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Routine: IBBDOC

IBBDOC.m

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  1. IBBDOC ;OAK/ELZ - APIS FOR OTHER PACKAGES FOR PFSS - DOCUMENT ;5-AUG-2004
  1.  ;;2.0;INTEGRATED BILLING;**267,260,286,361,384,404,737**;21-MAR-94;Build 19
  1.  ;;Per VA Directive 6402, this routine should not be modified.
  1.  ;
  1.  ; Documents the calls to the routine IBBAPI.
  1.  ;
  1. INSUR ;(DFN,IBDT,IBSTAT,IBR,IBFLDS)
  1.  ; Function to return patient insurance information
  1.  ; --Input:
  1.  ;   DFN    = patient
  1.  ;   IBDT   = date insured (optional - default is today's date)
  1.  ;   IBSTAT = Insurance Status filter (combinable based on groups below)
  1.  ;      Group 1
  1.  ;          A = Inactive included (Default is active only)
  1.  ;      Group 2
  1.  ;          R = Not reimbursable included (Default is reimbursable only)
  1.  ;          B = Indemnity included (Default is not included)
  1.  ;      Group 3
  1.  ;          P = Prescription coverage required (Default is all coverages)
  1.  ;          O = Outpatient coverage required (Default is all coverages)
  1.  ;          I = Inpatient coverage only (Default is all coverages)
  1.  ;          E = e-Pharmacy billable coverage required, i.e. should have 
  1.  ;            Pharmacy coverage and be able to process e-claims (Default 
  1.  ;            is all coverages)
  1.  ;
  1.  ;   IBR    = Array to return insurance information - passed by reference
  1.  ; Example of IBR Array when IBFLDS="1,6,14,17":
  1.  ; Third parameter is an incremental counter
  1.  ;
  1.  ; IBR("IBBAPI","INSUR",1)=IEN for the policy in #2.312
  1.  ; IBR("IBBAPI","INSUR",1,1)= Ins. Comp. IEN^Ins. Comp. Name (#2.312,.01)  internal^external
  1.  ; IBR("IBBAPI","INSUR",1,6)=Ins. Comp. Phone (#36,.131)
  1.  ; IBR("IBBAPI","INSUR",1,14)=Subscriber ID (#2.312,7.02)
  1.  ; IBR("IBBAPI","INSUR",1,17)=Inpatient Coverage? 0^NO/1^YES
  1.  ; IBR("IBBAPI","INSUR",2)= IEN for the policy in #2.312
  1.  ; IBR("IBBAPI","INSUR",2,1)=Ins. Comp. IEN^Ins. Comp. Name (#2.312,.01) internal^external
  1.  ; IBR("IBBAPI","INSUR",2,6)=Ins. Comp. Phone (#36,.131)
  1.  ; IBR("IBBAPI","INSUR",2,14)=Subscriber ID (#2.312,7.02)
  1.  ; IBR("IBBAPI","INSUR",2,17)=Inpatient Coverage? 0^NO/1^YES 
  1.  ; etc.
  1.  ;
  1.  ;   IBFLDS = List of fields to return (1-31) in a comma separated list or "*" for all
  1.  ;    IB*737/TAZ added list of possible fields for IBFLDS
  1.  ;      1 - Ins. Comp. Name (#2.312,.01) internal^external
  1.  ;      2 - Ins. Comp. Street Addr Line 1 (#36,.111)
  1.  ;      3 - Ins. Comp. City (#36,.114)
  1.  ;      4 - Ins. Comp. State (#36,.115) internal^external
  1.  ;      5 - Ins. Comp. Zip (#36,.116)
  1.  ;      6 - Ins. Comp. Phone (#36,.131)
  1.  ;      7 - COB (#2.312,.2) internal^external
  1.  ;      8 - Policy Name (#2.312,.18) internal^external
  1.  ;      9 - Policy Reimbursable (#36,1) 0^NO/1^YES
  1.  ;     10 - Policy Effective Date (#2.312,8) internal
  1.  ;     11 - Policy Expiration Date (#2.312,3) internal
  1.  ;     12 - Subscriber Relationship (#2.312,16) abbrev.^external
  1.  ;     13 - Subscriber Name (#2.312,7.01)
  1.  ;     14 - Subscriber ID (#2.312,7.02)
