STANDARD DATA DICTIONARY #354 -- BILLING PATIENT FILE 6/27/25 PAGE 1
STORED IN ^IBA(354, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
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DO NOT EDIT THIS FILE.
Under normal operation it is not necessary to edit the fields in this file directly. The option Manually Change Copay Exemption
(Hardships) can be used to update and correct this entry by creating a new exemption. If many patient records have problems the
option Print/Verify Patient Exemption Status can be used to correct the entries.
The data in this file is updated each time a new (current) exemption is created for a patient. Exemptions are automatically
created when changes in patient information change the exemption status or when an expired (older than 1 year) exemption is
encountered when determining the exemption status for pharmacy.
This file will contain specific information related to billing about individual patients. Current Status of the Medication
Copayment Exemption will be kept in this file. Conceptually this is different than the BILLING EXEMPTIONS File which maintains the
audit log and historical data related to billing exemptions.
Per VHA Directive 10-93-142, this file definition should not be modified.
DD ACCESS: @
RD ACCESS: @
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
AUDIT ACCESS: @
IDENTIFIED BY: COPAY INCOME EXEMPTION STATUS (#.04)[R], COPAY EXEMPTION REASON (#.05)[R]
POINTED TO BY: PATIENT field (#.02) of the BILLING EXEMPTIONS File (#354.1)
CROSS
REFERENCED BY: COPAY EXEMPTION REASON(AC), COPAY EXEMPTION STATUS DATE(AD), COPAY INCOME EXEMPTION STATUS(AENR04),
COPAY INCOME EXEMPTION STATUS(AEX), EVER HAD IVM INSURANCE?(AIVM), NO COVERAGE VERIFICATION DATE(AVDT),
PATIENT NAME(B)
354,.01 PATIENT NAME 0;1 POINTER TO PATIENT FILE (#2) (Required)
INPUT TRANSFORM: S DINUM=X
LAST EDITED: JAN 21, 1993
HELP-PROMPT: Enter the name of the patient as it appears in the patient file or enter the SSN or last four.
DESCRIPTION:
This is the name of the patient as it appears in the patient file.
TECHNICAL DESCR: This field is the pointer to the PATIENT file. It will use the same internal entry number in this
file as in the PATIENT file.
DELETE TEST: 1,0)= I 1 W !,"Deleting entries not allowed"
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 354^B
1)= S ^IBA(354,"B",$E(X,1,30),DA)=""
2)= K ^IBA(354,"B",$E(X,1,30),DA)
354,.03 COPAY EXEMPTION STATUS DATE 0;3 DATE (Required)
CURRENT RX COPAY INCOME EXEMPTION STATUS DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X K:X'=$P(^IBA(354,DA,0),U,3) X
LAST EDITED: FEB 10, 1993
HELP-PROMPT: Enter the date of the current income exemption.
DESCRIPTION: DO NOT EDIT THIS FIELD. It is maintained by the Copay Exemption Software.
This is the date that this patients Medication Copay Income Exemption Status was last updated. If
this date is not in the current calendar year this patient will be flagged as needing to have his
status updated.
TECHNICAL DESCR: This field will be updated by the Copay Exemption software every time a new current exemption is
added. It should not be edited.
Programmers must 4 slash stuff data into this field to bypass the input transform.
WRITE AUTHORITY: ^
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the COPAY INCOME EXEMPTION STATUS field of the BILLING PATIENT File
CROSS-REFERENCE: 354^AD
1)= S ^IBA(354,"AD",$E(X,1,30),DA)=""
2)= K ^IBA(354,"AD",$E(X,1,30),DA)
354,.04 COPAY INCOME EXEMPTION STATUS 0;4 SET (Required)
RX COPAY CURRENT INCOME EXEMPTION STATUS
'1' FOR EXEMPT;
'0' FOR NON-EXEMPT;
LAST EDITED: SEP 13, 2005
HELP-PROMPT: Enter whether this patient is currently exempt from pharmacy copay due to the income exemption.
DESCRIPTION: DO NOT EDIT THIS FIELD. It is maintained by the Copay Exemption Software.
This is the patients current Medication Copay Income Exemption Status. It is updated whenever an
entry in the Billing Exemptions file is made.
If a patient's income is less than the pension level, effective 10/29/92 the patient is exempt from
paying the Medication Copayment. If a patient is receiving a VA Pension, or is receiving Aid and
Attendence or House Bound benefits, or his income for the previous year is less than the pension
level, he is exempt.
TECHNICAL DESCR: This field will be updated by the Copay Exemption software every time a new current exemption is
added. It should not be edited.
Programmers must 4 slash stuff data into this field to bypass the input transform.
SCREEN: S DIC("S")="I $P(^IBA(354,DA,0),U,4)=Y!($G(IBJOB)>10)"
EXPLANATION: This field can only be edited/updated by the Copay Exemption software.
WRITE AUTHORITY: ^
CROSS-REFERENCE: 354^AEX
1)= S ^IBA(354,"AEX",$E(X,1,30),DA)=""
2)= K ^IBA(354,"AEX",$E(X,1,30),DA)
This is a regular cross-reference of the Pharmacy Copay Income Exemption Status of patients for
their most recent status.
CROSS-REFERENCE: ^^TRIGGER^354^.03
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(354,D0,0)):^(0),1:"") S X=$P(Y(1),U,3),X=X S DI
U=X K Y S X=DIV S X=DT S DIH=$G(^IBA(354,DIV(0),0)),DIV=X S $P(^(0),U,3)=DIV,DIH=354,DIG=.03 D ^DIC
R
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(354,D0,0)):^(0),1:"") S X=$P(Y(1),U,3),X=X S DI
U=X K Y S X="" S DIH=$G(^IBA(354,DIV(0),0)),DIV=X S $P(^(0),U,3)=DIV,DIH=354,DIG=.03 D ^DICR
CREATE VALUE)= S X=DT
DELETE VALUE)= @
FIELD)= #.03
CROSS-REFERENCE: 354^AENR04^MUMPS
1)= D E354^DGRTRIG(DA)
2)= D E354^DGRTRIG(DA)
3)= DO NOT DELETE
This cross-reference is used to notify HEC of changes that may affect enrollment.
