GLOBAL MAP DATA DICTIONARY #365 -- IIV RESPONSE FILE 6/27/25 PAGE 1
STORED IN ^IBCN(365, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.0)
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This file holds all responses to HL7 messages generated from the IIV Transmission Queue File for Insurance Identification and
Verification. Per VHA Directive 10-93-142, this file definition should not be modified.
CROSS
REFERENCED BY: TRANSMISSION STATUS(AC), DATE/TIME CREATED(AE), BUFFER ENTRY(AF), MESSAGE CONTROL ID(B), TRACE NUMBER(C)
INDEXED BY: DATE/TIME RECEIVED & PAYER & PATIENT (AD), DATE/TIME RECEIVED & PAYER & PATIENT & INSUR RECORD IEN & EIV AUTO-UPDATE
(AUTO)
^IBCN(365,D0,0)= (#.01) MESSAGE CONTROL ID [1F] ^ (#.02) PATIENT [2P:2] ^ (#.03) PAYER [3P:365.12] ^ (#.04) BUFFER ENTRY
==>[4P:355.33] ^ (#.05) TRANSMISSION QUEUE [5P:365.1] ^ (#.06) TRANSMISSION STATUS [6P:365.14] ^ (#.07) DATE/TIME
==>RECEIVED [7D] ^ (#.08) DATE/TIME CREATED [8D] ^ (#.09) TRACE NUMBER [9F] ^ (#.1) RESPONSE TYPE [10S] ^ (#.11) DO
==>NOT PURGE [11S] ^ (#.12) INSUR RECORD IEN [12N] ^ (#.13) EIV AUTO-UPDATE [13S] ^ (#.14) REQUESTED SERVICE DATE
==>[14D] ^ (#.15) REQUESTED SERVICE TYPE CODE [15P:365.013] ^
^IBCN(365,D0,1)= (#1.01) *NAME OF INSURED [1F] ^ (#1.02) INSURED DOB [2F] ^ (#1.03) INSURED SSN [3F] ^ (#1.04) INSURED SEX [4F] ^
==>(#1.05) *SUBSCRIBER ID [5F] ^ (#1.06) *GROUP NAME [6F] ^ (#1.07) *GROUP NUMBER [7F] ^ (#1.08) WHOSE INSURANCE
==>[8S] ^ (#1.09) PT RELATIONSHIP TO INSURED [9S] ^ (#1.1) SERVICE DATE [10D] ^ (#1.11) EFFECTIVE DATE [11D] ^
==>(#1.12) EXPIRATION DATE [12D] ^ (#1.13) COORDINATION OF BENEFITS [13S] ^ (#1.14) ERROR CONDITION [14P:365.017] ^
==>(#1.15) ERROR ACTION [15P:365.018] ^ (#1.16) DATE OF DEATH [16D] ^ (#1.17) CERTIFICATION DATE [17D] ^ (#1.18)
==>MEMBER ID [18F] ^ (#1.19) PAYER UPDATED POLICY [19D] ^ (#1.2) POLICY NUMBER [20F] ^
^IBCN(365,D0,2,0)=^365.02^^ (#2) ELIGIBILITY/BENEFIT
^IBCN(365,D0,2,D1,0)= (#.01) EB NUMBER [1N] ^ (#.02) ELIGIBILITY/BENEFIT INFO [2P:365.011] ^ (#.03) COVERAGE LEVEL [3P:365.012] ^
==>(#.04) *SERVICE TYPE [4P:365.013] ^ (#.05) INSURANCE TYPE [5P:365.014] ^ (#.06) PLAN COVERAGE DESCRIPTION
==>[6F] ^ (#.07) TIME PERIOD QUALIFIER [7P:365.015] ^ (#.08) MONETARY AMOUNT [8F] ^ (#.09) PERCENT [9N] ^
==>(#.1) QUANTITY QUALIFIER [10P:365.016] ^ (#.11) QUANTITY [11F] ^ (#.12) AUTHORIZATION/CERTIFICATION
==>[12P:365.033] ^ (#.13) IN PLAN [13P:365.033] ^
^IBCN(365,D0,2,D1,1)= (#1.01) PROCEDURE CODING METHOD [1P:365.035] ^ (#1.02) PROCEDURE CODE [2F] ^ (#1.03) PROCEDURE MODIFIER 1
