PSOBPSU1 ;BIRM/MFR - BPS (ECME) Utilities 1 ;10/15/04 ;;7.0;OUTPATIENT PHARMACY;**148,260**;DEC 1997;Build 84 ;Reference to $$EN^BPSNCPDP supported by IA 4415 ;References to $$NDCFMT^PSSNDCUT,$$GETNDC^PSSNDCUT supported by IA 4707 ;References to $$ECMEON^BPSUTIL,$$CMOPON^BPSUTIL supported by IA 4410 ;References to STORESP^IBNCPDP supported by IA 4299 ; ECMESND(RX,RFL,DATE,FROM,NDC,CMOP,RVTX,OVRC,CNDC,RESP,IGSW,ALTX,CLA,PA) ; - Sends Rx Release information to ECME/IB and ; updates NDC in the DRUG/PRESCRIPTION files ;Reference to routine EN^BPSNCPDP supported by DBIA #4304 ;Input: (r) RX - Rx IEN (#52) ; (o) RFL - Refill # (Default: most recent) ; (r) DATE - Date of Service ; (r) FROM - Function within OP (See BWHERE param. in EN^BPSNCPDP api) ; (o) NDC - NDC Number (If not passed, will be retrieved from DRUG file) ; (o) CMOP - CMOP Prescription (1-YES/0-NO) (Default: 0) ; (o) RVTX - REVERSE text (e.g., RX EDIT, RX RELEASE-NDC CHANGE, etc) ; (o) OVRC - Set of 3 NCPDP override codes separated by "^": ; Piece 1: NCPDP Professional Service Code for overriding DUR REJECTS ; Piece 2: NCPDP Reason for Service Code for overriding DUR REJECTS ; Piece 3: NCPDP Result of Service Code for overriding DUR REJECTS ; (o) CNDC - Changed NDC? 1 - Yes / 0 - No (Default: NO) ; (o) IGSW - Ignore Switches (Master and CMOP)? 1 - Yes / 0 - No (Default: NO) ; (o) ALTX - Alternative Text to be placed in the Rx ECME Activity Log ; (o) CLA - NCPDP Clarification Code for overriding DUR/RTS REJECTS ; (o) PA - NCPDP Prior Authorization Type and Number (separated by "^") ;Output: RESP - Response from $$EN^BPSNCPDP api ; ; - Retrieving the NDC code from the DRUG file if not passed in, then save it in the DRUG file N ACT,NDCACT,DA ; I '$D(RFL) S RFL=$$LSTRFL(RX) ; ; - ECME is not turned ON for the Rx's Division I '$G(IGSW),'$$ECMEON^BPSUTIL($$RXSITE^PSOBPSUT(RX,RFL)) S RESP="-1^ECME SWITCH OFF" Q ; ; - ECME CMOP is not turned ON for the Rx's Division I '$G(IGSW),$G(CMOP),'$$CMOPON^BPSUTIL($$RXSITE^PSOBPSUT(RX,RFL)) S RESP="-1^CMOP SWITCH OFF" Q ; ; - Saving the NDC to be displayed on the ECME Activity Log I $G(CNDC) D . I $G(NDC)'="" S NDCACT=NDC Q . S NDCACT=$$GETNDC^PSONDCUT(RX,RFL) ; I $$NDCFMT^PSSNDCUT($G(NDC))="" D . S NDC=$$GETNDC^PSSNDCUT($$GET1^DIQ(52,RX,6,"I"),$$RXSITE^PSOBPSUT(RX,RFL),+$G(CMOP)) . I $G(NDC)'="" D SAVNDC^PSONDCUT(RX,RFL,NDC,+$G(CMOP)) ; ; - Creating ECME Activity Log on the PRESCRIPTION file S ACT="Submitted" I $$STATUS^PSOBPSUT(RX,RFL)="E PAYABLE" S ACT="Reversal/Re-submit sent" S ACT=ACT_" to ECME:" ; ; - Marked any 'unresolved' REJECTS as 'resolved' (Reason: 1 - Claim re-submitted) N CLSCOM,COD1,COD2,COD3 S COD2=$P($G(OVRC),"^"),COD1=$P($G(OVRC),"^",2),COD3=$P($G(OVRC),"^",3) I $G(COD3)'="" S CLSCOM="DUR Override Codes "_COD1_"/"_COD2_"/"_COD3_" submitted." I $G(CLA)'="" S CLSCOM="Clarification Code "_CLA_" submitted." I $G(PA)'="" S CLSCOM="Prior Authorization Code ("_$P(PA,"^")_"/"_$P(PA,"^",2)_") submitted." D