IBAUTL8C ;ALB/MGD - DUPLICATE COPAY TRANSACTION UTILITIES CONT.; Sep 30, 2020@15:16:44
;;2.0;INTEGRATED BILLING;**630**;21-MAR-94;Build 39
;;Per VA Directive 6402, this routine should not be modified.
;
; ****************************************************************************
; This routine is designed to implement a series of final checks immediately *
; prior to IB releasing a charge over to Accounts Receivable (AR). *
; IBAUTL9 handles the storing of associated information related to any *
; duplicate copays found by IBAUTL8. * *
; These updates are part being released in IB*2.0*630. *
; ****************************************************************************
;
ICPYNEW(IBN,IBEVDT,IBACTION,IBINTACT) ;
; Perform checks for a new Inpatient Copay charge to determine if this charge should be passed over to AR.
; Input:
; IBN = Pointer to Inpatient Copay charge currently being reviewed in the INTEGRATED BILLING ACTION (#350) file
; IBEVDT = Event Date for the charge currently being reviewed in the INTEGRATED BILLING ACTION (#350) file
; IBACTION = Passed by reference. Passed in as 0:Pass to AR
; IBINTACT = Optional - Flag to indicate when the call is being made from an interactive option.
; 1:Interactive
; 0:Non-Interactive
; For more info see COPAYCHK above
;
; Output: IBACTION = 0 if the current charge being reviewed should be passed over to AR
; # The IEN of the existing Copay charge for the Patient/Date of interest.
; The charge being reviewed should NOT be passed over to AR.
;
; Inpatient Copays have precedence over Outpatient Observation Copays.
; If we are about to send a new Inpatient Copay over to AR OR if there is an existing Inpatient Copay
; already in AR for the patient/date, check to see if there is an existing Outpatient Observation Copay
; for the same date, and if there is, cancel the existing Outpatient Observation Copay.
;
; Verify incoming value of IBACTION and default to 0 if not defined
S IBACTION=$S(IBACTION'="":IBACTION,1:0)
; Quit if necessary data was not passed in
I +IBN<=0!(+IBEVDT'?7N) Q
; If IBINTACT was not passed in, default it to 0:Non-Interactive
S IBINTACT=$S(IBINTACT'="":IBINTACT,1:0)
N IBAT1,IBAT2,IBBFI,IBBFO,IBBFOB,IBBPD,IBCTOT,IBDFN,IBETOT,IBDATA0,IBLTC,IBRSN
; Load 0 node
S IBDATA0=$G(^IB(IBN,0))
; Load Patient IEN and ACTION TYPE
S IBDFN=+$P(IBDATA0,U,2),IBAT1=$P(IBDATA0,U,3)
; Quit if no IEN in record
I IBDFN<1 Q
; Determine if the Patient has an Inpatient Copay (BG#1 or BG#2) for the Event Date
S IBBFI=$$BFI^IBAUTL8C(IBDFN,IBEVDT,IBN)
; If the patient has NOT been charged an Inpatient Copay charge for the Event Date
; Set return value to pass the charge over to AR
I 'IBBFI D Q:IBACTION
. ; Set IBACTION = 0 so Inpatient Copay charge currently being reviewed will be passed over to AR
. S IBACTION=0
. ; Since we are going to pass the Inpatient Copay charge currently being reviewed over to AR
. ; we need to check for the existence of an existing Outpatient Observation Copay
. S IBBFOB=$$BFOB^IBAUTL8A(IBDFN,IBEVDT,IBN)
. ; if there is an existing Outpatient Observation Copay, Do the following
. I +IBBFOB D
. . ; Set IBACTION = IEN of Outpatient Observation Copay
. . S IBACTION=IBBFOB
. . ; Quit if interactive
. . Q:IBINTACT
. . ; ###Uncomment for Phase 2
. . ; IBND has to be set to 0 node for call to CANC^IBECEAU4
. . ; ### N IBND S IBND=$G(^IB(IBN,0))
. . ; IBFAC and IBSITE needed by Cancel operation below
. . ; ### N IBFAC,IBSITE
. . ; Calculate site from site parameters
. . ; ### D SITE^IBAUTL
. . ; Cancel the existing Outpatient Observation Copay charge with
. . ; CANCELLATION REASON = 42 - BILLED AT HIGHER TIER RATE
. . ; ### I 'IBINTACT D CANC^IBECEAU4(IBBFI,42,1)
. . ; Record related info into ^XTMP for MailMan message
. . S IBRSN="AN INPATIENT COPAY CHARGE BILLED AT HIGHER PRECEDENCE"
. . D STORE2^IBAUTL9(IBN,IBBFOB,IBRSN)
