$TXT Created by CARVDD.DOMAIN.EXT (KIDS) on Thursday, 08/07/14 at 23:34 ============================================================================= Run Date: SEP 17, 2014 Designation: IB*2*488 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #479 Status: Released Compliance Date: SEP 28, 2014 ============================================================================= Associated patches: (v)IB*2*133 <<= must be installed BEFORE `IB*2*488' (v)IB*2*451 <<= must be installed BEFORE `IB*2*488' (v)IB*2*458 <<= must be installed BEFORE `IB*2*488' (v)IB*2*473 <<= must be installed BEFORE `IB*2*488' (v)IB*2*476 <<= must be installed BEFORE `IB*2*488' (v)IB*2*489 <<= must be installed BEFORE `IB*2*488' Subject: HIPAA 5010 D.0 LEVEL II PHASE 2 Category: - Routine - Input Template - Data Dictionary - Enhancement (Mandatory) Description: ============ This patch enables local printing of the new CMS-1500 claim form. ************************************************************************** ********************** I M P O R T A N T N O T E ********************** ************************************************************************** *** *** *** ONCE THIS PATCH IS INSTALLED, IT CANNOT BE BACKED OUT! *** *** *** *** Before installing this patch, you must make sure that your site *** *** has a sufficient supply of the new, pre-printed CMS-1500 claim *** *** forms. New forms should be loaded into the default printer(s) *** *** for these claim forms at your site. *** *** *** *** Refer to the Pre/Post Installation Overview Instructions for *** *** further mandatory instructions for this patch. Sites are *** *** STRONGLY encouraged to test the printer set up with the new form *** *** in a mirror/test account before installing the software in *** *** production. *** *** *** *** Sites that are using Class III software to interface with *** *** Billing/Collection vendor software are responsible for *** *** contacting their vendors to ensure compatibility with VA *** *** software changes. The vendor(s) may be required to make *** *** software changes to ensure a smooth transition to the new *** *** CMS-1500 forms. *** *** *** ************************************************************************** ********************** I M P O R T A N T N O T E ********************** ************************************************************************** This patch is associated with Accounts Receivable PRCA*4.5*300 and each patch should be installed one after the other. There is no install order preference. This Integrated Billing (IB) patch introduces changes to VistA's Integrated Billing Module. Complete list of patch items: 1. Made the following modifications to Enter/Edit Billing Information [IB EDIT BILLING INFO] option: a) Removed the ability to force a claim to be printed at the Health Care Clearing House (HCCH) for institutional claims. b) Removed the ability to force a claim to be printed at the Health Care Clearing House (HCCH) for professional claims. c) Provided a Fatal Warning message to the user when EDI - Inst Payer Primary ID on an institutional claim equals HPRNT/SPRNT. d) Provided a Fatal Warning message to the user when EDI - Inst Payer Primary ID on a professional claim equals SPRNT/HPRNT. e) Provided the ability to prevent the authorization of a profession- al claim with no procedures. f) Provided the ability to prevent the authorization of an outpatient institutional claim with no procedures. g) Modified Billing Screen 3 so the payer sequence will display in the picklist of available payers that is displayed when a user enters an ambiguous partial entry at one of the following prompts: - Primary Insurance Policy - Secondary Insurance Policy - Tertiary Insurance Policy 2. Enhanced Provider ID Maintenance [IBCE PROVIDER MAINT] option with the following modifications: a) Provided the ability for users to enter ONLY a 9 digit ZIP Code for a non-VA facility address. b) Provided the ability to enter only a physical location in Address Line 1 for a non-VA facility. 