| [623] | 1 | IBCNRDV ;OAKFO/ELZ - INSURANCE INFORMATION EXCHANGE VIA RDV;27-MAR-03
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| 2 | ;;2.0;INTEGRATED BILLING;**214,231,361**;21-MAR-94;Build 9
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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 | ; This routine is used to exchange insurance information between
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| 6 | ; facilities.
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| 7 | OPT ; Menu option entry point. This is used to select a patient to request
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| 8 | ; information about from the remote treating facilities.
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| 9 | N DFN,DIC,X,Y,DTOUT,DUOUT,IBT,%,%Y,IBX,VADM,IBB,IBD,IBH,IBI,IBICN,IBR,IBRZ,IBX,IBY,IBZ,IBWAIT,IBL,DO,IBTYPE,IB1
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| 10 | ;
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| 11 | ; prompt for patient
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| 12 | AGAIN S DIC="^DPT(",DIC(0)="AEMNQ" D ^DIC Q:Y<1 S DFN=+Y
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| 13 | ;
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| 14 | BACKGND ; background/tasked entry point
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| 15 | ; IBTYPE is being used as a flag to indicate this is running in background
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| 16 | ;
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| 17 | ; look up treating facilities
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| 18 | K IBT S IBT=$$TFL^IBARXMU(DFN,.IBT)
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| 19 | I IBT<1,'$D(IBTYPE) W !!,"This patient has no remote treating facilities to query." G AGAIN
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| 20 | I IBT<1 Q
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| 21 | ;
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| 22 | ; display and verify we want to do this
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| 23 | I '$D(IBTYPE) D DEM^VADPT W !!,"The patient ",VADM(1)," has the following ",IBT," remote facilitie(s)",! S IBX=0 F S IBX=$O(IBT(IBX)) Q:IBX<1 W !?10,$P(IBT(IBX),"^",2)
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| 24 | I '$D(IBTYPE) W !!,"Do you want to perform this Remote Query" S %=1 D YN^DICN G:%'=1 AGAIN
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| 25 | ;
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| 26 | ; get ICN
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| 27 | S IBICN=$$ICN^IBARXMU(DFN) I 'IBICN,'$D(IBTYPE) W !!,"No ICN for this patient" G AGAIN
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| 28 | I 'IBICN Q
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| 29 | ;
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| 30 | ; sent off the remote queries and get back handles
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| 31 | S IBX=0 F S IBX=$O(IBT(IBX)) Q:IBX<1 D
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| 32 | . D SEND(.IBH,IBX,IBICN,$S($D(IBTYPE):"IBCN INSURANCE QUERY TASK",1:"IBCN INSURANCE QUERY"))
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| 33 | . X $S(IBH(0)'="":"S $P(IBT(IBX),U,5)=IBH(0)",1:"W:'$D(IBTYPE) !,""No handle returned for "",$P(IBT(IBX),U,2) K IBT(IBX)")
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| 34 | ;
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| 35 | ; no handles returned
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| 36 | I $D(IBT)<9,'$D(IBTYPE) W !!,"Unable to perform any remote queries.",! G AGAIN
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| 37 | I $D(IBT)<9 Q
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| 38 | ;
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| 39 | ; go through every IBT()
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| 40 | S IBP="|",IBX=0 F S IBX=$O(IBT(IBX)) Q:IBX<1!($D(IBT)<9) D
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| 41 | . ;
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| 42 | . ; do I have a return data.
