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1 | eInsurance_IB_2.0_602.zip | IB_2_0_P602_UM (Track Changes).doc | Wed Feb 27 18:49:30 2019 UTC |
2 | eInsurance_IB_2.0_602.zip | IB_2_0_P602_UM (Track Changes).doc | Wed Mar 20 12:36:27 2019 UTC |
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1 | Integrated Billing ( IB) Versio n 2.0 User GuideRevi sion Histo ry | |
2 | Integrated Billing ( IB) | |
3 | Version 2. 0 | |
4 | User Guide | |
5 | ||
6 | May March 20198 | |
7 | Department of Vetera ns Affairs | |
8 | Office of Informatio n and Tech nology (OI &T) | |
9 | Revision H istory | |
10 | Initiated on 12/29/2 004. | |
11 | DateRevisi onDescript ionAuthorM arch 20193 .1Patch IB *2.0*602 u pdates: | |
12 | Added menu option Ex pire Group Plan in P atient Ins urance Men u section, including descripti on and scr een and pr ompt sampl es.MCCF ED I TAS eIns urance, R. R.May 2018 3.0Patch I B*2.0*568 | |
13 | Updated Th ird Party Joint Inqu iry sample screen sh ots – Type column fo r active a nd inactiv e billsFY 16 Revenue Enhanceme ntsAugust 20162.9Pat ch IB*2.0* 549 update s: | |
14 | Updated Pa tient Poli cy Informa tion scree n shots. | |
15 | Updated Pa tient Insu rance Menu section. | |
16 | Updated th e List Pla ns by Insu rance Comp any Report screen. | |
17 | Added Insu rance Plan s Missing Data Repor t. | |
18 | Updated MC CR Site Pa rameter Di splay/Edit section. | |
19 | Updated MC CR Site Pa rameter Sc reen secti on.FY15 eI nsurance D evelopment Team, D.W .August 20 162.8Updat ed Introdu ction to r eference n ew Claims Tracking U ser Guide. | |
20 | Removed re ference to Claim Tra cking on p .4. | |
21 | Moved Sect ions below to a sepa rate Claim s Tracking User Guid e: | |
22 | Claims Tra cking Mast er Menu | |
23 | Supervisor s Menu (Cl aims Track ing) | |
24 | Reports Me nu (Claims Tracking) PM: T.T. | |
25 | Harris Tea mAugust 20 162.7Patch IB*2*0*55 0 updates: | |
26 | Updated Ti tle Page t o current OI&T Stand ards. | |
27 | Added desc ription fo r Release of Informa tion Repor tPM: T.T. | |
28 | Harris Tea mAugust 20 162.6Updat ed for pat ch IB*2.0* 562 | |
29 | Add new op tion IB MT FIX/DISCH SPECIAL C ASE p. 47T . D. | |
30 | T. D.June 20162.5Com prehensive Updates f or IB *2.0 *529 and I B*2.0*530 | |
31 | Updated ti tle page a nd footers | |
32 | Updated sc reen optio ns p.24 – 27 | |
33 | Added Reje ct Indicat or p. 60 | |
34 | Updated In surance Pa yment Tren d Report p . 146-147P M: T.T | |
35 | Tech Write r V.D.Febr uary 20162 .4Patch IB *2.0*525 a nd IB*2.0* 528 update s: | |
36 | Updated P atient to Subscriber | |
37 | Added sect ion on Man ually Adde d HPIDs to Billing C laim Repor t to Pati ent Billin g Reports Menu | |
38 | Added mate rial on vi ewing Pati ent Policy comments from Claim s Tracking edit opti onFY14 eIn surance De velopment TeamSeptem ber 20152. 3Updates f or IB*2.0* 522, ICD-1 0 Patient Treatment File (PTF) Modificat ions: | |
39 | Updated ti tle page a nd footers . | |
40 | Reformatte d Revision History. | |
41 | Added text describin g patch ch anges to E nter/Edit Billing In formation on p.45.VA OI&T Prod uct Develo pment, ICD -10 PTF Mo dification s TeamJanu ary 20152. 2Patch IB* 2.0*521 up dates: | |
42 | Updated co ver page. | |
43 | Updated fo oter dates . | |
44 | Updated sc reenshots on pages 3 4 and 296 for additi on of HPID /OEID in T PJI.PM: M. H. | |
45 | FirstView TeamNovemb er 20142.1 Patch IB*2 .0*519: | |
46 | Modified f ooter | |
47 | Updated sc reens for ‘Insurance Company E ditor’ scr eensPM: M. H. | |
48 | FirstView TeamSeptem ber 20142. 0Patch IB* 2.0*461 up dates. | |
49 | Changed al l referenc es to ICD- 9 to gener ic ICD: pp . 15, 116, 117, 122, 155 | |
50 | Added ICD- 10 text to Glossary: | |
51 | p. | |
52 | ||
53 | HYPERLINK \l "p461 _332" | |
54 | 334VA PM: K.T. | |
55 | Tech Write r: E.P. an d L.R.3/5/ 20141.9Pat ch IB*2.0* 385: | |
56 | Updated an d highligh ted the fo llowing op tions unde r the Medi cation Cop ayment Inc ome Exempt ion Menu t o include changes im plemented by the Vet erans’ Fin ancial Ass essment Pr oject impl emented wi th IB*2.0* 385. | |
57 | Letters to Exempt Pa tients | |
58 | Reprint Si ngle Incom e Test Rem inder Lett erD.S.1/27 /20141.8Pa tch IB*2.0 *497 updat es: | |
59 | Updated co ver page. | |
60 | Updated fo oter dates . | |
61 | Replaced s creenshots where scr eens went from doubl e column t o single c olumn to a ccommodate longer fi elds.PM: M .H. | |
62 | FirstView Team3/26/2 0131.7Docu ment forma tting revi sions: | |
63 | Updated co ver page. | |
64 | Added blan k pages an d noted pa ges left i ntentional ly blank: pp. iv, 6, 8, 10, 12 , 52, 78, 132, 138, 218, 292, and 308. | |
65 | Removed ex tra blank pages. | |
66 | Corrected heading st yles and u pdated Tab le of Cont ents. | |
67 | Added “Sam ple Screen s” label t o p. 187 a nd “Sample Output” l abel to p. 200. | |
68 | Rearranged options i n the IRM System Man ager’s Int egrated Bi lling Menu section t o better r eflect act ual menu l ayout in T able of Co ntents. Op tions were moved up to pp. 298 -307.PM: K .N. | |
69 | Tech Write r: K.R.3/2 6/20131.6U pdated for patch IB* 2.0*458: | |
70 | Added new ROI Consen t option t o Claims T racking Ed itor scree n on pp. 1 7, 21, and 22 | |
71 | Added new ROI Specia l Consent screen to pp. 20 and 22 | |
72 | Reformatte d bulleted lists and added not e about ad ditional r eview type s on pp.18 , 115, and 120; | |
73 | Updated Da ys Denied Report des cription a nd sample output on pp. 142-14 3; | |
74 | Added new ROI Expire d Consent Report to p. 217; | |
75 | Added new RC Change Facility T ype option to Charge Master IR M Menu on p. 317.PM: K.N. | |
76 | Tech Write r: K.R.3/2 6/20131.5U pdated for patch IB* 2.0*474. C hanged las t sentence under “Ra te Schedul e Adjustme nt Enter/E dit” optio n on p.317 .PM: A.S. | |
77 | Tech Write r: B.S.8/1 7/20111.4U pdated for patch IB* 2.0*449. | |
78 | Technical writer rev iew— forma tting and convert to Section 5 08 complia nt PDF.PM: C.M. | |
79 | Tech Write rs: E.Z. a nd S.S.10/ 16/20071.3 Updated fo r patch IB *2*303T.D. 5/27/20051 .2Re-paged for clari ty.M.G.12/ 29/20041.1 Updated to comply wi th SOP 192 -352 Displ aying Sens itive Data .M.G.12/29 /20041.0Pd f file che cked for a ccessibili ty to read ers with d isabilitie s.M.G.Pref ace | |
80 | This is th e user man ual for th e Integrat ed Billing (IB) soft ware packa ge. | |
81 | This manua l is desig ned to pro vide guida nce to a b road range of users within VA medical fa cilities i n daily us age of the Integrate d Billing software. | |
82 | Related Ma nuals | |
83 | ReferenceL ocationEle ctronic In surance Ve rification (eIV) Use r Guidehtt p://www.va .gov/vdl/d ocuments/F inancial_A dmin/Integ rated_Bill ing_(IB)/i b_2_0_eiv_ ug.pdfTabl e of Conte nts | |
84 | vPreface | |
85 | ||
86 | ||
87 | vRelated M anuals | |
88 | ||
89 | ||
90 | 1Introduct ion | |
91 | ||
92 | ||
93 | 5Orientati on | |
94 | ||
95 | ||
96 | 6Package M anagement | |
97 | ||
98 | ||
99 | 7Package O peration | |
100 | ||
101 | ||
102 | 8Billing C lerk's Men u | |
103 | ||
104 | ||
105 | 8Third Par ty Joint I nquiry | |
106 | ||
107 | ||
108 | 29Enter/Ed it Billing Informati on | |
109 | ||
110 | ||
111 | 32Automate d Means Te st Billing Menu | |
112 | ||
113 | ||
114 | 32Cancel/E dit/Add Pa tient Char ges | |
115 | ||
116 | ||
117 | 33Patient Billing Cl ock Mainte nance | |
118 | ||
119 | ||
120 | 33Estimate Category C Charges for an Adm ission | |
121 | ||
122 | ||
123 | 35On Hold Menu | |
124 | ||
125 | ||
126 | 35On Hold Charges Re leased to AR | |
127 | ||
128 | ||
129 | 35Count/Do llar Amoun t of Charg es on Hold | |
130 | ||
131 | ||
132 | 35Days on Hold Repor t | |
133 | ||
134 | ||
135 | 36Held Cha rges Repor t | |
136 | ||
137 | ||
138 | 36History of Held Ch arges | |
139 | ||
140 | ||
141 | 37Release Charges 'O n Hold' | |
142 | ||
143 | ||
144 | 37List Cha rges Await ing New Co pay Rate | |
145 | ||
146 | ||
147 | 38Send Con verted Cha rges to A/ R | |
148 | ||
149 | ||
150 | 39Release Charges 'P ending Rev iew' | |
151 | ||
152 | ||
153 | 39List Cur rent/Past Held Charg es by Pt | |
154 | ||
155 | ||
156 | 40Release Charges Aw aiting New Copay Rat e | |
157 | ||
158 | ||
159 | 40Patient Billing Cl ock Inquir y | |
160 | ||
161 | ||
162 | 41Category C Billing Activity List | |
163 | ||
164 | ||
165 | 42Single P atient Cat egory C Bi lling Prof ile | |
166 | ||
167 | ||
168 | 42Disposit ion Specia l Inpatien t Billing Cases | |
169 | ||
170 | ||
171 | 43List Spe cial Inpat ient Billi ng Cases | |
172 | ||
173 | ||
174 | 45CHAMPUS Billing Me nu | |
175 | ||
176 | ||
177 | 45Delete R eject Entr y | |
178 | ||
179 | ||
180 | 45Reject R eport | |
181 | ||
182 | ||
183 | 45Resubmit a Claim | |
184 | ||
185 | ||
186 | 46Reverse a Claim | |
187 | ||
188 | ||
189 | 46Transmis sion Repor t | |
190 | ||
191 | ||
192 | 46IB MT FI X/DISCH SP ECIAL CASE | |
193 | ||
194 | ||
195 | 47Patient Billing Re ports Menu | |
196 | ||
197 | ||
198 | 47Catastro phically D isabled Co pay Report | |
199 | ||
200 | ||
201 | 47Patient Currently Cont. Hosp italized s ince 1986 | |
202 | ||
203 | ||
204 | 48Print IB Actions b y Date | |
205 | ||
206 | ||
207 | 49Employer Report | |
208 | ||
209 | ||
210 | 50Episode of Care Bi ll List | |
211 | ||
212 | ||
213 | 50Estimate Category C Charges for an Adm ission | |
214 | ||
215 | ||
216 | 52Outpatie nt/Registr ation Even ts Report | |
217 | ||
218 | ||
219 | 54Held Cha rges Repor t | |
220 | ||
221 | ||
222 | 54Manually Added HPI Ds to Bill ing Claim Report | |
223 | ||
224 | ||
225 | 56Patient Billing In quiry | |
226 | ||
227 | ||
228 | 59List all Bills for a Patient | |
229 | ||
230 | ||
231 | 60Category C Billing Activity List | |
232 | ||
233 | ||
234 | 61Third Pa rty Output Menu | |
235 | ||
236 | ||
237 | 61Veterans w/Insuran ce and Dis charges | |
238 | ||
239 | ||
240 | 62Veteran Patient In surance In formation | |
241 | ||
242 | ||
243 | 63Veterans w/Insuran ce and Inp atient Adm issions | |
244 | ||
245 | ||
246 | 64Veterans w/Insuran ce and Opt . Visits | |
247 | ||
248 | ||
249 | 65Patient Review Doc ument | |
250 | ||
251 | ||
252 | 67Inpatien ts w/Unkno wn or Expi red Insura nce | |
253 | ||
254 | ||
255 | 70Outpatie nts w/Unkn own or Exp ired Insur ance | |
256 | ||
257 | ||
258 | 72Single P atient Cat egory C Bi lling Prof ile | |
259 | ||
260 | ||
261 | 73Third Pa rty Billin g Menu | |
262 | ||
263 | ||
264 | 73Print Bi ll Addendu m Sheet | |
265 | ||
266 | ||
267 | 74Authoriz e Bill Gen eration | |
268 | ||
269 | ||
270 | 75Enter/Ed it Billing Informati on | |
271 | ||
272 | ||
273 | 76Cancel B ill | |
274 | ||
275 | ||
276 | 77Copy and Cancel | |
277 | ||
278 | ||
279 | 78Delete A uto Biller Results | |
280 | ||
281 | ||
282 | 78Print Bi ll | |
283 | ||
284 | ||
285 | 79Patient Billing In quiry | |
286 | ||
287 | ||
288 | 81Print Au to Biller Results | |
289 | ||
290 | ||
291 | 82Print Au thorized B ills | |
292 | ||
293 | ||
294 | 83Return B ill Menu | |
295 | ||
296 | ||
297 | 83Edit Ret urned Bill | |
298 | ||
299 | ||
300 | 83Returned Bill List | |
301 | ||
302 | ||
303 | 85Return B ill to A/R | |
304 | ||
305 | ||
306 | 85UB-82 Te st Pattern Print | |
307 | ||
308 | ||
309 | 87UB-92 Te st Pattern Print | |
310 | ||
311 | ||
312 | 89HCFA-150 0 Test Pat tern Print | |
313 | ||
314 | ||
315 | 90Outpatie nt Visit D ate Inquir y | |
316 | ||
317 | ||
318 | 91Patient Insurance Menu | |
319 | ||
320 | ||
321 | 91Patient Insurance Info View/ Edit | |
322 | ||
323 | ||
324 | 99View Pat ient Insur ance | |
325 | ||
326 | ||
327 | 107Insuran ce Company Entry/Edi t | |
328 | ||
329 | ||
330 | 114View In surance Co mpany | |
331 | ||
332 | ||
333 | 119Process Insurance Buffer | |
334 | ||
335 | ||
336 | 122Manuall y Added HP IDs to Bil ling Claim Report | |
337 | ||
338 | ||
339 | 123Expire Group Plan (XPIR) | |
340 | ||
341 | ||
342 | 125Insuran ce Reports | |
343 | ||
344 | ||
345 | 125List In active Ins . Co. Cove ring Patie nts | |
346 | ||
347 | ||
348 | 127List Pl ans by Ins urance Com pany | |
349 | ||
350 | ||
351 | 128List Ne w not Veri fied Polic ies | |
352 | ||
353 | ||
354 | 128Insuran ce Plans M issing Dat a Report | |
355 | ||
356 | ||
357 | 130Release of Inform ation Repo rt | |
358 | ||
359 | ||
360 | 130Billing Superviso r Menu | |
361 | ||
362 | ||
363 | 130Insuran ce Buffer Activity | |
364 | ||
365 | ||
366 | 132Managem ent Report s (Billing ) Menu | |
367 | ||
368 | ||
369 | 132Statist ical Repor t (IB) | |
370 | ||
371 | ||
372 | 135Most Co mmonly use d Outpatie nt CPT Cod es | |
373 | ||
374 | ||
375 | 136Insuran ce Buffer Employee | |
376 | ||
377 | ||
378 | 138Clerk P roductivit y | |
379 | ||
380 | ||
381 | 139Rank In surance Ca rriers By Amount Bil led | |
382 | ||
383 | ||
384 | 141Billing Rates Lis t | |
385 | ||
386 | ||
387 | 144Revenue Code Tota ls by Rate Type | |
388 | ||
389 | ||
390 | 145Bill St atus Repor t | |
391 | ||
392 | ||
393 | 147Rate Ty pe Billing Totals Re port | |
394 | ||
395 | ||
396 | 148Insuran ce Payment Trend Rep ort | |
397 | ||
398 | ||
399 | 151Unbille d BASC for Insured P atient App ointments | |
400 | ||
401 | ||
402 | 151ROI Exp ired Conse nt | |
403 | ||
404 | ||
405 | 152Medicat ion Copaym ent Income Exemption Menu | |
406 | ||
407 | ||
408 | 152Print C harges Can celed Due to Income Exemption | |
409 | ||
410 | ||
411 | 154Edit Co pay Exempt ion Letter | |
412 | ||
413 | ||
414 | 156Inquire to Medica tion Copay Income Ex emptions | |
415 | ||
416 | ||
417 | 158Manuall y Change C opay Exemp tion (Hard ships) | |
418 | ||
419 | ||
420 | 159Letters to Exempt Patients | |
421 | ||
422 | ||
423 | 161List In come Thres holds | |
424 | ||
425 | ||
426 | 162Print P atient Exe mptions or summary | |
427 | ||
428 | ||
429 | 163Reprint Single In come Test Reminder L etter | |
430 | ||
431 | ||
432 | 165Add Inc ome Thresh olds | |
433 | ||
434 | ||
435 | 166Print/V erify Pati ent Exempt ion Status | |
436 | ||
437 | ||
438 | 167MCCR Sy stem Defin ition Menu | |
439 | ||
440 | ||
441 | 167Enter/E dit Automa ted Billin g Paramete rs | |
442 | ||
443 | ||
444 | 169Charge Master Men u | |
445 | ||
446 | ||
447 | 169Enter/E dit Charge Master | |
448 | ||
449 | ||
450 | 175Print C harge Mast er | |
451 | ||
452 | ||
453 | 175Activat e Revenue Codes | |
454 | ||
455 | ||
456 | 176Enter/E dit Billin g Rates | |
457 | ||
458 | ||
459 | 177Flag St op Codes/D isposition s/Clinics | |
460 | ||
461 | ||
462 | 177Flag St op Codes/C linics for Third Par ty | |
463 | ||
464 | ||
465 | 178Insuran ce Company Entry/Edi t | |
466 | ||
467 | ||
468 | 185List Fl agged Stop Codes/Dis positions/ Clinics | |
469 | ||
470 | ||
471 | 187List Fl agged Stop Codes/Cli nics for T hird Party | |
472 | ||
473 | ||
474 | 190Billing Rates Lis t | |
475 | ||
476 | ||
477 | 193MCCR Si te Paramet er Enter/E dit | |
478 | ||
479 | ||
480 | 199Purge I nsurance B uffer | |
481 | ||
482 | ||
483 | 200MCCR Si te Paramet er Display /Edit | |
484 | ||
485 | ||
486 | 205Re-Gene rate Avera ge Bill Am ounts | |
487 | ||
488 | ||
489 | 205Re-Gene rate Unbil led Amount s Report | |
490 | ||
491 | ||
492 | 206Send Te st Unbille d Amounts Bulletin | |
493 | ||
494 | ||
495 | 207View Un billed Amo unts | |
496 | ||
497 | ||
498 | 208Third P arty Joint Inquiry | |
499 | ||
500 | ||
501 | 229Fast En ter of New Billing R ates | |
502 | ||
503 | ||
504 | 229Delete Charges fr om the Cha rge Master | |
505 | ||
506 | ||
507 | 230Inactiv ate/List I nactive Co des in Cha rge Master | |
508 | ||
509 | ||
510 | 231IRM Sys tem Manage r's Integr ated Billi ng Menu | |
511 | ||
512 | ||
513 | 231Purge F unctionali ty | |
514 | ||
515 | ||
516 | 233Select Default De vice for F orms | |
517 | ||
518 | ||
519 | 234Display Integrate d Billing Status | |
520 | ||
521 | ||
522 | 235Enter/E dit IB Sit e Paramete rs | |
523 | ||
524 | ||
525 | 236Inquire an IB Act ion | |
526 | ||
527 | ||
528 | 236Patient IB Action Inquiry | |
529 | ||
530 | ||
531 | 236Repost IB Action to Filer | |
532 | ||
533 | ||
534 | 236Start t he Integra ted Billin g Backgrou nd Filer | |
535 | ||
536 | ||
537 | 237Stop th e Integrat ed Billing Backgroun d Filer | |
538 | ||
539 | ||
540 | 238Verify RX Co-Pay Links | |
541 | ||
542 | ||
543 | 239Forms O utput Util ity | |
544 | ||
545 | ||
546 | 246Purge M enu | |
547 | ||
548 | ||
549 | 246Purge U pdate File | |
550 | ||
551 | ||
552 | 247Archive Billing D ata | |
553 | ||
554 | ||
555 | 249Archive /Purge Log Inquiry | |
556 | ||
557 | ||
558 | 250Delete Entry from Search Te mplate | |
559 | ||
560 | ||
561 | 250Find Bi lling Data to Archiv e | |
562 | ||
563 | ||
564 | 251List Ar chive/Purg e Log Entr ies | |
565 | ||
566 | ||
567 | 252List Se arch Templ ate Entrie s | |
568 | ||
569 | ||
570 | 253Purge B illing Dat a | |
571 | ||
572 | ||
573 | 254Charge Master IRM Menu | |
574 | ||
575 | ||
576 | 254Load Ho st File In to Charge Master | |
577 | ||
578 | ||
579 | 254Rate Sc hedule Adj ustment En ter/Edit | |
580 | ||
581 | ||
582 | 254RC Chan ge Facilit y Type | |
583 | ||
584 | ||
585 | 255Start t he CHAMPUS Rx Billin g Engine | |
586 | ||
587 | ||
588 | 255Stop th e CHAMPUS Rx Billing Engine | |
589 | ||
590 | ||
591 | 255Edit th e CIDC Ins urance Swi tch | |
592 | ||
593 | ||
594 | 256Glossar y | |
595 | ||
596 | ||
597 | 260List Ma nager Appe ndix | |
598 | ||
599 | ||
600 | ||
601 | ||
602 | Introducti on | |
603 | The releas e of Integ rated Bill ing (IB) v ersion 2.0 introduce s fundamen tal change s to the w ay MCCR-re lated task s are done . This sof tware intr oduces thr ee new mod ules: Clai ms Trackin g, Encount er Form Ut ilities, a nd Insuran ce Data Ca pture. | |
604 | There are also signi ficant enh ancements to the two previous modules, P atient Bil ling and T hird Party Billing. IB has mov ed from a package wi th the sin gular purp ose of ide ntifying b illable ep isodes of care and c reating bi lls, to a package re sponsible for the wh ole billin g process through to the passi ng of char ges to Acc ounts Rece ivable (AR ). Functio nality has been adde d to assis t in captu ring patie nt data, t racking po tentially billable e pisodes of care, com pleting ut ilization review (UR ) tasks, a nd capturi ng more co mplete ins urance inf ormation. | |
605 | This versi on of IB h as been ta rgeted for a much wi der audien ce than pr evious ver sions. | |
606 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
607 | The Encoun ter Form U tilities m odule is u sed by MAS ADPACs or clinic su pervisors to create and print clinic-spe cific form s. Physici ans use th e forms an d conseque ntly provi de input i nto their creation. | |
608 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
609 | A separate Claims Tr acking Use r Manual h as been cr eated and Claim Trac king modul e informat ion can be located i n that doc ument. Thi s new User Guide can be utiliz ed by UR n urses with in MCCR an d Quality Management (QM) to t rack episo des of car e, do pre- certificat ions, do c ontinued s tay review s and comp lete other UR tasks. | |
610 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
611 | Insurance verifiers use the In surance Da ta Capture module to collect a nd store p atient and insurance carrier-s pecific da ta. | |
612 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
613 | The billin g clerks s ee substan tial chang es to thei r jobs wit h the enha ncements p rovided in the Patie nt Billing and Third Party Bil ling modul es. | |
614 | Following is an over view of th e major fu nctions of the Integ rated Bill ing softwa re, exclud ing the En counter Fo rm functio nality. Th at informa tion can b e found in the IB Us er Manual, Encounter Form Util ities Modu le. | |
615 | Patient Bi lling | |
616 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
617 | automates billing of pharmacy, inpatient , nursing home care unit (NHCU ), and out patient co payments; inpatient and NHCU p er diem ch arges; and passing c harges to Accounts R eceivable (AR). | |
618 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
619 | automatica lly exempt s patients who are e ligible fo r VA Pensi on, Aid an d Attendan ce, or Hou se Bound b enefits fr om the Med ication Co payment re quirement. | |
620 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
621 | provides f or manual assignment of hardsh ip exempti ons from t he copayme nt require ment and t he ability to track those exem ptions. | |
622 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
623 | integrates with the checkout f unctionali ty release d in the P IMS V. 5.3 package. Patients w ho claim e xposure to Agent Ora nge and en vironmenta l contamin ants, and who are tr eated for conditions not relat ed to this exposure, are bille d automati cally. | |
624 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
625 | allows pat ient charg es to be a dded, edit ed, or del eted if th ere is no automated charge or the automa ted charge is incorr ect. | |
626 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
627 | creates su bsistence charges fo r CHAMPVA patients a nd passes to Account s Receivab le. This f unctionali ty will no t be activ ated until the AR pa ckage rele ases a pat ch that al lows AR to process C HAMPVA rec eivables. | |
628 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
629 | allows Mea ns Test bi lling data to be tra nsmitted b etween fac ilities in conjuncti on with PD X V. 1.5. | |
630 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
631 | automatica lly create s Means Te st charges when a ve rified Mea ns Test is electroni cally rece ived from the Income Verificat ion Match (IVM) Cent er. | |
632 | Third Part y Billing | |
633 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
634 | automates the creati on of thir d party bi lling form s (UB-82, UB-92, HCF A-1500), a llowing fo r the entr y, editing , authoriz ing, print ing, and c anceling o f bills. | |
635 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
636 | provides t he ability to add pr escription refills a nd prosthe tic items to bills. | |
637 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
638 | expands th e UB-92 fu nctionalit y to inclu de ability to add/ed it all unl abeled for m locators (except 4 9), additi onal diagn osis, some occurrenc e spans, a nd value c odes. | |
639 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
640 | provides a check-off sheet (ca n be repla ced by the Encounter Form depe nding on l ocal needs ) that can be printe d in a var iety of si te configu rable form ats to be used in cl inics to i dentify Cu rrent Proc edural Ter minology ( CPT) codes . | |
641 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
642 | allows the transfer of CPT cod es between the billi ng screens and the S CHEDULING VISITS fil e. | |
643 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
644 | provides r eports to identify b illable ep isodes of care, pati ent and in surance in quiries, a nd statist ical data. | |
645 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
646 | provides t he ability to create CHAMPVA b ills. You will not b e able to pass them to Account s Receivab le until t he AR pack age releas es a patch that allo ws AR to p rocess CHA MPVA recei vables. | |
647 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
648 | provides a n employer report, w hich lists uninsured patients who are em ployed. | |
649 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
650 | allows pri nting of a ll authori zed bills in user-sp ecified or der. | |
651 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
652 | provides a n Automate d Biller w hich will automatica lly genera te reimbur sable insu rance bill s for inpa tient stay s, outpati ent visits , and pres cription r efills. Th rough the use of sit e paramete rs, sites can specif y which ty pes of eve nts are bi lled using the Autom ated Bille r. | |
653 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
654 | provides a n expanded HCFA-1500 claim for m to inclu de inpatie nt bills, user-speci fied charg es, and mu ltiple pag es. | |
655 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
656 | provides a n addendum sheet to HCFA-1500 claim form to list t he bill's prescripti on refills and prost hetic item s. | |
657 | Insurance Data Captu re | |
658 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
659 | stores mul tiple addr esses (mai n mailing, outpatien t claims, inpatient claims, pr escription claims, a ppeals, in quiries) f or each in surance ca rrier. | |
660 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
661 | provides i nsurance c ompany-spe cific bill ing parame ters so bi lls can re flect loca l insuranc e company requiremen ts. | |
662 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
663 | provides t he ability to establ ish group plans whic h will be pointed to by each p atient wit h a policy attached to the pla n. This sa ves re-ent ry of the same polic y data for each pati ent. | |
664 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
665 | stores ann ual benefi ts associa ted with g roup plans . | |
666 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
667 | provides t ools to ma intain and /or clean up the INS URANCE COM PANY file. | |
668 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
669 | allows pat ient insur ance infor mation to be updated and verif ied. | |
670 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
671 | stores ben efits used by a pati ent, such as deducti bles and l ifetime ma ximums. | |
672 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
673 | provides a n insuranc e workshee t for use by the ins urance ver ifier. | |
674 | Additional Functiona lity | |
675 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
676 | purges dat a from sel ected IB f iles. | |
677 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
678 | provides t he medical centers f lexibility in implem enting the package f unctionali ty through site para meters. | |
679 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
680 | provides t he ability to enter new billin g rates an d VA pensi on income thresholds . | |
681 | SYMBOL 183 \f "Symbo l" \s 12 \ h | |
682 | produces m anagement reports to provide w orkload, p roductivit y, statist ical, and historical data. | |
683 | Related ma terials in clude the IB User Ma nual, Enco unter Form Utilities Module; I B Technica l Manual; Package Se curity Gui de; Instal lation Gui de; and Re lease Note s. The Tec hnical Man ual assist s the site manager i n maintena nce of the software. The Packa ge Securit y Guide pr ovides inf ormation c oncerning security r equirement s for the package. T he Install ation Guid e provides assistanc e in insta llation of the packa ge while t he Release Notes des cribe modi fications and enhanc ements to the softwa re that ar e new to t his versio n. | |
684 | Orientatio n | |
685 | How to Use This Manu al | |
686 | This manua l is prese nted in an online fo rmat, but it may als o be print ed; howeve r, because its inten t is for o nline view ing, and i t is not a nticipated that is w ill be pri nted in it s entirety , it has n ot been fo rmatted fo r double-s ided print ing. | |
687 | The best w ay to navi gate throu gh this ma nual is by using the Table of Contents ( for Word f ormat) and Bookmarks (for pdf format). I n later ve rsions of Word, you may also u se the Nav igation pa ne. | |
688 | The Table of Content s and Book marks are presented in a forma t similar to the exp orted menu structure . | |
689 | Package Ma nagement | |
690 | Data in th e Integrat ed Billing Action fi le should not be add ed to, edi ted, or de leted. Thi s data is designed t o provide an audit t rail of tr ansactions . If the c harges for a copayme nt are rem oved, a se parate tra nsaction t hat is a c ancellatio n type wil l be creat ed and cau se the dec rease adju stment to be made. I f charges are to be changed, t he origina l (or last ) charges are cancel led and th e new char ges are se t-up as an update ty pe transac tion. Data in this f ile is mai ntained th rough docu mented rou tine calls from the Outpatient Pharmacy and MAS pa ckages to Integrated Billing. Data in ot her Integr ated Billi ng files s hould be m aintained through pa ckage opti ons. | |
691 | Instructio ns to ente r new bill ing rates and VA pen sion incom e threshol ds will be provided by DNS and/or the Albany IS C. | |
692 | The automa ted billin g of Categ ory C vete rans for o utpatient copayments , inpatien t copaymen ts, and pe r diems ha ppens auto matically through li nks to the schedulin g event dr iver, the MAS moveme nt event d river, and the night ly backgro und job. | |
693 | There are numerous p arameters in the IB SITE PARAM ETERS file that affe ct the fun ctional an d technica l operatio ns of the billing so ftware. | |
694 | There are several op tions that contain p arameters that affec t the oper ation of t he IB pack age. The M CCR Site P arameter E nter/Edit option par ameters af fect the o peration o f the Pati ent and Th ird Party Billing mo dules. The Select De fault Devi ce for For ms option affects wh ere forms will print . The Clai ms Trackin g Paramete r Edit opt ion affect s the oper ation of t he Claims Tracking m odule. The Enter/Edi t Automate d Billing Parameters option al lows the s ite to det ermine whe n and whic h bills th e Automate d Biller g enerates. The Enter/ Edit IB Si te Paramet ers option on the Sy stem Manag er's IB Me nu affects many of t he technic al aspects of the IB package. | |
695 | Per VHA Di rective 10 -93-142, m any of the IB routin es, data d ictionarie s, and dat a files ar e not to b e modified . Only the routines for Encoun ter Form u tilities a nd selecte d outputs may be mod ified. | |
696 | An electro nic signat ure code i s required for users of the Ma nually Cha nge Copay Exemption (Hardships ) option u nder the M edication Copayment Income Exe mption Men u and the Purge Upda te File an d Archive Billing Da ta options under the Purge Men u. | |
697 | Package Op eration | |
698 | On-line He lp | |
699 | When the f ormat of a response is specifi c, a Help message is usually p rovided fo r that pro mpt. Help messages p rovide lis ts of acce ptable res ponses or format req uirements which prov ide instru ction on h ow to resp ond. | |
700 | A Help mes sage can b e requeste d by typin g one or t wo questio n marks. T he Help me ssage will appear un der the pr ompt, then the promp t will be repeated. For exampl e: | |
701 | BILLING LOCATION OF CARE: 1 // | |
702 | and you ne ed assista nce answer ing. You enter ?? a nd the Hel p message would appe ar. | |
703 | BILLING LOCATION OF CARE: 1 // ?? | |
704 | This id entifies t he type of facility at which c are was ad ministered . | |
705 | Choos e from: | |
706 | 1 HOSP ITAL (INCL UDES CLINI C) - INPT. OR OPT. | |
707 | 2 SKIL LED NURSIN G (NHCU) | |
708 | 3 CLIN IC (WHEN I NDEPENDENT OR SATELL ITE) | |
709 | BILLING LOCATION OF CARE: 1 // | |
710 | For some p rompts, th e system w ill list t he possibl e answers from which you can c hoose. Any time choi ces appear with numb ers, the s ystem will usually a ccept the number or the name. | |
711 | A Help mes sage may n ot be avai lable for every prom pt. If you enter que stion mark s at a pro mpt that d oes not ha ve a Help message, t he system will repea t the prom pt. | |
712 | Note to Us ers with " QUME" Term inals | |
713 | It is very important that you set up you r Qume ter minal prop erly. Afte r entering your acce ss and ver ify codes, you will see the fo llowing pr ompt. | |
714 | Select TER MINAL TYPE NAME: {ty pe}// | |
715 | Please mak e sure tha t C-QUME i s entered here. This entry wil l become t he default and you c an then en ter <RET> for all su bsequent l og-ins. If any other terminal type confi guration i s set, opt ions using the List Manager ut ilities wi ll not dis play nor f unction pr operly on your termi nal. | |
716 | Billing Cl erk's Menu | |
717 | Third Part y Joint In quiry | |
718 | This optio n provides informati on needed to answer questions from insur ance carri ers regard ing specif ic bills o r episodes of care. This infor mation is presented in List Ma nager Scre ens. Becau se the sam e actions are availa ble on mos t screens, and most screens ca n be acces sed from a ny other s creen; the se “Common Actions” are listed first and are not r epeated un der each s creen desc ription. O nly action s specific to a scre en are inc luded with that scre en descrip tion. | |
719 | Note: When viewing t he TPJI ma in screen, the user must have already se lected a s pecific Cl aim # for which to s ee additio nal inform ation. | |
720 | You may QU IT from an y screen, which will bring you back one level or s creen. EXI T is also available on most sc reens. EXI T returns you to the menu. For more info rmation on the use o f the List Manager u tility, pl ease refer to the ap pendix at the end of this manu al. | |
721 | Claim Info rmation Jun 26, 20 14@09:08:1 4 Page: 1 of 3 | |
722 | %Kxxxxxx xxxxxxx E xxxx DOB: xxxxx Su bsc ID: xx xxxxxxx | |
723 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------ | |
724 | Insuranc e Demograp hics | |
725 | Bill P ayer: CIGN A* | |
726 | Claim Add ress: CIGN A HEALTH C ARE* | |
727 | PO B OX 188017 | |
728 | CHAT TANOOGA, T N 37422 | |
729 | Claim P hone: 800- 244-6224 | |
730 | Subscrib er Demogra phics | |
731 | Group Nu mber: 321X XXX | |
732 | Group Name: INTE RNATIONAL PAPER | |
733 | Subscribe r ID: U419 XXXXXX | |
734 | Empl oyer: xxxx xxxxxxxxx | |
735 | Insured's Name: xxxx xxxxxx | |
736 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------ | |
737 | + |% EEOB | Enter ?? f or more ac tions| | |
738 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------ | |
739 | BC Bill C harges AR Account Pr ofile | |
740 | VI Insura nce Compan y | |
741 | DX Bill D iagnosis CM Comment Hi story | |
742 | VP Policy | |
743 | PR Bill P rocedures IR Insurance Reviews | |
744 | AB Annual Benefits | |
745 | CB Change Bill HS Health Sum mary | |
746 | EL Patien t Eligibil ity | |
747 | ED EDI St atus AL Go to Acti ve List | |
748 | EB Expand Benefits | |
749 | RX ECME I nformation EP ERA/835 | |
750 | ||
751 | ||
752 | EX Exit | |
753 | Common Act ions | |
754 | BC Bill C harges - A ccesses th e Bill Cha rges scree n. | |
755 | DX Bill D iagnoses - Accesses the Bill D iagnoses s creen. | |
756 | PR Bill P rocedures - Accesses the Bill Procedures screen. | |
757 | CB Change Bill - Ac cesses the Change Bi ll screen. | |
758 | ED EDI St atus - Acc esses the EDI Status screen. | |
759 | RX ECME I nformation - Accesse s the EDI Informatio n screen. | |
760 | AR Account Profile - Accesses the Accoun t Profile screen. | |
761 | CM Commen t History - Accesses the Comme nt History screen. | |
762 | IR Insuran ce Reviews - Accesse s the Insu rance Revi ews screen . | |
763 | HS Health Summary - Displays a Health S ummary rep ort. The i nformation displayed on the He alth Summa ry is site specified through t he MCCR Si te Paramet er Display /Edit opti on. | |
764 | AL Go to Active Lis t- Returns you to th e Third Pa rty Active Bills scr een if tha t screen w as accesse d upon ent ering this option; o therwise, this actio n returns you to the menu | |
765 | EP ERA/83 5 - Access es the ERA /835 scree n. | |
766 | VI Insur ance Compa ny - Acces ses Insura nce Compan y Screen | |
767 | VP Policy - Display s the same informati on and act ion option s as when selecting the same a ction opti on from TP JI Main Sc reen and r eturns the user to t he ERA/835 screen. | |
768 | AB - Annua l Benefits - Accesse s the Annu al Benefit s screen. | |
769 | EL Patien t Eligibil ity - Disp lays the s ame inform ation and action opt ions as wh en the sam e action o ption is s elected fr om the TPJ I Main Scr een and re turns the user to th e ERA/835 screen. | |
770 | EB Expand Benefits – Displays detailed i nformation on patien t benefits | |
771 | EX Exit - Exit the TPJI Claim Informati on screen. | |
772 | CI Go to Claim Scre en - Retur ns you to the Claim Informatio n screen f rom any of the commo n actions screens an d is avail able on al l screens that may b e opened f rom the Cl aim Inform ation scre en. | |
773 | Third Part y Active B ills Scree n | |
774 | This is th e first sc reen displ ayed if yo u enter a patient na me at the first prom pt of this option. I t lists al l active t hird party bills for the speci fied patie nt in orde r of date created. A ll bills c reated in the Integr ated Billi ng Third P arty Billi ng module can be fou nd on this screen or the Inact ive Bills screen. | |
775 | Actions | |
776 | IL Inacti ve Bills - Accesses the Inacti ve Bills s creen. | |
777 | PI Patien t Insuranc e - Access es the Pat ient Insur ance scree n. | |
778 | CP Change Patient - Allows yo u to choos e another patient an d re-displ ays the Th ird Party Active Bil ls screen for that p atient. | |
779 | Inactive B ills Scree n | |
780 | This scree n lists in active bil ls for a s pecified p atient. Al l bills cr eated in t he Integra ted Billin g Third Pa rty Billin g module a re found o n this scr een or the Third Par ty Active Bills scre en. Bills are displa yed beginn ing with m ost recent “statemen t from” da te. | |
781 | Actions | |
782 | CD Change Dates - A llows you to change the bills listed by changing t he most re cent “stat ement from ” date to be display ed. | |
783 | Patient In surance Sc reen | |
784 | This scree n displays the list of insuran ce policie s for a pa tient. It is based o n the Pati ent Insura nce Manage ment scree n of the P atient Ins urance Inf o View/Edi t option. It is only available from the Third Part y Active B ills scree n. | |
785 | Claim Info rmation Sc reen | |
786 | This scree n contains bill data and statu s informat ion to pro vide an ov erall stat us of the bill. This is the pr imary clai m screen f or the inq uiry, and many actio ns are pro vided to e xpand on t he details of the cl aim. | |
787 | If a polic y has been updated b ut the bil l has not, those cha nges are n ot reflect ed on this screen. U pdated or current in surance in formation may be vie wed using the three insurance screens. | |
788 | Actions | |
789 | CB Change Bill - Al lows you t o change t he bill be ing displa yed. If yo u entered a patient name at th e first pr ompt of th is option, only bill s for that patient m ay be sele cted. If y ou entered a bill nu mber at th e first pr ompt, any bill may b e selected . | |
790 | Bill Charg es Screen | |
791 | This scree n displays a bill's charge inf ormation a s it would print on the bill. For UB-92 bills, thi s closely correspond s to Form Locators 4 2 - 49; th erefore, a ny prosthe tic items, Rx refill s, or addi tional dia gnoses and procedure s are incl uded. For HCFA 1500 bills, thi s closely correspond s to Block 24. | |
792 | Bill Diagn osis Scree n | |
793 | This scree n displays all diagn oses assig ned to the bill, in the order they are p rinted on the bill. | |
794 | Bill Proce dures Scre en | |
795 | This scree n lists al l procedur es assigne d to a bil l, in the order they are print ed on the bill. | |
796 | AR Account Profile S creen | |
797 | This scree n provides the finan cial histo ry of a cl aim's acco unt. This includes t he current status of the bill in both IB and AR, a s well as the paymen t or trans action his tory of th e bill fro m Accounts Receivabl e. This sc reen is lo osely base d on the P rofile of Accounts R eceivable option. | |
798 | Actions | |
799 | VT Transac tion Profi le – Acces ses the AR Transacti on Profile screen fo r a select ed transac tion. | |
800 | AR Transac tion Profi le Screen | |
801 | This scree n displays detailed account tr ansaction informatio n for indi vidual cla im transac tions. It is loosely based on the Accoun ts Receiva ble Transa ction Prof ile option . | |
802 | AR Comment History S creen | |
803 | This scree n displays AR commen ts for the claim's a ccount. | |
804 | Actions | |
805 | AD Add AR Comment – Allows yo u to add a n AR Trans action Com ment to th e bill bei ng display ed. Commen t transact ions may n ot be adde d to a bil l that has not been authorized in IB. | |
806 | Insurance Reviews/Co ntacts Scr een | |
807 | This scree n displays all insur ance revie ws and con tacts for the episod es of care on a bill . It is ba sed on the Insurance Reviews/C ontacts sc reen of th e Claims T racking In surance Re view Edit option. Th e primary difference between t he two scr eens is th at this sc reen conso lidates al l contacts for each episode be ing billed on a clai m, while t he Claims Tracking s creen disp lays the c ontacts fo r a single episode o f care. | |
808 | Actions | |
809 | VR Review s/Appeals - Displays expanded informatio n on a sel ected insu rance cont act. The s creen acce ssed by th is action will depen d on the t ype of con tact selec ted. If th e contact is an appe al or deni al, the Ex panded App eals/Denia ls screen is opened; otherwise , the Expa nded Insur ance Revie ws screen is opened. | |
810 | Expanded A ppeals/Den ials Scree n | |
811 | This scree n displays expanded informatio n on insur ance appea ls and den ials liste d on the I nsurance R eview/Cont acts scree n. This sc reen is ba sed on the Expanded Appeals/De nials scre en of the Claims Tra cking Appe al/Denial Edit optio n. | |
812 | Expanded I nsurance R eviews Scr een | |
813 | This scree n displays expanded informatio n on insur ance revie ws listed on the Ins urance Rev iews/Conta cts screen . This scr een is bas ed on the Expanded I nsurance R eviews scr een of the Claims Tr acking Ins urance Rev iew Edit o ption. | |
814 | Insurance Company Sc reen | |
815 | This scree n displays extended informatio n on an In surance Co mpany. It is based o n the Insu rance Comp any Editor screen of the Insur ance Compa ny Entry/E dit option . This scr een may be entered f rom the Pa tient Insu rance scre en or from any of th e bill spe cific scre ens. Once a bill is selected, this scree n displays only info rmation re lated to t he insuran ce carrier s assigned to that b ill. | |
816 | Patient Po licy Infor mation Scr een | |
817 | This scree n displays extended informatio n on insur ance polic ies. It is based on the Patien t Policy I nformation screen of the Patie nt Insuran ce Info Vi ew/Edit op tion. This screen ma y be enter ed from ei ther the P atient Ins urance scr een or fro m any of t he bill sp ecific scr eens. Once a bill is selected, this scre en will on ly display informati on related to the in surance po licies ass igned to t he bill. | |
818 | The PT act ion is use d to view Patient Po licy Comme nts histor y. This ac tion does not allow one to add , edit, or delete co mments. N OTE: You w ill NOT be able to v iew the Pa tient Poli cy Comment s history if TPJI wa s entered using a bi ll number at the fir st prompt of the opt ion. | |
819 | Annual Ben efits Scre en | |
820 | This scree n displays extended informatio n on the a nnual bene fits of in surance po licies. It is based on the Ann ual Benefi ts Editor screen of the Patien t Insuranc e Info Vie w/Edit opt ion. This screen may be entere d from the Patient I nsurance s creen or f rom any of the bill specific s creens. On ce a bill has been c hosen, thi s screen d isplays in formation related to the insur ance polic ies assign ed to that bill. | |
821 | Patient El igibility Screen | |
822 | This scree n displays the curre nt informa tion on th e patient' s eligibil ity for ca re and ser vice conne ction stat us. It is loosely ba sed on the Eligibili ty Inquiry for Patie nt Billing option. T his screen is availa ble from t he Third P arty Activ e Bills sc reen and t he bill sp ecific scr eens. | |
823 | If this sc reen is ac cessed fro m one of t he bill sp ecific scr eens, such as the Cl aim Inform ation scre en, the st andard lis t of bill screen act ions will be availab le from th is screen. | |
824 | If this sc reen is ac cessed fro m the Pati ent Insura nce screen , no other screens a re availab le as acti ons from t his screen ; and you must retur n to a pre vious scre en to acce ss other s creens. | |
825 | Sample Scr eens | |
826 | Third Part y Active B ills Feb 28, 20 18@15:19:4 4 Page: 1 of 1 | |
827 | IBPATIENT, ONE I9 999 NSC | |
828 | Bill # From To MT? Type Stat Rate Insur er Orig Am t Curr Amt | |
829 | 1 %K70B1Z L 01/03/ 17 01/03/1 7 NO O/I/ O A REIM IN NALC HI 8451.2 7 7519.05 | |
830 | 2 %K70C59 A 02/13/ 17 02/13/1 7 NO O/I/ O A REIM IN NALC HI 230.7 3 230.73 | |
831 | 3 K70CFN Le 04/04/ 17 04/04/1 7 NO O/ / R A REIM IN CAREM AR 158.6 8 78.52 | |
832 | 4 K70D3H Ke 05/02/ 17 05/02/1 7 NO O/ / R A REIM IN CAREM AR 132.3 1 93.12 | |
833 | 5 K70D9P Ke 05/05/ 17 05/05/1 7 NO O/ / R A REIM IN CAREM AR 158.6 8 78.52 | |
834 | |r Referre d|* MT on Hold |+ Mu lti Carrie rs|% EEOB| | |
835 | CI Claim Informatio n IL Inactive B ills PI Pati ent Insura nce | |
836 | CP Change Patient HS Health Sum mary EL Pati ent Eligib ility | |
837 | Select Act ion: Quit/ / | |
838 | Inactive B ills Feb 28, 20 18@15:40:4 8 Page: 1 of 4 | |
839 | IBPATIENT, ONE I99 99 * * All Inac tive Bills ** (51) | |
840 | Bill # Fro m To Type Stat Rate Insure r Orig Am t Curr Amt | |
841 | 1 K30AIK K 05/ 05/13 05/0 5/13 O/I/O CB REIM IN 0.0 0 0.00 | |
842 | 2 %K309XE F 04/ 02/13 04/0 2/13 O/I/O CC REIM IN +CLAIMS 3932.9 3 0.00 | |
843 | 3 K309BU X 04/ 01/13 04/1 6/13 I/P/I CB REIM IN +MEDICA R 0.0 0 0.00 | |
844 | 4 %K309TV 4 04/ 01/13 05/0 5/13 I/P/I CC REIM IN +CLAIMS 104.2 9 0.00 | |
845 | 5 K30A1G 7 04/ 01/13 05/0 5/13 I/P/I CB REIM IN +MEDICA R 0.0 0 0.00 | |
846 | 6 %K3097R 4 03/ 28/13 04/0 1/13 I/I/I CC REIM IN +CLAIMS 1184.0 0 0.00 | |
847 | 7 %K3099Q A 03/ 28/13 04/0 1/13 I/P/I CC REIM IN +CLAIMS 2.0 5 0.00 | |
848 | 8 %K3099T W 03/ 28/13 04/0 1/13 I/P/I CC REIM IN +CLAIMS 12.0 6 0.00 | |
849 | 9 %K3099T X 03/ 28/13 04/0 1/13 I/P/I CC REIM IN +CLAIMS 25.9 3 0.00 | |
850 | 10 %K3099T Y 03/ 28/13 04/0 1/13 I/P/I CC REIM IN +CLAIMS 1.7 1 0.00 | |
851 | 11 %K3099T Z 03/ 28/13 04/0 1/13 I/P/I CC REIM IN +CLAIMS 5.4 8 0.00 | |
852 | 12 %K3099U 2 03/ 28/13 04/0 1/13 I/P/I CC REIM IN +CLAIMS 19.5 4 0.00 | |
853 | 13 %K3099U 4 03/ 28/13 04/0 1/13 I/P/I CC REIM IN +CLAIMS 16.2 9 0.00 | |
854 | 14 %K3099U 5 03/ 28/13 04/0 1/13 I/P/I CC REIM IN +CLAIMS 19.5 4 0.00 | |
855 | 15 %K3099U 7 03/ 28/13 04/0 1/13 I/P/I CC REIM IN +CLAIMS 20.2 0 0.00 | |
856 | 16 %K309BV 0 03/ 28/13 04/0 1/13 I/P/I CC REIM IN +CLAIMS 1.7 1 0.00 | |
857 | + |r Referre d|* MT on Hold |+ Mu lti Carrie rs|% EEOB| | |
858 | ||
859 | CI Claim Informatio n AL Go to Acti ve List CD Chan ge Dates | |
860 | EX Exit | |
861 | Select Act ion: Next Screen// | |
862 | Claim Info rmation Dec 12, 20 13@08:10:1 0 Page: 1 of 3 | |
863 | K2013PIe P0000 DOB: 0 1/06/33 Subsc ID: XXXXXX000 | |
864 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
865 | Insuranc e Demograp hics | |
866 | Bill P ayer: CARE MARK 6XXXX X | |
867 | Claim Add ress: PO B OX XXXXX | |
868 | PHOE NIX, AZ XX XXX | |
869 | Claim P hone: 111- 111-1111 | |
870 | Subscrib er Demogra phics | |
871 | Group Nu mber: GRP PLN 160550 1 | |
872 | Group Name: GICR X | |
873 | Subscribe r ID: XXXX XX000 | |
874 | Empl oyer: BIG COMPANY | |
875 | Insured's Name: IB, SPOUSE | |
876 | Relation ship: SPOU SE | |
877 | +--------- |% EEOB | Enter ?? f or more ac tions|---- ---------- ---------- ---------- | |
878 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
879 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | |
880 | PR Bill P rocedures IR Insurance Reviews AB Annu al Benefit s | |
881 | CB Change Bill HS Health Sum mary EL Pati ent Eligib ility | |
882 | ED EDI St atus AL Go to Acti ve List EB Expa nd Benefit s | |
883 | RX ECME I nformation EX Exit | |
884 | Select Act ion: Next Screen// NEXT SCR EEN | |
885 | Claim Info rmation Dec 12, 20 13@08:10:2 1 Page: 2 of 3 | |
886 | K2013PIe PATIENT,I B P0000 DOB: 0 1/06/33 Subsc ID: XXXXXX000 | |
887 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
888 | C laim Infor mation | |
889 | Bill Typ e: OUTPATI ENT Charge Type: | |
890 | Time Fram e: ADMIT T HRU DISCHA RGE Service Dates: 01/ 31/12 - 01 /31/12 | |
891 | Rate Typ e: REIMBUR SABLE INS. Orig Claim: 12.85 | |
892 | AR Statu s: COLLECT ED/CLOSED Balanc e Due: 0.00 | |
893 | Sequenc e: PRIMARY | |
894 | Purch Sv c: NO | |
895 | ECME N o: XXXXXX0 00508 | |
896 | ECME Ap N o: XXXXXX0 00XXXXXX00 010 | |
897 | NP I: XXXXXX0 007 | |
898 | HPI D: 7XXXXXX XXX | |
899 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
900 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
901 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | |
902 | PR Bill P rocedures IR Insurance Reviews AB Annu al Benefit s | |
903 | CB Change Bill HS Health Sum mary EL Pati ent Eligib ility | |
904 | ED EDI St atus AL Go to Acti ve List EB Expa nd Benefit s | |
905 | RX ECME I nformation EX Exit | |
906 | Select Act ion: Next Screen// NEXT SCR EEN | |
907 | Claim Info rmation Dec 12, 20 13@08:10:2 4 Page: 3 of 3 | |
908 | K2013SWe PATIENT,I B P0000 DOB: 01/06/33 Subsc ID: XXXXXX000 | |
909 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
910 | En tered: 01/ 31/12 by IB,TESTER | |
911 | Autho rized: 01/ 31/12 by IB,TESTER | |
912 | First Pr inted: 01/ 31/12 by IB,TESTER | |
913 | Related Prescripti on Copay I nformation | |
914 | Rx: 23264 79 Chg: $ 8.00 Sta tus: On Ho ld Bill: | |
915 | ---------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
916 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
917 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | |
918 | PR Bill P rocedures IR Insurance Reviews AB Annu al Benefit s | |
919 | CB Change Bill HS Health Sum mary EL Pati ent Eligib ility | |
920 | ED EDI St atus AL Go to Acti ve List EB Expa nd Benefit s | |
921 | RX ECME I nformation EX Exit | |
922 | Select Act ion: Quit/ / | |
923 | Patient In surance | |
924 | May 31, 19 95 @10:07: 11 | |
925 | Page 1 of 1 | |
926 | ||
927 | Insurance Management for Patie nt: IBpati ent,one 1111 | |
928 | ||
929 | Insurance Co. | |
930 | Type of Po licy | |
931 | Group | |
932 | Holder | |
933 | Effect. | |
934 | Expires | |
935 | ||
936 | 1 HEALTH I NS LTD | |
937 | ||
938 | GN 4892322 2 | |
939 | SELF | |
940 | 01/01/87 | |
941 | 2 ABC | |
942 | MAJOR MEDI CAL | |
943 | AE 7689935 4 | |
944 | SPOUSE | |
945 | 10/1/90 | |
946 | 19/30/95 | |
947 | 3 XYZ INS | |
948 | INDEMNITY | |
949 | T109 | |
950 | OTHER | |
951 | 10/1/94 | |
952 | 01/01/95 | |
953 | 4 BC/BS | |
954 | MAJOR MEDI CAL | |
955 | GN 392043 | |
956 | SELF | |
957 | 01/01/90 | |
958 | 12/31/92 | |
959 | VI | |
960 | Insurance Company | |
961 | VP | |
962 | Policy | |
963 | AB | |
964 | Annual Ben efits | |
965 | AL | |
966 | Go to Acti ve List | |
967 | ||
968 | ||
969 | EX | |
970 | Exit Actio n | |
971 | Select Act ion: Quit/ / | |
972 | Bill Charg es | |
973 | May 31, 19 95 @10:07: 11 | |
974 | ||
975 | Page 1 of 1 | |
976 | ||
977 | N10072 | |
978 | IBpatient, one 1 111 | |
979 | DOB: 5/22/ 50 | |
980 | Subsc ID: 000111111 | |
981 | 11/16/93 - 11/17/93 | |
982 | ADMIT THRU DISCHARGE | |
983 | Orig Amt: 199.00 | |
984 | ||
985 | OUTPATIENT VISIT | |
986 | 500 | |
987 | OUTPATIENT SVS | |
988 | ||
989 | 178.00 | |
990 | ||
991 | 1 | |
992 | 178.00 | |
993 | ||
994 | PRESCRIPTI ON | |
995 | 257 | |
996 | DRGS/NONSC RPT | |
997 | ||
998 | 21.00 | |
999 | ||
1000 | 1 | |
1001 | 21.00 | |
1002 | 001 | |
1003 | TOTAL CHAR GE | |
1004 | ||
1005 | ||
1006 | ||
1007 | ||
1008 | 199.00 | |
1009 | ||
1010 | OP VISIT D ATE(S) BIL LED: | |
1011 | ||
1012 | NOV 16, 19 93 | |
1013 | ||
1014 | PRESCRIPTI ON REFILLS : | |
1015 | ||
1016 | 30948 | |
1017 | NOV 17, 19 93 | |
1018 | ||
1019 | ABBOCATH-T 18G 1.25 IN | |
1020 | ||
1021 | ||
1022 | ||
1023 | ||
1024 | QTY: 20 fo r 10 days supply | |
1025 | Bill Remar k: This is a demonst ration bil l created for Joint Billing In quiry. | |
1026 | Enter ?? f or more ac tions | |
1027 | ||
1028 | DX Bill D iagnosis AR Account Pr ofile VI Insu rance Comp any | |
1029 | PR Bill P rocedures CM Comment Hi story VP Poli cy | |
1030 | CI Go to Claim Scre en IR Insurance Reviews AB Annu al Benefit s | |
1031 | HS Health Sum mary EL Pati ent Eligib ility | |
1032 | AL Go to Acti ve List EX Exit Action | |
1033 | Select Act ion: Quit/ / | |
1034 | Bill Charg es | |
1035 | May 31, 19 95 @10:07: 11 | |
1036 | ||
1037 | Page 1 of 1 | |
1038 | ||
1039 | N10273 | |
1040 | IBpatient, one 1 111 | |
1041 | DOB: 5/22/ 50 | |
1042 | Subsc ID: 000111111 | |
1043 | 03/02/94 - 03/31/94 | |
1044 | INTERIM - FIRST CLAI M | |
1045 | Orig Amt: 11221.00 | |
1046 | 30 DAYS IN PATIENT CA RE | |
1047 | ||
1048 | INTERMEDIA TE CARE | |
1049 | 101 | |
1050 | ALL INCL R &B | |
1051 | ||
1052 | 246.00 | |
1053 | ||
1054 | 30 | |
1055 | 7380.00 | |
1056 | 240 | |
1057 | ALL INCL A NCIL | |
1058 | ||
1059 | 48.00 | |
1060 | ||
1061 | 30 | |
1062 | 1440.00 | |
1063 | 960 | |
1064 | PRO FEE | |
1065 | ||
1066 | 49.00 | |
1067 | ||
1068 | 30 | |
1069 | 1470.00 | |
1070 | 274 | |
1071 | PROSTH/ORT H DEV | |
1072 | 931.00 | |
1073 | ||
1074 | 1 | |
1075 | 931.00 | |
1076 | 001 | |
1077 | TOTAL CHAR GE | |
1078 | ||
1079 | ||
1080 | ||
1081 | ||
1082 | 11221.00 | |
1083 | ||
1084 | PROSTHETIC ITEMS: | |
1085 | ||
1086 | Sep 18, 19 94 WHEELC HAIR | |
1087 | ||
1088 | Sep 21, 19 94 CANE-A LL OTHER | |
1089 | Enter ?? f or more ac tions | |
1090 | ||
1091 | DX Bill D iagnosis AR Account Pr ofile VI Insu rance Comp any | |
1092 | PR Bill P rocedures CM Comment Hi story VP Poli cy | |
1093 | CI Go to Claim Scre en IR Insurance Reviews AB Annu al Benefit s | |
1094 | HS Health Sum mary EL Pati ent Eligib ility | |
1095 | AL Go to Acti ve List EX Exit Action | |
1096 | Select Act ion: Quit/ / | |
1097 | Bill Diagn osis May 17, 19 96 14:07:5 6 Page: 1 of 1 | |
1098 | N10072 I Bpatient,o ne 11 11 DOB: 5/22 /50 S ubsc ID: 0 00111111 | |
1099 | 11/16/93 - 11/17/93 AD MIT THRU D ISCHARGE C LAIM Ori g Amt: 1 99.00 | |
1100 | ||
1101 | 1) | |
1102 | 490. | |
1103 | BRONCHITIS NOS | |
1104 | ||
1105 | 2) | |
1106 | 030.1 | |
1107 | TUBERCULOI D LEPROSY | |
1108 | ||
1109 | 3) | |
1110 | 101. | |
1111 | VINCENT'S ANGINA | |
1112 | ||
1113 | 4) | |
1114 | 330.1 | |
1115 | CEREBRAL L IPIDOSES | |
1116 | ||
1117 | 5) | |
1118 | 461.0 | |
1119 | AC MAXILLA RY SINUSIT IS | |
1120 | ||
1121 | 6) | |
1122 | 310.0 | |
1123 | FRONTAL LO BE SYNDROM E | |
1124 | ||
1125 | 7) | |
1126 | 200.01 | |
1127 | RETICULOSA RCOMA HEAD | |
1128 | Enter ?? f or more ac tions | |
1129 | ||
1130 | ||
1131 | ||
1132 | ||
1133 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
1134 | PR Bill P rocedures CM Comment Hi story VP Poli cy | |
1135 | CI Go to Claim Scre en IR Insurance Reviews AB Annu al Benefit s | |
1136 | HS Health Sum mary EL Pati ent Eligib ility | |
1137 | AL Go to Acti ve List EX Exit Action | |
1138 | Select Act ion: Quit/ / | |
1139 | Bill Proce dures May 17, 19 96 14:12:5 8 Page: 1 of 1 | |
1140 | N10072 I Bpatient,o ne 11 11 DOB: 5/22 /50 S ubsc ID: 0 00111111 | |
1141 | 11/16/93 - 11/17/93 AD MIT THRU D ISCHARGE C LAIM Ori g Amt: 1 99.00 | |
1142 | ||
1143 | 11000 | |
1144 | SURGICAL C LEANSING O F SKIN | |
1145 | 11/16/93 | |
1146 | 11001 | |
1147 | ADDITIONAL CLEANSING OF SKIN | |
1148 | 11/16/93 | |
1149 | 12001 | |
1150 | REPAIR SUP ERFICIAL W OUND(S) | |
1151 | 11/16/93 | |
1152 | Enter ?? f or more ac tions | |
1153 | ||
1154 | ||
1155 | ||
1156 | ||
1157 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
1158 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | |
1159 | CI Go to Claim Scre en IR Insurance Reviews AB Annu al Benefit s | |
1160 | HS Health Sum mary EL Pati ent Eligib ility | |
1161 | AL Go to Acti ve List EX Exit Action | |
1162 | Select Act ion: Quit/ / | |
1163 | AR Account Profile May 31, 19 95 @10:07: 11 Page: 1 of 1 | |
1164 | N10273 I Bpatient,o ne 11 11 DOB: 5/ 22/50 Su bsc ID: 00 0111111 | |
1165 | AR Status: ACTIVE Orig Amt: 11 221.00 Balance Due: 856. 45 | |
1166 | ||
1167 | ||
1168 | 04/01/94 | |
1169 | IB Status: Printed (Last) | |
1170 | 11221.00 | |
1171 | 11221.00 | |
1172 | 1 | |
1173 | 1578 | |
1174 | 05/07/94 | |
1175 | PAYMENT (I N PART) | |
1176 | 7856.21 | |
1177 | 3364.79 | |
1178 | 2 | |
1179 | 1598 | |
1180 | 07/07/94 | |
1181 | PAYMENT (I N PART) | |
1182 | 2508.34 | |
1183 | 856.45 | |
1184 | 3 | |
1185 | 1601 | |
1186 | 07/08/94 | |
1187 | COMMENT | |
1188 | 0.00 | |
1189 | 856.45 | |
1190 | ||
1191 | Total Coll ected: | |
1192 | 10364.55 | |
1193 | ||
1194 | Percent Co llected: | |
1195 | 92.37% | |
1196 | ||
1197 | ||
1198 | ||
1199 | ||
1200 | Enter ?? f or more ac tions | |
1201 | ||
1202 | ||
1203 | ||
1204 | BC Bill C harges VT Transactio n Profile VI Insu rance Comp any | |
1205 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | |
1206 | PR Bill P rocedures IR Insurance Reviews AB Annu al Benefit s | |
1207 | CI Go to Claim Scre en HS Health Sum mary EL Pati ent Eligib ility | |
1208 | AL Go to Acti ve List EX Exit Action | |
1209 | Select Act ion: Quit/ / | |
1210 | AR Transac tion Profi le | |
1211 | May 31, 19 95 @10:07: 11 | |
1212 | ||
1213 | Page 1 of 1 | |
1214 | N10273 | |
1215 | IBpatient, one 1 111 | |
1216 | DOB: 5/22/ 50 | |
1217 | Subsc ID: 000111111 | |
1218 | AR Status: ACTIVE Orig Amt: 11221.00 Balance Due: 856. 45 | |
1219 | ||
1220 | TRANS. NO: | |
1221 | 1578 | |
1222 | TRANS. TYP E: | |
1223 | PAYMENT (I N PART) | |
1224 | ||
1225 | TRANS. DAT E: | |
1226 | 05/07/94 | |
1227 | DATE POSTE D: | |
1228 | 05/10/94 (ARH) | |
1229 | ||
1230 | TRANS. AMO UNT: | |
1231 | 7856.21 | |
1232 | RECEIPT #: | |
1233 | D2982398 | |
1234 | ||
1235 | ||
1236 | BALANCE | |
1237 | COLLECTED | |
1238 | ||
1239 | ||
1240 | ---------- --- | |
1241 | --------- ------ | |
1242 | ||
1243 | PRINCIPLE: | |
1244 | 3364.79 | |
1245 | 7856.21 | |
1246 | ||
1247 | INTEREST: | |
1248 | 0.00 | |
1249 | 0.00 | |
1250 | ||
1251 | ADMINISTRA TIVE: | |
1252 | 0.00 | |
1253 | 0.00 | |
1254 | ||
1255 | MARSHALL F EE: | |
1256 | 0.00 | |
1257 | 0.00 | |
1258 | ||
1259 | COURT COST : | |
1260 | 0.00 | |
1261 | 0.00 | |
1262 | ||
1263 | ||
1264 | -------- | |
1265 | --------- | |
1266 | ||
1267 | TOTAL: | |
1268 | 3364.79 | |
1269 | 7856.21 | |
1270 | ||
1271 | FY: 94 | |
1272 | PR AMT: 33 64.79 | |
1273 | ||
1274 | FY TR AMT: 7856.21 | |
1275 | COMMENTS: Date of D eposit: MA Y 10, 1994 | |
1276 | Enter ?? f or more ac tions | |
1277 | ||
1278 | ||
1279 | CI | |
1280 | Go to Clai m Screen | |
1281 | AL | |
1282 | Go to Acti ve List | |
1283 | EX | |
1284 | Exit Actio n | |
1285 | Select Act ion: Quit/ / | |
1286 | AR Comment History May 17, 19 96 14:21:3 7 Page: 1 of 1 | |
1287 | L10260 I Bpatient,o ne 1111 DOB: 5/ 22/50 S ubsc ID: A H33334 | |
1288 | AR Status: CANCELLED Orig Amt: 1026.02 Balanc e Due: 102 6.02 | |
1289 | 1582 | |
1290 | 04/21/92 | |
1291 | Copy of bi ll sent. | |
1292 | FOLLOW-UP DT: | |
1293 | 05/12/92 | |
1294 | ||
1295 | ||
1296 | Carrier di d not rece ive initia l bill. | |
1297 | 1594 | |
1298 | 05/20/92 | |
1299 | Bill cance led, wrong form type . | |
1300 | FOLLOW-UP DT: | |
1301 | 06/01/92 | |
1302 | ||
1303 | ||
1304 | Carrier re fuses to p rocess thi s type of bill on a UB-92. | |
1305 | ||
1306 | ||
1307 | They are r equiring t he HCFA 15 00 form. | |
1308 | Enter ?? f or more ac tions | |
1309 | ||
1310 | ||
1311 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
1312 | DX Bill D iagnosis AD Add AR Com ment VP Poli cy | |
1313 | PR Bill P rocedures IR Insurance Reviews AB Annu al Benefit s | |
1314 | CI Go to Claim Scre en HS Health Sum mary EL Pati ent Eligib ility | |
1315 | AL Go to Acti ve List EX Exit Action | |
1316 | Select Act ion: Quit/ / | |
1317 | Insurance Reviews/Co ntacts May 31, 19 95 @10:07: 11 Page: 1 of 1 | |
1318 | Insurance Review Ent ries for: N10072 IBpatient ,one 1111 | |
1319 | Date Ins. Co. Type Co ntact Action Auth. No . Days | |
1320 | ||
1321 | OUTPATIENT VISIT of AMBULATORY SURGERY O FFICE on 1 1/16/93 | |
1322 | 1 | |
1323 | 11/30/93 | |
1324 | HEALTH INS LIMITED | |
1325 | 1st Appeal -Clin | |
1326 | APPROVED | |
1327 | AU 39824 | |
1328 | 2 | |
1329 | 11/17/93 | |
1330 | HEALTH INS LIMITED | |
1331 | OPT | |
1332 | DENIAL | |
1333 | ||
1334 | 0 | |
1335 | ||
1336 | PRESCRIPTI ON REFILL of 30948 o n 11/17/93 | |
1337 | 3 | |
1338 | 11/17/93 | |
1339 | HEALTH INS LIMITED | |
1340 | OPT | |
1341 | APPROVED | |
1342 | RN 9384222 | |
1343 | S ervice Con nected: NO Previou s Spec. Bi lls: TORT >>> | |
1344 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
1345 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | |
1346 | PR Bill P rocedures VR Reviews/Ap peals AB Annu al Benefit s | |
1347 | CI Go to Claim Scre en HS Health Sum mary EL Pati ent Eligib ility | |
1348 | AL Go to Acti ve List EX Exit Action | |
1349 | Select Act ion: Quit/ / | |
1350 | Expanded A ppeals/Den ials | |
1351 | May 31, 19 95 @10:07: 11 | |
1352 | Page 1 of 2 | |
1353 | Insurance Appeal/Den ial for: | |
1354 | IBpatient, one 1111 | |
1355 | ROI: NOT R EQUIRED | |
1356 | ||
1357 | Visit Info rmation | |
1358 | Action Inf ormation | |
1359 | ||
1360 | Visit Type : | |
1361 | OUTPATIENT VISIT | |
1362 | Type Conta ct: | |
1363 | INITIAL AP PEAL | |
1364 | ||
1365 | Visit Date : | |
1366 | 03/09/94 9 :00 am | |
1367 | Appeal Typ e: | |
1368 | CLINICAL | |
1369 | ||
1370 | Clinic: | |
1371 | AMBULATORY SURGERY | |
1372 | Case Statu s: | |
1373 | OPEN | |
1374 | ||
1375 | Appt. Stat us: | |
1376 | CHECKED OU T | |
1377 | No Days Pe nding: | |
1378 | ||
1379 | Appt. Type : | |
1380 | REGULAR | |
1381 | Final Outc ome: | |
1382 | ||
1383 | Special Co nd: | |
1384 | ||
1385 | Clinical I nformation | |
1386 | Appeal Add ress Infor mation | |
1387 | ||
1388 | Provider: | |
1389 | ||
1390 | Ins. Co. N ame: | |
1391 | HEALTH INS LIMITED | |
1392 | ||
1393 | Provider: | |
1394 | ||
1395 | Alternate Name: | |
1396 | ||
1397 | Diagnosis: | |
1398 | ||
1399 | Street lin e 1: | |
1400 | HIL - APPE ALS OFFICE | |
1401 | ||
1402 | Diagnosis: | |
1403 | ||
1404 | Street lin e 2: | |
1405 | 1099 THIRD AVE, SUIT E | |
1406 | ||
1407 | Special Co nd: | |
1408 | ||
1409 | Street lin e 3: | |
1410 | ||
1411 | ||
1412 | ||
1413 | City/State /Zip: | |
1414 | TROY, NY 12345 | |
1415 | ||
1416 | Insurance Policy Inf ormation | |
1417 | ||
1418 | Ins. Co. N ame: | |
1419 | HEALTH INS LIMITED | |
1420 | Subscriber Name: | |
1421 | IBpatient, one | |
1422 | ||
1423 | Group Numb er: | |
1424 | GN 4892322 2 | |
1425 | Subscriber ID: | |
1426 | 000111111 | |
1427 | ||
1428 | Whose Insu rance: | |
1429 | VETERAN | |
1430 | Effective Date: | |
1431 | 01/01/87 | |
1432 | ||
1433 | Pre-Cert P hone: | |
1434 | 444-444-44 4 E | |
1435 | Expiration Date: | |
1436 | ||
1437 | User Infor mation | |
1438 | Contact In formation | |
1439 | ||
1440 | Entered By : | |
1441 | EMPLOYEE | |
1442 | Contact Da te: | |
1443 | 04/01/94 | |
1444 | ||
1445 | Entered On : | |
1446 | 11/16/93 3 :30 pm | |
1447 | Person Con tacted: | |
1448 | SPOUSE | |
1449 | ||
1450 | Last Edite d By: | |
1451 | ||
1452 | Contact Me thod: | |
1453 | PHONE | |
1454 | ||
1455 | Last Edite d On: | |
1456 | ||
1457 | Call Ref. Number: | |
1458 | RN 3320944 | |
1459 | ||
1460 | ||
1461 | ||
1462 | Review Dat e: | |
1463 | 06/02/95 | |
1464 | Comments | |
1465 | Policy sh ould cover treatment . | |
1466 | Service C onnected C onditions: | |
1467 | Service C onnected: NO | |
1468 | NO SC DIS ABILITIES LISTED | |
1469 | ||
1470 | Enter ?? f or more ac tions >>> | |
1471 | CI | |
1472 | Go to Clai m Screen | |
1473 | AL | |
1474 | Go to Acti ve List | |
1475 | EX | |
1476 | Exit Actio n | |
1477 | Select Act ion: Quit/ / | |
1478 | Expanded I nsurance R eviews | |
1479 | May 31, 19 95 @10:07: 11 | |
1480 | Page 1 of 2 | |
1481 | Insurance Review Ent ries for: | |
1482 | IBpatient, one 11 11 | |
1483 | ROI: NOT R EQUIRED | |
1484 | ||
1485 | Contact In formation | |
1486 | Action Inf ormation | |
1487 | ||
1488 | Contact Da te: | |
1489 | 11/17/93 | |
1490 | Type Conta ct: | |
1491 | OUTPATIENT TREATMEN | |
1492 | ||
1493 | Person Con tacted: | |
1494 | Steve | |
1495 | Opt Treatm ent: | |
1496 | RX REFILL | |
1497 | ||
1498 | Contact Me thod: | |
1499 | PHONE | |
1500 | Action: | |
1501 | APPROVED | |
1502 | ||
1503 | Call Ref. Number: | |
1504 | RN 9384222 | |
1505 | Auth. Numb er: | |
1506 | RN 9384222 | |
1507 | ||
1508 | Review Dat e: | |
1509 | 06/02/95 | |
1510 | ||
1511 | Insurance Policy Inf ormation | |
1512 | ||
1513 | Ins. Co. N ame: | |
1514 | HEALTH INS LIMITED | |
1515 | Subscriber Name: | |
1516 | IBpatient, one | |
1517 | ||
1518 | Group Numb er: | |
1519 | GN 4892322 2 | |
1520 | Subscriber ID: | |
1521 | 000111111 | |
1522 | ||
1523 | Whose Insu rance: | |
1524 | VETERAN | |
1525 | Effective Date: | |
1526 | 01/01/87 | |
1527 | ||
1528 | Pre-Cert P hone: | |
1529 | 933-3434 | |
1530 | Expiration Date: | |
1531 | ||
1532 | Appeal Add ress Infor mation | |
1533 | User Infor mation | |
1534 | ||
1535 | Ins. Co. N ame: | |
1536 | HEALTH INS LIMITED | |
1537 | Entered By : | |
1538 | EMPLOYEE | |
1539 | ||
1540 | Alternate Name: | |
1541 | ||
1542 | Entered On : | |
1543 | 11/17/93 1 2:54 pm | |
1544 | ||
1545 | Street lin e 1: | |
1546 | HIL - APPE ALS OFFICE | |
1547 | Last Edite d By: | |
1548 | EMPLOYEE | |
1549 | ||
1550 | Street lin e 2: | |
1551 | 1099 THIRD AVE, SUIT E 301 | |
1552 | Last Edite d On: | |
1553 | 11/20/93 1 2:55 pm | |
1554 | ||
1555 | Street lin e 3: | |
1556 | ||
1557 | City/State /Zip: | |
1558 | TROY, NY 1 2345 | |
1559 | Comments | |
1560 | One refil l of presc ription ap proved. | |
1561 | Service C onnected C onditions: | |
1562 | Service C onnected: NO | |
1563 | NO SC DIS ABILITIES LISTED | |
1564 | ||
1565 | Enter ?? f or more ac tions >>> | |
1566 | CI | |
1567 | Go to Clai m Screen | |
1568 | AL | |
1569 | Go to Acti ve List | |
1570 | EX | |
1571 | Exit Actio n | |
1572 | Select Act ion: Quit/ / | |
1573 | Insurance Company M ay 17, 199 6 15:25:42 Page: 1 of 5 | |
1574 | Insurance Company In formation for: HEALT H INS LIMI TED Primary | |
1575 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
1576 | ||
1577 | ||
1578 | ||
1579 | Billing Pa rameters | |
1580 | ||
1581 | Signature Required?: | |
1582 | YES | |
1583 | Attending Phys. ID: | |
1584 | AT PH ID V AH500000 | |
1585 | ||
1586 | Reimburse? : | |
1587 | WILL REIMB URSE | |
1588 | Hosp. Prov ider No.: | |
1589 | ||
1590 | Mult. Beds ections: | |
1591 | YES | |
1592 | Primary Fo rm Type: | |
1593 | ||
1594 | Diff. Rev. Codes: | |
1595 | ||
1596 | Billing Ph one: | |
1597 | ||
1598 | One Opt. V isit: | |
1599 | NO | |
1600 | Verificati on Phone: | |
1601 | ||
1602 | Amb. Sur. Rev. Code: | |
1603 | ||
1604 | Precert Co mp. Name: | |
1605 | ABC INSURA NCE | |
1606 | ||
1607 | Rx Refill Rev. Code: | |
1608 | ||
1609 | Precert Ph one: | |
1610 | 444-444-44 44 | |
1611 | ||
1612 | Filing Tim e Frame: | |
1613 | ||
1614 | Main Maili ng Address | |
1615 | ||
1616 | Street: | |
1617 | 2345 CENTR AL AVENUE | |
1618 | City/State : | |
1619 | ALBANY, NY 12345 | |
1620 | ||
1621 | Street 2: | |
1622 | FREAR BUIL DING | |
1623 | Phone: | |
1624 | 555-1234 | |
1625 | ||
1626 | Street 3: | |
1627 | ||
1628 | Fax: | |
1629 | 555-4884 | |
1630 | ||
1631 | Inpatient Claims Off ice Inform ation | |
1632 | ||
1633 | Street: | |
1634 | 2345 CENTR AL AVENUE | |
1635 | City/State : | |
1636 | ALBANY, NY 12345 | |
1637 | ||
1638 | Street 2: | |
1639 | FREAR BUIL DING | |
1640 | Phone: | |
1641 | 555-0392 | |
1642 | ||
1643 | Street 3: | |
1644 | ||
1645 | Fax: | |
1646 | 555-4432 | |
1647 | ||
1648 | Outpatient Claims Of fice Infor mation | |
1649 | ||
1650 | Street: | |
1651 | 789 3RD ST REET | |
1652 | City/State : | |
1653 | ALBANY, NY 12345 | |
1654 | ||
1655 | Street 2: | |
1656 | ||
1657 | Phone: | |
1658 | 333-444-56 76 | |
1659 | ||
1660 | Street 3: | |
1661 | ||
1662 | Fax: | |
1663 | 333-444-92 45 | |
1664 | ||
1665 | Prescripti on Claims Office Inf ormation | |
1666 | ||
1667 | Company Na me: | |
1668 | GHI PROCES SING | |
1669 | Street 3: | |
1670 | ||
1671 | Street: | |
1672 | 1933 CORPO RATE DRIVE | |
1673 | City/State : | |
1674 | RIVERSIDE, NY 39332 | |
1675 | ||
1676 | Street 2: | |
1677 | TANGLEWOOD PARK | |
1678 | Phone: | |
1679 | 339-0000 | |
1680 | ||
1681 | Fax: | |
1682 | ||
1683 | Appeals Of fice Infor mation | |
1684 | ||
1685 | Street: | |
1686 | HIL - APPE ALS OFFICE | |
1687 | City/State : | |
1688 | TROY, NY 1 2345 | |
1689 | ||
1690 | Street 2: | |
1691 | 1099 THIRD AVE, SUIT E 301 | |
1692 | Phone: | |
1693 | 555-1923 | |
1694 | ||
1695 | Street 3: | |
1696 | ||
1697 | Fax: | |
1698 | 555-5464 | |
1699 | ||
1700 | Inquiry Of fice Infor mation | |
1701 | ||
1702 | Street: | |
1703 | 2345 CENTR AL AVENUE | |
1704 | City/State : | |
1705 | ALBANY, NY 12345 | |
1706 | ||
1707 | Street 2: | |
1708 | FREAR BUIL DING | |
1709 | Phone: | |
1710 | 555-1923 | |
1711 | ||
1712 | Street 3: | |
1713 | ||
1714 | Fax: | |
1715 | 555-5336 | |
1716 | Remarks | |
1717 | Synonyms | |
1718 | Enter ?? f or more ac tions >>> | |
1719 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
1720 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | |
1721 | PR Bill P rocedures IR Insurance Reviews AB Annu al Benefit s | |
1722 | CI Go to Claim Scre en HS Health Sum mary EL Pati ent Eligib ility | |
1723 | AL Go to Acti ve List EX Exit Action | |
1724 | Select Act ion: Quit/ / | |
1725 | Patient Po licy Infor mation Dec 12, 20 13@08:13:2 1 Page: 1 of 5 | |
1726 | For: IB,PA TIENT XXX -XX-XXXX XX/XX/XXXX DoD: X X/XX/XXXX | |
1727 | IB INSURAN CE ** Plan Currently Active ** | |
1728 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
1729 | Insuranc e Company | |
1730 | Compan y: IB INSU RANCE | |
1731 | Stree t: SOME ST | |
