BPSUTIL ;BHAM ISC/FLS/SS - General Utility functions ;3/27/08 13:18
;;1.0;E CLAIMS MGMT ENGINE;**1,3,2,5,6,20,27,33**;JUN 2004;Build 5
;;Per VA Directive 6402, this routine should not be modified.
;
; ECMEON
; Input:
; SITE - Pointer to Outpatient Site file (#59)
; Output
; 1 - ECME is turned ON for the Outpatient Site
; 0 - ECME is not turned ON for the Outpatient Site.
; Note that ON means that the Outpatient site is linked to an active
; BPS Pharmacy that has a Pharmacy ID AND IB has ncpdp flagged as
; turned on.
ECMEON(SITE) ;
I '$$EPHON^IBNCPDPI Q 0
I '$G(SITE) Q 0
N BPSPHARM,FACID
S FACID=0
S BPSPHARM=$$GETPHARM(SITE)
I BPSPHARM="" Q 0
S FACID=$$GET1^DIQ(9002313.56,BPSPHARM_",",41.01)
I FACID="",'$$NPIREQ^BPSNPI(DT) S FACID=$$GET1^DIQ(9002313.56,BPSPHARM_",",.02)
Q $S(FACID:1,1:0)
;
CMOPON(SITE) ; - Returns 1 if CMOP is turned ON for ECME or 0 if not
; SITE - Pointer to #59 (OUTPATIENT SITE)
Q:'$G(SITE) 0
N PHRM S PHRM=$O(^BPS(9002313.56,"C",SITE,0)) I 'PHRM Q 0
Q $$GET1^DIQ(9002313.56,PHRM,1,"I")
;
;Function returns STATUS flag from BPS PHARMACIES (file #56)
; Returns '1' for active or '0' for inactive BPS Pharmacy
BPSACTV(BPSPHARM) ;
Q:'$G(BPSPHARM) 0
Q +$P($G(^BPS(9002313.56,BPSPHARM,0)),U,10)
;
BPSPLN(RXI,RXR) ; - Returns the insurance PLAN NAME (902.24) field from BPS TRANSACTION
;
; Input variables -> RXI - Internal Prescription File IEN
; RXR - Refill Number
;
I '$G(RXI) Q ""
I '$G(RXR) S RXR=0
N IEN59 S IEN59=$$IEN59^BPSOSRX(RXI,RXR) Q:IEN59="" ""
N CINS S CINS=$$GET1^DIQ(9002313.59,IEN59,901) Q:'CINS ""
Q $$GET1^DIQ(9002313.59902,CINS_","_IEN59,902.24)
;
BPSINSCO(RXI,RXR) ; - Returns the Insurance Company (902.33) field from BPS TRANSACTION
; MRD;BPS*1.0*20 - Created BPSINSCO by copying BPSPLN and modifying.
;
; Input variables -> RXI - Internal Prescription File IEN
; RXR - Refill Number
;
I '$G(RXI) Q ""
I '$G(RXR) S RXR=0
N IEN59 S IEN59=$$IEN59^BPSOSRX(RXI,RXR) Q:IEN59="" ""
N CINS S CINS=$$GET1^DIQ(9002313.59,IEN59,901) Q:'CINS ""
Q $$GET1^DIQ(9002313.59902,CINS_","_IEN59,902.33,"I")
;
;API for IB (IA #4146) to select BPS PHARMACY
;returns results as a local array BPPHARM
; Select the ECME Pharmacy or Pharmacies
;
; Input Variable -> BPSPHAR is passed by reference to get the result of user's selection
; BPPHARM = 1 One or More Pharmacies Selected
; = 0 User Entered 'ALL'
; If BPSPHAR = 1 then the BPSPHAR array will be defined where:
; BPSPHAR(ptr) = ptr ^ BPS PHARMACY NAME and
; ptr = Internal Pointer to BPS PHARMACIES file (#9002313.56)
;
; Return Value -> "" = Valid Entry or Entries Selected
; ^ = Exit
SELPHARM(BPSPHAR) ;
N BPRET,BPPHARM
S BPRET=$$SELPHARM^BPSRPT3()
M BPSPHAR=BPPHARM
Q BPRET
;
;
;API for IB (IA #4146) to determine whether is one or more BPS PHARMACIES in the system
;Function returns
;1 - if the site has more than one record in the file #9002313.56
;0 - if there are no any divisions
;0^NAME OF THE EPHARM - if only one division return 0 and its name
