STANDARD DATA DICTIONARY #392.2 -- BENEFICIARY TRAVEL CERTIFICATION FILE 3/24/25 PAGE 1
STORED IN ^DGBT(392.2, *** 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 income certification data for patients for Beneficiary Travel claims, including amount certified,
eligibility for for Bene. Travel, and means test status.
DD ACCESS: @
RD ACCESS: d
WR ACCESS: D
DEL ACCESS: D
LAYGO ACCESS: D
IDENTIFIED BY: NAME (#2)[R], ELIGIBLE (#3)[R]
POINTED TO BY: CERTIFICATION DATE field (#5) of the BENEFICIARY TRAVEL CLAIM File (#392)
CROSS
REFERENCED BY: DATE CERTIFIED(AENR01), DATE CERTIFIED(B), NAME(C), DATE CERTIFIED(IVM01), NAME(IVM2)
392.2,.01 DATE CERTIFIED 0;1 DATE (Required)
ANNUAL CERTIFICATION DATE
INPUT TRANSFORM: S %DT="ESXR" D ^%DT S X=Y K:Y<1 X I $D(X) S DINUM=9999999.99999-X
LAST EDITED: SEP 13, 2005
HELP-PROMPT: Enter the date of annual certification. Future dates are not allowed.
DESCRIPTION: This field contains the date of annual income certification used in the Beneficial Travel Claim
process.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 392.2^B
1)= S ^DGBT(392.2,"B",$E(X,1,30),DA)=""
2)= K ^DGBT(392.2,"B",$E(X,1,30),DA)
CROSS-REFERENCE: 392.2^IVM01^MUMPS
1)= D BT^IVMCUC(DA)
2)= D BT^IVMCUC(DA)
Used to log DCD defined events for nightly transmission to HEC.
CROSS-REFERENCE: 392.2^AENR01^MUMPS
1)= D E3922^DGRTRIG(DA)
2)= D E3922^DGRTRIG(DA)
3)= DO NOT DELETE
This cross-reference is used to notify HEC of changes that may affect enrollment.
392.2,2 NAME 0;2 POINTER TO PATIENT FILE (#2) (Required)
LAST EDITED: OCT 14, 1997
DESCRIPTION: This field points to the patient file and contains the IFN for the patient related to this
Beneficiary Travel certification date.
CROSS-REFERENCE: 392.2^C
1)= S ^DGBT(392.2,"C",$E(X,1,30),DA)=""
2)= K ^DGBT(392.2,"C",$E(X,1,30),DA)
CROSS-REFERENCE: 392.2^IVM2^MUMPS
1)= D BT^IVMCUC(DA)
2)= D BT^IVMCUC(DA)
Used to log DCD defined events for nightly transmission to HEC.
392.2,3 ELIGIBLE 0;3 SET (Required)
'0' FOR NO;
'1' FOR YES;
LAST EDITED: FEB 27, 1989
DESCRIPTION: This field is a set of codes (yes or no) indicating whether this person is eligible for Beneficiary
Travel.
392.2,4 AMOUNT CERTIFIED 0;4 NUMBER
ANNUAL INCOME
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>100000)!(X<0) X
HELP-PROMPT: Type a Dollar Amount between 0 and 100000, 2 Decimal Digits. Enter the patient's annual income for
the previous year.
DESCRIPTION:
This field is to be used to record the annual income reported by the patient.
392.2,5 EDITED BY 0;5 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: OCT 17, 1990
DESCRIPTION: This field is a pointer to the new person file and contains the IFN of the person who last edited
this Beneficiary Travel Certification date/time.
392.2,6 LAST EDITED 0;6 DATE
INPUT TRANSFORM: S %DT="ETX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JAN 14, 1989
DESCRIPTION:
This field contains the date this Beneficiary Travel Certification entry was last edited on.
392.2,11 ADDRESS LINE [1] A;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>35!($L(X)<3) X
LAST EDITED: MAR 02, 1989
HELP-PROMPT: ANSWER MUST BE 3-35 CHARACTERS IN LENGTH
DESCRIPTION: This field contains the first line of the address associated with this Beneficiary Travel
Certification date/time.
392.2,12 ADDRESS LINE [2] A;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAR 02, 1989
HELP-PROMPT: ANSWER MUST BE 3-30 CHARACTERS IN LENGTH
DESCRIPTION: This field contains the second line of the address associated with this Beneficiary Travel
Certification date/time.
392.2,13 ADDRESS LINE [3] A;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAR 02, 1989
HELP-PROMPT: ANSWER MUST BE 3-30 CHARACTERS IN LENGTH
DESCRIPTION: This field contains the third line of the address associated with this Beneficiary Travel
Certifiction date/time.
392.2,14 CITY A;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<2)!'(X'?1P.E) X I $D(X) D UP^DGBTHELP
LAST EDITED: OCT 30, 2001
HELP-PROMPT: ANSWER MUST BE 2-30 CHARACTERS IN LENGTH
DESCRIPTION: This field contains the free text 2-30 character name of the City associated with this Beneficiary
Travel Certification date/time.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
392.2,15 STATE A;5 POINTER TO STATE FILE (#5)
LAST EDITED: MAR 02, 1989
DESCRIPTION: This field points to the State File and contains the IFN of the State associated with this
Beneficiary Travel Certification date/time.
392.2,16 ZIP A;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<5) X I $D(X) D ZIPIN^VAFADDR
OUTPUT TRANSFORM: D ZIPOUT^VAFADDR
LAST EDITED: MAR 01, 1993
HELP-PROMPT: Answer must be 5 digit or 9 digit zip code.
DESCRIPTION: This field contains the 5-digit zip code associated with this Beneficiary Travel Certification
date/time.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
392.2,17 COUNTY CODE A;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<3)!'(X?3N) X
LAST EDITED: MAR 02, 1989
HELP-PROMPT: ANSWER MUST BE 3 NUMERIC CHARACTERS IN LENGTH
DESCRIPTION: This field contains three numeric characters in length for the County Code associated with this
Beneficiary Travel Certification date/time.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
392.2,18 MEANS TEST STATUS A;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: MAR 02, 1989
HELP-PROMPT: ANSWER MUST BE 1-2 CHARACTERS IN LENGTH
DESCRIPTION: This field contains the Means Test Status associated with this Beneficiary Travel Certification
date/time.
392.2,19 PRIMARY ELIGIBILITY A;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAR 02, 1989
HELP-PROMPT: ANSWER MUST BE 3-30 CHARACTERS IN LENGTH
DESCRIPTION: This field contains the primary eligibility associated with this Beneficiary Travel Certification
date/time.
FILES POINTED TO FIELDS
NEW PERSON (#200) EDITED BY (#5)
PATIENT (#2) NAME (#2)
STATE (#5) STATE (#15)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):