[613] | 1 | BPSOSQ4 ;BHAM ISC/FCS/DRS/DLF - Process responses ;06/01/2004
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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 | ; This routine has two components
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| 6 | ; Procedures to report Response info
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| 7 | ; Procedures to handle insurer asleep functions
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| 8 | Q
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| 9 | ;
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| 10 | ; The following are separate little utilities called from elsewhere.
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| 11 | ;
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| 12 | PAID(IEN59) ;quick query to see if it's paid
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| 13 | N TMP D RESPINFO(IEN59,.TMP) Q:'$D(TMP("RSP")) 0
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| 14 | N X S X=TMP("RSP")
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| 15 | I X="Payable" Q 1
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| 16 | Q 0
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| 17 | RESPINFO(RXI,DST) ;EP - BPSOS6M
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| 18 | ; quick way to get all the response info for a given RXI
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| 19 | ; IMPORTANT!! Do not change spelling, case, wording, or spacing!!!
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| 20 | ; If a reversal was attempted, it complicates things.
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| 21 | ; fills DST array as follows:
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| 22 | ; DST("HDR")=Response Status (header)
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| 23 | ; DST("RSP")=Response Status (prescription)
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| 24 | ; This could be: "Payable" "Rejected" "Captured" "Duplicate"
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| 25 | ; or "Accepted reversal" or "Rejected reversal"
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| 26 | ; or "null" or "null reversal" (no response or corrupt response
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| 27 | ; or maybe someone without insurance, so no request was sent)
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| 28 | ; DST("REJ",0)=count of reject codes
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| 29 | ; DST("REJ",n)=each reject code
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| 30 | ; DST("MSG")=message with the response
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| 31 | ; All of these are defined, even if originals were '$D.
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| 32 | ; The external forms are returned.
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| 33 | N REVERSAL S REVERSAL=$G(^BPST(RXI,4))>0
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| 34 | N RESP
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| 35 | I 'REVERSAL S RESP=$P(^BPST(RXI,0),U,5)
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| 36 | E S RESP=$P(^BPST(RXI,4),U,2)
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| 37 | I 'RESP Q
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| 38 | N ECME S POS=$P(^BPST(RXI,0),U,9) Q:'POS
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| 39 | N FMT S FMT="E"
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| 40 | S DST("HDR")=$$RESP500(RESP,FMT)
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| 41 | S DST("RSP")=$$RESP1000(RESP,POS,FMT)
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| 42 | S DST("REJ",0)=$$REJCOUNT(RESP,POS,FMT)
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| 43 | I DST("REJ",0) D
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| 44 | . N I F I=1:1:DST("REJ",0) S DST("REJ",I)=$$REJCODE(RESP,POS,I,FMT)
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| 45 | S DST("MSG")=$$RESPMSG(RESP,POS,FMT)
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| 46 | ; Dealing with oddities of PCS (and others'?) response to reversals
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| 47 | I REVERSAL,DST("RSP")["null" D
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| 48 | . I DST("RSP")["null" S DST("RSP")=DST("HDR")_" reversal"
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| 49 | Q
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| 50 | ; In the following quickies:
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| 51 | ; RESP = RESPIEN, pointer to 9002313.03
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| 52 | ; FMT = "I" for internal, "E" for external, defaults to internal
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| 53 | RESP500(RESP,FMT) ;EP - BPSOS57,BPSOSUC
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| 54 | ; returns the response header status
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| 55 | N X S X=$P($G(^BPSR(RESP,500)),U)
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| 56 | I $G(FMT)'="E" Q X
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| 57 | I X="" S X="null"
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| 58 | S X=$S(X="A":"Accepted",X="R":"Rejected",1:"?"_X)
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| 59 | Q X
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| 60 | RESP1000(RESP,POS,FMT) ;EP - BPSOSUC
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| 61 | ; returns the prescription response status
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| 62 | ; Note! Could be DP or DC for duplicates
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| 63 | N X S X=$P($G(^BPSR(RESP,1000,POS,500)),U)
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| 64 | I $G(FMT)'="E" Q X
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| 65 | I X="" S X="null"
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| 66 | ;
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| 67 | ;IHS/SD/lwj 10/07/02 NCPDP 5.1 changes - they will send an "A" back
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| 68 | ; now on the transaction level to indicate that it has been accepted
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| 69 | ; Next code line remarked out - following added
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| 70 | ;
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| 71 | S X=$S(X="A":"Accepted",X="P":"Payable",X="R":"Rejected",X="C":"Captured",X="D"!(X="DP")!(X="DC"):"Duplicate",1:"?"_X)
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| 72 | Q X
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| 73 | ;
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| 74 | REJCOUNT(RESP,POS,FMT) ; returns rejection count
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| 75 | Q +$P($G(^BPSR(RESP,1000,POS,511,0)),U,3)
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| 76 | ;
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| 77 | REJCODE(RESP,POS,N,FMT) ; returns Nth rejection code
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| 78 | ; if FMT="E", returns code:text
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| 79 | N CODE S CODE=$P($G(^BPSR(RESP,1000,POS,511,N,0)),U)
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| 80 | I CODE="" S CODE="null"
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| 81 | I FMT'="E" Q CODE
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| 82 | N X S X=$O(^BPSF(9002313.93,"B",CODE,0))
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| 83 | I X]"" S CODE=CODE_":"_$P($G(^BPSF(9002313.93,X,0)),U,2)
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| 84 | E S CODE="?"_CODE
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| 85 | Q CODE
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| 86 | ;
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| 87 | ; NCPDP 5.1 changes - message may not come back in 504. They may
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| 88 | ; come back in 526 instead
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| 89 | RESPMSG(RESP,POS,FMT) ; response message - additional text from insurer
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| 90 | ;
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| 91 | N MSG
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| 92 | S MSG=""
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| 93 | S MSG=$G(^BPSR(RESP,504))
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| 94 | S:MSG="" MSG=$G(^BPSR(RESP,1000,POS,504))
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| 95 | S:MSG="" MSG=$G(^BPSR(RESP,1000,POS,526))
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| 96 | Q MSG
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| 97 | ;
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| 98 | ;
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| 99 | NOW() N %,%H,%I,X D NOW^%DTC Q %
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| 100 | ;
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| 101 | ; The xxxSLEEP functions are called from BPSOSQL
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| 102 | ;
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| 103 | ; REJSLEEP - Check if the insurer should be asleep
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| 104 | ; based on the reject codes
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| 105 | ; Input
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| 106 | ; RESP - BPS Response IEN
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| 107 | ; POS - Multiple IEN
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| 108 | ; Return
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| 109 | ; 1 if the insurer is asleep
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| 110 | ; 0 if the insurer is not asleep
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| 111 | REJSLEEP(RESP,POS) ;EP - BPSOSQL
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| 112 | ;
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| 113 | ; DMB - Asleep functionality is disabled for VA until an analysis of reject
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| 114 | ; codes can be done and asleep code needs to handle a stranded prober.
