BPSNCPD6.m

BPSNCPD6 ;ALB/SS - Pharmacy API part 6 ;10-JAN-08

 ;;1.0;E CLAIMS MGMT ENGINE;**7,8,10,11,20**;JUN 2004;Build 27

 ;;Per VA Directive 6402, this routine should not be modified.

 ;

 ;All of the entry points in this routine except LOOK77 were 

 ; created from code that was copied from BPSNCPDP because BPSNCPDP 

 ; was too big.  The variables are newed in BPSNCPDP and returned back

 ; to BPSNCPDP

 ;== New Claim 

NEWCLAIM ;

 S BPRETV=$$NEWCLM^BPSNCPD5(.BP77NEW,BRXIEN,BFILL,DOS,BWHERE,BILLNDC,REVREAS,DURREC,BPOVRIEN,BPSCLARF,BPSAUTH,BPSDELAY,BPCOBIND,BPJOBFLG,IEN59,BPACTTYP,DFN,.BPSTART,$G(BPREQIEN),.BPSELIG,$G(BPSRTYPE),$G(BPSPLAN),.BPSPRDAT)

 S RESPONSE=+BPRETV

 ;to make LOG backward compatible

 D LOG^BPSOSL(IEN59,$T(+0)_"-After Submit of Claim.  Return Value: "_$S(RESPONSE=0:1,1:0))

 S CLMSTAT=$P(BPRETV,U,2)

 D DISPL^BPSNCPD4(WFLG,BPRETV,$G(BPSELIG))

 I RESPONSE=0 Q

 D LOG^BPSOSL(IEN59,$T(+0)_"-"_CLMSTAT)

 Q

 ;

 ;== Reversals for Payable claims

 ;(Note: BPSCLOSE parameter of EN^BPSNCPDP can be used in this case)

RVPAID ;

 S BPRETV=$$REVERSAL^BPSNCPD5(.BP77NEW,BRXIEN,BFILL,OLDRESP,DOS,BWHERE,$G(BILLNDC),REVREAS,DURREC,BPOVRIEN,BPSCLARF,BPSAUTH,BPSDELAY,IEN59,BPCOBIND,BPJOBFLG,BPACTTYP,.BPSTART,$G(BPREQIEN),.BPSCLOSE,$G(BPSRTYPE),.BPSPRDAT)

 S RESPONSE=+BPRETV

 ;to make LOG backward compatible

 D LOG^BPSOSL(IEN59,$T(+0)_"-After Submit of Reversal. Return Value: "_$S(RESPONSE=0:1,1:0))

 S CLMSTAT=$P(BPRETV,U,2)

 I BWHERE'="EREV" D DISPL^BPSNCPD4(WFLG,BPRETV,$G(BPSELIG))

 I RESPONSE=0 Q

 D LOG^BPSOSL(IEN59,$T(+0)_"-"_CLMSTAT)

 Q

 ;

 ;== Reversals+Resubmits for Payable claims

RVRSPAID ;

 S BPRETV=$$REVRESUB^BPSNCPD4(.BP77NEW,BRXIEN,BFILL,DOS,BWHERE,BILLNDC,REVREAS,DURREC,BPOVRIEN,BPSCLARF,BPSAUTH,BPSDELAY,BPCOBIND,BPJOBFLG,IEN59,DFN,.BPSTART,$G(BPREQIEN),OLDRESP,.BPSELIG,$G(BPSRTYPE),$G(BPSPLAN),.BPSPRDAT)

 S RESPONSE=+BPRETV

 ;if "Reversal only not resubmit" - display a message for the user

 I RESPONSE=10 D DISPL^BPSNCPD4(WFLG,"10^Claim Will Be Reversed But Will Not Be Resubmitted^D^2",$G(BPSELIG))

 ;to make LOG backward compatible

 D LOG^BPSOSL(IEN59,$T(+0)_"-After Submit of Reversal. Return Value: "_$S(RESPONSE=0:1,1:0))

 D DISPL^BPSNCPD4(WFLG,BPRETV,$G(BPSELIG))

 I RESPONSE=10 S CLMSTAT=$P(BPRETV,U,5) Q

 S CLMSTAT=$P(BPRETV,U,2)

 I RESPONSE=0 Q

 D LOG^BPSOSL(IEN59,$T(+0)_"-"_CLMSTAT)

