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Global: ^IBA(355.4

Package: Integrated Billing

Global: ^IBA(355.4


Information

FileMan FileNo FileMan Filename Package
355.4 ANNUAL BENEFITS Integrated Billing

Description

Directly Accessed By Routines, Total: 8

Package Total Routines
Integrated Billing 8 IBCNSA    IBCNSA0    IBCNSA1    IBCNSA2    IBCNSM5    IBCNSU    IBCNSU1    ^IBA(355.4

Accessed By FileMan Db Calls, Total: 3

Package Total Routines
Integrated Billing 3 IBCNSA    IBCNSA2    IBCNSU    

Pointer To FileMan Files, Total: 2

Package Total FileMan Files
Integrated Billing 1 GROUP INSURANCE PLAN(#355.3)[.02]    
Kernel 1 NEW PERSON(#200)[1.02, 1.04, 1.06]

Fields, Total: 60

Field # Name Loc Type Details
.01 BENEFIT YEAR BEGINNING ON 0;1 DATE
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S %DT="EX" D:$D(X) ^%DT S X=Y K:Y<1 X D DATECHK^IBCNSA2
  • LAST EDITED:  SEP 03, 1993
  • HELP-PROMPT:  Partial benefit years not allowed.
  • DESCRIPTION:  
    This is the year to which the health insurance policy's benefits apply.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  355.4^B
    1)= S ^IBA(355.4,"B",$E(X,1,30),DA)=""
    2)= K ^IBA(355.4,"B",$E(X,1,30),DA)
  • CROSS-REFERENCE:  355.4^APY1^MUMPS
    1)= S:$P(^IBA(355.4,DA,0),U,2) ^IBA(355.4,"APY",$P(^(0),U,2),-X,DA)=""
    2)= K ^IBA(355.4,"APY",+$P(^IBA(355.4,DA,0),U,2),-X,DA)
    3)= DO NOT DELETE
    Cross-reference of all policies by calendar year.
  • CROSS-REFERENCE:  ^^TRIGGER^355.4^1.01
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^IBA(355.4,D0,1)):^(1),1:"") S X=$P(Y(1),U,1)="" I X S X=DIV S Y(1)=$S($D(^IBA(355.4,D0,1)):^(1),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X=DIV S X=DT X ^DD(355.4,.01
    ,1,3,1.4)
    1.4)= S DIH=$S($D(^IBA(355.4,DIV(0),1)):^(1),1:""),DIV=X S $P(^(1),U,1)=DIV,DIH=355.4,DIG=1.01 D ^DICR:$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
  • CROSS-REFERENCE:  ^^TRIGGER^355.4^1.02
    1)= X ^DD(355.4,.01,1,4,1.3) I X S X=DIV S Y(1)=$S($D(^IBA(355.4,D0,1)):^(1),1:"") S X=$P(Y(1),U,2),X=X S DIU=X K Y S X=DIV S X=DUZ X ^DD(355.4,.01,1,4,1.4)
    1.3)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^IBA(355.4,D0,1)):^(1),1:"") S X=$S('$D(^VA(200,+$P(Y(1),U,2),0)):"",1:$P(^(0),U,1))=""
    1.4)= S DIH=$S($D(^IBA(355.4,DIV(0),1)):^(1),1:""),DIV=X S $P(^(1),U,2)=DIV,DIH=355.4,DIG=1.02 D ^DICR:$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
.02 HEALTH INSURANCE POLICY 0;2 POINTER TO GROUP INSURANCE PLAN FILE (#355.3) GROUP INSURANCE PLAN(#355.3)

  • LAST EDITED:  AUG 31, 1993
  • DESCRIPTION:  
    This is the particular health insurance policy that provides some subset of all of the possible benefits for the year selected.  Enter the name of the health insurance policy.
  • CROSS-REFERENCE:  355.4^C
    1)= S ^IBA(355.4,"C",$E(X,1,30),DA)=""
    2)= K ^IBA(355.4,"C",$E(X,1,30),DA)
  • CROSS-REFERENCE:  355.4^APY^MUMPS
    1)= S:+^IBA(355.4,DA,0) ^IBA(355.4,"APY",X,-^(0),DA)=""
    2)= K ^IBA(355.4,"APY",X,-^IBA(355.4,DA,0),DA)
    3)= DO NOT DELETE
    Cross-reference of all policies by calendar year.
.05 MAX. OUT OF POCKET 0;5 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
  • LAST EDITED:  AUG 25, 1993
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is the dollar amount that this policy does not cover in claims.  This information will be used in calculating whether reimbursement for claims against this policy are appropriate.
.06 AMBULANCE COVERAGE (%) 0;6 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAY 13, 1993
  • HELP-PROMPT:  Type a Number between 0 and 100, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy provides an ambulance coverage benefit, then this is the amount of that benefit.
1.01 DATE ENTERED 1;1 DATE

