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Routine: IBCB1

IBCB1.m

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  1. IBCB1 ;ALB/AAS - Process bill after enter/edited ;2-NOV-89
  1. ;;2.0;INTEGRATED BILLING;**70,106,51,137,161,182,155,327,432,592,623,641,718**;21-MAR-94;Build 73
  1. ;;Per VA Directive 6402, this routine should not be modified.
  1. ;
  1. ;MAP TO DGCRB1
  1. ;
  1. ;IBQUIT = Flag to stop processing
  1. ;IBVIEW = Flag for Bill has been viewed
  1. ;IBDISP = Flag for Bill entering display been viewed.
  1. ;
  1. K ^UTILITY($J) I $D(IBAC),IBAC>1 G @IBAC
  1. 1 ;complete bill
  1. D END,EDITS^IBCB2 G:IBQUIT END
  1. ;
  1. I '$$IICM^IBCB2(IBIFN) G END ; Ingenix ClaimsManager
  1. I '$$IIQMED^IBCB2(IBIFN) G END ; DSS QuadraMed Claims Scrubber
  1. ;
  1. 3 ;authorize bill/request MRA
  1. I '$D(^XUSEC("IB AUTHORIZE",DUZ))!('$D(IBIFN)) W !!,"You do not hold the Authorize Key.",! G END
  1. I '$P($G(^IBE(350.9,1,1)),"^",23),DUZ=$P(^DGCR(399,IBIFN,"S"),"^",2) W !!,"Entering user can not authorize.",! G END
  1. I $P(^DGCR(399,IBIFN,"S"),"^",9) W !,"Already Approved, Can't change" G END
  1. D:'$G(IBAC)!($G(IBAC)>1) EDITS^IBCB2 G:IBQUIT END
  1. ;
  1. I $G(IBAC)'=1,'$$IICM^IBCB2(IBIFN) G END ; Ingenix ClaimsManager
  1. I $G(IBAC)'=1,'$$IIQMED^IBCB2(IBIFN) G END ; DSS QuadraMed Claims Scrubber
  1. ;
  1. AUTH S IBMRA=$$REQMRA^IBEFUNC(IBIFN)
  1. S IBEND=0
  1. I IBMRA["R" D AUTH^IBCB11 G:IBEND END ;MRA normally required, but MEDIGAP ins co
  1. ; doesn't want/need it or MRA parameter off
  1. ;
  1. W !!,"THIS BILL WILL "_$P("NOT ^",U,$$TXMT^IBCEF4(IBIFN)+1)_"BE TRANSMITTED ELECTRONICALLY"
  1. W !!,"WANT TO ",$S('IBMRA:"AUTHORIZE BILL",1:"REQUEST AN MRA")," AT THIS TIME" S %=2 D YN^DICN G:%=-1!(%=2) END
  1. I '% W !?4,"YES - If finished entering bill information and to allow bill to be printed or transmitted",!?4,"No - To take no action" G AUTH
  1. S (DIC,DIE)=399,IBYY=$S('IBMRA:"@90",1:"@901"),DA=IBIFN,DR="[IB STATUS]" D ^DIE K DIC,DIE,IBYY D:$D(IBX3) DISAP^IBCBULL
  1. I $S('IBMRA:'$P(^DGCR(399,IBIFN,"S"),"^",9),1:'$P($G(^DGCR(399,IBIFN,"TX")),U,6)) G END
  1. ;
  1. ; Update the review status for all EOB's on file
  1. D STAT^IBCEMU2(IBIFN,3) ; Accepted - Complete EOB
  1. ;
  1. D AUTOCK^IBCEU2(IBIFN) ; Checks for need to add any codes to bill based on information already on bill, specifically for EDI purposes
  1. S IBTXSTAT=$$TXMT^IBCEF4(IBIFN,,1) ;Determine transmit, whether live/test
  1. I IBTXSTAT D I IBMRA D CTCOPY^IBCCCB(IBIFN,1) G END
  1. .W !," Adding "
  1. .W:+IBTXSTAT=2 "test " W "bill to BILL TRANSMISSION File"_$S('IBMRA:"",1:" for MRA submission")_".",!
