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Sub-Field: 9002071.01

Package: Contract Health Management Information System

CHS DENIAL DATA(#9002071)-->9002071.01

Sub-Field: 9002071.01


Information

Parent File Name Number Package
CHS DENIAL DATA(#9002071) DENIAL NUMBER 9002071.01 Contract Health Management Information System

Details

Field # Name Loc Type Details
.01 DENIAL NUMBER 0;1 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<5) X
  • LAST EDITED:  NOV 30, 1993
  • HELP-PROMPT:  Answer must be 5-15 characters in length.
  • CROSS-REFERENCE:  9002071.01^B
    1)= S ^ACHSDEN(DA(1),"D","B",$E(X,1,30),DA)=""
    2)= K ^ACHSDEN(DA(1),"D","B",$E(X,1,30),DA)
2 DATE DENIAL ISSUED 0;2 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  APR 04, 2003
  • HELP-PROMPT:  Enter Date Denial Issued
  • CROSS-REFERENCE:  9002071^AISSUE^MUMPS
    1)= S ^ACHSDEN(DA(1),"D","AISSUE",$E(X,1,30),DA)=""
    2)= K ^ACHSDEN(DA(1),"D","AISSUE",$E(X,1,30),DA)
3 ISSUED BY 0;3 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  NOV 30, 1993
  • HELP-PROMPT:  Enter User Issuing Document
4 DATE OF MEDICAL SERVICE 0;4 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  APR 08, 1994
  • HELP-PROMPT:  Enter Date Patient Received/Will Receive Medical Care
  • CROSS-REFERENCE:  9002071^ES^MUMPS
    1)= S ^ACHSDEN(DA(1),"D","ES",X,DA)=""
    2)= K ^ACHSDEN(DA(1),"D","ES",X,DA)
5 DATE REQUEST RECEIVED 0;5 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  NOV 30, 1993
  • HELP-PROMPT:  Enter Date Request Received in Contract Health
6 IS THIS PATIENT REGISTERED? 0;6 SET
  • 'Y' FOR YES;
  • 'N' FOR NO;

  • LAST EDITED:  NOV 30, 1993
  • HELP-PROMPT:  Enter 'N' If Patient Not Registered At Your Facility
7 REGISTERED PATIENT 0;7 POINTER TO PATIENT FILE (#9000001) PATIENT(#9000001)

  • LAST EDITED:  DEC 31, 2001
  • HELP-PROMPT:  Enter Name of Chart Number Of Patient
  • CROSS-REFERENCE:  9002071^C^MUMPS
    1)= I $G(^DPT(X,0))'="" S ^ACHSDEN(DA(1),"D","C",$P(^DPT(X,0),U,1),DA)=""
    2)= I $G(^DPT(X,0))'="" K ^ACHSDEN(DA(1),"D","C",$P(^DPT(X,0),U,1),DA)
    3)= Hey!  You NEED this cross ref!
    Patient name cross index for patient lookup
  • CROSS-REFERENCE:  9002071.01^D^MUMPS
    1)= S ^ACHSDEN(DA(1),"D","D",X,DA)=""
    2)= K ^ACHSDEN(DA(1),"D","D",X,DA)
8 CANCELLED/REVERSED 0;8 SET
  • 'Y' FOR Cancelled;
  • 'N' FOR Not Cancelled;
  • 'R' FOR Reversed;

  • LAST EDITED:  FEB 13, 2002
  • HELP-PROMPT:  Enter Y to cancel, R to reverse, or N to not cancel
  • DESCRIPTION:  
    This field shows whether the denial has been cancelled or reversed.
9 SEND LETTER TO PATIENT? 9;1 SET
************************REQUIRED FIELD************************
  • 'Y' FOR YES;
  • 'N' FOR NO;

  • LAST EDITED:  DEC 12, 2000
  • HELP-PROMPT:  Enter yes if the denial letter should go to the patient and no if the letter should go to someone else e.g. a guardian.
  • DESCRIPTION:  
    This field is asked to verify whether the denial letter should go to the patient or to someone else. This was added per the CHS workgroup from the November meeting.
9.5 ALTERNATE RECIPIENT 9.5;0 WORD-PROCESSING #9002071.12

  • DESCRIPTION:  
    This is the mailing address that the denial letter should be sent to. The user is responsible for putting the name, street and city, state zip on the proper lines.
10 PATIENT NAME 10;1 FREE TEXT

