| [613] | 1 | IBCNSP ;ALB/AAS - INSURANCE MANAGEMENT - EXPANDED POLICY ;05-MAR-1993
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| 2 | ;;2.0;INTEGRATED BILLING;**6,28,43,52,85,251,363,371**;21-MAR-94;Build 57
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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 | EN ; -- main entry point for IBCNS EXPANDED POLICY
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| 6 | N IB1ST
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| 7 | K VALMQUIT,IBPPOL
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| 8 | S IBTOP="IBCNSP"
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| 9 | D EN^VALM("IBCNS EXPANDED POLICY")
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| 10 | Q
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| 11 | ;
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| 12 | HDR ; -- header code
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| 13 | N W,X,Y,Z
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| 14 | S VALMHDR(1)="Expanded Policy Information for: "_$E($P(^DPT(DFN,0),U),1,20)_" "_$P($$PT^IBEFUNC(DFN),U,2)
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| 15 | S Z=$G(^DPT(DFN,.312,+$P(IBPPOL,U,4),0))
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| 16 | S W=$P($G(^IBA(355.3,+$P(Z,U,18),0)),U,11)
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| 17 | S Y=$E($P($G(^DIC(36,+Z,0)),U),1,20)_" Insurance Company"
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| 18 | S X="** Plan Currently "_$S(W:"Ina",1:"A")_"ctive **"
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| 19 | S VALMHDR(2)=$$SETSTR^VALM1(X,Y,48,29)
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| 20 | Q
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| 21 | ;
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| 22 | INIT ; -- init variables and list array
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| 23 | K VALMQUIT
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| 24 | S VALMCNT=0,VALMBG=1
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| 25 | I '$D(IBPPOL) D PPOL Q:$D(VALMQUIT)
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| 26 | K ^TMP("IBCNSVP",$J)
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| 27 | D BLD,HDR
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| 28 | Q
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| 29 | ;
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| 30 | BLD ; -- list builder
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| 31 | K ^TMP("IBCNSVP",$J),^TMP("IBCNSVPDX",$J)
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| 32 | D KILL^VALM10()
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| 33 | F I=1:1:20 D BLANK(.I) ; start with 20 blank lines
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| 34 | N IBCDFND,IBCDFND1,IBCDFND2,IBCDFND4,IBCDFND5
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| 35 | S IBCDFND=$G(^DPT(DFN,.312,$P(IBPPOL,U,4),0)),IBCDFND1=$G(^(1)),IBCDFND2=$G(^(2)),IBCDFND4=$G(^(4)),IBCDFND5=$G(^(5))
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| 36 | S IBCPOL=+$P(IBCDFND,U,18),IBCNS=+IBCDFND,IBCDFN=$P(IBPPOL,U,4)
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| 37 | S IBCPOLD=$G(^IBA(355.3,+$P(IBCDFND,U,18),0)),IBCPOLD1=$G(^(1))
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| 38 | S IBCPOLD2=$G(^IBA(355.3,+$G(IBCPOL),6)) ;; Daou/EEN adding BIN and PCN
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| 39 | ;
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| 40 | D POLICY^IBCNSP0 ; plan information
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| 41 | D INS^IBCNSP0 ; insurance company
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| 42 | D UR ; utilization review info
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| 43 | D EFFECT ; effective dates & source of info
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| 44 | D SUBSC^IBCNSP01 ; subscriber info
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| 45 | D EMP ; subscriber's employer info
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| 46 | D SPON^IBCNSP0 ; insured person's info
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| 47 | D ID^IBCNSP01 ; ins co ID numbers (IB*2*371)
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| 48 | D PLIM ; plan coverage limitations
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| 49 | D VER^IBCNSP01 ; user/verifier/editor info
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| 50 | D CONTACT^IBCNSP0 ; last insurance contact
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| 51 | D COMMENT ; comments - policy & plan
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| 52 | D RIDER^IBCNSP01 ; policy rider info
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| 53 | ;
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| 54 | S VALMCNT=+$O(^TMP("IBCNSVP",$J,""),-1)
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| 55 | Q
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| 56 | ;
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| 57 | COMMENT ; -- Comment region
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| 58 | N START,OFFSET,IBL,IBI
