============================================================================= Run Date: OCT 10, 2003 Designation: IB*2*135 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #214 Status: Released Compliance Date: NOV 10, 2003 ============================================================================= Subject: EDI LOCKBOX - IB CHANGES Category: - Data Dictionary - Routine - Other - Enhancement (Mandatory) Description: ============ INTRODUCTION ============ The software for this patch, IB*2*135, and associated patch PRCA*4.5*173, are not being distributed through the National Patch Module. These patches are being distributed as a single KIDS software distribution (host file). This patch contains the informational portion of IB*2*135 only. Refer to the patch documentation for patch PRCA*4.5*173 for the instructions on how to acquire, install, and implement the patch software. Patch IB*2*135 contains the Integrated Billing software changes that support the Third Party EDI Lockbox initiative where third party payers will be sending electronic funds transfers (EFT) to the V.A.'s Lockbox bank in place of paper checks currently sent to the sites. They will also be sending Explanation of Benefit (EOB) statements electronically as Electronic Remittance Advices (ERA) in place of the paper EOBs they currently send to AR at the sites. These electronic EOBs will be stored in the Integrated Billing EXPLANATION OF BENEFITS file #361.1 and are available to be viewed in TPJI under the Bill Charges action. An additional piece of functionality indirectly affecting the Integrated Billing software is the addition of a call to A/R to auto-audit a bill. This can occur if the IB system receives and files an electronic bill status message, the bill is currently not audited in AR, the rate type of the bill has been set up to allow auto-audit (an AR function) and the relay status code of the return message is one of a pre-determined set that indicates the bill has either been sent to the clearinghouse's print shop or sent electronically to the payer. TECHNICAL DESCRIPTION ===================== 1. New Fields: File: EXPLANATION OF BENEFITS (#361.1) CLAIM STATUS CODE (#.21) TRANSFERRED IN (#7.01) PAYER CONTACT NAME (#25.01) CONTACT NUMBER 1 (#25.02) CONTACT TYPE 1 (#25.03) CONTACT NUMBER 2 (#25.04) CONTACT TYPE 2 (#25.05) CONTACT NUMBER 3 (#25.06) CONTACT TYPE 3 (#25.07) MESSAGE CHECKSUM (#100.05) Subfile (exists): 835 LINE LEVEL ADJUSTMENTS (#361.115) SERVICE DATE TO (#.17) PROCEDURE TYPE (#.18) LINE ITEM REMARK CODE (#3.01) LINE ITEM REMARK CODE TEXT (#3.02) Subfile (new): AR AMOUNTS DISTRIBUTION (#361.18) BILL # (#.01) AMOUNT (#.02) BILL REFERENCE (#.03) File: RATE TYPE (#399.3) BILL RESULTING FROM (#.11) 2. Modified Fields: File: EXPLANATION OF BENEFITS (#361.1) EOB TYPE (#.04) - added output transform ENTRY DATE/TIME (#.05) - modified description EOB DATE/TIME (#.06) - modified description MESSAGE STORAGE ERRORS (#.20) - changed to no wrap mode Subfile: 835 LINE LEVEL ADJUSTMENTS (#361.115) AMOUNT PAID (#.03) - added negative numbers PROCEDURE (#.04) - changed the field from pointer to free text SERVICE DATE FROM (#.16) - modified name Subfile: ADJUSTMENTS (#361.1151) Subfile: REASONS (#1) AMOUNT (#.02) - added negative numbers Subfile: PAID MODIFIERS (#361.1152) PAID MODIFIERS (#.01) - changed to free text Subfile: 835 CLAIM LEVEL ADJUSTMENTS (#361.11) Subfile: REASONS (#1) AMOUNT (#.02) - added negative numbers 3. MODIFIED FILE ENTRIES: There are 2 entries in file 364.7 that have been included to correct a problem where electronic institutional (UB92) bills could not output more than 1 modifier for a procedure. These are internal entries #181 and #182 and will be automatically updated on your system. 