$TXT Created by HARPER,AMY R at DEVFEX.FO-ALBANY.MED.VA.GOV (KIDS) on Friday, 06/05/09 at 10:10 ============================================================================= Run Date: JUL 09, 2009 Designation: IB*2*399 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #380 Status: Released Compliance Date: AUG 09, 2009 ============================================================================= Associated patches: (v)IB*2*238 <<= must be installed BEFORE `IB*2*399' (v)IB*2*364 <<= must be installed BEFORE `IB*2*399' (v)IB*2*377 <<= must be installed BEFORE `IB*2*399' (v)IB*2*384 <<= must be installed BEFORE `IB*2*399' (v)IB*2*405 <<= must be installed BEFORE `IB*2*399' Subject: REASONABLE CHARGES ENHANCEMENTS II Category: - Routine - Data Dictionary - Input Template - Enhancement (Mandatory) Description: ============ This patch contains several updates to Integrated Billing for billable event processing and reports related to billing Reasonable Charges. No charges are updated or exported with this patch. New Reasons Not Billable and updates to Insurance Timely Filing Timeframe with supporting Claims Tracking functionality are the primary updates. UPDATE REASON NOT BILLABLE LIST =============================== The Reasons Not Billable (RNB) list is a standard set of reasons that may be assigned to an event in Claims Tracking to specify why the event is not billable. This list, exported by Integrated Billing, should not be locally modified. CLAIMS TRACKING NON-BILLABLE REASONS file (#356.8) There are significant changes to the list of Reasons Not Billable, both Reasons added and functionality changes. Note that this patch will modify the definition of Reasons Not Billable. Currently these are either reasons the event should not be billed (SC TREATMENT) or indicators that the event is not currently billable but may be if further work is done on the event (NEEDS SC DETERMINATION). This patch will add reasons indicating that although the event is only partially charged it has been billed in full (BILLED INSTITUTIONAL ONLY). STANDARD REASONS NOT BILLABLE ----------------------------- The list of Reasons Not Billable is standard and should not be locally modified. This patch will check each site to ensure that the standard list of Reasons are defined. Any missing RNBs will be identified during the patch installation. See the updated RNB list below for the 39 valid pre-patch standard Reasons Not Billable. INACTIVATE NON-STANDARD REASONS NOT BILLABLE -------------------------------------------- The list of Reasons Not Billable is standard and should not be locally modified. In addition, since many new RNBs will be added it is possible that locally added RNBs may duplicate new standard RNBs. Therefore this patch will check each sites system to ensure that only the standard list of Reasons exist. Any non-standard or locally modified RNBs found will be Inactivated and their ECME usage flags cleared so those RNBs will no longer be usable. Any RNBs inactivated will be identified during the patch installation. INACTIVATE STANDARD REASONS NOT BILLABLE ---------------------------------------- The ability to Inactivate a Reason Not Billable has been added. To accommodate inactivating RNBs a new field, INACTIVE (.05), was added to the CLAIMS TRACKING NON-BILLABLE REASONS file (#356.8). When a Reason Not Billable is entered for a Claims Tracking event an RNB with the Inactive flag set will not be selectable. Several existing RNBs will be inactivated and no longer available for use. Generally, these reasons are no longer applicable or were replaced by more specific reasons: SERVICE NOT COVERED BILL PURGED INSUFFICIENT DOCUMENTATION NON-BILLABLE PROVIDER (RESID.) NON-BILLABLE PROVIDER (OTHER) During the patch installation these 5 RNBs have their Inactive flag set and their ECME flags cleared. REASONS NOT BILLABLE FOR ECME PAPER PROCESSING ---------------------------------------------- At the request of the ePharmacy group two Reasons Not Billable have been changed for ECME. Two RNBs that currently identify Non-Billable prescriptions that may be billed on paper have been modified to remove the paper billing option: 90 DAY RX FILL NOT COVERED NOT A CONTRACTED PROVIDER These 2 Reasons Not Billable will no longer result in the Prescription being prompted to be billed on paper. The ECME PAPER FLAG (.03) in the CLAIMS TRACKING NON-BILLABLE REASONS file (#356.8) for the 2 RNBs is set to No during the post installation. ADD REASONS NOT BILLABLE CODE ----------------------------- A Code has been added to Reasons Not Billable to group and uniquely identify each RNB. The code will allow consistent identification and grouping of RNBs for display. To accommodate this a new CODE (.04) field was added to the CLAIMS TRACKING NON-BILLABLE REASONS file (#356.8). A Code for