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| 43 | . F IBWAIT=1:1:60 W:'$D(IBTYPE) "." H 1 D CHECK(.IBR,$P(IBT(IBX),"^",5)) I $G(IBR(0))["Done" Q
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| 44 | . I $G(IBR(0))'["Done" W:'$D(IBTYPE) !!,"Unable to communicate with ",$P(IBT(IBX),U,2) Q
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| 45 | . K IBR
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| 46 | . D RETURN(.IBR,$P(IBT(IBX),"^",5))
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| 47 | . ;
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| 48 | . ; no data returned or error message
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| 49 | . S IBRZ=$S(-1=+$G(IBR):IBR,$G(IBR(0))="":$G(IBR(1)),1:$G(IBR(0)))
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| 50 | . ;
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| 51 | . ; no info to proceed
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| 52 | . I IBRZ<1 W:'$D(IBTYPE) !,"Response from ",$P(IBT(IBX),U,2),!,$P(IBRZ,"^",2) K IBT(IBX) D:IBRZ="-1^No insurance on file" FILE(0) Q
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| 53 | . ;
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| 54 | . ; received insurance info, need to file and display message
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| 55 | . W:'$D(IBTYPE) !,"Received ",$G(IBR(0))," insurance companies from ",$P(IBT(IBX),U,2) D FILE(+IBR(0))
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| 56 | . ;
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| 57 | . S IBY=0 F S IBY=$O(IBR(IBY)) Q:IBY<1 D
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| 58 | .. F IBL=5:1 S IBT=$P($T(MAP+IBL),";",3) Q:IBT="" D
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| 59 | ... ;
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| 60 | ... ; am I on the right MAP line
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| 61 | ... I $P(IBT,IBP,3)=$S(IBY#6:IBY#6,1:6) S IBZ=$P(IBR(IBY),"^",$P(IBT,IBP,4)) I $L(IBZ) D
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| 62 | .... ;
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| 63 | .... ; xecute code to change external to internal
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| 64 | .... X:$L($P(IBT,IBP,7)) $P(IBT,IBP,7)
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| 65 | .... ;
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| 66 | .... ; put the info in the array for the buffer file
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| 67 | .... S:$D(IBZ) IBB($P(IBT,IBP,5))=IBZ
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| 68 | .. ;
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| 69 | .. ; need to avoid duplicates if possible.
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| 70 | .. I $G(IBB(20.01))["MEDICARE (WNR)" S X=0 F S X=$O(^DPT(DFN,.312,X)) Q:X<1 I $P($G(^DIC(36,+$P($G(^DPT(DFN,.312,X,0)),"^"),0)),"^")["MEDICARE (WNR)" K IBB Q
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| 71 | .. Q:'$D(IBB)
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| 72 | .. ;
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| 73 | .. ; file in the buffer file & where else needed
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| 74 | .. I IBY#6=0 D
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| 75 | ... I $L($G(IBB(20.01))) D
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| 76 | .... S IBB(.14)=$$IEN^XUAF4(+IBT(IBX))
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| 77 | .... S IBB=$$ADDSTF^IBCNBES($G(IBB(.03),1),DFN,.IBB)
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| 78 | ... I '$D(IB1),$D(IBTYPE),$L($G(IBB(20.01))) D SCH^IBTUTL2(DFN,$G(IBSAVEI),$G(IBSAVEJ)):IBTYPE="TRKR",ADM^IBTUTL($G(IBSAVE1),$G(IBSAVE2),$G(IBSAVE3),$G(IBSAVE4)):IBTYPE="ADM" S IB1=1
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| 79 | ... W:'$D(IBTYPE)&($L($G(IBB(20.01)))) !,$P($G(IBB),"^")," Buffer File entry for ",$G(IBB(20.01))
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| 80 | ... K IBB
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| 81 | ;
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| 82 | ; flag so I don't do this patient again within 90 days
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| 83 | S ^IBT(356,"ARDV",DFN,$$FMADD^XLFDT(DT,90))=""
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| 84 | ;
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| 85 | Q
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| 86 | ;
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| 87 | RPC(IBD,IBICN) ; RPC entry for looking up insurance info
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| 88 | N DFN,IBZ,IBX,IBY,IBP,IBI,IBT,IBZ
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| 89 | S DFN=$$DFN^IBARXMU(IBICN) I 'DFN S IBD(0)="-1^ICN Not found" Q
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| 90 | D ALL^IBCNS1(DFN,"IBY",3)
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| 91 | I '$D(IBY) S IBD(0)="-1^No insurance on file" Q
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| 92 | ; set up return format
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| 93 | ; IBD(0) = # of insurance companies
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| 94 | S IBD(0)=$G(IBY(0))
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| 95 | ;