. . Q
. Q
; If the Patient has already been charged an Inpatient Copay charge for the Event Date
I IBBFI D Q:IBACTION
. ; Load dollar amounts from the 2 charges
. S IBCTOT=+$P($G(^IB(IBN,0)),U,7),IBETOT=+$P($G(^IB(+IBBFI,0)),U,7)
. ; If the Inpatient Copay charge currently being processed is <= to the existing Inpatient Copay charge
. I IBCTOT<=IBETOT D Q
. . ; Set return value to the existing Inpatient Copay charge which will prevent the current charge being sent over to AR
. . S IBACTION=IBBFI
. . ; Cancel Inpatient Copay charge currently being reviewed with CANCELLATION REASON = 4 - ENTERED IN ERROR
. . ; ### Uncomment for Phase 2 D CNCLCHRG^IBAUTL8A(IBN,4)
. . ; Record related info into ^XTMP for MailMan message
. . I 'IBINTACT D
. . . S IBRSN="EXISTING INPATIENT COPAY CHARGE AT SAME OR HIGHER TIER RATE"
. . . D STORE1^IBAUTL9(IBN,IBBFI,IBRSN)
. . ; If there is an existing Outpatient Observation Copay charge, cancel it as well
. . ; with CANCELLATION REASON = 42 - BILLED AT HIGHER TIER RATE
. . S IBBFOB=$$BFOB^IBAUTL8A(IBDFN,IBEVDT,IBN)
. . I +IBBFOB D
. . . ; Quit if interactive
. . . Q:IBINTACT
. . . ; Set 2nd piece of IBACTION = IEN of Outpatient Observation Copay
. . . S $P(IBACTION,U,2)=IBBFOB
. . . ; ### Uncomment for Phase 2
. . . ; IBND has to be set to 0 node for call to CANC^IBECEAU4
. . . ; ### N IBND S IBND=$G(^IB(IBN,0))
. . . ; IBFAC and IBSITE needed by Cancel operation below
. . . ; ### N IBFAC,IBSITE
. . . ; Calculate site from site parameters
. . . ; ### D SITE^IBAUTL
. . . ; Cancel existing Outpatient Observation Copay charge
. . . ; UNCOMMENT THIS AND TEST MORE ON WHAT HAPPENS IN THE CANCELLATION PROCESS
. . . ; ### I 'IBINTACT D CANC^IBECEAU4(IBBFI,42,1)
. . . ; Record related info into ^XTMP for MailMan message
. . . S IBRSN="AN INPATIENT COPAY CHARGE BILLED AT HIGHER PRECEDENCE"
. . . D STORE2^IBAUTL9(IBN,IBBFOB,IBRSN)
. . Q
. ; If the Inpatient Copay charge currently being processed is > than the existing Inpatient Copay charge
. I IBCTOT>IBETOT D Q
. . ; Set return value to the existing Inpatient Copay charge which will prevent the current charge being sent over to AR
. . S IBACTION=IBBFI
. . ; ### Uncomment for Phase 2
. . ; IBND has to be set to 0 node for call to CANC^IBECEAU4
. . ; ### N IBND S IBND=$G(^IB(IBN,0))
. . ; IBFAC and IBSITE needed by Cancel operation below
. . ; ### N IBFAC,IBSITE
. . ; Calculate site from site parameters
. . ; ### D SITE^IBAUTL
. . ; Cancel existing Inpatient Copay charge with Reason = 42 - BILLED AT HIGHER TIER RATE
. . ; UNCOMMENT THIS AND TEST MORE ON WHAT HAPPENS IN THE CANCELLATION PROCESS
. . ; ### I 'IBINTACT D CANC^IBECEAU4(IBBFI,42,1)
. . ; Record related info into ^XTMP for MailMan message
. . I 'IBINTACT D
. . . S IBRSN="ANOTHER INPATIENT COPAY CHARGE AT HIGHER TIER RATE"
. . . D STORE2^IBAUTL9(IBN,IBBFI,IBRSN)
. . ; If there is an existing Outpatient Observation Copay charge, cancel it as well
. . ; with CANCELLATION REASON = 42 - BILLED AT HIGHER TIER RATE
. . S IBBFOB=$$BFOB^IBAUTL8A(IBDFN,IBEVDT,IBN)
. . I +IBBFOB D
. . . ; Quit if interactive
. . . Q:IBINTACT
. . . ; ### Uncomment for Phase 2
. . . ; IBND has to be set to 0 node for call to CANC^IBECEAU4
. . . ; ### N IBND S IBND=$G(^IB(IBN,0))
. . . ; IBFAC and IBSITE needed by Cancel operation below
. . . ; ### N IBFAC,IBSITE
. . . ; Calculate site from site parameters
. . . ; ### D SITE^IBAUTL
. . . ; Cancel existing Outpatient Observation Copay charge
. . . ; UNCOMMENT THIS AND TEST MORE ON WHAT HAPPENS IN THE CANCELLATION PROCESS
. . . ; ### I 'IBINTACT D CANC^IBECEAU4(IBBFI,42,1)
. . . ; Record related info into ^XTMP for MailMan message
. . . S IBRSN="ANOTHER INPATIENT COPAY CHARGE AT HIGHER TIER RATE"
. . . D STORE2^IBAUTL9(IBN,IBBFOB,IBRSN)
. . . Q
. . Q
. Q
; If there wasn't an existing Inpatient Copay charge for the date, continue here.
