STANDARD DATA DICTIONARY #392 -- BENEFICIARY TRAVEL CLAIM FILE 6/27/25 PAGE 1
STORED IN ^DGBT(392, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 1.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
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This file contains the completed travel claim entries for patients showing departure/destination data, as well as specific claim
data.
DD ACCESS: @
RD ACCESS: d
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
IDENTIFIED BY: NAME (#2)[R], ACCOUNT (#6)[R]
CROSS
REFERENCED BY: ACCOUNT(AC), ACCOUNT(ACTP), DEDUCTIBLE AMOUNT(AD), CLAIM DENIED(ADENIED), ELIGIBILITY(AE), COREFLS CARRIER(AFLS),
NAME(AI), CARRIER(AS), Claim DATE/TIME(B), NAME(C), DATE ENTERED INTO THE FILE(D)
INDEXED BY: Claim DATE/TIME & NAME & Claim DATE/TIME (AF)
LAST MODIFIED: NOV 28,2017@12:51:10
392,.01 Claim DATE/TIME 0;1 DATE (Required)
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X I $D(X) S DINUM=X
LAST EDITED: JUN 29, 2012
HELP-PROMPT: Enter the Beneficiary Travel CLAIM date/time in the usual fileman format.
DESCRIPTION:
Enter the date/time of the Bene Travel Claim.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 392^B
1)= S ^DGBT(392,"B",$E(X,1,30),DA)=""
2)= K ^DGBT(392,"B",$E(X,1,30),DA)
RECORD INDEXES: AF (#1101)
392,2 NAME 0;2 POINTER TO PATIENT FILE (#2) (Required)
LAST EDITED: JUN 29, 2012
DESCRIPTION:
Enter the patient that is related to this Bene Travel Claim.
UNEDITABLE
CROSS-REFERENCE: 392^C
1)= S ^DGBT(392,"C",$E(X,1,30),DA)=""
2)= K ^DGBT(392,"C",$E(X,1,30),DA)
CROSS-REFERENCE: 392^AI^MUMPS
1)= S ^DGBT(392,"AI",$E(X,1,30),9999999.99999-DA)=DA
2)= K ^DGBT(392,"AI",$E(X,1,30),9999999.99999-DA)
RECORD INDEXES: AF (#1101)
392,3 ELIGIBILITY 0;3 POINTER TO ELIGIBILITY CODE FILE (#8)
LAST EDITED: JAN 08, 1989
HELP-PROMPT: Enter the primary eligibility or other entitled eligibilities
DESCRIPTION:
This field contains the eligibililty of the patient for this Bene Travel Claim.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 392^AE
1)= S ^DGBT(392,"AE",$E(X,1,30),DA)=""
2)= K ^DGBT(392,"AE",$E(X,1,30),DA)
392,4 SC PERCENTAGE 0;4 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
HELP-PROMPT: Type a Number between 0 and 100, 0 Decimal Digits
DESCRIPTION:
Enter the SC percentage of this patient related to this Bene Travel Claim.
392,5 CERTIFICATION DATE 0;5 POINTER TO BENEFICIARY TRAVEL CERTIFICATION FILE (#392.2)
ANNUAL CERTIFICATION
INPUT TRANSFORM: S DIC("S")="I $P(^(0),U,2)=$P(^DGBT(392,DA,0),U,2)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JAN 06, 1989
DESCRIPTION:
This field contains the Beneficiary Travel Certification date.
SCREEN: S DIC("S")="I $P(^(0),U,2)=$P(^DGBT(392,DA,0),U,2)"
EXPLANATION: Only allowed to select Certification Dates for this patient
392,6 ACCOUNT 0;6 POINTER TO BENEFICIARY TRAVEL ACCOUNT FILE (#392.3) (Required)
INPUT TRANSFORM: S DIC("S")="I $P(^(0),U,3)'>DA&('$P(^(0),U,4)!($P(^(0),U,4)'10000)!(X<0) X
LAST EDITED: DEC 14, 1988
HELP-PROMPT: Type a Dollar Amount between 0 and 10000, 2 Decimal Digits
DESCRIPTION: This field contains the most economical cost amount (whatever cost less) for this Bene Travel
Claim.
392,9 DEDUCTIBLE AMOUNT 0;9 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99)!(X<0) X
LAST EDITED: SEP 24, 2012
HELP-PROMPT: Type a Dollar Amount between 0 and 99, 2 Decimal Digits
DESCRIPTION:
This field contains the deductible amount applied to this Bene Travel Claim.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 392^AD^MUMPS
1)= S ^DGBT(392,"AD",$P(^DGBT(392,DA,0),"^",2),$E(DA,2,5),DA)=X
2)= K ^DGBT(392,"AD",$P(^DGBT(392,DA,0),"^",2),$E(DA,2,5),DA)
392,10 AMOUNT PAYABLE 0;10 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>10000)!(X<0) X
LAST EDITED: JUL 03, 2012
HELP-PROMPT: Type a dollar amount between 0 and 10000, 2 decimal digits.
