source: WorldVistAEHR/trunk/r/INTEGRATED_BILLING-IB-PRQ--IBD--IBQ--PRQS/IBNCPDP.m

Last change on this file was 613, checked in by George Lilly, 15 years ago

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1IBNCPDP ;OAK/ELZ - APIS FOR NCPCP/ECME ;10-JUN-2003
2 ;;2.0;INTEGRATED BILLING;**223,276,363**;21-MAR-94;Build 35
3 ;;Per VHA Directive 2004-038, this routine should not be modified.
4 ;
5 ;
6RX(DFN,IBD) ; pharmacy package call, passing in IBD by ref
7 ; this is called by PSO for all prescriptions issued, return is
8 ; a responce to bill ECME or not with array for billing data elements
9 ;
10 ; IBD("IEN") = Prescription IEN
11 ; ("FILL NUMBER") = Fill number (0 is initial)
12 ; ("FILL DATE") = Fill or refill date
13 ; ("RELEASE DATE")= Date of the Rx release in FileMan format
14 ; ("NDC") = NDC number for drug
15 ; ("DEA") = DEA special handling info
16 ; ("COST") = cost of medication being dispenced
17 ; ("AO") = Agent Orange (0,1 OR Null)
18 ; ("EC") = Environmental Contaminant (0,1 OR Null)
19 ; ("HNC") = Head/neck cancer (0,1 OR Null)
20 ; ("IR") = Ionizing radiation (0,1 OR Null)
21 ; ("MST") = Military sexual trauma (0,1 OR Null)
22 ; ("SC") = Service connected (0,1 OR Null)
23 ; ("CV") = Combat Veteran (0,1 OR Null)
24 ; ("QTY") = Quantity of med
25 ; ("EPHARM") = #9002313.56 ien (E-PHARMACY division)
26 ;
27 ;
28 ; IBD("INS",n,1) = insurance array to bill in n order
29 ; file 355.3 ien (group)^bin^pcn^payer sheet^group id^
30 ; cardholder id^patient relationship code^
31 ; cardholder first name^cardholder last name^
32 ; home plan state
33 ; ("INS",n,2) = dispensing fee^basis of cost determination^
34 ; awp or tort rate or cost^gross amount due^
35 ; administrative fee
36 ;
37 ; for basis of cost determination the following is used:
38 ; "07" would be sent for Usual & Customary
39 ; "01" would be sent for AWP
40 ; "05" would be sent for Cost calculations
41 ;
42 ; ("INS",n,3) = group name^insurance co^phone number^plan ID
43 N IBRES,IBNB
44 S IBRES=$$RX^IBNCPDP1(DFN,.IBD)
45 ;remove "Not ECME billable: " from the reason text
46 S IBNB="Not ECME billable: "
47 I IBRES[IBNB S IBRES=$P(IBRES,U)_U_$P($P(IBRES,U,2),IBNB,2)
48 Q IBRES
49 ;
50 ;
51STORESP(DFN,IBD) ; this is an API for pharmacy/ecme to use to relay
52 ; results of billing using the ecme software. If electronic billing is
53 ; successful, then bills will be established. If not, then we will
54 ; flag the entry in ct for paper or not billable.
55 ;
56 ; IBD("STATUS") = Bill status (PAID, REJECTED,REVERSED
57 ; CLOSED,RELEASED,or SUBMITTED)
58 ; ("FILL DATE") = Fill Date
59 ; ("PRESCRIPTION") = Prescription IEN from drug file (#52)
60 ; ("FILL NUMBER") = Fill or refill number
61 ; ("BILLED") = Amount billed
62 ; ("PAID") = Amount paid
63 ; ("BCID") = Reference number to the claim for payment
64 ; BCID stands for Bill Claim ID
65 ; ("PLAN") = IEN of the the entry in the GROUP INSURANCE
66 ; PLAN file(#355.3)(captured from the
67 ; $$RX^IBNCPDP call)
68 ; ("COPAY") = Patient's copay from ECME response
69 ; ("RX NO") = RX number from file 52
70 ; ("DRUG") = IEN of file #50 DRUG
71 ; ("DAYS SUPPLY") = Days Supply
72 ; ("QTY") = Quantity
73 ; ("NDC") = NDC
74 ; ("CLOSE REASON") = Optional, Pointer to the IB file #356.8
75 ; "CLAIMS TRACKING NON-BILLABLE REASONS"
76 ; ("CLOSE COMMENT")= Optional, if the close reason is defined
77 ; then the Close Comment parameter may be
78 ; sent to IB
79 ; ("DROP TO PAPER")= Optional, this parameter may be set to 1(TRUE)
80 ; for certain Close Claim Reasons, indicating
81 ; that that the closed episode still may be
82 ; "dropped to paper" - passed to the Autobiller
83 ; ("RELEASE COPAY")= Optional, if the claim is being closed, setting
84 ; this parameter to 1 (TRUE) indicates that the
85 ; patients copay should be released off hold
86 ; ("DIVISION") = Pointer to the MC DIVISION file (#40.8)
87 ; ("AUTH #") = ECME approval/authorization number
88 ; ("CLAIMID") = Reference Number to ECME
89 ; ("EPHARM") = Optional, #9002313.56 ien (E-PHARMACY division)
90 ;
91 ;
92 ; Return is the bill number for success or 1 if not billable.
93 ; "0^reason" indicates not success
94 ;
95 Q $$ECME^IBNCPDP2(DFN,.IBD)
96 ;
97 ;
98UPAWP(IBNDC,IBAWP,IBADT) ; used to update AWPs. This is an API that
99 ; pharmacy will call.
100 ;
101 ; IBNDC = NDC number to update with the price.
102 ; IBAWP = average wholesale price of the NDC
103 ; IBADT = effective date of change (optional, default it today)
104 ;
105 ; return will be a positive number indicating success.
106 ; if it is unsuccessful, then "0^reason" will be returned.
107 ;
108 Q $$UPAWP^IBNCPDP3(IBNDC,IBAWP,$G(IBADT,DT))
109 ;
110 ;
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