| 1 | IBCNSU3 ;ALB/TMP - Functions for billing decisions; 08-AUG-95
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| 2 | ;;2.0;INTEGRATED BILLING;**43,80**;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 | PTCOV(DFN,IBVDT,IBCAT,ANYINS) ; Determine if patient is covered for coverage category on a visit dt
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| 6 | ; Function returns 1 if covered, 0 if not covered
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| 7 | ; DFN - ifn of patient (req)
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| 8 | ; IBVDT - fileman format visit date (req)
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| 9 | ; IBCAT - entry in file 355.31 limitation of coverage category (req)
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| 10 | ; ANYINS - optional parameter, but if passed by reference, returns 0 if
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| 11 | ; no active insurance at all and 1 if any active insurance found
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| 12 | N IBCOV,IBDD,PLAN,POLCY
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| 13 | S (IBCOV,ANYINS)=0
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| 14 | I $G(DFN)=""!($G(IBCAT)="")!($G(IBVDT)="") G PTCOVQ ; Required fields not present
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| 15 | S IBCAT=$O(^IBE(355.31,"B",IBCAT,"")) G:IBCAT="" PTCOVQ
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| 16 | S IBVDT=IBVDT\1
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| 17 | D ALL^IBCNS1(DFN,"IBDD",1,IBVDT) ;All active ins policies returned in IBDD array
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| 18 | S ANYINS=($O(IBDD(0))'="") ;Set flag for any active insurance found
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| 19 | S POLCY=0 F S POLCY=$O(IBDD(POLCY)) Q:'POLCY D Q:IBCOV
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| 20 | .S PLAN=$P($G(IBDD(POLCY,0)),U,18) Q:PLAN=""
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| 21 | .S IBCOV=$$PLCOV(PLAN,IBVDT,IBCAT)
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| 22 | .I 'IBCOV,$D(^IBA(355.7,"APP",DFN,POLCY,+$P($G(^IBE(355.31,+IBCAT,0)),U,3)))'=0 S IBCOV=1
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| 23 | PTCOVQ Q IBCOV
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| 24 | ;
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| 25 | PLCOV(IBPL,IBVDT,IBCAT,COMMENT) ; Determine if a specific plan covers a category of coverage as of a date and returns comments
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| 26 | ; IBPL - pointer to file 355.3 group insurance plan (req)
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| 27 | ; IBVDT - fileman format visit date (req)
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| 28 | ; IBCAT - pointer to file 355.31 limitation of coverage category (req)
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| 29 | ; COMMENT - if passed by reference and the coverage is conditional will contain limitation comments
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| 30 | N CATLIM,X,Y K COMMENT
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| 31 | S CATLIM=$O(^IBA(355.32,"APCD",IBPL,IBCAT,+$O(^IBA(355.32,"APCD",IBPL,IBCAT,-(IBVDT+1))),""))
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| 32 | S X=$S(CATLIM="":1,1:+$P($G(^IBA(355.32,CATLIM,0)),U,4))
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| 33 | I X>1 S COMMENT=CATLIM,Y=0 F S Y=$O(^IBA(355.32,CATLIM,2,Y)) Q:'Y S COMMENT(Y)=$G(^IBA(355.32,CATLIM,2,Y,0))
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| 34 | Q X
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| 35 | ;
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| 36 | RIDERS(DFN,IBCDFN,RIDERS) ; Returns all Riders (355.7) associated with a patient's policy in array if RIDERS is passed by reference
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| 37 | N Y K RIDERS
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| 38 | I +$G(DFN),+$G(IBCDFN) S Y=0 F S Y=$O(^IBA(355.7,"APP",DFN,IBCDFN,Y)) Q:'Y S RIDERS(Y)=$P($G(^IBE(355.6,Y,0)),U,1)
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| 39 | Q
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