source: FOIAVistA/tag/r/INTEGRATED_BILLING-IB-PRQ--IBD--IBQ--PRQS/IBCEOB00.m@ 636

Last change on this file since 636 was 636, checked in by George Lilly, 14 years ago

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1IBCEOB00 ;ALB/ESG - 835 EDI EOB MSG PROCESSING CONT ;30-JUN-2003
2 ;;2.0;INTEGRATED BILLING;**155,349**;21-MAR-94;Build 46
3 ;;Per VHA Directive 2004-038, this routine should not be modified.
4 Q
5 ;
6RCRU(IBZDATA,IB0,IBLN) ; Revenue Code Roll-up procedure check -
7 ; Total up outbound line items by revenue code and compare with
8 ; incoming EOB 40 record to see if it has been rolled up
9 ;
10 ; IBZDATA - UB output formatter array, passed by reference
11 ; IB0 - 40 record data
12 ; IBLN - output parameter, passed by reference
13 ;
14 NEW Z,LN,REV,UN,CH,RUD,RUD2,UCH,MRAUCH
15 I $P(IB0,U,4)="" G RCRUX
16 S IBLN="",Z=0
17 F S Z=$O(IBZDATA(Z)) Q:'Z S LN=IBZDATA(Z) D
18 . S REV=$P(LN,U,1),UN=$P(LN,U,4),CH=$P(LN,U,5),UCH=+$P(LN,U,3)
19 . I REV="" Q
20 . ;
21 . S RUD=$G(RUD(REV)) ; roll up data array for rev code
22 . S $P(RUD,U,1)=$P(RUD,U,1)+CH ; total charges
23 . S $P(RUD,U,2)=$P(RUD,U,2)+UN ; total units
24 . S $P(RUD,U,3)=$P(RUD,U,3)+1 ; total line items
25 . S RUD(REV)=RUD
26 . S RUD(REV,Z)=""
27 . ;
28 . S RUD2=$G(RUD2(REV,UCH)) ; roll up data array for rev code
29 . S $P(RUD2,U,1)=$P(RUD2,U,1)+CH ; total charges
30 . S $P(RUD2,U,2)=$P(RUD2,U,2)+UN ; total units
31 . S $P(RUD2,U,3)=$P(RUD2,U,3)+1 ; total line items
32 . S RUD2(REV,UCH)=RUD2
33 . S RUD2(REV,UCH,Z)=""
34 . ;
35 . Q
36 ;
37 I '$D(RUD),'$D(RUD2) G RCRUX
38 ;
39 ; delete the revenue code roll-up, if only 1 line item.
40 S REV="" ; this is not a roll up situation
41 F S REV=$O(RUD(REV)) Q:REV="" I $P(RUD(REV),U,3)=1 KILL RUD(REV)
42 ;
43 S (REV,UCH)=""
44 F S REV=$O(RUD2(REV)) Q:REV="" F S UCH=$O(RUD2(REV,UCH)) Q:UCH="" I $P(RUD2(REV,UCH),U,3)=1 KILL RUD2(REV,UCH)
45 ;
46 I '$D(RUD),'$D(RUD2) G RCRUX
47 ;
48 S RUD=$G(RUD($P(IB0,U,4))) ; compare with 40 record data
49 I RUD="" G RCRU2 ; make sure it exists
50 I $P(RUD,U,1)'=+$$DOLLAR^IBCEOB($P(IB0,U,15)) G RCRU2 ; charges
51 I $P(RUD,U,2)'=$P(IB0,U,16) G RCRU2 ; units
52 S IBLN=$O(RUD($P(IB0,U,4),"")) ; use the first line# found
53 G RCRUX
54 ;
55RCRU2 ; check roll-up data by rev code and unit charge
56 S MRAUCH=0
57 I $P(IB0,U,16) S MRAUCH=+$$DOLLAR^IBCEOB($P(IB0,U,15))/$P(IB0,U,16)
58 S RUD2=$G(RUD2($P(IB0,U,4),MRAUCH)) ; compare with 40 record data
59 I RUD2="" G RCRUX ; make sure it exists
60 I $P(RUD2,U,1)'=+$$DOLLAR^IBCEOB($P(IB0,U,15)) G RCRUX ; charges
61 I $P(RUD2,U,2)'=$P(IB0,U,16) G RCRUX ; units
62 S IBLN=$O(RUD2($P(IB0,U,4),MRAUCH,"")) ; use the first line# found
63 ;
64RCRUX ;
65 Q
66 ;
67ICN(IBEOB,ICN,COBN,IBOK) ; File the 835 ICN into the Bill
68 ;
69 ; Input parameters
70 ; IBEOB - ien to file 361.1
71 ; ICN - the ICN# from the 835 transmission
72 ; COBN - the insurance sequence#
73 ;
74 ; Output parameter
75 ; IBOK - returns as 0 if we get a filing error here
76 ;
77 ; The field in file 399 depends on the current payer sequence
