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Sub-Field: 2.312

Package: Registration

PATIENT(#2)-->2.312

Sub-Field: 2.312


Information

Parent File Name Number Package
PATIENT(#2) INSURANCE TYPE 2.312 Registration

Details

Field # Name Loc Type Details
.01 INSURANCE TYPE 0;1 POINTER TO INSURANCE COMPANY FILE (#36) INSURANCE COMPANY(#36)

  • INPUT TRANSFORM:  S DIC("S")="I '$P(^(0),""^"",5)" S:$D(DGCRINSS) DIC("S")=DIC("S")_",$P(^(0),""^"",2)'=""N""" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  APR 20, 2000
  • HELP-PROMPT:  Enter the insurance company with which the patient has insurance coverage.
  • DESCRIPTION:  
    Choose from the available listing the name(s) of the insurance company(ies) under which this applicant is covered.
  • SCREEN:  S DIC("S")="I '$P(^(0),""^"",5)" S:$D(DGCRINSS) DIC("S")=DIC("S")_",$P(^(0),""^"",2)'=""N"""
  • EXPLANATION:  ACTIVE INSURANCE COMPANIES ONLY
  • DELETE TEST:  399,0)= I $$DELP^IBCNSU(DA(1),$P(^DPT(DA(1),.312,DA,0),U),DA) W !!,$C(7),"THERE ARE BILLS ASSOCIATED WITH THIS COMPANY, DELETION NOT ALLOWED"
  • CROSS-REFERENCE:  2.312^ADGRU31201^MUMPS
    1)= D:($T(ADGRU^DGRUDD01)'="") ADGRU^DGRUDD01(+$G(DA(1)))
    2)= D:($T(ADGRU^DGRUDD01)'="") ADGRU^DGRUDD01(+$G(DA(1)))
    RAI/MDS: field monitored for changes.
  • CROSS-REFERENCE:  2.312^B
    1)= S ^DPT(DA(1),.312,"B",$E(X,1,30),DA)=""
    2)= K ^DPT(DA(1),.312,"B",$E(X,1,30),DA)
  • CROSS-REFERENCE:  2^AB
    1)= S ^DPT("AB",$E(X,1,30),DA(1),DA)=""
    2)= K ^DPT("AB",$E(X,1,30),DA(1),DA)
    Index of all insurance companies for the entire patient file.  This will be used to prevent deleting of insurance companies that are pointed to by the patient file.
  • CROSS-REFERENCE:  ^^TRIGGER^2.312^1.01
    1)= X ^DD(2.312,.01,1,4,1.3) I X S X=DIV S Y(1)=$S($D(^DPT(D0,.312,D1,1)):^(1),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X=DIV S X=DT X ^DD(2.312,.01,1,4,1.4)
    1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S Y(1)=$S($D(^DPT(D0,.312,D1,1)):^(1),1:"") S X=$P(Y(1),U,1)=""
    1.4)= S DIH=$S($D(^DPT(DIV(0),.312,DIV(1),1)):^(1),1:""),DIV=X S $P(^(1),U,1)=DIV,DIH=2.312,DIG=1.01 D ^DICR:$N(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= #1.01=""
    CREATE VALUE)= S X=DT
    DELETE VALUE)= NO EFFECT
    FIELD)= #1.01
    Triggers date entered field to current date only if null.
  • CROSS-REFERENCE:  ^^TRIGGER^2.312^1.02
    1)= X ^DD(2.312,.01,1,5,1.3) I X S X=DIV S Y(1)=$S($D(^DPT(D0,.312,D1,1)):^(1),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=DUZ X ^DD(2.312,.01,1,5,1.4)
    1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S Y(1)=$S($D(^DPT(D0,.312,D1,1)):^(1),1:"") S X=$S('$D(^VA(200,+$P(Y(1),U,2),0)):"",1:$P(^(0),U,1))=""
    1.4)= S DIH=$S($D(^DPT(DIV(0),.312,DIV(1),1)):^(1),1:""),DIV=X S $P(^(1),U,2)=DIV,DIH=2.312,DIG=1.02 D ^DICR:$N(^DD(DIH,DIG,1,0))>0
    2)= Q
    CREATE CONDITION)= #1.02=""
    CREATE VALUE)= S X=DUZ
    DELETE VALUE)= NO EFFECT
    FIELD)= #1.02
    Store user who entered insurance.
  • CROSS-REFERENCE:  2.312^AENR01^MUMPS
    1)= D EVENT^IVMPLOG($G(DA(1)))
    2)= D EVENT^IVMPLOG($G(DA(1)))
    3)=  DO NOT DELETE
    This cross-reference is used to notify HEC of changes that may affect enrollment.
.18 GROUP PLAN 0;18 POINTER TO GROUP INSURANCE PLAN FILE (#355.3) GROUP INSURANCE PLAN(#355.3)

  • INPUT TRANSFORM:  S DIC("S")="I +$P(^(0),U)=+$G(^DPT(DA(1),.312,DA,0))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  APR 20, 2000
  • HELP-PROMPT:  Enter the name or number of the Insurance Company you are trying to update benefits for.
  • DESCRIPTION:  Select the plan under which this patient is covered by the specified insurance company. If this is a group plan then there may already be an entry for this plan that you may select. Or, you may add a new plan. If this
    is an individual plan then it will be associated with only this patient.
  • SCREEN:  S DIC("S")="I +$P(^(0),U)=+$G(^DPT(DA(1),.312,DA,0))"
  • EXPLANATION:  MUST BE SAME INSURANCE COMPANY
  • CROSS-REFERENCE:  2.312^ADGRU31218^MUMPS
    1)= D:($T(ADGRU^DGRUDD01)'="") ADGRU^DGRUDD01(+$G(DA(1)))
    2)= D:($T(ADGRU^DGRUDD01)'="") ADGRU^DGRUDD01(+$G(DA(1)))
    RAI/MDS: field monitored for changes.
  • CROSS-REFERENCE:  2.312^AENR18^MUMPS
    1)= D EVENT^IVMPLOG($G(DA(1)))
    2)= D EVENT^IVMPLOG($G(DA(1)))
    3)=  DO NOT DELETE
    This cross-reference is used to notify HEC of changes that may affect enrollment.
.2 COORDINATION OF BENEFITS 0;20 SET
  • '1' FOR PRIMARY;
  • '2' FOR SECONDARY;
  • '3' FOR TERTIARY;

