STANDARD DATA DICTIONARY #355.9 -- IB BILLING PRACTITIONER ID FILE 3/24/25 PAGE 1
STORED IN ^IBA(355.9, *** 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 one record for each unique billing provider id number that an individual provider (practitioner) is assigned by
an insurance company or by a licensing or government entity. Entries without an insurance company indicate the number is assigned
to the practitioner by a licensing or government entity and will apply to all insurance companies.
This file contains the id numbers for the following ids:
o Assigned by gov't or licensing agency to a practitioner
for all ins co
o Assigned by an insurance co to an individual practitioner
o Assigned by an insurance co to an individual practitioner,
but a new number assigned for each care unit entry
DD ACCESS: @
RD ACCESS:
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
AUDIT ACCESS:
IDENTIFIED BY: INSURANCE CO (#.02), FORM TYPE APPLIED TO (#.04)[R], BILL CARE TYPE (#.05)[R], PROVIDER ID TYPE (#.06)[R]
CROSS
REFERENCED BY: PROVIDER ID CARE UNIT(ACARE), PRACTITIONER(B), PROVIDER ID(C)
INDEXED BY: PROVIDER ID TYPE & INDEX VALUE INSURANCE CO & PRACTITIONER (AC), PROVIDER ID TYPE & PRACTITIONER & INDEX VALUE
INSURANCE CO (AD), INSURANCE CO & PRACTITIONER (AE), PRACTITIONER & INSURANCE CO & PROVIDER ID CARE UNIT (AG),
PRACTITIONER & BILL CARE TYPE & INDEX VALUE INSURANCE CO & INDEX VALUE CARE UNIT & PROVIDER ID TYPE & FORM TYPE
APPLIED TO (AUNIQ)
355.9,.01 PRACTITIONER 0;1 VARIABLE POINTER (Required)
FILE ORDER PREFIX LAYGO MESSAGE
200 1 VA n VA PROVIDER
355.93 2 NVA y NON-VA PROVIDER
SCREEN ON FILE 355.93: S DIC("S")="I $P(^(0),U,2)=2"
SCREEN EXPLANATION: Only individual providers can be selected here.
INPUT TRANSFORM: I $G(DA) K:$$DUP^IBCEP1(.01,DA) X
LAST EDITED: DEC 20, 2000
HELP-PROMPT: Enter the name of the individual provider (practitioner). This cannot be a duplicate of any entry
in the NEW PERSON file.
DESCRIPTION: This is the practitioner (individual provider) for whom the id number is being defined. This
practitioner can either be a VA provider and reside in the NEW PERSON file or can be a NON-VA
provider and will reside in the IB NON-VA BILLING PROVIDER file as an individual provider (not as a
facility).
TECHNICAL DESCR:
DBIA #3272 was secured to allow this file's .01 field to point to file 200.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 355.9^B
1)= S ^IBA(355.9,"B",$E(X,1,30),DA)=""
2)= K ^IBA(355.9,"B",$E(X,1,30),DA)
CROSS-REFERENCE: ^^TRIGGER^355.9^.15
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^IBA(355.9,D0,0)):^(0),1:"") S X=$P(Y(1),U,
15)="" I X S X=DIV S Y(1)=$S($D(^IBA(355.9,D0,0)):^(0),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y S X=
DIV S X="*ALL*" X ^DD(355.9,.01,1,2,1.4)
1.4)= S DIH=$G(^IBA(355.9,DIV(0),0)),DIV=X S $P(^(0),U,15)=DIV,DIH=355.9,DIG=.15 D ^DICR
2)= Q
3)= Do not delete
CREATE CONDITION)= INDEX VALUE INSURANCE CO=""
CREATE VALUE)= "*ALL*"
DELETE VALUE)= NO EFFECT
FIELD)= INDEX VALUE INSURANCE CO
This trigger 'seeds' a value into the key field for insurance company so the value of the key is
never null, even if the insurance company is not entered.
CROSS-REFERENCE: ^^TRIGGER^355.9^.16
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^IBA(355.9,D0,0)):^(0),1:"") S X=$P(Y(1),U,
16)="" I X S X=DIV S Y(1)=$S($D(^IBA(355.9,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X=
DIV S X="*N/A*" X ^DD(355.9,.01,1,3,1.4)
1.4)= S DIH=$G(^IBA(355.9,DIV(0),0)),DIV=X S $P(^(0),U,16)=DIV,DIH=355.9,DIG=.16 D ^DICR
2)= Q
3)= Do not delete
CREATE CONDITION)= INDEX VALUE CARE UNIT=""
CREATE VALUE)= "*N/A*"
DELETE VALUE)= NO EFFECT
FIELD)= INDEX VALUE CARE UNIT
This trigger 'seeds' a value into the key field for care unit so the value of the key is never
null, even if the care unit is not entered.
