STANDARD DATA DICTIONARY #355.33 -- INSURANCE VERIFICATION PROCESSOR FILE 6/27/25 PAGE 1
STORED IN ^IBA(355.33, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
-----------------------------------------------------------------------------------------------------------------------------------
This file contains insurance information accumulated by various sources. The data is held in this file until an authorized person
processes the information by either rejecting it or moving it to the Insurance files.
Once an entry is processed most of the data is deleted leaving a stub entry in this file which can be used for reporting and
tracking purposes.
DD ACCESS: @
RD ACCESS: @
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
AUDIT ACCESS: @
POINTED TO BY: BUFFER ENTRY field (#.04) of the IIV RESPONSE File (#365)
BUFFER ENTRY field (#.05) of the IIV TRANSMISSION QUEUE File (#365.1)
SENDER BUFFER field (#1.05) of the INTERFACILITY INSURANCE UPDATE File (#365.19)
RECEIVER BUFFER field (#2.03) of the INTERFACILITY INSURANCE UPDATE File (#365.19)
CROSS
REFERENCED BY: DATE ENTERED(AEST), STATUS(AEST1), DATE ENTERED(AFST), DATE PROCESSED(AFST1), DATE VERIFIED(AFST2),
EFFECTIVE DATE(AI), PT. RELATIONSHIP TO INSURED(AI1), DATE ENTERED(B), PATIENT NAME(C),
INSURANCE COMPANY NAME(D), BPS RESPONSE(E)
355.33,.01 DATE ENTERED 0;1 DATE (Required)
INPUT TRANSFORM: S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: SEP 09, 1998
HELP-PROMPT: Enter the date this entry is added to the Insurance Buffer file.
DESCRIPTION:
This is the date this entry is added to the buffer file.
CROSS-REFERENCE: 355.33^B
1)= S ^IBA(355.33,"B",$E(X,1,30),DA)=""
2)= K ^IBA(355.33,"B",$E(X,1,30),DA)
CROSS-REFERENCE: ^^TRIGGER^355.33^.02
1)= X ^DD(355.33,.01,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,
2),X=X S DIU=X K Y S X=DIV S X=DUZ X ^DD(355.33,.01,1,2,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$S('$D(
^VA(200,+$P(Y(1),U,2),0)):"",1:$P(^(0),U,1))=""
1.4)= S DIH=$S($D(^IBA(355.33,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,2)=DIV,DIH=355.33,DIG=.02 D ^
DICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= ENTERED BY=""
CREATE VALUE)= S X=DUZ
DELETE VALUE)= NO EFFECT
FIELD)= ENTERED BY
Set Entered By to the user who created the entry.
CROSS-REFERENCE: ^^TRIGGER^355.33^.04
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(355.33,.01,1,3,69.2) S X=X="" I X S X=DIV S Y(1)=$
S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X=DIV S X="E" X ^DD(355.33,.0
1,1,3,1.4)
1.4)= S DIH=$S($D(^IBA(355.33,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,4)=DIV,DIH=355.33,DIG=.04 D ^
DICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
69.2)= S Y(2)=$C(59)_$S($D(^DD(355.33,.04,0)):$P(^(0),U,3),1:""),Y(1)=$S($D(^IBA(355.33,D0,0)):^(0)
,1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,4)_":",2),$C(59),1)
CREATE CONDITION)= STATUS=""
CREATE VALUE)= S X="E"
DELETE VALUE)= NO EFFECT
FIELD)= STATUS
Set initial Status to Entered.
CROSS-REFERENCE: 355.33^AEST^MUMPS
1)= I $P($G(^IBA(355.33,DA,0)),U,4)'="" S ^IBA(355.33,"AEST",$P(^(0),U,4),X,DA)=""
2)= I $P($G(^IBA(355.33,DA,0)),U,4)'="" K ^IBA(355.33,"AEST",$P(^(0),U,4),X,DA)
Cross reference by Status and Date Entered.
CROSS-REFERENCE: 355.33^AFST^MUMPS
1)= S ^IBA(355.33,"AFST","E",X,DA)=""
2)= K ^IBA(355.33,"AFST","E",X,DA)
Cross reference of all entries by action and date of action.
355.33,.02 ENTERED BY 0;2 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter the user that added this entry.
DESCRIPTION:
This is the user of the source package that entered this insurance entry.
NOTES: TRIGGERED by the DATE ENTERED field of the INSURANCE VERIFICATION PROCESSOR File
355.33,.03 SOURCE OF INFORMATION 0;3 POINTER TO SOURCE OF INFORMATION FILE (#355.12)
OUTPUT TRANSFORM: S Y=$$GET1^DIQ(355.12,Y_",",.02,"E")
LAST EDITED: OCT 31, 2006
HELP-PROMPT: Enter the source by which this insurance information was obtained.
DESCRIPTION:
This is the source by which this insurance information was obtained.
355.33,.04 STATUS 0;4 SET
'E' FOR ENTERED;
'A' FOR ACCEPTED;
'R' FOR REJECTED;
LAST EDITED: SEP 22, 1999
HELP-PROMPT: Enter the status of this entry.
DESCRIPTION: This is the status of this insurance entry.
E - Entered Locally but not yet processed
A - Processed and Accepted, data moved to Insurance files
R - Processed and Rejected, data Not moved to Insurance files
When an entry is processed most of the data is deleted from the Insurance Buffer file. Entries
with a status of Accepted or Rejected will only have stub entries in this file for reporting and
tracking purposes.
NOTES: TRIGGERED by the DATE ENTERED field of the INSURANCE VERIFICATION PROCESSOR File
CROSS-REFERENCE: ^^TRIGGER^355.33^.05
1)= X ^DD(355.33,.04,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,
5),X=X S DIU=X K Y X ^DD(355.33,.04,1,1,1.1) X ^DD(355.33,.04,1,1,1.4)
1.1)= S X=DIV N %I,%H,% D NOW^%DTC S X=%
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(355.33,.04,1,1,69.3) S X=X="REJECTED",Y=X,X=Y(4)
,X=X!Y,Y=X,X=Y(2),X=X&Y
1.4)= S DIH=$S($D(^IBA(355.33,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,5)=DIV,DIH=355.33,DIG=.05 D ^
DICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
69.2)= S Y(3)=$C(59)_$S($D(^DD(355.33,.04,0)):$P(^(0),U,3),1:""),Y(5)=$C(59)_$S($D(^DD(355.33,.04,0
)):$P(^(0),U,3),1:""),Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"")
69.3)= X ^DD(355.33,.04,1,1,69.2) S X=$P(Y(1),U,5)="",Y(2)=X S X=$P($P(Y(3),$C(59)_Y(0)_":",2),$C(5
9),1)="ACCEPTED",Y(4)=X S X=$P($P(Y(5),$C(59)_Y(0)_":",2),$C(59),1)
CREATE CONDITION)= (DATE PROCESSED="")&(STATUS="ACCEPTED"!(STATUS="REJECTED"))
CREATE VALUE)= NOW
DELETE VALUE)= NO EFFECT
FIELD)= DATE PROCESSED
Set Date Processed when Status is changed.
CROSS-REFERENCE: 355.33^AEST1^MUMPS
1)= I +$P($G(^IBA(355.33,DA,0)),U,1) S ^IBA(355.33,"AEST",X,+$P(^(0),U,1),DA)=""
2)= I +$P($G(^IBA(355.33,DA,0)),U,1) K ^IBA(355.33,"AEST",X,+$P(^(0),U,1),DA)
Cross reference by Status and Date Entered.
355.33,.05 DATE PROCESSED 0;5 DATE
INPUT TRANSFORM: S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: SEP 09, 1998
HELP-PROMPT: Enter the date this entry is processed by insurance personnel.
DESCRIPTION: This is the date authorized insurance personnel either accepted or rejected the information in this
entry.
NOTES: TRIGGERED by the STATUS field of the INSURANCE VERIFICATION PROCESSOR File
CROSS-REFERENCE: ^^TRIGGER^355.33^.06
1)= X ^DD(355.33,.05,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,
6),X=X S DIU=X K Y S X=DIV S X=DUZ X ^DD(355.33,.05,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$S('$D(
^VA(200,+$P(Y(1),U,6),0)):"",1:$P(^(0),U,1))=""
1.4)= S DIH=$S($D(^IBA(355.33,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,6)=DIV,DIH=355.33,DIG=.06 D ^
DICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= PROCESSED BY=""
CREATE VALUE)= S X=DUZ
DELETE VALUE)= NO EFFECT
FIELD)= PROCESSED BY
Set Processed By to the user who processed the entry.