1732 | Street 2: | |
1733 | City/Stat e: SOME C ITY, MD XX XXX | |
1734 | Billing P h: (XXX)XX X-XXXX | |
1735 | Precert P h: (XXX)XX X-XXXX | |
1736 | Plan Inf ormation | |
1737 | Is Gro up Plan: Y ES | |
1738 | Gro up Name: G ROUP NAME | |
1739 | Group Number: X XXXXXXXXX | |
1740 | BIN: | |
1741 | PCN: | |
1742 | Type of Plan: | |
1743 | Plan Fi ling TF: | |
1744 | eP harmacy Pl an ID: | |
1745 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
1746 | AL Active List PT Pt P olicy Comm ents EX Exit | |
1747 | Select Act ion: Next Screen// NEXT SCR EEN | |
1748 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 0 Page: 2 of 5 | |
1749 | For: IB,PA TIENT XXX -XX-XXXX XX/XX/XXXX DoD: X X/XX/XXXX | |
1750 | IB INSURAN CE ** Plan Currently Active ** | |
1751 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
1752 | ePhar macy Plan Name: | |
1753 | ePharma cy Natl St atus: | |
1754 | ePharmac y Local St atus: | |
1755 | Utilizat ion Review Info Effective Dates & S ource | |
1756 | Require UR : NO Effec tive Date: 01/01/13 | |
1757 | Requir e Amb Cert : NO Expira tion Date: | |
1758 | Requir e Pre-Cert : NO Sourc e of Info: INTERVIEW | |
1759 | Exclud e Pre-Cond : NO Stop Policy Fro m Billing: NO | |
1760 | Benefits A ssignable: YES | |
1761 | Subscrib er Informa tion | |
1762 | Whose I nsurance: VETERAN | |
1763 | Subscri ber Name: IB,PATIENT | |
1764 | Rela tionship: SELF | |
1765 | Pr imary ID: XXXXXX | |
1766 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
1767 | AL Go To Active Lis t PT Pt Policy Comments EX Exit | |
1768 | Select Act ion: Next Screen// NEXT SCR EEN | |
1769 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 1 Page: 3 of 5 | |
1770 | For: IB,PA TIENT XXX -XX-XXXX XX/XX/XXXX DoD: X X/XX/XXXX | |
1771 | IB INSURAN CE ** Plan Currently Active ** | |
1772 | Coord. Benefits: PRIMARY | |
1773 | Subscrib er's Emplo yer Inform ation | |
1774 | Employme nt Status: E mp Sponsor ed Plan: N o | |
1775 | Employer: C laims to E mployer: N o, Send to Insurance | |
1776 | Street: Retireme nt Date: | |
1777 | C ity/State: | |
1778 | Phone: | |
1779 | Primary P rovider: | |
1780 | Prim Pro v Phone: | |
1781 | Subscrib er's Infor mation (us e Subscrib er Update Action) | |
1782 | Insure d's DOB: X X/XX/XXXX | |
1783 | Str 1: S OME ST | |
1784 | Str 2: | |
1785 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
1786 | AL Active List PT Pt Policy Comments EX Exit | |
1787 | Select Act ion: Next Screen// NEXT SCR EEN | |
1788 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 2 Page: 4 of 5 | |
1789 | For: IB,PA TIENT XXX -XX-XXXX XX/XX/XXXX DoD: X X/XX/XXXX | |
1790 | IB INSURAN CE ** Plan Currently Active ** | |
1791 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
1792 | City: S OME CITY | |
1793 | St/Zip: M A XXXXX | |
1794 | SubDiv: | |
1795 | Country: | |
1796 | Phone: X XX-XXX-XXX X | |
1797 | Insure d's Sex: M ALE | |
1798 | Insured's Branch: A RMY | |
1799 | Insured 's Rank: | |
1800 | Insuranc e Company ID Numbers (use Subs criber Upd ate Action ) | |
1801 | Subscri ber ID: XX XXXX | |
1802 | Plan Cov erage Limi tations | |
1803 | Coverag e Effecti ve Date Covered? Limit Comments | |
1804 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
1805 | AL Active List PT Pt Policy Comments EX Exit | |
1806 | Select Act ion: Next Screen// NEXT SCR EEN | |
1807 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 9 Page: 5 of 5 | |
1808 | For: IB,PA TIENT XXX -XX-XXXX XX/XX/XXXX DoD: X X/XX/XXXX | |
1809 | IB INSURAN CE ** Plan Currently Active ** | |
1810 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
1811 | Comment –- Group P lan | |
1812 | None | |
1813 | Comment – Patient Policy | |
1814 | Dt Enter ed Entere d By Method Person Co ntacted | |
1815 | +03/17/16 IB,CLE RK | |
1816 | Patient Policy Com ment | |
1817 | 03/14/16 POSTMA STER | |
1818 | TEST COM ENT | |
1819 | Personal Riders | |
1820 | Rider #1: DENTAL COVERAGE | |
1821 | ---------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
1822 | AL Active List PT Pt Policy Comments EX Exi t | |
1823 | Select Act ion: Next Screen// NEXT SCR EEN | |
1824 | Annual Ben efits May 17, 19 96 15:39:2 3 P age: 1 o f 3 | |
1825 | ||
1826 | ||
1827 | Annual Ben efits for: GHI Ins. Co Primary | |
1828 | Policy: GN 489232 22 Ben Yr: MAR 0 1, 1993 | |
1829 | ||
1830 | ||
1831 | ||
1832 | Policy Inf ormation | |
1833 | ||
1834 | Max. Out o f Pocket: | |
1835 | $ | |
1836 | 500 | |
1837 | ||
1838 | Ambulance Coverage ( %): | |
1839 | 85 | |
1840 | % | |
1841 | ||
1842 | Inpatient | |
1843 | ||
1844 | Annual Ded uctible: | |
1845 | $ | |
1846 | 500 | |
1847 | Drug/Alcoh ol Lifet. Max: | |
1848 | $ | |
1849 | ||
1850 | Per Admis. Deductibl e: | |
1851 | $ | |
1852 | 100 | |
1853 | Drug/Alcoh ol Annual Max: | |
1854 | $ | |
1855 | ||
1856 | Inpt. Life time Max: | |
1857 | $ | |
1858 | ||
1859 | Nursing Ho me (%): | |
1860 | ||
1861 | Inpt. Annu al Max: | |
1862 | $ | |
1863 | ||
1864 | Other Inpt . Charges (%): | |
1865 | ||
1866 | Room & Boa rd (%): | |
1867 | ||
1868 | Outpatient | |
1869 | ||
1870 | Annual Ded uctible: | |
1871 | $ | |
1872 | 50 | |
1873 | Surgery (% ): | |
1874 | ||
1875 | Per Visit Deductible : | |
1876 | $ | |
1877 | 50 | |
1878 | Emergency (%): | |
1879 | ||
1880 | 85% | |
1881 | ||
1882 | Lifetime M ax: | |
1883 | $ | |
1884 | ||
1885 | Prescripti on (%): | |
1886 | ||
1887 | 80% | |
1888 | ||
1889 | Annual Max : | |
1890 | $ | |
1891 | ||
1892 | Adult Day Health Car e?: | |
1893 | UNK | |
1894 | ||
1895 | Visit (%): | |
1896 | ||
1897 | ||
1898 | Dental Cov . Type: | |
1899 | PERCENTAGE AMOU | |
1900 | ||
1901 | Max Visits Per Year: | |
1902 | ||
1903 | ||
1904 | Dental Cov . (%): | |
1905 | 48% | |
1906 | ||
1907 | Mental Hea lth Inpati ent | |
1908 | Mental Hea lth Outpat ient | |
1909 | ||
1910 | MH Inpt. M ax Days/Ye ar: | |
1911 | ||
1912 | ||
1913 | MH Opt. Ma x Days/Yea r: | |
1914 | ||
1915 | MH Lifetim e Inpt. Ma x: | |
1916 | $ | |
1917 | ||
1918 | MH Lifetim e Opt. Max : | |
1919 | $ | |
1920 | ||
1921 | MH Annual Inpt. Max: | |
1922 | $ | |
1923 | ||
1924 | MH Annual Opt. Max: | |
1925 | $ | |
1926 | ||
1927 | Mental Hea lth Inpt. (%): | |
1928 | ||
1929 | ||
1930 | Mental Hea lth Opt. ( %): | |
1931 | ||
1932 | Home Healt h Care | |
1933 | Hospice | |
1934 | ||
1935 | Care Level : | |
1936 | ||
1937 | ||
1938 | Annual Ded uctible: | |
1939 | $ | |
1940 | ||
1941 | Visits Per Year: | |
1942 | ||
1943 | ||
1944 | Inpatient Annual Max .: | |
1945 | $ | |
1946 | ||
1947 | Max. Days Per Year: | |
1948 | ||
1949 | ||
1950 | Lifetime M ax.: | |
1951 | $ | |
1952 | ||
1953 | Med. Equip ment (%): | |
1954 | ||
1955 | ||
1956 | Room and B oard (%): | |
1957 | ||
1958 | Visit Defi nition: | |
1959 | ||
1960 | ||
1961 | Other Inpt . Charges (%): | |
1962 | ||
1963 | Rehabilita tion | |
1964 | IV Managem ent | |
1965 | ||
1966 | OT Visits/ Yr: | |
1967 | ||
1968 | ||
1969 | IV Infusio n Opt?: | |
1970 | UNK | |
1971 | ||
1972 | PT Visits/ Yr: | |
1973 | ||
1974 | ||
1975 | IV Infusio n Inpt?: | |
1976 | UNK | |
1977 | ||
1978 | ST Visits/ Yr: | |
1979 | ||
1980 | ||
1981 | IV Antibio tics Opt?: | |
1982 | UNK | |
1983 | ||
1984 | Med Cnslg. Visits/Yr : | |
1985 | ||
1986 | ||
1987 | IV Antibio tics Inpt? : | |
1988 | UNK | |
1989 | ||
1990 | User Infor mation | |
1991 | ||
1992 | Entered By : | |
1993 | EMPLOYEE | |
1994 | ||
1995 | Entered On : | |
1996 | 02/02/94 | |
1997 | ||
1998 | Last Updat ed By: | |
1999 | EMPLOYEE | |
2000 | ||
2001 | Last Updat ed On: | |
2002 | 02/18/94 | |
2003 | Enter ?? f or more ac tions >>> | |
2004 | ||
2005 | ||
2006 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
2007 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | |
2008 | PR Bill P rocedures IR Insurance Reviews AB Annu al Benefit s | |
2009 | CI Go to Claim Scre en HS Health Sum mary EL Pati ent Eligib ility | |
2010 | AL Go to Acti ve List EX Exit Action | |
2011 | Select Act ion: Quit/ /Patient E ligibility May 20, 1 996 07:45: 44 Page: 1 of 1 | |
2012 | N10273 I Bpatient,o ne 11 11 DOB: 07/0 7/50 Sub sc ID: | |
2013 | Means T est: CATEG ORY A Ins ured: Yes | |
2014 | Date of T est: 08/24 /94 A/O Expo sure: | |
2015 | Co-pay E xemption T est: Rad. Expos ure: | |
2016 | Date of T est: | |
2017 | Prima ry Elig. C ode: NSC | |
2018 | Other Elig. Code (s): EMPLO YEE | |
2019 | AID & ATTENDANC E | |
2020 | Serv ice Connec ted: No | |
2021 | Rated Disabilit ies: BONE DISEASE (0 %-NSC) | |
2022 | DEGEN ERATIVE AR THRITIS (4 0%-NSC) | |
2023 | Enter ?? f or more ac tions | |
2024 | ||
2025 | ||
2026 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
2027 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | |
2028 | PR Bill P rocedures IR Insurance Reviews AB Annu al Benefit s | |
2029 | CI Go to Claim Scre en HS Health Sum mary EX Exit Action | |
2030 | AL Go to Acti ve List | |
2031 | Select Act ion: Quit/ / | |
2032 | Enter/Edit Billing I nformation | |
2033 | The IB EDI T security key is re quired to access thi s option. | |
2034 | The Enter/ Edit Billi ng Informa tion optio n is used to enter t he informa tion requi red to gen erate a th ird party bill and t o edit exi sting bill ing inform ation. A n ew bill ca n be enter ed or an e xisting bi ll can be edited, as long as t he existin g bill has not been authorized or cancel led. Once a bill has been file d (billing record nu mber estab lished), i t cannot b e deleted. The bill can be can celled thr ough the C ancel Bill option. | |
2035 | If the sel ected pati ent's elig ibility ha s not been verified and the AS K HINQ IN MCCR param eter is se t to YES, the user w ill have t he opportu nity to en ter a HINQ (Hospital Inquiry) request in to the HIN Q Suspense File. Thi s request will be tr ansmitted to the Vet erans Bene fits Admin istration to obtain the patien t's eligib ility info rmation. I f Means Te st data su ch as cate gory, Mean s Test las t applied, and date Means Test completed is availa ble, it wi ll be disp layed afte r the pati ent name o r bill num ber has be en entered . | |
2036 | When enter ing a new bill, the system wil l prompt f or EVENT D ATE. When billing fo r multiple outpatien t visits, the date o f the init ial visit is used. F or an inpa tient bill , the date of the ad mission is used. If an interim bill is b eing issue d, the EVE NT DATE sh ould be th e date of admission for that e pisode of care. | |
2037 | The Medica l Care Cos t Recovery data is a rranged so that it c an be view ed and edi ted throug h various screens. T he data is grouped i nto sectio ns for edi ting. Each section i s labeled with a num ber to the left of t he data it ems. Data group numb ers enclos ed by brac kets ([ ]) can be ed ited while those enc losed by a rrows (< > ) cannot. The patien t's name, social sec urity numb er, bill n umber, the bill clas sification (Inpatien t or Outpa tient) and the scree n number a ppear at t he top of every scre en. A <?> entered at the promp t which ap pears at t he bottom of every s creen will provide y ou with a HELP SCREE N for that particula r screen. The HELP S CREEN list s the data groups fo und on tha t screen, and provid es the nam e and numb er of each available screen in the optio n. Please see the Su pplement a t the end of this se ction for descriptio ns and sam ples of th e billing screens. | |
2038 | The bill m ailing add ress appea rs on this screen. P lease see the Supple ment at th e end of t his sectio n for impo rtant info rmation on how this is determi ned. | |
2039 | NOTE: In S eptember 2 015, the I npatient B ill/Claim was update d to accom modate the expanded number of ICD-10 dia gnosis and procedure codes ava ilable in the Patien t Treatmen t File (PT F). Enter/ Edit Billi ng Informa tion displ ays and al lows selec tion of al l diagnose s and proc edures in the PTF re cord withi n the date range of the bill, and the sc reen displ ays the Pr esent On A dmission ( POA) indic ator assoc iated with the diagn osis, if p resent in PTF. The s creen also displays an asteris k “*” befo re each PT F ICD proc edure that matches a procedure and date already as signed to the bill. It is poss ible that the same p rocedure m ay be comp leted mult iple times on the sa me date. T hese dupli cate ICD p rocedures are displa yed in the list of P TF ICD pro cedures as separate line items , and dupl icates are allowed t o be added to the bi ll. | |
2040 | When insur ance compa nies are e ntered int o the INSU RANCE COMP ANY file, the system prompts f or whether or not th is company will reim burse VA f or the cos t of the p atient's c are. Entry of an ins urance com pany that has been d esignated as "will n ot reimbur se" is not allowed a t this scr een. For b ills where the payer is the in surance co mpany and the patien t has one insurance company th at will re imburse th e governme nt, that c ompany wil l be store d as the p rimary ins urance com pany. Inac tivating t he insuran ce company has no ef fect on th e insuranc e carriers associate d with the bill. | |
2041 | Selection of insuran ce compani es is limi ted to the primary, secondary, and terti ary insura nce compan ies that a re billabl e for the event date . A provid er number can be ent ered for e ach of the three pos sible insu rance carr iers. This field wil l be loade d from the Hospital Provider N umber if o ne has bee n entered for the in surance ca rrier. | |
2042 | Insurance company ad dresses ca n only be edited thr ough the I nsurance C ompany Ent ry/Edit op tion. | |
2043 | Any bill w ith a CHAM PVA rate t ype requir es the pri mary insur ance carri er to have a type of coverage defined as CHAMPVA; otherwise, the bill cannot be authorized . | |
2044 | If the MUL TIPLE FORM TYPES sit e paramete r is set t o YES, a f orm type p rompt will appear. T he UB-82 a nd UB-92 a re conside red a sing le form, s o for a si te to have multiple forms they would hav e to use o ne of the UB forms a nd the HCF A-1500. | |
2045 | Changing t he form ty pe to HCFA -1500 will cause the CODING ME THOD field to defaul t to CPT-4 if it has not alrea dy been de fined. Cha nging the primary in surance ca rrier or r esponsible instituti on will ca use the re venue code s to be re built and charges to be recalc ulated. | |
2046 | If the MCC R site par ameter USE OP CPT SC REEN is se t to YES, the Curren t Procedur al Termino logy Code Screen wil l appear w hen editin g procedur e codes. T he screen will list CPT codes for the da tes associ ated with the bill. | |
2047 | An associa ted diagno sis (diagn osis respo nsible for the proce dure being performed ) must be entered fo r each pro cedure for HCFA-1500 s. You can enter fro m 1 to 4 a ssociated diagnoses. The assoc iated diag nosis must match one of the fi rst four d iagnoses e ntered. | |
2048 | Adding a B ASC proced ure or an OP VISIT D ATE will c ause the r evenue cod es to be r ebuilt and charges r ecalculate d for both UB-82/92 and HCFA-1 500 form t ypes. Only one visit date is a llowed on a UB-82/92 that also has BASC procedures . This res triction d oes not ap ply to HCF A-1500s. | |
2049 | A print or der can be specified for each procedure/ diagnosis entered. I f no print order is specified, the proce dures/diag noses will print in the order entered. T he six pro cedures an d nine dia gnoses wit h the lowe st print o rder will be printed in the bo xes on the form and the remain der will p rint as ad ditional p rocedures/ diagnoses. | |
2050 | If the TRA NSFER PROC EDURES TO SCHED? par ameter is set to YES , any ambu latory sur gery enter ed on the bill can b e transfer red to the Schedulin g Visits f ile and st ored under a 900 sto p code. An associate d clinic m ust be ent ered for a ll procedu res that a re to be t ransferred to the Sc heduling V isits file . | |
2051 | Several si te paramet ers and tw o security keys affe ct the pro mpts that will appea r at the e nd of this option. P lease see the Supple ment at th e end of t his sectio n for an e xplanation of how th ese site p arameters and securi ty keys af fect the o ption. | |
2052 | A mail gro up can be specified (through t he site pa rameters) so that ev ery time a bill is d isapproved during th e authoriz ation phas e of the b illing pro cess, all members of this grou p are noti fied via e lectronic mail. If t his group is not spe cified, on ly the bil ling super visor, the initiator of the bi lling reco rd and the user who disapprove d the bill will be a recipient of the me ssage. An example of this mess age can be found in the Supple ment. | |
2053 | The UB-82, UB-92, an d HCFA-150 0 billing forms are the output which can be produc ed from th is option. The data elements a nd design of these f orms has b een determ ined by th e National Uniform B illing Com mittee and has been adapted to meet the specific n eeds of th e Departme nt of Vete rans Affai rs. They m ust be gen erated (pr inted) at 80 charact ers per li ne at 10 p itch. Copi es of the billing fo rms are in cluded in the Print Bill optio n document ation. | |
2054 | The UB-82, UB-92, an d HCFA-150 0 billing forms are the output which may be produc ed from th is option. The data elements a nd design of these f orms has b een determ ined by th e National Uniform B illing Com mittee and has been adapted to meet the specific n eeds of th e Departme nt of Vete rans Affai rs. They m ust be gen erated (pr inted) at 80 charact ers per li ne at 10 p itch. Copi es of the billing fo rms are in cluded in the Print Bill optio n document ation. | |
2055 | Automated Means Test Billing M enu | |
2056 | Cancel/Edi t/Add Pati ent Charge s | |
2057 | The IB AUT HORIZE sec urity key is require d to acces s this opt ion. | |
2058 | The Cancel /Edit/Add Patient Ch arges opti on allows you to man ually canc el, edit, or add per diem and copayment patient ch arges or f ee service s for a sp ecified pa tient and date range . When a c harge is e dited, the original charge is canceled a nd a new c harge is a dded. Once added or edited, th e charges are passed to Accoun ts Receiva ble. You m ay receive Accounts Receivable mail mess ages when editing/ca nceling th rough this option. | |
2059 | You cannot add medic ation copa yment char ges for pa tients det ermined to be exempt from the medication copayment requireme nt. | |
2060 | You can ch oose wheth er or not to include pharmacy copay char ges. Only pharmacy c harges whi ch have be en added t hrough thi s option c an be edit ed or dele ted throug h this opt ion. | |
2061 | You can al so choose to bill CH AMPVA inpa tient subs istence ch arges for past admis sions. (Cu rrent and future adm issions wi ll be bill ed automat ically at discharge) . The CHAM PVA inpati ent subsis tence char ge may be canceled t hrough thi s option, but it wil l be cance led only i n IB. You must go in to the AR module to decrease t he receiva ble to zer o ($0). | |
2062 | Charges ar e displaye d for the specified patient an d date ran ge and sev eral "acti ons" can b e taken ag ainst thes e charges. You can a dd/edit/ca ncel a cha rge, pass a charge t o Accounts Receivabl e, change to another patient o r date ran ge, update an event by changin g the even t status, or change the date u sed to rec ord the la st date fo r which Me ans Test c harges wer e billed f or the adm ission. | |
2063 | List Manag er actions are also available (e.g., Fir st Screen, Last Scre en, Up a L ine, Down a Line, et c.). If yo u need hel p in using the List Manager fu nctionalit y, please refer to t he Appendi x of this user manua l. | |
2064 | Once actio n has been taken on a charge, the screen is redisp layed show ing the ne w data. If you have edited a c harge, the status of the origi nal entry is changed to CANCEL LED, and t wo new ent ries are a dded. The first entr y offsets the origin al charge (the amoun t appears in parenth eses indic ating a cr edit) and the new ch arge is sh own. | |
2065 | Charges ad ded or edi ted throug h this opt ion are ad ded/edited to the IN TEGRATED B ILLING ACT ION file ( #350). Whe n adjustme nts are ma de through this opti on which a ffect the number of inpatient days or in patient am ount, you are prompt ed to choo se whether or not yo u wish to make the a djustment to the Mea ns Test Bi lling Cloc k. | |
2066 | Patient Bi lling Cloc k Maintena nce | |
2067 | The IB AUT HORIZE sec urity key is require d to acces s this opt ion. | |
2068 | This optio n allows a dding or e diting of patient bi lling cloc ks. Most o ften this option wil l be used to add or edit clock s of patie nts transf erred from other fac ilities. T he followi ng fields are editab le: clock begin date , status, 90 day inp atient amo unts, and number of inpatient days. A fr ee text fi eld to inc lude a rea son for th e update i s also pro vided. | |
2069 | The fields contained in this o ption are used to de termine, a nd directl y affect, the copaym ent charge s billed t o the pati ent for ca re receive d. These f ields can also be af fected by other opti ons such a s the Canc el/Edit/Ad d Patient Charges op tion. For further de tails, ple ase see th at option documentat ion. | |
2070 | The clock will autom atically b e closed a fter 365 d ays or on the date t he patient is no lon ger Catego ry C, whic hever is e arlier. Bi lling cloc ks which m ay have be en "left o pen" due t o a lack o f billable activity will be cl osed durin g the nigh tly compil ation job which is r un automat ically. Bi lling cloc ks which m ust be del eted for a ny reason will have a status o f CANCELLE D. | |
2071 | Estimate C ategory C Charges fo r an Admis sion | |
2072 | This optio n is used to estimat e the Mean s Test/Cat egory C ch arges for an episode of hospit al or nurs ing home c are for a proposed l ength of s tay. It ca n also be used to es timate cha rges to be billed to a current inpatient for the r emainder o f his/her stay. | |
2073 | The report will indi cate wheth er or not the patien t has an a ctive bill ing clock, the start date, and the numbe r of inpat ient days of care wi thin that clock. | |
2074 | If a patie nt has an active clo ck and has already b een charge d a copaym ent for th e current 90 days of inpatient care, tha t amount b illed is s hown. Also provided is the amo unt of cop ay and per diem that would be billed for this prop osed episo de of care . Followin g is a des cription o f fields. | |
2075 | Field | |
2076 | Descriptio n | |
2077 | Clock date | |
2078 | Date the c urrent bil ling clock began for this pati ent. | |
2079 | Days of in patient | |
2080 | Number of days of in patient ca re within the curren t billing clock. | |
2081 | care withi n clock | |
2082 | Copayments made for | |
2083 | Total amou nt of copa yment made for the | |
2084 | current 90 days of | |
2085 | current 90 days of i npatient c are for th e | |
2086 | inpatient care | |
2087 | current bi lling cloc k. | |
2088 | COPAYMENT CHARGES | |
2089 | Amount of the copaym ent charge for this | |
2090 | FOR {type of care} | |
2091 | proposed i npatient s tay. The c opayment c harge diff ers depend ing on the type of i npatient c are; howev er, it wil l not exce ed the cur rent Medic aid deduct ible. Once the deduc tible is m et, the pa tient is c overed for a 90 day period. Fo r the seco nd, third and fourth 90 days o f hospital care, the copayment charge is half of t he current Medicaid deductible . For othe r than hos pital care (i.e., NH CU), the f ull deduct ible appli es for eac h 90 days of care. | |
2092 | billing da tes | |
2093 | Date(s) th e copaymen t occurred . If the p roposed ep isode of | |
2094 | {from/to} | |
2095 | care was f or a total of five d ays (2/1/9 2 – 2/5/92 ) but the deductible was met t he first d ay, the bi lling date s (from an d to) woul d reflect the first day only ( 2/1/92). | |
2096 | INPATIENT DAYS | |
2097 | On which d ays of the current 9 0 days of inpatient care | |
2098 | {1st/Last} | |
2099 | this copay ment occur red. If th e patient previously had two d ays of inp atient car e in the c urrent 90 days and t he deducti ble was me t the firs t day of t his propos ed episode of care, the "inpat ient days" would ref lect day t hree as th e days (1s t and last ) this cop ayment was incurred. | |
2100 | CLOCK DAYS | |
2101 | On which d ays of the current b illing clo ck this co payment | |
2102 | {1st/Last} | |
2103 | was incurr ed. If the current b illing clo ck began o n 2/1/92 a nd the cop ayment for this prop osed episo de of care was incur red on 2/1 5 and 2/16 /92, the " clock days " would re flect day 15 for the 1st and d ay 16 for the last. | |
2104 | CHARGE | |
2105 | Amount of the copaym ent or per diem char ge for thi s proposed episode o f care. | |
2106 | PER DIEM C HARGES FOR | |
2107 | A daily ch arge for t he inpatie nt stay. N o charge i s incurred | |
2108 | {type of c are} | |
2109 | for the da y of disch arge (i.e. , if the p roposed in patient st ay is 2/1/ 92 thru 2/ 5/92 and t he per die m rate is $10.00, th e total pe r diem cha rge would be $40.00) . | |
2110 | TOTAL ESTI MATED | |
2111 | Total of t he copayme nt and the per diem charges fo r the | |
2112 | CHARGES | |
2113 | proposed i npatient s tay. | |
2114 | On Hold Me nu | |
2115 | On Hold Ch arges Rele ased to AR | |
2116 | This repor t lists al l charges identified as once b eing ON HO LD (after the instal lation of patch IB*2 *70) that currently have a sta tus of BIL LED, and t he DATE LA ST UPDATED is within the speci fied date range. | |
2117 | Sample Out put | |
2118 | List of ON HOLD Char ges releas ed to AR b etween JA N 09, 1998 and MAR 1 0, 1998 | |
2119 | Date Print ed: MAR 10 ,1998 Page 1 | |
2120 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------- | |
2121 | Name Pt .ID Act.I D Bill # Type From To Charge | |
2122 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------- | |
2123 | IBpatient, one 1111 500 759 K700 069 OPT 08/30/94 08/30/94 36.00 | |
2124 | IBpatient, two 2222 500 1083 K700 079 OPT 02/07/96 02/07/96 41.00 | |
2125 | IBpatient, three 3333 500 852 K700 071 OPT 01/25/95 01/25/95 39.00 | |
2126 | IBpatient, four 4444 500 592 K700 068 OPT 05/02/94 05/02/94 36.00 | |
2127 | IBpatient, five 5555 500 1140 K700 077 OPT 05/14/96 05/14/96 41.00 | |
2128 | 5001244 K700078 INPT 01/ 21/97 01/ 21/97 73 6.00 | |
2129 | IBpatient, six 6666 500 680 K700 063 INPT 07/15/94 07/15/94 696.00 | |
2130 | 500773 K700063 INPT 10/ 13/94 10/ 13/94 34 8.00 | |
2131 | 500793 K700064 NHCU 11/ 09/94 11/ 10/94 34 8.00 | |
2132 | Count/Doll ar Amount of Charges on Hold | |
2133 | This optio n produces the Count and Dolla r Amount o f Charges on Hold Re port. The report pro vides a su btotal and subcount, by action type, of each patie nt charge with an ON HOLD stat us. These charges ha ve not bee n passed t o Accounts Receivabl e. Account ing is res ponsible f or supplyi ng these f igures to FMS on a m onthly bas is. | |
2134 | Days on Ho ld Report | |
2135 | This optio n produces the “Days on Hold R eport”. Th e report l ists all I ntegrated Billing ch arges that have had a status o f ON HOLD for an ext ended peri od of time . | |
2136 | Sample Out put | |
2137 | CHARGE S ON HOLD LONGER THA N 60 DAYS Mar 10, 1 998@11:42: 06 PAGE 1 | |
2138 | HELD CHARG ES CO RRESPONDIN G THIRD PA RTY BILLS | |
2139 | ========== ========== ========== ========== ========== ========== ========== ========== ========== =====||=== ========== ========== ========= | |
2140 | On H old # D ays || AR | |
2141 | Name Pt.ID A ct.ID T ype From To Date On Hold C harge|| Bi ll# Statu s Charge Paid | |
2142 | ========== ========== ========== ========== ========== ========== ========== ========== ========== =====||=== ========== ========== ========= | |
2143 | IBpatient, one 1550 P 5001254 INPT 04/10/97 0 4/10/97 08/11/97 88 368.00| | | |
2144 | 5 001256 I NPT 07/1 4/97 07/15 /97 08/1 1/97 88 7 36.00|| | |
2145 | Held Charg es Report | |
2146 | The Held C harges Rep ort provid es you wit h a list o f all char ges with a status of ON HOLD. Charges fo r Category C patient s with ins urance are placed on hold unti l the pati ent's insu rance comp any bill i s resolved . When pay ment is re ceived fro m the insu rance carr ier, the s tatus of t he charge is updated through t he Release Charges ' On Hold' o ption. | |
2147 | This repor t can be u sed to ins ure that t here is an insurance bill esta blished fo r each cha rge on hol d, and to identify c harges tha t should b e released when paym ents are r eceived fr om insuran ce carrier s. | |
2148 | Sample Out put | |
2149 | CATE GORY C CHA RGES ON HO LD MAR 10, 1998 PAGE 1 | |
2150 | HELD CHARG ES COR RESPONDING THIRD PAR TY BILLS | |
2151 | ========== ========== ========== ========== ========== ========== ========== ========== =====||=== ========== ========== ========== ==== | |
2152 | Name Pt.ID Act.ID Type B ill# Fro m To Charge || Bill# A R-Status Cha rge Paid | |
2153 | ========== ========== ========== ========== ========== ========== ========== ========== =====||=== ========== ========== ========== ==== | |
2154 | ========== ========== ========== ========== ========== ========== ========== ========== =====||=== ========== ========== ========== ==== | |
2155 | IBpatient, one 1 111 5009 42 OPT L10220 03/01/92 03/11/92 30.00 || L10209 NEW BIL L 148.00 0.00 | |
2156 | 500948 INPT L 10233 03/ 11/92 03 /14/92 652.00 || | |
2157 | 500954 OPT L 10229 03/ 11/92 03 /11/92 30.00 || | |
2158 | IBpatient, two 2 222 5002 661 OPT L10305 05/08/92 05/08/92 30.00 || | |
2159 | IBpatient, three 3 333 5001 488 OPT L10259 04/07/92 04/07/92 30.00 || | |
2160 | 5001512 OPT L 10259 04/ 03/92 04 /03/92 30.00 || L10342 N EW BILL 296.00 0.0 | |
2161 | IBpatient, four 4 444 5002 673 INPT L10304 05/19/92 05/19/92 238.00 || | |
2162 | IBpatient, five 5 555 5001 449 INPT L10178 03/01/92 03/01/92 652.00 || L10235 NEW BIL L 5736.00 0.00 | |
2163 | IBpatient, six 6 666 5001 476 INPT L10261 04/13/92 04/16/92 652.00 || | |
2164 | IBpatient, seven 7 777 5001 024 OPT L10121 03/23/92 03/23/92 30.00 || L10329 NEW BIL L 740.00 0.00 | |
2165 | 5001025 OPT L 10121 03/ 23/92 03 /23/92 30.00 || | |
2166 | 5001026 OPT L 10121 03/ 23/92 03 /23/92 30.00 || | |
2167 | 5001029 OPT L 10121 03/ 23/92 03 /23/92 30.00 || | |
2168 | 5001030 OPT L 10121 03/ 23/92 03 /23/92 30.00 || | |
2169 | CATE GORY C CHA RGES ON HO LD MAR 10, 1998 PAGE 1 | |
2170 | HELD CHARG ES COR RESPONDING THIRD PAR TY BILLS | |
2171 | ========== ========== ========== ========== ========== ========== ========== ========== =====||=== ========== ========== ========== ======= | |
2172 | Name Pt.ID A ct.ID T ype Bill # From To Ch arge || Bi ll# AR- Status Charge Paid | |
2173 | ========== ========== ========== ========== ========== ========== ========== ========== =====||=== ========== ========== ========== ======= | |
2174 | ========== ========== ========== ========== ========== ========== ========== ========== =====||=== ========== ========== ========== ======= | |
2175 | IBpatient, one 1111 Insur ance Co. Subscrib er ID Group Eff Dt Exp Dt | |
2176 | ========== ========== ========== ========== ========== ========== ========== ========== =====||=== ========== ========== ========== ======= | |
2177 | BLUE CROSS/BLU E GEE302 MAN32 01 /00/93 | |
2178 | Plan Cover age Effe ctive Date Covered ? Limi t Comments | |
2179 | ---------- --- ---- ---------- ------- - ---- ---------- | |
2180 | INPATIENT BY D EFAULT | |
2181 | OUTPATIENT BY D EFAULT | |
2182 | PHARMACY BY D EFAULT | |
2183 | DENTAL BY D EFAULT | |
2184 | MENTAL HEA LTH BY D EFAULT | |
2185 | LONG TERM CARE BY D EFAULT | |
2186 | PROSTHETIC S BY D EFAULT | |
2187 | ----- ---------- ---------- ---------- ---------- ---------- ---------- ---------- - | |
2188 | 5 001261 O PT 03/02 /98 03/0 2/98 4 5.80 || | |
2189 | History of Held Char ges | |
2190 | This optio n provides a count a nd dollar amount of charges th at have be en on hold for a spe cified dat e range. T his report sorts cha rges by th eir curren t status. You will b e able to keep track of how ma ny charges are cance lled, rele ased (bill ed), or re main on ho ld. This r eport only counts ch arges with an ON HOL D DATE def ined. | |
2191 | Release Ch arges 'On Hold' | |
2192 | The IB AUT HORIZE sec urity key is require d to acces s this opt ion. | |
2193 | The Releas e Charges 'On Hold' option is used to re lease Mean s Test Cat egory C ch arges, wit h a status of ON HOL D, to Acco unts Recei vable. Thi s option i s also ava ilable on the Agent Cashier's Menu in Ac counts Rec eivable. | |
2194 | If the HOL D MT BILL W/INS para meter is s et to YES, inpatient and outpa tient copa yments for Category C patients with insu rance will automatic ally be pl aced on ho ld. These charges wi ll not be passed to Accounts R eceivable until they are relea sed throug h this opt ion. Pleas e note tha t the $5/$ 10 hospita l/NHCU per diem char ges are no t placed o n hold. | |
2195 | If the ori ginal bill number is no longer open when the charg e is passe d to Accou nts Receiv able, a ne w bill num ber is ass igned. | |
2196 | List Charg es Awaitin g New Copa y Rate | |
2197 | The List C harges Awa iting New Copay Rate option is used to g enerate a list of al l Means Te st outpati ent copaym ent charge s which ha ve been pl aced on ho ld because the copay rate is o ver one ye ar old. | |
2198 | New billin g rates ar e schedule d to be re leased fro m VA Centr al Office at the beg inning of each fisca l year (10 /1). Howev er, there may be a d elay in th e release of these n ew rates. If the rat e on file for the Me ans Test o utpatient copayment charge is over one y ear old at the time the bill i s created, these cha rges will be held un til the ne w copay ra te is ente red. When the rate i s entered, you are g iven the o pportunity to releas e the char ges to Acc ounts Rece ivable at that time or they ca n be relea sed throug h the Rele ase Charge s Awaiting New Copay Rate opti on. | |
2199 | Sample Out put | |
2200 | LIST O F ALL OUTP ATIENT COP AYMENT CHA RGES 'ON H OLD' | |
2201 | AW AITING ENT RY OF THE NEW COPAYM ENT RATE | |
2202 | Page: 1 | |
2203 | Run Date: 10/18/93 | |
2204 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
2205 | Patient Na me (ID) Visit Date Charge | |
2206 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
2207 | IBpatient, one ( 1111) 10/08 /93 $33 | |
2208 | IBpatient, two ( 2222) 10/12 /93 $33 | |
2209 | IBpatient, three ( 3333) 10/05 /93 $33 | |
2210 | 10/04 /93 $33 | |
2211 | IBpatient, four ( 4444) 10/01 /93 $33 | |
2212 | IBpatient, five ( 5555) 10/05 /93 $33 | |
2213 | Send Conve rted Charg es to A/R | |
2214 | The IB AUT HORIZE sec urity key is require d to acces s this opt ion. | |
2215 | This optio n is desig ned for us e after th e Integrat ed Billing conversio n is compl eted. Afte r the conv ersion, ce rtain inpa tient and outpatient charges w ill have a status of CONVERTED . This opt ion allows you to ch oose which converted charges a re passed to Account s Receivab le. | |
2216 | During the conversio n, the BIL LS/CLAIMS file (#399 ) is check ed to insu re that ea ch outpati ent visit has been b illed. For each visi t without an establi shed bill, one is es tablished and given a status o f CONVERTE D. The con version ca nnot deter mine wheth er or not an episode of care h as been bi lled for i npatients; therefore , all bill able inpat ient episo des are pr ovided a s tatus of C ONVERTED a nd you mus t determin e which on es should be passed. | |
2217 | You can ch oose to pa ss the cha rges by pa tient or d ate. If pa tient is s elected, a ll billing actions w ith a stat us of CONV ERTED are displayed. You can t hen select which act ions will be passed to account s receivab le. If dat e is selec ted, all o utpatient copay and fee servic e billing actions th at were cr eated on o r before t he selecte d date are passed to accounts receivable . | |
2218 | If the HOL D MT BILL W/INS para meter at y our site i s set to Y ES, inpati ent and ou tpatient c opayments for Catego ry C patie nts with i nsurance w ill automa tically be placed on hold. The se charges will not be passed to Account s Receivab le until t hey are re leased thr ough the R elease Cha rges 'On H old' or Ca ncel/Edit/ Add Patien t Charges options. Y ou may wis h to set t his parame ter to NO until all charges th at should be passed to A/R are passed. | |
2219 | This optio n is being distribut ed as "out of order" as it is no longer needed and will prob ably be de leted in t he next re lease of I ntegrated Billing. | |
2220 | Release Ch arges 'Pen ding Revie w' | |
2221 | The Releas e Charges 'Pending R eview' opt ion is use d to revie w charges which have been crea ted when a n Income V erificatio n Match (I VM) verifi ed Means T est has be en receive d and file d at the m edical fac ility. If such a Mea ns Test re sults in c hanging th e patient' s Means Te st status from Categ ory A to C ategory C, copayment and per d iem charge s for prev ious episo des of car e will aut omatically be create d. The cha rges will not be aut omatically passed to Accounts Receivable but will be held in Billing u ntil a rev iew of the charges i s complete . A mail m essage is sent to th e Category C Billing mail grou p notifyin g users th at the cha rges have been creat ed and are pending r eview. | |
2222 | After revi ew, you ma y pass the charges t o Accounts Receivabl e for bill ing or can cel the ch arges. If passed to AR, the bi lling info rmation wi ll also be passed to the IVM s oftware wh ich will i n turn tra nsmit it t o the IVM Center in Atlanta. | |
2223 | Since the billing cl ock was up dated when the charg e was orig inally bui lt, you ma y need to update the billing c lock if th e charge i s cancelle d. This ca n be accom plished th rough the Patient Bi lling Cloc k Maintena nce option . | |
2224 | List Curre nt/Past He ld Charges by Pt | |
2225 | This optio n lists al l IB Actio ns for a p atient tha t are curr ently on h old or wer e on hold for a spec ified date range. Th e report l ists IB Ac tion ID, R ate Type, Bill #, AR status, I B Status a nd informa tion relat ed to corr esponding Third Part y Claims. Only charg es placed on hold si nce the in stallation of patch IB*2*70 wi ll appear on this re port. | |
2226 | Sample Out put | |
2227 | List of al l HELD bil ls for IBp atient,one SSN: 000-11-11 11 NOV 7,1997 P AGE 1 | |
2228 | PATIENT CH ARGES CORRESPOND ING THIRD PARTY BILL S | |
2229 | ========== ========== ========== ========== ========== ========== ======||== ========== ========== ========== = | |
2230 | Action ID Type Bi ll# Svc D t Dt to AR Charge AR-Sts IB-Sts|| B ill# AR-S tatus Cha rge % Pai d | |
2231 | ========== ========== ========== ========== ========== ========== ======||== ========== ========== ========== = | |
2232 | 5001254 INPT C 08/11 /97 368.00 ON HOL|| | |
2233 | 5001256 INPT C 08/11 /97 736.00 ON HOL|| | |
2234 | 5003424 OPT CO K7 0025 02/20 /97 05/07/ 97 38.80 ACTIVE BILLED|| | |
2235 | 5003423 OPT CO K7 0007 02/18 /97 04/25/ 97 38.80 COLLEC BILLED|| | |
2236 | 5003411 OPT CO K7 0007 02/06 /97 04/25/ 97 38.80 COLLEC BILLED|| K 70073 ACT IVE 194 .00 80 % | |
2237 | 5003409 OPT CO K7 0007 02/05 /97 04/25/ 97 38.80 COLLEC BILLED|| | |
2238 | 5003398 OPT CO 02/04 /97 38.80 CANCEL|| R EASON: INS URANCE CO PD IN FULL | |
2239 | 5003396 OPT CO K7 0006 02/03 /97 05/19/ 97 38.80 COLLEC BILLED|| K 70212 NEW BILL 194 .00 0 % | |
2240 | Release Ch arges Awai ting New C opay Rate | |
2241 | The Releas e Charges Awaiting N ew Copay R ate option is used t o release charges wh ich have b een placed on hold b ecause the outpatien t copay ra te is over one year old. | |
2242 | New billin g rates ar e schedule d to be re leased fro m VA Centr al Office at the beg inning of each fisca l year (10 /1). Howev er, there may be a d elay in th e release of these n ew rates. If the rat e on file for the Me ans Test o utpatient copayment charge is over one y ear old at the time the bill i s created, these cha rges will be held un til the ne w copay ra te is ente red. When the rate i s entered, you are g iven the o pportunity to releas e the char ges to Acc ounts Rece ivable at that time or they ca n be relea sed throug h this opt ion. You w ill be pro mpted to t ask off a job which will autom atically u pdate the dollar amo unt and bi ll all suc h charges. The user will recei ve a messa ge when th e tasked j ob has com pleted. | |
2243 | If the cop ay rate cu rrently in your Bill ing Table is too old to use, t he followi ng message will appe ar. | |
2244 | "The curre nt copay r ate (effec tive {date }) is stil l too old to use. Pl ease be su re that yo u have ent ered the m ost curren t rate in your Billi ng Rates t able." | |
2245 | Patient Bi lling Cloc k Inquiry | |
2246 | This optio n allows y ou to disp lay data c ontained i n the pati ent billin g clock. I t can be u sed to vie w the numb er of inpa tient days and amoun t billed f or inpatie nt copayme nts for Ca tegory C p atients. | |
2247 | When the p atient is selected, all billin g clocks f or that pa tient are displayed. The refer ence numbe r, patient name, and the cycle begin dat e are prov ided. Once a clock i s selected , informat ion such a s the cloc k status, primary el igibility code, cycl e begin an d end date s, number of inpatie nt days, a nd 90 day inpatient amounts ar e displaye d. | |
2248 | Category C Billing A ctivity Li st | |
2249 | The Catego ry C Billi ng Activit y List opt ion is use d to list all Means Test/Categ ory C char ges within a specifi ed date ra nge. The l ist is alp habetical by patient name. | |
2250 | This outpu t provides the patie nt name an d ID, a br ief descri ption, the status an d the bill ing period for the b ill, the u nits (the number of days a cha rge occurr ed), and t he amount of the cha rge. For i npatient c opay charg es, the de scription includes t he treatin g specialt y for the episode of care. | |
2251 | As stated above, the units ref lect the n umber of d ays a char ge occurre d. For inp atient cop ay charges the unit will alway s be one, even if th e patient accrued th e charges over a num ber of day s before t he Medicai d deductib le was met . | |
2252 | Sample Out put | |
2253 | Category C Billing A ctivity Li st FEB 2 6, 1992@09 :14:28 Page: 1 | |
2254 | Charges fr om 01/01/9 2 through 02/26/92 | |
2255 | PATIENT/ID DESC RIPTION STATUS FR OM T O UNITS CHARGE | |
2256 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------ | |
2257 | IBpatient, one 20 86 INPT PER DIEM BILLED 01/0 2/92 01/0 3/92 2 $20.00 | |
2258 | INPT COPAY (AL C) BILLED 01/0 2/92 01/0 3/92 1 $ 476.00 | |
2259 | IBpatient, two 87 45 OPT COPAY PENDIN G A/R 02/1 1/92 02/1 1/92 1 $0.00 | |
2260 | IBpatient, three 8761 INPT PER DIEM BILLED 01/1 3/92 01/1 4/92 2 $20.00 | |
2261 | INPT COPAY (ME D) BILLED 01/1 3/92 01/1 4/92 1 $ 652.00 | |
2262 | IBpatient, four 0 978 OPT COPAY PENDIN G A/R 02/1 2/92 02/1 2/92 1 $0.00 | |
2263 | IBpatient, five 9 065 OPT COPAY BILLED 02/1 7/92 02/1 7/92 1 $30.00 | |
2264 | IBpatient, six 12 43 OPT COPAY BILLED 02/1 3/92 02/1 3/92 1 $30.00 | |
2265 | IBpatient, seven 1122 INPT PER DIEM BILLED 01/1 3/91 01/1 8/92 6 $60.00 | |
2266 | INPT COPAY (ME D) BILLED 01/1 3/92 01/1 8/92 1 $24.00 | |
2267 | IBpatient, eight 9467 OPT COPAY BILLED 02/1 2/92 02/1 2/92 1 $30.00 | |
2268 | Single Pat ient Categ ory C Bill ing Profil e | |
2269 | The Single Patient C ategory C Billing Pr ofile opti on provide s a list o f all Mean s Test/Cat egory C ch arges with in a speci fied date range for a selected patient. | |
2270 | You will b e prompted for patie nt name, d ate range, and devic e. The def ault at th e "Start w ith DATE" prompt is October 1, 1990. Thi s is the e arliest da te for whi ch charges can be di splayed. | |
2271 | This outpu t displays the date the Catego ry C billi ng clock b egan, bill date, bil l type (in cluding th e treating specialty for inpat ient copay charges), the bill number, bi ll to date (for inpa tient char ges), amou nt of each charge, a nd the tot al charges for the s elected da te range. | |
2272 | Sample Out put | |
2273 | Category C Billing P rofile for IBpatient ,one 0 00-11-1111 | |
2274 | From 02/26 /91 throug h 02/26/92 FE B 10, 1994 @13:56 Page: 1 | |
2275 | BILL DATE BILL TYP E BILL # BILL TO TOT CHA RGE | |
2276 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
2277 | 04/28/91 Begin Ca tegory C B illing Clo ck | |
2278 | 04/28/91 OPT CO PAYMENT L10038 $26 .00 | |
2279 | 09/07/91 INPT P ER DIEM L10085 09/08/9 1 $20 .00 | |
2280 | 09/07/91 INPT C O-PAY (NEU ) L10084 09/08/9 1 $628 .00 | |
2281 | 02/10/92 OPT CO PAYMENT L10038 $30 .00 | |
2282 | 02/24/92 OPT CO PAYMENT L10038 $30 .00 | |
2283 | ------- --- | |
2284 | $774 .00 | |
2285 | Dispositio n Special Inpatient Billing Ca ses | |
2286 | The Dispos ition Spec ial Inpati ent Billin g Cases op tion is us ed to ente r the reas on for not billing i npatient b illing cas es for vet erans whos e care is related to their exp osure to A gent Orang e, ionizin g radiatio n, or envi ronmental contaminan ts. This o ption can also be us ed to edit the reaso n on cases that have already b een dispos itioned. | |
2287 | Inpatient bills crea ted for ve terans who claim exp osure to A gent Orang e, ionizin g radiatio n, or envi ronmental contaminan ts are aut omatically placed on hold. Onc e the vete ran's trea tment has been compl eted and s /he is dis charged, a determina tion needs to be mad e if in fa ct the car e rendered was relat ed to the claimed ex posure. If the case was not re lated, cha rges will have to be entered t hrough the Cancel/Ed it/Add Pat ient Charg es option and passed to Accoun ts Receiva ble for bi lling. If the care w as related , the pati ent will n ot be bill ed and the case will be dispos itioned af ter the re ason for n ot billing is entere d through this optio n. | |
2288 | You will b e prompted for the p atient nam e. The fol lowing inf ormation w ill be dis played for the case record: pa tient name , type, ad mission da te, discha rge date, care relat ed to expo sure (yes/ no), case dispositio ned (yes/n o), date r ecord last edited, a nd edited by. You wi ll then be prompted for the re ason the c ase was no t billed. This is a free text field allo wing up to 80 charac ters. | |
2289 | List Speci al Inpatie nt Billing Cases | |
2290 | The List S pecial Inp atient Bil ling Cases option is used to p rovide a l isting of all specia l inpatien t billing cases, bot h disposit ioned and un-disposi tioned. Sp ecial inpa tient bill ing cases are those where the veteran ha s claimed his need f or treatme nt is rela ted to exp osure to A gent Orang e, ionizin g radiatio n, or envi ronmental contaminan ts. | |
2291 | Inpatient care for N SC Categor y C vetera ns who cla im exposur e to Agent Orange, i onizing ra diation, o r environm ental cont aminants i s not auto matically billed. On ce the vet eran's tre atment has been comp leted and s/he is di scharged, a determin ation need s to be ma de if in f act the ca re rendere d was rela ted to the claimed e xposure. I f the care was relat ed, the pa tient shou ld not be billed and the case should be dispositio ned throug h the Disp osition Sp ecial Inpa tient Bill ing Cases option. If the case was not re lated to e xposure, c harges wil l have to be entered manually through th e Cancel/E dit/Add Pa tient Char ges option and passe d to Accou nts Receiv able for b illing. If the case is billed, the syste m automati cally disp ositions t he special case. | |
2292 | The follow ing inform ation may be display ed for eac h case rec ord on the output: p atient nam e, type, a dmission d ate, disch arge date, care rela ted to exp osure (yes /no), case dispositi oned (yes/ no), date record las t edited, and edited by. | |
2293 | Sample Out put | |
2294 | LIST ALL S PECIAL INP ATIENT BIL LING CASES | |
2295 | Page: 1 | |
2296 | Run Date: 10/20/93 | |
2297 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
2298 | Pt. Name: IBpatient ,one ( 1111) C are relate d to EC: N O | |
2299 | Type: ENV CONTA MINANT C ase Dispos itioned: Y ES | |
2300 | Adm Date: 11/17/93 2:23 pm Date Last Edited: 1 1/22/93 10 :04 am | |
2301 | Disc Date: 11/22/93 9:52 am Last Ed ited By: J OHN | |
2302 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
2303 | Charges B illed: | |
2304 | INPT COPAY (MED ) NEW 11/17 /93 11/1 7/93 $67 6 BILLED | |
2305 | INPT PER DIEM N EW 11/17 /93 11/2 1/93 $40 BILLED | |
2306 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
2307 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
2308 | Pt. Name: IBpatient ,one ( 1111) C are relate d to AO: Y ES | |
2309 | Type: AGENT ORA NGE C ase Dispos itioned: Y ES | |
2310 | Adm Date: 10/03/93 10:10 pm Date Last Edited: 1 0/20/93 7: 46 am | |
2311 | Disc Date: 10/06/93 2:25 pm Last Ed ited By: J ANE | |
2312 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
2313 | Reason fo r Non-Bill ing: | |
2314 | TREATMENT FOR AGENT ORANGE | |
2315 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------- | |
2316 | CHAMPUS Bi lling Menu | |
2317 | Delete Rej ect Entry | |
2318 | This optio n allows y ou to dele te individ ual entrie s from the CHAMPUS P HARMACY RE JECTS (#35 1.52) file . Entries are automa tically de leted from this file when a re jected tra nsmission is re-subm itted and subsequent ly approve d. However , there wi ll be inst ances when rejected transmissi ons will n ot be re-s ubmitted. Therefore, this opti on may be used to pu rge unwant ed reject transactio ns from th e file. | |
2319 | Reject Rep ort | |
2320 | The Reject Report al lows you t o view all of the en tries in t he CHAMPUS PHARMACY REJECTS (# 351.52) fi le and det ermine the reason(s) for the r ejected en tries. Rej ected entr ies for tr ansactions which wil l not be r e-submitte d and cont inue to be displayed on this r eport may be deleted using the Delete Re ject Entry option. | |
2321 | Sample Out put | |
2322 | ========== ========== ========== ========== ========== ========== ========== ======== | |
2323 | Date: 05/3 0/97 IPS Unresolved Reject Re port Page: 1 | |
2324 | ========== ========== ========== ========== ========== ========== ========== ======== | |
2325 | RX# 100136 , filled o n 09/10/96 (IBpatien t,one 0 00111111) rejected b ecause: | |
2326 | Invali d NDC Numb er | |
2327 | Missin g/Invalid Insurance data | |
2328 | NDC no t in local AWP file | |
2329 | Call F ailed | |
2330 | RX# 100114 , filled o n 02/03/94 (IBpatien t,one 0 00111111) rejected b ecause: | |
2331 | Modem is not Res ponding | |
2332 | Bad/In valid baud Rate Sett ing | |
2333 | Call I nterrupted by User | |
2334 | Bad/In valid Data bits Sett ing | |
2335 | Resubmit a Claim | |
2336 | This optio n is used to re-subm it a trans action tha t was orig inally rej ected by t he FI (Fis cal Interm ediary – t he company with whic h a Tricar e patient holds thei r Tricare insurance coverage). The user is allowed to select a prescri ption that has not b een submit ted for bi lling, or was submit ted and th en rejecte d. The pre scription is then pl aced in th e queue to be proces sed by the IB backgr ound filer , and it i s processe d in the s ame manner as prescr iptions th at are que ued by the foregroun d processo r. If the prescripti on was pre viously su bmitted an d rejected , the reje ct entry i n file #35 1.52 will automatica lly be del eted if th e prescrip tion is au thorized f or billing . | |
2337 | Reverse a Claim | |
2338 | This optio n may be u sed to rev erse or ca ncel a cla im for a p rescriptio n that was submitted in error. The user is allowed to select a prescri ption that was previ ously bill ed. The pr escription is then p laced in t he queue t o be proce ssed by th e IB backg round file r. The fil er creates a cancell ation-type transacti on message that is t ransmitted to the RN A package. When the receipt co nfirmation has been received b y VISTA fr om the Fis cal Interm ediary (FI ), through RNA, anot her job is queued wh ich cancel s the pati ent copaym ent charge and the c laim for t he FI. | |
2339 | Transmissi on Report | |
2340 | The Transm ission rep ort allows you to vi ew a list of pharmac y transmis sions for prescripti ons which were fille d during a specified date rang e. | |
2341 | Sample Out put | |
2342 | ========== ========== ========== ========== ========== ========== ========== ======= | |
2343 | Date: 05/3 0/97 IPS Pr escription Status Re port Page: 1 | |
2344 | JAN 1,1 996 throug h MAY 30,1 997 | |
2345 | RX# Fill Date Pat ient Name Patient SSN | |
2346 | NDC AWP Copay Ing C ost Fee P aid Total PD | |
2347 | Auth. # M essage | |
2348 | Reject Fai lure Codes | |
2349 | ========== ========== ========== ========== ========== ========== ========== ======= | |
2350 | 100136 09/10 /96 IBp atient,one 000 111111 | |
2351 | Drug Nam e: PRESAMI NE 50MG TA BS | |
2352 | Statu s: Rejecte d | |
2353 | Invali d NDC Numb er | |
2354 | Missin g/Invalid Insurance data | |
2355 | NDC no t in local AWP file | |
2356 | Call F ailed | |
2357 | IB MT FIX/ DISCH SPEC IAL CASE | |
2358 | This optio n will upd ate record s in the S pecial Inp atient Bil ling Cases File (#35 1.2) with discharge dates, if any exist in the Pat ient Movem ent File ( #405). | |
2359 | Patient Bi lling Repo rts Menu | |
2360 | Catastroph ically Dis abled Copa y Report | |
2361 | The Catast rophically Disabled Copay Repo rt option provides a list of c harges for a specifi ed date ra nge that m ay need to be cancel led due to a patient ’s Catastr ophically Disabled s tatus. The Catastrop hically Di sabled leg islation e ffective d ate is May 5, 2010. You should not enter a date pr ior to tha t date, an y date ent ered befor e that wil l be autom atically c hanged to May 5, 201 0. It shou ld be queu ed to a pr inter off hours as i t can take some time to run wi th at leas t a margin of 132 co lumns. The report is based on the Date o f Decision date stor ed in the Patient (# 2) file. E ven though charges m ay be canc elled, the report ma y continue to show $ 0 charges. If the ch arge in IB is cancel led but th ere are st ill charge s on the A R side on the same b ill number they will continue to appear on the rep ort. This is because there is no way of determinin g which ch arges on a n AR bill are actual ly cancell ed vs. not cancelled . Sites sh ould not e xpect to s ee a clean report; t he report is for inf ormational purposes for review . After re view of a specified timeframe is complet ed it is r ecommended sites use subsequen t timefram es for rev iew. | |
2362 | Sample Out put | |
2363 | Catastroph ically Dis abled Copa yment Char ge Report PAGE: 1 | |
2364 | PATIENT SSN CD DATE DOS RX TYP E BIL L NO STAT US BALAN CE PD PRIN INT AD M TOP FUND RS C | |
2365 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -- | |
2366 | IBPATIENT, ONE 0469 03/ 01/11 03/2 5/11 DG OPT CO K40 2KHM BILL ED 15. 00 0.00 0.00 0. 00 528703 | |
2367 | IBPATIENT, TWO A 7271 03/ 31/11 03/3 1/11 71281 5 PSO NSC R K40 2MEQ BILL ED 64. 00 0.00 0.00 0. 00 528701 | |
2368 | IBPATIENT, THREE 2111 02/ 05/11 05/3 1/11 71281 6 PSO NSC R K40 2MRR BILL ED 64. 00 0.00 0.00 0. 00 528701 | |
2369 | IBPATIENT, FOUR 3675 03/ 21/11 03/3 1/11 DG OPT CO K40 2LX1 BILL ED 185. 00 0.00 0.00 0. 00 528703 | |
2370 | Patient Cu rrently Co nt. Hospit alized sin ce 1986 | |
2371 | This optio n allows y ou to prin t a list ( from the I B CONTINUO US PATIENT file) of current in patients c ontinuousl y hospital ized at th e same lev el of care since 198 6. This re port can b e used to verify tha t all cont inuous pat ients are correctly identified . The marg in width f or this re port is 13 2 columns. | |
2372 | Patients c ontinuousl y hospital ized since 7/1/86 ar e exempt f rom the Me dicare ded uctible co payments, but may st ill be sub ject to pe r diem cha rges. Faci lities are authorize d to charg e inpatien ts a per d iem charge of $10.00 a day for each day of inpatie nt care or $5.00 for each day of NHCU ca re. | |
2373 | Sample Out put | |
2374 | APR 28,199 2 * **Patients Continuou sly Hospit alized Sin ce July 1, 1986*** PAG E 1 | |
2375 | Patient NA ME Pt-Id War d Location Last M eans Mean s Test Eligibili ty | |
2376 | Test D ate Stat us | |
2377 | ========== ========== ========== ========== ========== ========== ========== ========== ========== === | |
2378 | IBpatient, one 000 -11-1111 4D(NHCU) NSC | |
2379 | IBpatient, two 000 -22-2222 4A(NHCU) 04 /02/90 CATEGORY C NSC | |
2380 | IBpatient, three 000 -33-3333 4B(NHCU) 02 /18/92 CATEGORY C NSC | |
2381 | IBpatient, four 4B(NHCU) 02/ 18/92 C ATEGORY C NSC | |
2382 | Print IB A ctions by Date | |
2383 | The Print IB Actions by Date o ption prov ides a lis t of the I ntegrated Billing ac tions for a specifie d date ran ge. Althou gh totals are includ ed, this o utput shou ld not be used for s tatistical reporting . The Stat istical Re port optio n is provi ded for th at purpose . | |
2384 | This outpu t can be s orted by a specified field. <? ?> can be entered fo r a list o f appropri ate fields for selec tion and a dditional commands w hich may b e used to customize your repor t. If you choose to sort by a certain fi eld, you w ill be pro mpted to e nter a ran ge for tha t field. I f you acce pt the def ault of FI RST, the s ystem will assume yo u want to include fi rst to las t. | |
2385 | Sample Out put | |
2386 | INTEGRATED BILLING A CTION LIST APR 19,1991 1 0:34 PA GE 1 | |
2387 | PATIENT REF. NO TYPE STATUS DATE AD DED UNIT S CHARG E BRIEF D ESCRIPTION CHARG E ID | |
2388 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---- | |
2389 | IBpatient, one 5 00283 SC RX COPAY NEW BILL ED APR 5,1991 1 2.00 322 B-RANITIDI NE 15-1 5 00-M10027 | |
2390 | IBpatient, two 5 00285 SC RX COPAY NEW BILL ED APR 5,1991 1 2.00 230 A-AMPICILL IN 50-1 5 00-M10033 | |
2391 | IBpatient, three 5 00286 NS C RX COPAY NEW BILL ED APR 5,1991 1 2.00 193 B-BELLADON NA TI-1 5 00-M10033 | |
2392 | IBpatient, four 5 00287 SC RX COPAY NEW BILL ED APR 5,1991 3 6.00 357 -BENZTROPI NE 1M-3 5 00-M10009 | |
2393 | ----- ---- -- --- ----- --- | |
2394 | SUBTOTAL 6 12.0 0 | |
2395 | SUBCOUNT 4 | |
2396 | IBpatient, one 5 00263 SC RX COPAY NEW CANC ELLED APR 4,1991 1 2.00 352 -AMPICILLI N 25, 1 5 00-M10027 | |
2397 | IBpatient, two 5 00264 SC RX COPAY NEW CANC ELLED APR 4,1991 1 2.00 286 A-CIMETIDI NE 3, 1 5 00-M10027 | |
2398 | IBpatient, three 5 00275 SC RX COPAY NEW CANC ELLED APR 4,1991 3 6.00 167 A-ACETAMIN OPHE, 3 5 00-M10009 | |
2399 | ----- ---- ---- - ------- - | |
2400 | SUBTOTAL 5 10.0 0 | |
2401 | SUBCOUNT 3 | |
2402 | ----- ---- --- -- ------ -- | |
2403 | TOTAL 1 1 22.0 0 | |
2404 | COUNT 7 | |
2405 | Employer R eport | |
2406 | The Employ er Report option is used to pr ovide a li sting of p atients an d spouses' employers for patie nts withou t active i nsurance t hat can be used by b illing cle rks to con firm insur ance cover age with t hose emplo yers. | |
2407 | The report is sorted by employ er name an d is run f or a selec ted date r ange. You can run th e report f or inpatie nt admissi ons or out patient vi sits. One, many, or all divisi ons can be chosen. F or outpati ents, pati ents are i ncluded on the repor t if they have an ev ent within the speci fied date range, do not have a ctive insu rance on t he event d ate, and t he patient or spouse 's employm ent status is one of the follo wing. | |
2408 | EMPLOYED F ULL TIME | |
2409 | EMPLOYED P ART TIME | |
2410 | SELF EMPLO YED | |
2411 | RETIRED | |
2412 | Events inc lude admis sions for inpatients and sched uled/unsch eduled vis its and di spositions that are not Applic ation with out Exam f or outpati ents. | |
2413 | Deceased v eterans do not appea r on the r eport. | |
2414 | The follow ing inform ation may appear on the output : employer name, add ress, phon e number, patient na me, SSN, o ccupation, employmen t status, home and w ork phone numbers, p rimary eli gibility, admission date, tran saction ty pe, appoin tment date , and appo intment ty pe. This r eport requ ires a 132 column ma rgin width . | |
2415 | Sample Out put | |
2416 | EMPLOYER R EPORT FOR INPATIENT ADMISSIONS JUN 1,199 3 - OCT 21 ,1993 OCT 2 1, 1993 1 1:15 PAGE 1 | |
2417 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- - | |
2418 | ACME 4 444 E KIND ER RD, ALB ANY, NEW Y ORK 12443 | |
2419 | Patient : IBpatien t,one 000- 11-1111 NSC JU N 10, 1993 ADMISSI ON Ho me: | |
2420 | Employe d: Spouse: SPOUSE D AY CARE RETIRED | |
2421 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- - | |
2422 | XYZ, INC. 518-555123 4 5678 Sout h St, Troy , New York 12345 | |
2423 | Patient : IBpatien t,three 000-11-1 111 NSC JUN 10 , 1993 A DMISSION Home: 518-555939 3 | |
2424 | Employe d: Patient : IBpatien t,one 000-22-2 222 Her tygertyman F ULL TIME Work: 518-555838 3 | |
2425 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- - | |
2426 | XXX CORPOR ATION 000-11-1 111 1 XXX LA NE, OSSINI NG, NEW YO RK 10045 | |
2427 | Patient : IBpatien t, two 000-33-3 333 SC 1 JUN 02 , 1993 A DMISSION Home: 345-555233 2 | |
2428 | Employe d: Patient : IBpatien t, two 000-44-4 444 Com puter Oper ator F ULL TIME Work: 345-555123 4 | |
2429 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- - | |
2430 | Episode of Care Bill List | |
2431 | The Episod e of Care Bill List option is used to li st all bil ls related to an epi sode of ca re. The bi lls are li sted by ev ent date i n reverse date order . The bill number, r ate type, bill class ification, event dat e, stateme nt from an d to dates , bill sta tus, and t ime frame of bill wi ll be disp layed for each bill on the lis t. | |
2432 | You may en ter the bi ll number, event dat e, or pati ent name a t the bill selection prompt. I f the even t date or patient na me is ente red, all b ills with that event date or f or that pa tient will be listed for selec tion. Only patients with bills on file m ay be ente red. | |
2433 | The output produced by this op tion must be generat ed at a 13 2 column m argin widt h. | |
2434 | Sample Out put | |
2435 | LIST OF AL L BILLS FO R AN EPISO DE OF CARE JUL 5,1990 @08:16 P AGE 1 | |
2436 | FOR PATIEN T: IBpatie nt,one EVENT DA TE: FEB 13 ,1987 | |
2437 | STATEMENT STATEME NT | |
2438 | BILL NO. RATE TYPE CLASSIFICA TION EVEN T DATE F ROM DATE TO DATE STATUS TIMEFRA ME OF BILL | |
2439 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- - | |
2440 | 900071 MEANS TES T/CAT. C INPATIENT 02/ 13/87 02/13/87 03/12/87 PRINTED INTERI M - CONTIN UING | |
2441 | PAYOR: Patient - IBpatient ,one | |
2442 | 000491 REIMBURSA BLE INS. INPATIENT 02/1 3/87 0 3/13/87 04/12/87 PRINTED INTERIM - CONTINU ING | |
2443 | PAYOR: Insurance Co. - ABC INSURANCE | |
2444 | 000543 REIMBURSA BLE INS. INPATIENT 02/1 3/87 0 4/13/87 04/30/87 AUTHORIZE D INTERIM - LAST | |
2445 | PAYOR: Insurance Co. - ABC INSURANCE | |
2446 | Estimate C ategory C Charges fo r an Admis sion | |
2447 | This optio n is used to estimat e the Mean s Test/Cat egory C ch arges for an episode of hospit al or nurs ing home c are for a proposed l ength of s tay. It ma y be used to answer patient in quiries pe rtaining t o estimate d charges to be bill ed for an inpatient stay. | |
2448 | The report will indi cate wheth er or not the patien t has an a ctive bill ing clock, the start date, and the numbe r of inpat ient days of care wi thin that clock. | |
2449 | If a patie nt has an active clo ck and has already b een charge d a copaym ent for th e current 90 days of inpatient care, the amount bi lled is sh own. Also provided i s the amou nt of copa y and per diem that would be b illed for this propo sed episod e of care. A descrip tion of fi elds follo ws. | |
2450 | DATA ELEME NTDESCRIPT IONClock d ateDate th e current billing cl ock began for this p atient.Day s of inpat ient | |
2451 | care withi n clockNum ber of day s of inpat ient or nu rsing home care with in the cur rent billi ng clock.D ATA ELEMEN TDESCRIPTI ONCopaymen ts made fo r | |
2452 | current 90 days of | |
2453 | inpatient careTotal amount of copayments made for the curren t 90 days of inpatie nt care fo r the curr ent billin g clock.CO PAYMENT CH ARGES | |
2454 | FOR {type of care}Am ount of th e copaymen t charge f or this pr oposed inp atient sta y. The cop ayment cha rge differ s dependin g on the t ype of inp atient car e; however , it will not exceed the curre nt Medicar e deductib le. Once t he deducti ble is met , the pati ent is cov ered for 9 0 days of hospital c are. For t he second, third, an d fourth 9 0 days of hospital c are, the c opayment c harge is h alf of the current M edicaid de ductible. For other than hospi tal care ( i.e., NHCU ), the ful l deductib le applies for each 90 days of care.bill ing dates | |
2455 | {from/to}D ate(s) the copayment occurred. If the pr oposed epi sode of ca re was for a total o f five day s (2/1/92 – 2/5/92), but the d eductible was met th e first da y; the bil ling dates (from and to) would reflect t he first d ay only (2 /1/92).INP ATIENT DAY S | |
2456 | {1st/Last} On which d ays of the current 9 0 days of inpatient care this copayment occurred. If the pat ient previ ously had two days o f inpatien t care in the curren t 90 days and the de ductible w as met the first day of this p roposed ep isode of c are, the " inpatient days" woul d reflect day three as the day s (1st and last) thi s copaymen t was incu rred.DATA ELEMENTDES CRIPTIONCL OCK DAYS | |
2457 | {1st/Last} On which d ays of the current b illing | |
2458 | clock this copayment was incur red. If th e current billing cl ock began on 2/1/92 and the co payment fo r this pro posed epis ode of car e was incu rred on 2/ 15/92 and 2/16/92, t he "clock days" woul d reflect day 15 for the 1st a nd day 16 for the la st.CHARGEA mount of t he copayme nt or per diem charg e for this proposed episode of care.PER DIEM CHARG ES FOR | |
2459 | {type of c are}A dail y charge f or the inp atient sta y. | |
2460 | No charge is incurre d for the day of dis charge (i. e., if the proposed inpatient stay is 2/ 1/92 thru 2/5/92 and the per d iem rate i s $10.00, the total per diem c harge woul d be $40.0 0).TOTAL E STIMATED | |
2461 | CHARGESTot al of the copayment and the pe r diem cha rges for t he propose d inpatien t stay.Out patient/Re gistration Events Re port | |
2462 | In Integra ted Billin g V. 1.5, the Outpat ient/Regis tration Ev ents Repor t was used primarily to list p otentially billable outpatient activity (for Categ ory C vete rans) for the purpos e of billi ng charges that were not autom atically b illable by the syste m. As IB V . 2.0 comp letes the automation of Means Test billi ng for all outpatien t activity , this rep ort become s a valida tion tool. | |
2463 | This optio n lists al l episodes of outpat ient care for Catego ry C veter ans within a user sp ecified da te range; appointmen ts, stop c odes, and registrati ons. For e ach visit, the clini c, appoint ment time, type, and status ar e provided . Clinics with a def ault type of "resear ch" are fl agged on t he report to assist sites in d etermining if regula r appointm ents are b eing sched uled in cl inics wher e the prim ary intent is resear ch. For ea ch patient listed, t he report indicates whether th e patient has claime d exposure to Agent Orange, io nizing rad iation, or environme ntal conta minants an d whether the patien t has acti ve insuran ce. If exp osure is c laimed, th e response s to the C lassificat ion questi ons answer ed during the checko ut process are displ ayed. Any charges as sociated w ith the ep isode of c are are in cluded. | |
2464 | A separate page will print for each date within th e date ran ge; theref ore, you m ay wish to limit the date rang e selected . You may also wish to run thi s report d uring off hours, as it may be quite time consuming . | |
2465 | Sample Out put | |
2466 | Category C Outpatien t and Regi stration A ctivity fo r 09/01/93 | |
2467 | Printed: 09/13/93 Page: 1 | |
2468 | Patient/Ev ent Time Clin ic/Stop Appt.T ype (Status ) | |
2469 | IBpatient, one 111 1 [AO] **Insur ed** | |
2470 | CLINI C APPT 12:00 PODI ATRY REGULA R NO ACTI ON TAKEN | |
2471 | IBpatient, two 222 2 [AO] **Insur ed** | |
2472 | CLINI C APPT 09:00 GEN. MEDICAL REGULA R CHECKED OUT | |
2473 | Care related t o AO? YES | |
2474 | STOP CODE 09:00 EKG REGULA R | |
2475 | 09:00 LABO RATORY REGULA R | |
2476 | Category C Outpatien t and Regi stration A ctivity fo r 09/02/93 | |
2477 | Printed: 09/13/93 Page: 2 | |
2478 | Patient/Ev ent Time Clin ic/Stop Appt.T ype (Status ) | |
2479 | No Outpati ent activi ty recorde d for Cate gory C pat ients on 0 9/02/93. | |
2480 | Held Charg es Report | |
2481 | The Held C harges Rep ort provid es you wit h a list o f all char ges with a status of ON HOLD. Charges fo r Category C patient s with ins urance are placed on hold unti l the pati ent's insu rance comp any bill i s resolved . When pay ment is re ceived fro m the insu rance carr ier, the s tatus of t he charge is updated through t he Release Charges ' On Hold' o ption. | |
2482 | This repor t may be u sed to ins ure that t here is an insurance bill esta blished fo r each cha rge on hol d, and to identify c harges tha t should b e released when paym ents are r eceived fr om insuran ce carrier s. | |
2483 | Sample Out put | |
2484 | CATE GORY C CHA RGES ON HO LD MA Y 26,1992 PAGE 1 | |
2485 | HELD CHARG ES CORRESPOND ING THIRD PARTY BILL S | |
2486 | ========== ========== ========== ========== ========== ========== ========== ====||==== ========== ========== ========== ==== | |
2487 | Name Pt .ID Actio nID Type Bill# From To Charge || Bill# A R-Status Charge Paid | |
2488 | ========== ========== ========== ========== ========== ========== ========== ====||==== ========== ========== ========== ==== | |
2489 | IBpatient, one 1 111 5009 42 OPT L10220 03/01/92 03/11/92 30.00 || L10209 NEW BILL 148.00 0.00 | |
