STANDARD DATA DICTIONARY #365.19 -- INTERFACILITY INSURANCE UPDATE FILE 3/24/25 PAGE 1
STORED IN ^IBCN(365.19, *** 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 a list of recently verified 'active' policies that were either sent/shared to another VAMC or was received from
another VAMC. This file is the main file for the Interfacility Insurance Update (IIU) process. Per VA Directive 6402, this file
definition should not be modified.
DD ACCESS: @
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
AUDIT ACCESS: @
CROSS
REFERENCED BY: PATIENT NAME(B), SENDER STATUS(C)
INDEXED BY: PATIENT NAME & INSUR RECORD IEN (D), DIRECTION & DATE/TIME CREATED (DIR), SENT STATUS & SENT STATUS DATE/TIME (SSR)
LAST MODIFIED: JAN 3,2022@12:42:04
365.19,.01 PATIENT NAME 0;1 POINTER TO PATIENT FILE (#2) (Required)
LAST EDITED: FEB 10, 2021
HELP-PROMPT: Enter the patient name.
DESCRIPTION: This is the patient whose insurance was recently verified as 'active'. This patient's verified
active policy was either sent to a VAMC(s) or received from another VAMC.
CROSS-REFERENCE: 365.19^B
1)= S ^IBCN(365.19,"B",$E(X,1,30),DA)=""
2)= K ^IBCN(365.19,"B",$E(X,1,30),DA)
RECORD INDEXES: D (#1709)
365.19,.02 DATE/TIME CREATED 0;2 DATE (Required)
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:X<1 X
LAST EDITED: FEB 24, 2021
HELP-PROMPT: Enter the date and time that the entry was created.
DESCRIPTION:
This is the date/time that this entry was created in this file.
TECHNICAL DESCR: The value of the DIRECTION (#365.19,.03) field has a bearing on the meaning of this field. If
DIRECTION = SENDER, this is the date/time that the active policy, defined in this entry, was
verified as an active policy. It does NOT mean that the policy was 'sent' at this time. If the
DIRECTION = RECEIVER, then this is the date/time that the active policy was received from another
VAMC.
RECORD INDEXES: DIR (#1710)
365.19,.03 DIRECTION 0;3 SET (Required)
'S' FOR SENDER;
'R' FOR RECEIVER;
LAST EDITED: FEB 24, 2021
HELP-PROMPT: Enter the direction of the data flow.
DESCRIPTION: This is the data flow of this policy from the perspective of this VAMC. The direction is to be set
to SENDER if this VAMC was sending/sharing the recently verified active policy with one or more
VAMCs. Direction is to be set to RECEIVER if this VAMC received the recently verified active policy
from another VAMC.
RECORD INDEXES: DIR (#1710)
365.19,1.01 SENDER STATUS 1;1 SET
'W' FOR WAITING;
'P' FOR PARTIAL;
'C' FOR COMPLETE;
'F' FOR FAILED MISSING DATA;
LAST EDITED: SEP 23, 2021
HELP-PROMPT: Enter the status of the SENDER entry.
DESCRIPTION: This is the overall status of the SENDER entry. It indicates whether the entry has finished sending
the policy to all VAMCs that it intended to.
TECHNICAL DESCR: This field is only used (and is required) when the DIRECTION (#365.19,.03) field is set to SENDER.
WAITING indicates that the policy has NOT been shared with a VAMC yet. PARTIAL indicates that the
policy has been sent to some of the VAMCs that Interfacility Insurance Update (IIU) intends to
share it with; however, it has not successfully sent it to all VAMCs that it is intending to send
to. COMPLETE indicates that IIU has finished sending the policy to all VAMCs that it is intending
to. FAILED MISSING DATA indicates that not all of the IIU required fields are available; therefore,
the policy will not be shared to other VAMCs.
CROSS-REFERENCE: 365.19^C
1)= S ^IBCN(365.19,"C",$E(X,1,30),DA)=""
2)= K ^IBCN(365.19,"C",$E(X,1,30),DA)
This cross references the Sending Status of the entries.
