STANDARD DATA DICTIONARY #355.3 -- GROUP INSURANCE PLAN FILE 3/24/25 PAGE 1
STORED IN ^IBA(355.3, *** 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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This file contains the relevent data for Group insurance plans. The data in this file is specific to the plan itself.
This is in contrast to the patient file which contains data about patient's policies, where the policy may be for a group or Health
Insurance Plan.
Per VHA Directive 10-93-142, this file definition should not be modified.
DD ACCESS: @
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
AUDIT ACCESS: @
IDENTIFIED BY: IS THIS A GROUP POLICY? (#.02), *GROUP NAME (#.03), *GROUP NUMBER (#.04)
POINTED TO BY: GROUP PLAN field (#.18) of the INSURANCE TYPE sub-field (#2.312) of the PATIENT File (#2)
PLAN field (#.01) of the PLAN COVERAGE LIMITATIONS File (#355.32)
HEALTH INSURANCE POLICY field (#.02) of the ANNUAL BENEFITS File (#355.4)
POLICY field (#.01) of the INSURANCE CLAIMS YEAR TO DATE File (#355.5)
PLAN field (#.303) of the EVENT sub-field (#366.141) of the IB NCPDP EVENT LOG File (#366.14)
GROUP INSURANCE PLAN field (#.02) of the INSURANCE sub-field (#366.1412) of the EVENT sub-field (#366.141) of the IB
NCPDP EVENT LOG File (#366.14)
GROUP INSURANCE PLAN field (#1.04) of the BPS CLAIMS File (#9002313.02)
PAYER PLAN field (#.01) of the BPS ASLEEP PAYERS File (#9002313.15)
PLAN ID field (#.01) of the PATIENT INSURANCE MULTIPLE sub-field (#9002313.57902) of the BPS LOG OF TRANSACTIONS
File (#9002313.57)
PLAN ID field (#.01) of the PATIENT INSURANCE MULTIPLE sub-field (#9002313.59902) of the BPS TRANSACTION File
(#9002313.59)
PLAN ID field (#.08) of the BPS INSURER DATA File (#9002313.78)
CROSS
REFERENCED BY: *GROUP NAME(ACCP), *GROUP NUMBER(ACCP1), INSURANCE COMPANY(ACCP2), INSURANCE COMPANY(ACCP3),
*GROUP NUMBER(AENR04), *GROUP NAME(AGNA), INSURANCE COMPANY(AGNA1), *GROUP NUMBER(AGNU),
INSURANCE COMPANY(AGNU1), INSURANCE COMPANY(B), *GROUP NAME(D), *GROUP NUMBER(E)
LAST MODIFIED: MAR 14,2023@09:48:10
355.3,.01 INSURANCE COMPANY 0;1 POINTER TO INSURANCE COMPANY FILE (#36) (Required)
LAST EDITED: JAN 25, 1995
DESCRIPTION:
Select the insurance company that this policy is with.
CROSS-REFERENCE: 355.3^B
1)= S ^IBA(355.3,"B",$E(X,1,30),DA)=""
2)= K ^IBA(355.3,"B",$E(X,1,30),DA)
CROSS-REFERENCE: ^^TRIGGER^355.3^1.01
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^IBA(355.3,D0,1)):^(1),1:"") S X=$P(Y(1),U,
1)="" I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,1)):^(1),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y X ^DD(
355.3,.01,1,2,1.1) X ^DD(355.3,.01,1,2,1.4)
1.1)= S X=DIV N %I,%H,% D NOW^%DTC S X=%
1.4)= S DIH=$S($D(^IBA(355.3,DIV(0),1)):^(1),1:""),DIV=X S $P(^(1),U,1)=DIV,DIH=355.3,DIG=1.01 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= #1.01=""
CREATE VALUE)= NOW
DELETE VALUE)= NO EFFECT
FIELD)= #1.01
Triggers the date/time entered when creating a new entry.
CROSS-REFERENCE: ^^TRIGGER^355.3^1.02
1)= X ^DD(355.3,.01,1,3,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,1)):^(1),1:"") S X=$P(Y(1),U,2)
,X=X S DIU=X K Y S X=DIV S X=DUZ X ^DD(355.3,.01,1,3,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^IBA(355.3,D0,1)):^(1),1:"") S X=$S('$D(^
VA(200,+$P(Y(1),U,2),0)):"",1:$P(^(0),U,1))=""
1.4)= S DIH=$S($D(^IBA(355.3,DIV(0),1)):^(1),1:""),DIV=X S $P(^(1),U,2)=DIV,DIH=355.3,DIG=1.02 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= #1.02=""
CREATE VALUE)= S X=DUZ
DELETE VALUE)= NO EFFECT
FIELD)= #1.02
Triggers the user who created this entry.