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| 59 | S (START,IBL)=$O(^TMP("IBCNSVP",$J,""),-1)+1,OFFSET=2
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| 60 | S IB1ST("COMMENT")=START
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| 61 | D SET(START,OFFSET," Comment -- Patient Policy ",IORVON,IORVOFF)
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| 62 | S IBL=IBL+1
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| 63 | D SET(IBL,OFFSET,$S($P(IBCDFND1,U,8)="":"None",1:$P(IBCDFND1,U,8)))
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| 64 | S IBL=IBL+1
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| 65 | D SET(IBL,OFFSET," ")
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| 66 | S IBL=IBL+1
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| 67 | D SET(IBL,OFFSET," Comment -- Group Plan ",IORVON,IORVOFF)
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| 68 | S IBI=0 F S IBI=$O(^IBA(355.3,+IBCPOL,11,IBI)) Q:IBI<1 D
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| 69 | . S IBL=IBL+1
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| 70 | . D SET(IBL,OFFSET," "_$E($G(^IBA(355.3,+IBCPOL,11,IBI,0)),1,80))
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| 71 | . Q
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| 72 | S IBL=IBL+1 D SET(IBL,OFFSET," ")
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| 73 | S IBL=IBL+1 D SET(IBL,OFFSET," ")
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| 74 | Q
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| 75 | ;
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| 76 | EFFECT ; -- Effective date region
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| 77 | N START,OFFSET
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| 78 | S START=16,OFFSET=45
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| 79 | D SET(START,OFFSET-4," Effective Dates & Source ",IORVON,IORVOFF)
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| 80 | D SET(START+1,OFFSET," Effective Date: "_$$DAT1^IBOUTL($P(IBCDFND,U,8)))
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| 81 | D SET(START+2,OFFSET,"Expiration Date: "_$$DAT1^IBOUTL($P(IBCDFND,U,4)))
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| 82 | D SET(START+3,OFFSET," Source of Info: "_$$EXPAND^IBTRE(2.312,1.09,$P($G(IBCDFND1),U,9)))
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| 83 | D SET(START+4,OFFSET-4,"Policy Not Billable: "_$S($P($G(^DPT(DFN,.312,IBCDFN,3)),"^",4):"YES",1:"NO"))
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| 84 | Q
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| 85 | ;
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| 86 | UR ; -- UR of insurance region
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| 87 | N START,OFFSET
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| 88 | S START=16,OFFSET=2
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| 89 | D SET(START,OFFSET," Utilization Review Info ",IORVON,IORVOFF)
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| 90 | D SET(START+1,OFFSET," Require UR: "_$$EXPAND^IBTRE(355.3,.05,$P(IBCPOLD,U,5)))
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| 91 | D SET(START+2,OFFSET," Require Amb Cert: "_$$EXPAND^IBTRE(355.3,.12,$P(IBCPOLD,U,12)))
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| 92 | D SET(START+3,OFFSET," Require Pre-Cert: "_$$EXPAND^IBTRE(355.3,.06,$P(IBCPOLD,U,6)))
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| 93 | D SET(START+4,OFFSET," Exclude Pre-Cond: "_$$EXPAND^IBTRE(355.3,.07,$P(IBCPOLD,U,7)))
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| 94 | D SET(START+5,OFFSET,"Benefits Assignable: "_$$EXPAND^IBTRE(355.3,.08,$P(IBCPOLD,U,8)))
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| 95 | Q
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| 96 | EMP ; -- Insurance Employer Region
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| 97 | N OFFSET,START,IBADD
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| 98 | S START=24,OFFSET=40
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| 99 | D SET(START,OFFSET," Subscriber's Employer Information ",IORVON,IORVOFF)
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| 100 | D SET(START+1,OFFSET,"Emp Sponsored Plan: "_$S(+$P(IBCDFND2,U,10):"Yes",1:"No"))
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| 101 | D SET(START+2,OFFSET," Employer: "_$P(IBCDFND2,U,9))
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| 102 | D SET(START+3,OFFSET," Employment Status: "_$$EXPAND^IBTRE(2.312,2.11,$P(IBCDFND2,U,11)))
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| 103 | D SET(START+4,OFFSET," Retirement Date: "_$$DAT1^IBOUTL($P(IBCDFND2,U,12)))
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| 104 | D SET(START+5,OFFSET,"Claims to Employer: "_$S(+IBCDFND2:"Yes, Send to Employer",1:"No, Send to Insurance Company"))
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| 105 | ;
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| 106 | D SET(START+6,OFFSET," Street: "_$P(IBCDFND2,U,2)) S IBADD=1
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| 107 | I $P(IBCDFND2,U,3)'="" D SET(START+7,OFFSET," Street 2: "_$P(IBCDFND2,U,3)) S IBADD=2
