IBSC,' IBSTA S IB SCSA=0 | |
2486 | Q | |
2487 | ; | |
2488 | RESET ; Re set ^TMP g lobal | |
2489 | N IBDOS,I BTYP | |
2490 | S IBDOS=" " | |
2491 | F S IBDOS =$O(^TMP(" IBFBWL",$J ,IBDOS)) Q :IBDOS="" D | |
2492 | . S IBTYP ="" | |
2493 | . F S IBT YP=$O(^TMP ("IBFBWL", $J,IBDOS,I BTYP)) Q:I BTYP="" D | |
2494 | .. I $D(^ TMP("IBFBW L",$J,IBDO S,IBTYP,IB NAME,DFN,I BAUTH,IBFB A)) D | |
2495 | ... K ^TM P("IBFBWL" ,$J,IBDOS, IBTYP,IBNA ME,DFN,IBA UTH,IBFBA) | |
2496 | Q | |
2497 | ; | |
2498 | BILLING ; After fin al review by billing departmen t, prepare to bill | |
2499 | N IBBC,IB DD,IBFPNUM ,IBIFN,IBI DS,IBLOC,I BNPI,IBPAI D,IBPAYX,I BREND,IBRE T, IBRT,IB SER,IBSVC, IBSITE,IBS T,IBTAX,PR CASV | |
2500 | N IBFBVND ,IBA,IBHIT ,IBIBANPI | |
2501 | D DEM^VAD PT | |
2502 | D GETST^I BFBUTIL(IB IEN) ; Ge t Invoice, Start Dat e, Fee Pro gram | |
2503 | I '$D(IBF PNUM) Q | |
2504 | S IBIDS(" .03")=$G(I BST) ; St art Date o f Care | |
2505 | S IBLOC=$ S(IBFPNUM= 7:2,1:1) | |
2506 | S IBIDS(" .04")=IBLO C ; Locat ion of Car e 1 Hospit al 2 Skill ed Nursing | |
2507 | S IBBC=$S (IBFPNUM=2 :3,IBFPNUM =3:3,1:1) | |
2508 | S IBIDS(" .05")=IBBC ; Bill C lassificat ion 1 Inpa tient 3 Ou tpatient | |
2509 | S IBIDS(" .06")=1 ; Timeframe of Bill S et to 1 Ad mit throug h Discharg e | |
2510 | S IBRT="" | |
2511 | S IBRT=$O (^DGCR(399 .3,"B","FE E REIMB IN S",IBRT)) | |
2512 | S IBIDS(" .07")=IBRT ; Rate T ype Must b e Fee Reim bursable I nsurance | |
2513 | S IBIDS(" .11")="i" ; Whos Re sponsible This is al ways set t o "i" init ially | |
2514 | S IBDD=$P ($G(^IBE(3 50.9,1,1)) ,"^",25) | |
2515 | S IBIDS(" .22")=IBDD ; Defaul t Division - From IB Site Para meter File | |
2516 | S IBIDS(" .27")="" ; Bill Cha rge Type - This is a lways set to null in itially | |
2517 | S IBIDS(" 151")=$G(I BST) ; St atement Co vers From Date | |
2518 | S IBIDS(" 152")=$G(I BST) ; St atement Co vers To Da te | |
2519 | S IBIDS(" 155")=0 ; Sensitive Record - 0 is No | |
2520 | S IBSER=$ P(^IBE(350 .9,1,1),U, 14) | |
2521 | S PRCASV( "SER")=IBS ER ; MAS Service Po inter - Fr om IB Site Parameter File | |
2522 | D GETPAY^ IBFBUTIL(I BIEN) | |
2523 | S IBPAYX= "" | |
2524 | S IBPAYX= $O(IBRET(1 62.03,IBPA YX)) | |
2525 | S IBSITE= IBRET(162. 03,IBPAYX, 26,"I") | |
2526 | S PRCASV( "SITE")=IB SITE ; Si te | |
2527 | D ^IBCA2 ; This ca ll complet es initial bill and AR set up | |
2528 | S IBBILL= $P($G(IBDR ("0")),U,1 ) | |
2529 | S FDA(360 ,IBIEN_"," ,1.02)=IBB ILL | |
2530 | D UPDATE^ DIE("","FD A","IENROO T") | |
2531 | ; | |
2532 | S IBIFN=" " | |
2533 | S IBIFN=$ O(^DGCR(39 9,"B",IBBI LL,IBIFN)) | |
2534 | S IBNPI=I BRET(162.0 3,IBPAYX,6 4,"I") ; Non-VA Car e Facility NPI | |
2535 | I IBNPI=" " D ; See if NPI ca n be found via Auth and FB sid e | |
2536 | . S IBFBV ND=$$GET1^ DIQ(161.01 ,IBAUTH_", "_DFN_",", .04,"I") | |
2537 | . I IBFBV ND'="" S I BNPI=$$GET 1^DIQ(161. 2,IBFBVND_ ",",41.01, "I") | |
2538 | I IBNPI'= "" D | |
2539 | . S (IBIB A,IBHIT)=" " | |
2540 | . F S IB IBA=$O(^IB A(355.93,I BIBA)) Q:I BIBA="" D | |
2541 | .. S IBIB ANPI="" | |
2542 | .. F S I BIBANPI=$O (^IBA(355. 93,IBIBA," NPISTATUS" ,"C",IBIBA NPI)) Q:IB IB ANPI="" !(IBHIT) D | |
2543 | ... I IBI BANPI=IBNP I S IBHIT= 1 D | |
2544 | .... S FD A(399,IBIF N_",",232) =IBIBA | |
2545 | .... D UP DATE^DIE(" ","FDA") | |
2546 | S FDA(399 ,IBIFN_"," ,161)=30 | |
2547 | D UPDATE^ DIE("","FD A") | |
2548 | ; | |
2549 | ; Need to add billi ng provide r and prim ary dx, if possible | |
2550 | ; 252 BI LLING PROV IDER TAXON OMY <- Pntr [*P8 932.1'] | |
2551 | ; | |
2552 | W !,"Bill "_IBBILL_ " created for "_IBNA ME_"." | |
2553 | D PAUSE^V ALM1 | |
2554 | Q | |
2555 | ; | |
2556 | HELP ; -- help code | |
2557 | S X="?" D DISP^XQOR M1 W !! | |
2558 | Q | |
2559 | ; | |
2560 | EXIT ; -- exit code | |
2561 | D ^%ZISC | |
2562 | S VALMBCK ="R" | |
2563 | Q | |
2564 | ||
2565 | Routines | |
2566 | Activities | |
2567 | Routine Na me | |
2568 | ^IBFBWL4 – Worklist History | |