; to use in the header of the report
MULTPHRM() ;
N IBX
S IBX=+$O(^BPS(9002313.56,0))
I IBX=0 Q 0
I $O(^BPS(9002313.56,IBX))>0 Q 1
Q "0^"_$$GET1^DIQ(9002313.56,IBX,.01,"E")
;
; Function for IB (IA #4146) to return site linked to pharmacy
; Input
; BPSDIV - Outpatient Site
; Returns
; BPSPHARM - BPS Pharmacy IEN
GETPHARM(BPSDIV) ;
N BPSPHARM
I $G(BPSDIV)="" Q ""
S BPSPHARM=$O(^BPS(9002313.56,"C",BPSDIV,0)) I 'BPSPHARM Q ""
Q:'$$BPSACTV^BPSUTIL(BPSPHARM) ""
Q BPSPHARM
;
;API for the IB package (IA#4146)
;Input parameters:
; BPSRX - Rx ien (file #52)
; BPSREFNO - refill number
;Returned value:
; 1st piece:
; 0 - status "non-payable" OR there is no response from the payer for whatever reason OR wasn't submitted OR invalid parameters
; 1- status "payable"
; 2nd piece:
; amount the payer agreed to pay
; 3rd piece:
; Date of Service
;
PAIDAMNT(BPSRX,BPSREFNO) ;
I ($G(BPSRX)="")!($G(BPSREFNO)="") Q "0^"
N BPSTAT,BPSRET,IEN59,BPSRESP,BPDOS
S BPSTAT=$$STATUS^BPSOSRX(BPSRX,BPSREFNO)
;The status of the claim should be "payable" in order to get amount of the 3rd party payment
;If it was an attempt to reverse the payable claim AND reversal was rejected
;then the claim still is considered as "payable" and we still can get the amount paid by the 3rd party.
;In this case we return 1 (payable) in first piece and the amount paid in the 2nd piece of the returned value.
;All other statuses mean that we cannot get amount paid so we return 0 = "non payable"
I $P(BPSTAT,U)'="E PAYABLE",$P(BPSTAT,U)'="E REVERSAL REJECTED",$P(BPSTAT,U)'="E DUPLICATE" Q "0^"
;get ien for BPS TRANSACTION file
S IEN59=+$$IEN59^BPSOSRX(BPSRX,BPSREFNO)
I IEN59="" Q "0^" ;BPS Transaction IEN could not be calculated
S BPSRESP=+$P($G(^BPST(IEN59,0)),U,5)
;response from the payer was not found - either claim was never submitted OR there
;is no response for some reason - either way - we cannot provide the amount paid, so return "0"
I BPSRESP=0 Q "0^"
S BPDOS=+$P($G(^BPST(IEN59,12)),U,2)
S BPSRET=+$$INSPAID^BPSOS03(BPSRESP)
Q "1^"_BPSRET_U_BPDOS
;
; NPIEXTR
; This API was written for the NPI extract (XUSNPIX2) and returns
; the NCPDP and STATUS of the associated BPS Pharmacy
; Input:
; SITE - Pointer to Outpatient Site file (#59)
; Output
; NCPDP^STATUS (0 - inactive, 1 - active)
; "" if no SITE passed in or no linkage
NPIEXTR(SITE) ;
I '$G(SITE) Q ""
N BPSPHARM,NCPDP,STATUS
S BPSPHARM=$O(^BPS(9002313.56,"C",SITE,0))
I 'BPSPHARM Q ""
S STATUS=$$BPSACTV^BPSUTIL(BPSPHARM)
S NCPDP=$$GET1^DIQ(9002313.56,BPSPHARM_",",.02)
Q NCPDP_"^"_STATUS
;
; TOUCHED
; Input:
; BPS57 - IEN BPS LOG OF TRANSACTIONS file #9002313.57 - required
; Output:
; 0 - No touch or automated transaction
; 1 - touched or manual transaction
;
TOUCHED(BPS57) ;
;
N RXACTION
I $G(BPS57)="" Q 1
;
; Get the RXACTION for the transaction. This field is also referred
; to as BWHERE throughout the claims submission process.
