source: WorldVistAEHR/trunk/r/INTEGRATED_BILLING-IB-PRQ--IBD--IBQ--PRQS/IBRSUTL.m@ 1769

IBRSUTL ;ALB/ARH - ASCD INTERFACE UTILITIES ; 23-MAR-07

 ;;2.0;INTEGRATED BILLING;**369**;21-MAR-94;Build 2

 ;;Per VHA Directive 2004-038, this routine should not be modified.

 ;

CT(IB0E) ; Return Claims Tracking record for Outpatient Encounter

 ; Input:  IB0E - IEN of Outpatient Encounter #409.68

 ; Output: IEN of Outpatient Encounters Claims Tracking record #356

 ;         or null if no CT entry found

 ;

 N IBTRN S IBTRN="" I +$G(IB0E) S IBTRN=$O(^IBT(356,"ASCE",+IB0E,0))

 Q IBTRN

 ;

RNBU(IB0E,CHNG) ; Update Claims Tracking record Reason Not Billable for an Outpatient Encounter

 ; Input:  IB0E - IEN of Outpatient Encounter #409.68

 ;         CHNG - 1 if Outpatient Encounter changed from NSC to SC

 ;                2 if Outpatient Encounter changed from SC to NSC

 ; Output: 1 - Reason Not Billable SC TREATMENT was added to Outpatient Encounters Claims Tracking Record

 ;             also adds CT Billable Finding of NSC TO SC and Last Reviewed By

 ;         2 - Reason Not Billable SC TREATMENT was deleted from Outpatient Encounters Claims Tracking Record

 ;             also adds CT Billable Finding of SC TO NSC and Last Reviewed By

 ;         0 - no change made

 ;

 N DA,DR,DIC,DIE,DD,DO,DLAYGO,IBTRN,IBUPD,IBRNBSC,IBCTRNB,X,Y S DLAYGO=356.03,IBUPD=0

 I +$G(IB0E) S IBTRN=+$$CT(IB0E) I +IBTRN S IBCTRNB=$P($G(^IBT(356,IBTRN,0)),U,19)

 S IBRNBSC=$O(^IBE(356.8,"B","SC TREATMENT",""))

 ;

 I +$G(CHNG)=1,+IBTRN,IBCTRNB="" D  S IBUPD=1 ; if CT has no RNB then add RNB of SC - NSC to SC

 . S DA=IBTRN,DIE="^IBT(356,",DR=".19////"_IBRNBSC_";2.02////"_DUZ D ^DIE K DIE,DIC,DA,DR,X,Y

 . S X=$O(^IBT(356.85,"B","NSC TO SC",0)) I +X S DIC(0)="L",DA(1)=IBTRN,DIC="^IBT(356,"_DA(1)_",3," D FILE^DICN

 ;

 I +$G(CHNG)=2,+IBTRN,IBCTRNB=IBRNBSC D  S IBUPD=2 ; if CT has SC RNB then delete RNB - SC to NSC

 . S DA=IBTRN,DIE="^IBT(356,",DR=".19////@;2.02////"_DUZ D ^DIE K DIE,DIC,DA,DR,X,Y

 . S X=$O(^IBT(356.85,"B","SC TO NSC",0)) I +X S DIC(0)="L",DA(1)=IBTRN,DIC="^IBT(356,"_DA(1)_",3," D FILE^DICN

 ;

 Q IBUPD

 ;

FPBILL(IB0E) ; Return First Party Bill data for Outpatient Encounter, last encounter transaction if not cancelled

 ; Input:  IB0E - IEN of Outpatient Encounter #409.68

 ; Output: First Party AR Bill Number (#350,.11) ^ AR Transaction Number (#350,.12) ^ Total Charge (#350,.07)

 ;         null if no active First Party Bill found for encounter

 ;

 N IB0E0,DFN,IBFROM,IBIFN,IBFP0,IBFND,IBDT,IBPAR,IBNDT,IBLAST S IBFROM="409.68:"_$G(IB0E) S IBFND=""

 S IB0E0=$$SCE^IBSDU(+$G(IB0E)),DFN=$P(IB0E0,U,2),IBDT=+IB0E0\1

 ;

 I +DFN S IBIFN=0 F  S IBIFN=$O(^IB("AFDT",DFN,-IBDT,IBIFN)) Q:'IBIFN  D

 . S IBFP0=$G(^IB(IBIFN,0)) I IBFROM'=$P(IBFP0,U,4) Q

 . S IBPAR=$P(IBFP0,U,9),IBNDT=$O(^IB("APDT",IBPAR,"")),IBLAST=$O(^IB("APDT",IBPAR,IBNDT,""),-1) Q:'IBLAST

 . S IBFP0=$G(^IB(IBLAST,0)) I $P($G(^IBE(350.1,+$P(IBFP0,U,3),0)),U,5)=2 S IBFND="" Q  ; action type cancelled

 . I +$P($G(^IBE(350.21,+$P(IBFP0,U,5),0)),U,5) S IBFND="" Q  ; status cancelled

 . S IBFND=$P(IBFP0,U,11)_U_$P(IBFP0,U,12)_U_$P(IBFP0,U,7)

 ;

 Q IBFND

 ;

TPBILL(IB0E) ; Return Third Party Bill numbers for Outpatient Encounter, only not cancelled

 ; Input:  IB0E - IEN of Outpatient Encounter #409.68

 ; Output: Third Party Bill Number (#399,.01) ^ Third Party Bill Number (#399,.01) ^ ...