2569 | Enhancemen t Category | |
2570 | New | |
2571 | Modify | |
2572 | Delete | |
2573 | No Change | |
2574 | RTM | |
2575 | FRFEE-2.5 | |
2576 | Related Op tions | |
2577 | IB BILLING WORKLIST | |
2578 | ||
2579 | Related Ro utines | |
2580 | Routines “ Called By” | |
2581 | Routines “ Called” | |
2582 | ||
2583 | Called by IB BILLING WORKLIST Action “HI ” – HISTOR Y^IBFBWL | |
2584 | ||
2585 | Standard L istMan rou tines^DIQ | |
2586 | ||
2587 | Routines | |
2588 | Activities | |
2589 | Data Dicti onary (DD) Reference s | |
2590 | PATIENT FI LE (#2) | |
2591 | NEW PERSON FILE (#20 0)IB-FB IN TERFACE TR ACKING FIL E (#360) | |
2592 | Related Pr otocols | |
2593 | Lists | |
2594 | IB BILLING WORKLIST | |
2595 | IB BILLING WORKLIST HISTORY – HISTORY^IB FBWL | |
2596 | ||
2597 | Correspond ing Menu ( Protocol) | |
2598 | None | |
2599 | ||
2600 | Related In tegration Control Re gistration s (ICRs) | |
2601 | Yes – in p rocess | |
2602 | Data Passi ng | |
2603 | Input | |
2604 | Output Re ference | |
2605 | Both | |
2606 | Global Re ference | |
2607 | Local | |
2608 | Input Attr ibute Name and Defin ition | |
2609 | Name: None | |
2610 | Definition : None | |
2611 | Output Att ribute Nam e and Defi nition | |
2612 | Name: None | |
2613 | Definition : None | |
2614 | ||
2615 | Current Lo gic | |
2616 | New Routin e | |
2617 | ||
2618 | Modified L ogic (Chan ges are hi ghlighted) | |
2619 | IBFBWL4 ;A LB/PAW-IB BILLING Wo rklist Wor klist Hist ory ; 30-S EP-2015 | |
2620 | ;;2.0;INT EGRATED BI LLING;**55 4**;21-MAR -94;Build 3 | |
2621 | ;;Per VA Directive 6402, this routine s hould not be modifie d. | |
2622 | ;; | |
2623 | EN ; -- ma in entry p oint for I B BILLING WORKLIST H ISTORY | |
2624 | D EN^VALM ("IB BILLI NG WORKLIS T HISTORY" ) | |
2625 | Q | |
2626 | ; | |
2627 | HDR ; -- h eader code | |
2628 | N IBSS,IB SSX,IBSSLE ,IBSSLS | |
2629 | S VALM("T ITLE")=" W orklist Hi story" | |
2630 | S IBSSX=$ $GET1^DIQ( 2,DFN_",", .09,"I"),I BSSLE=$L(I BSSX),IBSS LS=6 I $E( IB | |
2631 | SSX,IBSSLE )="P" S IB SSLS=5 | |
2632 | S IBSS=$E (IBNAME,1) _$E(IBSSX, IBSSLS,IBS SLE) | |
2633 | S VALMHDR (2)=" PATI ENT: "_IBN AME_" (ID: "_IBSS_") " | |
2634 | Q | |
2635 | ; | |
2636 | INIT ; -- init varia bles and l ist array | |
2637 | ; input - ^TMP("IBF BWH",$J,IB A)=IBHDT^I BHLG^IBHUS R | |
2638 | ; output - Worklist History S creen for one Patien t / Auth | |
2639 | N IBA,IBH DT,IBHLG,I BLN,IBRUR, IBRURT,IBU SR,LINE,VC NT | |
2640 | S (VCNT,V ALMCNT)=0 | |
2641 | S IBA="" | |
2642 | F S IBA=$ O(^TMP("IB FBWH",$J,I BA)) Q:+IB A=0 D | |
2643 | . S IBRUR T="" | |
2644 | . S IBLN= ^TMP("IBFB WH",$J,IBA ) | |
2645 | . S IBHDT =$P(IBLN,U ,1) | |
2646 | . S IBHLG =$P($P(IBL N,U,2),"|" ) | |
2647 | . S IBRUR =$P($P(IBL N,U,2),"|" ,2) | |
2648 | . I IBRUR '="" D RUR | |
2649 | . S IBUSR =$P(IBLN,U ,3) | |
2650 | . I IBUSR ="" S IBUS R="SYSTEM" | |
2651 | . E S IBU SR=$$GET1^ DIQ(200,IB USR_",",.0 1) | |
2652 | . S VCNT= VCNT+1 | |
2653 | . S LINE= $$SETL("", VCNT,"",1, 4) ;line# | |
2654 | . D BLD | |
2655 | Q | |
2656 | ; | |
2657 | RUR ; Dete rmine RUR Reason Cod e | |
2658 | S IBRURT= $S(IBRUR=1 :"Pend Pay er Action" ,IBRUR=2:" Addl Info Req-FR",IB RUR=3:"Aut h Not Req - SC/SA",I BRUR=4:"Au thNotReq-P ayerCont", 1:"") | |
2659 | Q:IBRURT' ="" | |
2660 | S IBRURT= $S(IBRUR=5 :"Auth Not Reqd",IBR UR=6:"Auth Obtained" ,IBRUR=7:" Cont Stay Rev",IBRUR =8:"Discha rge Rev Re q",1:"") | |
2661 | Q:IBRURT' ="" | |
2662 | S IBRURT= $S(IBRUR=9 :"Part SC- Auth Worke d",IBRUR=1 0:"PartSta y/VisitApp d",IBRUR=1 1:"Auth De nied",1:"" ) | |
2663 | Q:IBRURT' ="" | |
2664 | S IBRURT= $S(IBRUR=1 2:"AuthNot Obt/NoROI/ FR",IBRUR= 13:"Relate d to Legal ",1:"") | |
2665 | Q | |
2666 | ; | |
2667 | BLD ; buil d data to display | |
2668 | S LINE=$$ SETL(LINE, IBHDT,"",5 ,8) | |
2669 | S LINE=$$ SETL(LINE, IBHLG,"",1 4,20) | |
2670 | S LINE=$$ SETL(LINE, IBRURT,"", 35,20) | |
2671 | S LINE=$$ SETL(LINE, IBUSR,"",5 6,23) | |