DESCRIPTION: This field contains the amount payable (cost minus any applied deductible) for this Bene Travel
Claim.
392,11 DIVISION 0;11 POINTER TO MEDICAL CENTER DIVISION FILE (#40.8) (Required)
LAST EDITED: JAN 27, 1989
DESCRIPTION:
This field contains the medical center division related to this Bene Travel Claim.
392,12 WHO ENTERED INTO FILE 0;12 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: OCT 17, 1990
DESCRIPTION:
The name of the user who first entered this patient into the Beneficiary Travel Claim file.
392,13 DATE ENTERED INTO THE FILE 0;13 DATE (Multiply asked)
INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAY 08, 2012
DESCRIPTION:
The date this beneficiary travel claim was entered into this file.
CROSS-REFERENCE: 392^D
1)= S ^DGBT(392,"D",$E(X,1,30),DA)=""
2)= K ^DGBT(392,"D",$E(X,1,30),DA)
392,14 COREFLS CARRIER 0;14 POINTER TO LOCAL VENDOR FILE (#392.31)
OUTPUT TRANSFORM: K DGBTPRV S DGBTPRV=$$PREV^DGBTCSL(.Y)
LAST EDITED: DEC 11, 2002
HELP-PROMPT: Enter a COREFLS Carrier for this claim.
DESCRIPTION:
This field contains the COREFLS Carrier for this Bene Travel Claim.
DELETE TEST: 1,0)= I 1 W !,*7,"DELETIONS ARE NOT ALLOWED"
CROSS-REFERENCE: 392^AFLS
1)= S ^DGBT(392,"AFLS",$E(X,1,30),DA)=""
2)= K ^DGBT(392,"AFLS",$E(X,1,30),DA)
392,21 PLACE OF DEPARTURE [LINE 1] D;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>35!($L(X)<3) X
LAST EDITED: AUG 18, 2010
HELP-PROMPT: Enter the first line of the place of departure address. Answer must be 3-35 characters in length.
DESCRIPTION: This field contains the first line of the address for the place of departure for this Bene Travel
Claim.
CROSS-REFERENCE: ^^TRIGGER^392^22
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGBT(392,D0,"D")):^("D"),1:"") S X=$P(Y(1),U,2),X=X
S DIU=X K Y S X="" S DIH=$G(^DGBT(392,DIV(0),"D")),DIV=X S $P(^("D"),U,2)=DIV,DIH=392,DIG=22 D ^DI
CR
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= PLACE OF DEPARTURE [LINE 2]
392,22 PLACE OF DEPARTURE [LINE 2] D;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: AUG 04, 2010
HELP-PROMPT: If the space provided in 'PLACE OF DEPARTURE [LINE 1] was not sufficient, enter the second line of
the place of departure address. Answer must be 3-30 characters in length.
DESCRIPTION: This field contains the second line of the address for the place of departure for this Bene Travel
Claim.
NOTES: TRIGGERED by the PLACE OF DEPARTURE [LINE 1] field of the BENEFICIARY TRAVEL CLAIM File
CROSS-REFERENCE: ^^TRIGGER^392^23
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGBT(392,D0,"D")):^("D"),1:"") S X=$P(Y(1),U,3),X=X
S DIU=X K Y S X="" S DIH=$G(^DGBT(392,DIV(0),"D")),DIV=X S $P(^("D"),U,3)=DIV,DIH=392,DIG=23 D ^DI
CR
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= PLACE OF DEPARTURE [LINE 3]
392,23 PLACE OF DEPARTURE [LINE 3] D;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: DEC 15, 1988
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION: This field contains the third line of the address for the place of departure for this Bene Travel
Claim.
NOTES: TRIGGERED by the PLACE OF DEPARTURE [LINE 2] field of the BENEFICIARY TRAVEL CLAIM File
392,24 CITY OF DEPARTURE D;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<2)!'(X'?1P.E) X I $D(X) D UP^DGHELP
LAST EDITED: FEB 27, 1989
HELP-PROMPT: Answer must be 2-30 characters in length.
