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Routine: IBCBB8

IBCBB8.m

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  1. IBCBB8 ;ALB/BGA - CON'T MEDICARE EDIT CHECKS ;08/12/98
  1. ;;2.0;INTEGRATED BILLING;**51,137,210,349,373**;21-MAR-94;Build 6
  1. ;;Per VHA Directive 2004-038, this routine should not be modified.
  1. ;
  1. ; UB-04 CLAIM CERTIFICATE ID NUMBER
  1. I '$$VALID(IBIFN) S IBQUIT=$$IBER^IBCBB3(.IBER,215) Q:IBQUIT
  1. ;
  1. ; Req. on Primary Payor when Medicare is secondary and value 12-15,43
  1. I $$COBN^IBCEF(IBIFN)=2 D Q:IBQUIT
  1. . I $O(IBVALCD(16),-1)'<12!$D(IBVALCD(43)) D
  1. . . K IBXDATA D F^IBCEF("N-ALL INSURED EMPLOYER INFO",,,IBIFN)
  1. . . ; employer name^city^state abbreviation^state ien
  1. . . ;I '$O(IBXDATA(0)) S IBQUIT=$$IBER^IBCBB3(.IBER,222) Q
  1. . . ; Employer name missing
  1. . . ;I $P($G(IBXDATA(1)),U)="" S IBQUIT=$$IBER^IBCBB3(.IBER,222)
  1. . . ; Employer address missing
  1. . . ;I $TR($P($G(IBXDATA(1)),U,2,4),U)="" S IBQUIT=$$IBER^IBCBB3(.IBER,223)
  1. . ;
  1. . ; Insured's Group Number
  1. . ; if Medicare is secondary, need insurance group number for primary
  1. . K IBXDATA D F^IBCEF("N-ALL INSURANCE GROUP NUMBER",,,IBIFN)
  1. . I $P($G(IBXDATA(1)),U)="" S IBQUIT=$$IBER^IBCBB3(.IBER,225)
  1. ;
  1. ; UB-04 Diagnosis Codes
  1. K IBXDATA D F^IBCEF("N-DIAGNOSES",,,IBIFN)
  1. ;
  1. S IBI=0
  1. F S IBI=$O(IBXDATA(IBI)) Q:'IBI D Q:IBQUIT
  1. . S IBDXC=$P($$ICD9^IBACSV(+$P(IBXDATA(IBI),U)),U)
  1. . ; no duplicate dx
  1. . I IBDXC'="",$D(IBDXARY(IBDXC)) S IBQUIT=$$IBER^IBCBB3(.IBER,227)
  1. . I IBDXC'="",'$D(IBDXARY(IBDXC)) S IBDXARY(IBDXC)=IBXDATA(IBI)
  1. Q:IBQUIT
  1. ;
  1. Q
  1. ;
  1. VALID(IBIFN) ; Verify HIC # is valid
  1. N VAL,IBXDATA
  1. S VAL=1
  1. G:'$$MCRWNR^IBEFUNC(+$$CURR^IBCEF2(IBIFN)) VALQ
  1. ;
  1. K IBXDATA D F^IBCEF("N-CURR INSURED ID",,,IBIFN)
  1. ;
  1. I $G(IBXDATA)="" S VAL=0 G VALQ
  1. ;
  1. S IBXDATA=$TR(IBXDATA,"-")
  1. ; HIC # must pass standard MEDICARE edits
  1. I '$$VALHIC^IBCNSMM(IBXDATA) S VAL=0
  1. ;
  1. VALQ Q VAL
  1. ;