Files > INSURANCE TYPE

parent
2
name
INSURANCE TYPE
number
2.312
Fields
#NameLocationTypeDetailsIndexDescription
.01insurance type0;1POINTER36BChoose from the available listing the name(s) of the insurance company(ies) under which this applicant is covered.
.18group plan0;18POINTER355.3Select 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.
.2coordination of benefits0;20SET OF CODES1:PRIMARY
2:SECONDARY
3:TERTIARY
1*subscriber id0;2FREE TEXTEnter the Subscriber's Primary ID number. This number is assigned by the payer and can be found on the subscriber's insurance card. This field is scheduled for deletion in May 2015.
1.01date entered1;1DATE-TIMEThis 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.
1.02entered by1;2POINTER200This 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.
1.03date last verified1;3DATE-TIMEInsurance 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.
1.04verified by1;4POINTER200This 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.
1.05date last edited1;5DATE-TIMEThis is the date this policy was last edited. This field is updated by the computer whenever anyone edits this patient's policy information.
1.06last edited by1;6POINTER200This is the user that last edited the policy. This field is updated by the computer whenever anyone edits this patients policy information.
1.08comment - patient policy1;8FREE TEXTThis 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.
1.09source of information1;9POINTER355.12Enter the last source of this information. If the insurance information was obtained by patient interview, then 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.
1.1date of source of information1;10DATE-TIME
2*group number0;3FREE TEXTEnter 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.
2.01send bill to employer2;1BOOLEAN1:YES
0:NO
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.
2.015subscriber's employer name2;9FREE TEXTThis is the name of the employer that will appear on the UB-04 if the bills should be sent to the employer for pre-processing.
2.02employer claims street address2;2FREE TEXTThis 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.
2.03employ claim st address line 22;3FREE TEXTThis 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.
2.04employ claim st address line 32;4FREE TEXTThis 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.
2.05employer claims city2;5FREE TEXTIf 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.
2.06employer claims state2;6POINTER5If 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.
2.07employer claims zip code2;7FREE TEXTEnter 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).
2.08employer claims phone2;8FREE TEXTEnter the phone number of the employer. This should be the phone number of the person to contact regarding insurance claims.
2.1esghp2;10BOOLEAN1:YES
0:NO
Enter 'Yes' if this policy is part of a plan that is sponsored or provided by the insured's current or past employer.
2.11employment status2;11SET OF CODES1:FULL TIME
2:PART TIME
3:NOT EMPLOYED
4:SELF EMPLOYED
5:RETIRED
6:ACTIVE MILITARY
9:UNKNOWN
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.
2.12retirement date2;12DATE-TIMEIf this is an Employer Sponsored Group Health Plan then this should be the date the insured retired from the employer that sponsors the plan.
3insurance expiration date0;4DATE-TIMEIf this insurance policy under which this applicant is covered expires on a specified date enter that date, otherwise, leave this field blank.
3.01insured's dob3;1DATE-TIMEThe field is used to store the date of birth of the insured person. The field value may be printed in block 11a of the CMS-1500 claim form. This is a required field for billing ChampUS patients.
3.02insured's branch3;2POINTER23This 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 CMS-1500 claim form.
3.03insured's rank3;3FREE TEXTThis 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 CMS-1500 claim form.
3.04policy not billable3;4BOOLEAN0:NO
1:YES
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.
3.05insured's ssn3;5FREE TEXTThis 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.
3.06insured's street 13;6FREE TEXTThis field contains the first street address of the policyholder.
3.07insured's street 23;7FREE TEXTThis field contains the second line of the street address of the policyholder.
3.08insured's city3;8FREE TEXTThis field contains the city of the policyholder.
3.09insured's state3;9POINTER5This field contains the state of the policyholder.
3.1insured's zip3;10FREE TEXTThis field contains the zip code of the policyholder.
3.11insured's phone3;11FREE TEXTThis field contains the phone number of the policyholder.
3.12insured's sex3;12SET OF CODESF:FEMALE
M:MALE
This field is used in insurance billing to help verify the policy coverage when the bill is submitted to the carrier. If the patient is the policy holder, this value should match the patient's sex. If the patient's spouse or other relative is the policy holder, the appropriate value should be determined and entered.
3.13insured's country3;13FREE TEXTThis field contains the country code of the policyholder.