; It is legal to have both an Inpatient Copay charge and an Inpatient Per diem on the same day
; for the combinations checked below. Determine if the Patient has an Per Diem Copay for the Event Date
S IBBPD=$$BFPD^IBAUTL8A(IBDFN,IBEVDT,IBN)
; If there was a Per Diem charge for this day check for legal pairings
I IBBPD D Q:IBACTION
. ; Set IBACTION = IEN of existing Per Diem Copay
. S IBACTION=IBBPD
. ; Load Action Type of the Per Diem charge
. S IBAT2=$P($G(^IB(IBBPD,0)),U,3)
. ; If 2 copays for a single day are a legal pairing, set IBACTION =0
. ; If the Action Type is CC INPATIENT (133) and the Per Diem is NOT CC PER DIEM (#130)
. I IBAT1=130,IBAT2=133 S IBACTION=0
. ; If the Action Type is one of the copays in Billing Group #2 and the Per Diem
. ; copay is not INPATIENT PER DIEM (#45) set IBACTION
. I "^16^17^18^19^20^21^22^23^"[("^"_IBAT1_"^"),IBAT2=45 S IBACTION=0
. ; If the Action Type is NHCU COPAY (#24) and the Per Diem is NOT NHCU PER DIEM (#48)
. I IBAT1=24,IBAT2=48 S IBACTION=0
. ; If an incorrect pairing was found, cancel charge
. I IBACTION D Q
. . ; Quit if interactive
. . Q:IBINTACT
. . ; ### Uncomment for Phase 2
. . ; IBND has to be set to 0 node for call to CANC^IBECEAU4
. . ; ### N IBND S IBND=$G(^IB(IBN,0))
. . ; IBFAC and IBSITE needed by Cancel operation below
. . ; ### N IBFAC,IBSITE
. . ; Calculate site from site parameters
. . ; ### D SITE^IBAUTL
. . ; Cancel existing Outpatient Observation Copay charge
. . ; UNCOMMENT THIS AND TEST MORE ON WHAT HAPPENS IN THE CANCELLATION PROCESS
. . ; ### I 'IBINTACT D CANC^IBECEAU4(IBBFI,42,1)
. . ; Record related info into ^XTMP for MailMan message
. . S IBRSN="AN INCORRECT INPATIENT COPAY & INPATIENT PER DIEM PAIRING"
. . D STORE2^IBAUTL9(IBN,IBBPD,IBRSN)
. . Q
. Q
;
; Determine if the Patient has an Outpatient Copay for the Event Date
S IBBFO=$$BFO^IBAUTL8A(IBDFN,IBEVDT,IBN)
; If the Patient has been charged an Outpatient Copay for the Event Date, set IBACTION and quit
I IBBFO D Q
. ; Set IBACTION = IEN of Outpatient Copay
. S IBACTION=IBBFO
. ; Quit if interactive
. Q:IBINTACT
. ; Record related info into ^XTMP for MailMan message
. S IBRSN="AN INPATIENT COPAY CHARGE BILLED AT HIGHER PRECEDENCE"
. D STORE2^IBAUTL9(IBN,IBBFO,IBRSN)
;
; Determine if the Patient has an Long Term Care Copay for the Event Date
S IBLTC=$$LTC^IBAUTL8B(IBDFN,IBEVDT,IBN)
; If the patient has been charged a Long Term Care Copay for the Event Date, set IBACTION and quit
I IBLTC D Q
. ; Set IBACTION = IEN of Outpatient Copay
. S IBACTION=IBLTC
. ; Quit if interactive
. Q:IBINTACT
. ; Record related info into ^XTMP for MailMan message
. S IBRSN="AN INPATIENT COPAY CHARGE BILLED AT HIGHER PRECEDENCE"
. D STORE2^IBAUTL9(IBN,IBLTC,IBRSN)
Q
;
BFI(DFN,IBDATE,IBNEW) ; Patient Billed For Inpatient Copay on a specified date?
