BPSRPT1 ;BHAM ISC/BEE - ECME REPORTS ;14-FEB-05 ;;1.0;E CLAIMS MGMT ENGINE;**1,5**;JUN 2004;Build 45 ;;Per VHA Directive 2004-038, this routine should not be modified. Q ; ; ECME Report Compile Routine - Looping/Filtering Routine ; ; Input Variables: ; BPRTYPE - Type of Report (1-7) ; BPGLTMP - Temporary storage global ; BPPHARM/BPPHARM(ptr) - Set to 0 for all pharmacies, if set to 1 array ; of internal pointers of selected pharmacies ; BPSUMDET - (1) Summary or (0) Detail format ; BPINSINF - Set to 0 for all insurances or insurance co name ; BPMWC - 1-ALL,2-Mail,3-Window,4-CMOP Prescriptions ; BPRTBCK - 1-ALL,2-RealTime,3-Backbill Claim Submission ; BPRLNRL - 1-ALL,2-RELEASED,3-NOT RELEASED ; BPDRUG - DRUG to report on (ptr to #50) ; BPDRGCL - DRUG CLASS to report on (0 for ALL) ; BPBEGDT - Beginning Date ; BPENDDT - Ending Date ; BPCCRSN - Set to 0 for all closed claim reasons or ptr to #356.8 ; BPAUTREV - 0-ALL,1-Auto Reversed ; BPACREJ - 0-ALL,1-REJECTED,2-ACCEPTED ; COLLECT(BPGLTMP) N BP02,BP57,BP59,BPENDDT1,BPLDT02,BPLDT57,X,Y,OK,BPIX ; ;Check Variables S OK=1 S:'$G(BPBEGDT) BPBEGDT=0 S:'$G(BPENDDT) BPENDDT=9999999 S BPENDDT=BPENDDT+0.9 I $G(BPRTYPE)=""!($G(BPGLTMP)="")!($G(BPPHARM)="")!($G(BPSUMDET)="")!($G(BPINSINF)="")!($G(BPMWC)="")!($G(BPRTBCK)="") S OK=-1 G EXIT ; ;Loop through BPS CLAIMS ; ;First look for fill/refill cross reference ;Loop through Date of Service Index in BPS CLAIMS file and find link to ;claim in BPS TRANSACTION. Process earliest Date of Service entry found in ;BPS TRANSACTION ; ;Choose Index to Loop through (different for Closed Claims) S BPIX="AF" S:BPRTYPE=7 BPIX="AG" ; S BPLDT02=$S(BPIX="AF":$$FM2YMD(BPBEGDT-0.00001),1:BPBEGDT) S:BPLDT02="" BPLDT02=0 S BPENDDT1=$S(BPIX="AF":$$FM2YMD(BPENDDT),1:BPENDDT_".9999999999") S:BPENDDT1="" BPENDDT1=99999999 F S BPLDT02=+$O(^BPSC(BPIX,BPLDT02)) Q:BPLDT02=0!(BPLDT02>BPENDDT1) D . S BP02=0 F S BP02=$O(^BPSC(BPIX,BPLDT02,BP02)) Q:+BP02=0 D . . S BP59=+$O(^BPST("AE",BP02,0)) . . Q:BP59=0 . . I $D(@BPGLTMP@("FILE59",BP59)) Q . . S @BPGLTMP@("FILE59",BP59)=BPLDT02_"^02" . . D PROCESS(BP59) ; ;#9002313.59 has only one entry per claim with, which has a date ; of the latest update for the claim ;#9002313.57 has more than one entries per claim and keep all ; changes made the claim ;so we have to go thru #9002313.57 to find the earliest date ;related to the claim to check it against BPBEGDT S BPLDT57=BPBEGDT-0.00001 F S BPLDT57=+$O(^BPSTL("AH",BPLDT57)) Q:BPLDT57=0!