| [613] | 1 | BPSECA1 ;BHAM ISC/FCS/DRS/VA/DLF - Assemble formatted claim ;05/14/2004
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| 2 | ;;1.0;E CLAIMS MGMT ENGINE;**1,5**;JUN 2004;Build 45
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| 3 | ;;Per VHA Directive 2004-038, this routine should not be modified.
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| 4 | ;----------------------------------------------------------------------
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| 5 | ; Assemble ASCII formatted claim submission record
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| 6 | ;
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| 7 | ; Input Variables:
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| 8 | ; CLAIMIEN - pointer into 9002313.02
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| 9 | ; MSG - Array passed by reference - This will have the claim packet
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| 10 | ;
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| 11 | ; NCPDP 5.1 changes
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| 12 | ; 5.1 has 14 claim segments (header, patient, insurance, claim
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| 13 | ; pharmacy provider, prescriber,
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| 14 | ; COB, workers comp, DUR, Pricing,
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| 15 | ; coupon, compound, prior auth,
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| 16 | ; clinical)
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| 17 | ; 5.1 requires field identifiers and separators on all fields
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| 18 | ; other than the header
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| 19 | ; 5.1 Segment separators are required prior to each segment
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| 20 | ; following the header
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| 21 | ; 5.1 Group separators appear at the end of each
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| 22 | ; transaction (prescription)
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| 23 | ;
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| 24 | ; Adjustments were also made to the reversal logic as well.
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| 25 | ;
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| 26 | ASCII(CLAIMIEN,MSG) ;EP - from BPSOSQG
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| 27 | N IEN,RECORD,BPS,UERETVAL,DET51,WP
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| 28 | ;
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| 29 | ; Quit if no Claim IEN
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| 30 | I '$G(CLAIMIEN) Q
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| 31 | I '$D(^BPSC(CLAIMIEN,0)) Q
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| 32 | ;
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| 33 | ; Setup IEN variables (used when executing format code)
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| 34 | S IEN(9002313.02)=CLAIMIEN
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| 35 | ;
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| 36 | ; Get Payer Sheet pointer
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| 37 | S IEN(9002313.92)=$P($G(^BPSC(IEN(9002313.02),0)),U,2)
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| 38 | ;
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| 39 | ; Quit if the payer sheet pointer is missing
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| 40 | I 'IEN(9002313.92) Q
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| 41 | ;
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| 42 | ; Quit if the payer sheet does not exist
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| 43 | I '$D(^BPSF(9002313.92,+IEN(9002313.92),0)) Q
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| 44 | ;
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| 45 | ; Retrieve claim submission record (used when executing format code)
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| 46 | D GETBPS2^BPSECX0(IEN(9002313.02),.BPS)
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| 47 | ;
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| 48 | ; Assemble required claim header and optional format sections
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| 49 | S RECORD=""
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| 50 | ;
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| 51 | ; Do non-repeating claim segments
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| 52 | D XLOOP^BPSOSH2("100^110^120",.IEN,.BPS,.RECORD)
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| 53 | ;
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| 54 | ; Set list of repeating claim segments
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| 55 | S DET51="130^140^150^160^170^180^190^200^210^220^230"
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| 56 | ;
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| 57 | ; Loop through prescription multiple and get create repeation segments
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| 58 | S IEN(9002313.01)=0
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| 59 | F S IEN(9002313.01)=$O(^BPSC(IEN(9002313.02),400,IEN(9002313.01))) Q:'IEN(9002313.01) D
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| 60 | . ;
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| 61 | . ;Retrieve prescription information (used when executing format code)
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| 62 | . K BPS(9002313.0201)
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| 63 | . D GETBPS3^BPSECX0(IEN(9002313.02),IEN(9002313.01),.BPS)
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| 64 | . ;
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| 65 | . ; Handle the DUR repeating flds
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| 66 | . D DURVALUE
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| 67 | . ;
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| 68 | . ; Append group separator character
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| 69 | . S RECORD=RECORD_$C(29)
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| 70 | . ;
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| 71 | . ; Assemble claim information required and optional sections
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| 72 | . D XLOOP^BPSOSH2(DET51,.IEN,.BPS,.RECORD)
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| 73 | ;
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| 74 | ; Need to store by segment due to HL7 constraints. Had to change field, group,
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| 75 | ; and segment separators to control characters for Vitria/AAC processing as well as
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| 76 | ; shortening the length of the xmit.
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| 77 | ; DMB 11/27/2006 - If the first NNODES has $C(30), this will bomb since OREC will not
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| 78 | ; have a value. Need to look into this.
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| 79 | N NNODES,INDEX,ONE,TWO,OREC
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| 80 | S NNODES=0 F S NNODES=$O(RECORD(NNODES)) Q:NNODES="" D
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| 81 | . I RECORD(NNODES)[$C(30) D
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| 82 | .. S ONE=$P(RECORD(NNODES),($C(30)_$C(28)),1),TWO=$P(RECORD(NNODES),($C(30)_$C(28)),2)
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| 83 | .. S RECORD(OREC)=RECORD(OREC)_ONE_$C(30)_$C(28),RECORD(NNODES)=TWO
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| 84 | . S OREC=NNODES
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| 85 | ;
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| 86 | ; Put claim packet into local array to be passed back to calling routine
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| 87 | S NNODES=""
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| 88 | S INDEX=1 F S NNODES=$O(RECORD(NNODES)) Q:NNODES="" D
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| 89 | . S MSG("HLS",INDEX)=RECORD(NNODES)
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| 90 | . S WP(INDEX/100+1,0)=RECORD(NNODES)
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| 91 | . S INDEX=INDEX+1
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| 92 | S MSG("HLS",0)=INDEX-1
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| 93 | ;
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| 94 | ; Store raw data into the BPS Claims record
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| 95 | D WP^DIE(9002313.02,CLAIMIEN_",",9999,"","WP")
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| 96 | Q
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| 97 | ;
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| 98 | ; DURVALUE - This subroutine will loop through the DUR/PPS repeating
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| 99 | ; fields and load their values into the BPS array for the claim
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| 100 | ; generation process
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| 101 | DURVALUE ;
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| 102 | N DURCNT,DUR
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| 103 | ;
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| 104 | K BPS(9002313.1001)
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| 105 | ;
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| 106 | ; Get the number of DUR records
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| 107 | S DURCNT=$P($G(^BPSC(IEN(9002313.02),400,IEN(9002313.01),473.01,0)),U,4)
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| 108 | ;
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| 109 | ; Loop through DURS and get the data
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| 110 | F DUR=1:1:DURCNT D
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| 111 | . D GETBPS4^BPSECX0(IEN(9002313.02),IEN(9002313.01),DUR,.BPS)
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| 112 | Q
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