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JCSM Shareware Collection 1996 September
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JCSM Shareware Collection (JCS Distribution) (September 1996).ISO
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medhelth
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INSTMED6.EXE
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MED_107.PT7
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1993-08-22
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EXIT TO DOS
MED#1 uses the <ESC> key to exit from all menu's and
functions. There is a tendency to press the <ESC> key
several times to get out of a function. To prevent an
accidental EXIT to DOS you are presented with an 'EXIT'
confirmation message. Pressing the <ESC> key on this
screen WILL NOT result in an EXIT to DOS. To EXIT to DOS
you must press the <ENTER> key in response to the 'YES'
request to EXIT FROM MED#1. Any other response will
return you to the MED#1 Master Menu.
Page 120
SERVICE / SUPPORT
MEDshare, Inc. provides service and support to the user
on a "Pay As You Go" type arrangement. Under this method
you pay only for the time and services needed to answer
your questions. The rate is $2.00 per minute with a 15
minute minimum. If you are a new 'REGISTERED' user of
MED#1 you have up to 2 hours of FREE SUPPORT available to
you for the first six months following registration.
After 2 hours of support, or the elapse of the six month
time, (which ever comes first) the $2.00 per minute fee
will be charged. All service and support is provided
over the phone, Monday - Friday, 9:00 am to 4:00 pm cst.
Phone:(214) 985-0759
(Note: MEDshare, Inc. does not, and will not, provide any
assistance with hardware, networking, and operating
system, problems. We recommend that you establish support
for these items from within your local area.)
MEDshare, Inc. also encourages local VAR's and RESELLER'S
to promote and service MED#1. Authorized VAR'S and
RESELLER'S provide a more personal level of support and
in many cases may be in your area. Their rates for their
support are not controlled by MEDshare and could be less.
For the name and phone number of an authorized VAR or
RESELLER in your area call:
Phone: 1-(214)-985-0759 or 1-(800)-233-0560
MEDshare, Inc. is always looking for VAR's and RESELLER'S
to support the MED#1 family of products we offer to the
medical practitioner. We offer an interesting, if not
unique, market participation plan to all VAR's and
RESELLER'S that wish to become authorized support centers
for our products. If you know of a VAR or RESELLER in
your area that would be interested in becoming an
authorized support center for our products have them call
us at:
Phone: 1-(214)-985-0759 or 1-(800)-233-0560
Page 121
UPGRADES
There are two types of UPGRADES to be considered:
1. The first type of upgrades are due to errors detected
in prior releases of MEDshare, Inc. products.
For all CURRENT REGISTERED USERS of MED#1 this type of
upgrade is FREE for the first six months following
registration. When we are notified of a problem we will
make all effort necessary to correct it in the shortest
time possible. When the correction is made we will
provide all CURRENT registered users with a copy of the
corrected program at no cost.
If you encounter an error in your program please do the
following:
A. Write down the error message - exactly as displayed.
B. Call MEDshare, Inc. immediately at (214) 985-0759 and
describe the problem and read to use the error message.
C. If possible capture to the printer a copy of the
screen that is displaying the error message. This can be
done by turning on your printer and pressing (at the same
time) the Shift and the 'Print Screen' keys on your
printer keyboard.
2. The second type of upgrade is due to improvements and
new features being incorporated into MEDshare, Inc.
products. MEDshare, Inc. is constantly in the process of
evaluating and improving the MED#1 and related software
products provided to our users. While we cannot give any
hard dates for releasing new versions of our programs we
hope to have one major release per year. Some of these
releases will be new programs and not upgrades to
existing programs. All new programs will be offered to
registered users for evaluation either FREE or for a
$10.00 handling charge. If you are not a current
registered user, and you would like to know if any new
features or programs have been released, give MEDshare,
Inc. a call at 1-(800)-233-0560.
Registered users: We encourage you to install all
upgrades when received. Some upgrades may require the
creation of new fields within your database. If you fail
to install all upgrades these fields will not be
available for the next upgrade or other new products
released that we send you.
