GLOBAL MAP DATA DICTIONARY #356.2 -- INSURANCE REVIEW FILE 3/24/25 PAGE 1
STORED IN ^IBT(356.2, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.0)
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This file contains information about the MCCR/UR portion of Utilization Review and the associated contacts with Insurance Carriers.
Appropriateness of care is inferred from the approval and denial of billing days by the insurance carriers UR section.
While this information appears to be primarily administrative in nature it may contain sensitive clinical information and should be
treated with the same confidentiality as required of all clinical data.
Per VHA Directive 10-93-142, this file definition should not be modified.
CROSS
REFERENCED BY: TYPE OF CONTACT(AC), ACTION(ACT), RELATED REVIEW(AD), PATIENT(ADFN), REVIEW DATE(ADFN1), REVIEW STATUS(AE),
INSURANCE COMPANY CONTACTED(AIACT), ACTION(AIACT1), PARENT REVIEW(AP), PATIENT(APACT), ACTION(APACT1),
NEXT REVIEW DATE(APEND), TRACKING ID(APRE), AUTHORIZATION NUMBER(APRE1), REVIEW DATE(ATIDT), TRACKING ID(ATIDT1),
TRACKING ID(ATRP), TYPE OF CONTACT(ATRTP1), REVIEW DATE(B), TRACKING ID(C), PATIENT(D)
^IBT(356.2,D0,0)= (#.01) REVIEW DATE [1D] ^ (#.02) TRACKING ID [2P:356] ^ (#.03) RELATED REVIEW [3P:356.1] ^ (#.04) TYPE OF
==>CONTACT [4P:356.11] ^ (#.05) PATIENT [5P:2] ^ (#.06) PERSON CONTACTED [6F] ^ (#.07) CONTACT PHONE # [7F] ^
==>(#.08) INSURANCE COMPANY CONTACTED [8P:36] ^ (#.09) *CALL REFERENCE NUMBER [9F] ^ (#.1) APPEAL STATUS [10S] ^
==>(#.11) ACTION [11P:356.7] ^ (#.12) CARE AUTHORIZED FROM [12D] ^ (#.13) CARE AUTHORIZED TO [13D] ^ (#.14)
==>DIAGNOSIS AUTHORIZED [14P:80] ^ (#.15) DATES OF DENIAL FROM [15D] ^ (#.16) DATES OF DENIAL TO [16D] ^ (#.17)
==>METHOD OF CONTACT [17S] ^ (#.18) PARENT REVIEW [18P:356.2] ^ (#.19) REVIEW STATUS [19S] ^ (#.2) CASE PENDING
==>[20S] ^ (#.21) NO COVERAGE [21S] ^ (#.22) FOLLOW-UP WITH APPEAL [22S] ^ (#.23) TYPE OF APPEAL [23S] ^ (#.24)
==>NEXT REVIEW DATE [24D] ^ (#.25) NUMBER OF DAYS PENDING APPEAL [25N] ^ (#.26) OUTPATIENT TREATMENT [26F] ^
==>(#.27) TREATMENT AUTHORIZED [27S] ^ (#.28) *AUTHORIZATION NUMBER [28F] ^ (#.29) FINAL OUTCOME OF APPEAL [29S] ^
^IBT(356.2,D0,1)= (#1.01) DATE ENTERED [1D] ^ (#1.02) ENTERED BY [2P:200] ^ (#1.03) DATE LAST EDITED [3D] ^ (#1.04) LAST EDITED
==>BY [4P:200] ^ (#1.05) HEALTH INSURANCE POLICY [5F] ^ ^ (#1.07) DENY ENTIRE ADMISSION [7S] ^ (#1.08) AUTHORIZE
==>ENTIRE ADMISSION [8S] ^
^IBT(356.2,D0,2)= (#2.01) CALL REFERENCE NUMBER [1F] ^ (#2.02) AUTHORIZATION NUMBER [2F] ^
^IBT(356.2,D0,11,0)=^356.211^^ (#11) COMMENTS
^IBT(356.2,D0,11,D1,0)= (#.01) COMMENTS [1W] ^
^IBT(356.2,D0,12,0)=^356.212PA^^ (#12) REASONS FOR DENIAL
^IBT(356.2,D0,12,D1,0)= (#.01) REASONS FOR DENIAL [1P:356.21] ^
^IBT(356.2,D0,13,0)=^356.213SA^^ (#13) PENALTY
^IBT(356.2,D0,13,D1,0)= (#.01) PENALTY [1S] ^ (#.02) AMOUNT OF PENALTY [2N] ^
^IBT(356.2,D0,14,0)=^356.214DA^^ (#14) APPROVE ON APPEAL FROM
^IBT(356.2,D0,14,D1,0)= (#.01) APPROVE ON APPEAL FROM [1D] ^ (#.02) APPROVE ON APPEAL TO [2D] ^
INPUT TEMPLATE(S):
^DIE(549)= IBT ACTION INFO
^DIE(555)= IBT ADD APPEAL
^DIE(550)= IBT APPEAL INFO
^DIE(546)= IBT COMMENT INFO
^DIE(547)= IBT CONTACT INFO
^DIE(557)= IBT FINAL OUTCOME
^DIE(576)= IBT INS VERIFICATION
^DIE(548)= IBT INSURANCE INFO
^DIE(545)= IBT QUICK EDIT
^DIE(554)= IBT REMOVE NEXT REVIEW
^DIE(552)= IBT STATUS CHANGE
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):