FeeBasis

System used by Medical Administration service to process and pay invoices from private vendors for authorized procedures provided to veterans. Initial version will include the the processing of Hometown Pharmacy, Patient Travel, and Outpatient Medical claims. Version 2 includes Contract Hospital and Community Nursing Home. Unauthorized claims has been added in version 3. Also in this version is an update to the vendor file for the conversion of CALM to FMS in Austin. The Community Nursing Home has been modified to handle multiple rates.

FeeBasis
fiscalYear Property fiscalYear Property fiscalYear fiscalYear Property Property Association Polyline coordinates describing hotspot on the image user Property user Property user user Property Property Association Polyline coordinates describing hotspot on the image messageText Property messageText Property messageText messageText Property Property Association Polyline coordinates describing hotspot on the image rejectText Property rejectText Property rejectText rejectText Property Property Association Polyline coordinates describing hotspot on the image modifier Property modifier Property modifier modifier Property Property Association Polyline coordinates describing hotspot on the image calendarYear Property calendarYear Property calendarYear calendarYear Property Property Association Polyline coordinates describing hotspot on the image calendarYear Property calendarYear Property calendarYear calendarYear Property Property Association Polyline coordinates describing hotspot on the image conversionCategory Property conversionCategory Property conversionCategory conversionCategory Property Property Association Polyline coordinates describing hotspot on the image calendarYear Property calendarYear Property calendarYear calendarYear Property Property Association Polyline coordinates describing hotspot on the image informationRequested Property informationRequested Property informationRequested informationRequested Property Property Association Polyline coordinates describing hotspot on the image postscript Property postscript Property postscript postscript Property Property Association Polyline coordinates describing hotspot on the image description Property description Property description description Property Property Association Polyline coordinates describing hotspot on the image unauthorizedClaim Property unauthorizedClaim Property unauthorizedClaim unauthorizedClaim Property Property Association Polyline coordinates describing hotspot on the image associated7078583 Property associated7078583 Property associated7078583 associated7078583 Property Property Association Polyline coordinates describing hotspot on the image proc1 Property proc1 Property proc1 proc1 Property Property Association Polyline coordinates describing hotspot on the image dischargeDrg Property dischargeDrg Property dischargeDrg dischargeDrg Property Property Association Polyline coordinates describing hotspot on the image dischargeTypeCode Property dischargeTypeCode Property dischargeTypeCode dischargeTypeCode Property Property Association Polyline coordinates describing hotspot on the image lineItemRenderingProv Property lineItemRenderingProv Property lineItemRenderingProv lineItemRenderingProv Property Property Association Polyline coordinates describing hotspot on the image adjustment Property adjustment Property adjustment adjustment Property Property Association Polyline coordinates describing hotspot on the image descriptionOfSuspension Property descriptionOfSuspension Property descriptionOfSuspension descriptionOfSuspension Property Property Association Polyline coordinates describing hotspot on the image rejectCode Property rejectCode Property rejectCode rejectCode Property Property Association Polyline coordinates describing hotspot on the image poa1 Property poa1 Property poa1 poa1 Property Property Association Polyline coordinates describing hotspot on the image associatedAdmission Property associatedAdmission Property associatedAdmission associatedAdmission Property Property Association Polyline coordinates describing hotspot on the image veteran Property veteran Property veteran veteran Property Property Association Polyline coordinates describing hotspot on the image oldBatchNumber Property oldBatchNumber Property oldBatchNumber oldBatchNumber Property Property Association Polyline coordinates describing hotspot on the image batchNumber Property batchNumber Property batchNumber batchNumber Property Property Association Polyline coordinates describing hotspot on the image genericDrug Property genericDrug Property genericDrug genericDrug Property Property Association Polyline coordinates describing hotspot on the image correspondingOutpatientDrug Property correspondingOutpatientDrug Property correspondingOutpatientDrug correspondingOutpatientDrug Property Property Association Polyline coordinates describing hotspot on the image formularyAlternative Property formularyAlternative Property formularyAlternative formularyAlternative Property Property Association Polyline coordinates describing hotspot on the image correspondingInpatientDrug Property correspondingInpatientDrug Property correspondingInpatientDrug correspondingInpatientDrug Property Property Association Polyline coordinates describing hotspot on the image remittanceRemark Property remittanceRemark Property remittanceRemark remittanceRemark