Users that have failed to purchase upgrades: If you have
failed to purchase upgrades as they become available you
may purchase them later at a nominal cost. The cost of
each upgrade will vary and will be determined by the new
features it incorporates. Please request a price listing
of all upgrades. You will need to purchase ALL upgrades
Page 122
released that have a higher version number than the
current version you are using (if you wish to carry your
current data up into the new formats). Some upgrades may
require the creation of new files or new fields within
your database. If you fail to install all upgrades as
they are released these files and fields will not be
available for the next upgrade that we send you.
(Sorry but we can only support our registered users.)
Page 123
NEW RELEASES
New releases are not to be confused with upgrades.
Upgrades are improvements in a specific product. New
releases are new products and may have a new name or a
new version number series.
MEDshare, Inc. is dedicated to providing you, the medical
practitioner, with the best program to manage your
practice with. We realize that one program cannot address
all needs all of the time. As changes are made in the
insurance industry, and as new computers and operating
systems be come available, improvements will be made to
MED#1 to take advantage of these changes. Also, as we
grow MEDshare, Inc. will be creating new programs for
various specialities and methods of practice management.
As these programs become available we will be notifying
all current users of our products of their availability.
Current registered users will be offered the opportunity
to purchase these products at a reduced rate.
Page 124
GLOSSARY
BUFFER The space in the computer's memory where
text is temporarily stored while the
computer is on.
CONFIG.SYS A file used to modify the parameters of
machine operation.
DBF Data base files.
DEFAULT Word used to designate 'standard', most
common. In MED#1, 'default' is 00 unless
specified otherwise.
DOS Disk operating system.
FIELDS Specific areas for receiving information.
FLAG An instruction put in one function that
cross references with another function
requesting an activity.
FREEFORM FIELD A field that doesn't require information
every time the function is used.
INITIALIZATION Bringing up the system and customizing it
to create DBF.
INSTALLATION Physically putting the software on disks
by copying.
MESSAGE LINE Space at the bottom and top of the screen
for 'prompts' and 'help'.
PROMPT A question or request that appears on
screen which has to be answered before
continuing with the function.
PURGE Remove outdated information and create
space for new information.
Page 125
INSURANCE FORMS
MED#1 contains internally over thirty different insurance
form formats. Nationally there are over 450 different
insurance forms used in the filing of medical claims.
Most of these forms are limited to specific fillings
within a single state and cannot be used in another
state. The 'STANDARD' HCFA-1500 (12/90) form has eight
MEDICARE variations depending upon which state you are
filing it in. There are three formats for general
filing, one format for CHAMPUS & CHAMPVA, and the
remaining variations for workmen's comp., etc. (KEEP IN
MIND THE THE PRINTED HCFA-1500 (12/90) FORM USED IS
DISTRIBUTED ONLY IN ONE BASIC FORMAT BUT EACH INSURANCE
CARRIER IT IS FILED WITH REQUIRES IT TO BE FILLED OUT
ACCORDING TO THEIR SPECIFIC REQUIREMENTS.)
INSURANCE FORMS PRINTED:
------------------------
'BLANK' = PATIENT insurance information printed on blank
paper.
MEDICARE (OLD HCFA_1500 (1/84):
-------------------------------
HCFA_84 = MEDICARE & Non MEDICARE.
MEDICARE - HCFA_1450 - MEDICARE part 'A'
----------------------------------------
UB_82 = (Note - use of this form requires a
modification to your charge table setup.
HCFA_1500 (12/90) as required for private carriers:
---------------------------------------------------
HCFA_90 = non MEDICARE insurance form to be used for all
fillings that do not require any special format
modifications.
HCFA_9A = non MEDICARE insurance form - uses three
'UNITS' 99.9.
HCFA_9B = non-MEDICARE
HCFA-1500 (12/90): The following is a partial listing of
the various formats of the HCFA-1500 (12/90):
MEDICARE INSURANCE FORMS: Eight HCFA-1500 (12/90) formats
have been added to the MEDshare insurance form library
to handle MEDICARE alone. Check your MEDICARE 'B'
instructions for the form you should be using.
