| 1 | IBCEOB00 ;ALB/ESG - 835 EDI EOB MSG PROCESSING CONT ;30-JUN-2003
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| 2 | ;;2.0;INTEGRATED BILLING;**155,349,377**;21-MAR-94;Build 23
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| 3 | ;;Per VHA Directive 2004-038, this routine should not be modified.
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| 4 | Q
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| 5 | ;
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| 6 | RCRU(IBZDATA,IB0,IBLN) ; Revenue Code Roll-up procedure check -
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| 7 | ; Total up outbound line items by revenue code and compare with
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| 8 | ; incoming EOB 40 record to see if it has been rolled up
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| 9 | ;
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| 10 | ; IBZDATA - UB output formatter array, passed by reference
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| 11 | ; IB0 - 40 record data
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| 12 | ; IBLN - output parameter, passed by reference
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| 13 | ;
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| 14 | NEW Z,LN,REV,UN,CH,RUD,RUD2,UCH,MRAUCH
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| 15 | I $P(IB0,U,4)="" G RCRUX
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| 16 | S IBLN="",Z=0
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| 17 | F S Z=$O(IBZDATA(Z)) Q:'Z S LN=IBZDATA(Z) D
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| 18 | . S REV=$P(LN,U,1),UN=$P(LN,U,4),CH=$P(LN,U,5),UCH=+$P(LN,U,3)
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| 19 | . I REV="" Q
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| 20 | . ;
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| 21 | . S RUD=$G(RUD(REV)) ; roll up data array for rev code
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| 22 | . S $P(RUD,U,1)=$P(RUD,U,1)+CH ; total charges
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| 23 | . S $P(RUD,U,2)=$P(RUD,U,2)+UN ; total units
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| 24 | . S $P(RUD,U,3)=$P(RUD,U,3)+1 ; total line items
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| 25 | . S RUD(REV)=RUD
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| 26 | . S RUD(REV,Z)=""
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| 27 | . ;
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| 28 | . S RUD2=$G(RUD2(REV,UCH)) ; roll up data array for rev code
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| 29 | . S $P(RUD2,U,1)=$P(RUD2,U,1)+CH ; total charges
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| 30 | . S $P(RUD2,U,2)=$P(RUD2,U,2)+UN ; total units
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| 31 | . S $P(RUD2,U,3)=$P(RUD2,U,3)+1 ; total line items
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| 32 | . S RUD2(REV,UCH)=RUD2
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| 33 | . S RUD2(REV,UCH,Z)=""
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| 34 | . ;
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| 35 | . Q
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| 36 | ;
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| 37 | I '$D(RUD),'$D(RUD2) G RCRUX
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| 38 | ;
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| 39 | ; delete the revenue code roll-up, if only 1 line item.
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| 40 | S REV="" ; this is not a roll up situation
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| 41 | F S REV=$O(RUD(REV)) Q:REV="" I $P(RUD(REV),U,3)=1 KILL RUD(REV)
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| 42 | ;
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| 43 | S (REV,UCH)=""
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| 44 | F S REV=$O(RUD2(REV)) Q:REV="" F S UCH=$O(RUD2(REV,UCH)) Q:UCH="" I $P(RUD2(REV,UCH),U,3)=1 KILL RUD2(REV,UCH)
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| 45 | ;
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| 46 | I '$D(RUD),'$D(RUD2) G RCRUX
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| 47 | ;
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| 48 | S RUD=$G(RUD($P(IB0,U,4))) ; compare with 40 record data
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| 49 | I RUD="" G RCRU2 ; make sure it exists
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| 50 | I $P(RUD,U,1)'=+$$DOLLAR^IBCEOB($P(IB0,U,15)) G RCRU2 ; charges
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| 51 | I $P(RUD,U,2)'=$P(IB0,U,16) G RCRU2 ; units
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| 52 | S IBLN=$O(RUD($P(IB0,U,4),"")) ; use the first line# found
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| 53 | G RCRUX
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| 54 | ;
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| 55 | RCRU2 ; check roll-up data by rev code and unit charge
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| 56 | S MRAUCH=0
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| 57 | I $P(IB0,U,16) S MRAUCH=+$$DOLLAR^IBCEOB($P(IB0,U,15))/$P(IB0,U,16)
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| 58 | S RUD2=$G(RUD2($P(IB0,U,4),MRAUCH)) ; compare with 40 record data
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| 59 | I RUD2="" G RCRUX ; make sure it exists
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| 60 | I $P(RUD2,U,1)'=+$$DOLLAR^IBCEOB($P(IB0,U,15)) G RCRUX ; charges