365.19,1.02 PAYER 1;2 POINTER TO PAYER FILE (#365.12)
LAST EDITED: FEB 24, 2021
HELP-PROMPT: Enter the Payer for this entry.
DESCRIPTION:
This is the Payer with whom this policy is associated.
TECHNICAL DESCR:
This field is only used for those entries that were SENT to another VAMC.
365.19,1.03 INSUR RECORD IEN 1;3 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: FEB 25, 2021
HELP-PROMPT: Enter the IEN of the insurance record sent. Type a number between 1 and 999, 0 decimal digits.
DESCRIPTION: This field is the IEN of the insurance record which Interfacility Insurance Update (IIU) uses to
pull policy information to send to another VAMC.
TECHNICAL DESCR: This field is only used for those entries that were SENT to another VAMC. This field is the IEN of
the insurance record on the INSURANCE TYPE subfile (#2.312) of the PATIENT file (#2) for the policy
that we want to send to other VAMCs via an HL7 message. This can NOT be a pointer field.
SOURCE OF DATA: PATIENT (#2) Insurance Type subfile (#2.312)
RECORD INDEXES: D (#1709)
365.19,1.04 EIV AUTO-UPDATE 1;4 SET (BOOLEAN Data Type)
LAST EDITED: FEB 24, 2021
HELP-PROMPT: Enter "YES" if this entry was auto updated or "NO" if it was not.
DESCRIPTION: This field indicates whether or not the active policy was verified via eIV's AUTO UPDATE process
(no touch process).
TECHNICAL DESCR: This field is only used for those entries that were SENT to another VAMC. If the field is null,
treat it as a "NO" value for reports or processing.
SOURCE OF DATA: EIV AUTO-UPDATE(#365,.13)
365.19,1.05 SENDER BUFFER 1;5 POINTER TO INSURANCE VERIFICATION PROCESSOR FILE (#355.33)
LAST EDITED: FEB 24, 2021
HELP-PROMPT: Enter the insurance buffer entry number or leave blank if auto updated.
DESCRIPTION: This field points to the buffer record that was verified as active insurance if the eIV AUTO-UPDATE
(#365.19,1.04) field is "NO".
TECHNICAL DESCR:
This field is only used for those entries that were SENT to another VAMC.
365.19,1.06 SENDER SUBSCRIBER ID 1;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<3) X
MAXIMUM LENGTH: 80
LAST EDITED: FEB 25, 2021
HELP-PROMPT: Enter the Subscriber ID that was sent to the receiving VAMC (3-80 characters).
DESCRIPTION: This field is used by reports to display the Subscriber ID that was sent as part of the verified
active policy.
TECHNICAL DESCR:
This field is used only for those entries that were SENT to another VAMC.
SOURCE OF DATA: SUBSCRIBER ID(#2.312,7.02)
365.19,1.07 SEND COORDINATION OF BENEFITS 1;7 SET
'1' FOR Primary;
'2' FOR Secondary;
'3' FOR Tertiary;
LAST EDITED: FEB 24, 2021
HELP-PROMPT: Enter the Coordination of Benefits sent to the receiving VAMC.
DESCRIPTION: This field is used by reports to display the Coordination of Benefits (COB) that was sent as part
of the verified active policy.
TECHNICAL DESCR:
This field is only used for those entries that were SENT to another VAMC.
SOURCE OF DATA: COORDINATION OF BENEFITS(#2.312,.2)
365.19,1.08 ICB PROCESSED BUFFER 1;8 SET (BOOLEAN Data Type)
LAST EDITED: SEP 17, 2021
HELP-PROMPT: Enter "YES" if this entry was processed by ICB or "NO" if it was not.
DESCRIPTION: The buffer entry in the INSURANCE VERIFICATION PROCESSOR file #355.33 was processed by the COTS ICB
product.
TECHNICAL DESCR: This field is only used for those entries that were SENT to another VAMC. If the field is null,
treat it as a "NO" value for processing.
365.19,1.1 DESTINATION VAMC 1.1;0 POINTER Multiple #365.191 (Add New Entry without Asking)
DESCRIPTION:
Track the VAMCs that this patient visited, thus where this verified active policy should be SENT.