  • LAST EDITED:  JUL 02, 1993
1 *SUBSCRIBER ID 0;2 FREE TEXT

  • INPUT TRANSFORM:  D SUBID^IBCNSU1
  • LAST EDITED:  NOV 20, 2013
  • HELP-PROMPT:  Answer must be 3-20 characters in length.
  • DESCRIPTION:  Enter the Subscriber's Primary ID number. This number is assigned by the payer and can be found on the subscriber's insurance card.
    This field is scheduled for deletion in May 2015.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the SUBSCRIBER ID field of the INSURANCE TYPE sub-field of the PATIENT File
  • CROSS-REFERENCE:  2.312^ADGRU3121^MUMPS
    1)= D:($T(ADGRU^DGRUDD01)'="") ADGRU^DGRUDD01(+$G(DA(1)))
    2)= D:($T(ADGRU^DGRUDD01)'="") ADGRU^DGRUDD01(+$G(DA(1)))
    RAI/MDS: field monitored for changes.
  • CROSS-REFERENCE:  2.312^AENR1^MUMPS
    1)= D EVENT^IVMPLOG($G(DA(1)))
    2)= D EVENT^IVMPLOG($G(DA(1)))
    3)=  DO NOT DELETE
    This cross-reference is used to notify HEC of changes that may affect enrollment.
  • CROSS-REFERENCE:  ^^TRIGGER^2.312^7.02
    1)= X ^DD(2.312,1,1,3,1.3) I X S X=DIV S Y(1)=$S($D(^DPT(D0,.312,D1,7)):^(7),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=$P(^DPT(DA(1),.312,DA,0),U,2) X ^DD(2.312,1,1,3,1.4)
    1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^DPT(DA(1),.312,DA,0),U,2)'=$E($P($G(^DPT(DA(1),.312,DA,7)),U,2),1,20))
    1.4)= S DIH=$G(^DPT(DIV(0),.312,DIV(1),7)),DIV=X S $P(^(7),U,2)=DIV,DIH=2.312,DIG=7.02 D ^DICR
    2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^DPT(DA(1),.312,DA,0),U,2)="") I X S X=DIV S Y(1)=$S($D(^DPT(D0,.312,D1,7)):^(7),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(2.312,1,1,3,2.4)
    2.4)= S DIH=$G(^DPT(DIV(0),.312,DIV(1),7)),DIV=X S $P(^(7),U,2)=DIV,DIH=2.312,DIG=7.02 D ^DICR
    CREATE CONDITION)= S X=($P(^DPT(DA(1),.312,DA,0),U,2)'=$E($P($G(^DPT(DA(1),.312,DA,7)),U,2),1,20))
    CREATE VALUE)= S X=$P(^DPT(DA(1),.312,DA,0),U,2)
    DELETE CONDITION)= S X=($P(^DPT(DA(1),.312,DA,0),U,2)="")
    DELETE VALUE)= @
    FIELD)= SUBSCRIBER ID
    Triggers field 2.312/7.02 if first 20 chars of its value differ from the value in this field. Deletes field 2.312/7.02 if field 2.312/1 is deleted.
1.01 DATE ENTERED 1;1 DATE

  • INPUT TRANSFORM:  S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUL 07, 1993
  • HELP-PROMPT:  Enter the Date time this entry was entered
  • DESCRIPTION:  
    This is the date this entry was added.  It will be created by the system whenever a new policy is added.  Entries created prior the installation of IB v2.0 will not have an entry in this field.
  • NOTES:  TRIGGERED by the INSURANCE TYPE field of the INSURANCE TYPE sub-field of the PATIENT File
1.02 ENTERED BY 1;2 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  MAR 03, 1993
  • DESCRIPTION:  
    This the user who added this entry.  It will be entered by the system whenever a new policy is added.  Entries created prior the installation of IB v2.0 will not have an entry in this field.
  • NOTES:  TRIGGERED by the INSURANCE TYPE field of the INSURANCE TYPE sub-field of the PATIENT File
1.03 DATE LAST VERIFIED 1;3 DATE

  • INPUT TRANSFORM:  S %DT="ETX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JAN 31, 2000
  • HELP-PROMPT:  Enter the date that this policy was last verified.
  • DESCRIPTION:  Insurance coverage is generally verified by calling the insurer and requesting an explanation of benefits. When coverage has been verified the person verifying the coverage should use the options to verify the coverage
    in VISTA.
    This is the date that this policy for this patient was last verified with the insurance company.  It is important to update the verification date regularly so that other users will know how current the information in
    VISTA is.
1.04 VERIFIED BY 1;4 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  MAR 03, 1993
  • DESCRIPTION:  This is the user that last contacted the insurance company to verify the policy. It is updated by using the appropriate DHCP options. It is important to update the verification date and user so that other users will
    know the insurance policy information is current.
1.05 DATE LAST EDITED 1;5 DATE

  • INPUT TRANSFORM:  S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  APR 28, 2010
  • HELP-PROMPT:  Enter the date the policy was last edited.
  • DESCRIPTION:  
    This is the date this policy was last edited.  This field is updated by the computer whenever anyone edits this patient's policy information.
  • CROSS-REFERENCE:  ^^TRIGGER^2.312^4.04
    1)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DPT(D0,.312,D1,4)):^(4),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X=DIV S X="0" X ^DD(2.312,1.05,1,1,1.4)
    1.4)= S DIH=$G(^DPT(DIV(0),.312,DIV(1),4)),DIV=X S $P(^(4),U,4)=DIV,DIH=2.312,DIG=4.04 D ^DICR
    2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DPT(D0,.312,D1,4)):^(4),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X=DIV S X="0" X ^DD(2.312,1.05,1,1,2.4)
    2.4)= S DIH=$G(^DPT(DIV(0),.312,DIV(1),4)),DIV=X S $P(^(4),U,4)=DIV,DIH=2.312,DIG=4.04 D ^DICR
    CREATE VALUE)= "0"
    DELETE VALUE)= "0"
    FIELD)= EIV AUTO-UPDATE
    Any change to this field will set EIV AUTO-UPDATE field (4.04) to "NO".
1.06 LAST EDITED BY 1;6 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  MAR 03, 1993
  • DESCRIPTION:  
    This is the user that last edited the policy.  This field is updated by the computer whenever anyone edits this patients policy information.
1.08 *COMMENT - PATIENT POLICY 1;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<3) X
  • LAST EDITED:  JUN 16, 2015
  • HELP-PROMPT:  Answer must be 3-80 characters in length. This is a short comment about this patients policy.
  • DESCRIPTION:  
    This is a place to record a short comment about this patients policy.  It is specific to this patient and to this policy.  The answer must be 3 to 80 characters.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the COMMENT field of the COMMENT - SUBSCRIBER POLICY sub-field of the INSURANCE TYPE sub-field of the PATIENT File
  • CROSS-REFERENCE:  2^AP^MUMPS
    1)= D TRIGSET^IBCN118
    2)= D TRIGKIL^IBCN118
    Triggers the edit of an existing entry or adds a new entry.  If existing entry exists at 2.312,1.18 for the same user and same date AND if the first 80 characters of the comment at 2.312,1.18,.03 differ from the comment
    at 2.312,1.08 then trigger the update at 2.312,1.18.
1.09 SOURCE OF INFORMATION 1;9 POINTER TO SOURCE OF INFORMATION FILE (#355.12) SOURCE OF INFORMATION(#355.12)

  • OUTPUT TRANSFORM:  S Y=$$GET1^DIQ(355.12,Y_",",.02,"E")
  • LAST EDITED:  OCT 31, 2006
  • HELP-PROMPT:  Enter the source by which this insurance information was obtained.
  • DESCRIPTION:  Enter the last source of this information. If the insurance information was obtained by patient interview, then enter interview, etc. If the information was initially or previously obtained by one source but updated by
    another source, then enter the most recent source of the information.
    The data in this field will be initially set to INTERVIEW with IB v2.  The data may be passed to Accounts Receivable and/or the MCCR NDB.
    If this field is being edited through the use of the pre-registration software, the default for this field will be set to PRE-REGISTRATION.
  • CROSS-REFERENCE:  ^^TRIGGER^2.312^1.1
    1)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DPT(D0,.312,D1,1)):^(1),1:"") S X=$P(Y(1),U,10),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S X=% X ^DD(2.312,1.09,1,1,1.4)
    1.1)= S X=DIV S %=$P($H,",",2),X=$E(DT_(%\60#60/100+(%\3600)+(%#60/10000)/100),1,12)
    1.4)= S DIH=$G(^DPT(DIV(0),.312,DIV(1),1)),DIV=X S $P(^(1),U,10)=DIV,DIH=2.312,DIG=1.1 D ^DICR
    2)= Q
    CREATE VALUE)= NOW
    DELETE VALUE)= NO EFFECT
    FIELD)= #1.1
1.1 DATE OF SOURCE OF INFORMATION 1;10 DATE

  • INPUT TRANSFORM:  S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUL 12, 1993
  • NOTES:  TRIGGERED by the SOURCE OF INFORMATION field of the INSURANCE TYPE sub-field of the PATIENT File
1.18 COMMENT - SUBSCRIBER POLICY 13;0 DATE Multiple #2.342 2.342

