GLOBAL MAP DATA DICTIONARY #355.33 -- INSURANCE VERIFICATION PROCESSOR FILE 3/24/25 PAGE 1
STORED IN ^IBA(355.33, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.0)
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This file contains insurance information accumulated by various sources. The data is held in this file until an authorized person
processes the information by either rejecting it or moving it to the Insurance files.
Once an entry is processed most of the data is deleted leaving a stub entry in this file which can be used for reporting and
tracking purposes.
CROSS
REFERENCED BY: DATE ENTERED(AEST), STATUS(AEST1), DATE ENTERED(AFST), DATE PROCESSED(AFST1), DATE VERIFIED(AFST2),
EFFECTIVE DATE(AI), PT. RELATIONSHIP TO INSURED(AI1), DATE ENTERED(B), PATIENT NAME(C),
INSURANCE COMPANY NAME(D), BPS RESPONSE(E)
^IBA(355.33,D0,0)= (#.01) DATE ENTERED [1D] ^ (#.02) ENTERED BY [2P:200] ^ (#.03) SOURCE OF INFORMATION [3P:355.12] ^ (#.04)
==>STATUS [4S] ^ (#.05) DATE PROCESSED [5D] ^ (#.06) PROCESSED BY [6P:200] ^ (#.07) NEW COMPANY [7S] ^ (#.08) NEW
==>GROUP/PLAN [8S] ^ (#.09) NEW POLICY [9S] ^ (#.1) DATE VERIFIED [10D] ^ (#.11) VERIFIED BY [11P:200] ^ (#.12)
==>IIV STATUS [12P:365.15] ^ (#.13) OVERRIDE FRESHNESS FLAG [13S] ^ (#.14) REMOTE LOCATION [14P:4] ^ (#.15) IIV
==>PROCESSED DATE [15D] ^ (#.16) REAL TIME VERIFICATION [16S] ^ (#.17) BPS RESPONSE [17P:9002313.03] ^ (#.18)
==>SERVICE DATE [18D] ^
^IBA(355.33,D0,20)= (#20.01) INSURANCE COMPANY NAME [1F] ^ (#20.02) PHONE NUMBER [2F] ^ (#20.03) BILLING PHONE NUMBER [3F] ^
==>(#20.04) PRECERTIFICATION PHONE NUMBER [4F] ^ (#20.05) REIMBURSE? [5S] ^
^IBA(355.33,D0,21)= (#21.01) STREET ADDRESS [LINE 1] [1F] ^ (#21.02) STREET ADDRESS [LINE 2] [2F] ^ (#21.03) STREET ADDRESS [LINE
==>3] [3F] ^ (#21.04) CITY [4F] ^ (#21.05) STATE [5P:5] ^ (#21.06) ZIP CODE [6F] ^
^IBA(355.33,D0,40)= (#40.01) IS THIS A GROUP POLICY? [1S] ^ (#40.02) *GROUP NAME [2F] ^ (#40.03) *GROUP NUMBER [3F] ^ (#40.04)
==>UTILITZATION REVIEW REQUIRED [4S] ^ (#40.05) PRECERTIFICATION REQUIRED [5S] ^ (#40.06) AMBULATORY CARE
==>CERTIFICATION [6S] ^ (#40.07) EXCLUDE PREEXISTING CONDITION [7S] ^ (#40.08) BENEFITS ASSIGNABLE [8S] ^
==>(#40.09) TYPE OF PLAN [9P:355.1] ^ (#40.1) BANKING IDENTIFICATION NUMBER [10F] ^ (#40.11) PROCESSOR CONTROL
==>NUMBER (PCN) [11F] ^
^IBA(355.33,D0,60)= (#60.01) PATIENT NAME [1P:2] ^ (#60.02) EFFECTIVE DATE [2D] ^ (#60.03) EXPIRATION DATE [3D] ^ (#60.04)
==>*SUBSCRIBER ID [4F] ^ (#60.05) WHOSE INSURANCE [5S] ^ (#60.06) PT. RELATIONSHIP TO INSURED [6S] ^ (#60.07)