CROSS-REFERENCE: 355.3^AGNA1^MUMPS
1)= I $P(^IBA(355.3,DA,0),U,3)]"" S ^IBA(355.3,"AGNA",X,$P(^(0),U,3),DA)=""
2)= I $P(^IBA(355.3,DA,0),U,3)]"" K ^IBA(355.3,"AGNA",X,$P(^(0),U,3),DA)
Cross reference of insurance companies and group names.
CROSS-REFERENCE: 355.3^AGNU1^MUMPS
1)= I $P(^IBA(355.3,DA,0),U,4)]"" S ^IBA(355.3,"AGNU",X,$P(^(0),U,4),DA)=""
2)= I $P(^IBA(355.3,DA,0),U,4)]"" K ^IBA(355.3,"AGNU",X,$P(^(0),U,4),DA)
Cross reference of insurance companies and group numbers.
CROSS-REFERENCE: 355.3^ACCP2^MUMPS
1)= I $P(^IBA(355.3,DA,0),"^",3)]"" N Y S Y=$$COMP^IBCNSJ($P(^IBA(355.3,DA,0),"^",3)) I $L(Y) S ^IB
A(355.3,"ACCP",+X,Y,DA)=""
2)= I $P(^IBA(355.3,DA,0),"^",3)]"" N Y S Y=$$COMP^IBCNSJ($P(^IBA(355.3,DA,0),"^",3)) I $L(Y) K ^IB
A(355.3,"ACCP",+X,Y,DA)
Compresses entries by eliminating punctuation marks and leading zeroes, and converting lowercase to
uppercase.
CROSS-REFERENCE: 355.3^ACCP3^MUMPS
1)= I $P(^IBA(355.3,DA,0),"^",4)]"" N Y S Y=$$COMP^IBCNSJ($P(^IBA(355.3,DA,0),"^",4)) I $L(Y) S ^IB
A(355.3,"ACCP",+X,Y,DA)=""
2)= I $P(^IBA(355.3,DA,0),"^",4)]"" N Y S Y=$$COMP^IBCNSJ($P(^IBA(355.3,DA,0),"^",4)) I $L(Y) K ^IB
A(355.3,"ACCP",+X,Y,DA)
Cross-reference of the Plan company and compressed plan number.
The "ACCP1" cross-reference in field #.04 is the companion cross-reference.
355.3,.02 IS THIS A GROUP POLICY? 0;2 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: MAY 25, 1993
HELP-PROMPT: If this is a group plan answer "YES" so that other patients may be associated with it. If this is
an individual plan answer "NO" and only the current patient can have this policy.
DESCRIPTION: Some policies are individual policies and are specific to a patient. Many policies are group plans
that many patients may have. If this is a group plan, answer 'YES' so that other patients may be
associated with this policy. If this is an individual plan then answer 'NO' and only this patient
can be associated with this policy.
355.3,.03 *GROUP NAME 0;3 FREE TEXT
INPUT TRANSFORM: K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>20!($L(X)<2) X
LAST EDITED: NOV 20, 2013
HELP-PROMPT: Answer must be 2-20 characters in length.
DESCRIPTION: If this is a group policy, enter the name of the group that this policy is associated with. This
is the name that the insurance company uses to identify the plan. This will appear on the health
claims forms in the appropriate blocks. It will also be used to help identify this policy so that
other patients with the same plan can be associated with it.
This field is scheduled for deletion in May 2015.
NOTES: TRIGGERED by the GROUP NAME field of the GROUP INSURANCE PLAN File
CROSS-REFERENCE: 355.3^D
1)= S ^IBA(355.3,"D",$E(X,1,30),DA)=""
2)= K ^IBA(355.3,"D",$E(X,1,30),DA)
CROSS-REFERENCE: 355.3^AGNA^MUMPS
1)= S:+^IBA(355.3,DA,0) ^IBA(355.3,"AGNA",+^(0),X,DA)=""
2)= K ^IBA(355.3,"AGNA",+^IBA(355.3,DA,0),X,DA)
Cross reference of insurance companies and group names.