 Q

 ;

 ;== Resubmits for Payable claims - DO NOT resubmit

RSPAID ;

 S RESPONSE=1

 ; Message varies depending the the previous response

 ; Reversal Accepted would not get here so this must be rejected, stranded, or other

 I OLDRESP["REVERSAL" S CLMSTAT="Can not resubmit a rejected or stranded reversal"

 E  S CLMSTAT="Previously billed through ECME: "_OLDRESP

 D DISPL^BPSNCPD4(WFLG,RESPONSE_U_CLMSTAT_"^D^2",$G(BPSELIG))

 D LOG^BPSOSL(IEN59,$T(+0)_"-"_CLMSTAT)

 Q

 ;== Reversals for Non-Payable claims - DO NOT reverse

RVNPAID ;

 ;if this is return to stock OR delete - close the claim

 I ",RS,DE,"[(","_BWHERE_",") D  Q

 . D CLOSE2^BPSBUTL(BRXIEN,BFILL,BWHERE)

 . S RESPONSE=3

 . S CLMSTAT="Claim was not payable so it has been closed.  No ECME claim created."

 . D DISPL^BPSNCPD4(WFLG,RESPONSE_U_CLMSTAT_"^D^2",$G(BPSELIG))

 . D LOG^BPSOSL(IEN59,$T(+0)_"-"_CLMSTAT)

 S RESPONSE=1

 S CLMSTAT="Claim has status "_OLDRESP_".  Not reversed."

 D DISPL^BPSNCPD4(WFLG,RESPONSE_U_CLMSTAT_"^D^2",$G(BPSELIG))

 D LOG^BPSOSL(IEN59,$T(+0)_"-"_CLMSTAT)

 Q

 ;

 ;== Resubmits AND Reversals+Resubmits for Non-Payable claims

 ;==  Also used for Resubmits without Reversals no matter the claim status (BPS*1*20)

RVRSNPD ;

 ; resubmit a claim

 S BPRETV=$$REVRESNP^BPSNCPD5(.BP77NEW,BRXIEN,BFILL,DOS,BWHERE,BILLNDC,REVREAS,DURREC,BPOVRIEN,BPSCLARF,BPSAUTH,BPSDELAY,BPCOBIND,BPJOBFLG,IEN59,BPACTTYP,DFN,.BPSTART,$G(BPREQIEN),OLDRESP,.BPSELIG,$G(BPSRTYPE),$G(BPSPLAN),.BPSPRDAT)

 S RESPONSE=+BPRETV

 ;to make LOG backward compatible

 I BWHERE'="ERWV" D LOG^BPSOSL(IEN59,$T(+0)_"-After Submit of Reversal. Return Value: "_$S(RESPONSE=0:1,1:0))

 I BWHERE="ERWV" D LOG^BPSOSL(IEN59,$T(+0)_"-After Submit of Claim w/o Reversal. Return Value: "_$S(RESPONSE=0:1,1:0))

 S CLMSTAT=$P(BPRETV,U,2)

 D DISPL^BPSNCPD4(WFLG,BPRETV,$G(BPSELIG))

 I RESPONSE=0 Q

 D LOG^BPSOSL(IEN59,$T(+0)_"-"_CLMSTAT)

 Q

 ;

 ; if Back Billing

BB ;

 S RESPONSE=1

 S CLMSTAT="Previously billed through ECME: "_OLDRESP

 D DISPL^BPSNCPD4(WFLG,RESPONSE_U_CLMSTAT_"^D^2",$G(BPSELIG))

 D LOG^BPSOSL(IEN59,$T(+0)_"-"_CLMSTAT)

 Q

 ;

 ; if we do not have a status for pre-existing claim AND this is a reversal request - DO NOT reverse

RVNEW ;

 S RESPONSE=1

 S CLMSTAT="Prescription not previously billed through ECME.  Cannot Reverse claim."