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| 115 | Q 0
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| 116 | ;
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| 117 | ; Validate parameters
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| 118 | I '$G(RESP) Q 0
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| 119 | I '$G(POS) Q 0
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| 120 | ;
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| 121 | ; This is basically old IHS logic
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| 122 | I $G(^BPSR(RESP,1000,POS,504))?1"EV16-".E Q 1
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| 123 | I $G(^BPSR(RESP,1000,POS,504))?1"EV38-".E Q 1
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| 124 | I $G(^BPSR(RESP,1000,POS,504))?1"EV32-".E Q 1
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| 125 | I $G(^BPSR(RESP,1000,POS,504))?1"EV25-".E Q 1 ; BPS*1.0T7*4
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| 126 | ;
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| 127 | ; NDC's, and theoretically, Envoy too, though they seem to do EV- msgs
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| 128 | I $O(^BPSR(RESP,1000,POS,511,"B",90))="" Q 0 ; cheap check
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| 129 | ;
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| 130 | ; But for a PCS case we see, Code 99 + some code < 90 ; BPS*1.0T7*2
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| 131 | ; isn't "asleep" - 99 is something PCS threw in ; BPS*1.0T7*2
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| 132 | ; so require 99 to be accompanied by something <99 too ; BPS*1.0T7*2
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| 133 | ;
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| 134 | N RET S RET=0 N I F I=92,93,99 D Q:RET
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| 135 | . I $D(^BPSR(RESP,1000,POS,511,"B",I)) S RET=1
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| 136 | . Q:I'=99 Q:'RET ; BPS*1.0T7*2
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| 137 | . I I=99,$O(^BPSR(RESP,1000,POS,511,"B",0))<90 S RET=0 ; BPS*1.0T7*2
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| 138 | Q RET
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| 139 | ;
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| 140 | ; INCSLEEP - Increment sleep time for this insurer, if necessary.
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| 141 | ; Input
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| 142 | ; IEN59 - BPS Transaction IEN
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| 143 | ; PAYSH - Payer Sheet IEN
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| 144 | ; Return the scheduled retry time
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| 145 | INCSLEEP(IEN59,PAYSH) ;EP - BPSOSQL
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| 146 | ;
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| 147 | ; Set retry time to be 10 minutes in the future
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| 148 | N X,RETRY
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| 149 | S X=600,RETRY=$$TADDNOWS^BPSOSUD(X)
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| 150 | ;
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| 151 | ; Set retry time to be 10 minutes
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| 152 | S $P(^BPSF(9002313.92,PAYSH,1),U,12)=RETRY
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| 153 | S $P(^BPST(IEN59,8),U,1)=RETRY
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| 154 | S $P(^BPST(IEN59,8),U,3)=PAYSH
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| 155 | ;
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| 156 | ; Fire up a packet process 10 seconds after the RETRY time so that the
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| 157 | ; claims can be processed as soon as the retry time expires
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| 158 | D TASKAT^BPSOSQA($$TADDNOWS^BPSOSUD(X+10))
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| 159 | ;
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| 160 | ; And run packeter right now, too, to stamp new times on the others in status 31
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| 161 | D TASK^BPSOSQA
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| 162 | Q RETRY
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| 163 | ;
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| 164 | ; Clear insurer sleeping condition
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| 165 | CLRSLEEP(IEN59,PAYSH) ;EP - BPSOSQL
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| 166 | N RETRY
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| 167 | ;
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| 168 | ; Reset Retry Time and Prober Flga
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| 169 | I $D(^BPST(IEN59,8)) S $P(^BPST(IEN59,8),U,1)="",$P(^BPST(IEN59,8),U,3)=""
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| 170 | ;
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| 171 | ; Get retry time from the payer sheet and quit if does not exist
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| 172 | S RETRY=$P($G(^BPSF(9002313.92,PAYSH,1)),U,12)
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| 173 | ;
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| 174 | ; Reset Retry Time and Prober
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| 175 | S $P(^BPSF(9002313.92,PAYSH,1),U,11)=""
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| 176 | S $P(^BPSF(9002313.92,PAYSH,1),U,12)=""
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| 177 | ;
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| 178 | ; If this insurer was asleep and there are other asleep transactions, fire off
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| 179 | ; the Packeter task to see if they should be done
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| 180 | I RETRY,$D(^BPST("AD",31)) D TASK^BPSOSQA
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| 181 | Q
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