IBCEU ;ALB/TMP - EDI UTILITIES ;02-OCT-96 ;;2.0;INTEGRATED BILLING;**51,137,207,232,349**;21-MAR-94;Build 46 ;;Per VHA Directive 2004-038, this routine should not be modified. ; DBIA SUPPORTED REF: GET^XUA4A72 = 1625 ; DBIA SUPPORTED REF: $$ESBLOCK^XUSESIG1 = 1557 ; TESTPT(DFN) ; Determine if pt is test pt ; Returns 1 if a test pt, 0 if not Q $E($P($G(^DPT(+DFN,0)),U,9),1,5)="00000" ; MAINPRV(IBIFN) ; Returns name^id^ien^type code of 'main' prov on bill IBIFN N IBPRV,IBCOB,IBQ,Z D GETPRV(IBIFN,"3,4",.IBPRV) S IBQ="",IBCOB=$$COBN^IBCEF(IBIFN) F Z=3,4 I $G(IBPRV(Z,1))'="" D Q . S IBQ=IBPRV(Z,1),$P(IBQ,U,4)=Z . I $G(IBPRV(Z,1,IBCOB))'="" S $P(IBQ,U,2)=IBPRV(Z,1,IBCOB) Q IBQ ; PRVOK(VAL,IBIFN) ; Check bill form & prov function agree ; VAL = internal value of prov function ; ; OTHER(9) valid on institutional (UB-04) bills ; REFERRING(1) valid only on professional (1500) claims ; Valid functions by bill types ; OUTPATIENT/UB-04: ATTENDING(4), OPERATING(2)-BILL TYPE 83X ; AND A PRIN. PROC EXISTS ; INPATIENT/UB-04 : ATTENDING(4), OPERATING(2)-BILL TYPE 11X ; AND A PRIN. PROC EXISTS ; OUTPATIENT/CMS-1500 : RENDERING(3), SUPERVISING(5) ; INPATIENT/CMS-1500 : RENDERING(3), SUPERVISING(5) ; N OK,IBUB S VAL=$$UP^XLFSTR(VAL) S OK=$S(VAL'="":1,1:0) G:'OK!'$G(IBIFN) PRVQ ; S IBUB=($$FT^IBCEF(IBIFN)=3) ; 1 if UB-04 ; 0 if CMS-1500 ; I VAL=1 S:IBUB OK=0 G PRVQ ; I "249"[VAL,'IBUB S OK=0 G PRVQ I $S(VAL=3:1,1:VAL=5),IBUB S OK=0 G PRVQ ; PRVQ Q OK ; PRVOK1(VAL,IBIFN) ; Check for both attending and rendering on bill N OK S OK=1 I $S("34"'[VAL:0,1:$D(^DGCR(399,IBIFN,"PRV","B",$S(VAL=3:4,1:3)))) D EN^DDIOL($S(VAL=3:"ATTENDING",1:"RENDERING")_" ALREADY EXISTS - CAN'T HAVE BOTH ON ONE BILL") S OK=0 Q OK ; SPEC(IBPRV,IBDT) ; Returns spec code for vp ien IBPRV from file 355.9 ; (for new person entries, as of date in IBDT) ; DBIA 1625 N IBSPEC S:'$G(IBDT) IBDT=DT I IBPRV'["IBA(355.93" S IBSPEC=$S(IBPRV:$P($$GET^XUA4A72(+IBPRV,IBDT),U,8),1:"") ; VA I IBPRV["IBA(355.93" S IBSPEC=$P($G(^IBA(355.93,+IBPRV,0)),U,4) ; Non-VA Q IBSPEC ; CRED(IBPRV,IBIFN,IBPIEN,IBTYP) ; Returns prov credentials ; IBPRV = vp of provider for file 200 or 355.93 ; IBIFN = bill ien in file 399 (optional) ; IBPIEN = prov ien - file 399.0222 (optional) ; IBTYP = the prov type ; N IBCRED S IBCRED="" I $G(IBIFN),'$D(^DGCR(399,IBIFN,"PRV",0)) G CREDQ I $G(IBIFN),($G(IBPIEN)!