  • DESCRIPTION:  This sub-file (#2.342 COMMENT - SUBSCRIBER POLICY) will contain the Subscriber's Policy Comments, the Date and Time the Subscriber's Policy Comments was entered, and the User's ID that entered the Subscriber's Policy
    comments.
  • INDEXED BY:  LAST EDITED BY & COMMENT DATE/TIME (BB)
2 *GROUP NUMBER 0;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>17!($L(X)<1) X
  • LAST EDITED:  JUN 01, 1993
  • HELP-PROMPT:  Answer must be 1-17 characters in length.
  • DESCRIPTION:  Enter any other appropriate number which identifies this policy, i.e., group number/code, under which this applicant is covered. Answer must be between 1 and 17 characters.
    This field is moved to the HEALTH INSURANCE POLICY file (355.3) beginning with IB v2.0.  It will be deleted with the first release 18 months after the release of IB V2.
  • CROSS-REFERENCE:  2.312^AENR2^MUMPS
    1)= D EVENT^IVMPLOG($G(DA(1)))
    2)= D EVENT^IVMPLOG($G(DA(1)))
    3)=  DO NOT DELETE
    This cross-reference is used to notify HEC of changes that may affect enrollment.
2.01 SEND BILL TO EMPLOYER 2;1 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  MAR 03, 1993
  • HELP-PROMPT:  Enter 'YES' if the employer should be mailed insurance claims for pre-processing. Enter 'NO' if the employer does not receive claims.
  • DESCRIPTION:  If the employer of the person who holds this policy requires that they pre-processed for the insurance policy then enter 'YES'. You will then be allowed to enter the company name and address that these bills should be
    sent to.  The bills will then automatically use this address.
    If the employer does not require this, or unknown, enter 'NO'.  The bills will then be sent to the insurance company.
    If the policy is held by other than the patient then this will not be the patient's employer but the employer of the person who is insured.
2.015 SUBSCRIBER'S EMPLOYER NAME 2;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  JAN 15, 2007
  • HELP-PROMPT:  Answer must be 3-30 characters in length. This is the name of the subsriber's employer that will appear on the UB-04 if this employer pre-processes insurance claims.
  • DESCRIPTION:  
    This is the name of the employer that will appear on the UB-04 if the bills should be sent to the employer for pre-processing.
2.02 EMPLOYER CLAIMS STREET ADDRESS 2;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAR 03, 1993
  • HELP-PROMPT:  Answer must be 3-30 characters in length. This is the street address, line 1, of the employer who should receive claims to pre-processs.
  • DESCRIPTION:  
    This is the street address of the employer who should receive claims to be pre-processed before the are forwarded to the insurance carrier.  The answer should be 3 to 30 characters.
2.03 EMPLOY CLAIM ST ADDRESS LINE 2 2;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAR 03, 1993
  • HELP-PROMPT:  Answer must be 3-30 characters in length. This is line 2 of the street address for employers who pre-process insurance claims.
  • DESCRIPTION:  
    This is line 2 of the street address for employers who pre-process insurance claims before they are forwarded to the insurance carrier for processing.  Answer must be 3-30 characters.
2.04 EMPLOY CLAIM ST ADDRESS LINE 3 2;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAR 03, 1993
  • HELP-PROMPT:  Answer must be 3-30 characters in length. This is line 3 of the street address for employers who pre-process insurance claims.
  • DESCRIPTION:  
    This is line 3 of the street address for employers who pre-process insurance claims before they are forwarded to the insurance carrier for processing.  Answer must be 3-30 characters.
2.05 EMPLOYER CLAIMS CITY 2;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<3) X
  • LAST EDITED:  MAR 03, 1993
  • HELP-PROMPT:  Answer must be 3-20 characters in length. Enter the city of the employer's address if the employer pre-processes insurance claims.
  • DESCRIPTION:  If the employer of the person who holds this policy pre-processes insurance claims prior to forwarding to the insurance carrier enter the city that claim should be sent to. This will be printed on the claim form. Answer
    must be 3 to 20 characters.
2.06 EMPLOYER CLAIMS STATE 2;6 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  MAR 03, 1993
  • DESCRIPTION:  If the employer of the person who holds this policy pre-processes insurance claims prior to forwarding to the insurance carrier enter the state that the claim should be sent to. This will be printed on the claim form.
    Answer must be 3 to 20 characters.
2.07 EMPLOYER CLAIMS ZIP CODE 2;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<5) X D:$D(X) ZIPIN^VAFADDR
  • LAST EDITED:  JUN 03, 1993
  • HELP-PROMPT:  Answer with either the 5 or 9 digit zip code.
  • DESCRIPTION:  Enter the zip code of the mailing address for this employer. Answer with either the 5 digit zip code (format 12345) or with the 9 digit zip code (in format 123456789 or 12345-6789).
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
2.08 EMPLOYER CLAIMS PHONE 2;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<7) X
  • LAST EDITED:  MAR 04, 1993
  • HELP-PROMPT:  Answer must be 7-15 characters in length.
  • DESCRIPTION:  
    Enter the phone number of the employer.  This should be the phone number of the person to contact regarding insurance claims.
2.1 ESGHP 2;10 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  AUG 13, 1997
  • HELP-PROMPT:  Enter 'Yes' if this policy is part of an Employer Sponsored Group Health Plan.
  • DESCRIPTION:  
    Enter 'Yes' if this policy is part of a plan that is sponsored or provided by the insured's current or past employer.
2.11 EMPLOYMENT STATUS 2;11 SET
  • '1' FOR FULL TIME;
  • '2' FOR PART TIME;
  • '3' FOR NOT EMPLOYED;
  • '4' FOR SELF EMPLOYED;
  • '5' FOR RETIRED;
  • '6' FOR ACTIVE MILITARY;
  • '9' FOR UNKNOWN;

  • LAST EDITED:  AUG 13, 1997
  • HELP-PROMPT:  Enter the insured's employment status with the employer that sponsors this plan.
  • DESCRIPTION:  
    If this is an Employer Sponsored Group Health Plan then this should be the employment status of the insured with the employer that sponsors the plan.
2.12 RETIREMENT DATE 2;12 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  AUG 13, 1997
  • HELP-PROMPT:  Enter the date the insured retired from the employer that sponsors this plan.
  • DESCRIPTION:  
    If this is an Employer Sponsored Group Health Plan then this should be the date the insured retired from the employer that sponsors the plan.
3 INSURANCE EXPIRATION DATE 0;4 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:((Y<1)!(X<$P($G(^DPT(DA(1),.312,DA,0)),"^",8))) X
  • LAST EDITED:  MAY 17, 2017
  • DESCRIPTION:  
    If this insurance policy under which this applicant is covered expires on a specified date enter that date, otherwise, leave this field blank.
  • AUDIT:  YES, ALWAYS
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  2.312^ADGRU3123^MUMPS
    1)= D:($T(ADGRU^DGRUDD01)'="") ADGRU^DGRUDD01(+$G(DA(1)))
    2)= D:($T(ADGRU^DGRUDD01)'="") ADGRU^DGRUDD01(+$G(DA(1)))
    RAI/MDS: field monitored for changes.  Cross reference also needed to force filing so input transform works.
  • CROSS-REFERENCE:  2.312^AENR3^MUMPS
    1)= D EVENT^IVMPLOG($G(DA(1)))
    2)= D EVENT^IVMPLOG($G(DA(1)))
    3)=  DO NOT DELETE
    This cross-reference is used to notify HEC of changes that may affect enrollment.
  • RECORD INDEXES:  ACHI (#1483) (WHOLE FILE #2)
3.01 INSURED'S DOB 3;1 DATE