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| 61 | I $P(RUD2,U,2)'=$P(IB0,U,16) G RCRUX ; units
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| 62 | S IBLN=$O(RUD2($P(IB0,U,4),MRAUCH,"")) ; use the first line# found
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| 63 | ;
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| 64 | RCRUX ;
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| 65 | Q
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| 66 | ;
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| 67 | ICN(IBEOB,ICN,COBN,IBOK) ; File the 835 ICN into the Bill
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| 68 | ;
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| 69 | ; Input parameters
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| 70 | ; IBEOB - ien to file 361.1
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| 71 | ; ICN - the ICN# from the 835 transmission
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| 72 | ; COBN - the insurance sequence#
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| 73 | ;
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| 74 | ; Output parameter
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| 75 | ; IBOK - returns as 0 if we get a filing error here
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| 76 | ;
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| 77 | ; The field in file 399 depends on the current payer sequence
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| 78 | ; 399,453 - primary ICN
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| 79 | ; 399,454 - secondary ICN
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| 80 | ; 399,455 - tertiary ICN
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| 81 | ;
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| 82 | NEW IBIFN,FIELD,D,D0,DA,DI,DIC,DIE,DQ,DR,X,Y
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| 83 | S IBEOB=+$G(IBEOB),COBN=+$G(COBN)
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| 84 | I 'IBEOB!'COBN G ICNX
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| 85 | S IBIFN=+$P($G(^IBM(361.1,IBEOB,0)),U,1)
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| 86 | I '$D(^DGCR(399,IBIFN)) G ICNX
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| 87 | I $G(ICN)="" G ICNX
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| 88 | I '$F(".1.2.3.","."_COBN_".") G ICNX
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| 89 | ;
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| 90 | S FIELD=452+COBN
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| 91 | S DIE=399,DA=IBIFN,DR=FIELD_"////"_ICN D ^DIE
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| 92 | S IBOK=($D(Y)=0)
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| 93 | I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Error in filing the ICN into the Bill/Claims file"
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| 94 | ICNX ;
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| 95 | Q
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| 96 | ;
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| 97 | 15(IB0,IBEGBL,IBEOB) ; Record '15'
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| 98 | ;
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| 99 | N A,IBOK
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| 100 | ;
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| 101 | 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"
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| 102 | ;
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| 103 | S IBOK=$$STORE^IBCEOB1(A,IB0,IBEOB)
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| 104 | I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Bad record 15 data" G Q15
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| 105 | ;
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| 106 | ; For Medicare MRA's only:
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| 107 | ; If the Covered Amount is present (15 record, piece 3), then file
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| 108 | ; a claim level adjustment with Group code=OA, Reason code=AB3.
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| 109 | ;
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| 110 | I $P($G(^IBM(361.1,IBEOB,0)),U,4)=1,+$P(IB0,U,3) D
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| 111 | . N IB20
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| 112 | . S IB20=20_U_$P(IB0,U,2)_U_"OA"_U_"AB3"_U_$P(IB0,U,3)_U_"0000000000"
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| 113 | . S IB20=IB20_U_"Covered Amount"
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| 114 | . S IBOK=$$20(IB20,IBEGBL,IBEOB)
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| 115 | . I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Could not file the OA-AB3 claim level adjustment for the Covered Amount"
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| 116 | . K ^TMP($J,20)
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| 117 | . Q
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| 118 | ;
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| 119 | Q15 Q IBOK
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| 120 | ;
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| 121 | 20(IB0,IBEGBL,IBEOB) ; Record '20'
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| 122 | ;
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| 123 | N A,LEVEL,IBGRP,IBDA,IBOK