; Input: DFN - Pointer to the patient in file #2
; IBDATE - Date of the Inpatient Visit
; IBNEW - IEN of new charge in File #350
; Output: 0 - Not billed the OPT copay on the visit date
; >0 - Pointer to charge in file #350 that was billed
;
; Inpatient Copays charges will have one of the following Billing Group & Action Types:
; Billing Group = INPT/NHCU FEE SERVICE (#1)
; 130 - CC (INPT) NEW
; Billing Group = INPT/NHCU COPAY (#2)
; 16 - DG INPT COPAY (SUR) NEW 17 - DG INPT COPAY (SPI) NEW
; 18 - DG INPT COPAY (PSY) NEW 19 - DG INPT COPAY (INT) NEW
; 20 - DG INPT COPAY (REH) NEW 21 - DG INPT COPAY (BLI) NEW
; 22 - DG INPT COPAY (NEU) NEW 23 - DG INPT COPAY (ALC) NEW
; 24 - DG NHCU COPAY NEW
;
N IBAMT,IBATYP,IBATYPN,IBCHK,IBCHRG,IBDATA0,IBN,IBSTOPDT
S (IBATYP,IBATYPN)="",IBAMT=0
; Initialize the return variable to 0 - Not billed the Inpatient copay on the visit date
S IBCHRG=0
I '$G(DFN)!('$G(IBDATE)) Q +$G(IBCHRG)
; Set stop date for loop
S IBSTOPDT=$P(IBDATE,".",1)
; Strip off time portion of DATA and reset IBDATE for looping by subtracting .000001
S IBDATE=$P(IBDATE,".",1)-.000001
; Loop through Date/Time entries (earliest to latest) for the single date being checked
F S IBDATE=$O(^IB("ACHDT",DFN,IBDATE)) Q:'IBDATE!($P(IBDATE,".",1)>IBSTOPDT) D
. ; Loop through the individual charges
. S IBN=0
. F S IBN=$O(^IB("ACHDT",DFN,IBDATE,IBN)) Q:'IBN D
. . ; Quit if entry found in ACHDT is the entry we are currently processing
. . Q:IBN=IBNEW
. . ; Initialize legal pair checking
. . S IBCHK=0
. . ; Load 0 node in File #350 for this record
. . S IBDATA0=$G(^IB(IBN,0))
. . ; Quit if ACTION TYPE is not an Inpatient Copay
. . Q:"^16^17^18^19^20^21^22^23^24^130^"'[("^"_$P(IBDATA0,U,3)_"^")
. . ; using the ACTION TYPE (#.03) field of the INTEGRATED BILLING ACTION file (#350) set IBATYP = 0 Node of the IB ACTION TYPE file (#350.1)
. . S IBATYP=$G(^IBE(350.1,+$P(IBDATA0,"^",3),0))
. . ; Using IBATYP set IBATYPN = NEW ACTION TYPE (#.09)
. . S IBATYPN=$G(^IBE(350.1,+$P(IBATYP,"^",9),0))
. . ; Quit if any of the key data for the checks is missing
. . I IBDATA0=""!(IBATYP="")!(IBATYPN="") Q
. . ; Check if the BILLING GROUP field (#.11) and the ACTION TYPE (#.03) matches to the
. . ; specific combinations provided by the SMEs.
. . ; Check for Billing Group = 1:INPT/NHCU FEE SERVICE & charge type = CC (INPT) NEW (130)
. . I $P(IBATYPN,"^",11)=1,($P(IBDATA0,U,3)=130) S IBCHK=1
. . ; Check for Billing Group = 2:INPT/NHCU COPAY & charge type = INPT COPAY (16^17^18^19^20^21^22^23^24)
. . I $P(IBATYPN,"^",11)=2,("^16^17^18^19^20^21^22^23^24^"[("^"_$P(IBDATA0,U,3)_"^")) S IBCHK=1
. . I IBCHK D
. . . ; IF 1:NEW or 3:UPDATE is contained in the SEQUENCE NUMBER field (#.05) in the IB ACTION TYPE file (#350.1)
. . . ; AND the STATUS field (#.05) in the INTEGRATED BILLING ACTION file (#350) is one of the following:
. . . ; 1:INCOMPLETE, 2:COMPLETE, 3:BILLED, 4:UPDATED, 8:ON HOLD, 20:HOLD - RATE
. . . ; THEN set Y = IEN of the Duplicate Inpatient Copy
. . . I "^1^3^"[("^"_$P(IBATYP,"^",5)_"^"),"^1^2^3^4^8^20^"[("^"_+$P(IBDATA0,"^",5)_"^") D
. . . . ; Compare the TOTAL CHARGE of this Inpatient Copay charge to any previously identified
. . . . ; Inpatient Copay for the same date and save the IEN of the highest charge
. . . . I +$P(IBDATA0,U,7)>IBAMT S IBAMT=+$P(IBDATA0,U,7),IBCHRG=IBN
. . . . Q
. . . Q
. . Q
. Q
Q +$G(IBCHRG)
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HIBAUTL8C 14705 printed Sep 23, 2025@19:44:27 Page 2
IBAUTL8C ;ALB/MGD - DUPLICATE COPAY TRANSACTION UTILITIES CONT.; Sep 30, 2020@15:16:44
+1 ;;2.0;INTEGRATED BILLING;**630**;21-MAR-94;Build 39
+2 ;;Per VA Directive 6402, this routine should not be modified.
+3 ;
+4 ; ****************************************************************************
+5 ; This routine is designed to implement a series of final checks immediately *
+6 ; prior to IB releasing a charge over to Accounts Receivable (AR). *
+7 ; IBAUTL9 handles the storing of associated information related to any *
+8 ; duplicate copays found by IBAUTL8. * *
+9 ; These updates are part being released in IB*2.0*630. *
+10 ; ****************************************************************************
+11 ;
ICPYNEW(IBN,IBEVDT,IBACTION,IBINTACT) ;
+1 ; Perform checks for a new Inpatient Copay charge to determine if this charge should be passed over to AR.
+2 ; Input:
+3 ; IBN = Pointer to Inpatient Copay charge currently being reviewed in the INTEGRATED BILLING ACTION (#350) file
+4 ; IBEVDT = Event Date for the charge currently being reviewed in the INTEGRATED BILLING ACTION (#350) file
+5 ; IBACTION = Passed by reference. Passed in as 0:Pass to AR
+6 ; IBINTACT = Optional - Flag to indicate when the call is being made from an interactive option.