4. PRE-INSTALLATION: The patch contains a pre-installation routine IBY135PR that deletes the data dictionary entry for the PROCEDURE field (#.04) in the EXPLANATION OF BENEFITS FILE (#361.1), field 835 LINE LEVEL ADJUSTMENTS (field #15, subfield #361.115). This is necesssary because the build contains this field and changes its type from pointer to free text. The kids build does not fully clean up the DD entry when this type of change is made, so the field must first be deleted in the pre-install and then re-added in the main part of the installation to prevent DD corruption. 5. ROUTINE SUMMARY: This patch consists of a total of 16 routines, including 7 new routines and 9 existing routines that have been modified. The following is a list of the routine(s) included in this patch. The second line of each of these routine(s) will look like: ;;2.0;INTEGRATED BILLING;**[patch list]**;21-MAR-94 CHECK^XTSUMBLD results Routine name Before Patch After Patch Patch List ============ ============ =========== ========== IBCE835 10852630 9078490 137,135 IBCE835A N/A 2956626 135 IBCECSA5 9356045 14446600 137,135 IBCECSA6 13453792 23185880 137,135 IBCECSA7 N/A 3424677 135 IBCEF22 20703815 20740762 51,137,135 IBCEMU1 N/A 737802 135 IBCEOB 19814300 16335907 137,135 IBCEOB0 N/A 23853864 135 IBCEOB1 19375262 13686445 137,135 IBCEOBAR N/A 925727 135 IBCEST 14403471 15507818 137,189,197,135 IBECEA 5007735 5087914 199,135 IBJTBA 14480346 13378794 39,80,51,137,135 IBJTBA1 N/A 8893946 135 IBY135PR N/A 802599 135 Number of Routines = 16 4. PRE-REQUISITE PATCHES This software distribution requires the following patches be installed prior to installation. KIDS will verify the patches are installed: For patch PRCA*4.5*173: PRCA*4.5*98 PRCA*4.5*107 PRCA*4.5*149 PRCA*4.5*167 PRCA*4.5*176 PRCA*4.5*207 For patch IB*2.0*135: IB*2.0*197 IB*2.0*199 IB*2.0*210 INSTALLATION INSTRUCTIONS ========================= Software and Documentation Retrieval ------------------------------------ The software for this patch is being distributed in a host file. The host file will contain two KIDS builds. The first build will be for the Accounts Receivable patch, PRCA*4.5*173, the second build will be for the Integrated Billing patch, IB*2.0*135. Please refer to the 'Software and Documentation Retrieval' section of the PRCA*4.5*173 patch description for instructions on how to acquire the patch software and documentation. After the patch is installed successfully, you can delete the pre-install routine IBY135PR. Routine Information: ==================== Routine Name: - IBCECSA5 Routine Checksum: Routine Name: - IBCECSA6 Routine Checksum: Routine Name: - IBCEOB1 Routine Checksum: Routine Name: - IBCEOB Routine Checksum: Routine Name: - IBCEOB0 Routine Checksum: Routine Name: - IBCEOBAR Routine Checksum: Routine Name: - IBECEA Routine Checksum: Routine Name: - IBCEST Routine Checksum: Routine Name: - IBJTBA Routine Checksum: Routine Name: - IBJTBA1 Routine Checksum: Routine Name: - IBCE835 Routine Checksum: Routine Name: - IBCE835A Routine Checksum: Routine Name: - IBCEMU1 Routine Checksum: Routine Name: - IBCECSA7 Routine Checksum: Routine Name: - IBCEF22 Routine Checksum: Routine Name: - IBY135PR Routine Checksum: ============================================================================= User Information: Entered By : KOPP,TERRY M Date Entered : JUN 06, 2000 Completed By: TORRANCE,LORI Date Completed: OCT 10, 2003 Released By : BOTTINI,STEVE Date Released : OCT 10, 2003 ============================================================================= Packman Mail Message: ===================== No routines included