  1. .W:+IBTXSTAT=1&IBMRA " Bill is no longer editable unless returned in error from Medicare."
  1. .S Y=$$ADDTBILL(IBIFN,+IBTXSTAT)
  1. .W ! W:'$P(Y,U,3) *7 W $S($P(Y,U,3):" Bill will be submitted electronically",1:" Error loading into transmit file - bill can not be transmitted.")
  1. .;JWS;IB*2.0*623v24;begin
  1. .N IB364
  1. .S IB364=$P(Y,U)
  1. .I $$GET1^DIQ(399,IBIFN_",",23,"I") D
  1. .. D SETSUB^IBCE837I(IB364,1)
  1. .. N DA,DR,DIE,X,Y
  1. .. S DA=IBIFN,DIE="^DGCR(399,",DR="23////0" D ^DIE
  1. .. Q
  1. .;JWS;IB*2.0*623v24;end
  1. ;
  1. W !,"Passing completed Bill to Accounts Receivable. Bill is no longer editable."
  1. D ARPASS(IBIFN,1)
  1. G:'$G(PRCASV("OKAY")) END
  1. W !,"Completed Bill Successfully sent to Accounts Receivable." D FIND^IBOHCK(DFN,IBIFN)
  1. ;
  1. ; Check to see if any unreviewed status messages or EOBs on file and
  1. ; what to do about them
  1. N IBTXBARR
  1. S IBRESUB=$$RESUB^IBCECSA4($S($G(IBCNCOPY):$P($G(^DGCR(399,IBIFN,0)),U,15),1:IBIFN),+IBTXSTAT,"E",.IBTXBARR)
  1. I IBRESUB=2 D ; update review statuses to be 'review complete'
  1. . N IBDA S IBDA=0
  1. . F S IBDA=$O(IBTXBARR(IBDA)) Q:'IBDA D UPDEDI^IBCEM(IBDA,$S($G(IBCNCOPY):"R",1:"E"))
  1. . Q
  1. ;
  1. K IBTXPRT
  1. ;
  1. 4 ;generate/print bill
  1. G:'$D(IBIFN) END
  1. S:'$D(IBMRA) IBMRA=+$$NEEDMRA^IBEFUNC(IBIFN)
  1. I 'IBMRA,'$P(^DGCR(399,IBIFN,"S"),"^",9) W !!,*7,"Not Authorized, Can Not Print!" G END
  1. I IBMRA,'$P(^DGCR(399,IBIFN,"TX"),"^",6) W !!,*7,"Not Ready For MRA Submission, Can Not Print!" G END
  1. S IBTXSTAT=$$TXMT^IBCEF4(IBIFN)
  1. I IBMRA,$$NEEDMRA^IBEFUNC(IBIFN)'["R" W !!,*7,"MRA Submission not yet confirmed by Austin, Can Not Print!" Q:$S('IBTXSTAT:1,1:"XP"'[$P($G(^IBA(364,+$$LAST364^IBCEF4(IBIFN),0)),U,3))
  1. I +IBTXSTAT,$D(^IBA(364,"ABDT",IBIFN)) S IBTXOK="" D I 'IBTXOK S %=2 G GENTX
  1. . N IBX,IBTST
  1. . S IBX=+$$LAST364^IBCEF4(IBIFN),IBTST=""
  1. . I $$TEST^IBCEF4(IBIFN) S (IBTXOK,IBTST)=1
  1. . I "XP"[$P($G(^IBA(364,IBX,0)),U,3) D:'IBTST Q
  1. .. ;JWS;IB*2.0*592
  1. .. I $$FT^IBCEF(IBIFN)=7 W !!,*7,"This Bill Can Not Be Printed"
  1. .. E W !!,*7,"This Bill Can Not Be Printed Until Transmit Confirmed"
  1. .. W:IBMRA " (to request an MRA)" D:'$D(IBVIEW) VIEW^IBCB2
