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

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

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1IBCEST ;ALB/TMP - 837 EDI STATUS MESSAGE PROCESSING ;17-APR-96
2 ;;2.0;INTEGRATED BILLING;**137,189,197,135,283,320**;21-MAR-94
3 ; IA 4042 for call to AUDITX^PRCAUDT
4 Q
5 ;
6UPD361(IBTDA) ; Update IB BILL STATUS MESSAGES file
7 ; IBTDA = ien of return message in file 364.2
8 ;
9 N IB,IB0,IBSEQ,IB00,IBBILL,IBBTCH,IBMNUM
10 ;
11 I '$$LOCK^IBCEM(IBTDA) G UPDQ ;Lock message in file 364.2
12 ;
13 S IB0=$G(^IBA(364.2,IBTDA,0))
14 S IBMNUM=$P(IB0,U) ; Message number
15 S IB00=$G(^IBA(364,+$P(IB0,U,5),0)) ; Transmit bill entry
16 S IBBILL=+IB00 ; Actual bill ien in file 399
17 S IBBTCH=$P(IB0,U,4) ; Batch #
18 ;
19 ; Auto-audit bills based on status code on '10' record of status msg
20 ; flat file
21 I IBBILL,$P($T(PRCAUDT+1^PRCAUDT),"**",2)[",173" D
22 . N Z,Z0,Z1,OK
23 . Q:+$$STA^PRCAFN(IBBILL)'=104
24 . S (Z,OK)=0
25 . 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
26 .. ; Strip leading spaces
27 .. F S Z0=$P(Z0," ",2,99) Q:$E(Z0)'=" "
28 .. Q:Z0=""
29 .. 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
30 ;
31 I $S(IBMNUM="":1,1:'IBBILL&(IBBTCH="")) D DELMSG^IBCESRV2(IBTDA) G UPDQ
32 ;
33 ; Individual bill
34 I IBBILL D G UPDQ
35 . N IBA1,IBMSG0,IBPID
36 . S IBPID="",IBA1=0
37 . F S IBA1=$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
38 . S IBSEQ=$P(IB00,U,8) S:IBSEQ="" IBSEQ="P"
39 . D STORE(IB0,IBBTCH,IBMNUM,IBTDA,IBBILL,IBSEQ,IBPID,1)
40 ;
41 ; Batch - update each bill separately
42 S IBBILL=""
43 F S IBBILL=$O(^IBA(364,"ABABI",+IBBTCH,IBBILL)) Q:'IBBILL D
44 . Q:$D(^TMP("IBCONF",$J,IBBILL)) ;Bill was rejected
45 . S IB=$O(^IBA(364,"ABABI",+IBBTCH,IBBILL,0)) Q:'IB
46 . S IBSEQ=$P($G(^IBA(364,IB,0)),U,8) S:IBSEQ="" IBSEQ="P"
47 . D STORE(IB0,IBBTCH,IBMNUM,IBTDA,IBBILL,IBSEQ,"",0)
48 ;
49 Q
50 ;
51STORE(IB0,IBBTCH,IBMNUM,IBTDA,IBBILL,IBSEQ,IBPID,IB1) ;
52 ;
53 ; IB0 = 0-node of message in file 364.2
54 ; IBBTCH = ien of batch in file 364.1
55 ; IBMNUM = actual message number
56 ; IBTDA = ien of message in file 364.2
57 ; IBBILL = ien of bill in 399
58 ; IBSEQ = P/S/T/ for COB sequence related to message
59 ; IBPID = the payer id returned from clearinghouse for the claim
60 ; IB1 = flag that says if the message was for a single bill or a batch.
61 ; Batch statuses have an additional standard text entry.