CROSS-REFERENCE: 355.33^AFST1^MUMPS
1)= I $P($G(^IBA(355.33,DA,0)),U,4)'="" S ^IBA(355.33,"AFST",$P(^(0),U,4),X,DA)=""
2)= I $P($G(^IBA(355.33,DA,0)),U,4)'="" K ^IBA(355.33,"AFST",$P(^(0),U,4),X,DA)
Cross reference of all entries by action and date of action.
355.33,.06 PROCESSED BY 0;6 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter the insurance user who processed this entry.
DESCRIPTION:
This is the insurance user who accepted or rejected this entry.
NOTES: TRIGGERED by the DATE PROCESSED field of the INSURANCE VERIFICATION PROCESSOR File
355.33,.07 NEW COMPANY 0;7 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter Yes if this entry resulted in a new Insurance Company.
DESCRIPTION: This flag indicates if this buffer entry resulted in a new Insurance Company being created. This
will only be Yes if the buffer entry was accepted and a new Insurance Company entry was added to
the Insurance Company File.
355.33,.08 NEW GROUP/PLAN 0;8 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter Yes if this entry resulted in a new Insurance Group/Plan.
DESCRIPTION: This flag indicates if this buffer entry resulted in a new Group/Plan being created. This will
only be Yes if the buffer entry was accepted and a new Group/Plan entry was added to the Group
Insurance Plan file.
355.33,.09 NEW POLICY 0;9 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter Yes if this entry resulted in a new Insurance Policy for this patient.
DESCRIPTION: This flag indicates if this buffer entry resulted in a new Patient Insurance Policy being created.
This will only be Yes if the buffer entry was accepted and a new Policy entry was added for this
patient.
355.33,.1 DATE VERIFIED 0;10 DATE
INPUT TRANSFORM: S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: SEP 22, 1999
HELP-PROMPT: This is the date the Buffer entry is verified by insurance personnel.
DESCRIPTION: This is the date insurance personnel verified this insurance information is correct. This will
only be used if the verification step was completed separately from the acceptance step of the
process.
CROSS-REFERENCE: ^^TRIGGER^355.33^.11
1)= X ^DD(355.33,.1,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,1
1),X=X S DIU=X K Y S X=DIV S X=DUZ X ^DD(355.33,.1,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$S('$D(
^VA(200,+$P(Y(1),U,11),0)):"",1:$P(^(0),U,1))=""
1.4)= S DIH=$S($D(^IBA(355.33,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,11)=DIV,DIH=355.33,DIG=.11 D
^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= VERIFIED BY=""
CREATE VALUE)= S X=DUZ
DELETE VALUE)= NO EFFECT
FIELD)= VERIFIED BY
Set Verified By to the user who verified the entry.
CROSS-REFERENCE: 355.33^AFST2^MUMPS
1)= S ^IBA(355.33,"AFST","V",X,DA)=""
2)= K ^IBA(355.33,"AFST","V",X,DA)
Cross reference of all entries by action and date of action.
355.33,.11 VERIFIED BY 0;11 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: AUG 04, 1998
HELP-PROMPT: This is the insurance user who verified this insurance information.
DESCRIPTION: This is the insurance user that verified this insurance information is correct. This should only
be entered if the entry is verified before it is accepted.
NOTES: TRIGGERED by the DATE VERIFIED field of the INSURANCE VERIFICATION PROCESSOR File
355.33,.12 IIV STATUS 0;12 POINTER TO IIV STATUS TABLE FILE (#365.15)
LAST EDITED: APR 14, 2003
HELP-PROMPT: Enter the IIV status associated with this buffer entry.
DESCRIPTION: This field is a pointer to the IIV STATUS TABLE file. This identifies the visual symbol that
should appear in the IIV status column in the insurance buffer listing of entries. The symbols
appear next to the patient name to indicate the current stage within the electronic verification
process.
355.33,.13 OVERRIDE FRESHNESS FLAG 0;13 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: JUL 08, 2002
HELP-PROMPT: Enter Yes to force an electronic transmission of this entry.
DESCRIPTION: The presence of this flag will alert the Buffer extract process and also the process that
electronically transmits the insurance verification request, that this buffer entry should get
transmitted and sent to the Payer - bypassing the National Insurance Cache. This is regardless of
the freshness date or of any other data elements. This flag trumps everything else in the
electronic verification process.
355.33,.14 REMOTE LOCATION 0;14 POINTER TO INSTITUTION FILE (#4)
LAST EDITED: JUL 15, 2003
HELP-PROMPT: Specify the facility where this insurance information came from.
DESCRIPTION: This is the remote location from where this insurance information was gathered from. This field is
optional and will only be completed if the information came from a remote facility.
355.33,.15 IIV PROCESSED DATE 0;15 DATE
INPUT TRANSFORM: S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUL 22, 2003
HELP-PROMPT: This is the date the response was received using eIIV.
DESCRIPTION: This date/time field is automatically updated when a response is received using the electronic
insurance eligibility communications via the IIV software.
355.33,.16 REAL TIME VERIFICATION 0;16 SET
PROCESSED BY REAL TIME VERIFICATION
'0' FOR NO;
'1' FOR YES;
LAST EDITED: SEP 13, 2010
HELP-PROMPT: Is the buffer entry verified by real time verification?
DESCRIPTION:
Flag that indicates if Real Time Verification processed and verified this insurance buffer entry.
TECHNICAL DESCR: Real Time Verification flag is set to 1 for YES if the insurance buffer entry was successfully
verified by Real Time Verification.
SOURCE OF DATA: SET BY THE REAL TIME VERIFICATION PROCESS
NOTES: TRIGGERED by the INSURANCE COMPANY NAME field of the INSURANCE VERIFICATION PROCESSOR File
TRIGGERED by the *GROUP NAME field of the INSURANCE VERIFICATION PROCESSOR File
TRIGGERED by the *GROUP NUMBER field of the INSURANCE VERIFICATION PROCESSOR File
TRIGGERED by the PATIENT NAME field of the INSURANCE VERIFICATION PROCESSOR File
TRIGGERED by the *SUBSCRIBER ID field of the INSURANCE VERIFICATION PROCESSOR File
TRIGGERED by the INSURED'S DOB field of the INSURANCE VERIFICATION PROCESSOR File
TRIGGERED by the PATIENT ID field of the INSURANCE VERIFICATION PROCESSOR File
TRIGGERED by the GROUP NAME field of the INSURANCE VERIFICATION PROCESSOR File
TRIGGERED by the GROUP NUMBER field of the INSURANCE VERIFICATION PROCESSOR File
TRIGGERED by the SUBSCRIBER ID field of the INSURANCE VERIFICATION PROCESSOR File
355.33,.17 BPS RESPONSE 0;17 POINTER TO BPS RESPONSES FILE (#9002313.03)
LAST EDITED: NOV 15, 2010
HELP-PROMPT: Enter the BPS RESPONSES entry linked with this buffer entry.
DESCRIPTION: This is the payer's response to an Eligibility Inquiry. When an ePharmacy Eligibility Inquiry
transaction is sent to the payer, the payer responds with an NCPDP Eligibility Response transaction
through the ECME engine. This response is stored by default in the BPS RESPONSES file. When this
happens an insurance buffer entry is also created. This field links the buffer entry with the BPS
Response entry.
TECHNICAL DESCR: This field will be automatically populated by the system when receiving Eligibility responses
through the ECME engine. It is only valid for buffer entries that have a Source of Information of
e-Pharmacy.
CROSS-REFERENCE: 355.33^E
1)= S ^IBA(355.33,"E",$E(X,1,30),DA)=""
2)= K ^IBA(355.33,"E",$E(X,1,30),DA)
355.33,.18 SERVICE DATE 0;18 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAY 07, 2013
HELP-PROMPT: Enter the service date to be included in eIV inquiry.
DESCRIPTION:
Service date to be included in eIV inquiry.
355.33,20.01 INSURANCE COMPANY NAME 20;1 FREE TEXT
INPUT TRANSFORM: S X=$$UP^XLFSTR(X),X=$$TRIM^XLFSTR(X) K:$L(X)>30!($L(X)<3) X
LAST EDITED: SEP 02, 2010
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
Enter the name of the Insurance Carrier that provides coverage for this patient.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 355.33^D
1)= S ^IBA(355.33,"D",$E(X,1,30),DA)=""
2)= K ^IBA(355.33,"D",$E(X,1,30),DA)
Insurance Company Cross-reference.
