| [613] | 1 | PSOREJU2 ;BIRM/MFR - BPS (ECME) - Clinical Rejects Utilities (1) ;10/15/04
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| 2 | ;;7.0;OUTPATIENT PHARMACY;**148,260**;DEC 1997;Build 84
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| 3 | ;Reference to $$NABP^BPSBUTL supported by IA 4719
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| 4 | ;Reference to File 9002313.23 - BPS NCPDP REASON FOR SERVICE CODE supported by IA 4714
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| 5 | ;
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| 6 | GET(RX,RFL,REJDATA,REJID,OKCL,CODE) ;
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| 7 | ; Input: (r) RX - Rx IEN (#52)
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| 8 | ; (o) RFL - Refill # (Default: most recent)
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| 9 | ; (r) REJDATA(REJECT IEN,FIELD) - Array where these Reject fields will be returned:
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| 10 | ; "CODE" - Reject Code (79 or 88)
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| 11 | ; "DATE/TIME" - DATE/TIME Reject was detected
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| 12 | ; "PAYER MESSAGE" - Message returned by the payer
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| 13 | ; "REASON" - Reject Reason description (from payer)
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| 14 | ; "INSURANCE NAME" - Patient's Insurance Company Name
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| 15 | ; "GROUP NAME" - Patient's Insurance Group Name
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| 16 | ; "GROUP NUMBER" - Patient's Insurance Group Number
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| 17 | ; "CARDHOLDER ID" - Patient's Insurance Cardholder ID
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| 18 | ; "PLAN CONTACT" - Plan's Contact (eg., "1-800-...")
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| 19 | ; "PLAN PREVIOUS FILL DATE" - Last time Rx was paid by payer
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| 20 | ; "STATUS" - REJECTS status ("OPEN/UNRESOLVED" or "CLOSED/RESOLVED")
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| 21 | ; "DUR TEXT" - Payer's DUR description
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| 22 | ; "OTHER REJECTS" - Other Rejects on the same response
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| 23 | ; "REASON SVC CODE" - Reason for Service Code
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| 24 | ; If REJECT is closed, the following fields will be returned:
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| 25 | ; "CLA CODE" - Clarification Code submitted
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| 26 | ; "PRIOR AUTH TYPE" - Prior Authorization Type
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| 27 | ; "PRIOR AUTH NUMBER" - Prior Authorization Type
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| 28 | ; "CLOSED DATE/TIME" - DATE/TIME Reject was closed
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| 29 | ; "CLOSED BY" - Name of the user responsible for closing Reject
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| 30 | ; "CLOSE REASON" - Reason for closing Reject (text)
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| 31 | ; "CLOSE COMMENTS" - User entered comments at close
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| 32 | ; (o) REJID - REJECT IEN in the PRESCRIPTION file for retrieve this REJECT
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| 33 | ; (o) OKCL - If set to 1, CLOSED REJECTs will also be returned
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| 34 | ; (o) CODE - Only REJECTs with this CODE should be returned
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| 35 | ;
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| 36 | N REJS,ARRAY,REJFLD,IDX,COM,Z
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| 37 | ;
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| 38 | I '$D(RFL) S RFL=$$LSTRFL^PSOBPSU1(RX)
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| 39 | ;
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| 40 | K REJDATA
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| 41 | I '$O(^PSRX(RX,"REJ",0)) Q
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| 42 | ;
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| 43 | K REJS S RFL=+$G(RFL)
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| 44 | I $G(REJID) D
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| 45 | . I +$P($G(^PSRX(RX,"REJ",REJID,0)),"^",4)'=RFL Q
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| 46 | . I '$G(OKCL),$P($G(^PSRX(RX,"REJ",REJID,0)),"^",5) Q
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| 47 | . S REJS(REJID)=""
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| 48 | E D
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| 49 | . S IDX=999
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| 50 | . F S IDX=$O(^PSRX(RX,"REJ",IDX),-1) Q:'IDX D
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| 51 | . . I +$P($G(^PSRX(RX,"REJ",IDX,0)),"^",4)'=RFL Q
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| 52 | . . I '$G(OKCL),$P($G(^PSRX(RX,"REJ",IDX,0)),"^",5) Q
