STANDARD DATA DICTIONARY #354.1 -- BILLING EXEMPTIONS FILE 3/24/25 PAGE 1
STORED IN ^IBA(354.1, *** 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 entries 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.
This file will hold the time sensitive data that is used to determine if a patient can be exluded from any type of billing for a
period of time. The initial use of this file is for storing the time sensitive data related to whether or not a patient is exempt
from pharmacy copay requirement due to income below the pension level.
The file then maintains the audit trail of changes to exemptions and historical data about exemptions. The data in this file
should be retained for approximately the current calendar year and the past calendar year. The ability to purge data in this file
will be added at a future time.
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: PATIENT (#.02)[R], STATUS (#.04)[R], ACTIVE (#.1)[R]
CROSS
REFERENCED BY: ACTIVE(AA), RETRO CANCEL BILLS END DATE(ACAN), PATIENT(ACAN1), EFFECTIVE DATE(ACY), ACTIVE(ACY2), TYPE(ACY3),
EFFECTIVE DATE(AIVDT), ACTIVE(AIVDT1), PATIENT(AIVDT2), TYPE(AIVDT3), ALERT(ALERT), PATIENT(AP), PATIENT(APIDT),
EFFECTIVE DATE(APIDT1), TYPE(APIDT2), PRIOR YEAR THRESHOLDS(APRIOR), EXEMPTION REASON(AR), STATUS(AS),
EFFECTIVE DATE(B), PATIENT(C)
354.1,.01 EFFECTIVE DATE 0;1 DATE (Required)
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: APR 07, 1993
DESCRIPTION: Enter the effective date of the exemption.
Patients will be given 1 year of exemption from the Medication Copayment requirement from this
effective date. For patients who's exemption is based on income data, every effort will be made to
keep this effective date consistent with the Means Test Date of Test or the Copayment Income Test
Date of Test.
DELETE TEST: 1,0)= I 1 W !,"Deleting entries not allowed"
UNEDITABLE
CROSS-REFERENCE: 354.1^B
1)= S ^IBA(354.1,"B",$E(X,1,30),DA)=""
2)= K ^IBA(354.1,"B",$E(X,1,30),DA)
CROSS-REFERENCE: 354.1^ACY^MUMPS
1)= I $P(^IBA(354.1,DA,0),"^",2),$P(^(0),U,3),$P(^(0),U,10) S ^IBA(354.1,"ACY",+$P(^(0),"^",3),+$P(
^(0),"^",2),$E(X,1,3),DA)=""
2)= K ^IBA(354.1,"ACY",+$P(^IBA(354.1,DA,0),"^",3),+$P(^(0),U,2),$E(X,1,3),DA)
Cross-reference of all ACTIVE entries for a patient for an effective date. For Pharmacy Co-pay
income exemption this equates to calendar year (CY).
CROSS-REFERENCE: 354.1^AIVDT^MUMPS
1)= N IBX S IBX=^IBA(354.1,DA,0) I $P(IBX,U,2),$P(IBX,U,3),$P(IBX,U,4)'="",$P(IBX,U,10) S ^IBA(354.
1,"AIVDT",+$P(IBX,U,3),+$P(IBX,U,2),-($P(IBX,U)),DA)=""
2)= K ^IBA(354.1,"AIVDT",+$P(^IBA(354.1,DA,0),U,3),+$P(^(0),U,2),-X,DA)
Inverse date cross reference of all exemption entries for a patient.
CROSS-REFERENCE: 354.1^APIDT1^MUMPS
1)= I $P(^IBA(354.1,DA,0),U,2),$P(^(0),U,3) S ^IBA(354.1,"APIDT",+$P(^(0),U,2),+$P(^(0),U,3),-X,DA)
=""
2)= K ^IBA(354.1,"APIDT",+$P(^IBA(354.1,DA,0),U,2),+$P(^(0),U,3),-X,DA)
Cross reference of all exemptions by patient, by type and by inverse date.
354.1,.02 PATIENT 0;2 POINTER TO BILLING PATIENT FILE (#354) (Required)
BILLING PATIENT
LAST EDITED: FEB 04, 1993
DESCRIPTION: This is the patient that this Billing Exemption Entry is for. The Patient must be in the Billing
Patient File. The Current Status for an exemption will be automatically stored in the Billing
Patient file.
UNEDITABLE
CROSS-REFERENCE: 354.1^AP
1)= S ^IBA(354.1,"AP",$E(X,1,30),DA)=""
2)= K ^IBA(354.1,"AP",$E(X,1,30),DA)
Cross-reference of Patient.
