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Sub-Field: 162.03

Package: Fee Basis

FEE BASIS PAYMENT(#162)-->162.01-->162.02-->162.03

Sub-Field: 162.03


Information

Parent File Name Number Package
162.02 SERVICE PROVIDED 162.03 Fee Basis

Details

Field # Name Loc Type Details
.01 SERVICE PROVIDED 0;1 POINTER TO CPT FILE (#81)
************************REQUIRED FIELD************************
CPT(#81)

  • LAST EDITED:  JUL 05, 2017
  • DESCRIPTION:  
    The Current Procedural Terminology Code (CPT Code) as specified on the vendors invoice identifying the service the vendor provided to the veteran.
  • CROSS-REFERENCE:  162.03^AE^MUMPS
    1)= D SCPT^FBAAUTL7
    2)= D KCPT^FBAAUTL7
    Cross-reference built to concatenate CPT with Modifier(s) for duplicate payment checks. The cross-reference is set by both the Service Provided field, as well as the CPT Modifier field.
    The cross-reference format is
    ^FBAAC("AE",pat IEN,ven IEN,date,cpt-mod list,serv prov IEN)="" where
    pat IEN is the PATIENT internal entry number in file 162. (dinum)
    ven IEN is the VENDOR multiple internal entry number. (dinum)
    date is the value of the INITIAL TREATMENT DATE (fileman format)
    cpt-mod list is the value of the SERVICE PROVIDED (internal)
    followed by a dash ("-") and a sorted list of values (internal) from
    the CPT MODIFER multiple. Examples:
    12345 for a service provided without any modifiers
    12345-11,12 for a service provided with two modifiers
    serv prov IEN is the SERVICE PROVIDED multiple internal entry number.
    ***If the need arises to re-index the entire cross-reference, it should be done by re-indexing the Service Provided field and not the CPT Modifier field. As a Service Provided (CPT code) is mandatory for each
    payment entry, but a CPT Modifier is not, to assure a complete cross-reference, the re-indexing should be done on the Service Provided field.
  • CROSS-REFERENCE:  162.03^B
    1)= S ^FBAAC(DA(3),1,DA(2),1,DA(1),1,"B",$E(X,1,30),DA)=""
    2)= K ^FBAAC(DA(3),1,DA(2),1,DA(1),1,"B",$E(X,1,30),DA)
.05 IPAC AGREEMENT 3;6 POINTER TO IPAC VENDOR AGREEMENT FILE FILE (#161.95) IPAC VENDOR AGREEMENT FILE(#161.95)

  • LAST EDITED:  JAN 30, 2014
  • HELP-PROMPT:  Enter the IPAC agreement associated with this invoice.
  • DESCRIPTION:  
    This is the pointer to the IPAC Agreement file that is associated with the invoice.
  • CROSS-REFERENCE:  162^IPAC
    1)= S ^FBAAC("IPAC",$E(X,1,30),DA(3),DA(2),DA(1),DA)=""
    2)= K ^FBAAC("IPAC",$E(X,1,30),DA(3),DA(2),DA(1),DA)
    This cross reference is used to identify any invoices that are associated with IPAC.
.055 DoD INVOICE NUMBER 3;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>22!($L(X)<3) X
  • LAST EDITED:  JAN 30, 2014
  • HELP-PROMPT:  Answer must be 3-22 characters in length.
  • DESCRIPTION:  
    The DoD invoice number that is associated with this VistA invoice. Note that one DoD invoice number may have more than one VistA invoice.
  • CROSS-REFERENCE:  162^DODI
    1)= S ^FBAAC("DODI",$E(X,1,30),DA(3),DA(2),DA(1),DA)=""
    2)= K ^FBAAC("DODI",$E(X,1,30),DA(3),DA(2),DA(1),DA)
    DoD invoice number cross reference
1 AMOUNT CLAIMED 0;2 NUMBER
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<.01) X
  • LAST EDITED:  MAR 01, 1988
  • HELP-PROMPT:  Type a Dollar Amount between .01 and 999999, 2 Decimal Digits
  • DESCRIPTION:  
    The amount the vendor is billing us for this service provided.
2 AMOUNT PAID 0;3 NUMBER
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S X=$TR(X,"$") K:+X'=X&(X'?.N.1".".2N)!(X>999999)!(X<0) X
  • LAST EDITED:  SEP 21, 2014
  • HELP-PROMPT:  Enter the amount to pay in dollars and cents between 0 and 999999.
  • DESCRIPTION:  
    The amount that the VA is going to pay for this service provided.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
3 AMOUNT SUSPENDED 0;4 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<.01) X
  • LAST EDITED:  MAR 01, 1988
  • HELP-PROMPT:  Type a Dollar Amount between .01 and 9999999, 2 Decimal Digits
  • DESCRIPTION:  
    The portion of the vendor's claimed amount that the VA will not pay for various reasons. This amount is usually the difference between the vendor's amount claimed and the amount paid.
3.5 DATE SUSPENDED 0;11 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  MAY 14, 1993
  • DESCRIPTION:  
    The date that this payment is suspended.
  • CROSS-REFERENCE:  162.03^AI1^MUMPS
    1)= S:$P(^FBAAC(DA(3),1,DA(2),1,DA(1),1,DA,0),U,5) ^FBAAC("AI",DA(2),$E(X,1,30),DA(3),$P(^(0),U,5),DA(1),DA)=""
    2)= K:$P(^FBAAC(DA(3),1,DA(2),1,DA(1),1,DA,0),U,5) ^FBAAC("AI",DA(2),$E(X,1,30),DA(3),$P(^(0),U,5),DA(1),DA)
    This will update the cross-reference on the suspense code field if the Date suspended has been changed.
4 SUSPEND CODE 0;5 POINTER TO FEE BASIS SUSPENSION FILE (#161.27) FEE BASIS SUSPENSION(#161.27)

