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1 | eInsurance_IB_2.0_602.zip | IB_2_0_P602_EIV_TM (Track Changes).docx | Wed Feb 27 18:49:30 2019 UTC |
2 | eInsurance_IB_2.0_602.zip | IB_2_0_P602_EIV_TM (Track Changes).docx | Wed Mar 20 12:59:08 2019 UTC |
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1 | INTEGRATED BILLING | |
2 | ELECTRONIC INSURANCE VERIFICAT ION INTERF ACE | |
3 | (eIV) | |
4 | ||
5 | TECHNICAL MANUAL / | |
6 | SECURITY G UIDE | |
7 | ||
8 | ||
9 | IB Version 2.0 | |
10 | ||
11 | Patch IB*2 .0*184, 24 6, 252, 27 1, 316, 30 0, 416, 44 4, 438, 49 7, 506, 52 5, 528, 54 9, 582, 59 3, 601, 59 5, 621, 60 2 | |
12 | ||
13 | March | |
14 | 2019 | |
15 | ||
16 | ||
17 | Veterans A ffairs | |
18 | Product De velopment (PD) | |
19 | ||
20 | ||
21 | (This page included for two-si ded copyin g.) | |
22 | ||
23 | ||
24 | ||
25 | ||
26 | ||
27 | ||
28 | ||
29 | ||
30 | ||
31 | ||
32 | ||
33 | ||
34 | ||
35 | ||
36 | ||
37 | ||
38 | ||
39 | ||
40 | Revision H istory | |
41 | ||
42 | Note: The revision history cy cle begins once chan ges or enh ancements are reques ted to an approved S RS. | |
43 | ||
44 | Date | |
45 | Revision | |
46 | Descriptio n | |
47 | Author | |
48 | 09/18/03 | |
49 | Patch 184 | |
50 | Initial Ve rsion | |
51 | Darlene Wh ite | |
52 | 9/2003 | |
53 | Patch 246 | |
54 | No change required | |
55 | N/A | |
56 | 2/2004 | |
57 | Patch 252 | |
58 | No change required | |
59 | N/A | |
60 | 02/08/05 | |
61 | Patch 271 | |
62 | Updated | |
63 | Darlene Wh ite | |
64 | 07/07/05 | |
65 | Patch 300 | |
66 | Updated | |
67 | Darlene Wh ite | |
68 | 01/17/06 | |
69 | Patch 300 | |
70 | Updated | |
71 | Ellen Nam | |
72 | 05/18/10 | |
73 | Patch 416 | |
74 | Updated | |
75 | Jonathan B olas | |
76 | 11/2010 | |
77 | Patch 444 | |
78 | No change required | |
79 | N/A | |
80 | 08/01/11 | |
81 | Patch 438 | |
82 | Updated | |
83 | Jonathan B olas/Berry Anderson | |
84 | 8/26/13 | |
85 | Patch 497 | |
86 | Updated | |
87 | FirstView Team | |
88 | 5/22/14 | |
89 | Patch 506 | |
90 | Updated | |
91 | FirstView Team | |
92 | 02/2016 | |
93 | Patch 525, 528 | |
94 | Updated | |
95 | Harris Tea m | |
96 | 08/2016 | |
97 | Patch 549 | |
98 | Updated | |
99 | Fred Altma n/Darlene White | |
100 | 11/2017 | |
101 | Patch 582 | |
102 | Only added this patc h number t o the cove r page to track that it was eI V related; however, the patch did not re quire upda tes to the contents of this do cument. | |
103 | Tim Zimmer | |
104 | 11/2017 | |
105 | Patch 593 | |
106 | Updated co ntents a r esult of I B*2*593. | |
107 | Tim Zimmer /Henry Nor mand | |
108 | 03/2018 | |
109 | Patch 601 | |
110 | Add new pr ogram sub- namespace | |
111 | Add new ro utines | |
112 | Update Fil e list | |
113 | Update Inp ut Templat es | |
114 | Add Protoc ol | |
115 | Update app endix F wi th new rou tine | |
116 | Daniel Mor an | |
117 | 06/2018 | |
118 | Patch 595 | |
119 | Update the Purging s ection | |
120 | Add mailma n msg from nighly jo b to Appen dix A | |
121 | Add “Group Number” t o column h eader in t est grid i n Appendix F | |
122 | ||
123 | Daniel Mor an | |
124 | 01/2019 | |
125 | Patch 621 | |
126 | Add Routin e | |
127 | Add Protoc ols | |
128 | Timothy Zi mmer | |
129 | 03/2019 | |
130 | Patch 602 | |
131 | Add automa tic purge text in th e Estimate d Global G rowth sect ion that w as missed with IB*2* 595. | |
132 | Daniel Mor an | |
133 | ||
134 | ||
135 | PREFACE | |
136 | ||
137 | This is th e Technica l Manual f or the Int egrated Bi lling (IB) software package’s electronic Insurance Identific ation and Verificati on Interfa ce (IIV) w hich was f irst intro duced as P atch IB*2. 0*184. It is design ed to assi st IRM per sonnel in the operat ion and ma intenance of the int erface. | |
138 | ||
139 | For inform ation rega rding use of the sof tware, ple ase refer to the Int egrated Bi lling Insu rance Iden tification and Verif ication In terface Us er Guide a nd the Int egrated Bi lling User Manual. | |
140 | ||
141 | For inform ation on t he install ation of t his interf ace, pleas e refer to the Integ rated Bill ing Insura nce Identi fication a nd Verific ation Inte rface (eIV ) Installa tion Guide . | |
142 | ||
143 | Symbols | |
144 | ||
145 | The follow ing are ex planations of the sy mbols used throughou t this man ual. | |
146 | ||
147 | <RET>Press the RETUR N or ENTER key. | |
148 | ||
149 | <SP>Press the SPACEB AR. | |
150 | ||
151 | <^>Up-arro w, which y ou enter b y pressing the SHIFT key and t he numeric 6 key sim ultaneousl y | |
152 | ||
153 | <?> <??> < ???>Enter single, do uble, or t riple ques tion marks to activa te on-line help, dep ending on the level of help yo u need. | |
154 | ||
155 | Note to Us ers with Q ume Termin als | |
156 | ||
157 | It is very important that you set up you r Qume ter minal prop erly. Aft er enterin g your acc ess and ve rify codes , you will see | |
158 | ||
159 | Select TER MINAL TYPE NAME: {ty pe} // | |
160 | ||
161 | Please mak e sure tha t <C-QUME> is entere d here. T his entry will becom e the defa ult. You can then press <RET > at this prompt for all subse quent logi ns. If an y other te rminal typ e configur ation is s et, option s using th e List Man ager utili ty will ne ither disp lay nor fu nction pro perly on y our termin al. The r eports and error mes saging sys tem in the interface makes ext ensive use of the Li st Manager functions . | |
162 | ||
163 | ||
164 | Who Should Read this Manual? | |
165 | ||
166 | This manua l is inten ded for te chnical IR M personne l who may be called upon to in stall and support th is softwar e. | |
167 | ||
168 | ||
169 | (This page included for two-si ded copyin g.) | |
170 | ||
171 | ||
172 | ||
173 | ||
174 | ||
175 | ||
176 | ||
177 | ||
178 | ||
179 | ||
180 | ||
181 | ||
182 | ||
183 | ||
184 | ||
185 | ||
186 | ||
187 | ||
188 | ||
189 | ||
190 | ||
191 | TABLE OF C ONTENTS | |
192 | INTRODUCTI ON1 | |
193 | Overview1 | |
194 | Functional Descripti on1 | |
195 | eIV Proces s Flow3 | |
196 | VistA Regi stration D ialog3 | |
197 | IMPLEMENTA TION AND M AINTENANCE 5 | |
198 | General No tes Regard ing Change s to this Software5 | |
199 | Platform R equirement s5 | |
200 | Hardware R equirement s5 | |
201 | Globals5 | |
202 | Globals to Journal6 | |
203 | Estimated Global Gro wth6 | |
204 | HL7 Manage ment7 | |
205 | Bulletins7 | |
206 | TECHNICAL NOTES8 | |
207 | Namespace8 | |
208 | File Numbe r Space8 | |
209 | Routines8 | |
210 | File List with Descr iptions15 | |
211 | Input Temp lates19 | |
212 | List Templ ates19 | |
213 | Mail Group 19 | |
214 | Options fo r eIV20 | |
215 | List Manag er Templat es25 | |
216 | Protocols2 6 | |
217 | HL7 Applic ation Para meters30 | |
218 | HL Logical Links30 | |
219 | Purging30 | |
220 | SECURITY32 | |
221 | File Prote ction32 | |
222 | Security K eys34 | |
223 | Options Lo cked by Se curity Key s35 | |
224 | EXTERNAL I NTERFACES3 6 | |
225 | HL7 Messag ing with t he Eligibi lity Commu nicator (E C)36 | |
226 | HL7 Commun ication Se tup36 | |
227 | Data Sent to the Eli gibility C ommunicato r36 | |
228 | Data Recei ved From t he Eligibi lity Commu nicator37 | |
229 | APPENDIX A – TABLE O F eIV GENE RATED Mail Man Messag es38 | |
230 | APPENDIX B – Incomin g Data Map ping44 | |
231 | APPENDIX C – TROUBLE SHOOTING54 | |
232 | APPENDIX D – eIV IMP LEMENTATIO N QUICK CH ECKLIST (I B*2.0*184 only)57 | |
233 | APPENDIX E – eIV Dat abase Inte gration Ag reements ( DBIAs)59 | |
234 | APPENDIX F – How to Test the e IV Interfa ce with th e Test Eli gibility C ommunicato r61 | |
235 | GLOSSARY67 | |
236 | ||
237 | INTRODUCTI ON | |
238 | ||
239 | Overview | |
240 | ||
241 | The releas e of Integ rated Bill ing patch IB*2.0*184 introduce d electron ic Insuran ce Identif ication an d Verifica tion (IIV) . The IIV project h as been re named and is now ref erred to a s Electron ic Insuran ce Verific ation (eIV ). | |
242 | ||
243 | The purpos e of eIV i s to autom ate: | |
244 | The determ ination of eligibili ty for cla imed insur ance (Veri fication). | |
245 | ||
246 | This inter face was p lanned and designed to be a Cl ass I init iative wit h the coor dination a nd assista nce of the national IB team. | |
247 | ||
248 | The softwa re enhance ments incl uded in th e patches that are d escribed w ithin this document directly s upport the following VHA progr am initiat ives: | |
249 | The VHA Re venue Cycl e Improvem ent Plan a pproved by Secretary Principe in Septemb er, 2001, and partic ularly: | |
250 | Recommenda tion 5 of that Plan, which cal ls for imp lementatio n of autom ated metho ds of iden tifying an d verifyin g veteran insurance coverage. | |
251 | Recommenda tion 3 of that Plan, which rec ommends ad opting a n ational po licy for t he update of patient data no l ess freque ntly than every six months. | |
252 | The VHA Of fice of Co mpliance a nd Busines s Integrit y (CBI) Pr ogram Indi cator No. 3a , which measures, among oth er things, whether p atient ins urance cov erage is v erified ev ery six mo nths. | |
253 | ||
254 | The Techno logy Servi ces Divisi on of DAOU Systems I nc., 8401 Connecticu t Ave. Sui te 700, Ch evy Chase, MD 20815, provided the interf ace betwee n the exis ting IB so ftware and the Eligi bility Com municator (EC), loca ted at the Financial Service C enter (FSC ) in Austi n, TX. | |
255 | ||
256 | Functional Descripti on | |
257 | ||
258 | The Electr onic Insur ance Verif ication (e IV) projec t provides an extens ion to the existing VistA Insu rance Buff er functio nality by enabling e lectronic confirmati on of thir d-party co mmercial h ealth insu rance cove rage for r egistered VA patient s. Each n ight a pro cess is ru n, which c ompiles a batch of i nsurance e ligibility inquiries based on activity w ithin the system. S ources inc lude unver ified insu rance info rmation en tered in t he Insuran ce Buffer as well as patients that have scheduled appointmen ts or have had past encounters , but have not had a recent ve rification of their insurance files. | |
259 | ||
260 | VistA perf orms both a Buffer E xtract and an Appoin tment Extr act. For the Appoin tment Extr act; VistA prepares HL7 inquir ies during the night in respon se to appo intment ev ents. For the Buffer Extract, VistA imme diately pr epares HL7 inquiries in respon se to regi stration a nd check i n events. The HL7 i nquiries a re transmi tted to th e Eligibil ity Commun icator at the FSC. The messag es are tra nslated in to 270 Hea lth Care E ligibility Benefits Inquiry me ssages. T hey are th en sent to the VA’s clearingho uses who t hen distri bute them to the cor rect insur ance compa nies. The 271 Health Care Elig ibility Be nefits Res ponses are returned from the p ayer throu gh the cle aringhouse s to FSC f or transla tion into an HL7 for mat and th en transmi tted to th e originat ing VistA system. T here the i nformation is either placed in to the ins urance buf fer for th e insuranc e clerk to review an d process to the pat ient’s ins urance fil e or used to automat ically upd ate the pa tient’s in surance fi le. | |
261 | ||
262 | ||
263 | Future App ts. | |
264 | Past Encou nters | |
265 | Insurance Buffer | |
266 | Responses | |
267 | Inquiry Qu eue | |
268 | Reports | |
269 | Austin | |
270 | The Cleari nghouse | |
271 | Payers | |
272 | Insurance Company Fi le | |
273 | Auto Match | |
274 | Future App ts. | |
275 | Past Encou nters | |
276 | Insurance Buffer | |
277 | Responses | |
278 | Inquiry Qu eue | |
279 | Reports | |
280 | Austin | |
281 | The Cleari nghouse | |
282 | Payers | |
283 | Insurance Company Fi le | |
284 | Auto Match | |
285 | ||
286 | Figu re 1. Ove rview of e IV Process | |
287 | ||
288 | Inquiries are then v erified th rough an e xchange of HIPAA-com pliant ele ctronic co mmunicatio ns between the VistA system an d an Eligi bility Com munication s server t hat is loc ated at th e FSC in A ustin, Tex as. This national datacenter receives the eligib ility inqu iry messag es and for wards the request to an electr onic clear inghouse o f insuranc e informat ion. The clearingho use, in tu rn, forwar ds the inq uiry to th e requeste d payer, e x. Aetna, Blue Cross /Blue Shie ld, etc. The payer issues a r esponse me ssage to c onfirm or deny cover age based on the inf ormation p rovided in the inqui ry. The re sponse mes sage is ro uted back to the Vis tA site an d may be p osted to t he Insuran ce Buffer where auth orized use rs can rev iew and ac cept the r eturned in formation into the c urrent ins urance fil es through enhanceme nts to the insurance buffer li st option. | |
289 | ||
290 | One challe nge inhere nt in this process r esults fro m the fact that each VA site i s able to maintain a separate list of in surance co mpanies. In order f or the var ious VistA locales t o be able to effecti vely reque st eligibi lity infor mation for the vario us payers, a nationa l VA insur ance payer list has been estab lished to provide a standard i dentificat ion system for all p ayers that are parti cipating i n this pro cess. Enh ancements have been added to a llow each VA site th e ability to link th e insuranc e companie s in their own site’ s list to the approp riate paye r in the n ational pa yer list. This stan dardizes t he identif ication of the payer to which each inqui ry should be directe d. | |
291 | ||
292 | Additional features were also added to a ssist the users of t he insuran ce buffer with eIV r elated tas ks. A fea ture named “Auto Mat ch” has be en added t hat allows the syste m to be “t aught” rul es for mat ching the user-enter ed insuran ce company names in the insura nce buffer to existi ng entries in the si te’s insur ance compa ny file. Also, a me thod has b een added for accept ing inform ation from an insura nce buffer entry int o the pati ent’s perm anent insu rance reco rds that a llows each data fiel d change t o be indiv idually ac cepted or rejected. Another f eature all ows a user to select multiple buffer ent ries for t he Process , Expand, and Reject entry act ions, to e ase the pr ocess of w orking wit h larger s ets of buf fer entrie s. | |
293 | ||
294 | ||
295 | ||
296 | ||
297 | eIV Proces s Flow | |
298 | ||
299 | Each VistA system, a s the Insu rance and Verificati on patch s oftware is installed , is eligi ble to sen d and rece ive messag es from th e Eligibil ity Commun icator (EC ,[ EC mess aging pass es through /via the Vitria ser ver]), the component of eIV l ocated at the Austin Informati on Technol ogy Center (AITC) fo rmerly Aus tin Automa tion Cente r (AAC). VistA comm unication methodolog y is throu gh a TCP/I P connecti on to the Vitria ser ver in the form of a n HL7 mess age. Vitr ia validat es the HL7 message. | |
300 | ||
301 | If the mes sage fails EC’s vali dation, th e sending VistA faci lity recei ves an err or message from EC. Otherwise EC process es the mes sage and r eturns res ponses to most of th em as defi ned in thi s Interfac e Design D ocument (I DD). | |
302 | ||
303 | Vitria tra nsforms th e HL7 mess age to a s tandard X1 2 270 mess age and se nds it on to the Cle aringhouse . | |
304 | ||
305 | The Cleari nghouse pr ocesses th e 270 mess age on to the approp riate paye r. When t he Clearin ghouse rec eives a re sponse fro m the paye r, it is f orwarded b ack to Vit ria at Aus tin. If t he respons e is a 997 error res ponse, ste ps to dete rmine the problem ar e taken to resolve t he problem . | |
306 | ||
307 | If a “succ ess” respo nse is rec eived from the payer via the C learinghou se in a 27 1 message, Vitria sa ves the da ta into th e National Insurance Cache and transform s it to an HL7 messa ge. The m essage is then sent back to th e VistA fa cility for processin g. Vista facilities can set s ite parame ters to ei ther have the messag es returne d real-tim e, or held and batch ed for pro cessing at a later t ime. | |
308 | ||
309 | ||
310 | ||
311 | ||
312 | ||
313 | Figure 2. Diagram o f the proc ess-flow f or electro nic eligib ility requ ests sent by the eIV process | |
314 | ||
315 | ||
316 | VistA Regi stration D ialog | |
317 | ||
318 | When a sit e installs the eIV s oftware an d performs all of th e post-ins tallation instructio ns, a regi stration m essage wil l be sent to confirm the regis tration an d update a ny site-sp ecific inf ormation. Any subse quent chan ges to the payer tab le are ini tiated by FSC. | |
319 | ||
320 | ||
321 | ||
322 | ||
323 | IMPLEMENTA TION AND M AINTENANCE | |
324 | ||
325 | General No tes Regard ing Change s to this Software | |
326 | ||
327 | Integrated Billing f iles may o nly be upd ated throu gh distrib uted optio ns. | |
328 | Per VA Dir ective 640 2 regardin g security of softwa re that af fects fina ncial syst ems, most of the IB routines a nd files m ay not be modified. Routines that may n ot be modi fied will be indicat ed by a co mment on t he third l ine. File s that may not be mo dified wil l have a n ote in the file desc ription. | |
329 | According to the sam e directiv e, most of the IB Da ta Diction aries may not be mod ified. | |
330 | ||
331 | ||
332 | Platform R equirement s | |
333 | ||
334 | VistA Syst em: | |
335 | ||
336 | A fully pa tched and complete V istA syste m is requi red, runni ng Integra ted Billin g (IB) Ver sion 2.0. | |
337 | ||
338 | In additio n, the Vis tA system must have a properly installed and funct ioning HL7 module. | |
339 | ||
340 | Hardware R equirement s | |
341 | ||
342 | The eIV pa tch requir es a stand ard implem entation o f VistA ru nning on a hardware platform t hat is com monly supp orted by V istA. | |
343 | ||
344 | Additional ly, TCP/IP network c onnectivit y needs to be availa ble betwee n the site ’s VistA s erver and the Eligib ility Comm unicator ( EC) server located a t the FSC in Austin, TX. The EC server is connect ed to the VA’s intra net; there fore conne ctivity sh ould be av ailable wi thout addi tional act ion as lon g as the V istA serve r is also connected to the VA’ s intranet . | |
345 | ||
346 | ||
347 | Globals | |
348 | ||
349 | Global ^IB CN should have been created pr ior to ins tallation of IB*2.0* 184. | |
350 | ||
351 | Data Files Stored in the Globa l ^IBCN: | |
352 | IIV RESPON SE (#365) | |
353 | IIV TRANSM ISSION QUE UE (#365.1 ) | |
354 | IIV AUTO M ATCH (#365 .11) | |
355 | EIV EICD T RACKING (# 365.18) | |
356 | IIV RESPON SE REVIEW (#365.2) | |
357 | ||
358 | Data Files Stored in the Globa l ^IBE: | |
359 | X12 271 EL IGIBILITY/ BENEFIT (# 365.011) | |
360 | X12 271 CO VERAGE LEV EL (#365.0 12) | |
361 | X12 271 SE RVICE TYPE (#365.013 ) | |
362 | X12 271 IN SURANCE TY PE (#365.0 14) | |
363 | X12 271 TI ME PERIOD QUALIFIER (#365.015) | |
364 | X12 271 QU ANTITY QUA LIFIER (#3 65.016) | |
365 | X12 271 ER ROR CONDIT ION (#365. 017) | |
366 | X12 271 ER ROR ACTION (#365.018 ) | |
367 | X12 271 CO NTACT QUAL IFIER (#36 5.021) | |
368 | PAYER (#36 5.12) | |
369 | PAYER APPL ICATION (# 365.13) | |
370 | IIV TRANSM ISSION STA TUS (#365. 14) | |
371 | IIV STATUS TABLE (#3 65.15) | |
372 | X12 271 EN TITY IDENT IFIER CODE (#365.022 ) | |
373 | X12 271 ID ENTIFICATI ON QUALIFI ER (#365.0 23) | |
374 | X12 271 PR OVIDER COD E (#365.02 4) | |
375 | X12 271 DE LIVERY FRE QUENCY COD E (#365.02 5) | |
376 | X12 271 DA TE QUALIFI ER FILE (# 365.026) | |
377 | X12 271 LO OP ID (#36 5.027) | |
378 | X12 271 RE F IDENTIFI CATION (#3 65.028) | |
379 | X12 271 UN ITS OF MEA SUREMENT ( #365.029) | |
380 | X12 271 EN TIITY RELA TIONSHIP C ODE (#365. 031) | |
381 | X12 271 DA TE FORMAT QUALIFIER (#365.032) | |
382 | X12 271 YE S/NO RESPO NSE CODE ( #365.033) | |
383 | X12 271 LO CATION QUA LIFER (#36 5.034) | |
384 | X12 271 PR OCEDURE CO DING METHO D (#365.03 5) | |
385 | X12 271 DE LIVERY PAT TERN (#365 .036) | |
386 | X12 271 PA TIENT RELA TIONSHIP ( #365.037) | |
387 | X12 271 IN JURY CATEG ORY (#365. 038) | |
388 | X12 271 MI LITARY PER SONNEL INF O STATUS C ODE (#365. 039) | |
389 | X12 271 MI LITARY GOV T SERVICE AFFILIATIO N (#365.04 1) | |
390 | X12 271 MI LITARY SER VICE RANK (#365.042) | |
391 | X12 271 EN TITY TYPE QUALIFIER (#365.043) | |
392 | X12 271 CO DE LIST QU ALIFIER (# 365.044) | |
393 | X12 271 NA TURE OF IN JURY CODES (#365.045 ) | |
394 | X12 271 MI LITARY EMP LOYMENT ST ATUS CODE (#365.046) | |
395 | ||
396 | Data Files Stored in the Globa l ^DIA: | |
397 | AUDIT (#1. 1) | |
398 | ||
399 | ||
400 | Globals to Journal | |
401 | ||
402 | Journaling for the g lobal IBCN is recomm ended. Jou rnaling in structions from the IB Technic al Manual should be followed. | |
403 | ||
404 | ||
405 | Estimated Global Gro wth | |
406 | ||