DESCRIPTION: This field contains the name of the city in the address for the place of departure for this Bene
Travel Claim.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
392,24.1 STATE OF DEPARTURE D;5 POINTER TO STATE FILE (#5)
LAST EDITED: FEB 27, 1989
DESCRIPTION: This field points to the State File and uses this for the state in the address for the place of
departure for this Bene Travel Claim.
392,24.2 ZIP CODE/DEPARTURE D;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<5) X I $D(X) D ZIPIN^VAFADDR
OUTPUT TRANSFORM: D ZIPOUT^VAFADDR
LAST EDITED: AUG 14, 2012
HELP-PROMPT: Answer with either 5 digit or 9 digit zip code.
DESCRIPTION: This field contains the 5-digit zip code used in the address for the place of departure for this
Bene Travel Claim.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
392,25 DESTINATION [LINE 1] T;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>35!($L(X)<3) X
LAST EDITED: AUG 04, 2010
HELP-PROMPT: Answer must be 3-35 characters in length.
DESCRIPTION: This field contains the first line of the address for place of destination for this Bene Travel
Claim.
CROSS-REFERENCE: ^^TRIGGER^392^26
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGBT(392,D0,"T")):^("T"),1:"") S X=$P(Y(1),U,2),X=X
S DIU=X K Y S X="" S DIH=$G(^DGBT(392,DIV(0),"T")),DIV=X S $P(^("T"),U,2)=DIV,DIH=392,DIG=26 D ^DI
CR
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= DESTINATION [LINE 2]
392,26 DESTINATION [LINE 2] T;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: AUG 04, 2010
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION: This field contains the second line of the address for the place of destination for this Bene
Travel Claim.
NOTES: TRIGGERED by the DESTINATION [LINE 1] field of the BENEFICIARY TRAVEL CLAIM File
CROSS-REFERENCE: ^^TRIGGER^392^27
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGBT(392,D0,"T")):^("T"),1:"") S X=$P(Y(1),U,3),X=X
S DIU=X K Y S X="" S DIH=$G(^DGBT(392,DIV(0),"T")),DIV=X S $P(^("T"),U,3)=DIV,DIH=392,DIG=27 D ^DI
CR
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= DESTINATION [LINE 3]
392,27 DESTINATION [LINE 3] T;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: FEB 08, 1989
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION: This field contains the third line of the address for the place of destination for this Bene Travel
Claim.
NOTES: TRIGGERED by the DESTINATION [LINE 2] field of the BENEFICIARY TRAVEL CLAIM File
392,28 CITY OF DESTINATION T;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<2)!'(X'?1P.E) X I $D(X) D UP^DGHELP
LAST EDITED: MAR 09, 1989
HELP-PROMPT: Answer must be 2-30 characters in length.
DESCRIPTION: This field contains the name of the city in the address for the place of destination for this Bene
Travel Claim.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
392,28.1 STATE OF DESTINATION T;5 POINTER TO STATE FILE (#5)
LAST EDITED: FEB 27, 1989
DESCRIPTION: This field points the the STATE file and contains the state used in the address for the place of
destination for this Bene Travel Claim.
392,28.2 ZIP CODE/DESTINATION T;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<5) X I $D(X) D ZIPIN^VAFADDR
OUTPUT TRANSFORM: D ZIPOUT^VAFADDR
LAST EDITED: MAR 01, 1993
HELP-PROMPT: Answer with either 5 digit or 9 digit zip code.
DESCRIPTION: This field contains the 5-digit zip code used in the address for the place of destination for this
Bene Travel Claim.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
392,31 ONE WAY/ROUND TRIP M;1 SET (Required)
'1' FOR ONE WAY;
'2' FOR ROUND TRIP;
LAST EDITED: FEB 08, 1989
DESCRIPTION:
This field indicates one way or round trip for this Bene Travel Claim.
392,32 MILEAGE/ONE WAY M;2 NUMBER (Required)
INPUT TRANSFORM: K:+X'=X!(X>10000)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JAN 29, 1989
HELP-PROMPT: Type a Number between 0 and 10000, 0 Decimal Digits
DESCRIPTION:
This field contains the one way mileage for this Bene Travel Calim.
EXECUTABLE HELP: S X="D MHELP^DGBTUTL" X X
392,33 TOTAL MILEAGE AMOUNT M;3 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>10000)!(X<0) X
LAST EDITED: JAN 07, 1989
HELP-PROMPT: Type a Dollar Amount between 0 and 10000, 2 Decimal Digits
DESCRIPTION: This is a numeric field containing the total mileage entered for a specific beneficiary travel
claim.