Property Property Association Polyline coordinates describing hotspot on the image adjustment Property adjustment Property adjustment adjustment Property Property Association Polyline coordinates describing hotspot on the image suspensionDescription Property suspensionDescription Property suspensionDescription suspensionDescription Property Property Association Polyline coordinates describing hotspot on the image rejectCode Property rejectCode Property rejectCode rejectCode Property Property Association Polyline coordinates describing hotspot on the image prescriptionNumber Property prescriptionNumber Property prescriptionNumber prescriptionNumber Property Property Association Polyline coordinates describing hotspot on the image batchAssigned Property batchAssigned Property batchAssigned batchAssigned Property Property Association Polyline coordinates describing hotspot on the image travelPaymentDate Property travelPaymentDate Property travelPaymentDate travelPaymentDate Property Property Association Polyline coordinates describing hotspot on the image rejectCode Property rejectCode Property rejectCode rejectCode Property Property Association Polyline coordinates describing hotspot on the image dateOfPurge Property dateOfPurge Property dateOfPurge dateOfPurge Property Property Association Polyline coordinates describing hotspot on the image patient Property patient Property patient patient Property Property Association Polyline coordinates describing hotspot on the image description Property description Property description description Property Property Association Polyline coordinates describing hotspot on the image ipacVendorAgreement Property ipacVendorAgreement Property ipacVendorAgreement ipacVendorAgreement Property Property Association Polyline coordinates describing hotspot on the image description Property description Property description description Property Property Association Polyline coordinates describing hotspot on the image ibNonOtherProvider Property ibNonOtherProvider Property ibNonOtherProvider ibNonOtherProvider Property Property Association Polyline coordinates describing hotspot on the image patient Property patient Property patient patient Property Property Association Polyline coordinates describing hotspot on the image personWhoChanged Property personWhoChanged Property personWhoChanged personWhoChanged Property Property Association Polyline coordinates describing hotspot on the image dateTimeCardNumberChanged Property dateTimeCardNumberChanged Property dateTimeCardNumberChanged dateTimeCardNumberChanged Property Property Association Polyline coordinates describing hotspot on the image name Property name Property name name Property Property Association Polyline coordinates describing hotspot on the image descriptionOfSuspension Property descriptionOfSuspension Property descriptionOfSuspension descriptionOfSuspension Property Property Association Polyline coordinates describing hotspot on the image narrative Property narrative Property narrative narrative Property Property Association Polyline coordinates describing hotspot on the image dateTimeOfContact Property dateTimeOfContact Property dateTimeOfContact dateTimeOfContact Property Property Association Polyline coordinates describing hotspot on the image modeOfTransportation Property modeOfTransportation Property modeOfTransportation modeOfTransportation Property Property Association Polyline coordinates describing hotspot on the image stateOfContact Property stateOfContact Property stateOfContact stateOfContact Property Property Association Polyline coordinates describing hotspot on the image associatedRequest Property associatedRequest Property associatedRequest associatedRequest Property Property Association Polyline coordinates describing hotspot on the image 7078DefaultAuthServiceText Property 7078DefaultAuthServiceText Property 7078DefaultAuthServiceText 7078DefaultAuthServiceText Property Property Association Polyline coordinates describing hotspot on the image state Property state Property state state Property Property Association Polyline coordinates describing hotspot on the image psaDefaultInstitution Property psaDefaultInstitution Property psaDefaultInstitution psaDefaultInstitution Property Property Association Polyline coordinates describing hotspot on the image name Property name Property name name Property Property Association Polyline coordinates describing hotspot on the image name Property name Property name name Property Property Association Polyline coordinates describing hotspot on the image associated7078 Property associated7078 Property associated7078 associated7078 Property Property Association Polyline coordinates describing hotspot on the image contract Property contract Property contract contract Property Property Association Polyline coordinates describing hotspot on the image vendor Property vendor Property vendor vendor Property Property Association Polyline coordinates describing hotspot on the image description Property description Property description description Property Property Association Polyline coordinates describing hotspot on the image 1725Letter Property 1725Letter Property 1725Letter 1725Letter Property Property Association Polyline coordinates describing hotspot on the image endOfLetter Property endOfLetter Property endOfLetter endOfLetter Property Property Association Polyline coordinates describing hotspot on