CROSS-REFERENCE: ^^TRIGGER^355.33^.16
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X
S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=D
IV,DIH=355.33,DIG=.16 D ^DICR
2)= Q
CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
DELETE VALUE)= NO EFFECT
FIELD)= REAL TIME
Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time
verification.
355.33,20.02 PHONE NUMBER 20;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Answer must be 7-20 characters in length.
DESCRIPTION:
Enter the phone number at which this insurance company can be reached.
355.33,20.03 BILLING PHONE NUMBER 20;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter the phone number of the billing office for this company. Answer must be 7-20 characters in
length.
DESCRIPTION:
The insurance carriers phone number where inquires about patient billing should be made.
355.33,20.04 PRECERTIFICATION PHONE NUMBER 20;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter the phone number for pre-certification of care with the insurance company, if required.
Answer must be 7-20 characters in length.
DESCRIPTION: If this company requires pre-certification of insurance coverage to be completed prior to a patient
being treated then enter the phone number of the pre-cert office.
355.33,20.05 REIMBURSE? 20;5 SET
'Y' FOR WILL REIMBURSE;
'*' FOR WILL REIMBURSE IF TREATED UNDER VAR 6046(C) OR VAR 6060.2(A);
'**' FOR DEPENDS ON POLICY, CHECK WITH COMPANY;
'N' FOR WILL NOT REIMBURSE;
LAST EDITED: MAR 24, 1998
HELP-PROMPT: Does this company reimburse the VA for care provided to it's policy holders?
DESCRIPTION: Choose from the available list of choices the appropriate code denoting whether or not and under
which circumstances this insurance carrier will reimburse the Dept of Veterans Affairs for care
received.
355.33,21.01 STREET ADDRESS [LINE 1] 21;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>35!($L(X)<3) X
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Answer must be 3-35 characters in length.
DESCRIPTION:
Enter the first line of the insurance company's mailing address street.
355.33,21.02 STREET ADDRESS [LINE 2] 21;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter the second line of the insurance company's mailing address street. Answer must be 3-30
characters in length.
DESCRIPTION: If the insurance company's mailing address street is longer than 1 line, enter the second line
here.
355.33,21.03 STREET ADDRESS [LINE 3] 21;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter the third line of the insurance company's mailing address street. Answer must be 3-30
characters in length.
DESCRIPTION: If the insurance company's mailing address street is longer than 2 lines, enter the third line
here.
355.33,21.04 CITY 21;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>25!($L(X)<2) X
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Answer must be 2-25 characters in length.
DESCRIPTION:
This is the insurance company's mailing address city.
355.33,21.05 STATE 21;5 POINTER TO STATE FILE (#5)
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter the company's mailing address state.
DESCRIPTION:
This is the insurance company's mailing address state.
355.33,21.06 ZIP CODE 21;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<5) X I $D(X) D ZIPIN^VAFADDR
OUTPUT TRANSFORM: D ZIPOUT^VAFADDR
LAST EDITED: FEB 10, 1998
HELP-PROMPT: Enter either a 5 or 9 digit zip code.
DESCRIPTION:
This is the insurance company's mailing address zip code.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
355.33,40.01 IS THIS A GROUP POLICY? 40;1 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter Yes if other patients may be associated with this plan, otherwise enter No.
DESCRIPTION: Some policies are individual policies and are specific to a patient. Many policies are group plans
that cover many patients.
355.33,40.02 *GROUP NAME 40;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<2) X
LAST EDITED: DEC 03, 2013
HELP-PROMPT: Enter the name of the group this policy is associated with. Answer must be 2-20 characters in
length.
DESCRIPTION: This is the name that the insurance company uses to identify this plan.
This field is scheduled for deletion in May 2015.
NOTES: TRIGGERED by the GROUP NAME field of the INSURANCE VERIFICATION PROCESSOR File
CROSS-REFERENCE: ^^TRIGGER^355.33^.16
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X
S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=D
IV,DIH=355.33,DIG=.16 D ^DICR
2)= Q
CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
DELETE VALUE)= NO EFFECT
FIELD)= REAL TIME
Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time
verification.
CROSS-REFERENCE: ^^TRIGGER^355.33^90.01
1)= X ^DD(355.33,40.02,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,90)):^(90),1:"") S X=$P(Y(1
),U,1),X=X S DIU=X K Y S X=DIV S X=$P(^IBA(355.33,DA,40),U,2) X ^DD(355.33,40.02,1,2,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,40),U,2)'=$E($P($G(^IBA(355.33,
DA,90)),U),1,20))
1.4)= S DIH=$G(^IBA(355.33,DIV(0),90)),DIV=X S $P(^(90),U,1)=DIV,DIH=355.33,DIG=90.01 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,40),U,2)="") I X S X=DIV S Y(1)=$
S($D(^IBA(355.33,D0,90)):^(90),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" X ^DD(355.33,40.02,1,2
,2.4)
2.4)= S DIH=$G(^IBA(355.33,DIV(0),90)),DIV=X S $P(^(90),U,1)=DIV,DIH=355.33,DIG=90.01 D ^DICR
CREATE CONDITION)= S X=($P(^IBA(355.33,DA,40),U,2)'=$E($P($G(^IBA(355.33,DA,90)),U),1,20))
CREATE VALUE)= S X=$P(^IBA(355.33,DA,40),U,2)
DELETE CONDITION)= S X=($P(^IBA(355.33,DA,40),U,2)="")
DELETE VALUE)= @
FIELD)= GROUP NAME
Triggers field 90.01 if first 20 chars of its value differ from the value in this field. Deletes
field 90.01 if field 40.02 is deleted.
355.33,40.03 *GROUP NUMBER 40;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<2) X
LAST EDITED: DEC 03, 2013
HELP-PROMPT: Enter the number that identifies this group/plan. Answer must be 2-17 characters in length.
DESCRIPTION: This is the number or code which the insurance company uses to identify this plan.
This field is scheduled for deletion in May 2015.
NOTES: TRIGGERED by the GROUP NUMBER field of the INSURANCE VERIFICATION PROCESSOR File
CROSS-REFERENCE: ^^TRIGGER^355.33^.16
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X
S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=D
IV,DIH=355.33,DIG=.16 D ^DICR
2)= Q
CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
DELETE VALUE)= NO EFFECT
FIELD)= REAL TIME
Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time
verification.
CROSS-REFERENCE: ^^TRIGGER^355.33^90.02
1)= X ^DD(355.33,40.03,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,90)):^(90),1:"") S X=$P(Y(1
),U,2),X=X S DIU=X K Y S X=DIV S X=$P(^IBA(355.33,DA,40),U,3) X ^DD(355.33,40.03,1,2,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,40),U,3)'=$E($P($G(^IBA(355.33,
DA,90)),U,2),1,17))
1.4)= S DIH=$G(^IBA(355.33,DIV(0),90)),DIV=X S $P(^(90),U,2)=DIV,DIH=355.33,DIG=90.02 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,40),U,3)="") I X S X=DIV S Y(1)=$
S($D(^IBA(355.33,D0,90)):^(90),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(355.33,40.03,1,2
,2.4)
2.4)= S DIH=$G(^IBA(355.33,DIV(0),90)),DIV=X S $P(^(90),U,2)=DIV,DIH=355.33,DIG=90.02 D ^DICR
CREATE CONDITION)= S X=($P(^IBA(355.33,DA,40),U,3)'=$E($P($G(^IBA(355.33,DA,90)),U,2),1,17))
CREATE VALUE)= S X=$P(^IBA(355.33,DA,40),U,3)
DELETE CONDITION)= S X=($P(^IBA(355.33,DA,40),U,3)="")
DELETE VALUE)= @
FIELD)= GROUP NUMBER
Triggers field 90.02 if first 17 chars of its value differ from the value in this field. Deletes
field 90.02 if field 40.03 is deleted.
355.33,40.04 UTILITZATION REVIEW REQUIRED 40;4 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter Yes if this plan requires Utilization Review for all billable cases.
DESCRIPTION: If this is answered Yes, then the UR staff will be required to follow-up on all billable cases. If
this is answered No then UR follow-up will be considered optional.
355.33,40.05 PRECERTIFICATION REQUIRED 40;5 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter Yes if pre-certification is required by this plan.
DESCRIPTION:
Enter Yes if this plan requires all non-emergent admissions to be pre-certified.