  • INPUT TRANSFORM:  S %DT="EXP",%DT(0)=-DT D ^%DT K %DT(0) S X=Y K:Y<1 X
  • LAST EDITED:  SEP 05, 2006
  • HELP-PROMPT:  Please enter the insured person's date of birth.
  • DESCRIPTION:  
    The field is used to store the date of birth of the insured person.  The field value may be printed in block 11a of the CMS-1500 claim form.  This is a required field for billing ChampUS patients.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
3.02 INSURED'S BRANCH 3;2 POINTER TO BRANCH OF SERVICE FILE (#23) BRANCH OF SERVICE(#23)

  • LAST EDITED:  SEP 05, 2006
  • HELP-PROMPT:  Please enter the Service Branch of the insured person.
  • DESCRIPTION:  This field may be used to store the service branch of the insured person. The field will be used primarily for CHAMPUS policies, where the subscriber, or sponsor, may be an active duty member of the military. The field
    value may be printed in block 11b of the CMS-1500 claim form.
3.03 INSURED'S RANK 3;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>12!($L(X)<2) X
  • LAST EDITED:  SEP 05, 2006
  • HELP-PROMPT:  Answer must be 2-12 characters in length.
  • DESCRIPTION:  This field contains the insured person's military rank. The field will be used primarily for CHAMPUS policies, where the subscriber, or sponsor, may be an active duty member of the military. The field value may be
    printed in block 11c of the CMS-1500 claim form.
3.04 STOP POLICY FROM BILLING 3;4 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  APR 14, 2016
  • HELP-PROMPT:  Enter YES if claims should not be created against this policy.
  • DESCRIPTION:  Determines whether or not claims may be created for the insurance policy. This field is used primarily for CHAMPUS policies. If the patient is covered under CHAMPUS, but it is known that claims should never be submitted
    to the CHAMPUS Fiscal Intermediary, then entering YES in this field will cause Pharmacy claims to the FI not to be created.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
3.05 INSURED'S SSN 3;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>13!($L(X)<9) X I $D(X) S X=$TR(X,"-","")
  • OUTPUT TRANSFORM:  S Y=$E(Y,1,3)_"-"_$E(Y,4,5)_"-"_$E(Y,6,9)
  • LAST EDITED:  MAY 06, 1997
  • HELP-PROMPT:  Answer must be 9-13 characters in length.
  • DESCRIPTION:  This field contains the policyholder's social security number, if it is different than the Subscriber ID. For CHAMPUS policies, this value may be automatically inserted into this field from the PATIENT (#2) or SPONSOR
    PERSON (#355.82) files.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
3.06 INSURED'S STREET 1 3;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>55!($L(X)<3)!'$$LENCHK^IBCNEUT1(X,30,0) X
  • LAST EDITED:  JUN 05, 2013
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This field contains the first street address of the policyholder.
  • TECHNICAL DESCR:  
    Length of this field is temporarily limited to 30 characters.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
3.07 INSURED'S STREET 2 3;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>55!($L(X)<3)!'$$LENCHK^IBCNEUT1(X,30,0) X
  • LAST EDITED:  JUN 05, 2013
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This field contains the second line of the street address of the policyholder.
  • TECHNICAL DESCR:  
    Length of this field is temporarily limited to 30 characters.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
3.08 INSURED'S CITY 3;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<2)!'$$LENCHK^IBCNEUT1(X,25,0) X
  • LAST EDITED:  JUN 05, 2013
  • HELP-PROMPT:  Answer must be 2-25 characters in length.
  • DESCRIPTION:  
    This field contains the city of the policyholder.
  • TECHNICAL DESCR:  
    Length of this field is temporarily limited to 25 characters.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
3.09 INSURED'S STATE 3;9 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  MAY 05, 1997
  • DESCRIPTION:  
    This field contains the state of the policyholder.
3.1 INSURED'S ZIP 3;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<5) X I $D(X) D ZIPIN^VAFADDR
  • OUTPUT TRANSFORM:  D ZIPOUT^VAFADDR
  • LAST EDITED:  MAY 05, 1997
  • HELP-PROMPT:  Answer must be 5-20 characters in length.
  • DESCRIPTION:  
    This field contains the zip code of the policyholder.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
3.11 INSURED'S PHONE 3;11 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  MAY 05, 1997
  • HELP-PROMPT:  Answer must be 7-20 characters in length.
  • DESCRIPTION:  
    This field contains the phone number of the policyholder.
3.12 INSURED'S SEX 3;12 SET
  • 'F' FOR FEMALE;
  • 'M' FOR MALE;

  • LAST EDITED:  OCT 02, 2006
  • HELP-PROMPT:  Enter the sex (M or F) of the policy holder.
  • DESCRIPTION:  This field is used in insurance billing to help verify the policy coverage when the bill is submitted to the carrier. If the patient is the policy holder, this value should match the patient's sex. If the patient's
    spouse or other relative is the policy holder, the appropriate value should be determined and entered.
3.13 INSURED'S COUNTRY 3;13 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<2) X
  • LAST EDITED:  SEP 16, 2010
  • HELP-PROMPT:  Answer must be 2-3 characters in length.
  • DESCRIPTION:  
    This field contains the country code of the policyholder.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, PID.11.6.
3.14 INSURED'S COUNTRY SUBDIVISION 3;14 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • LAST EDITED:  SEP 16, 2010
  • HELP-PROMPT:  Answer must be 1-3 characters in length.
  • DESCRIPTION:  
    This field contains the country subdivision code of the policyholder.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, PID.11.8.
4.01 PRIMARY CARE PROVIDER 4;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  AUG 14, 1997
  • HELP-PROMPT:  Answer must be 3-30 characters in length. Non-VA Provider to obtain a referral from for this patient.
  • DESCRIPTION:  
    This is the patient's Primary Care Provider within their managed care network that may refer the patient to the VA.
4.02 PRIMARY PROVIDER PHONE 4;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  AUG 14, 1997
  • HELP-PROMPT:  Answer must be 7-20 characters in length. The phone number of the PCP a referral may be obtained from.
  • DESCRIPTION:  
    This is the phone number of the Primary Care Provider that may refer the patient to the VA.
4.03 PT. RELATIONSHIP - HIPAA 4;3 SET
************************REQUIRED FIELD************************
  • '01' FOR SPOUSE;
  • '18' FOR SELF;
  • '19' FOR CHILD;
  • '20' FOR EMPLOYEE;
  • '29' FOR SIGNIFICANT OTHER;
  • '32' FOR MOTHER;
  • '33' FOR FATHER;
  • '39' FOR ORGAN DONOR;
  • '41' FOR INJURED PLAINTIFF;
  • '53' FOR LIFE PARTNER;
  • 'G8' FOR OTHER RELATIONSHIP;