$G(IBTYP)) D . I '$G(IBPIEN) S IBPIEN=+$O(^DGCR(399,IBIFN,"PRV","B",IBTYP,0)) . S IBCRED=$P($G(^DGCR(399,IBIFN,"PRV",IBPIEN,0)),U,3) I $G(IBPRV),IBCRED="" D . I IBPRV'["IBA(355.93" S IBCRED=$P($$ESBLOCK^XUSESIG1(+IBPRV),U,2) . I IBPRV["IBA(355.93" S IBCRED=$P($G(^IBA(355.93,+IBPRV,0)),U,3) CREDQ Q IBCRED ; GETPRV(IBIFN,IBTYP,IBPRV) ; Returns prov(s) of type(s) IBTYP for ; bill ien IBIFN. ; IBTYP = prov types needed, separated by ',' or ALL ; ; OUTPUT: ; IBPRV array: IBPRV(type)= 1 if prov is from old prov flds ; IBPRV(type,ct)=name^current COB id^vp provider ien^cred ; IBPRV(type,ct,seq)=COB seq specific id ; IBPRV(type)=default nm^def id ; IBPRV(type,"NOTOPT")= defined if a required prov type ; N IB,IBCT,IBD,IBY,IBZ,IBMRAND,IBID,IBWNR,IBPNM,Z ;,IBZFID ;S IBZFID="" D F^IBCEF("N-CURRENT INS POLICY TYPE","IBZ",,IBIFN) ;I IBZ="CI" D F^IBCEF("N-FEDERAL TAX ID","IBZFID",,IBIFN) S IBZFID=$TR(IBZFID,"-") S IBPRV=U_$G(IBZ),IBY=0 S IBMRAND=$$MCRONBIL^IBEFUNC(IBIFN) I IBMRAND D . F Z=1:1:3,5,6,7,8,9 S:Z=3&($$FT^IBCEF(IBIFN)=3) Z=4 S IBPRV(Z)=$S(Z=3!(Z=4):"DEPT VETERANS AFFAIRS",1:"")_"^VAD000" . I '$$INPAT^IBCEF(IBIFN,1),$$FT^IBCEF(IBIFN)=3 S IBPRV(4,1)="^SLF000" ; I '$D(^DGCR(399,+IBIFN,"PRV",0)) D G GETQ . N IBALL . S IBALL=(IBTYP="ALL") . I IBTYP[4!IBALL S:$P($G(^DGCR(399,+IBIFN,"U1")),U,13)'="" IBPRV(4,1)=$P(^("U1"),U,13),IBPRV(4)=1 Q:IBTYP=4 . I IBTYP[3!IBALL S:$P($G(^DGCR(399,+IBIFN,"UF2")),U)'="" IBPRV(3,1)=$P(^("UF2"),U),IBPRV(3)=1 Q:IBTYP=3 . I IBTYP[9!IBALL S:$P($G(^DGCR(399,+IBIFN,"U1")),U,14)'="" IBPRV(9,1)=$P(^("U1"),U,14),IBPRV(9)=1 ; S IBID=4+$$COBN^IBCEF(IBIFN),IBWNR=$$WNRBILL^IBEFUNC(IBIFN) F IBZ=1:1:$S(IBTYP="ALL":99,1:$L(IBTYP,",")) S (IBCT,IB)=0,IBY=$S(IBTYP'="ALL":$P(IBTYP,",",IBZ),1:$O(^DGCR(399,+IBIFN,"PRV","B",IBY))) Q:IBY="" F S IB=$O(^DGCR(399,+IBIFN,"PRV","B",IBY,IB)) Q:'IB D . S IBCT=IBCT+1 . S IBD=$G(^DGCR(399,+IBIFN,"PRV",IB,0)) . Q:'$P(IBD,U,2) . S