2672 | S VALMCNT =VALMCNT+1 | |
2673 | D SET^VAL M10(VALMCN T,LINE,VCN T) | |
2674 | Q | |
2675 | ; | |
2676 | SETL(LINE, DATA,LABEL ,COL,LNG) ; Creates a line of data to be set into the body | |
2677 | ; of the worklist | |
2678 | ; Input: LINE - Cur rent line being crea ted | |
2679 | ; DATA - Informatio n to be ad ded to the end of th e current line | |
2680 | ; LABEL - Label to describe t he informa tion being added | |
2681 | ; COL - C olumn posi tion in li ne to add informatio n add | |
2682 | ; LNG - M aximum len gth of dat a informat ion to inc lude on th e line | |
2683 | ; Returns : Line upd ated with added info rmation | |
2684 | S LINE=LI NE_$J("",( COL-$L(LAB EL)-$L(LIN E)))_LABEL _$E(DATA,1 ,LNG) | |
2685 | Q LINE | |
2686 | ; | |
2687 | HELP ; -- help code | |
2688 | S X="?" D DISP^XQOR M1 W !! | |
2689 | Q | |
2690 | ; | |
2691 | EXIT ; -- exit code | |
2692 | D ^%ZISC | |
2693 | S VALMBCK ="R" Q | |
2694 | Q | |
2695 | ||
2696 | Routines | |
2697 | Activities | |
2698 | Routine Na me | |
2699 | ^IBFBWLR– Prints His torical Wo rklist Act ion Data b y Patient or Date Ra nge | |
2700 | Enhancemen t Category | |
2701 | New | |
2702 | Modify | |
2703 | Delete | |
2704 | No Change | |
2705 | RTM | |
2706 | FRFEE-2.5, FRFEE-2.1 0 | |
2707 | Related Op tions | |
2708 | IB NVC BIL LING WORKL IST REPORT | |
2709 | ||
2710 | Related Ro utines | |
2711 | Routines “ Called By” | |
2712 | Routines “ Called” | |
2713 | ||
2714 | Called by VistA Opti on: IB NVC BILLING W ORKLIST RE PORT | |
2715 | ||
2716 | ||
2717 | Routines | |
2718 | Activities | |
2719 | Data Dicti onary (DD) Reference s | |
2720 | PATIENT FI LE (#2) | |
2721 | NEW PERSON FILE (#20 0)IB-FB IN TERFACE TR ACKING FIL E (#360) | |
2722 | Related Pr otocols | |
2723 | None | |
2724 | Related In tegration Control Re gistration s (ICRs) | |
2725 | Yes – in p rocess | |
2726 | Data Passi ng | |
2727 | Input | |
2728 | Output Re ference | |
2729 | Both | |
2730 | Global Re ference | |
2731 | Local | |
2732 | Input Attr ibute Name and Defin ition | |
2733 | Name: None | |
2734 | Definition : None | |
2735 | Output Att ribute Nam e and Defi nition | |
2736 | Name: None | |
2737 | Definition : None | |
2738 | ||
2739 | Current Lo gic | |
2740 | New Routin e | |
2741 | ||
2742 | Modified L ogic (Chan ges are hi ghlighted) | |
2743 | IBFBWLR ;A LB/PAW-NVC and Billi ng Worklis t Worklist History R eport ; 30 -SEP-2015 | |
2744 | ;;2.0;INT EGRATED BI LLING;**55 4**;21-MAR -94;Build 3 | |
2745 | ;;Per VA Directive 6402, this routine s hould not be modifie d. | |
2746 | ;; | |
2747 | EN ; -- Ma in entry p oint for N VC and Bil ling Workl ist Histor y Report | |
2748 | N DFN,IBC ,IBDA,IBDB ,IBDC,IBDL ,IBDT,IBDT R,IBDT1,IB DT2,IBDTTM | |
2749 | N IBDUZ,I BEVNT,IBHD T,IBI,IBPG ,IBQUIT,IB RANGE | |
2750 | D PROMPT | |
2751 | D PRINT | |
2752 | D EXIT | |
2753 | Q | |
2754 | ; | |
2755 | PROMPT ; - Report pr ompts | |
2756 | ; Can be run by PAT IENT or DA TE RANGE | |
2757 | S DIR(0)= "S^P:Patie nt;D:Date Range" | |
2758 | S DIR("A" )="Report by Patient or Date R ange" | |
2759 | S DIR("B" )="Date Ra nge" | |
2760 | S DIR("?" ,1)="Enter P to prin t the work list histo ry data fo r one pati ent." | |
2761 | S DIR("?" ,2)="Enter D to prin t all work list histo ry data fo r a date r ange." | |
2762 | S DIR("?" )="Enter a code from the list. " | |
2763 | D ^DIR K DIR G:$D(D IRUT) EXIT | |
2764 | S IBRANGE =$S(Y="D": 1,1:0) | |
2765 | ; | |
2766 | I IBRANGE D G:$D(DI RUT) EXIT | |
2767 | . ; Ask d ates | |
2768 | . S DIR(0 )="D^::EX" ,DIR("A")= "From Date " | |
2769 | . ; Defau lt from da te is firs t day of c urrent mon th | |
2770 | . S DIR(" B")=$$FMTE ^XLFDT($E( DT,1,5)_"0 1") | |
2771 | . D ^DIR K DIR Q:$D (DIRUT) | |
2772 | . S IBDT1 =Y | |
2773 | . S DIR(0 )="DA^"_IB DT1_"::EX" ,DIR("A")= "To Date: " | |
2774 | . ; Defau lt to date is last d ay of spec ified mont h | |
2775 | . S X=IBD T1 D DIM^I BYMTC | |
2776 | . S DIR(" B")=$$FMTE ^XLFDT($E( IBDT1,1,5) _X) | |