  • LAST EDITED:  JAN 08, 2008
  • HELP-PROMPT:  Select the HIPAA relationship code that describes the relationship this patient has to the holder of this insurance policy.
  • DESCRIPTION:  
    Enter the code which best describes the patient's relationship to the person who holds this policy (or insured).
  • NOTES:  TRIGGERED by the PT. RELATIONSHIP TO INSURED field of the INSURANCE TYPE sub-field of the PATIENT File
  • CROSS-REFERENCE:  ^^TRIGGER^2.312^16
    1)= X ^DD(2.312,4.03,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DPT(D0,.312,D1,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X=DIV S X=$$PRELCNV^IBCNSP1($P(^DPT(DA(1),.312,DA,4),U,3),0) X ^DD(2.312,4.03,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 N Z S Z=$$PRELCNV^IBCNSP1($P(^DPT(D0,.312,D1,4),U,3),0),X=(Z'=""&(Z'=$P(^DPT(D0,.312,D1,0),U,16)))
    1.4)= S DIH=$G(^DPT(DIV(0),.312,DIV(1),0)),DIV=X S $P(^(0),U,16)=DIV,DIH=2.312,DIG=16 D ^DICR
    2)= Q
    CREATE CONDITION)= N Z S Z=$$PRELCNV^IBCNSP1($P(^DPT(D0,.312,D1,4),U,3),0),X=(Z'=""&(Z'=$P(^DPT(D0,.312,D1,0),U,16)))
    CREATE VALUE)= S X=$$PRELCNV^IBCNSP1($P(^DPT(DA(1),.312,DA,4),U,3),0)
    DELETE VALUE)= NO EFFECT
    FIELD)= #16
    Triggers field 16 if its value differs from value in this field.
4.04 EIV AUTO-UPDATE 4;4 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  AUG 02, 2009
  • HELP-PROMPT:  Set this to YES if last update to INSURANCE TYPE sub-file was done via eIV auto-update.
  • DESCRIPTION:  
    Flag that determines how the last update to INSURANCE TYPE sub-file was done. Value of "YES" means that data was last updated via eIV auto-update, value of "NO" means that data was last updated via other means.
  • TECHNICAL DESCR:  
    This flag is set by eIV processing code (IBCNEHL* series) and cleared by a trigger on field 2.312/1.05 (DATE LAST EDITED).
  • NOTES:  TRIGGERED by the DATE LAST EDITED field of the INSURANCE TYPE sub-field of the PATIENT File
4.05 PHARMACY RELATIONSHIP CODE 4;5 POINTER TO BPS NCPDP PATIENT RELATIONSHIP CODE FILE (#9002313.19) BPS NCPDP PATIENT RELATIONSHIP CODE(#9002313.19)

  • LAST EDITED:  JUN 20, 2011
  • HELP-PROMPT:  Select the relationship of the patient to the cardholder.
  • DESCRIPTION:  This is the relationship of the patient to the cardholder.
    Code  Description
    ----  -----------
    0    Not Specified
    1    Cardholder - The individual that is enrolled in and receives
    benefits from a health plan
    2    Spouse - Patient is the husband/wife/partner of the cardholder
    3    Child - Patient is a child of the cardholder
    4    Other - Relationship to cardholder is not precise
  • TECHNICAL DESCR:  
    This field is NCPDP field 306-C6 - Patient Relationship Code
4.06 PHARMACY PERSON CODE 4;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • LAST EDITED:  JUN 21, 2011
  • HELP-PROMPT:  Answer must be 1-3 characters in length.
  • DESCRIPTION:  This is the code that is assigned by the payer to identify the patient. The payer may use a unique person code to identify each specific person on the pharmacy insurance policy. This code may also describe the patient's
    relationship to the cardholder.
    Enrollment Standard Examples:
    001 = Cardholder
    002 = Spouse
    003 - 999 = Dependents and Others (including second spouses, etc.)
  • TECHNICAL DESCR:  
    This is NCPDP field 303-C3 - Person Code
5.01 PATIENT ID 5;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2007
  • HELP-PROMPT:  Answer must be 1-30 characters in length
  • DESCRIPTION:  This is the patient's primary ID number for this insurance company. Enter this field when the patient and the subscriber are different and the patient has been given a unique ID number. If issued by this payer, the
    number should be present on the patient's insurance card.
    This data will print in box 8a on the UB-04 for institutional claims when the patient and the subscriber are different.
5.02 SUBSCRIBER'S SEC QUALIFIER(1) 5;2 SET
  • '23' FOR Client Number;
  • 'IG' FOR Insurance Policy Number;
  • 'SY' FOR Social Security Number;

  • INPUT TRANSFORM:  K:'$$CHKQUAL^IBCNSU1(DA(1),DA,X,4,6) X Q
  • LAST EDITED:  JUN 26, 2007
  • HELP-PROMPT:  Enter a Qualifier to identify the type of ID number.
  • DESCRIPTION:  Enter the subscriber secondary ID qualifier# 1. The qualifier describes the type of ID number.
    Up to 3 secondary ID's and qualifiers may be entered, but you cannot use the same qualifier more than once.  SY is not a valid qualifier when the payer is Medicare.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
5.03 SUBSCRIBER'S SEC ID(1) 5;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUN 26, 2007
  • HELP-PROMPT:  Answer must be 1-30 characters in length
  • DESCRIPTION:  
    Enter the subscriber's secondary ID #1.  You may enter up to 3 secondary ID's and qualifiers.
5.04 SUBSCRIBER'S SEC QUALIFIER(2) 5;4 SET
  • '23' FOR Client Number;
  • 'IG' FOR Insurance Policy Number;
  • 'SY' FOR Social Security Number;

  • INPUT TRANSFORM:  K:'$$CHKQUAL^IBCNSU1(DA(1),DA,X,2,6) X Q
  • LAST EDITED:  JUN 26, 2007
  • HELP-PROMPT:  Enter a Qualifier to identify the type of ID number.
  • DESCRIPTION:  Enter the subscriber secondary ID qualifier# 2. The qualifier describes the type of ID number.
    Up to 3 secondary ID's and qualifiers may be entered, but you cannot use the same qualifier more than once.  SY is not a valid qualifier when the payer is Medicare.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
5.05 SUBSCRIBER'S SEC ID(2) 5;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUN 26, 2007
  • HELP-PROMPT:  Answer must be 1-30 characters in length
  • DESCRIPTION:  
    Enter the subscriber's secondary ID #2.  You may enter up to 3 secondary ID's and qualifiers.
5.06 SUBSCRIBER'S SEC QUALIFIER(3) 5;6 SET
  • '23' FOR Client Number;
  • 'IG' FOR Insurance Policy Number;
  • 'SY' FOR Social Security Number;

  • INPUT TRANSFORM:  K:'$$CHKQUAL^IBCNSU1(DA(1),DA,X,2,4) X Q
  • LAST EDITED:  JUN 26, 2007
  • HELP-PROMPT:  Enter a Qualifier to identify the type of ID number.
  • DESCRIPTION:  Enter the subscriber secondary ID qualifier# 3. The qualifier describes the type of ID number.
    Up to 3 secondary ID's and qualifiers may be entered, but you cannot use the same qualifier more than once.  SY is not a valid qualifier when the payer is Medicare.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
5.07 SUBSCRIBER'S SEC ID(3) 5;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUN 26, 2007
  • HELP-PROMPT:  Answer must be 1-30 characters in length
  • DESCRIPTION:  
    Enter the subscriber's secondary ID #3.  You may enter up to 3 secondary ID's and qualifiers.
5.08 PATIENT'S SEC QUALIFIER(1) 5;8 SET
  • '23' FOR Client Number;
  • 'IG' FOR Insurance Policy Number;
  • 'SY' FOR Social Security Number;

  • INPUT TRANSFORM:  K:'$$CHKQUAL^IBCNSU1(DA(1),DA,X,10,12) X Q
  • LAST EDITED:  JUN 26, 2007
  • HELP-PROMPT:  Enter a Qualifier to identify the type of ID number.
  • DESCRIPTION:  Enter the patient secondary ID qualifier# 1. The qualifier describes the type of ID number. This should only be used when the patient and the subscriber are different.
    Up to 3 secondary ID's and qualifiers may be entered, but you cannot use the same qualifier more than once.  SY is not a valid qualifier when the payer is Medicare.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
5.09 PATIENT'S SECONDARY ID(1) 5;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUN 26, 2007
  • HELP-PROMPT:  Answer must be 1-30 characters in length
  • DESCRIPTION:  
    Enter the patient secondary ID #1.  You may enter up to 3 secondary ID's and qualifiers.  This should only be used when the patient and the subscriber are different.
5.1 PATIENT'S SEC QUALIFIER(2) 5;10 SET
  • '23' FOR Client Number;
  • 'IG' FOR Insurance Policy Number;
  • 'SY' FOR Social Security Number;

