$TXT Created by HOLLOWAY,THOMAS J at MNTVBB.FO-ALBANY.MED.VA.GOV (KIDS) on Thursday, 03/09/06 at 17:21 ============================================================================= Run Date: APR 13, 2006 Designation: IB*2*336 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #302 Status: Released Compliance Date: MAY 14, 2006 ============================================================================= Associated patches: (v)IB*2*309 <<= must be installed BEFORE `IB*2*336' Subject: PHARMACY CLAIMS TRACKING FIX Category: - Routine Description: ============ With the release of the Clinical Indicator Data Capture (CIDC) software, IB*2.0*260, it was discovered that some entries in the Claims Tracking (#356) file were not marked with a Reason Not Billable (RNB) for prescription claims. This could cause Service Connected (SC) prescriptions to be billed erroneously to the 3rd party insurance carrier. With the installation of this patch, new Claims Tracking entries will be appropriately marked, if applicable, with a RNB. In addition, an e-mail report will be automatically generated for the MCCF staff to review and make a billable determination. ASSOCIATED REMEDY: ================== 1. HD124070 Bills Being Created for SC RX Fills ASSOCIATED E3R(s): ================== N/A PARTICIPATING TEST SITES: ========================= DUBLIN, GA PHOENIX, AZ PROVIDENCE, RI UPSTATE NEW YORK HCS REMEDY OVERVIEW: ================ 1. HD124070 Bills Being Created for SC RX Fills Problem: -------- With the release of CIDC software, Claims Tracking had more complete information contained in new fields in the PRESCRIPTION (#52) file. However, those new fields are only populated for new prescriptions and not for existing refills. IB Claims Tracking was changed to look at only the new fields and did not keep the previous code to properly review older prescriptions that did not have the new fields. Resolution: ----------- A check was added to Claims Tracking that determines if a prescription has the new fields or not. If not, then IB Claims Tracking reverts to the previous evaluation rules for the prescription. TECHNICAL: ========== 1. HD124070 Bills Being Created for SC RX Fills: Code was added to check for existence of the "ICD" node in the PRESCRIPTION (#52) file. If the node exists then the CT software will continue to use the new enhanced CIDC evaluation of the prescription. However, if an "ICD" node does not exist then CT will use the pre-CIDC code to evaluate the prescription and mark the CT entry appropriately. A post install is included in this patch. The post install will evaluate all CT entries that have been added since the initial install of CIDC at the site. If the CT entry is prescription related, does not have a Reason Not Billable, and does not have an "ICD" node in the ^PSRX global then a re-evaluation is made based on the pre-CIDC RNB determination. If a RNB is found then the CT entry is included in the post install report. The post install report is automatically loaded into a MailMan message and addressed to the patch installer, holders of the IB SUPERVISOR key, and holders of the IB CLAIMS SUPERVISOR key. Sites should review the MailMan report to determine if any CT entries need a RNB added or any bills need to be cancelled. As an additional note, if sites were to review the "IBQ" node containing the SERVICE CONNECTED response in the PRESCRIPTION (#52) file, they might find inaccurate information for patients that are greater than 49% service connected. That field is used only for copayment processing in the Outpatient Pharmacy package and is not valid for any 3rd party billing determinations. ROUTINES: ======== 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 (old style) Routine name Before Patch After Patch Patch List ============ ============ =========== =========== IB20P336 N/A 10714031 336 IBTRKR3 10364435 15306575 13,43,121,160,247 275,260,309,336 CHECK1^XTSUMBLD results (new style) Routine name Before Patch After Patch Patch List ============ ============ =========== =========== IB20P336 N/A 28791862 336 IBTRKR3 23758062 39212949 13,43,121,160,247 275,260,309,336 Total Number of Routines - 2 INSTALLATION INSTRUCTIONS: ========================== If installed during the normal workday, it is recommended that the following selection in the OPTION (#19) file, and all of its descendants be disabled to prevent possible conflicts while running the KIDS install. Other VistA users will not affected. IBT SUP MANUALLY QUE RX FILLS It is recommended this patch not be installed when the IB MT NIGHT COMP task job is running. Install time - less than 10 minutes. 1. LOAD TRANSPORT GLOBAL --------------------- Choose the PackMan message containing this patch and invoke the INSTALL/CHECK MESSAGE PackMan option. 2. 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 3. Select Installation Option: -------------------------- NOTE: The following are OPTIONAL - (When prompted for the INSTALL NAME, enter IB*2.0*336): 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. 4. 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. b. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//', answer NO. c. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//' answer YES. d. When prompted "Enter options you wish to mark as 'Out Of Order':", enter the following option: Manually Add Rx Refills to Claims Tracking [IBT SUP MANUALLY QUE RX FILLS] e. When prompted "Enter protocols you wish to mark as 'Out Of Order':", press . 5. The post-install routine, IB20P336, may be deleted after the installation is complete. 6. As mentioned above, with the installation of this patch a MailMan message will be automatically sent to the holders of the IB SUPERVISOR key and the IB CLAIMS SUPERVISOR key. It is recommended that someone RESPOND to the mail message generated, indicating who will be working on it. INSTALLATION EXAMPLE: ==================== Select Installation Option: install Package(s) Select INSTALL NAME: IB*2.0*336 Loaded from Distribution 1/11/06@10:59:20 => IB*2*336 This Distribution was loaded on Jan 11, 2006@10:59:20 with header of IB*2*336 It consisted of the following Install(s): IB*2.0*336 Checking Install for Package IB*2.0*336 Install Questions for IB*2.0*336 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': IBT SUP MANUALLY QUE Manually Add Rx Refills to Claims Tracking 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// UCX/TELNET Install Started for IB*2.0*336 : Jan 11, 2006@14:08:07 Build Distribution Date: Dec 16, 2005 Installing Routines: Jan 11, 2006@14:08:07 IB*2.0*336 ------------------------------------------------------------------------ Running Post-Install Routine: ^IB20P336 Starting Post Install to evaluate CT entries... Sending report message... Message number 2007246 sent... Post Install Complete... Updating Routine file... Updating KIDS files... IB*2.0*336 Installed. Jan 11, 2006@14:08:09 Install Message sent #2007247 ------------------------------------------------------------------------ +------------------------------------------------------------+ 100% | 25 50 75 | Complete +------------------------------------------------------------+ Install Completed Routine Information: ==================== The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: IB20P336 Before: n/a After: B28791862 **336** Routine Name: IBTRKR3 Before: B23758062 After: B39212949 **13,43,121,160,247,275,260,309,336** ============================================================================= User Information: Entered By : ZEIGLER,EDWARD L Date Entered : DEC 15, 2005 Completed By: DAWSON,TIM Date Completed: APR 12, 2006 Released By : BOTTINI,STEVE Date Released : APR 13, 2006 ============================================================================= Packman Mail Message: ===================== $END TXT