TECHNICAL DESCR: This multiple is only used for those entries when the DIRECTION (#365.19,.03) field equals
"SENDER".
365.191,.01 DESTINATION VAMC 0;1 POINTER TO INSTITUTION FILE (#4)
LAST EDITED: FEB 24, 2021
HELP-PROMPT: Enter the Institution receiving the policy.
DESCRIPTION:
This field indicates the VAMC that should receive the verified active policy.
CROSS-REFERENCE: 365.191^B
1)= S ^IBCN(365.19,DA(1),1.1,"B",$E(X,1,30),DA)=""
2)= K ^IBCN(365.19,DA(1),1.1,"B",$E(X,1,30),DA)
365.191,.02 SENT STATUS 0;2 SET
'S' FOR SENT;
'R' FOR READY TO SEND;
LAST EDITED: SEP 17, 2021
HELP-PROMPT: Enter the sending status of the entry.
DESCRIPTION: This field indicates whether or not the verified active policy was successfully sent to the
DESTINATION VAMC(#365.191,.01).
TECHNICAL DESCR:
This field is only used for those entries that were SENT to another VAMC.
CROSS-REFERENCE: 365.191^C
1)= S ^IBCN(365.19,DA(1),1.1,"C",$E(X,1,30),DA)=""
2)= K ^IBCN(365.19,DA(1),1.1,"C",$E(X,1,30),DA)
This cross refence groups the entries by the SENT STATUS.
CROSS-REFERENCE: ^^TRIGGER^365.191^.03
1)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^IBCN(365.19,D0,1.1,D1,0)):^(0),1
:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S X=% X ^DD(365.191,.02,1,2,1.4)
1.4)= S DIH=$G(^IBCN(365.19,DIV(0),1.1,DIV(1),0)),DIV=X S $P(^(0),U,3)=DIV,DIH=365.191,DIG=.03 D ^D
ICR
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^IBCN(365.19,D0,1.1,D1,0)):^(0),1
:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S X=% X ^DD(365.191,.02,1,2,2.4)
2.4)= S DIH=$G(^IBCN(365.19,DIV(0),1.1,DIV(1),0)),DIV=X S $P(^(0),U,3)=DIV,DIH=365.191,DIG=.03 D ^D
ICR
3)= DO NOT DELETE
CREATE VALUE)= NOW
DELETE VALUE)= NOW
FIELD)= SENT STATUS DATE/TIME
NOREINDEX)= 1
This trigger will set the SENT STATUS DATE/TIME (#.03) to the current date/time whenever any
change/deletion is made to the SENT STATUS (#.02) field.
RECORD INDEXES: SSR (#1711) (WHOLE FILE #365.19)
365.191,.03 SENT STATUS DATE/TIME 0;3 DATE
INPUT TRANSFORM:S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: FEB 10, 2021
HELP-PROMPT: Enter the date and time that the entry was sent.
DESCRIPTION:
This field indicates the date/time of the current SENT STATUS (#365.191,.02).
TECHNICAL DESCR:
This field is only used for those entries that were SENT to another VAMC.
WRITE AUTHORITY:^
NOTES: TRIGGERED by the SENT STATUS field of the DESTINATION VAMC sub-field of the INTERFACILITY INSURANCE
UPDATE File
RECORD INDEXES: SSR (#1711) (WHOLE FILE #365.19)
365.19,2.01 RECEIVER STATUS 2;1 SET
'S' FOR SAVED TO BUFFER;
'V' FOR VISITED TOO LONG AGO;
'R' FOR RECEIVE IIU DATA IS OFF;
'D' FOR DUPLICATE;
'I' FOR IIU ENABLED IS OFF;
'E' FOR ERROR SAVING TO IIU;
'B' FOR ERROR SAVING TO BUFFER;
LAST EDITED: APR 21, 2021
HELP-PROMPT: Enter the status of the incoming data (received policy).
