BPSOSH2 ;BHAM ISC/SD/lwj/DLF - Assemble formatted claim ;06/01/2004
Source file <BPSOSH2.m>
Package | Total | Call Graph |
---|---|---|
E Claims Management Engine | 3 | $$NFF^BPSECFM $$VNUM^BPSECMPS GETFLDS^BPSOSHF |
VA FileMan | 1 | $$GET1^DIQ |
action | A | extended action | Ea | event driver | Ed | subscriber | Su | protocol | O | limited protocol | LP | run routine | RR | broker | B | edit | E | server | Se | P | screenman | SM | inquire | I |
Name | Comments | DBIA/ICR reference |
---|---|---|
XLOOP(NODES,IEN,BPS,REC) | ;EP - from BPSECA1
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SEGID(ND) | ; function, returns Segment ID
; Field 111 is the Segment Identifier - for each segment, other than ; the header, a unique value must be sent in this field ; to identify which segment is being sent. This value is not stored ; in the claim - as it changes with each of the 20 segments. The ; field does appear as part of the NCPDP Format, but is simply not stored. ; 01 = Patient 02 = Pharmacy Provider 03 = Prescriber ; 04 = Insurance 05 = COB/Other Payment 06 = Workers' Comp ; 07 = Claim 08 = DUR/PPS 09 = Coupon ; 10 = Compound 11 = Pricing 12 = Prior Auth ; 13 = Clinical 14 = Additional Doc 15 = Facility ; 16 = Narrative 17 = Purchaser 18 = Service Provider ; 19 = Intermediary 37 = Last Known 4Rx |
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PROCDUR | ; The DUR/PPS segment can repeat itself for any given
; transaction within a claim. This means we have to have special ; programming to handle the repeating fields. |
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PROCCOB | ;The COB OTHER PAYMENTS segment can repeat itself for any given
; transaction within a claim. This means we have to have special ; programming to handle the repeating fields. |
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AMTPAID | ; (#342) OTHER PAYER AMT PAID QUALIFIER multiple
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REJCODES | ; (#472) OTHER PAYER REJECT CODE
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PATPAID | ; (#353.01) OTHER PAYER-PATIENT RESPONSIBILITY multiple
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BENSTAGE | ; (#392.01) BENEFIT STAGE MLTPL multiple
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SUBCLAR(DATAFND,BPSIEN,SEGREC) | ;
