| [613] | 1 | IBNCPDP2 ;OAK/ELZ - PROCESSING FOR ECME RESP ;20-JUN-2003
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| 2 | ;;2.0;INTEGRATED BILLING;**223,276,342,347,363**;21-MAR-94;Build 35
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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 | ;NCPDP PHASE III
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| 6 | Q
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| 7 | ;
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| 8 | ECME(DFN,IBD) ; function called by STORESP^IBNCPDP
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| 9 | ; input - DFN - patient IEN for the prescription
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| 10 | ; IBD array passed in by reference
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| 11 | ; The IBD array is passed to various subroutines depending
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| 12 | ; on the ePharmacy event as evaluated by IBD("STATUS")
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| 13 | I $G(IBD("EPHARM"))="" S IBD("EPHARM")=$$EPHARM(+$G(IBD("PRESCRIPTION")),+$G(IBD("FILL NUMBER")))
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| 14 | I IBD("STATUS")="PAID" Q $$BILL(DFN,.IBD)
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| 15 | I IBD("STATUS")="REVERSED" Q $$REVERSE^IBNCPDP3(DFN,.IBD)
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| 16 | I IBD("STATUS")="CLOSED" Q $$CLOSE^IBNCPDP4(DFN,.IBD)
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| 17 | I IBD("STATUS")="RELEASED" Q $$RELEASE^IBNCPDP4(DFN,.IBD)
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| 18 | I IBD("STATUS")="SUBMITTED" Q $$SUBMIT^IBNCPDP4(DFN,.IBD)
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| 19 | I IBD("STATUS")="REOPEN" Q $$REOPEN^IBNCPDP4(DFN,.IBD)
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| 20 | D LOG("UNKNOWN")
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| 21 | Q "0^Cannot determine ECME event status"
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| 22 | ;
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| 23 | MATCH(BCID) ;
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| 24 | N IBX,IBHAVE
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| 25 | S IBX=0,IBHAVE=0 F S IBX=$O(^DGCR(399,"AG",BCID,IBX)) Q:'IBX S IBHAVE=1 I '$P($G(^DGCR(399,IBX,"S")),U,16) Q
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| 26 | I 'IBX,IBHAVE Q ""
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| 27 | Q +IBX
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| 28 | ;
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| 29 | ;
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| 30 | BILL(DFN,IBD) ; create fi bill
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| 31 | N IBRVCD,IBBS,IBUNITS,IBCPT,IBDIV,IBAA,IBTYPE,IBITEM,IBAMT,IBY,IBSERV,IBFAC,IBSITE,IBDRX,IB,IBCDFN,IBINS,IBIDS,IBIFN,IBDFN,PRCASV,PRCAERR,IBADT,IBRXN,IBFIL,IBTRKRN,DIE,DA,DR,IBRES,IBLOCK,IBLDT,IBNOW,IBDUZ,RCDUZ,IBPREV,IBQUERY,IBPAID,IBACT
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| 32 | ;
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| 33 | S IBDUZ=.5 ;POSTMASTER
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| 34 | ;I $G(IBD("FILLED BY")),$D(^VA(200,+IBD("FILLED BY"))) S IBDUZ=+IBD("FILLED BY")
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| 35 | S RCDUZ=IBDUZ
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| 36 | ;
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| 37 | S IBY=1,IBLOCK=0
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| 38 | I 'DFN S IBY="0^Missing DFN" G BILLQ
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| 39 | S IBAMT=+$G(IBD("BILLED")) ;FI portion of charge
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| 40 | I 'IBAMT S IBY="-1^Zero amount billed" G BILLQ
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| 41 | S IBADT=+$G(IBD("FILL DATE"),DT)
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| 42 | S IBRXN=+$G(IBD("PRESCRIPTION")) I 'IBRXN S IBY="0^Missing Rx IEN" G BILLQ
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| 43 | S IBFIL=+$G(IBD("FILL NUMBER"),-1) I IBFIL<0 S IBY="0^No fill number" G BILLQ
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| 44 | S IBDIV=+$G(IBD("DIVISION"))
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| 45 | I '$L($G(IBD("CLAIMID"))) S IBY="-1^Missing ECME Number" G BILLQ
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| 46 | S IBD("BCID")=(+IBD("CLAIMID"))_";"_IBADT ; The BCID#
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| 47 | L +^DGCR(399,"AG",IBD("BCID")):15 E S IBY="0^Cannot lock ECME number." G BILLQ
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| 48 | S IBLOCK=1
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| 49 | S IBLDT=$G(^DGCR(399,"AG",IBD("BCID"))) ;Last time called
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| 50 | D NOW^%DTC S IBNOW=%
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| 51 | ; 2 calls in 45 sec
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| 52 | I $P(IBLDT,"^",2)="B" I $$FMDIFF^XLFDT(IBNOW,+IBLDT,2)<45 S IBY="0^Duplicate billing call" G BILLQ
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| 53 | ;
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| 54 | I $$MATCH(IBD("BCID")) D ;cancel the previous bill
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| 55 | . N IBARR M IBARR=IBD I $$REVERSE^IBNCPDP3(DFN,.IBARR,2)
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| 56 | ;
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| 57 | ; derive minimal variables
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| 58 | I '$$CHECK^IBECEAU(0) S IBY="-1^IB SITE" G BILLQ
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| 59 | S IBSERV=$P($G(^IBE(350.1,1,0)),"^",4)
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| 60 | I '$$SERV^IBARX1(IBSERV) S IBY="-1^IB SERVICE" G BILLQ
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| 61 | I 'IBDIV S IBDIV=$P($$MCDIV^IBNCPEB(IBRXN,IBFIL),U,2)
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| 62 | I 'IBDIV S IBDIV=+$P($G(^SC(+$$FILE^IBRXUTL(IBRXN,5),0)),"^",15)
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| 63 | I 'IBDIV S IBDIV=+$P($G(^IBE(350.9,1,1)),U,25) ;dflt
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| 64 | I IBDIV S IBD("DIVISION")=IBDIV
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| 65 | ; - establish a stub claim/receivable
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| 66 | D SET^IBR I IBY<0 G BILLQ
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| 67 | ;
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| 68 | ; set up the following variables for claim establishment:
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| 69 | ; .01 BILL #
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| 70 | ; .17 ORIG CLAIM
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| 71 | ; .2 AUTO?