  1. . W !!,"This Bill Has Already Been Transmitted" W:IBMRA " (to request an MRA)"
  1. . S DIR("B")="Y",DIR("A")="WANT TO PRINT IT ANYWAY",DIR(0)="Y" D ^DIR K DIR Q:$D(DTOUT)!$D(DUOUT)!'Y S IBTXOK=1
  1. D DISP^IBCB2
  1. S:'$D(IBQUIT) IBQUIT=0
  1. D:'$D(IBVIEW) VIEW^IBCB2 G:IBQUIT END
  1. S IBPNT=$P(^DGCR(399,IBIFN,"S"),"^",12)
  1. GEN I $$TEST^IBCEF4(IBIFN) W !!,"THIS BILL IS BEING USED AS A TRANSMISSION TEST BILL"
  1. ;IB*2.0*718v5;EBILL-156;JWS;remove PRINT prompt for Dental Claims
  1. I $$FT^IBCEF(IBIFN)=7 D:+$G(IBAC)=1 END,CTCOPY^IBCCCB(IBIFN) G END
  1. W !!,"WANT TO ",$S(IBPNT]"":"RE-",1:""),"PRINT BILL AT THIS TIME" S %=2 D YN^DICN I %=-1 D:+$G(IBAC)=1 END,CTCOPY^IBCCCB(IBIFN) G END
  1. I '% W !?4,"YES - to print the bill now",!?4,"NO - To take no action" G GEN
  1. ;JWS;IB*2.0*592
  1. ;IB*2.0*718v5;EBILL-156;JWS;remove PRINT prompt for Dental claims
  1. ;;I %=1,$$FT^IBCEF(IBIFN)=7 W !!,*7,"Dental Claims can not be printed." G END
  1. GENTX I %'=1 D:+$G(IBAC)=1 END,CTCOPY^IBCCCB(IBIFN) G END
  1. ;
  1. N IBABORT ;WCJ;US3380
  1. ; Bill has never been printed. First time print.
  1. I 'IBPNT D G END
  1. . I $D(IBTXPRT) D TXPRTS
  1. . D EN1^IBCF(.IBABORT) ;WCJ;US3380
  1. . Q:$G(IBABORT) ;WCJ;IB641;V13;US3380;they aborted so stop already
  1. . I $D(IBRESULT) S IBRESULT=1 ;WCJ;IB641;US3380; if it is looking for a result (IBRESULT will be defined)
  1. . I $D(IBTXPRT) D TXPRT
  1. . ;D MRA^IBCEMU1(IBIFN) ; Printing the MRA ;WCJ;IB*2.0*432;MRA may have a different claim number if this is tertiary
  1. . D MRA^IBCEMU1($$GETMRACL^IBCAPR(IBIFN)) ;WCJ;IB*2.0*432;see above
  1. . I $G(IBMRANOT) D EOBALL^IBCAPR2(IBIFN) ;WCJ;IB*2.0*432 print all the EOBs (ask device once)
  1. . I +$G(IBAC)=1 D END,CTCOPY^IBCCCB(IBIFN)
  1. . Q
  1. ;
  1. ; Below section is for re-prints
  1. RPNT G:$$NEEDMRA^IBEFUNC(IBIFN) END
  1. R !!,"(2)nd Notice, (3)rd Notice, (C)opy or (O)riginal: C// ",IBPNT:DTIME S:IBPNT="" IBPNT="C" G:IBPNT["^" END
  1. S IBPNT=$E(IBPNT,1) I "23oOcC"'[IBPNT W !?5,"Enter 'O' to reprint the original bill or",!?5,"Enter 'C' to reprint the bill as a duplicate copy or",!?5,"Enter '2' or '3' to print 2nd or 3rd follow-up notices." S IBPNT=1 G RPNT
  1. W " (",$S("cC"[IBPNT:"COPY","oO"[IBPNT:"ORIGINAL",IBPNT=2:"2nd NOTICE",IBPNT=3:"3rd NOTICE",1:""),")"
