GLOBAL MAP DATA DICTIONARY #162.7 -- FEE BASIS UNAUTHORIZED CLAIMS FILE                                           3/24/25    PAGE 1
STORED IN ^FB583(  *** NO DATA STORED YET ***   SITE: WWW.BMIRWIN.COM   UCI: VISTA,VISTA                           (VERSION 3.5)   
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This file contains unauthorized claim information for active fee programs.  Sites have the ability to either track only complete
claims or incomplete claims, depending upon the value in the site parameter field.  A claim is considered complete once all
information is received in order to make a determination (dispostion).  
 
Per VHA Directive 10-93-142, this file definition should not be modified.  


CROSS
REFERENCED BY: AUTHORIZED FROM DATE(AA), FEE PROGRAM(AA1), DISPOSITION(AC), AUTHORIZED TO DATE(AD), FEE PROGRAM(AD1), 
               STATUS(AES), EXPIRATION DATE OF CLAIM(AES1), DATE CLAIM RECEIVED(AID), PRINT LETTER?(AL), DATE LETTER SENT(ALP), 
               MASTER CLAIM(AMC), MASTER CLAIM(AMP), MASTER CLAIM(AMS), CLAIM SUBMITTED BY(AOMS), MASTER CLAIM(AOMS1), 
               STATUS(AOMS2), STATUS(AOS), CLAIM SUBMITTED BY(AOS1), VETERAN(APF), TREATMENT FROM DATE(APF1), VETERAN(APMS), 
               MASTER CLAIM(APMS1), STATUS(APMS2), VETERAN(APS), STATUS(APS1), STATUS(AS), STATUS(ASD), 
               DATE OF CURRENT STATUS(ASD1), VENDOR(AVF), TREATMENT FROM DATE(AVF1), VENDOR(AVMS), MASTER CLAIM(AVMS1), 
               STATUS(AVMS2), VENDOR(AVS), STATUS(AVS1), DATE CLAIM RECEIVED(B), VENDOR(C), VETERAN(D)

INDEXED BY:    FPPS CLAIM ID (AFC), DATE LETTER SENT (AILT), STATUS & DISPOSITION & DATE CLAIM RECEIVED & DATE REQ INFO SENT & DATE
               VALID CLAIM RECEIVED & DATE OF DISPOSITION & REOPEN CLAIM DATE & NOTICE OF DISAGREEMENT RECV'D & STATEMENT OF THE
               CASE ISSUED & DATE SUBSTANTIVE APPEAL RECV'D & DATE APPEAL DISPOSITIONED & DATE APPEALED TO COVA & DATE COVA APPEAL
               DISPOSITIONED (AUD)


