STANDARD DATA DICTIONARY #364.4 -- IB EDI TRANSMISSION RULE FILE 6/27/25 PAGE 1
STORED IN ^IBE(364.4, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
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This file contains the rules to be applied to a bill to determine if it is eligible for transmission via national EDI.
DD ACCESS: @
RD ACCESS: @
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
AUDIT ACCESS: @
IDENTIFIED BY: SHORT DESCRIPTION (#.08)
CROSS
REFERENCED BY: TYPE OF RULE(AC), RULE NUMBER(B)
INDEXED BY: TRANSMISSION TYPE & TYPE OF CARE & FORM TYPE & INSURANCE COMPANY OPTION & INACTIVE DATE & TYPE OF RULE (AD)
LAST MODIFIED: NOV 2,2018@14:49:16
364.4,.01 RULE NUMBER 0;1 NUMBER (Required)
INPUT TRANSFORM: K:+X'=X!(X>999999)!(X<0)!(X?.E1"."1N.N) X I $D(X),X<99 N DIR,Y,IBX S IBX=X K X D EN^DDIOL("Use a #
> 99 to protect local rules from national updates") S DIR(0)="YA",DIR("A")="OK to continue? " D ^DI
R K DIR,X S:Y X=IBX
LAST EDITED: APR 26, 1999
HELP-PROMPT: Type a Number from 0-999999 (0-99 are reserved for national use. Use at your own risk!!)
DESCRIPTION: This is the rule # given to identify this rule. Rules 1-99 are reserved for National EDI rules and
are not editable.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 364.4^B
1)= S ^IBE(364.4,"B",$E(X,1,30),DA)=""
2)= K ^IBE(364.4,"B",$E(X,1,30),DA)
CROSS-REFERENCE: ^^TRIGGER^364.4^.04
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBE(364.4,D0,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S
DIU=X K Y S X=DIV S X=3 X ^DD(364.4,.01,1,2,1.4)
1.4)= S DIH=$S($D(^IBE(364.4,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,4)=DIV,DIH=364.4,DIG=.04 D ^DI
CR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBE(364.4,D0,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S
DIU=X K Y S X="" X ^DD(364.4,.01,1,2,2.4)
2.4)= S DIH=$S($D(^IBE(364.4,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,4)=DIV,DIH=364.4,DIG=.04 D ^DI
CR
3)= Do not delete
CREATE VALUE)= S X=3
DELETE VALUE)= @
FIELD)= #.04
This trigger is used to force a 3 into the TYPE OF CARE field because CO thinks it does not need
it, but the field thinks it might. For now, the code will assume it is always a '3' (both inpt and
outpt) and when/if they realize they need this field, it will be ready for their use.
364.4,.02 EARLIEST ACTIVATE DATE 0;2 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X),'$$BTDTOK^IBCEF61(DA,"",1,X) K X
LAST EDITED: MAY 03, 1999
HELP-PROMPT: Enter a date here if this rule should be effective in the future. Must be less than entered expire
date.
DESCRIPTION:
This is a date in the future when this rule will automatically be used.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
364.4,.03 TRANSMISSION TYPE 0;3 SET (Required)
'1' FOR EDI only;
'2' FOR MRA only;
'3' FOR Both EDI and MRA;
LAST EDITED: MAR 29, 2002
HELP-PROMPT: Select the type of transmission this rule will apply to
DESCRIPTION:
This is the type of transmission that the rule will be executed for.
RECORD INDEXES: AD (#138)
364.4,.04 TYPE OF CARE 0;4 SET (Required)
'1' FOR OUTPATIENT only;
'2' FOR INPATIENT only;
'3' FOR Both INPT and OUTPT;
LAST EDITED: MAR 29, 2002
HELP-PROMPT: Select the type of care this rule will apply to
DESCRIPTION:
This is the type of care that the rule will be executed for.
