| 1 | IBJDF41 ;ALB/RB - FIRST PARTY FOLLOW-UP REPORT (COMPILE) ;15-APR-00
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| 2 | ;;2.0;INTEGRATED BILLING;**123,159,204,356**;21-MAR-94
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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 | ST ; - Tasked entry point.
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| 6 | K IB,IBCAT,^TMP("IBJDF4",$J) S IBQ=0
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| 7 | ;
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| 8 | ; - Set selected categories for report.
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| 9 | I IBSEL[1 S IBCAT(2)=1
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| 10 | I IBSEL[2 S IBCAT(1)=2
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| 11 | I IBSEL[3 S IBCAT(18)=3 F X=22,23 S IBCAT(X)=4
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| 12 | I IBSEL[4 F X=33:1:39 S IBCAT(X)=5
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| 13 | ;
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| 14 | ; - Print the header line for the Excel spreadsheet
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| 15 | I $G(IBEXCEL) D PHDL
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| 16 | ;
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| 17 | ; - Find data required for report.
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| 18 | F IB=16,19,40 D G:IBQ ENQ
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| 19 | . I IBSTA="A",IB'=16 Q ; Active AR's only.
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| 20 | . I IBSTA="S",IB=16 Q ; Suspended AR's only.
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| 21 | . I IB'=40 D
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| 22 | . . S IBCAT=""
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| 23 | . . F S IBCAT=$O(IBCAT(IBCAT)) Q:IBCAT="" D
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| 24 | . . . D INIT^IBJDF43
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| 25 | . S IBA=0
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| 26 | . F S IBA=$O(^PRCA(430,"AC",IB,IBA)) Q:'IBA D Q:IBQ
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| 27 | . . D PROC
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| 28 | ;
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| 29 | I 'IBQ,'$G(IBEXCEL) D EN^IBJDF42 ; Print the report.
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| 30 | ;
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| 31 | ENQ K ^TMP("IBJDF4",$J)
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| 32 | I $D(ZTQUEUED) S ZTREQ="@" G ENQ1
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| 33 | ;
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| 34 | D ^%ZISC
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| 35 | ENQ1 K IB,IB0,IBA,IBA1,IBADM,IBAGE,IBAR,IBAR1,IBBA,IBBN,IBBU,IBC,IBCAT,IBCAT1
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| 36 | K IBELIG,IBEXCEL,IBFLG,IBAI,IBAIQ,IBIDX,IBIO,IBINT,IBN,IBPA,IBPD,IBPAT
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| 37 | K IBPT,IBQ,IBRFD,IBRFT,IBSRC,IBRP,IBVA,COM,COM1,DAT,DFN,X,X1,X2,Y,Z
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| 38 | Q
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| 39 | ;
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| 40 | PROC ; - Process data for report(s).
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| 41 | I IBA#100=0 D Q:IBQ
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| 42 | .S IBQ=$$STOP^IBOUTL("First Party Follow-Up Report")
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| 43 | S IBAR=$G(^PRCA(430,IBA,0)) I 'IBAR Q
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| 44 | S IBCAT=+$P(IBAR,U,2) I '$D(IBCAT(IBCAT)) Q ;Get valid AR category.
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| 45 | I '$$CLMACT^IBJD(IBA,IBCAT) Q ; Invalid IB claim/action.
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| 46 | S IBPT=$$PAT(IBA) I IBPT="" Q ; Get patient info.
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| 47 | S DFN=$P(IBPT,U,2)
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| 48 | S IBAGE=$$FMDIFF^XLFDT(DT,+$P(IBAR,U,10))
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| 49 | I IBSMN,IBAGE<IBSMN!(IBAGE>IBSMX) Q ; AR outside age range.
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| 50 | S IBVA=$$VA^IBJD1(DFN),IBBN=$P(IBAR,U),IBPD=$P($$PYMT^IBJD1(IBA),U)
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| 51 | S IBPAT=$P(IBPT,U)_"@@"_DFN
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| 52 | ;
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| 53 | ; - Check the AR balance amounts, if necessary.