all RNBs, new and existing, will be added during the post installation of this patch. Code = Group_# where groups are the following: BL - Reasons related to Billing CV - Reasons related to Coverage or Insurance DC - Reasons related to Documentation MC - Miscellaneous MN - Reasons related to Medical Necessity RX - Reasons specific to Pharmacy VA - Reasons specific to the VA See the list below for the Code added for each Reasons Not Billable. Note that the RNB of OTHER will still be available and active but since its use should be minimized it will have no Code assigned. OTHER should only be used when there is no other more accurate RNB. ADD NEW REASONS NOT BILLABLE ---------------------------- Many new Reasons Not Billable will be added with this patch. The purpose is to provide RNBs for many of the circumstance found in billing and in some cases to be more specific than existing RNBs. See below for the list of all 58 new Reasons Not Billable. CLAIMS TRACKING - Map Reasons Not Billable to Care Provided =========================================================== When events are added to Claims Tracking a Reason Not Billable may automatically be added. This has been updated to assign more specific Reasons if available. Outpatient and Prescription Coverage ------------------------------------ For patients that have insurance but not insurance that covers a specific type of care the Reason Not Billable of SERVICE NOT COVERED has been used. This generic RNB is being replaced by the new RNBs corresponding to the type of care: - The new RNB of NO OUTPATIENT COVERAGE will be used for outpatient care. - The new RNB of NO PHARMACY COVERAGE will be used for Prescriptions - note that this option will become active with the installation of IB*2*384 - ePHARMACY ENHANCEMENTS. Dental Coverage --------------- Although it has been possible to set Dental Coverage for insurance this has been informational only. Dental care has been identified and processed as Outpatient care even though it was possible to set Dental Coverage. This has been updated to identify Dental care with Stop Code 180. So Dental has been separated from the general Outpatient care and the Dental Coverage assigned to an insurance will now be applied. - The new RNB of NO DENTAL COVERAGE will be used for Outpatient events associated with Stop Code 180. Research Appointments --------------------- Several Appointment Types are not billable, including Research, and are assigned the Reason Not Billable of NON-BILLABLE APPOINTMENT TYPE. However there is a more specific RNB for Research that will now be used. - The RNB of RESEARCH VISIT will be used for Research appointments. CLAIMS TRACKING - Reason Not Billable and Additional Comments ============================================================= There are two cases where requirements for Additional Comments have been added based on the Reason Not Billable assigned to an event. Both of the following requirements have been added: - when an RNB is added to an event in Claims Tracking - when a bill is cancelled and RNBs are added to the associated events Reason Not Billable of OTHER ---------------------------- When the Reason Not Billable of OTHER is assigned to a Claims Tracking event it will now require a Comment added of at least 15 characters. Reason Not Billable of GLOBAL SURGERY ------------------------------------- When the new Reason Not Billable of Global Surgery is assigned to an event the related surgery date will be asked and appended to the Additional Comment as: 'Global Surgery: xx/xx/xx'. INSURANCE - Long Term Care Coverage =================================== Coverage limitations (CV) and Riders have been updated to include Long Term Care. This is informational only. New PLAN LIMITATION CATEGORY (#355.31): LONG TERM CARE New INSURANCE RIDERS (#355.6): LONG TERM CARE COVERAGE Note that the Long Term Care Plan Limitation will default to Yes - Covered for all existing Insurance Plans. INSURANCE - Standard Filing Time Frame ====================================== The insurance filing time frame is the amount of time from the date of service an insurance company or plan allows before submission of a claim. It is currently possible to identify a filing time frame for both Insurance Companies and Group Plans however these are free text fields that are informational only, they do not affect the processing of events. A Standard Filing Time Frame has been added to both Companies and Plans to automatically identify events past their filing time frame. The existing free text Filing Time Frame will continue to be available for additional related information or those cases where no Standard Filing Time Frame applies. A new INSURANCE FILING TIME FRAME (#355.13) file of Standard Filing Time Frames is created, all are relative to the Date of Service: DAYS Value - YES MONTH(S) Value - YES YEAR(S) Value - YES DAYS PLUS ONE YEAR Value - YES DAYS OF FOLLOWING YEAR Value - YES MONTHS OF FOLLOWING YEAR Value - YES END OF FOLLOWING YEAR Value - NO NO FILING TIME FRAME LIMIT Value - NO Where VALUE indicates a numeric value is required to fully identify the time frame. For example, DAYS the value required is the number of days. A Standard Filing Time Frame of 45 DAYS indicates the insurer will accept claims submitted within 45 days of the Date of Service and therefore events beyond that date should be considered as non-billable. Two new fields are added to both the Insurance Company and the Group Plan: INSURANCE COMPANY, STANDARD FTF (#36, .18) INSURANCE COMPANY, STANDARD FTF VALUE (#36, .19) GROUP INSURANCE PLAN, PLAN STANDARD FTF (#355.3, .16) GROUP INSURANCE PLAN, PLAN STANDARD FTF VALUE (#355.3, .17) It is not expected that this Standard Filing Time Frame will cover all possible time frames and is therefore optional. The free text Filing Time Frame currently existing will continue to be available for filing time frame related comments. When the Company and Plan information is edited these fields will be asked. For example, for a 6 month time frame the Standard Filing Time Frame would be MONTH(S) and the VALUE would be 6. The longest possible time frame should be used to ensure potential billables are not lost. STANDARD FILING TIME FRAME: DAYS// STANDARD FILING TIME FRAME VALUE: 30// 60 FILING TIME FRAME: 60 Days Paper, 30 Electronic When displayed on the various insurance information screens and reports, the Standard Filing Time Frame, if set for an insurance, will be displayed next to the free text Filing Time Frame and in parentheses: Filing Time Frame: 60 Days Paper, 30 Electronic (60 DAYS) When Outpatient events are added to Claims Tracking this Standard Filing Time Frame will be evaluated. If the event date is not within the range then the Reason Not Billable of FILING TIMEFRAME NOT MET will be added to the entry. Applying a Patient's Standard Filing Time Frame ----------------------------------------------- The Standard Filing Time Frame is used when adding Outpatient events to Claims Tracking to identify those events outside a patient's insurance filing time frame. These events are added to Claims Tracking with a Reason Not Billable of FILING TIMEFRAME NOT MET. To calculate a Patient's Filing Time Frame, each of the patient's active insurance plans will be evaluated: - If the Plan has a Standard Filing Time Frame assigned then it will be used - If the Plan does not have a Standard Filing Time Frame assigned, then the Insurance Company Standard Filing Time Frame will be used, if defined. - Neither the Plan nor Company have a Standard Filing Time Frame assigned then for automated purposes the filing time frame will be unlimited. For a patient with multiple Insurance Plans the Patient's Filing Time Frame will be calculated as: - If all companies/plans have a Standard Filing Time Frame assigned then the patient's Filing Time Frame will be the longest available. - If any of the companies/plans does not have a Standard Filing Time Frame or one has been assigned NO FILING TIME FRAME LIMIT then the patient has an unlimited Filing Time Frame and no events identified as non-billable. Only active Companies/Plans and Medicare (WNR) will be used to calculate a patient's Filing Time Frame. Medicare is included because in some cases, such as Supplemental or Secondary, an insurance company may allow their time frame to be based on the date of submission to Medicare (MRA) rather than the date of service. The nightly task that adds Outpatient Events to Claims Tracking will calculate the Patient's Filing Time Frame and if an event is outside that time frame it will assign the Reason Not Billable FILING TIMEFRAME NOT MET. Standard Filing Time Frame Conversion ------------------------------------- When this patch is installed a conversion will be preformed to replace existing free text Filing Time Frames with Standard Filing Time Frames if they can be positively identified. - The company or plan must be active and not Medicare. - If a Standard Filing Time Frame is identified it is added and the free text Filing Time Frame is deleted. INSURANCE COMPANY (#36) FILING TIME FRAME (#36,.12) converted to -> STANDARD FTF (.18) STANDARD FTF VALUE (.19) GROUP INSURANCE PLAN (#355.3) PLAN FILING TIME FRAME (.13) converted to -> PLAN STANDARD FTF (.16) PLAN STANDARD FTF VALUE (.17) The free text Filing Time Frame converted must match the following: - 'nnn' is any number, the specific value of time relative to the FTF - '_' is a space or blank, '3years' and '3 years' both match '3 YEAR(S)' - free text is converted to upper case, '30Days' and '30days' both '30 DAYS' Free Text FTF Convert To Standard FTF Value