+7 ; 1:Interactive
+8 ; 0:Non-Interactive
+9 ; For more info see COPAYCHK above
+10 ;
+11 ; Output: IBACTION = 0 if the current charge being reviewed should be passed over to AR
+12 ; # The IEN of the existing Copay charge for the Patient/Date of interest.
+13 ; The charge being reviewed should NOT be passed over to AR.
+14 ;
+15 ; Inpatient Copays have precedence over Outpatient Observation Copays.
+16 ; If we are about to send a new Inpatient Copay over to AR OR if there is an existing Inpatient Copay
+17 ; already in AR for the patient/date, check to see if there is an existing Outpatient Observation Copay
+18 ; for the same date, and if there is, cancel the existing Outpatient Observation Copay.
+19 ;
+20 ; Verify incoming value of IBACTION and default to 0 if not defined
+21 SET IBACTION=$SELECT(IBACTION'="":IBACTION,1:0)
+22 ; Quit if necessary data was not passed in
+23 IF +IBN<=0!(+IBEVDT'?7N)
QUIT
+24 ; If IBINTACT was not passed in, default it to 0:Non-Interactive
+25 SET IBINTACT=$SELECT(IBINTACT'="":IBINTACT,1:0)
+26 NEW IBAT1,IBAT2,IBBFI,IBBFO,IBBFOB,IBBPD,IBCTOT,IBDFN,IBETOT,IBDATA0,IBLTC,IBRSN
+27 ; Load 0 node
+28 SET IBDATA0=$GET(^IB(IBN,0))
+29 ; Load Patient IEN and ACTION TYPE
+30 SET IBDFN=+$PIECE(IBDATA0,U,2)
SET IBAT1=$PIECE(IBDATA0,U,3)
+31 ; Quit if no IEN in record
+32 IF IBDFN<1
QUIT
+33 ; Determine if the Patient has an Inpatient Copay (BG#1 or BG#2) for the Event Date
+34 SET IBBFI=$$BFI^IBAUTL8C(IBDFN,IBEVDT,IBN)
+35 ; If the patient has NOT been charged an Inpatient Copay charge for the Event Date
+36 ; Set return value to pass the charge over to AR
+37 IF 'IBBFI
Begin DoDot:1
+38 ; Set IBACTION = 0 so Inpatient Copay charge currently being reviewed will be passed over to AR
+39 SET IBACTION=0
+40 ; Since we are going to pass the Inpatient Copay charge currently being reviewed over to AR
+41 ; we need to check for the existence of an existing Outpatient Observation Copay
+42 SET IBBFOB=$$BFOB^IBAUTL8A(IBDFN,IBEVDT,IBN)
+43 ; if there is an existing Outpatient Observation Copay, Do the following
+44 IF +IBBFOB
Begin DoDot:2
+45 ; Set IBACTION = IEN of Outpatient Observation Copay
+46 SET IBACTION=IBBFOB
+47 ; Quit if interactive
+48 if IBINTACT
QUIT
+49 ; ###Uncomment for Phase 2
+50 ; IBND has to be set to 0 node for call to CANC^IBECEAU4
+51 ; ### N IBND S IBND=$G(^IB(IBN,0))
+52 ; IBFAC and IBSITE needed by Cancel operation below
+53 ; ### N IBFAC,IBSITE
+54 ; Calculate site from site parameters
+55 ; ### D SITE^IBAUTL
+56 ; Cancel the existing Outpatient Observation Copay charge with
+57 ; CANCELLATION REASON = 42 - BILLED AT HIGHER TIER RATE
+58 ; ### I 'IBINTACT D CANC^IBECEAU4(IBBFI,42,1)
+59 ; Record related info into ^XTMP for MailMan message
+60 SET IBRSN="AN INPATIENT COPAY CHARGE BILLED AT HIGHER PRECEDENCE"
+61 DO STORE2^IBAUTL9(IBN,IBBFOB,IBRSN)
+62 QUIT
End DoDot:2
+63 QUIT
End DoDot:1
if IBACTION
QUIT
+64 ; If the Patient has already been charged an Inpatient Copay charge for the Event Date
+65 IF IBBFI
Begin DoDot:1
+66 ; Load dollar amounts from the 2 charges
+67 SET IBCTOT=+$PIECE($GET(^IB(IBN,0)),U,7)
SET IBETOT=+$PIECE($GET(^IB(+IBBFI,0)),U,7)
+68 ; If the Inpatient Copay charge currently being processed is <= to the existing Inpatient Copay charge
+69 IF IBCTOT<=IBETOT
Begin DoDot:2
+70 ; Set return value to the existing Inpatient Copay charge which will prevent the current charge being sent over to AR
+71 SET IBACTION=IBBFI