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| 72 | ; .02 DFN
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| 73 | ; .06 TIMEFRAME
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| 74 | ; .07 RATE TYPE
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| 75 | ; .18 SC AT TIME?
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| 76 | ; .04 LOCATION
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| 77 | ; .22 DIVISION
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| 78 | ; .05 BILL CLASSIF (3)
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| 79 | ; .03 EVT DATE (FILL DATE)
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| 80 | ; 151 BILL FROM
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| 81 | ; 152 BILL TO
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| 82 | ; 101 PRIMARY INS CARRIER
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| 83 | K IB
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| 84 | S (IB(.02),IBDFN)=DFN
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| 85 | S IB(.07)=+$$RT^IBNCPDPU(DFN)
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| 86 | I 'IB(.07) S IBY="-1^IB RATE TYPE" G BILLQ
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| 87 | ;
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| 88 | S IBIFN=PRCASV("ARREC")
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| 89 | S IB(.01)=$P(PRCASV("ARBIL"),"-",2)
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| 90 | S IB(.17)=""
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| 91 | S IB(.2)=0
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| 92 | S IB(.06)=1
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| 93 | S IB(.18)=$$SC^IBCU3(DFN)
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| 94 | S IB(.04)=$S(+$P($G(^DG(40.8,+IBDIV,0)),U,3):7,1:1)
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| 95 | S:IBDIV IB(.22)=+IBDIV
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| 96 | S IB(.05)=3
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| 97 | S (IB(.03),IB(151),IB(152))=IBADT
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| 98 | S IBINS=$P($G(^IBA(355.3,+$G(IBD("PLAN")),0)),"^") I IBINS S IB(101)=IBINS
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| 99 | ;
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| 100 | ; set 362.4 node to rx#^p50^days sup^fill date^qty^ndc
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| 101 | S IB(362.4,IBRXN,1)=IBD("RX NO")_"^"_IBD("DRUG")_"^"_IBD("DAYS SUPPLY")_"^"_IBD("FILL DATE")_"^"_IBD("QTY")_"^"_IBD("NDC")
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| 102 | ;
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| 103 | ; call the autobiller module to create the claim with a default
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| 104 | ; diagnosis and procedure for prescriptions
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| 105 | D EN^IBCD3(.IBQUERY)
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| 106 | D CLOSE^IBSDU(.IBQUERY)
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| 107 | ;
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| 108 | S ^DGCR(399,"AG",IBD("BCID"))=IBNOW_"^B"
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| 109 | S DIE="^DGCR(399,",DA=IBIFN
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| 110 | ; update the ECME fields
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| 111 | S DR="460////^S X=IBD(""BCID"")" S:$L($G(IBD("AUTH #"))) DR=DR_";461////^S X=IBD(""AUTH #"")"
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| 112 | D ^DIE K DA,DR,DIE
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| 113 | D SETCT ; Set Claims Tracking record
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| 114 | ;
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| 115 | ; IEN to 2.3121
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| 116 | S IBCDFN=$$PLANN^IBNCPDPU(DFN,IBD("PLAN"),IBADT)
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| 117 | I 'IBCDFN S IBY="-1^Plan not found in Patient's Profile." G BILLQ
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| 118 | ;
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| 119 | ; add the payer (fiscal intermediary) to the claim
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| 120 | S IBINS=+IBCDFN,IBCDFN=$P(IBCDFN,"^",2)
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| 121 | S DIE="^DGCR(399,",DA=IBIFN,DR="112////"_IBCDFN
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| 122 | D ^DIE K DA,DR,DIE,DGRVRCAL
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| 123 | ;
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| 124 | ; need to make sure we have computed charges.
