$TXT Created by ZEIGLER,EDWARD L at MNTVBB.FO-ALBANY.MED.VA.GOV (KIDS) on Wednesday, 01/30/08 at 16:49 ============================================================================= Run Date: MAR 13, 2008 Designation: IB*2*395 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #359 Status: Released Compliance Date: APR 13, 2008 ============================================================================= Associated patches: (v)IB*2*266 <<= must be installed BEFORE `IB*2*395' (v)IB*2*371 <<= must be installed BEFORE `IB*2*395' (v)PSO*7*273 <<= must be installed BEFORE `IB*2*395' Subject: PHARMACY NPI FIX (REPLACES IB*2*388) Category: - Routine - Enhancement (Mandatory) Description: ============ This patch replaces the entered in error patch IB*2*388. IB*2*388 was entered in error as a result of conflicting routines with IB*2*371. Install of this patch will not only install the IB*3*388 functionality, but will make sure the any functionality that may have been lost from IB*2*371 is also restored. The issue being addressed is with printed prescription 3rd party claims. On the new UB-04 and CMS-1500 claim forms the facility's main NPI number was appearing on the printed bills instead of the Facility Pharmacy NPI number. All facilities have been previously issued Pharmacy NPI numbers with a Kernel patch in their respective institution files. Assuming the pharmacy site parameters in the Outpatient Site (#59), NPI INSTITUTION (#101) field are setup to the site's pharmacy institution, printed bills should print the appropriate pharmacy NPI on both the UB-04 and CMS-1500 claim forms. Since only one institutional NPI can be printed on a claim form an additional edit/check in the bill authorization process will be made to warn users if a bill contains prescriptions with multiple pharmacy NPI institutions. To further assist billing staff in resolving these multiple pharmacy NPI institutions, a new '?RX' feature will be available in option Enter/Edit Billing Information [IB EDIT BILLING INFO] that will display pharmacy related data that is on a bill. '?ID' was also updated to display the Pharmacy institution name and NPI if available. ASSOCIATED REMEDY: ================== 1. HD 205121 Insurance Companies rejecting claims due to NPI duplicate: HD 196832 Issues with NPI number 2. HD 231553 Patch IB*2*371 and IB*2*388 conflict ASSOCIATED NSR(s): ================== N/A PARTICIPATING TEST SITES: ========================= ALEXANDRIA, LA HEARTLAND-WEST HCS UPSTATE NEW YORK HCS EL PASO, TX REMEDY OVERVIEW: ================ 1. HD 205121 Insurance Companies rejecting claims due to NPI Problem: -------- When a printed claim form is printed there was never a consideration to utilize the prescription's related Pharmacy NPI number on either the UB-04 or CMS-1500. This resulted in claims being denied and the site having to change the NPI number on the form prior to mailing. Resolution: ----------- Modified routine IBCEF73A to utilize the Prescription's Pharmacy NPI number on either claim form if the bill is for prescription related items. The routine will look up the Outpatient Site from the Prescription (#52) file, DIVISION (#20 or #8 on refills) field. Look up the Institution from the Outpatient Site (#59) file, NPI Institution (#101) field, and the NPI number to utilize from the Institution (#4) file. Also FORMAT CODE (#101) filed in the IB FORM FIELD CONTENT (#364.7) file for the SERVICE FAC NPI (BX-32A) is being updated by IB20P395 to utilize the Pharmacy NPI. 1. HD 231553 Patch IB*2*371 and IB*2*388 conflict Problem: -------- There were 3 conflicting routines between IB*2*388 and IB*2*371. Resolution: ----------- The install of this patch will install the full IB*2*388 functionality including the 3 routines that conflicted with IB*2*371, maintaining the IB*2*371 functionality. These changes will effect the following Output Formatter fields: UB-04, BILLING PROVIDER NPI (FL-56) CMS-1500, SERVICE FAC NPI (BX-32A) CMS-1500, BILLING PROVIDER NPI (BX-33A) Since the claim forms do not allow for multiple NPI numbers for prescription claims, a new edit check is included at completion of a Bill. The following new warning message will be displayed indicating the number of associated NPI numbers that were found on the associated prescriptions: Bill has prescriptions resulting from 2 different NPI locations To further assist billing staff in resolving multiple NPIs on a prescription bill a new ?RX function is included within the billing option Enter/Edit Billing Information [IB EDIT BILLING INFO] to display pharmacy related data: Prescriptions