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| 96 | ; where n starts at 1 and increments 6 for each insurance company
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| 97 | ; IBD(n) = 355.33, zero node format
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| 98 | ; IBD(n+1) = 355.33, 20 node format
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| 99 | ; IBD(n+2) = 355.33, 21 node format
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| 100 | ; IBD(n+3) = 355.33, 40 node format
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| 101 | ; IBD(n+4) = 355.33, 60 node format
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| 102 | ; IBD(n+5) = 355.33, 61 node format
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| 103 | ;
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| 104 | S IBP="|"
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| 105 | S IBI=0 F S IBI=$O(IBY(IBI)) Q:IBI<1 F IBL=5:1 S IBT=$P($T(MAP+IBL),";",3) Q:IBT="" D
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| 106 | . S IBZ=$P($G(IBY(IBI,+IBT)),"^",$P(IBT,IBP,2)) ; set the existing data
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| 107 | . I $L($P(IBT,IBP,6)) X $P(IBT,IBP,6) ; output transform
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| 108 | . S $P(IBD(IBI-1*6+$P(IBT,IBP,3)),"^",$P(IBT,IBP,4))=IBZ ; set data IBD
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| 109 | Q
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| 110 | ;
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| 111 | MAP ; this is a mapping of data returned from ALL^IBCNS1 to the buffer file
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| 112 | ; format is: node number | piece | extract node | extract piece
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| 113 | ; | 355.33 field number | format out code (if any)
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| 114 | ; | format in code (if any)
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| 115 | ; the extract nodes will be sequential to match buffer file DD
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| 116 | ;;0|1|2|1|20.01|N Z X "F Z=0,.11,.13 S IBY(IBI,36+Z)=$G(^DIC(36,IBZ,Z))" S IBZ=$P(IBY(IBI,36),"^");ins co name
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| 117 | ;;0|2|5|4|60.04;subscriber id
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| 118 | ;;0|4|5|3|60.03;experation date
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| 119 | ;;0|6|5|5|60.05;who's insurance
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| 120 | ;;0|8|5|2|60.02;effective date
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| 121 | ;;0|16|5|6|60.06;pt relationship to insured
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| 122 | ;;0|17|5|7|60.07;name of insured
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| 123 | ;;0|20|5|12|60.12;coordination of benefits
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| 124 | ;;1|3|1|10|.1||I IBZ<$$FMADD^XLFDT(DT,-180) K IBZ;date (last) verified
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| 125 | ;;1|9|1|3|.03;source of information
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| 126 | ;;2|1|6|5|61.05;send bill to employer
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| 127 | ;;2|2|6|6|61.06;employer claims street address (line 1)
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| 128 | ;;2|3|6|7|61.07;employer claims street address line 2
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| 129 | ;;2|4|6|8|61.08;employer claims street address line 3
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| 130 | ;;2|5|6|9|61.09;employer claims city
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| 131 | ;;2|6|6|10|61.1|S IBZ=$$EXTERNAL^DILFD(2.312,2.06,"",IBZ)|N DIC,X,Y S DIC="^DIC(5,",X=IBZ,DIC(0)="OX" D ^DIC K:+Y<1 IBZ S:+Y>0 IBZ=+Y;employer claims state
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| 132 | ;;2|7|6|11|61.11;employer claims zip code
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| 133 | ;;2|8|6|12|61.12;employer claims phone
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| 134 | ;;2|10|6|1|61.01;esghp
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| 135 | ;;2|11|6|3|61.03;employment status
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| 136 | ;;2|12|6|4|61.04;retirement date
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| 137 | ;;3|1|5|8|60.08;insured's dob
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| 138 | ;;3|5|5|9|60.09;insured's ssn
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| 139 | ;;3|12|5|13|60.13;insured's sex
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| 140 | ;;4|1|5|10|60.1;primary care provider
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| 141 | ;;4|2|5|11|60.11;primary provider phone
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| 142 | ;;355.3|2|4|1|40.01;is this a group policy
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| 143 | ;;355.3|3|4|2|40.02;group name
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| 144 | ;;355.3|4|4|3|40.03;group number
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| 145 | ;;355.3|5|4|4|40.04;(is) utilization required
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| 146 | ;;355.3|6|4|5|40.05;(is) pre-certification required
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| 147 | ;;355.3|7|4|7|40.07;exclude pre-existing condition
