GLOBAL MAP DATA DICTIONARY #36 -- INSURANCE COMPANY FILE 3/24/25 PAGE 1
STORED IN ^DIC(36, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.0)
-----------------------------------------------------------------------------------------------------------------------------------
This file contains the names and addresses of insurance companies as needed by the local facility. The data in this file is NOT
EDITABLE USING VA FILEMANAGER. If a new entry needs to be made or an existing entry changed the user must be assigned the
appropriate MAS or IB module option.
Per VHA Directive 10-93-142, this file definition should not be modified.
CROSS
REFERENCED BY: ALTERNATE INST PAYER ID TYPE(AB), PAYER(AC), ALTERNATE PROF PAYER ID TYPE(AD), SCHEDULED FOR DELETION(ADEL),
EDI ID NUMBER - DENTAL(AED), EDI ID NUMBER - INST(AEI), EDI ID NUMBER - PROF(AEP), HPID/OEID(AHOD), NIF ID(ANIF),
INS COMPANY LINK PARENT(APC), NAME(B), SYNONYM(C)
INDEXED BY: 277DATE EDI ID NUMBER & 277EDI ID NUMBER & 277EDI TYPE & 277EDI ID NUMBER ON FILE (AEDIX)
^DIC(36,D0,0)= (#.01) NAME [1F] ^ (#1) REIMBURSE? [2S] ^ (#2) SIGNATURE REQUIRED ON BILL? [3S] ^ ^ (#.05) INACTIVE [5S] ^ (#.06)
==>ALLOW MULTIPLE BEDSECTIONS [6S] ^ (#.07) DIFFERENT REVENUE CODES TO USE [7F] ^ (#.08) ONE OPT. VISIT ON BILL ONLY
==>[8S] ^ (#.09) AMBULATORY SURG. REV. CODE [9P:399.2] ^ (#.1) ATTENDING PHYSICIAN ID. [10F] ^ (#.11) *HOSPITAL
==>PROVIDER NUMBER [11F] ^ (#.12) FILING TIME FRAME [12F] ^ (#.13) TYPE OF COVERAGE [13P:355.2] ^ ^ (#.15)
==>PRESCRIPTION REFILL REV. CODE [15P:399.2] ^ (#.16) REPOINT PATIENTS TO [16P:36] ^ (#.17) PROFESSIONAL PROVIDER
==>NUMBER [17F] ^ (#.18) STANDARD FTF [18P:355.13] ^ (#.19) STANDARD FTF VALUE [19N] ^
^DIC(36,D0,.11)= (#.111) STREET ADDRESS [LINE 1] [1F] ^ (#.112) STREET ADDRESS [LINE 2] [2F] ^ (#.113) STREET ADDRESS [LINE 3]
==>[3F] ^ (#.114) CITY [4F] ^ (#.115) STATE [5P:5] ^ (#.116) ZIP CODE [6F] ^ (#.117) BILLING COMPANY NAME [7F] ^ ^
==>(#.119) FAX NUMBER [9F] ^
^DIC(36,D0,.12)= (#.121) CLAIMS (INPT) STREET ADDRESS 1 [1F] ^ (#.122) CLAIMS (INPT) STREET ADDRESS 2 [2F] ^ (#.123) CLAIMS
==>(INPT) STREET ADDRESS 3 [3F] ^ (#.124) CLAIMS (INPT) PROCESS CITY [4F] ^ (#.125) CLAIMS (INPT) PROCESS STATE
==>[5P:5] ^ (#.126) CLAIMS (INPT) PROCESS ZIP [6F] ^ (#.127) CLAIMS (INPT) COMPANY NAME [7P:36] ^ (#.128) ANOTHER
==>CO. PROCESS IP CLAIMS? [8S] ^ (#.129) CLAIMS (INPT) FAX [9F] ^
