IBARXPFS ;OAK/ELZ - PFSS ROUTINE FOR INTER-FACILITY RX COPAY ;23-MAR-05
;;2.0;INTEGRATED BILLING;**308**;21-MAR-94
;;Per VHA Directive 10-93-142, this routine should not be modified.
;
NEW(DFN) ; this entry point will check patient cap knowledge status and queue to look up as necessary
N ZTSK,ZTRTN,ZTDESC,ZTDTH,ZTIO,ZTSAVE,X,Y,POP
I $D(^IBAM(354.7,DFN,0)) Q
L +^IBAM(DFN):5 I '$T Q
S ZTRTN="DQNEW^IBARXPFS",ZTDESC="IB INTER-FACILITY CAP QUERY",ZTDTH=$$NOW^XLFDT,(ZTIO,ZTSAVE("DFN"),ZTSAVE("IBADT"))=""
D ^%ZTLOAD
L -^IBAM(DFN)
Q
;
DQNEW ; tasked entry point for cap information query
I $D(^IBAM(354.7,DFN,0)) Q
L +^IBAM(DFN):5 I '$T Q
D ADD^IBARXMU(DFN)
BBE ; back billing entry assumes IBADT
N IBDT,IBT,IBX,IBS,IBD,IBB,DIE,DA,DR,X,IBA,IBP,IBZ,IBY,IBFD,IBTD
S IBDT=$E($S($G(IBADT):IBADT,1:DT),1,5)_"00"
S IBB=0,IBP=$$PRIORITY^IBARXMU(DFN)
S IBT=$$TFL^IBARXMU(DFN,.IBT) G:'IBT DQNEWQ
D CAP^IBARXMC(IBDT,IBP,.IBZ,.IBY,.IBFD,.IBTD) I 'IBY,'IBZ G DQNEWQ
I 'IBFD!('IBTD) G DQNEWQ
S IBX=0 F S IBX=$O(IBT(IBX)) Q:IBX<1 D
. ;
. ; need to query every month in the cap billing period
. S IBDT=IBFD D F S IBDT=$$NEXTMO^IBARXMC(IBDT) Q:IBDT>IBTD D
.. D UQUERY^IBARXMU(DFN,$E(IBDT,1,5)_"00",IBX,.IBD)
.. ;
.. ; error returned
.. I -1=+$G(IBD,"-1") Q
.. ;
.. ; loop through query and file data
.. S X=0 F S X=$O(IBD(X)) Q:X<1 S:$E(IBD(X),1,4)=(+IBT(IBX)_"-") IBA=$$ADD^IBARXMN(DFN,IBD(X)),IBB=IBB+$P(IBD(X),"^",11)
.. K IBD
DQNEWQ ;
L -^IBAM(DFN)
;
Q
;
MSG ; receives HL7 message from COTS product and files in 354.71 or others
N IBMSG,IBHEADER,IBICN,IBDFN,IBSSN,IBCLAIM,IBALIAS,IBSTAT,IBTYPE,IBINST
N IBRXDAT,IBRESLT,IB35471,IB351,IB35181,IB350,IBMTDT21,IBCODE,SEG,DFN,HLA
;
;parse message
S IBSTAT=$$STARTMSG^HLPRS(.IBMSG,HLMTIENS,.IBHEADER)
I 'IBSTAT S HLERR="Unable to start parse of message" G NEWTRANQ
;
F Q:'$$NEXTSEG^HLPRS(.IBMSG,.SEG) D
. F IBT=3:1 S IBD=$P($T(HL7DATA+IBT),";",4) Q:IBD="" D
. . I $P(IBD,"^",2)=SEG("SEGMENT TYPE") D
. . . S @$P(IBD,"^")=$$GET^HLOPRS(.SEG,$P(IBD,"^",3),$P(IBD,"^",4),$P(IBD,"^",5),$P(IBD,"^",6))
. . . S IBCODE=$P(IBD,"^",7,99)
. . . I $L(IBCODE),$L(@$P(IBD,"^")) S X=@$P(IBD,"^") X IBCODE S @$P(IBD,"^")=X
;
;check out data received from message
S DFN=$$PATIENT($G(IBICN),$G(IBDFN),$G(IBSSN),$G(IBVACLM),$G(IBALIAS))
G:'DFN NEWTRANQ
S IBTYPE=$G(IBTYPE)
;
D @($S(IBTYPE="IN":"35471",IBTYPE="MT":"351",IBTYPE="LB":"35181",IBTYPE="ML":"350",IBTYPE="ST":"QUERYVA",IBTYPE="BL":"BILLVA",1:"ERR")_"^IBARXMI")
;
;
NEWTRANQ ;
S HLA("HLA",1)="MSA"_HL("FS")_$S('$D(HLERR):"AA",1:"AE")_HL("FS")_HL("MID")
D GENACK^HLMA1(HL("EID"),HLMTIENS,HL("EIDS"),"LM",1,.IBRESLT)
Q
;
PATIENT(IBICN,IBDFN,IBSSN,IBVACLM,IBALIAS) ; this function will receive
; several patient data elements and validate them. Assuming the data
; meets expected requirements, the function will return the patient's
; DFN. The requirement is ICN is a must, the patient must also match
; at least 2 other data elements.
