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Routine: IBCAPP1

Package: Integrated Billing

Routine: IBCAPP1


Information

IBCAPP1 ;ALB/WCJ - Claims Auto Processing Utilities;27-AUG-10

Source Information

Source file <IBCAPP1.m>

Entry Points

Name Comments DBIA/ICR reference
AWAY
CRIT(IBIFN,IBEOB) ; Function to determine if a claim meets the criteria for auto-authorization and
; secondary/tertiary claim submission for NON MEDICARE claims
CRITX ;
CAS(IBEOB,ADJFLAG,REASON) ; This function determines if the EOB
; adjustment group codes and reason codes from file 361.1 (either
; claim level or line level or both) meet the criteria for auto-
; authorization and secondary claim submission.
CASX ;
ADJCHK ; This procedure checks the adjustments for this EOB. The group codes
; and reason codes are in the EOBADJ array structures from file 361.1.
ADJCHKX ;
BUILD ; This procedure builds the OKCOMBO array which identifies which
; combinations of group codes and reason codes are acceptable
BUILDX ;
OKCOMBO ; This section lists OK combinations of adjustment category group codes
; and associated reason codes.
; The format is as follows - semi-colon delimiter
; [3] Adjustment category (group code)
; [4] List of acceptable reason codes - comma delimiter
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