392,34 MEALS & LODGING M;4 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>10000)!(X<0) X
LAST EDITED: JAN 07, 1989
HELP-PROMPT: Type a Dollar Amount between 0 and 10000, 2 Decimal Digits
DESCRIPTION:
This field contains meals and lodging costs for this Bene Travel Claim.
392,35 FERRY, BRIDGES, ETC. M;5 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>10000)!(X<0) X
LAST EDITED: JAN 07, 1989
HELP-PROMPT: Type a Dollar Amount between 0 and 10000, 2 Decimal Digits
DESCRIPTION:
This field contains ferry, bridges, etc. costs for this Bene Travel Claim.
392,41 AUTHORIZING PERSON A;1 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JAN 27, 1993
DESCRIPTION: This field points the person file to indicate who the authorizing person responsible for this Bene
Travel Claim.
392,42 ATTENDANT/PAYEE A;2 FREE TEXT
INPUT TRANSFORM: K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>30!($L(X)<3)!(X?1P.E)!(X'?1U.ANP)!(X'[",") X I $D(X) D UP^DGH
ELP S Y=", " F I=0:0 Q:$F(X,Y)<1 S X=$E(X,1,($F(X,Y)-2))_$E(X,$F(X,Y),99)
LAST EDITED: JUL 30, 1993
HELP-PROMPT: Enter the name in 'Last,First Middle' format between 3-30 characters. With the exception of the
comma, period, space, hyphen, dash and apostrophe punctuation characters should be avoided.
DESCRIPTION: This field contains the 'Last, First Middle' name format of the attendent/payee of this Bene Travel
Claim.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
392,43 C&P REVIEW VISIT A;3 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: OCT 19, 2012
HELP-PROMPT: Answer whether this claim is a C&P review visit and should be paid at the C&P review visit mileage
rate as indicated in the BT parameters.
DESCRIPTION: This field indicates whether this is a C&P review visit and should be paid at the C&P review visit
mileage rate as indicated in the BT parameters for this Bene Travel Claim.
392,43.1 BT CLAIM ELIGIBILITY CODE 1;2 POINTER TO BT CLAIM ELIGIBILITY CODE FILE (#392.41)
LAST EDITED: AUG 02, 2012
HELP-PROMPT: Select the eligibility code.
DESCRIPTION:
This is the reason patient is eligible for BT.
392,43.2 BT CLAIM ELIGIBILITY ADDITION 1;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<1) X
LAST EDITED: AUG 06, 2012
HELP-PROMPT: Answer must be 1-80 characters in length.
DESCRIPTION: This is additional information or explanation if 'Other Eligibility Reason' was entered in the BT
CLAIM ELIGIBILITY CODE (#43.1) field.
392,43.4 SC APPOINTMENT A;12 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: OCT 19, 2012
HELP-PROMPT: Enter a 'Yes' or 'No'.
DESCRIPTION: This field contains 1(Yes) or 0(No) on whether or not the patients appointment was a SC
appointment.
392,43.5 QUALIFIED APPOINTMENT A;11 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: OCT 19, 2012
HELP-PROMPT: Enter 'Yes' if a Qualified Appointment, 'No' if not a Qualified Appointment.
DESCRIPTION: The field will contain the a 1(yes) or 0(no) on whether or not the patients appointment was a
qualified appointment for BT reimburstment.
392,44 MODE OF TRANSPORTATION A;4 POINTER TO BT COMMON CARRIER MODE OF TRANSPORTATION FILE (#392.43) (Required)
LAST EDITED: SEP 28, 2012
HELP-PROMPT: Enter the mode of transportation used for this Beneficiary Travel Claim.
DESCRIPTION:
This field indicates the mode of transportation used for this Beneficiary Travel Claim.
CROSS-REFERENCE: ^^TRIGGER^392^52
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$P($G(^DGBT(392.43,+Y(0),0)),U)'["BUS" I X S X=DIV S
Y(1)=$S($D(^DGBT(392,D0,"B")):^("B"),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" X ^DD(392,44,1,
2,1.4)
1.4)= S DIH=$G(^DGBT(392,DIV(0),"B")),DIV=X S $P(^("B"),U,1)=DIV,DIH=392,DIG=52 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGBT(392,D0,"B")):^("B"),1:"") S X=$P(Y(1),U,1),X=X
S DIU=X K Y S X="" S DIH=$G(^DGBT(392,DIV(0),"B")),DIV=X S $P(^("B"),U,1)=DIV,DIH=392,DIG=52 D ^DI
CR
CREATE CONDITION)= MODE OF TRANSPORTATION'["BUS"
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= BUS PASS OR TICKET
If mode of transportation is changed to something other than bus then the BUS PASS OR TICKET field
is automatically deleted as it's no longer relevant to this claim.
