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Patch Subject: MCCF EDI TAS EBILLING BUILD 5/6
Description:
============
Integrated Billing (IB) is a software module within Veterans Health
Information Systems and Technology Architecture (VistA) that provides
the ability for billing personnel to submit claims in either a paper or
electronic format to third-party payers.
The following features of the IB software will be affected by this
patch:
* Transmitting SNF Claims with Appropriate Revenue Codes
The IB VistA package has been modified to send Revenue Code 0022
and VA specific AAA00 RUG/Health Insurance Prospective Payment
System (HIPPS) Skilled Nursing Facility (SNF) rate codes for
Medicare Primary Institutional Part A claims with bill types 21x,
22x or 23x. Due to this modification, the System will no longer use
the Financial Service Center (FSC) workaround. Instead, the System
now has the ability to perform the identical checks that FSC used to
ensure that these SNF claims are sent. The System automatically
allows for this in the transmission of the flat file so that the
biller does not have to enter anything additional to have this
information transmitted. In addition, the VistA flat file for
Institutional 837s has been updated and the "View/Print EDI Bill
Extract Data" [IBCE EDI VIEW/PRINT EXTRACT] (VPE) option screens
depict the change in the flat file for the end user to view in the
INS segment.
* Add 'T' for Transmitted to RCB Screen
The IB VistA package has been modified to be enable the user to see
"** T = Test Claim" (to explain what the "T" indicator represents)
in the legend of the "View/Resubmit Claims - Live or Test" [IBCE
PREV TRANSMITTED CLAIMS] (RCB) option screen when viewing previously
Printed claims.
* Remove Ability to Define Insurance Company as non-EDI
The IB VistA package has been modified so the "Insurance Company
Entry/Edit" [IBCN INSURANCE CO EDIT] (EI) option no longer provides
the user the ability to select "0 - NO" as an option for "EDI -
Transmit?" prompt under the EDI Parameters section of the screen.
In addition, a one-time report from each site showing the value of
the field to determine whether an Insurance Company is active for
Electronic Data Interchange (EDI) will be sent to the eBiz Rapid
Response group.
* RCB Screen - Match COB Data to Payer Sequence
The IB VistA package has been modified to be enable the user to
resubmit, to the Test queue, a claim using the "View/Resubmit Claims
- Live or Test" [IBCE PREV TRANSMITTED CLAIMS] (RCB) option and have
only the Coordination of Benefits (COB) data that is correct for the
payer sequence be included in the transaction.
If a user selects:
o a Primary claim to resubmit and the claim has received an
EOB/MRA from the primary payer, VistA will not send the COB
data from the EOB/MRA and the amount billed will not be offset
by previous payments from the primary payer.
o a Secondary claim to resubmit and the claim has received an
EOB/MRA from the secondary payer, VistA will not send the COB
data from the EOB/MRA and the amount billed will not be offset
by previous payments from the secondary payer.
o a Tertiary claim to resubmit and the claim has received an
EOB/MRA from the tertiary payer, VistA will not send the COB
data from the EOB/MRA and the amount billed will not be offset
by previous payments from the tertiary payer.
If a user attempts to resubmit a claim(s) with EOB data in VistA to
the Production queue, the system will filter out the claim(s) and
not transmit it. These non-transmitted claims will be listed on the
screen as "Skipped".
* Non-MCCF Unbilled Amounts Report
The IB VistA package has been modified so the "Re-Generate
Unbilled Amounts Report" [IBT RE-GEN UNBILLED REPORT] option now
allows the user to select the following additional search criteria:
(M)CCF, (N)on-MCCF (Outpatient Only), or (B)oth claims
Non-MCCF Rate Types include: CHAMPVA, CHAMPVA Reimb. Ins., TRICARE,
TRICARE Reimb. Ins., Interagency, Sharing Agreement and Ineligible.
Non-MCCF Appointment Types include: Employee and Sharing Agreement.
Non-MCCF Eligibility of Encounters include: CHAMPVA, TRICARE,
Employee, Ineligible and Sharing Agreement.
