IBNCPDP3 ;OAK/ELZ - STORES NDC/AWP UPDATES ;20-JUN-2003 ;;2.0;INTEGRATED BILLING;**223,276,342,363**;21-MAR-94;Build 35 ;;Per VHA Directive 2004-038, this routine should not be modified. ; ; UPAWP(IBNDC,IBAWP,IBADT) ; updates AWP prices for NDCs ; N IBITEM,IBCS ; ; S IBCS=$P($G(^IBE(350.9,1,9)),"^",12) I 'IBCS Q "0^Unable to find Charge Set" ; S IBNDC=$$NDC^IBNCPDPU(IBNDC) ; S IBITEM=+$$ADDBI^IBCREF("NDC",IBNDC) I IBITEM Q "0^Unable to add item" ; I '$$ADDCI^IBCREF(IBCS,IBITEM,IBADT,IBAWP) Q "0^Unable to add charge" ; Q 1 ; ; ; ; REVERSE(DFN,IBD,IBAUTO) ;process reversed claims N IBIFN,I,IB,IBIL,IBCHG,IBCRES,IBY,X,Y,DA,DIE,DR,IBADT,IBLOCK,IBLDT N IBNOW,IBDUZ,IBCR,IBRELC,IBCC,IBPAP,IBRXN,IBFIL,IBRTS,IBARES,IBUSR S IBDUZ=.5 ; S IBLOCK=0 ; find bill number I 'DFN S IBY="0^No patient" G REVQ I '$L($G(IBD("CLAIMID"))) S IBY="0^Missing ECME Number" G REVQ S IBADT=+$G(IBD("FILL DATE")) I 'IBADT S IBY="0^Missing Fill Date" G REVQ S IBRXN=+$G(IBD("PRESCRIPTION")) I 'IBRXN S IBY="0^No Rx IEN" G REVQ S IBFIL=+$G(IBD("FILL NUMBER"),-1) I IBFIL<0 S IBY="0^No fill number" G REVQ I $E($G(IBD("RESPONSE")),1)="R" D G REVQ:+'$G(IBRTS) . S IBY="0^REVERSAL rejected by payer" . S IBRTS=$$RTS(IBD("REVERSAL REASON")) ; S IBD("BCID")=(+IBD("CLAIMID"))_";"_IBADT ; BC ID Number L +^DGCR(399,"AG",IBD("BCID")):15 E S IBY="0^Cannot lock ECME number" G REVQ S IBLOCK=1 S IBUSR=$S(+$G(IBD("USER"))=0:DUZ,1:IBD("USER")) I $D(^DGCR(399,"AG",IBD("BCID"))) S ^(IBD("BCID"))="" S IBIFN=$$MATCH^IBNCPDP2(IBD("BCID")) I $D(IBD("CLOSE REASON")),'$D(IBD("DROP TO PAPER")) S IBD("DROP TO PAPER")="" S IBCR=+$G(IBD("CLOSE REASON")) S IBPAP=$G(IBD("DROP TO PAPER")) S IBRELC=$G(IBD("RELEASE COPAY")) S IBCC=$G(IBD("CLOSE COMMENT")) D NONBR^IBNCPNB(DFN,IBRXN,IBFIL,IBADT,IBCR,IBPAP,IBRELC,IBCC,IBUSR) I 'IBIFN S IBY="0^"_$S(IBPAP:"Dropped to paper",IBCR>1:"Set non-billable reason in CT",1:"Cannot find the bill to reverse") G REVQ ; F I=0,"S" S IB(I)=$G(^DGCR(399,IBIFN,I)) I IB(0)="" S IBY="0^No data in bill" G REVQ I +$P(IB("S"),U,16),$P(IB("S"),U,17)]"" S IBY="0^Bill already cancelled" G REVQ ; S:'$D(IBCRES) IBCRES="ECME PRESCRIPTION REVERSED" S DA=IBIFN,DR="16////1;19////"_IBCRES,DIE="^DGCR(399," D ^DIE K DA,DIE,DR ; ; - decrease out the receivable in AR S IB("U1")=$G(^DGCR(399,IBIFN,"U1")) S IBIL=$P($G(^PRCA(430,IBIFN,0)),"^") S IBCHG=$S(IB("U1")']"":0,$P(IB("U1"),"^",1)]"":$P(IB("U1"),"^",1),1:0) ; S X="21^"_IBCHG_"^"_IBIL_"^"_IBDUZ_"^"_DT_"^"_IBCRES D ^PRCASER1 S IBARES=Y I IBARES<0 S IBY=IBARES D BULL ; S IBY=$S(IBARES<0:"0^"_$P(IBARES,"^",2),1:1) ; I