Files > INSURANCE CLAIMS YEAR TO DATE

name
INSURANCE CLAIMS YEAR TO DATE
number
355.5
location
^IBA(355.5,
description
This file will contain the claim to date information about a patient's health insurance claims to a specific carrier for a specific year. This will allow estimate of receivables based on whether claims exceed deductibles or other maximum benefits. Per VHA Directive 10-93-142, this file definition should not be modified.
Fields
#NameLocationTypeDetailsIndexDescription
.01policy(+)0;1POINTER355.3BSelect the patient's health insurance policy against which claims may have been made.
.02patient0;2POINTER2CEnter the name of the patient who is on this policy.
.03benefit year beginning on(+)0;3DATE-TIMEThis is the first day of the year in which the health insurance policy's benefits apply. Exact date (with month and day) is required.
.04deductible met?0;4BOOLEAN0:NO
1:YES
If the dollar amount of claims against this policy is less than the the policy's annual deductible, enter "NO". If it is equal to or greater than the annual deductible, enter "YES".
.05amount of deductible met0;5NUMERICEnter the dollar amount of claims against this policy.
.06deductible (inpt) met?0;6BOOLEAN1:YES
0:NO
If the dollar amount of claims for inpatient services is less than the policy's annual deductible for inpatient services, enter "NO". If it is equal to or greater than the annual deductible for such services, enter "YES".
.07amount of deductible (inp) met0;7NUMERICEnter the dollar amount of claims against this policy for inpatient services.
.08deductible (opt) met?0;8BOOLEAN0:NO
1:YES
If the dollar amount of claims for outpatient services is less than the policy's annual deductible for outpatient services, enter "NO". If it is equal to or greater than the annual deductible for such services, enter "YES".
.09amount of deductible (opt) met0;9NUMERICEnter the dollar amount of claims against this policy for outpatient services.
.1amt lifetime max used (opt)0;10NUMERICEnter the dollar amount of claims against this policy, which can then be compared to the maximum amount available over the life of the policy.
.11mh deductible (inp) met?0;11BOOLEAN0:NO
1:YES
If the dollar amount of claims for inpatient mental health services is less than the policy's annual deductible for these services, enter "NO". If it is equal to or greater than the annual deductible for such services, enter "YES".
.12amount of mh (inp) ded met0;12NUMERICEnter the dollar amount of claims against this policy for inpatient mental health services.
.13mh deductible (opt) met?0;13BOOLEAN0:NO
1:YES
If the dollar amount of claims for outpatient mental health services is less than the policy's annual deductible for these services, enter "NO". If it is equal to or greater than the annual deductible for such services, enter "YES".
.14amount of mh (opt) ded met0;14NUMERICEnter the dollar amount of claims against this policy for outpatient mental health services.
.15pre-existing conditions0;15FREE TEXTEnter the patient's pre-existing conditions.
.16coordination of benefits data0;16FREE TEXTIf the patient is included in a policy held by a family member, e.g. spouse, enter that information here.
.17patient policy pointer0;17NUMERIC
.18amt. mh lifet. max used (inpt)0;18NUMERICEnter the dollar amount of claims against this policy for mental health services.
.19amt lifetime max used (inpt)0;19NUMERICEnter the dollar amount of inpatient claims against this policy, which can then be compared to the maxium amount available over the life of the policy.
.2amt mh lifet max used (opt)0;20NUMERICEnter the dollar amount of MH claims against this policy, which can then be compared to the maximum amount available over the life of the policy.
1.01date entered1;1DATE-TIMEThis is the date that this entry was created. It is automatically triggered by the creation of the entry.
1.02entered by1;2POINTER200This is the user who created this entry. It is automatically triggered by the creation of this entry.
1.03date last verified1;3DATE-TIMEThis is the date that the entry was verified. It is automatically triggered by the verification process.
1.04verified by1;4POINTER200This is the person who verified the entry. It is automatically triggered by the verification process.
1.05date last edited1;5DATE-TIMEThis is the date that the entry was last edited. It is automatically triggered whenever editing takes place.
1.06edited by1;6POINTER200This is the name of the person who last edited the entry. It is automatically triggered whenever editing takes place.
1.07person contacted(+)1;7FREE TEXTGive the name of the person at the insurance company with whom you verified insurance claims information.
1.08comment - claims filed1;8FREE TEXTEnter any pertinent information here that you did not enter above.
1.09contact's phone number(+)1;9FREE TEXTGive the telephone number of the person who verified insurance claims information.

Not Referenced