2490 | 5009 48 INPT L10233 03/11/92 03/14/92 652.00 || | |
2491 | 5009 54 OPT L10229 03/11/92 03/11/92 30.00 || | |
2492 | IBpatient, two 2 222 5002 661 OPT L10305 05/08/92 05/08/92 30.00 || | |
2493 | IBpatient, three 3 333 5001 488 OPT L10259 04/07/92 04/07/92 30.00 || | |
2494 | 5001 512 OPT L10259 04/03/92 04/03/92 30.00 || L10342 NEW BILL 296.00 0.00 | |
2495 | IBpatient, four 4 444 5002 673 INPT L10304 05/19/92 05/19/92 238.00 || | |
2496 | IBpatient, five 5 555 5001 449 INPT L10178 03/01/92 03/01/92 652.00 || L10235 NEW BILL 5736.00 0.00 | |
2497 | IBpatient, six 6 666 5001 476 INPT L10261 04/13/92 04/16/92 652.00 || | |
2498 | IBpatient, seven 7 777 5001 024 OPT L10121 03/23/92 03/23/92 30.00 || L10329 NEW BILL 740.00 0.00 | |
2499 | 5001 025 OPT L10121 03/23/92 03/23/92 30.00 || | |
2500 | 5001 026 OPT L10121 03/23/92 03/23/92 30.00 || | |
2501 | 5001 029 OPT L10121 03/23/92 03/23/92 30.00 || | |
2502 | 5001 030 OPT L10121 03/23/92 03/23/92 30.00 || | |
2503 | Manually A dded HPIDs to Billin g Claim Re port | |
2504 | This repor t generate s a list o f Health P lan (HPID) numbers t hat have b een added directly t o claims. It allows billing st aff to tra ck the ins tances whe n an HPID number is added to a third-par ty claim a nd to gene rate an ad -hoc repor t of autho rized clai ms with th is entry i nformation . Only HPI Ds that ha ve been ma nually add ed will ap pear on th is report. | |
2505 | You will b e prompted for date range, rep ort format , and devi ce. The da te range p ertains to when the HPID was m anually ad ded to the claim. | |
2506 | This outpu t displays patient n ame, last 4 of SSN, payer, HPI D, claim n umber, use r name, da te HPID ad ded, Profe ssional ID and Insti tutional I D. | |
2507 | Sample Out put | |
2508 | MANUALLY A DDED HPIDS TO BILLIN G CLAIM RE PORT AU G 02, 2015 @19:59 Page: 1 | |
2509 | PT NAME SSN PAY ER HPI D C LAIM # USER NAM E DATE HP ID ADDED PROF ID INST ID | |
2510 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -- | |
2511 | IBPATIENT, ONE 1111 BLU E CROSS 741 4615444 5 00-K400003 IBUSER,O NE 12/02/ 2014 1234567890 098765432 1 | |
2512 | IBPATIENT, ONE 1111 BLU E CROSS 739 9982967 5 00-K400005 IBUSER,O NE 01/15/ 2015 1234567890 098765432 1 | |
2513 | IBPATIENT, ONE 1111 BLU E CROSS 794 7434214 5 00-K400003 IBUSER,O NE 01/22/ 2015 1234567890 098765432 1 | |
2514 | IBPATIENT, ONE 1111 BLU E CROSS 794 7434214 5 00-K400005 IBUSER,O NE 01/22/ 2015 1234567890 098765432 1 | |
2515 | IBPATIENT, ONE 1111 BLU E CROSS 746 7061371 5 00-K400003 IBUSER,O NE 01/23/ 2015 1234567890 098765432 1 | |
2516 | IBPATIENT, ONE 1111 BLU E CROSS 794 7434214 5 00-K400005 IBUSER,O NE 02/05/ 2015 1234567890 098765432 1 | |
2517 | IBPATIENT, TWO 9341 BLU E CROSS 746 2706327 5 00-K400008 IBUSER,O NE 02/09/ 2015 1234567890 098765432 1 | |
2518 | IBPATIENT, TWO 9341 BLU E CROSS 744 4643416 5 00-K400008 IBUSER,O NE 02/09/ 2015 1234567890 098765432 1 | |
2519 | IBPATIENT, TWO 9341 BLU E CROSS 790 8996151 5 00-K400008 IBUSER,O NE 02/09/ 2015 1234567890 098765432 1 | |
2520 | Patient Bi lling Inqu iry | |
2521 | The Patien t Billing Inquiry op tion allow s you to d isplay/pri nt informa tion on an y reimburs able insur ance bill, Pharmacy Copay, or Means Test bill. The informati on provide d differs depending on the bil l type. | |
2522 | For reimbu rsable ins urance bil ls, the in formation provided i ncludes bi ll status, rate type , reason c ancelled ( if applica ble), admi ssion date (for inpa tients), a ll outpati ent visits (for outp atients), charges, a mount paid , statemen t to and f rom dates, each acti on that wa s taken on that bill , and the user who p erformed i t. If you choose to view the f ull inquir y, address informati on from th e PATIENT file (#2) and the bi ll is also provided. | |
2523 | The inform ation prov ided in a brief inqu iry for Ph armacy Cop ay charges includes date of ch arge, type of charge (syntax: patient el igibility - action t ype - stat us), brief descripti on (syntax : prescrip tion # - d rug name - # of unit s), amount of charge or credit , and an e xplanation of any ch arge remov ed, if app licable. A full inqu iry, in ad dition to the inform ation prov ided in th e brief in quiry, pro vides info rmation fr om the PRE SCRIPTION file (#52) , as well as address informati on on the patient. | |
2524 | The displa y/output f or Means T est bills is very si milar to t he brief i nquiry for Pharmacy Copay. It includes t he date of charge, c harge type , brief de scription, units, an d amount o f charge. A full inq uiry also includes a ddress inf ormation o n the pati ent. | |
2525 | The medica tion copay ment exemp tion statu s and reas on are dis played for medicatio n copaymen t and Mean s Test bil ls. | |
2526 | Sample Out put of Bri ef Inquiry | |
2527 | IBpatient, one 000-11-111 1 50 0-000303 FEB 19, 1 992@14:17 PAGE: 1 | |
2528 | ========== ========== ========== ========== ========== ========== ========== ======== | |
2529 | Bill Statu s : PRI NTED - REC ORD IS UNE DITABLE | |
2530 | Rate Type : REI MBURSABLE INSURANCE | |
2531 | Form Type : UB- 82 | |
2532 | Op Visit d ates : APR 14,1992 | |
2533 | Charges : $14 8.00 | |
2534 | LESS Offse t : $3 0.00 | |
2535 | Bill Total : $11 8.00 | |
2536 | Statement From : APR 14,1992 | |
2537 | Statement To : APR 14,1992 | |
2538 | Entered : APR 15, 1992 by ED | |
2539 | First Revi ewed : APR 16, 1992 by SUE | |
2540 | Last Revie wed : APR 16, 1992 by SUE | |
2541 | Authorized : APR 16, 1992 by SUE | |
2542 | Last Print ed : APR 16, 1992 by GARY | |
2543 | IBpatient, one 000-11-111 1 500- 000303 FE B 19, 1992 @14:17 PAGE: 2 | |
2544 | ========== ========== ========== ========== ========== ========== ========== ======== | |
2545 | *** ADDRES S INFORMAT ION *** | |
2546 | Patient Ad dress: 117 TEST DRIV E | |
2547 | CO LONIE, NEW YORK | |
2548 | 51 8-555-0990 | |
2549 | Mailing Ad dress: ABC INS | |
2550 | 12 62 MOONBEA M AVENUE | |
2551 | LO S ANGELES, CALIFORNI A 12345 | |
2552 | Ins Co. Ad dress: ABC INS | |
2553 | 12 62 MOONBEA M AVENUE | |
2554 | LO S ANGELES, CALIFORNI A 12345 | |
2555 | 61 8-555-5555 | |
2556 | Sample Out put of Ful l Inquiry | |
2557 | IBpatient, one 0 00-11-1111 500 -L10098 FEB 24, 19 92@09:09 PAGE: 1 | |
2558 | Medication Copayment Exemption Status: N ON-EXEMPT | |
2559 | Patient's income is greater th an Copay I ncome Thre shold | |
2560 | ========== ========== ========== ========== ========== ========== ========== ======== | |
2561 | FEB 14, 19 92 INPT COPAY (MED ) NEW INP T CO-PAY ( MED) 1 $200.00 | |
2562 | FEB 20, 19 92 INPT COPAY (MED ) CAN INP T CO-PAY ( MED) 1 ( $200.00) | |
2563 | Charg e Removal Reason: MT CHARGE ED ITED | |
2564 | ---- -------- | |
2565 | $0.00 | |
2566 | IBpatient, one 500- L10098 F EB 24, 199 2@09:09 PAGE: 2 | |
2567 | Medication Copayment Exemption Status: N ON-EXEMPT | |
2568 | Patient's income is greater th an Copay I ncome Thre shold | |
2569 | ========== ========== ========== ========== ========== ========== ========== ======== | |
2570 | *** A DDRESS INF ORMATION * ** | |
2571 | Patient Ad dress: 28 TEST RD | |
2572 | EA STHAM, MAS SACHUSETTS | |
2573 | 50 8-555-4321 | |
2574 | Sample Out put of Bri ef Inquiry for a Pha rmacy Copa y bill. | |
2575 | IBpatient, one 000-11-111 1 500 -M10004 FEB 24, 19 92@09:18 PAGE: 1 | |
2576 | Medication Copayment Exemption Status: E XEMPT | |
2577 | Patient's income bel ow Copay I ncome Thre shold | |
2578 | DATE CHARG E TYPE BRI EF DESCRIP TION UNITS CHARGE | |
2579 | ========== ========== ========== ========== ========== ========== ========== ======== | |
2580 | MAR 15, 19 91 SC RX COPAY NEW RX# 111128-REF 5-ENDU 3 $6.00 | |
2581 | MAR 15, 19 91 SC RX COPAY NEW RX# 111199 999 9-CLONI 4 $8.00 | |
2582 | ---- -------- | |
2583 | $14.00 | |
2584 | List all B ills for a Patient | |
2585 | The List a ll Bills f or a Patie nt option is used to print a l ist of all bills on file for a selected patient. T he patient may be se lected by name or so cial secur ity number . | |
2586 | The bills are listed by date o f care in reverse da te order. The bill n umber, dat e printed, action/ra te type, c lassificat ion, date of care, s tatement f rom and to dates, am ount colle cted, stat us, and ti me-frame o f the bill will be d isplayed f or each bi ll on the list. Belo w is a bri ef explana tion of so me of thes e data ele ments. | |
2587 | Bill Numbe r | |
2588 | If IB acti on is inco mplete, "p ending" is displayed . If IB ac tion is co nverted, t his field will be bl ank. | |
2589 | Date Print ed | |
2590 | Date bill generated. | |
2591 | Action/Rat e Type | |
2592 | Action for IB action s; rate ty pe for ins urance bil ls. | |
2593 | Date of Ca re | |
2594 | Admission date for i npatients; opt visit date for outpatient s; date me dication d ispensed f or Pharmac y Copay. | |
2595 | Amount Col lected | |
2596 | Not applic able to pa tient bill s; amount from Accou nts Receiv able for i nsurance b ills. | |
2597 | Time frame of Bill | |
2598 | Null if IB action. | |
2599 | Reject Ind icator | |
2600 | The “c” in dicates a rejected b ill. A rej ect is def ined to be a billing reject th at is on t he Claim S tatus Awai ting Resol ution (CSA ) or Medic are Remitt ance Advic e Worklist (MRW) rep ort. | |
2601 | You will b e prompted for a pat ient name and whethe r or not t o include Pharmacy C opay charg es on the report. | |
2602 | The output produced by this op tion must be generat ed at a 13 2 column m argin widt h. | |
2603 | Sample Out put | |
2604 | List of al l Bills fo r IBpatien t,one MAR 5 ,1992@08:1 6 PAGE 1 | |
2605 | BILL DATE DAT E OF ST ATEMENT STATEMENT AMOUNT | |
2606 | NO. PR INTED A CTION/RATE TYPE C LASSIFICAT ION CAR E FRO M DATE TO DATE COLLECTED STATUS TIMEFRA ME OF BILL | |
2607 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
2608 | M10053 0 2/20/92 NSC RX COP AY PHARMACY C OPAY 02/ 20/92 02 /20/92 02/20/92 N/A BILLED | |
2609 | L10157 0 2/07/92 NSC RX COP AY PHARMACY C OPAY 02/ 07/92 02 /07/92 02/07/92 N/A UPDATE D | |
2610 | L10063 0 2/11/92 REIMBURSAB LE INS. O UTPATIENT 01/3 0/92 01/ 01/92 0 1/31/92 0.00 PRINTED ADMIT-D ISCHARGE | |
2611 | Category C Billing A ctivity Li st | |
2612 | The Catego ry C Billi ng Activit y List opt ion is use d to list all Means Test/Categ ory C char ges within a specifi ed date ra nge. The l ist is alp habetical by patient name. | |
2613 | This outpu t provides the patie nt name an d ID, a br ief descri ption, the status an d the bill ing period for the b ill, the u nits (the number of days a cha rge occurr ed), and t he amount of the cha rge. For i npatient c opay charg es, the de scription includes t he treatin g specialt y for the episode of care. | |
2614 | As stated above, the units ref lect the n umber of d ays a char ge occurre d. For inp atient cop ay charges the unit will alway s be one, even if th e patient accrued th e charges over a num ber of day s before t he Medicar e deductib le was met . | |
2615 | Sample Out put | |
2616 | Category C Billing A ctivity Li st FEB 26, 19 92@09:14:2 8 Page : 1 | |
2617 | Charges fr om 01/01/9 2 through 02/26/92 | |
2618 | PATIENT/ID DESCRIPT ION STATUS FROM TO UNITS CHAR GE | |
2619 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -- | |
2620 | IBpatient, one 111 1 INPT PER DIEM BILLED 01/02/92 01/03/92 2 $20 .00 | |
2621 | IN PT COPAY ( ALC) BILLED 01/02/92 01/03/92 1 $476 .00 | |
2622 | IBpatient, two 222 2 OPT COPA Y PENDING A/ R 02/11/92 02/11/92 1 $0 .00 | |
2623 | IBpatient, three 3 333 INPT P ER DIEM BILLED 01/13/92 01/14/92 2 $20 .00 | |
2624 | IN PT COPAY ( MED) BILLED 01/13/92 01/14/92 1 $652 .00 | |
2625 | IBpatient, four 44 44 OPT COP AY PENDING A/ R 02/12/92 02/12/92 1 $0 .00 | |
2626 | Third Part y Output M enu | |
2627 | Veterans w /Insurance and Disch arges | |
2628 | The Vetera ns w/Insur ance and D ischarges option is used to pr oduce a li st of all patients w ho have re imbursable insurance and who w ere discha rged from the medica l center d uring a se lected dat e range. F or dates o f care pri or to 10/1 /90, servi ce-connect ed veteran s with ins urance who were trea ted for a non-servic e-connecte d conditio n (from th e PTF reco rd) will b e included on the li st. This l ist may be used to h elp insure that a bi ll exists for all bi llable inp atient epi sodes of c are for th at date ra nge. | |
2629 | You may in clude unbi lled patie nts, previ ously bill ed patient s, or both on the re port. If y ou choose to print A LL (both u nbilled an d previous ly billed) , the repo rt is sort ed by thes e two cate gories. Th e unbilled patients portion di splays the patient I D#, patien t name, SS N, eligibi lity statu s, date of care (eve nt date), and the pa tient's in surance co mpanies. T he previou sly billed list disp lays the s ame data p lus every bill withi n the sele cted date range for each patie nt showing the bill number, bi ll rate ty pe, statem ent from a nd to date s, and the debtor. | |
2630 | The lists are printe d in alpha betical or der by pat ient name or numeric ally by te rminal dig it (8th an d 9th digi t of the S SN, then 6 th and 7th , etc.). F or multidi visional s ites, you may print a list for each divi sion. | |
2631 | It is reco mmended th e report b e queued t o print du ring non-p eak user h ours. | |
2632 | Sample Out put | |
2633 | *Veterans with Reimb ursable In surance an d INPATIEN T Discharg es for the period co vering FEB 01,1992 t hrough FEB 29,1992 | |
2634 | UNBILLED P ATIENTS fo r Division ALBANY Pri nted: MAR 01,1992@06 :00 Pa ge: 1 | |
2635 | PT ID PATI ENT S SN ELIGIBI LITY DATE OF D ISCHARGE INSURAN CE COMPANI ES | |
2636 | ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ======== | |
2637 | 1111 IBpa tient,one 0 00-11-1111 NON-SER VICE CONN FEB 20,19 92@15:51:1 5 ABC | |
2638 | 2222 IBpa tient,two 0 00-22-2222 NON-SER VICE CONN FEB 19,19 92@12:52:5 1 ALLSTAT E | |
2639 | 3333 IBpa tient,thre e 0 00-33-3333 NON-SER VICE CONN FEB 19,19 92@14:40:1 8 NORTHWE ST | |
2640 | *Veterans with Reimb ursable In surance an d INPATIEN T Discharg es for the period co vering FEB 01,1992 t hrough FEB 29,1992 | |
2641 | PREVIOUSLY BILLED PA TIENTS for Division ALBANY Pri nted: MAR 01,1992@06 :00 Pa ge: 1 | |
2642 | PT ID PATI ENT SSN ELIGIBILIT Y DA TE OF DISC HARGE INSURANCE COMPANIES | |
2643 | ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ======== | |
2644 | 1111 IBpa tient,one 000- 11-1111 NON-SERVIC E CONN FE B 7,1992@1 3:48:23 ABC | |
2645 | L10042 REIM INS-I NPT F rom: 02/07 /92 To: 02/07/92 Debt or: ABC | |
2646 | 2222 IBpa tient,two N ON-SERVICE CONN FEB 14,1992@1 3:00 A BC | |
2647 | L10030 REIM INS-I NPT F rom: 02/14 /92 To: 02/19/92 Debt or: ABC | |
2648 | 3333 IBpa tient,thre e 000- 33-3333 NON-SERVIC E CONN FE B 7,1992@1 3:48:23 ABC | |
2649 | L10042 REIM INS-I NPT F rom: 02/07 /92 To: 02/10/92 Debt or: ABC | |
2650 | Veteran Pa tient Insu rance Info rmation | |
2651 | The Vetera n Patient Insurance Informatio n option p rovides in surance in formation on veteran inpatient s. This in cludes suc h informat ion as ins urance com pany, insu rance numb er, group number, an d insuranc e expirati on date. M edical inf ormation i s also sho wn. Dates of admissi on and dis charge and status of the PTF r ecords are provided. The repor t is broke n down by patient, w ith inform ation on l ength of s tay for ea ch bedsect ion, diagn oses, and diagnostic codes. Th e total le ngth of st ay is show n with the primary d iagnosis. | |
2652 | The form i ndicates w hether or not the po licy shown will reim burse VA f or the cos t of medic al care. I f the REIM BURSE fiel d of the I NSURANCE C OMPANY fil e is set t o NO for a ny of the companies that cover the appli cant, an a sterisk (* ) will be shown next to the in surance co mpany name and the f ollowing m essage wil l appear. | |
2653 | * - Insur er may not reimburse !! | |
2654 | All of thi s informat ion is use d in billi ng the ins urance com panies for the cost of the vet eran's car e. | |
2655 | The report may be so rted seque ntially by discharge or admiss ion date. You will b e prompted for a dat e range an d device. Depending on the num ber of app licable ad missions a nd the siz e of the d ate range specified, generatio n of this report cou ld be time -consuming . You may choose to queue the report to print duri ng non-pea k user hou rs. | |
2656 | Sample Out put | |
2657 | THIRD PART Y REIMBURS EMENT PRIN TED: JAN 1 1,1991@091 5 | |
2658 | IBpatient, one EMPL OYMENT STA TUS: EMPLO YED | |
2659 | (PT ID: 00 0111111) EMPLO YER: ABC L UMBER | |
2660 | 307 TEST B LVD OCCUPAT ION: CARPE NTER | |
2661 | TOLEDO, OH IO 55555 | |
2662 | INSURANCE TYPE INSU RANCE # G ROUP # EXPIRES HO LDER | |
2663 | --------- ---- ---- ----- - - ---- - ------- -- ---- | |
2664 | ABC INS 123 8 87 01/01/9 3 VET ERAN | |
2665 | *XYZ INS 6409 8 2 1 12/31/9 1 VET ERAN | |
2666 | * - Insurer may not r eimburse!! | |
2667 | Admitted: APR 9,1990 @14:00 Discharg ed: APR 19 ,1990@13:3 9 | |
2668 | PTF Record not close d | |
2669 | DATE LOS BEDSEC TION LOS DI AGNOSES | |
2670 | ---- ---------- ----- ---- -- ------- | |
2671 | APR 10,199 0@11:29 OPHTHALMOL OGY 1 33 4.4 (CORNE AL ABRASIO N) | |
2672 | APR 11,199 0@10:10 UROLOGY 1 77 8.0 (URINA RY TRACT I NFECTION, | |
2673 | UNSPE C.) | |
2674 | APR 19,199 0@13:39 CARDIOLOGY 8 65 4.00 (MYOC ARDIAL INF ARCTION) | |
2675 | ---- -- --------- | |
2676 | TOTAL LOS: 10 DXL S: 654.00 (MYOCARDIA L INFARCTI ON) | |
2677 | Veterans w /Insurance and Inpat ient Admis sions | |
2678 | The Vetera ns w/Insur ance and I npatient A dmissions option is used to pr oduce a li st of all patients w ho have re imbursable insurance and who h ad admissi ons to the medical c enter duri ng a selec ted date r ange. For dates of c are prior to 10/1/90 , service- connected veterans w ith insura nce who we re treated for a non -service-c onnected c ondition ( from the P TF record) will be i ncluded on the list. This list may be us ed to help insure th at a bill exists for all inpat ient billa ble episod es of care for the s elected da te range. | |
2679 | You may in clude unbi lled patie nts, previ ously bill ed patient s, or both on the re port. If y ou choose to print A LL (both u nbilled an d previous ly billed) , the repo rt is sort ed by thes e two cate gories. Th e unbilled patients portion di splays the patient I D#, patien t name, SS N, eligibi lity statu s, date of care (eve nt date), and the pa tient's in surance co mpanies. T he previou sly billed list disp lays the s ame data p lus every bill withi n the sele cted date range for each patie nt showing the bill number, bi ll rate ty pe, statem ent from a nd to date s, and the debtor. | |
2680 | The lists are printe d in alpha betical or der by pat ient name or numeric ally by te rminal dig it (8th an d 9th digi t of the S SN, then 6 th and 7th , etc.). F or multidi visional s ites, you may print a list for each divi sion. | |
2681 | Depending on the siz e of your database a nd the dat e range se lected, th is report could be q uite lengt hy. It is recommende d the repo rt be queu ed to prin t during n on-peak us er hours. | |
2682 | Sample Out put | |
2683 | Veterans w ith Reimbu rsable Ins urance and INPATIENT Admission s for peri od coverin g FEB 1,19 92 through FEB 29, 1 992 | |
2684 | UNBILLED P ATIENTS fo r Division ALBANY Print ed: MAR 01 ,1992@06:0 0 Page: 1 | |
2685 | PT ID PAT IENT SSN ELIGIBILIT Y DA TE OF CARE INSURANCE COMPANIES | |
2686 | ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== == | |
2687 | 1111 IBp atient,one 000- 11-1111 NON-SERVIC E CONN FE B 05,1992@ 15:51:15 ABC | |
2688 | 2222 IBp atient,two 000- 22-2222 NON-SERVIC E CONN FE B 13,1992@ 13:40 NATIONWIDE | |
2689 | Veterans w ith Reimbu rsable Ins urance and INPATIENT Admission s for peri od coverin g FEB 1,19 92 through FEB 29, 1 992 | |
2690 | PREVIOUSLY BILLED PA TIENTS for Division ALBANY Prin ted: MAR 0 1,1992@06: 00 Page : 1 | |
2691 | PT ID PAT IENT SSN ELIGIBIL ITY DATE OF C ARE INSURAN CE COMPANI ES | |
2692 | ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== == | |
2693 | 1111 IBp atient,one 000 -11-1111 NON-SERV ICE CONN FEB 1,199 2@11:10 XYZ INS | |
2694 | 000272 REIM INS-I NPT Fr om: 02/01/ 92 To: 02/10/92 Debt or: XYZ IN S | |
2695 | 2222 IBp atient,two 000 -22-2222 NON-SERV ICE CONN FEB 24,19 92@08:09 UNITED WORKERS | |
2696 | 000312 REIM INS-I NPT Fr om: 02/24/ 92 To: 02/28/92 Debt or: UNITED WORKERS | |
2697 | 000346 REIM INS-I NPT Fr om: 02/28/ 92 To: 02/29/92 Debt or: UNITED WORKERS | |
2698 | 3333 IBp atient,thr ee 000 -33-3333 NON-SERV ICE CONN FEB 10,19 92@13:34 INTERNA TIONAL | |
2699 | 000287 REIM INS-I NPT Fr om: 02/10/ 92 To: 02/14/92 Debt or: INTERN ATIONAL | |
2700 | Veterans w /Insurance and Opt. Visits | |
2701 | The Vetera ns w/Insur ance and O pt. Visits option is used to p roduce a l ist of all patients who have r eimbursabl e insuranc e and who had outpat ient visit s to the m edical cen ter during a selecte d date ran ge. For da tes of car e prior to 10/1/90, service-co nnected ve terans wit h insuranc e will be included o n the list . | |
2702 | Non-count clinics an d unbillab le appoint ment types are exclu ded from t he list. T his list m ay be used to help i nsure that a bill ex ists for a ll outpati ent billab le episode s of care for that t ime frame. | |
2703 | This repor t includes patients who have e ither add/ edit stop codes, 10- 10 registr ations, or scheduled appointme nts during the selec ted date r ange. The stop code, registrat ion type, or clinic is include d on the o utput for each entry . This inf ormation m ay be used to aid in determini ng how a c harge shou ld be bill ed. | |
2704 | You may in clude unbi lled patie nts, previ ously bill ed patient s, or both on the re port. If y ou choose to print A LL (both u nbilled an d previous ly billed) , the repo rt is sort ed by thes e two cate gories. Th e unbilled patients portion di splays the patient I D#, patien t name, SS N, eligibi lity statu s, date of care (eve nt date), and the pa tient's in surance co mpanies. T he previou sly billed list disp lays the s ame data p lus every bill withi n the sele cted date range for each patie nt showing the bill number, bi ll rate ty pe, statem ent from a nd to date s, and the debtor. | |
2705 | The lists are printe d in alpha betical or der by pat ient name or numeric ally by te rminal dig it (8th an d 9th digi t of the S SN, then 6 th and 7th , etc.). F or multidi visional s ites, you may print a list for each divi sion. | |
2706 | It is reco mmended th e report b e queued t o print du ring non-p eak user h ours. | |
2707 | Sample Out put | |
2708 | Veterans w ith Reimbu rsable Ins urance and OUTPATIEN T Appointm ents for p eriod cove ring FEB 1 ,1992 thro ugh FEB 29 , 1992 | |
2709 | UNBILLED P ATIENTS fo r Division ALBANY Print ed: MAR 01 ,1992@06:0 0 Page: 1 | |
2710 | PT ID PAT IENT SSN ELIGIBILIT Y D ATE OF CAR E INSURANCE COMPANIES | |
2711 | ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== == | |
2712 | 1111 IBp atient,one 000 -11-1111 NON-SERVIC E CONN F EB 12,1992 @09:45 XYZ INS | |
2713 | Add/Edit Stop Code with 900, | |
2714 | 2222 IBp atient,two 000 -22-2222 NON-SERVIC E CONN F EB 23,1992 @13:40 ABC | |
2715 | Clinic: D ermatology | |
2716 | 3333 IBp atient,thr ee 000 -33-3333 NON-SERVIC E CONN F EB 29,1992 @09:44 ABC | |
2717 | Clinic: D ermatology | |
2718 | 4444 IBp atient,fou r 000 -44-4444 NON-SERVIC E CONN F EB 18,1992 @23:45 BLUE SHIE LD | |
2719 | Registrat ion: HOSPI TAL ADMISS ION | |
2720 | Veterans w ith Reimbu rsable Ins urance and OUTPATIEN T Appointm ents for p eriod cove ring FEB 1 ,1992 thro ugh FEB 29 , 1992 | |
2721 | PREVIOUSLY BILLED PA TIENTS for Division ALBANY Prin ted: MAR 0 1,1992@06: 00 Page : 1 | |
2722 | PT ID PAT IENT S SN ELIGIBI LITY DATE OF C ARE INSURAN CE COMPANI ES | |
2723 | ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== == | |
2724 | 1111 IBp atient,one 0 00-11-1111 NON-SER VICE CONN FEB 11,19 92@14:34 BLUE CR OSS | |
2725 | Add/Edit Stop Code with 102, 301, 706 | |
2726 | 00024A REIM INS- OUTP Fr om: 02/11/ 92 To: 02/11/92 De btor: BLUE CROSS | |
2727 | 2222 IBp atient,two 0 00-22-2222 NON-SER VICE CONN FEB 12,19 92@07:09 ABC I NSURANCE | |
2728 | Clinic: M EDICAL | |
2729 | 00089A REIM INS- OUTP Fr om: 02/12/ 92 To: 02/12/92 De btor: ABC INSURANC E | |
2730 | 3333 IBp atient,thr ee 0 00-33-3333 NON-SER VICE CONN FEB 26,19 92@09:45 ABC I NSURANCE | |
2731 | Clinic: M EDICAL | |
2732 | 00096A REIM INS- OUTP Fr om: 02/26/ 92 To: 02/29/92 De btor: ABC INSURANC E | |
2733 | Patient Re view Docum ent | |
2734 | The Patien t Review D ocument op tion is us ed to prin t the Thir d Party Re view Form by patient name and admission date speci fications. This form is used i n connecti on with ve teran pati ents admit ted to the hospital who have p rivate med ical insur ance. The form provi des patien t's name, patient ID #, admissi on date, d iagnoses, and ward l ocation. I nsurance i nformation provided includes i nsurance c ompany nam e, address and phone number, p olicy numb er, and gr oup number . The insu rance data is not di splayed if the insur ance has e xpired. | |
2735 | The form i s then div ided into four secti ons. Secti on one con cerns pre- admission certificat ion. It sh ows whethe r or not p re-admissi on certifi cation is required. If require d, it prov ides infor mation con cerning th e decision made by t he insuran ce company regarding the admis sion. Info rmation in cludes num ber of day s certifie d, whether medical i nformation is insuff icient, an d whether outpatient care is m ore approp riate. Sec tion two c oncerns th e need for a second surgical o pinion, if required, and resul ts of the second opi nion. Sect ion three provides i nformation concernin g the leng th of stay review; i f further stay was a pproved or if disapp roved, the reasons f or denial. Section f our shows bill statu s – denied in full, denied in part, or p aid in ful l. If deni ed, the re asons for denial are given. Th e bill num ber is als o shown. | |
2736 | Sample Out put | |
2737 | NAME: IBpa tient,one DA TE PRINTED : DEC 12, 1990 | |
2738 | PT ID: 000111111 | |
2739 | INSURANCE CARRIER: A BC Insuran ce Company | |
2740 | ADDRESS: 2 34 Test St ., Loma Li nda, Calif ornia 154 36 | |
2741 | PHONE: 5 55-4789 POL ICY #: 674 0879BB GRO UP #: 10 | |
2742 | PRE-CER T PHONE: BILLING PHONE: | |
2743 | INSURANCE CARRIER: | |
2744 | ADDRESS: | |
2745 | PHONE: POL ICY #: GRO UP #: | |
2746 | PRE-CER T PHONE: BILLING PHONE: | |
2747 | INSURANCE CARRIER: | |
2748 | ADDRESS: | |
2749 | PHONE: POL ICY #: GRO UP #: | |
2750 | PRE-CER T PHONE: BILLING PHONE: | |
2751 | ADMITTING DX: Pneumo nia WARD: 8A | |
2752 | SCHEDULED ADMISSION DATE: ADMISSI ON DATE: J UN 26, 198 6 | |
2753 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -- | |
2754 | PRE-ADMISS ION CERTIF ICATION: | |
2755 | ___NUMBER DAYS CERTI FIED ______ __________ ______AUTH ORIZATION NUMBER | |
2756 | ___NOT REQ UIRED | |
2757 | ___FAILURE TO MEET E STABLISHED ADMISSION CRITERIA | |
2758 | ___MEDICAL INFORMATI ON IS INSU FFICIENT | |
2759 | ___OPT CAR E IS MORE APPROPRIAT E | |
2760 | ___OTHER L EVELS OF S ERVICE ARE MORE APPR OPRIATE (N URSING HOM E VS HOSPI TAL) | |
2761 | ___POLICY DOES NOT C OVER MEDIC AL CARE RE QUIRED | |
2762 | ___COVERAG E EXHAUSTE D | |
2763 | ___OTHER PREPARED B Y ________ __________ __ | |
2764 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -- | |
2765 | SECOND SUR GICAL OPIN ION NEEDED : ______ YES ___ ___NO | |
2766 | SECOND SUR GICAL OPIN ION OBTAIN ED: ______ YES ____ ___OUTSIDE MD RECOMM ENDED AGAI NST SURGER Y | |
2767 | _____ _NOT APPLI CABLE ___ ____OTHER | |
2768 | _____ _NOT RECEI VED PREPARED B Y ________ __________ __ | |
2769 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -- | |
2770 | LOS REVIEW DATE: __ ________ D ATE APPROV ED: _____ __________ | |
2771 | NUMBER OF DAYS EXTEN DED: ____ ______ ____ __________ _AUTHORIZA TION NUMBE R | |
2772 | ___PRE-OP DAYS DENIE D ___APPRO PRIATE ALT ERNATIVE T REATMENT O PTIONS EXI ST | |
2773 | ___MORE ME DICAL INFO RMATION NE EDED ___ALTER NATIVE TRE ATMENT NOT COVERED B Y POLICY | |
2774 | ___FAILURE TO MEET C ONTINUED S TAY CRITER IA ___AVAIL ABILITY OF ALTERNATI VE TREATME NT | |
2775 | ___APPROPR IATE ALTER NATIVE TRE ATMENT OPT IONS EXIST ___COVER AGE EXHAUS TED | |
2776 | ___OTHER PREPARED B Y ________ __________ __ | |
2777 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -- | |
2778 | BILLS DENI ED IN FULL : BILL DENIED IN PART: | |
2779 | _________E XCLUSIONAR Y CLAUSE S TILL IN EF FECT ____ _____DEDUC TIBLE/COPA YMENT APPL IES | |
2780 | _________D EDUCTIBLE/ COPAYMENT APPLIES ____ _____PORTI ON OF CARE NOT COVER ED BY POLI CY | |
2781 | _________T YPE OF CAR E NOT COVE RED BY POL ICY ____ _____EXCEE DS USUAL A ND CUSTOMA RY CHARGES | |
2782 | _________P ATIENT DOE S NOT HAVE CURRENT C OVERAGE ____ _____PAYME NT LIMITED TO PREAUT HORIZED DA YS | |
2783 | _________I NSURER WIL L NOT PAY PER DIEM R ATES ____ _____OTHER | |
2784 | _________T REATMENT/A DMISSION N OT AUTHORI ZED BY INS URANCE CAR RIER | |
2785 | _________O THER ____ _____BILL PAID IN FU LL | |
2786 | PREPA RED BY ___ __________ __________ __ | |
2787 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -- | |
2788 | REMARKS: | |
2789 | BILL # ___ __________ | |
2790 | Inpatients w/Unknown or Expire d Insuranc e | |
2791 | This optio n allows y ou to prin t a list o f veteran inpatients with no i nsurance, expiring i nsurance ( expired or will expi re within 30 days), or unknown insurance . You may include an y or all o f these ca tegories. The output may then be used to obtain in surance in formation from veter ans while they are c urrent inp atients. | |
2792 | If your si te is mult idivisiona l, one, ma ny, or all divisions may be in cluded. A subtotal i s provided for each division. | |
2793 | The report may be pr inted for the curren t date or a specifie d date ran ge. When y ou select a date ran ge, all pa tients who were admi tted durin g that dat e range ar e included . If you c hoose to d isplay for the curre nt date, a ll patient s who are currently inpatients are inclu ded. The r eport may be further sorted by ward. | |
2794 | Producing this outpu t may be v ery time c onsuming. It is reco mmended yo u queue th is option to run dur ing off ho urs. The r equired ma rgin width is 132 co lumns. | |
2795 | Sample Out put | |
2796 | JUN 1,1993 PAGE 1 | |
2797 | VETERANS W ITH NO INS URANCE THA T WERE ADM ITTED BETW EEN MAY 22 ,1993 AND JUN 1,1993 | |
2798 | PATIENT /WARD PT ID ADMISSI ON DATE AGE %SC MARITAL ST ATUS EMP LOYMENT ST ATUS | |
2799 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
2800 | Divi sion: NORTH SIDE | |
2801 | ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== | |
2802 | Ward : 11B | |
2803 | IBpatie nt,one 000- 11-1111 MAY 22, 1993@16:37 55 40 WIDOW/WIDO WER EMP LOYED FULL TIME | |
2804 | 11B Addr ess: 555 KILB OURN T ele: 518-2 72-9292 | |
2805 | TROY,NY 12180 | |
2806 | Empl oyer: ACME CON STRUCTION T ele: 518-4 62-0926 | |
2807 | MAPLE A VE | |
2808 | ALBANY, NY 12208 | |
2809 | IBpatie nt,two 000- 22-2222 MAY 30, 1993@07:00 62 0 MARRIED EMP LOYED FULL TIME | |
2810 | 11B Addr ess: 000 1ST ST. Te le: 518-55 5-0909 | |
2811 | ALBANY, NY 12208 | |
2812 | Empl oyer: ALBANY P LUMBING T ele: 518-5 55-3311 | |
2813 | 23 RAIL ROAD AVE. | |
2814 | ALBANY, NY 12208 | |
2815 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
2816 | Ward : 11C | |
2817 | IBpatie nt,three 000- 33-3333 JUN 1,1 993@11:32 42 0 MARRIED EMP LOYED FULL TIME | |
2818 | 11C Addr ess: 121 TEST AVE T ele: 518-5 55-0097 | |
2819 | COHOES, NY 12184 | |
2820 | Empl oyer: VAMC ALB ANY T ele: 518-5 55-3311 | |
2821 | 113 HOL LAND AVE. | |
2822 | ALBANY, NY 12208 | |
2823 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
2824 | ---------- ------ | |
2825 | Subtota l: 3 | |
2826 | ---------- ------ | |
2827 | Total: 3 | |
2828 | JUN 1,1993 PAGE 2 | |
2829 | VETERANS W HOSE INSUR ANCE IS EX PIRED OR W ILL EXPIRE WITHIN 30 DAYS THAT WERE ADMI TTED BETWE EN MAY 22, 1993 AND J UN 1,1993 | |
2830 | PATIENT /WARD PT ID ADMISSI ON DATE AGE %SC MARITAL ST ATUS EMP LOYMENT ST ATUS | |
2831 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
2832 | Divi sion: NOR THSIDE | |
2833 | ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== | |
2834 | Ward : 11B | |
2835 | IBpatie nt,one 00 0-11-1111 MAY 25 ,1993@16:3 7 35 0 WIDOW/WIDO WER NOT EMPLOYED | |
2836 | 11B Ad dress: 49 TEST AVE T ele: 518-5 55-8374 | |
2837 | TROY,N Y 12180 | |
2838 | In surance: XYZ INS E xpiration: JUN 1 5,1993 | |
2839 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
2840 | ---------- ------ | |
2841 | Subtota l: 1 | |
2842 | ---------- ------ | |
2843 | Total: 1 | |
2844 | JUN 1,1993 PAGE 3 | |
2845 | VETERANS W HOSE INSUR ANCE IS UN KNOWN THAT WERE ADMI TTED BETWE EN MAY 22, 1993 AND J UN 1,1993 | |
2846 | PATIENT /WARD PT ID ADMISSI ON DATE AGE %SC MARITAL ST ATUS EMP LOYMENT ST ATUS | |
2847 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
2848 | Divi sion: NORT HSIDE | |
2849 | ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== | |
2850 | Ward : 11C | |
2851 | IBpatie nt,one 000 -11-1111 MAY 22 ,1993@16:3 7 82 10 WIDOW/WIDO WER RET IRED | |
2852 | 11C Add ress: 55 TEST AVE T ele: 518-5 55-9090 | |
2853 | TROY,N Y 12180 | |
2854 | IBpatie nt,two 000 -22-2222 MAY 25 ,1993@07:0 0 60 0 MARRIED EMP LOYED FULL TIME | |
2855 | 11C Add ress: 256 HOL LAND AVE. Te le: 518-55 5-0786 | |
2856 | ALBANY ,NY 12208 | |
2857 | Emp loyer: ABC SEC URITY T ele: 518-5 55-7485 | |
2858 | 519 4T H ST | |
2859 | TROY,N Y 12208 | |
2860 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
2861 | ---------- ------ | |
2862 | Subtota l: 2 | |
2863 | ---------- ------ | |
2864 | Total: 2 | |
2865 | Outpatient s w/Unknow n or Expir ed Insuran ce | |
2866 | This optio n allows y ou to prin t a list o f veteran outpatient s with no insurance, expiring insurance (expired o r will exp ire within 30 days), or unknow n insuranc e for a sp ecified da te range. You may in clude any or all of these cate gories. | |
2867 | One, many, or all di visions (i f your sit e is multi divisional ) and clin ics may be included. A subtota l is provi ded for ea ch divisio n/clinic. | |
2868 | This optio n may be u sed to ide ntify thos e patients who shoul d be inter viewed for insurance informati on while v isiting a specified clinic. Th is report may be pri nted for a specified date or r ange of da tes and se nt to the appropriat e clinic f or follow- up. | |
2869 | This outpu t may be v ery time c onsuming a nd should be queued. The margi n width is 132 colum ns. | |
2870 | Sample Out put | |
2871 | OUTPATIENT VISITS FO R VETERANS WITH NO I NSURANCE JUN 1,1992 PA GE 1 | |
2872 | FOR APPOIN TMENTS FRO M MAY 22,1 992 TO JUN 1,1992 | |
2873 | PATIENT NAME PT I D APPT DATE/TIME AGE %SC M ARITAL STA TUS EMPL OYMENT STA TUS | |
2874 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---- | |
2875 | Divi sion: ALBAN Y | |
2876 | Clin ic: DERMA TOLOGY | |
2877 | IBpatie nt,one 000- 11-1111 MAY 22,1992@16 :37 55 40 W IDOW/WIDOW ER EMPL OYED FULL TIME | |
2878 | Addr ess: 555 T EST Te le: 518-55 5-9292 | |
2879 | TROY ,NY 12180 | |
2880 | Empl oyer: ACME CONSTRUCTI ON Te le: 518-55 5-0926 | |
2881 | MAPL E AVE | |
2882 | ALBA NY,NY 1220 8 | |
2883 | _______ __________ ______ | |
2884 | Clinic Subtotal : 1 | |
2885 | Clin ic: ORTHO PEDIC | |
2886 | IBpatie nt,two 000- 22-2222 JUN 1,1992@11: 32 42 0 M ARRIED EMPL OYED FULL TIME | |
2887 | Addr ess: 121 T EST AVE Te le: 518-55 5-0097 | |
2888 | COHO ES,NY 1218 4 | |
2889 | Empl oyer: VAMC ALBANY Te le: 518-55 5-3311 | |
2890 | 113 HOLLAND AV E. | |
2891 | ALBA NY,NY 1220 8 | |
2892 | _______ __________ ______ | |
2893 | Clinic Subtotal : 1 | |
2894 | _______ __________ ______ | |
2895 | Divisio n Subtotal : 2 | |
2896 | _______ __________ ______ | |
2897 | Total : 2 | |
2898 | OUTPATIENT VISITS FO R VETERANS WHOSE INS URANCE IS EXPIRED OR WILL EXPI RE WITHIN 30 DAYS JUN 1,1992 PA GE 1 | |
2899 | FOR APPOIN TMENTS FRO M MAY 22,1 992 TO JUN 1,1992 | |
2900 | PATIENT NAME PT ID APP T DATE/TIM E AGE %SC MARITAL ST ATUS EMP LOYMENT ST ATUS | |
2901 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---- | |
2902 | Div ision: ALB ANY | |
2903 | Cli nic: OPH THALMOLOGY | |
2904 | IBpatie nt,one 00 0-11-1111 MAY 25,1992@1 6:37 35 0 WIDOW/WIDO WER NOT EMPLOYED | |
2905 | Ad dress: 49 T EST AVE T ele: 518-5 55-8374 | |
2906 | TRO Y,NY 12180 | |
2907 | In surance: XYZ INS E xpiration: JUN 1 5,1992 | |
2908 | _______ __________ ______ | |
2909 | Clinic Subtotal : 1 | |
2910 | _______ __________ ______ | |
2911 | Divisio n Subtotal : 1 | |
2912 | _______ __________ ______ | |
2913 | Total : 1 | |
2914 | OUTPATIENT VISITS FO R VETERANS WHOSE INS URANCE IS UNKNOWN JUN 1,1992 PA GE 1 | |
2915 | FOR APPOIN TMENTS FRO M MAY 22,1 992 TO JUN 1,1992 | |
2916 | PATIENT NAME PT I D APPT DATE/TIME AGE %SC M ARITAL STA TUS EMPL OYMENT STA TUS | |
2917 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---- | |
2918 | Divi sion: ALBAN Y | |
2919 | Clin ic: MEDIC AL | |
2920 | IBpatie nt,two 000- 22-2222 MAY 22,1992@16 :37 82 10 W IDOW/WIDOW ER RETI RED | |
2921 | Addr ess: 55 TE ST AVE Tele: 518-555-9 090 | |
2922 | TROY ,NY 12180 | |
2923 | _______ __________ ______ | |
2924 | Clinic Subtotal : 1 | |
2925 | Clin ic: SURGI CAL | |
2926 | IBpatie nt,three 000- 33-3333 MAY 25,1990@07 :00 60 0 M ARRIED EMPL OYED FULL TIME | |
2927 | Addr ess: 256 T ESTING AVE . Tel e: 518-555 -0786 | |
2928 | ALBA NY,NY 1220 8 | |
2929 | Empl oyer: GAVIN 'S SECURIT Y Te le: 518-55 5-7485 | |
2930 | 519 4TH ST | |
2931 | TROY ,NY 12208 | |
2932 | _______ __________ ______ | |
2933 | Clinic Subtotal : 1 | |
2934 | _______ __________ ______ | |
2935 | Divisio n Subtotal : 2 | |
2936 | _______ __________ ______ | |
2937 | Total : 2 | |
2938 | Single Pat ient Categ ory C Bill ing Profil e | |
2939 | The Single Patient C ategory C Billing Pr ofile opti on provide s a list o f all Mean s Test/Cat egory C ch arges with in a speci fied date range for a selected patient. | |
2940 | You will b e prompted for patie nt name, d ate range, and devic e. The def ault at th e "Start w ith DATE" prompt is October 1, 1990. Thi s is the e arliest da te for whi ch charges may be di splayed. | |
2941 | This outpu t displays the date the Catego ry C billi ng clock b egan, bill date, bil l type (in cluding th e treating specialty for inpat ient copay charges), the bill number, bi ll to date (for inpa tient char ges), amou nt of each charge, a nd the tot al charges for the s elected da te range. | |
2942 | Sample Out put | |
2943 | Category C Billing P rofile for IBpatient ,one 0 00-11-1111 | |
2944 | From 02/26 /91 throug h 02/26/92 FE B 10, 1994 @13:56 Page: 1 | |
2945 | BILL DATE BILL TYP E BILL # BILL TO TOT CHA RGE | |
2946 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
2947 | 04/28/91 Begin Ca tegory C B illing Clo ck | |
2948 | 04/28/91 OPT CO PAYMENT L10038 $26 .00 | |
2949 | 09/07/91 INPT P ER DIEM L10085 09/08/9 1 $20 .00 | |
2950 | 09/07/91 INPT C O-PAY (NEU ) L10084 09/08/9 1 $628 .00 | |
2951 | 02/10/92 OPT CO PAYMENT L10038 $30 .00 | |
2952 | 02/24/92 OPT CO PAYMENT L10038 $30 .00 | |
2953 | -------- --- | |
2954 | $774 .00 | |
2955 | Third Part y Billing Menu | |
2956 | Print Bill Addendum Sheet | |
2957 | This optio n is used to print t he addendu m sheets t hat may ac company HC FA-1500 pr escription refill or prostheti c bills. T he addendu m contains informati on that co uld not fi t on the b ill form. | |
2958 | Prescripti on refill data provi ded on the addendum sheet may include pr escription number, r efill date , drug, qu antity, # of days’ s upply, and the Natio nal Drug C ode (NDC) #. Prosthe tic data w ill includ e the date delivered to the pa tient and the item. | |
2959 | In order f or the bil l addendum s to autom atically p rint for e very HCFA- 1500 bill with presc ription re fills or p rosthetic items, the billing d efault pri nter for t he BILL AD DENDUM for m type mus t be set t hrough the Select De fault Devi ce for For ms option found on t he System Manager's Integrated Billing M enu. | |
2960 | Sample Out put | |
2961 | BILL ADDEN DUM FOR IB patient,on e - T10 088 J AN 28, 199 4 11:00 PAGE 1 | |
2962 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
2963 | PRESCRIPTI ON REFILLS : | |
2964 | 481 Jan 0 3, 1994 D IGOXIN 0.2 5MG Q TY: 60 D AYS SUPPLY : 30 NDC #: 19-929- 922 | |
2965 | 432 Jan 1 0, 1994 N APROXEX 25 0MG S.T. Q TY: 10 D AYS SUPPLY : 10 NDC #: 22-834- 871 | |
2966 | PROSTHETIC ITEMS: | |
2967 | JAN 02, 19 94 WAL KER-FOLDIN G-WHEELED | |
2968 | JAN 02, 19 94 CAN E-ALL OTHE R | |
2969 | Authorize Bill Gener ation | |
2970 | The Author ize Bill G eneration option is used to au thorize th e printing of third party bill s and the release of the infor mation to Fiscal Ser vice. | |
2971 | When a bil ling recor d is selec ted, the s ystem perf orms a che ck to dete rmine if a nother use r is curre ntly proce ssing the same recor d. If not, the syste m will loc k the reco rd. If the lock is u nsuccessfu l, it mean s another user alrea dy has tha t record l ocked and the follow ing messag e will be displayed. | |
2972 | "No furthe r processi ng of this record pe rmitted at this time . Record l ocked by a nother use r. Try aga in later." | |
2973 | A final re view/edit of the inf ormation i n the bill ing record may be pe rformed th rough this option. T he data is arranged so that it may be vi ewed and e dited thro ugh variou s screens. The data is grouped into sect ions for e diting. Ea ch section is labele d with a n umber to t he left of the data items. Dat a group nu mbers encl osed by br ackets ([ ]) may be edited whi le those e nclosed by arrows (< >) may no t. The pat ient's nam e, social security n umber, bil l number, the bill c lassificat ion (Inpat ient or Ou tpatient), and the s creen numb er appear at the top of every screen. A <?> entere d at the p rompt whic h appears at the bot tom of eve ry screen will provi de you wit h a HELP S CREEN for that parti cular scre en. The HE LP SCREEN lists the data group s found on that scre en, and al so provide s the name and numbe r of each available screen in the option . For more detailed documentat ion on edi ting a bil l, please see the En ter/Edit B illing Inf ormation o ption docu mentation. | |
2974 | For a deta iled expla nation of all screen s, please see the Su pplement a t the end of this se ction. | |
2975 | The CAN IN ITIATOR AU THORIZE? s ite parame ter and th e IB AUTHO RIZE secur ity key af fect the p rompts whi ch appear at the end of this o ption. | |
2976 | CAN INITIA TOR AUTHOR IZE? | |
2977 | If set to YES, the u ser who in itiated th e bill can authorize generatio n of billi ng form (i f required security key held). If this p arameter i s set to N O, the ini tiator of the bill w ill not be allowed t o authoriz e its gene ration. | |
2978 | IB AUTHORI ZE | |
2979 | Allows the holder to authorize generatio n of bills . You must hold this key to ac cess this option. | |
2980 | The UB-82, UB-92, an d HCFA-150 0 billing forms are the output which may be produc ed from th is option. The data elements a nd design of these f orms has b een determ ined by th e National Uniform B illing Com mittee and has been adapted to meet the specific n eeds of th e Departme nt of Vete rans Affai rs. They m ust be gen erated (pr inted) at 80 charact ers per li ne at 10 p itch. Copi es of the billing fo rms are in cluded in the Print Bill optio n document ation. | |
2981 | Enter/Edit Billing I nformation | |
2982 | The IB EDI T security key is re quired to access thi s option. | |
2983 | The Enter/ Edit Billi ng Informa tion optio n is used to enter t he informa tion requi red to gen erate a th ird party bill and t o edit exi sting bill ing inform ation. A n ew bill ma y be enter ed or an e xisting bi ll can be edited. On ly existin g bills th at have no t been aut horized or cancelled may be ed ited. Once a bill ha s been fil ed (billin g record n umber esta blished), it cannot be deleted . The bill may be ca ncelled th rough the Cancel Bil l option. | |
2984 | If the sel ected pati ent's elig ibility ha s not been verified and the AS K HINQ IN MCCR param eter is se t to YES, the user w ill have t he opportu nity to en ter a HINQ (Hospital Inquiry) request in to the HIN Q Suspense File. Thi s request will be tr ansmitted to the Vet erans Bene fits Admin istration to obtain the patien t's eligib ility info rmation. I f Means Te st data su ch as cate gory, Mean s Test las t applied, and date Means Test completed is availa ble, it wi ll be disp layed afte r the pati ent name o r bill num ber has be en entered . | |
2985 | When enter ing a new bill, the system wil l prompt f or EVENT D ATE. When billing fo r multiple outpatien t visits, the date o f the init ial visit is used. F or an inpa tient bill , the date of the ad mission is used. If an interim bill is b eing issue d, the EVE NT DATE sh ould be th e date of admission for that e pisode of care. | |
2986 | The Medica l Care Cos t Recovery data is a rranged so that it m ay be view ed and edi ted throug h various screens. T he data is grouped i nto sectio ns for edi ting. Each section i s labeled with a num ber to the left of t he data it ems. Data group numb ers enclos ed by brac kets ([ ]) may be ed ited while those enc losed by a rrows (< > ) may not. The patie nt's name, social se curity num ber, bill number, th e bill cla ssificatio n (Inpatie nt or Outp atient) an d the scre en number appear at the top of every scr een. A <?> entered a t the prom pt which a ppears at the bottom of every screen wil l provide you with a HELP SCRE EN for tha t particul ar screen. The HELP SCREEN lis ts the dat a groups f ound on th at screen and also p rovides th e name and number of each avai lable scre en in the option. | |
2987 | Cancel Bil l | |
2988 | The IB AUT HORIZE sec urity key is require d to acces s this opt ion. | |
2989 | The Cancel Bill opti on allows the user t o cancel a bill at a ny point i n the bill ing proces s. Once th e bill is cancelled, there is no way to view the d ata contai ned in tha t bill. | |
2990 | If you sel ect a bill which has been prev iously can celled, ce rtain prom pts will a ppear with defaults. | |
2991 | A mail gro up may be specified (through t he site pa rameters) so that ev ery time a bill is c ancelled, all member s of this group are notified t hrough ele ctronic ma il. If thi s group is not speci fied, only the billi ng supervi sor and th e user who cancelled the bill will be re cipients o f the mess age. An ex ample of t his messag e may be f ound in th e Example Section of this opti on. | |
2992 | When a bil l is cance lled, it i s removed as a Prior Bill Numb er from pr evious bil ls in the Primary/Se condary/Te rtiary Ser ies. | |
2993 | Sample Mai l Message | |
2994 | Subj: MAS UB-92 BILL CANCELLAT ION BULLET IN [#1207 74] 22 Mar 95 13:22 11 Lines | |
2995 | From: EMPL OYEE (ALBA NY ISC) i n 'IN' bas ket. Page 1 | |
2996 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
2997 | The follow ing UB-92 bill has b een cancel led: | |
2998 | Bill Numbe r: N10276 | |
2999 | Patient Na me: IBpati ent,one P T ID: 000- 11-1111 | |
3000 | Event Date : MAR 12,1 995@08:00 | |
3001 | Reason for cancellat ion: Patie nt is serv ice connec ted. | |
3002 | Status whe n cancelle d: CANCELL ED - Not passed to AR | |
3003 | Select MES SAGE Actio n: IGNORE (in IN bas ket)// | |
3004 | Copy and C ancel | |
3005 | The IB AUT HORIZE sec urity key is require d to acces s this opt ion. | |
3006 | The CAN IN ITIATOR AU THORIZE? s ite parame ter affect s this opt ion. | |
3007 | This optio n is used to cancel a bill, co py all the informati on into a new bill, and edit t he new bil l where ne cessary. T he status of the new bill is E NTERED/NOT REVIEWED. This proc ess preven ts having to use the Enter/Edi t Billing Informatio n option t o create a new bill which woul d require re-entry o f ALL data . Bills re turned fro m Accounts Receivabl e with min or inconsi stencies c an quickly and easil y be corre cted throu gh this op tion. | |
3008 | The Medica l Care Cos t Recovery data is a rranged so that it m ay be view ed and edi ted throug h various screens. T he data is grouped i nto sectio ns for edi ting. Each section i s labeled with a num ber to the left of t he data it ems. Data group numb ers enclos ed by brac kets ([ ]) may be ed ited while those enc losed by a rrows (< > ) may not. The patie nt's name, social se curity num ber, bill number, th e bill cla ssificatio n (Inpatie nt or Outp atient), a nd the scr een number appear at the top o f every sc reen. A <? > entered at the pro mpt which appears at the botto m of every screen wi ll provide you with a HELP SCR EEN for th at particu lar screen . The HELP SCREEN li sts the da ta groups found on t hat screen and also provides t he name an d number o f each ava ilable scr een in the option. | |
3009 | A mail gro up may be specified (through t he site pa rameters) so that ev ery time a bill is d isapproved during th e authoriz ation phas e of the b illing pro cess, or s uspended d uring the generation phase, al l members of this gr oup are no tified via electroni c mail. If this grou p is not s pecified, only the b illing sup ervisor, t he initiat or of the billing re cord, and the user w ho disappr oved or ge nerated th e bill wil l be recip ients of t he message . Examples of messag es may be found in t he Enter/E dit Billin g Informat ion docume ntation. A n explanat ion of how the bill mailing ad dress fiel d is deter mined is p rovided in the Suppl ement at t he end of this optio n document ation. | |
3010 | The UB-82, UB-92, an d HCFA-150 0 billing forms are the output which may be produc ed from th is option. The data elements a nd design of both fo rms has be en determi ned by the National Uniform Bi lling Comm ittee and has been a dapted to meet the s pecific ne eds of the Departmen t of Veter ans Affair s. Both mu st be gene rated (pri nted) at 8 0 characte rs per lin e at 10 pi tch. Copie s of the b illing for ms are inc luded in t he Print B ill option documenta tion. | |
3011 | Please see the Suppl ement foun d at the e nd of this section f or descrip tions of t he paramet er and sec urity key as well as a descrip tion of mo st fields included o n the bill ing screen s. | |
3012 | Delete Aut o Biller R esults | |
3013 | This optio n is used to delete entries fr om the Aut omated Bil ler Errors /Comments report pri or to a us er-selecte d date for any entry not assoc iated with a bill. | |
3014 | The auto b iller chec ks a varie ty of data elements concerning an event before a b ill is cre ated. The auto bille r will onl y create r eimbursabl e insuranc e bills, s o the pati ent must b e a vetera n with act ive insura nce. The d isposition prior to the event date is ch ecked and if the nee d for care was relat ed to an a ccident or the veter an's occup ation, the auto bill er will no t create a bill. Sin ce dental is usually billed se parately, any event with a den tal clinic stop will also be e xcluded. T he auto bi ller also checks to ensure tha t the even t has not already be en billed. | |
3015 | Entries ar e removed from the A utomated B iller Erro rs/ Commen ts report in two way s. If a bi ll was cre ated for t he event, the bill's entry is removed fr om the rep ort when t he bill is either pr inted or c ancelled. If a bill was not cr eated, thi s option m ust be use d to delet e the entr y. | |
3016 | You will b e prompted for a dat e. The def ault value provided is three d ays previo us to the current da te. | |
3017 | Print Bill | |
3018 | The Print Bill optio n is used to print t hird party bills on the approp riate form (UB-82/92 or HCFA-1 500) after all requi red inform ation has been input and the b illing rec ord has be en authori zed. You m ay also re print a pr eviously p rinted bil l. | |
3019 | A final re view of th e informat ion in the billing r ecord may be perform ed through this opti on. The da ta is arra nged so th at it may be viewed through va rious scre ens. The p atient's n ame, socia l security number, b ill number , the bill classific ation (Inp atient or Outpatient ), and the screen nu mber appea r at the t op of ever y screen. A <?> ente red at the prompt wh ich appear s at the b ottom of e ach screen will prov ide you wi th a HELP SCREEN for that part icular scr een. The H ELP SCREEN lists the name and number of each avail able scree n for the bill you a re working on and th e data gro ups for th at particu lar screen . | |
3020 | No editing of the da ta is allo wed in thi s option. Data can b e edited t hrough the Enter/Edi t Billing Informatio n option, if necessa ry. | |
3021 | The UB-82, UB-92, an d HCFA-150 0 billing forms are the output which may be produc ed from th is option. The data elements a nd design of these f orms has b een determ ined by th e National Uniform B illing Com mittee and has been adapted to meet the specific n eeds of th e Departme nt of Vete rans Affai rs. They m ust be gen erated (pr inted) at 80 charact ers per li ne at 10 p itch. | |
3022 | Patient Bi lling Inqu iry | |
3023 | The Patien t Billing Inquiry op tion allow s you to d isplay/pri nt informa tion on an y reimburs able insur ance bill, pharmacy copay, or Means Test bill. The informati on provide d differs depending on the bil l type. | |
3024 | For reimbu rsable ins urance bil ls, the in formation provided i ncludes bi ll status, rate type , reason c ancelled ( if applica ble), admi ssion date (for inpa tients), a ll outpati ent visits (for outp atients), charges, a mount paid , statemen t to and f rom dates, each acti on that wa s taken on that bill , and the user who p erformed i t. If you choose to view the f ull inquir y, address informati on from th e PATIENT file and t he bill is also prov ided. | |
3025 | The inform ation prov ided in a brief inqu iry for Ph armacy Cop ay charges includes date of ch arge, type of charge (syntax: patient el igibility - action t ype - stat us), brief descripti on (syntax : prescrip tion # - d rug name - # of unit s), amount of charge or credit , and an e xplanation of any ch arge remov ed, if app licable. A full inqu iry, in ad dition to the inform ation prov ided in th e brief in quiry, pro vides info rmation fr om the PRE SCRIPTION file, as w ell as add ress infor mation on the patien t. | |
3026 | The displa y/output f or Means T est bills is very si milar to t he brief i nquiry for Pharmacy Copay. It includes t he date of charge, c harge type , brief de scription, units, an d amount o f charge. A full inq uiry also includes a ddress inf ormation o n the pati ent. | |
3027 | Sample Out puts | |
3028 | Full inqui ry for a r eimbursabl e insuranc e bill. | |
3029 | IBpatient, one 000-11-111 1 500- 000303 FEB 19, 19 92@14:17 PAGE: 1 | |
3030 | ========== ========== ========== ========== ========== ========== ========== ======== | |
3031 | Bill Statu s : PRI NTED - REC ORD IS UNE DITABLE | |
3032 | Rate Type : REI MBURSABLE INSURANCE | |
3033 | Op Visit d ates : APR 14,1992 | |
3034 | Charges : $14 8.00 | |
3035 | LESS Offse t : $3 0.00 | |
3036 | Bill Total : $11 8.00 | |
3037 | Statement From : APR 14,1992 | |
3038 | Statement To : APR 14,1992 | |
3039 | Entered : APR 15, 1992 by ED | |
3040 | First Revi ewed : APR 16, 1992 by SUE | |
3041 | Last Revie wed : APR 16, 1992 by SUE | |
3042 | Authorized : APR 16, 1992 by SUE | |
3043 | Last Print ed : APR 16, 1992 by GARY | |
3044 | IBpatient, one 000-11-111 1 500- 000303 F EB 19, 199 2@14:17 PAGE: 2 | |
3045 | ========== ========== ========== ========== ========== ========== ========== ======== | |
3046 | *** ADDRES S INFORMAT ION *** | |
3047 | Patient Ad dress: 117 TEST DRIV E | |
3048 | CO LONIE, NEW YORK | |
3049 | 51 8-786-0990 | |
3050 | Mailing Ad dress: ABC | |
3051 | 12 62 TEST AV ENUE | |
3052 | LO S ANGELES, CALIFORNI A 12345 | |
3053 | Ins Co. Ad dress: ABC | |
3054 | 12 62 TEST AV ENUE | |
3055 | LO S ANGELES, CALIFORNI A 12345 | |
3056 | 61 8-567-5555 | |
3057 | Full inqui ry for a M eans Test bill. | |
3058 | IBpatient, one 0 00-11-1111 500-L1009 8 FEB 24 , 1992@09: 09 PAGE: 1 | |
3059 | ========== ========== ========== ========== ========== ========== ========== ======== | |
3060 | FEB 14, 19 92 INPT COPAY (MED ) NEW INP T CO-PAY ( MED) 1 $200.00 | |
3061 | FEB 20, 19 92 INPT COPAY (MED ) CAN INP T CO-PAY ( MED) 1 ( $200.00) | |
3062 | Charg e Removal Reason: MT CHARGE ED ITED | |
3063 | ---- -------- | |
3064 | $0.00 | |
3065 | IBpatient, one 0 00-11-1111 500-L1009 8 FEB 24 , 1992@09: 09 PAGE: 2 | |
3066 | ========== ========== ========== ========== ========== ========== ========== ======== | |
3067 | *** A DDRESS INF ORMATION * ** | |
3068 | Patient Ad dress: 28 TEST RD | |
3069 | EA STHAM, MAS SACHUSETTS | |
3070 | 50 8-321-4321 | |
3071 | Brief inqu iry for a Pharmacy C opay bill. | |
3072 | IBpatient, one 000-11-111 1 500 -M10004 FEB 24, 19 92@09:18 PAGE: 1 | |
3073 | DATE CHARG E TYPE BRIE F DESCRIPT ION UNITS CHARGE | |
3074 | ========== ========== ========== ========== ========== ========== ========== ======== | |
3075 | MAR 15, 19 91 SC RX COPAY NEW RX# 111128-REF 5-ENDU 3 $6.00 | |
3076 | MAR 15, 19 91 SC RX COPAY NEW RX# 111199 999 9-CLONI 4 $8.00 | |
3077 | ---- -------- | |
3078 | $14.00 | |
3079 | Print Auto Biller Re sults | |
3080 | This optio n is used to print t he Automat ed Biller Errors/Com ments repo rt. The re sults of t he executi on of the auto bille r are list ed on this report. F or Claims Tracking e vents for which the auto bille r attempte d to creat e a bill, this repor t will lis t either t he reason a bill was not creat ed or the bill numbe r and any comments o n the bill . | |
3081 | The auto b iller chec ks a varie ty of data elements concerning an event before a b ill is cre ated. The auto bille r will onl y create r eimbursabl e insuranc e bills, s o the pati ent must b e a vetera n with act ive insura nce. The d isposition prior to the event date is ch ecked and if the nee d for care was relat ed to an a ccident or the veter an's occup ation, the auto bill er will no t create a bill. Sin ce dental is usually billed se parately, any event with a den tal clinic stop will also be e xcluded. T he auto bi ller also checks to ensure tha t the even t has not already be en billed. | |
3082 | Entries ar e removed from the A utomated B iller Erro rs/ Commen ts report in two way s. If a bi ll was cre ated for t he event, the bill's entry is removed fr om the rep ort when t he bill is either pr inted or c ancelled. If a bill was not cr eated, the Delete Au to Biller Results op tion must be used to delete th e entry. | |
3083 | The bills will be gr ouped on t he output by the dat e entered. The follo wing infor mation may appear on the repor t: patient name, eve nt type, e pisode dat e, bill nu mber, bill status, t imeframe o f bill, an d statemen t covers f rom and to dates. Co mments rel ating to i ndividual bills may also be pr ovided. | |
3084 | You will b e prompted for a dat e range, a patient r ange, and a device. | |
3085 | Sample Out put | |
3086 | AUTOMATED BILLER ERR ORS/COMMEN TS FOR Nov 1, 1993 - Nov 10, 1 993 DEC 10,19 93 13:19 PAGE 1 | |
3087 | EVENT BILL TIMEFRAM E OF STATEMEN T STAT EMENT | |
3088 | PATIENT TYPE EPI SODE DATE NUMBER STATUS BILL COVERS F ROM COVE RS TO | |
3089 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3090 | DA TE ENTERED : NOV 1,1 993 | |
3091 | IBpatient, one B6711 INPA SEP 1,1993 17:07 N10003 ENTERED INTERIM - FIRST SEP 1,1 993 SEP 30,1993 | |
3092 | IBpatient, two C4949 INPA SEP 1,1993 01:00 N10005 ENTERED INTERIM - FIRST SEP 1,1 993 SEP 30,1993 | |
3093 | IBpatient, three K2123 INPA SEP 14,1993 11:42 N10002 ENTERED ADMIT TH RU DISC SEP 14,1 993 SEP 14,1993 | |
3094 | No billable D ays. | |
3095 | DA TE ENTERED : NOV 3,1 993 | |
3096 | IBpatient, one B6711 INPA SEP 1,1993 17:07 N10023 ENTERED INTERIM - CONTI OCT 1,1 993 OCT 31,1993 | |
3097 | IBpatient, one C4949 INPA SEP 1,1993 01:00 N10025 ENTERED INTERIM - CONTI OCT 1,1 993 OCT 31,1993 | |
3098 | DA TE ENTERED : NOV 8,1 993 | |
3099 | IBpatient, one D3333 INPA SEP 15,1993 12:30 N10027 ENTERED INTERIM - CONTI OCT 1,1 993 OCT 31,1993 | |
3100 | Print Auth orized Bil ls | |
3101 | The Print Authorized Bills opt ion will p rint all b ills with a status o f AUTHORIZ ED in a us er-specifi ed order. The bills may be sor ted by zip code, ins urance com pany name, and patie nt name. | |
3102 | You may en ter <??> a t the "Beg in printin g bills?" prompt to see a list of all th e bills wh ich will p rint when this optio n is utili zed. The l ist will s how bill n umber, pat ient name, event dat e, inpatie nt or outp atient bil l, bill ty pe, bill s tatus (AUT HORIZED), and bill f orm type. If this li st is quit e lengthy, you may w ish to que ue the out put to pri nt during off hours. | |
3103 | You are no t prompted for a dev ice in thi s option. Each bill form type will print on the bi lling defa ult printe r specifie d through the Select Default D evice for Forms opti on on the System Man ager's Int egrated Bi lling Menu . Any form type not set up the re, will n ot print w hen utiliz ing this o ption. | |
3104 | Return Bil l Menu | |
3105 | Edit Retur ned Bill | |
3106 | The IB EDI T security key is re quired to access thi s option. | |
3107 | The Edit R eturned Bi ll option is used to correct b ills with a status o f RETURNED FROM AR ( NEW) which have been returned to MAS fro m Accounts Receivabl e. You sho uld genera te the ret urned bill report th rough the Returned B ill List o ption befo re utilizi ng this op tion. That report co ntains a l isting of all bills which have been retu rned to MA S providin g the reas on returne d for each . This inf ormation i s required to make t he appropr iate corre ctions to each bill. The bill number app ears on th at report preceded b y the stat ion number . The stat ion number should no t be enter ed when se lecting th e bill for editing. | |
3108 | After edit ing, the o ption allo ws you to return the bill to A ccounts Re ceivable a nd print t he bill if the requi red securi ty key is held. It s hould be n oted that returned b ills with a status o f RETURNED FOR AMEND MENT canno t be edite d through this optio n and must be correc ted throug h the Copy and Cance l option. | |
3109 | Supplement al informa tion such as sample billing sc reens is p rovided in the Suppl ement at t he end of this secti on. | |
3110 | Note: It i s possible to edit a returned bill if it is not an "electron ically tra nsmittable " bill. Fo r returned electroni cally tran smittable bills/clai ms, the IB COPY AND CANCEL opt ion will n eed to be used. | |
3111 | Returned B ill List | |
3112 | The Return ed Bill Li st option prints a l isting of all bills that have been retur ned to MAS from Acco unts Recei vable. Whe n you log on the Bil ling Syste m, you may see the f ollowing m essage. | |
3113 | "You have {#} bill(s ) returned from Fisc al (New Bi ll)." | |
3114 | When this occurs, yo u need to generate t he output produced b y this opt ion to obt ain a list ing of the returned bills. | |
3115 | The follow ing data i tems may b e provided for each bill on th e list: bi ll number, payer, pr evious and current s tatus of b ill, origi nal bill a mount, ser vice which approved bill and w hen, retur ned by, re ason retur ned, and d ate return ed. The bi ll number appears on this repo rt precede d by the s tation num ber. The s tation num ber should not be en tered when selecting the bill for editin g. | |
3116 | You will n eed this r eport when using the Edit Retu rned Bill option to determine why the bi ll was ret urned and what needs to be cor rected. On ce the bil ls have be en correct ed and sen t back to Accounts R eceivable, they no l onger will appear on the Retur ned Bill L ist. | |
3117 | Sample Out put | |
3118 | << BILL RE TURNED FRO M AR >> | |
3119 | ========== ========== ========== ========== ========== ========== ========== ====== | |
3120 | BILL NO.: 500-90032A PA YER: ABC | |
3121 | PREV. STAT US: NEW BI LL C URR. STATU S: RETURNE D FROM AR (NEW) | |
3122 | ORIGINAL A MOUNT: $70 S ERVICE: ME DICAL ADMI NISTRATION | |
3123 | << SERV ICE >> | |
3124 | APPROV. BY : JAMES D ATE: JUL 2 ,1990 | |
3125 | << FISC AL >> | |
3126 | RETN'D BY: ALAN DA TE: JUL 5 ,1990 | |
3127 | RETN'D REA SON: | |
3128 | RETURNE D FOR CORR ECT RATES | |
3129 | ========== ========== ========== ========== ========== ========== ========== ====== | |
3130 | << BILL RE TURNED FRO M AR >> | |
3131 | ========== ========== ========== ========== ========== ========== ========== ====== | |
3132 | BILL NO.: 500-T00006 P AYER: ABC | |
3133 | PREV. STAT US: NEW BI LL C URR. STATU S: RETURNE D FROM AR (NEW) | |
3134 | ORIGINAL A MOUNT: $67 3 S ERVICE: ME DICAL ADMI NISTRATION | |
3135 | << SERV ICE >> | |
3136 | APPROV. BY : JAMES D ATE: JUL 2 ,1990 | |
3137 | << FISC AL >> | |
3138 | RETN'D BY: ALAN D ATE: JUL 5,1990 | |
3139 | RETN'D REA SON: | |
3140 | RETURNE D FOR CORR ECT INS AD DRESS | |
3141 | Return Bil l to A/R | |
3142 | The IB AUT HORIZE sec urity key is require d to acces s this opt ion. | |
3143 | The Return Bill to A /R option is used to send bill s that hav e been ret urned to M AS back to Accounts Receivable after the y have bee n correcte d. Editing is not al lowed in t his option . All edit ing is don e through the Edit R eturned Bi ll option; however, all billin g screens associated with the bill may b e displaye d for view ing. | |
3144 | UB-82 Test Pattern P rint | |
3145 | The UB-82 Test Patte rn Print o ption is u sed to pri nt a test pattern on the UB-82 billing f orm so tha t the form alignment in the pr inter may be checked . This wil l insure t hat each d ata item p rints in t he correct block on the form. | |
3146 | The test p attern dis plays whic h data ele ment shoul d appear i n the diff erent bloc ks of the billing fo rm. For ex ample, in Block 3 - Patient Co ntrol Numb er, "BILL NUMBER" wi ll be prin ted in tha t block wh en this op tion is ut ilized. | |
3147 | Sample Out put | |
3148 | *** UB-82 TES T PATTERN *** | |
3149 | AGENT CASH IER | |
3150 | AGENT CASH IER STREET F. L. 2 BIL L NUMBER XXX | |
3151 | CITY STATE ZIP | |
3152 | PHONE # BC/BS # FE D TAX # F. L. 9 | |
3153 | PATIENT NA ME PATIENT ADDRESS | |
3154 | PT DOB X X ADM DT HR X X AH DH XX FROM TO F. L. 27 | |
3155 | OC DATE OC DATE OC DATE OC DA TE OC D ATE | |
3156 | MAILING AD DRESS NAME | |
3157 | STREET ADD RESS 1 CC CC CC C C CC F. L. 45 | |
3158 | STREET ADD RESS 2 | |
3159 | STREET ADD RESS 3 | |
3160 | CITY STAT E ZIP | |
3161 | 000 DAYS M EDICAL CAR E | |
3162 | REV CODE 1 000.00 000 00 0000.00 | |
3163 | REV CODE 2 000.00 000 00 0000.00 | |
3164 | REV CODE 3 000.00 000 00 0000.00 | |
3165 | SUBTOTAL 00000.00 | |
3166 | TOTAL 00000.00 | |
3167 | PAYER 1 X X | |
3168 | PAYER 2 X X | |
3169 | PAYER 3 X X | |
3170 | INSURED NA ME 1 X XX P OLICY # 1 GROU P NAME 1 GROUP # 1 | |
3171 | INSURED NA ME 2 X XX P OLICY # 2 GROU P NAME 2 GROUP # 2 | |
3172 | INSURED NA ME 3 X XX P OLICY # 3 GROU P NAME 3 GROUP # 3 | |
3173 | X X EMPLOY ER NAME CITY ST ATE ZIP | |
3174 | PRINCIPAL DIAGNOSIS CODE CODE CO DE CODE CODE | |
3175 | X PRINCIP AL PROCEDU RE CODE DATE COD E DATE CO DE DATE | |
3176 | TX. AUTH . Dept. Ve terans Aff airs F. L. 93 | |
3177 | Patient ID : XXXXXXXX X | |
3178 | Bill Type: XXXX XXXX XXX | |
3179 | UB-82 TEST PATTERN | |
3180 | **TEST PAT TERN** UB-8 2 SIGNER N AME | |
3181 | UB-8 2 SIGNER T ITLE D ATE | |
3182 | UB-92 Test Pattern P rint | |
3183 | The UB-92 Test Patte rn Print o ption is u sed to pri nt a test pattern on the UB-92 billing f orm so tha t the form alignment in the pr inter may be checked . This wil l insure t hat each d ata item p rints in t he correct block on the form. | |
3184 | Sample Out put | |
3185 | ##SR *** UB -92 TEST P ATTERN *** | |
3186 | AGENT CASH IER | |
3187 | AGENT CASH IER STREET BN XXX XXX | |
3188 | CITY STAT E ZIP | |
3189 | PHONE # TAX# XXXX 5/1 /93 5/4/93 | |
3190 | PATIENT NA ME PT SHORT ADDRESS | |
3191 | DOB X X DATE HR X X DR ST 000- 00-0000 CC CC CC CC CC C C CC | |
3192 | OC DATE OC DATE OC DATE OC DATE OC DATE | |
3193 | RESPONSIBL E PARTY'S NAME | |
3194 | STREET ADD RESS 1 | |
3195 | STREET ADD RESS 2 | |
3196 | STREET ADD RESS 3 | |
3197 | CITY STAT E ZIP | |
3198 | CD1 REV C ODE descri ption xx xxx x.xx | |
3199 | CD2 REV C ODE descri ption xx xxx x.xx | |
3200 | CD3 REV C ODE descri ption xx xxx x.xx | |
3201 | Subto tal xxx x.xx | |
3202 | Total xxx x.xx | |
3203 | For your i nformation , even tho ugh the pa tient may be otherwi se eligibl e | |
3204 | for Medica re, no pay ment may b e made und er Medicar e to any F ederal pro vider | |
3205 | of medical care or s ervices an d may not be used as a reason for non-pa yment. | |
3206 | Please mak e your che ck payable to the De partment o f Veterans Affairs a nd | |
3207 | send to th e address listed abo ve. | |
3208 | The unders igned cert ifies that treatment rendered is not for a | |
3209 | service co nnected di sability. | |
3210 | Name of Pa yer 1 Prov ider # x x | |
3211 | Name of Pa yer 2 Prov ider # x x | |
3212 | Name of Pa yer 3 Prov ider # x x | |
3213 | Insured's Name 1 x I nsurance # G roup Name Group # | |
3214 | Insured's Name 2 x I nsurance # G roup Name Group # | |
3215 | Insured's Name 3 x I nsurance # G roup Name Group # | |
3216 | Treatment Auth. Cd x Employer Name Emp loyer Loca tion | |
3217 | x Employer Name Emp loyer Loca tion | |
3218 | x Employer Name Emp loyer Loca tion | |
3219 | PDX Dx Cd Dx Cd Dx Cd Dx Cd Dx Cd Dx Cd D x Cd Dx C d ADMT D X | |
