$TXT Created by KOPP,TERRY at DEVFEY.FO-ALBANY.MED.VA.GOV (KIDS) on Monday, 12/20/04 at 16:33 ============================================================================= Run Date: FEB 03, 2005 Designation: IB*2*291 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #269 Status: Released Compliance Date: MAR 06, 2005 ============================================================================= Associated patches: (v)IB*2*288 <<= must be installed BEFORE `IB*2*291' (v)IB*2*290 <<= must be installed BEFORE `IB*2*291' Subject: ALLOW FORCE PRINT OF SSN BY INSURANCE COMPANY Category: - Routine - Data Dictionary - Input Template - Other Description: ============ This patch includes three minor changes to third party claims processing in Integrated Billing. 1. The first change is a modification to the printed claim forms. After release of the EDI Enhancement patch (IB*2*232) that converted the VistA electronic claims to HIPAA compliant format, an issue was identified regarding the printing of the provider's SSN on the claims. A 'quick fix' was implemented in a subsequent patch (IB*2*290) that prevented the provider's SSN from EVER being printed locally on these two forms. This patch provides the final long term fix for this issue where the SSN ID is printed locally ONLY if it is required to do so by the payer. For HCFA 1500 claims that are sent electronically, and the payer requires a performing provider's SSN to print on the claim form, the SSN is sent as a secondary ID. WebMD is changing their print logic ONLY for the HCFA 1500 to check for the SSN as a secondary ID before printing it at Express Bill. Because WebMD will not be able to print the SSN on the UB92 claim forms, if an insurance company requires the SSN to print on the UB92, these claims MUST be printed locally. Two new parameters were added to the option for INSURANCE COMPANY ENTRY/EDIT [IBCN INSURANCE CO EDIT] to allow the site to indicate, for each insurance company, whether the provider's SSN is required to print on the UB92 and the HCFA 1500 claim form. These new parameters are found under the PROVIDER ID (ID) action on the main menu. The print form locators affected by this change are: UB92: PERFORMING PROVIDER ID data in form locators 82 and 83 HCFA 1500: REFERRING PROVIDER ID data in box 17A 2. The second change is a modification to the transmitted claims. The EDI Enhancement patch (IB*2*232) added a restriction to the field output for the billing facility's GROUP or PIN number so it could no longer be overridden by the output formatter. It has since been discovered that the standard VistA software does not accommodate all of the provider ID scenarios required by payers. As a result, this field will be re-opened for sites to add a local override for this data element if deemed necessary. 3. The third change included in this patch is a correction to the text displayed for the provider function when using the ?ID action within the billing screens. Only the rendering/attending provider function is displayed correctly. For all other provider functions, the wrong function type may be displayed. For example, the REFERRING provider's name and id may be reported as the OPERATING provider. Technical Description: ---------------------- The code to determine the default performing provider ID was modified in routine DEFID^IBCEF74. The change was made so that the performing provider's SSN is used as a default provider secondary id only if there is no other secondary id that is valid for the insurance company and provider combination AND if the new parameter for the claim form type indicates an SSN is required for the performing provider ID on printed forms. The code to send the provider's SSN as a secondary provider ID if the corresponding parameter for the insurance company and form type indicates the provider's SSN should print on a HCFA 1500 claim was added in routine PROVINF^IBCEF74. The code to force a UB92 claim form to print locally for an insurance company that requires the SSN as the secondary id to print locally was added to routine IBCBB21. The logic is used if the new UB92 parameter is set for an EDI activated insurance company (or the following insurance company in the case of an MRA request), AND the insurance company does not have an electronic routing id or the id ends in PRNT. A new error message was added to the billing inconsistencies checks that will be displayed when the conditions are met for this change. The two new parameter fields were added to the INSURANCE COMPANY file (#36) and are REQUIRE SSN ID FOR HCFA PRINT (#3.11) and REQUIRE SSN ID FOR UB92 PRINT (#3.12). The routine IBCNSC1 was modified to display these new parameters in list manager. The input template [IBEDIT INS CO1] from the INSURANCE COMPANY file (#36) was modified to allow editing of these two new fields. The output formatter file entry modified to allow the local override is found in file IB FORM SKELETON DEFINITION (#364.6) and is entry #1316. The field modified was LOCAL OVERRIDE ALLOWED (#.07) and was set to 1 (YES). The code to fix the text displayed for the provider function when using the ?ID action in the billing screens is fixed in routine DISPID^IBCEF74. The wrong variable was being used as the basis of the interpretation of the provider function code. This patch addresses the following New Service Request (NSR): ------------------------------------------------------------- There is no NSR associated with this patch. This patch addresses the following NOIS/Remedy message(s): ---------------------------------------------------------- There are no NOIS/Remedy messages associated with this patch. TEST SITES: =========== ALTOONA (VMS/CACHE) MONTANA HCS (NT/CACHE) UPSTATE NEW YORK HCS (VMS/CACHE) BATTLE CREEK (VMS/CACHE) ================INSTALLATION INSTRUCTIONS ================= This patch should be installed after normal working hours when no Integrated Billing users are using the system. Install Time - 2 minutes or less. Other VISTA users will not be affected. The following menus/options should be disabled prior to the start of the installation: Integrated Billing Master Menu [IB MANAGER MENU] Billing Supervisor Menu [IB BILLING SUPERVISOR MENU] Billing Clerk's Menu [IB BILLING CLERK MENU] Insurance Company Entry/Edit [IBCN INSURANCE CO EDIT] Also, make sure the auto-transmit of electronic claims option (Queue Auto Transmit EDI Bills [IBCE 837 AUTO TRANSMIT]) is not scheduled to run while the patch is being installed. It's best to check with your Billing section on this. There is an IB Site Parameter (file #350.9) called HOURS TO TRANSMIT BILLS (field #8.06) that may contain specific times to transmit bills. If there are no specific times set up in this parameter, claims will be transmitted when the [IB MT NIGHT COMP] job runs. 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 -------------------------- 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 ============ ============ =========== ========== IBCBB21 6600756 8144075 51,137,210,232,155 291 IBCEF74 21978087 22808327 232,280,155,290,291 IBCNSC1 6463359 7188752 62,137,232,291 Total number of routines modified: 3 Total number of new routines: 0 Total number of deleted routines: 0 Total number of routines: 3 The following is a list of fields included in this patch: Note: The fields in the INSURANCE COMPANY file (#36) are new fields. Field Name (Number) File Name (Number) ------------------- ------------------ REQUIRE SSN FOR PRINT HCFA (#3.11) INSURANCE COMPANY (#36) REQUIRE SSN FOR PRINT UB92 (#3.12) INSURANCE COMPANY (#36) CURRENT BILL PAYER SEQUENCE (#.21) BILL/CLAIMS (#399) PRIMARY INSURANCE CARRIER (#101) BILL/CLAIMS (#399) SECONDARY INSURANCE CARRIER (#102) BILL/CLAIMS (#399) The following is a list of templates included in this patch: Template Name Type File Name (Number) ------------- ---- ------------------ IBEDIT INS CO1 INPUT INSURANCE COMPANY (#36) IB SCREEN3 INPUT BILL/CLAIMS (#399) 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 -------------------------------------------------------------------- 36 INSURANCE COMPANY YES NO NO 350.8 IB ERROR NO NO YES OVER NO File entry sent: IB327 364.6 IB FORM SKELETON DEFINITION NO NO YES OVER YES File entry number sent: 1316 399 BILL/CLAIMS YES NO NO 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 --- 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 Select Installation Option: 5. SELECT INSTALLATION OPTION -------------------------- NOTE: The following are OPTIONAL (When prompted for the INSTALL NAME, enter IB*2.0*291): 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 the 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. INSTALL KIDS BUILD ------------------ a. Choose the Install Package(s) option of the Installation menu to start the patch install. b. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//', answer NO. c. When prompted 'Want to DISABLE Scheduled Options and Menu Options? YES//', take the default (YES). d. When prompted "Enter options you wish to mark as 'Out of Order':", enter the following options: Integrated Billing Master Menu [IB MANAGER MENU] Billing Supervisor Menu [IB BILLING SUPERVISOR MENU] Billing Clerk's Menu [IB BILLING CLERK MENU] Insurance Company Entry/Edit [IBCN INSURANCE CO EDIT] e. When prompted 'Enter protocols you wish to mark as 'Out Of Order':', press . 7. REBUILD MAPPED ROUTINES (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: - IBCEF74 Routine Checksum: Routine Name: - IBCNSC1 Routine Checksum: Routine Name: - IBCBB21 Routine Checksum: ============================================================================= User Information: Entered By : KOPP,TERRY M Date Entered : OCT 21, 2004 Completed By: TORRANCE,LORI Date Completed: FEB 02, 2005 Released By : JACKSON,SHERYL Date Released : FEB 03, 2005 ============================================================================= Packman Mail Message: ===================== $END TXT