MEDICARE - HCFA_1500 (12/90) insurance form formats:
----------------------------------------------------
CARE_00 = States used in: LA,MN,KY,MD,PA,
Page 126
CARE_01 = (special use only)
Block #24e = limit to only 1 diagnostic reference
CARE_02 = States used in: FL,NC,
Block #9 = use term "NA"
Block #12 = use term "SOF"
Block #13 = use term "SOF"
Block #19 = show date as "mmddyy"
Block #20 = remove '.' from dollar amounts
Block #21 = remove '.' from ICD-9-CM codes
Block #24e = print actual ICD-9-CM code (only one)
Block #24f = remove '.' from dollar amounts
Block #28 = remove '.' from dollar amounts
Block #29 = remove '.' from dollar amounts
Block #30 = remove '.' from dollar amounts
CARE_03 = States used in: CA,
Block #24g = show units as a three digit field with
the right most digit as tenths of a unit, show
leading zeros
CARE_04 = States used in: NY,
Block #31 = show physicians UPIN number
CARE_05 = Special use only: States used in GA,
Block #9 = use term "NA"
Block #12 = use term "SOF"
Block #13 = use term "SOF"
Block #19 = show date as "mmddyy"
Block #20 = remove '.' from dollar amounts
Block #21 = remove '.' from ICD-9-CM codes
Block @24a = show date in 'TO' column only
Block #24e = print actual ICD-9-CM code (only one)
Block #24f = remove '.' from dollar amounts
Block #28 = remove '.' from dollar amounts
Block #29 = remove '.' from dollar amounts
Block #30 = remove '.' from dollar amounts
CARE_06 = States used in: TN,
Block #9 = use term "NA"
Block #12 = print 'ON FILE' if applicable
Block #13 = print 'ON FILE' if block#12 is printed
Block #19 = show date as "mmddyy"
Block #20 = remove '.' from dollar amounts
Block #21 = remove '.' from ICD-9-CM codes
Block #24 a = print both 'from' and 'to' dates
Block #24e = ICD-9-CM codes from block #21 (1 2 3 4)
Block #24f = remove '.' from dollar amounts
Block #28 = remove '.' from dollar amounts
Block #29 = remove '.' from dollar amounts
Block #30 = remove '.' from dollar amounts
CARE_07 = States used in: ME,
block 24a - print both 'from' and 'to' dates
block 24k - do not print PIN no. if no GROUP PIN
number
CHAMPUS/CHAMPVA:
----------------
CHMP_00 = HCFA_1500 (12/90)
Page 127
WORKMEN'S COMPENSATIONS:
------------------------
WORK_NC = State: North Carolina - form 25 M (1/87)
WORK_OH = State: OHIO - form HCFA_1500 (12/90)
WORK_TX = State: TEXAS - form HCFA_1500 (12/90)
MEDICAID:
---------
CAID_KY = State: KENTUCKY - form HCFA_1500 (12/90)
CAID_NY = State: NEW YORK - form NYS MA TITLE XIX
CAID_OK = State: Oklahoma - form HCFA_1500 (12/90)
CAID_OH = State: OHIO - form DHS-6780
CAID_UT = State: UTAH - form
BLUE CROSS & BLUE SHIELD:
-------------------------
BCBS_OH = State: OHIO - form HCFA_1500 (12/90)
BCBS_ME = State: MAINE - form HCFA_1500 (12/90)
BCBS_NC = State: NORTH CAROLINA - form HCFA_1500 (12/90)
BCBS_RI = State: RHODE ISLAND - form MU-049-0-2/91
BCBS_VA = State: VIRGINIA - form BCBS 710062 (6/88 & MA
10/91)
OTHER STATE SPECIFIC FORMS:
---------------------------
AL_HCFA = State: Alabama HCFA-1500 CL-4-C (Rev. 5-90)
CA_MEDI = State: CALIFORNIA 'MEDI-CAL 15-1Z (04/91)'
CA_MED2 = State: CALIFORNIA 'MEDI-CAL 40-1Z (04/91)'
CO_HCFA = State: COLORADO DSS HCFA_1500 (rev 2/91)
FL_HCFA = State: FLORIDA - HCFA_1500 (4/80)
IL_2360 = State: ILLINOIS - DPA_2360 (12/87)
MI_HCFA = State: Michigan - HCFA_1500 (2/83)
MN_1497 = State: MINNESOTA - DHS_1497 (6/90)
NJ_1500 = State: New Jersey - HCFA_1500 (09/91)
PA_BS = State: Pennsylvania Blue Shield 1500A (6/89)
PA_HCFA = State: Pennsylvania - HCFA_1500A (12/81)
PA_319C = State: Pennsylvania - PA_319C (10/90)
Page 128
PLACE OF SERVICE CONVERSION TABLE
Claim type:
1=MEDICARE 3=CHAMPUS 5=GROUP HEALTH 7=WORKMANS 9=OTHER
2=MEDICAID 4=CHAMPVA 6=FECA 8=BCBS
Place of Service codes conversion table:
Input Printed on Ins. form.