  1.  ;     15 - Pharmacy Coverage? 0^NO/1^YES
  1.  ;     16 - Outpatient Coverage? 0^NO/1^YES
  1.  ;     17 - Inpatient Coverage? 0^NO/1^YES
  1.  ;     18 - Group Number (#2.312,.18) -> (#355.3,2.02)
  1.  ;     19 - Patient Relationship to Subscriber (#2.312,16) internal^external
  1.  ;     20 - VA Advantage (always returns 0) ^ Tricare plan (1/0)
  1.  ;     21 - Plan Type (#2.312,.18) -> (#355.3,.09) internal^external
  1.  ;     22 - Subscriber Sex (#2,.02) or (#2.312,3.12) depends if it is a dependent policy    abbrev.^external
  1.  ;     23 - Ins. Comp. Street Addr Line 2 (#36,.112)
  1.  ;     24 - Ins. Comp. Street Addr Line 3 (#36,.113)
  1.  ;     25 - Date Last Verified (#2.312,1.03) internal (may include time)
  1.  ;     26 - Insured's Street 1 (#2.312,3.06)
  1.  ;     27 - Insured's Street 2 (#2.312,3.07)
  1.  ;     28 - Insured's City (#2.312,3.08)
  1.  ;     29 - Insured's State (#2.312,3.09) internal^external
  1.  ;     30 - Insured's Zip (#2.312,3.1)
  1.  ;     31 - Insured's Phone (#2.312,3.11)
  1.  ;
  1.  ; --Output:
  1.  ;   -1     = error occurred (error message passed back in
  1.  ;            IBR("IBBAPI","INSUR","ERROR",x) where x is error number
  1.  ;            between 101 & 111
  1.  ;    0     = No insurance found based on parameters
  1.  ;    1     = Insurance found
  1.  ;
  1.  ;
  1. CIDC  ; (DFN)
  1.  ; Input:    DFN for the patient in question.
  1.  ; Output:   1 = Ask CIDC questions for the specified patient
  1.  ;           0 = Don't ask CIDC questions for the specified patient
  1.  ;
  1.  ; The API will evaluate both a CIDC switch and the patient's insurance
  1.  ; to determine if the CIDC questions should be asked.
  1.  ;
  1.  ; The switch will have three internal values:
  1.  ;    0 = Don't ask any patients
  1.  ;    1 = Ask for patients only with active billable insurance
  1.  ;    2 = Ask for all patients
  1.  ;
  1.  ;
  1. SWSTAT ; ()
  1.  ; Returns the current status of the PFSS On/Off Switch
  1.  ;
  1.  ; Output:   <switch_status>^<status_date/time>
  1.  ; 
  1.  ; <switch_status> will be one of the following:
  1.  ;    0 = OFF
  1.  ;    1 = ON
  1.  ;
  1. GETACCT ; (IBBDFN,IBBARFN,IBBEVENT,IBBAPLR,IBBPV1,IBBPV2,IBBPR1,IBBDG1,IBBZCL,IBBDIV,IBBRAIEN,IBBSURG)
  1.  ; Pass data to IBB for account/visit (ADT) messaging.
  1.  ;
  1.  ; Input:
  1.  ; IBBDFN   = Patient; IEN to file #2 [required]
  1.  ; IBBARFN  = Account Reference; 
  1.  ;            IEN to file #375 or null [required]
  1.  ; IBBEVENT = HL7 Event Code; e.g., "A04" [required]
  1.  ; IBBAPLR  = Calling Application; 
  1.  ;            <routine> or <tag>_;_<routine> 
  1.  ; IBBPV1   = array for PV1 segment data [required]
  1.  ;   IBBPV1(2)  - Patient Class (O=Outpatient;I=Inpatient)
  1.  ;   IBBPV1(3)  - IEN to file #44, or "FEE BASIS"
  1.  ;   IBBPV1(4)  - Appointment Type; IEN to file #409.1
  1.  ;   IBBPV1(7)  - Attending Physician; IEN to file #200
  1.  ;   IBBVP1(9)  - Consulting Physician; IEN to file #200
  1.  ;   IBBPV1(10) - Purpose of Visit; 
  1.  ;                (Scheduling: 1=C&P;2=10-10;3=SV;4=UV)
  1.  ;   IBBPV1(17) - Admitting Physician or Surgeon; 
  1.  ;                IEN to file #200
  1.  ;   IBBPV1(18) - Primary Stop Code; IEN to file #40.7