407 | Only three of the fi les relate d to eIV a re expecte d to grow significan tly over t ime. Thes e files ar e the EIV EICD TRACK ING (#365. 18), IIV T RANSMISSIO N QUEUE (# 365.1) and IIV RESPO NSE (#365) files. T he growth rate of th ese files is directl y proporti onal to th e number o f inquirie s/response s that are generated each day. The volu me of dail y activity at each s ite can be controlle d through the batch extract se ttings def ined in th e MCCR Sit e Paramete rs screen. As an ex ample, if 5,000 reco rds are ge nerated fo r one day, the total growth fo r that day may be up to 20 MB. | |
408 | ||
409 | ^IBCN(365) - .003 Mb per entry (IIV Resp onse File #365) | |
410 | ^IBCN(365. 1) - .001M b per entr y (IIV Tra nsmission Queue #365 .1) | |
411 | ^IBCN(365. 18) - .001 Mb per ent ry (EIV EI CD TRACKIN G #365.18) | |
412 | ||
413 | Note that functional ity has be en include d that all ows data i n these fi les to be purged if it is at l east six m onths old. With the introducti on of IB*2 .0*595 Vis tA will au tomaticall y purge re cords olde r than six months on the first of each m onth. Refe r to the p urging sec tion of th is documen t for furt her detail s. | |
414 | ||
415 | ||
416 | Another fi le that is expected to grow is the AUDIT (#1.1) us ed to trac k changes for the Us er Edit Re port. | |
417 | ||
418 | ^DIA(1.1) - 1KB/reco rd (Audit File #1.1) | |
419 | ||
420 | ||
421 | HL7 Manage ment | |
422 | ||
423 | eIV makes heavy use of HL7 mes saging. En sure that the HL7 gl obals have sufficien t room for growth. Reference HL*1.6*19 patch docu mentation for furthe r instruct ions. Als o, referen ce the Ext ernal Inte rfaces – H L7 Communi cations Se tup sectio n, in this manual, f or specifi c eIV HL7 informatio n. | |
424 | ||
425 | This inter face is de pendent up on both an IP addres s and the port on wh ich HL7 li stens. If any of th e followin g scenario s occur, y ou may nee d to adjus t the sett ings for o ne of the eIV logica l links. Without th is adjustm ent, the i nterface w ill stop t ransmittin g insuranc e inquirie s and rece iving elig ibility re sponses. In other w ords, the interface will stop working. | |
426 | ||
427 | The VAMC c hanges whi ch node is the start -up node. | |
428 | The VAMC c hanges the port on w hich HL7 i s listenin g. | |
429 | ||
430 | If either of the abo ve scenari os occurs, reference Appendix C for spec ific instr uctions re lated to a djusting t he eIV log ical links . | |
431 | ||
432 | ||
433 | Bulletins | |
434 | ||
435 | Currently there are no bulleti ns set up for the el ectronic I nsurance I dentificat ion and Ve rification Interface Version 1 .0 softwar e. | |
436 | ||
437 | ||
438 | ||
439 | ||
440 | TECHNICAL NOTES | |
441 | ||
442 | Namespace | |
443 | ||
444 | The eIV In terface ha s been ass igned the namespace IBCNE. Ap proval was obtained in order t o modify s ome routin es in the IBJPI name space. Th e IBCNE na mespace is used for all new ro utines, op tions etc. associate d with thi s interfac e. Routin es directl y associat ed with IB IIV Site Parameters uses the IBJPI name space. | |
445 | ||
446 | For all eI V routines , the next letter(s) in the ro utine name also prov ide guidan ce as to t he module to which t hat routin e belongs. The brea kdown of t he eIV int ernal name spaces is as follows : | |
447 | ||
448 | Sub-namesp ace | |
449 | Descriptio n | |
450 | IBCNEAM | |
451 | Auto Match routines | |
452 | IBCNEBF | |
453 | eIV to cre ate entry the Buffer File | |
454 | IBCNEDE | |
455 | Data Extra ct routine s | |
456 | IBCNEDST | |
457 | HL7 Regist ration Mes sage Stati stics (rep orts stati cs to FSC) | |
458 | IBCNEHL | |
459 | Processing inbound o r outbound HL7 messa ges | |
460 | IBCNEHLM | |
461 | Registrati on message and assoc iated ackn owledgemen t | |
462 | IBCNEHLK | |
463 | Registrati on message and assoc iated ackn owledgemen t | |
464 | IBCNEHLU | |
465 | HL7 relate d utilitie s | |
466 | IBCNEK | |
467 | Purge eIV data from IIV files (#365, #36 5.1, and 3 65.18) | |
468 | IBCNEML | |
469 | Mailman no tification to link P ayers | |
470 | IBCNEMS | |
471 | Mailman me ssages for eIV proce ssing (loc ation to s tore the b ody of mes sages to g enerate th us allowin g reuse fr om multipl e places a nd improve maintenan ce) | |
472 | IBCNEP | |
473 | Payer rela ted routin es (relate d to PAYER file #365 .12) | |
474 | IBCNEQ | |
475 | Request El ectronic I nquiry (ad hoc QUERY requests) | |
476 | IBCNERP | |
477 | Reports | |
478 | IBCNERTQ | |
479 | Makes eIV real-time insurance verificati on. | |
480 | IBCNES | |
481 | (excluding IBCNESI) Eligibilit y/Benefit display an d summary from eIV r esponses a nd summary . | |
482 | IBCNESI | |
483 | Potential Medicare w orklist. | |
484 | IBCNETST | |
485 | eIV Gate-k eeper test scenarios | |
486 | IBCNEUT | |
487 | Utilities | |
488 | ||
489 | File Numbe r Space | |
490 | ||
491 | The eIV pa ckage file range is 365-366.2. | |
492 | ||
493 | ||
494 | Routines | |
495 | ||
496 | These are current In tegrated B illing pro grams that are part of the ele ctronic In surance Ve rification software. | |
497 | ||
498 | Routine Na me | |
499 | Descriptio n | |
500 | IBCEMMR | |
501 | IB MRA Rep ort of Pat ients w/o Medicare W NR | |
502 | IBCN118 | |
503 | This progr am is Data Dictionar y trigger logic for comments. | |
504 | IBCNAU | |
505 | This progr am is part of the Us er Edit Re port. | |
506 | IBCNAU1 | |
507 | This progr am is part of the Us er Edit Re port. | |
508 | IBCNAU2 | |
509 | This progr am is part of the Us er Edit Re port. | |
510 | IBCNAU3 | |
511 | This progr am is part of the Us er Edit Re port. | |
512 | IBCNBAA | |
513 | This progr am display s subscrib er registr ation info rmation fr om the Ins urance Buf fer, IIV R esponse Re port file, and Annua l Benefits file (#35 5.4). | |
514 | IBCNBAC | |
515 | This progr am contain s subrouti nes for th e individu al accepta nce of buf fer entry informatio n. | |
516 | IBCNBAR | |
517 | Insurance Buffer Acc ept/Reject functions . | |
518 | IBCNBCD | |
519 | Compare bu ffer entry with exis ting patie nt insuran ce. | |
520 | IBCNBCD1 | |
521 | This progr am edits s ubscriber informatio n in the P atient Ins urance sub file (File #2.312). | |
522 | IBCNBCD2 | |
523 | This progr am sets up the Insur ance Buffe r to proce ss Accepts . | |
524 | IBCNBCD3 | |
525 | This progr am display s IB Annua l Benefits /Coverage Limitation s Display Screens. | |
526 | IBCNBCD4 | |
527 | This progr am is part of Subscr iber Displ ay Screens . | |
528 | IBCNBCD5 | |
529 | This progr am is part of Subscr iber Displ ay Screens . | |
530 | IBCNBCD6 | |
531 | This progr am is part of Subscr iber Displ ay Screens . | |
532 | IBCNBCD7 | |
533 | This progr am is part of Subscr iber Displ ay Screens . | |
534 | IBCNBCD8 | |
535 | This progr am is part of Subscr iber Displ ay Screen Fields. | |
536 | IBCNBEE | |
537 | This progr am edits e xisting en tries in t he Insuran ce Buffer. | |
538 | IBCNBES | |
539 | This progr am files n ew entries /data into the Insur ance Buffe r. | |
540 | IBCNBLA | |
541 | This progr am execute s List Man ager actio ns for the Insurance Buffer Li st Manager . | |
542 | IBCNBLA1 | |
543 | This progr am execute s List Man ager actio ns for the Insurance Buffer Li st Manager . | |
544 | IBCNBLA2 | |
545 | This progr am contain s subrouti nes for pr ocessing a nd validat ing the se lection of multiple entries fr om the INS URANCE VER IFICATION PROCESSOR file (#355 .33). | |
546 | IBCNBLB | |
547 | “Expand be nefits” op tion in In surance Bu ffer views . | |
548 | IBCNBLE | |
549 | This progr am is the Insurance Buffer ent ry screen. | |
550 | IBCNBLE1 | |
551 | This progr am perform s the Expa nd Entry a ction in t he Insuran ce Buffer List Manag er screen. Code to call utili ties to re evaluate t he eIV Sta tus and di splay revi sed values is includ ed, as wel l. | |
552 | IBCNBLL | |
553 | This progr am generat es the Ins urance Buf fer entrie s for the initial Li st Manager screen. | |
554 | IBCNBME | |
555 | This progr am is used to add or edit an I nsurance B uffer entr y for othe r packages . | |
556 | IBCNBMI | |
557 | This progr am moves d ata from t he Insuran ce Buffer to the Ins urance fil es. | |
558 | IBCNBOA | |
559 | This progr am contain s the Ins Buffer Act ivity Repo rt. | |
560 | IBCNBOE | |
561 | This progr am contain s the Ins Buffer Emp loyee Repo rt. | |
562 | IBCNBOF | |
563 | This progr am contain s the Ins Buffer Emp loyee Repo rt (Entere d) | |
564 | IBCNBU1 | |
565 | This progr am contain s Insuranc e Buffer u tilities. | |
566 | IBCNBUH | |
567 | This progr am contain s Insuranc e Buffer H elp text. | |
568 | IBCNEAMC | |
569 | This progr am produce s the list of auto m atched ent ries for t he INSURAN CE VERIFIC ATION PROC ESSOR file (#355.33) . | |
570 | IBCNEAME | |
571 | This progr am allows users to e nter or ed it Auto ma tched entr ies. | |
572 | IBCNEAMI | |
573 | This progr am perform s an input transform for the A uto Match functional ity. | |
574 | IBCNEBF | |
575 | This progr am will cr eate a Buf fer entry based upon input val ues. | |
576 | IBCNEDE | |
577 | This progr am is the main drive r for all data extra cts associ ated with the Insura nce Identi fication a nd Verific ation inte rface. Thi s program will run e ach extrac t in the s pecified o rder, whic h populate s the IIV Transmissi on File (s ometimes i t creates/ updates an entry in the insura nce buffer as well). It then begins to process th e inquirie s in the I IV TRANSMI SSION FILE (#365.1). | |
578 | IBCNEDE1 | |
579 | This progr am loops t hrough the insurance buffer an d creates eIV transa ction queu e entries when appro priate. P eriodicall y checks f or stop re quest for background task. | |
580 | IBCNEDE2 | |
581 | This progr am finds v eterans wh o are sche duled to b e seen wit hin a spec ified date range. P eriodicall y checks f or stop re quest for background task. | |
582 | IBCNEDE3 | |
583 | This progr am finds v eterans wh o have bee n seen wit hin a spec ified date range tha t have act ive insura nce record s that hav e not been verified recently. | |
584 | Periodical ly checks for stop r equest for backgroun d task. | |
585 | IBCNEDE4 | |
586 | This progr am finds v eterans wh o are sche duled to b e seen wit hin a spec ified date range but who have no active or no insu rance reco rds on fil e. Period ically che cks for st op request for backg round task . (This r outine was repurpose d with IB* 2.0*621 fo r EICD.) | |
587 | IBCNEDE5 | |
588 | This progr am contain s function calls use d for the data extra cts. | |
589 | IBCNEDE6 | |
590 | This progr am contain s function calls use d for the data extra cts. | |
591 | IBCNEDE7 | |
592 | This progr am was add ed to incl ude subrou tines orig inally in routine IB CNEDE when IBCNEDE h ad expande d beyond t he routine size limi tation in VistA. | |
593 | IBCNEDEP | |
594 | This progr am finds r ecords nee ding HL7 m essage cre ation and creates re cords in t he Transmi ssion Queu e and Resp onse Files . | |
595 | IBCNEDEQ | |
596 | This progr am contain s some sub routines f or process ing a tran smission. | |
597 | IBCNEDST | |
598 | HL7 Regist ration Mes sage Stati stics | |
599 | IBCNEHLD | |
600 | This progr am will pr ocess deac tivate reg istration MFN messag e. This s hould only be execut ed by inst ruction – to be used to turn o ff a site from elect ronic Insu rance Iden tification and Verif ication in terface. | |
601 | IBCNEHLI | |
602 | This progr am parses each incom ing HL7 me ssage and passes the message o n to the p rocessing program. | |
603 | IBCNEHL1 | |
604 | This progr am, which processes incoming R PI message s, replace s IBCNEHLR | |
605 | IBCNEHL2 | |
606 | This progr am, which processes incoming R PI message s, replace s IBCNEHLP | |
607 | IBCNEHL3 | |
608 | This progr am, which processes incoming R PI message s, replace s IBCNEHLS | |
609 | IBCNEHL4 | |
610 | This progr am, which processes incoming R PI message s, replace s IBCNEHLP | |
611 | IBCNEHL5 | |
612 | HL7 Proces s Incoming RPI Messa ges | |
613 | IBCNEHL6 | |
614 | HL7 Proces s Incoming RPI Conti nued | |
615 | IBCNEHL7 | |
616 | HL7 Proces s Incoming 271 Messa ges Contin ued | |
617 | IBCNEHLK | |
618 | This progr am process es the Reg istration MFN Acknow ledgement message. | |
619 | IBCNEHLM | |
620 | This progr am will cr eate the o utgoing Re gistration MFN messa ge. | |
621 | IBCNEHLO | |
622 | This progr am takes “ ready to t ransmit” r ecords and sets vari ables need ed to crea te the HL7 message. | |
623 | IBCNEHLQ | |
624 | This routi ne builds the HL7 se gments for an eIV Ve rification (RQI^I01) or Identi fication ( RQI^I03) r equest. | |
625 | IBCNEHLT | |
626 | This progr am will pr ocess inco ming HL7 M FN message s and upda te the app ropriate t ables | |
627 | IBCNEHLU | |
628 | This progr am contain s some spe cialized H L7 utility functions . | |
629 | IBCNEKI2 | |
630 | This progr am is a co ntinuation of the eI V purge lo gic in IBC NEKIT. | |
631 | IBCNEKIT | |
632 | This progr am handles the purgi ng of the eIV data s tored in t he IIV TRA NSMISSION QUEUE File (#365.1) and in the IIV RESPO NSE File ( #365). Us er can pic k a date r ange for t he purge. Data crea ted within 6 months cannot be purged. T he actual global kil ls are don e by a bac kground ta sk after h ours. | |
633 | IBCNEML | |
634 | MAILMAN NO TIFICATION TO LINK P AYERS | |
635 | IBCNEMS1 | |
636 | Consolidat ed Mailman messages | |
637 | IBCNEPM | |
638 | This progr am execute s the Paye r Maintena nce option . | |
639 | IBCNEPM1 | |
640 | This progr am is a co ntinuation of the Pa yer Mainte nance opti on. | |
641 | IBCNEPM2 | |
642 | This progr am is a co ntinuation of the Pa yer Mainte nance opti on. | |
643 | IBCNEPST | |
644 | This is th e KIDS pos t-installa tion progr am for IB* 2.0*184. | |
645 | IBCNEPY | |
646 | This progr am modifie s entries in the PAY ER File (# 365.12). | |
647 | IBCNEQU | |
648 | This progr am perform s the Requ est Electr onic Insur ance Inqui ry functio nality. | |
649 | IBCNERP0 | |
650 | This progr am is part of the eI V Statisti cal Report . | |
651 | IBCNERP1 | |
652 | This progr am is part of the eI V Response Report. | |
653 | IBCNERP2 | |
654 | This progr am is part of the eI V Response Report co mpile. | |
655 | IBCNERP3 | |
656 | This progr am is part of the eI V Response Report pr int. | |
657 | IBCNERP4 | |
658 | This progr am is part of the eI V Payer Re port. | |
659 | IBCNERP5 | |
660 | This progr am is part of the eI V Payer Re port compi le. | |
661 | IBCNERP6 | |
662 | This progr am is part of the eI V Payer Re port print . | |
663 | IBCNERP7 | |
664 | This progr am is part of the eI V Statisti cal Report . | |
665 | IBCNERP8 | |
666 | This progr am is part of the eI V Statisti cal Report compile. | |
667 | IBCNERP9 | |
668 | This progr am is part of the eI V Statisti cal Report print. | |
669 | IBCNERPA | |
670 | This progr am is part of the eI V Response Report. | |
671 | IBCNERPB | |
672 | This progr am is part of the eI V Payer Li nk Report. | |
673 | IBCNERPC | |
674 | This progr am is part of the eI V Payer Li nk Report. | |
675 | IBCNERPD | |
676 | This progr am is part of the eI V Payer Li nk Report. | |
677 | IBCNERPE | |
678 | This progr am is part of the eI V Response Report. | |
679 | IBCNERPF | |
680 | This progr am is part of the eI V Insuranc e Update R eport. | |
681 | IBCNERPG | |
682 | This progr am is part of the eI V Insuranc e Update R eport. | |
683 | IBCNERPH | |
684 | This progr am is part of the eI V Insuranc e Update R eport. | |
685 | IBCNERPI | |
686 | IBCNE eIV Secondary Insurance Report Pri nt | |
687 | IBCNERPJ | |
688 | This progr am is part of the HL 7 Response Report. | |
689 | IBCNERPK | |
690 | This progr am is part of the HL 7 Response Report. | |
691 | IBCNERPL | |
692 | This progr am is part of the HL 7 Response Report. | |
693 | IBCNERTC | |
694 | Covered by Health In surance | |
695 | IBCNERTQ | |
696 | Real-time Insurance Verificati on | |
697 | IBCNES | |
698 | Eligibilit y/Benefits screen. | |
699 | IBCNES1 | |
700 | Eligibilit y/Benefits screen ut ilities. | |
701 | IBCNES2 | |
702 | Eligibilit y/Benefits screen ac tion proto cols. | |
703 | IBCNES3 | |
704 | Eligibilit y/Benefits screen ac tion proto cols, cont . | |
705 | IBCNES4 | |
706 | Eligibilit y/Benefits screen ac tion proto cols, cont . | |
707 | IBCNESI | |
708 | Potential Medicare C OB Prompts | |
709 | IBCNESI1 | |
710 | MEDICARE P OTENTIAL C OB Patient Selection | |
711 | IBCNESI2 | |
712 | MEDICARE P ATIENTS WI TH SUBSEQU ENT INSURA NCE | |
713 | IBCNETST | |
714 | eIV Gate-k eeper test scenarios | |
715 | IBCNEUT1 | |
716 | This progr am contain s general eIV utilit ies. | |
717 | IBCNEUT2 | |
718 | This progr am contain s general eIV utilit ies. | |
719 | IBCNEUT3 | |
720 | This progr am contain s general eIV utilit ies. | |
721 | IBCNEUT4 | |
722 | This progr am contain s general eIV utilit ies. | |
723 | IBCNEUT5 | |
724 | This progr am contain s general eIV utilit ies. | |
725 | IBCNEUT6 | |
726 | This progr am contain s general eIV utilit ies. | |
727 | IBCNEUT7 | |
728 | This progr am contain s general eIV utilit ies. | |
729 | IBCNEUT8 | |
730 | This progr am contain s general eIV utilit ies. | |
731 | IBCNGPF | |
732 | This progr am is part of the Li st Group P lans witho ut Annual Benefits R eport. | |
733 | IBCNGPF1 | |
734 | This progr am is part of the Li st Group P lans witho ut Annual Benefits R eport. | |
735 | IBCNGPF2 | |
736 | This progr am is part of the Li st Group P lans witho ut Annual Benefits R eport. | |
737 | IBCNGPF3 | |
738 | This progr am is part of the Li st Group P lans witho ut Annual Benefits R eport. | |
739 | IBCNICB | |
740 | Update uti lities for the ICB i nterface. | |
741 | IBCNHPR | |
742 | This progr am is part of the Ma nually Add ed HPIDs t o Billing Claim Repo rt. | |
743 | IBCNHPR1 | |
744 | This progr am is part of the Ma nually Add ed HPIDs t o Billing Claim Repo rt. | |
745 | IBCNHPR2 | |
746 | This progr am is part of the Ma nually Add ed HPIDs t o Billing Claim Repo rt. | |
747 | IBCNS3 | |
748 | Display ex tended ins urance inf ormation. | |
749 | IBCNSC | |
750 | This progr am edits a n Insuranc e Company. | |
751 | IBCNSC01 | |
752 | This progr am edits a n Insuranc e Company. | |
753 | IBCNSC41 | |
754 | Insurance plan scree n utilitie s. | |
755 | IBCNSM | |
756 | This routi ne display s in list format one patient's policies, and allow s for edit ing of the se policie s. | |
757 | IBCNSM1 | |
758 | This routi ne display s in list format one patient's policies, and allow s for edit ing of the se policie s | |
759 | IBCNSM2 | |
760 | This routi ne display s in list format one patient's policies, and allow s for edit ing of the se policie s | |
761 | IBCNSM3 | |
762 | This routi ne contain s Insuranc e Manageme nt - Outpu ts | |
763 | IBCNSM4 | |
764 | These rout ines displ ay in list format on e patient' s policies , and allo ws for edi ting of th ese polici es. | |
765 | IBCNSM5 | |
766 | This routi ne prints the insura nce plan w orksheets and policy coverage reports. | |
767 | IBCNSM6 | |
768 | This routi ne prints the insura nce plan w orksheets and policy coverage reports. | |
769 | IBCNSM7 | |
770 | This routi ne prints the insura nce plan w orksheets and policy coverage reports. | |
771 | IBCNSM8 | |
772 | This routi ne prints the insura nce plan w orksheets and policy coverage reports. | |
773 | IBCNSM9 | |
774 | This routi ne prints the insura nce plan w orksheets and policy coverage reports. | |
775 | IBCNSM31 | |
776 | This routi ne display s in list format one patient's policies, and allow s for edit ing of the se policie s | |
777 | IBCNSM32 | |
778 | This routi ne display s in list format one patient's policies, and allow s for edit ing of the se policie s | |
779 | IBCNSP | |
780 | This routi ne display s policy d ata for a patient in expanded format and allows fo r editing of the dat a. | |
781 | IBCNSP0 | |
782 | This routi ne contain s Insuranc e Manageme nt – Expan ded Policy | |
783 | IBCNSP01 | |
784 | This routi ne contain s Insuranc e manageme nt – Expan ded Policy . | |
785 | IBCNSP02 | |
786 | This routi ne contain s Insuranc e Manageme nt - Expan ded Policy | |
787 | IBCNSP1 | |
788 | Insurance Management - Policy Actions | |
789 | IBCNSP2 | |
790 | This routi ne is the supported call to al low for ed iting of a patient's insurance policy an d plan inf ormation f rom regist ration and billing. | |
791 | IBCNSP3 | |
792 | This routi ne display s policy d ata for a patient in expanded format and allows fo r editing of the dat a. | |
793 | IBCNSP11 | |