(BPLDT57>BPENDDT) D . S BP57=0 F S BP57=$O(^BPSTL("AH",BPLDT57,BP57)) Q:+BP57=0 D . . S BP59=+$G(^BPSTL(BP57,0)) . . I $D(@BPGLTMP@("FILE59",BP59)) Q . . S @BPGLTMP@("FILE59",BP59)=BPLDT57_"^57" . . D PROCESS(BP59) ; ;Remove Portion of Scratch Global EXIT K @BPGLTMP@("FILE59") Q OK ; ;Convert FB date to YYYYMMDD FM2YMD(BPFMDT) N Y,Y1 S Y=$E(BPFMDT,2,3),Y1=$E(BPFMDT,1,1) S Y=$S(Y1=3:"20"_Y,Y1=2:"19"_Y,1:"") Q:Y Y_$E(BPFMDT,4,7) Q "" ; ;Process each Entry ; PROCESS(BP59) N BPBCK,BPDFN,BPREF,BPPAYBL,BPPLAN,BPREJ,BPRLSDT,BPRX,BPRXDRG,BPSTATUS ; ;Get ABSBRXI - ptr to #52 S BPRX=+$P($G(^BPST(BP59,1)),U,11) ; ;Get ABSBRXR - Prescription Number IEN S BPREF=+$P($G(^BPST(BP59,1)),U) ; ;Get PATIENT - ptr to #2 S BPDFN=+$P($G(^BPST(BP59,0)),U,6) ; ;Check for correct BPS Pharmacy (DIVISION) I $G(BPPHARM)=1,$$CHKPHRM(BP59)=0 G XPROC ; ;Check for Display 1-ALL,2-RELEASED,3-NOT RELEASED S BPRLSDT=$$RELEASED(BPRX,BPREF) I BPRLNRL'=1 I ((BPRLNRL=2)&(BPRLSDT=0))!((BPRLNRL=3)&(BPRLSDT)) G XPROC ; ;Get Status S BPSTATUS=$$STATUS^BPSRPT6(BPRX,BPREF) ; ;if REVERSAL I BPRTYPE=4,BPSTATUS'["REVERSAL" G XPROC ; exclude non-reversed ; ;if PAYABLE S BPPAYBL=BPSTATUS["PAYABLE" I BPRTYPE=1,'BPPAYBL G XPROC ; exclude non-payable I BPRTYPE=1,BPSTATUS["REVERSAL" G XPROC ; reversed ; ;if REJECTED S BPREJ=BPSTATUS["REJECTED" I BPRTYPE=2,BPSTATUS["REVERSAL" G XPROC ; exclude rejected reversals I BPRTYPE=2,'BPREJ G XPROC ; exclude non-rejected I BPRTYPE=2,$$CLSCLM(BP59) G XPROC ;exclude closed claims ; ;if SUBMITTED NOT RELEASED exclude released ones I BPRTYPE=3,BPRLSDT'=0 G XPROC I BPRTYPE=3,'BPPAYBL G XPROC ; exclude non-payable ; ;Auto Reverse Check I BPRTYPE=4,BPAUTREV,'$$AUTOREV(BP59) G XPROC ; ;if CLOSED I BPRTYPE=7,'$$CLSCLM(BP59) G XPROC ;exclude open claims I BPRTYPE=7,BPSTATUS'["REJECTED" G XPROC ;exclude non-rejected closed claims ; ;if Recent Transactions, exclude closed claims I BPRTYPE=5,$$CLSCLM(BP59) G XPROC ; ;If Totals by Date, include only rejects and payables I BPRTYPE=6,BPSTATUS'["REJECTED",BPSTATUS'["PAYABLE" G XPROC ; Reversed ; ;Realtime/Backbill Check S BPBCK=$$RTBCK(BP59) I BPRTBCK'=1 I ((BPRTBCK=2)&(BPBCK=0))!((BPRTBCK=3)&(BPBCK)) G XPROC ; ;Check for MAIL/WINDOW/CMOP/ALL I BPMWC'="A",$$MWC^BPSRPT6(BPRX,BPREF)'=BPMWC G XPROC ; ;Check for selected insurance S BPPLAN=$P($$INSNAM^BPSRPT6(BP59),U,2) I BPINSINF'=0,BPINSINF'=BPPLAN G XPROC ; ;Check for selected drug S BPRXDRG=$$GETDRUG^BPSRPT6(BPRX) I BPRXDRG=0 G XPROC I BPDRUG,BPDRUG'=BPRXDRG G XPROC ; ;Check for selected drug classes I BPDRGCL'=0,BPDRGCL'=$$DRGCLNAM^BPSRPT6($$GETDRGCL^BPSRPT6(BPRXDRG),99) G XPROC ; ;Check for selected Close Reason I BPCCRSN,BPCCRSN'=$P($$CLRSN^BPSRPT7(BP59),U) G XPROC ; ;Check for Accepted/Rejected I BPACREJ=1,BPSTATUS'["REJECTED" G XPROC I BPACREJ=2,BPSTATUS'["ACCEPTED" G XPROC ; ;Check for Specific Reject Code I BPREJCD'=0,'$$CKREJ(BP59,BPREJCD) G XPROC ; ;Save Entry for Report D SETTMP^BPSRPT2(BPGLTMP,BPDFN,BPRX,BPREF,BP59,BPBEGDT,BPENDDT,.BPPHARM,BPSUMDET,BPPLAN,BPRLSDT,BPPAYBL,BPREJ,BPRXDRG,$P(BPSTATUS,U)) ; XPROC Q ; ;Check if