the image beginningOfLetter Property beginningOfLetter Property beginningOfLetter beginningOfLetter Property Property Association Polyline coordinates describing hotspot on the image letter Property letter Property letter letter Property Property Association Polyline coordinates describing hotspot on the image forStatus Property forStatus Property forStatus forStatus Property Property Association Polyline coordinates describing hotspot on the image status Property status Property status status Property Property Association Polyline coordinates describing hotspot on the image masterClaim Property masterClaim Property masterClaim masterClaim Property Property Association Polyline coordinates describing hotspot on the image additionalDescription Property additionalDescription Property additionalDescription additionalDescription Property Property Association Polyline coordinates describing hotspot on the image disposition Property disposition Property disposition disposition Property Property Association Polyline coordinates describing hotspot on the image 1725Description Property 1725Description Property 1725Description 1725Description Property Property Association Polyline coordinates describing hotspot on the image description Property description Property description description Property Property Association Polyline coordinates describing hotspot on the image primaryServiceFacility Property primaryServiceFacility Property primaryServiceFacility primaryServiceFacility Property Property Association Polyline coordinates describing hotspot on the image feeProgram Property feeProgram Property feeProgram feeProgram Property Property Association Polyline coordinates describing hotspot on the image dataAudit Property dataAudit Property dataAudit dataAudit Property Property Association Polyline coordinates describing hotspot on the image description Property description Property description description Property Property Association Polyline coordinates describing hotspot on the image reasonForDisapproval Property reasonForDisapproval Property reasonForDisapproval reasonForDisapproval Property Property Association Polyline coordinates describing hotspot on the image covaDispositionRemarks Property covaDispositionRemarks Property covaDispositionRemarks covaDispositionRemarks Property Property Association Polyline coordinates describing hotspot on the image appealDispositionRemarks Property appealDispositionRemarks Property appealDispositionRemarks appealDispositionRemarks Property Property Association Polyline coordinates describing hotspot on the image dispositionRemarks Property dispositionRemarks Property dispositionRemarks dispositionRemarks Property Property Association Polyline coordinates describing hotspot on the image extensions Property extensions Property extensions extensions Property Property Association Polyline coordinates describing hotspot on the image authority Property authority Property authority authority Property Property Association Polyline coordinates describing hotspot on the image veteran Property veteran Property veteran veteran Property Property Association Polyline coordinates describing hotspot on the image feeProgram Property feeProgram Property feeProgram feeProgram Property Property Association Polyline coordinates describing hotspot on the image authorizedServices Property authorizedServices Property authorizedServices authorizedServices Property Property Association Polyline coordinates describing hotspot on the image userWhoCancelled Property userWhoCancelled Property userWhoCancelled userWhoCancelled Property Property Association Polyline coordinates describing hotspot on the image revenueCode Property revenueCode Property revenueCode revenueCode Property Property Association Polyline coordinates describing hotspot on the image procedure Property procedure Property procedure procedure Property Property Association Polyline coordinates describing hotspot on the image reasonCode Property reasonCode Property reasonCode reasonCode Property Property Association Polyline coordinates describing hotspot on the image hcfaTypeOfService Property hcfaTypeOfService Property hcfaTypeOfService hcfaTypeOfService Property Property Association Polyline coordinates describing hotspot on the image placeOfService Property placeOfService Property placeOfService placeOfService Property Property Association Polyline coordinates describing hotspot on the image description Property description Property description description Property Property Association Polyline coordinates describing hotspot on the image vaTypeOfService Property vaTypeOfService Property vaTypeOfService vaTypeOfService Property Property Association Polyline coordinates describing hotspot on the image primaryDiagnosis Property primaryDiagnosis Property primaryDiagnosis primaryDiagnosis Property Property Association Polyline coordinates describing hotspot on the image oldBatchNumber Property oldBatchNumber Property oldBatchNumber oldBatchNumber Property Property Association Polyline coordinates describing hotspot on the image suspensionDescription Property suspensionDescription Property suspensionDescription suspensionDescription Property Property Association Polyline coordinates describing hotspot on the image description Property description Property description description Property Property Association Polyline coordinates describing hotspot on the image description