794 | This routi ne display s policy d ata for a patient in expanded format and allows fo r editing of the dat a. | |
795 | IBCNUPD | |
796 | Update Sub scriber In fo for Sel ected Pati ents | |
797 | IBCNVCC | |
798 | This progr am is part of the Pa tient Insu rance Cons istency Ch ecker for System Sha ring Verif ied Insura nce. | |
799 | IBCNVCC1 | |
800 | This progr am is part of the Pa tient Insu rance Cons istency Ch ecker for System Sha ring Verif ied Insura nce. | |
801 | IBCNVPU0 | |
802 | This progr am is the PIN/HL7 Ut ility Func tions for HL7 System Sharing V erified In surance. | |
803 | IBCNVRD0 | |
804 | This progr am is part of System Sharing V erified In surance. | |
805 | IBCNVRD1 | |
806 | This progr am is part of System Sharing V erified In surance. | |
807 | IBCNVRP0 | |
808 | This progr am is part of the In terfacilit y Ins Upda te Activit y Report. | |
809 | IBCNVRP1 | |
810 | This progr am is part of the In terfacilit y Ins Upda te Activit y Report. | |
811 | IBCNVRP2 | |
812 | This progr am is part of the In terfacilit y Ins Upda te Activit y Report. | |
813 | IBCNVUT0 | |
814 | This progr am is part of System Sharing V erified In surance. | |
815 | IBCOC | |
816 | Prints a l ist of ina ctive insu rance comp anies stil l listed a s insuring patients. | |
817 | IBCOC1 | |
818 | Prints a l ist of new but not v erified in surance. | |
819 | IBCOMA | |
820 | Identify a ctive poli cies w/no effective date. | |
821 | IBCOMA1 | |
822 | Identify a ctive poli cies w/no effective date (con' t). | |
823 | IBCOMC | |
824 | Identify P t By Age W ith Or Wit hout Insur ance. | |
825 | IBCOMC1 | |
826 | ALB/CMS-id entify Pt by age wit h or witho ut insuran ce (con't) . | |
827 | IBCOMC2 | |
828 | Identify P t by age w ith or wit hout insur ance (con' t). | |
829 | IBCOMD | |
830 | Generate i nsurance c ompany lis tings. | |
831 | IBCOMD1 | |
832 | Generate i nsurance c ompany lis tings. | |
833 | IBCOMN | |
834 | Patients n o coverage verified report. | |
835 | IBCOMN1 | |
836 | Patients n o coverage verified report (co n't). | |
837 | IBCONS1 | |
838 | Veterans w ith insura nce output s. (Routi nes former ly named D GCRONS1, D GCRONS2, D GCRONSC.). | |
839 | IBCONS2 | |
840 | Veterans w ith insura nce output s. (Routi nes former ly named D GCRONS1, D GCRONS2, D GCRONSC.). | |
841 | IBCONS3 | |
842 | Veterans w ith insura nce output s interfac e with Cla ims Tracki ng. | |
843 | IBCONSC | |
844 | Veterans w ith insura nce output s. (Routi nes former ly named D GCRONS1, D GCRONS2, D GCRONSC.). | |
845 | IBCOPP | |
846 | List Ins. Plans by C o. (Driver ). | |
847 | IBCOPP1 | |
848 | List Ins. Plans by C o. (Driver 1). | |
849 | IBCOPP2 | |
850 | List Ins. Plans by C o. (Compil e). | |
851 | IBCOPP3 | |
852 | List Ins. Plans by C o. (Print) . | |
853 | IBCOPR | |
854 | Print doll ar amounts for Pre-r egistratio n. | |
855 | IBCOPR1 | |
856 | Print doll ar amounts for Pre-r egistratio n. | |
857 | IBJDI4 | |
858 | Patients w ith uniden tified ins urance. | |
859 | IBJDI41 | |
860 | Patients w ith uniden tified ins urance (co nt'd). | |
861 | IBJDI5 | |
862 | Insurance policies n ot verifie d. | |
863 | IBJPI | |
864 | This progr am is used to define the IIV S ite Parame ters. | |
865 | IBJPI2 | |
866 | This progr am perform s the IIV Site Param eters acti ons. | |
867 | IBJPI3 | |
868 | Most popul ar payer s creen. | |
869 | IBJPI4 | |
870 | Most popul ar payer s creen. | |
871 | IBJPI5 | |
872 | IBJP5 eIV Site Param eters Scre en | |
873 | IBJPM | |
874 | This progr am display s and allo ws editing of the MC CR Site Pa rameters. | |
875 | IBOTR | |
876 | Insurance Payment Tr end Report user inte rface. (R outines IB OTR and IB OTR1 were formerly n amed DGCRO TR, DGCROT R1.) | |
877 | IBOTR1 | |
878 | Insurance Payment Tr end Report user inte rface. (R outines IB OTR and IB OTR1 were formerly n amed DGCRO TR, DGCROT R1.) | |
879 | IBOTR2 | |
880 | Insurance Payment Tr end Report data comp ilation. (Routine f ormerly na med DGCROT R2.) | |
881 | IBOTR3 | |
882 | Insurance Payment Tr end Report output. (Routines formerly n amed DGCRO TR3, DGCRO TR4.) | |
883 | IBOTR4 | |
884 | Insurance Payment Tr end Report output. (Routines formerly n amed DGCRO TR3, DGCRO TR4.) | |
885 | IBOTR11 | |
886 | Insurance Payment Tr end Report user inte rface. (R outines IB OTR and IB OTR1 were formerly n amed DGCRO TR, DGCROT R1.) | |
887 | IBOUNP1 | |
888 | Inpatients w/Unknown or Expire d Insuranc e Report. | |
889 | IBOUNP2 | |
890 | Inpatients w/Unknown or Expire d Insuranc e Report. | |
891 | IBOUNP3 | |
892 | Inpatients w/Unknown or Expire d Insuranc e Report. | |
893 | IBOUNP4 | |
894 | Outpatient s w/Unknow n or Expir ed Insuran ce Report. | |
895 | IBOUNP5 | |
896 | Outpatient s w/Unknow n or Expir ed Insuran ce Report. | |
897 | IBOUNP6 | |
898 | Outpatient s w/Unknow n or Expir ed Insuran ce Report. | |
899 | ||
900 | ||
901 | File List with Descr iptions | |
902 | ||
903 | WARNING: It is not recommende d that you use VA Fi leManager to edit an y of the f iles direc tly! Furt hermore, e diting any of the ne w files wi thout dire ction from the inter face progr ammers may cause the interface to become non-funct ional! | |
904 | ||
905 | File # | |
906 | File Name | |
907 | Data Dicti onary | |
908 | 2 | |
909 | PATIENT | |
910 | ^DPT – con tains all the patien ts followe d by the m edical cen ter/Outpat ient clini c. | |
911 | 2.312 | |
912 | INSURANCE TYPE SUB_F ILE | |
913 | This multi ple contai ns patient ’s insuran ce informa tion. | |
914 | 2.322 | |
915 | ELIGIBILIT Y/BENEFIT SUB-FILE | |
916 | This multi ple contai ns all of the eligib ility and benefit da ta for a s pecific in sured pers on returne d from the Payer. | |
917 | 36 | |
918 | INSURANCE COMPANY | |
919 | ||
920 | ^DIC(36)- This file contains t he names a nd address es of insu rance comp anies as n eeded by t he local f acility. The data i n this fil e is NOT E DITABLE US ING VA FIL EMAN. If a new entr y needs to be made o r an exist ing entry changed, t he user mu st be assi gned the a ppropriate MAS or IB module op tion. | |
921 | 350.9 | |
922 | IB SITE PA RAMETERS | |
923 | ||
924 | ^IBE(350.9 ) – This f ile contai ns the dat a necessar y to run t he IB pack age. It ha s been mod ified to s tore the p arameters needed for the Insur ance Ident ification and Verifi cation Int erface. Al l data ele ments for the Insura nce Identi fication a nd Verific ation Inte rface will be number ed 51.nn. | |
925 | 350.9002 | |
926 | BATCH EXTR ACTS (sub- file) | |
927 | ||
928 | This multi ple contai ns site pa rameters r elated to batch extr acts. | |
929 | 353.1 | |
930 | PLACE OF S ERVICE | |
931 | ||
932 | 355.12 | |
933 | SOURCE OF INFORMATIO N | |
934 | ^IBE(355.1 2) – This file conta ins codes that respr esent the originatio n of the p atient’s i nsurance i nformation | |
935 | 355.33 | |
936 | INSURANCE VERIFICATI ON PROCESS OR | |
937 | ||
938 | ^IBA(355.3 3) – This file conta ins insura nce inform ation accu mulated by various s ources. T he data is held in t his file u ntil an au thorized p erson proc esses the informatio n by eithe r rejectin g it or mo ving it to the Insur ance files . | |
939 | 365 | |
940 | IIV RESPON SE | |
941 | ^IBCN(365) – This fi le holds a ll respons es to HL7 messages g enerated f rom the II V TRANSMIS SION QUEUE File (#36 5.1) for I nsurance I dentificat ion and Ve rification . | |
942 | 365.011 | |
943 | X12 271 EL IGIBILITY/ BENEFIT | |
944 | ^IBE(365.0 11) – This contains the eligib ility stat uses of th e individu al or the benefit re lated cate gories fro m the corr esponding X.12 271 E B01 codes. | |
945 | 365.012 | |
946 | X12 271 CO VERAGE LEV EL | |
947 | ^IBE(365.0 12) – This contains the level of coverag e of benef its from t he corresp onding X.1 2 271 EB02 codes. | |
948 | 365.013 | |
949 | X12 271 SE RVICE TYPE | |
950 | ^IBE(365.0 13) – This contains the classi fication o f services from the correspond ing X.12 2 71 EB03 co des. | |
951 | 365.014 | |
952 | X12 271 IN SURANCE TY PE | |
953 | ^IBE(365.0 14) – This contains different types of i nsurance p olicies fr om the cor responding X.12 271 EB04 codes . | |
954 | 365.015 | |
955 | X12 271 TI ME PERIOD QUALIFIER | |
956 | ^IBE(365.0 15) – This contains the time p eriod cate gory when qualifying benefit a vailabilit y from the correspon ding X.12 271 EB05 c odes. | |
957 | 365.016 | |
958 | X12 271 QU ANTITY QUA LIFIER | |
959 | ^IBE(365.0 16) – This contains the type o f units th at are con veyed when describin g a benefi t quantity from the correspond ing X.12 2 71 EB06 co des. | |
960 | 365.017 | |
961 | X12 271 ER ROR CONDIT ION | |
962 | ^IBE(365.0 17) – This file cont ains all t he corresp onding X.1 2 271 AAA0 3 codes. These valu es are ret urned beca use of an error in p rocessing. | |
963 | 365.018 | |
964 | X12 271 ER ROR ACTION | |
965 | ^IBE(365.0 18) – This file cont ains the a ction that eIV shoul d take as a result o f an error encounter ed. | |
966 | 365.02 | |
967 | ELIGIBILIT Y / BENEFI T SUB-FILE | |
968 | This multi ple contai ns eligibi lity/benef it informa tion. | |
969 | 365.021 | |
970 | X12 271 CO NTACT QUAL IFIER | |
971 | ^IBE(365.0 21) – This contains the differ ent types of communi cations. | |
972 | 365.022 | |
973 | X12 ENTITY IDENTIFIE R CODE | |
974 | This file contains a ll the cor responding X.12 code s which id entify an eligibilit y/benefit entity. | |
975 | 365.023 | |
976 | X12 271 ID ENTIFICATI ON QUALIFI ER | |
977 | This file contains a ll the cor responding X.12 code s for iden tification qualifier s. | |
978 | 365.024 | |
979 | X12 271 PR OVIDER COD E | |
980 | This file contains a ll the cor responding X.12 code s which id entify a p rovider. | |
981 | 365.025 | |
982 | X12 271 DE LIVERY FRE QUENCY COD E | |
983 | This file contains a ll the cor responding X.12 code s for deli very frequ ency. | |
984 | 365.026 | |
985 | X12 271 DA TE QUALIFI ER FILE | |
986 | This file contains a ll the cor responding X.12 code s for date /time qual ifiers. | |
987 | 365.027 | |
988 | X12 271 LO OP ID | |
989 | This file contains a ll the cor responding X.12 code s for loop IDS | |
990 | 365.028 | |
991 | X12 271 RE F IDENTIFI CATION | |
992 | This file contains a ll the cor responding X.12 code s for ref identifica tion. | |
993 | 365.029 | |
994 | X12 271 UN ITS OF MEA SUREMENT | |
995 | This file contains a ll the cor responding X.12 271 Units of m easurement . | |
996 | 365.031 | |
997 | X12 271 EN TITY RELAT IONSHIP CO DE | |
998 | This file contains a ll the cor responding X.12 271 Entity Rel ationship codes. | |
999 | 365.032 | |
1000 | X12 271 DA TE FORMAT QUALIFIER | |
1001 | This file contains a ll the cor responding X.12 271 date | |
1002 | format qua lifiers. | |
1003 | 365.033 | |
1004 | X12 271 YE S/NO RESPO NSE CODE | |
1005 | This file contains t he corresp onding X.1 2 271 YES/ NO conditi on or Resp onse codes . | |
1006 | 365.034 | |
1007 | X12 271 LO CATION QUA LIFER | |
1008 | This file contains a ll the cor responding X.12 271 Location Q ualifiers. | |
1009 | 365.035 | |
1010 | X12 271 PR OCEDURE CO DING METHO D | |
1011 | This file contains a ll the cor responding X.12 271 procedure coding met hods. | |
1012 | 365.036 | |
1013 | X12 271 DE LIVERY PAT TERN | |
1014 | This file contains a ll the cor responding X12 271 D elivery Pa ttern code s. | |
1015 | 365.037 | |
1016 | X12 271 PA TIENT RELA TIONSHIP | |
1017 | This file contains a ll the cor responding X.12 271 patient re lationship codes. | |
1018 | 365.038 | |
1019 | X12 271 IN JURY CATEG ORY | |
1020 | This file contains a ll the cor responding X.12 271 Nature of Injury Cat egory code s. | |
1021 | 365.039 | |
1022 | X12 271 MI LITARY PER SONNEL INF O STATUS C ODE | |
1023 | This file contains a ll the cor responding X.12 271 military p ersonnel i nformation status co des. | |
1024 | 365.041 | |
1025 | X12 271 MI LITARY GOV T SERVICE AFFILIATIO N | |
1026 | This file contains a ll the cor responding X.12 271 military p ersonnel i nformation governmen t service affiliatio n codes. | |
1027 | 365.042 | |
1028 | X12 271 MI LITARY SER VICE RANK | |
1029 | This file contains a ll the cor responding X.12 271 military p ersonnel i nformation rank code s. | |
1030 | 365.043 | |
1031 | X12 271 EN TITY TYPE QUALIFIER | |
1032 | This file contains a ll the cor responding X.12 271 Entity Typ e Qualifie rs. | |
1033 | 365.044 | |
1034 | X12 271 CO DE LIST QU ALIFIER | |
1035 | This file contains a ll the cor responding X.12 271 code list qualifiers . | |
1036 | 365.045 | |
1037 | X12 271 NA TURE OF IN JURY CODES | |
1038 | This file contains a ll the cor responding X.12 271 NATURE OF INJURY COD ES. | |
1039 | 365.046 | |
1040 | X12 271 MI LITARY EMP LOYMENT ST ATUS CODE | |
1041 | This file contains a ll the cor responding X.12 271 MPI employ ment statu s codes. | |
1042 | 365.1 | |
1043 | IIV TRANSM ISSION QUE UE | |
1044 | ^IBCN(365. 1) – This file conta ins record s, which h ave been s elected ba sed on spe cific crit eria to ge nerate an HL7 messag e. These messages w ill be sen t to the E ligibility Communica tor for pr ocessing. | |
1045 | 365.11 | |
1046 | IIV AUTO M ATCH | |
1047 | ^IBCN(365. 11) – Thi s file con tains reco rds, which have been entered b y the user s to assis t with the identific ation of a valid ins urance com pany names that are found in t he INSURAN CE COMPANY File (#36 ). | |
1048 | 365.12 | |
1049 | PAYER | |
1050 | ^IBE(365.1 2) – This file conta ins all pa yers, whic h can be c ommunicate d with ele ctronicall y for insu rance iden tification and verif ication. | |
1051 | 365.121 | |
1052 | APPLICATIO N SUB-FILE | |
1053 | This multi ple contai ns applica tion-relat ed data fo r a given payer. | |
1054 | 365.1212 | |
1055 | ACTIVE FLA G LOG (sub -file) | |
1056 | This multi ple contai ns log of changes to the “ACTI VE” flag. | |
1057 | 365.1213 | |
1058 | TRUSTED FL AG LOG (su b-file) | |
1059 | This multi ple contai ns log of changes to the “TRUS TED” flag. | |
1060 | 365.13 | |
1061 | PAYER APPL ICATION | |
1062 | ^IBE(365.1 3) – This file conta ins all th e differen t applicat ions that a payer co uld be con tacted ele ctronicall y for. | |
1063 | 365.14 | |
1064 | IIV TRANSM ISSION STA TUS | |
1065 | ^IBE(365.1 4) – This file conta ins all th e possible message s tatuses th at are fou nd in the IIV TRANSM ISSION QUE UE File (# 365.1) and the IIV R ESPONSE Fi le (#365). | |
1066 | 365.15 | |
1067 | IIV STATUS TABLE | |
1068 | ^IBE(365.1 5) – This file conta ins the po ssible eIV Status sy mbols, and in some c ases the a pplicable error mess age, that is found i n the Insu rance Buff er entries . | |
1069 | 365.152 | |
1070 | DESCRIPTIO N SUB-FILE | |
1071 | This is th e explanat ion of wha t the IIV status | |
1072 | means. Th is descrip tion will appear in the | |
1073 | Expand Ent ry action of the Ins urance Buf fer | |
1074 | applicatio n. | |
1075 | 365.17 | |
1076 | CORRECTIVE ACTION SU B-FILE | |
1077 | This is th e set of s teps a use r needs to follow | |
1078 | in order t o resolve this IIV p roblem tha t is | |
1079 | displayed on the Exp and Entry screen in the | |
1080 | Insurance Buffer. | |
1081 | 365.18 | |
1082 | EIV EICD T RACKING FI LE | |
1083 | This file allows Vis tA to trac k data ass ociated wi th the Ele ctronic In surance Co verage Dis covery (EI CD) extrac t process. Both Iden tification and Verif ication EI CD transac tions (inq uiries and responses ) are deta iled and t racked in this file. | |
1084 | 365.185 | |
1085 | INSURANCE DISCOVERED SUB-FILE | |
1086 | When an EI CD Identif ication re sponse ret urns with one or mor e discover ed policie s, they ar e detailed in this s ub-file to be used w hen creati ng EICD Ve rification inquiries . | |
1087 | 365.2 | |
1088 | IIV RESPON SE REVIEW | |
1089 | ^IBCN(365. 2) - This file holds the outco me of the reviews of MEDICARE (WNR) mess ages conta ined in th e IIV RESP ONSE file (#365). T he file is populated when the user enter s comments and statu ses agains t selected messages using the Medicare P otential C OB Worklis t [IBCNE P OTENTIAL C OB LIST] o ption. | |
1090 | 366 | |
1091 | IB SSVI PI N/HL7 PIVO T | |
1092 | ^IBCN(366) – This fi le collect s all of t he PIN eve nts that n eed to be broadcast to the sys tem. The entries in this file contain i nformation on how to get back to its par ent event in PIMS. T here are n o parent-c hild relat ionships s tored here . | |
1093 | 366.1 | |
1094 | IB INSURAN CE INCONSI STENT DATA | |
1095 | ^IBCN(366. 1) – This file conta ins those patients w ho were fo und to hav e missing and/or inc onsistent data eleme nts in the PATIENT f ile by the IB Insura nce Info V IEW/EDIT c onsistency checker. The incon sistent da ta element s are stor ed in this file wher e individu al checks can be tur ned on or off by the facility. Once the data is c orrected t hrough the appropria te insuran ce menu op tions, the entry wil l be remov ed from th is file. | |
1096 | 366.2 | |
1097 | IB INSURAN CE CONSIST ENCY ELEME NTS | |
1098 | ^IBCN(366. 2) – This file conta ins those entries wh ich are ch ecked by t he IB Insu rance Info View/Edit module co nsistency checker. Other than turning i ndividual checks on or off, th e user sho uld not al ter or add to this f ile in any way. Mak ing any mo dification to this f ile will d efinitely cause the consistenc y checker to functio n improper ly. | |
1099 | ||
1100 | ||
1101 | ||
1102 | Input Temp lates | |
1103 | ||
1104 | Following is a list of the VA FileMan in put templa tes associ ated with the proces sing and g eneration of X12 270 /271 messa ges. | |
1105 | ||
1106 | Input Temp late | |
1107 | File | |
1108 | IBCNE GENE RAL PARAME TER EDIT | |
1109 | IB SITE PA RAMETERS # 350.9 | |
1110 | IBCN PATIE NT INSURAN CE | |
1111 | IBCN PATIE NT INSURAN CE #2 | |
1112 | IBEDIT INS CO1 | |
1113 | INSURANCE COMPANY #3 6 | |
1114 | ||
1115 | ||
1116 | List Templ ates | |
1117 | ||
1118 | Following is a list of the VA FileMan li st templat es associa ted with t he process ing and ge neration o f X12 270/ 271 messag es. This includes L ist Templa tes associ ated with the VistA menu optio n PROCESS INSURANCE BUFFER [IB CN INSURAN CE BUFFER PROCESS]. | |
1119 | ||
1120 | List Templ ate | |
1121 | IBCNB INSU RANCE BUFF ER ENTRY | |
1122 | IBCNE MEDI CARE COB D ISPLAY | |
1123 | IBCNE MEDI CARE COB L IST | |
1124 | IBCNE AUTO MATCH BUF FER LIST | |
1125 | IBCNE PAYE R EXPAND L IST | |
1126 | IBCNE PAYE R MAINT LI ST | |
1127 | IBCNE REQU EST INS IN QUIRY LIST | |
1128 | IBJP IIV S ITE PARAME TERS | |
1129 | IBJP IIV M OST POPULA R PAYERS | |
1130 | IBJP MCCR PARAMETERS | |
1131 | IBCNB INSU RANCE BUFF ER LIST | |
1132 | IBCNE ELIG ILITY/BENE FIT INFO | |
1133 | IBCNS EXPA NDED POLIC Y | |
1134 | IBCNS INS CO PLAN DE TAIL | |
1135 | IBJT CLAIM INFO | |
1136 | IBCNE ELIG IBILITY/BE NEFIT INFO | |
1137 | IBCNE MEDI CARE COB D ISPLAY | |
1138 | IBCNE MEDI CARE COB L IST | |
1139 | IBCNB INSU RANCE BUFF ER PAYER | |
1140 | ||
1141 | ||
1142 | Mail Group | |
1143 | ||
1144 | Mail Group Name | |
1145 | Descriptio n | |
1146 | IBCNE EIV MESSAGE | |
1147 | This Mail Group rece ives messa ges when e IV encount ers a prob lem, which includes but is not limited t o: buildin g inquirie s, process ing respon ses, and o ther issue s with the HL7 messa ges. | |
1148 | IB SSVI | |
1149 | This Mail Group rece ives messa ges when S SVI encoun ters a pro blem, whic h includes but is no t limited to sending , receivin g, and pro cessing in terfacilit y insuranc e updates. | |
1150 | ||
1151 | ||
1152 | Options fo r eIV | |
1153 | ||
1154 | eIV (VistA ) options | |
1155 | Descriptio n | |
1156 | Attached t o Menu | |
1157 | Interfacil ity Ins Up date Activ ity Report | |
1158 | [IBCN INTE RFACILITY INS UPDATE ] | |
1159 | This optio n runs the new Inter facility I ns Update Activity R eport | |
1160 | . | |
1161 | Patient In surance Me nu | |
1162 | [IBCN INSU RANCE MGMT MENU] | |
1163 | List Group Plans wit hout Annua l Benefits Report | |
1164 | [IBCN GRP PLAN FILES RPT] | |
1165 | This optio n runs the List Grou p Plans wi thout Annu al Benefit s Report. | |
1166 | Insurance Reports | |
1167 | [IBCN INS RPTS] | |
1168 | HL7 Respon se Report | |
1169 | [IBCNE HL7 RESPONSE REPORT] | |
1170 | This optio n displays the time the reques t was sent to FSC an d the Time the respo nse was re ceive. It also show s the Buff er #, Paye r # and Pa tient # | |
1171 | eIV Menu | |
1172 | [IBCNE IIV MENU] | |
1173 | Insurance Reports | |
1174 | [IBCN INS RPTS] | |
1175 | This is th e main men u to view and print insurancer eports. | |
1176 | Patient In surance Me nu | |
1177 | [IBCN INSU RANCE MGMT MENU] | |
1178 | Insurance Company En try/Edit | |
