| 1 | IBCBB1 ;ALB/AAS - CONTINUATION OF EDIT CHECK ROUTINE ;2-NOV-89
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| 2 | ;;2.0;INTEGRATED BILLING;**27,52,80,93,106,51,151,148,153,137,232,280,155,320,343,349,363**;21-MAR-94;Build 35
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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 | ;MAP TO DGCRBB1
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| 6 | ;
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| 7 | % ;Bill Status
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| 8 | N Z,Z0,Z1
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| 9 | I $S(+IBST=0:1,1:"^1^2^3^4^7^"'[(U_IBST_U)) S IBER=IBER_"IB045;"
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| 10 | ;
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| 11 | ;Statement Covers From
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| 12 | I IBFDT="" S IBER=IBER_"IB061;"
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| 13 | I IBFDT]"",IBFDT'?7N&(IBFDT'?7N1".".N) S IBER=IBER_"IB061;"
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| 14 | I IBFDT>IBTDT S IBER=IBER_"IB061;" ; from must be on or before the to date
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| 15 | S IBFFY=$$FY^IBOUTL(IBFDT)
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| 16 | ; if inpat - from date must not be prior to admit date.
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| 17 | I $$INPAT^IBCEF(IBIFN,1),(IBFDT<($P($G(^DGPT(+$P(IBND0,U,8),0)),U,2)\1)) S IBER=IBER_"IB061;"
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| 18 | ;
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| 19 | ;Statement Covers To
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| 20 | I IBTDT="" S IBER=IBER_"IB062;"
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| 21 | I IBTDT]"",IBTDT'?7N&(IBTDT'?7N1".".N) S IBER=IBER_"IB062;"
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| 22 | I IBTDT>DT!(IBTDT<IBFDT) S IBER=IBER_"IB062;" ; to date must not be >than today's date
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| 23 | S IBTFY=$$FY^IBOUTL(IBTDT)
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| 24 | ;
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| 25 | ;Statement crosses fiscal years
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| 26 | ;I IBTFY'=IBFFY S IBER=IBER_"IB047;"
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| 27 | ;
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| 28 | ;Statement crosses calendar years
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| 29 | ;I $E(IBTDT,1,3)'=$E(IBFDT,1,3) S IBER=IBER_"IB046;"
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| 30 | ;
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| 31 | ;Total Charges
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| 32 | I +IBTC'>0!(+IBTC'=IBTC) S IBER=IBER_"IB064;"
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| 33 | ;
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| 34 | ;Billable charges for secondary claim
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| 35 | I $$MCRONBIL^IBEFUNC(IBIFN)&(($P(IBNDU1,U,1)-$P(IBNDU1,U,2))'>0) S IBER=IBER_"IB094;"
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| 36 | ;Fiscal Year 1
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| 37 | S IBFFY=$$FY^IBOUTL(IBFDT)
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| 38 | ;
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| 39 | ;Check provider link for current user, enterer, reviewer and Authorizor
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| 40 | I '$D(^VA(200,DUZ,0)) S IBER=IBER_"IB048;"
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| 41 | I IBEU]"",'$D(^VA(200,IBEU,0)) S IBER=IBER_"IB048;"
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| 42 | I IBRU]"",'$D(^VA(200,IBRU,0)) S IBER=IBER_"IB060;"
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| 43 | I IBAU]"",'$D(^VA(200,IBAU,0)) S IBER=IBER_"IB041;"
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| 44 | ;
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| 45 | ;Bill exists and not already new bill
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| 46 | ;I $S('$D(^PRCA(430,IBIFN,0)):1,$P($P(^PRCA(430,IBIFN,0),"^"),"-",2)'=IBBNO:1,1:0) S IBER=IBER_"IB056;"
