source: WorldVistAEHR/trunk/r/INTEGRATED_BILLING-IB-PRQ--IBD--IBQ--PRQS/IBCEF5.m@ 1464

IBCEF5 ;ALB/TMP - MRA/EDI ACTIVATED UTILITIES ;06-FEB-96

 ;;2.0;INTEGRATED BILLING;**137**;21-MAR-94

 ;

ADDRULE() ; Add a new rule to the EDI transmission rules file

 ; Function returns the entry number of the new rule or

 ;   0 if no rule added

 ;

 N DIR,X,Y,IBD,IBS,IBOK,IBDA1,IBC,DIC,DA,DR,DIE,IB,DO,DD,DLAYGO

 ;

 D FULL^VALM1

 S IBOK=1

 ;

 L +^IBE(364.4,0):10

 I '$T S IBOK=0 W !,"FILE LOCKED ... TRY AGAIN LATER" S IBOK=0 G ADDQ

 S X=$O(^IBE(364.4,"A"),-1)

 F  S X=X+1 I '$D(^IBE(364.4,X,0)) S DIC="^IBE(364.4,",DIC(0)="L",DLAYGO=364.4,DIC("DR")="10.01////"_DUZ_";10.02///"_$$NOW^XLFDT D FILE^DICN S IBDA1=+Y K DLAYGO,DIC Q

 L -^IBE(364.4,0)

 I IBDA1'>0 S IBOK=0 G ADDQ

 K DIR

 S DIR(0)="364.4,.11A",DIR("A")="New Rule's TYPE OF RULE: "

 D ^DIR K DIR

 I $D(DIRUT) S IBOK=0 G ADDQ ;Required

 S IB(.11)=+Y

 I +Y=0 W !,"YOU ARE ADDING A RULE THAT WILL ONLY ALLOW THE TRANSMISSION OF BILLS WHOSE",!,"  FORM TYPE IS INCLUDED IN THIS RULE."

 ;

 S IB(.03)=2 ;MRA ONLY

 I IB(.11)'=2 D  G:'IBOK ADDQ

 . S DIR(0)="364.4,.03A^^I X=2 K X",DIR("A")="New Rule's TRANSMISSION TYPE: "

 . D ^DIR K DIR,DA

 . I Y'>0 S IBOK=0 K IB(.03) ;Required

 . S IB(.03)=+Y

 ;

 S DIR("A")=$S(IB(.11)'=0:"APPLY RULE ONLY TO BILLS THAT ARE (I)NSTITUTIONAL, (P)ROFESSIONAL, OR (B)OTH: ",1:"ONLY TRANSMIT (I)NSTITUTIONAL, (P)ROFESSIONAL, OR (B)OTH: ")

 S DIR(0)="SAM^I:INSTITUTIONAL ONLY;P:PROFESSIONAL ONLY;B:BOTH TYPES"

 D ^DIR K DIR,DA

 I "IPB"'[Y S IBOK=0 G ADDQ

 S IB(.05)=$S(Y="I":1,Y="P":2,1:3)

 ;

 ;S DIR("A")="APPLY RULE ONLY TO BILLS THAT ARE (I)NPATIENT, (O)UTPATIENT, OR (B)OTH: "

 ;S DIR(0)="SAM^I:INPATIENT;OUTPATIENT;B:BOTH"

 ;D ^DIR K DIR,DA

 ;I "IPB"'[Y S IBOK=0 G ADDQ

 ;S IB(.04)=$S(Y="I":1,Y="P":2,1:3)

 S IB(.04)=3

 ;

 W !

 ;

 S IBS="",$P(IBS,"*",36)=""

 S DIR("A",1)=IBS

 S DIR("A",2)="THIS RULE WILL ONLY APPLY TO BILLS THAT MATCH ALL OF THE FOLLOWING CONDITIONS:"

 S IBD=2

 I IB(.11)'=2 D

 . S IBD=IBD+1

 . S DIR("A",IBD)=$J("",5)_"BILL IS "_$S(IB(.03)<3:"AN "_$P("EDI^MRA",U,+IB(.03)),1:"EITHER AN EDI OR MRA")_" BILL AND IS ALSO "

 . S Z=$S(IB(.11)=0:IB(.05)#2+1,1:+IB(.05))

 . S DIR("A",IBD)=DIR("A",IBD)_$S(IB(.05)<3:$P("AN INSTITUTIONAL^A PROFESSIONAL",U,Z),1:"EITHER A PROFESSIONAL OR INSTITUTIONAL")_" BILL"

 .;S IBD=IBD+1,DIR("A",IBD)=$J("",5)_"AND "_$S(IB(.04)<3:"IS ALSO AN "_$P("INPATIENT^OUTPATIENT",U,+IB(.04)),1:"IS EITHER AN INPATIENT OR OUTPATIENT")_" BILL."