355.33,40.06 AMBULATORY CARE CERTIFICATION 40;6 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter Yes if certification is required for ambulatory care.
DESCRIPTION: Enter Yes if this plan requires certification of ambulatory procedures. This may include
Ambulatory Surgeries, CAT Scans, MRI, non-invasive procedures, etc.
355.33,40.07 EXCLUDE PREEXISTING CONDITION 40;7 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter Yes if this plan excludes any pre-existing conditions.
DESCRIPTION: Enter Yes if the plan does not cover any pre-existing conditions the patient may have, otherwise
enter No.
355.33,40.08 BENEFITS ASSIGNABLE 40;8 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter Yes if this plan will allow assignment of benefits, otherwise enter No.
DESCRIPTION:
Enter Yes if assignment of benefits is allowed by this plan.
355.33,40.09 TYPE OF PLAN 40;9 POINTER TO TYPE OF PLAN FILE (#355.1)
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: FEB 11, 1998
HELP-PROMPT: Enter the Type of Plan that best describes this plan.
DESCRIPTION: Select the Type of Plan that best describes this plan. The Type of Plan may be used to determine
if reimbursement for claims from the insurance carrier is appropriate.
SCREEN: S DIC("S")="I '$P(^(0),U,4)"
EXPLANATION: Active Types of Plans Only!
355.33,40.1 BANKING IDENTIFICATION NUMBER 40;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: APR 09, 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.
355.33,40.11 PROCESSOR CONTROL NUMBER (PCN) 40;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: APR 09, 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.
355.33,60.01 PATIENT NAME 60;1 POINTER TO PATIENT FILE (#2)
LAST EDITED: SEP 02, 2010
HELP-PROMPT: Enter the patient covered by this insurance.
DESCRIPTION:
This is the patient covered by this insurance policy.
CROSS-REFERENCE: 355.33^C
1)= S ^IBA(355.33,"C",$E(X,1,30),DA)=""
2)= K ^IBA(355.33,"C",$E(X,1,30),DA)
Patient Cross-reference.
CROSS-REFERENCE: ^^TRIGGER^355.33^.16
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X
S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=D
IV,DIH=355.33,DIG=.16 D ^DICR
2)= Q
CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
DELETE VALUE)= NO EFFECT
FIELD)= REAL TIME
Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time
verification.
355.33,60.02 EFFECTIVE DATE 60;2 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X),$P($G(^IBA(355.33,DA,60)),U,3)'="",X>$P(^IBA(355.33,DA,60),
U,3) K X
LAST EDITED: OCT 17, 1998
HELP-PROMPT: The effective date of the policy for this patient, must not be greater than the expiration date.
DESCRIPTION:
This is the date this policy went into effect for this patient.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 355.33^AI^MUMPS
1)= Q
2)= Q
Cross reference to force filing of data so input transform will work.
355.33,60.03 EXPIRATION DATE 60;3 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X),X<$P($G(^IBA(355.33,DA,60)),U,2) K X
LAST EDITED: FEB 17, 1998
HELP-PROMPT: Enter the date this policy expires for this patient, date must not be before policy effective date.
DESCRIPTION: If this insurance policy coverage expires for this patient on a specified date, enter that date,
otherwise leave this blank.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
355.33,60.04 *SUBSCRIBER ID 60;4 FREE TEXT
SUBSCRIBER PRIMARY ID
INPUT TRANSFORM: K:$L(X)>20!($L(X)<3) X
LAST EDITED: DEC 03, 2013
HELP-PROMPT: Answer must be 3-20 characters in length.
DESCRIPTION: Enter the Subscriber's Primary ID number. This number is assigned by the payer and can be found on
the subscriber's insurance card.
This field is scheduled for deletion in May 2015.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the SUBSCRIBER ID field of the INSURANCE VERIFICATION PROCESSOR File
CROSS-REFERENCE: ^^TRIGGER^355.33^.16
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X
S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=D
IV,DIH=355.33,DIG=.16 D ^DICR
2)= Q
CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
DELETE VALUE)= NO EFFECT
FIELD)= REAL TIME
Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time
verification.
CROSS-REFERENCE: ^^TRIGGER^355.33^90.03
1)= X ^DD(355.33,60.04,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,90)):^(90),1:"") S X=$P(Y(1
),U,3),X=X S DIU=X K Y S X=DIV S X=$P(^IBA(355.33,DA,60),U,4) X ^DD(355.33,60.04,1,2,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,60),U,4)'=$E($P($G(^IBA(355.33,
DA,90)),U,3),1,20))
1.4)= S DIH=$G(^IBA(355.33,DIV(0),90)),DIV=X S $P(^(90),U,3)=DIV,DIH=355.33,DIG=90.03 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,60),U,4)="") I X S X=DIV S Y(1)=$
S($D(^IBA(355.33,D0,90)):^(90),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(355.33,60.04,1,2
,2.4)
2.4)= S DIH=$G(^IBA(355.33,DIV(0),90)),DIV=X S $P(^(90),U,3)=DIV,DIH=355.33,DIG=90.03 D ^DICR
CREATE CONDITION)= S X=($P(^IBA(355.33,DA,60),U,4)'=$E($P($G(^IBA(355.33,DA,90)),U,3),1,20))
CREATE VALUE)= S X=$P(^IBA(355.33,DA,60),U,4)
DELETE CONDITION)= S X=($P(^IBA(355.33,DA,60),U,4)="")
DELETE VALUE)= @
FIELD)= SUBSCRIBER ID
Triggers field 90.03 if first 20 chars of its value differ from the value in this field. Deletes
field 90.03 if field 60.04 is deleted.
355.33,60.05 WHOSE INSURANCE 60;5 SET
'v' FOR VETERAN;
's' FOR SPOUSE;
'o' FOR OTHER;
'p' FOR PATIENT;
LAST EDITED: OCT 18, 2005
HELP-PROMPT: Enter who holds the insurance policy (the insured).
DESCRIPTION: Enter 'v' if this insurance policy is held by the veteran, 's' if the veterans spouse holds the
policy, or 'o' if anyone else is the policy holder.
TECHNICAL DESCR: 'p' for PATIENT may be entered if the VistA system is non-VA. 'v' is excluded if the VistA system
is non-VA.
SCREEN: S DIC("S")="I ($G(DUZ(""AG""))'=""V""&(""pso""[Y))!($G(DUZ(""AG""))=""V""&(""vso""[Y))"
EXPLANATION: Exclude VA from selecting 'p' for Patient.
NOTES: TRIGGERED by the PT. RELATIONSHIP TO INSURED field of the INSURANCE VERIFICATION PROCESSOR File
355.33,60.06 PT. RELATIONSHIP TO INSURED 60;6 SET
'01' FOR PATIENT;
'02' FOR SPOUSE;
'03' FOR NATURAL CHILD;
'08' FOR EMPLOYEE;
'09' FOR DO NOT USE;
'11' FOR ORGAN DONOR;
'15' FOR INJURED PLANTIFF;
'18' FOR DO NOT USE;
'32' FOR MOTHER;
'33' FOR FATHER;
'34' FOR SIGNIFICANT OTHER;
'35' FOR LIFE PARTNER;
'36' FOR OTHER RELATIONSHIP;
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Enter the code for the patient's relationship to the insured (or policy holder).
DESCRIPTION: Enter the code which best describes the patient's relationship to the person who holds this policy
(or insured).
SCREEN: S DIC("S")="I X'=""09"",X'=""18"""
EXPLANATION: Cannot use 09 or 18 anymore
NOTES: TRIGGERED by the PT. RELATIONSHIP - HIPAA field of the INSURANCE VERIFICATION PROCESSOR File
CROSS-REFERENCE: 355.33^AI1^MUMPS
1)= Q
2)= Q
Cross reference to force filing of data so input transform will work.
CROSS-REFERENCE: ^^TRIGGER^355.33^60.14
1)= X ^DD(355.33,60.06,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,60)):^(60),1:"") S X=$P(Y(1
),U,14),X=X S DIU=X K Y S X=DIV S X=$$PRELCNV^IBCNSP1($P(^IBA(355.33,DA,60),U,6),1) X ^DD(355.33,60
.06,1,2,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 N Z S Z=$$PRELCNV^IBCNSP1($P(^IBA(355.33,D0,60),U,6),1),X=(Z'="
"&(Z'=$P(^IBA(355.33,D0,60),U,14)))
1.4)= S DIH=$G(^IBA(355.33,DIV(0),60)),DIV=X S $P(^(60),U,14)=DIV,DIH=355.33,DIG=60.14 D ^DICR
2)= Q
CREATE CONDITION)= N Z S Z=$$PRELCNV^IBCNSP1($P(^IBA(355.33,D0,60),U,6),1),X=(Z'=""&(Z'=$P(^IBA(355
.33,D0,60),U,14)))
CREATE VALUE)= S X=$$PRELCNV^IBCNSP1($P(^IBA(355.33,DA,60),U,6),1)
DELETE VALUE)= NO EFFECT
FIELD)= #60.14
Triggers field 60.14 if its value differs from value in this field.
