| [613] | 1 | IBCNSU1 ;ALB/AAS - INSURANCE UTILITY ROUTINE ;19-MAY-93
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| 2 | ;;2.0;INTEGRATED BILLING;**103,133,244,371**;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 | RCHK(X) ; -- Input transform for different revenue codes in file 36
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| 6 | ; Returns 1 if passes, 0 if not pass input transform
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| 7 | ;
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| 8 | N I,Y,RC,NO S Y=0
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| 9 | I $G(X)="" G RCHKQ
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| 10 | F I=1:1 S RC=$P(X,",",I) Q:RC="" I $S(RC?3N:0,RC?5N:0,1:1) S NO=1 Q
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| 11 | I '$G(NO) S Y=1
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| 12 | RCHKQ Q Y
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| 13 | ;
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| 14 | BU(DFN,IBCPOL,IBYR,IBCDFN,IBASK) ; -- Return entry in Benefits Used file
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| 15 | ; Input: IBCDFN = pointer to patient file policy (2.312)
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| 16 | ; DFN = patient pointer
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| 17 | ; IBCPOL = pointer to health insurance policy file
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| 18 | ; IBYR = fileman internal date, year will be calendar
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| 19 | ; year of the internal date, Default = dt
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| 20 | ; IBASK = 1 if want to ask okay to add new entry
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| 21 | ;
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| 22 | ; Output: IBCBU = pointer to Benefits Used file if added,
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| 23 | ; else null
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| 24 | ;
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| 25 | N DIR,IBCBU
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| 26 | S IBCBU=""
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| 27 | I $G(IBCPOL)="" G BUQ
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| 28 | I $G(IBYR)="" S IBYR=DT
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| 29 | ;
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| 30 | ;if no match display message
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| 31 | I '$O(^IBA(355.4,"APY",IBCPOL,-IBYR,0)) W !!,"You cannot add a new Benefits Used BENEFIT YEAR",!! G BUQ
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| 32 | ;
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| 33 | ; -- try to find entry for policy for year
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| 34 | S IBCBU=$O(^IBA(355.5,"APPY",DFN,IBCPOL,-IBYR,IBCDFN,0))
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| 35 | ;
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| 36 | ; -- if no match add new entry
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| 37 | I 'IBCBU D
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| 38 | .I $G(IBASK) S DIR(0)="Y",DIR("A")="Are you adding a new Benefits Used YEAR",DIR("B")="YES" D ^DIR I $D(DIRUT)!(Y<1) S VALMQUIT="" Q
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| 39 | .S IBCBU=$$ADDBU(DFN,IBCPOL,IBYR,IBCDFN)
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| 40 | .Q
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| 41 | ;
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| 42 | BUQ Q IBCBU
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| 43 | ;
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| 44 | ADDBU(DFN,IBCPOL,IBYR,IBCDFN) ; -- add entries to Benefits Used file
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| 45 | ; Input: DFN = pointer to patient file
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| 46 | ; IBCDFN = point to patient policy (2.312)
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| 47 | ; IBCPOL = pointer to health insurance policy file
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| 48 | ; IBYR = fileman internal date, year will be calendar
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| 49 | ; year of the internal date, Default = dt
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| 50 | ;
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| 51 | ; Output: IBCBU = pointer to Benefits Used file if added,
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| 52 | ; else null
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| 53 | ;
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| 54 | N %DT,IBN1,IBCBU,DIC,DIE,DR,DA,DLAYGO,DO,DD
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| 55 | S IBCBU=""
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| 56 | I $G(IBCDFN)="" G ADDBUQ
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| 57 | I $G(IBCPOL)="" G ADDBUQ
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| 58 | I $G(IBYR)="" S IBYR=DT
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| 59 | K DD,DO,DIC,DR S DIC="^IBA(355.5,",DIC(0)="L",DLAYGO=355.5
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| 60 | ;
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| 61 | ;S IBYR=$E(IBYR,1,3)_"0000"
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| 62 | S X=IBCPOL D FILE^DICN I +Y<0 G ADDBUQ
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| 63 | S (IBCBU,DA)=+Y,DIE="^IBA(355.5,",DR=".02////"_DFN_";.03////"_IBYR_";.17////"_IBCDFN_";1.01///NOW;1.02////"_DUZ
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| 64 | D ^DIE K DIC,DIE,DA,DR
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| 65 | ADDBUQ Q IBCBU
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| 66 | ;
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| 67 | VET() ; -- Input Transform for sub-file 2.312, Name of Insured (#17)
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| 68 | ; Quit 1 to stuff Patient Name
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| 69 | ; Quit 0 to not stuff and allow editing
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| 70 | ;
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| 71 | N IBY,IB0 S IBY=0
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| 72 | G VETQ ; IB*2*371 - Allow edits to the patient name in all cases
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| 73 | S IB0=$G(^DPT(+$G(DA(1)),.312,+$G(DA),0))
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| 74 | I $P(IB0,"^",6)'="v" G VETQ
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| 75 | I +IB0'=+$$GETWNR^IBCNSMM1 S IBY=1 G VETQ
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| 76 | I '$D(X),$P(IB0,"^",17)="" S IBY=1
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| 77 | VETQ Q IBY
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| 78 | ;
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| 79 | ;