392,45 DENIAL LETTER ISSUED A;6 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: AUG 08, 2012
HELP-PROMPT: Was a BT denial letter issued?
DESCRIPTION:
Field indicates whether or not a BT claim denial letter was issued.
392,45.1 DENIAL LETTER ISSUED DATE A;7 DATE
INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUL 03, 2012
HELP-PROMPT: Please enter date and time
DESCRIPTION:
Date and time the BT claim was denied and letter was issued.
392,45.2 CLAIM DENIED A;8 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: OCT 21, 2012
HELP-PROMPT: Is the claim denied?
DESCRIPTION:
This field will inform whether a claim has been approved or denied.
CROSS-REFERENCE: 392^ADENIED^MUMPS
1)= I X S DFN=$P(^DGBT(392,DA,0),"^",2) S ^DGBT(392,"ADENIED",DFN,DA)=""
2)= I $D(DA) S DFN=$P(^DGBT(392,DA,0),"^",2) K ^DGBT(392,"ADENIED",DFN,DA)
WHOLE FILE CROSS REFERENCE ON FIELD 45.2, CLAIM DENIED.
392,45.3 DATE CLAIM DENIED A;9 DATE
INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: AUG 07, 2012
HELP-PROMPT: Enter Date the Claim was Denied.
DESCRIPTION:
This field contains the date the claim was denied.
392,45.4 CLAIM DENIED REASON A;10 POINTER TO BENEFICIARY TRAVEL DENIAL REASONS FILE (#392.8)
LAST EDITED: AUG 08, 2012
HELP-PROMPT: Enter reason claim was denied.
DESCRIPTION:
Reason claim was denied.
392,51 REMARKS R;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>79!($L(X)<1)!(X[";") X
LAST EDITED: AUG 06, 2012
HELP-PROMPT: Answer must be 1-79 characters in length and not containing a "".
DESCRIPTION:
This field contains remarks related to this Beneficiary Travel Claim.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
392,52 BUS PASS OR TICKET B;1 SET
'P' FOR PASS;
'T' FOR TICKET;
LAST EDITED: AUG 08, 2012
HELP-PROMPT: Choose whether the patient has a monthly bus pass or a single use ticket.
DESCRIPTION: This field stores the type of ticket that the veteran used when riding the bus. The type of ticket
determines how the veteran is reimbursed.
NOTES: TRIGGERED by the MODE OF TRANSPORTATION field of the BENEFICIARY TRAVEL CLAIM File
CROSS-REFERENCE: ^^TRIGGER^392^53
1)= X ^DD(392,52,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DGBT(392,D0,"B")):^("B"),1:"") S X=$P(Y(1),U,2)
,X=X S DIU=X K Y S X="" S DIH=$G(^DGBT(392,DIV(0),"B")),DIV=X S $P(^("B"),U,2)=DIV,DIH=392,DIG=53 D
^DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$C(59)_$P($G(^DD(392,52,0)),U,3) S X=$P($P(Y(1)
,$C(59)_Y(0)_":",2),$C(59))'="PASS"
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGBT(392,D0,"B")):^("B"),1:"") S X=$P(Y(1),U,2),X=X
S DIU=X K Y S X="" S DIH=$G(^DGBT(392,DIV(0),"B")),DIV=X S $P(^("B"),U,2)=DIV,DIH=392,DIG=53 D ^DI
CR
CREATE CONDITION)= BUS PASS OR TICKET'="PASS"
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= BUS PASS EXPIRATION DATE
If the BUS PASS OR TICKET (#52) field doesn't contain "pass" as a value then the BUS PASS
EXPIRATION DATE (#53) field is deleted as it's no longer relevant.
392,53 BUS PASS EXPIRATION DATE B;2 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1!($P($G(^DGBT(392,DA,"B")),U)'="P") X I $D(X),X<$P(DA,".",1) K X
LAST EDITED: AUG 10, 2012
HELP-PROMPT: Enter the expiration date for the patient's bus pass.
DESCRIPTION: This field holds the expiration date of the bus pass and can only be filled in if the BUS PASS OR
TICKET (#52) field is set to pass. The bus pass expiration date can't before the claim date.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the BUS PASS OR TICKET field of the BENEFICIARY TRAVEL CLAIM File
392,54 COMMON CARRIER DATE REIMBURSED C;1 DATE (Required)
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JAN 16, 2012
HELP-PROMPT: Enter date reimbursement was given for use of common carrier. No future dates allowed.
DESCRIPTION:
This field holds the date of reimbursement for use of common carrier transportation.