  1. I $D(IBTXPRT) D
  1. . D TXPRTS
  1. . I "oOcC"[IBPNT S IBRESUB=$$RESUB^IBCECSA4(IBIFN,1,"P")
  1. S IBPNT=$S("oO"[IBPNT:1,"cC"[IBPNT:0,1:IBPNT)
  1. D EN1X^IBCF(.IBABORT)
  1. I $G(IBABORT) G END ; WCJ;IB641;V13;only do this stuff if it actually printed (was not ABORTED)
  1. I $D(IBRESULT) S IBRESULT=1 ;WCJ;IB641;US3380; if it is looking for a result (IBRESULT will be defined)
  1. D:$D(IBTXPRT) TXPRT
  1. D MRA^IBCEMU1(IBIFN) ; Printing the MRA
  1. ;
  1. ;
  1. END K IBER,IBEND D END^IBCBB1 K IBQUIT,IBVIEW,IBDISP,IBST,IB,PRCAERCD,PRCAERR,PRCASVC,PRCAT,DGRA2,IBBT,IBCH,IBNDS,IBOA,IBREV,IBX,DGXRF1,PRCAORA,IBX3,DGBILLBS,DGII,DGVISCNT,DGFIL,DGTE,IBTXOK,IBTXSTAT,IBMRA,IBNOFIX
  1. K %DT,DIC,DIE,I,J,X,Y,Y1,Y2,IBER,IBDFN,IBDSDT,IBJ,IBNDI1,IBZZ,VA,IBMA,IBXDT,DI,PRCAPAYR,DGBS,DGCNT,DGDA,DGPAG,DGREVC,DGRV,DGTEXT,DGTOTPAG,IBOPV,DGLCNT,DGTEXT1,DGRSPAC,DGSM,IBPNT,DGINPT,DGLL,IBCPTN,IBFL
  1. K IBRESUB,IBOPV1,IBOPV2,IBCHG,DGBIL1,DGU,DDH,IBA1,IBINS,IBPROC,PRCARI K:'$D(PRCASV("NOTICE")) PRCASV
  1. K ^TMP("IBXDATA",$J),^TMP("IBXEDIT",$J)
  1. K IBCISNT,IBCISTAT,IBCIERR ; remove ClaimsManager variables
  1. Q
  1. ;
  1. TX1(IBX,RESUB) ; Transmit a single bill from file 364 entry # IBX
  1. ; RESUB = flag (1 = resubmitting a bill, 0 = submitting bill 1st time)
  1. ; Returns 1 if successfully extracted to mailman queue for transmission,
  1. ; 0 if extract not successful
  1. N IBTXOK,IBVVSAVE
  1. K ^TMP("IBRESUBMIT",$J),^TMP("IBONE",$J)
  1. S IBVVSAVE("IBX")=IBX,^TMP("IBONE",$J)=+$G(RESUB),^($J,IBX)=""
  1. D ONE^IBCE837
  1. S IBX=IBVVSAVE("IBX")
  1. I $P($G(^IBA(364,IBX,0)),U,3)="P" S IBTXOK=1
  1. K ^TMP("IBONE",$J)
  1. Q $G(IBTXOK)
  1. ;
  1. ARONLY(IBIFN) ; Pass bill to A/R, but that's all
  1. D ARPASS(IBIFN,0)
  1. Q
  1. ;
  1. ARPASS(IBIFN,UPDOK) ;Pass bill to A/R as NEW BILL
  1. ;IBIFN = bill entry #
  1. ;UPDOK = flag 1: if error going to A/R, allow interactive edit
  1. ; 0: send bulletin to IB EDI for error going to A/R
  1. Q:+$$STA^PRCAFN(+IBIFN)'=201 ;Must not have been sent previously
  1. D GVAR^IBCBB
  1. ;Can't be an ins co that won't reimburse
  1. Q:$S($P($G(^DGCR(399,IBIFN,0)),U,11)="i":'IBNDMP,1:0)
  1. D ARRAY^IBCBB1,^PRCASVC6
