IBCNS2 ;ALB/AAS - INSURANCE POLICY CALLS FROM FILE 399 DD ;22-JULY-91 ;;2.0;INTEGRATED BILLING;**28,43,80,51,137,155**;21-MAR-94 ;;Per VHA Directive 10-93-142, this routine should not be modified. ; Q DD(IBX,IBDA,LEVEL) ; - called from input transform for field 111,112,113 ; -- input ibx = x from input transform ; ibda = internal entry in 399 ; level = 1=primary, 2=secondary, 3=tertiary ; -- output returns x=internal entry in 2.3121 (ins. Mult.) if valid ; N DFN,ACTIVE,INSDT D VAR S X=$$SEL(IBX,DFN,INSDT,ACTIVE) I +X<1 K X DDQ Q ; VAR S DFN=$P(^DGCR(399,IBDA,0),"^",2),ACTIVE=1,INSDT=$S(+$G(^DGCR(399,IBDA,"U")):+$G(^("U")),1:DT) Q ; SEL(IBX,DFN,INSDT,ACTIVE) ; -- Select insurance policy ; -- Input IBX = x from input transform ; DFN = patient ; INSDT = (optional) Active date of ins. (default = dt) ; ACTIVE = (optional) 1 if want active (default) ; = 2 if want all ins returned ; ; -- Output = pointer to 36 ^ pointer to 2.3121 ^ pointer to 355.3 ; N I,J,Y,DA,DE,DQ,DR,DIC,DIE,DIR,DIV,IBSEL,IBDD,IBD S IBSEL=1,Y="" I '$G(ACTIVE) S ACTIVE=1 S:'$G(INSDT) INSDT=DT I '$G(DFN) G SELQ D BLD ; ; -- call DIC to choose from list S X=IBX S DIC="^DPT("_DFN_",.312,",DIC(0)="EQMN" S DIC("S")="I $D(IBDD(+Y))" ; add not other selection S DIC("W")="W $P(^DIC(36,+^(0),0),U)_"" Group: ""_$$GRP^IBCNS($P(^DPT(DFN,.312,+Y,0),U,18))" D ^DIC SELQ Q +Y ; BLD K IBD,IBDD S (IBDD,IBCDFN)=0 F S IBCDFN=$O(^DPT(DFN,.312,IBCDFN)) Q:'IBCDFN I $D(^DPT(DFN,.312,IBCDFN,0)) D CHK(IBCDFN,ACTIVE,INSDT) Q ; CHK(IBCDFN,ACTIVE,INSDT) ; -- see if active N X,X1 S X=$G(^DPT(DFN,.312,IBCDFN,0)) S IBDD(IBCDFN)=+X_"^"_IBCDFN_"^"_$P(X,"^",18) I ACTIVE=2 G CHKQ S X1=$G(^DIC(36,+X,0)) I X1="" G CQ ;ins co entry doesn't exist I $P(X,"^",8) G:INSDT<$P(X,"^",8) CQ ;effective date later than care I $P(X,"^",4) G:INSDT>$P(X,"^",4) CQ ;care after expiration date I $P($G(^IBA(355.3,+$P(X,"^",18),0)),"^",11) G CQ ;plan is inactive G:$P(X1,"^",5) CQ ; ;ins company inactive ;G:$P(X1,"^",2)="N" CQ ; ;ins company will not reimburse G CHKQ CQ K IBDD(IBCDFN) CHKQ S:$D(IBDD(IBCDFN)) IBDD=IBDD+1,IBD(IBDD)=IBCDFN Q ; ; DDHELP(IBDA,LEVEL) ; -- Executable help ; -- write out list to choose from N DFN,ACTIVE,INSDT,I,IBINS D VAR,BLD ; I $G(IBDD)=0 W !,"No Insurance Policies to Select From" G DDHQ ; I '$D(IOM) D HOME^%ZIS N IBDTIN S IBDTIN=$G(INSDT) W ! D HDR^IBCNS S I=0 F S I=$O(IBD(I)) Q:'I D .S IBINS=$G(^DPT(DFN,.312,$G(IBD(I)),0)) .D D1^IBCNS DDHQ Q ; TRANS(IBDA,Y) ; -- output transform N DFN,ACTIVE,INSDT D VAR S Y=$P($G(^DIC(36,+$P($G(^DPT(DFN,.312,+$G(Y),0)),U),0)),U) Q Y ; INSCO(IBDA,IBCDFN) ; -- return pointer value of 36 from pt. file N DFN,ACTIVE,INSDT D VAR S Y=+$G(^DPT(DFN,.312,IBCDFN,0)) Q Y_$S(Y>0:"^"_$P($G(^DIC(36,+Y,0)),"^"),1:"") ; IX(DA,XREF) ; -- create i1, aic xrefs for fields 112, 113, 114 ; S ^DGCR(399,DA,XREF)=$$ZND^IBCNS1($P($G(^DGCR(399,DA,0)),"^",2),X) S ^DGCR(399,DA,"AIC",+$G(^DPT($P($G(^DGCR(399,DA,0)),"^",2),.312,+X,0)))="" Q ; KIX(DA,XREF) ; -- kill logic for above xref K ^DGCR(399,DA,XREF) K ^DGCR(399,DA,"AIC",+$G(^DPT($P($G(^DGCR(399,DA,0)),"^",2),.312,+X,0))) Q ; BPP(IBDA,IBMCR) ; Find Bill Payer Policy based on Payer Sequence and the P/S/T payers assigned to the bill,Ins Co must reimburse ; IBMCR = flag that says include MEDICARE WNR ; returns - Bill Payer Policy (ifn of policy entry in patient file) ; - null if either no Payer Sequence or there is no policy defined for the payer sequence ; or the policy defined by the payer sequence Will Not Reimburse and is not MEDICARE ; N IBI,IBX,IBY,IBP,IBC,IBM0 S IBX="",(IBP,IBC)=0 S IBMCR=+$G(IBMCR) S IBY=$$COBN^IBCEF(+IBDA) I IBY S IBY=IBY+11 I IBY S IBM0=$G(^DGCR(399,+IBDA,"M")),IBP=$P(IBM0,U,IBY) I IBP S IBY=IBY-11,(IBI,IBY)=$P(IBM0,U,IBY) I +IBY S IBC=$P($G(^DIC(36,+IBY,0)),U,2) I IBP,IBI,$S(IBC'="N":1,'IBMCR:0,1:$$MCRWNR^IBEFUNC(+IBY)) S IBX=IBP Q IBX