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VA Code in Flight Submission - eBilling Claims Compliance (IB*2*516 - KIDS patches)
Please use this identifier to cite or link to this publication: http://hdl.handle.net/10909/11116
Submitted by OI&T EPMO Lean Systems Engineering Open Source Coordination Office on 06-29-2015.
This Integrated Billing (IB) patch introduces changes to VistA's Electronic Claims processing in order to meet the Committee on Operating Rules for Information Exchange (CORE) Operating Rules.

Complete List of patch items:

1. Enter/Edit Billing Information [IB EDIT BILLING INFO]

a) Provide the ability for users to authorize a claim for Skilled Nursing Facility (SNF) with a revenue code(s) less than 100 (remove existing fatal error for codes outside the 100-999 range).

b) Provide the ability for users to add National Drug Codes to non- prescription claims.

c) Provide the ability for users to add a description to a claim with a procedure code that ends in 99 or contains the following in the code description:
Not Otherwise Classified
Not Otherwise
Unlisted
Not listed
Unspecified
Unclassified
Not otherwise specified
Non-specified
Not elsewhere specified
Not elsewhere
Nos (Note: Include "nos ", "nos;", "nos,")
Noc (Note: Include "noc ", "noc;", "noc,")

d) Prevent the ability to authorize claims with non-billable providers [provider has no National Provider Identification Number (NPI)] on the claim.

e) Prevent the ability to authorize a Fee Basis claim with a non-VA Lab or Facility that has no NPI.

f) Provide the ability to authorize a claim with Service Facility data that does not have a Lab or Facility Taxonomy Code without displaying a Warning (remove existing warning).

g) Provide the ability to print a TRICARE claim with a TRICARE-specific Pay-to Provider.

h) Provide the ability for users to re-sequence Diagnoses Codes (DX) after Procedures have been associated with the DX (Pointers) without breaking the association.

i) Provide the ability for users to view a list of the following Code sets by Code number when they enter ?? for Help on Billing Screen 4 and 5:
Occurrence Codes
Condition Codes
Value Codes

j) Provide the ability for users to lookup a Code from one of the following Code sets using the code number:
Occurrence Codes
Condition Codes
Value Codes

2. Insurance Company Editor

a) Remove functionality that provides the ability for a site to set a parameter that forces all claims to a particular payer, to use the VAMC as the Billing Provider instead of the lowest enumerated Billing Provider.

b) Change the Plan Type description for the Plan Type = FI- FEP (Federal Employee Plan) to Do Not Use for BC/BS when users enter ?? for Help at a Plan Type field.

3. Reports

a) Add the display of the new Health Plan Identifier (HPID) and the Other Entity Identifier (OEID) to the EDI Parameter Report. [IBCN INSURANCE EDI REPORT]

b) Remove the display of the Billing Provider override parameter from the EDI Parameter Report. [IBCN INSURANCE EDI REPORT]

c) Provide the ability to display partial or complete new HIPAA compliant electronic 270/271 Health Care Eligibility Benefit Inquiry and Response fields on IB reports.

d) Provide the ability for users to sort and display the Re-Generate Unbilled Amounts Report by Division.

4. Third Party Joint Inquiry (TPJI) [IBJ THIRD PARTY JOINT INQUIRY]

a) Provide the ability for users to see that a claim in TPJI, Active and Inactive claim lists, is an Institutional or a Professional claim.

b) Provide the ability for users to view the Co-payment amount associated with a claim in TPJI

5. Medicare-equivalent Remittance Advice (MRA)

a) Provide the ability to correctly display the MRA associated with Processed Medicare claims with no Patient responsibility or Deductible as PROCESSED.

6. COB Management Worklist (CBW) [IBCE COB MANAGEMENT]

a) Provide the ability for users to sort and display the CBW by Division Transactions.

7. Transactions

a) Provide the ability to transmit the HPID in the Institutional/Professional 837 claim transaction (Loops 2010BB and 2330B) - continue to transmit legacy primary and secondary IDs in the Institutional/Professional 837 claim transaction.

b) Provide the ability to transmit the same NPI (organizational) for a Service Facility and a Rendering Provider (individual) on an Institutional/Professional 837 claim transaction.

c) Remove monthly Mailman messages that notify CBO of how sites have the EDI Parameter for Billing Provider set.

d) Prevent an Institutional/Professional 837 claim transaction with a Y4 Property and Casualty Number Qualifier with no corresponding Property and Casualty Number.

e) Provide the ability to transmit the TRICARE Pay-to Provider on all claims with Rate Type equal to TRICARE and TRICARE REIMB. INS (Loop 2010AB).

f) Provide the ability to transmit a NDC code and units on a non- prescription 837 claim transaction.

8. Correct Rejected/Denied Bill (CRD) and Copy and Cancel Bill (CLON)

a) Remove the Security Key that locks the CLON option.

b) Remove the ability for users to CRD secondary/tertiary claims.

c) Provide the ability for as many fields as possible to be copied from an original claim to a copy.

9. View Cancelled Claim [IB VIEW CANCEL BILL]

a) Provide the ability to see all the data that was in a cancelled claim Provider ID Maintenance.

10. Provider ID Maintenance

a) Provide the ability for users to define an Outside Facility that is a sole-proprietorship with an NPI number that is also used by the provider who is the sole-proprietor.

11. MCCR Site Parameter Display/Edit [IBJ MCCR SITE PARAMETERS]

a) Provide the ability for users to define a Pay-to Provider to be used only on claims with a Rate Type equal to TRICARE or TRICARE REIMB. INS.

b) Provide the ability to lock the new Pay-to Provider functionality Printed CMS - 1500 and UB - 04 Forms

12. Printed CMS - 1500 and UB-04 Forms

a) Provide the ability to print an NDC code on a non-prescription claim.

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