GLOBAL MAP DATA DICTIONARY #162.5 -- FEE BASIS INVOICE FILE 3/24/25 PAGE 1
STORED IN ^FBAAI( *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 3.5)
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This file contains the payment data associated with the inpatient hospital programs of FEE Basis.
Per VHA Directive 10-93-142, this file definition should not be modified.
CROSS
REFERENCED BY: BATCH NUMBER(AC), CHECK NUMBER(ACK), CONTRACT(ACN), DATE FINALIZED(AD), VENDOR(AF), VETERAN(AG),
OLD BATCH NUMBER(AH), ASSOCIATED 7078/583(AJ), VETERAN(AK), VENDOR(AK1), ADJUSTMENT REASON(AL),
DATE FINALIZED(AP), NUMBER(B), VENDOR(C), VETERAN(D), DoD INVOICE NUMBER(DODI), IPAC VENDOR AGREEMENT(IPAC)
INDEXED BY: VENDOR & VETERAN & TREATMENT FROM DATE (AA), BATCH NUMBER & VETERAN (AE), FPPS CLAIM ID (AFC), VENDOR & INVOICE DATE
RECEIVED & VETERAN & SUSPEND CODE (AI)
^FBAAI(D0,0)= (#.01) NUMBER [1N] ^ (#1) INVOICE DATE RECEIVED [2D] ^ (#2) VENDOR [3P:161.2] ^ (#3) VETERAN [4P:161] ^ (#4)
==>ASSOCIATED 7078/583 [5V] ^ (#5) TREATMENT FROM DATE [6D] ^ (#6) TREATMENT TO DATE [7D] ^ (#7) AMOUNT CLAIMED [8N] ^
==>(#8) AMOUNT PAID [9N] ^ (#9) AMOUNT SUSPENDED [10N] ^ (#10) SUSPEND CODE [11P:161.27] ^ (#11) FEE PROGRAM
==>[12P:161.8] ^ (#12) PAYMENT TYPE CODE [13S] ^ (#16) VOID PAYMENT [14S] ^ (#17) SUPERVISOR WHO VOIDED [15P:200] ^
==>(#19) DATE FINALIZED [16D] ^ (#20) BATCH NUMBER [17P:161.7] ^ (#21) PURPOSE OF VISIT [18P:161.82] ^ (#22) PATIENT
==>TYPE CODE [19S] ^ (#23) PRIMARY SERVICE FACILITY [20P:4] ^ (#6.5) DISCHARGE TYPE CODE [21P:162.6] ^ (#6.6) BILLED
==>CHARGES [22N] ^ (#6.7) PAYMENT BY MEDICARE/FED AGENCY [23F] ^ (#24) DISCHARGE DRG [24P:80.2] ^ (#25) RESUBMISSION
==>[25S] ^ (#26) NVH PRICER AMOUNT [26N] ^
^FBAAI(D0,1,0)=^162.518^^ (#18) DESCRIPTION OF SUSPENSION
^FBAAI(D0,1,D1,0)= (#.01) DESCRIPTION OF SUSPENSION [1W] ^
^FBAAI(D0,2)= (#45) DATE PAID [1D] ^ (#46) VENDOR INVOICE DATE [2D] ^ (#47) PROMPT PAY TYPE [3S] ^ (#48) CHECK NUMBER [4F] ^
==>(#49) CANCELLATION DATE [5D] ^ (#50) REASON CODE [6P:162.95] ^ (#51) CANCELLATION ACTIVITY [7S] ^ (#52) DISBURSED
==>AMOUNT [8N] ^ (#53) INTEREST AMOUNT [9N] ^ (#54) COVERED DAYS [10N] ^ (#55) PATIENT CONTROL NUMBER [11F] ^ (#24.5)
