| [613] | 1 | IBBFAPI ;OAK/ELZ - FOR OTHER PACKAGES TO QUERY INSURANCE INFO ;19-AUG-2004
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| 2 | ;;2.0;INTEGRATED BILLING;**267,297,249,317,361**;21-MAR-94;Build 9
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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 | ; -- see IBBDOC for API documentation
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| 6 | ; no applications should call here directly
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| 7 | INSUR(DFN,IBDT,IBSTAT,IBR,IBFLDS) ; Return Patient Insurance Information
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| 8 | ;
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| 9 | N ERROR,ERRORT,FCNT,IBPLN,ICNT,INSP,N,N1,NOK,PASS,PASS1,X,%
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| 10 | K ERRORT D ERRORLD
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| 11 | S NOK=-1
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| 12 | S DFN=$G(DFN)
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| 13 | S IBSTAT=$G(IBSTAT)
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| 14 | S IBDT=$P($G(IBDT),".")
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| 15 | S IBFLDS=$G(IBFLDS)
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| 16 | I IBDT,IBSTAT["A" S ERROR=107 D ERROR Q NOK
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| 17 | S (ERROR,PASS)=0 K IBR
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| 18 | I 'DFN S ERROR=102 D ERROR Q NOK
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| 19 | I '$D(^DPT(DFN)) S ERROR=106 D ERROR Q NOK
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| 20 | I IBDT]"",IBDT'?7N S ERROR=104 D ERROR Q NOK
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| 21 | I +IBDT=0 D NOW^%DTC S IBDT=$P(%,".",1)
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| 22 | I IBSTAT]"" N Y F X=1:1:$L(IBSTAT) S Y=$E(IBSTAT,X) I '$F("^A^R^P^O^I^B^",(U_Y_U)) S ERROR=105 D ERROR Q
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| 23 | I ERROR=105 Q NOK
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| 24 | I IBFLDS]"",IBFLDS'="*" N Y F X=1:1:$L(IBFLDS,",") D
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| 25 | . S Y=$P(IBFLDS,",",X)
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| 26 | . I Y'?1N.N S ERROR=103
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| 27 | . I Y?1N.N,(Y<1)!(Y>21) S ERROR=103
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| 28 | I ERROR=103 D ERROR Q NOK
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| 29 | K IBR
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| 30 | ; set buffer file flag
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| 31 | S (X,IBR("BUFFER"))=0 F S X=$O(^IBA(355.33,"C",DFN,X)) Q:'X S IBR("BUFFER")=IBR("BUFFER")+1
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| 32 | S (ICNT,N)=0 F S N=$O(^DPT(DFN,.312,N)) Q:'N I $D(^(N,0)) D
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| 33 | . S X=^DPT(DFN,.312,N,0)
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| 34 | . N X1
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| 35 | . S X1=$G(^DIC(36,+X,0)) I X1="" Q ; no insurance company entry
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| 36 | . S INSP=$P(X,U,1),IBPLN=$P(X,U,18)
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| 37 | . I IBSTAT'["R",$P(X1,U,2)="N" Q ; does not reimburse
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| 38 | . I IBSTAT'["B",$$INDEM^IBCNS1(X) Q ; indemnity policy
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| 39 | . S PASS1=0
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| 40 | . I IBSTAT'["A" D
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| 41 | . . I $P(X,U,8),IBDT<$P(X,U,8) S PASS1=1 Q ;effective after care date
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| 42 | . . I $P(X,U,4),IBDT>$P(X,U,4) S PASS1=1 Q ;terminated before care date
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| 43 | . . I $P($G(^IBA(355.3,+$P(X,U,18),0)),U,11) S PASS1=1 Q ;inactive plan
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| 44 | . . I $P(X1,U,5) S PASS1=1 Q ; inactive insurance company
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| 45 | . Q:PASS1
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| 46 | . S ICNT=ICNT+1
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| 47 | . S FCNT=$S(IBFLDS="*":22,1:$L(IBFLDS,",")) ; number of fields to pull
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| 48 | . S IBR("IBBAPI","INSUR",ICNT)=""
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| 49 | . I IBFLDS'="" F N1=1:1:FCNT D
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| 50 | . . N RET,RETVAL
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| 51 | . . S RET=$S(IBFLDS="*":N1,1:$P(IBFLDS,",",N1)),RETVAL="" I RET?1N.N,RET>0,RET<23 D @RET S IBR("IBBAPI","INSUR",ICNT,RET)=RETVAL
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| 52 | . I IBSTAT["P"!(IBSTAT["O")!(IBSTAT["I") D I PASS1=0 K IBR("IBBAPI","INSUR",ICNT) S ICNT=ICNT-1
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| 53 | . . S PASS1=0 Q:IBPLN=""
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| 54 | . . I IBSTAT["P",+$$PLCOV(IBPLN,IBDT,"PHARMACY")>0 S PASS1=1
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| 55 | . . I IBSTAT["O",+$$PLCOV(IBPLN,IBDT,"OUTPATIENT")>0 S PASS1=1
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| 56 | . . I IBSTAT["I",+$$PLCOV(IBPLN,IBDT,"INPATIENT")>0 S PASS1=1
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| 57 | I $D(IBR("IBBAPI","INSUR")),$O(IBR("IBBAPI","INSUR",0))'="ERROR" S PASS=1 F X=1:1 Q:'$D(IBR("IBBAPI","INSUR",X)) K:'$O(IBR("IBBAPI","INSUR",X,"")) IBR("IBBAPI","INSUR",X)