Value Claim type: 1 2 3 4 5 6 7 8 9
---------------------------------------------------------
1=Inpatient Hospital ........: 21 1 21 21 1 1 1 1 1
2=Outpatient Hospital .......: 22 2 22 22 2 2 2 2 2
3=Doctor's Office ...........: 11 3 11 11 3 3 3 3 3
4=Patient's Home ............: 12 4 12 12 4 4 4 4 4
5=Day Care Facility (PSY)....: 52 5 52 52 5 5 5 5 5
6=Night Care Facility (PSY)..: 6 6 6 6 6 6 6 6 6
7=Nursing Home ..............: 32 7 32 32 7 7 7 7 7
8=Skilled Nursing Facility ..: 31 8 31 31 8 8 8 8 8
9=Ambulance .................: 41 9 41 41 9 9 9 9 9
0=Other Locations ...........: 99 0 99 99 0 0 0 0 0
A=Independent Laboratory ....: 81 A 81 81 A A A A A
B=Ambulatory Surgical Center.: 24 B 24 24 B B B B B
C=Residential Treatment Ctr..: 55 C 55 55 C C C C C
D=Specialized Treatment Fac..: 54 D 54 54 D D D D D
E=Comprehensive Outpat Rehab.: 62 E 62 62 E E E E E
F=Indep. Kidney Dis Trmnt Ctr: 65 F 65 65 F F F F F
G=Emergency Room (Hospital)..: 23 G 23 23 G G G G G
H=Birthing Center ...........: 25 H 25 25 H H H H H
I=Military Treatment Center .: 26 I 26 26 I I I I I
J=Custodial Care Facility ...: 33 J 33 33 J J J J J
K=Hospice ...................: 34 K 34 34 K K K K K
L=Ambulance (Air or Water) ..: 42 L 42 42 L L L L L
M=Inpatient Psychiatric Fac..: 51 M 51 51 M M M M M
N=Community Mental Health Ctr: 53 N 53 53 N N N N N
O=Psychiatric Resid Trmt Ctr.: 56 O 56 56 O O O O O
P=HMSA, Inpatient Hospital ..: P P P P P P P P P
Q=HMSA, Outpatient Hospital .: Q Q Q Q Q Q Q Q Q
R=HMSA, Office ..............: R R R R R R R R R
S=HMSA, Patient's Home ......: S S S S S S S S S
T=HMSA, Nursing Home ........: T T T T T T T T T
U=HMSA, Skilled Nursing Fac..: U U U U U U U U U
V=HMSA, Other ...............: V V V V V V V V V
W=HMSA, Ambulatory Surg. Ctr.: W W W W W W W W W
X=Comp. Inpatient Rehab. Fac.: 61 X 61 61 X X X X X
Y=State/Local Health Clinic..: 71 Y 71 71 Y Y Y Y Y
Z=Rural Health Clinic .......: 72 Z 72 72 Z Z Z Z Z
Page 129
TYPE OF SERVICE CONVERSION TABLE
Claim types:
1=MEDICARE 3=CHAMPUS 5=GROUP HEALTH 7=WORKMANS 9=OTHER
2=MEDICAID 4=CHAMPVA 6=FECA 8=BCBS
Type of Service codes conversion table:
Input Printed on Ins. form.