CROSS-REFERENCE: 354.1^AIVDT2^MUMPS
1)= N IBX S IBX=^IBA(354.1,DA,0) I $P(IBX,U,2),$P(IBX,U,3),$P(IBX,U,4)'="",$P(IBX,U,10) S ^IBA(354.
1,"AIVDT",+$P(IBX,U,3),+$P(IBX,U,2),-($P(IBX,U)),DA)=""
2)= K ^IBA(354.1,"AIVDT",+$P(^IBA(354.1,DA,0),"^",3),+X,-($P(^(0),U)),DA)
CROSS-REFERENCE: 354.1^C
1)= S ^IBA(354.1,"C",$E(X,1,30),DA)=""
2)= K ^IBA(354.1,"C",$E(X,1,30),DA)
Cross-reference of all ACTIVE entries for a patient by calendar year (CY). This equates to
$e(effective date,1,3).
CROSS-REFERENCE: 354.1^APIDT^MUMPS
1)= I $P(^IBA(354.1,DA,0),U,3),+^(0) S ^IBA(354.1,"APIDT",X,+$P(^(0),U,3),-($P(^(0),U)),DA)=""
2)= K ^IBA(354.1,"APIDT",+X,+$P(^IBA(354.1,DA,0),U,3),-($P(^(0),U)),DA)
Cross-reference of all records by patient, by type, by inverse date.
CROSS-REFERENCE: 354.1^ACAN1^MUMPS
1)= I $P(^IBA(354.1,DA,0),"^",14) S ^IBA(354.1,"ACAN",X,-$P(^(0),"^",14),DA)=""
2)= K ^IBA(354.1,"ACAN",X,-$P(^IBA(354.1,DA,0),"^",14),DA)
3)= DO NOT DELETE
This cross-reference is set whenever bills are retroactively canceled due to the medication
copayment exemption patch. It is used to prevent canceling charges in AR a second time. This is
necessary because the direct link between IB and AR is not maintained for this functionality as it
is necessary to remove admin and interest charges that may have accumulated.
354.1,.03 TYPE 0;3 SET (Required)
'1' FOR COPAY INCOME EXEMPTION;
LAST EDITED: FEB 04, 1993
DESCRIPTION: This is the type of exemption that this entry is for. Each type of exemption will have its own
record.
TECHNICAL DESCR:
Currently there is only one type of record. Pharmacy Copay Exemptions based on income.
UNEDITABLE
CROSS-REFERENCE: 354.1^AIVDT3^MUMPS
1)= N IBX S IBX=^IBA(354.1,DA,0) I $P(IBX,U,2),$P(IBX,U,3),$P(IBX,U,4)'="",$P(IBX,U,10) S ^IBA(354.
1,"AIVDT",+$P(IBX,U,3),+$P(IBX,U,2),-($P(IBX,U)),DA)=""
2)= K ^IBA(354.1,"AIVDT",+X,+$P(^IBA(354.1,DA,0),U,2),-($P(^(0),U)),DA)
Inverse date cross reference of all exemptions for a patient for a type of exemption.
CROSS-REFERENCE: 354.1^APIDT2^MUMPS
1)= I $P(^IBA(354.1,DA,0),U,2),+^(0) S ^IBA(354.1,"APIDT",+$P(^(0),U,2),+X,-($P(^(0),U)),DA)=""
2)= K ^IBA(354.1,"APIDT",+$P(^IBA(354.1,DA,0),U,2),+X,-($P(^(0),U)),DA)
Cross-reference of all records by patient, by type, by inverse date.
CROSS-REFERENCE: 354.1^ACY3^MUMPS
1)= I $P(^IBA(354.1,DA,0),U,2),+^(0) S ^IBA(354.1,"ACY",+X,+$P(^(0),U,2),+$E($P(^(0),U),1,3),DA)=""
2)= K ^IBA(354.1,"ACY",+X,+$P(^IBA(354.1,DA,0),U,2),+$E($P(^(0),U),1,3),DA)
Cross reference of all active entries for a patient by inverse date.
354.1,.04 STATUS 0;4 SET (Required)
EXEMPTION STATUS
'1' FOR EXEMPT;
'0' FOR NON-EXEMPT;
LAST EDITED: FEB 04, 1993
DESCRIPTION: This is the Exemption Status of this record. Enter whether the patient is exempt or not exempt
from the TYPE of billing of this record. Generally this data element will be entered by the
system.
