STANDARD DATA DICTIONARY #399 -- BILL/CLAIMS FILE 3/24/25 PAGE 1
STORED IN ^DGCR(399, *** 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 all of the information necessary to complete a Third Party billing form.
The entries in this file have matching entries in the Accounts Receivable file (430). The internal number in the AR file is the
same as the internal number in the BILL/CLAIMS file.
Per VHA Directive 10-93-142, this file definition should not be modified.
COMPILED CROSS-REFERENCE ROUTINE: IBXX
DD ACCESS: @
RD ACCESS: @
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
IDENTIFIED BY: PATIENT NAME (#.02)[R], EVENT DATE (#.03)[R], BILL CLASSIFICATION (#.05)[R], RATE TYPE (#.07)[R], STATUS (#.13)[R]
POINTED TO BY: THIRD PARTY BILL field (#.02) of the RCDPE FIRST PARTY CHARGE QUEUE File (#344.74)
FISCAL INTERMEDIARY CLAIM field (#.09) of the TRICARE PHARMACY TRANSACTIONS File (#351.5)
CLAIM field (#.01) of the CLAIMSMANAGER BILLS File (#351.9)
INITIAL BILL NUMBER field (#.11) of the CLAIMS TRACKING File (#356)
BILL NUMBER field (#.02) of the CLAIMS TRACKING/BILL File (#356.399)
BILL/CLAIMS field (#1.02) of the IB-FB INTERFACE TRACKING File (#360)
BILL NUMBER field (#.01) of the BILL STATUS MESSAGE File (#361)
BILL field (#.01) of the EXPLANATION OF BENEFITS File (#361.1)
ORIGINAL BILL NUMBER field (#.04) of the MOVE/COPY/REMOVE HISTORY sub-field (#361.1101) of the EXPLANATION OF
BENEFITS File (#361.1)
OTHER CLAIM NUMBERS field (#.01) of the OTHER CLAIM NUMBERS sub-field (#361.11016) of the MOVE/COPY/REMOVE HISTORY
sub-field (#361.1101) of the EXPLANATION OF BENEFITS File (#361.1)
BILL REFERENCE field (#.03) of the AR AMOUNTS DISTRIBUTION sub-field (#361.18) of the EXPLANATION OF BENEFITS File
(#361.1)
CLAIM field (#.01) of the EDI TEST CLAIM STATUS MESSAGE File (#361.4)
BILL NUMBER field (#.03) of the IB AUTOMATED BILLING COMMENTS File (#362.1)
BILL NUMBER field (#.02) of the IB BILL/CLAIMS DIAGNOSIS File (#362.3)
BILL NUMBER field (#.02) of the IB BILL/CLAIMS PRESCRIPTION REFILL File (#362.4)
BILL NUMBER field (#.02) of the IB BILL/CLAIMS PROSTHETICS File (#362.5)
BILL NUMBER field (#.01) of the EDI TRANSMIT BILL File (#364)
BILL field (#.301) of the EVENT sub-field (#366.141) of the IB NCPDP EVENT LOG File (#366.14)
PRIMARY BILL field (#7.02) of the EVENT sub-field (#366.141) of the IB NCPDP EVENT LOG File (#366.14)
PATIENT CONTROL NUMBER [D] field (#111.01) of the HEALTH CARE CLAIM RFAI (277) File (#368)
BILL COPIED FROM field (#.15) of the BILL/CLAIMS File (#399)
PRIMARY BILL field (#.17) of the BILL/CLAIMS File (#399)
BILL CLONED TO field (#29) of the BILL/CLAIMS File (#399)
BILL CLONED FROM field (#30) of the BILL/CLAIMS File (#399)
AUTO PROCESSED FROM CLAIM field (#34) of the BILL/CLAIMS File (#399)
PRIMARY BILL # field (#125) of the BILL/CLAIMS File (#399)
SECONDARY BILL # field (#126) of the BILL/CLAIMS File (#399)
TERTIARY BILL # field (#127) of the BILL/CLAIMS File (#399)
PRIMARY PAYER BILL field (#902.3) of the PATIENT INSURANCE MULTIPLE sub-field (#9002313.57902) of the BPS LOG OF
TRANSACTIONS File (#9002313.57)
PRIMARY PAYER BILL field (#902.3) of the PATIENT INSURANCE MULTIPLE sub-field (#9002313.59902) of the BPS
TRANSACTION File (#9002313.59)
PRIMARY PAYER BILL field (#1.09) of the BPS REQUESTS File (#9002313.77)
CROSS
REFERENCED BY: EVENT DATE(ABNDT), BILL CLASSIFICATION(ABT), PRIMARY BILL(AC), RATE TYPE(AD), STATUS DATE(AF), ECME NUMBER(AG),
FORM TYPE(AH), UB-04 BILL CLASSIFICATION(AI), PRIMARY INSURANCE POLICY(AI11), SECONDARY INSURANCE CARRIER(AI2),
SECONDARY INSURANCE POLICY(AI21), TERTIARY INSURANCE CARRIER(AI3), TERTIARY INSURANCE POLICY(AI31),
FORM TYPE(AJ), LAST ELECTRONIC EXTRACT DATE(ALEX), RESPONSIBLE INSTITUTION(AML),
WHO'S RESPONSIBLE FOR BILL?(AML1), BILL PAYER CARRIER(AML2), STATUS(AOP), OP VISITS DATE(S)(AOPV),
DATE FIRST PRINTED(AP), DATE ENTERED(APD), AUTHORIZATION DATE(APD3), STATEMENT COVERS FROM(APDS),
EVENT DATE(APDT), MRA REQUESTED DATE(APM), PTF ENTRY NUMBER(APTF), OP VISITS DATE(S)(AREV1),
STATEMENT COVERS FROM(AREV2), STATEMENT COVERS TO(AREV3), BILL PAYER CARRIER(AREV4),
RESPONSIBLE INSTITUTION(AREV5), WHO'S RESPONSIBLE FOR BILL?(AREV6), FORM TYPE(AREV7), PROCEDURE(ASC1),
DIVISION(ASC11), PROCEDURE(ASC2), DIVISION(ASC21), PROCEDURES(ASD), PROCEDURE DATE(ASD1), STATUS(AST),
BILL NUMBER(B), PATIENT NAME(C), AUTO PROCESS(CAP), EVENT DATE(D), PRIMARY HPID EDIT DATE/TIME(E),
SECONDARY HPID EDIT DATE/TIME(F), TERTIARY HPID EDIT DATE/TIME(G)
INDEXED BY: DEFAULT DIVISION & NON-VA FACILITY & BILL PAYER POLICY & FORM TYPE (ABP), DENTAL TREATMENT PLAN ENTRY (ADT), PRIMARY
INSURANCE CARRIER & SECONDARY INSURANCE CARRIER & TERTIARY INSURANCE CARRIER & PATIENT NAME (AE), FORM TYPE (AK),
FORM TYPE (AL), BILL CHARGE TYPE (AM), PRIMARY INSURANCE CARRIER & SECONDARY INSURANCE CARRIER & TERTIARY INSURANCE
CARRIER & SECONDARY INSURANCE POLICY & PRIMARY INSURANCE POLICY & TERTIARY INSURANCE POLICY (AUPDID)
LAST MODIFIED: OCT 25,2023@13:25:53
399,.01 BILL NUMBER 0;1 FREE TEXT
INPUT TRANSFORM: K:X[""""!($A(X)=45) X I $D(X) K:X'?.ANP X I $D(X) K:$E(X)=" " X I $D(X) K:$L(X)>10!($L(X)<7) X
LAST EDITED: JUL 14, 2010
HELP-PROMPT: Enter the unique bill number for this billing episode [7-10 characters].
DESCRIPTION: This is the unique bill number assigned to this billing episode. The bill numbers are determined
from entries in the AR BILL NUMBER file. New bill numbers consist of 7 characters (Example:
K000001). Bill numbers for bills that have been cancelled in Integrated Billing (IB) during the
process of correcting errors in the original bill, consist of 10 characters, the original bill plus
a hyphen and an incremental number (Example: K000001-01).
UNEDITABLE
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 399^B
1)= S ^DGCR(399,"B",$E(X,1,30),DA)=""
2)= K ^DGCR(399,"B",$E(X,1,30),DA)
CROSS-REFERENCE: ^^TRIGGER^399^1
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1)
,U,1)="" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y
S X=DIV N %I,%H,% D NOW^%DTC X ^DD(399,.01,1,3,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,1)=DIV,DIH=399,DIG=1 D ^DICR
2)= Q
CREATE CONDITION)= DATE ENTERED=""
CREATE VALUE)= TODAY
DELETE VALUE)= NO EFFECT
FIELD)= #1
CROSS-REFERENCE: ^^TRIGGER^399^2
1)= X ^DD(399,.01,1,4,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,2
),X=X S DIU=X K Y S X=DIV S X=$S(($D(DUZ)#2):DUZ,1:"") X ^DD(399,.01,1,4,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(
1),U,2),X=X S X=X=""
1.4)= S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,2)=DIV,DIH=399,DIG=2 D ^DICR
2)= Q
CREATE CONDITION)= INTERNAL(#2)=""
CREATE VALUE)= S X=$S(($D(DUZ)#2):DUZ,1:"")
DELETE VALUE)= NO EFFECT
FIELD)= #2
CROSS-REFERENCE: ^^TRIGGER^399^164
1)= X ^DD(399,.01,1,5,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,1
4),X=X S DIU=X K Y S X=DIV S X=$S($D(^IBE(350.9,1,1)):$P(^(1),U,6),1:"") X ^DD(399,.01,1,5,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(
1),U,14)=""
1.4)= S DIH=$G(^DGCR(399,DIV(0),"U")),DIV=X S $P(^("U"),U,14)=DIV,DIH=399,DIG=164 D ^DICR
2)= Q
CREATE CONDITION)= #164=""
CREATE VALUE)= S X=$S($D(^IBE(350.9,1,1)):$P(^(1),U,6),1:"")
DELETE VALUE)= NO EFFECT
FIELD)= #164
This will automatically store the default BC/BS PROVIDER # from the IB SITE PARAMETERS file into
the BC/BS PROVIDER # field for this bill.
CROSS-REFERENCE: ^^TRIGGER^399^.13
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,13),X=X S
DIU=X K Y S X=DIV S X=1 S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,13)=DIV,DIH=399,DIG=.13 D ^
DICR
2)= Q
CREATE VALUE)= S X=1
DELETE VALUE)= NO EFFECT
FIELD)= #.13
CROSS-REFERENCE: ^^TRIGGER^399^.19
1)= X ^DD(399,.01,1,7,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,19),X
=X S DIU=X K Y S X=DIV S X=3 S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,19)=DIV,DIH=399,DIG=.1
9 D ^DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($G(^IB
E(353,+$P(Y(1),U,19),0)),U)=""
2)= Q
3)= DO NOT DELETE
CREATE CONDITION)= FORM TYPE=""
CREATE VALUE)= S X=3
DELETE VALUE)= NO EFFECT
FIELD)= FORM TYPE
Sets the bill's form type to a 3 (UB) when the bill is created.
399,.02 PATIENT NAME 0;2 POINTER TO PATIENT FILE (#2) (Required)
LAST EDITED: FEB 12, 1997
HELP-PROMPT: Enter the name of the patient for whom this bill is being generated.
DESCRIPTION:
This is the name of the patient for whom this bill is being generated.
UNEDITABLE
CROSS-REFERENCE: 399^C
1)= S ^DGCR(399,"C",$E(X,1,30),DA)=""
2)= K ^DGCR(399,"C",$E(X,1,30),DA)
RECORD INDEXES: AE (#477)
399,.03 EVENT DATE 0;3 DATE (Required)
INPUT TRANSFORM: S %DT="ETP",%DT(0)="-0" D ^%DT S X=Y K:Y<1 X I $D(X),'$D(IBNWBL) W !?4,"Event date can no longer be
edited...cancel and submit a new bill if necessary." K X
LAST EDITED: FEB 20, 1992
HELP-PROMPT: Enter the date of admission for inpatient episodes of care. For outpatient visits, enter the date
of the initial outpatient visit.
DESCRIPTION: This is the date on which care was originated. For inpatient episodes of care, this is the
admission date. For outpatient visits, this is the date of the initial outpatient visit.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 399^D
1)= S ^DGCR(399,"D",$E(X,1,30),DA)=""
2)= K ^DGCR(399,"D",$E(X,1,30),DA)
CROSS-REFERENCE: 399^APDT^MUMPS
1)= S IBN=$P(^DGCR(399,DA,0),"^",2) S:$D(IBN) ^DGCR(399,"APDT",IBN,DA,9999999-X)="" K IBN
2)= S IBN=$P(^DGCR(399,DA,0),"^",2) I $D(IBN) K ^DGCR(399,"APDT",IBN,DA,9999999-X),IBN
Cross-reference of bills by patient and event date.
CROSS-REFERENCE: 399^ABNDT^MUMPS
1)= S ^DGCR(399,"ABNDT",DA,9999999-X)=""
2)= K ^DGCR(399,"ABNDT",DA,9999999-X)
Cross-reference of bills by inverse event date.
399,.04 LOCATION OF CARE 0;4 SET (Required)
TYPE OF BILL (1ST DIGIT)
'1' FOR HOSPITAL (INCLUDES CLINIC) - INPT. OR OPT.;
'2' FOR SKILLED NURSING (NHCU);
'7' FOR CLINIC (WHEN INDEPENDENT OR SATELLITE);
LAST EDITED: JAN 16, 2007
HELP-PROMPT: Enter the code which identifies the type of facility at which care was administered.
DESCRIPTION:
This identifies the type of facility at which care was administered.
CROSS-REFERENCE: ^^TRIGGER^399^.24
1)= X ^DD(399,.04,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,24),X
=X S DIU=X K Y S X=DIV S X=DIV,X=X S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,24)=DIV,DIH=399,
DIG=.24 D ^DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(399,.24,0)),U,3),Y(1)=$S($D(^D
GCR(399,D0,0)):^(0),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,24)_":",2),$C(59))=""
2)= Q
3)= Do Not Delete
CREATE CONDITION)= UB-04 LOCATION OF CARE=""
CREATE VALUE)= INTERNAL(LOCATION OF CARE)
DELETE VALUE)= NO EFFECT
FIELD)= UB-04 LOCATION OF CARE
This trigger forces the same initial value into the UB-04 LOCATION OF CARE field as the
system-calculated LOCATION OF CARE field.
399,.05 BILL CLASSIFICATION 0;5 SET (Required)
TYPE OF BILL (2ND DIGIT)
'1' FOR INPATIENT (MEDICARE PART A);
'2' FOR HUMANITARIAN EMERGENCY (INPT./MEDICARE PART B);
'3' FOR OUTPATIENT;
'4' FOR HUMANITARIAN EMERGENCY (OPT./ESRD);
LAST EDITED: JUL 28, 2011
HELP-PROMPT: Enter the code which designates inpatient or outpatient care.
DESCRIPTION:
This code identifies the care being billed for as inpatient or outpatient.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 399^ABT
1)= S ^DGCR(399,"ABT",$E(X,1,30),DA)=""
2)= K ^DGCR(399,"ABT",$E(X,1,30),DA)
CROSS-REFERENCE: ^^TRIGGER^399^.25
1)= X ^DD(399,.05,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,25),X
=X S DIU=X K Y S X=DIV S X=$$TRIG05^IBCU4(X,D0) S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,25)
=DIV,DIH=399,DIG=.25 D ^DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($G(^DG
CR(399.1,+$P(Y(1),U,25),0)),U)=""
2)= Q
CREATE CONDITION)= UB-04 BILL CLASSIFICATION=""
CREATE VALUE)= S X=$$TRIG05^IBCU4(X,D0)
DELETE VALUE)= NO EFFECT
FIELD)= UB-04 BILL CLASSIFICATION
CROSS-REFERENCE: ^^TRIGGER^399^158
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(399,.05,1,3,69.3) S Y(7)=$G(X) S X=Y(0),X=X S X=X=
3,Y=X,X=Y(6),X=X&Y I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,8),X=X S
DIU=X K Y S X=DIV S X=3 X ^DD(399,.05,1,3,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"U")),DIV=X S $P(^("U"),U,8)=DIV,DIH=399,DIG=158 D ^DICR
2)= Q
69.2)= S Y(2)=$C(59)_$P($G(^DD(399,158,0)),U,3),Y(5)=$S($D(^DGCR(399,D0,0)):^(0),1:""),Y(1)=$S($D(^
DGCR(399,D0,"U")):^("U"),1:"")
69.3)= X ^DD(399,.05,1,3,69.2) S X=$P($P(Y(2),$C(59)_$P(Y(1),U,8)_":",2),$C(59))="",Y(3)=$G(X),Y(4)
=$G(X) S X=$P(Y(5),U,27),X=X S X=X=1,Y=X,X=Y(3),X=X&Y,Y(6)=$G(X)
CREATE CONDITION)= (#158="")&(INTERNAL(#.27)=1)&(INTERNAL(#.05)=3)
CREATE VALUE)= S X=3
DELETE VALUE)= NO EFFECT
FIELD)= TYPE OF ADMISSION
This trigger is designed to set the TYPE OF ADMISSION to "3 for ELECTIVE", if it is empty, when the
BILL CHARGE TYPE field is equal to "1 for INSTITUTIONAL" and the BILL CLASSIFICATION field is equal
to "3 for OUTPATIENT".
399,.06 TIMEFRAME OF BILL 0;6 SET (Required)
TYPE OF BILL (3RD DIGIT)
'1' FOR ADMIT THRU DISCHARGE;
'2' FOR INTERIM - FIRST CLAIM;
'3' FOR INTERIM - CONTINUING CLAIM;
'4' FOR INTERIM - LAST CLAIM;
'5' FOR LATE CHARGES ONLY;
'6' FOR ADJUSTMENT PRIOR CLAIM;
'7' FOR REPLACEMENT PRIOR CLAIM;
'8' FOR VOID/CANCEL PRIOR CLAIM;
'0' FOR NON-PAY/ZERO CLAIM;
LAST EDITED: JUN 27, 2017
HELP-PROMPT: Enter the code which defines the frequency of this bill.
DESCRIPTION:
This code defines the frequency of this bill.
NOTES: TRIGGERED by the UB-04 TIMEFRAME OF BILL field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^.26
1)= X ^DD(399,.06,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,26),X
=X S DIU=X K Y S X=DIV S X=DIV,X=X S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,26)=DIV,DIH=399,
DIG=.26 D ^DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$P($G(^DD(399,.26,0)),U,3),Y(1)=$S($D(^D
GCR(399,D0,0)):^(0),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,26)_":",2),$C(59))=""
2)= Q
3)= Do not delete
CREATE CONDITION)= UB-04 TIMEFRAME OF BILL=""
CREATE VALUE)= INTERNAL(TIMEFRAME OF BILL)
DELETE VALUE)= NO EFFECT
FIELD)= UB-04 TIMEFRAME OF BILL
This trigger forces the same initial value into the UB-04 TIMEFRAME OF BILL field as the
system-calculated TIMEFRAME OF BILL field.
399,.07 RATE TYPE 0;7 POINTER TO RATE TYPE FILE (#399.3) (Required)
INPUT TRANSFORM: S DIC("S")="I '$P(^(0),U,3)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JUN 14, 2004
HELP-PROMPT: Enter the code which identifies the type of bill.
DESCRIPTION:
This identifies the type of bill.
SCREEN: S DIC("S")="I '$P(^(0),U,3)"
EXPLANATION: to screen out Inactive Rate Types
CROSS-REFERENCE: ^^TRIGGER^399^156
1)= X ^DD(399,.07,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,6
),X=X S DIU=X K Y S X=DIV S X=1 X ^DD(399,.07,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(399,.07,1,1,69.2) S X=$P($P(Y(102),$C(59)_$P(Y(1
01),U,5)_":",2),$C(59),1)["YES" S D0=I(0,0)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U")):^("U"),1:""),DIV=X S $P(^("U"),U,6)=DIV,DIH=399,DIG=156 D
^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= X ^DD(399,.07,1,1,2.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,6
),X=X S DIU=X K Y S X=DIV S X=0 X ^DD(399,.07,1,1,2.4)
2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(399,.07,1,1,79.2) S Y(101)=$S($D(^DGCR(399.3,D0,
0)):^(0),1:"") S X=$P($P(Y(102),$C(59)_$P(Y(101),U,5)_":",2),$C(59),1)'["YES" S D0=I(0,0)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U")):^("U"),1:""),DIV=X S $P(^("U"),U,6)=DIV,DIH=399,DIG=156 D
^DICR:$O(^DD(DIH,DIG,1,0))>0
69.2)= S I(0,0)=$S($D(D0):D0,1:""),D0=Y(0) S:'$D(^DGCR(399.3,+D0,0)) D0=-1 S Y(102)=$C(59)_$S($D(^D
D(399.3,.05,0)):$P(^(0),U,3),1:""),Y(101)=$S($D(^DGCR(399.3,D0,0)):^(0),1:"")
79.2)= S I(0,0)=$S($D(D0):D0,1:""),Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:""),D0=$P(Y(1),U,7) S:'$D(^DG
CR(399.3,+D0,0)) D0=-1 S Y(102)=$C(59)_$S($D(^DD(399.3,.05,0)):$P(^(0),U,3),1:"")
CREATE CONDITION)= RATE TYPE:IS THIS A THIRD PARTY BILL?["YES"
CREATE VALUE)= S X=1
DELETE CONDITION)= RATE TYPE:IS THIS A THIRD PARTY BILL?'["YES"
DELETE VALUE)= S X=0
FIELD)= ASSIGNMENT OF BENEFITS
CROSS-REFERENCE: ^^TRIGGER^399^.11
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,11),X=X S
DIU=X K Y S X=DIV S X=$P(^DGCR(399.3,$P(^DGCR(399,DA,0),U,7),0),U,7) X ^DD(399,.07,1,2,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,11)=DIV,DIH=399,DIG=.11 D ^DICR
2)= Q
CREATE VALUE)= S X=$P(^DGCR(399.3,$P(^DGCR(399,DA,0),U,7),0),U,7)
DELETE VALUE)= NO EFFECT
FIELD)= WHO'S RESPONSIBLE
CROSS-REFERENCE: 399^AD
1)= S ^DGCR(399,"AD",$E(X,1,30),DA)=""
2)= K ^DGCR(399,"AD",$E(X,1,30),DA)
399,.08 PTF ENTRY NUMBER 0;8 POINTER TO PTF FILE (#45) (Required)
INPUT TRANSFORM: D PTF^IBCU S DIC(0)="MN",DIC="^DGPT(",DIC("S")="I $D(IBDD1(+Y))" D ^DIC:X K DIC,IBDD1 S:$D(DIE) DIC
=DIE S X=+Y K:Y<0 X
LAST EDITED: SEP 02, 2008
HELP-PROMPT: ENTER A PTF RECORD BELONGING TO THIS PATIENT ONLY!
DESCRIPTION:
This identifies PTF records belonging to this patient only.
SCREEN: S DIC("S")="I $D(IBDD1(+Y))"
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^399^159
1)= X ^DD(399,.08,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,9
),X=X S DIU=X K Y S X=DIV S X=2 X ^DD(399,.08,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$S($D(^DD(399,159,0)):$P(^(0),U,3),1:"")
,Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,9)_":",2),$C(59),1)=""
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U")):^("U"),1:""),DIV=X S $P(^("U"),U,9)=DIV,DIH=399,DIG=159 D
^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= #159=""
CREATE VALUE)= S X=2
DELETE VALUE)= NO EFFECT
FIELD)= #159
CROSS-REFERENCE: ^^TRIGGER^399^158
1)= X ^DD(399,.08,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,8
),X=X S DIU=X K Y S X=DIV S X=2 X ^DD(399,.08,1,2,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$S($D(^DD(399,158,0)):$P(^(0),U,3),1:"")
,Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,8)_":",2),$C(59),1)=""
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U")):^("U"),1:""),DIV=X S $P(^("U"),U,8)=DIV,DIH=399,DIG=158 D
^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= #158=""
CREATE VALUE)= S X=2
DELETE VALUE)= NO EFFECT
FIELD)= #158
CROSS-REFERENCE: ^^TRIGGER^399^162
1)= X ^DD(399,.08,1,4,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,1
2),X=X S DIU=X K Y S X=DIV D DIS^IBCU S X=X X ^DD(399,.08,1,4,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$S('$
D(^DGCR(399.1,+$P(Y(1),U,12),0)):"",1:$P(^(0),U,1))=""
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U")):^("U"),1:""),DIV=X S $P(^("U"),U,12)=DIV,DIH=399,DIG=162 D
^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,12),X=
X S DIU=X K Y S X="" X ^DD(399,.08,1,4,2.4)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U")):^("U"),1:""),DIV=X S $P(^("U"),U,12)=DIV,DIH=399,DIG=162 D
^DICR:$O(^DD(DIH,DIG,1,0))>0
CREATE CONDITION)= #162=""
CREATE VALUE)= D DIS^IBCU S X=X
DELETE VALUE)= @
FIELD)= #162
This sets the discharge status to the correct entry based upon the Disposition Field type in the
PTF record.
CROSS-REFERENCE: 399^APTF
1)= S ^DGCR(399,"APTF",$E(X,1,30),DA)=""
2)= K ^DGCR(399,"APTF",$E(X,1,30),DA)
Cross reference of all PTF records with associated bills. To be used by PTF purge utilities.
CROSS-REFERENCE: ^^TRIGGER^399^165
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X I $P(^DGCR(399,DA,0),U,5)<3 I X S X=DIV S Y(1)=$S($D(^DG
CR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y S X=DIV S X=+$$LOS1^IBCU64(DA) X ^DD
(399,.08,1,6,1.4)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U")):^("U"),1:""),DIV=X S $P(^("U"),U,15)=DIV,DIH=399,DIG=165 D
^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= I $P(^DGCR(399,DA,0),U,5)<3
CREATE VALUE)= S X=+$$LOS1^IBCU64(DA)
DELETE VALUE)= NO EFFECT
FIELD)= LENGTH OF STAY
Sets Length of Stay based on PTF record and date range of bill. Inpatients only.
CROSS-REFERENCE: ^^TRIGGER^399^170
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$PPSC^IBCU64(DA) I X S X=DIV S Y(1)=$S($D(^DGCR(399
,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y S X=DIV S X=$$PPS^IBCU64(DA,X) X ^DD(399
,.08,1,7,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"U1")),DIV=X S $P(^("U1"),U,15)=DIV,DIH=399,DIG=170 D ^DICR
2)= Q
CREATE CONDITION)= S X=$$PPSC^IBCU64(DA)
CREATE VALUE)= S X=$$PPS^IBCU64(DA,X)
DELETE VALUE)= NO EFFECT
FIELD)= PPS
This trigger will create a default PPS (DRG) value into the claim. The trigger condition ensures
that the PPS field is currently blank and that the claim is an inpatient, UB type claim.
399,.09 PROCEDURE CODING METHOD 0;9 SET
'4' FOR CPT-4;
'5' FOR HCPCS (HCFA COMMON PROCEDURE CODING SYSTEM);
'9' FOR ICD;
INPUT TRANSFORM: S:X=4 X=5
LAST EDITED: JAN 28, 2014
HELP-PROMPT: Enter the code which identifies the method for procedure coding on this bill.
DESCRIPTION: This defines the outpatient procedure coding method utilized on this bill. If you select CPT-4, it
will be changed to HCPCS automatically.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the FORM TYPE field of the BILL/CLAIMS File
399,.11 WHO'S RESPONSIBLE FOR BILL? 0;11 SET (Required)
'p' FOR PATIENT;
'i' FOR INSURER;
'o' FOR OTHER;
LAST EDITED: SEP 24, 1997
HELP-PROMPT: Enter the code which identifies the party responsible for payment of this bill.
DESCRIPTION:
This identifies the party responsible for payment of this bill.
UNEDITABLE
NOTES: TRIGGERED by the RATE TYPE field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^112
1)= X ^DD(399,.11,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"M")):^("M"),1:"") S X=$P(Y(1),U,1
2),X=X S DIU=X K Y S X=DIV D EN1^IBCU5 X ^DD(399,.11,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=(X="i"&($S('$D(^DGCR(399,DA,"M")):1,'+^("M"):1,'$D
(^DIC(36,+^("M"),0)):1,1:0)))
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"M")):^("M"),1:""),DIV=X S $P(^("M"),U,12)=DIV,DIH=399,DIG=112 D
^DICR
2)= Q
CREATE CONDITION)= S X=(X="i"&($S('$D(^DGCR(399,DA,"M")):1,'+^("M"):1,'$D(^DIC(36,+^("M"),0)):1,1:0
)))
CREATE VALUE)= D EN1^IBCU5
DELETE VALUE)= NO EFFECT
FIELD)= #112
CROSS-REFERENCE: 399^AML1^MUMPS
1)= D EN^IBCU5
2)= D DEL^IBCU5
Loads/deletes the mailing address.
CROSS-REFERENCE: 399^AREV6^MUMPS
1)= S DGRVRCAL=1
2)= S DGRVRCAL=2
Variable causes revenue codes and charges to be re-calculated on return to the enter/edit billing
screens.
CROSS-REFERENCE: ^^TRIGGER^399^.21
1)= X ^DD(399,.11,1,4,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,21),X
=X S DIU=X K Y X ^DD(399,.11,1,4,1.1) X ^DD(399,.11,1,4,1.4)
1.1)= S X=DIV S X=DIV,X=X S X=X="i",Y(1)=X S X="P",Y(2)=X,Y(3)=X S X=DIV,X=X S X=X="p",Y(4)=X S X="
A",Y(5)=X S X=1,Y(6)=X S X="",X=$S(Y(1):Y(2),Y(4):Y(5),Y(6):X)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$S($D(^DD(399,.21,0)):$P(^(0),U,3),1:"")
,Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,21)_":",2),$C(59),1)=""
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,21)=DIV,DIH=399,DIG=.21 D ^DICR
:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$S($P(^DGCR(399,DA,0),U,11)'="i":1,"PST"'[$P(^DGCR(3
99,DA,0),U,21):1,1:0) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,21),X=X S
DIU=X K Y S X="" X ^DD(399,.11,1,4,2.4)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,21)=DIV,DIH=399,DIG=.21 D ^DICR
:$O(^DD(DIH,DIG,1,0))>0
CREATE CONDITION)= CURRENT BILL PAYER SEQUENCE=""
CREATE VALUE)= $S(INTERNAL(WHO'S RESPONSIBLE)="i":"P",INTERNAL(WHO'S RESPONSIBLE)="p":"A",1:"")
DELETE CONDITION)= S X=$S($P(^DGCR(399,DA,0),U,11)'="i":1,"PST"'[$P(^DGCR(399,DA,0),U,21):1,1:0)
DELETE VALUE)= @
FIELD)= CURRENT BILL PAYER SEQUENCE
If the Payer Sequence has not been set then set it based on Who's Responsible. When Who's
responsible is changed/deleted then update the Payer Sequence if insurer is not reponsible or the
payer sequence is not a valid sequence for an insurer.
399,.13 STATUS 0;13 SET (Required)
'0' FOR CLOSED;
'1' FOR ENTERED/NOT REVIEWED;
'2' FOR REQUEST MRA;
'3' FOR AUTHORIZED;
'4' FOR PRNT/TX;
'5' FOR **NOT USED**;
'7' FOR CANCELLED;
LAST EDITED: MAY 30, 2000
HELP-PROMPT: Enter the code which defines whether or not billing record is editable.
DESCRIPTION: This identifies the status of this billing record. That is, whether or not this record is open for
editing. Current valid statuses are: 1=ENTERED/NOT REVIEWED, 2=REQUEST MRA, 3=AUTHORIZED,
4=PRNT/TX, 7=CANCELLED, 0=CLOSED Note that 5:TRANSMITTED is not currently valid Only ENTERED/NOT
REVIEWED bills are editable.
NOTES: TRIGGERED by the BILL NUMBER field of the BILL/CLAIMS File
TRIGGERED by the DATE LAST PRINTED field of the BILL/CLAIMS File
TRIGGERED by the DATE BILL CANCELLED field of the BILL/CLAIMS File
TRIGGERED by the REQUEST AN MRA? field of the BILL/CLAIMS File
TRIGGERED by the AUTHORIZE BILL GENERATION? field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^.14
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,14),X=X S
DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC X ^DD(399,.13,1,1,1.4)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,14)=DIV,DIH=399,DIG=.14 D ^DICR
:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE VALUE)= TODAY
DELETE VALUE)= NO EFFECT
FIELD)= #.14
CROSS-REFERENCE: 399^AOP^MUMPS
1)= I X>0,X<3,$P(^DGCR(399,DA,0),U,2) S ^DGCR(399,"AOP",$P(^(0),U,2),DA)=""
2)= I $P(^DGCR(399,DA,0),U,2) K ^DGCR(399,"AOP",$P(^(0),U,2),DA)
CROSS-REFERENCE: 399^AST^MUMPS
1)= I +X=3 S ^DGCR(399,"AST",+X,DA)=""
2)= K ^DGCR(399,"AST",+X,DA)
Cross reference of all Authorized bills.
CROSS-REFERENCE: ^^TRIGGER^399^24
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=Y(0),X=X S X=X=2 I X S X=DIV S Y(1)=$S($D(^DGCR(399,
D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X=DIV S X="1N" X ^DD(399,.13,1,4,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,5)=DIV,DIH=399,DIG=24 D ^DICR
2)= X ^DD(399,.13,1,4,2.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U
,5),X=X S DIU=X K Y S X=DIV S X="0" S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,5)=DIV,DI
H=399,DIG=24 D ^DICR
2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(399,.13,1,4,79.2) S Y=X,X=Y(2),X=X!Y,Y(4)=X,Y(5)
=X S X=$P(Y(6),U,5),X=X S X=X,Y=X,X=Y(4),X=X&Y
3)= DO NOT DELETE
79.2)= S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:""),Y(6)=$S($D(^("TX")):^("TX"),1:"") S X=$P(Y(1),U,13)
,X=X S X=X=1,Y(2)=X,Y(3)=X S X=$P(Y(1),U,13),X=X S X=X=7
CREATE CONDITION)= INTERNAL(STATUS)=2
CREATE VALUE)= "1N"
DELETE CONDITION)= (INTERNAL(STATUS)=1!(INTERNAL(STATUS)=7))&(INTERNAL(CLAIM MRA STATUS))
DELETE VALUE)= "0"
FIELD)= CLAIM MRA STATUS
This trigger forces the CLAIM MRA STATUS field to be set to '1N' (MRA NEEDED/NOT YET REQUESTED)
whenever the STATUS of the claim is set to 2 (REQUEST MRA). If the STATUS of the claim is changed
to 1 (ENTERED/NOT REVIEWED) or 7 (CANCELLED) and the MRA CLAIM STATUS is currently '1N' or '1R',the
MRA CLAIM STATUS field is set to 0 (NO MRA NEEDED).
399,.14 STATUS DATE 0;14 DATE (Required)
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:Y<1 X
LAST EDITED: AUG 26, 2003
HELP-PROMPT: Enter the date of last status change.
DESCRIPTION:
This is the date of the last status change.
NOTES: TRIGGERED by the STATUS field of the BILL/CLAIMS File
CROSS-REFERENCE: 399^AF^MUMPS
1)= D BC^IBJVDEQ
2)= Q
This cross-reference sets the record into the nightly Data Extract queue if it meets the criteria.
399,.15 BILL COPIED FROM 0;15 POINTER TO BILL/CLAIMS FILE (#399)
INPUT TRANSFORM: S DIC("S")="I $P(^(0),U,13)=7" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JAN 26, 1990
HELP-PROMPT: Enter the bill that this bill was copied from.
DESCRIPTION: If this bill was copied from another bill, then this will be the bill it was copied from. This
field is automatically completed by the Copy and Cancel option.
SCREEN: S DIC("S")="I $P(^(0),U,13)=7"
EXPLANATION: BILL MUST BE CANCELLED TO COPY
399,.16 NON-VA DISCHARGE DATE 0;16 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: APR 20, 1990
HELP-PROMPT: Enter the discharge date for this admission. It must be since the admission date and not in the
future.
DESCRIPTION: This is the discharge date for NON-VA Admissions when no associated PTF record exists. The date
entered must be after the admission date and not into the future.
399,.17 PRIMARY BILL 0;17 POINTER TO BILL/CLAIMS FILE (#399)
LAST EDITED: MAY 24, 1990
DESCRIPTION: This is the initial bill that this episode is associated with. If an episode of care has more than
one bill but multiple event dates, then this field can be used.
CROSS-REFERENCE: 399^AC
1)= S ^DGCR(399,"AC",$E(X,1,30),DA)=""
2)= K ^DGCR(399,"AC",$E(X,1,30),DA)
399,.18 SC AT TIME OF CARE 0;18 FREE TEXT
INPUT TRANSFORM: I $D(X) D YN^IBCU
OUTPUT TRANSFORM: S Y=$S(Y:"YES",Y=0:"NO",1:"")
LAST EDITED: SEP 13, 1991
HELP-PROMPT: Was this patient Service Connected for any condition during the timeframe of this bill? Answer
'Yes' or 'No'.
DESCRIPTION: Was this patient Service Connected for any condition at the time the care in the bill was rendered.
This field is used to correctly assign Accounts Receivable AMIS segments to this bill if it is a
Reimbursable Insurance bill. Answer 'Yes' or 'No'.
The default for this field is the current value in the SC PATIENT field of the patient file. If
this field is left blank, the default value will be used to determine the AMIS segment.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,.19 FORM TYPE 0;19 POINTER TO BILL FORM TYPE FILE (#353) (Required)
INPUT TRANSFORM: S DIC("S")="I $$FTINPUT^IBCU9(Y)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: NOV 15, 2017
HELP-PROMPT: Enter the type of claim form to be used.
DESCRIPTION:
Select the form type on which to print the bill.
TECHNICAL DESCR:
Critical that this field either be a 2, 3, or a 7.
SCREEN: S DIC("S")="I $$FTINPUT^IBCU9(Y)"
EXPLANATION: Must be a printable national form type.
NOTES: TRIGGERED by the BILL NUMBER field of the BILL/CLAIMS File
TRIGGERED by the BILL CHARGE TYPE field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^.09
1)= X ^DD(399,.19,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,9),X=
X S DIU=X K Y S X=DIV S X=5 S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,9)=DIV,DIH=399,DIG=.09
D ^DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(399,.19,1,1,69.2) S X=$P($P(Y(3),$C(59)_$P(Y(2),
U,9)_":",2),$C(59))="",Y=X,X=Y(1),X=X&Y
2)= Q
69.2)= S Y(3)=$C(59)_$P($G(^DD(399,.09,0)),U,3),Y(2)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($G(^I
BE(353,+Y(0),0)),U)="CMS-1500",Y(1)=$G(X)
CREATE CONDITION)= FORM TYPE="CMS-1500"&(PROCEDURE CODING METHOD="")
CREATE VALUE)= S X=5
DELETE VALUE)= NO EFFECT
FIELD)= PROCEDURE CODING METHOD
If the CMS-1500 claim form is used and no coding method defined, then set coding method to HCPCS
CROSS-REFERENCE: 399^AREV7^MUMPS
1)= S DGRVRCAL=1
2)= S DGRVRCAL=2
3)= DO NOT DELETE
Variable causes revenue codes and chrges to be re-calculated on return to the enter/edit billing
screens.
CROSS-REFERENCE: 399^AH^MUMPS
1)= D ALLID^IBCEP3(DA,.19,1)
2)= D ALLID^IBCEP3(DA,.19,2)
3)= Do not delete
This cross reference determines if the change of form type requires the provider id's to be updated
or deleted. If it does, the update/deletion is performed for the claim.
CROSS-REFERENCE: ^^TRIGGER^399^140
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,1),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,1)=DIV,DIH=399,DIG=140
D ^DICR
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= PRIMARY PAYER-ALT ID TYPE
This trigger removes PRIMARY PAYER-ALT ID TYPE when Form Type is changed since ID Type is dependent
on FORM TYPE.
CROSS-REFERENCE: 399^AJ^MUMPS
1)= D ATTREND^IBCU1(DA,"","")
2)= D ATTREND^IBCU1(DA,"","")
3)= Do Not Delete
This Mumps cross reference is used to potentially trigger 6 other fields in file 399. The fields
are triggered when the insurance companies in the claim have flags set to use the attending or
rendering physicians as the billing provider secondary IDs. The flags in file 36 are field #4.06
(ATT/REND ID BILL SEC ID PROF) and field 4.08 (ATT/REND ID BILL SEC ID INST).
The following fields are the ones being "triggered": #122 PRIMARY PROVIDER # #123 SECONDARY
PROVIDER # #124 TERTIARY PROVIDER # #128 PRIMARY ID QUALIFER #129 SECONDARY ID QUALIFIER #130
TERTIARY ID QUALIFIER
CROSS-REFERENCE: ^^TRIGGER^399^141
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,2),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,2)=DIV,DIH=399,DIG=141
D ^DICR
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= PRIMARY PAYER-ALT ID
This trigger removes PRIMARY PAYER-ALT ID when Form Type is changed since ID is dependent on FORM
TYPE.
CROSS-REFERENCE: ^^TRIGGER^399^142
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,3),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,3)=DIV,DIH=399,DIG=142
D ^DICR
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= SECONDARY PAYER-ALT ID TYPE
This trigger removes SECONDARY PAYER-ALT ID TYPE when Form Type is changed since ID Type is
dependent on FORM TYPE.
CROSS-REFERENCE: ^^TRIGGER^399^143
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,4),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,4)=DIV,DIH=399,DIG=143
D ^DICR
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= SECONDARY PAYER-ALT ID
This trigger removes SECONDARY PAYER-ALT ID when Form Type is changed since ID is dependent on FORM
TYPE.
CROSS-REFERENCE: ^^TRIGGER^399^144
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,5),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,5)=DIV,DIH=399,DIG=144
D ^DICR
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= TERTIARY PAYER-ALT ID TYPE
This trigger removes TERTIARY PAYER-ALT ID TYPE when Form Type is changed since ID Type is
dependent on FORM TYPE.
CROSS-REFERENCE: ^^TRIGGER^399^145
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,6),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,6)=DIV,DIH=399,DIG=145
D ^DICR
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= TERTIARY PAYER-ALT ID
This trigger removes TERTIARY PAYER-ALT ID when Form Type is changed since ID is dependent on FORM
TYPE.
FIELD INDEX: AK (#984) MUMPS IR ACTION
Short Descr: Update the line level providers for claim FORM TYPE change.
Description: For Patch IB*2.0*432:
The patch introduces line providers to the Bill/Claims process. Line providers (Sub-file 399.0404)
are based on the claim FORM TYPE. So, when there is a change in claim FORM TYPE, then we want to
update the line level providers to be in agreement with the claim FORM TYPE (see below for FORM
TYPE and allowable line provider types). In the case when the FORM TYPE field is changed, then the
line provider types are checked to see if any, or all, line providers need to be deleted from the
claim.
Logic:
(1) IF $$LNPRVFT^IBCEU7(X,.IBLNPRV) is TRUE, then we have line providers
in the IBLNPRV array to be deleted.
Note: IBLNPRV array holds the procedure IENs (Sub-file 399.0304), and
line provider IENs and .01 field (Sub-file 399.0404,.01) equal to the
delete indicator "@" in FDA format
(FDA_ROOT(FILE#,"IENS",FIELD#)="VALUE".
(2) IF (1) TRUE, then we call FILE^DIE("E","IBLNPRV") to delete the line level providers in the
IBLNPRV array.
Allowable line provider types by FORM TYPE:
Allowable line provider functions for UB04 (FORM TYPE = 3)
Inpatient and UB04 Outpatient:
- Rendering Provider(VAL=3).
- Referring Provider(VAL=1).
- Operating Physician(VAL=2).
- Other Operating Physician(VAL=9).
Allowable line provider functions for CMS 1500 (FORM TYPE = 2)
Inpatient and CMS 1500 Outpatient:
- Rendering Provider(VAL=3).
- Referring Provider(VAL=1).
- Supervising Provider(VAL=5).
Set Logic: N IBLNPRV I $$LNPRVFT^IBCEU7(X,.IBLNPRV) D FILE^DIE("E","IBLNPRV") Q
Kill Logic: Q
X(1): FORM TYPE (399,.19) (Len 20) (forwards)
FIELD INDEX: AL (#985) MUMPS IR ACTION
Short Descr: Remove line level info from inpatient UBs.
Description: For Patch IB*2.0*432:
The patch introduces line providers and line level attachment information to the Bill/Claims
process. Billers are prevented from entering this information for inpatient UBs. However, if the
biller entered the information before changing the FORM TYPE to UB, the data may exist and needs to
be cleaned up. The clean up routine removes following line level attachment information from the
PROCEDURES sub-file (#399.0304): (#70) ATTACHMENT CONTROL NUMBER, (#71) ATTACHMENT REPORT TYPE and
(#72) ATTACHMENT REPORT TRANS CODE. It also removes all line level provider information in the LINE
PROVIDER sub-file (#399.0404).
Set Logic: D REMOVE^IBCEU7(DA,X(1))
Set Cond: S X=X(1)=3
Kill Logic: Q
X(1): FORM TYPE (399,.19) (Len 20) (forwards)
RECORD INDEXES: ABP (#820)
399,.2 AUTO 0;20 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: AUG 24, 1995
HELP-PROMPT: True if this bill was created by the auto biller.
DESCRIPTION: True if this bill was created by the auto biller. Should only be set by the auto biller software,
no manual entry.
CROSS-REFERENCE: ^^TRIGGER^399^2
1)= X ^DD(399,.2,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,2)
,X=X S DIU=X K Y S X=DIV S X=.5 X ^DD(399,.2,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$C(59)_$S($D(^DD(399,.2,0)):$P(^(0),U,3),1:"")
S X=$P($P(Y(1),$C(59)_Y(0)_":",2),$C(59),1)="YES"
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"S")):^("S"),1:""),DIV=X S $P(^("S"),U,2)=DIV,DIH=399,DIG=2 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= AUTO="YES"
CREATE VALUE)= S X=.5
DELETE VALUE)= NO EFFECT
FIELD)= ENTERED/EDITED BY
399,.21 CURRENT BILL PAYER SEQUENCE 0;21 SET
'P' FOR PRIMARY INSURANCE;
'S' FOR SECONDARY INSURANCE;
'T' FOR TERTIARY INSURANCE;
'A' FOR PATIENT;
LAST EDITED: APR 18, 2017
HELP-PROMPT: Enter the entity currently responsible for paying this bill.
DESCRIPTION:
This field determines the entity currently responsible for paying this bill.
SCREEN: S DIC("S")="I $S(X=""P"":$D(^DGCR(399,DA,""I1"")),X=""S"":$D(^DGCR(399,DA,""I2"")),X=""T"":$D(^DGCR
(399,DA,""I3"")),1:1)"
EXPLANATION: Primary/Secondary/Tertiary must have corresponding insurance co on bill.
