BPSNCPD3 ;BHAM ISC/LJE - Continuation of BPSNCPDP - DUR HANDLING ;06/16/2004
;;1.0;E CLAIMS MGMT ENGINE;**1,5,6,7,8,10,11,15,19,20,22,29**;JUN 2004;Build 41
;;Per VA Directive 6402, this routine should not be modified.
;
; Due to space considerations, these comments were moved from BPSNPCPD
; to this routine.
;
; ------------------ Beginning of BPSNCPDP comments ------------------
;Input
; BRXIEN = Prescription IEN
; BFILL = Fill Number
; DOS = Date of Service
; BWHERE (RX Action)
; AREV = Auto-Reversal
; BB = Back Billing
; CRLB = CMOP/OPAI Release & Rebill
; CRLR = CMOP/OPAI Release & Reverse (successful release)
; CRLX = CMOP/OPAI unsuccessful release & reverse
; CRRL = CMOP/OPAI Release - Original claim not paid, submit another claim, no reversal
; DC = Discontinue - only reverse un-released PAYABLE DC's, release date check
; should be in calling routine.
; DE = Delete
; ED = Edit (includes RX release with NDC edit)
; ERES = Resubmit from ECME user screen
; ERWV = Resubmit Without Reversal from ECME user screen (BPS*1*20)
; ERNB = Resubmit of a TRI/CVA non-billable entry from the ECME user screen (BPS*1*20)
; EREV = Reversal from ECME user screen
; HLD = Put prescription on Hold
; OREV = Reversal from Outpatient Pharmacy edit screen (BPS*1*20)
; RSNB = Resubmit Non-Billable TRICARE & CHAMPVA from PSO Reject Info Screen (BPS*1*20)
; OF = Original Fill
; P2 = Original submission from PRO Option, no reversal
; P2S = Resubmit from PRO Option
; PC = Pull CMOPs
; PE = Pull early from suspense
; PL = Pull local from suspense
; PP = Pull RX (PP) action from Patient Prescription Processing option
; RF = Refill
; RN = Renew
; RRL = Release - Original claim not paid, submit another claim, no reversal
; RS = Return-to-Stock
; BILLNDC = Valid NDC# with format 5-4-2
; REVREAS = Reversal Reason
; DURREC = String of up to three sets of DUR info. Sets are delimited with "~". Each set consists of three "^" pieces:
; Reason for Service Code
; Professional Service Code
; Result of Service Code
; BPOVRIEN = Pointer to BPS NCPDP OVERIDE file. This parameter will
; only be passed if there are overrides entered by the
; user via the Resubmit with Edits (RED) option in the
; user screen.
; BPSAUTH = Prior authorization code (Prior auth code^Prior auth number)
; BPSCLARF = Submission Clarification Code (external value from #9002313.25), entered by
; pharmacist and passed by Outpatient Pharmacy to ECME to put into the claim
; BPCOBIND = (optional, default is Primary) for COB indicators - so when the API is called for the particular
; COB claim the BPSNCPDP can handle it.
; BPJOBFLG = (optional, default is "F") B - if is called by unqueueing logic in background, F - by other (foreground) process,
; BPREQIEN = (optional) ien of BPS REQUEST file record, that needs to be unqueued
; BPSCLOSE = (optional) local array used with BWHERE="EREV" only, if the user had chosen to close the claim after reversal
; if claim needs to be closed then
; BPSCLOSE("CLOSE AFT REV")=1
; BPSCLOSE("CLOSE AFT REV REASON")=<#356.8 ien>
; BPSCLOSE("CLOSE AFT REV COMMENT")=<some text>
; BPSPLAN = (optional) IEN of the entry in the GROUP INSURANCE PLAN file (#355.3)
; BPSPRDAT = (optional) local array passed by reference. Contains primary claim data needed to submit a secondary claim.
; Format: BPSPRDAT(NCPDP field)
; BPSRTYPE = (optional) rate type ( ien of the file #399.3)
; BPSDELAY = Delay Reason Code (IEN of BPS NCPDP DELAY REASON CODE (#9002313.29), entered by the user
; in the Back Billing option of Claims Tracking and passed to ECME to put into the claim.
;
;Output (RESPONSE^MESSAGE^ELIGIBILITY^CLAIMSTATUS^COB^RXCOB^INSURANCE)
; RESPONSE
; 0 Submitted through ECME
; 1 No submission through ECME
; 2 IB not billable
; 3 Claim was closed, not submitted (RTS/Deletes)
; 4 Unable to queue claim
; 5 Incorrect information supplied to ECME
; 6 Inactive ECME - Primarily used for TRICARE/CHAMPVA to say ok to process rx
; 10 Reversal but no resubmit
; MESSAGE = Message associated with the response (error/submitted)
; ELIGIBILITY = V - Veteran, T - TRICARE, C - CHAMPVA
; CLAIMSTATUS = claim status (null or IN PROGRESS/E PAYABLE/etc...)