RECORD INDEXES: AC (#116), AD (#117), AE (#118), AG (#119), AUNIQ (#120)
355.9,.02 INSURANCE CO 0;2 POINTER TO INSURANCE COMPANY FILE (#36)
INPUT TRANSFORM: I $G(DA) K:$$DUP^IBCEP1(.02,DA) X
LAST EDITED: DEC 07, 2000
HELP-PROMPT: Enter the insurance company who has specific id's for the provider
DESCRIPTION: This is the insurance company that has assigned a specific id to the provider. If this data is not
entered, the id number will be assumed to apply to all insurance companies for the provider.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^355.9^.03
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.9,D0,0)):^(0),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" S DIH=$G(^IBA(355.9,DIV(0),0)),DIV=X S $P(^(0),U,3)=DIV,DIH=355.9,DIG=.03 D ^DICR
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= PROVIDER ID CARE UNIT
CROSS-REFERENCE: ^^TRIGGER^355.9^.15
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.9,D0,0)):^(0),1:"") S X=$P(Y(1),U,15),X=X S
DIU=X K Y S X=DIV S X=DIV,X=X S DIH=$G(^IBA(355.9,DIV(0),0)),DIV=X S $P(^(0),U,15)=DIV,DIH=355.9,D
IG=.15 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.9,D0,0)):^(0),1:"") S X=$P(Y(1),U,15),X=X S
DIU=X K Y S X=DIV S X="*ALL*" S DIH=$G(^IBA(355.9,DIV(0),0)),DIV=X S $P(^(0),U,15)=DIV,DIH=355.9,D
IG=.15 D ^DICR
3)= Do not delete
CREATE VALUE)= INTERNAL(INSURANCE CO)
DELETE VALUE)= "*ALL*"
FIELD)= INDEX VALUE INSURANCE CO
When the insurance company is entered or changed, trigger the same value into the field. When
insurance company is deleted, re-seed it with *ALL*
RECORD INDEXES: AE (#118), AG (#119)
355.9,.03 PROVIDER ID CARE UNIT 0;3 POINTER TO IB INS CO PROVIDER ID CARE UNIT FILE (#355.96)
INPUT TRANSFORM: S:$D(DA) DIC("S")="I +$G(^IBA(355.96,+Y,0))=+$P($G(^IBA(355.9,DA,0)),U,2)" D ^DIC K DIC S DIC=DIE,X
=+Y K:Y<0 X I $D(X),$G(DA) K:$$DUP^IBCEP1(.03,DA) X
LAST EDITED: JUN 02, 2004
HELP-PROMPT: Enter the specific care unit value needed to get the provider id.
DESCRIPTION: This is the actual data value of the care unit to use to assign this provider id to the insurance
company and provider. *** NOT CURRENTLY USED ***
SCREEN: S DIC("S")="I +$G(^IBA(355.96,+Y,0))=+$P($G(^IBA(355.9,DA,0)),U,2)"
EXPLANATION: Value must be defined as valid for the insurance co
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the INSURANCE CO field of the IB BILLING PRACTITIONER ID File
CROSS-REFERENCE: ^^TRIGGER^355.9^.16
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=Y(0),X=X I X S X=DIV S Y(1)=$S($D(^IBA(355.9,D0,0)):
^(0),1:"") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X=DIV S X=DIV,X=X X ^DD(355.9,.03,1,1,1.4)
1.4)= S DIH=$G(^IBA(355.9,DIV(0),0)),DIV=X S $P(^(0),U,16)=DIV,DIH=355.9,DIG=.16 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.9,D0,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X S
DIU=X K Y S X=DIV S X="*N/A*" S DIH=$G(^IBA(355.9,DIV(0),0)),DIV=X S $P(^(0),U,16)=DIV,DIH=355.9,D
IG=.16 D ^DICR
CREATE CONDITION)= INTERNAL(PROVIDER ID CARE UNIT)
CREATE VALUE)= INTERNAL(PROVIDER ID CARE UNIT)
DELETE VALUE)= "*N/A*"
FIELD)= INDEX VALUE CARE UNIT
CROSS-REFERENCE: 355.9^ACARE
1)= S ^IBA(355.9,"ACARE",$E(X,1,30),DA)=""
2)= K ^IBA(355.9,"ACARE",$E(X,1,30),DA)
3)= Do not delete
This xref allows quick access to the file by care unit.
