source: WorldVistAEHR/trunk/r/INTEGRATED_BILLING-IB-PRQ--IBD--IBQ--PRQS/IBCEU6.m@ 1464

IBCEU6 ;ALB/ESG - EDI UTILITIES FOR EOB PROCESSING ;29-JUL-2003

 ;;2.0;INTEGRATED BILLING;**155**;21-MAR-94

 ;

 Q

 ;

COBLINE(IBIFN,IBI,IBXDATA,SORT,IBXTRA) ; Extract all COB data for line item

 ;  from file 361.1 (EOB), subfile 15 into IBXDATA(IBI,"COB",n)

 ;

 ; IBIFN = bill entry #

 ; IBI = VistA outbound line item #

 ; IBXDATA = array returned with COB line item data/pass by reference

 ; SORT = flag that determines whether the data should be sorted for

 ;        output for the 837 record ('PR' group always there and has

 ;        a reason code for deductible first and co-insurance second -

 ;        even if they are 0).

 ;        1 = sort, 0 = no sort needed

 ;

 ;   Returns IBXDATA(IBI,"COB",COB,n) with COB data for each line item

 ;      found in an accepted EOB for the bill and = the '0' node data of

 ;      file 361.115 (LINE LEVEL ADJUSTMENTS)

 ;         -- AND --

 ;    IBXDATA(IBI,"COB",COB,n,z,p)=

 ;           the data on the '0' node for each subordinate entry of file

 ;           361.11511 (REASONS) (Only first 3 pieces for 837 output)

 ;               z = this is either piece 1 of the 0-node for subfile

 ;                   361.1151 (ADJUSTMENTS)

 ;                          OR

 ;                   for the 837 COB 'sorted' output, this will be ' PR'

 ;                    for the forced/extracted entries for deductible

 ;                    and co-insurance so they are always output first

 ;                    The space needs to be stripped off on output

 ;         -- AND --

 ; IBXTRA = array returned if passed by reference if line is found

 ;          associated with line IBI due to bundling/unbundling

 ;          IBXTRA("ALL",x,paid procedure)=COB SEQ ^ seq # corresponding

 ;                        to subscript n in IBXDATA(,"COB",COB,n

 ;                (x = line #-original proc-service dt)

 ;

 N A,B,B1,C,D,IBDATA,IB0,IB00,IBA,IBB,IBDED,IBCOI,IBS,IBN,IBDT

 ;

 ; If multiple EOB's reference this line for the same COB sequence,

 ;   extract only the last one marked accepted containing this line item.

 ;

 S A=0

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

 . I '$$EOBELIG^IBCEU1(A) Q   ; eob not eligible for secondary claim

 . S IBA=0

 . S IBDATA=$G(^IBM(361.1,A,0))

 . S IBS=$P(IBDATA,U,15)      ; insurance sequence#

 . S IBN=+$O(IBXDATA(IBI,"COB",IBS,0))

 . I IBN D  Q:IBN  ; check for later EOB

 .. I $G(IBDT(IBI,IBS)),IBDT(IBI,IBS)<$P(IBDATA,U,6) K IBDT(IBI,IBS),IBXDATA(IBI,"COB",IBS) S IBN=0

 . ;

 . S IBDT(IBI,IBS)=$P(IBDATA,U,6)

 . S B=0

 . F  S B=$O(^IBM(361.1,A,15,"AC",IBI,B)) Q:'B  S IB0=$G(^IBM(361.1,A,15,B,0)),IB0=IB0_U_IBDT(IBI,IBS) D

 .. Q:$TR(IB0,U)=""

 .. S IBA=IBA+1,IBXDATA(IBI,"COB",IBS,IBA)=IBI_U_IB0

 .. ;

 .. ; capture the modifiers (361.1152)

 .. I $D(^IBM(361.1,A,15,B,2)) M IBXDATA(IBI,"COBMOD")=^IBM(361.1,A,15,B,2)

 .. I $P(IB0,U,15)'="" D  ;Line involved in bundling/unbundling

 ... N Z0 S Z0=IBI_"-"_$P(IB0,U,15)_"-"_$P(IB0,U,16)

 ... S IBXTRA("ALL",Z0,$P(IB0,U,4))=IBS_U_IBA,$P(IBXDATA(IBI,"COB",IBS,IBA),U)=""

 .. S C=0,(IBDED(IBA),IBCOI(IBA))="0^0" ;Assume 0 if not found in list

 .. F  S C=$O(^IBM(361.1,A,15,B,1,C)) Q:'C  S IB0=$G(^(C,0)) D

 ... S D=0

 ... F  S D=$O(^IBM(361.1,A,15,B,1,C,1,D)) Q:'D  S IB00=$S($G(SORT):$P($G(^(D,0)),U,1,3),1:$G(^(D,0))) D

 .... I $G(SORT),$P(IB0,U)="PR" D  ;Check for deductible or co-ins

 ..... I 'IBDED(IBA),$P(IB00,U)=1 S IBDED(IBA)=IB00,IB00="" Q

 ..... I 'IBCOI(IBA),$P(IB00,U)=2 S IBCOI(IBA)=IB00,IB00="" Q

 .... I $TR(IB00,U)'="" S IBB=$O(IBXDATA(IBI,"COB",IBS,IBA,$P(IB0,U),""),-1)+1,IBXDATA(IBI,"COB",IBS,IBA,$P(IB0,U),IBB)=IB00

 .. Q:'$G(SORT)

 .. S IBXDATA(IBI,"COB",IBS,IBA," PR",1)=IBDED(IBA)

 .. S IBXDATA(IBI,"COB",IBS,IBA," PR",2)=IBCOI(IBA)

 Q

 ;