STANDARD DATA DICTIONARY #364.9 -- ACC X12 ENCOUNTERS FILE 5/26/26 PAGE 1
STORED IN ^IBA(364.9, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
-----------------------------------------------------------------------------------------------------------------------------------
This file contains the Automated Community Care (ACC) X12 837 claim encounter data as received from Payer EDI.
DD ACCESS: @
RD ACCESS: @
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
AUDIT ACCESS: @
IDENTIFIED BY: X12 CLAIM NUMBER (#.15), CLAIM NUMBER (#2.02)
"W.11": W " ",$E($P(^(0),U,11),6,9)
"W.12": W " ",$$NAKED^DIUTL("$$DATE^DIUTL($P(^(0),U,12))")
CROSS
REFERENCED BY: ASSIGNED TO GROUP(AC), STATUS(AD), PROVIDER NPI(ANPI), DATE/TIME ENTERED(B), CLAIM NUMBER(C),
X12 CLAIM NUMBER(D), READY FOR POWER BI EXTRACT?(E), PATIENT(F), PATIENT LAST NAME(G)
LAST MODIFIED: MAY 26,2026@00:41:53
364.9,.01 DATE/TIME ENTERED 0;1 DATE (Required)
INPUT TRANSFORM: S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: OCT 23, 2025
HELP-PROMPT: Enter the date and time the community care encounter was received in VistA.
DESCRIPTION:
This is the date and time the community care X12 837 claim encounter was received in VistA.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
CROSS-REFERENCE: 364.9^B
1)= S ^IBA(364.9,"B",$E(X,1,30),DA)=""
2)= K ^IBA(364.9,"B",$E(X,1,30),DA)
This cross reference of the DATE/TIME ENTERED field is used for lookup of automated community care
encounters by date and time.
364.9,.02 PATIENT LAST NAME 0;2 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>60!($L(X)<1) X
MAXIMUM LENGTH: 60
LAST EDITED: FEB 02, 2026
HELP-PROMPT: Enter the patient's last name.
DESCRIPTION:
This is the patient's last name as found in the community care X12 837 claim encounter data.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
CROSS-REFERENCE: 364.9^G
1)= S ^IBA(364.9,"G",$E(X,1,30),DA)=""
2)= K ^IBA(364.9,"G",$E(X,1,30),DA)
This cross reference of the PATIENT LAST NAME field is used for patient last name searching.
364.9,.03 PATIENT FIRST NAME 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>35!($L(X)<1) X
MAXIMUM LENGTH: 35
LAST EDITED: FEB 02, 2026
HELP-PROMPT: Enter the patient's first name.
DESCRIPTION:
This is the patient's first name as found in the community care X12 837 claim encounter data.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,.04 PATIENT MIDDLE NAME 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>25!($L(X)<1) X
MAXIMUM LENGTH: 25
LAST EDITED: FEB 26, 2026
HELP-PROMPT: Enter the patient's middle name or initial.
DESCRIPTION: This is the patient's middle name or initial as found in the community care X12 837 claim encounter
data.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,.05 IN-PATIENT/OUT-PATIENT 0;5 SET
'I' FOR IN-PATIENT;
'O' FOR OUT-PATIENT;
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter I for in-patient or O for out-patient service.
DESCRIPTION: This field indicates whether this encounter's medical service was performed as an in-patient or
out-patient.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,.06 FORM TYPE 0;6 POINTER TO BILL FORM TYPE FILE (#353) (Required)
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter the type of claim form the community care claim was received as.
DESCRIPTION: This is the claim form type for which service was billed by community care. This field value will
be either form type 2 (CMS-1500), form type 3 (UB-04) or form type 7 (J430D).
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,.07 PROVIDER 0;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>100!($L(X)<1) X
MAXIMUM LENGTH: 100
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter the provider for this encounter in the format of last name, first name.
DESCRIPTION:
This is the provider name found in the community care X12 837 claim encounter data.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,.08 PROVIDER TYPE 0;8 SET
'DN' FOR REFERRING PROVIDER;
'P3' FOR PRIMARY CARE PROVIDER;
'82' FOR RENDERING PROVIDER;
'DQ' FOR SUPERVISING PROVIDER;
'71' FOR ATTENDING PROVIDER;
'72' FOR OPERATING PHYSICIAN;
LAST EDITED: NOV 27, 2023
HELP-PROMPT: Enter a valid provider type.