RECORD INDEXES: AG (#119)
355.9,.04 FORM TYPE APPLIED TO 0;4 SET (Required)
'0' FOR BOTH UB-04 AND CMS-1500 FORMS;
'1' FOR UB-04 FORMS ONLY;
'2' FOR CMS-1500 FORMS ONLY;
LAST EDITED: JAN 16, 2007
HELP-PROMPT: Enter the form types that this id # will apply to.
DESCRIPTION: This designates whether the id number is to be used for just UB-04 form types, just CMS-1500 form
types or both form types.
RECORD INDEXES: AUNIQ (#120)
355.9,.05 BILL CARE TYPE 0;5 SET (Required)
'0' FOR BOTH INPATIENT AND OUTPATIENT;
'1' FOR INPATIENT ONLY;
'2' FOR OUTPATIENT ONLY;
'3' FOR PRESCRIPTION ONLY;
INPUT TRANSFORM: I $G(DA) K:$$DUP^IBCEP1(.05,DA) X
LAST EDITED: SEP 07, 2000
HELP-PROMPT: Enter the bill care type (inpatient/outpatient/Rx) that this id # will apply to.
DESCRIPTION: This designates whether the id number is to be used for just inpatient episodes, just outpatient
episodes, both inpatient and outpatient episodes, or for just prescriptions.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
RECORD INDEXES: AUNIQ (#120)
355.9,.06 PROVIDER ID TYPE 0;6 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97) (Required)
INPUT TRANSFORM: S DIC("S")="I $P(^(0),U,2)'=1" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X I $D(X),$G(DA) K:$$DUP^IBCEP1(.0
6,DA) X
LAST EDITED: SEP 06, 2000
HELP-PROMPT: Enter the type of id # being recorded.
DESCRIPTION:
This is the indicator of what type of id is being recorded.
SCREEN: S DIC("S")="I $P(^(0),U,2)'=1"
EXPLANATION: ID types that are limited to facility level cannot be selected.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
RECORD INDEXES: AC (#116), AD (#117), AUNIQ (#120)
355.9,.07 PROVIDER ID 0;7 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1)!'(X?1N.E!(X?1A.E)) X
LAST EDITED: MAY 07, 2001
HELP-PROMPT: Answer must be 1-15 characters in length and must begin with a number or letter.
DESCRIPTION: This is the provider id that will be used for a claim when all criteria defined on this record have
been met.
CROSS-REFERENCE: 355.9^C
1)= S ^IBA(355.9,"C",$E(X,1,30),DA)=""
2)= K ^IBA(355.9,"C",$E(X,1,30),DA)
3)= Do not delete
This allows a lookup on this file by provider id #
355.9,.15 INDEX VALUE INSURANCE CO 0;15 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: SEP 07, 2000
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: This field contains the key value for the insurance company or '*ALL*' if no insurance company is
selected. This is to assure uniqueness in the records in the file even if the insurance company is
blank.
TECHNICAL DESCR:
Triggered on entry of the record by the .01 field to *ALL*
WRITE AUTHORITY: ^
UNEDITABLE
NOTES: TRIGGERED by the PRACTITIONER field of the IB BILLING PRACTITIONER ID File
TRIGGERED by the INSURANCE CO field of the IB BILLING PRACTITIONER ID File
RECORD INDEXES: AC (#116), AD (#117), AUNIQ (#120)
355.9,.16 INDEX VALUE CARE UNIT 0;16 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: SEP 07, 2000
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: This field contains the key value for the care unit or '*N/A*' if no care unit is selected. This
is to assure uniqueness in the records in the file even if the care unit is blank.
