source: WorldVistAEHR/trunk/r/ACCOUNTS_RECEIVABLE-PRCA-PRY-RC/RCDPESR9.m@ 619

Last change on this file since 619 was 613, checked in by George Lilly, 15 years ago

initial load of WorldVistAEHR
File size: 7.6 KB
Line 
1RCDPESR9 ;ALB/TMK - ERA return file field captions ;09-SEP-2003
2 ;;4.5;Accounts Receivable;**173,252**;Mar 20, 1995;Build 63
3 ;;Per VHA Directive 2004-038, this routine should not be modified.
4 ;
5 ; Note: if the 835 flat file changes, make the corresponding changes
6 ; in this routine.
7835 ;;HEADER DATA
8 ;;835^^Return Message ID^S Y=X_" (ERA HEADER DATA)"
9 ;;835^^X12/Proprietary flag^S Y=$S(X="X":"X12",1:X)
10 ;;835^^File Date^S Y=$$FDT^RCDPESR9(X)
11 ;;835^^File Time^S Y=$E(X,1,2)-$S($E(X,1,2)>12:12,1:0)_":"_$E(X,3,4)_$S($E(X,1,2)=24:" AM",$E(X,1,2)>11:" PM",1:" AM")
12 ;;835^1^MRA^S Y=""
13 ;;835^^Payer Name
14 ;;835^^Payer ID
15 ;;835^^Trace Number
16 ;;835^^Date Claims Paid^S Y=$$FDT^RCDPESR9(X)
17 ;;835^^Total ERA Amount^S Y=$$ZERO^RCDPESR9(X,1)
18 ;;835^^Erroneous Provider Tax ID
19 ;;835^^Tax ID correction Flag^S Y=$S(X="E":"CHANGED BY EPHRA",X="C":"DETERMINED FROM CLAIM DATA",X="":"NO CHANGE MADE",1:X)
20 ;;835^^Sequence Control #
21 ;;835^^Sequence #
22 ;;835^^Last Sequence #
23 ;;835^^Contact Information
24 ;;835^^Payment Method Code
25 ;;835^^Billing Provider NPI
26 ;
2701 ;;PAYER CONTACT INFORMATION
28 ;;01^^ERA Contact Name
29 ;;01^^ERA Contact #1
30 ;;01^^ERA Contact #1 Type^S Y=$$EXTERNAL^DILFD(344.4,3.03,,X)
31 ;;01^^ERA Contact #2
32 ;;01^^ERA Contact #2 Type^S Y=$$EXTERNAL^DILFD(344.4,3.05,,X)
33 ;;01^^ERA Contact #3
34 ;;01^^ERA Contact #3 Type^S Y=$$EXTERNAL^DILFD(344.4,3.07,,X)
35 ;
3602 ;;PAYER ADJUSTMENT RECORD
37 ;;02^^Line Type^S Y=X_" (ERA LEVEL PAYER ADJUSTMENT RECORD)"
38 ;;02^^X12 Adjustment Reason Code
39 ;;02^^Provider Adjustment Identifier
40 ;;02^^Adjustment Amount^S Y=$$ZERO^RCDPESR9(X,1)
41 ;;02^^X12 Reason Text
42 ;
4305 ;;CLAIM PATIENT ID
44 ;;05^^Line Type^S Y=X_" (CLAIM LEVEL PATIENT ID DATA)"
45 ;;05^^Bill #
46 ;;05^^Patient Last Name
47 ;;05^^Patient First Name
48 ;;05^^Patient Middle Name
49 ;;05^^Patient ID #
50 ;;05^1^Record Contains Patient Name Change^S Y=""
51 ;;05^1^Record Contains Patient ID Change^S Y=""
52 ;;05^^Statement Start Date^S Y=$$FDT^RCDPESR9(X)
53 ;;05^^Statement End Date^S Y=$$FDT^RCDPESR9(X)
54 ;
5510 ;;CLAIM STATUS DATA
56 ;;10^^Line Type^S Y=X_" (CLAIM LEVEL CLAIM STATUS DATA)"
57 ;;10^^Bill #
58 ;;10^^Claim Processed^S Y=$$YN^RCDPESR9(X)
59 ;;10^^Claim Denied^S Y=$$YN^RCDPESR9(X)
60 ;;10^^Claim Pended^S Y=$$YN^RCDPESR9(X)
61 ;;10^^Claim Reversal^S Y=$$YN^RCDPESR9(X)
62 ;;10^^Claim Status Code
63 ;;10^1^Crossed Over Name^S Y=""
64 ;;10^1^Crossed Over ID^S Y=""
65 ;;10^^Submitted Charge^S Y=$$ZERO^RCDPESR9(X,1)
66 ;;10^^Amount Paid^S Y=$$ZERO^RCDPESR9(X,1)
67 ;;10^^ICN
68 ;;10^^DRG Code Used
69 ;;10^^DRG Weight Used^S Y=$J($$ZERO^RCDPESR9(X,1)/100,4)
70 ;;10^^Discharge Fraction^S Y=$$ZERO^RCDPESR9(X,1)
71 ;;10^^Rendering NPI
72 ;;10^^Entity Type Qualifier