; COB = Coordination Of Benefit indicator of the insurance as it is stored in the PATIENT file: 1-primary, 2-secondary, 3-tertiary
; RXCOB = the payer sequence indicator of the claim which was sent to the payer as a result of this call: 1-primary, 2-secondary)
; INSURANCE = Name of the insurance company that was billed as a result of this call
;
; ----------------- End of BPSNCPDP comments ----------------------
;
; ----------------- DUR1 ------------------------------------------
; DUR1 is called by PSO to get the reject information
;
;
; IA 4560 supports OP's use of this procedure
;
; Function call for DUR INFORMATION
; Parameters: BRXIEN = Prescription IEN
; BFILL = fill number
; DUR = DUR info passed back
; ERROR = error passed back
; BPRXCOB = payer sequence
; Note:
; DUR("BILLED")=0 if ecme off for pharmacy or no transaction in ECME
; DUR(<Insurance counter>,"BILLED")=1 if billed through ecme
DUR1(BRXIEN,BFILL,DUR,ERROR,BPRXCOB) ;
N SITE,IEN59,DUR1,DURIEN
I '$G(BRXIEN) S DUR("BILLED")=0 Q
I $G(BFILL)="" S DUR("BILLED")=0 Q
S BPRXCOB=+$G(BPRXCOB)
I BPRXCOB=0 S BPRXCOB=1 ;default is Primary
;
; Get Site info and check is ECME is turned on
; If not, set DUR("BILLED")=0 and quit
I '$G(BFILL) S SITE=$$RXAPI1^BPSUTIL1(BRXIEN,20,"I")
I $G(BFILL) S SITE=$$RXSUBF1^BPSUTIL1(BRXIEN,52,52.1,BFILL,8,"I")
I '$$ECMEON^BPSUTIL(SITE) S DUR("BILLED")=0 Q
;
; Set up the Transaction IEN
S IEN59=$$IEN59^BPSOSRX(BRXIEN,BFILL,BPRXCOB)
I IEN59="" S DUR("BILLED")=0 Q
;
; If the transaction record does not exist, set DUR("BILLED")=0 and quit
I '$D(^BPST(IEN59)) S DUR("BILLED")=0 Q
I $$GET1^DIQ(9002313.59,IEN59,301)="NOT INSURED" S DUR("BILLED")=0 Q
;
S DUR(BPRXCOB,"BILLED")=1
;
S DUR(BPRXCOB,"ELIGBLT")=$P($G(^BPST(IEN59,9)),U,4)
; Get Insurance Info and set into DUR array
S DUR(BPRXCOB,"INSURANCE POINTER")=$$GET1^DIQ(9002313.59902,"1,"_IEN59_",",902.33,"I") ; Insurance Company IEN
D GETS^DIQ(9002313.59902,"1,"_IEN59_",","902.05;902.06;902.24;902.25;902.26","E","DUR1","ERROR")
S DUR(BPRXCOB,"INSURANCE NAME")=$G(DUR1(9002313.59902,"1,"_IEN59_",",902.24,"E")) ; Insurance Company Name
S DUR(BPRXCOB,"GROUP NUMBER")=$G(DUR1(9002313.59902,"1,"_IEN59_",",902.05,"E")) ; Insurance Group Number
S DUR(BPRXCOB,"GROUP NAME")=$G(DUR1(9002313.59902,"1,"_IEN59_",",902.25,"E")) ; Insurance Group Name
S DUR(BPRXCOB,"PLAN CONTACT")=$G(DUR1(9002313.59902,"1,"_IEN59_",",902.26,"E")) ; Insurance Contact Number
S DUR(BPRXCOB,"CARDHOLDER ID")=$G(DUR1(9002313.59902,"1,"_IEN59_",",902.06,"E")) ; Cardholder ID
;
; Get Response IEN and Data
S DURIEN="",DURIEN=$P(^BPST(IEN59,0),"^",5)
D DURRESP(DURIEN,.DUR,BPRXCOB) ; Note: In the future, we may need to get/store DURIEN for each COB
Q
;
DURRESP(DURIEN,DUR,BPRXCOB) ;
;Input Variables:
; DURIEN - Claim Response IEN. Pointer to the BPS RESPONSES File #9002313.03
; BPRXCOB - (Optional) The Payer Sequence:
; 1 - Primary (default)
; 2 - Secondary
;
;Output Variables:
; DUR - Array of DUR related information for a specific claim response in the
; BPS RESPONSES file in the following format (INSN is the Payer Sequence):
;
; DUR(INSN,"RESPONSE IEN") - Pointer to the RESPONSE file (#9002313.03) for
; the claim submission
; DUR(INSN,"PCN") - Processor Control Number
; DUR(INSN,"MESSAGE") - The Transmission level specific data, Message field 504
; DUR(INSN,"PAYER MESSAGE") - Message returned from the payer in the Transaction
; level
; DUR(INSN,"STATUS") - Status of the claim (i.e. REJECTED CLAIM, PAYABLE)
;
; The following four fields are redundant with the fields in the DUR PPS
; array but are provided for backwards compatibility.