78 ; 399,453 - primary ICN
79 ; 399,454 - secondary ICN
80 ; 399,455 - tertiary ICN
81 ;
82 NEW IBIFN,FIELD,D,D0,DA,DI,DIC,DIE,DQ,DR,X,Y
83 S IBEOB=+$G(IBEOB),COBN=+$G(COBN)
84 I 'IBEOB!'COBN G ICNX
85 S IBIFN=+$P($G(^IBM(361.1,IBEOB,0)),U,1)
86 I '$D(^DGCR(399,IBIFN)) G ICNX
87 I $G(ICN)="" G ICNX
88 I '$F(".1.2.3.","."_COBN_".") G ICNX
89 ;
90 S FIELD=452+COBN
91 S DIE=399,DA=IBIFN,DR=FIELD_"////"_ICN D ^DIE
92 S IBOK=($D(Y)=0)
93 I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Error in filing the ICN into the Bill/Claims file"
94ICNX ;
95 Q
96 ;
9735(IB0,IBEGBL,IBEOB) ; Record '35'
98 ;
99 N A,IBOK
100 ;
101 S A="3;4.12;1;0;0^4;4.13;1;0;0^5;4.14;0;1;1^6;4.15;1;0;0^7;4.16;1;0;0^8;4.17;1;0;0^9;4.18;1;0;0^10;4.04;1;0;0^11;3.01;0;1;1^12;3.02;1;0;0^13;3.08;1;0;0^14;3.09;1;0;0"
102 ;
103 S IBOK=$$STORE^IBCEOB1(A,IB0,IBEOB)
104 I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Bad MEDICARE Inpt Adjudication data"
105Q35 Q $G(IBOK)
106 ;
10737(IB0,IBEGBL,IBEOB) ; Record '37'
108 ;
109 N IBOK,IBCT
110 S IBCT=$G(^TMP($J,37))+1
111 I IBCT>5 S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Too many Medicare Claim Level Adjudication Remarks" G Q37 ; Max 5 allowed
112 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"
113 S IBOK=$$STORE^IBCEOB1(A,IB0,IBEOB)
114 I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Bad Medicare Claim Level Adjudication Remarks data"
115 ;
116 ; 4/22/03 - esg - If claim level remark code MA15 is reported, then
117 ; this is a split EOB and we need to change the REVIEW STATUS
118 ; of this EOB to be ACCEPTED-INTERIM EOB.
119 ;
120 I $P(IB0,U,4)["MA15" D
121 . N DA,DIE,DR,DIC
122 . S DA=IBEOB,DIE=361.1,DR=".16////2" D ^DIE S IBOK=($D(Y)=0)
123 . I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Split EOB, but review status was not updated correctly"
124 . Q
125 ;
126Q37 S ^TMP($J,37)=$G(^TMP($J,37))+1 ; Saves the # of entries for 37 records
127 Q $G(IBOK)
128 ;
129 ;
130DET40(IB0,ARRAY) ; Format important details of record 40 for error
131 ; IB0 = data on 40 record (some pieces pre-formatted)
132 ; ARRAY(n)=formatted line is returned if passed by ref
133 N Q
134 S ARRAY(1)="Payer reported the following was billed to them:"
135 S ARRAY(2)=" "_$S($P(IB0,U,21)="NU":"Rev Cd",1:"Proc")_": "_$S($P(IB0,U,10)'="":$P(IB0,U,10),1:"Same as adjudicated")_" Chg: "_$J($P(IB0,U,15)/100,"",2)_" Units: "_$S($P(IB0,U,16):$P(IB0,U,16),1:1)
136 S ARRAY(3)=" Svc Date(s): "_$S($P(IB0,U,19)'="":$$FDT($P(IB0,U,19)),1:"??")_$S($P(IB0,U,20)'="":"-"_$$FDT($P(IB0,U,20)),1:"")
137 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:"")
138 S ARRAY(4)="Payer reported adjudication on:"
139 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))
140 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)
141 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:"")
142 Q
143 ;
144DET4X(RECID,IB0,ARRAY) ; Format important details of record 41-45 for error
145 ; RECID = 41,42,45
146 ; IB0 = data on RECID record
147 ; ARRAY(n)=formatted line is returned if passed by ref