nnn_D DAYS nnn nnn_DAYS DAYS nnn nnn_DAYS DOS DAYS nnn nnn_DAYS FROM DOS DAYS nnn nnn_M MONTH(S) nnn nnn_MO MONTH(S) nnn nnn_MOS MONTH(S) nnn nnn_MTHS MONTH(S) nnn nnn_MONTHS MONTH(S) nnn nnn_MO DOS MONTH(S) nnn nnn_MOS DOS MONTH(S) nnn nnn_MONTHS DOS MONTH(S) nnn nnn_MOS FROM DOS MONTH(S) nnn nnn_MONTHS FROM DOS MONTH(S) nnn nnn_YR YEAR(S) nnn nnn_YRS YEAR(S) nnn nnn_YEAR YEAR(S) nnn nnn_YEARS YEAR(S) nnn nnn_YR DOS YEAR(S) nnn nnn_YRS DOS YEAR(S) nnn nnn_YEAR DOS YEAR(S) nnn nnn_YEARS DOS YEAR(S) nnn nnn_YR FROM DOS YEAR(S) nnn nnn_YRS FROM DOS YEAR(S) nnn nnn_YEAR FROM DOS YEAR(S) nnn nnn_YEARS FROM DOS YEAR(S) nnn 3-31 FOL YR MONTHS OF FOLLOWING YEAR 3 3/31 FOL YR MONTHS OF FOLLOWING YEAR 3 3-31 FOLLOWING YR MONTHS OF FOLLOWING YEAR 3 3/31 FOLLOWING YR MONTHS OF FOLLOWING YEAR 3 3-31 FOLLOWING YEAR MONTHS OF FOLLOWING YEAR 3 3/31 FOLLOWING YEAR MONTHS OF FOLLOWING YEAR 3 12-31 FOL YR END OF FOLLOWING YEAR 12/31 FOL YR END OF FOLLOWING YEAR 12-31 FOLLOWING YR END OF FOLLOWING YEAR 12/31 FOLLOWING YR END OF FOLLOWING YEAR 12-31 FOLLOWING YEAR END OF FOLLOWING YEAR 12/31 FOLLOWING YEAR END OF FOLLOWING YEAR All other Filing Time Frames must be manually converted from free text to the standard set, if applicable. BILL/CLAIMS: ============ Skilled Nursing Facility Charges -------------------------------- Skilled Nursing Facility is identified on a bill and the corresponding SNF charges applied. However this was not working correctly for stays of 1 day. This has been updated for stays of 1 day identified as Skilled Nursing Facility will have the SNF charges applied. Procedure Revenue Code Links ---------------------------- It is possible to link particular procedures with the revenue code that should be billed. This function allows a range of procedures to be linked to a revenue code. However this linkage did not work correctly for HCPCS procedures. This has been corrected. REPORTS ======= Reasons Not Billable Report --------------------------- For the detailed printed RNB report the calculation of the Prosthetics and Prescription unbilled amounts were modified to more accurately reflect the true unbilled amounts. In particular, it takes into account any authorized insurance bills for the Claims Tracking event and subtracts from the unbilled amount. The Outpatient unbilled amount in the report was also modified to take into consideration any authorized insurance bills for the outpatient visit and subtracts it from the unbilled amount from the Claims Tracking event. On the detailed version of the Excel and printed report any Third Party bill that could be associated with the Claims Tracking Event was added under the Related Bill column for Prescription and Prosthetics portion of the report. For the Inpatient and Outpatient portions related bills were added under the "Comments". On both the Excel and printed detailed report the new reason not billable a "Next Admission" date line was added if an outpatient Claims Tracking event has a "72 hour rule" reason not billable. This "Next Admission" line contains the next admission for the patient if one exists On the Detailed Version of the Excel report the SSN field was changed to only show the last four digits of the SSN. Also, an Insurance Company field was added to the report which the denotes patient's primary insurance. Reasons Not Billable Report [IBJD REASONS NOT BILLABLE] Unbilled Report --------------- The outpatient amount on this report was modified to more accurately reflect the unbilled amount for an outpatient Claims Tracking event. In particular when the two component charges (Institutional and Professional) are combined into one charge on a bill or when the two charges are included in two separated bills. Re-Generate Unbilled Amounts Report [IBT RE-GEN UNBILLED REPORT] This patch addresses the following New Service Request (NSR): ------------------------------------------------------------- 20070541 Reasonable Charges Billing Enhancement This patch addresses the following NOIS/Remedy Ticket(s): --------------------------------------------------------- There is no NOIS/Remedy tickets associated with this patch. Components Sent With Patch =========================== The following is a list of Files and Fields included in this patch: UP SEND DATA USER DATE SEC. COMES SITE RSLV OVER FILE # FILE NAME DD CODE W/FILE DATA PTRS RIDE --------------------------------------------------------------------------- 36 INSURANCE COMPANY YES NO NO NO Partial DD: subDD: 36 fld: .18 fld: .19 355.13 INSURANCE FILING TIME FRAME YES YES NO 355.3 GROUP INSURANCE PLAN YES NO NO NO Partial DD: subDD: 355.3 fld: .16 fld: .17 356 CLAIMS TRACKING YES NO NO NO Partial DD: subDD: 356 fld: .19 356.8 CLAIMS TRACKING NON-BILLABLE REASONS YES NO NO NO 362.5 IB BILL/CLAIMS PROSTHETICS YES NO NO NO Partial DD: subDD: 