UNEDITABLE
CROSS-REFERENCE: 354.1^AS
1)= S ^IBA(354.1,"AS",$E(X,1,30),DA)=""
2)= K ^IBA(354.1,"AS",$E(X,1,30),DA)
Cross-reference of Status.
354.1,.05 EXEMPTION REASON 0;5 POINTER TO EXEMPTION REASON FILE (#354.2) (Required)
LAST EDITED: FEB 04, 1993
DESCRIPTION: Enter the reason that the patient is exempt or not exempt from this type of billing. Entry of this
field will automatically update the STATUS of this exemption record to the STATUS of the Exemption
Reason. For exmple, an exemption reason of "In Receipt of Pension" will automatically trigger a
STATUS of Exempt for the Pharmacy Copay Income Exemption.
UNEDITABLE
CROSS-REFERENCE: 354.1^AR
1)= S ^IBA(354.1,"AR",$E(X,1,30),DA)=""
2)= K ^IBA(354.1,"AR",$E(X,1,30),DA)
Cross-reference of Exemption Reasons.
354.1,.06 HOW ADDED 0;6 SET
'1' FOR SYSTEM;
'2' FOR MANUAL;
LAST EDITED: DEC 09, 1992
DESCRIPTION: This field indicates whether this record was automatically added by the system or manually entered
by a user.
This field will always be entered by the system.
TECHNICAL DESCR: This field is updated to manual whenever a user creates an entry that does not appear to be
consistent with the data returned from MAS or when adding a hardship exemption. Whenever this
field is set to manual an electronic signature should be required and a bulletin or alert sent to
an appropriate group.
354.1,.07 USER ADDING ENTRY 0;7 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: FEB 04, 1993
DESCRIPTION: This is the user who was responsible for adding this entry. If the entry was SYSTEM added then the
user would be the signed on user when the exemption was created. This may be a user who edited the
patient record or who entered a prescription or a user who corrected an exemption. All changes
except Hardship exemptions will be considered SYSTEM added. If the entry was Manually added then
this is the user who entered the Hardship exemption.
UNEDITABLE
354.1,.08 DATE/TIME ADDED 0;8 DATE (Required)
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: FEB 04, 1993
DESCRIPTION: This is the date and time this entry was added.
The date time added will be different from the effective date in many cases, where the entry is
based on actual income data and where there are changes to an exemption status. When the exemption
is based upon the fact that the patient is recieving pension, etc. the effective date and the date
added may be the same.
UNEDITABLE
354.1,.09 ALERT 0;9 POINTER TO BILLING ALERTS FILE (#354.4)
LAST EDITED: FEB 04, 1993
DESCRIPTION:
Future use.
CROSS-REFERENCE: 354.1^ALERT
1)= S ^IBA(354.1,"ALERT",$E(X,1,30),DA)=""
2)= K ^IBA(354.1,"ALERT",$E(X,1,30),DA)
This is an index of alerted exemptions.
354.1,.1 ACTIVE 0;10 SET (Required)
CURRENTLY ACTIVE
'1' FOR ACTIVE;
'0' FOR INACTIVE;
LAST EDITED: FEB 04, 1993
DESCRIPTION: Only 1 record for an effective date can be active at a time. When it is necessary to change a
patient's exemption status the user will be asked if this is the currently active record. If yes,
then all other records for the effective date will be inactivated automatically.
SCREEN: S DIC("S")="I $$ACTIVE^IBARXEU(X)"
EXPLANATION: Only 1 entry for a patient for an effective date can be active at one time
CROSS-REFERENCE: 354.1^AA
1)= S ^IBA(354.1,"AA",$E(X,1,30),DA)=""
2)= K ^IBA(354.1,"AA",$E(X,1,30),DA)
Cross-reference of Active Records.
CROSS-REFERENCE: 354.1^AIVDT1^MUMPS
1)= N IBX S IBX=^IBA(354.1,DA,0) I +X,$P(IBX,U,2),$P(IBX,U,3),$P(IBX,U,4)'="" S ^IBA(354.1,"AIVDT",
+$P(IBX,U,3),+$P(IBX,U,2),-($P(IBX,U)),DA)=""
2)= N IBX S IBX=^IBA(354.1,DA,0) K ^IBA(354.1,"AIVDT",+$P(IBX,U,3),+$P(IBX,U,2),-($P(IBX,U)),DA)
If this is the active record, patient has been entered, type has been entered, status has been
entered; set up an inverse cross reference.