Value Claim types: 1 2 3 4 5 6 7 8 9
---------------------------------------------------------
1=Medical Care ..............> 1 1 1 1 1 1 1 1 1
2=Surgery ...................> 2 2 2 2 2 2 2 2 2
3=Consultation ..............> 3 3 3 3 3 3 3 3 3
4=Diagnostic X-Ray ..........> 4 4 4 4 4 4 4 4 4
5=Diagnostic Laboratory .....> 5 5 5 5 5 5 5 5 5
6=Radiation Therapy .........> 6 6 6 6 6 6 6 6 6
7=Anesthesia ................> 7 7 7 7 7 7 7 7 7
8=Assistance at Surgery .....> 8 8 8 8 8 8 8 8 8
9=Other Medical Service .....> 9 9 9 9 9 9 9 9 9
0=Blood or Packed Red Cells .> 0 0 0 0 0 0 0 0 0
A=Used DME ..................> A A A A A A A A A
F=Ambulatory Surgical Center > F F F F F F F F F
H=Hospice ...................> H H H H H H H H H
L=Renal Supplies in the Home > L L L L L L L L L
M=Alt. Pay of Maint. Dialysis> M M M M M M M M M
N=Kidney Donor ..............> N N N N N N N N N
V=Pneumococcal Vaccine ......> V V V V V V V V V
Y=Second Opinion on Ele. Surg> Y Y Y Y Y Y Y Y Y
Z=Third Opinion on Ele. Surg.> Z Z Z Z Z Z Z Z Z
Page 130
CHAMPUS/CHAMPVA SPONSOR BRANCH OF SERVICE
------------------------
A=Army
C=CHAMPVA
E=Public Health Service
F=Air Force
I=NOAA
M=Marines
N=Navy
P=Coast Guard
X=Other
Z=Unknown
Page 131
CHAMPUS/CHAMPVA SPONSOR'S PAY GRADE
----------------------------------
01 = Enlisted E1
02 = Enlisted E2
03 = Enlisted E3
04 = Enlisted E4
05 = Enlisted E5
06 = Enlisted E6
07 = Enlisted E7
08 = Enlisted E8
09 = Enlisted E9
11 = Warrant Officer W1
12 = Warrant Officer W2
13 = Warrant Officer W3
14 = Warrant Officer W4
19 = Academy Student/OCS
21 = Officer O1
22 = Officer O2
23 = Officer O3
24 = Officer O4
25 = Officer O5
26 = Officer O6
27 = Officer O7
28 = Officer O8
29 = Officer O9
30 = Officer 10
21 = Officer 11
41 = GS1
42 = GS2
43 = GS3
44 = GS4
45 = GS5
46 = GS6
47 = GS7
48 = GS8
49 = GS9
50 = GS10
51 = GS11
52 = GS12
53 = GS13
54 = GS14
55 = GS15
56 = GS16
57 = GS17
58 = GS18
90 = Unknown (Including NATO)
95 = N/A (Including CHAMPVA)
99 = Other
Page 132
CHAMPUS/CHAMPVA SPONSOR STATUS CODES
Active Duty
----------------
A=Active duty
B=Recalled
J=Academy/OCS
N=National Guard
V=Reserves
T=Foreign (NATO)
Retired
----------------------
D=100% disabled
F=Former Member
I=Permanently disabled
O=Temporarily disabled
R=Retired
Deceased
-----------
K=Deceased
Other
-------------
C=Civilian
H=Medical of Honor
X=Other
Z=Unknown
Page 133
---------------------------------------------------------
FILE - PATIENT
---------------------------------------------------------
FIELD TYPE LEN DEC
ACCT C 5 Primary identification code for
billing functions. Each account
can have from 1 to 999 patients.
ACCT_DATE D 8 Date account was initially added
to the system.
ACCT_DISC N 4 1 Discount percentage to be
applied to all charges posted to
this account. (Example: 105 =
10.5%)
ACCT_TAX C 1 Flag in account master to
identify if this account is
subject to any sales tax
calculation. If 'N' then no tax
is calculated. If 'Y' then tax
is calculated for all taxable
charges.
ACCT_STMT C 1 Flag in account master to
identify if this account is to
receive statements. If 'N' then
no statement is to be printed.
If 'Y' then print statement.
ACCT_BILL C 1 Patient/Account 'BILLING CYCLE'
code. To be used to limit the
selection of this
patient/account for printing of
statements to a specific billing
cycle. Any code is valid (a
blank is a valid code).
