source: FOIAVistA/tag/r/INTEGRATED_BILLING-IB-PRQ--IBD--IBQ--PRQS/IBCEOB.m@ 636

IBCEOB ;ALB/TMP - 835 EDI EOB MESSAGE PROCESSING ;20-JAN-99
 ;;2.0;INTEGRATED BILLING;**137,135,265,155**;21-MAR-94
 Q
 ;
UPDEOB(IBTDA) ; Update EXPLANATION OF BENEFITS file (#361.1) from return msg
 ; IBTDA = ien of return message
 ; Function returns ien of EOB file entry or "" if errors found
 ;          the data.  Any errors found are
 ;          stored in array ^TMP("IBCERR-EOB",$J,n) in text format
 ;          n = seq # and are stored with the EOB in a wp field
 ;
 N IB0,IB100,IBBTCH,IBE,IBMNUM,IBT,DLAYGO,DIC,DD,DO,X,Y,Z,Z0,Z1,IBEOB,IBBAD,IBOK,IB,IBA1,IBIFN,IBFILE
 K ^TMP($J),^TMP("IBCERR-EOB",$J)
 ;
 S (IBBAD,IBEOB)=""
 S IB0=$G(^IBA(364.2,IBTDA,0))
 S IBMNUM=+$P(IB0,U)
 S X=+$G(^IBA(364,+$P(IB0,U,5),0))
 ;
 G:$S(IBMNUM=""!(X=""):1,1:$D(^IBM(361.1,"AC",IBMNUM))) UPDQ
 ;
 ; Duplicate EOB Check
 S IBFILE="^IBA(364.2,"_IBTDA_",2)"
 I $$DUP(IBFILE,X) G UPDQ
 ;
 I '$$LOCK^IBCEM(IBTDA) G UPDQ ;Lock msg file 364.2
 S IBEOB=+$$ADD3611(IBMNUM,$P(IB0,U,5),$P(IB0,U,4),X,0,IBFILE)
 L -^IBA(364.2,IBTDA,0)
 ;
 I IBEOB<0 S IBEOB="" G UPDQ
 D UPD3611(IBEOB,IBTDA,0)
 ;
UPDQ I IBEOB,$O(^TMP("IBCERR-EOB",$J,0)) D ERRUPD(IBEOB,"IBCERR-EOB")
 K ^TMP($J),^TMP("IBCERR-EOB",$J)
 D CLEAN^DILF
 Q +IBEOB
 ;
 ;
 ; NOTE: **** For all variables IB0,IBEGBL,IBEOB below:
 ; IB0 = raw data received for this record type on the 835 flat file
 ; IBEGBL = subscript to use in error global
 ; IBEOB = ien in file 361.1 for this EOB
 ;
835(IB0,IBEGBL,IBEOB) ; Store header
 ;
 Q $$HDR^IBCEOB1(IB0,IBEGBL,IBEOB)
 ;
5(IB0,IBEGBL,IBEOB) ; Record '05'
 ;
 N IBOK,IBBULL,DA,DR,DIE,X,Y
 K IBZDATA
 S DR=";",IBOK=1
 S DIE="^IBM(361.1,",DA=IBEOB
 ;
 S IBBULL=""
 I $$UPDNM^IBCEOB00(IBEOB,IB0,.IBBULL,.DR)!$$UPDID^IBCEOB00(IBEOB,IB0,.IBBULL,.DR) D  ; New insured's name and/or HIC # found
 . D CHGBULL^IBCEOB3(IBEOB,IBBULL) ;Send a bulletin reporting change
 ;
 I $P(IB0,U,9) S DR=DR_"1.1///"_$$DATE^IBCEU($P(IB0,U,9))_";"
 I $P(IB0,U,10) S DR=DR_"1.11///"_$$DATE^IBCEU($P(IB0,U,10))_";"
 S DR=$P(DR,";",2,$L(DR,";")-1)
 I DR'="" D ^DIE S IBOK=$D(Y)=0
 I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Bad record 5 data"
 Q IBOK
 ;
10(IB0,IBEGBL,IBEOB) ; Record '10'
 ;
 N DA,DR,DIE,X,Y,VAL,IBOK
 S DIE="^IBM(361.1,",DA=IBEOB
