IBCBB9.m

IBCBB9 ;ALB/BGA MEDICARE PART B EDIT CHECKS ;10/15/98

 ;;2.0;INTEGRATED BILLING;**51,137,155,349,371,432,547**;21-MAR-94;Build 119

 ;;Per VA Directive 6402, this routine should not be modified.

 ;

PARTB ; MEDICARE specific edit checks for PART B claims (CMS-1500)

 ;

 N IBXDATA,IBXERR,IBXIEN,IBXSAVE,IBPR,IBDTFLG

 ;

 I $$NEEDMRA^IBEFUNC(IBIFN) D

 . K IBXDATA

 . D F^IBCEF("N-HCFA 1500 SERVICE LINE (EDI)",,,IBIFN)

 . S IBI=0

 . F  S IBI=$O(IBXDATA(IBI)) Q:'IBI  D

 .. S IBJ=$P(IBXDATA(IBI),U,5)

 .. I IBJ'="","^CJ^HC^"[(U_$P(IBXDATA(IBI),U,6)_U) S IBPR(IBJ)=""

 . I $$REQMRA^IBEFUNC(IBIFN),$O(IBXDATA(""),-1)>12 D WARN^IBCBB11("This claim will be split into multiple EOB'S since there are more than 12"),WARN^IBCBB11("service lines being submitted on the claim.")

 . I $$REQMRA^IBEFUNC(IBIFN),$E(IBFDT,1,3)'=$E(IBTDT,1,3) D WARN^IBCBB11("This claim will be split into multiple EOB'S due to the service dates"),WARN^IBCBB11("spanning different calendar years.")

 . D NONMCR^IBCBB3(.IBPR,.IBLABS) ; Oxygen, labs, influenza shots

 . S Z="80000" F  S Z=$O(IBPR(Z)) Q:Z'?1"8"4N  S IBLABS=1

 . I $G(IBLABS) D WARN^IBCBB11("There are Lab procedures on this claim."),WARN^IBCBB11("Please verify that Medicare does not reimburse these labs at 100%.") Q

 . I $O(IBPR(""))="" S IBQUIT=$$IBER^IBCBB3(.IBER,"098")

 ;

 ; First char of the pat's first and last name must be present and

 ; must be an alpha

 ; IB*2.0*547 - remove error check 300

 K IBXDATA D F^IBCEF("N-PATIENT NAME",,,IBIFN)

 S IBXDATA=$$NAME^IBCEFG1(IBXDATA)

 ;I $S($G(IBXDATA)="":1,$E($P(IBXDATA,U))=" "!($E($P(IBXDATA,U))'?1A):1,$E($P(IBXDATA,U,2))=" "!($E($P(IBXDATA,U,2))'?1A):1,1:0) S IBQUIT=$$IBER^IBCBB3(.IBER,300) Q:IBQUIT

 ;

 ; Must be a valid HIC #

 I '$$VALID^IBCBB8(IBIFN) S IBQUIT=$$IBER^IBCBB3(.IBER,215) Q:IBQUIT

 ;

 ; Specialty code 99 is not valid for Medicare MRA request claims

 ;I $$REQMRA^IBEFUNC(IBIFN),$$BILLSPEC^IBCEU3(IBIFN)=99 S IBQUIT=$$IBER^IBCBB3(.IBER,122) Q:IBQUIT

 ; IB*2.0*432 add line-level check

 I $$REQMRA^IBEFUNC(IBIFN),$$LINSPEC^IBCEU3(IBIFN)[99 S IBQUIT=$$IBER^IBCBB3(.IBER,122) Q:IBQUIT

 ;

 Q

 ;

--- Routine Detail   --- with STRUCTURED ROUTINE LISTING ---IBCBB9   2129     printed  Apr 09, 2024@21:32:56                                                                                                                                                                                                      Page 2

IBCBB9    ;ALB/BGA MEDICARE PART B EDIT CHECKS ;10/15/98

 +1       ;;2.0;INTEGRATED BILLING;**51,137,155,349,371,432,547**;21-MAR-94;Build 119

 +2       ;;Per VA Directive 6402, this routine should not be modified.

