source: WorldVistAEHR/trunk/r/INTEGRATED_BILLING-IB-PRQ--IBD--IBQ--PRQS/IBCEF.m@ 1464

IBCEF ;ALB/TMP - FORMATTER SPECIFIC BILL FUNCTIONS ;22-JAN-96

 ;;2.0;INTEGRATED BILLING;**52,80,51,137,288,296,361**;21-MAR-94;Build 9

 ;;Per VHA Directive 2004-038, this routine should not be modified.

 ;

 ;IBIFN = bill ien throughout this routine

COB(IBIFN) ; Bill seq

 N A

 S A=$P($G(^DGCR(399,IBIFN,0)),U,21) S:A="" A="P"

 Q A

 ;

COBN(IBIFN,A) ; Return seq # of selected payer

 ; A = 'PST' or null to get current bill payer seq #

 I $G(A)="" S A=$$COB(IBIFN) S:"PST"'[A A="P"

 I 'A S A=$F("PST",A)-1 S:A<1 A=1

 Q A

 ;

POLICY(IBIFN,IBPC,IBCOBN) ; Return raw data from policy info on bill

 ; IBPC  = pc # of data element in policy (optional)

 ;          if null, 0-node is returned

 ; IBCOBN = bill designation 1-3 or 'PST' (optional)

 ;          if null, default to current

 N IBI

 I "PST"[$G(IBCOBN) S IBCOBN=$$COBN(IBIFN,$G(IBCOBN))

 S IBI=$G(^DGCR(399,IBIFN,"I"_IBCOBN))

 I $G(IBPC) S IBI=$P(IBI,U,IBPC)

POLICYQ Q IBI

 ;

INSADDR(IBIFN,IBCOB) ; Return insured's address in 7 pieces:

 ; ALL STREET ADDRESSES^CITY^STATE ABBREVIATION^ZIP^STREET ADDRESS 1^

 ;  STREET ADDRESS 2^STREET ADDRESS 3

 ; IBIFN = bill ien

 ; IBCOB = bill designation (P)rimary, (S)econdary, (T)ertiary

 ;          or 1-2-3. If not defined or null, return current

 ; If insured is patient or spouse, take from patient file top level

 ;   fields, then if top-level street addresses are blank and policy

 ;   level fields are not, use policy level

 ; If insured is other than patient/spouse, use policy level fields only

 N A,B,IBADDR,IBI,DFN,VAPA,VATEST

 S:$G(IBCOB)="" IBCOB=""

 I 'IBCOB S IBCOB=$$COBN(IBIFN,$G(IBCOB))

 S IBI=+$$POLICY(IBIFN,16,IBCOB)

 S DFN=+$P($G(^DGCR(399,IBIFN,0)),U,2)

 I $S('IBI:1,1:"12"'[IBI) S IBADDR="" G INSADDQ

 ; insured's address (patient/spouse) same as patient's

 S VATEST("ADD",9)=+$G(^DGCR(399,IBIFN,"U")),VATEST("ADD",10)=+$P($G(^("U")),U,2)

 D ADD^VADPT

 S IBADDR=VAPA(1)_" "_VAPA(2)_" "_VAPA(3)_U_VAPA(4)_U_$P($G(^DIC(5,+VAPA(5),0)),U,2)_U_VAPA(6)_U_VAPA(1)_U_VAPA(2)_U_VAPA(3)

INSADDQ S A=$P($G(^DGCR(399,IBIFN,"M")),U,(11+IBCOB))

 S A=$G(^DPT(DFN,.312,+A,3))

 I $TR($P(IBADDR,U)," ")="" D

 .S $P(IBADDR,U)=$P(A,U,6)_" "_$P(A,U,7),$P(IBADDR,U,5,6)=$P(A,U,6,7)

 .F B=2,4 S $P(IBADDR,U,B)=$P(A,U,B+6)

 .S $P(IBADDR,U,3)=$P($G(^DIC(5,+$P(A,U,9),0)),U,2)

 Q IBADDR

 ;

PTADDR(IBIFN,ELE) ;Return part of patient's permanent address

 ;IBIFN = bill ien

 ;ELE = subscript in ^UTILITY("VAPA", array for element needed

 ;