  • LAST EDITED:  MAY 14, 1993
  • DESCRIPTION:  
    The code that identifies why the amount paid was less than the amount claimed. The valid list of codes are contained in the Fee Basis Suspension file.
  • CROSS-REFERENCE:  162^AI^MUMPS
    1)= S:$P(^FBAAC(DA(3),1,DA(2),1,DA(1),1,DA,0),U,11) ^FBAAC("AI",DA(2),$P(^(0),U,11),DA(3),$E(X,1,30),DA(1),DA)=""
    2)= K:$P(^FBAAC(DA(3),1,DA(2),1,DA(1),1,DA,0),U,11) ^FBAAC("AI",DA(2),$P(^(0),U,11),DA(3),$E(X,1,30),DA(1),DA)
    This cross-reference is used to sort suspense letters.
5 DATE FINALIZED 0;6 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 11, 1990
  • DESCRIPTION:  
    The date that this payment line item was finalized (Certified) by the Fee Supervisor.
  • CROSS-REFERENCE:  162^AP^MUMPS
    1)= S ^FBAAC("AP",DA(2),$E(X,1,30),DA(3),DA(1),DA)=""
    2)= K ^FBAAC("AP",DA(2),$E(X,1,30),DA(3),DA(1),DA)
  • CROSS-REFERENCE:  162^AK
    1)= S ^FBAAC("AK",$E(X,1,30),DA(3),DA(2),DA(1),DA)=""
    2)= K ^FBAAC("AK",$E(X,1,30),DA(3),DA(2),DA(1),DA)
  • CROSS-REFERENCE:  162.03^AQ^MUMPS
    1)= I $P(^FBAAC(DA(3),1,DA(2),1,DA(1),1,DA,0),U,12)]"" S ^FBAAC("AQ",$P(^FBAAC(DA(3),1,DA(2),1,DA(1),1,DA,0),U,12),9999999-$E(X,1,30),DA(3),DA(2),DA(1),DA)=""
    2)= I $P(^FBAAC(DA(3),1,DA(2),1,DA(1),1,DA,0),U,12)]"" K ^FBAAC("AQ",$P(^FBAAC(DA(3),1,DA(2),1,DA(1),1,DA,0),U,12),9999999-$E(X,1,30),DA(3),DA(2),DA(1),DA)
6 CLERK 0;7 POINTER TO NEW PERSON FILE (#200)
************************REQUIRED FIELD************************
NEW PERSON(#200)

  • LAST EDITED:  APR 05, 1990
  • DESCRIPTION:  
    The Fee clerk who entered in the payment data.
7 BATCH NUMBER 0;8 POINTER TO FEE BASIS BATCH FILE (#161.7) FEE BASIS BATCH(#161.7)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(""ST""),U,1)=""O""" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  DEC 13, 2011
  • DESCRIPTION:  
    The batch number with which this payment was associated. If the batch file has been purged this may be blank.
  • SCREEN:  S DIC("S")="I $P(^(""ST""),U,1)=""O"""
  • EXPLANATION:  ALLOWS SELECTION OF ONLY BATCHES THAT ARE OPEN
  • CROSS-REFERENCE:  162^AC
    1)= S ^FBAAC("AC",$E(X,1,30),DA(3),DA(2),DA(1),DA)=""
    2)= K ^FBAAC("AC",$E(X,1,30),DA(3),DA(2),DA(1),DA)
  • RECORD INDEXES:  AJ (#1097) (WHOLE FILE #162)
8 OBLIGATION NUMBER 0;10 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>6!($L(X)<6) X D:$D(X) CKOB^FBAAUTL1
  • LAST EDITED:  APR 12, 1990
  • HELP-PROMPT:  ANSWER MUST BE 6 CHARACTERS IN LENGTH
  • DESCRIPTION:  
    The obligation number identifying which funds this payment will be paid with.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
12 DATE PAID 0;14 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JAN 02, 1986
  • HELP-PROMPT:  This is the date of the check, as issued by the treasury.
  • DESCRIPTION:  This is the date of the check, as issued by the treasury. This information will be passed back to DHCP from the Financial Management System (FMS) when the check is issued to the vendor. This field will use the
    check date beginning with version 3.5 of Fee Basis. Entries prior to version 3.5 are the date the system automatically entered when the payment line item was queued to be transmitted to the Austin Automation Center
    for payment.
13 DATE CORRECT INVOICE RECEIVED 0;15 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT K %DT(0) S X=Y K:Y<1 X
  • LAST EDITED:  MAR 08, 1993
  • DESCRIPTION:  Date that the VA receives what it feels to be a complete/correct invoice. This date is very important since it is the date used by the Central Fee system in determining if interest should be paid because of untimely
    processing by VA. Requirements for the prompt payment act apply.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
14 INVOICE NUMBER 0;16 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999999)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  DEC 13, 2011
  • HELP-PROMPT:  TYPE A WHOLE NUMBER BETWEEN 1 AND 999999999
  • DESCRIPTION:  
    An automatically generated number associated with a vendor's bill.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  162^C
    1)= S ^FBAAC("C",$E(X,1,30),DA(3),DA(2),DA(1),DA)=""
    2)= K ^FBAAC("C",$E(X,1,30),DA(3),DA(2),DA(1),DA)
  • RECORD INDEXES:  AJ (#1097) (WHOLE FILE #162)
15 PATIENT TYPE CODE 0;17 SET
************************REQUIRED FIELD************************
  • '00' FOR SURGICAL;
  • '10' FOR MEDICAL;
  • '60' FOR HOME NURSING SERVICE;
  • '85' FOR PSYCHIATRIC-CONTRACT;
  • '86' FOR PSYCHIATRIC;
  • '95' FOR NEUROLOGICAL-CONTACT;
  • '96' FOR NEUROLOGICAL;