3220 | P-code mmddyy P- code mmdd yy P-code mmddyy Attendin g Phys. ID # | |
3221 | P-code mmddyy P- code mmdd yy P-code mmddyy Other Ph ys. ID# | |
3222 | Pat ient ID#: xxx-xx-xxx x | |
3223 | Bill Type: xxx xxxxx x | |
3224 | UB 92 TEST PATTERN Provider R epresentat ive DATE | |
3225 | *** commen t *** | |
3226 | HCFA-1500 Test Patte rn Print | |
3227 | This optio n allows y ou to prin t a test p attern on the HCFA-1 500 form i n order fo r the form alignment in the pr inter to b e checked. The test pattern di splays whi ch data el ement shou ld appear in the dif ferent blo cks of the billing f orm. This insures th at each da ta item pr ints in th e correct block on t he form. | |
3228 | Sample Out put | |
3229 | INSURANCE CARRIER NA ME | |
3230 | CARRIER AD DRESS LINE 1 | |
3231 | CARRIER AD DRESS LINE 2 | |
3232 | CARRIER AD DRESS LINE 3 | |
3233 | CARRIER CI TY, STATE ZIP | |
3234 | S UBSCRIBER ID# | |
3235 | PATIENT NA ME MM DD YY I NSURED'S N AME | |
3236 | PATIENT AD DRESS STRE ET I NSURED'S A DDRESS STR EET | |
3237 | PATIENT AD DRESS CITY ST I NSURED'S A DDRESS CIT Y ST | |
3238 | PT ZIP COD E 999 99 9-9999 I NS ZIP COD E 999 99 9-9999 | |
3239 | OTHER INSU RED'S NAME I NSURED'S P OLICY GROU P | |
3240 | OTHER POLI CY NUMBER MM DD Y Y | |
3241 | MM DD YY ST I NSURED'S E MPLOYER | |
3242 | OTHER'S EM PLOYER I NSURANCE P LAN NAME | |
3243 | OTHER'S IN SURANCE PL AN | |
3244 | MM DD YY MM D D YY MM DD Y Y MM DD YY | |
3245 | REFERRING PHYSICIAN PHY SICIAN ID MM DD Y Y MM DD YY | |
3246 | 9999.99 9999.99 | |
3247 | X99.99 X 99.99 | |
3248 | X99.99 X 99.99 | |
3249 | MM DD YY M M DD YY CPT MODIF DIAG 9999.99 BC/BS# | |
3250 | MM DD YY M M DD YY CPT MODIF DIAG 9999.99 BC/BS# | |
3251 | FEDERAL TA X ID PAT ACCT # 9999.99 9999.99 9999.99 | |
3252 | VAMC A GENT CASHI ER (999) 999-9999 | |
3253 | STREET A DDRESS S TREET ADDR ESS | |
3254 | CITY, ST ATE ZIP C ITY, STATE ZIP | |
3255 | Outpatient Visit Dat e Inquiry | |
3256 | The Outpat ient Visit Date Inqu iry option allows yo u to displ ay informa tion on an y outpatie nt insuran ce bill fo r a select ed patient . You will be prompt ed for a p atient nam e and an o utpatient visit date . You may select any patient w ith billed outpatien t visits. <??> may b e entered at the sec ond prompt for a lis t of bille d visits f or the sel ected pati ent. | |
3257 | The inform ation prov ided inclu des bill s tatus, rat e type, re ason cance lled (if a pplicable) , outpatie nt visit d ate, charg es, amount paid, sta tement fro m and to d ates, each action th at was tak en on that bill, the date, and the user who perfor med it. | |
3258 | Sample Out put | |
3259 | IBpatient, one 000-11-111 1 500 -L10171 MAR 19, 1 992@14:17 PAGE: 1 | |
3260 | ========== ========== ========== ========== ========== ========== ========== ======= | |
3261 | Bill Statu s : CAN CELLED - R ECORD IS U NEDITABLE | |
3262 | Rate Type : REI MBURSABLE INS. | |
3263 | Reason Can celed: Wri te off | |
3264 | Op Visit d ates : JAN 25,1992 | |
3265 | Charges : $14 8.00 | |
3266 | LESS Offse t : $3 0.00 | |
3267 | Bill Total : $11 8.00 | |
3268 | Statement From : JAN 25,1991 | |
3269 | Statement To : JAN 25,1991 | |
3270 | Entered : FEB 15, 1991 by EDWARD | |
3271 | First Revi ewed : FEB 16, 1991 by SUE | |
3272 | Last Revie wed : FEB 16, 1991 by SUE | |
3273 | Authorized : FEB 16, 1991 by SUE | |
3274 | Last Print ed : FEB 16, 1991 by GARY | |
3275 | Cancelled : MAR 6, 1992 by EMPLOYE E | |
3276 | Patient In surance Me nu | |
3277 | Patient In surance In fo View/Ed it | |
3278 | The Patien t Insuranc e Info Vie w/Edit opt ion is use d to look at a patie nt's insur ance infor mation and edit that data, if necessary. The syste m groups i nformation that is s pecific to the insur ance compa ny, specif ic to the patient, s pecific to the group plan, spe cific to t he annual benefits a vailable, and the an nual benef its alread y used. Th is option also displ ays eIV Re sponse dat a. Inactiv e policies will be l isted as l ong as the patient h as not bee n repointe d from tha t inactive policy to an active policy. | |
3279 | About the Screens... | |
3280 | In the top left corn er of each screen is the scree n title. O n some scr eens, the following line is a descriptio n of the i nformation displayed . A plus s ign (+) at the botto m of the s creen indi cates ther e are addi tional scr eens. Left or right arrows (<< < >>>) ma y be displ ayed to in dicate the re is addi tional inf ormation t o the left or right of the scr een. Avail able actio ns are dis played bel ow the scr een. <??> entered at any "Sele ct Action" prompt di splays all available actions f or that sc reen. | |
3281 | You may QU IT from an y screen w hich will bring you back one l evel or sc reen. EXIT is also a vailable o n most scr eens. When EXIT is e ntered, yo u are aske d if you w ish to "Ex it option entirely?" . A yes re sponse ret urns you t o the menu . A NO res ponse has the same r esult as t he QUIT ac tion. For more infor mation on the use of the List Manager ut ility, ple ase refer to the app endix at t he end of this manua l. | |
3282 | Following is a listi ng of the screens fo und in thi s option a nd a brief descripti on of the actions th ey allow. Once an ac tion has b een select ed, <??> m ay be ente red at mos t of the p rompts tha t appear f or lists o f acceptab le respons es or inst ruction on how to re spond. | |
3283 | Patient In surance Ma nagement S creen | |
3284 | Once a pat ient is se lected, th is screen is display ed listing all the p atient's i nsurance p olicies. I nformation provided for each p olicy may include ty pe of poli cy, group name, hold er, effect ive date, and expira tion date. | |
3285 | Actions | |
3286 | AP Add Po licy - All ows you to add an in surance po licy for t he selecte d patient. | |
3287 | VP Policy Edit/View (accesses Patient P olicy Info rmation | |
3288 | screen) - Allows you to view a nd edit ex tensive in surance po licy data. | |
3289 | DP Delete Policy - Allows you to delete an insura nce policy for the s elected pa tient. IB INSURANCE SUPERVISOR security key is req uired. | |
3290 | AB Annual Benefits - (accesse s Annual B enefits Ed itor scree n) - Used to enter a nnual bene fits data for the se lected pol icy. IB GR OUP PLAN E DIT securi ty key is required f or editing . | |
3291 | EA Fast E dit All - A quick wa y to enter portions of the pat ient insur ance infor mation. IB GROUP PLA N EDIT sec urity key is require d for edit ing. | |
3292 | BU Benefi ts Used (a ccesses th e Benefits Used By D ate Editor screen) - Used to e nter polic y benefits already u sed. | |
3293 | VC Verify Coverage - Allows t he user to enter int o the syst em verific ation that the insur ance cover age exists and the i nformation is correc t. | |
3294 | RI Person al Riders - Displays current r iders and allows add ition of n ew riders. | |
3295 | CP Change Patient - Allows yo u to chang e to anoth er patient without r eturning t o the begi nning of t he option. | |
3296 | WP Worksh eet Print - Used to print the standard w orksheet s howing the data for the benefi t year wit hin the pa st 12 mont hs. If no benefit ye ar on file , will pri nt the sta ndard form without t he data. M ust be pri nted at 13 2 column m argin widt h. | |
3297 | PC Print Insurance Cov. - Sim ilar to wo rksheet. U sed when b ulk of inf ormation i s already in the com puter. Wil l show two most rece nt benefit years. If no benefi t years on file, wil l offer WP action (s ee above). | |
3298 | Patient Po licy Infor mation Scr een | |
3299 | This scree n is displ ayed listi ng expande d policy i nformation for the s elected co mpany. Cat egories in clude util ization re view data, subscribe r data, su bscriber's employer informatio n, effecti ve dates, plan cover age limita tions, las t contact, and comme nts on the patient p olicy or i nsurance g roup plan. The secti ons on use r informat ion and in surance co mpany info rmation ar e not edit able. | |
3300 | Actions | |
3301 | PI Change Plan Info - Allows entry/edit of group plan infor mation. IB GROUP PLA N EDIT sec urity is r equired to change pl an informa tion. | |
3302 | UI UR Inf o - Allows entry/edi t of utili zation rev iew inform ation. IB GROUP PLAN EDIT secu rity key i s required for editi ng. | |
3303 | ED Effect ive Dates - Allows y ou to edit the effec tive date and expira tion date of the ins urance pol icy. | |
3304 | SU Subscr iber Updat e - Allows you to ed it the sub scriber (p erson who holds the insurance coverage) informatio n. | |
3305 | IP Inacti ve Plan - Allows you to inacti vate an in surance pl an, or mov e subscrib ers from m ultiple in surance pl ans into o ne master plan. IB G ROUP PLAN EDIT secur ity key is required. | |
3306 | GC Group Plan Comme nts- Allow s the user to view, add, edit, or delete comments regarding the group plan. IB G ROUP PLAN EDIT secur ity key is required to edit co mments. | |
3307 | EM Employ er Info - Allows you to edit t he subscri ber's empl oyer infor mation. | |
3308 | PT Pt Pol icy Commen ts - Allow s the user to view, add, edit, or delete comments regarding the patien t's policy . | |
3309 | For more detailed informatio n on Patie nt Policy Comments, refer to t he eIV Use r Guide. | |
3310 | EA Fast E dit All - A quick wa y to enter portions of the pat ient insur ance infor mation. IB GROUP PLA N EDIT sec urity key is require d for edit ing. | |
3311 | CP Change Policy Pl an - Allow s you to c hange the plan to wh ich a vete ran is sub scribing. | |
3312 | VC Verify Coverage - Allows t he user to enter int o the syst em verific ation that the insur ance cover age exists and the i nformation is correc t. | |
3313 | AB Annual Benefits (accesses Annual Ben efits Edit or screen) - Used to enter ann ual benefi ts data fo r the sele cted polic y. | |
3314 | CV Add/Ed it Coverag e - Allows you to ad d or edit coverage l imitations for a spe cific plan . IB GROUP PLAN EDIT security key is req uired for editing. | |
3315 | BU Benefi ts Used - (accesses the Benefi ts Used By Date | |
3316 | Editor scr een) - Use d to enter policy be nefits alr eady used. | |
3317 | Annual Ben efits Edit or Screen | |
3318 | Once the b enefit yea r is selec ted, this screen is displayed listing al l the bene fits for t he selecte d insuranc e policy a nd benefit year. Ben efit categ ories may include in patient be nefits, ou tpatient b enefits, m ental heal th, home h ealth care , hospice, rehabilit ation, and IV manage ment. | |
3319 | Actions | |
3320 | PI Policy Informati on - Allow s entry/ed it of maxi mum out of pocket an d ambulanc e coverage . | |
3321 | IP Inpati ent - Allo ws entry/e dit of inp atient ben efits data . | |
3322 | OP Outpat ient - All ows entry/ edit of ou tpatient b enefits da ta. | |
3323 | MH Mental Health - Allows ent ry/edit of mental he alth inpat ient and o utpatient benefits d ata. | |
3324 | HH Home H ealth - Al lows entry /edit of h ome health care bene fits data. | |
3325 | HS Hospic e - Allows entry/edi t of hospi ce benefit s data. | |
3326 | RH Rehab - Allows e ntry/edit of rehabil itation be nefits dat a. | |
3327 | IV IV Mgm t. - Allow s entry/ed it of intr avenous ma nagement b enefits da ta. | |
3328 | EA Edit A ll - Lists editable fields lin e by line for quick data entry . | |
3329 | CY Change Year - Al lows you t o change t o another benefit ye ar. | |
3330 | Benefits U sed By Dat e Editor S creen | |
3331 | Once the b enefit yea r is selec ted, this screen is displayed listing al l the bene fits used for the se lected ins urance pol icy and be nefit year . Benefit categories may inclu de inpatie nt and out patient de ductibles. | |
3332 | PI Policy Info - Al lows entry /edit of p olicy info rmation su ch as dedu ctible met and pre-e xisting co nditions. | |
3333 | OD Opt De duct - All ows entry/ edit of th e outpatie nt deducti ble insura nce inform ation. | |
3334 | ID Inpt D educt - Al lows entry /edit of t he inpatie nt deducti ble insura nce inform ation. | |
3335 | AC Add Co mment - Al lows the u ser to add a comment regarding claims fi led. | |
3336 | EA Edit A ll - A qui ck way to enter port ions of th e patient insurance informatio n. | |
3337 | CY Change Year - Al lows you t o change t o another benefit ye ar. | |
3338 | Sample Scr eens | |
3339 | Select Pat ient Insur ance Menu <TEST ACCO UNT> Optio n: PI Pat ient Insur ance Info View/Edit | |
3340 | Select PAT IENT NAME: IBSUB,AC, ACTIVE A IBSUB,ACTI VE A 2-2-22 XXXXXXXX X NO NSC VET ERAN | |
3341 | Enrollmen t Priority : GROUP 8c Categor y: ENROLLE D End Date: | |
3342 | Patient In surance Ma nagement Jul 22, 20 13@11:51:3 9 Pa ge: 1 of 1 | |
3343 | Insurance Management for Patie nt: IBSUB, ACTIVE A I 8542 XX/XX /XXXX | |
3344 | *** Patien t has Insu rance Buff er Records | |
3345 | Insura nce Co. Type of P olicy Gr oup H older Ef fect. Expires | |
3346 | 1 AETNA COMPREHEN SIVE M GR P NUM 13 S POUSE 01 /01/13 | |
3347 | ---------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---->>> | |
3348 | AP Add Po licy EA Fast Edit All CP Chan ge Patient | |
3349 | VP Policy Edit/View BU Benefits U sed WP Work sheet Prin t | |
3350 | DP Delete Policy VC Verify Cov erage PC Prin t Insuranc e Cov. | |
3351 | AB Annual Benefits RI Personal R iders EB Expa nd Benefit s | |
3352 | RX RX COB Determina tion EX Exit | |
3353 | Select Ite m(s): Quit // VP Po licy Edit/ View .... .......... ......... | |
3354 | Patient Po licy Infor mation Dec 12, 20 13@08:13:2 1 Page: 1 of 9 | |
3355 | For: IB,PA TIENT XXX -XX-XXXX XX/XX/XXXX DoD: X X/XX/XXXX | |
3356 | IB INSURAN CE ** Plan Currently Active ** | |
3357 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3358 | Insuranc e Company | |
3359 | Compan y: IB INSU RANCE | |
3360 | Stree t: SOME ST | |
3361 | Street 2: | |
3362 | City/Stat e: SOME CI TY, MD XXX XX | |
3363 | Billing P h: (XXX)XX X-XXXX | |
3364 | Precert P h: (XXX)XX X-XXXX | |
3365 | Plan Inf ormation | |
3366 | Is Gro up Plan: Y ES | |
3367 | Gro up Name: G ROUP NAME | |
3368 | Group Number: X XXXXX | |
3369 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
3370 | PI Change Plan Info IC Insur. Con tact Inf. CP Chan ge Policy Plan | |
3371 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
3372 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
3373 | SU Subscr iber Updat e AC Add Commen t BU Bene fits Used | |
3374 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
3375 | EX Exit | |
3376 | Select Act ion: Next Screen// NEXT SCR EEN | |
3377 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 0 Page: 2 of 9 | |
3378 | For: IB,PA TIENT XXX -XX-XXXX XX/XX/XXXX DoD: X X/XX/XXXX | |
3379 | IB INSURAN CE ** Plan Currently Active ** | |
3380 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3381 | BIN: | |
3382 | PCN: | |
3383 | Type of Plan: M EDICARE (M ) | |
3384 | Plan C ategory: M EDICARE PA RT A | |
3385 | Electron ic Type: M EDICARE A or B | |
3386 | Plan Fi ling TF: 1 YEAR (1 Y EAR(S)) | |
3387 | ePh armacy Pla n ID: | |
3388 | ePhar macy Plan Name: | |
3389 | ePharma cy Natl St atus: | |
3390 | ePharmac y Local St atus: | |
3391 | Utilizat ion Review Info Effective Dates & S ource | |
3392 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
3393 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
3394 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
3395 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
3396 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
3397 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
3398 | EX Exit | |
3399 | Select Act ion: Next Screen// NEXT SCR EEN | |
3400 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 1 Page: 3 of 9 | |
3401 | For: IB,PA TIENT XXX -XX-XXXX XX/XX/XXXX DoD: X X/XX/XXXX | |
3402 | IB INSURAN CE ** Plan Currently Active ** | |
3403 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3404 | Require UR : NO Effec tive Date: 01/01/13 | |
3405 | Requir e Amb Cert : NO Expira tion Date: | |
3406 | Requir e Pre-Cert : NO Sourc e of Info: INTERVIEW | |
3407 | Exclud e Pre-Cond : NO Policy Not Billable: NO | |
3408 | Benefits Assignable : YES | |
3409 | Subscrib er Informa tion | |
3410 | Whose I nsurance: VETERAN | |
3411 | Subscri ber Name: IB,PATIENT | |
3412 | Rela tionship: SELF | |
3413 | Pr imary ID: XXXXXX | |
3414 | Coord. Benefits: PRIMARY | |
3415 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
3416 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
3417 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
3418 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
3419 | SU Subscr iber Updat e PT Pt Policy Comment BU Bene fits Used | |
3420 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
3421 | EX Exit | |
3422 | Select Act ion: Next Screen// NEXT SCR EEN | |
3423 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 1 Page: 4 of 9 | |
3424 | For: IB,PA TIENT XXX -XX-XXXX XX/XX/XXXX DoD: X X/XX/XXXX | |
3425 | IB INSURAN CE ** Plan Currently Active ** | |
3426 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3427 | Subscrib er's Emplo yer Inform ation | |
3428 | Employme nt Status: E mp Sponsor ed Plan: N o | |
3429 | Employer: C laims to E mployer: N o, Send to Insurance | |
3430 | Street: Retireme nt Date: | |
3431 | C ity/State: | |
3432 | Phone: | |
3433 | Primary P rovider: | |
3434 | Prim Pro v Phone: | |
3435 | Subscrib er's Infor mation (us e Subscrib er Update Action) | |
3436 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
3437 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
3438 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
3439 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
3440 | SU Subscr iber Updat e PT Pt Policy Comment BU Bene fits Used | |
3441 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
3442 | EX Exit | |
3443 | Select Act ion: Next Screen// NEXT SCR EEN | |
3444 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 2 Page: 5 of 9 | |
3445 | For: IB,PA TIENT XXX -XX-XXXX XX/XX/XXXX DoD: X X/XX/XXXX | |
3446 | IB INSURAN CE ** Plan Currently Active ** | |
3447 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3448 | Subscr iber's DOB : XX/XX/XX XX | |
3449 | Str 1: S OME ST | |
3450 | Str 2: | |
3451 | City: S OME CITY | |
3452 | St/Zip: M A XXXXX | |
3453 | SubDiv: | |
3454 | Country: | |
3455 | Phone: X XXXXX | |
3456 | Subscr iber's Sex : MALE | |
3457 | Subscribe r's Branch : ARMY | |
3458 | Subscri ber's Rank : | |
3459 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
3460 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
3461 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
3462 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
3463 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
3464 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
3465 | EX Exit | |
3466 | Select Act ion: Next Screen// NEXT SCR EEN | |
3467 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 6 Page: 6 of 9 | |
3468 | For: IB,PA TIENT XXX -XX-XXXX XX/XX/XXXX DoD: X X/XX/XXXX | |
3469 | IB INSURAN CE ** Plan Currently Active ** | |
3470 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3471 | Insuranc e Company ID Numbers (use Subs criber Upd ate Action ) | |
3472 | Subscri ber ID: XX XXXX | |
3473 | Plan Cov erage Limi tations | |
3474 | Coverag e Effecti ve Date Covered? Limit Comments | |
3475 | ------- - ------- ------- -------- ----- --------- | |
3476 | INPATIE NT 07/01/1 998 NO | |
3477 | 01/01/1 998 NO | |
3478 | 11/01/1 996 NO | |
3479 | OUTPATI ENT 07/01/1 998 NO | |
3480 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
3481 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
3482 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
3483 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
3484 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
3485 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
3486 | EX Exit | |
3487 | Select Act ion: Next Screen// NEXT SCR EEN | |
3488 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 7 Page: 7 of 9 | |
3489 | For: IB,PA TIENT XXX -XX-XXXX XX/XX/XXXX DoD: X X/XX/XXXX | |
3490 | IB INSURAN CE ** Plan Currently Active ** | |
3491 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3492 | 01/01/1 998 NO | |
3493 | 11/01/1 996 NO | |
3494 | PHARMAC Y 08/29/2 008 NO | |
3495 | 07/01/1 998 NO | |
3496 | 01/01/1 998 NO | |
3497 | 11/01/1 996 NO | |
3498 | DENTAL 07/01/1 998 NO | |
3499 | 01/01/1 998 NO | |
3500 | 11/01/1 996 NO | |
3501 | MENTAL HEALTH 07/01/1 998 NO | |
3502 | 01/01/1 998 NO | |
3503 | 11/01/1 996 NO | |
3504 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
3505 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
3506 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
3507 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
3508 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
3509 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
3510 | EX Exit | |
3511 | Select Act ion: Next Screen// NEXT SCR EEN | |
3512 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 8 Page: 8 of 9 | |
3513 | For: IB,PA TIENT XXX -XX-XXXX XX/XX/XXXX DoD: X X/XX/XXXX | |
3514 | IB INSURAN CE ** Plan Currently Active ** | |
3515 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3516 | LONG TE RM CARE 07/01/1 998 NO | |
3517 | 01/01/1 998 NO | |
3518 | PROSTHE TICS 07/01/1 998 NO | |
3519 | 01/01/1 998 NO | |
3520 | User Inf ormation | |
3521 | Ent ered By: | |
3522 | Ent ered On: 0 6/05/13 | |
3523 | Last Veri fied By: | |
3524 | Last Veri fied On: | |
3525 | Last Upd ated By: I B,TESTER | |
3526 | Last Upd ated On: 0 9/24/13 | |
3527 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
3528 | PI Change Plan Info IC Insur. Con tact Inf. CP Chan ge Policy Plan | |
3529 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
3530 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
3531 | SU Subscr iber Updat e AC Add Commen t BU Bene fits Used | |
3532 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
3533 | EX Exit | |
3534 | Select Act ion: Next Screen// NEXT SCR EEN | |
3535 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 9 Page: 9 of 9 | |
3536 | For: IB,PA TIENT XXX -XX-XXXX XX/XX/XXXX DoD: X X/XX/XXXX | |
3537 | IB INSURAN CE ** Plan Currently Active ** | |
3538 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3539 | Comment -- Group P lan | |
3540 | This is a long gro up comment . This are a can hold much more than 80 | |
3541 | Characte rs in the field. | |
3542 | Comment -- Patient Policy | |
3543 | Dt Enter ed Entere d By Method Person Co ntacted | |
3544 | 09/25/15 IBCLER K,TWO PHONE USER-A | |
3545 | JUST A C OMMENT AND NOTHING E LSE | |
3546 | +09/25/1 5 IBCLE RK,TWO PHONE USER-A | |
3547 | THIS IS A COMMENT THAT IS LO NGER THAN 77 CHARACT ERS TO TES T THE WRAP INDICATO | |
3548 | Personal Riders | |
3549 | Rider #1: DENTAL COVERAGE | |
3550 | ---------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
3551 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
3552 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
3553 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
3554 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
3555 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
3556 | EX Exit | |
3557 | Select Act ion: Quit/ / | |
3558 | View Patie nt Insuran ce | |
3559 | The View P atient Ins urance opt ion is use d to look at a patie nt's insur ance infor mation. Th e system g roups info rmation th at is spec ific to th e insuranc e company, specific to the pat ient, spec ific to th e group pl an, specif ic to the annual ben efits avai lable, and the annua l benefits already u sed. Editi ng of the data is no t allowed through th is option. | |
3560 | About the Screens... | |
3561 | In the top left corn er of each screen is the scree n title. O n some scr eens, the following line is a descriptio n of the i nformation displayed . A plus s ign (+) at the botto m of the s creen indi cates ther e are addi tional scr eens. Le ft or righ t arrows ( <<< >>>) may be dis played to indicate t here is ad ditional i nformation to the le ft or righ t of the s creen. Ava ilable act ions are d isplayed b elow the s creen. <?? > entered at any "Se lect Actio n" prompt displays a ll availab le actions for that screen. | |
3562 | You may QU IT from an y screen w hich will bring you back one l evel or sc reen. EXIT is also a vailable o n most scr eens. When EXIT is e ntered, yo u are aske d if you w ish to "Ex it option entirely?" . A yes re sponse ret urns you t o the menu . A NO res ponse has the same r esult as t he QUIT ac tion. For more infor mation on the use of the List Manager ut ility, ple ase refer to the app endix at t he end of this manua l. | |
3563 | Following is a listi ng of the screens fo und in thi s option a nd a brief descripti on of the actions th ey allow. | |
3564 | Patient In surance Ma nagement S creen | |
3565 | Once a pat ient is se lected, th is screen is display ed listing all the p atient's insurance policies. Informatio n provided for each policy may include t ype of pol icy, group name or i ndividual, holder, e ffective d ate, and e xpiration date. | |
3566 | VP View P olicy Info (accesses Patient P olicy Info rmation sc reen) - Al lows you t o view ext ensive ins urance pol icy data. | |
3567 | Actions | |
3568 | AB Annual Benefits - (accesse s Annual B enefits Ed itor scree n) - Used to view an nual benef its data f or the sel ected poli cy. | |
3569 | BU Benefi ts Used - (accesses Benefits U sed By Dat e Editor s creen) - U sed to vie w policy b enefits al ready used . | |
3570 | CP Change Patient - Allows yo u to chang e to anoth er patient without r eturning t o the begi nning of t he option. | |
3571 | Patient Po licy Infor mation Scr een | |
3572 | This scree n is displ ayed listi ng expande d policy i nformation for the s elected co mpany. Cat egories in clude util ization re view data, subscribe r data, su bscriber's employer informatio n, | |
3573 | policy inf ormation, effective dates, pla n coverage limitatio ns, last c ontact, co mments on the patien t policy o r insuranc e group pl an, and pe rsonal rid ers. The o nly action allowed f rom this s creen is E XIT. | |
3574 | Annual Ben efits Edit or Screen | |
3575 | Once the b enefit yea r is selec ted, this screen is displayed listing al l the bene fits for t he selecte d insuranc e policy a nd benefit year. Ben efit categ ories may include in patient be nefits, ou tpatient b enefits, m ental heal th, home h ealth care , hospice, rehabilit ation, and IV manage ment. The only actio ns allowed from this screen ar e CY to ch ange the b enefit yea r and EXIT . | |
3576 | Benefits U sed By Dat e Editor S creen | |
3577 | Once the b enefit yea r is selec ted, this screen is displayed listing al l the bene fits used for the se lected ins urance pol icy and be nefit year . Benefit categories may inclu de inpatie nt and out patient de ductibles. The only actions al lowed from this scre en are CY to change the benefi t year and EXIT. | |
3578 | Sample Scr eens | |
3579 | Select PAT IENT NAME: IBpatient ,one 11-2 8-31 0 00111111 YES SC VETERA N .. | |
3580 | Patient In surance Ma nagement Nov 22, 19 93 13:51:0 9 Page: 1 of 1 | |
3581 | ||
3582 | Insurance Management for Patie nt: IBpati ent,one 1111 XX/XX /XXXX | |
3583 | Insura nce Co. Type of Po licy Gro up H older Ef fect. Ex pires | |
3584 | ||
3585 | 1 RIGHA 15 46 UNKNOWN | |
3586 | 2 XYZ IN S MAJOR MED ICAL 12 3 SELF 0 4/01/93 | |
3587 | Enter ?? f or more ac tions >>> | |
3588 | ||
3589 | VP Policy Edit/View BU Benefits U sed EX Exit | |
3590 | AB Annual Benefits CP Change Pat ient | |
3591 | Select Ite m(s): Quit // VP=2 View Polic y Info | |
3592 | Patient In surance Ma nagement Jul 22, 20 13@11:51:3 9 Pa ge: 1 of 1 | |
3593 | Insurance Management for Patie nt: IBSUB, ACTIVE A I 8542 XX/XX /XXXX | |
3594 | *** Patien t has Insu rance Buff er Records | |
3595 | Insura nce Co. Type of P olicy Gr oup H older Ef fect. Expires | |
3596 | 1 AETNA COMPREHEN SIVE M GR P NUM 13 S POUSE 01 /01/13 | |
3597 | ---------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---->>> | |
3598 | AP Add Po licy EA Fast Edit All CP Chan ge Patient | |
3599 | VP Policy Edit/View BU Benefits U sed WP Work sheet Prin t | |
3600 | DP Delete Policy VC Verify Cov erage PC Prin t Insuranc e Cov. | |
3601 | AB Annual Benefits RI Personal R iders EB Expa nd Benefit s | |
3602 | RX RX COB Determina tion EX Exit | |
3603 | Select Ite m(s): Quit // VP Po licy Edit/ View .... .......... ......... | |
3604 | Patient Po licy Infor mation Dec 12, 20 13@08:13:2 1 Page: 1 of 9 | |
3605 | For: IBSUB ,TWOTRLRS XXX-XX-XX XX DOD:XX/XX /XXXX | |
3606 | MEDICARE ( WNR) Insur ance Compa ny ** Plan Curre ntly Activ e ** | |
3607 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3608 | Insuranc e Company | |
3609 | Compan y: MEDICAR E (WNR) | |
3610 | Stree t: PO BOX 10066 | |
3611 | Street 2: HEALTH CARE FINAN CING | |
3612 | City/Stat e: BALTIMO RE, MD 212 07 | |
3613 | Billing P h: (787)74 9-4949 | |
3614 | Precert P h: (787)74 0-4232 | |
3615 | Plan Inf ormation | |
3616 | Is Gro up Plan: Y ES | |
3617 | Gro up Name: M EDICARE PA RT A | |
3618 | Group Number: X XXXXX00010 | |
3619 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
3620 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
3621 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
3622 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
3623 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
3624 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
3625 | EX Exit | |
3626 | Select Act ion: Next Screen// NEXT SCR EEN | |
3627 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 0 Page: 2 of 9 | |
3628 | For: IBSUB ,TWOTRLRS XXX-XX-XX XX DOD:XX/XX /XXXX | |
3629 | MEDICARE ( WNR) Insur ance Compa ny ** Plan Curre ntly Activ e ** | |
3630 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3631 | BIN: | |
3632 | PCN: | |
3633 | Type of Plan: M EDICARE (M ) | |
3634 | Plan C ategory: M EDICARE PA RT A | |
3635 | Electron ic Type: M EDICARE A or B | |
3636 | Plan Fi ling TF: 1 YEAR (1 Y EAR(S)) | |
3637 | ePh armacy Pla n ID: | |
3638 | ePhar macy Plan Name: | |
3639 | ePharma cy Natl St atus: | |
3640 | ePharmac y Local St atus: | |
3641 | Utilizat ion Review Info Effective Dates & S ource | |
3642 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
3643 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
3644 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
3645 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
3646 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
3647 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
3648 | EX Exit | |
3649 | Select Act ion: Next Screen// NEXT SCR EEN | |
3650 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 1 Page: 3 of 9 | |
3651 | For: IBSUB ,TWOTRLRS XXX-XX-XX XX DOD:XX/XX /XXXX | |
3652 | MEDICARE ( WNR) Insur ance Compa ny ** Plan Curre ntly Activ e ** | |
3653 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3654 | Require UR : NO Effec tive Date: 01/01/13 | |
3655 | Requir e Amb Cert : NO Expira tion Date: | |
3656 | Requir e Pre-Cert : NO Sourc e of Info: INTERVIEW | |
3657 | Exclud e Pre-Cond : NO Policy Not Billable: NO | |
3658 | Benefits Assignable : YES | |
3659 | Subscrib er Informa tion | |
3660 | Whose I nsurance: VETERAN | |
3661 | Subscri ber Name: IBSUB,TWOT RLRS | |
3662 | Rela tionship: SELF | |
3663 | Pr imary ID: XXXXXX000A | |
3664 | Coord. Benefits: PRIMARY | |
3665 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
3666 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
3667 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
3668 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
3669 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
3670 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
3671 | EX Exit | |
3672 | Select Act ion: Next Screen// NEXT SCR EEN | |
3673 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 1 Page: 4 of 9 | |
3674 | For: IBSUB ,TWOTRLRS XXX-XX-XX XX XX/XX/XXXX | |
3675 | MEDICARE ( WNR) Insur ance Compa ny ** Plan Curre ntly Activ e ** | |
3676 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3677 | Subscrib er's Emplo yer Inform ation | |
3678 | Employme nt Status: E mp Sponsor ed Plan: N o | |
3679 | Employer: C laims to E mployer: N o, Send to Insurance | |
3680 | Street: Retireme nt Date: | |
3681 | C ity/State: | |
3682 | Phone: | |
3683 | Primary P rovider: | |
3684 | Prim Pro v Phone: | |
3685 | Insured Subscriber 's Informa tion (use Subscriber Update Ac tion) | |
3686 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
3687 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
3688 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
3689 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
3690 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
3691 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
3692 | EX Exit | |
3693 | Select Act ion: Next Screen// NEXT SCR EEN | |
3694 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 2 Page: 5 of 9 | |
3695 | For: IBSUB ,TWOTRLRS XXX-XX-XX XX DOD:XX/XX /XXXX | |
3696 | MEDICARE ( WNR) Insur ance Compa ny ** Plan Curre ntly Activ e ** | |
3697 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3698 | Subscr iber's DOB : 05/05/19 55 | |
3699 | Str 1: P ALMER HOUS E HEALTH C ARE | |
3700 | Str 2: S HEARER ST | |
3701 | City: P ALMER | |
3702 | St/Zip: M A 01069 | |
3703 | SubDiv: | |
3704 | Country: | |
3705 | Phone: X XXXXX0001 | |
3706 | Subscr iber's Sex : MALE | |
3707 | Subscribe r's Branch : ARMY | |
3708 | Subscri ber's Rank : | |
3709 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
3710 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
3711 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
3712 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
3713 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
3714 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
3715 | EX Exit | |
3716 | Select Act ion: Next Screen// NEXT SCR EEN | |
3717 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 6 Page: 6 of 9 | |
3718 | For: IBSUB ,TWOTRLRS XXX-XX-XX XX DOD:XX/XX /XXXX | |
3719 | MEDICARE ( WNR) Insur ance Compa ny ** Plan Curre ntly Activ e ** | |
3720 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3721 | Insuranc e Company ID Numbers (use Subs criber Upd ate Action ) | |
3722 | Subscri ber ID: XX XXXX000A | |
3723 | Plan Cov erage Limi tations | |
3724 | Coverag e Effecti ve Date Covered? Limit Comments | |
3725 | ------- - ------- ------- -------- ----- --------- | |
3726 | INPATIE NT 07/01/1 998 NO | |
3727 | 01/01/1 998 NO | |
3728 | 11/01/1 996 NO | |
3729 | OUTPATI ENT 07/01/1 998 NO | |
3730 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
3731 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
3732 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
3733 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
3734 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
3735 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
3736 | EX Exit | |
3737 | Select Act ion: Next Screen// NEXT SCR EEN | |
3738 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 7 Page: 7 of 9 | |
3739 | For: IBSUB ,TWOTRLRS XXX-XX-XX XX DOD:XX/XX /XXXX | |
3740 | MEDICARE ( WNR) Insur ance Compa ny ** Plan Curre ntly Activ e ** | |
3741 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3742 | 01/01/1 998 NO | |
3743 | 11/01/1 996 NO | |
3744 | PHARMAC Y 08/29/2 008 NO | |
3745 | 07/01/1 998 NO | |
3746 | 01/01/1 998 NO | |
3747 | 11/01/1 996 NO | |
3748 | DENTAL 07/01/1 998 NO | |
3749 | 01/01/1 998 NO | |
3750 | 11/01/1 996 NO | |
3751 | MENTAL HEALTH 07/01/1 998 NO | |
3752 | 01/01/1 998 NO | |
3753 | 11/01/1 996 NO | |
3754 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
3755 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
3756 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
3757 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
3758 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
3759 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
3760 | EX Exit | |
3761 | Select Act ion: Next Screen// NEXT SCR EEN | |
3762 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 8 Page: 8 of 9 | |
3763 | For: IBSUB ,TWOTRLRS XXX-XX-XX XX XX/XX/XXXX | |
3764 | MEDICARE ( WNR) Insur ance Compa ny ** Plan Curre ntly Activ e ** | |
3765 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3766 | LONG TE RM CARE 07/01/1 998 NO | |
3767 | 01/01/1 998 NO | |
3768 | PROSTHE TICS 07/01/1 998 NO | |
3769 | 01/01/1 998 NO | |
3770 | User Inf ormation | |
3771 | Ent ered By: I B,TESTER | |
3772 | Ent ered On: 0 6/05/13 | |
3773 | Last Veri fied By: | |
3774 | Last Veri fied On: | |
3775 | Last Upd ated By: I B,TESTER | |
3776 | Last Upd ated On: 0 9/24/13 | |
3777 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
3778 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
3779 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
3780 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
3781 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
3782 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
3783 | EX Exit | |
3784 | Select Act ion: Next Screen// NEXT SCR EEN | |
3785 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 9 Page: 9 of 9 | |
3786 | For: IBSUB ,TWOTRLRS XXX-XX-XX XX DOD:XX/XX /XXXX | |
3787 | MEDICARE ( WNR) Insur ance Compa ny ** Plan Curre ntly Activ e ** | |
3788 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3789 | Comment -- Group P lan | |
3790 | This is a long gro up comment . This are a can hold much more than 80 | |
3791 | Characte rs in the field. | |
3792 | Comment -- Patient Policy | |
3793 | Dt Entered Entered By Me thod P erson Cont acted | |
3794 | 09/25/15 IBCLER K,TWO PHONE USER-A | |
3795 | JUST A C OMMENT AND NOTHING E LSE | |
3796 | +09/25/1 5 IBCLE RK,TWO PHONE USER-A | |
3797 | THIS IS A COMMENT THAT IS LO NGER THAN 77 CHARACT ERS TO TES T THE WRAP INDICATO | |
3798 | Personal Riders | |
3799 | Rider #1: DENTAL COVERAGE | |
3800 | ---------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
3801 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
3802 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
3803 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
3804 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
3805 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
3806 | EX Exit | |
3807 | Select Act ion: Quit/ / | |
3808 | Insurance Company En try/Edit | |
3809 | The Insura nce Compan y Entry/Ed it option is used to enter new insurance companies into the INSURANCE COMPANY fi le and edi t data on existing c ompanies. An insuran ce company must be i n the INSU RANCE COMP ANY file b efore it c an be ente red into a patient's record. | |
3810 | When enter ing new in surance co mpanies, y ou will be prompted for the co mpany stre et address , city, an d whether or not the company w ill reimbu rse for tr eatment. | |
3811 | Following is a listi ng of the actions fo und on the screen in this opti on and a b rief descr iption of each. Once an action has been selected, <??> may b e entered at most of the promp ts that ap pear for l ists of ac ceptable r esponses o r instruct ion on how to respon d. | |
3812 | Insurance Company Ed itor Scree n | |
3813 | Once the i nsurance c ompany is selected, this scree n is displ ayed listi ng the fol lowing gro ups of inf ormation f or that co mpany: bil ling param eters, mai n mailing address, i npatient c laims offi ce data, o utpatient claims off ice data, prescripti on claims office dat a, appeals office da ta, inquir y office d ata, remar ks, and sy nonyms. | |
3814 | BP | |
3815 | Billing Pa rameters - Allows yo u to add/e dit the bi lling para meters for the selec ted insura nce compan y. | |
3816 | MM | |
3817 | Main Maili ng Address - Allows you to add /edit the company's main maili ng address . The addr ess entere d here wil l automati cally be e ntered for the other office ad dresses. | |
3818 | IC | |
3819 | Inpt Claim s Office - Allows yo u to add/e dit the co mpany's in patient cl aims offic e name, ad dress, pho ne and fax numbers. | |
3820 | OC | |
3821 | Opt Claims Office - Allows you to add/ed it the com pany's out patient cl aims offic e name, ad dress, pho ne and fax numbers. | |
3822 | PC | |
3823 | Prescr Cla ims Of - A llows you to add/edi t the comp any's pres cription c laims offi ce name, a ddress, ph one and fa x numbers. | |
3824 | AO | |
3825 | Appeals Of fice - All ows you to add/edit the compan y's appeal s office n ame, addre ss, phone and fax nu mbers. | |
3826 | IO | |
3827 | Inquiry Of fice - All ows you to add/edit the compan y's inquir y office n ame, addre ss, phone and fax nu mbers. | |
3828 | RE | |
3829 | Remarks - Allows the user to e nter comme nts concer ning the s elected in surance co mpany. | |
3830 | SY | |
3831 | Synonyms - Allows yo u to add/e dit any sy nonyms for the selec ted compan y. | |
3832 | EA | |
3833 | Edit All - Lists edi table fiel ds line by line for quick data entry. | |
3834 | AI | |
3835 | (In)Activa te Company - Allows you to act ivate/inac tivate the selected insurance company. T his may be used to i nactivate duplicate companies in the sys tem. When an insuran ce company is no lon ger valid, it is imp ortant to inactivate the compa ny rather than delet e it from the system . The IB I NSURANCE S UPERVISOR security k ey is requ ired. Once a company has been inactivate d, it may not be sel ected when entering billing in formation. | |
3836 | You may al so obtain a report o f patients insured b y a given company th rough this action. | |
3837 | CC | |
3838 | Change Ins urance Co. - Allows you to cha nge to ano ther compa ny without returning to the be ginning of the optio n. | |
3839 | DC | |
3840 | Delete Com pany - All ows you to delete an entry fro m the Insu rance Comp any (#36) file. If c laims have been subm itted to t he company , another company mu st be sele cted in wh ich to poi nt all cla ims and re ceivables informatio n. | |
3841 | PL | |
3842 | Plans (acc esses Insu rance Plan List scre en) - Allo ws you to display an d change p lan attrib utes assoc iated with the insur ance compa ny. | |
3843 | Insurance Plan List Screen | |
3844 | This scree n lists al l plans (a ctive and inactive, group and individual ) for the selected i nsurance c ompany. | |
3845 | Actions | |
3846 | VP | |
3847 | View/Edit Plan (acce sses View/ Edit Plan screen) - Allows you to displa y /change plan detai led inform ation. | |
3848 | IP | |
3849 | Inactive P lan - Allo ws you to inactivate an insura nce plan, or move su bscribers from multi ple insura nce plans into one m aster plan . IB GROUP PLAN EDIT security key is req uired. | |
3850 | AB | |
3851 | Annual Ben efits (acc esses Annu al Benefit s Editor s creen) - U sed to ent er annual benefits d ata for th e selected policy. I B GROUP PL AN EDIT se curity key is requir ed for edi ting. | |
3852 | Annual Ben efits Edit or Screen | |
3853 | Once the b enefit yea r is selec ted, this screen is displayed listing al l the bene fits for t he selecte d insuranc e policy a nd benefit year. Ben efit categ ories may include in patient be nefits, ou tpatient b enefits, m ental heal th, home h ealth care , hospice, rehabilit ation, and IV manage ment. | |
3854 | Actions | |
3855 | PI Policy Informati on - Allow s entry/ed it of maxi mum out of pocket an d ambulanc e coverage . | |
3856 | IP Inpati ent - Allo ws entry/e dit of inp atient ben efits data . | |
3857 | OP Outpat ient - All ows entry/ edit of ou tpatient b enefits da ta. | |
3858 | MH Mental Health - Allows ent ry/edit of mental he alth inpat ient and o utpatient benefits d ata. | |
3859 | HH Home H ealth - Al lows entry /edit of h ome health care bene fits data. | |
3860 | HS Hospic e - Allows entry/edi t of hospi ce benefit s data. | |
3861 | RH Rehab - Allows e ntry/edit of rehabil itation be nefits dat a. | |
3862 | IV IV Mgm t. - Allow s entry/ed it of intr avenous ma nagement b enefits da ta. | |
3863 | EA Edit A ll - Lists editable fields lin e by line for quick data entry . | |
3864 | CY Change Year - Al lows you t o change t o another benefit ye ar. | |
3865 | View/Edit Plan Scree n | |
3866 | This scree n displays plan info rmation fo r viewing/ editing in cluding ut ilization review inf o, plan co verage lim itations, annual ben efit dates , user inf ormation, and plan c omments. | |
3867 | Actions | |
3868 | PI Policy Informati on - Allow s entry/ed it of maxi mum out of pocket an d ambulanc e coverage . IB GROUP PLAN EDIT security key for ed iting. | |
3869 | UI UR Inf o - Allows entry/edi t of utili zation rev iew inform ation. IB GROUP PLAN EDIT secu rity key i s required for editi ng. | |
3870 | CV Add/Ed it Coverag e - Allows you to ad d or edit coverage l imitations for a spe cific plan . IB GROUP PLAN EDIT security key is req uired for editing. | |
3871 | PC Plan C omments - Allows edi ting of co mments for the plan. IB GROUP PLAN EDIT security k ey is requ ired for e diting. | |
3872 | IP (In)Ac tivate Pla n - Allows you to in activate a n insuranc e plan, or move subs cribers fr om multipl e insuranc e plans in to one mas ter plan. IB GROUP P LAN EDIT s ecurity ke y is requi red. | |
3873 | AB Annual Benefits - (accesse s Annual B enefits Ed itor scree n) - Used to enter a nnual bene fits data for the se lected pol icy. IB GR OUP PLAN E DIT securi ty key is required f or editing . | |
3874 | CP Change Plan - Al lows you t o select a nother pla n for this insurance company w ithout hav ing to exi t back to the previo us screen. | |
3875 | Although t his option is not lo cked, the MCCR Syste m Definiti on Menu is locked wi th the IB SUPERVISOR security key. | |
3876 | Sample Scr eens | |
3877 | Insurance Company Ed itor Nov 26, 20 14@12:19:2 5 Page: 1 of 9 | |
3878 | Insurance Company In formation for: INSUR ANCE COMPA NY | |
3879 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
3880 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3881 | Bil ling Param eters | |
3882 | Signatur e Required ?: YES Ty pe Of Cove rage: HEAL TH INSURAN | |
3883 | Reimburse ?: WILL NO T REIMBURS E Billing P hone: | |
3884 | Mult. Bedsection s: YES Veri fication P hone: | |
3885 | One Opt. Visi t: NO Prec ert Comp. Name: | |
3886 | Diff. Rev. Code s: Precert P hone: | |
3887 | Amb. Sur . Rev. Cod e: | |
3888 | Rx Refil l Rev. Cod e: | |
3889 | Filing Time Fram e: (1 YEA R(S)) | |
3890 | EDI Parame ters | |
3891 | Transm it?: YES-L IVE I nsurance T ype: GROUP POLICY | |
3892 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
3893 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
3894 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
3895 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
3896 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
3897 | PC Prescr Claims Of RE Remarks VP View Plans | |
3898 | AO Appeal s Office SY Synonyms EX Exit | |
3899 | Select Act ion: Next Screen// I nsurance C ompany Edi tor N ov 26, 201 4@12:24:58 Page: 2 of 9 | |
3900 | Insurance Company In formation for: INSUR ANCE COMPA NY | |
3901 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
3902 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3903 | Inst Pay er Primary ID: Prof Pay er Primary ID: | |
3904 | Inst Paye r Sec ID Q ual: Prof Paye r Sec ID Q ual: | |
3905 | Inst Payer Sec ID: Prof Payer Sec ID: | |
3906 | Inst Paye r Sec ID Q ual: Prof Paye r Sec ID Q ual: | |
3907 | Inst Payer Sec ID: Prof Payer Sec ID: | |
3908 | Bin Num ber: Pr nt Sec/Ter t Auto Cla ims: | |
3909 | HPID/O EID: Prnt Med Sec C laims w/o MRA: YES | |
3910 | Main Mailing Ad dress | |
3911 | St reet: PO B OX Cit y/State: | |
3912 | Stre et 2: Phone: | |
3913 | Stre et 3: Fax: | |
3914 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
3915 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
3916 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
3917 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
3918 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
3919 | PC Prescr Claims Of RE Remarks VP View Plans | |
3920 | AO Appeal s Office SY Synonyms EX Exit | |
3921 | Select Act ion: Next Screen// I nsurance C ompany Edi tor N ov 26, 201 4@12:26:11 Page: 3 of 9 | |
3922 | Insurance Company In formation for: INSUR ANCE COMPA NY | |
3923 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
3924 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3925 | Inpatien t Claims O ffice Info rmation | |
3926 | Company Name: INSU RANCE COMP ANY S treet 3: | |
3927 | St reet: Cit y/State: | |
3928 | Stre et 2: Phone: | |
3929 | Fax: | |
3930 | Outpatie nt Claims Office Inf ormation | |
3931 | Company Name: INSU RANCE COMP ANY S treet 3: | |
3932 | St reet: Cit y/State: | |
3933 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
3934 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
3935 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
3936 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
3937 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
3938 | PC Prescr Claims Of RE Remarks VP View Plans | |
3939 | AO Appeal s Office SY Synonyms EX Exit | |
3940 | Select Act ion: Next Screen// I nsurance C ompany Edi tor N ov 26, 201 4@12:26:53 Page: 4 of 9 | |
3941 | Insurance Company In formation for: INSUR ANCE COMPA NY | |
3942 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
3943 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3944 | Stre et 2: Phone: | |
3945 | Fax: | |
3946 | Prescript ion Claims Office In formation | |
3947 | Company Name: INSU RANCE COMP ANY S treet 3: | |
3948 | St reet: Cit y/State: | |
3949 | Stre et 2: Phone: | |
3950 | Fax: | |
3951 | App eals Offic e Informat ion | |
3952 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
3953 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
3954 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
3955 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
3956 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
3957 | PC Prescr Claims Of RE Remarks VP View Plans | |
3958 | AO Appeal s Office SY Synonyms EX Exit | |
3959 | Select Act ion: Next Screen//In surance Co mpany Edit or No v 26, 2014 @12:27:16 P age: 5 of 9 | |
3960 | Insurance Company In formation for: INSUR ANCE COMPA NY | |
3961 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
3962 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3963 | Company Name: INSU RANCE COMP ANY S treet 3: | |
3964 | St reet: Cit y/State: | |
3965 | Stre et 2: Phone: | |
3966 | Fax: | |
3967 | Inq uiry Offic e Informat ion | |
3968 | Company Name: INSU RANCE COMP ANY S treet 3: | |
3969 | St reet: Cit y/State: | |
3970 | Stre et 2: Phone: | |
3971 | Fax: | |
3972 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
3973 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
3974 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
3975 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
3976 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
3977 | PC Prescr Claims Of RE Remarks VP View Plans | |
3978 | AO Appeal s Office SY Synonyms EX Exit | |
3979 | Select Act ion: Next Screen// I nsurance C ompany Edi tor N ov 26, 201 4@12:27:39 Page: 6 of 9 | |
3980 | Insurance Company In formation for: INSUR ANCE COMPA NY | |
3981 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
3982 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
3983 | Assoc iated Insu rance Comp anies | |
3984 | This ins urance com pany is no t defined as either a Parent o r a Child. | |
3985 | Prov ider IDs | |
3986 | Billing Pr ovider Sec ondary ID | |
3987 | Additional Billing P rovider Se condary ID s | |
3988 | VA-Laborat ory or Fac ility Seco ndary IDs | |
3989 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
3990 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
3991 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
3992 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
3993 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
3994 | PC Prescr Claims Of RE Remarks VP View Plans | |
3995 | AO Appeal s Office SY Synonyms EX Exit | |
3996 | Select Act ion: Next Screen// I nsurance C ompany Edi tor N ov 26, 201 4@12:27:51 Page: 7 of 9 | |
3997 | Insurance Company In formation for: INSUR ANCE COMPA NY | |
3998 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
3999 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
4000 | ID P arameters | |
4001 | Attending/ Rendering Provider S econdary I D Qualifie r (1500): | |
4002 | Attending/ Rendering Provider S econdary I D Qualifie r (UB-04): | |
4003 | Attending/ Rendering Secondary ID Require ment: NONE REQUIRED | |
4004 | Referring Provider S econdary I D Qualifie r (1500): UPIN | |
4005 | Referring Provider S econdary I D Requirem ent: NONE | |
4006 | Use Att/Re nd ID as B illing Pro vider Sec. ID (1500) : NO | |
4007 | Use Att/Re nd ID as B illing Pro vider Sec. ID (UB-04 ): NO | |
4008 | Always use main VAMC as Billin g Provider (1500)?: NO | |
4009 | Always use main VAMC as Billin g Provider (UB-04)?: NO | |
4010 | Transmit n o Billing Provider S ec. ID for the Elect ronic Plan Types: | |
4011 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
4012 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
4013 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
4014 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
4015 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
4016 | PC Prescr Claims Of RE Remarks VP View Plans | |
4017 | AO Appeal s Office SY Synonyms EX Exit | |
4018 | Select Act ion: Next Screen// I nsurance C ompany Edi tor N ov 26, 201 4@12:28:12 Page: 8 of 9 | |
4019 | Insurance Company In formation for: INSUR NACE COMPA NY | |
4020 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
4021 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
4022 | Pa yer Inform ation: e- IV | |
4023 | Pa yer Name: INSURANCE COMPANY | |
4024 | VA Nat ional ID: VA1 CMS Nation al ID: | |
4025 | Payer App lication: eIV FSC Auto-U pdate: YES | |
4026 | Nationa l Active: YES Deacti vated: NO | |
4027 | Loca l Active: YES | |
4028 | Remarks | |
4029 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
4030 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
4031 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
4032 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
4033 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
4034 | PC Prescr Claims Of RE Remarks VP View Plans | |
4035 | AO Appeal s Office SY Synonyms EX Exit | |
4036 | Select Act ion: Next Screen// I nsurance C ompany Edi tor N ov 26, 201 4@12:28:30 Page: 9 of 9 | |
4037 | Insurance Company In formation for: INSUR ANCE COMPA NY | |
4038 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
4039 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
4040 | 6/05 Wi ll not pay for Omepr azole/Pril osec..jc | |
4041 | 1/1/04 All XXXXX are combin ed to this one this year and a n all incl usive | |
4042 | # is xx x-xxx-xxxx ..ID# are changing o ver to W + 9 digits now too..j c | |
4043 | This in surance ca rrier entr y and phon e number i s inclusiv e for the | |
4044 | 'Bxxxxx Company'. mdm | |
4045 | Synonyms | |
4046 | XXX | |
4047 | ---------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
4048 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
4049 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
4050 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
4051 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
4052 | PC Prescr Claims Of RE Remarks VP View Plans | |
4053 | AO Appeal s Office SY Synonyms EX Exit | |
4054 | Select Act ion: Quit/ / View Ins urance Com pany | |
4055 | The View I nsurance C ompany opt ion is use d to look at data re lated to a selected insurance company. E diting of the data i s not allo wed throug h this opt ion. | |
4056 | About the Screen... | |
4057 | In the top left corn er of each screen is the scree n title. T he followi ng line is a descrip tion of th e informat ion displa yed. A plu s sign (+) at the bo ttom of th e screen i ndicates t here are a dditional screens. L eft or rig ht arrows (<<< >>>) may be di splayed to indicate there is a dditional informatio n to the l eft or rig ht of the screen. Av ailable ac tions are displayed below the screen. <? ?> entered at any "S elect Acti on" prompt displays all availa ble action s for that screen. | |
4058 | You may QU IT from an y screen w hich will bring you back one l evel or sc reen. EXIT is also a vailable o n most scr eens. When EXIT is e ntered, yo u are aske d if you w ish to "Ex it option entirely?" . A yes re sponse ret urns you t o the menu . A NO res ponse has the same r esult as t he QUIT ac tion. For more infor mation on the use of the List Manager ut ility, ple ase refer to the app endix at t he end of this manua l. | |
4059 | Insurance Company Ed itor Scree n | |
4060 | Once the i nsurance c ompany is selected, this scree n is displ ayed listi ng the fol lowing gro ups of inf ormation f or that co mpany: bil ling param eters, mai n mailing address, i npatient c laims offi ce data, o utpatient claims off ice data, prescripti on claims office dat a, appeals office da ta, inquir y office d ata, remar ks, and sy nonyms. | |
4061 | The two ac tions avai lable thro ugh this o ption are CC Change Insurance Co. which allows yo u to chang e to anoth er company without r eturning t o the begi nning of t he option, and EXIT. | |
4062 | Sample Scr eens | |
4063 | Insurance Company Ed itor May 29, 20 14@13:46:3 6 Page: 1 of 8 | |
4064 | Insurance Company In formation for: BIG L OSS INSURA NCE | |
4065 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
4066 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
4067 | Bil ling Param eters | |
4068 | Signatur e Required ?: NO Ty pe Of Cove rage: HEAL TH INSURAN | |
4069 | Reimburse ?: WILL RE IMBURSE Billing P hone: | |
4070 | Mult. Bedsection s: YES Veri fication P hone: | |
4071 | One Opt. Visi t: NO Prec ert Comp. Name: | |
4072 | Diff. Rev. Code s: Precert P hone: | |
4073 | Amb. Sur . Rev. Cod e: | |
4074 | Rx Refil l Rev. Cod e: | |
4075 | Filing Time Fram e: (NO FI LING TIME FRAME LIMI T) | |
4076 | EDI Parame ters | |
4077 | Transm it?: YES-L IVE I nsurance T ype: GROUP POLICY | |
4078 | Inst Pay er Primary ID: Prof Pay er Primary ID: | |
4079 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
4080 | CC Change Insurance Co. EX Exit | |
4081 | Select Act ion: Next Screen// NEXT SCR EEN | |
4082 | Insurance Company Ed itor May 29, 20 14@13:46:5 0 Page: 2 of 8 | |
4083 | Insurance Company In formation for: BIG L OSS INSURA NCE | |
4084 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
4085 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
4086 | Inst Paye r Sec ID Q ual: Prof Paye r Sec ID Q ual: | |
4087 | Inst Payer Sec ID: Prof Payer Sec ID: | |
4088 | Inst Paye r Sec ID Q ual: Prof Paye r Sec ID Q ual: | |
4089 | Inst Payer Sec ID: Prof Payer Sec ID: | |
4090 | Bin Num ber: Pr nt Sec/Ter t Auto Cla ims: | |
4091 | HPID/O EID: Prnt Med Sec C laims w/o MRA: | |
4092 | Main Mailing Ad dress | |
4093 | St reet: 123 STREET Cit y/State: M EDICINE BO W, WY 5180 | |
4094 | Stre et 2: Phone: | |
4095 | Stre et 3: Fax: | |
4096 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
4097 | CC Change Insurance Co. EX Exit | |
4098 | Select Act ion: Next Screen// NEXT SCR EEN | |
4099 | Insurance Company Ed itor May 29, 20 14@13:47:3 9 Page: 3 of 8 | |
4100 | Insurance Company In formation for: BIG L OSS INSURA NCE | |
4101 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
4102 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
4103 | Inpatien t Claims O ffice Info rmation | |
4104 | Company Name: BIG LOSS INSUR ANCE S treet 3: | |
4105 | St reet: 123 STREET Cit y/State: M EDICINE BO W, WY 5180 | |
4106 | Stre et 2: Phone: | |
4107 | Fax: | |
4108 | Outpatie nt Claims Office Inf ormation | |
4109 | Company Name: BIG LOSS INSUR ANCE S treet 3: | |
4110 | St reet: 123 STREET Cit y/State: M EDICINE BO W, WY 5180 | |
4111 | Stre et 2: Phone: | |
4112 | Fax: | |
4113 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
4114 | CC Change Insurance Co. EX Exit | |
4115 | Select Act ion: Next Screen// NEXT SCR EENInsuran ce Company Editor May 29, 2014@13:4 7:42 Page: 4 of 8 | |
4116 | Insurance Company In formation for: BIG L OSS INSURA NCE | |
4117 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
4118 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
4119 | Prescript ion Claims Office In formation | |
4120 | Company Name: BIG LOSS INSUR ANCE S treet 3: | |
4121 | St reet: 123 STREET Cit y/State: M EDICINE BO W, WY 5180 | |
4122 | Stre et 2: Phone: | |
4123 | Fax: | |
4124 | App eals Offic e Informat ion | |
4125 | Company Name: BIG LOSS INSUR ANCE S treet 3: | |
4126 | St reet: 123 STREET Cit y/State: M EDICINE BO W, WY 5180 | |
4127 | Stre et 2: Phone: | |
4128 | Fax: | |
4129 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
4130 | CC Change Insurance Co. EX Exit | |
4131 | Select Act ion: Next Screen// NEXT SCR EEN | |
4132 | Insurance Company Ed itor May 29, 20 14@13:47:4 3 Page: 5 of 8 | |
4133 | Insurance Company In formation for: BIG L OSS INSURA NCE | |
4134 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
4135 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
4136 | Inq uiry Offic e Informat ion | |
4137 | Company Name: BIG LOSS INSUR ANCE S treet 3: | |
4138 | St reet: 123 STREET Cit y/State: M EDICINE BO W, WY 5180 | |
4139 | Stre et 2: Phone: | |
4140 | Fax: | |
4141 | Assoc iated Insu rance Comp anies | |
4142 | This ins urance com pany is no t defined as either a Parent o r a Child. | |
4143 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
4144 | CC Change Insurance Co. EX Exit | |
4145 | Select Act ion: Next Screen// NEXT SCR EEN | |
4146 | Insurance Company Ed itor May 29, 20 14@13:47:4 5 Page: 6 of 8 | |
4147 | Insurance Company In formation for: BIG L OSS INSURA NCE | |
4148 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
4149 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
4150 | Prov ider IDs | |
4151 | Billing Pr ovider Sec ondary ID | |
4152 | Additional Billing P rovider Se condary ID s | |
4153 | VA-Laborat ory or Fac ility Seco ndary IDs | |
4154 | ID P arameters | |
4155 | Attending/ Rendering Provider S econdary I D Qualifie r (1500): | |
4156 | Attending/ Rendering Provider S econdary I D Qualifie r (UB-04): | |
4157 | Attending/ Rendering Secondary ID Require ment: NONE REQUIRED | |
4158 | Referring Provider S econdary I D Qualifie r (1500): UPIN | |
4159 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
4160 | CC Change Insurance Co. EX Exit | |
4161 | Select Act ion: Next Screen// NEXT SCR EEN | |
4162 | Insurance Company Ed itor May 29, 20 14@13:47:4 6 Page: 7 of 8 | |
4163 | Insurance Company In formation for: BIG L OSS INSURA NCE | |
4164 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
4165 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
4166 | Referring Provider S econdary I D Requirem ent: NONE | |
4167 | Use Att/Re nd ID as B illing Pro vider Sec. ID (1500) : NO | |
4168 | Use Att/Re nd ID as B illing Pro vider Sec. ID (UB-04 ): NO | |
4169 | Always use main VAMC as Billin g Provider (1500)?: NO | |
4170 | Always use main VAMC as Billin g Provider (UB-04)?: NO | |
4171 | Transmit n o Billing Provider S ec. ID for the Elect ronic Plan Types: | |
4172 | Pa yer Inform ation: e- IV | |
4173 | Pa yer Name: BCBS DIST OF COLUMBI A (CAREFIR ST) | |
4174 | VA Nat ional ID: VA706 CMS Nation al ID: | |
4175 | Payer App lication: eIV FSC Auto-U pdate: YES | |
4176 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
4177 | CC Change Insurance Co. EX Exit | |
4178 | Select Act ion: Next Screen// NEXT SCR EEN | |
4179 | Insurance Company Ed itor May 29, 20 14@13:47:4 7 Page: 8 of 8 | |
4180 | Insurance Company In formation for: BIG L OSS INSURA NCE | |
4181 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
4182 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
4183 | Nationa l Active: YES Deacti vated: NO | |
4184 | Loca l Active: YES | |
4185 | Remarks | |
4186 | Synonyms | |
4187 | ---------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
4188 | CC Change Insurance Co. EX Exit | |
4189 | Select Act ion: Quit/ / | |
4190 | Process In surance Bu ffer | |
4191 | The IB INS URANCE SUP ERVISOR se curity key is requir ed to use the Reject Entry and Accept En try action s. Adding new insura nce compan ies requir es the IB INSURANCE COMPANY AD D security key. | |
4192 | This optio n is used to process and manag e the Insu rance Buff er through the use o f the foll owing scre ens and ac tions. | |
4193 | Insurance Buffer Lis t Screen | |
4194 | This scree n contains the list of all Ins urance Buf fer file e ntries tha t have not yet been processed by authori zed insura nce person nel. | |
4195 | Actions | |
4196 | Process En try Action | |
4197 | Opens the Insurance Buffer Pro cess scree n for a se lected buf fer entry. The buffe r entry ca n then be compared a gainst exi sting insu rance reco rds, viewe d, edited, rejected or accepte d. | |
4198 | Reject Ent ry Action | |
4199 | Allows you to reject a selecte d buffer e ntry witho ut any cha nges to th e existing permanent insurance records. This also results in the buffe r entries insurance and patien t data bei ng deleted , leaving a stub rec ord in the Buffer fi le for tra cking and reporting purposes. The perman ent Insura nce files are not mo dified by this actio n. If the patient ha s no activ e insuranc e then any bills on hold will be release d. | |
4200 | Expand Ent ry Action | |
4201 | Opens the Insurance Buffer Ent ry screen for a sele cted buffe r entry. T his screen displays the comple te buffer entry and allows the data to b e edited. | |
4202 | Add Action | |
4203 | Allows you to create then edit a new Ins urance Buf fer entry. | |
4204 | Sort List | |
4205 | Re-sorts t he list of unprocess ed buffer entries on the Insur ance Buffe r List scr een by a s elected da ta element . | |
4206 | Insurance Buffer Pro cess Scree n | |
4207 | This scree n contains the infor mation and actions n eeded to p rocess a b uffer entr y. The scr een displa y includes data to a ssist in m atching th e buffer e ntry with any existi ng insuran ce records . There ar e two vers ions of th is screen, Patient ( list is br oken into 2 sections ) and Insu rance Comp any. | |
4208 | Accept Ent ry Action | |
4209 | Allows you to accept the buffe r data and transfer the insura nce inform ation from the buffe r entry in to the per manent ins urance rec ords. New insurance records ca n be creat ed, or exi sting Insu rance reco rds can be updated w ith the bu ffer data. The new/u pdated Ins urance rec ord is fla gged as ve rified. Th e insuranc e and pati ent data i s deleted from the b uffer entr y leaving only a stu b record f or trackin g and repo rting purp oses. If a new polic y is added for the p atient, th e on hold date of an y patient bills is u pdated to the curren t date. | |
4210 | Reject Ent ry Action | |
4211 | Allows you to reject the buffe r entry wi thout any changes to the exist ing perman ent insura nce record s. This al so results in the bu ffer entri es insuran ce and pat ient data being dele ted, leavi ng a stub record in the Buffer file for tracking a nd reporti ng purpose s. The per manent ins urance fil es are not modified by this ac tion. If t he patient has no ac tive insur ance, any bills on h old are re leased. | |
4212 | Compare En try Action | |
4213 | Displays t he buffer entry and a user sel ected Insu rance Poli cy side by side so t hey can be compared to determi ne if they match. It is also p ossible to edit the buffer ent ry data wi thin this action. Th e display and editin g is broke n into 3 p arts: Insu rance Comp any data, Group/Plan data, and Patient P olicy data . | |
4214 | Expand Ent ry Action | |
4215 | Opens the Insurance Buffer Ent ry screen for the bu ffer entry . It displ ays the co mplete buf fer entry and allows the data to be edit ed. | |
4216 | Insurance Co/Patient Action | |
4217 | Toggles be tween the two versio ns of the Insurance Buffer Pro cess scree n: Patient or Insura nce Compan y. If an I nsurance C ompany is selected t he Insuran ce Company version o f the scre en is disp layed, if no company is select ed the Pat ient versi on of the screen is displayed. | |
4218 | Insurance Buffer Ent ry Screen | |
4219 | This scree n displays all data defined fo r a buffer entry and allows th at data to be edited . | |
4220 | Insurance Co Edit Ac tion | |
4221 | Edits the Insurance Company sp ecific dat a in the b uffer entr y. | |
4222 | Group/Plan Edit Acti on | |
4223 | Edits the Insurance Group/Plan specific data in th e buffer e ntry. | |
4224 | Patient Po licy Edit Action | |
4225 | Edits the Patient Po licy speci fic data i n the buff er entry. | |
4226 | All Edit A ction | |
4227 | Edits all three type s of data in the buf fer entry: Insurance Company, Group/Plan , and Pati ent Policy . | |
4228 | Verify Ent ry Action | |
4229 | Option to flag the b uffer entr y as verif ied before it is acc epted. If the buffer entry is later acce pted, the person tha t uses thi s action i s added as the verif ier in the permanent insurance policy. | |
4230 | Sample Scr eens | |
4231 | Insurance Buffer Lis t Nov 05, 19 98 09:44:0 9 P age: 1 o f 1 | |
4232 | Buffer Fil e entries not yet pr ocessed. (sorted by Patient N ame) | |
4233 | Patient Name I nsurance C ompany Su bscr Id S Ent ered iIE CH | |
4234 | 1 IBpati ent,one 2343 G EHA 12 3 I 10/ 09/98 I | |
4235 | 2 *IBpati ent,two 6666 H ARTFORD 00 6066666 I 09/ 15/98 i C | |
