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| # | Location | File | Last Modified |
|---|---|---|---|
| 1 | IB_2.0_577.zip | TAS+eBill+SDD+US976+v1.00.docx | Tue Aug 1 17:53:50 2017 UTC |
| 2 | IB_2.0_577.zip | TAS+eBill+SDD+US976+v1.00.docx | Tue Aug 1 19:28:49 2017 UTC |
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| 1 | MCCF EDI T AS US976 | |
| 2 | System Des ign Docume nt | |
| 3 | IB*2.0*577 | |
| 4 | ||
| 5 | ||
| 6 | ||
| 7 | ||
| 8 | Department of Vetera ns Affairs | |
| 9 | March 2017 | |
| 10 | Version 1. 0 | |
| 11 | ||
| 12 | User Story Number: T SEB-02 | |
| 13 | User Story Name: Pay er ID Repo rt- (TSEB- 2) | |
| 14 | Product Ba cklog ID: | |
| 15 | Rally ID: US976 | |
| 16 | Design/Res olution: | |
| 17 | The system processes a 277STAT message f rom Health Care Clea ring House (HCCH) an d evaluate s the Paye r ID to de termine if it is an updated or attempted update fo r the Paye r ID. Th is data is captured in fields and a cros s referenc e for repo rting purp oses. The Payer ID r eport to b e created needs to g o against the cross reference file and h ave the da ta extract ed from th ere and th e insuranc e file. T o produce this repor t the foll owing need s to be ac complished : | |
| 18 | Create a n ew report using the cross refe rence file named “AE DIX” locat ed in the Insurance file. | |
| 19 | Ask the us er for dat e range in which to run the re port. | |
| 20 | Ask the us er for a d evice to p rint repor t. | |
| 21 | Gather the data elem ents neede d for the report: In surance co mpany name , address, EDI type, date, and old vs. n ew EDI num ber. | |
| 22 | Print the report as indicated in the sam ple report format. | |
| 23 | Put the re port on th e Billing Supervisor menu opti ons as ind icated in the sample menu. | |
| 24 | ||
| 25 | FILE | |
| 26 | Activities | |
| 27 | File Name | |
| 28 | Insurance file ^DIC( 36 | |
| 29 | Enhancemen t Category | |
| 30 | New | |
| 31 | Modify | |
| 32 | Delete | |
| 33 | No Change | |
| 34 | RTM | |
| 35 | ||
| 36 | Related Op tions | |
| 37 | ||
| 38 | Related Ro utines | |
| 39 | Routines “ Called By” | |
| 40 | Routines “ Called” | |
| 41 | ||
| 42 | ||
| 43 | ||
| 44 | ||
| 45 | Data Dicti onary (DD) Reference s | |
| 46 | ||
| 47 | ||
| 48 | ||
| 49 | ||
| 50 | ||
| 51 | Use the fo llowing hi ghlighted data eleme nts for th e report: | |
| 52 | ||
| 53 | ||
| 54 | ||
| 55 | STORED IN: ^DIC(36, | |
| 56 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
| 57 | ||
| 58 | FILE SECUR ITY | |
| 59 | DD SE CURITY : # DE LETE SECUR ITY: d | |
| 60 | READ SECURITY : LA YGO SECURI TY : d | |
| 61 | WRITE SECURITY : D | |
| 62 | CROSS REFE RENCED BY: | |
| 63 | ALTE RNATE INST PAYER ID TYPE(AB) PAYER(AC) ALTERNATE PROF PAYE R ID TYPE( | |
| 64 | AD) SCHED ULED FOR D ELETION(AD EL) EDI I D NUMBER - INST(AEI) | |
| 65 | EDI ID NUMBER - PROF(AEP ) HPID/OE ID(AHOD) NIF ID(ANI F) | |