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| 80 | SUBID ; -- Input Transform for sub-file #2.312, Subscriber ID (#1)
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| 81 | N NODE,L,R,CHAR,X1
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| 82 | S CHAR="~`!@#$%^&*()_-+={}[]|\/?.,<>;:' """
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| 83 | S NODE=^DPT(DA(1),.312,DA,0)
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| 84 | ;
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| 85 | ; - if the policy is a Medicare policy, make sure the subscriber ID
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| 86 | ; is a valid HICN number
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| 87 | I $P(NODE,U)=+$$GETWNR^IBCNSMM1 S X=$TR(X,"-","") I '$$VALHIC^IBCNSMM(X) D HLP^IBCNSM32 K X Q
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| 88 | ;
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| 89 | S R=$P(NODE,U,16)
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| 90 | S L=$TR($P(^DPT(DA(1),0),U,9),CHAR,"")
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| 91 | S R=$S(R="01":1,R="":1,1:0)
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| 92 | ;
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| 93 | ; - if subscriber ID is the SSN of patient, remove all extraneous
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| 94 | ; characters
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| 95 | S X1=$TR(X,CHAR,"") I X1?9N,X1=L S X=X1
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| 96 | ;
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| 97 | K:$L(X)>20!($L(X)<3) X
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| 98 | Q
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| 99 | ;
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| 100 | ;
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| 101 | HICN(DFN) ; -- return Patient's Medicare HIC number
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| 102 | ; Return HICN of Medicare WNR Part A or Part B
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| 103 | ; Return -1 if none exits
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| 104 | ;
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| 105 | N IBWNR,IBX,IBY,IB0
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| 106 | S IBWNR=$$GETWNR^IBCNSMM1,IBY=""
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| 107 | I '$O(^DPT(DFN,.312,"B",+IBWNR,0)) S IBY=-1 G HICNQ
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| 108 | S IBX=0 F S IBX=$O(^DPT(DFN,.312,"B",+IBWNR,IBX)) Q:('IBX)!(IBY]"") D
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| 109 | .S IB0=$G(^DPT(DFN,.312,IBX,0))
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| 110 | .I $P(IB0,U,18)'=$P(IBWNR,U,3),$P(IB0,U,18)'=$P(IBWNR,U,5) Q
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| 111 | .; 8/18/2003 - Added translation code to remove hyphens if they exist.
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| 112 | .I $P(IB0,U,2)]"" S IBY=$TR($P(IB0,U,2),"- ","")
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| 113 | S:IBY="" IBY=-1
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| 114 | HICNQ Q IBY
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| 115 | ;
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| 116 | CHKQUAL(DFN,IEN,QUAL,PC1,PC2) ; check for duplicate qualifiers for patient
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| 117 | ; and subscriber secondary ID's. All parameters required.
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| 118 | ;
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| 119 | ; DFN - internal patient#
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| 120 | ; IEN - ien of 2.312 subfile
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| 121 | ; QUAL - passed in response of the user (this is what is being
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| 122 | ; checked to see if it is valid)
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| 123 | ; PC1 - this is the piece# for one of the other qualifiers
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| 124 | ; PC2 - this is the piece# for one of the other qualifiers
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| 125 | ;
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| 126 | ; Function returns 1 if the entered qualifier is OK.
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| 127 | ; Function returns 0 if the entered qualifier is not OK. It is either
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| 128 | ; a duplicate or is otherwise invalid.
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| 129 | ;
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| 130 | NEW OK,DATA,INS
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| 131 | S OK=1
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| 132 | I $G(QUAL)="" G CHKQUALX
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| 133 | S DATA=$G(^DPT(+$G(DFN),.312,+$G(IEN),5))
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| 134 | I $G(QUAL)=$P(DATA,U,+$G(PC1)) D CQ1 G CHKQUALX ; duplicate
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| 135 | I $G(QUAL)=$P(DATA,U,+$G(PC2)) D CQ1 G CHKQUALX ; duplicate
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| 136 | ;
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| 137 | ; prevent the SSN qualifier when Medicare is the payer
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| 138 | S INS=+$G(^DPT(+$G(DFN),.312,+$G(IEN),0))
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| 139 | I $G(QUAL)="SY",$$MCRWNR^IBEFUNC(INS) D CQ2 G CHKQUALX
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| 140 | ;
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| 141 | CHKQUALX ;
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| 142 | Q OK
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| 143 | ;
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| 144 | CQ1 ; specific error message#1
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| 145 | S OK=0
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| 146 | D EN^DDIOL("You cannot use the same qualifier more than once.",,"!!")
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| 147 | D EN^DDIOL("",,"!!?5")
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| 148 | Q
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| 149 | ;
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| 150 | CQ2 ; specific error message#2
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| 151 | S OK=0
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| 152 | D EN^DDIOL("You cannot use qualifier 'SY' for Medicare.",,"!!")
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| 153 | D EN^DDIOL("",,"!!?5")
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| 154 | Q
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| 155 | ;
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