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Routine: IBBDOC

IBBDOC.m

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IBBDOC ;OAK/ELZ - APIS FOR OTHER PACKAGES FOR PFSS - DOCUMENT ;5-AUG-2004

 ;;2.0;INTEGRATED BILLING;**267,260,286,361,384,404,737**;21-MAR-94;Build 19

 ;;Per VA Directive 6402, this routine should not be modified.

 ;

 ; Documents the calls to the routine IBBAPI.

 ;

INSUR ;(DFN,IBDT,IBSTAT,IBR,IBFLDS)

 ; Function to return patient insurance information

 ; --Input:

 ;   DFN    = patient

 ;   IBDT   = date insured (optional - default is today's date)

 ;   IBSTAT = Insurance Status filter (combinable based on groups below)

 ;      Group 1

 ;          A = Inactive included (Default is active only)

 ;      Group 2

 ;          R = Not reimbursable included (Default is reimbursable only)

 ;          B = Indemnity included (Default is not included)

 ;      Group 3

 ;          P = Prescription coverage required (Default is all coverages)

 ;          O = Outpatient coverage required (Default is all coverages)

 ;          I = Inpatient coverage only (Default is all coverages)

 ;          E = e-Pharmacy billable coverage required, i.e. should have 

 ;            Pharmacy coverage and be able to process e-claims (Default 

 ;            is all coverages)

 ;

 ;   IBR    = Array to return insurance information - passed by reference

 ; Example of IBR Array when IBFLDS="1,6,14,17":

 ; Third parameter is an incremental counter

 ;

 ; IBR("IBBAPI","INSUR",1)=IEN for the policy in #2.312

 ; IBR("IBBAPI","INSUR",1,1)= Ins. Comp. IEN^Ins. Comp. Name (#2.312,.01)  internal^external

 ; IBR("IBBAPI","INSUR",1,6)=Ins. Comp. Phone (#36,.131)

 ; IBR("IBBAPI","INSUR",1,14)=Subscriber ID (#2.312,7.02)

 ; IBR("IBBAPI","INSUR",1,17)=Inpatient Coverage? 0^NO/1^YES

 ; IBR("IBBAPI","INSUR",2)= IEN for the policy in #2.312

 ; IBR("IBBAPI","INSUR",2,1)=Ins. Comp. IEN^Ins. Comp. Name (#2.312,.01) internal^external

 ; IBR("IBBAPI","INSUR",2,6)=Ins. Comp. Phone (#36,.131)

 ; IBR("IBBAPI","INSUR",2,14)=Subscriber ID (#2.312,7.02)

 ; IBR("IBBAPI","INSUR",2,17)=Inpatient Coverage? 0^NO/1^YES 

 ; etc.

 ;

 ;   IBFLDS = List of fields to return (1-31) in a comma separated list or "*" for all

 ;    IB*737/TAZ added list of possible fields for IBFLDS

 ;      1 - Ins. Comp. Name (#2.312,.01) internal^external

 ;      2 - Ins. Comp. Street Addr Line 1 (#36,.111)

 ;      3 - Ins. Comp. City (#36,.114)

 ;      4 - Ins. Comp. State (#36,.115) internal^external

 ;      5 - Ins. Comp. Zip (#36,.116)

 ;      6 - Ins. Comp. Phone (#36,.131)

 ;      7 - COB (#2.312,.2) internal^external

 ;      8 - Policy Name (#2.312,.18) internal^external

 ;      9 - Policy Reimbursable (#36,1) 0^NO/1^YES

 ;     10 - Policy Effective Date (#2.312,8) internal

 ;     11 - Policy Expiration Date (#2.312,3) internal

 ;     12 - Subscriber Relationship (#2.312,16) abbrev.^external

 ;     13 - Subscriber Name (#2.312,7.01)

 ;     14 - Subscriber ID (#2.312,7.02)

 ;     15 - Pharmacy Coverage? 0^NO/1^YES

 ;     16 - Outpatient Coverage? 0^NO/1^YES

 ;     17 - Inpatient Coverage? 0^NO/1^YES

 ;     18 - Group Number (#2.312,.18) -> (#355.3,2.02)