  • INPUT TRANSFORM:  K:'$$CHKQUAL^IBCNSU1(DA(1),DA,X,8,12) X Q
  • LAST EDITED:  JUN 26, 2007
  • HELP-PROMPT:  Enter a Qualifier to identify the type of ID number.
  • DESCRIPTION:  Enter the patient secondary ID qualifier# 2. The qualifier describes the type of ID number. This should only be used when the patient and the subscriber are different.
    Up to 3 secondary ID's and qualifiers may be entered, but you cannot use the same qualifier more than once.  SY is not a valid qualifier when the payer is Medicare.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
5.11 PATIENT'S SECONDARY ID(2) 5;11 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUN 26, 2007
  • HELP-PROMPT:  Answer must be 1-30 characters in length
  • DESCRIPTION:  
    Enter the patient secondary ID #2.  You may enter up to 3 secondary ID's and qualifiers.  This should only be used when the patient and the subscriber are different.
5.12 PATIENT'S SEC QUALIFIER(3) 5;12 SET
  • '23' FOR Client Number;
  • 'IG' FOR Insurance Policy Number;
  • 'SY' FOR Social Security Number;

  • INPUT TRANSFORM:  K:'$$CHKQUAL^IBCNSU1(DA(1),DA,X,8,10) X Q
  • LAST EDITED:  JUN 26, 2007
  • HELP-PROMPT:  Enter a Qualifier to identify the type of ID number.
  • DESCRIPTION:  Enter the patient secondary ID qualifier# 3. The qualifier describes the type of ID number. This should only be used when the patient and the subscriber are different.
    Up to 3 secondary ID's and qualifiers may be entered, but you cannot use the same qualifier more than once.  SY is not a valid qualifier when the payer is Medicare.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
5.13 PATIENT'S SECONDARY ID(3) 5;13 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUN 26, 2007
  • HELP-PROMPT:  Answer must be 1-30 characters in length
  • DESCRIPTION:  
    Enter the patient secondary ID #3.  You may enter up to 3 secondary ID's and qualifiers.  This should only be used when the patient and the subscriber are different.
6 WHOSE INSURANCE 0;6 SET
************************REQUIRED FIELD************************
  • 'v' FOR VETERAN;
  • 's' FOR SPOUSE;
  • 'o' FOR OTHER;

  • LAST EDITED:  SEP 30, 1986
  • DESCRIPTION:  Enter 'v' if this insurance policy is held by the veteran (applicant), 's' if the veteran is married and the spouse holds the policy, or 'o' if someone other than the veteran or his/her spouse hold the policy, i.e.,
    employer.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the PT. RELATIONSHIP TO INSURED field of the INSURANCE TYPE sub-field of the PATIENT File
  • CROSS-REFERENCE:  2.312^AENR6^MUMPS
    1)= D EVENT^IVMPLOG($G(DA(1)))
    2)= D EVENT^IVMPLOG($G(DA(1)))
    3)=  DO NOT DELETE
    This cross-reference is used to notify HEC of changes that may affect enrollment.
7.01 NAME OF INSURED 7;1 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>130!($L(X)<2)!'$$LENCHK^IBCNEUT1(X,50,0)!(X'[",") X
  • LAST EDITED:  JAN 15, 2014
  • HELP-PROMPT:  Answer must be 2-50 characters in length.
  • DESCRIPTION:  Enter the name of the individual for which this insurance policy was issued. If the patient and the insurance subscriber are the same, then this field will be defaulted from the patient name field.
    The name must contain a comma and be entered in Last,First format.
  • TECHNICAL DESCR:  
    Replaces field 17. Length of this field is temporarily limited to 50 characters.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the *NAME OF INSURED field of the INSURANCE TYPE sub-field of the PATIENT File
  • CROSS-REFERENCE:  ^^TRIGGER^2.312^17
    1)= X ^DD(2.312,7.01,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DPT(D0,.312,D1,0)):^(0),1:"") S X=$P(Y(1),U,17),X=X S DIU=X K Y S X=DIV S X=$E($P(^DPT(DA(1),.312,DA,7),U),1,50) X ^DD(2.312,7.01,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^DPT(DA(1),.312,DA,0),U,17)'=$E($P(^DPT(DA(1),.312,DA,7),U),1,50))
    1.4)= S DIH=$G(^DPT(DIV(0),.312,DIV(1),0)),DIV=X S $P(^(0),U,17)=DIV,DIH=2.312,DIG=17 D ^DICR
    2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^DPT(DA(1),.312,DA,7),U)="") I X S X=DIV S Y(1)=$S($D(^DPT(D0,.312,D1,0)):^(0),1:"") S X=$P(Y(1),U,17),X=X S DIU=X K Y S X="" X ^DD(2.312,7.01,1,1,2.4)
    2.4)= S DIH=$G(^DPT(DIV(0),.312,DIV(1),0)),DIV=X S $P(^(0),U,17)=DIV,DIH=2.312,DIG=17 D ^DICR
    CREATE CONDITION)= S X=($P(^DPT(DA(1),.312,DA,0),U,17)'=$E($P(^DPT(DA(1),.312,DA,7),U),1,50))
    CREATE VALUE)= S X=$E($P(^DPT(DA(1),.312,DA,7),U),1,50)
    DELETE CONDITION)= S X=($P(^DPT(DA(1),.312,DA,7),U)="")
    DELETE VALUE)= @
    FIELD)= *NAME OF INSURED
    Triggers field 2.312/17 if its value differs from first 50 chars of the value in this field. Deletes field 2.312/17 if field 2.312/7.01 is deleted.
7.02 SUBSCRIBER ID 7;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1)!'$$LENCHK^IBCNEUT1(X,20,0) X
  • LAST EDITED:  NOV 20, 2013
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    Enter the Subscriber's Primary ID number. This number is assigned by the payer and can be found on the subscriber's insurance card.
  • TECHNICAL DESCR:  
    Replaces field 1. Length of this field is temporarily limited to 20 characters.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the *SUBSCRIBER ID field of the INSURANCE TYPE sub-field of the PATIENT File
  • CROSS-REFERENCE:  ^^TRIGGER^2.312^1
    1)= X ^DD(2.312,7.02,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DPT(D0,.312,D1,0)):^(0),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=$E($P(^DPT(DA(1),.312,DA,7),U,2),1,20) X ^DD(2.312,7.02,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^DPT(DA(1),.312,DA,0),U,2)'=$E($P(^DPT(DA(1),.312,DA,7),U,2),1,20))
    1.4)= S DIH=$G(^DPT(DIV(0),.312,DIV(1),0)),DIV=X S $P(^(0),U,2)=DIV,DIH=2.312,DIG=1 D ^DICR
    2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^DPT(DA(1),.312,DA,7),U,2)="") I X S X=DIV S Y(1)=$S($D(^DPT(D0,.312,D1,0)):^(0),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X="" X ^DD(2.312,7.02,1,1,2.4)
    2.4)= S DIH=$G(^DPT(DIV(0),.312,DIV(1),0)),DIV=X S $P(^(0),U,2)=DIV,DIH=2.312,DIG=1 D ^DICR
    CREATE CONDITION)= S X=($P(^DPT(DA(1),.312,DA,0),U,2)'=$E($P(^DPT(DA(1),.312,DA,7),U,2),1,20))
    CREATE VALUE)= S X=$E($P(^DPT(DA(1),.312,DA,7),U,2),1,20)
    DELETE CONDITION)= S X=($P(^DPT(DA(1),.312,DA,7),U,2)="")
    DELETE VALUE)= @
    FIELD)= *SUBSCRIBER ID
    Triggers field 2.312/1 if its value differs from first 20 chars of the value in this field. Deletes field 2.312/1 if field 2.312/7.02 is deleted.
8 EFFECTIVE DATE OF POLICY 0;8 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:(Y<1) X I $D(X),$P($G(^DPT(DA(1),.312,DA,0)),"^",4)'="",X>$P($G(^DPT(DA(1),.312,DA,0)),"^",4) K X
  • LAST EDITED:  MAY 17, 2017
  • HELP-PROMPT:  ANSWER MUST BE 3-10 CHARACTERS IN LENGTH
  • DESCRIPTION:  
    Enter the date that this insurance policy initially went into effect (the date the patient acquired this policy).
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  2.312^ADGRU3128^MUMPS
    1)= D:($T(ADGRU^DGRUDD01)'="") ADGRU^DGRUDD01(+$G(DA(1)))
    2)= D:($T(ADGRU^DGRUDD01)'="") ADGRU^DGRUDD01(+$G(DA(1)))
    RAI/MDS: field monitored for changes.  Cross reference also needed to force filing so input transform works.
  • CROSS-REFERENCE:  2.312^AENR8^MUMPS
    1)= D EVENT^IVMPLOG($G(DA(1)))
    2)= D EVENT^IVMPLOG($G(DA(1)))
    3)=  DO NOT DELETE
    This cross-reference is used to notify HEC of changes that may affect enrollment.
  • RECORD INDEXES:  ACHI (#1483) (WHOLE FILE #2)
8.01 REQUESTED SERVICE DATE 8;1 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  SEP 12, 2013
  • HELP-PROMPT:  Enter the Service Date of the Response.
  • DESCRIPTION:  
    This is the Eligibility/Service Date that is received on the eIV Response message.  If it is not present on the Response message then this is the Eligibility Date that was sent on the Inquiry message.
  • TECHNICAL DESCR:  
    The Service Date associated with the Eligibility Benefits when the Eligibility Benefits are saved from the Insurance Buffer to the Patient's Policy. This is the Service Date the Payer responded to at the top of the
    Eligibility Benefit section above the Insurance Status.
8.02 REQUESTED SERVICE TYPE 8;2 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  SEP 12, 2013
  • HELP-PROMPT:  Enter the Service Type of the Response
  • DESCRIPTION:  
    This is the Service Type that is received on the Response message.
  • TECHNICAL DESCR:  
    The Service Type that was inquired about when the Eligibility Benefits are saved from the Insurance Buffer to the Patient's Policy. This is the Service Type inquired about at the top of the Eligibility Benefit section
    above the Insurance Status.
8.03 EB DISPLAY ENTRY 8;3 POINTER TO IIV RESPONSE FILE (#365) IIV RESPONSE(#365)