2777 | . D ^DIR K DIR Q:$D (DIRUT) | |
2778 | . S IBDT2 =Y | |
2779 | ; | |
2780 | ; If not date range then ask patient | |
2781 | I 'IBRANG E D G:$D(D IRUT) EXIT | |
2782 | . S DIC=2 ,DIC(0)="A E" | |
2783 | . S DIC(" A")="Selec t Patient: " | |
2784 | . D ^DIC | |
2785 | . S DFN=$ P(Y,U) | |
2786 | ; | |
2787 | ; Ask dev ice | |
2788 | S %ZIS="Q M" D ^%ZIS G:POP EXI T | |
2789 | I $D(IO(" Q")) D G E XIT | |
2790 | . S ZTRTN ="QEN^IBFB WLR",ZTDES C="NVC/Bil ling Workl ist Histor y" | |
2791 | . F IBX=" IBAAIN","I BDT*","IBR ANGE" S ZT SAVE(IBX)= "" | |
2792 | . D ^%ZTL OAD,HOME^% ZIS K ZTSK | |
2793 | QEN ; queu ed entry | |
2794 | U IO | |
2795 | Q | |
2796 | ; | |
2797 | PRINT ; Re port data | |
2798 | S IBQUIT= 0 | |
2799 | S IBPG=0 D NOW^%DTC S Y=% D D D^%DT S IB DTR=Y | |
2800 | K IBDL S IBDL="",$P (IBDL,"-", IOM)="" | |
2801 | ; | |
2802 | ; Build p age header text for selection criteria | |
2803 | S:IBRANGE IBHDT(1)= " For "_$$ FMTE^XLFDT (IBDT1)_" through "_ $$FMTE^XLF DT(IBDT2) | |
2804 | ; | |
2805 | D HD | |
2806 | ; | |
2807 | ; Initial ize Counte r | |
2808 | S IBC=0 | |
2809 | ; | |
2810 | ; If by d ate range | |
2811 | I IBRANGE D | |
2812 | . S IBDT= IBDT1-.000 0001 | |
2813 | . F S IBD T=$O(^IBFB (360,"DT", IBDT)) Q:' IBDT!(IBDT >(IBDT2_". 999999")) D Q:IBQUIT | |
2814 | .. S IBDA ="" F S IB DA=$O(^IBF B(360,"DT" ,IBDT,IBDA )) Q:'IBDA D Q:IBQUI T | |
2815 | ... S IBD B="" F S I BDB=$O(^IB FB(360,"DT ",IBDT,IBD A,IBDB)) Q :'IBDB D Q :IBQUIT | |
2816 | .... S IB DC="" F S IBDC=$O(^I BFB(360,"D T",IBDT,IB DA,IBDB,IB DC)) Q:'IB DC D Q:IBQ UIT | |
2817 | ..... S D FN=IBDA | |
2818 | ..... D S ETVARS | |
2819 | ..... D P RINT1 | |
2820 | ; | |
2821 | ; If by p atient | |
2822 | I 'IBRANG E D | |
2823 | . S IBDA= "" F S IBD A=$O(^IBFB (360,"DFN" ,DFN,IBDA) ) Q:'IBDA D Q:IBQUIT | |
2824 | .. S IBDB ="" F S IB DB=$O(^IBF B(360,"DFN ",DFN,IBDA ,IBDB)) Q: 'IBDB D Q: IBQUIT | |
2825 | ... S IBD C="" F S I BDC=$O(^IB FB(360,"DF N",DFN,IBD A,IBDB,IBD C)) Q:'IBD C D Q:IBQU IT | |
2826 | .... D SE TVARS | |
2827 | .... D PR INT1 | |
2828 | ; | |
2829 | I IBC=0 W !,"No wor klist hist ory entrie s found." | |
2830 | ; | |
2831 | I IBQUIT W !!,"REPO RT STOPPED AT USER R EQUEST" | |
2832 | ; | |
2833 | I 'IBQUIT ,$E(IOST,1 ,2)="C-" S DIR(0)="E " D ^DIR K DIR | |
2834 | D ^%ZISC | |
2835 | Q | |
2836 | ; | |
2837 | SETVARS ; Set variab les | |
2838 | S IBDTTM= $P($G(^IBF B(360,IBDB ,4,IBDC,0) ),U,1) | |
2839 | S IBEVNT= $P($P($G(^ IBFB(360,I BDB,4,IBDC ,0)),U,2), "|") | |
2840 | S IBDUZ=$ P($G(^IBFB (360,IBDB, 4,IBDC,0)) ,U,3) | |
2841 | Q | |
2842 | ; | |
2843 | HD ; Page header | |
2844 | I $D(ZTQU EUED),$$S^ %ZTLOAD S ZTSTOP=1,I BQUIT=1 Q | |
2845 | I $E(IOST ,1,2)="C-" ,IBPG S DI R(0)="E" D ^DIR K DI R I 'Y S I BQUIT=1 Q | |
2846 | I $E(IOST ,1,2)="C-" !IBPG W @I OF | |
2847 | S IBPG=IB PG+1 | |
2848 | W !,"NVC/ Billing Wo rklist His tory " | |
2849 | I IBRANGE W "by Dat e Range" | |
2850 | E W "by P atient" | |
2851 | W ?49,IBD TR,?72,"pa ge ",IBPG | |
2852 | S IBI=0 F S IBI=$O( IBHDT(IBI) ) Q:'IBI W !,IBHDT(I BI) | |
2853 | W !!,"Dat e/Time",?1 9,"Patient ",?40,"Eve nt",?61,"U ser" | |
2854 | W !,IBDL | |
2855 | Q | |
2856 | ; | |
2857 | PRINT1 ; P rint one h istory rec ord | |
2858 | N IBCNT,I BRUR,IBRUR T,IBRURTX | |
2859 | S IBC=IBC +1 | |
2860 | I $Y+9>IO SL D HD Q: IBQUIT | |
2861 | S Y=IBDTT M D DD^%DT S IBDTTM= Y | |
2862 | W !,$P(IB DTTM,":",1 ,2),?19,$E ($$GET1^DI Q(2,DFN_", ",.01),1,2 0),?40,$E( IB | |
2863 | EVNT,1,20) ,?61,$E($$ GET1^DIQ(2 00,IBDUZ_" ,",.01),1, 18) | |
2864 | I $P($P($ G(^IBFB(36 0,IBDB,4,I BDC,0)),U, 2),"|",2)' ="" D | |
2865 | . S IBRUR T="" | |
2866 | . S IBRUR =$P($P(^IB FB(360,IBD B,4,IBDC,0 ),U,2),"|" ,2) | |
2867 | . S IBRUR T=$S(IBRUR =1:"Pend P ayer Actio n",IBRUR=2 :"Addl Inf o Req-FR", IB | |
2868 | RUR=3:"Aut h Not Req - SC/SA",I BRUR=4:"Au thNotReq-P ayerCont", 1:"") | |
2869 | . Q:IBRUR T'="" | |
2870 | . S IBRUR T=$S(IBRUR =5:"Auth N ot Reqd",I BRUR=6:"Au th Obtaine d",IBRUR=7 :" | |