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| 58 | Q PASS
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| 59 | ERRORLD ; load error array
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| 60 | F X=1:1:9 S ERRORT(X+100)=$P($T(ERRORLD1+X),";;",2)
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| 61 | Q
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| 62 | ;
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| 63 | ERRORLD1 ; error messages
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| 64 | ;;DATABASE IS UNAVAILABLE
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| 65 | ;;PATIENT ID IS REQUIRED
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| 66 | ;;INVALID FIELD LIST
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| 67 | ;;INVALID EFFECTIVE DATE
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| 68 | ;;INVALID INSURANCE STATUS FILTER
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| 69 | ;;INVALID PATIENT ID
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| 70 | ;;INVALID COMBINATION, YOU CANNOT USE ""A"" WITH A DATE
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| 71 | ;;DATA SOURCE IS NOT DEFINED
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| 72 | ;;NO DATA ELEMENTS TO STORE
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| 73 | ;;
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| 74 | ERROR ;
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| 75 | K IBR S IBR("IBBAPI","INSUR","ERROR",ERROR)=ERRORT(ERROR)
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| 76 | Q
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| 77 | ;
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| 78 | 1 ; Ins. Comp. name
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| 79 | S RETVAL=$$GET1^DIQ(2.312,N_","_DFN_",",.01,"I")_U_$$GET1^DIQ(2.312,N_","_DFN_",",.01)
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| 80 | Q
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| 81 | 2 ; Ins. Comp. Street Address Line 1
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| 82 | S RETVAL=$$GET1^DIQ(36,INSP_",",.111)
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| 83 | Q
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| 84 | 3 ; Ins. Comp. City
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| 85 | S RETVAL=$$GET1^DIQ(36,INSP_",",.114)
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| 86 | Q
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| 87 | 4 ; Ins. Comp. State
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| 88 | S RETVAL=$$GET1^DIQ(36,INSP_",",.115,"I") S:RETVAL RETVAL=RETVAL_U_$$GET1^DIQ(36,INSP_",",.115)
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| 89 | Q
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| 90 | 5 ; Ins. Comp. Zip
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| 91 | S RETVAL=$$GET1^DIQ(36,INSP_",",.116)
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| 92 | Q
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| 93 | 6 ; Ins. Comp. Phone
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| 94 | S RETVAL=$$GET1^DIQ(36,INSP_",",.131)
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| 95 | Q
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| 96 | 7 ; Coordination of Benefits
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| 97 | S RETVAL=$$GET1^DIQ(2.312,N_","_DFN_",",.2,"I")_U_$$GET1^DIQ(2.312,N_","_DFN_",",.2)
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| 98 | I RETVAL="^" S RETVAL=""
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| 99 | Q
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| 100 | 8 ; Policy Name
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| 101 | S RETVAL=$$GET1^DIQ(2.312,N_","_DFN_",",.18,"I") S:RETVAL RETVAL=RETVAL_U_$$GET1^DIQ(355.3,RETVAL,.03)
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| 102 | Q
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| 103 | 9 ; Policy Reimbursable?
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| 104 | S RETVAL=$$GET1^DIQ(36,INSP_",",1,"I")
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| 105 | S RETVAL=$S(RETVAL="Y":"1^YES",RETVAL="*":"1^YES",RETVAL="**":"1^YES",RETVAL="":"1^YES",1:"0^NO")
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| 106 | Q
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| 107 | 10 ; Policy Effective Date
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| 108 | S RETVAL=$$GET1^DIQ(2.312,N_","_DFN_",",8,"I")
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| 109 | Q
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| 110 | 11 ; Policy Expiration Date
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| 111 | S RETVAL=$$GET1^DIQ(2.312,N_","_DFN_",",3,"I")
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| 112 | Q
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| 113 | 12 ; Subscriber Relationship
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| 114 | S RETVAL=$$GET1^DIQ(2.312,N_","_DFN_",",16,"I")
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| 115 | S RETVAL=$S(RETVAL="01":"P^PATIENT",RETVAL="02":"S^SPOUSE",RETVAL:"O^OTHER",1:"")
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| 116 | Q
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| 117 | 13 ; Subscriber Name
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| 118 | S RETVAL=$$GET1^DIQ(2.312,N_","_DFN_",",17)
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| 119 | Q
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| 120 | 14 ; Subscriber ID
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| 121 | S RETVAL=$$GET1^DIQ(2.312,N_","_DFN_",",1)
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| 122 | Q
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| 123 | 15 ; Pharmacy Coverage?
