STANDARD DATA DICTIONARY #36 -- INSURANCE COMPANY FILE 3/24/25 PAGE 1
STORED IN ^DIC(36, *** 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 the names and addresses of insurance companies as needed by the local facility. The data in this file is NOT
EDITABLE USING VA FILEMANAGER. If a new entry needs to be made or an existing entry changed the user must be assigned the
appropriate MAS or IB module option.
Per VHA Directive 10-93-142, this file definition should not be modified.
DD ACCESS: #
WR ACCESS: D
DEL ACCESS: d
LAYGO ACCESS: d
IDENTIFIED BY: STREET ADDRESS [LINE 1] (#.111)[R], STREET ADDRESS [LINE 2] (#.112), STREET ADDRESS [LINE 3] (#.113), CITY (#.114),
STATE (#.115), ZIP CODE (#.116), REIMBURSE? (#1)[R]
POINTED TO BY: INJURING PARTIES INSURANCE field (#25) of the DISPOSITION LOG-IN DATE/TIME sub-field (#2.101) of the PATIENT File
(#2)
INSURANCE TYPE field (#.01) of the INSURANCE TYPE sub-field (#2.312) of the PATIENT File (#2)
CLAIMS (INPT) COMPANY NAME field (#.127) of the INSURANCE COMPANY File (#36)
PRECERT COMPANY NAME field (#.139) of the INSURANCE COMPANY File (#36)
APPEALS COMPANY NAME field (#.147) of the INSURANCE COMPANY File (#36)
INQUIRY COMPANY NAME field (#.157) of the INSURANCE COMPANY File (#36)
REPOINT PATIENTS TO field (#.16) of the INSURANCE COMPANY File (#36)
CLAIMS (OPT) COMPANY NAME field (#.167) of the INSURANCE COMPANY File (#36)
CLAIMS (RX) COMPANY NAME field (#.187) of the INSURANCE COMPANY File (#36)
CLAIMS (DENTAL) COMPANY NAME field (#.197) of the INSURANCE COMPANY File (#36)
INS COMPANY LINK PARENT field (#3.14) of the INSURANCE COMPANY File (#36)
REPOINT DELETED COMPANY TO field (#5.02) of the INSURANCE COMPANY File (#36)
DEBTOR field (#.01) of the AR DEBTOR File (#340)
INSURANCE COMPANY ON BILL field (#.04) of the ERA DETAIL sub-field (#344.41) of the ELECTRONIC REMITTANCE ADVICE
File (#344.4)
PATIENT OR INSURANCE COMPANY field (#4.02) of the IB SITE PARAMETERS File (#350.9)
INSURANCE COMPANY field (#4.06) of the IB SITE PARAMETERS File (#350.9)
NAME field (#.01) of the HCSR INSCO APPT LIST sub-field (#350.965) of the IB SITE PARAMETERS File (#350.9)
NAME field (#.01) of the HCSR INSCO ADM LIST sub-field (#350.966) of the IB SITE PARAMETERS File (#350.9)
INS. CO'S FOR MRA EXTRACT field (#.01) of the INS. CO's WITHHOLDING SUPPLIMENTAL PAYMENTS sub-field (#350.999) of
the IB SITE PARAMETERS File (#350.9)
INSURANCE COMPANY field (#.01) of the GROUP INSURANCE PLAN File (#355.3)
INSURANCE CO field (#.02) of the IB BILLING PRACTITIONER ID File (#355.9)
INSURANCE CO field (#.01) of the IB INSURANCE CO LEVEL BILLING PROV ID File (#355.91)
INSURANCE COMPANY field (#.01) of the FACILITY BILLING ID File (#355.92)
INSURANCE COMPANY field (#.03) of the IB PROVIDER ID CARE UNIT File (#355.95)
INSURANCE COMPANY field (#.03) of the IB INS CO PROVIDER ID CARE UNIT File (#355.96)
INSURANCE COMPANY CONTACTED field (#.08) of the INSURANCE REVIEW File (#356.2)
UMO NAME field (#.02) of the OTHER UMO sub-field (#356.2215) of the HCS REVIEW TRANSMISSION File (#356.22)
INSURANCE COMPANY field (#.04) of the CLAIMS TRACKING ROI File (#356.25)
PAYER NAME field (#.02) of the EXPLANATION OF BENEFITS File (#361.1)
INSURANCE COMPANY field (#.12) of the EDI TRANSMISSION BATCH File (#364.1)
EXCLUDED INSURANCE COMPANY field (#.01) of the EXCLUDED INSURANCE COMPANY sub-field (#364.42) of the IB EDI
TRANSMISSION RULE File (#364.4)
INCLUDED INSURANCE COMPANY field (#.01) of the INCLUDED INSURANCE COMPANY sub-field (#364.43) of the IB EDI
TRANSMISSION RULE File (#364.4)
INSURANCE COMPANY field (#.05) of the IB FORM FIELD CONTENT File (#364.7)
INSURANCE COMPANY field (#.02) of the HPID/OEID TRANSMISSION QUEUE File (#367.1)
PAYER NAME [D] field (#101.01) of the HEALTH CARE CLAIM RFAI (277) File (#368)
PRIMARY INSURANCE CARRIER field (#101) of the BILL/CLAIMS File (#399)
SECONDARY INSURANCE CARRIER field (#102) of the BILL/CLAIMS File (#399)
TERTIARY INSURANCE CARRIER field (#103) of the BILL/CLAIMS File (#399)
BILL PAYER CARRIER field (#135) of the BILL/CLAIMS File (#399)
SECONDARY INSURANCE CARRIER field (#19) of the ACCOUNTS RECEIVABLE File (#430)
TERTIARY INSURANCE CARRIER field (#19.1) of the ACCOUNTS RECEIVABLE File (#430)
INSURANCE CO field (#747.21) of the APPLICANT File (#453)
PLACEHOLD SHARE AGREEMNT INSUR field (#48) of the PRESCRIPTION EXTRACT File (#727.81)
PLACEHOLD SHARE AGREEMNT INSUR field (#45) of the PROSTHETICS EXTRACT File (#727.826)
INSURANCE COMPANY field (#902.33) of the PATIENT INSURANCE MULTIPLE sub-field (#9002313.57902) of the BPS LOG OF
TRANSACTIONS File (#9002313.57)
INSURANCE COMPANY field (#902.33) of the PATIENT INSURANCE MULTIPLE sub-field (#9002313.59902) of the BPS
TRANSACTION File (#9002313.59)
INSURANCE COMPANY field (#3.05) of the BPS INSURER DATA File (#9002313.78)
CROSS
REFERENCED BY: ALTERNATE INST PAYER ID TYPE(AB), PAYER(AC), ALTERNATE PROF PAYER ID TYPE(AD), SCHEDULED FOR DELETION(ADEL),
EDI ID NUMBER - DENTAL(AED), EDI ID NUMBER - INST(AEI), EDI ID NUMBER - PROF(AEP), HPID/OEID(AHOD), NIF ID(ANIF),
INS COMPANY LINK PARENT(APC), NAME(B), SYNONYM(C)
INDEXED BY: 277DATE EDI ID NUMBER & 277EDI ID NUMBER & 277EDI TYPE & 277EDI ID NUMBER ON FILE (AEDIX)
LAST MODIFIED: NOV 21,2024@17:16:31
36,.01 NAME 0;1 FREE TEXT (Required) (audited)
INSURANCE COMPANY FILE
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!'(X'?1P.E)!(X'?.ANP) X
LAST EDITED: APR 08, 2015
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION: Enter the name of the insurance carrier which at least one patient seen at your facility has. This
information must be updated using the 'Insurance Company Entry/Edit' option, NOT using VA FileMan.
Editing of this data through a filemanager option could cause negative impacts on the MAS and IB
software modules in addition to other DHCP modules.
AUDIT: YES, ALWAYS
DELETE TEST: 1,0)= I 1 W !!,"You must use the 'Delete Company' action to delete a company... "
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 36^B
1)= S ^DIC(36,"B",$E(X,1,30),DA)=""
2)= K ^DIC(36,"B",$E(X,1,30),DA)
CROSS-REFERENCE: ^^TRIGGER^36^4.04
1)= X ^DD(36,.01,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,4)):^(4),1:"") S X=$P(Y(1),U,4),X=X S
DIU=X K Y S X=DIV S X="22" S DIH=$G(^DIC(36,DIV(0),4)),DIV=X S $P(^(4),U,4)=DIV,DIH=36,DIG=4.04 D
^DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DIC(36,D0,4)):^(4),1:"") S X=$P($G(^IBE(
355.97,+$P(Y(1),U,4),0)),U)=""
2)= Q
CREATE CONDITION)= #4.04=""
CREATE VALUE)= "22"
DELETE VALUE)= NO EFFECT
FIELD)= #4.04
CROSS-REFERENCE: ^^TRIGGER^36^4.05
1)= X ^DD(36,.01,1,3,1.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,4)):^(4),1:"") S X=$P(Y(1),U,5),X=X S
DIU=X K Y S X=DIV S X="0" S DIH=$G(^DIC(36,DIV(0),4)),DIV=X S $P(^(4),U,5)=DIV,DIH=36,DIG=4.05 D ^
DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(36,4.05,0)),U,3),Y(1)=$S($D(^D
IC(36,D0,4)):^(4),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,5)_":",2),$C(59))=""
2)= Q
CREATE CONDITION)= REF PROV SEC ID REQ ON CLAIMS=""
CREATE VALUE)= "0"
DELETE VALUE)= NO EFFECT
FIELD)= REF PROV SEC ID REQ ON CLAIMS
CROSS-REFERENCE: ^^TRIGGER^36^4.06
1)= X ^DD(36,.01,1,4,1.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,4)):^(4),1:"") S X=$P(Y(1),U,6),X=X S
DIU=X K Y S X=DIV S X="0" S DIH=$G(^DIC(36,DIV(0),4)),DIV=X S $P(^(4),U,6)=DIV,DIH=36,DIG=4.06 D ^
DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(36,4.06,0)),U,3),Y(1)=$S($D(^D
IC(36,D0,4)):^(4),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,6)_":",2),$C(59))=""
2)= Q
CREATE CONDITION)= #4.06=""
CREATE VALUE)= "0"
DELETE VALUE)= NO EFFECT
FIELD)= ATT/REND ID BILL SEC ID PROF
CROSS-REFERENCE: ^^TRIGGER^36^4.07
1)= X ^DD(36,.01,1,5,1.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,4)):^(4),1:"") S X=$P(Y(1),U,7),X=X S
DIU=X K Y S X=DIV S X="1" S DIH=$G(^DIC(36,DIV(0),4)),DIV=X S $P(^(4),U,7)=DIV,DIH=36,DIG=4.07 D ^
DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(36,4.07,0)),U,3),Y(1)=$S($D(^D
IC(36,D0,4)):^(4),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,7)_":",2),$C(59))=""
2)= Q
CREATE CONDITION)= SEND LAB OR FAC IDS FOR VAMC=""
CREATE VALUE)= "1"
DELETE VALUE)= NO EFFECT
FIELD)= SEND LAB OR FAC IDS FOR VAMC
CROSS-REFERENCE: ^^TRIGGER^36^4.08
1)= X ^DD(36,.01,1,6,1.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,4)):^(4),1:"") S X=$P(Y(1),U,8),X=X S
DIU=X K Y S X=DIV S X="0" S DIH=$G(^DIC(36,DIV(0),4)),DIV=X S $P(^(4),U,8)=DIV,DIH=36,DIG=4.08 D ^
DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(36,4.08,0)),U,3),Y(1)=$S($D(^D
IC(36,D0,4)):^(4),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,8)_":",2),$C(59))=""
2)= Q
CREATE CONDITION)= #4.08=""
CREATE VALUE)= "0"
DELETE VALUE)= NO EFFECT
FIELD)= ATT/REND ID BILL SEC ID INST
36,.05 INACTIVE 0;5 SET (audited)
'0' FOR NO;
'1' FOR YES;
LAST EDITED: APR 08, 2015
HELP-PROMPT: Enter 'Yes" if this company is inactive and should no longer be allowed for selection.
DESCRIPTION: If this insurance company is no longer active in your area, enter INACTIVE here. This will
disallow users from selecting this insurance company entry.
AUDIT: YES, ALWAYS
DELETE TEST: 1,0)= I $D(DGINS)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
36,.06 ALLOW MULTIPLE BEDSECTIONS 0;6 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: NOV 17, 2005
HELP-PROMPT: Enter whether or not this Insurance Company will accept multiple bedsections on a claim form. If
left blank a NO is assumed.
DESCRIPTION: This field determines whether this insurance company will accept multiple bedsections on one claim
form. If answered 'YES' then selection of the PRIMARY INSURANCE CARRIER in MCCR will trigger
revenue codes for all bedsections within the STATEMENT COVERS FROM and STATEMENT COVERS TO dates.
If this is answered 'NO' or left blank then only the first bedsection in the date range will be
used.
36,.07 DIFFERENT REVENUE CODES TO USE 0;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<3) X I $D(X) X "F DGII=1:1:10 S DGINX=$P(X,"","",DGII) Q:DGINX="""" I DGINX'?3N.
"":""3N K X Q" K DGII,DGINX
LAST EDITED: NOV 17, 2005
HELP-PROMPT: Answer must be 3-40 characters in length. Enter the 3 digit rev code that is being replaced
followed by a ':' followed by the rev code to be used for this Ins Company. (old RC:new RC,old
RC:new RC)
DESCRIPTION: This field is used to replace standard revenue codes used on a bill with revenue codes requested by
an insurance company.
The standard revenue codes are those codes found in the Charge Master and are used for most bills.
Enter the standard revenue code to be replaced followed by ':' followed by the revenue code the
insurance company requires:
500:510 will result in revenue code 500 being replaced
by 510 on this insurance company bills
Separate multiple revenue code replacement sets by a comma:
101:240,500:510
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
36,.08 ONE OPT. VISIT ON BILL ONLY 0;8 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: NOV 17, 2005
HELP-PROMPT: Enter whether or not claom form's to this Insurance Company should allow only 1 outpatient visit
per bill.
DESCRIPTION: If this field is answered 'YES' then only one outpatient visit will be allowed per claim form for
this Insurance Company.
If it is unanswered or answered 'NO' then multiple (up to 10) outpatient bills will be allowed per
claim form.
36,.09 AMBULATORY SURG. REV. CODE 0;9 POINTER TO REVENUE CODE FILE (#399.2)
INPUT TRANSFORM: S DIC("S")="I $P(^(0),U,3)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: NOV 20, 1991
HELP-PROMPT: Enter the default revenue code for ambulatory surgical codes. This will automatically be used when
creating a bill.
DESCRIPTION: This is the Revenue Code that will automatically be generated for this insurance company if a
billable Ambulatory Surgical Code is listed as a procedure in this this bill.
