Routine: IBCF2P

Package	Total	Caller Graph
Integrated Billing	1	IBCF2

Name	Comments	DBIA/ICR reference
LINE29	; patient's signature; insured's signature (use PL 99-272, SECTION 1729 TITLE 38)
LINE26	; other insured's plan name; is there another benefit plan
LINE24	; other insured's employer; patient other accident; insured's insurance plan name
LINE22	; other insured's DOB, sex; patient auto accident & place; insured's employer
LINE20	; other insured's policy number; condition related to employment?; insured's date of birth and sex
PRINT	; print the form, IBFLD required
LINE16	; patient zip code, phone; patient employment status; insured's zip code, phone
LINE58
LINE12	; patient's address (street); pt. rel to ins.; insured's address
LINE10	; patient name, DOB, sex; insured's name ("SAME" if patient)
LINE56
LINE18	; other insured's name; insured's policy group
END
LINE38	; diagnosis codes 1 and 2; field 22 (MEDICAID) left blank
LINE35	; "not for SC" note line 1
LINE34	; name of referring physician; ID# referring physician; hospitalization dates related to services
LINE36	; "not for SC" note line 2; outside lab (now defaults to "no" in IBEHCFA)
LINE32	; date of current illness; date of similar illness; dates unable to work
LINE8	; insured's ID number
LINE60
LINE61
LINE14	; patient addr city, state code, marital status; insured's city, state
LINE44	;lines 44,46,48,50,52,54 all the same
LINE69
LINE40	; diagnosis codes 3 and 4; field 23 (prior authorization #)

Name	Line Occurrences
Function Call: WRITE	Prompt: !,?IBADDM,$G(IBFLD(0,IBI)) Line Location: PRINT+2
Function Call: WRITE	Prompt: ?($S(IBFLD("9BX")="M":17,1:23)),"X" Line Location: LINE22+1
Function Call: WRITE	Prompt: ! Line Location: LINE44+2
Function Call: WRITE	Prompt: ?25,$E(IBFLD(24,IBI_"A"),1,15) Line Location: LINE44+2
Function Call: WRITE	Prompt: ! Line Location: LINE44+3
Function Call: WRITE	Prompt: $P(IBFLD(24,IBI),U,1),?9,$P(IBFLD(24,IBI),U,2),?18,$P(IBFLD(24,IBI),U,3),?21,$P(IBFLD(24,IBI),U,4),?25,$E($P(IBFLD(24,IBI),U,5),1,15) Line Location: LINE44+4
Function Call: WRITE	Prompt: ?41,$P(IBFLD(24,IBI),U,6),?47,$S(+$P(IBFLD(24,IBI),U,7):$J($P(IBFLD(24,IBI),U,7),10,2),1:""),?57,$J($P(IBFLD(24,IBI),U,8),3) Line Location: LINE44+5
Function Call: WRITE	Prompt: ", "_IBFLD(32,"X") Line Location: LINE60+1
Function Call: WRITE	Prompt: ", "_IBFLD(33,"X") Line Location: LINE60+2
Function Call: WRITE	Prompt: @IOF,!,?IBADDM,"PAGE ",IBPAGE,!!!!!!!,?49,IBFLD("1A"),!!,IBFLD(2) Line Location: LINE61+4
Function Call: WRITE	Prompt: ! Line Location: LINE61+5

Name	Line Occurrences (* Changed, ! Killed)
^IBE(350.9 - [#350.9]	PRINT+1

Name	Line Occurrences
LINE38	LINE61+2

Name	Field # of Occurrence
IBADDM	PRINT+1*, PRINT+2, LINE61+4, END!
>> IBFLD("10A"	LINE20+1
>> IBFLD("10B"	LINE22+2
>> IBFLD("10BS"	LINE22+2
>> IBFLD("10C"	LINE24+1
>> IBFLD("11AX"	LINE20+1
>> IBFLD("11B"	LINE22+2
>> IBFLD("11C"	LINE24+1
>> IBFLD("11D"	LINE26+1
>> IBFLD("16A"	LINE32+1
>> IBFLD("16B"	LINE32+1
>> IBFLD("18A"	LINE34+1
>> IBFLD("18B"	LINE34+1
>> IBFLD("1A"	LINE8+1, LINE61+4
>> IBFLD("3D"	LINE10+1
>> IBFLD("3X"	LINE10+1
>> IBFLD("5S"	LINE14+1
>> IBFLD("5T"	LINE16+1
>> IBFLD("8E"	LINE16+1
>> IBFLD("8M"	LINE14+1
>> IBFLD("9A"	LINE20+1
>> IBFLD("9BD"	LINE22+1
>> IBFLD("9BX"	LINE22+1
>> IBFLD("9C"	LINE24+1
>> IBFLD("9D"	LINE26+1
>> IBFLD(0	PRINT+2
>> IBFLD(11	LINE18+1
>> IBFLD(12	LINE29+1
>> IBFLD(13	LINE29+1
>> IBFLD(14	LINE32+1
>> IBFLD(15	LINE32+1
>> IBFLD(19	LINE35+1, LINE36+1
>> IBFLD(2	LINE10+1, LINE61+4
>> IBFLD(21	LINE38+1, LINE40+1
>> IBFLD(23	LINE40+1
>> IBFLD(24	LINE44+1, LINE44+2, LINE44+3, LINE44+4, LINE44+5, LINE44+6, LINE61+2
>> IBFLD(25	LINE56
>> IBFLD(26	LINE56
>> IBFLD(28	LINE56
>> IBFLD(31	LINE69, LINE60, LINE61
>> IBFLD(32	LINE58, LINE69, LINE60+1
>> IBFLD(33	LINE58, LINE69, LINE60+2, LINE61
>> IBFLD(4	LINE10+1
>> IBFLD(5	LINE12+1, LINE14+1, LINE16+1
>> IBFLD(6	LINE12+1
>> IBFLD(7	LINE12+1
>> IBFLD(9	LINE18+1
>> IBI	PRINT+2, LINE44+1, LINE44+2, LINE44+3, LINE44+4, LINE44+5, LINE44+6, LINE61+5*
>> IBJ	LINE44+1*
IBPAGE	PRINT+1, LINE61+3, LINE61+4, END!
IOF	LINE61+4
U	PRINT+1, LINE44+1, LINE44+4, LINE44+5, LINE44+6

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