$TXT Created by KOPP,TERRY at DEVVCC.FO-ALBANY.MED.VA.GOV (KIDS) on Thursday, 09/16/04 at 15:46 ============================================================================= Run Date: OCT 06, 2004 Designation: IB*2*280 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #257 Status: Released Compliance Date: NOV 06, 2004 ============================================================================= Subject: HIPAA ENHANCEMENTS CLEAN UP Category: - Routine - Other Description: ============ **************************** IMPORTANT NOTE ***************************** This patch MUST be installed IMMEDIATELY after installing patch IB*2.0*232. Failure to do so may cause data problems with E_claims that will bring the wrath of the clearinghouse down on you. ************************************************************************* Associated patches: (v)IB*2.0*263 <<= must be installed BEFORE `IB*2.0*280' (v)IB*2.0*240 <<= must be installed BEFORE `IB*2.0*280' (v)IB*2.0*232 <<= must be installed BEFORE `IB*2.0*280' This patch will correct problems discovered very late in the testing of patch IB*2.0*232 (EDI Enhancements). 1. Some users were not able to add care units to the IB PROVIDER ID CARE UNIT file (#355.95). This was because a variable allowing the addition of the record (DLAYGO) was not set. This has been added to the code and the problem was corrected. Routine affected: IBCEP4A 2. The correct secondary provider id was not being pulled for pharmacy claims when the pharmacy id was assigned to a care unit AND another id was set up with the following characteristics for the same provider/insurance company: - it was assigned to the same form type as the pharmacy id - it was assigned to either an INPATIENT, an OUTPATIENT or both care types (the pharmacy id would be an 'RX' care type) - it had a care unit assigned to it also The code was changed to pull the correct pharmacy secondary provider id onto a pharmacy claim. Note the check sum for routine IBCEP3 will remain unchanged after the patch is installed because only comments were changed in that routine. Routines affected: IBCEP2, IBCEP3 3. Output Formatter changes have been made for the transmitted bill form. These changes are made in the pre-installation routine IBY280PR. - Two entries in the IB FORM FIELD CONTENT file (#364.7) are being deleted as they were moved by patch 232 and the old data was not removed. The entry #'s deleted from this file are 158 and 210. In addition, entry #390 was sent to replace entry #158. - The entry for the billing facility provider id has been changed to allow the site to use the output formatter override on this data for the transmission form. The data is output in the CI1-7 record in the 837 IB TRANSMISSION form and the change was made in entry #1316 in the IB FORM SKELETON DEFINITION file (#364.6). - The transmission fields for the institutional data for Form Locator 56 will no longer allow any data to be transmitted. The entry #'s changed in the IB FORM FIELD CONTENT file (#364.7) are 906, 907, 908, 909, 910. 4. A problem has been found when storing electronic explanation of benefits (EEOBs) where multiple line item remark codes are being sent by the payers. Up until this point, all but the last one was discarded. This patch allows for all of the remark codes to be stored. The post-installation will move all existing data in the LINE ITEM REMARK CODE field (#3.01) and the LINE ITEM REMARK CODE TEXT field (#3.02) of the EXPLANATION OF BENEFITS file (#361.1), 835 LINE LEVEL ADJUSTMENTS SUB-FIELD (#361.115) to a new multiple field so the data in the existing electronic explanation of benefits (EEOBs) is not lost. Once moved, the old LINE ITEM REMARK CODE data is deleted. Routines affected: IBCEOB0, IBCECSA5, IBY280PO 5. A new edit has been added to the billing authorization edits that prevents an insurance bill from being authorized if the COB payer sequence is not one of the following: PRIMARY, SECONDARY, TERTIARY. A new error entry for IB324 has been added to the IB ERROR file (#350.8) to report the error. Routine affected: IBCBB1 6. A few of the TRICARE intermediaries are requiring the sites to send a network id as a performing provider secondary id. This id must be the provider's SSN, but must still be identified as a network ID on the electronically submitted claims. Since this data already exists in VistA and it would be a huge burden on sites to enter this data a second time as a network ID, the system will automatically output the provider's SSN qualified as a network ID if the following two conditions are true: 1) The insurance company's ELECTRONIC PLAN TYPE field (#.15) in the GROUP INSURANCE PLAN file (#355.3) is identified as a TRICARE insurance. 2) There is no other network ID defined for the insurance company/provider combination. 7. When patch IB*2.0*240 was installed, it changed the EDI code to identify CHAMPUS/TRICARE insurance from CH to TR. This caused all electronic TRICARE claims to be rejected. This patch returns the EDI code for TRICARE (CHAMPUS) back to CH in the ELECTRONIC PLAN TYPE field (#.15) in the GROUP INSURANCE PLAN file (#355.3) and changes any 'TR' data in that field in the entries in the file back to 'CH'. 