source: FOIAVistA/trunk/r/OUTPATIENT_PHARMACY-PSO-APSP-HUIP/PSOREJP1.m@ 1015

Last change on this file since 1015 was 628, checked in by George Lilly, 15 years ago

initial load of FOIAVistA 6/30/08 version
File size: 9.5 KB
Line 
1PSOREJP1 ;BIRM/MFR - Third Party Reject Display Screen ;04/29/05
2 ;;7.0;OUTPATIENT PHARMACY;**148,247,260,281**;DEC 1997;Build 41
3 ;Reference to File 9002313.93 - BPS NCPDP REJECT CODES supported by IA 4720
4 ;Reference to ^PS(59.7 supported by IA 694
5 ;Reference to ^PSDRUG("AQ" supported by IA 3165
6 ;
7EN(RX,REJ,CHANGE) ; Entry point
8 ;
9 ; - DO NOT change the IF logic below as both of them might get executed (intentional)
10 N FILL,LASTLN
11 S FILL=+$$GET1^DIQ(52.25,REJ_","_RX,5)
12 I $$CLOSED(RX,REJ) D EN^VALM("PSO REJECT DISPLAY - RESOLVED")
13 I '$$CLOSED(RX,REJ) D EN^VALM("PSO REJECT DISPLAY")
14 D FULL^VALM1
15 Q
16 ;
17HDR ; - Builds the Header section
18 N LINE1,LINE2,X
19 S VALMHDR(1)=$$DVINFO^PSOREJU2(RX,FILL,1),VALMHDR(2)=$$PTINFO^PSOREJU2(RX,1)
20 S VALMHDR(3)=$$RXINFO(RX,FILL,1),VALMHDR(4)=$$RXINFO(RX,FILL,2)
21 Q
22 ;
23INIT ; Builds the Body section
24 N DATA,LINE
25 F I=1:1:$G(LASTLN) D RESTORE^VALM10(I)
26 K ^TMP("PSOREJP1",$J) S VALMCNT=0,LINE=0
27 D GET^PSOREJU2(RX,FILL,.DATA,REJ,1)
28 D REJ ; Display REJECT Info
29 D OTH ; Display Other Rejects Info
30 D COM^PSOREJP3 ; Display Comment
31 D INS ; Display Insurance Info
32 D CLS ; Display Resolution Info
33 S VALMCNT=LINE
34 Q
35 ;
36REJ ; - DUR Information
37 N TYPE,PFLDT
38 D SETLN("REJECT Information",1,1)
39 S TYPE=$S($G(DATA(REJ,"CODE"))=79:"79 - REFILL TOO SOON",1:"88 - DUR REJECT")
40 D SETLN("Reject Type : "_TYPE_" received on "_$$FMTE^XLFDT($G(DATA(REJ,"DATE/TIME"))),,,18)
41 D SETLN("Reject Status : "_$G(DATA(REJ,"STATUS")),,,18)
42 D SET("PAYER MESSAGE",63)
43 D SET("REASON",63)
44 S PFLDT=$$FMTE^XLFDT($G(DATA(REJ,"PLAN PREVIOUS FILL DATE")))
45 D SET("DUR TEXT",63,$S(PFLDT="":1,1:0))
46 I PFLDT'="" D SETLN("Last Fill Date : "_PFLDT_" (from payer)",,1,18)
47 Q
48 ;
49OTH ; - Other Rejects Information
50 N LST,I,RJC,J,LAST
51 S LST=$G(DATA(REJ,"OTHER REJECTS")) I LST="" Q
52 D SETLN()
53 D SETLN("OTHER REJECTS",1,1)
54 F I=1:1:$L(LST,",") S RJC=$P(LST,",",I) D
55 . S LAST=1 F J=(I+1):1:$L(LST,",") I $P(LST,",",J)'="" S LAST=0 Q
56 . I RJC'="" D SETLN(RJC_" - "_$$EXP(RJC),,$S(LAST:1,1:0),6)
57 Q
58 ;
59INS ; - Insurance Information
60 D SETLN()
61 D SETLN("INSURANCE Information",1,1)
62 D SETLN("Insurance : "_$G(DATA(REJ,"INSURANCE NAME")),,,18)
63 D SETLN("Contact : "_$G(DATA(REJ,"PLAN CONTACT")),,,18)
64 D SETLN("Group Name : "_$G(DATA(REJ,"GROUP NAME")),,,18)
65 D SETLN("Group Number : "_$G(DATA(REJ,"GROUP NUMBER")),,,18)
