$TXT Created by                       at DEVFEY.DOMAIN.EXT  (KIDS) on Friday, 07/14/17 at 16:19
=============================================================================
Run Date: APR 09, 2018                     Designation: FB*3.5*175
Package : FB - FEE BASIS                      Priority: Mandatory
Version : 3.5       SEQ #151                    Status: Released
                  Compliance Date: MAY 09, 2018
=============================================================================


Subject: PURCHASED CARE CLAIMS COMPLIANCE PHASE 4

Category: 
  - Data Dictionary
  - Enhancement (Mandatory)

Description:
============

 This effort is focused on providing Other Health Insurance (OHI) to users 
 of VistA Fee. This will be facilitated through a collaboration with DSS, 
 Inc. to transmit data from the central server located at the Health 
 Administration Center (HAC) through Fee Basis Claims System (FBCS) and 
 into the local facility VistA Fee.
  
 The new database fields introduced by the patch are going to be used by 
 FBCS application that will be modified by DSS. New FBCS functionality will
 make OHI data available for VA users on its Graphical User Interface (GUI)
 screens.
  
 This patch implements the MUMPS database portion of the project.
  
  
 Patch Components:
 -----------------
 N/A
  
 Files & Fields Associated:
  
  
 File Name (Number)            Field Name (Number)     New/Modified/Deleted
 ----------------------------  ----------------------  --------------------
 Subfile SERVICE PROVIDED
 (#162.03)  
                               OHI OTHER SUBSCRIBER INFO (#70)          New
                               OHI SERVICE LINE INFO (#71)              New
  
