Routine: IBINI04P

IBINI04P	; ; 21-MAR-1994

	;;Version 2.0 ; INTEGRATED BILLING ;; 21-MAR-94

	Q:'DIFQ(355.3)  F I=1:2 S X=$T(Q+I) Q:X=""  S Y=$E($T(Q+I+1),4,999),X=$E(X,4,999) S:$A(Y)=126 I=I+1,Y=$E(Y,2,999)_$E($T(Q+I+1),5,99) S:$A(Y)=61 Y=$E(Y,2,999) X NO E  S @X=Y

Q	Q

	;;^DD(355.3,.04,1,1,2)

	;;=K ^IBA(355.3,"E",$E(X,1,30),DA)

	;;^DD(355.3,.04,1,1,"DT")

	;;=2930525

	;;^DD(355.3,.04,1,2,0)

	;;=355.3^AGNU^MUMPS

	;;^DD(355.3,.04,1,2,1)

	;;=S:+^IBA(355.3,DA,0) ^IBA(355.3,"AGNU",+^(0),X,DA)=""

	;;^DD(355.3,.04,1,2,2)

	;;=K ^IBA(355.3,"AGNU",+^IBA(355.3,DA,0),X,DA)

	;;^DD(355.3,.04,1,2,"%D",0)

	;;=^^1^1^2930527^

	;;^DD(355.3,.04,1,2,"%D",1,0)

	;;=Cross reference of insurance companies and group names.

	;;^DD(355.3,.04,1,2,"DT")

	;;=2930527

	;;^DD(355.3,.04,3)

	;;=Answer must be 2-17 characters in length.

	;;^DD(355.3,.04,21,0)

	;;=^^3^3^2930603^

	;;^DD(355.3,.04,21,1,0)

	;;=If this is a group policy enter the number which identifies this policy,

	;;^DD(355.3,.04,21,2,0)

	;;=i.e. group number/code that the insurance company uses to identify this

	;;^DD(355.3,.04,21,3,0)

	;;=plan.  Answer must be between 1 and 17 characters.

	;;^DD(355.3,.04,"DT")

	;;=2930611

	;;^DD(355.3,.05,0)

	;;=IS UTILIZATION REVIEW REQUIRED^S^1:YES;0:NO;^0;5^Q

	;;^DD(355.3,.05,3)

	;;=Answer "YES" if this policy requires Utilization Review for all billable cases.  Otherwise, answer "NO".

	;;^DD(355.3,.05,21,0)

	;;=^^5^5^2930604^^

	;;^DD(355.3,.05,21,1,0)

	;;=Answer "YES" if Utilization Review is required by the insurance company

	;;^DD(355.3,.05,21,2,0)

	;;=for this policy.  Answer "NO" if it is not required.  The UR staff will

	;;^DD(355.3,.05,21,3,0)

	;;=automatically be required to follow-up on all billable cases where this

	;;^DD(355.3,.05,21,4,0)

	;;=field is answered "YES".  If the field is answered "NO" then UR follow-up

	;;^DD(355.3,.05,21,5,0)

	;;=will be considered optional.

	;;^DD(355.3,.05,"DT")

	;;=2930223

	;;^DD(355.3,.06,0)

	;;=IS PRE-CERTIFICATION REQUIRED?^S^1:YES;0:NO;^0;6^Q

	;;^DD(355.3,.06,3)

	;;=Answer "YES" if pre-certification is required by this policy.  Otherwise answer "NO".

	;;^DD(355.3,.06,21,0)

	;;=^^5^5^2930603^

	;;^DD(355.3,.06,21,1,0)

	;;=Answer "YES" if this policy requires Pre-certification of all non-emergent

	;;^DD(355.3,.06,21,2,0)

	;;=admissions.  Answer "NO" if pre-certification is not required.

	;;^DD(355.3,.06,21,3,0)

	;;=If pre-certification is required but not obtained, follow-up will be

	;;^DD(355.3,.06,21,4,0)

	;;=required by the MCCR tracking module.

	;;^DD(355.3,.06,21,5,0)

	;;=|

	;;^DD(355.3,.06,"DT")

	;;=2930223

	;;^DD(355.3,.07,0)

	;;=EXCLUDE PRE-EXISTING CONDITION^S^1:YES;0:NO;^0;7^Q

	;;^DD(355.3,.07,3)

	;;=Answer "YES" if this policy excludes any pre existing conditions.  Otherwise answer "NO".