 ;     19 - Patient Relationship to Subscriber (#2.312,16) internal^external

 ;     20 - VA Advantage (always returns 0) ^ Tricare plan (1/0)

 ;     21 - Plan Type (#2.312,.18) -> (#355.3,.09) internal^external

 ;     22 - Subscriber Sex (#2,.02) or (#2.312,3.12) depends if it is a dependent policy    abbrev.^external

 ;     23 - Ins. Comp. Street Addr Line 2 (#36,.112)

 ;     24 - Ins. Comp. Street Addr Line 3 (#36,.113)

 ;     25 - Date Last Verified (#2.312,1.03) internal (may include time)

 ;     26 - Insured's Street 1 (#2.312,3.06)

 ;     27 - Insured's Street 2 (#2.312,3.07)

 ;     28 - Insured's City (#2.312,3.08)

 ;     29 - Insured's State (#2.312,3.09) internal^external

 ;     30 - Insured's Zip (#2.312,3.1)

 ;     31 - Insured's Phone (#2.312,3.11)

 ;

 ; --Output:

 ;   -1     = error occurred (error message passed back in

 ;            IBR("IBBAPI","INSUR","ERROR",x) where x is error number

 ;            between 101 & 111

 ;    0     = No insurance found based on parameters

 ;    1     = Insurance found

 ;

 ;

CIDC  ; (DFN)

 ; Input:    DFN for the patient in question.

 ; Output:   1 = Ask CIDC questions for the specified patient

 ;           0 = Don't ask CIDC questions for the specified patient

 ;

 ; The API will evaluate both a CIDC switch and the patient's insurance

 ; to determine if the CIDC questions should be asked.

 ;

 ; The switch will have three internal values:

 ;    0 = Don't ask any patients

 ;    1 = Ask for patients only with active billable insurance

 ;    2 = Ask for all patients

 ;

 ;

SWSTAT ; ()

 ; Returns the current status of the PFSS On/Off Switch

 ;

 ; Output:   <switch_status>^<status_date/time>

 ; 

 ; <switch_status> will be one of the following:

 ;    0 = OFF

 ;    1 = ON

 ;

GETACCT ; (IBBDFN,IBBARFN,IBBEVENT,IBBAPLR,IBBPV1,IBBPV2,IBBPR1,IBBDG1,IBBZCL,IBBDIV,IBBRAIEN,IBBSURG)

 ; Pass data to IBB for account/visit (ADT) messaging.

 ;

 ; Input:

 ; IBBDFN   = Patient; IEN to file #2 [required]

 ; IBBARFN  = Account Reference; 

 ;            IEN to file #375 or null [required]

 ; IBBEVENT = HL7 Event Code; e.g., "A04" [required]

 ; IBBAPLR  = Calling Application; 

 ;            <routine> or <tag>_;_<routine> 

 ; IBBPV1   = array for PV1 segment data [required]

 ;   IBBPV1(2)  - Patient Class (O=Outpatient;I=Inpatient)

 ;   IBBPV1(3)  - IEN to file #44, or "FEE BASIS"

 ;   IBBPV1(4)  - Appointment Type; IEN to file #409.1

 ;   IBBPV1(7)  - Attending Physician; IEN to file #200

 ;   IBBVP1(9)  - Consulting Physician; IEN to file #200

 ;   IBBPV1(10) - Purpose of Visit; 

 ;                (Scheduling: 1=C&P;2=10-10;3=SV;4=UV)

 ;   IBBPV1(17) - Admitting Physician or Surgeon; 

 ;                IEN to file #200

 ;   IBBPV1(18) - Primary Stop Code; IEN to file #40.7

 ;   IBBPV1(25) - Check-In Date/Time (Scheduling)

 ;   IBBPV1(41) - Credit Stop Code; IEN to file #40.7

 ;   IBBPV1(44) - Admit Date/Time

 ;   IBBPV1(45) - Check-Out Date/Time (Scheduling)

 ;   IBBPV1(50) - Prescription #; IEN to file #52 (Pharmacy)

