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

IBNCPDP ;OAK/ELZ - APIS FOR NCPCP/ECME ;10-JUN-2003
 ;;2.0;INTEGRATED BILLING;**223,276,363**;21-MAR-94;Build 35
 ;;Per VHA Directive 2004-038, this routine should not be modified.
 ;
 ;
RX(DFN,IBD) ; pharmacy package call, passing in IBD by ref
 ; this is called by PSO for all prescriptions issued, return is
 ; a responce to bill ECME or not with array for billing data elements
 ;
 ; IBD("IEN")         = Prescription IEN
 ;    ("FILL NUMBER") = Fill number (0 is initial)
 ;    ("FILL DATE")   = Fill or refill date
 ;    ("RELEASE DATE")= Date of the Rx release in FileMan format
 ;    ("NDC")         = NDC number for drug
 ;    ("DEA")         = DEA special handling info
 ;    ("COST")        = cost of medication being dispenced
 ;    ("AO")          = Agent Orange (0,1 OR Null)
 ;    ("EC")          = Environmental Contaminant (0,1 OR Null)
 ;    ("HNC")         = Head/neck cancer (0,1 OR Null)
 ;    ("IR")          = Ionizing radiation (0,1 OR Null)
 ;    ("MST")         = Military sexual trauma (0,1 OR Null)
 ;    ("SC")          = Service connected (0,1 OR Null)
 ;    ("CV")          = Combat Veteran (0,1 OR Null)
 ;    ("QTY")         = Quantity of med
 ;    ("EPHARM")      = #9002313.56 ien (E-PHARMACY division)
 ;
 ;
 ; IBD("INS",n,1) = insurance array to bill in n order
 ;                  file 355.3 ien (group)^bin^pcn^payer sheet^group id^
 ;                  cardholder id^patient relationship code^
 ;                  cardholder first name^cardholder last name^
 ;                  home plan state
 ;    ("INS",n,2) = dispensing fee^basis of cost determination^
 ;                  awp or tort rate or cost^gross amount due^
 ;                  administrative fee
 ;
 ;   for basis of cost determination the following is used:
 ;      "07" would be sent for Usual & Customary
 ;      "01" would be sent for AWP
 ;      "05" would be sent for Cost calculations
 ;
 ;    ("INS",n,3) = group name^insurance co^phone number^plan ID
 N IBRES,IBNB
 S IBRES=$$RX^IBNCPDP1(DFN,.IBD)
 ;remove "Not ECME billable: " from the reason text
 S IBNB="Not ECME billable: "
 I IBRES[IBNB S IBRES=$P(IBRES,U)_U_$P($P(IBRES,U,2),IBNB,2)
 Q IBRES
 ;
 ;
STORESP(DFN,IBD) ; this is an API for pharmacy/ecme to use to relay
 ; results of billing using the ecme software.  If electronic billing is
 ; successful, then bills will be established.  If not, then we will
 ; flag the entry in ct for paper or not billable.
 ;
 ; IBD("STATUS")       = Bill status (PAID, REJECTED,REVERSED
 ;                        CLOSED,RELEASED,or SUBMITTED)
 ;    ("FILL DATE")    = Fill Date
 ;    ("PRESCRIPTION") = Prescription IEN from drug file (#52)
 ;    ("FILL NUMBER")  = Fill or refill number
 ;    ("BILLED")       = Amount billed
 ;    ("PAID")         = Amount paid
 ;    ("BCID")         = Reference number to the claim for payment
 ;                       BCID stands for Bill Claim ID
 ;    ("PLAN")         = IEN of the the entry in the GROUP INSURANCE 
 ;                       PLAN file(#355.3)(captured from the 
 ;                       $$RX^IBNCPDP call)
 ;    ("COPAY")        = Patient's copay from ECME response
 ;    ("RX NO")        = RX number from file 52
 ;    ("DRUG")         = IEN of file #50 DRUG
 ;    ("DAYS SUPPLY")  = Days Supply
 ;    ("QTY")          = Quantity
 ;    ("NDC")          = NDC
 ;    ("CLOSE REASON") = Optional, Pointer to the IB file #356.8 
 ;                      "CLAIMS TRACKING NON-BILLABLE REASONS"
 ;    ("CLOSE COMMENT")= Optional, if the close reason is defined 
 ;                       then the Close Comment parameter may be 
 ;                       sent to IB
 ;    ("DROP TO PAPER")= Optional, this parameter may be set to 1(TRUE) 
 ;                       for certain Close Claim Reasons, indicating
 ;                       that that the closed episode still may be 
 ;                       "dropped to paper" - passed to the Autobiller
 ;    ("RELEASE COPAY")= Optional, if the claim is being closed, setting
 ;                       this parameter to 1 (TRUE) indicates that the
 ;                       patients copay should be released off hold
 ;    ("DIVISION")     = Pointer to the MC DIVISION file (#40.8)
 ;    ("AUTH #")       = ECME approval/authorization number
 ;    ("CLAIMID")      = Reference Number to ECME
 ;    ("EPHARM")       = Optional, #9002313.56 ien (E-PHARMACY division)
 ;
 ;
 ; Return is the bill number for success or 1 if not billable.
 ; "0^reason" indicates not success
 ;
 Q $$ECME^IBNCPDP2(DFN,.IBD)
 ;
 ;
UPAWP(IBNDC,IBAWP,IBADT) ; used to update AWPs.  This is an API that
 ; pharmacy will call.
 ;
 ;  IBNDC = NDC number to update with the price.
 ;  IBAWP = average wholesale price of the NDC
 ;  IBADT  = effective date of change (optional, default it today)
 ;
 ;  return will be a positive number indicating success.
 ;  if it is unsuccessful, then "0^reason" will be returned.
 ;
 Q $$UPAWP^IBNCPDP3(IBNDC,IBAWP,$G(IBADT,DT))
 ;
 ;