 S DR=".13////"_$S($P(IB0,U,3)="Y":1,$P(IB0,U,4)="Y":2,$P(IB0,U,5)="Y":3,$P(IB0,U,6)="Y":4,1:5)_";.21////"_$P(IB0,U,7)
 S DR=DR_";2.04////"_$$DOLLAR($P(IB0,U,10))_";1.01////"_$$DOLLAR($P(IB0,U,11))_$S($P(IB0,U,12)'="":";.14///"_$P(IB0,U,12),1:"")
 S DR=DR_$S($P(IB0,U,13)'="":";.1///"_$P(IB0,U,13),1:"")_";.11///"_($P(IB0,U,14)/10000)_";.12///"_($P(IB0,U,15)/100)
 I $P(IB0,U,8)'="" S DR=DR_";.08////"_$P(IB0,U,8)_$S($P(IB0,U,9)'="":";.09///"_$P(IB0,U,9),1:"")
 ;
 D ^DIE
 S IBOK=($D(Y)=0)
 I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Bad record 10 data" G Q10
 ;
 ; File ICN in Bill
 D ICN^IBCEOB00(IBEOB,$P(IB0,U,12),$P($G(^IBM(361.1,IBEOB,0)),U,15),.IBOK)
 ;
Q10 Q IBOK
 ;
15(IB0,IBEGBL,IBEOB) ; Record '15'
 ;
 N A,IBOK
 ;
 S A="3;1.03;1;0;0^4;1.04;1;0;0^5;1.05;1;0;0^6;1.07;1;0;0^7;1.08;1;0;0^8;1.09;1;0;0^9;1.02;1;0;0^10;2.05;1;0;0"
 ;
 S IBOK=$$STORE^IBCEOB1(A,IB0,IBEOB)
 I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Bad record 15 data" G Q15
 ;
 ; For Medicare MRA's only:
 ; If the Covered Amount is present (15 record, piece 3), then file
 ; a claim level adjustment with Group code=OA, Reason code=AB3.
 ;
 I $P($G(^IBM(361.1,IBEOB,0)),U,4)=1,+$P(IB0,U,3) D
 . N IB20
 . S IB20=20_U_$P(IB0,U,2)_U_"OA"_U_"AB3"_U_$P(IB0,U,3)_U_"0000000000"
 . S IB20=IB20_U_"Covered Amount"
 . S IBOK=$$20(IB20,IBEGBL,IBEOB)
 . I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Could not file the OA-AB3 claim level adjustment for the Covered Amount"
 . K ^TMP($J,20)
 . Q
 ;
Q15 Q IBOK
 ;
17(IB0,IBEGBL,IBEOB) ; Record '17'
 N A,IBOK
 S A="3;25.01;0;1;0^4;25.02;0;1;0^5;25.03;0;1;0^6;25.04;0;1;0^7;25.05;0;1;0^8;25.06;0;1;0^9;25.07;0;1;0"
 S IBOK=$$STORE^IBCEOB1(A,IB0,IBEOB)
 I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Bad record 17 data"
Q17 Q IBOK
 ;
20(IB0,IBEGBL,IBEOB) ; Record '20'
 ;
 N A,LEVEL,IBGRP,IBDA,IBOK
 ;
 S IBGRP=$P(IB0,U,3)
 I IBGRP'="" S ^TMP($J,20)=IBGRP
 I IBGRP="" S IBGRP=$G(^TMP($J,20))
 I IBGRP="" S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Missing claim level adjustment group code" G Q20
 ;
 S IBDA(1)=$O(^IBM(361.1,IBEOB,10,"B",IBGRP,0))
 ;
 I 'IBDA(1) D  ;Needs a new entry at group level
 . N X,Y,DA,DD,DO,DIC,DLAYGO
 . S DIC="^IBM(361.1,"_IBEOB_",10,",DIC(0)="L",DLAYGO=361.11,DA(1)=IBEOB
 . S DIC("P")=$$GETSPEC^IBEFUNC(361.1,10)
 . S X=IBGRP
 . D FILE^DICN K DIC,DO,DD,DLAYGO