 ;   IBBPV1(52) - Other Provider; IEN to file #200

 ; IBBPV2   = array for PV2 segment data

 ;   IBBPV2(7)  - Eligibility of Visit; IEN to file #8.1

 ;   IBBPV2(8)  - Expected Admit/Visit Date/Time

 ;   IBBPV2(24) - Appointment Status; 

 ;                (Scheduling:

 ;                 R=Scheduled/Kept;I=Inpatient;

 ;                 NS=No-Show;NSR=No-Show, Rescheduled;

 ;                 CP=Cancelled by Patient;

 ;                 CPR=Cancelled by Patient, Rescheduled;

 ;                 CC=Cancelled by Clinic;

 ;                 CCR=Cancelled by Clinic, Rescheduled;

 ;                 NT=No Action Taken)

 ;   IBBPV2(46) - Date Appointment Made (Scheduling)

 ; IBBPR1   = array for PR1 segment data

 ;   IBBPR1(3)  - Procedure; IEN to file #81

 ;   IBBPR1(4)  - Procedure; free text

 ;   IBBPR1(5)  - Procedure Date/Time

 ;   IBBPR1(6)  - Functional Type;

 ;                (Prosthetics: 

 ;                 O=Home Oxygen;P=Purchasing;

 ;                 I=Stock Issue)

 ;                (Radiology: 

 ;                 ANI=Angio/Neuro/Interventional;

 ;                 CARD=Cardiology Studies;CT=CT Scan;

 ;                 RAD=General Radiology;

 ;                 MRI=Magnetic Resonance Imaging;

 ;                 MAM=Mammography;NM=Nuclear Medicine;

 ;                 US=Ultrasound;VAS=Vascular Lab)

 ;   IBBPR1(11) - Surgeon; IEN to file #200

 ;   IBBPR1(16) - <modifier><modifier><modifier>... 

 ;                where each <modifier> is an IEN to file #81.3

 ; IBBDG1   = array for DG1 segment data

 ;   IBBDG1(n,3) - Diagnosis; IEN to file #80

 ;   IBBDG1(1,4) - Diagnosis; free text; only one allowed

 ;   IBBDG1(n,6) - Diagnosis Type; (A=Admitting;

 ;                                  W=Working;

 ;                                  D=Discharge;

 ;                                  F=Final)

 ; IBBZCL   = array for ZCL segment data

 ;   IBBZCL(n,2) - Classification Type; 

 ;                 (1=AO;2=IR;3=SC;4=EC;5=MST;6=HNC;

 ;                  7=CV;8=SHAD)

 ;   IBBZCL(n,3) - Classification Value; (1=YES;0=NO)

 ; IBBDIV   = IEN to file #40.8

 ; IBBRAIEN = IEN to file #75.1

 ; IBBSURG  = array for special Surgery data

 ;   IBBSURG(1) - Surgical Case #; IEN to file #130

 ;   IBBSURG(2) - Surgical Specialty; IEN to file #45.3

 ;

 ; Returns the pointer to the PFSS ACCOUNT file (#375) where 

 ; all application input data is stored.

 ;

 ; Output:  IEN to file #375, or 0, if unsuccessful

 ; 

GETCHGID ; ()

 ; Returns a Unique Charge ID.

 ;

 ; Output: 1 + current value of field #2 of file #372.

 ;

CHARGE ; (IBBDFN,IBBARFN,IBBCTYPE,IBBUCID,IBBFT1,IBBPR1,IBBDG1,IBBZCL,IBBRXE,IBBORIEN,IBBPROS)

 ; Pass data to IBB for charge (DFT) messaging.

 ;

 ; Input:

 ; IBBDFN   = Patient; IEN to file #2 [required]

 ; IBBARFN  = Account Reference; IEN to file #375 [required]

 ; IBBCTYPE = Charge Type; (CG=debit;CD=credit) [required]

 ; IBBUCID  = Unique Charge ID [required]

 ; IBBFT1   = array for FT1 segment data [required]

 ;   IBBFT1(4)  - Transaction Date/Time

 ;   IBBFT1(7)  - Pharmacy Service Code

 ;   IBBFT1(10) - Transaction Quantity

 ;   IBBFT1(13) - Department Code

 ;   IBBFT1(16) - Patient Location; IEN to file #44

 ;   IBBFT1(18) - Patient Status; (Pharmacy: 1=Rx Copay Exempt;

