IBCBB14 ;ALB/WCJ - CONTINUATION OF EDIT CHECK ROUTINE FOR EPHARM ;15 Mar 2018 9:50 PM
;;2.0;INTEGRATED BILLING;**591,592,624**;21-MAR-94;Build 10
;;Per VA Directive 6402, this routine should not be modified.
;
Q
VALNDC(IBIFN,IBDFN) ; IB*2*363 - validate NDC# between PRESCRIPTION file (#52)
; and IB BILL/CLAIMS PRESCRIPTION REFILL file (#362.4)
; input - IBIFN = internal entry number of the billing record in the BILL/CLAIMS file (#399)
; IBDFN = internal entry number of patient record in the PATIENT file (#2)
N IBX,IBRXCOL
; call program that determines if NDC differences exist
D VALNDC^IBEFUNC3(IBIFN,IBDFN,.IBRXCOL)
Q:'$D(IBRXCOL)
; at least one RX on the IB record has an NDC discrepancy
S IBX=0 F S IBX=$O(IBRXCOL(IBX)) Q:'IBX D WARN^IBCBB11("NDC# on Bill does not equal the NDC# on Rx "_IBRXCOL(IBX))
Q
;
RXNPI(IBIFN) ; check for multiple pharmacy npi's on the same bill
N IBORG,IBRXNPI,IBX,IBY
S IBORG=$$RXSITE^IBCEF73A(IBIFN,.IBORG)
S IBX=0 F S IBX=$O(IBORG(IBX)) Q:'IBX S IBY=0 F S IBY=$O(IBORG(IBX,IBY)) Q:'IBY S IBRXNPI(+IBORG(IBX,IBY))=""
S (IBX,IBY)=0 F S IBX=$O(IBRXNPI(IBX)) Q:'IBX S IBY=IBY+1
I IBY>1 D WARN^IBCBB11("Bill has prescriptions resulting from "_IBY_" different NPI locations")
Q
;
ROICHK(IBIFN,IBDFN,IBINS) ; ROI Check
; Verify that an ROI is on file if the drug is flagged as sensitive.
; No ROI is required if the Date of Service is on or after the
; Mission Act Implementation Date (1/28/2019).
; input - IBIFN = IEN of the Bill/Claims file (#399)
; IBDFN = IEN of the patient
; IBINS = IEN of the payer insurance company (#36)
; OUTPUT - 0 = no error
; 1 = a prescription is sensitive and there is no ROI on file
;
N IBX,IBY0,IBRXIEN,IBDT,IBDRUG,ROIQ
S ROIQ=0
S IBX=0 F S IBX=$O(^IBA(362.4,"C",IBIFN,IBX)) Q:'IBX D
.S IBY0=^IBA(362.4,IBX,0),IBRXIEN=$P(IBY0,U,5) I 'IBRXIEN Q
.S IBDT=$P(IBY0,U,3),IBDRUG=$P(IBY0,U,4)
.D ZERO^IBRXUTL(IBDRUG)
.I $$SENS^IBNCPDR(IBDRUG) D ; Sensitive Diagnosis Drug - check for ROI
.. ; Skip ROI check if the DOS is on or after the Mission Act date.
.. I $$MACHK^IBNCPDR4(IBDT) Q
.. I $$ROI^IBNCPDR4(IBDFN,IBDRUG,IBINS,IBDT) Q ;ROI is on file
.. D WARN^IBCBB11("ROI not on file for prescription "_$$RXAPI1^IBNCPUT1(IBRXIEN,.01,"E"))
.. S ROIQ=1
ROICHKQ ;
K ^TMP($J,"IBDRUG")
Q ROIQ
;
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HIBCBB14 2402 printed Dec 13, 2024@02:08:50 Page 2
IBCBB14 ;ALB/WCJ - CONTINUATION OF EDIT CHECK ROUTINE FOR EPHARM ;15 Mar 2018 9:50 PM
+1 ;;2.0;INTEGRATED BILLING;**591,592,624**;21-MAR-94;Build 10
+2 ;;Per VA Directive 6402, this routine should not be modified.