3. Enhanced Insurance Company Entry/Edit [IBCN INSURANCE CO EDIT] option with the following modifications: a) Removed the ability to set the EDI - Inst Payer Primary ID equal to HPRNT, SPRNT, IPRNT or PPRNT. b) Removed the ability to set the EDI - Prof Payer Primary ID equal to SPRNT, HPRNT, IPRNT or PPRNT. c) Provided the functionality to set the value for EDI - Transmit?: to YES-LIVE when a new Insurance Company is created. 4. Provided the ability to view Message Storage Errors for inbound Medicare-equivalent MRAs in the MRA Management Worklist (MRW) [IBCE MRA MANAGEMENT] option. 5. Modified the Third Party Joint Inquiry (TPJI) [IBJ THIRD PARTY JOINT INQUIRY] option to display the message storage error messages which are generated when VistA is unable to upload inbound X12N 5010 Health Care Claim Payment/Advice (835) messages in a manner an end-user can understand. 6. Enhanced the Health Care Claim Transactions (837) with the following modifications: a) Provided the ability to transmit 1 - 12 diagnostic codes (DC1 - DC12) on a professional X12N 5010 Health Care Claim (837) transaction to FSC. b) Prevented the transmission of the following Property and Casualty data in the Service Facility loop of an institutional/professional 837 claim transaction: - P & C Contact Name - P & C Contact Telephone Number - P & C Contact Telephone Number Extension c) Provided the ability to transmit a Service Line Charge Amt (INS, Piece 9) with a maximum length equal to 18 numeric in an institutional X12N 5010 Health Care Claim (837) transaction to FSC. d) Provided the ability to transmit a Service Line Non-Covered Charge Amt (INS, Piece 12) with a maximum length equal to 18 numeric in an institutional X12N 5010 Health Care Claim (837) transaction to FSC. e) Provided the ability to transmit a professional claim with a Rate Type equal to Workers' Comp to FSC in an X12N 5010 Health Care Claim (837) transactions. f) Provided the ability to transmit an Assignment Code with the value of A in all professional/institutional X12N 5010 Health Care Claim (837) transactions to FSC. g) Provided the ability to transmit institutional/professional claims with Line Item Charge Amounts equal to $0.00. h) Provided the ability to transmit 2 A/N diagnoses pointers with diagnoses on a professional claim to FSC in an X12N 5010 Health Care Claim (837) transaction. 7. Enhanced the CMS - 1500 Printed Claim Form in the following ways: a) The IB System no longer prints the following information on a locally printed CMS - 1500 claim form: - Box 8 o Patient Marital Status o Patient Employment o Patient Student Status - Box 9 o 9b - Other Insured's DOB o 9b - Other Insured's Gender o 9c - Employer's Name o 9c - School Name - Box 11 o 11b - Employer's Name o 11b - School Name - Box 19 o EPSDT Flag o Attending Not Hospice Employee o Homebound Indicator o Special Program Indicator o Date Last Seen - Box 30 - Balance Due b) The IB System now prints the following data on a locally printed CMS - 1500 form when available on a professional claim: - Box 10 o 10d - NUCC designated Claim Condition Codes - Box 11 o 11b - Other Claim ID = Qualifier Y4 and Property and Casualty Number - Box 14 - Date Qualifier o 484 Last Menstrual Period (LMP, or o 431 Onset of Current Symptoms or Illness if no date for LMP - Box 15 - Date Qualifier o 439 Accident (Occurrence Codes) o 455 Last X-ray (Chiropractic Claim) o 453 Acute Manifestation of Chronic Condition (Chiropractic Claims) o 471 Prescription (RX Claims) o Initial Treatment (Occurrence Code - PT/OT/ Speech/Home IV/Cardiac Rehab) o Latest Visit or Consultation - Box 17 - Provider Qualifier o DN - Referring Provider o DQ - Supervising Provider - Box 19 - Rate Type = Worker's Comp. o PWK o Report Type Code o Transmission Type Code o Attachment Control Number - Box 19 - Rate Type not equal to Worker's Comp. o Free Text - Maximum 71 characters. - Box 21 o 21A-L - Up to 12 Diagnoses Codes o ICD Version Indicator - Box 24E o Diagnoses Pointers