66 D SETLN("Cardholder ID : "_$G(DATA(REJ,"CARDHOLDER ID")),,1,18)
67 Q
68 ;
69CLS ; - Resolution Information
70 N X
71 I '$$CLOSED(RX,REJ) Q
72 D SETLN()
73 D SETLN("RESOLUTION Information",1,1)
74 D SETLN("Resolved By : "_$G(DATA(REJ,"CLOSED BY")),,,18)
75 D SETLN("Date/Time : "_$G(DATA(REJ,"CLOSED DATE/TIME")),,,18)
76 I $G(DATA(REJ,"CLOSE COMMENTS"))'="" D SET("CLOSE COMMENTS",63)
77 I $G(DATA(REJ,"COD1"))'="" D SETLN("Reason for Svc : "_$$OVRX^PSOREJU1(1,$G(DATA(REJ,"COD1"))),,,18)
78 I $G(DATA(REJ,"COD2"))'="" D SETLN("Profes. Svc : "_$$OVRX^PSOREJU1(2,$G(DATA(REJ,"COD2"))),,,18)
79 I $G(DATA(REJ,"COD3"))'="" D SETLN("Result of Svc : "_$$OVRX^PSOREJU1(3,$G(DATA(REJ,"COD3"))),,,18)
80 I $G(DATA(REJ,"CLA CODE"))'="" D
81 . S X=$$GET1^DIQ(52.25,REJ_","_RX,24,"I")_" - "_(DATA(REJ,"CLA CODE"))
82 . D SETLN("Clarific. Code : "_X,,,18)
83 I $G(DATA(REJ,"PRIOR AUTH TYPE"))'="" D
84 . S X=$$GET1^DIQ(52.25,REJ_","_RX,25,"I")_" - "_(DATA(REJ,"PRIOR AUTH TYPE"))
85 . D SETLN("Prior Auth.Type: "_X,,,18),SETLN("Prior Auth. # : "_DATA(REJ,"PRIOR AUTH NUMBER"),,,18)
86 D SETLN("Reason : "_$G(DATA(REJ,"CLOSE REASON")),,1,18)
87 Q
88 ;
89 ;
90SET(FIELD,L,UND) ; Sets the lines for fields that require text wrapping
91 N TXT,T
92 S TXT=DATA(REJ,FIELD) I $L(TXT)'>L D SETLN($$LABEL(FIELD)_TXT,,$S($G(UND):1,1:0),80-L) Q
93 F I=1:1 Q:TXT="" D
94 . I I=1 D SETLN($$LABEL(FIELD)_$E(TXT,1,L),,,80-L) S TXT=$E(TXT,L+1,999) Q
95 . S T="",$E(T,81-L)=$E(TXT,1,L) D SETLN(T,,$S($E(TXT,L+1,999)=""&$G(UND):1,1:0),80-L) S TXT=$E(TXT,L+1,999)
96 Q
97 ;
98LABEL(FIELD) ; Sets the label for the field
99 I FIELD="REASON" Q "Reason : "
100 I FIELD="PAYER MESSAGE" Q "Payer Message : "
101 I FIELD="DUR TEXT" Q "DUR Text : "
102 I FIELD="CLOSE COMMENTS" Q "Comments : "
103 Q ""
104 ;
105VIEW ; - Rx View hidden action
106 N VALMCNT,TITLE
107 I $G(PSOBACK) D Q
108 . S VALMSG="Not available through Backdoor!",VALMBCK="R"
109 S TITLE=VALM("TITLE")
110 ;
111 ; - DO structure used to avoid losing variables RX,FILL,REJ,LINE,TITLE
112 DO
113 . N PSOVDA,DA,PS
114 . S (PSOVDA,DA)=RX,PS="REJECT"
115 . N RX,REJ,FILL,LINE,TITLE D DP^PSORXVW
116 ;
117 S VALMBCK="R",VALM("TITLE")=TITLE
118 Q
119 ;
120EDT ; - Rx Edit hidden action
121 N VALMCNT,TITLE
122 I $G(PSOBACK) D Q
123 . S VALMSG="Not available through Backdoor!",VALMBCK="R"
124 S TITLE=VALM("TITLE")
125 ;
126 ; - DO structure used to avoid losing variables RX,FILL,REJ,LINE,TITLE
127 DO
128 . N PSOSITE,ORN,PSOPAR,PSOLIST
129 . S PSOSITE=$$RXSITE^PSOBPSUT(RX,FILL),ORN=RX
130 . S PSOPAR=$G(^PS(59,PSOSITE,1)),PSOLIST(1)=ORN_","
131 . N RX,REJ,FILL,LINE,TITLE D EPH^PSORXEDT
132 ;
133 K VALMBCK I $$CLOSED(RX,REJ),$D(PSOSTFLT),PSOSTFLT="U" S CHANGE=1 Q
134 S VALMBCK="R",VALM("TITLE")=TITLE
135 Q
136 ;