+3 ;
+4 QUIT
VALNDC(IBIFN,IBDFN) ; IB*2*363 - validate NDC# between PRESCRIPTION file (#52)
+1 ; and IB BILL/CLAIMS PRESCRIPTION REFILL file (#362.4)
+2 ; input - IBIFN = internal entry number of the billing record in the BILL/CLAIMS file (#399)
+3 ; IBDFN = internal entry number of patient record in the PATIENT file (#2)
+4 NEW IBX,IBRXCOL
+5 ; call program that determines if NDC differences exist
+6 DO VALNDC^IBEFUNC3(IBIFN,IBDFN,.IBRXCOL)
+7 if '$DATA(IBRXCOL)
QUIT
+8 ; at least one RX on the IB record has an NDC discrepancy
+9 SET IBX=0
FOR
SET IBX=$ORDER(IBRXCOL(IBX))
if 'IBX
QUIT
DO WARN^IBCBB11("NDC# on Bill does not equal the NDC# on Rx "_IBRXCOL(IBX))
+10 QUIT
+11 ;
RXNPI(IBIFN) ; check for multiple pharmacy npi's on the same bill
+1 NEW IBORG,IBRXNPI,IBX,IBY
+2 SET IBORG=$$RXSITE^IBCEF73A(IBIFN,.IBORG)
+3 SET IBX=0
FOR
SET IBX=$ORDER(IBORG(IBX))
if 'IBX
QUIT
SET IBY=0
FOR
SET IBY=$ORDER(IBORG(IBX,IBY))
if 'IBY
QUIT
SET IBRXNPI(+IBORG(IBX,IBY))=""
+4 SET (IBX,IBY)=0
FOR
SET IBX=$ORDER(IBRXNPI(IBX))
if 'IBX
QUIT
SET IBY=IBY+1
+5 IF IBY>1
DO WARN^IBCBB11("Bill has prescriptions resulting from "_IBY_" different NPI locations")
+6 QUIT
+7 ;
ROICHK(IBIFN,IBDFN,IBINS) ; ROI Check
+1 ; Verify that an ROI is on file if the drug is flagged as sensitive.
+2 ; No ROI is required if the Date of Service is on or after the
+3 ; Mission Act Implementation Date (1/28/2019).
+4 ; input - IBIFN = IEN of the Bill/Claims file (#399)
+5 ; IBDFN = IEN of the patient
+6 ; IBINS = IEN of the payer insurance company (#36)
+7 ; OUTPUT - 0 = no error
+8 ; 1 = a prescription is sensitive and there is no ROI on file
+9 ;
+10 NEW IBX,IBY0,IBRXIEN,IBDT,IBDRUG,ROIQ
+11 SET ROIQ=0
+12 SET IBX=0
FOR
SET IBX=$ORDER(^IBA(362.4,"C",IBIFN,IBX))
if 'IBX
QUIT
Begin DoDot:1
+13 SET IBY0=^IBA(362.4,IBX,0)
SET IBRXIEN=$PIECE(IBY0,U,5)
IF 'IBRXIEN
QUIT
+14 SET IBDT=$PIECE(IBY0,U,3)
SET IBDRUG=$PIECE(IBY0,U,4)
+15 DO ZERO^IBRXUTL(IBDRUG)
+16 ; Sensitive Diagnosis Drug - check for ROI
IF $$SENS^IBNCPDR(IBDRUG)
Begin DoDot:2
+17 ; Skip ROI check if the DOS is on or after the Mission Act date.
+18 IF $$MACHK^IBNCPDR4(IBDT)
QUIT
+19 ;ROI is on file
IF $$ROI^IBNCPDR4(IBDFN,IBDRUG,IBINS,IBDT)
QUIT
+20 DO WARN^IBCBB11("ROI not on file for prescription "_$$RXAPI1^IBNCPUT1(IBRXIEN,.01,"E"))
+21 SET ROIQ=1
End DoDot:2
End DoDot:1
ROICHKQ ;
+1 KILL ^TMP($JOB,"IBDRUG")
+2 QUIT ROIQ
+3 ;