+72 ; Cancel Inpatient Copay charge currently being reviewed with CANCELLATION REASON = 4 - ENTERED IN ERROR
+73 ; ### Uncomment for Phase 2 D CNCLCHRG^IBAUTL8A(IBN,4)
+74 ; Record related info into ^XTMP for MailMan message
+75 IF 'IBINTACT
Begin DoDot:3
+76 SET IBRSN="EXISTING INPATIENT COPAY CHARGE AT SAME OR HIGHER TIER RATE"
+77 DO STORE1^IBAUTL9(IBN,IBBFI,IBRSN)
End DoDot:3
+78 ; If there is an existing Outpatient Observation Copay charge, cancel it as well
+79 ; with CANCELLATION REASON = 42 - BILLED AT HIGHER TIER RATE
+80 SET IBBFOB=$$BFOB^IBAUTL8A(IBDFN,IBEVDT,IBN)
+81 IF +IBBFOB
Begin DoDot:3
+82 ; Quit if interactive
+83 if IBINTACT
QUIT
+84 ; Set 2nd piece of IBACTION = IEN of Outpatient Observation Copay
+85 SET $PIECE(IBACTION,U,2)=IBBFOB
+86 ; ### Uncomment for Phase 2
+87 ; IBND has to be set to 0 node for call to CANC^IBECEAU4
+88 ; ### N IBND S IBND=$G(^IB(IBN,0))
+89 ; IBFAC and IBSITE needed by Cancel operation below
+90 ; ### N IBFAC,IBSITE
+91 ; Calculate site from site parameters
+92 ; ### D SITE^IBAUTL
+93 ; Cancel existing Outpatient Observation Copay charge
+94 ; UNCOMMENT THIS AND TEST MORE ON WHAT HAPPENS IN THE CANCELLATION PROCESS
+95 ; ### I 'IBINTACT D CANC^IBECEAU4(IBBFI,42,1)
+96 ; Record related info into ^XTMP for MailMan message
+97 SET IBRSN="AN INPATIENT COPAY CHARGE BILLED AT HIGHER PRECEDENCE"
+98 DO STORE2^IBAUTL9(IBN,IBBFOB,IBRSN)
End DoDot:3
+99 QUIT
End DoDot:2
QUIT
+100 ; If the Inpatient Copay charge currently being processed is > than the existing Inpatient Copay charge
+101 IF IBCTOT>IBETOT
Begin DoDot:2
+102 ; Set return value to the existing Inpatient Copay charge which will prevent the current charge being sent over to AR
+103 SET IBACTION=IBBFI
+104 ; ### Uncomment for Phase 2
+105 ; IBND has to be set to 0 node for call to CANC^IBECEAU4
+106 ; ### N IBND S IBND=$G(^IB(IBN,0))
+107 ; IBFAC and IBSITE needed by Cancel operation below
+108 ; ### N IBFAC,IBSITE
+109 ; Calculate site from site parameters
+110 ; ### D SITE^IBAUTL
+111 ; Cancel existing Inpatient Copay charge with Reason = 42 - BILLED AT HIGHER TIER RATE
+112 ; UNCOMMENT THIS AND TEST MORE ON WHAT HAPPENS IN THE CANCELLATION PROCESS
+113 ; ### I 'IBINTACT D CANC^IBECEAU4(IBBFI,42,1)
+114 ; Record related info into ^XTMP for MailMan message
+115 IF 'IBINTACT
Begin DoDot:3
+116 SET IBRSN="ANOTHER INPATIENT COPAY CHARGE AT HIGHER TIER RATE"
+117 DO STORE2^IBAUTL9(IBN,IBBFI,IBRSN)
End DoDot:3
+118 ; If there is an existing Outpatient Observation Copay charge, cancel it as well
+119 ; with CANCELLATION REASON = 42 - BILLED AT HIGHER TIER RATE
+120 SET IBBFOB=$$BFOB^IBAUTL8A(IBDFN,IBEVDT,IBN)
+121 IF +IBBFOB
Begin DoDot:3
+122 ; Quit if interactive
+123 if IBINTACT
QUIT
+124 ; ### Uncomment for Phase 2
+125 ; IBND has to be set to 0 node for call to CANC^IBECEAU4
+126 ; ### N IBND S IBND=$G(^IB(IBN,0))
+127 ; IBFAC and IBSITE needed by Cancel operation below
+128 ; ### N IBFAC,IBSITE
+129 ; Calculate site from site parameters
+130 ; ### D SITE^IBAUTL
+131 ; Cancel existing Outpatient Observation Copay charge
+132 ; UNCOMMENT THIS AND TEST MORE ON WHAT HAPPENS IN THE CANCELLATION PROCESS
+133 ; ### I 'IBINTACT D CANC^IBECEAU4(IBBFI,42,1)
+134 ; Record related info into ^XTMP for MailMan message
+135 SET IBRSN="ANOTHER INPATIENT COPAY CHARGE AT HIGHER TIER RATE"
+136 DO STORE2^IBAUTL9(IBN,IBBFOB,IBRSN)
+137 QUIT
End DoDot:3
+138 QUIT
End DoDot:2
QUIT
+139 QUIT
End DoDot:1
if IBACTION
QUIT
+140 ; If there wasn't an existing Inpatient Copay charge for the date, continue here.