 Subfile OHI OTHER SUBSCRIBER 
 INFO (#162.09) 
                               PAYER RESP SEQUENCE CODE (#.01)          New
                               INDIVIDUAL RELATIONSHIP CODE (#.02)      New
                               INSURED GROUP OR POL NUMBER (#.03)       New
                               OTHER INSUR GROUP NAME (#.04)            New
                               INSURANCE TYPE CODE (#.05)               New
                               CLAIM FILING INDICATOR CODE (#.06)       New
                               CLAIM LEVEL ADJUSTMENTS (#1)             New
                               COB PAYER PAID AMT QUAL CODE (#2.01)     New
                               COB PAYER PAID AMOUNT (#2.02)            New
                               REMAIN PAT LIAB AMT QUAL CODE (#3.01)    New
                               REMAIN PAT LIAB AMOUNT (#3.02)           New
                               COB TOT NON-COV AMT QUAL CODE (#4.01)    New
                               COB TOT NON-COV AMOUNT (#4.02)           New
                               OTH INS BENEF ASSIGN CERT INFO (#5.01)   New
                               OTH INS PAT SIGNAT SOURCE CODE (#5.02)   New
                               OTH INS ROI CODE (#5.03)                 New
                               INP ADJ QUANT COV DAYS VIS CNT (#6.01)   New
                               INP ADJ LIFETIME PSYCH CNT (#6.02)       New
                               INP ADJ REM PAT LIAB AMOUNT (#6.03)      New
                               INP ADJ REF ID-REM CODE MIA05 (#6.04)    New
                               INP ADJ AMT-CLM DISPR SHARE (#6.05)      New
                               INP ADJ AMT-CLM MSP PASS (#6.06)         New
                               INP ADJ AMT-CLM PPS CAPITAL (#6.07)      New
                               INP ADJ AMT-PPS CAP FSP DRG (#6.08)      New
                               INP ADJ AMT-PPS CAP HSP DRG (#7.01)      New
                               INP ADJ AMT-PPS CAP DSH DRG (#7.02)      New
                               INP ADJ AMT-OLD CAPITAL AMN (#7.03)      New
                               INP ADJ AMT-PPS CAPIT IME AMT (#7.04)    New
                               INP ADJ AMT-PPS OPER HOSP DRG (#7.05)    New
                               INP ADJ COST REPORT DAY COUNT (#7.06)    New
                               INP ADJ AMT-PPS OP FED SPE DRG (#7.07)   New
                               INP ADJ AMT-CLM PPS CAPIT OUTL (#7.08)   New
                               INP ADJ AMT-CLM INDIR TEACHING (#7.09)   New
                               INP ADJ AMT-NON-PAY PROF BILLD (#7.1)    New
                               INP ADJ REF ID-REM CODE MIA20 (#8.01)    New
                               INP ADJ REF ID-REM CODE MIA21 (#8.02)    New
                               INP ADJ REF ID-REM CODE MIA22 (#8.03)    New
                               INP ADJ REF ID-REM CODE MIA23 (#8.04)    New
                               INP ADJ AMT-PPS CAPITAL EXCEPT (#8.05)   New
                               OUTP ADJ REIMBURSE RATE (#9.01)          New
                               OUTP ADJ HCPCS PAYABLE AMT (#9.02)       New
                               OUTP ADJ REF ID-REM COD MOA03 (#9.03)    New
                               OUTP ADJ REF ID-REM COD MOA04 (#9.04)    New
                               OUTP ADJ REF ID-REM COD MOA05 (#10.01)   New
                               OUTP ADJ REF ID-REM COD MOA06 (#10.02)   New
                               OUTP ADJ REF ID-REM COD MOA07 (#10.03)   New
                               OUTP ADJ ESRD PAYM AMT (#10.04)          New
                               OUTP ADJ NON PAY PROF BILLED (#10.05)    New
                               OTH SUB ENTITY ID CODE (#11.01)          New
                               OTH SUB ENTITY TYPE QUAL (#11.02)        New
                               OTH SUB LAST NAME (#11.03)               New
                               OTH SUB FIRST NAME (#11.04)              New
                               OTH SUB MIDDLE NAME (#11.05)             New
                               OTH SUB NAME SUFFIX (#11.06)             New
                               OTH SUB ID CODE QUAL (#11.07)            New
                               OTH SUB INSURED ID (#11.08)              New
                               OTH SUB ADDR LINE 1 (#12.01)             New
                               OTH SUB ADDR LINE 2 (#12.02)             New
                               OTH SUB CITY NAME (#12.03)               New
                               OTH SUB STATE CODE (#12.04)              New
                               OTH SUB POSTAL ZIP (#12.05)              New
                               OTH SUB COUNTRY CODE (#12.06)            New
                               OTH SUB COUNTRY SUBDIV CODE (#12.07)     New
                               OTH SUB 2ND ID REF QUAL 1 (#13.01)       New
                               OTH SUB 2ND ID-ADDTNL ID 1 (#13.02)      New
                               OTH SUB 2ND ID REF QUAL 2 (#13.03)       New
                               OTH SUB 2ND ID-ADDTNL ID 2 (#13.04)      New
                               OTH PAYER ENTITY ID CODE (#14.01)        New
                               OTH PAYER ENTITY TYPE QUAL (#14.02)      New
                               OTH PAYER LAST OR ORG NAME (#14.03)      New
                               OTH PAYER ID CODE QUALIFIER (#14.04)     New
                               OTH PAYER PRIMARY IDENTIFIER (#14.05)    New
                               OTH PAYER ADDR LINE 1 (#15.01)           New
                               OTH PAYER ADDR LINE 2 (#15.02)           New
                               OTH PAYER CITY NAME (#15.03)             New
                               OTH PAYER STATE CODE (#15.04)            New
                               OTH PAYER POSTAL ZIP (#15.05)            New
                               OTH PAYER COUNTRY CODE (#15.06)          New
                               OTH PAYER COUNTRY SUBDIV CODE (#15.07)   New
                               OTH PAYER DATE TIME QUAL (#16.01)        New
                               OTH PAYER DTIME PER FORM QUAL (#16.02)   New
                               OTH PAYER ADJ OR PAYMENT DATE (#16.03)   New
                               OTH PAYER 2ND REF ID QUAL 1 (#17.01)     New
                               OTH PAYER 2NDARY ID 1 (#17.02)           New
                               OTH PAYER 2ND REF ID QUAL 2 (#17.03)     New
                               OTH PAYER 2NDARY ID 2 (#17.04)           New
                               OTH PAYER PR AUTH REF ID QUAL (#17.05)   New
                               OTH PAYER PRIOR AUTH NUM (#17.06)        New
                               OTH PAYER REFFERL REF ID QUAL (#17.07)   New
                               OTH PAYER REFFERAL NUMBER (#17.08)       New
                               OTH PAYER CLM ADJ REF ID QUAL (#18.01)   New
                               OTH PAYER CLAIM ADJ INDICATOR (#18.02)   New
                               OTH PAYER CLM CTRL REF ID QUAL (#18.03)  New
                               OTH PAYER CLAIM CTRL NUMBER (#18.04)     New
  
