STANDARD DATA DICTIONARY #365.12 -- PAYER FILE 3/24/25 PAGE 1
STORED IN ^IBE(365.12, (430 ENTRIES) SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
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This is a standard file exported by the IB package. It contains insurance payers for the VA. The payers included are used for
electronically verifying insurance, authorization and referral request, and/or the IIU payer application. Do not add, edit or
delete these entries except through the provided edit options.
At this time, payers added to this file are received from FSC via HL7 messages.
Per VA Directive 6402, this file definition should not be modified.
DD ACCESS: @
RD ACCESS:
WR ACCESS:
DEL ACCESS:
LAYGO ACCESS:
AUDIT ACCESS:
POINTED TO BY: PAYER field (#3.1) of the INSURANCE COMPANY File (#36)
MEDICARE PAYER field (#51.25) of the IB SITE PARAMETERS File (#350.9)
MBI PAYER field (#51.3) of the IB SITE PARAMETERS File (#350.9)
EICD PAYER field (#51.31) of the IB SITE PARAMETERS File (#350.9)
*POPULAR PAYER field (#.01) of the *POPULAR PAYERS sub-field (#350.9003) of the IB SITE PARAMETERS File (#350.9)
PAYER field (#.01) of the INCLUDE CLINIC FOR PAYERS sub-field (#350.9631) of the HCSR CLINIC LIST sub-field
(#350.963) of the IB SITE PARAMETERS File (#350.9)
PAYER field (#.01) of the INCLUDE WARD FOR PAYERS sub-field (#350.9641) of the HCSR WARD LIST sub-field (#350.964)
of the IB SITE PARAMETERS File (#350.9)
PAYER field (#.03) of the IIV RESPONSE File (#365)
PAYER field (#.03) of the IIV TRANSMISSION QUEUE File (#365.1)
EICD PAYER field (#.03) of the EIV EICD TRACKING File (#365.18)
PAYER field (#1.02) of the INTERFACILITY INSURANCE UPDATE File (#365.19)
CROSS
REFERENCED BY: PAYER NAME(B), VA NATIONAL ID(C)
INDEXED BY: PAYER NAME (BB)
LAST MODIFIED: MAR 14,2023@09:48:10
365.12,.01 PAYER NAME 0;1 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>80!($L(X)<1) X
MAXIMUM LENGTH: 80
LAST EDITED: OCT 05, 2022
HELP-PROMPT: Enter the Insurance Payer Name. Answer must be 1-80 characters in length.
DESCRIPTION:
This is the Insurance Company Name as named for electronic interface.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 365.12^B
1)= S ^IBE(365.12,"B",$E(X,1,30),DA)=""
2)= K ^IBE(365.12,"B",$E(X,1,30),DA)
Standard "B" cross-reference
FIELD INDEX: BB (#983) REGULAR IR LOOKUP & SORTING
Short Descr: Index on the .01 field to support the complete Payer's Name.
Description: This is an additional index for the PAYER NAME (#.01) for the complete Payer's Name.
Set Logic: S ^IBE(365.12,"BB",$E(X,1,80),DA)=""
Kill Logic: K ^IBE(365.12,"BB",$E(X,1,80),DA)
Whole Kill: K ^IBE(365.12,"BB")
X(1): PAYER NAME (365.12,.01) (Subscr 1) (Len 80) (forwards)
365.12,.02 VA NATIONAL ID 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: JUN 12, 2002
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION: This field will be created from the list of payers from the Eligibility Communicator which will be
used to uniquely identify the Insurance Payers.
CROSS-REFERENCE: 365.12^C
1)= S ^IBE(365.12,"C",$E(X,1,30),DA)=""
2)= K ^IBE(365.12,"C",$E(X,1,30),DA)
Cross-reference by the ID assigned by the VA to each Payer.
365.12,.03 CMS NATIONAL ID 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: MAY 17, 2002
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION: If and when the Centers for Medicare and Medicaid services determine what national payer id should
be assigned, then this field will get updated with that ID.