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| 53 | . . S REJS(IDX)=""
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| 54 | I '$D(REJS) Q
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| 55 | ;
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| 56 | S IDX=0
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| 57 | F S IDX=$O(REJS(IDX)) Q:'IDX D
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| 58 | . K ARRAY D GETS^DIQ(52.25,IDX_","_RX_",","*","","ARRAY")
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| 59 | . K REJFLD M REJFLD=ARRAY(52.25,IDX_","_RX_",")
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| 60 | . I $G(CODE),REJFLD(.01)'=CODE Q
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| 61 | . S REJDATA(IDX,"CODE")=$G(REJFLD(.01))
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| 62 | . S REJDATA(IDX,"DATE/TIME")=$G(REJFLD(1))
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| 63 | . S REJDATA(IDX,"PAYER MESSAGE")=$G(REJFLD(2))
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| 64 | . S REJDATA(IDX,"REASON")=$G(REJFLD(3))
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| 65 | . S REJDATA(IDX,"PHARMACIST")=$G(REJFLD(4))
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| 66 | . S REJDATA(IDX,"INSURANCE NAME")=$G(REJFLD(20))
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| 67 | . S REJDATA(IDX,"GROUP NAME")=$G(REJFLD(6))
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| 68 | . S REJDATA(IDX,"GROUP NUMBER")=$G(REJFLD(21))
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| 69 | . S REJDATA(IDX,"CARDHOLDER ID")=$G(REJFLD(22))
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| 70 | . S REJDATA(IDX,"PLAN CONTACT")=$G(REJFLD(7))
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| 71 | . S REJDATA(IDX,"PLAN PREVIOUS FILL DATE")=$G(REJFLD(8))
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| 72 | . S REJDATA(IDX,"STATUS")=$G(REJFLD(9))
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| 73 | . S REJDATA(IDX,"OTHER REJECTS")=$G(REJFLD(17))
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| 74 | . S REJDATA(IDX,"DUR TEXT")=$G(REJFLD(18))
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| 75 | . S REJDATA(IDX,"REASON SVC CODE")=$G(REJFLD(14))
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| 76 | . S REJDATA(IDX,"RESPONSE IEN")=$G(REJFLD(16))
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| 77 | . I '$G(OKCL) Q
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| 78 | . S REJDATA(IDX,"CLOSED DATE/TIME")=$G(REJFLD(10))
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| 79 | . S REJDATA(IDX,"CLOSED BY")=$G(REJFLD(11))
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| 80 | . S REJDATA(IDX,"CLOSE REASON")=$G(REJFLD(12))
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| 81 | . S REJDATA(IDX,"CLOSE COMMENTS")=$G(REJFLD(13))
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| 82 | . S REJDATA(IDX,"COD1")=$G(REJFLD(14))
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| 83 | . S REJDATA(IDX,"COD2")=$G(REJFLD(15))
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| 84 | . S REJDATA(IDX,"COD3")=$G(REJFLD(19))
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| 85 | . S REJDATA(IDX,"CLA CODE")=$G(REJFLD(24))
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| 86 | . S REJDATA(IDX,"PRIOR AUTH TYPE")=$G(REJFLD(25))
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| 87 | . S REJDATA(IDX,"PRIOR AUTH NUMBER")=$G(REJFLD(26))
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| 88 | . S COM=0 F S COM=$O(^PSRX(RX,"REJ",IDX,"COM",COM)) Q:'COM D
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| 89 | . . S Z=^PSRX(RX,"REJ",IDX,"COM",COM,0)
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| 90 | . . S REJDATA(IDX,"COMMENTS",COM,"DATE/TIME")=$P(Z,"^")
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| 91 | . . S REJDATA(IDX,"COMMENTS",COM,"USER")=$P(Z,"^",2)
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| 92 | . . S REJDATA(IDX,"COMMENTS",COM,"COMMENTS")=$P(Z,"^",3)
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| 93 | Q
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| 94 | ;
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| 95 | HELP(OPTS) ; Display the Help Text for the DUR handling options (OVERRIDE/IGNORE/STOP/QUIT)
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| 96 | ;
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| 97 | I OPTS["O" D
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| 98 | . W !?1,"(O)verride - This option will provide the prompts for the code sets needed to"
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| 99 | . W !?1," override this reject and get a payable 3rd party claim. Before"
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| 100 | . W !?1," you select this option, you may need to call the 3rd party payer"
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| 101 | . W !?1," to determine which code sets are needed to override a particular"
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| 102 | . W !?1," reject. Once the proper override is accepted the label will print"
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| 103 | . W !?1," and the prescription can be filled."