SCREEN: S DIC("S")="I $P(^(0),U,3)"
EXPLANATION: Only Activated Revenue Codes can be selected!
36,.1 ATTENDING PHYSICIAN ID. 0;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<3) X
LAST EDITED: MAR 21, 2001
HELP-PROMPT: Answer must be 3-22 characters in length.
DESCRIPTION:
This field is no longer used. Provider id's now come from the 355.9 files.
36,.11 *HOSPITAL PROVIDER NUMBER 0;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: JAN 16, 2007
HELP-PROMPT: Answer must be 1-15 characters in length.
DESCRIPTION: An identifier assigned to the facility by the insurance company. It will be printed in form
locator 51 of the UB-92 of bills for this insurance company.
This field is marked for deletion and can be deleted 11/23/2008.
TECHNICAL DESCR: Printed in form locator 51 of the UB-92
This field is marked for deletion and can be deleted 11/23/2008.
36,.111 STREET ADDRESS [LINE 1] .11;1 FREE TEXT (Required) (audited)
INPUT TRANSFORM: K:$L(X)>35!($L(X)<3) X
LAST EDITED: APR 01, 2015
HELP-PROMPT: Enter the first line of this company's street address with 3-35 characters.
DESCRIPTION:
Enter the first line of this company's street address with 3-35 characters.
AUDIT: YES, ALWAYS
DELETE TEST: 1,0)= I $D(DGINS)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^36^.112
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.11)):^(.11),1:"") S X=$P(Y(1),U,2),X=X S
DIU=X K Y S X="" X ^DD(36,.111,1,1,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.11)):^(.11),1:""),DIV=X S $P(^(.11),U,2)=DIV,DIH=36,DIG=.112 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.11)):^(.11),1:"") S X=$P(Y(1),U,2),X=X S
DIU=X K Y S X="" X ^DD(36,.111,1,1,2.4)
2.4)= S DIH=$S($D(^DIC(36,DIV(0),.11)):^(.11),1:""),DIV=X S $P(^(.11),U,2)=DIV,DIH=36,DIG=.112 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= STREET ADDRESS [LINE 2]
When changing or deleting STREET ADDRESS [LINE 1] delete STREET ADDRESS [LINE 2].
CROSS-REFERENCE: ^^TRIGGER^36^.113
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.11)):^(.11),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.111,1,2,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.11)):^(.11),1:""),DIV=X S $P(^(.11),U,3)=DIV,DIH=36,DIG=.113 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.11)):^(.11),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.111,1,2,2.4)
2.4)= S DIH=$S($D(^DIC(36,DIV(0),.11)):^(.11),1:""),DIV=X S $P(^(.11),U,3)=DIV,DIH=36,DIG=.113 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= STREET ADDRESS [LINE 3]
When changing or deleting STREET ADDRESS [LINE 1] delete STREET ADDRESS [LINE 3].
36,.112 STREET ADDRESS [LINE 2] .11;2 FREE TEXT (audited)
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(DA),.111) X
LAST EDITED: APR 01, 2015
HELP-PROMPT: If the Street Address is longer than one line, enter a second line between 3-30 characters. It can
not be the same as Line 1.
DESCRIPTION: If the Street Address is longer than one line, enter a second line between 3-30 characters. It can
not be the same as Line 1.
AUDIT: YES, ALWAYS
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the STREET ADDRESS [LINE 1] field of the INSURANCE COMPANY File
CROSS-REFERENCE: ^^TRIGGER^36^.113
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.11)):^(.11),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.112,1,1,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.11)):^(.11),1:""),DIV=X S $P(^(.11),U,3)=DIV,DIH=36,DIG=.113 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.11)):^(.11),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.112,1,1,2.4)
2.4)= S DIH=$S($D(^DIC(36,DIV(0),.11)):^(.11),1:""),DIV=X S $P(^(.11),U,3)=DIV,DIH=36,DIG=.113 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= STREET ADDRESS [LINE 3]
When changing or deleting STREET ADDRESS [LINE 2] delete STREET ADDRESS [LINE 3].
36,.113 STREET ADDRESS [LINE 3] .11;3 FREE TEXT (audited)
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(DA),.111,.112) X
LAST EDITED: APR 03, 2023
HELP-PROMPT: If the Street Address is longer than two lines, enter a third line between 3-30 characters. It can
not be the same as Line 1 or Line 2.
DESCRIPTION: If the Street Address is longer than two lines, enter a third line between 3-30 characters. It can
not be the same as Line 1 or Line 2.
AUDIT: YES, ALWAYS
DELETE TEST: 1,0)= I $D(DGINS)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the STREET ADDRESS [LINE 2] field of the INSURANCE COMPANY File
TRIGGERED by the STREET ADDRESS [LINE 1] field of the INSURANCE COMPANY File
36,.114 CITY .11;4 FREE TEXT
INPUT TRANSFORM: K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>25!($L(X)<2) X
LAST EDITED: FEB 26, 1993
HELP-PROMPT: Enter the city in which this company is located with 2-25 characters. If the space provided is not
sufficient, abbreviate the city to the best of your ability.
DESCRIPTION:
Enter the city of the mailing address for this insurance carrier.
DELETE TEST: 1,0)= I $D(DGINS)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
36,.115 STATE .11;5 POINTER TO STATE FILE (#5)
LAST EDITED: MAR 12, 1993
DESCRIPTION:
Enter the state of the mailing address for this insurance carrier.
DELETE TEST: 1,0)= I $D(DGINS)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
36,.116 ZIP CODE .11;6 FREE TEXT
INPUT TRANSFORM: K:($L(X)>10!($L(X)<9)) X I $D(X) K:'$$ZIPCHK9^IBCNSU(X) X I $D(X) D ZIPIN^VAFADDR
MAXIMUM LENGTH: 10
OUTPUT TRANSFORM: D ZIPOUT^VAFADDR
LAST EDITED: MAR 22, 2017
HELP-PROMPT: Answer must be nine (999999999) or ten characters (99999-9999) in length. The last 4 cannot be
'0000' or '9999'.
DESCRIPTION:
This is the ZIP code for the payer's main mailing address. Enter a 9 or 10 character ZIP code.
DELETE TEST: 1,0)= I $D(DGINS)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
36,.117 BILLING COMPANY NAME .11;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: JUL 15, 1993
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
Enter the name of the insurance carrier's billing company.
36,.119 FAX NUMBER .11;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: NOV 23, 1993
HELP-PROMPT: Enter the fax number of the company with 7 - 20 characters, ex. 415-444-6555.
DESCRIPTION:
Enter the fax number of this insurance carrier.
36,.12 FILING TIME FRAME 0;12 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: FEB 01, 1994
HELP-PROMPT: Enter maximum amount of time from date of service that the insurance company allows for submitting
claims. Answer must be 3-30 characters in length.
DESCRIPTION: Enter the maximum amount of time from the date of service that the insurance company allows for
submitting claims. Examples: 60 days, 90 days, 6 months, 1 year, 18 months; March 30 following
year of service, June 1 following year of service.
36,.121 CLAIMS (INPT) STREET ADDRESS 1 .12;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!'$G(IBCNS) X
LAST EDITED: JUN 19, 2007
HELP-PROMPT: If the inpatient claims process address of this company is different from its main address, enter
Line 1 of the inpatient claims street address. Answer must be 3-30 characters in length.
DESCRIPTION: If the inpatient claims process address of this company is different from its main address, enter
Line 1 of the inpatient claims street address. Answer must be 3-30 characters in length.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^36^.122
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.12)):^(.12),1:"") S X=$P(Y(1),U,2),X=X S
DIU=X K Y S X="" X ^DD(36,.121,1,1,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.12)):^(.12),1:""),DIV=X S $P(^(.12),U,2)=DIV,DIH=36,DIG=.122 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.12)):^(.12),1:"") S X=$P(Y(1),U,2),X=X S
DIU=X K Y S X="" X ^DD(36,.121,1,1,2.4)
2.4)= S DIH=$S($D(^DIC(36,DIV(0),.12)):^(.12),1:""),DIV=X S $P(^(.12),U,2)=DIV,DIH=36,DIG=.122 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= CLAIMS (INPT) STREET ADDRESS 2
When changing or deleting CLAIMS (INPT) STREET ADDRESS 1 delete CLAIMS (INPT) STREET ADDRESS 2.
CROSS-REFERENCE: ^^TRIGGER^36^.123
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.12)):^(.12),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.121,1,2,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.12)):^(.12),1:""),DIV=X S $P(^(.12),U,3)=DIV,DIH=36,DIG=.123 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.12)):^(.12),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.121,1,2,2.4)
2.4)= S DIH=$S($D(^DIC(36,DIV(0),.12)):^(.12),1:""),DIV=X S $P(^(.12),U,3)=DIV,DIH=36,DIG=.123 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= CLAIMS (INPT) STREET ADDRESS 3
When changing or deleting CLAIMS (INPT) STREET ADDRESS 1 delete CLAIMS STREET ADDRESS [LINE 3].
36,.122 CLAIMS (INPT) STREET ADDRESS 2 .12;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.121) X
LAST EDITED: JUN 19, 2007
HELP-PROMPT: If the Inpatient Claims Process Address is longer than one line, enter a second line between 3-30
characters. It can not be the same as Line 1.
DESCRIPTION: If the Inpatient Claims Process Address is longer than one line, enter a second line between 3-30
characters. It can not be the same as Line 1.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the CLAIMS (INPT) STREET ADDRESS 1 field of the INSURANCE COMPANY File
CROSS-REFERENCE: ^^TRIGGER^36^.123
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.12)):^(.12),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.122,1,1,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.12)):^(.12),1:""),DIV=X S $P(^(.12),U,3)=DIV,DIH=36,DIG=.123 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.12)):^(.12),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.122,1,1,2.4)
2.4)= S DIH=$S($D(^DIC(36,DIV(0),.12)):^(.12),1:""),DIV=X S $P(^(.12),U,3)=DIV,DIH=36,DIG=.123 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= CLAIMS (INPT) STREET ADDRESS 3
When changing or deleting CLAIMS (INPT) STREET ADDRESS 2 delete CLAIMS (INPT) STREET ADDRESS 3.
36,.123 CLAIMS (INPT) STREET ADDRESS 3 .12;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.121,.122) X
LAST EDITED: JUN 19, 2007
HELP-PROMPT: If the Inpatient Claims Process Address is longer than two lines, enter a third line between 3-30
characters. It can not be the same as Line 1 or Line 2.
DESCRIPTION: If the Inpatient Claims Process Address is longer than two lines, enter a third line between 3-30
characters. It can not be the same as Line 1 or Line 2.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the CLAIMS (INPT) STREET ADDRESS 1 field of the INSURANCE COMPANY File
TRIGGERED by the CLAIMS (INPT) STREET ADDRESS 2 field of the INSURANCE COMPANY File
36,.124 CLAIMS (INPT) PROCESS CITY .12;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>25!($L(X)<2) X
LAST EDITED: JUL 15, 1993
HELP-PROMPT: If the inpatient claims process address of this company is different from its main address, enter
city of the inpatient claims process address. Answer must be 2-25 characters in length.
DESCRIPTION:
Enter the city in which this insurance company's inpatient claims office is located.
36,.125 CLAIMS (INPT) PROCESS STATE .12;5 POINTER TO STATE FILE (#5)
LAST EDITED: OCT 07, 1993
HELP-PROMPT: If the inpatient claims process address of this company is different from its main address, enter
state of the inpatient claims process address.
DESCRIPTION: Enter the state in which this insurance company's inpatient claims office is located. Enter state
even if it is the same as the state of the company's main address.
36,.126 CLAIMS (INPT) PROCESS ZIP .12;6 FREE TEXT
INPUT TRANSFORM: K:($L(X)>10!($L(X)<9)) X I $D(X) K:'$$ZIPCHK9^IBCNSU(X) X I $D(X) D ZIPIN^VAFADDR
MAXIMUM LENGTH: 10
OUTPUT TRANSFORM: D ZIPOUT^VAFADDR
LAST EDITED: MAR 22, 2017
HELP-PROMPT: Answer must be nine (999999999) or ten characters (99999-9999) in length. The last 4 cannot be
'0000' or '9999'.
DESCRIPTION: This is the ZIP code for the address of the inpatient claims processing location when it differs
from the payer's main mailing address. Enter a 9 or 10 character ZIP code.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
36,.127 CLAIMS (INPT) COMPANY NAME .12;7 POINTER TO INSURANCE COMPANY FILE (#36)
INPUT TRANSFORM: S DIC(0)=DIC(0)_"F",DIC("S")="I '$P(^(0),U,5),'$P($G(^(.12)),U,7),(Y'=DA)" D ^DIC K DIC S DIC=DIE,X
=+Y K:Y<0 X
LAST EDITED: OCT 05, 1993
DESCRIPTION: You can only select a company that processes claims. The company specified in this field must be
an active insurance company, not the same company as the entry being edited, and must not have
another company specified as handling Inpatient Claims for it.
SCREEN: S DIC("S")="I '$P(^(0),U,5),'$P($G(^(.12)),U,7),(Y'=DA)"
EXPLANATION: Select a company that processes inpatient claims for this company. Must be active, not this compan
y, and process its own inpatient claims.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the ANOTHER CO. PROCESS IP CLAIMS? field of the INSURANCE COMPANY File
36,.128 ANOTHER CO. PROCESS IP CLAIMS? .12;8 SET
Are Inpatient Claims Processed by Another Insurance Co.?
'0' FOR NO;
'1' FOR YES;
LAST EDITED: APR 10, 2003
DESCRIPTION:
Enter "Yes" if another insurance company processes Inpatient Claims.
CROSS-REFERENCE: ^^TRIGGER^36^.127
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X='$P($G(^DIC(36,DA,.12)),"^",8) I X S X=DIV S Y(1)=$S
($D(^DIC(36,D0,.12)):^(.12),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(36,.128,1,1,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.12)):^(.12),1:""),DIV=X S $P(^(.12),U,7)=DIV,DIH=36,DIG=.127 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= S X='$P($G(^DIC(36,DA,.12)),"^",8)
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= #.127
Enter "Yes" if another insurance company processes Inpatient Claims.
36,.129 CLAIMS (INPT) FAX .12;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: NOV 22, 1993
HELP-PROMPT: Enter the fax number of the inpatient claims office with 7-20 characters, e.g. 444-8888,
614-333-9999.
DESCRIPTION:
Enter the fax number of this insurance carrier's inpatient claims office.
36,.13 TYPE OF COVERAGE 0;13 POINTER TO TYPE OF INSURANCE COVERAGE FILE (#355.2)
LAST EDITED: NOV 17, 2005
DESCRIPTION: If this insurance carrier provides only one type of coverage then select the entry that best
describes this carriers type of coverage. If this carrier provides more than one type of coverage
then select HEALTH INSURANCE. The default answer if left unanswered is Health Insurance.