  1.  ;   IBBPV1(25) - Check-In Date/Time (Scheduling)
  1.  ;   IBBPV1(41) - Credit Stop Code; IEN to file #40.7
  1.  ;   IBBPV1(44) - Admit Date/Time
  1.  ;   IBBPV1(45) - Check-Out Date/Time (Scheduling)
  1.  ;   IBBPV1(50) - Prescription #; IEN to file #52 (Pharmacy)
  1.  ;   IBBPV1(52) - Other Provider; IEN to file #200
  1.  ; IBBPV2   = array for PV2 segment data
  1.  ;   IBBPV2(7)  - Eligibility of Visit; IEN to file #8.1
  1.  ;   IBBPV2(8)  - Expected Admit/Visit Date/Time
  1.  ;   IBBPV2(24) - Appointment Status; 
  1.  ;                (Scheduling:
  1.  ;                 R=Scheduled/Kept;I=Inpatient;
  1.  ;                 NS=No-Show;NSR=No-Show, Rescheduled;
  1.  ;                 CP=Cancelled by Patient;
  1.  ;                 CPR=Cancelled by Patient, Rescheduled;
  1.  ;                 CC=Cancelled by Clinic;
  1.  ;                 CCR=Cancelled by Clinic, Rescheduled;
  1.  ;                 NT=No Action Taken)
  1.  ;   IBBPV2(46) - Date Appointment Made (Scheduling)
  1.  ; IBBPR1   = array for PR1 segment data
  1.  ;   IBBPR1(3)  - Procedure; IEN to file #81
  1.  ;   IBBPR1(4)  - Procedure; free text
  1.  ;   IBBPR1(5)  - Procedure Date/Time
  1.  ;   IBBPR1(6)  - Functional Type;
  1.  ;                (Prosthetics: 
  1.  ;                 O=Home Oxygen;P=Purchasing;
  1.  ;                 I=Stock Issue)
  1.  ;                (Radiology: 
  1.  ;                 ANI=Angio/Neuro/Interventional;
  1.  ;                 CARD=Cardiology Studies;CT=CT Scan;
  1.  ;                 RAD=General Radiology;
  1.  ;                 MRI=Magnetic Resonance Imaging;
  1.  ;                 MAM=Mammography;NM=Nuclear Medicine;
  1.  ;                 US=Ultrasound;VAS=Vascular Lab)
  1.  ;   IBBPR1(11) - Surgeon; IEN to file #200
  1.  ;   IBBPR1(16) - <modifier><modifier><modifier>... 
  1.  ;                where each <modifier> is an IEN to file #81.3
  1.  ; IBBDG1   = array for DG1 segment data
  1.  ;   IBBDG1(n,3) - Diagnosis; IEN to file #80
  1.  ;   IBBDG1(1,4) - Diagnosis; free text; only one allowed
  1.  ;   IBBDG1(n,6) - Diagnosis Type; (A=Admitting;
  1.  ;                                  W=Working;
  1.  ;                                  D=Discharge;
  1.  ;                                  F=Final)
  1.  ; IBBZCL   = array for ZCL segment data
  1.  ;   IBBZCL(n,2) - Classification Type; 
  1.  ;                 (1=AO;2=IR;3=SC;4=EC;5=MST;6=HNC;
  1.  ;                  7=CV;8=SHAD)
  1.  ;   IBBZCL(n,3) - Classification Value; (1=YES;0=NO)
  1.  ; IBBDIV   = IEN to file #40.8
  1.  ; IBBRAIEN = IEN to file #75.1
  1.  ; IBBSURG  = array for special Surgery data
  1.  ;   IBBSURG(1) - Surgical Case #; IEN to file #130
  1.  ;   IBBSURG(2) - Surgical Specialty; IEN to file #45.3
  1.  ;
  1.  ; Returns the pointer to the PFSS ACCOUNT file (#375) where 
  1.  ; all application input data is stored.
  1.  ;
  1.  ; Output:  IEN to file #375, or 0, if unsuccessful
  1.  ; 
  1. GETCHGID ; ()
  1.  ; Returns a Unique Charge ID.
  1.  ;
  1.  ; Output: 1 + current value of field #2 of file #372.
  1.  ;
  1. CHARGE ; (IBBDFN,IBBARFN,IBBCTYPE,IBBUCID,IBBFT1,IBBPR1,IBBDG1,IBBZCL,IBBRXE,IBBORIEN,IBBPROS)
  1.  ; Pass data to IBB for charge (DFT) messaging.
