source: WorldVistAEHR/trunk/r/INTEGRATED_BILLING-IB-PRQ--IBD--IBQ--PRQS/IBCBB9.m@ 1259

Last change on this file since 1259 was 623, checked in by George Lilly, 15 years ago

revised back to 6/30/08 version

File size: 2.2 KB
Line 
1IBCBB9 ;ALB/BGA MEDICARE PART B EDIT CHECKS ;10/15/98
2 ;;2.0;INTEGRATED BILLING;**51,137,155,349**;21-MAR-94;Build 46
3 ;;Per VHA Directive 2004-038, this routine should not be modified.
4 ;
5PARTB ; MEDICARE specific edit checks for PART B claims (CMS-1500)
6 ;
7 N IBXDATA,IBXERR,IBXIEN,IBXSAVE,IBPR,IBDTFLG
8 ;
9 I $$NEEDMRA^IBEFUNC(IBIFN) D
10 . K IBXDATA
11 . D F^IBCEF("N-HCFA 1500 SERVICE LINE (EDI)",,,IBIFN)
12 . S IBI=0
13 . F S IBI=$O(IBXDATA(IBI)) Q:'IBI D
14 .. S IBJ=$P(IBXDATA(IBI),U,5)
15 .. I IBJ'="","^CJ^HC^"[(U_$P(IBXDATA(IBI),U,6)_U) S IBPR(IBJ)=""
16 . I $$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.")
17 . I $$REQMRA^IBEFUNC(IBIFN),$E(IBFDT,1,3)'=$E(IBTDT,1,3) D WARN^IBCBB11("This claim will be split into multiple EOB'S due to the service dates"),WARN^IBCBB11("spanning different calendar years.")
18 . D NONMCR^IBCBB3(.IBPR,.IBLABS) ; Oxygen, labs, influenza shots
19 . S Z="80000" F S Z=$O(IBPR(Z)) Q:Z'?1"8"4N S IBLABS=1
20 . I $G(IBLABS) D WARN^IBCBB11("The only possible billable procedures on this bill are labs -"),WARN^IBCBB11(" Please verify that MEDICARE does not reimburse these labs at 100%") Q
21 . I $O(IBPR(""))="" S IBQUIT=$$IBER^IBCBB3(.IBER,"098")
22 ;
23 ; First char of the pat's first and last name must be present and
24 ; must be an alpha
25 K IBXDATA D F^IBCEF("N-PATIENT NAME",,,IBIFN)
26 S IBXDATA=$$NAME^IBCEFG1(IBXDATA)
27 I $S($G(IBXDATA)="":1,$E($P(IBXDATA,U))=" "!($E($P(IBXDATA,U))'?1A):1,$E($P(IBXDATA,U,2))=" "!($E($P(IBXDATA,U,2))'?1A):1,1:0) S IBQUIT=$$IBER^IBCBB3(.IBER,300) Q:IBQUIT
28 ;
29 ; First char of the pat's address and city must not be a space
30 K IBXDATA D F^IBCEF("N-PATIENT STREET ADDRESS LN 1",,,IBIFN)
31 I $G(IBXDATA)=""!($E($G(IBXDATA))=" ") S IBQUIT=$$IBER^IBCBB3(.IBER,302) Q:IBQUIT
32 ;
33 K IBXDATA D F^IBCEF("N-PATIENT CITY",,,IBIFN)
34 I $G(IBXDATA)=""!($E($G(IBXDATA))=" ") S IBQUIT=$$IBER^IBCBB3(.IBER,302) Q:IBQUIT
35 ;
36 ; Must be a valid HIC #
37 I '$$VALID^IBCBB8(IBIFN) S IBQUIT=$$IBER^IBCBB3(.IBER,215) Q:IBQUIT
38 ;
39 ; Specialty code 99 is not valid for Medicare MRA request claims
40 I $$REQMRA^IBEFUNC(IBIFN),$$BILLSPEC^IBCEU3(IBIFN)=99 S IBQUIT=$$IBER^IBCBB3(.IBER,122) Q:IBQUIT
41 ;
42 Q
43 ;
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