IBCBB3	;ALB/TMP - CONTINUATION OF EDIT CHECKS ROUTINE (MEDICARE) ;06/23/98
	;;2.0;INTEGRATED BILLING;**51,137,155,349,371,377**;21-MAR-94;Build 23
	;;Per VHA Directive 2004-038, this routine should not be modified.
	;
EDITMRA(IBQUIT,IBER,IBIFN,IBFT)	;
	; Requires execution of GVAR^IBCBB, IBIFN defined
	; File IB ERROR (350.8) contains error codes/text
	;
	N IBMRATYP,Z,IBZP,IBZP1,IBOK
	S IBQUIT=0 ;Flag to say we have too many errors - quit edits
	;
	S IBMRATYP=$$MRATYPE^IBEFUNC(IBIFN,"C")
	;
	I IBFT=3 D
	. D PARTA
	;
	I IBFT=2 D PARTB^IBCBB9
	;
	K IBXDATA D F^IBCEF("N-ADMITTING DIAGNOSIS",,,IBIFN)
	; Req. for UB-04 type of bills 11x!18x
	I $G(IBXDATA)="",IBFT=3 D  Q:IBQUIT
	. N Z
	. I "^11^18^"[(U_IBTOB12_U) S IBQUIT=$$IBER(.IBER,231) Q
	. I $$INPAT^IBCEF(IBIFN,1) S Z="Admitting Diagnosis may be required by payer, please verify" D WARN^IBCBB11(Z)
	;
	D GETPRV^IBCEU(IBIFN,"2,3,4",.Z)
	S IBOK=1,Z=0,IBZP=U F  S Z=$O(Z(Z)) Q:'Z  S:$S($P($G(Z(Z,1)),U,3)["VA(200":1,1:0) IBZP=IBZP_+$P(Z(Z,1),U,3)_U
	D ALLPROC^IBCVA1(IBIFN,.IBZP1)
	S Z=0 F  S Z=$O(IBZP1(Z)) Q:'Z  I $P(IBZP1(Z),U,18),IBZP'[(U_$P(IBZP1(Z),U,18)_U) S IBOK=0 Q
	I 'IBOK D WARN^IBCBB11("At least one provider on a procedure does not match your "_$S(IBFT=2:"render",1:"attend")_"ing or operating provider")
	I IBFT=2 D EN^IBCBB2
	; edit checks for UB-04 (institutional) forms
	I IBFT=3 D EN^IBCBB21(.IBZPRC92)
	;
	Q
	;
PARTA	; MEDICARE specific edit checks for PART A claims (UB-04 formats)
	;
	N IBI,IBJ,IBX,IBCTYP,VADM,VAPA,IBSTOP,IBDXC,IBDXARY,IBPR,IBLABS,REQMRA
	N IBS,IBTUNIT,IBCAGE,IBREV1,IBOCCS,IBOCSDT,IBVALCD,IBOCCD,IBNOPR
	N IBCCARY1,IBPATST,IBZADMIT,IBZDISCH,IBXIEN,IBXERR,IBXDATA,IBOCSP
	N IBCOV,IBNCOV,IBREVC,IBREVDUP,IBBCPT,IBREVC12,IBREVTOT,IBECAT,IBINC
	;
	; Medicare is the current payer, but no diagnosis codes
	I $$WNRBILL^IBEFUNC(IBIFN) D SET^IBCSC4D(IBIFN,.IBDX,.IBDXO) I '$P(IBDX,U,2) S IBQUIT=$$IBER(.IBER,120) Q:IBQUIT
	;
	; Type of Bill must be three digits
	I IBTOB'?3N S X=$$IBER(.IBER,103) Q
	;
	; Covered Days
	S IBCTYP=0
	S IBCOV=$P(IBNDU2,U,2),IBNCOV=$P(IBNDU2,U,3)
	;
	; If interim bill, covered days must not be greater than 60
	I "23"[$E(IBTOB,3),IBCOV>60 S IBQUIT=$$IBER(.IBER,"096") Q:IBQUIT
	;
	; I bill type is 11x or 18x or 21x then we need covered days
	I "^11^18^21^"[(U_IBTOB12_U) S IBCTYP=1 I IBCOV="" S IBQUIT=$$IBER(.IBER,106) Q:IBQUIT
	;
	S (IBI,IBJ)=0
	K IBXDATA D F^IBCEF("N-CONDITION CODES",,,IBIFN)
	; Re-sort the condition codes by code
	S IBI=0 F  S IBI=$O(IBXDATA(IBI)) Q:'IBI  S IBCCARY1($P(IBXDATA(IBI),U))=""
	;
	; for condition code 40, covered days must be 0
	I $D(IBCCARY1(40)),IBCOV'=0 S IBQUIT=$$IBER(.IBER,107) Q:IBQUIT
	;
	; cov days+non=to date -from date unless the patient status = 30 (still
	;  pt) or outpatient or if the to date and from date are same then add 1
	S IBPATST="",IBX=$P(IBNDU,U,12),IBPATST=$P($G(^DGCR(399.1,+IBX,0)),U,2)
	S IBINC=$S(IBPATST=30!(IBFDT=IBTDT):1,1:0)