3.14insured's country subdivision3;14FREE TEXTThis field contains the country subdivision code of the policyholder.
4.01primary care provider4;1FREE TEXTThis is the patient's Primary Care Provider within their managed care network that may refer the patient to the VA.
4.02primary provider phone4;2FREE TEXTThis is the phone number of the Primary Care Provider that may refer the patient to the VA.
4.03pt. relationship - hipaa(+)4;3SET OF CODES01:SPOUSE
18:SELF
19:CHILD
20:EMPLOYEE
29:SIGNIFICANT OTHER
32:MOTHER
33:FATHER
39:ORGAN DONOR
41:INJURED PLAINTIFF
53:LIFE PARTNER
G8:OTHER RELATIONSHIP
Enter the code which best describes the patient's relationship to the person who holds this policy (or insured).
4.04eiv auto-update4;4BOOLEAN0:NO
1:YES
Flag that determines how the last update to INSURANCE TYPE sub-file was done. Value of "YES" means that data was last updated via eIV auto-update, value of "NO" means that data was last updated via other means.
4.05pharmacy relationship code4;5POINTER9002313.19This is the relationship of the patient to the cardholder. Code Description ---- ----------- 0 Not Specified 1 Cardholder - The individual that is enrolled in and receives benefits from a health plan 2 Spouse - Patient is the husband/wife/partner of the cardholder 3 Child - Patient is a child of the cardholder 4 Other - Relationship to cardholder is not precise
4.06pharmacy person code4;6FREE TEXTThis is the code that is assigned by the payer to identify the patient. The payer may use a unique person code to identify each specific person on the pharmacy insurance policy. This code may also describe the patient's relationship to the cardholder. Enrollment Standard Examples: 001 = Cardholder 002 = Spouse 003 - 999 = Dependents and Others (including second spouses, etc.)
5.01patient id5;1FREE TEXTThis is the patient's primary ID number for this insurance company. Enter this field when the patient and the subscriber are different and the patient has been given a unique ID number. If issued by this payer, the number should be present on the patient's insurance card. This data will print in box 8a on the UB-04 for institutional claims when the patient and the subscriber are different.
5.02subscriber's sec qualifier(1)5;2SET OF CODES23:Client Number
IG:Insurance Policy Number
SY:Social Security Number
Enter the subscriber secondary ID qualifier# 1. The qualifier describes the type of ID number. Up to 3 secondary ID's and qualifiers may be entered, but you cannot use the same qualifier more than once. SY is not a valid qualifier when the payer is Medicare.
5.03subscriber's sec id(1)5;3FREE TEXTEnter the subscriber's secondary ID #1. You may enter up to 3 secondary ID's and qualifiers.
5.04subscriber's sec qualifier(2)5;4SET OF CODES23:Client Number
IG:Insurance Policy Number
SY:Social Security Number
Enter the subscriber secondary ID qualifier# 2. The qualifier describes the type of ID number. Up to 3 secondary ID's and qualifiers may be entered, but you cannot use the same qualifier more than once. SY is not a valid qualifier when the payer is Medicare.
5.05subscriber's sec id(2)5;5FREE TEXTEnter the subscriber's secondary ID #2. You may enter up to 3 secondary ID's and qualifiers.
5.06subscriber's sec qualifier(3)5;6SET OF CODES23:Client Number
IG:Insurance Policy Number
SY:Social Security Number
Enter the subscriber secondary ID qualifier# 3. The qualifier describes the type of ID number. Up to 3 secondary ID's and qualifiers may be entered, but you cannot use the same qualifier more than once. SY is not a valid qualifier when the payer is Medicare.
5.07subscriber's sec id(3)5;7FREE TEXTEnter the subscriber's secondary ID #3. You may enter up to 3 secondary ID's and qualifiers.
5.08patient's sec qualifier(1)5;8SET OF CODES23:Client Number
IG:Insurance Policy Number
SY:Social Security Number
Enter the patient secondary ID qualifier# 1. The qualifier describes the type of ID number. This should only be used when the patient and the subscriber are different. Up to 3 secondary ID's and qualifiers may be entered, but you cannot use the same qualifier more than once. SY is not a valid qualifier when the payer is Medicare.
5.09patient's secondary id(1)5;9FREE TEXTEnter the patient secondary ID #1. You may enter up to 3 secondary ID's and qualifiers. This should only be used when the patient and the subscriber are different.