137OVR ; - Override a REJECT action
138 I $$CLOSED(RX,REJ,1) Q
139 N COD1,COD2,COD3
140 D FULL^VALM1 W !
141 S COD1=$$OVRCOD^PSOREJU1(1,$$GET1^DIQ(52.25,REJ_","_RX,14)) I COD1="^" S VALMBCK="R" Q
142 S COD2=$$OVRCOD^PSOREJU1(2) I COD2="^" S VALMBCK="R" Q
143 S COD3=$$OVRCOD^PSOREJU1(3) I COD3="^" S VALMBCK="R" Q
144 D OVRDSP^PSOREJU1(COD1_"^"_COD2_"^"_COD3)
145 D SEND(COD1,COD2,COD3)
146 Q
147 ;
148RES ; - Re-submit a claim action
149 I $$CLOSED(RX,REJ,1) Q
150 D FULL^VALM1 W !
151 D SEND()
152 Q
153 ;
154CLA ; - Submit Clarification Code
155 N CLA
156 I $$CLOSED(RX,REJ,1) Q
157 D FULL^VALM1 W !
158 S CLA=$$CLA^PSOREJU1() I CLA="^" S VALMBCK="R" Q
159 W ! D SEND(,,,CLA)
160 Q
161 ;
162PA ; - Submit Prior Authorization
163 N PA
164 I $$CLOSED(RX,REJ,1) Q
165 D FULL^VALM1 W !
166 S PA=$$PA^PSOREJU2() I PA="^" S VALMBCK="R" Q
167 W ! D SEND(,,,,PA)
168 Q
169 ;
170SEND(COD1,COD2,COD3,CLA,PA) ; - Sends Claim to ECME and closes Reject
171 N DIR,OVRC,RESP,ALTXT,COM
172 S DIR(0)="Y",DIR("A")=" Confirm",DIR("B")="YES"
173 S DIR("A",1)=" When you confirm, a new claim will be submitted for"
174 S DIR("A",2)=" the prescription and this REJECT will be marked"
175 S DIR("A",3)=" resolved."
176 S DIR("A",4)=" "
177 W ! D ^DIR I $G(Y)=0!$D(DIRUT) S VALMBCK="R" Q
178 I $G(COD1)'="" S OVRC=$G(COD2)_"^"_$G(COD1)_"^"_$G(COD3)
179 S ALTXT="REJECT WORKLIST"
180 S:$G(OVRC)'="" ALTXT=ALTXT_"-DUR OVERRIDE CODES("_$G(COD1)_"/"_$G(COD2)_"/"_$G(COD3)_")"
181 S:$G(CLA) ALTXT=ALTXT_"(CLARIF. CODE="_CLA_")"
182 S:$G(PA) ALTXT=ALTXT_"(PRIOR AUTH.="_$TR(PA,"^","/")_")"
183 D ECMESND^PSOBPSU1(RX,FILL,,"ED",$$GETNDC^PSONDCUT(RX,FILL),,,$G(OVRC),,.RESP,,ALTXT,$G(CLA),$G(PA))
184 I $G(RESP) D Q
185 . W !!?10,"Claim could not be submitted. Please try again later!"
186 . W !,?10,"Reason: ",$S($P(RESP,"^",2)="":"UNKNOWN",1:$P(RESP,"^",2)),$C(7) H 2
187 ;
188 I $$PTLBL^PSOREJP2(RX,FILL) D PRINT(RX,FILL)
189 ;
190 I $D(PSOSTFLT),PSOSTFLT'="B" S CHANGE=1
191 Q
192 ;
193MP ; - Patient Medication Profile
194 I $G(PSOBACK) D Q
195 . S VALMSG="Not available through Backdoor!",VALMBCK="R"