* Non-MCCF Pay-To Address Rate Types
The IB VistA package has been modified to allow the user to be able
to define one or more Rate Types for which the non-MCCF Pay-to
Address (formerly the TRICARE Pay-to Address) will be used on claims
with one of those Rate Types. In addition, the following items are
capable:
o An authorized user with access to the IB Site Parameters and
the TRICARE Pay-to security key will be able to add/delete
a Rate Type for which claims with that Rate Type will use the
non-MCCF Pay-to Address data.
o The System will use the non-MCCF Pay-to Address data on claims
with specified Rate Types only when the non-MCCF Pay-to
Address is not exactly the same as the Billing Provider Name
and Address.
o The System will transmit the TRICARE Pay-to Address data on
claims with specified Rate Types in the 837-I, 837-P or 837-D
when the non-MCCF Pay-to Address is not exactly the same as
the Billing Provider Name and Address.
o The System will print the non-MCCF Pay-to Address data on
Institutional claims with specified Rate Types on the UB04
form (FL2) when the TRICARE Pay-to Address is not exactly
the same as the Billing Provider Name and Address.
o The System will print the non-MCCF Pay-to Address data on
Professional claims with specified Rate Types on the CMS
1500 form (Box 33) when the non-MCCF Pay-to Address is not
exactly the same as the Billing Provider Name and Address.
* Remove Fatal Error - Rendering Provider CMS 1500
The IB VistA package has been modified so that the previously fatal
error that prevented a biller from submitting a Professional Claim
with no Rendering Provider has been removed and instead now a
non-fatal warning message appears to the user when a Professional
Claim does not contain a Rendering Provider.
* CMN Oxygen and EPN Nutrition
The IB VistA package has been modified to enable the "Enter/Edit
Billing Information" [IB EDIT BILLING INFO] option to enter the
required data for an Oxygen Certificate of Medical Necessity (CMN)
(CMS-484.3) or an Enteral and Parenteral Nutrition CMN (CMS-10126)
when completing a professional bill for Durable Medical Equipment
(DME). In addition, the ability to transmit Professional claims has
been modified to include the CMN data in the proprietary 837-P
Transaction to the Financial Services Center (FSC).
Patch Components
================
Files & Fields Associated:
File Name (#) New/Modified/
Sub-file Name (#) Field Name (Number) Deleted
------------------- --------------------------------- -------------
INSURANCE COMPANY (#36) Modified
TRANSMIT ELECTRONICALLY (#3.01) Modified
IB ERROR (#350.8) Data Only
Screen: I $$INCLUDE^IBY608PR(8,Y)
IB SITE PARAMETERS (#350.9) Modified
CMN CPT CODES sub-file (#350.916) New
NON-MCCF RATE TYPES FOR PTP sub-file (#350.928) New
TRICARE PAY-TO PROVIDERS sub-file (#350.929) Modified
TC FACILITY (#.01) Modified
TC NAME (#.02) Modified
TC FEDERAL TAX NUMBER (#.03) Modified
TC TELEPHONE NUMBER (#.04) Modified
TC PARENT PAY-TO PROVIDER (#.05) Modified
TC STREET ADDRESS 1 (#1.01) Modified
TC STREET ADDRESS 2 (#1.02) Modified
TC CITY (#1.03) Modified
TC STATE (#1.04) Modified
TC ZIP (#1.05) Modified
IB DATA ELEMENT DEFINITION (#364.5) Data Only
Screen: I $$INCLUDE^IBY608PR(5,Y)
IB FORM SKELETON DEFINITION (#364.6) Data Only
Screen: I $$INCLUDE^IBY608PR(6,Y)
IB FORM FIELD CONTENT (#364.7) Data Only
Screen: I $$INCLUDE^IBY608PR(7,Y)
BILL/CLAIMS (#399) Modified
PROCEDURES sub-file (#399.0304) Modified
CMN REQUIRED? (#23) New
CMN FORM TYPE (#24) New
CMN CERTIFICATION TYPE (#24.01) New
CMN PATIENT HEIGHT (IN) (#24.02) New
CMN PATIENT WEIGHT (LBS) (#24.03) New
CMN MONTHS DME EQUIP NEEDED New
(#24.04)
CMN DATE THERAPY STARTED (#24.05) New
CMN LAST CERTIFICATION DATE New
(#24.06)
CMN RECERTIFICATION/REVISN DT New
(#24.07)
CMN REPLACEMENT ITEM? (#24.08) New
CMN ABG PO2 (MMHG) (#24.1) New
CMN O2 SATURATION % (#24.102) New
CMN DT LAST ABG PO2 AND O2 SAT New
(#24.103)
CMN EDEMA DUE TO CHF PRESENT? New
(#24.104)
CMN COR PULMONARY HYPERTENSN? New
(#24.105)
CMN HEMATOCRIT > 56%? (#24.106) New
CMN PT CONDITION AT TEST TIME New