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| 54 | S (IBADM,IBBA,IBINT,IBPA)=0,IBN=$G(^PRCA(430,IBA,7))
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| 55 | F X=1:1:5 D
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| 56 | . S IBBA=IBBA+$P(IBN,U,X)
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| 57 | . S:X=1 IBPA=+IBN S:X=2 IBINT=$P(IBN,U,2) S:X=3 IBADM=$P(IBN,U,3)
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| 58 | ;
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| 59 | I '$G(IBEXCEL) D EN^IBJDF43 I IBRPT="S" Q ; Get summary stats.
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| 60 | ;
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| 61 | I IBSAM,IBBA<IBSAM Q
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| 62 | ;
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| 63 | ; - Check if AR was referred to R-Regional Counsel, D-DMC, or T-TOP
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| 64 | ; and exclude, if necessary.
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| 65 | S IB0=$S(IB=40:19,1:IB),IBIDX=0,IBRFT=""
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| 66 | S IBAIQ=0,IBAI=$G(^TMP("IBJDF4",$J,IBPAT,0,"A"))
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| 67 | S IBRFD=$P($G(^PRCA(430,IBA,6)),U,4)
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| 68 | I IBRPT="D",IBRFD D I IBAIQ Q ; Referred to RC
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| 69 | . S IBRFT="R" I IBAI'["R" S IBAI=IBAI_"R"
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| 70 | . I 'IBSRC S IBAIQ=1 Q
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| 71 | . D SREF("R",IBRFD,IB0,,.IBIDX)
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| 72 | S IBRFD=+$G(^PRCA(430,IBA,12))
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| 73 | I IBRPT="D",IBRFD D ; Referred to DMC
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| 74 | . S IBRFT=IBRFT_"D" I IBAI'["D" S IBAI=IBAI_"D"
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| 75 | . D SREF("D",IBRFD,IB0,,.IBIDX)
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| 76 | S IBRFD=+$G(^PRCA(430,IBA,14))
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| 77 | I IBRPT="D",IBRFD D ; Referred to TOP
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| 78 | . S IBRFT=IBRFT_"T" I IBAI'["T" S IBAI=IBAI_"T"
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| 79 | . D SREF("T",IBRFD,IB0,,.IBIDX)
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| 80 | ;
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| 81 | ; - Check if AR is on P-Repayment plan or F-Defaulted repayment plan.
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| 82 | ; and exclude if repayment plan is active.
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| 83 | S IBRP=$$RP(IBA)
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| 84 | I IBRP D
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| 85 | . I IBRP=2 S IBRFT=IBRFT_"F" I IBAI'["F" S IBAI=IBAI_"F"
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| 86 | . I IBRP=1 S IBRFT=IBRFT_"P" I IBAI'["P"&(IBAI'["F") S IBAI=IBAI_"P"
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| 87 | . D SREF("P",$P(IBRP,"^",2),IB0,$S(+IBRP=2:1,1:0),.IBIDX)
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| 88 | ;
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| 89 | I IBIDX S IBFLG=1
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| 90 | ;
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| 91 | ; - Check if VA Employee
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| 92 | I $P(IBVA,"^")["*",IBAI'["V" S IBAI=IBAI_"V"
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| 93 | ;
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| 94 | I IBAI'="" S ^TMP("IBJDF4",$J,IBPAT,0,"A")=IBAI
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| 95 | ;
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| 96 | ; - Set up indexes for detail report.
