STANDARD DATA DICTIONARY #355.5 -- INSURANCE CLAIMS YEAR TO DATE FILE 6/27/25 PAGE 1
STORED IN ^IBA(355.5, *** 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 will contain the claim to date information about a patient's health insurance claims to a specific carrier for a specific
year. This will allow estimate of receivables based on whether claims exceed deductibles or other maximum benefits.
Per VHA Directive 10-93-142, this file definition should not be modified.
DD ACCESS: @
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
CROSS
REFERENCED BY: PATIENT(APPY), POLICY(APPY1), BENEFIT YEAR BEGINNING ON(APPY2), PATIENT POLICY POINTER(APPY3), POLICY(B),
PATIENT(C)
355.5,.01 POLICY 0;1 POINTER TO GROUP INSURANCE PLAN FILE (#355.3) (Required)
LAST EDITED: AUG 31, 1993
DESCRIPTION:
Select the patient's health insurance policy against which claims may have been made.
UNEDITABLE
CROSS-REFERENCE: 355.5^B
1)= S ^IBA(355.5,"B",$E(X,1,30),DA)=""
2)= K ^IBA(355.5,"B",$E(X,1,30),DA)
CROSS-REFERENCE: 355.5^APPY1^MUMPS
1)= I +$P(^IBA(355.5,DA,0),U,2),-$P(^(0),U,3),+$P(^(0),U,17) S ^IBA(355.5,"APPY",+$P(^(0),U,2),X,-$
P(^(0),U,3),+$P(^(0),U,17),DA)=""
2)= K ^IBA(355.5,"APPY",+$P(^IBA(355.5,DA,0),U,2),X,-$P(^(0),U,3),+$P(^(0),U,17),DA)
Cross-reference of patients by policy by year.
355.5,.02 PATIENT 0;2 POINTER TO PATIENT FILE (#2)
LAST EDITED: DEC 17, 1993
DESCRIPTION:
Enter the name of the patient who is on this policy.
UNEDITABLE
CROSS-REFERENCE: 355.5^C
1)= S ^IBA(355.5,"C",$E(X,1,30),DA)=""
2)= K ^IBA(355.5,"C",$E(X,1,30),DA)
CROSS-REFERENCE: 355.5^APPY^MUMPS
1)= I -$P(^IBA(355.5,DA,0),U,3),+^(0),+$P(^(0),U,17) S ^IBA(355.5,"APPY",X,+^(0),-$P(^(0),U,3),+$P(
^(0),U,17),DA)=""
2)= K ^IBA(355.5,"APPY",X,+^IBA(355.5,DA,0),-$P(^(0),U,3),+$P(^(0),U,17),DA)
Cross-references patient by policy by year.
355.5,.03 BENEFIT YEAR BEGINNING ON 0;3 DATE (Required)
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: DEC 17, 1993
DESCRIPTION: This is the first day of the year in which the health insurance policy's benefits apply. Exact
date (with month and day) is required.
TECHNICAL DESCR: This field must match the year for an entry for this patient and policy in the annual benefits
field. It is automatically stored by the system when creating an entry. It is not editable.
WRITE AUTHORITY: ^
UNEDITABLE
CROSS-REFERENCE: 355.5^APPY2^MUMPS
1)= I +$P(^IBA(355.5,DA,0),U,2),+^(0),+$P(^(0),U,17) S ^IBA(355.5,"APPY",+$P(^(0),U,2),+^(0),-X,+$P
(^(0),U,17),DA)=""
2)= K ^IBA(355.5,"APPY",+$P(^IBA(355.5,DA,0),U,2),+^(0),-X,+$P(^(0),U,17),DA)
Cross-reference of patients by policy by year.
355.5,.04 DEDUCTIBLE MET? 0;4 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: MAY 13, 1993
DESCRIPTION: If the dollar amount of claims against this policy is less than the the policy's annual deductible,
enter "NO". If it is equal to or greater than the annual deductible, enter "YES".
355.5,.05 AMOUNT OF DEDUCTIBLE MET 0;5 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
DESCRIPTION:
Enter the dollar amount of claims against this policy.
355.5,.06 DEDUCTIBLE (INPT) MET? 0;6 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: MAY 13, 1993
DESCRIPTION: If the dollar amount of claims for inpatient services is less than the policy's annual deductible
for inpatient services, enter "NO". If it is equal to or greater than the annual deductible for
such services, enter "YES".
355.5,.07 AMOUNT OF DEDUCTIBLE (INP) MET 0;7 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
DESCRIPTION:
Enter the dollar amount of claims against this policy for inpatient services.
355.5,.08 DEDUCTIBLE (OPT) MET? 0;8 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: MAY 13, 1993
DESCRIPTION: If the dollar amount of claims for outpatient services is less than the policy's annual deductible
for outpatient services, enter "NO". If it is equal to or greater than the annual deductible for
such services, enter "YES".
355.5,.09 AMOUNT OF DEDUCTIBLE (OPT) MET 0;9 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Type a Number between 0 and 999999, 0 Decimal Digits
DESCRIPTION:
Enter the dollar amount of claims against this policy for outpatient services.
355.5,.1 AMT LIFETIME MAX USED (OPT) 0;10 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: DEC 14, 1993
HELP-PROMPT: Type a Number between 0 and 9999999, 0 Decimal Digits
DESCRIPTION: Enter the dollar amount of claims against this policy, which can then be compared to the maximum
amount available over the life of the policy.
355.5,.11 MH DEDUCTIBLE (INP) MET? 0;11 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: MAY 13, 1993
DESCRIPTION: If the dollar amount of claims for inpatient mental health services is less than the policy's
annual deductible for these services, enter "NO". If it is equal to or greater than the annual
deductible for such services, enter "YES".