CROSS-REFERENCE: ^^TRIGGER^355.33^60.05
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,60)):^(60),1:"") S X=$P(Y(1),U,5),X=X
S DIU=X K Y S X=DIV S X=$S(+X=1:$S($G(DUZ("AG"))="V":"v",1:"p"),+X=2:"s",1:"o") X ^DD(355.33,60.06
,1,3,1.4)
1.4)= S DIH=$G(^IBA(355.33,DIV(0),60)),DIV=X S $P(^(60),U,5)=DIV,DIH=355.33,DIG=60.05 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,60)):^(60),1:"") S X=$P(Y(1),U,5),X=X
S DIU=X K Y S X="" S DIH=$G(^IBA(355.33,DIV(0),60)),DIV=X S $P(^(60),U,5)=DIV,DIH=355.33,DIG=60.05
D ^DICR
CREATE VALUE)= S X=$S(+X=1:$S($G(DUZ("AG"))="V":"v",1:"p"),+X=2:"s",1:"o")
DELETE VALUE)= @
FIELD)= #60.05
This trigger will set the WHOSE INSURANCE field (60.05). WHOSE INSURANCE will no longer be asked on
user interface screens.
355.33,60.07 *NAME OF INSURED 60;7 FREE TEXT
INPUT TRANSFORM: N Z1 S Z1=$G(^IBA(355.33,DA,60)) S:$P(Z1,U,6)="01"&X X=$P($G(^DPT(+Z1,0)),U,1) K:$L(X)>30!($L(X)<2)
X
LAST EDITED: NOV 20, 2013
HELP-PROMPT: Enter the name of the person who holds the policy. Answer must be 2-30 characters in length.
DESCRIPTION: Enter the name of the individual for which this policy was issued. If the Patients Relationship to
the Insured is 'Patient' then this name will default to the patients name via input transform.
This field is scheduled for deletion in May 2015.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the NAME OF INSURED field of the INSURANCE VERIFICATION PROCESSOR File
CROSS-REFERENCE: ^^TRIGGER^355.33^91.01
1)= X ^DD(355.33,60.07,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,91)):^(91),1:"") S X=$P(Y(1
),U,1),X=X S DIU=X K Y S X=DIV S X=$P(^IBA(355.33,DA,60),U,7) X ^DD(355.33,60.07,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,60),U,7)'=$E($P($G(^IBA(355.33,
DA,91)),U),1,30))
1.4)= S DIH=$G(^IBA(355.33,DIV(0),91)),DIV=X S $P(^(91),U,1)=DIV,DIH=355.33,DIG=91.01 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,60),U,7)="") I X S X=DIV S Y(1)=$
S($D(^IBA(355.33,D0,91)):^(91),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" X ^DD(355.33,60.07,1,1
,2.4)
2.4)= S DIH=$G(^IBA(355.33,DIV(0),91)),DIV=X S $P(^(91),U,1)=DIV,DIH=355.33,DIG=91.01 D ^DICR
CREATE CONDITION)= S X=($P(^IBA(355.33,DA,60),U,7)'=$E($P($G(^IBA(355.33,DA,91)),U),1,30))
CREATE VALUE)= S X=$P(^IBA(355.33,DA,60),U,7)
DELETE CONDITION)= S X=($P(^IBA(355.33,DA,60),U,7)="")
DELETE VALUE)= @
FIELD)= NAME OF INSURED
Triggers field 91.01 if first 30 chars of its value differ from the value in this field. Deletes
field 91.01 if field 60.07 is deleted.
355.33,60.08 INSURED'S DOB 60;8 DATE
INPUT TRANSFORM: S %DT="EXP" D ^%DT S X=Y K:Y<1 X
LAST EDITED: SEP 13, 2010
HELP-PROMPT: Enter the Date of Birth of the policy holder. This is only needed if the patient is not the
insured.
DESCRIPTION: This is the policy holder's (insured's) Date of Birth. This is not needed if the patient is not
the policy holder since the patient's DOB is stored elsewhere.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^355.33^.16
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X
S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=D
IV,DIH=355.33,DIG=.16 D ^DICR
2)= Q
CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
DELETE VALUE)= NO EFFECT
FIELD)= REAL TIME
Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time
verification.
355.33,60.09 INSURED'S SSN 60;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>13!($L(X)<9) X S:$D(X) X=$TR(X,"-","")
OUTPUT TRANSFORM: S Y=$E(Y,1,3)_"-"_$E(Y,4,5)_"-"_$E(Y,6,9)
LAST EDITED: FEB 10, 1998
HELP-PROMPT: If the insured is not the patient enter the insured's SSN. Answer must be 9-13 characters in
length.
DESCRIPTION: This is the policy holders (insured's) social security number. This only needs to be entered if it
is different than the Subscriber Id number and the insured is not the patient.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
355.33,60.1 PRIMARY CARE PROVIDER 60;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: FEB 10, 1998
HELP-PROMPT: If referral is required for VA reimbursement, enter the non-VA provider that referred this patient
to the VA. Answer must be 3-30 characters in length.
DESCRIPTION: This is the patient's Primary Care Provider within their managed care network that referred the
patient to the VA. In some cases if the patients PC Provider refers the patient to the VA their
HMO will reimburse.
355.33,60.11 PRIMARY PROVIDER PHONE 60;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: FEB 10, 1998
HELP-PROMPT: The phone number of the Primary Care Provider that referred the patient to the VA. Answer must be
7-20 characters in length.
DESCRIPTION: This is the phone number of the patients non-VA primary care provider that may refer the patient to
the VA for care.
355.33,60.12 COORDINATION OF BENEFITS 60;12 SET
'1' FOR PRIMARY;
'2' FOR SECONDARY;
'3' FOR TERTIARY;
LAST EDITED: AUG 03, 1998
HELP-PROMPT: Enter the code that best relates where in the payment sequence this policy should be placed.
DESCRIPTION: Enter '1' if this is the patient's primary insurance policy. Enter '2' if this policy is secondary
to (billed after) the primary policy. Enter '3' if this policy is tertiary or billed after the
secondary policy.
355.33,60.13 INSURED'S SEX 60;13 SET
'F' FOR FEMALE;
'M' FOR MALE;
LAST EDITED: OCT 02, 2006
HELP-PROMPT: Enter the sex (M or F) of the policy holder.
DESCRIPTION: This field is used in insurance billing to help verify the policy coverage when the bill is
submitted to the carrier. If the patient is the policy holder, this value should match the
patient's sex. If the patient's spouse or other relative is the policy holder, the appropriate
value should be determined and entered.
355.33,60.14 PT. RELATIONSHIP - HIPAA 60;14 SET
PT. RELATIONSHIP TO INSURED
'01' FOR SPOUSE;
'18' FOR SELF;
'19' FOR CHILD;
'20' FOR EMPLOYEE;
'29' FOR SIGNIFICANT OTHER;
'32' FOR MOTHER;
'33' FOR FATHER;
'39' FOR ORGAN DONOR;
'41' FOR INJURED PLAINTIFF;
'53' FOR LIFE PARTNER;
'G8' FOR OTHER RELATIONSHIP;
LAST EDITED: MAY 13, 2013
HELP-PROMPT: Enter the HIPAA code which indicates the patient's relationship to the injured party.
DESCRIPTION: Select the HIPAA relationship code that describes the relationship this patient has to the holder
of this insurance policy. If the policy belongs to the patient enter '18' for SELF. If the policy
belongs to the spouse enter '01' for SPOUSE, etc.