2871 | Cont Stay Rev",IBRUR =8:"Discha rge Rev Re q",1:"") | |
2872 | . Q:IBRUR T'="" | |
2873 | . S IBRUR T=$S(IBRUR =9:"Part S C-Auth Wor ked",IBRUR =10:"PartS tay/VisitA pp | |
2874 | d",IBRUR=1 1:"Auth De nied",1:"" ) | |
2875 | . Q:IBRUR T'="" | |
2876 | . S IBRUR T=$S(IBRUR =12:"AuthN otObt/NoRO I/FR",IBRU R=13:"Rela ted to Leg al",1:"") | |
2877 | I $G(IBRU RT)'="" W !?4,"RUR R eason: ",I BRURT | |
2878 | Q | |
2879 | ; | |
2880 | EXIT ; | |
2881 | I $D(ZTQU EUED) S ZT REQ="@" | |
2882 | K %,DIC,D IR,DIROUT, DIRUT,DTOU T,DUOUT,I, J,POP,X,Y | |
2883 | Q | |
2884 | Templates | |
2885 | Table 5: T emplates | |
2886 | Templates | |
2887 | Descriptio n | |
2888 | Template N ame | |
2889 | The Billin g Worklist utilizes VistA List Manager “ Lists” tha t are supp orted by “ Protocols” . Some of the Workli sts / Prot ocols are “shared” w ith the IB NBC Prece rt Worklis t (NSR #20 081010) | |
2890 | ||
2891 | List Templ ate (Main) | |
2892 | IB BILLING WORKLIST – EN^IBFBW L | |
2893 | ||
2894 | List Templ ate (Workl ist Action s) | |
2895 | IB BILLING WORKLIST ACTIONS - ACTIONS^IB FBWL | |
2896 | ||
2897 | List Templ ate (Expan d Authoriz ation View ) | |
2898 | IB BILLING WORKLIST EXPAND – E XPAND^IBFB WL | |
2899 | ||
2900 | List Templ ate (Autho rization H istory) | |
2901 | IB BILLING WORKLIST HISTORY – HISTORY^IB FBWL | |
2902 | ||
2903 | Enhancemen t Category | |
2904 | New | |
2905 | Modify | |
2906 | Delete | |
2907 | No Change | |
2908 | RSD | |
2909 | ||
2910 | Template T ype | |
2911 | Sort | |
2912 | Input | |
2913 | ||
2914 | Other | |
2915 | Related Op tions | |
2916 | ||
2917 | ||
2918 | Related Ro utines | |
2919 | Routines “ Called By” | |
2920 | Routines “ Called” | |
2921 | NONE | |
2922 | NONE | |
2923 | NONE | |
2924 | ||
2925 | Routines | |
2926 | Descriptio n | |
2927 | DD Referen ces | |
2928 | NONE | |
2929 | Global Ref erences | |
2930 | NONE | |
2931 | Bulletins | |
2932 | No Bulleti ns changed . | |
2933 | Data Entri es Affecte d by the D esign | |
2934 | No data En tries affe cted by th e Design. | |
2935 | Unique Rec ord(s) | |
2936 | No Unique Records ch anged. | |
2937 | File or Gl obal Size Changes | |
2938 | Table 6: F ile or Glo bal Size C hanges | |
2939 | File/Globa l Name(s) | |
2940 | Estimated Increase | |
2941 | Estimated Decrease | |
2942 | Integrated Billing F B Interfac e Tracking File (#36 0) | |
2943 | New File – Minimal p er each FB CS authori zation | |
2944 | N/A | |
2945 | Mail Group s | |
2946 | No Mail Gr oups chang es. | |
2947 | ||
2948 | Security K eys | |
2949 | No Securit y Keys cha nged. | |
2950 | ||
2951 | Options – Note: Per VA Policy Analyst De cision (12 /2016), IB Billing W orklist Op tion is di sabled. Co de will re main in pa tch. | |
2952 | Table 7: O ptions | |
2953 | Options | |
2954 | Activities | |
2955 | Option Nam e | |
2956 | IB BILLING WORKLIST | |
2957 | IB NVC BIL LING WORKL IST REPORT | |
2958 | Enhancemen t Category | |
2959 | New | |
2960 | Modify | |
2961 | Delete | |
2962 | No Change | |
2963 | Associated Menu Opti ons that w ill invoke this refe rence | |
2964 | None | |
2965 | Data Passi ng | |
2966 | Input | |
2967 | Output | |
2968 | Both | |
2969 | Global Re ference | |
2970 | Local Ref erence | |
2971 | Menu Text Descriptio n | |
2972 | None | |
2973 | Option Typ e | |
2974 | Edit | |
2975 | ||
2976 | Menu | |
2977 | Inquire | |
2978 | ||
2979 | Action | |
2980 | Run Routi ne | |
2981 | Other | |
2982 | ||
2983 | Associated Routine | |
2984 | EN^IBFBWL | |
2985 | EN^IBFBWLR | |
2986 | Option Def inition | |
2987 | This optio n will dis play the I B BILLING WORKLIST f or Facilit y Revenue, RUR-SC an d Billing workgroups | |
2988 | This optio n will dis play histo rical work list activ ity by pat ient or da te range | |
2989 | ||
2990 | Protocols | |
2991 | Table 8: P rotocols | |
2992 | Protocol N ame | |
2993 | Activities | |
2994 | ||