362.5 fld: .04 File Name (Number) Field Name (Number) ------------------ ------------------- INSURANCE COMPANY (#36) STANDARD FTF (.18) New field to identify the Insurance Company Standard Filing Time Frame INSURANCE COMPANY (#36) STANDARD FTF VALUE (.19) New field to identify the Insurance Company Standard Filing Time Frame Value #355.13 INSURANCE FILING TIME FRAME New file, contains the list of all Standard Time Frames GROUP INSURANCE PLAN (#355.3) PLAN STANDARD FTF (.16) New field to identify the Group Plan Standard Filing Time Frame GROUP INSURANCE PLAN (#355.3) PLAN STANDARD FTF VALUE (.17) New field to identify the Group Plan Standard Filing Time Frame Value CLAIMS TRACKING (#356) REASON NOT BILLABLE (.19) Update field, added ability to screen out any Inactive RNB from selection CLAIMS TRACKING NON-BILLABLE REASONS (#356.8) Update file, this file has two new fields added (.04, .05), both are also added as Identifiers. Sending the fields only will not export the Identifier information. Therefore the Full DD is exported with this patch to add the identifiers and the two new fields. CLAIMS TRACKING NON-BILLABLE REASONS (#356.8) CODE (.04) New field to contain a code to uniquely identify an RNB CLAIMS TRACKING NON-BILLABLE REASONS (#356.8) INACTIVE (.05) New field to identify the RNBs that are inactive and no longer available IB BILL/CLAIMS PROSTHETICS (#362.5) RECORD (.04) Cross reference "AE" added to field for searching items. The following is a list of templates included in this patch: Template Name Type File Name (Number) ------------- ---- ------------------ IBT BILLING INFO Input CLAIMS TRACKING (#356) Update Addt Comments IBT QUICK EDIT Input CLAIMS TRACKING (#356) Update Addt Comments IBEDIT INS CO1 Input INSURANCE COMPANY (#36) Add Standard FTF Test Sites: ----------- Bay Pines, FL Memphis, TN Montana HCS Portland, OR Pre/Post Installation Overview ------------------------------ The following are completed by the Post Installation: 1. Add new Insurance Rider LONG TERM CARE COVERAGE (#355.6) 2. Add new Plan Limitation Coverage LONG TERM CARE (#355.31) 3. Add 8 standard entries to Insurance Filing Time Frame file (#355.13) 4. Convert free text Filing Time Frames to Standard Filing Time Frames 5. Check for the 39 Standard Reasons Not Billable (#356.8) 6. Inactivate Active Non-Standard Reasons Not Billable (#356.8,.05) 7. Inactivate 5 Active Standard Reasons Not Billable (#356.8,.05) 8. Reset 2 Reason Not Billable ECME Paper Flags (#356.8,.03) 9. Add Code to 33 Existing RNBs (#356.8,.04) 10. Add 58 New Reasons Not Billable (#356.8) 11. Run AE cross reference on IB BILL/CLAIMS PROSTHETICS, RECORD (#362.5,.04) ===================== INSTALLATION INSTRUCTIONS ===================== If installed during the normal workday, it is recommended that the following selection(s) in the OPTION (#19) file, and all of their descendants be disabled to prevent possible conflicts while running the KIDS Install. Other VISTA users will not be affected. Insurance Company Entry/Edit [IBCN INSURANCE CO EDIT] Patient Insurance Info View/Edit [IBCN PATIENT INSURANCE] Enter/Edit Billing Information [IB EDIT BILLING INFO] Cancel Bill [IB CANCEL BILL] Manually Add Opt. Encounters to Claims Tracking [IBT SUP MANUALLY QUE ENCTRS] Claims Tracking Edit [IBT EDIT TRACKING ENTRY] Install Time - less than 30 minutes ******************** PRE-INSTALLATION INSTRUCTIONS ******************** The post-init of this patch converts the existing Filing Time Frame to a Standard Filing Time Frame for both the Insurance (#36) and Group Insurance Plan (#355.3). If an exact match is found then the Standard Filing Time Frame is added and the existing free text Filing Time Frame is deleted. The following two FileMan searches may be run before the patch installation to have available the pre-patch Filing Time Frames in case of questions concerning this conversion after the patch. These searches print the insurance and their Filing Time Frame before the patch and therefore before the conversion. Since the results might be very lengthy (thousands of entries) it is suggested the results be saved as a file rather than printed. 