Property description Property description description Property Property Association Polyline coordinates describing hotspot on the image descriptionEffectiveDate Property descriptionEffectiveDate Property descriptionEffectiveDate descriptionEffectiveDate Property Property Association Polyline coordinates describing hotspot on the image statusEffectiveDate Property statusEffectiveDate Property statusEffectiveDate statusEffectiveDate Property Property Association Polyline coordinates describing hotspot on the image statusEffectiveDate Property statusEffectiveDate Property statusEffectiveDate statusEffectiveDate Property Property Association Polyline coordinates describing hotspot on the image descriptionEffectiveDate Property descriptionEffectiveDate Property descriptionEffectiveDate descriptionEffectiveDate Property Property Association Polyline coordinates describing hotspot on the image associatedSuspendCode Property associatedSuspendCode Property associatedSuspendCode associatedSuspendCode Property Property Association Polyline coordinates describing hotspot on the image statusEffectiveDate Property statusEffectiveDate Property statusEffectiveDate statusEffectiveDate Property Property Association Polyline coordinates describing hotspot on the image descriptionEffectiveDate Property descriptionEffectiveDate Property descriptionEffectiveDate descriptionEffectiveDate Property Property Association Polyline coordinates describing hotspot on the image description Property description Property description description Property Property Association Polyline coordinates describing hotspot on the image batchNumber Property batchNumber Property batchNumber batchNumber Property Property Association Polyline coordinates describing hotspot on the image remittanceRemark Property remittanceRemark Property remittanceRemark remittanceRemark Property Property Association Polyline coordinates describing hotspot on the image adjustmentGroup Property adjustmentGroup Property adjustmentGroup adjustmentGroup Property Property Association Polyline coordinates describing hotspot on the image adjustmentReason Property adjustmentReason Property adjustmentReason adjustmentReason Property Property Association Polyline coordinates describing hotspot on the image adjustment Property adjustment Property adjustment adjustment Property Property Association Polyline coordinates describing hotspot on the image cptModifier Property cptModifier Property cptModifier cptModifier Property Property Association Polyline coordinates describing hotspot on the image descriptionOfSuspension Property descriptionOfSuspension Property descriptionOfSuspension descriptionOfSuspension Property Property Association Polyline coordinates describing hotspot on the image rejectCode Property rejectCode Property rejectCode rejectCode Property Property Association Polyline coordinates describing hotspot on the image vendor Property vendor Property vendor vendor Property Property Association Polyline coordinates describing hotspot on the image description Property description Property description description Property Property Association Polyline coordinates describing hotspot on the image suspendCode Property suspendCode Property suspendCode suspendCode Property Property Association Polyline coordinates describing hotspot on the image ipacAgreement Property ipacAgreement Property ipacAgreement ipacAgreement Property Property Association Polyline coordinates describing hotspot on the image serviceProvided Property serviceProvided Property serviceProvided serviceProvided Property Property Association Polyline coordinates describing hotspot on the image dateTimeOfLastNpiChange Property dateTimeOfLastNpiChange Property dateTimeOfLastNpiChange dateTimeOfLastNpiChange Property Property Association Polyline coordinates describing hotspot on the image socioeconomicGroupFpds Property socioeconomicGroupFpds Property socioeconomicGroupFpds socioeconomicGroupFpds Property Property Association Polyline coordinates describing hotspot on the image partCode Property partCode Property partCode partCode Property Property Association Polyline coordinates describing hotspot on the image state Property state Property state state Property Property Association Polyline coordinates describing hotspot on the image specialtyCode Property specialtyCode Property specialtyCode specialtyCode Property Property Association Polyline coordinates describing hotspot on the image serviceProvided Property serviceProvided Property serviceProvided serviceProvided Property Property Association Polyline coordinates describing hotspot on the image initialTreatmentDate Property initialTreatmentDate Property initialTreatmentDate initialTreatmentDate Property Property Association Polyline coordinates describing hotspot on the image applicableVendors Property applicableVendors Property applicableVendors applicableVendors Property Property Association Polyline coordinates describing hotspot on the image feeProgramAssociatedWith Property feeProgramAssociatedWith Property feeProgramAssociatedWith feeProgramAssociatedWith Property Property Association Polyline coordinates describing hotspot on the image definition Property definition Property definition definition Property Property Association Polyline coordinates describing hotspot on the image dataAudit Property dataAudit Property dataAudit dataAudit Property Property Association Polyline