 . S IBD=IBD+1,DIR("A",IBD)=""

 . S IBD=IBD+1,DIR("A",IBD)="NOTE: RULE WILL BE IGNORED FOR ANY BILLS THAT DO NOT MATCH ALL THE CONDITIONS"

 . ;

 . I IB(.11)=0 D INSINC(.IBD)

 . ;

 . I IB(.11)=1 D

 .. D INSINC(.IBD),RTINC(.IBD)

 . ;

 . I IB(.11)=9 D

 .. S IBD=IBD+1,DIR("A",IBD)=""

 .. D INSINC(.IBD)

 ;

 I IB(.11)=2 D

 . S IBD=IBD+1,DIR("A",IBD)=$J("",5)_"BILL IS AN MRA BILL"

 . S IBD=IBD+1,DIR("A",IBD)=$J("",5)_"AND IS ALSO "_$S(IB(.05)<3:$P("AN INSTITUTIONAL^A PROFESSIONAL",U,+IB(.05)),1:"EITHER A PROFESSIONAL OR INSTITUTIONAL")_" BILL"

 .;S IBD=IBD+1,DIR("A",IBD)=$J("",7)_"AND "_$S(IB(.04)<3:"IS ALSO AN "_$P("INPATIENT^OUTPATIENT",U,+IB(.04)),1:"IS EITHER AN INPATIENT OR OUTPATIENT")_" BILL"

 . S IBD=IBD+1,DIR("A",IBD)=$J("",5)_"AND ALSO HAS A NEXT INSURANCE THAT HAS BEEN INCLUDED IN THE"

 . S IBD=IBD+1,DIR("A",IBD)=$J("",8)_"'INSURANCE COMPANIES INCLUDED' LIST FOR THIS RULE."

 . S IBD=IBD+1,DIR("A",IBD)=""

 . S IBD=IBD+1,DIR("A",IBD)="NOTE: THIS RULE WILL BE IGNORED FOR ANY BILL THAT DOES NOT MATCH"

 . S IBD=IBD+1,DIR("A",IBD)="      ALL OF THESE CONDITIONS."

 . S IBD=IBD+1,DIR("A",IBD)=""

 . S IBD=IBD+1,DIR("A",IBD)="THE EFFECT OF THIS RULE WILL BE: IF A BILL MATCHES ALL OF THE ABOVE CONDITIONS,"

 . S IBD=IBD+1,DIR("A",IBD)="THE REQUEST AND RECEIPT OF AN MRA WILL NOT BE ALLOWED."

 S IBD=IBD+1,DIR("A",IBD)=IBS

 ;

 S DIR("A")="IS THIS CORRECT? "

 S DIR(0)="YA",DIR("B")="YES"

 D ^DIR K DIR

 I 'Y S IBOK=0 G ADDQ

 ;

 W !

 ;

 ; Combine inpatient/outpatient and inst/prof checks

 S IB(.05,"IN")=$S(IB(.04)=1:0,1:$S(IB(.05)=1:2,IB(.05)=2:1,1:3))

 S IB(.05,"OUT")=$S(IB(.04)=2:0,1:$S(IB(.05)=1:2,IB(.05)=2:1,1:3))

 S IB(1)=$S(IB(.11)=0:"I $$MULTYP^IBCEF5(.IB,"_IB(.05,"IN")_","_IB(.05,"OUT")_")",IB(.11)=1:"I $$BILLTYP^IBCEF5(IBIFN,$G(IBDA))",IB(.11)=2:"I $$REQMRA^IBEFUNC(IBIFN)",1:"")

 S DR=".03////"_IB(.03)_";.05////"_IB(.05)_";.02;.06;.08;4;.07"_$S(IB(.11)'=2:"",1:"////1")_";.11////"_IB(.11)

 S DR=DR_";1"_$S(IB(.11)<9:"////"_IB(1),1:"")

 S DIE="^IBE(364.4,",DA=IBDA1

 D ^DIE

 I $D(Y) S IBOK=0 G ADDQ

 ;

 W !