^DIC(36,D0,.13)= (#.131) PHONE NUMBER [1F] ^ (#.132) BILLING PHONE NUMBER [2F] ^ (#.133) PRECERTIFICATION PHONE NUMBER [3F] ^
==>(#.134) VERIFICATION PHONE NUMBER [4F] ^ (#.135) CLAIMS (INPT) PHONE NUMBER [5F] ^ (#.136) CLAIMS (OPT) PHONE
==>NUMBER [6F] ^ (#.137) APPEALS PHONE NUMBER [7F] ^ (#.138) INQUIRY PHONE NUMBER [8F] ^ (#.139) PRECERT COMPANY
==>NAME [9P:36] ^ ^ (#.1311) CLAIMS (RX) PHONE NUMBER [11F] ^ (#.1331) PRECERTIFICATION PORTAL [12F] ^
^DIC(36,D0,.14)= (#.141) APPEALS ADDRESS ST. [LINE 1] [1F] ^ (#.142) APPEALS ADDRESS ST. [LINE 2] [2F] ^ (#.143) APPEALS ADDRESS
==>ST. [LINE 3] [3F] ^ (#.144) APPEALS ADDRESS CITY [4F] ^ (#.145) APPEALS ADDRESS STATE [5P:5] ^ (#.146) APPEALS
==>ADDRESS ZIP [6F] ^ (#.147) APPEALS COMPANY NAME [7P:36] ^ (#.148) ANOTHER CO. PROCESS APPEALS? [8S] ^ (#.149)
==>APPEALS FAX [9F] ^
^DIC(36,D0,.15)= (#.151) INQUIRY ADDRESS ST. [LINE 1] [1F] ^ (#.152) INQUIRY ADDRESS ST. [LINE 2] [2F] ^ (#.153) INQUIRY ADDRESS
==>ST. [LINE 3] [3F] ^ (#.154) INQUIRY ADDRESS CITY [4F] ^ (#.155) INQUIRY ADDRESS STATE [5P:5] ^ (#.156) INQUIRY
==>ADDRESS ZIP CODE [6F] ^ (#.157) INQUIRY COMPANY NAME [7P:36] ^ (#.158) ANOTHER CO. PROCESS INQUIRIES? [8S] ^
==>(#.159) INQUIRY FAX [9F] ^
^DIC(36,D0,.16)= (#.161) CLAIMS (OPT) STREET ADDRESS 1 [1F] ^ (#.162) CLAIMS (OPT) STREET ADDRESS 2 [2F] ^ (#.163) CLAIMS (OPT)
==>STREET ADDRESS 3 [3F] ^ (#.164) CLAIMS (OPT) PROCESS CITY [4F] ^ (#.165) CLAIMS (OPT) PROCESS STATE [5P:5] ^
==>(#.166) CLAIMS (OPT) PROCESS ZIP [6F] ^ (#.167) CLAIMS (OPT) COMPANY NAME [7P:36] ^ (#.168) ANOTHER CO. PROCESS
==>OP CLAIMS? [8S] ^ (#.169) CLAIMS (OPT) FAX [9F] ^
^DIC(36,D0,.17)= ^ ^ ^ ^ ^ ^ ^ (#.178) ANOTHER CO. PROCESS PRECERTS? [8S] ^
^DIC(36,D0,.18)= (#.181) CLAIMS (RX) STREET ADDRESS 1 [1F] ^ (#.182) CLAIMS (RX) STREET ADDRESS 2 [2F] ^ (#.183) CLAIMS (RX)
==>STREET ADDRESS 3 [3F] ^ (#.184) CLAIMS (RX) CITY [4F] ^ (#.185) CLAIMS (RX) STATE [5P:5] ^ (#.186) CLAIMS (RX)
==>ZIP [6F] ^ (#.187) CLAIMS (RX) COMPANY NAME [7P:36] ^ (#.188) ANOTHER CO. PROCESS RX CLAIMS? [8S] ^ (#.189)
==>CLAIMS (RX) FAX [9F] ^
^DIC(36,D0,.19)= (#.191) CLAIMS (DENTAL) STREET ADDR 1 [1F] ^ (#.192) CLAIMS (DENTAL) STREET ADDR 2 [2F] ^ (#.193) BLANK [3F] ^
==>(#.194) CLAIMS (DENTAL) PROCESS CITY [4F] ^ (#.195) CLAIMS (DENTAL) PROCESS STATE [5P:5] ^ (#.196) CLAIMS
==>(DENTAL) PROCESS ZIP [6F] ^ (#.197) CLAIMS (DENTAL) COMPANY NAME [7P:36] ^ (#.198) ANOTHER CO. PROC DENT CLAIMS?
