Files > IIV RESPONSE

name
IIV RESPONSE
number
365
location
^IBCN(365,
description
This file holds all responses to HL7 messages generated from the IIV Transmission Queue File for Insurance Identification and Verification. Per VHA Directive 10-93-142, this file definition should not be modified.
Fields
#NameLocationTypeDetailsIndexDescription
.01message control id(+)0;1FREE TEXTBThis is the HL7 message control number that is generated at the time the HL7 message is generated and placed in the outgoing HL7 message queue.
.02patient0;2POINTER2This the patient who was identified on the outgoing HL7 message.
.03payer0;3POINTER365.12This is the payer that was selected for either identification or verification.
.04buffer entry0;4POINTER355.33AFThis field is a pointer to the Insurance Buffer File if a buffer record exists for this insurance inquiry.
.05transmission queue0;5POINTER365.1This is the reference back to the Transmission Queue File. It provides a link between the inquiry and the response.
.06transmission status0;6POINTER365.14ACThis is the status of the response record.
.07date/time received0;7DATE-TIMEThis is the date and time that the HL7 response was received from the payer via the Eligibility Communicator.
.08date/time created0;8DATE-TIMEAEThis is the date and time that the baseline response record was created when the outgoing HL7 message was generated.
.09trace number0;9FREE TEXTCThis field will contain the Trace Number assigned by EC that is used for tracking a message between EC and the vendor.
.1response type0;10SET OF CODESO:Original
U:Unsolicited
This field identifies whether a response originated from the Transmission Queue file (Original) or was received Unsolicited from the EC.
1.01*name of insured1;1FREE TEXTThis is the name of the insured person in LastName,FirstName MI format. If the patient is the subscriber, this field is the same. If the patient is a dependent, the subscriber's name is stored here. This field is scheduled for deletion in May 2015.
1.02insured dob1;2FREE TEXTThe date of birth of the insured person.
1.03insured ssn1;3FREE TEXTThe social security number of the insured person.
1.04insured sex1;4FREE TEXTThe sex of the insured person.
1.05*subscriber id1;5FREE TEXTThe subscriber identification of the insured person. This field is scheduled for deletion in May 2015.
1.06*group name1;6FREE TEXTThe name of the group or plan if not an individual policy. This field is scheduled for deletion in May 2015.
1.07*group number1;7FREE TEXTThe number that identifies the group or plan. This field is scheduled for deletion in May 2015.
1.08whose insurance1;8SET OF CODESv:VETERAN
s:SPOUSE
o:OTHER
This is a definition of who is the subscriber of the insurance; the veteran, a spouse or someone else.
1.09pt relationship to insured1;9SET OF CODES01:PATIENT
02:SPOUSE
03:NATURAL CHILD
08:EMPLOYEE
09:UNKNOWN
11:ORGAN DONOR
15:INJURED PLAINTIFF
18:PARENT
34:OTHER ADULT
This is a definition of the patient's relationship to the insured person.
1.1service date1;10DATE-TIMEThis is the date of service returned by the Eligibility Communicator. It may be different from the one sent in the original inquiry.
1.11effective date1;11DATE-TIMEThis is the date that the insurance coverage began.
1.12expiration date1;12DATE-TIMEThis is the date that the insurance coverage ends.
1.13coordination of benefits1;13SET OF CODES1:PRIMARY
2:SECONDARY
3:TERTIARY
If an insurance payer is identified as a primary, secondary or tertiary in the response.
1.14error condition1;14POINTER365.017This is an error value returned from either the payer or the Eligibility Communicator.
1.15error action1;15POINTER365.018When an error condition is returned in the response, there may be an action that directs what happens to the response.
1.16date of death1;16DATE-TIMEThis is the date that the payer indicates that the person that verification was requested for has died.
1.17certification date1;17DATE-TIMEThis field may be returned by the payer and is the date that the insurance coverage was certified.
1.18member id1;18FREE TEXTThe member identification of the insured person.
1.19payer updated policy1;19DATE-TIMEThe date/time that the payer indicated they had updated their record of this policy. This date/time was received by IIV from the Eligibility Communicator.
1.2policy number1;20FREE TEXTThis field may be returned by the payer. It is the policy number of the insured person.
2eligibility/benefit2;0MULTIPLE365.02This multiple contains all of the eligibility and benefit data for a specific insured person returned from the Payer.
3contact person3;0MULTIPLE365.03This field contains any persons identified by the Payer as a contact name and/or communications number. There could be up to 3 different methods of communication.
4.01error text4;1FREE TEXTThis field contains error message text which is sent from the Eligibility Communicator if an error does not fall within one of the standard X.12 error conditions.
5.01subscriber address line 15;1FREE TEXTSubscriber address, line 1.
5.02subscriber address line 25;2FREE TEXTSubscriber address, line 2.
5.03subscriber address city5;3FREE TEXTSubscriber address, city.
5.04subscriber address state5;4POINTER5Subscriber address, state.
5.05subscriber address zip5;5FREE TEXTSubscriber address, zip code.
5.06subscriber address country5;6FREE TEXTSubscriber address, country code.
5.07subscriber address subdivision5;7FREE TEXTSubscriber address, country subdivision code.
6reject reasons6;0MULTIPLE365.06This multiple contains reject reason codes.
7subscriber dates7;0MULTIPLE365.07Subscriber dates multiple. Contains subscriber level dates, as opposed to eligibility/benefit level dates.
8.01pt. relationship - hipaa8;1POINTER365.037This is the HIPAA relationship code that describes the relationship this patient has to the holder of this insurance policy. If the policy belongs to the patient enter '18' for SELF. If the policy belongs to the spouse enter '01' for SPOUSE, etc.
9group reference information9;0MULTIPLE365.09Subscriber/Dependent additional identification data.
10group provider info10;0MULTIPLE365.04Entries in this sub-file identify the characteristics of a provider.
11health care code information11;0MULTIPLE365.01To 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 TEXTFree-form text description that 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.
13.01name of insured13;1FREE TEXTThis is the name of the insured person in LastName,FirstName MI format. If the patient is the subscriber, this field is the same. If the patient is a dependent, the subscriber's name is stored here.
13.02subscriber id13;2FREE TEXTThe subscriber identification of the insured person.
14.01group name14;1FREE TEXTThe name of the group or plan if not an individual policy.
14.02group number14;2FREE TEXTThe number that identifies the group or plan.

Referenced by 1 types

  1. IIV RESPONSE REVIEW (365.2) -- response id