+141 ; It is legal to have both an Inpatient Copay charge and an Inpatient Per diem on the same day
+142 ; for the combinations checked below. Determine if the Patient has an Per Diem Copay for the Event Date
+143 SET IBBPD=$$BFPD^IBAUTL8A(IBDFN,IBEVDT,IBN)
+144 ; If there was a Per Diem charge for this day check for legal pairings
+145 IF IBBPD
Begin DoDot:1
+146 ; Set IBACTION = IEN of existing Per Diem Copay
+147 SET IBACTION=IBBPD
+148 ; Load Action Type of the Per Diem charge
+149 SET IBAT2=$PIECE($GET(^IB(IBBPD,0)),U,3)
+150 ; If 2 copays for a single day are a legal pairing, set IBACTION =0
+151 ; If the Action Type is CC INPATIENT (133) and the Per Diem is NOT CC PER DIEM (#130)
+152 IF IBAT1=130
IF IBAT2=133
SET IBACTION=0
+153 ; If the Action Type is one of the copays in Billing Group #2 and the Per Diem
+154 ; copay is not INPATIENT PER DIEM (#45) set IBACTION
+155 IF "^16^17^18^19^20^21^22^23^"[("^"_IBAT1_"^")
IF IBAT2=45
SET IBACTION=0
+156 ; If the Action Type is NHCU COPAY (#24) and the Per Diem is NOT NHCU PER DIEM (#48)
+157 IF IBAT1=24
IF IBAT2=48
SET IBACTION=0
+158 ; If an incorrect pairing was found, cancel charge
+159 IF IBACTION
Begin DoDot:2
+160 ; Quit if interactive
+161 if IBINTACT
QUIT
+162 ; ### Uncomment for Phase 2
+163 ; IBND has to be set to 0 node for call to CANC^IBECEAU4
+164 ; ### N IBND S IBND=$G(^IB(IBN,0))
+165 ; IBFAC and IBSITE needed by Cancel operation below
+166 ; ### N IBFAC,IBSITE
+167 ; Calculate site from site parameters
+168 ; ### D SITE^IBAUTL
+169 ; Cancel existing Outpatient Observation Copay charge
+170 ; UNCOMMENT THIS AND TEST MORE ON WHAT HAPPENS IN THE CANCELLATION PROCESS
+171 ; ### I 'IBINTACT D CANC^IBECEAU4(IBBFI,42,1)
+172 ; Record related info into ^XTMP for MailMan message
+173 SET IBRSN="AN INCORRECT INPATIENT COPAY & INPATIENT PER DIEM PAIRING"
+174 DO STORE2^IBAUTL9(IBN,IBBPD,IBRSN)
+175 QUIT
End DoDot:2
QUIT
+176 QUIT
End DoDot:1
if IBACTION
QUIT
+177 ;
+178 ; Determine if the Patient has an Outpatient Copay for the Event Date
+179 SET IBBFO=$$BFO^IBAUTL8A(IBDFN,IBEVDT,IBN)
+180 ; If the Patient has been charged an Outpatient Copay for the Event Date, set IBACTION and quit
+181 IF IBBFO
Begin DoDot:1
+182 ; Set IBACTION = IEN of Outpatient Copay
+183 SET IBACTION=IBBFO
+184 ; Quit if interactive
+185 if IBINTACT
QUIT
+186 ; Record related info into ^XTMP for MailMan message
+187 SET IBRSN="AN INPATIENT COPAY CHARGE BILLED AT HIGHER PRECEDENCE"
+188 DO STORE2^IBAUTL9(IBN,IBBFO,IBRSN)
End DoDot:1
QUIT
+189 ;
+190 ; Determine if the Patient has an Long Term Care Copay for the Event Date
+191 SET IBLTC=$$LTC^IBAUTL8B(IBDFN,IBEVDT,IBN)
+192 ; If the patient has been charged a Long Term Care Copay for the Event Date, set IBACTION and quit
+193 IF IBLTC
Begin DoDot:1
+194 ; Set IBACTION = IEN of Outpatient Copay
+195 SET IBACTION=IBLTC
+196 ; Quit if interactive
+197 if IBINTACT
QUIT
+198 ; Record related info into ^XTMP for MailMan message
+199 SET IBRSN="AN INPATIENT COPAY CHARGE BILLED AT HIGHER PRECEDENCE"
+200 DO STORE2^IBAUTL9(IBN,IBLTC,IBRSN)
End DoDot:1
QUIT
+201 QUIT
+202 ;
BFI(DFN,IBDATE,IBNEW) ; Patient Billed For Inpatient Copay on a specified date?