2995 | The Billin g Worklist utilizes VistA List Manager “ Lists” tha t are supp orted by “ Protocols” . Some of the Workli sts / Prot ocols are “shared” w ith the IB NBC Prece rt Worklis t (NSR #20 081010) | |
2996 | Following details th e relation ship betwe en the Lis t Template s and Prot ocols: | |
2997 | List Templ ate (Main) | |
2998 | IB BILLING WORKLIST – EN^IBFBW L | |
2999 | Correspond ing Menu ( Protocol) | |
3000 | IB BILLING WORKLIST MENU | |
3001 | Action Pro tocols | |
3002 | IB BILLING WORKLIST REFRESH - REFRESH^IB FBWL | |
3003 | IB BILLING WORKLIST EXPAND - E XPAND^IBFB WL | |
3004 | IB BILLING WORKLIST CLAIMS TRA CKING – LI NKCT^IBFBW L | |
3005 | IB BILLING WORKLIST ACTIONS – ACTIONS^IB FBWL | |
3006 | IB BILLING WORKLIST HISTORY – HISTORY^IB FBWL | |
3007 | ||
3008 | List Templ ate (Workl ist Action s) | |
3009 | IB BILLING WORKLIST ACTIONS - ACTIONS^IB FBWL | |
3010 | Correspond ing Menu ( Protocol) | |
3011 | IB BILLING WORKLIST ACTION MEN U | |
3012 | Action Pro tocols | |
3013 | IB BILLING WORKLIST COMPLETE – DONE^IBFB WL3 | |
3014 | IB BILLING WORKLIST REMOVE – R EM^IBFBWL3 | |
3015 | ||
3016 | List Manag er (Expand Authoriza tion View) | |
3017 | IB BILLING WORKLIST EXPAND – E XPAND^IBFB WL | |
3018 | Correspond ing Menu ( Protocol) | |
3019 | IB BILLING WORKLIST EXPAND MEN U PROTOCOL | |
3020 | Action Pro tocols | |
3021 | IB BILLING WORKLIST EXPAND REF RESH – REF RESH^IBFBW L2 | |
3022 | ||
3023 | List Manag er (Author ization Hi story) | |
3024 | IB BILLING WORKLIST HISTORY – HISTORY^IB FBWL | |
3025 | Correspond ing Menu ( Protocol) | |
3026 | None | |
3027 | Action Pro tocols | |
3028 | None | |
3029 | Enhancemen t Category | |
3030 | New Modi fy Delete No Chang e | |
3031 | Associated Protocols | |
3032 | None | |
3033 | Data Passi ng | |
3034 | Input Ou tput Both Global R eference Local Refe rence | |
3035 | Item Text Descriptio n | |
3036 | None | |
3037 | Protocol T ype | |
3038 | Action M enu Proto col Proto col Menu Limited Pr otocol Ex tended Act ion Dialo g Other ( See Above) | |
3039 | Associated Routine | |
3040 | ^IBWLST* | |
3041 | ||
3042 | RPC | |
3043 | No RPC cha nges. | |
3044 | Constants Defined in Interface | |
3045 | No Constan ts Defined in Interf ace. | |
3046 | Variables Defined in Interface | |
3047 | No Variabl es Defined in Interf ace. | |
3048 | Types Defi ned in Int erface | |
3049 | No Types d efined in Interface. | |
3050 | GUI | |
3051 | No GUI cha nges. | |
3052 | GUI Classe s | |
3053 | No GUI Cla ss changes . | |
3054 | Current Fo rm | |
3055 | No changes . | |
3056 | Modified F orm | |
3057 | No changes . | |
3058 | Components on Form | |
3059 | No changes . | |
3060 | Events | |
3061 | No Changes . | |
3062 | Methods | |
3063 | No Changes . | |
3064 | Special Re ferences | |
3065 | No changes . | |
3066 | Class Even ts | |
3067 | No changes . | |
3068 | Class Meth ods | |
3069 | No changes . | |
3070 | Class Prop erties | |
3071 | No changes . | |
3072 | Uses Claus e | |
3073 | No changes . | |
3074 | Forms | |
3075 | No changes . | |
3076 | ||
3077 | Functions | |
3078 | No changes . | |
3079 | ||
3080 | Dialog | |
3081 | No changes . | |
3082 | Help Frame | |
3083 | No changes . | |
3084 | ||
3085 | HL7 Applic ation Para meter | |
3086 | No changes . | |
3087 | HL7 Logica l Link | |
3088 | No changes . | |
3089 | ||
3090 | Commercial Off-the-S helf (COTS ) Interfac e | |
3091 | No changes . | |
3092 | Network De tailed Des ign | |
3093 | There are no network topology changes re lated to t his projec t. | |
3094 | Security a nd Privacy | |
3095 | This proje ct does no t add any additional security or privacy design co nsideratio ns. | |
3096 | Security | |
3097 | Security a nd Privacy are contr olled by t he VistA a pplication and the u nderlying operating system. Th is applica tion does not mandat e any addi tional sec urity or p rivacy req uirements. | |
3098 | Privacy | |