  • INPUT TRANSFORM:  S %DT="ESTX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  FEB 28, 1994
  • DESCRIPTION:  
    This is the date that the information was first entered.  It is necessary to supply a time as well as date, for example "12/12/93@1300".
    WRITE AUTHORITY:  ^
  • NOTES:  TRIGGERED by the BENEFIT YEAR BEGINNING ON field of the ANNUAL BENEFITS File
1.02 ENTERED BY 1;2 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  MAY 20, 1993
  • DESCRIPTION:  
    This is the name of the person who entered the information.
    WRITE AUTHORITY:  ^
  • NOTES:  TRIGGERED by the BENEFIT YEAR BEGINNING ON field of the ANNUAL BENEFITS File
1.03 DATE LAST VERIFIED 1;3 DATE

  • INPUT TRANSFORM:  S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUL 07, 1993
  • DESCRIPTION:  
    This is the date that the information was last verified.  It is necessary to supply a time as well as date, for example "12/12/93@1300".
1.04 VERIFIED BY 1;4 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  MAY 20, 1993
  • DESCRIPTION:  
    This is the name of the person who verified the information on "DATE LAST VERIFIED".
1.05 DATE LAST EDITED 1;5 DATE

  • INPUT TRANSFORM:  S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUL 07, 1993
  • DESCRIPTION:  
    This is the date that the information was last edited.  The time must be included, for example 12/12/93@1300.
    WRITE AUTHORITY:  ^
1.06 LAST EDIT BY 1;6 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  MAY 20, 1993
  • DESCRIPTION:  
    This is the name of the person who last edited the information.
    WRITE AUTHORITY:  ^
1.07 PERSON CONTACTED 1;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  JUL 01, 1993
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This is the name of the person who was contacted for verification purposes.
1.08 COMMENTS 1;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<3) X
  • LAST EDITED:  MAY 20, 1993
  • HELP-PROMPT:  Answer must be 3-80 characters in length.
  • DESCRIPTION:  
    Enter any additional information here.
1.09 CONTACT'S PHONE NUMBER 1;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  SEP 07, 1993
  • HELP-PROMPT:  Answer must be 7-20 characters in length.
  • DESCRIPTION:  
    Enter the telephone number of the person who was contacted for verification purposes.
2.01 ANNUAL DEDUCTIBLE (OPT) 2;1 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
  • LAST EDITED:  JUN 04, 1993
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is the amount that this policy does not cover in claims.  This information will be used in calculating whether reimbursement for claims against this policy are appropriate.
2.02 PER VISIT DEDUCTIBLE 2;2 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999)!(X<0) X
  • LAST EDITED:  MAY 13, 1993
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 99999, 2 Decimal Digits
  • DESCRIPTION:  
    This is the deductible that the patient must pay for each outpatient visit.
2.03 OUTPATIENT LIFETIME MAXIMUM 2;3 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
  • LAST EDITED:  OCT 28, 1993
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
  • DESCRIPTION:  
    If this policy has a lifetime maximum benefit for outpatient services, then this is the amount of that benefit.
2.04 OUTPATIENT ANNUAL MAXIMUM 2;4 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999)!(X<0) X
  • LAST EDITED:  MAY 13, 1993
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 99999, 2 Decimal Digits
  • DESCRIPTION:  
    If this policy has a benefit for outpatient services, then this amount is the maxiumum of that benefit for one year.
2.05 MH LIFETIME OUTPATIENT MAX. 2;5 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  OCT 28, 1993
  • HELP-PROMPT:  Type a Number between 0 and 9999999, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy has a lifetime maximum benefit for mental health services, then this is the amount of that benefit.
2.06 MH ANNUAL OUTPATIENT MAX. 2;6 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
  • LAST EDITED:  MAY 13, 1993
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
  • DESCRIPTION:  
    If this policy has a benefit for mental health services, then this amount is the maximum of that benefit for one year.
2.07 DENTAL COVERAGE TYPE 2;7 SET
  • '0' FOR NONE;
  • '1' FOR PER VISIT AMOUNT;
  • '2' FOR PERCENTAGE AMOUNT;