148 N CT,Q
149 I RECID=41 D Q
150 . S ARRAY(1)="Allowed Amt: "_$J($P(IB0,U,3)/100,"",2)_" Per Diem Amt: "_$J($P(IB0,U,4)/100,"",2)
151 ;
152 I RECID=42 D Q
153 . S ARRAY(1)="Line Item Remark Code: "_$P(IB0,U,3)
154 . 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)
155 ;
156 I RECID=45 D
157 . 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)
158 . 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)
159 Q
160 ;
161FDT(X) ; Format date in X (YYYYMMDD) to MM/DD/YYYY
162 S:X'="" X=$E(X,5,6)_"/"_$E(X,7,8)_"/"_$E(X,1,4)
163 Q X
164 ;
165UPDNM(IBEOB,IB0,IBBULL,IBDR) ; Update name on claim if it comes back changed
166 ; IBEOB = the internal entry # of the entry in file 361.1
167 ; IB0 = the raw data returned from the 835 flat file
168 ; IBBULL = holds result of name change check in piece 1 - if name
169 ; changed, first '^' piece is 1, 3rd '^' piece is the old
170 ; insured's name
171 ; IBDR = returned as the updated 'DR' string with the name changed
172 ; fields to use to update the EOB file (361.1) - pass by reference
173 ;
174 N IBCHGED,IBIFN,IBNEW,IBCOB,DIE,DR,X,Y
175 I $P(IB0,U,7) D
176 . S IBNEW=$P(IB0,U,3)_","_$P(IB0,U,4)_$S($P(IB0,U,5)'="":" "_$P(IB0,U,5),1:""),$P(IBBULL,U)=1
177 . S IBCOB=+$P($G(^IBM(361.1,IBEOB,0)),U,15)
178 . S IBIFN=+$G(^IBM(361.1,+IBEOB,0))
179 . S IB=$G(^DGCR(399,IBIFN,"I"_IBCOB))
180 . ;
181 . I IB'="",$P(IB,U,17)'=IBNEW D
182 .. ; Update the claim data only
183 .. S $P(IBBULL,U,3)=$P(IB,U,17) ; save old value
184 .. S $P(IB,U,17)=IBNEW
185 .. S DIE="^DGCR(399,",DA=IBIFN,DR="30"_IBCOB_"////"_IB
186 .. D:DA ^DIE
187 .. S IBCHGED=1
188 . S IBDR=$G(IBDR)_"6.01////"_$P(IB0,U,3)_","_$P(IB0,U,4)_" "_$P(IB0,U,5)_";"
189 ;
190 Q $G(IBCHGED)
191 ;
192UPDID(IBEOB,IB0,IBBULL,IBDR) ; Update id # on claim and policy if it comes back
193 ; changed
194 ; IBEOB = the internal entry # of the entry in file 361.1
195 ; IB0 = the raw data returned from the 835 flat file
196 ; IBBULL = holds result of id change check in piece 2 - if id changed,
197 ; second '^' piece = 1,4th '^' piece is the old insured's id
198 ; IBDR = returned as the updated 'DR' string with the id changed fields
199 ; to use to update the EOB file (361.1) - pass by reference
200 ;
201 N IBCHGED,IBNEW,IBCOB,IB,DIE,DR,DA,X,Y
202 I $P(IB0,U,8) D
203 . S IBNEW=$P(IB0,U,6),$P(IBBULL,U,2)=1
204 . S IBIFN=+$G(^IBM(361.1,+IBEOB,0))
205 . S IBCOB=+$P($G(^IBM(361.1,IBEOB,0)),U,15)
206 . S IB=$G(^DGCR(399,IBIFN,"I"_IBCOB))
207 . ;
208 . I IB'="",$P(IB,U,2)'=IBNEW D
209 .. ; Update the claim
210 .. S $P(IBBULL,U,4)=$P(IB,U,2) ; save old value
211 .. S $P(IB,U,2)=IBNEW
212 .. S DIE="^DGCR(399,",DA=IBIFN,DR="30"_IBCOB_"////"_IB D ^DIE
213 .. ;
214 .. ; Update the policy
215 .. S DA(1)=$P($G(^DGCR(399,IBIFN,0)),U,2),DA=$P($G(^("M")),U,(11+IBCOB)),DR="1////"_IBNEW,DIE="^DPT("_DA(1)_",.312,"
216 .. I DA(1),DA D ^DIE
217 .. S IBCHGED=1
218 . S IBDR=$G(IBDR)_"6.02////"_$P(IB0,U,6)_";"
219 ;
220 Q $G(IBCHGED)
221 ;
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