	;;^DD(355.3,.07,21,0)

	;;=^^7^7^2940213^^^^

	;;^DD(355.3,.07,21,1,0)

	;;=Answer "YES" if the policy excludes any pre existing conditions.  Answer

	;;^DD(355.3,.07,21,2,0)

	;;="NO" if the policy covers any pre existing conditions.  If a patient has

	;;^DD(355.3,.07,21,3,0)

	;;=pre-exisiting conditions that are not covered they should be entered in

	;;^DD(355.3,.07,21,4,0)

	;;=the patient policy comment field.

	;;^DD(355.3,.07,21,5,0)

;;=

	;;^DD(355.3,.07,21,6,0)

;;=

	;;^DD(355.3,.07,21,7,0)

;;=

	;;^DD(355.3,.07,"DT")

	;;=2930702

	;;^DD(355.3,.08,0)

	;;=BENEFITS ASSIGNABLE?^S^1:YES;0:NO;^0;8^Q

	;;^DD(355.3,.08,3)

;;=

	;;^DD(355.3,.08,21,0)

	;;=^^4^4^2940213^

	;;^DD(355.3,.08,21,1,0)

	;;=If this policy will allow assignment of benefits then answer YES,

	;;^DD(355.3,.08,21,2,0)

	;;=otherwise answer NO.  Normally this field will be answered YES.

	;;^DD(355.3,.08,21,3,0)

	;;=However, it may be useful to track policies that do not allow for

	;;^DD(355.3,.08,21,4,0)

	;;=assignment of benefits.

	;;^DD(355.3,.08,"DT")

	;;=2930223

	;;^DD(355.3,.09,0)

	;;=TYPE OF PLAN^P355.1'^IBE(355.1,^0;9^Q

IBINI04P  ; ; 21-MAR-1994

 +1       ;;Version 2.0 ; INTEGRATED BILLING ;; 21-MAR-94

 +2        IF 'DIFQ(355.3)

               QUIT

           FOR I=1:2

               SET X=$TEXT(Q+I)

               IF X=""

                   QUIT

               SET Y=$EXTRACT($TEXT(Q+I+1),4,999)

               SET X=$EXTRACT(X,4,999)

               IF $ASCII(Y)=126

                   SET I=I+1

                   SET Y=$EXTRACT(Y,2,999)_$EXTRACT($TEXT(Q+I+1),5,99)

               IF $ASCII(Y)=61

                   SET Y=$EXTRACT(Y,2,999)

               XECUTE NO

              IF '$TEST

                   SET @X=Y

Q          QUIT

 +1       ;;^DD(355.3,.04,1,1,2)

 +2       ;;=K ^IBA(355.3,"E",$E(X,1,30),DA)

 +3       ;;^DD(355.3,.04,1,1,"DT")

 +4       ;;=2930525

 +5       ;;^DD(355.3,.04,1,2,0)

 +6       ;;=355.3^AGNU^MUMPS

 +7       ;;^DD(355.3,.04,1,2,1)

 +8       ;;=S:+^IBA(355.3,DA,0) ^IBA(355.3,"AGNU",+^(0),X,DA)=""

 +9       ;;^DD(355.3,.04,1,2,2)

 +10      ;;=K ^IBA(355.3,"AGNU",+^IBA(355.3,DA,0),X,DA)

 +11      ;;^DD(355.3,.04,1,2,"%D",0)

 +12      ;;=^^1^1^2930527^

 +13      ;;^DD(355.3,.04,1,2,"%D",1,0)

 +14      ;;=Cross reference of insurance companies and group names.

 +15      ;;^DD(355.3,.04,1,2,"DT")

 +16      ;;=2930527

 +17      ;;^DD(355.3,.04,3)

 +18      ;;=Answer must be 2-17 characters in length.

 +19      ;;^DD(355.3,.04,21,0)

 +20      ;;=^^3^3^2930603^

 +21      ;;^DD(355.3,.04,21,1,0)

 +22      ;;=If this is a group policy enter the number which identifies this policy,

 +23      ;;^DD(355.3,.04,21,2,0)

 +24      ;;=i.e. group number/code that the insurance company uses to identify this

 +25      ;;^DD(355.3,.04,21,3,0)

 +26      ;;=plan.  Answer must be between 1 and 17 characters.

 +27      ;;^DD(355.3,.04,"DT")

 +28      ;;=2930611

 +29      ;;^DD(355.3,.05,0)

 +30      ;;=IS UTILIZATION REVIEW REQUIRED^S^1:YES;0:NO;^0;5^Q

 +31      ;;^DD(355.3,.05,3)

 +32      ;;=Answer "YES" if this policy requires Utilization Review for all billable cases.  Otherwise, answer "NO".

