| 1 | PSOREJP1 ;BIRM/MFR - Third Party Reject Display Screen ;04/29/05
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| 2 | ;;7.0;OUTPATIENT PHARMACY;**148,247,260**;DEC 1997;Build 84
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| 3 | ;Reference to File 9002313.93 - BPS NCPDP REJECT CODES supported by IA 4720
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| 4 | ;Reference to ^PS(59.7 supported by IA 694
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| 5 | ;Reference to ^PSDRUG("AQ" supported by IA 3165
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| 6 | ;
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| 7 | EN(RX,REJ,CHANGE) ; Entry point
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| 8 | ;
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| 9 | ; - DO NOT change the IF logic below as both of them might get executed (intentional)
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| 10 | N FILL,LASTLN
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| 11 | S FILL=+$$GET1^DIQ(52.25,REJ_","_RX,5)
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| 12 | I $$CLOSED(RX,REJ) D EN^VALM("PSO REJECT DISPLAY - RESOLVED")
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| 13 | I '$$CLOSED(RX,REJ) D EN^VALM("PSO REJECT DISPLAY")
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| 14 | D FULL^VALM1
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| 15 | Q
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| 16 | ;
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| 17 | HDR ; - Builds the Header section
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| 18 | N LINE1,LINE2,X
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| 19 | S VALMHDR(1)=$$DVINFO^PSOREJU2(RX,FILL,1),VALMHDR(2)=$$PTINFO^PSOREJU2(RX,1)
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| 20 | S VALMHDR(3)=$$RXINFO(RX,FILL,1),VALMHDR(4)=$$RXINFO(RX,FILL,2)
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| 21 | Q
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| 22 | ;
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| 23 | INIT ; Builds the Body section
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| 24 | N DATA,LINE
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| 25 | F I=1:1:$G(LASTLN) D RESTORE^VALM10(I)
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| 26 | K ^TMP("PSOREJP1",$J) S VALMCNT=0,LINE=0
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| 27 | D GET^PSOREJU2(RX,FILL,.DATA,REJ,1)
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| 28 | D REJ ; Display the REJECT Information
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| 29 | D OTH ; Display the Other Rejects Information
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| 30 | D COM^PSOREJP3 ; Display the Comment
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| 31 | D INS ; Display the Insurance Information
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| 32 | D CLS ; Display the Resolution Information
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| 33 | S VALMCNT=LINE
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| 34 | Q
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| 35 | ;
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| 36 | REJ ; - DUR Information
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| 37 | N TYPE,PFLDT
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| 38 | D SETLN("REJECT Information",1,1)
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| 39 | S TYPE=$S($G(DATA(REJ,"CODE"))=79:"79 - REFILL TOO SOON",1:"88 - DUR REJECT")
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| 40 | D SETLN("Reject Type : "_TYPE_" received on "_$$FMTE^XLFDT($G(DATA(REJ,"DATE/TIME"))),,,18)
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| 41 | D SETLN("Reject Status : "_$G(DATA(REJ,"STATUS")),,,18)
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| 42 | D SET("PAYER MESSAGE",63)
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| 43 | D SET("REASON",63)
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| 44 | S PFLDT=$$FMTE^XLFDT($G(DATA(REJ,"PLAN PREVIOUS FILL DATE")))
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| 45 | D SET("DUR TEXT",63,$S(PFLDT="":1,1:0))
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| 46 | I PFLDT'="" D SETLN("Last Fill Date : "_PFLDT_" (from payer)",,1,18)
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| 47 | Q
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| 48 | ;
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| 49 | OTH ; - Other Rejects Information
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| 50 | N LST,I,RJC,J,LAST
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| 51 | S LST=$G(DATA(REJ,"OTHER REJECTS")) I LST="" Q
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| 52 | D SETLN()
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| 53 | D SETLN("OTHER REJECTS",1,1)
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| 54 | F I=1:1:$L(LST,",") S RJC=$P(LST,",",I) D
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| 55 | . S LAST=1 F J=(I+1):1:$L(LST,",") I $P(LST,",",J)'="" S LAST=0 Q