DESCRIPTION: This is the provider type found in the community care X12 837 claim encounter data received from
Payer EDI for the provider assigned to this encounter.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,.09 PROVIDER NPI 0;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
MAXIMUM LENGTH: 10
LAST EDITED: NOV 27, 2023
HELP-PROMPT: Enter the provider's NPI.
DESCRIPTION:
This is the provider's NPI found in the community care X12 837 claim encounter data.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,.1 PATIENT DOB 0;10 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: NOV 27, 2023
HELP-PROMPT: Enter the patient's date of birth.
DESCRIPTION:
This is the patient's date of birth as found in the community care X12 837 claim encounter data.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,.11 PATIENT SSN 0;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>9!($L(X)<9) X
MAXIMUM LENGTH: 9
LAST EDITED: DEC 23, 2024
HELP-PROMPT: Enter the patient's 9 digit social security number.
DESCRIPTION: This is the patient's social security number as found in the community care X12 837 claim encounter
data.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,.12 SERVICE DATE 0;12 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAR 11, 2025
HELP-PROMPT: Enter the date of service for this encounter.
DESCRIPTION: This is the first service line's date of service found in the community care X12 837 claim
encounter data.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,.13 CPT 0;13 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
MAXIMUM LENGTH: 10
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter a current procedural terminology (CPT) code for this encounter.
DESCRIPTION: This is the first current procedural terminology (CPT) code found in the community care X12 837
claim encounter data.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,.14 PRIMARY DX 0;14 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
MAXIMUM LENGTH: 10
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter the primary diagnosis code for this encounter.
DESCRIPTION:
This is the primary diagnosis code found in the community care X12 837 claim encounter data.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,.15 X12 CLAIM NUMBER 0;15 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
MAXIMUM LENGTH: 30
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter the claim number for this external 837 claim.
DESCRIPTION:
This is the claim number assigned to the encounter by the clearinghouse.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
This is the value added network trace number (claim number) found in the X12 837 REF segment in
loop 2300 where REF01 (reference identification qualifier) equals 'D9'.
CROSS-REFERENCE: 364.9^D
1)= S ^IBA(364.9,"D",$E(X,1,30),DA)=""
2)= K ^IBA(364.9,"D",$E(X,1,30),DA)
This cross reference of the X12 CLAIM NUMBER field is used for Payer EDI encounter claim number
searching.
364.9,.16 STATUS 0;16 SET
'0' FOR OPEN;
'1' FOR IN PROGRESS;
'2' FOR CLOSED;
'3' FOR PURGED;
LAST EDITED: AUG 27, 2025
HELP-PROMPT: Enter the processing status of the community care encounter.
DESCRIPTION:
This is the current status of the community care encounter.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It is initially populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI. This status field is then updated by the VistA software based on user
actions performed while working the encounters off of a worklist.
CROSS-REFERENCE: 364.9^AD
1)= S ^IBA(364.9,"AD",$E(X,1,30),DA)=""
2)= K ^IBA(364.9,"AD",$E(X,1,30),DA)
This cross reference is used to sort the automated community care encounter entries by STATUS.
CROSS-REFERENCE: ^^TRIGGER^364.9^.22
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(364.9,D0,0)):^(0),1:"") S X=$P(Y(1),U,22),X=X S
DIU=X K Y S X=DIV S X=$$NOW^XLFDT S DIH=$G(^IBA(364.9,DIV(0),0)),DIV=X S $P(^(0),U,22)=DIV,DIH=364
.9,DIG=.22 D ^DICR
2)= Q
CREATE VALUE)= S X=$$NOW^XLFDT
DELETE VALUE)= NO EFFECT
FIELD)= STATUS DATE CHANGED
The STATUS DATE CHANGED field is triggered every time the STATUS is changed.
CROSS-REFERENCE: ^^TRIGGER^364.9^.21
1)= X ^DD(364.9,.16,1,3,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(364.9,D0,0)):^(0),1:"") S X=$P(Y(1),U,21
),X=X S DIU=X K Y S X=DIV S X=1 S DIH=$G(^IBA(364.9,DIV(0),0)),DIV=X S $P(^(0),U,21)=DIV,DIH=364.9,
DIG=.21 D ^DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$C(59)_$P($G(^DD(364.9,.16,0)),U,3) S X=$P($P(Y
(1),$C(59)_Y(0)_":",2),$C(59))'="PURGED"
2)= Q
CREATE CONDITION)= STATUS'="PURGED"
CREATE VALUE)= S X=1
DELETE VALUE)= NO EFFECT
FIELD)= READY
This trigger is used to force the community care encounter data to be extracted for power bi
external reporting.