This is useful information when contacting carriers, when creating claims for reimbursement, and
when estimating if the payment received is appropriate.
If this field is answered it may affect choices that can be selected when entering policy or
benefit information.
36,.131 PHONE NUMBER .13;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: FEB 26, 1993
HELP-PROMPT: Enter the telephone number of the company with 7 - 20 characters, ex. 777-8888, 415 111 2222 x123.
DESCRIPTION:
Enter the phone number at which this insurance carrier can be reached.
DELETE TEST: 1,0)= I $D(DGINS)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
36,.1311 CLAIMS (RX) PHONE NUMBER .13;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: JAN 04, 1994
HELP-PROMPT: Enter the telephone number of the prescription claims office with 7 - 20 characters, ex. 777-8888,
415 111 2222x123.
DESCRIPTION: Enter the phone number at which the prescription claims office of this insurance carrier can be
reached.
36,.132 BILLING PHONE NUMBER .13;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: MAY 04, 1990
HELP-PROMPT: Enter the telephone number of the billing office for this company. Answer must be 7-20 characters
in length.
DESCRIPTION: Enter the phone number of the insurance carrier where inquiries about patient billing should be
made.
36,.133 PRECERTIFICATION PHONE NUMBER .13;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: MAY 04, 1990
HELP-PROMPT: Enter the phone number for getting Precertification of insurance if this company requires it.
Answer must be 7-20 characters in length.
DESCRIPTION: If precertification is required prior to a patient being treated, enter the number of the insurance
carrier to which this request can be made.
36,.1331 PRECERTIFICATION PORTAL .13;12 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<1)!'(X'["/>") X
MAXIMUM LENGTH: 80
LAST EDITED: JUN 18, 2024
HELP-PROMPT: Answer must be between 1 and 80 characters and it cannot contain "/>".
DESCRIPTION: If precertification is required prior to a patient being treated, enter the website of the
insurance carrier to which this request can be made. Answer cannot contain "/>".
TECHNICAL DESCR:
Introduced with IB*2*794
36,.134 VERIFICATION PHONE NUMBER .13;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: MAR 29, 1993
HELP-PROMPT: Enter the phone number for getting verification of insurance. Answer must be 7-20 characters in
length.
DESCRIPTION:
Enter the phone number of the insurance carrier to which a Verification request can be made.
36,.135 CLAIMS (INPT) PHONE NUMBER .13;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: JUL 15, 1993
HELP-PROMPT: Enter the telephone number of the inpatient claims office with 7-20 characters, e.g. 777-8888, 415
111 2222 x123.
DESCRIPTION: Enter the telephone number at which this insurance carrier's inpatient claims office can be
reached.
36,.136 CLAIMS (OPT) PHONE NUMBER .13;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: JUL 15, 1993
HELP-PROMPT: Enter the telephone number of the outpatient claims office with 7 - 20 characters, ex. 777-8888,
415 111 2222 x123.
DESCRIPTION: Enter the phone number at which the outpatient claims office of this insurance carrier can be
reached.
36,.137 APPEALS PHONE NUMBER .13;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: JUL 15, 1993
HELP-PROMPT: Enter the telephone number of the appeals office with 7 - 20 characters, ex. 777-8888, 415 111 2222
x123.
DESCRIPTION:
Enter the telephone number at which the appeals office of this insurance carrier can be reached.
36,.138 INQUIRY PHONE NUMBER .13;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: JUL 15, 1993
HELP-PROMPT: Enter the telephone number of the inquiry office with 7 - 20 characters, ex. 777-8888, 415 111 222
x123.
DESCRIPTION:
Enter the telephone number at which the inquiry office of this insurance carrier can be reached.
36,.139 PRECERT COMPANY NAME .13;9 POINTER TO INSURANCE COMPANY FILE (#36)
INPUT TRANSFORM: S DIC(0)=DIC(0)_"F",DIC("S")="I '$P(^(0),U,5),'$P($G(^(.13)),U,9),(Y'=DA)" D ^DIC K DIC S DIC=DIE,X
=+Y K:Y<0 X
LAST EDITED: OCT 06, 1993
DESCRIPTION: You can only select a company that processes Precerts. The company specified in this field must be
an active insurance company, not the same company specified as handling Precerts for it.
SCREEN: S DIC("S")="I '$P(^(0),U,5),'$P($G(^(.13)),U,9),(Y'=DA)"
EXPLANATION: Select a company that processes precerts for this company. Must be active, not this company, and p
rocess its own precerts.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the ANOTHER CO. PROCESS PRECERTS? field of the INSURANCE COMPANY File
36,.141 APPEALS ADDRESS ST. [LINE 1] .14;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!'$G(IBCNS) X
LAST EDITED: JUN 19, 2007
HELP-PROMPT: If the appeals address of this company is different from its main address, enter Line 1 of the
appeals street address. Answer must be 3-30 characters in length.
DESCRIPTION: If the appeals address of this company is different from its main address, enter Line 1 of the
appeals street address. Answer must be 3-30 characters in length.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^36^.142
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.14)):^(.14),1:"") S X=$P(Y(1),U,2),X=X S
DIU=X K Y S X="" X ^DD(36,.141,1,1,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.14)):^(.14),1:""),DIV=X S $P(^(.14),U,2)=DIV,DIH=36,DIG=.142 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.14)):^(.14),1:"") S X=$P(Y(1),U,2),X=X S
DIU=X K Y S X="" X ^DD(36,.141,1,1,2.4)
2.4)= S DIH=$S($D(^DIC(36,DIV(0),.14)):^(.14),1:""),DIV=X S $P(^(.14),U,2)=DIV,DIH=36,DIG=.142 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= APPEALS ADDRESS ST. [LINE 2]
When changing or deleting APPEALS ADDRESS ST. [LINE 1] delete APPEALS ADDRESS ST. [LINE 2].
CROSS-REFERENCE: ^^TRIGGER^36^.143
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.14)):^(.14),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.141,1,2,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.14)):^(.14),1:""),DIV=X S $P(^(.14),U,3)=DIV,DIH=36,DIG=.143 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.14)):^(.14),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.141,1,2,2.4)
2.4)= S DIH=$S($D(^DIC(36,DIV(0),.14)):^(.14),1:""),DIV=X S $P(^(.14),U,3)=DIV,DIH=36,DIG=.143 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= APPEALS ADDRESS ST. [LINE 3]
When changing or deleting APPEALS ADDRESS ST. [LINE 1] delete APPEALS ADDRESS ST. [LINE 3].
36,.142 APPEALS ADDRESS ST. [LINE 2] .14;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.141) X
LAST EDITED: JUN 19, 2007
HELP-PROMPT: If the Appeals Address is longer than one line, enter a second line between 3-30 characters. It
can not be the same as Line 1.
DESCRIPTION: If the Appeals Address is longer than one line, enter a second line between 3-30 characters. It
can not be the same as Line 1.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the APPEALS ADDRESS ST. [LINE 1] field of the INSURANCE COMPANY File
CROSS-REFERENCE: ^^TRIGGER^36^.143
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.14)):^(.14),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.142,1,1,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.14)):^(.14),1:""),DIV=X S $P(^(.14),U,3)=DIV,DIH=36,DIG=.143 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.14)):^(.14),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.142,1,1,2.4)
2.4)= S DIH=$S($D(^DIC(36,DIV(0),.14)):^(.14),1:""),DIV=X S $P(^(.14),U,3)=DIV,DIH=36,DIG=.143 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= APPEALS ADDRESS ST. [LINE 3]
When changing or deleting APPEALS ADDRESS ST. [LINE 2] delete APPEALS ADDRESS ST. [LINE 3].
36,.143 APPEALS ADDRESS ST. [LINE 3] .14;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.141,.142) X
LAST EDITED: JUN 19, 2007
HELP-PROMPT: If the Appeals Address is longer than two lines, enter a third line between 3-30 characters. It
can not be the same as Line 1 or Line 2.
DESCRIPTION: If the Appeals Address is longer than two lines, enter a third line between 3-30 characters. It
can not be the same as Line 1 or Line 2.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the APPEALS ADDRESS ST. [LINE 2] field of the INSURANCE COMPANY File
TRIGGERED by the APPEALS ADDRESS ST. [LINE 1] field of the INSURANCE COMPANY File
36,.144 APPEALS ADDRESS CITY .14;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>25!($L(X)<2) X
LAST EDITED: FEB 25, 1993
HELP-PROMPT: If the appeals address of this company is different from its main address, enter city of the
appeals address. Answer must be 2-25 characters in length.
DESCRIPTION:
Enter the city in which the appeals office of this insurance company is located.
36,.145 APPEALS ADDRESS STATE .14;5 POINTER TO STATE FILE (#5)
LAST EDITED: OCT 07, 1993
HELP-PROMPT: If the appeals address of this company is different from its main address, enter state of the
appeals address.
DESCRIPTION: Enter the state in which the appeals office of this insurance company is located. Enter state even
if it is the same as the state of the company's main address.
36,.146 APPEALS ADDRESS ZIP .14;6 FREE TEXT
INPUT TRANSFORM: K:($L(X)>10!($L(X)<9)) X I $D(X) K:'$$ZIPCHK9^IBCNSU(X) X I $D(X) D ZIPIN^VAFADDR
MAXIMUM LENGTH: 10
OUTPUT TRANSFORM: D ZIPOUT^VAFADDR
LAST EDITED: MAR 22, 2017
HELP-PROMPT: Answer must be nine (999999999) or ten characters (99999-9999) in length. The last 4 cannot be
'0000' or '9999'.
DESCRIPTION: This is the ZIP code for the address of the appeals processing location when it differs from the
payer's main mailing address. Enter a 9 or 10 character ZIP code.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
36,.147 APPEALS COMPANY NAME .14;7 POINTER TO INSURANCE COMPANY FILE (#36)
INPUT TRANSFORM: S DIC(0)=DIC(0)_"F",DIC("S")="I '$P(^(0),U,5),'$P($G(^(.14)),U,7),(Y'=DA)" D ^DIC K DIC S DIC=DIE,X
=+Y K:Y<0 X
LAST EDITED: OCT 06, 1993
DESCRIPTION: You can only select a company that processes Appeals. The company specified in this field must be
an active insurance company, not the same company as the entry being edited, and must not have
another company specified as handling Appeals for it.
SCREEN: S DIC("S")="I '$P(^(0),U,5),'$P($G(^(.14)),U,7),(Y'=DA)"
EXPLANATION: Select a company that processes inpatient claims for this company. Must be active, not this compan
y, and process its own inpatient claims.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the ANOTHER CO. PROCESS APPEALS? field of the INSURANCE COMPANY File
36,.148 ANOTHER CO. PROCESS APPEALS? .14;8 SET
Are Appeals Processed by Another Insurance Co.?
'0' FOR NO;
'1' FOR YES;
LAST EDITED: OCT 07, 1993
DESCRIPTION:
Enter "Yes" if another insurance company processes appeals.
CROSS-REFERENCE: ^^TRIGGER^36^.147
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X='$P($G(^DIC(36,DA,.14)),"^",8) I X S X=DIV S Y(1)=$S
($D(^DIC(36,D0,.14)):^(.14),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(36,.148,1,1,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.14)):^(.14),1:""),DIV=X S $P(^(.14),U,7)=DIV,DIH=36,DIG=.147 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= S X='$P($G(^DIC(36,DA,.14)),"^",8)
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= #.147
36,.149 APPEALS FAX .14;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: NOV 22, 1993
HELP-PROMPT: Enter the fax number of this insurance carrier's appeals office with 7 - 20 characters, ex.
444-8888, 614-333-9999.
DESCRIPTION:
Enter the fax number of the appeals office of this insurance carrier.
36,.15 PRESCRIPTION REFILL REV. CODE 0;15 POINTER TO REVENUE CODE FILE (#399.2)
INPUT TRANSFORM: S DIC("S")="I $P(^(0),U,3)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: NOV 17, 2005
HELP-PROMPT: Enter revenue code to be used for Rx refills.
DESCRIPTION: This is the Revenue Code that will automatically be generated for this insurance company if a
prescription refill is listed on this bill.
SCREEN: S DIC("S")="I $P(^(0),U,3)"
EXPLANATION: This is the Revenue Code that will automatically be generated for this insurance company if a presc
ription refill is listed on this bill.
36,.151 INQUIRY ADDRESS ST. [LINE 1] .15;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!'$G(IBCNS) X
LAST EDITED: JUN 19, 2007
HELP-PROMPT: If the inquiry address of this company is different from its main address, enter Line 1 of the
inquiry street address. Answer must be 3-30 characters in length.
DESCRIPTION: If the inquiry address of this company is different from its main address, enter Line 1 of the
inquiry street address. Answer must be 3-30 characters in length.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^36^.152
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.15)):^(.15),1:"") S X=$P(Y(1),U,2),X=X S
DIU=X K Y S X="" X ^DD(36,.151,1,1,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.15)):^(.15),1:""),DIV=X S $P(^(.15),U,2)=DIV,DIH=36,DIG=.152 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.15)):^(.15),1:"") S X=$P(Y(1),U,2),X=X S
DIU=X K Y S X="" X ^DD(36,.151,1,1,2.4)
2.4)= S DIH=$S($D(^DIC(36,DIV(0),.15)):^(.15),1:""),DIV=X S $P(^(.15),U,2)=DIV,DIH=36,DIG=.152 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= INQUIRY ADDRESS ST. [LINE 2]
When changing or deleting INQUIRY ADDRESS ST. [LINE 1] delete INQUIRY ADDRESS ST. [LINE 2].
CROSS-REFERENCE: ^^TRIGGER^36^.153
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.15)):^(.15),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.151,1,2,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.15)):^(.15),1:""),DIV=X S $P(^(.15),U,3)=DIV,DIH=36,DIG=.153 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.15)):^(.15),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.151,1,2,2.4)
2.4)= S DIH=$S($D(^DIC(36,DIV(0),.15)):^(.15),1:""),DIV=X S $P(^(.15),U,3)=DIV,DIH=36,DIG=.153 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= INQUIRY ADDRESS ST. [LINE 3]
When changing or deleting INQUIRY ADDRESS ST. [LINE 1] delete INQUIRY ADDRESS ST. [LINE 3].
36,.152 INQUIRY ADDRESS ST. [LINE 2] .15;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.151) X
LAST EDITED: JUN 19, 2007
HELP-PROMPT: If the Inquiry Address is longer than one line, enter a second line between 3-30 characters. It
can not be the same as Line 1.