NOTES: TRIGGERED by the WHO'S RESPONSIBLE FOR BILL? field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^136
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,2),X
=X S DIU=X K Y S X=DIV S X=$$BPP^IBCNS2(DA) X ^DD(399,.21,1,1,1.4)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,2)=DIV,DIH=399,DIG=136
D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,2),X
=X S DIU=X K Y S X="" X ^DD(399,.21,1,1,2.4)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,2)=DIV,DIH=399,DIG=136
D ^DICR
CREATE VALUE)= S X=$$BPP^IBCNS2(DA)
DELETE VALUE)= @
FIELD)= BILL PAYER POLICY
Set the Bill Payer Policy to the Payer Policy corresponding to the Payer Sequence.
CROSS-REFERENCE: ^^TRIGGER^399^24
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=('$$REQMRA^IBEFUNC(DA)&$$NEEDMRA^IBEFUNC(DA)) I X S
X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X=DIV S X=0
X ^DD(399,.21,1,2,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,5)=DIV,DIH=399,DIG=24 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=('$$REQMRA^IBEFUNC(DA)&$$NEEDMRA^IBEFUNC(DA)) I X S
X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" X ^DD(
399,.21,1,2,2.4)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,5)=DIV,DIH=399,DIG=24 D ^DICR
CREATE CONDITION)= ('$$REQMRA^IBEFUNC(DA)&$$NEEDMRA^IBEFUNC(DA))
CREATE VALUE)= S X=0
DELETE CONDITION)= ('$$REQMRA^IBEFUNC(DA)&$$NEEDMRA^IBEFUNC(DA))
DELETE VALUE)= @
FIELD)= CLAIM MRA STATUS
When the payer sequence changes, this trigger will detect if an MRA is no longer needed, but the
CLAIM MRA STATUS field still indicates than an MRA is still needed. In this case, the CLAIM MRA
STATUS is updated to be 0 - NO MRA NEEDED.
CROSS-REFERENCE: ^^TRIGGER^399^27
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$S($$WNRBILL^IBEFUNC(DA,X):1,1:0) I X S X=DIV S Y(1)
=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" X ^DD(399,.21,1,3,
1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,8)=DIV,DIH=399,DIG=27 D ^DICR
2)= Q
3)= Do not delete
CREATE CONDITION)= S X=$S($$WNRBILL^IBEFUNC(DA,X):1,1:0)
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= FORCE CLAIM TO PRINT
If the insurance for the payer sequence is MEDICARE WNR, the data in field FORCE CLAIM TO PRINT
must be deleted as it is not valid to print an MRA request.
CROSS-REFERENCE: ^^TRIGGER^399^27
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$CREATE^IBCEF84(DA) I X S X=DIV S Y(1)=$S($D(^DGCR(
399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X=DIV S X=1 X ^DD(399,.21,1,4,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,8)=DIV,DIH=399,DIG=27 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$DELETE^IBCEF84(DA) I X S X=DIV S Y(1)=$S($D(^DGCR(
399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" X ^DD(399,.21,1,4,2.4)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,8)=DIV,DIH=399,DIG=27 D ^DICR
CREATE CONDITION)= S X=$$CREATE^IBCEF84(DA)
CREATE VALUE)= S X=1
DELETE CONDITION)= S X=$$DELETE^IBCEF84(DA)
DELETE VALUE)= @
FIELD)= FORCE CLAIM TO PRINT
This trigger is designed to set the FORCE CLAIM TO PRINT field 27 equal to 1 for SECONDARY MEDICARE
WNR claims if the carrier field PRINT SEC MED CLAIMS W/O MRA, 6.1 is set. If the current value of
field 27, FORCE CLAIM TO PRINT is equal to 1, and field .21, CURRENT BILL PAYER SEQUENCE is changed
to something other than "S", then the value in field 27, FORCE CLAIM TO PRINT, is deleted.
CROSS-REFERENCE: ^^TRIGGER^399^125
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=Y(0),X=X S X=X="P" I X S X=DIV S Y(1)=$S($D(^DGCR(39
9,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" X ^DD(399,.21,1,5,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,5)=DIV,DIH=399,DIG=125 D ^DICR
2)= Q
CREATE CONDITION)= INTERNAL(CURRENT BILL PAYER SEQUENCE)="P"
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= PRIMARY BILL #
This TRIGGER removes the PRIMARY BILL # when the CURRENT BILL PAYER SEQUENCE is set to "P"rimary to
prevent COB information from subsequent claims being placed on the 837 claims transmission.
CROSS-REFERENCE: ^^TRIGGER^399^126
1)= X ^DD(399,.21,1,6,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U
,6),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,6)=DIV,DIH=399,DIG
=126 D ^DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=Y(0),X=X S X=X="P",Y(1)=$G(X),Y(2)=$G(X) S X=Y(0),
X=X S X=X="S",Y=X,X=Y(1),X=X!Y
2)= Q
CREATE CONDITION)= INTERNAL(CURRENT BILL PAYER SEQUENCE)="P"!(INTERNAL(CURRENT BILL PAYER SEQUENCE)
="S")
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= SECONDARY BILL #
This TRIGGER removes the SECONDARY BILL # when the CURRENT BILL PAYER SEQUENCE is set to either
"P"rimary or "S"econdary to prevent COB information from subsequent claims being placed on the 837
claims transmission.
CROSS-REFERENCE: ^^TRIGGER^399^127
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,7),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,7)=DIV,DIH=399,DIG=127
D ^DICR
2)= Q
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= TERTIARY BILL #
This TRIGGER removes the TERTIARY BILL # when the CURRENT BILL PAYER SEQUENCE is set to either
"P"rimary, "S"econdary or "T"ertiary to prevent COB information from subsequent claims being placed
on the 837 claims transmission.
CROSS-REFERENCE: ^^TRIGGER^399^218
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=Y(0),X=X S X=X="P" I X S X=DIV S Y(1)=$S($D(^DGCR(39
9,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X="" X ^DD(399,.21,1,8,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,4)=DIV,DIH=399,DIG=218 D ^DICR
2)= Q
CREATE CONDITION)= INTERNAL(CURRENT BILL PAYER SEQUENCE)="P"
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= PRIMARY PRIOR PAYMENT
This TRIGGER removes the PRIMARY PRIOR PAYMENT when the CURRENT BILL PAYER SEQUENCE is set to
"P"rimary to properly adjust the calculation of the OFFSET AMOUNT for subsequent claims being
placed on the 837 claims tranmission.
CROSS-REFERENCE: ^^TRIGGER^399^219
1)= X ^DD(399,.21,1,9,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U
,5),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,5)=DIV,DIH=399,DIG
=219 D ^DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=Y(0),X=X S X=X="P",Y(1)=$G(X),Y(2)=$G(X) S X=Y(0),
X=X S X=X="S",Y=X,X=Y(1),X=X!Y
2)= Q
CREATE CONDITION)= INTERNAL(CURRENT BILL PAYER SEQUENCE)="P"!(INTERNAL(CURRENT BILL PAYER SEQUENCE)
="S")
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= SECONDARY PRIOR PAYMENT
This TRIGGER removes the SECONDARY PRIOR PAYMENT when the CURRENT BILL PAYER SEQUENCE is set to
"P"rimary or "S"econdary to properly adjust the calculation of the OFFSET AMOUNT for subsequent
claims being placed on the 837 claims transmission.
CROSS-REFERENCE: ^^TRIGGER^399^220
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,6),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,6)=DIV,DIH=399,DIG=220
D ^DICR
2)= Q
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= TERTIARY PRIOR PAYMENT
This TRIGGER removes the TERTIARY PRIOR PAYMENT when the CURRENT BILL PAYER SEQUENCE is set to
"P"rimary, "S"econdary or "T"ertiary to properly adjust the calculation of the OFFSET AMOUNT for
subsequent claims being placed on the 837 claims transmission.
399,.22 DEFAULT DIVISION 0;22 POINTER TO MEDICAL CENTER DIVISION FILE (#40.8)
LAST EDITED: JUN 14, 2006
HELP-PROMPT: Enter the default division that should be used in charge calculations.
DESCRIPTION: For rates specific to a division, this division will be used to determine the charges for all CPT's
that do not have a division specified.
CROSS-REFERENCE: ^^TRIGGER^399^235
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$CLIAREQ^IBCEP8A(DA) I X S X=DIV S Y(1)=$S($D(^DGCR
(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,13),X=X S DIU=X K Y S X=DIV S X=$$CLIA^IBCEP8A(DA) X ^DD
(399,.22,1,7,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,13)=DIV,DIH=399,DIG=235 D ^DICR
2)= Q
CREATE CONDITION)= S X=$$CLIAREQ^IBCEP8A(DA)
CREATE VALUE)= S X=$$CLIA^IBCEP8A(DA)
DELETE VALUE)= NO EFFECT
FIELD)= LAB CLIA NUMBER
This trigger will set the LAB CLIA NUMBER field to the default CLIA# for the division when the
division field is entered or changed. The trigger condition ensures that lab services are on the
claim.
RECORD INDEXES: ABP (#820)
399,.24 UB-04 LOCATION OF CARE 0;24 SET (Required)
'1' FOR HOSPITAL - INPT OR OPT (INCLUDES CLINICS);
'2' FOR SKILLED NURSING (NHCU);
'3' FOR HOME HEALTH AGENCY;
'7' FOR CLINIC (ONLY INDEPENDENT/SATELITE);
'8' FOR SPEC. FACILITY HOSP/AMB SURG CTR;
LAST EDITED: JAN 16, 2007
HELP-PROMPT: Enter the appropriate UB-04 location of care
DESCRIPTION: This field contains the code representing the location of care for a bill. This is the first digit
of the 3-digit UB-04 type of bill.
NOTES: TRIGGERED by the LOCATION OF CARE field of the BILL/CLAIMS File
399,.25 UB-04 BILL CLASSIFICATION 0;25 POINTER TO MCCR UTILITY FILE (#399.1) (Required)
INPUT TRANSFORM: S DIC("S")="I $P(^(0),U,23),$$TOBIN^IBCU4(Y,D0)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
LAST EDITED: JAN 16, 2007
HELP-PROMPT: Enter the appropriate UB-04 bill classification
DESCRIPTION: This field contains the code representing the bill classification for the bill. It is the second
digit in the 3-digit UB-04 type of bill.
SCREEN: S DIC("S")="I $P(^(0),U,23),$$TOBIN^IBCU4(Y,D0)"
EXPLANATION: CLASSIFICATION MUST BE CONSISTENT WITH LOC OF CARE VALUE
NOTES: TRIGGERED by the BILL CLASSIFICATION field of the BILL/CLAIMS File
CROSS-REFERENCE: 399^AI^MUMPS
1)= D ALLID^IBCEP3(DA,.25,1)
2)= D ALLID^IBCEP3(DA,.25,2)
3)= Do not delete
This cross reference determines if the change of care type requires the provider id's to be updated
or deleted. If it does, the update/deletion is performed for the claim.
399,.26 UB-04 TIMEFRAME OF BILL 0;26 SET (Required)
'1' FOR ADMIT THRU DISCHARGE;
'2' FOR INTERIM - 1ST CLAIM;
'3' FOR INTERIM - CONTINUING CLAIM;
'4' FOR INTERIM - LAST CLAIM;
'5' FOR LATE CHARGES ONLY;
'6' FOR ADJUSTMENT CLAIM;
'7' FOR REPLACEMENT CLAIM;
'8' FOR VOID/CANCEL PRIOR CLAIM;
'0' FOR NON-PAY/ZERO CLAIM;
LAST EDITED: JUN 27, 2017
HELP-PROMPT: Enter the appropriate UB-04 timeframe of bill
DESCRIPTION: This field contains the code representing the timeframe of the bill value for the bill. This is
the 3rd digit of the 3-digit UB-04 type of bill.
NOTES: TRIGGERED by the TIMEFRAME OF BILL field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^.06
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,6),X=X S D
IU=X K Y S X=DIV S X=DIV,X=X S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,6)=DIV,DIH=399,DIG=.06
D ^DICR
2)= Q
CREATE VALUE)= INTERNAL(UB-04 TIMEFRAME OF BILL)
DELETE VALUE)= NO EFFECT
FIELD)= TIMEFRAME OF BILL
399,.27 BILL CHARGE TYPE 0;27 SET
'1' FOR INSTITUTIONAL;
'2' FOR PROFESSIONAL;
LAST EDITED: JUL 28, 2011
HELP-PROMPT: Enter the part of the service to the patient this bill covers.
DESCRIPTION: The service to the patient may have two components, institutional/facility and professional. If
this bill only has charges for one of these components then enter that component.
CROSS-REFERENCE: ^^TRIGGER^399^.19
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,19),X=X S
DIU=X K Y S X=DIV S X=$$FT^IBCU3(DA,1) X ^DD(399,.27,1,1,1.4)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,19)=DIV,DIH=399,DIG=.19 D ^DICR
2)= Q
CREATE VALUE)= S X=$$FT^IBCU3(DA,1)
DELETE VALUE)= NO EFFECT
FIELD)= FORM TYPE
Sets the bill Form Type based on Insurance, Charge Type, and Site default.
CROSS-REFERENCE: ^^TRIGGER^399^158
1)= X ^DD(399,.27,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,8
),X=X S DIU=X K Y S X=DIV S X=3 S DIH=$G(^DGCR(399,DIV(0),"U")),DIV=X S $P(^("U"),U,8)=DIV,DIH=399,
DIG=158 D ^DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(399,.27,1,2,69.3) S Y(6)=$G(X) S X=$P(Y(7),U,5),
X=X S X=X=3,Y=X,X=Y(5),X=X&Y
2)= Q
69.2)= S Y(2)=$C(59)_$P($G(^DD(399,158,0)),U,3),Y(7)=$S($D(^DGCR(399,D0,0)):^(0),1:""),Y(1)=$S($D(^
DGCR(399,D0,"U")):^("U"),1:"")
69.3)= X ^DD(399,.27,1,2,69.2) S X=$P($P(Y(2),$C(59)_$P(Y(1),U,8)_":",2),$C(59))="",Y(3)=$G(X),Y(4)
=$G(X) S X=Y(0),X=X S X=X=1,Y=X,X=Y(3),X=X&Y,Y(5)=$G(X)
CREATE CONDITION)= (#158="")&(INTERNAL(#.27)=1)&(INTERNAL(#.05)=3)
CREATE VALUE)= S X=3
DELETE VALUE)= NO EFFECT
FIELD)= TYPE OF ADMISSION
This trigger is designed to set the TYPE OF ADMISSION to "3 for ELECTIVE", if it is empty, when the
BILL CHARGE TYPE field is equal to "1 for INSTITUTIONAL" and the BILL CLASSIFICATION field is equal
to "3 for OUTPATIENT".
FIELD INDEX: AM (#989) MUMPS IR ACTION
Short Descr: Trigger to reset the Revenue Code MANUALLY EDITED flag.
Description: This trigger is designed to remove the MANUALLY EDITED flag from all records in the REVENUE CODE
multiple when the BILL CHARGE TYPE field is changed.
Set Logic: D CMAEDALL^IBCU9(DA)
Kill Logic: D CMAEDALL^IBCU9(DA)
X(1): BILL CHARGE TYPE (399,.27) (Subscr 1) (forwards)
399,.28 INITIAL DATE OF SERVICE 0;28 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: AUG 31, 2021
HELP-PROMPT: Please enter the initial date of service.
DESCRIPTION:
This field contains initial date of service.
399,1 DATE ENTERED S;1 DATE (Required)
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAY 21, 1992
HELP-PROMPT: Enter the date on which this billing record was established.
DESCRIPTION:
This is the date on which this billing record was established.
UNEDITABLE
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the BILL NUMBER field of the BILL/CLAIMS File
CROSS-REFERENCE: 399^APD
1)= S ^DGCR(399,"APD",$E(X,1,30),DA)=""
2)= K ^DGCR(399,"APD",$E(X,1,30),DA)
Regular cross-reference used to speed up reports.
399,2 ENTERED/EDITED BY S;2 POINTER TO NEW PERSON FILE (#200) (Required)
LAST EDITED: SEP 21, 1990
HELP-PROMPT: Enter the user who established this billing record.
DESCRIPTION:
This is the user who established this billing record.
UNEDITABLE
NOTES: TRIGGERED by the BILL NUMBER field of the BILL/CLAIMS File
TRIGGERED by the AUTO field of the BILL/CLAIMS File
399,3 INITIAL REVIEW S;3 FREE TEXT
DO YOU APPROVE THIS BILL? (Y/N)
INPUT TRANSFORM: I $D(X) D YN^IBCU
OUTPUT TRANSFORM: S Y=$S(Y:"YES",Y=0:"NO",1:"")
LAST EDITED: MAR 10, 1994
HELP-PROMPT: Enter 'Yes' or '1' if the information in this record is accurate and complete or 'No' or '0' if the
information is inaccurate or incomplete.
DESCRIPTION:
This allows the user to approve or disapprove the information contained in this billing record.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^399^4
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1)
,U,4)="" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y
S X=DIV N %I,%H,% D NOW^%DTC X ^DD(399,3,1,1,1.4)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"S")):^("S"),1:""),DIV=X S $P(^("S"),U,4)=DIV,DIH=399,DIG=4 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= INITIAL REVIEW DATE=""
CREATE VALUE)= TODAY
DELETE VALUE)= NO EFFECT
FIELD)= INITIAL REVIEW DATE
CROSS-REFERENCE: ^^TRIGGER^399^5
1)= X ^DD(399,3,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,5),
X=X S DIU=X K Y S X=DIV S X=DUZ X ^DD(399,3,1,2,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$S('$
D(^VA(200,+$P(Y(1),U,5),0)):"",1:$P(^(0),U,1))=""
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"S")):^("S"),1:""),DIV=X S $P(^("S"),U,5)=DIV,DIH=399,DIG=5 D ^D
ICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= INITIAL REVIEWER=""
CREATE VALUE)= S X=DUZ
DELETE VALUE)= NO EFFECT
FIELD)= INITIAL REVIEWER
399,4 INITIAL REVIEW DATE S;4 DATE
INPUT TRANSFORM: S %DT="ETX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JAN 16, 1990
HELP-PROMPT: Enter the date on which this billing record was first reviewed.
DESCRIPTION:
This is the date on which this record was initially reviewed.
NOTES: TRIGGERED by the INITIAL REVIEW field of the BILL/CLAIMS File
399,5 INITIAL REVIEWER S;5 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: SEP 21, 1990
HELP-PROMPT: Enter the user who first reviewed this billing record.
DESCRIPTION:
This is the user who performed the initial review on this billing record.
UNEDITABLE
NOTES: TRIGGERED by the INITIAL REVIEW field of the BILL/CLAIMS File
399,6 SECONDARY REVIEW S;6 FREE TEXT
DO YOU APPROVE THIS BILL? (Y/N)
INPUT TRANSFORM: I $D(X) D YN^IBCU
OUTPUT TRANSFORM: S Y=$S(Y:"YES",Y=0:"NO",1:"")
LAST EDITED: JUL 24, 1998
HELP-PROMPT: Enter 'Yes' or '1' if the information in this record is accurate and complete, or 'No' or '0' if
the information is inaccurate or incomplete.
DESCRIPTION: This allows the user to approve or disapprove the information contained in this billing record
during the secondary review stage.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,7 MRA REQUESTED DATE S;7 DATE
INPUT TRANSFORM: S %DT="ETX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAY 28, 2004
HELP-PROMPT: Enter the date on which the last request for an MRA was performed.
DESCRIPTION:
This is the last date for which this record requested an MRA.
TECHNICAL DESCR: This field used to contain the SECONDARY REVIEW DATE data, but is being recycled for requesting MRA
date data.
WRITE AUTHORITY: ^
NOTES: TRIGGERED by the REQUEST AN MRA? field of the BILL/CLAIMS File
CROSS-REFERENCE: 399^APM
1)= S ^DGCR(399,"APM",$E(X,1,30),DA)=""
2)= K ^DGCR(399,"APM",$E(X,1,30),DA)
Regular cross-reference on the date the MRA was requested. Used to speed up reports.
399,8 MRA REQUESTOR S;8 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JUL 24, 1998
HELP-PROMPT: Enter the user who requested this bill be submitted to request an MRA
DESCRIPTION: This is the user who requested this bill be submitted to request an MRA because MEDICARE WNR is the
current insurance for the bill.
TECHNICAL DESCR: This field used to contain the SECONDARY REVIEWER data, but is being recycled for who requested an
MRA data.
NOTES: TRIGGERED by the REQUEST AN MRA? field of the BILL/CLAIMS File
399,9 AUTHORIZE BILL GENERATION? S;9 FREE TEXT
INPUT TRANSFORM: I $D(X) D YN^IBCU
OUTPUT TRANSFORM: S Y=$S(Y:"YES",Y=0:"NO",1:"")
LAST EDITED: JUN 20, 2003
HELP-PROMPT: Enter 'Yes' or '1' if the billing record has been reviewed and is ready for authorization, or 'No'
or '0' if the billing record is not ready to be authorized.
DESCRIPTION:
This allows the user to authorize the printing/transmitting of this bill.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^399^10
1)= X ^DD(399,9,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,10)
,X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC X ^DD(399,9,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(
1),U,10)="",Y(2)=X,Y(3)=X,Y=Y(0) X:$D(^DD(399,9,2)) ^(2) S X=Y="YES",Y=X,X=Y(2),X=X&Y
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"S")):^("S"),1:""),DIV=X S $P(^("S"),U,10)=DIV,DIH=399,DIG=10 D
^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= AUTHORIZATION DATE=""&(#9="YES")
CREATE VALUE)= TODAY
DELETE VALUE)= NO EFFECT
FIELD)= AUTHORIZATION DATE
CROSS-REFERENCE: ^^TRIGGER^399^11
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(399,9,1,2,69.2) S X=X="YES",Y=X,X=Y(2),X=X&Y I X S
X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,11),X=X S DIU=X K Y S X=DIV S X=D
UZ X ^DD(399,9,1,2,1.4)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"S")):^("S"),1:""),DIV=X S $P(^("S"),U,11)=DIV,DIH=399,DIG=11 D
^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
69.2)= S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$S('$D(^VA(200,+$P(Y(1),U,11),0)):"",1:$P(^
(0),U,1))="",Y(2)=X,Y(3)=X,Y=Y(0) X:$D(^DD(399,9,2)) ^(2) S X=Y
CREATE CONDITION)= AUTHORIZER=""&(#9="YES")
CREATE VALUE)= S X=DUZ
DELETE VALUE)= NO EFFECT
FIELD)= AUTHORIZER
CROSS-REFERENCE: ^^TRIGGER^399^.13
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y=Y(0) X:$D(^DD(399,9,2)) ^(2) S X=Y="YES" I X S X=DIV
S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,13),X=X S DIU=X K Y S X=DIV S X=3 X ^DD(399
,9,1,3,1.4)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,13)=DIV,DIH=399,DIG=.13 D ^DICR
:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= #9="YES"
CREATE VALUE)= S X=3
DELETE VALUE)= NO EFFECT
FIELD)= STATUS
CROSS-REFERENCE: ^^TRIGGER^399^25
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$EXTERNAL^DIDU(399,9,"",Y(0))="YES" I X S X=DIV S Y
(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X="" X ^DD(399,9,1,4
,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,6)=DIV,DIH=399,DIG=25 D ^DICR
2)= Q
CREATE CONDITION)= #9="YES"
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= REQUEST
If Authorize Bill Generation? (Fld #9) is answered with Yes, then the value in Request an MRA? (Fld
#25) gets removed (set to null).
399,10 AUTHORIZATION DATE S;10 DATE
INPUT TRANSFORM: S %DT="ETX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: AUG 24, 1995
HELP-PROMPT: Enter date on which this billing record was authorized for generation.
DESCRIPTION:
This is the date on which this bill was authorized for printing.
UNEDITABLE
NOTES: TRIGGERED by the AUTHORIZE BILL GENERATION? field of the BILL/CLAIMS File
CROSS-REFERENCE: 399^APD3
1)= S ^DGCR(399,"APD3",$E(X,1,30),DA)=""
2)= K ^DGCR(399,"APD3",$E(X,1,30),DA)
Regular cross-reference used to speed up reports.
399,11 AUTHORIZER S;11 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: SEP 21, 1990
HELP-PROMPT: Enter user who authorized this bill for generation.
DESCRIPTION:
This is the user who authorized the generation of this bill.
UNEDITABLE
NOTES: TRIGGERED by the AUTHORIZE BILL GENERATION? field of the BILL/CLAIMS File
399,12 DATE FIRST PRINTED S;12 DATE (Required)
INPUT TRANSFORM: S %DT="ETX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 18, 2004
HELP-PROMPT: Enter date on which this bill was first generated.
DESCRIPTION:
This is the date on which the bill was first printed.
CROSS-REFERENCE: ^^TRIGGER^399^14
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1)
,U,14)="" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,14),X=X S DIU=X K
Y S X=DIV N %I,%H,% D NOW^%DTC X ^DD(399,12,1,1,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,14)=DIV,DIH=399,DIG=14 D ^DICR
2)= Q
CREATE CONDITION)= #14=""
CREATE VALUE)= TODAY
DELETE VALUE)= NO EFFECT
FIELD)= #14
CROSS-REFERENCE: ^^TRIGGER^399^15
1)= X ^DD(399,12,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,15
),X=X S DIU=X K Y S X=DIV S X=DUZ S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,15)=DIV,DIH=3
99,DIG=15 D ^DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P($G
(^VA(200,+$P(Y(1),U,15),0)),U)=""
2)= Q
CREATE CONDITION)= #15=""
CREATE VALUE)= S X=DUZ
DELETE VALUE)= NO EFFECT
FIELD)= #15
CROSS-REFERENCE: ^^TRIGGER^399^13
1)= X ^DD(399,12,1,3,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,13
),X=X S DIU=X K Y S X=DIV S X=DUZ S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,13)=DIV,DIH=3
99,DIG=13 D ^DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P($G
(^VA(200,+$P(Y(1),U,13),0)),U)=""
2)= Q
CREATE CONDITION)= FIRST PRINTED BY=""
CREATE VALUE)= S X=DUZ
DELETE VALUE)= NO EFFECT
FIELD)= FIRST PRINTED BY
CROSS-REFERENCE: 399^AP
1)= S ^DGCR(399,"AP",$E(X,1,30),DA)=""
2)= K ^DGCR(399,"AP",$E(X,1,30),DA)
Regular cross-reference to be used to speed up reports.
399,13 FIRST PRINTED BY S;13 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: SEP 21, 1990
HELP-PROMPT: Enter user who first generated this bill.
DESCRIPTION:
This is the user who first generated this bill.
NOTES: TRIGGERED by the DATE FIRST PRINTED field of the BILL/CLAIMS File
399,14 DATE LAST PRINTED S;14 DATE
INPUT TRANSFORM: S %DT="ETX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 14, 2004
HELP-PROMPT: Enter date on which this bill was last generated.
DESCRIPTION:
This is the date on which this bill was last printed.
NOTES: TRIGGERED by the DATE FIRST PRINTED field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^.13
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,13),X=X S
DIU=X K Y S X=DIV S X=4 S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,13)=DIV,DIH=399,DIG=.13 D ^
DICR
2)= Q
CREATE VALUE)= S X=4
DELETE VALUE)= NO EFFECT
FIELD)= STATUS
CROSS-REFERENCE: ^^TRIGGER^399^15
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,15),X=
X S DIU=X K Y S X=DIV S X=DUZ S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,15)=DIV,DIH=399,D
IG=15 D ^DICR
2)= Q
CREATE VALUE)= S X=DUZ
DELETE VALUE)= NO EFFECT
FIELD)= #15
399,15 LAST PRINTED BY S;15 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: SEP 21, 1990
HELP-PROMPT: Enter user who generated this bill last.
DESCRIPTION:
This is the user who last printed this bill.
UNEDITABLE
NOTES: TRIGGERED by the DATE FIRST PRINTED field of the BILL/CLAIMS File
TRIGGERED by the DATE LAST PRINTED field of the BILL/CLAIMS File
399,16 CANCEL BILL? S;16 FREE TEXT
INPUT TRANSFORM: I $D(X) D YN^IBCU
OUTPUT TRANSFORM: S Y=$S(Y:"YES",Y=0:"NO",1:"")
LAST EDITED: APR 06, 2004
HELP-PROMPT: Enter 'Yes' or '1' if you want this billing record to be cancelled, 'No' or '0' if you do not want
this billing record to be cancelled.
DESCRIPTION:
This allows the user to cancel this bill.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^399^17
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$EXTERNAL^DIDU(399,16,"",Y(0))="YES" I X S X=DIV S
Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,17),X=X S DIU=X K Y S X=DIV N %I,%H,% D NO
W^%DTC X ^DD(399,16,1,1,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,17)=DIV,DIH=399,DIG=17 D ^DICR
2)= Q
CREATE CONDITION)= CANCEL BILL?="YES"
CREATE VALUE)= TODAY
DELETE VALUE)= NO EFFECT
FIELD)= #17
CROSS-REFERENCE: ^^TRIGGER^399^18
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$EXTERNAL^DIDU(399,16,"",Y(0))="YES" I X S X=DIV S
Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,18),X=X S DIU=X K Y S X=DIV S X=DUZ X ^DD(
399,16,1,2,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,18)=DIV,DIH=399,DIG=18 D ^DICR
2)= Q
CREATE CONDITION)= CANCEL BILL?="YES"
CREATE VALUE)= S X=DUZ
DELETE VALUE)= NO EFFECT
FIELD)= #18
399,17 DATE BILL CANCELLED S;17 DATE
INPUT TRANSFORM: S %DT="ETX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 14, 2004
HELP-PROMPT: Enter date on which this bill was cancelled.
DESCRIPTION:
This is the date on which this billing record was cancelled.
UNEDITABLE
NOTES: TRIGGERED by the CANCEL BILL? field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^.13
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1)
,U,16),X=X S X=X=1 I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P(Y(1),U,13),X=X S DIU
=X K Y S X=DIV S X=7 X ^DD(399,17,1,1,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),0)),DIV=X S $P(^(0),U,13)=DIV,DIH=399,DIG=.13 D ^DICR
2)= Q
CREATE CONDITION)= INTERNAL(#16)=1
CREATE VALUE)= S X=7
DELETE VALUE)= NO EFFECT
FIELD)= STATUS
399,18 BILL CANCELLED BY S;18 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: SEP 21, 1990
HELP-PROMPT: Enter user who cancelled this bill.
DESCRIPTION:
This is the user who cancelled this bill.
UNEDITABLE
NOTES: TRIGGERED by the CANCEL BILL? field of the BILL/CLAIMS File
399,19 REASON CANCELLED S;19 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>100!($L(X)<3)!'(X?1A.ANP) X I '$D(X) X ^DD(399,19,9.3)
LAST EDITED: JAN 21, 1992
HELP-PROMPT: Enter the 3-100 character reason(s) why this bill was cancelled.
DESCRIPTION: This is the reason(s) why this bill was cancelled. This entry is mandatory when cancelling a bill.
Enter 3-100 characters, the first character must be an alphabetic character.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,20 LAST AUSTIN CONFIRM DATE TX;1 DATE
INPUT TRANSFORM: S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: AUG 19, 1996
HELP-PROMPT: Enter the date/time that this bill was confirmed by Austin as received.
DESCRIPTION:
This is the last date/time that Austin received the bill.
399,21 LAST ELECTRONIC EXTRACT DATE TX;2 DATE
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:Y<1 X
LAST EDITED: APR 18, 2000
HELP-PROMPT: Enter the date/time that this bill was last extracted for EDI transmission.
DESCRIPTION:
This is the last time this bill was extracted to be transmitted to Austin.
CROSS-REFERENCE: 399^ALEX
1)= S ^DGCR(399,"ALEX",$E(X,1,30),DA)=""
2)= K ^DGCR(399,"ALEX",$E(X,1,30),DA)
3)= Please do not delete
This cross reference provides a way to easily find all bills extracted in a selected date range.
399,22 MRA RECORDED DATE TX;3 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: APR 21, 1999
HELP-PROMPT: Enter the date the MRA was received for this bill
DESCRIPTION:
This is the date that the MRA was recorded as being received for this bill.
NOTES: TRIGGERED by the CLAIM MRA STATUS field of the BILL/CLAIMS File
399,23 IS DUPLICATE? S;20 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: OCT 08, 2019
HELP-PROMPT: Enter 'Yes' if this claim is a valid duplicate claim. Otherwise, enter 'No'.
DESCRIPTION: If this claim is an EDI resubmission of a claim, then this field will be set to 'Yes'. If this
field value is 'No' and FSC identifies this claim as a duplicate (already transmitted), then it
will be ignored.
399,24 CLAIM MRA STATUS TX;5 SET
'0' FOR NO MRA NEEDED;
'1N' FOR MRA NEEDED/NOT YET REQUESTED;
'1R' FOR MRA REQUESTED;
'C' FOR VALID MRA RECEIVED;
'A' FOR MRA SKIPPED;
LAST EDITED: OCT 03, 2000
HELP-PROMPT: ENTER THE STATUS OF THE CLAIM FOR MRA
DESCRIPTION:
This field tracks the process of obtaining an MRA for a MEDICARE primary claim.
TECHNICAL DESCR: If 'CLAIM MRA STATUS, there is no need to check for MRA status any further as either the MRA has
been received or is not needed.
This field is used to determine what can happen to this claim. If an MRA is needed, this field
will prevent it from being sent to A/R and will protect it from any other action that would
compromise its integrity until a formal bill can be created for it.
NOTES: TRIGGERED by the STATUS field of the BILL/CLAIMS File
TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
TRIGGERED by the PRIMARY INSURANCE CARRIER field of the BILL/CLAIMS File
TRIGGERED by the SECONDARY INSURANCE CARRIER field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^22
1)= X ^DD(399,24,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,
3),X=X S DIU=X K Y S X=DIV S X=DT X ^DD(399,24,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(
Y(1),U,3)="",Y(2)=X,Y(3)=X S X=Y(0),X=X S X=X="C",Y=X,X=Y(2),X=X&Y
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"TX")):^("TX"),1:""),DIV=X S $P(^("TX"),U,3)=DIV,DIH=399,DIG=22
D ^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= MRA RECORDED DATE=""&(INTERNAL(CLAIM MRA STATUS)="C")
CREATE VALUE)= S X=DT
DELETE VALUE)= NO EFFECT
FIELD)= MRA RECORDED DATE
399,25 REQUEST AN MRA? TX;6 FREE TEXT
INPUT TRANSFORM: I $D(Y) D YN^IBCU
OUTPUT TRANSFORM: S Y=$P("NO^YES",U,Y+1)
LAST EDITED: JUL 25, 2003
HELP-PROMPT: Enter 'Yes' (1) if the bill has been reviewed and is ready for submission to MEDICARE for an MRA,
or 'No' (0) if the billing record is not ready to be submitted.
DESCRIPTION:
This field indicates that the bill is ready to send to MEDICARE for an MRA.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the AUTHORIZE BILL GENERATION? field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^.13
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=Y(0),X=X S X=X=1 I X S X=DIV S Y(1)=$S($D(^DGCR(399,
D0,0)):^(0),1:"") S X=$P(Y(1),U,13),X=X S DIU=X K Y S X=DIV S X=2 X ^DD(399,25,1,1,1.4)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),0)):^(0),1:""),DIV=X S $P(^(0),U,13)=DIV,DIH=399,DIG=.13 D ^DICR
:$O(^DD(DIH,DIG,1,0))>0
2)= Q
3)= Do not delete
CREATE CONDITION)= INTERNAL(REQUEST AN MRA)=1
CREATE VALUE)= S X=2
DELETE VALUE)= NO EFFECT
FIELD)= STATUS
This triggers the status of the bill to indicate an MRA is ready to be requested.
CROSS-REFERENCE: ^^TRIGGER^399^8
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(399,25,1,2,69.2) S X=X S X=X="",Y=X,X=Y(2),X=X&Y I
X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X=DIV S
X=DUZ X ^DD(399,25,1,2,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,8)=DIV,DIH=399,DIG=8 D ^DICR
2)= Q
69.2)= S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:""),Y(4)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y
(1),U,13),X=X S X=X=2,Y(2)=$G(X),Y(3)=$G(X) S X=$P(Y(4),U,8)
CREATE CONDITION)= (INTERNAL(#.13)=2)&(INTERNAL(#8)="")
CREATE VALUE)= S X=DUZ
DELETE VALUE)= NO EFFECT
FIELD)= MRA REQUESTOR
CROSS-REFERENCE: ^^TRIGGER^399^7
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X X ^DD(399,25,1,3,69.2) S X=X S X=X="",Y=X,X=Y(2),X=X&Y I
X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X=DIV S
X=DT X ^DD(399,25,1,3,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"S")),DIV=X S $P(^("S"),U,7)=DIV,DIH=399,DIG=7 D ^DICR
2)= Q
69.2)= S Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:""),Y(4)=$S($D(^DGCR(399,D0,"S")):^("S"),1:"") S X=$P(Y
(1),U,13),X=X S X=X=2,Y(2)=$G(X),Y(3)=$G(X) S X=$P(Y(4),U,7)
CREATE CONDITION)= (INTERNAL(#.13)=2)&(INTERNAL(#7)="")
CREATE VALUE)= S X=DT
DELETE VALUE)= NO EFFECT
FIELD)= MRA REQUESTED DATE
399,26 PRINTED VIA EDI? TX;7 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: JUL 12, 1999
HELP-PROMPT: Enter 1 if this claim was printed at the EDI contractor
DESCRIPTION: This field is the flag that says the bill was not transmitted electronically when the EDI
contractor got the claim, but was printed at their print shop and mailed out.
399,27 FORCE CLAIM TO PRINT TX;8 SET
'0' FOR NO FORCED PRINT;
'1' FOR FORCE LOCAL PRINT;
'2' FOR *FORCE CLEARINGHOUSE PRINT;
LAST EDITED: MAR 14, 2014
HELP-PROMPT: Enter 0 to transmit the claim electronically to the payer. Enter 1 to print the claim locally.
DESCRIPTION:
This field determines whether a claim is transmitted electronically (0) or printed locally (1).
SCREEN: S DIC("S")="I Y'=2"
EXPLANATION: Print to Clearinghouse is no longer an available option.
NOTES: TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
TRIGGERED by the PRIMARY INSURANCE CARRIER field of the BILL/CLAIMS File
TRIGGERED by the SECONDARY INSURANCE CARRIER field of the BILL/CLAIMS File
TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
TRIGGERED by the PRIMARY INSURANCE CARRIER field of the BILL/CLAIMS File
399,28 FORCE PRINT MRA SECONDARY TX;9 SET
'0' FOR NO FORCED PRINT;
'1' FOR MEDICARE SECONDARY FORCE LOCAL PRINT;
LAST EDITED: SEP 16, 2004
HELP-PROMPT: Enter a 1 to force print locally the subsequent MRA claim
DESCRIPTION: Once the MRA is received from Medicare, the payer sequence on this claim will be incremented and
this claim will become the subsequent MRA claim.
If this field is set to FORCE LOCAL PRINT, then the subsequent MRA claim cannot be electronically
transmitted and must be printed locally.
If this field is set to NO FORCED PRINT (Default), then the subsequent MRA claim may be sent
electronically to the next payer.
399,28.1 MRA REVIEW STATUS TX;10 SET
'0' FOR NOT BEING REVIEWED;
'1' FOR REVIEW IN PROCESS;
LAST EDITED: AUG 20, 2010
HELP-PROMPT: Enter code indicating whether this MRA claim is being reviewed.
DESCRIPTION:
Select code that indicates whether this claim is under review.
399,29 BILL CLONED TO S1;1 POINTER TO BILL/CLAIMS FILE (#399)
LAST EDITED: JUL 12, 2005
HELP-PROMPT: Select the Bill Number for which the new claim is being created.
DESCRIPTION:
This is the Bill Number for which the new claim is being created.
399,30 BILL CLONED FROM S1;2 POINTER TO BILL/CLAIMS FILE (#399)
LAST EDITED: JUL 11, 2005
HELP-PROMPT: Select the Bill Number from which this claim was cloned.
DESCRIPTION:
This is the bill number to which this claim is being cloned.
399,31 DATE BILL CLONED S1;3 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUL 11, 2005
HELP-PROMPT: Enter the date this bill was cloned.
DESCRIPTION:
This is the date this bill was cloned.
399,32 BILL CLONED BY S1;4 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JUL 11, 2005
HELP-PROMPT: Enter the name of the person who is cloning the claim.
DESCRIPTION:
This is the user who cloned the claim.
399,33 REASON CLONED S1;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: JUL 11, 2005
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the reason why the old claim was cloned to a new one.
399,34 AUTO PROCESSED FROM CLAIM S1;6 POINTER TO BILL/CLAIMS FILE (#399)
LAST EDITED: OCT 14, 2010
HELP-PROMPT: Select the claim which was used to auto-process the current claim.
DESCRIPTION: This claim was used to create the current claim by the commercial insurance auto-processing
routines. It is system generated and uneditable by the users.
399,35 AUTO PROCESS S1;7 SET
'1' FOR WORKLIST;
'2' FOR AUTO LOCAL PRINT;
'3' FOR AUTO EDI;
'4' FOR NO LONGER ON WORKLIST;
LAST EDITED: OCT 14, 2010
HELP-PROMPT: What is the result of the auto-processing of this claim?
DESCRIPTION: The result of the commercial claim auto-processing. There are three possible outcomes of the
auto-processing. The claim can automatically be sent electronically. The claim can automatically
be printed locally. Finally, the claim can be added to the worklist.
This claim will be changed to NO LONGER ON WORKLIST when this claim is 'worked' off either by
removing, cloning, or processing the claim. This removes the claim from the active worklist but
serves as an audit trail to show the result of the commercial claim auto-processing.
This field is set by the system and should not be edited through Fileman.
CROSS-REFERENCE: 399^CAP
1)= S ^DGCR(399,"CAP",$E(X,1,30),DA)=""
2)= K ^DGCR(399,"CAP",$E(X,1,30),DA)
This is the cross reference used to build the COB Management worklist.
399,36 AUTO PROCESS REASON S1;8 POINTER TO IB ERROR FILE (#350.8)
LAST EDITED: NOV 08, 2010
HELP-PROMPT: Why was this claim not auto-processed?
DESCRIPTION: This is the reason that the claim failed auto-processing and was put on the worklist. This is
system generated. Do not edit through Fileman.
399,37 REMOVED FROM WORKLIST BY S1;9 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: OCT 14, 2010
HELP-PROMPT: Select the user who removed the claim from the COB worklist.
DESCRIPTION: This is the user who removed the Claim from the COB worklist. Set by the system automatically.
Don't edit through Fileman.
399,37.1 ON TAS PCR? S1;10 SET (BOOLEAN Data Type)
LAST EDITED: OCT 03, 2022
HELP-PROMPT: Enter 'Yes' to indicate this claim has been included on the TAS Printed Claims Report (PCR).
Otherwise, enter 'No'.
DESCRIPTION:
Yes indicates this claim has been included on the TAS Printed Claims Report(PCR).
399,38 REMOVED FROM WORKLIST HOW UF32;4 SET
'RM' FOR REMOVE ACTION;
'PC' FOR PROCESS COB ACTION;
'CL' FOR CLONE ACTION;
'CA' FOR CANCELLED ACTION;
'CR' FOR CORRECTED ACTION;
LAST EDITED: MAR 18, 2011
HELP-PROMPT: How was the claim removed from the COB worklist?
DESCRIPTION: This is the action which removed this claim from the COB worklist. Set by the system automatically.
Don't edit through Fileman.
399,39 REMOVED FROM WORKLIST DATE UF32;5 DATE
INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:X<1 X
LAST EDITED: OCT 15, 2010
HELP-PROMPT: Enter the date that this claim was removed from COB management worklist.
DESCRIPTION: This is the date/time the claim was removed from the COB management worklist worklist. Set
automatically. Don't edit through Fileman.
399,40 CONDITION CODE CC;0 POINTER Multiple #399.04 (Add New Entry without Asking)
DESCRIPTION:
This identifies the condition(s) relating to this bill that may affect payer processing.
399.04,.01 CONDITION CODE 0;1 POINTER TO MCCR UTILITY FILE (#399.1) (Multiply asked)
INPUT TRANSFORM: S DIC("S")="I +$P($G(^DGCR(399.1,+Y,0)),U,15)",D="C^B" D MIX^DIC1 K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: MAR 18, 2014
HELP-PROMPT: Enter a Condition Code that applies to this bill.
DESCRIPTION: This identifies various condition(s) relating to the patient and care provided that is being
billed that may affect payer processing.
SCREEN: S DIC("S")="I +$P($G(^DGCR(399.1,+Y,0)),U,15)"
EXPLANATION: Valid Condition Codes Only!
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,41 OCCURRENCE CODE OC;0 POINTER Multiple #399.041 (Add New Entry without Asking)
DESCRIPTION:
This identifies the significant event(s) relating to this bill that may affect payer processing.
SCREEN: S DIC("S")="I $D(^DGCR(399.1,+Y,0)) I $P(^DGCR(399.1,+Y,0),""^"",4)=1 X ^DD(399.041,9.1)"
EXPLANATION: Valid MCCR Occurrence Codes only!
IDENTIFIED BY: DATE(#.02)[R]
399.041,.01 OCCURRENCE CODE 0;1 POINTER TO MCCR UTILITY FILE (#399.1) (Multiply asked)
INPUT TRANSFORM:S DIC("S")="I $P(^DGCR(399.1,+Y,0),U,4)=1,$S(+Y'=22:1,$P(^DPT($P(^DGCR(399,DA,0),U,2),0),U,2)=""F""
:1,1:0),$$CHK^IBCEF12(DA)",D="C^B" D MIX^DIC1 K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: NOV 13, 2017
HELP-PROMPT: This code defines the event(s) relating to this bill which may affect insurance
processing.
SCREEN: S DIC("S")="I $P(^DGCR(399.1,+Y,0),U,4)=1,$S(+Y'=22:1,$P(^DPT($P(^DGCR(399,DA,0),U,2),0),U,2)=""F""
:1,1:0),$$CHK^IBCEF12(DA)"
EXPLANATION: Valid MCCR Occurrence Codes only!
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE:399.041^B
1)= S ^DGCR(399,DA(1),"OC","B",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(1),"OC","B",$E(X,1,30),DA)
399.041,.02 DATE 0;2 DATE (Required)
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:DTX) X
LAST EDITED: NOV 18, 1999
HELP-PROMPT: TYPE A DATE BETWEEN 1/1/1900 AND TODAY
DESCRIPTION: This is the date that this event occured. This is the beginning date for the time period covered
by Occurrence Spans.
399.041,.03 STATE 0;3 POINTER TO STATE FILE (#5)
LAST EDITED: OCT 12, 2006
HELP-PROMPT: Enter the state in which the auto accident occurred.
DESCRIPTION:
This is the state in which the auto accident occurred.
399.041,.04 END DATE 0;4 DATE (Required)
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:X<1 X I $D(X),X<$P($G(^DGCR(399,DA(1),"OC",DA,0)),U,2) K X
LAST EDITED: JUN 25, 2007
HELP-PROMPT: The end date is required and can not be before the start date.
DESCRIPTION:
The end date is required and can not be before the start date.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,42 REVENUE CODE RC;0 POINTER Multiple #399.042 (Add New Entry without Asking)
LAST EDITED: MAR 31, 1999
DESCRIPTION:
This identifies specific accommodation(s), ancillary service(s) or billing calculation(s).