CROSS-REFERENCE: ^^TRIGGER^364.9^3.01
1)= X ^DD(364.9,.16,1,4,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(364.9,D0,3)):^(3),1:"") S X=$P(Y(1),U,1)
,X=X S DIU=X K Y S X="" S DIH=$G(^IBA(364.9,DIV(0),3)),DIV=X S $P(^(3),U,1)=DIV,DIH=364.9,DIG=3.01
D ^DICR
1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$C(59)_$P($G(^DD(364.9,.16,0)),U,3) S X=$P($P(Y
(1),$C(59)_Y(0)_":",2),$C(59))="CLOSED"
2)= Q
CREATE CONDITION)= STATUS="CLOSED"
CREATE VALUE)= @
DELETE VALUE)= NO EFFECT
FIELD)= ASSIGNED TO GROUP
Once the STATUS is CLOSED, it is no longer assigned to any group.
364.9,.17 PRIMARY INS 0;17 POINTER TO INSURANCE COMPANY FILE (#36)
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter the primary insurance company to be used for the VistA claim.
DESCRIPTION:
This is the primary insurance company to be used when creating the initial VistA claim.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,.18 SECONDARY INS 0;18 POINTER TO INSURANCE COMPANY FILE (#36)
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter the secondary insurance company to be used for the VistA claim.
DESCRIPTION:
This is the secondary insurance company to be used when creating the initial VistA claim.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,.19 TERTIARY INS 0;19 POINTER TO INSURANCE COMPANY FILE (#36)
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter the tertiary insurance company to be used for the VistA claim.
DESCRIPTION:
This is the tertiary insurance company to be used when creating the initial VistA claim.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,.2 SITE NUMBER 0;20 FREE TEXT
INPUT TRANSFORM: K:$L(X)>7!($L(X)<3) X
MAXIMUM LENGTH: 7
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter the VistA site(station) number concatenated with an optional two character division code.
Example: 123AB.
DESCRIPTION: This value is the numeric VistA site (station) number, optionally concatenated with a two character
division code. Example: 123AB.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming community care X12 837 encounters VistA receives
from Payer EDI.
364.9,.21 READY FOR POWER BI EXTRACT? 0;21 SET (BOOLEAN Data Type)
LAST EDITED: JAN 30, 2024
HELP-PROMPT: Enter a 1 if this entry needs to be extracted for Power BI reporting.
DESCRIPTION:
This field indicates when an entry needs to be extracted for Power BI reporting.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
NOTES: TRIGGERED by the CLAIM NUMBER field of the ACC X12 ENCOUNTERS File
TRIGGERED by the AUTHORIZED? field of the ACC X12 ENCOUNTERS File
TRIGGERED by the STATUS field of the ACC X12 ENCOUNTERS File
CROSS-REFERENCE: 364.9^E^MUMPS
1)= I X S ^IBA(364.9,"E",X,DA)=""
2)= K ^IBA(364.9,"E",X,DA)
This index is used to determine if X12 entry needs to be exported for Power BI reporting.
364.9,.22 STATUS DATE CHANGED 0;22 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: DEC 19, 2024
HELP-PROMPT: Enter the date the STATUS was changed.
DESCRIPTION:
This is the date the STATUS field was last changed.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It is initially populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI. This status date changed field is updated each time the STATUS field is
changed based on user actions performed while working the encounters off of a worklist.
NOTES: TRIGGERED by the STATUS field of the ACC X12 ENCOUNTERS File
364.9,.23 DAYS ON A WORKLIST ; COMPUTED
MUMPS CODE: S Y(364.9,.23,1)=$S($D(^IBA(364.9,D0,0)):^(0),1:"") N %I,%H,% D NOW^%DTC S X=X,X1=X,X2=$P(Y(364.9,.
23,1),U,1),X="" D:X2 ^%DTC:X1
ALGORITHM: TODAY-DATE/TIME ENTERED
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter Standard MUMPS code
DESCRIPTION: This computed field displays the number of days from the date an encounter was imported in field
(#.01) DATE/TIME ENTERED to today's date (DT).
TECHNICAL DESCR: This field is not intended for end user entering or editing. It is a computed field based on
length of time on a given worklist.