DESCRIPTION: If the Inquiry Address is longer than one line, enter a second line between 3-30 characters. It
can not be the same as Line 1.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the INQUIRY ADDRESS ST. [LINE 1] field of the INSURANCE COMPANY File
CROSS-REFERENCE: ^^TRIGGER^36^.153
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.15)):^(.15),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.152,1,1,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.15)):^(.15),1:""),DIV=X S $P(^(.15),U,3)=DIV,DIH=36,DIG=.153 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.15)):^(.15),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.152,1,1,2.4)
2.4)= S DIH=$S($D(^DIC(36,DIV(0),.15)):^(.15),1:""),DIV=X S $P(^(.15),U,3)=DIV,DIH=36,DIG=.153 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= INQUIRY ADDRESS ST. [LINE 3]
When changing or deleting INQUIRY ADDRESS ST. [LINE 2] delete INQUIRY ADDRESS ST. [LINE 3].
36,.153 INQUIRY ADDRESS ST. [LINE 3] .15;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.151,.152) X
LAST EDITED: JUN 19, 2007
HELP-PROMPT: If the Inquiry Address is longer than two lines, enter a third line between 3-30 characters. It
can not be the same as Line 1 or Line 2.
DESCRIPTION: If the Inquiry Address is longer than two lines, enter a third line between 3-30 characters. It
can not be the same as Line 1 or Line 2.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the INQUIRY ADDRESS ST. [LINE 1] field of the INSURANCE COMPANY File
TRIGGERED by the INQUIRY ADDRESS ST. [LINE 2] field of the INSURANCE COMPANY File
36,.154 INQUIRY ADDRESS CITY .15;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>25!($L(X)<2) X
LAST EDITED: FEB 25, 1993
HELP-PROMPT: If the inquiry address of this company is different from its main address, enter city of the
inquiry address. Answer must be 2-25 characters in length.
DESCRIPTION:
Enter the city in which this insurance company's inquiry address office is located.
36,.155 INQUIRY ADDRESS STATE .15;5 POINTER TO STATE FILE (#5)
LAST EDITED: FEB 25, 1993
HELP-PROMPT: If the inquiry address of this company is different from its main address, enter state of the
inquiry address.
DESCRIPTION: Enter the state in which this insurance company's inquiry address office is located. Enter state
even if it is the same as the state of the company's main address.
36,.156 INQUIRY ADDRESS ZIP CODE .15;6 FREE TEXT
INPUT TRANSFORM: K:($L(X)>10!($L(X)<9)) X I $D(X) K:'$$ZIPCHK9^IBCNSU(X) X I $D(X) D ZIPIN^VAFADDR
MAXIMUM LENGTH: 10
OUTPUT TRANSFORM: D ZIPOUT^VAFADDR
LAST EDITED: MAR 22, 2017
HELP-PROMPT: Answer must be nine (999999999) or ten characters (99999-9999) in length. The last 4 cannot be
'0000' or '9999'.
DESCRIPTION: This is the ZIP code for the address of the inquiry processing location when it differs from the
payer's main mailing address. Enter a 9 or 10 character ZIP code.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
36,.157 INQUIRY COMPANY NAME .15;7 POINTER TO INSURANCE COMPANY FILE (#36)
INPUT TRANSFORM: S DIC(0)=DIC(0)_"F",DIC("S")="I '$P(^(0),U,5),'$P($G(^(.15)),U,7),(Y'=DA)" D ^DIC K DIC S DIC=DIE,X
=+Y K:Y<0 X
LAST EDITED: OCT 08, 1993
DESCRIPTION: You can only select a company that processes Inquiries. The company specified in this field must
be an active insurance company, not the same company as the entry being edited, and must not have
another company specified as handling Inquiries for it.
SCREEN: S DIC("S")="I '$P(^(0),U,5),'$P($G(^(.15)),U,7),(Y'=DA)"
EXPLANATION: Select a company that processes inquiries for this company. Must be active, not this company, and
process its own inquiries.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the ANOTHER CO. PROCESS INQUIRIES? field of the INSURANCE COMPANY File
36,.158 ANOTHER CO. PROCESS INQUIRIES? .15;8 SET
Are Inquiries Processed by Another Insurance Co.?
'0' FOR NO;
'1' FOR YES;
LAST EDITED: OCT 07, 1993
DESCRIPTION:
Enter "Yes" if another insurance company processes Inquiries.
CROSS-REFERENCE: ^^TRIGGER^36^.157
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X='$P($G(^DIC(36,DA,.15)),"^",8) I X S X=DIV S Y(1)=$S
($D(^DIC(36,D0,.15)):^(.15),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(36,.158,1,1,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.15)):^(.15),1:""),DIV=X S $P(^(.15),U,7)=DIV,DIH=36,DIG=.157 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= S X='$P($G(^DIC(36,DA,.15)),"^",8)
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= #.157
36,.159 INQUIRY FAX .15;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: NOV 22, 1993
HELP-PROMPT: Enter the fax number of this insurance carrier's inquiries office with 7 - 20 characters, ex.
444-8888, 614-333-9999.
DESCRIPTION:
Enter the fax number of the inquiries office of this insurance carrier.
36,.16 REPOINT PATIENTS TO 0;16 POINTER TO INSURANCE COMPANY FILE (#36)
LAST EDITED: FEB 28, 1994
DESCRIPTION: If an insurance company has been inactivated and the patients repointed to another company then
this is the company that they are assigned.
TECHNICAL DESCR:
This field will be maintained by the computer. Do not manually enter/edit.
WRITE AUTHORITY: ^
36,.161 CLAIMS (OPT) STREET ADDRESS 1 .16;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>35!($L(X)<3)!'$G(IBCNS) X
LAST EDITED: JUN 19, 2007
HELP-PROMPT: If the outpatient claims process address of this company is different from its main address, enter
Line 1 of the outpatient claims street address. Answer must be 3-35 characters in length.
DESCRIPTION: If the outpatient claims process address of this company is different from its main address, enter
Line 1 of the outpatient claims street address. Answer must be 3-35 characters in length.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^36^.162
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.16)):^(.16),1:"") S X=$P(Y(1),U,2),X=X S
DIU=X K Y S X="" X ^DD(36,.161,1,1,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.16)):^(.16),1:""),DIV=X S $P(^(.16),U,2)=DIV,DIH=36,DIG=.162 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.16)):^(.16),1:"") S X=$P(Y(1),U,2),X=X S
DIU=X K Y S X="" X ^DD(36,.161,1,1,2.4)
2.4)= S DIH=$S($D(^DIC(36,DIV(0),.16)):^(.16),1:""),DIV=X S $P(^(.16),U,2)=DIV,DIH=36,DIG=.162 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= #.162
When changing or deleting CLAIMS (OPT) STREET ADDRESS 1 delete CLAIMS (OPT) STREET ADDRESS 2.
CROSS-REFERENCE: ^^TRIGGER^36^.163
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.16)):^(.16),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.161,1,2,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.16)):^(.16),1:""),DIV=X S $P(^(.16),U,3)=DIV,DIH=36,DIG=.163 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.16)):^(.16),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.161,1,2,2.4)
2.4)= S DIH=$S($D(^DIC(36,DIV(0),.16)):^(.16),1:""),DIV=X S $P(^(.16),U,3)=DIV,DIH=36,DIG=.163 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= #.163
When changing or deleting CLAIMS (OPT) STREET ADDRESS 1 delete CLAIMS (OPT) STREET ADDRESS 3.
36,.162 CLAIMS (OPT) STREET ADDRESS 2 .16;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>35!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.161) X
LAST EDITED: SEP 28, 2007
HELP-PROMPT: If the Outpatient Claims Process Address is longer than one line, enter a second line between 3-35
characters. It can not be the same as Line 1.
DESCRIPTION: If the Outpatient Claims Process Address is longer than one line, enter a second line between 3-35
characters. It can not be the same as Line 1.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the CLAIMS (OPT) STREET ADDRESS 1 field of the INSURANCE COMPANY File
CROSS-REFERENCE: ^^TRIGGER^36^.163
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.16)):^(.16),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.162,1,1,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.16)):^(.16),1:""),DIV=X S $P(^(.16),U,3)=DIV,DIH=36,DIG=.163 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.16)):^(.16),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.162,1,1,2.4)
2.4)= S DIH=$S($D(^DIC(36,DIV(0),.16)):^(.16),1:""),DIV=X S $P(^(.16),U,3)=DIV,DIH=36,DIG=.163 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= #.163
When changing or deleting CLAIMS (OPT) STREET ADDRESS 2 delete CLAIMS (OPT) STREET ADDRESS 3.
36,.163 CLAIMS (OPT) STREET ADDRESS 3 .16;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>35!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.161,.162) X
LAST EDITED: JUN 19, 2007
HELP-PROMPT: If the Outpatient Claims Process Address is longer than two lines, enter a third line between 3-35
characters. It can not be the same as Line 1 or Line 2.
DESCRIPTION: If the Outpatient Claims Process Address is longer than two lines, enter a third line between 3-35
characters. It can not be the same as Line 1 or Line 2.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the CLAIMS (OPT) STREET ADDRESS 1 field of the INSURANCE COMPANY File
TRIGGERED by the CLAIMS (OPT) STREET ADDRESS 2 field of the INSURANCE COMPANY File
36,.164 CLAIMS (OPT) PROCESS CITY .16;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>25!($L(X)<2) X
LAST EDITED: JUL 15, 1993
HELP-PROMPT: If the outpatient claims process address of this company is different from its main address, enter
city of the outpatient claims process address. Answer must be 2-25 characters in length.
DESCRIPTION:
Enter the city in which this insurance company's outpatient claims office is located.
36,.165 CLAIMS (OPT) PROCESS STATE .16;5 POINTER TO STATE FILE (#5)
LAST EDITED: JUL 15, 1993
HELP-PROMPT: If the outpatient claims process address of this company is different from its main address, enter
state of the outpatient claims address.
DESCRIPTION: Enter the state in which this insurance company's outpatient claims office is located. Enter state
even if it is the same as the state of the company's main address.
36,.166 CLAIMS (OPT) PROCESS ZIP .16;6 FREE TEXT
INPUT TRANSFORM: K:($L(X)>10!($L(X)<9)) X I $D(X) K:'$$ZIPCHK9^IBCNSU(X) X I $D(X) D ZIPIN^VAFADDR
MAXIMUM LENGTH: 10
OUTPUT TRANSFORM: D ZIPOUT^VAFADDR
LAST EDITED: MAR 22, 2017
HELP-PROMPT: Answer must be nine (999999999) or ten characters (99999-9999) in length. The last 4 cannot be
'0000' or '9999'.
DESCRIPTION: This is the ZIP code for the address of the outpatient claims processing location when it differs
from the payer's main mailing address. Enter a 9 or 10 character ZIP code.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
36,.167 CLAIMS (OPT) COMPANY NAME .16;7 POINTER TO INSURANCE COMPANY FILE (#36)
INPUT TRANSFORM: S DIC(0)=DIC(0)_"F",DIC("S")="I '$P(^(0),U,5),'$P($G(^(.16)),U,7),Y'=DA" D ^DIC K DIC S DIC=DIE,X=+
Y K:Y<0 X
LAST EDITED: OCT 01, 1993
DESCRIPTION: You can only select a company that processes claims. The company specified in this field must be
an active insurance company, not the same company as the entry being edited, and must not have
another company specified as handling Outpatient Claims for it.
SCREEN: S DIC("S")="I '$P(^(0),U,5),'$P($G(^(.16)),U,7),Y'=DA"
EXPLANATION: Select an active Insurance Company that will process Outpatient Claims for this company. It may no
t be this company or have another company process outpatient claims for it.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the ANOTHER CO. PROCESS OP CLAIMS? field of the INSURANCE COMPANY File
36,.168 ANOTHER CO. PROCESS OP CLAIMS? .16;8 SET
Are Outpatient Claims Processed by Another Insurance Co.?
'0' FOR NO;
'1' FOR YES;
LAST EDITED: APR 10, 2003
DESCRIPTION:
Enter "Yes" if another insurance company processes Outpatient Claims.
CROSS-REFERENCE: ^^TRIGGER^36^.167
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X='$P($G(^DIC(36,DA,.16)),"^",8) I X S X=DIV S Y(1)=$S
($D(^DIC(36,D0,.16)):^(.16),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(36,.168,1,1,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.16)):^(.16),1:""),DIV=X S $P(^(.16),U,7)=DIV,DIH=36,DIG=.167 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= S X='$P($G(^DIC(36,DA,.16)),"^",8)
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= #.167
36,.169 CLAIMS (OPT) FAX .16;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: NOV 22, 1993
HELP-PROMPT: Enter the fax number of the outpatient claims office with 7 - 20 characters, ex. 444-8888,
614-333-9999.
DESCRIPTION:
Enter the fax number of the outpatient claims office of this insurance carrier.
36,.17 PROFESSIONAL PROVIDER NUMBER 0;17 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: SEP 05, 2006
HELP-PROMPT: Answer must be 1-15 characters in length.
DESCRIPTION: An identifier for professional (CMS-1500) bills assigned by the insurance company. This field is a
counterpart to the Hospital Provider Number.
36,.178 ANOTHER CO. PROCESS PRECERTS? .17;8 SET
Are Precerts Processed by Another Insurance Co.?
'0' FOR NO;
'1' FOR YES;
LAST EDITED: OCT 07, 1993
DESCRIPTION:
Enter "Yes" if another insurance company processes precerts.
CROSS-REFERENCE: ^^TRIGGER^36^.139
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X='$P($G(^DIC(36,DA,.17)),"^",8) I X S X=DIV S Y(1)=$S
($D(^DIC(36,D0,.13)):^(.13),1:"") S X=$P(Y(1),U,9),X=X S DIU=X K Y S X="" X ^DD(36,.178,1,1,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.13)):^(.13),1:""),DIV=X S $P(^(.13),U,9)=DIV,DIH=36,DIG=.139 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= S X='$P($G(^DIC(36,DA,.17)),"^",8)
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= #.139
36,.18 STANDARD FTF 0;18 POINTER TO INSURANCE FILING TIME FRAME FILE (#355.13) (audited)
LAST EDITED: JUL 11, 2022
HELP-PROMPT: Enter the maximum standard filing time frame for this insurance company.
DESCRIPTION: This is the standard filing time frame for the insurance company. It may be automatically applied
to dates of service.
AUDIT: YES, ALWAYS
CROSS-REFERENCE: ^^TRIGGER^36^.19
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,0)):^(0),1:"") S X=$P(Y(1),U,19),X=X S DI
U=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),0)),DIV=X S $P(^(0),U,19)=DIV,DIH=36,DIG=.19 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,0)):^(0),1:"") S X=$P(Y(1),U,19),X=X S DI
U=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),0)),DIV=X S $P(^(0),U,19)=DIV,DIH=36,DIG=.19 D ^DICR
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= STANDARD FTF VALUE
When changing or deleting Standard Filing Time Frame delete the corresponding Value.
36,.181 CLAIMS (RX) STREET ADDRESS 1 .18;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!'$G(IBCNS) X
LAST EDITED: JUN 19, 2007
HELP-PROMPT: If the prescription claims address of this company is different from its main address, enter Line 1
of the prescription claims address. Answer must be 3-30 characters in length.