354,.05 COPAY EXEMPTION REASON 0;5 POINTER TO EXEMPTION REASON FILE (#354.2) (Required)
INPUT TRANSFORM: S DIC("S")="I Y=$P(^IBA(354,DA,0),U,5)!($G(IBJOB)>10)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: FEB 10, 1993
DESCRIPTION: DO NOT EDIT THIS FIELD. It is maintained by the Copay Exemption Software.
This is the exemption reason for the current copay exemption. It will be entered by the system.
TECHNICAL DESCR: This field will be updated by the Copay Exemption software every time a new current exemption is
added. It should not be edited.
Programmers must 4 slash stuff data into this field to bypass the input transform.
SCREEN: S DIC("S")="I Y=$P(^IBA(354,DA,0),U,5)!($G(IBJOB)>10)"
EXPLANATION: This field can only be edited/updated by the Copay Exemption software.
WRITE AUTHORITY: ^
CROSS-REFERENCE: 354^AC
1)= S ^IBA(354,"AC",$E(X,1,30),DA)=""
2)= K ^IBA(354,"AC",$E(X,1,30),DA)
354,50 EVER HAD IVM INSURANCE? IVM;1 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: APR 21, 1994
HELP-PROMPT: If patient has ever had insurance identified by IVM, type "YES"; otherwise, "NO".
DESCRIPTION: This field flags patients who have ever had at least one insurance policy that was identified by
the IVM Center.
CROSS-REFERENCE: 354^AIVM^MUMPS
1)= I X=1 S ^IBA(354,"AIVM",DA)=""
2)= K ^IBA(354,"AIVM",DA)
This cross-reference flags patients who have (or have ever had) insurance identified by IVM.
354,60 NO COVERAGE VERIFICATION DATE 60;1 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: OCT 08, 1998
HELP-PROMPT: Enter the date verification was made that the patient has no insurance coverage.
DESCRIPTION: This field contains the date that verification was made that this patient does not have any type of
insurance coverage. When a policy is entered for a patient, this field will be deleted.
CROSS-REFERENCE: 354^AVDT
1)= S ^IBA(354,"AVDT",$E(X,1,30),DA)=""
2)= K ^IBA(354,"AVDT",$E(X,1,30),DA)
3)= Do not delete.
This cross-reference is used to list the date patients were verified that they have no insurance
coverage.
FILES POINTED TO FIELDS
EXEMPTION REASON (#354.2) COPAY EXEMPTION REASON (#.05)
PATIENT (#2) PATIENT NAME (#.01)
INPUT TEMPLATE(S):
IB CURRENT STATUS JAN 19, 1993@10:05 USER #1453 ^IBXEXS
PRINT TEMPLATE(S):
IB BILLING PAT W/INCOME MAR 02, 1994@08:17 USER #1453 BILLING PATIENT LIST
IB BILLING PATIENT MAR 19, 1993@13:33 USER #1453 BILLING PATIENT LIST
IB BILLING PATIENT SUMMARY JAN 21, 1993@10:11 USER #1453 BILLING PATIENT LIST
IB DO NOT USE APR 29, 1993@10:49 USER #1453 @@
IB PATIENT ADDRESSES MAR 02, 1994@08:18 USER #1453 PATIENTS EXEMPT FROM MEDICATION COPAYMENT
SORT TEMPLATE(S):
IB BILLING PAT W/INCOME APR 08, 1993@15:59 USER #1453
SORT BY: @+COPAY EXEMPTION REASON// From 'NO INCOME DATA' To 'NO INCOME DATA^NO INCOME DATA'
WITHIN COPAY EXEMPTION REASON, SORT BY: '@COPAY EXEMPTION STATUS DATE// (User is asked range)
WITHIN COPAY EXEMPTION STATUS DATE, SORT BY: @PATIENT NAME// (User is asked range)
IB BILLING PATIENT BY REASON MAR 24, 1993@08:57 USER #1453
SORT BY: @+COPAY EXEMPTION REASON// (User is asked range)
WITHIN COPAY EXEMPTION REASON, SORT BY: '@COPAY EXEMPTION STATUS DATE// (User is asked range)
WITHIN COPAY EXEMPTION STATUS DATE, SORT BY: @PATIENT NAME// (User is asked range)
IB BILLING PATIENT BY STATUS MAR 24, 1993@08:19 USER #1453
SORT BY: @+COPAY INCOME EXEMPTION STATUS// (User is asked range)
WITHIN COPAY INCOME EXEMPTION STATUS, SORT BY: '@COPAY EXEMPTION STATUS DATE// (User is asked range)
WITHIN COPAY EXEMPTION STATUS DATE, SORT BY: @PATIENT NAME// (User is asked range)
IB EXEMPT PATIENTS APR 23, 1993@15:57 USER #0
SORT BY: @+COPAY INCOME EXEMPTION STATUS// From '1' To '1^1'
WITHIN COPAY INCOME EXEMPTION STATUS, SORT BY: '@COPAY EXEMPTION STATUS DATE// (User is asked range)
WITHIN COPAY EXEMPTION STATUS DATE, SORT BY: @PATIENT NAME// (User is asked range)
IB EXEMPTION LETTER JUN 04, 1993@15:44 USER #0
FORM(S)/BLOCK(S):