  • INPUT TRANSFORM:  K:(X["""")!($A(X)=45)!($L(X)>30)!($L(X)<3) X
  • LAST EDITED:  MAY 05, 2003
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  9002071.01^N
    1)= S ^ACHSDEN(DA(1),"D","N",$E(X,1,30),DA)=""
    2)= K ^ACHSDEN(DA(1),"D","N",$E(X,1,30),DA)
    3)= Cant look up non registered patients without this.
  • CROSS-REFERENCE:  9002071^C^MUMPS
    1)= S ^ACHSDEN(DA(1),"D","C",$E(X,1,30),DA)=""
    2)= K ^ACHSDEN(DA(1),"D","C",$E(X,1,30),DA)
    3)= Cant look up non registered patients without this.
11 MAILING ADDRESS-STREET 10;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  NOV 30, 1993
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
12 MAILING ADDRESS-CITY 10;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  NOV 30, 1993
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
13 MAILING ADDRESS-STATE 10;4 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  NOV 30, 1993
  • HELP-PROMPT:  Enter State Where Patient Receives Mail
14 MAILING ADDRESS-ZIP 10;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5) X
  • LAST EDITED:  NOV 30, 1993
  • HELP-PROMPT:  Answer must be 5-10 characters in length.
15 CHART # (OTHER FACILITY) 10;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>6!($L(X)<1) X
  • LAST EDITED:  NOV 30, 1993
  • HELP-PROMPT:  Answer must be 1-6 characters in length.
100 IS PRIMARY PROVIDER ON FILE? 100;1 SET
  • 'Y' FOR YES;
  • 'N' FOR NO;

  • LAST EDITED:  NOV 30, 1993
  • HELP-PROMPT:  Answer 'N' If Primary Provider Is Not On File At This Facility
102 PRIMARY PROVIDER (ON-FILE) 100;2 POINTER TO VENDOR FILE (#9999999.11) VENDOR(#9999999.11)

  • LAST EDITED:  NOV 30, 1993
  • HELP-PROMPT:  Enter Provider Name
103 PRIMARY PROVIDER (NOT ON-FILE) 100;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  NOV 30, 1993
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
104 MAILING ADDRESS-STREET 100;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  NOV 30, 1993
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
105 MAILING ADDRESS-CITY 100;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  NOV 30, 1993
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
106 MAILING ADDRESS-STATE 100;6 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  NOV 30, 1993
  • HELP-PROMPT:  Enter State Where Provider Receives Mail
107 MAILING ADDRESS-ZIP 100;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5) X
  • LAST EDITED:  NOV 30, 1993
  • HELP-PROMPT:  Answer must be 5-10 characters in length.
108 EST. CHARGE (PRIM. PROV.) 100;8 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
  • LAST EDITED:  APR 11, 1994
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
109 ACTUAL CHARGES (PRIM. PROV.) 100;9 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
  • LAST EDITED:  NOV 30, 1993
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
110 TYPE OF SERVICE 100;10 SET
  • 'I' FOR INPATIENT;
  • 'O' FOR OUTPATIENT;
  • 'A' FOR AMBULANCE;
  • 'P' FOR PATIENT ESCORT;
  • 'D' FOR DENTAL;

  • LAST EDITED:  NOV 30, 1993
  • HELP-PROMPT:  Enter Type Of Service Patient Received From Provider
200 OTHER PROVIDER (ON-FILE) 200;0 POINTER Multiple #9002071.02 9002071.02
210 OTHER PROVIDER (NOT ON-FILE) 210;0 Multiple #9002071.03 9002071.03
250 PRIMARY DENIAL REASON 250;1 POINTER TO CHS DENIAL REASON FILE (#9002073) CHS DENIAL REASON(#9002073)

  • INPUT TRANSFORM:  S DIC("S")="I '$G(^(10))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JUL 06, 2004
  • HELP-PROMPT:  Enter Primary Denial Reason
  • SCREEN:  S DIC("S")="I '$G(^(10))"
  • EXPLANATION:  SCREEN INACTIVE REASONS
252 PRIMARY DENIAL REASON OPTION 250;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • OUTPUT TRANSFORM:  Q:'Y S Y=$P(^ACHSDENS($P(^ACHSDEN(DUZ(2),"D",DA,250),U),20,Y,0),U)
  • LAST EDITED:  AUG 30, 2010
  • HELP-PROMPT:  Answer must be 1-3 characters in length.
  • TECHNICAL DESCR:  
    This is a free-text pointer to a multiple in the CHS DENIAL REASON FILE.  The multiple is field 20, OPTION(S).  The output transform retrieves the actual value of the pointed-to entry in CHS DENIAL REASON.
253 PRIMARY DENIAL REASON AVAL FAC 250;3 POINTER TO LOCATION FILE (#9999999.06) LOCATION(#9999999.06)