IDENTIFIED BY: BEDSECTION(#.05)[R]
INDEXED BY: REVENUE CODE & RX PROCEDURE (ADPR)
399.042,.001 NUMBER NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: JUL 10, 1990
HELP-PROMPT: Type a Number between 1 and 99999, 0 Decimal Digits
DESCRIPTION: This is the sequential number of the entry. Use of this number facilitates reference to the line
item charges and revenue codes it is associated with.
WRITE AUTHORITY: ^
399.042,.01 REVENUE CODE 0;1 POINTER TO REVENUE CODE FILE (#399.2) (Required) (Multiply asked)
INPUT TRANSFORM: S DIC("S")="I +$P(^(0),U,3)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JUN 22, 2000
HELP-PROMPT: Enter the code(s) which identify a specific accommodation, ancillary service, or billing
calculation. You may enter up to 10 codes per bill.
DESCRIPTION:
Enter the Revenue Code to assign the charge for the care being billed.
SCREEN: S DIC("S")="I +$P(^(0),U,3)"
EXPLANATION: Select active revenue codes only!
CROSS-REFERENCE: 399.042^B
1)= S ^DGCR(399,DA(1),"RC","B",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(1),"RC","B",$E(X,1,30),DA)
CROSS-REFERENCE: 399.042^ABS1^MUMPS
1)= I $P(^DGCR(399,DA(1),"RC",DA,0),U,5) S ^DGCR(399,DA(1),"RC","ABS",$P(^DGCR(399,DA(1),"RC",DA,0)
,U,5),$E(X,1,30),DA)=""
2)= I $P(^DGCR(399,DA(1),"RC",DA,0),U,5) K ^DGCR(399,DA(1),"RC","ABS",$P(^DGCR(399,DA(1),"RC",DA,0)
,U,5),$E(X,1,30),DA)
Cross reference of all revenue codes with bedsections.
FIELD INDEX: ADPR (#53) MUMPS IR ACTION
Short Descr: DELETES PROCEDURE ENTRY FOR RX REVENUE CODES
Set Logic: Q
Kill Logic: I X(2)'=""&'$D(^TMP("IBCRRX",$J)) D DELPR^IBCU1(DA(1),X(2))
X(1): REVENUE CODE (399.042,.01) (Subscr 1) (forwards)
X(2): RX PROCEDURE (399.042,.15) (forwards)
399.042,.02 CHARGES 0;2 NUMBER (Required)
INPUT TRANSFORM:S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<0) X
LAST EDITED: SEP 24, 2010
HELP-PROMPT: Type a dollar amount between 0 and 9999999.99, 2 decimal digits.
DESCRIPTION: This is the unit charge for this revenue code. It will be multiplied times the number of units to
determine the total cost for this revenue code.
CROSS-REFERENCE:399.042^TC1^MUMPS
1)= D 21^IBCU2
2)= D 22^IBCU2
Sets/deletes total charges.
CROSS-REFERENCE:^^TRIGGER^399.042^.16
1)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=+$G(IBMAED) I X S X=DIV S Y(1)=$S
($D(^DGCR(399,D0,"RC",D1,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X=DIV S X=1 X ^DD(399.0
42,.02,1,2,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"RC",DIV(1),0)),DIV=X S $P(^(0),U,16)=DIV,DIH=399.042,DIG=.16 D ^DI
CR
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=+$G(IBMAED) I X S X=DIV S Y(1)=$S
($D(^DGCR(399,D0,"RC",D1,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X=DIV S X=1 X ^DD(399.0
42,.02,1,2,2.4)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"RC",DIV(1),0)),DIV=X S $P(^(0),U,16)=DIV,DIH=399.042,DIG=.16 D ^DI
CR
3)= This is a software controlled field and should not be manually edited by a user.
CREATE CONDITION)= S X=+$G(IBMAED)
CREATE VALUE)= S X=1
DELETE CONDITION)= S X=+$G(IBMAED)
DELETE VALUE)= S X=1
FIELD)= MANUALLY EDITED
This trigger is designed to set the MANUALLY EDITED flag when a user directly edits the CHARGE
value for the REVENUE CODE. This is used in the process of preventing the auto charge update from
changing user entered values.
399.042,.03 UNITS OF SERVICE 0;3 NUMBER (Required)
INPUT TRANSFORM:K:X'?1.3N X I $D(X) S:X=0 X=1 I X>800 K X
LAST EDITED: MAY 05, 2014
HELP-PROMPT: Enter the number of units of service (accommodation days, miles, treatments, etc.) rendered to or
for this patient for this revenue code. Cannot be greater than 800.
DESCRIPTION: This is the number of day of inpatient care or the number of outpatient visits for this revenue
code. It will be multiplied by the CHARGES field to determine the TOTAL charges for this revenue
code.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE:399.042^TC^MUMPS
1)= D 31^IBCU2
2)= D 32^IBCU2
Adds/deletes total charges.
399.042,.04 TOTAL 0;4 NUMBER (Required)
INPUT TRANSFORM:K:X?1.10N.1".".2N X
LAST EDITED: SEP 21, 1992
HELP-PROMPT: Type a Dollar Amount between 0 and 9999999.99, 2 Decimal Digits
DESCRIPTION:
This is the total charges for this revenue code. It is computed by the system.
UNEDITABLE
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE:399.042^ATC^MUMPS
1)= S DGXRF=1 D TC^IBCU2 K DGXRF
2)= S DGXRF=2 D TC^IBCU2 K DGXRF
Sets/deletes total charges
399.042,.05 BEDSECTION 0;5 POINTER TO MCCR UTILITY FILE (#399.1) (Required)
INPUT TRANSFORM:S DIC("S")="I $P(^(0),U,5)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: MAY 14, 1990
DESCRIPTION: If this is an inpatient bill then this is the Specialty associated with authorized rates for the
type of care provided for this revenue code.
TECHNICAL DESCR:
Includes only billable bedsections.
SCREEN: S DIC("S")="I $P(^(0),U,5)"
EXPLANATION: ONLY BILLABLE BEDSECTIONS
CROSS-REFERENCE:399.042^ABS^MUMPS
1)= S ^DGCR(399,DA(1),"RC","ABS",$E(X,1,30),+^DGCR(399,DA(1),"RC",DA,0),DA)=""
2)= K ^DGCR(399,DA(1),"RC","ABS",$E(X,1,30),+^DGCR(399,DA(1),"RC",DA,0),DA)
Cross reference of all revenue codes with bedsections.
399.042,.06 PROCEDURE 0;6 POINTER TO CPT FILE (#81)
INPUT TRANSFORM:S ICPTVDT=$$BDATE^IBACSV($G(DA(1))),DIC("S")="I $$CPTACT^IBACSV(+Y,ICPTVDT)",DIC("W")="D EN^DDIOL("
" ""_$P($$CPT^IBACSV(+Y,ICPTVDT),U,2),,""?0"")" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
LAST EDITED: SEP 08, 2006
DESCRIPTION: This field may be used to associate the revenue code with a procedure. This will be needed
primarily to accomodate the CMS-1500 which allows charges by procedure not revenue code. The
charge associated with the revenue code will be printed on the CMS-1500 claim form in the same line
item as the procedure.
This field is also used for revenue codes that are for Billable Ambulatory Surgeries (BASC). It
identifies the CPT code of the surgery which is being billed for.
SCREEN: S ICPTVDT=$$BDATE^IBACSV($G(DA(1))),DIC("S")="I $$CPTACT^IBACSV(+Y,ICPTVDT)",DIC("W")="D EN^DDIOL("
" ""_$P($$CPT^IBACSV(+Y,ICPTVDT),U,2),,""?0"")"
EXPLANATION: Only codes active for the date of service may be selected.
CROSS-REFERENCE:399^ASC1^MUMPS
1)= I $$RC^IBEFUNC1(DA(1),DA) S ^DGCR(399,"ASC1",$E(X,1,30),DA(1),DA)=""
2)= K ^DGCR(399,"ASC1",$E(X,1,30),DA(1),DA)
All Billable Ambulatory Surgery Codes (BASC) that have been billed.
CROSS-REFERENCE:399^ASC2^MUMPS
1)= I $$RC^IBEFUNC1(DA(1),DA) S ^DGCR(399,"ASC2",DA(1),$E(X,1,30),DA)=""
2)= K ^DGCR(399,"ASC2",DA(1),$E(X,1,30),DA)
All bills with charges for Billable Ambulatory Surgery Codes (BASC).
399.042,.07 DIVISION 0;7 POINTER TO MEDICAL CENTER DIVISION FILE (#40.8)
LAST EDITED: MAR 10, 1994
HELP-PROMPT: Enter the division where the care was provided if the charges are based on CPT region and if it is
different than the bills Default Division.
DESCRIPTION: This identifes the division where the treatement being billed was performed. It is only required
if the charges are based on CPT and region and the division is different than the bills Default
Division.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE:399^ASC11^MUMPS
1)= I $$RC^IBEFUNC1(DA(1),DA) S ^DGCR(399,"ASC1",$P(^DGCR(399,DA(1),"RC",DA,0),U,6),DA(1),DA)=""
2)= K ^DGCR(399,"ASC1",+$P(^DGCR(399,DA(1),"RC",DA,0),U,6),DA(1),DA)
All Billable Ambulatory Surgery Codes (BASC) that have been billed.
CROSS-REFERENCE:399^ASC21^MUMPS
1)= I $$RC^IBEFUNC1(DA(1),DA) S ^DGCR(399,"ASC2",DA(1),$P(^DGCR(399,DA(1),"RC",DA,0),U,6),DA)=""
2)= K ^DGCR(399,"ASC2",DA(1),+$P(^DGCR(399,DA(1),"RC",DA,0),U,6),DA)
All bills with charges for Billable Ambulatory Surgery Codes (BASC).
399.042,.08 AUTO 0;8 SET
'1' FOR YES;
LAST EDITED: FEB 07, 1994
HELP-PROMPT: This field sould be automatically added by the software, user entry is not necessary.
DESCRIPTION: True if the revenue code and charge were added by the automatic charge calculation routine, blank
if added manually by the user.
TECHNICAL DESCR:Should only be true if the automatic charge calculator created the revenue code and charge based on
the chargable items on the bill. Should be null for any rev code manually entered by a user.
(FILE^IBCU62) This is used to determine which of the revenue codes should be deleted before the
calculator re-builds them. (ALL^IBCU61)
399.042,.09 NON-COVERED CHARGE 0;9 NUMBER
INPUT TRANSFORM:S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<0) X
LAST EDITED: SEP 24, 2010
HELP-PROMPT: Type a dollar amount between 0 and 9999999.99, 2 decimal digits.
DESCRIPTION: This is the amount of the charges that are not covered for this revenue code line item. Use to
record things such as pass days that need to be reported but are not chargeable.
399.042,.1 TYPE 0;10 SET
'1' FOR INPT BS;
'2' FOR OPT VST DT;
'3' FOR RX;
'4' FOR CPT;
'5' FOR PROS;
'6' FOR DRG;
'9' FOR UNASSOCIATED;
LAST EDITED: MAY 26, 2000
HELP-PROMPT: This is an indicator of the type of item the charge is for.
DESCRIPTION: The type of item the charge is for. This places the charges into categories and should correspond
to the billable event.
TECHNICAL DESCR:This defines the file reference of the item pointer. This is automatically set when the charges
are set by the auto calculator.
CROSS-REFERENCE:^^TRIGGER^399.042^.11
1)= Q
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"RC",D1,0)):^(0),1:"
") S X=$P(Y(1),U,11),X=X S DIU=X K Y S X="" X ^DD(399.042,.1,1,1,2.4)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"RC",DIV(1),0)),DIV=X S $P(^(0),U,11)=DIV,DIH=399.042,DIG=.11 D ^DI
CR
3)= DO NOT DELETE
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= ITEM
This erases the item pointer if the item type changes.
CROSS-REFERENCE:^^TRIGGER^399.042^.15
1)= Q
2)= X ^DD(399.042,.1,1,2,2.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"RC",D1,0)):^(0),1:"") S X=$P(Y
(1),U,15),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"RC",DIV(1),0)),DIV=X S $P(^(0),U,15)=DI
V,DIH=399.042,DIG=.15 D ^DICR
2.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"RC",D1,0
)):^(0),1:"") S X=$P(Y(1),U,10),X=X S X=X=3
3)= DO NOT DELETE
CREATE VALUE)= NO EFFECT
DELETE CONDITION)= INTERNAL(TYPE)=3
DELETE VALUE)= @
FIELD)= RX PROCEDURE
This xref deletes the RX pointer to the procedure whenever the type is changed
399.042,.11 ITEM 0;11 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>9999999999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: OCT 12, 2000
HELP-PROMPT: Type a Number between 0 and 9999999999, 0 Decimal Digits
DESCRIPTION: This is a soft pointer to the item being charged for. The TYPE field defines the file reference
this is pointing to. Automatically set when charges are set by the auto calculator.
NOTES: TRIGGERED by the TYPE field of the REVENUE CODE sub-field of the BILL/CLAIMS File
CROSS-REFERENCE:^^TRIGGER^399.042^.15
1)= Q
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=X'="" I X S X=DIV S Y(1)=$S($D(^D
GCR(399,D0,"RC",D1,0)):^(0),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y S X="" X ^DD(399.042,.11,1,1,2.
4)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"RC",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,15)=DIV,DIH=399.042
,DIG=.15 D ^DICR
CREATE VALUE)= NO EFFECT
DELETE CONDITION)= OLD ITEM'=""
DELETE VALUE)= @
FIELD)= #.15
This trigger deletes the reference to the prescription procedure when the item being billed is
changed.
399.042,.12 COMPONENT 0;12 SET
'1' FOR INSTITUTIONAL;
'2' FOR PROFESSIONAL;
LAST EDITED: DEC 02, 1996
HELP-PROMPT: Enter the component of the total charge this charge represents.
DESCRIPTION: The total charges for some events are broken into Institutional and Professional charges. If this
charge is for only one of these components enter it here.
TECHNICAL DESCR:This set should be a subset of the Charge Set Charge Type set (363.1,.04) Automatically set when
charges are set by the auto calculator.
399.042,.13 *UB92 FORM LOCATOR 49 0;13 FREE TEXT
INPUT TRANSFORM:K:$L(X)>4!($L(X)<1) X
LAST EDITED: FEB 14, 2007
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: This is the data that should print for a revenue code line in the form locator 49.
This field is marked for deletion and can be deleted 11/23/2008.
399.042,.15 RX PROCEDURE 0;15 FREE TEXT
INPUT TRANSFORM:S X=$$RXPRLOOK^IBCEU4(X) K:'X X
OUTPUT TRANSFORM:S Y=Y_" - "_$P($$PRCNM^IBCSCH1($P($G(^DGCR(399,D0,"CP",+Y,0)),U)),U)
LAST EDITED: SEP 08, 2006
HELP-PROMPT: Enter the procedure code from the procedure codes on the bill that this charge is for.
DESCRIPTION: This is a soft pointer to the CP multiple entry for prescriptions billed on a CMS-1500 billing
form.
TECHNICAL DESCR:
This field is hard-set when prescriptions are auto-entered on a bill.
EXECUTABLE HELP:I $$RXPRLOOK^IBCEU4(X)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the TYPE field of the REVENUE CODE sub-field of the BILL/CLAIMS File
TRIGGERED by the ITEM field of the REVENUE CODE sub-field of the BILL/CLAIMS File
CROSS-REFERENCE:399.042^ACP
1)= S ^DGCR(399,DA(1),"RC","ACP",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(1),"RC","ACP",$E(X,1,30),DA)
FIELD INDEX: ADPR (#53) MUMPS IR ACTION
Short Descr: DELETES PROCEDURE ENTRY FOR RX REVENUE CODES
Set Logic: Q
Kill Logic: I X(2)'=""&'$D(^TMP("IBCRRX",$J)) D DELPR^IBCU1(DA(1),X(2))
X(1): REVENUE CODE (399.042,.01) (Subscr 1) (forwards)
X(2): RX PROCEDURE (399.042,.15) (forwards)
399.042,.16 MANUALLY EDITED 0;16 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: JUL 19, 2011
HELP-PROMPT: Were revenue code CHARGES manually changed by the user?
DESCRIPTION:
This field indicates whether the user manually changed the CHARGES (#.02) field.
TECHNICAL DESCR:This field indicates whether the user manually changed the CHARGES (#.02) field. It is triggered
(set to 1 or yes) when the user makes changes to the CHARGES (#.02) field. It can also be
triggered (reset to empty) when BILL CHARGE TYPE (#399,.27), DIVISION (#399.0304,5), or PROCEDURES
(#399.0304,.01) fields are changed.
This field is used in routines IBCU61 and IBCU62 fields to determine if the REVENUE CODE should be
removed and replaced during the "automated revenue code generation" process. If the MANUALLY
EDITED field is equal to "1" then the REVENUE CODE should not be changed by the "automated revenue
code generation" process.
WRITE AUTHORITY:^
NOTES: TRIGGERED by the CHARGES field of the REVENUE CODE sub-field of the BILL/CLAIMS File
399,43 OP VISITS DATE(S) OP;0 DATE Multiple #399.043 (Add New Entry without Asking)
DESCRIPTION:
This identifies the outpatient visit date(s) which are included on this bill.
399.043,.01 OP VISITS DATE(S) 0;1 DATE (Multiply asked)
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:Y<1!('$D(IBIFN))!('$$OPV^IBCU41(X,IBIFN)) X I $D(X) S DINUM=X
LAST EDITED: SEP 03, 1993
HELP-PROMPT: Enter outpatient dates which are covered by this bill. These dates must be included within the
period which this statement covers.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 399^AOPV^MUMPS
1)= S ^DGCR(399,"AOPV",$P(^DGCR(399,DA(1),0),U,2),$E(X,1,30),DA(1))=""
2)= K ^DGCR(399,"AOPV",$P(^DGCR(399,DA(1),0),U,2),$E(X,1,30),DA(1))
Cross reference of bills by patient and outpatient visit date.
CROSS-REFERENCE: 399^AREV1^MUMPS
1)= S DGRVRCAL=1
2)= S DGRVRCAL=2
Variable causes revenue codes and chrges to be re-calculated on return to the enter/edit billing
screens.
399,44 REASON(S) DISAPPROVED-INITIAL D1;0 POINTER Multiple #399.044 (Add New Entry without Asking)
DESCRIPTION:
This defines the reason(s) why this billing record was disapproved during the initial review phase.
399.044,.01 REASON(S) DISAPPROVED-INITIAL 0;1 POINTER TO MCCR INCONSISTENT DATA ELEMENTS FILE (#399.4) (Multiply asked)
LAST EDITED: MAY 23, 1988
HELP-PROMPT: Select reason(s) why this billing record has been disapproved.
CROSS-REFERENCE: 399.044^B
1)= S ^DGCR(399,DA(1),"D1","B",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(1),"D1","B",$E(X,1,30),DA)
399,45 REASON(S) DISAPPROVED-SECOND D2;0 POINTER Multiple #399.045 (Add New Entry without Asking)
DESCRIPTION: This defines the reason(s) why this billing record was disapproved during the secondary review
phase.
399.045,.01 REASON(S) DISAPPROVED-SECOND 0;1 POINTER TO MCCR INCONSISTENT DATA ELEMENTS FILE (#399.4) (Multiply asked)
LAST EDITED: MAY 23, 1988
HELP-PROMPT: Select reason(s) why this billing record has been disapproved.
CROSS-REFERENCE: 399.045^B
1)= S ^DGCR(399,DA(1),"D2","B",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(1),"D2","B",$E(X,1,30),DA)
399,46 RETURNED LOG DATE/TIME R;0 DATE Multiple #399.046 (Add New Entry without Asking)
DESCRIPTION: This field provides the audit trail of who edited a bill after is has been returned from being
Audited for correction by the approving service. Data in this field is automatically entered by
the system whenever a returned bill is edited and/or returned to fiscal.
399.046,.01 LOG DATE/TIME 0;1 DATE
INPUT TRANSFORM: S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 05, 1990
DESCRIPTION:
This is the date and time that this entry was edited.
CROSS-REFERENCE: 399.046^B
1)= S ^DGCR(399,DA(1),"R","B",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(1),"R","B",$E(X,1,30),DA)
399.046,.02 USER 0;2 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: OCT 04, 1990
DESCRIPTION:
This is the user who edited or returned the bill.
399.046,.03 RETURNED COMMENTS 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<3) X
LAST EDITED: JUN 06, 1990
HELP-PROMPT: Answer must be 3-80 characters in length.
DESCRIPTION: Enter any comments that you would like stored with this bill. This may include documentation of
any changes and why they occured.
399.046,.04 RETURN TO A/R? 0;4 FREE TEXT
INPUT TRANSFORM: I $D(X) D YN^IBCU
OUTPUT TRANSFORM: S Y=$S(Y:"YES",Y=0:"NO",1:"")
LAST EDITED: SEP 21, 1992
HELP-PROMPT: Answer must be 1 character in length.
DESCRIPTION: Enter 'Yes' if you are returning this bill to Accounts Receivable at this time. Enter 'No' if
you do not wish to return this bill at this time.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 399.046^AC
1)= S ^DGCR(399,DA(1),"R","AC",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(1),"R","AC",$E(X,1,30),DA)
399,47 VALUE CODE CV;0 POINTER Multiple #399.047 (Add New Entry without Asking)
INDEXED BY: VALUE CODE (AC)
399.047,.01 VALUE CODE 0;1 POINTER TO MCCR UTILITY FILE (#399.1) (Multiply asked)
INPUT TRANSFORM:S DIC("S")="I +$P($G(^DGCR(399.1,+Y,0)),U,11),$$ALLOWVC^IBCVC(DA(1),+Y)",D="C^B" D MIX^DIC1 K DIC S
DIC=$G(DIE),X=+Y K:Y<0 X
LAST EDITED: JAN 21, 2014
HELP-PROMPT: Enter a Value Code that applies to this bill.
SCREEN: S DIC("S")="I +$P($G(^DGCR(399.1,+Y,0)),U,11),$$ALLOWVC^IBCVC(DA(1),+Y)"
EXPLANATION: Value Codes Only!
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE:399.047^B
1)= S ^DGCR(399,DA(1),"CV","B",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(1),"CV","B",$E(X,1,30),DA)
FIELD INDEX: AC (#723) MUMPS ACTION
Short Descr: VALUE field clean up
Description: If the VALUE CODE field is modified, make sure the VALUE field associated with it is still VALID.
If not, delete the VALUE.
Set Logic: D REMOVE^IBCVC(.DA)
Set Cond: S X=$$COND^IBCVC(.DA,X1(1),X2(1))
Kill Logic: Q
X(1): VALUE CODE (399.047,.01) (forwards)
399.047,.02 VALUE 0;2 FREE TEXT
INPUT TRANSFORM:K:'$$FORMCHK^IBCVC(X,.DA) X
MAXIMUM LENGTH: 10
LAST EDITED: MAR 28, 2023
TECHNICAL DESCR:
The executable help includes the input constraints .
EXECUTABLE HELP:D HELP^IBCVC
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,48 OTHER CARE OT;0 POINTER Multiple #399.048
DESCRIPTION:
Allows definition of the type of care to be other than the standard inpatient or outpatient.
TECHNICAL DESCR:
Used to identify the charges applied to the dates of care.
399.048,.01 OTHER CARE 0;1 POINTER TO MCCR UTILITY FILE (#399.1) (Multiply asked)
INPUT TRANSFORM:S DIC("S")="I +$P($G(^DGCR(399.1,+Y,0)),U,5),+$P($G(^DGCR(399.1,+Y,0)),U,25)" D ^DIC K DIC S DIC=DI
E,X=+Y K:Y<0 X
LAST EDITED: JAN 22, 2004
HELP-PROMPT: Identify care other than Inpatient or Outpatient.
DESCRIPTION: Identification of a range of dates for care to be other than the standard Inpatient or Outpatient.
Reasonable Charges will be applied for the type of care entered.
SCREEN: S DIC("S")="I +$P($G(^DGCR(399.1,+Y,0)),U,5),+$P($G(^DGCR(399.1,+Y,0)),U,25)"
EXPLANATION: Bedsections available for Other Care.
CROSS-REFERENCE:399.048^B
1)= S ^DGCR(399,DA(1),"OT","B",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(1),"OT","B",$E(X,1,30),DA)
399.048,.02 START DATE 0;2 DATE (Required)
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X) D OTDAT^IBCU4
LAST EDITED: JAN 22, 2004
HELP-PROMPT: Enter the date the patient began this type of care.
DESCRIPTION:
This is the date the patient entered this type of care.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399.048,.03 END DATE 0;3 DATE (Required)
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X) D OTDAT^IBCU4
LAST EDITED: JAN 22, 2004
HELP-PROMPT: Enter the date this type of care ended for the patient.
DESCRIPTION:
This is the date this type of care ended for the patient.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,51 *CPT PROCEDURE CODE (1) C;1 POINTER TO CPT FILE (#81)
CPT PROCEDURE CODE (1)
INPUT TRANSFORM: S DIC("S")="I $P(^(0),""^"",1)?5N" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JAN 22, 1992
HELP-PROMPT: CPT procedure codes may be selected if CPT is specified as the Procedure Coding Method for this
bill.
DESCRIPTION: This is a CPT outpatient procedure code.
This field has been marked for deletion 11/4/91.
SCREEN: S DIC("S")="I $P(^(0),""^"",1)?5N"
EXPLANATION: Only CPT codes may be selected!!
399,52 *CPT PROCEDURE CODE (2) C;2 POINTER TO CPT FILE (#81)
CPT PROCEDURE CODE (2)
INPUT TRANSFORM: S DIC("S")="I $P(^(0),""^"",1)?5N" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JAN 22, 1992
HELP-PROMPT: CPT outpatient procedure codes may only be selected if CPT is specified as the Procedure Coding
Method for this outpatient bill.
DESCRIPTION: This is a CPT outpatient procedure code.
This field has been marked for deletion on 11/4/91.
SCREEN: S DIC("S")="I $P(^(0),""^"",1)?5N"
EXPLANATION: Only CPT codes may be selected!!
399,53 *CPT PROCEDURE CODE (3) C;3 POINTER TO CPT FILE (#81)
CPT PROCEDURE CODE (3)
INPUT TRANSFORM: S DIC("S")="I $P(^(0),""^"",1)?5N" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JAN 22, 1992
HELP-PROMPT: CPT outpatient procedure codes may only be selected if CPT is specified as the Procedure Coding
Method for this outpatient bill.
DESCRIPTION: This is a CPT outpatient procedure code.
This field has been marked for deletion on 11/4/91.
SCREEN: S DIC("S")="I $P(^(0),""^"",1)?5N"
EXPLANATION: Only CPT codes may be selected!!
399,54 *ICD PROCEDURE CODE (1) C;4 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: JAN 22, 1992
HELP-PROMPT: Enter ICD procedure code associated with the outpatient episode of care.
DESCRIPTION: This is an ICD outpatient procedure code.
This field is marked for deletion on 11/4/91.
399,55 *ICD PROCEDURE CODE (2) C;5 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
ICD PROCEDURE CODE (2)
LAST EDITED: JAN 22, 1992
HELP-PROMPT: Enter ICD procedure code associated with this outpatient episode of care.
DESCRIPTION: This is an ICD outpatient procedure code.
This field is marked of deletion on 11/4/91.
399,56 *ICD PROCEDURE CODE (3) C;6 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
ICD PROCEDURE CODE (3)
LAST EDITED: JAN 22, 1992
HELP-PROMPT: Enter ICD procedure code associated with this outpatient episode of care.
DESCRIPTION: This is an ICD outpatient procedure code.
This field is marked for deletion on 11/4/91.
399,57 *HCFA PROCEDURE CODE (1) C;7 POINTER TO CPT FILE (#81)
HCFA PROCEDURE CODE (1)
INPUT TRANSFORM: S D="F" D IX^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JAN 22, 1992
HELP-PROMPT: Enter HCFA procedure code associated with this outpatient episode of care.
DESCRIPTION: This is a HCFA outpatient procedure code.
This field is marked for deletion on 11/4/91.
SCREEN: S DIC("S")="I $P(^(0),""^"",1)?1A.N"
EXPLANATION: Only HCFA codes may be selected!!
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,58 *HCFA PROCEDURE CODE (2) C;8 POINTER TO CPT FILE (#81)
HCFA PROCEDURE CODE (2)
INPUT TRANSFORM: S D="F" D IX^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JAN 22, 1992
HELP-PROMPT: Enter HCFA procedure code associated with this outpatient episode of care.
DESCRIPTION: This is a HCFA outpatient procedure code.
This field has been marked for deletion on 11/4/91.
SCREEN: S DIC("S")="I $P(^(0),""^"",1)?1A.N"
EXPLANATION: Only HCFA codes may be selected!!
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,59 *HCFA PROCEDURE CODE (3) C;9 POINTER TO CPT FILE (#81)
*HCFA PROCDURE CODE (3)
INPUT TRANSFORM: S D="F" D IX^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JAN 22, 1992
HELP-PROMPT: Enter HCFA procedure code associated with this outpatient episode of care.
DESCRIPTION: This is a HCFA outpatient procedure code.
This field has been marked for deletion on 11/4/91.
SCREEN: S DIC("S")="I $P(^(0),""^"",1)?1A.N"
EXPLANATION: Only HCFA codes may be selected!!
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,60 OUTPATIENT DIAGNOSIS C;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>45!($L(X)<1)!'(X?1U.ANP) X
LAST EDITED: JUN 13, 1990
HELP-PROMPT: Answer must be 1-45 characters in length.
DESCRIPTION:
The outpatient diagnosis is selectable from the ICD DIAGNOSIS file.
WRITE AUTHORITY: ^
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,61 *PROCDEDURE DATE (1) C;11 DATE (Required)
PROCEDURE DATE (1)
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y I $D(X) D DTMES^IBCU7
LAST EDITED: NOV 04, 1991
HELP-PROMPT: TYPE A DATE ON OR BEFORE TODAY
DESCRIPTION: This is the date on which the first procedure associated with this billing episode occurred.
This field has been marked for deletion on 11/4/91.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,62 *PROCEDURE DATE (2) C;12 DATE (Required)
PROCEDURE DATE (2)
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y I $D(X) D DTMES^IBCU7
LAST EDITED: NOV 04, 1991
DESCRIPTION: This is the date on which the second procedure associated with this billing episode occurred.
This field has been marked for deletion on 11/4/91.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,63 *PROCEDURE DATE (3) C;13 DATE (Required)
PROCEDURE DATE (3)
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y I $D(X) D DTMES^IBCU7
LAST EDITED: NOV 04, 1991
HELP-PROMPT: TYPE A DATE ON OR BEFORE TODAY
DESCRIPTION: This is the date on which the third procedure associated with this billing episode occurred.
This field has been marked for deletion on 11/4/91.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,65 *ICD DIAGNOSIS CODE (2) C;15 POINTER TO ICD DIAGNOSIS FILE (#80)
ICD DIAGNOSIS CODE (2)
LAST EDITED: NOV 10, 1993
HELP-PROMPT: Enter the ICD diagnosis code which pertains to this billing episode.
DESCRIPTION:
This is the second ICD diagnosis code associated with this billing episode.
TECHNICAL DESCR:
Replaced by a diagnosis file (362.3) with IB v2.0. "*" for deletion on 11/10/93.
399,66 *ICD DIAGNOSIS CODE (3) C;16 POINTER TO ICD DIAGNOSIS FILE (#80)
ICD DIAGNOSIS CODE (3)
LAST EDITED: NOV 10, 1993
HELP-PROMPT: Enter the ICD diagnosis code which pertains to this billing episode.
DESCRIPTION:
This is the third ICD diagnosis code associated with this billing episode.
TECHNICAL DESCR:
Replaced by a diagnosis file (362.3) with IB v2.0. "*" for deletion on 11/10/93.
399,67 *ICD DIAGNOSIS CODE (4) C;17 POINTER TO ICD DIAGNOSIS FILE (#80)
ICD DIAGNOSIS CODE (4)
LAST EDITED: NOV 10, 1993
HELP-PROMPT: Enter the ICD diagnosis code which pertains to this billing episode.
DESCRIPTION:
This is the fourth ICD diagnosis code associated with this billing episode.
TECHNICAL DESCR:
Replaced by a diagnosis file (362.3) with IB v2.0. "*" for deletion on 11/10/93.
399,68 *ICD DIAGNOSIS CODE (5) C;18 POINTER TO ICD DIAGNOSIS FILE (#80)
ICD DIAGNOSIS CODE (5)
LAST EDITED: NOV 10, 1993
HELP-PROMPT: Enter the ICD diagnosis code which pertains to this billing episode.
DESCRIPTION:
This is the fifth ICD diagnosis code associated with this billing episode.
TECHNICAL DESCR:
Replaced by a diagnosis file (362.3) with IB v2.0. "*" for deletion on 11/10/93.
399,77 MRA REQUEST CLAIM COMMENTS TXC;0 DATE Multiple #399.077 (Add New Entry without Asking)
LAST EDITED: NOV 05, 2007
DESCRIPTION: This multiple structure is available only for those claims in a status of 2 - REQUEST MRA. This
will allow the users to enter comments either in TPJI or in the MRA worklist that pertain to this
claim during the time the MRA request claim is sent to Medicare and before the MRA secondary claim
is authorized to the secondary payer.
Once entered, comments may not be edited or deleted by the users.
399.077,.01 COMMENT ENTERED DATE 0;1 DATE
INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:X<1 X
LAST EDITED: NOV 15, 2007
HELP-PROMPT: (No range limit on date)
DESCRIPTION: This is the date/time the comment was entered into the system. Set automatically. Don't edit
through Fileman.
CROSS-REFERENCE: 399.077^B
1)= S ^DGCR(399,DA(1),"TXC","B",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(1),"TXC","B",$E(X,1,30),DA)
CROSS-REFERENCE: ^^TRIGGER^399.077^.02
1)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"TXC",D1,0)):^(0),1:
"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=DUZ X ^DD(399.077,.01,1,2,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"TXC",DIV(1),0)),DIV=X S $P(^(0),U,2)=DIV,DIH=399.077,DIG=.02 D ^DI
CR
2)= Q
CREATE VALUE)= S X=DUZ
DELETE VALUE)= NO EFFECT
FIELD)= COMMENT ENTERED BY
399.077,.02 COMMENT ENTERED BY 0;2 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: NOV 05, 2007
DESCRIPTION: This is the user who entered the comment. Set by the system automatically. Don't edit through
Fileman.
NOTES: TRIGGERED by the COMMENT ENTERED DATE field of the MRA REQUEST CLAIM COMMENTS sub-field of the
BILL/CLAIMS File
399.077,.03 COMMENTS 1;0 WORD-PROCESSING #399.0771
LAST EDITED: NOV 15, 2007
399,78 EOB CLAIM COMMENTS TXC2;0 DATE Multiple #399.078 (Add New Entry without Asking)
DESCRIPTION: This multiple structure is available only for those claims on the COB Management Worklist. This
will allow the users to view comments either in TPJI or in the COB worklist.
Once entered, comments may not be edited or deleted by the users.
399.078,.01 EOB CLAIM COMMENTS 0;1 DATE
INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:X<1 X
LAST EDITED: OCT 08, 2010
HELP-PROMPT: (No range limit on date)
DESCRIPTION: This is the date/time the comment was entered into the system. Set automatically. Don't edit
through Fileman.
CROSS-REFERENCE: 399.078^B
1)= S ^DGCR(399,DA(1),"TXC2","B",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(1),"TXC2","B",$E(X,1,30),DA)
CROSS-REFERENCE: ^^TRIGGER^399.078^.02
1)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"TXC2",D1,0)):^(0),1
:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=DUZ X ^DD(399.078,.01,1,2,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"TXC2",DIV(1),0)),DIV=X S $P(^(0),U,2)=DIV,DIH=399.078,DIG=.02 D ^D
ICR
2)= Q
CREATE VALUE)= S X=DUZ
DELETE VALUE)= NO EFFECT
FIELD)= #.02
This trigger stores the user who added the comment in the COMMENT ENTERED BY (#.02) field of this
subfile (#399.078).
399.078,.02 COMMENT ENTERED BY 0;2 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: AUG 30, 2010
DESCRIPTION: This is the user who entered the comment. Set by the system automatically. Don't edit through
Fileman.
WRITE AUTHORITY:^
NOTES: TRIGGERED by the EOB CLAIM COMMENTS field of the EOB CLAIM COMMENTS sub-field of the BILL/CLAIMS
File
399.078,.03 COMMENTS 1;0 WORD-PROCESSING #399.0781 (IGNORE "|")
DESCRIPTION: These are the comments entered from the COB Management worklist for non-Medicare claims. They can
be viewed from either TPJI or the COB Management worklist.
LAST EDITED: AUG 30, 2010
399,92 BANDING DATE DEN;1 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 28, 2017
HELP-PROMPT: Enter the date the patient's orthodontic appliances were placed.
DESCRIPTION:
This is the date the patient's orthodontic appliances were placed.
399,93 TREATMENT MONTHS COUNT DEN;2 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999999999999999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JUN 28, 2017
HELP-PROMPT: Enter the estimated number of treatment months in whole numbers.
DESCRIPTION:
This is the estimated number of treatment months.
399,94 TREATMENT MONTHS REMAINING DEN;3 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999999999999999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JUN 28, 2017
HELP-PROMPT: Enter the number of months remaining required for a transfer patient, in whole numbers.
DESCRIPTION:
This is the number of months remaining required for a transfer patient.
399,95 TREATMENT INDICATOR DEN;4 SET
'1' FOR YES;
LAST EDITED: SEP 05, 2017
HELP-PROMPT: Enter 'YES' if services reported on this claim are for orthodontic purposes. Otherwise, leave
blank. REQUIRED when neither Treatment Months nor Treatment Months Remaining are present.
DESCRIPTION: This field indicates that services reported on this claim are for orthodontic purposes. REQUIRED
when neither Treatment Months nor Treatment Months Remaining are present.
399,96 TOOTH NUMBER DEN1;0 Multiple #399.096 (Add New Entry without Asking)
LAST EDITED: SEP 01, 2017
DESCRIPTION:
This is a multiple field defining the teeth that the dental services were related to.
IDENTIFIED BY: STATUS CODE(#.02)
399.096,.01 TOOTH NUMBER 0;1 NUMBER (Multiply asked)
INPUT TRANSFORM: K:+X'=X!(X>32)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: NOV 28, 2017
HELP-PROMPT: Type a number between 1 and 32, 0 decimal digits.
DESCRIPTION:
This is the tooth number (between 1 and 32) that is either missing or is to be extracted.
CROSS-REFERENCE: 399.096^B
1)= S ^DGCR(399,DA(1),"DEN1","B",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(1),"DEN1","B",$E(X,1,30),DA)
399.096,.02 STATUS CODE 0;2 SET
'E' FOR EXTRACTED;
'M' FOR MISSING;
LAST EDITED: JUN 28, 2017
HELP-PROMPT: Select the code that indicates whether a tooth will be extracted or is missing.
DESCRIPTION:
This code indicates whether a tooth will be extracted or is missing.
399,97 DENTAL CLAIM NOTE DEN2;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<1) X
MAXIMUM LENGTH: 80
LAST EDITED: JUN 28, 2017
HELP-PROMPT: Enter information that is needed to substantiate the medical treatment, 1 to 80 characters.
DESCRIPTION: This is an 80 character free text field to allow for the entry of information that is needed to
substantiate medical treatment.
399,101 PRIMARY INSURANCE CARRIER M;1 POINTER TO INSURANCE COMPANY FILE (#36) (Required)
INPUT TRANSFORM: D DD^IBCNS S DIC("S")="I $D(IBDD(+Y)),'$D(^DGCR(399,DA,""AIC"",+Y))" D ^DIC K DIC,IBDD S DIC=DIE,X=
+Y K:Y<0 X
LAST EDITED: NOV 12, 2015
HELP-PROMPT: Enter name of insurance carrier to which this bill is to be sent.
DESCRIPTION: This is the name of the insurance carrier to which this bill is to be sent. This is from the
entries in this patient's file of insurance companies.
TECHNICAL DESCR: Only valid/active insurance companies for this patient can be choosen, as defined by DD^IBCNS.
Company must not already be defined as a carrier (399,102-103) for this bill.
SCREEN: S DIC("S")="I $D(IBDD(+Y)),'$D(^DGCR(399,DA,""AIC"",+Y))"
EXPLANATION: Only valid insurance companies for this date of care.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the PRIMARY INSURANCE POLICY field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^122
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,2),X
=X S DIU=X K Y S X=DIV S X=$$PRVNUM^IBCU(DA,X,1) X ^DD(399,101,1,1,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,2)=DIV,DIH=399,DIG=122 D ^DICR
2)= Q
3)= Do Not Delete
CREATE VALUE)= S X=$$PRVNUM^IBCU(DA,X,1)
DELETE VALUE)= NO EFFECT
FIELD)= PRIMARY PROVIDER #
This trigger sets the Bill Primary Provider # based on the Form Type, using the Primary Insurance
Companies Hospital or Professional Provider Number. Special case for Medicare Part A.
CROSS-REFERENCE: ^^TRIGGER^399^24
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X I $$COBN^IBCEF(DA)=1 I X S X=DIV S Y(1)=$S($D(^DGCR(399,
D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y X ^DD(399,101,1,2,1.1) X ^DD(399,101,1,2,1
.4)
1.1)= S X=DIV S X=$S($$REQMRA^IBEFUNC(DA):"1N",1:"")
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"TX")):^("TX"),1:""),DIV=X S $P(^("TX"),U,5)=DIV,DIH=399,DIG=24
D ^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X I $$COBN^IBCEF(DA)=1 I X S X=DIV S Y(1)=$S($D(^DGCR(399,
D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" X ^DD(399,101,1,2,2.4)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"TX")):^("TX"),1:""),DIV=X S $P(^("TX"),U,5)=DIV,DIH=399,DIG=24
D ^DICR:$O(^DD(DIH,DIG,1,0))>0
3)= DO NOT DELETE
CREATE CONDITION)= I $$COBN^IBCEF(DA)=1
CREATE VALUE)= S X=$S($$REQMRA^IBEFUNC(DA):"1N",1:"")
DELETE CONDITION)= I $$COBN^IBCEF(DA)=1
DELETE VALUE)= @
FIELD)= CLAIM MRA STATUS
This triggers the CLAIM MRA STATUS to 'MRA NEEDED' (1N) if the primary insurance is the current
insurance and the current insurance = MEDICARE WNR.
CROSS-REFERENCE: ^^TRIGGER^399^27
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$S($$MCRWNR^IBEFUNC(X):$$COBN^IBCEF(DA)=1,1:0) I X S
X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" X ^DD
(399,101,1,3,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,8)=DIV,DIH=399,DIG=27 D ^DICR
2)= Q
3)= Do not delete
CREATE CONDITION)= S X=$S($$MCRWNR^IBEFUNC(X):$$COBN^IBCEF(DA)=1,1:0)
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= FORCE CLAIM TO PRINT
When the current insurance is the primary insurance and the primary insurance is MEDICARE WNR,
delete the FORCE CLAIM TO PRINT field as it is not valid to print an MRA request.
CROSS-REFERENCE: ^^TRIGGER^399^128
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,10),
X=X S DIU=X K Y S X=DIV S X=$$PRVQUAL^IBCU(DA,X,1) X ^DD(399,101,1,4,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,10)=DIV,DIH=399,DIG=128 D ^DICR
2)= Q
CREATE VALUE)= S X=$$PRVQUAL^IBCU(DA,X,1)
DELETE VALUE)= NO EFFECT
FIELD)= PRIMARY ID QUALIFIER
CROSS-REFERENCE: ^^TRIGGER^399^27
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$CREATE^IBCEF84(DA) I X S X=DIV S Y(1)=$S($D(^DGCR(
399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X=DIV S X=1 X ^DD(399,101,1,5,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,8)=DIV,DIH=399,DIG=27 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$DELETE^IBCEF84(DA) I X S X=DIV S Y(1)=$S($D(^DGCR(
399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" X ^DD(399,101,1,5,2.4)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,8)=DIV,DIH=399,DIG=27 D ^DICR
CREATE CONDITION)= S X=$$CREATE^IBCEF84(DA)
CREATE VALUE)= S X=1
DELETE CONDITION)= S X=$$DELETE^IBCEF84(DA)
DELETE VALUE)= @
FIELD)= FORCE CLAIM TO PRINT
This trigger is designed to set the FORCE CLAIM TO PRINT field 27 equal to 1 for SECONDARY MEDICARE
WNR claims if the carrier field PRINT SEC MED CLAIMS W/O MRA, 6.1 is set. If the current value of
field 27, FORCE CLAIM TO PRINT is equal to 1, and field 101, PRIMARY INSURANCE CARRIER is changed
to a carrier where field 6.1, PRINT SEC MED CLAIMS W/O MRA is not set, then the value in field 27,
FORCE CLAIM TO PRINT, is deleted.
CROSS-REFERENCE: ^^TRIGGER^399^140
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,1),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,1)=DIV,DIH=399,DIG=140
D ^DICR
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= PRIMARY PAYER-ALT ID TYPE
This trigger removes PRIMARY PAYER-ALT ID TYPE when PRIMARY INSURANCE CARRIER is changed since ID
Type is dependent on INSURANCE CARRIER.
CROSS-REFERENCE: ^^TRIGGER^399^141
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,2),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,2)=DIV,DIH=399,DIG=141
D ^DICR
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= PRIMARY PAYER-ALT ID
This trigger removes PRIMARY PAYER-ALT ID when PRIMARY INSURANCE CARRIER is changed since ID is
dependent on INSURANCE CARRIER.
RECORD INDEXES: AE (#477), AUPDID (#139)
399,102 SECONDARY INSURANCE CARRIER M;2 POINTER TO INSURANCE COMPANY FILE (#36)
INPUT TRANSFORM: D ^DIC K DIC,IBDD S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: NOV 12, 2015
HELP-PROMPT: Enter name of secondary insurance carrier from which the provider might expect some payment for
this bill.
DESCRIPTION: This is the name of the secondary insurance carrier from which the provider might expect some
payment for this bill.
SCREEN: S DIC("S")="I $D(IBDD(+Y)),'$D(^DGCR(399,DA,""AIC"",+Y))"
EXPLANATION: Only valid insurance companies for this date of care.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the SECONDARY INSURANCE POLICY field of the BILL/CLAIMS File
CROSS-REFERENCE: 399^AI2^MUMPS
1)= Q
2)= Q
CROSS-REFERENCE: ^^TRIGGER^399^123
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,3),X
=X S DIU=X K Y S X=DIV S X=$$PRVNUM^IBCU(DA,X,2) X ^DD(399,102,1,2,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,3)=DIV,DIH=399,DIG=123 D ^DICR
2)= Q
3)= Do Not Delete
CREATE VALUE)= S X=$$PRVNUM^IBCU(DA,X,2)
DELETE VALUE)= NO EFFECT
FIELD)= SECONDARY PROVIDER
This trigger sets the Bill Secondary Provider # based on the Form Type, using the Secondary
Insurance Companies Hospital or Professional Provider Number. Special case for Medicare Part A.
