source: WorldVistAEHR/trunk/r/INTEGRATED_BILLING-IB-PRQ--IBD--IBQ--PRQS/IBCEST.m@ 949

IBCEST ;ALB/TMP - 837 EDI STATUS MESSAGE PROCESSING ;17-APR-96
 ;;2.0;INTEGRATED BILLING;**137,189,197,135,283,320**;21-MAR-94
 ; IA 4042 for call to AUDITX^PRCAUDT
 Q
 ;
UPD361(IBTDA) ; Update IB BILL STATUS MESSAGES file
 ; IBTDA = ien of return message in file 364.2
 ;
 N IB,IB0,IBSEQ,IB00,IBBILL,IBBTCH,IBMNUM
 ;
 I '$$LOCK^IBCEM(IBTDA) G UPDQ ;Lock message in file 364.2
 ;
 S IB0=$G(^IBA(364.2,IBTDA,0))
 S IBMNUM=$P(IB0,U) ; Message number
 S IB00=$G(^IBA(364,+$P(IB0,U,5),0)) ; Transmit bill entry
 S IBBILL=+IB00 ; Actual bill ien in file 399
 S IBBTCH=$P(IB0,U,4) ; Batch #
 ;
 ; Auto-audit bills based on status code on '10' record of status msg
 ; flat file
 I IBBILL,$P($T(PRCAUDT+1^PRCAUDT),"**",2)[",173" D
 . N Z,Z0,Z1,OK
 . Q:+$$STA^PRCAFN(IBBILL)'=104
 . S (Z,OK)=0
 . F  S Z=$O(^IBA(364.2,IBTDA,2,Z)) Q:'Z  S Z0=$P($G(^(Z,0)),"##RAW DATA: ",2) I +Z0=10 S Z0=$P(Z0,U,5) D  Q:OK
 .. ; Strip leading spaces
 .. F  S Z0=$P(Z0," ",2,99) Q:$E(Z0)'=" "
 .. Q:Z0=""
 .. I "A3^AC^A7^A8^AA^2P^10^11"[Z0,$P($G(^DGCR(399.3,+$P($G(^DGCR(399,IBBILL,0)),U,7),0)),U,11) D AUDITX^PRCAUDT(IBBILL) S OK=1 ; IA 4042
 ;
 I $S(IBMNUM="":1,1:'IBBILL&(IBBTCH="")) D DELMSG^IBCESRV2(IBTDA) G UPDQ
 ;
 ; Individual bill
 I IBBILL D  G UPDQ
 . N IBA1,IBMSG0,IBPID
 . S IBPID="",IBA1=0
 . F  S IBA1=$O(^IBA(364.2,IBTDA,2,IBA1)) Q:'IBA1  S IBMSG0=$P($G(^(IBA1,0)),"##RAW DATA: ",2) I +IBMSG0=277,$P(IBMSG0,U,5)="N" S IBPID=$P(IBMSG0,U,11) Q
 . S IBSEQ=$P(IB00,U,8) S:IBSEQ="" IBSEQ="P"
 . D STORE(IB0,IBBTCH,IBMNUM,IBTDA,IBBILL,IBSEQ,IBPID,1)
 ;
 ; Batch - update each bill separately
 S IBBILL=""
 F  S IBBILL=$O(^IBA(364,"ABABI",+IBBTCH,IBBILL)) Q:'IBBILL  D
 . Q:$D(^TMP("IBCONF",$J,IBBILL))  ;Bill was rejected
 . S IB=$O(^IBA(364,"ABABI",+IBBTCH,IBBILL,0)) Q:'IB
 . S IBSEQ=$P($G(^IBA(364,IB,0)),U,8) S:IBSEQ="" IBSEQ="P"
 . D STORE(IB0,IBBTCH,IBMNUM,IBTDA,IBBILL,IBSEQ,"",0)
 ;
 Q
 ;
STORE(IB0,IBBTCH,IBMNUM,IBTDA,IBBILL,IBSEQ,IBPID,IB1) ;
 ;
 ; IB0 = 0-node of message in file 364.2
 ; IBBTCH = ien of batch in file 364.1
 ; IBMNUM = actual message number
 ; IBTDA = ien of message in file 364.2
 ; IBBILL = ien of bill in 399
 ; IBSEQ = P/S/T/ for COB sequence related to message
 ; IBPID = the payer id returned from clearinghouse for the claim
 ; IB1 = flag that says if the message was for a single bill or a batch.
 ;       Batch statuses have an additional standard text entry.
