| 1 | IBCBB8 ;ALB/BGA - CON'T MEDICARE EDIT CHECKS ;08/12/98
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| 2 | ;;2.0;INTEGRATED BILLING;**51,137,210,349**;21-MAR-94;Build 46
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| 3 | ;;Per VHA Directive 2004-038, this routine should not be modified.
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| 4 | ;
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| 5 | ; UB-04 CLAIM CERTIFICATE ID NUMBER
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| 6 | I '$$VALID(IBIFN) S IBQUIT=$$IBER^IBCBB3(.IBER,215) Q:IBQUIT
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| 7 | ;
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| 8 | ; Req. on Primary Payor when Medicare is secondary and value 12-15,43
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| 9 | I $$COBN^IBCEF(IBIFN)=2 D Q:IBQUIT
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| 10 | . I $O(IBVALCD(16),-1)'<12!$D(IBVALCD(43)) D
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| 11 | . . K IBXDATA D F^IBCEF("N-ALL INSURED EMPLOYER INFO",,,IBIFN)
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| 12 | . . ; employer name^city^state abbreviation^state ien
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| 13 | . . ;I '$O(IBXDATA(0)) S IBQUIT=$$IBER^IBCBB3(.IBER,222) Q
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| 14 | . . ; Employer name missing
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| 15 | . . ;I $P($G(IBXDATA(1)),U)="" S IBQUIT=$$IBER^IBCBB3(.IBER,222)
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| 16 | . . ; Employer address missing
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| 17 | . . ;I $TR($P($G(IBXDATA(1)),U,2,4),U)="" S IBQUIT=$$IBER^IBCBB3(.IBER,223)
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| 18 | . ;
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| 19 | . ; Insured's Group Number
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| 20 | . ; if Medicare is secondary, need insurance group number for primary
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| 21 | . K IBXDATA D F^IBCEF("N-ALL INSURANCE GROUP NUMBER",,,IBIFN)
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| 22 | . I $P($G(IBXDATA(1)),U)="" S IBQUIT=$$IBER^IBCBB3(.IBER,225)
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| 23 | ;
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| 24 | ; UB-04 Diagnosis Codes
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| 25 | K IBXDATA D F^IBCEF("N-DIAGNOSES",,,IBIFN)
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| 26 | ;
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| 27 | S IBI=0
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| 28 | F S IBI=$O(IBXDATA(IBI)) Q:'IBI D Q:IBQUIT
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| 29 | . S IBDXC=$P($$ICD9^IBACSV(+$P(IBXDATA(IBI),U)),U)
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| 30 | . ; no duplicate dx
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| 31 | . I IBDXC'="",$D(IBDXARY(IBDXC)) S IBQUIT=$$IBER^IBCBB3(.IBER,227)
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| 32 | . I IBDXC'="",'$D(IBDXARY(IBDXC)) S IBDXARY(IBDXC)=IBXDATA(IBI)
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| 33 | Q:IBQUIT
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| 34 | ;
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| 35 | Q
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| 36 | ;
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| 37 | VALID(IBIFN) ; Verify HIC # is valid
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| 38 | N VAL,IBXDATA
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| 39 | S VAL=1
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| 40 | G:'$$MCRWNR^IBEFUNC(+$$CURR^IBCEF2(IBIFN)) VALQ
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| 41 | ;
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| 42 | K IBXDATA D F^IBCEF("N-CURR INSURED ID",,,IBIFN)
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| 43 | ;
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| 44 | I $G(IBXDATA)="" S VAL=0 G VALQ
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| 45 | ;
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| 46 | S IBXDATA=$TR(IBXDATA,"-")
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| 47 | I $L(IBXDATA)<9 S VAL=0 G VALQ
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| 48 | ; HIC # must pass standard MEDICARE edits
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| 49 | I '$$VALHIC^IBCNSMM(IBXDATA) S VAL=0
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| 50 | ;
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| 51 | VALQ Q VAL
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| 52 | ;
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