1179 | [IBCN INSU RANCE CO E DIT] | |
1180 | This optio n allows t he editing of insura nce compan y informat ion. | |
1181 | Patient In surance Me nu | |
1182 | [IBCN INSU RANCE MGMT MENU] | |
1183 | Patient In surance Me nu | |
1184 | [IBCN INSU RANCE MGMT MENU] | |
1185 | This is a main menu to edit, v iew, and p rint insur ance infor mation. | |
1186 | Integrated Billing M aster Menu [IB MANAG ER MENU] | |
1187 | Patient In surance In fo View/Ed it | |
1188 | [IBCN PATI ENT INSURA NCE] | |
1189 | This optio n allows v iewing and editing o f patient insurance. | |
1190 | Patient In surance Me nu | |
1191 | [IBCN INSU RANCE MGMT MENU] | |
1192 | User Edit Report | |
1193 | [IBCN USER EDIT RPT] | |
1194 | This optio n runs the new User Edit Repor t. | |
1195 | Insurance Reports | |
1196 | [IBCN INS RPTS] | |
1197 | Enter/Edit Auto Matc h Entries | |
1198 | [IBCNE AUT O MATCH EN TER/EDIT] | |
1199 | This optio n is used to define and/or edi t eIV Auto Match rul es which a ssist the eIV softwa re with ma tching fre e-text ins urance com pany names in the In surance Bu ffer with insurance companies in the INS URANCE COM PANY File (#36). | |
1200 | eIV Menu | |
1201 | [IBCNE IIV MENU] | |
1202 | Add Auto M atch Entri es Using I nsurance B uffer Data | |
1203 | [IBCNE AUT O MATCH BU FFER] | |
1204 | This optio n is a too l that lis ts each of the free- text insur ance compa ny names i n the Insu rance Buff er to dete rmine whet her a matc h is able to be made to an exi sting insu rance comp any in the INSURANCE COMPANY F ile (#36). | |
1205 | eIV Menu | |
1206 | [IBCNE IIV MENU] | |
1207 | IIV Nightl y Process | |
1208 | [IBCNE IIV BATCH PRO CESS] | |
1209 | This optio n is used to begin t he nightly batch pro cessing. The nightl y processi ng checks to ensure that all r equired pa rameters a re defined , runs the inquiry e xtracts, s end a regi stration m essage to the EC, an d then pro ceeds to d eliver the inquiries . This op tion is ty pically ru n on a nig htly basis through a scheduled TaskMan t ask. | |
1210 | (TaskMan O NLY) | |
1211 | ||
1212 | Link Insur ance Compa nies to Pa yers | |
1213 | [IBCNE PAY ER LINK] | |
1214 | This optio n allows t he user to see payer s added du ring a dat e range en tered by t he user. T hey will t hen be abl e to link these paye rs to sele cted insur ance compa nies. | |
1215 | Payer Main tenance Me nu [IBCNE PAYER MAIN TENANCE ME NU] | |
1216 | Payer Main tenance Me nu | |
1217 | [IBCNE PAY ER MAINTEN ANCE MENU] | |
1218 | This menu lists opti ons to mai ntain the PAYER File (#365.12) . | |
1219 | Patient In surance Me nu | |
1220 | [IBCN INSU RANCE MGMT MENU] | |
1221 | IIV Statis tical Repo rt | |
1222 | [IBCNE IIV STATISTIC AL REPORT] | |
1223 | This optio n runs the eIV Stati stical Rep ort which contains a summary o f incoming and outgo ing messag e traffic, as well a s current statistics for the I nsurance B uffer. | |
1224 | eIV Menu | |
1225 | [IBCNE IIV MENU] | |
1226 | Unlinked P ayers Noti fication | |
1227 | [IBCNE EIV PAYER LIN K NOTIFY] | |
1228 | This optio n sends a Mailman no tification to eIV ma il group t hat contai ns total n umber of n ationally active unl inked paye rs with po tential in surance co mpany matc hes along with the l ist of nat ionally ac tive linke d payers t hat are lo cally inac tive. | |
1229 | ||
1230 | eIV Auto U pdate Repo rt | |
1231 | [IBCNE EIV UPDATE RE PORT] | |
1232 | This optio n generate s the eIV Auto Updat e Report b ased on eI V Inquirie s and Resp onses for a given da te range a nd current Patient I nsurance d ata. This report on ly reflect s policies that were last edit ed/verifie d (within the date r ange) by t he automat ic process ing (also known as A uto Update ) of an eI V payer re sponse (X1 2 271 mess age). | |
1233 | Patient In surance Me nu | |
1234 | [IBCN INSU RANCE MGMT MENU] | |
1235 | IIV Payer Link Repor t | |
1236 | [IBCNE IIV PAYER LIN K REPORT] | |
1237 | This optio n runs the eIV Payer Link Repo rt which p rovides ei ther a Pay er List or an Insura nce Compan y List. T he Payer L ist reflec ts the pay er / insur ance compa ny link in formation while the Insurance Company Li st reflect s the insu rance comp any / paye r link inf ormation. | |
1238 | eIV Menu | |
1239 | [IBCNE IIV MENU] | |
1240 | IIV Payer Report | |
1241 | [IBCNE IIV PAYER REP ORT] | |
1242 | This optio n runs the eIV Payer Report wh ich provid es statist ics on a p ayer-by-pa yer basis regarding the number of inquir ies sent a nd receive d and summ aries of e rror codes that have been retu rned. | |
1243 | eIV Menu | |
1244 | [IBCNE IIV MENU] | |
1245 | Payer Edit | |
1246 | [IBCNE PAY ER EDIT] | |
1247 | ||
1248 | *Requires the securi ty key IBC NE EIV MAI NTENANCE | |
1249 | This optio n is used to review the list p ayers that are curre ntly avail able for E DI communi cations in the natio nal payer list maint ained by t he EC. Th is option can be use d to local ly enable or disable each paye r for the site. | |
1250 | Payer Main tenance Me nu | |
1251 | [IBCNE PAY ER MAINTEN ANCE MENU] | |
1252 | Purge IIV Transactio ns | |
1253 | [IBCNE PUR GE IIV DAT A] | |
1254 | This optio n allows t he site to purge eIV inquiry a nd respons e data fro m the IIV TRANSMISSI ON QUEUE ( #365.1) an d IIV RESP ONSE (#365 ) files, r espectivel y. | |
1255 | Purge Menu | |
1256 | [IB PURGE MENU] | |
1257 | Request El ectronic I nsurance I nquiry | |
1258 | [IBCNE REQ UEST INQUI RY] | |
1259 | *Requires the securi ty key IBC NE IIV SUP ERVISOR | |
1260 | This optio n provides the means to manual ly request an electr onic eligi bility inq uiry for a specified patient a nd insuran ce company . This op tion also allows an identifica tion reque st to the sent for a specified patient t hat direct s the EC t o send all known ins urance for that pati ent. | |
1261 | eIV Menu | |
1262 | [IBCNE IIV MENU] | |
1263 | Link Insur ance Compa nies to Pa yers | |
1264 | [IBCNE PAY ER LINK] | |
1265 | ||
1266 | *Requires the securi ty key IB IBCNE EIV MAINTENANC E | |
1267 | This optio n is a too l that ass ists insur ance super visor staf f with mat ching the individual insurance companies in the IN SURANCE CO MPANY File (#36) to payers in the PAYER File (#365 .12) by ut ilizing th e professi onal and i nstitution al EDI ide ntifier to propose p otential m atches. | |
1268 | Payer Main tenance Me nu | |
1269 | [IBCNE PAY ER MAINTEN ANCE MENU] | |
1270 | IIV Ambigu ous Policy Report [I BCNE IIV A MBIGUOUS P OLICY RPT] | |
1271 | This optio n displays details o f ambiguou s response s that wer e received as a resu lt of iden tification inquiries . These r esponses a re not sto red in the buffer. Therefore, this repo rt was add ed as a me chanism fo r reviewin g this inf ormation. | |
1272 | Potential New Insura nce Found [IBCNE POT ENTIAL NEW INS FOUND ] | |
1273 | IIV Inacti ve Policy Report | |
1274 | [IBCNE IIV INACTIVE POLICY RPT ] | |
1275 | This optio n display details of no active insurance responses were rece ived as a result of identifica tion inqui ries. The se respons es are not stored in the buffe r. Theref ore, this report was added as a mechanis m for revi ewing this informati on. | |
1276 | Potential New Insura nce Found [IBCNE POT ENTIAL NEW INS FOUND ] | |
1277 | Potential New Insura nce Found [IBCNE POT ENTIAL NEW INS FOUND ] | |
1278 | This menu contains t he eIV Amb iguous Pol icy and eI V Inactive Policy re ports. | |
1279 | eIV MENU [ IBCNE IIV MENU] | |
1280 | eIV Respon se Report | |
1281 | [IBCNE IIV RESPONSE REPORT] | |
1282 | This optio n runs the eIV Respo nse Report that disp lays detai ls about t he incomin g electron ic respons es from th e payers v ia the Eli gibility C ommunicato r. | |
1283 | eIV MENU [ IBCNE IIV MENU] | |
1284 | Update Sub scriber In fo | |
1285 | [IBCN UPDA TE SUBSCRI BER INFO] | |
1286 | This optio n will upd ate subscr iber field s defined to the INS URANCE TYP E sub-file (2.312). | |
1287 | MCCR Syste m Definiti on Menu [ IB SYSTEM DEFINITION MENU] | |
1288 | Medicare P otential C OB Worklis t | |
1289 | [IBCNE POT ENTIAL COB LIST] | |
1290 | This optio n creates a list of those pati ents whom Medicare h as identif ied in a 2 71 HL7 res ponse mess age as hav ing insura nce subseq uent to th eir Medica re Insuran ce. | |
1291 | eIV MENU [ IBCNE IIV MENU] | |
1292 | MCCR Site Parameters | |
1293 | [IBJ MCCR SITE PARAM ETERS] | |
1294 | This optio n allows e diting of the MCCR S ite Parame ters | |
1295 | MCCR Syste m Definiti on Menu | |
1296 | [IB SYSTEM DEFINITIO N MENU] | |
1297 | Manually A dded HPIDs to Billin g Claim Re port | |
1298 | [IBCN HPID CLAIM RPT ] | |
1299 | This optio n runs the Manually Added HPID s to Billi ng Claim R eport. | |
1300 | Patient Bi lling Repo rts Menu [ IB OUTPUT PATIENT RE PORT MENU] | |
1301 | ||
1302 | Or | |
1303 | ||
1304 | Patient In surance Me nu, [IBCN INSURANCE MGMT MENU] | |
1305 | ||
1306 | ||
1307 | List Manag er Templat es | |
1308 | ||
1309 | List Manag er Templat e | |
1310 | Descriptio n | |
1311 | IBCN MEDIC ARE COB EX PAND | |
1312 | Display ty pe List Ma nager temp late for e xpanded Me dicare pat ients with subsequen t insuranc e | |
1313 | IBCNE AUTO MATCH BUF FER LIST | |
1314 | List Manag er templat e for the IBCNE AUTO MATCH BUF FER option . | |
1315 | IBCNE ELIG IBILITY/BE NEFIT INFO | |
1316 | Protocol t ype List M anager tem plate for Insurance Buffer Pro cess scree n | |
1317 | IBCNE MEDI CARE COB D ISPLAY | |
1318 | Protocol t ype List M anager tem plate for the displa y of the M EDICARE PO TENTIAL CO B worklist | |
1319 | IBCNE MEDI CARE COB L IST | |
1320 | Protocol t ype List M anager tem plate for the displa y of the M EDICARE PO TENTIAL CO B worklist | |
1321 | IBCNE REQU EST INS IN QUIRY LIST | |
1322 | List Manag er templat e to lists the veter an’s activ e and inac tive insur ance polic ies not in cluding an y ineligib le (Medica re or Medi caid) poli cies. | |
1323 | IBCNE PAYE R EXPAND L IST | |
1324 | List Manag er templat e to show detail inf ormation a bout a Pay er and Ins urance Com panies to link. | |
1325 | IBCNE PAYE R MAINT LI ST | |
1326 | List Manag er templat e that sho ws the num ber of Ins urance Com panies wit h a matchi ng EDI num ber that d oes not li nk to a Pa yer. | |
1327 | IBJP IIV M OST POPULA R PAYERS | |
1328 | List Manag er templat e that all ows the en try and ed its of the eIV Most Popular Pa yer list. | |
1329 | IBJP IIV S ITE PARAME TERS | |
1330 | List Manag er templat e for the Insurance Verificati on screen. | |
1331 | IBCNB INSU RANCE BUFF ER ENTRY | |
1332 | Protocol t ype List M anager tem plate to d isplay an expanded I nsurance B uffer Entr y. | |
1333 | IBCNB INSU RANCE BUFF ER LIST | |
1334 | Protocol t ype List M anager tem plate to d isplay Ins urance Buf fer entrie s. | |
1335 | IBCNB INSU RANCE BUFF ER PAYER | |
1336 | Protocol t ype List M anager tem plate to d isplay Eli gibility B enefits Pa yer Summar y informat ion. | |
1337 | IBCNB INSU RANCE BUFF ER PROCESS | |
1338 | Protocol t ype List M anager tem plate to p rocess an Insurance Buffer Ent ry. | |
1339 | ||
1340 | ||
1341 | Protocols | |
1342 | ||
1343 | Protocol | |
1344 | Type | |
1345 | IBCNB ELIG PAYER SUM MARY | |
1346 | Menu | |
1347 | IBCNB EDIT SUBSCRIBE R | |
1348 | Action | |
1349 | IBCNB ENTR Y EDIT ALL | |
1350 | Action | |
1351 | IBCNB ENTR Y EDIT GRO UP | |
1352 | Action | |
1353 | IBCNB ENTR Y EDIT INS URANCE | |
1354 | Action | |
1355 | IBCNB ENTR Y EDIT POL ICY | |
1356 | Action | |
1357 | IBCNB ENTR Y ESCALATE | |
1358 | Action | |
1359 | IBCNB ENTR Y RESPONSE REPORT | |
1360 | IB*2.0*549 - No long er called from withi n the opti on “IBCN I NSURANCE B UFFER PROC ESS” (was Action) | |
1361 | IBCNB ENTR Y SCREEN M ENU | |
1362 | Menu | |
1363 | IBCNB ENTR Y VERIFY | |
1364 | Removed wi th IB*2.0* 506 (was A ction) | |
1365 | IBCNB EXPA ND BENEFIT S | |
1366 | Action | |
1367 | IBCNB FAST EXIT | |
1368 | Action | |
1369 | IBCNB LIST ADD | |
1370 | Action | |
1371 | IBCNB LIST APPOINTME NTS VIEW | |
1372 | Removed wi th IB*2.0* 506 (was A ction) | |
1373 | IBCNB LIST CHECK NAM ES | |
1374 | Action | |
1375 | IBCNB LIST COMPLETE VIEW | |
1376 | Action | |
1377 | IBCNB LIST ENTRY SCR EEN | |
1378 | Action | |
1379 | IBCNB LIST EPHARMACY VIEW | |
1380 | Action | |
1381 | IBCNB LIST FAILURE V IEW | |
1382 | Action | |
1383 | IBCNB LIST MEDICARE VIEW | |
1384 | Action | |
1385 | IBCNB LIST NEGATIVE VIEW | |
1386 | Action | |
1387 | IBCNB LIST POSITIVE VIEW | |
1388 | Action | |
1389 | IBCNB LIST PROCESS S CREEN | |
1390 | Action | |
1391 | IBCNB LIST REJECT | |
1392 | Action | |
1393 | IBCNB LIST SCREEN ME NU | |
1394 | Menu | |
1395 | IBCNB LIST SORT | |
1396 | Action | |
1397 | IBCNB LIST TRICARE/C HAMPVA VIE W | |
1398 | Action | |
1399 | IBCNB PROC ESS ACCEPT | |
1400 | Action | |
1401 | IBCNB PROC ESS COMPAR E/EDIT | |
1402 | Action | |
1403 | IBCNB PROC ESS ENTRY SCREEN | |
1404 | Action | |
1405 | IBCNB PROC ESS REJECT | |
1406 | Action | |
1407 | IBCNB PROC ESS SCREEN MENU | |
1408 | Menu | |
1409 | IBCNB PROC ESS TOGGLE | |
1410 | Action | |
1411 | IBCNE AUTO MATCH BUF FER EXIT | |
1412 | Action | |
1413 | IBCNE AUTO MATCH BUF FER LINK | |
1414 | Action | |
1415 | IBCNE AUTO MATCH BUF FER MENU | |
1416 | Menu | |
1417 | IBCNE AUTO MATCH BUF FER SELECT | |
1418 | Action | |
1419 | IBCNE AB V IEW EXP EL IG BEN SCR EEN | |
1420 | Action | |
1421 | IBCNE EIV ID REQUEST | |
1422 | Subscriber | |
1423 | IBCNE EIV ID RESPONS E | |
1424 | Subscriber | |
1425 | IBCNE EIV PIN-I07 IN | |
1426 | Event driv er | |
1427 | IBCNE EIV RQP OUT | |
1428 | Event driv er | |
1429 | IBCNE ELIG BEN INFO MENU | |
1430 | Menu | |
1431 | IBCNE ELIG PAY SUM M ENU | |
1432 | Menu | |
1433 | IBCNE FAST EXIT | |
1434 | Action | |
1435 | IBCNE IIV ID REQUEST | |
1436 | Event driv er | |
1437 | IBCNE IIV IN | |
1438 | Event driv er | |
1439 | IBCNE IIV MFN OUT | |
1440 | Event driv er | |
1441 | IBCNE IIV MFN IN | |
1442 | Subscriber | |
1443 | IBCNE IIV REGISTER | |
1444 | Event driv er | |
1445 | IBCNE IIV RESPONSE | |
1446 | Subscriber | |
1447 | ||
1448 | ||
1449 | IBCNE IIV RQI OUT | |
1450 | Event driv er | |
1451 | ||
1452 | ||
1453 | IBCNE IIV RQV OUT | |
1454 | Event driv er | |
1455 | IBCNE IIV TABLE | |
1456 | Subscriber | |
1457 | IBCNE IIV VER REQUES T | |
1458 | Subscriber | |
1459 | IBCNE JT C OVERAGE LI MIT DATE R ANGE | |
1460 | Action | |
1461 | IBCNE JT V IEW EXP EL IG BEN SCR EEN | |
1462 | Action | |
1463 | IBCNE MBI REQUEST | |
1464 | Action | |
1465 | IBCNE MEDI CARE COB | |
1466 | Menu | |
1467 | IBCNE MEDI CARE COB A C | |
1468 | Action | |
1469 | IBCNE MEDI CARE COB C S | |
1470 | Action | |
1471 | IBCNE MEDI CARE COB D ISP | |
1472 | Menu | |
1473 | IBCNE MEDI CARE COB E E | |
1474 | Action | |
1475 | IBCNE PAYE R EXIT | |
1476 | Action | |
1477 | IBCNE PAYE R EXPAND | |
1478 | Action | |
1479 | IBCNE PAYE R EXPAND M ENU | |
1480 | Menu | |
1481 | IBCNE PAYE R LINK | |
1482 | Action | |
1483 | IBCNE PAYE R MAINT ME NU | |
1484 | Menu | |
1485 | IBCNE REVE RIFY INSUR ANCE MENU | |
1486 | Menu | |
1487 | IBCNE SELE CT INSURAN CE | |
1488 | Action | |
1489 | IBCNE SV V IEW EXP EL IG BEN SCR EEN | |
1490 | Action | |
1491 | IBCNE VP V IEW EXP EL IG BEN SCR EEN | |
1492 | Action | |
1493 | IBCNS EXIT | |
1494 | Action | |
1495 | IBCNS QUIT | |
1496 | Action | |
1497 | IBCNSA AN BEN ADD CO M | |
1498 | Action | |
1499 | IBCNSA AN BEN CH YR | |
1500 | Action | |
1501 | IBCNSA AN BEN ED ALL | |
1502 | Action | |
1503 | IBCNSA AN BEN HOME H EA | |
1504 | Action | |
1505 | IBCNSA AN BEN HOSPC | |
1506 | Action | |
1507 | IBCNSA AN BEN INPT | |
1508 | Action | |
1509 | IBCNSA AN BEN IV MGM T | |
1510 | Action | |
1511 | IBCNSA AN BEN MEN H | |
1512 | Action | |
1513 | IBCNSA AN BEN OPT | |
1514 | Action | |
1515 | IBCNSA AN BEN POL IN F | |
1516 | Action | |
1517 | IBCNSA AN BEN REHAB | |
1518 | Action | |
1519 | IBCNSA AN BEN USER I NF | |
1520 | Action | |
1521 | IBCNSA ANN UAL BENEFI TS | |
1522 | Menu | |
1523 | IBCNSC INS CO (IN)AC TIVATE COM PANY | |
1524 | Action | |
1525 | IBCNSC INS CO APPEAL S OFFICE | |
1526 | Action | |
1527 | IBCNSC INS CO ASSOCI ATION | |
1528 | Action | |
1529 | IBCNSC INS CO BILLIN G PARAMETE RS | |
1530 | Action | |
1531 | IBCNSC INS CO CHANGE COMPANY | |
1532 | Action | |
1533 | IBCNSC INS CO DELETE COMPANY | |
1534 | Action | |
1535 | IBCNSC INS CO EDIT A LL | |
1536 | Action | |
1537 | IBCNSC INS CO INPT C LAIMS | |
1538 | Action | |
1539 | IBCNSC INS CO INQUIR Y OFFICE | |
1540 | Action | |
1541 | IBCNSC INS CO MAIN M AILING ADD RESS | |
1542 | Action | |
1543 | IBCNSC INS CO OPT CL AIMS | |
1544 | Action | |
1545 | IBCNSC INS CO PAYER | |
1546 | Action | |
1547 | IBCNSC INS CO REMARK S | |
1548 | Action | |
1549 | IBCNSC INS CO RX CLA IMS | |
1550 | Action | |
1551 | IBCNSC INS CO SYNONY MS | |
1552 | Action | |
1553 | IBCNSC INS CO TELEPH ONE | |
1554 | Action | |
1555 | IBCNSC INS URANCE CO | |
1556 | Menu | |
1557 | IBCNSC PLA N DETAIL | |
1558 | Action | |
1559 | IBCNSC PLA N LIST | |
1560 | Menu | |
1561 | IBCNSC PRO VIDER ID P ARAMETERS | |
1562 | Action | |
1563 | IBCNSJ CHA NGE PLAN | |
1564 | Action | |
1565 | IBCNSJ EDI T COVERAGE LIMITS | |
1566 | Action | |
1567 | IBCNSJ EDI T PLAN INF O | |
1568 | Action | |
1569 | IBCNSJ INA CTIVATE PL AN | |
1570 | Action | |
1571 | IBCNSJ INS CO EDIT C OVERAGE LI MITS | |
1572 | Action | |
1573 | IBCNSJ INS CO INACTI VATE PLAN | |
1574 | Action | |
1575 | IBCNSJ INS CO PLANS | |
1576 | Action | |
1577 | IBCNSJ PLA N COMMENT | |
1578 | Action | |
1579 | IBCNSJ PLA N LOOKUP | |
1580 | Menu | |
1581 | IBCNSJ PLA N SELECT | |
1582 | Action | |
1583 | IBCNSJ PLA N UR INFO | |
1584 | Action | |
1585 | IBCNSJ PLA N VIEW/EDI T | |
1586 | Action | |
1587 | IBCNSJ SWI TCH PLANS | |
1588 | Action | |
1589 | IBCNSJ UPD ATE ANNUAL BENEFITS | |
1590 | Action | |
1591 | IBCNSM IN SURANCE MA NAGEMENT | |
1592 | Menu | |
1593 | IBCNSM ADD POLICY | |
1594 | Action | |
1595 | IBCNSM BEN EFITS USED | |
1596 | Action | |
1597 | IBCNSM CHA NGE PATIEN T | |
1598 | Action | |
1599 | IBCNSM DEL ETE POLICY | |
1600 | Action | |
1601 | IBCNSM EDI T ALL | |
1602 | Action | |
1603 | IBCNSM PAT IENT INSUR ANCE | |
1604 | Menu | |
1605 | IBCNSM PER SONAL RIDE RS | |
1606 | Action | |
1607 | IBCNSM PRI NT PATIENT INS | |
1608 | Action | |
1609 | IBCNSM PRI NT WORKSHE ET | |
1610 | Action | |
1611 | IBCNSM RX COB DETERM INATION | |
1612 | Action | |
1613 | IBCNSM UPD ATE ANNUAL BENEFITS | |
1614 | Action | |
1615 | IBCNSM UPD ATE INS BE NEFITS | |
1616 | Action | |
1617 | IBCNSM UPD ATE INS CO . | |
1618 | Action | |
1619 | IBCNSM UPD ATE POLICY | |
1620 | Action | |
1621 | IBCNSM VER IFY INS | |
1622 | Action | |
1623 | IBCNSM VIE W BENEFITS | |
1624 | Action | |
1625 | IBCNSM VIE W INS CO | |
1626 | Action | |
1627 | IBCNSM VIE W NAT INS CO | |
1628 | Action | |
1629 | IBCNSM VIE W PAT POLI CY | |
1630 | Action | |
1631 | IBCNSP ADD COMMENT | |
1632 | Action | |
1633 | IBCNSP ANN UAL BENEFI TS | |
1634 | Action | |
1635 | IBCNSP BEN EFITS USED | |
1636 | Action | |
1637 | IBCNSP EDI T ALL | |
1638 | Action | |
1639 | IBCNSP EDI T EFFECTIV E DATES | |
1640 | Action | |
1641 | IBCNSP EDI T POLICY I NFO | |
1642 | Action | |
1643 | IBCNSP EMP LOYER INFO FOR CLAIM S | |
1644 | Action | |
1645 | IBCNSP INS URANCE CON TACT INF | |
1646 | Action | |
1647 | IBCNSP PER SONAL RIDE RS | |
1648 | Action | |
1649 | IBCNSP POL ICY MENU | |
1650 | Action | |
1651 | IBCNSP SUB SCRIBER UP DATE | |
1652 | Action | |
1653 | IBCNSP UR INFO | |
1654 | Action | |
1655 | IBCNSP VER IFY COVERA GE | |
1656 | Action | |
1657 | IBCNSV ANN UAL BENEFI TS | |
1658 | Menu | |
1659 | IBCNSV BEN EFITS USED BY DATE | |
1660 | Menu | |
1661 | IBCNSV INS URANCE CO | |
1662 | Menu | |
1663 | IBCNSV PAT IENT INSUR ANCE | |
1664 | Action | |
1665 | IBCNSV POL ICY MENU | |
1666 | Menu | |
1667 | IBCNSV VIE W AN BEN | |
1668 | Action | |
1669 | IBCNSV VIE W BEN USED | |
1670 | Action | |
1671 | IBCNSV VIE W EXP POL | |
1672 | Action | |
1673 | IBJ EXIT | |
1674 | Action | |
1675 | IBJP AUTO BILLING SC REEN | |
1676 | Action | |
1677 | IBJP CLAIM S TRACKING SCREEN | |
1678 | Action | |
1679 | IBJP IB SI TE PARAMET ER SCREEN | |
1680 | Action | |
1681 | IBJP IB SI TE SELECTE D SERVICE CODES | |
1682 | Action | |
1683 | IBJP IIV B ATCH EXTRA CT EDIT | |
1684 | Action | |
1685 | IBJP IIV G ENERAL EDI T | |
1686 | Action | |
1687 | IBJP IIV M OST POPULA R ADD | |
1688 | Action | |
1689 | IBJP IIV M OST POPULA R DELETE | |
1690 | Action | |
1691 | IBJP IIV M OST POPULA R EDIT | |
1692 | Action | |
1693 | IBJP IIV M OST POPULA R EXIT | |
1694 | Action | |
1695 | IBJP IIV M OST POPULA R MENU | |
1696 | Action | |