ACCT_TYPE C 1 Code used to classify this
account for billing and other
functions. (1=regular account,
2=assignment account, 3=budget
account)
ACCT_INT C 1 Flag to identify if interest is
to be charged to this account
for balances over x days old. (x
is defined by you in the system
utilities for system
Page 134
---------------------------------------------------------
FILE - PATIENT
---------------------------------------------------------
FIELD TYPE LEN DEC
parameters.)
ACCT_BAMT N 7 2 If 'ACCT_TYPE' = '3' then this
is the amount of monthly
budgeted payment for this
account.
ACCT_BDATE D 8 If 'ACCT_TYPE' = '3' then this
is the date that the 1st
budgeted payment is to be made.
All remaining payments are on
the same day of each following
month.
ACCT_REFBY C 30 Account master 'Referred by'
comment field.
ACCT_REFDR C 2 Patient referring doctor's ID
number. This is the ID number
that is assigned to the doctor
when you set that doctor up in
your DOCTOR master file. (Note -
doctor must be in DOCTOR master
file before any reference can be
made.
PATIENT C 2 Code to identify this patient
within an account. You can have
up to 999 patients per account.
You must have at least one
patient per account.
CODE C 2 This is a open use code field to
be used for grouping of
accounts. You can use this code
to selectively process accounts
by various functions of this
system.
PREFIX C 10 Account master address prefix -
Mr., Mrs, The. (Note - This is
part of the name of the account
master but does not affect the
sequencing of the name.)
Page 135
---------------------------------------------------------
FILE - PATIENT
---------------------------------------------------------
FIELD TYPE LEN DEC
L_NAME C 32 Patients last name.
F_NAME C 14 First name of patient.
INITIAL C 1 Patients middle initial of name.
PAT_ADD C 32 Street address of patient
address.
PAT_CITY C 20 Patient city name for address.
PAT_STATE C 16 Patient state/country name of
address.
PAT_ZIP C 10 Patient home zip/postal code of
address.
PAT_PHONE C 12 Patient home phone number.
PAT_OCCUPT C 32 Description of the normal
occupation patient works in.
SALUTATION C 25 Salutation to be used in all
correspondance to this
patient/account.
EMPLOYER C 32 Name of employer that patient
works for.
W_ADD C 32 Patients address line for
employers address.
W_CITY C 20 Patients city name for employers
address.
W_STATE C 16 Patients state/country name for
employers address.
W_ZIP C 10 Patients zip/postal code for
employers address.
W_PHONE C 12 Patients work phone number.
W_PHEXT C 4 Patients work phone number
extension.
Page 136
---------------------------------------------------------
FILE - PATIENT
---------------------------------------------------------
FIELD TYPE LEN DEC
PAT_SSNO C 11 Patients social security number.
PAT_DLNO C 12 Patients drivers license number.
PAT_SEX C 1 Sex of patient. 'M' - male, 'F'
= female
PAT_BDATE D 8 Patient birth date.
PAT_DOC C 2 Patients normal doctor. Code
used to identify the doctor that
is normally responsable for this
patient. You can identify
another doctor that sees the
patient at time of transaction
posting.
CHG_TABLE C 2 Code to identify this charge
table of rates. You can setup
100 unique charge tables. The
table code of '00' is reserved
for the default 'standard'
charge table. Each table is
unique and is identified to the
patient at time of patient
setup. Table code can be
overriden at time of transaction
posting in order to post charges
to a patient from another table.
FIN_CODE C 1 Code field used to identify the
financial class of the patient.
These codes are user defined and
there is no validation made on
their input.
FIRST_DATE D 8 Date patient was first seen.
LAST_DATE D 8 Date patient was last seen.
INS_PROVDR C 2 Patient number of the patient
record within this account that
will be used to provide
Page 137
---------------------------------------------------------
FILE - PATIENT
---------------------------------------------------------
FIELD TYPE LEN DEC
insurance coverage for this
patient. Default is the patient
number for this patient record.
INS_ASSIGN C 1 Flag to identify if patient
account has been assigned to
insurance coverage. If 'Y' then
all transactions posted will be
automatically flaged for
insurance posting. If 'N' then
those transactions requiring
insurance filing must be
manually tagged.