DESCRIPTION: This is the overall status of the received entry. It indicates whether or not the policy that was
received from another VAMC was saved to the INSURANCE VERIFICATION PROCESSOR (#355.33) file as a
buffer entry.
TECHNICAL DESCR: This field is only used (and is required) when the DIRECTION (#365.19,.03) field equals RECEIVER.
This field will indicate the filing status of the entry; whether it was saved to the INSURANCE
VERIFICATION PROCESSOR (#355.33) file or rejected.
CROSS-REFERENCE: ^^TRIGGER^365.19^2.02
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBCN(365.19,D0,2)):^(2),1:"") S X=$P(Y(1),U,2),X=X
S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S X=% X ^DD(365.19,2.01,1,1,1.4)
1.4)= S DIH=$G(^IBCN(365.19,DIV(0),2)),DIV=X S $P(^(2),U,2)=DIV,DIH=365.19,DIG=2.02 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBCN(365.19,D0,2)):^(2),1:"") S X=$P(Y(1),U,2),X=X
S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S X=% X ^DD(365.19,2.01,1,1,2.4)
2.4)= S DIH=$G(^IBCN(365.19,DIV(0),2)),DIV=X S $P(^(2),U,2)=DIV,DIH=365.19,DIG=2.02 D ^DICR
3)= DO NOT DELETE
CREATE VALUE)= NOW
DELETE VALUE)= NOW
FIELD)= RECEIVER STATUS DATE/TIME
NOREINDEX)= 1
This trigger will set the RECEIVER STATUS DATE/TIME (#2.02) to the current date/time whenever any
change/deletion is made to the RECEIVER STATUS (#2.01) field.
365.19,2.02 RECEIVER STATUS DATE/TIME 2;2 DATE
INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: FEB 10, 2021
HELP-PROMPT: Enter the date and time of the RECEIVER STATUS.
DESCRIPTION:
This field indicates the date/time that this policy was received from another VAMC.
TECHNICAL DESCR:
This field is only used for those entries that were RECEIVED from another VAMC.
WRITE AUTHORITY: ^
NOTES: TRIGGERED by the RECEIVER STATUS field of the INTERFACILITY INSURANCE UPDATE File
365.19,2.03 RECEIVER BUFFER 2;3 POINTER TO INSURANCE VERIFICATION PROCESSOR FILE (#355.33)
LAST EDITED: FEB 24, 2021
HELP-PROMPT: Enter the Buffer Entry number
DESCRIPTION: This is the entry in the INSURANCE VERIFICATION PROCESSOR (#355.33) of where this policy was saved
for user processing.
TECHNICAL DESCR: This field is only used for those entries that were RECEIVED from another VAMC. This is only
populated if the RECEIVER STATUS(#365.19, 2.01) field equals "SAVED TO BUFFER". It is required in
this instance.
365.19,2.1 ORIGINATING VAMC 2.1;0 POINTER Multiple #365.192 (Add New Entry without Asking)
TECHNICAL DESCR:
This multiple contains the policy information that was RECEIVED from another VAMC.
365.192,.01 ORIGINATING VAMC 0;1 POINTER TO INSTITUTION FILE (#4)
LAST EDITED: FEB 24, 2021
HELP-PROMPT: Enter the VAMC from where you received the verified active policy.
DESCRIPTION:
This field identifies the VAMC where the verified active policy originated.
CROSS-REFERENCE: 365.192^B
1)= S ^IBCN(365.19,DA(1),2.1,"B",$E(X,1,30),DA)=""
2)= K ^IBCN(365.19,DA(1),2.1,"B",$E(X,1,30),DA)
365.192,.02 PATIENT ICN 0;2 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999999999999)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: FEB 25, 2021
HELP-PROMPT: Enter the Integration Control Number for the patient. A number between 1 and 999999999999.
DESCRIPTION: This field identifies the Integration Control Number (ICN) of the patient associated with the
received policy.
TECHNICAL DESCR:
This field is only used for those entries that were RECEIVED from another VAMC.
