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Sub-Field: 2.312

Package: Registration

VA PATIENT(#2)-->2.312

Sub-Field: 2.312


Information

Parent File Name Number Package
VA 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:  APR 20, 2000
  • HELP-PROMPT:  ANSWER MUST BE 3-20 CHARACTERS IN LENGTH
  • DESCRIPTION:  This is the Insured's unique identification number assigned by the payer organization. For Medicare enter the number as shown on the Health Insurance Care (HIC). For Medicaid enter the Medicaid identification number
    for the insured or case head Medicaid number show on the Medicaid Identification card.
    For commercial or Blue Cross insurance enter the insured ID number from the ID card.  If not available use the insured SSN.  If an individual insurance contract is involved, use the policy number.
    If the insured is self, you can enter "SS" to enter this patients SSN in this field.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • 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.





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 VA 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 VA 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:  JUL 07, 1993
  • DESCRIPTION:  
    This is the date this policy was last edited.  This field is updated by the computer whenever anyone edits this patients policy information.





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 03, 1993
  • 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.





1.09
SOURCE OF INFORMATION
1;9
SET

  • '1' FOR INTERVIEW;
  • '2' FOR DATA MATCH;
  • '3' FOR IVM;
  • '4' FOR PRE-REGISTRATION;
  • LAST EDITED:  MAY 06, 1997
  • DESCRIPTION:  Enter the last source of this information.  If the insurance information was obtained by patient interview the 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=$P(Y(1),U,10),X=X S DIU=X K Y X ^DD(2.312,1.09,1,1,1.1) X ^DD(2.312,1.09,1,1,1.4)
    1.1)= S X=DIV S %=$P($H,",",2),X=$E(DT_(%\60#60/100+(%\3600)+(%#60/10000)/100),1,12)
    1.4)= S DIH=$S($D(^DPT(DIV(0),.312,DIV(1),1)):^(1),1:""),DIV=X S $P(^(1),U,10)=DIV,DIH=2.312,DIG=1.1 D ^DICR:$N(^DD(DIH,DIG,1,0))>0
    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 VA PATIENT File





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:  MAY 20, 1993
  • 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-92 if this employer pre-processes insurance claims.
  • DESCRIPTION:  
    This is the name of the employer that will appear on the UB-82 or UB-92 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:  APR 20, 2000
  • HELP-PROMPT:  
  • DESCRIPTION:  
    If this insurance policy under which this applicant is covered expires on a specified date enter that date, otherwise, leave this field blank.
  • 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.





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:  AUG 18, 1999
  • 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 HCFA 1500 claim form.  It will primarily be used 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 23, 1996
  • 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 HCFA 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 23, 1996
  • 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 HCFA 1500 claim form.





3.04
POLICY NOT BILLABLE
3;4
SET

  • '0' FOR NO;
  • '1' FOR YES;
  • LAST EDITED:  AUG 13, 1996
  • HELP-PROMPT:  Enter YES if claims should not be created against this policy.
  • DESCRIPTION:  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.





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:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 05, 1997
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This field contains the first street address of the policyholder.





3.07
INSURED'S STREET 2
3;7
FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  MAY 05, 1997
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    This field contains the second street of the policyholder.





3.08
INSURED'S CITY
3;8
FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>25!($L(X)<2) X
  • LAST EDITED:  MAY 05, 1997
  • HELP-PROMPT:  Answer must be 2-25 characters in length.
  • DESCRIPTION:  
    This field contains the city of the policyholder.





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.





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.





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
  • 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
*RENEWAL DATE
0;7
DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  MAR 01, 1993
  • DESCRIPTION:  If applicable enter the date this policy is to be renewed, otherwise, leave blank.
    Field star'd for deleting in IB version 2.0.  This field will be deleted in the first release of IB 18 months after the release of IB version 2.0.





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($G(^DPT(DA(1),.312,DA,0)),"^",4) K X
  • LAST EDITED:  APR 20, 2000
  • HELP-PROMPT:  ANSWER MUST BE 3-10 CHARACTERS IN LENGTH
  • DESCRIPTION:  
    Enter the date that this insurance policy initially went into effect (the date the patient acquired this policy).
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  2.312^ADGRU3128^MUMPS
    1)= D:($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.