3099 | Security a nd Privacy are contr olled by t he VistA a pplication and the u nderlying operating system. Th is applica tion does not mandat e any addi tional sec urity or p rivacy req uirements. | |
3100 | SOA/ESS De tailed Des ign | |
3101 | Not applic able – ref erence Sec tion 4.4. | |
3102 | External S ystem Inte rface Desi gn | |
3103 | Not applic able – the re is no e xternal sy stem invol ved with t his projec t. | |
3104 | Human-Mach ine Interf ace | |
3105 | Not applic able – thi s project does not c hange the human-mach ine interf ace, which is done v ia the Vis tA user op tions. | |
3106 | ||
3107 | Attachment A – Appro val Signat ures | |
3108 | The signat ure below is an ackn owledgemen t that the signatory understan ds the pur pose and c ontent of this docum ent. By si gning this document, you agree to this a s the SDD to begin w ork on the project d escribed w ithin, and commitmen t of the n ecessary r esources. | |
3109 | ||
3110 | ||
3111 | ||
3112 | __________ __________ __________ __________ __________ __________ __________ ______ | |
3113 | Charles Du nn | |
3114 | Office of Informatio n & Techno logy (OI&T ) Project Manager (P jM),Date | |
3115 | Integrated Project T eam (IPT) Co-Chair | |
3116 | ||
3117 | ||
3118 | ||
3119 | __________ __________ __________ __________ __________ __________ __________ ______ | |
3120 | Greg Estes | |
3121 | Business S ponsorDate | |
3122 | ||
3123 | ||
3124 | ||
3125 | __________ __________ __________ __________ __________ __________ __________ ______ | |
3126 | Ann Kliegl | |
3127 | VHA PjM, I PT Co-Chai rDate | |
3128 | ||
3129 | ||
3130 | Attachment B – Acron yms | |
3131 | Table 8: A cronym Lis t | |
3132 | Term | |
3133 | Definition | |
3134 | AITC | |
3135 | Austin Inf ormation T echnology Center | |
3136 | API | |
3137 | Applicatio n Programm ing Interf ace | |
3138 | BN | |
3139 | Business N eed | |
3140 | BRD | |
3141 | Business R equirement s Document | |
3142 | CBO | |
3143 | Chief Busi ness Offic e | |
3144 | CBOC | |
3145 | Community Based Outp atient Cli nic | |
3146 | CLC | |
3147 | Community Living Cen ter | |
3148 | COTS | |
3149 | Commercial Off-the-S helf | |
3150 | CP&E | |
3151 | Claims Pro cessing an d Eligibil ity | |
3152 | CPRS | |
3153 | Computeriz ed Patient Record Sy stem | |
3154 | DBMS | |
3155 | Database M anagement System | |
3156 | DD | |
3157 | Data Dicti onary | |
3158 | EDI | |
3159 | Electronic Data Inte rchange | |
3160 | EHR | |
3161 | Electronic Health Re cord | |
3162 | ERD | |
3163 | Entity Rel ationship Diagram | |
3164 | ERR | |
3165 | Enterprise Requireme nts Reposi tory | |
3166 | ESS | |
3167 | Enterprise Shared Se rvices | |
3168 | FB | |
3169 | Fee Basis | |
3170 | FBCS | |
3171 | Fee Basis Claims Sys tem | |
3172 | GUI | |
3173 | Graphical User Inter face | |
3174 | HL7 | |
3175 | Health Lev el 7 | |
3176 | IB | |
3177 | Integrate d Billing | |
3178 | ICR | |
3179 | Integratio n Control Registrati on | |
3180 | IPT | |
3181 | Integrated Project T eam | |
3182 | LAN | |
3183 | Local Area Network | |
3184 | MCCF | |
3185 | Medical Ca re Collect ion Fund | |
3186 | MCCR | |
3187 | Medical Ca re Cost Re covery | |
3188 | MDWS | |
3189 | Medical Do main Web S ervices | |
3190 | MUMPS | |
3191 | Massachuse tts Genera l Hospital Utility M ulti-Progr amming Sys tem | |
3192 | NFPO | |
3193 | National F ee Program Office | |
3194 | OI&T | |
3195 | Office of Informatio n & Techno logy | |
3196 | OIG | |
3197 | Office of Inspector General | |
3198 | OWNR | |
3199 | Owner Requ irement | |
3200 | PjM | |
3201 | Project Ma nager | |
3202 | RPC | |
3203 | Remote Pro cedure Cal l | |
3204 | RSD | |
3205 | Requiremen ts Specifi cation Doc ument | |
3206 | RTM | |
3207 | Requiremen ts Traceab ility Matr ix | |
3208 | RUR | |
3209 | Revenue Ut ilization Review | |
3210 | SDD | |
3211 | System Des ign Docume nt | |
3212 | SOA | |
3213 | Service Or iented Arc hitecture | |
3214 | TSPR | |
3215 | Technical Services P roject Rep ository | |
3216 | VA | |
3217 | Department of Vetera ns Affairs | |