; BPSIEN, SEGREC passed by ref., SEGREC is updated with repeating fields ; 420-DK Submission Clarification Code, a repeating group |
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OAMTCLMD(DATAFND,BPSIEN,SEGREC) | ;
; BPSIEN, SEGREC passed by ref., SEGREC updated with pairs of repeating fields ; (#478.01) OTHER AMT CLAIMED MULTIPLE (sub-file 9002313.0601) |
FileNo | Call Tags |
---|---|
^BPSC - [#9002313.02] | GET1^DIQ |
9002313.5112 | GET1^DIQ |
^BPST - [#9002313.59] | GET1^DIQ |
^BPSF(9002313.91 - [#9002313.91] | GET1^DIQ |
Name | Line Occurrences (* Changed, ! Killed) |
---|---|
^BPS(9002313.511 - [#9002313.511] | XLOOP+115 |
^BPSC - [#9002313.02] | SUBCLAR+11, SUBCLAR+15, SUBCLAR+16, OAMTCLMD+11, OAMTCLMD+12 |
^BPSF(9002313.9 - [#9002313.9] | XLOOP+112 |
^BPSF(9002313.91 - [#9002313.91] | XLOOP+51, XLOOP+58, PROCDUR+34, PROCCOB+26, AMTPAID+9, REJCODES+9, PATPAID+8, BENSTAGE+9 |
^BPSF(9002313.92 - [#9002313.92] | XLOOP+6, XLOOP+17, XLOOP+39, XLOOP+42, XLOOP+45 |
>> | Not killed explicitly |
* | Changed |
! | Killed |
~ | Newed |
Name | Field # of Occurrence |
---|---|
BPCOB | PROCCOB+6~, PROCCOB+19*, PROCCOB+20*, PROCCOB+28, AMTPAID+1~, AMTPAID+2*, AMTPAID+3*, AMTPAID+11, REJCODES+1~, REJCODES+2* , REJCODES+3*, REJCODES+11, PATPAID+1~, PATPAID+2*, PATPAID+3*, PATPAID+10, BENSTAGE+2~, BENSTAGE+3*, BENSTAGE+4*, BENSTAGE+11 |
BPS | XLOOP~ |
BPS( | XLOOP+7, XLOOP+61, XLOOP+64, XLOOP+90, XLOOP+129, XLOOP+130, PROCDUR+15, PROCDUR+28, PROCDUR+36, PROCCOB+9 , PROCCOB+20, PROCCOB+28, AMTPAID+3, AMTPAID+11, REJCODES+3, REJCODES+11, PATPAID+3, PATPAID+10, BENSTAGE+4, BENSTAGE+11 |
BPSD0 | SUBCLAR+7~, SUBCLAR+9*, SUBCLAR+11, SUBCLAR+15, SUBCLAR+16, OAMTCLMD+7~, OAMTCLMD+9*, OAMTCLMD+11, OAMTCLMD+12 |
BPSD1 | SUBCLAR+7~, SUBCLAR+9*, SUBCLAR+11, SUBCLAR+15, SUBCLAR+16, OAMTCLMD+7~, OAMTCLMD+9*, OAMTCLMD+11, OAMTCLMD+12 |
BPSD2 | SUBCLAR+7~, SUBCLAR+9*, SUBCLAR+15*, SUBCLAR+16, OAMTCLMD+7~, OAMTCLMD+9*, OAMTCLMD+11*, OAMTCLMD+12 |
BPSIEN | SUBCLAR~, OAMTCLMD~ |
BPSIEN( | SUBCLAR+4, SUBCLAR+5, SUBCLAR+9, OAMTCLMD+4, OAMTCLMD+5, OAMTCLMD+9 |
BPSX | XLOOP+3~, XLOOP+114*, XLOOP+115*, XLOOP+116 |
DATAFND | XLOOP+2~, XLOOP+26*, XLOOP+65*, XLOOP+72, XLOOP+75, XLOOP+96, PROCDUR+39*, PROCCOB+34*, AMTPAID+17*, REJCODES+17* , PATPAID+15*, BENSTAGE+16*, SUBCLAR~, SUBCLAR+19*, OAMTCLMD~, OAMTCLMD+19* |