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| 47 | ;I $P($$BN^PRCAFN(IBIFN),"-",2)'=IBBNO S IBER=IBER_"IB056;"
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| 48 | ;I IBER="",$P(^PRCA(430,IBIFN,0),"^",8)=$O(^PRCA(430.3,"AC",104,"")) S IBER=IBER_"IB040;"
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| 49 | I IBER="",+$$STA^PRCAFN(IBIFN)=104 S IBER=IBER_"IB040;"
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| 50 | ; If ins bill, must have valid COB sequence
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| 51 | I $P(IBND0,U,11)="i",$S($P(IBND0,U,21)="":1,1:"PST"'[$P(IBND0,U,21)) S IBER=IBER_"IB324;"
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| 52 | ;
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| 53 | ; Check for valid sec provider id for current ins
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| 54 | S Z=0 F S Z=$O(^DGCR(399,IBIFN,"PRV",Z)) Q:'Z S Z0=$G(^(Z,0)),Z1=+$$COBN^IBCEF(IBIFN) I $P(Z0,U,4+Z1)'="",$P(Z0,U,11+Z1)'="" D
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| 55 | . I '$$SECIDCK^IBCEF74(IBIFN,Z1,$P(Z0,U,11+Z1),Z) D WARN^IBCBB11("Prov secondary id type for the "_$P("PRIMARY^SECONDARY^TERTIARY",U,Z1)_" "_$$EXTERNAL^DILFD(399.0222,.01,,+Z0)_" is invalid/won't transmit")
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| 56 | ; Check NPIs
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| 57 | D NPICHK^IBCBB11
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| 58 | ;
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| 59 | ; Check taxonomies
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| 60 | D TAXCHK^IBCBB11
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| 61 | ;
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| 62 | ; Check for Physician Name
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| 63 | K IBXDATA D F^IBCEF("N-ATT/REND PHYSICIAN NAME",,,IBIFN)
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| 64 | I $P($G(IBXDATA),U)="" S IBER=IBER_"IB303;"
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| 65 | ;
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| 66 | N FUNCTION,IBINS
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| 67 | S FUNCTION=$S($$FT^IBCEF(IBIFN)=3:4,1:3)
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| 68 | I IBER'["IB303;" D
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| 69 | . F IBINS=1:1:3 D
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| 70 | .. S Z=$$GETTYP^IBCEP2A(IBIFN,IBINS)
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| 71 | .. I Z,$P(Z,U,2) D ; Rendering/attending prov secondary id required
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| 72 | ... N IBID,IBOK,Q0
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| 73 | ... D PROVINF^IBCEF74(IBIFN,IBINS,.IBID,1,"C") ; check all as though they were current
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| 74 | ... S IBOK=0
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| 75 | ... S Q0=0 F S Q0=$O(IBID(1,FUNCTION,Q0)) Q:'Q0 I $P(IBID(1,FUNCTION,Q0),U,9)=+Z S IBOK=1 Q
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| 76 | ... I 'IBOK S IBER=IBER_$S(IBINS=1:"IB236;",IBINS=2:"IB237;",IBINS=3:"IB238;",1:"")
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| 77 | . I $$TXMT^IBCEF4(IBIFN) D
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| 78 | .. D F^IBCEF("N-ALL ATT/REND PROV SSN/EI","IBZ",,IBIFN)
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| 79 | .. I $P(IBZ,U,3)=""&($P(IBZ,U,4)="") S IBER=IBER_"IB321;" ; SSN/IEN required for rend/att
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| 80 | ;
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| 81 | N IBM,IBM1
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| 82 | S IBM=$G(^DGCR(399,IBIFN,"M"))
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| 83 | S IBM1=$G(^DGCR(399,IBIFN,"M1"))
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| 84 | I $P(IBM,U),$P($G(^DIC(36,$P(IBM,U),4)),U,6),$P(IBM1,U,2)="" S IBER=IBER_"IB244;"
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| 85 | I $P(IBM,U,2),$P($G(^DIC(36,$P(IBM,U,2),4)),U,6),$P(IBM1,U,3)="" S IBER=IBER_"IB245;"
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| 86 | I $P(IBM,U,3),$P($G(^DIC(36,$P(IBM,U,3),4)),U,6),$P(IBM1,U,4)="" S IBER=IBER_"IB246;"
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| 87 | ;