5.1patient's sec qualifier(2)5;10SET OF CODES23:Client Number
IG:Insurance Policy Number
SY:Social Security Number
Enter the patient secondary ID qualifier# 2. The qualifier describes the type of ID number. This should only be used when the patient and the subscriber are different. Up to 3 secondary ID's and qualifiers may be entered, but you cannot use the same qualifier more than once. SY is not a valid qualifier when the payer is Medicare.
5.11patient's secondary id(2)5;11FREE TEXTEnter the patient secondary ID #2. You may enter up to 3 secondary ID's and qualifiers. This should only be used when the patient and the subscriber are different.
5.12patient's sec qualifier(3)5;12SET OF CODES23:Client Number
IG:Insurance Policy Number
SY:Social Security Number
Enter the patient secondary ID qualifier# 3. The qualifier describes the type of ID number. This should only be used when the patient and the subscriber are different. Up to 3 secondary ID's and qualifiers may be entered, but you cannot use the same qualifier more than once. SY is not a valid qualifier when the payer is Medicare.
5.13patient's secondary id(3)5;13FREE TEXTEnter the patient secondary ID #3. You may enter up to 3 secondary ID's and qualifiers. This should only be used when the patient and the subscriber are different.
6whose insurance(+)0;6SET OF CODESv:VETERAN
s:SPOUSE
o:OTHER
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.
7.01name of insured(+)7;1FREE TEXTEnter the name of the individual for which this insurance policy was issued. If the patient and the insurance subscriber are the same, then this field will be defaulted from the patient name field. The name must contain a comma and be entered in Last,First format.
7.02subscriber id7;2FREE TEXTEnter the Subscriber's Primary ID number. This number is assigned by the payer and can be found on the subscriber's insurance card.
8effective date of policy0;8DATE-TIMEEnter the date that this insurance policy initially went into effect (the date the patient acquired this policy).
8.01requested service date8;1DATE-TIMEThis is the Eligibility/Service Date that is received on the eIV Response message. If it is not present on the Response message then this is the Eligibility Date that was sent on the Inquiry message.
8.02requested service type8;2POINTER365.013This is the Service Type that is received on the Response message.
9group reference information9;0MULTIPLE2.3129Subscriber/Dependent additional identification data.
10group provider info10;0MULTIPLE2.332Entries in this sub-file identify the characteristics of a provider.
11health care code information11;0MULTIPLE2.31211To supply information related to the delivery of health care.
12.01military info status code12;1POINTER365.039Code to indicate the status of the military information sent by the payer.
12.02military employment status12;2POINTER365.046Code showing the general military employment status of an employee/claimant.
12.03military govt affiliation code12;3POINTER365.041Code specifying the military service affiliation.
12.04military personnel description12;4FREE TEXTThis field further identifies the exact military unit.
12.05military service rank code12;5POINTER365.042Code specifying the military service rank.
12.06date time period format qual12;6POINTER365.032Code qualifier indicating the date format, time format, or date and time format respective of the DATE TIME PERIOD field (#12.07).
12.07date time period12;7FREE TEXTExpression of a date or range of dates that indicates the date span of military service.
15*group name0;15FREE TEXTIf 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.
16pt. relationship to insured(+)0;16SET OF CODES01:PATIENT
02:SPOUSE
03:NATURAL CHILD
08:EMPLOYEE
09:DO NOT USE
11:ORGAN DONOR
15:INJURED PLANTIFF
18:DO NOT USE
32:MOTHER
33:FATHER
34:SIGNIFICANT OTHER
35:LIFE PARTNER
36:OTHER RELATIONSHIP
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.
17*name of insured(+)0;17FREE TEXTEnter the name of the individual for which this insurance policy was issued. If the patient and the insurance subscriber are the same, then this field will be defaulted from the patient name field. The name must contain a comma and be entered in Last,First format. This field is scheduled for deletion in May 2015.
20new group nameCOMPUTEDThis computed field will yield the Group Name from file# 355.3 based on the current Group Plan in field# .18.
21new group numberCOMPUTEDThis computed field will yield the Group Number from file# 355.3 based on the current Group Plan in field# .18.
60eligibility/benefit6;0MULTIPLE2.322This multiple contains all of the eligibility and benefit data for a specific insured person returned from the Payer.

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