IBCAPP1 ;ALB/WCJ - Claims Auto Processing Utilities;27-AUG-10
Source file <IBCAPP1.m>
| 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 |