DESCRIPTION: If the prescription claims address of this company is different from its main address, enter Line 1
of the prescription claims address. Answer must be 3-30 characters in length.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^36^.182
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.18)):^(.18),1:"") S X=$P(Y(1),U,2),X=X S
DIU=X K Y S X="" X ^DD(36,.181,1,1,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.18)):^(.18),1:""),DIV=X S $P(^(.18),U,2)=DIV,DIH=36,DIG=.182 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.18)):^(.18),1:"") S X=$P(Y(1),U,2),X=X S
DIU=X K Y S X="" X ^DD(36,.181,1,1,2.4)
2.4)= S DIH=$S($D(^DIC(36,DIV(0),.18)):^(.18),1:""),DIV=X S $P(^(.18),U,2)=DIV,DIH=36,DIG=.182 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= #.182
When changing or deleting CLAIMS (RX) STREET 1 delete CLAIMS (RX) STREET ADDRESS 1.
CROSS-REFERENCE: ^^TRIGGER^36^.183
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.18)):^(.18),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.181,1,2,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.18)):^(.18),1:""),DIV=X S $P(^(.18),U,3)=DIV,DIH=36,DIG=.183 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.18)):^(.18),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.181,1,2,2.4)
2.4)= S DIH=$S($D(^DIC(36,DIV(0),.18)):^(.18),1:""),DIV=X S $P(^(.18),U,3)=DIV,DIH=36,DIG=.183 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= #.183
When changing or deleting CLAIMS (RX) STREET ADDRESS 1 delete CLAIMS (RX) STREET ADDRESS 2.
36,.182 CLAIMS (RX) STREET ADDRESS 2 .18;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.181) X
LAST EDITED: JUN 19, 2007
HELP-PROMPT: If the Prescription Claims Address is longer than one line, enter a second line between 3-30
characters. It can not be the same as Line 1.
DESCRIPTION: If the Prescription Claims Address is longer than one line, enter a second line between 3-30
characters. It can not be the same as Line 1.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the CLAIMS (RX) STREET ADDRESS 1 field of the INSURANCE COMPANY File
CROSS-REFERENCE: ^^TRIGGER^36^.183
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.18)):^(.18),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.182,1,1,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.18)):^(.18),1:""),DIV=X S $P(^(.18),U,3)=DIV,DIH=36,DIG=.183 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.18)):^(.18),1:"") S X=$P(Y(1),U,3),X=X S
DIU=X K Y S X="" X ^DD(36,.182,1,1,2.4)
2.4)= S DIH=$S($D(^DIC(36,DIV(0),.18)):^(.18),1:""),DIV=X S $P(^(.18),U,3)=DIV,DIH=36,DIG=.183 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= #.183
36,.183 CLAIMS (RX) STREET ADDRESS 3 .18;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.181,.182) X
LAST EDITED: JUN 19, 2007
HELP-PROMPT: If the Prescription Claims Address is longer than two lines, enter a third line between 3-30
characters. It can not be the same as Line 1 or Line 2.
DESCRIPTION: If the Prescription Claims Address is longer than two lines, enter a third line between 3-30
characters. It can not be the same as Line 1 or Line 2.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the CLAIMS (RX) STREET ADDRESS 1 field of the INSURANCE COMPANY File
TRIGGERED by the CLAIMS (RX) STREET ADDRESS 2 field of the INSURANCE COMPANY File
36,.184 CLAIMS (RX) CITY .18;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>25!($L(X)<2) X
LAST EDITED: JAN 03, 1994
HELP-PROMPT: If the prescription claims office address of this company is different from its main address, enter
city of the prescription claims address. Answer must be 2-25 characters in length.
DESCRIPTION:
Enter the city in which this insurance company's prescription claims office is located.
36,.185 CLAIMS (RX) STATE .18;5 POINTER TO STATE FILE (#5)
LAST EDITED: JAN 22, 2013
HELP-PROMPT: If the prescription claims office address of this company is different from its main address, enter
state of the prescription claims office.
DESCRIPTION: Enter the state in which this insurance company's prescription claims office is located. Enter
state even if it is the same as the state of the company's main address.
36,.186 CLAIMS (RX) ZIP .18;6 FREE TEXT
INPUT TRANSFORM: K:($L(X)>10!($L(X)<9)) X I $D(X) K:'$$ZIPCHK9^IBCNSU(X) X I $D(X) D ZIPIN^VAFADDR
MAXIMUM LENGTH: 10
OUTPUT TRANSFORM: D ZIPOUT^VAFADDR
LAST EDITED: MAR 22, 2017
HELP-PROMPT: Answer must be nine (999999999) or ten characters (99999-9999) in length. The last 4 cannot be
'0000' or '9999'.
DESCRIPTION: This is the ZIP code for the address of the prescription claims processing location when it differs
from the payer's main mailing address. Enter a 9 or 10 character ZIP code.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
36,.187 CLAIMS (RX) COMPANY NAME .18;7 POINTER TO INSURANCE COMPANY FILE (#36)
INPUT TRANSFORM: S DIC(0)=DIC(0)_"F",DIC("S")="I '$P(^(0),U,5),'$P($G(^(.18)),U,7),(Y'=DA)" D ^DIC K DIC S DIC=DIE,X
=+Y K:Y<0 X
LAST EDITED: JAN 04, 1994
DESCRIPTION: You can only select a company that processes Prescriptions. The company specified in this field
must be an active insurance company, not the same company as the entry being edited, and must not
have another company specified as handling Prescriptions for it.
SCREEN: S DIC("S")="I '$P(^(0),U,5),'$P($G(^(.18)),U,7),(Y'=DA)"
EXPLANATION: Select a company that processes prescription claims for this company. Must be active, not this com
pany, and process its own prescription claims.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the ANOTHER CO. PROCESS RX CLAIMS? field of the INSURANCE COMPANY File
36,.188 ANOTHER CO. PROCESS RX CLAIMS? .18;8 SET
Are Rx Claims Processed by Another Insurance Co.?
'0' FOR NO;
'1' FOR YES;
LAST EDITED: JAN 04, 1994
DESCRIPTION:
Enter "Yes" if another insurance company processes prescription claims.
CROSS-REFERENCE: ^^TRIGGER^36^.187
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X='$P($G(^DIC(36,DA,.18)),"^",8) I X S X=DIV S Y(1)=$S
($D(^DIC(36,D0,.18)):^(.18),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(36,.188,1,1,1.4)
1.4)= S DIH=$S($D(^DIC(36,DIV(0),.18)):^(.18),1:""),DIV=X S $P(^(.18),U,7)=DIV,DIH=36,DIG=.187 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= S X='$P($G(^DIC(36,DA,.18)),"^",8)
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= #.187
Enter "Yes" if another insurance company processes prescription claims.
36,.189 CLAIMS (RX) FAX .18;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: JAN 03, 1994
HELP-PROMPT: Enter the fax number of the prescription claims office with 7-20 characters, ex. 444-8888,
614-333-9999.
DESCRIPTION:
Enter the fax number of the prescription claims office of this insurance carrier.
36,.19 STANDARD FTF VALUE 0;19 NUMBER (audited)
INPUT TRANSFORM: K:+X'=X!(X>999999)!(X<0)!(X?.E1"."2N.N) X
LAST EDITED: JUL 11, 2022
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 STANDARD FTF field of the INSURANCE COMPANY File
36,.191 CLAIMS (DENTAL) STREET ADDR 1 .19;1 FREE TEXT (audited)
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!'$G(IBCNS) X
MAXIMUM LENGTH: 30
LAST EDITED: AUG 29, 2018
HELP-PROMPT: If the Dental claims process address of this company is different from its main address, enter Line
1 of the Dental claims street address. Answer must be 3-30 characters in length.
DESCRIPTION: If the Dental claims process address of this company is different from its main address, enter Line
1 of the Dental claims street address. Answer must be 3-30 characters in length.
AUDIT: YES, ALWAYS
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^36^.192
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.19)):^(.19),1:"") S X=$P(Y(1),U,2),X=X S
DIU=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),.19)),DIV=X S $P(^(.19),U,2)=DIV,DIH=36,DIG=.192 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DIC(36,D0,.19)):^(.19),1:"") S X=$P(Y(1),U,2),X=X S
DIU=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),.19)),DIV=X S $P(^(.19),U,2)=DIV,DIH=36,DIG=.192 D ^DICR
3)= When changing or deleting CLAIMS (DENTAL) STREET ADDR 1 delete CLAIMS (DENTAL) STREET ADDR 2.
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= CLAIMS (DENTAL) STREET ADDR 2
When changing or deleting CLAIMS (DENTAL) STREET ADDR 1 delete CLAIMS (DENTAL) STREET ADDR 2.
36,.1911 CLAIMS (DENTAL) PHONE NUMBER .19;11 FREE TEXT (audited)
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
MAXIMUM LENGTH: 20
LAST EDITED: AUG 29, 2018
HELP-PROMPT: Enter the telephone number of the Dental claims office with 7-20 characters, e.g. 777-8888, 415 111
2222 x123.
DESCRIPTION:
Enter the telephone number at which this insurance carrier's Dental claims office can be reached.
AUDIT: YES, ALWAYS
36,.192 CLAIMS (DENTAL) STREET ADDR 2 .19;2 FREE TEXT (audited)
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!$$DUPADDRL^IBCNSU(X,+$G(IBCNS),.191) X
MAXIMUM LENGTH: 30
LAST EDITED: AUG 29, 2018
HELP-PROMPT: If the Dental Claims Process Address is longer than one line, enter a second line between 3-30
characters. The response can not be the same as Line 1.
DESCRIPTION: If the Dental Claims Process Address is longer than one line, enter a second line between 3-30
characters. The response can not be the same as line 1.
AUDIT: YES, ALWAYS
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the CLAIMS (DENTAL) STREET ADDR 1 field of the INSURANCE COMPANY File
36,.193 BLANK .19;3 FREE TEXT (audited)
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
MAXIMUM LENGTH: 30
LAST EDITED: AUG 29, 2018
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
This is a place holder for a 3rd address line, if needed.
AUDIT: YES, ALWAYS
36,.194 CLAIMS (DENTAL) PROCESS CITY .19;4 FREE TEXT (audited)
INPUT TRANSFORM: K:$L(X)>25!($L(X)<2) X
MAXIMUM LENGTH: 25
LAST EDITED: AUG 29, 2018
HELP-PROMPT: If the Dental claims process address of this company is different from its main address, enter city
of the Dental claims process address. Answer must be 2-25 characters in length.
DESCRIPTION: Enter the state in which this insurance company's Dental claims office is located. Enter state
even if it is the same as the state of the company's main address.
AUDIT: YES, ALWAYS
36,.195 CLAIMS (DENTAL) PROCESS STATE .19;5 POINTER TO STATE FILE (#5) (audited)
LAST EDITED: AUG 29, 2018
HELP-PROMPT: If the Dental claims process address of this company is different from its main address, enter
state of the Dental claims process address.
DESCRIPTION: Enter the state in which this insurance company's Dental claims office is located. Enter state
even if it is the same as the state of the company's main address.
AUDIT: YES, ALWAYS
36,.196 CLAIMS (DENTAL) PROCESS ZIP .19;6 FREE TEXT (audited)
INPUT TRANSFORM: K:$L(X)>10!($L(X)<9) X I $D(X) K:'$$ZIPCHK9^IBCNSU(X) X I $D(X) D ZIPIN^VAFADDR
MAXIMUM LENGTH: 10
OUTPUT TRANSFORM: D ZIPOUT^VAFADDR
LAST EDITED: AUG 29, 2018
HELP-PROMPT: Answer must be nine (999999999) or ten characters (99999-9999) in length. The last 4 cannot be
'0000' or '9999'.
DESCRIPTION: This is the ZIP code for the address of the Dental claims processing location when it differs from
the payer's main mailing address. Enter a 9 or 10 character ZIP code.
AUDIT: YES, ALWAYS
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
36,.197 CLAIMS (DENTAL) COMPANY NAME .19;7 POINTER TO INSURANCE COMPANY FILE (#36) (audited)
INPUT TRANSFORM: S DIC(0)=DIC(0)_"F",DIC("S")="I '$P(^(0),U,5),'$P($G(^(.19)),U,7),Y'=DA" D ^DIC K DIC S DIC=DIE,X=+
Y K:Y<0 X
LAST EDITED: AUG 29, 2018
HELP-PROMPT: Select a company that processes Dental claims for this company.
DESCRIPTION: You can only select a company that processes claims. The company specified in this field must be
an active insurance company, not the same company as the entry being edited, and must not have
another company specified as handling Dental Claims for it.
SCREEN: S DIC("S")="I '$P(^(0),U,5),'$P($G(^(.19)),U,7),Y'=DA"
EXPLANATION: This company must be active, not the same company, and process its own Dental claims.
AUDIT: YES, ALWAYS
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the ANOTHER CO. PROC DENT CLAIMS? field of the INSURANCE COMPANY File
36,.198 ANOTHER CO. PROC DENT CLAIMS? .19;8 SET (audited)
Are Dental Claims Processed by Another Insurance Co.?
'0' FOR NO;
'1' FOR YES;
LAST EDITED: AUG 29, 2018
HELP-PROMPT: Enter 'Yes' if another insurance company processes Dental Claims.
DESCRIPTION: If another insurance company processes Dental Claims for this company, enter 'YES'. Otherwise,
enter 'NO'.
AUDIT: YES, ALWAYS
CROSS-REFERENCE: ^^TRIGGER^36^.197
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X='$P($G(^DIC(36,DA,.19)),"^",8) I X S X=DIV S Y(1)=$S
($D(^DIC(36,D0,.19)):^(.19),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(36,.198,1,1,1.4)
1.4)= S DIH=$G(^DIC(36,DIV(0),.19)),DIV=X S $P(^(.19),U,7)=DIV,DIH=36,DIG=.197 D ^DICR
2)= Q
CREATE CONDITION)= S X='$P($G(^DIC(36,DA,.19)),"^",8)
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= CLAIMS (DENTAL) COMPANY NAME
If another company processes Dental Claims for this company, the field CLAIMS (DENTAL) COMPANY NAME
is triggered for entry.
36,.199 CLAIMS (DENTAL) FAX .19;9 FREE TEXT (audited)
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
MAXIMUM LENGTH: 20
LAST EDITED: AUG 29, 2018
HELP-PROMPT: Enter the fax number of the inpatient claims office with 7-20 characters, e.g. 444-8888,
614-333-9999.
DESCRIPTION:
Enter the fax number of this insurance carrier's Dental claims office.
AUDIT: YES, ALWAYS
36,1 REIMBURSE? 0;2 SET (Required) (audited)
'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: APR 08, 2015
HELP-PROMPT: Enter the proper reimbursement code.
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.