selected BPS PHARMACY ; ; Defined Variable: BPPHARM(ptr) - List of BPS Pharmacies to Report on ; Input Variable: BP59 - Lookup to BPS TRANSACTION (#59) ; ; Returned Value -> 0 = Entry not in list of selected pharmacies ; 1 = Entry is in list of selected pharmacies CHKPHRM(BP59) N PHARM S PHARM=+$P($G(^BPST(BP59,1)),"^",7) S PHARM=$S($D(BPPHARM(PHARM)):1,1:0) Q PHARM ; ;Determine whether claim is Released or Not Released ; ; Input Variables: BPRX - ptr to PRESCRIPTION (#52) ; BPREF - refill # (0-No Refills,1-1st Refill, 2-2nd, ...) ; ; Return Value -> 0 = Not Released ; released date = Released ; RELEASED(BPRX,BPREF) N RDT ; I BPREF=0 S RDT=$$RXRELDT^BPSRPT6(BPRX)\1 I BPREF'=0 S RDT=$$REFRELDT^BPSRPT6(BPRX,BPREF)\1 Q RDT ; ;Determine if claim was Auto Reversed ; ; Input Variable: BP59 - Lookup to BPS TRANSACTION (#59) ; Return Value -> 1 = Auto Reversed ; 0 = Not Auto Reversed ; AUTOREV(BP59) N AR,BP02 S BP02=+$P($G(^BPST(BP59,0)),U,4) S AR=+$P($G(^BPSC(BP02,0)),U,7) Q AR ; ;Determine if claim was closed ; ; Input Variable: BP59 - Lookup to BPS TRANSACTION (#59) ; Return Value -> 1 = Closed ; 0 = Not Closed ; CLSCLM(BP59) N BP02,CL S BP02=+$P($G(^BPST(BP59,0)),U,4) S CL=+$G(^BPSC(BP02,900)) Q CL ; ;Determine whether claim is Realtime or Backbilled ; ; Input Variable: BP59 - Lookup to BPS TRANSACTION (#59) ; Return Value -> 1 = Backbilled ; 0 = Realtime RTBCK(BP59) N BB S BB=$P($G(^BPST(BP59,12)),U) S BB=$S(BB="BB":0,1:1) Q BB ; ;Screen Pause 1 ; ; Return variable - BPQ = 0 Continue ; 2 Quit PAUSE N X U IO(0) W !!,"Press RETURN to continue, '^' to exit:" R X:$G(DTIME) S:'$T X="^" S:X["^" BPQ=2 U IO Q ; ;Screen Pause 2 ; ; Return variable - BPQ = 0 Continue ; 2 Quit PAUSE2 N X U IO(0) W !!,"Press RETURN to continue:" R X:$G(DTIME) S:'$T X="^" S:X["^" BPQ=2 U IO Q ; ;Get ECME# ; ; Input Variable: BP59 - Lookup to BPS TRANSACTION (#59) ; Returned value -> Last 7 digits of ECME# ; ECMENUM(BP59) N BPY1,BPY2 S BPY1=(BP59\1),BPY2=$E(BPY1,$L(BPY1)-6,99) ;last 7 digits Q BPY2 ; ;Convert FM date or date.time to displayable (mm/dd/yy HH:MM) format ; DATTIM(X) N DATE,BPT,BPM,BPH,BPAP S DATE=$S(X:$E(X,4,5)_"/"_$E(X,6,7)_"/"_$E(X,2,3),1:"") S BPT=$P(X,".",2) S:$L(BPT)<4 BPT=BPT_$E("0000",1,4-$L(BPT)) S BPH=$E(BPT,1,2),BPM=$E(BPT,3,4) S BPAP="AM" I BPH>12 S BPH=BPH-12,BPAP="PM" S:$L(BPH)<2 BPH="0"_BPH I BPT S:'BPH BPH=12 S DATE=DATE_" "_BPH_":"_BPM_BPAP Q $G(DATE) ; ;Display RT-Realtime,BB-Backbill, or " " ; RTBCKNAM(BPINDEX) Q $S(BPINDEX=1:"RT",BPINDEX=0:"BB",1:" ") ; ;See for Specific Reject Code ; CKREJ(BP59,BPREJCD) N FREJ,I,REJ,X S FREJ=0 S X=$$REJTEXT^BPSRPT2(BP59,.REJ) S X="" F S X=$O(REJ(X)) Q:X="" D Q:FREJ=1 .S REJ=$P($G(REJ(X)),":") Q:REJ="" .S I="" F S I=$O(^BPSF(9002313.93,"B",REJ,I)) Q:I="" I I=BPREJCD S FREJ=1 Q FREJ