  1. D REL^PRCASVC:$G(PRCASV("OKAY"))
  1. I '$G(PRCASV("OKAY")) D
  1. . N IBQUIT,IBQUIT1
  1. . S IBQUIT=0
  1. . I $G(UPDOK) D Q
  1. .. F D Q:IBQUIT
  1. ... D DSPARERR^IBCB2("")
  1. ... Q:IBQUIT
  1. ... I $$ASKEDIT^IBCB2($G(IBAC)) D VIEW1^IBCB2 Q
  1. ... S IBQUIT=1
  1. . N XMSUB,XMY,XMTEXT,XMDUZ,IBT
  1. . S XMSUB="ERROR PASSING BILL TO A/R ON CONFIRMATION",XMTEXT="IBT(",XMY="G.IB EDI",XMDUZ=.5
  1. . S IBT(1)="A problem has been detected while trying to pass bill "_$P($G(^DGCR(399,IBIFN,0)),U)_" to"
  1. . S IBT(2)="Accounts Receivable when updating the bill's electronic confirmation."
  1. . S IBT(3)="Please use the option PASS BILL TO A/R to complete this process."
  1. . D ^XMD
  1. Q
  1. ;
  1. ADDTBILL(IBIFN,TXST,RSUB,IBFHIR) ;Add new transmit bill rec to file 364 for bill IBIFN
  1. ;JWS;IB*2.0*623;add field .09 setting.
  1. ; TXST = test flag 1=live, 2=test
  1. N COB,DD,DO,DIC,DLAYGO,X
  1. S TXST=($G(TXST)/2\1),COB=$$COB^IBCEF(IBIFN)
  1. ;JWS;IB*2.0*623v24;force test claim status if not Production system
  1. I '$$PROD^XUPROD(1) S TXST=1
  1. ;JWS;IB*2.0*641v9;change setting of FHIR transmit flag to 0 (wait for scheduled time) from 1 (instant)
  1. ; variable IBFHIR will be passed if needing to send immediate = 1 (rtn IBCE); not implemented but leaving for future knowledge
  1. ;;S IBFHIR=1 ; forcing to immediate transmit
  1. ;JWS;IB*2.0*641v7;need to add resbumission flag from IBCEPTC3
  1. S DIC(0)="L",DIC="^IBA(364,",DLAYGO=364,X=IBIFN,DIC("DR")=".03///X;.04///NOW;.07////"_TXST_";.08////"_COB_$S($$GET1^DIQ(350.9,"1,",8.21,"I")=1:";.09////1",1:"")_$S($G(RSUB)=1:";.1////1",1:"") D FILE^DICN
  1. Q Y
  1. ;
  1. TXPRTS ; Save off last print date to see if bill was reprinted without queueing
  1. I '$$NEEDMRA^IBEFUNC(IBIFN) S IBTXPRT("PRT")=$P($G(^DGCR(399,IBIFN,"S")),U,14)
  1. Q
  1. ;
  1. TXPRT ; Set variable if print was tasked or bill was printed (last print date changed)
  1. I '$$NEEDMRA^IBEFUNC(IBIFN),$S($G(ZTSK):1,1:IBTXPRT("PRT")'=$P($G(^DGCR(399,IBIFN,"S")),U,14)) S IBTXPRT=1
  1. Q
  1. ;
  1. ALT4(IBRESULT) ; WCJ;IB641;US3380;added an alternate tag 4 to pass in a parameter (by reference)
  1. ; to show if the request claim print actually came to a successful conclusion
  1. S IBRESULT=0
  1. G 4