==>*NAME OF INSURED [7F] ^ (#60.08) INSURED'S DOB [8D] ^ (#60.09) INSURED'S SSN [9F] ^ (#60.1) PRIMARY CARE
==>PROVIDER [10F] ^ (#60.11) PRIMARY PROVIDER PHONE [11F] ^ (#60.12) COORDINATION OF BENEFITS [12S] ^ (#60.13)
==>INSURED'S SEX [13S] ^ (#60.14) PT. RELATIONSHIP - HIPAA [14S] ^ (#60.15) PHARMACY RELATIONSHIP CODE
==>[15P:9002313.19] ^ (#60.16) PHARMACY PERSON CODE [16F] ^
^IBA(355.33,D0,61)= (#61.01) ESGHP? [1S] ^ (#61.02) SPONSORING EMPLOYER NAME [2F] ^ (#61.03) EMPLOYMENT STATUS [3S] ^ (#61.04)
==>RETIREMENT DATE [4D] ^ (#61.05) SEND BILL TO EMPLOYER [5S] ^ (#61.06) EMPLOYER CLAIMS STREET LINE 1 [6F] ^
==>(#61.07) EMPLOYER CLAIMS STREET LINE 2 [7F] ^ (#61.08) EMPLOYER CLAIMS STREET LINE 3 [8F] ^ (#61.09) EMPLOYER
==>CLAIMS CITY [9F] ^ (#61.1) EMPLOYER CLAIMS STATE [10P:5] ^ (#61.11) EMPLOYER CLAIMS ZIP CODE [11F] ^ (#61.12)
==>EMPLOYER CLAIMS PHONE NUMBER [12F] ^
^IBA(355.33,D0,62)= (#62.01) PATIENT ID [1F] ^ (#62.02) SUBSCRIBER ADDRESS LINE 1 [2F] ^ (#62.03) SUBSCRIBER ADDRESS LINE 2 [3F]
==>^ (#62.04) SUBSCRIBER ADDRESS CITY [4F] ^ (#62.05) SUBSCRIBER ADDRESS STATE [5P:5] ^ (#62.06) SUBSCRIBER
==>ADDRESS ZIP [6F] ^ (#62.07) SUBSCRIBER ADDRESS COUNTRY [7F] ^ (#62.08) SUBSCRIBER ADDRESS SUBDIVISION [8F] ^
==>(#62.09) SUBSCRIBER PHONE [9F] ^
^IBA(355.33,D0,80)= (#80.01) INQ SERVICE TYPE CODE 1 [1P:365.013] ^ (#80.02) INQ SERVICE TYPE CODE 2 [2P:365.013] ^ (#80.03) INQ
==>SERVICE TYPE CODE 3 [3P:365.013] ^ (#80.04) INQ SERVICE TYPE CODE 4 [4P:365.013] ^ (#80.05) INQ SERVICE TYPE
==>CODE 5 [5P:365.013] ^ (#80.06) INQ SERVICE TYPE CODE 6 [6P:365.013] ^ (#80.07) INQ SERVICE TYPE CODE 7
==>[7P:365.013] ^ (#80.08) INQ SERVICE TYPE CODE 8 [8P:365.013] ^ (#80.09) INQ SERVICE TYPE CODE 9 [9P:365.013]
==>^ (#80.1) INQ SERVICE TYPE CODE 10 [10P:365.013] ^ (#80.11) INQ SERVICE TYPE CODE 11 [11P:365.013] ^ (#80.12)
==>INQ SERVICE TYPE CODE 12 [12P:365.013] ^ (#80.13) INQ SERVICE TYPE CODE 13 [13P:365.013] ^ (#80.14) INQ
==>SERVICE TYPE CODE 14 [14P:365.013] ^ (#80.15) INQ SERVICE TYPE CODE 15 [15P:365.013] ^ (#80.16) INQ SERVICE
==>TYPE CODE 16 [16P:365.013] ^ (#80.17) INQ SERVICE TYPE CODE 17 [17P:365.013] ^ (#80.18) INQ SERVICE TYPE CODE
==>18 [18P:365.013] ^ (#80.19) INQ SERVICE TYPE CODE 19 [19P:365.013] ^ (#80.2) INQ SERVICE TYPE CODE 20
==>[20P:365.013] ^
^IBA(355.33,D0,90)= (#90.01) GROUP NAME [1F] ^ (#90.02) GROUP NUMBER [2F] ^ (#90.03) SUBSCRIBER ID [3F] ^
^IBA(355.33,D0,91)= (#91.01) NAME OF INSURED [1F] ^
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