TECHNICAL DESCR:
Triggered on entry of the record by the .01 field to *N/A*
WRITE AUTHORITY: ^
UNEDITABLE
NOTES: TRIGGERED by the PRACTITIONER field of the IB BILLING PRACTITIONER ID File
TRIGGERED by the PROVIDER ID CARE UNIT field of the IB BILLING PRACTITIONER ID File
RECORD INDEXES: AUNIQ (#120)
FILES POINTED TO FIELDS
IB INS CO PROVIDER ID CARE UNI
(#355.96) PROVIDER ID CARE UNIT (#.03)
IB NON/OTHER VA BILLING PROVID
(#355.93) PRACTITIONER (#.01)
IB PROVIDER ID # TYPE (#355.97) PROVIDER ID TYPE (#.06)
INSURANCE COMPANY (#36) INSURANCE CO (#.02)
NEW PERSON (#200) PRACTITIONER (#.01)
File #355.9
Record Indexes:
AC (#116) RECORD REGULAR IR SORTING ONLY
Short Descr: SORT BY PROVIDER TYPE,INS CO,PROVIDER
Description: This cross reference groups all of one type of provider for an insurance company. This can be used to get all
provider ids for an insurance co (or for ALL insurance companies)
Set Logic: S ^IBA(355.9,"AC",X(1),$E(X(2),1,30),X(3),DA)=""
Kill Logic: K ^IBA(355.9,"AC",X(1),$E(X(2),1,30),X(3),DA)
Whole Kill: K ^IBA(355.9,"AC")
X(1): PROVIDER ID TYPE (355.9,.06) (Subscr 1) (forwards)
X(2): INDEX VALUE INSURANCE CO (355.9,.15) (Subscr 2) (Len 30) (forwards)
X(3): PRACTITIONER (355.9,.01) (Subscr 3) (forwards)
AD (#117) RECORD REGULAR IR SORTING ONLY
Short Descr: Sequence by provider type,provider,insurance co
Description: This cross reference provides a sequencing of all the insurance company (or ALL) id's for a provider by
provider type. It can be used to get all insurance co id's for a provider, by provider type
Set Logic: S ^IBA(355.9,"AD",X(1),X(2),$E(X(3),1,30),DA)=""
Kill Logic: K ^IBA(355.9,"AD",X(1),X(2),$E(X(3),1,30),DA)
Whole Kill: K ^IBA(355.9,"AD")
X(1): PROVIDER ID TYPE (355.9,.06) (Subscr 1) (forwards)
X(2): PRACTITIONER (355.9,.01) (Subscr 2) (forwards)
X(3): INDEX VALUE INSURANCE CO (355.9,.15) (Subscr 3) (Len 30) (forwards)
AE (#118) RECORD REGULAR IR SORTING ONLY
Short Descr: XREF BY INSURANCE CO AND PROVIDER
Set Logic: S ^IBA(355.9,"AE",X(1),X(2),DA)=""
Kill Logic: K ^IBA(355.9,"AE",X(1),X(2),DA)
Whole Kill: K ^IBA(355.9,"AE")
X(1): INSURANCE CO (355.9,.02) (Subscr 1) (forwards)
X(2): PRACTITIONER (355.9,.01) (Subscr 2) (forwards)
AG (#119) RECORD MUMPS IR SORTING ONLY
Short Descr: WEFRWQ
Set Logic: S ^IBA(355.9,"AG",$S(X2(2)="":"ALL",1:X2(2)),$S(X2(3)="":"TBD",1:X2(3)),DA)=""
Set Cond: I X2(1)="" S X=0
Kill Logic: K ^IBA(355.9,"AG",$S(X1(2)="":"ALL",1:X1(2)),$S(X1(3)="":"TBD",1:X1(3)),DA)
X(1): PRACTITIONER (355.9,.01) (forwards)
X(2): INSURANCE CO (355.9,.02) (forwards)
X(3): PROVIDER ID CARE UNIT (355.9,.03) (forwards)
AUNIQ (#120) RECORD MUMPS IR SORTING ONLY
Short Descr: Xref by provider,ins co(or ALL),care unit,form type,pt stat,prov type
Description: This cross reference provides an index to insure that each record in this file has a unique combination of
provider,insurance company, form type, patient status and provider id type.
Set Logic: S ^IBA(355.9,"AUNIQ",X(1),$E(X(2),1,30),$E(X(3),1,30),X(4),X(5),X(6),DA)=""
Kill Logic: K ^IBA(355.9,"AUNIQ",X(1),$E(X(2),1,30),$E(X(3),1,30),X(4),X(5),X(6),DA)
Whole Kill: K ^IBA(355.9,"AUNIQ")
X(1): PRACTITIONER (355.9,.01) (Subscr 1) (forwards)
X(2): INDEX VALUE INSURANCE CO (355.9,.15) (Subscr 2) (Len 30) (forwards)
X(3): INDEX VALUE CARE UNIT (355.9,.16) (Subscr 3) (Len 30) (forwards)
X(4): FORM TYPE APPLIED TO (355.9,.04) (Subscr 4) (forwards)
X(5): BILL CARE TYPE (355.9,.05) (Subscr 5) (forwards)
X(6): PROVIDER ID TYPE (355.9,.06) (Subscr 6) (forwards)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):