355.5,.12 AMOUNT OF MH (INP) DED MET 0;12 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Type a Number between 0 and 999999, 0 Decimal Digits
DESCRIPTION:
Enter the dollar amount of claims against this policy for inpatient mental health services.
355.5,.13 MH DEDUCTIBLE (OPT) MET? 0;13 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: MAY 13, 1993
DESCRIPTION: If the dollar amount of claims for outpatient mental health services is less than the policy's
annual deductible for these services, enter "NO". If it is equal to or greater than the annual
deductible for such services, enter "YES".
355.5,.14 AMOUNT OF MH (OPT) DED MET 0;14 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Type a Number between 0 and 999999, 0 Decimal Digits
DESCRIPTION:
Enter the dollar amount of claims against this policy for outpatient mental health services.
355.5,.15 PRE-EXISTING CONDITIONS 0;15 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
Enter the patient's pre-existing conditions.
355.5,.16 COORDINATION OF BENEFITS DATA 0;16 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAY 13, 1993
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION: If the patient is included in a policy held by a family member, e.g. spouse, enter that
information here.
355.5,.17 PATIENT POLICY POINTER 0;17 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999999)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: AUG 31, 1993
HELP-PROMPT: Type a Number between 1 and 999999, 0 Decimal Digits
DELETE AUTHORITY: ^
WRITE AUTHORITY: ^
UNEDITABLE
CROSS-REFERENCE: 355.5^APPY3^MUMPS
1)= I $P(^IBA(355.5,DA,0),U,2),+^(0),-$P(^(0),U,3) S ^IBA(355.5,"APPY",+$P(^(0),U,2),+^(0),-$P(^(0)
,U,3),X,DA)=""
2)= K ^IBA(355.5,"APPY",+$P(^(0),U,2),+^(0),-$P(^(0),U,3),X,DA)
Cross-references patients by policy by year.
355.5,.18 AMT. MH LIFET. MAX USED (INPT) 0;18 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
LAST EDITED: DEC 14, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
DESCRIPTION:
Enter the dollar amount of claims against this policy for mental health services.
355.5,.19 AMT LIFETIME MAX USED (INPT) 0;19 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
LAST EDITED: DEC 14, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 9999999, 0 Decimal Digits
DESCRIPTION: Enter the dollar amount of inpatient claims against this policy, which can then be compared to the
maxium amount available over the life of the policy.
355.5,.2 AMT MH LIFET MAX USED (OPT) 0;20 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
LAST EDITED: DEC 14, 1993
HELP-PROMPT: Type a Dollar Amount between 0 and 9999999, 0 Decimal Digits
DESCRIPTION: Enter the dollar amount of MH claims against this policy, which can then be compared to the maximum
amount available over the life of the policy.
355.5,1.01 DATE ENTERED 1;1 DATE
INPUT TRANSFORM: S %DT="ETX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAY 13, 1993
DESCRIPTION: This is the date that this entry was created. It is automatically triggered by the creation of the
entry.
WRITE AUTHORITY: ^
355.5,1.02 ENTERED BY 1;2 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: MAY 13, 1993
DESCRIPTION: This is the user who created this entry. It is automatically triggered by the creation of this
entry.
WRITE AUTHORITY: ^
355.5,1.03 DATE LAST VERIFIED 1;3 DATE
INPUT TRANSFORM: S %DT="ETX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUL 07, 1993
DESCRIPTION: This is the date that the entry was verified. It is automatically triggered by the verification
process.
355.5,1.04 VERIFIED BY 1;4 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: MAY 13, 1993
DESCRIPTION: This is the person who verified the entry. It is automatically triggered by the verification
process.
355.5,1.05 DATE LAST EDITED 1;5 DATE
INPUT TRANSFORM: S %DT="ETX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUL 07, 1993
DESCRIPTION: This is the date that the entry was last edited. It is automatically triggered whenever editing
takes place.
WRITE AUTHORITY: ^
355.5,1.06 EDITED BY 1;6 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: MAY 13, 1993
DESCRIPTION: This is the name of the person who last edited the entry. It is automatically triggered whenever
editing takes place.
WRITE AUTHORITY: ^
355.5,1.07 PERSON CONTACTED 1;7 FREE TEXT (Required)
WHO DID YOU TALK TO AT THE INSURANCE COMPANY?
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: JUL 02, 1993
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION: Give the name of the person at the insurance company with whom you verified insurance claims
information.
355.5,1.08 COMMENT - CLAIMS FILED 1;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<3) X
LAST EDITED: JUN 11, 1993
HELP-PROMPT: Answer must be 3-80 characters in length.
DESCRIPTION:
Enter any pertinent information here that you did not enter above.
355.5,1.09 CONTACT'S PHONE NUMBER 1;9 FREE TEXT (Required)
WHAT WAS THEIR PHONE NUMBER?
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: JUL 02, 1993
HELP-PROMPT: Answer must be 7-20 characters in length.
DESCRIPTION:
Give the telephone number of the person who verified insurance claims information.
FILES POINTED TO FIELDS
GROUP INSURANCE PLAN (#355.3) POLICY (#.01)
NEW PERSON (#200) ENTERED BY (#1.02)
VERIFIED BY (#1.04)
EDITED BY (#1.06)
PATIENT (#2) PATIENT (#.02)
INPUT TEMPLATE(S):
IBCN BU ADD COM JUN 30, 1993@15:46 USER #11985
IBCN BU ED AL DEC 27, 1993@09:52 USER #0
IBCN BU INPT DEC 14, 1993@08:54 USER #0
IBCN BU OPT DEC 14, 1993@08:53 USER #0
IBCN BU POL JUL 08, 1993@12:23 USER #11985
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):