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inCOME VERIFICATION MATCH(IVM)TECHNICAL MANUALVersion 2.00ctober 1994Revised October 2021Department of Veterans AffairsOffice of Enterprise DevelopmentManagement, Enrollment and Financial Systems (MEFS)Revision HistoryDateDescriptionProject Manager (beginning 1/19/05)Author10/9/01Added OBX segment to ORU~Z07 HL7 Message Definition in Appendix AREDACTED10/9/01Updated OBX segment in ORF~Z11 and ORU~Z11 HL7 Message Definitions in Appendix AREDACTED10/9/01Updated OBX Segment Table in Appendix B to include NTR data descriptionsREDACTED10/9/01Added VA0052 and VA0053 to Supported/User-Defined Tables section in Appendix BREDACTED10/19/01Added OBX segment to ORF~Z07 HL7 Message Definition in Appendix AREDACTED10/19/01Added ORU/ORF~Z10 HL7 Message Definitions in Appendix AREDACTED10/19/01Added sequences 24 – 26 to ZMT segment table definition in appendix BREDACTED10/19/01Added sequences to 22 – 23 to ZIC Segment Table Definition in Appendix BREDACTED10/19/01Added sequences 6 – 13 to ZCD Segment Table Definition in Appendix BREDACTED10/19/01Added ZIV to Segment Table Definitions in Appendix BREDACTED10/30/01Added ORU/ORF to HL7 Message Events Table in Appendix AREDACTED12/7/01Added ORF~Z06 to HL7 Message Definitions in Appendix AREDACTED12/7/01Updated ZMT Segment Table in Appendix AREDACTED12/7/01Added Table VA0051 to Supported/User-Defined Tables section in Appendix BREDACTED12/7/01Updated Table VA15 in Supported/User-Defined Tables section in Appendix BREDACTED12/7/01Updated Table VA0035 in Supported/User-Defined Tables section in Appendix BREDACTED1/2/2002Updated Enrollment Trigger Events section in Appendix AREDACTED1/10/02Added ZMH Segment Table to Segment Table Definitions in Appendix BREDACTED4/18/02Changed narrative occurrences of HL7 V. 1.5 to reflect V. 1.6REDACTED4/18/02Corrected descriptions of ORU/ORF~Z10 to reflect that they are communications FROM HECREDACTED5/22/02Updated date in footersREDACTED5/23/02Updated ZEL Segment Table in Appendix BREDACTED5/23/02Added PD1 Segment Table to Segment Table Definitions in Appendix BREDACTED5/31/02Updated ZMT Segment Table in Appendix B to reflect new test typeREDACTED10/1/02Updated HL7 Message Definitions in Appendix A HL7 to support Address IndexingREDACTED10/7/02Updated HL7 Segment Table Definitions in Appendix B to support Geographic Means Test and Address IndexingREDACTED11/4/02Updated HL7 Appendices B to support Geographic Means Test and Address IndexingREDACTED11/5/02Updated HL7 Appendices B to support Geographic Means Test and Address IndexingREDACTED11/19/02Added Sequence 34 to ZEL Segment Table Definitions in Appendix B to support Geographic Means Test and Address IndexingREDACTED11/21/02Added Appendix D – HL7 Flow DiagramREDACTED2/11/03Added Table VA0040 to Appendix D to support Enrollment Sub-Priority GroupREDACTED2/12/03Updated Table VA0035 in Appendix D to support Enrollment Sub-Priority GroupREDACTED2/14/03Updated Table VA 0004 in appendix D to include Purple Heart codeREDACTED3/3/03Updated MSH Segment Table in Appendix B (IVM*2*69)REDACTED3/4/03Added FTI Segment Table in Appendix B (IVM*2*69)REDACTED3/4/03Updated PID Segment Table in Appendix B (IVM*2*69)REDACTED3/4/03Updated PD1 Segment Table in Appendix B (IVM*2*69)REDACTED3/4/03Updated ZIC Segment Table in Appendix B (IVM*2*69)REDACTED3/4/03Updated ZDP Segment Table in Appendix B (IVM*2*69)REDACTED3/4/03Updated ZIR Segment Table in Appendix B (IVM*2*69)REDACTED3/4/03Updated ZIV Segment Table in Appendix B (IVM*2*69)REDACTED3/4/03Updated ZMT Segment Table in Appendix B (IVM*2*69)REDACTED3/4/03Updated HL7 Data Types Table in Appendix B (IVM*2*69)REDACTED3/4/03Updated HL7 Message Definitions in Appendix A (IVM*2*69)REDACTED3/4/03Updated list of HL7 Segments in Appendix A (IVM*2*69)REDACTED3/7/03Updates per team feedbackREDACTED5/13/03Updated ORF/ORU~Z07, ORF/ORU~Z11 message definitions in Appendix A (IVM*2*75)REDACTED5/13/03Updated ZEL Segment Table in Appendix B (IVM*2*75)REDACTED6/19/03Updated ORU~Z05 message definition in Appendix A (IVMB*2*739)REDACTED6/19/03Updated EDB references in Appendix AREDACTED8/8/03Updated the VA-Specific Patient Information Segment (ZPD) in Appendix B HL7 Table Segment Definitions (IVM*2*85) to accommodate the additional Date of Death enhancement information (source of notification for date of death, date of last entry or update, and submitter/user information).REDACTED8/11/03Updated ORU~Z05, ORU~Z07, ORF~Z07, ORU~Z11, and ORF~Z11 message definitions in Appendix A (IVMB*2*85)REDACTED8/11/03Updated the VA-Specific Patient Information Segment (ZPD) in Appendix B HL7 Table Segment Definitions (IVM*2*85) 31 and 32 based on team feedback.REDACTED3/3/04Removed the ZPD VA-Specific Patient Info Segment Sequence #s 31 & 32 (IVM*2*85) from the Demographic Data Transmission - ORU~Z05 HL7 message definition in Appendix A.REDACTED3/12/04Added ZMH to the following message definitions in Appendix A:ORU/ORF~Z07ORU/ORF~Z11REDACTED5/20/04Added ZMT VA-Specific LTC Co-Pay Exemption Test Information segment sequences 1-4,7,9-10,12,16-18,22,25 to the ORF~Z10 message definition in Appendix A (IVM*2*56)Added sequences to segments QRD, QRF, ZIC and ZMT in the ORF~Z10 message definition in Appendix A (IVM*2*56)REDACTED5/20/04Added sequences to segments PID, ZPD, ZIE, ZEL, ZCD and OBX in the ORF~Z11 message definition in Appendix A (IVM*2*56)REDACTED5/20/04Updated the VA-Specific Patient Ineligible Segment (ZIE) table for seq. #s 5, 6 and 7 in Appendix B HL7 Table Segment Definitions (IVM*2*56)REDACTED5/20/04Updated the VA-Specific Military History Segment (ZMH) table for seq. #s 2, 3 and 4 in Appendix B HL7 Table Segment Definitions (IVM*2*56)REDACTED5/20/04Added Table VA038 - Military History Type in Appendix D - Supported/User-Defined VA HL7 Tables (IVM*2*56)REDACTED5/24/04Updated the VA-Specific Emergency Contact Segment (ZCT) table TBL# for SEQ 8 & 9 from VA01 To VA001 in Appendix B HL7 Table Segment Definitions (IVM*2*56)REDACTED5/24/04Updated the VA-Specific Patient Eligibility Segment (ZEL) table TBL# for seq. #s 2, 5, 8, 10, and 14-20 in Appendix B HL7 Table Segment Definitions (IVM*2*56). Also added missing information for seq. 29, Agent Orange Exposure Location, and new seq. #s 36, 37 and 38 in same VA-Specific Patient Eligibility Segment (ZEL) table.REDACTED5/27/04Added ZEL sequences 29, 37 & 38 to the ORU~Z07/ ORF~Z07 message definitions in Appendix A (IVM*2*56)REDACTED6/3/04Added COMBAT VETERAN END DATE (.5295) Enrollment Trigger Event to the Trigger Events Implemented via Cross-References table in Appendix A (IVM*2*56)REDACTED8/6/04Added ZEL sequence 22 to the ORF/ORU~Z07 HL7 message definitions and ZEL sequence 38 to the ORF/ORU~Z11 HL7 message definitions in Appendix A. Added sequence 33, Filipino Veteran Proof, to the ZPD (VA Specific Patient Info Segment) HL7 Segment Table Definitions in Appendix B. Added ZPD sequence 33 to the ORF/ORU~Z07 HL7 message definition in Appendix A. Added new Table VA048 - Filipino Veteran Proof in Appendix D. (IVM*2*97)REDACTED10/19/04Corrected Sequence 24 in the VA-Specific Patient Eligibility Segment (ZEL) table in Appendix B.REDACTED10/29/04Updated table of contents to include ZMH segment table and several supported HL7 reference tables.REDACTED11/04/04Added PID (Patient Identification Segment) sequence 2, PD1 Patient Demographic 1 Segment (SEQ 3), ZMT VA-Specific Means Test Information Segment sequences 22-29, ZMT VA-Specific LTC Test Information Segment (SEQ 1-5,7,9-10,12,16-18,22,25), ZCD VA-Specific Catastrophic Disability Segment sequences 6-13, ZIC VA-Specific Income Segment sequences 22 & 23, and OBX Observation/Result Segment sequence 12 to the ORF/ORU~Z07 HL7 message definitions in Appendix A.Deleted Sequences 5-12 in the Patient Demographic 1 Segment (PD1) table in the HL7 Segment Table Definitions in Appendix B.REDACTED11/10/04Added curly brackets indicating a repeating segment to the ZMH segment in the ORF/ORU~Z07/Z11 HL7 message definitions in Appendix A.REDACTED01/04/05Checked and updated for 508 compliance by adding alt text to graphics.REDACTED1/19/05Updates to ORU~Z05 message definition in Appendix AREDACTEDREDACTED1/19/05Updates to ZPD segment element names in Appendix BREDACTEDREDACTED4/22/05Updated ZPD segment, sequence length of Sequence 33, in Appendix B per email discussion with ESR team membersREDACTEDREDACTED4/22/05Added Table 0048 to Appendix CREDACTEDREDACTED4/22/05Added Table 0126 to Appendix CREDACTEDREDACTED4/22/05Updated ORU~Z07 message definition in Appendix A per email from Laurie SheppardREDACTEDREDACTED4/22/05Added supplemental data tables following the ZMH segment table in Appendix B per email from Pat WilsonREDACTEDREDACTED4/25/05Added Table 0017 (Transaction Type) to Appendix CREDACTEDREDACTED4/25/05Added Table 0105 (Source of Comment) to Appendix CREDACTEDREDACTED4/25/05Added Table 0005 (Race) to Appendix CREDACTEDREDACTED4/25/05Added Table 0006 (Religion) to Appendix CREDACTEDREDACTED4/25/05Added Table 0189 (Ethnic Group) to Appendix CREDACTEDREDACTED4/25/05Added Table 0136 (Yes/No Indicator) to Appendix CREDACTEDREDACTED4/25/05Added Table 0106 (Query/Response Format Code) to Appendix CREDACTEDREDACTED4/25/05Added Table 0091 (Query Priority) to Appendix CREDACTEDREDACTED4/25/05Added Table 0108 (Query Results Level) to Appendix CREDACTEDREDACTED4/25/05Added Table 0125 (Value Type) to Appendix CREDACTEDREDACTED4/25/05Added Table 0078 (Abnormal Flags) to Appendix CREDACTEDREDACTED4/25/05Added Table 0080 (Nature of Abnormal Testing) to Appendix CREDACTEDREDACTED4/25/05Added Table 0085 (Observation Result Status Codes Interpretation) to Appendix CREDACTEDREDACTED4/25/05Added Table 0283 (Referral Status) to Appendix CREDACTEDREDACTED4/25/05Added Table 0280 (Referral Priority) to Appendix CREDACTEDREDACTED4/25/05Added Table 0281 (Referral Type) to Appendix CREDACTEDREDACTED4/25/05Added Table 0282 (Referral Disposition) to Appendix CREDACTEDREDACTED4/25/05Added Table 0283 (Referral Category) to Appendix CREDACTEDREDACTED4/25/05Added Table VA041 (Determination Method) to Appendix DREDACTEDREDACTED4/29/05Added Table VA042 (Affected Extremity) to Appendix DREDACTEDREDACTED4/29/05Added Table VA043 (Condition Codes) to Appendix DREDACTEDREDACTED4/29/05Added Table VA045 (CD Permanent Indicator) to Appendix DREDACTEDREDACTED4/29/05Added Table VA017 (Enrollment Priority) to Appendix DREDACTEDREDACTED4/29/05Added Table VA022 (Radiation Exposure Method) to Appendix DREDACTEDREDACTED4/29/05Added Table VA036 (Military Sexual Trauma Status) to Appendix DREDACTEDREDACTED4/29/05Added placeholder for Table VA010 (Means Test Indicator) to Appendix DREDACTEDREDACTED4/29/05Added placeholder for Table VA060 (Type of Financial Test) to Appendix DREDACTEDREDACTED4/29/05Added Table VA012 (Type of Insurance) to Appendix DREDACTEDREDACTED4/29/05Added placeholder for Table 0176 (Master File Application Identifier) to Appendix CREDACTEDREDACTED4/29/05Added placeholder for Table 0102 (Delayed Acknowledgement Type) to Appendix CREDACTEDREDACTED4/29/05Added Table 0155 (Accept/Application Acknowledgement Conditions) to Appendix CREDACTEDREDACTED4/29/05Added Table 0211 (Alternate Character Sets) to Appendix CREDACTEDREDACTED4/29/05Added Table 0356 (Alternate Character Set Handling Scheme) to Appendix CREDACTEDREDACTED4/29/05Removed Table VA021 (Enrollment Priority) from Appendix D. (Replaced by Table VA017).REDACTEDREDACTED4/29/05Added code column to Table VA033 (Fee Basis Treatment Code Type) REDACTEDREDACTED4/29/05Added code column to Table VA034 (Fee Basis Program)REDACTEDREDACTED4/29/05Changed column heading Value to Code in all tables in Appendices C and DREDACTEDREDACTED4/29/05Added placeholder for Table 0072 (Insurance Plan ID) to Appendix CREDACTEDREDACTED4/29/05Added placeholder for Table 0132 (Transaction Code) to Appendix CREDACTEDREDACTED4/29/05Added placeholder for Table 0024 (Fee Schedule) to Appendix CREDACTEDREDACTED4/29/05Added placeholder for Table 0049 (Department Code) to Appendix CREDACTEDREDACTED4/29/05Added placeholder for Table 0018 (Patient Type) to Appendix C)REDACTEDREDACTED4/29/05Added placeholder for Table 0051 (Diagnosis Code) to Appendix CREDACTEDREDACTED4/29/05Added placeholder for Table 0084 (Performed by Code) to Appendix CREDACTEDREDACTED4/29/05Added placeholder for Table 0088 (Procedure Code) to Appendix CREDACTEDREDACTED4/29/05Added Placeholder for Table 0340 (Procedure Code Modifier) to Appendix CREDACTEDREDACTED4/29/05Added placeholder for Table 0296 (Primary Language) to Appendix CREDACTEDREDACTED4/29/05Added placeholder for Table 0171 (Citizenship) to Appendix CREDACTEDREDACTED4/29/05Added placeholder for Table 0172 (Veterans Military Status) to Appendix CREDACTEDREDACTED5/4/05Added Table VA010 (Means Test Indicator) to Appendix DREDACTEDREDACTED5/4/05Added Table 0132 (Transaction Code) to Appendix CREDACTEDREDACTED5/4/05Added Table VA060 (Type of Financial Test) to Appendix DREDACTEDREDACTED5/4/05Removed placeholder for Table 0176 (Master File Application Identifier) in Appendix C; removed references from all segment tables in Appendix BREDACTEDREDACTED5/4/05Added Table 0024 (Fee Schedule) to Appendix CREDACTEDREDACTED5/4/05Added Table 0018 (Patient Type) to Appendix C)REDACTEDREDACTED5/4/05Added Table 0102 (Delayed Acknowledgement Type) to Appendix CREDACTEDREDACTED5/4/05Added Table 0049 (Department Code) to Appendix CREDACTEDREDACTED5/4/05Added Table 0051 (Diagnosis Code) to Appendix CREDACTEDREDACTED5/4/05Removed placeholder for Table 0084 (Performed by Code) in Appendix C; removed references from all segment tablesREDACTEDREDACTED5/4/05Added Table 0088 (Procedure Code) to Appendix CREDACTEDREDACTED5/4/05Added Table 0340 (Procedure Code Modifier) to Appendix CREDACTEDREDACTED5/4/05Removed placeholder for Table 0296 (Primary Language) from Appendix C; removed references from all segment tables in Appendix BREDACTEDREDACTED5/4/05Removed placeholder for Table 0171 (Citizenship) to Appendix C; removed references from all segment tables in Appendix BREDACTEDREDACTED5/4/05Added Table 0172 (Veterans Military Status) to Appendix CREDACTEDREDACTED5/4/05Removed placeholder for Table 0072 (Insurance Plan ID) from Appendix C; removed references from all segment tables in Appendix BREDACTEDREDACTED5/4/05Removed references to IV tables from ZIV segment table in Appendix BREDACTEDREDACTED5/4/05Removed Table 0132 (Transaction Code) from Appendix C; removed reference from the FTI segment table in Appendix BREDACTEDREDACTED5/4/05Updated the FTI segment table in Appendix B based on email from Pat.REDACTEDREDACTED5/4/05Updated the ZIV segment table in Appendix B based on email from Pat. REDACTEDREDACTED9/20/05Updated ZPD segment table in Appendix B (IVM*2.0*113)REDACTEDREDACTED9/20/05Updated ORU~Z07, ORF~Z07, ORU~Z11, and ORF~Z11 message definitions in Appendix A (IVM*2.0*113)REDACTEDREDACTED9/22/05Updated Enrolment Trigger Events in Appendix AREDACTEDREDACTED10/25/05IVM Address Change Log File #301.7 added to Files List (IVM*2*108)REDACTEDREDACTED12/16/05IVM*2*109 – Enrollment VistA Changes Early Release – updated Table VA004 in Appendix DREDACTEDREDACTED12/16/05IVM*2*109 – Enrollment VistA Changes Early Release – updated Table VA015 in Appendix DREDACTEDREDACTED2/9/06IVM*2*109 – Enrollment VistA Changes Early Release – updated ZEL segment in Appendix BREDACTEDREDACTED2/9/06IVM*2*109 – Enrollment VistA Changes Early Release – modified the ORU~Z07 and ORF~Z07 message definitions in Appendix AREDACTEDREDACTED2/9/06IVM*2*109 – Enrollment VistA Changes Early Release – modified the ORU~Z11 and ORF~Z11 message definitions in Appendix AREDACTEDREDACTED3/16/06IVM*2*114 -Updated ORU~Z07, ORF~Z07, and ORF~Z11 message definitions in Appendix A REDACTEDREDACTED3/16/06IVM*2*114 -Added Table VA026 Military Service Component in Appendix D REDACTEDREDACTED3/18/06IVM*2*114 -Updated Enrollment Trigger Events in Appendix A REDACTEDREDACTED3/19/06IVM*2*114 -Updated ZPD segment table in Appendix B REDACTEDREDACTED5/22/06IVM*2*105 – Enrollment VistA Changes Release 1 - Modified the ORU~Z07 and ORF~Z07 message definitions in Appendix AREDACTEDREDACTED5/22/06IVM*2*105 – Enrollment VistA Changes Release 1 – updated the following segments in Appendix B:RF1ZCTZDPZELZIOZIRZMTZTAREDACTEDREDACTED5/23/06IVM*2*105 – Enrollment VistA Changes Release 1 – Added a portion of Table 0115 (Servicing Facility) to Appendix CREDACTEDREDACTED7/13/06IVM*2*21 (released 8/19/99) – National Reenrollment (a.k.a. Enrollment Phase Two) – removed Eligibility Code 21 (Catastrophically Disabled) from Table VA004 in Appendix DREDACTEDREDACTED8/30/06DG*5.3*656 – Add Field Triggers for ORU~Z07s – added enrollment trigger events to Appendix A for multiple fields listed in patch descriptionREDACTEDREDACTED9/14/06Retrofit changes made by REDACTED for IVM*2*114 - Operation Enduring & Iraqi Freedom (Z07 Enhancements) (See Revision History entries for 3/16/06-3/19/06.)REDACTEDREDACTED9/12/2006DG*5.3*656 – Add Field Triggers for ORU~Z07s – removed enrollment trigger events from Appendix A for five fields listed in patch descriptionREDACTEDREDACTED9/28/06IVM*2*105 – Enrollment VistA Changes Release 1 – Additional updates to segment tables in Appendix BREDACTEDREDACTED10/19/06IVM*2*105 – Enrollment VistA Changes Release 1 – Updated footers to reflect correct release month and patch numberREDACTEDREDACTED7/12/07IVM*2*105 – Enrollment VistA Changes Release 1 – Updated footers to reflect correct release month and patch number. Removed Draft indicators.REDACTEDREDACTED10/23/08IVM*2*115 - Enrollment VistA Changes Release 2 – Changed Environmental Contaminants to SW Asia Conditions. Updated ORU~Z10, ORF~Z10, ORU~Z11 & ORF~Z11 sections. Appendix B – HL7 Segment Table Definition updates.REDACTEDREDACTED10/30/08IVM*2*115 - Enrollment VistA Changes Release 2 – Updated ORU~Z07 & ORF~Z07 sections.REDACTEDREDACTED11/4/08IVM*2*115 - Enrollment VistA Changes Release 2 – Updated footer date to reflect new Release Date. Changed Austin Automation Center(AAC) to Austin Information Technology Center(AITC).REDACTEDREDACTED11/07/08IVM*2*115 - Enrollment VistA Changes Release 2 – Updated Z06, Z10 & Z11 sections per SQA . Removed Draft indicators.REDACTEDREDACTED3/18/09IVM*2*115 - Enrollment VistA Changes Release 2 – Updated footers to reflect new Release Date.REDACTEDREDACTED4/10/09DG*5.3*803 – Relaxed Priority Group 8 Changes – Added Code 8 to Table VA017 in Appendix D. Added sub-categories ‘b’ and ‘d’ to Table VA035 in Appendix D.REDACTEDREDACTED9/16/09IVM*2*121 –Veteran Online ApplicationsChanges- Updated IVM Transmission Error Processing Option. Added IVM Upload Insurance Screen. Added new sequence fields to HL7 messages.REDACTEDREDACTED5/19/10IVM*2*121 –Veteran Online ApplicationsChanges – Updated ZCT, ZPD sequences of ORU~Z04, ZPD, ZRD, ZDP seq. of ORU~Z07, ZPD, ZEM, ZDP seq. of ORF~Z07, ZDP seq. of ORU~Z10, ZDP seq. of ORF~Z10, ZDP seq. of ORU~Z11 data transmissions.REDACTEDREDACTED5/27/10IVM*2*121 –Veteran Online ApplicationsChanges – Enrollment Trigger Events Implemented via File Cross-References were added.REDACTEDREDACTED8/25/10IVM*2*121 –Veteran Online ApplicationsChanges – ESR 3.1_CCR10343 - removed PID-24 from the Z05 R10345 - removed ZPD-6 & ZPD-7 from the Z05 & Z07?R10346 - removed ZEM-4 & ZPD-6 from the?Z07?messages for the Veteran.Made changes to the ORF~Z07 PID segment to match the ORU~Z07 PID segment.REDACTEDREDACTED3/7/11 – 3/16/11IVM*2*TM_PFDG*5.3*838 made changes to Preferred Facility and the Z11 receiver; no associated IVM patch was necessary.Changes ESR 3.5_CR9620 – Added ZEN-14 to the ORF-Z11 and ORU-Z11 messages.Added Preferred Facility to the TriggersAdded ZEN 14 to the ZEN HL7 Message SegmentREDACTEDREDACTED7/1/11IVM*2*151 –Add a Person Changes – ESR 3.5CCR10441 – reversal of code to allow ORU-Z05 ZTA, ZEM and ZCT segmentsCCR10442 – reversal of code to allow ZPD-6 & ZPD-7 in the Z05 and Z07 messagesCCR10443 – reversal of code to allow ZEM-4 & ZPD-6 in the Z07 messageREDACTEDREDACTED10/12/11IVM*2*151 –Add a Person Changes – ESR 3.5Removed Draft indicator for final. Updated footer date from July to December.REDACTEDREDACTED11/19/2011IVM*2.0*141 - Updated ZMH tablesAdded information to SL, SNL, and SNNL rowsAdded MSD service indicators/qualifiers identified for the ZMH segment.REDACTEDREDACTED11/30/2011IVM*2.0*141 - Added MSD to the VA038 – Military History Type Table, updated footer dates to new Release Date.REDACTEDREDACTED12/5/2011IVM*2.0*141 - TW Review, minor formatting, removed Draft indicator for final review.REDACTEDREDACTED3/26/2012IVM*2*150 –VBA Pension Data Sharing Changes – ESR 3.6New HL7 message segment ZE2 added to patient data exchange table, and to ORU~Z07, ORF~Z07, QRY, ORF~Z11, ORU~Z11 message definitions. Added Pension Award trigger events in Appendix A table. Added VA-Specific Patient Eligibility (Addtl) Segment (ZE2) table in seg. definition section in Appendix B. Added SEQ. 12&13 (Class II Dental) to VA-Specific Service Period Segment (ZSP) table seg. definition section in Appendix B.TW Review – updated footers, formatting.REDACTEDREDACTED7/24/2012IVM*2.0*152 – Permanent Address Verification Changes – ESR 3.8Add new Referral Type PHH to RF1 segmentREDACTEDREDACTED1/8/2013IVM*2.0*152 – Permanent Address Verification Changes – ESR 3.8Updated footer date to December 2012 Release date.REDACTEDREDACTED4/16/2015IVM*2.0*158 – Catastrophic Disability Descriptor Changes – ES 4.1, ZCD segment changes; added VA440 tableREDACTEDREDACTED5/12/2015IVM*2.0*160 – Contributed to Spouse and BT Financial Indicator Changes – add Contributed to Spouse Indicator to VA-Specific Income Relation Segment (ZIR) HL7 Segment Table; add BTFI to the VA-Specific Means Test Information Segment (ZMT) HL7 Segment Table; add Contributed to Spouse - ZIR 15 to the ORF-Z07, ORU-Z07, ORF-Z10 and ORU-Z10 messages;add BT Financial Indicator - ZMT 31 sequence to the ORU-Z06, ORF-Z07, ORU-Z07, ORF-Z10 and ORU-Z10 messages.DG*5.3*906 – ACA Preference – add “ACA Preference” to Cancelled/Declined