 . I Y<0 K IBDA S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Adjustment group code could not be added" Q
 . S IBDA(1)=+Y
 ;
 I $G(IBDA(1)) D  ;Add a new entry at the reason code level
 . S DIC="^IBM(361.1,"_IBEOB_",10,"_IBDA(1)_",1,",DIC(0)="L",DLAYGO=361.111,DA(2)=IBEOB,DA(1)=IBDA(1)
 . S DIC("P")=$$GETSPEC^IBEFUNC(361.11,1)
 . S X=$P(IB0,U,4)
 . D FILE^DICN K DIC,DO,DD,DLAYGO
 . I Y<0 K IBDA S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Adjustment reason code could not be added" Q
 . S IBDA=+Y
 ;
 I $G(IBDA) D
 . S LEVEL=10,LEVEL("DIE")="^IBM(361.1,"_IBEOB_",10,"_IBDA(1)_",1,"
 . S LEVEL(0)=IBDA,LEVEL(1)=IBDA(1),LEVEL(2)=IBEOB
 . S A="5;.02;1;0;0^6;.03;0;1;1^7;.04;0;1;0"
 . S IBOK=$$STORE^IBCEOB1(A,IB0,IBEOB,.LEVEL)
 . I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Bad adjustment reason code ("_$P(IB0,U,4)_") data" Q
Q20 Q $G(IBOK)
 ;
30(IB0,IBEGBL,IBEOB) ; Record '30'
 ;
 N IBOK
 D 30^IBCEOB0(IB0,IBEOB,.IBOK)
Q30 Q $G(IBOK)
 ;
35(IB0,IBEGBL,IBEOB) ; Record '35'
 ; Moved due to space constraints
Q35 Q $$35^IBCEOB00(IB0,IBEGBL,IBEOB)
 ;
37(IB0,IBEGBL,IBEOB) ; Record '37'
 ; Moved due to space constraints
Q37 Q $$37^IBCEOB00(IB0,IBEGBL,IBEOB)
 ;
40(IB0,IBEGBL,IBEOB) ; Record '40'
 ;
 N IBOK
 D 40^IBCEOB0(IB0,IBEOB,.IBOK)
Q40 Q $G(IBOK)
 ;
41(IB0,IBEGBL,IBEOB) ; Record '41'
 ;
 N IBOK
 D 41^IBCEOB0(IB0,IBEOB,.IBOK)
Q41 Q $G(IBOK)
 ;
42(IB0,IBEGBL,IBEOB) ; Record '42'
 ;
 N IBOK
 D 42^IBCEOB0(IB0,IBEOB,.IBOK)
Q42 Q $G(IBOK)
 ;
45(IB0,IBEGBL,IBEOB) ; Record '45'
 ;
 N IBOK
 D 45^IBCEOB0(IB0,IBEOB,.IBOK)
 Q $G(IBOK)
 ;
DOLLAR(X) ; Convert value in X to dollar format XXX.XX
 Q $S(+X:$J(X/100,$L(+X),2),1:0)
 ;
ADD3611(IBMNUM,IBTBILL,IBBATCH,X,IBAR,IBFILE) ; Add stub record to file 361.1
 ; X = the ien of the referenced bill in file 399
 ; IBTBILL = ien of transmitted bill (optional)
 ; IBBATCH = ien of batch # the transmitted bill was in (optional)
 ; IBMNUM = the message # from which this record originally came
 ; IBAR = 1 only if called from AR
 ; IBFILE = array reference of raw EOB data
 ;
 N DIC,DA,DR,DO,DD,DLAYGO,Y,REVSTAT,BS
 F  L +^IBM(361.1,0):10 Q:$T
 ;
 ; default proper review status
 S BS=$P($G(^DGCR(399,X,0)),U,13)   ; bill status
 S REVSTAT=$S(BS=7:9,BS=3:3,BS=4:3,1:0)
 S DIC(0)="L",DIC="^IBM(361.1,",DLAYGO=361.1
 S DIC("DR")=".16////"_REVSTAT_";.17////0"_";100.02////"_IBMNUM_$S('$G(IBAR):";.19////"_+IBTBILL_";100.01////"_IBBATCH,1:"")