; DUR(INSN,"REASON") - Reason for Service Code pointer to BPS NCPDP REASON FOR
; SERVICE CODE file (#9002313.23)
; DUR(INSN,"PREV FILL DATE") - Plan's Previous Fill Date
; DUR(INSN,"DUR FREE TEXT DESC") - Drug Utilization Review (DUR) description
; and/or claims rejection free text information from the payer
; DUR(INSN,"DUR ADD MSG TEXT") - Drug Utilization Review (DUR) additional free
; text information from the payer
;
; The following fields are from the DUR PPS RESPONSE multiple.
; DUR(INSN,"DUR PPS",SEQ,"DUR PPS RESPONSE") - Total number of DUR PPS
; responses from the payer
; DUR(INSN,"DUR PPS",SEQ,"REASON FOR SERVICE CODE") - Code identifying the
; type of utilization conflict detected or the reason for the pharmacist
; professional service
; DUR(INSN,"DUR PPS",SEQ,"CLINICAL SIGNIFICANCE CODE") - Code identifying
; the significance or severity level of a clinical event as contained
; in the originating data base
; DUR(INSN,"DUR PPS",SEQ,"OTHER PHARMACY INDICATOR") - Code for the type of
; pharmacy dispensing the conflicting drug
; DUR(INSN,"DUR PPS",SEQ,"PREVIOUS DATE OF FILL") - Date prescription was
; previously filled
; DUR(INSN,"DUR PPS",SEQ,"QUANTITY OF PREVIOUS FILL") - Amount expressed in
; metric decimal units of the conflicting agent that was previously filled
; DUR(INSN,"DUR PPS",SEQ,"DATABASE INDICATOR") - Code identifying the source
; of drug information used for DUR processing
; DUR(INSN,"DUR PPS",SEQ,"OTHER PRESCRIBER INDICATOR") - Code comparing the
; prescriber of the current prescription to the prescriber of the previously
; filled conflicting prescription
; DUR(INSN,"DUR PPS",SEQ,"DUR FREE TEXT MESSAGE") - Text that provides
; additional detail regarding a DUR conflict
; DUR(INSN,"DUR PPS",SEQ,"DUR ADDITIONAL TEXT") - Descriptive information that
; further defines the referenced DUR alert
; DUR(INSN,"REJ CODE LST") - List of rejection code(s) returned by the payer
; separated by commas (i.e. 79,14)
; DUR(INSN,"REJ CODES",SEQ,REJ CODE) - Array of rejection code descriptions
; where REJ CODE correlates to DUR(INSN,"REJ CODE LST") value(s) and SEQ
; equals a sequential number
;
I '$G(DURIEN) Q
S BPRXCOB=+$G(BPRXCOB)
I BPRXCOB=0 S BPRXCOB=1 ;default is Primary
N ADDMESS,I,DUR1,CLMIEN
S DUR(BPRXCOB,"RESPONSE IEN")=DURIEN
;
;Get BIN from claim
S CLMIEN=$$GET1^DIQ(9002313.03,DURIEN,.01,"I")
S DUR(BPRXCOB,"BIN")=$$GET1^DIQ(9002313.02,CLMIEN_",",101) ; BIN Number
;
;Get PCN from claim
S DUR(BPRXCOB,"PCN")=$$GET1^DIQ(9002313.02,CLMIEN_",",104) ; PCN Number
;
; Get the Transmission specific data (Message)
S DUR(BPRXCOB,"MESSAGE")=$$GET1^DIQ(9002313.03,DURIEN_",",504,"E")
;
; Get the Additional Message Information from the transaction
D ADDMESS^BPSSCRLG(DURIEN,1,.ADDMESS)
M DUR(BPRXCOB,"PAYER MESSAGE")=ADDMESS
;
; Get the other transaction level data
D GETS^DIQ(9002313.0301,"1,"_DURIEN_",","501;567.01*","E","DUR1","ERROR")
S DUR(BPRXCOB,"STATUS")=$G(DUR1(9002313.0301,"1,"_DURIEN_",",501,"E")) ;Status of Response
;
; The following four fields are redundant with the fields in the DUR PPS
; multiple but are needed for backwards compatibility with the OP code
S DUR(BPRXCOB,"REASON")=$G(DUR1(9002313.1101,"1,1,"_DURIEN_",",439,"E")) ;Reason for Service Code