INS_ASSPCT N 3 0 For patients assigned to
insurance coverage this is the
percent of all charges not
covered by insurance. (Note -
this field is not used in the
'SHAREWARE' version of 'MED
#1'.)
INS_DATE D 8 This is the date you accepted
insurance assignment for this
patient. You should have on file
a signed patients authorization
for you to accept insurance
payments effective as of this
date. (Note - this dated
authorization is only good for
one calendar year.)
INS_FORM C 1 Code that will be used to
identify the type of insurance
processing form (or file) you
are to create for this patient.
Currently this is limited to the
HCFA-1500 form only.
INS_ASS_CO C 8 If this patient has been flaged
as being assigned to insurance
coverage then the code for that
insurance company is contained
in this field. This code is one
Page 138
---------------------------------------------------------
FILE - PATIENT
---------------------------------------------------------
FIELD TYPE LEN DEC
of the two available for person
providing coverage of this
patient.
INS_PROREL C 1 Code used to identify the
relationship of the patient
record that is providing
insurance coverage to this
patient. Values are: 'X' = self,
'S' = spouse,
'P' = parent, 'O' = other.
INS_CODE_1 C 8 Code identifying the 1st
insurance company providing
coverage for this patient.
POL_ID_1 C 18 Insurance policy identification
number for first insurance
company providing coverage for
patient.
GRP_ID_1 C 15 Insurance group id number for
1st insurance provider listed
for patient.
INS_CODE_2 C 8 Code identifying the 2nd
insurance company providing
coverage for this patient.
POL_ID_2 C 18 Policy identification number for
second insurance company
providing coverage for patient.
GRP_ID_2 C 15 Insurance group id number for
second insurance provider listed
for patient.
LUPDATE D 8 Date of last maintenance for
this record - mm/dd/yy.
TOTAL RECORD LENGTH.. 570
Page 139
---------------------------------------------------------
FILE - PATCASE
---------------------------------------------------------
FIELD TYPE LEN DEC
ACCT C 5 Primary identification code for
billing functions. Each account
can have from 1 to 999 patients.
PATIENT C 2 Code to identify this patient
within an account. You can have
up to 999 patients per account.
You must have at least one
patient per account.
PAT_CASE C 1 Patient 'case' number. This
case record contains information
releative to a specific patient
condition. Currently there can
only be one case record per
patient and this value will only
be a '1'. In the future this
will be expanded so that there
can be up to nine case records
per patient.
DX1 C 8 Primary diagnostic code for all
postings for this patient for
this case.
DX2 C 8 Secondary diagnostic code for
all postings for this patient
for this case.
DX3 C 8 Third diagnostic code for all
postings for this patient for
this case.
DX4 C 8 Fourth diagnostic code for all
postings for this patient for
this case.
PAT_STATUS C 1 Patient marital status:
M=married, S=single,
blank=other.
PAT_EMPLOY C 1 Is patient employed: Y=yes,
N=no.
PAT_STUDNT C 1 If patient is a student enter:
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FIELD TYPE LEN DEC
F=full time, P=part time,
otherwise leave blank.
CHP_STATUS C 1 CHAMPUS sponsors status at time
of first visit for this patient
case.
CHP_BRANCH C 1 CHAMPUS sponsors branch of
service.
CHP_PAYGRD C 2 CHAMPUS sponsors pay grade at
time of first visit for this
patient case.
INSUREDID1 C 15 Patients insureds identification
number for policy 1 of 2.
INS_CLAIM1 C 1 Type of insurance claim for
policy no. 1 of 2 for this
patient.
INSUREDID2 C 15 Patients insureds identification
number for policy 2 of 2.
INS_CLAIM2 C 1 Type of insurance claim for this
policy no. 2 of 2 for this
patient.
INS_MEDGP1 C 1 Policy 1 of 2: If MEDIGAP enter
'M', if SUPPLEMENTAL enter 'S',
otherwise enter a 'blank'.
INS_MEDGP2 C 1 If policy 2 of 2 is a MEDIGAP
policy enter a 'M', if it is a
SUPPLEMENTAL policy enter a 'S',
otherwise enter a 'blank'.
REF_DR C 2 Enter the identification number
for the doctor that referred
this patient or ordered any
tests, x-rays, or lab work.