;
N DFN,IBMATCH,IBX
S (IBMATCH,IBX)=0,HLERR=""
S DFN=$$DFN^IBARXMU(IBICN) I 'DFN S HLERR="Invalid ICN: "_IBICN G PATQ
;
I DFN=IBDFN S IBMATCH=1
E S HLERR=DFN_" Doesn't match ICN DFN "_IBDFN
;
I IBSSN,$P($G(^DPT(DFN,0)),"^",9)=IBSSN S IBMATCH=IBMATCH+1
E S HLERR=HLERR_" SSN Mismatch:"_IBSSN
I IBMATCH>1 G PATQ
;
I $L(IBVACLM),$P($G(^DPT(DFN,.31)),"^",3)=IBVACLM S IBMATCH=IBMATCH+1
E S:$L(IBVACLM) HLERR=HLERR_" VA Claim Mismatch:"_IBVACLM
I IBMATCH>1 G PATQ
;
F S IBX=$O(^DPT(DFN,.01,IBX)) Q:'IBX!(IBMATCH>1) I $L(IBALIAS),$P($G(^DPT(DFN,.01,IBX,0)),"^",2)=IBALIAS S IBMATCH=IBMATCH+1 Q
I IBMATCH<2 S DFN=0,HLERR=HLERR_" ALIAS Mismatch"
PATQ ;
I DFN K HLERR
Q DFN
;
HL7DATA ; hl7 data mapping
; format: description ; IB Variable ^ segment ^ seq ^ comp ^ subcomp ^
; extract code
;;patient icn;IBICN^PID^3^1^1^1
;;patient dfn;IBDFN^PID^3^1^1^2^S IBINST=$E(X,1,3),X=$E(X,4,99)
;;patient ssn;IBSSN^PID^3^1^1^3
;;patient va claim;IBVACLM^PID^3^1^1^4
;;patient alias ssn;IBALIAS^PID^3^1^1^5
;;receiver trans type;IBTYPE^FT1^6
;;transaction number;IB35471(.01)^FT1^2
;;trans eff date;IB35471(.03)^FT1^4^1^1^^S X=$$FMDATE^HLFNC(X)
;;trans status;IB35471(.05)^FT1^8
;;rx number;IB35471(.091)^RXE^15
;;refill number;IB35471(.092)^RXE^12
;;units;IB35471(.07)^FT1^12^5^1
;;total charge;IB35471(.08)^FT1^12^1^1
;;parent transaction;IB35471(.1)^FT1^9
;;billed amount;IB35471(.11)^FT1^11^1^1
;;unbilled amount;IB35471(.12)^FT1^15^1^1
;;mt clock begin date;IB351(.03)^ZMT^35^^^^S X=$$FMDATE^HLFNC(X)
;;mt clock status;IB351(.04)^ZMT^36
;;1st 90 day amt;IB351(.05)^ZMT^37
;;2nd 90 day amt;IB351(.06)^ZMT^38
;;3rd 90 day amt;IB351(.07)^ZMT^39
;;4th 90 day amt;IB351(.08)^ZMT^40
;;number of inpt days;IB351(.09)^ZMT^41
;;mt clock end date;IB351(.1)^ZMT^42^^^^S X=$$FMDATE^HLFNC(X)
;;ltc clock begin date;IB35181(.03)^ZMT^43^^^^S X=$$FMDATE^HLFNC(X)
;;ltc clock end date;IB35181(.04)^ZMT^44^^^^S X=$$FMDATE^HLFNC(X)
;;ltc clock status;IB35181(.05)^ZMT^45
;;ltc 21 exempt dates;IBMTD21^ZMT^46^^^^S IBMTDT21=$G(IBMTDT21)+1,IBMTDT21(IBMTDT21)=$$FMDATE^HLFNC(X)
;;charege type;IB350("TYP")^ZMT^47
