source: FOIAVistA/trunk/r/OUTPATIENT_PHARMACY-PSO-APSP-HUIP/PSOCP.m@ 1397

Last change on this file since 1397 was 628, checked in by George Lilly, 15 years ago

initial load of FOIAVistA 6/30/08 version
File size: 9.0 KB
Line 
1PSOCP ;BIR/BAB - Pharmacy CO-PAY Application Utilities for IB ;02/06/92
2 ;;7.0;OUTPATIENT PHARMACY;**20,46,71,85,137,157,143,219,239,201**;DEC 1997
3 ;
4 ;REF/IA - IBARX/125, SDCO22/1579, PS(55/2228, PSDRUG(/221, DGMSTAPI/2716
5CP ;Check if COPAY-Requires RXP,PSOSITE7
6 I '$D(PSOPAR) D ^PSOLSET G CP
7 K PSOCP
8 S PSOCPN=$P(^PSRX(RXP,0),"^",2) ; Set COPAY dfn PTR TO PATIENT
9 S PSOCP=$P($G(^PSRX(RXP,"IB")),"^") ; IB action type
10 S PSOSAVE=$S(PSOCP:1,1:"") ; save current copay status
11 ; Set x=service^dfn^actiontype^user duz
12 I +$G(PSOSITE7)'>0 S PSOSITE7=$P(^PS(59,PSOSITE,"IB"),"^")
13 S X=PSOSITE7_"^"_PSOCPN_"^"_PSOCP_"^"_$P(^PSRX(RXP,0),"^",16)
14 ;
15RX ;Determine Orig or Refill for RX
16 N PSOIB,PSOPFS S (PSOIB,PSOREF)=0
17 I $G(^PSRX(RXP,1,+$G(YY),0))]"" S PSOREF=YY
18 D PFSA^PSOPFSU1(RXP,PSOREF,2) G PFS:+PSOPFS
19 ; Check if bill exists
20 I 'PSOREF,+$P($G(^PSRX(RXP,"IB")),"^",2)>0 D CHKIB^PSOCP1 I PSOIB G QUIT
21 I 'PSOREF,+$P($G(^PSRX(RXP,"IB")),"^",4)>0 G QUIT ; 'POTENTIAL BILL' - ALREADY ATTEMPTED TO BILL, BUT EXCEEDED ANNUAL COPAY CAP
22 I PSOREF,+$G(^PSRX(RXP,1,PSOREF,"IB")) D CHKIB^PSOCP1 I PSOIB G QUIT
23 I PSOREF,+$P($G(^PSRX(RXP,1,PSOREF,"IB")),"^",2) G QUIT ; POTENTIAL BILL
24PFS ;
25 S PSOCHG=1 ; set tem var to copay and check exception
26 N MAILMSG
27 D COPAYREL
28 I 'PSOCHG D D:PSOPFS CHRG^PSOPFSU1(RXP,PSOREF,"CG",PSOPFS) G QUIT
29 . I PSOSAVE S PSODA=RXP,PREA="R" D ACTLOG^PSOCPA S $P(^PSRX(RXP,"IB"),"^",1)=""
30 I PSOCHG=2 D I 'PSOCP D:PSOPFS CHRG^PSOPFSU1(RXP,PSOREF,"CG",PSOPFS) G QUIT ; IF 'SC' QUESTION APPLIES, BUT HAS NOT BEEN ANSWERED, SEND MAIL MSG AND KEEP COPAY STATUS AS IT WAS
31 . D MAIL2^PSOCPE ; SEND MAIL TO PHARMACIST, PROVIDER, AND HOLDERS OF THE PSO COPAY KEY
32 I PSOCHG=1,PSOSAVE="" D I PSOREF S PSOCOMM="",PSOOLD="No Copay",PSONW="Copay" S PSODA=RXP,PREA="R" D ACTLOG^PSOCPA
33 . I '$D(^PSRX(RXP,"IB")),'PSOREF S $P(^PSRX(RXP,"IB"),"^",1)=1 Q
34 . S $P(^PSRX(RXP,"IB"),"^",1)=1
35 . S PSOCP=1,$P(X,"^",3)=PSOCP
36 I PSOCHG'=2 I $G(MAILMSG) D MAIL2^PSOCPE ; SEND MAIL TO PHARM, PROV, AND HOLDERS OF PSO COPAY KEY HOLDERS
37 ; Units for COPAY
38 S PSOCPUN=$P(($P(^PSRX(RXP,0),"^",8)+29)/30,".",1)
39 ; Build softlink for x(n)=softlink^units