73 ;;10^^Last Name
74 ;;10^^First Name
75 ;
7615 ;;CLAIM STATUS DATA
77 ;;15^^Line Type^S Y=X_" (CLAIM LEVEL CLAIM STATUS DATA (CONTINUED))"
78 ;;15^^Bill #
79 ;;15^^Covered Amount^S Y=$$ZERO^RCDPESR9(X,1)
80 ;;15^1^Discount Amount^S Y=$$ZERO^RCDPESR9(X,1,1)
81 ;;15^1^Day Limit Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
82 ;;15^1^Interest Amount^S Y=$$ZERO^RCDPESR9(X,1,1)
83 ;;15^1^Tax Amount^S Y=$$ZERO^RCDPESR9(X,1,1)
84 ;;15^1^Total Before Taxes Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
85 ;;15^^Patient Responsibility Amount^S Y=$$ZERO^RCDPESR9(X,1)
86 ;;15^1^Negative Reimbursement^S Y=$$ZERO^RCDPESR9(X,1,1)
87 ;
8817 ;;CLAIM LEVEL PAYER CONTACT INFORMATION
89 ;;17^^Line Type^S Y=X_" (CLAIM LEVEL PAYER CONTACT INFO)"
90 ;;17^^Bill #
91 ;;17^^Contact Name
92 ;;17^^Contact #1
93 ;;17^^Contact #1 Type^S Y=$$EXTERNAL^DILFD(361.1,25.03,,X)
94 ;;17^^Contact #2
95 ;;17^^Contact #2 Type^S Y=$$EXTERNAL^DILFD(361.1,25.05,,X)
96 ;;17^^Contact #3
97 ;;17^^Contact #3 Type^S Y=$$EXTERNAL^DILFD(361.1,25.07,,X)
98 ;
9920 ;;CLAIM LEVEL ADJUSTMENT DATA
100 ;;20^^Line Type^S Y=X_" (CLAIM LEVEL CLAIM ADJUSTMENT DATA)"
101 ;;20^^Bill #
102 ;;20^^Adjustment Group Code
103 ;;20^^Adjustment Reason Code
104 ;;20^^Adjustment Amount^S Y=$$ZERO^RCDPESR9(X,1)
105 ;;20^^Quantity^S Y=$$ZERO^RCDPESR9(X)
106 ;;20^^Reason Code Text
107 ;
10830 ;;CLAIM LEVEL MEDICARE INPT ADJUDICATION DATA
109 ;;30^^Line Type^S Y=X_" (CLAIM LEVEL MEDICARE INPATIENT ADJUDICATION DATA)"
110 ;;30^^Bill #
111 ;;30^^Covered Days/Visits^S Y=$$ZERO^RCDPESR9(X)
112 ;;30^1^Lifetime Reserve Days Count^S Y=$$ZERO^RCDPESR9(X,,1)
113 ;;30^1^Lifetime Psych Days Count^S Y=$$ZERO^RCDPESR9(X,,1)
114 ;;30^^Claim DRG Amt^S Y=$$ZERO^RCDPESR9(X,1)
115 ;;30^1^Claim Disproportionate Share Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
116 ;;30^1^Claim MSP Pass thru Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
117 ;;30^1^Claim PPS Capital Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
118 ;;30^1^PPS-Capital FSP DRG Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
119 ;;30^1^PPS-Capital HSP DRG Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
120 ;;30^1^PPS-Capital DSH DRG Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
121 ;;30^1^Old Capital Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
122 ;;30^^Non-Covered Days^S Y=$$ZERO^RCDPESR9(X)
123 ;
12435 ;;CLAIM LEVEL MEDICARE ADJUDICATION DATA
125 ;;35^^Line Type^S Y=X_" (CLAIM LEVEL MEDICARE ADJUDICATION DATA)"
126 ;;35^^Bill #
127 ;;35^1^PPS-Capital IME Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
128 ;;35^1^PPS-Operating Hosp Specific DRG Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
129 ;;35^1^Cost Report Day Count^S Y=$$ZERO^RCDPESR9(X)
130 ;;35^1^PPS-Operating Fed Specific DRG Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
131 ;;35^1^Claim PPS Capital Outlier Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
