IBCEST ;ALB/TMP - 837 EDI STATUS MESSAGE PROCESSING ;17-APR-96 ;;2.0;INTEGRATED BILLING;**137,189,197,135,283,320**;21-MAR-94 ; IA 4042 for call to AUDITX^PRCAUDT Q ; UPD361(IBTDA) ; Update IB BILL STATUS MESSAGES file ; IBTDA = ien of return message in file 364.2 ; N IB,IB0,IBSEQ,IB00,IBBILL,IBBTCH,IBMNUM ; I '$$LOCK^IBCEM(IBTDA) G UPDQ ;Lock message in file 364.2 ; S IB0=$G(^IBA(364.2,IBTDA,0)) S IBMNUM=$P(IB0,U) ; Message number S IB00=$G(^IBA(364,+$P(IB0,U,5),0)) ; Transmit bill entry S IBBILL=+IB00 ; Actual bill ien in file 399 S IBBTCH=$P(IB0,U,4) ; Batch # ; ; Auto-audit bills based on status code on '10' record of status msg ; flat file I IBBILL,$P($T(PRCAUDT+1^PRCAUDT),"**",2)[",173" D . N Z,Z0,Z1,OK . Q:+$$STA^PRCAFN(IBBILL)'=104 . S (Z,OK)=0 . F S Z=$O(^IBA(364.2,IBTDA,2,Z)) Q:'Z S Z0=$P($G(^(Z,0)),"##RAW DATA: ",2) I +Z0=10 S Z0=$P(Z0,U,5) D Q:OK .. ; Strip leading spaces .. F S Z0=$P(Z0," ",2,99) Q:$E(Z0)'=" " .. Q:Z0="" .. I "A3^AC^A7^A8^AA^2P^10^11"[Z0,$P($G(^DGCR(399.3,+$P($G(^DGCR(399,IBBILL,0)),U,7),0)),U,11) D AUDITX^PRCAUDT(IBBILL) S OK=1 ; IA 4042 ; I $S(IBMNUM="":1,1:'IBBILL&(IBBTCH="")) D DELMSG^IBCESRV2(IBTDA) G UPDQ ; ; Individual bill I IBBILL D G UPDQ . N IBA1,IBMSG0,IBPID . S IBPID="",IBA1=0 . F S IBA1=$O(^IBA(364.2,IBTDA,2,IBA1)) Q:'IBA1 S IBMSG0=$P($G(^(IBA1,0)),"##RAW DATA: ",2) I +IBMSG0=277,$P(IBMSG0,U,5)="N" S IBPID=$P(IBMSG0,U,11) Q . S IBSEQ=$P(IB00,U,8) S:IBSEQ="" IBSEQ="P" . D STORE(IB0,IBBTCH,IBMNUM,IBTDA,IBBILL,IBSEQ,IBPID,1) ; ; Batch - update each bill separately S IBBILL="" F S IBBILL=$O(^IBA(364,"ABABI",+IBBTCH,IBBILL)) Q:'IBBILL D . Q:$D(^TMP("IBCONF",$J,IBBILL)) ;Bill was rejected . S IB=$O(^IBA(364,"ABABI",+IBBTCH,IBBILL,0)) Q:'IB . S IBSEQ=$P($G(^IBA(364,IB,0)),U,8) S:IBSEQ="" IBSEQ="P" . D STORE(IB0,IBBTCH,IBMNUM,IBTDA,IBBILL,IBSEQ,"",0) ; Q ; STORE(IB0,IBBTCH,IBMNUM,IBTDA,IBBILL,IBSEQ,IBPID,IB1) ; ; ; IB0 = 0-node of message in file 364.2 ; IBBTCH = ien of batch in file 364.1 ; IBMNUM = actual message number ; IBTDA = ien of message in file 364.2 ; IBBILL = ien of bill in 399 ; IBSEQ = P/S/T/ for COB sequence related to message ; IBPID = the payer id returned from clearinghouse for the claim ; IB1 = flag that says if the message was for a single bill or a batch. ; Batch statuses have an additional standard text entry. ; 1 = single bill 0 = batch ; N DA,DIK,DIE,DIC,X,Y,DR,DO,DD,DLAYGO,Z,Z0,Z1,IBT,IBDUP,IBFLDS,IBY,IBAUTO ; S X=IBBILL,IBDUP=0 ; I $D(^IBM(361,"AC",IBMNUM\1)) D ; Message already there for bill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tuff fields into existing entry . ; (may be needed for