NOTES: TRIGGERED by the PT. RELATIONSHIP TO INSURED field of the INSURANCE VERIFICATION PROCESSOR File
CROSS-REFERENCE: ^^TRIGGER^355.33^60.06
1)= X ^DD(355.33,60.14,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,60)):^(60),1:"") S X=$P(Y(1
),U,6),X=X S DIU=X K Y S X=DIV S X=$$PRELCNV^IBCNSP1($P(^IBA(355.33,DA,60),U,14),0) X ^DD(355.33,60
.14,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 N Z S Z=$$PRELCNV^IBCNSP1($P(^IBA(355.33,D0,60),U,14),0),X=(Z'=
""&(Z'=$P(^IBA(355.33,D0,60),U,6)))
1.4)= S DIH=$G(^IBA(355.33,DIV(0),60)),DIV=X S $P(^(60),U,6)=DIV,DIH=355.33,DIG=60.06 D ^DICR
2)= Q
CREATE CONDITION)= N Z S Z=$$PRELCNV^IBCNSP1($P(^IBA(355.33,D0,60),U,14),0),X=(Z'=""&(Z'=$P(^IBA(35
5.33,D0,60),U,6)))
CREATE VALUE)= S X=$$PRELCNV^IBCNSP1($P(^IBA(355.33,DA,60),U,14),0)
DELETE VALUE)= NO EFFECT
FIELD)= PT. RELATIONSHIP TO INSURED
Triggers field 60.06 if its value differs from value in this field.
355.33,60.15 PHARMACY RELATIONSHIP CODE 60;15 POINTER TO BPS NCPDP PATIENT RELATIONSHIP CODE FILE (#9002313.19)
LAST EDITED: JUN 21, 2011
HELP-PROMPT: Select the relationship of the patient to the cardholder.
DESCRIPTION: This is the relationship of the patient to the cardholder.
Code Description
---- -----------
0 Not Specified
1 Cardholder - The individual that is enrolled in and receives
benefits from a health plan
2 Spouse - Patient is the husband/wife/partner of the cardholder
3 Child - Patient is a child of the cardholder
4 Other - Relationship to cardholder is not precise
TECHNICAL DESCR:
This field is NCPDP field 306-C6 - Patient Relationship Code
355.33,60.16 PHARMACY PERSON CODE 60;16 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: JUN 21, 2011
HELP-PROMPT: Answer must be 1-3 characters in length.
DESCRIPTION: This is the code that is assigned by the payer to identify the patient. The payer may use a unique
person code to identify each specific person on the pharmacy insurance policy. This code may also
describe the patient's relationship to the cardholder.
Enrollment Standard Examples:
001 = Cardholder
002 = Spouse
003 - 999 = Dependents and Others (including second spouses, etc.)
TECHNICAL DESCR:
This is NCPDP field 303-C3 - Person Code
355.33,61.01 ESGHP? 61;1 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: FEB 10, 1998
HELP-PROMPT: Enter Yes if this policy is part of an Employer Sponsored Group Health Plan.
DESCRIPTION: Enter Yes if this policy is part of a plan that is sponsored or provided by the insured's (policy
holder's) current or past employer.
355.33,61.02 SPONSORING EMPLOYER NAME 61;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter the name of the employer that sponsors this policy. Answer must be 3-30 characters in
length.
DESCRIPTION: If this is an Employer Sponsored Group Health Plan then enter the name of the employer that
sponsors the plan.
355.33,61.03 EMPLOYMENT STATUS 61;3 SET
'1' FOR FULL TIME;
'2' FOR PART TIME;
'3' FOR NOT EMPLOYED;
'4' FOR SELF EMPLOYED;
'5' FOR RETIRED;
'6' FOR ACTIVE MILITARY;
'9' FOR UNKNOWN;
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter the insured's (policy holder's) employment status with the employer that sponsors this plan.
DESCRIPTION: If this plan is an Employer Sponsored Group Health Plan then enter the policy holders employment
status with the sponsoring employer.
355.33,61.04 RETIREMENT DATE 61;4 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter the date the insured retired from the employer that sponsors this plan.
DESCRIPTION: If this plan is an Employer Sponsored Group Health Plan then enter the date the insured retired
from the employer that sponsors the plan.
355.33,61.05 SEND BILL TO EMPLOYER 61;5 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter Yes if the insurance claims should be mailed to the employer for pre-processing.
DESCRIPTION: If this is an Employer Sponsored Group Health Plan and the sponsoring employer requires claims
against the policy be sent first to them for pre-processing, rather than the insurance company,
then enter Yes. You will then be able to enter an address that these bills should be sent to. If
the employer does not require this then the bills will be sent directly to the insurance company.
355.33,61.06 EMPLOYER CLAIMS STREET LINE 1 61;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter the first line of the street address of the employers claims office if the employer
pre-processes insurance claims. Answer must be 3-30 characters in length.
DESCRIPTION: Enter the first line of the street address of the sponsoring employers claims office if this is an
Employer Sponsored Group Health Plan and the sponsoring employer requires claims against the policy
be sent to them for pre-processing.
355.33,61.07 EMPLOYER CLAIMS STREET LINE 2 61;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter the second line of the street address of the employers claims office if the employer
pre-processes insurance claims. Answer must be 3-30 characters in length.
DESCRIPTION: Enter the second line of the street address of the sponsoring employers claims office if this is an
Employer Sponsored Group Health Plan and the sponsoring employer requires claims against the policy
be sent to them for pre-processing.
355.33,61.08 EMPLOYER CLAIMS STREET LINE 3 61;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter the third line of the street address of the employers claims office if the employer
pre-processes insurance claims. Answer must be 3-30 characters in length.
DESCRIPTION: Enter the third line of the street address of the sponsoring employers claims office if this is an
Employer Sponsored Group Health Plan and the sponsoring employer requires claims against the policy
be sent to them for pre-processing.
355.33,61.09 EMPLOYER CLAIMS CITY 61;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<3) X
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter the city of the employers claims office if the employer pre-processes insurance claims.
Answer must be 3-20 characters in length.
DESCRIPTION: Enter the city of the sponsoring employers claims office if this is an Employer Sponsored Group
Health Plan and the sponsoring employer requires claims against the policy be sent to them for
pre-processing.
355.33,61.1 EMPLOYER CLAIMS STATE 61;10 POINTER TO STATE FILE (#5)
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter the state of the employers claims office address if the employer pre-processes insurance
claims. Answer must be 3-30 characters in length.
DESCRIPTION: Enter the State of the sponsoring employers claims office if this is an Employer Sponsored Group
Health Plan and the sponsoring employer requires claims against the policy be sent to them for
pre-processing.
355.33,61.11 EMPLOYER CLAIMS ZIP CODE 61;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<5) X D:$D(X) ZIPIN^VAFADDR
LAST EDITED: MAR 17, 1998
HELP-PROMPT: Enter the zip code of the employers claims office if the employer pre-processes insurance claims.
Answer must be 5 or 9 digits in length.
DESCRIPTION: Enter the zip code of the sponsoring employers claims office if this is an Employer Sponsored Group
Health Plan and the sponsoring employer requires claims against the policy be sent to them for
pre-processing.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
355.33,61.12 EMPLOYER CLAIMS PHONE NUMBER 61;12 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<7) X
LAST EDITED: FEB 09, 1998
HELP-PROMPT: Enter the phone number of the employers claims office if the employer pre-processes insurance
claims. Answer must be 7-15 characters in length.
DESCRIPTION: Enter the phone number of the sponsoring employers claims office if this is an Employer Sponsored
Group Health Plan and the sponsoring employer requires claims against the policy be sent to them
for pre-processing.
355.33,62.01 PATIENT ID 62;1 FREE TEXT
PATIENT PRIMARY ID
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: NOV 14, 2011
HELP-PROMPT: Answer must be 1-30 characters in length
DESCRIPTION: This is the patient's primary ID number for this insurance company. Enter this field when the
patient and the subscriber are different and the patient has a unique ID number.
CROSS-REFERENCE: ^^TRIGGER^355.33^.16
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X
S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=D
IV,DIH=355.33,DIG=.16 D ^DICR
2)= Q
CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
DELETE VALUE)= NO EFFECT
FIELD)= REAL TIME VERIFICATION
Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time
verification.
355.33,62.02 SUBSCRIBER ADDRESS LINE 1 62;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>55!($L(X)<1) X
LAST EDITED: OCT 08, 2009
HELP-PROMPT: Answer must be 1-55 characters in length.
DESCRIPTION:
Subscriber address, line 1.
355.33,62.03 SUBSCRIBER ADDRESS LINE 2 62;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>55!($L(X)<1) X
LAST EDITED: OCT 08, 2009
HELP-PROMPT: Answer must be 1-55 characters in length.
DESCRIPTION:
Subscriber address, line 2.
