| [613] | 1 | IBCNSM6 ;ALB/NLR - INSURANCE MANAGEMENT WORKSHEET, AN BEN ; 30-JUL-93
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| 2 | ;;Version 2.0 ; INTEGRATED BILLING ;; 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 | BL1 ; --print subscriber's employer info, policy info, insurance co.
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| 6 | ;
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| 7 | W !,$TR($J(" ",IOM)," ","=")
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| 8 | W !?66-($L("* PLAN *")\2),"* PLAN *"
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| 9 | W !?5,$TR($J(" ",IOM-12)," ","-")
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| 10 | W !?6,"1.",?33-($L("** INSURANCE COMPANY **")\2),"** INSURANCE COMPANY **"
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| 11 | D VLINE^IBCNSM7
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| 12 | W ?72,"2.",?99-($L("** PLAN INFO, UR **")\2),"** PLAN INFO, UR **"
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| 13 | W !?3,$J("Company:",23),?28,$E($$DOL(36,.01,$P($G(^DIC(36,+IBCDFND,0)),"^"),IBLINE),1,22) D VLINE^IBCNSM7
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| 14 | W ?83,$J("Require UR?:",23),?108,$$DOL(355.3,.05,$$YN^IBCNSM($P(IBCPOLD,"^",5),1),IBLINE)
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| 15 | W !?3,$J("Street:",23),?28,$E($$DOL(36,.111,$P($G(IBCDFNDA),"^"),IBLINE),1,22) D VLINE^IBCNSM7
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| 16 | W ?83,$J("Require Pre-cert?:",23),?108,$$DOL(355.3,.06,$$YN^IBCNSM($P(IBCPOLD,"^",6),1),IBLINE)
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| 17 | W !?3,$J("Street 2:",23),?28,$E($$DOL(36,.112,$P($G(IBCDFNDA),"^",2),IBLINE),1,22) D VLINE^IBCNSM7
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| 18 | W ?83,$J("Benefits Assignable?:",23),?108,$$DOL(355.3,.08,$$YN^IBCNSM($P(IBCPOLD,"^",8),1),IBLINE)
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| 19 | W !?3,$J("City:",23),?28,$E($$DOL(36,.114,$P(IBCDFNDA,"^",4),IBLINE),1,22) D VLINE^IBCNSM7
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| 20 | W ?83,$J("Effective Date:",23),?108,$$DOL(FILE,8,$$DAT1^IBOUTL($P(IBCDFND,"^",8)),IBLINE)
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| 21 | W !?3,$J("State:",23),?28,$E($$DOL(36,.115,$P(IBCDFNDA,"^",5),IBLINE),1,22) D VLINE^IBCNSM7
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| 22 | W ?83,$J("Expiration Date:",23),?108,$$DOL(FILE,3,$$DAT1^IBOUTL($P(IBCDFND,"^",4)),IBLINE)
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| 23 | W !,?3,$J("Phone:",23),?28,$$DOL(36,.131,$P(IBCDFNDB,"^",1),IBLINE) D VLINE^IBCNSM7
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| 24 | W ?83,$J("Whose Insurance:",23),?108,$$EXPAND^IBTRE(2.312,6,$$DOL(FILE,6,$P($G(IBCDFND),"^",6),IBLINE))
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| 25 | W !?3,$J("Precert Phone:",23),?28,$$DOL(36,.133,$$PHONE^IBCNSC01(IBCDFNDB),IBLINE) D VLINE^IBCNSM7
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| 26 | W ?83,$J("Subscriber ID:",23),?108,$$DOL(FILE,1,$P($G(IBCDFND),"^",2),IBLINE)
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| 27 | W !?3,$J("Verification Phone:",23),?28,$$DOL(36,.134,$P(IBCDFNDB,"^",4),IBLINE) D VLINE^IBCNSM7
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| 28 | W ?83,$J("Insured's Name:",23),?108,$E($$DOL(FILE,17,$P($G(IBCDFND),"^",17),IBLINE),1,23)
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| 29 | W !,?3,$J("Filing Time Frame:",23),?28,$$DOL(36,.12,$P($G(^DIC(36,+IBCDFND,0)),"^",12),IBLINE) D VLINE^IBCNSM7
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| 30 | Q
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| 31 | ;
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| 32 | ;
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| 33 | DOL(FILE,FIELD,VALUE,LINE) ; -- data or line
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| 34 | ; -- expand data if it exists or else print a blank line
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| 35 | ; if $g(line) print a line for worksheet
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| 36 | N X
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| 37 | ;S:VALUE'="" LINE=0 S X=""
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| 38 | I VALUE="" S X=$S(LINE:"_______________________",1:"") G DOLQ
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| 39 | ;I VALUE=""!(LINE) G DOLQ
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| 40 | S X=$$EXPAND^IBTRE(FILE,FIELD,VALUE)
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| 41 | DOLQ Q X
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