(#24.107)
CMN TEST CONDITIONS (#24.108) New
CMN PORTABLE O2 INDICATOR (#24.109) New
CMN HIGHEST O2 FLOW RATE (#24.11) New
CMN LAST 4 LPM ABG PO2 (MMHG) New
(#24.111)
CMN LAST 4 LPM O2 SATURATION % New
(#24.113)
CMN DATE OF LAST 4 LPM TESTS New
(#24.114)
CMN EQUIPMENT/COST DESCRIPTION New
(#24.115)
CMN SM BOWEL ABSORPTION DOC? New
(#24.201)
CMN ENTERAL NUTRITION BY TUBE? New
(#24.202)
CMN PROCEDURE A CALORIES (#24.203) New
CMN PROCEDURE A (#24.204) New
CMN METHOD OF ADMINISTRATION New
(#24.205)
CMN DAYS PER WEEK ADMINISTERED New
(#24.206)
CMN SEVERE MALABSORPTION DOC? New
(#24.207)
CMN AMINO ACID (ML/DAY) (#24.208) New
CMN AMINO ACID CONCENTRATION % New
(#24.209)
CMN AMINO ACID PROTEIN (GM/DY) New
(#24.21)
CMN DEXTROSE (ML/DAY) (#24.211) New
CMN DEXTROSE CONCENTRATION % New
(#24.212)
CMN LIPIDS (ML/DAY) (#24.213) New
CMN ROUTE OF ADMINISTRATION New
(#24.214)
CMN LIPIDS (DAYS/WEEK) (#24.215) New
CMN LIPIDS CONCENTRATE % (#24.216) New
CMN PARENTERAL/ENTERAL/BOTH New
(#24.217)
CMN PROCEDURE B CALORIES (#24.218) New
CMN PROCEDURE B (#24.219) New
CMN FORM TYPES (#399.6) New
Bulletins Associated:
New/Modified/
Bulletin Name Deleted
------------- -------------
N/A
Dialogs Associated:
New/Modified/
Dialog Name Deleted
----------- -------------
N/A
Forms Associated:
New/Modified/
Form Name File Name (Number) Deleted
--------- ------------------ -------------
N/A
Functions Associated:
New/Modified/
Function Name Deleted
------------- -------------
N/A
HL Logical Link:
New/Modified/
HL Logical Name Deleted
--------------- -------------
N/A
HL7 Application Parameters:
New/Modified/
HL7 Parameter Name Deleted
------------------ -------------
N/A
HLO Application Registry:
New/Modified/
HLO Registry Name Deleted
----------------- -------------
N/A
Help Frames Associated:
New/Modified/
Help Frame Name Deleted
--------------- -------------
N/A
Mail Groups Associated:
New/Modified/
Mail Group Name Deleted
--------------- -------------
N/A
Options Associated:
New/Modified/
Option Name Type Deleted
----------- ---- -------------
N/A
Parameter Definitions:
New/Modified/
Parameter Name Deleted
-------------- -------------
N/A
Parameter Template:
New/Modified/
Template Name Deleted
------------- -------------
N/A
Protocols Associated:
New/Modified/
Protocol Name Deleted
------------- -------------
IBJP IB NON-MCCF PAY-TO PROVIDERS MENU New
IBJP IB NON-MCCF RATE TYPE ADD New
IBJP IB NON-MCCF RATE TYPE DEL New
IBJP IB NON-MCCF RATE TYPES New
IBJP IB NON-MCCF RATE TYPES MENU New
IBJP IB TRICARE PAY-TO PROVIDER ADD Modified
IBJP IB TRICARE PAY-TO PROVIDER DEL Modified
IBJP IB TRICARE PAY-TO PROVIDER DIVISIONS Modified
IBJP IB TRICARE PAY-TO PROVIDER EDIT Modified
IBJP IB TRICARE PAY-TO PROVIDERS MENU Deleted
IBJPS CMN CPT ADD New
IBJPS CMN CPT DEL New
IBJPS CMN CPT MENU New
Remote Procedures Associated:
New/Modified/
Remote Procedure Name Deleted
--------------------- -------------
N/A
Security Keys Associated:
New/Modified/
Security Key Name Deleted
----------------- -------------
N/A
Templates, Input Associated:
New/Modified/
Template Name Type File Name (Number) Deleted
------------- ---- ------------------ -------------
IBEDIT INS CO1 Input INSURANCE COMPANY (#36) Modified
Templates, List Associated:
New/Modified/
Template Name Type Deleted
------------- ---- -------------
IBJP IB NON-MCCF List New
RATE TYPES
IBJP IB TRICARE List Modified
PAY-TO PROVS
IBJPS CMN CPTS List New
Templates, Print Associated:
New/Modified/
Template Name Type File Name (Number) Deleted
------------- ---- ------------------ -------------
N/A
Templates, Sort Associated:
New/Modified/
Template Name Type File Name (Number) Deleted
------------- ---- ------------------ -------------
N/A
New Service Requests (NSRs)
----------------------------
N/A
Patient Safety Issues (PSIs)
-----------------------------
N/A
Defect Tracking System Ticket(s) & Overview
-------------------------------------------
1. INC4006791 - The option to add a Dental Payer ID and address in the
Insurance Company Editor is missing. This is a VA wide issue.