AUDIT: YES, ALWAYS
DELETE TEST: 1,0)= I $D(DGINS)
36,2 SIGNATURE REQUIRED ON BILL? 0;3 SET (Required)
'0' FOR NO;
'1' FOR YES;
LAST EDITED: DEC 22, 1991
HELP-PROMPT: Enter 'Yes' if a bill sent to this insurance carrier requires a manual signature or 'No' if it does
not.
DESCRIPTION: Enter a yes or no in this field denoting whether a signature is required on a bill before being
submitted to the insurance carrier.
DELETE TEST: 1,0)= I $D(DGINS)
36,3.01 TRANSMIT ELECTRONICALLY 3;1 SET (Required) (audited)
'1' FOR YES-LIVE;
'2' FOR YES-TEST;
INPUT TRANSFORM: K:'$$EDIKEY^IBCNSC X
LAST EDITED: AUG 29, 2018
HELP-PROMPT: Enter 1 to bill electronically 2 to only transmit for testing
DESCRIPTION: This field determines whether an electronic claim to this insurance company is sent as a test or a
production claim.
AUDIT: YES, ALWAYS
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
36,3.02 EDI ID NUMBER - PROF 3;2 FREE TEXT (audited)
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1)!($$UP^XLFSTR(X)["PRNT") X I $D(X) K:'$$EDIKEY^IBCNSC X
LAST EDITED: FEB 18, 2020
HELP-PROMPT: Answer must be 1-30 characters. PRNT values are not allowed.
DESCRIPTION: This is the ID number used to identify the Payer on professional claim transmissions. PRNT values
are not valid Payer IDs.
AUDIT: YES, ALWAYS
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 36^AEP
1)= S ^DIC(36,"AEP",$E(X,1,30),DA)=""
2)= K ^DIC(36,"AEP",$E(X,1,30),DA)
This cross-reference allows users to lookup an Insurance Company entry by Primary EDI # within the
RCB option only.
36,3.03 BIN NUMBER 3;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<2) X
LAST EDITED: AUG 14, 1996
HELP-PROMPT: Answer must be 2-15 characters in length.
DESCRIPTION: This field is used for facilities who are billing CHAMPUS prescription charges electronically to
the CHAMPUS fiscal intermediary. The Bin number identifies this company as the CHAMPUS FI to the
electronic billing system so that the claim is correctly routed to the FI.
36,3.04 EDI ID NUMBER - INST 3;4 FREE TEXT (audited)
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1)!($$UP^XLFSTR(X)["PRNT") X I $D(X) K:'$$EDIKEY^IBCNSC X
LAST EDITED: FEB 18, 2020
HELP-PROMPT: Answer must be 1-30 characters. PRNT values are not allowed.
DESCRIPTION: This is the ID number used to identify the Payer on institutional claim transmissions. PRNT values
are not valid Payer IDs.
AUDIT: YES, ALWAYS
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 36^AEI
1)= S ^DIC(36,"AEI",$E(X,1,30),DA)=""
2)= K ^DIC(36,"AEI",$E(X,1,30),DA)
This cross-reference allows users to lookup an Insurance Company entry by Primary EDI # within the
RCB option only.
36,3.05 LAST EXTRACT DATE FOR TEST 3;5 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 02, 1997
HELP-PROMPT: Enter the date that bills for this insurance company were last extracted for transmission.
DESCRIPTION: The last date that bills for this insurance company were extracted. This date is used to reset the
counter for the # of test bills submitted.
36,3.06 MAX NUMBER TEST BILLS PER DAY 3;6 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>10000)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: JUN 02, 1997
HELP-PROMPT: Type a Number between 1 and 10000, 0 Decimal Digits
DESCRIPTION: This field is used to indicate the maximum number of test bills to send per day to this insurance
company.
36,3.07 NUMBER TEST BILLS FOR LAST DT 3;7 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>10000)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: JUN 02, 1997
HELP-PROMPT: Type a Number between 1 and 10000, 0 Decimal Digits
DESCRIPTION: This is the number of test bills that were sent on the last date when test bills were sent
electronically for this insurance company.
36,3.09 ELECTRONIC INSURANCE TYPE 3;9 SET
'1' FOR HMO;
'2' FOR COMMERCIAL;
'3' FOR MEDICARE;
'4' FOR MEDICAID;
'5' FOR GROUP POLICY;
'9' FOR OTHER;
INPUT TRANSFORM: K:'$$EDIKEY^IBCNSC X
LAST EDITED: OCT 23, 2006
HELP-PROMPT: ENTER THE TYPE OF INSURANCE FOR ELECTRONIC TRANSMISSION PURPOSES
DESCRIPTION: This field contains the code to be used in the electronic transmission of claims to identify the
type of insurance company the claim is for. The default, if this field is blank, is Group Policy.
If you select GROUP POLICY, this will force a check in the GROUP insurance box of the CMS 1500/BOX
1.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
36,3.1 PAYER 3;10 POINTER TO PAYER FILE (#365.12) (audited)
INPUT TRANSFORM: S DIC("S")="I $P($G(^(0)),U,1)'=""~NO PAYER"",$$ACTAPP^IBCNEUT5(Y)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y
<0 X
LAST EDITED: APR 01, 2015
HELP-PROMPT: Please choose an entry in the Payer File.
DESCRIPTION: This field points to an entry in the Payer File (#365.12). This field is not required, but it
allows the insurance company entry to be able to conduct business electronically by linking the
insurance company with a payer for various electronic applications.
SCREEN: S DIC("S")="I $P($G(^(0)),U,1)'=""~NO PAYER"",$$ACTAPP^IBCNEUT5(Y)"
EXPLANATION: Only valid payers may be selected.
AUDIT: YES, ALWAYS
CROSS-REFERENCE: 36^AC
1)= S ^DIC(36,"AC",$E(X,1,30),DA)=""
2)= K ^DIC(36,"AC",$E(X,1,30),DA)
This cross-reference is used to find insurance companies pointing to a specific payer.
36,3.13 INS COMPANY LINK TYPE 3;13 SET
Define Insurance Company as Parent or Child
'P' FOR PARENT;
'C' FOR CHILD;
INPUT TRANSFORM: K:$D(^DIC(36,"APC",DA))&(X'="P") X K:'$$EDIKEY^IBCNSC X
LAST EDITED: MAY 04, 2006
DESCRIPTION: This field indicates if the insurance company is identified as a Parent insurance company or a
Child insurance company. This linkage between parent insurance companies and children insurance
companies allows for easier maintenance of billing provider secondary ID's.
If this insurance company is currently defined as a Parent insurance company and there are Children
insurance companies associated with it, then this field cannot be changed. You must first
disassociate the Children from the Parent.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the INS COMPANY LINK PARENT field of the INSURANCE COMPANY File
CROSS-REFERENCE: ^^TRIGGER^36^3.14
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DIC(36,D0,3)):^(3),1:"") S X=$P(Y(1),U,13)
,X=X S X=X'="C" I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,3)):^(3),1:"") S X=$P(Y(1),U,14),X=X S DIU=X K
Y S X="" X ^DD(36,3.13,1,1,2.4)
2.4)= S DIH=$G(^DIC(36,DIV(0),3)),DIV=X S $P(^(3),U,14)=DIV,DIH=36,DIG=3.14 D ^DICR
CREATE VALUE)= NO EFFECT
DELETE CONDITION)= INTERNAL(INS COMPANY LINK TYPE)'="C"
DELETE VALUE)= @
FIELD)= INS COMPANY LINK PARENT
36,3.14 INS COMPANY LINK PARENT 3;14 POINTER TO INSURANCE COMPANY FILE (#36)
Associate with which Parent Insurance Company
INPUT TRANSFORM: S DIC("S")="I $P($G(^DIC(36,Y,3)),U,13)=""P"",$P($G(^DIC(36,DA,3)),U,13)=""C""" D ^DIC K DIC S DIC=
$G(DIE),X=+Y K:Y<0 X K:'$$EDIKEY^IBCNSC X
LAST EDITED: MAY 04, 2006
DESCRIPTION: This field identifies the parent insurance company link for maintenance of billing provider
secondary ID's. This field is only valid for insurance companies identified as children.
SCREEN: S DIC("S")="I $P($G(^DIC(36,Y,3)),U,13)=""P"",$P($G(^DIC(36,DA,3)),U,13)=""C"""
EXPLANATION: Only parent insurance companies may be selected.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the INS COMPANY LINK TYPE field of the INSURANCE COMPANY File
CROSS-REFERENCE: 36^APC
1)= S ^DIC(36,"APC",$E(X,1,30),DA)=""
2)= K ^DIC(36,"APC",$E(X,1,30),DA)
Cross reference by Parent insurance company.
CROSS-REFERENCE: ^^TRIGGER^36^3.13
1)= X ^DD(36,3.14,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,3)):^(3),1:"") S X=$P(Y(1),U,13),X=X
S DIU=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),3)),DIV=X S $P(^(3),U,13)=DIV,DIH=36,DIG=3.13 D ^DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(3)=$S($D(^DIC(36,D0,3)):^(3),1:"") S X=Y(0),X=X S
X=X="",Y(1)=$G(X),Y(2)=$G(X) S X=$P(Y(3),U,13),X=X S X=X="C",Y=X,X=Y(1),X=X&Y
2)= X ^DD(36,3.14,1,2,2.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,3)):^(3),1:"") S X=$P(Y(1),U,13),X=X
S DIU=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),3)),DIV=X S $P(^(3),U,13)=DIV,DIH=36,DIG=3.13 D ^DICR
2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DIC(36,D0,3)):^(3),1:"") S X=$P(Y(1),U,1
4),X=X S X=X="",Y(2)=$G(X),Y(3)=$G(X) S X=$P(Y(1),U,13),X=X S X=X="C",Y=X,X=Y(2),X=X&Y
CREATE CONDITION)= INTERNAL(INS COMPANY LINK PARENT)=""&(INTERNAL(INS COMPANY LINK TYPE)="C")
CREATE VALUE)= @
DELETE CONDITION)= INTERNAL(INS COMPANY LINK PARENT)=""&(INTERNAL(INS COMPANY LINK TYPE)="C")
DELETE VALUE)= @
FIELD)= INS COMPANY LINK TYPE
36,3.15 EDI ID NUMBER - DENTAL 3;15 FREE TEXT (audited)
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1)!($$UP^XLFSTR(X)["PRNT") X
MAXIMUM LENGTH: 30
LAST EDITED: AUG 29, 2018
HELP-PROMPT: Answer must be 1-30 characters in length. PRNT values are not allowed.
DESCRIPTION: This is the ID number used to identify the Payer on Dental claim transmissions. PRNT values are
not valid Payer IDs.
AUDIT: YES, ALWAYS
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 36^AED
1)= S ^DIC(36,"AED",$E(X,1,30),DA)=""
2)= K ^DIC(36,"AED",$E(X,1,30),DA)
This cross-reference allows users to lookup an Insurance Company entry by Dental EDI # within the
RCB option only.
36,4.01 PERF PROV SECOND ID TYPE 1500 4;1 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97)
INPUT TRANSFORM: S DIC("S")="I $P(^(0),U,3)'=""1A"",$P(^(0),U,3)'=""TJ"",$$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))" D ^D
IC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: SEP 05, 2006
HELP-PROMPT: Enter the type of performing provider id # the insurance co requires on its CMS-1500 bills
DESCRIPTION: This is the type of performing provider secondary id # that the insurance company expects on
CMS-1500 bills received from the V.A. When the payer-specific provider id is extracted, this field
is used to determine where to get the default data from if another secondary id is not entered for
the claim.
SCREEN: S DIC("S")="I $P(^(0),U,3)'=""1A"",$P(^(0),U,3)'=""TJ"",$$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))"
EXPLANATION: Must be valid id type for performing provider id
36,4.02 PERF PROV SECOND ID TYPE UB 4;2 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97)
INPUT TRANSFORM: S DIC("S")="I $P(^(0),U,3)'=""TJ"",$$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))" D ^DIC K DIC S DIC=$G(DIE
),X=+Y K:Y<0 X
LAST EDITED: JAN 16, 2007
HELP-PROMPT: Enter the type of performing provider id # the insurance co requires on its UB-04 bills
DESCRIPTION: This is the type of performing provider id # that the insurance company expects on UB-04 bills
received from the V.A. When the payer-specific provider id is extracted, this field is used to
determine where to get the data from.
SCREEN: S DIC("S")="I $P(^(0),U,3)'=""TJ"",$$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))"
EXPLANATION: Must be valid id type for performing provider id.
36,4.03 SECONDARY ID REQUIREMENTS 4;3 SET
'0' FOR NONE REQUIRED;
'1' FOR CMS-1500 REQUIRED;
'2' FOR UB-04 REQUIRED;
'3' FOR BOTH UB-04 AND CMS-1500 REQUIRED;
LAST EDITED: JAN 16, 2007
HELP-PROMPT: Enter the code to specify the secondary performing provider id requirement for this ins co by form
type
DESCRIPTION: This field is used to identify if the insurance company requires the performing provider secondary
id on the UB-04, the CMS-1500 or both.
36,4.04 REF PROV SEC ID DEF CMS-1500 4;4 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97)
INPUT TRANSFORM: S DIC("S")="I $P(^(0),U,3)'=""1A"",$$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))" D ^DIC K DIC S DIC=$G(DIE
),X=+Y K:Y<0 X
LAST EDITED: SEP 05, 2006
HELP-PROMPT: Enter the referring providers secondary ID type to be used on outgoing claims
DESCRIPTION: This is the default qualifier for a referring provider if there is a referring provider and the
form type is CMS-1500.
SCREEN: S DIC("S")="I $P(^(0),U,3)'=""1A"",$$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))"
EXPLANATION: Must be an allowable ID for a person
NOTES: TRIGGERED by the NAME field of the INSURANCE COMPANY File
36,4.05 REF PROV SEC ID REQ ON CLAIMS 4;5 SET
'1' FOR CMS-1500;
'0' FOR NONE;
LAST EDITED: OCT 12, 2006
HELP-PROMPT: Enter 1 if this qualifier is required on CMS-1500 claims that have a referring provider
DESCRIPTION:
Set this field to CMS-1500 if the default ID for a Referring Provider is REQUIRED on a claim.
NOTES: TRIGGERED by the NAME field of the INSURANCE COMPANY File
36,4.06 ATT/REND ID BILL SEC ID PROF 4;6 SET
For CMS-1500 claims, use the Rendering ID as a Billing Provider secondary ID
'0' FOR NO;
'1' FOR YES;
LAST EDITED: SEP 05, 2006
HELP-PROMPT: Enter 1 if att/rend ID should be used as Billing Provider's secondary ID for CMS-1500 claims
DESCRIPTION: This flag is set for insurance companies that wish to have the attending/rendering provider
secondary ID used as a billing provider secondary ID. This applies to CMS-1500 claims.