 ;         or null if no Third Party Bill found for encounter

 ;

 N IB0E0,DFN,IBDT,IBOPV,IBIFN,IBTP0,IBCPT,IBFND S IBFND=""

 S IB0E0=$$SCE^IBSDU(+$G(IB0E)),DFN=$P(IB0E0,U,2),IBDT=+IB0E0\1

 ;

 I +DFN S IBOPV=IBDT-.1 F  S IBOPV=$O(^DGCR(399,"AOPV",DFN,IBOPV)) Q:'IBOPV!(IBOPV>(IBDT+.6))  D

 . S IBIFN=0 F  S IBIFN=$O(^DGCR(399,"AOPV",DFN,IBOPV,IBIFN)) Q:'IBIFN  D

 .. S IBTP0=$G(^DGCR(399,IBIFN,0)) I $P(IBTP0,U,13)=7 Q

 .. ;

 .. S IBCPT=0 F  S IBCPT=$O(^DGCR(399,IBIFN,"CP",IBCPT)) Q:'IBCPT  I +$P($G(^DGCR(399,IBIFN,"CP",IBCPT,0)),U,20)=IB0E S IBFND=IBFND_$P(IBTP0,U,1)_U Q

 ;

 Q IBFND

 ;

FIRST(IB0E) ; Return true if Outpatient Encounter is Billable for First Party

 ; Input:  IB0E - IEN of Outpatient Encounter #409.68

 ; Output: 0 ^ non-billable reason

 ;         1 if encounter is First Party billable

 ; 

 N IB0E0,DFN,IBDT,IBFND S IB0E=+$G(IB0E),IBFND=1

 S IB0E0=$$SCE^IBSDU(+$G(IB0E)),DFN=$P(IB0E0,U,2),IBDT=+IB0E0\1 I 'DFN Q 0

 ;

 I '$$BIL^DGMTUB(DFN,+IBDT) S IBFND=0_U_"Patient not MT billable"

 I '$$APPTCT^IBEFUNC(IB0E0) S IBFND=0_U_"Appt Status, not billable"

 I $$NCTCL^IBEFUNC(IB0E0) S IBFND=0_U_"Non-count Clinic, not billable"

 I $$IGN^IBEFUNC(+$P(IB0E0,U,10),IBDT) S IBFND=0_U_"Appt Type not MT billable"

 I $$NBCL^IBEFUNC(+$P(IB0E0,U,4),IBDT) S IBFND=0_U_"Clinic not MT billable"

 I $$NBCSC^IBEFUNC(+$P(IB0E0,U,3),IBDT) S IBFND=0_U_"Stop code not MT billable"

 ;

 Q IBFND

 ;

THIRD(IB0E) ; Return true if Outpatient Encounter is Billable for Third Party

 ; Input:  IB0E - IEN of Outpatient Encounter #409.68

 ; Output: 0 ^ non-billable reason

 ;         1 if encounter is Third Party billable

 ;

 N IB0E0,DFN,IBDT,IBFND S IB0E=+$G(IB0E),IBFND=1

 S IB0E0=$$SCE^IBSDU(+$G(IB0E)),DFN=$P(IB0E0,U,2),IBDT=+IB0E0\1 I 'DFN Q 0

 ;

 I '$$APPTCT^IBEFUNC(IB0E0) S IBFND=0_U_"Appt Status, not billable"

 I $$NCTCL^IBEFUNC(IB0E0) S IBFND=0_U_"Non-count Clinic, not billable"

 I '$$RPT^IBEFUNC(+$P(IB0E0,U,10),IBDT) S IBFND=0_U_"Appt Type not TP billable"

 I $$NBCT^IBEFUNC(+$P(IB0E0,U,4),IBDT) S IBFND=0_U_"Clinic not TP billable"

 I $$NBST^IBEFUNC(+$P(IB0E0,U,3),IBDT) S IBFND=0_U_"Stop code not TP billable"

 ;

 Q IBFND

 ;

TPCHG(IB0E) ; Return Outpatient Encounters potential Third Party charges, based on encounters procedures

 ; Input:  IB0E - IEN of Outpatient Encounter #409.68

 ; Output: Total Institutional Amount ^ Total Professional Amount

 ;         0 if no encounter billable procedures with charges

 ;

 N IB0E0,DFN,IBDT,IBDV,IBRT,IBCPTS,IBZERR,IBFN,IBCPT,IBINST,IBPROF,IBFND S (IBINST,IBPROF)=0,IBFND=0

 S IB0E0=$$SCE^IBSDU(+$G(IB0E)),DFN=$P(IB0E0,U,2),IBDT=+IB0E0\1,IBDV=$P(IB0E0,U,11) I 'DFN Q 0

 S IBRT=$O(^DGCR(399.3,"B","REIMBURSABLE INS.")) I 'IBRT S IBRT=8

 I '$$THIRD(IB0E) Q 0

 ;

 D GETCPT^SDOE(IB0E,"IBCPTS","IBZERR")

 S IBFN=0 F  S IBFN=$O(IBCPTS(IBFN)) Q:'IBFN  D  S IBFND=IBINST_U_IBPROF

 . S IBCPT=$P(IBCPTS(IBFN),U,1)

 . ;

 . S IBINST=IBINST+$$BICOST^IBCRCI(IBRT,3,IBDT,"PROCEDURE",IBCPT,,IBDV,1,1)

 . S IBPROF=IBPROF+$$BICOST^IBCRCI(IBRT,3,IBDT,"PROCEDURE",IBCPT,,IBDV,1,2)

 ;

 Q IBFND