will be A-L values 8) Made the following modifications to requirements that previously existed: a) Functional Requirement FEAT765: Transmit Revenue/Procedure Codes With Zero Charge Amount - Provided the ability to transmit Revenue/Procedure codes which generate zero charge amounts in 837 Health Care Claim Transmissions (PRF, Piece 5 and INS, Piece 9). b) Functional Requirement FEAT602: Transmit Service Facility Contact Data - Deleted the ability to transmit the following data with a Professional 837 claim transmission when a Service Facility Communication Number is present on a claim (2310C PER01, PER03): - Contact Function Code: IC Information Contact - Communication Number Qualifier: TE Telephone - Communication Number: Telephone - Communication Number Qualifier: EX Telephone Extension - Communication Number: Extension Number ***NOTE*** The Property and Casualty data entered on Billing Screen 8 will continue to transmit. The above fields will be relabeled as Property and Casualty data but will not be transmitted in the Service Facility loop. Patch Components ================ Files & Fields Associated: File Name (#) Field Name (#) New/Modified/Deleted ------------------ ---------------- -------------------- INSURANCE COMPANY (#36) Modified EDI ID NUMBER - PROF (#3.02) Modified EDI ID NUMBER - INST (#3.04) Modified IB ERROR (#350.8) New/Modified Entries IB NON/OTHER VA BILLING PROVIDER (#355.93) Modified STREET ADDRESS (#.05) Modified ZIP CODE (#.08) Modified P&C CONTACT NAME (#1.01) Modified P&C CONTACT PHONE NUMBER (#1.02) Modified P&C CONTACT PHONE EXTENSION (#1.03) Modified IB DATA ELEMENT DEFINITION (#364.5) New/Modified Entries Screen: I $$INCLUDE^IB488PRE(5,Y) IB FORM SKELETON DEFINITION (#364.6) New/Modified Entries Screen: I $$INCLUDE^IB488PRE(6,Y) IB FORM FIELD CONTENT (#364.7) New/Modified Entries Screen: I $$INCLUDE^IB488PRE(7,Y) BILL/CLAIMS(#399) Modified FORCE CLAIM TO PRINT (#27) Modified HOMEBOUND (#236) Modified DATE LAST SEEN (#237) Modified SPECIAL PROGRAM INDICATOR (#238) Modified PROPERTY/CASUALTY CLAIM NUMBER (#261) Modified FORM LOC 19-UNSPECIFIED DATA (#459) Modified PROCEDURES sub-file (#399.0304) Modified PURCHASED COST (#19) Modified ATTENDING NOT HOSPICE EMPLOYEE (#50.03) Modified EPSDT FLAG (#50.07) Modified SERVICE LINE COMMENT (#50.08) Modified SERVICE LINE COMMENT QUALIFIER (#50.09) Modified REVENUE CODE sub-file (#399.042) Modified UNITS OF SERVICE (#.03) Modified RATE TYPE file (#399.3) ELECTRONIC TRANSMIT (#.1) Modified Entry Templates Associated: New/Modified/ Template Name Type File Name (#) Deleted ------------- ---- ------------- --------- IB SCREEN102 Input BILL/CLAIMS(#399) Modified IB SCREEN10H Input BILL/CLAIMS(#399) Modified IB SCREEN8 Input BILL/CLAIMS (#399) Modified New Service Requests (NSRs): ---------------------------- 20110503 - Electronic Data Interchange (EDI) New Standards and Operating Rules (Veterans Health Administration) VHA Provider-Side TCRs Remedy Ticket(s) & Overviews: ----------------------------- Remedy Ticket # 618231 - Claims Without CPT The claims are being transmitted without CPT codes. The biller is not inputting CPT codes and the system is not generating an error message. Resolution: ----------- Added two fatal edits when authorizing a bill without CPT codes, one for professional claims and one for institutional claims. TEST Sites: =========== Tennessee Valley HCS Mountain Home, TN Richmond, VA Asheville, NC Hampton, VA Documentation Retrieval Instructions: ------------------------------------- Updated documentation describing the new functionality introduced by this patch is available. The preferred method is to FTP the files from ftp://download.vista.domain.ext/. This transmits the files from the first available FTP server. Sites may also elect to retrieve software directly from a specific server as follows: Albany ftp.domain.ext Hines ftp.domain.ext Salt Lake City ftp.domain.ext The documentation will be in the form of Adobe Acrobat files. Documentation can also