132 width Search for Insurance Companies (#36) with Filing Time Frame (FM) Select OPTION: SEARCH FILE ENTRIES OUTPUT FROM WHAT FILE: INSURANCE COMPANY// 36 INSURANCE COMPANY -A- SEARCH FOR INSURANCE COMPANY FIELD: FILING TIME FRAME -A- CONDITION: 'NULL -B- SEARCH FOR INSURANCE COMPANY FIELD: IF: A// FILING TIME FRAME NOT NULL STORE RESULTS OF SEARCH IN TEMPLATE: SORT BY: NAME// START WITH NAME: FIRST// FIRST PRINT FIELD: NAME THEN PRINT FIELD: NUMBER THEN PRINT FIELD: STREET ADDRESS [LINE 1];L20 THEN PRINT FIELD: FILING TIME FRAME THEN PRINT FIELD: Heading (S/C): INSURANCE COMPANY SEARCH Replace Search for Insurance Group Plans (#355.3) with Plan Filing Time Frame (FM) Select OPTION: SEARCH FILE ENTRIES OUTPUT FROM WHAT FILE: GROUP INSURANCE // 355.3 GROUP INSURANCE PLAN -A- SEARCH FOR GROUP INSURANCE PLAN FIELD: PLAN FILING TIME FRAME -A- CONDITION: 'NULL -B- SEARCH FOR GROUP INSURANCE PLAN FIELD: IF: A// PLAN FILING TIME FRAME NOT NULL STORE RESULTS OF SEARCH IN TEMPLATE: SORT BY: NUMBER// INSURANCE COMPANY START WITH INSURANCE COMPANY: FIRST// WITHIN INSURANCE COMPANY, SORT BY: FIRST PRINT FIELD: INSURANCE COMPANY THEN PRINT FIELD: GROUP NAME THEN PRINT FIELD: GROUP NUMBER THEN PRINT FIELD: NUMBER THEN PRINT FIELD: PLAN FILING TIME FRAME THEN PRINT FIELD: Heading (S/C): GROUP INSURANCE PLAN SEARCH Replace *********************************************************************** 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 ... 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 Select Installation Option: 3. Select Installation Option: --------------------------- NOTE: The following are OPTIONAL - (When prompted for the INSTALL NAME, enter IB*2*399): 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. 4. 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. When prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install? YES//' Answer YES unless your system does this in a nightly TaskMan process. b. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//' answer NO c. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//' answer YES d. When prompted 'Enter options you wish to mark as 'Out Of Order':' Enter the following options: Insurance Company Entry/Edit [IBCN INSURANCE CO EDIT] Patient Insurance Info View/Edit [IBCN PATIENT INSURANCE] Enter/Edit Billing Information [IB EDIT BILLING INFO] Cancel Bill [IB CANCEL BILL] Manually Add Opt. Encounters to Claims Tracking [IBT SUP MANUALLY QUE ENCTRS] Claims Tracking Edit [IBT EDIT TRACKING ENTRY] e. When prompted 'Enter protocols you wish to mark as 'Out Of Order':' press . 5. Clean-up Post-Init Routine -------------------------- Optional - Once this patch has been successfully installed you may delete the 5 post-init routines: IBY399P* ******************* POST-INSTALLATION INSTRUCTIONS ******************* Check the install file to ensure all the data updates in the post-init were completed successfully. An example is given below. In particular, there are two sections that may indicate some post install actions are required. Potential Post Install Actions: A. >> Check for the 39 Standard Reasons Not Billable (#356.8)... If there are any Reasons Not Billable listed in this section then your site does not have all the standard Reasons Not Billable. Contact EPS for assistance. B. >> Inactivate Any Active Non-Standard Reasons Not Billable (#356.8,.05) If there are any Reasons Not Billable listed in this section contact your MCCR staff to inform them these will no longer be available. Below is an example of the Post-init if the site has no local modifications to their Reasons Not Billable. Note the new NON COVERED DRUG PER PLAN and NO PHARMACY COVERAGE RNBs are being exported by both this patch and IB*2*384 ePHARMACY ENHANCEMENTS. The first patch installed will add the RNB, if it already exists when this patch is installed then it will be recognized as existing and only the Code field will be updated. IB*2*399 Post-Install ..... >> LONG TERM CARE COVERAGE Insurance Rider (#355.6) added >> LONG TERM CARE Plan Limitation Category (#355.31) added >> Add 8 Standard Filing Time Frames (#355.13)... DAYS added MONTH(S) added YEAR(S) added DAYS PLUS ONE YEAR added DAYS OF FOLLOWING YEAR added MONTHS OF FOLLOWING YEAR added END OF FOLLOWING YEAR added NO FILING TIME FRAME LIMIT added Updated: 8 of 8 New FTFs Added >> Insurance Companies (#36) Converted to Standard Filing Time Frames, 951 >> Insurance Plan (#355.3) Converted to Standard Filing Time Frames, 8476 >> Check for the 39 Standard Reasons Not Billable (#356.8)... No Errors: All 39 Standard RNBs Found >> Inactivate Any Active Non-Standard Reasons Not Billable (#356.8,.05)... No Change: No Active Non-Standard RNBs Found >> Inactivate 5 Active Standard Reasons Not Billable (#356.8,.05)... SERVICE NOT COVERED has been inactivated BILL PURGED has been inactivated INSUFFICIENT DOCUMENTATION has been inactivated NON-BILLABLE PROVIDER (RESID.) has been inactivated NON-BILLABLE PROVIDER (OTHER) has been inactivated Updated: 5 of 5 RNBs Inactivated >> Reset 2 Reason Not Billable ECME Paper Flags (#356.8,.03)... 