source: WorldVistAEHR/trunk/r/INTEGRATED_BILLING-IB-PRQ--IBD--IBQ--PRQS/IBCEOB.m@ 861

IBCEOB ;ALB/TMP - 835 EDI EOB MESSAGE PROCESSING ;20-JAN-99

 ;;2.0;INTEGRATED BILLING;**137,135,265,155**;21-MAR-94

 Q

 ;

UPDEOB(IBTDA) ; Update EXPLANATION OF BENEFITS file (#361.1) from return msg

 ; IBTDA = ien of return message

 ; Function returns ien of EOB file entry or "" if errors found

 ;          the data.  Any errors found are

 ;          stored in array ^TMP("IBCERR-EOB",$J,n) in text format

 ;          n = seq # and are stored with the EOB in a wp field

 ;

 N IB0,IB100,IBBTCH,IBE,IBMNUM,IBT,DLAYGO,DIC,DD,DO,X,Y,Z,Z0,Z1,IBEOB,IBBAD,IBOK,IB,IBA1,IBIFN,IBFILE

 K ^TMP($J),^TMP("IBCERR-EOB",$J)

 ;

 S (IBBAD,IBEOB)=""

 S IB0=$G(^IBA(364.2,IBTDA,0))

 S IBMNUM=+$P(IB0,U)

 S X=+$G(^IBA(364,+$P(IB0,U,5),0))

 ;

 G:$S(IBMNUM=""!(X=""):1,1:$D(^IBM(361.1,"AC",IBMNUM))) UPDQ

 ;

 ; Duplicate EOB Check

 S IBFILE="^IBA(364.2,"_IBTDA_",2)"

 I $$DUP(IBFILE,X) G UPDQ

 ;

 I '$$LOCK^IBCEM(IBTDA) G UPDQ ;Lock msg file 364.2

 S IBEOB=+$$ADD3611(IBMNUM,$P(IB0,U,5),$P(IB0,U,4),X,0,IBFILE)

 L -^IBA(364.2,IBTDA,0)

 ;

 I IBEOB<0 S IBEOB="" G UPDQ

 D UPD3611(IBEOB,IBTDA,0)

 ;

UPDQ I IBEOB,$O(^TMP("IBCERR-EOB",$J,0)) D ERRUPD(IBEOB,"IBCERR-EOB")

 K ^TMP($J),^TMP("IBCERR-EOB",$J)

 D CLEAN^DILF

 Q +IBEOB

 ;

 ;

 ; NOTE: **** For all variables IB0,IBEGBL,IBEOB below:

 ; IB0 = raw data received for this record type on the 835 flat file

 ; IBEGBL = subscript to use in error global

 ; IBEOB = ien in file 361.1 for this EOB

 ;

835(IB0,IBEGBL,IBEOB) ; Store header

 ;

 Q $$HDR^IBCEOB1(IB0,IBEGBL,IBEOB)

 ;

5(IB0,IBEGBL,IBEOB) ; Record '05'

 ;

 N IBOK,IBBULL,DA,DR,DIE,X,Y

 K IBZDATA

 S DR=";",IBOK=1

 S DIE="^IBM(361.1,",DA=IBEOB

 ;

 S IBBULL=""

 I $$UPDNM^IBCEOB00(IBEOB,IB0,.IBBULL,.DR)!$$UPDID^IBCEOB00(IBEOB,IB0,.IBBULL,.DR) D  ; New insured's name and/or HIC # found

 . D CHGBULL^IBCEOB3(IBEOB,IBBULL) ;Send a bulletin reporting change

 ;

 I $P(IB0,U,9) S DR=DR_"1.1///"_$$DATE^IBCEU($P(IB0,U,9))_";"

 I $P(IB0,U,10) S DR=DR_"1.11///"_$$DATE^IBCEU($P(IB0,U,10))_";"

 S DR=$P(DR,";",2,$L(DR,";")-1)

 I DR'="" D ^DIE S IBOK=$D(Y)=0

 I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Bad record 5 data"

 Q IBOK

 ;

10(IB0,IBEGBL,IBEOB) ; Record '10'

 ;