 D DISPL^BPSNCPD4(WFLG,RESPONSE_U_CLMSTAT_"^D^2",$G(BPSELIG))

 D LOG^BPSOSL(IEN59,$T(+0)_"-"_CLMSTAT)

 Q

 ;

 ; This was meant to called by BPSSCR04 to collect requests for the User Screen that don't have BPS TRANSACTION records 

 ; However, it is currently not called.  This is still here in case, it is needed in the future.  The call that should

 ; be used is D LOOK77^BPSNCPD6(BPBDT,BPEDT,BPTMP1)

LOOK77(BPBEGDT,BPENDDT,BPTMP) ;

 N BPLDT77,BP77,BP59,BPRXRF

 S BPLDT77=BPBEGDT-0.00001

 F  S BPLDT77=+$O(^BPS(9002313.77,"E",BPLDT77)) Q:BPLDT77=0!(BPLDT77>BPENDDT)  D

 . S BP77=0 F  S BP77=$O(^BPS(9002313.77,"E",BPLDT77,BP77)) Q:+BP77=0  D

 . . S BPRXRF=$P($G(^BPS(9002313.77,BP77,0)),U,1,2)

 . . S BP59=$$IEN59^BPSOSRX(+BPRXRF,$P(BPRXRF,U,2)) ;calculate BPS TRANSACTION ien (even if it doesn't exist yet)

 . . I $D(@BPTMP@(BP59)) Q  ;don't create an entry if the claim is already there

 . . S @BPTMP@(BP59)=(BPLDT77\1)_"^77-"

 Q

 ;

--- Routine Detail   --- with STRUCTURED ROUTINE LISTING ---BPSNCPD6   5655     printed  Mar 13, 2025@20:55:58                                                                                                                                                                                                    Page 2

BPSNCPD6  ;ALB/SS - Pharmacy API part 6 ;10-JAN-08

 +1       ;;1.0;E CLAIMS MGMT ENGINE;**7,8,10,11,20**;JUN 2004;Build 27

 +2       ;;Per VA Directive 6402, this routine should not be modified.

 +3       ;

 +4       ;All of the entry points in this routine except LOOK77 were 

 +5       ; created from code that was copied from BPSNCPDP because BPSNCPDP 

 +6       ; was too big.  The variables are newed in BPSNCPDP and returned back

 +7       ; to BPSNCPDP

 +8       ;== New Claim 

NEWCLAIM  ;

 +1        SET BPRETV=$$NEWCLM^BPSNCPD5(.BP77NEW,BRXIEN,BFILL,DOS,BWHERE,BILLNDC,REVREAS,DURREC,BPOVRIEN,BPSCLARF,BPSAUTH,BPSDELAY,BPCOBIND,BPJOBFLG,IEN59,BPACTTYP,DFN,.BPSTART,$GET(BPREQIEN),.BPSELIG,$GET(BPSRTYPE),$GET(BPSPLAN),.BPSPRDAT)

 +2        SET RESPONSE=+BPRETV

 +3       ;to make LOG backward compatible

 +4        DO LOG^BPSOSL(IEN59,$TEXT(+0)_"-After Submit of Claim.  Return Value: "_$SELECT(RESPONSE=0:1,1:0))

 +5        SET CLMSTAT=$PIECE(BPRETV,U,2)

 +6        DO DISPL^BPSNCPD4(WFLG,BPRETV,$GET(BPSELIG))

 +7        IF RESPONSE=0

               QUIT 

 +8        DO LOG^BPSOSL(IEN59,$TEXT(+0)_"-"_CLMSTAT)

 +9        QUIT 

 +10      ;

 +11      ;== Reversals for Payable claims

 +12      ;(Note: BPSCLOSE parameter of EN^BPSNCPDP can be used in this case)

RVPAID    ;

 +1        SET BPRETV=$$REVERSAL^BPSNCPD5(.BP77NEW,BRXIEN,BFILL,OLDRESP,DOS,BWHERE,$GET(BILLNDC),REVREAS,DURREC,BPOVRIEN,BPSCLARF,BPSAUTH,BPSDELAY,IEN59,BPCOBIND,BPJOBFLG,BPACTTYP,.BPSTART,$GET(BPREQIEN),.BPSCLOSE,$GET(BPSRTYPE),.BPSPRDAT)

 +2        SET RESPONSE=+BPRETV

 +3       ;to make LOG backward compatible

 +4        DO LOG^BPSOSL(IEN59,$TEXT(+0)_"-After Submit of Reversal. Return Value: "_$SELECT(RESPONSE=0:1,1:0))

 +5        SET CLMSTAT=$PIECE(BPRETV,U,2)