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| 124 | ;
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| 125 | S IBGRP=$P(IB0,U,3)
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| 126 | I IBGRP'="" S ^TMP($J,20)=IBGRP
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| 127 | I IBGRP="" S IBGRP=$G(^TMP($J,20))
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| 128 | I IBGRP="" S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Missing claim level adjustment group code" G Q20
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| 129 | ;
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| 130 | S IBDA(1)=$O(^IBM(361.1,IBEOB,10,"B",IBGRP,0))
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| 131 | ;
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| 132 | I 'IBDA(1) D ;Needs a new entry at group level
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| 133 | . N X,Y,DA,DD,DO,DIC,DLAYGO
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| 134 | . S DIC="^IBM(361.1,"_IBEOB_",10,",DIC(0)="L",DLAYGO=361.11,DA(1)=IBEOB
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| 135 | . S DIC("P")=$$GETSPEC^IBEFUNC(361.1,10)
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| 136 | . S X=IBGRP
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| 137 | . D FILE^DICN K DIC,DO,DD,DLAYGO
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| 138 | . I Y<0 K IBDA S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Adjustment group code could not be added" Q
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| 139 | . S IBDA(1)=+Y
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| 140 | ;
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| 141 | I $G(IBDA(1)) D ;Add a new entry at the reason code level
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| 142 | . S DIC="^IBM(361.1,"_IBEOB_",10,"_IBDA(1)_",1,",DIC(0)="L",DLAYGO=361.111,DA(2)=IBEOB,DA(1)=IBDA(1)
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| 143 | . S DIC("P")=$$GETSPEC^IBEFUNC(361.11,1)
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| 144 | . S X=$P(IB0,U,4)
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| 145 | . D FILE^DICN K DIC,DO,DD,DLAYGO
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| 146 | . I Y<0 K IBDA S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Adjustment reason code could not be added" Q
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| 147 | . S IBDA=+Y
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| 148 | ;
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| 149 | I $G(IBDA) D
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| 150 | . S LEVEL=10,LEVEL("DIE")="^IBM(361.1,"_IBEOB_",10,"_IBDA(1)_",1,"
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| 151 | . S LEVEL(0)=IBDA,LEVEL(1)=IBDA(1),LEVEL(2)=IBEOB
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| 152 | . S A="5;.02;1;0;0^6;.03;0;1;1^7;.04;0;1;0"
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| 153 | . S IBOK=$$STORE^IBCEOB1(A,IB0,IBEOB,.LEVEL)
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| 154 | . I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Bad adjustment reason code ("_$P(IB0,U,4)_") data" Q
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| 155 | Q20 Q $G(IBOK)
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| 156 | ;
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| 157 | 35(IB0,IBEGBL,IBEOB) ; Record '35'
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| 158 | ;
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| 159 | N A,IBOK
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| 160 | ;
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| 161 | S A="3;4.12;1;0;0^4;4.13;1;0;0^5;4.14;0;1;1^6;4.15;1;0;0^7;4.16;1;0;0^8;4.17;1;0;0^9;4.18;1;0;0^10;4.04;1;0;0^11;3.01;0;1;1^12;3.02;1;0;0^13;3.08;1;0;0^14;3.09;1;0;0"
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| 162 | ;
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| 163 | S IBOK=$$STORE^IBCEOB1(A,IB0,IBEOB)
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| 164 | I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Bad MEDICARE Inpt Adjudication data"
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| 165 | Q35 Q $G(IBOK)
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| 166 | ;
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| 167 | 37(IB0,IBEGBL,IBEOB) ; Record '37'
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| 168 | ;
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| 169 | N IBOK,IBCT
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| 170 | S IBCT=$G(^TMP($J,37))+1
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| 171 | I IBCT>5 S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Too many Medicare Claim Level Adjudication Remarks" G Q37 ; Max 5 allowed
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| 172 | S A="4;"_$S($P(IB0,U,3)="O":"3.0"_(IBCT+2),1:"5.0"_IBCT)_";0;0;0^5;5.0"_IBCT_"1;0;0;0"
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| 173 | S IBOK=$$STORE^IBCEOB1(A,IB0,IBEOB)
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| 174 | I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Bad Medicare Claim Level Adjudication Remarks data"
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| 175 | ;
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| 176 | ; 4/22/03 - esg - If claim level remark code MA15 is reported, then
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| 177 | ; this is a split EOB and we need to change the REVIEW STATUS
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| 178 | ; of this EOB to be ACCEPTED-INTERIM EOB.