CROSS-REFERENCE: 355.3^ACCP^MUMPS
1)= N Y S Y=$$COMP^IBCNSJ(X) I $L(Y) S ^IBA(355.3,"ACCP",+^IBA(355.3,DA,0),Y,DA)=""
2)= N Y S Y=$$COMP^IBCNSJ(X) I $L(Y) K ^IBA(355.3,"ACCP",+^IBA(355.3,DA,0),Y,DA)
Compresses entries by eliminating punctuation marks and leading zeroes, and converting lowercase to
uppercase.
CROSS-REFERENCE: ^^TRIGGER^355.3^2.01
1)= X ^DD(355.3,.03,1,4,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,2)):^(2),1:"") S X=$P(Y(1),U,1)
,X=X S DIU=X K Y S X=DIV S X=$P(^IBA(355.3,DA,0),U,3) X ^DD(355.3,.03,1,4,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.3,DA,0),U,3)'=$E($P($G(^IBA(355.3,DA,
2)),U),1,20))
1.4)= S DIH=$G(^IBA(355.3,DIV(0),2)),DIV=X S $P(^(2),U,1)=DIV,DIH=355.3,DIG=2.01 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.3,DA,0),U,3)="") I X S X=DIV S Y(1)=$S(
$D(^IBA(355.3,D0,2)):^(2),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" X ^DD(355.3,.03,1,4,2.4)
2.4)= S DIH=$G(^IBA(355.3,DIV(0),2)),DIV=X S $P(^(2),U,1)=DIV,DIH=355.3,DIG=2.01 D ^DICR
CREATE CONDITION)= S X=($P(^IBA(355.3,DA,0),U,3)'=$E($P($G(^IBA(355.3,DA,2)),U),1,20))
CREATE VALUE)= S X=$P(^IBA(355.3,DA,0),U,3)
DELETE CONDITION)= S X=($P(^IBA(355.3,DA,0),U,3)="")
DELETE VALUE)= @
FIELD)= GROUP NAME
Triggers field 2.01 if first 20 chars of its value differ from the value in this field. Deletes
field 2.01 if field .03 is deleted.
355.3,.04 *GROUP NUMBER 0;4 FREE TEXT
INPUT TRANSFORM: I $D(X) K:$L(X)>17!($L(X)<2) X
LAST EDITED: APR 27, 2020
HELP-PROMPT: Answer must be 2-17 characters in length.
DESCRIPTION: If this is a group policy enter the number which identifies this policy, i.e. group number/code
that the insurance company uses to identify this plan.
This field is scheduled for deletion in May 2015.
TECHNICAL DESCR: DEVELOPERS, as long as there is a cross-reference calling the EVENT^IVMPLOG tag associated with
this field, contact the Enrollment System (ES) leadership if your patch modification will result in
mass updates to this field upon installation.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the GROUP NUMBER field of the GROUP INSURANCE PLAN File
CROSS-REFERENCE: 355.3^E
1)= S ^IBA(355.3,"E",$E(X,1,30),DA)=""
2)= K ^IBA(355.3,"E",$E(X,1,30),DA)
CROSS-REFERENCE: 355.3^AGNU^MUMPS
1)= S:+^IBA(355.3,DA,0) ^IBA(355.3,"AGNU",+^(0),X,DA)=""
2)= K ^IBA(355.3,"AGNU",+^IBA(355.3,DA,0),X,DA)
Cross reference of insurance companies and group names.
CROSS-REFERENCE: 355.3^ACCP1^MUMPS
1)= N Y S Y=$$COMP^IBCNSJ(X) I $L(Y) S ^IBA(355.3,"ACCP",+^IBA(355.3,DA,0),Y,DA)=""
2)= N Y S Y=$$COMP^IBCNSJ(X) I $L(Y) K ^IBA(355.3,"ACCP",+^IBA(355.3,DA,0),Y,DA)
Compresses entries by eliminating punctuation marks and leading zeroes, and converting lowercase to
uppercase.
CROSS-REFERENCE: 355.3^AENR04^MUMPS
1)= D EVENT^IVMPLOG($P($G(^IBA(355.3,DA,0)),U,10))
2)= D EVENT^IVMPLOG($P($G(^IBA(355.3,DA,0)),U,10))
3)= DO NOT DELETE
This cross-reference is used to notify HEC of changes that may affect enrollment.