4236 | 3 IBpati ent,three 0111 B LUE CROSS/ BLUE S 12 345 I 09/ 29/98 i | |
4237 | 4 IBpati ent,four 0111 G HI P 09/ 30/98 i | |
4238 | 5 IBpati ent,five 0111 H ARTFORD I 09/ 30/98 i | |
4239 | Enter ?? f or more ac tions | |
4240 | Proces s Entry EE Expand Ent ry Sort List | |
4241 | Reject Entry Add Entry X Exit | |
4242 | Select Act ion: Quit/ / | |
4243 | Insurance Buffer Pro cess Nov 05, 19 98 11:01:2 1 Page: 1 of 1 | |
4244 | IBpatient, one 000 -11-1111 DOB: JUN 2,1926 AGE: 72 | |
4245 | HA RTFORD ( 2222 SOUTH STREET, S AN DIEGO, CA) | |
4246 | -HARTFO RD 000-CH AMPUS 0 06066666 PATIEN | |
4247 | Pati ent's Exis ting Insur ance | |
4248 | Insuran ce Company Group # S ubscriber Id Holder Effectiv e Expires | |
4249 | 1 HARTFO RD 000 0 00111111 SPOUSE 01/01/97 | |
4250 | 2 BC/BS OF ALBANY 415 0 00111111 PATIEN | |
4251 | Any Grou p/Plan tha t may matc h Group Na me or Grou p Number | |
4252 | Insur ance Compa ny Group Name Group Nu mber | |
4253 | 3 HARTF ORD 2222 South St CHAMPUS PR IM 000 | |
4254 | Enter ?? f or more ac tions | |
4255 | Accept Entry Compare En try Insu rance Co/P atient | |
4256 | Reject Entry EE Expand Ent ry X Exit | |
4257 | Select Act ion: Quit/ / | |
4258 | Manually A dded HPIDs to Billin g Claim Re port | |
4259 | This repor t generate s a list o f Health P lan (HPID) numbers t hat have b een added directly t o claims. It allows billing st aff to tra ck the ins tances whe n an HPID number is added to a third-par ty claim a nd to gene rate an ad -hoc repor t of autho rized clai ms with th is entry i nformation . Only HPI Ds that ha ve been ma nually add ed will ap pear on th is report. | |
4260 | You will b e prompted for date range, rep ort format , and devi ce. The da te range p ertains to when the HPID was m anually ad ded to the claim. | |
4261 | This outpu t displays patient n ame, last 4 of SSN, payer, HPI D, claim n umber, use r name, da te HPID ad ded, Profe ssional ID and Insti tutional I D. | |
4262 | Sample Out put | |
4263 | MANUALLY A DDED HPIDS TO BILLIN G CLAIM RE PORT AU G 02, 2015 @19:59 Page: 1 | |
4264 | PT NAME SSN PAY ER HPI D C LAIM # USER NAM E DATE HP ID ADDED PROF ID INST ID | |
4265 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -- | |
4266 | IBPATIENT, ONE 1111 BLU E CROSS 741 4615444 5 00-K400003 IBUSER,O NE 12/02/ 2014 1234567890 098765432 1 | |
4267 | IBPATIENT, ONE 1111 BLU E CROSS 739 9982967 5 00-K400005 IBUSER,O NE 01/15/ 2015 1234567890 098765432 1 | |
4268 | IBPATIENT, ONE 1111 BLU E CROSS 794 7434214 5 00-K400003 IBUSER,O NE 01/22/ 2015 1234567890 098765432 1 | |
4269 | IBPATIENT, ONE 1111 BLU E CROSS 794 7434214 5 00-K400005 IBUSER,O NE 01/22/ 2015 1234567890 098765432 1 | |
4270 | IBPATIENT, ONE 1111 BLU E CROSS 746 7061371 5 00-K400003 IBUSER,O NE 01/23/ 2015 1234567890 098765432 1 | |
4271 | IBPATIENT, ONE 1111 BLU E CROSS 794 7434214 5 00-K400005 IBUSER,O NE 02/05/ 2015 1234567890 098765432 1 | |
4272 | IBPATIENT, TWO 9341 BLU E CROSS 746 2706327 5 00-K400008 IBUSER,O NE 02/09/ 2015 1234567890 098765432 1 | |
4273 | IBPATIENT, TWO 9341 BLU E CROSS 744 4643416 5 00-K400008 IBUSER,O NE 02/09/ 2015 1234567890 098765432 1 | |
4274 | IBPATIENT, TWO 9341 BLU E CROSS 790 8996151 5 00-K400008 IBUSER,O NE 02/09/ 2015 1234567890 098765432 1 | |
4275 | Expire Gro up Plan (X PIR) | |
4276 | This Patie nt Insuran ce Menu (P I) option is used to specify a n expirati on date fo r all subs cribers in a plan, e ffectively “terminat ing” the p lan, witho ut having to move th e subscrib ers to a d ifferent p lan. This option off ers the us er the opt ion to ina ctivate th e plan as part of th e expirati on or to a llow the p lan to rem ain active . | |
4277 | Sample Scr eens/Promp ts | |
4278 | EXPIRE ALL SUBSCRIBE RS WITHIN A GROUP PL AN | |
4279 | You can us e this opt ion to spe cify an ex piration d ate for al l subscrib er policie s in a gro up plan wi thout movi ng the sub scribers t o another group plan . If the g roup plan status is currently “active,” you can al so choose to “inacti vate” the group plan . | |
4280 | Select INS URANCE COM PANY: | |
4281 | You may se lect an ex isting Pla n from a l ist or ent er a speci fic Plan. | |
4282 | Do you wis h to enter a specifi c plan? NO | |
4283 | If the use r response is NO, th e Group Pl an Lookup screen dis plays: | |
4284 | If the use r response is YES, t he followi ng prompts display: | |
4285 | ||
4286 | When the u ser select s a Group Plan, the following prompts di splay: | |
4287 | ||
4288 | Collecting Subscribe rs . . . | |
4289 | This group plan has ## subscri bers. All subscriber s will be expired. | |
4290 | Do you wan t to expir e all subs cribers’ p olicies fo r this pla n? //YES | |
4291 | Enter expi ration dat e (applies to all su bscribers in this pl an): | |
4292 | You select ed to expi re ## subs criber(s) with Expir ation Date <MMM dd, yyyy> for: | |
4293 | ||
4294 | Insurance Company <I NSURANCE C OMPANY NAM E> | |
4295 | ||
4296 | Plan Name <GROUP NAM E> | |
4297 | ||
4298 | Number <GR P NUM #### #> | |
4299 | Please not e that the policy wi ll be EXPI RED in the patient p rofile!! | |
4300 | Okay to co ntinue? // YES | |
4301 | Expiring P olicies . . . | |
4302 | Done. ## S ubscribers ’ policies were expi red as of <MMM dd, y yyy>. | |
4303 | A Bulletin was sent to you and members o f ‘IB NEW INSURANCE’ Mail Grou p. | |
4304 | = = = = = = = = = = = = = = = = = = = = = = | |
4305 | EXPIRE ALL SUBSCRIBE RS WITHIN A GROUP PL AN | |
4306 | = = = = = = = = = = = = = = = = = = = = = = | |
4307 | One of the following messages may displa y if there are subsc ribers (po licies) th at were no t/could no t be expir ed: | |
4308 | These # en tries coul d not be p rocessed, they’ll ne ed to be a djusted ma nually. | |
4309 | Patient Na me/ID | |
4310 | Whose | |
4311 | ||
4312 | Employer | |
4313 | Effective | |
4314 | Expires | |
4315 | <patient n ame ####> | |
4316 | <relati on> | |
4317 | <employer> | |
4318 | <date> | |
4319 | <date> | |
4320 | Examine th e entries that could not be pr ocessed. | |
4321 | Press RETU RN to cont inue. | |
4322 | -or- | |
4323 | After proc essing, no changes w ere needed , no polic ies were e xpired. | |
4324 | Press RETU RN to cont inue. | |
4325 | = = = = = = = = = = = = = = = = = = = = = = | |
4326 | EXPIRE ALL SUBSCRIBE RS WITHIN A GROUP PL AN | |
4327 | = = = = = = = = = = = = = = = = = = = = = = | |
4328 | If the gro up plan is active, t he inactiv ate plan p rompt, sho wn below, displays. The follow ing warnin g displays with the inactivate plan prom pt if ther e are subs cribers (p olicies) t hat were n ot/could n ot be expi red: | |
4329 | * * * * * * * * * * * * * * * * * * * * * * * * | |
4330 | ||
4331 | ||
4332 | ||
4333 | Warning | |
4334 | ||
4335 | There are still acti ve subscri bers | |
4336 | ||
4337 | ||
4338 | that will need to be adjusted manually. | |
4339 | * * * * * * * * * * * * * * * * * * * * * * * * | |
4340 | Do you wis h to inact ivate plan <GROUP NA ME>? //N | |
4341 | If user re sponse is YES, the f ollowing d isplays: | |
4342 | The <GROUP NAME> pla n has been inactivat ed. | |
4343 | If user re sponse is NO, the fo llowing di splays: | |
4344 | The <GROUP NAME> pla n is still active. | |
4345 | If the gro up plan is inactive, the follo wing promp t displays : | |
4346 | Please no te the <GR OUP NAME> plan is al ready inac tive. | |
4347 | = = = = = = = = = = = = = = = = = = = = = = | |
4348 | EXPIRE AL L SUBSCRIB ERS WITHIN A GROUP P LAN | |
4349 | = = = = = = = = = = = = = = = = = = = = = = | |
4350 | Insurance Reports | |
4351 | The Insura nce Report s menu pro vides the options to run the f ollowing r eports: | |
4352 | ABUF | |
4353 | Insurance Buffer Act ivity | |
4354 | AU | |
4355 | User Edit Report | |
4356 | EBUF | |
4357 | Insurance Buffer Emp loyee | |
4358 | GP | |
4359 | List Group Plans wit hout Annua l Benefits | |
4360 | ID | |
4361 | Generate I nsurance C ompany Lis tings | |
4362 | IN | |
4363 | Patients w ith Uniden tified Ins urance | |
4364 | INSC | |
4365 | Veterans w /Insurance and Inpat ient Admis sions | |
4366 | IU | |
4367 | eIV Patien t Insuranc e Update R eport | |
4368 | LC | |
4369 | List Inact ive Ins. C o. Coverin g Patients | |
4370 | LP | |
4371 | List Plans by Insura nce Compan y | |
4372 | LR | |
4373 | eIV Payer Link Repor t | |
4374 | MD | |
4375 | Insurance Plans Miss ing Data R eport | |
4376 | NC | |
4377 | Verificati on of No C overage Re port | |
4378 | NE | |
4379 | Active Pol icies with no Effect ive Date R eport | |
4380 | NI | |
4381 | Potential New Insura nce Found ... | |
4382 | NV | |
4383 | List New n ot Verifie d Policies | |
4384 | ONSC | |
4385 | Veterans w /Insurance and Opt. Visits | |
4386 | PO | |
4387 | Insurance Policies N ot Verifie d | |
4388 | PR | |
4389 | eIV Payer Report | |
4390 | PT | |
4391 | Insurance Payment Tr end Report ) | |
4392 | RR | |
4393 | eIV Respon se Report | |
4394 | SOUR | |
4395 | Source Of Informatio n Report | |
4396 | SR | |
4397 | eIV Statis tical Repo rt | |
4398 | UNKI | |
4399 | Inpatients w/Unknown or Expire d Insuranc e | |
4400 | UNKO | |
4401 | Outpatient s w/Unknow n or Expir ed Insuran ce | |
4402 | WNR | |
4403 | Patients W ithout MED ICARE (WNR ) Insuranc e | |
4404 | WO | |
4405 | Patients w ith or wit hout Insur ance Repor t | |
4406 | List Inact ive Ins. C o. Coverin g Patients | |
4407 | The List I nactive In s. Co. Cov ering Pati ents optio n is used to provide a listing of inacti ve insuran ce compani es that ar e listed i n the syst em as prov iding pati ent covera ge. | |
4408 | Occasional ly, an ins urance com pany may b e in the s ystem twic e under sl ightly dif ferent nam es (i.e., Blue Cross and Blue Cross of N ew York) w hen in fac t they are the same company. O nce the co rrect name is establ ished, it would be n ecessary t o inactiva te the inc orrect nam e and "rep oint" thos e patients to the co rrect name . This opt ion provid es the num ber of pat ients whic h should b e repointe d to anoth er company . | |
4409 | Informatio n provided on the ou tput inclu des insura nce compan y name and address a nd the num ber of pat ients the system sho ws as havi ng coverag e by that company. | |
4410 | Sample Out put | |
4411 | INACTIVE I NSURANCE C OMPANIES W ITH PATIEN TS NOV 16,1993 08:46 P AGE 1 | |
4412 | NUMBER | |
4413 | INSURANCE COMPANY STREET CITY STATE PATIENTS | |
4414 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
4415 | ABC INSURA NCE COMPAN Y 2123 M AIN STREET NEW YORK NY 1 | |
4416 | ABC INS 235 PE NN AVE COHO ES NY 19 | |
4417 | NATIONWIDE 77 PAR KER BLVD ROCH ESTER MN 1 | |
4418 | XYZ INS 345 SE COND AVE ALBA NY NY 2 | |
4419 | List Plans by Insura nce Compan y | |
4420 | This repor t provides insurance informati on from bo th a plan and subscr iber persp ective. It is design ed to gene rate lists of plans by insuran ce company , and list s of subsc ribers (po licies) by insurance plan. It can be use d to gener ate plan a nd subscri ber lists to be used for your database c lean-up ef forts. Onc e your dat abase inte grity has been resto red, the r eport can be used to generate a list of subscriber s to parti cular plan s or compa nies. | |
4421 | This repor t is forma tted to pr int at 132 columns. | |
4422 | Sample Scr een | |
4423 | Insurance Plan Looku p Sep 19, 19 95 13:29:5 0 Pa ge: 1 of 1 | |
4424 | All Plans for: ABC I NS P hone: 618- 567-987 | |
4425 | 123 M AIN Ave. Prece rts: 987-9 65-8754 | |
4426 | LOS A NGELES, CA 00098 | |
4427 | # + => In div. Plan * => In active Pla n Pre- Pr e- Ben | |
4428 | Group Name Group N umber Type of Plan UR? Ct? Ex C? As? | |
4429 | 1 AE 93932 MEDICAL EXPEN NO YES YE S YES | |
4430 | 2 NYS 1234322 1 MEDI-CAL YES YES YE S YES | |
4431 | 3 KROGER 112222 MAJOR ME DICAL NO YES NO YES | |
4432 | 4 RETIRE D 4321 MAJOR ME DICAL YES YES NO YES | |
4433 | Enter ?? f or more ac tions | |
4434 | ||
4435 | SP Select Plan | |
4436 | Select Act ion: Quit/ / sp=1 4 Select Pl an | |
4437 | Would you like to se lect any o ther plans ? NO// <RE T> | |
4438 | Sample Out put | |
4439 | LIST OF PL ANS BY INS URANCE COM PANY MAR 12, 2015@1 3:19 Page: 1 | |
4440 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
4441 | + =>INDIV. PLAN * => INACTI VE | |
4442 | Filters: A ctive Insu rance, Act ive Group Plans | |
4443 | INSURANCE COMPANY TW O | |
4444 | PO BOX XXX XXX FTF= 1(Y RS) | |
4445 | ||
4446 | GROUP PLAN TOTAL= 4 | |
4447 | ||
4448 | KANSAS CIT Y, MO | |
4449 | ||
4450 | ||
4451 | ||
4452 | SUBSCRIBER TOTAL= 10 00 | |
4453 | 64106-7711 | |
4454 | GROUP NUMBER | |
4455 | ||
4456 | GROUP NAME TYPE O F PLAN ELEC PLAN FTF | |
4457 | ||
4458 | PART A | |
4459 | ||
4460 | ||
4461 | PART A | |
4462 | MEDI CARE MEDICARE | |
4463 | 1(YRS) | |
4464 | ||
4465 | ||
4466 | SUBSCRIBER S = 250 | |
4467 | PART B | |
4468 | ||
4469 | ||
4470 | PART B | |
4471 | MEDI CARE MEDICARE | |
4472 | 1(YRS) | |
4473 | ||
4474 | ||
4475 | SUBSCRIBER S = 20 | |
4476 | ||
4477 | +PART A RR | |
4478 | ||
4479 | PART A RR | |
4480 | MEDI CARE MEDICARE | |
4481 | 1(YRS) | |
4482 | ||
4483 | ||
4484 | SUBSCRIBER S = 1 | |
4485 | PART B RR | |
4486 | ||
4487 | ||
4488 | PART B RR | |
4489 | MEDI CARE MEDICARE | |
4490 | 1(YRS) | |
4491 | ||
4492 | ||
4493 | SUBSCRIBER S = 250 | |
4494 | *INSURANCE COMPANY T HREE | |
4495 | ||
4496 | ||
4497 | PO BOX XXX XXX FTF= 1(Y RS) | |
4498 | KANSAS CIT Y, MO GROUP PL AN TOTAL= 5 | |
4499 | ||
4500 | 66666-5555 SUBSCRIB ER TOTAL= 1000 | |
4501 | GROUP NUMBER | |
4502 | ||
4503 | GROUP NAME TYPE O F PLAN E LEC PLAN FTF | |
4504 | ||
4505 | PART A | |
4506 | ||
4507 | ||
4508 | PART A | |
4509 | MED ICARE M EDICARE | |
4510 | 1(YRS) | |
4511 | ||
4512 | ||
4513 | SUBSCRIBER S = 250 | |
4514 | *PART B | |
4515 | ||
4516 | ||
4517 | PART B | |
4518 | MED ICARE M EDICARE | |
4519 | 1(YRS) | |
4520 | ||
4521 | ||
4522 | SUBSCRIBER S = 20 | |
4523 | ||
4524 | PART A RR | |
4525 | ||
4526 | ||
4527 | PART A RR | |
4528 | MED ICARE M EDICARE | |
4529 | 1(YRS) | |
4530 | ||
4531 | ||
4532 | SUBSCRIBER S = 5 | |
4533 | PART B RR | |
4534 | ||
4535 | ||
4536 | PART B RR | |
4537 | MED ICARE M EDICARE | |
4538 | 1(YRS) | |
4539 | ||
4540 | ||
4541 | SUBSCRIBER S = 250 | |
4542 | *****End of Report **** | |
4543 | List New n ot Verifie d Policies | |
4544 | The List N ew not Ver ified Poli cies optio n is used to produce a list by patient o f new insu rance entr ies that h ave not be en verifie d. After r unning thi s report, you would use the Ve rify Cover age action of the Pa tient Insu rance Info View/Edit option to verify co verage for individua l patients . | |
4545 | You may sp ecify a da te range a nd patient name rang e to limit the param eters of t he report. | |
4546 | Informatio n provided on the ou tput inclu des patien t name and ID#, insu rance comp any name, subscriber ID, perso n who made the entry , and date entered. A total co unt is als o provided . | |
4547 | REPORT OF NEW, NOT V ERIFIED IN SURANCE EN TRIES FROM : 8/01/93 TO: 12/01/ 93 D EC 16,1993 15:05 PAGE 1 | |
4548 | PATIENT PAT IENT ID I NSURANCE C O SUB SCRIBER ID WH O ENTERED DATE ENTERED | |
4549 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
4550 | IBpatient, one 000 111111 X YZ INS 348 3920 NA NCY AUG 1 7,1993 | |
4551 | IBpatient, two 000 222222 B LUE CROSS BLUE SHIEL D 123 456 BE TH SEP 1 7,1993 | |
4552 | IBpatient, three 000 333333 X YZ INS 258 7 EL LEN OCT 1 2,1993 | |
4553 | ---------- ---------- ----- | |
4554 | COUNT 3 | |
4555 | Insurance Plans Miss ing Data R eport | |
4556 | The Insura nce Plans Missing Da ta option creates a list of in surance pl an missing specified informati on. | |
4557 | This repor t can disp lay plans that are m issing gro up number, type of p lan, timel y filing t ime frame, electroni c plan typ e, coverag e limitati ons, BIN, and PCN. | |
4558 | Sample Scr een | |
4559 | 1. List Al l 1365 Act ive Ins. C ompanies | |
4560 | 2. List On ly Active Ins. Compa nies That You Select | |
4561 | SELEC T 1 or 2: | |
4562 | Display Ac tive Group (s) missin g Group Nu mber? YES/ / YES | |
4563 | Display Ac tive Group (s) missin g Type of Plan? YES/ /YES | |
4564 | Display Ac tive Group (s) missin g Timely F iling Time Frame? YE S//YES | |
4565 | Display Ac tive Group (s) missin g Electron ic Plan Ty pe? YES//Y ES | |
4566 | Display Ac tive Group (s) missin g Coverage Limitatio ns? YES//Y ES | |
4567 | Display Ac tive Group (s) missin g BIN? YES //YES | |
4568 | Display Ac tive Group (s) missin g PCN? YES //YES | |
4569 | DEVICE: HO ME// | |
4570 | Sample Out put | |
4571 | INSURANCE PLANS MISS ING DATA MA R 12, 2015 @13:19 Page: 1 of 1 | |
4572 | Missing Da ta: Group #, Plan Ty pe, FTF, E lec Plan, BIN, PCN, Coverage L imitation | |
4573 | MEDICARE ( WNR) | |
4574 | PO BOX xxx xx KANS AS CITY, M O 64444-1 111 | |
4575 | GROUP # GROUP N AME TYP E OF PLAN ELEC PLA N FTF | |
4576 | ||
4577 | -------- ------- --- --- -------- -------- - --- | |
4578 | ######## | |
4579 | PART B | |
4580 | MED ICARE | |
4581 | MEDICAR E | |
4582 | 1(YRS) | |
4583 | PART B | |
4584 | PART B | |
4585 | MED ICARE | |
4586 | MEDICAR E | |
4587 | ###### # | |
4588 | PART A RR | |
4589 | ######## MEDICA RE | |
4590 | MEDICAR E | |
4591 | ###### # | |
4592 | PART B RR | |
4593 | PART B | |
4594 | ### ### | |
4595 | MEDICARE | |
4596 | ###### # | |
4597 | ||
4598 | PART G | |
4599 | PART G | |
4600 | MED ICARE | |
4601 | ####### ## 1(Y RS) | |
4602 | PART A RR | |
4603 | ####### MEDICA RE | |
4604 | MEDICAR E | |
4605 | ###### # | |
4606 | Covera ge Effect ive Date Covered? | |
4607 | ------ -- ------ -------- -------- | |
4608 | INPATI ENT ###### ## BY DEFAUL T | |
4609 | PART G | |
4610 | PART G | |
4611 | MEDICARE | |
4612 | ####### ## 1(Y RS) | |
4613 | PART A R R | |
4614 | ####### | |
4615 | MEDICARE | |
4616 | MEDICAR E | |
4617 | ###### # | |
4618 | CAREMARK | |
4619 | PO BOX 139 99 KANS AS CITY, M O 64106-7 711 PRE SCRIPTION ONLY | |
4620 | GROUP # | |
4621 | GROUP NAME TYPE OF PLAN ELEC PLAN FTF BIN | |
4622 | PCN | |
4623 | -------- ------- --- -- --------- ------- -- --- --- --- | |
4624 | ######## | |
4625 | PART B | |
4626 | PR ESCRIPTION PRESCRI PTION 1(Y RS) ### A8R1264 | |
4627 | ######## | |
4628 | PART B | |
4629 | PR ESCRIPTION PRESCRI PTION 1(Y RS) 12365 4 ##### | |
4630 | PART B | |
4631 | PART B | |
4632 | PR ESCRIPTION PRESCRI PTION 1(Y RS) ### ##### | |
4633 | *****End o f Report** ** | |
4634 | Release of Informati on Report | |
4635 | This repor t provides a list of Release o f Informat ions (ROI) for sensi tive diagn osis medic ation and the associ ated expir ation date s. The ROI report is designed to sort by expiratio n date, in reverse c hronologoc ial order. | |
4636 | This repor t is forma tted to pr int at 132 columns. | |
4637 | Sample Out put | |
4638 | BEGINNING EXPIRATION DATE: T-1 80// (MA Y 07, 2015 ) | |
4639 | ENDING EXP IRATION DA TE: T+60// (JAN 02 , 2016) | |
4640 | Selec t one of t he followi ng: | |
4641 | A ACTIVE | |
4642 | I INACTIVE | |
4643 | B BOTH | |
4644 | Display (A )ctive or (I)active or (B)oth ROI Status :: Both// BOTH | |
4645 | Export the report to Microsoft Excel (Y/ N)? NO// | |
4646 | WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED. | |
4647 | IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES | |
4648 | DEVICE: HO ME// 0;132 VIRTUAL TELNET | |
4649 | Please wai t... | |
4650 | Release of Informati on Expirat ion Report P age: 1 | |
4651 | Date Range : 05/07/20 15 - 01/02 /2016 Run Date: Nov 03, 20 15@12:38:3 5 | |
4652 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
4653 | Date of Eff. Exp. Dat e | |
4654 | Patient Na me Death Date Date St Add ed En tered By Ins urance Nam e Dru g Name | |
4655 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
4656 | PATIENT,ON E 12/16/15 01/02/16 A 12/ 30/15 US ER,ONE ABC INSURANCE DRU G ONE | |
4657 | PATIENT,TW O 01/01/15 12/31/15 A 05/ 24/13 US ER,FOUR ABC INSURANCE DRU G TWO | |
4658 | PATIENT,TW O 01/01/15 12/31/15 A 02/ 13/13 US ER,ONE ABC INSURANCE DRU G ONE | |
4659 | PATIENT,TH REE 01/01/15 12/31/15 A 05/ 28/15 US ER,TWO XYZ INSURANCE DRU G THREE | |
4660 | *** END OF REPORT ** * | |
4661 | Billing Su pervisor M enu | |
4662 | *Documenta tion for t he Unbille d Amounts Menu, whic h was rele ased to th e field as patch IB* 2*19, has been inclu ded in thi s section of the man ual as a m atter of c onvenience . The Unbi lled Amoun ts Menu [I BT UNBILLE D MENU] ne ed not be assigned t o the Bill ing Superv isor Menu. It may be assigned to any men u in Integ rated Bill ing, or to a user’s secondary menu, as d eemed appr opriate by IRMS. | |
4663 | Insurance Buffer Act ivity | |
4664 | This repor t provides a summary of the ac tivity wit hin the In surance Bu ffer for a specified date rang e. Counts, percentag es, and av erage proc essing tim es are inc luded for both proce ssed and u nprocessed entries. The report can be pr inted with totals on ly or by m onth withi n the sele cted date range. | |
4665 | Sample Out put | |
4666 | INSURANCE BUFFER ACT IVITY REPO RT Apr 1 7, 1998 - Nov 05, 19 98 11/5/98 11:06 PAG E 1 | |
4667 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
4668 | TOT ALS | |
4669 | AVERAGE LONG EST SH ORTEST | |
4670 | STATUS COUNT PERCENT # DAYS # DA YS # DAYS | |
4671 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------- | |
4672 | ENTERED 24 58.5% 39.0 146 .0 0.0 | |
4673 | VERIFIED 4 9.8% 26.7 105 .0 0.0 | |
4674 | ACCEPTED ( &V) 5 12.2% 22.6 108 .9 0.2 | |
4675 | REJECTED 7 17.1% 62.6 146 .0 3.0 | |
4676 | REJECTED ( V) 1 2.4% 4.8 4 .8 4.8 | |
4677 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------- | |
4678 | NOT PROCES SED 28 68.3% 37.3 146 .0 0.0 | |
4679 | PROCESSED 13 31.7% 42.8 146 .0 0.2 | |
4680 | TOTAL 41 100.0% 39.0 146 .0 0.0 | |
4681 | 0 New Co mpanies (0 %), 0 New Group/Plan s (0%), 1 New Patien t Policy ( 20%) | |
4682 | Management Reports ( Billing) M enu | |
4683 | Statistica l Report ( IB) | |
4684 | This repor t lists th e total nu mber of In tegrated B illing act ions by ac tion type along with the total charge by type for a date ran ge. Integr ated Billi ng actions include i npatient c opayments by treatin g specialt y, inpatie nt and NHC U per diem s; and NHC U, outpati ent, and p harmacy co payments. | |
4685 | Net statis tics compu te the cur rent statu s for each new entry in the se lected dat e range to calculate the net t otals. Net totals ar e derived from the l ast update for a par ent (even when the u pdate is n ot within the date r ange) usin g the foll owing form ula: new e ntries (+) updates w ithin the date range (-) cance llations. | |
4686 | The gross statistics count onl y the entr ies in the date rang e. It is p ossible th at the net and gross statistic s may not match. For example, if a charg e was canc elled afte r the sele cted date range of t he report but before the repor t actually ran, the net figure s would re flect this but the g ross figur es would n ot. | |
4687 | Sample Out put | |
4688 | INTEGRATED BILLING S TATISTICAL REPORT | |
4689 | ALBANY (50 0) | |
4690 | From: JUN 10, 1992 | |
4691 | To: JUN 10 , 1992 | |
4692 | Date Print ed: JUN 10 , 1992 | |
4693 | Page: 1 | |
4694 | ---------- ---------- ------ | |
4695 | NET TOTALS BY ACTION TYPE | |
4696 | F EE SERVICE (OPT) NEW | |
4697 | NU MBER ENTRI ES: 1 | |
4698 | DO LLAR AMOUN T: $30 | |
4699 | INPT COPAY (ALC) NEW | |
4700 | NU MBER ENTRI ES: 0 | |
4701 | DO LLAR AMOUN T: $0 | |
4702 | INPT COPAY (PSY) NEW | |
4703 | NU MBER ENTRI ES: 1 | |
4704 | DO LLAR AMOUN T: $162 | |
4705 | INPT PE R DIEM NEW | |
4706 | NU MBER ENTRI ES: 1 | |
4707 | DO LLAR AMOUN T: $10 | |
4708 | OPT COPAY NEW | |
4709 | NU MBER ENTRI ES: 13 | |
4710 | DO LLAR AMOUN T: $390 | |
4711 | SC RX COPAY NEW | |
4712 | NU MBER ENTRI ES: 5 | |
4713 | DO LLAR AMOUN T: $24 | |
4714 | NSC RX CO PAY UPDATE | |
4715 | NU MBER ENTRI ES: 1 | |
4716 | DO LLAR AMOUN T: $2 | |
4717 | GROS S TOTALS B Y ACTION T YPE | |
4718 | F EE SERVICE (OPT) NEW | |
4719 | NU MBER ENTRI ES: 1 | |
4720 | DO LLAR AMOUN T: $30 | |
4721 | INPT COPAY (ALC) NEW | |
4722 | NU MBER ENTRI ES: 1 | |
4723 | DO LLAR AMOUN T: $238 | |
4724 | INTEGRATED BILLING S TATISTICAL REPORT | |
4725 | ALBANY (50 0) | |
4726 | From: JUN 10, 1992 | |
4727 | To: JUN 10 , 1992 | |
4728 | Date Print ed: JUN 10 , 1992 | |
4729 | Page: 2 | |
4730 | ---------- ---------- ------ | |
4731 | INPT COPAY (PSY) NEW | |
4732 | NU MBER ENTRI ES: 1 | |
4733 | DO LLAR AMOUN T: $162 | |
4734 | INPT PE R DIEM NEW | |
4735 | NU MBER ENTRI ES: 1 | |
4736 | DO LLAR AMOUN T: $10 | |
4737 | OPT COPAY NEW | |
4738 | NU MBER ENTRI ES: 16 | |
4739 | DO LLAR AMOUN T: $480 | |
4740 | NSC RX COPAY NEW | |
4741 | NU MBER ENTRI ES: 1 | |
4742 | DO LLAR AMOUN T: $2 | |
4743 | SC RX COPAY NEW | |
4744 | NU MBER ENTRI ES: 5 | |
4745 | DO LLAR AMOUN T: $28 | |
4746 | INP T COPAY (A LC) CANCEL | |
4747 | NU MBER ENTRI ES: 1 | |
4748 | DO LLAR AMOUN T: $238 | |
4749 | OPT CO PAY CANCEL | |
4750 | NU MBER ENTRI ES: 3 | |
4751 | DO LLAR AMOUN T: $90 | |
4752 | NSC RX CO PAY CANCEL | |
4753 | NU MBER ENTRI ES: 2 | |
4754 | DO LLAR AMOUN T: $44 | |
4755 | SC RX CO PAY UPDATE | |
4756 | NU MBER ENTRI ES: 1 | |
4757 | DO LLAR AMOUN T: $4 | |
4758 | Most Commo nly used O utpatient CPT Codes | |
4759 | This optio n will lis t the most common am bulatory p rocedures and ambula tory surge ries perfo rmed withi n a date r ange for s elected cl inic(s). T his list m ay be used to help s elect whic h codes to include w hen buildi ng CPT che ck-off she ets throug h the Buil d CPT Chec k-off Shee t option u nder the A mbulatory Surgery Ma intenance Menu. | |
4760 | You may so rt by clin ic or proc edure. Whe n sorting by procedu re, you ma y also inc lude full procedure descriptio ns. | |
4761 | All report s provide the CPT co de and pro cedure, a count of e ach proced ure that h as been en tered for a clinic v isit, numb er billed, the OPC s tatus, and charge am ount. The status and charge am ount given are as of the curre nt date. I f no charg e amount i s shown, t he procedu re is not a billable procedure . | |
4762 | This outpu t requires 132 colum n margin w idth. | |
4763 | Depending on the dat e range ch osen, this report co uld be qui te lengthy . You may wish to qu eue this t o print du ring non-w ork hours. | |
4764 | Sample Out put | |
4765 | CLINIC CPT USAGE FOR JAN 1,199 1 - JAN 1, 1992 APR 16, 1992 11:22 PA GE 1 | |
4766 | ALL DIVISI ONS AND CL INICS | |
4767 | AMBULATORY PROCEDURE COUNT # BILLED OP C STATUS C HARGE | |
4768 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ----- | |
4769 | 10121 REM OVE FOREIG N BODY 38 38 NA TIONALLY A CTIVE 2 56.50 | |
4770 | INC ISION AND REMOVAL OF FOREIGN B ODY, SUBCU TANEOUS TI SSUES; | |
4771 | COM PLICATED | |
4772 | 11000 SUR GICAL CLEA NSING OF S KIN 56 NA TIONALLY A CTIVE | |
4773 | DEB RIDEMENT O F EXTENSIV E ECZEMATO US OR INFE CTED SKIN; UP TO 10% OF | |
4774 | BOD Y SURFACE | |
4775 | 13152 REP AIR OF WOU ND OR LESI ON 89 34 NA TIONALLY A CTIVE 3 94.20 | |
4776 | REP AIR, COMPL EX, EYELID S, NOSE, E ARS AND/OR LIPS; 2.6 CM TO 7.5 CM | |
4777 | 24925 AMP UTATION FO LLOW-UP SU RGERY 29 3 94.20 | |
4778 | AMP UTATION, A RM THROUGH HUMERUS; SECONDARY CLOSURE OR SCAR REVI SION | |
4779 | 40654 REP AIR LIP 1 1 NA TIONALLY A CTIVE 3 94.20 | |
4780 | REP AIR LIP, F ULL THICKN ESS; OVER ONE HALF V ERTICAL HE IGHT, OR | |
4781 | COM PLEX | |
4782 | 65235 REM OVE FOREIG N BODY FRO M EYE 18 15 IN ACTIVE 3 43.80 | |
4783 | REM OVAL OF FO REIGN BODY , INTRAOCU LAR; FROM ANTERIOR C HAMBER OR LENS | |
4784 | 66820 INC ISION, SEC ONDARY CAT ARACT 36 NA TIONALLY A CTIVE | |
4785 | DIS CISSION OF SECONDARY MEMBRANEO US CATARAC T (OPACIFI ED POSTERI OR | |
4786 | LEN S CAPSULE AND/OR ANT ERIOR HYAL OID; STAB INCISION T ECHNIQUE | |
4787 | (ZI EGLER OR W HEELER KNI FE) | |
4788 | 85102 BON E MARROW B IOPSY 12 NA TIONALLY A CTIVE | |
4789 | BON E MARROW B IOPSY, NEE DLE OR TRO CAR; | |
4790 | Insurance Buffer Emp loyee | |
4791 | This repor t provides a summary of entrie s and acti ons in the Insurance Buffer by employee for a spec ified date range. It can be pr inted for those empl oyees who create buf fer entrie s (primari ly non-ins urance per sonnel) or for those employees who verif y and proc ess (accep t/reject) buffer ent ries (prim arily insu rance pers onnel). Th e report c an also be printed f or one spe cific empl oyee or al l employee s. Counts, percentag es, and av erage proc essing tim es are inc luded and can be pri nted with totals onl y or by mo nth. | |
4792 | Sample Out put | |
4793 | INSURANCE BUFFER EMP LOYEE REPO RT Apr 1 7, 1998 - Nov 05, 19 98 11/5/98 11:13 PAG E 1 | |
4794 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
4795 | ELLEN TOTALS | |
4796 | AVERAGE LONG EST SH ORTEST | |
4797 | STATUS COUNT PERCENT # DAYS # DA YS # DAYS | |
4798 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------- | |
4799 | ACCEPTED ( &V) 1 12.5% 0.2 0 .2 0.2 | |
4800 | REJECTED 6 75.0% 72.5 146 .0 21.7 | |
4801 | REJECTED ( V) 1 12.5% 4.8 4 .8 4.8 | |
4802 | TOTAL 8 100.0% 55.0 146 .0 0.2 | |
4803 | 0 New Co mpanies (0 %), 0 New Group/Plan s (0%), 1 New Patien t Policy ( 100%) | |
4804 | INSURANCE BUFFER EMP LOYEE REPO RT Apr 1 7, 1998 - Nov 05, 19 98 11/5/98 11:13 PAG E 2 | |
4805 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
4806 | HARPER,A TOTALS | |
4807 | AVERAGE LONG EST SH ORTEST | |
4808 | STATUS COUNT PERCENT # DAYS # DA YS # DAYS | |
4809 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------- | |
4810 | VERIFIED 1 20.0% 105.0 105 .0 1 05.0 | |
4811 | ACCEPTED ( &V) 3 60.0% 37.3 108 .9 1.0 | |
4812 | REJECTED 1 20.0% 3.0 3 .0 3.0 | |
4813 | TOTAL 5 100.0% 44.0 108 .9 1.0 | |
4814 | 0 New Co mpanies (0 %), 0 New Group/Plan s (0%), 0 New Patien t Policies (0%) | |
4815 | INSURANCE BUFFER EMP LOYEE REPO RT Apr 1 7, 1998 - Nov 05, 19 98 11/5/98 11:13 PAG E 3 | |
4816 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
4817 | GRAVES,CAT HI TOTALS | |
4818 | AVERAGE LONG EST SH ORTEST | |
4819 | STATUS COUNT PERCENT # DAYS # DA YS # DAYS | |
4820 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------- | |
4821 | VERIFIED 3 75.0% 0.6 1 .0 0.0 | |
4822 | ACCEPTED ( &V) 1 25.0% 0.8 0 .8 0.8 | |
4823 | TOTAL 4 100.0% 0.7 1 .0 0.0 | |
4824 | 0 New Co mpanies (0 %), 0 New Group/Plan s (0%), 0 New Patien t Policies (0%) | |
4825 | INSURANCE BUFFER EMP LOYEE REPO RT Apr 1 7, 1998 - Nov 05, 19 98 11/5/98 11:13 PAG E 4 | |
4826 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
4827 | TO TALS | |
4828 | AVERAGE LONG EST SH ORTEST | |
4829 | STATUS COUNT PERCENT # DAYS # DA YS # DAYS | |
4830 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------- | |
4831 | VERIFIED 4 23.5% 26.7 105 .0 0.0 | |
4832 | ACCEPTED ( &V) 5 29.4% 22.6 108 .9 0.2 | |
4833 | REJECTED 7 41.2% 62.6 146 .0 3.0 | |
4834 | REJECTED ( V) 1 5.9% 4.8 4 .8 4.8 | |
4835 | TOTAL 17 100.0% 39.0 146 .0 0.0 | |
4836 | 0 New Co mpanies (0 %), 0 New Group/Plan s (0%), 1 New Patien t Policy ( 20%) | |
4837 | Clerk Prod uctivity | |
4838 | The Clerk Productivi ty option allows you to print a report f or bills e ntered, au thorized, or printed within a selected d ate range. The repor t is sorte d alphabet ically by the clerk who first entered, a uthorized, or printe d the bill . | |
4839 | You may pr int either a full or summary r eport. If you print a full rep ort, you m ay select specific c lerk(s) an d rate typ e(s) you w ish to inc lude. | |
4840 | A summary report wil l list the clerk, ra te type, a nd the cou nt and dol lar amount of bills entered fo r each rat e type for each cler k. A subto tal is pro vided for each clerk . The tota l amount f or the rep ort is als o displaye d. | |
4841 | The full r eport will list the clerk, rat e type, da te entered , current status, bi ll number, total cha rges, pati ent name, and patien t ID for e ach bill i ncluded on the repor t. The ful l report s hould be p rinted at 132 column margin wi dth. | |
4842 | Depending on the dat e range an d other sp ecificatio ns you cho ose, this report cou ld be quit e lengthy. You may w ish to que ue the rep ort to pri nt during off hours. | |
4843 | Sample Out put | |
4844 | CLERK PROD UCTIVITY R EPORT FOR JUN 1,1995 - NOV 26, 1995 N OV 26,1995 13:02 PAGE 1 | |
4845 | BILL TO TAL | |
4846 | ENTERED/ED ITED BY RATE TYP E DATE E NTERED CU RRENT STAT US NUMBE R AMO UNT NAME PAT IENT ID | |
4847 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
4848 | JOHN REIMBURS ABLE INS. NOV 10, 1995 ENT ERED/NOT R EV N10026 IBpati ent,one 000- 11-1111 | |
4849 | REIMBURS ABLE INS. NOV 17, 1995 ENT ERED/NOT R EV N10032 IBpati ent,two 000- 22-2222 | |
4850 | REIMBURS ABLE INS. NOV 17, 1995 ENT ERED/NOT R EV N10033 IBpati ent,three 000- 33-3333 | |
4851 | ----- -- ------ --- | |
4852 | SUBTOTAL 0 .00 | |
4853 | SUBCOUNT 3 | |
4854 | ANDREW REIMBURS ABLE INS. SEP 7, 1995 ENT ERED/NOT R EV L10562 IBpati ent,one 000- 11-1111 | |
4855 | REIMBURS ABLE INS. SEP 7, 1995 AUT HORIZED L10563 5000. 00 IBpati ent,two 000- 22-2222 | |
4856 | REIMBURS ABLE INS. SEP 7, 1995 ENT ERED/NOT R EV L10564 IBpati ent,three 000- 33-3333 | |
4857 | REIMBURS ABLE INS. SEP 7, 1995 ENT ERED/NOT R EV L10565 IBpati ent,four 000- 44-4444 | |
4858 | REIMBURS ABLE INS. SEP 7, 1995 ENT ERED/NOT R EV L10566 IBpati ent,five 000- 55-5555 | |
4859 | REIMBURS ABLE INS. SEP 7, 1995 ENT ERED/NOT R EV L10567 IBpati ent,six 000- 66-6666 | |
4860 | REIMBURS ABLE INS. SEP 7, 1995 ENT ERED/NOT R EV L10568 IBpati ent,seven 000- 77-7777 | |
4861 | REIMBURS ABLE INS. SEP 7, 1995 ENT ERED/NOT R EV L10569 IBpati ent,eight 000- 88-8888 | |
4862 | REIMBURS ABLE INS. SEP 7, 1995 ENT ERED/NOT R EV L10570 IBpati ent,nine 000- 99-9999 | |
4863 | REIMBURS ABLE INS. SEP 7, 1995 ENT ERED/NOT R EV L10571 IBpati ent,ten 000- 00-0000 | |
4864 | REIMBURS ABLE INS. NOV 23, 1995 ENT ERED/NOT R EV N10073 IBpati ent,one 000- 11-1111 | |
4865 | REIMBURS ABLE INS. NOV 25, 1995 ENT ERED/NOT R EV N10074 IBpati ent,two 000- 22-2222 | |
4866 | ----- -- ------ --- | |
4867 | SUBTOTAL 5000 .00 | |
4868 | SUBCOUNT 12 | |
4869 | CHARLES REIMBURS ABLE INS. SEP 28, 1995 ENT ERED/NOT R EV L10681 IBpati ent,one 000- 11-1111 | |
4870 | ----- -- ------ --- | |
4871 | SUBTOTAL 0 .00 | |
4872 | SUBCOUNT 1 | |
4873 | PAUL REIMBURS ABLE INS. SEP 10, 1995 AUT HORIZED L10676 163. 00 IBpati ent,two 000- 22-2222 | |
4874 | ----- -- ------ --- | |
4875 | SUBTOTAL 163 .00 | |
4876 | SUBCOUNT 1 | |
4877 | LINDA REIMBURS ABLE INS. JUN 10, 1995 ENT ERED/NOT R EV L10549 IBpati ent,three 000- 33-3333 | |
4878 | REIMBURS ABLE INS. JUN 10, 1995 ENT ERED/NOT R EV L10550 163. 00 IBpati ent,four 000- 44-4444 | |
4879 | ----- -- ------ --- | |
4880 | SUBTOTAL 163 .00 | |
4881 | SUBCOUNT 2 | |
4882 | BETH REIMBURS ABLE INS. SEP 15, 1995 CAN CELLED L10677 163. 00 IBpati ent,five 000 -55-5555 | |
4883 | ----- -- ------ --- | |
4884 | SUBTOTAL 163 .00 | |
4885 | SUBCOUNT 1 | |
4886 | ----- -- ------ --- | |
4887 | TOTAL 5489 .00 | |
4888 | COUNT 20 | |
4889 | Rank Insur ance Carri ers By Amo unt Billed | |
4890 | The Rank I nsurance C arriers By Amount Bi lled optio n is used to generat e a listin g of insur ance carri ers ranked by the to tal amount billed. Y ou will be prompted for a date range fro m which bi lls should be select ed and the number of carriers to be rank ed. | |
4891 | Please not e that ins urance car riers whic h have bee n inactiva ted will b e flagged as such on this repo rt. If an inactivate d company is associa ted with a n active c ompany to which all patients’ policies h ave been r ecorded, t he amount billed to the inacti ve company is credit ed to the active com pany. | |
4892 | This optio n no longe r allows y ou to tran smit the r eport to t he MCCR Pr ogram Offi ce. Now, y our IRM Se rvice has the capabi lity to tr ansmit the report el ectronical ly to the Program Of fice. A pa tch will b e issued w ith specif ic instruc tions shou ld this re port be re quired to be transmi tted. | |
4893 | Sample Out put | |
4894 | Ra nking Of T he Top 9 I nsurance C arriers By Total Amo unt Billed | |
4895 | Facility : ALBANY ( 633) Ru n Date: 05 /24/95 | |
4896 | Date Range : 10/01/93 thru 05/2 4/95 Page: 1 | |
4897 | ** - denotes a n inactive company | |
4898 | ========== ========== ========== ========== ========== ========== ========== ======== | |
4899 | Rank Insurance Carrier Total Amt Bille d | |
4900 | ========== ========== ========== ========== ========== ========== ========== ======== | |
4901 | 1. H EALTH INSU RANCE LTD. $215 ,868.78 | |
4902 | 23 3RD ST | |
4903 | Suite 450 | |
4904 | TROY, NEW YORK 121 81 | |
4905 | 2. A BC INS $3 5,843.63 | |
4906 | 123 Ave Of The Moons | |
4907 | LOS ANGELE S, CALIFOR NIA 0009 8 | |
4908 | 3. ** G HI $ 4,902.00 | |
4909 | 675 THIRD AVE | |
4910 | TROY, NEW YORK 123 45 | |
4911 | 4. A BC INS $ 4,048.06 | |
4912 | 789 UBIQUI TOUS STREE T | |
4913 | SALT LAKE CITY, UTAH 44432 | |
4914 | 5. A BC INS $ 3,153.24 | |
4915 | 567 RAIN A VE. | |
4916 | SIOUX CITY , IOWA 3 3321 | |
4917 | 6. X YZ INS $ 2,862.43 | |
4918 | 123 MAIN S TREET | |
4919 | YORKVILLE, NEW YORK 33343 | |
4920 | 7. A BC INS $ 1,576.00 | |
4921 | 123 MASON STREET | |
4922 | NEW YORK, NEW YORK 11234 | |
4923 | 8. S TRAIT INSU RANCE $950.00 | |
4924 | 98 PARK AV E | |
4925 | SAN ANTONI O, TEXAS 43222 | |
4926 | 9. T RAVELERS-R ICHMOND $482.69 | |
4927 | 1234 THOMA S ST. | |
4928 | RICHMOND, VIRGINIA 12345 | |
4929 | Total Amou nt Billed to all Ran ked Carrie rs: $26 9,686.83 | |
4930 | Billing Ra tes List | |
4931 | The Billin g Rates Li st option will print a list of billing r ates for a selected date range . It is an efficient way to ve rify that all billin g rate ent ries have been enter ed correct ly. | |
4932 | The output generated by this o ption disp lays the C HAMPVA, He alth Care Finance Ad ministrati on (HCFA) ambulatory surgery r ates, Medi care deduc tible, and copayment s. The eff ective dat e, amount (basic rat e), and ad ditional a mount will be shown for each r ate, if ap plicable. Certain am bulatory s urgeries m ay be bill ed at the HCFA rate. The amoun t shown (i f any) in the "Addit ional Amou nt" column is an ext ra amount which may be charged for all p rocedures within tha t rate gro up. The am ount shown under "In patient Pe r Diem" an d "NHCU Pe r Diem" is the daily charge fo r Category C patient s. | |
4933 | Any billin g rate tha t is effec tive for a ny date wi thin the s elected ra nge is dis played. If more than one rate was effect ive within the date range, bot h rates ar e displaye d. | |
4934 | Sample Out put | |
4935 | JUN 11,199 7 ** *Billing R ates Listi ng*** PAGE 1 | |
4936 | Ra tes in eff ect from: JAN 01, 19 97 | |
4937 | to: JUN 11, 19 97 | |
4938 | ========== ========== ========== ========== ========== ========== ========== ======== | |
4939 | CHAMPVA LI MIT | |
4940 | Effectiv e Date Amount Addition al Amount | |
4941 | OCT 01, 1991 $25 | |
4942 | CHAMPVA SU BSISTENCE | |
4943 | Effectiv e Date Amount Addition al Amount | |
4944 | OCT 01, 1994 $9.50 | |
4945 | HCFA AMB. SURG. RATE 1 | |
4946 | Effectiv e Date Amount Addition al Amount | |
4947 | JAN 01, 1992 $285 | |
4948 | HCFA AMB. SURG. RATE 2 | |
4949 | Effectiv e Date Amount Addition al Amount | |
4950 | JAN 01, 1992 $382 | |
4951 | Sample Out put | |
4952 | JUN 11,199 7 ** *Billing R ates Listi ng*** PAGE 2 | |
4953 | Ra tes in eff ect from: JAN 01, 19 97 | |
4954 | to: JUN 11, 19 97 | |
4955 | ========== ========== ========== ========== ========== ========== ========== ======== | |
4956 | HCFA AMB. SURG. RATE 3 | |
4957 | Effectiv e Date Amount Addition al Amount | |
4958 | JAN 01, 1992 $438 | |
4959 | HCFA AMB. SURG. RATE 4 | |
4960 | Effectiv e Date Amount Addition al Amount | |
4961 | JAN 01, 1992 $539 | |
4962 | HCFA AMB. SURG. RATE 5 | |
4963 | Effectiv e Date Amount Addition al Amount | |
4964 | JAN 01, 1992 $615 | |
4965 | HCFA AMB. SURG. RATE 6 | |
4966 | Effectiv e Date Amount Addition al Amount | |
4967 | JAN 01, 1992 $580 $200 | |
4968 | JUN 11,199 7 ** *Billing R ates Listi ng*** PAGE 3 | |
4969 | Ra tes in eff ect from: JAN 01, 19 97 | |
4970 | to: JUN 11, 19 97 | |
4971 | ========== ========== ========== ========== ========== ========== ========== ======== | |
4972 | HCFA AMB. SURG. RATE 7 | |
4973 | Effectiv e Date Amount Addition al Amount | |
4974 | JAN 01, 1992 $853 | |
4975 | HCFA AMB. SURG. RATE 8 | |
4976 | Effectiv e Date Amount Addition al Amount | |
4977 | JAN 01, 1992 $705 $200 | |
4978 | HCFA AMB. SURG. RATE 9 | |
4979 | Effectiv e Date Amount Addition al Amount | |
4980 | JAN 01, 1992 $0 | |
4981 | INPATIENT PER DIEM | |
4982 | Effectiv e Date Amount Addition al Amount | |
4983 | OCT 01, 1990 $10 | |
4984 | Sample Out put | |
4985 | JUN 11,199 7 ** *Billing R ates Listi ng*** PAGE 4 | |
4986 | Ra tes in eff ect from: JAN 01, 19 97 | |
4987 | to: JUN 11, 19 97 | |
4988 | ========== ========== ========== ========== ========== ========== ========== ======== | |
4989 | MEDICARE D EDUCTIBLE | |
4990 | Effectiv e Date Amount Addition al Amount | |
4991 | JAN 01, 1996 $736 | |
4992 | NHCU PER D IEM | |
4993 | Effectiv e Date Amount Addition al Amount | |
4994 | OCT 01, 1990 $5 | |
4995 | NSC PHARMA CY COPAY | |
4996 | Effectiv e Date Amount Addition al Amount | |
4997 | OCT 01, 1992 $2 | |
4998 | JUN 09, 1997 $5.00 $2.00 | |
4999 | SC PHARMAC Y COPAY | |
5000 | Effectiv e Date Amount Addition al Amount | |
5001 | OCT 01, 1990 $2 | |
5002 | Revenue Co de Totals by Rate Ty pe | |
5003 | The Revenu e Code Tot als by Rat e Type opt ion prints the total amount bi lled by re venue code for a sel ected rate type and date range . | |
5004 | Circular 1 0-91-012 r equires th at revenue code 100 be used fo r the $10. 00 hospita l per diem and reven ue code 55 0 be used for the $5 .00 nursin g home per diem. The purpose o f this rep ort is to allow site s to calcu late the t otal amoun t billed f or $5 (rev enue code 550) and $ 10 (revenu e code 100 ) Means Te st per die ms for inp ut to AMIS segments 295 and 29 6. | |
5005 | You may pr int a list of all re venue code s (for the date rang e) with th e associat ed patient name, pat ient ID, b ill #, and individua l amount o r a summar y list whi ch provide s the tota l amount a nd total n umber of b ills for e ach code. It should be noted t hat becaus e more tha n one reve nue code m ay appear on a bill, the total number of bills doe s not equa l the sum of the num ber of bil ls contain ing a spec ific reven ue code. | |
5006 | Revenue Co de Totals for MEANS TEST/CAT. C J UN 3, 199 2@15:34:31 PAGE 1 | |
5007 | For Bills First Prin ted JUN 1 , 1992 to JUN 3, 1992 | |
5008 | Patient Pt. ID. Bill No. Rev. Co de A mount | |
5009 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
5010 | IBpatient, one 000-11-1 111 L10 068 51 0 $30.00 | |
5011 | IBpatient, two 000-22-2 222 L10 069 10 0 $50.00 | |
5012 | IBpatient, three 000-33-3 333 L10 174 00 1 $652.00 | |
5013 | IBpatient, four 000-44-4 444 L10 203 55 0 $155.00 | |
5014 | IBpatient, five 000-55-5 555 L10 239 10 0 $150.00 | |
5015 | IBpatient, six 000-66-6 666 L10 489 55 0 $90.00 | |
5016 | ---------- ---------- ---------- ---------- ------ | |
5017 | REVENUE CO DE TOTALS | |
5018 | Revenue Co de: 001 .. ........ $652 .00 1 Bi lls | |
5019 | Revenue Co de: 100 .. ........ $200 .00 2 Bi lls | |
5020 | Revenue Co de: 510 $3 0.00 1 B ills | |
5021 | Revenue Co de: 550 $24 5.00 2 B ills | |
5022 | --------- ----- | |
5023 | $1,12 7.00 6 B ills | |
5024 | Bill Statu s Report | |
5025 | The Bill S tatus Repo rt option is used to print a l isting of bills and their stat us for a s pecified d ate range. You may c hoose to i nclude all statuses or a singl e status. The report may be so rted by th e event da te (date b eginning t he bill's episode of care), bi ll date (d ate the bi ll was ini tially pri nted) or e ntered dat e (date th e bill was first ent ered). | |
5026 | The follow ing data i tems will be provide d in the f irst porti on of the report for each bill listed: b ill number , patient name and p atient ID# , event da te, initia ls of the person who entered t he bill, r ate type, Means Test category, charges, and bill s tatus with date of t hat status . If you c hoose to s ort by bil l date or entered da te, the bi lls are gr ouped for each date (billed or entered) of the sel ected rang e. The sec ond portio n of the r eport prov ides summa ry totals. The dolla r amount a nd total n umber of b ills for e ach bill t ype and fo r each sta tus are in cluded. Gr and totals are also provided. | |
5027 | For bills which have been disa pproved du ring the a uthorizati on process , the repo rt will sh ow *REVIEW ED/DISAPP (will appe ar only fo r bills pr ior to thi s version of the IB software) or *AUTHOR IZED/DISAP P after th e status. The bill s tatus will be follow ed by the initials o f the user responsib le for tha t status a nd his/her DUZ numbe r. This is a number which uniq uely ident ifies the user to th e system. If a bill is pending (i.e., no t printed or cancell ed), the b ill status will be p receded by an asteri sk (*) on the report . | |
5028 | Date/Time Printed: D EC 16,1993 @09:14 | |
5029 | Medical Ca re Cost Re covery Bil l Status R eport for period cov ering JUN 1, 1993 th rough JUN 16, 1993 Page 1 | |
5030 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
5031 | E VENT E NTRD MT | |
5032 | BILL NO. P ATIENT NAM E PT.ID DA TE B Y RATE TYPE C ATEGORY CHARGES BILL ST ATUS | |
5033 | ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== | |
5034 | L10574 IBpatient, one 1111 0 6/01/93 ARH REI M INS-OPT N/A $936.40 * AUTHOR IZED 09/07 /93 (ARH/1 0869) | |
5035 | L10651 IBpatient, two 2222 0 6/02/93 ARH REI M INS-OPT A $442.20 * AUTHOR IZED 09/07 /93 (ARH/1 0869) | |
5036 | L10647 IBpatient, three 3333 0 6/03/93 ARH MT/ CAT C-OPT N/A $30.00 PRINTE D 09/07/93 (ARH/1086 9) | |
5037 | N10046 IBpatient, four 1111 0 6/03/93 ARH REI M INS-OPT R $633.10 PRINTE D 11/19/93 (ARH/1086 9) | |
5038 | L10660 IBpatient, five 5555 0 6/04/93 ARH REI M INS-OPT N/A $623.60 * AUTHOR IZED 09/07 /93 (ARH/1 0869) | |
5039 | L10620 IBpatient, six 6666 0 6/07/93 ARH REI M INS-OPT N/A $0.00 * ENTERE D 09/07/93 (ARH/1086 9) | |
5040 | L10648 IBpatient, seven 7777 0 6/07/93 ARH CRI ME-OPT N/A $0.00 * AUTHOR IZED 09/07 /93 (ARH/1 0869) | |
5041 | L10601 IBpatient, eight 8888 0 6/09/93 ARH REI M INS-OPT N $150.00 * ENTERE D 09/07/93 (ARH/1086 9) | |
5042 | L10632 IBpatient, nine 9999 0 6/09/93 ARH REI M INS-OPT A $128.00 * ENTERE D 09/07/93 (ARH/1086 9) | |
5043 | L10549 IBpatient, ten 0000 0 6/10/93 LR REI M INS-OPT N/A $491.80 * ENTERE D 06/10/93 (LR/700) | |
5044 | * Denotes that the b ill status is not Pr inted or C ancelled | |
5045 | Date/Time Printed: D EC 16,1993 @09:14 | |
5046 | Medical Ca re Cost Re covery Bil l Status R eport for period cov ering JUN 1, 1993 th rough JUN 16, 1993 Page 2 | |
5047 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
5048 | REPORT STATISTIC S | |
5049 | ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== | |
5050 | CRIME-OPT .. .......... ........ $0.00 1 BIL LS | |
5051 | MT/CAT C-O PT .. .......... ........ $ 30.00 1 BIL LS | |
5052 | REIM INS-O PT .. .......... ........ $3,4 05.10 8 BIL LS | |
5053 | ---------- ------- ---------- --- | |
5054 | $3, 435.10 10 BI LLS | |
5055 | AUTHORIZED .. .......... ........ $2,0 02.20 4 BIL LS | |
5056 | ENTERED .. .......... ........ $7 69.80 4 BIL LS | |
5057 | PRINTED .. .......... ........ $6 63.10 2 BIL LS | |
5058 | ---------- ------- ---------- --- | |
5059 | $3, 435.10 10 BI LLS | |
5060 | Rate Type Billing To tals Repor t | |
5061 | The Rate T ype Billin g Totals R eport opti on is used to obtain a listing of all bi lling tota ls for eac h rate typ e for a sp ecified da te range. The date r ange is se lected by event date (the date beginning the bill' s episode of care) o r bill dat e (the dat e the bill was initi ally print ed). | |
5062 | The report is genera ted in two sections. The first section d ivides all the bills for each rate type (Category C, Workman 's Compens ation, Tor t Feasor, etc.) into the follo wing categ ories: ini tiated, pe nding, pri nted, and cancelled. The exact number of bills and dollar am ount for e ach catego ry is prov ided. The total amou nts (sum o f all rate types) ar e also giv en for eac h category . | |
5063 | The second section o f the repo rt is a br eakdown of all the p ending bil ling recor ds (the "p ending" ca tegory in the first section). All the pe nding bill s for each rate type are divid ed into th e followin g categori es: no act ion, revie wed, and a uthorized. The exact number of bills and the dolla r amount f or each ca tegory is provided. The total amounts (s um of all rate types ) are also given for each cate gory. | |
5064 | The margin width of this outpu t is 132. | |
5065 | Sample Out put | |
5066 | Date/Time Printed: J UL 14,1988 @07:46 | |
5067 | Billing Su mmary Repo rt for per iod coveri ng JAN 3,1 988 throug h MAR 1,19 88 (by Eve nt Date) | |
5068 | __________ __________ __________ __________ __________ __________ __________ __________ __________ _________ | |
5069 | INITIATE D | PENDING | PRINTED | CANCELL ED | | |
5070 | BILL TYPE Nu mber Do llars| Nu mber Do llars| Nu mber Dollars| Number Dollars| | |
5071 | ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== | |
5072 | CRIME VICT IM 0 $ 0.00 | 0 $ 0.00 | 0 $0.00 | 0 $0.00 | | |
5073 | DENTAL 1 $12 7.00 | 0 $ 0.00 | 0 $0.00 | 1 $127.00 | | |
5074 | HUMANITARI AN 1 $ 0.00 | 1 $ 0.00 | 0 $0.00 | 0 $0.00 | | |
5075 | INTERAGENC Y 1 $7,20 0.00 | 0 $ 0.00 | 1 $7, 200.00 | 0 $0.00 | | |
5076 | MEANS TEST /CAT. C 1 3 $11,96 4.00 | 8 $11,28 4.00 | 4 $ 160.00 | 1 $520.00 | | |
5077 | MEDICARE E SRD 1 $124,90 0.00 | 1 $124,90 0.00 | 0 $0.00 | 0 $0.00 | | |
5078 | NO FAULT I NS. 0 $0 .00 | 0 $0 .00 | 0 $0.00 | 0 $0.00 | | |
5079 | REIMBURSAB LE INS. 20 $138,852 .00 | 6 $12,190 .00 | 8 $102,9 85.00 | 6 $23 ,677.00 | | |
5080 | SHARING AG REEMENT 0 $ 0.00 | 0 $ 0.00 | 0 $0.00 | 0 $0.00 | | |
5081 | TORT FEASO R 0 $ 0.00 | 0 $ 0.00 | 0 $0.00 | 0 $0.00 | | |
5082 | UNKNOWN 0 $ 0.00 | 0 $ 0.00 | 0 $0.00 | 0 $0.00 | | |
5083 | WORKERS' C OMP. 1 $2,250 .00 | 0 $0 .00 | 1 $2,2 50.00 | 0 $0.00 | | |
5084 | __________ __________ __________ __________ __________ __________ __________ __________ __________ _________ | |
5085 | TOTALS 3 8 $285,29 3.00 | 1 6 $148,37 4.00 | 1 4 $112, 595.00 | 8 $2 4,324.00 | | |
5086 | Date/Time Printed: J UL 14,1988 @07:46 | |
5087 | Summary of Pending B ill Author izations f or period covering J AN 3,1988 through MA R 1,1988 ( by Event D ate) | |
5088 | __________ __________ __________ __________ __________ __________ __________ __________ __________ _________ | |
5089 | TOTAL PEND ING | NO ACTIO N | REVIEWED | AUTHOR IZED | | |
5090 | BILL TYPE Nu mber Do llars| Nu mber Do llars| Nu mber Dollars| Number Dollars| | |
5091 | ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== | |
5092 | CRIME VICT IM 0 $ 0.00 | 0 $ 0.00 | 0 $0.00 | 0 $0.00 | | |
5093 | DENTAL 0 $ 0.00 | 0 $ 0.00 | 0 $0.00 | 0 $0.00 | | |
5094 | HUMANITARI AN 1 $ 0.00 | 1 $ 0.00 | 0 $0.00 | 0 $0.00 | | |
5095 | INTERAGENC Y 0 $ 0.00 | 0 $ 0.00 | 0 $0.00 | 0 $0.00 | | |
5096 | MEANS TEST /CAT. C 8 $11,28 4.00 | 3 $ 0.00 | 0 $0.00 | 5 $1 1,284.00 | | |
5097 | MEDICARE E SRD 1 $124,90 0.00 | 1 $124,90 0.00 | 0 $0.00 | 0 $0.00 | | |
5098 | NO FAULT I NS. 0 $0 .00 | 0 $0 .00 | 0 $0.00 | 0 $0.00 | | |
5099 | REIMBURSAB LE INS. 6 $12,190 .00 | 2 $0 .00 | 3 $12,1 40.00 | 1 $50.00 | | |
5100 | SHARING AG REEMENT 0 $ 0.00 | 0 $ 0.00 | 0 $0.00 | 0 $0.00 | | |
5101 | TORT FEASO R 0 $ 0.00 | 0 $ 0.00 | 0 $0.00 | 0 $0.00 | | |
5102 | UNKNOWN 0 $ 0.00 | 0 $ 0.00 | 0 $0.00 | 0 $0.00 | | |
5103 | WORKERS' C OMP. 0 $0 .00 | 0 $0 .00 | 0 $0.00 | 0 $0.00 | | |
5104 | __________ __________ __________ __________ __________ __________ __________ __________ __________ _________ | |
5105 | PENDING TO TALS 1 6 $148,37 4.00 | 7 $124,90 0.00 | 3 $12, 140.00 | 6 $1 1,334.00 | | |
5106 | Insurance Payment Tr end Report | |
5107 | This optio n allows y ou to anal yze paymen t trends a mong insur ance compa nies and t rack recei vables whi ch are due your faci lity. Many different criteria may be spe cified to limit the selection of bills s uch as rat e type, in patient or outpatien t bills, o pen or clo sed bills, treatment dates, bi ll printed dates, an d insuranc e companie s. | |
5108 | The report may be ru n for a si ngle insur ance compa ny or a ra nge of com panies. In addition, the user may analyz e any spec ialized su bset of bi lls by sel ecting an additional field fro m the BILL /CLAIMS fi le (#399) and specif ying a ran ge of valu es for tha t field. | |
5109 | The Insura nce Paymen t Trend Re port displ ays the Pa yer’s Name /TIN in th e Header o n the Summ ary and Ma in reports using the Payer TIN and Name stored in the (835). | |
5110 | The Insura nce Paymen t Trend Re port displ ays the 83 5 indicato r (%) in f ront of th e Patient Name if an 835 (ERA) is attach ed to the reported c laim. | |
5111 | Sample Out put | |
5112 | REIMBURSAB LE INS. PA YMENT TREN D REPORT - OUTPATIEN T BILLING MA Y 06, 2014 PAGE 1 | |
5113 | DATE BILL PRINTED: 0 5/05/14 - 05/06/14 | |
5114 | Note: ' *' after t he Bill No . denotes a CLOSED b ill | |
5115 | BILL PATIENT DATE DATE B ILL # | |
5116 | AMOUNT AMOUNT AMO UNT AM OUNT PE RC | |
5117 | NUMBER NAME (A GE) BILL FROM - T O PRINTE D CLOSE D DAYS | |
5118 | BILLED COLLECT ED UNP AID PE NDING CO LL | |
5119 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
5120 | M A I N R E P O R T | |
5121 | INSU RANCE CARR IER: AARP/ <PAYER TIN > | |
5122 | P.O. BOX 819 | |
5123 | ATLANTA, GEORGIA 303740189 Pho ne: 800 52 3-5800 | |
5124 | Group #42 | |
5125 | Kxxxxxx %<Patie nt Name> 04/07/14 0 4/07/14 0 5/06/14 A CTIVE 0 | |
5126 | 19.1 1 0. 00 1 9.11 19.11 0 .00 | |
5127 | You have t he option to run a d etailed re port for a ll claims which meet the repor t criteria , or to pr int summar y statisti cs only. T he detaile d report i ncludes th e bill num ber, patie nt name an d age (as of the bil l event da te), bill from and t o dates, d ate the bi ll was pri nted (auth orized), d ate the bi ll closed, the numbe r of days the bill h as been op en (the di fference b etween the DATE PRIN TED and th e DATE BIL L CLOSED f ields), th e amounts billed, co llected, u npaid, rem aining ope n, and per centage co llected. T he AMOUNT PENDING co lumn has b een added to differe ntiate the number of unpaid do llars and the number of dollar s which ar e still pe nding coll ection. If the bill is not clo sed, the a mount pend ing is the same as t he amount unpaid. If the bill is closed (signified by an ast erisk next to the bi ll number) , the amou nt pending is zero. | |
5128 | The report is sorted alphabeti cally by i nsurance c ompany nam e and a su btotal for number of bills, am ount bille d, amount collected, amount un paid, amou nt pending , and perc entage col lected is given for each compa ny. If you choose on ly to prin t summary statistics , only the se subtota ls are pri nted. Also included, for eithe r the deta iled or su mmary repo rt, are th e grand to tals for t hese categ ories. A m argin widt h of 132 c ols. is re quired for this outp ut. | |
5129 | The DATE B ILL CLOSED field wil l always h ave an ent ry. If the bill is n ot actuall y closed, the Accoun ts Receiva ble status of the bi ll will ap pear on th e report i n the DATE BILL CLOS ED column. If a bill is closed , an aster isk (*) wi ll appear after the bill numbe r. If a bi ll is reje cted a “c” will disp lay next t o that bil l number. | |
5130 | Sample Out put for a Range of I nsurance C ompanies | |
5131 | REIMBURSAB LE INS. PA YMENT TREN D REPORT -- COMBIN ED INPATIE NT AND OUT PATIENT BI LLING NO V 26, 1993 PAGE: 1 | |
5132 | DATE BILL PRIN TED: 01/01 /92 - 03 /04/92 Note : '*' afte r the Bill Number de notes a CL OSED bill | |
5133 | DISC HARGE STAT US: ALL VA LUES | |
5134 | BILL PATIENT DATE DATE BI LL # AMOUNT AMOUNT AMOUNT AMOUNT PERCENT | |
5135 | NUMBER NAME/ (AGE ) BILL FR OM - TO PRINTED CLOSED DAYS BILLED C OLLECTED UNPAID PENDING COLLECTED | |
5136 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
5137 | PR IMARY INSU RANCE CARR IER: ABC | |
5138 | 123 Ave Of The Moons | |
5139 | LOS ANGELES, C ALIFORNIA 00098 Phone: 6 18-567-987 1 | |
5140 | L10042 IB patient,on e (49) 02/07 /92 02/07 /92 02/07 /92 NEW B ILL 658 200.00 100.00 100.0 0 100.0 0 50.00 | |
5141 | --------- --------- --------- --------- -------- | |
5142 | TOTAL NUMB ER OF BILL S: 1 200.00 100.00 100.00 100.00 50.00 | |
5143 | PR IMARY INSU RANCE CARR IER: ABC | |
5144 | 789 UBIQUITOUS STREET | |
5145 | SALT LAKE CITY , UTAH 4 4432 | |
5146 | L10030 IB patient,tw o (33) 04/09/9 1 04/14/9 1 02/06/9 2 NEW BIL L 659 2770.00 0.00 2770.00 2770.00 0.00 | |
5147 | --------- --------- --------- --------- -------- | |
5148 | TOTAL NUMB ER OF BILL S: 1 2770.00 0.00 2770.00 2770.00 0.00 | |
5149 | PR IMARY INSU RANCE CARR IER: STRAI T INSURANC E | |
5150 | 98 P ARK AVE | |
5151 | SAN ANTONIO, T EXAS 432 22 | |
5152 | L10029 IB patient,th ree (4 5) 02/05/ 91 02/05/ 91 02/18/ 92 11/26/ 93 647 950.00 702.50 247.50 0.00 75.00 | |
5153 | --------- --------- --------- --------- -------- | |
5154 | TOTAL NUMB ER OF BILL S: 1 950.00 702.50 247.50 0.00 75.00 | |
5155 | GRAN D TOTAL NU MBER OF BI LLS: 3 | |
5156 | GRAN D TOTAL AM OUNT BILLE D: 3920.00 | |
5157 | GRAN D TOTAL AM OUNT COLLE CTED: 802.50 | |
5158 | GRAN D TOTAL AM OUNT UNPAI D: 3117.50 | |
5159 | GRAN D TOTAL AM OUNT PENDI NG: 2870.00 | |
5160 | PERC ENTAGE COL LECTED: 20.47 | |
5161 | Sample Out put for a Single Ins urance Com pany | |
5162 | REIMBURSAB LE INS. PA YMENT TREN D REPORT -- COMBIN ED INPATIE NT AND OUT PATIENT BI LLING SE P 27, 1995 PAGE: 1 | |
5163 | DATE BILL PRIN TED: 01/01 /95 - 09 /27/95 Note : '*' afte r the Bill Number de notes a CL OSED bill | |
5164 | BILL PATIENT DATE DATE BILL # AMOUNT AMOUNT AMOUNT AMOUNT PERC | |
5165 | NUMBER NAME/ (AGE ) BILL FROM - TO PRINTED CLOSED DAYS BILLED C OLLECTED UNPAID PENDING COLL | |
5166 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
5167 | PRIM ARY INSURA NCE CARRIE R: ABC | |
5168 | 123 AV E OF THE M OONS | |
5169 | LOS AN GELES, CAL IFORNIA 0 0098 Phone: 618-555-98 71 | |
5170 | L01226 IBpatient, one (70 ) 06/22 /95 07/10 /95 09/20 /95 NEW BILL 1 194.0 0 0. 00 194. 00 194 .00 0.00 | |
5171 | L01227 IBpatient, two (70 ) 07/17 /95 07/31 /95 09/20 /95 NEW BILL 1 194.0 0 0. 00 194. 00 194 .00 0.00 | |
5172 | L00381 IBpatient, three ( 46) 01/01 /92 07/02 /92 03/28 /95 NEW BILL 177 4460.0 0 0. 00 4460. 00 4460 .00 0.00 | |
5173 | L00823 IBpatient, four (6 8) 10/22 /93 10/22 /93 03/15 /95 NEW BILL 190 178.0 0 0. 00 178. 00 178 .00 0.00 | |
5174 | --- ------- - -------- -------- --------- ----- | |
5175 | TOTAL NUMB ER OF BILL S: 4 5 026.00 0.00 5026.00 5026.00 0.00 | |
5176 | GRAN D TOTAL NU MBER OF BI LLS: 4 | |
5177 | GRAN D TOTAL AM OUNT BILLE D: 5026.00 | |
5178 | GRAN D TOTAL AM OUNT COLLE CTED: 0.00 | |
5179 | GRAN D TOTAL AM OUNT UNPAI D: 5026.00 | |
5180 | GRAN D TOTAL AM OUNT PENDI NG: 5026.00 | |
5181 | PERC ENTAGE COL LECTED: 0.00 | |
5182 | Unbilled B ASC for In sured Pati ent Appoin tments | |
5183 | The Unbill ed BASC fo r Insured Patient Ap pointments report li sts all BA SC (billab le ambulat ory surgic al code) p rocedures for schedu led appoin tments of insured pa tients tha t could no t be match ed with BA SC procedu res entere d on a bil l for the patient fo r a select ed date ra nge. The m atch is ba sed on the appointme nt date in Schedulin g and the procedure date in Bi lling. The purpose o f this rep ort is to find all C PTs that w ere entere d in Sched uling but never brou ght into B illing. | |
5184 | The list i s printed in alphabe tical orde r by patie nt name an d provides the patie nt ID, app ointment d ate, CPT c ode, and p rocedure. | |
5185 | Sample Out put | |
5186 | PATIENT NAME PAT IENT ID APPOINTM ENT DATE BILLABLE AMBULATOR Y PROCEDUR E | |
5187 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------- | |
5188 | IBpatie nt,one 000 -11-1111 MAR 27 ,1992 15950 R EMOVE THIG H PRESSURE SORE | |
5189 | 15951 R EMOVE THIG H PRESSURE SORE | |
5190 | IBpatie nt,two 000 -22-2222 MAR 3, 1992 85102 B ONE MARROW BIOPSY | |
5191 | IBpatie nt,three 000 -33-3333 MAR 7, 1992 11042 C LEANSING O F SKIN/TIS SUE | |
5192 | IBpatie nt,four 000 -44-4444 MAR 13 ,1992 24925 A MPUTATION FOLLOW-UP SURGERY | |
5193 | ROI Expire d Consent | |
5194 | This repor t will lis t the ROI Special Co nsents tha t will exp ire within a user-sp ecified da te range. | |
5195 | Sample Out put | |
5196 | ROI Specia l Consent To Expire Feb 01, 20 13 - Apr 0 1, 20133/2 6/13 11:4 0 PAGE 1 | |
5197 | Patient Effe ctive Expirat ion | |
5198 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
5199 | IBpatient, one Jun 26, 2012 Mar 31, 2013 | |
5200 | IBpatient, one Jun 26, 2012 Apr 01, 2013 | |
5201 | IBpatient, five Mar 01, 2013 Mar 31, 2013 | |
5202 | IBpatient, six Jan 01, 2013 Mar 20, 2013 | |
5203 | IBpatient, nine Jan 01, 2013 Apr 01, 2013 | |
5204 | IBpatient, nine Feb 01, 2013 Mar 20, 2013 | |
5205 | Medication Copayment Income Ex emption Me nu | |
5206 | Print Char ges Cancel ed Due to Income Exe mption | |
5207 | This optio n enables you to pri nt a repor t which li sts patien ts and med ication co payment ch arges that are cance lled due t o the inco me exempti on (charge s to patie nts determ ined to be exempt fr om the med ication co payment re quirement) . | |
5208 | You are pr ompted for a date ra nge. The " start date " defaults to the ef fective da te of the medication copayment legislati on (Public Law 102-5 68), Octob er 30, 199 2, and the "to date" defaults to the dat e of the c onversion completion . | |
5209 | This repor t should b e reconcil ed periodi cally with the Accou nts Receiv able Medic ation Co-P ay Exempti on Report (Medicatio n Co-Pay E xemption R eport opti on) to ins ure accura cy of pati ents' acco unts. | |
5210 | Initially, this repo rt will pr int a list of charge s cancelle d during t he install ation/conv ersion pro cess. Late r, this re port may b e used to list charg es automat ically can celled. Th is occurs when a pat ient with a status o f NON-EXEM PT due to no income data becom es EXEMPT due to inc ome below the thresh old level. | |
5211 | This repor t includes the patie nt name an d ID, pres cription d ate and nu mber, canc el date an d IB numbe r, bill nu mber and a mount, a p atient cou nt, and do llar total . You may also print a Convers ion Quick Status Rep ort with t he listing which inc ludes data such as t he dates t he convers ion starte d and comp leted, tot al number of patient s checked, number of patients exempt and non-exemp t, the num ber of bil ls checked , dollar a mount chec ked, total bills can celled, an d amount c ancelled. | |
5212 | You may wi sh to queu e this rep ort to pri nt during non-work h ours as it may be ve ry lengthy . The outp ut for thi s option r equires 13 2 columns. | |
5213 | Sample Out put | |
5214 | Medication Copayment Exemption Conversio n Status | |
5215 | Conversion was start ed on: FE B 4, 1993 @11:18:28 | |
5216 | The conver sion compl eted on: F EB 4, 199 3@18:19:01 | |
5217 | Elapse tim e for Conv ersion was : 7 Hours, 0 Minute s, 33 Sec onds | |
5218 | Last Pat ient DFN C hecked == 91 | |
5219 | 1. Total P atients Ch ecked == 745 5 | |
5220 | Exempt Pa tients == 20 69 | |
5221 | Non -Exempt Pa tients == 53 86 | |
5222 | 2. Total Number of Bills che cked == 365 68 | |
5223 | Dolla r Amount C hecked == $ 862 52 | |
5224 | N o. of Exem pt Bills C hecked == 142 18 | |
5225 | Exem pt Dollar amount == $ 334 26 | |
5226 | No. o f Non-Exem pt Bills C hecked == 223 50 | |
5227 | Non-exem pt Dollar amount == $ 528 26 | |
5228 | 3. Tota l Bills Ac tually can celed == 1411 3 | |
5229 | Amount A ctually ca nceled == $ 331 58 | |
5230 | Rx Copay I ncome Exem ption Repo rt MA R 4, 1993 11:18:43 Page 1 | |
5231 | Cancel Cance l Or iginal | |
5232 | Name P t. ID Rx Date Rx/Refi ll Date IB Nu mber Bil l No. Amount | |
5233 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------- | |
5234 | IBpatient, one 0 00-11-1111 02/01/93 100146 02/02/ 93 50021 0 50 0-P30048 $2 | |
5235 | 02/01/93 100147 02/02/ 93 50021 1 50 0-P30048 $2 | |
5236 | -------- ------ | |
5237 | Count = 2 | |
5238 | Amount = $ 4 | |
5239 | IBpatient, two 0 00-22-2222 01/26/93 100037 /1 01/27/ 93 50015 7 50 0-P30014 $4 | |
5240 | 01/26/93 1003 01/27/ 93 50015 8 50 0-P30014 $2 | |
5241 | -------- ------ | |
5242 | Count = 2 | |
5243 | Amount = $ 6 | |
5244 | IBpatient, three 000-33-333 3 01/26/9 3 10004 5 01/27 /93 5001 55 5 00-P30016 $2 | |
5245 | 01/26/9 3 10004 5/1 01/27 /93 5001 56 5 00-P30016 $2 | |
5246 | -------- ------ | |
5247 | Count = 2 | |
5248 | Amount = $ 4 | |
5249 | ===== ========== ========== ========== === | |
5250 | T otal Patie nt Count = 3 | |
5251 | T otal Rx Co unt = 6 | |
5252 | T otal Dolla r amount = $ 14 | |
5253 | Edit Copay Exemption Letter | |
5254 | This optio n allows y ou to edit IB form l etters. Yo u are firs t prompted to edit t he header field. Thi s text is automatica lly center ed at the top of the letter (i t is not n ecessary f or you to center the m), and mu st be edit ed to your facility' s name and address. You are li mited to s ix lines o f text. | |
5255 | The second field, th e MAIN BOD Y, contain s the text of the le tter inclu ding the s igner's ti tle. Becau se the per son signin g this let ter may be site spec ific, it m ight be ne cessary to edit the signer's t itle. | |
5256 | The defaul t for the starting a ddress lin e (patient address) is 15. Thi s may be e dited to a ny number between 10 and 25. T his featur e is provi ded to acc ount for s light diff erences in printers and automa ted letter folders a t each sit e. | |
5257 | When editi ng the IB Income Tes t Reminder letter yo u are also prompted for a repr int date, whether or not to ex clude domi ciliary pa tients, an d to sched ule the da ys on whic h you want the lette rs to prin t. The day s you sele ct to prin t the lett ers actual ly represe nt the mor nings you want to pi ck up the letters fr om the pri nter. For example, i f you choo se Monday the letter s actually print Sun day evenin g and are ready to b e picked u p on Monda y morning. You can a lso | |
5258 | prevent th e letters from being printed b y answerin g YES to t he “Do you wish to s top this j ob from ru nning?” pr ompt. | |
5259 | After edit ing is com pleted, yo u can test print one letter. I f you choo se to test print, yo u are prom pted to se lect a pat ient and d evice. The letter is queueable to any pr inter. | |
5260 | Sample Let ter | |
5261 | Department of Vetera ns Affairs Medical C enter | |
5262 | 113 Hollan d Avenue | |
5263 | Albany, Ne w York 1 2208 | |
5264 | DEC 14, 19 95 | |
5265 | In Reply Refer To: | |
5266 | 000-11-1 111 | |
5267 | ONE I BPATIENT | |
5268 | 54 BR OADWAY | |
5269 | BOSTO N, MA 044 43 | |
5270 | The VA is required b y law to c harge vete rans who r eceive med ications | |
5271 | on an outp atient bas is for the treatment of nonser vice-conne cted | |
5272 | conditions , a copaym ent of $2. 00 for eac h 30-day ( or less) s upply | |
5273 | of medicat ion provid ed. Based on the inc ome inform ation requ ested | |
5274 | each year, some vete rans may b e exempt f rom the co payment. | |
5275 | Our record s indicate that your medicatio n copaymen t exemptio n | |
5276 | status wil l expire o n December 31, 1995. | |
5277 | To update your incom e informat ion so we may review your | |
5278 | copayment exemption status, pl ease call 555-3311 x 9372 | |
5279 | to set up an appoint ment to pr ovide us w ith curren t | |
5280 | income inf ormation. | |
5281 | Chief, MAS | |
5282 | Inquire to Medicatio n Copay In come Exemp tions | |
5283 | This optio n allows y ou to prin t a brief or full in quiry of e xemptions for a pati ent. The b rief inqui ry is used to view p ast and/or present e xemptions, and the f ull inquir y is used to view th e entire a udit histo ry of all changes to a patient 's exempti on status. | |
5284 | Both inqui ries provi de the pat ient name and curren t status. The brief inquiry pr ovides the following informati on on all active exe mptions fo r the sele cted patie nt: effect ive date, type, stat us, reason , how the entry was added, and when. The full inqu iry provid es the fol lowing inf ormation f or each ex emption fo r the pati ent: effec tive date, status, w hether act ive or ina ctive, how the entry was added , by whom and when, type, and reason for exemption . | |
5285 | Note to Pr ogrammers | |
5286 | For users whose File Man Access ="@" (DUZ (0)="@"), the full i nquiry fea ture will display th e patient internal e ntry numbe r and the billing ex emption in ternal ent ry number to aid in problem re solution. | |
5287 | Sample Out put | |
5288 | Billing Ex emption In quiry MAR 5, 19 93 13:10:4 6 Page 1 | |
5289 | IBpatient, one 1111 Currently : NON-EXEM PT-INCOME> PENSION 02/10/93 | |
5290 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
5291 | Effectiv e Date: FE B 10, 1993 Type: CO PAY INCOME EXEMPTION | |
5292 | Status: NO N-EXEMPT Reason: NO INCOME DA TA | |
5293 | Active: NO , INACTIVE User: AL AN | |
5294 | How Added: SY STEM When Added: FE B 10, 1993 @15:14:12 | |
5295 | Effectiv e Date: FE B 10, 1993 Type: CO PAY INCOME EXEMPTION | |
5296 | Status: EX EMPT Reason: HA RDSHIP | |
5297 | Active: NO , INACTIVE User: MI CHAEL | |
5298 | How Added: MA NUAL When Added: FE B 11, 1993 @09:17:06 | |
5299 | Charges Ca nceled: FE B 10, 1993 To: FE B 11, 1993 | |
5300 | Effectiv e Date: FE B 10, 1993 Type: CO PAY INCOME EXEMPTION | |
5301 | Status: NO N-EXEMPT Reason: IN COME>PENSI ON | |
5302 | Active: NO , INACTIVE User: MI CHAEL | |