tableDG*5.3*871 – Health Benefit Plan – add ZHP to the HL7 Segments; add ZHP segment to the ORF-Z07, ORU-Z07, ORF-Z11 and ORU-Z11 messages; andadd VA-Specific Health Benefit Plan Segment (ZHP) to the HL7 Segment Tables. REDACTEDREDACTED11/05/2015TW review; DG_53_P891REDACTEDREDACTED11/23/15DG*5.3*890 – Added Contributed to Spousal Support (E40822^DGRTRIG) to Trigger EventsTW reviewREDACTEDREDACTED3/21/2016IVM*2.0*161 – Updated ZEL segment in ORU~Z07, ORF~Z07, ORF~Z11, and ORU~Z11 (Appendix A pp. 23, 25, 30, 31)Added CL-V trigger information (pp. 36-37)Added Camp Lejeune fields to the ZEL segment (p. 48).REDACTEDREDACTED09/06/2017DG*5.3*940 – Modified the ORU/ORF-Z11 message definitions on pages 30 and 31. Sequence 15 was added to the ZEN segment of these message definitions.Modified Appendix B - VA-Specific Enrollment Segment (ZEN). Added Sequence 15: Reason For Closed Application (Page 50).Modified Appendix D Table VA015 Enrollment Status. Code 24 - Closed Application added to table (page 82).New table VA117 - Reason For Closed Application added to Appendix D (Page 87).REDACTEDREDACTED11/06/2017DG*5.3*935 – Modified the ORU/ORF~Z11 message definitions on pages 30 and 31. Sequence 8 was added to the ZMH segment of these message definitions. Updated ZMH table (Appendix B p. 56) to include Future Discharge Date (Seq 8). IVM*2*167 - Updated ZMH table (Appendix B p. 56) with note that FDD will not occur on the ORU-07 and ORF-Z07.REDACTEDREDACTED10/24/2018DG*5.3*947 – Reason for Early Separation: Modified the ORU/ORF~Z11 message definitions on pages 30 and 31. Sequence 9 was added to the ZMH segment of these message definitions. Updated ZMH table (Appendix B p. 55) to include Reason for Early Separation (Seq 9). REDACTEDREDACTED12/05/2018DG*5.3*941 - Updated Table 0363 Source of Address to include VET360 code (p. 77).IVM*2.0*164 – Added VA-Specific Address Validation Segment ZAV to HL7 Message Segment Table (p. 18), ORU~Z05 Transmission (p. 20), ORU~Z07 Transmission (p. 23), and ORF~Z07 Transmission (p. 25); Updated Enrollment Trigger Events Table to include field RESIDENTIAL ADDR CHANGE DT/TM (#.1158) with the PATIENT(#2) File (p. 32); Updated IVM Trigger Events Table to include Residential Address Cross-References IVM1151 – IVM1157 and IVM11571 – IVM11573 (p. 37); Added VA-Specific Address Validation Segment (ZAV) Table (p. 46).REDACTEDREDACTED01/21/2019IVM*2.0*175 – Reason for Early Separation Code: Modified the ORU/ORF~Z11 message definitions on pages 30 and 31. Sequence 10 was added to the ZMH segment of these message definitions. Updated ZMH table (Appendix B p. 56) to include Reason for Early Separation Code (Seq 10).REDACTEDREDACTED01/21/2019IVM*2.0*172 – Other Health Insurance (OHI) to VistA: Updated the Insurance Segment (IN1) Table (Appendix B p. 40) to include VISTA Element Name and VISTA File Field or Expression for Insured’s Date of Birth (Seq. 18). Updated VA-Specific Message Processing Segment (ZIV) Table (Appendix B p. 54) to include Source of Information Code (Seq. 13).REDACTEDREDACTED09/09/2019IVM*2.0*180 – Updated ORU~Z07 and ORF~Z07 to include 7th – 10th sequence numbers in ZIO segment (p. 23, p. 25); Updated ORF~Z11 and ORU~Z11 to include ZIO segment (p. 30, p. 31); Updated ZIO segment to include Original Appointment fields 7 – 10 (p. 53).REDACTEDREDACTED12/02/2019IVM*2.0*183 – Medal of Honor (MOH) Awardees in Priority Group 1: Updated VA-Specific Military History Segment (ZMH) tables (Appendix B p. 57 and 58) to include MOH data elements in the existing fields. REDACTEDREDACTED1/16/2020IVM*2.0*184 – OTH: Updated ZEL segment to include OTH fields (#45-#47) and added new ZTE segment (p. 63-65).REDACTEDREDACTED02/20/2020IVM*2.0*191 – Updated the 4th sequence of a QRD segment in a QRY message to pass in the Integration Control Number (ICN) along with the patient’s DFN (p.30). Updated QRD table to change the length of the 4th sequence to 23 characters and add the ICN to be included in with the patient DFN (Appendix B p.43).REDACTEDREDACTED03/27/2020DG*5.3*1011 - EMERGENCY RESPONSE - PANDEMIC WORKLOAD REPORTING: Updated VA-Specific Patient Information Segment (ZPD) Table, SEQ 40 Emergency Response Indicator, to EMERGENCY RESPONSE INDICATOR Field (#.181) Value: P - PANDEMIC (p. 61).REDACTEDREDACTED08/10/2020IVM*2.0*193 - NOK/E-Contact Foreign Address, Hardship Expiration: Change ZGD 2 from required to optional in VA-Specific Guardian Segment (ZGD) Table (p. 51); added SEQ 32 to ZMT Segment of ORU-Z07 (p. 23), ORF-Z07 (p. 25), ORU-Z10 (p. 28), and ORF-Z10 (p. 29); added SEQ 32, Hardship Expiration Date to VA-Specific Means Test Information Segment (ZMT) Table, (p. 59).REDACTEDREDACTED08/24/2020IVM*2.0*162 – Registration Only Enrollment Status: Updated ORU~Z11 and ORF-Z11 to include 16th -19th sequence numbers in ZEN segment (p. 30, p. 31); Updated VA-Specific Enrollment Segment (ZEN) table to include 16th-19th sequence numbers (p. 50 - 51).REDACTEDREDACTED12/02/2020IVM*2.0*194: Added VA-Specific Community Care Eligibility Segment (ZCE) to HL7 Message Segments Table (p. 18); added ZCE Segment to ORU-Z07 (p. 23 ), ORF-Z07 (p. 25), ORF-Z11 (p. 30) and ORU-Z11 (p. 31); added ACCCP cross-references to Enrollment Trigger Events Table (p. 34); added VA-Specific Community Care Eligibility Segment (ZCE) Table (p. 47).IVM*2.0*162 – Registration Only Enrollment Status: Updated Table VA015 Enrollment Status to include Code 25 Registration Only (p. 87).REDACTEDREDACTED12/14/2020IVM*2.0*197: Added Table VA018 - Agency/Allied Country to Appendix D: Supported/User-Defined VA HL7 Tables (p. 87). REDACTEDREDACTED03/18/2021IVM*2.0*199: Updated Table VA018 – Agency/Allied Country to include 20 additional federal agencies (p. 87).REDACTEDREDACTED04/07/2021IVM*2.0*200: Updated Table VA018 – Agency/Allied Country to include 7 additional federal agencies (p. 87).REDACTEDREDACTED06/30/2021IVM*2.0*196: Renamed “ENROLLMENT APPLICATION DATE” to “APPLICATION DATE” (p. 33, 49).Added missing update related to patch DG*5.3*993: Added Table VA0047 – PATIENT REGISTRATION ONLY REASON (p. 91)REDACTEDREDACTED06/30/2021IVM*2.0*198 – Add Space Force Branch of Service: Updated Table VA011 Period of Service to change “AIR FORCE—ACTIVE DUTY” to “USAF, USSF - ACTIVE DUTY” (p. 85).REDACTEDREDACTED09/23/2021IVM*2.0*201 – Send user identifying information and change date/time in newly created ZUD segment of HL7 ORU/ORF~Z07 when contact information is modified (p. 24 and p. 26; ZUD – VA Specific VistA User Data Segment Table, p. 65). REDACTEDPM: REDACTEDAuth: Liberty ITS TW10/11/2021IVM*2.0*202 – Added new eligibility codes (24 – COMPACT ACT ELIGIBLE and 25 – SPECIAL TX AUTHORITY CARE) to Table VA004 – Eligibility (p. 82).REDACTEDPM: REDACTEDAuth: Liberty ITS TWTable of Contents TOC \o "2-3" \h \z \t "Heading 1,1,Title,1" Revision History PAGEREF _Toc78452153 \h iiIntroduction PAGEREF _Toc78452154 \h 1Background PAGEREF _Toc78452155 \h 1Functionality PAGEREF _Toc78452156 \h 1Implementation and Maintenance PAGEREF _Toc78452157 \h 3Routines PAGEREF _Toc78452158 \h 4Callable Routines PAGEREF _Toc78452159 \h 4Routines to Map PAGEREF _Toc78452160 \h 4Routine List PAGEREF _Toc78452161 \h 4Files PAGEREF _Toc78452162 \h 5Globals to Journal PAGEREF _Toc78452163 \h 5File List PAGEREF _Toc78452164 \h 5File Flow (Relationships Between Files) PAGEREF _Toc78452165 \h 5Exported Options PAGEREF _Toc78452166 \h 7Menu Diagram PAGEREF _Toc78452167 \h 7Archiving and Purging PAGEREF _Toc78452168 \h 9Archiving PAGEREF _Toc78452169 \h 9Purging PAGEREF _Toc78452170 \h 9Package-wide Variables PAGEREF _Toc78452171 \h 9SACC Exemptions/Non-Standard Code PAGEREF _Toc78452172 \h 9External/Internal Relations PAGEREF _Toc78452173 \h 10External Relations PAGEREF _Toc78452174 \h 10DBIA Agreements PAGEREF _Toc78452175 \h 10Internal Relations PAGEREF _Toc78452176 \h 10Security PAGEREF _Toc78452177 \h 11Security Management PAGEREF _Toc78452178 \h 11Security Keys PAGEREF _Toc78452179 \h 11VA FileMan Access Codes PAGEREF _Toc78452180 \h 12How to Generate On-line Documentation PAGEREF _Toc78452181 \h 13Xindex PAGEREF _Toc78452182 \h 13List File Attributes PAGEREF _Toc78452183 \h 13Glossary PAGEREF _Toc78452184 \h 14Appendix A – IVM Data Transmissions PAGEREF _Toc78452185 \h 16Purpose PAGEREF _Toc78452186 \h 16Scope PAGEREF _Toc78452187 \h 16General PAGEREF _Toc78452188 \h 16Communications Protocol PAGEREF _Toc78452189 \h 16Background Messages PAGEREF _Toc78452190 \h 16Batch Messages PAGEREF _Toc78452191 \h 17HL7 Message Event Types PAGEREF _Toc78452192 \h 17HL7 Message Segments PAGEREF _Toc78452193 \h 18HL7 Message Definitions PAGEREF _Toc78452194 \h 19SSN Data Transmission – (ORU~Z03) PAGEREF _Toc78452195 \h 19Insurance Data Transmission – (ORU~Z04) PAGEREF _Toc78452196 \h 20Demographic Data Transmission – (ORU~Z05) PAGEREF _Toc78452197 \h 20Date of Death Transmission – (ORU~Z05) PAGEREF _Toc78452198 \h 20Guardian Data Transmission – (ORU~Z05) PAGEREF _Toc78452199 \h 21Means Test Data Transmission – (ORF~Z06) NOTE: This message has been retired. PAGEREF _Toc78452200 \h 22Means Test Data Transmission – (ORU~Z06) PAGEREF _Toc78452201 \h 22Full Data Transmission – (ORU~Z07) PAGEREF _Toc78452202 \h 23Full Data Transmission – (ORF~Z07) PAGEREF _Toc78452203 \h 25Case Status Data Transmission – (ORU~Z08) (Message has been retired) PAGEREF _Toc78452204 \h 26Billing/Collection Data Transmission – (ORU~Z09) PAGEREF _Toc78452205 \h 26Billing/Collection Data Transmission – (ORU~Z09) PAGEREF _Toc78452206 \h 26Income Test Data Transmission – (ORU~Z10) PAGEREF _Toc78452207 \h 27Income Test Data Transmission – (ORF~Z10) PAGEREF _Toc78452208 \h 27VISTA Initiated – Enrollment/Eligibility Query Data Transmission – (QRY) PAGEREF _Toc78452209 \h 29Enrollment/Eligibility Data Transmission – (ORF~Z11) PAGEREF _Toc78452210 \h 29Enrollment/Eligibility Data Transmission – (ORU~Z11) PAGEREF _Toc78452211 \h 30Trigger Events PAGEREF _Toc78452212 \h 31Enrollment Trigger Events PAGEREF _Toc78452213 \h 31IVM Trigger Events PAGEREF _Toc78452214 \h 36Appendix B – HL7 Segment Table Definitions PAGEREF _Toc78452215 \h 38HL7 Abbreviated Column Headings PAGEREF _Toc78452216 \h 38HL7 Data Types PAGEREF _Toc78452217 \h 38HL7 Segment Tables PAGEREF _Toc78452218 \h 39Financial Transaction (FTI) PAGEREF _Toc78452219 \h 39Insurance Segment (IN1) PAGEREF _Toc78452220 \h 40Notes and Comments Segment (NTE) PAGEREF _Toc78452221 \h 41Patient Identification Segment (PID) PAGEREF _Toc78452222 \h 42Patient Demographic 1 Segment (PD1) PAGEREF _Toc78452223 \h 42Query Definition Segment (QRD) PAGEREF _Toc78452224 \h 43Observation/Result Segment (OBX) PAGEREF _Toc78452225 \h 43Query Filter Segment (QRF) PAGEREF _Toc78452226 \h 44Referral Information Segment (RF1) PAGEREF _Toc78452227 \h 44VA-Specific Address Validation Segment (ZAV) PAGEREF _Toc78452228 \h 45VA-Specific Beneficiary Travel Segment (ZBT) PAGEREF _Toc78452229 \h 45VA-Specific Catastrophic Disability Segment (ZCD) PAGEREF _Toc78452230 \h 45VA-Specific Community Care Eligibility Segment (ZCE) PAGEREF _Toc78452231 \h 46VA-Specific Emergency Contact Segment (ZCT) PAGEREF _Toc78452232 \h 46VA-Specific Patient Dependent Information Segment (ZDP) PAGEREF _Toc78452233 \h 47VA-Specific Patient Eligibility Segment (ZEL) PAGEREF _Toc78452234 \h 47VA-Specific Patient Eligibility (Addtl) Segment (ZE2) PAGEREF _Toc78452235 \h 48VA-Specific Employment Information Segment (ZEM) PAGEREF _Toc78452236 \h 48VA-Specific Enrollment Segment (ZEN) PAGEREF _Toc78452237 \h 49VA-Specific Fee Basis Segment (ZFE) PAGEREF _Toc78452238 \h 51VA-Specific Guardian Segment (ZGD) PAGEREF _Toc78452239 \h 52VA-Specific Income Information Segment (ZIC) – old format PAGEREF _Toc78452240 \h 53VA-Specific Income Information Segment (ZIC) – Feb 2005 1010EZ format PAGEREF _Toc78452241 \h 54VA-Specific Health Benefit Plan Segment (ZHP) PAGEREF _Toc78452242 \h 54VA-Specific Patient Ineligible Segment (ZIE) PAGEREF _Toc78452243 \h 55VA-Specific Inpatient/Outpatient Information Segment (ZIO) PAGEREF _Toc78452244 \h 55VA-Specific Income Relation Segment (ZIR) PAGEREF _Toc78452245 \h 55VA-Specific Message Processing Segment (Ziv) PAGEREF _Toc78452246 \h 56VA-Specific Military History Segment (ZMH) PAGEREF _Toc78452247 \h 57VA-Specific Means Test Information Segment (ZMT) PAGEREF _Toc78452248 \h 59VA-Specific Patient Information Segment (ZPD) PAGEREF _Toc78452249 \h 61VA-Specific Rated Disabilities Segment (ZRD) PAGEREF _Toc78452250 \h 62VA-Specific Service Period Segment (ZSP) PAGEREF _Toc78452251 \h 62VA-Specific Temporary Address Segment (ZTA) PAGEREF _Toc78452252 \h 63VA Specific Temporary Eligibility Segment (ZTE) PAGEREF _Toc78452253 \h 63Batch Header Segment (BHS) PAGEREF _Toc78452254 \h 65Batch Trailer Segment (BTS) PAGEREF _Toc78452255 \h 66Message Header Segment (MSH) PAGEREF _Toc78452256 \h 66Message Acknowledgment Segment (MSA) PAGEREF _Toc78452257 \h 67Master File Identification Segment (MFI) PAGEREF _Toc78452258 \h 67Master File Entry Segment (MFE) PAGEREF _Toc78452259 \h 67Location Identification Segment (LOC) PAGEREF _Toc78452260 \h 68Appendix C – Supported/User-Defined Standard HL7 Tables PAGEREF _Toc78452261 \h 69Table 0001 – Sex PAGEREF _Toc78452262 \h 69Table 0002 – Marital Status PAGEREF _Toc78452263 \h 69Table 0003 – Event Type Codes PAGEREF _Toc78452264 \h 69Table 0005 – Race PAGEREF _Toc78452265 \h 69Table 0006 – Religion PAGEREF _Toc78452266 \h 70Table 0008 – Acknowledgment Code PAGEREF _Toc78452267 \h 71Table 0017 – Transaction Type PAGEREF _Toc78452268 \h 71Table 0018 – Patient Type PAGEREF _Toc78452269 \h 72Table 0024 – Fee Schedule PAGEREF _Toc78452270 \h 72Table 0048 – What Subject Filter PAGEREF _Toc78452271 \h 73Table 0049 – Department Code PAGEREF _Toc78452272 \h 73Table 0051 – Diagnosis Code PAGEREF _Toc78452273 \h 74Table 0076 – Message Type PAGEREF _Toc78452274 \h 74Table 0078 – Abnormal Flags PAGEREF _Toc78452275 \h 74Table 0080 – Nature of Abnormal Testing PAGEREF _Toc78452276 \h 75Table 0085 – Observation Result Status Codes Interpretation PAGEREF _Toc78452277 \h 75Table 0088 – Procedure Code PAGEREF _Toc78452278 \h 75Table 0091 – Query Priority PAGEREF _Toc78452279 \h 75Table 0102 – Delayed Acknowledgement Type PAGEREF _Toc78452280 \h 75Table 0103 – Processing ID PAGEREF _Toc78452281 \h 76Table 0104 – Version ID PAGEREF _Toc78452282 \h 76Table 0105 – Source of Comment PAGEREF _Toc78452283 \h 76Table 0106 – Query/Response Format Code PAGEREF _Toc78452284 \h 76Table 0108 – Query Results Level PAGEREF _Toc78452285 \h 76Table 0115 – Servicing Facility PAGEREF _Toc78452286 \h 76Table 0125 – Value Type PAGEREF _Toc78452287 \h 77Table 0126 – Quantity Limited Request PAGEREF _Toc78452288 \h 77Table 0136 – Yes/No Indicator PAGEREF _Toc78452289 \h 77Table 0155 – Accept/Application Acknowledgment Conditions PAGEREF _Toc78452290 \h 77Table 0172 – Veterans Military Status PAGEREF _Toc78452291 \h 78Table 0175 – Master File Identifier Code PAGEREF _Toc78452292 \h 78Table 0178 – File Level Event Code PAGEREF _Toc78452293 \h 78Table 0179 – Response Level PAGEREF _Toc78452294 \h 78Table 0180 – Record Level Event Code PAGEREF _Toc78452295 \h 78Table 0189 – Ethnic Group PAGEREF _Toc78452296 \h 78Table 0211 – Alternate Character Sets PAGEREF _Toc78452297 \h 79Table 0280 – Referral Priority PAGEREF _Toc78452298 \h 79Table 0281 – Referral Type PAGEREF _Toc78452299 \h 79Table 0282 – Referral Disposition PAGEREF _Toc78452300 \h 79Table 0283 – Referral Status PAGEREF _Toc78452301 \h 79Table 0284 – Referral Category PAGEREF _Toc78452302 \h 80Table 0340 – Procedure Code Modifier PAGEREF _Toc78452303 \h 80Table 0356 – Alternate Character Set Handling Scheme PAGEREF _Toc78452304 \h 80Table 0363 – Source of Address PAGEREF _Toc78452305 \h 80Appendix D – Supported/User-Defined VA HL7 Tables PAGEREF _Toc78452306 \h 81Table VA001 – Yes/No PAGEREF _Toc78452307 \h 81Table VA002 – Current Means Test Status PAGEREF _Toc78452308 \h 81Table VA003 – Employment Status PAGEREF _Toc78452309 \h 81Table VA004 – Eligibility PAGEREF _Toc78452310 \h 82Table VA005 – Disability Retirement From Military PAGEREF _Toc78452311 \h 82Table VA006 – Eligibility Status PAGEREF _Toc78452312 \h 82Table VA007 – Race PAGEREF _Toc78452313 \h 83Table VA008 – Religion PAGEREF _Toc78452314 \h 83Table VA009 – Relationship Number PAGEREF _Toc78452315 \h 84Table VA010 – Means Test Indicator PAGEREF _Toc78452316 \h 84Table VA011 – Period of Service PAGEREF _Toc78452317 \h 85Table VA012 – Type of Insurance PAGEREF _Toc78452318 \h 85Table VA013 – Rated Disabilities PAGEREF _Toc78452319 \h 86Table VA014 – Medication Copayment Exemption Status PAGEREF _Toc78452320 \h 86Table VA015 – Enrollment Status PAGEREF _Toc78452321 \h 86Table VA016 – Reason Enrollment Canceled/Declined PAGEREF _Toc78452322 \h 86Table VA017 – Enrollment Priority PAGEREF _Toc78452323 \h 87Table VA018 – Agency/Allied Country PAGEREF _Toc78452324 \h 87Table VA022 - Radiation Exposure Method PAGEREF _Toc78452325 \h 88Table VA026 - Military Service Component PAGEREF _Toc78452326 \h 88Table VA033 - Fee Basis Treatment Code Type PAGEREF _Toc78452327 \h 88Table VA034 - Fee Basis Program PAGEREF _Toc78452328 \h 88Table VA035 - Enrollment Sub-Group PAGEREF _Toc78452329 \h 89Table VA036 - Military Sexual Trauma Status PAGEREF _Toc78452330 \h 89Table VA038 - Military History Type PAGEREF _Toc78452331 \h 89Table VA0040 - Enrollment Group Threshold Type PAGEREF _Toc78452332 \h 90Table VA041 - Determination Method PAGEREF _Toc78452333 \h 90Table VA042 - Affected Extremity PAGEREF _Toc78452334 \h 90Table VA043 - Condition Codes PAGEREF _Toc78452335 \h 90Table VA045 - CD Permanent Indicator PAGEREF _Toc78452336 \h 90Table VA0047 - PATIENT REGISTRATION ONLY REASON Values PAGEREF _Toc78452337 \h 91Table VA048 - Filipino Veteran Proof PAGEREF _Toc78452338 \h 91Table VA0051 - Means Test Signature Status PAGEREF _Toc78452339 \h 91Table VA0052 - NTR Verification Method PAGEREF _Toc78452340 \h 91Table VA0053 - NTR Qualifiers PAGEREF _Toc78452341 \h 92Table VA060 - Type of Financial Test PAGEREF _Toc78452342 \h 92Table VA061 - Invalid Address Reason PAGEREF _Toc78452343 \h 92Table VA0115 - Servicing Facility PAGEREF _Toc78452344 \h 92Table VA117 - Reason For Closed Application PAGEREF _Toc78452345 \h 92Table VA440 – CD Descriptors PAGEREF _Toc78452346 \h 92IntroductionBackgroundPublic Law 101-508 permits the Department of Veterans Affairs (VA) to verify income data with the Internal Revenue Service (IRS) and Social Security Administration (SSA) for veterans receiving VA health care services whose eligibility for medical care is based on income. The income verification match process for Veterans Health Administration (VHA) medical facilities is centralized and performed at the Health Eligibility Center (HEC) in Atlanta, Georgia.FunctionalityIVM provides all of the functionality required to complete the eligibility verification process; electronically receive the revised VA Form 10-10F from the HEC; and automatically file the updated test in the VistA Means Test module.User Interactive FunctionsNoninteractive FunctionsView/verify patient demographic, insurance, and SSN information received from SSA and IRS.Upload verified data.View billing/collection and Means Test activity.Configure, monitor, and purge the IVM system.Exchange of data, on an ad hoc basis, between your facility and the HEC via electronic transmissions.Scheduled transmission to the HEC of all Means Tests meeting IVM criteria, as well as IVM-related billing and collections activity, via the IVM Background Job option.Note: Certain enrollment events, when they occur, are also sent to the HEC via the nightly background job.Related ManualsIVM V. 2.0 User ManualIVM V. 2.0 Installation GuideIVM V. 2.0 Release NotesIntegrationIVM V. 2.0 provides functionality that impacts Registration, Medical Care Cost Recovery (MCCR), and Information Resource Management (IRM) staff at your facility. It is highly integrated with the following packages.Package NameIntegrationPatient Information Management System (PIMS)PIMS demographic, Means Test, enrollment, eligibility, and income information is sent to the HEC.Means Test and demographic information verified by the HEC is uploaded into PIMS files.Integrated Billing (IB)IB provides billing and collections information, for billings resulting from IVM activity, that is transmitted back to the HEC and the Enrollment Database (EDB).Health Level 7 (HL7)Provides the foundation for all communications between your facility and the HEC.Implementation and MaintenanceThere are three parameters included with the IVM software. These parameters, which can be edited through the IVM Parameter Enter/Edit option, control whether notification messages are sent to the IVM MESSAGES mail group when SSN, demographic, and insurance information is received from the HEC. If no entry is made, the default action is to generate the messages. This option may be used to inactivate the messages.The background option IVM Background Job must be queued to run daily. It is recommended that it is run during non-peak hours. The option will transmit the following information to the HEC: Means Test, patient demographic, eligibility, income test, insurance, enrollment, and IVM-related billing and collections.All IVM notifications generated by the system are sent to the IVM Messages mail group. At a minimum, both the IRM Support Specialist and the IVM systems coordinator should be added as members of this group. No data in the IVM files should be edited. This data is added and maintained automatically by the module.RoutinesPer VHA Directive 10-93-142 regarding security of software that affects financial systems, most of the IVM routines may not be modified. The third line of routines that may not be modified is so noted. The IVM output routines in the IVMR* namespace are exempt from this requirement.Callable RoutinesThe IVM package has no supported callable routines.Routines to MapIt is recommended that the following routines be mapped.IVML*IVMR*IVMU*Routine ListTake the following steps to obtain a list of routines in the IVM V. 2.0 software:1. Programmer Options Menu2. Routine Tools Menu3. First Line Routine Print Option4. Routine Selector: IVM*FilesGlobals to JournalThe IVM global is the only global used with the IVM software and it should be journaled.File ListPer VHA Directive 10-93-142 regarding security of software that affects financial systems, the IVM Data Dictionaries may not be modified. The file descriptions of these files are so noted.File NumberFile NameGlobal301.5IVM PATIENT^IVM(301.5301.6IVM TRANSMISSION LOG^IVM(301.6301.61IVM BILLING TRANSMISSION^IVM(301.61301.63IVM EXTRACT MANAGEMENT^IVM(301.63301.7IVM ADDRESS CHANGE LOG^IVM(301.7301.9IVM SITE PARAMETER^IVM(301.9301.91*IVM REASONS FOR NOT UPLOADING INSURANCE^IVM(301.91301.92*IVM DEMOGRAPHIC UPLOAD FIELDS^IVM(301.92301.93*IVM CASE CLOSURE REASON^IVM(301.93*File comes with dataTake the following steps to obtain information about the files and templates in the IVM software:File Flow (Relationships Between Files) 1. VA FileMan Menu2. Data Dictionary Utilities Menu3. List File Attributes Option4. Enter File # or range of File #s5. Select Listing Format: Standard6. You will see what files point to the selected file. To see what files the selected file points to, look for fields that say, “POINTER TO”.Templates1. VA FileMan Menu2. Print File Entries Option3. Output from what File:Print TemplateSort TemplateInput TemplateList Template4. Sort by: Name5. Start with name: IVM6. Within name, sort by: <RET>7. First print field: NameExported OptionsTake the following are the steps to obtain information about menus, exported protocols, exported options, and exported remote procedures relating to the IVM package.Menu Diagram1. Programmers Options2. Menu Management Menu3. Display Menus and Options Menu4. Diagram Menus5. Select User or Option Name: O.IVM MAIN MENUExported Protocols1. VA FileMan Menu2. Print File Entries Option3. Output from what File: PROTOCOL4. Sort by: Name5. Start with name: IVM6. Within name, sort by: <RET>7. First print field: NameExported Options1. VA FileMan Menu2. Print File Entries Option3. Output from what File: OPTION4. Sort by: Name5. Start with name: IVM6. Within name, sort by: <RET>7. First print field: NameExported Remote Procedures1. VA FileMan Menu2. Print File Entries Option3. Output from what File: REMOTE PROCEDURE4. Sort by: Name5. Start with name: IVM6. Within name, sort by: <RET>7. First print field: NameArchiving and PurgingArchiving There are no archiving capabilities included with the IVM software.Purging The Purge IVM Transmissions option allows IRM to purge entries from the IVM TRANSMISSION LOG File (#301.6) which are associated with closed cases (entries in the IVM PATIENT File (#301.5)) from the previous Means Test year).Package-wide VariablesThere are no package-wide variables associated with the IVM software package.SACC Exemptions/Non-Standard Code There are no SACC Exemptions associated with the IVM software package.External/Internal RelationsExternal Relations The following VistA package versions (or higher) MUST be installed PRIOR to loading this version of IVM.Kernel V. 7.1VA FileManV. 