;;patient type;IB350("IO")^PV1^2
;;event date/time;IB350("EDT")^PV1^44^1^^^S X=$$FMDATE^HLFNC(X)
;;bed section;IB350("BS")^ZMT^48
;;units;IB350(.06)^ZMT^49
;;total charge;IB350(.07)^ZMT^50
;;event date;IB350(.17)^ZMT^51^^^^S X=$$FMDATE^HLFNC(X)
;;from date;IB350(.14)^ZMT^52^^^^S X=$$FMDATE^HLFNC(X)
;;to date;IB350(.15)^ZMT^53^^^^S X=$$FMDATE^HLFNC(X)
;;stop code;IB350(.2)^ZMT^54
;;trans status;IB350(.05)^ZMT^55
;;idx visit number;IB350("IDX")^PV1^19^1
;;
;
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HIBARXPFS 5740 printed Sep 23, 2025@19:43:54 Page 2
IBARXPFS ;OAK/ELZ - PFSS ROUTINE FOR INTER-FACILITY RX COPAY ;23-MAR-05
+1 ;;2.0;INTEGRATED BILLING;**308**;21-MAR-94
+2 ;;Per VHA Directive 10-93-142, this routine should not be modified.
+3 ;
NEW(DFN) ; this entry point will check patient cap knowledge status and queue to look up as necessary
+1 NEW ZTSK,ZTRTN,ZTDESC,ZTDTH,ZTIO,ZTSAVE,X,Y,POP
+2 IF $DATA(^IBAM(354.7,DFN,0))
QUIT
+3 LOCK +^IBAM(DFN):5
IF '$TEST
QUIT
+4 SET ZTRTN="DQNEW^IBARXPFS"
SET ZTDESC="IB INTER-FACILITY CAP QUERY"
SET ZTDTH=$$NOW^XLFDT
SET (ZTIO,ZTSAVE("DFN"),ZTSAVE("IBADT"))=""
+5 DO ^%ZTLOAD
+6 LOCK -^IBAM(DFN)
+7 QUIT
+8 ;
DQNEW ; tasked entry point for cap information query
+1 IF $DATA(^IBAM(354.7,DFN,0))
QUIT
+2 LOCK +^IBAM(DFN):5
IF '$TEST
QUIT
+3 DO ADD^IBARXMU(DFN)
BBE ; back billing entry assumes IBADT
+1 NEW IBDT,IBT,IBX,IBS,IBD,IBB,DIE,DA,DR,X,IBA,IBP,IBZ,IBY,IBFD,IBTD
+2 SET IBDT=$EXTRACT($SELECT($GET(IBADT):IBADT,1:DT),1,5)_"00"
+3 SET IBB=0
SET IBP=$$PRIORITY^IBARXMU(DFN)
+4 SET IBT=$$TFL^IBARXMU(DFN,.IBT)
if 'IBT
GOTO DQNEWQ
+5 DO CAP^IBARXMC(IBDT,IBP,.IBZ,.IBY,.IBFD,.IBTD)
IF 'IBY
IF 'IBZ
GOTO DQNEWQ
+6 IF 'IBFD!('IBTD)
GOTO DQNEWQ
+7 SET IBX=0
FOR
SET IBX=$ORDER(IBT(IBX))
if IBX<1
QUIT
Begin DoDot:1
+8 ;
+9 ; need to query every month in the cap billing period
+10 SET IBDT=IBFD
Begin DoDot:2
+11 DO UQUERY^IBARXMU(DFN,$EXTRACT(IBDT,1,5)_"00",IBX,.IBD)
+12 ;
+13 ; error returned
+14 IF -1=+$GET(IBD,"-1")
QUIT
+15 ;
+16 ; loop through query and file data
+17 SET X=0
FOR
