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Routine: IBCEF11

IBCEF11.m

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  1. IBCEF11 ;ALB/TMP - FORMATTER SPECIFIC BILL FUNCTIONS - CONT ;30-JAN-96
  1. ;;2.0;INTEGRATED BILLING;**51,137,155,309,335,348,349,371,432,447,473,516,577,592,608,623,641**;21-MAR-94;Build 61
  1. ;;Per VA Directive 6402, this routine should not be modified.
  1. ;
  1. BOX24D(A,IB) ; Returns the lines for boxes 19-24 of the CMS-1500 display
  1. ; IB = flag is 1 if only box 24 is needed
  1. Q $S('$G(IB):"36",1:"44")_"^55"
  1. ;
  1. RCBOX() ; Returns the lines for revenue code boxes of the UB-04 display
  1. Q "19^41"
  1. ;
  1. OUTPT(IBIFN,IBPRINT) ; Returns an array of service line data from
  1. ; CMS-1500 box 24. Output is in IBXDATA(n)
  1. ; IBPRINT = print flag 1: return print fields
  1. ; 0: return EDI fields
  1. ; Uses diagnosis array ^TMP("IBXSAVE",$J,"DX",IBIFN,DIAG CODE)=SEQ #
  1. ; if it already exists. If not, it builds it from N-DIAGNOSES element
  1. ;
  1. ; For EDI call: Returns IBXDATA(n)=
  1. ; begin date(YYYYMMDD) ^ end date(YYYYMMDD) ^ pos ^ tos ^
  1. ; proc code/revenue code - if no procedure (not the pointers) ^
  1. ; type of code ^ dx pointer(s ) ^ unit charge ^ units ^ modifiers separated by ;
  1. ; ^ purchased charge amount ^ anesthesia minutes ^ emergency indicator ^
  1. ; lab-type service flag ^ NDC ^ Units/Quantity ^ Unit/Basis of Measurement (vd/IB*2*577)
  1. ;
  1. ; Also Returns IBXDATA(IBI,"COB",COB,m) with COB data for each line
  1. ; item found in an accepted EOB for the bill and = the reference
  1. ; line in the first '^' piece followed by the '0' node data of file
  1. ; 361.115 (LINE LEVEL ADJUSTMENTS)
  1. ; COB = COB sequence # of adjustment's ins co, m = seq #
  1. ; -- AND --
  1. ; IBXDATA(IBI,"COB",COB,m,z,p)=
  1. ; the data on the '0' node for each subordinate entry of file
  1. ; 361.11511 (REASONS) (Only first 3 pieces for 837 output)
  1. ; z = group code, sometimes preceeded by a space p = seq #
  1. ;
  1. ; For Print call: Returns begin date(DDMMYYYY)^end date(DDMMYYYY) or
  1. ; null if equal to begin date^pos^tos^bedsection name(if no procedure)
  1. ; or procedure code(not the pointer)^ ... refer to EDI call results
  1. ; Also, IBXDATA(n,"TEXT")=the text to print on first line of box 24,
  1. ; If no procedure code, returns IBXDATA(n,"A")=rev code abbrev
  1. ;
  1. ; For both calls, returns IBXDATA(n,item type,item ptr)=""
  1. ; -- AND --
  1. ; IBXDATA(n,"RX")=RX#^drug name^NDC^refill #^(re)fill date^qty^days
  1. ; ^chrge^ien of file 362.4^NDC format
  1. ; If line references a prescription
  1. ; -- AND --
  1. ; If no revenue code for a prescription, returns IBXDATA(n,"ARX")=""
  1. ; -- AND --
  1. ; IBXDATA(n,"AUX")='AUX' node of the procedure entry
  1. ;
  1. ; Also returns IBXDATA(n,"CPLNK") = soft link to corresponding entry in PROCEDURES multiple of file 399
  1. ;