20.0PIMS V. 5.3Integrated Billing V. 2.0OERR V. 2.5VISTA HL7 V. 1.6DBIA Agreements Take the following steps to obtain database integration agreements for the IVM package.Custodial PackageSubscriber PackageFORUMDBA MENUIntegration Agreement Menu Custodial Package MenuActive by Custodial Package OptionSelect Package Name: IVMForumDBA MENUIntegration Agreement MenuSubscriber Package MenuPrint Active by Subscriber Package OptionStart with subscriber package: IVMInternal Relations All of the IVM V. 2.0 package options have been designed to stand alone.SecuritySecurity ManagementPublic Law 101-508 permits the Department of Veterans Affairs (VA) to verify income data with the Internal Revenue Service (IRS) and Social Security Administration (SSA) for veterans receiving VA health care services whose eligibility for medical care is based on income. The IVM process for Veterans Health Administration (VHA) medical facilities is centralized and performed at the HEC in Atlanta, Georgia.Per VHA Directive 10-93-142 regarding security of software that affects financial systems and central data bases, IVM routines may not be modified with the following exception: IVMR* - IVM Reports. In compliance with this same directive, the IVM Data Dictionaries may not be modified.Security Keys Take the following steps to obtain information about the security keys contained in the IVM software:VA FileMan MenuPrint File EntriesOutput From What File: Security KeySort By: NameStart With Name: First// IVMGo To Name: Last// IVMZWithin Name, Sort By: <RET>First Print Field: NameThen Print Field: DescriptionVA FileMan Access Codes The following is a list of recommended VA FileMan access codes for the files in the IVM software.File NumberFile NameDD AccessRD AccessWR AccessDEL AccessLAYGO Access301.5IVM PATIENT@@@@301.6IVM TRANSMISSION LOG@@@@301.61IVM BILLING TRANSMISSION@@@@301.63IVM EXTRACT MANAGEMENT@@@@301.7IVM ADDRESS CHANGE LOG@@@@301.9IVM SITE PARAMETER@@@@301.91IVM REASONS FOR NOT UPLOADING INSURANCE@@@@301.92IVM DEMOGRAPHIC UPLOAD FIELDS@@@@301.93IVM CASE CLOSURE REASON@@@@How to Generate On-line DocumentationThis section describes some of the various methods by which users may secure IVM technical documentation. On-line technical documentation pertaining to the IVM software, in addition to that which is located in the help prompts, may be generated through utilization of several Kernel options, including those listed in this section. Refer to the VistA Kernel Reference Manual for further information about other utilities which supply on-line technical documentation.Xindex This option analyzes the structure of a routine(s) to determine in part if the routine(s) adheres to VistA Programming Standards. The XINDEX output may include the following components: compiled list of errors and warnings, routine listing, local variables, global variables, naked globals, label references, and external references. By running XINDEX for a specified set of routines, the user might discover any deviations from VistA Programming Standards which exist in the selected routine(s) and see how routines interact with one another, that is, which routines call or are called by other routines.To run XINDEX for the IVM package, specify the IVM namespace at the “routine(s) ?>” prompt. IVM initialization routines which reside in the UCI in which XINDEX is being run, as well as local routines found within the IVM namespace, should be omitted at the “routine(s)?>” prompt. To omit routines from selection, preface the namespace with a minus sign (-).List File Attributes This VA FileMan option allows the user to generate documentation pertaining to files and file structure. Using this option via the “Standard” format will yield the following data dictionary information for a specified file(s): file name and description, identifiers, cross-references, files pointed to by the file specified, files which point to the file specified, input templates, print templates, and sort templates. In addition, the following applicable data is supplied for each field in the file: field name, number, title, global location, description, help prompt, cross-reference(s), input transform, date last edited, and notes.Using the “Global Map” format of this option generates an output which lists all cross-references for the file selected, global location of each field in the file, input templates, print templates, and sort templates, when applicable. For a comprehensive list of IVM files, please refer to the FILES section of this manual.GlossaryThis glossary contains terms and their definitions as they relate to the IVM package.Category A veteranA patient who, as a result of Means Testing, is in the mandatory category in regard to eligibility for VA care.Category C veteranA patient who, as a result of Means Testing, is in the discretionary category in regard to eligibility for VA care.Enrollment Database (EDB)Oracle database physically located at the Austin Information Technology Center (AITC), formerly known as the Austin Automation Center, that will be the central repository for enrollment, eligibility, means test and IVM data.Full Data TransmissionA complete information profile transmitted to the HEC containing patient demographic, eligibility, Means Test, income, insurance, and enrollment information.HECHealth Eligibility Center (formerly IVM Center)HL7Health Level 7 is an interface specification designed to standardize the way in which health care information is transferred between systems. IVM utilizes the VistA HL7 package to assist in transporting data using this specification.IRSInternal Revenue ServiceIVMIncome Verification Match. A program designed to verify income and insurance data reported by the veteran with that received from IRS (Internal Revenue Service), SSA (Social Security Administration), and other sources.Means TestEligibility for VA hospital care and nursing home care is divided into two categories – mandatory and discretionary. An income assessment is made to determine whether a non service-connected veteran, who is not in receipt of VA monetary benefits or otherwise exempt from income assessment, is eligible for cost-free VA medical care. This income assessment is known as “Means Testing”. Patients whose income is above the defined income levels must agree to make copayments to VA for outpatient and inpatient care rendered. SSASocial Security AdministrationSuggested SSNPatient or spouse SSNs returned from SSA as possible matches based on name, sex, and date of birth. These SSNs will be validated by the HEC before being returned to the field facilities.Third Party ClaimWhen a party other than the patient, such as an insurance company, is billed.Appendix A – IVM Data TransmissionsBasic knowledge of the HL7 protocol is assumed and the information contained in the HL7 protocol will not be repeated here. Further information concerning the HL7 protocol may be found in the HL7 Interface Standards V. 2.3.1.PurposeThis document specifies the purpose of the interface between the VistA IVM package and the HEC (non- VistA) system based on the HL7 protocol. It is intended that this interface form the basis for exchange of healthcare information between the VistA IVM package and the HEC system.ScopeThis document describes the messages that are exchanged between the VistA IVM package and the HEC (non- VistA) system for the purpose of exchanging income test, demographic, insurance, and enrollment information.GeneralThis application uses the abstract message approach and encoding rules specified by HL7. HL7 is used for communicating data associated with various events that occur in healthcare environments. For example, when a Means Test is added in VistA, the event will trigger a Full Data Transmission message to the munications ProtocolHL7 V. 1.6 of the VA MailMan lower level protocol (LLP) will be used to transmit HL7 messages between the local site and the HEC.Background MessagesOn a daily basis, the data associated with various events that occur in VistA will be transmitted to the HEC. The IVM Background Job option will be used to transmit a HL7 unsolicited Full Data Transmission (ORU~Z07) for each VistA event occurring that day.Batch MessagesAll HL7 unsolicited messages sent from the VistA IVM application and received from the HEC (non- VistA) system will be in a batch format. Each batch will contain 1-100 messages/records per batch.HL7 Message Event TypesIVM V. 2.0 supports the receipt and transmission of the following HL7 message event types (data transmissions).HL7 Transmission NameHL7 MESSAGE TYPEHL7 Event CodeSSN Data TransmissionORUZ03Insurance Data TransmissionORUZ04Follow-up Data TransmissionORUZ04Demographic Data TransmissionORUZ05Means Test Data TransmissionORF/ORUZ06Full Data TransmissionORF/ORUZ07Case Status Data TransmissionORUZ08Billing/Collection Data TransmissionORUZ09Income Test Data TransmissionORU/ORFZ10Enrollment/Eligibility Data TransmissionORF/ORUZ11VISTA – Initiated Enrollment/Eligibility Query TransmissionQRYQRYIVM – Initiated Query TransmissionQRYQRYHL7 Message SegmentsIVM V.2.0 utilizes the following HL7 segments to support the exchange of patient data.Segment IDSegment NameBHSBatch Header SegmentBTSBatch Trailer SegmentFT1Financial SegmentIN1Insurance SegmentLOCLocation Identification SegmentMFAMaster File AcknowledgementMFEMaster File Entry SegmentMFIMaster File Identification SegmentMSAMessage AcknowledgementMSHMessage HeaderNTENotes And Comments SegmentOBXObservation/Result SegmentPD1Patient Demographic 1 ScreenPIDPatient Identification SegmentQRDQuery Definition SegmentQRFQuery Filter SegmentRF1Referral Information SegmentZAVVA-Specific Address Validation SegmentZBTVA-Specific Beneficiary Travel SegmentZCDVA-Specific Catastrophic Disability SegmentZCEVA-Specific Community Care Eligibility SegmentZCTVA-Specific Emergency Contact SegmentZDPVA-Specific Patient Dependent Information SegmentZEGVA Specific Enrollment Group Threshold SegmentZELVA-Specific Patient Eligibility SegmentZE2VA-Specific Patient Eligibility (Addtl) SegmentZEMVA-Specific Employment Information SegmentZHPVA-Specific Health Benefit Plan SegmentZENVA-Specific Enrollment SegmentZFEVA-Specific Fee Basis SegmentZGDVA-Specific Guardian SegmentZICVA-Specific Income SegmentZIEVA-Specific Patient Ineligible SegmentZIOVA-Specific Inpatient/Outpatient Information SegmentZIRVA-Specific Income Relation SegmentZIVVA-Specific Message Processing SegmentZMHVA-Specific Military History SegmentZMTVA-Specific Means Test/Copay Test Information SegmentZPDVA-Specific Patient Information SegmentZRDVA-Specific Rated Disabilities SegmentZSPVA-Specific Service Period SegmentZTAVA-Specific Temporary Address SegmentZTEVA Specific Temporary Eligibility SegmentHL7 Message DefinitionsIn this section, the following elements will be defined for each HL7 message. Message TypeMessage Event CodeAbstract Message Syntax (list of segments used in the message)List of Data Fields (sequence numbers used for each segment)An HL7 message is composed of individual HL7 segments. Each individual segment contains logical groupings of data. The Braces { } indicate one or more repetitions of the enclosed group of segments. The Brackets [ ] indicate that a segment may be optional. For each message, there will be a list of HL7 standard segments or VA-specific “Z” segments used in the message. The data fields (represented by sequence numbers) utilized in each segment will also be specified. The HL7 Transmission/Event Type Codes are annotated beside each message type.Please note that an ORF transmission contains the MSA and QRD segments, but the ORU transmission does not.SSN Data Transmission – (ORU~Z03)The SSN data transmission transmits new veteran or spouse social security numbers to your facility from the HEC.BHSBatch Header Segment{MSHMessage HeaderPIDPatient Identification Segment (SEQ 1,3,5,7,19)ZIVVA-Specific Message Processing Segment (SEQ 1-7,12)}BTSBatch TrailerInsurance Data Transmission – (ORU~Z04)The insurance data transmission transmits patient insurance information to your facility from HEC.BHSBatch Header{MSHmessage headerPIDPatient Information Segment (SEQ 1-3,5,7,19)IN1Insurance Segment (SEQ 1,4,5,7-9,12,13,15-18,28,36)ZIVVA-Specific Message Processing Segment (SEQ 1,9,13)}BTSBatch TrailerFollow-up insurance data transmissions are transmitted from your facility to alert the HEC as to the action taken regarding insurance information acceptance or rejection. The format for the responding transmission follows (message will NOT be batched).MSHMessage HeaderPIDPatient Identification Segment (SEQ 1,2,3,5,7,19)IN1Insurance Segment (SEQ 1,4, 36)ZIVVA-Specific Message Processing Segment (SEQ 1,9-11)Demographic Data Transmission – (ORU~Z05)Newly identified or updated demographic-type information for a patient transmitted from the HEC to the VAMC. BHSBatch Header{MSHMessage HeaderPIDPatient Identification Segment (SEQ 1-3, 5,7, 8, 10,11,13, 16-17, 19, 22,24)ZPDVA-Specific Patient Info Segment (SEQ 1,6,7,30, 34)ZTAVA-Specific Temporary Address Segment (SEQ 1-9){ZAVVA-Specific Address Validation Segment (SEQ 1-3)}ZGDVA-Specific Guardian Segment (SEQ 1)ZCT VA-Specific Emergency Contact Segment (SEQ 1-7, 10)}ZEM VA-Specific Employment Info Segment (SEQ 1-7, 9)}RF1Referral Information Segment (SEQ 3,6,7)BTSBatch TrailerDate of Death Transmission – (ORU~Z05)Newly identified or updated date of death-type information for a patient transmitted from the HEC to the VAMC. BHSBatch Header{MSHMessage HeaderPIDPatient Identification Segment (SEQ 1-3, 5,7, 8,19)ZPDVA-Specific Patient Info Segment (SEQ 1, 9, 31,32)ZTAVA-Specific Temporary Address Segment (SEQ)ZGDVA-Specific Guardian Segment (SEQ)ZCT VA-Specific Emergency Contact Segment (SEQ)ZEM VA-Specific Employment Info Segment (SEQ)RF1Referral Information Segment (SEQ )BTSBatch TrailerGuardian Data Transmission – (ORU~Z05)Newly identified or updated VA Guardian-type information for a patient transmitted from the HEC to the VAMC. BHSBatch Header{MSHMessage HeaderPIDPatient Identification Segment (SEQ 1,2, 5,7, 8, 11, 19)ZPDVA-Specific Patient Info Segment (SEQ 1, 8)ZTAVA-Specific Temporary Address Segment (SEQ)ZGDVA-Specific Guardian Segment (SEQ 1-8)ZCT VA-Specific Emergency Contact Segment (SEQ)ZEM VA-Specific Employment Info Segment (SEQ)RF1Referral Information Segment (SEQ)BTSBatch TrailerMeans Test Data Transmission – (ORF~Z06) NOTE: This message has been retired.The means test data transmission returns an observation of the means test signature in response to the site’s transmission of a means test image. (HEC to VistA) BHSBatch Header{MSHMessage HeaderPIDPatient Identification Segment (SEQ 1,3,19)}ZMTVA-Specific Means Test Info Segment (SEQ 1-5,7-12,15,17-21)}BTSBatch TrailerMeans Test Data Transmission – (ORU~Z06)The means test data transmission transmits the IVM-verified means test from the ES to your facility.BHSBatch Header{MSHMessage HeaderPIDPatient Identification Segment (SEQ 1-3,5,7,8,19)ZICVA-Specific Income Segment (SEQ 1)ZIRVA-Specific Income Relation Segment (SEQ 1){ZDPVA-Specific Dependent Info Segment (SEQ 1)ZICVA-Specific Income Segment (SEQ 1)ZIRVA-Specific Income Relation Segment (SEQ 1)}ZMTVA-Specific Means Test Info Segment (SEQ 1-3,7,8,10,12,15,17,18,20,25,26,31)ZIVVA-Specific Message Processing Segment (SEQ 1,2,8)}BTSBatch TrailerFull Data Transmission – (ORU~Z07)The Full Data Transmission transmits a complete profile of patient demographic, eligibility, Means Test, income, insurance, and enrollment information to the HEC.BHSBatch Header{MSHMessage HeaderPIDPatient Identification Segment (SEQ 1-3, 5-7, 8, 10-14, 16, 17, 19,22, 24)PD1Patient Demographic Segment (SEQ 3)ZPDVA-Specific Patient Info Segment (SEQ 1,6-9,11-13,17,19,30,31-34,35,40,41)ZTAVA-Specific Temporary Address Segment (SEQ 1-9){ZAVVA-Specific Address Validation Segment (SEQ 1-3)} ZIEVA-Specific Patient Ineligible Segment (SEQ 1-3){ZELVA-Specific Patient Eligibility Segment (SEQ 1,2,5-8,10,11,13-25,29,34,35,37,38-47 for primary eligibility and SEQ 1,2 for all other eligibilities)}{[ZE2VA-Specific Patient Eligibility (Addtl) Segment (1,2)]}{[ZTEVA Specific Temporary Eligibility Segment]}[{ZCEVA Specific Community Care Eligibility Segment (SEQ 1-4)}] [{ZHPVA-Specific Health Benefit Plan Segment (SEQ 1-4)}]ZENVA-Specific Enrollment Segment (SEQ 1-19)ZCDVA-Specific Catastrophic Disability Segment (SEQ 1-17)[{ZMH}VA-Specific Military History Segment (SEQ 1-5)]{ZRDVA-Specific Rated Disabilities Segment (SEQ 1-4, 12-14)}ZCTVA-Specific Emergency Contact Segment (SEQ 1-7,10){ZEMVA-Specific Employment Info Segment (SEQ 1-7 for Veteran and SEQ 1-7 for Spouse)}{ZGDVA-Specific Guardian Segment (SEQ 1-8) } ZICVA-Specific Income Segment (SEQ 1-20 when ZMT SEQ 30 (version) is 0, SEQ 1-3,9,12-16,18-19 when ZMT SEQ 30 (version) is 1) ZIRVA-Specific Income Relation Segment (SEQ 1-5,10,15){ZDPVA-Specific Dependent Information Segment (SEQ 1-14 for spouse and SEQ 1-7,9-11 for all other dependents) ZICVA-Specific Income Segment (SEQ 1-12,16-20 for spouse, SEQ 1-12,15 for dependents whenZMT-30 (version) is 0) (SEQ 1-3,9,12,16,18-19 for spouse, SEQ 1,2,3,9,12,15,16,19 fordependents when ZMT-30 (version) is 1) ZIRVA-Specific Income Relation Segment (SEQ 1-3 for spouse, SEQ 1-5,6-9,14 for other dependents)}ZIOVA-Specific Patient Info Segment (SEQ 1-10){NTENotes & Comments (SEQ 1,3) }{IN1Insurance Segment (SEQ 1, 4, 5,7-9,12,13,15-17,28,36) }ZMTVA-Specific Means Test Information Segment (SEQ 1-18,21-31, 32)ZMTVA-Specific CoPay Test Information Segment (SEQ 1-7,9-10,12,15-18,21-22,25-26,30,31, 32)ZMTVA-Specific LTC Test Information Segment (SEQ 1-5,7,9-10,12,16-18,22,25,30,31, 32)ZBTVA-Specific Beneficiary Travel Information Segment (SEQ 1-4,7)[{ZFEVA-Specific Fee Basis Segment (SEQ 1-5)}]ZSPVA-Specific Service Period Segment (SEQ 1-8,10,11){[OBXObservation/Result Segment For Patient Sensitivity Information (SEQ 2,3,5,11,14,16)For NTR (SEQ 2,3,5,11,12,14,15-17)]}{RF1Referral Information Segment (SEQ 3,6,7) }{ZUDVA-Specific VistA User Data Segment (SEQ 1-5) }}BTSBatch TrailerFull Data Transmission – (ORF~Z07)The Full Data Transmission transmits a complete profile of patient demographic, eligibility, Means Test, income, insurance, and enrollment information to the HEC.MSHMessage HeaderMSAMessage AcknowledgmentQRDQuery Definition (segment as submitted in HEC initiated query)PIDPatient Identification Segment (SEQ 1-3,5-7,8,10-14,16,17,19,22,24)PD1Patient Demographic Segment (SEQ 3)ZPDVA-Specific Patient Info Segment (SEQ 1,6-9,11-13,17,19,30,31-34,35, 40,41)ZTAVA-Specific Temporary Address Segment (SEQ 1-9){ZAVVA-Specific Address Validation Segment (SEQ 1-3)}ZIEVA-Specific Patient Ineligible Segment (SEQ 1-3){ZELVA-Specific Patient Eligibility Segment (SEQ 1,2,5-8,10,11,13-25,29,34,35,37,38-47 for primaryeligibility and SEQ 1,2 for all other eligibilities)}{[ZE2VA-Specific