5303 | How Added: SY STEM When Added: FE B 11, 1993 @09:55:38 | |
5304 | Effectiv e Date: FE B 10, 1993 Type: CO PAY INCOME EXEMPTION | |
5305 | Status: EX EMPT Reason: HA RDSHIP | |
5306 | Active: NO , INACTIVE User: PE TER | |
5307 | How Added: MA NUAL When Added: FE B 11, 1993 @09:56:22 | |
5308 | Charges Ca nceled: FE B 10, 1993 To: FE B 11, 1993 | |
5309 | Effectiv e Date: FE B 10, 1993 Type: CO PAY INCOME EXEMPTION | |
5310 | Status: NO N-EXEMPT Reason: IN COME>PENSI ON | |
5311 | Active: NO , INACTIVE User: ST EPHEN | |
5312 | How Added: SY STEM When Added: FE B 11, 1993 @10:00:37 | |
5313 | Effectiv e Date: FE B 10, 1993 Type: CO PAY INCOME EXEMPTION | |
5314 | Status: EX EMPT Reason: HA RDSHIP | |
5315 | Active: NO , INACTIVE User: PE TER | |
5316 | How Added: MA NUAL When Added: FE B 11, 1993 @10:00:49 | |
5317 | Charges Ca nceled: FE B 10, 1993 To: FE B 11, 1993 | |
5318 | Effectiv e Date: FE B 10, 1993 Type: CO PAY INCOME EXEMPTION | |
5319 | Status: NO N-EXEMPT Reason: IN COME>PENSI ON | |
5320 | Active: NO , INACTIVE User: PE TER | |
5321 | How Added: SY STEM When Added: FE B 17, 1993 @15:28:39 | |
5322 | Manually C hange Copa y Exemptio n (Hardshi ps) | |
5323 | This optio n is desig ned to gra nt and/or remove har dship waiv ers for pa tients who request t he new cop ay income test. It m ay also be used to g rant exemp tions to M eans Test patients; however, i f MAS gran ts a hards hip waiver to the Me ans Test b y changing a patient 's Means T est status from Cate gory C to Category A , a hardsh ip exempti on is auto matically generated. | |
5324 | A message or alert i s generate d anytime a hardship exemption is grante d or remov ed. If the USE ALERT S site par ameter is set to NO (or the fi eld is lef t unanswer ed), a mai l bulletin is genera ted; if se t to YES, an alert i s generate d. A sampl e mail bul letin is p rovided in the examp le. | |
5325 | The system attempts to keep th e effectiv e date of the exempt ion the sa me as the effective date of th e income t est by def aulting to the effec tive date of the las t exemptio n at the " Select Eff ective Dat e" prompt. Only the date of pr evious exe mptions or the curre nt date ma y be enter ed at this prompt. | |
5326 | Occasional ly, the cr eation of a patient' s exemptio n may be i nterrupted unexpecte dly. In su ch cases, this optio n may be u sed to det ect copay exemption discrepanc ies and co rrect/ | |
5327 | update the patient's exemption status. | |
5328 | Once a wai ver is gra nted, the exemption is good fo r one year from the date it is granted. An electro nic signat ure code i s required to grant a hardship waiver. | |
5329 | Sample Out put | |
5330 | Subj: Medi cation Cop ayment Exe mption Sta tus Change [#547] 2 0 Apr 93 1 4:53 | |
5331 | 11 Lines | |
5332 | From: INTE GRATED BIL LING PACKA GE in 'IN ' basket. Page 1 * *NEW** | |
5333 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---- | |
5334 | The follow ing Patien t's Medica tion Copay ment Exemp tion Statu s has chan ged: | |
5335 | Patien t: IBpatie nt,one PT. ID: 00 0-11-1111 | |
5336 | Old Statu s: NON-EXE MPT - NO I NCOME DATA Dated 03 /09/93 | |
5337 | New Statu s: EXEMPT - HARD SHIP Date d 03/10/93 | |
5338 | Patient ha s been giv en a Hards hip Exempt ion. | |
5339 | by: MA RK/(Manual ) | |
5340 | on: MA R 10, 1993 @ 14:53:4 0 | |
5341 | Select MES SAGE Actio n: DELETE (from IN b asket)// | |
5342 | Letters to Exempt Pa tients | |
5343 | This optio n is used to print t he letters to be sen t to patie nts who ha ve been de termined t o be exemp t from the medicatio n copay. A range of patients a nd exempti on effecti ve dates m ay be spec ified. No letters wi ll print f or decease d patients , non-vete rans, and patients w ho are SC> 50%. | |
5344 | When this option is initially run, you a re asked i f you woul d like to store the results of the searc h in a tem plate. If you answer YES, a se arch templ ate, IB EX EMPTION LE TTER, is c reated. Th is data ma y be acces sed throug h the Prin t File Ent ries optio n in FileM an. For ea ch subsequ ent search , you are asked if y ou wish to delete th e results of the pre vious sear ch. If you answer YE S, the pre vious sear ch templat e is delet ed, and yo u again ha ve the opt ion of sto ring the r esults of your searc h. Only on e IB EXEMP TION LETTE R search t emplate ma y exist at a time. | |
5345 | Medication copayment exemption s based on annual in come must be re-eval uated year ly on the anniversar y of a pat ient's cop ayment tes t. If a pa tient is e xempt due to income below the threshold, a renewal date is s hown below the "in r eply" head ing of the letter. T he patient must comp lete a new copay inc ome test b y the rene wal date o r he/she w ill no lon ger be con sidered ex empt from the pharma cy copayme nt require ment. | |
5346 | This lette r is desig ned to be one page a nd to prin t to a pin fed print er, on pla in paper, in either 10 or 12 p itch. The default is set to st art the ad dress on l ine 15; ho wever, thi s may be e dited thro ugh the Ed it Copay E xemption L etter opti on. If add ress line three cont ains data, that data prints at the end o f address line two. If defined , temporar y addresse s are used . | |
5347 | IB*2.0*385 is part o f VistA ho st file DG _53_P858.K ID and pro vides Inte grated Bil ling (IB) enhancemen ts to supp ort the Ve terans Fin ancial Ass essment (V FA) Projec t. The VFA Project e liminates the annual means tes t renewal requiremen t for Vete rans subje ct to mean s testing. Prior to the implem entation o f VFA, me ans test w ith a stat us of MT C OPAY EXEMP T, GMT COP AY REQUIRE D, or PEND ING ADJUDI CATION wer e consider ed “expire d” 365 day s from the effective date. Me ans tests with these statuses will no lo nger expir e, and wil l be consi dered “cur rent” when the means test effe ctive date is less t han one ye ar old fro m the VFA start date and forwa rd. The V FA START D ATE is a n ew field i n the MAS PARAMETER File set t o 1/1/2013 during in stallation of the VF A host fil e. | |
5348 | Please not e: The VF A Project did not in clude nor make any e nhancement s to copay exemption tests. | |
5349 | The follow ing busine ss rules p ertain for exemption s letters where the billing ex emption re cord was b ased on cu rrent mean s tests: | |
5350 | Exemptions letters b ased on a current me ans test w ill not in clude the renewal da te. The le tter shoul d not stat e the mean s test nee ds to be r e-evaluate d yearly o n the mean s test ann iversary d ate. | |
5351 | Sample Let ter | |
5352 | Department of Vetera ns Affairs Medical C enter | |
5353 | 113 Hollan d Avenue | |
5354 | Albany, NY 12208 | |
5355 | MAY 5, 19 93 | |
5356 | In Reply R efer To: | |
5357 | 000-11-111 1 | |
5358 | Renewal Da te: MAY 3 , 1994 | |
5359 | ONE I BPATIENT | |
5360 | 77 MA IN ST | |
5361 | CABOT COVE, ME 09876 | |
5362 | Public Law 102-568 e nacted on October 29 , 1992, pr ovided for an exempt ion | |
5363 | to the pre scription copayment for those veterans w ho had inc ome levels | |
5364 | less than the maximu m rate of VA pension . Charges establishe d before | |
5365 | October 29 , 1992, we re not exe mpted by t he legisla tion. | |
5366 | We have re viewed you r income a nd eligibi lity infor mation con tained in our | |
5367 | records an d determin ed that yo u are elig ible for t he exempti on. We are | |
5368 | currently reviewing your accou nt and wil l make the appropria te adjustm ents | |
5369 | to it in t he near fu ture. If y ou are eli gible for a refund f or payment s | |
5370 | made on ch arges esta blished si nce Octobe r 29, 1992 , we will forward yo u a | |
5371 | check. Whi le we are reviewing your accou nt we will not be se nding out a | |
5372 | statement. | |
5373 | Medication copayment exemption s based up on annual income mus t be | |
5374 | re-evaluat ed yearly on the ann iversary o f your mea ns test or copayment | |
5375 | test. If a renewal d ate is sho wn below t he 'in rep ly' headin g you must complete a new copa y income t est by tha t date or you will n o longer b e consider ed exempt from the p harmacy co payment re quirement. | |
5376 | Please do not send i n any more payments until we h ave comple ted this r eview | |
5377 | and forwar ded a stat ement to y ou. | |
5378 | FINANCE OF FICER | |
5379 | List Incom e Threshol ds | |
5380 | This optio n allows y ou to prin t an outpu t which li sts the in come thres holds used in the me dication c opayment i ncome exem ption proc ess sorted by type o f threshol d and effe ctive date . | |
5381 | If you acc ept the de fault of F IRST at th e start da te prompt, first to last is as sumed. | |
5382 | This outpu t requires 132 colum ns. | |
5383 | Sample Out put | |
5384 | Medication Copayment Income Th resholds MAR 15,1 993 08:29 PAGE 1 | |
5385 | EFFECTIVE 1 2 3 4 5 6 7 8 ADD ITIONAL | |
5386 | DATE BASE RATE DEPENDEN T DEPENDE NTS DEPEN DENTS DEP ENDENTS D EPENDENTS DEPENDENT S DEPENDE NTS DEPEN DENTS AMOUNT | |
5387 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------- | |
5388 | TY PE: PENSIO N PLUS A&A | |
5389 | DEC 1,199 2 12187. 00 14548 .00 1584 4.00 17 140.00 18436.00 19732.00 21028.0 0 22324 .00 236 20.00 1296.00 | |
5390 | Print Pati ent Exempt ions or su mmary | |
5391 | This optio n allows y ou to prin t a list o f copaymen t exemptio n statisti cs. Both e xempt and non-exempt patients are includ ed. | |
5392 | You are gi ven the op tion to pr int a deta iled patie nt listing or a summ ary. The d etailed re port may b e sorted b y either e xemption s tatus or e xemption r eason. The informati on given i ncludes th e patient name, pati ent ID, pr imary elig ibility co de, status , reason f or exempti on/non-exe mption, an d status d ate. This data is fo llowed by a summary showing su btotals fo r each exe mption rea son and to tals for e xempt and non-exempt patients. If you ch oose to "P rint Summa ry Only", the detail ed portion of the ou tput is om itted. Dec eased pati ents are n ot include d in the s ummary pro vided with the detai led listin g; however , if you c hoose to p rint the s ummary onl y, decease d patients are inclu ded. | |
5393 | When print ing only a summary, sorting by the EXEMP TION STATU S default reduces th e time req uired to p roduce the report. | |
5394 | The detail ed patient listing r equires 13 2 columns. You may w ish to que ue this ou tput to pr int during non-work hours as i t may be v ery length y. | |
5395 | Sample Out put | |
5396 | Patient Me dication C opayment E xemption R eport | |
5397 | MAR 15,199 3 17:00 PAGE 1 | |
5398 | PATIENT PT ID PRIMARY ELIGIBILI TY STATUS REAS ON STAT US DATE | |
5399 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------- | |
5400 | IBpatient, one 000-11-111 1 NSC NON-EX EMPT INCO ME>PENSION JAN 25,1993 | |
5401 | IBpatient, two 000-22-222 2 SC NON-EX EMPT INCO ME>PENSION FEB 1,1993 | |
5402 | IBpatient, three 000-33-333 3 NSC NON-EX EMPT INCO ME>PENSION JAN 21,1993 | |
5403 | IBpatient, four 000-44-444 4 SC NON-EX EMPT NO I NCOME DATA FEB 4,1993 | |
5404 | IBpatient, five 000-55-555 5 SC NON-EX EMPT NO I NCOME DATA FEB 4,1993 | |
5405 | IBpatient, six 000-66-666 6 NSC EXEMPT DIS. RETIREMEN T FEB 10,1993 | |
5406 | IBpatient, seven 000-77-777 7 NSC EXEMPT DIS. RETIREMEN T FEB 17,1993 | |
5407 | IBpatient, eight 000-88-888 8 NSC EXEMPT DIS. RETIREMEN T JAN 25,1993 | |
5408 | IBpatient, nine 0 00-99-9999 NSC EXEMPT HARDS HIP FEB 5,1993 | |
5409 | IBpatient, ten 000-00-000 0 HUMANIT ARIAN EXEMPT NON- VETERAN FEB 10,1993 | |
5410 | IBpatient, eleven 000-11-111 1 HUMANIT ARIAN EXEMPT NON- VETERAN JAN 25,1993 | |
5411 | ========== ========== ========== ========== ========== == | |
5412 | Non-Exempt Status: | |
5413 | INCOM E>PENSION = 3 | |
5414 | NO IN COME DATA = 2 | |
5415 | Exempt Sta tus: | |
5416 | DIS. RETIREMENT = 3 | |
5417 | HARDS HIP = 1 | |
5418 | IN RE CEIPT OF A &A = 8 | |
5419 | IN RE CEIPT OF H B = 0 | |
5420 | IN RE CEIPT OF P ENSION = 0 | |
5421 | INCOM E<PENSION = 0 | |
5422 | NON-V ETERAN = 2 | |
5423 | Total Exem pt Patient s = 5 | |
5424 | Total Non- Exempt Pat ients = 6 | |
5425 | Reprint Si ngle Incom e Test Rem inder Lett er | |
5426 | This optio n is used to generat e an Incom e Test rem inder lett er for a p atient who se effecti ve copay e xemption i s based up on income. | |
5427 | If the pat ient is cu rrently no n-exempt d ue to no i ncome data reported, a letter may be gen erated if the patien t’s previo us exempti on status is based o n income. | |
5428 | IB*2.0*385 is part o f VistA ho st file DG _53_P858.K ID and pro vides Inte grated Bil ling (IB) enhancemen ts to supp ort the Ve terans Fin ancial Ass essment (V FA) Projec t. The VF A Project eliminates the annua l means te st renewal requireme nt for Vet erans subj ect to mea ns testing . Prior to the imple mentation of VFA, m eans test with a sta tus of MT COPAY EXEM PT, GMT CO PAY REQUIR ED, or PEN DING ADJUD ICATION we re conside red “expir ed” 365 da ys from th e effectiv e date. M eans tests with thes e statuses will no l onger expi re, and wi ll be cons idered “cu rrent” whe n the mean s test eff ective dat e is less than one y ear old fr om the VFA start dat e and forw ard. The V FA START D ATE is a n ew field i n the MAS PARAMETER File set t o 1/1/2013 during in stallation of the VF A host fil e. | |
5429 | Please not e: The VF A Project did not in clude nor make any e nhancement s to copay exemption tests. | |
5430 | The follow ing busine ss rules p ertain for reminder letters wh ere the bi lling exem ption reco rd was bas ed on curr ent means tests: | |
5431 | Reminder L etters: | |
5432 | The user w ill receiv e a warnin g when the Veterans current me dication c opayment e xemption i s based on a current means tes t. The use r is retur ned to the (menu or select pat ient promp t) and the letter is not print ed. | |
5433 | Sample Let ter | |
5434 | Department of Vetera ns Affairs Medical C enter | |
5435 | 113 Hollan d Avenue | |
5436 | Albany, Ne w York 1 2208 | |
5437 | DEC 14, 19 95 | |
5438 | In Reply Refer To: | |
5439 | 000-11-1 111 | |
5440 | ONE I BPATIENT | |
5441 | 00 BR OADWAY | |
5442 | BOSTO N, MA 044 43 | |
5443 | The VA is required b y law to c harge vete rans who r eceive med ications | |
5444 | on an outp atient bas is for the treatment of nonser vice-conne cted | |
5445 | conditions , a copaym ent of $2. 00 for eac h 30-day ( or less) s upply | |
5446 | of medicat ion provid ed. Based on the inc ome inform ation requ ested | |
5447 | each year, some vete rans may b e exempt f rom the co payment. | |
5448 | Our record s indicate that your medicatio n copaymen t exemptio n | |
5449 | status wil l expire o n December 31, 1995. | |
5450 | To update your incom e informat ion so we may review your | |
5451 | copayment exemption status, pl ease call 462-3311 x 9372 | |
5452 | to set up an appoint ment to pr ovide us w ith curren t | |
5453 | income inf ormation. | |
5454 | Chief, MAS | |
5455 | Add Income Threshold s | |
5456 | This optio n is used to enter/e dit the in come thres holds used in the me dication c opayment i ncome exem ption. | |
5457 | The thresh olds are d etermined and releas ed by VBA (Veterans Benefits A dministrat ion) Decem ber 1 of e ach year. These are the same t hresholds used for A &A pension s. | |
5458 | Once the A DDITIONAL DEPENDENT AMOUNT is entered, t he amount for each a dditional dependent can be aut omatically calculate d when the copayment income ex emptions a re built. However, i f the amou nt for eac h addition al depende nt does no t have to be calcula ted, the e xemption c an be buil t much fas ter; there fore, it i s advantag eous to en ter the am ount for e ach depend ent. | |
5459 | In the eve nt that th e new inco me thresho lds are re leased or entered af ter the no rmal effec tive date, this pack age was de signed to note exemp tions crea ted with t hresholds over one y ear old an d to allow automatic recomputa tion of ju st those e xemptions. | |
5460 | Print/Veri fy Patient Exemption Status | |
5461 | This optio n will sea rch the BI LLING EXEM PTIONS fil e (#354.1) and compa re the cur rently sto red active exemption for each patient ag ainst what the syste m calculat es to be t he correct exemption status fo r the pati ent based on current data from the MAS f iles. | |
5462 | Once you s elect a da te range, you are as ked whethe r or not y ou wish to update ea ch incorre ct exempti on status. If you en ter NO, a list of di screpancie s is print ed without updating the incorr ect status es. If you enter YES , the same report wi ll print a nd the sta tuses are updated. I nitially, the report should be run witho ut updatin g the exem ptions. | |
5463 | The Manual ly Change Copay Exem ptions (Ha rdship) op tion may a lso be use d to updat e exemptio ns to the correct st atus one p atient at a time. | |
5464 | This outpu t requires 132 colum ns. You ma y wish to queue to p rint durin g non-work hours as it can be quite leng thy. | |
5465 | Sample Out put | |
5466 | Medication Copayment Exemption Problem R eport MAR 17, 1993 0 9:42 Page 1 | |
5467 | Patient PT. ID Error Curren t Exemptio n C omputed Ex emption Action | |
5468 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
5469 | IBpatient, one 000-11-111 1 Exempti on incorre ct 02/10/ 93 NO INCO ME DATA 0 2/10/93 IN COME<PENSI ON Nothin g Updated | |
5470 | IBpatient, two 000-22-222 2 Exempti on incorre ct 02/17/ 93 NO INCO ME DATA 0 2/17/93 IN COME<PENSI ON Nothin g Updated | |
5471 | IBpatient, three 000-33-333 3 Exempti on incorre ct 01/25/ 93 DIS. RE TIREMENT 0 1/25/93 IN COME<PENSI ON Nothin g Updated | |
5472 | There were 3 discrep ancies fou nd in 75 e xemptions checked. | |
5473 | MCCR Syste m Definiti on Menu | |
5474 | The MCCR S ystem Defi nition Men u is locke d with the IB SUPERV ISOR secur ity key. | |
5475 | Enter/Edit Automated Billing P arameters | |
5476 | The Enter/ Edit Autom ated Billi ng Paramet ers option is used t o enter or edit the parameters that cont rol automa ted third party bill ing. Only entries in the Claim s Tracking module wi ll be bill ed automat ically. Cu rrently, o nly inpati ent stays, outpatien t encounte rs, and pr escription refills a re include d in autom ated billi ng. | |
5477 | Following is a brief descripti on of the parameters . | |
5478 | AUTO BILLE R FREQUENC Y | |
5479 | Number of days betwe en each ex ecution of the autom ated bille r. For exa mple, if t he auto bi ller shoul d run once a week, e nter 7; if it should run every night, en ter 1. If this field is left b lank, the auto bille r will nev er run. | |
5480 | INPATIENT STATUS (AB ) | |
5481 | This is th e status t hat a PTF record mus t be in be fore the a utomated b iller will attempt t o create a n inpatien t bill. Th e PTF reco rd must be closed be fore an au tomated bi ll can be created. | |
5482 | AUTOMATE B ILLING | |
5483 | This param eter contr ols the au tomated cr eation of bills. If this field is set to YES, the bills will be automa tically cr eated for possible b illable ev ents with no user in teraction. If this f ield is le ft blank, the earlie st auto bi ll date mu st be adde d to each event in C laims Trac king befor e a bill i s automati cally crea ted by the auto bill er. | |
5484 | BILLING CY CLE | |
5485 | This is th e maximum number of days allow ed to be b illed on a single bi ll. If thi s field is left blan k, the dat e range wi ll default to the ev ent date t hrough the end of th e month in which the event too k place or for inpat ient inter im bills, the next m onth after the last interim bi ll. | |
5486 | Claims Tra cking even ts may be added to t he list of events fo r which an auto bill should be created b y adding a date to t he earlies t auto bil l date in Claims Tra cking. Eve nts may be removed f rom the au to biller list by ad ding a rea son not bi llable or deleting t he earlies t auto bil l date. | |
5487 | DAYS DELAY | |
5488 | This field controls the number of days a fter the e nd of the BILLING CY CLE that a bill shou ld be crea ted. This parameter is used at two diffe rent point s to deter mine if a bill shoul d be creat ed. The fi rst is whe n the Clai ms Trackin g entry is first cre ated. At t hat time, the EARLIE ST AUTO BI LL DATE wi ll be set to the cur rent date plus the n umber of D AYS DELAY. The secon d time thi s paramete r is used is when th e auto bil ler is try ing to set up a date range for the event s bill. In that case , DAYS DEL AY is adde d to the B ILLING CYC LE to dete rmine if t he correct amount of time has elapsed fo r the bill to be cre ated. | |
5489 | For exampl e, if DAYS DELAY is 3 and BILL ING CYCLE is 10, a b ill will n ot be crea ted for at least 13 days after the initi al entry w as created in Claims Tracking. Inpatient s are slig htly diffe rent. If a n inpatien t is disch arged, the auto bill er will tr y to creat e a bill f or that st ay DAYS DE LAY after the discha rge date. The auto b iller cann ot, howeve r, create a bill unt il the PTF record is closed. T herefore, the actual delay bef ore bill c reation fo r inpatien t bills ma y be longe r than DAY S DELAY. | |
5490 | Charge Mas ter Menu | |
5491 | Enter/Edit Charge Ma ster | |
5492 | This optio n is used for the ma intenance of Third P arty rates and charg es. It con tains the List Manag er screens , which di splay all rate eleme nts/fields . It also includes e nter and e dit action s so each element ca n be updat ed. All ed it actions within th ese screen s require the IB SUP ERVISOR ke y. | |
5493 | Screen Des criptions | |
5494 | Introducti on Screen | |
5495 | This scree n displays a brief d escription of the el ements of the Charge Master th at may be viewed/edi ted throug h this opt ion. You c an display /edit rate types, bi lling rate s, charge sets, and rate sched ules. | |
5496 | Rate Type Screen | |
5497 | This is a display/ed it screen for Billin g Rate Typ es. All Ra te Types c urrently d efined are displayed . | |
5498 | Billing Ra tes Screen | |
5499 | This is a display/ed it screen for Billin g Rates. A ll Billing Rates cur rently def ined are d isplayed. Part of th e definiti on of a Bi lling Rate includes what types of item t he rate’s charges ar e associat ed with (B illable It em) and ho w the char ge should be calcula ted (Charg e Method). | |
5500 | Charge Set Screen | |
5501 | This is a display/ed it screen for Charge Sets. All Charge Se ts current ly defined will be d isplayed. These sets define a sub-set of charges f or a Billi ng Rate. T he editing of Charge Sets is r estricted to non-cri tical elem ents if th ere are Ch arge Items defined f or the set . Since Re venue Code and Bedse ction are required t o add char ges to a b ill, the D efault Rev enue Code and Defaul t Bedsecti on are req uired unle ss these a re defined for each individual Charge It em in the Set. | |
5502 | Charge Ite m Screen | |
5503 | This is a display/ed it screen for Charge Items. Th ese are th e actual r ecords of the item a nd its cor responding charge. T his screen displays items that have acti ve charges in a spec ified date range for the selec ted Charge Set. All active Cha rge Items are displa yed for a Charge Set with a Bi llable Ite m of Bedse ction. How ever, this screen ha s been spe cifically limited to displayin g either o ne CPT or one AWP it em at a ti me. The Ef fective Da te is requ ired for a ll entries and contr ols when t he charge is active. Each item entry ove rrides any previousl y effectiv e charge f or the ite m. A Reven ue Code is only requ ired if th e Revenue Code for t he item is different from the Default Re venue Code of the Ch arge Set. | |
5504 | Billing Re gions Scre en | |
5505 | This is a display/ed it screen for Billin g Regions. All Billi ng Regions currently defined w ill be dis played. Bi lling Regi ons can be set-up wh ich show t he set of divisions that are b illed the same charg es for a p articular Billing Ra te. A Bill ing Region need only be define d if the c harges for a rate va ry by regi on/localit y/division and more than one R egion will be billed at the si te. Curren tly only B illing Rat es based o n CPT char ges may va ry by regi on. | |
5506 | Rate Sched ule Screen | |
5507 | This is a display/ed it screen for Rate S chedules. These sche dules link the charg es and the types of bills they may be ad ded to. Al l Rate Sch edules cur rently def ined are d isplayed. Rate Sched ules must be defined for both inpatient and outpat ient charg es for a R ate Type a nd all Cha rge Sets t hat may be charged t o that typ e of bill should be added. A C harge Set can set-up to be aut omatically added to bills or t o require user input before th e charges are added. The effec tive dates should on ly be adde d if there is a spec ific date that billi ng to the payer can start or s top. | |
5508 | Sample Scr eens | |
5509 | Introducti on M ay 29, 199 7 13:09:26 Page: 1 of 1 | |
5510 | Only autho rized pers ons may ed it this da ta: IB SUP ERVISOR ke y required to edit. | |
5511 | Rate Type: Type o f Payer. | |
5512 | Billing Ra te: Type o f Charge. | |
5513 | Charge Set : Charge s for a sp ecific Bil ling Rate, broken do wn by | |
5514 | type of event t o be bille d/charged. | |
5515 | Charg e Item: The ind ividual it ems for a Set | |
5516 | and th eir charge amounts. | |
5517 | Billi ng Region: The reg ion or div isions the | |
5518 | charge s apply to . | |
5519 | Rate Sched ule: Defini tion of ch arges bill able to sp ecific pay ers. | |
5520 | Link between Ch arge Sets and Rate T ypes. | |
5521 | Once the Rate T ype is set for a bil l, the | |
5522 | Rate Schedule w ill be use d to find all charge s to | |
5523 | add t o the bill . | |
5524 | ||
5525 | Enter ?? f or more ac tions | |
5526 | ||
5527 | RS Rate S chedules RT Rate Types | |
5528 | CS Charge Sets BR Billing Ra tes | |
5529 | Select Act ion: Quit/ / | |
5530 | Rate Types M ay 29, 199 7 13:14:25 Page: 1 of 5 | |
5531 | This is a Standard f ile with e ntries rel eased nati onally. | |
5532 | ||
5533 | Rate Type: CHAM PUS | |
5534 | Bill Name: CHAM PUS AR Catego ry: CHAMPU S | |
5535 | Abbrevia tion: CHAM PUS Who's Resp ns: INSURE R | |
5536 | Third Pa rty?: YES R I Statemen t?: YES | |
5537 | Inac tive: NSC Statement ?: YES | |
5538 | Rate Type: CHAM PVA REIMB. INS. | |
5539 | Bill Name: REIM BURSABLE I NS. AR Categor y: CHAMPVA THIRD PAR TY | |
5540 | Abbrevia tion: REIM INS Who's Resp ns: INSURE R | |
5541 | Third Pa rty?: YES R I Statemen t?: YES | |
5542 | Inac tive: NSC Statement ?: YES | |
5543 | Rate Type: CRIM E VICTIM | |
5544 | Bill Name: THIR D PARTY AR Catego ry: CRIME OF PER.VIO . | |
5545 | Abbrevia tion: CRIM E Who's Resp ns: INSURE R | |
5546 | Third Pa rty?: YES R I Statemen t?: | |
5547 | Inac tive: NSC Statement ?: YES | |
5548 | ||
5549 | + Enter ?? f or more ac tions | |
5550 | ||
5551 | ED Edit R ate Type MS Main Scree n EX Exit | |
5552 | Select Act ion: Next Screen// | |
5553 | Billing Ra tes M ay 29, 199 7 13:16:47 Page: 1 of 1 | |
5554 | Rate Abbrv Dist rb Bil l Item Chg Mthd | |
5555 | INTERAGE NCY IA NATI ONAL BED SECTION COUNT | |
5556 | TORTIOUS LY LIABLE TORT NATI ONAL BED SECTION COUNT | |
5557 | VA COST VA COS T NATI ONAL VA COST | |
5558 | AMBULATO RY SURGERY ASC LOCA L CPT COUNT | |
5559 | AVERAGE WHOLESALE PRICE AWP LOCA L NDC # QUANTITY | |
5560 | CMAC CMAC LOCA L CPT COUNT | |
5561 | Enter ?? f or more ac tions | |
5562 | ||
5563 | ED Edit R ate MS Main Scree n EX Exit | |
5564 | Select Act ion: Quit/ / | |
5565 | Charge Set s M ay 29, 199 7 13:19:06 Page: 1 of 2 | |
5566 | D efault | |
5567 | Charge Se t Bi ll Event Type Rv C d Bedsect ion Regio n | |
5568 | ||
5569 | B illing Rat e: AMBULAT ORY SURGER Y | |
5570 | AMB SURG R EGION 1 PR OC 500 OUTPATI ENT | |
5571 | AMB SURG R EGION 2 PR OC 490 OPT DNT L | |
5572 | B illing Rat e: INTERAG ENCY | |
5573 | IA-INPT IN PT BEDS 001 | |
5574 | IA-OPT DEN TAL OP T VST DT 512 | |
5575 | IA-OPT VST OP T VST DT 500 | |
5576 | IA-RX FILL RX FILL 257 | |
5577 | B illing Rat e: TORTIOU SLY LIABLE | |
5578 | TL-INPT (I NCLUSIVE) IN PT BEDS 001 | |
5579 | TL-INPT (N PF) IN PT BEDS INST | |
5580 | TL-INPT (P F) IN PT BEDS PROF 960 | |
5581 | TL-CAT C O PT COPAY OP T VST DT 500 | |
5582 | TL-OPT DEN TAL OP T VST DT 512 | |
5583 | ||
5584 | + Enter ?? f or more ac tions | |
5585 | ||
5586 | CI Charge Items RG Billing Re gions BR Bill ing Rates | |
5587 | ED Edit C harge Set MS Main Scree n EX Exit | |
5588 | Select Act ion: Next Screen// | |
5589 | Charge Ite ms M ay 29, 199 7 13:25:32 Page: 1 of 1 | |
5590 | BEDSECTION items bil lable to C harge Set TL-INPT (I NCLUSIVE) on 05/29/9 7 | |
5591 | Default Re venue Code : 001 | |
5592 | Charge I tem Unit Charge R v Cd Ef fective I nactive | |
5593 | ||
5594 | ALCOHOL AND DRUG T REATMENT 300 .00 05 /27/97 | |
5595 | BLIND RE HABILITATI ON 973 .00 10 /01/96 | |
5596 | GENERAL MEDICAL CA RE 1046 .00 10 /01/96 | |
5597 | INTERMED IATE CARE 428 .00 10 /01/96 | |
5598 | NEUROLOG Y 1014 .00 10 /01/96 | |
5599 | NURSING HOME CARE 288 .00 10 /01/96 | |
5600 | PSYCHIAT RIC CARE 501 .00 10 /01/96 | |
5601 | REHABILI TATION MED ICINE 822 .00 10 /01/96 | |
5602 | SPINAL C ORD INJURY CARE 977 .00 10 /01/96 | |
5603 | SURGICAL CARE 1923 .00 10 /01/96 | |
5604 | Enter ?? f or more ac tions | |
5605 | ||
5606 | CD Change Dates CI Change Ite m BI Bill ing Item E dit | |
5607 | ED Edit C harge Item MS Main Scree n EX Exit | |
5608 | Select Act ion: Quit/ / | |
5609 | Billing Re gions M ay 29, 199 7 13:34:38 Page: 1 of 1 | |
5610 | Sets of di visions co vered by t he same ch arges | |
5611 | Region Divis ion | |
5612 | ||
5613 | No Billing Regions d efined | |
5614 | Enter ?? f or more ac tions | |
5615 | ||
5616 | ED Edit R egion MS Main Scree n EX Exit | |
5617 | Select Act ion: Quit/ / | |
5618 | Rate Sched ules M ay 29, 199 7 13:37:01 Page: 1 of 4 | |
5619 | Link types of payers and charg es | |
5620 | Schedule Bill Svs Charge Set(s) Effe ctiv Inac tive Adj | |
5621 | CRIME VICTIM: In patient | |
5622 | CV-INPT INPT TL-INPT (NPF) | |
5623 | TL-INPT (PF) | |
5624 | CRIME VICTIM: Ou tpatient | |
5625 | CV-OPT TL-OPT VST | |
5626 | TL-RX F ILL | |
5627 | DENTAL : Outpatie nt | |
5628 | DNTL-OPT D ENTAL TL-OPT DENTAL | |
5629 | HUMANI TARIAN: In patient | |
5630 | HMN-INPT INPT TL-INPT (INCLUSIV E) | |
5631 | HUMANI TARIAN: Ou tpatient | |
5632 | HMN-OPT TL-OPT VST | |
5633 | TL-RX F ILL | |
5634 | ||
5635 | + ~ charges not auto a dded to bi lls >>> | |
5636 | ED Edit S chedule MS Main Scree n EX Exit | |
5637 | Select Act ion: Next Screen// | |
5638 | Print Char ge Master | |
5639 | This optio n provides reports f or all ele ments of t he Charge Master and maintenan ce of Thir d Party ra tes. The f ull Charge Item repo rt could b e lengthy if many it ems have b een added, such as C MAC (CHAMP US Maximum Allowable Charges) charges. | |
5640 | Sample Out put | |
5641 | RATE TYPE LIST M AY 27,1997 08:48 PAGE 1 | |
5642 | NSC | |
5643 | TH IRD STA TEMENT | |
5644 | PA RTY ACCOU NTS RECEIV ABLE WHO 'S REIMB ON UB | |
5645 | NAME BILL NAM E INACTI VE ABBREV IATION BI LL? CATEG ORY RES PONSIBLE INS? BIL LS | |
5646 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
5647 | CHAMPUS CHAMPUS CHAMPU S YE S CHAMP US INS URER YES YES | |
5648 | CHAMPVA RE IMB. INS. REIMBURSA BLE INS. REIM INS YES CHAMPVA THIRD PAR TY INSUR ER YE S YES | |
5649 | CRIME VICT IM THIRD PA RTY CRIME YE S CRIME OF PER.VI O. INSU RER N O YES | |
5650 | DENTAL DENTAL DENTAL NO EMERG ENCY/HUMAN ITARI PAT IENT YES YES | |
5651 | HUMANITARI AN HUMANITA RIAN HUMAN NO EMERG ENCY/HUMAN ITARI PAT IENT NO NO | |
5652 | INTERAGENC Y INTERAGE NCY INTER YE S INTER AGENCY OTH ER (INST YES | |
5653 | MEANS TEST /CAT. C MEANS TE ST/CAT. C NO MT/CAT C NO C (ME ANS TEST) PAT IENT NO YES | |
5654 | MEDICARE E SRD MEDICARE ESRD MEDICA RE YE S INTER AGENCY OTH ER (INST NO YES | |
5655 | MILITARY MILITARY NO MIL YE S INTER AGENCY OTH ER (INST YES | |
5656 | NO FAULT I NS. NO FAULT INS. NO FAULT YES REIMBUR S.HEALTH I NS. INSURE R NO YES | |
5657 | REIMBURSAB LE INS. REIMBURSA BLE INS. REIM INS YES REIMBUR S.HEALTH I NS. INSURE R YES YES | |
5658 | SHARING AG REEMENT SHARING AGREEMENT SHARIN G YE S SHARI NG AGREEME NTS OTH ER (INST YES | |
5659 | Activate R evenue Cod es | |
5660 | The Activa te Revenue Codes opt ion allows users to activate t he revenue codes whi ch their s ites have chosen to use for th ird party billing. | |
5661 | The revenu e codes ar e provided by the Na tional Uni form Billi ng Committ ee. The fu ll set of 999 codes is sent to each site . All code s have an INACTIVE s tatus when received. The site chooses wh ich codes they wish to use for billing p urposes by activatin g them thr ough this option. So me of the codes are reserved f or nationa l assignme nt (no def inition as yet). The se reserve codes can not be act ivated. On ly activat ed revenue codes may be select ed during the billin g process. | |
5662 | Adding cod es to or d eleting th em from th e REVENUE CODE file is NOT all owed. | |
5663 | Enter/Edit Billing R ates | |
5664 | The Enter/ Edit Billi ng Rates o ption is u sed to edi t billing rates for per diem r ates; the Medicare d eductible (this is t he only pl ace the Me dicare ded uctible is entered); the HCFA ambulatory surgery r ates, phar macy copay ment amoun ts, and CH AMPVA subs istence ra tes that a re used in the autom atic calcu lation of costs when preparing a third p arty bill. | |
5665 | Although t he option allows ent ry of new rates, it should onl y be used for editin g and for the entry of duplica te rates. Duplicate rates are those wher e two diff erent rate s are used for the s ame revenu e code/bed section/ef fective da te depende nt on payo r. All oth er new bil ling rates should be entered t hrough the Fast Ente r New Bill ing Rates option. | |
5666 | If YES is answered a t the "NON -STANDARD RATE" prom pt, that b illing rat e will onl y be used with insur ance compa nies where the selec ted revenu e code has been list ed in the DIFFERENT REVENUE CO DES TO USE field of the INSURA NCE COMPAN Y file. | |
5667 | You may en ter an add itional am ount as we ll as the basic amou nt to be c harged for all rates . This is a fixed ad ditional d ollar amou nt that wi ll be adde d to the b asic charg e after it has been computed. An example would be the additi onal charg e of $200 added to H CFA Ambula tory Surge ry rate gr oups for i nter-ocula r lens imp lants. | |
5668 | Accuracy i n entering billing r ates is cr itical. In correct en tries will result in erroneous bills. Af ter new ra tes are en tered, it is suggest ed you pri nt the Bil ling Rates List (Bil ling Rates List opti on on the Management Reports M enu) to ve rify that all entrie s are corr ectly reco rded. | |
5669 | Flag Stop Codes/Disp ositions/C linics | |
5670 | Outpatient encounter s recorded in the Sc heduling p ackage as either reg istrations or "stand -alone" st op codes w ill be bil led automa tically as those eve nts are ch ecked out. The Flag Stop Codes /Dispositi ons/Clinic s option i s used to flag/unfla g those st op codes a nd disposi tions whic h should n ot be bill ed. The op tion may a lso be use d to flag clinics wh ere Means Test billi ng is not appropriat e. | |
5671 | If you mak e more tha n one sele ction, you will be g iven the o pportunity to review the selec tions and deselect a ny, if nec essary. Al l selectio ns will be assigned the same e ffective d ate and bi llable sta tus. | |
5672 | Note that once a sel ection has been flag ged as non -billable, it may la ter be fla gged as bi llable if it is subs equently d etermined it would b e appropri ate to con tinue bill ing. | |
5673 | Flag Stop Codes/Clin ics for Th ird Party | |
5674 | Non-billab le stop co des or cli nics are t hose that should not be billed to a Thir d Party pa yer. By de fault, if a stop cod e or clini c is non-b illable, i t will not be billed by the au to biller; and there fore, is n on-auto bi llable. | |
5675 | Non-auto b illable st op codes o r clinics are those that may b e billable to a Thir d Party pa yer, but t he auto bi ller shoul d not be u sed for bi lling. The se are vis its that m ay need mo re researc h than can be perfor med by the auto bill er to dete rmine if t hey are bi llable. | |
5676 | These para meters are flagged b y date and may be in activated and reacti vated. | |
5677 | Insurance Company En try/Edit | |
5678 | The Insura nce Compan y Entry/Ed it option is used to enter new insurance companies into the INSURANCE COMPANY fi le and edi t data on existing c ompanies. An insuran ce company must be i n the INSU RANCE COMP ANY file b efore it c an be ente red into a patient's record. | |
5679 | When enter ing new in surance co mpanies, y ou will be prompted for the co mpany stre et address , city, an d whether or not the company w ill reimbu rse for tr eatment. | |
5680 | Following is a listi ng of the actions fo und on the screen in this opti on and a b rief descr iption of each. Once an action has been selected, <??> may b e entered at most of the promp ts that ap pear for l ists of ac ceptable r esponses o r instruct ion on how to respon d. | |
5681 | Insurance Company Ed itor Scree n | |
5682 | Once the i nsurance c ompany is selected, this scree n is displ ayed listi ng the fol lowing gro ups of inf ormation f or that co mpany: bil ling param eters, mai n mailing address, i npatient c laims offi ce data, o utpatient claims off ice data, prescripti on claims office dat a, appeals office da ta, inquir y office d ata, remar ks, and sy nonyms. | |
5683 | BP Billin g Paramete rs - Allow s you to a dd/edit th e billing parameters for the s elected in surance co mpany. | |
5684 | MM Main M ailing Add ress - All ows you to add/edit the compan y's main m ailing add ress. The address en tered here will auto matically be entered for the o ther offic e addresse s. | |
5685 | IC Inpt C laims Offi ce - Allow s you to a dd/edit th e company' s inpatien t claims o ffice name , address, phone and fax numbe rs. | |
5686 | OC Opt Cl aims Offic e - Allows you to ad d/edit the company's outpatien t claims o ffice name , address, phone and fax numbe rs. | |
5687 | PC Prescr Claims Of - Allows you to add /edit the company's prescripti on claims office nam e, address , phone an d fax numb ers. | |
5688 | AO Appeal s Office - Allows yo u to add/e dit the co mpany's ap peals offi ce name, a ddress, ph one and fa x numbers. | |
5689 | IO Inquir y Office - Allows yo u to add/e dit the co mpany's in quiry offi ce name, a ddress, ph one and fa x numbers. | |
5690 | RE Remark s - Allows the user to enter c omments co ncerning t he selecte d insuranc e company. | |
5691 | SY Synony ms - Allow s you to a dd/edit an y synonyms for the s elected co mpany. | |
5692 | EA Edit A ll - Lists editable fields lin e by line for quick data entry . | |
5693 | AI (In)Ac tivate Com pany - All ows you to activate/ inactivate the selec ted insura nce compan y. This ma y be used to inactiv ate duplic ate compan ies in the system. W hen an ins urance com pany is no longer va lid, it is important to inacti vate the c ompany rat her than d elete it f rom the sy stem. The IB INSURAN CE SUPERVI SOR securi ty key is required. Once a com pany has b een inacti vated, it may not be selected when enter ing billin g informat ion. | |
5694 | You may al so obtain a report o f patients insured b y a given company th rough this action. | |
5695 | CC Change Insurance Co. - All ows you to change to another c ompany wit hout retur ning to th e beginnin g of the o ption. | |
5696 | DC Delete Company - Allows yo u to delet e an entry from the Insurance Company (# 36) file. If claims have been submitted to the com pany, anot her compan y must be selected i n which to point all claims an d receivab les inform ation. | |
5697 | PL Plans (accesses Insurance Plan List screen) - Allows you to displa y and chan ge plan at tributes a ssociated with the i nsurance c ompany. | |
5698 | Insurance Plan List Screen | |
5699 | This scree n lists al l plans (a ctive and inactive, group and individual ) for the selected i nsurance c ompany. | |
5700 | Actions | |
5701 | VP View/E dit Plan ( accesses t he View/Ed it Plan sc reen) - Al lows you t o display/ change pla n detailed informati on. | |
5702 | IP Inacti ve Plan - Allows you to inacti vate an in surance pl an, or mov e subscrib ers from m ultiple in surance pl ans into o ne master plan. | |
5703 | AB Annual Benefits - (accesse s Annual B enefits Ed itor scree n) - Used to enter a nnual bene fits data for the se lected pol icy. | |
5704 | Annual Ben efits Edit or Screen | |
5705 | Once the b enefit yea r is selec ted, this screen is displayed listing al l the bene fits for t he selecte d insuranc e policy a nd benefit year. Ben efit categ ories may include in patient be nefits, ou tpatient b enefits, m ental heal th, home h ealth care , hospice, rehabilit ation, and IV manage ment. | |
5706 | Actions | |
5707 | PI Policy Informati on - Allow s entry/ed it of maxi mum out of pocket an d ambulanc e coverage . | |
5708 | IP Inpati ent - Allo ws entry/e dit of inp atient ben efits data . | |
5709 | OP Outpat ient - All ows entry/ edit of ou tpatient b enefits da ta. | |
5710 | MH Mental Health - Allows ent ry/edit of mental he alth inpat ient and o utpatient benefits d ata. | |
5711 | HH Home H ealth - Al lows entry /edit of h ome health care bene fits data. | |
5712 | HS Hospic e - Allows entry/edi t of hospi ce benefit s data. | |
5713 | RH Rehab - Allows e ntry/edit of rehabil itation be nefits dat a. | |
5714 | IV IV Mgm t. - Allow s entry/ed it of intr avenous ma nagement b enefits da ta. | |
5715 | EA Edit A ll - Lists editable fields lin e by line for quick data entry . | |
5716 | CY Change Year - Al lows you t o change t o another benefit ye ar. | |
5717 | View/Edit Plan Scree n | |
5718 | This scree n displays plan info rmation fo r viewing/ editing in cluding ut ilization review inf o, plan co verage lim itations, annual ben efit dates , user inf ormation, and plan c omments. | |
5719 | Actions | |
5720 | PI Policy Informati on - Allow s entry/ed it of maxi mum out of pocket an d ambulanc e coverage . | |
5721 | UI UR Inf o - Allows entry/edi t of utili zation rev iew inform ation. | |
5722 | CV Add/Ed it Coverag e - Allows you to ad d or edit coverage l imitations for a spe cific plan . | |
5723 | PC Plan C omments - Allows edi ting of co mments for the plan. | |
5724 | IP Inpati ent - Allo ws entry/e dit of inp atient ben efits data . | |
5725 | AB Annual Benefits - (accesse s Annual B enefits Ed itor scree n) - Used to enter a nnual bene fits data for the se lected pol icy. | |
5726 | CP Change Plan - Al lows you t o select a nother pla n for this insurance company w ithout hav ing to exi t back to the previo us | |
5727 | screen. | |
5728 | Sample Scr een | |
5729 | Insurance Company Ed itor Nov 26, 20 14@12:19:2 5 Page: 1 of 9 | |
5730 | Insurance Company In formation for: INSUR ANCE COMPA NY | |
5731 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
5732 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
5733 | Bil ling Param eters | |
5734 | Signatur e Required ?: YES Ty pe Of Cove rage: HEAL TH INSURAN | |
5735 | Reimburse ?: WILL NO T REIMBURS E Billing P hone: | |
5736 | Mult. Bedsection s: YES Veri fication P hone: | |
5737 | One Opt. Visi t: NO Prec ert Comp. Name: | |
5738 | Diff. Rev. Code s: Precert P hone: | |
5739 | Amb. Sur . Rev. Cod e: | |
5740 | Rx Refil l Rev. Cod e: | |
5741 | Filing Time Fram e: (1 YEA R(S)) | |
5742 | EDI Parame ters | |
5743 | Transm it?: YES-L IVE I nsurance T ype: GROUP POLICY | |
5744 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
5745 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
5746 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
5747 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
5748 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
5749 | PC Prescr Claims Of RE Remarks VP View Plans | |
5750 | AO Appeal s Office SY Synonyms EX Exit | |
5751 | Select Act ion: Next Screen//In surance Co mpany Edit or No v 26, 2014 @12:24:58 P age: 2 of 9 | |
5752 | Insurance Company In formation for: INSUR ANCE COMPA NY | |
5753 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
5754 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
5755 | Inst Pay er Primary ID: Prof Pay er Primary ID: | |
5756 | Inst Paye r Sec ID Q ual: Prof Paye r Sec ID Q ual: | |
5757 | Inst Payer Sec ID: Prof Payer Sec ID: | |
5758 | Inst Paye r Sec ID Q ual: Prof Paye r Sec ID Q ual: | |
5759 | Inst Payer Sec ID: Prof Payer Sec ID: | |
5760 | Bin Num ber: Pr nt Sec/Ter t Auto Cla ims: | |
5761 | HPID/O EID: Prnt Med Sec C laims w/o MRA: YES | |
5762 | Main Mailing Ad dress | |
5763 | St reet: Cit y/State: | |
5764 | Stre et 2: Phone: | |
5765 | Stre et 3: Fax: | |
5766 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
5767 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
5768 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
5769 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
5770 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
5771 | PC Prescr Claims Of RE Remarks VP View Plans | |
5772 | AO Appeal s Office SY Synonyms EX Exit | |
5773 | Select Act ion: Next Screen//In surance Co mpany Edit or No v 26, 2014 @12:26:11 P age: 3 of 9 | |
5774 | Insurance Company In formation for: INSUR ANCE COMPA NY | |
5775 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
5776 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
5777 | Inpatien t Claims O ffice Info rmation | |
5778 | Company Name: INSU RANCE COMP ANY S treet 3: | |
5779 | St reet: Cit y/State: | |
5780 | Stre et 2: Phone: | |
5781 | Fax: | |
5782 | Outpatie nt Claims Office Inf ormation | |
5783 | Company Name: INSU RANCE COMP ANY S treet 3: | |
5784 | St reet: Cit y/State: | |
5785 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
5786 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
5787 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
5788 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
5789 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
5790 | PC Prescr Claims Of RE Remarks VP View Plans | |
5791 | AO Appeal s Office SY Synonyms EX Exit | |
5792 | Select Act ion: Next Screen// I nsurance C ompany Edi tor N ov 26, 201 4@12:26:53 Page: 4 of 9 | |
5793 | Insurance Company In formation for: INSUR ANCE COMPA NY | |
5794 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
5795 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
5796 | Stre et 2: Phone: | |
5797 | Fax: | |
5798 | Prescript ion Claims Office In formation | |
5799 | Company Name: INSU RANCE COMP ANY S treet 3: | |
5800 | St reet: Cit y/State: | |
5801 | Stre et 2: Phone: | |
5802 | Fax: | |
5803 | App eals Offic e Informat ion | |
5804 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
5805 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
5806 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
5807 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
5808 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
5809 | PC Prescr Claims Of RE Remarks VP View Plans | |
5810 | AO Appeal s Office SY Synonyms EX Exit | |
5811 | Select Act ion: Next Screen//In surance Co mpany Edit or No v 26, 2014 @12:27:16 P age: 5 of 9 | |
5812 | Insurance Company In formation for: INSUR ANCE COMPA NY | |
5813 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
5814 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
5815 | Company Name: INSU RANCE COMP ANY S treet 3: | |
5816 | St reet: Cit y/State: | |
5817 | Stre et 2: Phone: | |
5818 | Fax: | |
5819 | Inq uiry Offic e Informat ion | |
5820 | Company Name: INSU RANCE COMP ANY S treet 3: | |
5821 | St reet: Cit y/State: | |
5822 | Stre et 2: Phone: | |
5823 | Fax: | |
5824 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
5825 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
5826 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
5827 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
5828 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
5829 | PC Prescr Claims Of RE Remarks VP View Plans | |
5830 | AO Appeal s Office SY Synonyms EX Exit | |
5831 | Select Act ion: Next Screen// I nsurance C ompany Edi tor N ov 26, 201 4@12:27:39 Page: 6 of 9 | |
5832 | Insurance Company In formation for: INSUR ANCE COMPA NY | |
5833 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
5834 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
5835 | Assoc iated Insu rance Comp anies | |
5836 | This ins urance com pany is no t defined as either a Parent o r a Child. | |
5837 | Prov ider IDs | |
5838 | Billing Pr ovider Sec ondary ID | |
5839 | Additional Billing P rovider Se condary ID s | |
5840 | VA-Laborat ory or Fac ility Seco ndary IDs | |
5841 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
5842 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
5843 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
5844 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
5845 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
5846 | PC Prescr Claims Of RE Remarks VP View Plans | |
5847 | AO Appeal s Office SY Synonyms EX Exit | |
5848 | Select Act ion: Next Screen// I nsurance C ompany Edi tor N ov 26, 201 4@12:27:51 Page: 7 of 9 | |
5849 | Insurance Company In formation for: INSUR ANCE COMPA NY | |
5850 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
5851 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
5852 | ID P arameters | |
5853 | Attending/ Rendering Provider S econdary I D Qualifie r (1500): | |
5854 | Attending/ Rendering Provider S econdary I D Qualifie r (UB-04): | |
5855 | Attending/ Rendering Secondary ID Require ment: NONE REQUIRED | |
5856 | Referring Provider S econdary I D Qualifie r (1500): UPIN | |
5857 | Referring Provider S econdary I D Requirem ent: NONE | |
5858 | Use Att/Re nd ID as B illing Pro vider Sec. ID (1500) : NO | |
5859 | Use Att/Re nd ID as B illing Pro vider Sec. ID (UB-04 ): NO | |
5860 | Always use main VAMC as Billin g Provider (1500)?: NO | |
5861 | Always use main VAMC as Billin g Provider (UB-04)?: NO | |
5862 | Transmit n o Billing Provider S ec. ID for the Elect ronic Plan Types: | |
5863 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
5864 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
5865 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
5866 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
5867 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
5868 | PC Prescr Claims Of RE Remarks VP View Plans | |
5869 | AO Appeal s Office SY Synonyms EX Exit | |
5870 | Select Act ion: Next Screen// I nsurance C ompany Edi tor N ov 26, 201 4@12:28:12 Page: 8 of 9 | |
5871 | Insurance Company In formation for: INSUR ANCE COMPA NY | |
5872 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
5873 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
5874 | Pa yer Inform ation: e- IV | |
5875 | Pa yer Name: INSURANCE COMPANY | |
5876 | VA Nat ional ID: VA1 CMS Nation al ID: | |
5877 | Payer App lication: eIV FSC Auto-U pdate: YES | |
5878 | Nationa l Active: YES Deacti vated: NO | |
5879 | Loca l Active: YES | |
5880 | Remarks | |
5881 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
5882 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
5883 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
5884 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
5885 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
5886 | PC Prescr Claims Of RE Remarks VP View Plans | |
5887 | AO Appeal s Office SY Synonyms EX Exit | |
5888 | Select Act ion: Next Screen// I nsurance C ompany Edi tor N ov 26, 201 4@12:28:30 Page: 9 of 9 | |
5889 | Insurance Company In formation for: INSUR ANCE COMPA NY | |
5890 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
5891 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
5892 | 6/05 Wi ll not pay for Omepr azole/Pril osec..jc | |
5893 | 1/1/04 All XXXXX are combin ed to this one this year and a n all incl usive | |
5894 | # is xx x-xxx-xxxx ..ID# are changing o ver to W + 9 digits now too..j c | |
5895 | This in surance ca rrier entr y and phon e number i s inclusiv e for the | |
5896 | 'Bxxxxx Company'. mdm | |
5897 | Synonyms | |
5898 | XXX | |
5899 | ---------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ------->>> | |
5900 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
5901 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
5902 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
5903 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
5904 | PC Prescr Claims Of RE Remarks VP View Plans | |
5905 | AO Appeal s Office SY Synonyms EX Exit | |
5906 | Select Act ion: Quit/ / List Fla gged Stop Codes/Disp ositions/C linics | |
5907 | The List F lagged Sto p Codes/Di spositions /Clinics o ption is u sed to gen erate a li st of all stop codes , disposit ions, and clinics wh ich have b een flagge d as not b eing billa ble for Me ans Test b illing. | |
5908 | You are pr ompted for the effec tive date of the lis t and a de vice. The output con tains a se parate pag e for non- billable d isposition s, stop co des, and c linics. | |
5909 | Sample Out put | |
5910 | ========== ========== ========== ========== ========== ========== ========== ======== | |
5911 | LIST OF NON-BILLA BLE DISPOS ITIONS | |
5912 | As Of: 12/16/93 | |
5913 | Page: 1 | |
5914 | Run Date: 12/16/93 | |
5915 | ========== ========== ========== ========== ========== ========== ========== ======== | |
5916 | DEAD ON AR RIVAL | |
5917 | ========== ========== ========== ========== ========== ========== ========== ======== | |
5918 | LIST OF N ON-BILLABL E CLINIC S TOP CODES | |
5919 | As Of: 12/16/93 | |
5920 | Page: 2 | |
5921 | Run Date: 12/16/93 | |
5922 | ========== ========== ========== ========== ========== ========== ========== ======== | |
5923 | EMPLOYEE H EALTH | |
5924 | ========== ========== ========== ========== ========== ========== ========== ======== | |
5925 | LIST OF NON-BI LLABLE CLI NICS | |
5926 | As Of: 12/16/93 | |
5927 | Page: 3 | |
5928 | Run Date: 12/16/93 | |
5929 | ========== ========== ========== ========== ========== ========== ========== ======== | |
5930 | ALLERGY RE SEARCH | |
5931 | List Flagg ed Stop Co des/Clinic s for Thir d Party | |
5932 | This outpu t is used to generat e a list o f all stop codes and clinics t hat are fl agged thro ugh the Fl ag Stop Co des/Clinic s for Thir d Party op tion as no n-billable or non-au to billabl e. These f lags can b e deactiva ted and re activated through th e above me ntioned op tion. | |
5933 | Non-billab le stop co des or cli nics are t hose that should not be billed to a Thir d Party pa yer. By de fault, if a stop cod e or clini c is non-b illable, i t will not be billed by the au to biller; and there fore, is n on-auto bi llable. | |
5934 | Non-auto b illable st op codes o r clinics are those that may b e billable to a Thir d Party pa yer, but t he auto bi ller shoul d not be u sed for bi lling. The se are vis its that m ay need mo re researc h than can be perfor med by the auto bill er to dete rmine if t hey are bi llable. | |
5935 | Sample Out put | |
5936 | ========== ========== ========== ========== ========== ========== ========== ======= | |
5937 | LIST OF C LINIC STOP CODES FLA GGED FOR T HIRD PARTY BILLING | |
5938 | As Of: 10/01/96 | |
5939 | Page: 1 | |
5940 | Run Date: 10/01/96 | |
5941 | ========== ========== ========== ========== ========== ========== ========== ======= | |
5942 | NON-BI LLABLE | |
5943 | AMPUTATION CLINIC CARDIAC SU RGERY | |
5944 | CARDIOVASC ULAR NUCLE AR MED CWT SUBSTA NCE ABUSE | |
5945 | CWT/TR-HCM I CWT/TR-SUB STANCE ABU SE | |
5946 | EMPLOYEE H EALTH ENT | |
5947 | RMS COMPEN SATED WORK THERAPY RMS COMPEN SATED WORK THERAPY | |
5948 | RMS INCENT IVE THERAP Y RMS INCENT IVE THERAP Y | |
5949 | RMS VOCATI ONAL ASSIS TANCE RMS VOCATI ONAL ASSIS TANCE | |
5950 | TELEPHONE TRIAGE TELEPHONE/ ALCOHOL DE PENDENCE | |
5951 | TELEPHONE/ ANCILLARY TELEPHONE/ DENTAL | |
5952 | TELEPHONE/ DIAGNOSTIC TELEPHONE/ DIALYSIS | |
5953 | TELEPHONE/ DRUG DEPEN DENCE TELEPHONE/ GENERAL PS YCHIATRY | |
5954 | TELEPHONE/ MEDICINE TELEPHONE/ PROSTHETIC S/ORTHOTIC | |
5955 | Enter RETU RN to cont inue or '^ ' to exit: <RET> | |
5956 | ========== ========== ========== ========== ========== ========== ========== ======= | |
5957 | LIST OF C LINIC STOP CODES FLA GGED FOR T HIRD PARTY BILLING | |
5958 | As Of: 10/01/96 | |
5959 | Page: 2 | |
5960 | Run Date: 10/01/96 | |
5961 | ========== ========== ========== ========== ========== ========== ========== ======= | |
5962 | TELEPHONE/ PTSD TELEPHONE/ REHAB AND SUPPORT | |
5963 | TELEPHONE/ SPECIAL PS YCHIATRY TELEPHONE/ SUBSTANCE ABUSE | |
5964 | TELEPHONE/ SURGERY | |
5965 | NOT AUTO BILLED | |
5966 | GENERAL ME DICINE | |
5967 | ========== ========== ========== ========== ========== ========== ========== ======== | |
5968 | LIST OF CLINIC S FLAGGED FOR THIRD PARTY BILL ING | |
5969 | As Of: 10/01/96 | |
5970 | Page: 3 | |
5971 | Run Date: 10/01/96 | |
5972 | ========== ========== ========== ========== ========== ========== ========== ======== | |
5973 | NON-BI LLABLE | |
5974 | No clinics are flagg ed as NON- BILLABLE | |
5975 | NOT AUTO BILLED | |
5976 | GENERAL ME DICAL | |
5977 | Billing Ra tes List | |
5978 | The Billin g Rates Li st option will print a list of billing r ates for a selected date range . It is an efficient way to ve rify that all billin g rate ent ries have been enter ed correct ly. | |
5979 | The output generated by this o ption disp lays the C HAMPVA, He alth Care Finance Ad ministrati on (HCFA) ambulatory surgery r ates, Medi care deduc tible, and copayment s. The eff ective dat e, amount (basic rat e), and ad ditional a mount will be shown for each r ate, if ap plicable. Certain am bulatory s urgeries m ay be bill ed at the HCFA rate. The amoun t shown (i f any) in the "Addit ional Amou nt" column is an ext ra amount which may be charged for all p rocedures within tha t rate gro up. The am ount shown under "In patient Pe r Diem" an d "NHCU Pe r Diem" is the daily charge fo r Category C patient s. | |
5980 | Any billin g rate tha t is effec tive for a ny date wi thin the s elected ra nge is dis played. If more than one rate was effect ive within the date range, bot h rates ar e displaye d. | |
5981 | Sample Out put | |
5982 | JUN 11,199 7 ** *Billing R ates Listi ng*** PAGE 1 | |
5983 | Ra tes in eff ect from: JAN 01, 19 97 | |
5984 | to: JUN 11, 19 97 | |
5985 | ========== ========== ========== ========== ========== ========== ========== ======== | |
5986 | CHAMPVA LI MIT | |
5987 | Effectiv e Date Amount Addition al Amount | |
5988 | OCT 01, 1991 $25 | |
5989 | CHAMPVA SU BSISTENCE | |
5990 | Effectiv e Date Amount Addition al Amount | |
5991 | OCT 01, 1994 $9.50 | |
5992 | HCFA AMB. SURG. RATE 1 | |
5993 | Effectiv e Date Amount Addition al Amount | |
5994 | JAN 01, 1992 $285 | |
5995 | HCFA AMB. SURG. RATE 2 | |
5996 | Effectiv e Date Amount Addition al Amount | |
5997 | JAN 01, 1992 $382 | |
5998 | JUN 11,199 7 ** *Billing R ates Listi ng*** PAGE 2 | |
5999 | Ra tes in eff ect from: JAN 01, 19 97 | |
6000 | to: JUN 11, 19 97 | |
6001 | ========== ========== ========== ========== ========== ========== ========== ======== | |
6002 | HCFA AMB. SURG. RATE 3 | |
6003 | Effectiv e Date Amount Addition al Amount | |
6004 | JAN 01, 1992 $438 | |
6005 | HCFA AMB. SURG. RATE 4 | |
6006 | Effectiv e Date Amount Addition al Amount | |
6007 | JAN 01, 1992 $539 | |
6008 | HCFA AMB. SURG. RATE 5 | |
6009 | Effectiv e Date Amount Addition al Amount | |
6010 | JAN 01, 1992 $615 | |
6011 | HCFA AMB. SURG. RATE 6 | |
6012 | Effectiv e Date Amount Addition al Amount | |
6013 | JAN 01, 1992 $580 $200 | |
6014 | JUN 11,199 7 ** *Billing R ates Listi ng*** PAGE 3 | |
6015 | Ra tes in eff ect from: JAN 01, 19 97 | |
6016 | to: JUN 11, 19 97 | |
6017 | ========== ========== ========== ========== ========== ========== ========== ======== | |
6018 | HCFA AMB. SURG. RATE 7 | |
6019 | Effectiv e Date Amount Addition al Amount | |
6020 | JAN 01, 1992 $853 | |
6021 | HCFA AMB. SURG. RATE 8 | |
6022 | Effectiv e Date Amount Addition al Amount | |
6023 | JAN 01, 1992 $705 $200 | |
6024 | HCFA AMB. SURG. RATE 9 | |
6025 | Effectiv e Date Amount Addition al Amount | |
6026 | JAN 01, 1992 $0 | |
6027 | INPATIENT PER DIEM | |
6028 | Effectiv e Date Amount Addition al Amount | |
6029 | OCT 01, 1990 $10 | |
6030 | JUN 11,199 7 ** *Billing R ates Listi ng*** PAGE 4 | |
6031 | Ra tes in eff ect from: JAN 01, 19 97 | |
6032 | to: JUN 11, 19 97 | |
6033 | ========== ========== ========== ========== ========== ========== ========== ======== | |
6034 | MEDICARE D EDUCTIBLE | |
6035 | Effectiv e Date Amount Addition al Amount | |
6036 | JAN 01, 1996 $736 | |
6037 | NHCU PER D IEM | |
6038 | Effectiv e Date Amount Addition al Amount | |
6039 | OCT 01, 1990 $5 | |
6040 | NSC PHARMA CY COPAY | |
6041 | Effectiv e Date Amount Addition al Amount | |
6042 | OCT 01, 1992 $2 | |
6043 | JUN 09, 1997 $5.00 $2.00 | |
6044 | SC PHARMAC Y COPAY | |
6045 | Effectiv e Date Amount Addition al Amount | |
6046 | OCT 01, 1990 $2 | |
6047 | MCCR Site Parameter Enter/Edit | |
6048 | The MCCR S ite Parame ter Enter/ Edit optio n allows t he user to define an d edit the MCCR site specific billing pa rameters. The parame ters are d isplayed u pon enteri ng the opt ion. They are divide d into gro ups for ed iting. Eac h group is labeled w ith a numb er to the left of th e data ite ms. Some v alues may be filled in by the system. | |
6049 | Group 1: T he medical center na me is auto matically filled in and is not editable. The feder al tax num ber is the tax ID# a ssigned to the medic al center and is a r equired fi eld. There may be mo re than on e Blue Cro ss/Blue Sh ield provi der number assigned to a site for differ ent catego ries of ca re. The ma in Blue Cr oss/Blue S hield prov ider numbe r should b e entered here. This is a requ ired field . The Medi care provi der number is furnis hed to you r facility by Medica re. The MA S Service Pointer is Medical A dministrat ion Servic e the way it is ente red in you r HOSPITAL SERVICE f ile. The d efault div ision will appear as the defau lt to the division q uestion wh en enterin g Billable Ambulator y Surgical Codes on a bill. | |
6050 | Group 2: T he name an d title of bill sign er will ap pear on th e third pa rty billin g form. Th e billing supervisor name does not appea r on the f orm. This is used in conjuncti on with th e Bill Can cellation and Bill D isapproval Mail Grou ps. If the se groups are not sp ecified, t he billing superviso r will be one of the few recip ients of b oth messag es. | |
6051 | Group 3: T he Multipl e Form Typ es paramet er should be set to YES if you r facility uses more than one health ins urance bil ling form. UB forms and HCFA-1 500 are th e forms cu rrently av ailable. I f this fie ld is left blank or answered N O, only UB forms wil l be allow ed. Beginn ing with v ersion 1.5 of Integr ated Billi ng, the re view step of creatin g a bill h as been el iminated. If the CAN INITIATOR AUTHORIZE parameter is set to YES and t he initiat or holds t he IB AUTH ORIZE secu rity key, the initia tor of the bill will be allowe d to autho rize the b ill. If th is paramet er is set to NO, ano ther user who holds the IB AUT HORIZE key will have to author ize the bi ll. | |
6052 | The CAN CL ERK ENTER NON-PTF CO DES parame ter affect s editing of diagnos is and pro cedure cod es on inpa tient bill s. If this parameter is set to YES, diag nosis and procedure codes not found in t he PTF rec ord may be entered i nto the bi lling reco rd. The AS K HINQ IN MCCR param eter, if s et to YES, will allo w the bill ing clerk to enter a request i n the HINQ Suspense file while entering a bill for a patient whose eli gibility h as not bee n verified . If set t o YES, the USE OP CP T SCREEN p arameter w ill allow the Curren t Procedur al Termino logy Codes Screen fo r outpatie nt bills t o be displ ayed on Bi lling Scre en 5. The date range of this l isting wil l be deter mined by t he OP VISI T DATE(S) on file in the bill. If there are none, the STATEM ENT COVERS FROM and TO dates w ill be use d to deter mine which CPT codes can be se lected for inclusion in the bi ll. | |
6053 | When billi ng Billabl e Ambulato ry Surgica l Codes (B ASC), the entry at t he DEFAULT AMB SURG REV CODE p arameter w ill be the default r evenue cod e stored i n the bill . If this is not app ropriate f or any par ticular in surance co mpany, the AMBULATOR Y SURG. RE V. CODE fi eld in the Insurance Company f ile may be entered a nd used fo r that par ticular in surance co mpany entr y. | |
6054 | CPT proced ures may b e stored a s ambulato ry procedu res in the Schedulin g Visits f ile (using the Add/E dit Stop C ode option ), and the y may be s tored in t he billing record as procedure s to print on a bill . There is now a two way shari ng of info rmation be tween thes e two file s. If the TRANSFER P ROCEDURES TO SCHED p arameter i s answered YES, as C PT procedu res that a re also am bulatory p rocedures are entere d into a b ill, the u ser will b e prompted to indica te whether they shou ld also be transferr ed to the Scheduling Visits fi le. Conver sely, the USE OP CPT SCREEN pa rameter al lows impor ting of am bulatory p rocedures into a bil l. Only CP T procedur es that ar e either B illable Am bulatory S urgical Co des or nat ionally or locally a ctive ambu latory pro cedures ma y be trans ferred. | |
6055 | The per di em start d ate is the date that your faci lity infor med Catego ry C patie nts of the new per d iem charge s and bega n per diem billing. This field represent s the earl iest date for which the hospit al or nurs ing home p er diem ch arge may b e billed t o a Catego ry C patie nt. This b illing is mandated b y Public L aw 101-508 , which wa s implemen ted on Nov ember 5, 1 990. Pleas e note tha t per diem billing w ill not oc cur if thi s field is blank. | |
6056 | A default revenue co de, diagno sis code, and CPT pr ocedure co de can be set to be used on ev ery bill t hat has pr escription refills. The revenu e code def ault will be overrid den by the PRESCRIPT ION REFILL REV. CODE for an in surance co mpany, if one exists . Only act ivated rev enue codes can be en tered. | |
6057 | Set the SU PPRESS MT INS BULLET IN paramet er to YES to suppres s the bull etin sent when any M eans Test charge cov ered by th e patient' s health i nsurance i s billed. | |
6058 | Group 4: T his number is the re venue code for total charges. If the HOL D MT BILLS W/INS par ameter is answered Y ES, automa ted Catego ry C bills will auto matically be placed on hold if the patie nt has act ive insura nce. The b ills may b e released to Accoun ts Receiva ble after claim disp osition fr om the ins urance com pany. The next param eter allow s the user to enter remarks to appear on every pri nted UB bi lling form type. The UB-92 Add ress Col a nd HCFA 15 00 Addr Co l paramete rs determi ne where t he mailing address w ill begin printing o n the bill ing form. The cancel lation rem ark is the message w hich will be sent to Fiscal Se rvice ever y time a b ill is can celled in MAS. | |
6059 | The next t wo paramet ers in thi s group al low mail g roups to b e set up s o that whe never a bi ll is canc elled or d isapproved , members of these g roups are notified v ia electro nic mail. If these g roups are not specif ied, only the billin g supervis or, user w ho cancell ed/disappr oved, and the initia tor of the bill (for disapprov al message only) wil l be notif ied. The C opay Backg round Erro r group is the mail group that will rece ive mail m essages fr om the IBE filer whe n an unsuc cessful at tempt to f ile is det ected. The Category C Billing mail group members w ill receiv e messages when Mean s Test/Cat egory C bi lling proc essing err ors have b een encoun tered, and when move ments and Means Test s for Cate gory C pat ients have been edit ed or dele ted. The m ail groups must have been esta blished th rough Mail Man in ord er to be e ntered at these prom pts. | |
6060 | Group 5: T he agent c ashier's m ailing sym bol, compl ete addres s, and tel ephone num ber are sp ecified he re. The st reet addre ss will no t appear o n the scre en. All bi lling paym ents made to the sit e should b e received at the ag ent cashie r's office . | |
6061 | The defaul t form typ e is the f orm most c ommonly us ed at your facility (UB-82 or UB-92). Al l new bill s and all follow-up bills will be printe d on this form unles s the prim ary insure r has the other UB f orm define d as their form type . The defa ult form t ype parame ter helps to control the trans ition betw een the UB -82 and th e UB-92. | |
6062 | The MCCR S ystem Defi nition Men u and this option is locked wi th the IB SUPERVISOR security key. | |
6063 | If necessa ry, please refer to the Data S upplement at the end of this o ption docu mentation for an exp lanation o f the requ ired respo nse for ea ch paramet er. | |
6064 | Sample Scr een | |
6065 | MEDICAL CARE COST RECOVERY P ARAMETER E NTER/EDIT | |
6066 | ========== ========== ========== ========== ========== ========== ========== === | |
6067 | [1] Medica l Center N ame: SAN D IEGO Federal Tax # : 13-88877 99 | |
6068 | Defaul t BC/BS # : 10297 65384123 Medicare Number : 12332143 | |
6069 | MAS Se rvice Poin ter: MEDIC AL ADMIN. Default D ivision : SAN DIEGO | |
6070 | [2] Bill S igner Name : HARVE Y Title: C HIEF, MAS | |
6071 | Billin g Supervis or : PATRI CIA | |
6072 | [3] Multip le Form Ty pes: YES Initiator Authorize : YES | |
6073 | Use No n-PTF Code s? : UNSPE CIFIED Ask Hin q in MCCR? : UNSPECIF IED | |