S DUR(BPRXCOB,"PREV FILL DATE")=$G(DUR1(9002313.1101,"1,1,"_DURIEN_",",530,"E")) ;Previous Date of Fill
S DUR(BPRXCOB,"DUR FREE TEXT DESC")=$G(DUR1(9002313.1101,"1,1,"_DURIEN_",",544,"E")) ;DUR Free Text Message from Payer
S DUR(BPRXCOB,"DUR ADD MSG TEXT")=$G(DUR1(9002313.1101,"1,1,"_DURIEN_",",570,"E")) ;DUR Additional Message Text from Payer
;
; Get DUR PPS RESPONSE multiple values
S DUR(BPRXCOB,"DUR PPS RESPONSE")=""
F I=1:1 Q:'$D(DUR1(9002313.1101,I_",1,"_DURIEN_",",.01)) D
. S DUR(BPRXCOB,"DUR PPS RESPONSE")=I
. S DUR(BPRXCOB,"DUR PPS",I,"DUR PPS RESPONSE")=$G(DUR1(9002313.1101,I_",1,"_DURIEN_",",.01,"E"))
. S DUR(BPRXCOB,"DUR PPS",I,"REASON FOR SERVICE CODE")=$G(DUR1(9002313.1101,I_",1,"_DURIEN_",",439,"E"))
. S DUR(BPRXCOB,"DUR PPS",I,"CLINICAL SIGNIFICANCE CODE")=$G(DUR1(9002313.1101,I_",1,"_DURIEN_",",528,"E"))
. S DUR(BPRXCOB,"DUR PPS",I,"OTHER PHARMACY INDICATOR")=$G(DUR1(9002313.1101,I_",1,"_DURIEN_",",529,"E"))
. S DUR(BPRXCOB,"DUR PPS",I,"PREVIOUS DATE OF FILL")=$G(DUR1(9002313.1101,I_",1,"_DURIEN_",",530,"E"))
. S DUR(BPRXCOB,"DUR PPS",I,"QUANTITY OF PREVIOUS FILL")=$G(DUR1(9002313.1101,I_",1,"_DURIEN_",",531,"E"))
. S DUR(BPRXCOB,"DUR PPS",I,"DATABASE INDICATOR")=$G(DUR1(9002313.1101,I_",1,"_DURIEN_",",532,"E"))
. S DUR(BPRXCOB,"DUR PPS",I,"OTHER PRESCRIBER INDICATOR")=$G(DUR1(9002313.1101,I_",1,"_DURIEN_",",533,"E"))
. S DUR(BPRXCOB,"DUR PPS",I,"DUR FREE TEXT MESSAGE")=$G(DUR1(9002313.1101,I_",1,"_DURIEN_",",544,"E"))
. S DUR(BPRXCOB,"DUR PPS",I,"DUR ADDITIONAL TEXT")=$G(DUR1(9002313.1101,I_",1,"_DURIEN_",",570,"E"))
;
; Get DUR reject codes and description and store in DUR
D GETS^DIQ(9002313.0301,"1,"_DURIEN_",","511*","I","DUR1","ERROR") ;get DUR codes and descriptions
S DUR(BPRXCOB,"REJ CODE LST")=""
F I=1:1 Q:'$D(DUR1(9002313.03511,I_",1,"_DURIEN_",")) D
. N REJX,REJN
. S REJX=$G(DUR1(9002313.03511,I_",1,"_DURIEN_",",.01,"I")) Q:REJX="" ; external reject code
. S REJN=+$O(^BPSF(9002313.93,"B",REJX,0)) Q:'REJN ; internal reject code ien
. S DUR(BPRXCOB,"REJ CODES",I,REJX)=$P($G(^BPSF(9002313.93,REJN,0)),U,2) ; reject code description
. S DUR(BPRXCOB,"REJ CODE LST")=DUR(BPRXCOB,"REJ CODE LST")_","_REJX
S DUR(BPRXCOB,"REJ CODE LST")=$E(DUR(BPRXCOB,"REJ CODE LST"),2,9999)
Q
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HBPSNCPD3 14195 printed Oct 16, 2024@17:52:04 Page 2
BPSNCPD3 ;BHAM ISC/LJE - Continuation of BPSNCPDP - DUR HANDLING ;06/16/2004
+1 ;;1.0;E CLAIMS MGMT ENGINE;**1,5,6,7,8,10,11,15,19,20,22,29**;JUN 2004;Build 41
+2 ;;Per VA Directive 6402, this routine should not be modified.
+3 ;
+4 ; Due to space considerations, these comments were moved from BPSNPCPD
+5 ; to this routine.
+6 ;
+7 ; ------------------ Beginning of BPSNCPDP comments ------------------
+8 ;Input
+9 ; BRXIEN = Prescription IEN
+10 ; BFILL = Fill Number
+11 ; DOS = Date of Service
+12 ; BWHERE (RX Action)
+13 ; AREV = Auto-Reversal
+14 ; BB = Back Billing
+15 ; CRLB = CMOP/OPAI Release & Rebill
+16 ; CRLR = CMOP/OPAI Release & Reverse (successful release)
+17 ; CRLX = CMOP/OPAI unsuccessful release & reverse
+18 ; CRRL = CMOP/OPAI Release - Original claim not paid, submit another claim, no reversal
+19 ; DC = Discontinue - only reverse un-released PAYABLE DC's, release date check
+20 ; should be in calling routine.
