$TXT Created by TJERNAGEL,STEVE at MNTVBB.FO-ALBANY.MED.VA.GOV (KIDS) on Friday, 12/10/10 at 10:45 ============================================================================= Run Date: JAN 26, 2011 Designation: IB*2*436 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #408 Status: Released Compliance Date: FEB 26, 2011 ============================================================================= Associated patches: (v)IB*2*323 <<= must be installed BEFORE `IB*2*436' (v)IB*2*349 <<= must be installed BEFORE `IB*2*436' (v)IB*2*400 <<= must be installed BEFORE `IB*2*436' Subject: HIPAA 5010-MRA & DUAL PROVIDER STATUS & LEGAL CLAIMS Category: - Data Dictionary - Routine - Enhancement (Mandatory) Description: ============ This patch will cover HIPAA 5010 - AR FOR MEDICARE POLICY TYPE, DUAL PROVIDER STATUS & ENTITY TYPE, and LEGAL CLAIMS AND THE NPI. A. AR FOR MEDICARE POLICY TYPE: --------------------------- The IB and AR modules are integrated parts of the overall VistA system that exists at each site. The IB and AR modules make use of FileMan and MailMan. The IB module receives a MailMan message containing the flatfile 835 (MRA) via the VA Financial Service Center in Austin, TX from Medicare. In addition, the IB module transmits the flat-file 837 Health Care Claim data to the VA Financial Service Center in Austin, TX via MailMan. The scope of this enhancement is to manage the requirements for the VistA system's IB module as specified below: 1. Create a new plan type in VistA to accommodate MediGap plan (F&G). "MEDIGAP (SUPPL - COINS, DED, PART B EXC)" 2. When the Medicare Remittance Advice (MRA) is returned: All MRA secondary insurance claims will be billed the patient responsibility amount unless one of the following conditions is true. If an MRA, and the claim is an OUTPATIENT claim and the MRA secondary insurance plan type is NOT "MEDIGAP (SUPPLEMENTAL)" then the secondary insurance claim will be billed under the new calculation of patient responsibility PLUS MediGap unpaid amount. If an MRA, and the claim is an INPATIENT PROFESSIONAL claim (professional means the same thing as Part B and the same thing as a CMS1500) and the MRA secondary insurance plan type is NOT "MEDIGAP (SUPPLEMENTAL)" then the secondary insurance claim will be billed under the new calculation of patient responsibility PLUS MediGap unpaid amount. Therefore, for those MRA secondary insurance's whose plan type is the new one for MEDIGAP PLAN F & MEDIGAP PLAN G - only Outpatient claims and INPATIENT Professional claims will fall in the new calculation of of patient responsibility PLUS MediGap unpaid amount. All inpatient UB04 claims with this new plan type for MEDIGAP PLAN F & MEDIGAP PLAN G will use the original calculation of patient responsibility. B. DUAL PROVIDER STATUS & ENTITY TYPE: ---------------------------------- The scope of this enhancement is to manage the requirements for the VistA system's IB module as specified below: 1. To allow for entry and storage of a given provider's name (Last, First Middle) to exist in identical content and format in the NEW PERSON file (#200) and the IB NON/OTHER VA BILLING PROVIDER file (#355.93). 2. To allow the use of a comma in Non-VA Facility names. 3. A clean-up effort is required during the patch installation process: Synchronize values between the NEW PERSON File (#200) and the IB NON/OTHER VA BILLING PROVIDER File (#355.93). This utility is run one time during the installation process to compare the Provider Name values using the NPI as the common field. When differences are identified, the provider name in the NEW PERSON file will be copied to the provider name field of the IB NON/OTHER VA BILLING PROVIDER file. 4. Create a one-time report of all the changes resulting from the aforementioned installation utility. 5. Email the above report to those users with the "IB PROVIDER EDIT" security key. C. LEGAL CLAIMS AND THE NPI: ------------------------ NOTE: For the purpose of these requirements, legal claims will be defined as a Billing Rate Type of "NO FAULT INS.", "WORKERS' COMP.", and "TORT FEASOR". The scope of this enhancement is to manage the requirements for the VistA System's IB module as specified below to allow for the: 1. Ability to authorize specified legal claims lacking an NPI. 2. Ability to locally print legal claims lacking an NPI. 3. Ability to locally print legal claims with any NPI, if any NPI is available. 4. Ability to ensure that if the "NO FAULT INS.", "WORKERS' COMP." or "TORT FEASOR" claim is ultimately deemed billable to third-party insurance that the requirement for the NPI remains. This patch addresses the following New Service Request (NSR): =========================================================== The NSR associated with this patch is out of date with the requirements. This patch addresses the following Remedy Ticket(s): =================================================== There are no Remedy Tickets associated with this patch. Components Sent With Patch ========================== FILES ===== The following is a list of files included in this patch: UP SEND DATA DATE SEC. COMES SITE RSLV FILE # NAME DD CODE W/FILE DATA PTS -------------------------------------------------------------------- 355.93 IB NON/OTHER VA BILLING PROVIDER Y Y N N N FIELDS ====== The following is a list of fields included in this patch: Field Name (Number) ------------------- NAME (.01) PROVIDER TYPE (.02) STREET ADDRESS LINE 2 (.1) OPTIONS ======= The following is a list of the options included in this patch: Option Name Type New/Modified ------------ ----- ------------- None HL7 APPLICATION PARAMETERS ========================== The following is a list of the HL7 Application Parameters included in this patch: HL7 Application Parameter ------------------------- None LOGICAL LINKS ============= The following is a list of the HL Logical Links included in this patch: HL Logical Link --------------- None Documentation Retrieval ======================= The release notes, technical manual, and user's guide may also be retrieved from the following OI Field Offices' Anonymous.Software Directories. Use the appropriate FTP capability to retrieve the files and use BINARY format. OI Field Office FTP Address Directory --------------- ----------- --------- ALBANY ftp.fo-albany.med.va.gov anonymous.software HINES ftp.fo-hines.med.va.gov anonymous.software SALT LAKE ftp.fo-slc.med.va.gov anonymous.software FIRST AVAILABLE SERVER download.vista.med.va.gov anonymous.software The documentation includes: File Name Description --------- ----------- IB_20_P436_RN.doc Release Notes IB_20_P436_TM.doc Technical Manual edi_user_guide.pdf User's Guide Test Sites ========== HEARTLAND-WEST HCS HONOLULU, HI LOMA LINDA, CA TENNESSEE VALLEY HCS Pre/Post Installation Overview ============================== INSTALLATION INSTRUCTIONS ------------------------- It is recommended that this patch be installed outside of normal working hours, however, if installed during the normal workday, other VistA users will not be affected. Users ARE allowed to be on the system during the installation except for those options listed below. It is recommended that the patch be installed during non-peak time. It will take about ten minutes to install the patch, but you may queue the installation if you wish. You DO NOT need to stop TaskMan or the background filers. The following options need to be disabled for this patch: ENTER/EDIT BILLING INFORMATION [IB EDIT BILLING INFO] PROVIDER ID MAINTENANCE [IBCE PROVIDER MAINT] POST-INSTALLATION INSTRUCTIONS ------------------------------ After this patch has been installed, those with the "IB PROVIDER EDIT" security key (these individuals would have access to the PROVIDER ID MAINTENANCE option) must review their MailMan messages for the report that is generated as a result of this installation. The subject line of this email is: "**CLEAN-UP REPORT** - #200 to #355.93". INSTALLATION INSTRUCTIONS ========================= 1. LOAD TRANSPORT GLOBAL --------------------- Choose the PackMan message containing this patch and invoke the INSTALL/CHECK MESSAGE PackMan option. 2. START UP KIDS ------------- Start up the Kernel Installation and Distribution System Menu [XPD MAIN]: Edits and Distribution ... Utilities ... Installation ... 3. Select Kernel Installation & Distribution System Option: INStallation --------------------------------------------------------------------- Load a Distribution Print Transport Global Compare Transport Global to Current System Verify Checksums in Transport Global Install Package(s) Restart Install of Package(s) Unload a Distribution Backup a Transport Global 4. Select Installation Option: --------------------------- NOTE: The following are OPTIONAL - (When prompted for the INSTALL NAME, enter IB*2.0*436): a. Backup a Transport Global - This option will create a backup message of any routines exported with this patch. It will not backup any other changes such as DD's or templates. b. Compare Transport Global to Current System - This option will allow you to view all changes that will be made when this patch is installed. It compares all components of this patch (routines, DD's, templates, etc.). c. Verify Checksums in Transport Global - This option will allow you to ensure the integrity of the routines that are in the transport global. 5. Select Installation Option: Install Package(s) ---------------------------------------------- **This is the step to start the installation of this KIDS patch: a. Choose the Install Package(s) option to start the patch install. b. When prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install? YES//' answer NO c. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//' answer NO d. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//' answer YES (unless otherwise indicated). e. When prompted 'Enter options you wish to mark as 'Out Of Order':' Enter the following options: ENTER/EDIT BILLING INFORMATION [IB EDIT BILLING INFO] PROVIDER ID MAINTENANCE [IBCE PROVIDER MAINT] Routine Information: ==================== The second line of each of these routines now looks like: ;;2.0;INTEGRATED BILLING;**[Patch List]**;21-MAR-94;Build 31 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: IB20A436 Before: n/a After: B428203 **436** Routine Name: IB20P436 Before: n/a After: B74022170 **436** Routine Name: IBCBB11 Before: B25043010 After: B32717107 **51,343,363,371,395,392,401, 384,400,436** Routine Name: IBCCCB Before: B57002902 After: B81507982 **80,106,51,151,137,182,155,323,436** Routine Name: IBCEMU2 Before: B35260966 After: B50579600 **155,320,349,436** Routine Name: IBCEP6 Before: B19310181 After: B25055673 **137,232,320,377,436** Routine Name: IBCEP8 Before: B51555046 After:B118559850 **51,137,232,288,320,343,374, 377,391,400,436** Routine list of preceding patches: 323, 349, 400 ============================================================================= User Information: Entered By : WHITE,DARLENE Date Entered : JUN 04, 2010 Completed By: TJERNAGEL,STEVE Date Completed: JAN 25, 2011 Released By : CAULFIELD,MARY Date Released : JAN 26, 2011 ============================================================================= Packman Mail Message: ===================== $END TXT