$TXT Created by CRUZ,ORLANDO at DEVFEX.FO-ALBANY.MED.VA.GOV (KIDS) on Thursday, 03/09/06 at 09:56 ============================================================================= Run Date: APR 27, 2006 Designation: IB*2*323 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #304 Status: Released Compliance Date: MAY 28, 2006 ============================================================================= Associated patches: (v)IB*2*155 <<= must be installed BEFORE `IB*2*323' Subject: MRA STATION NUMBER BUG FIX Category: - Routine - Other - Enhancement (Mandatory) Description: ============ This patch will address several bugs related to e-MRA (Medicare Remittance Advice) as described in their respective Remedy Tickets. In various locations of the Integrated Billing (IB) package, e-MRA is retrieving the site number incorrectly using the $$SITE^VASITE function. As a result, numerous claims using e-MRA have been rejected. This patch will modify code that uses this function incorrectly. Two changes to the e-MRA process have been requested by the Chief Business Office. One change will prevent syntax errors in the VistA-to-Austin transmissions of certain MRA secondary claims. The other change will enable MRA's to be automatically turned into authorized secondary claims without user intervention. Change request 1: ----------------- Round the value of LCOB-12 (PAID UNITS) to the nearest integer value. Currently VistA can send a number with decimals to Austin. Austin can only accept integers (all numeric). Change request 2: ----------------- Add MRA adjustment PR-122 (psych. reduction) to the list of valid adjustment group and reason codes to be automatically converted into an MRA secondary claim. MRA claims have been rejected at various location because e-MRA(Trailblazer software) cannot accept punctuation characters in city fields of an address. This patch modifies code for output formatters so that any punctuation in an address is stripped off. BCBS Anthem is denying/not paying MRA secondary professional claims printed at express bill because the secondary Provider ID is manually entered on screen 3 <2> of the MRA claim. The Provider ID is not copied over to secondary claim when the system automatically creates the claims after receiving the MRA from Trailblazer (TB). This patch will modify ^IBCU routine to prevent manual deletion or change of the Provider ID when one exist for the primary MRA claim. When there are 2 MRAs for a claim, and both are split MRAs, (one denied and one is processed), the Balance Due calculation for the MRA secondary claim to the secondary payer is incorrect because of the way the claim Total Charges is retrieved. The Balance Due being sent to the secondary payer is much higher than it should be in these cases. This patch addresses the following New Service Request (NSR): ------------------------------------------------------------- There is no NSR associated with this patch. This patch addresses the following Remedy Tickets: -------------------------------------------------- 1. 100796 Box 24K for e-MRA 2. 101145 e-MRA problem 3. 104366 Problem: MEDICAL CENTER DIVISION & INSTITUTION Files 4. 64696 LCOB-12 Paid Units 5. 92303 CBO Requested Changes to e-MRA 6. 63312 Rejects from Winston-Salem Domain 7. 105527 BCBS/Anthem Secondary Bills Done by Authorized IB 8. 129137 Balance Due bug fix for split MRA claims Overview of Remedy Ticket(s): ----------------------------- 1. 100796 Box 24K for e-MRA Problem: -------- Data is incorrectly displayed in the Site Number field of the IBCE EDI VIEW/PRINT EXTRACT option screen because the data is being extracted from the INSTITUTION file (#4) instead of the STATION NUMBER file (#389.9). Resolution: ----------- Modify the EXTRACT CODE (#1) field of the IB DATA ELEMENT DEFINITION (#364.5) file IEN# 134 N-SITE NUMBER to extract the data from the piece [3] of the results of the function $$SITE^VASITE. 2. 101145 e-MRA problem Problem: -------- The site number was wrong in block 24k on the HCFA 1500 which resulted in billing errors/rejects. Resolution: ----------- Modify FORMAT CODE (#1) field of the IB FORM FIELD CONTENT (#364.7) file and EXTRACT CODE (#1) field in the IB DATA ELEMENT DEFINITION (#364.5) file IENS# 116, 117, 118, 119, 155 and 231.This output formatter will extract data from the piece [3] of the $$SITE^VASITE function. 3. 104366 Problem: MEDICAL CENTER DIVISION & INSTITUTION Files Problem: -------- The station number is being incorrectly retrieved from the database in certain places related to the IB MRA project. Resolution: ----------- Modify code in $$MCR24k^IBCEU, $$CLMPRNT^IBCEMRAA and $$HDR^IBCEMRAB functions to extract piece[3] of $$SITE^VASITE function. 4. 64696 LCOB-12 Paid Units Problem: -------- The FORMAT CODE (#1) field in the IB FORM FIELD CONTENT (#364.7) file for IEN# 965 COB Line Paid Units data element does not round to the nearest integer. Resolution: ----------- Modify FORMAT CODE (#1) field in the IB FORM FIELD CONTENT (#364.7) file for IEN# 965 COB Line Paid Units data element so that it does round to the nearest integer. 