Assigned to this Bill -------------------------------------------------------------------------- RX #: 100248 DATE: Jul 19, 2007 DRUG: ASPIRIN BUFFERED 325MG TAB NDC: 00182-0196-10 DAYS SUPPLY: 90 QUANTITY: 1 NPI INSTITUTION: TEST1 PHARMACY RX NPI: 8787654568 PROVIDER: PROVIDER,DOCTOR RX #: 1231233 DATE: Jul 20, 2007 DRUG: ASPIRIN BUFFERED 500MG TAB NDC: 123-234-2323 DAYS SUPPLY: 20 QUANTITY: 3 NPI INSTITUTION: TEST2 PHARMACY RX NPI: 8787654599 PROVIDER: PROVIDER,DOCTOR TWO ================== INSTALLATION INSTRUCTIONS ================== It is recommended that this patch be installed outside of normal working hours when no Integrated Billing users are on the system. However, 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. Enter/Edit Billing Information [IB EDIT BILLING INFO] Print Bill [IB PRINT BILL] Print Authorized Bills [IB BATCH PRINT BILLS] View/Print EDI Bill Extract Data [IBCE EDI VIEW/PRINT EXTRACT] Provider ID Maintenance [IBCE PROVIDER MAINT] **** Do not install this patch when the IB MT NIGHT COMP background job is running. Also, make sure that electronic claims are NOT scheduled to be transmitted via TaskManager while the patch is being installed. It's best to check with your Billing section. There is a field called HOURS TO TRANSMIT BILLS (#8.06) in the IB SITE PARAMETERS file (#350.9) that may contain specific times to transmit bills. Any future tasks set up in TaskManager based on the HOURS TO TRANSMIT BILLS (#8.06) field in the IB SITE PARAMETERS file (#350.9) would appear similar to this: 5310003: FORMOUT^IBCEFG7, OUTPUT FORMATTER - FORM: IB 837 TRANSMISSION. No device. ACT,ACT. From Today at 1:01, By you. Scheduled for Today at 16:00 If there are no specific times set up in this parameter, claims will be transmitted when the Queue Means Test Compilation of Charges [IB MT NIGHT COMP] job runs. Install time - less than 2 minutes. 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 3. Select Installation Option: --------------------------- NOTE: The following are OPTIONAL - (When prompted for the INSTALL NAME, enter IB*2.0*395): 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. b. When prompted "Want KIDS to INHIBIT LOGONs during the install? NO//" 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: Enter/Edit Billing Information [IB EDIT BILLING INFO] Print Bill [IB PRINT BILL] Print Authorized Bills [IB BATCH PRINT BILLS] View/Print EDI Bill Extract Data [IBCE EDI VIEW/PRINT EXTRACT] Provider ID Maintenance [IBCE PROVIDER MAINT] e. When prompted 'Enter protocols you wish to mark as 'Out Of Order': press . ================ POST INSTALLATION INSTRUCTIONS ================ Post install routine IB20P395 can be deleted from system upon successful completion of install. Post-install Note ----------------- The install of IB*2*395 updates the national UB-04 and CMS-1500 claim form. Sites may have a local override on the fields being updated. The local overrides will not be deleted with the install and will not directly be updated. But depending on how sites have implemented their local overrides, they may or may not change. Sites should review any local overrides on the following fields to make sure they print the NPI desired: UB-04, BILLING PROVIDER NPI (FL-56) CMS-1500, SERVICE FAC NPI (BX-32A) CMS-1500, BILLING PROVIDER NPI (BX-33A) Routine Information: ==================== The second line of each of these routines now looks like: ;;2.0;INTEGRATED BILLING;**[Patch List]**;21-MAR-94;Build 3 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: IB20P395 Before: n/a After: B11117397 **395** Routine Name: IBCBB1 Before: B66788213 After: B67930710 **27,52,80,93,106,51,151,148, 153,137,232,280,155,320,343, 349,363,371,395** Routine Name: IBCBB11 Before: B16826545 After: B19890435 **51,343,363,371,395** Routine Name: IBCEF73A Before: B18483698 After: B31578985 **343,374,395** Routine Name: IBCEF74A Before: B19511866 After: B20383624 **320,343,349,395** Routine Name: IBCSCH Before: B62017089 After: B63443719 **52,80,106,124,138,51,148,137, 161,245,232,287,348,349,374, 371,395** Routine Name: IBCSCH1 Before: B21600403 After: B30182718 **106,125,51,245,266,395** Routine list of preceding patches: 266, 371 ============================================================================= User Information: Entered By : ZEIGLER,EDWARD L Date Entered : JAN 30, 2008 Completed By: LYNCH,MARY F. Date Completed: MAR 12, 2008 Released By : BOTTINI,STEVE Date Released : MAR 13, 2008 ============================================================================= Packman Mail Message: ===================== $END TXT