STANDARD DATA DICTIONARY #360 -- IB-FB INTERFACE TRACKING FILE 3/24/25 PAGE 1
STORED IN ^IBFB(360, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
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This file is used to link FB authorizations to FB payment file invoices and, ultimately, IB bills.
DD ACCESS:
RD ACCESS:
WR ACCESS:
DEL ACCESS:
LAYGO ACCESS:
AUDIT ACCESS:
IDENTIFIED BY: PATIENT (#.02), FB AUTHORIZATION (#.03)
CROSS
REFERENCED BY: AUTH DELETION DATE/TIME (AC), CLAIMS TRACKING ENTRY NUMBER(AD), ENTRY NUMBER(B), PATIENT(C)
INDEXED BY: BI QUEUE (BI), PATIENT & FB AUTHORIZATION (D), PATIENT & INVOICE NUMBER (F), FR QUEUE (FR), IV QUEUE (IV), SC QUEUE
(SC), UR QUEUE (UR)
LAST MODIFIED: APR 19,2017@12:13:57
360,.01 ENTRY NUMBER 0;1 NUMBER (Required)
INPUT TRANSFORM: K:+X'=X!(X>9999999)!(X<0)!(X?.E1"."1N.N) X S:$D(X) DINUM=X
LAST EDITED: FEB 17, 2016
HELP-PROMPT: Enter an entry number, between 1 - 9999999
DESCRIPTION: This is the internal entry number to identify the link between claims/bills and Fee Basis payments
and authorizations.
TECHNICAL DESCR: Manual cross references:
; ^IBFB(360,"DFN",DFN,DT,IEN,IBLOG)="" Log cross reference by Patient
; ^IBFB(360,"DT",DT,DFN,IEN,IBLOG)="" Log cross reference by Date
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 360^B
1)= S ^IBFB(360,"B",$E(X,1,30),DA)=""
2)= K ^IBFB(360,"B",$E(X,1,30),DA)
360,.02 PATIENT 0;2 POINTER TO PATIENT FILE (#2)
LAST EDITED: FEB 17, 2016
HELP-PROMPT: Enter a Patient name.
DESCRIPTION:
Patient name to link authorizations, payments and claims/bills.
CROSS-REFERENCE: 360^C
1)= S ^IBFB(360,"C",$E(X,1,30),DA)=""
2)= K ^IBFB(360,"C",$E(X,1,30),DA)
This cross reference is used to easily track entries made by a particular user. User and entry
number.
RECORD INDEXES: D (#1428), F (#1429)
360,.03 FB AUTHORIZATION 0;3 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99999999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: FEB 17, 2016
HELP-PROMPT: Enter a Patient Authorization number, between 1 - 99999999
DESCRIPTION:
Enter an Authorization IEN to link authorizations, payments and claims/bills.
TECHNICAL DESCR:
This is the Authorization number not a pointer. It references file 161.01
RECORD INDEXES: D (#1428)
360,.04 AUTH DELETION DATE/TIME 0;4 DATE
INPUT TRANSFORM: S %DT="ETR" D ^%DT S X=Y K:X<1 X
LAST EDITED: FEB 17, 2016
HELP-PROMPT: Enter the date/time the Authorization was deleted.
DESCRIPTION:
This is the date that an Authorization was deleted completely. Used for tracking purposes.
TECHNICAL DESCR:
We're tracking in an Authorization was deleted and there were pointers to claims or bills present.
CROSS-REFERENCE: 360^AC
1)= S ^IBFB(360,"AC",$E(X,1,30),DA)=""
2)= K ^IBFB(360,"AC",$E(X,1,30),DA)
Payment ID cross reference used for linking FB to IB.
360,.05 INITIAL TREATMENT DATE 0;5 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:X<1 X
LAST EDITED: FEB 17, 2016
HELP-PROMPT: Enter date of Initial Treatment.
DESCRIPTION:
This is the date of the initial Non-VA Care treatment was provided.
360,1.01 CLAIMS TRACKING ENTRY NUMBER 1;1 POINTER TO CLAIMS TRACKING FILE (#356)
LAST EDITED: SEP 01, 2016
HELP-PROMPT: Enter a claim ID.
DESCRIPTION:
Enter a Claim ID to assist in linking NVC authorizations and payments to claims in file #356.
TECHNICAL DESCR: We need a claim ID to assist in linking NVC authorizations and third party claims to payments.
Without this field we lose the ability to link 3rd party claims to fee basis.
CROSS-REFERENCE: 360^AD
1)= S ^IBFB(360,"AD",$E(X,1,30),DA)=""
2)= K ^IBFB(360,"AD",$E(X,1,30),DA)
Used to be able to quickly lookup an entry based on the pointer to file #356 (Claim).