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| 148 | ;;355.3|8|4|8|40.08;benefits assignable
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| 149 | ;;355.3|9|4|9|40.09;type of plan
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| 150 | ;;355.3|12|4|6|40.06;ambulatory care certification
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| 151 | ;;36|2|2|5|20.05;reimburse
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| 152 | ;;36.11|1|3|1|21.01;street address line 1
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| 153 | ;;36.11|2|3|2|21.02;street address line 2
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| 154 | ;;36.11|3|3|3|21.03;street address line 3
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| 155 | ;;36.11|4|3|4|21.04;city
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| 156 | ;;36.11|5|3|5|21.05|S IBZ=$$EXTERNAL^DILFD(36,.115,"",IBZ)|N DIC,X,Y S DIC="^DIC(5,",X=IBZ,DIC(0)="OX" D ^DIC K:+Y<1 IBZ S:+Y>0 IBZ=+Y;state
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| 157 | ;;36.11|6|3|6|21.06;zip code
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| 158 | ;;36.13|1|2|2|20.02;phone number
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| 159 | ;;36.13|2|2|3|20.03;billing phone number
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| 160 | ;;36.13|3|2|4|20.04;precertification phone number
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| 161 | ;;
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| 162 | ;
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| 163 | SEND(IBH,IBX,IBICN,IBRPC) ; called to send off queries
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| 164 | D EN1^XWB2HL7(.IBH,IBX,IBRPC,"",IBICN)
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| 165 | Q
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| 166 | ;
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| 167 | CHECK(IBR,IBH) ; called to check the return status of an RPC
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| 168 | D RPCCHK^XWB2HL7(.IBR,IBH)
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| 169 | Q
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| 170 | ;
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| 171 | RETURN(IBR,IBH) ; called to get the return data and clear the broker
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| 172 | N IBZ
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| 173 | D RTNDATA^XWBDRPC(.IBR,IBH),CLEAR^XWBDRPC(.IBZ,IBH)
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| 174 | Q
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| 175 | ;
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| 176 | TASK ; queue off task job
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| 177 | N ZTRTN,ZTDESC,ZTDTH,ZTIO,ZTSK,ZTSAVE
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| 178 | S ZTRTN="BACKGND^IBCNRDV",ZTDESC="Query Remote Facilities for Insurance",ZTDTH=$$FMADD^XLFDT($$NOW^XLFDT),(ZTIO,ZTSAVE("DFN"),ZTSAVE("IBSAVE*"),ZTSAVE("IBTYPE"))="" D ^%ZTLOAD
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| 179 | Q
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| 180 | ;
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| 181 | TRKR(DFN,IBSAVEI,IBSAVEJ,IBDUZ) ; claims tracking entry
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| 182 | N IBTYPE,IBT
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| 183 | Q:$D(^IBT(356,"ARDV",DFN)) ; have already done recently
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| 184 | Q:'$$TFL^IBARXMU(DFN,.IBT) ; no remote facilities
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| 185 | S IBTYPE="TRKR" D
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| 186 | . I DUZ=.5 N DUZ S DUZ=+$G(IBDUZ),DUZ(2)=+$$SITE^VASITE
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| 187 | . D TASK
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| 188 | Q
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| 189 | ;
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| 190 | ADM(DFN,IBSAVE1,IBSAVE2,IBSAVE3,IBSAVE4) ; admit event entry
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| 191 | N IBTYPE S IBTYPE="ADM" D TASK
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| 192 | Q
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| 193 | ;
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| 194 | FILE(IBX) ; updates data into the log file
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| 195 | ;IBX = number of insurance co's found
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| 196 | N DIC,DA,DIE,IBM,DO,X,Y,IBZ,DR
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| 197 | S IBM=$E($$DT^XLFDT,1,5)_"00",DA=+$O(^IBA(355.34,"B",IBM,0))
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| 198 | I 'DA K DA L +^IBA(355.34,"B",IBM):10 S X=IBM,DIC="^IBA(355.34,",DIC(0)="F" D FILE^DICN S DA=+Y L -^IBA(355.34,"B",IBM)
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| 199 | L +^IBA(355.34,DA):10
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| 200 | S IBZ=^IBA(355.34,DA,0),DIE="^IBA(355.34,"
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| 201 | S DR=".02///"_($P(IBZ,"^",2)+1)_";.03///"_($P(IBZ,"^",3)+IBX) D ^DIE
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| 202 | L -^IBA(355.34,DA)
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| 203 | Q
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