$TXT Created by GUSTAFSON,ERIC S at DEVVNN.FO-ALBANY.MED.VA.GOV (KIDS) on Thursday, 04/17/08 at 16:34 ============================================================================= Run Date: JUN 05, 2008 Designation: IB*2*377 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #361 Status: Released Compliance Date: JUL 06, 2008 ============================================================================= Associated patches: (v)IB*2*250 <<= must be installed BEFORE `IB*2*377' (v)IB*2*276 <<= must be installed BEFORE `IB*2*377' (v)IB*2*296 <<= must be installed BEFORE `IB*2*377' (v)IB*2*347 <<= must be installed BEFORE `IB*2*377' (v)IB*2*371 <<= must be installed BEFORE `IB*2*377' (v)IB*2*374 <<= must be installed BEFORE `IB*2*377' Subject: E-CLAIMS PLUS ITERATION 3 PHASE 2 Category: - Enhancement (Mandatory) - Data Dictionary - Input Template - Routine Description: ============ This patch includes many functional enhancements to electronic billing and related user options. Full list of patch items: 1. Option MRA Management WorkList [IBCE MRA MANAGEMENT] now allows users to enter and view claim level comments for Medicare-equivalent Remittance Advice (MRA) request claims. Users may also enter and view an MRA review status for MRA request claims. 2. Option Third Party Joint Inquiry [IBJ THIRD PARTY JOINT INQUIRY] now allows users to enter and view MRA comments for a given claim. If both Accounts Receivable (AR) and MRA comments exist, AR comments are displayed first, followed by MRA comments. 3. Option Patient Insurance Info View/Edit [IBCN PATIENT INSURANCE] now uses Health Insurance Portability and Accountability Act (HIPAA) codes for the field PT. RELATIONSHIP TO INSURED (#16) in the INSURANCE TYPE multiple (#.3121) of the PATIENT file (#2): '01' FOR SPOUSE; '18' FOR SELF; '19' FOR CHILD; '20' FOR EMPLOYEE; '29' FOR SIGNIFICANT OTHER; '32' FOR MOTHER; '33' FOR FATHER; '39' FOR ORGAN DONOR; '41' FOR INJURED PLAINTIFF; '53' FOR LIFE PARTNER; 'G8' FOR OTHER RELATIONSHIP; During the installation of this patch, old VistA codes are automatically converted into new HIPAA codes for all existing patient insurance policies. 4. The menus, screens and actions in the option Provider ID Maintenance [IBCE PROVIDER MAINT] were significantly re-designed and enhanced so they are easier to use and understand. 5. Option Enter/Edit Billing Information [IB EDIT BILLING INFO] now allows users to properly add non-VA providers and non-VA facilities from billing screen 8 for both professional and institutional claims. Billing screen 7 was also enhanced to allow for the entry of non- covered charges for procedures on institutional outpatient claims. 6. Option Cancel Bill [IB CANCEL BILL] has been enhanced to display more Claims Tracking information when cancelling a claim in Integrated Billing (IB). Additional Claims Tracking data include the outpatient clinic name, visit date, admission date, prescription#, drug, refill date, and prosthetic item description. Also, users may now enter up to 80 characters of additional free text comments into Claims Tracking. 7. When Medicare sends the Medicare-equivalent Remittance Advice (MRA X12 835 transaction) into VistA and there is an indication that Medicare has returned the corrected patient name or the corrected patient ID# in the MRA, the patient's Medicare insurance policies will be updated with this information automatically. Also, the alert "EOB for bill # [claim#] indicates a new name or id exists for patient" has been removed from the system. 