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 |