5. 92303 CBO Requested Changes to e-MRA Problem: -------- PR-122 not currently in list for MRA adjustment authorized for secondary claim. Resolution: ----------- Add MRA adjustment PR-122 (psych, reduction) to the existing adjustment category group code - "PR" in routine OKCOMBO^IBCEMQC. 6. 63312 Rejects from Winston-Salem Domain Problem: -------- MRA Claims being rejected by Emdeon because address fields in the IB 837 form transmission cannot contain punctuation characters. Resolution: ----------- Modify FORMAT CODE (#1) field of the IB FORM FIELD CONTENT(#364.7) file and EXTRACT CODE (#1) field in the IB DATA ELEMENT DEFINITION (#364.5) file in IENS# 5,22,55,128,146,151,358, 390,457. These output formatter will remove any punctuation from any city field. 7. 105527 BCBS/Anthem Secondary Bills Done by Authorized IB Problem: -------- Prevent the billing Provider ID on billing screen 3 from being deleted or changed when the claim is turned into an MRA secondary claim. Resolution: ----------- Modify code in the $$PRVNUM^IBCU function so that when MRA is being processed into an MRA secondary claim and the billing provider# already exists, then leave it alone. 8. 129137 Balance Due bug fix for split MRA claims Problem: -------- The claim's total charges are being retrieved from the EXPALANATION OF BENEFITS (#361.1) file rather than from the BILLS/CLAIMS (#399) file. Resolution: ----------- Modify code in IBCCCB routine to retrieve charges from TOTAL CHARGES (#201) field in the BILLS/CLAIMS (#399) file. Components Sent With Patch -------------------------- 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 Before Patch After Patch Patch List ------- ------------ ----------- ---------- IBCCCB 18946749 18929796 80,106,51,151 137,182,155,323 IBCEMQC 8894519 8898283 155,323 IBCEMRAA 12519053 12531469 155,323 IBCEMRAB 14094662 14172459 155,323 IBCEU3 12557344 12588880 51,137,155,323 IBCU 14555083 14584383 52,106,51,191,232 323 IBY323PR N/A deleted ** Number of Routines = 7 ** Pre-init routine IBY323PR will be automatically deleted. 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 CHECK1^XTSUMBLD results Routine Before Patch After Patch Patch List ------- ------------ ----------- ---------- IBCCCB 57071055 57002902 80,106,51,151 137,182,155,323 IBCEMQC 29727908 29766412 155,323 IBCEMRAA 61733871 61799153 155,323 IBCEMRAB 51933708 52079518 155,323 IBCEU3 42120644 42203561 51,137,155,323 IBCU 36886371 37317111 52,106,51,191,232 323 IBY323PR N/A deleted ** Number of Routines = 7 ** Pre-init routine IBY323PR will be automatically deleted. 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 -------------------------------------------------------------------- 364.5 IB DATA ELEMENT DEFINITION NO NO YES OVER YES File entry numbers sent: 177,258,319 364.7 IB FORM FIELD CONTENT NO NO YES OVER YES File entry numbers sent: 5,22,55,128,146,187,188,358 390,457,472,799,965,1032 TEST SITES: ----------- Northern Indiana HCS Salem Salisbury Upstate New York HCS West Palm Beach ================INSTALLATION INSTRUCTIONS ================= This patch may be installed during the day, but it is important that this patch is NOT installed at the same time that your site transmits electronic claims. To determine when your site transmits electronic claims, follow this menu path: MCCR System Definition Menu SITE - MCCR Site Parameter Display/Edit IB Site Parameters Set# [15] Hours to Auto-Transmit Alternatively, you could inquire to IB SITE PARAMETERS (#350.9) file, field (#8.06). Avoid the listed times for patch installation. Install Time - 2 minutes or less. 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 Select Installation Option: 3. Select Installation Option: --------------------------- NOTE: The following are OPTIONAL (When prompted for the INSTALL NAME, enter IB*2.0*323): 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. 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 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//', answer NO. Routine Information: ==================== The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: IBCCCB Before: B57071055 After: B57002902 **80,106,51,151,137,182,155,323** Routine Name: IBCEMQC Before: B29727908 After: B29766412 **155,323** Routine Name: IBCEMRAA Before: B61733871 After: B61799153 **155,323** Routine Name: IBCEMRAB Before: B51933708 After: B52079518 **155,323** Routine Name: IBCEU3 Before: B42120644 After: B42203561 **51,137,155,323** Routine Name: IBCU Before: B36886371 After: B37317111 **52,106,51,191,232,323** Routine Name: IBY323PR Before: n/a After: B330612 **323** ============================================================================= User Information: Entered By : GUSTAFSON,ERIC S Date Entered : JUL 29, 2005 Completed By: ROBBINS,BRADLEY Date Completed: APR 21, 2006 Released By : WARREN,BRENDA A Date Released : APR 27, 2006 ============================================================================= Packman Mail Message: ===================== $END TXT