364.9,.24 SITE NUMBER IN JSON 0;24 FREE TEXT
INPUT TRANSFORM: K:$L(X)>7!($L(X)<3) X
MAXIMUM LENGTH: 7
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter the VistA site(station) number concatenated with an optional two character division code that
was received in the original X12 encounter.
DESCRIPTION: This value is the original numeric site (station) number, optionally concatenated with a two
character division code. Example: 123AB.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming community care X12 837 encounters VistA receives
from Payer EDI.
364.9,.25 SERVICE FACILITY 0;25 FREE TEXT
INPUT TRANSFORM: K:$L(X)>60!($L(X)<1) X
MAXIMUM LENGTH: 60
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter the service facility for this encounter.
DESCRIPTION:
This is the service facility name found in the community care X12 837 claim encounter data.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,.26 SERVICE FACILITY NPI 0;26 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
MAXIMUM LENGTH: 10
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter the service facility's national provider id (NPI).
DESCRIPTION: This is the service facility's national provider id (NPI) found in the community care X12 837 claim
encounter data.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,.27 PAID AMOUNT 0;27 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999999)!(X<0) X
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter the dollar amount of the amount paid by VA for this community care encounter.
DESCRIPTION:
This is the amount the VA paid on this community care encounter.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,.28 CHARGE AMOUNT 0;28 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999999)!(X<0) X
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter the dollar amount of the original charges on the community care claim.
DESCRIPTION: This is the original community care claim charge amount found in the community care X12 837 claim
encounter data.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,.29 PAYER CLAIM CONTROL NUMBER 0;29 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
MAXIMUM LENGTH: 50
LAST EDITED: JAN 28, 2025
HELP-PROMPT: Enter the payer claim control number assigned to this community care encounter.
DESCRIPTION: This is the payer claim control number assigned to this encounter when the VA paid the community
care claim.
364.9,.3 SECONDARY DX 0;30 FREE TEXT
INPUT TRANSFORM: K:$L(X)>225!($L(X)<1) X
MAXIMUM LENGTH: 225
LAST EDITED: JAN 29, 2025
HELP-PROMPT: Enter the secondary diagnosis code(s), separated by a comma, for this community care encounter.
DESCRIPTION:
These are the secondary diagnosis codes received on the community care encounter.
364.9,.31 EXEMPT FROM SC/SA 0;31 SET (BOOLEAN Data Type)
LAST EDITED: FEB 26, 2026
HELP-PROMPT: Enter 'Yes' if this encounter should be considered non-service connected. Otherwise, enter 'No'.
DESCRIPTION: If the patient on this encounter is set up as service connected but the actual service on this
encounter is billable, then this field should be set to 'Yes' in order for the encounter to be
billed. Otherwise, the value should be 'No'.
364.9,1.01 SEGMENT 1;0 Multiple #364.9001 (Add New Entry without Asking)
DESCRIPTION:
These are the original X12 segments received in the community care X12 837 claim encounter data.
TECHNICAL DESCR: This multiple is not intended for end user entering or editing. They will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9001,.01 SEGMENT 0;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>300!($L(X)<3) X
MAXIMUM LENGTH: 300
LAST EDITED: NOV 28, 2023
HELP-PROMPT: Enter the original X12 segment data.
DESCRIPTION:
These entries are the original X12 segment information received for the community care claims.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,2.01 PATIENT 2;1 POINTER TO PATIENT FILE (#2)
LAST EDITED: DEC 19, 2024
HELP-PROMPT: Enter the patient this community care encounter is for.
DESCRIPTION:
This is the patient found from information in the community care X12 837 claim encounter data.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
CROSS-REFERENCE: 364.9^F
1)= S ^IBA(364.9,"F",$E(X,1,30),DA)=""
2)= K ^IBA(364.9,"F",$E(X,1,30),DA)
This cross reference is used for sorting the encounter file entries by patient.
364.9,2.02 CLAIM NUMBER 2;2 POINTER TO BILL/CLAIMS FILE (#399)
LAST EDITED: DEC 19, 2024
HELP-PROMPT: Enter the VistA claim number which was generated for this community care encounter.