+21 ; DE = Delete
+22 ; ED = Edit (includes RX release with NDC edit)
+23 ; ERES = Resubmit from ECME user screen
+24 ; ERWV = Resubmit Without Reversal from ECME user screen (BPS*1*20)
+25 ; ERNB = Resubmit of a TRI/CVA non-billable entry from the ECME user screen (BPS*1*20)
+26 ; EREV = Reversal from ECME user screen
+27 ; HLD = Put prescription on Hold
+28 ; OREV = Reversal from Outpatient Pharmacy edit screen (BPS*1*20)
+29 ; RSNB = Resubmit Non-Billable TRICARE & CHAMPVA from PSO Reject Info Screen (BPS*1*20)
+30 ; OF = Original Fill
+31 ; P2 = Original submission from PRO Option, no reversal
+32 ; P2S = Resubmit from PRO Option
+33 ; PC = Pull CMOPs
+34 ; PE = Pull early from suspense
+35 ; PL = Pull local from suspense
+36 ; PP = Pull RX (PP) action from Patient Prescription Processing option
+37 ; RF = Refill
+38 ; RN = Renew
+39 ; RRL = Release - Original claim not paid, submit another claim, no reversal
+40 ; RS = Return-to-Stock
+41 ; BILLNDC = Valid NDC# with format 5-4-2
+42 ; REVREAS = Reversal Reason
+43 ; DURREC = String of up to three sets of DUR info. Sets are delimited with "~". Each set consists of three "^" pieces:
+44 ; Reason for Service Code
+45 ; Professional Service Code
+46 ; Result of Service Code
+47 ; BPOVRIEN = Pointer to BPS NCPDP OVERIDE file. This parameter will
+48 ; only be passed if there are overrides entered by the
+49 ; user via the Resubmit with Edits (RED) option in the
+50 ; user screen.
+51 ; BPSAUTH = Prior authorization code (Prior auth code^Prior auth number)
+52 ; BPSCLARF = Submission Clarification Code (external value from #9002313.25), entered by
+53 ; pharmacist and passed by Outpatient Pharmacy to ECME to put into the claim
+54 ; BPCOBIND = (optional, default is Primary) for COB indicators - so when the API is called for the particular
+55 ; COB claim the BPSNCPDP can handle it.
+56 ; BPJOBFLG = (optional, default is "F") B - if is called by unqueueing logic in background, F - by other (foreground) process,
+57 ; BPREQIEN = (optional) ien of BPS REQUEST file record, that needs to be unqueued
+58 ; BPSCLOSE = (optional) local array used with BWHERE="EREV" only, if the user had chosen to close the claim after reversal
+59 ; if claim needs to be closed then
+60 ; BPSCLOSE("CLOSE AFT REV")=1
+61 ; BPSCLOSE("CLOSE AFT REV REASON")=<#356.8 ien>
+62 ; BPSCLOSE("CLOSE AFT REV COMMENT")=<some text>
+63 ; BPSPLAN = (optional) IEN of the entry in the GROUP INSURANCE PLAN file (#355.3)
+64 ; BPSPRDAT = (optional) local array passed by reference. Contains primary claim data needed to submit a secondary claim.
+65 ; Format: BPSPRDAT(NCPDP field)
+66 ; BPSRTYPE = (optional) rate type ( ien of the file #399.3)
+67 ; BPSDELAY = Delay Reason Code (IEN of BPS NCPDP DELAY REASON CODE (#9002313.29), entered by the user
+68 ; in the Back Billing option of Claims Tracking and passed to ECME to put into the claim.
+69 ;
+70 ;Output (RESPONSE^MESSAGE^ELIGIBILITY^CLAIMSTATUS^COB^RXCOB^INSURANCE)
+71 ; RESPONSE
+72 ; 0 Submitted through ECME
+73 ; 1 No submission through ECME
+74 ; 2 IB not billable
+75 ; 3 Claim was closed, not submitted (RTS/Deletes)
+76 ; 4 Unable to queue claim
+77 ; 5 Incorrect information supplied to ECME
+78 ; 6 Inactive ECME - Primarily used for TRICARE/CHAMPVA to say ok to process rx
+79 ; 10 Reversal but no resubmit
+80 ; MESSAGE = Message associated with the response (error/submitted)
+81 ; ELIGIBILITY = V - Veteran, T - TRICARE, C - CHAMPVA
+82 ; CLAIMSTATUS = claim status (null or IN PROGRESS/E PAYABLE/etc...)
