$TXT Created by HOLLOWAY,THOMAS J at DEVFEY.FO-ALBANY.MED.VA.GOV (KIDS) on Tuesday, 01/21/03 at 10:05 ============================================================================= Run Date: APR 02, 2003 Designation: IB*2*207 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #190 Status: Released Compliance Date: MAY 03, 2003 ============================================================================= Associated patches: (v)IB*2*137 <<= must be installed BEFORE `IB*2*207' Subject: Fixes for EDI billing fields Category: - Input Template - Data Dictionary - Routine Description: ============ This patch modifies two entries in file 364.7 - IB FORM FIELD CONTENT to address issues with insurance company rejections when Medicare is indicated as the primary insurance and with missing Admit/Discharge dates on outpatient professional claims. It also modifies the way the provider id is pulled when a care unit is needed and the billing is for the secondary coverage on a claim where Medicare is primary. ASSOCIATED E3R(s): ================== N/A ASSOCIATED NOIS: ================ 1. LIT-1102-70321 Problem W/Box 24K on HCFA Claims Duplicate: BOI-1102-50254 2. WAS-0902-20562 ERROR: DISCHARGE DATE IS REQUIRED 3. CTX-1002-70456 Medicare as Primary Rejecting NOIS OVERVIEW: ============== 1. LIT-1102-70321 Problem W/Box 24K on HCFA Claims Problem: -------- When a Payer (a Blue in this case) who is secondary on a claim that includes MEDICARE coverage requires a special provider id based on a care unit for a professional claim, that id is not being transmitted correctly. Instead, the default MEDICARE id is transmitted. Resolution: ----------- This patch corrects the issue by modifying screen 8 for both UB92 and HCFA to get the correct provider id for a secondary insurance if a care unit is required. 2. WAS-0902-20562 ERROR: DISCHARGE DATE IS REQUIRED Problem: -------- For outpatient professional claims, not related to an inpatient episode, the Discharge Date was not being filled. Some payers required an entry in that field. Resolution: ----------- The program will now output the statement 'To Date' in the Discharge Date field for outpatient professional claims. 3. CTX-1002-70456 Medicare as Primary Rejecting Problem: -------- HCFA claims were being rejected when billing the secondary coverage where Medicare was primary due to an invalid policy type code being sent. Resolution: ----------- The output formatter is changed to send the correct code. TECHNICAL: ========== 1. Changes are made to routines: IBCEU, IBCSC8H, IBCEP3 For file #399 -- BILL/CLAIMS FILE Changes are made to input templates: IB SCREEN8H, IB SCREEN82 Changes are made to field 222 -- PROVIDER, sub-fields: .09 PRIMARY PROV ID CARE UNIT .1 SECONDRY PROV ID CARE UNIT .11 TERTIARY PROV ID CARE UNIT 2. Entry 28 in file 364.7 is affected as follows: Field 1-FORMAT CODE is changed from: K IBXDATA I $G(IBXSAVE("DISDT")) S IBXDATA=$$DT^IBCEFG1(IBXSAVE ("DISDT")\1,"","D8") to: S IBXDATA=$G(IBXSAVE("DISDT")) D:$S(IBXDATA="":'$$INPAT^IBCEF (IBXIEN,1),1:0) F^IBCEF("N-STATEMENT COVERS TO DATE",,,IBXIEN) I IBXDATA S IBXDATA=$$DT^IBCEFG1(IBXDATA\1,"","D8") Field 3-FORMAT CODE DESCRIPTION is changed from: Extract only date from date/time retrieved from IBXSAVE array previously extracted. Format date in CCYYMMDD format. If data element's value is null, do not output. to: Extract only date from date/time retrieved from IBXSAVE array previously extracted. For an outpatient claim not related to an inpatient episode, output the statement 'To Date'. Format date in CCYYMMDD format. If data element's value is null, do not output. 