  • LAST EDITED:  JAN 11, 1991
  • DESCRIPTION:  
    The patient's type code (ie medical, surgical) related to this payment line item. This is based on the authorization that is selected during the payment process.
15.5 AUTHORIZATION POINTER 3;9 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999)!(X<1)!(X?.E1"."1.N) X
  • LAST EDITED:  MAR 04, 2014
  • HELP-PROMPT:  Enter the internal entry number of the authorization in the FEE BASIS PATIENT file.
  • DESCRIPTION:  
    Type a number between 1 and 9999999, 0 decimal digits. This field is automatically populated with the internal entry number of the patient's authorization in the Fee Basis Patient file.
  • TECHNICAL DESCR:  
    This field was added by patch FB*3.5*154 to replace the AUTHORIZATION POINTER field in the INITIAL TREATMENT DATE multiple.
  • CROSS-REFERENCE:  162^AFN
    1)= S ^FBAAC("AFN",$E(X,1,30),DA(3),DA(2),DA(1),DA)=""
    2)= K ^FBAAC("AFN",$E(X,1,30),DA(3),DA(2),DA(1),DA)
    This cross-reference is used to locate payments that are associated with an authorization in the FEE BASIS PATIENT file.
16 PURPOSE OF VISIT 0;18 POINTER TO FEE BASIS PURPOSE OF VISIT FILE (#161.82)
************************REQUIRED FIELD************************
FEE BASIS PURPOSE OF VISIT(#161.82)

  • INPUT TRANSFORM:  N FBZ S FBZ=$P($G(^FBAAC(DA(3),1,DA(2),1,DA(1),1,DA,0)),U,9),DIC("S")="I $S($G(FBZ):$P(^(0),U,2)=FBZ,1:1)&($S('$G(^(""I"")):1,DT'>^(""I""):1,1:0))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JAN 13, 1995
  • DESCRIPTION:  
    This identifies the purpose that the veteran received the service provided. This data is obtained from the authorization data for the patient, at the time of payment entry.
  • SCREEN:  S DIC("S")="I $S($G(FBZ):$P(^(0),U,2)=FBZ,1:1)&($S('$G(^(""I"")):1,DT'>^(""I""):1,1:0))"
  • EXPLANATION:  A Purpose of Visit that matches the Fee Program selected and the POV must not have an inactive date.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
17 TREATMENT TYPE CODE 0;19 SET
************************REQUIRED FIELD************************
  • '1' FOR SHORT TERM FEE STATUS;
  • '2' FOR HOME NURSING SERVICE;
  • '3' FOR I.D. CARD STATUS;

  • LAST EDITED:  JAN 29, 1993
  • DESCRIPTION:  
    The treatment type code this payment is related to. It is obtained from the authorization data for the patient which was selected at the time of payment entry.
18 PAYMENT TYPE CODE 0;20 SET
************************REQUIRED FIELD************************
  • 'R' FOR REIMBURSEMENT;
  • 'S' FOR STATISTICAL;
  • 'V' FOR VENDOR;
  • 'SR' FOR STAT-REIMBURSEMENT;

  • LAST EDITED:  APR 24, 1986
  • DESCRIPTION:  Identifies whether this is a payment to a vendor, a reimbursement to the veteran, a statistical payment which only updates veteran year-to-date amounts and results in NO payment and a statistical reimbursement which
    allows the user to update payment record with a reimbursement paid out of system.
19 REJECT STATUS FBREJ;1 SET
  • 'P' FOR REJECTED, PENDING;
  • 'C' FOR REJECTED, COMPLETED;