40 S X(1)="52:"_RXP S:PSOREF>0 X(1)=X(1)_";1:"_PSOREF S X(1)=X(1)_"^"_PSOCPUN
41 ; Set correct user duz if refill
42 I PSOREF S:+$P(^PSRX(RXP,1,PSOREF,0),"^",7)>0 $P(X,"^",4)=$P(^PSRX(RXP,1,PSOREF,0),"^",7)
43 ;
44IBNEW ; Load ^TMP global for IB call
45 Q:$G(RXP)'>0
46 I PSOPFS D CHRG^PSOPFSU1(RXP,PSOREF,"CG",PSOPFS)
47 G QUIT:PSOPFS
48 N D0
49 G QUIT:'$D(X)
50 S XTMP=X,XTMP(1)=X(1)
51 ;
52 ; Requires x=service^dfn^action type^user duz
53 ; x(n)=softlink^units
54 I $P(X,"^",3)="" S $P(X,"^",3)=$P(^PSRX(RXP,"IB"),"^",1)
55 D NEW^IBARX
56 ; Returns y=1^total charges for this group or Y=-1^error code
57 ; y(n)=IB number^charge for this Rx^AR bill #^Cap met^Partial or Full charge^Copay Exempt^Number from file 354.71
58 ; Cap met ('1' - If patient has met cap amount or reached cap with this charge or '0' if not)
59 ; Partial or Full ('P' for partial billing, 'F' for full billing, null for no billing)
60 ; Copay Exempt - ('1' for exempt, '0' for non-exempt, '-1' for copay off (manila)),
61 ; ('1' - If patient has met cap amount or reach cap with this charge
62 ; Entry from file 354.71 will only be saved for fills that met the annual cap and could not be fully billed
63 ;
64 G QUIT:+Y=-1
65 S XTMP=XTMP_"^"_Y,XTMP(1)=XTMP(1)_"^"_Y(1)
66 ;
67 ; see if exempt or copay cap was met
68 I $P(Y(1),"^",6) D G QUIT
69 . S PREA="R",PSOOLD="Copay",PSONW="No Copay"
70 . S PSOCOMM="RX COPAY INCOME EXEMPTION" S PSODA=RXP D ACTLOG^PSOCPA
71 . S $P(^PSRX(RXP,"IB"),"^",1)=""
72 I $P(Y(1),"^",4) D
73 . S PSOCOMM=$S($P(Y(1),"^",5)="F":" FULL BILLING FOR THIS FILL",$P(Y(1),"^",5)="P":" PARTIAL BILLING FOR THIS FILL ",1:" NO BILLING FOR THIS FILL")
74 . S PREA="A"
75 . S PSODA=RXP D ACTLOG^PSOCPA
76 . I $P(Y(1),"^",5)'="F" D
77 . . I PSOREF S $P(^PSRX(RXP,1,PSOREF,"IB"),"^",2)=$P(Y(1),"^",7) Q
78 . . S $P(^PSRX(RXP,"IB"),"^",4)=$P(Y(1),"^",7)
79 I $P(Y(1),"^",1)="" G QUIT
80 ;
81FILE ;File IB number in ^PSRX
82 S PSOCP2=0
83 S PSOCP2=+$P(XTMP(1),":",3)
84 S:PSOCP2>0 ^PSRX(RXP,1,PSOCP2,"IB")=$P(XTMP(1),U,3) ; Filing in refill node
85 I PSOCP2>0,'$D(^PSRX(RXP,"IB")) S ^PSRX(RXP,"IB")="1^^" ; If refill "IB" exists, need "IB" entry on original fill node
86 S:PSOCP2=0 $P(^PSRX(RXP,"IB"),"^",2)=$P(XTMP(1),U,3) ;Filing in original fill (zero node)
87QUIT ;
88 K Y,PSOCP1,PSOCP2,QQ,PSOCPN,X,X2,XTMP,PSOCPUN,PSOREF,PSOCHG,PSOSAVE,PSOCOMM,PSOOLD,PSONW,PREA,PSORSN
89 Q
90EN D ^PSOLSET