 ;       1 = single bill 0 = batch
 ; 
 N DA,DIK,DIE,DIC,X,Y,DR,DO,DD,DLAYGO,Z,Z0,Z1,IBT,IBDUP,IBFLDS,IBY,IBAUTO
 ;
 S X=IBBILL,IBDUP=0
 ;
 I $D(^IBM(361,"AC",IBMNUM\1)) D  ; Message already there for bill
 . S Z=0 F  S Z=$O(^IBM(361,"AC",IBMNUM\1,Z)) Q:'Z  I +$G(^IBM(361,Z,0))=IBBILL S IBDUP=Z Q
 ;
 S IBFLDS=".02////"_$P(IB0,U,3)
 S IBFLDS=IBFLDS_";.03////"_$S($$EXTERNAL^DILFD(364.2,.02,"U",$P(IB0,U,2))["REJ":"R",1:"I")_";.05////"_IBBTCH_";.06////"_IBMNUM_";.04////"_+$P(IB0,U,8)_";.07////"_IBSEQ_$S($P(IB0,U,5):";.11////"_$P(IB0,U,5),1:"")
 S IBFLDS=IBFLDS_";.12////"_$P(IB0,U,10)_";.09////0"
 S IBFLDS=IBFLDS_";.15////"_$$CHKSUM^IBCEST1("^IBA(364.2,"_IBTDA_",2)")
 I IBPID'="" D
 . S IBPID("TYPE")=$S($$FT^IBCEF(IBBILL)=2:"P",1:"I")
 . D UPDINS(.IBPID,$$POLICY^IBCEF(IBBILL,1,$TR(IBSEQ,"PST","123")),IBBILL)
 ;
 I IBDUP D  I $D(Y) G UPDQ
 . ; Stuff fields into existing entry
 . ; (may be needed for reprocessing of aborted updates)
 . S DIE="^IBM(361,",DA=IBDUP,DR=IBFLDS_";1///@"
 . D ^DIE
 . I $D(Y) S IBY=-1 Q  ;Update not successful
 . S IBY=IBDUP
 ;
 K IBT
 I 'IBDUP D  ; Create new entry and stuff fields
 . S DIC(0)="L",DIC="^IBM(361,",DLAYGO=361
 . S DIC("DR")=IBFLDS
 . D FILE^DICN
 . K DO,DD,DLAYGO,DIC
 . S IBY=+Y
 . Q:IBY'>0
 . ;
 . ; IB*2*320 - Check for duplicate status message
 . NEW IBNEW,IBOLD,PCE,Z,DIK,DA
 . S IBNEW=""
 . F PCE=3,4,5,7,8,11,15 S IBNEW=IBNEW_$P($G(^IBM(361,IBY,0)),U,PCE)_U
 . S Z=0
 . F  S Z=$O(^IBM(361,"B",IBBILL,Z)) Q:'Z  I Z'=IBY D  Q:IBY'>0
 .. S IBOLD=""
 .. F PCE=3,4,5,7,8,11,15 S IBOLD=IBOLD_$P($G(^IBM(361,Z,0)),U,PCE)_U
 .. I IBNEW'=IBOLD Q   ; no duplicate so get the next one
 .. S DIK="^IBM(361,",DA=IBY,IBY=-1 D ^DIK D DELMSG^IBCESRV2(IBTDA)
 .. Q
 . Q
 ;
 I IBY>0 D  ;Move text over
 . K IBT
 . ;
 . D BLDMSG(IB1,IBTDA,.IBT,.IBAUTO)
 . ;
 . ; IB*2*320 - esg - 2Q messages will be filed as informational
 . I $P($G(^IBM(361,+IBY,0)),U,3)="R",$G(IBT(1))["2Q  CLAIM REJECTED BY CLEARINGHOUSE" D
 .. S IBAUTO=1
 .. S DIE=361,DA=+IBY,DR=".03////I" D ^DIE
 .. Q
 . ;
 . ; if info msg, ck for no review needed based on first line of text
 . I $G(IBAUTO),$P($G(^IBM(361,+IBY,0)),U,3)="I" D
 .. S DIE="^IBM(361,",DR=".09////2;.14////1;.1////F",DA=+IBY D ^DIE
 .. I IB1,$P($G(^IBM(361,+IBY,0)),U,11),$$PRINTUPD^IBCEU0($G(IBT(1)),$P($G(^IBM(361,+IBY,0)),U,11))
 . ;
 . D WP^DIE(361,+IBY_",",1,"A","IBT")    ; file message text
 . ;
 . ; Delete message after it successfully updates the database.
 . D DELMSG^IBCESRV2(IBTDA)
 . Q
 ;
UPDQ L -^IBA(364.2,IBTDA,0)
 Q
 ;
BLDMSG(IB1,IBTDA,IBT,IBAUTO) ; Builds message text
 ; IB1 = flag for batch message
 ; IBTDA = ien of entry in file 364.2
 ; IBT = array returned with message text
 ; IBAUTO = if passed by reference, returns 1 if text indicates review
 ;          not needed
 N IBDATA,IBCK,IBZ,IBZ0,IBZ1,Z
 S (IBZ,IBZ0,IBDATA,IBAUTO,IBCK)=0
 I 'IB1 S IBT(1)="Status message received for batch "_$P($G(^IBA(364.1,IBBTCH,0)),U)_" dated "_$$FMTE^XLFDT($P($G(^IBA(364.2,IBTDA,0)),U,10),2),IBZ0=1
 ; Don't move the raw data over, just move the text of the message
 F  S IBZ=$O(^IBA(364.2,IBTDA,2,IBZ)) Q:'IBZ  S IBZ1=$G(^(IBZ,0)) S IBDATA=($E(IBZ1,1,2)="##") Q:IBDATA  S IBZ0=IBZ0+1,IBT(IBZ0)=IBZ1 I 'IBCK S Z=$$CKREVU^IBCEM4(IBZ1,,,.IBCK),IBAUTO=$S(IBCK:0,Z:1,1:IBAUTO)
 ;
 ; Convert Message Lines in IBT to be no longer than 70 chars
 D MSGLNSZ(.IBT)
 Q
 ;
UPDINS(IBPID,IBINS,IBIFN) ; Update the insurance id or the bill printed at
 ;    the EDI contractor's print shop and mailed to the ins co.