  • LAST EDITED:  OCT 26, 1994
  • DESCRIPTION:  
    Identifies whether this line item has been rejected and is pending assignment to another batch.
20 REJECT REASON FBREJ;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>40!($L(X)<2) X
  • LAST EDITED:  AUG 11, 1986
  • HELP-PROMPT:  ANSWER MUST BE 2-40 CHARACTERS IN LENGTH
  • DESCRIPTION:  
    The reason this line item was rejected for payment. Normally, the Austin reject code is entered.
21 OLD BATCH NUMBER FBREJ;3 POINTER TO FEE BASIS BATCH FILE (#161.7) FEE BASIS BATCH(#161.7)

  • LAST EDITED:  AUG 11, 1986
  • DESCRIPTION:  
    The batch number this line item was associated with before the line item was rejected.
  • CROSS-REFERENCE:  162^AH
    1)= S ^FBAAC("AH",$E(X,1,30),DA(3),DA(2),DA(1),DA)=""
    2)= K ^FBAAC("AH",$E(X,1,30),DA(3),DA(2),DA(1),DA)
21.3 INTERFACE REJECT FBREJ;4 SET
  • '1' FOR YES;

  • LAST EDITED:  DEC 13, 2011
  • HELP-PROMPT:  Enter YES if the line item was rejected by Central Fee.
  • DESCRIPTION:  This field is populated by the FBAA BATCH SERVER and FBAA REJECT SERVER server options when a payment line item is rejected via the interface with Central Fee. This field is used to distinguish line items that were
    locally rejected from those that were rejected by a downstream system. This field is not populated for a local reject.
21.6 REJECT CODE FBREJC;0 Multiple #162.031 162.031

  • DESCRIPTION:  The REJECT CODE multiple is populated with one to four reject codes by the FBAA BATCH SERVER and FBAA REJECT SERVER server options when a line item is rejected via the interface with Central Fee. The REJECT CODE
    multiple is not used for local rejects. The reason for a local reject is entered into the REJECT REASON (#20) field.
22 DESCRIPTION OF SUSPENSION 1;0 WORD-PROCESSING #162.05

  • DESCRIPTION:  
    This field is used only when the suspend code entered is '4' meaning 'Other'. This allows the entering of the reason that the payment amount was not in full. This will be printed on the suspense letter.
23 FEE PROGRAM 0;9 POINTER TO FEE BASIS PROGRAM FILE (#161.8) FEE BASIS PROGRAM(#161.8)

  • LAST EDITED:  SEP 08, 1992
  • DESCRIPTION:  
    The Fee program that this line item is associated with (ie Outpatient Medical, Contract Hospital).
  • CROSS-REFERENCE:  162^AN^MUMPS
    1)= S:X'=2 ^FBAAC("AN",X,DA(3),DA(2),DA(1),DA)=""
    2)= K ^FBAAC("AN",X,DA(3),DA(2),DA(1),DA)
    Cross-reference is used to easily identify those fee services which belong to fee programs other than outpatient medical.
24 VOID PAYMENT 0;21 SET

  • LAST EDITED:  MAR 25, 1988
  • DESCRIPTION:  This field is set when a payment was made in error and the site has initiated a bill of collection to retrieve the dollars expended. The ability to void a payment is restricted to the holder of the FBAASUPERVISOR
    security key.
24.5 REASON FOR VOIDED PAYMENT R;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>75!($L(X)<3) X
  • LAST EDITED:  AUG 31, 1992
  • HELP-PROMPT:  Answer must be 3-75 characters in length.
  • DESCRIPTION:  
    This field will allow the Fee Supervisor to store the reason why they had to void a payment.
25 SUPERVISOR 0;22 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  APR 05, 1990
  • DESCRIPTION:  
    This is the Fee Supervisor who cancelled(voided) the payment.
26 PRIMARY SERVICE FACILITY 0;12 POINTER TO INSTITUTION FILE (#4) INSTITUTION(#4)

  • LAST EDITED:  APR 19, 1990
  • DESCRIPTION:  
    The VA Hospital responsible for the veterans care.
27 ASSOCIATED 7078/583 0;13 VARIABLE POINTER VA FORM 10-7078(#162.4)  FEE BASIS UNAUTHORIZED CLAIMS(#162.7)  

  • LAST EDITED:  SEP 18, 1990
  • DESCRIPTION:  
    Contains the related 7078 or 583 if an unauthorized claim.
  • CROSS-REFERENCE:  162^AM
    1)= S ^FBAAC("AM",$E(X,1,30),DA(3),DA(2),DA(1),DA)=""
    2)= K ^FBAAC("AM",$E(X,1,30),DA(3),DA(2),DA(1),DA)
28 PRIMARY DIAGNOSIS 0;23 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  MAY 26, 1993
  • DESCRIPTION:  
    This field contains the primary diagnosis of the patient for the service provided.
  • TECHNICAL DESCR:  
    This field is a pointer to the ICD DIAGNOSIS (#80) file. It is used to attach a diagnosis to a CPT code.
29 VA TYPE OF SERVICE 0;24 POINTER TO FEE BASIS VA TYPE OF SERVICE FILE (#163.85) FEE BASIS VA TYPE OF SERVICE(#163.85)