91EN1 S DIR(0)="NO",DIR("A")="Enter PRESCRIPTION number" D ^DIR K DIR G:$D(DIRUT) EXIT S RXP=X I +$G(^PSRX(RXP,0))'>0!+$P($G(^PSRX(RXP,"IB")),"^",0)>0 W !,?10,"RE-CHECK PRESCRIPTION NUMBER AND RE-ENTER " G EN1
92 S PSOSITE7=$P(^PS(59,PSOSITE,"IB"),"^")
93 S PSODFN=$P(^PSRX(RXP,0),"^",2)
94 D CP G EN1
95EXIT K RXP D FINAL^PSOLSET Q
96 ;
97SC(PSODFN,PSODD) ;sup ref for CPRS, Pre-Copay enhancement
98 N PSOSC
99 I $$DT^PSOMLLDT S PSOSC="" G SCQ
100 I $G(PSODD),($P($G(^PSDRUG(PSODD,0)),"^",3)["S")!($P($G(^(0)),"^",3)["I") S PSOSC=1 G SCQ
101 I $P($G(^PS(55,+$G(PSODFN),"PS")),"^"),$P($G(^PS(53,+$P(^("PS"),"^"),0)),"^",7) S PSOSC=1 G SCQ
102 N I,J,X S (X,PSOSC)=""
103 S J=0 F S J=$O(^PS(59,J)) Q:'J I +$G(^(J,"IB")) S X=+^("IB") Q
104 G:'X SCQ
105 S X=X_"^"_PSODFN D XTYPE^IBARX
106 S J="" F S J=$O(Y(J)) Q:'J S I="" F S I=$O(Y(J,I)) Q:I="" S:I>0 PSOSC=I
107SCQ Q $S($G(PSOSC)=2:0,1:1)
108 ;
109COPAYREL ; Recheck copay status at release
110 ; check Rx patient status
111 I $P(^PSRX(RXP,0),"^",3)'="",$P($G(^PS(53,$P(^PSRX(RXP,0),"^",3),0)),"^",7)=1 S PSOCHG=0,PSOCOMM="Rx Patient Status Change",PSOOLD="Copay",PSONW="No Copay" Q
112 ; see if drug is investigational or supply
113 N DRG,DRGTYP,X
114 S DRG=+$P(^PSRX(RXP,0),"^",6),DRGTYP=$P($G(^PSDRUG(DRG,0)),"^",3)
115 I DRGTYP["I" S PSOCOMM="Investigational Drug",PSOCHG=0,PSOOLD="Copay",PSONW="No Copay",PSOCHG=0
116 I DRGTYP["S" S PSOCOMM="Supply Item",PSOCHG=0,PSOOLD="Copay",PSONW="No Copay",PSOCHG=0
117 K PSOTG,CHKXTYPE
118 I +$G(^PSRX(RXP,"IBQ")) D XTYPE1^PSOCP1
119 I $G(^PSRX(RXP,"IBQ"))["1" D S PSOCHG=0,PSOOLD="Copay",PSONW="No Copay" Q ; COPAY EXEMPT
120 . N EXMT,II,PSOCIBQ
121 . S PSOCIBQ=$G(^PSRX(RXP,"IBQ"))
122 . F II=1,7,3,4,5,6,2 I $P(PSOCIBQ,"^",II)=1 S EXMT=$S(II=1:"SC",II=7:"CV",II=3:"AO",II=4:"IR",II=5:"EC",II=2:"MST",II=6:"HNC",1:"") D:EXMT'="" SETCOMM Q
123 D SCNEW(.PSOTG,PSOCPN,DRG,RXP)
124 N EXMT
125 I '$D(CHKXTYPE) D XTYPE
126 F EXMT="SC","CV","AO","IR","EC","MST","HNC" I $D(PSOTG(EXMT)) D I 'PSOCHG Q
127 . I PSOTG(EXMT)=1 S PSOCHG=0 D SETCOMM
128 I 'PSOCHG S PSOOLD="Copay",PSONW="No Copay" Q
129 ;
130 ; If any of the applicable exemption quest have never been answered, send a mail msg with all of the quest
131 S EXMT="",MAILMSG=0 F S EXMT=$O(PSOTG(EXMT)) Q:EXMT="" I PSOTG(EXMT)="" S MAILMSG=1 Q
132 I MAILMSG,$D(PSOTG("SC")) I $G(PSOTG("SC"))="" S PSOCHG=2 ; 'SC' quest not answered, don't reset copay status to 'copay'
133 Q
134 ;
135SCNEW(PSOTG,PSOPT,PSODR,PSORN) ;CPRS supported ref
136 I '$$DT^PSOMLLDT Q
137 I '$G(PSOPT) Q