1697 | IBJP IIV M OST POPULA R MODIFY | |
1698 | Action | |
1699 | IBJP IIV M OST POPULA R REORDER | |
1700 | Action | |
1701 | IBJP IIV M OST POPULA R RESTORE | |
1702 | Action | |
1703 | IBJP IIV M OST POPULA R SAVE | |
1704 | Action | |
1705 | IBJP IIV P AT W/O INS | |
1706 | Action | |
1707 | IBJP INS V ER MENU | |
1708 | Action | |
1709 | IBJP INS V ER SCREEN | |
1710 | Action | |
1711 | IBJP MCCR PARAMETERS MENU | |
1712 | Menu | |
1713 | IBJT ACTIV E LIST SCR EEN SKIP | |
1714 | Action | |
1715 | IBJT AR AC COUNT PROF ILE SCREEN | |
1716 | Action | |
1717 | IBJT AR CO MMENT HIST ORY SCREEN | |
1718 | Action | |
1719 | IBJT BILL CHARGES SC REEN | |
1720 | Action | |
1721 | IBJT BILL DX SCREEN | |
1722 | Action | |
1723 | IBJT BILL PROCEDURES SCREEN | |
1724 | Action | |
1725 | IBJT CHANG E BILL | |
1726 | Action | |
1727 | IBJT CLAIM MENU SCRE EN | |
1728 | Menu | |
1729 | IBJT CLAIM SCREEN SK IP | |
1730 | Action | |
1731 | IBJT CT/IR COMMUNICA TIONS LIST SCREEN | |
1732 | Action | |
1733 | IBJT EDI S TATUS SCRE EN | |
1734 | Action | |
1735 | IBJT HS HE ALTH SUMMA RY | |
1736 | Action | |
1737 | IBJT NS VI EW AN BEN MENU | |
1738 | Menu | |
1739 | IBJT NS VI EW AN BEN REDISPLAY | |
1740 | Action | |
1741 | IBJT NS VI EW AN BEN SCREEN | |
1742 | Action | |
1743 | IBJT NS VI EW EXP POL MENU | |
1744 | Menu | |
1745 | IBJT NS VI EW EXP POL REDISPLAY | |
1746 | Action | |
1747 | IBJT NS VI EW EXP POL SCREEN | |
1748 | Action | |
1749 | IBJT NS VI EW INS CO SCREEN | |
1750 | Action | |
1751 | IBJT PT EL IGIBILITY SCREEN | |
1752 | Action | |
1753 | VALM BLANK 1 | |
1754 | Menu | |
1755 | VALM PRINT LIST | |
1756 | Menu | |
1757 | VALM SEARC H LIST | |
1758 | Action | |
1759 | ||
1760 | ||
1761 | ||
1762 | HL7 Applic ation Para meters | |
1763 | ||
1764 | HL7 Applic ation Para meter | |
1765 | IIV EC | |
1766 | IIV VistA | |
1767 | ||
1768 | ||
1769 | HL Logical Links | |
1770 | ||
1771 | HL Logical Link | |
1772 | Descriptio n | |
1773 | IIV EC | |
1774 | Link to Au stin from VistA | |
1775 | ||
1776 | ||
1777 | Purging | |
1778 | ||
1779 | All inquir ies and re sponses fo r electron ic eligibi lity reque sts made t hrough eIV are store d in the I IV TRANSMI SSION QUEU E File (#3 65.1) and the IIV RE SPONSE Fil e (#365). Over time these fil es will co ntinue to grow as mo re inquiri es and res ponses are stored. Therefore, the optio n Purge In surance Ve rification Transacti ons [IBCNE PURGE IIV DATA] has been prov ided to al low inquir y and resp onse data that is at least six months ol d to be pu rged. Not e that it is critica l to the e IV softwar e to maint ain at lea st six mon ths of inq uiry and r esponse da ta to prop erly deter mine when a new inqu iry should be made. This is d ue to the fact that eIV uses t he informa tion in th ese histor ies to det ermine whe n inquirie s were mad e for spec ific patie nts/payers . The eIV nightly p rocess wil l send an email remi nder notic e to the I BCNE eIV M ESSAGE mai l group on the first day of ea ch month i f records are found that are e ligible to be purged . | |
1780 | ||
1781 | In patch I B*2.0*621 it was dec ided to ad d the new EIV EICD T RACKING Fi le (#365.1 8) (TRACKI NG) to the purge fun ctionality in order to insure that the f iles stay in sync. Entries in the IIV T RANSMISSIO N QUEUE Fi le (#365.1 ) (TQ) and the IIV R ESPONSE Fi le (#365) (RESPONSE) will not be purged unless the associate d entries in the EIV EICD TRAC KING File (365.18) h ave been p urged. | |
1782 | ||
1783 | Notice: A TRACKING r ecord may point to 1 (one) or more sets of TQ and RESPONSE r ecords. I f any RESP ONSE recor d associat ed with a TRACKING r ecord cont ains a “Do Not Purge ” field se t to “1” ( Yes) then all associ ated TQ an d RESPONSE records o f that TRA CKING reco rd will be retained. There is no limit to the num ber of set s of TQ an d RESPONSE records t hat can be associate d with a T RACKING re cord. | |
1784 | ||
1785 | It was dec ided that implementi ng an auto matic purg e of recor ds from th e IIV TRAN SMISSION Q UEUE File (#365.1) a nd the IIV RESPONSE File (#365 ) would mi nimize the growth of these fil es. As of patch IB*2 .0*595, th e nightly process on the first day of th e month wi ll automat ically pur ge records older tha n 180 days old where the DO NO T PURGE fl ag (#365,. 11) is set to NO, th us retaini ng the req uired six months wor th of data to facili tate inqui ries and r eports. | |
1786 | ||
1787 | A modifica tion was m ade with p atch IB*2. 0*549 wher e the fiel d DO NOT P URGE (#.11 ) was adde d to the I IV RESPONS E FILE (#3 65). This flag is s et to yes – meaning do not pur ge – when it is asso ciated wit h a respon se to whic h the INSU RANCE TYPE subfile ( #2.312) is pointing. Therefor e, even th ough a res ponse and its associ ated inqui ry may be older than six month s, it may not be eli gible to b e purged. The flag will be se t back to no – meani ng it can be purged – once the INSURANCE TYPE subf ile (#2.31 2) is no l onger poin ting to th e record. The INSUR ANCE TYPE subfile po ints to a response r ecord when one of tw o situatio ns occur: a) eIV pa yer respon se (X12 27 1 message) is auto u pdated and processed programma tically up dating the patient’s policy wi thout user intervent ion , b) A buffer en try (Insur ance Verif ication Pr ocessor fi le #355.33 ) is manua lly accept ed and the user elec ts to upda te/accept the eligib ility bene fit inform ation. If the INSUR ANCE TYPE subfile po ints to a response r ecord prio r to eithe r of those situation s, the DO NOT PURGE flag (#365 , .11) on the origin al message will be c hanged fro m YES to N O. Then t he INSURAN CE TYPE su bfile will be update d to point to the ne w (the acc epted) eIV Response and the DO NOT PURGE flag will be set to YES for t he current record. | |
1788 | ||
1789 | ||
1790 | ||
1791 | ||
1792 | ||
1793 | SECURITY | |
1794 | ||
1795 | ||
1796 | File Prote ction | |
1797 | ||
1798 | The Insura nce Identi fication a nd Verific ation Inte rface cont ains files that are standardiz ed. They c arry a hig her level of file pr otection w ith regard to Delete , Read, Wr ite, and L AYGO acces s, and sho uld not be edited lo cally unle ss otherwi se directe d. The dat a dictiona ries for a ll files s hould NOT be altered . | |
1799 | ||
1800 | The follow ing is a l ist of rec ommended V A FileMan access cod es associa ted with e ach file c ontained i n the KIDS build for the eIV i nterface. | |
1801 | ||
1802 | File # | |
1803 | File Name | |
1804 | DD | |
1805 | RD | |
1806 | WR | |
1807 | DEL | |
1808 | LAYGO | |
1809 | AUDIT | |
1810 | 365 | |
1811 | IIV RESPON SE | |
1812 | @ | |
1813 | ||
1814 | ||
1815 | ||
1816 | ||
1817 | ||
1818 | 365.011 | |
1819 | X12 271 EL IGIBILITY/ BENEFIT | |
1820 | @ | |
1821 | ||
1822 | ||
1823 | @ | |
1824 | @ | |
1825 | ||
1826 | 365.012 | |
1827 | X12 271 CO VERAGE LEV EL | |
1828 | @ | |
1829 | ||
1830 | ||
1831 | @ | |
1832 | @ | |
1833 | ||
1834 | 365.013 | |
1835 | X12 271 SE RVICE TYPE | |
1836 | @ | |
1837 | ||
1838 | ||
1839 | @ | |
1840 | @ | |
1841 | ||
1842 | 365.014 | |
1843 | X12 271 IN SURANCE TY PE | |
1844 | @ | |
1845 | ||
1846 | ||
1847 | @ | |
1848 | @ | |
1849 | ||
1850 | 365.015 | |
1851 | X12 271 TI ME PERIOD QUALIFIER | |
1852 | @ | |
1853 | ||
1854 | ||
1855 | @ | |
1856 | @ | |
1857 | ||
1858 | 365.016 | |
1859 | X12 271 QU ANTITY QUA LIFIER | |
1860 | @ | |
1861 | ||
1862 | ||
1863 | @ | |
1864 | @ | |
1865 | ||
1866 | 365.017 | |
1867 | X12 271 ER ROR CONDIT ION | |
1868 | @ | |
1869 | ||
1870 | ||
1871 | @ | |
1872 | @ | |
1873 | ||
1874 | 365.018 | |
1875 | X12 271 ER ROR ACTION | |
1876 | @ | |
1877 | ||
1878 | ||
1879 | @ | |
1880 | @ | |
1881 | ||
1882 | 365.021 | |
1883 | X12 271 CO NTACT QUAL IFIER | |
1884 | @ | |
1885 | ||
1886 | ||
1887 | @ | |
1888 | @ | |
1889 | ||
1890 | 365.022 | |
1891 | X12 ENTITY IDENTIFIE R CODE | |
1892 | @ | |
1893 | ||
1894 | ||
1895 | @ | |
1896 | @ | |
1897 | ||
1898 | 365.023 | |
1899 | X12 271 ID ENTIFICATI ON QUALIFI ER | |
1900 | @ | |
1901 | ||
1902 | ||
1903 | @ | |
1904 | @ | |
1905 | ||
1906 | 365.024 | |
1907 | X12 271 PR OVIDER COD E | |
1908 | @ | |
1909 | ||
1910 | ||
1911 | @ | |
1912 | @ | |
1913 | ||
1914 | 365.025 | |
1915 | X12 271 DE LIVERY FRE QUENCY COD E | |
1916 | @ | |
1917 | ||
1918 | ||
1919 | @ | |
1920 | @ | |
1921 | ||
1922 | 365.026 | |
1923 | X12 271 DA TA QUALIFI ER FILE | |
1924 | @ | |
1925 | ||
1926 | ||
1927 | @ | |
1928 | @ | |
1929 | ||
1930 | 365.027 | |
1931 | X12 271 LO OP ID | |
1932 | @ | |
1933 | ||
1934 | ||
1935 | @ | |
1936 | @ | |
1937 | ||
1938 | 365.028 | |
1939 | X12 271 RE FERENCE ID ENTIFICATI ON | |
1940 | @ | |
1941 | ||
1942 | ||
1943 | @ | |
1944 | @ | |
1945 | ||
1946 | 365.029 | |
1947 | X12 271 UN ITS OF MEA SUREMENT | |
1948 | @ | |
1949 | ||
1950 | ||
1951 | @ | |
1952 | @ | |
1953 | ||
1954 | 365.031 | |
1955 | X12 271 EN TITY RELAT IONSHIP CO DE | |
1956 | @ | |
1957 | ||
1958 | ||
1959 | @ | |
1960 | @ | |
1961 | ||
1962 | 365.032 | |
1963 | X12 271 DA TE FORMAT QUALIFIER | |
1964 | ||
1965 | ||
1966 | ||
1967 | ||
1968 | ||
1969 | ||
1970 | 365.033 | |
1971 | X12 271 YE S/NO RESPO NSE CODE | |
1972 | @ | |
1973 | ||
1974 | ||
1975 | @ | |
1976 | @ | |
1977 | ||
1978 | 365.034 | |
1979 | X12 271 LO CATION QUA LIFER | |
1980 | ||
1981 | ||
1982 | ||
1983 | ||
1984 | ||
1985 | ||
1986 | 365.035 | |
1987 | X12 271 PR OCEDURE CO DING METHO D | |
1988 | @ | |
1989 | ||
1990 | ||
1991 | @ | |
1992 | @ | |
1993 | ||
1994 | 365.036 | |
1995 | X12 271 DE LIVERY PAT TERN | |
1996 | ||
1997 | ||
1998 | ||
1999 | ||
2000 | ||
2001 | ||
2002 | 365.037 | |
2003 | X12 271 PA TIENT RELA TIONSHIP | |
2004 | @ | |
2005 | ||
2006 | ||
2007 | @ | |
2008 | @ | |
2009 | ||
2010 | 365.038 | |
2011 | X12 271 IN JURY CATEG ORY | |
2012 | ||
2013 | ||
2014 | ||
2015 | ||
2016 | ||
2017 | ||
2018 | 365.039 | |
2019 | X12 271 MI LITARY PER SONNEL INF O STATUS C ODE | |
2020 | @ | |
2021 | ||
2022 | ||
2023 | @ | |
2024 | @ | |
2025 | ||
2026 | 365.041 | |
2027 | X12 271 MI LITARY GOV T SERVICE AFFILIATIO N | |
2028 | ||
2029 | ||
2030 | ||
2031 | ||
2032 | ||
2033 | ||
2034 | 365.042 | |
2035 | X12 271 MI LITARY SER VICE RANK | |
2036 | @ | |
2037 | ||
2038 | ||
2039 | @ | |
2040 | @ | |
2041 | ||
2042 | 365.043 | |
2043 | X12 271 EN TITY TYPE QUALIFIER | |
2044 | ||
2045 | ||
2046 | ||
2047 | ||
2048 | ||
2049 | ||
2050 | 365.044 | |
2051 | X12 271 CO DE LIST QU ALIFIER | |
2052 | @ | |
2053 | ||
2054 | ||
2055 | @ | |
2056 | @ | |
2057 | ||
2058 | 365.045 | |
2059 | X12 271 NA TURE OF IN JURY CODES | |
2060 | ||
2061 | ||
2062 | ||
2063 | ||
2064 | ||
2065 | ||
2066 | 365.046 | |
2067 | X12 271 MI LITARY EMP LOYMENT ST ATUS CODE | |
2068 | @ | |
2069 | ||
2070 | ||
2071 | @ | |
2072 | @ | |
2073 | ||
2074 | 365.1 | |
2075 | IIV TRANSM ISSION QUE UE | |
2076 | @ | |
2077 | ||
2078 | ||
2079 | ||
2080 | ||
2081 | ||
2082 | 365.11 | |
2083 | IIV AUTO M ATCH | |
2084 | @ | |
2085 | ||
2086 | ||
2087 | ||
2088 | ||
2089 | ||
2090 | 365.12 | |
2091 | PAYER | |
2092 | @ | |
2093 | ||
2094 | ||
2095 | ||
2096 | ||
2097 | ||
2098 | 365.13 | |
2099 | PAYER APPL ICATION | |
2100 | @ | |
2101 | ||
2102 | ||
2103 | ||
2104 | ||
2105 | ||
2106 | 365.14 | |
2107 | IIV TRANSM ISSION STA TUS | |
2108 | @ | |
2109 | ||
2110 | ||
2111 | @ | |
2112 | @ | |
2113 | ||
2114 | 365.15 | |
2115 | IIV STATUS TABLE | |
2116 | @ | |
2117 | ||
2118 | ||
2119 | @ | |
2120 | @ | |
2121 | ||
2122 | 365.18 | |
2123 | EIV EICD T RACKING | |
2124 | @ | |
2125 | ||
2126 | ||
2127 | ||
2128 | ||
2129 | ||
2130 | 365.2 | |
2131 | IIV RESPON SE REVIEW | |
2132 | @ | |
2133 | @ | |
2134 | @ | |
2135 | @ | |
2136 | @ | |
2137 | ||
2138 | 366 | |
2139 | IB SSVI PI N/HL7 PIVO T | |
2140 | ||
2141 | ||
2142 | ||
2143 | ||
2144 | ||
2145 | ||
2146 | 366.1 | |
2147 | IB INSURAN CE INCONSI STENT DATA | |
2148 | ||
2149 | ||
2150 | ||
2151 | ||
2152 | ||
2153 | ||
2154 | 366.2 | |
2155 | IB INSURAN CE CONSIST ENCY ELEME NTS | |
2156 | ||
2157 | ||
2158 | ||
2159 | ||
2160 | ||
2161 | ||
2162 | ||
2163 | ||
2164 | Security K eys | |
2165 | ||
2166 | Security K ey Name | |
2167 | Descriptio n | |
2168 | IBCNE EIV MAINTENANC E | |
2169 | This secur ity key is for Elect ronic Insu rance Veri fication p roject (eI V). It is used to r estrict ac cess to th e Auto Mat ch add/edi t options, functions , and appl ications. Auto Matc h is a uti lity that links inco rrect, use r entered insurance company na mes with c orrect, ac tive insur ance compa ny names. Only user s holding this key m ay add, ed it, or del ete entrie s in the A uto Match file. | |
2170 | IBCNE IIV SUPERVISOR | |
2171 | ||
2172 | ||
2173 | This secur ity key is for the E lectronic Insurance Verificati on project (eIV). I t will be used to re strict acc ess to cer tain eIV o ptions and applicati ons. Only users hol ding this key will b e allowed to access these eIV options an d applicat ions. | |
2174 | IBCNE IIV AUTO MATCH | |
2175 | Changed to IBCNE EIV MAINTENAN CE by patc h IB*2.0*5 28. | |
2176 | IB INSURAN CE COMPANY EDIT | |
2177 | This secur ity key is for both integrated billing a nd the Ele ctronic In surance Ve rification project ( eIV). It will be us ed within the Insura nce Verifi cation Pro cessor to determine what warni ng message to displa y to the u ser if one needs to create an insurance company wh ile proces sing an en try from w ithin the buffer | |
2178 | IB GROUP/P LAN EDIT | |
2179 | This secur ity key is for both integrated billing a nd the Ele ctronic In surance Ve rification project ( eIV). It will be us ed within the Insura nce Verifi cation Pro cessor to determine what warni ng message to displa y to the u ser if one needs to create a g roup/plan while proc essing an entry from within th e buffer. | |
2180 | ||
2181 | ||
2182 | Options Lo cked by Se curity Key s | |
2183 | ||
2184 | Options/Pr ograms loc ked by a S ecurity Ke y | |
2185 | Security K ey | |
2186 | Request El ectronic I nsurance I nquiry [IB CNE REQUES T INQUIRY] option | |
2187 | IBCNE IIV SUPERVISOR | |
2188 | Payer Edit (Activat e/Inactiva te) [IBCNE PAYER EDI T] option | |
2189 | IBCNE EIV MAINTENANC E | |
2190 | Link Insur ance Compa nies to Pa yers [IBCN E PAYER LI NK] option | |
2191 | IBCNE EIV MAINTENANC E | |
2192 | The Auto M atch routi nes progra mmatically check for the exist ence of th is securit y key befo re allowin g a user t o add, del ete, or up date an en try in the Auto Matc h File. U sers witho ut the key may still view exis ting entri es in the Auto Match File. | |
2193 | IBCNE EIV MAINTENANC E | |
2194 | Update Sub scriber In fo [IBCN U PDATE SUBS CRIBER INF O] option | |
2195 | IB SUPERVI SOR | |
2196 | Insurance Company En try/Edit [ IBCN INSUR ANCE CO ED IT] | |
2197 | IB INSURAN CE COMPANY EDIT | |
2198 | Payer Main tenance [I BCNE PAYER MAINTENAN CE] option | |
2199 | IBCNE EIV MAINTENANC E | |
2200 | Payer Acti on (PA) on the [IBCN INSURANCE CO EDIT] option | |
2201 | IBCNE EIV MAINTENANC E | |
2202 | ||
2203 | ||
2204 | ||
2205 | EXTERNAL I NTERFACES | |
2206 | ||
2207 | ||
2208 | HL7 Messag ing with t he Eligibi lity Commu nicator (E C) | |
2209 | ||
2210 | Interfacin g between the two sy stems is a ccomplishe d by using VistA’s H L7 softwar e to commu nicate wit h the Elig ibility Co mmunicator . The HL7 software opens a TC P/IP port to transmi t data to the Vitria BusinessW are applic ation. Th e HL7 soft ware liste ner waits for a resp onse and p rocesses t he data wh en a respo nse is rec eived. | |
2211 | ||
2212 | ||
2213 | HL7 Commun ication Se tup | |
2214 | ||
2215 | Your facil ity should already b e using HL 7 for othe r VistA mo dules. Additional informati on on the setup of t he HL7 pac kage may b e found at http:// DNS . URL /hl7/archi ve/1.6/hl7 1_6p19.pdf . | |
2216 | ||
2217 | The logica l links ne eded for t his patch will be se nt as part of the In stallation KIDS. | |
2218 | ||
2219 | ||
2220 | ||
2221 | SYSTEM LINK MONIT OR for VAM C | |
2222 | ||
2223 | MESS AGES MESS AGES MES SAGES MES SAGES DEV ICE | |
2224 | NODE RECE IVED PROC ESSED TO SEND SEN T TYP E STAT E | |
2225 | ||
2226 | IIV E C 850 850 850 850 NC Inac tive | |
2227 | ||
2228 | ||
2229 | ||
2230 | ||
2231 | ||
2232 | ||
2233 | Incom ing filers running = > 1 TaskM an running | |
2234 | Outgo ing filers running = > 1 Link Manager ru nning | |
2235 | ||
2236 | Selec t a Comman d: | |
2237 | (N)EXT ( B)ACKUP ( A)LL LINKS (S)CREEN ED (V)IEW S (Q)UIT (?) HELP: | |
2238 | ||
2239 | ||
2240 | The IIV EC Logical L ink is the link that is used t o transmit messages. It is de fined as a CLIENT (S ENDER). A CLIENT (S ENDER) ind icates tha t this Log ical Link connects t o a target system, w ith the cu rrent syst em acting as the sen der. Sinc e the eIV HL7 messag es are tra nsmitted i n batch mo de, it als o has a de finition o f NON-PERS ISTENT so that when all the me ssages hav e been sen t, it will go to an Inactive s tate. | |
2241 | ||
2242 | ||
2243 | Data Sent to the Eli gibility C ommunicato r | |
2244 | ||
2245 | As VistA s ites insta ll the Ins urance Ide ntificatio n and Veri fication p atch, Vist A sends im portant in formation to the Eli gibility C ommunicato r. This r egistratio n dialog t riggers se veral even ts; a down load of th e Payer Ta ble and an update to the Eligi bility Com municator’ s Facility Table. T he Eligibi lity Commu nicator re turns an M SA Acknowl edgement m essage to the facili ty, so tha t eIV proc essing can begin at the regist ering site . | |
2246 | ||
2247 | REGISTRATI ON - The R egistratio n Request is the HL7 message t hat VistA sends to E C to pass site ident ifying inf ormation. A site se nds an ini tial reque st. Subse quently th e site sen ds additio nal reques ts on a da ily basis to update the regist ration sho uld any ch anges have taken pla ce in the 24 hours b efore and to report local VAMC eIV stati stics. | |
2248 | ELIGIBILIT Y INQUIRY – The Elig ibility In quiry Requ est is the HL7 messa ge that Vi stA sends to EC to a sk for ide ntificatio n of insur ance for a veteran. | |
2249 | ||
2250 | Note: The details fo r the mapp ing of the se message s (last up dated with patch IB* 2.0*549) c an be foun d in the m ost curren t ICD docu ment, eIV_ ICD_v4.doc . This do cument can be found at the fol lowing VA location: | |
2251 | http:// DNS . URL /warboard/ anotebk.as p?proj=173 3&Type=Act ive | |
2252 | ||
2253 | Data Recei ved From t he Eligibi lity Commu nicator | |
2254 | ||
2255 | REGISTRATI ON ACKNOWL EDGEMENT - The Eligi bility Com municator sends the Registrati on Acknowl edgement a fter recei ving the r equest and filing th e registra tion infor mation in the Cache. | |
2256 | ELIGIBILIT Y RESPONSE - The Eli gibility R esponse Me ssages rep ort payer’ s answers that did n ot include any error indicatio ns. Those that did are report ed using t he Inquiry Problem M essage. N on-error r esponse me ssages are an RPI^I0 1 event re gardless a s to wheth er the inq uiry was f or an iden tification or a veri fication. | |
2257 | ELIGIBILIT Y INQUIRY PROBLEM ME SSAGES - T here are t wo types o f Inquiry Problem Me ssages. O ne type of message o ccurs when EC receiv es an HL7 message fr om a VistA facility and it is validated. If data i s found mi ssing or i naccurate so that tr anslation to the X12 270 messa ge cannot be done co rrectly, E C sends an email mes sage to EC support s taff for r esolution. This is o ne type of Inquiry P roblem mes sage. The other typ e of Inqui ry Problem message i s after EC has sent the X12 27 0 messages on to the Payer and the Payer returns i t with an error in t he X12 ‘AA A’ segment . Some er ror codes may be ret urned to t he VistA f acility as an Inquir y Problem Message fo r handling and some errors may remain wi th EC for resolution . The mes sage event is the sa me for eit her Inquir y Problem type. | |
2258 | TABLE UPDA TES - All table mess ages are a n MFN^M01 event. Wh en a VistA site init ially inst alls the e IV softwar e, the Eli gibility C ommunicato r for eIV is notifie d via an M FN^M01 mes sage. The EC sends all curren t Payer id entificati ons to the VistA sit e as part of this en rollment p rocess. A ny subsequ ent modifi cations or additions to the Pa yer table maintained by the EC are sent in the sam e manner. Table upd ates are a lso used t o maintain some othe r eIV dict ionaries a nd some eI V paramete r settings . | |
2259 | ||
2260 | Note: The details fo r the mapp ing of the se message s (last up dated with patch IB* 2.0*549) c an be foun d in the m ost curren t ICD docu ment, eIV_ ICD_v4.doc . This docum ent can be found at the follow ing VA loc ation: htt p:// DNS . URL /warboard/ anotebk.as p?proj=173 3&Type=Act ive | |