132 ;;35^1^Claim Indirect Teaching Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
133 ;;35^1^Non-payable Professional Component Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
134 ;;35^1^PPS-Capital Exception Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
135 ;;35^1^Outpatient Reimbursement %^S Y=$$ZERO^RCDPESR9(X)
136 ;;35^1^HCPCS Payable Amount^S Y=$$ZERO^RCDPESR9(X,1,1)
137 ;;35^1^ESRD Paid Amount^S Y=$$ZERO^RCDPESR9(X,1,1)
138 ;;35^1^Non-payable Professional Component^S Y=$$ZERO^RCDPESR9(X,1,1)
139 ;
14037 ;;CLAIM LEVEL MEDICARE ADJUDICATION DATA REMARKS
141 ;;37^^Line Type^S Y=X_" (CLAIM LEVEL MEDICARE ADJUDICATION DATA REMARKS)"
142 ;;37^^Bill #
143 ;;37^^Type^S Y=$S(X="O":"MOA",X="I":"MIA",1:X)
144 ;;37^^Claim Payment Remark Code
145 ;;37^^Claim Payment Remark Code Message Text
146 ;
14740 ;;SERVICE LINE DATA
148 ;;40^^Line Type^S Y=X_" (CLAIM LEVEL SERVICE LINE DATA)"
149 ;;40^^Bill #
150 ;;40^^Procedure
151 ;;40^^Revenue Code
152 ;;40^^Modifier 1
153 ;;40^^Modifier 2
154 ;;40^^Modifier 3
155 ;;40^^Modifier 4
156 ;;40^^Description
157 ;;40^^Original Procedure
158 ;;40^^Original Modifier 1
159 ;;40^^Original Modifier 2
160 ;;40^^Original Modifier 3
161 ;;40^^Original Modifier 4
162 ;;40^^Original Charge^S Y=$$ZERO^RCDPESR9(X,1)
163 ;;40^^Original Units^S Y=$$ZERO^RCDPESR9(X,1)
164 ;;40^^Amount Paid^S Y=$$ZERO^RCDPESR9(X,1)
165 ;;40^^Covered Units^S Y=$$ZERO^RCDPESR9(X,1)
166 ;;40^^Service From Date^S Y=$$FDT^RCDPESR9(X)
167 ;;40^^Service To Date^S Y=$$FDT^RCDPESR9(X)
168 ;;40^^Procedure Type
169 ;;40^^Applies to Billing Line
170 ;
17141 ;;SERVICE LINE DATA
172 ;;41^^Line Type^S Y=X_" (CLAIM LEVEL SERVICE LINE DATA (CONTINUED))"
173 ;;41^^Bill #
174 ;;41^^Allowed Amount^S Y=$$ZERO^RCDPESR9(X,1)
175 ;;41^1^Per Diem Amount^S Y=$$ZERO^RCDPESR9(X,1,1)
176 ;
17742 ; SERVICE LINE DATA
178 ;;42^^Line Type^S Y=X_" (CLAIM LEVEL SERVICE LINE DATA (CONTINUED))"
179 ;;42^^Bill #
180 ;;42^^Line Item Remark Code
181 ;;42^^Line Item Remark Code Text
182 ;
18345 ;;SERVICE LINE ADJUSTMENT DATA
184 ;;45^^Line Type^S Y=X_" (CLAIM LEVEL SERVICE LINE ADJUSTMENT DATA)"
185 ;;45^^Bill #
186 ;;45^^Adjustment Group Code
187 ;;45^^Adjustment Reason Code
188 ;;45^^Adjustment Amount^S Y=$$ZERO^RCDPESR9(X,1)
189 ;;45^^Quantity^S Y=$$ZERO^RCDPESR9(X)
190 ;;45^^Reason Code Text
191 ;
192FDT(X) ; returns MM/DD/YYYY or MM/DD/YY from YYYYMMDD or YYMMDD in X
193 I $L(X)=8,X?8N S X=$E(X,5,6)_"/"_$E(X,7,8)_"/"_$E(X,1,4)
194 I $L(X)=6,X?6N S X=$E(X,3,4)_"/"_$E(X,5,6)_"/"_$E(X,1,2)
195 Q X
196 ;
197ZERO(X,D,NULL) ; Returns numeric value of X without leading 0's
198 ; or null if no value wanted for 0 amount
199 ; D = 1 if dollar amt
200 N Z
201 I X["." S Z=$P(X,"."),X=+Z_"."_$P(X,".",2)
202 I X'["." D
203 . I $G(D) S X=+$E(X,1,$L(X)-2)_"."_$E(X,$L(X)-1,$L(X))
204 . S X=$S('$G(D):+X,1:$J(X,"",2))
205 Q $S(X:X,$G(NULL):"",1:X)
206 ;
207YN(X) ; Returns YES for X="Y" and NO for X="N"
208 S X=$S(X="Y":"YES",X="N":"NO",1:X)
209 Q X
210 ;
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