+83 ; COB = Coordination Of Benefit indicator of the insurance as it is stored in the PATIENT file: 1-primary, 2-secondary, 3-tertiary
+84 ; RXCOB = the payer sequence indicator of the claim which was sent to the payer as a result of this call: 1-primary, 2-secondary)
+85 ; INSURANCE = Name of the insurance company that was billed as a result of this call
+86 ;
+87 ; ----------------- End of BPSNCPDP comments ----------------------
+88 ;
+89 ; ----------------- DUR1 ------------------------------------------
+90 ; DUR1 is called by PSO to get the reject information
+91 ;
+92 ;
+93 ; IA 4560 supports OP's use of this procedure
+94 ;
+95 ; Function call for DUR INFORMATION
+96 ; Parameters: BRXIEN = Prescription IEN
+97 ; BFILL = fill number
+98 ; DUR = DUR info passed back
+99 ; ERROR = error passed back
+100 ; BPRXCOB = payer sequence
+101 ; Note:
+102 ; DUR("BILLED")=0 if ecme off for pharmacy or no transaction in ECME
+103 ; DUR(<Insurance counter>,"BILLED")=1 if billed through ecme
DUR1(BRXIEN,BFILL,DUR,ERROR,BPRXCOB) ;
+1 NEW SITE,IEN59,DUR1,DURIEN
+2 IF '$GET(BRXIEN)
SET DUR("BILLED")=0
QUIT
+3 IF $GET(BFILL)=""
SET DUR("BILLED")=0
QUIT
+4 SET BPRXCOB=+$GET(BPRXCOB)
+5 ;default is Primary
IF BPRXCOB=0
SET BPRXCOB=1
+6 ;
+7 ; Get Site info and check is ECME is turned on
+8 ; If not, set DUR("BILLED")=0 and quit
+9 IF '$GET(BFILL)
SET SITE=$$RXAPI1^BPSUTIL1(BRXIEN,20,"I")
+10 IF $GET(BFILL)
SET SITE=$$RXSUBF1^BPSUTIL1(BRXIEN,52,52.1,BFILL,8,"I")
+11 IF '$$ECMEON^BPSUTIL(SITE)
SET DUR("BILLED")=0
QUIT
+12 ;
+13 ; Set up the Transaction IEN
+14 SET IEN59=$$IEN59^BPSOSRX(BRXIEN,BFILL,BPRXCOB)
+15 IF IEN59=""
SET DUR("BILLED")=0
QUIT
+16 ;
+17 ; If the transaction record does not exist, set DUR("BILLED")=0 and quit
+18 IF '$DATA(^BPST(IEN59))
SET DUR("BILLED")=0
QUIT
+19 IF $$GET1^DIQ(9002313.59,IEN59,301)="NOT INSURED"
SET DUR("BILLED")=0
QUIT
+20 ;
+21 SET DUR(BPRXCOB,"BILLED")=1
+22 ;
+23 SET DUR(BPRXCOB,"ELIGBLT")=$PIECE($GET(^BPST(IEN59,9)),U,4)
+24 ; Get Insurance Info and set into DUR array
+25 ; Insurance Company IEN
SET DUR(BPRXCOB,"INSURANCE POINTER")=$$GET1^DIQ(9002313.59902,"1,"_IEN59_",",902.33,"I")
+26 DO GETS^DIQ(9002313.59902,"1,"_IEN59_",","902.05;902.06;902.24;902.25;902.26","E","DUR1","ERROR")
+27 ; Insurance Company Name
SET DUR(BPRXCOB,"INSURANCE NAME")=$GET(DUR1(9002313.59902,"1,"_IEN59_",",902.24,"E"))
+28 ; Insurance Group Number
SET DUR(BPRXCOB,"GROUP NUMBER")=$GET(DUR1(9002313.59902,"1,"_IEN59_",",902.05,"E"))
+29 ; Insurance Group Name
SET DUR(BPRXCOB,"GROUP NAME")=$GET(DUR1(9002313.59902,"1,"_IEN59_",",902.25,"E"))
+30 ; Insurance Contact Number
SET DUR(BPRXCOB,"PLAN CONTACT")=$GET(DUR1(9002313.59902,"1,"_IEN59_",",902.26,"E"))
+31 ; Cardholder ID
SET DUR(BPRXCOB,"CARDHOLDER ID")=$GET(DUR1(9002313.59902,"1,"_IEN59_",",902.06,"E"))
+32 ;
+33 ; Get Response IEN and Data
+34 SET DURIEN=""
SET DURIEN=$PIECE(^BPST(IEN59,0),"^",5)
+35 ; Note: In the future, we may need to get/store DURIEN for each COB
DO DURRESP(DURIEN,.DUR,BPRXCOB)
+36 QUIT
+37 ;
DURRESP(DURIEN,DUR,BPRXCOB) ;
+1 ;Input Variables:
+2 ; DURIEN - Claim Response IEN. Pointer to the BPS RESPONSES File #9002313.03
+3 ; BPRXCOB - (Optional) The Payer Sequence:
+4 ; 1 - Primary (default)
+5 ; 2 - Secondary
+6 ;
+7 ;Output Variables:
+8 ; DUR - Array of DUR related information for a specific claim response in the
+9 ; BPS RESPONSES file in the following format (INSN is the Payer Sequence):
+10 ;
+11 ; DUR(INSN,"RESPONSE IEN") - Pointer to the RESPONSE file (#9002313.03) for
+12 ; the claim submission
+13 ; DUR(INSN,"PCN") - Processor Control Number
+14 ; DUR(INSN,"MESSAGE") - The Transmission level specific data, Message field 504
+15 ; DUR(INSN,"PAYER MESSAGE") - Message returned from the payer in the Transaction
+16 ; level
+17 ; DUR(INSN,"STATUS") - Status of the claim (i.e. REJECTED CLAIM, PAYABLE)
+18 ;
+19 ; The following four fields are redundant with the fields in the DUR PPS
+20 ; array but are provided for backwards compatibility.