360,1.02 BILL/CLAIMS 1;2 POINTER TO BILL/CLAIMS FILE (#399)
LAST EDITED: DEC 03, 2015
HELP-PROMPT: Enter an existing Bill for the Patient.
DESCRIPTION: We use this to link an existing entry in file #399 to an existing fee basis authorization and
payment.
360,1.03 INVOICE NUMBER 1;3 POINTER TO FEE BASIS INVOICE FILE (#162.5)
LAST EDITED: SEP 01, 2016
HELP-PROMPT: Enter a fee basis invoice number.
DESCRIPTION: This field is a pointer to the Inpatient Payment File and a soft pointer to the Outpatient Payment
File.
TECHNICAL DESCR:
We need a Invoice ID to assist in linking NVC authorizations and claims/bills to payments.
RECORD INDEXES: F (#1429)
360,1.04 INTEGRATED BILLING ACTION 1;4 POINTER TO INTEGRATED BILLING ACTION FILE (#350)
LAST EDITED: DEC 03, 2015
HELP-PROMPT: Enter a copayment associated with the FB auth
DESCRIPTION:
Enter a first party copay IEN to link to a FB Auth and payment.
TECHNICAL DESCR: We need a Bill ID to assist in linking NVC authorizations and first party claims to payments.
Without this field we lose the ability to link 1st party claims to fee basis Authorizations and
payments.
360,2.01 IV QUEUE 2;1 SET
Insurance Verification Precert Queue
'IV' FOR IV QUEUE;
'XX' FOR REMOVED;
LAST EDITED: FEB 17, 2016
HELP-PROMPT: Select from an IV Precert Queue type
DESCRIPTION:
This is the Insurance Verification Precertification Queue
FIELD INDEX: IV (#1431) REGULAR IR LOOKUP & SORTING
Short Descr: IV QUEUE
Description: Used for Insurance Verification to be able to track the entries that need Insurance verification in
the Worklist.
Set Logic: S ^IBFB(360,"IV",$E(X,1,240),DA)=""
Kill Logic: K ^IBFB(360,"IV",$E(X,1,240),DA)
Whole Kill: K ^IBFB(360,"IV")
X(1): IV QUEUE (360,2.01) (Subscr 1) (Len 240) (forwards)
360,2.02 UR QUEUE 2;2 SET
RUR Precert Queue
'UR' FOR UR QUEUE;
'XX' FOR REMOVED;
LAST EDITED: FEB 17, 2016
HELP-PROMPT: Select from an UR Precert Queue entry
DESCRIPTION:
This is the RUR Precertification Queue
FIELD INDEX: UR (#1433) REGULAR IR LOOKUP & SORTING
Short Descr: UR QUEUE
Description: Used to track entries that need Utilization review completed.
Set Logic: S ^IBFB(360,"UR",$E(X,1,240),DA)=""
Kill Logic: K ^IBFB(360,"UR",$E(X,1,240),DA)
Whole Kill: K ^IBFB(360,"UR")
X(1): UR QUEUE (360,2.02) (Subscr 1) (Len 240) (forwards)
360,2.03 FR QUEUE 2;3 SET
Facility Revenue Billing Queue
'FR' FOR FR QUEUE;
'XX' FOR REMOVED;
LAST EDITED: FEB 17, 2016
HELP-PROMPT: Select from an FR Billing Queue entry
DESCRIPTION:
This is the Facility Revenue Billing Queue
FIELD INDEX: FR (#1430) REGULAR IR LOOKUP & SORTING
Short Descr: FR QUEUE
Description: Used to track entries that need Facility Revenue reviews completed.
Set Logic: S ^IBFB(360,"FR",$E(X,1,240),DA)=""
Kill Logic: K ^IBFB(360,"FR",$E(X,1,240),DA)
Whole Kill: K ^IBFB(360,"FR")
X(1): FR QUEUE (360,2.03) (Subscr 1) (Len 240) (forwards)
360,2.04 SC QUEUE 2;4 SET
RUR Service Connected Billing Queue
'SC' FOR SC QUEUE;
'XX' FOR REMOVED;
LAST EDITED: FEB 17, 2016
HELP-PROMPT: Select from an SC Billing Queue entry
DESCRIPTION:
This is the RUR Service Connected Billing Queue
FIELD INDEX: SC (#1432) REGULAR IR LOOKUP & SORTING
Short Descr: SC QUEUE
Description: Used to notate if this entry is - Service Connected / Special Authority Eligibility entries.