62 ; 1 = single bill 0 = batch
63 ;
64 N DA,DIK,DIE,DIC,X,Y,DR,DO,DD,DLAYGO,Z,Z0,Z1,IBT,IBDUP,IBFLDS,IBY,IBAUTO
65 ;
66 S X=IBBILL,IBDUP=0
67 ;
68 I $D(^IBM(361,"AC",IBMNUM\1)) D ; Message already there for bill
69 . S Z=0 F S Z=$O(^IBM(361,"AC",IBMNUM\1,Z)) Q:'Z I +$G(^IBM(361,Z,0))=IBBILL S IBDUP=Z Q
70 ;
71 S IBFLDS=".02////"_$P(IB0,U,3)
72 S IBFLDS=IBFLDS_";.03////"_$S($$EXTERNAL^DILFD(364.2,.02,"U",$P(IB0,U,2))["REJ":"R",1:"I")_";.05////"_IBBTCH_";.06////"_IBMNUM_";.04////"_+$P(IB0,U,8)_";.07////"_IBSEQ_$S($P(IB0,U,5):";.11////"_$P(IB0,U,5),1:"")
73 S IBFLDS=IBFLDS_";.12////"_$P(IB0,U,10)_";.09////0"
74 S IBFLDS=IBFLDS_";.15////"_$$CHKSUM^IBCEST1("^IBA(364.2,"_IBTDA_",2)")
75 I IBPID'="" D
76 . S IBPID("TYPE")=$S($$FT^IBCEF(IBBILL)=2:"P",1:"I")
77 . D UPDINS(.IBPID,$$POLICY^IBCEF(IBBILL,1,$TR(IBSEQ,"PST","123")),IBBILL)
78 ;
79 I IBDUP D I $D(Y) G UPDQ
80 . ; Stuff fields into existing entry
81 . ; (may be needed for reprocessing of aborted updates)
82 . S DIE="^IBM(361,",DA=IBDUP,DR=IBFLDS_";1///@"
83 . D ^DIE
84 . I $D(Y) S IBY=-1 Q ;Update not successful
85 . S IBY=IBDUP
86 ;
87 K IBT
88 I 'IBDUP D ; Create new entry and stuff fields
89 . S DIC(0)="L",DIC="^IBM(361,",DLAYGO=361
90 . S DIC("DR")=IBFLDS
91 . D FILE^DICN
92 . K DO,DD,DLAYGO,DIC
93 . S IBY=+Y
94 . Q:IBY'>0
95 . ;
96 . ; IB*2*320 - Check for duplicate status message
97 . NEW IBNEW,IBOLD,PCE,Z,DIK,DA
98 . S IBNEW=""
99 . F PCE=3,4,5,7,8,11,15 S IBNEW=IBNEW_$P($G(^IBM(361,IBY,0)),U,PCE)_U
100 . S Z=0
101 . F S Z=$O(^IBM(361,"B",IBBILL,Z)) Q:'Z I Z'=IBY D Q:IBY'>0
102 .. S IBOLD=""
103 .. F PCE=3,4,5,7,8,11,15 S IBOLD=IBOLD_$P($G(^IBM(361,Z,0)),U,PCE)_U
104 .. I IBNEW'=IBOLD Q ; no duplicate so get the next one
105 .. S DIK="^IBM(361,",DA=IBY,IBY=-1 D ^DIK D DELMSG^IBCESRV2(IBTDA)
106 .. Q
107 . Q
108 ;
109 I IBY>0 D ;Move text over
110 . K IBT
111 . ;
112 . D BLDMSG(IB1,IBTDA,.IBT,.IBAUTO)
113 . ;
114 . ; IB*2*320 - esg - 2Q messages will be filed as informational
115 . I $P($G(^IBM(361,+IBY,0)),U,3)="R",$G(IBT(1))["2Q CLAIM REJECTED BY CLEARINGHOUSE" D
116 .. S IBAUTO=1
117 .. S DIE=361,DA=+IBY,DR=".03////I" D ^DIE
118 .. Q
119 . ;
120 . ; if info msg, ck for no review needed based on first line of text
121 . I $G(IBAUTO),$P($G(^IBM(361,+IBY,0)),U,3)="I" D
122 .. S DIE="^IBM(361,",DR=".09////2;.14////1;.1////F",DA=+IBY D ^DIE
123 .. I IB1,$P($G(^IBM(361,+IBY,0)),U,11),$$PRINTUPD^IBCEU0($G(IBT(1)),$P($G(^IBM(361,+IBY,0)),U,11))
124 . ;
125 . D WP^DIE(361,+IBY_",",1,"A","IBT") ; file message text
126 . ;
127 . ; Delete message after it successfully updates the database.
128 . D DELMSG^IBCESRV2(IBTDA)
129 . Q
130 ;
131UPDQ L -^IBA(364.2,IBTDA,0)
132 Q
133 ;
134BLDMSG(IB1,IBTDA,IBT,IBAUTO) ; Builds message text
135 ; IB1 = flag for batch message
136 ; IBTDA = ien of entry in file 364.2
137 ; IBT = array returned with message text
138 ; IBAUTO = if passed by reference, returns 1 if text indicates review
139 ; not needed
140 N IBDATA,IBCK,IBZ,IBZ0,IBZ1,Z
141 S (IBZ,IBZ0,IBDATA,IBAUTO,IBCK)=0
142 I 'IB1 S IBT(1)="Status message received for batch "_$P($G(^IBA(364.1,IBBTCH,0)),U)_" dated "_$$FMTE^XLFDT($P($G(^IBA(364.2,IBTDA,0)),U,10),2),IBZ0=1
143 ; Don't move the raw data over, just move the text of the message
144 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)
145 ;
146 ; Convert Message Lines in IBT to be no longer than 70 chars
147 D MSGLNSZ(.IBT)
148 Q
149 ;
150UPDINS(IBPID,IBINS,IBIFN) ; Update the insurance id or the bill printed at
151 ; the EDI contractor's print shop and mailed to the ins co.
