source: FOIAVistA/trunk/r/INTEGRATED_BILLING-IB-PRQ--IBD--IBQ--PRQS/IBTRC.m@ 635

IBTRC ;ALB/AAS - CLAIMS TRACKING INSURANCE REVIEWS ; 27-JUN-1993
 ;;Version 2.0 ; INTEGRATED BILLING ;; 21-MAR-94
 ;;Per VHA Directive 10-93-142, this routine should not be modified.
 ;
% ;
EN ; -- main entry point for IBT COMMUNICATIONS EDITOR from menu's
 I '$D(DT) D DT^DICRW
 K XQORS,VALMEVL,IBTRN,IBTRND,IBCNT,DFN,IBTRC,IBTRV,IBTRD,IBCNS,IBCDFN,IBFASTXT,VALMQUIT,VA,VAIN,VAERR
 ;I '$D(IBTRN) D EN^IBTRE Q
 D PAT^IBCNSM I $D(VALMQUIT) G ENQ
 D TRAC^IBTRV I $D(VALMQUIT) G ENQ
 I '$G(IBTRPRF) S IBTRPRF="12"
 D EN^VALM("IBT COMMUNICATIONS EDITOR")
ENQ K XQORS,VALMEVL,IBTRN,IBTRND,IBCNT,DFN,IBTRC,IBTRV,IBTRD,IBCNS,IBCDFN,IBFASTXT,VALMQUIT,IBTRPRF,VA,VAIN,VAERR,X,Y,I,J,IBETYP
 K IBAMT,IBAPR,IBADG,IBDA,IBDGCR,IBDGCRU1,IBDV,IBETYP,IBETYPD,IBI,IBICD,IBLCNT,IBSEL,IBT,IBTEXT,IBTNOD,IBTSAV,VAUTD
 K IBAPEAL,IBCDFN,IBCNT,IBDEN,IBDENIAL,IBDENIAL,IBPARNT,IBPEN,IBPENAL,IBTCOD,IBTRDD,IBTRSV,IBTYPE,VAINDT,VA,VALMBCK,OFFSET,I1,I3,IBNEW,IBDENT,IBOE,Z1,T,SDCNT
 D KVAR^VADPT
 Q
 ;
HDR ; -- header code
 D PID^VADPT
 S VALMHDR(1)="Insurance Review Entries for: "_$$PT^IBTUTL1(DFN)_"   ROI: "_$$EXPAND^IBTRE(356,.31,$P(^IBT(356,IBTRN,0),"^",31))
 S VALMHDR(2)="                         for: "_$$EXPAND^IBTRE(356,.18,$P(IBTRND,"^",18))_" on "_$$DAT1^IBOUTL($P(IBTRND,"^",6),"2P")
 Q
 ;
INIT ; -- init variables and list array
 S U="^",VALMCNT=0,VALMBG=1
 K ^TMP("IBTRC",$J),^TMP("IBTRCDX",$J)
 K I,X,XQORNOD,DA,DR,DIE,DNM,DQ
 S IBTRND=$G(^IBT(356,IBTRN,0))
 D BLD
 Q
 ;
BLD ; -- Build list of Insurnace contacts
 K ^TMP("IBTRC",$J),^TMP("IBTRCDX",$J)
 N IBI,J,IBTRC,IBTRCD,IBTRCD1
 S VALMSG=$$MSG^IBTUTL3(DFN)
 S (IBTRC,IBCNT,VALMCNT)=0,IBI=""
 F  S IBI=$O(^IBT(356.2,"ATIDT",IBTRN,IBI)) Q:'IBI  S IBTRC=0 F  S IBTRC=$O(^IBT(356.2,"ATIDT",IBTRN,IBI,IBTRC)) Q:'IBTRC  D
 .S IBTRCD=$G(^IBT(356.2,+IBTRC,0))
 .S IBTRCD1=$G(^IBT(356.2,+IBTRC,1))
 .Q:'+$P(IBTRCD,"^",19)  ;quit if inactive
 .S IBCNT=IBCNT+1
 .S IBETYP=$G(^IBE(356.11,+$P(IBTRCD,"^",4),0))
 .W "."