WRITE AUTHORITY: ^
NOTES: TRIGGERED by the RULE NUMBER field of the IB EDI TRANSMISSION RULE File
RECORD INDEXES: AD (#138)
364.4,.05 FORM TYPE 0;5 SET (Required)
'1' FOR INSTITUTIONAL (UB-04) only;
'2' FOR PROFESSIONAL (CMS-1500 and J430D) only;
'3' FOR Both INST (UB-04) and PROF (CMS-1500 and J430D);
LAST EDITED: APR 28, 2017
HELP-PROMPT: Select the form type this rule will apply to
DESCRIPTION:
This is the form type that the rule will be executed for.
RECORD INDEXES: AD (#138)
364.4,.06 INACTIVE DATE 0;6 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X),'$$BTDTOK^IBCEF61(DA,"",2,X) K X
LAST EDITED: MAR 29, 2002
HELP-PROMPT: Enter the date when this edit will no longer be used to determine if a bill is transmittable. Must
not be earlier than entered active date.
DESCRIPTION: This is the date on which this edit will not longer be used to determine 'transmittable' for a
bill.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
RECORD INDEXES: AD (#138)
364.4,.07 INSURANCE COMPANY OPTION 0;7 SET (Required)
'1' FOR APPLY ONLY TO SPECIFIC COMPANIES;
'2' FOR DO NOT APPLY TO SPECIFIC COMPANIES;
'3' FOR APPLY TO ALL COMPANIES;
LAST EDITED: MAR 29, 2002
HELP-PROMPT: Select the option to determine which insurance companies to apply this rule to.
DESCRIPTION: This is the option to determine which insurance companies to apply this rule to. If 1 or 2 are
chosen, the list of insurance companies to be included or excluded should be entered in the
appropriate multiple within this file.
RECORD INDEXES: AD (#138)
364.4,.08 SHORT DESCRIPTION 0;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
LAST EDITED: APR 29, 1999
HELP-PROMPT: Answer must be 1-40 characters in length.
DESCRIPTION:
This is a short description of the rule used for identification purposes on lookup.
364.4,.1 BILL TYPE RESTRICTIONS BTYP;0 Multiple #364.41 (Add New Entry without Asking)
LAST EDITED: APR 29, 1999
364.41,.01 BILL TYPE 0;1 FREE TEXT (Required) (Multiply asked)
INPUT TRANSFORM:K:$L(X)>4!($L(X)<3)!'(X?1"-"2N1"X"!(X?2N1"X")!(X?1"-"1N2"X")!(X?1N2"X")!(X?1"-"3N)!(X?3N)!(X?3"X"))
X
LAST EDITED: JAN 16, 2007
HELP-PROMPT: Answer must be 3-4 characters in length.
DESCRIPTION: This field contains the UB-04 type of bill that should only be transmitted electronically. It
needs to be entered in a 3-digit format. The first digit must be numeric, but the second and third
digits can be an X to indicate any number in that position applies (11X would include 111-119).
CROSS-REFERENCE:364.41^B
1)= S ^IBE(364.4,DA(1),"BTYP","B",$E(X,1,30),DA)=""
2)= K ^IBE(364.4,DA(1),"BTYP","B",$E(X,1,30),DA)
364.41,.02 EARLIEST ACTIVATE DATE 0;2 DATE
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X),'$$BTDTOK^IBCEF61(DA(1),DA,1,X) K X
LAST EDITED: MAY 03, 1999
HELP-PROMPT: Enter the future date this bill type should begin to be excluded from transmission checks.
DESCRIPTION: This is the date in the future that this bill type should start to be excluded from transmission.
This date is specific for this bill type.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
364.41,.03 INACTIVE DATE 0;3 DATE
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X),'$$BTDTOK^IBCEF61(DA(1),DA,2,X) K X
LAST EDITED: MAY 03, 1999
HELP-PROMPT: Enter the future date this bill type should begin to be excluded from transmission checks.
