| [613] | 1 | IBCNS2 ;ALB/AAS - INSURANCE POLICY CALLS FROM FILE 399 DD ;22-JULY-91
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| 2 | ;;2.0;INTEGRATED BILLING;**28,43,80,51,137,155**;21-MAR-94
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| 3 | ;;Per VHA Directive 10-93-142, this routine should not be modified.
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| 4 | ;
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| 5 | Q
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| 6 | DD(IBX,IBDA,LEVEL) ; - called from input transform for field 111,112,113
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| 7 | ; -- input ibx = x from input transform
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| 8 | ; ibda = internal entry in 399
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| 9 | ; level = 1=primary, 2=secondary, 3=tertiary
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| 10 | ; -- output returns x=internal entry in 2.3121 (ins. Mult.) if valid
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| 11 | ;
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| 12 | N DFN,ACTIVE,INSDT
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| 13 | D VAR
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| 14 | S X=$$SEL(IBX,DFN,INSDT,ACTIVE)
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| 15 | I +X<1 K X
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| 16 | DDQ Q
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| 17 | ;
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| 18 | VAR S DFN=$P(^DGCR(399,IBDA,0),"^",2),ACTIVE=1,INSDT=$S(+$G(^DGCR(399,IBDA,"U")):+$G(^("U")),1:DT)
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| 19 | Q
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| 20 | ;
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| 21 | SEL(IBX,DFN,INSDT,ACTIVE) ; -- Select insurance policy
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| 22 | ; -- Input IBX = x from input transform
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| 23 | ; DFN = patient
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| 24 | ; INSDT = (optional) Active date of ins. (default = dt)
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| 25 | ; ACTIVE = (optional) 1 if want active (default)
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| 26 | ; = 2 if want all ins returned
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| 27 | ;
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| 28 | ; -- Output = pointer to 36 ^ pointer to 2.3121 ^ pointer to 355.3
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| 29 | ;
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| 30 | N I,J,Y,DA,DE,DQ,DR,DIC,DIE,DIR,DIV,IBSEL,IBDD,IBD
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| 31 | S IBSEL=1,Y=""
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| 32 | I '$G(ACTIVE) S ACTIVE=1
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| 33 | S:'$G(INSDT) INSDT=DT
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| 34 | I '$G(DFN) G SELQ
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| 35 | D BLD
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| 36 | ;
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| 37 | ; -- call DIC to choose from list
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| 38 | S X=IBX
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| 39 | S DIC="^DPT("_DFN_",.312,",DIC(0)="EQMN"
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| 40 | S DIC("S")="I $D(IBDD(+Y))" ; add not other selection
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| 41 | S DIC("W")="W $P(^DIC(36,+^(0),0),U)_"" Group: ""_$$GRP^IBCNS($P(^DPT(DFN,.312,+Y,0),U,18))"
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| 42 | D ^DIC
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| 43 | SELQ Q +Y
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| 44 | ;
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| 45 | BLD K IBD,IBDD
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| 46 | S (IBDD,IBCDFN)=0 F S IBCDFN=$O(^DPT(DFN,.312,IBCDFN)) Q:'IBCDFN I $D(^DPT(DFN,.312,IBCDFN,0)) D CHK(IBCDFN,ACTIVE,INSDT)
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| 47 | Q
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| 48 | ;
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| 49 | CHK(IBCDFN,ACTIVE,INSDT) ; -- see if active
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| 50 | N X,X1
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| 51 | S X=$G(^DPT(DFN,.312,IBCDFN,0))
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| 52 | S IBDD(IBCDFN)=+X_"^"_IBCDFN_"^"_$P(X,"^",18)
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| 53 | I ACTIVE=2 G CHKQ
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| 54 | S X1=$G(^DIC(36,+X,0)) I X1="" G CQ ;ins co entry doesn't exist
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| 55 | I $P(X,"^",8) G:INSDT<$P(X,"^",8) CQ ;effective date later than care
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| 56 | I $P(X,"^",4) G:INSDT>$P(X,"^",4) CQ ;care after expiration date
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| 57 | I $P($G(^IBA(355.3,+$P(X,"^",18),0)),"^",11) G CQ ;plan is inactive
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| 58 | G:$P(X1,"^",5) CQ ; ;ins company inactive
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| 59 | ;G:$P(X1,"^",2)="N" CQ ; ;ins company will not reimburse