355.33,62.04 SUBSCRIBER ADDRESS CITY 62;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: OCT 08, 2009
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
Subscriber address, city.
355.33,62.05 SUBSCRIBER ADDRESS STATE 62;5 POINTER TO STATE FILE (#5)
LAST EDITED: OCT 08, 2009
HELP-PROMPT: Please select state.
DESCRIPTION:
Subscriber address, state.
355.33,62.06 SUBSCRIBER ADDRESS ZIP 62;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: OCT 08, 2009
HELP-PROMPT: Answer must be 1-15 characters in length.
DESCRIPTION:
Subscriber address, zip code.
355.33,62.07 SUBSCRIBER ADDRESS COUNTRY 62;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<2) X
LAST EDITED: SEP 16, 2010
HELP-PROMPT: Answer must be 2-3 characters in length.
DESCRIPTION:
Subscriber address, country code.
TECHNICAL DESCR:
Source: 271 HL7 message, PID.11.6.
355.33,62.08 SUBSCRIBER ADDRESS SUBDIVISION 62;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: SEP 16, 2010
HELP-PROMPT: Answer must be 1-3 characters in length.
DESCRIPTION:
Subscriber address, country subdivision code.
TECHNICAL DESCR:
Source: 271 HL7 message, PID.11.8.
355.33,62.09 SUBSCRIBER PHONE 62;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: APR 02, 2015
HELP-PROMPT: Enter the subscriber's phone number. The entry must be 7-20 characters in length.
DESCRIPTION:
This field contains the phone number of the policyholder.
355.33,80.01 INQ SERVICE TYPE CODE 1 80;1 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
First Service Type Code to be sent with eIV insurance inquiry.
355.33,80.02 INQ SERVICE TYPE CODE 2 80;2 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
Second Service Type Code to be sent with eIV Insurance Inquiry.
355.33,80.03 INQ SERVICE TYPE CODE 3 80;3 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
Third Service Type Code to be sent with eIV Insurance Inquiry.
355.33,80.04 INQ SERVICE TYPE CODE 4 80;4 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
Fourth Service Type Code to be sent with eIV Insurance Inquiry.
355.33,80.05 INQ SERVICE TYPE CODE 5 80;5 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
Fifth Service Type Code to be sent with eIV Insurance Inquiry.
355.33,80.06 INQ SERVICE TYPE CODE 6 80;6 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
Sixth Service Type Code to be sent with eIV Insurance Inquiry.
355.33,80.07 INQ SERVICE TYPE CODE 7 80;7 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
Seventh Service Type Code to be sent with eIV Insurance Inquiry.
355.33,80.08 INQ SERVICE TYPE CODE 8 80;8 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
Eighth Service Type Code to be sent with eIV Insurance Inquiry.
355.33,80.09 INQ SERVICE TYPE CODE 9 80;9 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
Ninth Service Type Code to be sent with eIV Insurance Inquiry.
355.33,80.1 INQ SERVICE TYPE CODE 10 80;10 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
Tenth Service Type Code to be sent with eIV Insurance Inquiry.
355.33,80.11 INQ SERVICE TYPE CODE 11 80;11 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
Eleventh Service Type Code to be sent with eIV Insurance Inquiry.
355.33,80.12 INQ SERVICE TYPE CODE 12 80;12 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
Twelfth Service Type Code to be sent with eIV Insurance Inquiry.
355.33,80.13 INQ SERVICE TYPE CODE 13 80;13 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
Thirteenth Service Type Code to be sent with eIV Insurance Inquiry.
355.33,80.14 INQ SERVICE TYPE CODE 14 80;14 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
Fourteenth Service Type Code to be sent with eIV Insurance Inquiry.
355.33,80.15 INQ SERVICE TYPE CODE 15 80;15 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
Fifteenth Service Type Code to be sent with eIV Insurance Inquiry.
355.33,80.16 INQ SERVICE TYPE CODE 16 80;16 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
Sixteenth Service Type Code to be sent with eIV Insurance Inquiry.
355.33,80.17 INQ SERVICE TYPE CODE 17 80;17 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
Seventeenth Service Type Code to be sent with eIV Insurance Inquiry.
355.33,80.18 INQ SERVICE TYPE CODE 18 80;18 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
Eighteenth Service Type Code to be sent with eIV Insurance Inquiry.
355.33,80.19 INQ SERVICE TYPE CODE 19 80;19 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
Nineteenth Service Type Code to be sent with eIV Insurance Inquiry.
355.33,80.2 INQ SERVICE TYPE CODE 20 80;20 POINTER TO X12 271 SERVICE TYPE FILE (#365.013)
LAST EDITED: AUG 22, 2010
HELP-PROMPT: Enter service type code to be sent with eIV insurance inquiry.
DESCRIPTION:
Twentieth Service Type Code to be sent with eIV Insurance Inquiry.
355.33,90.01 GROUP NAME 90;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<2)!'$$LENCHK^IBCNEUT1(X,20,0) X
LAST EDITED: DEC 03, 2013
HELP-PROMPT: Answer must be 2-20 characters in length.
DESCRIPTION:
This is the name that the insurance company uses to identify this plan.
TECHNICAL DESCR:
Replaces field 40.02. Length of this field is temporarily limited to 20 characters.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the *GROUP NAME field of the INSURANCE VERIFICATION PROCESSOR File
CROSS-REFERENCE: ^^TRIGGER^355.33^40.02
1)= X ^DD(355.33,90.01,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,40)):^(40),1:"") S X=$P(Y(1
),U,2),X=X S DIU=X K Y S X=DIV S X=$E($P(^IBA(355.33,DA,90),U),1,20) X ^DD(355.33,90.01,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P($G(^IBA(355.33,DA,40)),U,2)'=$E($P(^IBA(355.33
,DA,90),U),1,20))
1.4)= S DIH=$G(^IBA(355.33,DIV(0),40)),DIV=X S $P(^(40),U,2)=DIV,DIH=355.33,DIG=40.02 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,90),U)="") I X S X=DIV S Y(1)=$S(
$D(^IBA(355.33,D0,40)):^(40),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(355.33,90.01,1,1,2
.4)
2.4)= S DIH=$G(^IBA(355.33,DIV(0),40)),DIV=X S $P(^(40),U,2)=DIV,DIH=355.33,DIG=40.02 D ^DICR
CREATE CONDITION)= S X=($P($G(^IBA(355.33,DA,40)),U,2)'=$E($P(^IBA(355.33,DA,90),U),1,20))
CREATE VALUE)= S X=$E($P(^IBA(355.33,DA,90),U),1,20)
DELETE CONDITION)= S X=($P(^IBA(355.33,DA,90),U)="")
DELETE VALUE)= @
FIELD)= *GROUP NAME
Triggers field 40.02 if its value differs from first 20 chars of the value in this field. Deletes
field 40.02 if field 90.01 is deleted.
CROSS-REFERENCE: ^^TRIGGER^355.33^.16
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X
S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=D
IV,DIH=355.33,DIG=.16 D ^DICR
2)= Q
CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
DELETE VALUE)= NO EFFECT
FIELD)= REAL TIME
Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time
verification.
355.33,90.02 GROUP NUMBER 90;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>55!($L(X)<2)!'$$LENCHK^IBCNEUT1(X,17,0) X
LAST EDITED: DEC 03, 2013
HELP-PROMPT: Answer must be 2-17 characters in length.
DESCRIPTION:
This is the number or code which the insurance company uses to identify this plan.
TECHNICAL DESCR:
Replaces field 40.03. Length of this field is temporarily limited to 17 characters.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the *GROUP NUMBER field of the INSURANCE VERIFICATION PROCESSOR File
CROSS-REFERENCE: ^^TRIGGER^355.33^40.03
1)= X ^DD(355.33,90.02,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,40)):^(40),1:"") S X=$P(Y(1
),U,3),X=X S DIU=X K Y S X=DIV S X=$E($P(^IBA(355.33,DA,90),U,2),1,17) X ^DD(355.33,90.02,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P($G(^IBA(355.33,DA,40)),U,3)'=$E($P(^IBA(355.33
,DA,90),U,2),1,17))
1.4)= S DIH=$G(^IBA(355.33,DIV(0),40)),DIV=X S $P(^(40),U,3)=DIV,DIH=355.33,DIG=40.03 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,90),U,2)="") I X S X=DIV S Y(1)=$
S($D(^IBA(355.33,D0,40)):^(40),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(355.33,90.02,1,1
,2.4)
2.4)= S DIH=$G(^IBA(355.33,DIV(0),40)),DIV=X S $P(^(40),U,3)=DIV,DIH=355.33,DIG=40.03 D ^DICR
CREATE CONDITION)= S X=($P($G(^IBA(355.33,DA,40)),U,3)'=$E($P(^IBA(355.33,DA,90),U,2),1,17))
CREATE VALUE)= S X=$E($P(^IBA(355.33,DA,90),U,2),1,17)
DELETE CONDITION)= S X=($P(^IBA(355.33,DA,90),U,2)="")
DELETE VALUE)= @
FIELD)= *GROUP NUMBER
Triggers field 40.03 if its value differs from first 17 chars of the value in this field. Deletes
field 40.03 if field 90.02 is deleted.