392,55 COMMON CARRIER FEE C;2 NUMBER (Required)
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>1000000)!(X<0) X
LAST EDITED: AUG 10, 2012
HELP-PROMPT: Type a dollar amount between 0 and 1000000, 2 decimal digits.
DESCRIPTION:
This is the amount charged for use of the common carrier transportation.
392,55.1 COMMON CARRIER REQUIRED C;3 SET (Required)
'1' FOR YES;
'0' FOR NO;
LAST EDITED: AUG 10, 2012
HELP-PROMPT: Is Common Carrier required?
DESCRIPTION: Field is used to indicate whether or not the use of a common carrier was best or only way to travel
to a VA medical center.
392,56 TYPE OF CLAIM 0;15 SET (Required)
IS THIS FOR A MILEAGE OR SPECIAL MODE CLAIM
'M' FOR MILEAGE;
'S' FOR SPECIAL MODE;
LAST EDITED: AUG 07, 2012
HELP-PROMPT: Choose claim type.
DESCRIPTION:
This field indicates what type of claim this is.
392,57 SPECIAL MODE OF TRANSPORTATION SP;1 POINTER TO BT SPECIAL MODE OF TRANSPORTATION FILE (#392.42) (Required)
TYPE OF SPECIAL MODE OF TRANSPORTATION
LAST EDITED: FEB 24, 2012
HELP-PROMPT: Select the method of the Special Mode of Transportation.
DESCRIPTION:
This is the type of Special Mode of Transportation.
392,58 INVOICE NUMBER SP;2 FREE TEXT (Required)
VENDOR INVOICE NUMBER
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: FEB 24, 2012
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: The field contains the invoice number from the vendor who provided the special mode of
transportation for the patient.
392,59 DATE INVOICE RECEIVED SP;3 DATE
SPECIAL MODE DATE INVOICE RECEIVED
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: AUG 06, 2012
HELP-PROMPT: Enter the date the invoice was received by the VA from the patient or vendor for the special mode
transportation.
DESCRIPTION: This is the date the invoice was received by the VA from either the patient or the vendor for the
special mode transportation.
392,60 TOTAL INVOICE AMOUNT SP;4 NUMBER (Required)
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<1) X
LAST EDITED: SEP 05, 2017
HELP-PROMPT: Type a dollar amount between 1 and 999999, 2 decimal digits.
DESCRIPTION: This is the total of all charges by a vendor for the transportation of the patient by special mode.
This includes all cost and special add-on fees.
392,61 BASE RATE FEE SP;5 NUMBER (Required)
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>100000)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: AUG 11, 2012
HELP-PROMPT: Type a dollar amount between 0 and 100,000, 2 decimal digits.
DESCRIPTION: This is the base rate fee if any, charged by the vendor for transporting the patient by special
mode.
392,62 MILEAGE FEE SP;6 NUMBER (Required)
SPECIAL MODE MILEAGE FEE
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>500000)!(X<0) X
LAST EDITED: SEP 05, 2017
HELP-PROMPT: Type a dollar amount between 0 and 500000, 2 decimal digits.
DESCRIPTION:
This is the per mile amount charged by the vendor for transporting the patient by special mode.
392,63 NO SHOW/NO LOAD FEE SP;7 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>1000)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: SEP 05, 2017
HELP-PROMPT: Type a dollar amount between 0 and 1,000, 2 decimal digits.
DESCRIPTION:
Vendor's charge for a no-show patient.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
392,64 WAIT TIME FEE SP;8 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>1000)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: AUG 11, 2012
HELP-PROMPT: Type a dollar amount between 0 and 1,000, 2 decimal digits.
DESCRIPTION:
This is the fee charged by the vendor to wait for the patient.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
392,65 EXTRA CREW FEE SP;9 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>10000)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: AUG 11, 2012
HELP-PROMPT: Type a dollar amount between 0 and 10,000, 2 decimal digits.
DESCRIPTION: This is the fee charged by the vendor when extra crew is provided by the vendor to transport the
patient by special mode.
392,66 SPECIAL EQUIPMENT FEE SP;10 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>5000)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: AUG 11, 2012
HELP-PROMPT: Type a dollar amount between 0 and 5,000, 2 decimal digits.
DESCRIPTION: This is the fee charged by the vendor to provide special equipment during the special mode
transportation.
392,67 SPECIAL MODE RT/ONE-WAY SP;11 SET (Required)
'R' FOR ROUND TRIP;
'O' FOR ONE WAY;
LAST EDITED: FEB 24, 2012
HELP-PROMPT: Choose trip type.
DESCRIPTION:
This field indicates whether the special mode transportation was round trip or one way.