CROSS-REFERENCE: ^^TRIGGER^355.3^2.02
1)= X ^DD(355.3,.04,1,5,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,2)):^(2),1:"") S X=$P(Y(1),U,2)
,X=X S DIU=X K Y S X=DIV S X=$P(^IBA(355.3,DA,0),U,4) X ^DD(355.3,.04,1,5,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.3,DA,0),U,4)'=$E($P($G(^IBA(355.3,DA,
2)),U,2),1,17))
1.4)= S DIH=$G(^IBA(355.3,DIV(0),2)),DIV=X S $P(^(2),U,2)=DIV,DIH=355.3,DIG=2.02 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.3,DA,0),U,4)="") I X S X=DIV S Y(1)=$S(
$D(^IBA(355.3,D0,2)):^(2),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(355.3,.04,1,5,2.4)
2.4)= S DIH=$G(^IBA(355.3,DIV(0),2)),DIV=X S $P(^(2),U,2)=DIV,DIH=355.3,DIG=2.02 D ^DICR
CREATE CONDITION)= S X=($P(^IBA(355.3,DA,0),U,4)'=$E($P($G(^IBA(355.3,DA,2)),U,2),1,17))
CREATE VALUE)= S X=$P(^IBA(355.3,DA,0),U,4)
DELETE CONDITION)= S X=($P(^IBA(355.3,DA,0),U,4)="")
DELETE VALUE)= @
FIELD)= GROUP NUMBER
Triggers field 2.02 if first 17 chars of its value differ from the value in this field. Deletes
field 2.02 if field .04 is deleted.
355.3,.05 IS UTILIZATION REVIEW REQUIRED 0;5 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: FEB 23, 1993
HELP-PROMPT: Answer "YES" if this policy requires Utilization Review for all billable cases. Otherwise, answer
"NO".
DESCRIPTION: Answer "YES" if Utilization Review is required by the insurance company for this policy. Answer
"NO" if it is not required. The UR staff will automatically be required to follow-up on all
billable cases where this field is answered "YES". If the field is answered "NO" then UR follow-up
will be considered optional.
355.3,.06 IS PRE-CERTIFICATION REQUIRED? 0;6 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: FEB 23, 1993
HELP-PROMPT: Answer "YES" if pre-certification is required by this policy. Otherwise answer "NO".
DESCRIPTION: Answer "YES" if this policy requires Pre-certification of all non-emergent admissions. Answer "NO"
if pre-certification is not required. If pre-certification is required but not obtained,
follow-up will be required by the MCCR tracking module.
355.3,.07 EXCLUDE PRE-EXISTING CONDITION 0;7 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: JUL 02, 1993
HELP-PROMPT: Answer "YES" if this policy excludes any pre existing conditions. Otherwise answer "NO".
DESCRIPTION: Answer "YES" if the policy excludes any pre existing conditions. Answer "NO" if the policy covers
any pre existing conditions. If a patient has pre-exisiting conditions that are not covered they
should be entered in the patient policy comment field.
355.3,.08 BENEFITS ASSIGNABLE? 0;8 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: FEB 23, 1993
DESCRIPTION: If this policy will allow assignment of benefits then answer YES, otherwise answer NO. Normally
this field will be answered YES. However, it may be useful to track policies that do not allow for
assignment of benefits.
355.3,.09 TYPE OF PLAN 0;9 POINTER TO TYPE OF PLAN FILE (#355.1) (audited)
INPUT TRANSFORM: S DIC("S")="I '$P(^(0),U,4)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JUL 11, 2022
HELP-PROMPT: Enter the type of policy that best describes this policy.
DESCRIPTION: Select the type of plan that best describes this plan. The type of policy will be used to
determine if reimbursement for claims from the insurance carrier is appropriate. It will also be
used to determine what other fields and displays are appropriate for this plan. If unknown or
unsure, pick the more general type of plan.
SCREEN: S DIC("S")="I '$P(^(0),U,4)"
EXPLANATION: Active Types of Plans Only!