 N DA,DR,DIE,X,Y,VAL,IBOK

 S DIE="^IBM(361.1,",DA=IBEOB

 S DR=".13////"_$S($P(IB0,U,3)="Y":1,$P(IB0,U,4)="Y":2,$P(IB0,U,5)="Y":3,$P(IB0,U,6)="Y":4,1:5)_";.21////"_$P(IB0,U,7)

 S DR=DR_";2.04////"_$$DOLLAR($P(IB0,U,10))_";1.01////"_$$DOLLAR($P(IB0,U,11))_$S($P(IB0,U,12)'="":";.14///"_$P(IB0,U,12),1:"")

 S DR=DR_$S($P(IB0,U,13)'="":";.1///"_$P(IB0,U,13),1:"")_";.11///"_($P(IB0,U,14)/10000)_";.12///"_($P(IB0,U,15)/100)

 I $P(IB0,U,8)'="" S DR=DR_";.08////"_$P(IB0,U,8)_$S($P(IB0,U,9)'="":";.09///"_$P(IB0,U,9),1:"")

 ;

 D ^DIE

 S IBOK=($D(Y)=0)

 I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Bad record 10 data" G Q10

 ;

 ; File ICN in Bill

 D ICN^IBCEOB00(IBEOB,$P(IB0,U,12),$P($G(^IBM(361.1,IBEOB,0)),U,15),.IBOK)

 ;

Q10 Q IBOK

 ;

15(IB0,IBEGBL,IBEOB) ; Record '15'

 ;

 N A,IBOK

 ;

 S A="3;1.03;1;0;0^4;1.04;1;0;0^5;1.05;1;0;0^6;1.07;1;0;0^7;1.08;1;0;0^8;1.09;1;0;0^9;1.02;1;0;0^10;2.05;1;0;0"

 ;

 S IBOK=$$STORE^IBCEOB1(A,IB0,IBEOB)

 I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Bad record 15 data" G Q15

 ;

 ; For Medicare MRA's only:

 ; If the Covered Amount is present (15 record, piece 3), then file

 ; a claim level adjustment with Group code=OA, Reason code=AB3.

 ;

 I $P($G(^IBM(361.1,IBEOB,0)),U,4)=1,+$P(IB0,U,3) D

 . N IB20

 . S IB20=20_U_$P(IB0,U,2)_U_"OA"_U_"AB3"_U_$P(IB0,U,3)_U_"0000000000"

 . S IB20=IB20_U_"Covered Amount"

 . S IBOK=$$20(IB20,IBEGBL,IBEOB)

 . I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Could not file the OA-AB3 claim level adjustment for the Covered Amount"

 . K ^TMP($J,20)

 . Q

 ;

Q15 Q IBOK

 ;

17(IB0,IBEGBL,IBEOB) ; Record '17'

 N A,IBOK

 S A="3;25.01;0;1;0^4;25.02;0;1;0^5;25.03;0;1;0^6;25.04;0;1;0^7;25.05;0;1;0^8;25.06;0;1;0^9;25.07;0;1;0"

 S IBOK=$$STORE^IBCEOB1(A,IB0,IBEOB)

 I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Bad record 17 data"

Q17 Q IBOK

 ;

20(IB0,IBEGBL,IBEOB) ; Record '20'

 ;

 N A,LEVEL,IBGRP,IBDA,IBOK

 ;

 S IBGRP=$P(IB0,U,3)

 I IBGRP'="" S ^TMP($J,20)=IBGRP

 I IBGRP="" S IBGRP=$G(^TMP($J,20))

 I IBGRP="" S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Missing claim level adjustment group code" G Q20

 ;

 S IBDA(1)=$O(^IBM(361.1,IBEOB,10,"B",IBGRP,0))

 ;

 I 'IBDA(1) D  ;Needs a new entry at group level

 . N X,Y,DA,DD,DO,DIC,DLAYGO

 . S DIC="^IBM(361.1,"_IBEOB_",10,",DIC(0)="L",DLAYGO=361.11,DA(1)=IBEOB

 . S DIC("P")=$$GETSPEC^IBEFUNC(361.1,10)