196 N SITE,PATIENT
197 D FULL^VALM1 W !
198 S SITE=+$$RXSITE^PSOBPSUT(RX,FILL) S:$G(PSOSITE) SITE=PSOSITE
199 S PATIENT=+$$GET1^DIQ(52,RX,2,"I")
200 D LST^PSOPMP0(SITE,PATIENT) S VALMBCK="R"
201 Q
202 ;
203EXIT ;
204 K ^TMP("PSOREJP1",$J)
205 Q
206 ;
207SETLN(TEXT,REV,UND,HIG) ; Sets a line to be displayed in the Body section
208 N X
209 S:$G(TEXT)="" $E(TEXT,80)=""
210 S:$L(TEXT)>80 TEXT=$E(TEXT,1,80)
211 S LINE=LINE+1,^TMP("PSOREJP1",$J,LINE,0)=$G(TEXT)
212 ;
213 I LINE>$G(LASTLN) D SAVE^VALM10(LINE) S LASTLN=LINE
214 ;
215 I $G(REV) D Q
216 . D CNTRL^VALM10(LINE,1,$L(TEXT),IORVON,IOINORM)
217 . I $G(UND) D CNTRL^VALM10(LINE,$L(TEXT)+1,80,IOUON,IOINORM)
218 I $G(UND) D CNTRL^VALM10(LINE,1,80,IOUON,IOINORM)
219 I $G(HIG) D
220 . D CNTRL^VALM10(LINE,HIG,80,IOINHI_$S($G(UND):IOUON,1:""),IOINORM)
221 Q
222HELP ;
223 Q
224 ;
225RXINFO(RX,FILL,LINE) ; Returns header displayable Rx Information
226 N TXT,RXINFO,LBL,CMOP,DRG
227 I LINE=1 D
228 . S RXINFO="Rx# : "_$$GET1^DIQ(52,RX,.01)_"/"_FILL
229 . S $E(RXINFO,30)="ECME#: "_$E(10000000+RX,2,8)
230 . S $E(RXINFO,55)="Fill Date: "_$$FMTE^XLFDT($$RXFLDT^PSOBPSUT(RX,FILL))
231 I LINE=2 D
232 . S DRG=$$GET1^DIQ(52,RX,6,"I"),CMOP=$S($D(^PSDRUG("AQ",DRG)):1,1:0)
233 . S RXINFO=$S(CMOP:"CMOP ",1:"")_"Drug",$E(RXINFO,10)=": "_$E($$GET1^DIQ(52,RX,6),1,43)
234 . S $E(RXINFO,56)="NDC Code: "_$$GETNDC^PSONDCUT(RX,FILL)
235 Q $G(RXINFO)
236 ;
237CLOSED(RX,REJ,MSG) ; Returns whether the REJECT is RESOLVED or NOT
238 I $$GET1^DIQ(52.25,REJ_","_RX,10,"I") D:$G(MSG) Q 1
239 . S VALMSG="This Reject is marked resolved!",VALMBCK="R" W $C(7)
240 Q 0
241 ;
242REOPN(RX,REJ) ; Returns whether the REJECT was RE-OPENED or NOT
243 Q $S($$GET1^DIQ(52.25,REJ_","_RX,23)="":0,1:1)
244 ;
245EXP(CODE) ; - Returns the explanation field (.02) for a reject code
246 ; Input: (r) CODE - .01 field (Code) value from file 9002313.93
247 ; Output: .02 field (Explanation) value from file 9002313.93
248 N DIC,X,Y
249 S DIC=9002313.93,DIC(0)="Z",X=CODE D ^DIC
250 Q $P($G(Y(0)),"^",2)
251 ;
252OUT(RX) ; - Supported call by outside PROTOCOLs to act on specific REJECTs
253 N I,RFL,DATA,REJ,PSOBACK,VALMCNT,RXN
254 I '$D(^XUSEC("PSORPH",DUZ)) S VALMSG="PSORPH key required to use the REJ action.",VALMBCK="R" Q
255 I $G(PS)="REJECT" D Q
256 . S VALMSG="REJ action is not available at this point.",VALMBCK="R"
257 S PSOBACK=1
258 S (RFL,I)=0 F I=1:1 Q:'$D(^PSRX(RX,1,I)) S RFL=I
259 S X=$$FIND^PSOREJUT(RX,RFL,.DATA) S REJ=$O(DATA(""))
260 I '$G(REJ) S VALMSG="Invalid selection!",VALMBCK="R" Q
261 D EN(RX,REJ) S VALMBCK="R"
262 Q
263 ;
264PRINT(RX,RFL) ; Print Label for specific Rx/Fill
265 N PPL,PSOSITE,PSOPAR,PSOSYS,PSOLAP,PSOBARS,PSOBAR0,PSOBAR1,PSOIOS,PSOBFLAG
266 N POP,DFN,PDUZ,RXFL
267 ;
268 S PSOSITE=$$RXSITE^PSOBPSUT(RX,RFL),PSOPAR=^PS(59,PSOSITE,1)
269 S DFN=$$GET1^DIQ(52,RX,2,"I"),PDUZ=DUZ,PSOSYS=$G(^PS(59.7,1,40.1))
270 S PPL=RX I RFL S RXFL(RX)=RFL
271 W ! S PSOBFLAG=1 D LBL^PSOLSET I $G(PSOQUIT) Q
272 ;
273 S IOP=PSOLAP D ^%ZIS,DQ^PSOLBL,^%ZISC
274 Q
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