392,68 SPECIAL MODE TOTAL MILES SP;12 NUMBER (Required)
INPUT TRANSFORM: K:+X'=X!(X>10000)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: JUN 24, 2015
HELP-PROMPT: Type a number between 1 and 10000, 0 decimal digits.
DESCRIPTION:
This is the total mileage for the special mode transportation trip.
392,69 OTHER SM TRANSPORTATION SP;25 FREE TEXT
OTHER TYPES OF SM MODE TRANSPORTATION
INPUT TRANSFORM: K:$L(X)>45!($L(X)<3) X
LAST EDITED: AUG 10, 2012
HELP-PROMPT: Answer must be 3-45 characters in length.
DESCRIPTION: Other types of special mode transportation used when 'OTHER' is selected from the SPECIAL MODE OF
TRANSPORTATION (#57) field.
392,70 PRE-AUTHORIZED SP;13 SET (Required)
'1' FOR YES;
'0' FOR NO;
LAST EDITED: AUG 10, 2012
HELP-PROMPT: Was trip pre-authorized for Special Mode transportation?
DESCRIPTION:
This field indicates whether the transportation for the Special Mode trip was pre-authorized.
392,71 SPECIAL MODE VENDOR SP;14 POINTER TO VENDOR FILE (#440) (Required)
LAST EDITED: FEB 24, 2012
HELP-PROMPT: Enter the Special Mode Transportation Vendor.
DESCRIPTION:
This is the vendor who supplied the special mode transportation for the patient.
392,72 SPECIAL MODE OTHER REMARKS SP;26 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<3) X
LAST EDITED: FEB 02, 2012
HELP-PROMPT: Answer must be 3-50 characters in length.
DESCRIPTION:
This field is any additional information about the special mode of transportation claim.
392,73 SP MODE DEPARTURE ADDRESS1 SPAD;1 FREE TEXT (Required)
SPECIAL MODE DEPARTURE ADDRESS [LINE1]
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: AUG 14, 2012
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: Line one of the address the patient departed from for this claim. It defaults to line one of the
patient's home address.
392,74 SP MODE DEPARTURE ADDRESS2 SPAD;2 FREE TEXT
SPECIAL MODE DEPARTURE ADDRESS [LINE2]
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: AUG 06, 2012
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: This is the second line of the departure address of the patient. It defaults to the patient's 2nd
line of their home address.
392,75 SP MODE DEPARTURE CITY SPAD;3 FREE TEXT (Required)
SPECIAL MODE DEPARTURE CITY
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: AUG 06, 2012
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: This is the city the patient departed from for this claim. It defaults to the patient's home
address city.
392,76 SP MODE DEPARTURE STATE SPAD;4 POINTER TO STATE FILE (#5) (Required)
SPECIAL MODE DEPARTURE STATE
LAST EDITED: DEC 28, 2011
HELP-PROMPT: Select the departure state.
DESCRIPTION: This is the state from which the patient departed for the claim. It defaults to the state from the
patient's home address.
392,77 SP MODE DEPARTURE ZIP CODE SPAD;5 FREE TEXT (Required)
SPECIAL MODE DEPARTURE ZIP CODE
INPUT TRANSFORM: K:$L(X)>20!($L(X)<5) X I $D(X) D ZIPIN^VAFADDR
OUTPUT TRANSFORM: D ZIPOUT^VAFADDR
LAST EDITED: AUG 14, 2012
HELP-PROMPT: Answer with either 5 digit or 9 digit zip code.
DESCRIPTION: This is the patient's departure ZIP code for this claim. It defaults to the ZIP code from the
patient's home address.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
392,78 SP MODE DESTINATION 1 SPAD;6 FREE TEXT (Required)
SPECIAL MODE DESTINATION [LINE 1]
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: FEB 18, 2012
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
This is line one of the destination address. It defaults to the site's address.
392,79 SP MODE DESTINATION 2 SPAD;7 FREE TEXT
SPECIAL MODE DESTINATION [LINE 2]
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: AUG 10, 2012
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
This is line 2 of the destination address. It defaults to the site's address line 2.
392,80 SP MODE DESTINATION 3 SPAD;8 FREE TEXT
SPECIAL MODE DESTINATION [LINE 3]
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: AUG 06, 2012
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
This is the third line of the site's address. It defaults to the site's address line 3.
392,81 SP MODE DESTINATION CITY SPAD;9 FREE TEXT (Required)
SPECIAL MODE DESTINATION CITY
INPUT TRANSFORM: K:$L(X)>25!($L(X)<3) X
LAST EDITED: DEC 28, 2011
HELP-PROMPT: Answer must be 3-25 characters in length.