  • LAST EDITED:  JAN 28, 2016
  • HELP-PROMPT:  Enter a valid IIV Response entry.
  • DESCRIPTION:  
    This field will contains a pointer to the IIV Response entry that was manually or automatically accepted.  It is used to display fields from the IIV Response file in the Eligibility Benefits action.
  • TECHNICAL DESCR:  
    Before this field is set, it is checked to see if it contains a previous value.  If it does, the DO NOT PURGE field (#.11) in the IIV Response file (#365) of the previously set entry is set to 0. This allows the  previous
    IIV Response entry to be purged the next time the purge is run.  The DO NOT PURGE flag of the current IIV Response entry is then set to 1 to prevent it from being purged.
9 GROUP REFERENCE INFORMATION 9;0 Multiple #2.3129 2.3129

  • DESCRIPTION:  
    Subscriber/Dependent additional identification data.
10 GROUP PROVIDER INFO 10;0 Multiple #2.332 2.332

  • DESCRIPTION:  
    Entries in this sub-file identify the characteristics of a provider.
11 HEALTH CARE CODE INFORMATION 11;0 Multiple #2.31211 2.31211

  • DESCRIPTION:  
    To supply information related to the delivery of health care.
12.01 MILITARY INFO STATUS CODE 12;1 POINTER TO X12 271 MILITARY PERSONNEL INFO STATUS CODE FILE (#365.039) X12 271 MILITARY PERSONNEL INFO STATUS CODE(#365.039)

  • LAST EDITED:  MAY 20, 2013
  • HELP-PROMPT:  Enter the military information status code.
  • DESCRIPTION:  
    Code to indicate the status of the military information sent by the payer.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message ZMP.2
12.02 MILITARY EMPLOYMENT STATUS 12;2 POINTER TO X12 271 MILITARY EMPLOYMENT STATUS CODE FILE (#365.046) X12 271 MILITARY EMPLOYMENT STATUS CODE(#365.046)

  • LAST EDITED:  MAY 20, 2013
  • HELP-PROMPT:  Select the appropriate code for claimant's military employment status.
  • DESCRIPTION:  
    Code showing the general military employment status of an employee/claimant.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message ZMP.3
12.03 MILITARY GOVT AFFILIATION CODE 12;3 POINTER TO X12 271 MILITARY GOVT SERVICE AFFILIATION FILE (#365.041) X12 271 MILITARY GOVT SERVICE AFFILIATION(#365.041)

  • LAST EDITED:  JUN 12, 2013
  • HELP-PROMPT:  Select the code that supports the claimant's military affiliation.
  • DESCRIPTION:  
    Code specifying the military service affiliation.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message ZMP.4
12.04 MILITARY PERSONNEL DESCRIPTION 12;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1) X
  • LAST EDITED:  MAY 20, 2013
  • HELP-PROMPT:  Answer must be 1-80 characters in length.
  • DESCRIPTION:  
    This field further identifies the exact military unit.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message ZMP.5
12.05 MILITARY SERVICE RANK CODE 12;5 POINTER TO X12 271 MILITARY SERVICE RANK FILE (#365.042) X12 271 MILITARY SERVICE RANK(#365.042)

  • LAST EDITED:  MAY 21, 2013
  • HELP-PROMPT:  Select the Military Service Rank code.
  • DESCRIPTION:  
    Code specifying the military service rank.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message ZMP.6
12.06 DATE TIME PERIOD FORMAT QUAL 12;6 POINTER TO X12 271 DATE FORMAT QUALIFIER FILE (#365.032) X12 271 DATE FORMAT QUALIFIER(#365.032)

  • LAST EDITED:  MAY 20, 2013
  • HELP-PROMPT:  Select the qualifier for the date time period.
  • DESCRIPTION:  
    Code qualifier indicating the date format, time format, or date and time format respective of the DATE TIME PERIOD field (#12.07).
  • TECHNICAL DESCR:  
    Source: 271 HL7 message ZMP.7
12.07 DATE TIME PERIOD 12;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>17!($L(X)<8)!'(X?8N!(X?8N1"-"8N)) X
  • LAST EDITED:  MAY 20, 2013
  • HELP-PROMPT:  Enter the date or range of dates in CCYYMMD or CCYYMMDD-CCYYMMDD format
  • DESCRIPTION:  
    Expression of a date or range of dates that indicates the date span of military service.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message ZMP.8
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
15 *GROUP NAME 0;15 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  JUN 01, 1993
  • HELP-PROMPT:  ANSWER MUST BE 1-20 CHARACTERS IN LENGTH
  • DESCRIPTION:  If this insurance policy is a group policy, enter the name of the group.
    This field is moved to the HEALTH INSURANCE POLICY file (355.3) beginning with IB v2.0.  It will be deleted with the first release 18 months after the release of IB V2.
16 PT. RELATIONSHIP TO INSURED 0;16 SET
************************REQUIRED FIELD************************
  • 2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DPT(D0,.312,D1,0)):^(0),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X="" S DIH=$G(^DPT(DIV(0),.312,DIV(1),0)),DIV=X S $P(^(0),U,6)=DIV,DIH=2.312,DIG=6 D ^DICR
  • CREATE VALUE)= S X=$S(+X=1:"v",+X=2:"s",1:"o")
  • DELETE VALUE)= @
  • FIELD)= WHOSE INSURANCE
  • This trigger will set the WHOSE INSURANCE field (#6). WHOSE INSURANCE will no longer be asked on user interface screens.