==>DRG WEIGHT [12N] ^ (#61) ROUTING NUMBER [13F] ^ (#62) ACCOUNT NUMBER [14F] ^ (#63) FINANCIAL INSTITUTION [15F] ^
==>(#90) PAYMENT METHODOLOGY [16P:163.98] ^
^FBAAI(D0,3)= (#56) FPPS CLAIM ID [1F] ^ (#57) FPPS LINE ITEM [2F] ^
^FBAAI(D0,4)= (#64) ATTENDING PROV NAME [1F] ^ (#65) ATTENDING PROV NPI [2F] ^ (#66) ATTENDING PROV TAXONOMY CODE [3F] ^ (#67)
==>OPERATING PROV NAME [4F] ^ (#68) OPERATING PROV NPI [5F] ^ (#69) RENDERING PROV NAME [6F] ^ (#70) RENDERING PROV
==>NPI [7F] ^ (#71) RENDERING PROV TAXONOMY CODE [8F] ^ (#72) SERVICING PROV NAME [9F] ^ (#73) SERVICING PROV NPI
==>[10F] ^ (#74) REFERRING PROV NAME [11F] ^ (#75) REFERRING PROV NPI [12F] ^
^FBAAI(D0,5)= (#80) SERVICING FACILITY ADDRESS [1F] ^ (#81) SERVICING FACILITY CITY [2F] ^ (#82) SERVICING FACILITY STATE [3P:5]
==>^ (#83) SERVICING FACILITY ZIP [4F] ^ (#85) UNIQUE CLAIM IDENTIFIER [5F] ^ ^ (#86) DoD INVOICE NUMBER [7F] ^ (#60)
==>CONTRACT [8P:161.43] ^ (#39) ADMITTING DIAGNOSIS [9P:80] ^ (#87) IPAC VENDOR AGREEMENT [10P:161.95] ^
^FBAAI(D0,7)= (#88) AUTHORIZATION NUMBER [1F] ^ (#89) CLAIM LEVEL ALLOWED AMOUNT [2N] ^
^FBAAI(D0,8,0)=^162.558P^^ (#58) ADJUSTMENT
^FBAAI(D0,8,D1,0)= (#.01) ADJUSTMENT REASON [1P:161.91] ^ (#1) ADJUSTMENT GROUP [2P:161.92] ^ (#2) ADJUSTMENT AMOUNT [3N] ^
^FBAAI(D0,9,0)=^162.559P^^ (#59) REMITTANCE REMARK
^FBAAI(D0,9,D1,0)= (#.01) REMITTANCE REMARK [1P:161.93] ^ (#1) ADJUSTMENT [2N] ^
^FBAAI(D0,10,0)=^162.591A^^ (#91) ATTACHMENT ID
^FBAAI(D0,10,D1,0)= (#.01) ATTACHMENT ID [1F] ^ (#.02) ATTACHMENT REPORT TYPE [2P:353.3] ^
^FBAAI(D0,DX)= (#30) ICD1 [1P:80] ^ (#31) ICD2 [2P:80] ^ (#32) ICD3 [3P:80] ^ (#33) ICD4 [4P:80] ^ (#34) ICD5 [5P:80] ^ (#35)
==>ICD6 [6P:80] ^ (#35.1) ICD7 [7P:80] ^ (#35.2) ICD8 [8P:80] ^ (#35.3) ICD9 [9P:80] ^ (#35.4) ICD10 [10P:80] ^
==>(#35.5) ICD11 [11P:80] ^ (#35.6) ICD12 [12P:80] ^ (#35.7) ICD13 [13P:80] ^ (#35.8) ICD14 [14P:80] ^ (#35.9) ICD15
==>[15P:80] ^ (#36) ICD16 [16P:80] ^ (#36.1) ICD17 [17P:80] ^ (#36.2) ICD18 [18P:80] ^ (#36.3) ICD19 [19P:80] ^
==>(#36.4) ICD20 [20P:80] ^ (#36.5) ICD21 [21P:80] ^ (#36.6) ICD22 [22P:80] ^ (#36.7) ICD23 [23P:80] ^ (#36.8) ICD24
==>[24P:80] ^ (#36.9) ICD25 [25P:80] ^