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| 88 | ; If outside facility, check for ID and qualifier in 355.93
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| 89 | ; 5/15/06 - esg - hard error IB243 turned into warning message instead
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| 90 | S Z=$P($G(^DGCR(399,IBIFN,"U2")),U,10)
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| 91 | I Z D
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| 92 | . I $P($G(^IBA(355.93,Z,0)),U,9)=""!($P($G(^IBA(355.93,Z,0)),U,13)="") D
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| 93 | .. N Z1,Z2
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| 94 | .. S Z1="Missing Lab or Facility Primary ID for non-VA facility, "
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| 95 | .. S Z2=$$EXTERNAL^DILFD(399,232,,Z)
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| 96 | .. I $L(Z2)'>19 D WARN^IBCBB11(Z1_Z2) Q
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| 97 | .. D WARN^IBCBB11(Z1),WARN^IBCBB11(" "_Z2)
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| 98 | .. Q
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| 99 | . Q
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| 100 | ;
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| 101 | ; Must be one and only one division on bill
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| 102 | S IBZ=$$MULTDIV^IBCBB11(IBIFN,IBND0)
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| 103 | I IBZ S IBER=IBER_$S(IBZ=1:"IB095;",IBZ=2:"IB104;",1:"IB105;")
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| 104 | ; Division address must be defined in institution file
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| 105 | I $P(IBND0,U,22) D
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| 106 | . N Z,Z0,Z1
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| 107 | . S Z0=$G(^DIC(4,+$P($G(^DG(40.8,+$P(IBND0,U,22),0)),U,7),0))
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| 108 | . S Z1=$G(^DIC(4,+$P($G(^DG(40.8,+$P(IBND0,U,22),0)),U,7),1))
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| 109 | . I $P(Z0,U,2)="" S IBER=IBER_"IB097;" Q
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| 110 | . F Z=1,3,4 I $P(Z1,U,Z)="" S IBER=IBER_"IB097;" Q
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| 111 | ;
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| 112 | ;CHAMPVA Rate Type and Primary Insurance Carriers Type of Coverage must match
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| 113 | S (IBRTCHV,IBPICHV)=0
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| 114 | I $P($G(^DGCR(399.3,+IBAT,0)),U,1)="CHAMPVA" S IBRTCHV=1
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| 115 | I $P($G(^IBE(355.2,+$P($G(^DIC(36,+IBNDMP,0)),U,13),0)),U,1)="CHAMPVA" S IBPICHV=1
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| 116 | I (+IBRTCHV!+IBPICHV)&('IBRTCHV!'IBPICHV) S IBER=IBER_"IB085;"
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| 117 | ;
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| 118 | N IBZPRC,IBZPRCUB
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| 119 | D F^IBCEF("N-ALL PROCEDURES","IBZPRC",,IBIFN)
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| 120 | ; Procedure Clinic is required for Surgical Procedures Outpt Facility Charges
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| 121 | I +$P(IBND0,U,27)'=2,$$BILLRATE^IBCRU3(IBAT,IBCL,IBEVDT,"RC OUTPATIENT") D
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| 122 | . N Z,Z0,Z1,ZE S (ZE,Z)=0 F S Z=$O(^DGCR(399,IBIFN,"CP",Z)) Q:'Z D I +ZE S IBER=IBER_"IB320;" Q
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| 123 | .. S Z0=$G(^DGCR(399,IBIFN,"CP",Z,0)),Z1=+Z0 I Z0'[";ICPT(" Q
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| 124 | .. I '((Z1'<10000)&(Z1'>69999))&'((Z1'<93501)&(Z1'>93533)) Q
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| 125 | .. I '$P(Z0,U,7) S ZE=1
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| 126 | ;
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| 127 | ; Extract procedures for UB-04
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| 128 | D F^IBCEF("N-UB-04 PROCEDURES","IBZPRCUB",,IBIFN)
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| 129 | ; Does this bill have ANY prescriptions associated with it?