  • LAST EDITED:  JAN 07, 1994
  • DESCRIPTION:  
    This indicates whether there is a dental benefit, and if so, the per visit or percentage amount.
  • CROSS-REFERENCE:  ^^TRIGGER^355.4^2.08
    1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.4,D0,2)):^(2),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" X ^DD(355.4,2.07,1,1,1.4)
    1.4)= S DIH=$S($D(^IBA(355.4,DIV(0),2)):^(2),1:""),DIV=X S $P(^(2),U,8)=DIV,DIH=355.4,DIG=2.08 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^IBA(355.4,D0,2)):^(2),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" X ^DD(355.4,2.07,1,1,2.4)
    2.4)= S DIH=$S($D(^IBA(355.4,DIV(0),2)):^(2),1:""),DIV=X S $P(^(2),U,8)=DIV,DIH=355.4,DIG=2.08 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= #2.08
    When changing or deleting DENTAL COVERAGE TYPE delete DENTAL COVERAGE $ OR %.
2.08 DENTAL COVERAGE $ OR % 2;8 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAY 13, 1993
  • HELP-PROMPT:  Type a Number between 0 and 99999, 0 Decimal Digits if coverage is a $ amount, or between 0 and 100 if %.
  • DESCRIPTION:  
    If there is a dental benefit, this number indicates the dollar or percentage amount of that benefit.
  • NOTES:  TRIGGERED by the DENTAL COVERAGE TYPE field of the ANNUAL BENEFITS File
2.09 OUTPATIENT VISIT (%) 2;9 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 03, 1993
  • HELP-PROMPT:  Type a Number between 0 and 100, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy has an outpatient benefit, this is the percentage coverage per outpatient visit.
2.1 EMERGENCY OUTPATIENT (%) 2;10 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 07, 1993
  • HELP-PROMPT:  Type a Number between 0 and 999999, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy has a benefit for emergency outpatient services, this is the percentage covered by that benefit.
2.11 MENTAL HEALTH OUTPATIENT (%) 2;11 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 03, 1993
  • HELP-PROMPT:  Type a Number between 0 and 100, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy has a benefit for mental health outpatient services, this is the percentage covered by that benefit.
2.12 PRESCRIPTION (%) 2;12 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAY 13, 1993
  • HELP-PROMPT:  Type a Number between 0 and 999999, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy has a benefit for prescription services, this is the percentage covered by that benefit.
2.13 OUTPATIENT SURGERY (%) 2;13 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAY 13, 1993
  • HELP-PROMPT:  Type a Number between 0 and 999999, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy has a benefit for outpatient surgery services, this is the percentage covered by that benefit.
2.14 MH OPT. MAX DAYS PER YEAR 2;14 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>365)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUL 08, 1993
  • HELP-PROMPT:  Type a Number between 0 and 365, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy provides a benefit for mental health outpatient services, this is the maximum number of days per year of this benefit.
2.15 OUTPATIENT VISITS PER YEAR 2;15 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>365)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  AUG 25, 1993
  • HELP-PROMPT:  Type a Number between 0 and 365, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy provides outpatient benefits, this is the maximum number of visits per year.
2.17 ADULT DAY HEALTH CARE 2;17 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  AUG 27, 1993
  • DESCRIPTION:  
    This indicates whether the policy has a benefit for Adult Day Health Care services.
3.01 HOME HEALTH CARE LEVEL 3;1 SET
  • '0' FOR NONE;
  • '1' FOR NURSES AIDE;
  • '2' FOR LPN;
  • '3' FOR RN;
  • '4' FOR THERAPIST/OTHER;