SET X=$ORDER(IBD(X))
if X<1
QUIT
if $EXTRACT(IBD(X),1,4)=(+IBT(IBX)_"-")
SET IBA=$$ADD^IBARXMN(DFN,IBD(X))
SET IBB=IBB+$PIECE(IBD(X),"^",11)
+18 KILL IBD
End DoDot:2
FOR
SET IBDT=$$NEXTMO^IBARXMC(IBDT)
if IBDT>IBTD
QUIT
Begin DoDot:2
End DoDot:2
End DoDot:1
DQNEWQ ;
+1 LOCK -^IBAM(DFN)
+2 ;
+3 QUIT
+4 ;
MSG ; receives HL7 message from COTS product and files in 354.71 or others
+1 NEW IBMSG,IBHEADER,IBICN,IBDFN,IBSSN,IBCLAIM,IBALIAS,IBSTAT,IBTYPE,IBINST
+2 NEW IBRXDAT,IBRESLT,IB35471,IB351,IB35181,IB350,IBMTDT21,IBCODE,SEG,DFN,HLA
+3 ;
+4 ;parse message
+5 SET IBSTAT=$$STARTMSG^HLPRS(.IBMSG,HLMTIENS,.IBHEADER)
+6 IF 'IBSTAT
SET HLERR="Unable to start parse of message"
GOTO NEWTRANQ
+7 ;
+8 FOR
if '$$NEXTSEG^HLPRS(.IBMSG,.SEG)
QUIT
Begin DoDot:1
+9 FOR IBT=3:1
SET IBD=$PIECE($TEXT(HL7DATA+IBT),";",4)
if IBD=""
QUIT
Begin DoDot:2
+10 IF $PIECE(IBD,"^",2)=SEG("SEGMENT TYPE")
Begin DoDot:3
+11 SET @$PIECE(IBD,"^")=$$GET^HLOPRS(.SEG,$PIECE(IBD,"^",3),$PIECE(IBD,"^",4),$PIECE(IBD,"^",5),$PIECE(IBD,"^",6))
+12 SET IBCODE=$PIECE(IBD,"^",7,99)
+13 IF $LENGTH(IBCODE)
IF $LENGTH(@$PIECE(IBD,"^"))
SET X=@$PIECE(IBD,"^")
XECUTE IBCODE
SET @$PIECE(IBD,"^")=X
End DoDot:3
End DoDot:2
End DoDot:1
+14 ;
+15 ;check out data received from message
+16 SET DFN=$$PATIENT($GET(IBICN),$GET(IBDFN),$GET(IBSSN),$GET(IBVACLM),$GET(IBALIAS))
+17 if 'DFN
GOTO NEWTRANQ
+18 SET IBTYPE=$GET(IBTYPE)
+19 ;
+20 DO @($SELECT(IBTYPE="IN":"35471",IBTYPE="MT":"351",IBTYPE="LB":"35181",IBTYPE="ML":"350",IBTYPE="ST":"QUERYVA",IBTYPE="BL":"BILLVA",1:"ERR")_"^IBARXMI")
+21 ;
+22 ;
NEWTRANQ ;
+1 SET HLA("HLA",1)="MSA"_HL("FS")_$SELECT('$DATA(HLERR):"AA",1:"AE")_HL("FS")_HL("MID")
+2 DO GENACK^HLMA1(HL("EID"),HLMTIENS,HL("EIDS"),"LM",1,.IBRESLT)
+3 QUIT
+4 ;
PATIENT(IBICN,IBDFN,IBSSN,IBVACLM,IBALIAS) ; this function will receive
+1 ; several patient data elements and validate them. Assuming the data
+2 ; meets expected requirements, the function will return the patient's
+3 ; DFN. The requirement is ICN is a must, the patient must also match
+4 ; at least 2 other data elements.