Patient Eligibility (Addtl) Segment (1,2)]}{[ZTEVA Specific Temporary Eligibility Segment]}[{ZCEVA Specific Community Care Eligibility Segment (SEQ 1-4)}][{ZHPVA-Specific Health Benefit Plan Segment (SEQ 1-4)}]ZENVA-Specific Enrollment Segment (SEQ 1-19)ZCDVA-Specific Catastrophic Disability Segment (SEQ 1-17){ZMH}VA-Specific Military History Segment (SEQ 1-5){ZRDVA-Specific Rated Disabilities Segment (SEQ 1-4, 12-14)}ZCTVA-Specific Emergency Contact Segment (SEQ 1-7,10){ZEMVA-Specific Employment Info Segment (SEQ 1-7 for Veteran and SEQ 1-7 for Spouse 7, 9)}{ZGDVA-Specific Guardian Segment (SEQ 1-8) } ZICVA-Specific Income Segment (SEQ 1-20 when ZMT SEQ 30 (version) is 0, SEQ 1-3,9,12-16,18-19 when ZMT SEQ 30 (version) is 1)) ZIRVA-Specific Income Relation Segment (SEQ 1-5,10,15){ZDPVA-Specific Dependent Information Segment (SEQ 1-14 for spouse and SEQ 1-7,9-11 for all other dependents) ZICVA-Specific Income Segment (SEQ 1-12,16-20 for spouse, SEQ 1-12,15 for dependents whenZMT-30 (version) is 0 (SEQ 1-3,9,12,16,18-19 for spouse, SEQ 1,2,3,9,12,15,16,19 fordependents when ZMT-30 (version) is 1) ZIRVA-Specific Income Relation Segment (SEQ 1-3 for spouse, SEQ 1-5,6-9,14 for dependents)}ZIOVA-Specific Patient Info Segment (SEQ 1-10){NTENotes & Comments (SEQ 1,3) }{IN1Insurance Segment (SEQ 1,4,5,7-9,12,13,15-17,28,36) }ZMTVA-Specific Means Test Information Segment (SEQ 1-18, ,21-30,31, 32)ZMTVA-Specific CoPay Test Information Segment (SEQ 1-7,9-10,12,15-18,21-22,25-26,30,31, 32)ZMTVA-Specific LTC Test Information Segment (SEQ 1-5,7,9-10,12,16-18,22,25,30,31, 32)ZBTVA-Specific Beneficiary Travel Information Segment (SEQ 1-4,7)[{ZFEVA-Specific Fee Basis Segment (SEQ 1-5)}]ZSPVA-Specific Service Period Segment (SEQ 1-8,10, 11){[OBXObservation/Result Segment For Patient Sensitivity Information (SEQ 2,3,5,11,14,16)for NTR (SEQ 2,3,5,11,12,14,15-17)]}{RF1Referral Information Segment (SEQ 3,6,7)}{ZUDVA-Specific VistA User Data Segment (SEQ 1-5) }}BTSBatch TrailerCase Status Data Transmission – (ORU~Z08) (Message has been retired)The case status data transmission is generated by the HEC to alert your facility of closed cases.BHSBatch Header{MSHMessage HeaderPIDPatient Identification Segment (SEQ 1,3,5,7,19)ZIVVA-Specific Message Processing Segment (SEQ 1,2,8)}BTSBatch TrailerBilling/Collection Data Transmission – (ORU~Z09)The billing/collection data transmission transmits IVM-related billing and collections information to the HEC for cases that were closed via the HEC Legacy system.BHSBatch Header{MSHMessage HeaderPIDPatient Identification Segment (SEQ 1,3,5,7,8,19)FT1Financial Transaction (SEQ 1,4,6,7,9,11)}ZICVA-Specific Income Segment (SEQ 1,2)}BTSBatch TrailerBilling/Collection Data Transmission – (ORU~Z09)The billing/collection data transmission transmits IVM-related billing and collections information to the EDB for cases that were closed via a Z06 from EDB.BHSBatch Header{MSHMessage HeaderPIDPatient Identification Segment (SEQ 1-5,7,8,19)PD1Patient Demographic Segment (SEQ 1,3){FT1Financial Transaction (SEQ 1,4,6,7,9,11,12)}ZICVA-Specific Income Segment (SEQ 1,2)}BTSBatch TrailerIncome Test Data Transmission – (ORU~Z10)The income test data transmission transmits income data for veteran, spouse, and dependents from the HEC. NOTE: The ORF~Z06 Means Test Transmission to VistA has been eliminated; instead, the Means Test Signature information will be sent to VistA in the Z10.BHSBatch Header{MSHMessage HeaderPIDPatient Identification Segment (SEQ 1,3,5,7,8,19)ZICVA-Specific Income Segment (SEQ 1-20 when ZMT SEQ 30 [Version] equals 0) (SEQ 1-3,9,12-16,18-19 when ZMT SEQ 30 [Version] equals 1 and income year 2008 orearlier) (SEQ 1-3,9,12 when ZMT SEQ 30 [Version] equals 1 and income year 2009 or later)ZIRVA-Specific Income Relation Segment (SEQ 1-4,10, 15){ZDPVA-Specific Dependent Information Segment (SEQ 1-14 for spouse and SEQ 1-6,9-12 for dependents)ZICVA-Specific Income Segment (SEQ 1-12,16-20 for spouse and SEQ 1-12,15 for all other dependents when ZMT SEQ 30 [Version] is equal to 0) (SEQ 1-3,9,12,16,18-19 for spouse and SEQ 1-3,9,12,15-16,18-19 for dependents when ZMT SEQ 30 [Version] is equal to 1 and Income Year 2008 or earlier)(SEQ 1-3,9,12 when ZMT SEQ 30 [Version] is equal to 1 and Income Year 2009 or later)ZIRVA-Specific Income Relation Segment (SEQ 1 for spouse and SEQ 1,3-4,6-9,14 for all other dependents)}ZMTVA-Specific Means Test Information Segment (SEQ 1-19,22-30 for Income Year 2008 or earlier) (SEQ 1-4,6-19,22-31, 32 for Income Year 2009 or later)ZMTVA-Specific Co-Pay Test Information Segment (SEQ 1-4,9,10,12,15-19,22,25-26,30-31, 32)ZMTVA-Specific LTC Co-Pay Exemption Test Information Segment (SEQ 1-4,7,9,10,12,16-18,22,25,30-31, 32)ZBTVA-Specific Beneficiary Travel Information Segment (SEQ 1-4)}BTSBatch TrailerIncome Test Data Transmission – (ORF~Z10)The income test data transmission transmits income data for veteran, spouse, and dependents from the HEC. NOTE: The ORF~Z06 Means Test Transmission to VistA has been eliminated; instead, the Means Test Signature information will be sent to VistA in the Z10.MSHMessage HeaderMSAMessage AcknowledgmentQRDQuery Definition (SEQ 1-4, 7-10,12)QRFQuery Filter (SEQ 1,4,5)PIDPatient Identification Segment (SEQ 1,3,5,7,8,19)ZICVA-Specific Income Segment (SEQ 1-20 when ZMT SEQ 30 [Version] equals 0) (SEQ 1-3,9,12-16,18-19 when ZMT SEQ 30 [Version] equals 1 and Income Year 2008 or earlier) (SEQ 1-3,9,12-15 when ZMT SEQ 30 [Version] equals 1 and Income Year 2009 or later)ZIRVA-Specific Income Relation Segment (SEQ 1-4,10, 15){ZDPVA-Specific Dependent Information Segment (SEQ 1-14 for spouse and SEQ 1-6,9-12 for all other dependents)ZICVA-Specific Income Segment (SEQ 1-12,16-20 for spouse and SEQ 1-12,15 for all other dependents when ZMT SEQ 30 [Version] is equal to 0) (SEQ 1-3,9,12,16,18-19 for spouse and SEQ 1-3,9,12,15-16,18-19 for dependents when ZMT SEQ 30 [Version] is equal to 1 and Income Year 2008 or earlier)(SEQ 1-3,9,12-15 when ZMT SEQ 30 [Version] is equal to 1 and Income Year 2009 or later)ZIRVA-Specific Income Relation Segment (SEQ 1 for spouse and SEQ 1,3,4,6-9,14 for all other dependents)}ZMTVA-Specific Means Test Information Segment (SEQ 1-19,22-30 for Income Year 2008 or earlier) (SEQ 1-19,22-31, 32 for Income Year 2009 or later)ZMTVA-Specific Co-Pay Test Information Segment (SEQ 1-4,9-10,12,15-19,22,25-26,30,31, 32)ZMTVA-Specific LTC Co-Pay Exemption Test Information Segment (SEQ 1-4,7,9-10,12,16-18,22,25,30,31, 32)ZBTA-Specific Beneficiary Travel Information Segment (SEQ 1-4)BTSBatch TrailerNote: The ORU and ORF Z10- ZDP, ZIC, and ZIR segments will be contain data as follows:Vet has a spouse, spouse is activeZDP – spouse dataZIC – with dataZIR – with dataVet does not have a spouseZDP – sequence 6 = 2ZIC with no dataZIR with no dataVet has an inactive spouseZDP – seq 6 set to 2ZIC – no dataZIR – no dataZDP – inactive spouse to include all dataNO ZIC, ZIRVet has a current and inactive spouseZDP – with data for current/active spouseZIC – with dataZIR – with dataZDP – inactive spouse to include all dataNO ZIC, ZIRVet with spouse and active dependentsZDP – spouse with dataZIC – with dataZIR – with dataZDP – dependent with dataZIC – with dataZIR – with dataVet with inactive dependents, no spouseZDP – set seq 6 to 2ZIC no dataZIR – no dataZDP – with inactive dependent dataNO ZIC, NO ZIRVISTA Initiated – Enrollment/Eligibility Query Data Transmission – (QRY)MSHMessage HeaderQRDQuery Definition (SEQ 1-4,7-10,12)SEQ 1 – Query Date/TimeSEQ 2 – Query Format Code (“R”: Record-Oriented)SEQ 3 – Query Priority (“I”: Immediate)SEQ 4 – Query ID (Internal VISTA-specific Patient DFN[component separator]Integration Control Number (ICN)SEQ 7 – Quantity Limited Request (“1~RD”: One/single record)SEQ 8 – Who Subject Filter (VISTA-specific Patient SSN)SEQ 9 – What Subject Filter (“OTH”: Other)SEQ 10 – What Department Data Code (“ENROLLMENT”)SEQ 11 – What data code value(Date for which to return enrollment, if no date is specified assume the most recent enrollment data is being requested.)SEQ 12 – Query Results Level (“T”: Full Results)QRFQuery Filter (SEQ 1,4,5)SEQ 1 – Where Subject Filer (“IVM”)SEQ 4 – What User Qualifier (VISTA-specific Patient Date of Birth)SEQ 5 – Other Subject Query Filter (VISTA-specific Patient Sex; “M” or “F”)Enrollment/Eligibility Data Transmission – (ORF~Z11)The Enrollment/Eligibility Data Transmission transmits a veteran’s eligibility and enrollment information from the HEC to the VAMCs.MSHMessage HeaderMSAMessage AcknowledgmentQRDQuery Definition (segment as submitted in VISTA initiated query)QRFQuery Filter (segment as submitted in VISTA initiated query)PIDPatient Identification Segment (SEQ 1-3,5,7,8,19)ZPDVA-Specific Patient Info Segment (SEQ 1,12,13,30,34,35,40)ZIEVA-Specific Patient Ineligible Segment (SEQ 1-4)ZIOVA-Specific Patient Info Segment (SEQ 1-10){ZELVA-Specific Patient Eligibility Segment (SEQ 1,2,5-8,10,11,13-25,29,34,35,38-47 for primary eligibility and SEQ 1-2 for all other eligibilities)}{[ZE2VA-Specific Patient Eligibility (Addtl) Segment (1-3)]}{[ZTEVA Specific Temporary Eligibility Segment]}[{ZCEVA Specific Community Care Eligibility Segment (SEQ 1-4)}][{ZHPVA-Specific Health Benefit Plan Segment (SEQ 1-4)}]ZENVA-Specific Enrollment Segment (SEQ 1-19)ZMTVA-Specific Means Test Information Segment (SEQ 1,3)In this message, the segment is meant only to convey the Means Test status on which the enrollment priority was based. The SET ID Field should contain a value of “1” (“1” means that the segment refers to a means test and “2” means that the segment refers to a copay test) and SEQ 3 should contain the means test status.ZCDVA-Specific Catastrophic Disability Segment (SEQ 1-17)ZSPVA-Specific Service Period Segment (SEQ 1-4,6-8,10,13){ZMH}VA-Specific Military History Segment (SEQ 1-5, 8, 9, 10){ZRDVA-Specific Rated Disabilities Segment (SEQ 1-3,12-14)}[OBXObservation/Result Segment (SEQ 1-3,5,11,12,14-17) – NTR(SEQ 2,3,5,11,14,16) – Sensitive Patient Information]Enrollment/Eligibility Data Transmission – (ORU~Z11)The Enrollment/Eligibility Data Transmission transmits a veteran’s eligibility and enrollment information from the HEC to the VAMCs.BHSBatch Header{MSHMessage HeaderPIDPatient Identification Segment (SEQ 1-3,5,7,8,19)ZPDVA-Specific Patient Info Segment (SEQ 1,12,13,30,34,35,40)ZIEVA-Specific Patient Ineligible Segment (SEQ 1-4)ZIOVA-Specific Patient Info Segment (SEQ 1-10){ZELVA-Specific Patient Eligibility Segment (SEQ 1,2,5-8,10,11,13-25,29,34,35,38-47 for primary eligibility and SEQ 1,2 for all other eligibilities) }{[ZE2VA-Specific Patient Eligibility (Addtl) Segment (1-3)]}{[ZTEVA Specific Temporary Eligibility Segment]}[{ZCEVA Specific Community Care Eligibility Segment (SEQ 1-4)}][{ZHPVA-Specific Health Benefit Plan Segment (SEQ 1-4)}]ZENVA-Specific Enrollment Segment (SEQ 1-19)ZMTVA-Specific Means Test Information Segment (SEQ 1,3) In this message the segment is meant only to convey the means test status on which the enrollment priority was based. The SET ID Field should contain a value of ‘1’ (‘1’ means that the segment refers to a means test and ‘2’ means that the segment refers to a copay test) and SEQ 3 should contain the means test status.ZCDVA-Specific Catastrophic Disability Segment (SEQ 1-17)ZSPVA-Specific Service Period Segment (SEQ 1-4,6-8,10,13){ZMH}VA-Specific Military History Segment (SEQ 1-5, 8, 9, 10){ZRDVA-Specific Rated Disabilities Segment (SEQ 1-3,12-14)}[OBXObservation/Result Segment (SEQ 1-3,5,11,12,14-17) – NTR(SEQ 2,3,5,11,14,16) – Sensitive Patient Information]}BTSBatch TrailerTrigger EventsEnrollment Trigger EventsThe following enrollment events in VistA will trigger an HL7 Full Data Transmission (ORU~Z07) message to be sent to the HEC for a patient.Trigger Events Implemented via File Cross-ReferencesFile Name (File #)Field Name (Field #)Cross-ReferenceAPI CallPATIENT (#2)PRIMARY ELIGIBILITY (.361)AENR361AUTOUPD^DGENA2PATIENT (#2)ELIGIBILITY (.01) in the PATIENT ELIGIBILITIES sub-file (2.0361)AENR01AUTOUPD^DGENA2PATIENT (#2)DATE OF DEATH (.351)AENR351AUTOUPD^DGENA2PATIENT (#2)SERVICE CONNECTED (.301)AENR301AUTOUPD^DGENA2PATIENT (#2)SERVICE CONNECTED PERCENTAGE (.302)AENR302AUTOUPD^DGENA2PATIENT (#2)POW STATUS INDICATED (.525)AENR525AUTOUPD^DGENA2PATIENT (#2)RECEIVING A&A BENEFITS (.36205)AENR36205AUTOUPD^DGENA2PATIENT (#2)RECEIVING HOUSEBOUND BENEFITS (.36215)AENR36215AUTOUPD^DGENA2PATIENT (#2)RECEIVING A VA PENSION (.36235)AENR36235AUTOUPD^DGENA2PATIENT (#2)TOTAL ANNUAL VA CHECK AMOUNT (.36295)AENR36295AUTOUPD^DGENA2PATIENT (#2)DISABILITY RET. FROM MILITARY (.362)AENR362AUTOUPD^DGENA2PATIENT (#2)MEDICAID (.381)AENR381AUTOUPD^DGENA2PATIENT (#2)EXPOSED TO AGENT ORANGE (.32102)AENR32102AUTOUPD^DGENA2PATIENT (#2)RADIATION EXPOSURE (.32103)AENR32103AUTOUPD^DGENA2PATIENT (#2)SW ASIA CONDITIONS (.322013)AENR322013AUTOUPD^DGENA2PATIENT (#2)NAME (.01)AENR01EVENT^IVMPLOGPATIENT (#2)SEX (.02)AENR02EVENT^IVMPLOGPATIENT (#2)DATE OF BIRTH (.03)AENR03EVENT^IVMPLOGPATIENT (#2)STREET ADDRESS [LINE 3] (.113)AENR113EVENT^IVMPLOGPATIENT (#2)COUNTY (.117)AENR117EVENT^IVMPLOGPATIENT (#2)PHONE NUMBER [RESIDENCE] (.131)AENR131EVENT^IVMPLOGPATIENT (#2)PHONE NUMBER [WORK] (.132)AENR132EVENT^IVMPLOGPATIENT (#2)INELIGIBLE DATE (.152)AENR152EVENT^IVMPLOGPATIENT (#2)EMERGENCY RESPONSE INDICATOR (.181)AENR181EVENT^IVMPLOGPATIENT (#2)COMBAT VETERAN END DATE (.5295)AENR5295EVENT^IVMPLOGPATIENT (#2)*CLAIM FOLDER LOCATION (#.312)AENR312EVENT^IVMPLOGPATIENT (#2)ADDRESS CHANGE DT/TM (#.118)AENR118EVENT^IVMPLOGPATIENT (#2)RESIDENTIAL ADDR CHANGE DT/TM (#.1158)AENR1158EVENT^IVMPLOGPATIENT (#2)APPOINTMENT REQUEST DATE (#1010.1511)AENR10101511EVENT^IVMPLOGPATIENT (#2)APPOINTMENT REQUEST ON 1010EZ (#1010.159)AENR1010159EVENT^IVMPLOGPATIENT (#2) BAD ADDRESS INDICATOR (#.121)AENR121EVENT^IVMPLOGPATIENT (#2)CLAIM NUMBER (#313)AENR313EVENT^IVMPLOGPATIENT (#2)CONFIDENTIAL ADDR CHANGE DT/TM (#.14112)AENR14112EVENT^IVMPLOGPATIENT (#2)CONFIDENTIAL ADDRESS COUNTY (#.14111)AENR14111EVENT^IVMPLOGPATIENT (#2)COVERED BY HEALTH INSURANCE? (#.3192)AENR3192EVENT^IVMPLOGPATIENT (#2)CURRENT PURPLE HEART REMARKS (#.533)AENR533EVENT^IVMPLOGPATIENT (#2)CURRENT PURPLE HEART STATUS (#.532)AENR532EVENT^IVMPLOGPATIENT (#2)DATE MEDICAID LAST ASKED (#.382)AENR382EVENT^IVMPLOGPATIENT (#2)DATE OF DEATH LAST UPDATED (#.354)AENR354EVENT^IVMPLOGPATIENT (#2)DATE OF DECISION (#.392)AENR392EVENT^IVMPLOGPATIENT (#2)DECIDED BY (#.391)AENR391EVENT^IVMPLOGPATIENT (#2)ELIGIBILITY STATUS (#.3611)AENR3611EVENT^IVMPLOGPATIENT (#2)ELIGIBILITY STATUS DATE (#.3612)AENR3612EVENT^IVMPLOGPATIENT (#2)ELIGIBILITY VERIF. METHOD (#.3615)AENR3615EVENT^IVMPLOGPATIENT (#2)EMPLOYER NAME (#.3111)AENR3111EVENT^IVMPLOGPATIENT (#2)EMPLOYMENT STATUS (#.31115)AENR31115EVENT^IVMPLOGPATIENT (#2)FACILITY MAKING DETERMINATION (#.393)AENR393EVENT^IVMPLOGPATIENT (#2)INELIGIBLE REASON (#.307)AENR307EVENT^IVMPLOGPATIENT (#2)INELIGIBLE VARO DECISION (#.1656)AENR1656EVENT^IVMPLOGPATIENT (#2)INTEGRATED CONTROL NUMBER (#991.01)AENR99101EVENT^IVMPLOGPATIENT (#2)MARITAL STATUS (#.05)AENR05EVENT^IVMPLOGPATIENT (#2)METHOD OF DETERMINATION (#.395)AENR395EVENT^IVMPLOGPATIENT (#2)P&T (#.304) AENR304EVENT^IVMPLOGPATIENT (#2)PERIOD OF SERVICE (#.323) AENR323EVENT^IVMPLOGPATIENT (#2)PRIMARY NOK CHANGE DATE/TIME (#.21012) AENR21012EVENT^IVMPLOGPATIENT (#2)RATED INCOMPETENT? (#.293)AENR293EVENT^IVMPLOGPATIENT (#2)PENSION AWARD EFFECTIVE DATE(#.3851)AENR3851EVENT^IVMPLOGPATIENT (#2)PENSION AWARD REASON(#.3852)AENR3852EVENT^IVMPLOGPATIENT (#2)RECEIVING VA DISABILITY? (#.3025) AENR3025EVENT^IVMPLOGPATIENT (#2)REVIEW DATE (#.394) AENR394EVENT^IVMPLOGPATIENT (#2)SOURCE OF NOTIFICATION (#.353) AENR353EVENT^IVMPLOGPATIENT (#2)TEMPORARY ADDRESS CHANGE DT/TM (#.12113)AENR12113EVENT^IVMPLOGPATIENT (#2)TEMPORARY ADDRESS COUNTY (#.12111) AENR12111EVENT^IVMPLOGPATIENT (#2)TEMPORARY PHONE NUMBER (#.1219) AENR1219EVENT^IVMPLOGPATIENT (#2)USER ENROLLEE SITE (#.3618)AENR3618EVENT^IVMPLOGPATIENT (#2)USER ENROLLEE VALID THROUGH (#.3617)AENR3617EVENT^IVMPLOGPATIENT (#2)SECONDARY NOK CHANGE DATE/TIME (#.211012)AENR211012EVENT^IVMPLOGPATIENT (#2)E-CONTACT CHANGE DATE/TIME (#.33012)AENR33012EVENT^IVMPLOGPATIENT (#2)E2-CONTACT CHANGE DATE/TIME (#.33112)AENR33112EVENT^IVMPLOGPATIENT (#2)DESIGNEE CHANGE DATE/TIME (#.3412)AENR3412EVENT^IVMPLOGPATIENT (#2)PREFERRED FACILITY (#27.02)AENR2702EVENT^IVMPLOGPATIENT FILE (#2)RATED DISABILITIES SUB-FILE (#.3721)DISABILITY % (#2) AENR2EVENT^IVMPLOGPATIENT FILE (#2)RATED DISABILITIES SUB-FILE (#.3721)RATED DISABILITIES (VA) (#.01)AENR01EVENT^IVMPLOGPATIENT FILE (#2)RATED DISABILITIES SUB-FILE (#.3721)SERVICE CONNECTED (#3)AENR3EVENT^IVMPLOGPATIENT FILE (#2)INSURANCE TYPE SUB-FILE (#.3121)*GROUP NUMBER (#2)AENR2EVENT^IVMPLOGPATIENT FILE (#2)INSURANCE TYPE SUB-FILE (#.3121)EFFECTIVE DATE OF POLICY (#8)AENR8EVENT^IVMPLOGPATIENT FILE (#2)INSURANCE TYPE SUB-FILE(#.3121)GROUP PLAN (#.18) AENR18EVENT^IVMPLOGPATIENT FILE (#2)INSURANCE TYPE SUB-FILE (#.3121)INSURANCE EXPIRATION DATE (#3) AENR3EVENT^IVMPLOGPATIENT FILE (#2)INSURANCE TYPE SUB-FILE (#.3121)INSURANCE TYPE (#.01)AENR01EVENT^IVMPLOGPATIENT FILE (#2)INSURANCE TYPE SUB-FILE (#.3121)NAME OF INSURED (#17)AENR17EVENT^IVMPLOGPATIENT FILE (#2)INSURANCE TYPE SUB-FILE (#.3121)SUBSCRIBER ID (#1)AENR1EVENT^IVMPLOGPATIENT FILE (#2)INSURANCE TYPE SUB-FILE (#.3121)WHOSE INSURANCE (#6)AENR6EVENT^IVMPLOGPATIENT FILE (#2)CD STATUS DIAGNOSES SUB-FILE (#.396)CD STATUS DIAGNOSES (#.01)AENR01EVENT^IVMPLOGPATIENT FILE (#2)CD STATUS PROCEDURES SUB-FILE (#.397)AFFECTED EXTREMITY (#1)AENR1EVENT^IVMPLOGPATIENT FILE (#2)CD STATUS PROCEDURES SUB-FILE (#.397)CD STATUS PROCEDURES (#.01)AENR01EVENT^IVMPLOGPATIENT FILE (#2)CD STATUS CONDITIONS SUB-FILE (#.398)CD STATUS CONDITIONS (#.01)AENR01EVENT^IVMPLOGPATIENT FILE (#2)CD STATUS CONDITIONS SUB-FILE (#.398)PERMANENT INDICATOR (#2)AENR2EVENT^IVMPLOGPATIENT FILE (#2)CD STATUS CONDITIONS SUB-FILE (#.398)SCORE (#1)AENR1EVENT^IVMPLOGPATIENT FILE (#2) COMMUNITY CARE PROGRAM SUB-FILE (#.191)CCP LAST UPDATED DATE (#.01)ACCCPEECHG^DGRPCTRGPATIENT FILE (#2) COMMUNITY CARE PROGRAM SUB-FILE (#.191)COMMUNITY CARE PROGRAM CODE (#1)ACCCPEECHG^DGRPCTRGPATIENT FILE (#2) COMMUNITY CARE PROGRAM SUB-FILE (#.191)EFFECTIVE DATE (#2)ACCCPEECHG^DGRPCTRGPATIENT FILE (#2) COMMUNITY CARE PROGRAM SUB-FILE (#.191)END DATE (#3)ACCCPEECHG^DGRPCTRGPATIENT ENROLLMENT (#27.11)EFFECTIVE DATE (#.08)AENR08DGRTRIGPATIENT ENROLLMENT (#27.11)ENROLLMENT DATE (#.01)AENR01DGRTRIGPATIENT ENROLLMENT (#27.11)ENROLLMENT DATE (#.1)AENR1DGRTRIGPATIENT ENROLLMENT (#27.11)ENROLLMENT END DATE (#.11)AENR11DGRTRIGPATIENT ENROLLMENT (#27.11)ENROLLMENT PRIORITY (#.07)AENR07DGRTRIGPATIENT ENROLLMENT (#27.11)ENROLLMENT STATUS (#.04)AENR04DGRTRIGPATIENT ENROLLMENT (#27.11)ENROLLMENT SUBGROUP (#.12)AENR12DGRTRIGPATIENT ENROLLMENT (#27.11)FACILITY RECEIVED (#.06)AENR06DGRTRIGPATIENT ENROLLMENT (#27.11)SOURCE OF ENROLLMENT (#.03)AENR03DGRTRIGMST HISTORY (#29.11)MST CHANGE STATUS DATE (#.01)AENR01DGRTRIGMST HISTORY (#29.11)MST STATUS (#3)AENR3DGRTRIGMST HISTORY (#29.11)SITE DETERMINING STATUS (#6)AENR6DGRTRIGBILLING PATIENT (#354)COPAY INCOME EXEMPTION STATUS (#.04)AENR04DGRTRIGBENEFICIARY TRAVEL CERTIFICATION (#392.2)DATE CERTIFIED (#.01)AENR01DGRTRIGPATIENT RELATION (#408.12)RELATIONSHIP (#.02)AENR02DGRTRIGPATIENT RELATION (#408.12)EFFECTIVE DATE SUB-FILE (#75)EFFECTIVE DATE (#.01)AENR01DGRTRIGINCOME PERSON (#408.13)DATE OF BIRTH (#.03)AENR03DGRTRIGINCOME PERSON (#408.13)MAIDEN NAME (#1.1)AENR11DGRTRIGINCOME PERSON (#408.13)NAME (#.01)AENR09DGRTRIGINCOME PERSON (#408.13)SEX (#.02)AENR02DGRTRIGINCOME PERSON (#408.13)SOCIAL SECURITY NUMBER (#.09)AENR09DGRTRIGINDIVIDUAL ANNUAL INCOME (#408.21)ALL OTHER INCOME (#.17)AENR17DGRTRIGINDIVIDUAL ANNUAL INCOME (#408.21)CASH, AMOUNTS IN BANK ACCOUNTS (#2.01)AENR201DGRTRIGINDIVIDUAL ANNUAL INCOME (#408.21)DEBTS (#2.05)AENR205DGRTRIGINDIVIDUAL ANNUAL INCOME (#408.21)EDUCATIONAL EXPENSES (#1.03)AENR103DGRTRIGINDIVIDUAL ANNUAL INCOME (#408.21)FUNERAL AND BURIAL EXPENSES (#1.02)AENR102DGRTRIGINDIVIDUAL ANNUAL INCOME (#408.21)INTEREST, DIVIDEND, OR ANNUITY (#.15)AENR15DGRTRIGINDIVIDUAL ANNUAL INCOME (#408.21)MEDICAL EXPENSES (#1.01)AENR101DGRTRIGINDIVIDUAL ANNUAL INCOME (#408.21)MILITARY RETIREMENT (#.11)AENR11DGRTRIGINDIVIDUAL ANNUAL INCOME (#408.21)OTHER PROPERTY OR ASSETS (#2.04) AENR204DGRTRIGINDIVIDUAL ANNUAL INCOME (#408.21)OTHER RETIREMENT (#.13)AENR13DGRTRIGINDIVIDUAL ANNUAL INCOME (#408.21)REAL PROPERTY (#2.03)AENR203DGRTRIGINDIVIDUAL ANNUAL INCOME (#408.21)SOCIAL SECURITY (NOT SSI) (#.08)AENR08DGRTRIGINDIVIDUAL ANNUAL INCOME (#408.21)STOCKS AND BONDS (#2.02)AENR202DGRTRIGINDIVIDUAL ANNUAL INCOME (#408.21)TOTAL INCOME FROM EMPLOYMENT (#.14)AENR14DGRTRIGINDIVIDUAL ANNUAL INCOME (#408.21)U.S. CIVIL SERVICE (#.09)AENR09DGRTRIGINDIVIDUAL ANNUAL INCOME (#408.21)U.S. RAILROAD RETIREMENT (#.1)AENR1DGRTRIGINDIVIDUAL ANNUAL INCOME (#408.21)UNEMPLOYMENT COMPENSATION (#.12)AENR12DGRTRIGINDIVIDUAL ANNUAL INCOME (#408.21)WORKERS COMP. OR BLACK LUNG (#.16)AENR16DGRTRIGINDIVIDUAL ANNUAL INCOME (#408.21)YEAR (#.01)AENR01DGRTRIGINCOME RELATION (#408.22)AMOUNT CONTRIBUTED TO SPOUSE (#.07)AENR07DGRTRIGINCOME RELATION (#408.22)CHILD 18-23 IN SCHOOL (#.18)AENR18DGRTRIGINCOME RELATION (#408.22)CHILD HAD INCOME (#.11)AENR11DGRTRIGINCOME RELATION (#408.22)CONTRIBUTED TO SPOUSAL SUPPORT (#.21)E40822DGRTRIGINCOME RELATION (#408.22)CONTRIBUTED TO SUPPORT (#.1)AENR1DGRTRIGINCOME RELATION (#408.22)DEPENDENT CHILDREN (#.08)AENR08DGRTRIGINCOME RELATION (#408.22)INCAPABLE OF SELF-SUPPORT (#.09)AENR09DGRTRIGINCOME RELATION (#408.22)INCOME AVAILABLE TO YOU (#.12)AENR12DGRTRIGINCOME RELATION (#408.22)LIVED WITH PATIENT (#.06)AENR06DGRTRIGINCOME RELATION (#408.22)MARRIED LAST CALENDAR YEAR (#.05)AENR05DGRTRIGINCOME RELATION (#408.22)NUMBER OF DEPENDENT CHILDREN (#.13)AENR13DGRTRIGANNUAL MEANS TEST (#408.31)DATE/TIME TEST LAST EDITED (#2.02)AENR202DGRTRIGTrigger Events Implemented via Event DriversEvent DriverEvent ProtocolAPI CallDG MEANS TEST EVENTSDGEN AUTOMATIC ENROLLMENT UPDATEAUTOUPD^DGENA2Trigger