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| 108 | I $P(IBCDFND2,U,4)'="" D SET(START+8,OFFSET," Street 3: "_$P(IBCDFND2,U,4)) S IBADD=3
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| 109 | D SET(START+6+IBADD,OFFSET," City/State: "_$E($P(IBCDFND2,U,5),1,15)_$S($P(IBCDFND2,U,5)="":"",1:", ")_$P($G(^DIC(5,+$P(IBCDFND2,U,6),0)),U,2)_" "_$E($P(IBCDFND2,U,7),1,5))
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| 110 | D SET(START+7+IBADD,OFFSET," Phone: "_$P(IBCDFND2,U,8))
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| 111 | ;
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| 112 | ; couple of blank lines to end this section
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| 113 | D SET(START+8+IBADD,2," ")
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| 114 | D SET(START+9+IBADD,2," ")
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| 115 | ;
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| 116 | EMPQ Q
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| 117 | ;
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| 118 | PLIM ; plan coverage limitations/plan limitation category display
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| 119 | N START,END S START=$O(^TMP("IBCNSVP",$J,""),-1)+1
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| 120 | S IB1ST("PLIM")=START
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| 121 | D LIMBLD^IBCNSC41(START,2)
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| 122 | S END=$O(^TMP("IBCNSVP",$J,""),-1) ; last line constructed
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| 123 | D SET(END+1,2," ") ; 2 blank lines to end this section
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| 124 | D SET(END+2,2," ")
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| 125 | PLIMX ;
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| 126 | Q
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| 127 | ;
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| 128 | HELP ; -- help code
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| 129 | S X="?" D DISP^XQORM1 W !!
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| 130 | Q
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| 131 | ;
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| 132 | EXIT ; -- exit code
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| 133 | K IBPPOL,VALMQUIT,IBCNS,IBCPOL,IBCPOLD,IBCPOLD1,IBCPOLD2,IBCDFND,IBCDFND1,IBCDFND2
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| 134 | D CLEAN^VALM10,CLEAR^VALM1
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| 135 | Q
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| 136 | ;
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| 137 | EXPND ; -- expand code
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| 138 | Q
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| 139 | ;
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| 140 | PPOL ; -- select patient, select policy
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| 141 | I '$D(DFN) D G:$D(VALMQUIT) PPOLQ
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| 142 | .S DIC="^DPT(",DIC(0)="AEQMN" D ^DIC
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| 143 | .S DFN=+Y
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| 144 | I $G(DFN)<1 S VALMQUIT="" G PPOLQ
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| 145 | ;
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| 146 | I '$O(^DPT(DFN,.312,0)) W !!,"Patient doesn't have Insurance" K DFN G PPOL
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| 147 | ;
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| 148 | S DIC="^DPT("_DFN_",.312,",DIC(0)="AEQMN",DIC("A")="Select Patient Policy: "
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| 149 | D ^DIC I +Y<1 S VALMQUIT=""
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| 150 | G:$D(VALMQUIT) PPOLQ
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| 151 | S IBPPOL="^2^"_DFN_U_+Y_U_$G(^DPT(DFN,.312,+Y,0))
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| 152 | PPOLQ K DIC Q
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| 153 | ;
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| 154 | BLANK(LINE) ; -- Build blank line
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| 155 | D SET^VALM10(.LINE,$J("",80))
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| 156 | Q
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| 157 | ;
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| 158 | SET(LINE,COL,TEXT,ON,OFF) ; -- set display info in array
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| 159 | I '$D(@VALMAR@(LINE,0)) D BLANK(.LINE) S VALMCNT=$G(VALMCNT)+1
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| 160 | D SET^VALM10(.LINE,$$SETSTR^VALM1(.TEXT,@VALMAR@(LINE,0),.COL,$L(TEXT)))
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| 161 | D:$G(ON)]""!($G(OFF)]"") CNTRL^VALM10(.LINE,.COL,$L(TEXT),$G(ON),$G(OFF))
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| 162 | W:'(LINE#5) "."
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| 163 | Q
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