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=$$IEN59^BPSOSRX(+BPRXRF,$P(BPRXRF,U,2)) ;calculate BPS TRANSACTION ien (even if it doesn't exist yet)
. . I $D(@BPTMP@(BP59)) Q ;don't create an entry if the claim is already there
. . S @BPTMP@(BP59)=(BPLDT77\1)_"^77-"
Q
;
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HBPSNCPD6 5655 printed Oct 16, 2024@17:52:07 Page 2
BPSNCPD6 ;ALB/SS - Pharmacy API part 6 ;10-JAN-08
+1 ;;1.0;E CLAIMS MGMT ENGINE;**7,8,10,11,20**;JUN 2004;Build 27
+2 ;;Per VA Directive 6402, this routine should not be modified.
+3 ;
+4 ;All of the entry points in this routine except LOOK77 were
+5 ; created from code that was copied from BPSNCPDP because BPSNCPDP
+6 ; was too big. The variables are newed in BPSNCPDP and returned back
+7 ; to BPSNCPDP
+8 ;== New Claim
NEWCLAIM ;
+1 SET BPRETV=$$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 ;