365.12,.04 DATE/TIME CREATED 0;4 DATE (Required)
INPUT TRANSFORM: S %DT="ESTR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JAN 10, 2003
DESCRIPTION:
DATE/TIME THAT THIS ENTRY WAS ADDED TO THE PAYER FILE.
365.12,.05 EDI ID NUMBER - PROF 0;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: JAN 10, 2003
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
This is the ID number used to identify the insurance company for professional claim transmissions.
365.12,.06 EDI ID NUMBER - INST 0;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: JAN 10, 2003
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
This is the id number used to identify the insurance company for institutional claim transmissions.
365.12,.07 DEACTIVATED 0;7 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: SEP 17, 2020
HELP-PROMPT: Enter 1 to Deactivate or 0 to not Deactivate
DESCRIPTION: This field is the flag which determines if a payer is no longer active.
This field will be applied by the EC. Users should not modify this field.
365.12,.08 DATE/TIME DEACTIVATED 0;8 DATE
INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: SEP 17, 2020
HELP-PROMPT: Enter Date/Time of Deactivation
DESCRIPTION:
This is the date and time that the payer was deactivated.
365.12,.09 ISBLUE 0;9 SET (BOOLEAN Data Type)
LAST EDITED: JUN 02, 2022
HELP-PROMPT: Enter 1 if Payer is Blue Cross/Blue Shield or 0 if not.
DESCRIPTION:
This field identifies whether or not this payer is a Blue Cross/Blue Shield payer.
TECHNICAL DESCR:
This field is updated by FSC only as part of Payer Table Updates.
365.12,1 APPLICATION 1;0 POINTER Multiple #365.121
365.121,.01 APPLICATION 0;1 POINTER TO PAYER APPLICATION FILE (#365.13) (Multiply asked)
LAST EDITED: MAY 17, 2002
DESCRIPTION:
This field identifies the specific application which may have an interface.
CROSS-REFERENCE: 365.121^B
1)= S ^IBE(365.12,DA(1),1,"B",$E(X,1,30),DA)=""
2)= K ^IBE(365.12,DA(1),1,"B",$E(X,1,30),DA)
Standard "B" cross-reference
365.121,.02 NATIONALLY ENABLED 0;2 SET
'0' FOR Not Enabled;
'1' FOR Enabled;
LAST EDITED: SEP 24, 2020
HELP-PROMPT: Enter 1 for Enabled or 0 for Not Enabled.
DESCRIPTION: This field identifies whether a particular payer is set up and accepting data from the
Eligibility Communicator for this application.
365.121,.03 LOCALLY ENABLED 0;3 SET (audited)
'0' FOR Not Enabled;
'1' FOR Enabled;
LAST EDITED: OCT 07, 2020
HELP-PROMPT: Answer must be '0' for NOT ENABLED or '1' for ENABLED.
DESCRIPTION: This field identifies whether the local VA facility is allowing for electronic interface for this
payer and application.
AUDIT: YES, ALWAYS
365.121,.04 USER EDITED LOCAL 0;4 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: OCT 28, 2019
DESCRIPTION:
This is the user who last edited the local active switch.
365.121,.05 DATE/TIME LOCAL EDITED 0;5 DATE
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:X<1 X
LAST EDITED: OCT 28, 2019
HELP-PROMPT: (No range limit on date)
DESCRIPTION:
This field indicates the date and time the local switch was last edited.
365.121,.06 DATE/TIME NATIONAL EDITED 0;6 DATE
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:X<1 X
LAST EDITED: JAN 23, 2003
DESCRIPTION:
This field indicates the date and time that this payer application was last updated via EC.
365.121,.07 *AUTO-ACCEPT 0;7 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: AUG 19, 2020
DESCRIPTION: This field indicates whether the site will automatically accept the incoming application
information and file it into VISTA rather than storing the information in a temporary file for
manual intervention.
For insurance identification and verification, this data will be stored in the Insurance Buffer
file.
This field is scheduled for deletion with patch IB*2.0*668. The data was moved to
(#365.121,4.01).