IBPNM=$$EXPAND^IBTRE(399.0222,.02,$P(IBD,U,2)) . I IBWNR Q:'$D(IBPRV(IBY)) S $P(IBD,U,IBID)=$P(IBPRV(IBY),U,2) . S IBPRV(IBY,IBCT)=IBPNM_U_$S($P(IBD,U,IBID)'="":$P(IBD,U,IBID),$P($G(IBPRV(IBY)),U,2)'="":$P(IBPRV(IBY),U,2),1:$P($$DEFID^IBCEF74(IBIFN,IB),U,IBID-4))_U_$P(IBD,U,2) . S $P(IBPRV(IBY,IBCT),U,4)=$$CRED($P(IBPRV(IBY,IBCT),U,3),IBIFN,$S($P(IBD,U,3)'=""!'$P(IBPRV(IBY,IBCT),U,3):IB,1:"")) . F Z=1:1:3 D .. ;I IBZFID'="",'$$INPAT^IBCEF(IBIFN,1),$P(IBPRV(IBY,IBCT),U,2)="SLF000" S IBZFID="" .. ;I $S(Z=1:1,1:$D(^DGCR(399,IBIFN,"I"_Z))) S IBPRV(IBY,IBCT,Z)=$S($G(IBZFID)'="":IBZFID,$P(IBD,U,Z+4)'="":$P(IBD,U,Z+4),1:"") .. I $S(Z=1:1,1:$D(^DGCR(399,IBIFN,"I"_Z))) S IBPRV(IBY,IBCT,Z)=$S($P(IBD,U,Z+4)'="":$P(IBD,U,Z+4),1:$P($$DEFID^IBCEF74(IBIFN,IB),U,Z)) GETQ D NEEDPRV(IBIFN,IBTYP,.IBPRV) Q ; NEEDPRV(IBIFN,IBTYP,IBPRV) ; Check for needed prov ; If needed, not entered, insert defaults for MCR only N IB0,IBINP,IBFT,IBMRAND,IBTOB S IB0=$G(^DGCR(399,+IBIFN,0)) S IBFT=($$FT^IBCEF(IBIFN)=3),IBINP=$$INPAT^IBCEF(IBIFN,1),IBTOB=$$TOB^IBCBB(IB0) ; Only allow defaults for MCR S IBMRAND=$$WNRBILL^IBEFUNC(IBIFN) ;$$MCRONBIL^IBEFUNC(IBIFN) ; I IBTYP="ALL"!((IBTYP_",")["2,") D:IBFT . ; only for bill type inpt - 11X, outpt - 83X . Q:$S(IBINP:$E(IBTOB,1,2)'="11",1:$E(IBTOB,1,2)'="83") . ; UB-04 bill includes HCPCS procs - operating phys required . N Z . S Z=0 F S Z=$O(^DGCR(399,IBIFN,"CP",Z)) Q:'Z I $P($G(^(Z,0)),U)["ICP" D Q .. S IBPRV(2,"NOTOPT")=1 .. Q:'IBMRAND .. I '$O(IBPRV(2,0)) S IBPRV(2,"REQ")=1,IBPRV(2,1)=$G(IBPRV(2)) ; I IBTYP="ALL"!((IBTYP_",")["3,") D:'IBFT . ; if a CMS-1500 bill, rendering is required . S IBPRV(3,"NOTOPT")=1 . Q:'IBMRAND . I '$O(IBPRV(3,0)) S IBPRV(3,1)=$G(IBPRV(3)),IBPRV(3,"REQ")=1 ; I IBTYP="ALL"!((IBTYP_",")["4,") D:IBFT . ; if a UB-04, attending required . S IBPRV(4,"NOTOPT")=1 . Q:'IBMRAND . I '$O(IBPRV(4,0)) S IBPRV(4,1)=$G(IBPRV(4)),IBPRV(4,"REQ")=1 Q ; CKPROV(IBIFN,IBTYP,IBVAL) ; Checks if prov of type IBTYP in 'PRV' node ; of bill IBIFN ; If IBVAL = 1, skips the check for an existing provider, just looks ; for existence of the function itself N OK,IBFT,Z,R S OK=0,IBFT=$$FT^IBCEF(IBIFN) S