  1. N IB,IBI,IBJ,IBFLD,IBDXI,IBXIEN,Z,IBXTRA,IBRX,IBRX0,IBRX1,Z0,Z1
  1. ;
  1. K ^TMP($J,"IBITEM")
  1. S ^TMP($J,"IBITEM")=""
  1. ; Build diagnosis array if not already built
  1. I $O(^TMP("IBXSAVE",$J,"DX",IBIFN,""))="",$O(^IBA(362.3,"AIFN"_IBIFN,"")) D
  1. .N Z,IBXDATA D F^IBCEF("N-DIAGNOSES",,,IBIFN)
  1. .S Z="" F S Z=$O(IBXDATA(Z)) K:$O(IBXDATA(0))=""&(Z="") IBXDATA Q:Z="" S:$P(IBXDATA(Z),U,2) ^TMP("IBXSAVE",$J,"DX",IBIFN,$P(IBXDATA(Z),U,2))=Z
  1. ;
  1. S IB(0)=$G(^DGCR(399,IBIFN,0)),IB("U")=$G(^("U")),IB("U1")=$G(^("U1"))
  1. S IBI="" F S IBI=$O(^TMP("IBXSAVE",$J,"DX",IBIFN,IBI)) Q:IBI="" S IBDXI(IBI)=^(IBI)
  1. I '$G(IBPRINT) D RVCE^IBCF23(IBIFN,IBIFN)
  1. I $G(IBPRINT) D RVCE^IBCF23(,IBIFN)
  1. ; Returns IBFLD(24) = begin date ^ end date ^ pos ^ tos ^
  1. ; proc/bedsection/revenue code ^ dx pointer ^ unit charge ^
  1. ; units ^ modifiers ^ purchased charge amount ^ anesthesia minutes ^
  1. ; emergency indicator ^ soft pointer to PROCEDURES multiple in file 399 ^
  1. ; NDC ^ Units
  1. ; IBFLD(24,n,type,item)=""
  1. ; IBFLD(24,n_"A") = revenue code abbreviation if no procedure
  1. ; IBFLD(24,n,"AUX") = 'AUX' node of line item
  1. ; IBFLD(24,n,"RX") = soft pointer to file 362.4 from 'item' fld
  1. ; (can be null)
  1. ;
  1. D SET^IBCSC5A(IBIFN,.IBRX) ;prescriptions
  1. ; IBRX1(ien 362.4)=RX#^drug ien^NDC^refil #^(re)fil date^qty^days^chrge
  1. I IBRX S IBRX="" F S IBRX=$O(IBRX(IBRX)) Q:IBRX="" S IBRX0=0 F S IBRX0=$O(IBRX(IBRX,IBRX0)) Q:'IBRX0 D
  1. . N IBRXH
  1. . S IBRXH=IBRX(IBRX,IBRX0)
  1. . ; **IB*2.0*432** added _U_$P(IBRXH,U,9) (Rx Date) to Output Formatter
  1. . S IBRX1(+IBRXH)=IBRX_U_$P(IBRXH,U,2)_U_$P(IBRXH,U,5)_U_$P(IBRXH,U,7)_U_IBRX0_U_$P(IBRXH,U,4)_U_$P(IBRXH,U,3)_U_$P(IBRXH,U,6)_U_+IBRXH_U_$P(IBRXH,U,8)_U_$P(IBRXH,U,9)
  1. K IBRX
  1. ;
  1. ; for EDI, remove any $0 line items from the IBFLD array before
  1. ; dropping down into the next loop (IB*2*371)
  1. ; Start IB*2.0*447 BI - Code removed to allow 0 dollars to print.
  1. ;I '$G(IBPRINT) D
  1. ;. NEW IBZ,IBI,Z
  1. ;. M IBZ=IBFLD K IBFLD
  1. ;. S (IBI,Z)=0
  1. ;. F S IBI=$O(IBZ(24,IBI)) Q:IBI'=+IBI D
  1. ;.. I $P(IBZ(24,IBI),U,7)*$P(IBZ(24,IBI),U,8)'>0 Q
  1. ;.. S Z=Z+1
  1. ;.. M IBFLD(24,Z)=IBZ(24,IBI)
  1. ;.. S IBFLD(24)=Z
  1. ;.. Q
  1. ;. Q
  1. ; End IB*2.0*447 BI
  1. ;
  1. S IBI=0
  1. F S IBI=$O(IBFLD(24,IBI)) Q:IBI'=+IBI D
  1. . S IBRX1=0
  1. . S IBXDATA(IBI)=$P(IBFLD(24,IBI),U)_U_$P(IBFLD(24,IBI),U,$S($P(IBFLD(24,IBI),U,2)=""&'$G(IBPRINT):1,1:2))
  1. . S $P(IBXDATA(IBI),U,3,5)=$P(IBFLD(24,IBI),U,3,5)
  1. . S $P(IBXDATA(IBI),U,6)=$S($D(IBFLD(24,IBI_"X")):"CJ",1:"HC")
  1. . S $P(IBXDATA(IBI),U,7,13)=$P(IBFLD(24,IBI),U,6,12)
  1. . S $P(IBXDATA(IBI),U,14)=+$$ISLAB(IBXDATA(IBI))
  1. . ; MRD;IB*2.0*516 - Added NDC and Units to line level of claim,
  1. . ; pieces 14 & 15 of IBFLD, pieces 15 & 16 of IBXDATA. Print
  1. . ; in Box 24 by setting in IBXDATA(IBI,"TEXT").