Events Implemented via Routine HookRoutine NameAPI Call (Hook)DescriptionDGMSTAPINEWSTAT^DGMSTAPICall to create a new MST HISTORY FILE (#29.11) entry.Will also queue HL7 message for HEC database updatesIVM Trigger EventsThe following IVM events in VistA will trigger an HL7 Full Data Transmission (ORU~Z07) message to be sent to the HEC for a patient.Trigger Events Implemented via File Cross-ReferencesFile/Field #Cross-ReferenceFunction CallPATIENT (#2) FILENAME (.01)IVM01DPT^IVMPXFRSEX (.02)IVM02DPT^IVMPXFRDATE OF BIRTH (.03)IVM03DPT^IVMPXFRSOCIAL SECURITY NUMBER (.09)IVM09DPT^IVMPXFRSTREET ADDRESS [LINE 1] (.111)IVM111DPT^IVMPXFRSTEEET ADDRESS [LINE 2] (-112)IVM112DPT^IVMPXFRSTREET ADDRESS [LINE 3] (.113)IVM113DPT^IVMPXFRCITY (.114)IVM114DPT^IVMPXFRSTATE (.115)IVM115DPT^IVMPXFRCOUNTY (.117)IVM117DPT^IVMPXFRZIP+4 (.1112)IVM1112DPT^IVMPXFRPHONE NUMBER [RESIDENCE] (.131)IVM131DPT^IVMPXFRPHONE NUMBER [WORK] (.132)IVM132 DPT^IVMPXFRDATE OF DEATH (.351)IVM351DPT^IVMPXFRRESIDENTIAL ADDRESS [LINE 1] (.1151)IVM1151DPT^IVMPXFRRESIDENTIAL ADDRESS [LINE 2] (-1152)IVM1152DPT^IVMPXFRRESIDENTIAL ADDRESS [LINE 3] (.1153)IVM1153DPT^IVMPXFRRESIDENTIAL CITY (.1154)IVM1154DPT^IVMPXFRRESIDENTIAL STATE (.1155)IVM1155DPT^IVMPXFRRESIDENTIAL COUNTY (.1157)IVM1157DPT^IVMPXFRRESIDENTIAL ZIP+4 (.1156)IVM1156DPT^IVMPXFRRESIDENTIAL PROVINCE (.11571)IVM11571DPT^IVMPXFRRESIDENTIAL POSTAL CODE (.11572)IVM11572DPT^IVMPXFRRESIDENTIAL COUNTRY (.11573)IVM11573DPT^IVMPXFRTrigger Events Implemented via File Event DriversEvent DriverEvent ProtocolFunction CallDG MEANS TEST EVENTSIVM MEANS TEST EVENTEN^IVMPMTETrigger Events Implemented via Routine HookRoutine NameAPI Call (Hook)DescriptionDGNTAPI FILENTR^DGNTAPICall to create a new NTR HISTORY FILE (#28.11) entry. Will also queue HL7 message for HEC database updates.DGRPEIS2LOGDCD^IVMCUCRoutine hook will monitor changes to the fields contained on Screen #9 (Income Screening Data) of the Registration module.DGENCLEAAUTOUPD^DGENA2Call to trigger an HL7 Full Data Transmission (ORU~Z07) message to be sent to the HEC for a Veteran when the Veteran’s Military Service Episodes are edited and they no longer meet the eligibility qualifications to receive Camp Lejeune benefits.DGRP6EFAUTOUPD^DGENA2Call to trigger an HL7 Full Data Transmission (ORU~Z07) message to be sent to the HEC for a patient when the Camp Lejeune question is answered by the user.Appendix B – HL7 Segment Table DefinitionsFor each HL7 segment, the data elements contained in the segment are described in table format. These tables are described in the following sections. The abbreviated column headings contained in the tables and associated HL7 data types are also defined.HL7 Abbreviated Column HeadingsColumn HeadingDefinitionSEQSequence of data element in segmentLENMaximum length of data elementDTData TypeR/ORequired/Optional (R = Required, blank = Optional)RP/#Repeats/Maximum number of repetitions (Y for repeats)TBL#Number of corresponding HL7 user defined/supported tableHL7 Data TypesData TypeDefinitionVA FileMan Data TypeADAddressFree TextCECoded ElementSet of Codes or PointerCKCheck DigitNo EquivalentCMCompositeNo EquivalentCPComposite PriceFree TextCXExtended Composite ID with Check DigitSet of Codes or PointerDLNDrivers License NumberNo EquivalentDTDateDate OnlyEIEntity IdentifierSet of Codes or PointerFTFormatted Text DataNo EquivalentHDHierarchic DesignatorNo EquivalentIDCoded ValueSet of Codes or PointerISCoded Value for user-defined tablesSet of Codes or PointerNMNumericNumericPNPerson NameFree TextPTProcessing TypeNo EquivalentSISequence IDNumericSTStringFree TextTMTimeTime OnlyTNTelephone NumberFree TextTSTime StampDate/TimeTXTextWord processingXCNExtended Composite ID Number and Name for PersonsNo EquivalentXONExtended Composite Name and Identification Number for OrganizationsNo EquivalentXPNExtended Person NameNo EquivalentXTNExtended Telecommunication NumberNo EquivalentXADExtended Address (Complex)No EquivalentHL7 Segment TablesFinancial Transaction (FTI)SEQLENDTR/ORP/#TBL #ELEMENT NAMEVISTA File# 301.61 – IVM BILLING TRANSMISSION14SI0Set ID-FT1SEQUENTIAL NUMBER212STOTransaction IDNot used310STOTransaction Batch IDNot used426TSRTransaction DateDATE BILL CREATED (#.07)526TSOTransaction Posting DateNot used68ISR0017Transaction TypeIf BILL CANCELLED (#.11) then 2If DATE BILL CLOSED (#.1) ANDDATE LAST TRANSMITTED (#.13) Then 4If AMOUNT COLLECTED (#.09) ANDDATE LAST TRANSMITTED (#.13) Then 3Else 1780CERTransaction CodeThis field is used to uniquely identify each bill or charge which is stored in this file. This number will be equal to the bill number for insurance claims, or to the REFERENCE NUMBER (#.01) for charges stored in File #350, INTEGRATED BILLING ACTIONS. 840STBTransaction DescriptionNot used940STBTransaction Description – Alt4 Components:CLASSIFICATION (#.03)BILL TYPE (#.04)BILL FROM (#.05)BILL TO (#.06)109NMOTransaction QuantityNot used1112CPOTransaction Amount – ExtendedAMOUNT COLLECTED (#.09)1213CPOTransaction Amount – UnitAMOUNT BILLED (#.08)1360CEO0049Department CodeNot used1460CEOInsurance Plan IdNot used1512CPOInsurance AmountNot used1680PLOAssigned Patient LocationNot used171ISO0024Fee ScheduleNot used182ISO0018Patient TypeNot used1960CEOY0051Diagnosis CodeNot used20120XCNOPerformed By CodeNot used21120XCNOOrdered By CodeNot used2212CPOUnit CostNot used2322EIOFilter Order NumberNot used24120XCNOEntered By CodeNot used2580CEO0088Procedure CodeNot used2680CEO0340Procedure Code ModifierNot usedInsurance Segment (IN1) SEQLENDTR/ORP/#TBL #Element NameVISTA Element NameVISTA File Field or Expression14SIRSet ID-InsuranceSequential number.28IDInsurance Plan IDNot used at this time.36STInsurance Company IDNot used at this time.445STRInsurance Company NameNAME Field (#.01) of INSURANCE COMPANY (#36) File. 5106ADInsurance Company AddressADDRESS fields (#.111-.116) of INSURANCE COMPANY (#36) File. 648PNInsurance Co. Contact PersNot used at this time.740TNInsurance Co. Phone NumberPHONE NUMBER Field (#.131) of INSURANCE COMPANY (#36) File.812ST*R Group NumberGROUP NUMBER Field (.04) of GROUP INSURANCE PLAN File. (#355.3). 935ST*R Group NameGROUP NAME Field (.03) of GROUP INSURANCE PLAN File (#355.3).1012ST Insured’s Group Emp. IDNot used at this time.1145STInsured’s Group Emp. NameNot used at this time.128DTPlan Effective DateEFFECTIVE DATE OF POLICY (Mult .312, Field #8) of PATIENT (#2) File. 138DT Plan Expiration DateINSURANCE EXPIRATION DATE (Mult .312, Field #4) of PATIENT (#2) File. 1455ST Authorization InformationNot used at this time.152IDPlan TypeTYPE OF PLAN Field (#.09), of GROUP INSURANCE PLAN (#355.3) File.1648PN*R Name of InsuredNAME OF INSURED (Mult .312, Field #6) (Mult. .312, Field #17) of PATIENT (#2) File. 172IDR Insured’s Relation To PatientWHOSE INSURANCE Field of PATIENT (#2) File. 188DTInsured’s Date of BirthINSURED’S DOB field (#60.08) of the INSURANCE VERIFICATION PROCESSOR file (#355.33)*Required if patient is not the policy holder.19106ADInsured’s AddressNot used at this time.202IDAssignment of BenefitsNot used at this time.212IDCoordination of BenefitsNot used at this time.222STCord. of Benefits PriorityNot used at this time.232IDNotice of Admission CodeNot used at this time.248DTNotice of Admission DateNot used at this time.252IDRpt of Eligibility CodeNot used at this time.268DTRpt of Eligibility DateNot used at this time.272IDRelease of Information CodeNot used at this time.281ISVA001Pre-Admit Cert. (Pac)IS PRE-CERT. REQ. Field (#.06) of GROUP INSURANCE PLAN File (#355.3).298DTVerification Date Not used at this time.3060CMVerification ByNot used at this time.312IDType of Agreement CodeNot used at this time.Insurance Segment (IN1), continuedSEQLENDTR/ORP/#TBL #Element NameVISTA Element NameVISTA File Field or Expression322IDBilling StatusNot used at this time.334NMLifetime Reserve DaysNot used at this time.344NMDelay Before L. R. DayNot used at this time.358STCompany Plan CodeNot used at this time.3615STRPolicy NumberINSURANCE NUMBER (Mult 2.312, Field #1) of PATIENT (#2) File. 3712NMPolicy DeductibleNot used at this time.3812NMPolicy Limit – AmountNot used at this time.394NMPolicy Limit – DaysNot used at this time.4012NMRoom Rate – Semi PrivateNot used at this time.4112NMRoom Rate – PrivateNot used at this time.421IDInsured’s Employment StatusNot used at this time.431IDInsured’s SexNot used at this time.44106ADInsured’s Employer AddressNot used at this time.Field SEQ 8 and Field SEQ 9 – At a minimum, one of these fields is required.Field SEQ 16 – This field is required if Field SEQ 17 does not contain a “v” for veteran.Notes and Comments Segment (NTE) SEQLENDTR/ORP/#TBL #Element NameVISTA Element NameANNUAL MEANS TEST (#408.31) File Field or Expression14SIRSet IDSequential number28ID0105Source of CommentNot used at this time.3120TX CommentCOMMENT Field (#50) Patient Identification Segment (PID)SEQLENDTR/ORP/#TBL#Element NameVISTA DescriptionPATIENT (#2) File Field or Expression14SIOSet ID – Patient IDSequential Number220CXOPrimary Long IDIntegrated Control # (ICN) (991.01) & Checksum (991.02) – ICN & “V” & Checksum320CXRYPatient ID (Internal ID)Pointer to entry in PATIENT (#2) File420CXOYAlternate Patient IDPRIMARY SHORT ID Field (#.364) or VA(“PID)548XPNRYPatient NameNAME Field (#.01)648XPNOMother’s Maiden NameMOTHER’S MAIDEN NAME Field (#.2403)726TSODate/Time of BirthDATE OF BIRTH (#.03)81ISO0001SexSEX (#.02)948XPNOYPatient AliasALIAS (Multiple 1, Field #.01)101ISO0005RaceRace 11106XADOYPatient AddressADDRESS Field Identified by Address TypePermanent (USA: .111 - .115, .1112, .1173 Foreign: .111 - .114, .1171-.1173)Confidential (USA: .141, .1411-.1418, .14111, .14116 Foreign: .141, .1411-.1414, .1417, .1418, .14114-.14116)Residential (USA:.1151-.1157,.11573, Foreign: .1151-.1154,.11571-.11573)124ISBCounty CodeVA COUNTY CODE Field (#.117)1340XTNOYPhone Number – HomePHONE NUMBER (RESIDENCE) Field (#.131)PHONE NUMBER (WORK) Field (#.132)EMAIL ADDRESS (#.133)PHONE NUMBER [CELLULAR] (#.134)PAGER NUMBER (#.135)CONFIDENTIAL PHONE NUMBER Field (#.1315)1440XTNOYPhone Number – BusinessPHONE NUMBER (WORK) Field (#.132)1560CEOPrimary LanguageNot used161ISO0002Marital StatusMARITAL STATUS Field (#.05)173ISO0006ReligionReligion Field(#.08)1820CKOPatient Account NumberNot used1916STOSSN Number – PatientSOCIAL SECURITY NUMBER Field (#.09)2025DLNODriver’s License Number – PatientNot used2120CKOYMother’s IdentifierNot used221ISO0189Ethnic Group Ethnicity Information Multiple (#2.06.01)2360STOBirth PlaceNot used242IDO0136Multiple Birth Indicator Multiple Birth Indicator Field (#994)252NMOBirth OrderNot used264ISOYCitizenshipNot used2760CEO0172Veterans Military StatusNot used2880CEONationality Not used2926TSOPatient Death and TimeNot used301IDO0136Patient Death IndicatorNot used Patient Demographic 1 Segment (PD1)SEQLENDTR/ORP/#TBL#Element NameVISTA Description12ISRSet ID 22IDLiving ArrangementNOT USED390XON CIRN (Master of Record) ~ ~ Station NumberCIRN MASTER OF RECORD (Field 991.03) ~ ~ STATION NUMBER (File #4 Field 99)490XCNPATIENT PRIMARY CARE PROVIDER NAME & ID No2 Sub-ComponentsPointer to entry in NEW PERSON File (#200) &Facility Number (File #389.9 Field.04)<family name (ST) ><last name prefix (ST)><given name (ST)><middle initial or name (ST)><suffix (e.g., JR or III) (ST)><prefix (e.g., DR) (ST)><degree (e.g., MD) (IS)>This will always be VA200 (NEW PERSON File)Query Definition Segment (QRD) SEQLENDTR/ORP/#TBL#Element NameVISTA Description126TSRQuery Date/TimeDate/Time query was generated.21IDR0106Query Format CodeSee Table 0106 in Appendix C for codes.31IDR0091Query PrioritySee Table 0091 in Appendix C for codes.423STRQuery IDVISTA -specific internal entry number of PATIENT (#2) File and Integration Control Number (ICN) if available.51IDDeferred Response TypeNot used at this time.626TSDeferred Response Date/TimeNot used at this time.710CQR0126Quantity Limited RequestSee Table 0126 in Appendix C for codes.820STRWho Subject FilterSOCIAL SECURITY NUMBER (#.09) Field of PATIENT (#2) File.93IDRY0048What Subject FilterSee Table 0048 in Appendix C for codes.1020STRYWhat Department Data CodeComputed Field (Income Year).1120STRYWhat Data Code ValueNot used at this time.121ID0108Query Results LevelSee Table 0108 in Appendix C for codes.Observation/Result Segment (OBX) SEQLENDTR/ORP/#TBL #Element NameVISTA DESCRIPTION110SIOSet ID – OBXNot used22IDC0125Value TypeCE3590CERObservation Identifier38.1^SECURITY LOG (patient security)VISTA ~28.11 (NTR) 420STCObservation Sub-IDNot used565536*CYObservation ValueSensitive = Y (patient security)Not Sensitive = N (patient security)NOTE: This will be a repeating field for NTR.<identifier (ST)>~<text (ST)>~<name of coding system (ST)>|<identifier #2 (ST)>~<text #2(ST)>~<name of coding system #2(ST)>|etc…660CEOUnitsNot used710STOReferences RangeNot used85IDOY/50078Abnormal FlagsNot used95NMOProbabilityNot used102IDOY0080Nature of Abnormal TestNot used111IDR0085Observ Result StatusR=Results entered, Not verified (patient security)F=Final Results (NTR)1226TSODate Last Obs Normal ValuesDiagnosed With Head and Neck Cancer Date/Time (NTR)1320STOUser Defined Access ChecksNot used1426TSODate/Time of the ObservationDate/Time of the Observation (patient security)Verification Method Date/Time (NTR)1560CEOProducer’s IDStation Number of Site Reporting Verification Method Status (NTR)1680XCNOResponsible Observer‘Security Assigned Remotely By’ = AITC (patient security)Component #14, Sub-Component #2 – Station Number of Site Reporting Diagnosed With Head and Neck Cancer Status (NTR)1760CEOYObservation MethodVerification Method: (NTR) S (Qual Military Srvc) M (Military Med Rec) N (Not Qualified)Query Filter Segment (QRF)SEQLENDTR/ORP/#TBL#Element NameVISTA Description120STRYWhere Subject FilterIdentifies Dept., System to Which Query Pertains219TSWhen Data Start Date/TimeNot used at this time320TSWhen Data End Date/TimeNot used at this time420STYWhat User QualifierSpecific Patient Date of Birth520STYOther Query Subject FilterSpecific Patient Sex; “M” or “F”Referral Information Segment (RF1)SEQLENDTR/ORP/#TBL #Element NameVISTA Element NamePATIENT (#2) File Field or Expression1250CEO0283Referral StatusNot Used2250CEO0280Referral PriorityNot Used3250CEO0281Referral TypeSAD = Street Address ChangeCAD = Confidential Address ChangeCPH = Cell Phone Number ChangePNO = Pager Number ChangeEAD = E-Mail Address ChangePHH – Home Phone Number Change4250CEOY0282Referral DispositionNot Used5250CEO0284Referral CategoryNot Used630EIR0363Originating Referral Identifier4 components:1 – Site of ChangeSAD (Field #.12 of the Patient [#2] File)CAD (Field #.14113 of the Patient [#2] File)CPH (Field #.13111 of the Patient [#2] File)PNO (Field #.1314 of the Patient [#2] File)EAD (Field #.138 of the Patient [#2] File)PHH (Field #.1323 of the Patient [#2] File)2 – Source of ChangeSAD (Field #.119 of the Patient [#2] File)CAD (n/a)CPH (Field #.1311 of the Patient [#2] File)PNO (Field #.1313 of the Patient [#2] File)EAD (Field #.137 of the Patient [#2] File)PHH (Field #.1322 of the Patient [#2] File)3 – Not Used4 – Not used726TSOEffective DateDate/Time of change SAD (Field #.118 of the Patient [#2] File)CAD (Field #.14112 of the Patient [#2] File)CPH (Field #.139 of the Patient [#2] File)PNO (Field #.1312 of the Patient [#2] File)EAD (Field #.136 of the Patient [#2] File)PHH (Field #.1321 of Patient [#2] File)826TSOExpiration DateInvalid Address Date (TBD at a later date)926TSOProcess DateDate Checked by NCOA (TBD at a later date)10250CEOYVA061Referral ReasonInvalid Address Reason (TBD at a later date)1130EIOYExternal Referral IdentifierNot UsedVA-Specific Address Validation Segment (ZAV)SEQLENDTR/ORP/#TBL#Element NameVISTA Element NameVISTA PATIENT File (#2) Field14SIRSet IDSequential Number25ISRAddress TypeExpected values:P for Permanent Mailing AddressR for Residential AddressC for Temporary Mailing AddressCNF for Confidential Address32ISRAddress Validation IndicatorStreet Addr CASS Ind (Field #.1118)Residential CASS Ind (Field #.1159)Temporary Addr CASS Ind (Field #.12115)Confidential Addr CASS Ind (Field #.14117)Expected values:Y – CertifiedF – FailedNC – Not CheckedPV – ProcessingVA-Specific Beneficiary Travel Segment (ZBT)SEQLENDTR/ORP/#TBL#Element NameVISTA Element NameVISTA BENEFICIARY TRAVEL CERTIFICATION File (#392.2) Field or Expression14SIRSet IDSequential Number28DTDate CertifiedDate Certified Field (#.01) of File #392.231ISVA01EligibleEligible Field (#3) of File #392.2410NMAmount CertifiedAmount Certified Field (#4) of File #392.252ISVA02Means Test StatusMeans Test Status (A;8) of File #392.262ISVA04Primary Eligibility CodePrimary Elig. Code (A;9) of File #392.2719TSTravel Claim Date/TimeClaim Date/Time (#.01) of File #392**Fields are from BENEFICIARY TRAVEL CLAIM File (#392).VA-Specific Catastrophic Disability Segment (ZCD)SEQLENDTR/ORP/#TBL#Element NameVISTA Element NamePATIENT (#2) File Field or Expression14SIRSet IDSEQUENTIAL NUMBER28DTRReview DateREVIEW DATE (#394)335STRDecided byDECIDED BY (.#391)47IDRVA0115Facility Making DeterminationFACILITY MAKING DETERMINATION (#393)58DTRDate of DecisionDATE OF DECISION (#392)660CERVA041Determination MethodMETHOD OF DETERMINATION Field (#395)760CEOCD DiagnosisCD STATUS DIAGNOSES Field (#396)860CEOCD ProcedureCD STATUS PROCEDURES Field (#397)960CEOVA042Affected ExtremityAFFECTED EXTREMITY Field (#397.1) 104CEOVA043CD ConditionCD STATUS CONDITIONS Field (#398)116STOScoreSCORE Field (#398.1). Valid Value any whole number.121IDR0136Catastrophically DisabledVETERAN CATASTROPHICALLY DISABLED? Field (#399.39)1360CEOVA045Permanent IndicatorPERMANENT INDICATOR Field (#398.2)148DTODate Veteran Requested CD EvaluationDATE VETERAN REQUESTED CD EVAL (#.3951)158DTODate Facility Initiated ReviewDATE FACILITY INITIATED REVIEW (#.3952)168DTODate Veteran Was NotifiedDATE VETERAN WAS NOTIFIED (#.3953)1760CEORVA440CD DESCRIPTORCD DESCRIPTOR field (#.401)VA-Specific Community Care Eligibility Segment (ZCE)SEQLENDTR/ORP/#TBL #Element NameVISTA Element NamePATIENT (#2) File Field or Expression14SIRSet IDSequential Number21IDRCommunity Care Program CodeExpected Values:A – ART/IVFC – Marriage/Family CounselingI – NewbornT – TransplantCOMMUNITY CARE PRORAM CODE (Sub-File #2.191, Field #1) of PATIENT (#2) File.38DTREffective DateEFFECTIVE DATE (Sub-File #2.191, Field #2) of PATIENT (#2) File.48DTEnd DateEND DATE (Sub-File #2.191, Field #3) of PATIENT (#2) File.519TSRCCP Last Updated DateDate/Time the Program Code was Assigned / UnassignedCCP LAST UPDATED DATE (Sub-File #2.191, Field #.01) of PATIENT (#2) File.VA-Specific Emergency Contact Segment (ZCT)SEQLENDTR/ORP/#TBL #Element NameVISTA Element NamePATIENT (#2) File Field or Expression14SIRSet IDSequential Number22IDRContact Type1=NOK, 2=2nd NOK, 3=E-Contact, 4=2nd E-Contact, 5=Designee335STContact NameName of Contact Person (See note below.)430STContact RelationshipRelationship to Patient of Contact Person (See note below.)5106ADContact AddressAddress of Contact Person (See note below.)640TNContact Phone NumberPhone Number of Contact Person (See note below.)740TNContact Work Phone NumberWork Phone Number of Contact Person (See note below.)81ISVA001Contact Address Same As NOK?Address Same as Patient’s (See Note – NOK And NOK2 Only)91ISVA001Contact Person Same As NOK?Same as NOK? (See Note – First E-Contact And Designee Only)1024TSContact Date/Time Last UpdatedPRIMARY NOK CHANGE DATE/TIME (#.21012)Note: Data is returned from various PATIENT File nodes based on the CONTACT TYPE: Type=1, Node=.21; Type=2, Node=.211; Type=3, Node=.33; Type=4, Node=.331; Type=5, Node=34.VA-Specific Patient Dependent Information Segment (ZDP) SEQLENDTR/ORP/#TBL #Element NameVISTA Element NameVISTA Field or Expression14SIRSet IDSequential Number248PNRName* NAME Field (#.01)31ID0001Sex* SEX Field (#.02)48DTDate of Birth* DATE OF BIRTH Field (#.03)516STSocial Security Number* SOCIAL SECURITY NUMBER Field (#.09)62ISVA009Relationship To PatientRELATIONSHIP (#.02) Field of PATIENT RELATION (#408.12 ) File710NMInternal Entry NumberInternal Entry Number(IEN) of entry in PATIENT RELATION (#408.12) File830STSpouse’s Maiden NameMAIDEN NAME Field (#1.1) of INCOME PERSON File (#408.13)98DTDependent DateEFFECTIVE DATE (Mult 408.1275; Field #.01)101STPseudo SSN ReasonPSEUDO SSN REASON (#.1)R=REFUSED TO PROVIDES=SSN UNKNOWN/FOLLOW-UP REQUIREDN=NO SSN ASSIGNED118DTInactivation DateCalculated Value from 408.1275;.01 and 408.1275;.02121STSSN Verification StatusSSN VERIFICATION STATUS (#..11)13250XADSPOUSE ADDRESSSPOUSE ADDRESS (1.2, 1.3, 1.4, 1.5, 1.6, 1.7, (1.9) 14250XTNSPOUSE HOME PHONE NUMBERSPOUSE HOME PHONE NUMBER (1.8)VA-Specific Patient Eligibility Segment (ZEL)SEQLENDTR/ORP/#TBL#Element NameVISTA Element NamePATIENT (#2) File Field or Expression14SIRSet IDSequential Number (1 is always Primary Elig.)22ISVA004Eligibility CodeEligibility Code316CK Long IDLong ID (Multiple 361, Field #.01)412STShort IDShort ID (Multiple 361, Field #.04)51ID0136Military Disability RetirementMilitary Disability Retirement Field (#.3602)Data values:1=YES, RECEIVING MILITARY RETIREMENT 68NMClaim Folder NumberCLAIM FOLDER NUMBER Field (#.313)740STClaim Folder Location*CLAIM FOLDER LOCATION Field (#.312)81ISVA001Veteran?VETERAN? Field (#1901)930STType of PatientTYPE OF PATIENT Field (#391)101ISVA006Eligibility StatusELIGIBILITY STATUS Field (#.3611)118DTEligibility Status DateELIGIBILITY STATUS DATE Field (#.3612)128DTEligibility Interim ResponseELIGIBILITY INTERIM RESPONSE Field (#.3614)1350STEligibility Verification MethodELIGIBILITY VERIFICATION METHOD Field (#.3615)141ISVA001Receiving A&A Benefits?RECEIVING A&A BENEFITS? Field (#.36205)151ISVA001Receiving Housebound Benefits?RECEIVING HOUSEBOUND BENEFITS? Field (#.36215)161ISVA001Receiving A VA Pension?RECEIVING VA PENSION? Field (#.36235)171ISVA001Receiving A VA Disability?Receiving VA Disability? Field (#.3025)181ISVA001Exposed To Agent OrangeAGENT ORANGE EXPOS. INDICATED Field (#.32102)191ISVA001Radiation Exposure IndicatedRADIATION EXPOSURE INDICATED? Field (#.32103)201ISVA001SW