	I $$INPAT^IBCEF(IBIFN,1),(IBCOV+IBNCOV)'=($$FMDIFF^XLFDT(IBTDT,IBFDT)+IBINC) S IBQUIT=$$IBER(.IBER,108) Q:IBQUIT
	;
	; if covered days >100 and type of bill is 21x or 18x error
	I IBCOV>100,(IBTOB12=18!(IBTOB12=21)) S IBQUIT=$$IBER(.IBER,109) Q:IBQUIT
	;
	S (IBJ,IBTUNIT,IBS,IBREVTOT("AC"),IBREVTOT("AI"),IBREVTOT("AO"),IBREVTOT)=0
	;
	K IBXDATA D F^IBCEF("N-UB-04 SERVICE LINE (EDI)",,,IBIFN) ;Get rev codes
	;
	; Re-sort the revenue codes by code
	;>> IBREV1(rev code,x)=Rev code^ptr cpt^unit chg^units^total^tot unc
	;   IBREV1(rev code) = revenue code edit category
	;
	; IBNOPR = flag that determines if there are revenue codes with
	;          charges that do not have a procedure - no need to check
	;          for billable MCR procedures if at least one RC is billable
	;          1 = there is at least one billable revenue code without a
	;              procedure
	;
	S REQMRA=$$REQMRA^IBEFUNC(IBIFN)
	S (IBNOPR,IBI)=0
	F  S IBI=$O(IBXDATA(IBI)) Q:'IBI  D
	. I REQMRA D GYMODCHK(IBXDATA(IBI))      ; IB*2*377 GY modifier check
	. S IBJ=$P(IBXDATA(IBI),U),IBECAT=""
	. I 'IBNOPR D
	.. I $P(IBXDATA(IBI),U,2)'="" S IBPR($P(IBXDATA(IBI),U,2))=IBI Q
	.. S IBNOPR=1 K IBPR
	. S:$D(IBREV1(IBJ)) IBECAT=$G(IBREV1(IBJ))
	. I '$D(IBREV1(IBJ))!(IBECAT="") D  S IBREV1(IBJ)=IBECAT
	. . ;
	. . ; Accomodations (AC)
	. . I (IBJ'<100&(IBJ'>219))!(IBJ=224) S IBECAT="AC" Q
	. . ;
	. . ; Ancillary Outpatient (AO)
	. . I '$$INPAT^IBCEF(IBIFN,1) S IBECAT="AO" Q
	. . ;
	. . ; Ancillary Inpatient (AI)
	. . S IBECAT="AI"
	. ;
	. S IBREV1(IBJ,+$O(IBREV1(IBJ,""),-1)+1)=IBXDATA(IBI)
	. S IBREVTOT(IBECAT)=IBREVTOT(IBECAT)+$P(IBXDATA(IBI),U,6)
	. I IBECAT="AC" S IBTUNIT=IBTUNIT+$P(IBXDATA(IBI),U,4)
	;
	I $$NEEDMRA^IBEFUNC(IBIFN),$O(IBPR(""))'="" D  Q:IBQUIT
	. ; Don't allow a bill containing only billable procedures for:
	. ;    Oxygen, labs, or influenza shots
	. ;  OR a bill with prosthetics on it
	. ;    to be sent to MEDICARE for an MRA
	. D NONMCR(.IBPR,.IBLABS) ; Remove Oxygen, labs, influenza shots
	. I $G(IBLABS) D WARN^IBCBB11("The only possible billable procedures on this bill are labs -"),WARN^IBCBB11(" Please verify that MEDICARE does not reimburse these labs at 100%") Q
	. I $O(IBPR(""))="" D
	.. S IBQUIT=$$IBER(.IBER,"098")
	;
	; covered days+non covered = units of accom rev codes
	; Check room and board
	I IBTUNIT,IBTUNIT'=(IBCOV+IBNCOV) S IBQUIT=$$IBER(.IBER,114) Q:IBQUIT
	;
	; Non Covered Days
	;   required when the type of bill is 11x,18x,21x or covered days=0
	I IBNCOV="",(IBCTYP!(IBCOV=0)) S IBQUIT=$$IBER(.IBER,115) Q:IBQUIT
	;
	; if cc code=40 then non-covered days must be 1
	I $D(IBCCARY1(40)),IBNCOV'=1 S IBQUIT=$$IBER(.IBER,116) Q:IBQUIT
	;
	; Patient Sex
	; must be "M" or "F"
	D DEM^VADPT
	I $P(VADM(5),U)'="M",$P(VADM(5),U)'="F" S IBQUIT=$$IBER(.IBER,124) Q:IBQUIT
	;
	; esg - 10/17/07 - patch 371
	; For Part A replacement MRA request claims, make sure
	; the Medicare ICN/DCN number is present and also text in FL-80.