 +33      ;;^DD(355.3,.05,21,0)

 +34      ;;=^^5^5^2930604^^

 +35      ;;^DD(355.3,.05,21,1,0)

 +36      ;;=Answer "YES" if Utilization Review is required by the insurance company

 +37      ;;^DD(355.3,.05,21,2,0)

 +38      ;;=for this policy.  Answer "NO" if it is not required.  The UR staff will

 +39      ;;^DD(355.3,.05,21,3,0)

 +40      ;;=automatically be required to follow-up on all billable cases where this

 +41      ;;^DD(355.3,.05,21,4,0)

 +42      ;;=field is answered "YES".  If the field is answered "NO" then UR follow-up

 +43      ;;^DD(355.3,.05,21,5,0)

 +44      ;;=will be considered optional.

 +45      ;;^DD(355.3,.05,"DT")

 +46      ;;=2930223

 +47      ;;^DD(355.3,.06,0)

 +48      ;;=IS PRE-CERTIFICATION REQUIRED?^S^1:YES;0:NO;^0;6^Q

 +49      ;;^DD(355.3,.06,3)

 +50      ;;=Answer "YES" if pre-certification is required by this policy.  Otherwise answer "NO".

 +51      ;;^DD(355.3,.06,21,0)

 +52      ;;=^^5^5^2930603^

 +53      ;;^DD(355.3,.06,21,1,0)

 +54      ;;=Answer "YES" if this policy requires Pre-certification of all non-emergent

 +55      ;;^DD(355.3,.06,21,2,0)

 +56      ;;=admissions.  Answer "NO" if pre-certification is not required.

 +57      ;;^DD(355.3,.06,21,3,0)

 +58      ;;=If pre-certification is required but not obtained, follow-up will be

 +59      ;;^DD(355.3,.06,21,4,0)

 +60      ;;=required by the MCCR tracking module.

 +61      ;;^DD(355.3,.06,21,5,0)

 +62      ;;=|

 +63      ;;^DD(355.3,.06,"DT")

 +64      ;;=2930223

 +65      ;;^DD(355.3,.07,0)

 +66      ;;=EXCLUDE PRE-EXISTING CONDITION^S^1:YES;0:NO;^0;7^Q

 +67      ;;^DD(355.3,.07,3)

 +68      ;;=Answer "YES" if this policy excludes any pre existing conditions.  Otherwise answer "NO".

 +69      ;;^DD(355.3,.07,21,0)

 +70      ;;=^^7^7^2940213^^^^

 +71      ;;^DD(355.3,.07,21,1,0)

 +72      ;;=Answer "YES" if the policy excludes any pre existing conditions.  Answer

 +73      ;;^DD(355.3,.07,21,2,0)

 +74      ;;="NO" if the policy covers any pre existing conditions.  If a patient has

 +75      ;;^DD(355.3,.07,21,3,0)

 +76      ;;=pre-exisiting conditions that are not covered they should be entered in

 +77      ;;^DD(355.3,.07,21,4,0)

 +78      ;;=the patient policy comment field.

 +79      ;;^DD(355.3,.07,21,5,0)

 +80      ;;=

 +81      ;;^DD(355.3,.07,21,6,0)

 +82      ;;=

 +83      ;;^DD(355.3,.07,21,7,0)

 +84      ;;=

 +85      ;;^DD(355.3,.07,"DT")

 +86      ;;=2930702

 +87      ;;^DD(355.3,.08,0)

 +88      ;;=BENEFITS ASSIGNABLE?^S^1:YES;0:NO;^0;8^Q

 +89      ;;^DD(355.3,.08,3)

 +90      ;;=

 +91      ;;^DD(355.3,.08,21,0)

 +92      ;;=^^4^4^2940213^

 +93      ;;^DD(355.3,.08,21,1,0)

 +94      ;;=If this policy will allow assignment of benefits then answer YES,

 +95      ;;^DD(355.3,.08,21,2,0)

 +96      ;;=otherwise answer NO.  Normally this field will be answered YES.

 +97      ;;^DD(355.3,.08,21,3,0)

 +98      ;;=However, it may be useful to track policies that do not allow for

 +99      ;;^DD(355.3,.08,21,4,0)

 +100     ;;=assignment of benefits.

 +101     ;;^DD(355.3,.08,"DT")

 +102     ;;=2930223

 +103     ;;^DD(355.3,.09,0)

 +104     ;;=TYPE OF PLAN^P355.1'^IBE(355.1,^0;9^Q

IBINI04P.m