Asia ConditionsSW ASIA CONDITIONS? Field (#.322013)218NMTotal Annual VA Check AmountTOTAL ANNUAL VA CHECK AMOUNT Field (#.36295)221IDVA022Radiation Exposure MethodRADIATION EXPOSURE METHOD Field (#.3212)231IDVA036Current MST StatusComputed2419TSMST Status Change DateComputed 257IDVA0115Site Determining MST statusComputed 268DTAgent Orange Reg DateAGENT ORANGE REGISTRATION DATE Field (#.32107)278DTAgent Orange Exam DateAGENT ORANGE EXAM DATE Field (#.32109)286NMAgent Orange Reg #AGENT ORANGE REGISTRATION # Field (#.3211)2920CEAgent Orange Exposure LocationAGENT ORANGE EXPOSURE LOCATION Field (#.3213)308DTRadiation Exposure DateRADIATION EXPOSURE DATE Field (#.32111)318DTSW Asia Conditions Exam DateSW ASIA COND. EXAM DATE Field (#.322015)328DTSW Asia Conditions Reg DateSW ASIA COND.. REGISTRATION DATE Field (#.322014)338DTMonetary Benefits DateMONETARY BEN. VERIFY DATE Field (#.306)348DTUser Enrollee Valid ThroughUSER ENROLLEE STATUS (#.3617)35User Enrollee SiteUSER ENROLLEE STIE (#.3618)36Eligibility Verification Source and SiteNot used at this time371IDVA001Combat Veteran Eligibility IndicatorCOMBAT SERVICE INDICATED? Field (#.5291) (Computed)388DTCombat Veteran Eligibility End DateCOMBAT VETERAN END DATE Field (#.5295)391ID0136Discharge Due to DisabilityDischarge Due to Disability Field (#.3603)Data values:1=YES, RECEIVING MILITARY RETIREMENT 401ST0136SHAD (Shipboard Hazard And Defense)PROJ 112/SHAD (#.3215)411ISCamp LejeuneCAMP LEJEUNE INDICATED (#.321701)428DTCamp Lejeune DateCAMP LEJEUNE DATE (#.321702)4310STCamp Lejeune Change SiteCAMP LEJEUNE CHANGE SITE (#.321703)4410STCamp Lejeune SourceCAMP LEJEUNE SOURCE (#.321704)451ISVA001OTH Eligibility IndicatorValues:Blank – patient was never OTH0 – patient was OTH, but not any longer1 – patient is OTH461ISOTH Eligibility Factor CodeValues:‘1’ – OTH-90‘2’ – OTH-EXT47TS19OTH Eligibility Update DateDate/Time of OTH Eligibility ChangeVA-Specific Patient Eligibility (Addtl) Segment (ZE2)SEQLENDTR/ORP/#TBL#Element NameVISTA Element NamePATIENT (#2) File Field or Expression1109DRRPension Dates2 components:1 – Pension Award Effective Date (Field #.3851 of the Patient [#2] File)2 – Pension Terminated Date (Field #.3853 of the Patient [#2] File251CWEPension Award Reason CodePension Award Reason (Field #.3852 of the Patient [#2] File351CWE Pension Terminated Reason(s)Pension Terminated Reason #1 (Field #.3854 of the Patient [#2] FilePension Terminated Reason #2 (Field #.3855 of the Patient [#2] FilePension Terminated Reason #3 (Field #.3856 of the Patient [#2] FilePension Terminated Reason #4 (Field #.3857 of the Patient [#2] FileVA-Specific Employment Information Segment (ZEM)SEQLENDTR/ORP/#TBL #Element NameVISTA Element NamePATIENT (#2) File Field or Expression14SIRSet IDSequential Number21IDEmployment Person1 if Patient, 2 if Spouse32ISVA003Employment StatusEmployment Status: Patient (#.31115) or Spouse (#.2515) 430STEmployer NameEmployer Name: Patient (#.3111) or Spouse (#.251)530STOccupationOccupation (#.07) or Spouse’s Occupation (#.2514)6106ADEmployer AddressEmployer Address: Patient (#.3113-#.3118) or Spouse (#.252-#.257)740TNEmployer PhoneEmployer Phone Number: Patient (#.3119) or Spouse (#.258)81ISVA001Government AgencyGovernment Agency (#.3112) (Patient Only)98DTDate of RetirementDate of Retirement Patient (#.31116) ,Spouse (#.2516)VA-Specific Enrollment Segment (ZEN)SEQLENDTR/ORP/#TBL#Element NameVISTA Element NameVISTA Field or Expression14SIRSet IDSequential Number28DTEnrollment DateENROLLMENT DATE Field (#.1) of the PATIENT ENROLLMENT File (#27.11)31IDSource of EnrollmentSOURCE OF ENROLLMENT Field (#.03) of the PATIENT ENROLLMENT File (#27.11)1 = VAMC; 2 = HEC; 3 = Other VAMC41ISVA015Enrollment StatusENROLLMENT STATUS Field (#.04) of the PATIENT ENROLLMENT File (#27.11)52ISVA016Reason Canceled/DeclinedREASON CANCELED/DECLINED Field #.05) of the PATIENT ENROLLMENT File (#27.11)660TXCanceled/Declined RemarksCANCELED/DECLINED REMARKS Field (#25) of the PATIENT ENROLLMENT File (#27.11)77ISVA0115Facility ReceivedFACILITY RECEIVED Field (#.06) of the PATIENT ENROLLMENT File (#27.11)87ISVA0115Preferred FacilityPREFERRED FACILITY Field (#27.02) of the PATIENT File (#2)91ISVA017Enrollment PriorityENROLLMENT PRIORITY Field (#.07) of the PATIENT ENROLLMENT File (#27.11)108DTEffective DateEFFECTIVE DATE Field (#.08) of the PATIENT ENROLLMENT File (#27.11)118DTEnrollment DateENROLLMENT DATE Field (#.01) of the PATIENT ENROLLMENT File (#27.11)128DTEnrollment End DateENROLLMENT END DATE Field (#.11) of the PATIENT ENROLLMENT File (#27.11)131ISVA035Enrollment Sub-groupENROLLMENT SUB-GROUP Field (#.12) of the PATIENT ENROLLMENT File (#27.11)142IDPreferred Facility Source DesignationSOURCE DESIGNATION Field (#.2702) of the PATIENT File (#2)V=VistA; E=ESR; PA=PCP Active; PI=PCP Inactive151ISVA117REASON FOR CLOSED APPLICATION (Z11 only)REASON FOR CLOSED APPLICATION (.13)161ISVA001PT APPLIED FOR ENROLLMENT? PT APPLIED FOR ENROLLMENT? Field (#.14) of the PATIENT ENROLLMENT File (#27.11)0 – No1 – Yes171ISREGISTRATION ONLY REASONREGISTRATION ONLY REASON (.15) of the PATIENT ENROLLMENT File (#27.11) pointing to the PATIENT REGISTRATION ONLY REASON FILE (#408.43) 1 – C&P DISABILITY BENEFITS EXAM2 – ACTIVE DUTY3 – SERVICE CONNECTED ONLY4 – EXPOSURE REGISTRY EXAM5 – RESEARCH6 – HUMANITARIAN/EMERGENCY7 – EMPLOYEE8 – BENEFICIARY9 – OTHER THAN HONORABLE (OTH)10 – MARRIAGE/FAMILY COUNSELING11 – COLLATERAL (OTHER)12 – ART/IVF13 – NEWBORN14 – LEGISLATIVE MANDATE15 – OTHER16 – NORTH CHICAGO ACTIVE DUTY17 – UNANSWERED18 – CAREGIVER19 – VHA TRANSPLANT PROGRAM 188DTREGISTRATION ONLY DATEREGISTRATION ONLY DATE (.16) of the PATIENT ENROLLMENT File (#27.11)198STSOURCE OF REGISTRATIONSOURCE OF REGISTRATION (.17) of the PATIENT ENROLLMENT File (#27.11)Valid values:1 – VAMC2 – HEC3 – HCA4 – CARMA5 – OTHERVA-Specific Fee Basis Segment (ZFE)SEQLENDTR/ORP/#TBL#Element NameVISTA Element NameVISTA Field or Expression14STRSet IDSequential Number2200CEOVA033Treatment CodeTreatment Code, shown as identifier and the name of the coding system. Ex: SHORT TERM FEE STATUS^^VA0033 is the identifier (SHORT TERM FEE STATUS) and the coding system (VA0033 table) The second piece of this string is null (text describing the identifier). 3200CERVA034Fee Basis ProgramFee Basis Program, shown as the identifier and the name of the coding system. Ex: OUTPATIENT^^VA0034 is the identifier (OUTPATIENT) and the coding system (VA0034 table). The second piece of this string is null (text describing the identifier).426DTOAuthorization From DateBeginning date of the Fee Basis authorizationThe date must be Y2K compliant.526DTOAuthorization To DateEnding date of the Fee Basis authorizationThe date must be Y2K compliant.VA-Specific Guardian Segment (ZGD)SEQLENDTR/ORP/#TBL #Element NameVISTA Element NamePATIENT (#2) File Field or Expression14SIRSet IDSequential Number22IDGuardian Type1=VA Guardian; 2=Civil Guardian335STGuardian NameName of Guardian (See Note Below.)430STGuardian InstitutionInstitution Where Guardian is Located (See Note Below.)530STGuardian RelationshipRelationship To Patient of Guardian (See Note Below.)6106ADGuardian AddressAddress of Guardian (See Note Below.)740TNGuardian Phone NumberPhone Number of Guardian (See Note Below.)88DTDate Ruled IncompetentDate Ruled Incompetent (See Note Below.)Data is returned from a different PATIENT File (#2) node depending on the GUARDIAN TYPE: If the GUARDIAN TYPE=1, data will be returned from the .29 node. If the GUARDIAN TYPE=2, data will be returned from the .291 node. VA-Specific Income Information Segment (ZIC) – old formatThis format of the ZIC segment is used when the Version of the means test is before FEB 2005 1010EZ (sequence 30 of the ZMT segment is equal to 0)SEQLENDTR/ORP/#TBL #Element NameVISTA Element NameINDIVIDUAL ANNUAL INCOME (#408.21) File Field or Expression14SIRSet IDSequential Number (1 is always Primary Eligibility.)28DTIncome YearYEAR Field (#.01) (Month and Date will be 0.)38NM Social SecuritySOCIAL SECURITY (NOT SSI) Field (#.08)48NMUs Civil ServiceU.S. CIVIL SERVICE Field (#.09)58NMUs Railroad RetirementU.S. RAILROAD RETIREMENT Field (#.1)68NMMilitary RetirementMILITARY RETIREMENT Field (#.11)78NMUnemployment CompensationUNEMPLOYMENT COMPENSATION Field (#.12)88NMOther RetirementOTHER RETIREMENT Field (#.13)99NMEmployment IncomeTOTAL INCOME FROM EMPLOYMENT Field (#.14)108NMInterest, Dividend, AnnuityINTEREST, DIVIDEND, ANNUITY Field (#.15)118NMWorkers Comp/Black LungWORKERS COMP. OR BLACK LUNG Field (#.16)129NMOther IncomeALL OTHER INCOME Field (#.17)138NMMedical ExpensesMEDICAL EXPENSES Field (#1.01) (Veteran Only)148NMFuneral And Burial ExpensesFUNERAL AND BURIAL EXPENSES Field (#1.02) (Veteran Only)158NMEducational ExpensesEDUCATIONAL EXPENSES Field (#1.03) (Veteran Only)169NMCash, Amount in Bank AccountsCASH,AMOUNTS IN BANK ACCOUNTS Field (#2.01) [vet/spouse only]179NMStocks and BondsSTOCKS AND BONDS Field (#2.02) (veteran/spouse only)189NMReal PropertyREAL PROPERTY Field (#2.03) (veteran/spouse only)199NMOther Property or AssetsOTHER PROPERTY OR ASSETS Field (#2.04) (veteran/spouse only)209NMDebtsDEBTS Field (#2.05) (veteran/spouse only)218DTDate Income Screening CollectedENTERED ON Field (#102)223NMSite Conducting TestSITE CONDUCTING TEST Field (#2.05)238DTSource of TestSOURCE OF TEST Field (#.23) – 1=VAMC, 2=IVMVA-Specific Income Information Segment (ZIC) – Feb 2005 1010EZ formatThis format of the ZIC segment is used when the Version of the means test is FEB 2005-101EZ (sequence 30 of the ZMT segment is equal to 1)SEQLENDTR/ORP/#TBL #Element NameVISTA Element NameINDIVIDUAL ANNUAL INCOME (#408.21) File Field or Expression14SIRSet IDSequential Number (1 is always Primary Eligibility.)28DTIncome YearYEAR Field (#.01) (Month and Date will be 0.)38NM Other Income Amounts (Soc. Sec., Compensation, Pension, Interest, Divid. Income)SOCIAL SECURITY (NOT SSI) Field (#.08) [vet/spouse/child]99NMTotal Employment Income (Wages, Bonuses, Tips)TOTAL INCOME FROM EMPLOYMENT Field (#.14)[vet/spouse/child]129NMNet Income from Farm, Ranch, Property, BusinessALL OTHER INCOME Field (#.17) [vet/spouse/child]138NMMedical ExpensesMEDICAL EXPENSES Field (#1.01) [Veteran Only] The value is the adjusted medical expenses.148NMFuneral And Burial ExpensesFUNERAL AND BURIAL EXPENSES Field (#1.02) [Veteran Only]158NMEducational ExpensesEDUCATIONAL EXPENSES Field (#1.03) [Veteran Only]169NMCash, Amount in Bank Accounts (CDs, IRAs, Stocks, Bonds)CASH,AMOUNTS IN BANK ACCOUNTS Field (#2.01) [vet/spouse/child]189NMLand, Bldgs Less Mortgage, Liens (Not Primary Home)REAL PROPERTY Field (#2.03) [veteran/spouse/child]199NMOther Property (Farm, Bus) or Assets (Art, Collectibles) Less Amt OwedOTHER PROPERTY OR ASSETS Field (#2.04) [veteran/spouse/child]VA-Specific Health Benefit Plan Segment (ZHP)SEQLENDTR/ORP/#TBL #Element NameVISTA Element NamePATIENT (#2) File, CURRENT HEALTH BENEFIT PLAN (#25.01) Sub-File Field or Expression14SIRSet IDSequential Number (1 is always Primary Eligibility.)23CERHBP CODEHBP CODE (#.01)319TSR HBP LAST UPDATE DATEASSIGNED DATE/TIME (#21)412STRHBP LAST UPDATED BYASSIGNED ENTERED BY (#2)56STRHBP LAST UPDATED BY STATION NUMBERHBP LAST UPDATED BY STATION NUMBERVA-Specific Patient Ineligible Segment (ZIE)SEQLENDTR/ORP/#TBL#Element NameVISTA Element NamePATIENT (#2) File Field or Expression14SIRSet IDSequential Number28DTIneligible DateINELIGIBLE DATE Field (#.152)340STIneligible ReasonINELIGIBLE REASON Field (#.307)475STIneligible VARO DecisionINELIGIBLE VARO DECISION Field (#.1656)530STIneligible Twx CityINELIGIBLE TWX CITY (#.1653)61IDIneligible Twx SourceINELIGIBLE TWX SOURCE (#.1651)74IDIneligible Twx StateINELIGIBLE TWX STATE (#.1654)VA-Specific Inpatient/Outpatient Information Segment (ZIO)SEQLENDTR/ORP/#TBL #Element NameVISTA Element NameVISTA Field or Expression14SIRSet IDSequential Number 23NMNumber of Inpatient Days Since Last Means TestComputed field33NM Number of Outpatient Days Since Last Means TestComputed field48DTDate of Last VisitComputed field (Last Opt or Inpatient Stay)51ID0136Appointment Request on 1010EZAPPOINTMENT REQUEST ON 1010EZ (#1010.159)68DTAppointment Request DateAPPOINTMENT REQUEST DATE (#1010.1511)719TSUpdate Date/TimeDate/time stamp of appointment request on 1010E81ISOriginal Appointment Request98DTOriginal Appointment Request Date1019TSUpdate Date/TimeDate/time stamp of original appointment requestVA-Specific Income Relation Segment (ZIR)SEQLENDTR/ORP/#TBL#Element NameVISTA Element NameINCOME RELATION (#408.22) File Field or Expression14SIRSet IDSequential Number21ISVA001Married Last Calendar YearMARRIED LAST CALENDAR YEAR Field (#.05)31ISVA001Lived With PatientLIVED WITH PATIENT Field (#.06)48NMAmount Contributed to SpouseAMOUNT CONTRIBUTED TO SPOUSE Field (#.07)51ISVA001Dependent ChildrenDEPENDENT CHILDREN Field (#.08)61ISVA001Incapable of Self SupportINCAPABLE OF SELF-SUPPORT Field (#.09)71ISVA001Contributed to SupportCONTRIBUTED TO SUPPORT Field (#.1)81ISVA001Child Had IncomeCHILD HAD INCOME Field (#.11)91ISVA001Income Available to YouINCOME AVAILABLE TO YOU Field (#.12)102NMNumber of Dependent ChildrenNUMBER OF DEPENDENT CHILDREN Field (#.13)110STTotal DependentsComputed: NUMBER OF DEPENDENT CHILDREN field (#.13) + 1 (If Spouse Indicated), (MARRIED LAST CALENDAR YEAR Field (#.05) or LIVED WITH PATIENT Field (#.06) or AMOUNT CONTRIBUTED TO SPOUSE Field (#.07)), otherwise, + 0120NMPatient IncomeComputed: Income – same fields as ZIC incomes130STVA010Total Dependents Not Applicable FOR MT Indicators AS,N,X,UComputed: If MT Indicator not = to Cat A or Cat C, change number of dependents to XX (not applicable)141ID0136Dependent Child School IndicatorCHILD 18-23 IN SCHOOL (#.18)151ISCONTRIBUTED TO SPOUSAL SUPPORTCONTRIBUTED TO SPOUSAL SUPPORT (#.21)VA-Specific Message Processing Segment (Ziv)SEQLENDTR/ORP/#TBL #ELEMENT NAMEVISTA ELEMENT NAMEVISTA Field or Expression14SIRSet IDSequential number28DTIncome YearYEAR Field (#.01) Individual Annual Income (#408.21) File32IDClient ID Error MessageNo corresponding VISTA field at this time.416STNew Client SSNSSN Field (#.09) PATIENT (#2) File52IDSpouse ID Error MessageNo corresponding VISTA field at this time.616STNew Spouse SSNSSN (.09) Income Person (#408.13) File716CKSpouse ID (Internal Entry Number)Internal Entry Number of PATIENT RELATION (#408.12) File82IDIVM Care Status0 – Cancel Z06 MT1 – Create/Update Z06 MT and Close/Convert Case916CK IVM ID (Internal)IVM SPECIFIC INTERNAL ENTRY ID Field (#.07)101IDInsurance Upload StatusUPLOAD INSURANCE DATA (.04) 0 – NOT UPLOADED 1 – UPLOADED112IDReason Ins. Not UploadedREASON NOT UPLOADING INSURANCE Field (#.08) 1 – ALREADY HAVE INSURANCE POLICY 2 – DATA APPEARS TO BE INCORRECT 3 – INSURANCE COMPANY CLOSED 4 – POLICY PLAN TYPE IS HMO 5 – POLICY PLAN TYPE IS PPO 6 – POLICY COVERAGE EXPIRED 7 – POLICY BENEFITS FULLY USED 8 – BENEFITS NOT AVAILABLE 9 – COVERAGE FOR SPOUSE ONLY1219TSClient Date of DeathDATE OF DEATH Field (#.351) Patient (#2) File132NMRSOURCE OF INFORMATION CODEEXPECTED VALUES:3 – IVM14 – Purchased Care CHOICEVA-Specific Military History Segment (ZMH)SEQLENDTR/ORP/#TBL #ELEMENT NAMEVISTA ELEMENT NAMEPATIENT (#2) File Field or Expression14SIRSET ID – MILITARY HISTORYSEQUENTIAL NUMBER24IFRVA038MILITARY HISTORY TYPEVaries based upon Service – (.321) or (.322) or (.52). See table below.380CERSERVICE INDICATORVaries based upon Service – (.321) or (.322) or (.52). See table below429DR0SERVICE ENTRY DATE AND SERVICE SEPARATION DATEVaries based upon Service – (.321) or (.322) or (.52). See table below58ISOVA026SERVICE COMPONENTVaries based upon Service – (.321) or (.322) or (.52). See table below6Not Used7Not Used88DTOFUTURE DISCHARGE DATEFUTURE DISCHARGE DATE field # 2.3216,.08The Future Discharge Date (FDD) will only occur on the ORU-Z11 or ORF-Z11 messages (NOTE: FDD will not occur on the ORU-07 and ORF-Z07). The FDD will only occur once. A patient cannot have more than one FDD. NOTE: The absence of the FDD record in the ZMH segment on the ORU-Z11 or ORF-Z11 HL7 message from ES will result in the deletion of the FDD record in VistA.99STOREASON FOR EARLY SEPARATIONREASON FOR EARLY SEPARATION field # 2.3216,.09The Reason for Early Separation will only occur on the ORU-Z11 or ORF-Z11 messages (NOTE: Reason for Early Separation will not occur on the ORU-Z07 and ORF-Z07). The absence of the Reason for Early Separation on the ORU-Z11 or ORF-Z11 HL7 message from ES will result in the deletion of the Reason for Early Separation record in VistA.1010STOSEPARATION REASON CODESEPARATION REASON CODE field # 2.3216,.1The Separation Reason Code will only occur on the ORU-Z11 or ORF-Z11 messages (NOTE: Separation Reason Code will not occur on the ORU-Z07 and ORF-Z07). The absence of the Separation Reason Code on the ORU-Z11 or ORF-Z11 HL7 message from ES will result in the deletion of the Separation Reason Code record in VistA.This table details the field number for each field * - indicates multiple occurrences are possibleTypeIndicator #1Indicator #2Indicator #3From DateTo DateService ComponentSLService Branch (#2.3216, .03)ORService branch [Last] (.325)Service Number (#2.3216, .05)ORService number [Last] (.328)Service Discharge Type (#2.3216, .06)ORService Discharge Type [Last] (.324)Service Entry Date (#2.3216, .01)ORService Entry Date [Last] (.326)Service Separation Date (#2.3216, .02)ORService Separation Date [Last] (.327)Service Component (#2.3216, .04)ORService Component [Last] (.32911)SNLService Branch (#2.3216, .03)ORService branch [NTL] (.3291)Service Number (#2.3216, .05)OR Service number [NTL] (.3294)Service Discharge Type (#2.3216, .06)OR Service Discharge Type [NTL] (.329)Service Entry Date (#2.3216, .01)OR Service Entry Date [NTL] (.3292)Service Separation Date (#2.3216, .02)OR Service Separation Date [NTL] (.3293)Service Component (#2.3216, .04)OR Service Component [NTL] (.32912)SNNLService Branch (#2.3216, .03)ORService branch [NNTL] (.3296)Service Number (#2.3216, .05)OR Service number [NNTL] (.3299)Service Discharge Type (#2.3216, .06)OR Service Discharge Type [NNTL] (.3295)Service Entry Date (#2.3216, .01)OR Service Entry Date [NNTL] (.3297)Service Separation Date (#2.3216, .02)OR Service Separation Date [NNTL] (.3298)Service Component (#2.3216, .04)OR Service Component [NNTL] (.32913)*MSDService Branch (#2.3216, .03)Service Number (#2.3216, .05)Service Discharge Type (#2.3216, .06)Service Entry Date (#2.3216, .01)Service Separation Date (#2.3216, .02)Service Component (#2.3216, .04)POWPOW Status Indicated (.525)POW Confinement Location (.526)Not usedPOW from date (.527)POW to date (.528)Not usedCOMBCombat Service Indicated (.5291)Combat Service Location (.5292)Not usedCombat from date (.5293)Combat to date (.5294)Not usedVIETVietnam Service Indicated (.32101)Not usedNot usedVietnam from date (.32104)Vietnam to date (.32105)Not usedLEBALebanon Service Indicated (.3221)Not usedNot usedLebanon from date (.3222)Lebanon to date (.3223)Not usedGRENGrenada Service Indicated (.3224)Not usedNot usedGrenada from date (.3325)Grenada to date (.3226)Not usedPANAPanama Service Indicated (.3227)Not usedNot usedPanama from date (.3228)Panama to date (.3229)Not usedGULF Persian Gulf Service (.32201)Not usedNot usedPersian Gulf from date (.322011)Persian Gulf to date (.322012)Not usedSOMASomalia Service Indicated (.322016)Not usedNot usedSomalia from date (.322017)Somalia to date (.322018)Not usedYUGOYugoslavia Service Indicated (.322019)Not usedNot usedYugoslavia from date (.32202)Yugoslavia to date (.322021)Not usedPHCurrent PH Indicator (.531)Current Purple Heart Status (.532)Current Purple Heart Remarks (.533)Not usedNot usedNot used*OEIFLocation of Service (#2.3215,.01)Entered by Site (#2.3215,.06)Not usedFrom Date (#2.3215,.02)To Date (#2.3215,.03)Not usedMHMedal of Honor Indicator (ADR)Not usedNot usedMOH Award DateMOH Status DateNot usedThis table depicts the service indicators/qualifiers identified for the ZMH segment.TypeIndicator #1Indicator #2Indicator #3From DateTo DateService ComponentSLService branch Service numberDischarge typeEnteredSeparatedService ComponentSNLService branchService numberDischarge typeEnteredSeparatedService ComponentSNNLService branchService numberDischarge typeEnteredSeparatedService ComponentMSDService branchService numberDischarge typeEnteredSeparatedService ComponentPOWIndicated – ‘Y’, ‘N’ or ‘U’Confinement LocationNot usedFrom dateTo dateNot usedCOMBIndicated – ‘Y’, ‘N’ or ‘U’Service LocationNot usedFrom dateTo dateNot usedVIETIndicated – ‘Y’, ‘N’ or ‘U’Not usedNot usedFrom dateTo dateNot usedLEBAIndicated – ‘Y’, ‘N’ or ‘U’Not usedNot usedFrom dateTo dateNot usedGRENIndicated – ‘Y’, ‘N’ or ‘U’Not usedNot usedFrom dateTo dateNot usedPANAIndicated – ‘Y’, ‘N’ or ‘U’Not usedNot usedFrom dateTo dateNot usedGULF Indicated – ‘Y’, ‘N’ or ‘U’Not usedNot usedFrom dateTo dateNot usedSOMAIndicated – ‘Y’, ‘N’ or ‘U’Not usedNot usedFrom dateTo dateNot usedYUGOIndicated – ‘Y’, ‘N’ or ‘U’Not usedNot usedFrom dateTo dateNot usedPHPH IndicatorPH StatusRejected RemarksNot usedNot usedNot usedOEIFLocation of ServiceEntered By SiteNot usedFrom dateTo dateNot usedMHMedal of Honor Indicator – Y’ or ‘N’Not usedNot usedMOH Award DateMOH Status DateNot usedVA-Specific Means Test Information Segment (ZMT)SEQLENDTR/ORP/#TBL #Element NameVISTA Element NameANNUAL MEANS TEST (#408.31) File Field or Expression14SIR*Set ID – Patient IDSequential Number (1= Means Test, 2 = Copay Test. 4 = LTC Copay Test Exemption Test) 28DTMeans Test DateDATE OF TEST Field (#.01)32ISVA002Means Test StatusSTATUS Field (#.03)410NMIncomeINCOME Field (#.04)510NMNet WorthNET WORTH Field (#.05)619TSDate/Time of AdjudicationADJUDICATION DATE/TIME Field (#.1)71ISVA001Agreed to Pay DeductibleAGREED TO PAY DEDUCTIBLE Field (#.11)88NMThreshold ATHRESHOLD A Field (#.12)910NMDeductible ExpensesDEDUCTIBLE EXPENSES Field (#.15)1019TSDate/Time MT CompletedDATE/TIME COMPLETED Field (#.07)111ISVA001Previous Yr MT Threshold FlagPREVIOUS YEARS THRESHOLD Field (#.16)122NMTotal DependentsTOTAL DEPENDENTS Field (#.18)131ISVA001HardshipHARDSHIP Field (#.2)148DTHardship Review DateHARDSHIP REVIEW DATE Field (#.21)1519TSDate Veteran Signed TestDATE VETERAN SIGNED TEST Field (#.24)161ISVA001Declines to Give Income InfoDECLINES TO GIVE INCOME INFO Field (#.14)171IDVA060Type of TestTYPE OF TEST Field (#.019) 1 = Means Test2= Copay Test4 = LTC Copay Exemption Test181ID***Source of TestSOURCE OF TEST Field (#.23) (1=VAMC, 2=IVM, 3=DCD, 4=Other Facility)191ISVA001Primary Test?PRIMARY INCOME TEST FOR YEAR? Field (#2)208DTDate IVM Verif. MT CompletedDATE IVM VERIFIED MEANS TEST COMPLETED Field (#.25)VA-Specific Means Test Information Segment (ZMT), continuedSEQLENDTR/ORP/#TBL #Element NameVISTA Element NameANNUAL MEANS TEST (#408.31) File Field or Expression211ISVA001Refused To SignREFUSED TO SIGN Field (#.26)223NMVA115****Site Conducting TestSITE CONDUCTING TEST Field (#2.05)233NMVA115Hardship Review SiteSITE GRANTING HARDSHIP Field (#2.04)248DTHardship Effective DateHARDSHIP EFFECTIVE DATE Field (#2.01)25DTDate/Time Last EditedDATE/TIME LAST EDITED Field (#2.02)262IDVA 02Test determined StatusTEST DETERMINED STATUS Field (#2.03)271ISVA0051***Means Test Signature IndicatorMEANS TEST SIGNED? Field (#.29)288NMGMT ThresholdGMT THRESHOLD Field (#.27)2980FTHardship ReasonHARDSHIP REASON Field (#2.09)301STMeans Test VersionMEANS TEST VERSION (#2.11)0 = Before Feb 2005 format1 = Feb 2005 2 = TBD (in case there is a need to expand into the future)311ISVA001BT FINANCIAL INDICATORBT FINANCIAL INDICATOR (#4)328DTHARDSHIP EXPIRATION DATEHARDSHIP EXPIRATION DATE (#2.13) (Precise)Notes:Deletion of a Test: SEQ 1 indicates the type of test to delete.SEQ 2 will be used to indicate which income year test to delete. The income year is the year prior to the date of the means test.SEQ 3 = HLQ will indicate that the test should be deleted.