CROSS-REFERENCE: ^^TRIGGER^399^24
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X I $$COBN^IBCEF(DA)=2 I X S X=DIV S Y(1)=$S($D(^DGCR(399,
D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y X ^DD(399,102,1,3,1.1) X ^DD(399,102,1,3,1
.4)
1.1)= S X=DIV S X=$S($$REQMRA^IBEFUNC(DA):"1N",1:"")
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"TX")):^("TX"),1:""),DIV=X S $P(^("TX"),U,5)=DIV,DIH=399,DIG=24
D ^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X I $$COBN^IBCEF(DA)=2 I X S X=DIV S Y(1)=$S($D(^DGCR(399,
D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" X ^DD(399,102,1,3,2.4)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"TX")):^("TX"),1:""),DIV=X S $P(^("TX"),U,5)=DIV,DIH=399,DIG=24
D ^DICR:$O(^DD(DIH,DIG,1,0))>0
3)= DO NOT DELETE
CREATE CONDITION)= I $$COBN^IBCEF(DA)=2
CREATE VALUE)= S X=$S($$REQMRA^IBEFUNC(DA):"1N",1:"")
DELETE CONDITION)= I $$COBN^IBCEF(DA)=2
DELETE VALUE)= @
FIELD)= CLAIM MRA STATUS
This trigger forces the CLAIM MRA STATUS field to be set appropriately if the current insurance is
the secondary insurance company and it will require an MRA request.
CROSS-REFERENCE: ^^TRIGGER^399^27
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$S($$MCRWNR^IBEFUNC(X):$$COBN^IBCEF(DA)=2,1:0) I X S
X=DIV S Y(1)=$S($D(^DGCR(399,D0,"TX")):^("TX"),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" X ^DD
(399,102,1,4,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"TX")),DIV=X S $P(^("TX"),U,8)=DIV,DIH=399,DIG=27 D ^DICR
2)= Q
3)= Do not delete
CREATE CONDITION)= S X=$S($$MCRWNR^IBEFUNC(X):$$COBN^IBCEF(DA)=2,1:0)
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= FORCE CLAIM TO PRINT
When the current insurance is the secondary insurance and the secondary insurance is MEDICARE WNR,
delete the FORCE CLAIM TO PRINT field as it is not valid to print an MRA request.
CROSS-REFERENCE: ^^TRIGGER^399^129
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,11),
X=X S DIU=X K Y S X=DIV S X=$$PRVQUAL^IBCU(DA,X,2) X ^DD(399,102,1,5,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,11)=DIV,DIH=399,DIG=129 D ^DICR
2)= Q
CREATE VALUE)= S X=$$PRVQUAL^IBCU(DA,X,2)
DELETE VALUE)= NO EFFECT
FIELD)= SECONDARY ID QUALIFIER
CROSS-REFERENCE: ^^TRIGGER^399^142
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,3),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,3)=DIV,DIH=399,DIG=142
D ^DICR
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= SECONDARY PAYER-ALT ID TYPE
This trigger removes SECONDARY PAYER-ALT ID TYPE when SECONDARY INSURANCE CARRIER is changed since
ID Type is dependent on INSURANCE CARRIER.
CROSS-REFERENCE: ^^TRIGGER^399^143
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,4),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,4)=DIV,DIH=399,DIG=143
D ^DICR
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= SECONDARY PAYER-ALT ID
This trigger removes SECONDARY PAYER-ALT ID when SECONDARY INSURANCE CARRIER is changed since ID is
dependent on INSURANCE CARRIER.
RECORD INDEXES: AE (#477), AUPDID (#139)
399,103 TERTIARY INSURANCE CARRIER M;3 POINTER TO INSURANCE COMPANY FILE (#36)
INPUT TRANSFORM: D ^DIC K DIC,IBDD S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: NOV 12, 2015
HELP-PROMPT: Enter name of tertiary insurance carrier from which the provider might expect some payment for this
bill.
DESCRIPTION: This is the name of the tertiary insurance carrier from which the provider might expect some
payment for this bill.
SCREEN: S DIC("S")="I $D(IBDD(+Y)),'$D(^DGCR(399,DA,""AIC"",+Y))"
EXPLANATION: Only valid insurance companies for this date of care.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the TERTIARY INSURANCE POLICY field of the BILL/CLAIMS File
CROSS-REFERENCE: 399^AI3^MUMPS
1)= Q
2)= Q
CROSS-REFERENCE: ^^TRIGGER^399^124
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,4),X
=X S DIU=X K Y S X=DIV S X=$$PRVNUM^IBCU(DA,X,3) X ^DD(399,103,1,2,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,4)=DIV,DIH=399,DIG=124 D ^DICR
2)= Q
3)= Do Not Delete
CREATE VALUE)= S X=$$PRVNUM^IBCU(DA,X,3)
DELETE VALUE)= NO EFFECT
FIELD)= TERTIARY PROVIDER
This trigger sets the Bill Tertiary Provider # based on the Form Type, using the Tertiary
Insurance Companies Hospital or Professional Provider Number. Special case for Medicare Part A.
CROSS-REFERENCE: ^^TRIGGER^399^130
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,12),
X=X S DIU=X K Y S X=DIV S X=$$PRVQUAL^IBCU(DA,X,3) X ^DD(399,103,1,3,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,12)=DIV,DIH=399,DIG=130 D ^DICR
2)= Q
CREATE VALUE)= S X=$$PRVQUAL^IBCU(DA,X,3)
DELETE VALUE)= NO EFFECT
FIELD)= TERTIARY ID QUALIFIER
CROSS-REFERENCE: ^^TRIGGER^399^145
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,6),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,6)=DIV,DIH=399,DIG=145
D ^DICR
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= TERTIARY PAYER-ALT ID
This trigger removes TERTIARY PAYER-ALT ID when TERTIARY INSURANCE CARRIER is changed since ID is
dependent on INSURANCE CARRIER.
CROSS-REFERENCE: ^^TRIGGER^399^144
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,5),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,5)=DIV,DIH=399,DIG=144
D ^DICR
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= TERTIARY PAYER-ALT ID TYPE
This trigger removes TERTIARY PAYER-ALT ID TYPE when TERTIARY INSURANCE CARRIER is changed since ID
Type is dependent on INSURANCE CARRIER.
RECORD INDEXES: AE (#477), AUPDID (#139)
399,104 MAILING ADDRESS NAME M;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: MAY 23, 1988
HELP-PROMPT: Enter the name or title of the person to which this bill is to be sent.
DESCRIPTION:
This is the name of the party to whom this bill is to be sent.
399,105 MAILING ADDRESS STREET M;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>35!($L(X)<3) X
LAST EDITED: JAN 31, 1989
HELP-PROMPT: Enter the 3-35 character street address to which this bill is to be mailed.
DESCRIPTION:
This is the street address to which this bill is to be sent.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,106 MAILING ADDRESS STREET2 M;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>35!($L(X)<3) X
HELP-PROMPT: Enter the 3-35 character street address to which this bill is to be mailed.
DESCRIPTION:
This is the street address to which this bill is to be sent.
399,107 MAILING ADDRESS CITY M;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>25!($L(X)<2) X
LAST EDITED: FEB 13, 1989
HELP-PROMPT: Enter the 2-25 character city to which this bill is to be mailed.
DESCRIPTION:
This is the city to which this bill is to be sent.
399,108 MAILING ADDRESS STATE M;8 POINTER TO STATE FILE (#5)
LAST EDITED: MAY 23, 1988
HELP-PROMPT: Enter the state to which this bill is to be mailed.
DESCRIPTION:
This is the state to which this bill is to be sent.
399,109 MAILING ADDRESS ZIP CODE M;9 FREE TEXT
INPUT TRANSFORM: S:$E(X,6)="-" X=$TR(X,"-") K:$L(X)>9!($L(X)<5)!'(X?5N!(X?9N)) X
LAST EDITED: MAY 10, 1999
HELP-PROMPT: Enter the 5-digit or 9-digit zip code to which this bill is to be sent.
DESCRIPTION:
This is the 5-digit or 9-digit zip code to which this bill is to be sent.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,110 *PATIENT SHORT MAILING ADDRESS M;10 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>47!($L(X)<1) X
LAST EDITED: FEB 07, 2007
HELP-PROMPT: Answer with the 1-47 character short form of the patient mailing address. This is all the
information run together with a maximum of 47 characters.
DESCRIPTION: This is the 1-47 character patient mailing address that will print in block 11 on the UB-82 form
and block 13 on the UB-92. The computer will try to calculate this. If the length of all the
patient address fields is longer than 47 characters you will need to abbreviate this in order to
get it to print in this block.
This field is marked for deletion and can be deleted 11/23/2008.
399,111 RESPONSIBLE INSTITUTION M;11 POINTER TO INSTITUTION FILE (#4) (Required)
LAST EDITED: MAY 15, 1990
HELP-PROMPT: Enter name of the institution or organization responsible for payment of this bill.
DESCRIPTION:
This is the name of the institution or organization responsible for payment of this bill.
CROSS-REFERENCE: 399^AML^MUMPS
1)= D MAILIN^IBCU5
2)= D DEL^IBCU5
Sets/deletes mailing address.
CROSS-REFERENCE: 399^AREV5^MUMPS
1)= S DGRVRCAL=1
2)= S DGRVRCAL=2
Variable causes revenue codes and chrges to be re-calculated on return to the enter/edit billing
screens.
399,112 PRIMARY INSURANCE POLICY M;12 FREE TEXT
INPUT TRANSFORM: K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>20!($L(X)<1) X D:$D(X) DD^IBCNS2(X,DA,1)
OUTPUT TRANSFORM: S Y=$$TRANS^IBCNS2($G(DA,D0),Y)
LAST EDITED: SEP 03, 2014
HELP-PROMPT: Select this patient's insurance policy that is the primary policy to be billed. Enter the name of
the Ins. Company or its internal entry number.
DESCRIPTION:
The policy to be billed for this episode of care.
EXECUTABLE HELP: D DDHELP^IBCNS2(DA,1)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the WHO'S RESPONSIBLE FOR BILL? field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^101
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M")):^("M"),1:"") S X=$P(Y(1),U,1),X=X
S DIU=X K Y X ^DD(399,112,1,1,1.1) X ^DD(399,112,1,1,1.4)
1.1)= S X=DIV S X=+$$INSCO^IBCNS2(DA,$P(^DGCR(399,DA,"M"),U,12))
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"M")):^("M"),1:""),DIV=X S $P(^("M"),U,1)=DIV,DIH=399,DIG=101 D
^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M")):^("M"),1:"") S X=$P(Y(1),U,1),X=X
S DIU=X K Y S X="" X ^DD(399,112,1,1,2.4)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"M")):^("M"),1:""),DIV=X S $P(^("M"),U,1)=DIV,DIH=399,DIG=101 D
^DICR
CREATE VALUE)= S X=+$$INSCO^IBCNS2(DA,$P(^DGCR(399,DA,"M"),U,12))
DELETE VALUE)= @
FIELD)= #101
CROSS-REFERENCE: 399^AI11^MUMPS
1)= D IX^IBCNS2(DA,"I1")
2)= D KIX^IBCNS2(DA,"I1")
Sets "I1" x-ref and "aic" x-ref for bill/claims file. These indexes previously were set by field
#101.
CROSS-REFERENCE: ^^TRIGGER^399^136
1)= X ^DD(399,112,1,3,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U
,2),X=X S DIU=X K Y S X=DIV S X=$$BPP^IBCNS2(DA,1) X ^DD(399,112,1,3,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$S($D(^DD(399,.21,0)):$P(^(0),U,3),1:"")
,Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,21)_":",2),$C(59),1)="PRIMA
RY INSURANCE"
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,2)=DIV,DIH=399,DIG=136
D ^DICR
2)= X ^DD(399,112,1,3,2.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U
,2),X=X S DIU=X K Y S X="" X ^DD(399,112,1,3,2.4)
2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$S($D(^DD(399,.21,0)):$P(^(0),U,3),1:"")
,Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,21)_":",2),$C(59),1)="PRIMA
RY INSURANCE"
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,2)=DIV,DIH=399,DIG=136
D ^DICR
CREATE CONDITION)= CURRENT BILL PAYER SEQUENCE="PRIMARY INSURANCE"
CREATE VALUE)= S X=$$BPP^IBCNS2(DA,1)
DELETE CONDITION)= CURRENT BILL PAYER SEQUENCE="PRIMARY INSURANCE"
DELETE VALUE)= @
FIELD)= BILL PAYER POLICY
If this is a Primary Bill then set Bill Payer to the Primary Payer.
CROSS-REFERENCE: ^^TRIGGER^399^163
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,13),X=
X S DIU=X K Y S X=DIV S X=$$AUTH^IBCNS4(D0,X) S DIH=$G(^DGCR(399,DIV(0),"U")),DIV=X S $P(^("U"),U,1
3)=DIV,DIH=399,DIG=163 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,13),X=
X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"U")),DIV=X S $P(^("U"),U,13)=DIV,DIH=399,DIG=163 D
^DICR
CREATE VALUE)= S X=$$AUTH^IBCNS4(D0,X)
DELETE VALUE)= @
FIELD)= TREATMENT AUTH
CROSS-REFERENCE: ^^TRIGGER^399^253
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"UF32")):^("UF32"),1:"") S X=$P(Y(1),U,
1),X=X S DIU=X K Y S X=DIV S X=$$REF^IBCNS4(D0,X) X ^DD(399,112,1,5,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"UF32")),DIV=X S $P(^("UF32"),U,1)=DIV,DIH=399,DIG=253 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"UF32")):^("UF32"),1:"") S X=$P(Y(1),U,
1),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"UF32")),DIV=X S $P(^("UF32"),U,1)=DIV,DIH=399,
DIG=253 D ^DICR
CREATE VALUE)= S X=$$REF^IBCNS4(D0,X)
DELETE VALUE)= @
FIELD)= PRIMARY REF
RECORD INDEXES: AUPDID (#139)
399,113 SECONDARY INSURANCE POLICY M;13 FREE TEXT
INPUT TRANSFORM: K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>20!($L(X)<1) X D:$D(X) DD^IBCNS2(X,DA,2)
OUTPUT TRANSFORM: S Y=$$TRANS^IBCNS2($G(DA,D0),Y)
LAST EDITED: SEP 03, 2014
HELP-PROMPT: Select this patient's insurance policy that is the secondary policy to be billed. Enter the name
of the Ins. Company or its internal entry number.
DESCRIPTION:
The secondary policy to be billed for this episode of care.
EXECUTABLE HELP: D DDHELP^IBCNS2(DA,2)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^399^102
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M")):^("M"),1:"") S X=$P(Y(1),U,2),X=X
S DIU=X K Y X ^DD(399,113,1,1,1.1) X ^DD(399,113,1,1,1.4)
1.1)= S X=DIV S X=+$$INSCO^IBCNS2(DA,+$P(^DGCR(399,DA,"M"),U,13))
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"M")):^("M"),1:""),DIV=X S $P(^("M"),U,2)=DIV,DIH=399,DIG=102 D
^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M")):^("M"),1:"") S X=$P(Y(1),U,2),X=X
S DIU=X K Y S X="" X ^DD(399,113,1,1,2.4)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"M")):^("M"),1:""),DIV=X S $P(^("M"),U,2)=DIV,DIH=399,DIG=102 D
^DICR
CREATE VALUE)= S X=+$$INSCO^IBCNS2(DA,+$P(^DGCR(399,DA,"M"),U,13))
DELETE VALUE)= @
FIELD)= SECONDARY INSURANCE CARRIER
CROSS-REFERENCE: 399^AI21^MUMPS
1)= D IX^IBCNS2(DA,"I2")
2)= D KIX^IBCNS2(DA,"I2")
Sets "I2" x-ref and "aic" x-ref for bill/claims file. These indexes previously were set by field
#102.
CROSS-REFERENCE: ^^TRIGGER^399^136
1)= X ^DD(399,113,1,3,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U
,2),X=X S DIU=X K Y S X=DIV S X=$$BPP^IBCNS2(DA,1) X ^DD(399,113,1,3,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$S($D(^DD(399,.21,0)):$P(^(0),U,3),1:"")
,Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,21)_":",2),$C(59),1)="SECON
DARY INSURANCE"
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,2)=DIV,DIH=399,DIG=136
D ^DICR
2)= X ^DD(399,113,1,3,2.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U
,2),X=X S DIU=X K Y S X="" X ^DD(399,113,1,3,2.4)
2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$S($D(^DD(399,.21,0)):$P(^(0),U,3),1:"")
,Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,21)_":",2),$C(59),1)="SECON
DARY INSURANCE"
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,2)=DIV,DIH=399,DIG=136
D ^DICR
CREATE CONDITION)= CURRENT BILL PAYER SEQUENCE="SECONDARY INSURANCE"
CREATE VALUE)= S X=$$BPP^IBCNS2(DA,1)
DELETE CONDITION)= CURRENT BILL PAYER SEQUENCE="SECONDARY INSURANCE"
DELETE VALUE)= @
FIELD)= BILL PAYER POLICY
If this is a Secondary Bill then set the Bill Payer to the Secondary Payer.
CROSS-REFERENCE: ^^TRIGGER^399^230
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,8),X
=X S DIU=X K Y S X=DIV S X=$$AUTH^IBCNS4(D0,X) S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),
U,8)=DIV,DIH=399,DIG=230 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,8),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,8)=DIV,DIH=399,DIG=230
D ^DICR
CREATE VALUE)= S X=$$AUTH^IBCNS4(D0,X)
DELETE VALUE)= @
FIELD)= SECONDARY AUTH
CROSS-REFERENCE: ^^TRIGGER^399^254
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"UF32")):^("UF32"),1:"") S X=$P(Y(1),U,
2),X=X S DIU=X K Y S X=DIV S X=$$REF^IBCNS4(D0,X) X ^DD(399,113,1,5,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"UF32")),DIV=X S $P(^("UF32"),U,2)=DIV,DIH=399,DIG=254 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"UF32")):^("UF32"),1:"") S X=$P(Y(1),U,
2),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"UF32")),DIV=X S $P(^("UF32"),U,2)=DIV,DIH=399,
DIG=254 D ^DICR
CREATE VALUE)= S X=$$REF^IBCNS4(D0,X)
DELETE VALUE)= @
FIELD)= SECONDARY REF
RECORD INDEXES: AUPDID (#139)
399,114 TERTIARY INSURANCE POLICY M;14 FREE TEXT
INPUT TRANSFORM: K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>20!($L(X)<1) X D:$D(X) DD^IBCNS2(X,DA,3)
OUTPUT TRANSFORM: S Y=$$TRANS^IBCNS2($G(DA,D0),Y)
LAST EDITED: SEP 03, 2014
HELP-PROMPT: Select this patient's insurance policy that is the tertiary policy to be billed. Enter the name of
the Ins. Company or its internal entry number.
DESCRIPTION:
The tertiary policy to be billed for this episode of care.
EXECUTABLE HELP: D DDHELP^IBCNS2(DA,3)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^399^103
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M")):^("M"),1:"") S X=$P(Y(1),U,3),X=X
S DIU=X K Y X ^DD(399,114,1,1,1.1) X ^DD(399,114,1,1,1.4)
1.1)= S X=DIV S X=+$$INSCO^IBCNS2(DA,+$P(^DGCR(399,DA,"M"),U,14))
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"M")):^("M"),1:""),DIV=X S $P(^("M"),U,3)=DIV,DIH=399,DIG=103 D
^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M")):^("M"),1:"") S X=$P(Y(1),U,3),X=X
S DIU=X K Y S X="" X ^DD(399,114,1,1,2.4)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"M")):^("M"),1:""),DIV=X S $P(^("M"),U,3)=DIV,DIH=399,DIG=103 D
^DICR
CREATE VALUE)= S X=+$$INSCO^IBCNS2(DA,+$P(^DGCR(399,DA,"M"),U,14))
DELETE VALUE)= @
FIELD)= TERTIARY INSURANCE CARRIER
CROSS-REFERENCE: 399^AI31^MUMPS
1)= D IX^IBCNS2(DA,"I3")
2)= D KIX^IBCNS2(DA,"I3")
Sets "I3" x-ref and "aic" x-ref for bill/claims file. These indexes previously were set by field
#103.
CROSS-REFERENCE: ^^TRIGGER^399^136
1)= X ^DD(399,114,1,3,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U
,2),X=X S DIU=X K Y S X=DIV S X=$$BPP^IBCNS2(DA) X ^DD(399,114,1,3,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$S($D(^DD(399,.21,0)):$P(^(0),U,3),1:"")
,Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,21)_":",2),$C(59),1)="TERTI
ARY INSURANCE"
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,2)=DIV,DIH=399,DIG=136
D ^DICR
2)= X ^DD(399,114,1,3,2.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U
,2),X=X S DIU=X K Y S X="" X ^DD(399,114,1,3,2.4)
2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(2)=$C(59)_$S($D(^DD(399,.21,0)):$P(^(0),U,3),1:"")
,Y(1)=$S($D(^DGCR(399,D0,0)):^(0),1:"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,21)_":",2),$C(59),1)="TERTI
ARY INSURANCE"
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,2)=DIV,DIH=399,DIG=136
D ^DICR
CREATE CONDITION)= CURRENT BILL PAYER SEQUENCE="TERTIARY INSURANCE"
CREATE VALUE)= S X=$$BPP^IBCNS2(DA)
DELETE CONDITION)= CURRENT BILL PAYER SEQUENCE="TERTIARY INSURANCE"
DELETE VALUE)= @
FIELD)= BILL PAYER POLICY
If this is a Tertiary Bill then set the Bill Payer to the Tertiary Payer.
CROSS-REFERENCE: ^^TRIGGER^399^231
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,9),X
=X S DIU=X K Y S X=DIV S X=$$AUTH^IBCNS4(D0,X) S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),
U,9)=DIV,DIH=399,DIG=231 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,9),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,9)=DIV,DIH=399,DIG=231
D ^DICR
CREATE VALUE)= S X=$$AUTH^IBCNS4(D0,X)
DELETE VALUE)= @
FIELD)= TERTIARY AUTH
CROSS-REFERENCE: ^^TRIGGER^399^255
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"UF32")):^("UF32"),1:"") S X=$P(Y(1),U,
3),X=X S DIU=X K Y S X=DIV S X=$$REF^IBCNS4(D0,X) X ^DD(399,114,1,5,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"UF32")),DIV=X S $P(^("UF32"),U,3)=DIV,DIH=399,DIG=255 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"UF32")):^("UF32"),1:"") S X=$P(Y(1),U,
3),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"UF32")),DIV=X S $P(^("UF32"),U,3)=DIV,DIH=399,
DIG=255 D ^DICR
CREATE VALUE)= S X=$$REF^IBCNS4(D0,X)
DELETE VALUE)= @
FIELD)= TERTIARY REF
RECORD INDEXES: AUPDID (#139)
399,121 MAILING ADDRESS STREET3 M1;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>35!($L(X)<3) X
LAST EDITED: JAN 10, 1989
HELP-PROMPT: Enter the 3-35 character street address to which this bill is to be sent.
DESCRIPTION:
This is the street address to which this bill is to be sent.
399,122 PRIMARY PROVIDER # M1;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>13!($L(X)<3)!($TR(X," ")="") X
LAST EDITED: MAR 06, 2009
HELP-PROMPT: Answer must be 3-13 characters in length.
DESCRIPTION: This is the number assigned to the provider by the primary payer. Printed in Form Locator 57 for
the Primary Insurance Carrier on the UB-04.
TECHNICAL DESCR: This field is set via the "ABP" new-style MUMPS x-refs from the following fields in the BILL/CLAIMS
file (#399) and in the IB BILL/CLAIMS PRESCRIPTION REFILL file (#362.4):
399,.22 - DEFAULT DIVISION
399,232 - NON-VA FACILITY
399,136 - BILL PAYER POLICY
399,.19 - FORM TYPE 362.4,.02 - BILL NUMBER
Whenever these fields are edited, the billing provider may change and this may also change the
billing provider secondary IDs and Qualifiers for all payers on the claim.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the PRIMARY INSURANCE CARRIER field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^128
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(
1),U,2)="" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,10),X=X S DIU=X
K Y S X="" X ^DD(399,122,1,1,2.4)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,10)=DIV,DIH=399,DIG=128 D ^DICR
CREATE VALUE)= NO EFFECT
DELETE CONDITION)= PRIMARY PROVIDER #=""
DELETE VALUE)= @
FIELD)= PRIMARY ID QUALIFIER
This trigger will delete the PRIMARY ID QUALIFIER when the PRIMARY PROVIDER # is deleted
399,123 SECONDARY PROVIDER # M1;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>13!($L(X)<3)!($TR(X," ")="") X
LAST EDITED: MAR 06, 2009
HELP-PROMPT: Answer must be 3-13 characters in length.
DESCRIPTION: This is the number assigned to the provider by the secondary payer. Printed in Form Locator 57 for
the Secondary Insurance Carrier on the UB-04.
TECHNICAL DESCR: This field is set via the "ABP" new-style MUMPS x-refs from the following fields in the BILL/CLAIMS
file (#399) and in the IB BILL/CLAIMS PRESCRIPTION REFILL file (#362.4):
399,.22 - DEFAULT DIVISION
399,232 - NON-VA FACILITY
399,136 - BILL PAYER POLICY
399,.19 - FORM TYPE 362.4,.02 - BILL NUMBER
Whenever these fields are edited, the billing provider may change and this may also change the
billing provider secondary IDs and Qualifiers for all payers on the claim.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the SECONDARY INSURANCE CARRIER field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^129
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(
1),U,3)="" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,11),X=X S DIU=X
K Y S X="" X ^DD(399,123,1,1,2.4)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,11)=DIV,DIH=399,DIG=129 D ^DICR
CREATE VALUE)= NO EFFECT
DELETE CONDITION)= SECONDARY PROVIDER #=""
DELETE VALUE)= @
FIELD)= SECONDARY ID QUALIFIER
This trigger will delete the SECONDARY ID QUALIFIER when the SECONDARY PROVIDER # is deleted
399,124 TERTIARY PROVIDER # M1;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>13!($L(X)<3)!($TR(X," ")="") X
LAST EDITED: MAR 06, 2009
HELP-PROMPT: Answer must be 3-13 characters in length.
DESCRIPTION: This is the number assigned to the provider by the tertiary payer. Printed in Form Locator 57 for
the Tertiary Insurance Carrier on the UB-04.
TECHNICAL DESCR: This field is set via the "ABP" new-style MUMPS x-refs from the following fields in the BILL/CLAIMS
file (#399) and in the IB BILL/CLAIMS PRESCRIPTION REFILL file (#362.4):
399,.22 - DEFAULT DIVISION
399,232 - NON-VA FACILITY
399,136 - BILL PAYER POLICY
399,.19 - FORM TYPE 362.4,.02 - BILL NUMBER
Whenever these fields are edited, the billing provider may change and this may also change the
billing provider secondary IDs and Qualifiers for all payers on the claim.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the TERTIARY INSURANCE CARRIER field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^130
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(
1),U,4)="" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"M1")):^("M1"),1:"") S X=$P(Y(1),U,12),X=X S DIU=X
K Y S X="" X ^DD(399,124,1,1,2.4)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"M1")),DIV=X S $P(^("M1"),U,12)=DIV,DIH=399,DIG=130 D ^DICR
CREATE VALUE)= NO EFFECT
DELETE CONDITION)= TERTIARY PROVIDER #=""
DELETE VALUE)= @
FIELD)= TERTIARY ID QUALIFIER
This trigger will delete the TERTIARY ID QUALIFIER when the TERTIARY PROVIDER # is deleted
399,125 PRIMARY BILL # M1;5 POINTER TO BILL/CLAIMS FILE (#399)
INPUT TRANSFORM: S DIC("S")="I $P(^(0),U,21)=""P""" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: AUG 21, 1997
HELP-PROMPT: Enter the Primary Bill in the series for this episode of care.
DESCRIPTION:
This is the bill to the Primary Payer for the episode(s) on this bill.
SCREEN: S DIC("S")="I $P(^(0),U,21)=""P"""
EXPLANATION: Primary Bills Only!
NOTES: TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
399,126 SECONDARY BILL # M1;6 POINTER TO BILL/CLAIMS FILE (#399)
INPUT TRANSFORM: S DIC("S")="I $P(^(0),U,21)=""S""" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: AUG 21, 1997
HELP-PROMPT: Enter the Secondary Bill in the series for this episode of care.
DESCRIPTION:
This is the bill to the Secondary Payer for the episode(s) on this bill.
SCREEN: S DIC("S")="I $P(^(0),U,21)=""S"""
EXPLANATION: Secondary Bills Only!
NOTES: TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
399,127 TERTIARY BILL # M1;7 POINTER TO BILL/CLAIMS FILE (#399)
INPUT TRANSFORM: S DIC("S")="I $P(^(0),U,21)=""T""" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: AUG 21, 1997
HELP-PROMPT: Enter the Tertiary Bill in the series for this episode of care.
DESCRIPTION:
This is the bill to the Tertiary Payer for the episode(s) on this bill.
SCREEN: S DIC("S")="I $P(^(0),U,21)=""T"""
EXPLANATION: Tertiary Bills Only!
NOTES: TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
399,128 PRIMARY ID QUALIFIER M1;10 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97)
INPUT TRANSFORM: S DIC("S")="I $$BPS^IBCEPU(Y)!($$EPT^IBCEPU(Y))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: MAR 06, 2009
HELP-PROMPT: Enter the Qualifier for the Primary Insurance ID #
DESCRIPTION:
This is the qualifier for PRIMARY PROVIDER #.
TECHNICAL DESCR: This field is set via the "ABP" new-style MUMPS x-refs from the following fields in the BILL/CLAIMS
file (#399) and in the IB BILL/CLAIMS PRESCRIPTION REFILL file (#362.4):
399,.22 - DEFAULT DIVISION
399,232 - NON-VA FACILITY
399,136 - BILL PAYER POLICY
399,.19 - FORM TYPE 362.4,.02 - BILL NUMBER
Whenever these fields are edited, the billing provider may change and this may also change the
billing provider secondary IDs and Qualifiers for all payers on the claim.
SCREEN: S DIC("S")="I $$BPS^IBCEPU(Y)!($$EPT^IBCEPU(Y))"
EXPLANATION: Only Billing Provider Secondary IDs allowed
NOTES: TRIGGERED by the PRIMARY INSURANCE CARRIER field of the BILL/CLAIMS File
TRIGGERED by the PRIMARY PROVIDER # field of the BILL/CLAIMS File
399,129 SECONDARY ID QUALIFIER M1;11 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97)
INPUT TRANSFORM: S DIC("S")="I $$BPS^IBCEPU(Y)!($$EPT^IBCEPU(Y))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: MAR 06, 2009
HELP-PROMPT: Enter the Qualifier for the Secondary Insurance ID #
DESCRIPTION:
This is the qualifier for the SECONDARY PROVIDER #.
TECHNICAL DESCR: This field is set via the "ABP" new-style MUMPS x-refs from the following fields in the BILL/CLAIMS
file (#399) and in the IB BILL/CLAIMS PRESCRIPTION REFILL file (#362.4):
399,.22 - DEFAULT DIVISION
399,232 - NON-VA FACILITY
399,136 - BILL PAYER POLICY
399,.19 - FORM TYPE 362.4,.02 - BILL NUMBER
Whenever these fields are edited, the billing provider may change and this may also change the
billing provider secondary IDs and Qualifiers for all payers on the claim.
SCREEN: S DIC("S")="I $$BPS^IBCEPU(Y)!($$EPT^IBCEPU(Y))"
EXPLANATION: Only Billing Provider Secondary IDs allowed
NOTES: TRIGGERED by the SECONDARY INSURANCE CARRIER field of the BILL/CLAIMS File
TRIGGERED by the SECONDARY PROVIDER # field of the BILL/CLAIMS File
399,130 TERTIARY ID QUALIFIER M1;12 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97)
INPUT TRANSFORM: S DIC("S")="I $$BPS^IBCEPU(Y)!($$EPT^IBCEPU(Y))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: MAR 06, 2009
HELP-PROMPT: Enter the Qualifier for the Tertiary Insurance ID #
DESCRIPTION:
This is the qualifier for the TERTIARY PROVIDER #.
TECHNICAL DESCR: This field is set via the "ABP" new-style MUMPS x-refs from the following fields in the BILL/CLAIMS
file (#399) and in the IB BILL/CLAIMS PRESCRIPTION REFILL file (#362.4):
399,.22 - DEFAULT DIVISION
399,232 - NON-VA FACILITY
399,136 - BILL PAYER POLICY
399,.19 - FORM TYPE 362.4,.02 - BILL NUMBER
Whenever these fields are edited, the billing provider may change and this may also change the
billing provider secondary IDs and Qualifiers for all payers on the claim.
SCREEN: S DIC("S")="I $$BPS^IBCEPU(Y)!($$EPT^IBCEPU(Y))"
EXPLANATION: Only Billing Provider Secondary IDs allowed
NOTES: TRIGGERED by the TERTIARY INSURANCE CARRIER field of the BILL/CLAIMS File
TRIGGERED by the TERTIARY PROVIDER # field of the BILL/CLAIMS File
399,135 BILL PAYER CARRIER MP;1 POINTER TO INSURANCE COMPANY FILE (#36)
INPUT TRANSFORM: S DIC("S")="I $D(^DGCR(399,DA,""AIC"",+Y))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: MAR 05, 1999
HELP-PROMPT: Select the Insurance Carrier responsible for this bill.
DESCRIPTION: This is the Insurance Carrier responsible for the bill. This may only be set to the Carrier
assigned as Primary, Secondary, or Tertiary carrier that corresponds to the Payer Sequence.
SCREEN: S DIC("S")="I $D(^DGCR(399,DA,""AIC"",+Y))"
EXPLANATION: Only Insurance Companies already assigned to this bill!
NOTES: TRIGGERED by the BILL PAYER POLICY field of the BILL/CLAIMS File
CROSS-REFERENCE: 399^AML2^MUMPS
1)= D MAILA^IBCU5
2)= D DEL^IBCU5
Sets Mailing Address to the address of the Bill Payer.
CROSS-REFERENCE: 399^AREV4^MUMPS
1)= S DGRVRCAL=1
2)= S DGRVRCAL=2
This variable causes the bills charges to be recalculated.
399,136 BILL PAYER POLICY MP;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X K:$G(X)'=$$BPP^IBCNS2(DA) X
OUTPUT TRANSFORM: S Y=$$TRANS^IBCNS2($G(DA,D0),Y)
LAST EDITED: JAN 31, 2003
HELP-PROMPT: Select the policy responsible for this bill.
DESCRIPTION: This is the policy responsible for this bill. This may only be set to the policy assigned as
Primary, Secondary, or Tertiary policy that corresponds to the Payer Sequence.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
TRIGGERED by the PRIMARY INSURANCE POLICY field of the BILL/CLAIMS File
TRIGGERED by the SECONDARY INSURANCE POLICY field of the BILL/CLAIMS File
TRIGGERED by the TERTIARY INSURANCE POLICY field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^135
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X='$$WNRBILL^IBEFUNC(DA) I X S X=DIV S Y(1)=$S($D(^DGC
R(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y X ^DD(399,136,1,1,1.1) X ^DD(399,136
,1,1,1.4)
1.1)= S X=DIV S X=+$$INSCO^IBCNS2(DA,+$P(^DGCR(399,DA,"MP"),U,2))
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,1)=DIV,DIH=399,DIG=135
D ^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,1),X
=X S DIU=X K Y S X="" X ^DD(399,136,1,1,2.4)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"MP")):^("MP"),1:""),DIV=X S $P(^("MP"),U,1)=DIV,DIH=399,DIG=135
D ^DICR:$O(^DD(DIH,DIG,1,0))>0
CREATE CONDITION)= S X='$$WNRBILL^IBEFUNC(DA)
CREATE VALUE)= S X=+$$INSCO^IBCNS2(DA,+$P(^DGCR(399,DA,"MP"),U,2))
DELETE VALUE)= @
FIELD)= BILL PAYER CARRIER
Sets the BILL PAYER CARRIER to the Bill Payer Policy Insurance Company if insurance is not Medicare
- will not reimburse.
RECORD INDEXES: ABP (#820)
399,140 PRIMARY PAYER-ALT ID TYPE M2;1 POINTER TO IB ALTERNATE PRIMARY ID TYPE FILE (#355.98)
INPUT TRANSFORM: S DIC("S")="I $$ACIDS^IBCU(DA,1,+Y)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
LAST EDITED: NOV 19, 2015
HELP-PROMPT: Enter an Alternate Payer ID Type.
DESCRIPTION: This is the Alternate Inst Primary Payer ID Type which is used to identify an Alternate Inst
Primary Payer ID for this payer.
SCREEN: S DIC("S")="I $$ACIDS^IBCU(DA,1,+Y)"
EXPLANATION: Only allow ID types set up in Insurance Company Editor.
NOTES: TRIGGERED by the PRIMARY INSURANCE CARRIER field of the BILL/CLAIMS File
TRIGGERED by the FORM TYPE field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^141
1)= X ^DD(399,140,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U
,2),X=X S DIU=X K Y S X=DIV S X=$$ACIDD^IBCU(DA,1,X) X ^DD(399,140,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(
Y(1),U,2)=""
1.4)= S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,2)=DIV,DIH=399,DIG=141 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,2),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,2)=DIV,DIH=399,DIG=141
D ^DICR
CREATE CONDITION)= #141=""
CREATE VALUE)= S X=$$ACIDD^IBCU(DA,1,X)
DELETE VALUE)= @
FIELD)= #141
Trigger the default Alternate ID for this INSURANCE COMPANY and this FORM TYPE.
399,141 PRIMARY PAYER-ALT ID M2;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1)!($$UP^XLFSTR(X)["PRNT") X
LAST EDITED: NOV 19, 2015
HELP-PROMPT: Answer must be 1-30 characters in length and not contain PRNT.
DESCRIPTION: This is the Alternate Inst Prim Payer ID which is used to route claims to an alternate
administration contractor for certain claims.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the PRIMARY PAYER-ALT ID TYPE field of the BILL/CLAIMS File
TRIGGERED by the PRIMARY INSURANCE CARRIER field of the BILL/CLAIMS File
TRIGGERED by the FORM TYPE field of the BILL/CLAIMS File
399,142 SECONDARY PAYER-ALT ID TYPE M2;3 POINTER TO IB ALTERNATE PRIMARY ID TYPE FILE (#355.98)
INPUT TRANSFORM: S DIC("S")="I $$ACIDS^IBCU(DA,2,+Y)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
LAST EDITED: NOV 19, 2015
HELP-PROMPT: Enter an Alternate Payer ID Type.
DESCRIPTION: This is the Alternate Inst Primary Payer ID Type which is used to identify an Alternate Inst
Primary Payer ID for this payer.
SCREEN: S DIC("S")="I $$ACIDS^IBCU(DA,2,+Y)"
EXPLANATION: Only allow ID types set up in Insurance Company Editor.
NOTES: TRIGGERED by the SECONDARY INSURANCE CARRIER field of the BILL/CLAIMS File
TRIGGERED by the FORM TYPE field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^143
1)= X ^DD(399,142,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U
,4),X=X S DIU=X K Y S X=DIV S X=$$ACIDD^IBCU(DA,2,X) X ^DD(399,142,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(
Y(1),U,4)=""
1.4)= S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,4)=DIV,DIH=399,DIG=143 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,4),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,4)=DIV,DIH=399,DIG=143
D ^DICR
CREATE CONDITION)= #143=""
CREATE VALUE)= S X=$$ACIDD^IBCU(DA,2,X)
DELETE VALUE)= @
FIELD)= #143
Trigger the default Alternate ID for this INSURANCE COMPANY and this FORM TYPE.
399,143 SECONDARY PAYER-ALT ID M2;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1)!($$UP^XLFSTR(X)["PRNT") X
LAST EDITED: NOV 19, 2015
HELP-PROMPT: Answer must be 1-30 characters in length and not contain PRNT.
DESCRIPTION: This is the Alternate Inst Prim Payer ID which is used to route claims to an alternate
administration contractor for certain claims.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the SECONDARY PAYER-ALT ID TYPE field of the BILL/CLAIMS File
TRIGGERED by the SECONDARY INSURANCE CARRIER field of the BILL/CLAIMS File
TRIGGERED by the FORM TYPE field of the BILL/CLAIMS File
399,144 TERTIARY PAYER-ALT ID TYPE M2;5 POINTER TO IB ALTERNATE PRIMARY ID TYPE FILE (#355.98)
INPUT TRANSFORM: S DIC("S")="I $$ACIDS^IBCU(DA,3,+Y)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
LAST EDITED: NOV 19, 2015
HELP-PROMPT: Enter an Alternate Payer ID Type.
DESCRIPTION: This is the Alternate Inst Primary Payer ID Type which is used to identify an Alternate Inst
Primary Payer ID for this payer.
SCREEN: S DIC("S")="I $$ACIDS^IBCU(DA,3,+Y)"
EXPLANATION: Only allow ID types set up in Insurance Company Editor.
NOTES: TRIGGERED by the TERTIARY INSURANCE CARRIER field of the BILL/CLAIMS File
TRIGGERED by the FORM TYPE field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^145
1)= X ^DD(399,144,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U
,6),X=X S DIU=X K Y S X=DIV S X=$$ACIDD^IBCU(DA,3,X) X ^DD(399,144,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(
Y(1),U,6)=""
1.4)= S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,6)=DIV,DIH=399,DIG=145 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"M2")):^("M2"),1:"") S X=$P(Y(1),U,6),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"M2")),DIV=X S $P(^("M2"),U,6)=DIV,DIH=399,DIG=145
D ^DICR
CREATE CONDITION)= #145=""
CREATE VALUE)= S X=$$ACIDD^IBCU(DA,3,X)
DELETE VALUE)= @
FIELD)= #145
Trigger the default Alternate ID for this INSURANCE COMPANY and this FORM TYPE.
399,145 TERTIARY PAYER-ALT ID M2;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1)!($$UP^XLFSTR(X)["PRNT") X
LAST EDITED: NOV 19, 2015
HELP-PROMPT: Answer must be 1-30 characters in length and not contain PRNT.
DESCRIPTION: This is the Alternate Inst Prim Payer ID which is used to route claims to an alternate
administration contractor for certain claims.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the TERTIARY PAYER-ALT ID TYPE field of the BILL/CLAIMS File
TRIGGERED by the TERTIARY INSURANCE CARRIER field of the BILL/CLAIMS File
TRIGGERED by the FORM TYPE field of the BILL/CLAIMS File
399,151 STATEMENT COVERS FROM U;1 DATE (Required)
INPUT TRANSFORM: S %DT="ETP" D ^%DT S X=Y K:Y<1 X I $D(X) D DDAT^IBCU4 K IB00
LAST EDITED: OCT 23, 2001
HELP-PROMPT: Enter the beginning service date of the period included on this bill.
DESCRIPTION: This is the beginning service date of the period covered by this bill. The date range for
inpatient interim bills should not be overlapped.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^399^165
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X I $P(^DGCR(399,DA,0),U,5)<3 I X S X=DIV S Y(1)=$S($D(^DG
CR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y S X=DIV S X=$$LOS1^IBCU64(DA) X ^DD(
399,151,1,1,1.4)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U")):^("U"),1:""),DIV=X S $P(^("U"),U,15)=DIV,DIH=399,DIG=165 D
^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= I $P(^DGCR(399,DA,0),U,5)<3
CREATE VALUE)= S X=$$LOS1^IBCU64(DA)
DELETE VALUE)= NO EFFECT
FIELD)= LENGTH OF STAY
Sets Length of Stay based on PTF record and date range of bill. Inpatient only.
CROSS-REFERENCE: 399^AREV2^MUMPS
1)= S DGRVRCAL=1
2)= S DGRVRCAL=2
Variable causes revenue codes and charges to be re-calculated on return to the enter/edit billing
screens.
CROSS-REFERENCE: ^^TRIGGER^399^201
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X I +$G(^DGCR(399,DA,"U1"))=0 I X S X=DIV S Y(1)=$S($D(^DG
CR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X=DIV S X=0 X ^DD(399,151,1,3,1.4
)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"U1")),DIV=X S $P(^("U1"),U,1)=DIV,DIH=399,DIG=201 D ^DICR
2)= Q
CREATE CONDITION)= I +$G(^DGCR(399,DA,"U1"))=0
CREATE VALUE)= S X=0
DELETE VALUE)= NO EFFECT
FIELD)= TOTAL CHARGE
CROSS-REFERENCE: 399^APDS^MUMPS
1)= S:$P(^DGCR(399,DA,0),"^",2) ^DGCR(399,"APDS",$P(^(0),U,2),-X,DA)=""
2)= K:$P(^DGCR(399,DA,0),"^",2) ^DGCR(399,"APDS",$P(^(0),U,2),-X,DA)
Patients and bills by inverse Statement From Date.
399,152 STATEMENT COVERS TO U;2 DATE (Required)
INPUT TRANSFORM: S %DT="ETP" D ^%DT S X=Y K:Y<1 X I $D(X) D DDAT1^IBCU4 K IB00
LAST EDITED: OCT 18, 1993
HELP-PROMPT: Enter the ending service date of period covered by this bill.
DESCRIPTION: This is the ending service date of the period covered by this bill. The date range for inpatient
interim bills should not be overlapped.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^399^165
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X I $P(^DGCR(399,DA,0),U,5)<3 I X S X=DIV S Y(1)=$S($D(^DG
CR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y S X=DIV S X=$$LOS1^IBCU64(DA) X ^DD(
399,152,1,1,1.4)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U")):^("U"),1:""),DIV=X S $P(^("U"),U,15)=DIV,DIH=399,DIG=165 D
^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE CONDITION)= I $P(^DGCR(399,DA,0),U,5)<3
CREATE VALUE)= S X=$$LOS1^IBCU64(DA)
DELETE VALUE)= NO EFFECT
FIELD)= LENGTH OF STAY
Sets Length of Stay based on PTF record and date range of bill. (Inpatient only.)
CROSS-REFERENCE: 399^AREV3^MUMPS
1)= S DGRVRCAL=1
2)= S DGRVRCAL=2
Variable causes revenue codes and chrges to be re-calculated on return to the enter/edit billing
screens.
399,153 POWER OF ATTORNEY COMPLETED? U;3 FREE TEXT (Required)
INPUT TRANSFORM: I $D(X) D YN^IBCU
OUTPUT TRANSFORM: S Y=$S(Y:"YES",Y=0:"NO",1:"")
LAST EDITED: JUN 07, 1988
HELP-PROMPT: Enter 'Yes' or '1' if Power of Attorney has been completed, 'No' or '0' if Power of Attorney has
not been completed.
DESCRIPTION:
This identifies whether or not the power of attorney forms (if necessary) have been signed.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,154 WHOSE EMPLOYMENT INFO.? U;4 SET (Required)
'p' FOR PATIENT;
's' FOR SPOUSE;
LAST EDITED: MAY 23, 1988
HELP-PROMPT: Enter the code which indicates whether the employment information given applies to the patient or
to the patient's spouse.