  1. . ;S $P(IBXDATA(IBI),U,15,16)=$P(IBFLD(24,IBI),U,14,15)
  1. . ;I $P(IBFLD(24,IBI),U,14)'="" S IBXDATA(IBI,"TEXT")="N4"_$P(IBFLD(24,IBI),U,14)_" UN"_$P(IBFLD(24,IBI),U,15)
  1. . ; vd/IB*2*577 - Added Unit/Basis of Measurement to line level of claim,
  1. . ; piece 16 of IBFLD, piece 17 of IBXDATA.
  1. . ; Print in Box 24 by setting in IBXDATA(IBI,"TEXT").
  1. . S $P(IBXDATA(IBI),U,15,17)=$P(IBFLD(24,IBI),U,14,16)
  1. . I $P(IBFLD(24,IBI),U,14)'="" S IBXDATA(IBI,"TEXT")="N4"_$P(IBFLD(24,IBI),U,14)_" "_$P(IBFLD(24,IBI),U,16)_$P(IBFLD(24,IBI),U,15)
  1. . ;
  1. . I $D(IBFLD(24,IBI,"RX")) D ;Rx
  1. .. S IBRX1=1
  1. .. I $P($G(IBFLD(24,IBI,"AUX")),U,8)'="" S $P(IBFLD(24,IBI,"AUX"),U,8)="",$P(IBFLD(24,IBI,"AUX"),U,9)="" ;No free text allowed for rx's
  1. .. I $D(IBRX1(+IBFLD(24,IBI,"RX"))) D Q ;Soft link exists
  1. ...D ZERO^IBRXUTL(+$P(IBRX1(+IBFLD(24,IBI,"RX")),U,2))
  1. ... S IBXDATA(IBI,"RX")=IBRX1(+IBFLD(24,IBI,"RX")),$P(IBXDATA(IBI,"RX"),U,2)=$E($G(^TMP($J,"IBDRUG",+$P(IBRX1(+IBFLD(24,IBI,"RX")),U,2),.01)),1,30)
  1. ... K IBRX1(+IBFLD(24,IBI,"RX"))
  1. ... ; No soft link - must find the first Rx with the same charge
  1. .. S IBRX="" F S IBRX=$O(IBRX1(IBRX)) Q:'IBRX I +$P(IBRX1(IBRX),U,8)=+$P(IBXDATA(IBI),U,8) D Q
  1. ... D ZERO^IBRXUTL(+$P(IBRX1(IBRX),U,2))
  1. ... S IBXDATA(IBI,"RX")=IBRX1(IBRX),$P(IBXDATA(IBI,"RX"),U,2)=$E($G(^TMP($J,"IBDRUG",+$P(IBRX1(IBRX),U,2),.01)),1,30) K IBRX1(IBRX) Q
  1. ... Q
  1. .. Q
  1. . ;
  1. . ; MRD;IB*2.0*516 - If additional service line comments to appear in
  1. . ; Box 24, concatenate to front if something (NDC) is already there.