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| 97 | I $G(IBEXCEL) D Q
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| 98 | . S IBEXCEL1=$P($G(^PRCA(430.2,IBCAT,0)),U,2)_U_$P(IBPT,U,3)_U_$P(IBVA,U)_U_$P(IBPT,U,4)_U_$$DT^IBJD($P(IBPT,U,6),1)_U_$$ELIG^IBJDF42(+$P(IBPT,U,5))_U
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| 99 | . S IBEXCEL1=IBEXCEL1_$$GET1^DIQ(2,DFN,.381)_U_$$MTRX(DFN)_U_IBBN_U_$S(IB=16:"A",1:"S")_U_IBRFT_U_$$DT^IBJD($P(IBAR,U,10),1)_U_$$DT^IBJD(IBPD,1)_U_IBBA_U_IBPA_U_IBINT_U_IBADM_U
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| 100 | . I IBSH D COM
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| 101 | . S IBD=0 I DAT!IBPD S IBD=$$FMDIFF^XLFDT(DT,$S('DAT:IBPD,1:$G(DAT)))
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| 102 | . S IBEXCEL1=IBEXCEL1_U_IBD W !,IBEXCEL1 K IBD,IBEXCEL1
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| 103 | ;
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| 104 | I '($D(^TMP("IBJDF4",$J,IBPAT))#10) D
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| 105 | . S ^TMP("IBJDF4",$J,IBPAT)=$P(IBPT,U,3,5)_U_$$MTRX(DFN)_U_$P(IBPT,U,6)_"^"_$P(IBVA,"^",2)_"^"_$$ACCBAL($P(IBPT,U,7))
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| 106 | S ^TMP("IBJDF4",$J,IBPAT,IB0,IBCAT,IBBN)=IBPD_U_IBBA_U_IBPA_U_IBINT_U_IBADM_U_IBIDX
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| 107 | ;
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| 108 | I IBSH D COM
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| 109 | ;
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| 110 | Q
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| 111 | ;
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| 112 | ACCBAL(DFN) ; Calculates the Account Balance for the Bill
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| 113 | ; Input: DFN - Patient/Debtor internal number
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| 114 | ; Output: BAL - Patient/Debtor Account Balance
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| 115 | ;
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| 116 | N B0,B7,BAL,BILL,I
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| 117 | S (BAL,BILL)=0
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| 118 | F S BILL=$O(^PRCA(430,"C",DFN,BILL)) Q:BILL="" D
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| 119 | . S B0=$G(^PRCA(430,BILL,0)) I $P(B0,"^",8)'=16 Q
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| 120 | . S B7=$G(^PRCA(430,BILL,7))
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| 121 | . F I=1:1:5 S BAL=BAL+$P(B7,"^",I)
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| 122 | Q BAL
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| 123 | ;
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| 124 | PHDL ; - Print the header line for the Excel spreadsheet
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| 125 | N X
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| 126 | S X="Cat^Patient^VA Empl.?^SSN^Dt Death^Prim.Elig.^Med.Elig.?^"
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| 127 | S X=X_"Means Tst Sts^Means Tst Dt^RX Copay Exemp.Sts^RX Copay Exemp.Dt^"
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| 128 | S X=X_"Bill #^Act/Susp^Refer. to^Dt Bill prep.^Last Pymt Dt^"
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| 129 | S X=X_"Curr.Bal.^Princ.Bal.^Int.^Admin.^Last Comm.Dt^Days Lst Comm."
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| 130 | W !,X
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| 131 | Q
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| 132 | ;
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| 133 | PAT(X) ; - Find the AR patient and decide to include the AR.
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| 134 | ; Input: X=AR pointer to file #430 and pre-set variables IBS*
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| 135 | ; Output: Y=Sort key (name or last 4) ^ Patient pointer to file #2
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| 136 | ; ^ Name ^ SSN ^ Eligibilities ^ Date of death (if any)
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| 137 | ; ^ Debtor pointer to file #340
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| 138 | N PAT,KEY,DBTR,DFN,DEATH,NAME,SSN,VAEL,VADM,X1,X2
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| 139 | S PAT="" G:'$G(X) PATQ
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| 140 | S DBTR=+$P($G(^PRCA(430,X,0)),U,9)
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| 141 | S X1=$P($G(^RCD(340,DBTR,0)),U) G:X1'["DPT" PATQ
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| 142 | S DFN=+X1 G:'DFN PATQ D DEM^VADPT
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| 143 | S NAME=VADM(1),SSN=$P(VADM(2),"^"),DEATH=VADM(6)\1
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| 144 | S KEY=$S(IBSN="N":NAME,1:$E(SSN,6,9))
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| 145 | I KEY=""!(IBSNF'="@"&('DFN)) G PATQ
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| 146 | I $D(IBSNA) G:IBSNA="ALL"&('DFN) PATQ G:IBSNA="NULL"&(DFN) PATQ
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| 147 | I $G(IBSNA)="ALL" G PATC
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| 148 | I IBSNF="@",IBSNL="zzzzz" G PATC
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| 149 | I IBSNF'=KEY,IBSNF]KEY G PATQ
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| 150 | I IBSNL'=KEY,KEY]IBSNL G PATQ
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| 151 | ;
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| 152 | PATC ; - Set patient eligibilities.
