$TXT Created by HOLLOWAY,THOMAS J at MNTVBB.FO-ALBANY.MED.VA.GOV (KIDS) on Monday, 07/07/03 at 17:04 ============================================================================= Run Date: FEB 05, 2004 Designation: IB*2*216 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #226 Status: Released Compliance Date: MAR 07, 2004 ============================================================================= Subject: ADMIT & DISCHARGE HOUR (Outpatient Claim) Category: - Routine Description: ============ This patch changes the settings in the IB FORM SKELETON DEFINITION file (#364.6) to allow local Output Formatter code to be written for the ADMISSION HOUR and DISCHARGE HOUR fields on the EDI 837 Transmission. ASSOCIATED E3R(s): ================== N/A ASSOCIATED NOIS: ================ 1. AUG-0103-31330 ADMIT & DISCHARGE HOUR (Outpatient Claim) PARTICIPATING TEST SITES: ========================= Butler, PA Bronx, NY Miami, FL Tomah, WI Wilmington, DE NOIS OVERVIEW: ============== 1. AUG-0103-31330 ADMIT & DISCHARGE HOUR (Outpatient Claim) Problem: -------- Some of the insurance companies are rejecting outpatient claims when submitted by electronic billing because the claims do not contain an ADMISSION HOUR and/or a DISCHARGE HOUR. So far, this is a very small minority of companies and does not seem to warrant a nationwide change to the electronic billing procedures. Normally, these fields do not apply to outpatient visits. If a regional payer is requiring them, they may have specific edit checks in place that do not apply to other regions. Resolution: ----------- The ADMISSION HOUR and DISCHARGE HOUR fields of the EDI 837 Transmission will be flagged to allow the local sites to create an Output Formatter override. If a site has a payer requiring these fields then it will be necessary to find out exactly what the payer wants entered in the field and have the local IRM staff write the code to be used in the Output Formatter. If you are not receiving rejected outpatient claims because of these fields, then you do not need to take any action. The sites that successfully tested the override utilized the data element type of CONSTANT VALUE. For more information on using the Output Formatter see the Tips & Tricks document Output_Formatter_ITC_1999.pdf which can be downloaded from the anonymous.software ftp sites. Albany ftp.fo-albany.med.va.gov anonymous.software Hines ftp.fo-hines.med.va.gov anonymous.software Salt Lake City ftp.fo-slc.med.va.gov anonymous.software TECHNICAL: ========== 1. AUG-0103-31330 ADMIT & DISCHARGE HOUR (Outpatient Claim) a. File 364.6, records 55 and 57, field .07 changed from 0 to 1, this changes up-arrow piece 7 of the zero node. The 7th piece represents (LOCAL OVERRIDE ALLOWED; 0=NO and 1=YES). Example from record 55: Before: ^IBA(364.6,55,0) = 8^N^^50^1^^0^15^2^ADMISSION HOUR^^1 After: ^IBA(364.6,55,0) = 8^N^^50^1^^1^15^2^ADMISSION HOUR^^1 ROUTINE SUMMARY =============== 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 ============ ============ =========== ========== IB20P216 N/A 615921 216 INSTALLATION INSTRUCTIONS ========================= This patch can be installed at any time. Users do not need to be off the system. Installation time will be less than 2 minutes. 1. Choose the PackMan message containing this patch and invoke the INSTALL/CHECK MESSAGE PackMan option. 2. (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 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*216): 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*216. 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 NO. 6. (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. INSTALLATION EXAMPLE: ===================== Select INSTALL NAME: IB*2.0*216 Loaded from Distribution 5/7/03@14:21:46 => IB*2*216 This Distribution was loaded on May 07, 2003@14:21:46 with header of IB*2*216 It consisted of the following Install(s): IB*2.0*216 Checking Install for Package IB*2.0*216 Install Questions for IB*2.0*216 Want KIDS to INHIBIT LOGONs during the install? YES// NO Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES// NO 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// UCX/TELNET Install Started for IB*2.0*216 : May 07, 2003@14:22:39 Build Distribution Date: May 07, 2003 Installing Routines: May 07, 2003@14:22:39 Running Pre-Install Routine: ^IB20P216 Updating the LOCAL OVERRIDE ALLOWED field for IEN #55 in the IB FORM SKELETON DEFINITION file. Updating the LOCAL OVERRIDE ALLOWED field for IEN #57 in the IB FORM SKELETON DEFINITION file. Step complete. Installing PACKAGE COMPONENTS: Updating Routine file... Updating KIDS files... IB*2.0*216 Installed. May 07, 2003@14:22:40 Install Message sent #406071 ---------------------------------------------------------------------------- +------------------------------------------------------------+ 100% | 25 50 75 | Complete +------------------------------------------------------------+ Install Completed Routine Information: ==================== Routine Name: - IB20P216 Routine Checksum: ============================================================================= User Information: Entered By : THEROUX,JOHN Date Entered : APR 15, 2003 Completed By: PEREZ,CAROL Date Completed: FEB 04, 2004 Released By : NEWLIN,JARED Date Released : FEB 05, 2004 ============================================================================= Packman Mail Message: ===================== $END TXT