2261 | ||
2262 | ||
2263 | ||
2264 | ||
2265 | ||
2266 | APPENDIX A – TABLE O F eIV GENE RATED Mail Man Messag es | |
2267 | ||
2268 | The eIV in terface wi ll create a MailMan message un der certai n circumst ances. Th is chart w ill help t o identify when thes e messages are trigg ered and f rom where. If the r ecipient o f the mess age was no t defined, then the message wi ll be rero uted to th e ‘Postmas ter’. | |
2269 | ||
2270 | Triggering Event | |
2271 | Routine Re ference | |
2272 | Recipients | |
2273 | Subject | |
2274 | Message Te xt | |
2275 | Error retu rned when adding an Insurance Buffer ent ry | |
2276 | IBCNEBF+15 6 | |
2277 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2278 | Error crea ting Buffe r Entry | |
2279 | Error retu rned by $$ ADDSTF^IBC NBES: | |
2280 | {Error Mes sage} | |
2281 | Values: | |
2282 | Patient DF N = {Patie nt IEN} | |
2283 | Pt Ins Rec ord IEN = {Patient I ns IEN} | |
2284 | Please log a NOIS fo r this pro blem. | |
2285 | Error retu rned when creating a n IIV Tran smission Q ueue entry | |
2286 | IBCNEDE+19 9 | |
2287 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2288 | IIV Proble m: Trouble setting e ntry in Fi le 365.1 | |
2289 | Tried to c reate an e ntry in th e IIV TRAN SMISSION Q UEUE File | |
2290 | (#365.1) w ithout suc cess. | |
2291 | Error enco untered: { Error Mess age} | |
2292 | The data t hat was to be stored is as fol lows: | |
2293 | Transactio n #: {Tran saction #} | |
2294 | Patient: { Patient Na me} | |
2295 | Extract: { Data Extra ct} | |
2296 | Payer: {Pa yer Name} | |
2297 | Please log a NOIS fo r this pro blem. | |
2298 | Unable to schedule t he daily e IV Statist ical repor t and dist ribute via MailMan | |
2299 | IBCNEDE+24 9 | |
2300 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2301 | IIV Statis tical Mess age Not Se nt | |
2302 | TaskManage r could no t schedule the daily eIV MailM an message at the sp ecified ti me of {DAI LY MSG TIM E (#350.9, 51.03)}. T his is def ined in th e eIV Site Parameter s option. | |
2303 | Missing Pe rson, 'AUT OUPDATE,IB EIV' and/o r 'INTERFA CE,IB EIV' from NEW PERSON (#2 00) | |
2304 | IBCNEDE^ C HKPER | |
2305 | Messages M ailgroup ( #350.9,51. 04) and ou tlook: PII | |
2306 | Missing EI V New Pers on entries | |
2307 | Missing EI V New Pers on entries , for stat ion xxx | |
2308 | Entry for 'AUTOUPDAT E,IBEIV' i s missing | |
2309 | Entry for 'INTERFACE ,IB EIV' i s missing | |
2310 | Error retu rned when creating a n outgoing HL7 messa ge | |
2311 | IBCNEDEQ+2 7 | |
2312 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2313 | IIV HL7 Cr eation Err or | |
2314 | Error – {H L7 Result} occurred when tryin g to creat e the outg oing HL7 m essage for Patient: {Patient N ame} and P ayer: {Pay er Name} | |
2315 | Please log a NOIS fo r this pro blem. | |
2316 | Error when NUMBER RE TRIES (#35 0.9, 51.06 ) is not d efined and the timeo ut has ela psed witho ut a respo nse (*only if FAILUR E MSG flag is YES) | |
2317 | IBCNEDEQ+5 2 | |
2318 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2319 | IIV Commun ication Er ror | |
2320 | VistA was unable to electronic ally confi rm insuran ce for Pat ient: {Pat ient Name} and Payer : {Payer N ame}. | |
2321 | A single a ttempt was made to e lectronica lly confir m the insu rance with this paye r. | |
2322 | The number of retrie s have bee n exceeded indicatin g that a c ommunicati on failure has occur red (*only if FAILUR E MSG flag is YES) | |
2323 | IBCNEDEQ+7 5 | |
2324 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2325 | IIV Commun ication Er ror | |
2326 | VistA was unable to electronic ally confi rm insuran ce for Pat ient: {Pat ient Name} and Payer : {Payer N ame}. | |
2327 | Error crea ting an II V Response File entr y | |
2328 | IBCNEDEQ+1 37 | |
2329 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2330 | Error crea ting Respo nse | |
2331 | {Error Mes sages retu rned by FI LE^DIE cal l} | |
2332 | Please log a NOIS fo r this pro blem. | |
2333 | A response has not b een receiv ed in TIME OUT DAYS ( IB SITE PA RAMETERS f ield) (*on ly if TIME OUT MSG fl ag is YES) | |
2334 | IBCNEDEQ+1 49 | |
2335 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2336 | IIV Commun ication Ti meout | |
2337 | No Respons e has been received within the defined f ailure day s of {Time out Days} for Patien t: {Patien t Name} an d Payer: { Payer Name } | |
2338 | Error retu rned when creating a n outgoing HL7 messa ge to deac tivate IIV | |
2339 | IBCNEHLD+5 7 | |
2340 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2341 | IIV Deacti vation Fai lure | |
2342 | IIV Deacti vation Mes sage not c reated. E rror – {HL 7 Result} | |
2343 | Please log a NOIS fo r this pro blem. | |
2344 | MSH Segmen t is not t he first s egment in the HL7 me ssage when processin g response s | |
2345 | IBCNEHLI+7 8 | |
2346 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2347 | INCOMING I IV HL7 PRO BLEM | |
2348 | MSH Segmen t is not t he first s egment fou nd. | |
2349 | Please log a NOIS fo r this pro blem. | |
2350 | Protocol n ot defined for the H L7 Event T ype when p rocessing responses | |
2351 | IBCNEHLI+7 8 | |
2352 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2353 | INCOMING I IV HL7 PRO BLEM | |
2354 | Unable to find a pro tocol for Event = {E vent Type} | |
2355 | Please log a NOIS fo r this pro blem | |
2356 | ACK – AE r eceived wh en process ing respon ses | |
2357 | IBCNEHLI+7 8 | |
2358 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2359 | INCOMING I IV HL7 PRO BLEM | |
2360 | N/A | |
2361 | Error retu rned when creating/u pdating an IIV Respo nse File e ntry | |
2362 | IBCNEHLI+7 8 | |
2363 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2364 | INCOMING I IV HL7 PRO BLEM | |
2365 | {Error mes sages arra y from mul tiple call s to FILE^ DIE} and may also i nclude | |
2366 | National I D: {VA Nat ional ID} not found in Payer T able for T race Numbe r: {Trace #} | |
2367 | OR | |
2368 | Not able t o create a Response for an uns olicited r esponse fo r Trace Nu mber: {Tra ce #} | |
2369 | Error retu rned when creating/u pdating no n-Payer fi les | |
2370 | IBCNEHLI+7 8 | |
2371 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2372 | INCOMING I IV HL7 PRO BLEM | |
2373 | File Numbe r not foun d in MFN m essage | |
2374 | OR | |
2375 | File {File Number} n ot found i n the Data Dictionar y | |
2376 | ||
2377 | Error(s) r eturned wh en creatin g the HL7 Registrati on message for Vitri a | |
2378 | IBCNEHLM+1 16 | |
2379 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2380 | eIV Regist ration Fai lure | |
2381 | The “HL7 R esponse Pr ocessing M ethod” sel ected is B atch but t he HL7 Bat ch Start a nd End Tim es are bla nk. | |
2382 | OR | |
2383 | The follow ing IIV Si te Paramet ers are no t defined: | |
2384 | “Days betw een electr onic rever ification checks” is blank. | |
2385 | OR | |
2386 | “Look at a patient’s inactive insurance? ” is blank . | |
2387 | OR | |
2388 | “HL7 Respo nse Proces sing Metho d” is blan k. | |
2389 | Error retu rned when creating/u pdating an IIV Respo nse File e ntry | |
2390 | IBCNEHLR+7 9 | |
2391 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2392 | Error crea ting IIV R esponse | |
2393 | An invalid Eligibili ty Status flag {Stat us Flag} w as receive d for site {VA Natio nal ID}, t race numbe r {Trace # } and mess age contro l id {Mess age Contro l ID}. It has been i nterpreted as an amb iguous res ponse in V istA. | |
2394 | Message re ceived fro m the Elig ibility Co mmunicator could not be proces sed. | |
2395 | IBCNEHLR+1 93 | |
2396 | MESSAGES M AILGROUP | |
2397 | (#350.9, 5 1.04) | |
2398 | IMPORTANT: Error Whi le Process ing Respon se Message from the EC | |
2399 | IMPORTANT: Error Whi le Process ing Respon se Message from the EC. | |
2400 | ***IRM*** Please log a NOIS be cause the response m essage rec eived from the Eligi bility Com municator could not be process ed. Progra mming chan ges may be necessary to proper ly handle the respon se. The as sociated t race is {T race #}. If applica ble, pleas e review t he respons e with the IIV Respo nse Report by Trace #. | |
2401 | Date of De ath receiv ed in insu rance veri fication r esponse | |
2402 | IBCNEHLS+1 35 | |
2403 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2404 | Date of De ath Receiv ed | |
2405 | A Date of Death ({Da te of Deat h}) was re ceived for patient: {Patient N ame} / {Pa tient SSN} from paye r {Payer N ame}. The re is no c urrent Dat e of Death on file f or this pa tient. | |
2406 | Date of De ath receiv ed in insu rance veri fication r esponse do es not mat ch the Dat e of Death on file | |
2407 | IBCNEHLS+1 41 | |
2408 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2409 | Variant Da te of Deat h | |
2410 | A Date of Death ({Da te of Deat h}) was re ceived for patient: {Patient N ame} / {Pa tient SSN} from paye r {Payer N ame}. Thi s Date of Death does not curre ntly match the Date of Death ( {Patient D ate of Dea th}) on fi le for thi s patient. | |
2411 | New Error Action cod e received from the Eligibilit y Communic ator | |
2412 | IBCNEHLS+2 57 | |
2413 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2414 | Message Co ntrol Id F ield is Bl ank | |
2415 | A response was recei ved with a blank Mes sage Contr ol ID and Trace # {T race #}, I CN #: {ICN #}, Patie nt: {Patie nt Name}. It is lik ely that t here are c ommunicati on issues with the E C. This r esponse ca nnot be pr ocessed. Please log a NOIS. | |
2416 | IIV payer tables may be out of sync with master li st. | |
2417 | IBCNEHLT+1 08 | |
2418 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2419 | IIV payer tables may be out of sync with master li st. | |
2420 | {IBCN Type } {IBCN Ac tion} acti on receive d. Payer a nd/or Appl ication ma y be unkno wn. VA Nat ional: {VA National ID} Payer Name: {Pay er Name}, Applicatio n: {Applic ation Name }. Log a NOIS for t his issue. Please i nclude in the NOIS t hat VistA did not re ceive the required i nformation or the ac curate inf ormation t o add/upda te this Pa yer. | |
2421 | IIV Date b ecomes ava ilable for purging. | |
2422 | IBCNEKI2+6 3 | |
2423 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2424 | IIV Data E ligible fo r Purge | |
2425 | ATTENTION IRM: There are IIV T RANSMISSIO N QUEUE an d IIV RESP ONSE recor ds eligibl e to be pu rged. Plea se run IBC NE PURGE I IV DATA – Purge IIV Transactio ns, if you would lik e to purge the eligi ble record s. To purg e IIV data , journali ng should be tempora rily disab led for ^I BCN. | |
2426 | Unable to schedule t he backgro und compil e of the M ost Popula r Insuranc e Company List | |
2427 | IBCNEPST+6 4 | |
2428 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2429 | Most Popul ar Insuran ce Company List was not compil ed | |
2430 | The Most P opular Ins urance Com pany List could not be compile d for {TOD AY-365 Day s} to {TOD AY} becaus e task cou ld not be scheduled in the bac kground. | |
2431 | Error(s) i dentified during Bat ch Extract parameter set-up in IB SITE P ARAMETERS | |
2432 | IBCNEPST+1 50 | |
2433 | PATCHES | |
2434 | IIV Batch Extract# { Batch IEN} not set-u p properly | |
2435 | {Error mes sages retu rned by FI LE^DIE} | |
2436 | Daily IIV Statistica l Report v ia MailMan | |
2437 | IBCNERP9+1 22 | |
2438 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2439 | ** IIV Sta tistical R pt ** | |
2440 | IIV Statis tical Repo rt with da ta for the previous 24 hours. | |
2441 | ** END OF REPORT** | |
2442 | OR | |
2443 | ** NO DATA FOUND** | |
2444 | Inconsiste nt IIV res ponses for IIV queue . | |
2445 | IBY271PS+4 6 | |
2446 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2447 | IIV Respon ses for an IIV Trans mission Qu eue entry are incons istent. | |
2448 | IIV Transm ission Que ue entry { Transmissi on Queue E ntry} has a status o f Response Received. None of t he associa ted respon ses have t his status . Please create a N OIS specif ying that this Trans mission Qu eue entry is inconsi stent with its assoc iated resp onses and, as a resu lt, its st atus could not be ad justed. | |
2449 | Most popul ar insuran ce sites. | |
2450 | IBY271PS+7 7 | |
2451 | MESSAGES M AILGROUP ( #350.9, 51 .04) | |
2452 | Most Popul ar Insuran ce Site Pa rameter | |
2453 | As part of patch IB* 2.0*271, t he Most Po pular Insu rance func tionality, accessed by the MP action of the IIV Si te Paramet ers, has b een modifi ed. Prior to this pa tch, the M ost Popula r Insuranc e Companie s were aut omatically identifie d based on the numbe r of autho rized bill s created. IB*2.0*27 1 has chan ged two as pects of t he functio nality. T he list wi ll now con tain payer s rather t han insura nce compan ies. In a ddition, t hese payer s will be manually e ntered by each site. As a res ult of the se changes , the prio r values o f this lis t have bee n deleted. If your site has e lected to use this f unctionali ty, please update th e table wi th the pay ers that a re most co mmonly use d in your facility a nd who are nationall y active f or IIV. P lease sele ct option, “IBJ MCCR SITE PARA METERS”, a ction MP ( Most Popul ar Payers) within th e IIV para meters to populate t he list. | |
2454 | ||
2455 | ||
2456 | ||
2457 | ||
2458 | APPENDIX B – Incomin g Data Map ping | |
2459 | ||
2460 | The follow ing table identifies the mappi ng of each data elem ent of an incoming e ligibility response message (H L7 Message Type: RPI ^I01) to t he corresp onding sto rage locat ion within the VistA Files. T he right-m ost column indicates the stora ge locatio n for each data elem ent upon a cceptance of the Ins urance Buf fer entry informatio n. | |
2461 | ||
2462 | IIV Respon se file (# 365) inclu des a poin ter BUFFER ENTRY (#. 04) to the Insurance Verificat ion Proces sor file ( #355.33). | |
2463 | Patient fi le’s (#2), Insurance Type subf ile (#2.31 2) include s a pointe r EB DISPL AY ENTRY ( #8.03) to the IIV Re sponse fil e (#365). | |
2464 | Patient fi le’s (#2), Insurance Type subf ile (#2.31 2) that ar e auto upd ated are i ndicated b y ‘Auto Up date’. Fi elds that are manual ly updated are indic ated by ‘M anual Upda te’. Note that some fields ma y be both auto and m anually up dated. | |
2465 | ||
2466 | IIV Respon se File ( #365) | |
2467 | Insurance Verificati on Process or file (# 355.33) | |
2468 | Patient Fi le (#2) – Patient’s policy | |
2469 | OR | |
2470 | Group Insu rance Plan File (#35 5.3) | |
2471 | Display of data rela ted to Eli gibility B enefits af ter Payer response i s manually accepted or auto up dated | |
2472 | MESSAGE CO NTROL ID | |
2473 | (#365, .01 ) | |
2474 | N/A | |
2475 | EB DISPLAY ENTRY | |
2476 | (# 2.312, 8.03) | |
2477 | Auto Updat e | |
2478 | N/A | |
2479 | PATIENT | |
2480 | (#365, .02 ) | |
2481 | N/A | |
2482 | N/A | |
2483 | N/A | |
2484 | PAYER | |
2485 | (#365, .03 ) | |
2486 | N/A | |
2487 | N/A | |
2488 | N/A | |
2489 | BUFFER ENT RY | |
2490 | (#365, .04 ) | |
2491 | N/A | |
2492 | N/A | |
2493 | N/A | |
2494 | TRANSMISSI ON QUEUE | |
2495 | (#365, .05 ) | |
2496 | N/A | |
2497 | N/A | |
2498 | N/A | |
2499 | TRANSMISSI ON STATUS | |
2500 | (#365, .06 ) | |
2501 | N/A | |
2502 | N/A | |
2503 | N/A | |
2504 | DATE/TIME RECEIVED | |
2505 | (#365, .07 ) | |
2506 | N/A | |
2507 | N/A | |
2508 | N/A | |
2509 | DATE/TIME CREATED | |
2510 | (#365, .08 ) | |
2511 | N/A | |
2512 | N/A | |
2513 | N/A | |
2514 | TRACE NUMB ER | |
2515 | (#365, .09 ) | |
2516 | N/A | |
2517 | N/A | |
2518 | Uses point er to IIV Response f ile (#365) to displa y data | |
2519 | RESPONSE T YPE | |
2520 | (#365, .1) | |
2521 | N/A | |
2522 | REQUESTED SERVICE TY PE | |
2523 | (#2.312,8. 02) | |
2524 | Auto Updat e | |
2525 | N/A | |
2526 | DO NOT PUR GE (#365,. 11) | |
2527 | N/A | |
2528 | N/A | |
2529 | N/A | |
2530 | INSURED DO B | |
2531 | (#365, 1.0 2) | |
2532 | INSURED'S DOB | |
2533 | (#355.33, 60.08) | |
2534 | INSURED'S DOB | |
2535 | (#2.312, 3 .01) | |
2536 | Manual Upd ate/Auto U pdate | |
2537 | Uses point er to IIV Response f ile (#365) to displa y data | |
2538 | INSURED SS N | |
2539 | (#365, 1.0 3) | |
2540 | INSURED'S SSN | |
2541 | (#355.33, 60.09) | |
2542 | INSURED'S SSN | |
2543 | (#2.312, 3 .05) | |
2544 | Manual Upd ate/Auto U pdate | |
2545 | Uses point er to IIV Response f ile (#365) to displa y data | |
2546 | INSURED SE X | |
2547 | (#365, 1.0 4) | |
2548 | N/A | |
2549 | INSURED'S SEX (# 2.3 12, 3.12) | |
2550 | Manual Upd ate | |
2551 | Uses point er to IIV Response f ile (#365) to displa y data | |
2552 | WHOSE INSU RANCE | |
2553 | (#365, 1.0 8) | |
2554 | WHOSE INSU RANCE | |
2555 | (#355.33, 60.05) | |
2556 | WHOSE INSU RANCE | |
2557 | (#2.312, 6 ) | |
2558 | Manual Upd ate/Auto U pdate | |
2559 | Uses point er to IIV Response f ile (#365) to displa y data | |
2560 | PT RELATIO NSHIP TO I NSURED (#3 65, 1.09) | |
2561 | PT. RELATI ONSHIP TO INSURED (# 355.33, 60 .06) | |
2562 | PT. RELATI ONSHIP - H IPAA | |
2563 | (#2.312, 4 .03) Auto Update | |
2564 | ||
2565 | PT. RELATI ONSHIP TO INSURED | |
2566 | (# 2.312, 16) Manua l Update | |
2567 | Uses point er to IIV Response f ile (#365) to displa y data | |
2568 | SERVICE DA TE | |
2569 | (#365, 1.1 ) | |
2570 | N/A | |
2571 | REQUESTED SERVICE DA TE | |
2572 | (# 2.312, 8.01) | |
2573 | Manual Upd ate/Auto U pdate | |
2574 | N/A | |
2575 | EFFECTIVE DATE | |
2576 | (#365, 1.1 1) | |
2577 | EFFECTIVE DATE | |
2578 | (#355.33, 60.02) | |
2579 | EFFECTIVE DATE OF PO LICY | |
2580 | (#2.312, 8 ) Manual U pdate | |
2581 | Uses point er to IIV Response f ile (#365) to displa y data | |
2582 | EXPIRATION DATE | |
2583 | (#365, 1.1 2) | |
2584 | EXPIRATION DATE | |
2585 | (#355.33, 60.03) | |
2586 | INSURANCE EXPIRATION DATE | |
2587 | (#2.312, 3 ) Manual U pdate | |
2588 | Uses point er to IIV Response f ile (#365) to displa y data | |
2589 | COORDINATI ON OF BENE FITS (#365 ,1.13) | |
2590 | COORDINATI ON OF BENE FITS (#35 5.33, 60.1 2) | |
2591 | COORDINATI ON OF BENE FITS | |
2592 | (#2.312,.2 ) Manual U pdate | |
2593 | Uses point er to IIV Response f ile (#365) to displa y data | |
2594 | ERROR COND ITION | |
2595 | (#365, 1.1 4) | |
2596 | N/A | |
2597 | N/A | |
2598 | N/A | |
2599 | ERROR ACTI ON | |
2600 | (#365, 1.1 5) | |
2601 | N/A | |
2602 | N/A | |
2603 | N/A | |
2604 | DATE OF DE ATH | |
2605 | (#365, 1.1 6) | |
2606 | N/A | |
2607 | N/A | |
2608 | Uses point er to IIV Response f ile (#365) to displa y data | |
2609 | CERTIFICAT ION DATE | |
2610 | (#365, 1.1 7) | |
2611 | N/A | |
2612 | N/A | |
2613 | Uses point er to IIV Response f ile (#365) to displa y data | |
2614 | MEMBER ID | |
2615 | (#365, 1.1 8) | |
2616 | N/A | |
2617 | N/A | |
2618 | Uses point er to IIV Response f ile (#365) to displa y data | |
2619 | PAYER UPDA TED POLICY (#365, 1. 19) | |
2620 | N/A | |
2621 | N/A | |
2622 | Uses point er to IIV Response f ile (#365) to displa y data | |
2623 | POLICY NUM BER (#365, 1.2) | |
2624 | N/A | |
2625 | N/A | |
2626 | Uses point er to IIV Response f ile (#365) to displa y data | |
2627 | ELIGIBILIT Y/BENEFIT (#365, 2) (multiple subfile is #365.02) | |
2628 | N/A | |
2629 | N/A | |
2630 | N/A | |
2631 | EB NUMBER (#365.02, .01) | |
2632 | N/A | |
2633 | N/A | |
2634 | EB NUMBER (#2.322, . 01) | |
2635 | ELIGIBILIT Y/BENEFIT INFO (#365 .02, .02) | |
2636 | N/A | |
2637 | N/A | |
2638 | ELIGIBILIT Y/BENEFIT INFO (#2.3 22, .02) | |
2639 | COVERAGE L EVEL (#365 .02, .03) | |
2640 | N/A | |
2641 | N/A | |
2642 | COVERAGE L EVEL (#2.3 22, .03) | |
2643 | INSURANCE TYPE (#365 .02, .05) | |
2644 | N/A | |
2645 | N/A | |
2646 | INSURANCE TYPE (#2.3 22, .05) | |
2647 | PLAN COVER AGE DESCRI PTION (#36 5.02, .06) | |
2648 | N/A | |
2649 | N/A | |
2650 | PLAN COVER AGE DESCRI PTION (#2. 322, .06) | |
2651 | TIME PERIO D QUALIFIE R (#365.02 , .07) | |
2652 | N/A | |
2653 | N/A | |
2654 | TIME PERIO D QUALIFIE R (#2.322, .07) | |
2655 | MONETARY A MOUNT (#36 5.02, .08) | |
2656 | N/A | |
2657 | N/A | |
2658 | MONETARY A MOUNT (#2. 322, .08) | |
2659 | PERCENT (# 365.02, .0 9) | |
2660 | N/A | |
2661 | N/A | |
2662 | PERCENT (# 2.322, .09 ) | |
2663 | QUANTITY Q UALIFIER ( #365.02, . 1) | |
2664 | N/A | |
2665 | N/A | |
2666 | QUANTITY Q UALIFIER ( #2.322, .1 ) | |
2667 | QUANTITY ( #365.02, . 11) | |
2668 | N/A | |
2669 | N/A | |
2670 | QUANTITY ( #2.322, .1 1) | |
2671 | AUTHORIZAT ION/CERTIF ICATION (# 365.02, .1 2) | |
2672 | N/A | |
2673 | N/A | |
2674 | AUTHORIZAT ION/CERTIF ICATION (# 2.322, .12 ) | |
2675 | IN PLAN (# 365.02, .1 3) | |
2676 | N/A | |
2677 | N/A | |
2678 | IN PLAN (# 2.322, .13 ) | |
2679 | PROCEDURE CODING MET HOD (#365. 02, 1.01) | |
