IBTOUR2 ;ALB/AAS - CLAIMS TRACKING UR/ACTIVITY REPORT ; 27-OCT-93 ;;Version 2.0 ; INTEGRATED BILLING ;**45**; 21-MAR-94 ; % ; ; -- insurance: ^tmp($j,"ibtour", $s(pt. name/specialty/review date) ,pt. name,sort3,ibtrc)=^ibt(ibtrc,0) ; ^tmp($j,"ibtour0,ibtrn)=ibtrn (case list) ; ^tmp($j,"ibtour1",specialty)=days approved ^ days denied ^ $approved ^ $denied ; ; -- hospital: ^tmp($j,"ibtour3",$s... ; ^tmp($j,"ibtour2",specialty)= adm. met ^ adm not met ^ days met ^ days not met ; ^tmp($j,"ibtour4",ibtrn)=ibtrn (case list) ; ; IREV ; -- count and sort reviews N IBDT,J S IBDT=IBBDT-.00001 F S IBDT=$O(^IBT(356.2,"B",IBDT)) Q:'IBDT!(IBDT>(IBEDT+.9))!(IBQUIT) D .S IBTRC=0 F S IBTRC=$O(^IBT(356.2,"B",IBDT,IBTRC)) Q:'IBTRC!(IBQUIT) D ..S IBTRCD=$G(^IBT(356.2,+IBTRC,0)) Q:IBTRCD="" ..S IBTRN=$P(IBTRCD,"^",2) ..Q:$P(IBTRCD,"^",19)<10 ..D SET Q ; SET ; -- set utility array Q:'$G(IBTRN) N DFN,SORT1,SORT2,SORT3,IBSPEC,IBBBS,RATE,IBAC,IBDAY,IBDA,IBDD,IBCDT S DFN=+$P(IBTRCD,"^",5) Q:'DFN ; S IBSPEC=$$SPEC^IBTOSUM1(IBTRC) S IBBBS=$$BBS^IBTOSUM1(+IBSPEC) S RATE=$$RATE^IBTOSUM1(IBBBS,+IBTRCD) S IBAC=$$ACTION^IBTOSUM1(IBTRC) S IBSPEC=$P(IBSPEC,"^",2) S:IBSPEC="" IBSPEC="Unknown" ; I $P(^IBT(356,+$P(IBTRCD,"^",2),0),"^",4) S IBSPEC="OUTPATIENT VISIT",RATE=178 ; I $P(^IBT(356,+$P(IBTRCD,"^",2),0),"^",8) S IBSPEC="PRESCRIPTION",RATE=20 I $P(^IBT(356,+$P(IBTRCD,"^",2),0),"^",9) S IBSPEC="PROSTHETICS",RATE=0 ; S SORT3=$P($G(^DPT(DFN,0)),"^") I IBHOW="P" S (SORT1,SORT2)=SORT3 I IBHOW="S" S SORT1=IBSPEC,SORT2=SORT3 I IBHOW="R" S SORT1=$P($G(^VA(200,+$P($G(^IBT(356.2,+IBTRC,1)),"^",4),0)),"^"),SORT2=$P($G(^IBE(356.11,+$P(IBTRCD,"^",4),0)),"^") S:SORT1="" SORT1="Unknown" S:SORT2="" SORT2="Unknown" S:SORT3="" SORT2="Unknown" S ^TMP($J,"IBTOUR",SORT1,SORT2,SORT3,IBTRC)=IBTRCD ; S IBDAY="" ;I $P(^IBT(356,IBTRN,0),"^",5),$P(^IBT(356.2,+IBTRC,1),"^",7) S IBCDT=$$CDT^IBTODD1(IBTRN),IBDAY=$$DAY^IBTUTL3(+IBCDT,$S(+$P(IBCDT,"^",2):$P(IBCDT,"^",2),1:DT),IBTRN) ; -- replace the above line with the following line to add in admissions ; approved for the entire stay to report I $P(^IBT(356,IBTRN,0),"^",5),($P(^IBT(356.2,+IBTRC,1),"^",7)!