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| 56 | . I RJC'="" D SETLN(RJC_" - "_$$EXP(RJC),,$S(LAST:1,1:0),6)
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| 57 | Q
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| 58 | ;
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| 59 | INS ; - Insurance Information
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| 60 | D SETLN()
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| 61 | D SETLN("INSURANCE Information",1,1)
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| 62 | D SETLN("Insurance : "_$G(DATA(REJ,"INSURANCE NAME")),,,18)
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| 63 | D SETLN("Contact : "_$G(DATA(REJ,"PLAN CONTACT")),,,18)
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| 64 | D SETLN("Group Name : "_$G(DATA(REJ,"GROUP NAME")),,,18)
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| 65 | D SETLN("Group Number : "_$G(DATA(REJ,"GROUP NUMBER")),,,18)
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| 66 | D SETLN("Cardholder ID : "_$G(DATA(REJ,"CARDHOLDER ID")),,1,18)
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| 67 | Q
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| 68 | ;
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| 69 | CLS ; - Resolution Information
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| 70 | N X
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| 71 | I '$$CLOSED(RX,REJ) Q
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| 72 | D SETLN()
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| 73 | D SETLN("RESOLUTION Information",1,1)
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| 74 | D SETLN("Resolved By : "_$G(DATA(REJ,"CLOSED BY")),,,18)
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| 75 | D SETLN("Date/Time : "_$G(DATA(REJ,"CLOSED DATE/TIME")),,,18)
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| 76 | I $G(DATA(REJ,"CLOSE COMMENTS"))'="" D SET("CLOSE COMMENTS",63)
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| 77 | I $G(DATA(REJ,"COD1"))'="" D SETLN("Reason for Svc : "_$$OVRX^PSOREJU1(1,$G(DATA(REJ,"COD1"))),,,18)
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| 78 | I $G(DATA(REJ,"COD2"))'="" D SETLN("Profes. Svc : "_$$OVRX^PSOREJU1(2,$G(DATA(REJ,"COD2"))),,,18)
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| 79 | I $G(DATA(REJ,"COD3"))'="" D SETLN("Result of Svc : "_$$OVRX^PSOREJU1(3,$G(DATA(REJ,"COD3"))),,,18)
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| 80 | I $G(DATA(REJ,"CLA CODE"))'="" D
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| 81 | . S X=$$GET1^DIQ(52.25,REJ_","_RX,24,"I")_" - "_(DATA(REJ,"CLA CODE"))
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| 82 | . D SETLN("Clarific. Code : "_X,,,18)
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| 83 | I $G(DATA(REJ,"PRIOR AUTH TYPE"))'="" D
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| 84 | . S X=$$GET1^DIQ(52.25,REJ_","_RX,25,"I")_" - "_(DATA(REJ,"PRIOR AUTH TYPE"))
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| 85 | . D SETLN("Prior Auth.Type: "_X,,,18),SETLN("Prior Auth. # : "_DATA(REJ,"PRIOR AUTH NUMBER"),,,18)
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| 86 | D SETLN("Reason : "_$G(DATA(REJ,"CLOSE REASON")),,1,18)
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| 87 | Q
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| 88 | ;
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| 89 | ;
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| 90 | SET(FIELD,L,UND) ; Sets the lines for fields that require text wrapping
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| 91 | N TXT,T
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| 92 | S TXT=DATA(REJ,FIELD) I $L(TXT)'>L D SETLN($$LABEL(FIELD)_TXT,,$S($G(UND):1,1:0),80-L) Q
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| 93 | F I=1:1 Q:TXT="" D
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| 94 | . I I=1 D SETLN($$LABEL(FIELD)_$E(TXT,1,L),,,80-L) S TXT=$E(TXT,L+1,999) Q
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| 95 | . S T="",$E(T,81-L)=$E(TXT,1,L) D SETLN(T,,$S($E(TXT,L+1,999)=""&$G(UND):1,1:0),80-L) S TXT=$E(TXT,L+1,999)
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| 96 | Q
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| 97 | ;
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| 98 | LABEL(FIELD) ; Sets the label for the field
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| 99 | I FIELD="REASON" Q "Reason : "
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| 100 | I FIELD="PAYER MESSAGE" Q "Payer Message : "
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| 101 | I FIELD="DUR TEXT" Q "DUR Text : "
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| 102 | I FIELD="CLOSE COMMENTS" Q "Comments : "
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| 103 | Q ""
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| 104 | ;
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| 105 | VIEW ; - Rx View hidden action