SOURCE OF DATA: INTEGRATION CONTROL NUMBER(#2,991.01)
365.192,.03 INSURANCE COMPANY NAME 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
MAXIMUM LENGTH: 30
LAST EDITED: FEB 10, 2021
HELP-PROMPT: Enter the Insurance Company Name (3-30 characters).
DESCRIPTION:
This field identifies the name of the insurance carrier associated with the received policy.
TECHNICAL DESCR:
This field is only used for those entries that were RECEIVED from another VAMC.
SOURCE OF DATA: NAME(#36,.01)
365.192,.04 GROUP NAME 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<2) X
MAXIMUM LENGTH: 80
LAST EDITED: FEB 22, 2021
HELP-PROMPT: Enter the Group Name (2-80 characters).
DESCRIPTION: This field identifies the group name associated with the received policy. This is the name that
the insurance company uses to identify the plan.
TECHNICAL DESCR:
This field is only used for those entries that were RECEIVED from another VAMC.
SOURCE OF DATA: NEW GROUP NAME(#2.312,20)
365.192,.05 GROUP NUMBER 0;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>55!($L(X)<2) X
MAXIMUM LENGTH: 55
LAST EDITED: FEB 22, 2021
HELP-PROMPT: Enter the Group Number (2-55 characters).
DESCRIPTION: This field identifies the group number associated with the received policy. This is the group
number/code that the insurance company uses to identify this plan.
TECHNICAL DESCR:
This field is only used for those entries that were RECEIVED from another VAMC.
SOURCE OF DATA: NEW GROUP NUMBER(#2.312,21)
365.192,.06 BANKING IDENTIFICATION NUMBER 0;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
MAXIMUM LENGTH: 10
LAST EDITED: FEB 24, 2021
HELP-PROMPT: Enter the Plan's Banking Identification Number (BIN) (1-10 characters).
DESCRIPTION: This field identifies the Banking Identification Number (BIN) associated with the received
policy. The BIN is used for NCPDP transmissions.
TECHNICAL DESCR:
This is only used for those entries that were RECEIVED from another VAMC.
SOURCE OF DATA: GROUP PLAN(#2.312,.18) > GROUP INSURANCE PLAN(#355.3) > BANKING IDENTIFICATION NUMBER(#355.3,6.02
)
365.192,.07 PROCESSOR CONTROL NUMBER (PCN) 0;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
MAXIMUM LENGTH: 20
LAST EDITED: FEB 24, 2021
HELP-PROMPT: Enter the plan's Processor Control Number (PCN) (1-20 characters).
DESCRIPTION: This field identifies the Processor Control Number (PCN) associated with the received policy. The
PCN is used for NCPDP transmissions.
TECHNICAL DESCR:
This field is only used for those entries that were RECEIVED from another VAMC.
SOURCE OF DATA: GROUP PLAN(#2.312,.18) > GROUP INSURANCE PLAN(#355.3) > PROCESSOR CONTROL NUMBER(#355.3,6.03)
365.192,.08 TYPE OF PLAN 0;8 POINTER TO TYPE OF PLAN FILE (#355.1)
LAST EDITED: FEB 24, 2021
HELP-PROMPT: Enter the Type of Plan that best describes this plan.
DESCRIPTION: This field identifies the type of plan associated with the received policy. The type of policy is
used to determine if reimbursement for claims from the insurance carrier is appropriate.
TECHNICAL DESCR:
This field is only used for those entries that were RECEIVED from another VAMC.
SOURCE OF DATA: GROUP PLAN(#2.312,.18) > GROUP INSURANCE PLAN(#355.3) > TYPE OF PLAN(#355.3,.09)
365.192,.09 EFFECTIVE DATE OF POLICY 0;9 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:X<1 X
LAST EDITED: FEB 24, 2021
HELP-PROMPT: Enter the effective date of this policy for the applicant.
DESCRIPTION: This field identifies the effective date associated with the received policy. This is the date
the policy went into effect for the applicant.
TECHNICAL DESCR:
This field is only used for those entries that were RECEIVED from another VAMC.