| 66 | INS COMPANY LI NK PARENT( APC) NAME (B) SYNON YM(C) | |
| 67 | ||
| 68 | ||
| 69 | FILE ST RUCTURE | |
| 70 | ||
| 71 | FIELD FIELD | |
| 72 | NUMBER NAME | |
| 73 | ||
| 74 | .01 NAME (RFXa ), [0;1] | |
| 75 | .05 INACTIVE ( SXa), [0;5 ] | |
| 76 | .06 ALLOW MULT IPLE BEDSE CTIONS (S) , [0;6] | |
| 77 | .07 DIFFERENT REVENUE CO DES TO USE (FX), [0; 7] | |
| 78 | .08 ONE OPT. V ISIT ON BI LL ONLY (S ), [0;8] | |
| 79 | .09 AMBULATORY SURG. REV . CODE (*P 399.2'), [ 0;9] | |
| 80 | .1 ATTENDING PHYSICIAN ID. (F), [ 0;10] | |
| 81 | .11 *HOSPITAL PROVIDER N UMBER (F), [0;11] | |
| 82 | .111 STREET ADD RESS [LINE 1] (RFXa) , [.11;1] | |
| 83 | .112 STREET ADD RESS [LINE 2] (FXa), [.11;2] | |
| 84 | .113 STREET ADD RESS [LINE 3] (FX), [.11;3] | |
| 85 | .114 CITY (FX), [.11;4] | |
| 86 | .115 STATE (P5' X), [.11;5 ] | |
| 87 | ||
| 88 | ||
| 89 | ||
| 90 | ||
| 91 | ||
| 92 | Cross refe rence file : | |
| 93 | ||
| 94 | Select OPT ION: 8 DA TA DICTION ARY UTILIT IES | |
| 95 | Select DAT A DICTIONA RY UTILITY OPTION: 1 LIST FIL E ATTRIBUT ES | |
| 96 | START WIT H What Fil e: INSURAN CE COMPANY // (1558 entries) | |
| 97 | GO T O What Fil e: INSURAN CE COMPANY // (1558 entries) | |
| 98 | Sele ct SUB-FIL E: | |
| 99 | Select LIS TING FORMA T: STANDAR D// INDEXE S ONLY | |
| 100 | What type of cross-r eference ( Traditiona l or New)? Both// NE W | |
| 101 | Which fiel d: ALL// | |
| 102 | DEVICE: ;; 99999 HOM E (CRT) Right Ma rgin: 80// | |
| 103 | NEW-STYLE INDEX LIST -- FILE # 36INDEX AN D CROSS-RE FERENCE LI ST | |
| 104 | ||
| 105 | Subfile #3 6.017 | |
| 106 | ||
| 107 | New-Styl e Indexes: | |
| 108 | ||
| 109 | AEDIX (# 1454) R ECORD M UMPS IR SORTIN G ONLY WHOLE FILE (#36) | |
| 110 | Shor t Descr: 277STAT TR ANSACTION PAYER STOR AGE US129 | |
| 111 | Descriptio n: This c ross refer ence allow s for repo rting of 2 77STAT | |
| 112 | Set Logic : S ^DIC( 36,"AEDIX" ,X(1),DA(1 ),X(2),X(3 ))=X(4) | |
| 113 | S et Cond: S X=(X(1)] ""&(X(2)]" ")&(X(3)]" ")) | |
| 114 | Kil l Logic: Q | |
| 115 | X(1): 277DATE ED I ID NUMBE R (36.017 ,.02) (Le n 10) (fo rwards) | |
| 116 | X(2): 277EDI ID NUMBER (3 6.017,.01) (Len 30) (forward s) | |
| 117 | X(3): 277EDI TYP E (36.017 ,.03) (Le n 1) (for wards) | |
| 118 | X(4): 277EDI ID NUMBER ON FILE (36. 017,.04) (Len 30) | |
| 119 | (forwards) | |
| 120 | ||
| 121 | Structure: | |
| 122 | ||
| 123 | ^DIC(36,” | |
| 124 | AEDIX”,DAT E,INSURANC E IEN,EDI ID NUMBER, TYPE “P” O R “I”)=EDI ID NUMBER ON FILE ( If null co nsidered u pdated, no t attempte d) | |
| 125 | ||
| 126 | ||
| 127 | Sample dat a: | |
| 128 | Global ^DI C(36,"AEDI X" | |
| 129 | ^DIC(36,"A EDIX",3030 617,3,"EDI 12345","I" )="4EDIONF ILE" | |
| 130 | " P")="" | |
| 131 | Note: For more infor mation on how the da ta is capt ured refer ence US129 , ^IBCEST. | |
| 132 | ||
| 133 | ||
| 134 | ||
| 135 | ||
| 136 | ||
| 137 | FILE | |
| 138 | Activities | |