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| 106 | N VALMCNT,TITLE
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| 107 | I $G(PSOBACK) D Q
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| 108 | . S VALMSG="Not available through Backdoor!",VALMBCK="R"
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| 109 | S TITLE=VALM("TITLE")
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| 110 | ;
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| 111 | ; - DO structure used to avoid losing variables RX,FILL,REJ,LINE,TITLE
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| 112 | DO
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| 113 | . N PSOVDA,DA,PS
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| 114 | . S (PSOVDA,DA)=RX,PS="REJECT"
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| 115 | . N RX,REJ,FILL,LINE,TITLE D DP^PSORXVW
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| 116 | ;
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| 117 | S VALMBCK="R",VALM("TITLE")=TITLE
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| 118 | Q
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| 119 | ;
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| 120 | EDT ; - Rx Edit hidden action
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| 121 | N VALMCNT,TITLE
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| 122 | I $G(PSOBACK) D Q
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| 123 | . S VALMSG="Not available through Backdoor!",VALMBCK="R"
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| 124 | S TITLE=VALM("TITLE")
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| 125 | ;
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| 126 | ; - DO structure used to avoid losing variables RX,FILL,REJ,LINE,TITLE
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| 127 | DO
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| 128 | . N PSOSITE,ORN,PSOPAR,PSOLIST
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| 129 | . S PSOSITE=$$RXSITE^PSOBPSUT(RX,FILL),ORN=RX
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| 130 | . S PSOPAR=$G(^PS(59,PSOSITE,1)),PSOLIST(1)=ORN_","
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| 131 | . N RX,REJ,FILL,LINE,TITLE D EPH^PSORXEDT
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| 132 | ;
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| 133 | K VALMBCK I $$CLOSED(RX,REJ),$D(PSOSTFLT),PSOSTFLT="U" S CHANGE=1 Q
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| 134 | S VALMBCK="R",VALM("TITLE")=TITLE
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| 135 | Q
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| 136 | ;
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| 137 | OVR ; - Override a REJECT action
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| 138 | I $$CLOSED(RX,REJ,1) Q
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| 139 | N COD1,COD2,COD3
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| 140 | D FULL^VALM1 W !
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| 141 | S COD1=$$OVRCOD^PSOREJU1(1,$$GET1^DIQ(52.25,REJ_","_RX,14)) I COD1="^" S VALMBCK="R" Q
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| 142 | S COD2=$$OVRCOD^PSOREJU1(2) I COD2="^" S VALMBCK="R" Q
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| 143 | S COD3=$$OVRCOD^PSOREJU1(3) I COD3="^" S VALMBCK="R" Q
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| 144 | D OVRDSP^PSOREJU1(COD1_"^"_COD2_"^"_COD3)
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| 145 | D SEND(COD1,COD2,COD3)
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| 146 | Q
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| 147 | ;
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| 148 | RES ; - Re-submit a claim action
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| 149 | I $$CLOSED(RX,REJ,1) Q
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| 150 | D FULL^VALM1 W !
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| 151 | D SEND()
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| 152 | Q
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| 153 | ;
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| 154 | CLA ; - Submit Clarification Code
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| 155 | N CLA
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| 156 | I $$CLOSED(RX,REJ,1) Q
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| 157 | D FULL^VALM1 W !
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| 158 | S CLA=$$CLA^PSOREJU1() I CLA="^" S VALMBCK="R" Q
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| 159 | W ! D SEND(,,,CLA)
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| 160 | Q
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| 161 | ;
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| 162 | PA ; - Submit Prior Authorization
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| 163 | N PA
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| 164 | I $$CLOSED(RX,REJ,1) Q
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| 165 | D FULL^VALM1 W !