+21 ; DUR(INSN,"REASON") - Reason for Service Code pointer to BPS NCPDP REASON FOR
+22 ; SERVICE CODE file (#9002313.23)
+23 ; DUR(INSN,"PREV FILL DATE") - Plan's Previous Fill Date
+24 ; DUR(INSN,"DUR FREE TEXT DESC") - Drug Utilization Review (DUR) description
+25 ; and/or claims rejection free text information from the payer
+26 ; DUR(INSN,"DUR ADD MSG TEXT") - Drug Utilization Review (DUR) additional free
+27 ; text information from the payer
+28 ;
+29 ; The following fields are from the DUR PPS RESPONSE multiple.
+30 ; DUR(INSN,"DUR PPS",SEQ,"DUR PPS RESPONSE") - Total number of DUR PPS
+31 ; responses from the payer
+32 ; DUR(INSN,"DUR PPS",SEQ,"REASON FOR SERVICE CODE") - Code identifying the
+33 ; type of utilization conflict detected or the reason for the pharmacist
+34 ; professional service
+35 ; DUR(INSN,"DUR PPS",SEQ,"CLINICAL SIGNIFICANCE CODE") - Code identifying
+36 ; the significance or severity level of a clinical event as contained
+37 ; in the originating data base
+38 ; DUR(INSN,"DUR PPS",SEQ,"OTHER PHARMACY INDICATOR") - Code for the type of
+39 ; pharmacy dispensing the conflicting drug
+40 ; DUR(INSN,"DUR PPS",SEQ,"PREVIOUS DATE OF FILL") - Date prescription was
+41 ; previously filled
+42 ; DUR(INSN,"DUR PPS",SEQ,"QUANTITY OF PREVIOUS FILL") - Amount expressed in
+43 ; metric decimal units of the conflicting agent that was previously filled
+44 ; DUR(INSN,"DUR PPS",SEQ,"DATABASE INDICATOR") - Code identifying the source
+45 ; of drug information used for DUR processing
+46 ; DUR(INSN,"DUR PPS",SEQ,"OTHER PRESCRIBER INDICATOR") - Code comparing the
+47 ; prescriber of the current prescription to the prescriber of the previously
+48 ; filled conflicting prescription
+49 ; DUR(INSN,"DUR PPS",SEQ,"DUR FREE TEXT MESSAGE") - Text that provides
+50 ; additional detail regarding a DUR conflict
+51 ; DUR(INSN,"DUR PPS",SEQ,"DUR ADDITIONAL TEXT") - Descriptive information that
+52 ; further defines the referenced DUR alert
+53 ; DUR(INSN,"REJ CODE LST") - List of rejection code(s) returned by the payer
+54 ; separated by commas (i.e. 79,14)
+55 ; DUR(INSN,"REJ CODES",SEQ,REJ CODE) - Array of rejection code descriptions
+56 ; where REJ CODE correlates to DUR(INSN,"REJ CODE LST") value(s) and SEQ
+57 ; equals a sequential number
+58 ;
+59 IF '$GET(DURIEN)
QUIT
+60 SET BPRXCOB=+$GET(BPRXCOB)
+61 ;default is Primary
IF BPRXCOB=0
SET BPRXCOB=1
+62 NEW ADDMESS,I,DUR1,CLMIEN
+63 SET DUR(BPRXCOB,"RESPONSE IEN")=DURIEN
+64 ;
+65 ;Get BIN from claim
+66 SET CLMIEN=$$GET1^DIQ(9002313.03,DURIEN,.01,"I")
+67 ; BIN Number
SET DUR(BPRXCOB,"BIN")=$$GET1^DIQ(9002313.02,CLMIEN_",",101)
+68 ;
+69 ;Get PCN from claim
+70 ; PCN Number
SET DUR(BPRXCOB,"PCN")=$$GET1^DIQ(9002313.02,CLMIEN_",",104)
+71 ;
+72 ; Get the Transmission specific data (Message)
+73 SET DUR(BPRXCOB,"MESSAGE")=$$GET1^DIQ(9002313.03,DURIEN_",",504,"E")
+74 ;
+75 ; Get the Additional Message Information from the transaction
+76 DO ADDMESS^BPSSCRLG(DURIEN,1,.ADDMESS)
+77 MERGE DUR(BPRXCOB,"PAYER MESSAGE")=ADDMESS