  1. . I $G(IBFLD(24,IBI,"AUX"))'="" D
  1. .. I $G(IBPRINT),$P(IBFLD(24,IBI,"AUX"),U,8)'="" D
  1. ... I $G(IBXDATA(IBI,"TEXT"))'="" S IBXDATA(IBI,"TEXT")=$E($P(IBFLD(24,IBI,"AUX"),U,8)_" "_IBXDATA(IBI,"TEXT"),1,59)
  1. ... E S IBXDATA(IBI,"TEXT")=$P(IBFLD(24,IBI,"AUX"),U,8)
  1. ... S $P(IBFLD(24,IBI,"AUX"),U,8)=""
  1. ... Q
  1. .. S IBXDATA(IBI,"AUX")=IBFLD(24,IBI,"AUX")
  1. .. Q
  1. . ;
  1. . ;JWS;IB*2.0*592:US131
  1. . I $G(IBFLD(24,IBI,"DEN"))'="" S IBXDATA(IBI,"DEN")=IBFLD(24,IBI,"DEN")
  1. . I $G(IBFLD(24,IBI,"DEND"))'="" S IBXDATA(IBI,"DEND")=$P(IBFLD(24,IBI,"DEND"),"^",4)
  1. . I $O(IBFLD(24,IBI,"DEN1",0)) M IBXDATA(IBI,"DEN1")=IBFLD(24,IBI,"DEN1")
  1. . ;end - ;JWS;IB*2.0*592:US131
  1. . I $G(IBPRINT) D
  1. .. ; START IB*2.0*447 BI ZERO DOLLAR CHANGES
  1. .. ; I '$P(IBXDATA(IBI),U,8),'$G(IBXDATA(IBI,"RX")) D Q
  1. .. I $P(IBXDATA(IBI),U,8)="",'$G(IBXDATA(IBI,"RX")) D Q
  1. ... ; END IB*2.0*447 BI ZERO DOLLAR CHANGES
  1. ... I $G(IBNOSHOW) Q ; don't show errors/warnings
  1. ... S IBXDATA(IBI,"TEXT")="Warning:** REV CODE UNITS < #PROCEDURES, THEY MUST BE ="
  1. ... I $D(IBXDATA(IBI,"AUX")) S $P(IBXDATA(IBI,"AUX"),U,9)=""
  1. ... Q
  1. .. ;
  1. .. I $G(IBFLD(24,IBI_"A"))'="" D Q
  1. ... S IBXDATA(IBI,"A")=IBFLD(24,IBI_"A")
  1. ... I $G(IBNOSHOW) Q ; don't show errors/warnings
  1. ... S IBXDATA(IBI,"TEXT")="Warning:** REV CODE UNITS > #PROCEDURES, THEY MUST BE=: "_IBFLD(24,IBI_"A")
  1. ... I $D(IBXDATA(IBI,"AUX")) S $P(IBXDATA(IBI,"AUX"),U,9)=""
  1. ... Q
  1. .. ;
  1. .. S IBRX=$G(IBXDATA(IBI,"RX"))
  1. .. I IBRX'="" D ;Format Rx detail
  1. ... N Z
  1. ... S Z=$P(IBRX,U)
  1. ... S Z=$S(Z'="":"Rx#"_Z_" ",1:"RX: ")
  1. ... S IBXDATA(IBI,"TEXT")=Z_$S($P(IBRX,U,3)'="":"NDC: "_$P(IBRX,U,3),1:"NOC: "_$P(IBRX,U,2))_" Qty: "_$P(IBRX,U,6)_" Days: "_$P(IBRX,U,7)
  1. ... S $P(IBXDATA(IBI,"AUX"),U,9)="N4" ; service line comment qualifier for RX's
  1. ... Q
  1. .. Q
  1. . S IBXDATA(IBI,"CPLNK")=$P(IBFLD(24,IBI),U,13)
  1. . I '$G(IBPRINT) D COBLINE^IBCEU6(IBIFN,IBI,.IBXDATA,,.IBXTRA)
  1. . Q
  1. ;
  1. I $G(IBPRINT) D
  1. . S IBRX=0 F S IBRX=$O(IBRX1(IBRX)) Q:'IBRX D
  1. .. S IBI=+$O(IBXDATA(""),-1)+1
  1. .. S IBXDATA(IBI)=$$DATE($P(IBRX1(IBRX),U,5))
  1. .. S IBXDATA(IBI,"TEXT")="**** ERROR - NO PROC LINK TO REV CODE FOR DRUG: RX#: "_$P(IBRX1(IBRX),U)_" NDC #: "_$P(IBRX1(IBRX),U,3)
  1. .. I $D(IBXDATA(IBI,"AUX")) S $P(IBXDATA(IBI,"AUX"),U,9)=""
