| 1 | BPSOSQ2 ;BHAM ISC/FCS/DRS/DLF - form transmission packets ;06/01/2004
|
|---|
| 2 | ;;1.0;E CLAIMS MGMT ENGINE;**1,5**;JUN 2004;Build 45
|
|---|
| 3 | ;;Per VHA Directive 2004-038, this routine should not be modified.
|
|---|
| 4 | ; Construct packets for transmission
|
|---|
| 5 | Q
|
|---|
| 6 | ;
|
|---|
| 7 | PACKETS ; EP - Tasked by BPSOSQA
|
|---|
| 8 | ;
|
|---|
| 9 | ; Initialize
|
|---|
| 10 | N ERROR,RXILIST,STATUS
|
|---|
| 11 | ;
|
|---|
| 12 | ; First handle insurer alseep transactions
|
|---|
| 13 | D STATUS31^BPSOSQF
|
|---|
| 14 | ;
|
|---|
| 15 | ; Handle claims that need the packet to be built
|
|---|
| 16 | I $D(^BPST("AD",30)) D STATUS30
|
|---|
| 17 | ;
|
|---|
| 18 | ; If there are still any claims with status 30 (perhaps due to failed
|
|---|
| 19 | ; LOCK59), queue up BPSOSQ2 to run again
|
|---|
| 20 | I $O(^BPST("AD",30,0)) H 60 D TASK^BPSOSQA
|
|---|
| 21 | Q
|
|---|
| 22 | ;
|
|---|
| 23 | ; Walk through claims at 30%, bundle, and create the claim
|
|---|
| 24 | STATUS30 ;
|
|---|
| 25 | N IEN59
|
|---|
| 26 | S IEN59=""
|
|---|
| 27 | I '$$LOCK59(30) Q
|
|---|
| 28 | ;
|
|---|
| 29 | ; Loop though claims at 30%, bundle with other 30% claims, and process
|
|---|
| 30 | F S IEN59=$$NEXT59(IEN59,30) Q:IEN59="" D
|
|---|
| 31 | . ; Intialize the list
|
|---|
| 32 | . K RXILIST
|
|---|
| 33 | . S RXILIST(IEN59)=""
|
|---|
| 34 | . ;
|
|---|
| 35 | . ; Update the status to 40 (Building the packet)
|
|---|
| 36 | . D SETSTAT^BPSOSU(IEN59,40)
|
|---|
| 37 | . ;
|
|---|
| 38 | . ; If reversal, only one claim per packet
|
|---|
| 39 | . I $G(^BPST(IEN59,4)) G POINTX
|
|---|
| 40 | . ;
|
|---|
| 41 | . ; If prior auth are entered, only one claim per packet
|
|---|
| 42 | . G:$$CHKPA() POINTX
|
|---|
| 43 | . ;
|
|---|
| 44 | . ; Code below is for bundling claims. The VA is not doing this
|
|---|
| 45 | . ; so we are skipping it. However, the code is left here in
|
|---|
| 46 | . ; case we do bundling in the future. If so, the code will need to be
|
|---|
| 47 | . ; rewritten to look at the corect fields.
|
|---|
| 48 | . G POINTX
|
|---|
| 49 | . ;
|
|---|
| 50 | . N RA0,RA1 S RA0=^BPST(IEN59,0),RA1=^(1)
|
|---|
| 51 | . N IEN59 S IEN59="" ; preserve the top-level index!