8. Option Batch Status Detail Report [IBCE BATCH STATUS DETAIL] has been removed with this patch. It has been replaced with a new option called EDI Claim Status Report [IBCED EDI CLAIM STATUS REPORT]. This new report allows users to view their electronic claim activity utilizing many different selection and sorting criteria. 9. Option View/Print EDI Bill Extract Data [IBCE EDI VIEW/PRINT EXTRACT] has been enhanced with this patch. Users may now choose to display all of the claim's EDI segments or only selected EDI segments. The piece numbers are displayed next to the field name, and all of the field names have been updated to reflect their true HIPAA name. 10. The Print Report action in the option Claims Status Awaiting Resolution [IBCE CLAIMS STATUS AWAITING] (CSA) has been enhanced to optionally display the Review Comments associated with the CSA rejection messages on file. Users will be asked if they want to include Review Comments with the report. 11. Chiropractic data is prevented from being transmitted on an electronic institutional claim. 12. Two new IB edit checks were added to make sure the current payer address is valid and also any other payer addresses are valid. A valid payer address contains at a minimum address line 1, city, state, and zipcode. 13. FL-59 on the UB-04 printed claim form is the code for the patient relationship to insured. For pharmacy claims, this patch restores the printed codes to the pre-HIPAA usage. Namely, 01 for patient/self/ cardholder, 02 for spouse, 03 for child, and 04 for other. 14. A new IB edit check was added for UB-04 MRA Request claims. For any line item on these claims where the modifier "GY" exists, the system now requires non-covered charges for that line item. This patch addresses the following New Service Request (NSR): ------------------------------------------------------------- There are no New Service Requests associated with this patch. This patch addresses the following Remedy Tickets: ---------------------------------------------------- 1. HD64525 IND-1204-40898 UNABLE TO MAKE BILL COMMENT ON REQUESTED MRA BILL 2. HD240240 HIPPA X12 codes printing on claims Overview of Remedy Tickets: ---------------------------- 1. HD64525 IND-1204-40898 UNABLE TO MAKE BILL COMMENT ON REQUESTED MRA BILL Problem: -------- Billers cannot add Bill Comments in TPJI when the claim is in a status of REQUEST MRA. The ability to add additional comments to claims is a needed functionality request. Resolution: ----------- This patch allows the billers to enter and view claim level comments for MRA Request claims in both the Third Party Joint Inquiry (TPJI) screen and in the MRA WorkList screen. 2. HD240240 HIPPA X12 codes printing on claims Problem: -------- Paper pharmacy UB-04 claims are printing the HIPAA X12 patient relationship to insured code in FL-59. These codes are not valid for pharmacy claims. Resolution: ----------- Modify the output formatter entry for FL-59 on the UB-04 printed claim form to convert the VistA internal patient relationship code to the HIPAA code for non-pharmacy claims and to the National Council for Prescription Drug Programs (NCPDP) code for pharmacy claims. The valid NCPDP codes are: 01 - Cardholder 02 - Spouse 03 - Child 04 - Other Components Sent With Patch -------------------------- 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 ----------------------------------------------------------------------- 2 PATIENT YES YES NO 350.8 IB ERROR NO NO YES OVER NO 350.9 IB SITE PARAMETERS YES YES NO 355.33 INSURANCE BUFFER YES YES NO 356 CLAIMS TRACKING YES YES NO 361.1 