	I $$REQMRA^IBEFUNC(IBIFN),$F(".137.138.117.118.","."_IBTOB_".") D  Q:IBQUIT
	. N IBZ,FL80TXT
	. D F^IBCEF("N-CURR INS FORM LOC 64","IBZ",,IBIFN)  ; see CI3-11
	. I IBZ="" S IBQUIT=$$IBER(.IBER,205) Q:IBQUIT      ; missing ICN/DCN
	. S FL80TXT=$P($G(^DGCR(399,IBIFN,"UF2")),U,3)
	. I FL80TXT="" S IBQUIT=$$IBER(.IBER,206) Q:IBQUIT  ; missing FL80 text
	. Q
	;
	D ^IBCBB4
	Q
	;
IBER(IBER,ERRNO)	; Sets error list
	; NOTE: add code to check error list > 20 ... If so, display message and
	;   quit so we don't get too many errors at once to handle
	;   Print all if printing list
	;
	I '$G(IBQUIT) D
	. I ERRNO?1N.N S:$L(ERRNO)<3 ERRNO=$E("00",1,3-$L(ERRNO))_ERRNO
	. I $L(IBER,";")>19,'$G(IBPRT("PRT")) S IBER=IBER_"IB999;",IBQUIT=1
	. I $G(IBER)'[("IB"_ERRNO_";") S IBER=IBER_"IB"_ERRNO_";"
	Q IBQUIT
	;
NONMCR(IBPR,IBLABS)	;  Delete all oxygen and lab, flu shot CPT entries from IBPR
	; IBPR = array subscripted by CPT codes from bill
	; IBLABS = flag returned =1 if labs found on bill
	N Z S IBLABS=0
	; Oxygen
	F Z="A0422","A4575","A4616","A4619","A4620","A4621","E0455","E1353","E1355" K IBPR(Z)
	F Z=77:1:85 S Z0="E13"_Z K IBPR(Z0)
	; Labs
	S Z="80000" F  S Z=$O(IBPR(Z)) Q:Z'?1"8"4N  S IBLABS=1
	; Flu shots
	F Z="90724","G0008","90732","G0009","90657","90658","90659","90660" K IBPR(Z)
	Q
	;
MCRANUM(IBIFN)	; Determine MEDICARE A provider ID # from bedsection for
	; bill ien IBIFN
	N IBX
	; PART A MRA (only) needed - determine if psych/non-psych claim
	N IBX,IBI
	S IBI=$P($G(^DGCR(399,IBIFN,"U")),U,11)
	S IBX=$S($TR($P($G(^DGCR(399.1,+IBI,0)),U),"psych","PSYCH")'["PSYCH":670899,1:674499)
	Q IBX
	;
MCRACK(IBIFN,X,IBFLD)	; Check for MEDICARE A for bill IBIFN
	; Called from CLAIM STATUS MRA field (#24) xrefs in file 399
	; X = current value of field 399;24
	; IBFLD = 1 for primary ins co, 2 for secondary, 3 for tertiary
	N IB
	S IB=0
	I +X,$$COBN^IBCEF(IBIFN)=IBFLD,$$WNRBILL^IBEFUNC(IBIFN,IBFLD),$$MRATYPE^IBEFUNC(IBIFN,"C")="A" S IB=1
	Q IB
	;
GYMODCHK(Z)	; GY modifier check procedure.  IB*2*377 - 2/4/08
	; Z is the IBXDATA(IBI) service line EDI
	N MODS
	I IBER["IB123" Q     ; error already found
	S MODS=$P(Z,U,9)     ; list of modifiers separated by commas
	I MODS'["GY" Q       ; GY modifier not here on this line item
	I $P(Z,U,6) Q        ; non-covered charges exist on this line item
	S IBQUIT=$$IBER(.IBER,123)
GYMODX	;
	Q
	;