DESCRIPTION: This indicates whether the employment information give applies to the patient or to the patient's
spouse.
399,155 IS THIS A SENSITIVE RECORD? U;5 FREE TEXT (Required)
INPUT TRANSFORM: I $D(X) D YN^IBCU
OUTPUT TRANSFORM: S Y=$S(Y:"YES",Y=0:"NO",1:"")
LAST EDITED: JUN 07, 1988
HELP-PROMPT: Enter 'Yes' or '1' if this record contains sensitive information pertaining to, but not limited
to, drugs, alcohol, and/or sickle cell anemia, 'No' or '0' if it does not.
DESCRIPTION: This indicates whether or not this record contains information pertaining to, but not limited to,
drugs, alcohol, or sickle cell anemia, and if so, allows the user to identify this record as
"sensitive".
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,156 ASSIGNMENT OF BENEFITS U;6 FREE TEXT (Required)
INPUT TRANSFORM: I $D(X) D YN^IBCU I $D(X) X:X=0 ^DD(399,156,9.3) K IBRATY
OUTPUT TRANSFORM: S Y=$S(Y="":"","Yy1"[Y:"YES","Nn0"[Y:"NO",1:"")
LAST EDITED: SEP 21, 1999
HELP-PROMPT: Enter the code which indicates whether or not a third party is authorized to pay the provider for
services covered by this bill.
DESCRIPTION: This indicates whether or not a third party is authorized to pay the provider for services covered
by this bill.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the RATE TYPE field of the BILL/CLAIMS File
399,157 R.O.I. FORM(S) COMPLETED? U;7 FREE TEXT
INPUT TRANSFORM: I $D(X) D YN^IBCU S:$G(X)=1 X=$$ROI399^IBNCPDR4($G(DA))
OUTPUT TRANSFORM: S Y=$S(Y:"YES",Y=0:"NO",1:"")
LAST EDITED: OCT 22, 2008
HELP-PROMPT: Enter 'Yes' or '1' if Release Of Information form(s) are completed, 'No' or '0' if Release Of
Information form(s) are not completed.
DESCRIPTION: This allows the user to indicate if the Release of Information forms (if necessary) have been
signed.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,158 TYPE OF ADMISSION U;8 SET
'1' FOR EMERGENCY;
'2' FOR URGENT;
'3' FOR ELECTIVE;
'4' FOR NEWBORN;
'5' FOR TRAUMA;
'9' FOR INFORMATION NOT AVAILABLE;
LAST EDITED: NOV 13, 2008
HELP-PROMPT: Enter a code indicating the priority/type of this admission.
DESCRIPTION:
Enter the Priority/Type of this admission.
NOTES: TRIGGERED by the PTF ENTRY NUMBER field of the BILL/CLAIMS File
TRIGGERED by the BILL CLASSIFICATION field of the BILL/CLAIMS File
TRIGGERED by the BILL CHARGE TYPE field of the BILL/CLAIMS File
399,159 SOURCE OF ADMISSION U;9 SET
'1' FOR PHYSICIAN REFERRAL;
'2' FOR CLINIC REFERRAL;
'3' FOR HMO REFERRAL;
'4' FOR TRANSFER FROM HOSPITAL;
'5' FOR TRANSFER FROM SKILLED NURSING FAC.;
'6' FOR TRANSFER FROM OTHER HEALTH CARE FAC.;
'7' FOR EMERGENCY ROOM;
'8' FOR COURT/LAW ENFORCEMENT;
'9' FOR INFO NOT AVAILABLE;
LAST EDITED: APR 03, 1989
HELP-PROMPT: Enter the code which indicates the source of this admission.
DESCRIPTION: This indicates the source of this admission or how an outpatient came to be treated at the
facility.
NOTES: TRIGGERED by the PTF ENTRY NUMBER field of the BILL/CLAIMS File
399,159.5 NON-PTF ADMISSION HOUR U;20 FREE TEXT
INPUT TRANSFORM: D NOPTF^IBCU
OUTPUT TRANSFORM: S Y=$S(Y=0:"12AM",Y<12:Y_"AM",Y=12:"12PM",Y=99:Y,1:(Y-12)_"PM")
LAST EDITED: FEB 22, 2000
HELP-PROMPT: Type an hour from 0-23 or you may enter 1-12 with AM/PM. Use 99 if hr is unknown.
DESCRIPTION:
This is the actual hour the patient was admitted for non-PTF related bills.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,160 ACCIDENT HOUR U;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1)!(X=99) X
LAST EDITED: FEB 22, 2000
HELP-PROMPT: Enter the hour at which an accident took place if this bill is related to an accident.
DESCRIPTION: This indicates the hour at which an accident occurred if this episode of care is related to an
accident.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,161 DISCHARGE BEDSECTION U;11 POINTER TO MCCR UTILITY FILE (#399.1)
INPUT TRANSFORM: S DIC("S")="I $P(^DGCR(399.1,+Y,0),""^"",5)=1" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JUN 14, 2004
HELP-PROMPT: Enter the bedsection from which this patient was discharged.
DESCRIPTION:
This is the bedsection from which this patient was discharged.
SCREEN: S DIC("S")="I $P(^DGCR(399.1,+Y,0),""^"",5)=1"
EXPLANATION: Valid MCCR Bedsections only!
CROSS-REFERENCE: ^^TRIGGER^399^162
1)= X ^DD(399,161,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P(Y(1),U,1
2),X=X S DIU=X K Y S X=DIV D DIS^IBCU S X=X S DIH=$G(^DGCR(399,DIV(0),"U")),DIV=X S $P(^("U"),U,12)
=DIV,DIH=399,DIG=162 D ^DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"U")):^("U"),1:"") S X=$P($G
(^DGCR(399.1,+$P(Y(1),U,12),0)),U)=""
2)= Q
CREATE CONDITION)= #162=""
CREATE VALUE)= D DIS^IBCU S X=X
DELETE VALUE)= NO EFFECT
FIELD)= #162
Sets the Discharge Status field to the correct status based upon the Disposition Type field in the
PTF Record.
399,162 DISCHARGE STATUS U;12 POINTER TO MCCR UTILITY FILE (#399.1)
INPUT TRANSFORM: S DIC("S")="I $P(^DGCR(399.1,+Y,0),""^"",6)=1" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: AUG 31, 1988
HELP-PROMPT: Enter the code which indicates patient status as of statement covers through date.
DESCRIPTION:
This is the patient status as of the statement covers through date.
SCREEN: S DIC("S")="I $P(^DGCR(399.1,+Y,0),""^"",6)=1"
EXPLANATION: Valid MCCR Discharge Statuses only!
NOTES: TRIGGERED by the PTF ENTRY NUMBER field of the BILL/CLAIMS File
TRIGGERED by the DISCHARGE BEDSECTION field of the BILL/CLAIMS File
399,163 TREATMENT AUTHORIZATION CODE U;13 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
MAXIMUM LENGTH: 50
LAST EDITED: APR 27, 2017
HELP-PROMPT: Answer must be 1-50 characters in length.
DESCRIPTION: This indicates that the treatment covered by this bill has been authorized by the primary payer.
On the CMS-1500 this is box 23, PRIOR AUTHORIZATION NUMBER. On the UB-04, this is reported in
FL63.
NOTES: TRIGGERED by the PRIMARY INSURANCE POLICY field of the BILL/CLAIMS File
399,164 BC/BS PROVIDER # U;14 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>13!($L(X)<3)!'(X?.ANP) X
LAST EDITED: AUG 19, 1991
HELP-PROMPT: Enter the Blue Cross/Shield provider number for this particular billing episode.
DESCRIPTION:
This is the Blue Cross/Blue Shield Provider Number for this billing episode.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the BILL NUMBER field of the BILL/CLAIMS File
399,165 LENGTH OF STAY U;15 FREE TEXT
INPUT TRANSFORM: K:$L(X)>6!($L(X)<1)!'(X?.N) X
LAST EDITED: MAR 15, 2001
HELP-PROMPT: Enter the length of stay for this inpatient episode excluding pass, AA and UA days.
DESCRIPTION:
This defines the length of stay in days for this inpatient episode excluding pass, AA, and UA days.
TECHNICAL DESCR: If no PTF defined then uses the Statement From and To dates for LOS. Excludes pass, AA, UA days
but includes days in non-billable bedsections. Notice that the number of units of service under
revenue code only includes billable bedsections so the number of units may not add up to the length
of stay if the patient was in a non-billable bedsection for awhile. LOS of a stay where admit
day=discharge day is 1. LOS of a stay where admit date+1=discharge date also has an LOS of 1. The
discharge date is not charged. Therefore, on continuous first and interum bills the LOS is the
date range inclusive of the last day on the bill, all other bills exclude the last day (with
exception of admit=discharge day).
NOTES: TRIGGERED by the PTF ENTRY NUMBER field of the BILL/CLAIMS File
TRIGGERED by the STATEMENT COVERS FROM field of the BILL/CLAIMS File
TRIGGERED by the STATEMENT COVERS TO field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^216
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P($G(^DGCR(399,DA,"U2")),U,2)=""&$$INPAT^IBCEF(DA,
1)) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X
=DIV S X=DIV X ^DD(399,165,1,1,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,2)=DIV,DIH=399,DIG=216 D ^DICR
2)= Q
3)= Do not delete
CREATE CONDITION)= S X=($P($G(^DGCR(399,DA,"U2")),U,2)=""&$$INPAT^IBCEF(DA,1))
CREATE VALUE)= LENGTH OF STAY
DELETE VALUE)= NO EFFECT
FIELD)= COVERED DAYS
This cross reference populates the covered days field with the length of stay if the bill is for an
inpatient episode and there is not already a value entered for covered days on this bill.
CROSS-REFERENCE: ^^TRIGGER^399^217
1)= X ^DD(399,165,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U
,3),X=X S DIU=X K Y S X=DIV N Z S X=$$LOS1^IBCU64(DA,.Z),X=+$G(Z) X ^DD(399,165,1,2,1.4)
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=($P($G(^DGCR(399,DA,"U2")),U,3)=""&$$INPAT^IBCEF(D
A,1))
1.4)= S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,3)=DIV,DIH=399,DIG=217 D ^DICR
2)= Q
3)= Do not delete
CREATE CONDITION)= S X=($P($G(^DGCR(399,DA,"U2")),U,3)=""&$$INPAT^IBCEF(DA,1))
CREATE VALUE)= N Z S X=$$LOS1^IBCU64(DA,.Z),X=+$G(Z)
DELETE VALUE)= NO EFFECT
FIELD)= NON-COVERED DAYS
This cross reference populates the non-covered days field with the # of leave/pass days if the bill
is for an inpatient episode and there is not already a value entered for non-covered days on this
bill.
399,166 UNABLE TO WORK FROM U;16 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: SEP 21, 2006
HELP-PROMPT: Enter the beginning date the patient became unable to work due to current condition.
DESCRIPTION: Enter the beginning date for the period of time that the patient could not work due to the
condition for which this claim is being submitted. Printed on the CMS-1500.
399,167 UNABLE TO WORK TO U;17 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: SEP 21, 2006
HELP-PROMPT: Enter the ending date of the time that the patient was unable to work due to current condition.
DESCRIPTION: This is the ending date of the period of time during which the patient was unable to work due to
the condition for which this claim is being submitted. Used on the CMS-1500.
399,168 *PLACE OF SERVICE U;18 POINTER TO PLACE OF SERVICE FILE (#353.1)
LAST EDITED: JUN 11, 1993
HELP-PROMPT: Enter the code corresponding to the Place of Service of patient care.
DESCRIPTION: This indicates the Place of Service, used on the HCFA 1500. Not used after IB v1.5, replaced by
PLACE OF SERVICE (304,8) associated with a specific procedure. Marked for deletion 6/11/93.
399,169 *TYPE OF SERVICE U;19 POINTER TO TYPE OF SERVICE FILE (#353.2)
LAST EDITED: JUN 11, 1993
HELP-PROMPT: Enter the appropriate Type of Service code for this visit.
DESCRIPTION: Code indicating the Type of Service preformed. Used on the HCFA 1500. Not used after IB v1.5,
replaced by TYPE OF SERVICE (304,9) associated with a specific procedure. Marked for deletion
6/11/93.
399,170 PPS U1;15 POINTER TO DRG FILE (#80.2)
Prospective Payment System Code (DRG)
LAST EDITED: NOV 04, 2008
HELP-PROMPT: Enter one DRG from the PTF or enter one from the DRG file.
DESCRIPTION: Accept the default Discharge DRG as the PPS value or enter another DRG from the PTF file or from
the DRG file.
NOTES: TRIGGERED by the PTF ENTRY NUMBER field of the BILL/CLAIMS File
399,201 TOTAL CHARGES U1;1 NUMBER
LAST EDITED: OCT 23, 2001
HELP-PROMPT: Enter the total amount of the revenue code charges for this bill in dollars.
DESCRIPTION:
This is the total amount of the revenue code charges for this bill.
WRITE AUTHORITY: ^
UNEDITABLE
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the STATEMENT COVERS FROM field of the BILL/CLAIMS File
399,202 OFFSET AMOUNT U1;2 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999)!(X<0) X
LAST EDITED: APR 18, 2017
HELP-PROMPT: Enter the dollar amount between 0 and 99999.99 that is to be subtracted from the total charges on
this bill. Offset includes, but is not limited to, co-payments and deductibles.
DESCRIPTION: This is the dollar amount which is to be subtracted from the total charges on this bill. Offset
includes, but is not limited to, co-payments, credits, and deductibles.
NOTES: TRIGGERED by the PRIMARY PRIOR PAYMENT field of the BILL/CLAIMS File
TRIGGERED by the SECONDARY PRIOR PAYMENT field of the BILL/CLAIMS File
TRIGGERED by the TERTIARY PRIOR PAYMENT field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^203
1)= Q
2)= X ^DD(399,202,1,1,2.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U
,3),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"U1")),DIV=X S $P(^("U1"),U,3)=DIV,DIH=399,DIG
=203 D ^DICR
2.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(
Y(1),U,2)="",Y(2)=$G(X) S X=$P(Y(1),U,2)=0,Y=X,X=Y(2),X=X!Y
2.4)= S DIH=$G(^DGCR(399,DIV(0),"U1")),DIV=X S $P(^("U1"),U,3)=DIV,DIH=399,DIG=203 D ^DICR
CREATE VALUE)= NO EFFECT
DELETE CONDITION)= OFFSET AMOUNT=""!(OFFSET AMOUNT=0)
DELETE VALUE)= @
FIELD)= #203
When the OFFSET AMOUNT is deleted or is equal to ZERO, remove the OFFSET DESCRIPTION.
399,203 OFFSET DESCRIPTION U1;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>24!($L(X)<3) X
LAST EDITED: MAR 17, 1994
HELP-PROMPT: Enter reason for Offset Amount. Offset Description may include, but is not limited to,
deductibles, copayments, credits, etc.
DESCRIPTION:
This defines the reason for offset amount. Maximum length is 24 characters.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the OFFSET AMOUNT field of the BILL/CLAIMS File
TRIGGERED by the PRIMARY PRIOR PAYMENT field of the BILL/CLAIMS File
TRIGGERED by the SECONDARY PRIOR PAYMENT field of the BILL/CLAIMS File
TRIGGERED by the TERTIARY PRIOR PAYMENT field of the BILL/CLAIMS File
399,204 *UB82 FORM LOCATOR 2 U1;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<2) X
LAST EDITED: JAN 16, 2007
HELP-PROMPT: Enter the information (2-30 characters) which is to appear in form locator 2 on the UB-82 form.
DESCRIPTION: This allows the user to enter information which will appear in form locator 2 on the UB-82 form.
This field is marked for deletion and can be deleted 11/23/2008.
TECHNICAL DESCR: The name (LABEL) of this field has been changed from: FORM LOCATOR 2 to: UB82 FORM LOCATOR 2 to
distinguish it from field #450.
This field is marked for deletion and can be deleted 11/23/2008.
399,205 *FORM LOCATOR 9 U1;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>7!($L(X)<2) X
LAST EDITED: JAN 16, 2007
HELP-PROMPT: Enter the information (2-7 characters) which will appear in form locator 9 on the UB-82 form.
DESCRIPTION: This allows the user to enter information which will appear in form locator 9 on the UB-82 form.
This field is marked for deletion and can be deleted 11/23/2008.
TECHNICAL DESCR: Was temporarily used to hold Admitting DX for the UB-92 (FL 76), but was replaced by FL 215.
This field is marked for deletion and can be deleted 11/23/2008.
399,206 *FORM LOCATOR 27 U1;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<2) X
LAST EDITED: JAN 16, 2007
HELP-PROMPT: Enter the information (2-8 characters) which is to appear in form locator 27 on the UB-82 form.
DESCRIPTION: This allows the user to enter information will will appear in form locator 27 on the UB-82 form.
This field is marked for deletion and can be deleted 11/23/2008.
399,207 *FORM LOCATOR 45 U1;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<2) X
LAST EDITED: JAN 16, 2007
HELP-PROMPT: Enter the information (2-17 characters) which will appear in form locator 45 on the UB-82 form.
DESCRIPTION: This allows the user to enter information which will appear in form locator 45 on the UB-82 form.
This field is marked for deletion and can be deleted 11/23/2008.
399,208 *BILL COMMENT U1;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>35!($L(X)<2) X
LAST EDITED: FEB 09, 2007
HELP-PROMPT: Answer must be 2-35 characters in length
DESCRIPTION: This field is not used after IB patch 349. The new remarks field for FL-80 on the UB-04 is BILL
REMARKS (field#402).
399,209 *FISCAL YEAR 1 U1;9 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>2!($L(X)<2)!'(X?.N) X
LAST EDITED: MAY 22, 2001
HELP-PROMPT: Enter the 2 digit fiscal year associated with this bill.
DESCRIPTION: This defines the first fiscal year with which this bill is associated. OBSOLETE AS OF PATCH
IB*2*137 -- 2001
399,210 *FY 1 CHARGES U1;10 NUMBER (Required)
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
LAST EDITED: MAY 22, 2001
HELP-PROMPT: Enter the charges incurred during the first fiscal year associated with this bill.
DESCRIPTION: These are the charges incurred during the first fiscal year associated with this bill. OBSOLETE AS
OF PATCH IB*2*137 -- 2001
399,211 *FISCAL YEAR 2 U1;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<2)!'(X?.N) X
LAST EDITED: MAY 22, 2001
HELP-PROMPT: Enter the 2 digit second fiscal year associated with this bill.
DESCRIPTION: This is the second fiscal year with which this bill is associated. OBSOLETE AS OF PATCH IB*2*137
-- 2001
TECHNICAL DESCR:
Beginning with 1.5 bills can no longer span fical years, so this is no longer needed.
399,212 *FY 2 CHARGES U1;12 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
LAST EDITED: MAY 22, 2001
HELP-PROMPT: Enter the charges incurred during the second fiscal year associated with this bill.
DESCRIPTION: These are the charges incurred during the second fiscal year associated with this bill. OBSOLETE
AS OF PATCH IB*2*137 -- 2001
WRITE AUTHORITY: ^
399,213 *FORM LOCATOR 92 U1;13 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<3) X
LAST EDITED: JAN 16, 2007
HELP-PROMPT: Answer must be 3-32 characters in length.
DESCRIPTION: This is the Attending Physician ID (UPIN) and is printed on the UB-82 in form locator 92 and form
locator 82 on the UB-92. This field will be loaded with the ATTENDING PHYSICIAN ID code required
by the primary insurer, if that insurer has a code defined.
This field is marked for deletion and can be deleted 11/23/2008.
TECHNICAL DESCR: This field may be null or a value the billing clerk inserted while editing on screen 8 or a value
that the primary insurer requires to print in form locator 92 of the UB-82 or FL 82 of the UB-92.
If the field is null then the print routines print the string 'Dept. of Veterans Affairs' in form
locator 82/92.
This field is marked for deletion and can be deleted 11/23/2008.
399,214 *FORM LOCATOR 93 U1;14 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<3) X
LAST EDITED: MAY 11, 1999
HELP-PROMPT: Answer must be 3-32 characters in length.
DESCRIPTION: Enter the 'Other Physician ID'. The name and/or number of the licensed physician other than the
attending physician or what the primary insurer requires in this field on the form. Will print in
form locator 93 on the UB-82 and form locator 83 on the UB-92.
TECHNICAL DESCR:
This field will be deleted 18 months from 1-1-2000.
399,215 ADMITTING DIAGNOSIS U2;1 POINTER TO ICD DIAGNOSIS FILE (#80)
INPUT TRANSFORM: S ICDVDT=$$BDATE^IBACSV(+$G(DA)),DIC("S")="I $$ICD9ACT^IBACSV(+Y,ICDVDT)",DIC("W")="D EN^DDIOL(""
""_$P($$ICD9^IBACSV(+Y,ICDVDT),U,3),,""?0"")" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
LAST EDITED: JAN 16, 2007
HELP-PROMPT: Enter the code for the admitting diagnosis.
DESCRIPTION: The ICD-9 diagnosis code provided at the time of admission as stated by the physician.
The admitting diagnosis code will be printed in Form Locator 69 on the UB-04.
SCREEN: S ICDVDT=$$BDATE^IBACSV(+$G(DA)),DIC("S")="I $$ICD9ACT^IBACSV(+Y,ICDVDT)",DIC("W")="D EN^DDIOL(""
""_$P($$ICD9^IBACSV(+Y,ICDVDT),U,3),,""?0"")"
EXPLANATION: Only codes active for the date of service may be selected.
NOTES: TRIGGERED by the ORDER field of the IB BILL/CLAIMS DIAGNOSIS File
399,216 COVERED DAYS U2;2 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JAN 17, 2007
HELP-PROMPT: Type a number between 0 and 999, 0 Decimal Digits
DESCRIPTION:
The number of days covered by the primary payer, as qualified by the payer organization.
NOTES: TRIGGERED by the LENGTH OF STAY field of the BILL/CLAIMS File
399,217 NON-COVERED DAYS U2;3 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JAN 17, 2007
HELP-PROMPT: Type a Number between 0 and 9999, 0 Decimal Digits
DESCRIPTION:
Days of care not covered by the primary payer.
NOTES: TRIGGERED by the LENGTH OF STAY field of the BILL/CLAIMS File
399,218 PRIMARY PRIOR PAYMENT U2;4 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<0) X
LAST EDITED: AUG 21, 1997
HELP-PROMPT: Type a Dollar Amount between 0 and 99999999, 2 Decimal Digits
DESCRIPTION:
This is the amount the primary insurance has already paid on this bill.
NOTES: TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^202
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,2),X
=X S DIU=X K Y S X=DIV S X=DIU+DIV X ^DD(399,218,1,1,1.4)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U1")):^("U1"),1:""),DIV=X S $P(^("U1"),U,2)=DIV,DIH=399,DIG=202
D ^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,2),X
=X S DIU=X K Y S X=DIV S X=DIU-X X ^DD(399,218,1,1,2.4)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U1")):^("U1"),1:""),DIV=X S $P(^("U1"),U,2)=DIV,DIH=399,DIG=202
D ^DICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= OFFSET AMOUNT+PRIMARY PRIOR PAYMENT
DELETE VALUE)= OFFSET AMOUNT-OLD PRIMARY PRIOR PAYMENT
FIELD)= OFFSET AMOUNT
Adds Primary Prior Payment to the Offset Amount.
CROSS-REFERENCE: ^^TRIGGER^399^203
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,3),X
=X S DIU=X K Y S X=DIV S X="PRIOR PAYMENT(S)" X ^DD(399,218,1,2,1.4)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U1")):^("U1"),1:""),DIV=X S $P(^("U1"),U,3)=DIV,DIH=399,DIG=203
D ^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE VALUE)= "PRIOR PAYMENT(S)"
DELETE VALUE)= NO EFFECT
FIELD)= OFFSET DESCRIPTION
Sets Offset Description if a Primary Prior Payment is entered.
399,219 SECONDARY PRIOR PAYMENT U2;5 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<0) X
LAST EDITED: AUG 21, 1997
HELP-PROMPT: Type a Dollar Amount between 0 and 99999999, 2 Decimal Digits
DESCRIPTION:
This is the amount the secondary insurance has already paid on this bill.
NOTES: TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^202
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,2),X
=X S DIU=X K Y S X=DIV S X=DIU+DIV X ^DD(399,219,1,1,1.4)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U1")):^("U1"),1:""),DIV=X S $P(^("U1"),U,2)=DIV,DIH=399,DIG=202
D ^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,2),X
=X S DIU=X K Y S X=DIV S X=DIU-X X ^DD(399,219,1,1,2.4)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U1")):^("U1"),1:""),DIV=X S $P(^("U1"),U,2)=DIV,DIH=399,DIG=202
D ^DICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= OFFSET AMOUNT+SECONDARY PRIOR PAYMENT
DELETE VALUE)= OFFSET AMOUNT-OLD SECONDARY PRIOR PAYMENT
FIELD)= OFFSET AMOUNT
Adds the Secondary Prior Payment to the Offset Amount.
CROSS-REFERENCE: ^^TRIGGER^399^203
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,3),X
=X S DIU=X K Y S X=DIV S X="PRIOR PAYMENT(S)" X ^DD(399,219,1,2,1.4)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U1")):^("U1"),1:""),DIV=X S $P(^("U1"),U,3)=DIV,DIH=399,DIG=203
D ^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE VALUE)= "PRIOR PAYMENT(S)"
DELETE VALUE)= NO EFFECT
FIELD)= OFFSET DESCRIPTION
Sets Offset Description if a Secondary Prior Payment is entered.
399,220 TERTIARY PRIOR PAYMENT U2;6 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<0) X
LAST EDITED: AUG 21, 1997
HELP-PROMPT: Type a Dollar Amount between 0 and 99999999, 2 Decimal Digits
DESCRIPTION:
This is the amount the tertiary insurance has already paid on this bill.
NOTES: TRIGGERED by the CURRENT BILL PAYER SEQUENCE field of the BILL/CLAIMS File
CROSS-REFERENCE: ^^TRIGGER^399^202
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,2),X
=X S DIU=X K Y S X=DIV S X=DIU+DIV X ^DD(399,220,1,1,1.4)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U1")):^("U1"),1:""),DIV=X S $P(^("U1"),U,2)=DIV,DIH=399,DIG=202
D ^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,2),X
=X S DIU=X K Y S X=DIV S X=DIU-X X ^DD(399,220,1,1,2.4)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U1")):^("U1"),1:""),DIV=X S $P(^("U1"),U,2)=DIV,DIH=399,DIG=202
D ^DICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= OFFSET AMOUNT+TERTIARY PRIOR PAYMENT
DELETE VALUE)= OFFSET AMOUNT-OLD TERTIARY PRIOR PAYMENT
FIELD)= OFFSET AMOUNT
Adds the Tertiary Prior Payments to the Offset Amount.
CROSS-REFERENCE: ^^TRIGGER^399^203
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U1")):^("U1"),1:"") S X=$P(Y(1),U,3),X
=X S DIU=X K Y S X=DIV S X="PRIOR PAYMENT(S)" X ^DD(399,220,1,2,1.4)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U1")):^("U1"),1:""),DIV=X S $P(^("U1"),U,3)=DIV,DIH=399,DIG=203
D ^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
CREATE VALUE)= "PRIOR PAYMENT(S)"
DELETE VALUE)= NO EFFECT
FIELD)= OFFSET DESCRIPTION
Sets the Offset Description if a Tertiary Prior Payment is entered.
399,221 CO-INSURANCE DAYS U2;7 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JAN 17, 2007
HELP-PROMPT: Type a number between 0 and 999, 0 Decimal Digits
DESCRIPTION:
This is the # of days.
399,222 PROVIDER PRV;0 SET Multiple #399.0222 (Add New Entry without Asking)
LAST EDITED: APR 26, 2001
SCREEN: S DIC("S")="I $$PRVOK^IBCEU(+Y,$S($D(D0):D0,1:$G(DA)))"
EXPLANATION: Rendering is for prof only. Operating/Attending are for inst only.
IDENTIFIED BY: PERFORMED BY(#.02)
INDEXED BY: DELETE 2006 .09 (AUPDID1), DELETE 2006 .1 (AUPDID2), DELETE 2006 .11 (AUPDID3)
399.0222,.01 FUNCTION 0;1 SET (Required) (Multiply asked)
'1' FOR REFERRING;
'2' FOR OPERATING;
'3' FOR RENDERING;
'4' FOR ATTENDING;
'5' FOR SUPERVISING;
'9' FOR OTHER OPERATING;
'6' FOR ASSISTANT SURGEON;
LAST EDITED: OCT 05, 2017
HELP-PROMPT: Select the function performed by a provider for this bill.
DESCRIPTION: There are providers who performed specific functions for the services on this bill. These
providers are needed to enable the V.A. to collect reimbursement when more than one provider
function is involved in the billable episode (like an operating physician or referring provider).
This data identifies the type of function that was performed by a provider. There can only be 1
provider recorded for each function on a claim.
SCREEN: S DIC("S")="I $$PRVOK^IBCEU(+Y,$S($G(D0):D0,1:$G(DA)))"
EXPLANATION: Function must match bill form type. Use '??' to see the function definitions.
EXECUTABLE HELP: D PRVHELP^IBCEU5
PRE-LOOKUP: S X=$$UP^XLFSTR(X)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 399.0222^B
1)= S ^DGCR(399,DA(1),"PRV","B",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(1),"PRV","B",$E(X,1,30),DA)
CROSS-REFERENCE: ^^TRIGGER^399.0222^.04
1)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=Y(0),X=X S X=X'=1 I X S X=DIV S Y
(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X="" X ^DD(399.02
22,.01,1,2,1.4)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"PRV",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,4)=DIV,DIH=399.022
2,DIG=.04 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:
"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X="" X ^DD(399.0222,.01,1,2,2.4)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"PRV",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,4)=DIV,DIH=399.022
2,DIG=.04 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
3)= Do not delete
CREATE CONDITION)= INTERNAL(PROVIDER FUNCTION)'=1
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= PROVIDER STATE
This xref is used to delete the state field if the provider is not a referring provider function
type.
CROSS-REFERENCE:399.0222^C^MUMPS
1)= S ^DGCR(399,DA(1),"PRV","C",$E($$EXTERNAL^DILFD(399.0222,.01,,X),1,30),DA)=""
2)= K ^DGCR(399,DA(1),"PRV","C",$E($$EXTERNAL^DILFD(399.0222,.01,,X),1,30),DA)
CROSS-REFERENCE:399.0222^CA^MUMPS
1)= S ^DGCR(399,DA(1),"PRV","C",$$LOW^XLFSTR($E($$EXTERNAL^DILFD(399.0222,.01,,X),1,30)),DA)=""
2)= K ^DGCR(399,DA(1),"PRV","C",$$LOW^XLFSTR($E($$EXTERNAL^DILFD(399.0222,.01,,X),1,30)),DA)
399.0222,.02 PERFORMED BY 0;2 VARIABLE POINTER
FILE ORDER PREFIX LAYGO MESSAGE
200 1 VA n VistA identified provider
355.93 2 NVA y Non-VA provider
SCREEN ON FILE 200: S DIC("S")="I $O(^(""USC1"",0))"
SCREEN EXPLANATION: VistA provider must have a person class defined
SCREEN ON FILE 355.93: S DIC("S")="I $$INDIVIDUAL^IBCU4($G(IBIFN),$P(^(0),U,2),$P($G(^DGCR(399,D0,""PRV"",D1,0)),U)
)"
SCREEN EXPLANATION: Non VA providers can be individuals or facilities. They can not be facility type on certain fo
rms.
LAST EDITED: MAR 23, 2022
HELP-PROMPT: Enter the name of the provider who performed the indicated function.
DESCRIPTION: Providers may be VA providers found in the VistA NEW PERSON file or NON-VA providers found in the
IB NON VA BILLING PROVIDER file.
EXECUTABLE HELP:D INDIVHELP^IBCU4
NOTES: TRIGGERED by the PRIMARY INS CO ID NUMBER field of the PROVIDER sub-field of the BILL/CLAIMS File
CROSS-REFERENCE:^^TRIGGER^399.0222^.05
1)= X ^DD(399.0222,.02,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$
P(Y(1),U,5),X=X S DIU=X K Y S X="" X ^DD(399.0222,.02,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,
0)):^(0),1:"") S X=$P(Y(1),U,5)="SLF000"
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"PRV",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,5)=DIV,DIH=399.022
2,DIG=.05 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
3)= Do not delete
CREATE CONDITION)= PRIMARY INS CO ID NUMBER="SLF000"
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= PRIMARY INS CO ID NUMBER
This cross reference deletes any SLF000 id in the primary insurance id if a provider name is
entered.
CROSS-REFERENCE:^^TRIGGER^399.0222^.03
1)= X ^DD(399.0222,.02,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$
P(Y(1),U,3),X=X S DIU=X K Y S X=DIV S X=$$EXTCR^IBCEU5(X) X ^DD(399.0222,.02,1,2,1.4)
1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S Y(2)=$S($D(^DGCR(399,D0,"PRV",D1,
0)):^(0),1:""),Y=Y(0) X:$D(^DD(399.0222,.02,2)) ^(2) S X=Y'["*",Y(1)=X S X=$P(Y(2),U,3)="",Y=X,X=Y(
1),X=X&Y
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"PRV",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,3)=DIV,DIH=399.022
2,DIG=.03 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:
"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(399.0222,.02,1,2,2.4)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"PRV",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,3)=DIV,DIH=399.022
2,DIG=.03 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
3)= Do not delete
CREATE CONDITION)= CREDENTIALS=""
CREATE VALUE)= S X=$$EXTCR^IBCEU5(X)
DELETE VALUE)= @
FIELD)= CREDENTIALS
This trigger will force the CREDENTIALS field of the provider multiple to be set to the first 3
characters of the provider's degree if the credentials don't already exist.
CROSS-REFERENCE:^^TRIGGER^399.0222^.08
1)= X ^DD(399.0222,.02,1,3,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$
P(Y(1),U,8),X=X S DIU=X K Y S X=DIV S X=$$SPEC^IBCEU(X,$P($G(^DGCR(399,D0,"U")),U)) X ^DD(399.0222,
.02,1,3,1.4)
1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,
0)):^(0),1:"") S X=$P(Y(1),U,8)=""
1.4)= S DIH=$G(^DGCR(399,DIV(0),"PRV",DIV(1),0)),DIV=X S $P(^(0),U,8)=DIV,DIH=399.0222,DIG=.08 D ^D
ICR
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:
"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" X ^DD(399.0222,.02,1,3,2.4)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"PRV",DIV(1),0)),DIV=X S $P(^(0),U,8)=DIV,DIH=399.0222,DIG=.08 D ^D
ICR
3)= Do not delete
CREATE CONDITION)= SPECIALTY=""
CREATE VALUE)= S X=$$SPEC^IBCEU(X,$P($G(^DGCR(399,D0,"U")),U))
DELETE VALUE)= @
FIELD)= SPECIALTY
This trigger will force the SPECIALTY field of the provider multiple to be set to the current
specialty of the provider.
CROSS-REFERENCE:^^TRIGGER^399.0222^.05
1)= Q
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:
"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" X ^DD(399.0222,.02,1,4,2.4)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"PRV",DIV(1),0)),DIV=X S $P(^(0),U,5)=DIV,DIH=399.0222,DIG=.05 D ^D
ICR
3)= Do not delete
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= PRIMARY INS CO ID NUMBER
This xref deletes the PRIMARY INS CO ID NUMBER when the provider is changed.
CROSS-REFERENCE:^^TRIGGER^399.0222^.06
1)= Q
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:
"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X="" X ^DD(399.0222,.02,1,5,2.4)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"PRV",DIV(1),0)),DIV=X S $P(^(0),U,6)=DIV,DIH=399.0222,DIG=.06 D ^D
ICR
3)= Do not delete
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= SECONDARY INS CO ID NUMBER
This xref deletes the SECONDARY INS CO ID NUMBER when the provider is changed.
CROSS-REFERENCE:^^TRIGGER^399.0222^.07
1)= Q
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:
"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(399.0222,.02,1,6,2.4)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"PRV",DIV(1),0)),DIV=X S $P(^(0),U,7)=DIV,DIH=399.0222,DIG=.07 D ^D
ICR
3)= Do not delete
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= TERTIARY INS CO ID NUMBER
This xref deletes the TERTIARY INS CO ID NUMBER when the provider is changed.
CROSS-REFERENCE:^^TRIGGER^399.0222^.15
1)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:
"") S X=$P(Y(1),U,15),X=X S DIU=X K Y X ^DD(399.0222,.02,1,7,1.1) X ^DD(399.0222,.02,1,7,1.4)
1.1)= S X=DIV S X=$P($$GETTAX^IBCEF73A(X,$P(^DGCR(399,D0,0),U,3)),U,2)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"PRV",DIV(1),0)),DIV=X S $P(^(0),U,15)=DIV,DIH=399.0222,DIG=.15 D ^
DICR
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:
"") S X=$P(Y(1),U,15),X=X S DIU=X K Y S X="" X ^DD(399.0222,.02,1,7,2.4)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"PRV",DIV(1),0)),DIV=X S $P(^(0),U,15)=DIV,DIH=399.0222,DIG=.15 D ^
DICR
3)= Do not delete
CREATE VALUE)= S X=$P($$GETTAX^IBCEF73A(X,$P(^DGCR(399,D0,0),U,3)),U,2)
DELETE VALUE)= @
FIELD)= TAXONOMY
This trigger updates the TAXONOMY field with the provider's taxonomy code if the event date of the
claim is covered, otherwise, it will set the TAXONOMY field to null.
399.0222,.03 CREDENTIALS 0;3 FREE TEXT
INPUT TRANSFORM:K:$L(X)>3!($L(X)<1) X
LAST EDITED: APR 05, 2000
HELP-PROMPT: Enter up to 3 digits to describe the providers credentials
DESCRIPTION: This field should contain the 1-3 digit code for the provider's credentials as they apply to the
services being billed for.
NOTES: TRIGGERED by the PERFORMED BY field of the PROVIDER sub-field of the BILL/CLAIMS File
399.0222,.04 STATE 0;4 POINTER TO STATE FILE (#5)
LAST EDITED: MAY 16, 2002
HELP-PROMPT: ENTER THE STATE FOR THE REFERRING PROVIDER
DESCRIPTION:
This is the state of the referring provider. This is only used for referring provider types
NOTES: TRIGGERED by the FUNCTION field of the PROVIDER sub-field of the BILL/CLAIMS File
399.0222,.05 PRIMARY INS CO ID NUMBER 0;5 FREE TEXT
PRIM INS PERF PROV SECONDARY ID
INPUT TRANSFORM:I $D(DA) N Z S Z=$G(^DGCR(399,DA(1),"PRV",DA,0)) S:X="/ID" X=$$RECALC^IBCEP2A(.DA,1,$P(Z,U,5)) K:$L
(X)>15!'$L(X) X I $D(X),$P(Z,U,2)="",$S($$INPAT^IBCEF(DA(1),1):1,1:X'="SLF000") K X
LAST EDITED: MAY 08, 2006
HELP-PROMPT: Enter the # the primary ins co uses for the provider. If outpatient and self-referred, use SLF000.
DESCRIPTION:
This is the primary insurance co specific provider's secondary id number.
EXECUTABLE HELP:D INSPAR^IBCEP2A(DA(1),1)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the PERFORMED BY field of the PROVIDER sub-field of the BILL/CLAIMS File
TRIGGERED by the PERFORMED BY field of the PROVIDER sub-field of the BILL/CLAIMS File
CROSS-REFERENCE:^^TRIGGER^399.0222^.02
1)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=Y(0)="SLF000" I X S X=DIV S Y(1)=
$S($D(^DGCR(399,D0,"PRV",D1,0)):^(0),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(399.0222,.
05,1,1,1.4)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"PRV",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,2)=DIV,DIH=399.022
2,DIG=.02 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= Q
3)= Do not delete
CREATE CONDITION)= PRIMARY INS CO ID NUMBER="SLF000"
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= PERFORMED BY
This erases the provider name if the id is SLF000.
CROSS-REFERENCE:399.0222^AC^MUMPS
1)= D ATTREND^IBCU1(DA(1),DA,.05)
2)= D ATTREND^IBCU1(DA(1),DA,.05)
3)= Do Not Delete
This Mumps cross reference is used to trigger #122 PRIMARY PROVIDER #. The field is triggered when
the primary insurance company in the claim has flags set to use the attending or rendering
physicians as the billing provider secondary IDs. The flags in file 36 are field #4.06 (ATT/REND
ID BILL SEC ID PROF) and field 4.08 (ATT/REND ID BILL SEC ID INST).
399.0222,.06 SECONDARY INS CO ID NUMBER 0;6 FREE TEXT
SECOND INS PERF PROV SECONDARY ID
INPUT TRANSFORM:I $D(DA) N Z S Z=$G(^DGCR(399,DA(1),"PRV",DA,0)) S:X="/ID" X=$$RECALC^IBCEP2A(.DA,2,$P(Z,U,6)) K:$L
(X)>15!'$L(X) X I $D(X),$P(Z,U,2)="",$S($$INPAT^IBCEF(DA(1),1):1,1:X'="SLF000") K X
LAST EDITED: MAY 08, 2006
HELP-PROMPT: Enter the # the secondary ins co uses for the provider. If outpatient and self-referred, use
SLF000.
DESCRIPTION:
This is the secondary ins company's specific secondary provider id number.
EXECUTABLE HELP:D INSPAR^IBCEP2A(DA(1),2)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the PERFORMED BY field of the PROVIDER sub-field of the BILL/CLAIMS File
CROSS-REFERENCE:399.0222^AD^MUMPS
1)= D ATTREND^IBCU1(DA(1),DA,.06)
2)= D ATTREND^IBCU1(DA(1),DA,.06)
3)= Do Not Delete
This Mumps cross reference is used to trigger #123 SECONDARY PROVIDER #. The field is triggered
when the secondary insurance company in the claim has flags set to use the attending or rendering
physicians as the billing provider secondary IDs. The flags in file 36 are field #4.06 (ATT/REND
ID BILL SEC ID PROF) and field 4.08 (ATT/REND ID BILL SEC ID INST).
399.0222,.07 TERTIARY INS CO ID NUMBER 0;7 FREE TEXT
TERTIARY INS PERF PROV SECONDARY ID
INPUT TRANSFORM:I $D(DA) N Z S Z=$G(^DGCR(399,DA(1),"PRV",DA,0)) S:X="/ID" X=$$RECALC^IBCEP2A(.DA,3,$P(Z,U,7)) K:$L
(X)>15!'$L(X) X I $D(X),$P(Z,U,2)="",$S($$INPAT^IBCEF(DA(1),1):1,1:X'="SLF000") K X
LAST EDITED: MAY 08, 2006
HELP-PROMPT: Enter the # the tertiary ins co uses for the provider. If outpatient and self-referred, use
SLF000.
DESCRIPTION:
This is the tertiary ins company's specific secondary provider id number.
EXECUTABLE HELP:D INSPAR^IBCEP2A(DA(1),3)
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the PERFORMED BY field of the PROVIDER sub-field of the BILL/CLAIMS File
CROSS-REFERENCE:399.0222^AE^MUMPS
1)= D ATTREND^IBCU1(DA(1),DA,.07)
2)= D ATTREND^IBCU1(DA(1),DA,.07)
3)= Do Not Delete
This Mumps cross reference is used to trigger #124 TERTIARY PROVIDER #. The field is triggered
when the tertiary insurance company in the claim has flags set to use the attending or rendering
physicians as the billing provider secondary IDs. The flags in file 36 are field #4.06 (ATT/REND
ID BILL SEC ID PROF) and field 4.08 (ATT/REND ID BILL SEC ID INST).
399.0222,.08 SPECIALTY 0;8 FREE TEXT
INPUT TRANSFORM:K:$L(X)>2!($L(X)<2) X
LAST EDITED: APR 11, 2000
HELP-PROMPT: Enter the 2 digit specialty code designation
DESCRIPTION: This field contains the specialty code for the provider if the provider is not resident in VistA's
NEW PERSON file.
NOTES: TRIGGERED by the PERFORMED BY field of the PROVIDER sub-field of the BILL/CLAIMS File
399.0222,.09 DELETE 2006 .09 0;9 POINTER TO IB INS CO PROVIDER ID CARE UNIT FILE (#355.96) (Required)
INPUT TRANSFORM:S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,1,1)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: MAY 21, 2004
HELP-PROMPT: Enter the care unit that applies to this bill for the primary insurance co's performing provider id
DESCRIPTION: The primary insurance company requires a specific care unit value to identify the correct id for
the performing provider. You must enter a care unit value here so a valid id can be determined.
This care unit must be valid for the insurance co, form type, care type and provider type required
by the insurance co.
SCREEN: S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,1,1)"
EXPLANATION: Must be a valid care unit for the ins co, care type, form type and performing prov id type
EXECUTABLE HELP:D CAREID^IBCEP1("PERF",1,DA(1))
FIELD INDEX: AUPDID1 (#140) MUMPS ACTION
Short Descr: UPDATE PRIMARY PROVIDER ID WHEN DATA FIELDS CHANGE AT PROVIDER LEVEL OF FILE
Description: This cross reference maintains the integrity of the rendering or attending provider id whenever the
primary insurance company care unit is added, deleted or changed on the claim. If a valid provider
number can be determined by the new value of the care unit, this id # is placed in the primary id
field. If no valid id can be determined for the provider, the primary id field for the provider is
deleted.
Set Logic: D:X1(1)'=X2(1) SETID^IBCEP3(DA(1),1)
Kill Logic: D:X1(1)'=X2(1)&(X(1)'="") DELID^IBCEP3(DA(1),1,1)
Whole Kill: Q
X(1): DELETE 2006 .09 (399.0222,.09) (forwards)
399.0222,.1 DELETE 2006 .1 0;10 POINTER TO IB INS CO PROVIDER ID CARE UNIT FILE (#355.96) (Required)
INPUT TRANSFORM:S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,1,2)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: MAY 21, 2004
HELP-PROMPT: Enter the care unit that applies to this bill for the secondary insurance co's performing provider
id
DESCRIPTION: If the secondary insurance company requires a specific care unit specification to identify the
correct id for the performing provider, this is the exact data value related to this claim that
will allow the system to perform this match.
SCREEN: S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,1,2)"
EXPLANATION: Must be a valid care unit for the ins co, care type, form type and performing prov id type
EXECUTABLE HELP:D CAREID^IBCEP1("PERF",2,DA(1))
FIELD INDEX: AUPDID2 (#141) MUMPS ACTION
Short Descr: UPDATE SECONDARY PROVIDER ID WHEN DATA FIELDS CHANGE AT PROVIDER LEVEL OF FILE
Description: This cross reference maintains the integrity of the rendering or attending provider id whenever the
secondary insurance company care unit is added, deleted or changed on the claim. If a valid
provider number can be determined by the new value of the care unit, this id # is placed in the
secondary id field. If no valid id can be determined for the provider, the secondary id field for
the provider is deleted.