| 139 | File Name | |
| 140 | New Entry in Option (#19) file | |
| 141 | Enhancemen t Category | |
| 142 | New | |
| 143 | Modify | |
| 144 | *adding ne w report o ption to m enu | |
| 145 | Delete | |
| 146 | No Change | |
| 147 | ||
| 148 | ||
| 149 | RTM | |
| 150 | ||
| 151 | Related Op tions | |
| 152 | ||
| 153 | Related Ro utines | |
| 154 | Routines “ Called By” | |
| 155 | Routines “ Called” | |
| 156 | ||
| 157 | ||
| 158 | ||
| 159 | ||
| 160 | Data Dicti onary (DD) Reference s | |
| 161 | ||
| 162 | ||
| 163 | ||
| 164 | ||
| 165 | ||
| 166 | Add new re port optio n: | |
| 167 | ||
| 168 | Put the ne w report o ption unde r the foll owing menu options: | |
| 169 | ||
| 170 | ||
| 171 | Select OPT ION NAME: BILLING SU PERVISOR M ENU IB BI LLING SUPE RVISOR MEN U | |
| 172 | ||
| 173 | ||
| 174 | AAM Reimbursab le Insuran ce Claims Report | |
| 175 | BI Claims Tra cking Menu for Billi ng ... | |
| 176 | BILL Enter/Edit Billing I nformation | |
| 177 | CATC Automated Means Test Billing M enu ... | |
| 178 | EDI EDI Menu F or Electro nic Bills ... | |
| 179 | LTC LTC Billin g Menu ... | |
| 180 | OUTP Patient Bi lling Repo rts Menu . .. | |
| 181 | REPT Management Reports ( Billing) M enu ... | |
| 182 | RXEX Medication Copay Inc ome Exempt ion Menu . .. | |
| 183 | SYST MCCR Syste m Definiti on Menu .. . | |
| 184 | TPB Third Part y Billing Menu ... | |
| 185 | TPJI Third Part y Joint In quiry | |
| 186 | NON-VA Fac ility Data | |
| 187 | ||
| 188 | Select Bil ling Super visor Menu <TEST ACC OUNT> Opti on: SYST MCCR Syste m Definiti | |
| 189 | on Menu | |
| 190 | ||
| 191 | ||
| 192 | AUTO Enter/Edit Automated Billing P arameters | |
| 193 | CHGM Charge Mas ter Menu . .. | |
| 194 | EM EDIT E&M C ODE QUANTI TY FLAG | |
| 195 | ENTR Enter/Edit Billing R ates | |
| 196 | EPR Insurance Company ED I Paramete r Report | |
| 197 | FLAG Flag Stop Codes/Disp ositions/C linics | |
| 198 | FLTP Flag Stop Codes/Clin ics for Th ird Party | |
| 199 | HID HCCH Payer ID Report -----New o ption INS U Insura nce Compan y Entry/Ed it LISF List Flag ged Stop C odes/Dispo sitions/Cl inics LIS P List F lagged Sto p Codes/Cl inics for Third Part y LIST Billing Ra tes List NVA NON -VA Facili ty Data P BUF Purg e Insuranc e Buffer PROV Pro vider ID M aintenance SITE M CCR Site P arameter D isplay/Edi t USI Update Sub scriber In fo | |
| 200 | ||
| 201 | Add the op tion to th e options #19 file t o add the report opt ion, as TY PE: Run Ro utine | |
| 202 | Add the op tion as an ITEM to t he Menu (i nclude dis play order ) | |
| 203 | Add the op tion to th e Build as SEND TO S ITE | |
| 204 | Add the me nu to the build as U SE AS LINK FOR MENU/ ITEM/SUBSC RIBERS | |
| 205 | ||
| 206 | ||
| 207 | ||
| 208 | ||
| 209 | ||
| 210 | ||
| 211 | ||
| 212 | ||
| 213 | ||
| 214 | Routine NE W | |
| 215 | Routines | |
| 216 | Activities | |
| 217 | Routine Na me | |
| 218 | IBCERP7 | |