9
*AGENT'S NAME
0;9
FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>25!($L(X)<3) X
  • LAST EDITED:  JUL 02, 1993
  • HELP-PROMPT:  Answer must be 3-25 characters in length.
  • DESCRIPTION:  Enter the name of the insurance agent from which the patient acquired this insurance policy.
    Field star'd for deleting in IB version 2.0.  This field will be deleted in the first release of IB 18 months after the release of IB version 2.0.





10
*AGENT'S TELEPHONE NUMBER
0;10
FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<7) X
  • LAST EDITED:  MAR 03, 1993
  • HELP-PROMPT:  Answer must be 7-15 characters in length.
  • DESCRIPTION:  Enter the phone number of the insurance agent from which this patient acquired this insurance policy.
    Field star'd for deleting in IB version 2.0.  This field will be deleted in the first release of IB 18 months after the release of IB version 2.0.





11
*AGENT'S STREET
0;11
FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>25!($L(X)<3) X
  • LAST EDITED:  JUL 02, 1993
  • HELP-PROMPT:  Answer must be 3-25 characters in length.
  • DESCRIPTION:  Enter the street address of the insurance agent from which this patient acquired this insurance policy.
    Field star'd for deleting in IB version 2.0.  This field will be deleted in the first release of IB 18 months after the release of IB version 2.0.





12
*AGENT'S CITY
0;12
FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<3) X
  • LAST EDITED:  MAY 25, 1993
  • HELP-PROMPT:  Answer must be 3-15 characters in length.
  • DESCRIPTION:  Enter the city in which the insurance agent that supplied the patient with this policy is located.
    Field star'd for deleting in IB version 2.0.  This field will be deleted in the first release of IB 18 months after the release of IB version 2.0.





13
*AGENT'S STATE
0;13
POINTER TO STATE FILE (#5)
STATE(#5)
  • LAST EDITED:  FEB 22, 1993
  • DESCRIPTION:  Enter the state in which the insurance agent that supplied the patient with this policy is located.
    Field star'd for deleting in IB version 2.0.  This field will be deleted in the first release of IB 18 months after the release of IB version 2.0.





14
*AGENT'S ZIP CODE
0;14
FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>5!($L(X)<5)!'(X?5N) X
  • LAST EDITED:  FEB 22, 1993
  • HELP-PROMPT:  ANSWER MUST BE 5 NUMERICS IN LENGTH
  • DESCRIPTION:  Enter the zip code of the address for the insurance agent that supplied this policy to the patient.
    Field star'd for deleting in IB version 2.0.  This field will be deleted in the first release of IB 18 months after the release of IB version 2.0.





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************************
  • '01' FOR PATIENT;
  • '02' FOR SPOUSE;
  • '03' FOR NATURAL CHILD;
  • '08' FOR EMPLOYEE;
  • '09' FOR UNKNOWN;
  • '11' FOR ORGAN DONOR;
  • '15' FOR INJURED PLANTIFF;
  • '18' FOR PARENT;
  • LAST EDITED:  JUN 01, 1993
  • 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.
  • CROSS-REFERENCE:  2.312^AC^MUMPS
    1)= Q
    2)= Q
    Cross-reference to force filing of data.





17
NAME OF INSURED
0;17
FREE TEXT 

************************REQUIRED FIELD************************
  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<2) X S:$$VET^IBCNSU1() X=$P($G(^DPT(DA(1),0)),"^") I $G(X)'?.E1",".E K X
  • LAST EDITED:  JAN 31, 2000
  • HELP-PROMPT:  ENTER 3-30 CHARACTER NAME OF PERSON WHO HOLDS THIS INSURANCE POLICY
  • DESCRIPTION:  
    Enter the name of the individual for which this insurance policy was issued.  If the 'WHOSE INSURANCE' field was answered 'v' for veteran, this field will be created with this patient's name.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  2.312^AENR17^MUMPS
    1)= D EVENT^IVMPLOG($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.





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,D0,0)):^(0),1:"") S X=$P(Y(2.312,20,101),U,3) S D0=Y(2.312,20,80) S D1=Y(2.312,20,81)
    9.2 = S Y(2.312,20,81)=$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





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,D0,0)):^(0),1:"") S X=$P(Y(2.312,21,101),U,4) S D0=Y(2.312,21,80) S D1=Y(2.312,21,81)
    9.2 = S Y(2.312,21,81)=$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







    



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