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| 104 | ;
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| 105 | I OPTS["I" D
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| 106 | . W !?1,"(I)gnore - Choosing Ignore will by-pass 3rd party processing and will allow"
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| 107 | . W !?1," you to print a label and fill the prescription. This essentially"
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| 108 | . W !?1," ignores the clinical safety issues suggested by the 3rd party"
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| 109 | . W !?1," payer and will NOT result in a payable claim."
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| 110 | ;
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| 111 | I OPTS["Q" D
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| 112 | . W !?1,"(Q)uit - Choosing Quit will postpone the processing of this prescription"
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| 113 | . W !?1," until this 3rd party reject is resolved. A label will not be"
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| 114 | . W !?1," printed for this prescription and it can not be filled/dispensed"
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| 115 | . W !?1," until this reject is resolved. Rejects can be resolved through"
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| 116 | . W !?1," the Worklist option under the ePharmacy menu."
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| 117 | Q
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| 118 | ;
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| 119 | DVINFO(RX,RFL,LM) ; Returns header displayable Division Information
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| 120 | ;Input: (r) RX - Rx IEN (#52)
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| 121 | ; (o) RFL - Refill # (Default: most recent)
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| 122 | ; (o) LM - ListManager format? (1 - Yes / 0 - No) - Default: 0
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| 123 | N TXT,DVINFO,NCPNPI
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| 124 | S DVINFO="Division : "_$$GET1^DIQ(59,+$$RXSITE^PSOBPSUT(RX,RFL),.01)
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| 125 | S NCPNPI=$P($$NABP^BPSBUTL(RX,RFL)," ")
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| 126 | S $E(DVINFO,$S($G(LM):58,1:51))=$S($L(NCPNPI)=7:"NCPDP",1:" NPI")_"#: "_NCPNPI
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| 127 | Q DVINFO
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| 128 | ;
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| 129 | PTINFO(RX,LM) ; Returns header displayable Patient Information
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| 130 | ;Input: (r) RX - Rx IEN (#52)
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| 131 | ; (o) LM - ListManager format? (1 - Yes / 0 - No) - Default: 0
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| 132 | N DFN,VADM,PTINFO
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| 133 | S DFN=$$GET1^DIQ(52,RX,2,"I") D DEM^VADPT
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| 134 | S PTINFO="Patient : "_$E($G(VADM(1)),1,$S($G(LM):24,1:20))_"("_$P($G(VADM(2)),"^",2)_")"
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| 135 | S PTINFO=PTINFO_" Sex: "_$P($G(VADM(5)),"^")
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| 136 | S $E(PTINFO,$S($G(LM):61,1:54))="DOB: "_$P($G(VADM(3)),"^",2)_"("_$P($G(VADM(4)),"^")_")"
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| 137 | Q PTINFO
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| 138 | ;
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| 139 | RETRXF(RX,RFL,ONOFF) ; - Set/Reset the Re-transmission flag
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| 140 | ;Input: (r) RX - Rx IEN (#52)
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| 141 | ; (r) RFL - Refill IEN (#52.1)
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| 142 | ; (o) ONOFF - Turn flag ON or OFF (1 - ON / 0 - OFF) (Default: OFF)
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| 143 | N DA,DIE,DR
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| 144 | S DR="82///"_$S($G(ONOFF):"YES",1:"@")
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| 145 | I 'RFL S DA=RX,DIE="^PSRX("
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| 146 | I RFL S DA(1)=RX,DA=RFL,DIE="^PSRX("_RX_",1,"
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| 147 | D ^DIE
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| 148 | Q
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| 149 | ;
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| 150 | REASON(TXT) ; Extracts the Reason for service code from the REASON text field