 . S X=IBGRP

 . D FILE^DICN K DIC,DO,DD,DLAYGO

 . I Y<0 K IBDA S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Adjustment group code could not be added" Q

 . S IBDA(1)=+Y

 ;

 I $G(IBDA(1)) D  ;Add a new entry at the reason code level

 . S DIC="^IBM(361.1,"_IBEOB_",10,"_IBDA(1)_",1,",DIC(0)="L",DLAYGO=361.111,DA(2)=IBEOB,DA(1)=IBDA(1)

 . S DIC("P")=$$GETSPEC^IBEFUNC(361.11,1)

 . S X=$P(IB0,U,4)

 . D FILE^DICN K DIC,DO,DD,DLAYGO

 . I Y<0 K IBDA S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Adjustment reason code could not be added" Q

 . S IBDA=+Y

 ;

 I $G(IBDA) D

 . S LEVEL=10,LEVEL("DIE")="^IBM(361.1,"_IBEOB_",10,"_IBDA(1)_",1,"

 . S LEVEL(0)=IBDA,LEVEL(1)=IBDA(1),LEVEL(2)=IBEOB

 . S A="5;.02;1;0;0^6;.03;0;1;1^7;.04;0;1;0"

 . S IBOK=$$STORE^IBCEOB1(A,IB0,IBEOB,.LEVEL)

 . I 'IBOK S ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)="Bad adjustment reason code ("_$P(IB0,U,4)_") data" Q

Q20 Q $G(IBOK)

 ;

30(IB0,IBEGBL,IBEOB) ; Record '30'

 ;

 N IBOK

 D 30^IBCEOB0(IB0,IBEOB,.IBOK)

Q30 Q $G(IBOK)

 ;

35(IB0,IBEGBL,IBEOB) ; Record '35'

 ; Moved due to space constraints

Q35 Q $$35^IBCEOB00(IB0,IBEGBL,IBEOB)

 ;

37(IB0,IBEGBL,IBEOB) ; Record '37'

 ; Moved due to space constraints

Q37 Q $$37^IBCEOB00(IB0,IBEGBL,IBEOB)

 ;

40(IB0,IBEGBL,IBEOB) ; Record '40'

 ;

 N IBOK

 D 40^IBCEOB0(IB0,IBEOB,.IBOK)

Q40 Q $G(IBOK)

 ;

41(IB0,IBEGBL,IBEOB) ; Record '41'

 ;

 N IBOK

 D 41^IBCEOB0(IB0,IBEOB,.IBOK)

Q41 Q $G(IBOK)

 ;

42(IB0,IBEGBL,IBEOB) ; Record '42'

 ;

 N IBOK

 D 42^IBCEOB0(IB0,IBEOB,.IBOK)

Q42 Q $G(IBOK)

 ;

45(IB0,IBEGBL,IBEOB) ; Record '45'

 ;

 N IBOK

 D 45^IBCEOB0(IB0,IBEOB,.IBOK)

 Q $G(IBOK)

 ;

DOLLAR(X) ; Convert value in X to dollar format XXX.XX

 Q $S(+X:$J(X/100,$L(+X),2),1:0)

 ;

ADD3611(IBMNUM,IBTBILL,IBBATCH,X,IBAR,IBFILE) ; Add stub record to file 361.1

 ; X = the ien of the referenced bill in file 399

 ; IBTBILL = ien of transmitted bill (optional)

 ; IBBATCH = ien of batch # the transmitted bill was in (optional)

 ; IBMNUM = the message # from which this record originally came

 ; IBAR = 1 only if called from AR

 ; IBFILE = array reference of raw EOB data

 ;

 N DIC,DA,DR,DO,DD,DLAYGO,Y,REVSTAT,BS

 F  L +^IBM(361.1,0):10 Q:$T

 ;

 ; default proper review status

 S BS=$P($G(^DGCR(399,X,0)),U,13)   ; bill status

 S REVSTAT=$S(BS=7:9,BS=3:3,BS=4:3,1:0)