  • LAST EDITED:  DEC 03, 2007
  • HELP-PROMPT:  Enter the code which indicates the patient's relationship to the insured party.
  • DESCRIPTION:  Select the relationship code that describes the relationship this patient has to the holder of this insurance policy. If the policy belongs to the patient enter '01' for patient. If the policy belongs to the spouse
    enter '02' for spouse, etc.
  • SCREEN:  S DIC("S")="I X'=""09"",X'=""18"""
  • EXPLANATION:  Cannot use 09 or 18 anymore
  • NOTES:  TRIGGERED by the PT. RELATIONSHIP - HIPAA field of the INSURANCE TYPE sub-field of the PATIENT File
  • CROSS-REFERENCE:  ^^TRIGGER^2.312^6
    1)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DPT(D0,.312,D1,0)):^(0),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X=DIV S X=$S(+X=1:"v",+X=2:"s",1:"o") X ^DD(2.312,16,1,1,1.4)
    1.4)= S DIH=$G(^DPT(DIV(0),.312,DIV(1),0)),DIV=X S $P(^(0),U,6)=DIV,DIH=2.312,DIG=6 D ^DICR
    2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DPT(D0,.312,D1,0)):^(0),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X="" S DIH=$G(^DPT(DIV(0),.312,DIV(1),0)),DIV=X S $P(^(0),U,6)=DIV,DIH=2.312,DIG=6 D ^DICR
    CREATE VALUE)= S X=$S(+X=1:"v",+X=2:"s",1:"o")
    DELETE VALUE)= @
    FIELD)= WHOSE INSURANCE
    This trigger will set the WHOSE INSURANCE field (#6).  WHOSE INSURANCE will no longer be asked on user interface screens.
  • CROSS-REFERENCE:  ^^TRIGGER^2.312^4.03
    1)= X ^DD(2.312,16,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DPT(D0,.312,D1,4)):^(4),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X=DIV S X=$$PRELCNV^IBCNSP1($P(^DPT(DA(1),.312,DA,0),U,16),1) X ^DD(2.312,16,1,2,1.4)
    1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 N Z S Z=$$PRELCNV^IBCNSP1($P(^DPT(D0,.312,D1,0),U,16),1),X=(Z'=""&(Z'=$P($G(^DPT(D0,.312,D1,4)),U,3)))
    1.4)= S DIH=$G(^DPT(DIV(0),.312,DIV(1),4)),DIV=X S $P(^(4),U,3)=DIV,DIH=2.312,DIG=4.03 D ^DICR
    2)= Q
    CREATE CONDITION)= N Z S Z=$$PRELCNV^IBCNSP1($P(^DPT(D0,.312,D1,0),U,16),1),X=(Z'=""&(Z'=$P($G(^DPT(D0,.312,D1,4)),U,3)))
    CREATE VALUE)= S X=$$PRELCNV^IBCNSP1($P(^DPT(DA(1),.312,DA,0),U,16),1)
    DELETE VALUE)= NO EFFECT
    FIELD)= #4.03
    Triggers field 4.03 if its value differs from value in this field.
17 *NAME OF INSURED 0;17 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<2)!(X'[",") X
  • LAST EDITED:  JAN 15, 2014
  • HELP-PROMPT:  Enter 2-50 character name of person who holds this insurance policy.
  • DESCRIPTION:  
    Enter the name of the individual for which this insurance policy was issued.  If the patient and the insurance subscriber are the same, then this field will be defaulted from the patient name field.
    The name must contain a comma and be entered in Last,First format.
    This field is scheduled for deletion in May 2015.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the NAME OF INSURED field of the INSURANCE TYPE sub-field of the PATIENT File
  • CROSS-REFERENCE:  2.312^AENR17^MUMPS
    1)= D EVENT^IVMPLOG($G(DA(1)))
    2)= D EVENT^IVMPLOG($G(DA(1)))
    3)=  DO NOT DELETE
    This cross-reference is used to notify HEC of changes that may affect enrollment.
  • CROSS-REFERENCE:  ^^TRIGGER^2.312^7.01
    1)= X ^DD(2.312,17,1,2,1.3) I X S X=DIV S Y(1)=$S($D(^DPT(D0,.312,D1,7)):^(7),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X=DIV S X=$P(^DPT(DA(1),.312,DA,0),U,17) X ^DD(2.312,17,1,2,1.4)
    1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^DPT(DA(1),.312,DA,0),U,17)'=$E($P($G(^DPT(DA(1),.312,DA,7)),U),1,50))
    1.4)= S DIH=$G(^DPT(DIV(0),.312,DIV(1),7)),DIV=X S $P(^(7),U,1)=DIV,DIH=2.312,DIG=7.01 D ^DICR
    2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=($P(^DPT(DA(1),.312,DA,0),U,17)="") I X S X=DIV S Y(1)=$S($D(^DPT(D0,.312,D1,7)):^(7),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" X ^DD(2.312,17,1,2,2.4)
    2.4)= S DIH=$G(^DPT(DIV(0),.312,DIV(1),7)),DIV=X S $P(^(7),U,1)=DIV,DIH=2.312,DIG=7.01 D ^DICR
    CREATE CONDITION)= S X=($P(^DPT(DA(1),.312,DA,0),U,17)'=$E($P($G(^DPT(DA(1),.312,DA,7)),U),1,50))
    CREATE VALUE)= S X=$P(^DPT(DA(1),.312,DA,0),U,17)
    DELETE CONDITION)= S X=($P(^DPT(DA(1),.312,DA,0),U,17)="")
    DELETE VALUE)= @
    FIELD)= NAME OF INSURED
    Triggers field 2.312/7.01 if first 50 chars of its value differ from the value in this field. Deletes field 2.312/7.01 if field 2.312/17 is deleted.
20 NEW GROUP NAME COMPUTED

  • MUMPS CODE:  X ^DD(2.312,20,9.2) S D0=$P(Y(2.312,20,1),U,18) S:'$D(^IBA(355.3,+D0,0)) D0=-1 S Y(2.312,20,101)=$S($D(^IBA(355.3,D0,2)):^(2),1:"") S X=$P(Y(2.312,20,101),U,1) S D0=Y(2.312,20,80) S D1=Y(2.312,20,81)
    9.2 = S Y(2.312,20,81)=$S($D(D1):D1,1:""),Y(2.312,20,80)=$S($D(D0):D0,1:""),Y(2.312,20,1)=$S($D(^DPT(D0,.312,D1,0)):^(0),1:"")
  • ALGORITHM:  #.18:GROUP NAME
  • LAST EDITED:  SEP 11, 2014
  • DESCRIPTION:  
    This computed field will yield the Group Name from file# 355.3 based on the current Group Plan in field# .18.
21 NEW GROUP NUMBER COMPUTED

  • MUMPS CODE:  X ^DD(2.312,21,9.2) S D0=$P(Y(2.312,21,1),U,18) S:'$D(^IBA(355.3,+D0,0)) D0=-1 S Y(2.312,21,101)=$S($D(^IBA(355.3,D0,2)):^(2),1:"") S X=$P(Y(2.312,21,101),U,2) S D0=Y(2.312,21,80) S D1=Y(2.312,21,81)
    9.2 = S Y(2.312,21,81)=$S($D(D1):D1,1:""),Y(2.312,21,80)=$S($D(D0):D0,1:""),Y(2.312,21,1)=$S($D(^DPT(D0,.312,D1,0)):^(0),1:"")
  • ALGORITHM:  #.18:GROUP NUMBER
  • LAST EDITED:  SEP 11, 2014
  • DESCRIPTION:  
    This computed field will yield the Group Number from file# 355.3 based on the current Group Plan in field# .18.
60 ELIGIBILITY/BENEFIT 6;0 Multiple #2.322 2.322

  • LAST EDITED:  JUL 22, 2009
  • DESCRIPTION:  
    This multiple contains all of the eligibility and benefit data for a specific insured person returned from the Payer.
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