|
|---|
| 52 | . F S IEN59=$$NEXT59(IEN59,30) Q:'IEN59 D
|
|---|
| 53 | .. N RB0,RB1 S RB0=^BPST(IEN59,0),RB1=^(1)
|
|---|
| 54 | .. ; Only bundle when you have the same:
|
|---|
| 55 | .. ; Patient, Visit, Division, Division Source, Insurer, Pharmacy
|
|---|
| 56 | .. I $P(RA0,U,6,7)'=$P(RB0,U,6,7) Q
|
|---|
| 57 | .. I $P(RA1,U,4,7)'=$P(RB1,U,4,7) Q
|
|---|
| 58 | .. I $P(RB0,U,2)'=30 Q ; might have been canceled, or maybe 31'd
|
|---|
| 59 | .. D SETSTAT^BPSOSU(IEN59,40)
|
|---|
| 60 | .. S RXILIST(IEN59)=""
|
|---|
| 61 | POINTX . ; Reversals and prior auth claims branch to here to bypass multi-claim packeting
|
|---|
| 62 | . ;
|
|---|
| 63 | . ; BPSOSQG will build the claim data, create the packet, and send to HL7
|
|---|
| 64 | . S ERROR=$$PACKET^BPSOSQG
|
|---|
| 65 | . ;
|
|---|
| 66 | . ; If an error is returned, log the error to each transaction
|
|---|
| 67 | . I ERROR S IEN59="" F S IEN59=$O(RXILIST(IEN59)) Q:IEN59="" D
|
|---|
| 68 | .. D ERROR^BPSOSU($T(+0),IEN59,$P(ERROR,U),$P(ERROR,U,2,$L(ERROR,U)))
|
|---|
| 69 | D UNLOCK59(30)
|
|---|
| 70 | Q
|
|---|
| 71 | ;
|
|---|
| 72 | NEXT59(IEN59,STATUS) ;EP - BPSOSQF
|
|---|
| 73 | N INS,PAYSH,PAYSHNM,RETRY
|
|---|
| 74 | N59A ;
|
|---|
| 75 | ; Get next transaction for the given status
|
|---|
| 76 | S IEN59=$O(^BPST("AD",STATUS,IEN59))
|
|---|
| 77 | I IEN59="" Q IEN59 ; end of list, return ""
|
|---|
| 78 | ;
|
|---|
| 79 | ; but if the insurer is asleep, don't take this one
|
|---|
| 80 | S INS=$P(^BPST(IEN59,9),U,1)
|
|---|
| 81 | ;
|
|---|
| 82 | ; Not sure when this would happen, but do not want to take it out
|
|---|
| 83 | I INS="" S INS=1,$P(^BPST(IEN59,9),U,1)=INS ;LJE;8/25/03 ;current insurance
|
|---|
| 84 | ;
|
|---|
| 85 | ; Get the payer sheet, name, and retry time
|
|---|
| 86 | S PAYSH=$$PAYERSH^BPSOSQF(IEN59)
|
|---|
| 87 | S PAYSHNM=$$GET1^DIQ(9002313.92,PAYSH_",",.01,"E")
|
|---|
| 88 | S RETRY=$$GET1^DIQ(9002313.92,PAYSH_",",1.12,"I") ;RETRY TIME
|
|---|
| 89 | ;
|
|---|
| 90 | ; If no retry time, insurer is not asleep and we can return the transaction
|
|---|
| 91 | I 'RETRY Q IEN59
|
|---|
| 92 | ;
|
|---|
| 93 | ; Insurer is asleep -
|
|---|
| 94 | ; If necessary, update the .59's record of when to retry
|
|---|
| 95 | I $P($G(^BPST(IEN59,8)),U)'=RETRY D ;
|
|---|
| 96 | . S $P(^BPST(IEN59,8),U)=RETRY ; stamp with latest retry time
|
|---|
| 97 | . D SETSTAT^BPSOSU(IEN59,31) ; force screen update, too
|
|---|
| 98 | . D LOG^BPSOSL(IEN59,$T(+0)_"-Insurer still asleep - retry at "_RETRY_" for "_$G(PAYSHNM))
|
|---|
| 99 | ;
|
|---|
| 100 | ; If time to retry, return this transaction for processing
|
|---|
| 101 | I RETRY'>$$NOW Q IEN59
|
|---|
| 102 | ;
|
|---|
| 103 | ; If we are checking status 30, convert to insurer asleep
|
|---|
| 104 | I STATUS=30 D
|
|---|
| 105 | . D SETSTAT^BPSOSU(IEN59,31)
|
|---|
| 106 | . S $P(^BPST(IEN59,8),U)=$P($G(^BPSF(9002313.92,PAYSH,1)),"^",12)
|
|---|
| 107 | . S $P(^BPST(IEN59,8),U,3)=PAYSH
|
|---|
| 108 | ;
|
|---|
| 109 | ; Still asleep, go to next transaction
|
|---|
| 110 | G N59A
|
|---|
| 111 | ;
|
|---|
| 112 | ;
|
|---|
| 113 | LOCK59(STATUS) ;EP - BPSOSQF
|
|---|
| 114 | L +^BPST("AD",STATUS):60
|
|---|
| 115 | Q $T
|
|---|
| 116 | ;
|
|---|
| 117 | UNLOCK59(STATUS) ;EP - BPSOSQF
|
|---|
| 118 | L -^BPST("AD",STATUS)
|
|---|
| 119 | Q
|
|---|
| 120 | ;
|
|---|
| 121 | CHKPA() ;
|
|---|
| 122 | N PATYP,PANUM,PACLM
|
|---|
| 123 | S PACLM=0
|
|---|
| 124 | ;
|
|---|
| 125 | S PATYP=$P($G(^BPST(IEN59,1)),U,15) ;prior auth type code
|
|---|
| 126 | S PANUM=$P($G(^BPST(IEN59,1)),U,9) ;prior auth number
|
|---|
| 127 | I ($G(PATYP)'="")!($G(PANUM)'="") S PACLM=1
|
|---|
| 128 | ;
|
|---|
| 129 | Q PACLM
|
|---|
| 130 | ;
|
|---|
| 131 | NOW() N %,%H,%I,X D NOW^%DTC Q %
|
|---|