 ; IBPID = the id returned from the EDI contractor for the ins co
 ;      ("TYPE") = P if professional id or I if institutional id
 ; IBINS = the ien of the insurance co it was sent to (file 36)
 ; IBIFN = the ien of the claim (file 399)
 ;
 N IBID,IBIDFLD,IBPRT,IBLOOK,DA,DR,DIE,X,Y,Z
 ;
 Q:'$G(IBINS)!($G(IBPID)="")
 ;
 ; Strip spaces off the end of data
 S IBLOOK=""
 I $L(IBPID) F Z=$L(IBPID):-1:1 I $E(IBPID,Z)'=" " S IBLOOK=$E(IBPID,1,Z) Q
 ;
 S IBPRT=($E(IBLOOK,2,5)="PRNT")
 I IBPRT D  ; Set printed via EDI field on bill
 . S DA=IBIFN,DIE="^DGCR(399,",DR="26////1" D ^DIE
 ;
 S IBLOOK=$E($S('IBPRT:$P(IBLOOK,"PAYID=",2),1:""),1,5)
 Q:IBLOOK=""!($E(IBLOOK,2,5)="PRNT")
 S IBIDFLD="3.0"_$S($G(IBPID("TYPE"))="I":4,1:2)
 S IBID=$P($G(^DIC(36,+IBINS,3)),U,IBIDFLD*100#100)
 Q:IBID=IBLOOK
 I IBID="" D  G UPDINSQ ; Update insurance co electronic id # if blank
 . S DIE="^DIC(36,",DR=IBIDFLD_"////"_IBLOOK,DA=IBINS D ^DIE
 I IBID'="",IBLOOK'="" D  ; Bulletin that the id on file and id returned
 . ; are different
 . N XMTO,XMDUZ,XMBODY,IBXM,XMSUBJ,XMZ
 . S XMTO("I:G.IB EDI")=""
 . S XMDUZ="",XMBODY="IBXM",XMSUBJ="PAYER ID RETURNED IS DIFFERENT THAN PAYER ID ON FILE"
 . S IBXM(1)="BILL #     : "_$P($G(^DGCR(399,IBIFN,0)),U)
 . S IBXM(2)="PAYER      : "_$P($G(^DIC(36,+IBINS,0)),U)
 . S IBXM(3)="BILL TYPE  : "_$S($G(IBPID("TYPE"))="I":"INSTITUT",1:"PROFESS")_"IONAL"
 . S IBXM(4)="ID ON FILE : "_IBID
 . S IBXM(5)="ID RETURNED: "_IBLOOK
 . S IBXM(6)=" ",IBXM(7)="   Please determine which id number is correct and correct the id in the",IBXM(8)="insurance file for this payer, if needed"
 . D SENDMSG^XMXAPI(XMDUZ,XMSUBJ,XMBODY,.XMTO,,.XMZ)
 ;
UPDINSQ Q
 ;
MSGLNSZ(MSG) ; Change Input Message Lines to be no more than 70 characters long each
 ;
 ; Input/Output:   MSG  - array of Input Message Lines; this is also the Output Message
 ; which is an array of Converted Message Lines (with lines no more than 70 chars each)
 ;
 N LN,XARY,XARYLN,CNT,OUTMSG,TMPMSG,LDNGSP
 S LN="",CNT=0
 F  S LN=$O(MSG(LN)) Q:LN=""  D  ;
 . ;
 . ; Find any leading spaces in original message line, 
 . ; to be used if line got split below
 . S TMPMSG=$$TRIM^XLFSTR(MSG(LN),"L"," ")  ;Trim Leading Spaces
 . S LDNGSP=$P(MSG(LN),TMPMSG,1)  ;get leading spaces if any
 . ;
 . ; Converts a single line to multiple lines with a maximum width of 70 each
 . ; If line is 70 chars or less, this call returns the exact line
 . K XARY D FSTRNG^IBJU1(MSG(LN),70,.XARY)
 . ;
 . ; Scan lines and merge them into the final output array (OUTMSG)
 . ; On lines 2 and higher, add Leading Spaces found above, if any.
 . S XARYLN=""
 . F  S XARYLN=$O(XARY(XARYLN)) Q:XARYLN=""  S CNT=CNT+1,OUTMSG(CNT)=$S(XARYLN=1:XARY(XARYLN),1:LDNGSP_XARY(XARYLN))
 ;
 ; Move the final Message Lines (OUTMSG) into MSG array to be returned
 K MSG M MSG=OUTMSG
 Q  ;MSGLNSZ
 ;