Set Logic: D:X1(1)'=X2(1) SETID^IBCEP3(DA(1),2)
Kill Logic: D:X1(1)'=X2(1) DELID^IBCEP3(DA(1),2,1)
Whole Kill: Q
X(1): DELETE 2006 .1 (399.0222,.1) (forwards)
Transform (Display):
399.0222,.11 DELETE 2006 .11 0;11 POINTER TO IB INS CO PROVIDER ID CARE UNIT FILE (#355.96) (Required)
INPUT TRANSFORM:S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,1,3)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: MAY 21, 2004
HELP-PROMPT: Enter the care unit that applies to this bill for the tertiary insurance's performing provider id
DESCRIPTION: If the tertiary insurance company requires a specific care unit specification to identify the
correct id for the performing provider, this is the exact data value related to this claim that
will allow the system to perform this match.
SCREEN: S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,1,3)"
EXPLANATION: Must be a valid care unit for the ins co, care type, form type and performing prov id type
EXECUTABLE HELP:D CAREID^IBCEP1("PERF",3,DA(1))
FIELD INDEX: AUPDID3 (#142) MUMPS ACTION
Short Descr: UPDATE TERTIARY PROVIDER ID WHEN DATA FIELDS CHANGE AT PROVIDER LEVEL OF FILE
Description: This cross reference maintains the integrity of the rendering or attending provider id whenever the
tertiary insurance company care unit is added, deleted or changed on the claim. If a valid
provider number can be determined by the new value of the care unit, this id # is placed in the
tertiary id field. If no valid id can be determined for the provider, the tertiary id field for
the provider is deleted.
Set Logic: D:X1(1)'=X2(1) SETID^IBCEP3(DA(1),3)
Kill Logic: D:X1(1)'=X2(1) DELID^IBCEP3(DA(1),3,1)
Whole Kill: Q
X(1): DELETE 2006 .11 (399.0222,.11) (forwards)
Transform (Display):
399.0222,.12 PRIM INS PROVIDER ID TYPE 0;12 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97)
PRIM INS PERF PROV SECONDARY ID TYPE
INPUT TRANSFORM:S DIC("S")="I $$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: MAY 08, 2006
HELP-PROMPT: Enter the type of id the primary payer requires as a secondary id.
DESCRIPTION:
This is the type of id the primary payer uses as a secondary id.
SCREEN: S DIC("S")="I $$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))"
EXPLANATION: Must be valid for transmission.
CROSS-REFERENCE:399.0222^AF^MUMPS
1)= D ATTREND^IBCU1(DA(1),DA,.12)
2)= D ATTREND^IBCU1(DA(1),DA,.12)
3)= Do Not Delete
This Mumps cross reference is used to trigger #128 PRIMARY ID QUALIFIER. The field is triggered
when the primary insurance company in the claim has flags set to use the attending or rendering
physicians as the billing provider secondary IDs. The flags in file 36 are field #4.06 (ATT/REND
ID BILL SEC ID PROF) and field 4.08 (ATT/REND ID BILL SEC ID INST).
399.0222,.13 SEC INS PROVIDER ID TYPE 0;13 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97)
SECOND INS PERF PROV SECONDARY ID TYPE
INPUT TRANSFORM:S DIC("S")="I $$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: MAY 08, 2006
HELP-PROMPT: Enter the type of id the secondary payer requires as a secondary id.
SCREEN: S DIC("S")="I $$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))"
EXPLANATION: Must be valid for transmission.
CROSS-REFERENCE:399.0222^AG^MUMPS
1)= D ATTREND^IBCU1(DA(1),DA,.13)
2)= D ATTREND^IBCU1(DA(1),DA,.13)
3)= Do Not Delete
This Mumps cross reference is used to trigger #129 SECONDARY ID QUALIFIER. The field is triggered
when the secondary insurance company in the claim has flags set to use the attending or rendering
physicians as the billing provider secondary IDs. The flags in file 36 are field #4.06 (ATT/REND
ID BILL SEC ID PROF) and field 4.08 (ATT/REND ID BILL SEC ID INST).
399.0222,.14 TERT INS PROVIDER ID TYPE 0;14 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97)
TERTIARY INS PERF PROV SECONDARY ID TYPE
INPUT TRANSFORM:S DIC("S")="I $$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: MAY 08, 2006
HELP-PROMPT: Enter the type of id the tertiary payer requires as a secondary id.
DESCRIPTION:
This is the type of id the tertiary payer uses as a secondary id.
SCREEN: S DIC("S")="I $$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))"
EXPLANATION: Must be valid for transmission.
CROSS-REFERENCE:399.0222^AH^MUMPS
1)= D ATTREND^IBCU1(DA(1),DA,.14)
2)= D ATTREND^IBCU1(DA(1),DA,.14)
3)= Do Not Delete
This Mumps cross reference is used to trigger #130 TERTIARY ID QUALIFIER. The field is triggered
when the tertiary insurance company in the claim has flags set to use the attending or rendering
physicians as the billing provider secondary IDs. The flags in file 36 are field #4.06 (ATT/REND
ID BILL SEC ID PROF) and field 4.08 (ATT/REND ID BILL SEC ID INST).
399.0222,.15 TAXONOMY 0;15 POINTER TO PERSON CLASS FILE (#8932.1)
LAST EDITED: JUN 13, 2006
HELP-PROMPT: Enter the Taxonomy Code associated with this entry.
NOTES: TRIGGERED by the PERFORMED BY field of the PROVIDER sub-field of the BILL/CLAIMS File
399.0222,1.01 DELETE 2006 1.01 1;1 POINTER TO IB INS CO PROVIDER ID CARE UNIT FILE (#355.96)
INPUT TRANSFORM:S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,2,1)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: MAY 21, 2004
HELP-PROMPT: Enter the care unit that applies to this bill for the EMC id for the primary insurance
DESCRIPTION: This is the exact data you need to use to allow the system to match the provider with the correct
EMC id # for the primary insurance co based on this piece of data and relating directly to this
claim.
SCREEN: S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,2,1)"
EXPLANATION: Must be a valid care unit for the ins co, care type, form type and EMC id type
EXECUTABLE HELP:D CAREID^IBCEP1("EMC",1,DA(1))
399.0222,1.02 DELETE 2006 1.02 1;2 POINTER TO IB INS CO PROVIDER ID CARE UNIT FILE (#355.96)
INPUT TRANSFORM:S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,2,2)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: MAY 21, 2004
HELP-PROMPT: Enter the care unit that applies to this bill for the EMC id for the secondary insurance
DESCRIPTION: This is the exact data you need to use to allow the system to match the provider with the correct
EMC id # for the secondary insurance co based on this piece of data and relating directly to this
claim.
SCREEN: S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,2,2)"
EXPLANATION: Must be a valid care unit for the ins co, care type, form type and EMC id type
EXECUTABLE HELP:D CAREID^IBCEP1("EMC",2,DA(1))
399.0222,1.03 DELETE 2006 1.03 1;3 POINTER TO IB INS CO PROVIDER ID CARE UNIT FILE (#355.96)
INPUT TRANSFORM:S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,2,3)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: MAY 21, 2004
HELP-PROMPT: Enter the care unit that applies to this bill for the EMC id for the tertiary insurance
DESCRIPTION: This is the exact data you need to use to allow the system to match the provider with the correct
EMC id # for the tertiary insurance co based on this piece of data and relating directly to this
claim.
SCREEN: S DIC("S")="I $$CAREUOK^IBCEP4(DA(1),+Y,2,3)"
EXPLANATION: Must be a valid care unit for the ins co, care type, form type and EMC id type
EXECUTABLE HELP:D CAREID^IBCEP1("EMC",3,DA(1))
399,230 SECONDARY AUTHORIZATION CODE U2;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
MAXIMUM LENGTH: 50
LAST EDITED: APR 27, 2017
HELP-PROMPT: Answer must be 1-50 characters in length.
DESCRIPTION: This indicates that the treatment covered by this bill has been authorized by the secondary payer.
On the CMS-1500 this is box 23, PRIOR AUTHORIZATION NUMBER. On the UB-04, this is reported in
FL63.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the SECONDARY INSURANCE POLICY field of the BILL/CLAIMS File
399,231 TERTIARY AUTHORIZATION CODE U2;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
MAXIMUM LENGTH: 50
LAST EDITED: APR 27, 2017
HELP-PROMPT: Answer must be 1-50 characters in length.
DESCRIPTION: This indicates that the treatment covered by this bill has been authorized by the tertiary payer.
On the CMS-1500 this is box 23, PRIOR AUTHORIZATION NUMBER. On the UB-04, this is reported in
FL63.
NOTES: TRIGGERED by the TERTIARY INSURANCE POLICY field of the BILL/CLAIMS File
399,232 NON-VA FACILITY U2;10 POINTER TO IB NON/OTHER VA BILLING PROVIDER FILE (#355.93)
INPUT TRANSFORM: S DIC("S")="I $P(^(0),U,2)=1" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
LAST EDITED: SEP 16, 2010
HELP-PROMPT: Enter the non-VA/other VA facility where care was given.
DESCRIPTION:
The is the name of the non-VA or outside VA facility where the services were rendered.
SCREEN: S DIC("S")="I $P(^(0),U,2)=1"
EXPLANATION: Must be a facility provider type entry.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^399^234
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,12),
X=X S DIU=X K Y X ^DD(399,232,1,1,1.1) X ^DD(399,232,1,1,1.4)
1.1)= S X=DIV S I(0,0)=$S($D(D0):D0,1:""),D0=DIV S:'$D(^IBA(355.93,+D0,0)) D0=-1 S Y(101)=$S($D(^IB
A(355.93,D0,0)):^(0),1:"") S X=$P(Y(101),U,9) S D0=I(0,0)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U2")):^("U2"),1:""),DIV=X S $P(^("U2"),U,12)=DIV,DIH=399,DIG=23
4 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,12),
X=X S DIU=X K Y S X="" X ^DD(399,232,1,1,2.4)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U2")):^("U2"),1:""),DIV=X S $P(^("U2"),U,12)=DIV,DIH=399,DIG=23
4 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
CREATE VALUE)= NON-VA FACILITY:FACILITY DEFAULT ID NUMBER
DELETE VALUE)= @
FIELD)= NON-VA CARE ID #
CROSS-REFERENCE: ^^TRIGGER^399^233
1)= Q
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,11),
X=X S DIU=X K Y S X="" X ^DD(399,232,1,2,2.4)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"U2")):^("U2"),1:""),DIV=X S $P(^("U2"),U,11)=DIV,DIH=399,DIG=23
3 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
3)= Do not delete
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= NON-VA CARE TYPE
This cross reference deletes the NON-VA CARE TYPE field when the NON-VA Facility value is deleted.
CROSS-REFERENCE: ^^TRIGGER^399^235
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$CLIAREQ^IBCEP8A(DA) I X S X=DIV S Y(1)=$S($D(^DGCR
(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,13),X=X S DIU=X K Y S X=DIV S X=$$CLIA^IBCEP8A(DA) X ^DD
(399,232,1,3,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,13)=DIV,DIH=399,DIG=235 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S X=$$CLIAREQ^IBCEP8A(DA) I X S X=DIV S Y(1)=$S($D(^DGCR
(399,D0,"U2")):^("U2"),1:"") S X=$P(Y(1),U,13),X=X S DIU=X K Y S X=DIV S X=$$CLIA^IBCEP8A(DA) X ^DD
(399,232,1,3,2.4)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"U2")),DIV=X S $P(^("U2"),U,13)=DIV,DIH=399,DIG=235 D ^DICR
CREATE CONDITION)= S X=$$CLIAREQ^IBCEP8A(DA)
CREATE VALUE)= S X=$$CLIA^IBCEP8A(DA)
DELETE CONDITION)= S X=$$CLIAREQ^IBCEP8A(DA)
DELETE VALUE)= S X=$$CLIA^IBCEP8A(DA)
FIELD)= LAB CLIA NUMBER
This trigger will set the LAB CLIA NUMBER field to the default CLIA# for the facility - either VA
facility or non-VA facility. The trigger condition ensures that lab services are on the claim.
CROSS-REFERENCE: ^^TRIGGER^399^244
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U3")):^("U3"),1:"") S X=$P(Y(1),U,3),X
=X S DIU=X K Y S X=DIV S X=$P($$TAXGET^IBCEP81(X),U,2) X ^DD(399,232,1,4,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"U3")),DIV=X S $P(^("U3"),U,3)=DIV,DIH=399,DIG=244 D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"U3")):^("U3"),1:"") S X=$P(Y(1),U,3),X
=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"U3")),DIV=X S $P(^("U3"),U,3)=DIV,DIH=399,DIG=244
D ^DICR
3)= Do not delete
CREATE VALUE)= S X=$P($$TAXGET^IBCEP81(X),U,2)
DELETE VALUE)= @
FIELD)= #244
This xref updates the NON-VA FACILITY TAXONOMY field with the non-VA facility's default taxonomy.
RECORD INDEXES: ABP (#820)
399,233 NON-VA CARE TYPE U2;11 SET
'1' FOR FEE BASIS, NON-LAB;
'2' FOR FEE BASIS, LAB;
'3' FOR NON-FEE BASIS, NON-LAB;
'4' FOR NON-FEE BASIS, LAB;
LAST EDITED: AUG 25, 1999
HELP-PROMPT: Enter the type of outside care that was provided
DESCRIPTION: This is the code that identifies if the care given was fee basis lab, fee basis non-lab, or non-fee
basis care.
NOTES: TRIGGERED by the NON-VA FACILITY field of the BILL/CLAIMS File
399,234 NON-VA CARE ID # U2;12 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: JUL 22, 1999
HELP-PROMPT: Answer must be 1-15 characters in length.
DESCRIPTION: This is the id number to be reported on the bill for the non-VA facility where care was provided.
For a lab, this should be the CLIA #
NOTES: TRIGGERED by the NON-VA FACILITY field of the BILL/CLAIMS File
399,235 LAB CLIA NUMBER U2;13 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: DEC 28, 2005
HELP-PROMPT: Answer must be 1-15 characters in length.
DESCRIPTION: Enter the CLIA number for the VA Division if the service was performed by the VA. Enter the CLIA
number for the Other Facility if the service was performed by a non-VA facility.
You can define a CLIA number as a secondary ID for a non-VA Facility through Provider ID Maint. If
you enter a CLIA number here that is not defined in Provider ID Maint (non-VA) or the Institution
file (VA), it will be sent with this claim only.
NOTES: TRIGGERED by the NON-VA FACILITY field of the BILL/CLAIMS File
TRIGGERED by the DEFAULT DIVISION field of the BILL/CLAIMS File
399,236 HOMEBOUND U2;14 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: JAN 29, 2014
HELP-PROMPT: Enter yes if patient was homebound for purchased labs.
DESCRIPTION: This is to indicate that the patient is homebound or institutionalized. Refer to MEDICARE
regulations on when to use this field.
399,237 DATE LAST SEEN U2;15 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JAN 29, 2014
HELP-PROMPT: Enter the last date the patient was seen if care was provided by an outside provider of PT/OT or
routine foot care.
DESCRIPTION:
This is the date a patient was last seen. Refer to MEDICARE regulations on when to use this field.
399,238 SPECIAL PROGRAM INDICATOR U2;16 SET
'01' FOR EPSDT/CHAP;
'02' FOR Phys Handicapped Children Program;
'03' FOR Special Fed Funding;
'05' FOR Disability;
'07' FOR Induced Abortion - Danger to Life;
'08' FOR Induced Abortion - Rape or Incest;
'09' FOR 2nd Opinion/Surgery;
LAST EDITED: JAN 29, 2014
HELP-PROMPT: Enter the code indicating the Special Program under which the patient services were rendered.
DESCRIPTION: This is the Special Program with which a claim is associated. Refer to MEDICARE regulations to
decide when to use this field.
399,239 PRIMARY EMC ID CARE UNIT U2;17 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: NOV 09, 2000
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: This is the data value needed to allow the system to match the attending/rendering provider with
the correct EMC id # for the primary ins co.
EXECUTABLE HELP: D CAREID^IBCEP1("EMC",1,DA)
399,240 SECONDARY EMC ID CARE UNIT U2;18 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: NOV 09, 2000
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: This is the data value needed to allow the system to match the attending/rendering provider with
the correct EMC id # for the secondary ins co.
EXECUTABLE HELP: D CAREID^IBCEP1("EMC",2,DA)
399,241 TERTIARY EMC ID CARE UNIT U2;19 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: NOV 09, 2000
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: This is the data value needed to allow the system to match the attending/rendering provider with
the correct EMC id # for the tertiary ins co.
EXECUTABLE HELP: D CAREID^IBCEP1("EMC",3,DA)
399,242 MAMMOGRAPHY CERT NUMBER U3;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: DEC 28, 2005
HELP-PROMPT: Answer must be 1-15 characters in length
DESCRIPTION: Enter the Mammography Certification number for the VAMC if the service was performed by the VA.
Enter the Mammography Certification number for the Other Facility if the service was performed by a
non-VA facility.
You can define a Mammography Certification number for a non-VA Facility through Provider ID Maint.
If you enter a Mammography Certification number here that is not defined in Provider ID Maint
(non-VA) or the Institution file (VA), it will be sent with this claim only.
399,243 SERVICE FACILITY TAXONOMY U3;2 POINTER TO PERSON CLASS FILE (#8932.1)
INPUT TRANSFORM: S DIC("S")="I $P($G(^(90002)),U,2)=""N""" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
LAST EDITED: MAR 06, 2009
HELP-PROMPT: Enter the Taxonomy Code associated with the Service Facility.
DESCRIPTION: This field contains the organizational taxonomy code for the Service Facility. You may override
the default taxonomy code here.
TECHNICAL DESCR: This field is set via the "ABP" new-style MUMPS x-refs from the following fields in the BILL/CLAIMS
file (#399) and in the IB BILL/CLAIMS PRESCRIPTION REFILL file (#362.4):
399,.22 - DEFAULT DIVISION
399,232 - NON-VA FACILITY
399,136 - BILL PAYER POLICY
399,.19 - FORM TYPE 362.4,.02 - BILL NUMBER
Whenever these fields are edited, the service facility may change and thus a new default service
facility taxonomy code is filed.
SCREEN: S DIC("S")="I $P($G(^(90002)),U,2)=""N"""
EXPLANATION: Only entries for 'Non-Individuals' may be selected.
399,244 NON-VA FACILITY TAXONOMY U3;3 POINTER TO PERSON CLASS FILE (#8932.1)
INPUT TRANSFORM: S DIC("S")="I $P($G(^(90002)),U,2)=""N""" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JUN 13, 2006
HELP-PROMPT: Enter the Taxonomy Code associated with this Non-VA Facility.
SCREEN: S DIC("S")="I $P($G(^(90002)),U,2)=""N"""
EXPLANATION: Only entries for 'Non-Individuals' may be selected.
NOTES: TRIGGERED by the NON-VA FACILITY field of the BILL/CLAIMS File
399,245 LAST XRAY DATE U3;4 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X) D CHDAT^IBCU4
LAST EDITED: JUN 19, 2007
HELP-PROMPT: Enter the last date the patient had an Xray (for chiropractic only).
DESCRIPTION: If an Xray was used to demonstrate a subluxation of the spine, enter the date of the last Xray. If
an Xray date is entered, it will automatically print on CMS-1500.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,246 DATE OF INITIAL TREATMENT U3;5 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X) D CHDAT^IBCU4
LAST EDITED: JUN 19, 2007
HELP-PROMPT: Enter the date on which the chiropractic treatment began.
DESCRIPTION:
Date on which these treatments were started.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,247 DATE OF ACUTE MANIFESTATION U3;6 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X) D CHDAT^IBCU4
LAST EDITED: JUN 19, 2007
HELP-PROMPT: Enter the date on which the acute chiropractic condition began.
DESCRIPTION: If the Patient's Condition Code equals Acute Condition or Acute Manifestation of a Chronic
Condition, you must enter the date on which the acute condition started.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,248 PATIENT CONDITION CODE U3;7 SET
'A' FOR Acute Condition;
'C' FOR Chronic Condition;
'D' FOR Non-acute Condition;
'E' FOR Non-Life Threatening;
'F' FOR Routine;
'G' FOR Symptomatic;
'M' FOR Acute Manifestation of a Chronic Condition;
LAST EDITED: MAY 24, 2007
HELP-PROMPT: Enter a code describing the chiropractic condition.
DESCRIPTION:
Enter one of the following required codes;
399,249 PRV DIAGNOSIS (1) U3;8 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 03, 2008
HELP-PROMPT: Please enter the first "Patient reason for visit" diagnosis.
DESCRIPTION:
This is the first PRV diagnosis.
399,250 PRV DIAGNOSIS (2) U3;9 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 03, 2008
HELP-PROMPT: Please enter the second "Patient reason for visit" diagnosis.
DESCRIPTION:
This is the second PRV diagnosis.
399,251 PRV DIAGNOSIS (3) U3;10 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 03, 2008
HELP-PROMPT: Please enter the third "Patient reason for visit" diagnosis.
DESCRIPTION:
This is the third PRV diagnosis.
399,252 BILLING PROVIDER TAXONOMY U3;11 POINTER TO PERSON CLASS FILE (#8932.1)
INPUT TRANSFORM: S DIC("S")="I $P($G(^(90002)),U,2)=""N""" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
LAST EDITED: MAR 06, 2009
HELP-PROMPT: Enter the Taxonomy Code associated with the Billing Provider.
DESCRIPTION: This field contains the organizational taxonomy code for the Billing Provider. You may override
the default taxonomy code here.
TECHNICAL DESCR: This field is set via the "ABP" new-style MUMPS x-refs from the following fields in the BILL/CLAIMS
file (#399) and in the IB BILL/CLAIMS PRESCRIPTION REFILL file (#362.4):
399,.22 - DEFAULT DIVISION
399,232 - NON-VA FACILITY
399,136 - BILL PAYER POLICY
399,.19 - FORM TYPE 362.4,.02 - BILL NUMBER
Whenever these fields are edited, the billing provider may change and thus a new default billing
provider taxonomy code is filed.
SCREEN: S DIC("S")="I $P($G(^(90002)),U,2)=""N"""
EXPLANATION: Only entries for 'Non-Individuals' may be selected.
399,253 PRIMARY REFERRAL NUMBER UF32;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
MAXIMUM LENGTH: 50
LAST EDITED: APR 27, 2017
HELP-PROMPT: Answer must be 1-50 characters in length.
DESCRIPTION:
This is the primary referral number assigned to the insurance.
NOTES: TRIGGERED by the PRIMARY INSURANCE POLICY field of the BILL/CLAIMS File
399,254 SECONDARY REFERRAL NUMBER UF32;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
MAXIMUM LENGTH: 50
LAST EDITED: APR 27, 2017
HELP-PROMPT: Answer must be 1-50 characters in length.
DESCRIPTION:
This is the secondary referral number assigned to the insurance.
NOTES: TRIGGERED by the SECONDARY INSURANCE POLICY field of the BILL/CLAIMS File
399,255 TERTIARY REFERRAL NUMBER UF32;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
MAXIMUM LENGTH: 50
LAST EDITED: APR 27, 2017
HELP-PROMPT: Answer must be 1-50 characters in length.
DESCRIPTION:
This is the tertiary referral number assigned to the insurance.
NOTES: TRIGGERED by the TERTIARY INSURANCE POLICY field of the BILL/CLAIMS File
399,260 COB TOTAL NON-COVERED AMOUNT U4;1 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999999999999)!(X<0) X
LAST EDITED: OCT 19, 2010
HELP-PROMPT: Type a dollar amount between 0 and 999999999999999, 2 decimal digits.
DESCRIPTION: This is a dollar amount that must equal the Total Claim Charge Amount. Required when the current
payer allows providers to bypass claim submission to the otherwise prior payer (example: Medicare
secondary with no MRA).
399,261 PROPERTY/CASUALTY CLAIM NUMBER U4;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1)!($TR(X," ")="")!($E(X)=" ") X
MAXIMUM LENGTH: 50
LAST EDITED: APR 27, 2017
HELP-PROMPT: Answer must be 1-50 characters in length, not all spaces, no leading spaces.
DESCRIPTION:
This is a payer-assigned claim number for a property and casualty claim.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,262 PROP/CAS DATE OF 1ST CONTACT U4;3 DATE
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:Y<1 X
LAST EDITED: OCT 19, 2010
HELP-PROMPT: Enter the date of first contact, if applicable.
DESCRIPTION: This is the date the patient first consulted the service provider for this property and casualty
related condition. Required when state mandated.
399,263 DISABILITY START DATE U4;4 DATE
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:DT$P($G(^DGCR(399,DA,"U4
")),U,5) K X
LAST EDITED: OCT 19, 2010
HELP-PROMPT: Enter the Disability start date. Cannot be a future date or after Disability end date.
DESCRIPTION: This is the Disability start date. Cannot be a future date, and cannot be after Disability end
date.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,264 DISABILITY END DATE U4;5 DATE
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:DT60!($L(X)<1) X
LAST EDITED: AUG 12, 2010
HELP-PROMPT: Answer must be 1-60 characters in length.
DESCRIPTION: This is the name of the person to be contacted regarding this Property and Casualty claim if
different from the Patient/Subscriber.
399,269 PROP/CAS COMMUNICATION NUMBER U4;10 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999999999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: AUG 27, 2010
HELP-PROMPT: Type a number between 0 and 9999999999, 0 decimal digits.
DESCRIPTION: Enter the area code and phone number for the person to be contacted regarding this Property and
Casualty claim.
399,269.1 PROP/CAS EXTENSION NUMBER U4;11 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999999999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: FEB 10, 2011
HELP-PROMPT: Type a number between 1 and 9999999999, 0 decimal digits.
DESCRIPTION: This is the extension number for the person to be contacted regarding this Property and Casualty
claim.
399,271 AMBULANCE P/U ADDRESS 1 U5;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>55!($L(X)<1) X
MAXIMUM LENGTH: 55
LAST EDITED: APR 27, 2017
HELP-PROMPT: Answer must be 1-55 characters in length.
DESCRIPTION: This is line one of the street address where the patient was picked up. Required for ambulance
transportation.
399,272 AMBULANCE P/U ADDRESS 2 U5;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>55!($L(X)<1) X
MAXIMUM LENGTH: 55
LAST EDITED: APR 27, 2017
HELP-PROMPT: Answer must be 1-55 characters in length.
DESCRIPTION:
This is line two of the address where the patient was picked up.
399,273 AMBULANCE P/U CITY U5;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: JUL 25, 2010
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
This is the City where the patient was picked up. Required for ambulance transportation.
399,274 AMBULANCE P/U STATE U5;5 POINTER TO STATE FILE (#5)
LAST EDITED: JUL 25, 2010
HELP-PROMPT: Enter the Ambulance P/U State.
DESCRIPTION:
This is the State where the patient was picked up. Required for ambulance transportation.
399,275 AMBULANCE P/U ZIP U5;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: JUL 25, 2010
HELP-PROMPT: Answer must be 1-15 characters in length.
DESCRIPTION: This is the Zip code of the location where the patient was picked up. Required for ambulance
transportation.
399,276 AMBULANCE D/O LOCATION U6;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>60!($L(X)<1) X
LAST EDITED: AUG 05, 2010
HELP-PROMPT: Answer must be 1-60 characters in length.
DESCRIPTION:
This is the name of the location where the patient was dropped off, if it is known.
399,277 AMBULANCE D/O ADDRESS 1 U6;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>55!($L(X)<1) X
MAXIMUM LENGTH: 55
LAST EDITED: APR 27, 2017
HELP-PROMPT: Answer must be 1-55 characters in length.
DESCRIPTION: This is line one of the street address where the patient was dropped off. Required for ambulance
transportation.
399,278 AMBULANCE D/O ADDRESS 2 U6;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>55!($L(X)<1) X
MAXIMUM LENGTH: 55
LAST EDITED: APR 27, 2017
HELP-PROMPT: Answer must be 1-55 characters in length.
DESCRIPTION:
This is line two of the address where the patient was dropped off.
399,279 AMBULANCE D/O CITY U6;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: AUG 05, 2010
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
This is the City where the patient was dropped off. Required for ambulance transportation.
399,280 AMBULANCE D/O STATE U6;5 POINTER TO STATE FILE (#5)
LAST EDITED: AUG 05, 2010
HELP-PROMPT: Enter the Ambulance D/O State.
DESCRIPTION:
This is the State where the patient was dropped off. Required for ambulance transportation.
399,281 AMBULANCE D/O ZIP U6;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: AUG 05, 2010
HELP-PROMPT: Answer must be 1-15 characters in length.
DESCRIPTION: This is the Zip code of the location where the patient was dropped off. Required for ambulance
transportation.
399,282 ASSUMED CARE DATE U4;13 DATE
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:DT$P($G(^DGCR(399,DA,"U
4")),U,14) K X
LAST EDITED: OCT 19, 2010
HELP-PROMPT: Enter the date the provider assumed care. Cannot be a future date or greater than the Relinquished
Care Date.
DESCRIPTION: This is the date on which the provider on this claim assumed the post-operative care associated
with this claim. Cannot be a future date or greater than the relinquished care date.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399,283 RELINQUISHED CARE DATE U4;14 DATE
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:DT30!($L(X)<1) X
LAST EDITED: AUG 16, 2010
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: This is an Attachment Control Number (alphanumeric) that can be used to identify the documentation
that will provide additional information for this claim. This applies to the entire claim.
399,285 ATTACHMENT REPORT TYPE U8;2 POINTER TO IB ATTACHMENT REPORT TYPE FILE (#353.3)
INPUT TRANSFORM: S DIC("S")="I $$RTYPOK^IBCEU(X,DA)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: APR 06, 2017
HELP-PROMPT: Select an Attachment Report Type.
DESCRIPTION: This is a Report Type to describe the type of documentation that will provide additional
information for this claim. This applies to the entire claim.
SCREEN: S DIC("S")="I $$RTYPOK^IBCEU(X,DA)"
EXPLANATION: Form types have different valid Attachment Report Types
399,286 ATTACHMENT REPORT TRANS CODE U8;3 SET
'AA' FOR Available on Request at Provider Site;
'BM' FOR By Mail;
'EL' FOR Electronically Only;
'EM' FOR E-Mail;
'FT' FOR File Transfer;
'FX' FOR By Fax;
LAST EDITED: AUG 16, 2010
HELP-PROMPT: Choose a code for the Attachment Transmission Method.
DESCRIPTION:
This is the code for the Attachment Transmission Method. This applies to the entire claim.
399,287 PATIENT WEIGHT (LB) U7;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>1000)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: JUL 28, 2011
HELP-PROMPT: Enter a whole number for the patient's weight (1-1000 Pounds).
DESCRIPTION:
This is a whole number for the patient's weight.
399,288 TRANSPORT REASON CODE U7;2 POINTER TO TRANSPORT REASON CODE FILE (#353.4)
LAST EDITED: JUL 28, 2011
HELP-PROMPT: Select the code indicating the reason for transport.
DESCRIPTION:
This is the code indicating the reason for transport.
399,289 AMBULANCE TRANSPORT DISTANCE U7;3 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>10000)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JUL 28, 2011
HELP-PROMPT: Enter a whole number for the distance traveled during transport (0-10000 Miles).
DESCRIPTION:
This is a whole number for the distance traveled during transport.
399,290 ROUND TRIP PURPOSE DESCRIPTION U7;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<1) X
LAST EDITED: JUL 28, 2011
HELP-PROMPT: Enter a free text explanation of the purpose of the R/T service (1-80 characters).
DESCRIPTION:
This is a free text explanation of the purpose of the R/T service.
399,291 STRETCHER PURPOSE DESCRIPTION U7;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<1) X
LAST EDITED: JUL 28, 2011
HELP-PROMPT: Enter a free text explanation of why a stretcher was used (1-80 characters).
DESCRIPTION:
This is a free text explanation of why a stretcher was used.
399,292 AMBULANCE CONDITION INDICATOR U9;0 POINTER Multiple #399.0292 (Add New Entry without Asking)
DESCRIPTION: This allows up to five patient condition indicators to describe the patient during ambulance
pickup, transport, and drop off.
399.0292,.01 AMBULANCE CONDITION INDICATOR 0;1 POINTER TO AMBULANCE CONDITION INDICATORS FILE (#353.5) (Multiply asked)
INPUT TRANSFORM: S DIC("S")="I $$SCREEN1^IBCSC9(DA(1))" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
LAST EDITED: AUG 10, 2011
HELP-PROMPT: Select an Ambulance Condition Indicator. Answer must be 1-2 characters in length.
DESCRIPTION: This is the Ambulance Condition Code associated with the patient's condition in relation to
ambulance transportation.
SCREEN: S DIC("S")="I $$SCREEN1^IBCSC9(DA(1))"
EXPLANATION: This limits the entry to five condition indicators.
CROSS-REFERENCE: 399.0292^B
1)= S ^DGCR(399,DA(1),"U9","B",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(1),"U9","B",$E(X,1,30),DA)
399,301 PRIMARY NODE I1;E1,240 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>240!($L(X)<1) X
LAST EDITED: JAN 29, 1990
HELP-PROMPT: This is the information pertaining to the primary insurance carrier associated with this bill.
DESCRIPTION: This is the information pertaining to the primary insurance carrier which is associated with this
bill.
TECHNICAL DESCR: Set by trigger on Primary Insurance Carrier (399,101) and at UPDT^IBSCSE. This node is a duplicate
of the insurance's node in the patient file. ^DGCR(399,IBIFN,"I1")=^DPT(DFN,.312,X)
where +^DPT(DFN,.312,X)=(399,101) primary insurer
399,302 SECONDARY NODE I2;E1,240 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>240!($L(X)<1) X
LAST EDITED: JAN 29, 1990
HELP-PROMPT: This is the information pertaining to the secondary insurance carrier which is associated with this
bill.
DESCRIPTION: This is the information pertaining to the secondary insurance carrier which is associated with this
bill.
TECHNICAL DESCR: Set by trigger on Secondary Insurance Carrier (399,102) and by UPDT^IBCSCE. This node is a
duplicate of the insurance's node in the patient file. ^DGCR(399,IBIFN,"I2")=^DPT(DFN,.312,X)
where +^DPT(DFN,.312,X)=(399,102) secondary insurer for bill
399,303 TERTIARY NODE I3;E1,240 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>240!($L(X)<1) X
LAST EDITED: JAN 29, 1990
HELP-PROMPT: This is the information pertaining to the tertiary insurance carrier associated with this bill.
DESCRIPTION:
This is the information pertaining to the tertiary insurance carrier associated with this bill.
399,304 PROCEDURES CP;0 VARIABLE POINTER Multiple #399.0304
LAST EDITED: NOV 01, 1991
DESCRIPTION:
These are ICD or CPT procedures that are associated with this bill.
TECHNICAL DESCR:
IDENTIFIED BY:
"WRITE": D DISPID^IBCSC4D
INDEXED BY: DIVISION (AC), PROCEDURES (AD)
399.0304,.01 PROCEDURES 0;1 VARIABLE POINTER (Multiply asked)
FILE ORDER PREFIX LAYGO MESSAGE
81 1 CPT n CPT
80.1 2 ICD n ICD operation/procedure
SCREEN ON FILE 81: S ICPTVDT=$$BDATE^IBACSV($G(DA(1)),$G(DA)),DIC("S")="I $$CPTACT^IBACSV(+Y,ICPTVDT)",DIC("W")="D
EN^DDIOL("" ""_$P($$CPT^IBACSV(+Y,ICPTVDT),U,2),,""?0"")"
SCREEN EXPLANATION: Only codes active for the date of service may be selected.
SCREEN ON FILE 80.1: S ICDVDT=$$BDATE^IBACSV($G(DA(1)),$G(DA)),DIC("S")="I $$ICD0ACT^IBACSV(+Y,ICDVDT)",DIC("W")="D
EN^DDIOL("" ""_$P($$ICD0^IBACSV(+Y,ICDVDT),U,4),,""?0"")"
SCREEN EXPLANATION: Only codes active for the date of service may be selected.
LAST EDITED: JUL 06, 2011
HELP-PROMPT: Procedure coding must match the PROCEDURE CODING METHOD entry for this bill.
DESCRIPTION:
These are ICD, CPT, or HCFA procedure codes associated with the episode of care on this bill.
TECHNICAL DESCR:
EXECUTABLE HELP:D 3^IBCSCH1
PRE-LOOKUP: D ^IBCU7
DELETE TEST: 1,0)= N IBZ S IBZ=$$RXLINK^IBCSC5C(DA(1),DA) I IBZ D EN^DDIOL(" Can't delete this procedure while
linked to RX revenue code #"_IBZ)
CROSS-REFERENCE:399.0304^B
1)= S ^DGCR(399,DA(1),"CP","B",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(1),"CP","B",$E(X,1,30),DA)
3)= Required Index for Variable Pointer
CROSS-REFERENCE:399^ASD^MUMPS
1)= I $P(X,";",2)="ICPT(",$D(^DGCR(399,DA(1),"CP",DA,0)),$P(^(0),"^",2) S ^DGCR(399,"ASD",-$P(^(0),
"^",2),+X,DA(1),DA)=""
2)= I $P(X,";",2)="ICPT(",$D(^DGCR(399,DA(1),"CP",DA,0)),$P(^(0),"^",2) K ^DGCR(399,"ASD",-$P(^(0),
"^",2),+X,DA(1),DA)
3)= DO NOT DELETE
Index procedure date and all CPT procedures.
CROSS-REFERENCE:^^TRIGGER^399.0304^20
1)= Q
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,0)):^(0),1:"
") S X=$P(Y(1),U,20),X=X S DIU=X K Y S X="" X ^DD(399.0304,.01,1,3,2.4)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),0)),DIV=X S $P(^(0),U,20)=DIV,DIH=399.0304,DIG=20 D ^DI
CR
3)= Do Not Delete
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= OUTPATIENT ENCOUNTER
Delete the Outpatient Encounter link if the Procedure is modified.
FIELD INDEX: AD (#991) MUMPS IR ACTION
Short Descr: Remove MANUALLY EDITED flag from Revenue Code.
Description: This cross reference is designed to remove the MANUALLY EDITED flag from records in the REVENUE
CODE multiple if changes were made to the PROCEDURE CODE pointed to by the soft pointer in the ITEM
(#399.042,.11) field.
Set Logic: Q
Kill Logic: D FROMPROC^IBCU9(DA(1),DA,"D")
X(1): PROCEDURES (399.0304,.01) (Subscr 1) (forwards)
399.0304,1 PROCEDURE DATE 0;2 DATE
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X),$D(IBIFN),'$$OPV2^IBCU41(X,IBIFN,1) K X
LAST EDITED: JAN 23, 1999
HELP-PROMPT: Procedure date must be within the bill's STATEMENT FROM and STATEMENT TO dates.
DESCRIPTION:
This is the date the procedure was performed.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE:399^ASD1^MUMPS
1)= I $D(^DGCR(399,DA(1),"CP",DA,0)),+^(0),$P($P(^(0),"^",1),";",2)="ICPT(" S ^DGCR(399,"ASD",-X,+^
(0),DA(1),DA)=""
2)= I $D(^DGCR(399,DA(1),"CP",DA,0)),+^(0),$P($P(^(0),"^",1),";",2)="ICPT(" K ^DGCR(399,"ASD",-X,+^
(0),DA(1),DA)
3)= DO NOT DELETE
Index procedure date and all CPT procedures.
399.0304,2 *ADDITIONAL PROCEDURE NAME 0;3 FREE TEXT
ADDITIONAL PROCEDURE NAME
INPUT TRANSFORM:K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>28!($L(X)<3)!'(X?.ANP) X
LAST EDITED: NOV 04, 1991
HELP-PROMPT: Answer must be 3-28 characters in length.
DESCRIPTION: This is the name of the procedure.
This field has been marked for deletion 11/4/91.
WRITE AUTHORITY:^
UNEDITABLE
399.0304,3 PRINT ORDER 0;4 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X I $D(X),$D(^DGCR(399,DA(1),"CP","D",X)) W !!,*7,"This number
already used!" K X
LAST EDITED: JAN 31, 2007
HELP-PROMPT: Type a Number between 1 and 99, 0 Decimal Digits
DESCRIPTION: This is the relative order that this procedure will appear on the bill. For the UB-04, the
procedure with the lowest print order is the principal procedure and the rest print in FL74 in
lowest to highest print order.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE:399.0304^D
1)= S ^DGCR(399,DA(1),"CP","D",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(1),"CP","D",$E(X,1,30),DA)
399.0304,4 BASC BILLABLE 0;5 SET
'1' FOR YES;
LAST EDITED: FEB 28, 1992
DESCRIPTION: This field will be completed by the system if this procedure is an Ambulatory Surgery that can be
billed under the HCFA rate system.
CROSS-REFERENCE:399.0304^AREV7^MUMPS
1)= S DGRVRCAL=1
2)= S DGRVRCAL=2
When this field is edited or changed, the revenue codes and charges for this bill will
automatically be recalculated.
CROSS-REFERENCE:399.0304^ASC
1)= S ^DGCR(399,DA(1),"CP","ASC",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(1),"CP","ASC",$E(X,1,30),DA)
This cross-reference is used to determine if any procedures entered are billable as Ambulatory
Surgery Codes.
399.0304,5 DIVISION 0;6 POINTER TO MEDICAL CENTER DIVISION FILE (#40.8)
LAST EDITED: JUL 06, 2011
HELP-PROMPT: Enter the division where this procedure was performed if the CPT charges are based on region and if
it is different than the bills Default Division.
DESCRIPTION: Enter the Division at which this procedure was performed. This is only required if the bill's
charges are based on CPT and region and the division is different than the bill's Default Division.
NOTES: TRIGGERED by the ASSOCIATED CLINIC field of the PROCEDURES sub-field of the BILL/CLAIMS File
FIELD INDEX: AC (#990) MUMPS IR ACTION
Short Descr: Remove MANUALLY EDITED flag from Revenue Code
Description: This cross reference is designed to remove the MANUALLY EDITED flag from records in the REVENUE
CODE multiple if changes were made to the PROCEDURE CODE pointed to by the soft pointer in the ITEM
(#399.042,.11) field.
Set Logic: D FROMPROC^IBCU9(DA(1),DA,"E")
Kill Logic: Q
X(1): DIVISION (399.0304,5) (Subscr 1) (forwards)
399.0304,6 ASSOCIATED CLINIC 0;7 POINTER TO HOSPITAL LOCATION FILE (#44)
INPUT TRANSFORM:S DIC("S")="I +$$CLNSCRN^IBCU(+$P($G(^DGCR(399,+$G(DA(1)),""CP"",+$G(DA),0)),U,2),+Y)" D ^DIC K DIC
S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JAN 30, 1999
HELP-PROMPT: Enter the clinic associated with this procedures visit.
DESCRIPTION: Enter the clinic where this procedure was performed. This field must be completed in order for
this procedure to be successfully transferred to the Add/Edit Stop code logic for inclusion in OPC
workload.
SCREEN: S DIC("S")="I +$$CLNSCRN^IBCU(+$P($G(^DGCR(399,+$G(DA(1)),""CP"",+$G(DA),0)),U,2),+Y)"
EXPLANATION: Only active clinics!
CROSS-REFERENCE:^^TRIGGER^399.0304^5
1)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,0)):^(0),1:"
") S X=$P(Y(1),U,6),X=X S DIU=X K Y X ^DD(399.0304,6,1,1,1.1) X ^DD(399.0304,6,1,1,1.4)
1.1)= S X=DIV X ^DD(399.0304,6,1,1,49.2) S X=X S X=X S D0=I(0,0) S D1=I(1,0)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"CP",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,6)=DIV,DIH=399.0304
,DIG=5 D ^DICR
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,0)):^(0),1:"
") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X="" X ^DD(399.0304,6,1,1,2.4)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"CP",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,6)=DIV,DIH=399.0304
,DIG=5 D ^DICR
49.2)= S I(1,0)=$S($D(D1):D1,1:""),I(0,0)=$S($D(D0):D0,1:""),D0=DIV S:'$D(^SC(+D0,0)) D0=-1 S Y(102
)=$S($D(^SC(D0,0)):^(0),1:""),Y(101)=X S X=$P(Y(102),U,15)
CREATE VALUE)= ASSOCIATED CLINIC:INTERNAL(#3.5)
DELETE VALUE)= @
FIELD)= DIVISION
Auto set the procedures division to the clinics division.
399.0304,7 *ASSOCIATED DIAGNOSIS 0;8 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 16, 1993
HELP-PROMPT: Enter the diagnosis related to this procedure.
DESCRIPTION:
This is the diagnosis most closely related to this procedure. Used on the HFCA 1500, block 24e.
TECHNICAL DESCR:Replaced by (399,304,10-13) so that could point to the diagnosis file (362.3). "*"ed for deletion
11/16/93.
399.0304,8 PLACE OF SERVICE 0;9 POINTER TO PLACE OF SERVICE FILE (#353.1)
LAST EDITED: SEP 08, 2006
HELP-PROMPT: Enter the Place of Service appropriate for this procedure.
DESCRIPTION: This is the Place of Service appropriate for this Procedure. Used only for the CMS-1500 claim
form.
399.0304,9 TYPE OF SERVICE 0;10 POINTER TO TYPE OF SERVICE FILE (#353.2)
LAST EDITED: JAN 31, 2007
HELP-PROMPT: Enter the Type of Service appropriate for this procedure.
DESCRIPTION:
This is the Type of Service to be associated with this procedure.
CROSS-REFERENCE:^^TRIGGER^399.0304^15
1)= X ^DD(399.0304,9,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,0)):^(0),1:"") S X=$P(Y
(1),U,16),X=X S DIU=X K Y S X="" X ^DD(399.0304,9,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X,I(1,0)=$S($D(D1):D1,1:""),I(0,0)=$S
($D(D0):D0,1:""),D0=Y(0) S:'$D(^IBE(353.2,+D0,0)) D0=-1 S Y(101)=$S($D(^IBE(353.2,D0,0)):^(0),1:"")
,X=$P(Y(101),U,2)'="ANESTHESIA",D0=I(0,0),D1=I(1,0)
1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"CP",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,16)=DIV,DIH=399.030
4,DIG=15 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,0)):^(0),1:"
") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X="" X ^DD(399.0304,9,1,1,2.4)
2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"CP",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,16)=DIV,DIH=399.030
4,DIG=15 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
CREATE CONDITION)= TYPE OF SERVICE:NAME'="ANESTHESIA"
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= MINUTES
399.0304,10 ASSOCIATED DIAGNOSIS (1) 0;11 POINTER TO IB BILL/CLAIMS DIAGNOSIS FILE (#362.3)
INPUT TRANSFORM:S DIC("S")="I +$P(^IBA(362.3,Y,0),U,2)=+$G(DA(1))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JAN 31, 2007
HELP-PROMPT: Enter the diagnosis related to this procedure.
DESCRIPTION:
The diagnosis most closely related to this procedure. Used only for the CMS-1500, box 24e.
TECHNICAL DESCR:
Converted from (399,304,7) with IB 2.0.
SCREEN: S DIC("S")="I +$P(^IBA(362.3,Y,0),U,2)=+$G(DA(1))"
EXPLANATION: Only Diagnosis for this bill may be chosen.
399.0304,11 ASSOCIATED DIAGNOSIS (2) 0;12 POINTER TO IB BILL/CLAIMS DIAGNOSIS FILE (#362.3)
INPUT TRANSFORM:S DIC("S")="I +$P(^IBA(362.3,Y,0),U,2)=+$G(DA(1))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JAN 31, 2007
HELP-PROMPT: Enter a diagnosis related to this procedure.