DESCRIPTION:
This is the city the site is located in. It defaults to the site's city.
392,82 SP MODE DESTINATION STATE SPAD;10 POINTER TO STATE FILE (#5) (Required)
SPECIAL MODE DESTINATION STATE
LAST EDITED: DEC 28, 2011
HELP-PROMPT: Select the state of destination.
DESCRIPTION:
This is the destination state of the site. It defaults to the site's state.
392,83 SP MODE DESTINATION ZIP CODE SPAD;11 FREE TEXT (Required)
SPECIAL MODE DESTINATION ZIP CODE
INPUT TRANSFORM: K:$L(X)>20!($L(X)<5) X I $D(X) D ZIPIN^VAFADDR
OUTPUT TRANSFORM: D ZIPOUT^VAFADDR
LAST EDITED: AUG 14, 2012
HELP-PROMPT: Answer with either 5 digit or 9 digit zip code.
DESCRIPTION:
This is the destination ZIP code of the site. It defaults to the site's ZIP code.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
392,84 PRE-AUTHORIZED BY SP;16 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: AUG 06, 2012
HELP-PROMPT: Enter User who PRE-AUTHORIZED the Claim.
DESCRIPTION:
This is User who PRE-AUTHORIZED the Claim. By default it's user who entered the claim.
392,85 SPECIAL MODE CLAIM AUTHORIZED SP;15 SET
IS SPECIAL MODE CLAIM AUTHORIZED?
'1' FOR YES;
'0' FOR NO;
LAST EDITED: AUG 10, 2012
HELP-PROMPT: Enter 'YES' if Special Mode Claim is Authorized, enter 'NO' if Special Mode Claim is Denied.
DESCRIPTION:
This field indicates whether Special Mode transportation is authorized or denied.
392,86 DATE/TIME AUTHORIZED SP;17 DATE
INPUT TRANSFORM: S %DT="ETX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: AUG 06, 2012
HELP-PROMPT: Enter Date/Time the trip was authorized.
DESCRIPTION:
This is the date/time the travel was authorized if not a pre-authorized trip.
FILES POINTED TO FIELDS
BENEFICIARY TRAVEL ACCOUNT
(#392.3) ACCOUNT (#6)
BENEFICIARY TRAVEL CERTIFICATI
(#392.2) CERTIFICATION DATE (#5)
BENEFICIARY TRAVEL DENIAL REAS
(#392.8) CLAIM DENIED REASON (#45.4)
BT CLAIM ELIGIBILITY CODE
(#392.41) BT CLAIM ELIGIBILITY CODE (#43.1)
BT COMMON CARRIER MODE OF TRAN
(#392.43) MODE OF TRANSPORTATION (#44)
BT SPECIAL MODE OF TRANSPORTAT
(#392.42) SPECIAL MODE OF TRANSPORTATION (#57)
ELIGIBILITY CODE (#8) ELIGIBILITY (#3)
LOCAL VENDOR (#392.31) COREFLS CARRIER (#14)
MEDICAL CENTER DIVISION (#40.8) DIVISION (#11)
NEW PERSON (#200) WHO ENTERED INTO FILE (#12)
AUTHORIZING PERSON (#41)
PRE-AUTHORIZED BY (#84)
PATIENT (#2) NAME (#2)
STATE (#5) STATE OF DEPARTURE (#24.1)
STATE OF DESTINATION (#28.1)
SP MODE DEPARTURE STATE (#76)
SP MODE DESTINATION STATE (#82)
VENDOR (#440) CARRIER (#7)
SPECIAL MODE VENDOR (#71)
File #392
Record Indexes:
AF (#1101) RECORD MUMPS IR ACTION
Short Descr: CROSS REFERENCE OF CURRENT MONTH AND DFN
Description: THIS CROSS REFERENCE WILL CROSS REFERENCE THE WHOLE FILE USING THE CURRENT MONTH AND THE PATIENT'S DFN AND
CLAIM DATE.
Set Logic: S ^DGBT(392,"AF",X2(1),X2(2),X2(3))=""
Kill Logic: K ^DGBT(392,"AF",X1(1),X1(2),X1(3))
X(1): Claim DATE/TIME (392,.01) (Subscr 1) (Len 5) (forwards)
Transform (Storage): S X=$E(X,1,5)
X(2): NAME (392,2) (Subscr 2) (Len 30) (forwards)
X(3): Claim DATE/TIME (392,.01) (Subscr 3) (Len 15) (forwards)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
DGBT CLAIM STATS JUN 16, 1993@11:28 USER #0 Claim Statistics
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):