SOURCE OF DATA: EFFECTIVE DATE OF POLICY(#2.312,8)
365.192,.1 PT. RELATIONSHIP - HIPAA 0;10 SET
'01' FOR SPOUSE;
'18' FOR SELF;
'19' FOR CHILD;
'20' FOR EMPLOYEE;
'29' FOR SIGNIFICANT OTHER;
'32' FOR MOTHER;
'33' FOR FATHER;
'39' FOR ORGAN DONOR;
'41' FOR INJURED PLAINTIFF;
'53' FOR LIFE PARTNER;
'G8' FOR OTHER RELATIONSHIP;
LAST EDITED: FEB 22, 2021
HELP-PROMPT: Select the HIPAA relationship code that describes the relationship this patient has to the holder
of this insurance policy.
DESCRIPTION: This field identifies the HIPAA Patient Relationship associated with the received policy. This
describes the patient's relationship to the person who holds this policy (or insured).
TECHNICAL DESCR:
This field is only used for those entries that were RECEIVED from another VAMC.
SOURCE OF DATA: PT. RELATIONSHIP - HIPAA(#2.312,4.03)
365.192,1.01 PATIENT ID 1;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
MAXIMUM LENGTH: 30
LAST EDITED: FEB 22, 2021
HELP-PROMPT: Enter the patient's primary ID number (member number) (1-30 characters).
DESCRIPTION: This field identifies the Patient Identifier (aka member number) associated with the received
policy. This is the patient's primary ID number for this insurance company. Enter this field when
the patient and the subscriber are different and the patient has been given a unique ID number.
TECHNICAL DESCR:
This field is only used for those entries that were RECEIVED from another VAMC.
SOURCE OF DATA: PATIENT ID(#2.312,5.01)
365.192,1.02 NAME OF INSURED 1;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>130!($L(X)<2) X
MAXIMUM LENGTH: 130
LAST EDITED: FEB 24, 2021
HELP-PROMPT: Enter the name of the individual for which this policy was issued (2-130 characters).
DESCRIPTION: This field identifies the name of the insured (aka subscriber's or policy holder's name)
associated with the received policy. This the name of the individual for which this insurance
policy was issued.
TECHNICAL DESCR:
This field is only used for those entries that were RECEIVED from another VAMC.
SOURCE OF DATA: NAME OF INSURED(#2.312,7.01)
365.192,1.03 SUBSCRIBER ID 1;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<1) X
MAXIMUM LENGTH: 80
LAST EDITED: FEB 24, 2021
HELP-PROMPT: Enter the subscriber's primary ID number (1-80 characters).
DESCRIPTION: This field is the subscriber's identifier (aka policy holder's identifier) associated with the
received policy. This is the primary number that was assigned by the payer and can be found on
the subscriber's insurance card.
TECHNICAL DESCR:
This field is only used for those entries that were RECEIVED from another VAMC.
SOURCE OF DATA: SUBSCRIBER ID(#2.312,7.02)
365.192,1.04 INSURED'S DOB 1;4 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:X<1 X
LAST EDITED: FEB 24, 2021
HELP-PROMPT: Enter the Date of Birth of the policy holder.
DESCRIPTION: This field identifies the date of birth of the insured (aka subscriber or policy holder)
associated with the received policy.
TECHNICAL DESCR:
This field is only used for those entries that were RECEIVED from another VAMC.
SOURCE OF DATA: INSURED'S DOB(#2.312,3.01)
365.192,1.05 COORDINATION OF BENEFITS 1;5 SET
'1' FOR PRIMARY;
'2' FOR SECONDARY;
'3' FOR TERTIARY;
LAST EDITED: FEB 22, 2021
HELP-PROMPT: Enter the code that best relates where in the payment sequence this policy should be placed.
DESCRIPTION: This field identifies the coordination of benefits associated with the received policy. Enter '1'
if this is the patient's primary insurance policy. Enter '2' if this policy is secondary to
(billed after) the primary policy. Enter '3' if this policy is tertiary or billed after the
secondary policy.
TECHNICAL DESCR:
This field is only used for those entries that were RECEIVED from another VAMC.