Set Logic: S ^IBFB(360,"SC",$E(X,1,240),DA)=""
Kill Logic: K ^IBFB(360,"SC",$E(X,1,240),DA)
Whole Kill: K ^IBFB(360,"SC")
X(1): SC QUEUE (360,2.04) (Subscr 1) (Len 240) (forwards)
360,2.05 BI QUEUE 2;5 SET
Billing Review Queue
'BI' FOR BI QUEUE;
'XX' FOR REMOVED;
LAST EDITED: FEB 17, 2016
HELP-PROMPT: Select from a BI Billing Queue entry
DESCRIPTION:
This is the Billing Review Queue
FIELD INDEX: BI (#1427) REGULAR IR LOOKUP & SORTING
Short Descr: BI QUEUE
Description: Used to track claims that are ready to be billed after all verifications are completed.
Set Logic: S ^IBFB(360,"BI",$E(X,1,240),DA)=""
Kill Logic: K ^IBFB(360,"BI",$E(X,1,240),DA)
Whole Kill: K ^IBFB(360,"BI")
X(1): BI QUEUE (360,2.05) (Subscr 1) (Len 240) (forwards)
360,3.01 NEXT REVIEW DT 3;1 DATE
Date of next RUR precertification review
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:X<1 X
LAST EDITED: FEB 17, 2016
HELP-PROMPT: Enter a date for the next review.
DESCRIPTION: This field holds the date of the next RUR precertification review. If a date has been entered in
this field, the authorization will not display on the RUR precertification work queue until the
date specified.
360,3.02 1ST OR 3RD PTY 3;2 NUMBER
First Party Copay or Third Party Insurance
INPUT TRANSFORM: K:+X'=X!(X>3)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: FEB 17, 2016
HELP-PROMPT: First party copay or third party insurance, number between 1-3
DESCRIPTION:
This field indicates if the bill is for first party copay or third party insurance.
TECHNICAL DESCR: First Party Copay = $P(^IBFB(360,IEN,3),"^",2)=1 Third Party Insurance =
$P(^IBFB(360,IEN,3),"^",2)=3
360,4 LOG 4;0 DATE Multiple #360.04 (Add New Entry without Asking)
DESCRIPTION:
This is an audit field to track entries and changes made to the file for auditing purposes.
360.04,.01 DATE/TIME 0;1 DATE
INPUT TRANSFORM: S %DT="ESTR" D ^%DT S X=Y K:X<1 X
LAST EDITED: FEB 17, 2016
HELP-PROMPT: Enter the date/time of the change to the entries.
DESCRIPTION:
Used to capture the changes to the entries in the file, by date and time of change.
360.04,.02 EVENT 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>45!($L(X)<1) X
LAST EDITED: FEB 17, 2016
HELP-PROMPT: Enter the event that occurred that we logged. 1-45 characters.
360.04,.03 USER 0;3 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: FEB 17, 2016
HELP-PROMPT: Enter the user that made the change.
DESCRIPTION:
The user that made the addition/edit of the file #360 entry.
FILES POINTED TO FIELDS
BILL/CLAIMS (#399) BILL/CLAIMS (#1.02)
CLAIMS TRACKING (#356) CLAIMS TRACKING ENTRY NUMBER (#1.01)
FEE BASIS INVOICE (#162.5) INVOICE NUMBER (#1.03)
INTEGRATED BILLING ACTION
(#350) INTEGRATED BILLING ACTION (#1.04)
NEW PERSON (#200) LOG:USER (#.03)
PATIENT (#2) PATIENT (#.02)
File #360
Record Indexes:
D (#1428) RECORD REGULAR IR LOOKUP & SORTING
Short Descr: Lookup index
Description: Used to lookup/sort entries by Patient and Fee Basis Authorization, this will show the user possible multiple
entries for an auth.
Set Logic: S ^IBFB(360,"D",X(1),X(2),DA)=""
Kill Logic: K ^IBFB(360,"D",X(1),X(2),DA)
Whole Kill: K ^IBFB(360,"D")
X(1): PATIENT (360,.02) (Subscr 1) (forwards)
X(2): FB AUTHORIZATION (360,.03) (Subscr 2) (forwards)
F (#1429) RECORD REGULAR IR LOOKUP & SORTING
Short Descr: Cross reference by patient and invoice
Description: Used to sort/lookup entries by Patient and Invoice, there could be multiple entries for one auth, but only one
per Invoice.
Set Logic: S ^IBFB(360,"F",X(1),X(2),DA)=""
Kill Logic: K ^IBFB(360,"F",X(1),X(2),DA)
Whole Kill: K ^IBFB(360,"F")
X(1): PATIENT (360,.02) (Subscr 1) (forwards)
X(2): INVOICE NUMBER (360,1.03) (Subscr 2) (forwards)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):