3218 | VACO | |
3219 | VA Central Office | |
3220 | VAMC | |
3221 | VA Medical Center | |
3222 | VHA | |
3223 | Veterans H ealth Admi nistration | |
3224 | VISN | |
3225 | Veterans I ntegrated Service Ne tworks | |
3226 | VistA | |
3227 | Veterans H ealth Info rmation Sy stems and Technology Architect ure | |
3228 | ||
3229 | Attachment C – Addit ional Info rmation | |
3230 | This secti on and its sub-secti ons are to be determ ined. Blan k sections have been kept for version co ntrol. | |
3231 | A.1 Identi fication o f Technolo gy and Sta ndards | |
3232 | A.2 Constr aining Pol icies, Dir ectives an d Procedur es | |
3233 | A.3 RTM | |
3234 | The Fee-Re venue Enha ncements R TM is avai lable via TSPR here: http:// DNS /warboard/ anotebk.as p?proj=178 6&Type=Act ive | |
3235 | Until the RTM is app roved and posted to TSPE, it w ill be mad e availabl e upon req uest from the projec t team. | |
3236 | A.4 Packag ing and In stallation | |
3237 | A.5 Design Metrics | |
3238 | ||
3239 | Attachment D – Chang e Log | |
3240 | Change Log Version | |
3241 | Change | |
3242 | Notes | |
3243 | Status/Res olution | |
3244 | 0.02 | |
3245 | Globally: Verbiage u pdated to match acro ss all 5 S DDs | |
3246 | ||
3247 | ||
3248 | 0.02 | |
3249 | Globally: Ensure acr onyms are defined at first men tion; upda te Acronym s table ac cordingly | |
3250 | ||
3251 | ||
3252 | 0.02 | |
3253 | Globally: 508 diagra ms – add a lternative text | |
3254 | ||
3255 | ||
3256 | 0.02 | |
3257 | Sections 3 .1.1 and 3 .2.1: Othe r SDDs hav e figure h ere; need to include one? | |
3258 | ||
3259 | ||
3260 | 0.02 | |
3261 | Section 8: Was remov ed in late st version ; replaced here for outline co nsistency | |
3262 | ||
3263 | ||
3264 | ||
3265 | Template R evision Hi story | |
3266 | Date | |
3267 | Version | |
3268 | Descriptio n | |
3269 | Author | |
3270 | June 2015 | |
3271 | 2.10 | |
3272 | Changed He ading 1 de fault sett ing to eli minate pag e break be fore | |
3273 | Process Ma nagement | |
3274 | May 2015 | |
3275 | 2.9 | |
3276 | Edited for Section 5 08 conform ance and r emediated with Commo n Look Off ice tool | |
3277 | Process Ma nagement | |
3278 | February 2 015 | |
3279 | 2.8 | |
3280 | Incorporat es revisio ns from PM AS Reform Lockdown; namely rem oving requ irements f or informa tion that can be obt ained from other PMA S authorit ative sour ces. | |
3281 | Andrew Sla wter, Offi ce of Tech nology Str ategies | |
3282 | September 2014 | |
3283 | 2.7 | |
3284 | Adds Enter prise Shar ed Service s terms an d requires AERB Comp liance Cer tificate a ttachment. | |
3285 | Process Ma nagement | |
3286 | August 201 4 | |
3287 | 2.6 | |
3288 | Signature block upda te authori zed by AER B CR_01893 4 | |
3289 | Process Ma nagement | |
3290 | March 2014 | |
3291 | 2.5 | |
3292 | Section 50 8 repairs to new ver sion appro ved by AER B Chair ap proved | |
3293 | Process Ma nagement | |
3294 | August 201 3 | |
3295 | 2.3 | |
3296 | Replaced t he Service Architect ure sub-se ction with new sub-s ections fo r consumed and provi ded servic es. Also a pplied mis cellaneous feedback from VA te am. | |
3297 | ASD Enterp rise Share d Services (ESS) Wor k Group | |
3298 | June 2013 | |
3299 | 1.3 | |
3300 | Upgraded t o MS Offic e 2007-201 0 format | |
3301 | Process Ma nagement | |
3302 | June 2013 | |
3303 | 1.2 | |
3304 | Address in consistenc ies in Sec tion 3, Co nceptual D esign, Cor rect headi ngs | |
3305 | Process Ma nagement | |
3306 | March 2013 | |
3307 | 1.1 | |
3308 | Formatted to documen tation sta ndards and edited fo r Section 508 confor mance | |
3309 | Process Ma nagement | |
3310 | January 20 13 | |
3311 | 1.0 | |
3312 | Initial Do cument | |
3313 | PMAS Busin ess Office | |
3314 | ||
3315 | ||
3316 | See TOGAF® 9.1, Part III: ADM Guidelines & Techniq ues, Gap A nalysis on TOGAF web site at ht tp://pubs. opengroup. org/archit ecture/tog af9-doc/ar ch/chap27. html |
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