** Deletion of a Hardship Determination: SEQ 24 = HLQ will indicate that the hardship determination should be deleted.SEQ 2 will be used to indicate for which income year to delete the hardship determination . The income year is the year prior to the date of the means test.*** Means Test Signature IndicatorSEQ 27 was added by Patch IVMB*2*600 for the Implement Signed Means Test Strategy project. VAMCs receive and store data from SEQ 27, but do not include this sequence in transmissions to the HEC. VAMCs send means test signature images to the HEC via FAX. HEC staff processes those images using commercial software with updates to the HEC database via custom remote procedure calls (RPCs). VA-Specific Patient Information Segment (ZPD)SEQLENDTR/ORP/#TBL#Element NameVISTA Element NamePATIENT (#2) File Field or Expression14SIRSet ID – Patient IDSequential Number260STRemarksREMARKS Field (#.091)320STPlace of Birth CityPLACE OF BIRTH CITY Field (#.092)42STPlace of Birth StatePLACE OF BIRTH STATE Field (#.093) (Abbreviation Only)52ISVA002Current Means Test StatusCURRENT MEANS TEST STATUS Field (#.14)635STFather’s NameFATHER’S NAME Field (#.2401)735STMother’s NameMOTHER’S NAME Field (#.2402)81ISVA001Rated IncompetentRATED INCOMPETENT Field (#.293)919TSDate of DeathDATE OF DEATH Field (#.351)1048PNCollateral SponsorCOLLATERAL SPONSOR Field (#.3601)111ISVA001Active Health Insurance?Active Health Insurance? (Computed)121ISVA001Eligible For Medicaid?ELIGIBLE FOR MEDICAID? Field (#.381)1319TSDate Medicaid Last AskedDATE MEDICAID LAST ASKED Field (#.382)141ISVA007RaceRACE Field (#.06)153ISVA008ReligionRELIGION Field (#.08)161ISVA001Homeless IndicatorHomeless Indicator (Computed)171STPOW Status Indicated?POW STATUS INDICATED? Field (#.525) (Y = Yes; N = No; U = Unknown)182ISVA012Type of InsuranceTYPE OF INSURANCE (Computed)191ISVA014Medication Copayment Exemption StatusMEDICATION COPAY EXEMPTION STATUS (Computed) (#354) (.04)202ISPOW Confinement LocationNot used at this time; sent in ZMH segment212STPrimary Care Team (as defined in PCMM)PRIMARY CARE TEAM (File# 404.51)221ISVA001GI Insurance PolicyGIN INSURANCE POLICY? Field (#.36265)236NMAmount of GI InsuranceAMOUNT OF GI INSURANCE Field (#.3626)248DTMost Recent Date of CareMOST RECENT DATE OF CARE Field (#1010.151)2530STMost Recent Location of CareMOST RECENT LOCATION OF CARE Field (#1010.152)268DT2nd Most Recent Date of Care2nd MOST RECENT DATE OF CARE Field (#1010.153)2730ST2nd Most Recent Location of Care2nd MOST RECENT LOCATION OF CARE Field (#1010.154)288DTDate Ruled Incompetent (Civil)DATE RULED INCOMPETENT (CIVIL) Field (#.292)298DTDate Ruled Incompetent (VA)DATE RULED INCOMPETENT (VA) Field (#.291)301IDSpinal Cord InjurySPINAL CORD INJURY Field (#57.4) Values: 1:PARAPLEGIA-TRAUMATIC 2:QUADRIPLEGIA- TRAUMATIC 3: PARAPLEGIA-NONTRAUMATIC 4: QUADRIPLEGIA- NONTRAUMATIC X:NOT APPLICABLE311IDSource of NotificationSOURCE OF NOTIFICATION FOR DATE OF DEATH Field (#.353) Values: 1:INPATIENT AT VAMC 2:NON-VA MEDICAL FACILITY 3:DEATH CERTIFICATE ON FILE 4:VBA 5:VA INSURANCE 6:SSA 7:NCA 8:NEXT OF KIN/FAMILY/FRIEND 9: OTHER328DTDate of Death Last UpdatedDATE OF LAST ENTRY OR UPDATE Field (#.354)VA-Specific Patient Information Segment (ZPD), continuedSEQLENDTR/ORP/#TBL#Element NameVISTA Element NamePATIENT (#2) File Field or Expression332ISVA048Filipino Veteran ProofFILIPINO VETERAN PROOF Field (#3214). Values: PP – US PASSPORT, BC – US BIRTH CERTIFICATE; BA – REPORT OF BIRTH ABROAD OF US CITIZEN, NA – VERIFICATION OF NATURALIZATION, PR – VERIFICATION OF PERMANENT RESIDENCY, VA – VA COMPENSATION AT FULL DOLLAR RATE, NO – NO PROOF.341STPseudo SSN ReasonPSEUDO SSN REASON Field (#.0906). Values: R – REFUSED TO PROVIDE, S – SSN UNKNOWN/FOLLOW-UP REQUIRED, N – NO SSN ASSIGNED3515IDVA018Agency/Allied CountryAGENCY/ALLIED COUNTRY Field (#.309). Pointer to OTHER FEDERAL AGENCY File (#35)36-39TBDTBDTBDTBDTBDTBDTBD401STEmergency Response Indicator EMERGENCY RESPONSE INDICATOR Field (#.181) Values: P – PANDEMICVA-Specific Rated Disabilities Segment (ZRD)SEQLENDTR/ORP/#TBL#Element NameVISTA Element NamePATIENT (#2.3721) Sub-File Field or Expression14SIRSet IDSequential Number24CEDisability Condition *(See below.)RATED DISABILITIES (VA) Field (#.01)33NMDisability %DISABILITY % Field (#2)41ISVA001Service Connected Rated DisabilitySERVICE CONNECTED Field (#3)DISABILITY CONDITION has the coded element data type, which is one of the composite data types. The ‘~’ is always used within the IVM and Enrollment packages as the component separator. The general format for the coded element data type, from the 2.3 version of the HL7 standard, is:<identifier (ST)>~<text (ST)>~<name of coding system (ST)>~<alternate identifier (ST>~The actual format for the DISABILITY CONDITION is:<4-digit DX CODE from the Disability Condition File (#31)>~<45-character NAME Field from the Disability Condition File>If the DISABILITY CONDITION Field is included in the segment then both of its components are required.Here is an example of the ZRD segment: ZRD^1^5001~BONE DISEASE^30^1VA-Specific Service Period Segment (ZSP)SEQLENDTR/ORP/#TBL#Element NameVISTA Element NamePATIENT (#2) File Field or Expression14SIRSet IDSequential Number21ISRVA001Service Connected?SERVICE CONNECTED? Field (#.301)33NMService Connected PercentageSERVICE CONNECTED PERCENTAGE Field (#.302)42ISVA011Period of ServicePERIOD OF SERVICE Field (#.323)51STVietnam Service Indicated?VIETNAM SERVICE INDICATED? Field (#.32101)61ISVA001P&TP&T Field (#.304)71ISVA001UnemployableUNEMPLOYABLE Field (#.305)819TSSC Award DateSC AWARD DATE Field (#.3012)98DTService Verification DateSERVICE VERIFICATION DATE (#.322)108DTP&T Effective DateP&T EFFECTIVE DATE (#.3013)118DTCombined SC Percent Effective DateEFF. DATE COMBINED SC% EVAL. (#.3014)121ISVA001Eligible For Class II DentalCLASS II DENTAL INDICATOR (#.3858)138DTClass II Dental Application Due Before DateDENTAL APPL DUE BEFORE DATE (#.3859)VA-Specific Temporary Address Segment (ZTA)SEQLENDTR/ORP/#TBL #Element NameVISTA Element NamePATIENT (#2) File Field or Expression14SIRSet ID – Patient IDSequential Number21ISVA001Temporary Address?TEMPORARY ADDRESS ENTER/EDIT? Field (#.12105)38DTTemporary Address StartTEMPORARY ADDRESS START DATE Field (#.1217)48DTTemporary Address EndTEMPORARY ADDRESS END DATE Field (#.1218)5106XADTemporary AddressTEMPORARY ADDRESS Fields (For USA: #.1211-.1215, .12111, .12112, .1223 For Foreign: .1211-.1213, .12111 .1221-.1223)64IDTemporary Address CountyTEMPORARY ADDRESS COUNTY Field (#.12111)740TNTemporary Address PhoneTEMPORARY PHONE NUMBER Field (#.1219)826TSTemporary Address Date/Time Last UpdatedTEMPORARY ADDRESS CHANGE DT/TM (.12113)910NM0115Temporary Address Site of ChangeTEMPORARY ADDRESS CHANGE SITE (#.12114)VA Specific Temporary Eligibility Segment (ZTE)SEQLENDTR/ORP/#TBL #ELEMENT NAMEVISTAFile# 33 – OTH ELIGIBILITY PATIENT14SIRSET IDSequential Number28DTODATE REQUEST SUBMITTEDDate of request submission to CMOPending? - file 33, field .03Approved – sub-file 33.11, field .03Denied – sub-file 33.03, field .02319TSOORIGINAL REQUEST ENTERED DATE/TIMESystem timestamp when request is originally entered41STRAUTHORIZATION STATUSAUTHORIZATION STATUSA = ApprovedP = PendingD = Denied519TSODATE/TIME REQUEST UPDATEDTimestamp of last record modificationPending? - file 33, field .05Approved – sub-file 33.11, field .06Denied – sub-file 33.03, field .05660STOREQUEST ENTERED BYName of the user who modified the recordPending? - file 33, field .04Approved – sub-file 33.11, field .05Denied – sub-file 33.03, field .04710ISOVA0115SITE OF CHANGEFacility (station number) that modified the recordPending? - file 33, field .06Approved – sub-file 33.11, field .08Denied – sub-file 33.03, field .0684NMO365 DAY PERIOD NUMBERSequential number of 365 day period. Only applicable to approved requests, blank for pending and denied requests.Approved – sub-file 33.01, field .0194NMO90 DAY PERIOD NUMBERSequential number of 90 day period. Only applicable to approved requests, blank for pending and denied requests.Approved – sub-file 33.11, field .01108DTOAUTHORIZATION DATEDate when authorization was received from CMO. Only applicable to approved requests, blank for pending and denied requests.Approved – sub-file 33.11, field .041160STOAUTHORIZED BYName of the person who approved the request. Only applicable to approved requests, blank for pending and denied requests.Approved – sub-file 33.11, field .07128DTOSTART DATEStart date of the approved 90 day period. Only applicable to approved requests, blank for pending and denied requests.Approved – sub-file 33.11, field .021360STOAUTHORIZATION COMMENTComment / reason for request denial. Only applicable to denied requests, blank for approved and pending requests.Denied – sub-file 33.03, field .03ZUD – VA Specific VistA User Data SegmentSEQLENDTR/ORP/#TBL #Element NameVISTA Element NamePATIENT (#2) File Field or Expression14SIRSET IDSequential Number25ISRCONTACT INFO TYPESeq 2 will be populated with one of the following codes to identify the type of information:SAD = Street Address ChangeCAD = Confidential Address ChangeCPH = Cell Phone Number ChangePNO = Pager Number ChangeEAD = E-Mail Address ChangePHH = Home Phone Number ChangeRAD=Residential Address ChangePHB=Business Phone ChangePHC=Confidential Phone Change319TSRLAST UPDATED DATE/TIMEUPDATE DATE/TIME (#) Date/time the contact information was updated435XPNUPDATED BYFormat:LAST~FIRST~MIDDLE~SUFFIXVistA User Name (200.01)59NMUSER NUMBERVistA User Number (200.001)Batch Header Segment (BHS)SEQLENDTR/ORP/#TBL#Element NameVISTA Description11STRBatch Field SeparatorRecommended value is ^ (caret)24STRBatch Encoding CharactersRecommended delimiter values:Component = ~ (tilde)Repeat = | (bar)Escape = \ (back slash)Subcomponent = & (ampersand)315STBatch Sending ApplicationWhen originating from facility: IVMWhen originating from HEC: IVM CENTER420STBatch Sending FacilityWhen originating from facility: Station’s facility numberWhen originating from HEC: 724515STBatch Receiving ApplicationWhen originating from facility: IVM CENTERWhen originating from HEC: IVM620STBatch Receiving FacilityWhen originating from facility: 724When originating from HEC: Station’s facility number726TSBatch Creation Date/TimeDate and time batch message was created840STBatch SecurityNot used920STBatch Name / ID / TypeThe following fields in File #101: #770.4#770.6#770.8#770.9#770.951080STBatch CommentOnly used for acknowledgmentsERROR MESSAGE Field (#22) of File #7721120STBatch Control IDMESSAGE ID Field (#2) of File #7721220STReference Batch Control IDMESSAGE ID Field (#2) of File #772Batch Header Segment (BHS), continuedSEQLENDTR/ORP/#TBL#Element NameVISTA Description920STBatch Name/ID/Type4 Components:Component 1: Batch Name (Not used)Component 2: Processing IDComponent 3: Message TypeComponent 4: Version IDThese 4 components must be separated by the HL7 component separator. The processing ID, message type, and version ID correspond to fields of the same name in the MSH segment1080STBatch Comment2 Components:Component 1: Refer to Table 0008Component 2: Text Message1120STBatch Control IDAutomatically generated by VISTA HL7 Package1220STReference Batch Control IDBatch Control ID of batch message being acknowledgedBatch Trailer Segment (BTS)SEQLENDTR/ORP/#TBL#Element NameVISTA Description110STBatch Message CountNumber of messages within the batch message280STBatch CommentNot used at this time3100CMYBatch TotalsNot used at this timeMessage Header Segment (MSH)SEQLENDTR/ORP/#TBL#Element NameVISTA Description11STRField SeparatorRecommended value is ^ (caret) (File #771, Field #100)24STREncoding CharactersRecommended delimiter values:Component = ~ (tilde)Repeat = | (bar)Escape = \ (back slash)Subcomponent = & (ampersand)3180HDOSending ApplicationSending application (File #771, Field #.01)4180HDOSending FacilitySending facility (File #771, Field #3)5180HDOReceiving ApplicationReceiving application (File #771, Field #.01)6180HDOReceiving FacilityReceiving facility (File #771 Field #3)726TSODate/Time of MessageDate and time message was created840STOSecurityNot used97CMR00760003Message Type2 Components:Component 1: Refer to Table 0076 in Appendix CComponent 2?: Message Event Type Code1020STRMessage Control IDAutomatically generated by VISTA HL7 Package113PTR0103Processing IDP (PRODUCTION) (File #101 Field #770.6)128IDR0104Version Id2.3.1 (HL7 VERSION 2.3.1) (File #101 Field #770.95)1315NMOSequence NumberNot used 14180STOContinuation PointerNot used 152IDO0155Accept Acknowledgment TypeAL – Always used (File #101 Field #770.8)162IDO0155Application Acknowledgment TypeAL – Always used (File #101 Field #770.9)172IDOCountry CodeUS (File #771 Field #7)186IDOY/30211Character SetNot used1960CEOPrincipal Language Of MessageNot used2020IDO0356Alternate Character Set Handling SchemeNot usedMessage Header Segment (MSH) , continuedSEQLENDTR/ORP/#TBL#Element NameVISTA Description630STReceiving FacilityStation #726TSDate/Time of MessageDate and time message was created840STSecurityNot used97CMR0076Message TypeMFN~M0F1020STRMessage Control IDAutomatically generated by VISTA HL7 Package111IDR0103Processing IDP (Production)128IDR0104Version ID2.3 (Version 2.3)1315NMSequence NumberNot used at this time14180STContinuation PointerNot used at this time152ID0155Accept Acknowledgment TypeNE (never acknowledge)162ID0155Application Acknowledgment TypeAL (always acknowledge)173IDCountry CodeUS186IDY/30211Character SetNot used at this time1960CEPrincipal Language of MessageNot used at this timeMessage Acknowledgment Segment (MSA)SEQLENDTR/ORP/#TBL#Element NameVISTA Description12IDR0008Acknowledgment CodeRefer to Table 0008 in Appendix C220STRMessage Control IDMessage Control ID of message being acknowledged380STText MessageError text denoting why the message was rejected415NMExpected Sequence NumberNot used51ID0102Delayed Acknowledgment TypeNot used6100CEError ConditionNot usedMaster File Identification Segment (MFI)SEQLENDTR/ORP/#TBL#Element NameVISTA Description160CER0175Master File Identifier‘5P12~POSTAL CODE~VHA’ or ‘5P13~COUNTY CODE~VHA’2180HDOMaster File Application IdentifierNot used33IDR0178File-Level Event Code‘UPD’426TSOEntered Date/TimeNot used526TSOEffective Date/TimeNot used62IDR0179Response Level Code‘NE’Master File Entry Segment (MFE)SEQLENDTR/ORP/#TBL#Element NameVISTA Description13IDR0180Record-Level Event Code‘MAD’ or ‘MUP’220STCMFN Control IDNot used326TSEffective Date/TimeEffective Date/Time460CERYPrimary Key ValueSame as LOC Sequence #1Location Identification Segment (LOC)SEQLENDTR/ORP/#TBL#Element NameVISTA Description1200PLRPrimary Key Value – LOCPostal Code: CODE Field (#.01) of the POSTAL CODE File (#5.12). This data was obtained from the U. S. Postal Service, but could include other external sources in the future as postal codes belonging to other countries are introduced to the system.County Code: 5-digit FIPS CODE Field (#.01) of the COUNTY CODE File (#5.13)248STOLocation DescriptionPostal Code: Postal Code Master File UpdateCounty Code: County Code Master File Update32ISRLocation Type – LOCL490XONOOrganization Name – LOCNot Used5106XADOLocation AddressPostal Code: POSTAL CODE File (#5.12)County Code: COUNTY CODE File (#5.12)640XTNOLocation PhoneNot used760CEOLicense NumberNot used83ISOLocation EquipmentNot UsedAppendix C – Supported/User-Defined Standard HL7 TablesTable 0001 – SexCodeDescriptionFFEMALEMMALEOOTHERUUNKNOWNTable 0002 – Marital StatusCodeDescriptionASEPARATEDDDIVORCEDMMARRIEDSSINGLEWWIDOWEDTable 0003 – Event Type CodesCodeDescriptionM05 MFN/MFKPatient location master fileTable 0005 – RaceCodeDescription 1002-5American Indian or Alaska Native2028-9Asian2054-5Black or African American2076-8Native Hawaiian or Other Pacific Islander2106-3White2131-1Other RaceTable 0006 – ReligionCodeDescription ABCChristian: American Baptist ChurchAGNAgnosticAMEChristian: African Methodist Episcopal ZionAMTChristian: African Methodist EpiscopalANGChristian: AnglicanAOGChristian: Assembly of GodATHAtheistBAHBaha’iBAPChristian: BaptistBMABuddhist: MahayanaBOTBuddhist: OtherBTABuddhist: TantrayanaBTHBuddhist: TheravadaBUDBuddhistCATChristian: Roman CatholicCFRChinese Folk ReligionistCHRChristianCHSChristian: Christian ScienceCMAChristian: Christian Missionary AllianceCNFConfucianCOCChristian: Church of ChristCOGChristian: Church of GodCOIChristian: Church of God in ChristCOLChristian: CongregationalCOMChristian: CommunityCOPChristian: Other PentecostalCOTChristian: OtherCRRChristian: Christian ReformedEOTChristian: Eastern OrthodoxEPIChristian: EpiscopalianERLEthnic ReligionistEVCChristian: Evangelical ChurchFRQChristian: FriendsFWBChristian: Free Will BaptistGREChristian: Greek OrthodoxHINHinduHOTHindu: OtherHSHHindu: ShaivitesHVAHindu: VaishnavitesJAIJainJCOJewish: ConservativeJEWJewishJORJewish: OrthodoxJOTJewish: OtherJRCJewish: ReconstructionistJRFJewish: ReformJRNJewish: RenewalJWNChristian: Jehovah’s WitnessLMSChristian: Lutheran Missouri SynodLUTChristian: LutheranMENChristian: MennoniteMETChristian: MethodistMOMChristian: Latter-day SaintsMOSMuslimMOTMuslim: OtherMSHMuslim: ShiiteMSUMuslim: SunniNAMNative AmericanNAZChristian: Church of the NazareneTable 0006 – Religion, continuedNOENonreligiousNRLNew ReligionistORTChristian: OrthodoxOTHOtherPENChristian: PentecostalPRCChristian: Other ProtestantPREChristian: PresbyterianPROChristian: ProtestantQUAChristian: FriendsRECChristian: Reformed ChurchREOChristian: Reorganized Church of Jesus Christ-LDSSAAChristian: Salvation ArmySEVChristian: Seventh Day AdventistSHNShintoistSIKSikhSOUChristian: Southern BaptistSPISpiritistUCCChristian: United Church of ChristUMDChristian: United MethodistUNIChristian: UnitarianUNUChristian: Unitarian UniversalistVARUnknownWESChristian: WesleyanWMCChristian: Wesleyan MethodistTable 0008 – Acknowledgment CodeCodeDescriptionAAOriginal Mode: Application AcceptEnhanced Mode: Application Acknowledgment: AcceptAEOriginal Mode: Application ErrorEnhanced Mode: Application Acknowledgment: ErrorAROriginal Mode: Application RejectEnhanced Mode: Application Acknowledgment: RejectCAEnhanced Mode: Accept Acknowledgment: Commit AcceptCEEnhanced Mode: Accept Acknowledgment: Commit ErrorCREnhanced Mode: Accept Acknowledgment: Commit RejectTable 0017 – Transaction TypeCodeDescription AJAdjustmentCDCreditCGChargeCOCo-paymentPYPaymentTable 0018 – Patient TypeCodeDescription 00Surgical10Medical60Home Nursing Service85Psychiatric Contract86Psychiatric95Neurological Contract96NeurologicalTable 0024 – Fee ScheduleCodeDescription1Charge exceeds maximum payable2Math error, 3-Not entitled to treatment4Other, 5-Previously Paid6Exceed monthly dollar limitation7Physician’s signature missing8Patient’s signature missing9Medication not emergentAPharmacist’s certification missingBPharmacist’s signature missingCRequired drug information missingDItem not on payable listEVeteran information missingFPersonal items/Private RoomGVet refused transferHFor recurring or refill medicationIPayment made for Generic drugJMill Bill AuthorityTable 0048 – What Subject FilterCodeDescription ADVAdvice/diagnosisANUNursing unit lookup (returns patients in beds, excluding empty beds)APAAccount number query, return matching visitAPMMedical record number query, returns visits for a medical record numberAPNPatient name lookupAPPPhysician lookupARNNursing unit lookup (returns patients in beds, including empty beds)CANCancel. Used to cancel a queryDEMDemographicsFINFinancialGIDGenerate new identifierGOLGoalsMRIMost recent inpatientMROMost recent outpatientNCKNetwork clockNSCNetwork status changeNSTNetwork statisticORDOrderOTHOtherPRBProblemsPROProcedureRARPharmacy administration informationRDRPharmacy dispense informationRERPharmacy encoded order informationRESResultRGRPharmacy give informationRORPharmacy prescription informationSALAll schedule related information, including open slots, booked slots, blocked slotsSBKBooked slots on the identified scheduleSBLBlocked slots on the identified scheduleSOFFirst open slot on the identified schedule after the start date/timeSOPOpen slots on the identified schedule between the begin and end of the start date/time rangeSSATime slots available for a