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| 124 | N IBCOV
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| 125 | S IBCOV=$$PLCOV(IBPLN,IBDT,"PHARMACY")
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| 126 | S RETVAL=$S(+IBCOV=0:"0^NO",1:"1^YES")
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| 127 | Q
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| 128 | 16 ; Outpatient Coverage?
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| 129 | N IBCOV
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| 130 | S IBCOV=$$PLCOV(IBPLN,IBDT,"OUTPATIENT")
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| 131 | S RETVAL=$S(+IBCOV=0:"0^NO",1:"1^YES")
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| 132 | Q
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| 133 | 17 ; Inpatient Coverage?
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| 134 | N IBCOV
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| 135 | S IBCOV=$$PLCOV(IBPLN,IBDT,"INPATIENT")
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| 136 | S RETVAL=$S(+IBCOV=0:"0^NO",1:"1^YES")
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| 137 | Q
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| 138 | 18 ; Group Number
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| 139 | S RETVAL=$$GET1^DIQ(355.3,$$GET1^DIQ(2.312,N_","_DFN_",",.18,"I")_",",.04)
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| 140 | Q
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| 141 | ;
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| 142 | 19 ; Patient Relationship to Subscriber
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| 143 | S RETVAL=$$GET1^DIQ(2.312,N_","_DFN_",",16,"I") S:RETVAL RETVAL=RETVAL_U_$$GET1^DIQ(2.312,N_","_DFN_",",16)
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| 144 | Q
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| 145 | ;
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| 146 | 20 ; VA Advantage and Tricare plan
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| 147 | S RETVAL=0 ; VA Advantage to be determined at a later date
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| 148 | N PLN,TYP1,TYP2,RETVAL1
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| 149 | S PLN=$$GET1^DIQ(2.312,N_","_DFN_",",.18,"I")
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| 150 | S TYP1=$$GET1^DIQ(355.3,PLN_",",.09,"I")
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| 151 | S TYP2=$$GET1^DIQ(355.1,TYP1_",",.03,"I")
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| 152 | S RETVAL1=$S(TYP2=7:1,1:0) ; determine if Tricare plan
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| 153 | S RETVAL=RETVAL_U_RETVAL1
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| 154 | Q
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| 155 | ;
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| 156 | 21 ; Plan Type
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| 157 | N PLN,TYP1
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| 158 | S PLN=$$GET1^DIQ(2.312,N_","_DFN_",",.18,"I")
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| 159 | S TYP1=$$GET1^DIQ(355.3,PLN_",",.09,"I")
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| 160 | S RETVAL=$S(TYP1:TYP1_U_$$GET1^DIQ(355.1,TYP1_",",.01,"I"),1:"")
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| 161 | Q
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| 162 | ;
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| 163 | 22 ; Subscriber Sex
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| 164 | D 12
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| 165 | I $E(RETVAL)="P" S RETVAL=$$GET1^DIQ(2,DFN_",",.02,"I") S:$L(RETVAL) RETVAL=RETVAL_U_$$GET1^DIQ(2,DFN_",",.02)
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| 166 | E S RETVAL=$$GET1^DIQ(2.312,N_","_DFN_",",3.12,"I") S:$L(RETVAL) RETVAL=RETVAL_U_$$GET1^DIQ(2.312,N_","_DFN_",",3.12)
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| 167 | Q
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| 168 | ;
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| 169 | PLCOV(IBPL,IBVDT,IBCAT) ; Determine if a specific plan covers a category of coverage as of a date
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| 170 | ; IBPL - pointer to file 355.3 group insurance plan (req)
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| 171 | ; IBVDT - fileman format visit date (req)
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| 172 | ; IBCAT - pointer to file 355.31 limitation of coverage category (req)
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| 173 | N CATLIM,X,Y
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| 174 | I '$G(IBPL)!('$G(IBVDT))!('$L($G(IBCAT))) Q 0
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| 175 | S X=0
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| 176 | S IBCAT=$O(^IBE(355.31,"B",IBCAT,"")) G:IBCAT="" PLCOVQ
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| 177 | S CATLIM=$O(^IBA(355.32,"APCD",IBPL,IBCAT,+$O(^IBA(355.32,"APCD",IBPL,IBCAT,-(IBVDT+1))),""))
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| 178 | S X=$S(CATLIM="":1,1:+$P($G(^IBA(355.32,CATLIM,0)),U,4))
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| 179 | PLCOVQ Q X
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| 180 | ;
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