| [613] | 1 | IBCNBAR ;ALB/ARH-Ins Buffer: process Accept and Reject ;1 Jun 97
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| 2 | ;;2.0;INTEGRATED BILLING;**82,240,345**;21-MAR-94;Build 28
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| 3 | ;;Per VHA Directive 2004-038, this routine should not be modified.
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| 4 | ;
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| 5 | ;
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| 6 | ACCEPT(IBBUFDA,DFN,IBINSDA,IBGRPDA,IBPOLDA,IBMVINS,IBMVGRP,IBMVPOL,IBNEWINS,IBNEWGRP,IBNEWPOL) ; move buffer data into Insurance files then cleanup
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| 7 | ; 1) data moved into insurance files, new records created if needed or edit existing ones
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| 8 | ; 2) complete some general functions that are executed whenever insurance is entered/edited
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| 9 | ; 3) allow user to view buffer entry and new/updated insurance records
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| 10 | ; 4) buffer ins/group/policy data deleted
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| 11 | ; 5) buffer entry status updated
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| 12 | ;
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| 13 | ;
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| 14 | PROCESS ; process all changes selected by user, add/edit insurance files based on buffer data
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| 15 | ;
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| 16 | N IVMINSUP,IBNEW,IBCDFN S IBCDFN=IBPOLDA S:+IBNEWPOL IBNEW=1 D BEFORE^IBCNSEVT ; insurance event driver
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| 17 | ;
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| 18 | N DIR,X,Y,IBX,IBINSH,IBGRPH,IBPOLH S (IBINSH,IBGRPH,IBPOLH)="Updated" W " ...",!
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| 19 | ;
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| 20 | I +IBNEWINS S IBINSDA=+$$NEWINS^IBCNBMN(IBBUFDA) G:'IBINSDA ACCPTQ S IBINSH="Created"
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| 21 | I +IBNEWGRP S IBGRPDA=+$$NEWGRP^IBCNBMN(IBBUFDA,+IBINSDA) G:'IBGRPDA ACCPTQ S IBGRPH="Created"
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| 22 | I +IBNEWPOL S IBPOLDA=+$$NEWPOL^IBCNBMN(IBBUFDA,+IBINSDA,+IBGRPDA) G:'IBPOLDA ACCPTQ S IBPOLH="Created"
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| 23 | ;
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| 24 | I +IBINSDA,+IBMVINS D INS^IBCNBMI(IBBUFDA,IBINSDA,+IBMVINS) W !,"Insurance Company "_IBINSH_"..."
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| 25 | I +IBINSDA,+IBMVGRP,+IBGRPDA D GRP^IBCNBMI(IBBUFDA,IBGRPDA,+IBMVGRP) W !,"Group/Plan "_IBGRPH_"..."
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| 26 | I +IBINSDA,+IBMVPOL,+IBGRPDA,+IBPOLDA D POLICY^IBCNBMI(IBBUFDA,IBPOLDA,+IBMVPOL) W !,"Patient Policy "_IBPOLH_"..."
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| 27 | ;
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| 28 | CLEANUP ; general updates and checks done whenever insurance is added/edited and clean up buffer file
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| 29 | N IBSOURCE S IBSOURCE=$P($G(^IBA(355.33,IBBUFDA,0)),U,3)
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| 30 | ;
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| 31 | I +IBPOLDA D PAT^IBCNBMI(DFN,IBPOLDA) ; update DOB&SSN of Pat Ins from Pat file
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| 32 | D POL^IBCNSU41(DFN) ; update Tricare sponsor data
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| 33 | D COVERED^IBCNSM31(DFN) ; update 'Covered by Insurance' field (2,.3192
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| 34 | I +IBSOURCE=3 D IVM(1,IBBUFDA) ; update/notify IVM
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| 35 | I +IBINSDA,+IBPOLDA S IBX=$$DUPCO^IBCNSOK1(DFN,IBINSDA,IBPOLDA,1) ; warning if duplicate policy added for patient
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| 36 | I +IBGRPDA S IBX=$$DUPPOL^IBCNSOK1(IBGRPDA,1) ; warning if duplicate plan was added
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| 37 | I +IBNEWPOL I +$$PTHLD^IBOHCR(DFN,1,1) W !!,"Patient's bills On Hold date updated due to new insurance."