6074 | Use OP CPT Scree n? : UNSPE CIFIED Default A SC Rev. Cd : 490 | |
6075 | Xfer P roc to Sch ed?: YES Per Diem Start Date : NOV 5, 1990 | |
6076 | Defaul t RX Rev. Cd : 257 Supp ress MT In s Bulletin : UNSPECIF IED | |
6077 | Defaul t RX Dx Cd : V68.1 Default RX CPT Cd : 99070 | |
6078 | [4] '001' for Total? : YES Hold MT B ills W/Ins : YES | |
6079 | Remark on each b ill: TEST BILL UB-92 A ddress Col : UNSPECIF IED | |
6080 | Cancel lation Rem ark: TESTI NG HCFA 150 0 Addr Col : 25 | |
6081 | Cancel led Mailgr oup: PTF Disap. Mailgroup : PTF | |
6082 | Copay Mailgroup : IB ER ROR Cat C Mailgroup : IB CAT C | |
6083 | [5] Agent Cashier : DN S 04 | |
6084 | Phone : 518-5 62-4307 Default F orm Type : UB-92 | |
6085 | Enter 1-5 to EDIT, o r '^' to Q UIT: | |
6086 | DATA SUPPL EMENT | |
6087 | AGENT CASH IER MAIL S YMBOLMaili ng symbol of agent c ashier at your facil ity.AGENT CASHIER ST REET ADDRE SSMailing address of agent cas hier at yo ur facilit y.AGENT CA SHIER CITY AGENT CASH IER STATEA GENT CASHI ER ZIP COD EAGENT CAS HIER PHONE NUMBERTel ephone num ber of age nt cashier at your f acility.AS K HINQ IN MCCRYES or NO: Allow billing c lerk to en ter a requ est in the HINQ Susp ense file while ente ring a bil l for a pa tient whos e eligibil ity is not verified. BILL CANCE LLATION MA IL GROUPSp ecify the mail group you want notified w henever a third part y bill is cancelled. BILL DISAP PROVED MAI L GROUPSpe cify the m ail group you want n otified wh enever a t hird party bill is d isapproved .BILLING S UPERVISOR NAMEName o f billing supervisor at your f acility.BL UE CROSS/S HIELD PROV IDER #Main provider number (3 - 13 chara cters).CAN CLERK ENT ER NON-PTF CODESYES or NO - Ca n diagnosi s and proc edure code s not foun d in the P TF record be entered into the billing re cord.CAN I NITIATOR A UTHORIZEYE S or NO - Beginning with Versi on 1.5 of Integrated Billing, the review step of c reating a bill has b een elimin ated. If t his parame ter is ans wered YES and the in itiator ho lds the IB AUTHORIZE key, the initiator of the bil l will be allowed to authorize the bill. If this f ield is an swered NO, another u ser who ho lds the IB AUTHORIZE key must authorize the bill.C ANCELLATIO N REMARK F OR FISCALR emark (rea son for ca ncellation , 3-75 cha racters) w hich will be sent to Fiscal Sv c. every t ime a bill is cancel led in MAS .CATEGORY C BILLING MAIL GROUP Members of this mail group wil l receive messages w hen Means Test/Categ ory C bill ing proces sing error s have bee n encounte red, and w hen moveme nts and Me ans Tests for Catego ry C patie nts have b een edited or delete d.COPAY BA CKGROUND E RROR GROUP This is th e mail gro up that wi ll receive mail mess ages from the IBE fi ler when a n unsucces sful attem pt to file is detect ed.DEFAULT AMB SURG REV CODEWh en billing BASCs (Bi llable Amb ulatory Su rgical Cod es), this will be th e default revenue co de stored in the bil l. If this is not ap propriate for any pa rticular i nsurance c ompany, th e AMBULATO RY SURG. R EV. CODE f ield in th e Insuranc e Company file may b e used for that part icular ins urance com pany entry .DEFAULT D IVISIONThi s field wi ll appear as the def ault answe r to the d ivision qu estion whe n entering Billable Ambulatory Surgeries on a bill .DEFAULT F ORM TYPEEn ter the fo rm type mo st commonl y used at your facil ity. Choos e from UB- 82 or UB-9 2.DEFAULT RX REFILL CPTEnter a CPT proce dure code that shoul d be print ed on ever y bill tha t contains RX refill s. If ente red, this procedure will autom atically b e added to every bil l that has a prescri ption refi ll.DEFAULT RX REFILL DXEnter a diagnosis code that should be added to every RX r efill bill . If enter ed, this d iagnosis w ill automa tically be added to every bill that has a prescrip tion refil l.DEFAULT RX REFILL REV CODEEn ter the re venue code that shou ld be used for RX re fills. Thi s default will be ov er-ridden by the PRE SCRIPTION REFILL REV . CODE for an insura nce compan y, if one exists. On ly activat ed revenue codes can be select ed.FEDERAL TAX NUMBE REnter the federal t ax number for your f acility in NN-NNNNNN N format.H CFA 1500 A DDRESS COL UMNThis is the colum n the mail ing addres s should b egin print ing on row 1 of the HCFA-1500 form.HOLD MT BILLS W /INSIf thi s paramete r is answe red YES, t he automat ed Categor y C bills will autom atically b e placed o n hold for patients with activ e insuranc e. The bil ls may be released t o Accounts Receivabl e after cl aim dispos ition from the insur ance compa ny.MAS SER VICE POINT ERMedical Administra tion Servi ce as it i s entered in your HO SPITAL SER VICE file. MEDICARE P ROVIDER NU MBERProvid ed by Medi care to yo ur facilit y (1-8 cha racters). This numbe r will pri nt in Form Locator 7 on the UB -82 form.M ULTIPLE FO RM TYPESYE S or NO - Set this f ield to YE S if your facility u ses more t han one ty pe of heal th insuran ce form. T he UB form s and the HCFA-1500 are the fo rm types c urrently a vailable. If this pa rameter is set to NO or left b lank, only UB forms will be al lowed.NAME OF CLAIM FORM SIGNE RName of p erson resp onsible fo r signingP ER DIEM ST ART DATETh is is the date that your facil ity inform ed Categor y C patien ts of the new per di em charges and began per diem billing. P er diem bi lling will not occur if this f ield is le ft blank.P RINT '001' FOR TOTAL CHARGESYE S or NO - Print '001 ' (revenue code for total char ges) next to total c harges on third part y bill.REM ARKS TO AP PEAR ON EA CH FORMFac ility spec ific remar ks to prin t on every UB type b ill.SUPPRE SS MT INS BULLETINYE S or NO - Set this p arameter t o YES to s uppress th e bulletin sent when any Means Test char ge covered by the pa tient's he alth insur ance is bi lled.TITLE OF CLAIM FORM SIGNE RTitle of person res ponsible f or signing TRANSFER P ROCEDURES TO SCHEDYE S or NO - If this pa rameter is answered UB-92 ADDR ESS COLUMN This is th e column o n which th e mailing address sh ould begin printing on the UB- 92.USE OP CPT SCREEN YES or NO - Allow Cu rrent Proc edural Ter minology C odes Scree n to appea r when edi ting proce dure codes on Screen 5. The sc reen will list CPT c odes for t he dates a ssociated with the b ill.Purge Insurance Buffer | |
6088 | When a Buf fer entry is process ed, most o f the data is immedi ately dele ted from t hat entry leaving on ly a stub entry for tracking a nd reporti ng purpose s. This op tion delet es Insuran ce Buffer entries th at were pr ocessed (a ccepted or rejected) before th e selected date. A m inimum of 1 year of buffer pro cessed rec ords is ma intained o n line; th erefore, t he latest selectable date is o ne year pr ior to the current d ate. | |
6089 | Sample Scr een | |
6090 | IN SURANCE BU FFER PURGE | |
6091 | This op tion will purge Buff er file re cords Proc essed befo re a given date. | |
6092 | When a Buffer rec ord is Pro cessed a s tub entry remains in the Buffe r file | |
6093 | for tra cking and reporting purposes. This optio n deletes all stub e ntries | |
6094 | of Buff er records processed at least a year ago . Once a r ecord is p urged, | |
6095 | it can not be ret rieved and will no l onger be i ncluded in Buffer re ports. | |
6096 | To main tain a rec ord of the Buffer ac tivity, co nsider pri nting the Buffer | |
6097 | reports for the d ate range you are go ing to be purging. | |
6098 | Purge Buff er Records Processed Before: N ov 05, 199 7// 6/1/97 (JUN 01, 1997) | |
6099 | Ok to Purg e Buffer r ecords Pro cessed bef ore Jun 01 , 1997? y YES | |
6100 | Purge of I nsurance B uffer queu ed for thi s evening at 8:00pm. | |
6101 | MCCR Site Parameter Display/Ed it | |
6102 | Parameter Group | |
6103 | Security K ey Require d | |
6104 | IB Site Pa rameters | |
6105 | IB PARAMET ER EDIT | |
6106 | Claims Tra cking Para meters | |
6107 | IB PARAMET ER EDIT | |
6108 | IB PARAMET ER EDIT | |
6109 | Third Part y Auto Bil ling Param eters | |
6110 | IB PARAMET ER EDIT | |
6111 | Insurance Verificati on | |
6112 | IB SUPERVI SOR | |
6113 | MCCR SITE PARAMETERS | |
6114 | IB PARAMET ER EDIT | |
6115 | This optio n consolid ates param eters from the Enter /Edit IB S ite Parame ters, MCCR Site Para meter Ente r/Edit, Cl aims Track ing Parame ter Edit, and Enter/ Edit Autom ated Billi ng Paramet ers option s. The ini tial scree n lists th ree parame ter groups . | |
6116 | Following is a list of the scr eens, the actions th ey provide , and a br ief descri ption of e ach action . Actions shown in i talics acc ess other screens. | |
6117 | MCCR Site Parameters Screen | |
6118 | IB Site Pa rameters - accesses the IB Sit e Paramete r screen w hich displ ays genera l Integrat ed Billing site para meters. | |
6119 | Claims Tra cking Para meters - a ccesses th e Claims T racking Pa rameters s creen whic h displays parameter s specific to the se t-up and c ontrol of Claims Tra cking func tions. | |
6120 | Third Part y Auto Bil ling Param eters - ac cesses the Automated Billing P arameters screen whi ch display s the cont rol parame ters for t he Third P arty Autom ated Bille r. | |
6121 | Insurance Verificati on - acces ses the IV site para meters scr een. More detail in the IV sit e paramete rs is prov ided in th e eIV User Guide, Se ction 2. | |
6122 | IB Site Pa rameters S creen | |
6123 | Descriptio ns for mos t of the p arameters included o n this scr een can be found in the Enter/ Edit IB Si te Paramet ers and MC CR Site Pa rameter En ter/Edit o ption docu mentation. Following is a desc ription of the six p arameters (group 12) used to c onfigure t he Tricare Pharmacy billing in terfaces t hat are us er set. Th e other se ven parame ters in th is group t hat appear on the ri ght hand s ide of the screen ar e set by t he system. | |
6124 | Rx Billing Port - Th is is the logical po rt that is opened to establish a TCP/IP connection with the RNA packag e to submi t Pharmacy claims. T his is nor mally a nu mber betwe en 2000 an d 10000. T he number that is se lected is programmed into the RNA packag e, as this is the po rt that th e RNA pack age consta ntly polls for input from VIST A. The Bil ling port must be en tered to s tart the b illing eng ine. | |
6125 | AWP Update Port - Th is is the logical po rt that is opened to establish a TCP/IP connection with the RNA packag e to recei ve AWP upd ates. This is normal ly a numbe r between 2000 and 1 0000. This number is also prog rammed int o the RNA package, a s it is th e port thr ough which the RNA p ackage tra nsmits the AWP updat es. This p ort number must be d ifferent f rom the Bi lling port number, o r the back ground job to receiv e AWP upda tes will n ot be queu ed to run. | |
6126 | TCP/IP Add ress - Thi s is the T CP/IP addr ess used t o reach th e RNA pack age. This address is usually d etermined by the fac ility syst ems manage r and supp lied to RN A on the P lan Instal lation Wor ksheet. Th is address must be e ntered to start the billing en gine. | |
6127 | Task UCI,V OL - This is UCI and Volume se t on which the queue d backgrou nd jobs sh ould run. If this fi eld has no value (i. e., for Al pha sites) , the jobs will be q ueued to r un on the current UC I and Volu me. | |
6128 | AWP Charge Set - Th is is the Charge Set within th e Charge M aster whic h was used to load t he AWP. Th e interfac e must kno w which Ch arge Set s hould be u sed to ext ract a uni t price fo r a specif ic NDC num ber (drug) . A valid Charge Set must be e ntered to start the billing en gine. | |
6129 | Prescriber ID - This is the DE A number a ssigned to your faci lity, whic h you shou ld determi ne prior t o the inst allation o f the RNA package. T his number must be s ubmitted w ith the Ph armacy Bil ling trans action. Th e number m ust be ent ered to st art the bi lling engi ne. | |
6130 | Edit Set - This acti on allows you to vie w/edit the fields in cluded in the 12 set s displaye d. | |
6131 | Claims Tra cking Para meters Scr een | |
6132 | Descriptio ns of the parameters included on this sc reen can b e found in the Claim s Tracking Parameter Edit opti on documen tation. | |
6133 | Tracking - allows yo u to edit the data d isplayed u nder the T racking Pa rameters h eading. Th ese parame ters contr ol which e pisodes of care are added to C laims Trac king. | |
6134 | Random Sam ple - allo ws you to edit the d ata displa yed under the Random Sample Pa rameters h eading. Th ese parame ters contr ol the sel ection of random sam ples. | |
6135 | General - allows you to edit t he data di splayed un der the Ge neral Para meters hea ding. | |
6136 | Edit All - allows yo u to edit all data d isplayed o n the Clai ms Trackin g Paramete rs screen. | |
6137 | Automated Billing Pa rameters S creen | |
6138 | Descriptio ns of the parameters included on this sc reen can b e found in the Enter /Edit Auto mated Bill ing Parame ters optio n document ation. | |
6139 | General - allows you to edit t he data di splayed un der the Ge neral Para meters hea ding. | |
6140 | Inpatient - allows y ou to edit the data displayed under the Inpatient Admission heading. T hese param eters cont rol if and when inpa tient epis odes of ca re are pro cessed by the Third Party auto mated bill er. | |
6141 | Outpatient - allows you to edi t the data displayed under Out patient Vi sit the he ading. The se paramet ers contro l if and w hen outpat ient visit s are proc essed by t he Third P arty autom ated bille r. | |
6142 | Prescripti on - allow s you to e dit the da ta display ed under t he Prescri ption Refi ll heading . These pa rameters c ontrol if and when p rescriptio n refills are proces sed by the Third Par ty automat ed biller. | |
6143 | Sample Scr eens | |
6144 | MCCR Site Parameters M ay 13, 199 6 10:45:52 Page: 1 of 1 | |
6145 | Display/Ed it MCCR Si te Paramet ers. | |
6146 | Only autho rized pers ons may ed it this da ta. | |
6147 | IB Site P arameters Claims Tracking P arameters | |
6148 | Facili ty Definit ion Gene ral Parame ters | |
6149 | Mail G roups Trac king Param eters | |
6150 | Patien t Billing Rand om Samplin g | |
6151 | Third Party Bill ing | |
6152 | Third Par ty Auto Bi lling Para meters | |
6153 | Genera l Paramete rs | |
6154 | Inpati ent Admiss ion | |
6155 | Outpat ient Visit | |
6156 | Prescr iption Ref ill | |
6157 | Enter ?? f or more ac tions | |
6158 | ||
6159 | IB Site P arameter CT Claims Tra cking EX Exit Action | |
6160 | CT Claims Tracking IV Ins. Verif ication | |
6161 | Select Act ion: Quit/ / | |
6162 | IB Site P arameters M ar 10, 199 8 11:49:27 Page: 1 of 3 | |
6163 | ||
6164 | Only autho rized pers ons may ed it this da ta. | |
6165 | [1] Copay Background Error Mg: IB ERROR | |
6166 | Copay Exemption Mailgroup: IB ERROR | |
6167 | Use Al erts for E xemption : NO | |
6168 | [2] Hold M T Bills w/ Ins : YES # of Days Char ges Held: 90 | |
6169 | Suppre ss MT Ins Bulletin : NO | |
6170 | Cat C Mailgroup : IB CAT C | |
6171 | Per Di em Start D ate : 01/01/91 | |
6172 | [3] Disapp roval Mail group : | |
6173 | Cancel lation Mai lgroup : | |
6174 | Cancel lation Rem ark : CANCELLED BY MAS | |
6175 | [4] New In surance Ma ilgroup : IB NEW IN SURANCE | |
6176 | Unbill ed Mailgro up : IB UNBILL ED AMOUNTS | |
6177 | Auto P rint Unbil led List : NO | |
6178 | + Enter ?? f or more ac tions | |
6179 | ||
6180 | EP Edit S et EX Exit Action | |
6181 | Select Act ion: Next Screen// M CCR System Definitio n Menu | |
6182 | Claims Tra cking Para meters M ay 13, 199 6 10:52:27 P age: 1 o f 1 | |
6183 | Only autho rized pers ons may ed it this da ta. | |
6184 | Tracking Parameters Ra ndom Sampl e Paramete rs | |
6185 | Track Inpatient : ALL PATI ENTS Me dicine Sam ple: 5 | |
6186 | Track Outpatient : INSURED ONLY Medici ne Admissi ons: 5 | |
6187 | Track Rx : ALL PATI ENTS S urgery Sam ple: 5 | |
6188 | Track P rosthetics : INSURED ONLY Surge ry Admissi ons: 5 | |
6189 | Reports Can Add CT : YES Psych Sam ple: 0 | |
6190 | Psy ch Admissi ons: 5 | |
6191 | General P arameters | |
6192 | Initializ ation Date : 09/01/94 | |
6193 | Use Admis sion Sheet : YES | |
6194 | Hea der Line 1 : ALBANY V AMC | |
6195 | Hea der Line 2 : 113 HOLL AND AVE | |
6196 | Hea der Line 3 : ALBANY, NY 12305 | |
6197 | Enter ?? f or more ac tions | |
6198 | ||
6199 | TP Tracki ng RS Random Sam ple GP Gene ral | |
6200 | EA Edit A ll EX Exit Action | |
6201 | Select Act ion: Quit/ / | |
6202 | Automated Billing Pa rameters May 13, 19 96 10:54:1 1 Pa ge: 1 of 1 | |
6203 | Only autho rized pers ons may ed it this da ta. | |
6204 | GENERAL P ARAMETERS INPATIENT ADMISSION | |
6205 | Auto Bill er Frequen cy: 1 Autom ate Billin g: YES | |
6206 | Date La st Complet ed: 04/30/ 96 Bi lling Cycl e: 20 | |
6207 | Inpa tient Stat us: Closed Days Dela y: 1 | |
6208 | OUTPATIEN T VISIT PRESCRIPTI ON REFILL | |
6209 | Auto mate Billi ng: YES Autom ate Billin g: YES | |
6210 | B illing Cyc le: 10 Bi lling Cycl e: 3 | |
6211 | Days Del ay: 1 Days Dela y: 1 | |
6212 | Enter ?? f or more ac tions | |
6213 | ||
6214 | GP Genera l IP Inpatient OP Outp atient | |
6215 | RX Prescr iption EX Exit Action | |
6216 | Select Act ion: Quit/ / | |
6217 | Re-Generat e Average Bill Amoun ts | |
6218 | This optio n is used to rebuild and store the month ly and yea rly counts and dolla r amounts of inpatie nt and out patient bi lls for a single mon th. This d ata will o verwrite a ny previou sly stored data. | |
6219 | If a past month is s elected, t he monthly totals fo r that mon th are rec omputed an d the subs equent yea rly totals are updat ed. Previo us months' data is a lso calcul ated, when required, in order to obtain yearly val ues. This informatio n is used to compute the avera ge bill am ount for t he Unbille d Amounts Report. | |
6220 | Once the a verage bil l amounts are calcul ated, the Unbilled A mounts Rep ort is aut omatically generated , via ele ctronic ma il, for th e selected month. Th is mail me ssage is s ent to the mail grou p specifie d in the U NBILLED MA IL GROUP f ield of th e IB SITE PARAMETERS file. | |
6221 | Re-Generat e Unbilled Amounts R eport | |
6222 | This optio n is used to regener ate the Un billed Amo unts Repor t for a si ngle month . This rec omputes th e unbilled care for the month and update s the unbi lled amoun ts. To sim ply view p reviously computed d ata, pleas e use the View Unbil led Amount s option. | |
6223 | Sample Out put | |
6224 | Unbilled I npatient P atient Lis ting for: 01/95 Pa ge 1 Mar 20, 1995@1 0:40:09 | |
6225 | Claims | |
6226 | Patient Na me Pt. ID. Date of Care Tracking ID Eligi bility Insuran ce Compani es | |
6227 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- - | |
6228 | IBpatient, one 000-11-111 1 Nov 27, 1993@11:2 2 500382 NON- SERVICE CO NN GHI,BI G TREE I | |
6229 | IBpatient, two 000-22-222 2 Mar 29, 1994@13:0 0 500410 SC, LESS THAN 50 BLUE C ROSS | |
6230 | IBpatient, three 000-33-333 3 Mar 24, 1994@07:3 4 500399 HUMA NITARIAN E ME HEALTH INS | |
6231 | IBpatient, four 000-44-444 4 Sep 01, 1993@17:0 7 50020 SC, 50% TO 100 % GHI | |
6232 | Send Test Unbilled A mounts Bul letin | |
6233 | This optio n allows y ou to send a test ma il message to the ma il group r eceiving t he unbille d amounts messages. This optio n should b e used pri or to repo rting prob lems to as sist sites in determ ining whet her the ma il groups are set up correctly . The mail group you wish to r eceive the message s hould be s pecified i n the UNBI LLED MAIL GROUP (6.2 5) field i n the IB S ITE PARAME TERS file (350.9). | |
6234 | Sample Mes sage | |
6235 | Subj: UNBI LLED AMOUN TS Report for Oct. 2 099 [#121 659] 06 Ju l 95 09:38 | |
6236 | 20 Lines | |
6237 | From: INTE GRATED BIL LING PACKA GE in 'IN ' basket. Page 1 * *NEW** | |
6238 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
6239 | The Unbill ed Amounts for Oct. 2099 has s uccessfull y complete d for | |
6240 | ALBANY (63 3). | |
6241 | Test Data Only, Test Data Only , Test Dat a Only | |
6242 | Inpatient Care | |
6243 | Number of Unbille d Inpt Cas es : 1,111 | |
6244 | Average Inpt. Bil l Amount : $9,999.99 | |
6245 | Total U nbilled In pt Care : $11,1 09,988.89 | |
6246 | Outpatient Care: | |
6247 | Number of Unbille d Opt Case s : 33,333 | |
6248 | Average Opt. Bill Amount : $222.22 | |
6249 | Total U nbilled Op t. Care : $7,4 07,259.26 | |
6250 | Total Unbi lled Amoun t all care : $18,5 17,248.15 | |
6251 | Enter RETU RN to cont inue or '^ ' to exit: <RET> | |
6252 | Subj: UNBI LLED AMOUN TS Report for Oct. 2 099 [#121 659] Pa ge 2 | |
6253 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
6254 | Note: Aver age bill A mount is b ased on Bi lls Author ized durin g the 12 | |
6255 | mon ths preced ing the mo nth of thi s report. | |
6256 | Note: Numb er of case s is insur ed cases i n Claims T racking th at are | |
6257 | not billed (o r bill not authorize d) but app ear to be billable. | |
6258 | Select MES SAGE Actio n: IGNORE (in IN bas ket)// | |
6259 | View Unbil led Amount s | |
6260 | This optio n is used to view pr eviously c omputed un billed amo unts witho ut having to re-comp ile the da ta. | |
6261 | Sample Out put | |
6262 | Unbilled A mounts Rep ort P age 1 Mar 22, 1995@ 09:09:28 | |
6263 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
6264 | Inpatient Care: 02/ 95 | |
6265 | Number of Unbille d Inpt. Ca ses: 54 | |
6266 | Av erage Inpt . Bill Amo unt: $5,552.22 | |
6267 | T otal Inpat ient Unbil led: $2 99,819.88 | |
6268 | Outpatien t Care: 02 /95 | |
6269 | Number of Unbille d Opt. Cas es: 192 | |
6270 | A verage Opt . Bill Amo unt: $179.00 | |
6271 | To tal Outpat ient Unbil led: $ 34,368.00 | |
6272 | Inpatient Care: 01/ 95 | |
6273 | Number of Unbille d Inpt. Ca ses: 16 | |
6274 | Av erage Inpt . Bill Amo unt: $5,832.75 | |
6275 | T otal Inpat ient Unbil led: $ 93,324.00 | |
6276 | Outpatien t Care: 01 /95 | |
6277 | Number of Unbille d Opt. Cas es: 0 | |
6278 | A verage Opt . Bill Amo unt: $178.93 | |
6279 | To tal Outpat ient Unbil led: $0.00 | |
6280 | Third Part y Joint In quiry | |
6281 | This optio n provides informati on needed to answer questions from insur ance carri ers regard ing specif ic bills o r episodes of care. This infor mation is presented in List Ma nager Scre ens. | |
6282 | Because th e same act ions are a vailable o n most scr eens, and most scree ns can be accessed f rom any ot her screen ; these “C ommon Acti ons” are l isted firs t and are not repeat ed under e ach screen descripti on. Only a ctions spe cific to a screen ar e included with that screen de scription. | |
6283 | You may QU IT from an y screen w hich will bring you back one l evel or sc reen. EXIT is also a vailable o n most scr eens. EXIT returns y ou to the menu. For more infor mation on the use of the List Manager ut ility, ple ase refer to the app endix at t he end of this manua l. | |
6284 | Actions sh own in ita lics acces s other sc reens. | |
6285 | Common Act ions | |
6286 | BC | |
6287 | Bill Charg es - Acces ses the Bi ll Charges screen. | |
6288 | DX | |
6289 | Bill Diagn oses - Acc esses the Bill Diagn oses scree n. | |
6290 | PR | |
6291 | Bill Proce dures - Ac cesses the Bill Proc edures scr een. | |
6292 | CI | |
6293 | Go to Clai m Screen - Returns y ou to the Claim Info rmation sc reen. Avai lable on a ll screens that may be opened from the C laim Infor mation scr een. | |
6294 | AR | |
6295 | Account Pr ofile - Ac cesses the AR Accoun t Profile screen. | |
6296 | CM | |
6297 | Comment Hi story - Ac cesses the AR Commen t History screen. | |
6298 | IR | |
6299 | Insurance Reviews - Accesses t he Insuran ce Reviews / Contacts screen. | |
6300 | HS | |
6301 | Health Sum mary - Dis plays a He alth Summa ry report. The infor mation dis played on the Health Summary i s site spe cified thr ough the M CCR Site P arameter D isplay/Edi t option. | |
6302 | AL | |
6303 | Go to Acti ve List - Returns yo u to the T hird Party Active Bi lls screen if that s creen was accessed u pon enteri ng this op tion; othe rwise, thi s action r eturns you to the me nu. | |
6304 | VI | |
6305 | Insurance Company - Accesses t he Insuran ce Company screen. | |
6306 | VP | |
6307 | Policy - A ccesses th e Patient Policy Inf ormation s creen. | |
6308 | AB | |
6309 | Annual Ben efits - Ac cesses the Annual Be nefits scr een. | |
6310 | EL | |
6311 | Patient El igibility - Accesses the Patie nt Eligibi lity scree n. | |
6312 | EX | |
6313 | Exit Actio n - Exits the option . | |
6314 | Third Part y Active B ills Scree n | |
6315 | This is th e first sc reen displ ayed if yo u enter a patient na me at the first prom pt of this option. I t lists al l active t hird party bills for the speci fied patie nt in orde r of date created. A ll bills c reated in the Integr ated Billi ng Third P arty Billi ng module can be fou nd on this screen or the Inact ive Bills screen. | |
6316 | Actions | |
6317 | IL | |
6318 | Inactive B ills - Acc esses the Inactive B ills scree n. | |
6319 | PI | |
6320 | Patient In surance - Accesses t he Patient Insurance screen. | |
6321 | CP | |
6322 | Change Pat ient - All ows you to choose an other pati ent and re -displays the Third Party Acti ve Bills s creen for that patie nt. | |
6323 | Inactive B ills Scree n | |
6324 | This scree n lists in active bil ls for a s pecified p atient. Al l bills cr eated in t he Integra ted Billin g Third Pa rty Billin g module a re found o n this scr een or the Third Par ty Active Bills scre en. Bills are displa yed beginn ing with m ost recent “statemen t from” da te. | |
6325 | Actions | |
6326 | CD Change Dates - A llows you to change the bills listed by | |
6327 | changing t he most re cent “stat ement from ” date to be display ed. | |
6328 | Patient In surance Sc reen | |
6329 | This scree n displays the list of insuran ce policie s for a pa tient. It is based o n the Pati ent Insura nce Manage ment scree n of the P atient Ins urance Inf o View/Edi t option. It is only available from the Third Part y Active B ills scree n. | |
6330 | Claim Info rmation Sc reen | |
6331 | This scree n contains bill data and statu s informat ion to pro vide an ov erall stat us of the bill. This is the pr imary clai m screen f or the inq uiry, and many actio ns are pro vided to e xpand on t he details of the cl aim. | |
6332 | If a polic y has been updated b ut the bil l has not, those cha nges are n ot reflect ed on this screen. U pdated or current in surance in formation may be vie wed using the three insurance screens. | |
6333 | Actions | |
6334 | CB Change Bill - Al lows you t o change t he bill be ing displa yed. If yo u entered a patient name at th e first pr ompt of th is option, only bill s for that patient m ay be sele cted. If y ou entered a bill nu mber at th e first pr ompt, any bill may b e selected . | |
6335 | Bill Charg es Screen | |
6336 | ||
6337 | cont. | |
6338 | This scree n displays a bill's charge inf ormation a s it would print on the bill. For UB-92 bills, thi s closely correspond s to Form Locators 4 2-49; ther efore, any prostheti c items, R x refills, or additi onal diagn oses and p rocedures are includ ed. For HC FA 1500 bi lls, this closely co rresponds to Block 2 4. | |
6339 | Bill Diagn osis Scree n | |
6340 | This scree n displays all diagn oses assig ned to the bill, in the order they are p rinted on the bill. | |
6341 | Bill Proce dures Scre en | |
6342 | This scree n lists al l procedur es assigne d to a bil l, in the order they are print ed on the bill. | |
6343 | AR Account Profile S creen | |
6344 | This scree n provides the finan cial histo ry of a cl aim's acco unt. This includes t he current status of the bill in both IB and AR, a s well as the paymen t or trans action his tory of th e bill fro m Accounts Receivabl e. This sc reen is lo osely base d on the P rofile of Accounts R eceivable option. | |
6345 | Actions | |
6346 | VT Transa ction Prof ile - Acce sses the A R Transact ion Profil e screen f or a selec ted transa ction. | |
6347 | AR Transac tion Profi le Screen | |
6348 | This scree n displays detailed account tr ansaction informatio n for indi vidual cla im transac tions. It is loosely based on the Accoun ts Receiva ble Transa ction Prof ile option . | |
6349 | AR Comment History S creen | |
6350 | This scree n displays AR commen ts for the claim's a ccount. | |
6351 | Actions | |
6352 | AD Add AR Comment - Allows yo u to add a n AR Trans action Com ment to th e bill bei ng display ed. Commen t transact ions may n ot be adde d to a bil l that has not been authorized in IB. | |
6353 | Insurance Reviews/Co ntacts Scr een | |
6354 | This scree n displays all insur ance revie ws and con tacts for the episod es of care on a bill . It is ba sed on the Insurance Reviews/C ontacts sc reen of th e Claims T racking In surance Re view Edit option. Th e primary difference between t he two scr eens is th at this sc reen conso lidates al l contacts for each episode be ing billed on a clai m, while t he Claims Tracking s creen disp lays the c ontacts fo r a single episode o f care. | |
6355 | Actions | |
6356 | VR Review s/Appeals - Displays expanded informatio n on a sel ected insu rance cont act. The s creen acce ssed by th is action will depen d on the t ype of con tact selec ted. If th e contact is an appe al or deni al, the Ex panded App eals/Denia ls screen is opened; otherwise , the Expa nded Insur ance Revie ws screen is opened. | |
6357 | Expanded A ppeals/Den ials Scree n | |
6358 | This scree n displays expanded informatio n on insur ance appea ls and den ials liste d on the I nsurance R eview/Cont acts scree n. This sc reen is ba sed on the Expanded Appeals/De nials scre en of the Claims Tra cking Appe al/Denial Edit optio n. | |
6359 | Expanded I nsurance R eviews Scr een | |
6360 | This scree n displays expanded informatio n on insur ance revie ws listed on the Ins urance Rev iews/Conta cts screen . This scr een is bas ed on the Expanded I nsurance R eviews scr een of the Claims Tr acking Ins urance Rev iew Edit o ption. | |
6361 | Insurance Company Sc reen | |
6362 | This scree n displays extended informatio n on an In surance Co mpany. It is based o n the Insu rance Comp any Editor screen of the Insur ance Compa ny Entry/E dit option . This scr een may be entered f rom the Pa tient Insu rance scre en or from any of th e bill spe cific scre ens. Once a bill is selected, this scree n displays only info rmation re lated to t he insuran ce carrier s assigned to that b ill. | |
6363 | Patient Po licy Infor mation Scr een | |
6364 | This scree n displays extended informatio n on insur ance polic ies. It is based on the Patien t Policy I nformation screen of the Patie nt Insuran ce Info Vi ew/Edit op tion. This screen ma y be enter ed from ei ther the P atient Ins urance scr een or fro m any of t he bill sp ecific scr eens. Once a bill is selected, this scre en will on ly display informati on related to the in surance po licies ass igned to t he bill. | |
6365 | Annual Ben efits Scre en | |
6366 | This scree n displays extended informatio n on the a nnual bene fits of in surance po licies. It is based on the Ann ual Benefi ts Editor screen of the Patien t Insuranc e Info Vie w/Edit opt ion. This screen may be entere d from the Patient I nsurance s creen or f rom any of the bill specific s creens. On ce a bill has been c hosen, thi s screen d isplays in formation related to the insur ance polic ies assign ed to that bill. | |
6367 | Patient El igibility Screen | |
6368 | This scree n displays the curre nt informa tion on th e patient' s eligibil ity for ca re and ser vice conne ction stat us. It is loosely ba sed on the Eligibili ty Inquiry for Patie nt Billing option. T his screen is availa ble from t he Third P arty Activ e Bills sc reen and t he bill sp ecific scr eens. | |
6369 | If this sc reen is ac cessed fro m one of t he bill sp ecific scr eens, such as the Cl aim Inform ation scre en, the st andard lis t of bill screen act ions will be availab le from th is screen. | |
6370 | If this sc reen is ac cessed fro m the Pati ent Insura nce screen , no other screens a re availab le as acti ons from t his screen ; and you must retur n to a pre vious scre en to acce ss other s creens. | |
6371 | Sample Scr eens | |
6372 | Third Part y Active B ills | |
6373 | May 31, 19 95 @10:07: 11 | |
6374 | Page 1 of 1 | |
6375 | IBpatient, one 1111 | |
6376 | NSC | |
6377 | Bill # | |
6378 | From | |
6379 | To | |
6380 | Type | |
6381 | Stat | |
6382 | Rate | |
6383 | Insurer | |
6384 | Orig Amt | |
6385 | Curr Amt | |
6386 | 1 | |
6387 | L10263 | |
6388 | 04/20/92 | |
6389 | 04/20/92 | |
6390 | O/P/O | |
6391 | BI | |
6392 | REIM INS | |
6393 | HEALTH | |
6394 | 0.00 | |
6395 | 0.00 | |
6396 | 2 | |
6397 | L10270 | |
6398 | 04/20/92 | |
6399 | 04/24/92 | |
6400 | O/P/O | |
6401 | PC | |
6402 | REIM INS | |
6403 | HEALTH | |
6404 | 698.30 | |
6405 | 698.30 | |
6406 | 3 | |
6407 | N10072 * | |
6408 | 11/16/93 | |
6409 | 11/17/93 | |
6410 | O/P/O | |
6411 | N | |
6412 | REIM INS | |
6413 | + HEALTH | |
6414 | 199.00 | |
6415 | 199.00 | |
6416 | 4 | |
6417 | N10094 | |
6418 | 02/16/94 | |
6419 | 02/16/94 | |
6420 | O/P/I | |
6421 | PC | |
6422 | REIM INS | |
6423 | + HEALTH | |
6424 | 196.00 | |
6425 | 196.00 | |
6426 | 5 | |
6427 | N10123 * | |
6428 | 03/01/94 | |
6429 | 03/15/94 | |
6430 | O/P/O | |
6431 | BI | |
6432 | REIM INS | |
6433 | + HEALTH | |
6434 | 0.00 | |
6435 | 0.00 | |
6436 | 6 | |
6437 | N10150 * | |
6438 | 03/14/94 | |
6439 | 03/15/94 | |
6440 | O/P/R | |
6441 | BI | |
6442 | REIM INS | |
6443 | + ABC | |
6444 | 0.00 | |
6445 | 0.00 | |
6446 | 7 | |
6447 | N10173 * | |
6448 | 03/02/94 | |
6449 | 03/03/94 | |
6450 | O/P/P | |
6451 | BI | |
6452 | REIM INS | |
6453 | ABC | |
6454 | 0.00 | |
6455 | 0.00 | |
6456 | 8 | |
6457 | N10174 * | |
6458 | 03/06/94 | |
6459 | 03/07/94 | |
6460 | O/I/O | |
6461 | N | |
6462 | REIM INS | |
6463 | ABC | |
6464 | 356.00 | |
6465 | 356.00 | |
6466 | 9 | |
6467 | N10222 | |
6468 | 05/01/94 | |
6469 | 05/31/94 | |
6470 | I/P/I | |
6471 | BI | |
6472 | REIM INS | |
6473 | HEALTH | |
6474 | 0.00 | |
6475 | 0.00 | |
6476 | 10 | |
6477 | N10236 | |
6478 | 06/01/94 | |
6479 | 06/05/94 | |
6480 | I/P/P | |
6481 | BI | |
6482 | REIM INS | |
6483 | HEALTH | |
6484 | 0.00 | |
6485 | 0.00 | |
6486 | 11 | |
6487 | N10273 * | |
6488 | 03/03/94 | |
6489 | 03/31/94 | |
6490 | I/I/P | |
6491 | A | |
6492 | REIM INS | |
6493 | + HEALTH | |
6494 | 11221.00 | |
6495 | 856.45 | |
6496 | 12 | |
6497 | N10275 | |
6498 | 08/30/94 | |
6499 | 09/30/94 | |
6500 | I/P/I | |
6501 | BI | |
6502 | REIM INS | |
6503 | ABC | |
6504 | 0.00 | |
6505 | 0.00 | |
6506 | ||
6507 | + | * Cat C Charges on Hold | + 2nd/3rd Ca rrier | | |
6508 | ||
6509 | ||
6510 | CI Claim Informatio n IL Inactive B ills PI Pati ent Insura nce | |
6511 | CP Change Patient HS Health Sum mary EL Pati ent Eligib ility | |
6512 | Select Act ion: Next Screen// | |
6513 | Inactive Bills May 17, 1 996 13:30: 26 | |
6514 | Page: 1 of 2 | |
6515 | IBpatient, one 1111 | |
6516 | ** All Ina ctive Bill s ** (9) | |
6517 | Bill # | |
6518 | From | |
6519 | To | |
6520 | Type | |
6521 | Stat | |
6522 | Rate | |
6523 | Insurer | |
6524 | Orig Amt | |
6525 | Curr Amt | |
6526 | ||
6527 | 1 | |
6528 | N10397 | |
6529 | 06/01/94 | |
6530 | 06/05/94 | |
6531 | I/P/I | |
6532 | CC | |
6533 | REIM INS | |
6534 | + ABC | |
6535 | 935.00 | |
6536 | 0.00 | |
6537 | 2 | |
6538 | N10198 | |
6539 | 06/01/94 | |
6540 | 06/05/94 | |
6541 | I/P/R | |
6542 | CB | |
6543 | REIM INS | |
6544 | + HEALTH | |
6545 | 0.00 | |
6546 | 0.00 | |
6547 | 3 | |
6548 | N10212 | |
6549 | 05/07/94 | |
6550 | 05/12/94 | |
6551 | I/P/R | |
6552 | CB | |
6553 | REIM INS | |
6554 | HEALTH | |
6555 | 0.00 | |
6556 | 0.00 | |
6557 | 4 | |
6558 | N10148 * | |
6559 | 03/02/94 | |
6560 | 03/03/94 | |
6561 | O/P/P | |
6562 | CB | |
6563 | REIM INS | |
6564 | ||
6565 | 0.00 | |
6566 | 0.00 | |
6567 | 5 | |
6568 | N10162 * | |
6569 | 03/02/94 | |
6570 | 03/03/94 | |
6571 | O/P/R | |
6572 | CB | |
6573 | REIM INS | |
6574 | ||
6575 | 0.00 | |
6576 | 0.00 | |
6577 | 6 | |
6578 | N10095 | |
6579 | 02/16/94 | |
6580 | 02/16/94 | |
6581 | O/P/O | |
6582 | CB | |
6583 | REIM INS | |
6584 | ||
6585 | 0.00 | |
6586 | 0.00 | |
6587 | 7 | |
6588 | L10260 | |
6589 | 04/14/92 | |
6590 | 04/20/92 | |
6591 | O/P/O | |
6592 | CB | |
6593 | REIM INS | |
6594 | ABC | |
6595 | 1026.02 | |
6596 | 1026.02 | |
6597 | 8 | |
6598 | L00389 | |
6599 | 02/08/90 | |
6600 | 02/08/90 | |
6601 | O/P/R | |
6602 | CC | |
6603 | REIM INS | |
6604 | BC/BS | |
6605 | 26.00 | |
6606 | 0.00 | |
6607 | 9 | |
6608 | 00036A | |
6609 | 02/07/90 | |
6610 | 02/07/90 | |
6611 | O/P/R | |
6612 | CC | |
6613 | REIM INS | |
6614 | BC/BS | |
6615 | 26.00 | |
6616 | 0.00 | |
6617 | + |* Cat C C harges on Hold |+ 2n d/3rd Carr ier | | |
6618 | ||
6619 | CI Claim Informatio n AL Go to Acti ve List CD Chan ge Dates | |
6620 | EX Exit Action | |
6621 | Select Act ion: Next Screen// | |
6622 | Claim Info rmation Dec 12, 20 13@08:10:1 0 Page: 1 of 3 | |
6623 | K2013PIe P0000 DOB: 0 1/06/33 Subsc ID: XXXXXX000 | |
6624 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
6625 | Insuranc e Demograp hics | |
6626 | Bill P ayer: CARE MARK 6XXXX X | |
6627 | Claim Add ress: PO B OX XXXXX | |
6628 | PHOE NIX, AZ XX XXX | |
6629 | Claim P hone: 111- 111-1111 | |
6630 | Subscrib er Demogra phics | |
6631 | Group Nu mber: GRP PLN 160550 1 | |
6632 | Group Name: GICR X | |
6633 | Subscribe r ID: XXXX XX000 | |
6634 | Empl oyer: BIG COMPANY | |
6635 | Insured's Name: IB, SPOUSE | |
6636 | Relation ship: SPOU SE | |
6637 | +--------- |% EEOB | Enter ?? f or more ac tions|---- ---------- ---------- ---------- | |
6638 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
6639 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | |
6640 | PR Bill P rocedures IR Insurance Reviews AB Annu al Benefit s | |
6641 | CB Change Bill HS Health Sum mary EL Pati ent Eligib ility | |
6642 | ED EDI St atus AL Go to Acti ve List EB Expa nd Benefit s | |
6643 | RX ECME I nformation EX Exit | |
6644 | Select Act ion: Next Screen// NEXT SCR EEN | |
6645 | Claim Info rmation Dec 12, 20 13@08:10:2 1 Page: 2 of 3 | |
6646 | K2013PIe PATIENT,I B P0000 DOB: 0 1/06/33 Subsc ID: XXXXXX000 | |
6647 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
6648 | C laim Infor mation | |
6649 | Bill Typ e: OUTPATI ENT Charge Type: | |
6650 | Time Fram e: ADMIT T HRU DISCHA RGE Service Dates: 01/ 31/12 - 01 /31/12 | |
6651 | Rate Typ e: REIMBUR SABLE INS. Orig Claim: 12.85 | |
6652 | AR Statu s: COLLECT ED/CLOSED Balanc e Due: 0.00 | |
6653 | Sequenc e: PRIMARY | |
6654 | Purch Sv c: NO | |
6655 | ECME N o: XXXXXX0 00508 | |
6656 | ECME Ap N o: XXXXXX0 00XXXXXX00 010 | |
6657 | NP I: XXXXXX0 007 | |
6658 | HPI D: 7XXXXXX XXX | |
6659 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
6660 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
6661 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | |
6662 | PR Bill P rocedures IR Insurance Reviews AB Annu al Benefit s | |
6663 | CB Change Bill HS Health Sum mary EL Pati ent Eligib ility | |
6664 | ED EDI St atus AL Go to Acti ve List EB Expa nd Benefit s | |
6665 | RX ECME I nformation EX Exit | |
6666 | Select Act ion: Next Screen// NEXT SCR EEN | |
6667 | Claim Info rmation Dec 12, 20 13@08:10:2 4 Page: 3 of 3 | |
6668 | K2013SWe PATIENT,I B P0000 DOB: 01/06/33 Subsc ID: XXXXXX000 | |
6669 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
6670 | En tered: 01/ 31/12 by IB,TESTER | |
6671 | Autho rized: 01/ 31/12 by IB,TESTER | |
6672 | First Pr inted: 01/ 31/12 by IB,TESTER | |
6673 | Related Prescripti on Copay I nformation | |
6674 | Rx: 23264 79 Chg: $ 8.00 Sta tus: On Ho ld Bill: | |
6675 | ---------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
6676 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
6677 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | |
6678 | PR Bill P rocedures IR Insurance Reviews AB Annu al Benefit s | |
6679 | CB Change Bill HS Health Sum mary EL Pati ent Eligib ility | |
6680 | ED EDI St atus AL Go to Acti ve List EB Expa nd Benefit s | |
6681 | RX ECME I nformation EX Exit | |
6682 | Select Act ion: Quit/ / | |
6683 | Patient In surance | |
6684 | May 31, 19 95 @10:07: 11 | |
6685 | Page 1 of 1 | |
6686 | ||
6687 | Insurance Management for Patie nt: IBpati ent,one 1111 | |
6688 | ||
6689 | Insurance Co. | |
6690 | Type of Po licy | |
6691 | Group | |
6692 | Holder | |
6693 | Effect. | |
6694 | Expires | |
6695 | ||
6696 | 1 HEALTH I NS LTD | |
6697 | ||
6698 | GN 4892322 2 | |
6699 | SELF | |
6700 | 01/01/87 | |
6701 | 2 ABC | |
6702 | MAJOR MEDI CAL | |
6703 | AE 7689935 4 | |
6704 | SPOUSE | |
6705 | 10/1/90 | |
6706 | 19/30/95 | |
6707 | 3 XYZ INS | |
6708 | INDEMNITY | |
6709 | T109 | |
6710 | OTHER | |
6711 | 10/1/94 | |
6712 | 01/01/95 | |
6713 | 4 BC/BS | |
6714 | MAJOR MEDI CAL | |
6715 | GN 392043 | |
6716 | SELF | |
6717 | 01/01/90 | |
6718 | 12/31/92 | |
6719 | VI | |
6720 | Insurance Company | |
6721 | VP | |
6722 | Policy | |
6723 | AB | |
6724 | Annual Ben efits | |
6725 | AL | |
6726 | Go to Acti ve List | |
6727 | ||
6728 | ||
6729 | EX | |
6730 | Exit Actio n | |
6731 | Select Act ion: Quit/ / | |
6732 | Bill Charg es | |
6733 | May 31, 19 95 @10:07: 11 | |
6734 | ||
6735 | Page 1 of 1 | |
6736 | ||
6737 | N10072 | |
6738 | IBpatient, one 1 111 | |
6739 | DOB: 00/00 /00 | |
6740 | Subsc ID: 000111111 | |
6741 | 11/16/93 - 11/17/93 | |
6742 | ADMIT THRU DISCHARGE | |
6743 | Orig Amt: 199.00 | |
6744 | ||
6745 | OUTPATIENT VISIT | |
6746 | 500 | |
6747 | OUTPATIENT SVS | |
6748 | ||
6749 | 178.00 | |
6750 | ||
6751 | 1 | |
6752 | 178.00 | |
6753 | ||
6754 | PRESCRIPTI ON | |
6755 | 257 | |
6756 | DRGS/NONSC RPT | |
6757 | ||
6758 | 21.00 | |
6759 | ||
6760 | 1 | |
6761 | 21.00 | |
6762 | 001 | |
6763 | TOTAL CHAR GE | |
6764 | ||
6765 | ||
6766 | ||
6767 | ||
6768 | 199.00 | |
6769 | ||
6770 | OP VISIT D ATE(S) BIL LED: | |
6771 | ||
6772 | NOV 16, 19 93 | |
6773 | ||
6774 | PRESCRIPTI ON REFILLS : | |
6775 | ||
6776 | 30948 | |
6777 | NOV 17, 19 93 | |
6778 | ||
6779 | ABBOCATH-T 18G 1.25 IN | |
6780 | ||
6781 | ||
6782 | ||
6783 | ||
6784 | QTY: 20 fo r 10 days supply | |
6785 | Bill Remar k: This is a demonst ration bil l created for Joint Billing In quiry. | |
6786 | Enter ?? f or more ac tions | |
6787 | ||
6788 | DX Bill D iagnosis AR Account Pr ofile VI Insu rance Comp any | |
6789 | PR Bill P rocedures CM Comment Hi story VP Poli cy | |
6790 | CI Go to Claim Scre en IR Insurance Reviews AB Annu al Benefit s | |
6791 | HS Health Sum mary EL Pati ent Eligib ility | |
6792 | AL Go to Acti ve List EX Exit Action | |
6793 | Select Act ion: Quit/ / | |
6794 | Bill Charg es | |
6795 | May 31, 19 95 @10:07: 11 | |
6796 | ||
6797 | Page 1 of 1 | |
6798 | ||
6799 | N10273 | |
6800 | IBpatient, one 1 111 | |
6801 | DOB: 00/00 /00 | |
6802 | Subsc ID: 000111111 | |
6803 | 03/02/94 - 03/31/94 | |
6804 | INTERIM - FIRST CLAI M | |
6805 | Orig Amt: 11221.00 | |
6806 | 30 DAYS IN PATIENT CA RE | |
6807 | ||
6808 | INTERMEDIA TE CARE | |
6809 | 101 | |
6810 | ALL INCL R &B | |
6811 | ||
6812 | 246.00 | |
6813 | ||
6814 | 30 | |
6815 | 7380.00 | |
6816 | 240 | |
6817 | ALL INCL A NCIL | |
6818 | ||
6819 | 48.00 | |
6820 | ||
6821 | 30 | |
6822 | 1440.00 | |
6823 | 960 | |
6824 | PRO FEE | |
6825 | ||
6826 | 49.00 | |
6827 | ||
6828 | 30 | |
6829 | 1470.00 | |
6830 | 274 | |
6831 | PROSTH/ORT H DEV | |
6832 | 931.00 | |
6833 | ||
6834 | 1 | |
6835 | 931.00 | |
6836 | 001 | |
6837 | TOTAL CHAR GE | |
6838 | ||
6839 | ||
6840 | ||
6841 | ||
6842 | 11221.00 | |
6843 | ||
6844 | PROSTHETIC ITEMS: | |
6845 | ||
6846 | Sep 18, 19 94 WHEELC HAIR | |
6847 | ||
6848 | Sep 21, 19 94 CANE-A LL OTHER | |
6849 | Enter ?? f or more ac tions | |
6850 | ||
6851 | DX Bill D iagnosis AR Account Pr ofile VI Insu rance Comp any | |
6852 | PR Bill P rocedures CM Comment Hi story VP Poli cy | |
6853 | CI Go to Claim Scre en IR Insurance Reviews AB Annu al Benefit s | |
6854 | HS Health Sum mary EL Pati ent Eligib ility | |
6855 | AL Go to Acti ve List EX Exit Action | |
6856 | Select Act ion: Quit/ / | |
6857 | Bill Diagn osis May 17, 19 96 14:07:5 6 Page: 1 of 1 | |
6858 | N10072 I Bpatient,o ne 11 11 DOB: 00/00 /00 Su bsc ID: 00 0111111 | |
6859 | 11/16/93 - 11/17/93 AD MIT THRU D ISCHARGE C LAIM Ori g Amt: 1 99.00 | |
6860 | ||
6861 | 1) | |
6862 | 490. | |
6863 | BRONCHITIS NOS | |
6864 | ||
6865 | 2) | |
6866 | 030.1 | |
6867 | TUBERCULOI D LEPROSY | |
6868 | ||
6869 | 3) | |
6870 | 101. | |
6871 | VINCENT'S ANGINA | |
6872 | ||
6873 | 4) | |
6874 | 330.1 | |
6875 | CEREBRAL L IPIDOSES | |
6876 | ||
6877 | 5) | |
6878 | 461.0 | |
6879 | AC MAXILLA RY SINUSIT IS | |
6880 | ||
6881 | 6) | |
6882 | 310.0 | |
6883 | FRONTAL LO BE SYNDROM E | |
6884 | ||
6885 | 7) | |
6886 | 200.01 | |
6887 | RETICULOSA RCOMA HEAD | |
6888 | Enter ?? f or more ac tions | |
6889 | ||
6890 | ||
6891 | ||
6892 | ||
6893 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
6894 | PR Bill P rocedures CM Comment Hi story VP Poli cy | |
6895 | CI Go to Claim Scre en IR Insurance Reviews AB Annu al Benefit s | |
6896 | HS Health Sum mary EL Pati ent Eligib ility | |
6897 | AL Go to Acti ve List EX Exit Action | |
6898 | Select Act ion: Quit/ / | |
6899 | Bill Proce dures May 17, 19 96 14:12:5 8 Page: 1 of 1 | |
6900 | N10072 I Bpatient,o ne 11 11 DOB: 00/00 /00 Su bsc ID: 00 0111111 | |
6901 | 11/16/93 - 11/17/93 AD MIT THRU D ISCHARGE C LAIM Ori g Amt: 1 99.00 | |
6902 | ||
6903 | 11000 | |
6904 | SURGICAL C LEANSING O F SKIN | |
6905 | 11/16/93 | |
6906 | 11001 | |
6907 | ADDITIONAL CLEANSING OF SKIN | |
6908 | 11/16/93 | |
6909 | 12001 | |
6910 | REPAIR SUP ERFICIAL W OUND(S) | |
6911 | 11/16/93 | |
6912 | Enter ?? f or more ac tions | |
6913 | ||
6914 | ||
6915 | ||
6916 | ||
6917 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
6918 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | |
6919 | CI Go to Claim Scre en IR Insurance Reviews AB Annu al Benefit s | |
6920 | HS Health Sum mary EL Pati ent Eligib ility | |
6921 | AL Go to Acti ve List EX Exit Action | |
6922 | Select Act ion: Quit/ / | |
6923 | AR Account Profile May 31, 19 95 @10:07: 11 Page: 1 of 1 | |
6924 | N10273 I Bpatient,o ne 1111 DOB: 5/2 2/50 Sub sc ID: 000 111111 | |
6925 | AR Status: ACTIVE Orig Amt: 11 221.00 Balance Due: 856. 45 | |
6926 | ||
6927 | ||
6928 | 04/01/94 | |
6929 | IB Status: Printed (Last) | |
6930 | 11221.00 | |
6931 | 11221.00 | |
6932 | 1 | |
6933 | 1578 | |
6934 | 05/07/94 | |
6935 | PAYMENT (I N PART) | |
6936 | 7856.21 | |
6937 | 3364.79 | |
6938 | 2 | |
6939 | 1598 | |
6940 | 07/07/94 | |
6941 | PAYMENT (I N PART) | |
6942 | 2508.34 | |
6943 | 856.45 | |
6944 | 3 | |
6945 | 1601 | |
6946 | 07/08/94 | |
6947 | COMMENT | |
6948 | 0.00 | |
6949 | 856.45 | |
6950 | ||
6951 | Total Coll ected: | |
6952 | 10364.55 | |
6953 | ||
6954 | Percent Co llected: | |
6955 | 92.37% | |
6956 | ||
6957 | ||
6958 | ||
6959 | ||
6960 | Enter ?? f or more ac tions | |
6961 | ||
6962 | ||
6963 | ||
6964 | BC Bill C harges VT Transactio n Profile VI Insu rance Comp any | |
6965 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | |
6966 | PR Bill P rocedures IR Insurance Reviews AB Annu al Benefit s | |
6967 | CI Go to Claim Scre en HS Health Sum mary EL Pati ent Eligib ility | |
6968 | AL Go to Acti ve List EX Exit Action | |
6969 | Select Act ion: Quit/ / | |
6970 | AR Transac tion Profi le | |
6971 | May 31, 19 95 @10:07: 11 | |
6972 | ||
6973 | Page 1 of 1 | |
6974 | N10273 | |
6975 | IBpatient, one 1111 | |
6976 | DOB: 00/00 /00 | |
6977 | Subsc ID: 000111111 | |
6978 | AR Status: ACTIVE Orig Amt: 11221.00 Balance Due: 856. 45 | |
6979 | ||
6980 | TRANS. NO: | |
6981 | 1578 | |
6982 | TRANS. TYP E: | |
6983 | PAYMENT (I N PART) | |
6984 | ||
6985 | TRANS. DAT E: | |
6986 | 05/07/94 | |
6987 | DATE POSTE D: | |
6988 | 05/10/94 (ARH) | |
6989 | ||
6990 | TRANS. AMO UNT: | |
6991 | 7856.21 | |
6992 | RECEIPT #: | |
6993 | D2982398 | |
6994 | ||
6995 | ||
6996 | BALANCE | |
6997 | COLLECTED | |
6998 | ||
6999 | ||
7000 | ---------- --- | |
7001 | --------- ------ | |
7002 | ||
7003 | PRINCIPLE: | |
7004 | 3364.79 | |
7005 | 7856.21 | |
7006 | ||
7007 | INTEREST: | |
7008 | 0.00 | |
7009 | 0.00 | |
7010 | ||
7011 | ADMINISTRA TIVE: | |
7012 | 0.00 | |
7013 | 0.00 | |
7014 | ||
7015 | MARSHALL F EE: | |
7016 | 0.00 | |
7017 | 0.00 | |
7018 | ||
7019 | COURT COST : | |
7020 | 0.00 | |
7021 | 0.00 | |
7022 | ||
7023 | ||
7024 | -------- | |
7025 | --------- | |
7026 | ||
7027 | TOTAL: | |
7028 | 3364.79 | |
7029 | 7856.21 | |
7030 | ||
7031 | FY: 94 | |
7032 | PR AMT: 33 64.79 | |
7033 | ||
7034 | FY TR AMT: 7856.21 | |
7035 | COMMENTS: Date of D eposit: MA Y 10, 1994 | |
7036 | Enter ?? f or more ac tions | |
7037 | ||
7038 | ||
7039 | CI | |
7040 | Go to Clai m Screen | |
7041 | AL | |
7042 | Go to Acti ve List | |
7043 | EX | |
7044 | Exit Actio n | |
7045 | Select Act ion: Quit/ / | |
7046 | AR Comment History May 17, 19 96 14:21:3 7 Page: 1 of 1 | |
7047 | L10260 I Bpatient,o ne 1111 DOB: 5/ 22/50 S ubsc ID: A H33334 | |
7048 | AR Status: CANCELLED Orig Amt: 1026.02 Balanc e Due: 102 6.02 | |
7049 | 1582 | |
7050 | 04/21/92 | |
7051 | Copy of bi ll sent. | |
7052 | FOLLOW-UP DT: | |
7053 | 05/12/92 | |
7054 | ||
7055 | ||
7056 | Carrier di d not rece ive initia l bill. | |
7057 | 1594 | |
7058 | 05/20/92 | |
7059 | Bill cance led, wrong form type . | |
7060 | FOLLOW-UP DT: | |
7061 | 06/01/92 | |
7062 | ||
7063 | ||
7064 | Carrier re fuses to p rocess thi s type of bill on a UB-92. | |
7065 | ||
7066 | ||
7067 | They are r equiring t he HCFA 15 00 form. | |
7068 | Enter ?? f or more ac tions | |
7069 | ||
7070 | ||
7071 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
7072 | DX Bill D iagnosis AD Add AR Com ment VP Poli cy | |
7073 | PR Bill P rocedures IR Insurance Reviews AB Annu al Benefit s | |
7074 | CI Go to Claim Scre en HS Health Sum mary EL Pati ent Eligib ility | |
7075 | AL Go to Acti ve List EX Exit Action | |
7076 | Select Act ion: Quit/ / | |
7077 | Insurance Reviews/Co ntacts May 31, 19 95 @10:07: 11 Page: 1 of 1 | |
7078 | Insurance Review Ent ries for: N10072 IBpatient ,one 1111 | |
7079 | Date Ins. Co. Type Co ntact Action Auth. No . Days | |
7080 | ||
7081 | OUTPATIENT VISIT of AMBULATORY SURGERY O FFICE on 1 1/16/93 | |
7082 | 1 | |
7083 | 11/30/93 | |
7084 | HEALTH INS LIMITED | |
7085 | 1st Appeal -Clin | |
7086 | APPROVED | |
7087 | AU 39824 | |
7088 | 2 | |
7089 | 11/17/93 | |
7090 | HEALTH INS LIMITED | |
7091 | OPT | |
7092 | DENIAL | |
7093 | ||
7094 | 0 | |
7095 | ||
7096 | PRESCRIPTI ON REFILL of 30948 o n 11/17/93 | |
7097 | 3 | |
7098 | 11/17/93 | |
7099 | HEALTH INS LIMITED | |
7100 | OPT | |
7101 | APPROVED | |
7102 | RN 9384222 | |
7103 | S ervice Con nected: NO Previou s Spec. Bi lls: TORT >>> | |
7104 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
7105 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | |
7106 | PR Bill P rocedures VR Reviews/Ap peals AB Annu al Benefit s | |
7107 | CI Go to Claim Scre en HS Health Sum mary EL Pati ent Eligib ility | |
7108 | AL Go to Acti ve List EX Exit Action | |
7109 | Select Act ion: Quit/ / | |
7110 | Expanded A ppeals/Den ials | |
7111 | May 31, 19 95 @10:07: 11 | |
7112 | Page 1 of 2 | |
7113 | Insurance Appeal/Den ial for: | |
7114 | IBpatient, one 1111 | |
7115 | ROI: NOT R EQUIRED | |
7116 | ||
7117 | Visit Info rmation | |
7118 | Action Inf ormation | |
7119 | ||
7120 | Visit Type : | |
7121 | OUTPATIENT VISIT | |
7122 | Type Conta ct: | |
7123 | INITIAL AP PEAL | |
7124 | ||
7125 | Visit Date : | |
7126 | 03/09/94 9 :00 am | |
7127 | Appeal Typ e: | |
7128 | CLINICAL | |
7129 | ||
7130 | Clinic: | |
7131 | AMBULATORY SURGERY | |
7132 | Case Statu s: | |
7133 | OPEN | |
7134 | ||
7135 | Appt. Stat us: | |
7136 | CHECKED OU T | |
7137 | No Days Pe nding: | |
7138 | ||
7139 | Appt. Type : | |
7140 | REGULAR | |
7141 | Final Outc ome: | |
7142 | ||
7143 | Special Co nd: | |
7144 | ||
7145 | Clinical I nformation | |
7146 | Appeal Add ress Infor mation | |
7147 | ||
7148 | Provider: | |
7149 | ||
7150 | Ins. Co. N ame: | |
7151 | HEALTH INS LIMITED | |
7152 | ||
7153 | Provider: | |
7154 | ||
7155 | Alternate Name: | |
7156 | ||
7157 | Diagnosis: | |
7158 | ||
7159 | Street lin e 1: | |
7160 | HIL - APPE ALS OFFICE | |
7161 | ||
7162 | Diagnosis: | |
7163 | ||
7164 | Street lin e 2: | |
7165 | 1099 THIRD AVE, SUIT E | |
7166 | ||
7167 | Special Co nd: | |
7168 | ||
7169 | Street lin e 3: | |
7170 | ||
7171 | ||
7172 | ||
7173 | City/State /Zip: | |
7174 | TROY, NY 12345 | |
7175 | ||
7176 | Insurance Policy Inf ormation | |
7177 | ||
7178 | Ins. Co. N ame: | |
7179 | HEALTH INS LIMITED | |
7180 | Subscriber Name: | |
7181 | IBpatient, one | |
7182 | ||
7183 | Group Numb er: | |
7184 | GN 4892322 2 | |
7185 | Subscriber ID: | |
7186 | 000111111 | |
7187 | ||
7188 | Whose Insu rance: | |
7189 | VETERAN | |
7190 | Effective Date: | |
7191 | 01/01/87 | |
7192 | ||
7193 | Pre-Cert P hone: | |
7194 | 444-444-44 4 E | |
7195 | Expiration Date: | |
7196 | ||
7197 | User Infor mation | |
7198 | Contact In formation | |
7199 | ||
7200 | Entered By : | |
7201 | EMPLOYEE | |
7202 | Contact Da te: | |
7203 | 04/01/94 | |
7204 | ||
7205 | Entered On : | |
7206 | 11/16/93 3 :30 pm | |
7207 | Person Con tacted: | |
7208 | SPOUSE | |
7209 | ||
7210 | Last Edite d By: | |
7211 | ||
7212 | Contact Me thod: | |
7213 | PHONE | |
7214 | ||
7215 | Last Edite d On: | |
7216 | ||
7217 | Call Ref. Number: | |
7218 | RN 3320944 | |
7219 | ||
7220 | ||
7221 | ||
7222 | Review Dat e: | |
7223 | 06/02/95 | |
7224 | Comments | |
7225 | Policy sh ould cover treatment . | |
7226 | Service C onnected C onditions: | |
7227 | Service C onnected: NO | |
7228 | NO SC DIS ABILITIES LISTED | |
7229 | ||
7230 | Enter ?? f or more ac tions >>> | |
7231 | CI | |
7232 | Go to Clai m Screen | |
7233 | AL | |
7234 | Go to Acti ve List | |
7235 | EX | |
7236 | Exit Actio n | |
7237 | Select Act ion: Quit/ / | |
7238 | Expanded I nsurance R eviews | |
7239 | May 31, 19 95 @10:07: 11 | |
7240 | Page 1 of 2 | |
7241 | Insurance Review Ent ries for: | |
7242 | IBpatient, one 1111 | |
7243 | ROI: NOT R EQUIRED | |
7244 | ||
7245 | Contact In formation | |
7246 | Action Inf ormation | |
7247 | ||
7248 | Contact Da te: | |
7249 | 11/17/93 | |
7250 | Type Conta ct: | |
7251 | OUTPATIENT TREATMEN | |
7252 | ||
7253 | Person Con tacted: | |
7254 | Steve | |
7255 | Opt Treatm ent: | |
7256 | RX REFILL | |
7257 | ||
7258 | Contact Me thod: | |
7259 | PHONE | |
7260 | Action: | |
7261 | APPROVED | |
7262 | ||
7263 | Call Ref. Number: | |
7264 | RN 9384222 | |
7265 | Auth. Numb er: | |
7266 | RN 9384222 | |
7267 | ||
7268 | Review Dat e: | |
7269 | 06/02/95 | |
7270 | ||
7271 | Insurance Policy Inf ormation | |
7272 | ||
7273 | Ins. Co. N ame: | |
7274 | HEALTH INS LIMITED | |
7275 | Subscriber Name: | |
7276 | IBpatient, one | |
7277 | ||
7278 | Group Numb er: | |
7279 | GN 4892322 2 | |
7280 | Subscriber ID: | |
7281 | 000111111 | |
7282 | ||
7283 | Whose Insu rance: | |
7284 | VETERAN | |
7285 | Effective Date: | |
7286 | 01/01/87 | |
7287 | ||
7288 | Pre-Cert P hone: | |
7289 | 933-3434 | |
7290 | Expiration Date: | |
7291 | ||
7292 | Appeal Add ress Infor mation | |
7293 | User Infor mation | |
7294 | ||
7295 | Ins. Co. N ame: | |
7296 | HEALTH INS LIMITED | |
7297 | Entered By : | |
7298 | EMPLOYEE | |
7299 | ||
7300 | Alternate Name: | |
7301 | ||
7302 | Entered On : | |
7303 | 11/17/93 1 2:54 pm | |
7304 | ||
7305 | Street lin e 1: | |
7306 | HIL - APPE ALS OFFICE | |
7307 | Last Edite d By: | |
7308 | EMPLOYEE | |
7309 | ||
7310 | Street lin e 2: | |
7311 | 1099 THIRD AVE, SUIT E 301 | |
7312 | Last Edite d On: | |
7313 | 11/20/93 1 2:55 pm | |
7314 | ||
7315 | Street lin e 3: | |
7316 | ||
7317 | City/State /Zip: | |
7318 | TROY, NY 1 2345 | |
7319 | Comments | |
7320 | One refil l of presc ription ap proved. | |
7321 | Service C onnected C onditions: | |
7322 | Service C onnected: NO | |
7323 | NO SC DIS ABILITIES LISTED | |
7324 | ||
7325 | Enter ?? f or more ac tions >>> | |
7326 | CI | |
7327 | Go to Clai m Screen | |
7328 | AL | |
7329 | Go to Acti ve List | |
7330 | EX | |
7331 | Exit Actio n | |
7332 | Select Act ion: Quit/ / | |
7333 | Insurance Company M ay 17, 199 6 15:25:42 Page: 1 of 5 | |
7334 | Insurance Company In formation for: HEALT H INS LIMI TED Primary | |
7335 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
7336 | ||
7337 | ||
7338 | ||
7339 | Billing Pa rameters | |
7340 | ||
7341 | Signature Required?: | |
7342 | YES | |
7343 | Attending Phys. ID: | |
7344 | AT PH ID V AH500000 | |
7345 | ||
7346 | Reimburse? : | |
7347 | WILL REIMB URSE | |
7348 | Hosp. Prov ider No.: | |
7349 | ||
7350 | Mult. Beds ections: | |
7351 | YES | |
7352 | Primary Fo rm Type: | |
7353 | ||
7354 | Diff. Rev. Codes: | |
7355 | ||
7356 | Billing Ph one: | |
7357 | ||
7358 | One Opt. V isit: | |
7359 | NO | |
7360 | Verificati on Phone: | |
7361 | ||
7362 | Amb. Sur. Rev. Code: | |
7363 | ||
7364 | Precert Co mp. Name: | |
7365 | ABC INSURA NCE | |
7366 | ||
7367 | Rx Refill Rev. Code: | |
7368 | ||
7369 | Precert Ph one: | |
7370 | 444-444-44 44 E | |
7371 | ||
7372 | Filing Tim e Frame: | |
7373 | ||
7374 | Main Maili ng Address | |
7375 | ||
7376 | Street: | |
7377 | 2345 CENTR AL AVENUE | |
7378 | City/State : | |
7379 | ALBANY, NY 12345 | |
7380 | ||
7381 | Street 2: | |
7382 | FREAR BUIL DING | |
7383 | Phone: | |
7384 | 555-1234 | |
7385 | ||
7386 | Street 3: | |
7387 | ||
7388 | Fax: | |
7389 | 555-4884 | |
7390 | ||
7391 | Inpatient Claims Off ice Inform ation | |
7392 | ||
7393 | Street: | |
7394 | 2345 CENTR AL AVENUE | |
7395 | City/State : | |
7396 | ALBANY, NY 12345 | |
7397 | ||
7398 | Street 2: | |
7399 | FREAR BUIL DING | |
7400 | Phone: | |
7401 | 555-0392 | |
7402 | ||
7403 | Street 3: | |
7404 | ||
7405 | Fax: | |
7406 | 555-4432 | |
7407 | ||
7408 | Outpatient Claims Of fice Infor mation | |
7409 | ||
7410 | Street: | |
7411 | 789 3RD ST REET | |
7412 | City/State : | |
7413 | ALBANY, NY 12345 | |
7414 | ||
7415 | Street 2: | |
7416 | ||
7417 | Phone: | |
7418 | 333-555-56 76 | |
7419 | ||
7420 | Street 3: | |
7421 | ||
7422 | Fax: | |
7423 | 333-555-92 45 | |
7424 | ||
7425 | Prescripti on Claims Office Inf ormation | |
7426 | ||
7427 | Company Na me: | |
7428 | GHI PROCES SING | |
7429 | Street 3: | |
7430 | ||
7431 | Street: | |
7432 | 1933 CORPO RATE DRIVE | |
7433 | City/State : | |
7434 | RIVERSIDE, NY 39332 | |
7435 | ||
7436 | Street 2: | |
7437 | TANGLEWOOD PARK | |
7438 | Phone: | |
7439 | 555-0000 | |
7440 | ||
7441 | Fax: | |
7442 | ||
7443 | Appeals Of fice Infor mation | |
7444 | ||
7445 | Street: | |
7446 | HIL - APPE ALS OFFICE | |
7447 | City/State : | |
7448 | TROY, NY 1 2345 | |
7449 | ||
7450 | Street 2: | |
7451 | 1099 THIRD AVE, SUIT E 301 | |
7452 | Phone: | |
7453 | 555-1923 | |
7454 | ||
7455 | Street 3: | |
7456 | ||
7457 | Fax: | |
7458 | 555-5464 | |
7459 | ||
7460 | Inquiry Of fice Infor mation | |
7461 | ||
7462 | Street: | |
7463 | 2345 CENTR AL AVENUE | |
7464 | City/State : | |
7465 | ALBANY, NY 12345 | |
7466 | ||
7467 | Street 2: | |
7468 | FREAR BUIL DING | |
7469 | Phone: | |
7470 | 555-1923 | |
7471 | ||
7472 | Street 3: | |
7473 | ||
7474 | Fax: | |
7475 | 555-5336 | |
7476 | Remarks | |
7477 | Synonyms | |
7478 | Enter ?? f or more ac tions >>> | |
7479 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
7480 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | |
7481 | PR Bill P rocedures IR Insurance Reviews AB Annu al Benefit s | |
7482 | CI Go to Claim Scre en HS Health Sum mary EL Pati ent Eligib ility | |
7483 | AL Go to Acti ve List EX Exit Action | |
7484 | Select Act ion: Quit/ / | |
7485 | Patient Po licy Infor mation Dec 12, 20 13@08:13:2 1 Page: 1 of 9 | |
7486 | For: IBSUB ,TWOTRLRS XXX-XX-X0 00 | |
7487 | MEDICARE ( WNR) Insur ance Compa ny ** Plan Curre ntly Activ e ** | |
7488 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
7489 | Insuranc e Company | |
7490 | Compan y: MEDICAR E (WNR) | |
7491 | Stree t: PO BOX 10066 | |
7492 | Street 2: HEALTH CARE FINAN CING | |
7493 | City/Stat e: BALTIMO RE, MD 212 07 | |
7494 | Billing P h: (787)74 9-4949 | |
7495 | Precert P h: (787)74 0-4232 | |
7496 | Plan Inf ormation | |
7497 | Is Gro up Plan: Y ES | |
7498 | Gro up Name: M EDICARE PA RT A | |
7499 | Group Number: X XXXXX00010 | |
7500 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
7501 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
7502 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
7503 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
7504 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
7505 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
7506 | EX Exit | |
7507 | Select Act ion: Next Screen// NEXT SCR EEN | |
7508 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 0 Page: 2 of 9 | |
7509 | For: IBSUB ,TWOTRLRS XXX-XX-X0 00 DoD:XX/XX /XXXX | |
7510 | MEDICARE ( WNR) Insur ance Compa ny ** Plan Curre ntly Activ e ** | |
7511 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
7512 | BIN: | |
7513 | PCN: | |
7514 | Type of Plan: M EDICARE (M ) | |
7515 | Plan C ategory: M EDICARE PA RT A | |
7516 | Electron ic Type: M EDICARE A or B | |
7517 | Plan Fi ling TF: 1 YEAR (1 Y EAR(S)) | |
7518 | ePh armacy Pla n ID: | |
7519 | ePhar macy Plan Name: | |
7520 | ePharma cy Natl St atus: | |
7521 | ePharmac y Local St atus: | |
7522 | Utilizat ion Review Info Effective Dates & S ource | |
7523 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
7524 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
7525 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
7526 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
7527 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
7528 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
7529 | EX Exit | |
7530 | Select Act ion: Next Screen// NEXT SCR EEN | |
7531 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 1 Page: 3 of 9 | |
7532 | For: IBSUB ,TWOTRLRS XXX-XX-X0 00 DoD:XX/XX /XXXX | |
7533 | MEDICARE ( WNR) Insur ance Compa ny ** Plan Curre ntly Activ e ** | |
7534 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
7535 | Require UR : NO Effec tive Date: 01/01/13 | |
7536 | Requir e Amb Cert : NO Expira tion Date: | |
7537 | Requir e Pre-Cert : NO Sourc e of Info: INTERVIEW | |
7538 | Exclud e Pre-Cond : NO Policy Not Billable: NO | |
7539 | Benefits Assignable : YES | |
7540 | Subscrib er Informa tion | |
7541 | Whose I nsurance: VETERAN | |
7542 | Subscri ber Name: IBSUB,TWOT RLRS | |
7543 | Rela tionship: SELF | |
7544 | Pr imary ID: XXXXXX000A | |
7545 | Coord. Benefits: PRIMARY | |
7546 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
7547 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
7548 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
7549 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
7550 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
7551 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
7552 | EX Exit | |
7553 | Select Act ion: Next Screen// NEXT SCR EEN | |
7554 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 1 Page: 4 of 9 | |
7555 | For: IBSUB ,TWOTRLRS XXX-XX-X0 00 DoD:XX/XX /XXXX | |
7556 | MEDICARE ( WNR) Insur ance Compa ny ** Plan Curre ntly Activ e ** | |
7557 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
7558 | Subscrib er's Emplo yer Inform ation | |
7559 | Employme nt Status: E mp Sponsor ed Plan: N o | |
7560 | Employer: C laims to E mployer: N o, Send to Insurance | |
7561 | Street: Retireme nt Date: | |
7562 | C ity/State: | |
7563 | Phone: | |
7564 | Primary P rovider: | |
7565 | Prim Pro v Phone: | |
7566 | Subscrib er's Infor mation (us e Subscrib er Update Action) | |
7567 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
7568 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
7569 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
7570 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
7571 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
7572 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
7573 | EX Exit | |
7574 | Select Act ion: Next Screen// NEXT SCR EEN | |
7575 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 2 Page: 5 of 9 | |
7576 | For: IBSUB ,TWOTRLRS XXX-XX-X0 00 DoD:XX/XX /XXXX | |
7577 | MEDICARE ( WNR) Insur ance Compa ny ** Plan Curre ntly Activ e ** | |
7578 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
7579 | Subscr iber's DOB : 05/05/19 55 | |
7580 | Str 1: P ALMER HOUS E HEALTH C ARE | |
7581 | Str 2: S HEARER ST | |
7582 | City: P ALMER | |
7583 | St/Zip: M A 01069 | |
7584 | SubDiv: | |
7585 | Country: | |
7586 | Phone: X XXXXX0001 | |
7587 | Subscr iber's Sex : MALE | |
7588 | Subscribe r's Branch : ARMY | |
7589 | Subscri ber's Rank : | |
7590 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
7591 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
7592 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
7593 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
7594 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
7595 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
7596 | EX Exit | |
7597 | Select Act ion: Next Screen// NEXT SCR EEN | |
7598 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 6 Page: 6 of 9 | |
7599 | For: IBSUB ,TWOTRLRS XXX-XX-X0 00 DoD:XX/XX /XXXX | |
7600 | MEDICARE ( WNR) Insur ance Compa ny ** Plan Curre ntly Activ e ** | |
7601 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
7602 | Insuranc e Company ID Numbers (use Subs criber Upd ate Action ) | |
7603 | Subscri ber ID: XX XXXX000A | |
7604 | Plan Cov erage Limi tations | |
7605 | Coverag e Effecti ve Date Covered? Limit Comments | |
7606 | ------- - ------- ------- -------- ----- --------- | |
7607 | INPATIE NT 07/01/1 998 NO | |
7608 | 01/01/1 998 NO | |
7609 | 11/01/1 996 NO | |
7610 | OUTPATI ENT 07/01/1 998 NO | |
7611 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
7612 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
7613 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
7614 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
7615 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
7616 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
7617 | EX Exit | |
7618 | Select Act ion: Next Screen// NEXT SCR EEN | |
7619 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 7 Page: 7 of 9 | |
7620 | For: IBSUB ,TWOTRLRS XXX-XX-X0 00 DoD:XX/XX /XXXX | |
7621 | MEDICARE ( WNR) Insur ance Compa ny ** Plan Curre ntly Activ e ** | |
7622 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
7623 | 01/01/1 998 NO | |
7624 | 11/01/1 996 NO | |
7625 | PHARMAC Y 08/29/2 008 NO | |
7626 | 07/01/1 998 NO | |
7627 | 01/01/1 998 NO | |
7628 | 11/01/1 996 NO | |
7629 | DENTAL 07/01/1 998 NO | |
7630 | 01/01/1 998 NO | |
7631 | 11/01/1 996 NO | |
7632 | MENTAL HEALTH 07/01/1 998 NO | |
7633 | 01/01/1 998 NO | |
7634 | 11/01/1 996 NO | |
7635 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
7636 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
7637 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
7638 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
7639 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
7640 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
7641 | EX Exit | |
7642 | Select Act ion: Next Screen// NEXT SCR EEN | |
7643 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 8 Page: 8 of 9 | |
7644 | For: IBSUB ,TWOTRLRS XXX-XX-X0 00 DoD:XX/XX /XXXX | |
7645 | MEDICARE ( WNR) Insur ance Compa ny ** Plan Curre ntly Activ e ** | |
7646 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
7647 | LONG TE RM CARE 07/01/1 998 NO | |
7648 | 01/01/1 998 NO | |
7649 | PROSTHE TICS 07/01/1 998 NO | |
7650 | 01/01/1 998 NO | |
7651 | User Inf ormation Insuranc e Contact (last) | |
7652 | Ent ered By: I B,TESTER Person Contacted: | |
7653 | Ent ered On: 0 6/05/13 Method of Contact: PHONE | |
7654 | Last Veri fied By: Contact 's Phone: | |
7655 | Last Veri fied On: Call Ref. No.: | |
7656 | Last Upd ated By: I B,TESTER Contact Date: SEP 24, 2013 | |
7657 | Last Upd ated On: 0 9/24/13 | |
7658 | +--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
7659 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
7660 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
7661 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
7662 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
7663 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
7664 | EX Exit | |
7665 | Select Act ion: Next Screen// NEXT SCR EEN | |
7666 | Patient Po licy Infor mation Dec 12, 20 13@08:13:3 9 Page: 9 of 9 | |
7667 | For: IBSUB ,TWOTRLRS XXX-XX-X0 00 DoD:XX/XX /XXXX | |
7668 | MEDICARE ( WNR) Insur ance Compa ny ** Plan Curre ntly Activ e ** | |
7669 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
7670 | Comment -- Group P lan | |
7671 | This is a long gro up comment . This are a can hold much more than 80 | |
7672 | Characte rs in the field. | |
7673 | Comment -- Patient Policy | |
7674 | Dt Entered Entered By Me thod P erson Cont acted | |
7675 | 09/25/15 IBCLER K,TWO PHONE USER-A | |
7676 | JUST A C OMMENT AND NOTHING E LSE | |
7677 | +09/25/1 5 IBCLE RK,TWO PHONE USER-A | |
7678 | THIS IS A COMMENT THAT IS LO NGER THAN 77 CHARACT ERS TO TES T THE WRAP INDICATO | |
7679 | Personal Riders | |
7680 | Rider #1: DENTAL COVERAGE | |
7681 | ---------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ---------- | |
7682 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
7683 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
7684 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
7685 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
