- Timestamp:
- Dec 4, 2009, 8:26:01 PM (14 years ago)
- Location:
- FOIAVistA/tag/r
- Files:
-
- 1 edited
- 1 copied
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FOIAVistA/tag/r/INTEGRATED_BILLING-IB-PRQ--IBD--IBQ--PRQS/IBCEU1.m
r628 r636 1 1 IBCEU1 ;ALB/TMP - EDI UTILITIES FOR EOB PROCESSING ;10-FEB-99 2 ;;2.0;INTEGRATED BILLING;**137,155,296,349 ,371**;21-MAR-94;Build 572 ;;2.0;INTEGRATED BILLING;**137,155,296,349**;21-MAR-94;Build 46 3 3 ;;Per VHA Directive 2004-038, this routine should not be modified. 4 4 ; … … 75 75 . S (IBTOT,Z)=0 76 76 . F S Z=$O(^IBM(361.1,"ABS",IBIFN,IBCOBN,Z)) Q:'Z D 77 .. ; HD64841 IB*2*371 - total up the payer paid amounts 78 .. S IBTOT=IBTOT+$P($G(^IBM(361.1,Z,1)),U,1) 77 .. S IBTOT=IBTOT+$P($G(^IBM(361.1,Z,1)),U,2) 79 78 Q IBTOT 80 79 ; … … 128 127 Q 129 128 ; 130 COBOUT(IBXSAVE,IBXDATA,CL) ; build LCOB segment data 131 ; The IBXSAVE array used here is built by INS-2, then LCOB-1.9 132 ; This is basically the 361.115, but all the piece numbers here in this 133 ; local array are one higher than the pieces in subfile 361.115. 129 COBOUT(IBXSAVE,IBXDATA,CL) ; 134 130 N Z,M,N,P,PCCL 135 131 S (N,Z,P)=0 F S Z=$O(IBXSAVE("LCOB",Z)) Q:'Z D … … 143 139 ; 144 140 COBPYRID(IBXIEN,IBXSAVE,IBXDATA) ; cob insurance company payer id 145 N CT, N,NUM141 N CT,Z,N,NUM 146 142 K IBXDATA 147 143 I '$D(IBXSAVE("LCOB")) G COBPYRX 148 144 D ALLPAYID^IBCEF2(IBXIEN,.NUM,1) 149 S NUM=$G(NUM(1)) 150 S NUM=$E(NUM_$J("",5),1,5) 145 S Z=$$COID^IBCEF2(IBXIEN),NUM=$G(NUM(1)) 146 S:Z="" Z="0000" 147 S NUM=$E(NUM_$J("",5),1,5)_$E(Z_$J("",4),1,4) 151 148 S (CT,N)=0 152 149 F S N=$O(IBXSAVE("LCOB",N)) Q:'N S CT=CT+1,IBXDATA(CT)=NUM … … 159 156 ; The EOB is not eligible if the review status is not 3, or if there 160 157 ; is no insurance sequence indicator, or if the EOB has been DENIED 161 ; and the patient responsibility for that EOB is $0 and that EOB is 162 ; not a split EOB. Split EOB's need to be included (IB*2*371). 158 ; and the patient responsibility for that EOB is $0. 163 159 ; 164 160 NEW ELIG,IBDATA,PTRESP … … 167 163 S IBDATA=$G(^IBM(361.1,IBEOB,0)) 168 164 I $P(IBDATA,U,4)'=1 G EOBELIGX ; Only MRA EOB's for now 169 I $D(^IBM(361.1,IBEOB,"ERR")) G EOBELIGX ; filing error170 165 I $P(IBDATA,U,16)'=3 G EOBELIGX ; review status - accepted-complete 171 166 I '$P(IBDATA,U,15) G EOBELIGX ; insurance sequence must exist 172 167 S PTRESP=$P($G(^IBM(361.1,IBEOB,1)),U,2) ; Pt Resp Amount for 1500s 173 168 I $$FT^IBCEF(+IBDATA)=3 S PTRESP=$$PTRESPI^IBCECOB1(IBEOB) ; for UBs 174 I PTRESP'>0,$P(IBDATA,U,13)=2,'$$SPLIT^IBCEMU1(IBEOB) G EOBELIGX ; Denied & No Pt. Resp. & not a split MRA 169 I PTRESP'>0,$P(IBDATA,U,13)=2 G EOBELIGX ; Denied & No Pt. Resp. 170 I $D(^IBM(361.1,IBEOB,"ERR")) G EOBELIGX ; filing error 175 171 ; 176 172 S ELIG=1
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