DESCRIPTION: This is the link to the BILL/CLAIMS file for the VistA claim which was auto-created from the
community care X12 837 claim encounter data.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
CROSS-REFERENCE: ^^TRIGGER^364.9^.21
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(364.9,D0,0)):^(0),1:"") S X=$P(Y(1),U,21),X=X S
DIU=X K Y S X=DIV S X=1 S DIH=$G(^IBA(364.9,DIV(0),0)),DIV=X S $P(^(0),U,21)=DIV,DIH=364.9,DIG=.21
D ^DICR
2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(364.9,D0,0)):^(0),1:"") S X=$P(Y(1),U,21),X=X S
DIU=X K Y S X=DIV S X=0 S DIH=$G(^IBA(364.9,DIV(0),0)),DIV=X S $P(^(0),U,21)=DIV,DIH=364.9,DIG=.21
D ^DICR
CREATE VALUE)= S X=1
DELETE VALUE)= S X=0
FIELD)= READY
CROSS-REFERENCE: 364.9^C
1)= S ^IBA(364.9,"C",$E(X,1,30),DA)=""
2)= K ^IBA(364.9,"C",$E(X,1,30),DA)
This cross reference is used to lookup a community care encounter by the associated VistA claim
number.
364.9,2.03 AUTHORIZED? 2;3 SET (BOOLEAN Data Type)
LAST EDITED: JAN 30, 2024
HELP-PROMPT: Enter 1 (Yes) if this VistA claim was auto-authorized.
DESCRIPTION:
This value will be 1 (Yes) if the VistA claim was able to be auto-authorized.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
CROSS-REFERENCE: ^^TRIGGER^364.9^.21
1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(364.9,D0,0)):^(0),1:"") S X=$P(Y(1),U,21),X=X S
DIU=X K Y S X=DIV S X=1 S DIH=$G(^IBA(364.9,DIV(0),0)),DIV=X S $P(^(0),U,21)=DIV,DIH=364.9,DIG=.21
D ^DICR
2)= Q
CREATE VALUE)= S X=1
DELETE VALUE)= NO EFFECT
FIELD)= READ
This trigger sets the READY FOR POWER BI EXTRACT? field when the VistA claim is successfully
authorized for submission to the payer.
364.9,3.01 ASSIGNED TO GROUP 3;1 SET
'FRT' FOR FACILITY REVENUE TECHNICIANS;
'RUR' FOR REVENUE UTILIZATION REVIEW;
'IV' FOR INSURANCE VERIFICATION;
'BILL' FOR BILLING;
'PTF' FOR FACILITY REVENUE TECHNICIANS PTF;
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter the group of users this claim should be assigned to.
DESCRIPTION: This is the current workgroup this claim is assigned to. When a claim is reassigned, this field is
updated with the workgroup it was reassigned to.
NOTES: TRIGGERED by the REASSIGNED TO GROUP field of the PREVIOUS ACTIVITY sub-field of the ACC X12
ENCOUNTERS File
TRIGGERED by the STATUS field of the ACC X12 ENCOUNTERS File
CROSS-REFERENCE: 364.9^AC
1)= S ^IBA(364.9,"AC",$E(X,1,30),DA)=""
2)= K ^IBA(364.9,"AC",$E(X,1,30),DA)
This cross reference is used as the main lookup to create the List Manager work lists for each
workgroup.
364.9,3.02 INITIAL ASSIGNED GROUP 3;2 SET
'FRT' FOR FACILITY REVENUE TECHNICIANS;
'RUR' FOR REVENUE UTILIZATION REVIEW;
'IV' FOR INSURANCE VERIFICATION;
'BILL' FOR BILLING;
'PTF' FOR FACILITY REVENUE TECHNICIANS PTF;
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter the group this encounter is assigned to when initially imported.
DESCRIPTION:
This is the first user group this encounter was assigned to upon import into VistA.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,3.03 DATE ASSIGNED 3;3 DATE
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: DEC 19, 2024
HELP-PROMPT: Enter the date this encounter was assigned to a workgroup.
DESCRIPTION: This is the date when the encounter is assigned to a particular work group in the #3.01 ASSIGNED TO
GROUP field.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It is initially populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI. Each time the encounter gets assigned to a group, this field is updated.
364.9,3.04 DAYS ON GROUP WORKLIST ; COMPUTED
MUMPS CODE: S X=$$DAYSONWRKGRP^IBACCWLUTIL1(D0)
ALGORITHM: S X=$$DAYSONWRKGRP^IBACCWLUTIL1(D0)
LAST EDITED: DEC 19, 2024
DESCRIPTION: This computed field displays the number of days from the date an encounter is assigned to a group
in field (#3.03) DATE ASSIGNED until today's date (DT).