EXPLANATION OF BENEFITS YES YES NO 364.5 IB DATA ELEMENT DEFINITION NO NO YES OVER YES 364.6 IB FORM SKELETON DEFINITION YES NO YES OVER YES 364.7 IB FORM FIELD CONTENT NO NO YES OVER YES 399 BILL/CLAIMS YES YES NO The following is a list of fields included in this patch: Field Name (Number) File Name (Number) ------------------- ------------------ PT. RELATIONSHIP - HIPAA (4.03) INSURANCE TYPE (sub-file) (2.312) PT. RELATIONSHIP TO INSURED (16) INSURANCE TYPE (sub-file) (2.312) NAME OF INSURED (17) INSURANCE TYPE (sub-file) (2.312) REMARKS TO APPEAR ON EACH FORM (1.04) IB SITE PARAMETERS (350.9) PT. RELATIONSHIP TO INSURED (60.06) INSURANCE BUFFER (355.33) PT. RELATIONSHIP - HIPAA (60.14) INSURANCE BUFFER (355.33) ADDITIONAL COMMENT (1.08) CLAIMS TRACKING (356) CORRECTED DATA MESSAGE (6.03) EXPLANATION OF BENEFITS (361.1) ORIGINAL 06 RECORD DATA (61.01) EXPLANATION OF BENEFITS (361.1) MAILMAN HEADER INFORMATION (62.01) EXPLANATION OF BENEFITS (361.1) SHORT DESCRIPTION (.1) IB FORM SKELETON DEFINITION (364.6) MRA REVIEW STATUS (28.1) BILL/CLAIMS (399) NON-COVERED CHARGE (.09) REVENUE CODE (sub-file) (399.042) COMMENT ENTERED DATE (.01) MRA REQUEST CLAIM COMMENTS (sub-file) (399.077) COMMENT ENTERED BY (.02) MRA REQUEST CLAIM COMMENTS (sub-file) (399.077) COMMENTS (.03) MRA REQUEST CLAIM COMMENTS (sub-file) (399.077) The following is a list of templates included in this patch: Template Name Type File Name (Number) ------------- ---- ------------------ IB SCREEN7 INPUT BILL/CLAIMS (399) IB SCREEN82 INPUT BILL/CLAIMS (399) IB SCREEN8H INPUT BILL/CLAIMS (399) IBCN PATIENT INSURANCE INPUT INSURANCE TYPE (sub-file) (2.312) The following is a list of protocols included in this patch: Protocol -------- IBCE 2ND PRVCARE ADD SEND TO SITE IBCE 2ND PRVCARE DELETE SEND TO SITE IBCE 2ND PRVCARE EDIT SEND TO SITE IBCE 2ND PRVCARE MENU SEND TO SITE IBCE EXIT SEND TO SITE IBCE PRVCARE ADD SEND TO SITE IBCE PRVCARE DELETE SEND TO SITE IBCE PRVCARE EDIT SEND TO SITE IBCE PRVCARE UNIT MAINT SEND TO SITE IBCE PRVCARE UNIT MENU SEND TO SITE IBCE PRVINS ADD SEND TO SITE IBCE PRVINS CHG FORMAT SEND TO SITE IBCE PRVINS CHG INS SEND TO SITE IBCE PRVINS DELETE SEND TO SITE IBCE PRVINS DISPLAY PARAMS SEND TO SITE IBCE PRVINS EDIT SEND TO SITE IBCE PRVINS ID SEND TO SITE IBCE PRVINS JUMP SEND TO SITE IBCE PRVMAINT DELETE AT SITE IBCE PRVMAINT ACTION DELETE AT SITE IBCE PRVNUM ADD SEND TO SITE IBCE PRVNUM DELETE SEND TO SITE IBCE PRVNUM EDIT SEND TO SITE IBCE PRVNVA DEMOG SEND TO SITE IBCE PRVNVA IDS DELETE AT SITE IBCE PRVNVA LOF ADD SEND TO SITE IBCE PRVNVA LOF DELETE SEND TO SITE IBCE PRVNVA LOF EDIT SEND TO SITE IBCE PRVNVA LOF MAINT SEND TO SITE IBCE PRVNVA MAINT SEND TO SITE IBCE PRVNVA NF LI SEND TO SITE IBCE PRVNVA NF LO SEND TO SITE IBCE PRVNVA NONIND MAINT SEND TO SITE IBCE PRVNVA NP PI SEND TO SITE IBCE PRVNVA NP PO SEND TO SITE IBCE PRVNVA PROVINFO SEND TO SITE IBCE PRVNVA SECIDS DELETE AT SITE IBCE PRVPRV MAINT SEND TO SITE IBCEM COB COMMENTS SEND TO SITE IBCEM COB MANAGEMENT USE AS LINK FOR MENU ITEMS IBCEM ENTER COMMENTS SEND TO SITE IBCEM ENTER COMMENTS 1 SEND TO SITE IBCEM MRA STATUS SEND TO SITE IBCEM VIEW COMMENTS SEND TO SITE IBCI BLANK PROTOCOL SEND TO SITE IBJT AR COMMENT ADD SEND TO SITE VALM QUIT SEND TO SITE The following is a list of List Templates included in this patch: IBCE PRVMAINT DELETE AT SITE IBCEM MRA COMMENTS SEND TO SITE IBCEM MRA MANAGEMENT SEND TO SITE IBJT AR COMMENT HISTORY SEND TO SITE The following is a list of Options included in this patch: IBCE BATCH STATUS DETAIL DELETE AT SITE IBCE