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| 166 | S PA=$$PA^PSOREJU2() I PA="^" S VALMBCK="R" Q
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| 167 | W ! D SEND(,,,,PA)
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| 168 | Q
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| 169 | ;
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| 170 | SEND(COD1,COD2,COD3,CLA,PA) ; - Sends Claim to ECME and closes Reject
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| 171 | N DIR,OVRC,RESP,ALTXT,COM
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| 172 | S DIR(0)="Y",DIR("A")=" Confirm",DIR("B")="YES"
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| 173 | S DIR("A",1)=" When you confirm, a new claim will be submitted for"
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| 174 | S DIR("A",2)=" the prescription and this REJECT will be marked"
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| 175 | S DIR("A",3)=" resolved."
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| 176 | S DIR("A",4)=" "
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| 177 | W ! D ^DIR I $G(Y)=0!$D(DIRUT) S VALMBCK="R" Q
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| 178 | I $G(COD1)'="" S OVRC=$G(COD2)_"^"_$G(COD1)_"^"_$G(COD3)
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| 179 | S ALTXT="REJECT WORKLIST"
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| 180 | S:$G(OVRC)'="" ALTXT=ALTXT_"-DUR OVERRIDE CODES("_$G(COD1)_"/"_$G(COD2)_"/"_$G(COD3)_")"
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| 181 | S:$G(CLA) ALTXT=ALTXT_"(CLARIF. CODE="_CLA_")"
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| 182 | S:$G(PA) ALTXT=ALTXT_"(PRIOR AUTH.="_$TR(PA,"^","/")_")"
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| 183 | D ECMESND^PSOBPSU1(RX,FILL,,"ED",$$GETNDC^PSONDCUT(RX,FILL),,,$G(OVRC),,.RESP,,ALTXT,$G(CLA),$G(PA))
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| 184 | I $G(RESP) D Q
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| 185 | . W !!?10,"Claim could not be submitted. Please try again later!"
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| 186 | . W !,?10,"Reason: ",$S($P(RESP,"^",2)="":"UNKNOWN",1:$P(RESP,"^",2)),$C(7) H 2
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| 187 | ;
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| 188 | I $$PTLBL^PSOREJP2(RX,FILL) D PRINT(RX,FILL)
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| 189 | ;
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| 190 | I $D(PSOSTFLT),PSOSTFLT'="B" S CHANGE=1
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| 191 | Q
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| 192 | ;
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| 193 | MP ; - Patient Medication Profile
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| 194 | I $G(PSOBACK) D Q
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| 195 | . S VALMSG="Not available through Backdoor!",VALMBCK="R"
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| 196 | N SITE,PATIENT
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| 197 | D FULL^VALM1 W !
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| 198 | S SITE=+$$RXSITE^PSOBPSUT(RX,FILL) S:$G(PSOSITE) SITE=PSOSITE
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| 199 | S PATIENT=+$$GET1^DIQ(52,RX,2,"I")
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| 200 | D LST^PSOPMP0(SITE,PATIENT) S VALMBCK="R"
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| 201 | Q
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| 202 | ;
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| 203 | EXIT ;
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| 204 | K ^TMP("PSOREJP1",$J)
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| 205 | Q
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| 206 | ;
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| 207 | SETLN(TEXT,REV,UND,HIG) ; Sets a line to be displayed in the Body section
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| 208 | N X
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| 209 | S:$G(TEXT)="" $E(TEXT,80)=""
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| 210 | S:$L(TEXT)>80 TEXT=$E(TEXT,1,80)
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| 211 | S LINE=LINE+1,^TMP("PSOREJP1",$J,LINE,0)=$G(TEXT)
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| 212 | ;
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| 213 | I LINE>$G(LASTLN) D SAVE^VALM10(LINE) S LASTLN=LINE
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| 214 | ;
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| 215 | I $G(REV) D Q
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| 216 | . D CNTRL^VALM10(LINE,1,$L(TEXT),IORVON,IOINORM)
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| 217 | . I $G(UND) D CNTRL^VALM10(LINE,$L(TEXT)+1,80,IOUON,IOINORM)
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| 218 | I $G(UND) D CNTRL^VALM10(LINE,1,80,IOUON,IOINORM)
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| 219 | I $G(HIG) D