152 ; IBPID = the id returned from the EDI contractor for the ins co
153 ; ("TYPE") = P if professional id or I if institutional id
154 ; IBINS = the ien of the insurance co it was sent to (file 36)
155 ; IBIFN = the ien of the claim (file 399)
156 ;
157 N IBID,IBIDFLD,IBPRT,IBLOOK,DA,DR,DIE,X,Y,Z
158 ;
159 Q:'$G(IBINS)!($G(IBPID)="")
160 ;
161 ; Strip spaces off the end of data
162 S IBLOOK=""
163 I $L(IBPID) F Z=$L(IBPID):-1:1 I $E(IBPID,Z)'=" " S IBLOOK=$E(IBPID,1,Z) Q
164 ;
165 S IBPRT=($E(IBLOOK,2,5)="PRNT")
166 I IBPRT D ; Set printed via EDI field on bill
167 . S DA=IBIFN,DIE="^DGCR(399,",DR="26////1" D ^DIE
168 ;
169 S IBLOOK=$E($S('IBPRT:$P(IBLOOK,"PAYID=",2),1:""),1,5)
170 Q:IBLOOK=""!($E(IBLOOK,2,5)="PRNT")
171 S IBIDFLD="3.0"_$S($G(IBPID("TYPE"))="I":4,1:2)
172 S IBID=$P($G(^DIC(36,+IBINS,3)),U,IBIDFLD*100#100)
173 Q:IBID=IBLOOK
174 I IBID="" D G UPDINSQ ; Update insurance co electronic id # if blank
175 . S DIE="^DIC(36,",DR=IBIDFLD_"////"_IBLOOK,DA=IBINS D ^DIE
176 I IBID'="",IBLOOK'="" D ; Bulletin that the id on file and id returned
177 . ; are different
178 . N XMTO,XMDUZ,XMBODY,IBXM,XMSUBJ,XMZ
179 . S XMTO("I:G.IB EDI")=""
180 . S XMDUZ="",XMBODY="IBXM",XMSUBJ="PAYER ID RETURNED IS DIFFERENT THAN PAYER ID ON FILE"
181 . S IBXM(1)="BILL # : "_$P($G(^DGCR(399,IBIFN,0)),U)
182 . S IBXM(2)="PAYER : "_$P($G(^DIC(36,+IBINS,0)),U)
183 . S IBXM(3)="BILL TYPE : "_$S($G(IBPID("TYPE"))="I":"INSTITUT",1:"PROFESS")_"IONAL"
184 . S IBXM(4)="ID ON FILE : "_IBID
185 . S IBXM(5)="ID RETURNED: "_IBLOOK
186 . 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"
187 . D SENDMSG^XMXAPI(XMDUZ,XMSUBJ,XMBODY,.XMTO,,.XMZ)
188 ;
189UPDINSQ Q
190 ;
191MSGLNSZ(MSG) ; Change Input Message Lines to be no more than 70 characters long each
192 ;
193 ; Input/Output: MSG - array of Input Message Lines; this is also the Output Message
194 ; which is an array of Converted Message Lines (with lines no more than 70 chars each)
195 ;
196 N LN,XARY,XARYLN,CNT,OUTMSG,TMPMSG,LDNGSP
197 S LN="",CNT=0
198 F S LN=$O(MSG(LN)) Q:LN="" D ;
199 . ;
200 . ; Find any leading spaces in original message line,
201 . ; to be used if line got split below
202 . S TMPMSG=$$TRIM^XLFSTR(MSG(LN),"L"," ") ;Trim Leading Spaces
203 . S LDNGSP=$P(MSG(LN),TMPMSG,1) ;get leading spaces if any
204 . ;
205 . ; Converts a single line to multiple lines with a maximum width of 70 each
206 . ; If line is 70 chars or less, this call returns the exact line
207 . K XARY D FSTRNG^IBJU1(MSG(LN),70,.XARY)
208 . ;
209 . ; Scan lines and merge them into the final output array (OUTMSG)
210 . ; On lines 2 and higher, add Leading Spaces found above, if any.
211 . S XARYLN=""
212 . F S XARYLN=$O(XARY(XARYLN)) Q:XARYLN="" S CNT=CNT+1,OUTMSG(CNT)=$S(XARYLN=1:XARY(XARYLN),1:LDNGSP_XARY(XARYLN))
213 ;
214 ; Move the final Message Lines (OUTMSG) into MSG array to be returned
215 K MSG M MSG=OUTMSG
216 Q ;MSGLNSZ
217 ;
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