 S IB(.07)=$P($G(^IBE(364.4,IBDA1,0)),U,7)

 ;

 D:IB(.07)'=3 INSCO^IBCEF51(.IB,.IBOK,IBDA1)

 I 'IBOK K IB G ADDQ

 I IB(.11)=1 D BTYP^IBCEF51(.IB,.IBOK) ;Enter applicable bill types

 I 'IBOK K IB G ADDQ

 ;

 I IBOK D ADDBTYP^IBCEF61(.IB,IBDA1),INSADD^IBCEF61(.IB,IBDA1)

 ;

ADDQ I $G(IBDA1),'IBOK S DA=IBDA1,DIK="^IBE(364.4," D ^DIK

 I IBOK D REBLD^IBCEF6($G(IBACTIVE))

 Q $S(IBOK:IBDA1,1:0)

 ;

BILLTYP(IBIFN,IBDA) ; Check bill type for valid to transmit

 N IB,IB0,IB00,IB399,IBOK,IBALL,IBB,IBEXC,IBQUIT,IBINC,Z,Z1

 S Z=$$FT^IBCEF(IBIFN)

 S IB399=$G(^DGCR(399,IBIFN,0))

 S IB0=$P(IB399,U,24,26)

 S IB0=$P(IB0,U)_$P($G(^DGCR(399.1,+$P(IB0,U,2),0)),U,2)_$P(IB0,U,3)

 ;

 S (IB,IBINC,IBOK,IBALL)=0

 ;

 ; Check for all bill types allowed, dates allowed

 F  S IB=$O(^IBE(364.4,IBDA,"BTYP","B","XXX",IB)) Q:'IB  D  Q:IBALL

 . S IB00=$G(^IBE(364.4,IBDA,"BTYP",IB,0))

 . I $S($P(IB00,U,2):$P(IB00,U,2)'>DT,1:1),$S($P(IB00,U,3):$P(IB00,U,3)>DT,1:1) S IBALL=1 Q

 ;

 ; If not all bill types are included, find out if any are included

 I 'IBALL S IB="",IBINC=0 F  S IB=$O(^IBE(364.4,IBDA,"BTYP","B",IB),-1)  Q:IB=""!($E(IB)="-")  D  Q:IBINC

 . S IBB=+$O(^IBE(364.4,IBDA,"BTYP","B",IB,0)),IB00=$G(^IBE(364.4,IBDA,"BTYP",IBB,0))

 . I $S($P(IB00,U,2):$P(IB00,U,2)'>DT,1:1),$S($P(IB00,U,3):$P(IB00,U,3)>DT,1:1) S IBINC=1 Q

 ;

 I IB0'="" D  ;Check bill's type of bill in included list, or is excluded

 . S (IBQUIT,IBEXC)=0

 . F Z1=1,2 Q:Z1=2&'IBOK  S:'IBINC Z1=2,IBOK=1 F IB=$E(IB0)_"XX",$E(IB0,1,2)_"X",IB0 S IBQUIT=0 D  Q:IBQUIT

 .. I Z1=2 S IB="-"_IB ;Checking for exclusions on this pass

 .. S Z=0

 .. F  S Z=$O(^IBE(364.4,+$G(IBDA),"BTYP","B",IB,Z)) Q:'Z  S IB00=$G(^IBE(364.4,IBDA,"BTYP",Z,0)),IBQUIT=0 D  Q:IBQUIT

 ... I $P(IB00,U,2)>DT Q  ;Not effective yet

 ... I $P(IB00,U,3),$P(IB00,U,3)'>DT Q  ;Expired

 ... I $E(IB00)'="-" S (IBQUIT,IBOK)=1 Q  ; Bill type included

 ... I $E(IB00)="-" S IBOK=0,(IBEXC,IBQUIT)=1 Q  ; Bill type is excluded

 . I 'IBALL,'IBINC,'IBEXC S IBOK=1 ;No active restrictions found

 ;

BTYPQ Q IBOK

 ;

QUIT ; DIR call to continue processing after error message display

 S DIR("A")="Press RETURN to continue: "