+78 ;
+79 ; Get the other transaction level data
+80 DO GETS^DIQ(9002313.0301,"1,"_DURIEN_",","501;567.01*","E","DUR1","ERROR")
+81 ;Status of Response
SET DUR(BPRXCOB,"STATUS")=$GET(DUR1(9002313.0301,"1,"_DURIEN_",",501,"E"))
+82 ;
+83 ; The following four fields are redundant with the fields in the DUR PPS
+84 ; multiple but are needed for backwards compatibility with the OP code
+85 ;Reason for Service Code
SET DUR(BPRXCOB,"REASON")=$GET(DUR1(9002313.1101,"1,1,"_DURIEN_",",439,"E"))
+86 ;Previous Date of Fill
SET DUR(BPRXCOB,"PREV FILL DATE")=$GET(DUR1(9002313.1101,"1,1,"_DURIEN_",",530,"E"))
+87 ;DUR Free Text Message from Payer
SET DUR(BPRXCOB,"DUR FREE TEXT DESC")=$GET(DUR1(9002313.1101,"1,1,"_DURIEN_",",544,"E"))
+88 ;DUR Additional Message Text from Payer
SET DUR(BPRXCOB,"DUR ADD MSG TEXT")=$GET(DUR1(9002313.1101,"1,1,"_DURIEN_",",570,"E"))
+89 ;
+90 ; Get DUR PPS RESPONSE multiple values
+91 SET DUR(BPRXCOB,"DUR PPS RESPONSE")=""
+92 FOR I=1:1
if '$DATA(DUR1(9002313.1101,I_",1,"_DURIEN_",",.01))
QUIT
Begin DoDot:1
+93 SET DUR(BPRXCOB,"DUR PPS RESPONSE")=I
+94 SET DUR(BPRXCOB,"DUR PPS",I,"DUR PPS RESPONSE")=$GET(DUR1(9002313.1101,I_",1,"_DURIEN_",",.01,"E"))
+95 SET DUR(BPRXCOB,"DUR PPS",I,"REASON FOR SERVICE CODE")=$GET(DUR1(9002313.1101,I_",1,"_DURIEN_",",439,"E"))
+96 SET DUR(BPRXCOB,"DUR PPS",I,"CLINICAL SIGNIFICANCE CODE")=$GET(DUR1(9002313.1101,I_",1,"_DURIEN_",",528,"E"))
+97 SET DUR(BPRXCOB,"DUR PPS",I,"OTHER PHARMACY INDICATOR")=$GET(DUR1(9002313.1101,I_",1,"_DURIEN_",",529,"E"))
+98 SET DUR(BPRXCOB,"DUR PPS",I,"PREVIOUS DATE OF FILL")=$GET(DUR1(9002313.1101,I_",1,"_DURIEN_",",530,"E"))
+99 SET DUR(BPRXCOB,"DUR PPS",I,"QUANTITY OF PREVIOUS FILL")=$GET(DUR1(9002313.1101,I_",1,"_DURIEN_",",531,"E"))
+100 SET DUR(BPRXCOB,"DUR PPS",I,"DATABASE INDICATOR")=$GET(DUR1(9002313.1101,I_",1,"_DURIEN_",",532,"E"))
+101 SET DUR(BPRXCOB,"DUR PPS",I,"OTHER PRESCRIBER INDICATOR")=$GET(DUR1(9002313.1101,I_",1,"_DURIEN_",",533,"E"))
+102 SET DUR(BPRXCOB,"DUR PPS",I,"DUR FREE TEXT MESSAGE")=$GET(DUR1(9002313.1101,I_",1,"_DURIEN_",",544,"E"))
+103 SET DUR(BPRXCOB,"DUR PPS",I,"DUR ADDITIONAL TEXT")=$GET(DUR1(9002313.1101,I_",1,"_DURIEN_",",570,"E"))
End DoDot:1
+104 ;
+105 ; Get DUR reject codes and description and store in DUR
+106 ;get DUR codes and descriptions
DO GETS^DIQ(9002313.0301,"1,"_DURIEN_",","511*","I","DUR1","ERROR")
+107 SET DUR(BPRXCOB,"REJ CODE LST")=""
+108 FOR I=1:1
if '$DATA(DUR1(9002313.03511,I_",1,"_DURIEN_","))
QUIT
Begin DoDot:1
+109 NEW REJX,REJN
+110 ; external reject code
SET REJX=$GET(DUR1(9002313.03511,I_",1,"_DURIEN_",",.01,"I"))
if REJX=""
QUIT
+111 ; internal reject code ien
SET REJN=+$ORDER(^BPSF(9002313.93,"B",REJX,0))
if 'REJN
QUIT
+112 ; reject code description
SET DUR(BPRXCOB,"REJ CODES",I,REJX)=$PIECE($GET(^BPSF(9002313.93,REJN,0)),U,2)
+113 SET DUR(BPRXCOB,"REJ CODE LST")=DUR(BPRXCOB,"REJ CODE LST")_","_REJX
End DoDot:1
+114 SET DUR(BPRXCOB,"REJ CODE LST")=$EXTRACT(DUR(BPRXCOB,"REJ CODE LST"),2,9999)
+115 QUIT