CROSS-REFERENCE: ^^TRIGGER^355.33^.16
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X
S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=D
IV,DIH=355.33,DIG=.16 D ^DICR
2)= Q
CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
DELETE VALUE)= NO EFFECT
FIELD)= REAL TIME
Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time
verification.
355.33,90.03 SUBSCRIBER ID 90;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<3)!'$$LENCHK^IBCNEUT1(X,20,0) X
LAST EDITED: DEC 03, 2013
HELP-PROMPT: Answer must be 3-20 characters in length.
DESCRIPTION: Enter the Subscriber's Primary ID number. This number is assigned by the payer and can be found on
the subscriber's insurance card.
TECHNICAL DESCR:
Replaces field 60.04. Length of this field is temporarily limited to 20 characters.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the *SUBSCRIBER ID field of the INSURANCE VERIFICATION PROCESSOR File
CROSS-REFERENCE: ^^TRIGGER^355.33^60.04
1)= X ^DD(355.33,90.03,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,60)):^(60),1:"") S X=$P(Y(1
),U,4),X=X S DIU=X K Y S X=DIV S X=$E($P(^IBA(355.33,DA,90),U,3),1,20) X ^DD(355.33,90.03,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P($G(^IBA(355.33,DA,60)),U,4)'=$E($P(^IBA(355.33
,DA,90),U,3),1,20))
1.4)= S DIH=$G(^IBA(355.33,DIV(0),60)),DIV=X S $P(^(60),U,4)=DIV,DIH=355.33,DIG=60.04 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,90),U,3)="") I X S X=DIV S Y(1)=$
S($D(^IBA(355.33,D0,60)):^(60),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X="" X ^DD(355.33,90.03,1,1
,2.4)
2.4)= S DIH=$G(^IBA(355.33,DIV(0),60)),DIV=X S $P(^(60),U,4)=DIV,DIH=355.33,DIG=60.04 D ^DICR
CREATE CONDITION)= S X=($P($G(^IBA(355.33,DA,60)),U,4)'=$E($P(^IBA(355.33,DA,90),U,3),1,20))
CREATE VALUE)= S X=$E($P(^IBA(355.33,DA,90),U,3),1,20)
DELETE CONDITION)= S X=($P(^IBA(355.33,DA,90),U,3)="")
DELETE VALUE)= @
FIELD)= *SUBSCRIBER ID
Triggers field 60.04 if its value differs from first 20 chars of the value in this field. Deletes
field 60.04 if field 90.03 is deleted.
CROSS-REFERENCE: ^^TRIGGER^355.33^.16
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.33,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X
S DIU=X K Y S X=DIV S X=$$TRIG^IBCNERTQ(DA) S DIH=$G(^IBA(355.33,DIV(0),0)),DIV=X S $P(^(0),U,16)=D
IV,DIH=355.33,DIG=.16 D ^DICR
2)= Q
CREATE VALUE)= S X=$$TRIG^IBCNERTQ(DA)
DELETE VALUE)= NO EFFECT
FIELD)= REAL TIME
Sets the REAL TIME VERIFICATION (#.16) field to 1 when this record has been queued for real time
verification.
355.33,91.01 NAME OF INSURED 91;1 FREE TEXT
INPUT TRANSFORM: N Z1 S Z1=$G(^IBA(355.33,DA,60)) S:$P(Z1,U,6)="01"&X X=$P($G(^DPT(+Z1,0)),U,1) K:$L(X)>130!($L(X)<2
)!'$$LENCHK^IBCNEUT1(X,30,0) X
LAST EDITED: NOV 20, 2013
HELP-PROMPT: Enter the name of the person who holds the policy. Answer must be 2-30 characters in length.
DESCRIPTION: This is the name of the individual for which this policy was issued. If the Patient Relationship to
the Insured is 'Patient' then this name will default to the patient name via input transform.
TECHNICAL DESCR:
Replaces field 60.07. Length of this field is temporarily limited to 30 characters.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the *NAME OF INSURED field of the INSURANCE VERIFICATION PROCESSOR File
CROSS-REFERENCE: ^^TRIGGER^355.33^60.07
1)= X ^DD(355.33,91.01,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.33,D0,60)):^(60),1:"") S X=$P(Y(1
),U,7),X=X S DIU=X K Y S X=DIV S X=$E($P(^IBA(355.33,DA,91),U),1,30) X ^DD(355.33,91.01,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P($G(^IBA(355.33,DA,60)),U,7)'=$E($P(^IBA(355.33
,DA,91),U),1,30))
1.4)= S DIH=$G(^IBA(355.33,DIV(0),60)),DIV=X S $P(^(60),U,7)=DIV,DIH=355.33,DIG=60.07 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P(^IBA(355.33,DA,91),U)="") I X S X=DIV S Y(1)=$S(
$D(^IBA(355.33,D0,60)):^(60),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(355.33,91.01,1,1,2
.4)
2.4)= S DIH=$G(^IBA(355.33,DIV(0),60)),DIV=X S $P(^(60),U,7)=DIV,DIH=355.33,DIG=60.07 D ^DICR
CREATE CONDITION)= S X=($P($G(^IBA(355.33,DA,60)),U,7)'=$E($P(^IBA(355.33,DA,91),U),1,30))
CREATE VALUE)= S X=$E($P(^IBA(355.33,DA,91),U),1,30)
DELETE CONDITION)= S X=($P(^IBA(355.33,DA,91),U)="")
DELETE VALUE)= @
FIELD)= *NAME OF INSURED
Triggers field 60.07 if its value differs from first 30 chars of the value in this field. Deletes
field 60.07 if field 91.01 is deleted.
FILES POINTED TO FIELDS
BPS NCPDP PATIENT RELATIONSHIP
(#9002313.19) PHARMACY RELATIONSHIP CODE (#60.15)
BPS RESPONSES (#9002313.03) BPS RESPONSE (#.17)
IIV STATUS TABLE (#365.15) IIV STATUS (#.12)
INSTITUTION (#4) REMOTE LOCATION (#.14)
NEW PERSON (#200) ENTERED BY (#.02)
PROCESSED BY (#.06)
VERIFIED BY (#.11)
PATIENT (#2) PATIENT NAME (#60.01)
SOURCE OF INFORMATION (#355.12) SOURCE OF INFORMATION (#.03)
STATE (#5) STATE (#21.05)
EMPLOYER CLAIMS STATE (#61.1)
SUBSCRIBER ADDRESS STATE (#62.05)
TYPE OF PLAN (#355.1) TYPE OF PLAN (#40.09)
X12 271 SERVICE TYPE (#365.013) INQ SERVICE TYPE CODE 1 (#80.01)
INQ SERVICE TYPE CODE 2 (#80.02)
INQ SERVICE TYPE CODE 3 (#80.03)
INQ SERVICE TYPE CODE 4 (#80.04)
INQ SERVICE TYPE CODE 5 (#80.05)
INQ SERVICE TYPE CODE 6 (#80.06)
INQ SERVICE TYPE CODE 7 (#80.07)
INQ SERVICE TYPE CODE 8 (#80.08)
INQ SERVICE TYPE CODE 9 (#80.09)
INQ SERVICE TYPE CODE 10 (#80.1)
INQ SERVICE TYPE CODE 11 (#80.11)
INQ SERVICE TYPE CODE 12 (#80.12)
INQ SERVICE TYPE CODE 13 (#80.13)
INQ SERVICE TYPE CODE 14 (#80.14)
INQ SERVICE TYPE CODE 15 (#80.15)
INQ SERVICE TYPE CODE 16 (#80.16)
INQ SERVICE TYPE CODE 17 (#80.17)
INQ SERVICE TYPE CODE 18 (#80.18)
INQ SERVICE TYPE CODE 19 (#80.19)
INQ SERVICE TYPE CODE 20 (#80.2)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):