;
S RXACTION=$$GET1^DIQ(9002313.57,BPS57,1201)
;
; Transactions with the below actions are No Touch transactions.
;
I ",AREV,CRLB,CRLR,CRLX,CRRL,DC,DE,HLD,OF,PC,PE,PL,PP,RF,RN,RRL,"[(","_RXACTION_",") Q 0
;
Q 1
;
CSNPI(RX,RFL) ; BPS Pharmacy for CS NCPDP# and NPI
;
; Input -> RX - Internal Prescription File IEN
; RFL - Refill Number
;
; Determine if the drug on the Rx is a Controlled Substance (CS).
; CS drugs are defined as those which contain 2, 3, 4 or 5 in
; field DEA, SPECIAL HDLG (#3) of the DRUG file (#50).
;
; If the drug is a CS, check BPS PHARMACIES (#9002313.56) to see if
; a different pharmacy is defined to dispense CS drugs. Field #2
; of BPS PHARMACIES is BPS PHARMACY FOR CS. This is a
; pointer to another entry in BPS PHARMACIES. This is the pharmacy
; assigned to dispense CS drugs for the original pharmacy.
;
; Return the NCPDP# and NPI of the BPS PHARMACY FOR CS if it exists.
;
N BPSCSID,BPSDEA,BPSDIV,BPSDRGI,BPSPHARM,NCPDP,NPI
;
; Get Drug IEN and DEA, SPECIAL HDLG info
S BPSDRGI=$$GET1^DIQ(52,RX,6,"I")
S BPSDEA=$$GET1^DIQ(50,BPSDRGI,3)
;
; Quit if not a Controlled Substance
I '((BPSDEA["2")!(BPSDEA["3")!(BPSDEA["4")!(BPSDEA["5")) Q "-1^Non CS"
;
; Get Division and BPS Pharmacy info
S BPSDIV=+$$RXSITE^PSOBPSUT(RX,RFL)
S BPSPHARM=$$GETPHARM^BPSUTIL(BPSDIV)
I BPSPHARM="" Q "-1^No BPS Pharm"
;
; Get BPS Pharmacy for CS info
S BPSCSID=$$GET1^DIQ(9002313.56,BPSPHARM,2,"I")
I BPSCSID="" Q "-1^No CS Pharm"
;
; Return NCPDP and NPI for BPS Pharmacy for CS
S NCPDP=$$GET1^DIQ(9002313.56,BPSCSID,.02)
S NPI=$$GET1^DIQ(9002313.56,BPSCSID,41.01)
;
Q NCPDP_"^"_NPI
;
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HBPSUTIL 8032 printed Apr 09, 2024@20:55:32 Page 2
BPSUTIL ;BHAM ISC/FLS/SS - General Utility functions ;3/27/08 13:18
+1 ;;1.0;E CLAIMS MGMT ENGINE;**1,3,2,5,6,20,27,33**;JUN 2004;Build 5
+2 ;;Per VA Directive 6402, this routine should not be modified.
+3 ;
+4 ; ECMEON
+5 ; Input:
+6 ; SITE - Pointer to Outpatient Site file (#59)
+7 ; Output
+8 ; 1 - ECME is turned ON for the Outpatient Site
+9 ; 0 - ECME is not turned ON for the Outpatient Site.
+10 ; Note that ON means that the Outpatient site is linked to an active
+11 ; BPS Pharmacy that has a Pharmacy ID AND IB has ncpdp flagged as
+12 ; turned on.