AUDIT: YES, ALWAYS
CROSS-REFERENCE: ^^TRIGGER^355.3^.14
1)= X ^DD(355.3,.09,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,0)):^(0),1:"") S X=$P(Y(1),U,14
),X=X S DIU=X K Y S X="" X ^DD(355.3,.09,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(355.3,.09,1,1,69.4) S X=X S Y=X,X=Y(107),X=X S X
=X[Y,X=$S(Y(103):Y(105),Y(106):X) S D0=I(0,0)
1.4)= S DIH=$S($D(^IBA(355.3,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,14)=DIV,DIH=355.3,DIG=.14 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= X ^DD(355.3,.09,1,1,2.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,0)):^(0),1:"") S X=$P(Y(1),U,14
),X=X S DIU=X K Y S X="" X ^DD(355.3,.09,1,1,2.4)
2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(355.3,.09,1,1,79.4) S X=X S Y=X,X=Y(107),X=X S X
=X[Y,X=$S(Y(103):Y(105),Y(106):X) S D0=I(0,0)
2.4)= S DIH=$S($D(^IBA(355.3,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,14)=DIV,DIH=355.3,DIG=.14 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
3)= Do not delete
69.2)= S I(0,0)=$S($D(D0):D0,1:""),Y(2)=$S($D(^IBA(355.3,D0,0)):^(0),1:""),D0=Y(0) S:'$D(^IBE(355.1
,+D0,0)) D0=-1 S Y(102)=$C(59)_$S($D(^DD(355.1,.03,0)):$P(^(0),U,3),1:"")
69.3)= X ^DD(355.3,.09,1,1,69.2) S Y(101)=$S($D(^IBE(355.1,D0,0)):^(0),1:"") S X=$P($P(Y(102),$C(59
)_$P(Y(101),U,3)_":",2),$C(59),1)="MEDICARE",Y(103)=X S X="ABC"
69.4)= X ^DD(355.3,.09,1,1,69.3) S Y(104)=X S X=$P(Y(2),U,14),X=X S Y=X,X=Y(104),X=X S X=X'[Y,Y(105
)=X S X=1,Y(106)=X S X="ABC",Y(107)=X S X=$P(Y(2),U,14)
79.2)= S I(0,0)=$S($D(D0):D0,1:""),Y(1)=$S($D(^IBA(355.3,D0,0)):^(0),1:""),D0=$P(Y(1),U,9) S:'$D(^I
BE(355.1,+D0,0)) D0=-1 S Y(102)=$C(59)_$S($D(^DD(355.1,.03,0)):$P(^(0),U,3),1:"")
79.3)= X ^DD(355.3,.09,1,1,79.2) S Y(101)=$S($D(^IBE(355.1,D0,0)):^(0),1:"") S X=$P($P(Y(102),$C(59
)_$P(Y(101),U,3)_":",2),$C(59),1)="MEDICARE",Y(103)=X S X="ABC"
79.4)= X ^DD(355.3,.09,1,1,79.3) S Y(104)=X S X=$P(Y(1),U,14),X=X S Y=X,X=Y(104),X=X S X=X'[Y,Y(105
)=X S X=1,Y(106)=X S X="ABC",Y(107)=X S X=$P(Y(1),U,14)
CREATE CONDITION)= $S(TYPE OF PLAN:MAJOR CATEGORY="MEDICARE":"ABC"'[INTERNAL(PLAN CATEGORY),1:"ABC"
[INTERNAL(PLAN CATEGORY))
CREATE VALUE)= @
DELETE CONDITION)= $S(TYPE OF PLAN:MAJOR CATEGORY="MEDICARE":"ABC"'[INTERNAL(PLAN CATEGORY),1:"ABC"
[INTERNAL(PLAN CATEGORY))
DELETE VALUE)= @
FIELD)= PLAN CATEGORY
This trigger makes sure that if the type of plan has a MEDICARE major category, the PLAN CATEGORY
is either null or is A, B, or C. Also, if the type of plan does not have a MEDICARE major
category, that the PLAN CATEGORY field is deleted.
355.3,.1 INDIVIDUAL POLICY PATIENT 0;10 POINTER TO PATIENT FILE (#2)
LAST EDITED: JUN 01, 1993
DESCRIPTION: This is the patient associated with this policy if this is an individual policy.
If this is an individual policy, the system will store the patient in this field. Only one patient
may be associated with an individual policy. Many patients can be associated with a group policy.
355.3,.11 INACTIVE 0;11 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: NOV 02, 1994
HELP-PROMPT: ENTER 'YES' IF THIS PLAN IS INACTIVE AND SHOULD NO LONGER BE ALLOWED FOR SELECTION.
DESCRIPTION: If this plan is no longer active in your area, enter INACTIVE here. This will disallow users from
selecting this entry.