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| 151 | ; Input: (r) TXT - Reason text (e.g., NN Reason for Service Code Text)
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| 152 | ;Output: REASON - NN (if on valid and on file (#9002313.23), null otherwise)
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| 153 | N REASON,DIC,X,Y
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| 154 | S REASON=$P(TXT," ") I $L(REASON)'=2 Q ""
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| 155 | S DIC=9002313.23,X=REASON D ^DIC I Y<0 Q ""
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| 156 | Q REASON
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| 157 | ;
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| 158 | SETOPN(RX,REJ) ; - Set the Reject RE-OPENED flag to YES
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| 159 | ;Input: (r) RX - Rx IEN (#52)
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| 160 | ; (r) REJ - Reject IEN (#52.25)
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| 161 | ;
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| 162 | I '$D(^PSRX(RX,"REJ",REJ)) Q
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| 163 | N DIE,DA,DR
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| 164 | S DIE="^PSRX("_RX_",""REJ"",",DA(1)=RX,DA=REJ,DR="23///YES" D ^DIE
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| 165 | Q
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| 166 | ;
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| 167 | PRT(FIELD,P,L) ; Sets the lines for fields that require text wrapping
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| 168 | ;Input: FIELD - Subscript name from the DATA(REJ,FIELD) array
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| 169 | ; P - Position where the content should be printed
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| 170 | ; L - Lenght of the text on each line
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| 171 | N TXT,I
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| 172 | S TXT=DATA(REJ,FIELD) I $L(TXT)'>L W ?P,TXT Q
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| 173 | F I=1:1 Q:TXT="" D
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| 174 | . I I=1 W ?P,$E(TXT,1,L),! S TXT=$E(TXT,L+1,999) Q
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| 175 | . W ?P,$E(TXT,1,L) S TXT=$E(TXT,L+1,999) W:TXT'="" !
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| 176 | Q
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| 177 | ;
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| 178 | PA() ; - Ask for Prior Authorization Type and Number
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| 179 | ;Output:(PAT^PAN) PAT - Prior Authorization Type (See DD File#52,
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| 180 | ; Sub-file#52.25,field#25 for possible values)
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| 181 | ; PAN - Prior Authorization Number (11 digits)
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| 182 | ;
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| 183 | N DIR,Y,DIRUT,DIROUT,PAT,PAN
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| 184 | S DIR(0)="52.25,25",DIR("A")=" Prior Authorization Type",DIR("B")="0"
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| 185 | S (DIR("?"),DIR("??"))="^D PAHLP^PSOREJU2"
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| 186 | D ^DIR I $D(DIRUT)!$D(DIROUT) Q "^"
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| 187 | S PAT=Y
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| 188 | K DIR S DIR(0)="52.25,26",DIR("A")="Prior Authorization Number"
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| 189 | S DIR("?")="^D PANHLP^PSOREJU2",DIR("??")=""
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| 190 | D ^DIR I (Y["^")!$D(DIROUT) Q "^"
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| 191 | S PAN=Y
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| 192 | Q (PAT_"^"_PAN)
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| 193 | ;
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| 194 | PAHLP ; Prior Authorization Type Help
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| 195 | W !?9,"EPSDT - Early Periodic Screening Diagnosis Treatment"
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| 196 | W !?9,"AFDC - Aid to Family with Dependent Children"
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| 197 | Q
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| 198 | ;
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| 199 | PANHLP ; Prior Authorization Number Help
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| 200 | W "OR you may leave it blank if the claim does not require a number."
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| 201 | Q
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