 S DIC("DR")=DIC("DR")_";100.05////"_$$CHKSUM^IBCEMU1(IBFILE)
 D FILE^DICN
 L -^IBM(361.1,0)
 Q +Y
 ;
UPD3611(IBEOB,IBTDA,IBAR) ; From flat file 835 format, add EOB record
 ; IBEOB = the ien of the entry in file 361.1 being updated
 ; IBTDA = the ien in the source file
 ; IBAR = 1 if being called from AR
 N IBA1,IBFILE,IBEGBL,Z,IBREC,Q
 S IBFILE=$S('$G(IBAR):"^IBA(364.2,"_IBTDA_",2)",1:"^TMP("_$J_",""RCDP-EOB"","_IBTDA_")")
 S IBEGBL=$S('$G(IBAR):"IBCERR-EOB",1:"RCDPERR-EOB")
 I $G(IBAR),'$$HDR^IBCEOB1($G(^TMP($J,"RCDPEOB","HDR")),IBEGBL,IBEOB) Q
 S IBA1=0
 F  S IBA1=$O(@IBFILE@(IBA1)) Q:'IBA1  S IB0=$S('$G(IBAR):$P($G(^(IBA1,0)),"##RAW DATA: ",2),1:$G(@IBFILE@(IBA1,0))) I IB0'="" D
 . S IBREC=+IB0
 . I IBREC'=37 K ^TMP($J,37)
 . I IBREC S IB="S IBOK=$$"_IBREC_"(IB0,IBEGBL,IBEOB)",Q=IBREC_"^IBCEOB" I $T(@Q)'="" X IB S:'IBOK ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)=$S('$G(IBAR):"  ##RAW DATA: ",1:"")_IB0
 ;
 Q
 ;
ERRUPD(IBEOB,IBEGBL) ; Update error text in entry, if needed
 D WP^DIE(361.1,IBEOB_",",20,"","^TMP(IBEGBL,$J)","")
 Q
 ;
 ;
DUP(IBARRAY,IBIFN) ; Duplicate Check
 ; This function determines if the EOB data already exists in file
 ; 361.1 by comparing the checksums of the raw 835 data.
 ;
 ; IBARRAY = Literal array reference where the raw 835 data exists.
 ;           The data exists at @IBARRAY@(n,0), where n is the seq#.
 ;           For example, IBARRAY = "^IBA(364.2,IBIEN,2)"
 ;
 ; IBIFN = the bill # (ptr to 399).  The checksums of the EOB's on 
 ;         file for this bill will be compared to the checksum of the
 ;         835 raw data in the IBARRAY reference.
 ;
 ; This function returns 0 if the entry is not found (no duplicate),
 ; Otherwise, the IEN of the entry in file 361.1 is returned if this
 ; is a duplicate EOB.
 ;
 NEW DUP,IBEOB,CHKSUM1,CHKSUM2
 S DUP=0,IBIFN=+$G(IBIFN)
 I $G(IBARRAY)=""!'IBIFN G DUPX
 I '$D(^IBM(361.1,"B",IBIFN)) G DUPX     ; no EOB's on file yet
 S CHKSUM1=$$CHKSUM^IBCEMU1(IBARRAY)     ; checksum of current EOB
 I 'CHKSUM1 G DUPX                       ; must be able to be calculated
 S IBEOB=0
 F  S IBEOB=$O(^IBM(361.1,"B",IBIFN,IBEOB)) Q:'IBEOB  D  Q:DUP
 . S CHKSUM2=+$P($G(^IBM(361.1,IBEOB,100)),U,5)   ; checksum of old EOB
 . I 'CHKSUM2 Q
 . I CHKSUM1=CHKSUM2 S DUP=IBEOB Q                    ; comparison
 . Q
DUPX ;
 Q DUP
 ;