7686 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
7687 | EX Exit | |
7688 | Select Act ion: Quit/ / | |
7689 | Annual Ben efits May 17, 19 96 15:39:2 3 Page: 1 of 3 | |
7690 | Annual Ben efits for: ABC Ins. Co Primary | |
7691 | Policy: GN 489232 22 Ben Yr: MAR 0 1, 1993 | |
7692 | ||
7693 | Policy Inf ormation | |
7694 | ||
7695 | Max. Out o f Pocket: | |
7696 | $ | |
7697 | 500 | |
7698 | ||
7699 | Ambulance Coverage ( %): | |
7700 | 85 | |
7701 | % | |
7702 | ||
7703 | Inpatient | |
7704 | ||
7705 | Annual Ded uctible: | |
7706 | $ | |
7707 | 500 | |
7708 | Drug/Alcoh ol Lifet. Max: | |
7709 | $ | |
7710 | ||
7711 | Per Admis. Deductibl e: | |
7712 | $ | |
7713 | 100 | |
7714 | Drug/Alcoh ol Annual Max: | |
7715 | $ | |
7716 | ||
7717 | Inpt. Life time Max: | |
7718 | $ | |
7719 | ||
7720 | Nursing Ho me (%): | |
7721 | ||
7722 | Inpt. Annu al Max: | |
7723 | $ | |
7724 | ||
7725 | Other Inpt . Charges (%): | |
7726 | ||
7727 | Room & Boa rd (%): | |
7728 | ||
7729 | Outpatient | |
7730 | ||
7731 | Annual Ded uctible: | |
7732 | $ | |
7733 | 50 | |
7734 | Surgery (% ): | |
7735 | ||
7736 | Per Visit Deductible : | |
7737 | $ | |
7738 | 50 | |
7739 | Emergency (%): | |
7740 | ||
7741 | 85% | |
7742 | ||
7743 | Lifetime M ax: | |
7744 | $ | |
7745 | ||
7746 | Prescripti on (%): | |
7747 | ||
7748 | 80% | |
7749 | ||
7750 | Annual Max : | |
7751 | $ | |
7752 | ||
7753 | Adult Day Health Car e?: | |
7754 | UNK | |
7755 | ||
7756 | Visit (%): | |
7757 | ||
7758 | ||
7759 | Dental Cov . Type: | |
7760 | PERCENTAGE AMOU | |
7761 | ||
7762 | Max Visits Per Year: | |
7763 | ||
7764 | ||
7765 | Dental Cov . (%): | |
7766 | 48% | |
7767 | ||
7768 | Mental Hea lth Inpati ent | |
7769 | Mental Hea lth Outpat ient | |
7770 | ||
7771 | MH Inpt. M ax Days/Ye ar: | |
7772 | ||
7773 | ||
7774 | MH Opt. Ma x Days/Yea r: | |
7775 | ||
7776 | MH Lifetim e Inpt. Ma x: | |
7777 | $ | |
7778 | ||
7779 | MH Lifetim e Opt. Max : | |
7780 | $ | |
7781 | ||
7782 | MH Annual Inpt. Max: | |
7783 | $ | |
7784 | ||
7785 | MH Annual Opt. Max: | |
7786 | $ | |
7787 | ||
7788 | Mental Hea lth Inpt. (%): | |
7789 | ||
7790 | ||
7791 | Mental Hea lth Opt. ( %): | |
7792 | ||
7793 | Home Healt h Care | |
7794 | Hospice | |
7795 | ||
7796 | Care Level : | |
7797 | ||
7798 | ||
7799 | Annual Ded uctible: | |
7800 | $ | |
7801 | ||
7802 | Visits Per Year: | |
7803 | ||
7804 | ||
7805 | Inpatient Annual Max .: | |
7806 | $ | |
7807 | ||
7808 | Max. Days Per Year: | |
7809 | ||
7810 | ||
7811 | Lifetime M ax.: | |
7812 | $ | |
7813 | ||
7814 | Med. Equip ment (%): | |
7815 | ||
7816 | ||
7817 | Room and B oard (%): | |
7818 | ||
7819 | Visit Defi nition: | |
7820 | ||
7821 | ||
7822 | Other Inpt . Charges (%): | |
7823 | ||
7824 | Rehabilita tion | |
7825 | IV Managem ent | |
7826 | ||
7827 | OT Visits/ Yr: | |
7828 | ||
7829 | ||
7830 | IV Infusio n Opt?: | |
7831 | UNK | |
7832 | ||
7833 | PT Visits/ Yr: | |
7834 | ||
7835 | ||
7836 | IV Infusio n Inpt?: | |
7837 | UNK | |
7838 | ||
7839 | ST Visits/ Yr: | |
7840 | ||
7841 | ||
7842 | IV Antibio tics Opt?: | |
7843 | UNK | |
7844 | ||
7845 | Med Cnslg. Visits/Yr : | |
7846 | ||
7847 | ||
7848 | IV Antibio tics Inpt? : | |
7849 | UNK | |
7850 | ||
7851 | User Infor mation | |
7852 | ||
7853 | Entered By : | |
7854 | EMPLOYEE | |
7855 | ||
7856 | Entered On : | |
7857 | 02/02/94 | |
7858 | ||
7859 | Last Updat ed By: | |
7860 | EMPLOYEE | |
7861 | ||
7862 | Last Updat ed On: | |
7863 | 02/18/94 | |
7864 | Enter ?? f or more ac tions >>> | |
7865 | ||
7866 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
7867 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | |
7868 | PR Bill P rocedures IR Insurance Reviews AB Annu al Benefit s | |
7869 | CI Go to Claim Scre en HS Health Sum mary EL Pati ent Eligib ility | |
7870 | AL Go to Acti ve List EX Exit Action | |
7871 | Select Act ion: Quit/ / | |
7872 | Patient El igibility May 20, 19 96 07:45:4 4 Page: 1 of 1 | |
7873 | N10273 I Bpatient,o ne 11 11 DOB: 0 7/07/50 Subsc ID: | |
7874 | Means T est: CATEG ORY A Ins ured: Yes | |
7875 | Date of T est: 08/24 /94 A/O Expo sure: | |
7876 | Co-pay E xemption T est: Rad. Expos ure: | |
7877 | Date of T est: | |
7878 | Prima ry Elig. C ode: NSC | |
7879 | Other Elig. Code (s): EMPLO YEE | |
7880 | AID & ATTENDANC E | |
7881 | Serv ice Connec ted: No | |
7882 | Rated Disabilit ies: BONE DISEASE (0 %-NSC) | |
7883 | DEGEN ERATIVE AR THRITIS (4 0%-NSC) | |
7884 | Enter ?? f or more ac tions | |
7885 | ||
7886 | ||
7887 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
7888 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | |
7889 | PR Bill P rocedures IR Insurance Reviews AB Annu al Benefit s | |
7890 | CI Go to Claim Scre en HS Health Sum mary EX Exit Action | |
7891 | AL Go to Acti ve List | |
7892 | Select Act ion: Quit/ / | |
7893 | Fast Enter of New Bi lling Rate s | |
7894 | The IB SUP ERVISOR se curity key is requir ed to edit . | |
7895 | This optio n is desig ned to all ow quick e ntry of ne w rates in to the Cha rge Master for Inter agency and Tortiousl y Liable B illing Rat es. This o ption shou ld only be used for the annual updated I nteragency and Torti ously Liab le Rates. The charge s will be asked for by charge type categ ory: inpat ient, outp atient, pr escription , outpatie nt dental, Cat C cop ayment. En ter all ch arges for a category , then mov e to the n ext sectio n for the next categ ory. For e xample, yo u are firs t prompted for Inpat ient Charg es. When y ou have en tered all inpatient bedsection s and thei r related charges, a <RET> ent ered at th e "Select Inpatient Bedsection " prompt w ill bring you to the next char ge type, O utpatient, and so on until you have ente red the ch arges for all charge types. | |
7896 | Revenue co des may be edited th rough the Enter/Edit Charge Ma ster optio n. | |
7897 | Delete Cha rges from the Charge Master | |
7898 | The IB SUP ERVISOR se curity key is requir ed to edit . | |
7899 | This optio n is used to delete charges fr om a Charg e Set that are no lo nger neede d. All cha rges that are inacti ve or that have been replaced before the specified date are deleted. A report of charges t hat will b e deleted based on t he date en tered can be printed before th e actual d eletion to confirm t he charges should be deleted. | |
7900 | Sample Out put | |
7901 | Charges (t o be delet ed) in TL- OPT DENTAL set (ALL CHARGES IN SET) May 28, 1997 09:49 Pag e 1 | |
7902 | Charge Ite m Effect ive Inac tive Charge Rev Cd | |
7903 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
7904 | CHARGE SET : TL-OPT D ENTAL | |
7905 | OUTPATIENT DENTAL 10/01/ 92 97.00 | |
7906 | OUTPATIENT DENTAL 10/01/ 93 102.00 | |
7907 | OUTPATIENT DENTAL 10/01/ 94 119.00 | |
7908 | OUTPATIENT DENTAL 10/01/ 95 104.00 | |
7909 | OUTPATIENT DENTAL 10/01/ 96 121.00 | |
7910 | 5 Charges to be dele ted | |
7911 | Enter RETU RN to cont inue or '^ ' to exit: | |
7912 | Inactivate /List Inac tive Codes in Charge Master | |
7913 | This optio n searches the charg es in the Charge Mas ter for in active CPT codes. It then inac tivates al l charges associated with thos e inactive CPT codes . To confi rm the cha rges shoul d be inact ivated, a report of charges fo r inactive CPT codes may be pr inted. | |
7914 | Sample Out put | |
7915 | Charges fo r Inactive CPT's May 29, 19 97 13:47 Page 1 | |
7916 | Charge Ite m E ffective Inactive Charge Set Charge Rev Cd | |
7917 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
7918 | 00806 0 2/01/95 AMB SUR G REGION 394.00 333 | |
7919 | 11701 0 2/01/95 AMB SUR G REGION 343.34 | |
7920 | 11701 - 54 0 5/01/96 AMB SUR G REGION 34.20 | |
7921 | 25146 - 66 0 2/01/95 AMB SUR G REGION 942.00 | |
7922 | 25153 0 5/01/96 AMB SUR G REGION 234.23 | |
7923 | 5 Charges for Inacti ve CPT's | |
7924 | IRM System Manager's Integrate d Billing Menu | |
7925 | Purge Func tionality | |
7926 | The first option in the Purge Menu, Purg e Update F ile, is us ed to dele te all CPT entries f rom the te mporary fi le, UPDATE BILLABLE AMBULATORY SURGICAL CODE (#350 .41), afte r they hav e been tra nsferred t o the perm anent file , BILLABLE AMBULATOR Y SURGICAL CODES (#3 50.4). Thi s is usual ly done ye arly, afte r a HCFA u pdate of t he CPT cod es. | |
7927 | The remain der of the options i n this men u are used to archiv e and purg e billing data. The files whic h may be a rchived an d subseque ntly purge d are the INTEGRATED BILLING A CTION file (#350) (p harmacy co payment tr ansactions only), th e CATEGORY C BILLING CLOCK fil e (#351), and the BI LL/CLAIMS file (#399 ). | |
7928 | Billing da ta from th e current and one pr evious fis cal year, at a minim um, must b e maintain ed on-line ; however, you may c hoose to m aintain da ta from ad ditional f iscal year s, if desi red. | |
7929 | The follow ing criter ia must be met to pu rge billin g data. | |
7930 | INTEGRATED BILLING A CTION file | |
7931 | (pharmacy copayment actions) | |
7932 | The prescr iption tha t caused t he action to be crea ted must h ave been p urged from the pharm acy databa se before the action may be ar chived. In addition, the bill must be cl osed in Ac counts Rec eivable. T he date th e bill was closed is the date used to de termine wh ether it w ill be inc luded. | |
7933 | CATEGORY C | |
7934 | Only clock s with a s tatus of C LOSED or | |
7935 | BILLING CL OCK file | |
7936 | CANCELLED and a cloc k end date prior | |
7937 | ||
7938 | to the sel ected time frame are included. | |
7939 | BILL/CLAIM S file | |
7940 | The bill m ust be clo sed in Acc ounts Rece ivable. Th e date the bill was closed is the date u sed to det ermine whe ther it wi ll be incl uded. | |
7941 | There are three step s involved in the ar chiving an d purging of these f iles. | |
7942 | SYMBOL 183 \f "Symbo l" \s 10 \ h | |
7943 | A search i s conducte d to find all entrie s which ma y be archi ved throug h the Find Billing D ata to Arc hive optio n. You cho ose which of the thr ee files y ou wish to include i n the sear ch. The en tries foun d are temp orarily st ored in a sort (sear ch) templa te in the SORT TEMPL ATE file ( #.401). An entry is also made to the IB ARCHIVE/PU RGE LOG fi le (#350.6 ). This lo g may be v iewed thro ugh the Ar chive/Purg e Log Inqu iry and Li st Archive /Purge Log Entries o ptions. | |
7944 | The List S earch Temp late Entri es option allows you to view t he content s of a sea rch templa te. You ma y delete e ntries fro m the sear ch templat e using th e Delete E ntry from Search Tem plate opti on. | |
7945 | SYMBOL 183 \f "Symbo l" \s 10 \ h | |
7946 | The entrie s are arch ived using the Archi ve Billing Data opti on. It is highly rec ommended t hat you ar chive the entries to paper (pr int to a n on-slave p rinter) as there is currently no functio nality to retrieve o r restore data that has been a rchived. | |
7947 | SYMBOL 183 \f "Symbo l" \s 10 \ h | |
7948 | The data i s purged f rom the da tabase usi ng the Pur ge Billing Data opti on. The se arch templ ate contai ning the p urged entr ies is als o deleted. An electr onic signa ture code and the XU MGR securi ty key are required to archive and purge data. | |
7949 | Select Def ault Devic e for Form s | |
7950 | This optio n is used to select the defaul t devices on which t hird party claim for ms will pr int. The d evices ent ered throu gh this op tion will appear as the defaul t devices when using options w hich gener ate these forms. Sep arate devi ces may be entered f or each ty pe of form . | |
7951 | You will b e prompted for the f orm type. To avoid m aking dupl icate entr ies of the same form type, it is suggest ed you typ e <??> at this prom pt to firs t view the selection s. | |
7952 | You will t hen be pro mpted for a default printer (i n Billing) and a fol low-up pri nter (in A ccounts Re ceivable). You must enter an A ccounts Re ceivable d efault dev ice for fo llow-ups f or every f orm except the UB-82 . | |
7953 | In order t o utilize the Print Authorized Bills opt ion on the Third Par ty Billing Menu, you must set up billing default p rinters fo r each for m type thr ough this option. An y form typ e not set up with a billing de fault prin ter will n ot print w hen utiliz ing the Pr int Author ized Bills option. | |
7954 | The billin g default printer mu st be adde d for the BILL ADDEN DUM form t ype in ord er for the addendums to automa tically pr int for ev ery HCFA-1 500 bill w ith prescr iption ref ills or pr osthetic i tems. | |
7955 | Display In tegrated B illing Sta tus | |
7956 | The Displa y Integrat ed Billing Status op tion allow s you to v iew data f rom the IB SITE PARA METER file and perti nent infor mation abo ut the sta tus of the IB backgr ound filer . For furt her explan ation of t he IB site parameter s, please refer to t he Enter/E dit IB Sit e Paramete rs option documentat ion. | |
7957 | One or mor e of the f ollowing m essages ma y appear. | |
7958 | "The Integ rated Bill ing filer has more t han 10 tra nsactions in the que ue." | |
7959 | "The Integ rated Bill ing filer is not run ning and h as transac tions to f ile." | |
7960 | "The Integ rated Bill ing filer is late. I t hasn't r un since { date/time} ." | |
7961 | If the sec ond messag e appears, use the S tart the I ntegrated Billing Ba ckground F iler optio n to start the filer . If the f irst or th ird messag e appear, recheck th e status i n a few mi nutes. If the messag e(s) persi sts or the "Number o f Transact ions in Qu eue" incre ases, use the Start the Integr ated Billi ng Backgro und Filer option to start the filer. | |
7962 | Enter/Edit IB Site P arameters | |
7963 | The Enter/ Edit IB Si te Paramet ers option allows yo u to enter or edit t he INTEGRA TED BILLIN G SITE PAR AMETER fil e. | |
7964 | The follow ing is a l ist of the parameter s which ma y be enter ed/edited through th is option. It should be noted that modif ication of these par ameters ma y affect t he perform ance of th e Integrat ed Billing backgroun d filer. | |
7965 | FACILITY N AME - The name of yo ur facilit y from you r INSTITUT ION file ( there must be a stat ion number associate d with thi s entry). This value will be u sed by IFC AP in dete rmining th e bill num ber. | |
7966 | FILE IN BA CKGROUND - If set to YES, the background filer wil l run as a backgroun d job. If set to NO or left bl ank, filin g will occ ur as appl ications p ass data t o Integrat ed Billing . | |
7967 | FILER UCI, VOL - The UCI and vo lume set w here you w ant the IB E filer to run. It i s recommen ded that t he filer r un on the volume set that cont ains eithe r the IB g lobals or the PRC gl obals. VAX sites sho uld leave this field blank. | |
7968 | FILER HANG TIME - Th e number o f seconds that the f iler will remain idl e after fi nishing al l transact ions and b efore chec king for m ore transa ctions to file. The filer will shut itse lf down af ter 200 ha ngs with n o activity detected. If this f ield is le ft blank, the defaul t value is two. | |
7969 | COPAY BACK GROUND ERR OR GROUP - This is t he mail gr oup you wi sh to rece ive mail m essages fr om the IBE filer whe n an unsuc cessful at tempt to f ile is det ected. "IB ERROR" wi ll be ente red during installat ion and wi ll appear as a defau lt the fir st time th is option is used; h owever, it may be ed ited to an y mail gro up you cho ose. | |
7970 | COPAY EXEM PTION MAIL GROUP - T his is the mail grou p you wish to receiv e the copa y exemptio n messages . The mail group spe cified as the Copay Background Error Gro up will be entered d uring inst allation a nd will ap pear as th e default the first time this option is used. It m ay be edit ed to any mail group you choos e. | |
7971 | USE ALERTS - If your facility has Versio n 7 or hig her of Ker nel instal led, you m ay choose whether or not to us e alerts o r bulletin s for inte rnal messa ges in Int egrated Bi lling. The same mail group (Co pay Backgr ound Error Group) wi ll receive both aler ts and bul letins. Th is functio nality is only avail able for t he Medicat ion Copaym ent Exempt ion softwa re; howeve r, if this is a desi rable feat ure it may be expand ed in the future. If this fiel d is left unanswered , it defau lts to NO and IB wil l use bull etins. | |
7972 | CATEGORY C BILLING M AIL GROUP - Members of this ma il group w ill receiv e messages when Mean s Test/Cat egory C bi lling proc essing err ors have b een encoun tered and when movem ents and M eans Tests for Categ ory C pati ents have been edite d or delet ed. "IB CA T C" will be entered during in stallation and will appear as a default the first time this option is used; howe ver, it ma y be edite d to any m ail group you choose . | |
7973 | PER DIEM S TART DATE - The date that your facility informed C ategory C patients o f the new per diem c harges and began per diem bill ing. This field repr esents the earliest date for w hich the h ospital ($ 10.00) or nursing ho me ($5.00) per diem charge may be billed to a Cate gory C pat ient as ma ndated by Public Law 101-508 ( implemente d on Novem ber 5, 199 0). Per di em billing will not occur if t his field is left bl ank. | |
7974 | Inquire an IB Action | |
7975 | The Inquir e an IB Ac tion optio n provides a display of a capt ioned inqu iry for a specified IB action. The purpo se of this inquiry i s to provi de a quick reference of all th e fields f or all IB actions fo r a partic ular refer ence numbe r. | |
7976 | Patient IB Action In quiry | |
7977 | The Patien t IB Actio n Inquiry option pro vides a br ief displa y of IB ac tions for a selected patient a nd date ra nge. The p urpose of this inqui ry is to p rovide a q uick refer ence of al l the fiel ds for all IB action s for a pa rticular p atient. | |
7978 | Repost IB Action to Filer | |
7979 | The Repost IB Action to Filer option all ows Integr ated Billi ng action entries th at did not successfu lly pass t o Accounts Receivabl e to be re posted to the IB fil er. | |
7980 | Though thi s option w ill seldom , if ever, be used, it allows transactio ns with a status of COMPLETE ( which do n ot have an Accounts Receivable transacti on number assigned t o them) to be repost ed. | |
7981 | If there i s not enou gh data to repost th e action o r if the n umber sele cted alrea dy has an Accounts R eceivable transactio n number a ssigned to it, an ap propriate message wi ll be disp layed and the first prompt wil l be repea ted. If th e repostin g is succe ssful, you will simp ly return to the fir st prompt. | |
7982 | Start the Integrated Billing B ackground Filer | |
7983 | When a fil er job has terminate d unexpect edly, this option ma y be used to force a filer to start runn ing. | |
7984 | If a filer is curren tly runnin g, the fol lowing mes sage will be display ed. | |
7985 | "<<<<WARNI NG!!! File r appears to have be en started on (date/ time)>>>>" . | |
7986 | You will t hen be giv en the opt ion of sta rting a se cond filer . | |
7987 | Stop the I ntegrated Billing Ba ckground F iler | |
7988 | This optio n may be u sed to shu tdown the IB backgro und filer. The filer will ceas e when it has finish ed process ing all it s known tr ansactions . Processi ng with Ac counts Rec eivable wi ll then be accomplis hed in the foregroun d. | |
7989 | When you s hutdown th e filer th rough this option, t he FILE IN BACKGROUN D site par ameter is automatica lly edited to NO. Th e IB engin e will fil e in the f oreground until that parameter is edited to YES th rough the Enter/Edit IB Site P arameters option. | |
7990 | Verify RX Co-Pay Lin ks | |
7991 | The Verify RX Co-Pay Links opt ion compar es the sof tlink stor ed in Inte grated Bil ling with the pointe r in the P RESCRIPTIO N file poi nting back to Integr ated Billi ng to prov ide a disp lay/printo ut of all integrated billing a ctions whi ch do not verify for a selecte d range of reference numbers. | |
7992 | Means Test charges m ay appear on this re port if th ey are lis ted in the B cross-r eference w hen there is no actu al entry f or the ref erence (th is should rarely hap pen) or if the Means Test char ge has no softlink. | |
7993 | This optio n should b e used as a tool for resolving problems. False err ors may be reported for a numb er of legi timate occ urrences, such as th e RX was d eleted or the copay cancelled. | |
7994 | Sample Out put | |
7995 | Verify Int egrated Bi lling link s to Pharm acy APR 1 0, 1991 P age:1 | |
7996 | Verify IB Reference Number 500 1 to 50010 | |
7997 | REF. NO. PATIENT SSN RX# REFILL IB LINK | |
7998 | CHARGE ID TRANS ER ROR MESSAG E | |
7999 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
8000 | 5001 IBpatie nt,one 1111 RX#125 1 20 52:125 | |
8001 | 500-M10003 5 RX ENTRY MIS SING IB NO DE | |
8002 | 5002 IBpatie nt,two 2222 RX#11112 5 51 52:11112 5;1:1 | |
8003 | 500-M10003 5 RX ENTRY MIS SING IB NO DE | |
8004 | 5003 IBpatie nt,three 3333 RX#11112 8 1 52:11112 8;1:1 | |
8005 | 500-M10004 6 RX ENTRY MIS SING IB NO DE | |
8006 | 5004 IBpatie nt,four 4444 RX#11119 9 99991 52:11119 9;1:1 | |
8007 | 500-M10004 6 RX ENTRY MIS SING IB NO DE | |
8008 | 5007 IBpatie nt,five 5555 RX#125 1 20 52:125 | |
8009 | 500-M10006 11 RX ENTRY MIS SING IB NO DE | |
8010 | 5008 IBpatie nt,six 6666 RX#11112 5 51 52:11112 5;1:1 | |
8011 | 500-M10006 11 RX ENTRY MIS SING IB NO DE | |
8012 | 5009 IBpatie nt,seven 7777 RX#11112 8 1 52:11112 8;1:1 | |
8013 | 500-M10007 12 RX ENTRY MIS SING IB NO DE | |
8014 | 5009 IBpatie nt,eight 8888 RX#11112 8 1 52:11112 8;1:1 | |
8015 | 500-M10007 12 IB CROSS-REF ERENCE BUT NO ENTRY | |
8016 | 50010 IBpatie nt,nine 9999 RX#111199 99991 52:111199 ;1:1 | |
8017 | 500-M10007 12 RX ENTRY MIS SING IB NO DE | |
8018 | Forms Outp ut Utility | |
8019 | This optio n displays a list of local for ms defined for your site and t he associa ted action s allow yo u to add l ocal forms and data elements a nd to over ride speci fic fields on a loca l form ass ociated wi th the nat ional one. It also a llows you to define a local SC REEN 9 for bill data entry. | |
8020 | List of Lo cal Forms Screen | |
8021 | Add Local Form | |
8022 | This actio n allows y ou to defi ne local o utput bill ing forms and local input data screens t hat are no t supporte d national ly but are needed fo r specific insurance companies or bill t ypes. It p rovides th e ability to create new forms/ screens fr om scratch , as well as provide s for two ways to ea sily creat e a new fo rm "copy" based on a n existing nationall y released form. | |
8023 | The WANT T O ASSOCIAT E THIS FOR M WITH A N ATIONAL FO RM? field allows you to associ ate a new local form with a na tionally r eleased fo rm without actually copying an y data. Th is associa tion allow s each sit e to creat e a local form, but only requi re modific ations to the fields of the fo rm that ar e differen t from the nationall y released definitio ns. Any fo rm field d efinition that is no t changed on the loc al form wi ll continu e to use t he standar d national definitio n. Any cha nges from the nation al definit ion howeve r, will be stored as local ent ries that, when a bi ll is gene rated usin g this loc al form de finition, will overr ide the na tionally r eleased de finition f or these c hanged fie lds only. This way, data chang es can be made witho ut the sit e having t o take res ponsibilit y for main taining th e entire f orm. Only forms that have the same BASE FILE NUMBE R and FORM TYPE can be copied. Any local changes m ade must b e tracked carefully as the sit e will be responsibl e for main taining an y locally modified f ields shou ld future changes be come neces sary. Sinc e unmodifi ed fields still rely on the na tional for m for thei r definiti on, any ch anges made via a nat ionally re leased upd ate to unm odified fi elds on th e form wil l be autom atically i ncorporate d into a l ocal form definition associate d with a n ational fo rm definit ion. | |
8024 | The WANT T O COPY ALL FIELDS FR OM AN EXIS TING FORM? field all ows a stra ight copy, where the field def initions f or a selec ted form a re all cop ied into n ew entries referenci ng the new local for m. Any loc al form cr eated via an "unasso ciated" co py will ha ve NO link back to t he nationa l form onc e the copy is comple ted. | |
8025 | Since no c hanges to nationally released software w ill be mad e to these local ent ries, you are free t o modify t he new for m definiti on in what ever way y ou need to and are r esponsible for any a nd all cha nges that are made o r will nee d to be ma de in the future. | |
8026 | Form View/ Edit | |
8027 | Allows you to view a nd edit a selected f orm. This action bri ngs you to the Detai led View o f Local Fo rm Screen. See below . | |
8028 | Add/Edit L ocal Data Elements | |
8029 | Allows you to define local dat a elements that are not suppor ted nation ally but a re needed to be incl uded on on e or more local bill ing form(s ). Nationa lly releas ed data el ement defi nitions CA NNOT be mo dified via this acti on. | |
8030 | View Data Element | |
8031 | Allows you to view t he descrip tion, extr act code, and other attributes of any da ta element defined a t the site , both nat ional and local. | |
8032 | Test Form | |
8033 | Allows you to test t he output of a selec ted form. | |
8034 | Detailed V iew of Loc al Form Sc reen | |
8035 | Edit Local Form Demo graphics | |
8036 | Allows you to edit t he name, d escription , pre and post proce ssing logi c and the extract an d output l ogic for l ocal forms . | |
8037 | Delete A L ocal Form | |
8038 | Allows you to delete a locally defined f orm. When the form i s deleted, all form fields and form fiel d definiti ons (not d ata elemen t definiti ons) assoc iated with that form are also deleted. | |
8039 | Edit Form Fields | |
8040 | Allows you to edit t he field c ontent def ined for a local for m associat ed with a national f orm that h as local " override" field cont ent defini tions; or to edit an y local, u nassociate d form fie ld's form position d ata and fi eld conten t definiti ons. This action bri ngs you to the Bill Form Field s Screen. See below. | |
8041 | Switch For m | |
8042 | Allows you to switch between f orms witho ut exiting the optio n. | |
8043 | Bill Form Fields Scr een | |
8044 | Add Local/ Override F ield | |
8045 | Allows you to add fi elds to a local unas sociated f orm and al lows the a ddition of ‘override ’ fields f or local m odificatio ns to any form. | |
8046 | Delete Loc al Form Fi eld | |
8047 | Allows you to delete the 'over ride' form field con tent defin itions for a local f orm associ ated with a national form or t o delete a ny fields defined fo r an unass ociated lo cal form t hat do not have over ride field s defined for them ( You must d elete any override f ields firs t). | |
8048 | Edit Local Form Fiel d | |
8049 | Allows you to edit t he field c ontent for a local f orm such a s page or sequence, first line number, s tarting co lumn or pi ece, maxim um number of lines, short desc ription, e tc. | |
8050 | Local Fiel d Content Definition | |
8051 | Allows you to edit t he "overri de" form f ield conte nt definit ions for a local for m associat ed with a national f orm, or to edit the form field content o f any fiel d on an un associated local for m. | |
8052 | Add/Edit L ocal Data Elements | |
8053 | Allows you to define local dat a elements that are not suppor ted nation ally but a re needed to be incl uded on on e or more local bill ing form(s ). Nationa lly releas ed data el ement defi nitions CA NNOT be mo dified via this acti on. | |
8054 | View Data Element | |
8055 | Allows you to view t he descrip tion, extr act code, and other attributes of any da ta element defined a t the site , both nat ional and local. | |
8056 | View Form Fields | |
8057 | Allows you to view t he composi tion of a local ‘ove rride’ or national f orm field for a loca l form. Th is include s both the form fiel d's form p osition da ta as well as the as sociated f orm field content de finition. | |
8058 | Example 1 - CUSTOM B ILL PRINT | |
8059 | Your site needs to p rint the t otal charg e, not uni t charge, in Block 2 4F on the HCFA 1500. | |
8060 | 1. | |
8061 | If there i s not curr ently a lo cal form d efined for the HCFA 1500, use the ADD A LOCAL FORM option to add a for m that wil l become t he local H CFA 1500. Base file will be 39 9, print f orm type w ill be P ( printed). Respond Ye s to assoc iate with national f orm questi on and cho ose the HC FA 1500 as the paren t form. Gi ve it a fo rm length of 66 and enter a sh ort descri ption like Local 150 0. Since t his form i s now "ass ociated" w ith the na tional HCF A 1500 for m, all of the fields will defa ult to the definitio n provided by the na tional HCF A 1500 for m when the bills are printed. The only t ime you'll want to c hange the pre and po st process ing, edit or output routines i s if you d o not want the natio nal defaul ts, but wa nt to writ e your own . Be very careful if you chang e any of t hese execu table fiel ds. | |
8062 | 2. | |
8063 | Select Vie w Form and , if promp ted for se lection, e nter the l ocal HCFA 1500 form sequence # from the list displ ayed. This will disp lay the ge neral char acteristic s of this form. | |
8064 | 3. | |
8065 | Choose the Edit Form Fields ac tion (FF). This will display a list of t he form fi elds that make up th is form. | |
8066 | 4. | |
8067 | Press retu rn for NEX T SCREEN u ntil the f ield CHARG ES (BX-24F ) appears in the fie ld list. | |
8068 | 5. | |
8069 | The charge field is a data ele ment that is not abl e to be ex tracted on its own. Its value depends on the "line " within b ox 24 that it will p rint on be cause it d epends on revenue, c ode, date, etc. This kind of d ata elemen t is consi dered part of a "gro up" elemen t and that group ele ment must be extract ed before any of its group mem ber data e lement can be output . The grou p data ele ment for c harges is N-HCFA 150 0 SERVICES (PRINT). If you use the View Data Eleme nt option and enter this group element n ame, you'l l see it s ets up the array, IB XSAVE("BOX 24",line # ) for late r use by i ts group m ember elem ents. You will also see that t he 9th "^" piece of this array is the # of units. This is a calculate only field (no outpu t from it when it is processed ). | |
8070 | 6. | |
8071 | Select the Add Local /Override Field opti on and ent er the seq uence numb er of the CHARGES fi eld. | |
8072 | 7. | |
8073 | Respond Ye s to OK? p rompt and to the cop y over fro m the orig inal field question. This is a lmost alwa ys a good idea so yo u can see what the o riginal fo rmat of th e field wa s. | |
8074 | 8. | |
8075 | Leave the data eleme nt field t he same an d do not e nter an in surance co mpany or b ill type u nless you want to re strict thi s change t o a specif ic insuran ce company and/or bi ll type. | |
8076 | 9. | |
8077 | Now change the forma t field to multiply the value of charges (in varia ble IBXDAT A(line #)) by the va lue of the units on the corres ponding li ne # (in t he 9th "^" piece of IBXSAVE("B OX24",line #)). | |
8078 | Replace $J (IBXDATA(Z ) | |
8079 | With $J(IB XDATA(Z)*$ P($G(IBXSA VE("BOX24" ,Z)),"^",9 ) | |
8080 | 10. | |
8081 | Now modify the forma t descript ion to ref lect the c hange you just made, and the o verride of the field is comple te. | |
8082 | 11. | |
8083 | To make th e formatte r print th e local co py of the HCFA 1500, use the I RM menu op tion, Sele ct Default Device Fo r Forms, a nd enter t he name of your loca l form as the value of the PRI NT FORM fi eld. The n ext time a HCFA 1500 bill prin ts, it wil l print th e charges as total c harges, no t a unit c harge. | |
8084 | Example 2 - LOCAL SC REEN 9 | |
8085 | Your site needs to p rint the p rovider's phone numb er in Form Locator 1 1 on the U B-92 for i npatient b ills for i nsurance c ompany Blu e Cross of East Wher ever and t his data i s not curr ently capt ured in VI STA. | |
8086 | There are several st eps involv ed in this task. Fir st, you mu st set up a local fi eld for th is data in the bill/ claims fil e and defi ne a local data elem ent in the forms dat a element file, then create or modify a local Scre en 9 to en able the c lerks to i nput this data for t his insura nce compan y's bills. You then need to ed it your lo cal UB-92 print form to includ e this dat a in Form Locator 11 for this insurance company an d attach t his local Screen 9 t o the nati onal UB-92 bill form . Only the steps for the creat ion of loc al Screen 9 are incl uded here. | |
8087 | 1. | |
8088 | Use FileMa n to add a local for m field, n umbered at least 100 00 and sto red on a n umeric nod e of at le ast 10000 for this n ew data el ement. The se are the only kind of fields that can be INPUT o n a local Screen 9 ( any field can be dis played). | |
8089 | 2. | |
8090 | Using the output for matter, se lect the A dd/Edit Lo cal Data E lements ac tion. Ente r a name f or this ne w data ele ment. Only national fields can start wit h N-, so a ny other n ame is val id. Set th e base fil e to 399 a nd the typ e of eleme nt to "F" (FileMan). Type the name that you gave t he local f ield in st ep 1 as th e FileMan field refe rence. Mak e sure you type it c orrectly a s no edit checks are made on t he field a t this poi nt. For Fi leMan retu rn format, use "I" i f you want the "raw" data retu rned or "E " if you w ant FileMa n to retur n it in di splay form at. Then e nter a des cription o f the fiel d so you c an identif y it the n ext time y ou need to see the l ist of loc al data el ements. | |
8091 | 3. | |
8092 | Again usin g the outp ut formatt er, if the re is not currently a local fo rm defined for local Screen 9 for the na tional UB- 92 form, u se the ADD A LOCAL F ORM option to add th is form. B ase file w ill be 399 , print fo rm type wi ll be S (s creen). Re spond No t o associat e with nat ional form question and to the copy fiel ds form an other form question. Enter a s hort descr iption. Fo r now, do not put an y code in the form p re and pos t processi ng fields. Code can be written to do edi ts for the data on t he screen that will prevent it from bein g authoriz ed unless the edits are passed (post-pro cessing). The pre-pr ocessing i s used to set up any variables that may be needed to process this scre en. The pr e-processi ng is exec uted befor e the scre en is disp layed, the post-proc essing tak es place a fter the s tandard au thorize ed its are ex ecuted upo n leaving the bill. | |
8093 | 4. | |
8094 | Select Vie w Form (VF ) and, if prompted f or selecti on, enter the local UB-92 scre en form se quence #. This will display th e general characteri stics of t his form. | |
8095 | 5. | |
8096 | Choose the Edit Form Fields ac tion (FF). This will display a list of t he form fi elds that make up th is form or , if a new form, wil l display "No fields currently defined f or this fo rm". | |
8097 | 6. | |
8098 | Choose Add Local/Ove rride Fiel d action ( AF). If th ere are an y fields a lready def ined for t his screen , there wi ll be a pr ompt to al low you to override an existin g field. R espond No if this qu estion is asked. Res pond 1 for page/seq then enter the numbe r of the l ine on the screen wh ere you wa nt to prom pt for thi s field to appear an d the colu mn the pro mpt should start in. Skip max # of lines since thi s data ele ment can h ave only o ne value p er bill. E nter a len gth for th e field an d it shoul d be long enough to hold the d ata and it s prompt, if one is desired. L eave pad a s none, an d edit sta tus as edi table. Giv e it an ed it group n umber that is differ ent from a ny other g roup that may alread y be on th e screen. For this d ata elemen t, assume the field will be ou tput exact ly as it i s stored, so no form at code is needed. | |
8099 | 7. | |
8100 | Now follow steps 1-3 in the fi rst exampl e, but use the UB-92 national form where ver it say s to use t he HCFA 15 00. | |
8101 | 8. | |
8102 | Press retu rn for NEX T SCREEN u ntil the f ield FORM LOCATOR 11 (FL-11/1) appears i n the fiel d display area. | |
8103 | 9. | |
8104 | Select the Add Local /Override Field acti on and ent er the seq uence numb er of the FORM LOCAT OR 11 (FL- 11/1) fiel d. | |
8105 | 10. | |
8106 | Respond Ye s to OK? p rompt and No to the copy over from the o riginal fi eld questi on. This i s OK in th is case be cause the new data e lement is a single-v alued fiel d that has absolutel y nothing to do with the field it is ove rriding. | |
8107 | 11. | |
8108 | Enter the name of yo ur local d ata elemen t for the provider p hone numbe r in the d ata elemen t field. E nter the B LUE CROSS of EAST WH EREVER ins urance com pany name at the ins urance com pany promp t. Enter b ill type a s inpatien t to restr ict this c hange to a specific bill type for this o ne insuran ce company . There is no need t o enter Fo rmat code or descrip tion as we 're assumi ng the dat a is displ ayed the s ame way it is stored in the da tabase. If you want it display ed with da shes, but store just the numer ics, you c an reforma t it using M code he re. Make s ure there is a FileM an input t ransform o n the data field to strip out the dashes before it stores it . This wil l now be t he overrid e field ou tput for i npatient b ills for t he BL CR o f EAST WHE REVER insu rance comp any's form locator 1 1. | |
8109 | 12. | |
8110 | To make th e formatte r print th e local co py of the UB-92 and to associa te this lo cal Screen 9 with th e UB-92 fo rm type, u se the IRM menu opti on, Select Default D evice For Forms, and enter the name of y our local form as th e value of the PRINT FORM fiel d and the name of yo ur local U B-92 Scree n 9 as the local for m you just created/e dited. | |
8111 | 13. | |
8112 | The next t ime a UB-9 2 bill is entered/ed ited whose insurance company i s BL CROSS of EAST W HEREVER, t here will be a Scree n 9 availa ble to all ow entry o f the prov ider phone #. This f ield will also print on the UB -92 as the first lin e in Form Locator 11 when the bill is pr inted. | |
8113 | Purge Menu | |
8114 | Purge Upda te File | |
8115 | The XUMGR security k ey is requ ired to ac cess this option. | |
8116 | The Purge Update Fil e option i s used to delete all CPT entri es in the temporary file, UPDA TE BILLABL E AMBULATO RY SURGICA L CODE (#3 50.41) tha t have bee n successf ully trans ferred to the perman ent file, BILLABLE A MBULATORY SURGICAL C ODE (#350. 4). Upon c ompletion, a total n umber of e ntries del eted is pr ovided. | |
8117 | If the UPD ATE BILLAB LE AMBULAT ORY SURGIC AL CODE fi le is not purged, th e next tim e you tran sfer the f ile throug h the Run Amb. Surg. Update op tion, all of the ent ries that were previ ously tran sferred su ccessfully will show as errors under "Co des alread y have ent ries for g iven effec tive date" and "Code s unable t o transfer ". | |
8118 | Archive Bi lling Data | |
8119 | The XUMGR security k ey and an electronic signature code are required t o complete the archi ve process . | |
8120 | This optio n is used to archive data cont ained in s earch temp lates. Sea rch templa tes are cr eated from the INTEG RATED BILL ING ACTION file (#35 0) (pharma cy copayme nt transac tions only ), the CAT EGORY C BI LLING CLOC K file (#3 51), and/o r the BILL /CLAIMS fi le (#399) using the Find Billi ng Data to Archive o ption. You may selec t which of the files you wish to archive . | |
8121 | It is reco mmended th at you arc hive the e ntries to paper (pri nt to a de vice) as t here is cu rrently no functiona lity to re trieve or restore ar chived dat a. | |
8122 | The archiv e process is automat ically que ued. All d ata elemen ts in the file for e ach entry in the sea rch templa te are arc hived. | |
8123 | You will b e notified of the re sults via electronic mail. The ARCHIVE/P URGE LOG f ile (#350. 6) is upda ted when t he purge i s complete d. The log # provide d in the m ail messag e may be u sed for in quiries to this file . | |
8124 | Sample Mes sage | |
8125 | Subj: INTE GRATED BIL LING ARCHI VING OF BI LLING DATA [#109348 ] 24 Jun 9 2 15:32 8 Lines | |
8126 | From: INTE GRATED BIL LING PACKA GE in 'IN ' basket. Page 1 ** NEW** | |
8127 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------ | |
8128 | The subjec t job has yielded th e followin g results: | |
8129 | Arc hive Archi ve # Records | |
8130 | File Log # Begin D ate/Time End Date /Time Archived | |
8131 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
8132 | CATEGORY C BILLING C LOCK 12 0 06/24/9 2@15:29:26 06/24/92 @15:51:07 235 | |
8133 | BILL/CLAIM S 12 1 06/24/9 2@15:51:10 06/24/92 @16:32:39 463 | |
8134 | Select MES SAGE Actio n: IGNORE (in IN bas ket)// | |
8135 | Sample Out puts | |
8136 | Archived C ATEGORY C BILLING CL OCK JUN 24, 1 992@15:29: 28 Page: 1 | |
8137 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
8138 | REFERENCE NUMBER: 50 045 | |
8139 | PATIENT: I Bpatient,o ne | |
8140 | CLOCK BE GIN DATE: JAN 11, 19 86 | |
8141 | STATUS: CL OSED | |
8142 | 1ST 90 D AY INPATIE NT AMOUNT: 1738.00 | |
8143 | NUMBER INP ATIENT DAY S: 2 | |
8144 | CLOCK EN D DATE: JA N 10, 1987 | |
8145 | REFERENCE NUMBER: 50 178 | |
8146 | PATIENT: I Bpatient,t wo | |
8147 | CLOCK BE GIN DATE: MAR 16, 19 89 | |
8148 | STATUS: CA NCELLED | |
8149 | 1ST 90 D AY INPATIE NT AMOUNT: 754.00 | |
8150 | NUMBER INP ATIENT DAY S: 1 | |
8151 | CLOCK EN D DATE: MA R 17, 1989 | |
8152 | USER ADDIN G ENTRY: J OHN | |
8153 | DATE ENT RY ADDED: MAR 19, 19 89 | |
8154 | Archived B ILL/CLAIMS JUN 24, 1 992@15:30: 30 Page: 1 | |
8155 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
8156 | ACCOUNTS R ECEIVABLE NUMBER: 50 0-K20987 | |
8157 | BILL NUMBE R: K20987 | |
8158 | PATIENT NA ME: IBpati ent,one | |
8159 | EVENT DATE : NOV 3, 1988 | |
8160 | LOCATION O F CARE: HO SPITAL (IN CLUDES CLI NIC) - INP T. OR OPT. | |
8161 | BILL CLASS IFICATION: OUTPATIEN T | |
8162 | TIMEFRAME OF BILL: A DMIT THRU DISCHARGE CLAIM | |
8163 | RATE TYPE: MEANS TES T/CAT. C | |
8164 | WHO'S RESP ONSIBLE FO R BILL?: P ATIENT | |
8165 | STATUS: PR INTED | |
8166 | STATUS DAT E: JAN 30, 1990 | |
8167 | PRIMARY BI LL: K20987 | |
8168 | SC AT TIME OF CARE: YES | |
8169 | FORM TYPE: UB-82 | |
8170 | MAILING AD DRESS NAME : ONE IBPA TIENT | |
8171 | MAILING AD DRESS STRE ET: 123 MA IN STREET | |
8172 | MAILING AD DRESS CITY : ALBANY | |
8173 | MAILING AD DRESS STAT E: NEW YOR K | |
8174 | MAILING AD DRESS ZIP CODE: 1220 8 | |
8175 | NUMBER: 50 0 | |
8176 | REVENUE CO DE: 500 | |
8177 | CHARGES: 1 27.00 | |
8178 | UNITS OF S ERVICE: 1 | |
8179 | TOTAL: 127 .00 | |
8180 | BEDSECTION : OUTPATIE NT VISIT | |
8181 | DATE ENTER ED: NOV 3 , 1988 | |
8182 | ENTERED/ED ITED BY: R ICHARD | |
8183 | INITIAL RE VIEW: YES | |
8184 | INITIAL RE VIEW DATE: NOV 3, 1 988 | |
8185 | INITIAL RE VIEWER: RI CHARD | |
8186 | SECONDARY REVIEW: YE S | |
8187 | SECONDARY REVIEW DAT E: NOV 3, 1988 | |
8188 | SECONDARY REVIEWER: RICHARD | |
8189 | AUTHORIZE BILL GENER ATION?: YE S | |
8190 | AUTHORIZAT ION DATE: NOV 3, 19 88 | |
8191 | AUTHORIZER : RICHARD | |
8192 | DATE FIRST PRINTED: NOV 3, 19 88 | |
8193 | FIRST PRIN TED BY: RI CHARD | |
8194 | DATE LAST PRINTED: N OV 3, 198 8 | |
8195 | LAST PRINT ED BY: RIC HARD | |
8196 | STATEMENT COVERS FRO M: NOV 3, 1988 | |
8197 | STATEMENT COVERS TO: NOV 3, 1 988 | |
8198 | IS THIS A SENSITIVE RECORD?: N O | |
8199 | BC/BS PROV IDER #: 00 0111222 | |
8200 | TOTAL CHAR GES: 127.0 0 | |
8201 | FISCAL YEA R 1: 89 | |
8202 | FY 1 CHARG ES: 127.00 | |
8203 | Archive/Pu rge Log In quiry | |
8204 | The XUMGR security k ey is requ ired to ac cess this option. | |
8205 | This optio n is used to provide a full in quiry of a ny entry i n the IB A RCHIVE/PUR GE LOG fil e (#350.6) . Once you enter the log #, al l fields i n the file for the s elected en try will b e displaye d. | |
8206 | This outpu t may be u sed to det ermine the status of a search template, whether ar chiving or purging h as been co mpleted, a nd who com pleted the search an d/or archi ve/purge. The number of record s, log sta tus, initi ator, and begin and end time f or each of the three stages of the proce ss (if app licable) a re provide d. The num ber of rec ords found , archived , or purge d will dif fer if rec ords are d eleted fro m the sear ch templat e between processing steps. | |
8207 | Sample Out put | |
8208 | LOG #: 121 BILL/C LAIMS JUN 24 , 1992@17: 38:16 | |
8209 | ========== ========== ========== ========== ========== ========== ========== ======== | |
8210 | S earch Temp late : IB ARCHIVE/PU RGE #121 | |
8211 | # Records Pu rged : 33 | |
8212 | Log St atus : CLO SED | |
8213 | Search B egin Date/ Time : JUN 24, 1992@ 14:51:38 | |
8214 | Search End Date/ Time : JUN 24, 1992@ 15:24:08 | |
8215 | Se arch Initi ator : EMP LOYEE | |
8216 | Archive B egin Date/ Time : JUN 24, 1992@ 15:40:10 | |
8217 | Archive End Date/ Time : JUN 24, 1992@ 16:15:39 | |
8218 | Arc hive Initi ator : EMP LOYEE | |
8219 | Purge B egin Date/ Time : JUN 24, 1992@ 16:32:47 | |
8220 | Purge End Date/ Time : JUN 24, 1992@ 17:10:05 | |
8221 | P urge Initi ator : EMP LOYEE | |
8222 | Delete Ent ry from Se arch Templ ate | |
8223 | Once an en try meets the search criteria to be arch ived and s ubsequentl y purged a nd has bee n included in a sear ch templat e, this op tion may b e used to remove the entry fro m the temp late and p revent it from being purged. T his option might be used for e ntries tha t meet the search cr iteria but because o f unusual circumstan ces must b e maintain ed on-line . | |
8224 | If more th an one sea rch templa te exists, they will be displa yed for se lection. O nce select ed, all re cords in t hat templa te will be displayed . You will then be a llowed to choose whi ch records to delete from the template. | |
8225 | Find Billi ng Data to Archive | |
8226 | The Purge Menu and t his option are locke d with the XUMGR sec urity key. | |
8227 | This optio n is used to identif y records that meet the criter ia to be a rchived an d purged f rom the IN TEGRATED B ILLING ACT ION file ( #350), the CATEGORY C BILLING CLOCK file (#351), a nd the BIL L/CLAIMS f ile (#399) . Entries which are selected t o be archi ved and su bsequently purged ar e placed i n a search (sort) te mplate in the SORT T EMPLATE fi le (#.401) . These en tries may be viewed/ printed th rough the List Searc h Template Entries o ption. | |
8228 | You may ch oose which of the th ree files to include in the se arch and s pecify a d ifferent a rchive/pur ge time fr ame for ea ch file; h owever, a minimum of the curre nt plus on e previous fiscal ye ar must be maintaine d on-line. In cases where inte rim claims exist, th ey may onl y be archi ved/purged if the fi nal claim can be arc hived/purg ed. | |
8229 | The follow ing criter ia must be met in or der for th e prescrip tion, cloc k, or bill to be inc luded. | |
8230 | INTEGRATED BILLING A CTION file (pharmacy copay act ions) | |
8231 | The prescr iption whi ch caused the action to be cre ated must have been purged fro m the phar macy datab ase before the actio n may be a rchived. I n addition , the bill must be c losed in A ccounts Re ceivable. The date t he bill wa s closed i s the date used to d etermine w hether it will be in cluded. | |
8232 | BILLING CL OCK file | |
8233 | Only clock s with a s tatus of C LOSED or C ANCELLED a nd a clock end date prior to t he selecte d time fra me are inc luded. | |
8234 | BILL/CLAIM S file | |
8235 | The bill m ust be clo sed in Acc ounts Rece ivable. Th e date the bill was closed is used to de termine wh ether it w ill be inc luded. | |
8236 | The search is automa tically qu eued and y ou are not ified of t he results via elect ronic mail . An entry is made i n the ARCH IVE/PURGE LOG file ( #350.6) ea ch time a search tem plate is c reated. Th e log # pr ovided in the mail m essage may be used f or inquiri es to this file. | |
8237 | Sample Mes sage | |
8238 | Subj: INTE GRATED BIL LING SEARC H OF BILLI NG DATA [ #114481] 1 6 Dec 93 1 4:41 | |
8239 | 8 Lines | |
8240 | From: INTE GRATED BIL LING PACKA GE in 'IN ' basket. Page 1 * *NEW** | |
8241 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
8242 | The subjec t job has yielded th e followin g results: | |
8243 | Sea rch Searc h # Records | |
8244 | File Log # Begin D ate/Time End Date /Time Found | |
8245 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
8246 | CATEGORY C BILLING C LOCK 15 4 12/16/9 3@14:40:50 12/16/93 @14:40:54 82 | |
8247 | BILL/CLAIM S 15 5 12/16/9 3@14:40:55 12/16/93 @14:40:58 1 | |
8248 | Select MES SAGE Actio n: IGNORE (in IN bas ket)// | |
8249 | List Archi ve/Purge L og Entries | |
8250 | The XUMGR security k ey is requ ired to ac cess this option. | |
8251 | This optio n is used to list al l log entr ies in the IB ARCHIV E/PURGE LO G file (#3 50.6). Ent ries are l isted in t he order i n which th ey were ad ded to the file. A n ew entry i s filed ea ch time a new search template is created through t he Find Bi lling Data to Archiv e option. The log nu mber, arch ive file, date creat ed, initia tor, and s tatus is p rovided fo r each ent ry. | |
8252 | For a more detailed display on specific entries, p lease use the Archiv e/Purge Lo g Inquiry option. | |
8253 | Sample Out put | |
8254 | INTEGRATED BILLING A RCHIVE/PUR GE LOG ENT RIES JUN 25,1992 07:57 P AGE 1 | |
8255 | DATE | |
8256 | LOG# ARCH IVE FILE CREATED INITIA TOR ST ATUS | |
8257 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
8258 | 1 INTE GRATED BIL LING ACTIO N 05/01/9 2 IBpati ent,one CL OSED | |
8259 | 2 CATE GORY C BIL LING CLOCK 05/01/9 2 IBpati ent,two CA NCELLED | |
8260 | 3 CATE GORY C BIL LING CLOCK 05/01/9 2 IBpati ent,three CL OSED | |
8261 | 4 BILL /CLAIMS 05/01/9 2 IBpati ent,four CL OSED | |
8262 | 5 INTE GRATED BIL LING ACTIO N 06/01/9 2 IBpati ent,five CL OSED | |
8263 | 6 CATE GORY C BIL LING CLOCK 06/01/9 2 IBpati ent,six CL OSED | |
8264 | 7 BILL /CLAIMS 06/01/9 2 IBpati ent,seven CL OSED | |
8265 | 8 INTE GRATED BIL LING ACTIO N 07/02/9 2 IBpati ent,eight CL OSED | |
8266 | 9 CATE GORY C BIL LING CLOCK 07/02/9 2 IBpati ent,nine CAN CELLED | |
8267 | 10 BILL /CLAIMS 07/02/9 2 IBpati ent, ten CL OSED | |
8268 | List Searc h Template Entries | |
8269 | A search t emplate is created i n the SORT TEMPLATE file (#.40 1) each ti me the Fin d Billing Data to Ar chive opti on is used . The List Search Te mplate Ent ries optio n is used to list al l entries in a searc h template that are scheduled to be arch ived and s ubsequentl y purged. This list may be use d to revie w the entr ies and en sure that they shoul d be inclu ded in the archive/p urge of th e file. If you have an entry t hat meets the purge criteria, but due to unusual c ircumstanc es must be maintaine d on-line, it may be deleted f rom the se arch templ ate throug h the Dele te Entry f rom Search Template option. | |
8270 | If more th an one tem plate exis ts, they w ill be lis ted for se lection. T he output may be sor ted by pat ient as we ll as an a dditional specified field. <?? > may be e ntered for a list of appropria te fields for select ion and ad ditional c ommands wh ich may be used to c ustomize y our list. The select able field s differ d epending o n the file . You will be prompt ed to ente r a range for patien t name(s) and the ad ditional f ield (if s elected). If you acc ept the de fault of F IRST, the system wil l assume y ou wish to include a ll entries . | |
8271 | The fields included in the dis play will depend on which of t he three f iles the t emplate is created f rom. The p atient nam e and stat us is disp layed for all three files. The INTEGRATE D BILLING ACTION fil e (#350) a lso displa ys a brief descripti on of the pharmacy p rescriptio n and the date it wa s added to the field . The CATE GORY C BIL LING CLOCK file (#35 1) display s the cloc k begin an d end date s. The BIL L/CLAIMS f ile (#399) displays the rate t ype and st atus date. | |
8272 | Sample Out put | |
8273 | CATEGORY C BILLING C LOCK SEARC H TEMPLATE JUN 23,1992 16:35 P AGE 1 | |
8274 | CLOCK BE GIN CLOC K END | |
8275 | PATIENT DATE STATU S DATE | |
8276 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
8277 | IBpatient, one JUN 28,1 988 CLOSE D JUN 27,1989 | |
8278 | IBpatient, two MAY 30,1 989 CANCE LLED MAY 29,1990 | |
8279 | IBpatient, three MAR 15,1 989 CLOSE D MAR 14,1990 | |
8280 | IBpatient, four SEP 1,1 988 CLOSE D AUG 31,1989 | |
8281 | IBpatient, five JAN 2,1 989 CLOSE D JAN 1,1990 | |
8282 | Purge Bill ing Data | |
8283 | This optio n is used to purge d ata from t he INTEGRA TED BILLIN G ACTION f ile (#350) (pharmacy copayment transacti ons only), the CATEG ORY C BILL ING CLOCK file (#351 ), and/or the BILL/C LAIMS file (#399). I n order fo r entries to be purg ed, they m ust first be stored in a searc h template created b y the Find Billing D ata to Arc hive optio n, and arc hived thro ugh the Ar chive Bill ing Data o ption. If there is m ore than o ne search template c reated and archived, you may s elect whic h file(s) you wish t o purge. | |
8284 | The XUMGR security k ey and an electronic signature code are required t o complete the purge process. The purge is automat ically que ued, all d ata elemen ts in the file for e ach entry in the sea rch templa te are pur ged, and t he search template i s deleted. | |
8285 | You will b e notified of the re sults via electronic mail. The ARCHIVE/P URGE LOG f ile (#350. 6) is upda ted when t he archive is comple ted. The l og # provi ded in the mail mess age may be used for inquiries to this fi le. | |
8286 | Sample Mes sage | |
8287 | Subj: INTE GRATED BIL LING PURGI NG OF BILL ING DATA [#109349] 24 Jun 92 15:41 | |
8288 | 8 Lines | |
8289 | From: INTE GRATED BIL LING PACKA GE in 'IN ' basket. Page 1 ** NEW** | |
8290 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ----- | |
8291 | The subjec t job has yielded th e followin g results: | |
8292 | Pu rge Purg e # Records | |
8293 | File Log # Begin D ate/Time End Date /Time Purged | |
8294 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------- | |
8295 | CATEGORY C BILLING C LOCK 12 0 06/24/9 2@15:35:56 06/24/92 @15:50:29 235 | |
8296 | BILL/CLAIM S 12 1 06/24/9 2@15:50:47 06/24/92 @16:41:05 463 | |
8297 | Select MES SAGE Actio n: IGNORE (in IN bas ket)// | |
8298 | Charge Mas ter IRM Me nu | |
8299 | Load Host File Into Charge Mas ter | |
8300 | This optio n allows n ew rates a nd charges to be add ed to the Charge Mas ter form h ost files. This is o nly availa ble for sp ecific rat es and cha rges. The Host file must be in a predefi ned format to be rea d correctl y. Followi ng are the available choices. | |
8301 | Load CMAC into XTMP - Upload t he CMAC fr om a host file. | |
8302 | Load AWP i nto XTMP - Upload Av erage Whol esale Pric e list fro m a host f ile. | |
8303 | Assign Cha rge Set - Assign cha rges loade d into XTM P to Charg e Sets. | |
8304 | Check Data Validity - Check fi les waitin g to be lo aded into the Charge Master fo r data val idity. | |
8305 | Load into Charge Mas ter - Chec k files wa iting to b e loaded i nto the Ch arge Maste r for data validity, and uploa d them. | |
8306 | Delete XTM P files - Delete fil es in XTMP . | |
8307 | Rate Sched ule Adjust ment Enter /Edit | |
8308 | This optio n allows t he enter/e dit of the Rate Sche dule Adjus tment fiel d (#363.10 ). This fi eld causes all charg es for a p articular schedule t o be adjus ted by a s ite define d amount. It require s M-code t hat is exe cuted to p rovide the adjusted amounts an d; therefo re, requir es program mer access (DUZ(0)=" @"). | |
8309 | This Adjus tment will have an i mmediate e ffect on t he charges of the Ra te Schedul e. The use r can conf irm the ad justment w ith a Yes response, deny the a djustment with a No response, or enter ‘ ^’ to exit the optio n and not change the adjustmen t. | |
8310 | RC Change Facility T ype | |
8311 | This optio n allows a site to c hange the Facility D esignation of a part icular div ision for which char ges have b een instal led from P rovider Ba sed to Non -provider Based or v ice versa. This enta ils multip le steps t o inactiva te the exi sting char ges and th en calcula te and loa d the new charges. | |
8312 | Start the CHAMPUS Rx Billing E ngine | |
8313 | This optio n is used by IRM per sonnel to queue the background filer. Se veral para meters mus t be set b efore this job can b e queued t o run; if they are n ot set, th e job will not be qu eued. This job actua lly will c ause four jobs to be queued. T he first j ob is the background filer its elf. After this job has been q ueued and has succes sfully ope ned a TCP/ IP channel with the RNA system , this job will queu e off a se condary fi ler job. I f the firs t job abor ts in any way, the s econdary f iler will assume the responsib ilities of the prima ry filer a nd spawn a nother sec ondary fil er. The op tion also directly q ueues a se cond job t o open a s eparate TC P/IP chann el with th e RNA syst em to rece ive update s of the A verage Who lesale Pri celist (AW P). This u pdate is n ormally re ceived wee kly. The A WP Update job will a lso spawn a secondar y job, in a manner s imilar to the backgr ound filer , which wi ll take ov er for the primary A WP update job if tha t job abor ts. Note t hat after the AWP Up date is re ceived, me mbers of t he IB CHAM P RX START mail grou p will rec eive an al ert notify ing the us er that th e update h as complet ed. | |
8314 | Stop the C HAMPUS Rx Billing En gine | |
8315 | This optio n may be u sed to gra cefully sh ut down th e billing engine if a planned system shu tdown is s cheduled t o occur, o r if the R NA system is schedul ed to be s hutdown. T he option sets a fla g which ca lls for bo th the bac kground fi ler and AW P update e ngine to s top runnin g. The sec ondary job s for both of these jobs will shutdown a s well. | |
8316 | Edit the C IDC Insura nce Switch | |
8317 | The IB SUP ERVISOR se curity key is requir ed to acce ss this op tion. | |
8318 | This optio n is used to edit th e CIDC (Cl inical Ind icators Da ta Capture ) insuranc e switch. The CIDC s witch cont rols how C IDC will f unction in related V istA appli cations. | |
8319 | Depending on how the parameter is set, u sers who h old a PROV IDER KEY w ill, or wi ll not be prompted w ith CIDC q uestions. | |
8320 | Following are the pa rameters f or the CID C switch. The defaul t is set t o ‘0’. Cha nging this default p arameter w ill affect how other CIDC rela ted applic ations int eract with both Prov iders and Back Door users. | |
8321 | 0 = Do not prompt an y patients (CIDC pro mpts do no t appear). | |
8322 | 1 = Prompt patients only with active bil lable insu rance (CID C prompts appear; co nditional) . | |
8323 | 2 = Prompt for all p atients (C IDC prompt s appear). | |
8324 | Glossary | |
8325 | Admission Sheet | |
8326 | Worksheet commonly u sed in fro nt of inpa tient char ts with a workspace available for concur rent revie ws. | |
8327 | ALOS | |
8328 | Average Le ngth of St ay | |
8329 | AMIS | |
8330 | Automated Management Informati on System | |
8331 | Automated Biller | |
8332 | Utility wh ich establ ishes thir d party bi lls with n o user int ervention. | |
8333 | Background Filer | |
8334 | A backgrou nd job tha t accumula tes charge s and caus es adjustm ent transa ctions to a bill. | |
8335 | BASC | |
8336 | Billable A mbulatory Surgical C ode | |
8337 | Billing Cl ock | |
8338 | A 365 day period, us ually begi nning when a patient is Means Tested and is placed in Catego ry C, thro ugh which a patient' s Means Te st charges are track ed. An inp atient's M edicare de ductible c opayment e ntitles th e patient to 90 days of hospit al/nursing home care . These 90 days must fall with in the 365 day billi ng clock. | |
8339 | Category C Patient | |
8340 | Those pati ents respo nsible for making co payments a s a result of Means Test legis lation. | |
8341 | Check-off Sheet | |
8342 | A site-con figurable printed fo rm contain ing CPT co des, descr iptions, a nd dollar amounts (o ptional). Each check -off sheet may be as signed to an individ ual clinic or multip le clinics . | |
8343 | Claims Tra cking | |
8344 | Module whi ch allows for the tr acking of an episode of care, from sched uling thro ugh final dispositio n of the b ill. | |
8345 | Collateral | |
8346 | A visit by a non-vet eran patie nt whose a ppointment is | |
8347 | Visit | |
8348 | related to or associ ated with a patient' s treatmen t. | |
8349 | Continuous | |
8350 | Patients c ontinuousl y hospital ized at th e same lev el of care | |
8351 | Patient | |
8352 | since July 1, 1986. | |
8353 | Converted | |
8354 | During the conversio n, the BIL LS/CLAIMS file (#399 ) is | |
8355 | Charges | |
8356 | checked to insure th at each ou tpatient v isit has b een billed . For each visit wit hout an es tablished bill, one is establi shed and g iven a sta tus of CON VERTED. | |
8357 | Copayment | |
8358 | The charge s, require d by legis lation, th at a patie nt is bill ed for ser vices or s upplies. | |
8359 | CPT | |
8360 | Current Pr ocedural T erminology | |
8361 | A coding m ethod deve loped by t he America n Hospital Associati on to assi gn code nu mbers to p rocedures which are used for r esearch, s tatistical , and reim bursement purposes. | |
8362 | Diagnosis Code | |
8363 | A numeric or alpha-n umeric cla ssificatio n of the t erms descr ibing medi cal condit ions, caus es, or dis eases. | |
8364 | Encounter Form | |
8365 | A paper fo rm used to display d ata pertai ning to an out-patie nt visit a nd used to collect a dditional data perta ining to t hat visit. | |
8366 | Form Locat or | |
8367 | A block on the UB-82 or UB-92 bill form. | |
8368 | HCFA | |
8369 | Health Car e Finance Administra tion | |
8370 | HCFA-1500 | |
8371 | AMA approv ed health insurance claim form used for outpatient third par ty billing s. | |
8372 | HINQ | |
8373 | Hospital I nquiry | |
8374 | HPID | |
8375 | Health Pla n Identifi er | |
8376 | ICD-9 | |
8377 | Internatio nal Classi fication o f Diseases , Ninth Mo dification | |
8378 | A coding s ystem desi gned by th e World He alth Organ ization to assign co de numbers to diagno ses and pr ocedures f or statist ical, rese arch, and reimbursem ent purpos es. | |
8379 | ICD-10 | |
8380 | Internatio nal Classi fication o f Diseases , Tenth Mo dification | |
8381 | A coding s ystem desi gned by th e World He alth Organ ization to assign co de numbers to diagno ses and pr ocedures f or statist ical, rese arch, and reimbursem ent purpos es. | |
8382 | Integrated | |
8383 | The billin g record o f an event or an inc rease/decr ease in | |
8384 | Billing Ac tion | |
8385 | the charge s related to an even t. An even t is any b illable go ods or ser vices prov ided by th e VA. | |
8386 | Interqual Criteria | |
8387 | A method o f evaluati ng appropr iateness o f care. | |
8388 | Locality R ate | |
8389 | The Geogra phic Wage Index that is used t o account for wage | |
8390 | Modifier | |
8391 | difference s in diffe rent local ities when calculati ng the amb ulatory su rgery char ge. It is multiplied by the wa ge compone nt to get the final geographic wage comp onent of t he charge. | |
8392 | MCCR | |
8393 | Medical Ca re Cost Re covery - T he collect ion of mon ies by the | |
8394 | Department of Vetera ns Affairs (VA). | |
8395 | Means Test | |
8396 | A financia l report u sed to det ermine if a patient may be req uired to m ake copaym ents for c are. | |
8397 | OEID | |
8398 | Other Enti ty Identif ier | |
8399 | Principal | |
8400 | Condition, establish ed after s tudy, to b e chiefly responsibl e | |
8401 | Diagnosis | |
8402 | for the pa tient's ad mission. | |
8403 | Provider | |
8404 | A person, facility, organizati on, or sup plier whic h furnishe s health c are servic es. | |
8405 | Reimbursab le | |
8406 | Health ins urance tha t will rei mburse VA for the co st of | |
8407 | Insurance | |
8408 | medical ca re provide d to its s ubscribers . | |
8409 | Revenue Co de | |
8410 | A code on a third pa rty bill i dentifying a specifi c accommod ation, anc illary ser vice, or b illing cal culation. | |
8411 | Stop Code | |
8412 | A three-di git number correspon ding to an additiona l stop/ | |
8413 | service a patient re ceived in conjunctio n with a c linic visi t. Stop co de entries are used so that me dical faci lities may receive c redit for the servic es rendere d during a patient v isit. | |
8414 | Third Part y Billings | |
8415 | Instances where a pa rty other than the p atient is charged. | |
8416 | UB-82 | |
8417 | AMA approv ed health insurance claim form previousl y used for third par ty billing s. | |
8418 | UB-92 | |
8419 | AMA approv ed health insurance claim form used for third part y billings . | |
8420 | Utilizatio n Review | |
8421 | Review car ried out b y allied h ealth pers onnel at p redetermin ed times d uring the hospital s tay to ass ess the ap propriaten ess of car e. | |
8422 | Wage Perce ntage | |
8423 | The percen tage of th e rate gro up unit ch arge that is the wag e componen t to be us ed in calc ulating th e HCFA cha rge for am bulatory s urgical pr ocedures. | |
8424 | Military T ime Conver sion Table | |
8425 | STANDARD | |
8426 | MILITARY | |
8427 | 12:00 MIDN IGHT | |
8428 | 2400 HOURS | |
8429 | 11:00 PM | |
8430 | 2300 HOURS | |
8431 | 10:00 PM | |
8432 | 2200 HOURS | |
8433 | 9:00 PM | |
8434 | 2100 HOURS | |
8435 | 8:00 PM | |
8436 | 2000 HOURS | |
8437 | 7:00 PM | |
8438 | 1900 HOURS | |
8439 | 6:00 PM | |
8440 | 1800 HOURS | |
8441 | 5:00 PM | |
8442 | 1700 HOURS | |
8443 | 4:00 PM | |
8444 | 1600 HOURS | |
8445 | 3:00 PM | |
8446 | 1500 HOURS | |
8447 | 2:00 PM | |
8448 | 1400 HOURS | |
8449 | 1:00 PM | |
8450 | 1300 HOURS | |
8451 | 12:00 NOON | |
8452 | 1200 HOURS | |
8453 | 11:00 AM | |
8454 | 1100 HOURS | |
8455 | 10:00 AM | |
8456 | 1000 HOURS | |
8457 | 9:00 AM | |
8458 | 0900 HOURS | |
8459 | 8:00 AM | |
8460 | 0800 HOURS | |
8461 | 7:00 AM | |
8462 | 0700 HOURS | |
8463 | 6:00 AM | |
8464 | 0600 HOURS | |
8465 | 5:00 AM | |
8466 | 0500 HOURS | |
8467 | 4:00 AM | |
8468 | 0400 HOURS | |
8469 | 3:00 AM | |
8470 | 0300 HOURS | |
8471 | 2:00 AM | |
8472 | 0200 HOURS | |
8473 | 1:00 AM | |
8474 | 0100 HOURS | |
8475 | List Manag er Appendi x | |
8476 | The List M anager is a tool tha t displays a list of items in a screen f ormat and provides t he followi ng functio nality. | |
8477 | SYMBOL 183 \f "Symbo l" \s 10 \ h | |
8478 | browse thr ough the l ist | |
8479 | SYMBOL 183 \f "Symbo l" \s 10 \ h | |
8480 | select ite ms that ne ed action | |
8481 | SYMBOL 183 \f "Symbo l" \s 10 \ h | |
8482 | take actio n against those item s | |
8483 | SYMBOL 183 \f "Symbo l" \s 10 \ h | |
8484 | select oth er List Ma nager acti ons withou t leaving the option | |
8485 | Actions(s) are enter ed by typi ng the nam e(s) or mn emonics(s) at the "S elect Acti on" prompt . Where ap plicable, multiple a ctions may be select ed with on e entry by separatin g them wit h a semico lon (;). F or example , the sing le entry " AL;CI" wou ld cause t he softwar e to advan ce through two separ ate action s (Appoint ment Lists and Check In). | |
8486 | You can al so select an action and entry number by using an e quals sign (=). | |
8487 | CI=1 | |
8488 | will proce ss entry 1 for check in | |
8489 | CI=3 4 5 | |
8490 | will proce ss entries 3, 4, 5 f or check i n | |
8491 | CI=1-3 | |
8492 | will proce ss entries 1, 2, 3 f or check i n | |
8493 | In additio n to the v arious act ions that may be ava ilable spe cific to t he option you are wo rking in, List Manag er provide s generic actions ap plicable t o any List Manager s creen. You may enter double qu estion mar ks (??) at the "Sele ct Action" prompt fo r a list o f all acti ons availa ble. On th e followin g page is a list of generic Li st Manager actions w ith a brie f descript ion. The m nemonic fo r each act ion is sho wn in brac kets [ ] f ollowing t he action name. Ente ring the m nemonic is the quick est way to select an action. | |
8494 | Action | |
8495 | Descriptio n | |
8496 | Next Scree n [+] | |
8497 | move to th e next scr een | |
8498 | Previous S creen [-] | |
8499 | move to th e previous screen | |
8500 | Up a Line [UP] | |
8501 | move up on e line | |
8502 | Down a Lin e [DN] | |
8503 | move down one line | |
8504 | Shift View to Right [>] | |
8505 | move the s creen to t he right i f the scre en width i s more tha n 80 chara cters | |
8506 | Shift View to Left [ <] | |
8507 | move the s creen to t he left if the scree n width is more than 80 charac ters | |
8508 | First Scre en [FS] | |
8509 | move to th e first sc reen | |
8510 | Last Scree n [LS] | |
8511 | move to th e last scr een | |
8512 | Go to Page [GO] | |
8513 | move to an y selected page in t he list | |
8514 | Re Display Screen (R D) | |
8515 | redisplay the curren t screen | |
8516 | Print Scre en [PS] | |
8517 | prints the header an d the port ion of the list curr ently disp layed | |
8518 | Print List [PL] | |
8519 | prints the list of e ntries cur rently dis played | |
8520 | Search Lis t [SL] | |
8521 | finds sele cted text in list of entries | |
8522 | Auto Displ ay(On/Off) [ADPL] | |
8523 | toggles th e menu of actions to be displa yed/not di splayed au tomaticall y | |
8524 | Quit [QU] | |
8525 | exits the screen | |
8526 | � When the Patient P olicy Info rmation Sc reen is ac cessed by either the Third Par ty Joint I nquiry [IB J Third Pa rty Joint Inquiry] o ption or a ny of the Claims Tra cking Edit ing option s, the pat ient polic y comments are in vi ew only mo de. User will not b e able to edit, add, or delete d comments . | |
8527 | ||
8528 | March 1994 | |
8529 | IB V. 2.0 User Manua l | |
8530 | cccxxxv | |
8531 | Revised Ju ne 2013 |
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