BATCHES PENDING TOO LONG SEND TO SITE IBCE TXMT MGMNT REPORTS USE AS LINK FOR MENU ITEMS IBCED EDI CLAIM STATUS REPORT SEND TO SITE Test Sites: ----------- Hudson Valley HCS Martinsburg Memphis North Chicago Tennessee Valley HCS Upstate New York HCS Documentation Retrieval ----------------------- The EDI Billing User's Guide has been updated. This guide is available for download at the following websites: http://www.va.gov/vdl/Financial_Admin.asp?appID=45 http://vaww.vistau.med.va.gov/VistaU/e-bp/e-claims.htm The 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 File Name --------- IB_2_377UG.PDF Pre/Post Installation Overview ------------------------------ The pre and post installation routines are automatically deleted after this patch is installed. The pre-installation routine deletes changed output formatter entries in this build so they are installed cleanly, and it removes obsolete data from the patient insurance policy file, and it deletes a traditional x-ref in an output formatter infrastructure file. The post-installation routine runs a conversion that populates the patient's relationship to the policy holder information in both the PATIENT file (#2) and the INSURANCE BUFFER file (#355.33). It also sends an email message to staff at the Austin FSC so they are alerted when a site has installed this VistA patch. ================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 selections 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] Patient Insurance Info View/Edit [IBCN PATIENT INSURANCE] MRA Management WorkList [IBCE MRA MANAGEMENT] Third Party Joint Inquiry [IBJ THIRD PARTY JOINT INQUIRY] Provider ID Maintenance [IBCE PROVIDER MAINT] Cancel Bill [IB CANCEL BILL] View/Print EDI Bill Extract Data [IBCE EDI VIEW/PRINT EXTRACT] Claims Status Awaiting Resolution [IBCE CLAIMS STATUS AWAITING] **** 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 on this. 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 - Anywhere from 10 minutes up to 2 hours depending on the size of the patient database. All patient insurance policies are examined in both the pre-install routine and the post-install routine. 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*2.0*377): 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 Rebuild Menu Trees Upon Completion of Install? NO//' Answer YES, unless your system does this in a nightly TaskMan process. c. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//' answer NO d. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//' answer YES if installing during working hours 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] Patient Insurance Info View/Edit [IBCN PATIENT INSURANCE] MRA Management WorkList [IBCE MRA MANAGEMENT] Third Party Joint Inquiry [IBJ THIRD PARTY JOINT INQUIRY] Provider ID Maintenance [IBCE PROVIDER MAINT] Cancel Bill [IB CANCEL BILL] View/Print EDI Bill Extract Data [IBCE EDI VIEW/PRINT EXTRACT] Claims Status Awaiting Resolution [IBCE CLAIMS STATUS AWAITING] f. When prompted 'Enter protocols you wish to mark as 'Out Of Order':' press . Routine Information: ==================== The second line of each of these routines now looks like: ;;2.0;INTEGRATED BILLING;**[Patch List]**;21-MAR-94;Build 23 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: IBCBB Before: B70083781 After: B71092497 **80,51,137,288,327,361,371,377** Routine Name: IBCBB0 Before: n/a After: B3028781 **377** Routine Name: IBCBB3 Before: B41352216 After: B47525889 **51,137,155,349,371,377** Routine Name: IBCC1 Before: B14938424 After: B38579110 **19,95,160,159,320,347,377** Routine Name: IBCE835 Before: B36249252 After: B38860252 **137,135,155,377** Routine Name: IBCE837A Before: B42933569 After: B49945293 **137,191,211,232,296,377** Routine Name: IBCEBUL Before: B7594280 After: B14688365 **137,250,377** Routine Name: IBCECOB1 Before: B67244551 After: B68510086 **137,155,288,348,377** Routine Name: IBCECOB6 Before: n/a After: B23813020 **377** Routine Name: IBCECSA3 Before: B27586417 After: B42335133 **137,320,371,377** Routine Name: IBCEDC Before: n/a After: B29467886 **377** Routine Name: IBCEDP Before: n/a After: B32525754 **377** Routine Name: IBCEDS Before: n/a After: B75763086 **377** Routine Name: IBCEDS1 Before: n/a After: B30639639 **377** Routine Name: IBCEF73 Before: B54498448 After: B59655554 **232,320,358,349,377** Routine Name: IBCEFG1 Before: B26758325 After: B23263677 **52,51,137,181,197,232,288, 349,371,377** Routine Name: IBCEMCA2 Before: B17866540 After: B19841299 **320,377** Routine Name: IBCEOB Before: B66548072 After: B58527801 **137,135,265,155,377** Routine Name: IBCEOB00 Before: B60829108 After: B75423000 **155,349,377** Routine Name: IBCEOB01 Before: n/a After: B24417822 **377** Routine Name: IBCEP0 Before: B68376329 After: B72988183 **137,191,239,232,320,348,349,377** Routine Name: IBCEP0A Before: B41076613 After: B41455887 **137,232,320,377** Routine Name: IBCEP4 Before: B23664048 After: B23601105 **137,320,348,349,377** Routine Name: IBCEP4A Before: B49631156 After: B54389720 **137,232,280,349,377** Routine Name: IBCEP5 Before: B48846448 After: B48717212 **137,232,320,348,349,377** Routine Name: IBCEP6 Before: B11155166 After: B19310181 **137,232,320,377** Routine Name: IBCEP8 Before: B72198572 After: B80393448 **51,137,232,288,320,343,374,377** Routine Name: IBCEP82 Before: B24437621 After: B31460736 **343,374,377** Routine Name: IBCEPA Before: B50420799 After: B57987337 **320,348,377** Routine Name: IBCERP3 Before: B8609666 After: B24573380 **137,296,377** Routine Name: IBCEXTRP Before: B22039999 After: B44709750 **137,197,211,348,349,377** Routine Name: IBCNADD Before: B5277961 After: B6555779 **52,80,377** Routine Name: IBCNBEE Before: B45297417 After: B44866934 **82,184,252,251,356,361,371,377** Routine Name: IBCNQ Before: B25553746 After: B25492974 **51,320,377** Routine Name: IBCNSP01 Before: B32694224 After: B32701738 **43,52,85,251,371,377** Routine Name: IBCNSP1 Before: B54597105 After: B59835347 **6,28,40,43,52,85,103,361,371,377** Routine Name: IBCSC3 Before: B36137301 After: B37249647 **8,43,52,80,82,51,137,232,320,377** Routine Name: IBJPS Before: B5288376 After: B5270103 **39,52,70,115,143,51,137,161, 155,320,348,349,377** Routine Name: IBJPS2 Before: B48618964 After: B47271248 **39,52,115,143,51,137,161,155, 320,348,349,377** Routine Name: IBJTA1 Before: B15741142 After: B18194531 **39,137,377** Routine Name: IBJTTC Before: B12317143 After: B21337725 **39,377** Routine Name: IBTOBI1 Before: B18274759 After: B18898112 **276,377** Routine Name: IBY377PO Before: n/a After: B47817727 **377** Routine Name: IBY377PR Before: n/a After: B41295354 **377** Routine list of preceding patches: 250, 276, 296, 347, 371, 374 ============================================================================= User Information: Entered By : JUTZI,BILL Date Entered : AUG 14, 2007 Completed By: ROBBINS,BRADLEY Date Completed: MAY 23, 2008 Released By : CAULFIELD,MARY Date Released : JUN 05, 2008 ============================================================================= Packman Mail Message: ===================== $END TXT