2680 | N/A | |
2681 | N/A | |
2682 | PROCEDURE CODING MET HOD (#2.32 2, 1.01) | |
2683 | PROCEDURE CODE (#365 .02, 1.02) | |
2684 | N/A | |
2685 | N/A | |
2686 | PROCEDURE CODE (#2.3 22, 1.02) | |
2687 | PROCEDURE MODIFIER 1 (#365.02, 1.03) | |
2688 | N/A | |
2689 | N/A | |
2690 | PROCEDURE MODIFIER 1 (#2.322, 1.03) | |
2691 | PROCEDURE MODIFIER 2 (#365.02, 1.04) | |
2692 | N/A | |
2693 | N/A | |
2694 | PROCEDURE MODIFIER 2 (#2.322, 1.04) | |
2695 | PROCEDURE MODIFIER 3 (#365.02, 1.05) | |
2696 | N/A | |
2697 | N/A | |
2698 | PROCEDURE MODIFIER 3 (#2.322, 1.05) | |
2699 | PROCEDURE MODIFIER 4 (#365.02, 1.06) | |
2700 | N/A | |
2701 | N/A | |
2702 | PROCEDURE MODIFIER 4 (#2.322, 1.06) | |
2703 | NOTES (#36 5.02, 2) | |
2704 | N/A | |
2705 | N/A | |
2706 | NOTES (#2. 322, 2) | |
2707 | ENTITY ID CODE (#365 .02, 3.01) | |
2708 | N/A | |
2709 | N/A | |
2710 | ENTITY ID CODE (#2.3 22, 3.01) | |
2711 | ENTITY TYP E (#365.02 , 3.02) | |
2712 | N/A | |
2713 | N/A | |
2714 | ENTITY TYP E (#2.322, 3.02) | |
2715 | NAME (#365 .02, 3.03) | |
2716 | N/A | |
2717 | N/A | |
2718 | NAME (#2.3 22, 3.03) | |
2719 | ENTITY ID (#365.02, 3.04) | |
2720 | N/A | |
2721 | N/A | |
2722 | ENTITY ID (#2.322, 3 .04) | |
2723 | ENTITY ID QUALIFIER (#365.02, 3.05) | |
2724 | N/A | |
2725 | N/A | |
2726 | ENTITY ID QUALIFIER (#2.322, 3 .05) | |
2727 | ENTITY REL ATIONSHIP CODE (#365 .02, 3.06) | |
2728 | N/A | |
2729 | N/A | |
2730 | ENTITY REL ATIONSHIP CODE (#2.3 22, 3.06) | |
2731 | ADDRESS LI NE 1 (#365 .02, 4.01) | |
2732 | N/A | |
2733 | INSURED'S STREET 1 | |
2734 | (# 2.312, 3.06) | |
2735 | Manual Upd ate/Auto U pdate | |
2736 | ADDRESS LI NE 1 (#2.3 22, 4.01) | |
2737 | ADDRESS LI NE 2 (#365 .02, 4.02) | |
2738 | N/A | |
2739 | INSURED'S STREET 2 | |
2740 | (# 2.312, 3.07) | |
2741 | Manual Upd ate /Auto Update | |
2742 | ADDRESS LI NE 2 (#2.3 22, 4.02) | |
2743 | CITY (#365 .02, 4.03) | |
2744 | N/A | |
2745 | INSURED'S CITY | |
2746 | (# 2.312, 3.08) | |
2747 | Manual Upd ate /Auto Update | |
2748 | CITY (#2.3 22, 4.03) | |
2749 | STATE (#36 5.02, 4.04 ) | |
2750 | N/A | |
2751 | INSURED'S STATE | |
2752 | (# 2.312, 3.09) | |
2753 | Manual Upd ate /Auto Update | |
2754 | STATE (#2. 322, 4.04) | |
2755 | ZIP (#365. 02, 4.05) | |
2756 | N/A | |
2757 | INSURED'S ZIP | |
2758 | (# 2.312, 3.1) | |
2759 | Manual Upd ate/Auto U pdate | |
2760 | ZIP (#2.32 2, 4.05) | |
2761 | COUNTRY CO DE (#365.0 2, 4.06) | |
2762 | N/A | |
2763 | INSURED'S COUNTRY | |
2764 | (# 2.312, 3.13) | |
2765 | Manual Upd ate /Auto Update | |
2766 | COUNTRY CO DE (#2.322 , 4.06) | |
2767 | LOCATION ( #365.02, 4 .07) | |
2768 | N/A | |
2769 | N/A | |
2770 | LOCATION ( #2.322, 4. 07) | |
2771 | LOCATION Q UALIFIER ( #365.02, 4 .08) | |
2772 | N/A | |
2773 | N/A | |
2774 | LOCATION Q UALIFIER ( #2.322, 4. 08) | |
2775 | SUBDIVISIO N CODE (#3 65.02, 4.0 9) | |
2776 | N/A | |
2777 | INSURED'S COUNTRY SU BDIVISION (# 2.312, 3.14) | |
2778 | Manual Upd ate /Auto Update | |
2779 | SUBDIVISIO N CODE (#2 .322, 4.09 ) | |
2780 | PROVIDER C ODE (#365. 02, 5.01) | |
2781 | N/A | |
2782 | N/A | |
2783 | PROVIDER C ODE (#2.32 2, 5.01) | |
2784 | REFERENCE ID (#365.0 2, 5.02) | |
2785 | N/A | |
2786 | N/A | |
2787 | REFERENCE ID (#2.322 , 5.02) | |
2788 | REFERENCE ID QUALIFI ER (#365.0 2, 5.03) | |
2789 | N/A | |
2790 | N/A | |
2791 | REFERENCE ID QUALIFI ER (#2.322 , 5.03) | |
2792 | CONTACT IN FORMATION (#365.02, 6) | |
2793 | N/A | |
2794 | N/A | |
2795 | CONTACT IN FORMATION (#2.322, 6 ) | |
2796 | SEQUENCE ( #365.26, . 01) | |
2797 | N/A | |
2798 | N/A | |
2799 | SEQUENCE ( #2.3226, . 01) | |
2800 | NAME (#365 .26, .02) | |
2801 | N/A | |
2802 | N/A | |
2803 | NAME (#2.3 226, .02) | |
2804 | COMMUNICAT ION QUALIF IER (#365. 26, .04) | |
2805 | N/A | |
2806 | N/A | |
2807 | COMMUNICAT ION QUALIF IER (#2.32 26, .04) | |
2808 | COMMUNICAT ION NUMBER (#365.26, 1) | |
2809 | N/A | |
2810 | N/A | |
2811 | COMMUNICAT ION NUMBER 1 (#2.322 6, 1) | |
2812 | HEALTHCARE SERVICES DELIVERY ( #365.02, 7 ) | |
2813 | N/A | |
2814 | N/A | |
2815 | HEALTHCARE SERVICES DELIVERY ( #2.322, 7) | |
2816 | SEQUENCE ( #365.27, . 01) | |
2817 | N/A | |
2818 | N/A | |
2819 | SEQUENCE ( #2.3227, . 01) | |
2820 | BENEFIT QU ANTITY (#3 65.27, .02 ) | |
2821 | N/A | |
2822 | N/A | |
2823 | BENEFIT QU ANTITY (#2 .3227, .02 ) | |
2824 | QUANTITY Q UALIFIER ( #365.27, . 03) | |
2825 | N/A | |
2826 | N/A | |
2827 | QUANTITY Q UALIFIER ( #2.3227, . 03) | |
2828 | SAMPLE SEL ECTION MOD ULUS (#365 .27, .04) | |
2829 | N/A | |
2830 | N/A | |
2831 | SAMPLE SEL ECTION MOD ULUS (#2.3 227, .04) | |
2832 | UNITS OF M EASUREMENT (#365.27, .05) | |
2833 | N/A | |
2834 | N/A | |
2835 | UNITS OF M EASUREMENT (#2.3227, .05) | |
2836 | TIME PERIO DS (#365.2 7, .06) | |
2837 | N/A | |
2838 | N/A | |
2839 | TIME PERIO DS (#2.322 7, .06) | |
2840 | TIME PERIO D QUALIFIE R (#365.27 , .07) | |
2841 | N/A | |
2842 | N/A | |
2843 | TIME PERIO D QUALIFIE R (#2.3227 , .07) | |
2844 | DELIVERY F REQUENCY ( #365.27, . 08) | |
2845 | N/A | |
2846 | N/A | |
2847 | DELIVERY F REQUENCY ( #2.3227, . 08) | |
2848 | DELIVERY P ATTERN (#3 65.27, .09 ) | |
2849 | N/A | |
2850 | N/A | |
2851 | DELIVERY P ATTERN (#2 .3227, .09 ) | |
2852 | SUBSCRIBER DATES (#3 65.02, 8) | |
2853 | N/A | |
2854 | N/A | |
2855 | SUBSCRIBER DATES | |
2856 | (#2.322, 8 ) | |
2857 | SEQUENCE ( #365.28, . 01) | |
2858 | N/A | |
2859 | N/A | |
2860 | SEQUENCE ( #2.3228, . 01) | |
2861 | DATE (#365 .28, .02) | |
2862 | N/A | |
2863 | N/A | |
2864 | DATE (#2.3 228, .02) | |
2865 | DATE QUALI FIER (#365 .28, .03) | |
2866 | N/A | |
2867 | N/A | |
2868 | DATE QUALI FIER (#2.3 228, .03) | |
2869 | DATE FORMA T (#365.28 , .04) | |
2870 | N/A | |
2871 | N/A | |
2872 | DATE FORMA T (#2.3228 , .04) | |
2873 | SUBSCRIBER ADDITIONA L INFO (#3 65.02, 9) | |
2874 | N/A | |
2875 | N/A | |
2876 | SUBSCRIBER ADDITIONA L INFO (#2 .322, 9) | |
2877 | SEQUENCE ( #365.29, . 01) | |
2878 | N/A | |
2879 | N/A | |
2880 | SEQUENCE ( #2.3229, . 01) | |
2881 | PLACE OF S ERVICE (#3 65.29, .02 ) | |
2882 | N/A | |
2883 | N/A | |
2884 | PLACE OF S ERVICE | |
2885 | (#2.3229, .02) | |
2886 | DIAGNOSIS (#365.29, .03) | |
2887 | N/A | |
2888 | N/A | |
2889 | DIAGNOSIS (#2.3229, .03) | |
2890 | QUALIFIER (#365.29, .04) | |
2891 | N/A | |
2892 | N/A | |
2893 | QUALIFIER (#2.3229, .04) | |
2894 | NATURE OF INJURY COD E (#365.29 , .05) | |
2895 | N/A | |
2896 | N/A | |
2897 | NATURE OF INJURY COD E (#2.3229 , .05) | |
2898 | NATURE OF INJURY CAT EGORY (#36 5.29, .06) | |
2899 | N/A | |
2900 | N/A | |
2901 | NATURE OF INJURY CAT EGORY (#2. 3229, .06) | |
2902 | NATURE OF INJURY TEX T (#365.29 , .07) | |
2903 | N/A | |
2904 | N/A | |
2905 | NATURE OF INJURY TEX T (#2.3229 , .07) | |
2906 | SUBSCRIBER REFERENCE ID (#365. 02, 10) | |
2907 | N/A | |
2908 | N/A | |
2909 | SUBSCRIBER REFERENCE ID (#2.32 2, 10) | |
2910 | SEQUENCE ( #365.291, .01) | |
2911 | N/A | |
2912 | N/A | |
2913 | SEQUENCE ( #2.3229, . 01) | |
2914 | REFERENCE ID (#365.2 91, .02) | |
2915 | N/A | |
2916 | N/A | |
2917 | REFERENCE ID (#2.322 9, .02) | |
2918 | REFERENCE ID QUALIFI ER (#365.2 91, .03) | |
2919 | N/A | |
2920 | N/A | |
2921 | REFERENCE ID QUALIFI ER (#2.322 9, .03) | |
2922 | DESCRIPTIO N (#365.29 1, .04) | |
2923 | N/A | |
2924 | N/A | |
2925 | DESCRIPTIO N (#2.3229 , .04) | |
2926 | SERVICE TY PES (#365. 02, 14) | |
2927 | N/A | |
2928 | N/A | |
2929 | SERVICE TY PES (#2.32 2, 11) | |
2930 | SERVICE TY PES (#365. 292, .01) | |
2931 | N/A | |
2932 | N/A | |
2933 | SERVICE TY PES | |
2934 | (#2.32292, .01) | |
2935 | CONTACT PE RSON | |
2936 | (#365, 3) | |
2937 | N/A | |
2938 | N/A | |
2939 | Uses point er to IIV Response f ile (#365) to displa y data | |
2940 | CONTACT PE RSON | |
2941 | (#365.03, .01) | |
2942 | N/A | |
2943 | N/A | |
2944 | Uses point er to IIV Response f ile (#365) to displa y data | |
2945 | COMMUNICAT ION QUALIF IER #1 (# 365.03, .0 2) | |
2946 | N/A | |
2947 | N/A | |
2948 | Uses point er to IIV Response f ile (#365) to displa y data | |
2949 | COMMUNICAT ION QUALIF IER #2 (# 365.03, .0 4) | |
2950 | N/A | |
2951 | N/A | |
2952 | Uses point er to IIV Response f ile (#365) to displa y data | |
2953 | COMMUNICAT ION QUALIF IER #3 (# 365.03, .0 6) | |
2954 | N/A | |
2955 | N/A | |
2956 | Uses point er to IIV Response f ile (#365) to displa y data | |
2957 | COMMUNICAT ION NUMBER #1 | |
2958 | (# 365.03, 1) | |
2959 | N/A | |
2960 | N/A | |
2961 | Uses point er to IIV Response f ile (#365) to displa y data | |
2962 | COMMUNICAT ION NUMBER #2 | |
2963 | (# 365.03, 2) | |
2964 | N/A | |
2965 | N/A | |
2966 | Uses point er to IIV Response f ile (#365) to displa y data | |
2967 | COMMUNICAT ION NUMBER #3 | |
2968 | (# 365.03, 3) | |
2969 | N/A | |
2970 | N/A | |
2971 | Uses point er to IIV Response f ile (#365) to displa y data | |
2972 | ERROR TEXT | |
2973 | (#365, 4.0 1) | |
2974 | N/A | |
2975 | N/A | |
2976 | N/A | |
2977 | SUBSCRIBER ADDRESS L INE 1 (#36 5, 5.01) | |
2978 | N/A | |
2979 | N/A | |
2980 | Uses point er to IIV Response f ile (#365) to displa y data | |
2981 | SUBSCRIBER ADDRESS L INE 2 (#36 5, 5.02) | |
2982 | N/A | |
2983 | N/A | |
2984 | Uses point er to IIV Response f ile (#365) to displa y data | |
2985 | SUBSCRIBER ADDRESS C ITY (#365, 5.03) | |
2986 | N/A | |
2987 | N/A | |
2988 | Uses point er to IIV Response f ile (#365) to displa y data | |
2989 | SUBSCRIBER ADDRESS S TATE (#365 , 5.04) | |
2990 | N/A | |
2991 | N/A | |
2992 | Uses point er to IIV Response f ile (#365) to displa y data | |
2993 | SUBSCRIBER ADDRESS Z IP (#365, 5.05) | |
2994 | N/A | |
2995 | N/A | |
2996 | Uses point er to IIV Response f ile (#365) to displa y data | |
2997 | SUBSCRIBER ADDRESS C OUNTRY (#3 65, 5.06) | |
2998 | N/A | |
2999 | N/A | |
3000 | Uses point er to IIV Response f ile (#365) to displa y data | |
3001 | SUBSCRIBER ADDRESS S UBDIVISION (#365, 5. 07) | |
3002 | N/A | |
3003 | N/A | |
3004 | Uses point er to IIV Response f ile (#365) to displa y data | |
3005 | REJECT REA SON (#365, 6) (multi ple subfil e is #365. 06) | |
3006 | N/A | |
3007 | N/A | |
3008 | N/A | |
3009 | SEQUENCE ( #365.06, . 01) | |
3010 | N/A | |
3011 | N/A | |
3012 | N/A | |
3013 | ERROR LOCA TION (#365 .06, .02) | |
3014 | N/A | |
3015 | N/A | |
3016 | N/A | |
3017 | REJECT REA SON (#365. 06, .03) | |
3018 | N/A | |
3019 | N/A | |
3020 | N/A | |
3021 | ACTION COD E (#365.06 , .04) | |
3022 | N/A | |
3023 | N/A | |
3024 | N/A | |
3025 | LOOP ID (# 365.06, .0 5) | |
3026 | N/A | |
3027 | N/A | |
3028 | N/A | |
3029 | SOURCE (#3 65.06, .06 ) | |
3030 | N/A | |
3031 | N/A | |
3032 | N/A | |
3033 | ADDITIONAL MSGS (#36 5.06, 1) ( multiple s ubfile is #365.061) | |
3034 | N/A | |
3035 | N/A | |
3036 | N/A | |
3037 | ADDITIONAL MSG (#365 .061, .01) | |
3038 | N/A | |
3039 | N/A | |
3040 | N/A | |
3041 | SUBSCRIBER DATES (#3 65, 7) (mu ltiple sub file is #3 65.07) | |
3042 | N/A | |
3043 | N/A | |
3044 | N/A | |
3045 | SEQUENCE ( #365.07, . 01) | |
3046 | N/A | |
3047 | N/A | |
3048 | N/A | |
3049 | DATE (#365 .07, .02) | |
3050 | N/A | |
3051 | N/A | |
3052 | N/A | |
3053 | DATE QUALI FIER (#365 .07, .03) | |
3054 | N/A | |
3055 | N/A | |
3056 | N/A | |
3057 | LOOP ID(#3 65.07, .04 ) | |
3058 | N/A | |
3059 | N/A | |
3060 | N/A | |
3061 | PT. RELATI ONSHIP – H IPAA (#365 , 8.01) | |
3062 | N/A | |
3063 | N/A | |
3064 | N/A | |
3065 | GROUP REFE RENCE INFO RMATION (# 365, 9) (m ultiple su bfile is # 365.09) | |
3066 | N/A | |
3067 | N/A | |
3068 | N/A | |
3069 | SEQUENCE ( #365.09, . 01) | |
3070 | N/A | |
3071 | SEQUENCE ( GROUP) (# 2.3129, .0 1) | |
3072 | Auto Updat e | |
3073 | SEQUENCE ( #2.3129, . 01) | |
3074 | REFERENCE ID (GROUP) (#365.09, .02) | |
3075 | N/A | |
3076 | REFERENCE ID (GROUP) (# 2.3129 , .02) | |
3077 | Auto Updat e | |
3078 | REFERENCE ID (GROUP) (#2.3129, .02) | |
3079 | REF ID QUA LIFIER (GR OUP) (#365 .09, .03) | |
3080 | N/A | |
3081 | REF ID QUA LIFIER (GR OUP) (# 2. 3129, .03) | |
3082 | Auto Updat e | |
3083 | REF ID QUA LIFIER (GR OUP) (#2.3 129, .03) | |
3084 | DESCRIPTIO N (#365.09 , .04) | |
3085 | N/A | |
3086 | DESCRIPTIO N (# 2.312 9, .04) | |
3087 | Auto Updat e | |
3088 | DESCRIPTIO N (#2.3129 , .04) | |
3089 | GROUP PROV IDER INFO (#365,10) (multiple subfile is #365.04) | |
3090 | N/A | |
3091 | N/A | |
3092 | N/A | |
3093 | SEQUENCE ( #365.04, . 01) | |
3094 | N/A | |
3095 | SEQUENCE ( # 2.332, . 01) | |
3096 | Auto Updat e | |
3097 | SEQUENCE ( #2.332, .0 1) | |
3098 | PROVIDER C ODE (#365. 04, .02) | |
3099 | N/A | |
3100 | PROVIDER C ODE | |
3101 | (# 2.332, .02) Auto Update | |
3102 | PROVIDER C ODE (#2.33 2, .02) | |
3103 | PROV REFER ENCE ID (# 365.04, .0 3) | |
3104 | N/A | |
3105 | PROV REFER ENCE ID | |
3106 | (# 2.332, .03) Auto Update | |
3107 | PROV REFER ENCE ID (# 2.332, .03 ) | |
3108 | HEALTH CAR E CODE INF ORMATION ( #365, 11) (multiple subfile is #365.01) | |
3109 | N/A | |
3110 | N/A | |
3111 | N/A | |
3112 | SEQUENCE ( #365.01, . 01) | |
3113 | N/A | |
3114 | SEQUENCE ( # 2.31211, .01) | |
3115 | Auto Updat e | |
3116 | SEQUENCE ( #2.31211, .01) | |
3117 | DIAGNOSIS CODE (#365 .01, .02) | |
3118 | N/A | |
3119 | DIAGNOSIS CODE (# 2. 31211, .02 ) | |
3120 | Auto Updat e | |
3121 | DIAGNOSIS CODE (#2.3 1211, .02) | |
3122 | DIAGNOSIS CODE QUALI FIER (#365 .01, .03) | |
3123 | N/A | |
3124 | DIAGNOSIS CODE QUALI FIER (# 2. 31211, .03 ) | |
3125 | Auto Updat e | |
3126 | DIAGNOSIS CODE QUALI FIER (#2.3 1211, .03) | |
3127 | PRIMARY OR SECONDARY ? (#365.01 , .04) | |
3128 | N/A | |
3129 | PRIMARY OR SECONDARY ? (# 2.312 11, .04) | |
3130 | Auto Updat e | |
3131 | PRIMARY OR SECONDARY ? (#2.3121 1, .04) | |
3132 | MILITARY I NFO STATUS CODE (#36 5, 12.01) | |
3133 | N/A | |
3134 | N/A | |
3135 | MILITARY I NFO STATUS CODE (#2. 312, 12.01 ) | |
3136 | MILITARY E MPLOYMENT STATUS (#3 65, 12.02) | |
3137 | N/A | |
3138 | N/A | |
3139 | MILITARY E MPLOYMENT STATUS (#2 .312, 12.0 2) | |
3140 | MILITARY G OVT AFFILI ATION CODE (#365, 12 .03) | |
3141 | N/A | |
3142 | N/A | |
3143 | MILITARY G OVT AFFILI ATION CODE (#2.312, 12.03) | |
3144 | MILITARY P ERSONNEL D ESCRIPTION (#365, 12 .04) | |
3145 | N/A | |
3146 | N/A | |
3147 | MILITARY P ERSONNEL D ESCRIPTION (#2.312, 12.04) | |
3148 | MILITARY S ERVICE RAN K CODE (#3 65, 12.05) | |
3149 | N/A | |
3150 | N/A | |
3151 | MILITARY S ERVICE RAN K CODE (#2 .312, 12.0 5) | |
3152 | DATE TIME PERIOD FOR MAT QUAL ( #365, 12.0 6) | |
3153 | N/A | |
3154 | N/A | |
3155 | DATE TIME PERIOD FOR MAT QUAL ( #2.312, 12 .06) | |
3156 | DATE TIME PERIOD (#3 65, 12.07) | |
3157 | N/A | |
3158 | N/A | |
3159 | DATE TIME PERIOD (#2 .312, 12.0 7) | |
3160 | NAME OF IN SURED (#36 5, 13.01) | |
3161 | NAME OF IN SURED | |
3162 | (#355.33, 91.01) | |
3163 | NAME OF IN SURED (LON G) | |
3164 | (# 2.312, 7.01) | |
3165 | Manual Upd ate /Auto Update | |
3166 | Uses point er to IIV Response f ile (#365) to displa y data as the field “Subscribe r” | |
3167 | SUBSCRIBER ID | |
3168 | (#365, 13. 02) | |
3169 | SUBSCRIBER ID | |
3170 | (#355.33, 90.03) | |
3171 | SUBSCRIBER ID (FX) | |
3172 | (# 2.312, 50.02) Man ual Update | |
3173 | Uses point er to IIV Response f ile (#365) to displa y data | |
3174 | GROUP NAME (#365, 14 .01) | |
3175 | GROUP NAME | |
3176 | (#355.33, 90.01) | |
3177 | GROUP NAME (LONG) | |
3178 | (# 355.3, 2.01) Manu al Update | |
3179 | Uses point er to IIV Response f ile (#365) to displa y data | |
3180 | GROUP NUMB ER | |
3181 | (#365, 14. 02) | |
3182 | GROUP NUMB ER | |
3183 | (#355.33, 90.02) | |
3184 | GROUP NUMB ER (LONG) | |
3185 | (# 355.3, 2.02) Manu al Update | |
3186 | Uses point er to IIV Response f ile (#365) to displa y data | |
3187 | ||
3188 | ||
3189 | ||
3190 | APPENDIX C – TROUBLE SHOOTING | |
3191 | ||
3192 | eIV makes heavy use of HL7 mes saging. En sure that the HL7 gl obals have sufficien t room for growth. Reference HL*1.6*19 patch docu mentation for furthe r instruct ions. Als o, referen ce the Ext ernal Inte rfaces – H L7 Communi cations Se tup sectio n, in this manual, f or specifi c eIV HL7 informatio n. | |
3193 | ||
3194 | The HL7 Lo gical Link associate d with thi s interfac e is IIV E C. | |
3195 | ||
3196 | How To Det ermine If Connectivi ty To Aust in Is Lost … | |
3197 | ||
3198 | If the “In quiries Se nt” and “R esponses R eceived” e ntries on the IIV St atistical report [IB CNE IIV ST ATISTICAL REPORT] bo th remain at zero wh ile the “Q ueued Inqu iries” ent ry on the report con tinues to increase o ver a peri od of time , then no IIV inquir ies are be ing sent ( See Sectio n 6 of the Integrate d Billing Insurance Identifica tion and V erificatio n Interfac e User Gui de). If t his situat ion occurs over a tw o days ela pse and bo th the “In quiries Se nt” and “R esponses R eceived” e ntries rem ain at zer o, there i s a commun ications p roblem. | |
3199 | ||
3200 | How To Res tore Conne ctivity To Austin… | |
3201 | ||
3202 | Verify tha t the name of the HL 7 Logical Link has n ot changed . It must be “IIV E C”. | |
3203 | Verify the following settings for the HL 7 Logical Link “IIV EC”: | |
3204 | The instit ution fiel d is blank | |
3205 | The domain field is set to
|
|
3206 | The AUTOST ART field is set to enabled | |
3207 | The TCP/IP address i s left bla nk. It wi ll self po pulate lat er. | |
3208 | The TCP/IP Port is s et to 5100 | |
3209 | Verify tha t the HL7 Logical Li nk “IIV EC ” is runni ng. | |
3210 | Ask your I B Supervis or or insu rance pers onnel who brought th is communi cation iss ue to your attention , to revie w the IIV Statistica l report t he followi ng day and confirm t hat connec tivity has been rest ored with Austin. | |
3211 | If this do es not res olve your communicat ion with A ustin for IIV, ask t he IB Supe rvisor or insurance personnel to log a R emedy Tick et with th e VA suppo rt. | |
3212 | ||
3213 | ||
3214 | Example – HL7 Logica l Link | |
3215 | CHOOSE 1-1 5: 11 HL MAIN MENU HL7 Ma in Menu | |
3216 | ||
3217 | ||
3218 | Systems Li nk Monitor | |
3219 | Filer and Link Manag ement Opti ons ... | |
3220 | Message Ma nagement O ptions ... | |
3221 | Interface Developer Options .. . | |
3222 | Site Param eter Edit | |
3223 | ||
3224 | Select HL7 Main Menu Option: F ILER and L ink Manage ment Optio ns | |
3225 | ||
3226 | ||
3227 | SM Systems Li nk Monitor | |
3228 | FM Monitor, S tart, Stop Filers | |
3229 | LM TCP Link M anager Sta rt/Stop | |
3230 | SA Stop All M essaging B ackground Processes | |
3231 | RA Restart/St art All Li nks and Fi lers | |
3232 | DF Default Fi lers Start up | |
3233 | SL Start/Stop Links | |
3234 | PI Ping (TCP Only) | |
3235 | ED Link Edit | |
3236 | ER Link Error s ... | |
3237 | ||
3238 | ||
3239 | Select Fil er and Lin k Manageme nt Options Option: E D Link Ed it | |
3240 | ||
3241 | Select HL LOGICAL LI NK NODE: I IV | |
3242 | 1 I IV EC | |
3243 | ||
3244 | ||
3245 | ||
3246 | Example – HL7 Logica l Link “II V EC” | |
3247 | ||
3248 | HL7 LOGICAL LI NK | |
3249 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ----- | |
3250 | ||
3251 | NODE: IIV EC | |
3252 | ||
3253 | INSTITU TION: | |
3254 | ||
3255 | DO MAIN: DNS.URL | |
3256 | ||
3257 | AUTOS TART: Enab led | |
3258 | ||
3259 | QUEUE SIZE: 10 | |
3260 | ||
3261 | LLP TYPE: TCP | |
3262 | ||
3263 | ||
3264 | ||
3265 | HL7 LOGICAL LI NK | |
3266 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ----- | |
3267 | [------- ---------- ---TCP LOW ER LEVEL P ARAMETERS- ---------- ---------- ----] | |
3268 | | IIV EC | | |
3269 | | | | |
3270 | | TCP/I P SERVICE TYPE: CLIE NT (SENDER ) | | |
3271 | | TCP/IP ADD RESS: it w ill self-p opulate | | |
3272 | | TCP/IP PO RT: 5100 | | | | |
3273 | | | | |
3274 | | ACK TIMEOUT: 6 0 R E-TRANSMIS ION ATTEMP TS: | | |
3275 | | READ TIMEOUT: 6 0 EXC EED RE-TRA NSMIT ACTI ON: restar t | | |
3276 | | BLO CK SIZE: SAY HE LO: | | |
3277 | | | | |
3278 | |STARTUP NODE: PERSISTE NT: NO | | |
3279 | | RETE NTION: 60 UNI-DIRE CTIONAL WA IT: | | |
3280 | [------- ---------- ---------- ---------- ---------- ---------- ---------- ----] | |
3281 | __________ __________ __________ __________ __________ __________ __________ _____ | |
3282 | ||
3283 | COMMAND: Press <PF1>H fo r help I nsert | |
3284 | ||
3285 | ||
3286 | ||
3287 | APPENDIX D – eIV IMP LEMENTATIO N QUICK CH ECKLIST (I B*2.0*184 only) | |
3288 | ||
3289 | ||
3290 | The follow ing tasks must be ac complished before, d uring and after the eIV patch IB*2.0*184 is instal led at you r medical center. T his quick checklist identifies the order in which tasks must be comple ted and re sponsible parties fo r either p erforming an action or providi ng informa tion. Ple ase refer to the eIV Installat ion Guide for step-b y-step ins tructions on how to complete t hese actio ns. | |