 .S X=""
 .S X=$$SETFLD^VALM1(IBCNT,X,"NUMBER")
 .S X=$$SETFLD^VALM1($P($$DAT1^IBOUTL(+IBTRCD,"2P")," "),X,"DATE")
 .S X=$$SETFLD^VALM1($P($G(^DIC(36,+$P(IBTRCD,"^",8),0)),"^"),X,"INS CO")
 .S X=$$SETFLD^VALM1($$EXPAND^IBTRE(356.2,.11,$P(IBTRCD,"^",11)),X,"ACTION")
 .;
 .S X=$$SETFLD^VALM1($P(IBETYP,"^",3),X,"TYPE")
 .S X=$$SETFLD^VALM1($P(IBTRCD,"^",28),X,"PRE-CERT")
 .I $P(IBTRCD,"^",13) S X=$$SETFLD^VALM1($J($$DAY^IBTUTL3($P(IBTRCD,"^",12),$P(IBTRCD,"^",13),IBTRN),3),X,"DAYS")
 .I $P($G(^IBE(356.7,+$P(IBTRCD,"^",11),0)),"^",3)=20 S X=$$SETFLD^VALM1($J($$DAY^IBTUTL3($P(IBTRCD,"^",15),$P(IBTRCD,"^",16),IBTRN),3),X,"DAYS")
 .I $P(IBTRCD1,"^",7)!($P(IBTRCD1,"^",8)) S X=$$SETFLD^VALM1("ALL",X,"DAYS")
 .S X=$$SETFLD^VALM1($P(IBTRCD,"^",6),X,"CONTACT")
 .S X=$$SETFLD^VALM1($P(IBTRCD,"^",7),X,"PHONE")
 .S X=$$SETFLD^VALM1($P(IBTRCD,"^",9),X,"REF NO")
 .I $P(IBETYP,"^",2)=60!($P(IBETYP,"^",2)=65) D APPEAL^IBTRC3
 .D SET(X)
 Q
 ;
SET(X) ; -- set arrays
 S VALMCNT=VALMCNT+1
 S ^TMP("IBTRC",$J,VALMCNT,0)=X
 S ^TMP("IBTRC",$J,"IDX",VALMCNT,IBCNT)=""
 S ^TMP("IBTRCDX",$J,IBCNT)=VALMCNT_"^"_IBTRC
 Q
HELP ; -- help code
 S X="?" D DISP^XQORM1 W !!
 Q
 ;
EXIT ; -- exit code
 K ^TMP("IBTRC",$J),^TMP("IBTRCDX",$J)
 K IBTRC
 D CLEAN^VALM10
 Q
 ;
TYPE(IBTRC) ; -- compute default type of contact
 N TYPE,IBTRTP,IBTRN,IBSCHED
 S TYPE=""
 I '$P($G(^IBT(356.2,IBTRC,0)),"^",2) S TYPE=70 G TYPEQ ;no tracking id default is patient
 S IBTRN=$P($G(^IBT(356.2,IBTRC,0)),"^",2),IBTRTP=$$TRTP^IBTRE1(IBTRN)
 ;
 ; -- if from a review
 I $G(IBTRV) S TYPE=$$TRTP^IBTRV(IBTRV) G TYPEQ ; if from review use review type
 I IBTRTP>1 S TYPE=50 G TYPEQ ; outpatient
 S IBSCHED=$S($P($G(^DGPM(+$P($G(^IBT(356,IBTRN,0)),U,5),0)),U,25):10,1:20)
 I '$O(^IBT(356.2,"ATRTP",IBTRN,0)) S TYPE=IBSCHED G TYPEQ ; default for first is urgent admission
 S TYPE=30 ; default is continued stay
 ;
TYPEQ Q $P($G(^IBE(356.11,+$O(^IBE(356.11,"ACODE",+TYPE,0)),0)),"^")
 ;
TCODE(IBTRC) ; -- return type code for entry
 Q $P($G(^IBE(356.11,+$P($G(^IBT(356.2,+$G(IBTRC),0)),"^",4),0)),"^",2)
 ;
CONTCT(DA,Y) ; -- screen for type of contact
 ; -- called by dic(s) on lookup of type of contact field in 356.2
 ;
 ;"I ($P(^(0),U,2)>60&('$P(^IBT(356.2,DA,0),U,2)))!($P(^(0),U,2))"
 N IBOK,TCODE S IBOK=1
 S TCODE=$P(^(0),U,2)
 I TCODE=85 S IBOK=0 G CONTQ ;insurance verification from ins menu only
 I TCODE=15 S IBOK=0 G CONTQ ;Admission review only for hosp reviews
 I '$P($G(^IBT(356.2,DA,0)),U,2),TCODE<70 S IBOK=0 G CONTQ ;no tracking id, only patient or other
 I TCODE=60,'$P($G(^IBT(356.2,DA,0)),U,18) S IBOK=0 G CONTQ ;appeals must have an associated parent denial
 S IBTRTP=$$TRTP^IBTRE1($P($G(^IBT(356.2,DA,0)),U,2))
 I IBTRTP>1,TCODE<50 S IBOK=0 ; not inpatient care, not inpt codes
CONTQ Q IBOK