 Subfile CLAIM LEVEL 
 ADJUSTMENTS  (#162.13) 
                               CLAIM ADJUSTMENT GROUP CODE (#.01)       New
                               ADJ REASON CODE 1 (#1.01)                New
                               ADJ REASON CODE 2 (#1.02)                New
                               ADJ REASON CODE 3 (#1.03)                New
                               ADJ REASON CODE 4 (#1.04)                New
                               ADJ REASON CODE 5 (#1.05)                New
                               ADJ REASON CODE 6 (#1.06)                New
                               ADJ AMOUNT 1 (#2.01)                     New
                               ADJ AMOUNT 2 (#2.02)                     New
                               ADJ AMOUNT 3 (#2.03)                     New
                               ADJ AMOUNT 4 (#2.04)                     New
                               ADJ AMOUNT 5 (#2.05)                     New
                               ADJ AMOUNT 6 (#2.06)                     New
                               ADJ QUANTITY 1 (#3.01)                   New
                               ADJ QUANTITY 2 (#3.02)                   New
                               ADJ QUANTITY 3 (#3.03)                   New
                               ADJ QUANTITY 4 (#3.04)                   New
                               ADJ QUANTITY 5 (#3.05)                   New
                               ADJ QUANTITY 6 (#3.06)                   New
  
 Subfile OHI SERVICE LINE INFO
 (#162.371) 
                               SERVICE LINE NUMBER (#.01)               New
                               LINE ADJUDICATION INFORMATION (#1)       New
  
 Subfile LINE ADJUDICATION 
 INFORMATION (#162.3711) 
                               OTHER PRIMARY PAYER ID (#.01)            New
                               SERVICE LINE PAID AMT (#.02)             New
                               PROD OR SERV ID QUAL (#1.01)             New
                               PROCEDURE CODE (#1.02)                   New
                               PROC MODIF SVD03-3 (#1.03)               New
                               PROC MODIF SVD03-4 (#1.04)               New
                               PROC MODIF SVD03-5 (#1.05)               New
                               PROC MODIF SVD03-6 (#1.06)               New
                               PROC CODE DESCRIPTION (#1.07)            New
                               PRODUCT OR SERV ID (#1.08)               New
                               PAID SERV UNIT CNT (#1.09)               New
                               BUNDL OR UNBUNDL LINE NUM (#1.1)         New
                               LINE ADJUSTMENT (#2)                     New
                               LN CHK DATE TIME QUALIFIER (#3.01)       New
                               LN CHK DATE TIME PER FORM QUAL (#3.02)   New
                               LN CHK ADJ OR PAYMENT DATE (#3.03)       New
                               REMAIN PAT LIAB AMT QUAL CODE (#4.01)    New
                               REMAIN PAT LIABILITY AMOUNT (#4.02)      New
  
 Subfile LINE ADJUSTMENT 
 (#162.37112) 
                               CLAIM ADJUSTMENT GROUP CODE (#.01)       New
                               ADJ REASON CODE 1 (#1.01)                New
                               ADJ REASON CODE 2 (#1.02)                New
                               ADJ REASON CODE 3 (#1.03)                New
                               ADJ REASON CODE 4 (#1.04)                New
                               ADJ REASON CODE 5 (#1.05)                New
                               ADJ REASON CODE 6 (#1.06)                New
                               ADJ AMOUNT 1 (#2.01)                     New
                               ADJ AMOUNT 2 (#2.02)                     New
                               ADJ AMOUNT 3 (#2.03)                     New
                               ADJ AMOUNT 4 (#2.04)                     New
                               ADJ AMOUNT 5 (#2.05)                     New
                               ADJ AMOUNT 6 (#2.06)                     New
                               ADJ QUANTITY 1 (#3.01)                   New
                               ADJ QUANTITY 2 (#3.02)                   New
                               ADJ QUANTITY 3 (#3.03)                   New
                               ADJ QUANTITY 4 (#3.04)                   New
                               ADJ QUANTITY 5 (#3.05)                   New
                               ADJ QUANTITY 6 (#3.06)                   New
  