DESCRIPTION: This is the first date on which this edit will no longer be used to determine 'transmittable' for a
bill of this bill type.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
364.4,.11 TYPE OF RULE 0;11 SET (Required)
'0' FOR LIMIT TO FORM TYPE;
'1' FOR LIMIT TO SOME BILL TYPES;
'2' FOR MRA REQUEST RESTRICTIONS;
'9' FOR LOCALLY DEFINED;
LAST EDITED: JAN 16, 2007
HELP-PROMPT: Select the 'type' of rule this is.
DESCRIPTION: This flag puts the rule into a 'type' category for conflict checking. It is also a flag that can
indicate this rule needs to be executed to determine if an MRA request is valid for the MEDIGAP
insurance that is next in line for COB or if the claim should be directly shuttled to the MEDIGAP
carrier.
TYPE OF RULE = 0 (LIMIT TO FORM TYPES) is used to further limit the transmission of PROFESSIONAL
(CMS-1500) or INSTITUTIONAL (UB-04) form types. If you pick one form type, no bills of the other
form type will be transmitted for: a) the insurance companies you selected to include OR b) the
insurance companies not entered on the excluded list OR c) any insurance co if all insurance
companies are selected.
TYPE OF RULE = 1 (LIMIT TO SOME BILL TYPES) is used to further limit the transmission of the UB-04
equivalent of bill type (111,131,etc). These rules can be used to restrict transmissions to
specific bill types or to allow all bill types except those specified (these are entered preceeded
by a dash). A 'wild card' character of X can be used to indicate that a character in that position
is included (ie 11X will allow 111,112,113,etc) The rule will not allow transmission of bills
matching the EDI/MRA and PROF/INST parameters and insurance co restrictions (see rule 0 above)
unless they match the allowed bill types and do not match any of the excluded bill types.
TYPE OF RULE = 9 (LOCAL EDITS) are local edits. If this type of rule is used, the code entered for
the edit must return a truth value of 1 if the bill should be transmitted or 0 if the bill should
not be transmitted. The variable IBIFN is the internal entry # of the bill (file 399), the IB(x)
array contains the value of fields #.03,.04,.05,.07,.11 for the rule where 'x' is the field #. IBDA
is the ien of the rule (file 364.4).
CROSS-REFERENCE: 364.4^AC
1)= S ^IBE(364.4,"AC",$E(X,1,30),DA)=""
2)= K ^IBE(364.4,"AC",$E(X,1,30),DA)
3)= Please don't delete
This xref allows a check on all rules of the same type for conflict checking purposes.
RECORD INDEXES: AD (#138)
364.4,1 RULE CODE 1;E1,245 MUMPS
INPUT TRANSFORM: K:$L(X)>245 X D:$D(X) ^DIM
LAST EDITED: APR 19, 1999
HELP-PROMPT: This is Standard MUMPS code that will be executed to enforce this rule.
DESCRIPTION: This is the MUMPS call that will execute the edit's logic and will set $T to 1 for edit passed or
to 0 for edit failed. You can assume the following variables are available:
IBIFN = ien of the bill in file 399
IB(.03) = Current value of the bill's transmission type
IB(.05) = Current value of the bill's form type
IB(.07) = Current value of the bill's insurance option
WRITE AUTHORITY: @
364.4,2 EXCLUDED INSURANCE COMPANY 2;0 POINTER Multiple #364.42 (Add New Entry without Asking)
364.42,.01 EXCLUDED INSURANCE COMPANY 0;1 POINTER TO INSURANCE COMPANY FILE (#36) (Multiply asked)
LAST EDITED: APR 16, 1999
HELP-PROMPT: Enter the insurance companies that this edit should NOT be executed for.
DESCRIPTION:
This is the set of insurance companies for which this edit will not be executed.
CROSS-REFERENCE: 364.42^B
1)= S ^IBE(364.4,DA(1),2,"B",$E(X,1,30),DA)=""
2)= K ^IBE(364.4,DA(1),2,"B",$E(X,1,30),DA)
364.4,3 INCLUDED INSURANCE COMPANY 3;0 POINTER Multiple #364.43 (Add New Entry without Asking)
364.43,.01 INCLUDED INSURANCE COMPANY 0;1 POINTER TO INSURANCE COMPANY FILE (#36) (Multiply asked)
LAST EDITED: APR 16, 1999
HELP-PROMPT: Enter the insurance companies that this edit should only be executed for.