DESCRIPTION:
The diagnosis most closely related to this procedure. Used only for the CMS-1500, box 24e.
SCREEN: S DIC("S")="I +$P(^IBA(362.3,Y,0),U,2)=+$G(DA(1))"
EXPLANATION: Only Diagnosis for this bill may be chosen.
399.0304,12 ASSOCIATED DIAGNOSIS (3) 0;13 POINTER TO IB BILL/CLAIMS DIAGNOSIS FILE (#362.3)
INPUT TRANSFORM:S DIC("S")="I +$P(^IBA(362.3,Y,0),U,2)=+$G(DA(1))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JAN 31, 2007
HELP-PROMPT: Enter a diagnosis related to this procedure.
DESCRIPTION:
The diagnosis most closely related to this procedure. Used only for the CMS-1500, box 24e.
SCREEN: S DIC("S")="I +$P(^IBA(362.3,Y,0),U,2)=+$G(DA(1))"
EXPLANATION: Only Diagnosis for this bill may be chosen.
399.0304,13 ASSOCIATED DIAGNOSIS (4) 0;14 POINTER TO IB BILL/CLAIMS DIAGNOSIS FILE (#362.3)
INPUT TRANSFORM:S DIC("S")="I +$P(^IBA(362.3,Y,0),U,2)=+$G(DA(1))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JAN 31, 2007
HELP-PROMPT: Enter a diagnosis related to this procedure.
DESCRIPTION:
The diagnosis most closely related to this procedure. Used only for the CMS-1500, box 24e.
SCREEN: S DIC("S")="I +$P(^IBA(362.3,Y,0),U,2)=+$G(DA(1))"
EXPLANATION: Only Diagnosis for this bill may be chosen.
399.0304,14 *CPT MODIFIER 0;15 POINTER TO CPT MODIFIER FILE (#81.3)
INPUT TRANSFORM:S DIC("S")="N IBXZ S IBXZ=$G(^DGCR(399,+$G(DA(1)),""CP"",+$G(DA),0)) I +IBXZ,+$$MODP^ICPTMOD(+IBXZ,
+Y,""I"",+$P(IBXZ,U,2))>0" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: AUG 20, 1999
HELP-PROMPT: Enter a CPT modifier.
DESCRIPTION:
Enter the modifier which should be printed on the claim form with the CPT code.
TECHNICAL DESCR:
This field has been marked for deletion on 9/1/99.
SCREEN: S DIC("S")="N IBXZ S IBXZ=$G(^DGCR(399,+$G(DA(1)),""CP"",+$G(DA),0)) I +IBXZ,+$$MODP^ICPTMOD(+IBXZ,
+Y,""I"",+$P(IBXZ,U,2))>0"
EXPLANATION: Only acceptable modifiers for this CPT Code may be selected!
399.0304,15 MINUTES 0;16 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: FEB 19, 1999
HELP-PROMPT: Enter the # of minutes for this service.
DESCRIPTION:
Enter the number of minutes of care, usually related to Anesthesia.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the TYPE OF SERVICE field of the PROCEDURES sub-field of the BILL/CLAIMS File
399.0304,16 CPT MODIFIER SEQUENCE MOD;0 Multiple #399.30416 (Add New Entry without Asking)
LAST EDITED: DEC 15, 1998
IDENTIFIED BY: CPT MODIFIER(#.02)[R]
"WRITE": W ?10,$P($$MOD^ICPTMOD(+$P(^(0),U,2),"I"),U,3)
399.30416,.01 CPT MODIFIER SEQUENCE 0;1 NUMBER (Multiply asked)
INPUT TRANSFORM:K:+X'=X!(X>10)!(X<1)!(X?.E1"."1N.N) X I $D(X) N Z S Z=$O(^DGCR(399,DA(2),"CP",DA(1),"MOD","B",X,0
)) I Z,Z'=DA D EN^DDIOL(X_" has already been used!!",,"!,*7,?10") K X
LAST EDITED: DEC 15, 1998
HELP-PROMPT: Type a unique sequence number between 1 and 10, 0 Decimal Digits
DESCRIPTION:
This field determines the billing priority of the modifier.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE:399.30416^B
1)= S ^DGCR(399,DA(2),"CP",DA(1),"MOD","B",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(2),"CP",DA(1),"MOD","B",$E(X,1,30),DA)
399.30416,.02 CPT MODIFIER 0;2 POINTER TO CPT MODIFIER FILE (#81.3) (Required)
INPUT TRANSFORM:D B30416^IBACSV D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
LAST EDITED: APR 29, 2004
HELP-PROMPT: ENTER A VALID CPT MODIFIER FOR THE PROCEDURE
SCREEN: D B30416^IBACSV
EXPLANATION: Only acceptable modifiers for the CPT Code may be selected!
CROSS-REFERENCE:399.30416^C
1)= S ^DGCR(399,DA(2),"CP",DA(1),"MOD","C",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(2),"CP",DA(1),"MOD","C",$E(X,1,30),DA)
399.0304,17 EMERGENCY PROCEDURE? 0;17 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: DEC 10, 1998
HELP-PROMPT: Enter YES if this was an emergency procedure
DESCRIPTION:
This field stores whether the procedure performed was emergency or scheduled/routine.
399.0304,18 PROVIDER 0;18 POINTER TO NEW PERSON FILE (#200)
INPUT TRANSFORM:S DIC("S")="I $O(^(""USC1"",0))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JUN 14, 2006
HELP-PROMPT: Enter the provider who performed this procedure.
DESCRIPTION:
This is the provider who performed the procedure.
SCREEN: S DIC("S")="I $O(^(""USC1"",0))"
EXPLANATION: Only medical personnel are selectable for this field.
399.0304,19 PURCHASED COST 0;19 NUMBER
Purchased Cost
INPUT TRANSFORM:S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<0) X
LAST EDITED: MAR 19, 2014
HELP-PROMPT: Type a dollar amount between 0 and 9999999.99, 2 decimal digits.
DESCRIPTION: This is the actual amount the VA paid for a service provided to a VA patient at a NON-VA facility
or provider.
399.0304,20 OUTPATIENT ENCOUNTER 0;20 POINTER TO OUTPATIENT ENCOUNTER FILE (#409.68)
LAST EDITED: MAY 10, 2001
HELP-PROMPT: Link between procedure and encounter.
DESCRIPTION:
The Outpatient Encounter where this procedure was performed.
TECHNICAL DESCR:
This field is stuffed by the application for procedures extracted from the Outpatient Encounter
file.
NOTES: TRIGGERED by the PROCEDURES field of the PROCEDURES sub-field of the BILL/CLAIMS File
399.0304,21 MILES 0;21 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>99999)!(X<0)!(X?.E1"."2N.N) X
LAST EDITED: SEP 30, 2003
HELP-PROMPT: Type a Number between 0 and 99999, 1 Decimal Digit
DESCRIPTION:
Enter the number of miles the patient was transported.
399.0304,22 HOURS 0;22 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>999)!(X<0)!(X?.E1"."2N.N) X
LAST EDITED: DEC 03, 2003
HELP-PROMPT: Type a Number between 0 and 999, 1 Decimal Digit
DESCRIPTION:
Enter the number of hours of care, usually related to Observation.
399.0304,23 CMN REQUIRED? CMN;1 SET (Required)
CMN Required?
'0' FOR NO;
'1' FOR YES;
LAST EDITED: NOV 15, 2017
HELP-PROMPT: Enter 'Yes' (1) if this procedure requires a Certificate of Medical Necessity, or 'No' (0) if it
does not.
DESCRIPTION: This field indicates whether a Certificate of Medical Necessity must be submitted with this
procedure.
399.0304,24 CMN FORM TYPE CMN;2 POINTER TO CMN FORM TYPES FILE (#399.6)
CMN Form type
LAST EDITED: MAR 08, 2018
HELP-PROMPT: Select the REQUIRED CMN form type that will be sent with this procedure.
DESCRIPTION: This field indicates the Certificate of Medical Necessity form type that is to be submitted with
this procedure.
TECHNICAL DESCR:
If the CMN Required? field is set to "Y"es, this field must be an entry in the CMS FORM TYPES file
#399.6.
399.0304,24.01 CMN CERTIFICATION TYPE CMN;3 SET
Certification Type
'I' FOR INITIAL;
'R' FOR RENEWAL;
'S' FOR REVISED;
LAST EDITED: MAR 08, 2018
HELP-PROMPT: Select the REQUIRED Type of Certification requested.
DESCRIPTION:
This field indicates the type of Certification that is being requested.
399.0304,24.02 CMN PATIENT HEIGHT (IN) CMN;4 NUMBER
Patient Height (in)
INPUT TRANSFORM:K:+X'=X!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: APR 03, 2018
HELP-PROMPT: Enter the Patient's height in whole numbers representing inches.
DESCRIPTION:
This field indicates the Patient's height in whole numbers representing inches.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399.0304,24.03 CMN PATIENT WEIGHT (LBS) CMN;5 NUMBER
Patient Weight (lbs)
INPUT TRANSFORM:K:+X'=X!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: MAR 02, 2018
HELP-PROMPT: Enter the Patient's weight in whole numbers representing pounds.
DESCRIPTION:
This field indicates the Patient's weight in whole numbers representing pounds.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399.0304,24.04 CMN MONTHS DME EQUIP NEEDED CMN;6 NUMBER
Months DME Equipment Needed
INPUT TRANSFORM:K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: NOV 14, 2017
HELP-PROMPT: Enter the number of MONTHS the patient will need the DME Equipment. Enter 1-99 with 99 equal to a
lifetime.
DESCRIPTION: This field indicates the number of MONTHS that the Patient will need the DME Equipment. '99'
represents a lifetime.
399.0304,24.05 CMN DATE THERAPY STARTED CMN;7 DATE
Date Therapy Started
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAR 08, 2018
HELP-PROMPT: Enter the REQUIRED date the therapy began.
DESCRIPTION:
This field indicates the date the therapy began.
399.0304,24.06 CMN LAST CERTIFICATION DATE CMN;8 DATE
Last Certification Date
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAR 08, 2018
HELP-PROMPT: Enter the REQUIRED date the physician signed the Certificate of Medical Necessity.
DESCRIPTION:
This field indicates the date the physician signed the Certificate of Medical Necessity.
399.0304,24.07 CMN RECERTIFICATION/REVISN DT CMN;9 DATE
Recertification/Revision Date
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: NOV 14, 2017
HELP-PROMPT: If the Certification Type is a Renewal or Revised, enter a REQUIRED Recertification/Revision date.
DESCRIPTION: If the Certification Type is a Renewal or Revised, this field is REQUIRED and indicates the date of
the Recertification/Renewal.
399.0304,24.08 CMN REPLACEMENT ITEM? CMN;10 SET
Replacement Item?
'0' FOR NO;
'1' FOR YES;
LAST EDITED: NOV 14, 2017
HELP-PROMPT: Enter 'Yes' (1) if this item is being billed as a replacement item, or 'No' (0) if it is not.
DESCRIPTION:
This field indicates whether or not the item being billed is a Replacement item.
399.0304,24.1 CMN ABG PO2 (MMHG) CMN-484;16 NUMBER
ABG PO2 (mmHg)
INPUT TRANSFORM:K:+X'=X!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: MAR 02, 2018
HELP-PROMPT: Enter the result of the most recent ABG test. Enter a whole Number which will be reported as mmHg.
DESCRIPTION: This field indicates the result of the most recent ABG test. The Number entered will be reported
as mmHg.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399.0304,24.102 CMN O2 SATURATION % CMN-484;2 NUMBER
O2 Saturation (%)
INPUT TRANSFORM:K:+X'=X!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: MAR 02, 2018
HELP-PROMPT: Enter the result of the most recent Oxygen saturation test. Enter a whole number which will be
reported as %.
DESCRIPTION: This field indicates the result of the most recent Oxygen saturation test. The number entered will
be reported as %.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399.0304,24.103 CMN DT LAST ABG PO2 AND O2 SAT CMN-484;3 DATE
Date of Last ABG PO2 and/or O2 Saturation Test(s)
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAR 14, 2018
HELP-PROMPT: Enter the REQUIRED date for the most recent ABG PO2 and/or O2 Saturation Test(s).
DESCRIPTION:
This field indicates the Date for the most recent ABG PO2 and/or O2 Saturation test(s).
399.0304,24.104 CMN EDEMA DUE TO CHF PRESENT? CMN-484;4 SET
Edema due to CHF Present?
'0' FOR NO;
'1' FOR YES;
LAST EDITED: NOV 14, 2017
HELP-PROMPT: Enter 'Yes' (1) if Edema being due to CHF being Present, or 'No' (0) if it is not.
DESCRIPTION: This field indicates whether or not the patient has dependent Edema due to Congestive Heart
Failure.
399.0304,24.105 CMN COR PULMONARY HYPERTENSN? CMN-484;5 SET
COR Pulmonale/Pulmonary Hypertension Present?
'0' FOR NO;
'1' FOR YES;
LAST EDITED: NOV 14, 2017
HELP-PROMPT: Enter 'Yes' (1) if COR Pulmonale or Pulmonary Hypertension is Present, or 'No' (0) if it is not.
DESCRIPTION: This field indicates whether or not the patient has cor pulmonate or pulmonary hypertension
documented by P pulmonale on an EKG or echocardiogram, gated blood pool scan or direct pulmonary
artery pressure measurement.
399.0304,24.106 CMN HEMATOCRIT > 56%? CMN-484;6 SET
Hematocrit > 56%?
'0' FOR NO;
'1' FOR YES;
LAST EDITED: NOV 14, 2017
HELP-PROMPT: Enter 'Yes' (1) if the patient has a Hematocrit level greater that 56% or 'No' (0) if not.
DESCRIPTION:
This field indicates whether or not the patient has a Hematocrit level greater than 56%.
399.0304,24.107 CMN PT CONDITION AT TEST TIME CMN-484;7 SET
Patient Condition At Test Time
'1' FOR CHRONIC AND STABLE AS OUTPT;
'2' FOR W/I TWO DAYS PRIOR TO D/C FROM INPT FACILITY;
'3' FOR UNDER OTHER CIRCUMSTANCES;
LAST EDITED: NOV 14, 2017
HELP-PROMPT: Enter the patient's condition at the time of the ABG and/or O2 Saturation test(s).
DESCRIPTION:
This field indicates the patient's condition at the time of the ABG and/or O2 Saturation test(s).
399.0304,24.108 CMN TEST CONDITIONS CMN-484;8 SET
Test Conditions
'1' FOR AT REST;
'2' FOR DURING EXERCISE;
'3' FOR DURING SLEEP;
LAST EDITED: NOV 14, 2017
HELP-PROMPT: Enter the conditions for the ABG and/or O2 Saturation test(s).
DESCRIPTION:
This field indicates the condition for the ABG and/or O2 Saturation test(s).
399.0304,24.109 CMN PORTABLE O2 INDICATOR CMN-484;9 SET
Portable O2 Indicator
'Y' FOR PATIENT MOBILE WITHIN HOME;
'N' FOR PATIENT NOT MOBILE WITHIN HOME;
'D' FOR NOT ORDERING PORTABLE OXYGEN;
LAST EDITED: NOV 14, 2017
HELP-PROMPT: Enter the patient's mobility if ordering portable oxygen or indicate if not ordering portable
oxygen.
DESCRIPTION:
This field indicates the patient's mobility concerning the ordering of portable oxygen.
399.0304,24.11 CMN HIGHEST O2 FLOW RATE CMN-484;10 FREE TEXT
Highest O2 Flow Rate
INPUT TRANSFORM:K:$L(X)>50!($L(X)<1) X
MAXIMUM LENGTH: 50
LAST EDITED: MAR 02, 2018
HELP-PROMPT: Enter the highest oxygen flow rate ordered for this patient in liters per minute (LPM). Enter a
number. If oxygen rate is less than 1 LPM, enter 'X'.
DESCRIPTION: This field indicates the highest oxygen flow rate ordered for this Patient in liters per minute
(LPM). The value is either a number, or if the value is less than 1 LPM, it should be entered as
an "X".
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399.0304,24.111 CMN LAST 4 LPM ABG PO2 (MMHG) CMN-484;11 NUMBER
Latest 4 LPM ABG PO2 (mmHg)
INPUT TRANSFORM:K:+X'=X!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: MAR 02, 2018
HELP-PROMPT: Enter the result of the most recent ABG test taken on 4 LPM. Enter a whole number which will be
reported as mmHg.
DESCRIPTION: This field indicates the result of the most recent ABG test taken on 4 LPM. The number entered
will be reported as mmHg.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399.0304,24.113 CMN LAST 4 LPM O2 SATURATION % CMN-484;13 NUMBER
Latest 4 LPM O2 Saturation (%)
INPUT TRANSFORM:K:+X'=X!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: MAR 02, 2018
HELP-PROMPT: Enter the result of the most recent Oxygen saturation test. Enter a whole number which will be
reported as %.
DESCRIPTION: This field indicates the result of the most recent Oxygen saturation test. The number entered will
be reported as %.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399.0304,24.114 CMN DATE OF LAST 4 LPM TESTS CMN-484;14 DATE
Date of the Latest 4 LPM Test(s)
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAR 14, 2018
HELP-PROMPT: Enter the REQUIRED date for the most recent 4 LPM Test(s).
DESCRIPTION: This field indicates the Date for the most recent ABG PO2 and/or O2 Saturation test(s) taken on 4
LPM.
399.0304,24.115 CMN EQUIPMENT/COST DESCRIPTION CMN-484;15 FREE TEXT
Equipment/Cost Description
INPUT TRANSFORM:K:$L(X)>50!($L(X)<1) X
MAXIMUM LENGTH: 50
LAST EDITED: NOV 14, 2017
HELP-PROMPT: Enter a 1-50 character free text description of items, accessories, and options ordered, suppliers
charge and Medicare Fee Schedule allowance for each item, accessory and option.
DESCRIPTION: This field indicates the description of the items, accessories, and options ordered, suppliers
charge and Medicare Fee Schedule Allowance for each item, accessory and option.
399.0304,24.201 CMN SM BOWEL ABSORPTION DOC? CMN-10126;1 SET
Small Bowel Absorption Documentation Present?
'0' FOR NO;
'1' FOR YES;
LAST EDITED: NOV 14, 2017
HELP-PROMPT: Enter 'Yes' (1) if there is documentation on file for Small Bowel Absorption, or 'No' (0) if there
is not.
DESCRIPTION: This field indicates whether or not there is documentation in the medical record that supports the
patient's permanent non-function or disease of the structures that permit food to reach or be
absorbed from the small bowel.
399.0304,24.202 CMN ENTERAL NUTRITION BY TUBE? CMN-10126;2 SET
Enteral Nutrition by Tube?
'0' FOR NO;
'1' FOR YES;
LAST EDITED: NOV 21, 2017
HELP-PROMPT: Enter 'Yes' (1) if the Enteral Nutrition is being administered by a tube, or 'No' (0) if it is not.
DESCRIPTION: This field indicates whether or not the Enteral Nutrition is being administered via a tube
(Example: gastrostomy tube).
399.0304,24.203 CMN PROCEDURE A CALORIES CMN-10126;3 NUMBER
Procedure A Calories
INPUT TRANSFORM:K:+X'=X!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: APR 20, 2018
HELP-PROMPT: Enter the calories per day associated with Procedure A.
DESCRIPTION:
This field indicates the calories per day associated with Procedure A.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399.0304,24.204 CMN PROCEDURE A CMN-10126;4 POINTER TO CPT FILE (#81)
Procedure A
LAST EDITED: APR 20, 2018
HELP-PROMPT: Enter first procedure with associated calories.
DESCRIPTION:
This is the procedure code to which the "Procedure A Calories" field corresponds.
399.0304,24.205 CMN METHOD OF ADMINISTRATION CMN-10126;5 SET
Method of Administration
'1' FOR SYRINGE;
'2' FOR GRAVITY;
'3' FOR PUMP;
'4' FOR ORAL;
LAST EDITED: NOV 15, 2017
HELP-PROMPT: Select the appropriate method by which the service was administered.
DESCRIPTION:
This field indicates the method by which the service was administered.
399.0304,24.206 CMN DAYS PER WEEK ADMINISTERED CMN-10126;6 NUMBER
Days/Week Administered
INPUT TRANSFORM:K:+X'=X!(X>7)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: NOV 14, 2017
HELP-PROMPT: Enter the number of days per week that the nutrition is administered or infused.
DESCRIPTION:
This field indicates the number of days per week that the nutrition is administered or infused.
399.0304,24.207 CMN SEVERE MALABSORPTION DOC? CMN-10126;7 SET
Severe Malabsorption Documentation Present?
'0' FOR NO;
'1' FOR YES;
LAST EDITED: NOV 14, 2017
HELP-PROMPT: Enter 'Yes' (1) if there is documentation on file for Severe Malabsorption, or 'No' (0) if there is
not.
DESCRIPTION: This field indicates whether or not there is documentation in the medical record that supports the
patient having permanent disease of the gastrointestinal tract causing malabsorption severe enough
to prevent maintenance of weight and strength.
399.0304,24.208 CMN AMINO ACID (ML/DAY) CMN-10126;8 NUMBER
Amino Acid (ml/day)
INPUT TRANSFORM:K:+X'=X!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: MAR 02, 2018
HELP-PROMPT: Enter the number of milliliters of the component Amino Acid that are administered per day in this
nutritional formula.
DESCRIPTION: This field indicates the number of milliliters of the component Amino Acid that are administered
per day in this nutritional formula.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399.0304,24.209 CMN AMINO ACID CONCENTRATION % CMN-10126;9 NUMBER
Amino Acid Concentration (%)
INPUT TRANSFORM:K:+X'=X!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: MAR 02, 2018
HELP-PROMPT: Enter the percent concentration of Amino Acids in this nutritional formula.
DESCRIPTION:
This field indicates the percent concentration of Amino Acids in this nutritional formula.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399.0304,24.21 CMN AMINO ACID PROTEIN (GM/DY) CMN-10126;10 NUMBER
Amino Acid Protein (gm/day)
INPUT TRANSFORM:K:+X'=X!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: MAR 02, 2018
HELP-PROMPT: Enter the amount of protein administered in grams/day in this nutritional formula.
DESCRIPTION:
This field indicates the amount of protein administered in grams/day in this nutritional formula.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399.0304,24.211 CMN DEXTROSE (ML/DAY) CMN-10126;11 NUMBER
Dextrose (ml/day)
INPUT TRANSFORM:K:+X'=X!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: MAR 02, 2018
HELP-PROMPT: Enter the number of milliliters of the component Dextrose that are administered per day in this
nutritional formula.
DESCRIPTION: This field indicates the number of milliliters of the component Dextrose that are administered per
day in this nutritional formula.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399.0304,24.212 CMN DEXTROSE CONCENTRATE % CMN-10126;12 NUMBER
Dextrose Concentrate (%)
INPUT TRANSFORM:K:+X'=X!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: MAR 02, 2018
HELP-PROMPT: Enter the percent concentration of Dextrose in this nutritional formula.
DESCRIPTION:
This field indicates the percent concentration of Dextrose in this nutritional formula.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399.0304,24.213 CMN LIPIDS (ML/DAY) CMN-10126;13 NUMBER
Lipids (ml/day)
INPUT TRANSFORM:K:+X'=X!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: MAR 02, 2018
HELP-PROMPT: Enter the number of milliliters of the component Lipids that are administered per day in this
nutritional formula.
DESCRIPTION: This field indicates the number of milliliters of the component Lipids that are administered per
day in this nutritional formula.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399.0304,24.214 CMN ROUTE OF ADMINISTRATION CMN-10126;14 SET
Route of Administration
'1' FOR CENTRAL LINE (INCLUDES PICC);
'2' FOR HEMODIALYSIS ACCESS LINE;
'3' FOR PERITONEAL CATHETER;
LAST EDITED: NOV 14, 2017
HELP-PROMPT: Enter the number that represents the appropriate route by which the nutrition was administered.
DESCRIPTION:
This field indicates the route by which the nutrition was administered.
399.0304,24.215 CMN LIPIDS (DAYS/WEEK) CMN-10126;15 NUMBER
Lipids (days/wk)
INPUT TRANSFORM:K:+X'=X!(X>7)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: NOV 14, 2017
HELP-PROMPT: Enter the number of days per week the component lipids are administered in this nutritional
formula.
DESCRIPTION: This field indicates the number of days per week the component Lipids are administered in this
nutritional formula.
399.0304,24.216 CMN LIPIDS CONCENTRATE % CMN-10126;16 NUMBER
Lipids Concentrate (%)
INPUT TRANSFORM:K:+X'=X!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: MAR 02, 2018
HELP-PROMPT: Enter the percent concentration of Lipids in this nutritional formula.
DESCRIPTION:
This field indicates the percent concentration of Lipids in this nutritional formula.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399.0304,24.217 CMN PARENTERAL/ENTERAL/BOTH CMN-10126;17 SET
Is this for Parenteral nutrition, Enteral nutrition, or Both?
'P' FOR PARENTERAL;
'E' FOR ENTERAL;
'B' FOR BOTH;
LAST EDITED: APR 23, 2018
HELP-PROMPT: Is this CMN for Parenteral nutrition, enteral nutrition, or both?
DESCRIPTION: This field designates whether this CMN form is for Parenteral nutrition, enteral nutrition, or
both.
399.0304,24.218 CMN PROCEDURE B CALORIES CMN-10126;18 NUMBER
Procedure B Calories
INPUT TRANSFORM:K:+X'=X!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: APR 23, 2018
HELP-PROMPT: Enter the calories per day associated with Procedure B.
DESCRIPTION:
This field indicates the calories per day associated with Procedure B.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
399.0304,24.219 CMN PROCEDURE B CMN-10126;19 POINTER TO CPT FILE (#81)
Procedure B
LAST EDITED: APR 20, 2018
HELP-PROMPT: Enter second procedure with associated calories.
DESCRIPTION:
This is the procedure code to which the "Procedure B Calories" field corresponds.
399.0304,50.01 *HCFA BOX 24K (LOCAL USE ONLY) AUX;1 FREE TEXT
INPUT TRANSFORM:K:$L(X)>15!($L(X)<1) X
LAST EDITED: OCT 13, 2006
HELP-PROMPT: This field is no longer used. Answer must be 1-15 characters in length.
DESCRIPTION: This field is obsolete. Field contains the text to print in HCFA box 24K for this line item when
the bill is printed locally only. If anything is entered in this field, it will override any
system defaults that may apply to this field. However, this data will NEVER be transmitted
electronically for the claim. If you need to submit data in this field, set the PRINT LOCAL flag
on the claim so you can print and mail it from the site.
399.0304,50.02 *LAST XRAY DATE AUX;2 DATE
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAY 24, 2007
HELP-PROMPT: This field is obsolete.
DESCRIPTION:
This field has been deactivated and is not in use anymore.
399.0304,50.03 ATTENDING NOT HOSPICE EMPLOYEE AUX;3 SET
Attending not Hospice Employee
'1' FOR ATTENDING PHYSICIAN IS NOT A HOSPICE EMPLOYEE;
LAST EDITED: MAR 25, 2014
HELP-PROMPT: Enter a 1 if billing for hospice care and the attending physician is not employed by the hospice.
DESCRIPTION: This is the flag that indicates that an attending physician for hospice care charges was not
employed by the hospice.
399.0304,50.04 *LEVEL OF SUBLUXATION AUX;4 FREE TEXT
INPUT TRANSFORM:K:$L(X)>7!($L(X)<2)!'(X?2.3E1"-"2.3E!(X?2.3E&(X'["-"))) X
LAST EDITED: MAY 25, 2007
HELP-PROMPT: This field is obsolete.
DESCRIPTION:
This field has been deactivated and is not in use anymore.
399.0304,50.05 *CHIRO TREATMENT SERIES NUM AUX;5 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>99999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAY 25, 2007
HELP-PROMPT: This field is obsolete.
DESCRIPTION:
This field has been deactivated and is not in use anymore.
399.0304,50.06 *CHIROPRACTIC QUANTITY AUX;6 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>99999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAY 25, 2007
HELP-PROMPT: This field is obsolete.
DESCRIPTION:
This field has been deactivated and is not in use anymore.
399.0304,50.07 EPSDT FLAG AUX;7 SET
EPSDT Flag
'1' FOR YES;
LAST EDITED: MAR 19, 2014
HELP-PROMPT: Enter a 1 if the item being billed is EPSDT related
DESCRIPTION: This is the field to indicate a service is EPSDT related (Early and Periodic Screen for Diagnosis
and Treatment of children). For printed claims, this data will print in CMS-1500 box 24H.
399.0304,50.08 SERVICE LINE COMMENT AUX;8 FREE TEXT
Service Line Comment
INPUT TRANSFORM:K:$L(X)>59!($L(X)<1) X
LAST EDITED: MAR 19, 2014
HELP-PROMPT: Answer must be 1-59 characters in length
DESCRIPTION: Enter a free text comment as supplemental information associated with this procedure. This text
will print up to 59 characters across the shaded line of Box 24 of the CMS-1500 form.
The following qualifiers can be entered after the text when reporting NDC units when the NDC Units
are required in addition to the HCPCS units:
F2 International Unit GR Gram ML Milliliter UN Unit
399.0304,50.09 SERVICE LINE COMMENT QUALIFIER AUX;9 FREE TEXT
Service Line Comment Qualifier
INPUT TRANSFORM:K:$L(X)>7!($L(X)<1) X
LAST EDITED: MAR 19, 2014
HELP-PROMPT: Answer must be 1-7 characters in length
DESCRIPTION: Enter an optional free text Qualifier.
The following qualifiers should be used when reporting the following services.
7 Anesthesia information
ZZ Narrative description of unspecified code
N4 National Drug Codes (NDC)
VP Vendor Product Number Health Industry Business Communications
Council (HIBCC) Labeling Standard
OZ Product Number Health Care Uniform Code Council - Global Trade
Item Number (GTIN)
CTR Contract rate
If required to report other supplemental information not listed above, follow payer instructions
for the use of a qualifier for the information being reported. When reporting a service that does
not have a qualifier, then leave this field blank. In this case, two blank spaces will be inserted
on the printed 1500 form before the service line supplemental information is displayed.
399.0304,51 PROCEDURE DESCRIPTION 1;4 FREE TEXT
INPUT TRANSFORM:K:$L(X)>80!($L(X)<1) X
LAST EDITED: MAY 08, 2014
HELP-PROMPT: Enter a 1-80 character NOC - Not Otherwise Classified - procedure description.
DESCRIPTION:
Enter a 1-80 character NOC - Not Otherwise Classified - procedure description.
399.0304,52 UNITS/BASIS OF MEASUREMENT 2;1 SET
Units/Basis of Measurement
'F2' FOR International Unit;
'GR' FOR Gram;
'ME' FOR Milligram;
'ML' FOR Milliliter;
'UN' FOR Unit;
LAST EDITED: JUN 13, 2017
HELP-PROMPT: Enter the units or basis for measurement associated with the Medication.
DESCRIPTION:
This field is used to associate the correct unit of measurement when Medication is being specified.
TECHNICAL DESCR:
This file is required if there is an NDC Number.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the NDC field of the PROCEDURES sub-field of the BILL/CLAIMS File
399.0304,53 NDC 1;7 FREE TEXT
INPUT TRANSFORM:K:$L(X)>13!($L(X)<13)!'(X?5N1"-"4N1"-"2N) X
LAST EDITED: JUN 13, 2017
HELP-PROMPT: Enter a National Drug Code in a 5-4-2 format (nnnnn-nnnn-nn) if required on a non-prescription
claim.
DESCRIPTION: Enter a National Drug Code in a 5-4-2 format (nnnnn-nnnn-nn) if required on a non-prescription
claim.
TECHNICAL DESCR:
Enter a National Drug Code in a 5-4-2 format (nnnnn-nnnn-nn) if required on a non-prescription
claim.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE:^^TRIGGER^399.0304^52
1)= Q
2)= X ^DD(399.0304,53,1,1,2.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,1)):^(1),1:""),Y(1)=$S
($D(^DGCR(399,D0,"CP",D1,2)):^(2),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" X ^DD(399.0304,53,1
,1,2.4)
2.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,1
)):^(1),1:"") S X=$P(Y(1),U,7)=""
2.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),2)),DIV=X S $P(^(2),U,1)=DIV,DIH=399.0304,DIG=52 D ^DIC
R
CREATE VALUE)= NO EFFECT
DELETE CONDITION)= NDC=""
DELETE VALUE)= @
FIELD)= UNITS/BASIS OF MEASUREMENT
When the NDC Code is removed, the UNITS/BASIS OF MEASUREMENT field should be removed as well.
CROSS-REFERENCE:^^TRIGGER^399.0304^54
1)= Q
2)= X ^DD(399.0304,53,1,2,2.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,1)):^(1),1:"") S X=$P(
Y(1),U,8),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),1)),DIV=X S $P(^(1),U,8)=DIV
,DIH=399.0304,DIG=54 D ^DICR
2.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,1
)):^(1),1:"") S X=$P(Y(1),U,7)=""
CREATE VALUE)= NO EFFECT
DELETE CONDITION)= NDC=""
DELETE VALUE)= @
FIELD)= UNITS
When the NDC Code is removed, the UNITS field should be removed as well.
399.0304,54 UNITS 1;8 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>99999999999)!(X<0)!((X[".")&(X'?.11N1"."1.3N)) X
LAST EDITED: JUN 13, 2017
HELP-PROMPT: Enter a number between 0 and 99999999999 with up to 3 decimal digits.
DESCRIPTION:
Enter the number of units of the non-prescription medication administerd.
TECHNICAL DESCR:
The number entered must be greater than zero and have format of 99999999999 and up to 3 decimal
digits.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
TRIGGERED by the NDC field of the PROCEDURES sub-field of the BILL/CLAIMS File
399.0304,60 LINE PROVIDER LNPRV;0 SET Multiple #399.0404
DESCRIPTION:
These are the providers who performed specific functions for the services on this claim line.
IDENTIFIED BY:LINE PERFORMED BY(#.02)
INDEXED BY: LINE FUNCTION (C)
399.0404,.01 LINE FUNCTION 0;1 SET (Multiply asked)
'1' FOR REFERRING;
'2' FOR OPERATING;
'3' FOR RENDERING;
'4' FOR ATTENDING;
'5' FOR SUPERVISING;
'9' FOR OTHER OPERATING;
'6' FOR ASSISTANT SURGEON;
LAST EDITED: MAR 01, 2017
HELP-PROMPT: Select the function performed by a provider for this claim line.
DESCRIPTION: There are providers who performed specific functions for the services on this claim line. These
providers are needed to enable the V.A. to collect reimbursement when more than one provider
function is involved in the billable episode (like an operating physician or referring provider).
This data identifies the type of function that was performed by a provider. There can only be 1
provider recorded for each function on a claim line.
SCREEN: S DIC("S")="I $$LNPRVOK^IBCEU7(+Y,$G(DA(2)))"
EXPLANATION: Function must match bill form type. Use '??' to see the function definitions.
EXECUTABLE HELP:D LNPRVHLP^IBCEU7
CROSS-REFERENCE:399.0404^B
1)= S ^DGCR(399,DA(2),"CP",DA(1),"LNPRV","B",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(2),"CP",DA(1),"LNPRV","B",$E(X,1,30),DA)
CROSS-REFERENCE:^^TRIGGER^399.0404^.04
1)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(0)=X S X=Y(0),X=X S X=X
'=1 I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S
DIU=X K Y S X="" X ^DD(399.0404,.01,1,2,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,4)=DIV,DIH=399.040
4,DIG=.04 D ^DICR
2)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(1)=$S($D(^DGCR(399,D0,"
CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X="" X ^DD(399.0404,.01,1,2,2.4
)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,4)=DIV,DIH=399.040
4,DIG=.04 D ^DICR
3)= Do Not Delete
CREATE CONDITION)= INTERNAL(LINE PROVIDER LINE FUNCTION)'=1
CREATE VALUE)= @
DELETE VALUE)= @
FIELD)= LINE PROVIDER STATE
This xref is used to delete the state field if the provider is not a referring provider function
type.
FIELD INDEX: C (#178) REGULAR IR LOOKUP & SORTING
Short Descr: External value of LINE FUNCTION field.
Set Logic: S ^DGCR(399,DA(2),"CP",DA(1),"LNPRV","C",$E(X(2),1,30),DA)=""
Kill Logic: K ^DGCR(399,DA(2),"CP",DA(1),"LNPRV","C",$E(X(2),1,30),DA)
Whole Kill: K ^DGCR(399,DA(2),"CP",DA(1),"LNPRV","C")
X(1): LINE FUNCTION (399.0404,.01) (Len 30) (forwards)
X(2): Computed Code: S X=$$EXTERNAL^DILFD(399.0404,.01,,X(1))
(Subscr 1) (Len 30)
399.0404,.02 LINE PERFORMED BY 0;2 VARIABLE POINTER
FILE ORDER PREFIX LAYGO MESSAGE
200 1 VA n VistA identified provider
355.93 2 NVA y Non-VA provider
SCREEN ON FILE 200: S DIC("S")="I $O(^(""USC1"",0))"
SCREEN EXPLANATION: VistA provider must have a person class defined in NEW PERSON File (200).
SCREEN ON FILE 355.93: S DIC("S")="I $$INDIVIDUAL^IBCU4($G(IBIFN),$P(^(0),U,2),$P($G(^DGCR(399,D0,""CP"",D1,""LNP
RV"",D2,0)),U))"
SCREEN EXPLANATION: Non VA providers can be individuals or facilities. They can not be facility type on certain
forms.
LAST EDITED: MAR 16, 2022
HELP-PROMPT:Select the provider who performed the indicated function.
DESCRIPTION:Providers may be VA providers found in the VistA NEW PERSON file or NON-VA providers found in the
IB NON VA BILLING PROVIDER file.
EXECUTABLE HELP:D INDIVHELP^IBCU4
NOTES: TRIGGERED by the PRIMARY INS CO ID NUMBER field of the LINE PROVIDER sub-field of the PROCEDURES
sub-field of the BILL/CLAIMS File
CROSS-REFERENCE:^^TRIGGER^399.0404^.05
1)= X ^DD(399.0404,.02,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1
:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" X ^DD(399.0404,.02,1,1,1.4)
1.3)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(0)=X S Y(1)=$S($D(^DG
CR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,5)="SLF000"
1.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,5)=DIV,DIH=399.040
4,DIG=.05 D ^DICR
2)= Q
3)= Do Not Delete
CREATE CONDITION)= PRIMARY INS CO ID NUMBER="SLF000"
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= PRIMARY INS CO ID NUMBER
This cross reference deletes any SLF000 id in the primary insurance id if a provider name is
entered.
CROSS-REFERENCE:^^TRIGGER^399.0404^.03
1)= X ^DD(399.0404,.02,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1
:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV S X=$$EXTCR^IBCEU5(X) X ^DD(399.0404,.02,1,2,1.4)
1.3)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(0)=X S Y(1)=$S($D(^DG
CR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,3)=""
1.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,3)=DIV,DIH=399.040
4,DIG=.03 D ^DICR
2)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(1)=$S($D(^DGCR(399,D0,"
CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(399.0404,.02,1,2,2.4
)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,3)=DIV,DIH=399.040
4,DIG=.03 D ^DICR
3)= Do not delete
CREATE CONDITION)= CREDENTIALS=""
CREATE VALUE)= S X=$$EXTCR^IBCEU5(X)
DELETE VALUE)= @
FIELD)= CREDENTIALS
This trigger will force the CREDENTIALS field of the line provider multiple to be set to the first
3 characters of the provider's degree if the credentials don't already exist.
CROSS-REFERENCE:^^TRIGGER^399.0404^.08
1)= X ^DD(399.0404,.02,1,3,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1
:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y X ^DD(399.0404,.02,1,3,1.1) X ^DD(399.0404,.02,1,3,1.4)
1.1)= S X=DIV S X=$$SPEC^IBCEU(X,$P($G(^DGCR(399,D0,"U")),U))
1.3)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(0)=X S Y(1)=$S($D(^DG
CR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,8)=""
1.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,8)=DIV,DIH=399.040
4,DIG=.08 D ^DICR
2)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(1)=$S($D(^DGCR(399,D0,"
CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" X ^DD(399.0404,.02,1,3,2.4
)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,8)=DIV,DIH=399.040
4,DIG=.08 D ^DICR
3)= Do not delete
CREATE CONDITION)= SPECIALTY=""
CREATE VALUE)= S X=$$SPEC^IBCEU(X,$P($G(^DGCR(399,D0,"U")),U))
DELETE VALUE)= @
FIELD)= SPECIALTY
This trigger will force the SPECIALTY field of the line provider multiple to be set to the current
specialty of the provider.
CROSS-REFERENCE:^^TRIGGER^399.0404^.05
1)= Q
2)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(1)=$S($D(^DGCR(399,D0,"
CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X="" X ^DD(399.0404,.02,1,4,2.4
)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,5)=DIV,DIH=399.040
4,DIG=.05 D ^DICR
3)= Do not delete
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= PRIMARY INS CO ID NUMBER
This xref deletes the PRIMARY INS CO ID NUMBER when the provider is changed.
CROSS-REFERENCE:^^TRIGGER^399.0404^.06
1)= Q
2)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(1)=$S($D(^DGCR(399,D0,"
CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X="" X ^DD(399.0404,.02,1,5,2.4
)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,6)=DIV,DIH=399.040
4,DIG=.06 D ^DICR
3)= Do not delete
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= SECONDARY INS CO ID NUMBER
This xref deletes the SECONDARY INS CO ID NUMBER when the provider is changed.
CROSS-REFERENCE:^^TRIGGER^399.0404^.07
1)= Q
2)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(1)=$S($D(^DGCR(399,D0,"
CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,7),X=X S DIU=X K Y S X="" X ^DD(399.0404,.02,1,6,2.4
)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,7)=DIV,DIH=399.040
4,DIG=.07 D ^DICR
3)= Do not delete
CREATE VALUE)= NO EFFECT
DELETE VALUE)= @
FIELD)= TERTIARY INS CO ID NUMBER
This xref deletes the TERTIARY INS CO ID NUMBER when the provider is changed.
CROSS-REFERENCE:^^TRIGGER^399.0404^.15
1)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(1)=$S($D(^DGCR(399,D0,"
CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y X ^DD(399.0404,.02,1,7,1.1) X ^D
D(399.0404,.02,1,7,1.4)
1.1)= S X=DIV S X=$P($$GETTAX^IBCEF73A(X,$P(^DGCR(399,D0,0),U,3)),U,2)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,15)=DIV,DIH=399.04
04,DIG=.15 D ^DICR
2)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(1)=$S($D(^DGCR(399,D0,"
CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y S X="" X ^DD(399.0404,.02,1,7,2.
4)
2.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,15)=DIV,DIH=399.04
04,DIG=.15 D ^DICR
3)= Do not delete
CREATE VALUE)= S X=$P($$GETTAX^IBCEF73A(X,$P(^DGCR(399,D0,0),U,3)),U,2)
DELETE VALUE)= @
FIELD)= LINE TAXONOMY
This trigger updates the LINE TAXONOMY field with the provider's taxonomy code if the event date of
the claim is covered, otherwise, it will set the LINE TAXONOMY field to null.
399.0404,.03 CREDENTIALS 0;3 FREE TEXT
INPUT TRANSFORM:K:$L(X)>3!($L(X)<1) X
LAST EDITED: OCT 14, 2010
HELP-PROMPT:Enter up to 3 digits to describe the provider's credentials.
DESCRIPTION:This field should contain the 1-3 digit code for the provider's credentials as they apply to the
services being billed for.
NOTES: TRIGGERED by the LINE PERFORMED BY field of the LINE PROVIDER sub-field of the PROCEDURES sub-field
of the BILL/CLAIMS File
399.0404,.04 STATE 0;4 POINTER TO STATE FILE (#5)
LAST EDITED: OCT 14, 2010
HELP-PROMPT:Enter the state for the Referring Provider.
DESCRIPTION:
This is the state of the Referring Provider. This is only used for referring provider types.
NOTES: TRIGGERED by the LINE FUNCTION field of the LINE PROVIDER sub-field of the PROCEDURES sub-field of
the BILL/CLAIMS File
TRIGGERED by the LINE FUNCTION field of the LINE PROVIDER sub-field of the PROCEDURES sub-field of
the BILL/CLAIMS File
399.0404,.05 PRIMARY INS CO ID NUMBER 0;5 FREE TEXT
PRIM INS PERF PROV SECONDARY ID
INPUT TRANSFORM:K:$L(X)>15!($L(X)<1) X
LAST EDITED: OCT 14, 2010
HELP-PROMPT:Answer must be 1-15 characters in length.
DESCRIPTION:
This is the primary insurance co specific provider's secondary id number.
NOTES: TRIGGERED by the LINE PERFORMED BY field of the LINE PROVIDER sub-field of the PROCEDURES sub-field
of the BILL/CLAIMS File
TRIGGERED by the LINE PERFORMED BY field of the LINE PROVIDER sub-field of the PROCEDURES sub-field
of the BILL/CLAIMS File
CROSS-REFERENCE:^^TRIGGER^399.0404^.02
1)= K DIV S DIV=X,D0=DA(2),DIV(0)=D0,D1=DA(1),DIV(1)=D1,D2=DA,DIV(2)=D2 S Y(0)=X S X=Y(0)="SLF000"
I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,"LNPRV",D2,0)):^(0),1:"") S X=$P(Y(1),U,2),X=X S DIU=
X K Y S X="" X ^DD(399.0404,.05,1,1,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),"LNPRV",DIV(2),0)),DIV=X S $P(^(0),U,2)=DIV,DIH=399.040
4,DIG=.02 D ^DICR
2)= Q
3)= Do not delete
CREATE CONDITION)= PRIMARY INS CO ID NUMBER="SLF000"
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= LINE PERFORMED BY
This erases the provider name if the id is SLF000.
399.0404,.06 SECONDARY INS CO ID NUMBER 0;6 FREE TEXT
SECOND INS PERF PROV SECONDARY ID
INPUT TRANSFORM:K:$L(X)>15!($L(X)<1) X
LAST EDITED: OCT 14, 2010
HELP-PROMPT:Answer must be 1-15 characters in length.
DESCRIPTION:
This is the secondary ins company's specific secondary provider id number.
NOTES: TRIGGERED by the LINE PERFORMED BY field of the LINE PROVIDER sub-field of the PROCEDURES sub-field
of the BILL/CLAIMS File
399.0404,.07 TERTIARY INS CO ID NUMBER 0;7 FREE TEXT
TERTIARY INS PERF PROV SECONDARY ID
INPUT TRANSFORM:K:$L(X)>15!($L(X)<1) X
LAST EDITED: OCT 14, 2010
HELP-PROMPT:Answer must be 1-15 characters in length.
DESCRIPTION:
This is the tertiary ins company's specific secondary provider id number.
