| [613] | 1 | BPSRES ;BHAM ISC/BEE - ECME SCREEN RESUBMIT W/EDITS ;19-MAY-06
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| 2 | ;;1.0;E CLAIMS MGMT ENGINE;**3,5**;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 | Q
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| 6 | ;
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| 7 | ;ECME Resubmit w/EDITS Protocol (Hidden) - Called by [BPS USER SCREEN]
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| 8 | ;
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| 9 | RESED N BPSEL
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| 10 | ;
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| 11 | I '$D(@(VALMAR)) G XRESED
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| 12 | D FULL^VALM1
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| 13 | ;
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| 14 | ;Select the claim to resubmit
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| 15 | W !,"Enter the line number for the claim to be resubmitted."
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| 16 | S BPSEL=$$ASKLINE("Select item","Please select a SINGLE claim only when using the Resubmit w/EDITS action option.")
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| 17 | I BPSEL<1 S VALMBCK="R" G XRESED
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| 18 | ;
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| 19 | ;Attempt to resubmit the claim, update the content of the screen, and display
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| 20 | ;only if claim submitted successfully
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| 21 | I $$DOSELCTD(BPSEL) D REDRAW^BPSSCRUD("Updating screen for resubmitted claim...")
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| 22 | E S VALMBCK="R"
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| 23 | ;
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| 24 | XRESED Q
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| 25 | ;
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| 26 | ;Attempt to Edit and Resubmit Selected Claim
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| 27 | ;
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| 28 | ; Input Value -> BPRXI - Entry with ptr to BPS TRANSACTION file
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| 29 | ;
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| 30 | ; Return Value -> 0 - Claim was not resubmitted
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| 31 | ; 1 - Claim was resubmitted
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| 32 | ;
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| 33 | DOSELCTD(BPRXI) N BP02,BP59,BPBILL,BPCLTOT,BPDFN,BPDOSDT,BPOVRIEN,BPQ,BPRXIEN,BPRXR,BPSTATUS,BPUPDFLG
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| 34 | S (BPQ)=""
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| 35 | S (BPCLTOT,BPUPDFLG)=0
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| 36 | ;
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| 37 | ;Pull BPS TRANSACTION/BPS CLAIMS entries
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| 38 | S BP59=$P(BPRXI,U,4) I BP59="" W !!,"No Initial Claim Submission Found - Data Elements are NOT Editable for Re-Submission",! G XRES
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| 39 | S BP02=+$P($G(^BPST(BP59,0)),U,4) I 'BP02 W !!,"No Initial Claim Submission Found - Data Elements are NOT Editable for Re-Submission",! G XRES
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| 40 | ;
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| 41 | ;Write Form Feed
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| 42 | W @IOF
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| 43 | ;
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| 44 | ;Display selected claim and ask to submit
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| 45 | S BPDFN=+$P($G(^BPST(BP59,0)),U,6)
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| 46 | W !,"You've chosen to RESUBMIT the following prescription for "_$E($$PATNAME^BPSSCRU2(BPDFN),1,13)
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| 47 | W !,@VALMAR@(+$P(BPRXI,U,5),0)
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| 48 | S BPQ=$$YESNO^BPSSCRRS("Are you sure?(Y/N)")
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| 49 | I BPQ'=1 S BPQ="^" G XRES
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| 50 | ;
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| 51 | ;Check to make sure claim can be Resubmitted w/EDITS
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| 52 | S BPRXIEN=$P(BP59,".")