IBDUZ'=DUZ D ; set the real user . N IBI,IBT S IBI=18,IBT(399,IBIFN_",",IBI)=IBDUZ D FILE^DIE("","IBT") ; REVQ ; perform end of job tasks D LOG^IBNCPDP2($S($G(IBAUTO)=1:"AUTO REVERSE",$G(IBAUTO)=2:"BILL CANCELLED",1:"REVERSE"),IBY) I IBLOCK L -^DGCR(399,"AG",IBD("BCID")) I IBY=1,$G(IBIFN) S IBY=+IBIFN Q IBY ; RTS(IBRR) ; Return to Stock processing on Released Rx ; input - IBRR = reversal reason ; IBCRSN = passed in by reference ; output - 0 = reversal not due to a Rx RETURN TO STOCK or Rx DELETE ; 1 = reversal due to a Rx RETURN TO STOCK or Rx DELETE ; IBCRSN = charge removal reason I IBRR'="RX RETURNED TO STOCK"&(IBRR'="RX DELETED") Q 0 N IBTRKRN,IBLOCK2,IBCMT,DA,DIE,DR S IBTRKRN=+$O(^IBT(356,"ARXFL",IBRXN,IBFIL,0)) I 'IBTRKRN Q 0 ; CT record does not exist I '$P($G(^IBT(356,IBTRKRN,0)),U,11) Q 0 ; BILL does not exist S IBCRES=$$GETRSN(DFN,IBRXN,IBFIL) ; recorded in file 399 entry L +^IBT(356,IBTRKRN):5 S IBLOCK2=$T S DIE="^IBT(356,",DA=IBTRKRN,IBCMT="Rx RTS - May Need Refund" S DR="1.08////"_IBCMT D ^DIE I IBLOCK2 L -^IBT(356,IBTRKRN) Q 1 ; BULL ; Generate a bulletin if there is an error in cancelling the claim. N IBC,IBT,IBPT,IBGRP,XMDUZ,XMTEXT,XMSUB,XMY ; S IBPT=$$PT^IBEFUNC(DFN) S XMSUB=$E($P(IBPT,"^"),1,14)_" "_$P(IBPT,"^",3)_" - ERROR ENCOUNTERED" S XMDUZ="INTEGRATED BILLING PACKAGE",XMTEXT="IBT(" S XMY(IBDUZ)="" S XMY("G.IBCNR EPHARM")="" ; S IBT(1)="An error occurred while cancelling the Pharmacy claim from ECME" S IBT(2)="fiscal intermediary for the following patient:" S IBT(3)=" " S IBC=3 D PAT^IBAERR1 ; Accepts IBDUZ S IBC=IBC+1,IBT(IBC)=" Bill #: "_IBIL S IBC=IBC+1,IBT(IBC)=" " S IBC=IBC+1,IBT(IBC)="The following error was encountered:" S IBC=IBC+1,IBT(IBC)=" " D ERR^IBAERR1 S IBC=IBC+1,IBT(IBC)=" " S IBC=IBC+1,IBT(IBC)="Please review the circumstances surrounding this error and decrease" S IBC=IBC+1,IBT(IBC)="out this receivable in Accounts Receivable if necessary." D ^XMD Q ; GETRSN(DFN,IBRXN,IBFIL) ; ; retrieve charge removal reason from file 354.71 ; input - DFN,IBRXN=Rx ien,IBFIL=fill number ; output - charge removal reason N IBDT,IBDA,IBXRSN,IBRXFIL,IB0 S (IBDT,IBDA)=0,IBXRSN="" S IBRXFIL=$S('IBFIL:IBRXN,1:IBRXN_";"_IBFIL) F S IBDT=$O(^IBAM(354.71,"AD",DFN,IBDT)) Q:'IBDT Q:IBXRSN]"" D . F S IBDA=$O(^IBAM(354.71,"AD",DFN,IBDT,IBDA)) Q:'IBDA Q:IBXRSN]"" D . . S IB0=^IBAM(354.71,IBDA,0) . . Q:$P(IB0,"^",6)'[IBRXFIL . . S IBXRSN=$$GET1^DIQ(354.71,IBDA_",",.19) S:IBXRSN']"" IBXRSN="CHARGE REMOVAL REASON NOT FOUND" Q "Reversal Rej, no pymt due<>"_IBXRSN ; ;IBNCPDP3