NOTES: TRIGGERED by the NAME field of the INSURANCE COMPANY File
36,4.07 *SEND LAB OR FAC IDS FOR VAMC 4;7 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: JUL 25, 2014
HELP-PROMPT: Enter a 1 (YES) if Lab or Facility IDs should be sent for procedures performed at VAMC
DESCRIPTION: This flag determines whether to send the lab/facility IDs and facility data when services are
performed at the VAMC. Some payers will not accept the same data in both the Billing Provider and
the Service Facility loops.
This flag only affects electronic claims and is only valid when one of the "Always use main VAMC as
Billing Provider" fields (4.11 or 4.12) is set to "Yes". MRD;IB*2.0*516 - This field has been
marked for deletion and can be deleted after 3/15/2018.
NOTES: TRIGGERED by the NAME field of the INSURANCE COMPANY File
36,4.08 ATT/REND ID BILL SEC ID INST 4;8 SET
For UB claims, use the Attending ID as a Billing Provider secondary ID
'0' FOR NO;
'1' FOR YES;
LAST EDITED: MAY 04, 2006
HELP-PROMPT: Enter 1 if att/rend ID should be used as Billing Provider's secondary ID for UB claims
DESCRIPTION: This flag is set for insurance companies that wish to have the attending/rendering provider
secondary ID used as a billing provider secondary ID. This applies to UB claims.
NOTES: TRIGGERED by the NAME field of the INSURANCE COMPANY File
36,4.09 PERF PROV CARE UNIT PROMPT 4;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: MAY 07, 2001
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: This is the name of the specific care unit this insurance company needs on each claim to determine
the correct performing provider id #. For example, if specialty code is the care unit that the
provider id # is based on, you would enter SPECIALTY CODE here and, on each claim, enter the actual
specialty code in the PROVIDER ID CARE UNIT field for the performing provider.
TECHNICAL DESCR:
This data will appear in the executable help for the PROVIDER ID CARE UNIT field.
36,4.1 DELETE 2006 4.1 4;10 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97)
INPUT TRANSFORM: S DIC("S")="I $P(^(0),U,2)'>4,$P(^(0),U,6)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: MAY 19, 2004
HELP-PROMPT: Enter the provider id type to use if the id from the performing prov source is not found
DESCRIPTION: This is the alternate provider id type to use to find the performing provider's id when the default
id as defined by the performing provider id type cannot be found.
SCREEN: S DIC("S")="I $P(^(0),U,2)'>4,$P(^(0),U,6)"
EXPLANATION: Must be a valid type for performing provider and have no minimum source level or have source 1-4
36,4.11 *USE VAMC AS BILL PROV ON 1500 4;11 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: JUL 23, 2014
HELP-PROMPT: Enter a 1 (YES) if main VAMC should always be used as billing provider for CMS-1500.
DESCRIPTION: Setting this parameter to YES will cause the following to occur: the system will no longer
determine the Billing Provider based upon the location of care; the Billing Provider on a
professional claim will be the VAMC; the Division on the claim will print/transmit as the Service
Facility. MRD;IB*2.0*516 - This field has been marked for deletion and can be deleted after
3/15/2018.
36,4.12 *USE VAMC AS BILL PROV ON UB04 4;12 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: JUL 23, 2014
HELP-PROMPT: Enter a 1 (YES) if main VAMC should always be used as billing provider for UB-04.
DESCRIPTION: Setting this parameter to YES will cause the following to occur: the system will no longer
determine the Billing Provider based upon the location of care; the Billing Provider on an
institutional claim will be the VAMC; the Division on the claim will transmit as the Service
Facility. MRD;IB*2.0*516 - This field has been marked for deletion and can be deleted after
3/15/2018.
36,4.13 *USE BILL PROV VAMC ADDRESS 4;13 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: JUL 25, 2014
HELP-PROMPT: Enter a 1 (YES) if name and address of billing provider (VAMC) should be taken from INSTITUTION
file.
DESCRIPTION: When this parameter is set to YES, the Billing Provider on a claim will be the VAMC but the name
and address will be the name and street address from the institution file. When this parameter is
set to NO, the Billing Provider on a claim will be the VAMC but the name and address will be the
name and address of the VAMC's Pay-to Provider. MRD;IB*2.0*516 - This field has been marked for
deletion and can be deleted after 3/15/2018.
36,5.01 SCHEDULED FOR DELETION 5;1 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: AUG 04, 1995
DESCRIPTION: This field will be used if a company is scheduled for deletion. Setting this field to 'Yes' will
set a cross-reference which will allow quick retrieval of this company when the deletion clean-up
background job begins to run. That job will delete the entire insurance company entry.
TECHNICAL DESCR: This field is used to flag insurance companies which will be deleted during a background process
which should run within the same day that this field is set to 'Yes.' The Insurance Company Editor
will not allow selection of companies where this field has been set to 'Yes.'
CROSS-REFERENCE: 36^ADEL^MUMPS
1)= I X=1 S ^DIC(36,"ADEL",DA)=""
2)= K ^DIC(36,"ADEL",DA)
This cross-reference contains a list of all entries which have been flagged for deletion.
36,5.02 REPOINT DELETED COMPANY TO 5;2 POINTER TO INSURANCE COMPANY FILE (#36)
LAST EDITED: AUG 04, 1995
DESCRIPTION: When an Insurance Company is deleted, it may be necessary to repoint billing activity associated
with that company to another company. This field stored the pointer to that company.
TECHNICAL DESCR: The pointer to the company to which all billing activity needs to be repointed is used during the
tasked insurance company deletion clean-up job. Thus, it is stored with the company when the
company is flagged for deletion.
36,6.01 EDI INST SECONDARY ID QUAL(1) 6;1 SET
'2U' FOR PAYER ID #;
'FY' FOR CLAIM OFFICE #;
'NF' FOR NAIC CODE;
'TJ' FOR FED TAXPAYER #;
INPUT TRANSFORM: K:$$DUPQUAL^IBCNSC($G(IBCNS),X,6.03) X Q
LAST EDITED: JUL 30, 2007
HELP-PROMPT: Enter the qualifier for this secondary Payer ID. You can not use the same qualifier multiple times
for institutional payer IDs.
DESCRIPTION:
Enter a secondary payer ID qualifier if provided by the payer.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the EDI INST SECONDARY ID(1) field of the INSURANCE COMPANY File
CROSS-REFERENCE: ^^TRIGGER^36^6.02
1)= Q
2)= X ^DD(36,6.01,1,1,2.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,2),X=X
S DIU=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),6)),DIV=X S $P(^(6),U,2)=DIV,DIH=36,DIG=6.02 D ^DICR
2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(36,6.01,0)),U,3),Y(1)=$S($D(^D
IC(36,D0,6)):^(6),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,1)_":",2),$C(59))=""
CREATE VALUE)= NO EFFECT
DELETE CONDITION)= #6.01=""
DELETE VALUE)= @
FIELD)= #6.02
36,6.02 EDI INST SECONDARY ID(1) 6;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: JUN 26, 2007
HELP-PROMPT: Answer must be 1-30 characters in length
DESCRIPTION:
Enter a secondary payer ID number if provided by the payer.
NOTES: TRIGGERED by the EDI INST SECONDARY ID QUAL(1) field of the INSURANCE COMPANY File
CROSS-REFERENCE: ^^TRIGGER^36^6.01
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,2)=
"" I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" X ^DD
(36,6.02,1,1,2.4)
2.4)= S DIH=$G(^DIC(36,DIV(0),6)),DIV=X S $P(^(6),U,1)=DIV,DIH=36,DIG=6.01 D ^DICR
CREATE VALUE)= NO EFFECT
DELETE CONDITION)= #6.02=""
DELETE VALUE)= @
FIELD)= #6.01
36,6.03 EDI INST SECONDARY ID QUAL(2) 6;3 SET
'2U' FOR PAYER ID #;
'FY' FOR CLAIM OFFICE #;
'NF' FOR NAIC CODE;
'TJ' FOR FED TAXPAYER #;
INPUT TRANSFORM: K:$$DUPQUAL^IBCNSC($G(IBCNS),X,6.01) X Q
LAST EDITED: JUL 30, 2007
HELP-PROMPT: Enter the qualifier for this secondary Payer ID. You can not use the same qualifier multiple times
for institutional payer IDs.
DESCRIPTION:
Enter a secondary payer ID qualifier if provided by the payer.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the EDI INST SECONDARY ID(2) field of the INSURANCE COMPANY File
CROSS-REFERENCE: ^^TRIGGER^36^6.04
1)= Q
2)= X ^DD(36,6.03,1,1,2.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,4),X=X
S DIU=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),6)),DIV=X S $P(^(6),U,4)=DIV,DIH=36,DIG=6.04 D ^DICR
2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(36,6.03,0)),U,3),Y(1)=$S($D(^D
IC(36,D0,6)):^(6),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,3)_":",2),$C(59))=""
CREATE VALUE)= NO EFFECT
DELETE CONDITION)= #6.03=""
DELETE VALUE)= @
FIELD)= #6.04
36,6.04 EDI INST SECONDARY ID(2) 6;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: JUN 26, 2007
HELP-PROMPT: Answer must be 1-30 characters in length
DESCRIPTION:
Enter a secondary payer ID number if provided by the payer.
NOTES: TRIGGERED by the EDI INST SECONDARY ID QUAL(2) field of the INSURANCE COMPANY File
CROSS-REFERENCE: ^^TRIGGER^36^6.03
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,4)=
"" I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD
(36,6.04,1,1,2.4)
2.4)= S DIH=$G(^DIC(36,DIV(0),6)),DIV=X S $P(^(6),U,3)=DIV,DIH=36,DIG=6.03 D ^DICR
CREATE VALUE)= NO EFFECT
DELETE CONDITION)= #6.04=""
DELETE VALUE)= @
FIELD)= #6.03
36,6.05 EDI PROF SECONDARY ID QUAL(1) 6;5 SET
'2U' FOR PAYER ID #;
'FY' FOR CLAIM OFFICE #;
'NF' FOR NAIC CODE;
'TJ' FOR FED TAXPAYER #;
INPUT TRANSFORM: K:$$DUPQUAL^IBCNSC($G(IBCNS),X,6.07) X Q
LAST EDITED: JUL 30, 2007
HELP-PROMPT: Enter the qualifier for this secondary Payer ID. You can not use the same qualifier multiple times
for professional payer IDs.
DESCRIPTION:
Enter a secondary payer ID qualifier if provided by the payer.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the EDI PROF SECONDARY ID(1) field of the INSURANCE COMPANY File
CROSS-REFERENCE: ^^TRIGGER^36^6.06
1)= Q
2)= X ^DD(36,6.05,1,1,2.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,6),X=X
S DIU=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),6)),DIV=X S $P(^(6),U,6)=DIV,DIH=36,DIG=6.06 D ^DICR
2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(36,6.05,0)),U,3),Y(1)=$S($D(^D
IC(36,D0,6)):^(6),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,5)_":",2),$C(59))=""
CREATE VALUE)= NO EFFECT
DELETE CONDITION)= #6.05=""
DELETE VALUE)= @
FIELD)= #6.06
36,6.06 EDI PROF SECONDARY ID(1) 6;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: JUN 26, 2007
HELP-PROMPT: Answer must be 1-30 characters in length
DESCRIPTION:
Enter a secondary payer ID number if provided by the payer.
NOTES: TRIGGERED by the EDI PROF SECONDARY ID QUAL(1) field of the INSURANCE COMPANY File
CROSS-REFERENCE: ^^TRIGGER^36^6.05
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,6)=
"" I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" X ^DD
(36,6.06,1,1,2.4)
2.4)= S DIH=$G(^DIC(36,DIV(0),6)),DIV=X S $P(^(6),U,5)=DIV,DIH=36,DIG=6.05 D ^DICR
CREATE VALUE)= NO EFFECT
DELETE CONDITION)= #6.06=""
DELETE VALUE)= @
FIELD)= #6.05
36,6.07 EDI PROF SECONDARY ID QUAL(2) 6;7 SET
'2U' FOR PAYER ID #;
'FY' FOR CLAIM OFFICE #;
'NF' FOR NAIC CODE;
'TJ' FOR FED TAXPAYER #;
INPUT TRANSFORM: K:$$DUPQUAL^IBCNSC($G(IBCNS),X,6.05) X Q
LAST EDITED: JUL 30, 2007
HELP-PROMPT: Enter the qualifier for this secondary Payer ID. You can not use the same qualifier multiple times
for professional payer IDs.
DESCRIPTION:
Enter a secondary payer ID qualifier if provided by the payer.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the EDI PROF SECONDARY ID(2) field of the INSURANCE COMPANY File
CROSS-REFERENCE: ^^TRIGGER^36^6.08
1)= Q
2)= X ^DD(36,6.07,1,1,2.3) I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,8),X=X
S DIU=X K Y S X="" S DIH=$G(^DIC(36,DIV(0),6)),DIV=X S $P(^(6),U,8)=DIV,DIH=36,DIG=6.08 D ^DICR
2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(36,6.07,0)),U,3),Y(1)=$S($D(^D
IC(36,D0,6)):^(6),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,7)_":",2),$C(59))=""
CREATE VALUE)= NO EFFECT
DELETE CONDITION)= #6.07=""
DELETE VALUE)= @
FIELD)= #6.08
36,6.08 EDI PROF SECONDARY ID(2) 6;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: JUN 26, 2007
HELP-PROMPT: Answer must be 1-30 characters in length
DESCRIPTION:
Enter a secondary payer ID number if provided by the payer.
NOTES: TRIGGERED by the EDI PROF SECONDARY ID QUAL(2) field of the INSURANCE COMPANY File
CROSS-REFERENCE: ^^TRIGGER^36^6.07
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,8)=
"" I X S X=DIV S Y(1)=$S($D(^DIC(36,D0,6)):^(6),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD
(36,6.08,1,1,2.4)
2.4)= S DIH=$G(^DIC(36,DIV(0),6)),DIV=X S $P(^(6),U,7)=DIV,DIH=36,DIG=6.07 D ^DICR
CREATE VALUE)= NO EFFECT
DELETE CONDITION)= #6.08=""
DELETE VALUE)= @
FIELD)= #6.07
36,6.09 PRINT SEC/TERT AUTO CLAIMS? 6;9 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: AUG 11, 2010
HELP-PROMPT: Enter YES if automatically-processed secondary or tertiary claims to this payer must be printed
locally.
DESCRIPTION: YES means that automatically-processed secondary or tertiary claims to this payer must be printed
locally.
36,6.1 PRINT SEC MED CLAIMS W/O MRA? 6;10 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: OCT 12, 2010
HELP-PROMPT: Enter YES if secondary Medicare claims to this payer which have not been transmitted to Medicare
and for which no MRA has been received, must be printed locally.