 I '$D(^UTILITY("VAPA",$J)) D  ; once per pt

 .N VAHOW,DFN,VAPA

 .S VAHOW=2,DFN=+$P($G(^DGCR(399,IBIFN,0)),U,2),VAPA("P")=""

 .D ADD^VADPT

 Q $P($G(^UTILITY("VAPA",$J,ELE)),U)

 ;

PTDEM(IBIFN,ELE,PC) ;Return part of patient's demographics

 ;IBIFN = bill ien

 ;ELE = subscript in ^UTILITY("VADM" array for demographic element needed

 ;PC = pc of string at subscript ELE to be returned

 ;

 I '$G(PC) S PC=1

 I '$D(^UTILITY("VADM",$J)) D  ; once per pt

 .N VAHOW,DFN,VADM

 .S VAHOW=2,DFN=+$P($G(^DGCR(399,IBIFN,0)),U,2)

 .D DEM^VADPT

 Q $P($G(^UTILITY("VADM",$J,ELE)),U,PC)

 ;

PTEMPL(IBIFN,ELE,WHOSE,VAOA) ;Return part of pt's or spouse's employer info

 ;ELE = subscript in VAOA array for employer element needed

 ;WHOSE = 6 if spouse's info needed  5 if pt info needed (DEFAULT)

 ;

 N DFN

 S DFN=+$P($G(^DGCR(399,IBIFN,0)),U,2),VAOA("A")=$S($G(WHOSE):WHOSE,1:5)

 D OAD^VADPT

 Q $P($G(VAOA(ELE)),U)

 ;

INSDEM(IBIFN,IBCOB) ; Return insured's demographics in 6 pieces:

 ; DATE OF BIRTH^SEX^PHONE^BRANCH pointer^RANK^SSN(no dashes)

 ; IBIFN = bill ien

 ; IBCOB = bill designation (P)rimary (default), (S)econdary, (T)ertiary

 ;          or 1,2,3 ... if not defined or null, return current

 ; If insured is patient/spouse, take from patient file top level

 ;   fields, then if top-level are blank and policy level aren't,

 ;   use policy level

 ; If insured other than patient/spouse, use policy level fields only

 N A,B,IBDEM,IBI,DFN,VADM

 S:$G(IBCOB)="" IBCOB=""

 S:'IBCOB IBCOB=$$COBN(IBIFN,IBCOB)

 S IBI=$$WHOSINS(IBIFN,IBCOB)

 S DFN=+$P($G(^DGCR(399,IBIFN,0)),U,2)

 I $S('IBI:1,1:"12"'[IBI) S IBDEM="" G INSDEM1

 ; If it gets here, assume insured is patient/spouse

 S A=$$PTDEM(IBIFN,0),A=$$PTADDR(IBIFN,0)

 F A=2,3,5 S VADM(A)=$P($G(^UTILITY("VADM",$J,A)),U)

 S VAPA(8)=$P($G(^UTILITY("VAPA",$J,8)),U)

 I VADM(5)="",'VADM(3),VAPA(8)="" S IBDEM="" G INSDEM1

 S $P(IBDEM,U,3)=VAPA(8),$P(IBDEM,U,6)=VADM(2)

 I IBI=1,VADM(3) S $P(IBDEM,U)=VADM(3) ;Patient's own policy only

INSDEM1 S A=$P($G(^DGCR(399,IBIFN,"M")),U,(11+IBCOB))

 S A=$G(^DPT(DFN,.312,+A,3))

 S:"MF"'[$G(VADM(5)) VADM(5)=""

 S $P(IBDEM,U,2)=$S(IBI=1:VADM(5),1:$P(A,U,12))

 S $P(IBDEM,U,4,5)=$P(A,U,2)_U_$P(A,U,3)

 S:'$P(IBDEM,U) $P(IBDEM,U)=$P(A,U)

 S:$P(IBDEM,U,3)="" $P(IBDEM,U,3)=$P(A,U,11)

 S:$P(IBDEM,U,6)="" $P(IBDEM,U,6)=$P(A,U,5)

 Q IBDEM

 ;

INSEMPL(IBIFN,IBCOB) ; Return insured's employer data in 5 pieces:

 ; EMPLOYER NAME^EMPLOYER CITY^EMPLOYER STATE ABBREVIATION^STATE IEN^STREET 1

 ; IBCOB = bill designation (P)rimary-default, (S)econdary, (T)ertiary

 ;            or 123 - if not defined or null, return current

 N A,IBEMPL,IBI,DFN,VAOA

 S IBI=$$WHOSINS(IBIFN,$G(IBCOB))

 I $S('IBI:1,1:"12"'[IBI) S IBEMPL="^^" G INSEMPQ

 ; insured = pt/spouse

 S DFN=+$P($G(^DGCR(399,IBIFN,0)),U,2)

 S A=$$PTEMPL(IBIFN,0,IBI+4,.VAOA)

 S IBEMPL=VAOA(9)_U_VAOA(4)_U_$P($G(^DIC(5,+VAOA(5),0)),U,2)_U_+VAOA(5)_U_VAOA(1)

INSEMPQ Q IBEMPL

 ;

WHOSINS(IBIFN,IBCOB) ; Determine who is insured for bill IBIFN and 

 ; seq of coverage COB (123 or PST) or if not defined or null, current

 N Z,Z0,VAEL,DFN

 S Z=+$$POLICY(IBIFN,16,$G(IBCOB))

 I 'Z D

 .S Z0=$$POLICY(IBIFN,6,$G(IBCOB)),DFN=$P($G(^DGCR(399,IBIFN,0)),U,2)

 .I Z0="v" D ELIG^VADPT I VAEL(4) S Z=1 Q  ;vet is pt

 .I Z0="s" D ELIG^VADPT I VAEL(4) S Z=2 Q  ;vet is pt, so vets spouse is pt's spouse

 .S Z=9 ; relationship of insured to pt unknown

 Q Z

 ;

EMPSTAT(IBIFN,WHOSE) ;Return employment status

 ; IBIFN = bill ien

 ; WHOSE = v for vet, s for spouse status

 N STAT,DFN,VAPD

 S STAT="",DFN=+$P($G(^DGCR(399,IBIFN,0)),U,2)

 I WHOSE="v" D OPD^VADPT S STAT=$P(VAPD(7),U)

 I WHOSE="s" S STAT=$P($G(^DPT(DFN,.25)),U,15)

 I STAT="" S STAT=9

 Q STAT

 ;

INPAT(IBIFN,OUT) ; Determine if bill is inpatient

 ; OUT = optional - if 1, return output value based on 

 ;  inpatient/outpatient from UB-04 type of bill field

 ; Return 1 if inpatient, 0 if not inpatient or can't be determined

 N INPT,CODE,CODE0,IB0

 S IB0=$G(^DGCR(399,IBIFN,0))

 S OUT=+$G(OUT),CODE=+$P(IB0,U,5)

 I 'OUT S INPT=CODE

 I OUT D

 . S CODE0=$P($G(^DGCR(399.1,+$P(IB0,U,25),0)),U,2)

 . I CODE0=8,$P(IB0,U,24)=1 S INPT=$P(IB0,U,5) Q  ; 18X

 . I CODE0=9,$P(IB0,U,24)=8 S INPT=$P(IB0,U,5) Q  ; 89X

 . I CODE0=1,$P(IB0,U,24)=8 S INPT=0 Q  ; 81X

 . I CODE0=1,$P(IB0,U,24)=7 S INPT=0 Q  ; 71X

 . I CODE0=2,$P(IB0,U,24)=7 S INPT=0 Q  ; 72X

 . S INPT=CODE0

 Q $S(INPT:INPT'>2,1:0)

 ;

INSPRF(IBIFN) ; Function to determine if bill is prof or inst

 ; Return 1 if institutional (UB-04) claim, 0 if professional (CMS-1500) claim

 N A

 S A=$G(^DGCR(399,IBIFN,0))

 I $P(A,U,27)="" S $P(A,U,27)=$S($P(A,U,19)=3:1,1:0)

 Q $S($P(A,U,27)=1:1,1:0)

 ;

F(FLD,IBXRET,IBXERR1,IBIEN) ;Execute extract for data element FLD and bill IBIEN

 ; If IBXDATA array to be returned as data value(s) of fld

 ;   D F^IBCEF("FLD NAME","IBXDATA","IBXERR") or D F^IBCEF("FLD NAME") 