365.121,.08 *IDENT REQUIRES SUBSCRIBER ID 0;8 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: AUG 19, 2020
HELP-PROMPT: Enter YES if the Payer requires the Subscriber ID for identification transactions, Enter NO
otherwise.
DESCRIPTION: This flag is set by the Eligibility Communicator (EC). It should not be modified via FileMan.
The flag indicates whether or not a payer requires a Subscriber ID for identification
transactions.
This field is scheduled for deletion with patch IB*2.0*668. The data was moved to (#365.121,4.02)
and renamed to better align with the meaning of the field.
365.121,.09 *USE SSN FOR SUBSCRIBER ID 0;9 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: AUG 19, 2020
HELP-PROMPT: Enter 1 for Yes, if the Payer uses the patient's SSN as the Subscriber ID. Enter 0 for No,
otherwise.
DESCRIPTION: This flag is set by the Eligibility Communicator (EC). It should not be modified via FileMan.
The flag indicates whether or not a payer recognizes a patient's SSN as a valid Subscriber ID.
This field is scheduled for deletion with patch IB*2.0*668.
365.121,.1 *TRANSMIT SSN 0;10 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: AUG 19, 2020
HELP-PROMPT: Enter YES if the patient's SSN should be transmitted for this payer application, Enter NO
otherwise.
DESCRIPTION: This flag is set by the Eligibility Communicator (EC). It should not be modified via FileMan.
The flag indicates whether or not a payer accepts a patient's SSN for transactions.
This field is scheduled for deletion with patch IB*2.0*668.
365.121,.11 *DEACTIVATED? 0;11 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: AUG 18, 2020
HELP-PROMPT: Enter 1 to Deactivate or 0 to Activate
DESCRIPTION: This field is the flag which determines if a payer and application is no longer active.
This field will be applied by the EC. Users should not modify this field.
This field is scheduled for deletion with patch IB*2.0*668. The data was moved to (#365.12,.07).
365.121,.12 *DATE/TIME DEACTIVATED 0;12 DATE
INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: AUG 18, 2020
DESCRIPTION: This is the date and time that the payer and application were deactivated.
This field is scheduled for deletion with patch IB*2.0*668. The data was moved to (#365.12,.08).
365.121,.13 DATE/TIME CREATED 0;13 DATE
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:X<1 X
LAST EDITED: JAN 23, 2003
DESCRIPTION: This is the date/time that this application was created. This field should not be edited through
FileMan.
365.121,.14 *FUTURE SERVICE DAYS 0;14 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: AUG 19, 2020
HELP-PROMPT: Type a Number between 0 and 9999
DESCRIPTION: A service date is acceptable to the payer if the service date is not greater than "T+" this
value.
This field is scheduled for deletion with patch IB*2.0*668. The data was moved to
(#365.121,4.03).
365.121,.15 *PAST SERVICE DAYS 0;15 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: AUG 19, 2020
HELP-PROMPT: Type a Number between 0 and 9999
DESCRIPTION: A service date is acceptable to the payer if the service date is not less than "T-" this value.
This field is scheduled for deletion with patch IB*2.0*668. The data was moved to
(#365.121,4.04).
365.121,2 NATIONALLY ENABLED LOG 2;0 DATE Multiple #365.1212 (Add New Entry without Asking)
LAST EDITED: AUG 20, 2020
DESCRIPTION:
Log of changes to the NATIONALLY ENABLED flag.
TECHNICAL DESCR: A new entry is added every time Payer Update HL7 message is received that contains a change to
the current NATIONALLY ENABLED flag setting (field 365.121/.02).
365.1212,.01 NATIONALLY ENABLED LOG DATE 0;1 DATE (Required)
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: AUG 20, 2020
HELP-PROMPT: Enter the date/time the NATIONALLY ENABLED flag was changed.
DESCRIPTION:
This is the date/time the NATIONALLY ENABLED flag (field 365.121/.02) was changed.
TECHNICAL DESCR:
Date/time of the change.