SOURCE OF DATA: COORDINATION OF BENEFITS(#2.312,.2)
365.192,1.06 WHOSE INSURANCE 1;6 SET
'v' FOR VETERAN;
's' FOR SPOUSE;
'o' FOR OTHER;
LAST EDITED: FEB 24, 2021
HELP-PROMPT: Enter who holds the insurance policy (the insured).
DESCRIPTION: This field identifies the holder of the received policy. Enter 'v' if this insurance policy is
held by the veteran (applicant), 's' if the veteran is married and the spouse holds the policy,
or 'o' if someone other than the veteran or his/her spouse hold the policy, i.e., employer.
TECHNICAL DESCR:
This field is only used for those entries that were RECEIVED from another VAMC.
SOURCE OF DATA: WHOSE INSURANCE(#2.312,6)
365.192,1.07 PAYER'S VA NATIONAL ID 1;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
MAXIMUM LENGTH: 10
LAST EDITED: FEB 22, 2021
HELP-PROMPT: Enter the payer's VA National ID (1-10 characters).
DESCRIPTION: This field identifies the payer associated with the received policy. This identifier is used to
uniquely identify the insurance payers.
TECHNICAL DESCR: This field is only used for those entries that were RECEIVED from another VAMC. The identifier is
assigned by the Eligibility Communicator which is controlled by the Financial Service Center
(FSC).
SOURCE OF DATA: VA NATIONAL ID(#365.12,.02)
FILES POINTED TO FIELDS
INSTITUTION (#4) DESTINATION VAMC:DESTINATION VAMC (#.01)
ORIGINATING VAMC:ORIGINATING VAMC (#.01)
INSURANCE VERIFICATION PROCESS
(#355.33) SENDER BUFFER (#1.05)
RECEIVER BUFFER (#2.03)
PATIENT (#2) PATIENT NAME (#.01)
PAYER (#365.12) PAYER (#1.02)
TYPE OF PLAN (#355.1) ORIGINATING VAMC:TYPE OF PLAN (#.08)
File #365.19
Record Indexes:
D (#1709) RECORD REGULAR IR LOOKUP & SORTING
Short Descr: Patient and Insurance Type
Description: This cross references the Patient with the Insurance Type entry.
Set Logic: S ^IBCN(365.19,"D",X(1),$E(X(2),1,30),DA)=""
Kill Logic: K ^IBCN(365.19,"D",X(1),$E(X(2),1,30),DA)
Whole Kill: K ^IBCN(365.19,"D")
X(1): PATIENT NAME (365.19,.01) (Subscr 1) (forwards)
X(2): INSUR RECORD IEN (365.19,1.03) (Subscr 2) (Len 30) (forwards)
DIR (#1710) RECORD REGULAR IR LOOKUP & SORTING
Short Descr: Direction of transmission
Description: This cross refences the entries by DIRECTION and DATE/TIME CREATED.
Set Logic: S ^IBCN(365.19,"DIR",X(1),X(2),DA)=""
Kill Logic: K ^IBCN(365.19,"DIR",X(1),X(2),DA)
Whole Kill: K ^IBCN(365.19,"DIR")
X(1): DIRECTION (365.19,.03) (Subscr 1) (forwards)
X(2): DATE/TIME CREATED (365.19,.02) (Subscr 2) (forwards)
Subfile #365.191
Record Indexes:
SSR (#1711) RECORD REGULAR IR LOOKUP & SORTING WHOLE FILE (#365.19)
Short Descr: Sent Status Reports
Description: This cross references the entries by SENT STATUS and SENT STATUS DATE/TIME at the file level.
Set Logic: S ^IBCN(365.19,"SSR",X(1),X(2),DA(1),DA)=""
Set Cond: S X=X(1)="S"
Kill Logic: K ^IBCN(365.19,"SSR",X(1),X(2),DA(1),DA)
Whole Kill: K ^IBCN(365.19,"SSR")
X(1): SENT STATUS (365.191,.02) (Subscr 1) (forwards)
X(2): SENT STATUS DATE/TIME (365.191,.03) (Subscr 2) (forwards)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):