 +6        IF BWHERE'="EREV"

               DO DISPL^BPSNCPD4(WFLG,BPRETV,$GET(BPSELIG))

 +7        IF RESPONSE=0

               QUIT 

 +8        DO LOG^BPSOSL(IEN59,$TEXT(+0)_"-"_CLMSTAT)

 +9        QUIT 

 +10      ;

 +11      ;== Reversals+Resubmits for Payable claims

RVRSPAID  ;

 +1        SET BPRETV=$$REVRESUB^BPSNCPD4(.BP77NEW,BRXIEN,BFILL,DOS,BWHERE,BILLNDC,REVREAS,DURREC,BPOVRIEN,BPSCLARF,BPSAUTH,BPSDELAY,BPCOBIND,BPJOBFLG,IEN59,DFN,.BPSTART,$GET(BPREQIEN),OLDRESP,.BPSELIG,$GET(BPSRTYPE),$GET(BPSPLAN),.BPSPRDAT)

 +2        SET RESPONSE=+BPRETV

 +3       ;if "Reversal only not resubmit" - display a message for the user

 +4        IF RESPONSE=10

               DO DISPL^BPSNCPD4(WFLG,"10^Claim Will Be Reversed But Will Not Be Resubmitted^D^2",$GET(BPSELIG))

 +5       ;to make LOG backward compatible

 +6        DO LOG^BPSOSL(IEN59,$TEXT(+0)_"-After Submit of Reversal. Return Value: "_$SELECT(RESPONSE=0:1,1:0))

 +7        DO DISPL^BPSNCPD4(WFLG,BPRETV,$GET(BPSELIG))

 +8        IF RESPONSE=10

               SET CLMSTAT=$PIECE(BPRETV,U,5)

               QUIT 

 +9        SET CLMSTAT=$PIECE(BPRETV,U,2)

 +10       IF RESPONSE=0

               QUIT 

 +11       DO LOG^BPSOSL(IEN59,$TEXT(+0)_"-"_CLMSTAT)

 +12       QUIT 

 +13      ;

 +14      ;== Resubmits for Payable claims - DO NOT resubmit

RSPAID    ;

 +1        SET RESPONSE=1

 +2       ; Message varies depending the the previous response

 +3       ; Reversal Accepted would not get here so this must be rejected, stranded, or other

 +4        IF OLDRESP["REVERSAL"

               SET CLMSTAT="Can not resubmit a rejected or stranded reversal"

 +5       IF '$TEST

               SET CLMSTAT="Previously billed through ECME: "_OLDRESP

 +6        DO DISPL^BPSNCPD4(WFLG,RESPONSE_U_CLMSTAT_"^D^2",$GET(BPSELIG))

 +7        DO LOG^BPSOSL(IEN59,$TEXT(+0)_"-"_CLMSTAT)

 +8        QUIT 

 +9       ;== Reversals for Non-Payable claims - DO NOT reverse

RVNPAID   ;

 +1       ;if this is return to stock OR delete - close the claim

 +2        IF ",RS,DE,"[(","_BWHERE_",")

               Begin DoDot:1

 +3                DO CLOSE2^BPSBUTL(BRXIEN,BFILL,BWHERE)

 +4                SET RESPONSE=3

 +5                SET CLMSTAT="Claim was not payable so it has been closed.  No ECME claim created."

 +6                DO DISPL^BPSNCPD4(WFLG,RESPONSE_U_CLMSTAT_"^D^2",$GET(BPSELIG))

 +7                DO LOG^BPSOSL(IEN59,$TEXT(+0)_"-"_CLMSTAT)

               End DoDot:1

               QUIT 

 +8        SET RESPONSE=1

 +9        SET CLMSTAT="Claim has status "_OLDRESP_".  Not reversed."