| 219 | Enhancemen t Category | |
| 220 | New | |
| 221 | Modify | |
| 222 | Delete | |
| 223 | No Change | |
| 224 | RTM | |
| 225 | ||
| 226 | Related Op tions | |
| 227 | None | |
| 228 | Related Ro utines | |
| 229 | Routines “ Called By” | |
| 230 | Routines “ Called” | |
| 231 | ||
| 232 | ||
| 233 | ||
| 234 | ||
| 235 | Data Dicti onary (DD) Reference s | |
| 236 | ^DIC(19, ^ DIC(36 | |
| 237 | Related Pr otocols | |
| 238 | None | |
| 239 | Related In tegration Control Re gistration s (ICRs) | |
| 240 | None | |
| 241 | Data Passi ng | |
| 242 | Input | |
| 243 | Output Re ference | |
| 244 | Both | |
| 245 | Global Re ference | |
| 246 | Local | |
| 247 | Routine Na me | |
| 248 | IBCERP7 | |
| 249 | ||
| 250 | Set up a n ew routine : IBCERP7 | |
| 251 | ||
| 252 | Ask the us er for a d ate range- Earliest Date : (se t default T-30) | |
| 253 | La test Date: (set defa ult T) | |
| 254 | Use the DI R API. | |
| 255 | Make sure the earlie st and lat est dates are not in the futur e. | |
| 256 | Make sure the latest date is g reater tha n the earl iest date. | |
| 257 | For Exampl e: | |
| 258 | ; this use s a begin date no ea rlier than 01/01/200 0 | |
| 259 | START W ! S DIR(0)=" DA^3000101 :NOW:EX",D IR("A")="E nter Earli est Date: " D ^DIR K DIR S IBA BEG=+Y Q:' Y;END W ! S DIR(0)=" DA^"_+Y_": NOW:EX",DI R("A")="En ter Latest Date: ",D IR("B")=$$ DAT2^IBOUT L(DT) D ^D IR K DIR S IBAEND=+Y Q:'Y W !, "DONE"_" B EGIN="_IBA BEG_" END= "_IBAEND | |
| 260 | ||
| 261 | ||
| 262 | Ask the us er for a d evice: | |
| 263 | Let the us er know th at this Re port requi res 132 co lumns. | |
| 264 | Allow for queuing of the repor t | |
| 265 | For exampl e: | |
| 266 | W !,"You w ill need a 132 colum n printer for this r eport",! S %ZIS="QM" D ^%ZIS I POP S IBQ UIT=1 Q I $D(IO("Q") ) D S IBQ UIT=1 Q . S ZTRTN="I BCERP7" . S ZTDESC ="HCCH Pay er ID Repo rt" . D ^% ZTLOAD . W !!,$S($D( ZTSK):"You r task num ber "_ZTSK _" has bee n queued." ,1:"Unable to queue this job." ) . K ZTSK ,IO("Q") D HOME^%ZIS | |
| 267 | ||
| 268 | Set up Tag called Ga ther to do the follo wing: | |
| 269 | $Order thr ough cross reference file: | |
| 270 | ^DIC(36,”A EDIX”,DATE ,INSURANCE IEN,) to get data w ithin date range. | |
| 271 | ||
| 272 | If data is within da te range | |
| 273 | $ Order th rough rest of cross reference subscripts to set up ^TMP($J f ile with a ll data ne eded for t he report. | |
| 274 | ^DIC(36,” | |
| 275 | AEDIX”,DAT E, INSURAN CE IEN ,ED I ID NUMBE R,TYPE “P” OR “I”)=E DI ID NUMB ER ON FILE | |
| 276 | ||
| 277 | (If EDI N UMBER ON F ILE is nul l- it is c onsidered updated, not attemp ted) | |
| 278 | ||
| 279 | Use t he insuran ce ien fro m Cross re f to extra ct the nam e, address , city, an d state f rom the ^D IC(36,IEN | |
| 280 | Use GETS^D IQ to retr ieve data IE: D GETS ^DIQ(FILE, IENS,FIELD ,FLAG,"TAR GET") | |
| 281 | ||
