$TXT Created by HARPER,AMY R at DEVFEX.FO-ALBANY.MED.VA.GOV (KIDS) on Monday, 08/27/07 at 14:19 ============================================================================= Run Date: SEP 27, 2007 Designation: IB*2*369 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #342 Status: Released Compliance Date: OCT 28, 2007 ============================================================================= Subject: IB SUPPORT FOR ASCD Category: - Routine - Enhancement (Mandatory) Description: ============ This patch exports API's to support the Automated Service Connected Designation (ASCD) project (SD*5.3*495). The ASCD project allows review of an encounters Service Connected designation after the encounter is checked out. The IB API's in this patch provide Billing data for ASCD reports and the ability to update an encounters Reason Not Billable. Update Encounters Reason Not Billable: With ASCD the Service Connected designation for an encounter is reviewed and potentially changed after check-out. If that encounter has already been added to Claims Tracking, then it is possible that the original Reason Not Billable added for the encounter is no longer appropriate. Therefore, an encounters Reason Not Billable may be updated by the ASCD review. When an encounters Service Connected designation is changed in ASCD, Claims Tracking may also be updated: o If an encounter is changed to Service Connected during the ASCD review and an entry exists in Claims Tracking for the encounter with no Reason Not Billable, then the encounters Claims Tracking entry is updated: - The Reason Not Billable of 'SC TREATMENT' is added - The Billable Finding of 'NSC TO SC' and Last Reviewed By is added Note that if the encounter is already billed, then the bill and the new Billable Finding will be added to the CT Entered/Not Reviewed Report [IBT ENTERED NOT REVIEWED] o If an encounter is changed to Non-Service Connected during the ASCD review and an entry exists in Claims Tracking for the encounter with a Reason Not Billable of 'SC TREATMENT', then the encounters Claims Tracking entry is updated: - The Reason Not Billable of 'SC TREATMENT' is deleted - The Billable Finding of 'SC TO NSC' and Last Reviewed By is added Note that the encounter will be added to the Un-reviewed Claims for Coders Report [IBT UNREVIEWED CODING REPORT] and if the encounter is already billed, then the bill and the new Billable Finding will be added to the CT Entered/Not Reviewed Report [IBT ENTERED NOT REVIEWED] This patch addresses the following New Service Request (NSR): ------------------------------------------------------------- NSR 20050705 Automated Service Connected Designation (in support of) This patch addresses the following NOIS/Remedy Ticket(s): --------------------------------------------------------- There is no NOIS/Remedy tickets associated with this patch. TECHNICAL DESCRIPTION: ====================== The following are the API's exported with this patch: CT^IBRSUTL - identify an encounters Claims Tracking entry Input: IEN of Outpatient Encounter (#409.68) Output: IEN of encounters Claims Tracking record (#356) null if none found RNBU^IBRSUTL - update an encounters Claims Tracking Reason Not Billable Input: IEN of Outpatient Encounter (#409.68) CHG = 1 if encounter changed from NSC to SC 2 if encounter changed from SC to NSC Output: 1 Reason Not Billable of SC TREATMENT added to CT entry also adds Billable Finding of 'NSC TO SC' and Last Reviewed By (only if the CT entry did not already have a RNB) 2 Reason Not Billable of SC TREATMENT deleted from CT entry also adds Billable Finding of 'SC TO NSC' and Last Reviewed By (only if the CT entry RNB was SC TREATMENT) 0 no update/change Note that encounters changed to Service Connected that have already been billed will be added to the CT Entered/Not Reviewed Report [IBT ENTERED NOT REVIEWED]. Encounters changed to Non-Service Connected will be displayed on the Un-reviewed Claims for Coders Report [IBT UNREVIEWED CODING REPORT]. And if the encounter is already billed then it will be added to the CT Entered/Not Reviewed Report [IBT ENTERED NOT REVIEWED] FPBILL^IBRSUTL - returns an encounters First Party bill and charge Input: IEN of Outpatient Encounter (#409.68) Output: AR Bill (#350,.11) ^ AR Trans (#350,.12) ^ Total Charge (#350,.07) Null if no non-cancelled charge found for encounter Returns charge of last transaction for the encounter if the charge Status (#350,.05) is not a Cancelled Status and the charge Action Type (#350,.03) is not a Cancellation Action Type. Note that only charges passed to AR will have an AR Bill Number and AR Transaction Number. Charges not yet passed to AR, such as charges On Hold, will only have a Total Charge. TPBILL^IBRSUTL - returns an encounters Third Party Bills Input: IEN of Outpatient Encounter (#409.68) Output: Bill Number (#399,.01) ^ Bill Number (#399,.01) ^ ... Null if no non-cancelled bills found for encounter Encounters may have multiple Third Party bills. This function returns a string of all Third Party bills that have not been cancelled and have one of the encounters procedures assigned. FIRST^IBRSUTL - check if encounter is billable for First Party Input: IEN of Outpatient Encounter (#409.68) Output: 1 if encounter is First Party billable 0 ^ reason encounter not billable This function checks various elements related to the patient and the specific encounter: - Patient is Category C - Appointment Status is billable - Appointment Type is billable - Encounter Clinic is not Non-Count - Encounter Clinic is billable for First Party - Encounter Stop Code is billable for First Party THIRD^IBRSUTL - check if encounter is billable for Third Party Input: IEN of Outpatient Encounter (#409.68) Output: 1 if encounter is Third Party billable 0 ^ reason encounter not billable This function checks various elements related to the patient and the specific encounter: - Appointment Status is billable - Appointment Type is billable - Encounter Clinic is not Non-Count - Encounter Clinic is billable for Third Party - Encounter Stop Code is billable for Third Party TPCHG^IBRSUTL - return an encounters potential Third Party charges Input: IEN of Outpatient Encounter (#409.68) Output: Total Institutional Charge ^ Total Professional Charge 0 for no billable procedure charges found This function calculates the charges based on the procedures assigned to the encounter in PCE (not the encounter procedures that have been billed). The returned amounts are the sum of the individual Reimbursable Insurance charges for each PCE procedure. Database Integration Agreement (DBIA) 4987 - IB BILLING DATA API Components Sent With Patch -------------------------- 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 ============ ============ =========== ========== IBRSUTL N/A 10187865 369 CHECK1^XTSUMBLD results Routine name Before Patch After Patch Patch List ============ ============ =========== ========== IBRSUTL N/A 26299507 369 Number of Routines = 1 Test Sites: ----------- Bedford MA Fargo ND North Texas HCS Puget Sounds HCS Tampa FL ======================= INSTALLATION INSTRUCTIONS ======================= No options need to be disabled during the installation of this patch. 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. 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: 3. Select Installation Option: --------------------------- NOTE: The following are OPTIONAL - (When prompted for the INSTALL NAME, enter IB*2.0*369): 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 NO Routine Information: ==================== The second line of each of these routines now looks like: ;;2.0;INTEGRATED BILLING;**[Patch List]**;21-MAR-94;Build 2 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: IBRSUTL Before: n/a After: B26299507 **369** ============================================================================= User Information: Entered By : HARPER,AMY R Date Entered : FEB 20, 2007 Completed By: LYNCH,MARY F. Date Completed: SEP 25, 2007 Released By : HARRIS,ANGELA Date Released : SEP 27, 2007 ============================================================================= Packman Mail Message: ===================== $END TXT