364.9,4 PREVIOUS ACTIVITY 4;0 DATE Multiple #364.94 (Add New Entry without Asking)
LAST EDITED: NOV 16, 2023
DESCRIPTION: This multiple contains a record of all activity performed by workgroup users on a community care
encounter.
TECHNICAL DESCR:
This multiple field is not intended for end user entering or editing.
364.94,.01 DATE/TIME ENTERED 0;1 DATE
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 23, 2025
HELP-PROMPT: Enter the date and time the activity occurred on this encounter.
DESCRIPTION:
This is the date and time the PREVIOUS ACTIVITY was entered.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will be populated each time an
activity entry is made by the VistA software.
CROSS-REFERENCE: 364.94^B
1)= S ^IBA(364.9,DA(1),4,"B",$E(X,1,30),DA)=""
2)= K ^IBA(364.9,DA(1),4,"B",$E(X,1,30),DA)
This cross reference is for sorting the PREVIOUS ACTIVITY entries for each encounter.
364.94,.02 ENTERED BY 0;2 POINTER TO NEW PERSON FILE (#200) (Required)
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter the user who added the comment.
DESCRIPTION:
This is the user who added the PREVIOUS ACTIVITY.
TECHNICAL DESCR: This field is not intended for end user entering or editing. This field will be updated by the
VistA software each time an activity entry is made.
364.94,.03 ACTIVITY CODE 0;3 POINTER TO ACC ACTIVITY CODES FILE (#364.92)
LAST EDITED: DEC 18, 2024
HELP-PROMPT: Enter the activity code which represents the action taken.
DESCRIPTION:
This is the action taken (activity code).
364.94,.04 ASSIGNING GROUP 0;4 SET (Required)
'FRT' FOR FACILITY REVENUE TECHNICIANS;
'RUR' FOR REVENUE UTILIZATION REVIEW;
'IV' FOR INSURANCE VERIFICATION;
'BILL' FOR BILLING;
'PTF' FOR FACILITY REVENUE TECHNICIANS PTF;
LAST EDITED: MAR 17, 2025
HELP-PROMPT: Enter the workgroup who reassigned this claim.
DESCRIPTION: This is the workgroup which reassigned this claim to another workgroup via the action taken. The
field (#.05) REASSIGNED TO GROUP is the workgroup the claim was reassigned to.
TECHNICAL DESCR: This field is not intended for end user entering or editing. This field will be updated when a
user performs a reassignment action in the VistA software.
364.94,.05 REASSIGNED TO GROUP 0;5 SET
'FRT' FOR FACILITY REVENUE TECHNICIANS;
'RUR' FOR REVENUE UTILIZATION REVIEW;
'IV' FOR INSURANCE VERIFICATION;
'BILL' FOR BILLING;
'PTF' FOR FACILITY REVENUE TECHNICIANS PTF;
LAST EDITED: MAR 17, 2025
HELP-PROMPT: Enter the workgroup to reassign this claim to.
DESCRIPTION:
This is the work group that a user reassigned the claim to by using a particular action.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will be updated by the VistA
software by an action the end user takes to reassign an encounter from one workgroup to another.
CROSS-REFERENCE: ^^TRIGGER^364.9^3.01
1)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA S Y(0)=X I 1 I X S X=DIV S Y(1)=$S($D(^IBA(364.9,D0,3)):
^(3),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y X ^DD(364.94,.05,1,1,1.1) X ^DD(364.94,.05,1,1,1.4)
1.1)= S X=DIV S Y(1)=$C(59)_$P($G(^DD(364.94,.05,0)),U,3) S X=$P($P(Y(1),$C(59)_DIV_":",2),$C(59))
1.4)= S DIH=$G(^IBA(364.9,DIV(0),3)),DIV=X S $P(^(3),U,1)=DIV,DIH=364.9,DIG=3.01 D ^DICR
2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA S Y(1)=$S($D(^IBA(364.9,D0,3)):^(3),1:"") S X=$P(Y(1),U,
1),X=X S DIU=X K Y X ^DD(364.94,.05,1,1,2.1) S DIH=$G(^IBA(364.9,DIV(0),3)),DIV=X S $P(^(3),U,1)=DI
V,DIH=364.9,DIG=3.01 D ^DICR
2.1)= S X=DIV S Y(2)=$C(59)_$P($G(^DD(364.94,.05,0)),U,3),Y(1)=$S($D(^IBA(364.9,D0,4,D1,0)):^(0),1:
"") S X=$P($P(Y(2),$C(59)_$P(Y(1),U,5)_":",2),$C(59))
CREATE CONDITION)= I 1
CREATE VALUE)= REASSIGNED TO GROUP
DELETE VALUE)= REASSIGNED TO GROUP
DIC)=
FIELD)= ASSIGNED TO GROUP
This trigger updates field ASSIGN TO GROUP when the software or a user reassigns a community care
X12 837 claim encounter to another worklist user group.