coordinates describing hotspot on the image justification Property justification Property justification justification Property Property Association Polyline coordinates describing hotspot on the image archEligibility Property archEligibility Property archEligibility archEligibility Property Property Association Polyline coordinates describing hotspot on the image reportOfContact Property reportOfContact Property reportOfContact reportOfContact Property Property Association Polyline coordinates describing hotspot on the image clerk Property clerk Property clerk clerk Property Property Association Polyline coordinates describing hotspot on the image narrative Property narrative Property narrative narrative Property Property Association Polyline coordinates describing hotspot on the image authorization Property authorization Property authorization authorization Property Property Association Polyline coordinates describing hotspot on the image contract Property contract Property contract contract Property Property Association Polyline coordinates describing hotspot on the image referringProvider Property referringProvider Property referringProvider referringProvider Property Property Association Polyline coordinates describing hotspot on the image primaryServiceArea Property primaryServiceArea Property primaryServiceArea primaryServiceArea Property Property Association Polyline coordinates describing hotspot on the image reportingStation Property reportingStation Property reportingStation reportingStation Property Property Association Polyline coordinates describing hotspot on the image clerk Property clerk Property clerk clerk Property Property Association Polyline coordinates describing hotspot on the image creator Property creator Property creator creator Property Property Association Polyline coordinates describing hotspot on the image patient Property patient Property patient patient Property Property Association Polyline coordinates describing hotspot on the image icdDiagnosis Property icdDiagnosis Property icdDiagnosis icdDiagnosis Property Property Association Polyline coordinates describing hotspot on the image icd9CodesNotToUseWith Property icd9CodesNotToUseWith Property icd9CodesNotToUseWith icd9CodesNotToUseWith Property Property Association Polyline coordinates describing hotspot on the image icd9CodesRequiredWith Property icd9CodesRequiredWith Property icd9CodesRequiredWith icd9CodesRequiredWith Property Property Association Polyline coordinates describing hotspot on the image codeNotCcWith Property codeNotCcWith Property codeNotCcWith codeNotCcWith Property Property Association Polyline coordinates describing hotspot on the image purposeOfVisitCode Property purposeOfVisitCode Property purposeOfVisitCode purposeOfVisitCode Property Property Association Polyline coordinates describing hotspot on the image authorizationRemarks Property authorizationRemarks Property authorizationRemarks authorizationRemarks Property Property Association Polyline coordinates describing hotspot on the image associated7078583FeeBasisUnauthorizedClaims Property associated7078583FeeBasisUnauthorizedClaims Property associated7078583FeeBasisUnauthorizedClaims associated7078583FeeBasisUnauthorizedClaims Property Property Association Polyline coordinates describing hotspot on the image associated7078583VAForm107078 Property associated7078583VAForm107078 Property associated7078583VAForm107078 associated7078583VAForm107078 Property Property Association Polyline coordinates describing hotspot on the image vendor Property vendor Property vendor vendor Property Property Association Polyline coordinates describing hotspot on the image vendor Property vendor Property vendor vendor Property Property Association Polyline coordinates describing hotspot on the image feeProgram Property feeProgram Property feeProgram feeProgram Property Property Association Polyline coordinates describing hotspot on the image name Property name Property name name Property Property Association Polyline coordinates describing hotspot on the image collateralSponsorsName Property collateralSponsorsName Property collateralSponsorsName collateralSponsorsName Property Property Association Polyline coordinates describing hotspot on the image endingDate beginningDate dateCompiled seventyFifthPercentile totalOccurances fiscalYear FiscalYear cptCodeModifier FeeBasisFeeSchedule newValue oldValue field# iens file# dateTimeChanged invoiceNumber FeeBasisFPPSAudit messageText MessageText rejectText RejectText rejectStatus ackDateTime ackFlag stationNumber transactionType messageDateTime messageId status invoiceFileNumber invoiceNumber FFPSQueuedInvoices percentagePaid modifier Modifier conversionFactor calendarYear CalendarYear162_991 nonpayable baseUnits malpracticeExpenseRvu facilityPracticeExpenseRvu nonFacPracticeExpenseRvu workRelativeValueUnit modifierLevel calendarYear CalendarYear162_971 malpracticeGpci practiceExpenseGpci workGpci calendarYear CalendarYear162_961 description modifierRateLevel FeeBasisModifierTableIndex cptCategory FeeBasisHCFAConversion cptCodeModifier FeeBasisCptRVU zipCode FeeBasisGeographicIndex postscript Postscript description Description162_931 active reason number FeeBasisUnauthorizedRequestedInformation requestedBy receivedBy dateInformationReceived comments dateInformationRequested FeeBasisUnauthorizedClaimsPendingInfo inactiveDate inactiveFlag drgGrouperEffectiveDate