| 1 | IBCBB9 ;ALB/BGA MEDICARE PART B EDIT CHECKS ;10/15/98
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| 2 | ;;2.0;INTEGRATED BILLING;**51,137,155,349**;21-MAR-94;Build 46
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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 | PARTB ; MEDICARE specific edit checks for PART B claims (CMS-1500)
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| 6 | ;
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| 7 | N IBXDATA,IBXERR,IBXIEN,IBXSAVE,IBPR,IBDTFLG
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| 8 | ;
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| 9 | I $$NEEDMRA^IBEFUNC(IBIFN) D
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| 10 | . K IBXDATA
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| 11 | . D F^IBCEF("N-HCFA 1500 SERVICE LINE (EDI)",,,IBIFN)
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| 12 | . S IBI=0
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| 13 | . F S IBI=$O(IBXDATA(IBI)) Q:'IBI D
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| 14 | .. S IBJ=$P(IBXDATA(IBI),U,5)
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| 15 | .. I IBJ'="","^CJ^HC^"[(U_$P(IBXDATA(IBI),U,6)_U) S IBPR(IBJ)=""
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| 16 | . I $$REQMRA^IBEFUNC(IBIFN),$O(IBXDATA(""),-1)>12 D WARN^IBCBB11("This claim will be split into multiple EOB'S since there are more than 12"),WARN^IBCBB11("service lines being submitted on the claim.")
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| 17 | . I $$REQMRA^IBEFUNC(IBIFN),$E(IBFDT,1,3)'=$E(IBTDT,1,3) D WARN^IBCBB11("This claim will be split into multiple EOB'S due to the service dates"),WARN^IBCBB11("spanning different calendar years.")
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| 18 | . D NONMCR^IBCBB3(.IBPR,.IBLABS) ; Oxygen, labs, influenza shots
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| 19 | . S Z="80000" F S Z=$O(IBPR(Z)) Q:Z'?1"8"4N S IBLABS=1
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| 20 | . I $G(IBLABS) D WARN^IBCBB11("The only possible billable procedures on this bill are labs -"),WARN^IBCBB11(" Please verify that MEDICARE does not reimburse these labs at 100%") Q
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| 21 | . I $O(IBPR(""))="" S IBQUIT=$$IBER^IBCBB3(.IBER,"098")
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| 22 | ;
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| 23 | ; First char of the pat's first and last name must be present and
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| 24 | ; must be an alpha
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| 25 | K IBXDATA D F^IBCEF("N-PATIENT NAME",,,IBIFN)
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| 26 | S IBXDATA=$$NAME^IBCEFG1(IBXDATA)
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| 27 | I $S($G(IBXDATA)="":1,$E($P(IBXDATA,U))=" "!($E($P(IBXDATA,U))'?1A):1,$E($P(IBXDATA,U,2))=" "!($E($P(IBXDATA,U,2))'?1A):1,1:0) S IBQUIT=$$IBER^IBCBB3(.IBER,300) Q:IBQUIT
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| 28 | ;
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| 29 | ; First char of the pat's address and city must not be a space
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| 30 | K IBXDATA D F^IBCEF("N-PATIENT STREET ADDRESS LN 1",,,IBIFN)
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| 31 | I $G(IBXDATA)=""!($E($G(IBXDATA))=" ") S IBQUIT=$$IBER^IBCBB3(.IBER,302) Q:IBQUIT
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| 32 | ;
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| 33 | K IBXDATA D F^IBCEF("N-PATIENT CITY",,,IBIFN)
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| 34 | I $G(IBXDATA)=""!($E($G(IBXDATA))=" ") S IBQUIT=$$IBER^IBCBB3(.IBER,302) Q:IBQUIT
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| 35 | ;
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| 36 | ; Must be a valid HIC #
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| 37 | I '$$VALID^IBCBB8(IBIFN) S IBQUIT=$$IBER^IBCBB3(.IBER,215) Q:IBQUIT
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| 38 | ;
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| 39 | ; Specialty code 99 is not valid for Medicare MRA request claims
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| 40 | I $$REQMRA^IBEFUNC(IBIFN),$$BILLSPEC^IBCEU3(IBIFN)=99 S IBQUIT=$$IBER^IBCBB3(.IBER,122) Q:IBQUIT
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| 41 | ;
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| 42 | Q
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| 43 | ;
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