  1. .. S IBXDATA(IBI,"ARX")=""
  1. .. D ZERO^IBRXUTL(+$P(IBRX1(IBRX),U,2))
  1. .. S IBXDATA(IBI,"RX")=IBRX1(IBRX),$P(IBXDATA(IBI,"RX"),U,2)=$E($G(^TMP($J,"IBDRUG",+$P(IBRX1(IBRX),U,2),.01)),1,30) K IBRX1(IBRX)
  1. .. Q
  1. . Q
  1. ;
  1. I '$G(IBPRINT),$D(IBXTRA) D COMBO^IBCEU2(.IBXDATA,.IBXTRA,0) ;Handle bundled/unbundled lines
  1. K ^TMP($J,"IBDRUG")
  1. Q
  1. ;
  1. ISLAB(LDATA) ; Returns 0/1 if line item data indicates the item is a lab (1)
  1. ; 'LAB' is defined here as type of service = 5
  1. Q $E($P(LDATA,U,4))="5"
  1. ;
  1. FMT(DATA,DLEN,FLEN) ; Returns a string in DATA with a max length of DLEN
  1. ; and a field length of FLEN
  1. Q $E($E(DATA,1,DLEN)_$J("",FLEN),1,FLEN)
  1. ;
  1. DATE(X,DEL) ; Returns FM date in X as MMxDDxYYYY where x=DEL
  1. S DEL=$G(DEL)
  1. S X=$$DATE^IBCF2(X,1,1)
  1. I X'="" S X=$E(X,1,2)_DEL_$E(X,3,4)_DEL_$E(X,5,8)
  1. Q X
  1. ;
  1. BATCH() ; Sets up record for and stores/returns the next batch number
  1. N NUM,FAC,DO,DD,DLAYGO,DIC,X,Y
  1. ;Keep latest batch number for view/print edi bill extract data option
  1. I $D(IBVNUM) S NUM=IBVNUM G BATCHQ
  1. ;Check for batch resubmit - if yes, use same number as original batch
  1. I $P($G(^TMP("IBRESUBMIT",$J)),U,3)=1 S NUM=$P(^($J),U) G BATCHQ
  1. ;JWS;IB*2.0*623v24;7/17/19 increased lock timeout to 10 sec from 5
  1. ;JWS;IB*2.0*641v12;5/21/20 testing increase of lock timeout to 30 sec, from 10
  1. L +^IBA(364.1,0):30 I '$T Q 0
  1. S FAC=+$P($$SITE^VASITE(),U,3),NUM=$O(^IBA(364.1,"B",""),-1)
  1. S NUM=NUM+1
  1. ;JWS;IB*2.0*641v8;increase batch# field from 10 to 12
  1. ;;I $L(NUM)<12 S NUM=FAC_"00"_$E(NUM,4,10)
  1. ;I $D(^IBA(364.1,+NUM,0)),$P(^(0),U,2)="" F D Q:'NUM!($P($G(^IBA(364.1,+NUM,0)),U,2)'="")
  1. ;. I $D(^IBA(364.1,NUM,0)) S DA=NUM,DIK="^IBA(364.1," D ^DIK
  1. ;. S NUM=$O(^IBA(364.1,"B",""),-1)
  1. ;JWS;IB*2.0*623v24;commented out code below, thus needed to set NUM=NUM+1 above
  1. ;JWS;IB*2.0*623;bug when number = 4424420000
  1. ;F S NUM=$S($P(NUM,FAC,2)'="":NUM+1,1:FAC_"0000001") Q:'$D(^IBA(364.1,"B",NUM))
  1. ;JWS;IB*2.0*623v24;commented out code below, looking for unused batch#s
  1. ;I $E(NUM,1,3)'=FAC S NUM=FAC_"0000001"
  1. ;F Q:'$D(^IBA(364.1,"B",NUM)) S NUM=NUM+1
  1. ;
  1. K DO,DD S DIC="^IBA(364.1,",DLAYGO=364.1,DIC(0)="L",X=NUM D FILE^DICN K DD,DO I Y'>0 S NUM=0
  1. L -^IBA(364.1,0)
  1. ;
  1. BATCHQ Q NUM
  1. ;