==>[3F] ^ (#1.04) PROCEDURE MODIFIER 2 [4F] ^ (#1.05) PROCEDURE MODIFIER 3 [5F] ^ (#1.06) PROCEDURE MODIFIER 4
==>[6F] ^
^IBCN(365,D0,2,D1,2,0)=^365.22^^ (#2) NOTES
^IBCN(365,D0,2,D1,2,D2,0)= (#.01) NOTES [1W] ^
^IBCN(365,D0,2,D1,3)= (#3.01) ENTITY ID CODE [1P:365.022] ^ (#3.02) ENTITY TYPE [2P:365.043] ^ (#3.03) NAME [3F] ^ (#3.04) ENTITY
==>ID [4F] ^ (#3.05) ENTITY ID QUALIFIER [5P:365.023] ^ (#3.06) ENTITY RELATIONSHIP CODE [6P:365.031] ^
^IBCN(365,D0,2,D1,4)= (#4.01) ADDRESS LINE 1 [1F] ^ (#4.02) ADDRESS LINE 2 [2F] ^ (#4.03) CITY [3F] ^ (#4.04) STATE [4P:5] ^
==>(#4.05) ZIP [5F] ^ (#4.06) COUNTRY CODE [6F] ^ (#4.07) LOCATION [7F] ^ (#4.08) LOCATION QUALIFIER
==>[8P:365.034] ^ (#4.09) SUBDIVISION CODE [9F] ^
^IBCN(365,D0,2,D1,5)= (#5.01) PROVIDER CODE [1P:365.024] ^ (#5.02) REFERENCE ID [2F] ^ (#5.03) REFERENCE ID QUALIFIER
==>[3P:365.028] ^
^IBCN(365,D0,2,D1,6,0)=^365.26A^^ (#6) CONTACT INFORMATION
^IBCN(365,D0,2,D1,6,D2,0)= (#.01) SEQUENCE [1N] ^ (#.02) NAME [2F] ^ (#.03) *COMMUNICATION NUMBER [3F] ^ (#.04) COMMUNICATION
==>QUALIFIER [4P:365.021] ^
^IBCN(365,D0,2,D1,6,D2,1)= (#1) COMMUNICATION NUMBER [1F] ^
^IBCN(365,D0,2,D1,7,0)=^365.27A^^ (#7) HEALTHCARE SERVICES DELIVERY
^IBCN(365,D0,2,D1,7,D2,0)= (#.01) SEQUENCE [1N] ^ (#.02) BENEFIT QUANTITY [2N] ^ (#.03) QUANTITY QUALIFIER [3P:365.016] ^ (#.04)
==>SAMPLE SELECTION MODULUS [4F] ^ (#.05) UNITS OF MEASUREMENT [5P:365.029] ^ (#.06) TIME PERIODS [6N] ^
==>(#.07) TIME PERIOD QUALIFIER [7P:365.015] ^ (#.08) DELIVERY FREQUENCY [8P:365.025] ^ (#.09) DELIVERY
==>PATTERN [9P:365.036] ^
^IBCN(365,D0,2,D1,8,0)=^365.28^^ (#8) SUBSCRIBER DATES
^IBCN(365,D0,2,D1,8,D2,0)= (#.01) SEQUENCE [1N] ^ (#.02) DATE [2F] ^ (#.03) DATE QUALIFIER [3P:365.026] ^ (#.04) DATE FORMAT
==>[4P:365.032] ^
^IBCN(365,D0,2,D1,9,0)=^365.29A^^ (#9) SUBSCRIBER ADDITIONAL INFO
^IBCN(365,D0,2,D1,9,D2,0)= (#.01) SEQUENCE [1N] ^ (#.02) PLACE OF SERVICE [2P:353.1] ^ (#.03) DIAGNOSIS [3P:80] ^ (#.04)
==>QUALIFIER [4P:365.044] ^ (#.05) NATURE OF INJURY CODE [5P:365.045] ^ (#.06) NATURE OF INJURY CATEGORY
==>[6P:365.038] ^ (#.07) NATURE OF INJURY TEXT [7F] ^
^IBCN(365,D0,2,D1,10,0)=^365.291A^^ (#10) SUBSCRIBER REFERENCE ID
^IBCN(365,D0,2,D1,10,D2,0)= (#.01) SEQUENCE [1N] ^ (#.02) REFERENCE ID [2F] ^ (#.03) REFERENCE ID QUALIFIER [3P:365.028] ^ (#.04)
==>DESCRIPTION [4F] ^
^IBCN(365,D0,2,D1,14,0)=^365.292PA^^ (#14) SERVICE TYPES
^IBCN(365,D0,2,D1,14,D2,0)= (#.01) SERVICE TYPES [1P:365.013] ^
^IBCN(365,D0,3,0)=^365.03^^ (#3) CONTACT PERSON
^IBCN(365,D0,3,D1,0)= (#.01) CONTACT PERSON [1F] ^ (#.02) COMMUNICATION QUALIFIER #1 [2P:365.021] ^ (#.03) *COMMUNICATION NUMBER