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| 60 | G CHKQ
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| 61 | CQ K IBDD(IBCDFN)
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| 62 | CHKQ S:$D(IBDD(IBCDFN)) IBDD=IBDD+1,IBD(IBDD)=IBCDFN
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| 63 | Q
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| 64 | ;
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| 65 | ;
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| 66 | DDHELP(IBDA,LEVEL) ; -- Executable help
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| 67 | ; -- write out list to choose from
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| 68 | N DFN,ACTIVE,INSDT,I,IBINS
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| 69 | D VAR,BLD
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| 70 | ;
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| 71 | I $G(IBDD)=0 W !,"No Insurance Policies to Select From" G DDHQ
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| 72 | ;
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| 73 | I '$D(IOM) D HOME^%ZIS
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| 74 | N IBDTIN
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| 75 | S IBDTIN=$G(INSDT)
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| 76 | W ! D HDR^IBCNS
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| 77 | S I=0 F S I=$O(IBD(I)) Q:'I D
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| 78 | .S IBINS=$G(^DPT(DFN,.312,$G(IBD(I)),0))
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| 79 | .D D1^IBCNS
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| 80 | DDHQ Q
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| 81 | ;
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| 82 | TRANS(IBDA,Y) ; -- output transform
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| 83 | N DFN,ACTIVE,INSDT
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| 84 | D VAR
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| 85 | S Y=$P($G(^DIC(36,+$P($G(^DPT(DFN,.312,+$G(Y),0)),U),0)),U)
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| 86 | Q Y
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| 87 | ;
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| 88 | INSCO(IBDA,IBCDFN) ; -- return pointer value of 36 from pt. file
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| 89 | N DFN,ACTIVE,INSDT
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| 90 | D VAR
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| 91 | S Y=+$G(^DPT(DFN,.312,IBCDFN,0))
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| 92 | Q Y_$S(Y>0:"^"_$P($G(^DIC(36,+Y,0)),"^"),1:"")
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| 93 | ;
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| 94 | IX(DA,XREF) ; -- create i1, aic xrefs for fields 112, 113, 114
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| 95 | ;
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| 96 | S ^DGCR(399,DA,XREF)=$$ZND^IBCNS1($P($G(^DGCR(399,DA,0)),"^",2),X)
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| 97 | S ^DGCR(399,DA,"AIC",+$G(^DPT($P($G(^DGCR(399,DA,0)),"^",2),.312,+X,0)))=""
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| 98 | Q
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| 99 | ;
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| 100 | KIX(DA,XREF) ; -- kill logic for above xref
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| 101 | K ^DGCR(399,DA,XREF)
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| 102 | K ^DGCR(399,DA,"AIC",+$G(^DPT($P($G(^DGCR(399,DA,0)),"^",2),.312,+X,0)))
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| 103 | Q
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| 104 | ;
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| 105 | BPP(IBDA,IBMCR) ; Find Bill Payer Policy based on Payer Sequence and the P/S/T payers assigned to the bill,Ins Co must reimburse
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| 106 | ; IBMCR = flag that says include MEDICARE WNR
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| 107 | ; returns - Bill Payer Policy (ifn of policy entry in patient file)
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| 108 | ; - null if either no Payer Sequence or there is no policy defined for the payer sequence
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| 109 | ; or the policy defined by the payer sequence Will Not Reimburse and is not MEDICARE
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| 110 | ;
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| 111 | N IBI,IBX,IBY,IBP,IBC,IBM0 S IBX="",(IBP,IBC)=0
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| 112 | S IBMCR=+$G(IBMCR)
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| 113 | S IBY=$$COBN^IBCEF(+IBDA) I IBY S IBY=IBY+11
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| 114 | I IBY S IBM0=$G(^DGCR(399,+IBDA,"M")),IBP=$P(IBM0,U,IBY)
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| 115 | I IBP S IBY=IBY-11,(IBI,IBY)=$P(IBM0,U,IBY) I +IBY S IBC=$P($G(^DIC(36,+IBY,0)),U,2)
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| 116 | I IBP,IBI,$S(IBC'="N":1,'IBMCR:0,1:$$MCRWNR^IBEFUNC(+IBY)) S IBX=IBP
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| 117 | Q IBX
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