3291 | ||
3292 | ||
3293 | Pre-Implem entation T asks | |
3294 | IRM | |
3295 | Revenue Co ordinator and/or Ins urance Sup ervisor | |
3296 | ||
3297 | Verify tha t required IB patche s were ins talled. | |
3298 | ||
3299 | ||
3300 | ||
3301 | Verify tha t the doma in reflect ed in patc h XM*DBA*1 53 was man ually adde d to the s ystem. | |
3302 | ||
3303 | ||
3304 | ||
3305 | Identify m embers of the IBCNE IIV MESSAG E mail gro up. | |
3306 | ||
3307 | ||
3308 | ||
3309 | ||
3310 | Patch Inst allation T ask | |
3311 | IRM | |
3312 | Revenue Co ordinator and/or Ins urance Sup ervisor | |
3313 | ||
3314 | With the a ssistance of a syste m administ rator (sys tem manage r) define the new IB CN global. | |
3315 | ||
3316 | ||
3317 | ||
3318 | Ensure tha t all Inte grated Bil ling users are logge d off the system. | |
3319 | ||
3320 | ||
3321 | ||
3322 | Install th e IB*2.0*1 84 patch. | |
3323 | ||
3324 | ||
3325 | ||
3326 | Enable jou rnaling fo r the new ^IBCN glob al. | |
3327 | ||
3328 | ||
3329 | ||
3330 | ||
3331 | Post-Insta llation Ta sks | |
3332 | IRM | |
3333 | Revenue Co ordinator and/or Ins urance Sup ervisor | |
3334 | ||
3335 | Add member s to the I BCNE IIV M ESSAGE mai l group. | |
3336 | ||
3337 | ||
3338 | ||
3339 | Assign sec urity keys & menus t o users. | |
3340 | ||
3341 | ||
3342 | ||
3343 | Setup HL7 logical li nks for II V | |
3344 | ||
3345 | ||
3346 | ||
3347 | Configure the eIIV s ite parame ters as re commended in the Ins tallation Guide. | |
3348 | IRM must p rovide ass istance wi th setting up the eI IV Site Pa rameters t hat corres pond with HL7 messag es / traff ic. | |
3349 | ||
3350 | ||
3351 | ||
3352 | ||
3353 | ||
3354 | ||
3355 | ||
3356 | ||
3357 | Site Regis tration Ta sks | |
3358 | IRM | |
3359 | Revenue Co ordinator and/or Ins urance Sup ervisor | |
3360 | ||
3361 | Execute th e IBCNE II V BATCH PR OCESS opti on and wai t for it t o complete . | |
3362 | ||
3363 | ||
3364 | ||
3365 | Check IBCN E IIV MESS AGE mail g roup messa ges. Proc eed if no “problem” messages w ere receiv ed. | |
3366 | Otherwise, reconcile any “prob lem” messa ges and st art over. | |
3367 | ||
3368 | ||
3369 | ||
3370 | Check the HL7 system monitor f or incomin g messages and verif y that 350 + messages were rece ived. | |
3371 | ||
3372 | ||
3373 | ||
3374 | Check IBCN E IIV MESS AGE mail g roup messa ges again. Proceed if no “pro blem” mess ages were received. Otherwise , reconcil e any “pro blem” mess ages and s tart over. | |
3375 | ||
3376 | ||
3377 | ||
3378 | Confirm th e HL7 logi cal link s ettings. Proceed if they have not been updated. Otherwise, start ove r. | |
3379 | ||
3380 | ||
3381 | ||
3382 | ||
3383 | Post-Regis tration Ta sks | |
3384 | IRM | |
3385 | Revenue Co ordinator and/or Ins urance Sup ervisor | |
3386 | ||
3387 | Link insur ance compa nies to pa yers. | |
3388 | ||
3389 | ||
3390 | ||
3391 | Enable the linked pa yers. | |
3392 | ||
3393 | ||
3394 | ||
3395 | Schedule t he nightly IBCNE IIV BATCH PRO CESS throu gh TaskMan . | |
3396 | ||
3397 | ||
3398 | ||
3399 | Use the II V Site Par ameters an d graduall y enable I IV extract s to begin sending i nquires an d receivin g response s. | |
3400 | ||
3401 | ||
3402 | ||
3403 | ||
3404 | ||
3405 | ||
3406 | APPENDIX E – eIV Dat abase Inte gration Ag reements ( DBIAs) | |
3407 | ||
3408 | ||
3409 | This appen dix lists the associ ated DBIAs for the e IV softwar e. Please refer to FORUM for the most u p-to-date listing of active DB IAs. | |
3410 | ||
3411 | ||
3412 | IA # | |
3413 | Between IB and | |
3414 | Related to | |
3415 | FORUM | |
3416 | Status | |
3417 | DBIA950 | |
3418 | INCOME VER IFICATION MATCH | |
3419 | Direct glo bal read a nd w/Filem an to fiel ds at ^DP T(D0,.31), Write wit h Fileman to fields at ^DPT(D 0,.312,D1) | |
3420 | Active | |
3421 | DBIA2780 | |
3422 | PATIENT DA TA EXCHANG E | |
3423 | Both R/W w /Fileman to fields at ^DPT(D0 ,.31), ^DP T(D0,.312, D1) | |
3424 | Active | |
3425 | DBIA2782 | |
3426 | MENTAL HEA LTH | |
3427 | Direct Glo bal Read & w/Fileman to fields at ^DPT(D 0,.312,D1) | |
3428 | Active | |
3429 | DBIA3302 | |
3430 | ENROLLMENT APPLICATI ON SYSTEM | |
3431 | $$BUFF^IBC NBES1 | |
3432 | Active | |
3433 | DBIA4238-A | |
3434 | REGISTRATI ON | |
3435 | $$MFE^VAFH LMFE | |
3436 | Active | |
3437 | DBIA4238-B DBIA4239 | |
3438 | REGISTRATI ON | |
3439 | $$MFI^VAFH LMFI | |
3440 | Active | |
3441 | DBIA4240 | |
3442 | PCE – PATI ENT CARE E NCOUNTER | |
3443 | ^AUPNVSIT direct ref erences | |
3444 | VISIT FILE | |
3445 | Active | |
3446 | DBIA4242 | |
3447 | REGISTRATI ON | |
3448 | ^DG(43 dir ect access MAS PARAM ETERS FILE (#43) | |
3449 | Active | |
3450 | DBIA4243 | |
3451 | REGISTRATI ON | |
3452 | ^DGPR(408. 13 direct reference | |
3453 | INCOME PER SON File (#403.13) | |
3454 | Active | |
3455 | DBIA4244 | |
3456 | REGISTRATI ON | |
3457 | ^DGPR(408. 12 direct reference | |
3458 | PATIENT RE LATION Fil e(#408.12) | |
3459 | Active | |
3460 | DBIA4785 | |
3461 | REGISTRATI ON | |
3462 | Direct Glo bal Read & w/Fileman to all fi elds store d at ^IBA( #355.33) | |
3463 | Active | |
3464 | DBIA419 | |
3465 | REGISTRATI ON | |
3466 | ^DGPM(D0,0 ) | |
3467 | ||
3468 | Active | |
3469 | DBIA263-A | |
3470 | HL7 | |
3471 | EN^VAFHLPI D | |
3472 | Approved b y Donna H. Harris 9/ 8/03. Ack nowledged by Cameron 9/8/03. | |
3473 | DBIA2120 | |
3474 | KERNAL | |
3475 | KCHK^XUSRB | |
3476 | Approved b y Joel L. Ivey 9/9/0 3. Acknowl edged by C ameron 9/9 /03. | |
3477 | DBIA5293 | |
3478 | INSURANCE CAPTURE BU FFER | |
3479 | Read w/Fil eMan to f ields at^I BA(355.3,D 0,0) and ^ IBA(355.3, D0,6) | |
3480 | FileMan re ad/write t o fields a t ^IBA(355 .3,D0,11,D 1,0) | |
3481 | Active | |
3482 | DBIA5294 | |
3483 | INSURANCE CAPTURE BU FFER | |
3484 | FileMan re ad/write t o fields a t: | |
3485 | ^IBA(355.3 3,D0,0) | |
3486 | ^IBA(355.3 3,D0,20) | |
3487 | ^IBA(355.3 3,D0,21) | |
3488 | ^IBA(355.3 3,D0,40) | |
3489 | ^IBA(355.3 3,D0,60) | |
3490 | ^IBA(355.3 3,D0,61) | |
3491 | ^IBA(355.3 3,D0,62) | |
3492 | Active | |
3493 | DBIA5304 | |
3494 | INSURANCE CAPTURE BU FFER | |
3495 | Fileman re ad/write t o fields a t ^DPT(D0, .31) | |
3496 | Read w/Fil eMan to fi elds at | |
3497 | ^DPT(D0,.3 12,D1,0) | |
3498 | ^DPT(D0,.3 12,D1,1) | |
3499 | ^DPT(D0,.3 12,D1,2) | |
3500 | ^DPT(D0,.3 12,D1,3) | |
3501 | ^DPT(D0,.3 12,D1,4) | |
3502 | ^DPT(D0,.3 12,D1,5) | |
3503 | ^DPT(D0,.3 12,D1,7) | |
3504 | Active | |
3505 | ||
3506 | ||
3507 | APPENDIX F – How to Test the e IV Interfa ce with th e Test Eli gibility C ommunicato r | |
3508 | ||
3509 | This appen dix explai ns how to test the e lectronic Insurance Verificati on interfa ce from a VistA test or develo pment acco unt with t he test El igibility Communicat or (EC) th at is loca ted in Aus tin. | |
3510 | ||
3511 | In order t o test the eIV inter face from a developm ent/test a ccount wit h the test EC, the d eveloper m ust use a small set of preappr oved test patients w ith specif ic criteri a that the Financial Services Center (FS C) has agr eed upon. This is b ecause eIV inquiries (270 tran smission) to the ins urance cle aringhouse can only be made fo r actual p atients. Therefore, when this testing i s performe d FSC does not send or receive messages from the c learinghou se and ins tead retur ns back a canned res ponse (271 transmiss ion – paye r response ) that is hardcoded for each t ype of tes t being pe rformed. | |
3512 | ||
3513 | Prior to p atch IB*2. 0*549, if the interf ace was on for a dev elopment/t est accoun t and the developer sent a 270 transmiss ion (eIV i nquiry) fo r a patien t that was not one o f the agre ed upon te st patient s, or key data eleme nts (e.g. , subscrib er ID, pat ient’s dat e of birth , patient’ s sex, pat ient’s nam e, and pay er’s name) of that p atient did not match the data that FSC w as expecti ng, an err or would o ccur at FS C and the issue woul d have to be fixed m anually be fore testi ng could p roceed aga in. No ot her test e IV inquiri es would b e processe d from any VistA dev elopment/t est accoun t while FS C was manu ally addre ssing the situation of receivi ng an eIV inquiry wi th unexpec ted data. Not only did this c ause manua l work, bu t it also stopped ot her people from test ing with e IV. | |
3514 | ||
3515 | With the i ntroductio n of IB*2. 0*549, the system ch ecks to se e if the s ite is in test or pr oduction m ode. If t he site is in test m ode, the s ystem chec ks the dat a in the t ransmissio n to deter mine if al l of the d ata fields match a t est that h as been pr eviously a pproved by FSC. If the eIV in quiry did not match a test the n the eIV inquiry is not trans mitted to FSC but wo uld instea d remain i n the IIV Transmissi on Queue ( #365.1) wi th a statu s of ‘Read y to Trans mit’. Thi s alleviat es the bot tleneck th at would h ave occurr ed when im proper tes t data was sent to F SC and had to be man ually dele ted. This check is done in th e XMITOK m ethod of r outine IBC NETST. Af ter July 2 016, FSC w ill send a default A AA error r esponse (m essage wit h error co de T4) whe never Vist A sends an eIV inqui ry to the test EC sy stem for w hich there is no pre determined (previous ly agreed upon) resp onse based on the Su bscriber I D/Patient ID and Pay er’s VA Na tional ID combinatio n. It is important to maintai n the exis tence of X MITOK^IBCN ETST to co ntrol the number eIV inquiries /responses between V istA and t he test EC system es pecially w hen one is trying to trace a s pecific sc enario. | |
3516 | ||
3517 | Below is a table whi ch lists t he data re quired for the curre ntly agree d upon tes t cases. If a diffe rent set o f criteria is needed to test s omething t hat these cases do n ot current ly cover, the develo per must t alk to som eone at FS C to eithe r modify a n existing test case or add a new one. Any new or modified test case must be up dated in b oth the XM ITOK^IBCNE TST routin e and in t he chart b elow in th is documen t. These two items must remai n in synch for futur e develope rs and eff orts. | |
3518 | ||
3519 | ||
3520 | ||
3521 | Important things to know to re ad this ch art: | |
3522 | ||
3523 | PAYER | |
3524 | The patien t must hav e an insur ance polic y that is active (no expiratio n date) in VistA wit h an insur ance compa ny (#2.312 , .01) tha t is activ e and link ed to the payer in t he “Payer” column of this char t. This p ayer must be Nationa lly Active and Local ly Active in file #3 65.12 for the applic ation “IIV ”. This p ayer must also have the VA Nat ional ID m atch what is listed below in t he chart. | |
3525 | ||
3526 | * Note the VA Nation al ID may be differe nt than wh at the VA National I D is in pr oduction f or that Pa yer. For example, t he payer “ CMS” has a different VA Nation al ID for testing th an for pro duction. | |
3527 | ||
3528 | Group ID | |
3529 | The patien t’s active policy on file must have the NEW GROUP NUMBER (#2 .312, 21) match exac tly what i s listed i n the “Gro up ID” col umn of thi s chart, i ncluding s paces. It is case s ensitive d ue to XMIT OK^IBCNETS T and Auto Update. | |
3530 | ||
3531 | * Note: Fo r these te st cases i t does not matter wh at the Gro up Name is . It is r ecommended that the NEW GROUP NAME (#2.3 12,20) is set to the same thin g as the G roup ID. It will he lp reduce confusion when revie wing test data and w hen troubl eshooting with FSC. | |
3532 | ||
3533 | ** Note: T he patient ’s policy uses GROUP PLAN (#2. 312, .18) to point t o the GROU P INSURANC E PLAN fil e #355.3. It is thi s pointer that calcu lates the fields (#2 .312, 20) & (#2.312, 21). | |
3534 | ||
3535 | Subscriber ID | |
3536 | The patien t’s active policy on file must have the SUBSCRIBER ID (#2.31 2, 7.02) m atch exact ly what is listed in the “Subs criber ID” column of this char t. It is case sensi tive due t o XMITOK^I BCNETST an d Auto Upd ate. | |
3537 | ||
3538 | Subscriber | |
3539 | The patien t’s active policy on file must have the NAME OF IN SURED (#2. 312, 7.01) match exa ctly what is listed in the “Su bscriber” column of this chart . It is c ase sensit ive due to XMITOK^IB CNETST and Auto Upda te. | |
3540 | ||
3541 | Patient ID | |
3542 | The patien t’s active policy on file must have the PATIENT ID (#2.312, 5.01) matc h exactly what is li sted in th e “Patient ID” colum n. It is case sensi tive due t o XMITOK^I BCNETST an d Auto Upd ate. | |
3543 | ||
3544 | Patient | |
3545 | The patien t’s active policy on file must have the NAME (#2, .01) be th e exact sa me as the name liste d in the “ Subscriber ” column i f not stat ed otherwi se below i n the char t. Refer to the “Pa tient” col umn for in structions of what t he value o f this fie ld should be. It is case sensi tive due t o XMITOK^I BCNETST an d Auto Upd ate. | |
3546 | ||
3547 | * Note: Th e test pat ient must have an IN TEGRATION CONTROL NU MBER (#2,9 91.01) pop ulated bef ore it can be used a s a test p atient for an eIV in quiry. | |
3548 | ||
3549 | Patient’s DOB | |
3550 | The patien t’s active policy on file must have the DATE OF BI RTH (#2, . 03) match exactly wh at is list ed in the “Patient’s DOB” colu mn. | |
3551 | ||
3552 | Patient’s Sex | |
3553 | The patien t’s active policy on file must have the SEX (#2, . 02) match exactly wh at is list ed in the “Patient’s Sex” colu mn. In th e future, a develope r may drop the SEX f rom XMITOK ^IBCNETST and the ch art below with FSC p ermission. Currentl y, FSC and eIV Auto Match chec ks (AUTOUP D^IBCNEHL1 ) does not need this data elem ent to wor k but XMIT OK^IBCNETS T checks f or this va lue. | |
3554 | ||
3555 | What is re turned & A dditional Instructio ns | |
3556 | This colum n may give other imp ortant inf ormation n eeded in o rder to se t up the t est case p roperly in VistA. T his column tells you what type of payer response y ou will re ceive back from FSC for each d ifferent t est case. | |
3557 | ||
3558 | * Note: Fo r Dependen t eIV inqu iries (the patient i s not the subscriber ), the INS URED’S DOB (#2.312, 3.01) must be set to the subsc riber’s da te of birt h, the INS URED’S SEX (#2.312, 3.12) must be set to the subsc riber’s se x, and the PT. RELAT IONSHIP TO INSURED ( #2.312, 16 ) must be set as ind icated in the below chart. Th e subscrib er must al ready be a patient d efined in VistA with the appro priate NAM E (#2, .01 ), DATE O F BIRTH (# 2, .03) an d SEX (#2, .02) fiel ds set to the approp riate valu es for the subscribe r’s inform ation. | |
3559 | ||
3560 | ||
3561 | ||
3562 | Payer | |
3563 | Group ID | |
3564 | (a.k.a. Gr oup Number ) | |
3565 | Subscriber ID | |
3566 | Subscriber | |
3567 | Patient ID | |
3568 | Patient | |
3569 | Patient’s DoB | |
3570 | Patient’s Sex | |
3571 | What is re turned & a dditional instructio ns | |
3572 | Aetna | |
3573 | ||
3574 | (with VA N ational ID "VA1") | |
3575 | GRP NUM 13 805 | |
3576 | 111111AE | |
3577 | IBSUB,ACTI VE | |
3578 | 111111AE | |
3579 | Same as su bscriber | |
3580 | 2/2/1922 | |
3581 | M | |
3582 | FSC return s an Activ e response for a pat ient who i s the subs criber. T he respons e contains benefit i nformation . | |
3583 | ||
3584 | ||
3585 | ||
3586 | ||
3587 | ||
3588 | ||
3589 | ||
3590 | ||
3591 | ||
3592 | ||
3593 | ||
3594 | ||
3595 | CIGNA | |
3596 | ||
3597 | (with VA N ational ID "VA10") | |
3598 | GRP NUM 54 42 | |
3599 | 222222CI | |
3600 | IBSUB,ACTI VE | |
3601 | Same as su bscriber I D | |
3602 | Same as su bscriber | |
3603 | 2/2/1922 | |
3604 | M | |
3605 | FSC return s an Activ e response for a pat ient who i s the subs criber. T he respons e contains benefit i nformation . | |
3606 | ||
3607 | ||
3608 | ||
3609 | ||
3610 | ||
3611 | ||
3612 | ||
3613 | ||
3614 | Aetna | |
3615 | ||
3616 | (with VA N ational ID "VA1") | |
3617 | GRP NUM 13 188 | |
3618 | 111111FG | |
3619 | IBSUB,INAC TIVE | |
3620 | 111111FG | |
3621 | Same as su bscriber | |
3622 | 1/1/1948 | |
3623 | F | |
3624 | FSC return s an Inact ive respon se for a p atient who is the su bscriber. | |
3625 | ||
3626 | ||
3627 | ||
3628 | ||
3629 | ||
3630 | ||
3631 | Cigna | |
3632 | ||
3633 | (with VA N ational ID "VA10") | |
3634 | GRP NUM 54 42 | |
3635 | 012345678 | |
3636 | IBSUB,AAAE RROR | |
3637 | 012345678 | |
3638 | Same as su bscriber | |
3639 | 2/11/1947 | |
3640 | M | |
3641 | FSC return s a respon se for a p atient who is the su bscriber. The respo nse will c ontain a A AA (271 ms g with an error). ( i.e., Pati ent not fo und.) | |
3642 | CMS | |
3643 | ||
3644 | (with VA N ational ID "VA1628") | |
3645 | Doesn't ma tter | |
3646 | 333113333A | |
3647 | IB,PATIENT | |
3648 | 333113333A | |
3649 | Same as su bscriber | |
3650 | 3/9/1935 | |
3651 | M | |
3652 | FSC return s an Activ e response for a pat ient who i s the subs criber. T he respons e contains 1 additio nal ‘poten tial’ insu rance repo rted by Me dicare (1 trailer). | |
3653 | CMS | |
3654 | ||
3655 | (with VA N ational ID "VA1628") | |
3656 | Doesn't ma tter | |
3657 | 111223333A | |
3658 | IBSUB,TWOT RLRS | |
3659 | 111223333A | |
3660 | Same as su bscriber | |
3661 | 5/5/1955 | |
3662 | M | |
3663 | FSC return s an Activ e response for a pat ient who i s the subs criber. T he respons e contains 2 additio nal ‘poten tial’ insu rances rep orted by M edicare (2 trailers) . | |
3664 | Aetna (wit h VA Natio nal ID "VA 1") | |
3665 | AET1234 | |
3666 | W123456111 1 | |
3667 | IBINS,ACTI VE | |
3668 | W123452222 | |
3669 | IBDEP,ACTI VE | |
3670 | 3/4/1990 | |
3671 | F | |
3672 | FSC return s an Activ e response for a pat ient who i s a depend ent of the subscribe r. For FS C setup on ly: Depend ent resp. with EB12= WFor VistA setup onl y: Set the Subscribe r’s DOB to 7/26/41. Make sure the subsc riber (not patient) is a Male. Define t he depende nt ‘IBDEP, ACTIVE’ to be the su bscriber’s CHILD by setting th e patient relationsh ip to insu red. | |
3673 | Aetna | |
3674 | ||
3675 | (with VA N ational ID "VA1") | |
3676 | GRP NUM 13 805 | |
3677 | 222222AE | |
3678 | IBSUB,CANN OTFIND | |
3679 | 222222AE | |
3680 | Same as su bscriber | |
3681 | 7/7/1922 | |
3682 | M | |
3683 | FSC return s an respo nse saying that the user can n ot be foun d by reply ing with a n ambigiou s reponse but no AAA message f or a patie nt who is the subscr iber. Thi s is happe ning today in the re al world. | |
3684 | ||
3685 | ||
3686 | ||
3687 | ||
3688 | GLOSSARY | |
3689 | ||
3690 | Term | |
3691 | Descriptio n | |
3692 | AITC | |
3693 | Austin Inf ormation T echnology Center (fo rmerly Aus tin Automa tion Cente r - AAC) | |
3694 | EC | |
3695 | Eligibilit y Communic ator – thi s refers t o the Nati onal Healt h Insuranc e Cache da tabase tha t is house d in the A ITC in Aus tin, TX. The eIV so ftware com municates with the E ligibility Communica tor direct ly through HL7. The EC in turn communica tes with C ommunicati on Partner s to creat e an eligi bility res ponse that is return ed to the VistA syst em. | |
3696 | EICD | |
3697 | Electronic Insurance Coverage Discovery – this ref ers to the added fun ctionality IB*2*621 delivered to identif y patient insurance through an electroni c transact ion sent t o a contra cted clear inghouse. | |
3698 | FSC | |
3699 | Austin Fin ancial Ser vices Cent er | |
3700 | HIPAA | |
3701 | Health Ins urance Por tability a nd Account ability Ac t of 1996 | |
3702 | HL7 | |
3703 | Health Lev el Seven, a standard ized appli cation lev el communi cations pr otocol tha t enables systems to exchange informatio n and to a ffect requ ests and r esponses. Basically, HL7 is an agreement between t wo HL7-com pliant sys tems that specifies where to e xpect cert ain data i n a stream of charac ters. | |
3704 | IB | |
3705 | Integrated Billing | |
3706 | MCCR | |
3707 | Medical Ca re Cost Re covery. Th e collecti on of moni es by the Department of Vetera ns Affairs (VA). | |
3708 | Required V ariable | |
3709 | An attribu te of a pa ckage inte rface. It is a varia ble that m ust exist in order f or the int erface's e ntry point to be cal led. | |
3710 | Security K ey | |
3711 | Used in co njunction with locke d options or functio ns. Only h olders of this key m ay perform these opt ions/funct ions. Use d for opti ons, which perform a sensitive task. | |
3712 | SSVI | |
3713 | System Sha red Verifi ed Insuran ce. This f unctionali ty provide s higher q uality pat ient insur ance data to users b oth locall y and nati onally as well as re duces redu ndant data entry. T his is ach ieved by e nsuring th at patient insurance data fiel ds are fil led in and that data is moved to other s ites where the patie nt has bee n seen. | |
3714 |
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