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| 153 | D ELIG^VADPT S X2=+$G(VAEL(1))_";"
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| 154 | I +X2 S X1=0 F S X1=$O(VAEL(1,X1)) Q:'X1 S X2=X2_X1_";"
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| 155 | ;
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| 156 | S PAT=KEY_U_DFN_U_$E(NAME,1,26)_U_SSN_U_X2_U_DEATH
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| 157 | S PAT=PAT_U_DBTR
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| 158 | PATQ Q PAT
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| 159 | ;
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| 160 | RP(X) ; - Check if claim/receivable is under a repayment plan.
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| 161 | ; Input: X=Bill pointer to file #399/#430
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| 162 | ; Output: 0-Not on repay plan, 1-On repay plan, 2-On defaulted plan
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| 163 | N Z
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| 164 | S Z=$$REPDATA^RCBECHGA(X,1) I Z="" Q 0
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| 165 | I '$P(Z,"^",7) Q ("1^"_$P(Z,"^"))
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| 166 | Q ("2^"_$P(Z,"^"))
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| 167 | ;
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| 168 | MTRX(X) ; - Return patient's means test and/or RX copay status and most recent
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| 169 | ; test dates for both.
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| 170 | ; Input: X=Patient pointer to file #2 and opt. variable IBEXCEL
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| 171 | ; Output: Y=Means test status ^ Date ^ RX copay status ^ Date
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| 172 | N MTST,RXST,Y
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| 173 | S Y="^^^",MTST=$$LST^DGMTU(X),RXST=$$RXST^IBARXEU(X)
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| 174 | I '$G(IBEXCEL) D
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| 175 | . S $P(Y,"^",1,2)=$P(MTST,"^",3)_"^"_$$DAT1^IBOUTL($P(MTST,"^",2))
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| 176 | . S $P(Y,"^",3)=$S('RXST:"NON-EXEMPT",+RXST=1:"EXEMPT",1:"")
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| 177 | . I $P(Y,"^",3)'="" S $P(Y,"^",4)=$$DAT1^IBOUTL($P(RXST,"^",5))
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| 178 | I $G(IBEXCEL) D
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| 179 | . S $P(Y,"^",1,2)=$P(MTST,"^",4)_"^"_$$DT^IBJD($P(MTST,"^",2),1)
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| 180 | . S $P(Y,"^",3)=$S('RXST:"M",+RXST=1:"E",1:"")
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| 181 | . I $P(Y,"^",3)'="" S $P(Y,"^",4)=$$DT^IBJD($P(RXST,"^",5),1)
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| 182 | Q Y
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| 183 | ;
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| 184 | SREF(RFT,DAT,STS,DEF,IDX) ; Set the "referred to" information on the
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| 185 | ; temporary global ^TMP
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| 186 | ;Input: RFT: "R": RC, "D": DMC, "T": TOP, "P": REPAYMENT PLAN
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| 187 | ; DAT: Date it was referred/established
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| 188 | ; STS: Receivable status (16-Active,19-Suspended)
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| 189 | ; DEF: Repayment Plan in Default? (1 - YES, 0 - NO)
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| 190 | ; IDX: Subscript to be set in the Temporary global ^TMP
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| 191 | ;Output: IDX: Subscript set in the Temporary global ^TMP
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| 192 | ;
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| 193 | N SREF,IDX1
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| 194 | S DEF=+$G(DEF),IDX=+$G(IDX)
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| 195 | I RFT="R" S SREF="REFERRED TO RC"
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| 196 | I RFT="D" S SREF="REFERRED TO DMC"
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| 197 | I RFT="T" S SREF="REFERRED TO TOP"
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| 198 | I RFT="P" D
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| 199 | . S SREF="REPAYMENT PLAN ESTABLISHED"
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| 200 | . I $G(DEF) S SREF=SREF_" (CURRENTLY IN DEFAULT)"
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| 201 | ;
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| 202 | I 'IDX S IDX=$O(^TMP("IBJDF4",$J,IBPAT,0,"C",STS,""),-1)+1
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| 203 | S IDX1=$O(^TMP("IBJDF4",$J,IBPAT,0,"C",STS,IDX,""),-1)+1
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| 204 | S ^TMP("IBJDF4",$J,IBPAT,0,"C",STS,IDX,IDX1)=DAT
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| 205 | S ^TMP("IBJDF4",$J,IBPAT,0,"C",STS,IDX,IDX1,1)=SREF
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| 206 | Q
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| 207 | ;
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| 208 | COM ; - Get bill comments.