reprocessing of aborted updates) . S DIE="^IBM(361,",DA=IBDUP,DR=IBFLDS_";1///@" . D ^DIE . I $D(Y) S IBY=-1 Q ;Update not successful . S IBY=IBDUP ; K IBT I 'IBDUP D ; Create new entry and stuff fields . S DIC(0)="L",DIC="^IBM(361,",DLAYGO=361 . S DIC("DR")=IBFLDS . D FILE^DICN . K DO,DD,DLAYGO,DIC . S IBY=+Y . Q:IBY'>0 . ; . ; IB*2*320 - Check for duplicate status message . NEW IBNEW,IBOLD,PCE,Z,DIK,DA . S IBNEW="" . F PCE=3,4,5,7,8,11,15 S IBNEW=IBNEW_$P($G(^IBM(361,IBY,0)),U,PCE)_U . S Z=0 . F S Z=$O(^IBM(361,"B",IBBILL,Z)) Q:'Z I Z'=IBY D Q:IBY'>0 .. S IBOLD="" .. F PCE=3,4,5,7,8,11,15 S IBOLD=IBOLD_$P($G(^IBM(361,Z,0)),U,PCE)_U .. I IBNEW'=IBOLD Q ; no duplicate so get the next one .. S DIK="^IBM(361,",DA=IBY,IBY=-1 D ^DIK D DELMSG^IBCESRV2(IBTDA) .. Q . Q ; I IBY>0 D ;Move text over . K IBT . ; . D BLDMSG(IB1,IBTDA,.IBT,.IBAUTO) . ; . ; IB*2*320 - esg - 2Q messages will be filed as informational . I $P($G(^IBM(361,+IBY,0)),U,3)="R",$G(IBT(1))["2Q CLAIM REJECTED BY CLEARINGHOUSE" D .. S IBAUTO=1 .. S DIE=361,DA=+IBY,DR=".03////I" D ^DIE .. Q . ; . ; if info msg, ck for no review needed based on first line of text . I $G(IBAUTO),$P($G(^IBM(361,+IBY,0)),U,3)="I" D .. S DIE="^IBM(361,",DR=".09////2;.14////1;.1////F",DA=+IBY D ^DIE .. I IB1,$P($G(^IBM(361,+IBY,0)),U,11),$$PRINTUPD^IBCEU0($G(IBT(1)),$P($G(^IBM(361,+IBY,0)),U,11)) . ; . D WP^DIE(361,+IBY_",",1,"A","IBT") ; file message text . ; . ; Delete message after it successfully updates the database. . D DELMSG^IBCESRV2(IBTDA) . Q ; UPDQ L -^IBA(364.2,IBTDA,0) Q ; BLDMSG(IB1,IBTDA,IBT,IBAUTO) ; Builds message text ; IB1 = flag for batch message ; IBTDA = ien of entry in file 364.2 ; IBT = array returned with message text ; IBAUTO = if passed by reference, returns 1 if text indicates review ; not needed N IBDATA,IBCK,IBZ,IBZ0,IBZ1,Z S (IBZ,IBZ0,IBDATA,IBAUTO,IBCK)=0 I 'IB1 S IBT(1)="Status message received for batch "_$P($G(^IBA(364.1,IBBTCH,0)),U)_" dated "_$$FMTE^XLFDT($P($G(^IBA(364.2,IBTDA,0)),U,10),2),IBZ0=1 ; Don't move the raw data over, just move the text of the message F S IBZ=$O(^IBA(364.2,IBTDA,2,IBZ)) Q:'IBZ S IBZ1=$G(^(IBZ,0)) S IBDATA=($E(IBZ1,1,2)="##") Q:IBDATA S IBZ0=IBZ0+1,IBT(IBZ0)=IBZ1 I 'IBCK S Z=$$CKREVU^IBCEM4(IBZ1,,,.IBCK),IBAUTO=$S(IBCK:0,Z:1,1:IBAUTO) ; ; Convert Message Lines in IBT to be no longer than 70 chars D MSGLNSZ(.IBT) Q ; UPDINS(IBPID,IBINS,IBIFN) ; Update the insurance id or the bill printed at ; the EDI contractor's print shop and mailed to the ins co. ; IBPID = the id returned from the EDI contractor for the ins co ; ("TYPE") = P if professional id or I if institutional id ; IBINS = the ien of the insurance co it was sent to (file 36) ; IBIFN = the ien of the claim (file 399) ; N IBID,IBIDFLD,IBPRT,IBLOOK,DA,DR,DIE,X,Y,Z ; Q:'$G(IBINS)!