NOTES: TRIGGERED by the LINE PERFORMED BY field of the LINE PROVIDER sub-field of the PROCEDURES sub-field
of the BILL/CLAIMS File
399.0404,.08 SPECIALTY 0;8 FREE TEXT
INPUT TRANSFORM:K:$L(X)>2!($L(X)<2) X
LAST EDITED: SEP 14, 2010
HELP-PROMPT:Enter the 2 digit specialty code designation.
DESCRIPTION:This field contains the specialty code for the provider if the provider is not resident in VistA's
NEW PERSON file.
NOTES: TRIGGERED by the LINE PERFORMED BY field of the LINE PROVIDER sub-field of the PROCEDURES sub-field
of the BILL/CLAIMS File
399.0404,.12 PRIM INS PROVIDER ID TYPE 0;12 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97)
PRIM INS PERF PROV SECONDARY ID TYPE
INPUT TRANSFORM:S DIC("S")="I $$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
LAST EDITED: SEP 14, 2010
HELP-PROMPT:Enter the type of id the primary payer requires as a secondary id.
DESCRIPTION:
This is the type of id the primary payer uses as a secondary id.
SCREEN: S DIC("S")="I $$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))"
EXPLANATION:Must be valid for transmission.
399.0404,.13 SEC INS PROVIDER ID TYPE 0;13 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97)
SECOND INS PERF PROV SECONDARY ID TYPE
INPUT TRANSFORM:S DIC("S")="I $$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
LAST EDITED: OCT 14, 2010
HELP-PROMPT:Enter the type of id the secondary payer requires as a secondary id.
DESCRIPTION:
This is the type of id the secondary payer requires as a secondary id.
SCREEN: S DIC("S")="I $$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))"
EXPLANATION:Must be valid for transmission.
399.0404,.14 TERT INS PROVIDER ID TYPE 0;14 POINTER TO IB PROVIDER ID # TYPE FILE (#355.97)
TERTIARY INS PERF PROV SECONDARY ID TYPE
INPUT TRANSFORM:S DIC("S")="I $$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
LAST EDITED: SEP 14, 2010
HELP-PROMPT:Enter the type of id the tertiary payer requires as a secondary id.
DESCRIPTION:
This is the type of id the tertiary payer uses as a secondary id.
SCREEN: S DIC("S")="I $$RAINS^IBCEPU(Y)!($$RAOWN^IBCEPU(Y))"
EXPLANATION:Must be valid for transmission.
399.0404,.15 LINE TAXONOMY 0;15 POINTER TO PERSON CLASS FILE (#8932.1)
LAST EDITED: OCT 14, 2010
HELP-PROMPT:Enter the Taxonomy Code associated with this entry.
DESCRIPTION:
This is the Taxonomy Code associated with this entry.
NOTES: TRIGGERED by the LINE PERFORMED BY field of the LINE PROVIDER sub-field of the PROCEDURES sub-field
of the BILL/CLAIMS File
399.0304,70 ATTACHMENT CONTROL NUMBER 1;1 FREE TEXT
INPUT TRANSFORM:K:$L(X)>30!($L(X)<1) X
LAST EDITED: OCT 25, 2010
HELP-PROMPT:Enter an (1-30 chars) Attachment Control Number (alphanumeric).
DESCRIPTION:The Attachment Control Number (alphanumeric) identifies the documentation that will provide
additional information for this claim line.
399.0304,71 ATTACHMENT REPORT TYPE 1;2 POINTER TO IB ATTACHMENT REPORT TYPE FILE (#353.3)
LAST EDITED: OCT 25, 2010
HELP-PROMPT:Enter a Report Type.
DESCRIPTION:The Report Type describes the type of documentation that will provide additional information for
this claim line.
399.0304,72 ATTACHMENT REPORT TRANS CODE 1;3 SET
'AA' FOR Available on Request at Provider Site;
'BM' FOR By Mail;
'EL' FOR Electronically Only;
'EM' FOR E-Mail;
'FT' FOR File Transfer;
'FX' FOR By Fax;
LAST EDITED: OCT 25, 2010
HELP-PROMPT:Select the Attachment Transmission Method.
DESCRIPTION:
This is the method for transmitting the claim line.
399.0304,74 ADDITIONAL OB MINUTES 1;5 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>1440)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: OCT 26, 2010
HELP-PROMPT:Enter the number of additional minutes (1-1440) needed for anesthesia for obstetric services than
those reported in the normal procedure base units.
DESCRIPTION:This is the number of additional minutes needed for anesthesia for obstetric services than those
reported in the normal procedure base units.
399.0304,90.01 ORAL CAVITY DESIGNATION (1) DEN;1 SET
'00' FOR Entire Oral Cavity;
'01' FOR Maxillary Arch;
'02' FOR Mandibular Arch;
'10' FOR Upper Right Quadrant;
'20' FOR Upper Left Quadrant;
'30' FOR Lower Left Quadrant;
'40' FOR Lower Right Quadrant;
LAST EDITED: MAR 02, 2017
HELP-PROMPT:Enter a valid Cavity Designation code. The entered code must not already be present in Oral Cavity
Designations #2, #3, #4 or #5.
DESCRIPTION:
The first Oral Cavity Designation code. You can enter up to five codes.
SCREEN: S DIC("S")="I $$ORALCAV^IBCU7(90.01)"
EXPLANATION:Only allows Oral Cavity Designation Codes that are not already present in Oral Cavity Designations
#2, #3, #4 or #5.
399.0304,90.02 ORAL CAVITY DESIGNATION (2) DEN;2 SET
'00' FOR Entire Oral Cavity;
'01' FOR Maxillary Arch;
'02' FOR Mandibular Arch;
'10' FOR Upper Right Quadrant;
'20' FOR Upper Left Quadrant;
'30' FOR Lower Left Quadrant;
'40' FOR Lower Right Quadrant;
LAST EDITED: MAR 02, 2017
HELP-PROMPT:Enter a valid Oral Cavity Designation Code. The entered code must not already be present in Oral
Cavity Designations #1, #3, #4 or #5.
DESCRIPTION:
The second Oral Cavity Designation code. You can enter up to five codes.
SCREEN: S DIC("S")="I $$ORALCAV^IBCU7(90.02)"
EXPLANATION:Only allows Oral Cavity Designation Codes that are not already present in Oral Cavity Designations
#1, #3, #4 or #5.
399.0304,90.03 ORAL CAVITY DESIGNATION (3) DEN;3 SET
'00' FOR Entire Oral Cavity;
'01' FOR Maxillary Arch;
'02' FOR Mandibular Arch;
'10' FOR Upper Right Quadrant;
'20' FOR Upper Left Quadrant;
'30' FOR Lower Left Quadrant;
'40' FOR Lower Right Quadrant;
LAST EDITED: MAR 02, 2017
HELP-PROMPT:Enter a valid Oral Cavity Designation Code. The entered code must not already be present in Oral
Cavity Designations #1, #2, #4 or #5.
DESCRIPTION:
The third Oral Cavity Designation code. You can enter up to five codes.
SCREEN: S DIC("S")="I $$ORALCAV^IBCU7(90.03)"
EXPLANATION:Only allows Oral Cavity Designation Codes that are not already present in Oral Cavity Designations
#1, #2, #4 or #5.
399.0304,90.04 ORAL CAVITY DESIGNATION (4) DEN;4 SET
'00' FOR Entire Oral Cavity;
'01' FOR Maxillary Arch;
'02' FOR Mandibular Arch;
'10' FOR Upper Right Quadrant;
'20' FOR Upper Left Quadrant;
'30' FOR Lower Left Quadrant;
'40' FOR Lower Right Quadrant;
LAST EDITED: MAR 02, 2017
HELP-PROMPT:Enter a valid Oral Cavity Designation code. The entered code must not already be present in Oral
Cavity Designations #1, #2, #3 or #5.
DESCRIPTION:
The fourth Oral Cavity Designation code. You can enter up to five codes.
SCREEN: S DIC("S")="I $$ORALCAV^IBCU7(90.04)"
EXPLANATION:Only allows Oral Cavity Designation Codes that are not already present in Oral Cavity Designations
#1, #2, #3 or #5.
399.0304,90.05 ORAL CAVITY DESIGNATION (5) DEN;5 SET
'00' FOR Entire Oral Cavity;
'01' FOR Maxillary Arch;
'02' FOR Mandibular Arch;
'10' FOR Upper Right Quadrant;
'20' FOR Upper Left Quadrant;
'30' FOR Lower Left Quadrant;
'40' FOR Lower Right Quadrant;
LAST EDITED: MAR 02, 2017
HELP-PROMPT:Enter a valid Oral Cavity Designation code. The entered code must not already be present in Oral
Cavity Designations #1, #2, #3 or #4.
DESCRIPTION:
The fifth Oral Cavity Designation code. You can enter up to five codes.
SCREEN: S DIC("S")="I $$ORALCAV^IBCU7(90.05)"
EXPLANATION:Only allows Oral Cavity Designation Codes that are not already present in Oral Cavity Designations
#1, #2, #3 and #4.
399.0304,90.06 PROSTHESIS/CROWN/INLAY CODE DEN;6 SET
'I' FOR Initial Placement;
'R' FOR Replacement;
LAST EDITED: JUN 28, 2017
HELP-PROMPT:Select a code that indicates the placement status of the prosthesis, crown or inlay.
DESCRIPTION:
This code indicates the placement status of the prosthesis.
399.0304,90.07 PRIOR PLACEMENT DATE QUALIFIER DEN;7 SET
'139' FOR Estimated;
'441' FOR Prior Placement;
LAST EDITED: JUN 14, 2017
HELP-PROMPT:Select a qualifier that indicates whether or not the Prior Placement Date is known or just
estimated.
DESCRIPTION:
This qualifier indicates whether or not the Prior Placement Date is known or just estimated.
399.0304,90.08 PRIOR PLACEMENT DATE DEN;8 DATE
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 14, 2017
HELP-PROMPT:Enter the date when the prosthesis, crown or inlay was replaced. Date is REQUIRED when
Prosthesis/Crown/Inlay code equals Replacement.
DESCRIPTION:This is the date when a prosthesis, crown or inlay was replaced. Date is REQUIRED when
Prosthesis/Crown/Inlay code equals Replacement. replaced.
399.0304,90.09 ORTHODONTIC BANDING DATE DEN;9 DATE
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 28, 2017
HELP-PROMPT:Enter the date the patient's orthodontic appliances were placed if different from the claim level
date.
DESCRIPTION:This is the date the patient's orthodontic appliances were placed if different from the claim level
date.
399.0304,90.1 ORTHO BANDING REPLACEMENT DATE DEN;10 DATE
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 28, 2017
HELP-PROMPT:Enter the date the patient's orthodontic appliances were replaced.
DESCRIPTION:
This is the date the patient's orthodontic appliances were replaced.
399.0304,90.11 TREATMENT START DATE DEN;11 DATE
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 28, 2017
HELP-PROMPT:Enter the date for initial impression or preparation for a crown or dentures or initial endodontic
treatment or the implant fixture placement.
DESCRIPTION:This is the date for initial impression or preparation for a crown or dentures or initial
endodontic treatment or the implant fixture placement.
399.0304,90.12 TREATMENT COMPLETION DATE DEN;12 DATE
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 28, 2017
HELP-PROMPT:Enter the date that a course of treatment was completed.
DESCRIPTION:
This is the date that a course of treatment was completed.
399.0304,91 TOOTH INFORMATION DEN1;0 POINTER Multiple #399.30491 (Add New Entry without Asking)
DESCRIPTION:
This multiple holds tooth information for the dental service line.
399.30491,.01 TOOTH CODE 0;1 POINTER TO X12 278 DENTAL NUMBERING SYSTEM FILE (#356.022) (Multiply asked)
LAST EDITED: MAR 02, 2017
HELP-PROMPT:Enter a valid Tooth Code.
DESCRIPTION:
This identifies the tooth that requires work.
CROSS-REFERENCE:399.30491^B
1)= S ^DGCR(399,DA(2),"CP",DA(1),"DEN1","B",$E(X,1,30),DA)=""
2)= K ^DGCR(399,DA(2),"CP",DA(1),"DEN1","B",$E(X,1,30),DA)
399.30491,.02 TOOTH SURFACE (1) 0;2 SET
'B' FOR Buccal;
'D' FOR Distal;
'F' FOR Facial;
'I' FOR Incisal;
'L' FOR Lingual;
'M' FOR Mesial;
'O' FOR Occlusal;
LAST EDITED: MAR 02, 2017
HELP-PROMPT:Enter a valid Tooth Surface code. The entered code must not already be present in Tooth Surfaces
#2, #3, #4 or #5.
DESCRIPTION:
This code represents the Tooth Surface code associated with this procedure.
SCREEN: S DIC("S")="I $$TOOTHS^IBCU7(.02)"
EXPLANATION:Only allow Tooth Surface Codes that are not already present in Tooth Surfaces #2, #3, #4 or #5.
399.30491,.03 TOOTH SURFACE (2) 0;3 SET
'B' FOR Buccal;
'D' FOR Distal;
'F' FOR Facial;
'I' FOR Incisal;
'L' FOR Lingual;
'M' FOR Mesial;
'O' FOR Occlusal;
LAST EDITED: MAR 02, 2017
HELP-PROMPT:Enter a valid Tooth Surface code. The entered code must not already be present in Tooth Surfaces
#1, #3, #4 or #5.
DESCRIPTION:
This code represents the Tooth Surface code associated with this procedure.
SCREEN: S DIC("S")="I $$TOOTHS^IBCU7(.03)"
EXPLANATION:Only allow Tooth Surface Codes that are not already present in Tooth Surfaces #1, #3, #4 or #5.
399.30491,.04 TOOTH SURFACE (3) 0;4 SET
'B' FOR Buccal;
'D' FOR Distal;
'F' FOR Facial;
'I' FOR Incisal;
'L' FOR Lingual;
'M' FOR Mesial;
'O' FOR Occlusal;
LAST EDITED: MAR 02, 2017
HELP-PROMPT:Enter a valid Tooth Surface code. The entered code must not already be present in Tooth Surfaces
#1, #2, #4 or #5.
DESCRIPTION:
This code represents the Tooth Surface code associated with this procedure.
SCREEN: S DIC("S")="I $$TOOTHS^IBCU7(.04)"
EXPLANATION:Only allow Tooth Surface Codes that are not already present in Tooth Surfaces #1, #2, #4 or #5.
399.30491,.05 TOOTH SURFACE (4) 0;5 SET
'B' FOR Buccal;
'D' FOR Distal;
'F' FOR Facial;
'I' FOR Incisal;
'L' FOR Lingual;
'M' FOR Mesial;
'O' FOR Occlusal;
LAST EDITED: MAR 02, 2017
HELP-PROMPT:Enter a valid Tooth Surface code. The entered code must not alrready be present in Tooth
Surfaces #1, #2, #3 or #5.
DESCRIPTION:
This code represents the Tooth Surface code associated with this procedure.
SCREEN: S DIC("S")="I $$TOOTHS^IBCU7(.05)"
EXPLANATION:Only allow Tooth Surface codes that are not already present in Tooth Surfaces #1, #2, #3 or #5.
399.30491,.06 TOOTH SURFACE (5) 0;6 SET
'B' FOR Buccal;
'D' FOR Distal;
'F' FOR Facial;
'I' FOR Incisal;
'L' FOR Lingual;
'M' FOR Mesial;
'O' FOR Occlusal;
LAST EDITED: MAR 02, 2017
HELP-PROMPT:Enter a valid Tooth Surface code. The entered code must not already be present in Tooth Surfaces
#1, #2, #3 or #4.
DESCRIPTION:
This cide represents the Tooth Surface code associated with this procedure.
SCREEN: S DIC("S")="I $$TOOTHS^IBCU7(.06)"
EXPLANATION:Only allow Tooth Surface codes that are not already present in Tooth Surfaces #1, #2, #3 or #4.
399.30491,.07 DENTAL TREATMENT PLAN ENTRY 0;7 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>9999999999)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: JUL 31, 2018
HELP-PROMPT:Type a number between 1 and 9999999999, 0 decimal digits.
DESCRIPTION:This value represents the entry in file 228.2, TREATMENT PLAN TRANSACTION/EXAM, that was used to
default any related Dental data for the procedure code line entry.
FIELD INDEX: ADT (#1523) REGULAR IR SORTING ONLY WHOLE FILE (#399)
Short Descr: This index is used to identify entries in file 228.2
Description: This index will indentify entries in file 228.2, Treatment Plan Transaction file, that were used
to default Dental related data at the claim line level.
Set Logic: S ^DGCR(399,"ADT",$E(X,1,20),DA(2),DA(1),DA)=""
Kill Logic: K ^DGCR(399,"ADT",$E(X,1,20),DA(2),DA(1),DA)
Whole Kill: K ^DGCR(399,"ADT")
X(1): DENTAL TREATMENT PLAN ENTRY (399.30491,.07) (Subscr 1) (Len 20) (forwards)
399,371 PRIMARY NODE 7 I17;E1,240 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>240!($L(X)<1) X
LAST EDITED: MAY 29, 2014
HELP-PROMPT: This is addl. information pertaining to the primary insurance carrier associated with this bill.
Value must be 1 to 240 characters in length.
DESCRIPTION: This is addl. information pertaining to the primary insurance carrier associated with this bill.
It is equal to the 7 node of the INSURANCE TYPE sub-file of the PATIENT file.
TECHNICAL DESCR: This node is set by a trigger on PRIMARY INSURANCE CARRIER (399,101) and at UPDT^IBSCSE. This node
is a duplicate of the 7 node of the INSURANCE TYPE sub-file of the PATIENT file.
^DGCR(399,IBIFN,"I17")=^DPT(DFN,.312,X,7)
399,372 SECONDARY NODE 7 I27;E1,240 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>240!($L(X)<1) X
LAST EDITED: MAY 29, 2014
HELP-PROMPT: This is addl. information pertaining to the secondary insurance carrier associated with this bill.
Value must be 1 to 240 characters in length.
DESCRIPTION: This is addl. information pertaining to the secondary insurance carrier associated with this bill.
It is equal to the 7 node of the INSURANCE TYPE sub-file of the PATIENT file.
TECHNICAL DESCR: This node is set by a trigger on SECONDARY INSURANCE CARRIER (399,102) and by UPDT^IBSCSE. This
node is a duplicate of the 7 node of the INSURANCE TYPE sub-file of the PATIENT file.
^DGCR(399,IBIFN,"I27")=^DPT(DFN,.312,X,7)
399,373 TERTIARY NODE 7 I37;E1,240 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>240!($L(X)<1) X
LAST EDITED: MAY 28, 2014
HELP-PROMPT: This is addl. information pertaining to the tertiary insurance carrier associated with this bill.
Value must be 1 to 240 characters in length.
DESCRIPTION: This is addl. information pertaining to the tertiary insurance carrier associated with this bill.
It is equal to the 7 node of the INSURANCE TYPE sub-file of the PATIENT file.
TECHNICAL DESCR: This node is set by a trigger on TERTIARY INSURANCE CARRIER (399,103) and by UPDT^IBSCSE. This
node is a duplicate of the 7 node of the INSURANCE TYPE sub-file of the PATIENT file.
^DGCR(399,IBIFN,"I37")=^DPT(DFN,.312,X,7)
399,400 BLOCK 31 UF2;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>63!($L(X)<3) X
LAST EDITED: SEP 08, 2006
HELP-PROMPT: Answer must be 3-63 characters in length.
DESCRIPTION: Entry will be printed in block 31 of the CMS-1500. This block is 3 lines of 21 characters each.
Set up for the physicians name and number.
399,402 BILL REMARKS UF2;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<1) X
LAST EDITED: AUG 08, 2007
HELP-PROMPT: Answer must be 1-80 characters in length
DESCRIPTION: Enter up to 80 characters of free text which will print in FL-80.
FL-80 on the UB-04 claim form is a 4-line box. Line 1 can hold a maximum of 19 characters after a
mandatory 5 character indentation. Lines 2-4 can hold a maximum of 24 characters each.
The display of these remarks on billing screen 8 is exactly how the remarks will appear on the
printed claim form.
TECHNICAL DESCR:
This field is also transmitted via EDI in the UB1 segment, piece 21.
399,453 FORM LOCATOR 64A UF3;4 FREE TEXT
PRIMARY INSURANCE ICN/DCN
INPUT TRANSFORM: K:$L(X)>50!($L(X)<3) X
LAST EDITED: SEP 23, 2010
HELP-PROMPT: Answer must be 3-50 characters in length.
DESCRIPTION: Form Locator 64A on the UB-04. This field is nationally reserved on adjustment/replacement type
bills for the Internal Control Number (ICN)/Document Control Number (DCN) assigned to the original
bill by the primary payer.
399,454 FORM LOCATOR 64B UF3;5 FREE TEXT
SECONDARY INSURANCE ICN/DCN
INPUT TRANSFORM: K:$L(X)>50!($L(X)<3) X
LAST EDITED: SEP 23, 2010
HELP-PROMPT: Answer must be 3-50 characters in length.
DESCRIPTION: Form Locator 64B on the UB-04. This field is nationally reserved on adjustment/replacement type
bills for the Internal Control Number (ICN)/Document Control Number (DCN) assigned to the original
bill by the secondary payer.
399,455 FORM LOCATOR 64C UF3;6 FREE TEXT
TERTIARY INSURANCE ICN/DCN
INPUT TRANSFORM: K:$L(X)>50!($L(X)<3) X
LAST EDITED: SEP 23, 2010
HELP-PROMPT: Answer must be 3-50 characters in length.
DESCRIPTION: Form Locator 64C on the UB-04. This field is nationally reserved on adjustment/replacement type
bills for the Internal Control Number (ICN)/Document Control Number (DCN) assigned to the original
bill by the tertiary payer.
399,457 *FORM LOCATOR 57 UF31;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>27!($L(X)<3) X
LAST EDITED: JAN 17, 2007
HELP-PROMPT: Answer must be 3-27 characters in length.
DESCRIPTION: Unlabled Form Locator 57 on the UB-92.
This field is marked for deletion and can be deleted 11/23/2008.
399,458 *FORM LOCATOR 78 UF31;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>5!($L(X)<3) X
LAST EDITED: JAN 17, 2007
HELP-PROMPT: Answer must be 3-5 characters in length.
DESCRIPTION: Printed in Form Locator 78 on the UB-92. If more than 3 characters are entered this will be
printed on two lines.
This field is marked for deletion and can be deleted 11/23/2008.
TECHNICAL DESCR: Unlabled Form Locator 78 on the UB-92. On the form the block is two lines of 2 and 3 characters,
with the upper line optional. Therefore, if string is longer than 3 characters it must be split
and printed on both lines.
This field is marked for deletion and can be deleted 11/23/2008.
399,459 FORM LOC 19-UNSPECIFIED DATA UF31;3 FREE TEXT
CMS-1500 Box 19
INPUT TRANSFORM: K:$L(X)>80!($L(X)<1) X
LAST EDITED: FEB 25, 2014
HELP-PROMPT: Answer must be 1-80 characters in length. Only 71 Characters will print.
DESCRIPTION: This is an 71 character free text field that will print in Box 19 of the CMS-1500. Use this field
to enter additional Payer required IDs in the format of: QualifierID number<3
spaces>QualifierID number.
TECHNICAL DESCR: This returns the Paperwork Attachment
Information in the following format:
PWKNNFX12348907CHEY<3 Spaces>Next set if more than one on claim PWK is the qualifier for data,
followed by the appropriate Report Type Code, the appropriate Transmission Type Code, then the
Attachment Control Number. Do not enter spaces between qualifiers and data.
399,460 ECME NUMBER M1;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: JUL 09, 2003
HELP-PROMPT: Enter the ECME reference number for this bill.
DESCRIPTION: This is the reference number back to the ECME transaction to identify bills created electronically
by the ECME/Pharmacy NCPDP process.
CROSS-REFERENCE: 399^AG
1)= S ^DGCR(399,"AG",$E(X,1,30),DA)=""
2)= K ^DGCR(399,"AG",$E(X,1,30),DA)
399,461 ECME APPROVAL M1;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: SEP 16, 2003
HELP-PROMPT: Enter the ECME approval number.
DESCRIPTION:
This is the approval for payment received from the FI for ECME electronically processed claims.
399,471 PRIMARY INSURANCE HPID M1;13 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999999999)!(X<1000000000)!(X?.E1"."1N.N)!$$HOD^IBCNHUT1(X) X
LAST EDITED: JUN 30, 2014
HELP-PROMPT: Enter a valid HPID. Must be 10 digits, all numeric, no decimal.
DESCRIPTION:
This field is the HPID to be sent for the primary insurer on this claim.
TECHNICAL DESCR:
This field is the HPID to be sent for the primary insurer on this claim.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^399^474
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,3),X
=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S X=% X ^DD(399,471,1,1,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"MP")),DIV=X S $P(^("MP"),U,3)=DIV,DIH=399,DIG=474 D ^DICR
2)= Q
CREATE VALUE)= NOW
DELETE VALUE)= NO EFFECT
FIELD)= PRIMARY HPID EDIT
When the PRIMARY INSURANCE HPID field is changed, update the PRIMARY HPID EDIT DATE/TIME Field
(#474) with the current date and time.
CROSS-REFERENCE: ^^TRIGGER^399^475
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,4),X
=X S DIU=X K Y S X=DIV S X=$S(($D(DUZ)#2):DUZ,1:"") X ^DD(399,471,1,2,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"MP")),DIV=X S $P(^("MP"),U,4)=DIV,DIH=399,DIG=475 D ^DICR
2)= Q
CREATE VALUE)= S X=$S(($D(DUZ)#2):DUZ,1:"")
DELETE VALUE)= NO EFFECT
FIELD)= PRIMARY HPID CH
When the PRIMARY INSURANCE HPID field is changed, update the PRIMARY HPID CHANGES MADE BY Field
(#475) with the ID of the user making the change.
399,472 SECONDARY INSURANCE HPID M1;14 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999999999)!(X<1000000000)!(X?.E1"."1N.N)!$$HOD^IBCNHUT1(X) X
LAST EDITED: JUN 30, 2014
HELP-PROMPT: Enter a valid HPID. Must be 10 digits, all numeric, no decimal.
DESCRIPTION:
This field is the HPID to be sent for the secondary insurer on this claim.
TECHNICAL DESCR:
This field is the HPID to be sent for the secondary insurer on this claim.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^399^476
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,5),X
=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S X=% X ^DD(399,472,1,1,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"MP")),DIV=X S $P(^("MP"),U,5)=DIV,DIH=399,DIG=476 D ^DICR
2)= Q
CREATE VALUE)= NOW
DELETE VALUE)= NO EFFECT
FIELD)= SECONDARY HPID ED
When the SECONDARY INSURANCE HPID field is changed, update the SECONDARY HPID EDIT DATE/TIME Field
(#476) with the current date and time.
CROSS-REFERENCE: ^^TRIGGER^399^477
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,6),X
=X S DIU=X K Y S X=DIV S X=$S(($D(DUZ)#2):DUZ,1:"") X ^DD(399,472,1,2,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"MP")),DIV=X S $P(^("MP"),U,6)=DIV,DIH=399,DIG=477 D ^DICR
2)= Q
CREATE VALUE)= S X=$S(($D(DUZ)#2):DUZ,1:"")
DELETE VALUE)= NO EFFECT
FIELD)= SECONDARY HPID C
When the SECONDARY INSURANCE HPID field is changed, update the SECONDARY HPID CHANGES MADE BY Field
(#477) with the ID of the user making the change.
399,473 TERTIARY INSURANCE HPID M1;15 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999999999)!(X<1000000000)!(X?.E1"."1N.N)!$$HOD^IBCNHUT1(X) X
LAST EDITED: JUN 30, 2014
HELP-PROMPT: Enter a valid HPID. Must be 10 digits, all numeric, no decimal.
DESCRIPTION:
This field is the HPID to be sent for the tertiary insurer on this claim.
TECHNICAL DESCR:
This field is the HPID to be sent for the tertiary insurer on this claim.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: ^^TRIGGER^399^478
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,7),X
=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S X=% X ^DD(399,473,1,1,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"MP")),DIV=X S $P(^("MP"),U,7)=DIV,DIH=399,DIG=478 D ^DICR
2)= Q
CREATE VALUE)= NOW
DELETE VALUE)= NO EFFECT
FIELD)= TERTIARY HPID ED
When the TERTIARY INSURANCE HPID field is changed, update the TERTIARY HPID EDIT DATE/TIME Field
(#478) with the current date and time.
CROSS-REFERENCE: ^^TRIGGER^399^479
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^DGCR(399,D0,"MP")):^("MP"),1:"") S X=$P(Y(1),U,8),X
=X S DIU=X K Y S X=DIV S X=$S(($D(DUZ)#2):DUZ,1:"") X ^DD(399,473,1,2,1.4)
1.4)= S DIH=$G(^DGCR(399,DIV(0),"MP")),DIV=X S $P(^("MP"),U,8)=DIV,DIH=399,DIG=479 D ^DICR
2)= Q
CREATE VALUE)= S X=$S(($D(DUZ)#2):DUZ,1:"")
DELETE VALUE)= NO EFFECT
FIELD)= TERTIARY HPID C
When the TERTIARY INSURANCE HPID field is changed, update the TERTIARY HPID CHANGES MADE BY Field
(#479) with the ID of the user making the change.
399,474 PRIMARY HPID EDIT DATE/TIME MP;3 DATE
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: DEC 15, 2014
HELP-PROMPT: Enter the date/time the PRIMARY INSURANCE HPID Field (#471) was updated.
DESCRIPTION: This is the date/time the PRIMARY INSURANCE HPID Field (#471) was updated. It is triggered by
Field #471.
WRITE AUTHORITY: ^
NOTES: TRIGGERED by the PRIMARY INSURANCE HPID field of the BILL/CLAIMS File
CROSS-REFERENCE: 399^E
1)= S ^DGCR(399,"E",$E(X,1,30),DA)=""
2)= K ^DGCR(399,"E",$E(X,1,30),DA)
This index will be used to look up the claim by the date the PRIMARY INSURANCE HPID Field (#471)
was last edited.
399,475 PRIMARY HPID CHANGES MADE BY MP;4 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JAN 15, 2015
HELP-PROMPT: Enter the user who last edited the PRIMARY INSURANCE HPID (Field #471).
DESCRIPTION: This is the user who last edited the PRIMARY INSURANCE HPID Field (#471). It is triggered by Field
#471.
WRITE AUTHORITY: ^
NOTES: TRIGGERED by the PRIMARY INSURANCE HPID field of the BILL/CLAIMS File
399,476 SECONDARY HPID EDIT DATE/TIME MP;5 DATE
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: DEC 15, 2014
HELP-PROMPT: Enter the date/time the SECONDARY INSURANCE HPID Field (#472) was updated.
DESCRIPTION: This is the date/time the SECONDARY INSURANCE HPID Field (#472) was updated. It is triggered by
Field #472.
WRITE AUTHORITY: ^
NOTES: TRIGGERED by the SECONDARY INSURANCE HPID field of the BILL/CLAIMS File
CROSS-REFERENCE: 399^F
1)= S ^DGCR(399,"F",$E(X,1,30),DA)=""
2)= K ^DGCR(399,"F",$E(X,1,30),DA)
This index will be used to look up the claim by the date the SECONDARY INSURANCE HPID Field (#472)
was last edited.
399,477 SECONDARY HPID CHANGES MADE BY MP;6 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: NOV 25, 2014
HELP-PROMPT: Enter the user who last edited the SECONDARY INSURANCE HPID Field (#472).
DESCRIPTION: This is the user who last edited the SECONDARY INSURANCE HPID Field (#472). It is triggered by
Field #472.
NOTES: TRIGGERED by the SECONDARY INSURANCE HPID field of the BILL/CLAIMS File
399,478 TERTIARY HPID EDIT DATE/TIME MP;7 DATE
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: DEC 15, 2014
HELP-PROMPT: Enter the date/time the TERTIARY INSURANCE HPID Field (#473) was updated.
DESCRIPTION: This is the date/time the TERTIARY INSURANCE HPID Field (#473) was updated. It is triggered by
Field #473.
WRITE AUTHORITY: ^
NOTES: TRIGGERED by the TERTIARY INSURANCE HPID field of the BILL/CLAIMS File
CROSS-REFERENCE: 399^G
1)= S ^DGCR(399,"G",$E(X,1,30),DA)=""
2)= K ^DGCR(399,"G",$E(X,1,30),DA)
This index will be used to look up the claim by the date the TERTIARY INSURANCE HPID Field (#473)
was last edited.
399,479 TERTIARY HPID CHANGES MADE BY MP;8 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JAN 15, 2015
HELP-PROMPT: Enter the user who last edited the TERTIARY INSURANCE HPID Field (#473).
DESCRIPTION: This is the user who last edited the TERTIARY INSURANCE HPID Field (#473). It is triggered by
Field #473.
WRITE AUTHORITY: ^
NOTES: TRIGGERED by the TERTIARY INSURANCE HPID field of the BILL/CLAIMS File
FILES POINTED TO FIELDS
AMBULANCE CONDITION INDICATORS
(#353.5) AMBULANCE CONDITION INDICATOR:AMBULANCE CONDITION INDICATOR (#.01)
BILL FORM TYPE (#353) FORM TYPE (#.19)
BILL/CLAIMS (#399) BILL COPIED FROM (#.15)
PRIMARY BILL (#.17)
BILL CLONED TO (#29)
BILL CLONED FROM (#30)
AUTO PROCESSED FROM CLAIM (#34)
PRIMARY BILL # (#125)
SECONDARY BILL # (#126)
TERTIARY BILL # (#127)
CMN FORM TYPES (#399.6) FIELD^NL^91^97:CMN FORM TYPE (#24)
CPT (#81) *CPT PROCEDURE CODE (1) (#51)
*CPT PROCEDURE CODE (2) (#52)
*CPT PROCEDURE CODE (3) (#53)
*HCFA PROCEDURE CODE (1) (#57)
*HCFA PROCEDURE CODE (2) (#58)
*HCFA PROCEDURE CODE (3) (#59)
PRIMARY SURGICAL PROC CODE (#266)
SECONDARY SURGICAL PROC CODE (#267)
FIELD^NL^91^97:CMN PROCEDURE A (#24.204)
CMN PROCEDURE B (#24.219)
REVENUE CODE:PROCEDURE (#.06)
CPT MODIFIER (#81.3) FIELD^NL^91^97:*CPT MODIFIER (#14)
CPT MODIFIER SEQUENCE:CPT MODIFIER (#.02)
DRG (#80.2) PPS (#170)
HOSPITAL LOCATION (#44) FIELD^NL^91^97:ASSOCIATED CLINIC (#6)
IB ALTERNATE PRIMARY ID TYPE
(#355.98) PRIMARY PAYER-ALT ID TYPE (#140)
SECONDARY PAYER-ALT ID TYPE (#142)
TERTIARY PAYER-ALT ID TYPE (#144)
IB ATTACHMENT REPORT TYPE
(#353.3) ATTACHMENT REPORT TYPE (#285)
FIELD^NL^91^97:ATTACHMENT REPORT TYPE (#71)
IB BILL/CLAIMS DIAGNOSIS
(#362.3) FIELD^NL^91^97:ASSOCIATED DIAGNOSIS (1) (#10)
ASSOCIATED DIAGNOSIS (2) (#11)
ASSOCIATED DIAGNOSIS (3) (#12)
ASSOCIATED DIAGNOSIS (4) (#13)
IB ERROR (#350.8) AUTO PROCESS REASON (#36)
IB INS CO PROVIDER ID CARE UNI
(#355.96) PROVIDER:DELETE 2006 .09 (#.09)
DELETE 2006 .1 (#.1)
DELETE 2006 .11 (#.11)
DELETE 2006 1.01 (#1.01)
DELETE 2006 1.02 (#1.02)
DELETE 2006 1.03 (#1.03)
IB NON/OTHER VA BILLING PROVID
(#355.93) NON-VA FACILITY (#232)
IB PROVIDER ID # TYPE (#355.97) PRIMARY ID QUALIFIER (#128)
SECONDARY ID QUALIFIER (#129)
TERTIARY ID QUALIFIER (#130)
PROVIDER:PRIM INS PROVIDER ID TYPE (#.12)
SEC INS PROVIDER ID TYPE (#.13)
TERT INS PROVIDER ID TYPE (#.14)
LINE PROVIDER:PRIM INS PROVIDER ID TYPE (#.12)
SEC INS PROVIDER ID TYPE (#.13)
TERT INS PROVIDER ID TYPE (#.14)
ICD DIAGNOSIS (#80) *ICD DIAGNOSIS CODE (2) (#65)
*ICD DIAGNOSIS CODE (3) (#66)
*ICD DIAGNOSIS CODE (4) (#67)
*ICD DIAGNOSIS CODE (5) (#68)
ADMITTING DIAGNOSIS (#215)
PRV DIAGNOSIS (1) (#249)
PRV DIAGNOSIS (2) (#250)
PRV DIAGNOSIS (3) (#251)
FIELD^NL^91^97:*ASSOCIATED DIAGNOSIS (#7)
ICD OPERATION/PROCEDURE (#80.1) *ICD PROCEDURE CODE (1) (#54)
*ICD PROCEDURE CODE (2) (#55)
*ICD PROCEDURE CODE (3) (#56)
INSTITUTION (#4) RESPONSIBLE INSTITUTION (#111)
INSURANCE COMPANY (#36) PRIMARY INSURANCE CARRIER (#101)
SECONDARY INSURANCE CARRIER (#102)
TERTIARY INSURANCE CARRIER (#103)
BILL PAYER CARRIER (#135)
MCCR INCONSISTENT DATA ELEMENT
(#399.4) REASON(S) DISAPPROVED-INITIAL:REASON(S) DISAPPROVED-INITIAL (#.01)
REASON(S) DISAPPROVED-SECOND:REASON(S) DISAPPROVED-SECOND (#.01)
MCCR UTILITY (#399.1) UB-04 BILL CLASSIFICATION (#.25)
DISCHARGE BEDSECTION (#161)
DISCHARGE STATUS (#162)
CONDITION CODE:CONDITION CODE (#.01)
OCCURRENCE CODE:OCCURRENCE CODE (#.01)
REVENUE CODE:BEDSECTION (#.05)
VALUE CODE:VALUE CODE (#.01)
OTHER CARE:OTHER CARE (#.01)
MEDICAL CENTER DIVISION (#40.8) DEFAULT DIVISION (#.22)
FIELD^NL^91^97:DIVISION (#5)
REVENUE CODE:DIVISION (#.07)
NEW PERSON (#200) ENTERED/EDITED BY (#2)
INITIAL REVIEWER (#5)
MRA REQUESTOR (#8)
AUTHORIZER (#11)
FIRST PRINTED BY (#13)
LAST PRINTED BY (#15)
BILL CANCELLED BY (#18)
BILL CLONED BY (#32)
REMOVED FROM WORKLIST BY (#37)
PRIMARY HPID CHANGES MADE BY (#475)
SECONDARY HPID CHANGES MADE BY (#477)
TERTIARY HPID CHANGES MADE BY (#479)
FIELD^NL^91^97:PROVIDER (#18)
RETURNED LOG DATE/TIME:USER (#.02)
MRA REQUEST CLAIM COMMENTS:COMMENT ENTERED BY (#.02)
EOB CLAIM COMMENTS:COMMENT ENTERED BY (#.02)
OUTPATIENT ENCOUNTER (#409.68) FIELD^NL^91^97:OUTPATIENT ENCOUNTER (#20)
PATIENT (#2) PATIENT NAME (#.02)
PERSON CLASS (#8932.1) SERVICE FACILITY TAXONOMY (#243)
NON-VA FACILITY TAXONOMY (#244)
BILLING PROVIDER TAXONOMY (#252)
PROVIDER:TAXONOMY (#.15)
LINE PROVIDER:LINE TAXONOMY (#.15)
PLACE OF SERVICE (#353.1) *PLACE OF SERVICE (#168)
FIELD^NL^91^97:PLACE OF SERVICE (#8)
PTF (#45) PTF ENTRY NUMBER (#.08)
RATE TYPE (#399.3) RATE TYPE (#.07)
REVENUE CODE (#399.2) REVENUE CODE:REVENUE CODE (#.01)
STATE (#5) MAILING ADDRESS STATE (#108)
AMBULANCE P/U STATE (#274)
AMBULANCE D/O STATE (#280)
PROVIDER:STATE (#.04)
LINE PROVIDER:STATE (#.04)
OCCURRENCE CODE:STATE (#.03)
TRANSPORT REASON CODE (#353.4) TRANSPORT REASON CODE (#288)
TYPE OF SERVICE (#353.2) *TYPE OF SERVICE (#169)
FIELD^NL^91^97:TYPE OF SERVICE (#9)
X12 278 DENTAL NUMBERING SYSTE
(#356.022) TOOTH INFORMATION:TOOTH CODE (#.01)
File #399
Record Indexes:
ABP (#820) RECORD MUMPS IR ACTION
Short Descr: Update default taxonomy codes and billing provider IDs
Description: Whenever the fields in this x-ref are changed in any way (add/edit/delete) the billing provider and service
facility for the claim may change so we need to recalculate the default values of the billing provider taxonomy
code, the service facility taxonomy code, and the billing provider secondary IDs and Qualifiers for every payer
on the claim.
Please note that this x-ref will potentially update the values of 8 fields in file 399:
399,243 - SERVICE FACILITY TAXONOMY 399,252 - BILLING PROVIDER TAXONOMY 399,122 - PRIMARY PROVIDER # 399,123 -
SECONDARY PROVIDER # 399,124 - TERTIARY PROVIDER # 399,128 - PRIMARY ID QUALIFIER 399,129 - SECONDARY ID
QUALIFIER 399,130 - TERTIARY ID QUALIFIER
Set Logic: D TAX^IBCEF79(DA)
Kill Logic: D TAX^IBCEF79(DA)
X(1): DEFAULT DIVISION (399,.22) (forwards)
X(2): NON-VA FACILITY (399,232) (forwards)
X(3): BILL PAYER POLICY (399,136) (forwards)
X(4): FORM TYPE (399,.19) (forwards)
AE (#477) RECORD MUMPS IR SORTING ONLY
Short Descr: Index by patient and insurance company
Description: Cross reference of patients and bills to payer responsible for the bill. This will be used to prevent deletion
of insurance policy entries from the patient file if a bill has been created for this insurance company.
Created with patch IB*2.0*288 replacing traditional cross-reference #1 in field 135 of file 399. Medicare is
now a valid insurance company for this index file.
Set Logic: N CURR S CURR=+$$COBN^IBCEF(DA) I $G(X(4)),$G(X(CURR)) S ^DGCR(399,"AE",X(4),X(CURR),DA)=""
Kill Logic: N G I $G(X(4)) F G=1,2,3 I $G(X(G)) K ^DGCR(399,"AE",X(4),X(G),DA)
Whole Kill: K ^DGCR(399,"AE")
X(1): PRIMARY INSURANCE CARRIER (399,101) (forwards)
X(2): SECONDARY INSURANCE CARRIER (399,102) (forwards)
X(3): TERTIARY INSURANCE CARRIER (399,103) (forwards)
X(4): PATIENT NAME (399,.02) (forwards)
AUPDID (#139) RECORD MUMPS IR ACTION
Short Descr: UPDATE PROVIDER ID WHEN DATA FIELDS CHANGE AT TOP LEVEL OF FILE
Description: This cross reference maintains the integrity of the rendering or attending provider id whenever an insurance
company is added, deleted or changed on the claim. If either of these provider functions exist on the bill,
this cross reference sets the default id data based on the insurance co's parameters.
Set Logic: D:X1(1)'=X2(1)!(X1(5)'=X2(5)) SETID^IBCEP3(DA,1) D:X1(2)'=X2(2)!(X1(4)'=X2(4)) SETID^IBCEP3(DA,2) D:X1(3)'=X2(3
)!(X1(6)'=X2(6)) SETID^IBCEP3(DA,3)
Set Cond: S X=$S($O(^DGCR(399,DA,"PRV",0)):1,1:0)
Kill Logic: D:X1(1)'=X2(1)!(X1(5)'=X2(5)) DELID^IBCEP3(DA,1) D:X1(2)'=X2(2)!(X1(4)'=X2(4)) DELID^IBCEP3(DA,2) D:X1(3)'=X2(3
)!(X1(6)'=X2(6)) DELID^IBCEP3(DA,3)
Kill Cond: S X=$S($O(^DGCR(399,DA,"PRV",0)):1,1:0)
X(1): PRIMARY INSURANCE CARRIER (399,101) (forwards)
X(2): SECONDARY INSURANCE CARRIER (399,102) (forwards)
X(3): TERTIARY INSURANCE CARRIER (399,103) (forwards)
X(4): SECONDARY INSURANCE POLICY (399,113) (forwards)
X(5): PRIMARY INSURANCE POLICY (399,112) (forwards)
Transform (Display):
X(6): TERTIARY INSURANCE POLICY (399,114) (forwards)
Transform (Display):
INPUT TEMPLATE(S):
IB MAIL JUN 24, 1988 USER #0
Enter/edit a bill's mailing address.
IB REVCODE EDIT SEP 17, 1992@10:08 USER #0
Enter/Edit a bill's revenue code information.
IB SCREEN1 JUL 26, 2010@14:48 USER #0 ^IBXS1
Enter/Edit billing screen 1, demographic information.
IB SCREEN10 SEP 01, 2010@20:16 USER #0 ^IBXSA
IB SCREEN102 MAY 25, 2017@12:11 USER #0 ^IBXSA2
IB SCREEN10H MAR 27, 2018@19:54 USER #0 ^IBXSAH
IB SCREEN2 MAR 08, 1994@16:06 USER #10882^IBXS2
IB SCREEN3 JUN 30, 2014@08:21 USER #0 ^IBXS3
IB SCREEN4 MAR 28, 2007@15:20 USER #0 ^IBXS4
IB billing screen 4 is for Inpatient information.
IB SCREEN5 JUL 30, 2018@15:55 USER #0 ^IBXS5
IB SCREEN6 JAN 02, 2019@13:52 USER #0 ^IBXS6
IB SCREEN7 JAN 02, 2019@13:51 USER #0 ^IBXS7
IB SCREEN8 NOV 30, 2017@14:01 USER #0 ^IBXS8
IB SCREEN9 AUG 01, 2011@14:47 USER #0 ^IBXS9
Ambulance Information
IB STATUS JUN 08, 2004@15:54 USER #0 ^IBXST
Edit a bill's status.
PRINT TEMPLATE(S):
IB CLK PROD AUG 23, 1996@17:07 USER #0 [IB CLK PROD HDR]
Clerk Productivity Report.
IB CLK PROD HDR AUG 26, 1996@09:36 USER #0 @
SORT TEMPLATE(S):
IB CLK PROD MAY 21, 1992@11:36 USER #10882
SORT BY: 'DATE ENTERED;"Date Entered"// (User is asked range)
WITHIN DATE ENTERED, SORT BY: +@ENTERED/EDITED BY;"Clerk Entered By";S1// (User is asked range)
WITHIN ENTERED/EDITED BY, SORT BY: @RATE TYPE;"Rate Type";// (User is asked range)
WITHIN RATE TYPE, SORT BY: DATE ENTERED//
Clerk Productivity Report.
FORM(S)/BLOCK(S):