| 282 | Use t he Type fr om cross r ef as the EDI PayerI D for the report. Fo r printing the I=”In st”;P=”Pro f” | |
| 283 | Use t he EDI ID NUMBER fro m Cross re f to be th e NewValue on report . | |
| 284 | Use t he EDI ID NUMBER ON FILE from cross ref to be the OldValue o n report | |
| 285 | If th e EDI ID N UMBER ON F ILE from c ross ref i s null- se t the “upd ated” valu e for repo rt to be “ Yes”, othe rwise “No” | |
| 286 | ||
| 287 | ||
| 288 | Set up a t ag called Header – t o be calle d when pri nting the report wit h the head ing inform ation as f ollows: | |
| 289 | Line1: “Clearing House Pay er ID Repo rt “ Toda ys date an d time of running | |
| 290 | Line2: “Page:” # of # | |
| 291 | Line3: “Timefram e:” Earlie st Date us er entered “thru” La test Date user enter ed | |
| 292 | Line4: Bl ank | |
| 293 | Line5: “Insuranc e Co” “Addres s’ “ Date” “EDI-Paye rID” “OldValue” “NewV alue” “U pdated” | |
| 294 | Line6: Pr int Line u nderscorin g line 5 | |
| 295 | ||
| 296 | ||
| 297 | Set up a t ag called Print- to be called after gath er tag is finished c reated the ^TMP file . Data nee ds to be s orted by i nsurance n ame and da te. | |
| 298 | Loop the ^TMP f ile to pri nt the fol lowing inf ormation: | |
| 299 | ||
| 300 | Insurance Name, Addr ess, city, State, Da te of chan ge/attempt ed change, payer typ e, old and new EDI v alues, | |
| 301 | ||
| 302 | Conve rt the int ernal date to extern al date pr int format . | |
| 303 | Match up data p rinting wi th the hea der printi ng. | |
| 304 | This informatio n is to be printed o n the devi ce specifi ed from th e user, in the forma t listed i n the | |
| 305 | sample pro vided. | |
| 306 | ||
| 307 | If there i s no data to print- call the h eader tag- print the header in formation and print | |
| 308 | “**** * NO DATA TO PRINT * ****” | |
| 309 | ||
| 310 | Use the pa using- whe n device s elected is the scree n- hit ret urn to con tinue prom pt- when d ata return ed is more than one page. | |
| 311 | ||
| 312 | ||
| 313 | ||
| 314 | ||
| 315 | ||
| 316 | ||
| 317 | ||
| 318 | ||
| 319 | ||
| 320 | Sample rep ort: | |
| 321 | Earliest D ate: T-30 | |
| 322 | Latest Dat e: T | |
| 323 | ||
| 324 | ||
| 325 | ||
| 326 | ||
| 327 | ||
| 328 | Clearingho use Payer ID Report Jan 1 1, 2017@09 :53:18 P age: 1 of 1 | |
| 329 | Timeframe: 12/17/16 thru 01/11 /17 | |
| 330 | ||
| 331 | Insurance Co Addres s Dat e E DI-PayerID OldValu e NewVal ue Update d | |
| 332 | __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ ________ | |
| 333 | AETNA PO BOX 2295 FT. WAYNE INDI ANA 12/ 28/16 P rof 60054 Yes | |
| 334 | AETNA HEAL TH PLANS PO BOX 12340 FRE SNO CALIFO RNIA 01/ 02/16 P rof 60054 Yes | |
| 335 | BANKERS FI DELITY PO BOX 105652 AT LANTA GEOR GIA 12/ 19/16 P rof XYZ123 123456 No | |
| 336 | MEDICARE ( WNR) PO BOX 660159 DA LLAS TX 01/ 01/17 I nst XXXXX1 XXXXX2 No | |
| 337 |
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