| [613] | 1 | IBCEMQA ;DAOU/ESG - MRA QUIET BILL AUTHORIZATION ;25-MAR-2003
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| 2 | ;;2.0;INTEGRATED BILLING;**155**;21-MAR-94
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| 3 | ;;Per VHA Directive 10-93-142, this routine should not be modified.
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| 4 | ;
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| 5 | Q ; must be called at proper entry point
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| 6 | ;
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| 7 | ;
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| 8 | AUTOCOB(IBIFN,IBEOB,ERRMSG) ; This procedure mimics and automates the
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| 9 | ; Process COB action on the MRA management screen. This is intended
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| 10 | ; to be called in background mode (no user interface).
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| 11 | ;
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| 12 | ; Input
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| 13 | ; IBIFN - bill#
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| 14 | ; IBEOB - ien of entry in file 361.1 (MRA)
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| 15 | ;
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| 16 | ; Output
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| 17 | ; ERRMSG - optional output parameter, passed by reference
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| 18 | ; - error message text
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| 19 | ;
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| 20 | NEW MRADATA,IB364,IBCBASK,IBCBCOPY,IBCAN,IBIFNH,IBAUTO,IBDA
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| 21 | NEW IBCE,IBSILENT,IBPRCOB,IBERRMSG
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| 22 | NEW IBCOB,IBCOBIL,IBCOBN,IBINS,IBINSN,IBINSOLD,IBMRAIO,IBMRAO,IBNMOLD
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| 23 | S (IBIFN,IBIFNH)=+$G(IBIFN),IBEOB=+$G(IBEOB),ERRMSG=""
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| 24 | ;
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| 25 | S MRADATA=$G(^IBM(361.1,IBEOB,0))
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| 26 | I $P(MRADATA,U,1)'=IBIFN S ERRMSG="Incorrect Bill or MRA EOB" G AUCOBX
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| 27 | I $P(MRADATA,U,4)'=1 S ERRMSG="EOB is not a Medicare MRA" G AUCOBX
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| 28 | S IB364=+$P(MRADATA,U,19)
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| 29 | I 'IB364 S ERRMSG="Missing or incorrect Transmission record" G AUCOBX
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| 30 | ;
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| 31 | I '$P($G(^DGCR(399,IBIFN,"I"_($$COBN^IBCEF(IBIFN)+1))),U,1) D G AUCOBX
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| 32 | . S ERRMSG="No next payer for this bill"
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| 33 | . Q
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| 34 | ;
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| 35 | ; Make sure that Medicare WNR is the current insurance for this bill
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| 36 | I '$$WNRBILL^IBEFUNC(IBIFN) D G AUCOBX
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| 37 | . S ERRMSG="Medicare (WNR) is not the current payer for this bill"
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| 38 | . Q
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| 39 | ;
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| 40 | ; Set variable flags for use in IBCCCB/IBCCC2
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| 41 | S (IBCBASK,IBCBCOPY,IBCAN,IBAUTO,IBCE("EDI"),IBSILENT,IBPRCOB)=1
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| 42 | S IBDA=IBEOB
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| 43 | ;
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| 44 | D CHKB1^IBCCCB
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| 45 | ;
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| 46 | S IBIFN=IBIFNH ; restore bill#
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| 47 | I $G(IBERRMSG)'="" S ERRMSG=IBERRMSG G AUCOBX ; error message
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| 48 | D UPDEDI^IBCEM(IB364,"Z") ; status updates
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| 49 | AUCOBX ;
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| 50 | Q
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| 51 | ;
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| 52 | ;
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| 53 | AUTH(IBIFN,ERRMSG) ; Entry Point
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| 54 | ; This procedure's job is to authorize this bill. The manual
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| 55 | ; process to authorize a bill is found in routine IBCB1. This
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| 56 | ; routine borrows heavily from that routine.