DUR | PROCDUR+12~, PROCDUR+27*, PROCDUR+28*, PROCDUR+36 |
FDATA | XLOOP+2~, XLOOP+51*, XLOOP+52, XLOOP+53 |
FIELD | PROCDUR+12~, PROCDUR+23, PROCCOB+6~, PROCCOB+16 |
FIELD( | PROCDUR+30, PROCDUR+31, PROCDUR+32, PROCCOB+22, PROCCOB+23, PROCCOB+24, AMTPAID+5, AMTPAID+6, AMTPAID+7, REJCODES+5 , REJCODES+6, REJCODES+7, PATPAID+5, PATPAID+6, PATPAID+7, BENSTAGE+6, BENSTAGE+7, BENSTAGE+8 |
FLAG | XLOOP+2~ |
FLD | SEGID+14~, SEGID+16*, SEGID+17*, SEGID+19, PROCDUR+12~, PROCDUR+32*, PROCDUR+33*, PROCDUR+36, PROCCOB+6~, PROCCOB+24* , PROCCOB+25*, PROCCOB+28, PROCCOB+37, PROCCOB+38, PROCCOB+39, PROCCOB+40, AMTPAID+1~, AMTPAID+7*, AMTPAID+8*, AMTPAID+11 , REJCODES+1~, REJCODES+7*, REJCODES+8*, REJCODES+11, PATPAID+1~, PATPAID+7*, PATPAID+10, BENSTAGE+2~, BENSTAGE+8*, BENSTAGE+11 |
FLDDATA | XLOOP+2~, XLOOP+61*, XLOOP+64*, XLOOP+65, XLOOP+69*, XLOOP+78, XLOOP+80, XLOOP+81, XLOOP+90*, XLOOP+91 , XLOOP+129*, XLOOP+130*, XLOOP+132, XLOOP+137, XLOOP+138, PROCDUR+12~, PROCDUR+18*, PROCDUR+19, PROCDUR+36*, PROCDUR+37 , PROCDUR+39, PROCDUR+41, PROCCOB+12*, PROCCOB+13, PROCCOB+28*, PROCCOB+30, PROCCOB+31, PROCCOB+32, PROCCOB+34, PROCCOB+35 , AMTPAID+1~, AMTPAID+11*, AMTPAID+14, AMTPAID+15, AMTPAID+18, REJCODES+1~, REJCODES+11*, REJCODES+14, REJCODES+15, REJCODES+17 , REJCODES+19, PATPAID+1~, PATPAID+10*, PATPAID+13, PATPAID+16, BENSTAGE+2~, BENSTAGE+11*, BENSTAGE+14, BENSTAGE+17 |
FLDID | XLOOP+2~, XLOOP+58*, PROCDUR+12~, PROCDUR+34*, PROCDUR+39, PROCCOB+26*, PROCCOB+34, AMTPAID+1~, AMTPAID+9*, AMTPAID+15 , REJCODES+1~, REJCODES+9*, REJCODES+15, REJCODES+17, PATPAID+1~, PATPAID+8*, PATPAID+13, BENSTAGE+2~, BENSTAGE+9*, BENSTAGE+14 |
FLDIEN | XLOOP+2~, XLOOP+48*, XLOOP+49, XLOOP+51, XLOOP+58, XLOOP+116*, XLOOP+125, PROCDUR+12~, PROCDUR+31*, PROCDUR+34 , PROCCOB+23*, PROCCOB+26, AMTPAID+1~, AMTPAID+6*, AMTPAID+9, REJCODES+1~, REJCODES+6*, REJCODES+9, PATPAID+1~, PATPAID+6* , PATPAID+8, BENSTAGE+2~, BENSTAGE+7*, BENSTAGE+9 |
FLDNUM | XLOOP+2~, XLOOP+53*, XLOOP+54, XLOOP+56*, XLOOP+61, XLOOP+64, XLOOP+69, XLOOP+72, XLOOP+75, XLOOP+76 , XLOOP+125*, XLOOP+126, XLOOP+127*, XLOOP+129, XLOOP+130 |
IEN | XLOOP~, XLOOP+72, XLOOP+75 |
IEN( | XLOOP+6, XLOOP+7, XLOOP+17, XLOOP+39, XLOOP+42, XLOOP+45, XLOOP+61, XLOOP+64, XLOOP+90, XLOOP+105 , XLOOP+129, XLOOP+130, PROCDUR+23, PROCCOB+16 |