==>[8S] ^ (#.199) CLAIMS (DENTAL) FAX [9F] ^ ^ (#.1911) CLAIMS (DENTAL) PHONE NUMBER [11F] ^
^DIC(36,D0,3)= (#3.01) TRANSMIT ELECTRONICALLY [1S] ^ (#3.02) EDI ID NUMBER - PROF [2F] ^ (#3.03) BIN NUMBER [3F] ^ (#3.04) EDI
==>ID NUMBER - INST [4F] ^ (#3.05) LAST EXTRACT DATE FOR TEST [5D] ^ (#3.06) MAX NUMBER TEST BILLS PER DAY [6N] ^
==>(#3.07) NUMBER TEST BILLS FOR LAST DT [7N] ^ ^ (#3.09) ELECTRONIC INSURANCE TYPE [9S] ^ (#3.1) PAYER [10P:365.12]
==>^ ^ ^ (#3.13) INS COMPANY LINK TYPE [13S] ^ (#3.14) INS COMPANY LINK PARENT [14P:36] ^ (#3.15) EDI ID NUMBER -
==>DENTAL [15F] ^
^DIC(36,D0,4)= (#4.01) PERF PROV SECOND ID TYPE 1500 [1P:355.97] ^ (#4.02) PERF PROV SECOND ID TYPE UB [2P:355.97] ^ (#4.03)
==>SECONDARY ID REQUIREMENTS [3S] ^ (#4.04) REF PROV SEC ID DEF CMS-1500 [4P:355.97] ^ (#4.05) REF PROV SEC ID REQ ON
==>CLAIMS [5S] ^ (#4.06) ATT/REND ID BILL SEC ID PROF [6S] ^ (#4.07) *SEND LAB OR FAC IDS FOR VAMC [7S] ^ (#4.08)
==>ATT/REND ID BILL SEC ID INST [8S] ^ (#4.09) PERF PROV CARE UNIT PROMPT [9F] ^ (#4.1) DELETE 2006 4.1 [10P:355.97]
==>^ (#4.11) *USE VAMC AS BILL PROV ON 1500 [11S] ^ (#4.12) *USE VAMC AS BILL PROV ON UB04 [12S] ^ (#4.13) *USE BILL
==>PROV VAMC ADDRESS [13S] ^
^DIC(36,D0,5)= (#5.01) SCHEDULED FOR DELETION [1S] ^ (#5.02) REPOINT DELETED COMPANY TO [2P:36] ^
^DIC(36,D0,6)= (#6.01) EDI INST SECONDARY ID QUAL(1) [1S] ^ (#6.02) EDI INST SECONDARY ID(1) [2F] ^ (#6.03) EDI INST SECONDARY ID
==>QUAL(2) [3S] ^ (#6.04) EDI INST SECONDARY ID(2) [4F] ^ (#6.05) EDI PROF SECONDARY ID QUAL(1) [5S] ^ (#6.06) EDI
==>PROF SECONDARY ID(1) [6F] ^ (#6.07) EDI PROF SECONDARY ID QUAL(2) [7S] ^ (#6.08) EDI PROF SECONDARY ID(2) [8F] ^
==>(#6.09) PRINT SEC/TERT AUTO CLAIMS? [9S] ^ (#6.1) PRINT SEC MED CLAIMS W/O MRA? [10S] ^
^DIC(36,D0,7)= (#7.01) EDI - UMO (278) ID [1F] ^
^DIC(36,D0,8)= (#8.01) HPID/OEID [1F] ^ (#8.02) CHP/SHP [2S] ^ (#8.03) PARENT CHP (HPID) [3F] ^ (#8.04) NIF ID [4F] ^
^DIC(36,D0,10,0)=^36.03^^ (#10) SYNONYM
^DIC(36,D0,10,D1,0)= (#.01) SYNONYM [1F] ^
^DIC(36,D0,11,0)=^36.011^^ (#11) REMARKS
^DIC(36,D0,11,D1,0)= (#.01) REMARKS [1W] ^
^DIC(36,D0,13,0)=^36.013SA^^ (#13) PLAN TYPES NO BILL PRV SEC ID
^DIC(36,D0,13,D1,0)= (#.01) PLAN TYPES NO BILL PRV SEC ID [1S] ^
^DIC(36,D0,15,0)=^36.015P^^ (#15) ALTERNATE INST PAYER ID TYPE
^DIC(36,D0,15,D1,0)= (#.01) ALTERNATE INST PAYER ID TYPE [1P:355.98] ^ (#.02) ALTERNATE INST PAYER ID [2F] ^
^DIC(36,D0,16,0)=^36.016P^^ (#16) ALTERNATE PROF PAYER ID TYPE
^DIC(36,D0,16,D1,0)= (#.01) ALTERNATE PROF PAYER ID TYPE [1P:355.98] ^ (#.02) ALTERNATE PROF PAYER ID [2F] ^
^DIC(36,D0,17,0)=^36.017A^^ (#17) 277EDI ID NUMBER
^DIC(36,D0,17,D1,0)= (#.01) 277EDI ID NUMBER [1F] ^ (#.02) 277DATE EDI ID NUMBER [2D] ^ (#.03) 277EDI TYPE [3S] ^ (#.04) 277EDI
==>ID NUMBER ON FILE [4F] ^
INPUT TEMPLATE(S):
^DIE(558)= IBEDIT INS CO1
PRINT TEMPLATE(S):
^DIPT(252)= IB INACTIVE INS CO
SORT TEMPLATE(S):
^DIBT(132)= IB INACTIVE INS CO
FORM(S)/BLOCK(S):