  • LAST EDITED:  AUG 26, 2010
  • HELP-PROMPT:  Enter the facility available for the patient to recieve care.
255 PRIMARY DENIAL REASON COMMENT 255;0 WORD-PROCESSING #9002071.1255
256 PRIMARY DEN REASON ALT RES TYP 256;0 Multiple #9002071.1256 9002071.1256

  • LAST EDITED:  AUG 30, 2010
260 Medicare Resource 260;0 POINTER Multiple #9002071.13 9002071.13
300 OTHER DENIAL REASONS 300;0 POINTER Multiple #9002071.04 9002071.04
320 ALTERNATE RESOURCES 320;0 Multiple #9002071.13 9002071.13
400 UNMET NEED TYPE 400;1 SET

  • LAST EDITED:  JUL 16, 2010
  • HELP-PROMPT:  Enter Unmet Need Category
401 UNMET NEED COMMENT 401;0 WORD-PROCESSING #9002071.1401

  • LAST EDITED:  JUL 16, 2010
420 MEDICAL PRIORITY CATEGORY 400;2 POINTER TO CHS MEDICAL PRIORITY FILE (#9002073.1)
************************REQUIRED FIELD************************
CHS MEDICAL PRIORITY(#9002073.1)

  • LAST EDITED:  AUG 16, 1994
  • HELP-PROMPT:  Enter CHS Medical Priority Category
430 APPEAL STATUS 400;3 POINTER TO CHS DENIAL STATUS FILE (#9002074) CHS DENIAL STATUS(#9002074)

  • LAST EDITED:  DEC 01, 1993
  • HELP-PROMPT:  Enter Status Of This Denial
431 APPEAL TRANSACTION RECORD 431;0 DATE Multiple #9002071.1431 9002071.1431

  • LAST EDITED:  APR 02, 2003
440 DENIAL FOR LACK OF FUNDS? 400;4 SET
  • LAST EDITED: APR 19, 1994
  • HELP-PROMPT: For historical purposes not used now

  • LAST EDITED:  APR 19, 1994
  • HELP-PROMPT:  For historical purposes not used now
500 DIAGNOSIS (ICD) 500;0 POINTER Multiple #9002071.05 9002071.05

  • LAST EDITED:  MAR 03, 2014
700 PROCEDURE (CPT) 700;0 POINTER Multiple #9002071.07 9002071.07
800 OTHER RESOURCES 800;0 POINTER Multiple #9002071.08 9002071.08

  • DESCRIPTION:  
    THESE ARE POSSIBLE PRIVATE OR GOVERNMENT RESOURCES THAT MIGHT BE AVAILABLE TO THE PATIENT
825 OTHER IHS RESOURCES 825;0 POINTER Multiple #9002071.1825 9002071.1825
850 DOCUMENT CONTROL 850;1 SET

  • LAST EDITED:  DEC 01, 1993
  • HELP-PROMPT:  Enter 'Y' If Receipt Of Denial Has Been Acknowledged
851 RECEIPT TYPE 850;2 SET

  • LAST EDITED:  JAN 04, 2002
  • HELP-PROMPT:  Enter 'P' If Picked Up By Person, 'C' If Sent By Certified Mail, or 'M' If Sent By Regular Mail
852 DATE DENIAL RECEIVED 850;3 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  DEC 01, 1993
  • HELP-PROMPT:  Enter Date Denial Received By Patient
853 PERSON RECEIVING DENIAL 850;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • OUTPUT TRANSFORM:  D L^ACHS(9002071.01,853)
  • LAST EDITED:  JUL 20, 1995
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
900 CHS OFFICE COMMENTS 900;0 WORD-PROCESSING #9002071.09
950 PROVIDER ACCOUNT NUMBER 950;0 Multiple #9002071.11 9002071.11

  • LAST EDITED:  AUG 16, 1994
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