IEN511 | XLOOP+2~, XLOOP+106*, XLOOP+107, XLOOP+115, XLOOP+116 |
IEN59 | XLOOP+2~, XLOOP+105*, XLOOP+106 |
INDEX | XLOOP+2~, XLOOP+10*, XLOOP+11 |
MDATA | XLOOP+2~, XLOOP+45*, XLOOP+46, XLOOP+48 |
ND | SEGID~, SEGID+16 |
NODE | XLOOP+2~, XLOOP+11*, XLOOP+14, XLOOP+17, XLOOP+20, XLOOP+21, XLOOP+24, XLOOP+29, XLOOP+32, XLOOP+37 , XLOOP+38, XLOOP+39, XLOOP+42, XLOOP+45, XLOOP+61, XLOOP+64, XLOOP+69, XLOOP+80, XLOOP+81, XLOOP+87 , XLOOP+112, XLOOP+129, XLOOP+130, XLOOP+137, XLOOP+138, XLOOP+143, XLOOP+144, XLOOP+145, XLOOP+146, PROCDUR+18 , PROCDUR+23, PROCCOB+12, PROCCOB+16 |
NODEIEN | XLOOP+2~, XLOOP+112*, XLOOP+113, XLOOP+115 |
NODES | XLOOP~, XLOOP+10, XLOOP+11 |
ORD | PROCDUR+12~, PROCDUR+29*, PROCDUR+30*, PROCDUR+31, PROCDUR+32, PROCCOB+6~, PROCCOB+21*, PROCCOB+22*, PROCCOB+23, PROCCOB+24 , AMTPAID+1~, AMTPAID+4*, AMTPAID+5*, AMTPAID+6, AMTPAID+7, REJCODES+1~, REJCODES+4*, REJCODES+5*, REJCODES+6, REJCODES+7 , PATPAID+1~, PATPAID+4*, PATPAID+5*, PATPAID+6, PATPAID+7, BENSTAGE+2~, BENSTAGE+5*, BENSTAGE+6*, BENSTAGE+7, BENSTAGE+8 |
ORDER | XLOOP+2~, XLOOP+34*, XLOOP+35, XLOOP+39*, XLOOP+40, XLOOP+42 |
PMODE | XLOOP+2~ |
REC | XLOOP~, XLOOP+145* |
REC( | XLOOP+143*, XLOOP+145*, XLOOP+146* |
RECMIEN | XLOOP+2~, XLOOP+41*, XLOOP+42*, XLOOP+43, XLOOP+45 |
SEGREC | XLOOP+2~, XLOOP+27*, XLOOP+72, XLOOP+75, XLOOP+80*, XLOOP+81*, XLOOP+89, XLOOP+91*, XLOOP+137*, XLOOP+138* , XLOOP+143, XLOOP+146, PROCDUR+19*, PROCDUR+41*, PROCCOB+13*, PROCCOB+35*, AMTPAID+18*, REJCODES+19*, PATPAID+16*, BENSTAGE+17* , SUBCLAR~, SUBCLAR+18*, OAMTCLMD~, OAMTCLMD+18* |
TYPE | XLOOP+3~, XLOOP+7*, XLOOP+20, XLOOP+21, XLOOP+24, XLOOP+87 |
U | XLOOP+6, XLOOP+10, XLOOP+11, XLOOP+48, XLOOP+53, XLOOP+58, PROCDUR+31, PROCDUR+32, PROCDUR+34, PROCCOB+23 , PROCCOB+24, PROCCOB+26, AMTPAID+6, AMTPAID+7, AMTPAID+9, REJCODES+6, REJCODES+7, REJCODES+9, PATPAID+6, PATPAID+7 , PATPAID+8, BENSTAGE+7, BENSTAGE+8, BENSTAGE+9, SUBCLAR+11, SUBCLAR+16, OAMTCLMD+14, OAMTCLMD+15 |
VER | XLOOP+3~, XLOOP+6*, XLOOP+21 |
X | OAMTCLMD+7~, OAMTCLMD+12*, OAMTCLMD+13, OAMTCLMD+14, OAMTCLMD+15 |
X1 | SUBCLAR+7~, SUBCLAR+16*, SUBCLAR+17, SUBCLAR+18 |
X2 | OAMTCLMD+7~, OAMTCLMD+14*, OAMTCLMD+16, OAMTCLMD+18 |
X3 | OAMTCLMD+7~, OAMTCLMD+15*, OAMTCLMD+17, OAMTCLMD+18 |
X4 | SUBCLAR+7~, SUBCLAR+11*, SUBCLAR+13 |