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| 130 | ; Must bill prescriptions separately from other charges
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| 131 | ;
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| 132 | I $$ISRX^IBCEF1(IBIFN) D
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| 133 | . N IBZ,IBRXDEF
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| 134 | . S IBRXDEF=$P($G(^IBE(350.9,1,1)),U,30),IBZ=0
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| 135 | . F S IBZ=$O(IBZPRCUB(IBZ)) Q:'IBZ I IBZPRCUB(IBZ),+$P(IBZPRCUB(IBZ),U)'=IBRXDEF S IBER=IBER_"IB102;" Q
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| 136 | . K IBZ
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| 137 | ;
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| 138 | ; Check that COB sequences are not skipped
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| 139 | K Z
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| 140 | F Z=1:1:3 S:+$G(^DGCR(399,IBIFN,"I"_Z)) Z(Z)=""
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| 141 | F Z=0:1:2 S Z0=$O(Z(Z)) Q:'Z0 I Z0'=(Z+1) S IBER=IBER_"IB322;" Q
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| 142 | K Z
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| 143 | I $P($G(^DGCR(399,IBIFN,0)),U,21)="" S IBER=IBER_"IB323;"
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| 144 | K IBXDATA D F^IBCEF("N-PROCEDURE CODING METHD",,,IBIFN)
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| 145 | ; Coding method should agree with types of procedure codes
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| 146 | S IBOK=$S('$O(IBZPRC(0))!(IBXDATA=""):1,1:0)
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| 147 | I 'IBOK S IBOK=1,IBZ=0 F S IBZ=$O(IBZPRC(IBZ)) Q:'IBZ I IBZPRC(IBZ),$P(IBZPRC(IBZ),U)'[$S(IBXDATA=9:"ICD",1:"ICP") S IBOK=0 Q
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| 148 | I 'IBOK D WARN^IBCBB11("Coding Method does not agree with all procedure codes found on bill")
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| 149 | D EDITMRA^IBCBB3(.IBQUIT,.IBER,IBIFN,IBFT)
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| 150 | Q:$G(IBQUIT)
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| 151 | ;
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| 152 | ;Other things that could be added: Rev Code - calculating charges
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| 153 | ; Diagnosis Coding, if MT copay - check for other co-payments
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| 154 | ;
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| 155 | I $P(IBNDTX,U,8),$$REQMRA^IBEFUNC(IBIFN) S IBER=IBER_"IB121;" ; can't force MRAs to print
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| 156 | I $P(IBNDTX,U,8)!$P(IBNDTX,U,9) D WARN^IBCBB11($S($$REQMRA^IBEFUNC(IBIFN)&($P(IBNDTX,U,9)):"MRA Secondary ",1:"")_"Bill has been forced to print "_$S($P(IBNDTX,U,8)=1!($P(IBNDTX,U,9)=1):"locally",1:"at clearinghouse"))
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| 157 | N IBXZ,IBIZ F IBIZ=12,13,14 S IBXZ=$P(IBNDM,U,IBIZ) I +IBXZ S IBXZ=$P($G(^DPT(DFN,.312,IBXZ,0)),U,18) I +IBXZ S IBXZ=$G(^IBA(355.3,+IBXZ,0)) I +$P(IBXZ,U,12) D
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| 158 | . D WARN^IBCBB11($P($G(^DIC(36,+IBXZ,0)),U,1)_" requires Amb Care Certification")
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| 159 | ;
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| 160 | D VALNDC^IBCBB11(IBIFN,DFN) ;validate NDC#
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| 161 | ;Build AR array if no errors and MRA not needed or already rec'd
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| 162 | I IBER="",$S($$NEEDMRA^IBEFUNC(IBIFN)!($$REQMRA^IBEFUNC(IBIFN)):0,1:1) D ARRAY
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| 163 | ;
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| 164 | END ;Don't kill IBIFN, IBER, DFN
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| 165 | I $O(^TMP($J,"BILL-WARN",0)),$G(IBER)="" S IBER="WARN" ;Warnings only
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| 166 | K IBBNO,IBEVDT,IBLOC,IBCL,IBTF,IBAT,IBWHO,IBST,IBFDT,IBTDT,IBTC,IBFY,IBFY1,IBAU,IBRU,IBEU,IBARTP,IBFYC,IBMRA,IBTOB,IBTOB12,IBNDU2,IBNDUF3,IBNDUF31,IBNDTX
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| 167 | K IBNDS,IBND0,IBNDU,IBNDM,IBNDMP,IBNDU1,IBFFY,IBTFY,IBFT,IBRTCHV,IBPICHV,IBXDATA,IBOK
