Files > IB COPAY CAPS

name

IB COPAY CAPS

number

354.75

location

^IBAM(354.75,

description

DO NOT delete entries in this file. DO NOT edit data in this file with VA File Manager. This file comes populated with data. The data in this file should not be edited, added, or deleted locally. The information stored here is the cap amounts for outpatient medication copayment. Once a patient has reached his cap, billing will stop for the remainder of the period indicated. Per VHA Directive 10-93-142, this file definition should not be modified.

Fields

#	Name	Location	Type	Details	Index	Description
.01	effective date(+)	0;1	DATE-TIME		B	This is the effective date of this cap entry. Based upon the date of the transaction, this will be used to determine if a billing transaction is above the cap or not.
.02	priority level	0;2	NUMERIC			This is the priority level of the cap. This will be used based upon the patient's priority level to determine what their cap amount is.
.03	monthly cap amount	0;3	NUMERIC			This is the monthly cap amount that will be used to determine if the bill is above the cap or not. This is a total monthly amount that can be billed to a patient for pharmacy copay.
.04	yearly cap amount	0;4	NUMERIC			This is the yearly cap amount that will be used to determine if the bill is above the cap or not based on the year basis specified. This is the total yearly amount that can be billed to a patient for pharmacy copay.
.05	termination date	0;5	DATE-TIME			This is the termination date of this cap amount. This is optional.
.06	year basis	0;6	SET OF CODES	C:CALENDAR YEAR F:FISCAL YEAR		This is the year basis for this cap amount. This will be used to determine the timeframe to calculate the amounts billed to a patient.