DESCRIPTION:
This is the set of insurance companies for which this edit should only be executed.
CROSS-REFERENCE: 364.43^B
1)= S ^IBE(364.4,DA(1),3,"B",$E(X,1,30),DA)=""
2)= K ^IBE(364.4,DA(1),3,"B",$E(X,1,30),DA)
364.4,4 RULE DESCRIPTION 4;0 WORD-PROCESSING #364.44
LAST EDITED: APR 16, 1999
HELP-PROMPT: Enter text here to provide a broader description of the transmission rule.
DESCRIPTION:
This is a broader description of the transmission rule.
364.4,10.01 RULE ADDED BY 10;1 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: APR 27, 1999
HELP-PROMPT: Enter the name of the person who entered this rule
DESCRIPTION:
This is the person responsible for adding this rule to this file.
364.4,10.02 RULE ADDED DATE 10;2 DATE
INPUT TRANSFORM: S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: APR 27, 1999
HELP-PROMPT: Enter the date this rule was first added to the file.
DESCRIPTION:
This is the date this rule entry was first added to this file.
364.4,10.03 RULE LAST EDITED BY 10;3 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: APR 27, 1999
HELP-PROMPT: Enter the name of the person who last edited this rule entry.
DESCRIPTION:
This is the name of the person who last edited this rule entry.
364.4,10.04 RULE LAST EDITED DATE 10;4 DATE
INPUT TRANSFORM: S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: APR 27, 1999
HELP-PROMPT: Enter the date this rule was last edited.
DESCRIPTION:
This is the last date this rule was edited.
FILES POINTED TO FIELDS
INSURANCE COMPANY (#36) EXCLUDED INSURANCE COMPANY:EXCLUDED INSURANCE COMPANY (#.01)
INCLUDED INSURANCE COMPANY:INCLUDED INSURANCE COMPANY (#.01)
NEW PERSON (#200) RULE ADDED BY (#10.01)
RULE LAST EDITED BY (#10.03)
File #364.4
Record Indexes:
AD (#138) RECORD MUMPS IR SORTING ONLY
Short Descr: Sets the first level of xref to determine which edits are most general.
Set Logic: S ^IBE(364.4,"AD",X2(1),X2(2),$S(X2(3)=3:X2(3),X2(6)=0:X2(3)#2+1,1:X2(3)),X2(4),DA)=+X2(5)
Set Cond: I X2(1)=""!(X2(2)="")!(X2(3)="")!(X2(4)="") S X=0
Kill Logic: K ^IBE(364.4,"AD",X1(1),X1(2),$S(X1(3)=3:X1(3),X1(6)=0:X1(3)#2+1,1:X1(3)),X1(4),DA)
Kill Cond: I X1(1)=""!(X1(2)="")!(X1(3)="")!(X1(4)="") S X=0
Whole Kill: K ^IBE(364.4,"AD")
X(1): TRANSMISSION TYPE (364.4,.03) (Subscr 1) (forwards)
X(2): TYPE OF CARE (364.4,.04) (Subscr 2) (forwards)
X(3): FORM TYPE (364.4,.05) (Subscr 3) (forwards)
X(4): INSURANCE COMPANY OPTION (364.4,.07) (Subscr 4) (forwards)
X(5): INACTIVE DATE (364.4,.06) (forwards)
X(6): TYPE OF RULE (364.4,.11) (forwards)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
IBCE RULE DISPLAY APR 29, 1999@17:38 USER #0 [IBCE RULE DISPLAY HEADER]
IBCE RULE DISPLAY HEADER APR 29, 1999@08:33 USER #0 IB EDI TRANSMISSION RULE LIST
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):