+1 ; Input: DFN - Pointer to the patient in file #2
+2 ; IBDATE - Date of the Inpatient Visit
+3 ; IBNEW - IEN of new charge in File #350
+4 ; Output: 0 - Not billed the OPT copay on the visit date
+5 ; >0 - Pointer to charge in file #350 that was billed
+6 ;
+7 ; Inpatient Copays charges will have one of the following Billing Group & Action Types:
+8 ; Billing Group = INPT/NHCU FEE SERVICE (#1)
+9 ; 130 - CC (INPT) NEW
+10 ; Billing Group = INPT/NHCU COPAY (#2)
+11 ; 16 - DG INPT COPAY (SUR) NEW 17 - DG INPT COPAY (SPI) NEW
+12 ; 18 - DG INPT COPAY (PSY) NEW 19 - DG INPT COPAY (INT) NEW
+13 ; 20 - DG INPT COPAY (REH) NEW 21 - DG INPT COPAY (BLI) NEW
+14 ; 22 - DG INPT COPAY (NEU) NEW 23 - DG INPT COPAY (ALC) NEW
+15 ; 24 - DG NHCU COPAY NEW
+16 ;
+17 NEW IBAMT,IBATYP,IBATYPN,IBCHK,IBCHRG,IBDATA0,IBN,IBSTOPDT
+18 SET (IBATYP,IBATYPN)=""
SET IBAMT=0
+19 ; Initialize the return variable to 0 - Not billed the Inpatient copay on the visit date
+20 SET IBCHRG=0
+21 IF '$GET(DFN)!('$GET(IBDATE))
QUIT +$GET(IBCHRG)
+22 ; Set stop date for loop
+23 SET IBSTOPDT=$PIECE(IBDATE,".",1)
+24 ; Strip off time portion of DATA and reset IBDATE for looping by subtracting .000001
+25 SET IBDATE=$PIECE(IBDATE,".",1)-.000001
+26 ; Loop through Date/Time entries (earliest to latest) for the single date being checked
+27 FOR
SET IBDATE=$ORDER(^IB("ACHDT",DFN,IBDATE))
if 'IBDATE!($PIECE(IBDATE,".",1)>IBSTOPDT)
QUIT
Begin DoDot:1
+28 ; Loop through the individual charges
+29 SET IBN=0
+30 FOR
SET IBN=$ORDER(^IB("ACHDT",DFN,IBDATE,IBN))
if 'IBN
QUIT
Begin DoDot:2
+31 ; Quit if entry found in ACHDT is the entry we are currently processing
+32 if IBN=IBNEW
QUIT
+33 ; Initialize legal pair checking
+34 SET IBCHK=0
+35 ; Load 0 node in File #350 for this record
+36 SET IBDATA0=$GET(^IB(IBN,0))
+37 ; Quit if ACTION TYPE is not an Inpatient Copay
+38 if "^16^17^18^19^20^21^22^23^24^130^"'[("^"_$PIECE(IBDATA0,U,3)_"^")
QUIT
+39 ; using the ACTION TYPE (#.03) field of the INTEGRATED BILLING ACTION file (#350) set IBATYP = 0 Node of the IB ACTION TYPE file (#350.1)
+40 SET IBATYP=$GET(^IBE(350.1,+$PIECE(IBDATA0,"^",3),0))
+41 ; Using IBATYP set IBATYPN = NEW ACTION TYPE (#.09)
+42 SET IBATYPN=$GET(^IBE(350.1,+$PIECE(IBATYP,"^",9),0))
+43 ; Quit if any of the key data for the checks is missing
+44 IF IBDATA0=""!(IBATYP="")!(IBATYPN="")
QUIT
+45 ; Check if the BILLING GROUP field (#.11) and the ACTION TYPE (#.03) matches to the
+46 ; specific combinations provided by the SMEs.
+47 ; Check for Billing Group = 1:INPT/NHCU FEE SERVICE & charge type = CC (INPT) NEW (130)
+48 IF $PIECE(IBATYPN,"^",11)=1
IF ($PIECE(IBDATA0,U,3)=130)
SET IBCHK=1
+49 ; Check for Billing Group = 2:INPT/NHCU COPAY & charge type = INPT COPAY (16^17^18^19^20^21^22^23^24)
+50 IF $PIECE(IBATYPN,"^",11)=2
IF ("^16^17^18^19^20^21^22^23^24^"[("^"_$PIECE(IBDATA0,U,3)_"^"))
SET IBCHK=1
+51 IF IBCHK
Begin DoDot:3
+52 ; IF 1:NEW or 3:UPDATE is contained in the SEQUENCE NUMBER field (#.05) in the IB ACTION TYPE file (#350.1)
+53 ; AND the STATUS field (#.05) in the INTEGRATED BILLING ACTION file (#350) is one of the following:
+54 ; 1:INCOMPLETE, 2:COMPLETE, 3:BILLED, 4:UPDATED, 8:ON HOLD, 20:HOLD - RATE
+55 ; THEN set Y = IEN of the Duplicate Inpatient Copy
+56 IF "^1^3^"[("^"_$PIECE(IBATYP,"^",5)_"^")
IF "^1^2^3^4^8^20^"[("^"_+$PIECE(IBDATA0,"^",5)_"^")
Begin DoDot:4
+57 ; Compare the TOTAL CHARGE of this Inpatient Copay charge to any previously identified
+58 ; Inpatient Copay for the same date and save the IEN of the highest charge
+59 IF +$PIECE(IBDATA0,U,7)>IBAMT
SET IBAMT=+$PIECE(IBDATA0,U,7)
SET IBCHRG=IBN
+60 QUIT
End DoDot:4
+61 QUIT
End DoDot:3
+62 QUIT
End DoDot:2
+63 QUIT
End DoDot:1
+64 QUIT +$GET(IBCHRG)