90 DAY RX FILL NOT COVERED ECME Paper Flag to No NOT A CONTRACTED PROVIDER ECME Paper Flag to No Updated: 2 of 2 RNB ECME Paper Flags Reset >> Add Code to 33 Existing RNBs (#356.8,.04)... NOT INSURED code added CV01 SC TREATMENT code added VA01 AGENT ORANGE code added VA02 IONIZING RADIATION code added VA03 SOUTHWEST ASIA code added VA04 COVERAGE CANCELED code added CV02 NEEDS SC DETERMINATION code added VA05 NON-BILLABLE APPOINTMENT TYPE code added MC01 INVALID PRESCRIPTION ENTRY code added RX01 REFILL ON VISIT DATE code added RX02 PRESCRIPTION DELETED code added RX03 PRESCRIPTION NOT RELEASED code added RX04 DRUG NOT BILLABLE code added RX05 HMO POLICY code added CV03 REFUSES TO SIGN RELEASE (ROI) code added MC02 NON-BILLABLE STOP CODE code added MC03 RESEARCH VISIT code added MC04 NON-BILLABLE CLINIC code added MC05 MILITARY SEXUAL TRAUMA code added VA06 CREDENTIALING ISSUE code added MC06 NO DOCUMENTATION code added DC01 OTHER COMPLIANCE code added MC07 OUT OF NETWORK (PPO) code added CV04 HEAD/NECK CANCER code added VA07 COMBAT VETERAN code added VA08 MRA REC'D. NO SEC RESP EXISTS code added CV05 MRA REC'D. SEC NOT BILLED code added CV06 90 DAY RX FILL NOT COVERED code added RX06 NOT A CONTRACTED PROVIDER code added RX07 INVALID MULTIPLES PER DAY SUPP code added RX08 REFILL TOO SOON code added RX09 INVALID NDC FROM CMOP code added RX10 PROJECT 112/SHAD code added VA09 Updated: 33 of 33 RNBs Code Set >> Add 58 New Reasons Not Billable (#356.8)... NON COVERED DRUG PER PLAN added FILING TIMEFRAME NOT MET added GLOBAL SURGERY added CHARGES SPLIT added PRE-CERT NOT OBTAINED added DUPLICATE ENCOUNTER added MEDICARE REPLACEMENT POLICY added COVERED BY MEDICARE AT 100% added BENEFITS MAXED added C&P EXAM/REGISTRY EXAM added TELEPHONE ENCOUNTER added NO TX PROVIDED/ADVICE ONLY added ROI NOT OBTAINED added UNSIGNED DOCUMENT added CONCURRENT CARE added 72 HOUR RULE added CUSTODIAL/RESIDENTIAL CARE added OBSERVATION-OP BILLED added BILLED INSTITUTIONAL ONLY added BILLED PROFESSIONAL ONLY added NO OUTPATIENT COVERAGE added NO INPATIENT COVERAGE added NO PHARMACY COVERAGE added NO DENTAL COVERAGE added NO MENTAL HEALTH COVERAGE added NO LTC COVERAGE added MED NEC-DX NOT COVERED added MED NEC-CPT NOT COVERED added MED NEC-LCD EDIT added MED NEC-OTHER added MEDICARE EXCLUDED SERVICE added RESIDENT SUPERVISION NOT MET added ANCILLARY PROVIDER AT CBOC added NON-COVERED PROVIDER added NO DIAGNOSIS/SYMPTOMS IN NOTE added NO CHIEF COMPLAINT added NOTE NOT WRITTEN TIMELY added NO PHYSICIAN ORDER added NO PLAN OF CARE added STUDENT NOTE ONLY added ALL BILLABLE CPT CODES BILLED added NO INPT PROF FEES BILLED added REPETITIVE SERVICES added PENDING CODE SET UPDATE added PENDING RC CHARGE UPDATE added NPI/TAXONOMY ISSUES added RX DUR REJECT added RX PRIOR AUTH NOT OBTAINED added RX MEDICARE PART D added RX DISCOUNT CARD added DATE OF BIRTH MISMATCH added NEW PT/NO HX added NEW PT/NO EXAM added NEW PT/NO COMPLEXITY added EST PT/NO HX/NO EXAM added EST PT/NO HX/NO COMPLEXITY added EST PT/NO EXAM/NO COMPLEXITY added NO VISION COVERAGE added Updated: 58 of 58 New RNBs Added >> Indexing new 'AE' xref IB BILL/CLAIMS PROSTHETICS, RECORD (#362.5,.04). IB*2*399 Post-Install Complete ********************************************************************** ******************** Reason Not Billable Updates ******************** Compiled list of all changes to the Reasons Not Billable. 1. 39 existing Standard Reasons Not Billable 2. Any Non-Standard Reasons Not Billable are Inactivated (none shown) 3. 5 Inactive Standard Reasons Not Billable (34 remaining active) 4. 2 Reason Not Billable ECME Paper Flags reset 5. 33 active existing Standard RNBs added Code (all except 1, OTHER) 6. 58 New Reasons Not Billable Added, with Code and ECME Flags After this patch there are a total of 92 active standard Reasons Not Billable. Note the Number (IEN) listed below may or may not correspond with the number at a site depending on patch installation order and local changes. Numbers (IEN) 72 and 90 are specifically skipped so if the Number is used for data entry then the RNBs with these IENs will not conflict with the two Reasons with names that begin with these numbers. CLAIMS TRACKING NON-BILLABLE REASONS LIST ECME ECME PAPER NUMBER NAME FLAG FLAG CODE INACTIVE ------------------------------------------------------------------------- 1 NOT INSURED YES NO CV01 2 SC TREATMENT VA01 3 AGENT ORANGE VA02 4 IONIZING RADIATION VA03 5 SOUTHWEST ASIA VA04 6 SERVICE NOT COVERED INACTIVE 7 COVERAGE CANCELED YES NO CV02 8 NEEDS SC DETERMINATION VA05 9 NON-BILLABLE APPOINTMENT TYPE MC01 10 INVALID PRESCRIPTION ENTRY YES NO RX01 11 REFILL ON VISIT DATE RX02 12 PRESCRIPTION DELETED YES NO RX03 13 PRESCRIPTION NOT RELEASED YES NO RX04 14 DRUG NOT BILLABLE YES NO RX05 15 HMO POLICY CV03 16 REFUSES TO SIGN RELEASE (ROI) MC02 17 NON-BILLABLE STOP CODE MC03 18 RESEARCH VISIT MC04 19 BILL PURGED INACTIVE 20 NON-BILLABLE CLINIC MC05 21 MILITARY SEXUAL TRAUMA VA06 22 CREDENTIALING ISSUE MC06 23 INSUFFICIENT DOCUMENTATION INACTIVE 24 NO DOCUMENTATION DC01 25 NON-BILLABLE PROVIDER (RESID.) INACTIVE 26 NON-BILLABLE PROVIDER (OTHER) INACTIVE 27 OTHER COMPLIANCE MC07 28 OUT OF NETWORK (PPO) CV04 29 HEAD/NECK