IBCBB ;ALB/AAS - EDIT CHECK ROUTINE TO BE INVOKED BEFORE ALL BILL APPROVAL ACTIONS ;2-NOV-89 ;;2.0;INTEGRATED BILLING;**80,51,137,288,327,361,371,377**;21-MAR-94;Build 23 ;;Per VHA Directive 2004-038, this routine should not be modified. ; ;MAP TO DGCRBB ; ;IBNDn = IBND(n) = ^ib(399,n) ;RETURNS: ;IBER=fields with errors separated by semi-colons ;PRCASV("OKAY")=1 if iber="" and $D(prcasv("array")) compete ; GVAR ;set up variables for mccr Q:'$D(IBIFN) F I=0,"M","U","U1","S","MP","TX","UF3","UF31","U2" S @("IBND"_I)=$G(^DGCR(399,IBIFN,I)) S IBBNO=$P(IBND0,"^"),DFN=$P(IBND0,"^",2),IBEVDT=$P(IBND0,"^",3) S IBLOC=$P(IBND0,"^",4),IBCL=$P(IBND0,"^",5),IBTF=$P(IBND0,"^",6) S IBAT=$P(IBND0,"^",7),IBWHO=$P(IBND0,"^",11),IBST=$P(IBND0,"^",13),IBFT=$P(IBND0,"^",19) S IBFDT=$P(IBNDU,"^",1),IBTDT=$P(IBNDU,"^",2) S IBTC=$P(IBNDU1,"^",1),IBFY=$P(IBNDU1,"^",9),IBFYC=$P(IBNDU1,"^",10) S IBEU=$P(IBNDS,"^",2),IBRU=$P(IBNDS,"^",5),IBAU=$P(IBNDS,"^",8) S IBTOB=$$TOB(IBND0),IBTOB12=$E(IBTOB,1,2) K ^TMP($J,"BILL-WARN") Q ; EN ;Entry to check for errors N IBQ,IBXERR,IBXDATA,IBXSAVE,IBZPRC92,IBQUIT,IBISEQ,IDDATA,IBFOR,IBC I $D(IBFL) N IBFL K ^TMP($J) W ! S IBER="" D GVAR I '$D(IBND0) S IBER=-1 Q ; ;patient in patient file I DFN="" S IBER=IBER_"IB057;" I DFN]"",'$D(^DPT(DFN)) S IBER=IBER_"IB057;" ; ;Event date in correct format I IBEVDT="" S IBER=IBER_"IB049;" I IBEVDT]"",IBEVDT'?7N&(IBEVDT'?7N1".".N) S IBER=IBER_"IB049;" ; ;Rate Type I IBAT="" S IBER=IBER_"IB059;" I IBAT]"",'$D(^DGCR(399.3,IBAT,0)) S IBER=IBER_"IB059;" I IBAT]"",$D(^DGCR(399.3,IBAT,0)),'$P(^(0),"^",6) S IBER=IBER_"IB059;",IBAT="" I IBAT]"",$P($G(^DGCR(399.3,IBAT,0)),"^",6) S IBARTP=$P($$CATN^PRCAFN($P(^DGCR(399.3,IBAT,0),"^",6)),"^",3) ;Check that AR category expects same debtor as defined in who's responsible. I $D(IBARTP),IBWHO="i"&(IBARTP'="T")!(IBWHO="p"&("PC"'[IBARTP))!(IBWHO="o"&(IBARTP'="N")) S IBER=IBER_"IB058;" ; ;Who's Responsible I IBWHO=""!($L(IBWHO)>1)!("iop"'[IBWHO) S IBER=IBER_"IB065;" S IBMRA=$S($$MCRWNR^IBEFUNC(+$$CURR^IBCEF2(IBIFN)):$$TXMT^IBCEF4(IBIFN)>0,1:0) ; MCR will not reimburse is only valid if there is subsequent insurance ; that will reimburse I IBWHO="i" D . I IBMRA D Q .. N Z,IBZ .. S IBZ=0 .. F Z=$$COBN^IBCEF(IBIFN):1:3 I $D(^DGCR(399,IBIFN,"I"_(Z+1))),$P($G(^DIC(36,+$G(^DGCR(399,IBIFN,"I"_(Z+1))),0)),U,2)'="N" S IBZ=1 Q .. I 'IBZ S IBER=IBER_"IB054;" D WARN^IBCBB11("A valid claim for MEDICARE WNR needs subsequent ins. that will reimburse") .. . I $$COB^IBCEF(IBIFN)="S",$$MCRWNR^IBEFUNC(+$$CURR^IBCEF2(IBIFN))=1,$D(^DGCR(399,IBIFN,"I3")) Q . I $S('IBNDMP:1,1:$P(IBNDMP,U,2)'=$$BPP^IBCNS2(IBIFN,1)) S IBER=IBER_"IB054;" I IBWHO="o",'$P(IBNDM,"^",11) S IBER=IBER_"IB053;" ; ; All insurance subscribers must have a birth date on file ; - 11/10/04 - IB*2.0*288 ; - 12/14/06 - IB*2.0*361 - must have INSURED'S SEX too ; IB error codes ; IB221 - Primary