  1. GETLDAT(IBXIEN) ; Extract data for 837 transmission LDAT record
  1. ; IBXIEN - ien in file 399
  1. ; Sets up IBXSAVE("LDAT",n) array:
  1. ; Attachment report type ^ Attachment report transmission code ^ Attachment control number ^
  1. ; OB Anesthesia Additional Units ^ Purchase Service Provider ID ^ Purchase Service Amount ^
  1. N CPIEN,FTYPE,IBXDATA,IDS,IBIDS,NODE1,PSAMNT,PSPID,Z,PCE1,LINE
  1. I '+$G(IBXIEN) Q
  1. K IBXSAVE("LDAT")
  1. S FTYPE=$$FT^IBCEF(IBXIEN)
  1. ;JWS;IB*2.0*592; added Dental form
  1. I FTYPE=2!(FTYPE=7) D OUTPT(IBXIEN,0)
  1. I FTYPE=3 D HOS^IBCEF2(IBXIEN)
  1. D ALLIDS^IBCEFP(IBXIEN,.IDS,1)
  1. S (PSPID,PSAMNT)=""
  1. ; IB*2.0*473/TAZ - Convert PROVIDER code to function call to PSID^IBCEFP
  1. I $$SUB1OK^IBCEP8A(IBXIEN),(FTYPE=2) D
  1. . D PSID^IBCEFP(IBXIEN,.IDS,.IBIDS)
  1. . S PSPID=$G(IBIDS(0)) I PSPID="" S PSPID=$P($G(IBIDS(1)),U,1)
  1. ;IB*2.0*473/TAZ - END
  1. S Z=0 F S Z=$O(IBXDATA(Z)) Q:'Z D
  1. . S CPIEN=+$G(IBXDATA(Z,"CPLNK")) ;I 'CPIEN Q
  1. . I FTYPE=2,$$SUB1OK^IBCEP8A(IBXIEN) S PSAMNT=$$DOLLAR^IBCEFG1($P($G(IBXDATA(Z)),U,11))
  1. . S (PCE1,NODE1)=""
  1. . I CPIEN D
  1. . . S NODE1=$G(^DGCR(399,IBXIEN,"CP",CPIEN,1))
  1. . . S PCE1=$$GET1^DIQ(399.0304,CPIEN_","_IBXIEN_",",71)
  1. . . Q
  1. . ; MRD;IB*2.0*516 - Added addl. procedure description as piece 7
  1. . ; of IBXSAVE, which will exist only if the procedure ends in '99'
  1. . ; or is an 'NOC/NOS' procedure.
  1. . ;JWS;IB*2.0*592;do not include NOC description here for Dental claims
  1. . S IBXSAVE("LDAT",Z)=PCE1_U_$P(NODE1,U,3)_U_$P(NODE1,U)_U_$P(NODE1,U,5)_U_$G(PSPID)_U_$G(PSAMNT)_U_$S(FTYPE=7:"",1:$P(NODE1,U,4))
  1. . Q
  1. Q
  1. ;
  1. ;/Beginning of IB*2.0*608 (US9) - vd
  1. LDAT ;
  1. N Z K IBXDATA
  1. S Z=0 F S Z=$O(IBXSAVE("LDAT",Z)) Q:'Z D
  1. . S IBXDATA(Z)=Z D:Z>1 ID^IBCEF2(Z,"LDAT")
  1. ;
  1. I +$G(VC80) D
  1. . S Z=$O(IBXDATA(""),-1)+1
  1. . D ID^IBCEF2(Z,"LDAT")
  1. . D VC80L(IBXIEN,Z) ; Process for 'SNF' claims & the last claim line
  1. . S A=Z
  1. . S IBXDATA(Z)=A
  1. Q
  1. ;
  1. VC80L(IBIFN,LN) ; Extracts the data for the "LDAT" record for VALUE CODE 80 Line item.
  1. ; IBIFN = Claims internal id number
  1. ; LN =
  1. N VC80LN
  1. S VC80LN=LN
  1. S $P(IBXSAVE("LDAT",VC80LN),U,11)="6R"
  1. S $P(IBXSAVE("LDAT",VC80LN),U,12)=VC80LN_"_"_$$GET1^DIQ(399,IBIFN_", ",.01)
  1. Q
  1. ;/Ending of IB*2.0*608 - vd
  1. ;