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| 53 | S BPRXR=+$E($P(BP59,".",2),1,4)
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| 54 | I $$RXDEL^BPSOS($P(BP59,".",1),+$E($P(BP59,".",2),1,4)) W !!,"The claim: ",!,@VALMAR@(+$P(BPRXI,U,5),0),!,"cannot be Resubmitted w/EDITS because it has been deleted in Pharmacy.",! G XRES
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| 55 | S BPSTATUS=$P($$CLAIMST^BPSSCRU3(BP59),U)
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| 56 | I BPSTATUS["IN PROGRESS" W !!,"The claim: ",!,@VALMAR@(+$P(BPRXI,U,5),0),!,"is still In Progress and cannot be Resubmitted w/EDITS",! G XRES
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| 57 | I BPSTATUS'["E REJECTED" W !!,"The claim: ",!,@VALMAR@(+$P(BPRXI,U,5),0),!,"is NOT Rejected and cannot be Resubmitted w/EDITS",! G XRES
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| 58 | ;
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| 59 | ;Prompt for EDIT Information
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| 60 | S BPOVRIEN=$$PROMPTS(BP59,BP02) I BPOVRIEN=-1 G XRES
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| 61 | ;
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| 62 | ;Retrieve DOS
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| 63 | S BPDOSDT=$$DOSDATE^BPSSCRRS(BPRXIEN,BPRXR)
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| 64 | ;
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| 65 | ;Resubmit Claim
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| 66 | S BPBILL=$$EN^BPSNCPDP(BPRXIEN,BPRXR,BPDOSDT,"ERES","","ECME RESUBMIT","",BPOVRIEN)
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| 67 | ;
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| 68 | ;Print Return Value Message
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| 69 | W !!
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| 70 | W:+BPBILL>0 $S(+BPBILL=10:"Reversal but no Resubmit:",1:"Not Processed:"),!," "
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| 71 | ;
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| 72 | ;Change Return Message for SC/EI
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| 73 | S:$P(BPBILL,U,2)="NEEDS SC DETERMINATION" $P(BPBILL,U,2)="NEEDS SC/EI DETERMINATION"
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| 74 | W $P(BPBILL,U,2)
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| 75 | ;
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| 76 | ;0 Prescription/Fill successfully submitted to ECME
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| 77 | ;1 ECME did not submit prescription/fill
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| 78 | ;2 IB says prescription/fill is not ECME billable or the data returned from IB is not valid
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| 79 | ;3 ECME closed the claim but did not submit it to the payer
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| 80 | ;4 Unable to queue the ECME claim
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| 81 | ;5 Invalid input
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| 82 | ;10 Reversal Processed But Claim Was Not Resubmitted
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| 83 | ;
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| 84 | I +BPBILL=0 D
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| 85 | . D ECMEACT^PSOBPSU1(+BPRXIEN,+BPRXR,"Claim resubmitted to 3rd party payer: ECME USER's SCREEN")
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| 86 | . S BPUPDFLG=1,BPCLTOT=1
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| 87 | XRES I BPCLTOT W !,BPCLTOT," claim",$S(BPCLTOT'=1:"s have",1:" has")," been resubmitted.",!
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| 88 | D PAUSE^VALM1
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| 89 | Q BPUPDFLG
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| 90 | ;
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| 91 | ;Enter EDIT information for claim
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| 92 | ;
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| 93 | ; Input Values -> BP59 - The BPS TRANSACTION entry
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| 94 | ; BP02 - The BPS CLAIMS entry
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| 95 | ; Output Value -> BPQ - -1 - The user chose to quit
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| 96 | ; "" - The user completed the EDITS
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| 97 | PROMPTS(BP59,BP02) N %,BP300,BPCLCD,BPFDA,BPFLD,BPOVRIEN,BPMED,BPMSG,BPPSNCD,BPPREAUT,BPPRETYP,BPQ,BPRELCD,DIC,DIR,DIROUT,DTOUT,DUOUT,X,Y
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| 98 | ;
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| 99 | S BPQ=""
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| 100 | ;
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| 101 | ;Pull Information from Claim
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| 102 | S BP300=$G(^BPSC(BP02,300))
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| 103 | S BPRELCD=$TR($E($P(BP300,U,6),3,99)," ")
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| 104 | S BPPSNCD=$TR($E($P(BP300,U,3),3,99)," ")
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| 105 | S (BPPRETYP,BPPREAUT,BPCLCD)="",BPMED=0 F S BPMED=$O(^BPSC(BP02,400,BPMED)) Q:'BPMED D I BPPREAUT]"",BPCLCD]"" Q
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| 106 | .N BP460 S BP460=$G(^BPSC(BP02,400,BPMED,460))
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| 107 | .S:BPPREAUT="" BPPREAUT=$TR($E($P(BP460,U,2),3,99)," "),BPPRETYP=$TR($E($P(BP460,U),3,99)," ")
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| 108 | .S:BPCLCD="" BPCLCD=$TR($E($P($G(^BPSC(BP02,400,BPMED,400)),U,20),3,99)," ")
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| 109 | ;
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| 110 | W ! S DIR(0)="FO^1:1",DIR("A")="Relationship Code"
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| 111 | S DIR("B")=BPRELCD
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| 112 | K DIR("?")