  • LAST EDITED:  JUN 30, 1992
  • DESCRIPTION:  
    The information recorded in this field will be sent with the payment record to the Austin DPC. It will allow the program office to do some comparisons between VA supplied services and those supplied by Fee Basis.
  • TECHNICAL DESCR:  
    This filed is a pointer to Fee Basis VA Type of Service (#163.85) file. It is a static table file populated by the program office.
30 PLACE OF SERVICE 0;25 POINTER TO PLACE OF SERVICE FILE (#353.1) PLACE OF SERVICE(#353.1)

  • OUTPUT TRANSFORM:  N FBX S FBX=$G(^IBE(353.1,+Y,0)) Q:FBX']"" S Y=$P(FBX,U,2)_" ("_$P(FBX,U)_")"
  • LAST EDITED:  JUN 10, 1996
  • DESCRIPTION:  
    This field determines where the service was administered to the veteran.
  • TECHNICAL DESCR:  
    This field is a pointer to the Place of Service (#353.1) file. It contains data supplied by the Health Care Finance Administration and is recorded on HCFA form 1500.
31 HCFA TYPE OF SERVICE 0;26 POINTER TO TYPE OF SERVICE FILE (#353.2) TYPE OF SERVICE(#353.2)

  • OUTPUT TRANSFORM:  N FBX S FBX=$G(^IBE(353.2,+Y,0)) Q:FBX']"" S Y=$P(FBX,U,2)_" ("_$P(FBX,U)_")"
  • LAST EDITED:  JUN 10, 1996
  • DESCRIPTION:  
    This information will be used to determine payment amounts in the future. It is currently asked on the HCFA 1500 form.
  • TECHNICAL DESCR:  
    This field is a pointer to the Type of Service (#353.2) file. It is a table file with data supplied by the Health Care finance Administration.
32 SERVICE CONNECTED CONDITION? 0;27 FREE TEXT

  • INPUT TRANSFORM:  I $D(X) D YN^FBAAUTL3
  • OUTPUT TRANSFORM:  D OUTYN^FBAAUTL3
  • LAST EDITED:  MAR 18, 1994
  • HELP-PROMPT:  Answer 'Yes' or '1' for YES and 'No' or '0' for NO.
  • DESCRIPTION:  
    Indicates whether the service provided was for a Service Connected condition. Answer 'Yes' if service provided was for a Service Connected condition, 'No' if eligible under NSC such as Aid and Attendance.
  • TECHNICAL DESCR:  
  • EXECUTABLE HELP:  I $G(DFN) W !?1,*7,"Patient: ",$$NAME^FBCHREQ2(DFN) D DIS^DGRPDB W !!
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
33 VENDOR INVOICE DATE 2;1 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:Y<1 X I X>$P(^FBAAC(DA(3),1,DA(2),1,DA(1),1,DA,0),"^",15) W !,*7,"Vendor Invoice Date cannot be later than the Date Correct Invoice Received" K X
  • LAST EDITED:  APR 14, 1994
  • HELP-PROMPT:  Enter the date the vendor issued the invoice.
  • DESCRIPTION:  
    This is the date that the vendor issued the invoice.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
34 PROMPT PAY TYPE 2;2 SET

  • LAST EDITED:  MAR 18, 1994
  • HELP-PROMPT:  Set equal to 1 if payment is subject to interest payments.
  • DESCRIPTION:  
    Field is set to 1 if the payment is subject to interest payments (prompt pay). Otherwise it remains blank.
35 CHECK NUMBER 2;3 FREE TEXT

  • INPUT TRANSFORM:  K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>8!($L(X)<1)!'(X?.NA) X
  • LAST EDITED:  APR 25, 1994
  • HELP-PROMPT:  Answer must be 1-8 characters in length.
  • DESCRIPTION:  
    Contains the check number as issued by the treasury. This field is updated after the check is issued, through a server option that records actual payment information for each Fee payment made.
  • CROSS-REFERENCE:  162^ACK^MUMPS
    1)= S ^FBAAC("ACK",X,DA(3),DA(2),DA(1),DA)=""
    2)= K ^FBAAC("ACK",X,DA(3),DA(2),DA(1),DA)
    This cross-reference is used for finding payment items for specific check numbers.
36 CANCELLATION DATE 2;4 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  MAR 15, 1994
  • HELP-PROMPT:  The date the check was cancelled by the treasury.
  • DESCRIPTION:  
    This is the date the treasury cancelled the check. This field is updated through a server option that records cancellations of previously recorded payment data.
37 REASON CODE 2;5 POINTER TO FEE BASIS CHECK CANCELLATION REASON FILE (#162.95) FEE BASIS CHECK CANCELLATION REASON(#162.95)