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| 220 | . D CNTRL^VALM10(LINE,HIG,80,IOINHI_$S($G(UND):IOUON,1:""),IOINORM)
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| 221 | Q
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| 222 | HELP ;
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| 223 | Q
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| 224 | ;
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| 225 | RXINFO(RX,FILL,LINE) ; Returns header displayable Rx Information
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| 226 | N TXT,RXINFO,LBL,CMOP,DRG
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| 227 | I LINE=1 D
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| 228 | . S RXINFO="Rx# : "_$$GET1^DIQ(52,RX,.01)_"/"_FILL
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| 229 | . S $E(RXINFO,30)="ECME#: "_$E(10000000+RX,2,8)
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| 230 | . S $E(RXINFO,55)="Fill Date: "_$$FMTE^XLFDT($$RXFLDT^PSOBPSUT(RX,FILL))
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| 231 | I LINE=2 D
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| 232 | . S DRG=$$GET1^DIQ(52,RX,6,"I"),CMOP=$S($D(^PSDRUG("AQ",DRG)):1,1:0)
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| 233 | . S RXINFO=$S(CMOP:"CMOP ",1:"")_"Drug",$E(RXINFO,10)=": "_$E($$GET1^DIQ(52,RX,6),1,43)
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| 234 | . S $E(RXINFO,56)="NDC Code: "_$$GETNDC^PSONDCUT(RX,FILL)
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| 235 | Q $G(RXINFO)
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| 236 | ;
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| 237 | CLOSED(RX,REJ,MSG) ; Returns whether the REJECT is RESOLVED or NOT
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| 238 | I $$GET1^DIQ(52.25,REJ_","_RX,10,"I") D:$G(MSG) Q 1
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| 239 | . S VALMSG="This Reject is marked resolved!",VALMBCK="R" W $C(7)
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| 240 | Q 0
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| 241 | ;
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| 242 | REOPN(RX,REJ) ; Returns whether the REJECT was RE-OPENED or NOT
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| 243 | Q $S($$GET1^DIQ(52.25,REJ_","_RX,23)="":0,1:1)
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| 244 | ;
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| 245 | EXP(CODE) ; - Returns the explanation field (.02) for a reject code
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| 246 | ; Input: (r) CODE - .01 field (Code) value from file 9002313.93
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| 247 | ; Output: .02 field (Explanation) value from file 9002313.93
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| 248 | N DIC,X,Y
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| 249 | S DIC=9002313.93,DIC(0)="Z",X=CODE D ^DIC
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| 250 | Q $P($G(Y(0)),"^",2)
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| 251 | ;
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| 252 | OUT(RX) ; - Supported call by outside PROTOCOLs to act on specific REJECTs
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| 253 | N I,RFL,DATA,REJ,PSOBACK,VALMCNT
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| 254 | S PSOBACK=1
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| 255 | S (RFL,I)=0 F I=1:1 Q:'$D(^PSRX(RX,1,I)) S RFL=I
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| 256 | S X=$$FIND^PSOREJUT(RX,RFL,.DATA) S REJ=$O(DATA(""))
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| 257 | I '$G(REJ) S VALMSG="Invalid selection!",VALMBCK="R" Q
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| 258 | D EN(RX,REJ) S VALMBCK="R"
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| 259 | Q
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| 260 | ;
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| 261 | PRINT(RX,RFL) ; Print Label for specific Rx/Fill
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| 262 | N PPL,PSOSITE,PSOPAR,PSOSYS,PSOLAP,PSOBARS,PSOBAR0,PSOBAR1,PSOIOS,PSOBFLAG
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| 263 | N POP,DFN,PDUZ,RXFL
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| 264 | ;
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| 265 | S PSOSITE=$$RXSITE^PSOBPSUT(RX,RFL),PSOPAR=^PS(59,PSOSITE,1)
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| 266 | S DFN=$$GET1^DIQ(52,RX,2,"I"),PDUZ=DUZ,PSOSYS=$G(^PS(59.7,1,40.1))
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| 267 | S PPL=RX I RFL S RXFL(RX)=RFL
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| 268 | W ! S PSOBFLAG=1 D LBL^PSOLSET I $G(PSOQUIT) Q
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| 269 | ;
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| 270 | S IOP=PSOLAP D ^%ZIS,DQ^PSOLBL,^%ZISC
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| 271 | Q
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