 ; Variable ref-ed by IBXERR1 will contain error message if an error

 ; @IBXRET always defined on return.  It will be null if error

 I $G(IBIEN) N IBXIEN S IBXIEN=IBIEN

 I $G(IBXERR1)="" S IBXERR1="IBXERR"

 N IBXHOLD

 S IBXHOLD=""

 I $G(IBXRET)=""!($G(IBXRET)="IBXDATA") S IBXHOLD="IBXDATA",IBXRET="IBXRET"

 S @IBXERR1=""

 ;

 N FLDN,OFLD,STOP,Z,IBXERR2,IBXRETX

 ;

 I '$G(IBXIEN) S @IBXERR1="Invalid entry #" G FQ

 I '$D(^IBA(364.5,"B",FLD)) S OFLD=FLD,STOP=0 D  I FLD="" S @IBXERR1=OFLD_" Field not found!!" G FQ

 .F  S FLD=$O(^IBA(364.5,"B",FLD))  D  Q:STOP

 ..I $E(FLD,1,$L(OFLD))'=OFLD S FLD=""

 ..S STOP=1

 ;

 S Z=0

 F  S Z=$O(^IBA(364.5,"B",FLD,Z)) Q:'Z  I $P($G(^IBA(364.5,Z,0)),U,5)=399 Q

 I 'Z S @IBXERR1=FLD_" Field not found!!" G FQ

 ;

 S FLDN(1)=Z D EXTONE^IBCEFG0(IBXIEN,.FLDN,""_IBXRET_"",.IBXERR2)

 ;

 I $G(IBXERR2)'="" S @IBXERR1=IBXERR2

FQ S IBXARRY=$S(IBXHOLD="IBXDATA":"IBXDATA",1:""_IBXRET_"")

 I @IBXERR1'="" K @IBXARRY S @IBXARRY="" Q

 ;

 I IBXHOLD="IBXDATA" S IBXRET="IBXRET"

 M IBXRETX=@IBXRET K @IBXARRY M @IBXARRY=IBXRETX(1)

 S:'($D(@IBXARRY)#2) @IBXARRY=""

 Q

 ;

SERVDT(IBIFN,LENGTH,FORMAT) ; Return default service date for 

 ; outpatient/UB-04 lines or X12-837 institutional lines

 ; LENGTH = null/8 for 8 digit date, 6 for 6 digit date

 ; FORMAT = 1 = X12 format (YYYYMMDD), 2 = FM internal (NNNNNNN),

 ;          0 = external (MMDDYY or MMDDYYYY)

 N IBZ

 G:$$INPAT^IBCEF(IBIFN,1)!($$FT^IBCEF(IBIFN)'=3) SERVDTQ ;Inpatient claim or billed on a CMS-1500

 S LENGTH=$G(LENGTH),FORMAT=$G(FORMAT)

 D F("N-STATEMENT COVERS FROM DATE","IBZ",,IBIFN)

 I '$G(IBZ)!(FORMAT=2) G SERVDTQ

 ;

 I FORMAT=1 S IBZ=$$DT^IBCEFG1(IBZ,"",$S(LENGTH'=6:"D8",1:"D6")) G SERVDTQ

 S IBZ=$$DATE^IBCF2(IBZ,$S(LENGTH=6:0,1:1),1)

 ;

SERVDTQ Q $G(IBZ)

 ;

NOPUNCT(X,SPACE,EXC) ; Strip punctuation from data in X

 ; SPACE = flag if 1 strip SPACES

 ; EXC = list of punctuation not to strip

 ;

 N PUNCT,Z

 S PUNCT=".,-+(){}[]\/><:;?|=_*&%$#@!~`^'"""

 I $G(SPACE) S PUNCT=PUNCT_" "

 I $G(EXC)'="" F Z=1:1:$L(EXC) S PUNCT=$TR(PUNCT,$E(EXC,Z))

 S X=$TR(X,PUNCT)

 Q X

 ;

FT(IBIFN) ; Internal code for bill form type

 Q +$P($G(^DGCR(399,IBIFN,0)),U,19)

 ;

COBCT(IBIFN) ; # of payers on claim

 N CT,Z

 S CT=0 F Z="I1","I2","I3" Q:'$D(^DGCR(399,IBIFN,Z))  S CT=CT+1

 Q CT

 ;