  • LAST EDITED:  MAR 15, 1994
  • HELP-PROMPT:  Enter the reason the check was cancelled.
  • DESCRIPTION:  
    This field contains a pointer to the Fee Basis Check Cancellation Reason file. It is populated through a server option that updates the payment record when the treasury cancels a check that was previously payed.
38 CANCELLATION ACTIVITY 2;6 SET

  • LAST EDITED:  APR 26, 1994
  • HELP-PROMPT:  Field will contain the cancellation code if there has been cancellation activity on this payment.
  • DESCRIPTION:  This field is populated when a cancellation is recorded for the payment referenced. This field will always remain populated, to indicate that there was cancellation activity on this payment at one time. New
    payments will replace the cancellation date and reason code fields, but the cancellation activity flag will not be overwritten. This flag will allow the user to know that previous cancellation activity existed,
    and to review the cancellation history output for further information.
40 DISBURSED AMOUNT 2;8 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
  • LAST EDITED:  APR 21, 1994
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is the dollar amount paid by the treasury, less any interest paid.
41 INTEREST AMOUNT 2;9 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
  • LAST EDITED:  APR 21, 1994
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
  • DESCRIPTION:  
    The interest amount paid on this line item by the treasury.
42 SITE OF SERVICE ZIP CODE 2;10 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>5!($L(X)<5)!'(X?5N&(X'?5"0")) X
  • LAST EDITED:  MAY 05, 1999
  • HELP-PROMPT:  Answer must be 5 characters in length.
  • DESCRIPTION:  
    Zip Code of the location where the service was actually performed.
43 ANESTHESIA TIME (MINUTES) 2;11 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999)!(X<15)!(X?.E1"."1N.N) X
  • LAST EDITED:  FEB 12, 2016
  • HELP-PROMPT:  Type a Number between 15 and 9999, 0 Decimal Digits
  • DESCRIPTION:  
    Enter time billed for an anesthesia service in minutes. The bill may specify anesthesia units which will need to be converted to minutes.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
44 FEE SCHEDULE AMOUNT 2;12 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999.99)!(X<0) X
  • LAST EDITED:  MAY 05, 1999
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 999999.99, 2 Decimal Digits
  • DESCRIPTION:  
    This is the dollar amount obtained from a fee schedule for the service provided.
45 FEE SCHEDULE 2;13 SET

  • LAST EDITED:  MAY 05, 1999
  • HELP-PROMPT:  Enter the fee schedule used to obtain the fee schedule amount.
  • DESCRIPTION:  
    Specifies which fee schedule was used to obtain the fee schedule amount for this service provided.
46 CPT MODIFIER M;0 POINTER Multiple #162.06 162.06
47 UNITS PAID 2;14 NUMBER
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 26, 2003
  • HELP-PROMPT:  Type a Number between 1 and 99999, 0 Decimal Digits
  • DESCRIPTION:  
    Units of service being paid for this line item if any payment is being made for the line item. If payment disapproved for the line item then enter the units of service that were billed.
48 REVENUE CODE 2;15 POINTER TO REVENUE CODE FILE (#399.2) REVENUE CODE(#399.2)

  • LAST EDITED:  JUN 17, 2003
  • HELP-PROMPT:  Answer with the revenue code associated with this charge.
  • DESCRIPTION:  Revenue code is a 3-digit code associated with itemized charges on a UB92 billing invoice. A revenue code should be entered if a CPT/HCPCS code was not specified for the line item. If both revenue code and a
    CPT/HCPCS code have been entered for a line item, the revenue code will be considered the more accurate description of the service.
  • TECHNICAL DESCR:  
    IA #4128 allows Fee Basis to point to the REVENUE CODE (#399.2) file.
49 PATIENT ACCOUNT NUMBER 2;16 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  JUN 17, 2003
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    Please enter the Patient control number. This could be either the Patient Identification Number or Patient Account Number from the vendor's invoice.
50 FPPS CLAIM ID 3;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>32!($L(X)<1)!'(X?1.32N) X
  • LAST EDITED:  JUN 18, 2003
  • HELP-PROMPT:  Enter a non-zero number from 1 to 32 digits long, 0 decimal digits.
  • DESCRIPTION:  
    Enter the entire FPPS Claim ID as shown on the invoice document. (1-32 character text ID created by FPPS system).
  • FIELD INDEX:  AFC (#299) REGULAR IR SORTING ONLY WHOLE FILE (#162)
    Short Descr: Whole file cross-reference on FPPS CLAIM ID.
    Description: Regular, whole-file cross-reference on the FPPS CLAIM ID field.
    Set Logic: S ^FBAAC("AFC",$E(X,1,32),DA(3),DA(2),DA(1),DA)=""
    Kill Logic: K ^FBAAC("AFC",$E(X,1,32),DA(3),DA(2),DA(1),DA)
    Whole Kill: K ^FBAAC("AFC")
    X(1): FPPS CLAIM ID (162.03,50) (Subscr 1) (Len 32) (forwards)
51 FPPS LINE ITEM 3;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>40!($L(X)<1) X
  • LAST EDITED:  JUN 17, 2003
  • HELP-PROMPT:  This response must be a number or a list or range, e.g., 1,3,5 or 2-4,8.
  • DESCRIPTION:  Enter the line item sequence number associated with this charge. Each charge on the FPPS invoice document will have a line item sequence number associated with it. A line item can be entered individually or a
    group of charges from multiple lines can be entered. If all line items in a group are in numerical sequence, you may enter the first line item sequence number followed by a hyphen and the last line item sequence
    number. If the grouped charges are not in sequential order, each line item must be entered individually, followed by a comma.
52 ADJUSTMENT 7;0 POINTER Multiple #162.07 162.07
53 REMITTANCE REMARK 8;0 POINTER Multiple #162.08 162.08
54 CONTRACT 3;8 POINTER TO FEE BASIS CONTRACT FILE (#161.43) FEE BASIS CONTRACT(#161.43)