single appointmentSSRTime slots available for a recurring appointmentSTAStatusVXIVaccine InformationXIDGet cross-referenced identifiersTable 0049 – Department CodeCodeDescription0NET 301Subject to interestTable 0051 – Diagnosis CodeCodeDescription253.2PANHYPOPITUITARISM253.3PITUITARY DWARFISM253.4ANTER PITUITARY DIS NEC253.5DIABETES INSIPIDUS253.6NEUROHYPOPHYSIS DIS NEC253.7IATROGENIC PITUITARY DIS253.8DISEASES OF THYMUS NEC253.8DISEASES OF THYMUS NEC253.9PITUITARY DISORDER NOS254.1ABSCESS OF THYMUSTable 0076 – Message TypeCodeDescriptionADTADT MESSAGEACKGENERAL ACKNOWLEDGMENTMFNMASTER FILE NOTIFICATIONORFOBSERV. RESULT/RECORD RESPONSEORUOBSERV RESULT/UNSOLICITEDQRYQUERYNote: This is not the complete table. It contains those message types used by the VISTA/HEC interface.Table 0078 – Abnormal FlagsCodeDescription <Below absolute low-off instrument scale>Above absolute high-off instrument scaleAAbnormal (applies to non-numeric results)AAVery abnormal (applies to non-numeric units, analogous to panic limits for numeric units)BBetter–use when direction not relevantDSignificant change downHAbove high normalHHAbove upper panic limitsIIntermediate. Indicates for microbiology susceptibilities only.LBelow low normalLLBelow lower panic limitsMSModerately susceptible. Indicates for microbiology susceptibilities only.NNormal (applies to non-numeric results)nullNo range defined, or normal ranges don’t applyRResistant. Indicates for microbiology susceptibilities only.SSusceptible. Indicates for microbiology susceptibilities only.USignificant change upVSVery susceptible. Indicates for microbiology susceptibilities only.WWorse–use when direction not relevantTable 0080 – Nature of Abnormal TestingCodeDescription AAn age-based populationBBreedNNone – generic normal rangeRA race-based populationSA sex-based populationSPSpeciesSTStrainTable 0085 – Observation Result Status Codes InterpretationCodeDescription CRecord coming over is a correction and thus replaces a final resultDDeletes the OBX recordFFinal results; Can only be changed with a corrected result.ISpecimen in lab; results pendingNNot asked; used to affirmatively document that the observation identified in the OBX was not sought when the universal service ID in OBR-4 implies that it would be sought.OOrder detail description only (no result)PPreliminary resultsRResults entered – not verifiedSPartial resultsUResults status change to final without retransmitting results already sent as _preliminary._ E.g., radiology changes status from preliminary to finalWPost original as wrong, e.g., transmitted for wrong patientXResults cannot be obtained for this observationTable 0088 – Procedure CodeCodeDescription 10141INCISION AND DRAINAGE OF HEMATOMA; COMPLICATEDTable 0091 – Query PriorityCodeDescriptionDDeferredIImmediateTable 0102 – Delayed Acknowledgement TypeCodeDescriptionDMessage received, stored for later processingFAcknowledgment after processingTable 0103 – Processing IDCodeDescriptionDDEBUGGINGPPRODUCTIONTTRAININGTable 0104 – Version IDCodeDescription2.0RELEASE 2.02.0DDEMO 2.02.1RELEASE 2.12.2RELEASE 2.2Table 0105 – Source of CommentCodeDescription LAncillary (filler) department is source of commentOOther system is source of commentPOrderer (placer) is source of commentTable 0106 – Query/Response Format CodeCodeDescription DResponse is in display formatRResponse is in record-oriented formatTResponse is in tabular formatTable 0108 – Query Results LevelCodeDescription OOrder plus order statusRResults without bulk textSStatus onlyTFull resultsTable 0115 – Servicing FacilitySample of possible values; the complete table in the Messaging Workbench.CodeDescription327LOUISVILLE-RO358MANILA-RO402TOGUS VAMROC402GACARIBOU402GCRUMFORD402GDSACO VA CLINIC402HBBANGOR402HCPORTLAND402HKCALAIS/MACHIAS405WHITE RIVER JCT VAMROCTable 0125 – Value TypeCodeDescription ADAddressCECoded EntryCFCoded Element With Formatted ValuesCKComposite ID With Check DigitCNComposite ID And NameCPComposite PriceCXExtended Composite ID With Check DigitDTDateEDEncapsulated DataFTFormatted Text (Display)MOMoneyNMNumericPNPerson NameRPReference PointerSNStructured NumericSTString Data.TMTimeTNTelephone NumberTSTime Stamp (Date & Time)TXText Data (Display)XADExtended AddressXCNExtended Composite Name And Number For PersonsXONExtended Composite Name And Number For OrganizationsXPNExtended Person NameXTNExtended Telecommunications NumberTable 0126 – Quantity Limited RequestCodeDescription CHCharactersLILinesPGPagesRDRecordsZOLocally definedTable 0136 – Yes/No IndicatorCodeDescription NNoYYesTable 0155 – Accept/Application Acknowledgment ConditionsCodeDescription ALAlwaysERError/reject conditions onlyNENeverSUSuccessful completion onlyTable 0172 – Veterans Military StatusCodeDescriptionNNon VeteranYVeteranTable 0175 – Master File Identifier CodeCodeDescriptionZ04VHA INSTITUTION (#4) File5P12POSTAL CODE (#5.12) File5P13COUNTY CODE (#5.13) FileTable 0178 – File Level Event CodeCodeDescriptionREPReplace current version of this master file with the version contained in this messageUPDChange file records as defined in the record level event codes for each record that followsTable 0179 – Response LevelCodeDescriptionNENever. No application-level response neededERError/Reject conditions only. Only MFA segments denoting errors must be returned via the application-level acknowledgment for this messageALAlways. All MFA segments (whether denoting errors or not) must be returned via the application-level acknowledgment messageSUSuccess. Only MFA segments denoting success must be returned via the application-level acknowledgment for this messageTable 0180 – Record Level Event CodeCodeDescriptionMADAdd record to master fileMDLDelete record from master fileMUPUpdate record for master fileMDCDeactivate: discontinue using record in master file, but do not delete from databaseMACReactivate deactivated recordTable 0189 – Ethnic GroupCodeDescription HHispanic or LatinoNNot Hispanic or LatinoUUnknownTable 0211 – Alternate Character SetsCode Description8859/1The printable characters from the ISO 8859/1 Character set8859/2The printable characters from the ISO 8859/2 Character set8859/3The printable characters from the ISO 8859/3 Character set8859/4The printable characters from the ISO 8859/4 Character set8859/5The printable characters from the ISO 8859/5 Character set8859/6The printable characters from the ISO 8859/6 Character set8859/7The printable characters from the ISO 8859/7 Character set8859/8The printable characters from the ISO 8859/8 Character set8859/9The printable characters from the ISO 8859/9 Character setASCIIThe printable 7-bit ASCII character set. (This is the default if this field is omitted)ISO IR14Code for Information Exchange (one byte)(JIS X 0201-1976). Note that the code contains a space, i.e. “ISO IR14”.ISO IR159Code of the supplementary Japanese Graphic Character set for information interchange (JIS X 0212-1990). Note that the code contains a space, i.e. “ISO IR159”.ISO IR87Code for the Japanese Graphic Character set for information interchange (JIS X 0208-1990), Note that the code contains a space, i.e. “ISO IR87”.UNICODEThe world wide character standard from ISO/IEC 10646-1-19931Table 0280 – Referral PriorityCodeDescription AASAPRRoutineSSTATTable 0281 – Referral TypeCodeDescription HomHome CareLabLaboratoryMedMedicalPsyPsychiatricRadRadiologySknSkilled NursingTable 0282 – Referral DispositionCodeDescription AMAssume ManagementRPReturn Patient After EvaluationSOSecond OpinionWRSend Written ReportTable 0283 – Referral StatusCodeDescription AAcceptedEExpiredPPendingRRejectedTable 0284 – Referral CategoryCodeDescription AAmbulatoryEEmergencyIInpatientOOutpatientTable 0340 – Procedure Code ModifierCodeDescription57DECISION FOR SURGERYTable 0356 – Alternate Character Set Handling SchemeCode Description<null>This is the default, indicating that there is no character set switching occurring in this message.2.3The character set switching mode specified in HL7 2.3, sections 2.8.28.6.1, and 2.9.2. Note that the escape sequences used in this mode do not use the ASCII “esc” character. They are “HL7 escape sequences” as defined in HL7 2.3, sec. 2.9 as defined in IISO 2022-1994This standard is titled “Information Technology – Character Code Structure and Extension Technique”. This standard specifies an escape sequence from basic one byte character set to specified other character set, and vice versa. Table 0363 – Source of AddressADDRESS CHANGE SOURCE Field (#.119) of PATIENT File (#2)CodeDescriptionUSVAHECUS VA Health Eligibility CenterUSVAMCUS VA Medical CenterUSVAHBSCUS VA Health Benefits Service CenterUSNCOAUS National Change Of AddressUSVABVAUS VA Board of Veteran’s Appeals ApplicationUSVAINSUS VA Philadelphia Insurance CenterUSPSUS COA electronic file from the US Postal Service with forwarding address generated from enrollment lettersUSVAUS Department of Veterans AffairsVET360VET360 address validation serviceAppendix D – Supported/User-Defined VA HL7 TablesTable VA001 – Yes/NoCodeDescription0NO1YESTable VA002 – Current Means Test StatusCODE (#.02) Field of MEANS TEST STATUS (#408.32) FileCodeDescription0EXEMPT (LTC CO-PAY EXEMPTION TEST)1NON- EXEMPT (LTC CO-PAY EXEMPTION TEST)AMT COPAY EXEMPTBCATEGORY BCMT COPAY REQUIREDEEXEMPTGGMT COPAY REQUIREDIINCOMPLETELNO LONGER APPLICABLEMNON-EXEMPTNNO LONGER REQUIREDPPENDING ADJUDICATIONRREQUIREDTable VA003 – Employment StatusEMPLOYMENT STATUS (#.31115) Field of PATIENT (#2) FileCodeDescription1EMPLOYED FULL TIME2EMPLOYED PART TIME3NOT EMPLOYED4SELF EMPLOYED5RETIRED6ACTIVE MILITARY DUTY9UNKNOWNTable VA004 – EligibilityInternal Entry Number of MAS ELIGIBILITY CODE (#8.1) FileCodeDescription1SERVICE CONNECTED 50% to 100%2AID & ATTENDANCE3SC LESS THAN 50%4NSC – VA PENSION5NSC6OTHER FEDERAL AGENCY7ALLIED VETERAN8HUMANITARIAN EMERGENCY9SHARING AGREEMENT12CHAMPVA13COLLATERAL OF VET.14EMPLOYEE15HOUSEBOUND17WORLD WAR I18PRISONER OF WAR19TRICARE20MEDICARE22PURPLE HEART23EXPANDED MH CARE NON-ENROLLEE24COMPACT ACT ELIGIBLE25SPECIAL TX AUTHORITY CARETable VA005 – Disability Retirement From MilitaryDISABILITY RET. FROM MILITARY? (#.362) Field of PATIENT (#2) FileCodeDescription0NO1YES, RECEIVING MILITARY RETIREMENT2YES, RECEIVING MILITARY RETIREMENT IN LIEU OF VA COMPENSATION3UNKNOWNTable VA006 – Eligibility StatusELIGIBILITY STATUS (#.3611) Field of PATIENT (#2) FileCodeDescriptionPPENDING VERIFICATIONRPENDING RE-VERIFICATIONVVERIFIEDTable VA007 – RaceABBREVIATION (#2) Field of RACE (#10) FileCodeDescription1HISPANIC, WHITE2HISPANIC, BLACK3AMERICAN INDIAN OR ALASKA NATIVE4BLACK, NOT OF HISPANIC ORIGIN5ASIAN OR PACIFIC ISLANDER6WHITE, NOT OF HISPANIC ORIGIN7UNKNOWNTable VA008 – ReligionCODE (#3) Field of RELIGION (#13) FileCodeDescription0CATHOLIC1JEWISH2EASTERN ORTHODOX3BAPTIST4METHODIST5LUTHERAN6PRESBYTERIAN7UNITED CHURCH OF CHRIST8EPISCOPALIAN9ADVENTIST10ASSEMBLY OF GOD11BRETHREN12CHRISTIAN SCIENTIST13CHURCH OF CHRIST14CHURCH OF GOD15DISCIPLES OF CHRIST16EVANGELICAL COVENANT17FRIENDS18JEHOVAH’S WITNESS19LATTER-DAY SAINTS20ISLAM21NAZARENE22OTHER23PENTECOSTAL24PROTESTANT, OTHER25PROTESTANT, NO PREFERENCE26REFORMED27SALVATION ARMY28UNITARIAN; UNIVERSALIST29UNKNOWN/NO PREFERENCETable VA009 – Relationship NumberRELATIONSHIP NUMBER (#.001) Field [internal entry number] of RELATIONSHIP (#408.11) FileCodeDescription1SELF2SPOUSE3SON4DAUGHTER5STEPSON6STEPDAUGHTER7FOSTER SON8FOSTER DAUGHTER9SON-IN-LAW10DAUGHTER-IN-LAW11BROTHER12SISTER13STEPBROTHER14STEPSISTER15BROTHER-IN-LAW16SISTER-IN-LAW17FATHER18MOTHER19STEPFATHER20STEPMOTHER21FATHER-IN-LAW22MOTHER-IN-LAW23GRANDFATHER24GRANDMOTHER25GREAT-GRANDFATHER26GREAT-GRANDMOTHER27GRANDSON28GRANDDAUGHTER29GREAT-GRANDSON30GREAT-GRANDDAUGHTER31NEPHEW32NIECE33UNCLE34AUNT99OTHERTable VA010 – Means Test IndicatorCodeDescriptionANThis Means Test category includes NSC veterans who are required to complete VA Form 10-10F (Financial Worksheet) and those NSC veterans in receipt of VA pension, aid and attendance, housebound allowance, or entitled to State Medicaid.ASThis Means Test category includes all compensable service-connected (0-100%) veterans and special category veterans.CThis Means Test category includes those veterans who, based on income and/or net worth, are required to reimburse VA for care rendered.NThis Means Test category includes only non-veterans receiving treatment at VA facilities.UThis Means Test category includes only those patients who require a Means Test, and the Means Test has not been done/completed. The Austin Information Technology Center (AITC) will not accept an OPC transaction unless the Means Test has been completed.XThis Means Test category includes treatment of patients who are not required to complete the Means Test for the care being provided.Table VA011 – Period of ServiceInternal Entry Number of PERIOD OF SERVICE (#21) FileCodeDescription0KOREAN1WORLD WAR I2WORLD WAR II3SPANISH AMERICAN4PRE-KOREAN5POST-KOREAN6OPERATION DESERT SHIELD7VIETNAM ERA8POST-VIETNAM9OTHER OR NONEAARMY—ACTIVE DUTYBNAVY, MARINE—ACTIVE DUTYCUSAF, USSF - ACTIVE DUTYDCOAST GUARD—ACTIVE DUTYERETIRED, UNIFORMED FORCESFMEDICAL REMEDIAL ENLISTGMERCHANT SEAMEN—USPHSHOTHER USPHS BENEFICIARIESIOBSERVATION/EXAMINATIONJOFFICE OF WORKERS COMPKJOB CORPS/PEACE CORPSLRAILROAD RETIREMENTMBENEFICIARIES-FOREIGN GOVNHUMANITARIAN (NON-VET)OCHAMPUS RESTOREPOTHER REIMBURS. (NON-VET)QOTHER FEDERAL – DEPENDENTRDONORS (NON-VET)SSPECIAL STUDIES (NON-VET)TOTHER NON-VETERANSUCHAMPVA—SPOUSE, CHILDVCHAMPUSWCZECHOSLOVAKIA/POLAND SVCXPERSIAN GULF WARYCAV/NPSZMERCHANT MARINETable VA012 – Type of InsuranceCodeDescription0 NO INSURANCE1 MAJOR MEDICAL10PRESCRIPTION11MEDICARE SUPPLEMENTAL12ALL OTHER2DENTAL3HMO4PPO5MEDICARE6MEDICAID7CHAMPUS8WORKMAN COMP9INDEMNITYTable VA013 – Rated DisabilitiesNUMBER (.001) Field [internal entry number] of the DISABILITY CONDITION (#31) File(Sample listing of possible values)CodeDescription1OSTEOMYELITIS2BONE DISEASE3RHEUMATOID ARTHRITIS4DEGENERATIVE ARTHRITIS5ARTHRITISTable VA014 – Medication Copayment Exemption StatusCodeDescription0NON-EXEMPT1EXEMPTTable VA015 – Enrollment Status(#.04) Field of the PATIENT ENROLLMENT (#27.11) FileCodeDescription1Unverified2Verified3Inactive (not used at this time)4Rejected (not used at this time)5Suspended (not used at this time)6Deceased7Canceled/Declined8Expired (not used at this time)9Pending (not used at this time)10Not Eligible11Rejected; Fiscal Year12Rejected; Mid-cycle13Rejected; Stop New Enrollments14Rejected; Initial Application by VAMC15Pending, No Eligibility Code16Pending; Means Test Required17Pending; Eligibility Status is Unverified18Pending; Other19Not Eligible; Refused to Pay Copay20Not Eligible; Ineligible Date21Pending; Purple Heart Unconfirmed22Rejected; Below Enrollment Group Threshold23Not Applicable24Closed Application25Registration OnlyTable VA016 – Reason Enrollment Canceled/Declined(#.05) Field of the PATIENT ENROLLMENT (#27.11) FileCodeDescription1Dissatisfied with Care2Geographic Access3Other Insurance4Other5ACA PreferenceTable VA017 – Enrollment PriorityCodeDescription1Priority 12Priority 23Priority 34Priority 45Priority 56Priority 67Priority 78Priority 8Table VA018 – Agency/Allied CountryCodeDescriptionACFHHS – CHILDREN AND FAMILIESAUSTRALIAAUSTRALIACANADACANADACIV SERCIVIL SERVICE COMMISSIONCZECHCZECHOSLOVAKIADCFCCDC FEDERAL CIRCUIT COURTDCSDNYUS DC SOUTHERN DISTRICT OF NYDEADOJ? - DRUG ENFORCEMENT ADMINDFCDEVELOPMENT FINANCE CORPDHSDEPT OF HOMELAND SECURITYDOADEPARTMENT OF AGRICULTUREDODDEPARTMENT OF DEFENSEDOEDEPARTMENT OF ENERGYDOIDEPARTMENT OF INTERIORDOJDEPARTMENT OF JUSTICEDOLDEPARTMENT OF LABORDOSDEPARTMENT OF STATEDOTDEPARTMENT OF TRANSPORTATIONEDDEPARTMENT OF EDUCATIONEPAENVIRONMENTAL PROTECTION AGCYFAAFEDERAL AVIATION ADMIN.FDAHHS – FOOD AND DRUG ADMINFRANCEFRANCEGSAGENERAL SERVICES ADMINHHSDEPT HEALTH AND HUMAN SERVICESHHSOIGHHS – OFC OF THE INSP GENERALHUDDEPT HOUSING AND URBAN DEVNARANAT ARCHIVES AND RECORDS ADMINNZNEW ZEALANDOEOOFFICE OF ECONOMIC OPPURTUNITYOFECOFFICE OF EMPLOYEE’S COMP.OPMOFFICE OF PERSONNEL MANAGEMENTOTHEROTHERPCPEACE CORPSPOLANDPOLANDS. AFRICASOUTH AFRICASBASMALL BUSINESS ADMINISTRATIONSVHVA – STATE VETERANS HOMEUKUK GRT BRITAIN AND N. IRELANDUSDCDEPARTMENT OF COMMERCEUSDTDEPARTMENT OF THE TREASURYUSFJUS FEDERAL JUDICIARYUSFSDOA – FOREST SERVICEUSSRSOVIET UNIONVAVETERANS ADMINISTRATIONTable VA022 - Radiation Exposure MethodCodeDescription 2Nagasaki - Hiroshima3Nuclear Testing4BothTable VA026 - Military Service ComponentCodeDescriptionRRegularVActivated reserveGActivated national guardTable VA033 - Fee Basis Treatment Code TypeCodeDescription1Short Term Fee Status2Home Nursing Services3For I.D. Card Status4State HomeTable VA034 - Fee Basis ProgramCode Description 1CHAMPVA2Civil Hospital3Comp & Pension4Contract Halfway House5Contract Nursing Home6Contract Readjustment Counseling7Dental8Dialysis9Home Health Services10Inpatient11Other Institutional Services12Outpatient13Oxygen Services14Pharmacy15State HomeTable VA035 - Enrollment Sub-GroupEnrollment Sub-Group (.12) of Patient Enrollment File (#27.11)CodeDescriptionaNon-compensable zero percent service connected veterans who were in an enrolled status on a specified date and who have remained continuously enrolled thereafterbNon-compensable zero percent service connected veterans who apply for enrollment on or after 1/1/2009 AND the current Financial assessment identifies income above the VA MT or GMT threshold (which ever is higher) by 10% or lessORNon-compensable zero percent service connected veterans who submit a 2008 Income Year Means test or later that calculates the income (income minus medical and educational expenses) under the VA MT threshold and income plus assets are greater than or equal to $80KcNon-service connected veterans who were in an enrolled status on a specified date and who have remained continuously enrolled thereafterdNon-service connected veterans who apply for enrollment on or after 1/1/2009 AND the most current financial assessment identifies income above the VA MT or GMT threshold (which ever is higher) by 10% or lessORNon-service connected veterans who submit a 2008 Income Year Means test or later that calculates the income (income minus medical and educational expenses) under the VA MT threshold and income plus assets are greater than or equal to $80Ke0% non-compensable service-connected veterans who apply for enrollment on or after the EGT effective dategNon-service-connected veterans who apply for enrollment on or after the EGT effective dateTable VA036 - Military Sexual Trauma StatusCodeDescriptionDSCREENED, DECLINES TO ANSWERNNO, SCREENED DOES NOT REPORT MSTUUNKNOWN, NOT SCREENEDYYES, SCREENED REPORTS MSTTable VA038 - Military History TypeCodeDescriptionSLSERVICE LAST EPISODESNLSERVICE SECOND EPISODESNNLSERVICE THIRD EPISODEMSDMILITARY SERVICE DATAPOWPRISONER OF WARCOMBCOMBATVIETVIETNAMLEBALEBANONGRENGRENADAPANAPANAMAGULFGULF WARSOMASOMALIAPHPURPLE HEARTYUGOYUGOSLAVIAOEIFOPERATION ENDURING/IRAQI FREEDOMTable VA0040 - Enrollment Group Threshold TypeEGT Type (.04) of Enrollment Group Threshold File (#27.16)CodeDescription1ANNUAL FISCAL YEAR2STOP NEW ENROLLMENTS DURING CYCLE3MID-CYCLE CHANGE4ENROLLMENT DECISIONTable VA041 - Determination MethodCodeDescription 1Automated Record Review2Medical Record Review3Physical ExaminationTable VA042 - Affected ExtremityCodeDescription 1RUE (Right Upper Extremity)2RLE (Right Lower Extremity)3LUE (Left Upper Extremity)4LLE (Left Lower ExtremityTable VA043 - Condition CodesCodeDescription 1KATZ2FOLS3RUG34FIM5GAFTable VA045 - CD Permanent IndicatorCodeDescription 1Permanent2Not permanent3Unknown Table VA0047 - PATIENT REGISTRATION ONLY REASON ValuesValueDescription2ACTIVE DUTY12ART/IVF8BENEFICIARY1C&P DISABILITY BENEFITS EXAM18CAREGIVER11COLLATERAL (OTHER)7EMPLOYEE4EXPOSURE REGISTRY EXAM6HUMANITARIAN/EMERGENCY14LEGISLATIVE MANDATE10MARRIAGE/FAMILY COUNSELING13NEWBORN16NORTH CHICAGO ACTIVE DUTY15OTHER9OTHER THAN HONORABLE (OTH)5RESEARCH3SERVICE CONNECTED ONLY17UNANSWERED19 VHA TRANSPLANT PROGRAMTable VA048 - Filipino Veteran ProofCodeDescriptionPPUS PassportBCUS Birth CertificateBAReport of Birth Abroad of US CitizenNAVerification of NaturalizationPRVerification of Permanent ResidencyVAVA Compensation at Full Dollar RateNONo ProofTable VA0051 - Means Test Signature StatusCodeDescription1YES; Means Test image received and signed0NO; Means Test image received, but unsigned9DELETED; Means Test signature indicator has been deletedTable VA0052 - NTR Verification MethodCodeDescriptionSQual Military Srvc (Qualifying Military Service)MMilitary Med Rec (Military Medical Record)NNot QualifiedTable VA0053 - NTR QualifiersCodeDescription1Received NTR Trmt (Received NTR Treatment)2Aviator Pre 1955 (Aviator Prior to 1955)3Sub Trainee pre 1965 (Navy Sub Trainee Prior 1965)4Dx With Head Neck Cancer (Diagnosed With Head and Neck Cancer)5No NTR Trmt (No NTR Treatment)6Not Aviator Pre 1955 (Not Aviator Prior to 1955)7Not Sub Trainee pre 1965 (Not Navy Sub Trainee Prior 1965)8Not Dx With Head Neck Cancer (Not Diagnosed With Head and Neck Cancer)9NTR Trmt Unknown (NTR Treatment Unknown)Table VA060 - Type of Financial TestCodeDescription1MEANS TEST2CO-PAY EXEMPTION TEST4LTC CO-PAY EXEMPTION TESTTable VA061 - Invalid Address ReasonCodeDescription1Address Does Not Exist (maps to Code 1 errors)2Veteran Does Not Reside at Address (maps to NCOA invalid address and mail returned by USPS due to Forwarding Order Expired, etc.)3Missing Required Address Field (maps to HEC Errors/AITC Errors)4Death5OtherTable VA0115 - Servicing Facility (Sample listing of possible values)CodeDescription512 9ACPerry Point (Nursing Home)Table VA117 - Reason For Closed Application(#.13) Field of the PATIENT ENROLLMENT (#27.11) FileCodeDescription1Abandoned ApplicationTable VA440 – CD Descriptors CodeDescription1QUADRIPLEGIA2PARAPLEGIA3PERSISTENT VEGETATIVE STATE4LEGAL BLINDNESS5AMPUTATION, DISARTICULATION, OR DETACHMENT6DEFICIENCIES OF PHYSICAL OR MENTAL FUNCTION7DEAFNESS ................
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