descriptionVersioned operationProcVersioned effectiveDate acsName anesthesiaRug screenOrType numberOfBloodUnits requestedBloodKind operationLength majorORProc activationDate description useOnlyWithSex icdExpanded majorDiagnosticCategory mdc24 operationProcedure identifier codeNumber ICDOperationProcedure reference drgGrouperEffeciveDate descriptionVersioned effectiveDate breakevenFiscalYearQuarter fiscalYearWeights&trims inactivationDate inactive activationDate localBreakeven localHighTrimDays localLowTrimDays avgLengthOfStayDays weightIntaffil weightNonaffil highTrimDays lowTrimDays weight description surgery name number DRG code name number FeeBasisDispositionCode renderingProvTaxonomyCode renderingProvNpi renderingProvName lineItemNumber LineItemRenderingProv adjustmentAmount adjustmentGroup adjustmentReason Adjustment162_558 descriptionOfSuspension DescriptionOfSuspension162_518 rejectCode RejectCode162_515 ipacVendorAgreement dodInvoiceNumber uniqueClaimIdentifier servicingFacilityZip servicingFacilityState servicingFacilityCity servicingFacilityAddress referringProvNpi referringProvName servicingProvNpi servicingProvName renderingProvTaxonomyCode renderingProvNpi renderingProvName operatingProvNpi operatingProvName attendingProvTaxonomyCode attendingProvNpi attendingProvName financialInstitution accountNumber routingNumber contract remittanceRemark fppsLineItem fppsClaimId patientControlNumber coveredDays interestAmount disbursedAmount cancellationActivity reasonCode cancellationDate checkNumber promptPayType vendorInvoiceDate datePaid proc25 proc24 proc23 proc22 proc21 proc20 proc19 proc18 proc17 proc16 proc15 proc14 proc13 proc12 proc11 proc10 proc9 proc8 proc7 proc6 proc5 proc4 proc3 proc2 admittingDiagnosis poa25 icd25 poa24 icd24 poa23 icd23 poa22 icd22 poa21 icd21 poa20 icd20 poa19 icd19 poa18 icd18 poa17 icd17 poa16 icd16 poa15 icd15 poa14 icd14 poa13 icd13 poa12 icd12 poa11 icd11 poa10 icd10 poa9 icd9 poa8 icd8 poa7 icd7 poa6 icd6 poa5 icd5 poa4 icd4 poa3 icd3 poa2 icd2 icd1 nvhPricerAmount resubmission drgWeight primaryServiceFacility patientTypeCode purposeOfVisit batchNumber dateFinalized supervisorWhoVoided reasonForVoidedPayment voidPayment interfaceReject oldBatchNumber rejectReason rejectStatus paymentTypeCode feeProgram suspendCode amountSuspended amountPaid amountClaimed paymentByMedicareFedAgency billedCharges treatmentToDate treatmentFromDate veteran vendor invoiceDateReceived number FeeBasisInvoice associatedAuthorization nursingHome dischargeType transferType admissionType activeAdmission activityType dateTime number FeeCnhActivity applicationPackagesUse unitDoseSchedule unitDoseScheduleType unitDoseMedRoute dayNdOrDoseNlLimit visnNonFormulary localNonFormulary currentInventory actionProfileMessageOp ndc nationalFormularyIndicator opExternalDispense cmopId vaDrugClassCode packageType packageSize psndfVaProductNameEntry vaProductName invOrderUnits pricePerDispenseUnit dispenseUnitsPerOrderUnit dispenseUnit normalAmountToOrder pricePerOrderUnit reorderLevel genderSpecificLblsOnAllRx newWarningLabelList warningLabel fsn standardSig maximumDosePerDay deaSpecialHdlg vaClassification ahfsNumber genericName number inpatientPharmacyLocation quantityDispenseMessage activityLog cmopDispense atcMnemonic restriction message inactiveDate ncpdpQuantityMultiplier ncpdpDispenseUnit dawCode strength serviceCode arWsAmisConversionNumber arWsAmisCategory Drug adjustmentAmount adjustmentGroup adjustmentReason Adjustment162_14 suspensionDescription SuspensionDescription162_12 rejectCode RejectCode162_111 dodInvoiceNumber fppsLineItem interestAmount disbursedAmount cancellationActivity reasonCode cancellationDate checkNumber promptPayType datePaid authorizationPointer associated7078583 primaryServiceFacility supervisor reasonForVoidedPayment voidPayment pharmacyRemarks genericDrugOnlyStatus interfaceReject rejectReason rejectStatus paymentTypeCode dateCertifiedForPayment obligationNumber dateOfDetermination pharmacist pharmacyDetermination substituteGenericDrug lineItemStatus suspendCode amountPaid amountSuspended redBookCost patient amountClaimed datePrescriptionFilled quantity strength manufacturer drugName prescriptionNumber PrescriptionNumber ipacVendorAgreement fppsClaimId vendorInvoiceDate paidToDate genericDrugNameStatus totalLineCount totalAmountPaid totalAmountClaimed invoiceStatus chainStore vendor dataEntryClerk dateInvoiceEntered dateCorrectInvoiceRecvd number FeeBasisPharmacyInvoice rejectCode RejectCode162_041 interestAmount disbursedAmount cancellationActivity reasonCode cancellationDate checkNumber datePaid dateFinalized interfaceReject oldBatchNumber rejectReason rejectStatus paymentTypeCode travelObligationNumber travelAmount travelBatchNumber travelPaymentDate TravelPaymentDate travelDataPurged pharmacyDataPurged optMedicalDataPurged purgeDate DateOfPurge vendor FeeBasisPayment description Description161_991 code FeeBasisPaymentRejectCode dateTransmitted status action ipacVendorAgreementId sequenceNumber IPACVendorAgreementMRA description Description161_942 shortDescription code PresentOnAdmission npi p&cContactPhoneExtension p&cContactPhoneNumber p&cContactName mammographyCertificationNumber stateLicenseNumber x12TypeOfFacility streetAddressLine2 facilityDefaultIdNumber zipCode city streetAddress specialty credentials providerType name IBNonOtherVABillingProvider taxonomyAdded npiAdded providerType