 +3       ;

PARTB     ; MEDICARE specific edit checks for PART B claims (CMS-1500)

 +1       ;

 +2        NEW IBXDATA,IBXERR,IBXIEN,IBXSAVE,IBPR,IBDTFLG

 +3       ;

 +4        IF $$NEEDMRA^IBEFUNC(IBIFN)

               Begin DoDot:1

 +5                KILL IBXDATA

 +6                DO F^IBCEF("N-HCFA 1500 SERVICE LINE (EDI)",,,IBIFN)

 +7                SET IBI=0

 +8                FOR 

                       SET IBI=$ORDER(IBXDATA(IBI))

                       if 'IBI

                           QUIT 

                       Begin DoDot:2

 +9                        SET IBJ=$PIECE(IBXDATA(IBI),U,5)

 +10                       IF IBJ'=""

                               IF "^CJ^HC^"[(U_$PIECE(IBXDATA(IBI),U,6)_U)

                                   SET IBPR(IBJ)=""

                       End DoDot:2

 +11               IF $$REQMRA^IBEFUNC(IBIFN)

                       IF $ORDER(IBXDATA(""),-1)>12

                           DO WARN^IBCBB11("This claim will be split into multiple EOB'S since there are more than 12")

                           DO WARN^IBCBB11("service lines being submitted on the claim.")

 +12               IF $$REQMRA^IBEFUNC(IBIFN)

                       IF $EXTRACT(IBFDT,1,3)'=$EXTRACT(IBTDT,1,3)

                           DO WARN^IBCBB11("This claim will be split into multiple EOB'S due to the service dates")

                           DO WARN^IBCBB11("spanning different calendar years.")

 +13      ; Oxygen, labs, influenza shots

                   DO NONMCR^IBCBB3(.IBPR,.IBLABS)

 +14               SET Z="80000"

                   FOR 

                       SET Z=$ORDER(IBPR(Z))

                       if Z'?1"8"4N

                           QUIT 

                       SET IBLABS=1

 +15               IF $GET(IBLABS)

                       DO WARN^IBCBB11("There are Lab procedures on this claim.")

                       DO WARN^IBCBB11("Please verify that Medicare does not reimburse these labs at 100%.")

                       QUIT 

 +16               IF $ORDER(IBPR(""))=""

                       SET IBQUIT=$$IBER^IBCBB3(.IBER,"098")

               End DoDot:1

 +17      ;

 +18      ; First char of the pat's first and last name must be present and

 +19      ; must be an alpha

 +20      ; IB*2.0*547 - remove error check 300

 +21       KILL IBXDATA

           DO F^IBCEF("N-PATIENT NAME",,,IBIFN)

 +22       SET IBXDATA=$$NAME^IBCEFG1(IBXDATA)

 +23      ;I $S($G(IBXDATA)="":1,$E($P(IBXDATA,U))=" "!($E($P(IBXDATA,U))'?1A):1,$E($P(IBXDATA,U,2))=" "!($E($P(IBXDATA,U,2))'?1A):1,1:0) S IBQUIT=$$IBER^IBCBB3(.IBER,300) Q:IBQUIT

 +24      ;

 +25      ; Must be a valid HIC #

 +26       IF '$$VALID^IBCBB8(IBIFN)

               SET IBQUIT=$$IBER^IBCBB3(.IBER,215)

               if IBQUIT

                   QUIT 

 +27      ;

 +28      ; Specialty code 99 is not valid for Medicare MRA request claims

 +29      ;I $$REQMRA^IBEFUNC(IBIFN),$$BILLSPEC^IBCEU3(IBIFN)=99 S IBQUIT=$$IBER^IBCBB3(.IBER,122) Q:IBQUIT

 +30      ; IB*2.0*432 add line-level check

 +31       IF $$REQMRA^IBEFUNC(IBIFN)

               IF $$LINSPEC^IBCEU3(IBIFN)[99

                   SET IBQUIT=$$IBER^IBCBB3(.IBER,122)

                   if IBQUIT

                       QUIT 

 +32      ;

 +33       QUIT 

 +34      ;