IBNCPDP ;OAK/ELZ - APIS FOR NCPCP/ECME ;10-JUN-2003 ;;2.0;INTEGRATED BILLING;**223,276,363**;21-MAR-94;Build 35 ;;Per VHA Directive 2004-038, this routine should not be modified. ; ; RX(DFN,IBD) ; pharmacy package call, passing in IBD by ref ; this is called by PSO for all prescriptions issued, return is ; a responce to bill ECME or not with array for billing data elements ; ; IBD("IEN") = Prescription IEN ; ("FILL NUMBER") = Fill number (0 is initial) ; ("FILL DATE") = Fill or refill date ; ("RELEASE DATE")= Date of the Rx release in FileMan format ; ("NDC") = NDC number for drug ; ("DEA") = DEA special handling info ; ("COST") = cost of medication being dispenced ; ("AO") = Agent Orange (0,1 OR Null) ; ("EC") = Environmental Contaminant (0,1 OR Null) ; ("HNC") = Head/neck cancer (0,1 OR Null) ; ("IR") = Ionizing radiation (0,1 OR Null) ; ("MST") = Military sexual trauma (0,1 OR Null) ; ("SC") = Service connected (0,1 OR Null) ; ("CV") = Combat Veteran (0,1 OR Null) ; ("QTY") = Quantity of med ; ("EPHARM") = #9002313.56 ien (E-PHARMACY division) ; ; ; IBD("INS",n,1) = insurance array to bill in n order ; file 355.3 ien (group)^bin^pcn^payer sheet^group id^ ; cardholder id^patient relationship code^ ; cardholder first name^cardholder last name^ ; home plan state ; ("INS",n,2) = dispensing fee^basis of cost determination^ ; awp or tort rate or cost^gross amount due^ ; administrative fee ; ; for basis of cost determination the following is used: ; "07" would be sent for Usual & Customary ; "01" would be sent for AWP ; "05" would be sent for Cost calculations ; ; ("INS",n,3) = group name^insurance co^phone number^plan ID N IBRES,IBNB S IBRES=$$RX^IBNCPDP1(DFN,.IBD) ;remove "Not ECME billable: " from the reason text S IBNB="Not ECME billable: " I IBRES[IBNB S IBRES=$P(IBRES,U)_U_$P($P(IBRES,U,2),IBNB,2) Q IBRES ; ; STORESP(DFN,IBD) ; this is an API for pharmacy/ecme to use to relay ; results of billing using the ecme software. If electronic billing is ; successful, then bills will be established. If not, then we will ; flag the entry in ct for paper or not billable. ; ; IBD("STATUS") = Bill status (PAID, REJECTED,REVERSED ; CLOSED,RELEASED,or SUBMITTED) ; ("FILL DATE") = Fill Date ; ("PRESCRIPTION") = Prescription IEN from drug file (#52) ; ("FILL NUMBER") = Fill or refill number ; ("BILLED") = Amount billed ; ("PAID") = Amount paid ; ("BCID") = Reference number to the claim for payment ; BCID stands for Bill Claim ID ; ("PLAN") = IEN of the the entry in the GROUP INSURANCE ; PLAN file(#355.3)(captured from the ; $$RX^IBNCPDP call) ; ("COPAY") = Patient's copay from ECME response ; ("RX NO") = RX number from file 52 ; ("DRUG") = IEN of file #50 DRUG ; ("DAYS SUPPLY") = Days Supply ; ("QTY") = Quantity ; ("NDC") = NDC ; ("CLOSE REASON") = Optional, Pointer to the IB file #356.8 ; "CLAIMS TRACKING NON-BILLABLE REASONS" ; ("CLOSE COMMENT")= Optional, if the close reason is defined ; then the Close Comment parameter may be ; sent to IB ; ("DROP TO PAPER")= Optional, this parameter may be set to 1(TRUE) ; for certain Close Claim Reasons, indicating ; that that the closed episode still may be ; "dropped to paper" - passed to the Autobiller ; ("RELEASE COPAY")= Optional, if the claim is being closed, setting ; this parameter to 1 (TRUE) indicates that the ; patients copay should be released off hold ; ("DIVISION") = Pointer to the MC DIVISION file (#40.8) ; ("AUTH #") = ECME approval/authorization number ; ("CLAIMID") = Reference Number to ECME ; ("EPHARM") = Optional, #9002313.56 ien (E-PHARMACY division) ; ; ; Return is the bill number for success or 1 if not billable. ; "0^reason" indicates not success ; Q $$ECME^IBNCPDP2(DFN,.IBD) ; ; UPAWP(IBNDC,IBAWP,IBADT) ; used to update AWPs. This is an API that ; pharmacy will call. ; ; IBNDC = NDC number to update with the price. ; IBAWP = average wholesale price of the NDC ; IBADT = effective date of change (optional, default it today) ; ; return will be a positive number indicating success. ; if it is unsuccessful, then "0^reason" will be returned. ; Q $$UPAWP^IBNCPDP3(IBNDC,IBAWP,$G(IBADT,DT)) ; ;