364.94,.06 ENTERED BY (FT) 0;6 FREE TEXT
INPUT TRANSFORM:K:$L(X)>70!($L(X)<3) X
MAXIMUM LENGTH: 70
LAST EDITED: DEC 19, 2024
HELP-PROMPT: Enter the name (in any format) of the person creating the activity.
DESCRIPTION: This is the free text version of the name of the person creating the activity to be used when the
encounter is transferred to another site.
TECHNICAL DESCR:This field is only used to capture the name of the person originally entering the activity since
the pointer will point to the wrong person at the receiving site.
364.94,10 PREVIOUS ACTIVITY COMMENTS 10;0 WORD-PROCESSING #364.9401 (IGNORE "|")
LAST EDITED: NOV 16, 2023
DESCRIPTION: Comments entered during reassignment of this claim. This can include explanations of what the user
did or requests of the reassigned to group to perform some action on this encounter.
LAST EDITED: JAN 26, 2026
HELP-PROMPT: Enter comments describing the action taken during this reassignment.
364.9,5 REASONS NOT AUTOBILLED 5;0 POINTER Multiple #364.95 (Add New Entry without Asking)
DESCRIPTION: These are the reasons the VistA claim was not 'auto-generated' or the reasons the VistA claim was
not 'auto-billed'.
TECHNICAL DESCR:
This multiple field is not intended for end user entering or editing.
364.95,.01 REASON NOT AUTOBILLED 0;1 POINTER TO ACC X12 CLAIM FAILURES FILE (#364.91)
LAST EDITED: DEC 19, 2024
HELP-PROMPT: Enter the reason code an X12 ACC claim could not be auto-billed.
DESCRIPTION: This REASON NOT AUTOBILLED code represents a reason the VistA claim was either not
'auto-generated' or not 'auto-billed'.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
CROSS-REFERENCE: 364.95^B
1)= S ^IBA(364.9,DA(1),5,"B",$E(X,1,30),DA)=""
2)= K ^IBA(364.9,DA(1),5,"B",$E(X,1,30),DA)
This cross reference is used to search for specific failure reason codes within a given automated
community care encounter.
364.95,.02 REASON NOTE 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
MAXIMUM LENGTH: 50
LAST EDITED: NOV 28, 2023
HELP-PROMPT: Enter a short note that is helpful to describe the reason code.
DESCRIPTION: This is a short note indicating further information why claim failed either 'auto-generation' or
'auto-billing'.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.95,.03 WORKLIST 0;3 SET
'FRT' FOR FACILITY REVENUE TECHNICIANS;
'RUR' FOR REVENUE UTILIZATION REVIEW;
'IV' FOR INSURANCE VERIFICATION;
'BILL' FOR BILLING;
'PTF' FOR FACILITY REVENUE TECHNICIANS PTF;
LAST EDITED: JAN 29, 2025
HELP-PROMPT: Enter the worklist this failure reason should display on.
DESCRIPTION:
This is the worklist where this failure reason will display.
364.95,.04 PROVIDER NPI 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
MAXIMUM LENGTH: 10
LAST EDITED: FEB 26, 2026
HELP-PROMPT: Enter the provider's 10 digit NPI.
DESCRIPTION: This is the provider NPI that was received in the community care encounter. This NPI, if
present, was not found in the VistA database.
CROSS-REFERENCE: 364.9^ANPI
1)= S ^IBA(364.9,"ANPI",$E(X,1,30),DA(1),DA)=""
2)= K ^IBA(364.9,"ANPI",$E(X,1,30),DA(1),DA)
This cross reference is used to identify an NPI for a provider or facility that was not found in
the VistA database.
364.9,6 SERVICE LINE NUMBER 6;0 Multiple #364.96 (Add New Entry without Asking)
DESCRIPTION: This is the service line level payment information received on the incoming community care
encounter.
TECHNICAL DESCR: This multiple field is not intended for end user entering or editing. It will only be populated by
the remote procedure that is handling the incoming automated community care X12 837 encounters
VistA receives from Payer EDI.