355.3,.12 AMBULATORY CARE CERTIFICATION 0;12 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: AUG 13, 1997
HELP-PROMPT: Answer "YES" if certification is required by this plan for ambulatory care.
DESCRIPTION: Answer "YES" if this plan requires certification of ambulatory procedures. This may include
Ambulatory surgeries, CAT scans, MRI, non-invasive procedures, etc.
355.3,.13 PLAN FILING TIME FRAME 0;13 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: SEP 03, 1997
HELP-PROMPT: Enter maximum amount of time from date of service that this Plan allows for submitting a claim.
Answer must be 3-30 characters in length.
DESCRIPTION: This is the maximum amount of time from the date of service to submission of the claim allowed by
this Insurance Plan. Examples: 60 days, 90 days, 6 months, 1 year, March 30 following year of
service.
355.3,.14 PLAN CATEGORY 0;14 SET
'A' FOR MEDICARE PART A;
'B' FOR MEDICARE PART B;
'C' FOR MEDICARE OTHER;
LAST EDITED: JUL 30, 1998
HELP-PROMPT: Select the specific type of Category this MEDICARE plan covers.
DESCRIPTION: If the Type of Plan's Major Category is MEDICARE, this field should contain the specific type of
coverage that this plan represents.
SCREEN: S DIC("S")="I $$CATOK^IBCEMRA(Y)"
EXPLANATION: Type of plan Major Category must equal MEDICARE
NOTES: TRIGGERED by the TYPE OF PLAN field of the GROUP INSURANCE PLAN File
355.3,.15 ELECTRONIC PLAN TYPE 0;15 SET
'16' FOR HMO MEDICARE;
'MX' FOR MEDICARE A or B;
'TV' FOR TITLE V;
'MC' FOR MEDICAID;
'BL' FOR BC/BS;
'CH' FOR TRICARE;
'15' FOR INDEMNITY;
'CI' FOR COMMERCIAL;
'HM' FOR HMO;
'DS' FOR DISABILITY;
'12' FOR PPO;
'13' FOR POS;
'ZZ' FOR OTHER;
'FI' FOR FEP - Do not use for BC/BS;
'17' FOR DENTAL;
LAST EDITED: MAY 22, 2014
HELP-PROMPT: Enter the appropriate type of plan to be used for electronic billing.
DESCRIPTION:
This field contains the X12 data to identify the source of pay type.
TECHNICAL DESCR: This field must be consistent with the ELECTRONIC TYPE OF INSURANCE (#3.09) field in the INSURANCE
COMPANY (#36) file.
355.3,.16 PLAN STANDARD FTF 0;16 POINTER TO INSURANCE FILING TIME FRAME FILE (#355.13) (audited)
LAST EDITED: APR 02, 2015
HELP-PROMPT: Enter the maximum standard filing time frame for this plan.
DESCRIPTION: This is the standard filing time frame for the insurance plan. It may be automatically applied to
dates of service.
AUDIT: YES, ALWAYS
CROSS-REFERENCE: ^^TRIGGER^355.3^.17
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.3,D0,0)):^(0),1:"") S X=$P(Y(1),U,17),X=X S
DIU=X K Y S X="" S DIH=$G(^IBA(355.3,DIV(0),0)),DIV=X S $P(^(0),U,17)=DIV,DIH=355.3,DIG=.17 D ^DIC
R
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.3,D0,0)):^(0),1:"") S X=$P(Y(1),U,17),X=X S
DIU=X K Y S X="" S DIH=$G(^IBA(355.3,DIV(0),0)),DIV=X S $P(^(0),U,17)=DIV,DIH=355.3,DIG=.17 D ^DIC
R
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= PLAN STANDARD FTF VALUE
When changing or deleting Standard Filing Time Frame delete the corresponding Value.
355.3,.17 PLAN STANDARD FTF VALUE 0;17 NUMBER (audited)
INPUT TRANSFORM: K:+X'=X!(X>999999)!(X<0)!(X?.E1"."2N.N) X
LAST EDITED: APR 02, 2015
HELP-PROMPT: Type a Number between 0 and 999999, 1 Decimal Digit
DESCRIPTION: Enter the value corresponding to the Standard Filing Time Frame. For example, for the time frame of
Days, enter the number of days.