($G(IBPID)="") ; ; Strip spaces off the end of data S IBLOOK="" I $L(IBPID) F Z=$L(IBPID):-1:1 I $E(IBPID,Z)'=" " S IBLOOK=$E(IBPID,1,Z) Q ; S IBPRT=($E(IBLOOK,2,5)="PRNT") I IBPRT D ; Set printed via EDI field on bill . S DA=IBIFN,DIE="^DGCR(399,",DR="26////1" D ^DIE ; S IBLOOK=$E($S('IBPRT:$P(IBLOOK,"PAYID=",2),1:""),1,5) Q:IBLOOK=""!($E(IBLOOK,2,5)="PRNT") S IBIDFLD="3.0"_$S($G(IBPID("TYPE"))="I":4,1:2) S IBID=$P($G(^DIC(36,+IBINS,3)),U,IBIDFLD*100#100) Q:IBID=IBLOOK I IBID="" D G UPDINSQ ; Update insurance co electronic id # if blank . S DIE="^DIC(36,",DR=IBIDFLD_"////"_IBLOOK,DA=IBINS D ^DIE I IBID'="",IBLOOK'="" D ; Bulletin that the id on file and id returned . ; are different . N XMTO,XMDUZ,XMBODY,IBXM,XMSUBJ,XMZ . S XMTO("I:G.IB EDI")="" . S XMDUZ="",XMBODY="IBXM",XMSUBJ="PAYER ID RETURNED IS DIFFERENT THAN PAYER ID ON FILE" . S IBXM(1)="BILL # : "_$P($G(^DGCR(399,IBIFN,0)),U) . S IBXM(2)="PAYER : "_$P($G(^DIC(36,+IBINS,0)),U) . S IBXM(3)="BILL TYPE : "_$S($G(IBPID("TYPE"))="I":"INSTITUT",1:"PROFESS")_"IONAL" . S IBXM(4)="ID ON FILE : "_IBID . S IBXM(5)="ID RETURNED: "_IBLOOK . S IBXM(6)=" ",IBXM(7)=" Please determine which id number is correct and correct the id in the",IBXM(8)="insurance file for this payer, if needed" . D SENDMSG^XMXAPI(XMDUZ,XMSUBJ,XMBODY,.XMTO,,.XMZ) ; UPDINSQ Q ; MSGLNSZ(MSG) ; Change Input Message Lines to be no more than 70 characters long each ; ; Input/Output: MSG - array of Input Message Lines; this is also the Output Message ; which is an array of Converted Message Lines (with lines no more than 70 chars each) ; N LN,XARY,XARYLN,CNT,OUTMSG,TMPMSG,LDNGSP S LN="",CNT=0 F S LN=$O(MSG(LN)) Q:LN="" D ; . ; . ; Find any leading spaces in original message line, . ; to be used if line got split below . S TMPMSG=$$TRIM^XLFSTR(MSG(LN),"L"," ") ;Trim Leading Spaces . S LDNGSP=$P(MSG(LN),TMPMSG,1) ;get leading spaces if any . ; . ; Converts a single line to multiple lines with a maximum width of 70 each . ; If line is 70 chars or less, this call returns the exact line . K XARY D FSTRNG^IBJU1(MSG(LN),70,.XARY) . ; . ; Scan lines and merge them into the final output array (OUTMSG) . ; On lines 2 and higher, add Leading Spaces found above, if any. . S XARYLN="" . F S XARYLN=$O(XARY(XARYLN)) Q:XARYLN="" S CNT=CNT+1,OUTMSG(CNT)=$S(XARYLN=1:XARY(XARYLN),1:LDNGSP_XARY(XARYLN)) ; ; Move the final Message Lines (OUTMSG) into MSG array to be returned K MSG M MSG=OUTMSG Q ;MSGLNSZ ;