CLSALL^PSOREJUT(RX,RFL,DUZ,1,$G(CLSCOM),$G(COD1),$G(COD2),$G(COD3),$G(CLA),$G(PA)) ; ; - Call to ECME (NEWing STAT because ECME was overwriting it - Important variable for CMOP release PSXVND) N STAT I $G(RVTX)="",FROM="ED" S RVTX="RX EDITED" S RESP=$$EN^BPSNCPDP(RX,RFL,$$DOS(RX,RFL,.DATE),FROM,NDC,$G(RVTX),$G(OVRC),,$G(CLA),$G(PA)) ; ; - Reseting the Re-transmission flag D RETRXF^PSOREJU2(RX,RFL,0) ; ; - Logging ECME Activity Log to the PRESCRIPTION file I $G(ALTX)="" D . N X S X="" . S:FROM="OF" X="WINDOW FILL(NDC:"_$$GETNDC^PSONDCUT(RX,RFL)_")" . S:FROM="RF" X="WINDOW REFILL(NDC:"_$$GETNDC^PSONDCUT(RX,RFL)_")" . S:FROM="RN" X="RX RENEWED(NDC:"_$$GETNDC^PSONDCUT(RX,RFL)_")" . S:FROM="PL" X="SUSP LABEL PRINTED(NDC:"_$$GETNDC^PSONDCUT(RX,RFL)_")" . S:FROM="PE"!(FROM="PP") X="PULLED FROM SUSPENSE(NDC:"_$$GETNDC^PSONDCUT(RX,RFL)_")" . S:FROM="PC" X="CMOP TRANSMISSION(NDC:"_$$GETNDC^PSONDCUT(RX,RFL)_")" . S:FROM="RRL" X="RELEASED RX PREVIOUSLY REVERSED" . S:FROM="ED" X="RX EDITED" . S:$G(RVTX)'="" X=RVTX . S:$G(OVRC)'="" X="DUR OVERRIDE CODES("_$G(COD1)_"/"_$G(COD2)_"/"_$G(COD3)_")" . S:$G(CNDC) X=X_"(NDC:"_NDCACT_")" S ACT=ACT_X . S ACT=ACT_$$STS(RX,RFL,RESP) I $G(ALTX)'="" S ACT=ACT_ALTX_$$STS(RX,RFL,RESP) I +RESP=2 S ACT="Not ECME Billable: "_$P(RESP,"^",2) I +RESP=10 S ACT="ECME reversed/NOT re-submitted: "_$P(RESP,"^",2) D RXACT^PSOBPSU2(RX,RFL,ACT,"M",DUZ) ; ; -Logs an ECME Activity Log if Rx Quantity is different than Billing Quantity I 'RESP,$T(NCPDPQTY^PSSBPSUT)'="" D . N DRUG,RXQTY,BLQTY,BLDU,Z . S DRUG=$$GET1^DIQ(52,RX,6,"I") . S RXQTY=$S('RFL:$$GET1^DIQ(52,RX,7,"I"),1:$$GET1^DIQ(52.1,RFL_","_RX,1))/1 . S Z=$$NCPDPQTY^PSSBPSUT(DRUG,RXQTY),BLQTY=Z/1,BLDU=$P(Z,"^",2) . I RXQTY'=BLQTY D . . D RXACT^PSOBPSU2(RX,RFL,"BILLING QUANTITY submitted: "_$J(BLQTY,0,$L($P(BLQTY,".",2)))_" ("_BLDU_")","M",DUZ) ; Q ; REVERSE(RX,RFL,FROM,RSN,RTXT,IGRL,NDC) ; - Reverse a claim and close all OPEN/UNRESOLVED Rejects ;Input: (r) RX - Rx IEN (#52) ; (o) RFL - Refill # (Default: most recent) ; (r) FROM - Function within OP (See BWHERE param. in EN^BPSNCPDP api) ; (o) RSN - Close Reason (2:RX ON HOLD;4: RX RETURNED TO STOCK,5:RX DELETED,etc...) ; (o) RTXT - Close Reason TEXT (Usually no passed if RSN is passed) ; (o) IGRL - Ignore RELEASE DATE, reverse anyway ; (o) NDC - NDC number related to the reversal (Note: might be an invalid NDC) ; I '$D(RFL) S RFL=$$LSTRFL(RX) ; I $$STATUS^PSOBPSUT(RX,RFL)="" Q ; N RESP,STS,ACT,STAT,DA,STATUS,NOACT S RSN=+$G(RSN),RTXT=$G(RTXT) I RTXT="",RSN D . S:RSN=2 RTXT="RX PLACED ON HOLD" S:RSN=3 RTXT="RX SUSPENDED" S:RSN=4 RTXT="RX RETURNED TO STOCK" . S:RSN=5 RTXT="RX DELETED" S:RSN=7 RTXT="RX DISCONTINUED" S:RSN=8 RTXT="RX EDITED" ; D CLSALL^PSOREJUT(RX,RFL,DUZ,RSN,RTXT) ; I '$G(IGRL),$$RXRLDT^PSOBPSUT(RX,RFL) Q ; ; - Reseting the Re-transmission flag if Rx is being suspended I RSN=3!