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| 113 | S DIR("?",1)="Select the relationship code that describes the relationship this patient has"
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| 114 | S DIR("?",2)="to the holder of this insurance policy. The standard NCPDP Patient"
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| 115 | S DIR("?",3)="Relationship Code list is shown below. However, it is important to note"
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| 116 | S DIR("?",4)="that some payers use their own set of codes for this field so the field"
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| 117 | S DIR("?",5)="should be populated based upon the payer's expectations."
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| 118 | S DIR("?",6)=" "
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| 119 | S DIR("?",7)="Choose from:"
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| 120 | S DIR("?",8)=" 0 Not Specified"
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| 121 | S DIR("?",9)=" 1 Cardholder"
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| 122 | S DIR("?",10)=" 2 Spouse"
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| 123 | S DIR("?",11)=" 3 Child"
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| 124 | S DIR("?")=" 4 Other"
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| 125 | D ^DIR
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| 126 | I $G(DTOUT)!$G(DUOUT) S BPQ=-1 G XPROMPTS
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| 127 | S BPRELCD=Y
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| 128 | ;
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| 129 | ;Person Code
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| 130 | K DIR("?") S DIR(0)="FO^1:3",DIR("A")="Person Code",DIR("?")="Enter the Specific Person Code Assigned to the Patient by the Payer"
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| 131 | S DIR("B")=BPPSNCD
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| 132 | D ^DIR
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| 133 | I $G(DTOUT)!$G(DUOUT) S BPQ=-1 G XPROMPTS
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| 134 | S BPPSNCD=Y
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| 135 | ;
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| 136 | ;Pre-Authorization
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| 137 | K DIR("?") S DIR(0)="FO^1:11",DIR("A")="Prior Authorization Number",DIR("?")="Enter the Number Submitted by the Provider to Identify the Prior Authorization"
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| 138 | S DIR("B")=BPPREAUT
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| 139 | D ^DIR
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| 140 | I $G(DTOUT)!$G(DUOUT) S BPQ=-1 G XPROMPTS
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| 141 | S BPPREAUT=Y
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| 142 | ;
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| 143 | ;Prior-Authorization Type Code
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| 144 | N X,DIC,Y
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| 145 | S DIC("B")=+BPPRETYP
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| 146 | S DIC(0)="QEAM",DIC=9002313.82461,DIC("A")="Prior Authorization Type Code: "
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| 147 | D ^DIC
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| 148 | ;
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| 149 | ;Check for "^" or timeout
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| 150 | I ($G(DUOUT)=1)!($G(DTOUT)=1)!(Y=-1) S BPQ=-1 K X,DIC,Y G XPROMPTS
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| 151 | S BPPRETYP=$P(Y,U,2)
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| 152 | K X,DIC,Y
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| 153 | ;
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| 154 | ;Submission Clarification Code
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| 155 | N X,DIC,Y
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| 156 | S DIC("B")=+BPCLCD
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| 157 | S DIC(0)="QEAM",DIC=9002313.8242,DIC("A")="Submission Clarification Code: "
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| 158 | D ^DIC
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| 159 | ;
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| 160 | ;Check for "^" or timeout
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| 161 | I ($G(DUOUT)=1)!($G(DTOUT)=1)!(Y=-1) S BPQ=-1 K X,DIC,Y G XPROMPTS
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| 162 | S BPCLCD=$P(Y,U,2)
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| 163 | K X,DIC,Y
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| 164 | ;
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| 165 | ;Ask to proceed