^FBAAI(D0,FBREJ)= (#13) REJECT STATUS [1S] ^ (#14) REJECT REASON [2F] ^ (#15) OLD BATCH NUMBER [3P:161.7] ^ (#15.3) INTERFACE
==>REJECT [4S] ^
^FBAAI(D0,FBREJC,0)=^162.515^^ (#15.6) REJECT CODE
^FBAAI(D0,FBREJC,D1,0)= (#.01) REJECT CODE [1F] ^
^FBAAI(D0,POA)= (#30.02) POA1 [1P:161.94] ^ (#31.02) POA2 [2P:161.94] ^ (#32.02) POA3 [3P:161.94] ^ (#33.02) POA4 [4P:161.94] ^
==>(#34.02) POA5 [5P:161.94] ^ (#35.02) POA6 [6P:161.94] ^ (#35.12) POA7 [7P:161.94] ^ (#35.22) POA8 [8P:161.94] ^
==>(#35.32) POA9 [9P:161.94] ^ (#35.42) POA10 [10P:161.94] ^ (#35.52) POA11 [11P:161.94] ^ (#35.62) POA12
==>[12P:161.94] ^ (#35.72) POA13 [13P:161.94] ^ (#35.82) POA14 [14P:161.94] ^ (#35.92) POA15 [15P:161.94] ^ (#36.02)
==>POA16 [16P:161.94] ^ (#36.12) POA17 [17P:161.94] ^ (#36.22) POA18 [18P:161.94] ^ (#36.32) POA19 [19P:161.94] ^
==>(#36.42) POA20 [20P:161.94] ^ (#36.52) POA21 [21P:161.94] ^ (#36.62) POA22 [22P:161.94] ^ (#36.72) POA23
==>[23P:161.94] ^ (#36.82) POA24 [24P:161.94] ^ (#36.92) POA25 [25P:161.94] ^
^FBAAI(D0,PROC)= (#40) PROC1 [1P:80.1] ^ (#41) PROC2 [2P:80.1] ^ (#42) PROC3 [3P:80.1] ^ (#43) PROC4 [4P:80.1] ^ (#44) PROC5
==>[5P:80.1] ^ (#44.06) PROC6 [6P:80.1] ^ (#44.07) PROC7 [7P:80.1] ^ (#44.08) PROC8 [8P:80.1] ^ (#44.09) PROC9
==>[9P:80.1] ^ (#44.1) PROC10 [10P:80.1] ^ (#44.11) PROC11 [11P:80.1] ^ (#44.12) PROC12 [12P:80.1] ^ (#44.13)
==>PROC13 [13P:80.1] ^ (#44.14) PROC14 [14P:80.1] ^ (#44.15) PROC15 [15P:80.1] ^ (#44.16) PROC16 [16P:80.1] ^
==>(#44.17) PROC17 [17P:80.1] ^ (#44.18) PROC18 [18P:80.1] ^ (#44.19) PROC19 [19P:80.1] ^ (#44.2) PROC20 [20P:80.1]
==>^ (#44.21) PROC21 [21P:80.1] ^ (#44.22) PROC22 [22P:80.1] ^ (#44.23) PROC23 [23P:80.1] ^ (#44.24) PROC24
==>[24P:80.1] ^ (#44.25) PROC25 [25P:80.1] ^
^FBAAI(D0,R)= (#16.5) REASON FOR VOIDED PAYMENT [1F] ^
^FBAAI(D0,RPROV,0)=^162.579^^ (#79) LINE ITEM RENDERING PROV
^FBAAI(D0,RPROV,D1,0)= (#.01) LINE ITEM NUMBER [1N] ^ (#.02) RENDERING PROV NAME [2F] ^ (#.03) RENDERING PROV NPI [3F] ^ (#.04)
==>RENDERING PROV TAXONOMY CODE [4F] ^
INPUT TEMPLATE(S):
^DIE(1026)= FBCH EDIT PAYMENT
^DIE(1025)= FBCH ENTER PAYMENT
^DIE(1036)= FBNH EDIT PAYMENT
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):