Problem:
-------
The option to add a Dental Payer ID and address in the Insurance Company
Entry/Edit [IBCN INSURANCE CO EDIT] is missing. This is a VA wide issue.
Resolution:
----------
Insurance Company Entry/Edit [IBCN INSURANCE CO EDIT] which
was enhanced in IB*2.0*592 to support the addition of electronic
dental claims, EDI X12 837D, was overwritten in error in a subsequent
patch and is being restored in order to prompt users for Dental Payer ID
and address.
Test Sites:
----------
Dublin
Martinsburg
Orlando
Tomah
Documentation Retrieval Instructions
------------------------------------
Updated documentation describing the new functionality introduced by this
patch is available.
The preferred method is to retrieve files from download.vista.domain.ext.
This transmits the files from the first available server. Sites may also
elect to retrieve files directly from a specific server.
Sites may retrieve the documentation directly using Secure File Transfer
Protocol (SFTP) from the ANONYMOUS.SOFTWARE directory at the following OI
Field Offices:
Hines: domain.ext
Salt Lake City: domain.ext
Documentation can also be found on the VA Software Documentation Library
at:
https://www.domain.ext/vdl/
Title File Name FTP Mode
-----------------------------------------------------------------------
Deployment, Installation, ib_2_0_p608_ig.pdf Binary
Back-out/Rollback Guide (IB*2.0*608)
EDI User Guide ib_2_0_p608_edi_ug.pdf Binary
Integrated Billing (IB) V.2.0 ib_2_0_p608_tm.pdf Binary
Technical Manual
Patch Installation:
Pre/Post Installation Overview
------------------------------
Of note, included in this patch is a modification to line 2 in the routine
IBCU7 to correct the patch sequencing that was entered as part of the
IB*2.0*592 patch. This change has no effect on the functionality of the
routine and was only made to correct the patch sequencing of line 2.
*************************************************************************
* IMPORTANT NOTE *
* In PRODUCTION, there is one **MANDATORY** pre-installation activity *
* associated with this install. *
* *
* The IB Staff MUST empty the 837 extract/transmission queue PRIOR to *
* the installation of this patch. *
*************************************************************************
INSTRUCTIONS ON HOW TO EMPTY THE 837 EXTRACT TRANSMISSION QUEUE:
===============================================================
The site Information Resource Management (IRM) MUST coordinate with the
Billing Department to ensure that the 837 extract/transmission queue is
empty. Once the Billing Department has completed the instructions, the
Billing department is to inform IRM that the patch installation may
proceed.
The instructions to empty the queue are as follows:
Select the option: TRANSMIT EDI BILLS - MANUAL [IBCE 837 MANUAL TRANSMIT]
What is the purpose of this option?
This option is used to by-pass the normal daily/nightly transmission
queues if the need arises to get the claim to the payer quickly.
When is this option used?
There are occasions when there is a need to transmit a claim(s)
immediately instead of waiting for the batching frequency as scheduled
in the MCCR Site Parameter. This option will allow sending individual
claim(s) or all claims in a ready for extract status.
Upon selecting this option, you will be prompted with the following:
Select one of the following:
A Transmit (A)LL bills in READY FOR EXTRACT status
S Transmit only (S)ELECTED bills
You should select 'A' for ALL
There are no other mandatory pre-installation activities associated with
this patch.
------------------------------------------------------------------------
The Pre-install routine (IBY608PR) will automatically do the following:
* Add/Update entries used by the Forms Output Utility [IBCE OUTPUT
FORMATTER].
* Add new entries in IB ERROR file (#350.8).
The Post-install routine (IBY608PO) will automatically generate the one-
time Insurance Company EDI Parameter Report and send an email to the
eBiz Rapid Response Group ("[email protected]"). This report will
list all of the insurance companies that have the current setting for
the Transmit Electronically parameter set to ZERO which equals 'NO'.
In addition, the Post-install routine will automatically add 50 CPT
codes to the new CMN CPT CODE INCLUSION IB Site Parameter. This list of
codes is a basis of those CPT codes to be referenced in processing
claims which contain CMN Oxygen EPN Nutrition data. This list of CPT
codes can be maintained when accessing the IB Site Parameters.
Routines IBY608PO and IBY608PR may be manually deleted by IT/IRM upon
completion of the installation.
Use default answers for KIDS load/install questions.
Patch-Files: http://code.osehra.org/VistA.git/tree/master/Packages/Integrated+Billing/Patches/IB_2.0_608- Loading branch information
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