liNumber processDate fbInternalControlNumber program FeeBasisPaidToIB reasonForChange cardNumber dateTimeCardNumberChanged DateTimeCardNumberChanged FeeBasisIDCardAudit descriptionOfSuspension DescriptionOfSuspension162_215 narrative Narrative161_5171 user dateTimeOfContact DateTimeOfContact modeOfTransportation number BeneficiaryTravelModeOfTransportation requestStatus referringProvider associated7078 suspenseCode userEnteringMedicalDeterm dateOfMedicalDetermination medicalEntitlement userEnteringLegalDeterm dateOfLegalDetermination legalEntitlement userEnteringNotification attenPhysicianPhoneNumber attendingPhysician admittingDiagnosis authorizedFromDateTime dateTimeOfAdmission veteran personWhoCalled vendor dateTime FeeNotificationRequest dateTimeOfAdmission approvingOfficial veteranHaveOtherInsurance insuranceType tentativeDiagnosis attendPhysicianTelephoneNo attendingPhysician zipCodeOfContact cityOfContact streetAddress2OfContact streetAddress1OfContact phoneNumOfPersonContacted personContacted typeOfContact authorizationFromDate initialDateOfContact veteran vendor FeeChReportOfContact newIens oldIens fileNum FeeBasisPaymentMoves 7078DefaultAuthServiceText 7078DefaultAuthServiceText lastIpacNumber allowFbPaidToIb uniqueClaimIdentifierSeq projectArchReminderDelay fppsTransmitEnd fppsTransmitStart ucLetterLinesAfterCc stationNameEditable printUCOnLetterhead numberOfCopies unauthorizedClaimLetter unauthorizedClaimPrinter initialEntryStatusForUC trackIncompleteUnauthClaim transmissionHeader outpatientMonthlyLimitation dateBatchPurgeLastRun copiesOf7078ToBePrinted title7078ApprovingOfficial approvingOfficialFor7078 editAuthDuringPayment maxNumCnhPaymentLines maxNumChPaymentLines maxNumPaymentLineItems stationAddressLine3 askVendorDuringAuth defaultAuthTimeRange pharmacyPaymntVendorDisplay medicalPaymentVendorDisplay nextInvoiceNumber nextBatchNumber medicaidDispensingFee titleOfApprovingOfficial approvingOfficialFor7079 stationTelephoneNumber mailCode zip city stationAddressLine2 stationAddressLine1 stationOfJurisdictionName number FeeBasisSiteParameters shortTermMra authFromDateChanged dateTransmitted type pointerToAuthorizationNode status FeeBasisPatientMRA linkedVendor dateTransmitted feeOnlyIndicator nonPharmacyTypeOfCorr pharmacyTypeAction FeeBasisVendorCorrection contract perDiemRate patient toDate fromDate FeeBasisCnhAuthorizationRate dollarAmount number FeeBasisCnhRate expirationDate effectiveDate number FeeBasisCnhContract description Description162_921 endOfLetter EndOfLetter beginningOfLetter BeginningOfLetter typeOfLetter name FeeBasisLetter daysPrior1725Expiration statusOrder daysPriorExpiration active status number FeeBasisUnathorizedClaimsStatus additionalDescription AdditionalDescription 1725Description 1725Description description Description162_911 code active disposition number FeeBasisUnauthorizedClaimsDispositions changedBy newValue oldValue field changedDateTime DataAudit162_793 description Description162_941 active name number FeeBasisUnauthorizedDisapprovalReasons covaDispositionRemarks CovaDispositionRemarks appealDispositionRemarks AppealDispositionRemarks dispositionRemarks DispositionRemarks comments extensionDate enteredBy extensionEnteredDateTime Extensions edrCode nursingHome active cfr# *regulation# name number VAAdmittingRegulation authorizedServices AuthorizedServices manuallyEdited rxProcedure *ub92FormLocator49 component item type nonCoveredCharge auto total unitsOfService charges number RevenueCode399_042 inactivationFlag reasonCode cancellationReason FeeBasisCheckCancellationReason abbreviation name code TypeOfService abbreviation name code PlaceOfService description Description163_851 vaCode name FeeBasisVATypeOfService suspensionDescription SuspensionDescription161_914 description Description161_9221 description Description161_9121 feeUse status statusEffectiveDate StatusEffectiveDate161_911 descriptionEffectiveDate DescriptionEffectiveDate161_912 shortDescription descriptionEffectiveDate DescriptionEffectiveDate161_922 feeUse status statusEffectiveDate StatusEffectiveDate161_921 description Description161_9321 feeUse status statusEffectiveDate StatusEffectiveDate161_931 descriptionEffectiveDate DescriptionEffectiveDate161_932 transmittedBatchWasRejected statusSetToRetransmitDate statusSetToRetransmitBy voucherMsgAckStatus voucherMsgDate finalizedWithVista statisticalBatch batchExempt contractHospitalBatch stationNumber rejectsPending personWhoCompleted dateFinalized dateTransmitted status paymentLineCount invoiceCount totalDollars supervisorWhoCertified dateSupervisorClosed dateClerkClosed clerkWhoOpened dateOpened type obligationNumber number FeeBasisBatch code RemittanceRemark code AdjustmentGroup code AdjustmentReason adjustmentAmount Adjustment162_07 activeDate inactiveDate inactiveFlag source code name modifier CPTModifier descriptionOfSuspension DescriptionOfSuspension162_05 rejectCode RejectCode162_031 description Description161_28 shortDescription code FeeBasisSuspension miscellaneousInfo2 miscellaneousInfo1 descOfGoods&Services completeLineOfAccounting stationContactEmail stationContactPhone stationContactName obligatingDocumentNo agencyFieldStationNumber senderTas receiverTas customerAlc sharingAgreementNo description status fiscalYear id IPACVendorAgreementFile description sex ageHigh ageLow activeDate inactiveDate source inactiveFlag shortName cptCode CPT personAffectingLastChange npi