CANCER VA07 30 COMBAT VETERAN VA08 31 MRA REC'D. NO SEC RESP EXISTS CV05 32 MRA REC'D. SEC NOT BILLED CV06 33 90 DAY RX FILL NOT COVERED YES NO RX06 34 NOT A CONTRACTED PROVIDER YES NO RX07 35 INVALID MULTIPLES PER DAY SUPP YES NO RX08 36 REFILL TOO SOON YES NO RX09 37 INVALID NDC FROM CMOP YES NO RX10 38 PROJECT 112/SHAD VA09 39 NON COVERED DRUG PER PLAN YES NO RX11 new 40 FILING TIMEFRAME NOT MET YES NO CV07 new 41 GLOBAL SURGERY MC08 new 42 CHARGES SPLIT BL01 new 43 PRE-CERT NOT OBTAINED MC09 new 44 DUPLICATE ENCOUNTER MC10 new 45 MEDICARE REPLACEMENT POLICY CV08 new 46 COVERED BY MEDICARE AT 100% CV09 new 47 BENEFITS MAXED CV10 new 48 C&P EXAM/REGISTRY EXAM VA10 new 49 TELEPHONE ENCOUNTER MC11 new 50 NO TX PROVIDED/ADVICE ONLY DC02 new 51 ROI NOT OBTAINED MC12 new 52 UNSIGNED DOCUMENT DC03 new 53 CONCURRENT CARE CV11 new 54 72 HOUR RULE MC13 new 55 CUSTODIAL/RESIDENTIAL CARE CV12 new 56 OBSERVATION-OP BILLED BL02 new 57 BILLED INSTITUTIONAL ONLY BL03 new 58 BILLED PROFESSIONAL ONLY BL04 new 59 NO OUTPATIENT COVERAGE CV13 new 60 NO INPATIENT COVERAGE CV14 new 61 NO PHARMACY COVERAGE YES NO CV15 new 62 NO DENTAL COVERAGE CV16 new 63 NO MENTAL HEALTH COVERAGE CV17 new 64 NO LTC COVERAGE CV18 new 65 MED NEC-DX NOT COVERED MN01 new 66 MED NEC-CPT NOT COVERED MN02 new 67 MED NEC-LCD EDIT MN03 new 68 MED NEC-OTHER MN04 new 69 MEDICARE EXCLUDED SERVICE CV19 new 70 RESIDENT SUPERVISION NOT MET MC14 new 71 ANCILLARY PROVIDER AT CBOC MC15 new 73 NON-COVERED PROVIDER CV20 new 74 NO DIAGNOSIS/SYMPTOMS IN NOTE DC04 new 75 NO CHIEF COMPLAINT DC05 new 76 NOTE NOT WRITTEN TIMELY DC06 new 77 NO PHYSICIAN ORDER DC07 new 78 NO PLAN OF CARE DC08 new 79 STUDENT NOTE ONLY DC09 new 80 ALL BILLABLE CPT CODES BILLED BL05 new 81 NO INPT PROF FEES BILLED BL06 new 82 REPETITIVE SERVICES BL07 new 83 PENDING CODE SET UPDATE MC16 new 84 PENDING RC CHARGE UPDATE MC17 new 85 NPI/TAXONOMY ISSUES YES NO MC18 new 86 RX DUR REJECT YES NO RX12 new 87 RX PRIOR AUTH NOT OBTAINED YES NO RX13 new 88 RX MEDICARE PART D YES NO RX14 new 89 RX DISCOUNT CARD YES NO RX15 new 91 DATE OF BIRTH MISMATCH YES NO MC19 new 92 NEW PT/NO HX DC10 new 93 NEW PT/NO EXAM DC11 new 94 NEW PT/NO COMPLEXITY DC12 new 95 EST PT/NO HX/NO EXAM DC13 new 96 EST PT/NO HX/NO COMPLEXITY DC14 new 97 EST PT/NO EXAM/NO COMPLEXITY DC15 new 98 NO VISION COVERAGE CV21 new 999 OTHER YES YES Routine Information: ==================== The second line of each of these routines now looks like: ;;2.0;INTEGRATED BILLING;**[Patch List]**;21-MAR-94;Build 8 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: IBCC1 Before: B38579110 After: B52622675 **19,95,160,159,320,347,377,399** Routine Name: IBCNS Before: B27231717 After: B27665348 **28,43,80,82,133,399** Routine Name: IBCNS3 Before: B53375755 After: B55507373 **287,399** Routine Name: IBCNSC01 Before: B54638863 After: B55064562 **52,137,191,184,232,320,349, 371,399** Routine Name: IBCNSM3 Before: B13886577 After: B14041849 **6,28,85,211,251,399** Routine Name: IBCNSP0 Before: B32537201 After: B33094001 **28,43,52,85,93,103,137,229, 251,363,371,399** Routine Name: IBCNSP11 Before: B11397293 After: B11695386 **28,43,85,103,137,251,399** Routine Name: IBCNSU31 Before: n/a After: B8416261 **399** Routine Name: IBCNSUR2 Before: B18290866 After: B18995204 **103,238,399** Routine Name: IBCRBG2 Before: B7401317 After: B7812503 **245,175,332,364,399** Routine Name: IBCRU6 Before: B8897462 After: B11770100 **106,138,399** Routine Name: IBCU3 Before: B25333825 After: B26112094 **52,80,91,106,51,137,211,245, 348,399** Routine Name: IBCU4 Before: B20355514 After: B20382256 **109,122,137,245,349,371,399** Routine Name: IBJDB21 Before: B47981210 After: B54088092 **123,159,185,399** Routine Name: IBJDB22 Before: B44469351 After: B49159652 **123,159,399** Routine Name: IBTRKR41 Before: B32576267 After: B35256445 **43,55,91,132,174,247,260,315, 292,312,339,399** Routine Name: IBTUBO1 Before: B45713033 After: B47180115 **19,31,32,91,123,159,247,155, 277,339,399** Routine Name: IBTUTL5 Before: n/a After: B53886235 **399** Routine Name: IBY399P Before: n/a After: B7558055 **399** Routine Name: IBY399P1 Before: n/a After: B40098573 **399** Routine Name: IBY399P2 Before: n/a After: B20211575 **399** Routine Name: IBY399P3 Before: n/a After: B5389442 **399** Routine Name: IBY399P4 Before: n/a After: B24305575 **399** Routine list of preceding patches: 133, 138, 185, 238, 287, 339, 348, 364 371, 377 ============================================================================= User Information: Entered By : CRUZ,ORLANDO Date Entered : MAY 22, 2008 Completed By: LYNCH,MARY F. Date Completed: JUL 01, 2009 Released By : BOTTINI,STEVE Date Released : JUL 09, 2009 ============================================================================= Packman Mail Message: ===================== $END TXT