364.96,.01 SERVICE LINE NUMBER 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: DEC 19, 2024
HELP-PROMPT: Enter the service line number from the community care X12 837 claim encounter.
DESCRIPTION:
This is the line number of the service found on the incoming community care encounter.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
CROSS-REFERENCE: 364.96^B
1)= S ^IBA(364.9,DA(1),6,"B",$E(X,1,30),DA)=""
2)= K ^IBA(364.9,DA(1),6,"B",$E(X,1,30),DA)
This cross reference provides service line number searching within the SERVICE LINE NUMBER
multiple.
364.96,.02 LINE PAYMENT AMOUNT 0;2 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999999)!(X<0) X
LAST EDITED: DEC 19, 2024
HELP-PROMPT: Enter the line level payment amount the VA paid on this community care service.
DESCRIPTION: This is the service line level payment amount that was found in the community care X12 837 claim
encounter data.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.9,7 INITIAL REASON NOT AUTOBILLED 7;0 POINTER Multiple #364.97 (Add New Entry without Asking)
DESCRIPTION: These are the initial reasons the VistA claim was not 'auto-generated' or the initial reasons the
VistA claim was not 'auto-billed'.
TECHNICAL DESCR:
This multiple field is not intended for end user entering or editing.
364.97,.01 INITIAL REASON NOT AUTOBILLED 0;1 POINTER TO ACC X12 CLAIM FAILURES FILE (#364.91) (Multiply asked)
LAST EDITED: OCT 23, 2025
HELP-PROMPT: Enter the initial reason code an X12 ACC claim could not be auto-billed.
DESCRIPTION: This INITIAL REASON NOT AUTOBILLED code represents a reason the VistA claim was either not
'auto-generated' or not 'auto-billed'.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
CROSS-REFERENCE: 364.97^B
1)= S ^IBA(364.9,DA(1),7,"B",$E(X,1,30),DA)=""
2)= K ^IBA(364.9,DA(1),7,"B",$E(X,1,30),DA)
364.97,.02 REASON NOTE 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
MAXIMUM LENGTH: 50
LAST EDITED: OCT 23, 2025
HELP-PROMPT: Enter a short note that is helpful to describe the reason code.
DESCRIPTION: This is a short note indicating further information why the claim failed either 'auto-generation'
or 'auto-billing'.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.97,.03 WORKLIST 0;3 SET
'FRT' FOR FACILITY REVENUE TECHNICIANS;
'RUR' FOR REVENUE UTILIZATION REVIEW;
'IV' FOR INSURANCE VERIFICATION;
'BILL' FOR BILLING;
'PTF' FOR FACILITY REVENUE TECHNICIANS PTF;
LAST EDITED: OCT 23, 2025
HELP-PROMPT: Enter the worklist this failure reason should display on.
DESCRIPTION:
This is the worklist where this failure reason will display.
TECHNICAL DESCR: This field is not intended for end user entering or editing. It will only be populated by the
remote procedure that is handling the incoming automated community care X12 837 encounters VistA
receives from Payer EDI.
364.97,.04 PROVIDER NPI 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
MAXIMUM LENGTH: 10
LAST EDITED: OCT 23, 2025
HELP-PROMPT: Answer must be 10 characters in length.
DESCRIPTION: This is the provider NPI that was received in the community care encounter. This NPI, if
present, was not found in the VistA database.
FILES POINTED TO FIELDS
ACC ACTIVITY CODES (#364.92) PREVIOUS ACTIVITY:ACTIVITY CODE (#.03)
ACC X12 CLAIM FAILURES (#364.91) REASONS NOT AUTOBILLED:REASON NOT AUTOBILLED (#.01)
INITIAL REASON NOT AUTOBILLED:INITIAL REASON NOT AUTOBILLED (#.01)
ACC X12 ENCOUNTERS (#364.9) PREVIOUS ACTIVITY:REASSIGNED TO GROUP (#.05)
BILL FORM TYPE (#353) FORM TYPE (#.06)
BILL/CLAIMS (#399) CLAIM NUMBER (#2.02)
INSURANCE COMPANY (#36) PRIMARY INS (#.17)
SECONDARY INS (#.18)
TERTIARY INS (#.19)
NEW PERSON (#200) PREVIOUS ACTIVITY:ENTERED BY (#.02)
PATIENT (#2) PATIENT (#2.01)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):