  1.  ;
  1.  ; Input:
  1.  ; IBBDFN   = Patient; IEN to file #2 [required]
  1.  ; IBBARFN  = Account Reference; IEN to file #375 [required]
  1.  ; IBBCTYPE = Charge Type; (CG=debit;CD=credit) [required]
  1.  ; IBBUCID  = Unique Charge ID [required]
  1.  ; IBBFT1   = array for FT1 segment data [required]
  1.  ;   IBBFT1(4)  - Transaction Date/Time
  1.  ;   IBBFT1(7)  - Pharmacy Service Code
  1.  ;   IBBFT1(10) - Transaction Quantity
  1.  ;   IBBFT1(13) - Department Code
  1.  ;   IBBFT1(16) - Patient Location; IEN to file #44
  1.  ;   IBBFT1(18) - Patient Status; (Pharmacy: 1=Rx Copay Exempt;
  1.  ;                                           0=Not Exempt)
  1.  ;   IBBFT1(20) - Rendering Provider; IEN to file #200
  1.  ;   IBBFT1(21) - Ordering Provider; IEN to file #200
  1.  ;   IBBFT1(22) - Unit Cost
  1.  ;   IBBFT1(29) - <NDC><generic_name>
  1.  ;   IBBFT1(31) - Transaction Type; 
  1.  ;                (Pharmacy: 1=PSO NSC Rx Copay;
  1.  ;                           2=PSO SC Rx Copay;
  1.  ;                           3=PSO NSC Rx Copay Cancel
  1.  ;                           4=PSO NSC Rx Copay Update
  1.  ;                           5=PSO SC Rx Copay Cancel
  1.  ;                           6=PSO SC Rx Copay Update)
  1.  ; IBBPR1   = array for PR1 segment data;
  1.  ;            (required except Pharmacy)
  1.  ;   IBBPR1(3)    - Procedure; IEN to file #81
  1.  ;   IBBPR1(4)    - Procedure; free text
  1.  ;   IBBPR1(5)    - Procedure Date/Time
  1.  ;   IBBPR1(6)    - Functional Type; 
  1.  ;                  (Prosthetics: O=Home Oxygen;
  1.  ;                                P=Purchasing;
  1.  ;                                I=Stock Issue)
  1.  ;   IBBPR1(11,1) - Surgeon; IEN to file #200
  1.  ;   IBBPR1(11,2) - Attending Surgeon; IEN to file #200
  1.  ;   IBBPR1(16)   - <modifier><modifier><modifier>...;
  1.  ;                  each <modifier> is an IEN to file #81.3
  1.  ; IBBDG1   = array for DG1 segment data
  1.  ;   IBBDG1(n,3) - Diagnosis; IEN to file #80
  1.  ;   IBBDG1(n,6) - Diagnosis Type; (A=Admitting;W=Working;
  1.  ;                                  D=Discharge;F=Final)
  1.  ; IBBZCL   = array for ZCL segment data
  1.  ;   IBBZCL(n,2) - Classification Type; 
  1.  ;                 (1=AO;2=IR;3=SC;4=EC;5=MST;
  1.  ;                  6=HNC;7=CV;8=SHAD)
  1.  ;   IBBZCL(n,3) - Classification Value; (1=YES;0=NO)
  1.  ; IBBRXE   = data for RXE segment data (Pharmacy only)
  1.  ;   IBBRXE(1)  - <quantity>_;_<days_supply>
  1.  ;   IBBRXE(17) - Refills Dispensed
  1.  ;   IBBRXE(18) - Release Date/Time
  1.  ;   IBBRXE(31) - DEA, Special Handling codes
  1.  ; IBBPROS  = array for special Prosthetics data
  1.  ;   IBBPROS(1) - Vendor; IEN to file #440
  1.  ;   IBBPROS(2) - OBL#
  1.  ;
  1.  ; Returns success indicator.
  1.  ;
  1.  ; Output: 1, if successful; 0 otherwise
  1.  ;
  1. SETACCT ; (IBBDFN,HLMTIENS)
  1.  ; Store visit/account # from external billing system in PFSS
  1.  ; ACCOUNT record; the file #375 record is found based on data
  1.  ; contained in the HL7 message referenced by HLMTIENS.
  1.  ; Most of the ADT messages involved originate in VistA and 
  1.  ; are returned by the external billing system with visit#
  1.  ; attached.
  1.  ; Some ADT-A01 messages originate in the external billing
  1.  ; system; these cause a new record to be created in file #375.
  1.  ; 
  1.  ; Input:
  1.  ; IBBDFN   = Patient; IEN to file #2 [required]
  1.  ; HLMTIENS = HL7 Message (standard VistA HL7 variable); 
  1.  ;            IEN to file #773 [required]
  1.  ;
  1.  ; Returns PFSS Account Reference.
  1.  ;
  1.  ; Output: IEN to file #375
  1.  ;
  1. EXTNUM ; (IBBDFN,IBBARFN)
  1.  ; Obtain the visit/account # of the external billing system
  1.  ; that has been associated with the PFSS ACCOUNT file (#375)
  1.  ; record.
  1.  ; 
  1.  ; Input:
  1.  ; IBBDFN   = Patient; IEN to file #2 [required]
  1.  ; IBBARFN  = Account Reference; IEN to file #375 [required]
  1.  ;
  1.  ; Returns the value of field #.02 from the file #375 record.
  1.  ;
  1.  ; Output: external visit/account #, or 0, if unsuccessful
  1.  ;