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| 38 | I $$HOLD^IBCNBLL(DFN) W !!,"There are bills On Hold for this patient."
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| 39 | ;
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| 40 | W !! S DIR(0)="FO",DIR("A")="Press 'V' to view the changes or Return to continue" D ^DIR
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| 41 | I Y="V"!(Y="v") W !! D INS^IBCNBCD(IBBUFDA,IBINSDA),WAIT^IBCNBUH,GRP^IBCNBCD(IBBUFDA,IBGRPDA),WAIT^IBCNBUH,POLICY^IBCNBCD(IBBUFDA,IBPOLDA),WAIT^IBCNBUH
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| 42 | ;
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| 43 | ; update buffer file entry so only stub remains and status is changed
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| 44 | D STATUS^IBCNBEE(IBBUFDA,"A",IBNEWINS,IBNEWGRP,IBNEWPOL) ; update buffer entry's status to accepted
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| 45 | D DELDATA^IBCNBED(IBBUFDA) ; delete buffer's insurance/patient data
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| 46 | ;
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| 47 | S IBCDFN=IBPOLDA S:+IBSOURCE=3 IVMINSUP=1 D AFTER^IBCNSEVT,^IBCNSEVT ; insurance event driver
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| 48 | ;
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| 49 | ACCPTQ Q
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| 50 | ;
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| 51 | ;
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| 52 | REJECT(IBBUFDA) ; process a buffer entry reject
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| 53 | ; 1) update/notify IVM
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| 54 | ; 2) buffer ins/group/policy data deleted
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| 55 | ; 3) buffer entry status updated
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| 56 | ; 4) if patient has no other active insurance then release any patient bills On Hold
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| 57 | ;
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| 58 | N DFN S DFN=+$G(^IBA(355.33,+IBBUFDA,60))
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| 59 | ;
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| 60 | I +$P($G(^IBA(355.33,+IBBUFDA,0)),U,3)=3 D IVM(0,IBBUFDA)
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| 61 | ;
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| 62 | D STATUS^IBCNBEE(+IBBUFDA,"R",0,0,0),DELDATA^IBCNBED(+IBBUFDA) W " ... done."
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| 63 | ;
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| 64 | I +DFN,'$$INSURED^IBCNS1(DFN),'$$BUFFER^IBCNBU1(DFN) D
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| 65 | . I +$$PTHLD^IBOHCR(DFN,2,1) W !!,"Patient has no other active Insurance.",!,"All patient bills On Hold waiting for Insurance have been released." D WAIT^IBCNBUH
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| 66 | ;
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| 67 | Q
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| 68 | ;
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| 69 | ;
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| 70 | IVM(AR,IBBUFDA) ; IVM must be notified whenever a buffer entry that originated in IVM is accepted or rejected
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| 71 | ; this lets them clean up their files since they also have a buffer type file of insurance uploaded from the IVM center
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| 72 | ; if rejected they then ask the user for a reason it was rejected
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| 73 | ; input: AR = 1 if accepted, 0 if rejected
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| 74 | ;
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| 75 | N DFN,IBX,IBY I $P($G(^IBA(355.33,+IBBUFDA,0)),U,3)'=3 Q
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| 76 | ;
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| 77 | S DFN=+$G(^IBA(355.33,+IBBUFDA,60))
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| 78 | S IBX=$P($G(^IBA(355.33,+IBBUFDA,20)),U,1)_U_$P($G(^IBA(355.33,+IBBUFDA,21)),U,1)_U_$P($G(^IBA(355.33,+IBBUFDA,40)),U,3)
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| 79 | ;
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| 80 | S IBY=$$UPDATE^IVMLINS4(DFN,AR,IBX)
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| 81 | Q
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