DESCRIPTION: YES means that secondary Medicare claims to this payer which have not been transmitted to Medicare
and for which no MRA has been received, must be printed locally.
36,7.01 EDI - UMO (278) ID 7;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<2) X
LAST EDITED: NOV 23, 2015
HELP-PROMPT: Answer must be 2-80 characters in length.
DESCRIPTION: This is the Utilization Management Organization identifier which will be sent in the 278
transaction with the qualifier of PI.
36,8.01 HPID/OEID 8;1 FREE TEXT
Health Plan/Other Entity Identifier
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: NOV 10, 2014
HELP-PROMPT: Answer must be 1-10 digits in length.
DESCRIPTION: The HPID/OEID is a 10-digit, all-numeric identifier following the ISO Standard 7812 format with a
Luhn check-digit as the tenth digit. The start digit of the HPID/OEID signals whether the
identifier has been provided to a health plan and not to an "other entity". If the start digit is a
seven (7) then it is an HPID and identifies a health plan, a six (6) indicates an "other entity"
(OEID). The OEID serves as the identifier for entities that are not health plans, healthcare
providers, or individuals (persons) who are not eligible for the HPID or National Provider
Identifier (NPI),yet they need to be identified in standard transactions and for other lawful
purposes.
CROSS-REFERENCE: 36^AHOD
1)= S ^DIC(36,"AHOD",$E(X,1,30),DA)=""
2)= K ^DIC(36,"AHOD",$E(X,1,30),DA)
This non look-up cross-reference will be used by routine IBCNHUT1 to internally locate an Insurance
Company using the HPID/OEID (Health Plan or Other Entity Identifier).
36,8.02 CHP/SHP 8;2 SET
'C' FOR Controlling Health Plan (CHP);
'S' FOR Subhealth Plan (SHP);
LAST EDITED: JUN 19, 2014
HELP-PROMPT: Enter the type of plan; Controlling Health Plan (CHP) or a Sub-health Plan.
DESCRIPTION: Define whether this health plan is a Controlling Health Plan (CHP) or a Sub-health Plan (SHP). CHP
is a health plan that controls its own business activities, actions, or policies. A plan can have 0
to many sub-health plans associated to it. SHP is a health plan whose business activities, actions,
or policies are directed by a CHP.
36,8.03 PARENT CHP (HPID) 8;3 FREE TEXT
Parent CHP (HPID)
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: JUN 19, 2014
HELP-PROMPT: Answer must be 1-10 digits in length.
DESCRIPTION: Only enter data IF this insurance company entry is NOT the parent CHP for this HPID/OEID. This
would be the HPID of the parent Insurance Company.
36,8.04 NIF ID 8;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: NOV 10, 2014
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION: This is the internal identifier of the correlated entry in the FSC NIF. The NIF ID associates the
new HPID/OEID data element with their correlated entry in the NIF (National Insurance File) so that
there will be a linkage between VA/VistA and the FSC's NIF.
CROSS-REFERENCE: 36^ANIF
1)= S ^DIC(36,"ANIF",$E(X,1,30),DA)=""
2)= K ^DIC(36,"ANIF",$E(X,1,30),DA)
This non look-up cross-reference will be used by routine IBCNHUT1 to internally locate an Insurance
Company using the NIF ID (National Insurance File Identifier).
36,10 SYNONYM 10;0 Multiple #36.03
36.03,.01 SYNONYM 0;1 FREE TEXT (Multiply asked)
INPUT TRANSFORM: K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAR 26, 1993
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
Enter other terms for referring to this insurance company.
CROSS-REFERENCE: 36.03^B
1)= S ^DIC(36,DA(1),10,"B",$E(X,1,30),DA)=""
2)= K ^DIC(36,DA(1),10,"B",$E(X,1,30),DA)
CROSS-REFERENCE: 36^C
1)= S ^DIC(36,"C",$E(X,1,30),DA(1),DA)=""
2)= K ^DIC(36,"C",$E(X,1,30),DA(1),DA)
36,11 REMARKS 11;0 WORD-PROCESSING #36.011
LAST EDITED: NOV 09, 1993
DESCRIPTION: You may enter unlimited free text comments about this insurance company. It may be helpful to date
ongoing comments and identify the source of the comments.
LAST EDITED: NOV 09, 1993
HELP-PROMPT: You may enter comments about this insurance company.
36,13 PLAN TYPES NO BILL PRV SEC ID 13;0 SET Multiple #36.013 (Add New Entry without Asking)
DESCRIPTION: Enter all the Electronic plan types which will suppress Billing Provider Secondary and Additional
IDs from being sent.
36.013,.01 PLAN TYPES NO BILL PRV SEC ID 0;1 SET (Multiply asked)
'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;
LAST EDITED: MAR 09, 2006
HELP-PROMPT: Enter all the Electronic plan types which will suppress Billing Provider Secondary and Additional
IDs from being sent.
DESCRIPTION: These are electronic plan types which cause the billing provider secondary ids to be suppressed
on the claim.
CROSS-REFERENCE: 36.013^B
1)= S ^DIC(36,DA(1),13,"B",$E(X,1,30),DA)=""
2)= K ^DIC(36,DA(1),13,"B",$E(X,1,30),DA)
36,15 ALTERNATE INST PAYER ID TYPE 15;0 POINTER Multiple #36.015
DESCRIPTION: This ID Type designates the type of claims which are processed by a different Administration
Contractor than normal claims. It determines which Alternate Institutional Payer Primary ID will be
transmitted.
In order for an Alternate ID to be added to the Bill/Claims, it has to be in this sub-file.
36.015,.01 ALTERNATE INST PAYER ID TYPE 0;1 POINTER TO IB ALTERNATE PRIMARY ID TYPE FILE (#355.98) (Multiply asked)
INPUT TRANSFORM: S DIC("S")="I $$ALLOWED^IBCNSC(Y)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
LAST EDITED: JAN 21, 2016
HELP-PROMPT: Enter an Alternate Institutional Payer ID Type.
DESCRIPTION: This ID Type designates the type of claims which are processed by a different Administration
Contractor than normal claims. It determines which Alternate Institutional Payer Primary ID will
be transmitted.
CROSS-REFERENCE: 36.015^B
1)= S ^DIC(36,DA(1),15,"B",$E(X,1,30),DA)=""
2)= K ^DIC(36,DA(1),15,"B",$E(X,1,30),DA)
CROSS-REFERENCE: 36^AB
1)= S ^DIC(36,"AB",$E(X,1,30),DA(1),DA)=""
2)= K ^DIC(36,"AB",$E(X,1,30),DA(1),DA)
This cross reference is used to determine if any insurance company is using a specific Payer ID
Type. If a Payer ID Type is in use by an Insurance Company, it cannot be deleted from the IB
SITE PARAMETERS (#350.9) file.
36.015,.02 ALTERNATE INST PAYER ID 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1)!($$UP^XLFSTR(X)["PRNT") X I $D(X) K:'$$EDIKEY^IBCNSC X
LAST EDITED: NOV 18, 2015
HELP-PROMPT: Answer must be 1-30 characters in length and not contain PRNT.
DESCRIPTION:
Enter an alternate institutional primary payer ID number.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
36,16 ALTERNATE PROF PAYER ID TYPE 16;0 POINTER Multiple #36.016
DESCRIPTION: This ID Type designates the type of claims which are processed by a different Administration
Contractor than normal claims. It determines which Alternate Professional Payer Primary ID will be
transmitted.
In order for an Alternate ID to be added to the Bill/Claims, it has to be in this sub-file.
36.016,.01 ALTERNATE PROF PAYER ID TYPE 0;1 POINTER TO IB ALTERNATE PRIMARY ID TYPE FILE (#355.98) (Multiply asked)
INPUT TRANSFORM: S DIC("S")="I $$ALLOWED^IBCNSC(Y)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
LAST EDITED: JAN 21, 2016
HELP-PROMPT: Enter an Alternate Institutional Payer ID Type.
DESCRIPTION: This ID Type designates the type of claims which are processed by a different Administration
Contractor than normal claims. It determines which Alternate Professional Payer Primary ID will
be transmitted.
SCREEN: S DIC("S")="I $$ALLOWED^IBCNSC(Y)"
EXPLANATION: Only allow entries defined in the IB Site Parameters.
CROSS-REFERENCE: 36.016^B
1)= S ^DIC(36,DA(1),16,"B",$E(X,1,30),DA)=""
2)= K ^DIC(36,DA(1),16,"B",$E(X,1,30),DA)
CROSS-REFERENCE: 36^AD
1)= S ^DIC(36,"AD",$E(X,1,30),DA(1),DA)=""
2)= K ^DIC(36,"AD",$E(X,1,30),DA(1),DA)
This cross reference is used to determine if any insurance company is using a specific Payer ID
Type. If a Payer ID Type is in use by an Insurance Company, it cannot be deleted from the IB
SITE PARAMETERS (#350.9) file.
36.016,.02 ALTERNATE PROF PAYER ID 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1)!($$UP^XLFSTR(X)["PRNT") X I $D(X) K:'$$EDIKEY^IBCNSC X
LAST EDITED: NOV 18, 2015
HELP-PROMPT: Answer must be 1-30 characters in length and not contain PRNT.
DESCRIPTION:
Enter an alternate professional primary payer ID number.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
36,17 277EDI ID NUMBER 17;0 Multiple #36.017 (Add New Entry without Asking)
DESCRIPTION: This is the ID information needed to capture data for reporting purposes from processing 277stat
transactions.
36.017,.01 277EDI ID NUMBER 0;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
MAXIMUM LENGTH: 30
LAST EDITED: MAR 06, 2017
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: This is the ID number used to identify the payer on a professional or an institutional claim
transmission. This is for reporting purposes only.
CROSS-REFERENCE: 36.017^B
1)= S ^DIC(36,DA(1),17,"B",$E(X,1,30),DA)=""
2)= K ^DIC(36,DA(1),17,"B",$E(X,1,30),DA)
RECORD INDEXES: AEDIX (#1477) (WHOLE FILE #36)
36.017,.02 277DATE EDI ID NUMBER 0;2 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAY 08, 2017
HELP-PROMPT: Enter the date of the 277STAT transaction from the clearing house.
DESCRIPTION: This is the date from the 277stat transmission from the clearing house. This is for reporting
purposes only.
RECORD INDEXES: AEDIX (#1477) (WHOLE FILE #36)
36.017,.03 277EDI TYPE 0;3 SET
'P' FOR PROFESSIONAL;
'I' FOR INSTITUTIONAL;
'D' FOR DENTAL;
'P2' FOR PROFESSIONAL (Secondary);
'I2' FOR INSTITUTIONAL (Secondary);
LAST EDITED: JUL 09, 2019
HELP-PROMPT: Enter the type of claim "P" for professional, "I" for institutional, or "D" for Dental. Enter 2nd
char as a "2" if the data is for a Secondary ID otherwise the data is for a Primary ID.
DESCRIPTION:
This determines the specific PAYER ID being reported.
RECORD INDEXES: AEDIX (#1477) (WHOLE FILE #36)
36.017,.04 277EDI ID NUMBER ON FILE 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
MAXIMUM LENGTH: 30
LAST EDITED: MAR 06, 2017
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: This is the ID number that was stored on file to determine the payer on a claim prior to the
277stat transaction update. If there is no number that means there will be an update. This is
for reporting purposes only.
RECORD INDEXES: AEDIX (#1477) (WHOLE FILE #36)
FILES POINTED TO FIELDS
IB ALTERNATE PRIMARY ID TYPE
(#355.98) ALTERNATE INST PAYER ID TYPE:ALTERNATE INST PAYER ID TYPE (#.01)
ALTERNATE PROF PAYER ID TYPE:ALTERNATE PROF PAYER ID TYPE (#.01)
IB PROVIDER ID # TYPE (#355.97) PERF PROV SECOND ID TYPE 1500 (#4.01)
PERF PROV SECOND ID TYPE UB (#4.02)
REF PROV SEC ID DEF CMS-1500 (#4.04)
DELETE 2006 4.1 (#4.1)
INSURANCE COMPANY (#36) CLAIMS (INPT) COMPANY NAME (#.127)
PRECERT COMPANY NAME (#.139)
APPEALS COMPANY NAME (#.147)
INQUIRY COMPANY NAME (#.157)
REPOINT PATIENTS TO (#.16)
CLAIMS (OPT) COMPANY NAME (#.167)
CLAIMS (RX) COMPANY NAME (#.187)
CLAIMS (DENTAL) COMPANY NAME (#.197)
INS COMPANY LINK PARENT (#3.14)
REPOINT DELETED COMPANY TO (#5.02)
INSURANCE FILING TIME FRAME
(#355.13) STANDARD FTF (#.18)
PAYER (#365.12) PAYER (#3.1)
REVENUE CODE (#399.2) AMBULATORY SURG. REV. CODE (#.09)
PRESCRIPTION REFILL REV. CODE (#.15)
STATE (#5) STATE (#.115)
CLAIMS (INPT) PROCESS STATE (#.125)
APPEALS ADDRESS STATE (#.145)
INQUIRY ADDRESS STATE (#.155)
CLAIMS (OPT) PROCESS STATE (#.165)
CLAIMS (RX) STATE (#.185)
CLAIMS (DENTAL) PROCESS STATE (#.195)
TYPE OF INSURANCE COVERAGE
(#355.2) TYPE OF COVERAGE (#.13)
Subfile #36.017
Record Indexes:
AEDIX (#1477) RECORD MUMPS IR SORTING ONLY WHOLE FILE (#36)
Short Descr: 277STAT TRANSACTION PAYER STORAGE US129
Description: This cross reference allows for reporting of 277STAT updates to the EDI number to determine the correct Payer
ID.
Set Logic: S ^DIC(36,"AEDIX",X(1),DA(1),X(2),X(3))=X(4)
Set Cond: S X=(X(1)]""&(X(2)]"")&(X(3)]""))
Kill Logic: Q
X(1): 277DATE EDI ID NUMBER (36.017,.02) (Len 10) (forwards)
X(2): 277EDI ID NUMBER (36.017,.01) (Len 30) (forwards)
X(3): 277EDI TYPE (36.017,.03) (Len 2) (forwards)
X(4): 277EDI ID NUMBER ON FILE (36.017,.04) (Len 30) (forwards)
INPUT TEMPLATE(S):
IBEDIT INS CO1 JUN 11, 2024@14:27 USER #0
PRINT TEMPLATE(S):
IB INACTIVE INS CO NOV 04, 1993@11:12 USER #1453 INACTIVE INSURANCE COMPANIES WITH PATIENTS
SORT TEMPLATE(S):
IB INACTIVE INS CO NOV 04, 1993@11:10 USER #1453
SORT BY: '@INACTIVE// From '1' To '1^1'
WITHIN INACTIVE, SORT BY: @NAME;"INSURANCE COMPANY"// (User is asked range)
FORM(S)/BLOCK(S):