3. The data element in VistA's flat file for the Other Insurance Billing Provider Id type (OI1-13, mapped to 2330B/REF(3)) was using the INSURANCE CO LEVEL parameter to determine the correct code to send. It will now use the POLICY LEVEL parameter as does the corresponding data for the CURRENT INSURANCE (CI1-9). Entry 900 in file 364.7 is affected as follows: Field .03-DATA ELEMENT is changed from: 234 [N-OTHER INSURANCE CO TYPES] to: 236 [N-OTH INS POL TYPES ] Field #1 - FORMAT CODE is changed from: N Z,IBZ M IBZ=IBXDATA K IBXDATA F Z=1,2 I $P($G(IBZ),U,Z),$D(^DGCR (399,IBXIEN,"I"_(Z+1))) S IBXDATA(Z)=$P("G2^1C^1D^1H^G2^",U,+$P(IBZ, U,Z)) I IBXDATA(Z)="" S IBXDATA(Z)="G2" to: N A,Z,Q S Q=IBXDATA K IBXDATA F Z=1,2 S A=$P(Q,U,Z) I $D(^DGCR(399, IBXIEN,"I"_(Z+1))) S IBXDATA(Z)=$S(A="":"G2","MAMB16"[A:"1C",A="TV"! (A="MC"):"1D",A="CH":"1H",A="BL":$S($$FT^IBCEF(IBXIEN)=2:"1B",1:"1A") ,1:"G2") Field #3 - FORMAT CODE DESCRIPTION is changed from: This is a group data element so more than 1 occurrence of a value is possible for the data element in the IBXDATA array. If any 'other' insurance company data is found, the data is formatted as the insurance type of the insurance company in X12 format. to: If any 'other' insurance company data is found, the data is formatted from the electronic type of plan of the insurance company policy in X12 format. Refer to the 837 V4010 (professional) field 2330/REF(3)/01 for details. The pre-init routine, IB20P207, handles the data file changes described above in items 2 and 3. PARTICIPATING TEST SITES: ========================= INDIANAPOLIS CENTRAL TEXAS VHCS LITTLE ROCK VAMC PALO ALTO VAMC WASHINGTON VAMC ROUTINE SUMMARY =============== The following is a list of the routines included in this patch. The second line of each of these routines now looks like: ;;2.0;INTEGRATED BILLING;**[PATCH LIST]**;21-MAR-94 CHECK^XTSUMBLD results Routine name Before Patch After Patch Patch List ============ ============ =========== =========== IBCEP3 10241732 10299570 137,207 IBCEU 13162792 13254284 51,137,207 IBCSC8H 10788187 12543053 51,137,207 IB20P207 N/A 6552022 207 INSTALLATION INSTRUCTIONS ========================= This patch can be installed at any time, however, all IB users need to be off the system, the IB MT NIGHT COMP job should not be running and sites should not be actively transmitting claims. If installed during the normal workday it is recommended that the following menu options (File #19) be disabled to prevent possible conflicts while running the KIDS Install. Other VISTA users will not be affected. Billing Supervisor Menu [IB BILLING SUPERVISOR MENU] Billing Clerk's Menu [IB BILLING CLERK MENU] EDI Menu For Electronic Bills [IBCE 837 EDI MENU] Install time - less than 5 minutes. 1. LOAD TRANSPORT GLOBAL --------------------- Choose the PackMan message containing this patch and invoke the INSTALL/CHECK MESSAGE PackMan option. 2. DISABLE ROUTINE MAPPING (DSM for open VMS sites only) ----------------------- Disable routine mapping on all systems for the routines listed in the routine summary NOTE: If the routines included in this patch are not currently in your mapped routine set, please skip this step. 3. 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 --- 1 Load a Distribution 2 Verify Checksums in Transport Global 3 Print Transport Global 4 Compare Transport Global to Current System 5 Backup a Transport Global 6 Install Package(s) Restart Install of Package(s) Unload a Distribution 4. From this menu, you may elect to use the following options (When prompted for the INSTALL NAME, enter IB*2.0*207): 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. 5. Use the Install Package(s) option and select the package IB*2.0*207. a. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//', answer NO. b. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//' answer YES. c. When prompted 'Enter options you wish to mark as 'Out of Order':' Enter the following: Billing Supervisor Menu [IB BILLING SUPERVISOR MENU] Billing Clerk's Menu [IB BILLING CLERK MENU] EDI Menu For Electronic Bills [IBCE 837 EDI MENU] d. When prompted 'Enter protocols you wish to mark as 'Out of Order': Enter the following: (press return) 6. REBUILD MAPPED ROUTINES(S) (DSM for Open VMS sites only) -------------------------- Optional - Include the routines distributed with this patch in the mapped routine set. NOTE: This step is only necessary if you performed step 2 or if you wish to include the routines in your mapped set. 7. DELETE PRE-INIT ROUTINE ------------------------ Delete IB20P207 routine from your system after successful installation of this patch. INSTALLATION EXAMPLE: --------------------- Select Installation Option: 6 Install Package(s) Select INSTALL NAME: IB*2.0*207 Loaded from Distribution 1/10/03@17:06:48 => IB*2*207 This Distribution was loaded on Jan 10, 2003@17:06:48 with header of IB*2*207 It consisted of the following Install(s): IB*2.0*207 Checking Install for Package IB*2.0*207 Install Questions for IB*2.0*207 Incoming Files: 399 BILL/CLAIMS (Partial Definition) Note: You already have the 'BILL/CLAIMS' File. Want KIDS to INHIBIT LOGONs during the install? YES// NO Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES// Enter options you wish to mark as 'Out Of Order': IB BILLING SUPERVISOR MENU Billing Supervisor Menu Enter options you wish to mark as 'Out Of Order': IB BILLING CLERK MENU Bi lling Clerk's Menu Enter options you wish to mark as 'Out Of Order': IBCE 837 EDI MENU EDI Me nu For Electronic Bills Enter options you wish to mark as 'Out Of Order': Enter protocols you wish to mark as 'Out Of Order': Delay Install (Minutes): (0-60): 0// Enter the Device you want to print the Install messages. You can queue the install by enter a 'Q' at the device prompt. Enter a '^' to abort the install. DEVICE: HOME// VIRTUAL CONNECTION Install Started for IB*2.0*207 : Jan 10, 2003@17:14:06 Build Distribution Date: Jan 10, 2003 Installing Routines: Jan 10, 2003@17:14:06 Running Pre-Install Routine: ^IB20P207 Updating format code for Admit Date. Updating format code description for Admit Date. Step complete. For IEN 900, file 364.7: changing data element from N-OTHER INSURANCE CO TYPES to N-OTH INS POL TYPES. Updating format code for N-OTH INS POL TYPES. Updating format code description for N-OTH INS POL TYPES. Step complete. Installing Data Dictionaries: . Jan 10, 2003@17:14:08 Installing PACKAGE COMPONENTS: Installing INPUT TEMPLATE Jan 10, 2003@17:14:09 Updating Routine file... The following Routines were created during this install: IBXX IBXX1 IBXX10 IBXX11 IBXX12 IBXX13 IBXX14 IBXX15 IBXX16 IBXX17 IBXX18 IBXX19 IBXX2 IBXX20 IBXX21 IBXX22 IBXX23 IBXX24 IBXX25 IBXX26 IBXX3 IBXX4 IBXX5 IBXX6 IBXX7 IBXX8 IBXX9 IBXSC8H IBXSC8H1 IBXSC8H2 IBXSC8H3 IBXSC8H4 IBXSC8H5 IBXSC8H6 IBXSC8H7 IBXSC8H8 IB*2.0*207 -------------------------------------------------------------------------------- IBXSC8H9 IBXSC82 IBXSC821 IBXSC822 IBXSC823 IBXSC824 IBXSC825 IBXSC826 IBXSC827 IBXSC828 IBXSC829 Updating KIDS files... IB*2.0*207 Installed. Jan 10, 2003@17:14:10 Install Message sent #8710 -------------------------------------------------------------------------------- +------------------------------------------------------------+ 100% | 25 50 75 | Complete +------------------------------------------------------------+ Install Completed Routine Information: ==================== Routine Name: - IB20P207 This is a pre-install routine to update data entries in file 364.7 Routine Checksum: Routine Name: - IBCEP3 Routine Checksum: Routine Name: - IBCSC8H Routine Checksum: Routine Name: - IBCEU Routine Checksum: ============================================================================= User Information: Entered By : HOLLOWAY,THOMAS J Date Entered : DEC 20, 2002 Completed By: PEREZ,CAROL Date Completed: APR 02, 2003 Released By : JACKSON,SHERYL Date Released : APR 02, 2003 ============================================================================= Packman Mail Message: ===================== $END TXT