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| 168 | I $D(IBER),IBER="" W !,"No Errors found for National edits"
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| 169 | Q
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| 170 | ;
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| 171 | ARRAY ;Build PRCASV(array)
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| 172 | N IBCOBN,X
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| 173 | K PRCASV
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| 174 | Q:$$MCRWNR^IBEFUNC(+$$CURR^IBCEF2(IBIFN))
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| 175 | S IBCOBN=$$COBN^IBCEF(IBIFN)
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| 176 | S X=IBIFN
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| 177 | S PRCASV("BDT")=DT,PRCASV("ARREC")=IBIFN
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| 178 | S PRCASV("APR")=DUZ
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| 179 | S PRCASV("PAT")=DFN,PRCASV("CAT")=$P(^DGCR(399.3,IBAT,0),"^",6)
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| 180 | I IBWHO="i" S PRCASV("DEBTOR")=+IBNDMP_";DIC(36,"
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| 181 | S PRCASV("DEBTOR")=$S(IBWHO="p":DFN_";DPT(",IBWHO="o":$P(IBNDM,"^",11)_";DIC(4,",IBWHO="i":PRCASV("DEBTOR"),1:"")
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| 182 | S PRCASV("CARE")=$E($$TOB^IBCEF1(IBIFN),1,2)
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| 183 | S PRCASV("FY")=$$FY^IBOUTL(DT)_U_($P(IBNDU1,U)-$P(IBNDU1,U,2))
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| 184 | ;S PRCASV("FY")=$P(IBNDU1,U,9)_U_$S($P(IBNDU1,U,2)]"":($P(IBNDU1,U,10)-$P(IBNDU1,U,2)),1:$P(IBNDU1,U,10))_$S($P(IBNDU1,U,11)]"":U_$P(IBNDU1,U,11)_U_$P(IBNDU1,U,12),1:"")
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| 185 | PLUS I IBWHO="i",$P(IBNDM,"^",2),$D(^DIC(36,$P(IBNDM,"^",2),0)) S PRCASV("2NDINS")=$P(IBNDM,"^",2)
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| 186 | I IBWHO="i",$P(IBNDM,"^",3),$D(^DIC(36,$P(IBNDM,"^",3),0)) S PRCASV("3RDINS")=$P(IBNDM,"^",3)
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| 187 | ;
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| 188 | N IBX S IBX=$P(IBND0,U,21),IBX=$S(IBX="P":"I1",IBX="S":"I2",IBX="T":"I3",1:"") Q:IBX=""
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| 189 | N IBNDI1
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| 190 | Q:'$D(^DGCR(399,IBIFN,IBX)) S IBNDI1=^(IBX)
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| 191 | S:$P(IBNDI1,"^",3)]"" PRCASV("GPNO")=$P(IBNDI1,"^",3)
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| 192 | S:$P(IBNDI1,"^",15)]"" PRCASV("GPNM")=$P(IBNDI1,"^",15)
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| 193 | S:$P(IBNDI1,"^",17)]"" PRCASV("INPA")=$P(IBNDI1,"^",17)
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| 194 | S:$P(IBNDI1,"^",2)]"" PRCASV("IDNO")=$P(IBNDI1,"^",2),PRCASV("INID")=PRCASV("IDNO")
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| 195 | ; Check that this is a secondary or tertiary bill and insurance for previous
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| 196 | ; COB sequence is Medicare WNR and MRA is active --> send data elements to AR
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| 197 | I IBCOBN>1,$$WNRBILL^IBEFUNC(IBIFN,IBCOBN-1),$$EDIACTV^IBCEF4(2) D MRA
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| 198 | Q
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| 199 | ;
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| 200 | MRA N IBEOB S IBEOB=0
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| 201 | ;
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| 202 | K PRCASV("MEDURE"),PRCASV("MEDCA")
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| 203 | ; Get EOB data
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| 204 | F S IBEOB=$O(^IBM(361.1,"B",IBIFN,IBEOB)) Q:'IBEOB D
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| 205 | . D MRACALC^IBCEMU2(IBEOB,IBIFN,1,.PRCASV)
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| 206 | Q ;MRA
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| 207 | ;
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| 208 | ;; PREGNANCY DX CODES: V22**-V24**, V27**-V28**, 630**-677**
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| 209 | ;; FLU SHOTS PROCEDURE CODES: 90724, G0008, 90732, G0009
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