status dateTimeOfLastNpiChange DateTimeOfLastNPIChange applicableBusType display shortDesc effectiveDate codeIndex name number CodeIndex codeReportedToAustin name number FeeBasisParticipationCode capital county usStateOrPossession aacRecognized vaStateCode abbreviation name number State specialtyCode name FeeBasisSpecialtyCode uniqueClaimIdentifier servicingFacilityZip servicingFacilityState servicingFacilityCity servicingFacilityAddress liRenderingProvTaxonomy liRenderingProvNpi liRenderingProvName referringProvNpi referringProvName servicingProvNpi servicingProvName renderingProvTaxonomyCode renderingProvNpi renderingProvName operatingProvNpi operatingProvName attendingProvTaxonomyCode attendingProvNpi attendingProvName financialInstitution accountNumber routingNumber contract fppsLineItem fppsClaimId patientAccountNumber unitsPaid feeSchedule feeScheduleAmount anesthesiaTimeMinutes siteOfServiceZipCode interestAmount disbursedAmount cancellationActivity cancellationDate checkNumber promptPayType vendorInvoiceDate serviceConnectedCondition associated7078583 primaryServiceFacility supervisor reasonForVoidedPayment voidPayment feeProgram interfaceReject rejectReason rejectStatus paymentTypeCode treatmentTypeCode purposeOfVisit patientTypeCode invoiceNumber dateCorrectInvoiceReceived datePaid obligationNumber clerk dateFinalized dateSuspended amountSuspended amountPaid amountClaimed dodInvoiceNumber ServiceProvided authorizationPointer initialTreatmentDate InitialTreatmentDate definition Definition161_821 changedBy newValue oldValue field changedDateTime DataAudit161_193 active projectArchJustification FeeBasisProjectArchJustification narrative Narrative161_04 inputDate typeOfContact dx vendorProviderTelephoneNo vendorProvider dateOfContact ReportOfContact verificationOfMileage archEligibilityDetermination archEligibility archEligibilityDate ArchEligibility status contractNumber FeeBasisContract identifier history currentLocation billingFacilityName inactiveFacilityFlag officialVaName stationNumber pointerToAgency agencyCode domain facilityDeaNumber acosHospitalId taxonomyCode effectiveDateTime npi associations status multiDivisionFacility zipMailing stateMailing cityMailing stAddr2Mailing stAddr1Mailing contact zip city streetAddr2 streetAddr1 region vaTypeCode shortName district state name Institution room initial dateEntered terminationDate sex nickName mailCode name entryLastEditDate emailAddress dob vpid ssn vaNumber supplyEmployee terminationReason alias NewPerson versionedCc inactiveDate unacceptableAsPrincipalDx inactiveFlag mdcEffectiveDate drgGrouperEffectiveDate complicationComorbidity descriptionVersioned diagnosisVersioned effectiveDate activationDate ageHigh ageLow description sex icdExpanded mdc25 mdc24 mdc13 diagnosis identifier codeNumber ICDDiagnosis ltcCopayType inactivationDate austinCode name FeeBasisPurposeOfVisit authorizationRemarks AuthorizationRemarks dateCovaAppealDispositioned dateAppealedToCova dateAppealDispositioned dateSubstantiveAppealRecv'd statementOfTheCaseIssued noticeOfDisagreementRecv'd fppsClaimId 38USC1725 authorization dischargeType dateEnteredLastEdited enteredLastEditedBy expirationDateOfClaim dateOfCurrentStatus claimSubmittedByFeeBasisVendor claimSubmittedByNewPerson claimSubmittedByPatient dateOfOriginalDisposition reopenClaimDate dateReqInfoSent dateLetterSent printLetter amountApproved authorizedToDate authorizedFromDate dateOfDisposition patientTypeCode amountClaimed dateValidClaimReceived icdDiagnosis diagnosis treatmentToDate treatmentFromDate veteran vendor dateClaimReceived FeeBasisUnauthorizedClaims referringProviderNpi referringProvider reasonForPendingDisposition dateOfIssue status userEntering estimatedAmount dateOfDischarge authorizationToDate dateOfAdmission authorizationFromDate vendor dateCancelled referenceNumber VAForm107078 taxonomyCode npi taxIdSsnFlag providerCode fmsVendorType 1099Vendor pricerExempt austinNameField businessTypeFpds faxNumber medicareIdNumber dateOfLastAssessment certifiedMedicareMedicaid inspectedAccredited phoneNumber stationAffectingLastChange dateOfAustinDelete dateLastUpdateFromAustin dateLastCorrectionToAustin austinDeleted chain typeOfVendor county mailRouteCode zipCode city streetAddress2 streetAddress idNumber numberOfCnhBeds name FeeBasisVendor Vendor active centralFeeSystemIdentifier name FeeBasisProgram dateDeleteMraTransmitted austinDeleteFlag datePrinted typeOfCare printAuthorizationYN potentialCostRecoveryCase accidentRelatedYN treatmentTypeCode dxLine3 dxLine2 dxLine1 patientTypeCode dischargeType toDate fromDate Authorization temporaryAddressActive networkIdentifier veteranY_N fugitiveFelonFlag dateCommentLastEdited multipleBirthIndicator type preferredFacility ethnicityInformation raceInformation alias testPatientIndicator serviceConnected mothersMaidenNameComponents mothersMaidenName mothersNameComponents mothersName fathersNameComponents fathersName confidentialAddressActive remarks maritalStatus dateOfBirth sex nameComponents name Patient reasonForCardNumberChange feeIdCardExpirationDate feeIdCardIssueDate feeIdCardNumber FeeBasisPatient

Diagrams

Properties:

Alias
informationDomain
Keywords
modeler
NameFeeBasis
Name Expression
NamespaceHybrid
Nesting PackageHybrid
Owned Template Signature
OwnerHybrid
Owning Template Parameter
projectID
Qualified NameHybrid::FeeBasis
StereotypeModelDictionary
Template Parameter
VisibilityPublic