Z=+$O(^DGCR(399,IBIFN,"PRV","B",+IBTYP,0)) I $G(^DGCR(399,IBIFN,"PRV",Z,0))'="" D . ; Only outpt UB-04 can have SLF000 as prov ID with no name . I IBFT=3,'$$INPAT^IBCEF(IBIFN,1),$P(^DGCR(399,IBIFN,"PRV",Z,0),U,2)="",$P(^(0),U,5)="SLF000" S OK=1 Q . I '$G(IBVAL) Q:$P(^DGCR(399,IBIFN,"PRV",Z,0),U,2)="" . S OK=1 Q OK ; XFER(IBQ) ; Transfer DILIST ; IBQ = # of entries already found N Z,IBZ S (Z,IBZ)=0 F S Z=$O(^TMP("DILIST",$J,1,Z)) Q:'Z S IBZ=IBZ+1,^TMP("IBLIST",$J,1,IBZ+IBQ)=^TMP("DILIST",$J,1,Z),^TMP("IBLIST",$J,2,IBZ+IBQ)=^TMP("DILIST",$J,2,Z) M ^TMP("IBLIST",$J,"ID",IBZ+IBQ)=^TMP("DILIST",$J,"ID",Z) ; I $D(^TMP("DILIST",$J,0)) S ^TMP("IBLIST",$J,0)=^TMP("DILIST",$J,0) S $P(^TMP("IBLIST",$J,0),U)=IBQ+IBZ Q ; DATE(X) ; Convert date X in YYYYMMDD or YYMMDD to FM format ; FP = flag to indicate if past or future dates are expected N %DT,Y I $L(X)=8,$E(X,1,4)<2100,$E(X,5,6)<13,$E(X,7,8)<32 S X=$E(X,1,4)-1700_$E(X,5,8) G DTQ I $L(X)=6,$E(X,3,4)<13,$E(X,5,6)<32 S X=$E(X,3,4)_"/"_$E(X,5,6)_"/"_$E(X,1,2),%DT="N" D ^%DT I Y>0 S X=Y DTQ Q X ; BCLASS(IBIFN) ; Returns actual bill classif. code from ptr fld ; .25 in file 399 for bill ien IBIFN Q $P($G(^DGCR(399.1,+$P($G(^DGCR(399,IBIFN,0)),U,25),0)),U,2) ; ADMHR(IBIFN,IBDTTM) ; Extract admit hr from admit dt/tm ; Default 00 if no time and bill is 11X or 18X N TM S TM=$P(IBDTTM,".",2) I TM="","18"[$$BCLASS(IBIFN),$P($G(^DGCR(399,IBIFN,0)),U,24)=1 S TM="00" I TM'="",TM'="00" S TM=$E(TM_"0000",1,4) Q TM ; OLAB(IBIFN) ; Returns 1 if bill IBIFN is outside lab N IBL,IBLAB S IBL=0 S IBLAB=$P($G(^DGCR(399,IBIFN,"U2")),U,11) I IBLAB,"24"[IBLAB S IBL=1 Q IBL ; PSRV(IBIFN) ; Returns 1 if bill IBIFN has any purch services N IBZ,IBXDATA,IBXSAVE,Z S IBZ=0 D F^IBCEF("N-HCFA 1500 PROCEDURES",,,IBIFN) S Z=0 F S Z=$O(IBXSAVE("BOX24",Z)) Q:'Z I $P(IBXSAVE("BOX24",Z),U,11) S IBZ=1 Q Q IBZ ; SEQBILL(IBIFN) ; Returns the ien's of all bills in COB sequence for bill IBIFN ; Return value is "^" delimited: primary ien^secondary ien^tertiary ien N IBSEQ,Z S IBSEQ=$P($G(^DGCR(399,IBIFN,"M1")),U,5,7) S Z=$$COBN^IBCEF(IBIFN) I $P(IBSEQ,U,Z)="" S $P(IBSEQ,U,Z)=IBIFN Q IBSEQ ;