^FB583(D0,0)= (#.01) DATE CLAIM RECEIVED [1D] ^ (#.5) FEE PROGRAM [2P:161.8] ^ (#1) VENDOR [3P:161.2] ^ (#2) VETERAN [4P:2] ^ 
           ==>(#3) TREATMENT FROM DATE [5D] ^ (#4) TREATMENT TO DATE [6D] ^ (#6) PRIMARY SERVICE FACILITY [7P:4] ^ (#7) DATE 
           ==>VALID CLAIM RECEIVED [8D] ^ (#8) AMOUNT CLAIMED [9N] ^ (#9) PATIENT TYPE CODE [10S] ^ (#10) DISPOSITION 
           ==>[11P:162.91] ^ (#11) DATE OF DISPOSITION [12D] ^ (#12) AUTHORIZED FROM DATE [13D] ^ (#13) AUTHORIZED TO DATE [14D] 
           ==>^ (#14) AMOUNT APPROVED [15N] ^ (#19) PRINT LETTER? [16S] ^ (#27) ENTERED/LAST EDITED BY [17P:200] ^ (#28) DATE 
           ==>ENTERED/LAST EDITED [18D] ^ (#19.5) DATE LETTER SENT [19D] ^ (#20) MASTER CLAIM [20P:162.7] ^ (#21) REOPEN CLAIM 
           ==>DATE [21D] ^ (#22) DATE OF ORIGINAL DISPOSITION [22D] ^ (#23) CLAIM SUBMITTED BY [23V] ^ (#24) STATUS [24P:162.92] 
           ==>^ (#25) DATE OF CURRENT STATUS [25D] ^ (#26) EXPIRATION DATE OF CLAIM [26D] ^ (#30) AUTHORIZATION [27N] ^ (#31) 38 
           ==>U.S.C. 1725 [28S] ^ 
^FB583(D0,1,0)=^162.716^^  (#16) *DISPOSITON DESCRIPTION
^FB583(D0,1,D1,0)= (#.01) DISPOSITION DESCRIPTION [1W] ^ 
^FB583(D0,2,0)=^162.717^^  (#17) *REASON FOR PENDING
^FB583(D0,2,D1,0)= (#.01) REASON FOR PENDING [1W] ^ 
^FB583(D0,3,0)=^162.701D^^  (#26.5) EXTENSIONS
^FB583(D0,3,D1,0)= (#.01) EXTENSION ENTERED DATE/TIME [1D] ^ (#.02) ENTERED BY [2P:200] ^ (#.03) FOR STATUS [3P:162.92] ^ (#.04) 
                ==>EXTENSION DATE [4D] ^ 
^FB583(D0,3,D1,1)= (#.05) COMMENTS [1F] ^ 
^FB583(D0,4,0)=^162.702^^  (#10.5) DISPOSITION REMARKS
^FB583(D0,4,D1,0)= (#.01) DISPOSITION REMARKS [1W] ^ 
^FB583(D0,5)= (#32) FPPS CLAIM ID [1F] ^ 
^FB583(D0,6)= (#19.6) DATE REQ INFO SENT [1D] ^ 
^FB583(D0,A)= (#50) NOTICE OF DISAGREEMENT RECV'D [1D] ^ (#51) STATEMENT OF THE CASE ISSUED [2D] ^ (#52) DATE SUBSTANTIVE APPEAL 
           ==>RECV'D [3D] ^ (#53) DATE APPEAL DISPOSITIONED [4D] ^ (#54) DATE APPEALED TO COVA [5D] ^ (#55) DATE COVA APPEAL 
           ==>DISPOSITIONED [6D] ^ 
^FB583(D0,A1,0)=^162.703^^  (#10.6) APPEAL DISPOSITION REMARKS
^FB583(D0,A1,D1,0)= (#.01) APPEAL DISPOSITION REMARKS [1W] ^ 
^FB583(D0,A2,0)=^162.704^^  (#10.7) COVA DISPOSITION REMARKS
^FB583(D0,A2,D1,0)= (#.01) COVA DISPOSITION REMARKS [1W] ^ 
^FB583(D0,D,0)=^162.715PA^^  (#15) REASON FOR DISAPPROVAL
^FB583(D0,D,D1,0)= (#.01) REASON FOR DISAPPROVAL [1P:162.94] ^ 
^FB583(D0,DX)= (#5) DIAGNOSIS [1F] ^ (#5.1) ICD DIAGNOSIS [2P:80] ^ 
^FB583(D0,LOG1,0)=^162.792D^^  (#292) USER AUDIT
^FB583(D0,LOG1,D1,0)= (#.01) DATE/TIME EDITED [1D] ^ (#1) EDITED BY [2P:200] ^ (#2) COMMENTS [3F] ^ 
^FB583(D0,LOG2,0)=^162.793D^^  (#293) DATA AUDIT
^FB583(D0,LOG2,D1,0)= (#.01) CHANGED DATE/TIME [1D] ^ (#1) FIELD [2F] ^ (#2) OLD VALUE [3F] ^ (#3) NEW VALUE [4F] ^ (#4) CHANGED 
                   ==>BY [5P:200] ^ 


INPUT TEMPLATE(S):
^DIE(1049)= FB UNAUTHORIZED APPEAL    
^DIE(1050)= FB UNAUTHORIZED APPEAL EDIT    
^DIE(1051)= FB UNAUTHORIZED COVA APPEAL    
^DIE(1052)= FB UNAUTHORIZED DISPOSITION    
^DIE(1048)= FB UNAUTHORIZED EDIT    
^DIE(1043)= FB UNAUTHORIZED ENTER    
^DIE(1054)= FB UNAUTHORIZED LETTER UPDATE    
^DIE(1053)= FB UNAUTHORIZED PREVIOUS    
^DIE(1046)= FB UNAUTHORIZED UPDATE    

PRINT TEMPLATE(S):
^DIPT(592)= FBUC STATUS BY PATIENT    
^DIPT(593)= FBUC STATUS BY VENDOR    

SORT TEMPLATE(S):
^DIBT(303)= FBUC STATUS BY PATIENT    
^DIBT(304)= FBUC STATUS BY VENDOR    

FORM(S)/BLOCK(S):