be found on the VA Software Documentation Library at: http://www4.domain.ext/vdl/ File Description File Name FTP Mode -------------------------------------------------------------------------- EDI User Manual edi_user_guide_R0814.pdf Binary IB Release Notes/Installation Guide IB_2_0_P488_rn.pdf Binary Patch Installation: Pre/Post Installation Overview ------------------------------ ****Important Note: There is one **MANDATORY** pre-installation activity associated with this install. The IB Staff MUST empty the 837 extract/transmission queue PRIOR to the installation of this patch. *** The site IRM would coordinate with the Billing Department to insure that the 837 extract/transmission queue is empty. The instructions to empty the queue is as follows: Select the option: TRANSMIT EDI BILLS - MANUAL [IBCE 837 MANUAL TRANSMIT] What is the purpose of this option? This option is used to by-pass the normal daily/nightly transmission queues if the need arises to get the claim to the payer quickly. When is this option used? There are occasions when there is a need to transmit a claim(s) immediately instead of waiting for the batching frequency as scheduled in the MCCR Site Parameter. This option will allow sending individual claim(s) or all claims in a ready for extract status. Upon selecting this option you will be prompted with the following: Select one of the following: A Transmit (A)LL bills in READY FOR EXTRACT status S Transmit only (S)ELECTED bills You should select 'A' for ALL Once the Billing Department has completed the instruction, the Billing department is to inform IRM that the patch installation could proceed. The pre-installation routine, IB488PRE, defines several new error messages that are used by the Billing Screens. These new error messages are stored as new entries in the IB ERROR file (#350.8). The pre-installation routine also updates the Rate Type File (#399.3) with the Electronic Billable Flag for Worker's Compensation. Lastly, the pre-installation routine will delete unused 4010 Output Formatter entries. The post installation routine will recompile the Input Templates for the Billing Screens. Installation Instructions ------------------------- ****************************************************************** * You should install this patch during non-peak hours, when no * * Integrated Billing or Accounts Receivable users are on the * * system. * ****************************************************************** The installation will take less than 2 minutes. This patch is associated with Accounts Receivable PRCA*4.5*300. 1. Use the INSTALL/CHECK MESSAGE option on the PackMan menu. 2. From the Kernel Installation & Distribution System (KIDS) menu, select the Installation menu. 3. From this menu, you may select to use the following options (when prompted for INSTALL NAME, enter IB*2.0*488). a. Backup a Transport Global - This option will create a backup message of any routines exported with the patch. It will NOT back up any other changes such as DDs or templates. b. Compare Transport Global to Current System - This option will allow you to view all changes that will be made when the patch is installed. It compares all components of the patch (routines, DDs, templates, etc.). c. Verify Checksums in Transport Global - This option will ensure the integrity of the routines that are in the transport global. d. Print Transport Global - This option will allow you to view the components of the KIDS build. 4. Use the Install Package(s) option and select the package IB*2.0*488. 5. When prompted "Want KIDS to INHIBIT LOGONs during the install? NO//" respond NO. 6. When prompted "Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//" respond YES. 7. 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] 8. When prompted "Enter protocols you wish to mark as 'Out Of Order':", press the ENTER key by pass the prompt. 9. When prompted "Delay Install (Minutes): (0-60): 0//", you may press the ENTER key to accept the default. 