ECMEON(SITE) ;
+1 IF '$$EPHON^IBNCPDPI
QUIT 0
+2 IF '$GET(SITE)
QUIT 0
+3 NEW BPSPHARM,FACID
+4 SET FACID=0
+5 SET BPSPHARM=$$GETPHARM(SITE)
+6 IF BPSPHARM=""
QUIT 0
+7 SET FACID=$$GET1^DIQ(9002313.56,BPSPHARM_",",41.01)
+8 IF FACID=""
IF '$$NPIREQ^BPSNPI(DT)
SET FACID=$$GET1^DIQ(9002313.56,BPSPHARM_",",.02)
+9 QUIT $SELECT(FACID:1,1:0)
+10 ;
CMOPON(SITE) ; - Returns 1 if CMOP is turned ON for ECME or 0 if not
+1 ; SITE - Pointer to #59 (OUTPATIENT SITE)
+2 if '$GET(SITE)
QUIT 0
+3 NEW PHRM
SET PHRM=$ORDER(^BPS(9002313.56,"C",SITE,0))
IF 'PHRM
QUIT 0
+4 QUIT $$GET1^DIQ(9002313.56,PHRM,1,"I")
+5 ;
+6 ;Function returns STATUS flag from BPS PHARMACIES (file #56)
+7 ; Returns '1' for active or '0' for inactive BPS Pharmacy
BPSACTV(BPSPHARM) ;
+1 if '$GET(BPSPHARM)
QUIT 0
+2 QUIT +$PIECE($GET(^BPS(9002313.56,BPSPHARM,0)),U,10)
+3 ;
BPSPLN(RXI,RXR) ; - Returns the insurance PLAN NAME (902.24) field from BPS TRANSACTION
+1 ;
+2 ; Input variables -> RXI - Internal Prescription File IEN
+3 ; RXR - Refill Number
+4 ;
+5 IF '$GET(RXI)
QUIT ""
+6 IF '$GET(RXR)
SET RXR=0
+7 NEW IEN59
SET IEN59=$$IEN59^BPSOSRX(RXI,RXR)
if IEN59=""
QUIT ""
+8 NEW CINS
SET CINS=$$GET1^DIQ(9002313.59,IEN59,901)
if 'CINS
QUIT ""
+9 QUIT $$GET1^DIQ(9002313.59902,CINS_","_IEN59,902.24)
+10 ;
BPSINSCO(RXI,RXR) ; - Returns the Insurance Company (902.33) field from BPS TRANSACTION
+1 ; MRD;BPS*1.0*20 - Created BPSINSCO by copying BPSPLN and modifying.
+2 ;
+3 ; Input variables -> RXI - Internal Prescription File IEN
+4 ; RXR - Refill Number
+5 ;
+6 IF '$GET(RXI)
QUIT ""
+7 IF '$GET(RXR)
SET RXR=0
+8 NEW IEN59
SET IEN59=$$IEN59^BPSOSRX(RXI,RXR)
if IEN59=""
QUIT ""
+9 NEW CINS
SET CINS=$$GET1^DIQ(9002313.59,IEN59,901)
if 'CINS
QUIT ""
+10 QUIT $$GET1^DIQ(9002313.59902,CINS_","_IEN59,902.33,"I")
+11 ;
+12 ;API for IB (IA #4146) to select BPS PHARMACY
+13 ;returns results as a local array BPPHARM
+14 ; Select the ECME Pharmacy or Pharmacies
+15 ;
+16 ; Input Variable -> BPSPHAR is passed by reference to get the result of user's selection
+17 ; BPPHARM = 1 One or More Pharmacies Selected
+18 ; = 0 User Entered 'ALL'
+19 ; If BPSPHAR = 1 then the BPSPHAR array will be defined where:
+20 ; BPSPHAR(ptr) = ptr ^ BPS PHARMACY NAME and
+21 ; ptr = Internal Pointer to BPS PHARMACIES file (#9002313.56)
+22 ;
+23 ; Return Value -> "" = Valid Entry or Entries Selected
+24 ; ^ = Exit
SELPHARM(BPSPHAR) ;
+1 NEW BPRET,BPPHARM
+2 SET BPRET=$$SELPHARM^BPSRPT3()
+3 MERGE BPSPHAR=BPPHARM
+4 QUIT BPRET
+5 ;
+6 ;
+7 ;API for IB (IA #4146) to determine whether is one or more BPS PHARMACIES in the system
+8 ;Function returns
+9 ;1 - if the site has more than one record in the file #9002313.56
+10 ;0 - if there are no any divisions
+11 ;0^NAME OF THE EPHARM - if only one division return 0 and its name
+12 ; to use in the header of the report
MULTPHRM() ;
+1 NEW IBX
+2 SET IBX=+$ORDER(^BPS(9002313.56,0))
+3 IF IBX=0
QUIT 0
+4 IF $ORDER(^BPS(9002313.56,IBX))>0
QUIT 1
+5 QUIT "0^"_$$GET1^DIQ(9002313.56,IBX,.01,"E")
+6 ;
+7 ; Function for IB (IA #4146) to return site linked to pharmacy