^iba(354.1,"aivdt",type,patient,inverse effective date,da)=""
CROSS-REFERENCE: 354.1^ACY2^MUMPS
1)= I X,+$P(^IBA(354.1,DA,0),U,2),+$P(^(0),U,3),+^(0) S ^IBA(354.1,"ACY",+$P(^(0),U,3),+$P(^(0),U,2
),+$E($P(^(0),U),1,3),DA)=""
2)= K ^IBA(354.1,"ACY",+$P(^IBA(354.1,DA,0),U,3),+$P(^(0),U,2),+$E($P(^(0),U),1,3),DA)
Cross-reference of all ACTIVE entries for a patient by calendar year (CY). This equates to
$e(effective date,1,3).
354.1,.11 ELECTRONIC SIGNATURE 0;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<6) X
OUTPUT TRANSFORM: S Y(0)=Y S Y=""
LAST EDITED: APR 22, 1993
HELP-PROMPT: Answer must be 6-20 characters in length.
DESCRIPTION: Enter your Electronic Signature. This field will be required whenever a user trys to create an
exemption that is different from the exemption computed by the system. This would be required in
order to create a hardship exemption.
354.1,.12 SECOND ELECTRONIC SIGNATURE 0;12 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<3) X
LAST EDITED: APR 22, 1993
HELP-PROMPT: Answer must be 3-40 characters in length.
DESCRIPTION: A second electronic signature for hardship exemptions will be implemented in a future release.
354.1,.13 RETRO CANCEL BILLS START DATE 0;13 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:3991231X) X
LAST EDITED: DEC 09, 1992
HELP-PROMPT: TYPE A DATE BETWEEN 1/29/1992 AND 12/31/2099
DESCRIPTION: If this exemption requires retroactively canceling prior charges, this is the beginning date for
the retroactive cancellation. This must be tracked to prevent duplicate retroactive cancellations
of the same charges.
354.1,.14 RETRO CANCEL BILLS END DATE 0;14 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:3991231X) X
LAST EDITED: JAN 13, 1993
HELP-PROMPT: TYPE A DATE BETWEEN 1/29/1992 AND 12/31/2099
DESCRIPTION: If this exemption requires retroactively canceling prior charges, this is the ending date for the
retroactive cancellation. This must be tracked to prevent duplicate retroactive cancellations of
the same charges.
CROSS-REFERENCE: 354.1^ACAN^MUMPS
1)= I $P(^IBA(354.1,DA,0),"^",2) S ^IBA(354.1,"ACAN",$P(^(0),"^",2),-X,DA)=""
2)= K ^IBA(354.1,"ACAN",$P(^IBA(354.1,DA,0),"^",2),-X,DA)
3)= DO NOT DELETE
This cross-reference is set whenever bills are retroactively canceled due to the medication
copayment exemption patch. It is used to prevent canceling charges in AR for the same period.
This is necessary because the direct link between IB and AR is not maintained for this
functionality as it is necessary to remove admin and interest charges that may have accumulated.
354.1,.15 PRIOR YEAR THRESHOLDS 0;15 DATE
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JAN 26, 1993
DESCRIPTION: This field will contain the date of the threshold used to calculate exemptions based on income only
if the date of the threshold was over 1 year in the past. This will be used by the add threshold
option to list and recompute these exemptions when new thresholds are entered.
CROSS-REFERENCE: 354.1^APRIOR
1)= S ^IBA(354.1,"APRIOR",$E(X,1,30),DA)=""
2)= K ^IBA(354.1,"APRIOR",$E(X,1,30),DA)
This is a cross reference of all active exemptions created with prior year thresholds. It will be
used when entering new thresholds to identfy patient exemptions in need of updating. It will be
deleted by the IB INACTIVATE EXEMPTION TEMPLATE when creating a new exemption for this date.
354.1,.16 REMINDER LETTER DATE 0;16 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAR 27, 1995
DESCRIPTION: This field is used to indicate the date on which the income test reminder letter was printed, based
on this exemption. This field is updated during the nightly background job which prints the
letters. If this exemption is encountered after a letter has already been printed (based on this
exemption) another letter will not be printed.
FILES POINTED TO FIELDS
BILLING ALERTS (#354.4) ALERT (#.09)
BILLING PATIENT (#354) PATIENT (#.02)
EXEMPTION REASON (#354.2) EXEMPTION REASON (#.05)
NEW PERSON (#200) USER ADDING ENTRY (#.07)
INPUT TEMPLATE(S):
IB INACTIVATE EXEMPTION JAN 26, 1993@11:53 USER #1453 ^IBXEXI
IB NEW EXEMPTION SEP 03, 2002@17:09 USER #0 ^IBXEX
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):