==>#1 [3F] ^ (#.04) COMMUNICATION QUALIFIER #2 [4P:365.021] ^ (#.05) *COMMUNICATION NUMBER #2 [5F] ^ (#.06)
==>COMMUNICATION QUALIFIER #3 [6P:365.021] ^ (#.07) *COMMUNICATION NUMBER #3 [7F] ^
^IBCN(365,D0,3,D1,1)= (#1) COMMUNICATION NUMBER #1 [1F] ^
^IBCN(365,D0,3,D1,2)= (#2) COMMUNICATION NUMBER #2 [1F] ^
^IBCN(365,D0,3,D1,3)= (#3) COMMUNICATION NUMBER #3 [1F] ^
^IBCN(365,D0,4)= (#4.01) ERROR TEXT [1F] ^
^IBCN(365,D0,5)= (#5.01) SUBSCRIBER ADDRESS LINE 1 [1F] ^ (#5.02) SUBSCRIBER ADDRESS LINE 2 [2F] ^ (#5.03) SUBSCRIBER ADDRESS
==>CITY [3F] ^ (#5.04) SUBSCRIBER ADDRESS STATE [4P:5] ^ (#5.05) SUBSCRIBER ADDRESS ZIP [5F] ^ (#5.06) SUBSCRIBER
==>ADDRESS COUNTRY [6F] ^ (#5.07) SUBSCRIBER ADDRESS SUBDIVISION [7F] ^
^IBCN(365,D0,6,0)=^365.06A^^ (#6) REJECT REASONS
^IBCN(365,D0,6,D1,0)= (#.01) SEQUENCE [1N] ^ (#.02) ERROR LOCATION [2F] ^ (#.03) REJECT REASON [3P:365.017] ^ (#.04) ACTION CODE
==>[4P:365.018] ^ (#.05) LOOP ID [5P:365.027] ^ (#.06) SOURCE [6F] ^
^IBCN(365,D0,6,D1,1,0)=^365.061A^^ (#1) ADDITIONAL MSGS
^IBCN(365,D0,6,D1,1,D2,0)= (#.01) ADDITIONAL MSG [1F] ^
^IBCN(365,D0,7,0)=^365.07A^^ (#7) SUBSCRIBER DATES
^IBCN(365,D0,7,D1,0)= (#.01) SEQUENCE [1N] ^ (#.02) DATE [2F] ^ (#.03) DATE QUALIFIER [3P:365.026] ^ (#.04) LOOP ID [4P:365.027]
==>^
^IBCN(365,D0,8)= (#8.01) PT. RELATIONSHIP - HIPAA [1P:365.037] ^
^IBCN(365,D0,9,0)=^365.09^^ (#9) GROUP REFERENCE INFORMATION
^IBCN(365,D0,9,D1,0)= (#.01) SEQUENCE [1N] ^ (#.02) REFERENCE ID (GROUP) [2F] ^ (#.03) REF ID QUALIFIER (GROUP) [3P:365.028] ^
==>(#.04) DESCRIPTION [4F] ^
^IBCN(365,D0,10,0)=^365.04^^ (#10) GROUP PROVIDER INFO
^IBCN(365,D0,10,D1,0)= (#.01) SEQUENCE [1N] ^ (#.02) PROVIDER CODE [2P:365.024] ^ (#.03) PROV REFERENCE ID [3F] ^
^IBCN(365,D0,11,0)=^365.01^^ (#11) HEALTH CARE CODE INFORMATION
^IBCN(365,D0,11,D1,0)= (#.01) SEQUENCE [1N] ^ (#.02) DIAGNOSIS CODE [2P:80] ^ (#.03) DIAGNOSIS CODE QUALIFIER [3F] ^ (#.04)
==>PRIMARY OR SECONDARY? [4S] ^
^IBCN(365,D0,12)= (#12.01) MILITARY INFO STATUS CODE [1P:365.039] ^ (#12.02) MILITARY EMPLOYMENT STATUS [2P:365.046] ^ (#12.03)
==>MILITARY GOVT AFFILIATION CODE [3P:365.041] ^ (#12.04) MILITARY PERSONNEL DESCRIPTION [4F] ^ (#12.05) MILITARY
==>SERVICE RANK CODE [5P:365.042] ^ (#12.06) DATE TIME PERIOD FORMAT QUAL [6P:365.032] ^ (#12.07) DATE TIME PERIOD
==>[7F] ^
^IBCN(365,D0,13)= (#13.01) NAME OF INSURED [1F] ^ (#13.02) SUBSCRIBER ID [2F] ^
^IBCN(365,D0,14)= (#14.01) GROUP NAME [1F] ^ (#14.02) GROUP NUMBER [2F] ^
INPUT TEMPLATE(S):
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