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| 209 | I 'IBIDX,'$G(IBEXCEL) D
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| 210 | . S IBFLG=0,IBIDX=$O(^TMP("IBJDF4",$J,IBPAT,0,"C",IB0,""),-1)+1
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| 211 | ;
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| 212 | S DAT=0,IBA1=$S(IBSH1="M":999999999,1:0)
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| 213 | F S IBA1=$S(IBSH1="M":$O(^PRCA(433,"C",IBA,IBA1),-1),1:$O(^PRCA(433,"C",IBA,IBA1))) Q:'IBA1 D I IBSH1="M",DAT Q
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| 214 | . S IBC=$G(^PRCA(433,IBA1,1)) Q:'IBC
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| 215 | . I $G(IBSH2),$$FMDIFF^XLFDT(DT,+IBC)>IBSH2 Q ; Comment age not minimum.
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| 216 | . I $P(IBC,U,2)'=35,$P(IBC,U,2)'=45 Q ; Not decrease/comment transact.
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| 217 | . S DAT=$S(IBC:+IBC\1,1:+$P(IBC,U,9)\1)
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| 218 | . I $G(IBEXCEL),IBSH1="M" S IBEXCEL1=IBEXCEL1_$$DT^IBJD(DAT,1) Q
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| 219 | . ;
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| 220 | . ; - Append brief and transaction comments.
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| 221 | . K COM,COM1 S COM(0)=DAT,X1=0
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| 222 | . S COM1(1)=$P($G(^PRCA(433,IBA1,5)),U,2)
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| 223 | . S COM1(2)=$E($P($G(^PRCA(433,IBA1,8)),U,6),1,70)
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| 224 | . S COM(1)=COM1(1)_$S(COM1(1)]""&(COM1(2)]""):"|",1:"")_COM1(2)
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| 225 | . I COM(1)]"" S COM(1)="**"_COM(1)_"**",X1=1
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| 226 | . ;
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| 227 | . ; - Get main comments.
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| 228 | . S X2=0
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| 229 | . F S X2=$O(^PRCA(433,IBA1,7,X2)) Q:'X2 D
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| 230 | . . S COM($S(X1:X2+1,1:X2))=^PRCA(433,IBA1,7,X2,0)
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| 231 | . ;
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| 232 | . I $G(IBEXCEL) Q
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| 233 | . ;
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| 234 | . S IBFLG=1,^TMP("IBJDF4",$J,IBPAT,0,"C",IB0,IBIDX,IBA1)=$G(COM(0)),X1=0
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| 235 | . F S X1=$O(COM(X1)) Q:X1="" D
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| 236 | . . S ^TMP("IBJDF4",$J,IBPAT,0,"C",IB0,IBIDX,IBA1,X1)=COM(X1)
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| 237 | ;
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| 238 | I '$G(IBEXCEL),IBFLG D
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| 239 | . S $P(^TMP("IBJDF4",$J,IBPAT,IB0,IBCAT,IBBN),"^",6)=IBIDX
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| 240 | Q
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