BPSOSH2 ;BHAM ISC/SD/lwj/DLF - Assemble formatted claim for 5.1 ;06/01/2004 ;;1.0;E CLAIMS MGMT ENGINE;**1,5**;JUN 2004;Build 45 ;;Per VHA Directive 2004-038, this routine should not be modified. ;---------------------------------------------------------------------- ; Changes for NCPDP 5.1 ; 5.1 has 14 claim segments (header, patient, insurance, claim ; pharmacy provider, prescriber, ; COB, workers comp, DUR, Pricing, ; coupon, compound, prior auth, ; clinical) ; 5.1 requires field identifiers and separators on all fields ; other than the header ; 5.1 segment separators are required prior to each segment ; following the header ; 5.1 Group separators appear at the end of each ; transaction (prescription) ; 5.1 we only want to send segments that have data - a new ; segment record will hold the data until we are sure ; we have something to send ; ; ;---------------------------------------------------------------------- ;Put together ascii formatted record via NCPDP Record definition ; ;Input Variables: NODES - (100^110^120 or ; 130^140^150^160^170^180^190^ ; 200^210^220^230) ; .IEN - Internal Entry Number array ; .BPS - Formatted Data Array with claim and ; prescription data ; .REC - Formatted Ascii record (result) ;---------------------------------------------------------------------- XLOOP(NODES,IEN,BPS,REC) ;EP - from BPSECA1 ; ; Manage local variables N ORDER,RECMIEN,MDATA,FLDIEN,PMODE,FLAG,NODE,FDATA,FLDNUM,FLDDATA N INDEX,FLDID N SEGREC,DATAFND,FDATA5 ; ;Loop through the NODES defined in NODES variable parsed by U F INDEX=1:1:$L(NODES,U) D . S NODE=$P(NODES,U,INDEX) . Q:NODE="" . ; . ; VA does not support these nodes . Q:",230,220,210,200,170,160,"[NODE . ; . ; Quit if the payer sheet does not have the node . Q:'$D(^BPSF(9002313.92,+IEN(9002313.92),NODE,0)) . ; . ; Per NCPDP standard, reversals do not support segments listed below - DMB 5/2/2005 . I $G(BPS(9002313.02,+$G(IEN(9002313.02)),103,"I"))="B2",",230,220,210,200,170,160,150,140,"[NODE Q . ; . S DATAFND=0 ;indicates if data is on the segment for us to send . S SEGREC="" ;holds the segment's information . ; . D:NODE=180 PROCDUR . ; . S ORDER="" . F D Q:'ORDER .. ; .. Q:NODE=180 ;already had to process the DUR/PPS section (repeating) .. S ORDER=$O(^BPSF(9002313.92,+IEN(9002313.92),NODE,"B",ORDER)) .. Q:'ORDER .. S RECMIEN="" .. S RECMIEN=$O(^BPSF(9002313.92,+IEN(9002313.92),NODE,"B",ORDER,RECMIEN)) .. Q:RECMIEN="" .. ; .. S MDATA=$G(^BPSF(9002313.92,+IEN(9002313.92),NODE,RECMIEN,0)) .. Q:MDATA="" .. ; .. S FLDIEN=$P(MDATA,U,2) .. Q:FLDIEN="" .. ; .. S FDATA=$G(^BPSF(9002313.91,FLDIEN,0)) .. Q:FDATA="" .. S FLDNUM=$P(FDATA,U,1) .. Q:FLDNUM="" .. ; .. S FDATA5=$G(^BPSF(9002313.91,FLDIEN,5)) ;5.1 id and length .. S FLDID=$P(FDATA5,U,1) ;5.1 ID .. ; .. ;header data .. S:NODE<130 FLDDATA=$G(BPS(9002313.02,IEN(9002313.02),FLDNUM,"I")) .. ; .. ;transaction data .. S:NODE>120 FLDDATA=$G(BPS(9002313.0201,IEN(9002313.01),FLDNUM,"I")) .. ; .. I FLDID'=$TR(FLDDATA,"0 {}") S DATAFND=1 ;fld chk-is the field empty? .. ; .. ;check if this is the seg id - call this after fld chk since .. ;we don't want to send the segment if this is all there is .. I (NODE>100)&(FLDNUM=111) S FLDDATA=$$SEGID(NODE) .. ; .. Q:FLDDATA="" ;lje;7/23/03; don't want extra field separators when field is blank for testing for WebMD. .. ; .. S:NODE=100 SEGREC=SEGREC_FLDDATA ;no FS on the header rec .. S:NODE>100 SEGREC=SEGREC_$C(28)_FLDDATA ;FS always proceeds fld .. ; . ; . I (DATAFND)&(NODE=100) S REC(NODE)=SEGREC ;no SS when it's the header . I (DATAFND)&(NODE>100) D .. I '$D(REC(NODE)) S REC(NODE)=REC I REC[$C(29) S REC="" .. S REC(NODE)=REC(NODE)_$C(30)_SEGREC ;SS before the seg ; Q ; SEGID(ND) ; Field 111 is the Segment Identifier - for each segment, other than ; the header, a pre-defined, unique value must be sent in this field ; to identify which segment is being sent. This value is not stored ; in the claim - as it changes with each of the 13 segments. The ; field does appear as part of the NCPCP Format, put is simply not ; stored. ; 01 = Patient 02 = Pharmacy Provider 03 = Prescriber ; 04 = Insurance 05 = COB/Other Payment 06 = Workers Comp ; 07 = Claim 08 = DUR/PPS 09 = Coupon ; 10 = Compound 11 = Pricing 12 = Prior Auth ; 13 = Clinical ; N FLD ; S FLD=$S(ND=110:"01",ND=120:"04",ND=130:"07",ND=140:"02",ND=150:"03",ND=160:"05",ND=170:"06",ND=180:"08",ND=190:11,ND=200:"09",ND=210:10,ND=220:12,ND=230:13,1:"00") S FLD="AM"_$$NFF^BPSECFM(FLD,2) ; Q FLD ; PROCDUR ;NCPDP 5.1 - The DUR/PPS segment can repeat itself for any given ; transaction within a claim. This means we have to have special ; programming to handle the repeating fields. ; ; Note that BPS array is set in BPSOSC* routines ; N FIELD,DUR,FLD,ORD ; ; If there isn't any data in this segment, then lets quit Q:'$D(BPS(9002313.1001)) ; ; Second thing - create the 111 field entry as it is not repeating S FLDDATA=$$SEGID(NODE) S SEGREC=SEGREC_$C(28)_FLDDATA ;FS always proceeds fld ; ; Next- let's look to the format to see which DUR/PPS fields are ; needed (remember - ALL fields on the DUR/PPS segment are optional) D GETFLDS^BPSOSHF(+IEN(9002313.92),NODE,.FIELD) ; ; Finally -loop through and process the fields for as many times ; as they appear S DUR=0 F S DUR=$O(BPS(9002313.1001,DUR)) Q:DUR="" D . S ORD=0 . F S ORD=$O(FIELD(ORD)) Q:ORD="" D .. S FLDIEN=$P(FIELD(ORD),U) .. S FLD=$P(FIELD(ORD),U,2) .. S:FLD=473 FLD=.01 ;473 value stored in the .01 field .. S FDATA5=$G(^BPSF(9002313.91,FLDIEN,5)) ;5.1 id and length .. S FLDID=$P(FDATA5,U,1) ;5.1 ID .. ; .. ; Transaction data .. S FLDDATA=$G(BPS(9002313.1001,DUR,FLD,"I")) .. ; .. I FLDID'=$TR(FLDDATA,"0 {}") S DATAFND=1 ;fld chk-is the fld empty? .. ; .. S SEGREC=SEGREC_$C(28)_FLDDATA ;FS always proceeds fld Q