($P(^(1),"^",8))) S IBCDT=$$CDT^IBTODD1(IBTRN),IBDAY=$$DAY^IBTUTL3(+IBCDT,$S(+$P(IBCDT,"^",2):$P(IBCDT,"^",2),1:DT),IBTRN) ; I IBAC=10,'IBDAY S IBDAY=$$DAY^IBTUTL3(+$P(IBTRCD,"^",12),+$P(IBTRCD,"^",13),IBTRN) I IBAC=20,'IBDAY S IBDAY=$$DAY^IBTUTL3(+$P(IBTRCD,"^",15),+$P(IBTRCD,"^",16),IBTRN) I 'IBDAY,$P(^IBT(356,IBTRN,0),"^",4) S IBDAY=1 ;opt encounter =1 day S IBDA=$S(IBAC=10:IBDAY,1:0) S IBDD=$S(IBAC=20:IBDAY,1:0) S ^TMP($J,"IBTOUR0",+IBTRN)=IBTRN ; I $P(^IBT(356,+IBTRN,0),"^",5),IBSPEC'="Unknown" D .I '$D(^TMP($J,"IBTOUR1",IBSPEC)) S ^TMP($J,"IBTOUR1",IBSPEC)="0^0^0^0^" .S X=$G(^TMP($J,"IBTOUR1",IBSPEC)) .S ^TMP($J,"IBTOUR1",IBSPEC)=($P(X,"^")+IBDA)_"^"_($P(X,"^",2)+IBDD)_"^"_($P(X,"^",3)+(IBDA*RATE))_"^"_($P(X,"^",4)+(IBDD*RATE)) Q ; HREV ; -- count and sort reviews N IBDT,J S IBDT=IBBDT-.00001 F S IBDT=$O(^IBT(356.1,"B",IBDT)) Q:'IBDT!(IBDT>(IBEDT+.9))!(IBQUIT) D .S IBTRV=0 F S IBTRV=$O(^IBT(356.1,"B",IBDT,IBTRV)) Q:'IBTRV!(IBQUIT) D ..S IBTRVD=$G(^IBT(356.1,+IBTRV,0)) Q:IBTRVD="" ..S IBTRN=$P(IBTRVD,"^",2) ..I $P(IBTRVD,"^",21)=10 D HSET Q ; HSET ; -- set up review cases S ^TMP($J,"IBTOUR4",IBTRN)=IBTRN Q ; HSET1 ; -- build by specialy report for hosp. reviews. I $G(IBSPEC)="" D .N VAIN,DFN .S DFN=$P(^IBT(356,IBTRN,0),"^",2) .S VAINDT=$P(^IBT(356,IBTRN,0),"^",6)\1+.2359 D INP^VADPT S IBSPEC=$P(VAIN(3),"^",2) .I $G(IBSPEC)="" S IBSPEC="Unknown" I '$D(^TMP($J,"IBTOUR2",IBSPEC)) S ^TMP($J,"IBTOUR2",IBSPEC)="0^0^0^0^" S X=$G(^TMP($J,"IBTOUR2",IBSPEC)) S ^TMP($J,"IBTOUR2",IBSPEC)=($P(X,"^")+IBP1)_"^"_($P(X,"^",2)+IBP2)_"^"_($P(X,"^",3)+IBP3)_"^"_($P(X,"^",4)+IBP4) Q ; HSET2 ; -- set utility array N DFN,SORT1,SORT2,SORT3 S DFN=+$P(IBTRND,"^",2) Q:'DFN ; S SORT3=$P($G(^DPT(DFN,0)),"^") I IBHOW="P" S (SORT1,SORT2)=SORT3 I IBHOW="S" S SORT1=IBSPEC,SORT2=SORT3 I IBHOW="R" S SORT1=$P($G(^VA(200,+$P($G(^IBT(356,+IBTRN,1)),"^",5),0)),"^"),SORT2=$P($G(^IBE(356.11,+$P(IBTRVD,"^",22),0)),"^") S:SORT1="" SORT1="Unknown" S:SORT2="" SORT2="Unknown" S:SORT3="" SORT2="Unknown" ; S ^TMP($J,"IBTOUR3",SORT1,SORT2,SORT3,IBTRN)=IBADM_"^"_IBDAYS_"^"_IBDAYN Q