 ;                                           0=Not Exempt)

 ;   IBBFT1(20) - Rendering Provider; IEN to file #200

 ;   IBBFT1(21) - Ordering Provider; IEN to file #200

 ;   IBBFT1(22) - Unit Cost

 ;   IBBFT1(29) - <NDC><generic_name>

 ;   IBBFT1(31) - Transaction Type; 

 ;                (Pharmacy: 1=PSO NSC Rx Copay;

 ;                           2=PSO SC Rx Copay;

 ;                           3=PSO NSC Rx Copay Cancel

 ;                           4=PSO NSC Rx Copay Update

 ;                           5=PSO SC Rx Copay Cancel

 ;                           6=PSO SC Rx Copay Update)

 ; IBBPR1   = array for PR1 segment data;

 ;            (required except Pharmacy)

 ;   IBBPR1(3)    - Procedure; IEN to file #81

 ;   IBBPR1(4)    - Procedure; free text

 ;   IBBPR1(5)    - Procedure Date/Time

 ;   IBBPR1(6)    - Functional Type; 

 ;                  (Prosthetics: O=Home Oxygen;

 ;                                P=Purchasing;

 ;                                I=Stock Issue)

 ;   IBBPR1(11,1) - Surgeon; IEN to file #200

 ;   IBBPR1(11,2) - Attending Surgeon; IEN to file #200

 ;   IBBPR1(16)   - <modifier><modifier><modifier>...;

 ;                  each <modifier> is an IEN to file #81.3

 ; IBBDG1   = array for DG1 segment data

 ;   IBBDG1(n,3) - Diagnosis; IEN to file #80

 ;   IBBDG1(n,6) - Diagnosis Type; (A=Admitting;W=Working;

 ;                                  D=Discharge;F=Final)

 ; IBBZCL   = array for ZCL segment data

 ;   IBBZCL(n,2) - Classification Type; 

 ;                 (1=AO;2=IR;3=SC;4=EC;5=MST;

 ;                  6=HNC;7=CV;8=SHAD)

 ;   IBBZCL(n,3) - Classification Value; (1=YES;0=NO)

 ; IBBRXE   = data for RXE segment data (Pharmacy only)

 ;   IBBRXE(1)  - <quantity>_;_<days_supply>

 ;   IBBRXE(17) - Refills Dispensed

 ;   IBBRXE(18) - Release Date/Time

 ;   IBBRXE(31) - DEA, Special Handling codes

 ; IBBPROS  = array for special Prosthetics data

 ;   IBBPROS(1) - Vendor; IEN to file #440

 ;   IBBPROS(2) - OBL#

 ;

 ; Returns success indicator.

 ;

 ; Output: 1, if successful; 0 otherwise

 ;

SETACCT ; (IBBDFN,HLMTIENS)

 ; Store visit/account # from external billing system in PFSS

 ; ACCOUNT record; the file #375 record is found based on data

 ; contained in the HL7 message referenced by HLMTIENS.

 ; Most of the ADT messages involved originate in VistA and 

 ; are returned by the external billing system with visit#

 ; attached.

 ; Some ADT-A01 messages originate in the external billing

 ; system; these cause a new record to be created in file #375.

 ; 

 ; Input:

 ; IBBDFN   = Patient; IEN to file #2 [required]

 ; HLMTIENS = HL7 Message (standard VistA HL7 variable); 

 ;            IEN to file #773 [required]

 ;

 ; Returns PFSS Account Reference.

 ;

 ; Output: IEN to file #375

 ;

EXTNUM ; (IBBDFN,IBBARFN)

 ; Obtain the visit/account # of the external billing system

 ; that has been associated with the PFSS ACCOUNT file (#375)

 ; record.

 ; 

 ; Input:

 ; IBBDFN   = Patient; IEN to file #2 [required]

 ; IBBARFN  = Account Reference; IEN to file #375 [required]

 ;

 ; Returns the value of field #.02 from the file #375 record.

 ;

 ; Output: external visit/account #, or 0, if unsuccessful

 ;