  • LAST EDITED:  SEP 24, 1993
  • DESCRIPTION:  
    If this policy provides home health care, this is the highest level of nursing care that it will cover.
3.02 HOME HEALTH VISITS PER YEAR 3;2 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>365)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAY 13, 1993
  • HELP-PROMPT:  Type a Number between 0 and 365, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy provides home health care, this is the maximum number of visits per year.
3.03 HOME HEALTH MAX DAYS PER YEAR 3;3 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>365)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAY 13, 1993
  • HELP-PROMPT:  Type a Number between 0 and 365, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy provides home health care, this is the maximum number of days per year of home health care services.
3.04 HOME HEALTH MED. EQUIPMENT (%) 3;4 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAY 13, 1993
  • HELP-PROMPT:  Type a Number between 0 and 100, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy provides a benefit for medical equipment used in home health care services, this is the percentage of that benefit.
3.05 HOME HEALTH VISIT DEFINITION 3;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 13, 1993
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    If this policy provides for home health visits, this defines the nature of the visits.
3.06 OCCUPATIONAL THERAPY # VISITS 3;6 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>365)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  AUG 26, 1993
  • HELP-PROMPT:  Type a Number between 0 and 365, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy has a benefit for occupational therapy, then this is the maximum number of OT visits that the policy allows in one year.
3.07 PHYSICAL THERAPY # VISITS 3;7 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>365)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  AUG 26, 1993
  • HELP-PROMPT:  Type a Number between 0 and 365, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy has a benefit for physical therapy, then this is the maximum number of PT visits that the policy allows in one year.
3.08 SPEECH THERAPY # VISITS 3;8 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>365)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  AUG 26, 1993
  • HELP-PROMPT:  Type a Number between 0 and 365, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy has a benefit for speech therapy, then this is the maximum number of ST visits that the policy allows in one year.
3.09 MEDICATION COUNSELING # VISITS 3;9 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>365)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  AUG 26, 1993
  • HELP-PROMPT:  Type a Number between 0 and 365, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy has a benefit for medication counseling, then this is the maximum number of MC visits that the policy allows in one year.
4.01 HOSPICE ANNUAL DEDUCTIBLE 4;1 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
  • LAST EDITED:  MAY 13, 1993
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
  • DESCRIPTION:  
    If this policy provides hospice services, this is the amount that the policy does not cover in claims.  This information will be used in calculating whether reimbursement for claims against this policy are appropriate.
4.02 HOSPICE INPATIENT ANNUAL MAX 4;2 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
  • LAST EDITED:  MAY 13, 1993
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
  • DESCRIPTION:  
    If this policy provides hospice inpatient services, this is the maximum amount of coverage for one year.
4.03 HOSPICE INPT. LIFETIME MAX 4;3 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
  • LAST EDITED:  OCT 28, 1993
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
  • DESCRIPTION:  
    If this policy provides hospice inpatient services, this is the maximum amount over the life of the policy for this benefit.
4.04 ROOM AND BOARD (%) 4;4 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAY 13, 1993
  • HELP-PROMPT:  Type a Number between 0 and 100, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy provides a room and board benefit, this is the percentage of the charges that the policy will cover.
4.05 OTHER INPATIENT CHARGES (%) 4;5 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAY 13, 1993
  • HELP-PROMPT:  Type a Number between 0 and 100, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy provides a benefit for other inpatient charges, this is the percentage covered by that benefit.
4.06 IV INFUSION OPT. 4;6 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  AUG 26, 1993
  • DESCRIPTION:  
    This indicates whether the policy has a benefit for outpatient IV Infusion services.
4.07 IV INFUSION INPT. 4;7 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  AUG 26, 1993
  • DESCRIPTION:  
    This indicates whether the policy has a benefit for inpatient IV Infusion services.
4.08 IV ANTIBIOTICS OPT. 4;8 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  AUG 26, 1993
  • DESCRIPTION:  
    This indicates whether the policy has a benefit for outpatient IV Antibiotics services.
4.09 IV ANTIBIOTICS INPT. 4;9 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  SEP 07, 1993
  • DESCRIPTION:  
    This indicates whether the policy has a benefit for inpatient IV Antibiotics.
5.01 ANNUAL DEDUCTIBLE (INPATIENT) 5;1 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
  • LAST EDITED:  JUN 04, 1993
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
  • DESCRIPTION:  If this policy provides for inpatient services, this is the amount that the policy does not cover in claims. This information will be used in calculating whether reimburseent for claims against this policy are
    appropriate.
5.02 PER ADMISSION DEDUCTIBLE 5;2 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
  • LAST EDITED:  MAY 20, 1993
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
  • DESCRIPTION:  
    This is the dollar amount that this policy does not cover in claims for each admission.
5.03 INPATIENT LIFETIME MAXIMUM 5;3 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
  • LAST EDITED:  OCT 28, 1993
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
  • DESCRIPTION:  
    If this policy provides inpatient services, this is the maximum amount over the life of this policy for this benefit.
5.04 INPATIENT ANNUAL MAXIMUM 5;4 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
  • LAST EDITED:  MAY 20, 1993
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
  • DESCRIPTION:  
    If this policy provides inpatient services, this is the maximum annual amount of this benefit.
5.05 MH LIFETIME INPATIENT MAXIMUM 5;5 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
  • LAST EDITED:  OCT 28, 1993
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
  • DESCRIPTION:  
    If this policy provides a benefit for mental health inpatient services, this is the maximum amount over the life of the policy for this benefit.
5.06 MH ANNUAL INPATIENT MAXIMUM 5;6 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
  • LAST EDITED:  MAY 20, 1993
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
  • DESCRIPTION:  
    If this policy provides a benefit for mental health inpatient services, this is the maximum amount that this policy will pay toward these services in one year.
5.07 DRUG & ALCOHOL LIFETIME MAX 5;7 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
  • LAST EDITED:  OCT 28, 1993
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
  • DESCRIPTION:  
    If this policy provides a benefit for drug and alcohol services, this is the maximum amount over the life of the policy for this benefit.
5.08 DRUG & ALCOHOL ANNUAL MAX 5;8 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
  • LAST EDITED:  MAY 20, 1993
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
  • DESCRIPTION:  
    If this policy provides a benefit for drug and alcohol services, this is the maximum amount that this policy will pay toward these services in one year.
5.09 ROOM AND BOARD (%) 5;9 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAY 20, 1993
  • HELP-PROMPT:  Type a Number between 0 and 100, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy provides a room and board benefit, this is the percentage of room and board charges that the policy will cover.
5.1 NURSING HOME (%) 5;10 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAY 20, 1993
  • HELP-PROMPT:  Type a Number between 0 and 100, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy provides a benefit for nursing home services, this is the percentage of nursing home charges that the policy will cover.
5.11 MENTAL HEALTH INPATIENT (%) 5;11 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAY 20, 1993
  • HELP-PROMPT:  Type a Number between 0 and 100, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy provides a benefit for mental health inpatient services, this is the percentage of the charges that the policy will cover.
5.12 OTHER INPATIENT CHARGES (%) 5;12 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>100)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAY 20, 1993
  • HELP-PROMPT:  Type a Number between 0 and 100, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy provides a benefit for other inpatient charges, this is the percentage of those charges that the policy will cover.
5.14 MH INPT. MAX DAYS PER YEAR 5;14 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>365)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUL 08, 1993
  • HELP-PROMPT:  Type a Number between 0 and 365, 0 Decimal Digits
  • DESCRIPTION:  
    If this policy provides a benefit for mental health inpatient services, this is the maximum number of days per year of this benefit.