AUDIT: YES, ALWAYS
NOTES: TRIGGERED by the PLAN STANDARD FTF field of the GROUP INSURANCE PLAN File
355.3,1.01 DATE ENTERED 1;1 DATE
INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: NOV 02, 1993
DESCRIPTION:
This is the date that this policy was entered. It is triggered by the creation of this entry.
NOTES: TRIGGERED by the INSURANCE COMPANY field of the GROUP INSURANCE PLAN File
355.3,1.02 ENTERED BY 1;2 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JUN 03, 1993
DESCRIPTION: This is the user who created this entry. It is automatically triggered by the creation of this
entry.
NOTES: TRIGGERED by the INSURANCE COMPANY field of the GROUP INSURANCE PLAN File
355.3,1.03 DATE LAST VERIFIED 1;3 DATE
INPUT TRANSFORM: S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 03, 1993
DESCRIPTION: This is the date that this policy was last verified. A policy is verified by selecting the Verify
Policy Action on the Patient Insurance Management screen. Generally this is the last time that
somebody contacted the insurance company and verified that policy information is correct.
355.3,1.04 VERIFIED BY 1;4 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JUN 03, 1993
DESCRIPTION:
This is the user who last verified that the policy information is correct.
355.3,1.05 DATE LAST EDITED 1;5 DATE
INPUT TRANSFORM: S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 03, 1993
DESCRIPTION: This is the date that this policy was last edited. It is automatically updated any time a policy
is editing using one of the options provided.
355.3,1.06 LAST EDITED BY 1;6 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JUN 03, 1993
DESCRIPTION: This is the user who last edited this policy. It is automatically updated everytime a policy is
edited using one of the options.
355.3,1.07 DATE LAST MATCHED 1;7 DATE
INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:X<1 X
LAST EDITED: JUL 05, 2018
HELP-PROMPT: (No range limit on date)
DESCRIPTION:
This is the date the policy was last matched.
355.3,1.08 LAST MATCHED BY 1;8 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JUL 05, 2018
DESCRIPTION:
This is the user who last matched the policy.
355.3,2.01 GROUP NAME 2;1 FREE TEXT (audited)
INPUT TRANSFORM: K:$L(X)>80!($L(X)<2)!'$$LENCHK^IBCNEUT1(X,20,0) X
LAST EDITED: APR 02, 2015
HELP-PROMPT: Answer must be 2-20 characters in length.
DESCRIPTION: If this is a group policy, enter the name of the group that this policy is associated with. This is
the name that the insurance company uses to identify the plan. This will appear on the health
claims forms in the appropriate blocks. It will also be used to help identify this policy so that
other patients with the same plan can be associated with it.
TECHNICAL DESCR:
Replaces field .03. Length of this field is temporarily limited to 20 characters.
AUDIT: YES, ALWAYS
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the *GROUP NAME field of the GROUP INSURANCE PLAN File
CROSS-REFERENCE: ^^TRIGGER^355.3^.03
1)= X ^DD(355.3,2.01,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,0)):^(0),1:"") S X=$P(Y(1),U,3
),X=X S DIU=X K Y S X=DIV S X=$E($P(^IBA(355.3,DA,2),U),1,20) X ^DD(355.3,2.01,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.3,DA,0),U,3)'=$E($P(^IBA(355.3,DA,2),
U),1,20))
1.4)= S DIH=$G(^IBA(355.3,DIV(0),0)),DIV=X S $P(^(0),U,3)=DIV,DIH=355.3,DIG=.03 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.3,DA,2),U)="") I X S X=DIV S Y(1)=$S($D
(^IBA(355.3,D0,0)):^(0),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(355.3,2.01,1,1,2.4)
2.4)= S DIH=$G(^IBA(355.3,DIV(0),0)),DIV=X S $P(^(0),U,3)=DIV,DIH=355.3,DIG=.03 D ^DICR
CREATE CONDITION)= S X=($P(^IBA(355.3,DA,0),U,3)'=$E($P(^IBA(355.3,DA,2),U),1,20))
CREATE VALUE)= S X=$E($P(^IBA(355.3,DA,2),U),1,20)
DELETE CONDITION)= S X=($P(^IBA(355.3,DA,2),U)="")
DELETE VALUE)= @
FIELD)= *GROUP NAME
Triggers field .03 if its value differs from first 20 chars of the value in this field. Deletes
field .03 if field 2.01 is deleted.