 S DIC(0)="L",DIC="^IBM(361.1,",DLAYGO=361.1

 S DIC("DR")=".16////"_REVSTAT_";.17////0"_";100.02////"_IBMNUM_$S('$G(IBAR):";.19////"_+IBTBILL_";100.01////"_IBBATCH,1:"")

 S DIC("DR")=DIC("DR")_";100.05////"_$$CHKSUM^IBCEMU1(IBFILE)

 D FILE^DICN

 L -^IBM(361.1,0)

 Q +Y

 ;

UPD3611(IBEOB,IBTDA,IBAR) ; From flat file 835 format, add EOB record

 ; IBEOB = the ien of the entry in file 361.1 being updated

 ; IBTDA = the ien in the source file

 ; IBAR = 1 if being called from AR

 N IBA1,IBFILE,IBEGBL,Z,IBREC,Q

 S IBFILE=$S('$G(IBAR):"^IBA(364.2,"_IBTDA_",2)",1:"^TMP("_$J_",""RCDP-EOB"","_IBTDA_")")

 S IBEGBL=$S('$G(IBAR):"IBCERR-EOB",1:"RCDPERR-EOB")

 I $G(IBAR),'$$HDR^IBCEOB1($G(^TMP($J,"RCDPEOB","HDR")),IBEGBL,IBEOB) Q

 S IBA1=0

 F  S IBA1=$O(@IBFILE@(IBA1)) Q:'IBA1  S IB0=$S('$G(IBAR):$P($G(^(IBA1,0)),"##RAW DATA: ",2),1:$G(@IBFILE@(IBA1,0))) I IB0'="" D

 . S IBREC=+IB0

 . I IBREC'=37 K ^TMP($J,37)

 . I IBREC S IB="S IBOK=$$"_IBREC_"(IB0,IBEGBL,IBEOB)",Q=IBREC_"^IBCEOB" I $T(@Q)'="" X IB S:'IBOK ^TMP(IBEGBL,$J,+$O(^TMP(IBEGBL,$J,""),-1)+1)=$S('$G(IBAR):"  ##RAW DATA: ",1:"")_IB0

 ;

 Q

 ;

ERRUPD(IBEOB,IBEGBL) ; Update error text in entry, if needed

 D WP^DIE(361.1,IBEOB_",",20,"","^TMP(IBEGBL,$J)","")

 Q

 ;

 ;

DUP(IBARRAY,IBIFN) ; Duplicate Check

 ; This function determines if the EOB data already exists in file

 ; 361.1 by comparing the checksums of the raw 835 data.

 ;

 ; IBARRAY = Literal array reference where the raw 835 data exists.

 ;           The data exists at @IBARRAY@(n,0), where n is the seq#.

 ;           For example, IBARRAY = "^IBA(364.2,IBIEN,2)"

 ;

 ; IBIFN = the bill # (ptr to 399).  The checksums of the EOB's on 

 ;         file for this bill will be compared to the checksum of the

 ;         835 raw data in the IBARRAY reference.

 ;

 ; This function returns 0 if the entry is not found (no duplicate),

 ; Otherwise, the IEN of the entry in file 361.1 is returned if this

 ; is a duplicate EOB.

 ;

 NEW DUP,IBEOB,CHKSUM1,CHKSUM2

 S DUP=0,IBIFN=+$G(IBIFN)

 I $G(IBARRAY)=""!'IBIFN G DUPX

 I '$D(^IBM(361.1,"B",IBIFN)) G DUPX     ; no EOB's on file yet

 S CHKSUM1=$$CHKSUM^IBCEMU1(IBARRAY)     ; checksum of current EOB

 I 'CHKSUM1 G DUPX                       ; must be able to be calculated

 S IBEOB=0

 F  S IBEOB=$O(^IBM(361.1,"B",IBIFN,IBEOB)) Q:'IBEOB  D  Q:DUP

 . S CHKSUM2=+$P($G(^IBM(361.1,IBEOB,100)),U,5)   ; checksum of old EOB

 . I 'CHKSUM2 Q

 . I CHKSUM1=CHKSUM2 S DUP=IBEOB Q                    ; comparison

 . Q

DUPX ;

 Q DUP

 ;