8. The pre-install also corrects several data-related problems introduced by the original EDI Enhancements patch IB*2.0*232. a. All provider id types in the file (#355.97) have been updated with the correct X12 codes. b. A trigger cross reference (#1) on the field now called DELETE 2006 4.1 (#4.1) in the INSURANCE COMPANY file (#36) is deleted. This cross reference triggered a field that no longer exists (ALTERNATE PERF PROV ID SOURCE). c. In the INSURANCE COMPANY file (#36), if this is the first time patch IB*2*280 has been installed at the site, the data for the parameters for PERFORMING PROVIDER SECONDARY ID TYPE (UB) (field #4.02) and for PERFORMING PROVIDER SECONDARY ID TYPE (HCFA) (field #4.01) is deleted. d. In patch IB*2.0*232, the remote mail group member for mail group MCR was removed mistakenly. This patch puts it back in to prevent loss of receipt of status messages at the site for claims that were sent before the patch 232 installation. The following is a list of files included in this patch: --------------------------------------------------------- File: GROUP INSURANCE PLAN (#355.3) Field: ELECTRONIC PLAN TYPE (#.15) This patch addresses the following New Service Request (NSR): ------------------------------------------------------------- There is no NSR associated with this patch. This patch addresses the following NOIS message(s): -------------------------------------------------- BED-0904-10431 TriCare claims rejecting NYH-0804-12097 Syntax: 63 375520 SBR 9TR HWH-0804-41716 Tricare Claims Rejecting - TR in the Identified Data Element Test Sites: ----------- CENTRAL PLAINS HCS CENTRAL TEXAS HCS EASTERN COLORADO HCS INDIANAPOLIS Other 'add-on' pilot sites also tested the software. ================INSTALLATION INSTRUCTIONS ================= It is recommended this patch be installed outside of normal business hours to avoid any complications resulting from Integrated Billing users on the system. Installation will take less than 5 minutes. Other VISTA users will not be affected. The following menus/options should be disabled prior to the start of the installation: Billing Clerk's Menu [IB BILLING CLERK MENU] Billing Supervisor Menu [IB BILLING SUPERVISOR MENU] Integrated Billing Master Menu [IB MANAGER 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 step 3 below. NOTE: If the routines included in this patch are not currently in Your mapped routine set, please skip this step. 3. COMPONENTS SENT WITH PATCH IB*2*280 ----------------------------------- 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 ============ ============ =========== ========== IBCBB1 16120102 16099428 27,52,80,93,106 51,151,148,153,137 232,280 IBCECSA5 14392627 15390816 137,135,263,280 IBCEF74 19367427 21276290 232,280 IBCEOB0 23853864 24365381 135,280 IBCEP2 16361218 18894285 137,181,232,280 IBCEP3 9164022 9164022 137,207,232,280 IBCEP4A 18271696 18584149 137,232,280 IBY280PO N/A 2423532 280 IBY280PR N/A 4549434 280 Total number of routines in the patch: 9 Total number of routines modified: 7 Total number of new routines: 2 Total number of deleted routines: 0 4. 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: 5. Select Installation Option: -------------------------- The following steps are OPTIONAL - 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. 6. 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. When prompted for the INSTALL NAME, enter IB*2.0*280 b. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//' answer NO (unless otherwise indicated) c. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//' answer YES (unless otherwise indicated) d. When prompted 'Enter options you wish to mark as 'Out Of Order':' Enter the following options: Billing Clerk's Menu [IB BILLING CLERK MENU] Billing Supervisor Menu [IB BILLING SUPERVISOR MENU] Integrated Billing Master Menu [IB MANAGER MENU] e. When prompted 'Enter protocols you wish to mark as 'Out Of Order':' press . 7. REBUILD MAPPED ROUTINE(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. Routine Information: ==================== Routine Name: - IBCEP2 Routine Checksum: Routine Name: - IBCEP3 Routine Checksum: Routine Name: - IBCEP4A Routine Checksum: Routine Name: - IBY280PR Routine Checksum: Routine Name: - IBY280PO Routine Checksum: Routine Name: - IBCBB1 Routine Checksum: Routine Name: - IBCEOB0 Routine Checksum: Routine Name: - IBCECSA5 Routine Checksum: Routine Name: - IBCEF74 Routine Checksum: ============================================================================= User Information: Entered By : KOPP,TERRY M Date Entered : JUL 30, 2004 Completed By: TORRANCE,LORI Date Completed: OCT 04, 2004 Released By : JACKSON,SHERYL Date Released : OCT 06, 2004 ============================================================================= Packman Mail Message: ===================== $END TXT