  
  
 Forms Associated:
  
 Form Name   File #    New/Modified/Deleted
 ---------    ------    --------------------
 N/A
  
 Mail Groups Associated:
  
 Mail Group Name    New/Modified/Deleted
 ---------------    --------------------
 N/A
  
 Options Associated:
  
 Mail Group Name    New/Modified/Deleted
 ---------------    --------------------
 N/A
  
 Options Associated:
  
 Option Name    Type    New/Modified/Deleted
 -----------    ----    --------------------
 N/A
  
 Protocols Associated:
  
 Protocol Name    New/Modified/Deleted
 -------------    --------------------
 N/A
  
 Security Keys Associated:
  
 Security Key Name
 -----------------
 N/A
  
 Templates Associated:
  
 Template Name    Type    File Name (Number)  New/Modified/Deleted
 -------------    ----     ------------------ --------------------
 N/A
  
 Additional Information:
 N/A
  
  
 New Service Requests (NSRs):
 ----------------------------
 N/A
  
 Patient Safety Issues (PSIs):
 -----------------------------
 N/A
  
 Defect Tracking System Ticket(s) & Overview:
 --------------------------------------------
 N/A
  
 Problem:
 --------
 N/A
  
 Resolution:
 -----------
 N/A
  
 Test Sites:
 -----------
 New Orleans
 Minneapolis
  
  
 Software and Documentation Retrieval Instructions:
 -------------------------------------
 The software is distributed in the PackMan message generated from the
 National Patch Module on Forum. Documentation describing new 
 functionality introduced by this patch is available.
  
 Sites may retrieve documentation directly using Secure File Transfer 
 Protocol (SFTP) from the ANONYMOUS.SOFTWARE directory at the following 
 OI Field Offices:
  
 Hines:          domain.ext  
 Salt Lake City: domain.ext
  
 Documentation can also be found on the VA Software Documentation Library
 at: https://www.domain.ext/vdl/
  
 Title                                     File Name             FTP Mode
 ------------------------------------------------------------------------
 FB*3.5*175 Release Notes                  FB_3_5_P175_RN.pdf    binary
 FB*3.5*175 Deployment, Installation,      FB_3_5_P175_IG.pdf    binary
 Back-Out, and Rollback Guide
  
  
 Patch Installation:
  
  
 Pre/Post Installation Overview
 ------------------------------
  
 There are no Pre/Post installation routine processes.
  
  
 Pre-Installation Instructions
 -----------------------------
 This patch may be installed with users on the system although it is 
 recommended that it be installed during non-peak hours to minimize
 potential disruption to users.  This patch should take less than 
 5 minutes to install.
  
  
 Installation Instructions
 -------------------------
 1.  Choose the PackMan message containing this patch.
  
 2.  Choose the INSTALL/CHECK MESSAGE PackMan option.
  
 3.  From the Kernel Installation and Distribution System Menu, select
     the Installation Menu.  From this menu, use the
     following option. When prompted for the INSTALL enter the patch #
     (FB*3.5*175):
  
     a. 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.).
  
 4.  From the Installation Menu, select the Install Package(s) option and
     choose the patch to install. Enter FB*3.5*175.
  
 5.  If prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of  
     Install? NO//', respond NO.
  
 6.  When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//',
     respond NO.
  
 7.  When prompted 'Want to DISABLE Scheduled Options, Menu Options, and
     Protocols? NO//', respond NO.
  
 8.  If prompted 'Delay Install (Minutes):  (0 - 60): 0//', respond 0.
  
 Post-Installation Instructions
 ------------------------------
 N/A
  
 Back-Out Plan:
 -------------------
 See FB_3_5_P175_IG install guide for detailed Back-Out instructions.
  

Routine Information:
====================
No routines included.

=============================================================================
User Information:
Entered By  :                               Date Entered  : JAN 12, 2017
Completed By:                               Date Completed: APR 04, 2018
Released By :                               Date Released : APR 09, 2018
=============================================================================


Packman Mail Message:
=====================

$END TXT