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| 57 | ;
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| 58 | ; *** Any changes here should be considered also in IBCB1 ***
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| 59 | ;
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| 60 | ; This routine is called when receiving an incoming MRA from
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| 61 | ; Medicare. If that MRA/EOB meets certain criteria, then the bill
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| 62 | ; will become a secondary bill and we will try to authorize it (using
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| 63 | ; this procedure) and put it in the EDI queue ready for extract.
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| 64 | ;
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| 65 | ; Input
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| 66 | ; IBIFN - internal bill#
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| 67 | ;
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| 68 | ; Output
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| 69 | ; ERRMSG - optional output parameter, passed by reference
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| 70 | ; - error message text
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| 71 | ;
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| 72 | NEW CST,IBTXSTAT,IB364,PRCASV,DFN,STSMSG
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| 73 | NEW DIE,DA,DR,IBYY
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| 74 | ;
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| 75 | ; Check the bill, make sure the current status is valid
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| 76 | S IBIFN=+$G(IBIFN),ERRMSG=""
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| 77 | S CST=$P($G(^DGCR(399,IBIFN,0)),U,13)
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| 78 | I CST="" S ERRMSG="Bill has no current status defined." G AUTHX
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| 79 | I CST'=2 S ERRMSG="This bill's status is "_$$GET1^DIQ(399,IBIFN_",",.13)_". It must be REQUEST MRA." G AUTHX
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| 80 | ;
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| 81 | ; authorize the bill quietly
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| 82 | S DIE=399,DA=IBIFN,DR="[IB STATUS]",IBYY="@902" D ^DIE
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| 83 | ;
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| 84 | ; Update the review status for all EOB's on file
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| 85 | D STAT^IBCEMU2(IBIFN,3) ; Accepted - Complete EOB
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| 86 | ;
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| 87 | ; Checks for need to add any codes to bill for EDI (call in quiet mode)
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| 88 | D AUTOCK^IBCEU2(IBIFN,1)
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| 89 | ;
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| 90 | ; Calculate transmittable status
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| 91 | ; 0 = not transmittable
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| 92 | ; 1 = yes, live transmittable
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| 93 | ; 2 = yes, test transmittable
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| 94 | S IBTXSTAT=+$$TXMT^IBCEF4(IBIFN)
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| 95 | ;
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| 96 | ; If transmittable, add this bill to the bill transmission file
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| 97 | I IBTXSTAT D I ERRMSG'="" G AUTHX
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| 98 | . S IB364=$$ADDTBILL^IBCB1(IBIFN,IBTXSTAT)
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| 99 | . I '$P(IB364,U,3) S ERRMSG="Error loading bill into transmit file."
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| 100 | . Q
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| 101 | ;
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| 102 | ; Pass completed bill to Accounts Receivable (quietly)
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| 103 | D ARPASS^IBCB1(IBIFN,0)
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| 104 | I '$G(PRCASV("OKAY")) S ERRMSG="Error while passing bill to A/R." G AUTHX
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| 105 | ;
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| 106 | ; Find and process any IB charges on hold
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| 107 | S DFN=+$P($G(^DGCR(399,IBIFN,0)),U,2)
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| 108 | D FIND^IBOHCK(DFN,IBIFN)
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| 109 | ;
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| 110 | ; If transmittable, check for unreviewed items & update 364 status
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| 111 | I IBTXSTAT D
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| 112 | . S STSMSG=$$STATUS^IBCEF4(IBIFN)
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| 113 | . I $P(STSMSG,U,1) D UPDEDI^IBCEM($P(STSMSG,U,1),"E")
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| 114 | . I $P(STSMSG,U,2),$P(STSMSG,U,2)'=$P(STSMSG,U,1) D UPDEDI^IBCEM($P(STSMSG,U,2),"E")
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| 115 | . Q
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| 116 | ;
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| 117 | AUTHX ;
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| 118 | Q
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| 119 | ;
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