CROSS-REFERENCE: 365.1212^B
1)= S ^IBE(365.12,DA(2),1,DA(1),2,"B",$E(X,1,30),DA)=""
2)= K ^IBE(365.12,DA(2),1,DA(1),2,"B",$E(X,1,30),DA)
365.1212,.02 NATIONALLY ENABLED LOG SETTING 0;2 SET (Required)
'0' FOR OFF;
'1' FOR ON;
LAST EDITED: AUG 20, 2020
HELP-PROMPT: Select the new value of NATIONALLY ENABLED flag.
DESCRIPTION:
New value of NATIONALLY ENABLED flag.
TECHNICAL DESCR:
New value of NATIONALLY ENABLED flag.
365.121,3 AUTO-UPDATE LOG 3;0 DATE Multiple #365.1213 (Add New Entry without Asking)
LAST EDITED: AUG 20, 2020
DESCRIPTION:
Log of changes to the AUTO-UPDATE flag.
TECHNICAL DESCR: A new entry is added every time Payer Update HL7 message is received that contains a change to
the current AUTO-UPDATE flag setting (field 365.121/.07).
365.1213,.01 AUTO-UPDATE LOG DATE 0;1 DATE (Required)
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: AUG 20, 2020
HELP-PROMPT: Enter the date/time the AUTO-UPDATE flag was changed.
DESCRIPTION:
This is the date/time the AUTO-UPDATE flag (field 365.121/.07) was changed.
TECHNICAL DESCR:
Date/time of the change.
CROSS-REFERENCE: 365.1213^B
1)= S ^IBE(365.12,DA(2),1,DA(1),3,"B",$E(X,1,30),DA)=""
2)= K ^IBE(365.12,DA(2),1,DA(1),3,"B",$E(X,1,30),DA)
365.1213,.02 AUTO-UPDATE LOG SETTING 0;2 SET (Required)
'0' FOR OFF;
'1' FOR ON;
LAST EDITED: AUG 20, 2020
HELP-PROMPT: Select the new value of AUTO-UPDATE flag.
DESCRIPTION:
New value of AUTO-UPDATE flag.
TECHNICAL DESCR:
New value of AUTO-UPDATE flag.
365.121,4.01 AUTO-UPDATE 4;1 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: SEP 25, 2020
HELP-PROMPT: Enter 1 to Auto Update or 0 to not Auto Update.
DESCRIPTION: This field indicates whether the site will automatically accept the incoming application
information and file it into VISTA rather than storing the information in a temporary file
for manual intervention.
For insurance identification and verification, this data will be stored in the Insurance
Buffer file.
365.121,4.02 270 REQUIRES SUB ID 4;2 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: AUG 27, 2020
HELP-PROMPT: Enter YES if the Payer requires the Subscriber ID for a X12 270 transaction, Enter NO
otherwise.
DESCRIPTION: This flag is set by the Eligibility Communicator (EC). It should not be modified via
FileMan. The flag indicates whether or not a payer requires a Subscriber ID for a X12 270
transaction.
365.121,4.03 FUTURE SERVICE DAYS 4;3 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: AUG 20, 2020
HELP-PROMPT: Type a number between 0 and 9999, 0 decimal digits.
DESCRIPTION: A service date is acceptable to the payer if the service date is not greater than "T+" this
value.
365.121,4.04 PAST SERVICE DAYS 4;4 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: AUG 20, 2020
HELP-PROMPT: Type a number between 0 and 9999, 0 decimal digits.
DESCRIPTION: A service date is acceptable to the payer if the service date is not less than "T-" this
value.
365.121,5.01 RECEIVE IIU DATA 5;1 SET (BOOLEAN Data Type) (audited)
Receive IIU Data
LAST EDITED: JUL 07, 2022
DESCRIPTION: This field identifies whether the local VA facility is allowing IIU data to be displayed to
the user for processing.
EXECUTABLE HELP: D HELP1^IBCNEPY
AUDIT: YES, ALWAYS
FILES POINTED TO FIELDS
NEW PERSON (#200) APPLICATION:USER EDITED LOCAL (#.04)
PAYER APPLICATION (#365.13) APPLICATION:APPLICATION (#.01)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):