| 1 | IBACUS ;ALB/CPM - TRICARE BILLING UTILITIES ; 02-AUG-96
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| 2 | ;;2.0;INTEGRATED BILLING;**52,240,274**;21-MAR-94
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| 3 | ;;Per VHA Directive 10-93-142, this routine should not be modified.
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| 4 | ;
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| 5 | CUS(DFN,IBDT) ; Does the patient have TRICARE coverage?
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| 6 | ; Input: DFN -- Pointer to the patient in file #2
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| 7 | ; DATE -- Date on which coverage is to be determined
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| 8 | ; Output: IBCOV -- 0, if the vet has no billable TRICARE coverage
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| 9 | ; >0 => pointer to such coverage in file #2.312
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| 10 | ;
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| 11 | N IBCOV,IBPOL,IBI
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| 12 | S IBCOV=0
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| 13 | I '$G(DFN) G CUSQ
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| 14 | S:'$G(IBDT) IBDT=DT
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| 15 | ;
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| 16 | ; - find a billable TRICARE policy
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| 17 | D ALL^IBCNS1(DFN,"IBPOL",1,IBDT)
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| 18 | S IBI=0 F S IBI=$O(IBPOL(IBI)) Q:'IBI D Q:IBCOV
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| 19 | .Q:$P($G(IBPOL(IBI,3)),"^",4) ; ignore billing this policy
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| 20 | .I $P($G(^IBE(355.1,+$P($G(IBPOL(IBI,355.3)),"^",9),0)),"^",3)=7 S IBCOV=IBI
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| 21 | CUSQ Q IBCOV
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| 22 | ;
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| 23 | ;
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| 24 | TRI() ; Is the Tricare Billing engine up and running?
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| 25 | ; Input: none
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| 26 | ; Output: 0 - No 1 - Yes
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| 27 | ;
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| 28 | Q $P($G(^IBE(350.9,1,9)),"^",4)>0
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| 29 | ;
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| 30 | ;
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| 31 | CHPUS(DFN,DATE,IBRX,IBREF,IBLAB,IBRSITE,IBDUZ) ; Bill this patient for TRICARE?
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| 32 | ; Input: DFN -- Pointer to the patient in file #2
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| 33 | ; DATE -- Date on which coverage is to be determined
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| 34 | ; IBRX -- Pointer to the prescription in file #52
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| 35 | ; IBREF -- Pointer to the refill in file #52.1, or
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| 36 | ; 0 if billing the original prescription
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| 37 | ; IBLAB -- Pharmacy label printing device
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| 38 | ; IBRSITE -- Pointer to the Pharmacy in file #59
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| 39 | ; IBDUZ -- Pointer to the Pharmacy user in file #200
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| 40 | ; Output: IBCHK -- 0 => can't bill rx || 1 => bill rx
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| 41 | ;
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| 42 | N IBCHK,IBKEY S IBCHK=0
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| 43 | I '$G(DFN) G CHPUSQ
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| 44 | D POL^IBCNSU41(DFN)
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| 45 | ;
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| 46 | ; - make sure system is running and the patient has TRICARE coverage
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| 47 | I '$$TRI() G CHPUSQ
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| 48 | I '$$CUS(DFN,DATE) G CHPUSQ
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| 49 | ;
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| 50 | ; - check remaining user input
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| 51 | I '$G(IBRX) G CHPUSQ
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| 52 | I $G(IBREF)="" G CHPUSQ
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| 53 | I $G(IBLAB)=""!('$G(IBRSITE))!('$G(IBDUZ)) G CHPUSQ
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| 54 | ;
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| 55 | ; - perform all Pharmacy edits
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| 56 | I '$$CHK^PSOCPTRI(IBRX,IBREF) G CHPUSQ
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| 57 | ;
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| 58 | ; - queue rx for billing
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| 59 | S IBCHK=1,IBKEY=IBRX_";"_IBREF
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| 60 | S ^IBA(351.5,"APOST",IBKEY)=IBLAB_"^"_IBRSITE_"^"_IBDUZ
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| 61 | ;
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| 62 | CHPUSQ Q IBCHK
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| 63 | ;
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| 64 | ;
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| 65 | ;
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| 66 | ;
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| 67 | ; The following three queued entry points are invoked by the
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| 68 | ; TRICARE Rx Billing engine. The following two variables are
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| 69 | ; defined for each of the jobs:
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| 70 | ;
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| 71 | ; IBCHTRN -- Pointer to the transaction entry in file #351.5
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| 72 | ; IBKEYD -- 1 ^ 2 ^ 3, where
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| 73 | ; 1 = Rx label printing device
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| 74 | ; 2 = Pointer to the Pharmacy in file #59
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| 75 | ; 3 = Pointer to the Pharmacy user in file #200
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| 76 | ;
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| 77 | RXLAB ; Queued entry point to print the TRICARE Rx label.
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| 78 | I $G(IBKEYD)="" G RXLABQ
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| 79 | S IBCOP=$J(+$G(^IBA(351.5,+$G(IBCHTRN),2)),0,2)
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| 80 | I 'IBCOP G RXLABQ
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| 81 | D LABEL^PSOCPTRI(+$G(^IBA(351.5,IBCHTRN,0)),$P(IBKEYD,"^"),$P(IBKEYD,"^",2),$P(IBKEYD,"^",3),IBCOP)
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| 82 | RXLABQ K IBCOP
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| 83 | Q
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| 84 | ;
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| 85 | ;
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| 86 | RXBIL ; Queued entry point to create TRICARE Rx Billing charges.
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| 87 | ;
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| 88 | ; - check some basic input
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| 89 | I '$$RXSET G RXBILQ
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| 90 | ;
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| 91 | ; - create copay charge
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| 92 | D BILL^IBACUS1(IBKEY,IBCHTRN)
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| 93 | ;
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| 94 | ; - create fiscal intermediary claim
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| 95 | D BILL^IBACUS2(IBKEY,IBCHTRN)
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| 96 | ;
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| 97 | RXBILQ Q
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| 98 | ;
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| 99 | ;
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| 100 | RXCAN ; Queued entry point to cancel TRICARE Rx Billing charges.
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| 101 | ;
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| 102 | ; - check some basic input
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| 103 | I '$$RXSET G RXCANQ
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| 104 | ;
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| 105 | ; - cancel copay charge
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| 106 | D CANC^IBACUS1(IBCHTRN)
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| 107 | ;
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| 108 | ; - cancel fiscal intermediary claim
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| 109 | D CANC^IBACUS2(IBCHTRN)
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| 110 | ;
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| 111 | RXCANQ Q
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| 112 | ;
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| 113 | ;
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| 114 | RXSET() ; Establish the session.
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| 115 | N IBOK S IBOK=0
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| 116 | ;
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| 117 | ; - check some basic input
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| 118 | I '$G(IBCHTRN) G RXSETQ
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| 119 | S IBKEY=$P($G(^IBA(351.5,IBCHTRN,0)),"^")
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| 120 | I IBKEY="" G RXSETQ
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| 121 | S DUZ=+$P(IBKEYD,"^",3)
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| 122 | I $G(^VA(200,DUZ,0))="" G RXSETQ
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| 123 | ;
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| 124 | N DIQUIET S DIQUIET=1 D DT^DICRW
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| 125 | S IBOK=1
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| 126 | ;
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| 127 | RXSETQ Q IBOK
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