355.3,2.02 GROUP NUMBER 2;2 FREE TEXT (audited)
INPUT TRANSFORM: K:$L(X)>55!($L(X)<2)!'$$LENCHK^IBCNEUT1(X,17,0) X
LAST EDITED: APR 27, 2020
HELP-PROMPT: Answer must be 2-17 characters in length.
DESCRIPTION: If this is a group policy enter the number which identifies this policy, i.e. group number/code
that the insurance company uses to identify this plan.
TECHNICAL DESCR: DEVELOPERS, as long as there is a trigger to another field which has a cross-reference calling the
EVENT^IVMPLOG tag, contact the Enrollment System (ES) leadership if your patch modification will
result in mass updates to this field upon installation.
Replaces field .04. Length of this field is temporarily limited to 17 characters.
AUDIT: YES, ALWAYS
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the *GROUP NUMBER field of the GROUP INSURANCE PLAN File
CROSS-REFERENCE: ^^TRIGGER^355.3^.04
1)= X ^DD(355.3,2.02,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.3,D0,0)):^(0),1:"") S X=$P(Y(1),U,4
),X=X S DIU=X K Y S X=DIV S X=$E($P(^IBA(355.3,DA,2),U,2),1,17) X ^DD(355.3,2.02,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.3,DA,0),U,4)'=$E($P(^IBA(355.3,DA,2),
U,2),1,17))
1.4)= S DIH=$G(^IBA(355.3,DIV(0),0)),DIV=X S $P(^(0),U,4)=DIV,DIH=355.3,DIG=.04 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.3,DA,2),U,2)="") I X S X=DIV S Y(1)=$S(
$D(^IBA(355.3,D0,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X="" X ^DD(355.3,2.02,1,1,2.4)
2.4)= S DIH=$G(^IBA(355.3,DIV(0),0)),DIV=X S $P(^(0),U,4)=DIV,DIH=355.3,DIG=.04 D ^DICR
CREATE CONDITION)= S X=($P(^IBA(355.3,DA,0),U,4)'=$E($P(^IBA(355.3,DA,2),U,2),1,17))
CREATE VALUE)= S X=$E($P(^IBA(355.3,DA,2),U,2),1,17)
DELETE CONDITION)= S X=($P(^IBA(355.3,DA,2),U,2)="")
DELETE VALUE)= @
FIELD)= *GROUP NUMBER
Triggers field .04 if its value differs from first 17 chars of the value in this field. Deletes
field .04 if field 2.02 is deleted.
355.3,6.01 PLAN ID 6;1 POINTER TO PLAN FILE (#366.03)
LAST EDITED: NOV 10, 2003
HELP-PROMPT: Enter the Group Insurance Plan's Plan ID.
DESCRIPTION:
The Group Insurance Plan's Plan ID.
355.3,6.02 BANKING IDENTIFICATION NUMBER 6;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: APR 08, 2004
HELP-PROMPT: Enter the Plan's Banking Identification Number (BIN). Answer must be 1-10 characters in length.
DESCRIPTION:
The Plan's Banking Identification Number (BIN). Used for NCPDP transmissions.
355.3,6.03 PROCESSOR CONTROL NUMBER (PCN) 6;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: APR 08, 2004
HELP-PROMPT: Enter the Plan's Processor Control Number (PCN). Answer must be 1-20 characters in length.
DESCRIPTION:
The Plan's Processor Control Number (PCN). Used for NCPDP transmissions.
355.3,11 COMMENTS 11;0 WORD-PROCESSING #355.311
DESCRIPTION: Enter comments that are specific to this group plan. Do not enter comments about a specific
patient or patient care here.
LAST EDITED: NOV 09, 1993
HELP-PROMPT: Enter comments specific to this Group Plan. These comments will pertain to multiple patients who
have this same group plan.
FILES POINTED TO FIELDS
INSURANCE COMPANY (#36) INSURANCE COMPANY (#.01)
INSURANCE FILING TIME FRAME
(#355.13) PLAN STANDARD FTF (#.16)
NEW PERSON (#200) ENTERED BY (#1.02)
VERIFIED BY (#1.04)
LAST EDITED BY (#1.06)
LAST MATCHED BY (#1.08)
PATIENT (#2) INDIVIDUAL POLICY PATIENT (#.1)
PLAN (#366.03) PLAN ID (#6.01)
TYPE OF PLAN (#355.1) TYPE OF PLAN (#.09)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):