10. When prompted "DEVICE: HOME//", enter the device you want to print the Install messages. Post-Installation Instructions ------------------------------ Pre install routine IB488PRE and post install routine IBY488PO can be deleted from system upon successful completion of install. Routine Information: ==================== The second line of each of these routines now looks like: ;;2.0;INTEGRATED BILLING;**[Patch List]**;21-MAR-94;Build 184 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: IB488PRE Before: n/a After: B27990371 **488** Routine Name: IBCBB1 Before: B98716914 After:B116504133 **27,52,80,93,106,51,151,148, 153,137,232,280,155,320,343, 349,363,371,395,384,432,447, 488** Routine Name: IBCBB2 Before: B51205466 After: B54197066 **51,137,210,245,232,296,320, 349,371,403,432,447,473,488** Routine Name: IBCBB7 Before: B27582918 After: B28157499 **51,137,240,447,488** Routine Name: IBCECOB Before: B17473873 After: B17969465 **137,155,288,432,488** Routine Name: IBCECOB1 Before:B102535687 After:B112283735 **137,155,288,348,377,417,432, 447,488** Routine Name: IBCECOB2 Before:B167373990 After:B183092638 **137,155,433,432,447,488** Routine Name: IBCECOB5 Before: B13879653 After: B17731543 **137,155,349,417,488** Routine Name: IBCECSA5 Before: B62841003 After: B69687266 **137,135,263,280,155,349,489,488** Routine Name: IBCECSA6 Before:B167601727 After:B168448681 **137,135,155,417,431,451,488** Routine Name: IBCEF2 Before: B64226101 After: B64374819 **52,85,51,137,232,155,296,349, 403,400,432,488** Routine Name: IBCEF22 Before: B61306963 After: B79219296 **51,137,135,155,309,349,389, 432,488** Routine Name: IBCEF3 Before: B45972715 After: B47162871 **52,84,121,51,152,210,155,348, 349,389,488** Routine Name: IBCEF31 Before: B12054415 After: B11345418 **155,296,349,400,432,488** Routine Name: IBCEF83 Before: B56319703 After: B64584926 **432,488** Routine Name: IBCEOB Before: B95746536 After:B100427168 **137,135,265,155,377,407,431, 432,488** Routine Name: IBCEOB0 Before: B83008311 After: B90917821 **135,280,155,431,488** Routine Name: IBCEOB00 Before: B76540225 After: B89820593 **155,349,377,431,488** Routine Name: IBCEOB1 Before: B69809131 After:B103312053 **137,135,155,296,356,349,431,488** Routine Name: IBCEP8B Before: B20063767 After: B34200270 **391,432,476,488** Routine Name: IBCEU3 Before: B75406373 After:B105297417 **51,137,155,323,348,371,400, 432,488** Routine Name: IBCF2 Before: B18859512 After: B20654334 **17,52,88,122,51,137,488** Routine Name: IBCF21 Before: B13370698 After: B15664460 **8,80,51,488** Routine Name: IBCF22 Before: B10161856 After: B23925078 **52,80,122,51,210,488** Routine Name: IBCF23 Before: B40963193 After: B46459420 **52,80,106,122,51,152,137,402, 432,488** Routine Name: IBCF2P Before: B10880923 After: B12251451 **8,52,133,488** Routine Name: IBCF2TP Before: B9069243 After: B8889377 **488** Routine Name: IBCNS2 Before: B14096238 After: B24154529 **28,43,80,51,137,155,488** Routine Name: IBCNSC Before: B24159861 After: B26150929 **46,137,184,276,320,371,400,488** Routine Name: IBCSC10H Before: B48673264 After: B44927826 **432,488** Routine Name: IBCSC8 Before: B7203948 After: B9775351 **432,447,488** Routine Name: IBCSCH Before: B49539365 After: B50914116 **52,80,106,124,138,51,148,137, 161,245,232,287,348,349,374, 371,395,400,432,447,458,488** Routine Name: IBCU7 Before: B81426431 After: B76838380 **62,52,106,125,51,137,210,245, 228,260,348,371,432,447,488** Routine Name: IBJTBA1 Before: B50433175 After: B55203137 **135,265,155,349,417,451,488** Routine Name: IBY488PO Before: n/a After: B892589 **488** Routine list of preceding patches: 133, 451, 458, 473, 476, 489 ============================================================================= User Information: Entered By : Date Entered : NOV 01, 2012 Completed By: Date Completed: SEP 10, 2014 Released By : Date Released : SEP 17, 2014 ============================================================================= Packman Mail Message: ===================== $END TXT