138 ;I $G(PSODR),($P($G(^PSDRUG(PSODR,0)),"^",3)["S")!($P($G(^(0)),"^",3)["I") Q ;CIDC ALWAYS ASK
139 N PSOCIBQ,PSOQMSH,PSOQVEH,PSOQRQD,PSOQHNC,PSOQPGW,DFN,PSOSCA,ZXX
140 K PSOANSQ("SC>50")
141 S DFN=PSOPT
142 D SCP^PSORN52D S:PSOSCP>49&(PSOSCA) PSOANSQ("SC>50")=1
143 I $G(PSORN) D
144 . S PSOCIBQ=$G(^PSRX(PSORN,"IBQ"))
145 . I $TR(PSOCIBQ,"^")="" S ZXX=$G(^PSRX(PSORN,"ICD",1,0)) D ICD:ZXX'=""
146 I '$G(PSORN) S PSOCIBQ=""
147 ;Rx Patient Status check is not being done here
148 N PSOSCMX,Y,I,J,X S (X,PSOSCMX)=""
149 S J=0 F S J=$O(^PS(59,J)) Q:'J I +$G(^(J,"IB")) S X=+^("IB") Q
150 G:'X SKIP
151 S X=X_"^"_PSOPT D XTYPE^IBARX
152 S J="" F S J=$O(Y(J)) Q:'J S I="" F S I=$O(Y(J,I)) Q:I="" S:I>0 PSOSCMX=I
153SKIP ;
154 I $G(PSOSCA)!($G(PSOSCMX)=2) S PSOTG("SC")=$S($P(PSOCIBQ,"^")=1:1,$P(PSOCIBQ,"^")=0:0,$G(PSORN)&($P($G(^PSRX(+$G(PSORN),"IB")),"^")):0,1:"")
155 S:$$AO^SDCO22(PSOPT) PSOTG("AO")=$S($P(PSOCIBQ,"^",3)=1:1,$P(PSOCIBQ,"^",3)=0:0,1:"")
156 S:$$IR^SDCO22(PSOPT) PSOTG("IR")=$S($P(PSOCIBQ,"^",4)=1:1,$P(PSOCIBQ,"^",4)=0:0,1:"")
157 S:$$EC^SDCO22(PSOPT) PSOTG("EC")=$S($P(PSOCIBQ,"^",5)=1:1,$P(PSOCIBQ,"^",5)=0:0,1:"")
158 S:$P($$GETSTAT^DGMSTAPI(PSOPT),"^",2)="Y" PSOTG("MST")=$S($P(PSOCIBQ,"^",2)=1:1,$P(PSOCIBQ,"^",2)=0:0,1:"")
159 I $T(GETCUR^DGNTAPI)]"" N PSONC,PSONCX S PSONCX=$$GETCUR^DGNTAPI(PSOPT,"PSONC") I $P($G(PSONC("IND")),"^")="Y" S PSOTG("HNC")=$S($P(PSOCIBQ,"^",6)=1:1,$P(PSOCIBQ,"^",6)=0:0,1:"")
160 S:$P($$CVEDT^DGCV(PSOPT),"^",3) PSOTG("CV")=$S($P(PSOCIBQ,"^",7)=1:1,$P(PSOCIBQ,"^",7)=0:0,1:"")
161 Q
162 ;
163ICD ;
164 D ICD^PSOCP1
165 Q
166XTYPE ;
167 N PSOCIBQ,PSOSCMX,Y,I,J,X,SAVY,ZXX
168 S (X,PSOSCMX,SAVY)=""
169 S PSOCIBQ=$G(^PSRX(RXP,"IBQ")) I $TR(PSOCIBQ,"^")="" S ZXX=$G(^PSRX(RXP,"ICD",1,0)) D ICD:ZXX'=""
170 I $P(PSOCIBQ,"^",1)'="" S PSOTG("SC")=$P(PSOCIBQ,"^",1)
171 I $D(PSOTG("SC")),$P(PSOCIBQ,"^",1)="" S PSOTG("SC")="" ; USE "CURRENT" SETTING AS ANS TO SC QUEST IF IT APPLIES
172 S J=0 F S J=$O(^PS(59,J)) Q:'J I +$G(^(J,"IB")) S X=+^("IB") Q
173 I 'X Q
174 S X=X_"^"_PSOCPN D XTYPE^IBARX
175 I $G(Y)'=1 Q
176 S J="" F S J=$O(Y(J)) Q:'J S I="" F S SAVY=I,I=$O(Y(J,I)) Q:I="" S:I>0 PSOSCMX=I
177 I PSOSCMX="",SAVY=0 S PSOCHG=0 S PSOCOMM="Exempt from copayment" Q ; INCOME EXEMPT OR SC
178 I PSOSCMX=2,'$D(PSOTG("SC")) S PSOTG("SC")=$S(($G(RXP)&($P($G(^PSRX(+$G(RXP),"IB")),"^")))!($P(PSOCIBQ,"^")=0):0,$P(PSOCIBQ,"^")=1:1,1:"") Q
179 Q
180 ;
181SETCOMM ;
182 D SETCOMM^PSOCP1
183 Q
184 ;
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