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| 125 | D BILL^IBCRBC(IBIFN)
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| 126 | ;
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| 127 | ; update the authorize/print fields
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| 128 | S DIE="^DGCR(399,",DA=IBIFN
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| 129 | S DR="9////1;12////"_DT D ^DIE
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| 130 | K DA,DR,DIE
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| 131 | ;
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| 132 | ; pass the claim to AR
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| 133 | D GVAR^IBCBB,ARRAY^IBCBB1 S PRCASV("APR")=IBDUZ D ^PRCASVC6
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| 134 | I 'PRCASV("OKAY") S IBY="-1^Cannot establish receivable in AR." G BILLQ
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| 135 | D REL^PRCASVC
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| 136 | ;
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| 137 | ; update the AR status to Active
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| 138 | ; D AUDITX^PRCAUDT(PRCASV("ARREC"))
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| 139 | S PRCASV("STATUS")=16
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| 140 | D STATUS^PRCASVC1
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| 141 | ;
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| 142 | ; decrease adjust bill
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| 143 | ; Auto decrease from service Bill#,Tran amt,person,reason,Tran date
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| 144 | S IBAMT=$G(^DGCR(399,IBIFN,"U1"))
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| 145 | S IBPAID=IBD("PAID")
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| 146 | D:IBAMT-IBPAID>.01
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| 147 | . D DEC^PRCASER1(PRCASV("ARREC"),IBAMT-IBPAID,IBDUZ,"Adjust based on ECME amount paid.",IBADT)
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| 148 | . I 'IBPAID S PRCASV("STATUS")=22 D STATUS^PRCASVC1 ; collected/closed
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| 149 | ;
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| 150 | D ; set the user in 399
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| 151 | . N IBI,IBT F IBI=2,5,11,13,15 S IBT(399,IBIFN_",",IBI)=IBDUZ
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| 152 | . D FILE^DIE("","IBT")
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| 153 | ;
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| 154 | BILLQ S IBRES=$S(IBY<0:"0^"_$S($L($P(IBY,"^",2)):$P(IBY,"^",2),1:$P(IBY,"^",3)),$G(IBIFN):+IBIFN,1:IBY)
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| 155 | I $G(IBIFN) S IBD("BILL")=IBIFN
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| 156 | D LOG("BILL",IBRES)
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| 157 | I IBY<0 D BULL^IBNCPEB($G(DFN),.IBD,IBRES,$G(IBIFN))
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| 158 | I IBLOCK L -^DGCR(399,"AG",IBD("BCID"))
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| 159 | Q IBRES
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| 160 | ;
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| 161 | ; update claims tracking saying bill has been billed
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| 162 | SETCT ;
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| 163 | S IBTRKRN=+$O(^IBT(356,"ARXFL",IBRXN,IBFIL,0))
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| 164 | I IBTRKRN S DIE="^IBT(356,",DA=IBTRKRN,DR=".11////^S X=IBIFN;.17///@" D ^DIE
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| 165 | I IBTRKRN,IBIFN D CTB^IBCDC(IBTRKRN,IBIFN)
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| 166 | Q
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| 167 | ;
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| 168 | ;/**
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| 169 | ;Log values passed into IB by outside applications
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| 170 | ;
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| 171 | ;implicit input variables/arrays :
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| 172 | ; IBD array with values sent to IB (see calling subroutines)
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| 173 | ; DFN - patient's IEN (file #2)
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| 174 | ; DUZ - user's IEN(file #200)
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| 175 | ;explicit parameters:
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| 176 | ; PROC - type of event as string, i.e. BILL, REJECT and so on
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| 177 | ; RESULT - result of the event processing, format: return_code^message
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| 178 | LOG(PROC,RESULT) ;Store the data
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| 179 | D LOG^IBNCPLOG(.IBD,DFN,PROC,RESULT,$J,$$NOW^XLFDT(),+DUZ)
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| 180 | Q
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| 181 | ;
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| 182 | ;returns ien of #9002313.56 BPS PHARMACIES associated
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| 183 | ;with the prescription specified by:
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| 184 | ; IBRX - IEN in file #52
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| 185 | ; IBREFILL - zero(0) for the original prescription or the refill
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| 186 | ; number for a refill (IEN of REFILL multiple #52.1)
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| 187 | EPHARM(IBRX,IBREFILL) ;
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| 188 | I +$G(IBRX)=0 Q ""
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| 189 | I $G(IBREFILL)="" Q ""
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| 190 | N IBDIV59
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| 191 | S IBDIV59=+$$RXSITE^PSOBPSUT(+IBRX,+IBREFILL)
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| 192 | I IBDIV59>0 Q $$GETPHARM^BPSUTIL(IBDIV59)
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| 193 | Q ""
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| 194 | ;
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| 195 | ;IBNCPDP2
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