($$GET1^DIQ(52,RX,100,"I")=5) D RETRXF^PSOREJU2(RX,RFL,1) ; S STATUS=$$STATUS^PSOBPSUT(RX,RFL),NOACT=0 I STATUS'="E PAYABLE",STATUS'="IN PROGRESS",STATUS'="E REVERSAL REJECTED",STATUS'="E REVERSAL STRANDED",STATUS'="E DUPLICATE" S NOACT=1 ; S RESP=$$EN^BPSNCPDP(RX,RFL,$$DOS(RX,RFL),FROM,$$GETNDC^PSONDCUT(RX,RFL),RTXT) ; ; - Logging ECME Activity Log I '$G(NOACT) D . S ACT="Reversal sent to ECME: "_RTXT_$S($G(NDC)'="":" ("_NDC_")",1:"")_$$STS(RX,RFL,+RESP) . D RXACT^PSOBPSU2(RX,RFL,ACT,"M",DUZ) ; Q ; DOS(RX,RFL,DATE) ; Return the Date Of Service for ECME ;Input: (r) RX - Rx IEN (#52) ; (o) RFL - Refill # (Default: most recent) ; (o) DATE - Possible Date Of Service ;Output: DOS - Actual Date Of Service ; I '$D(RFL) S RFL=$$LSTRFL(RX) ; ; - Retrieving FILL DATE from the PRESCRIPTION file if not passed I $G(DATE)="" S DATE=$$RXRLDT^PSOBPSUT(RX,RFL) ; - Retrieving FILL DATE from the PRESCRIPTION file if not passed I 'DATE S DATE=$$RXFLDT^PSOBPSUT(RX,RFL) ; - Future Date not allowed I DATE>DT!'DATE S DATE=DT ; Q (DATE\1) ; RELEASE(RX,RFL,USR) ; - Notifies IB that the Rx was RELEASED ;Input: (r) RX - Rx IEN (#52) ; (o) RFL - Refill # (Default: most recent) ; (o) USR - User responsible for releasing the Rx (Default: .5 - Postmaster) ; N IBAR,RXAR,FLDT,RFAR ; S:'$D(RFL) RFL=$$LSTRFL(RX) S:'$D(USR) USR=.5 ; D GETS^DIQ(52,RX_",",".01;2;6;7;8;22","I","RXAR") S DFN=+$G(RXAR(52,RX_",",2,"I")) S IBAR("PRESCRIPTION")=RX,IBAR("RX NO")=$G(RXAR(52,RX_",",.01,"I")) S IBAR("CLAIMID")=$E((RX#10000000)+10000000,2,8),IBAR("USER")=USR S IBAR("DRUG")=RXAR(52,RX_",",6,"I"),IBAR("NDC")=$$GETNDC^PSONDCUT(RX,RFL) S FLDT=$$RXFLDT^PSOBPSUT(RX,RFL) I FLDT>DT S FLDT=DT S IBAR("FILL NUMBER")=RFL,IBAR("FILL DATE")=FLDT S IBAR("QTY")=$G(RXAR(52,RX_",",7,"I")),IBAR("DAYS SUPPLY")=$G(RXAR(52,RX_",",8,"I")) ; I RFL D . D GETS^DIQ(52.1,RFL_","_RX_",",".01;1;1.1","I","RFAR") . S IBAR("QTY")=$G(RFAR(52.1,RFL_","_RX_",",1,"I")) . S IBAR("DAYS SUPPLY")=$G(RFAR(52.1,RFL_","_RX_",",1.1,"I")) ; S IBAR("STATUS")="RELEASED" D STORESP^IBNCPDP(DFN,.IBAR) ; Q ; LSTRFL(RX) ; - Returns the latest fill for the Prescription ; Input: (r) RX - Rx IEN (#52) ;Output: LSTRFL - Most recent refill # N I,LSTRFL S (I,LSTRFL)=0 F S I=$O(^PSRX(RX,1,I)) Q:'I S LSTRFL=I Q LSTRFL ; ECMEACT(RX,RFL,COMM,USR) ; - Add an Activity to the ECME Activity Log (PRESCRIPTION file) ;Input: (r) RX - Rx IEN (#52) ; (o) RFL - Refill # (Default: most recent) ; (r) COMM - Comments (up to 75 characters) ; (o) USR - User logging the comments (Default: DUZ) ; S:'$D(RFL) RFL=$$LSTRFL^PSOBPSU1(RX) D RXACT^PSOBPSU2(RX,RFL,COMM,"M",+$G(USR)) Q ; STS(RX,RFL,RSP) ; Adds the Status to the ECME Activity Log according to Rx/fill claim status Response N STS S STS=$S($$STATUS^PSOBPSUT(RX,RFL)'="IN PROGRESS"&($$STATUS^PSOBPSUT(RX,RFL)'=""):"-"_$$STATUS^PSOBPSUT(RX,RFL),1:"") S:+RSP=1 STS="-NO SUBMISSION THROUGH ECME" S:+RSP=3 STS="-NO REVERSAL NEEDED" S:+RSP=4 STS="-NOT PROCESSED" S:+RSP=5 STS="-SOFTWARE ERROR" I +RSP=2,$$STATUS^PSOBPSUT(RX,RFL)'="" S STS="-NOT BILLABLE:"_$P(RSP,"^",2) Q STS