IBCEF ;ALB/TMP - FORMATTER SPECIFIC BILL FUNCTIONS ;22-JAN-96 ;;2.0;INTEGRATED BILLING;**52,80,51,137,288,296,361**;21-MAR-94;Build 9 ;;Per VHA Directive 2004-038, this routine should not be modified. ; ;IBIFN = bill ien throughout this routine COB(IBIFN) ; Bill seq N A S A=$P($G(^DGCR(399,IBIFN,0)),U,21) S:A="" A="P" Q A ; COBN(IBIFN,A) ; Return seq # of selected payer ; A = 'PST' or null to get current bill payer seq # I $G(A)="" S A=$$COB(IBIFN) S:"PST"'[A A="P" I 'A S A=$F("PST",A)-1 S:A<1 A=1 Q A ; POLICY(IBIFN,IBPC,IBCOBN) ; Return raw data from policy info on bill ; IBPC = pc # of data element in policy (optional) ; if null, 0-node is returned ; IBCOBN = bill designation 1-3 or 'PST' (optional) ; if null, default to current N IBI I "PST"[$G(IBCOBN) S IBCOBN=$$COBN(IBIFN,$G(IBCOBN)) S IBI=$G(^DGCR(399,IBIFN,"I"_IBCOBN)) I $G(IBPC) S IBI=$P(IBI,U,IBPC) POLICYQ Q IBI ; INSADDR(IBIFN,IBCOB) ; Return insured's address in 7 pieces: ; ALL STREET ADDRESSES^CITY^STATE ABBREVIATION^ZIP^STREET ADDRESS 1^ ; STREET ADDRESS 2^STREET ADDRESS 3 ; IBIFN = bill ien ; IBCOB = bill designation (P)rimary, (S)econdary, (T)ertiary ; or 1-2-3. If not defined or null, return current ; If insured is patient or spouse, take from patient file top level ; fields, then if top-level street addresses are blank and policy ; level fields are not, use policy level ; If insured is other than patient/spouse, use policy level fields only N A,B,IBADDR,IBI,DFN,VAPA,VATEST S:$G(IBCOB)="" IBCOB="" I 'IBCOB S IBCOB=$$COBN(IBIFN,$G(IBCOB)) S IBI=+$$POLICY(IBIFN,16,IBCOB) S DFN=+$P($G(^DGCR(399,IBIFN,0)),U,2) I $S('IBI:1,1:"12"'[IBI) S IBADDR="" G INSADDQ ; insured's address (patient/spouse) same as patient's S VATEST("ADD",9)=+$G(^DGCR(399,IBIFN,"U")),VATEST("ADD",10)=+$P($G(^("U")),U,2) D ADD^VADPT S IBADDR=VAPA(1)_" "_VAPA(2)_" "_VAPA(3)_U_VAPA(4)_U_$P($G(^DIC(5,+VAPA(5),0)),U,2)_U_VAPA(6)_U_VAPA(1)_U_VAPA(2)_U_VAPA(3) INSADDQ S A=$P($G(^DGCR(399,IBIFN,"M")),U,(11+IBCOB)) S A=$G(^DPT(DFN,.312,+A,3)) I $TR($P(IBADDR,U)," ")="" D .S $P(IBADDR,U)=$P(A,U,6)_" "_$P(A,U,7),$P(IBADDR,U,5,6)=$P(A,U,6,7) .F B=2,4 S $P(IBADDR,U,B)=$P(A,U,B+6) .S $P(IBADDR,U,3)=$P($G(^DIC(5,+$P(A,U,9),0)),U,2) Q IBADDR ; PTADDR(IBIFN,ELE) ;Return part of patient's permanent address ;IBIFN = bill ien ;ELE = subscript in ^UTILITY("VAPA", array for element needed ; I '$D(^UTILITY("VAPA",$J)) D ; once per pt .N VAHOW,DFN,VAPA .S VAHOW=2,DFN=+$P($G(^DGCR(399,IBIFN,0)),U,2),VAPA("P")="" .D ADD^VADPT Q $P($G(^UTILITY("VAPA",$J,ELE)),U) ; PTDEM(IBIFN,ELE,PC) ;Return part of patient's demographics ;IBIFN = bill ien ;ELE = subscript in ^UTILITY("VADM" array for demographic element needed ;PC = pc of string at subscript ELE to be returned ; I '$G(PC) S PC=1 I '$D(^UTILITY("VADM",$J)) D ; once per pt .N VAHOW,DFN,VADM .S VAHOW=2,DFN=+$P($G(^DGCR(399,IBIFN,0)),U,2) .D DEM^VADPT Q $P($G(^UTILITY("VADM",$J,ELE)),U,PC) ; PTEMPL(IBIFN,ELE,WHOSE,VAOA) ;Return part of pt's or spouse's employer info ;ELE = subscript in VAOA array for employer element needed ;WHOSE = 6 if spouse's info needed 5 if pt info needed (DEFAULT) ; N DFN S DFN=+$P($G(^DGCR(399,IBIFN,0)),U,2),VAOA("A")=$S($G(WHOSE):WHOSE,1:5) D OAD^VADPT Q $P($G(VAOA(ELE)),U) ; INSDEM(IBIFN,IBCOB) ; Return insured's demographics in 6 pieces: ; DATE OF BIRTH^SEX^PHONE^BRANCH pointer^RANK^SSN(no dashes) ; IBIFN = bill ien ; IBCOB = bill designation (P)rimary (default), (S)econdary, (T)ertiary ; or 1,2,3 ... if not defined or null, return current ; If insured is patient/spouse, take from patient file top level ; fields, then if top-level are blank and policy level aren't, ; use policy level ; If insured other than patient/spouse, use policy level fields only N A,B,IBDEM,IBI,DFN,VADM S:$G(IBCOB)="" IBCOB="" S:'IBCOB IBCOB=$$COBN(IBIFN,IBCOB) S IBI=$$WHOSINS(IBIFN,IBCOB) S DFN=+$P($G(^DGCR(399,IBIFN,0)),U,2) I $S('IBI:1,1:"12"'[IBI) S IBDEM="" G INSDEM1 ; If it gets here, assume insured is patient/spouse S A=$$PTDEM(IBIFN,0),A=$$PTADDR(IBIFN,0) F A=2,3,5 S VADM(A)=$P($G(^UTILITY("VADM",$J,A)),U) S VAPA(8)=$P($G(^UTILITY("VAPA",$J,8)),U) I VADM(5)="",'VADM(3),VAPA(8)="" S IBDEM="" G INSDEM1 S $P(IBDEM,U,3)=VAPA(8),$P(IBDEM,U,6)=VADM(2) I IBI=1,VADM(3) S $P(IBDEM,U)=VADM(3) ;Patient's own policy only INSDEM1 S A=$P($G(^DGCR(399,IBIFN,"M")),U,(11+IBCOB)) S A=$G(^DPT(DFN,.312,+A,3)) S:"MF"'[$G(VADM(5)) VADM(5)="" S $P(IBDEM,U,2)=$S(IBI=1:VADM(5),1:$P(A,U,12)) S $P(IBDEM,U,4,5)=$P(A,U,2)_U_$P(A,U,3) S:'$P(IBDEM,U) $P(IBDEM,U)=$P(A,U) S:$P(IBDEM,U,3)="" $P(IBDEM,U,3)=$P(A,U,11) S:$P(IBDEM,U,6)="" $P(IBDEM,U,6)=$P(A,U,5) Q IBDEM ; INSEMPL(IBIFN,IBCOB) ; Return insured's employer data in 5 pieces: ; EMPLOYER NAME^EMPLOYER CITY^EMPLOYER STATE ABBREVIATION^STATE IEN^STREET 1 ; IBCOB = bill designation (P)rimary-default, (S)econdary, (T)ertiary ; or 123 - if not defined or null, return current N A,IBEMPL,IBI,DFN,VAOA S IBI=$$WHOSINS(IBIFN,$G(IBCOB)) I $S('IBI:1,1:"12"'[IBI) S IBEMPL="^^" G INSEMPQ ; insured = pt/spouse S DFN=+$P($G(^DGCR(399,IBIFN,0)),U,2) S A=$$PTEMPL(IBIFN,0,IBI+4,.VAOA) S IBEMPL=VAOA(9)_U_VAOA(4)_U_$P($G(^DIC(5,+VAOA(5),0)),U,2)_U_+VAOA(5)_U_VAOA(1) INSEMPQ Q IBEMPL ; WHOSINS(IBIFN,IBCOB) ; Determine who is insured for bill IBIFN and ; seq of coverage COB (123 or PST) or if not defined or null, current N Z,Z0,VAEL,DFN S Z=+$$POLICY(IBIFN,16,$G(IBCOB)) I 'Z D .S Z0=$$POLICY(IBIFN,6,$G(IBCOB)),DFN=$P($G(^DGCR(399,IBIFN,0)),U,2) .I Z0="v" D ELIG^VADPT I VAEL(4) S Z=1 Q ;vet is pt .I Z0="s" D ELIG^VADPT I VAEL(4) S Z=2 Q ;vet is pt, so vets spouse is pt's spouse .S Z=9 ; relationship of insured to pt unknown Q Z ; EMPSTAT(IBIFN,WHOSE) ;Return employment status ; IBIFN = bill ien ; WHOSE = v for vet, s for spouse status N STAT,DFN,VAPD S STAT="",DFN=+$P($G(^DGCR(399,IBIFN,0)),U,2) I WHOSE="v" D OPD^VADPT S STAT=$P(VAPD(7),U) I WHOSE="s" S STAT=$P($G(^DPT(DFN,.25)),U,15) I STAT="" S STAT=9 Q STAT ; INPAT(IBIFN,OUT) ; Determine if bill is inpatient ; OUT = optional - if 1, return output value based on ; inpatient/outpatient from UB-04 type of bill field ; Return 1 if inpatient, 0 if not inpatient or can't be determined N INPT,CODE,CODE0,IB0 S IB0=$G(^DGCR(399,IBIFN,0)) S OUT=+$G(OUT),CODE=+$P(IB0,U,5) I 'OUT S INPT=CODE I OUT D . S CODE0=$P($G(^DGCR(399.1,+$P(IB0,U,25),0)),U,2) . I CODE0=8,$P(IB0,U,24)=1 S INPT=$P(IB0,U,5) Q ; 18X . I CODE0=9,$P(IB0,U,24)=8 S INPT=$P(IB0,U,5) Q ; 89X . I CODE0=1,$P(IB0,U,24)=8 S INPT=0 Q ; 81X . I CODE0=1,$P(IB0,U,24)=7 S INPT=0 Q ; 71X . I CODE0=2,$P(IB0,U,24)=7 S INPT=0 Q ; 72X . S INPT=CODE0 Q $S(INPT:INPT'>2,1:0) ; INSPRF(IBIFN) ; Function to determine if bill is prof or inst ; Return 1 if institutional (UB-04) claim, 0 if professional (CMS-1500) claim N A S A=$G(^DGCR(399,IBIFN,0)) I $P(A,U,27)="" S $P(A,U,27)=$S($P(A,U,19)=3:1,1:0) Q $S($P(A,U,27)=1:1,1:0) ; F(FLD,IBXRET,IBXERR1,IBIEN) ;Execute extract for data element FLD and bill IBIEN ; If IBXDATA