insurance subscriber missing date of birth ; IB222 - Secondary insurance subscriber missing date of birth ; IB223 - Tertiary insurance subscriber missing date of birth ; IB261 - Primary insurance subscriber is missing INSURED'S SEX ; IB262 - Secondary insurance subscriber is missing INSURED'S SEX ; IB263 - Tertiary insurance subscriber is missing INSURED'S SEX ; F IBISEQ=1:1:3 D . I '$P($G(^DGCR(399,IBIFN,"I"_IBISEQ)),U,1) Q ; no insurance here . K ^UTILITY("VADM",$J),^UTILITY("VAPA",$J) . S IDDATA=$$INSDEM^IBCEF(IBIFN,IBISEQ) . K ^UTILITY("VADM",$J),^UTILITY("VAPA",$J) . ; . I '$P(IDDATA,U,1) D ERR(221) ; birth date missing . ; . I "^M^F^"'[(U_$P(IDDATA,U,2)_U) D ERR(261) ; sex missing . ; . ; IB*2*371 - esg - check for other missing insurance pieces . ; check insured's name, primary ID#, pt. relationship to insured, . ; and subscriber address data . N INNAME,SUBID,PTREL,SFA,CAS,LN,FN . ; . ; IB273 - Primary Insurance name of insured missing . ; IB274 - Secondary Insurance name of insured missing . ; IB275 - Tertiary Insurance name of insured missing . S INNAME=$$POLICY^IBCEF(IBIFN,17,IBISEQ) . S LN=$P(INNAME,",",1),FN=$P(INNAME,",",2) ; last name,first name . S LN=$$NOPUNCT^IBCEF(LN,1) . S FN=$$NOPUNCT^IBCEF(FN,1) . I LN=""!(FN="") D ERR(273) ; name of insured missing or invalid . S LN=$$NAME^IBCEFG1(INNAME) ; additional name checks . S FN=$P(LN,U,2) . S LN=$P(LN,U,1) . I LN=""!(FN="") D ERR(273) ; name of insured missing or invalid . ; . ; IB276 - Primary Insurance subscriber ID missing . ; IB277 - Secondary Insurance subscriber ID missing . ; IB278 - Tertiary Insurance subscriber ID missing . S SUBID=$$NOPUNCT^IBCEF($$POLICY^IBCEF(IBIFN,2,IBISEQ),1) . I SUBID="" D ERR(276) ; subscriber ID# missing . ; . ; IB279 - Primary Insurance missing pt relationship . ; IB280 - Secondary Insurance missing pt relationship . ; IB281 - Tertiary Insurance missing pt relationship . S PTREL=$$POLICY^IBCEF(IBIFN,16,IBISEQ) . I PTREL="" D ERR(279) ; missing patient relationship to insured . ; . ; subscriber address section . S SFA=$$INSADDR^IBCEF(IBIFN,IBISEQ) ; full address all pieces . S CAS=$$NOPUNCT^IBCEF($P(SFA,U,2,5),1) ; string city,st,zip,addr1 . ; . ; IB282 - Primary Insurance address line 1 missing . ; IB283 - Secondary Insurance address line 1 missing . ; IB284 - Tertiary Insurance address line 1 missing . I $$NOPUNCT^IBCEF($P(SFA,U,5),1)="" D ; address line 1 is blank .. ; pat=subscriber and current insurance - address is required .. I +PTREL=1,IBISEQ=$$COBN^IBCEF(IBIFN) D ERR(282) Q .. ; if any part of the address is there, then all fields are required .. I CAS'="" D ERR(282) Q .. Q . ; . ; IB285 - Primary Insurance city missing . ; IB286 - Secondary Insurance city missing . ; IB287 - Tertiary Insurance city missing . I $$NOPUNCT^IBCEF($P(SFA,U,2),1)="" D ; city is blank .. ; pat=subscriber and current insurance - address is required .. I +PTREL=1,IBISEQ=$$COBN^IBCEF(IBIFN) D ERR(285) Q .. ; if any part of the address is there, then all fields are required .. I CAS'="" D ERR(285) Q .. Q . ; . ; IB288 - Primary Insurance state missing . ; IB289 - Secondary Insurance state missing . ; IB290 - Tertiary Insurance state missing . I $$NOPUNCT^IBCEF($P(SFA,U,3),1)="" D ; state is blank .. ; pat=subscriber and current insurance - address is required .. I +PTREL=1,IBISEQ=$$COBN^IBCEF(IBIFN) D ERR(288) Q .. ; if any part of the address is there, then all fields are required .. I CAS'="" D ERR(288) Q .. Q . ; . ; IB291 - Primary Insurance zipcode missing . ; IB292 - Secondary Insurance zipcode missing . ; IB293 - Tertiary Insurance zipcode missing . I $$NOPUNCT^IBCEF($P(SFA,U,4),1)="" D ; zipcode is blank .. ; pat=subscriber and current insurance - address is required .. I +PTREL=1,IBISEQ=$$COBN^IBCEF(IBIFN) D ERR(291) Q .. ; if any part of the address is there, then all fields are required .. I CAS'="" D ERR(291) Q .. Q . ; . Q ; ; esg - IB*2*371 - check patient address fields K ^UTILITY("VAPA",$J) ; S IBFOR=0 ; foreign address flag S IBC=+$$PTADDR^IBCEF(IBIFN,25) ; country code ien I IBC D . N CODE . S CODE=$$GET1^DIQ(779.004,IBC,.01) ; .01 code field file 779.004 . I CODE'="",CODE'="USA" S IBFOR=1 ; foreign country exists . Q ; I $$NOPUNCT^IBCEF($$PTADDR^IBCEF(IBIFN,1),1)="" S IBER=IBER_"IB269;" I $$NOPUNCT^IBCEF($$PTADDR^IBCEF(IBIFN,4),1)="" S IBER=IBER_"IB270;" I $$NOPUNCT^IBCEF($$PTADDR^IBCEF(IBIFN,5),1)="",'IBFOR S IBER=IBER_"IB271;" I $$NOPUNCT^IBCEF($$PTADDR^IBCEF(IBIFN,11),1)="",'IBFOR S IBER=IBER_"IB272;" K ^UTILITY("VAPA",$J) ; D PAYERADD^IBCBB0(IBIFN) ; check the payer addresses ; ; esg - 9/20/07 - IB patch 371 - prevent EDI transmission for 3 payer ; claims for all but the first payer. To be removed when Emdeon ; and FSC are able to deal with these. ; I +$G(^DGCR(399,IBIFN,"I2")),+$G(^DGCR(399,IBIFN,"I3")),$$TXMT^IBCEF4(IBIFN) D . ; for MRA request claims, make sure the MRA secondary claim is forced to print . I $$REQMRA^IBEFUNC(IBIFN) D Q .. I '$P($G(^DGCR(399,IBIFN,"TX")),U,9) S IBER=IBER_"IB146;" .. Q . ; . I $$COBN^IBCEF(IBIFN)=1 Q ; primary payer sequence claims are OK . ; . ; But claims with a payer sequence of 2 or 3 need to print locally . S IBER=IBER_"IB147;" . Q ; D ^IBCBB1 Q ; EDIT(IBIFN) ; Run edits from within the billing edit screens N IBVIEW,IBDISP,IBNOFIX,DIR,X,Y S (IBNOFIX,IBVIEW,IBDISP)=1 D EDITS^IBCB2 W ! S DIR("A")="Press RETURN to continue",DIR(0)="E" D ^DIR K DIR Q ; TOB(IBND0) ; ; IBND0 = the 0-node of the bill (file 399) Q ($P(IBND0,U,24)_$P($G(^DGCR(399.1,+$P(IBND0,U,25),0)),U,2)_$P(IBND0,U,26)) ; ERR(Z) ; update IBER variable from the above insurance checks ; Z is the IB error code# for the primary insurance error N IBERRNO S IBERRNO="IB"_(Z+IBISEQ-1) I IBER[IBERRNO Q S IBER=IBER_IBERRNO_";" Q ;