REF_COMENT C 26 If information is to be printed
in block 19 of the HCFA_1500
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FIELD TYPE LEN DEC
(12/90) insurance form enter it
into this field.
REF_DATE D 8 If an entry is to be made into
block #19 of the HCFA_1500
(12/90) insurance form enter the
date of that entry here.
INS_INFORL C 1 Information release
autorization: 'Y' = yes, 'N' =
no.
C_EMPLOY C 1 If patients condition for this
case is related to employment
enter: 'Y' = yes, 'N' = no.
C_CRIME C 1 If patient condition for this
case was due to an act of crime
enter: 'Y' = yes, 'N' = no.
C_ACCIDENT C 1 If patients condition for this
case is releated to an accident
enter: 'Y' = yes, 'N' = no.
C_ACCID_DT D 8 If patients condition for this
case was due to an accident then
the date of the accident should
be entered into this field.
C_AUTO C 1 If patients condition for this
case was due to an accident and
this accident was an auto
accident enter: 'A' = auto, 'O'
if other type of accident,
otherwise enter a 'blank'.
C_AUTO_ST C 2 If patients condition for this
case was due to an accident and
this was an auto accident then
enter: the two character 'State'
code, otherwise enter a 'Blank'.
C_EMERGNCY C 1 Was patient condition for this
case an emergency: 'Y' = yes,
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FIELD TYPE LEN DEC
'N' = no.
C_PLACESRV C 50 If the place of service was not
the doctors office or patients
home enter the name and address
of the place of service.
C_PRIORATH C 15 If treatment for this condition
for this patient case requires
authorization from the insurance
carrier enter the authorization
number otherwise leave 'blank'.
C_LABWORK C 1 If there was outside lab work
for this patient case enter: 'Y'
= yes, 'N' = no.
C_LABFEE N 7 2 If there was outside lab work
for this patient case enter the
dollar amount for this lab work.
C_EPSDT C 1 If this is a MEDICAID claim and
early Periodic Screening
Diagnosis Treatment is involved
enter 'Y' = yes, otherwise enter
'N' = no.
C_FAMILYPL C 1 If this is a MEDICAID claim and
also Family Planning is involved
enter a 'Y' = yes, otherwise 'N'
= no.
C_ILL_PREG C 15 Enter a brief description for
the type of illness.
C_1STSYMPT D 8 Enter date of first sysptom for
this patient case. If this
condition was due to an accident
then the date of accident will
also be entered here.
C_1STSEEN D 8 Enter the date that the patient
was first seen for this
condition.
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FIELD TYPE LEN DEC
C_SIMILAR D 8 Enter the date of a previous
similiar condition for this
condition.
C_WORK D 8 Enter the date that the patient
can return to work.
C_TOTAL_FM D 8 Enter the 'From' date for total
disability.
C_TOTAL_TO D 8 Enter the 'To' date for total
disability.
C_PARTL_FM D 8 Enter the 'From' date of partial
disability.
C_PARTL_TO D 8 Enter the 'To' date of partial
disability.
C_HOSPL_FM D 8 Enter the 'From' date of
hospitalization.
C_HOSPL_TO D 8 Enter the 'To' date of
hospitalization.
C_XRAY D 8 Enter the date of last x-ray for
this patient condition.
C_DEATH D 8 Enter the date of death.
LUPDATE D 8 Date of last maintenance for
this record - mm/dd/yy.
TOTAL RECORD LENGTH.. 327
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FILE - COMMENTS
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FIELD TYPE LEN DEC
ACCT C 5 Primary identification code for
billing functions. Each account
can have from 1 to 999 patients.
PATIENT C 2 Code to identify this patient
within an account. You can have
up to 999 patients per account.
You must have at least one
patient per account.
C_DATE D 8 Date of comment - mm/dd/yy.
C_LINE C 2 Line number assigned to this
comment record for this date.
This number is not displayed any
where and is only used to
maintain proper sequencing of
comments.
COMMENT C 50 Message portion of comment
record. Multiple comment records
can be tied together for a
single comment.
LUPDATE D 8 Date of last maintenance for
this record - mm/dd/yy.
TOTAL RECORD LENGTH.. 75
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