  • LAST EDITED:  JUL 09, 2009
  • HELP-PROMPT:  If applicable, enter the contract.
  • DESCRIPTION:  
    If the payment is for contracted services, the contract number can be specified in this field. The selected contract must be active and applicable to the vendor being paid.
  • TECHNICAL DESCR:  
    In some cases this field will be automatically populated by the software based on the associated authorization. In other cases, the user will be prompted for a value.
  • CROSS-REFERENCE:  162^ACN
    1)= S ^FBAAC("ACN",$E(X,1,30),DA(3),DA(2),DA(1),DA)=""
    2)= K ^FBAAC("ACN",$E(X,1,30),DA(3),DA(2),DA(1),DA)
    This is an index of contracts entered for outpatient and ancillary payments. The index will be used to prevent deletion of entries from the FEE BASIS CONTRACT file that are referenced (pointed to) by a
    payment.
55 ROUTING NUMBER 2;17 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>9!($L(X)<9) X
  • LAST EDITED:  MAY 13, 2011
  • HELP-PROMPT:  Answer must be 9 characters in length.
  • DESCRIPTION:  Enter the financial routing number information that was returned with the payment from Central Fee for Electronic Fund Transfer (EFT) entries. This information will be forwarded to FPPS so that the vendor can
    be notified of the payment. This field must be 9 characters, including any leading zeros. Note: The Central Fee nightly update will automatically set this field if the data is included in their message.
56 ACCOUNT NUMBER 2;18 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>17!($L(X)<1) X
  • LAST EDITED:  MAY 13, 2011
  • HELP-PROMPT:  Answer must be 1-17 characters in length.
  • DESCRIPTION:  Enter the financial account number information that was returned with the payment from Central Fee for Electronic Fund Transfer (EFT) entries. This information will be forwarded to FPPS so that the vendor can
    be notified of the payment. This field must be 1-17 characters, including any leading zeros. Note: The Central Fee nightly update will automatically set this field if the data is included in their message.
57 FINANCIAL INSTITUTION 2;19 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  MAY 13, 2011
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  Enter the financial institution name that was returned with the payment from Central Fee for Electronic Fund Transfer (EFT) entries. This information will be forwarded to FPPS so that the vendor can be
    notified of the payment. Note: The Central Fee nightly update will automatically set this field if the data is included in their message.
58 ATTENDING PROV NAME 4;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  OCT 13, 2011
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    Enter the Attending Provider's name found in the claim information.
59 ATTENDING PROV NPI 4;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • LAST EDITED:  OCT 13, 2011
  • HELP-PROMPT:  Answer must be 10 characters in length.
  • DESCRIPTION:  
    Enter the Attending Provider's National Provider Identifier (NPI) found in the claim information. This value must be 10 characters, including any leading zeros.
60 ATTENDING PROV TAXONOMY CODE 4;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • LAST EDITED:  OCT 13, 2011
  • HELP-PROMPT:  Answer must be 10 characters in length.
  • DESCRIPTION:  
    Enter the Attending Provider's Taxonomy code found in the claim information. This value must be 10 characters, including any leading zeros.
61 OPERATING PROV NAME 4;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  OCT 13, 2011
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    Enter the Operating Provider's name found in the claim information.
62 OPERATING PROV NPI 4;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • LAST EDITED:  OCT 13, 2011
  • HELP-PROMPT:  Answer must be 10 characters in length.
  • DESCRIPTION:  
    Enter the Operating Provider's National Provider Identifier (NPI) found in the claim information. This value must be 10 characters, including any leading zeros.
63 RENDERING PROV NAME 4;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  OCT 13, 2011
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    Enter the Rendering Provider's name found in the claim information.
64 RENDERING PROV NPI 4;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • LAST EDITED:  OCT 13, 2011
  • HELP-PROMPT:  Answer must be 10 characters in length.
  • DESCRIPTION:  
    Enter the Rendering Provider's National Provider Identifier (NPI) found in the claim information. This value must be 10 characters, including any leading zeros.
65 RENDERING PROV TAXONOMY CODE 4;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • LAST EDITED:  OCT 13, 2011
  • HELP-PROMPT:  Answer must be 10 characters in length.
  • DESCRIPTION:  
    Enter the Rendering Provider's Taxonomy code found in the claim information. This value must be 10 characters, including any leading zeros.
66 SERVICING PROV NAME 4;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  OCT 13, 2011
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    Enter the Servicing Provider's name found in the claim information.
67 SERVICING PROV NPI 4;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • LAST EDITED:  OCT 13, 2011
  • HELP-PROMPT:  Answer must be 10 characters in length.
  • DESCRIPTION:  
    Enter the Servicing Provider's National Provider Identifier (NPI) found in the claim information. This value must be 10 characters, including any leading zeros.
68 REFERRING PROV NAME 4;11 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  OCT 13, 2011
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    Enter the Referring Provider's name found in the claim information.
69 REFERRING PROV NPI 4;12 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • LAST EDITED:  OCT 13, 2011
  • HELP-PROMPT:  Answer must be 10 characters in length.
  • DESCRIPTION:  
    Enter the Referring Provider's National Provider Identifier (NPI) found in the claim information. This value must be 10 characters, including ay leading zeros.
70 OHI OTHER SUBSCRIBER INFO 6;0 Multiple #162.09 162.09