+8 ; Input
+9 ; BPSDIV - Outpatient Site
+10 ; Returns
+11 ; BPSPHARM - BPS Pharmacy IEN
GETPHARM(BPSDIV) ;
+1 NEW BPSPHARM
+2 IF $GET(BPSDIV)=""
QUIT ""
+3 SET BPSPHARM=$ORDER(^BPS(9002313.56,"C",BPSDIV,0))
IF 'BPSPHARM
QUIT ""
+4 if '$$BPSACTV^BPSUTIL(BPSPHARM)
QUIT ""
+5 QUIT BPSPHARM
+6 ;
+7 ;API for the IB package (IA#4146)
+8 ;Input parameters:
+9 ; BPSRX - Rx ien (file #52)
+10 ; BPSREFNO - refill number
+11 ;Returned value:
+12 ; 1st piece:
+13 ; 0 - status "non-payable" OR there is no response from the payer for whatever reason OR wasn't submitted OR invalid parameters
+14 ; 1- status "payable"
+15 ; 2nd piece:
+16 ; amount the payer agreed to pay
+17 ; 3rd piece:
+18 ; Date of Service
+19 ;
PAIDAMNT(BPSRX,BPSREFNO) ;
+1 IF ($GET(BPSRX)="")!($GET(BPSREFNO)="")
QUIT "0^"
+2 NEW BPSTAT,BPSRET,IEN59,BPSRESP,BPDOS
+3 SET BPSTAT=$$STATUS^BPSOSRX(BPSRX,BPSREFNO)
+4 ;The status of the claim should be "payable" in order to get amount of the 3rd party payment
+5 ;If it was an attempt to reverse the payable claim AND reversal was rejected
+6 ;then the claim still is considered as "payable" and we still can get the amount paid by the 3rd party.
+7 ;In this case we return 1 (payable) in first piece and the amount paid in the 2nd piece of the returned value.
+8 ;All other statuses mean that we cannot get amount paid so we return 0 = "non payable"
+9 IF $PIECE(BPSTAT,U)'="E PAYABLE"
IF $PIECE(BPSTAT,U)'="E REVERSAL REJECTED"
IF $PIECE(BPSTAT,U)'="E DUPLICATE"
QUIT "0^"
+10 ;get ien for BPS TRANSACTION file
+11 SET IEN59=+$$IEN59^BPSOSRX(BPSRX,BPSREFNO)
+12 ;BPS Transaction IEN could not be calculated
IF IEN59=""
QUIT "0^"
+13 SET BPSRESP=+$PIECE($GET(^BPST(IEN59,0)),U,5)
+14 ;response from the payer was not found - either claim was never submitted OR there
+15 ;is no response for some reason - either way - we cannot provide the amount paid, so return "0"
+16 IF BPSRESP=0
QUIT "0^"
+17 SET BPDOS=+$PIECE($GET(^BPST(IEN59,12)),U,2)
+18 SET BPSRET=+$$INSPAID^BPSOS03(BPSRESP)
+19 QUIT "1^"_BPSRET_U_BPDOS
+20 ;
+21 ; NPIEXTR
+22 ; This API was written for the NPI extract (XUSNPIX2) and returns
+23 ; the NCPDP and STATUS of the associated BPS Pharmacy
+24 ; Input:
+25 ; SITE - Pointer to Outpatient Site file (#59)
+26 ; Output
+27 ; NCPDP^STATUS (0 - inactive, 1 - active)
+28 ; "" if no SITE passed in or no linkage
NPIEXTR(SITE) ;
+1 IF '$GET(SITE)
QUIT ""
+2 NEW BPSPHARM,NCPDP,STATUS
+3 SET BPSPHARM=$ORDER(^BPS(9002313.56,"C",SITE,0))
+4 IF 'BPSPHARM
QUIT ""
+5 SET STATUS=$$BPSACTV^BPSUTIL(BPSPHARM)
+6 SET NCPDP=$$GET1^DIQ(9002313.56,BPSPHARM_",",.02)
+7 QUIT NCPDP_"^"_STATUS
+8 ;
+9 ; TOUCHED
+10 ; Input:
+11 ; BPS57 - IEN BPS LOG OF TRANSACTIONS file #9002313.57 - required
+12 ; Output:
+13 ; 0 - No touch or automated transaction
+14 ; 1 - touched or manual transaction
+15 ;
TOUCHED(BPS57) ;
+1 ;
+2 NEW RXACTION
+3 IF $GET(BPS57)=""
QUIT 1
+4 ;
+5 ; Get the RXACTION for the transaction. This field is also referred
+6 ; to as BWHERE throughout the claims submission process.
