IBCEU6 ;ALB/ESG - EDI UTILITIES FOR EOB PROCESSING ;29-JUL-2003 ;;2.0;INTEGRATED BILLING;**155**;21-MAR-94 ; Q ; COBLINE(IBIFN,IBI,IBXDATA,SORT,IBXTRA) ; Extract all COB data for line item ; from file 361.1 (EOB), subfile 15 into IBXDATA(IBI,"COB",n) ; ; IBIFN = bill entry # ; IBI = VistA outbound line item # ; IBXDATA = array returned with COB line item data/pass by reference ; SORT = flag that determines whether the data should be sorted for ; output for the 837 record ('PR' group always there and has ; a reason code for deductible first and co-insurance second - ; even if they are 0). ; 1 = sort, 0 = no sort needed ; ; Returns IBXDATA(IBI,"COB",COB,n) with COB data for each line item ; found in an accepted EOB for the bill and = the '0' node data of ; file 361.115 (LINE LEVEL ADJUSTMENTS) ; -- AND -- ; IBXDATA(IBI,"COB",COB,n,z,p)= ; the data on the '0' node for each subordinate entry of file ; 361.11511 (REASONS) (Only first 3 pieces for 837 output) ; z = this is either piece 1 of the 0-node for subfile ; 361.1151 (ADJUSTMENTS) ; OR ; for the 837 COB 'sorted' output, this will be ' PR' ; for the forced/extracted entries for deductible ; and co-insurance so they are always output first ; The space needs to be stripped off on output ; -- AND -- ; IBXTRA = array returned if passed by reference if line is found ; associated with line IBI due to bundling/unbundling ; IBXTRA("ALL",x,paid procedure)=COB SEQ ^ seq # corresponding ; to subscript n in IBXDATA(,"COB",COB,n ; (x = line #-original proc-service dt) ; N A,B,B1,C,D,IBDATA,IB0,IB00,IBA,IBB,IBDED,IBCOI,IBS,IBN,IBDT ; ; If multiple EOB's reference this line for the same COB sequence, ; extract only the last one marked accepted containing this line item. ; S A=0 F S A=$O(^IBM(361.1,"B",IBIFN,A)) Q:'A D . I '$$EOBELIG^IBCEU1(A) Q ; eob not eligible for secondary claim . S IBA=0 . S IBDATA=$G(^IBM(361.1,A,0)) . S IBS=$P(IBDATA,U,15) ; insurance sequence# . S IBN=+$O(IBXDATA(IBI,"COB",IBS,0)) . I IBN D Q:IBN ; check for later EOB .. I $G(IBDT(IBI,IBS)),IBDT(IBI,IBS)<$P(IBDATA,U,6) K IBDT(IBI,IBS),IBXDATA(IBI,"COB",IBS) S IBN=0 . ; . S IBDT(IBI,IBS)=$P(IBDATA,U,6) . S B=0 . F S B=$O(^IBM(361.1,A,15,"AC",IBI,B)) Q:'B S IB0=$G(^IBM(361.1,A,15,B,0)),IB0=IB0_U_IBDT(IBI,IBS) D .. Q:$TR(IB0,U)="" .. S IBA=IBA+1,IBXDATA(IBI,"COB",IBS,IBA)=IBI_U_IB0 .. ; .. ; capture the modifiers (361.1152) .. I $D(^IBM(361.1,A,15,B,2)) M IBXDATA(IBI,"COBMOD")=^IBM(361.1,A,15,B,2) .. I $P(IB0,U,15)'="" D ;Line involved in bundling/unbundling ... N Z0 S Z0=IBI_"-"_$P(IB0,U,15)_"-"_$P(IB0,U,16) ... S IBXTRA("ALL",Z0,$P(IB0,U,4))=IBS_U_IBA,$P(IBXDATA(IBI,"COB",IBS,IBA),U)="" .. S C=0,(IBDED(IBA),IBCOI(IBA))="0^0" ;Assume 0 if not found in list .. F S C=$O(^IBM(361.1,A,15,B,1,C)) Q:'C S IB0=$G(^(C,0)) D ... S D=0 ... F S D=$O(^IBM(361.1,A,15,B,1,C,1,D)) Q:'D S IB00=$S($G(SORT):$P($G(^(D,0)),U,1,3),1:$G(^(D,0))) D .... I $G(SORT),$P(IB0,U)="PR" D ;Check for deductible or co-ins ..... I 'IBDED(IBA),$P(IB00,U)=1 S IBDED(IBA)=IB00,IB00="" Q ..... I 'IBCOI(IBA),$P(IB00,U)=2 S IBCOI(IBA)=IB00,IB00="" Q .... I $TR(IB00,U)'="" S IBB=$O(IBXDATA(IBI,"COB",IBS,IBA,$P(IB0,U),""),-1)+1,IBXDATA(IBI,"COB",IBS,IBA,$P(IB0,U),IBB)=IB00 .. Q:'$G(SORT) .. S IBXDATA(IBI,"COB",IBS,IBA," PR",1)=IBDED(IBA) .. S IBXDATA(IBI,"COB",IBS,IBA," PR",2)=IBCOI(IBA) Q ;