ICR, Total: 1

ICR LINK Subscribing Package(s) Fields Referenced Description
ICR #5339
  • INSURANCE CAPTURE BUFFER
    		•

    External References

    Name Field # of Occurrence
    ^%DT .01+1, 1.01+1, 1.03+1, 1.05+1
    ^DICR .01(XREF 3n1.4), .01(XREF 4n1.4), 2.07(XREF 1n1.4), 2.07(XREF 1n2.4)
    Y^DIQ ID.02+1
    DATECHK^IBCNSA2 .01+1

    Global Variables Directly Accessed

    Name Line Occurrences  (* Changed,  ! Killed)
    ^DD( .01(XREF 3n1.4), .01(XREF 4n1.4), 2.07(XREF 1n1.4), 2.07(XREF 1n2.4)
    ^DD(355.3 ID.02+1
    ^DD(355.4 .01(XREF 3S), .01(XREF 4S), 2.07(XREF 1S), 2.07(XREF 1K)
    ^IBA(355.3 - [#355.3] ID.02+1
    ^IBA(355.4 - [#355.4] .01(XREF 1S), .01(XREF 1K), .01(XREF 2S), .01(XREF 2K), .01(XREF 3S), .01(XREF 3n1.4), .01(XREF 4S), .01(XREF 4n1.3), .01(XREF 4n1.4), .02(XREF 1S)
    , .02(XREF 1K), .02(XREF 2S), .02(XREF 2K), 2.07(XREF 1S), 2.07(XREF 1n1.4), 2.07(XREF 1K), 2.07(XREF 1n2.4)
    ^VA(200 - [#200] .01(XREF 4n1.3)

    Naked Globals

    Name Field # of Occurrence
    ^(0 ID.02+1, .01(XREF 2S), .01(XREF 4n1.3), .02(XREF 2S)
    ^(1 .01(XREF 3S), .01(XREF 3n1.4), .01(XREF 4S), .01(XREF 4n1.3), .01(XREF 4n1.4)
    ^(2 2.07(XREF 1S), 2.07(XREF 1n1.4), 2.07(XREF 1K), 2.07(XREF 1n2.4)

    Local Variables

    Legend:

    >> Not killed explicitly
    * Changed
    ! Killed
    ~ Newed

    Name Field # of Occurrence
    >> %DT .01+1*, 1.01+1*, 1.03+1*, 1.05+1*
    %I ID.02+1*!
    >> C ID.02+1*
    >> D0 .01(XREF 3S), .01(XREF 4S), .01(XREF 4n1.3), 2.07(XREF 1S), 2.07(XREF 1K)
    >> DA .01(XREF 1S), .01(XREF 1K), .01(XREF 2S), .01(XREF 2K), .01(XREF 3S), .01(XREF 4n1.3), .02(XREF 1S), .02(XREF 1K), .02(XREF 2S), .02(XREF 2K)
    , 2.07(XREF 1S), 2.07(XREF 1K)
    >> DIC ID.02+1
    >> DIG .01(XREF 3n1.4), .01(XREF 4n1.4), 2.07(XREF 1n1.4), 2.07(XREF 1n2.4)
    >> DIH .01(XREF 3n1.4), .01(XREF 4n1.4), 2.07(XREF 1n1.4), 2.07(XREF 1n2.4)
    >> DIU .01(XREF 3S), .01(XREF 4S), 2.07(XREF 1S), 2.07(XREF 1K)
    DIV .01(XREF 3S), .01(XREF 3n1.4), .01(XREF 4S), .01(XREF 4n1.3), .01(XREF 4n1.4), 2.07(XREF 1S), 2.07(XREF 1n1.4), 2.07(XREF 1K), 2.07(XREF 1n2.4)
    DIV(0 .01(XREF 3S), .01(XREF 3n1.4), .01(XREF 4n1.3), .01(XREF 4n1.4), 2.07(XREF 1S), 2.07(XREF 1n1.4), 2.07(XREF 1K), 2.07(XREF 1n2.4)
    DT .01(XREF 3S)
    DUZ .01(XREF 4S)
    U ID.02+1, .01(XREF 2S), .01(XREF 2K), .01(XREF 3S), .01(XREF 3n1.4), .01(XREF 4S), .01(XREF 4n1.3), .01(XREF 4n1.4), 2.07(XREF 1S), 2.07(XREF 1n1.4)
    , 2.07(XREF 1K), 2.07(XREF 1n2.4)
    X .01+1*!, .01(XREF 1S), .01(XREF 1K), .01(XREF 2S), .01(XREF 2K), .01(XREF 3S), .01(XREF 3n1.4), .01(XREF 4S), .01(XREF 4n1.3), .01(XREF 4n1.4)
    , .02(XREF 1S), .02(XREF 1K), .02(XREF 2S), .02(XREF 2K), .05+1*!, .06+1!, 1.01+1*!, 1.03+1*!, 1.05+1*!, 1.07+1!
    , 1.08+1!, 1.09+1!, 2.01+1*!, 2.02+1*!, 2.03+1*!, 2.04+1*!, 2.05+1!, 2.06+1*!, 2.07(XREF 1S), 2.07(XREF 1n1.4)
    , 2.07(XREF 1K), 2.07(XREF 1n2.4), 2.08+1!, 2.09+1!, 2.1+1!, 2.11+1!, 2.12+1!, 2.13+1!, 2.14+1!, 2.15+1!
    , 3.02+1!, 3.03+1!, 3.04+1!, 3.05+1!, 3.06+1!, 3.07+1!, 3.08+1!, 3.09+1!, 4.01+1*!, 4.02+1*!
    , 4.03+1*!, 4.04+1!, 4.05+1!, 5.01+1*!, 5.02+1*!, 5.03+1*!, 5.04+1*!, 5.05+1*!, 5.06+1*!, 5.07+1*!
    , 5.08+1*!, 5.09+1!, 5.1+1!, 5.11+1!, 5.12+1!, 5.14+1!
    Y ID.02+1*, .01+1, .01(XREF 3S), .01(XREF 4S), 1.01+1, 1.03+1, 1.05+1, 2.07(XREF 1S), 2.07(XREF 1K)
    Y(0 .01(XREF 3S), .01(XREF 4n1.3)
    Y(1 .01(XREF 3S), .01(XREF 4S), .01(XREF 4n1.3), 2.07(XREF 1S), 2.07(XREF 1K)
    Info |  Desc |  Directly Accessed By Routines |  Accessed By FileMan Db Calls |  Pointer To FileMan Files |  Fields |  ICR |  Found Entries |  External References |  Global Variables Directly Accessed |  Naked Globals |  Local Variables |  All