+5 ;
+6 NEW DFN,IBMATCH,IBX
+7 SET (IBMATCH,IBX)=0
SET HLERR=""
+8 SET DFN=$$DFN^IBARXMU(IBICN)
IF 'DFN
SET HLERR="Invalid ICN: "_IBICN
GOTO PATQ
+9 ;
+10 IF DFN=IBDFN
SET IBMATCH=1
+11 IF '$TEST
SET HLERR=DFN_" Doesn't match ICN DFN "_IBDFN
+12 ;
+13 IF IBSSN
IF $PIECE($GET(^DPT(DFN,0)),"^",9)=IBSSN
SET IBMATCH=IBMATCH+1
+14 IF '$TEST
SET HLERR=HLERR_" SSN Mismatch:"_IBSSN
+15 IF IBMATCH>1
GOTO PATQ
+16 ;
+17 IF $LENGTH(IBVACLM)
IF $PIECE($GET(^DPT(DFN,.31)),"^",3)=IBVACLM
SET IBMATCH=IBMATCH+1
+18 IF '$TEST
if $LENGTH(IBVACLM)
SET HLERR=HLERR_" VA Claim Mismatch:"_IBVACLM
+19 IF IBMATCH>1
GOTO PATQ
+20 ;
+21 FOR
SET IBX=$ORDER(^DPT(DFN,.01,IBX))
if 'IBX!(IBMATCH>1)
QUIT
IF $LENGTH(IBALIAS)
IF $PIECE($GET(^DPT(DFN,.01,IBX,0)),"^",2)=IBALIAS
SET IBMATCH=IBMATCH+1
QUIT
+22 IF IBMATCH<2
SET DFN=0
SET HLERR=HLERR_" ALIAS Mismatch"
PATQ ;
+1 IF DFN
KILL HLERR
+2 QUIT DFN
+3 ;
HL7DATA ; hl7 data mapping
+1 ; format: description ; IB Variable ^ segment ^ seq ^ comp ^ subcomp ^
+2 ; extract code
+3 ;;patient icn;IBICN^PID^3^1^1^1
+4 ;;patient dfn;IBDFN^PID^3^1^1^2^S IBINST=$E(X,1,3),X=$E(X,4,99)
+5 ;;patient ssn;IBSSN^PID^3^1^1^3
+6 ;;patient va claim;IBVACLM^PID^3^1^1^4
+7 ;;patient alias ssn;IBALIAS^PID^3^1^1^5
+8 ;;receiver trans type;IBTYPE^FT1^6
+9 ;;transaction number;IB35471(.01)^FT1^2
+10 ;;trans eff date;IB35471(.03)^FT1^4^1^1^^S X=$$FMDATE^HLFNC(X)
+11 ;;trans status;IB35471(.05)^FT1^8
+12 ;;rx number;IB35471(.091)^RXE^15
+13 ;;refill number;IB35471(.092)^RXE^12
+14 ;;units;IB35471(.07)^FT1^12^5^1
+15 ;;total charge;IB35471(.08)^FT1^12^1^1
+16 ;;parent transaction;IB35471(.1)^FT1^9
+17 ;;billed amount;IB35471(.11)^FT1^11^1^1
+18 ;;unbilled amount;IB35471(.12)^FT1^15^1^1
+19 ;;mt clock begin date;IB351(.03)^ZMT^35^^^^S X=$$FMDATE^HLFNC(X)
+20 ;;mt clock status;IB351(.04)^ZMT^36
+21 ;;1st 90 day amt;IB351(.05)^ZMT^37
+22 ;;2nd 90 day amt;IB351(.06)^ZMT^38
+23 ;;3rd 90 day amt;IB351(.07)^ZMT^39
+24 ;;4th 90 day amt;IB351(.08)^ZMT^40
+25 ;;number of inpt days;IB351(.09)^ZMT^41
+26 ;;mt clock end date;IB351(.1)^ZMT^42^^^^S X=$$FMDATE^HLFNC(X)
+27 ;;ltc clock begin date;IB35181(.03)^ZMT^43^^^^S X=$$FMDATE^HLFNC(X)
+28 ;;ltc clock end date;IB35181(.04)^ZMT^44^^^^S X=$$FMDATE^HLFNC(X)
+29 ;;ltc clock status;IB35181(.05)^ZMT^45
+30 ;;ltc 21 exempt dates;IBMTD21^ZMT^46^^^^S IBMTDT21=$G(IBMTDT21)+1,IBMTDT21(IBMTDT21)=$$FMDATE^HLFNC(X)
+31 ;;charege type;IB350("TYP")^ZMT^47
+32 ;;patient type;IB350("IO")^PV1^2
+33 ;;event date/time;IB350("EDT")^PV1^44^1^^^S X=$$FMDATE^HLFNC(X)
+34 ;;bed section;IB350("BS")^ZMT^48
+35 ;;units;IB350(.06)^ZMT^49
+36 ;;total charge;IB350(.07)^ZMT^50
+37 ;;event date;IB350(.17)^ZMT^51^^^^S X=$$FMDATE^HLFNC(X)
+38 ;;from date;IB350(.14)^ZMT^52^^^^S X=$$FMDATE^HLFNC(X)
+39 ;;to date;IB350(.15)^ZMT^53^^^^S X=$$FMDATE^HLFNC(X)
+40 ;;stop code;IB350(.2)^ZMT^54
+41 ;;trans status;IB350(.05)^ZMT^55
+42 ;;idx visit number;IB350("IDX")^PV1^19^1
+43 ;;
+44 ;