 S DIR(0)="EA" D ^DIR K DIR

 ;

 Q

 ;

MULTYP(IB,IN,OUT) ; Code to execute to determine multiple types

 ;   of I/O and prof/inst bills combinations OK to transmit

 ; IB = ien of bill in file 399

 ; IB(x) = array containing necessary data for xref search from bill

 ;         subscripted by x=field # in file 364.4

 ; IN  =0 or null for no inpt at all

 ;     =1 for inpt,prof only;  =2 for inpt,inst only; =3 for inpt,both

 ; OUT =0 or null for no outpt at all

 ;     =1 for outpt,prof only;  =2 for outpt,inst only; =3 for outpt,both

 ;

 ;  Function returns 1 if edit passes, 0 if edit fails

 ;

 ; Functionality has been removed, but code remains in case they decide

 ; they need it later (INPT/OUTPT part)

 ;

 N IBOK

 S IBOK=1

 ; IB(.04) = the value of the bill's type of care (1=outpt, 2=inpt)

 ; IB(.05) = the value of the bill's form type (1=inst, 2=prof)

 ; outpatient bill

 I $G(IB(.04))=1,$G(OUT)'=3 D  G:'IBOK MULTQ

 . I +$G(OUT)=0 S IBOK=0 Q

 . I $G(OUT)=1,$G(IB(.05))'=2 S IBOK=0 Q

 . I $G(OUT)=2,$G(IB(.05))'=1 S IBOK=0 Q

 ; inpatient bill

 I $G(IB(.04))=2,$G(IN)'=3 D  G:'IBOK MULTQ

 . I +$G(IN)=0 S IBOK=0 Q

 . I $G(IN)=1,$G(IB(.05))'=2 S IBOK=0 Q

 . I $G(IN)=2,$G(IB(.05))'=1 S IBOK=0 Q

MULTQ Q IBOK

 ;

INSINC(IBD) ; Insurance include/exclude condition explanation

 ; IBD = line counter - pass by reference

 S IBD=IBD+1,DIR("A",IBD)=""

 S IBD=IBD+1,DIR("A",IBD)="THE EFFECT OF THIS RULE WILL BE: IF A BILL MATCHES BOTH OF THE ABOVE CONDITIONS,"

 S IBD=IBD+1,DIR("A",IBD)="THE RULE WILL BE APPLIED AND THE BILL WILL NOT BE TRANSMITTED IF:"

 S IBD=IBD+1,DIR("A",IBD)=" - THE RULE APPLIES TO ALL INSURANCE COMPANIES"

 S IBD=IBD+1,DIR("A",IBD)=$J("",17)_"OR"

 S IBD=IBD+1,DIR("A",IBD)=" - THE RULE 'APPLIES TO' ONLY SPECIFIC INSURANCE COMPANIES AND THE BILL'S"

 S IBD=IBD+1,DIR("A",IBD)="   INSURANCE COMPANY APPEARS ON THE RULE'S 'INCLUDE LIST'"

 S IBD=IBD+1,DIR("A",IBD)=$J("",17)_"OR"

 S IBD=IBD+1,DIR("A",IBD)=" - THE RULE 'EXCLUDES' SPECIFIC INSURANCE COMPANIES AND THE BILL'S"

 S IBD=IBD+1,DIR("A",IBD)="   INSURANCE COMPANY DOES NOT APPEAR ON THE RULE'S 'EXCLUDE LIST'"

 Q

 ;

RTINC(IBD) ; Bill type include/exclude condition explanation

 ; IBD = line counter - pass by reference

 ;

 S IBD=IBD+1,DIR("A",IBD)="*** AND ***"

 S IBD=IBD+1,DIR("A",IBD)=" - THE RULE HAS NO BILL TYPE RESTRICTIONS OR APPLIES TO ALL BILL TYPES"

 S IBD=IBD+1,DIR("A",IBD)=$J("",17)_"OR"

 S IBD=IBD+1,DIR("A",IBD)=" - THE RULE IS RESTRICTED TO CERTAIN BILL TYPES AND THE BILL'S BILL TYPE IS"

 S IBD=IBD+1,DIR("A",IBD)="   INCLUDED FOR THE RULE OR IS NOT EXCLUDED FOR THE RULE"

 Q

 ;