+7 ;
+8 SET RXACTION=$$GET1^DIQ(9002313.57,BPS57,1201)
+9 ;
+10 ; Transactions with the below actions are No Touch transactions.
+11 ;
+12 IF ",AREV,CRLB,CRLR,CRLX,CRRL,DC,DE,HLD,OF,PC,PE,PL,PP,RF,RN,RRL,"[(","_RXACTION_",")
QUIT 0
+13 ;
+14 QUIT 1
+15 ;
CSNPI(RX,RFL) ; BPS Pharmacy for CS NCPDP# and NPI
+1 ;
+2 ; Input -> RX - Internal Prescription File IEN
+3 ; RFL - Refill Number
+4 ;
+5 ; Determine if the drug on the Rx is a Controlled Substance (CS).
+6 ; CS drugs are defined as those which contain 2, 3, 4 or 5 in
+7 ; field DEA, SPECIAL HDLG (#3) of the DRUG file (#50).
+8 ;
+9 ; If the drug is a CS, check BPS PHARMACIES (#9002313.56) to see if
+10 ; a different pharmacy is defined to dispense CS drugs. Field #2
+11 ; of BPS PHARMACIES is BPS PHARMACY FOR CS. This is a
+12 ; pointer to another entry in BPS PHARMACIES. This is the pharmacy
+13 ; assigned to dispense CS drugs for the original pharmacy.
+14 ;
+15 ; Return the NCPDP# and NPI of the BPS PHARMACY FOR CS if it exists.
+16 ;
+17 NEW BPSCSID,BPSDEA,BPSDIV,BPSDRGI,BPSPHARM,NCPDP,NPI
+18 ;
+19 ; Get Drug IEN and DEA, SPECIAL HDLG info
+20 SET BPSDRGI=$$GET1^DIQ(52,RX,6,"I")
+21 SET BPSDEA=$$GET1^DIQ(50,BPSDRGI,3)
+22 ;
+23 ; Quit if not a Controlled Substance
+24 IF '((BPSDEA["2")!(BPSDEA["3")!(BPSDEA["4")!(BPSDEA["5"))
QUIT "-1^Non CS"
+25 ;
+26 ; Get Division and BPS Pharmacy info
+27 SET BPSDIV=+$$RXSITE^PSOBPSUT(RX,RFL)
+28 SET BPSPHARM=$$GETPHARM^BPSUTIL(BPSDIV)
+29 IF BPSPHARM=""
QUIT "-1^No BPS Pharm"
+30 ;
+31 ; Get BPS Pharmacy for CS info
+32 SET BPSCSID=$$GET1^DIQ(9002313.56,BPSPHARM,2,"I")
+33 IF BPSCSID=""
QUIT "-1^No CS Pharm"
+34 ;
+35 ; Return NCPDP and NPI for BPS Pharmacy for CS
+36 SET NCPDP=$$GET1^DIQ(9002313.56,BPSCSID,.02)
+37 SET NPI=$$GET1^DIQ(9002313.56,BPSCSID,41.01)
+38 ;
+39 QUIT NCPDP_"^"_NPI
+40 ;