 +10       DO DISPL^BPSNCPD4(WFLG,RESPONSE_U_CLMSTAT_"^D^2",$GET(BPSELIG))

 +11       DO LOG^BPSOSL(IEN59,$TEXT(+0)_"-"_CLMSTAT)

 +12       QUIT 

 +13      ;

 +14      ;== Resubmits AND Reversals+Resubmits for Non-Payable claims

 +15      ;==  Also used for Resubmits without Reversals no matter the claim status (BPS*1*20)

RVRSNPD   ;

 +1       ; resubmit a claim

 +2        SET BPRETV=$$REVRESNP^BPSNCPD5(.BP77NEW,BRXIEN,BFILL,DOS,BWHERE,BILLNDC,REVREAS,DURREC,BPOVRIEN,BPSCLARF,BPSAUTH,BPSDELAY,BPCOBIND,BPJOBFLG,IEN59,BPACTTYP,DFN,.BPSTART,$GET(BPREQIEN),OLDRESP,.BPSELIG,$GET(BPSRTYPE),$GET(BPSPLAN),.BPSPRDAT)

 +3        SET RESPONSE=+BPRETV

 +4       ;to make LOG backward compatible

 +5        IF BWHERE'="ERWV"

               DO LOG^BPSOSL(IEN59,$TEXT(+0)_"-After Submit of Reversal. Return Value: "_$SELECT(RESPONSE=0:1,1:0))

 +6        IF BWHERE="ERWV"

               DO LOG^BPSOSL(IEN59,$TEXT(+0)_"-After Submit of Claim w/o Reversal. Return Value: "_$SELECT(RESPONSE=0:1,1:0))

 +7        SET CLMSTAT=$PIECE(BPRETV,U,2)

 +8        DO DISPL^BPSNCPD4(WFLG,BPRETV,$GET(BPSELIG))

 +9        IF RESPONSE=0

               QUIT 

 +10       DO LOG^BPSOSL(IEN59,$TEXT(+0)_"-"_CLMSTAT)

 +11       QUIT 

 +12      ;

 +13      ; if Back Billing

BB        ;

 +1        SET RESPONSE=1

 +2        SET CLMSTAT="Previously billed through ECME: "_OLDRESP

 +3        DO DISPL^BPSNCPD4(WFLG,RESPONSE_U_CLMSTAT_"^D^2",$GET(BPSELIG))

 +4        DO LOG^BPSOSL(IEN59,$TEXT(+0)_"-"_CLMSTAT)

 +5        QUIT 

 +6       ;

 +7       ; if we do not have a status for pre-existing claim AND this is a reversal request - DO NOT reverse

RVNEW     ;

 +1        SET RESPONSE=1

 +2        SET CLMSTAT="Prescription not previously billed through ECME.  Cannot Reverse claim."

 +3        DO DISPL^BPSNCPD4(WFLG,RESPONSE_U_CLMSTAT_"^D^2",$GET(BPSELIG))

 +4        DO LOG^BPSOSL(IEN59,$TEXT(+0)_"-"_CLMSTAT)

 +5        QUIT 

 +6       ;

 +7       ; This was meant to called by BPSSCR04 to collect requests for the User Screen that don't have BPS TRANSACTION records 

 +8       ; However, it is currently not called.  This is still here in case, it is needed in the future.  The call that should

 +9       ; be used is D LOOK77^BPSNCPD6(BPBDT,BPEDT,BPTMP1)

LOOK77(BPBEGDT,BPENDDT,BPTMP) ;

 +1        NEW BPLDT77,BP77,BP59,BPRXRF

 +2        SET BPLDT77=BPBEGDT-0.00001

 +3        FOR 

               SET BPLDT77=+$ORDER(^BPS(9002313.77,"E",BPLDT77))

               if BPLDT77=0!(BPLDT77>BPENDDT)

                   QUIT 

               Begin DoDot:1

 +4                SET BP77=0

                   FOR 

                       SET BP77=$ORDER(^BPS(9002313.77,"E",BPLDT77,BP77))

                       if +BP77=0

                           QUIT 

                       Begin DoDot:2

 +5                        SET BPRXRF=$PIECE($GET(^BPS(9002313.77,BP77,0)),U,1,2)

 +6       ;calculate BPS TRANSACTION ien (even if it doesn't exist yet)

                           SET BP59=$$IEN59^BPSOSRX(+BPRXRF,$PIECE(BPRXRF,U,2))

 +7       ;don't create an entry if the claim is already there

                           IF $DATA(@BPTMP@(BP59))

                               QUIT 

 +8                        SET @BPTMP@(BP59)=(BPLDT77\1)_"^77-"

                       End DoDot:2

               End DoDot:1

 +9        QUIT 

 +10      ;