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| 166 | W ! S BPQ=$$YESNO^BPSSCRRS("Are you sure?(Y/N)")
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| 167 | I BPQ'=1 S BPQ=-1 G XPROMPTS
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| 168 | ;
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| 169 | ;Save into BPS NCPDP OVERRIDES (#9002313.511)
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| 170 | S BPFDA(9002313.511,"+1,",.01)=BP59
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| 171 | D NOW^%DTC
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| 172 | S BPFDA(9002313.511,"+1,",.02)=%
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| 173 | S BPFLD=$O(^BPSF(9002313.91,"B",303,"")) I BPFLD]"" S BPFDA(9002313.5111,"+2,+1,",.01)=BPFLD,BPFDA(9002313.5111,"+2,+1,",.02)=BPPSNCD
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| 174 | S BPFLD=$O(^BPSF(9002313.91,"B",306,"")) I BPFLD]"" S BPFDA(9002313.5111,"+3,+1,",.01)=BPFLD,BPFDA(9002313.5111,"+3,+1,",.02)=BPRELCD
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| 175 | S BPFLD=$O(^BPSF(9002313.91,"B",462,"")) I BPFLD]"" S BPFDA(9002313.5111,"+4,+1,",.01)=BPFLD,BPFDA(9002313.5111,"+4,+1,",.02)=BPPREAUT
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| 176 | S BPFLD=$O(^BPSF(9002313.91,"B",461,"")) I BPFLD]"" S BPFDA(9002313.5111,"+5,+1,",.01)=BPFLD,BPFDA(9002313.5111,"+5,+1,",.02)=BPPRETYP
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| 177 | S BPFLD=$O(^BPSF(9002313.91,"B",420,"")) I BPFLD]"" S BPFDA(9002313.5111,"+6,+1,",.01)=BPFLD,BPFDA(9002313.5111,"+6,+1,",.02)=BPCLCD
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| 178 | D UPDATE^DIE("","BPFDA","BPOVRIEN","BPMSG")
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| 179 | ;
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| 180 | I $D(BPMSG("DIERR")) W !!,"Could Not Save Override information into BPS NCPDP OVERRIDES FILES",! S BPQ=-1 G XPROMPTS
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| 181 | ;
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| 182 | XPROMPTS S BPOVRIEN=$S(BPQ=-1:BPQ,$G(BPOVRIEN(1))]"":BPOVRIEN(1),1:-1)
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| 183 | Q BPOVRIEN
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| 184 | ;
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| 185 | ;Prompt User for Claim to Resubmit (w/EDITS)
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| 186 | ;
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| 187 | ; Input values -> BPROMPT - prompt string
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| 188 | ; BPERRMES - the message to display when the user tries
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| 189 | ; to make multi line selection (optional)
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| 190 | ; Piece
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| 191 | ;output values -> 1 - 1 = okay, <0 = errors, 0 = quit
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| 192 | ; 2 - patient ien #2
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| 193 | ; 3 - insurance ien #36
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| 194 | ; 4 - ptr to #9002313.59
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| 195 | ; 5 - 1st line for index(es) in LM "VALM" array
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| 196 | ; 6 - patient's index
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| 197 | ; 7 - claim's index
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| 198 | ASKLINE(BPROMPT,BPERRMES) ;
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| 199 | N BPRET,BPCNT
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| 200 | S BPRET="",BPCNT=0
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| 201 | F S BPRET=$$SELLINE^BPSSCRU4(BPROMPT,"C",VALMAR,"") Q:BPRET'<0 D
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| 202 | . ;
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| 203 | . I BPCNT<1 S BPCNT=BPCNT+1 W !
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| 204 | . E S BPCNT=0 D RE^VALM4
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| 205 | . I BPRET=-1 W "Invalid line number" ; (invalid Patient summary line)"
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| 206 | . I BPRET=-8 W $S($G(BPERRMES)]"":BPERRMES,1:" Invalid line number")
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| 207 | . I BPRET=-4 W "Invalid line number" ; (invalid RX line)"
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| 208 | . I BPRET=-2 W "Please select Patient's summary line."
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| 209 | . I BPRET=-3 W "Please specify RX line."
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| 210 | . I ",-1,-8,-4,-2,-3,"'[(","_BPRET_",") W "Incorrect format." ; Corrupted array (",BPRET,")"
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| 211 | Q BPRET
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