array to be returned as data value(s) of fld ; D F^IBCEF("FLD NAME","IBXDATA","IBXERR") or D F^IBCEF("FLD NAME") ; Variable ref-ed by IBXERR1 will contain error message if an error ; @IBXRET always defined on return. It will be null if error I $G(IBIEN) N IBXIEN S IBXIEN=IBIEN I $G(IBXERR1)="" S IBXERR1="IBXERR" N IBXHOLD S IBXHOLD="" I $G(IBXRET)=""!($G(IBXRET)="IBXDATA") S IBXHOLD="IBXDATA",IBXRET="IBXRET" S @IBXERR1="" ; N FLDN,OFLD,STOP,Z,IBXERR2,IBXRETX ; I '$G(IBXIEN) S @IBXERR1="Invalid entry #" G FQ I '$D(^IBA(364.5,"B",FLD)) S OFLD=FLD,STOP=0 D I FLD="" S @IBXERR1=OFLD_" Field not found!!" G FQ .F S FLD=$O(^IBA(364.5,"B",FLD)) D Q:STOP ..I $E(FLD,1,$L(OFLD))'=OFLD S FLD="" ..S STOP=1 ; S Z=0 F S Z=$O(^IBA(364.5,"B",FLD,Z)) Q:'Z I $P($G(^IBA(364.5,Z,0)),U,5)=399 Q I 'Z S @IBXERR1=FLD_" Field not found!!" G FQ ; S FLDN(1)=Z D EXTONE^IBCEFG0(IBXIEN,.FLDN,""_IBXRET_"",.IBXERR2) ; I $G(IBXERR2)'="" S @IBXERR1=IBXERR2 FQ S IBXARRY=$S(IBXHOLD="IBXDATA":"IBXDATA",1:""_IBXRET_"") I @IBXERR1'="" K @IBXARRY S @IBXARRY="" Q ; I IBXHOLD="IBXDATA" S IBXRET="IBXRET" M IBXRETX=@IBXRET K @IBXARRY M @IBXARRY=IBXRETX(1) S:'($D(@IBXARRY)#2) @IBXARRY="" Q ; SERVDT(IBIFN,LENGTH,FORMAT) ; Return default service date for ; outpatient/UB-04 lines or X12-837 institutional lines ; LENGTH = null/8 for 8 digit date, 6 for 6 digit date ; FORMAT = 1 = X12 format (YYYYMMDD), 2 = FM internal (NNNNNNN), ; 0 = external (MMDDYY or MMDDYYYY) N IBZ G:$$INPAT^IBCEF(IBIFN,1)!($$FT^IBCEF(IBIFN)'=3) SERVDTQ ;Inpatient claim or billed on a CMS-1500 S LENGTH=$G(LENGTH),FORMAT=$G(FORMAT) D F("N-STATEMENT COVERS FROM DATE","IBZ",,IBIFN) I '$G(IBZ)!(FORMAT=2) G SERVDTQ ; I FORMAT=1 S IBZ=$$DT^IBCEFG1(IBZ,"",$S(LENGTH'=6:"D8",1:"D6")) G SERVDTQ S IBZ=$$DATE^IBCF2(IBZ,$S(LENGTH=6:0,1:1),1) ; SERVDTQ Q $G(IBZ) ; NOPUNCT(X,SPACE,EXC) ; Strip punctuation from data in X ; SPACE = flag if 1 strip SPACES ; EXC = list of punctuation not to strip ; N PUNCT,Z S PUNCT=".,-+(){}[]\/><:;?|=_*&%$#@!~`^'""" I $G(SPACE) S PUNCT=PUNCT_" " I $G(EXC)'="" F Z=1:1:$L(EXC) S PUNCT=$TR(PUNCT,$E(EXC,Z)) S X=$TR(X,PUNCT) Q X ; FT(IBIFN) ; Internal code for bill form type Q +$P($G(^DGCR(399,IBIFN,0)),U,19) ; COBCT(IBIFN) ; # of payers on claim N CT,Z S CT=0 F Z="I1","I2","I3" Q:'$D(^DGCR(399,IBIFN,Z)) S CT=CT+1 Q CT ;