  • LAST EDITED:  APR 18, 2017
  • DESCRIPTION:  
    This multiple contains information that pertains to payers that are known to be involved in the paying on this claim.
  • TECHNICAL DESCR:  
    OHI data stored in X12, #2320 Other Subscriber Information. (Up to 10 entries).
71 OHI SERVICE LINE INFO 11;0 Multiple #162.371 162.371

  • DESCRIPTION:  
    This multiple contains payment and payer information for each specific service provided to the patient.
  • TECHNICAL DESCR:  
    OHI Service Line number information, X12, #2400.
73 LI RENDERING PROV NAME 3;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  MAY 17, 2011
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  Enter the associated line item Rendering Provider's name found in the line item level claim information. Note: This field is only necessary if the line item Rendering Provider is different than the
    claim Rendering Provider.
74 LI RENDERING PROV NPI 3;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • LAST EDITED:  APR 25, 2011
  • HELP-PROMPT:  Answer must be 10 characters in length.
  • DESCRIPTION:  Enter the associated line item Rendering Provider's name found in the line item level claim information. This value must be 10 characters, including any leading zeros.
    Note: This field is only necessary if the line item Rendering Provider is different than the claim Rendering Provider.
75 LI RENDERING PROV TAXONOMY 3;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • LAST EDITED:  APR 25, 2011
  • HELP-PROMPT:  Answer must be 10 characters in length.
  • DESCRIPTION:  Enter the associated line item Rendering Provider's Taxonomy code found in the line item level of the claim information. This value must be 10 characters, including any leading zeros.
    Note: This field is only necessary if the line item Rendering Provider is different than the claim Rendering Provider.
76 SERVICING FACILITY ADDRESS 5;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>60!($L(X)<1) X
  • LAST EDITED:  OCT 13, 2011
  • HELP-PROMPT:  Answer must be 1-60 characters in length.
  • DESCRIPTION:  
    Enter the Servicing Facility street address found in the claim information.
77 SERVICING FACILITY CITY 5;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  OCT 13, 2011
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    Enter the Servicing Facility city found in the claim information.
78 SERVICING FACILITY STATE 5;3 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  OCT 13, 2011
  • DESCRIPTION:  
    Enter the Servicing Facility state found in the claim information.
79 SERVICING FACILITY ZIP 5;4 FREE TEXT

  • INPUT TRANSFORM:  K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>20!($L(X)<5) X I $D(X) D ZIPIN^VAFADDR
  • OUTPUT TRANSFORM:  D ZIPOUT^VAFADDR
  • LAST EDITED:  OCT 13, 2011
  • HELP-PROMPT:  Answer with either 5 digit or 9 digit zip code.
  • DESCRIPTION:  
    Enter the Servicing Facility zip code, in either the 5 digit format (e.g. 12345) or 9 digit format (e.g. 12345.6789 or 123456789).
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
81 UNIQUE CLAIM IDENTIFIER 5;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>28!($L(X)<1) X
  • LAST EDITED:  MAR 22, 2012
  • HELP-PROMPT:  Answer must be 1-28 characters in length.
  • DESCRIPTION:  
    This field contains a unique identifier for tracking claims. Fee5010 Project.
82 PAYMENT METHODOLOGY 2;7 POINTER TO FEE BASIS PAYMENT METHODOLOGY FILE (#163.98) FEE BASIS PAYMENT METHODOLOGY(#163.98)

  • LAST EDITED:  APR 17, 2015
  • HELP-PROMPT:  Enter a valid Fee Basis Payment Methodology
  • DESCRIPTION:  
    The values in this field come from FBCS and represents the actual payment methodology used in FBCS to adjudicate the claim.
83 AUTHORIZATION NUMBER 9;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 27, 2015
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This field holds the authorization numbers transmitted from FBCS.
84 ATTACHMENT ID 10;0 Multiple #162.0384 162.0384

  • DESCRIPTION:  
    This multiple holds Attachment IDs and Attachment Report Types supporting this payment in the Attachment Retrieval System (ARS).
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