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| 179 | ;
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| 180 | I $P(IB0,U,4)["MA15" D
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| 181 | . N DA,DIE,DR,DIC
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| 182 | . S DA=IBEOB,DIE=361.1,DR=".16////2" D ^DIE S IBOK=($D(Y)=0)
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| 183 | . I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Split EOB, but review status was not updated correctly"
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| 184 | . Q
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| 185 | ;
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| 186 | Q37 S ^TMP($J,37)=$G(^TMP($J,37))+1 ; Saves the # of entries for 37 records
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| 187 | Q $G(IBOK)
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| 188 | ;
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| 189 | ;
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| 190 | DET40(IB0,ARRAY) ; Format important details of record 40 for error
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| 191 | ; IB0 = data on 40 record (some pieces pre-formatted)
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| 192 | ; ARRAY(n)=formatted line is returned if passed by ref
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| 193 | N Q
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| 194 | S ARRAY(1)="Payer reported the following was billed to them:"
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| 195 | S ARRAY(2)=" "_$S($P(IB0,U,21)="NU":"Rev Cd",1:"Proc")_": "_$S($P(IB0,U,10)'="":$P(IB0,U,10),1:"Same as adjudicated")_" Chg: "_$J($P(IB0,U,15)/100,"",2)_" Units: "_$S($P(IB0,U,16):$P(IB0,U,16),1:1)
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| 196 | S ARRAY(3)=" Svc Date(s): "_$S($P(IB0,U,19)'="":$$FDT($P(IB0,U,19)),1:"??")_$S($P(IB0,U,20)'="":"-"_$$FDT($P(IB0,U,20)),1:"")
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| 197 | I $P(IB0,U,11)'="" S ARRAY(3)=ARRAY(3)_" Mods: " F Q=11:1:14 I $P(IB0,U,Q)'="" S ARRAY(3)=ARRAY(3)_$P(IB0,U,Q)_$S(Q=14:"",$P(IB0,U,Q+1)'="":",",1:"")
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| 198 | S ARRAY(4)="Payer reported adjudication on:"
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| 199 | S ARRAY(5)=" "_$S($P(IB0,U,21)="NU":"Rev Cd",1:"Proc")_": "_$S($P(IB0,U,3)'="":$P(IB0,U,3),1:$P(IB0,U,4))
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| 200 | S ARRAY(5)=ARRAY(5)_" Type: "_$P(IB0,U,21)_$S($P(IB0,U,21)'="NU":" Rev Cd: "_$P(IB0,U,4),1:"")_" Units: "_$S($P(IB0,U,18):$P(IB0,U,18)/100,1:1)_" Amt: "_$J($P(IB0,U,17)/100,"",2)
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| 201 | I $P(IB0,U,5)'="" S ARRAY(5)=ARRAY(5)_" Mods: " F Q=5:1:8 I $P(IB0,U,Q)'="" S ARRAY(5)=ARRAY(5)_$P(IB0,U,Q)_$S(Q=8:"",$P(IB0,U,Q+1)'="":",",1:"")
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| 202 | Q
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| 203 | ;
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| 204 | DET4X(RECID,IB0,ARRAY) ; Format important details of record 41-45 for error
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| 205 | ; RECID = 41,42,45
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| 206 | ; IB0 = data on RECID record
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| 207 | ; ARRAY(n)=formatted line is returned if passed by ref
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| 208 | N CT,Q
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| 209 | I RECID=41 D Q
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| 210 | . S ARRAY(1)="Allowed Amt: "_$J($P(IB0,U,3)/100,"",2)_" Per Diem Amt: "_$J($P(IB0,U,4)/100,"",2)
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| 211 | ;
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| 212 | I RECID=42 D Q
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| 213 | . S ARRAY(1)="Line Item Remark Code: "_$P(IB0,U,3)
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| 214 | . I $P(IB0,U,4)'="" S CT=1 F Q=0:80:190 I $E($P(IB0,U,4),Q+1,Q+80)'="" S CT=CT+1,ARRAY(CT)=$E($P(IB0,U,4),Q+1,Q+80)
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| 215 | ;
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| 216 | I RECID=45 D
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| 217 | . S ARRAY(1)="Adj Group Cd: "_$P(IB0,U,3)_" Reason Cd: "_$P(IB0,U,4)_" Amt: "_$J($P(IB0,U,5)/100,"",2)_" Quantity: "_+$P(IB0,U,6)
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| 218 | . I $P(IB0,U,7)'="" S CT=1 F Q=0:80:190 I $E($P(IB0,U,7),Q+1,Q+80)'="" S CT=CT+1,ARRAY(CT)=$E($P(IB0,U,7),Q+1,Q+80)
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| 219 | Q
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| 220 | ;
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| 221 | FDT(X) ; Format date in X (YYYYMMDD) to MM/DD/YYYY
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| 222 | S:X'="" X=$E(X,5,6)_"/"_$E(X,7,8)_"/"_$E(X,1,4)
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| 223 | Q X
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| 224 | ;
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