IBCEF4 ;ALB/TMP - MRA/EDI ACTIVATED UTILITIES ;06-FEB-96
;;2.0;INTEGRATED BILLING;**51,137,232,155,296,327,349,592**;21-MAR-94;Build 58
;;Per VA Directive 6402, this routine should not be modified.
;
EDIACTV(IBEDIMRA) ; Returns 0 if EDI or MRA is not active,
; otherwise, returns 1
; IBEDIMRA : 1= checking if EDI is active, 2= checking if MRA is active
N IBEDI
S IBEDI=$P($G(^IBE(350.9,1,8)),U,10)
Q $S('IBEDI:0,IBEDI=3:1,1:IBEDI=IBEDIMRA)
;
RATEOK(IBIFN) ; Returns 1 if rate type of bill IBIFN is transmittable
Q +$P($G(^DGCR(399.3,+$P($G(^DGCR(399,IBIFN,0)),U,7),0)),U,10)
;
INSOK(INS) ; Determine EDI activation status of insurance co
Q +$G(^DIC(36,INS,3)) ;1 = TEST, 2 = LIVE, 0 = NOT ACTIVE FOR EDI
;
BSTATX(IBIFN) ; Returns internal value of bill's latest transmission status
N IBDA
Q $P($G(^IBA(364,+$$LAST364(IBIFN),0)),U,3)
;
LAST364(IBIFN) ; Determine ien of latest transmit bill record for a bill
Q +$O(^IBA(364,"ABDT",IBIFN,+$O(^IBA(364,"ABDT",IBIFN,""),-1),""),-1)
;
TXMT(IBIFN,IBWHY,IBNEW) ; Determine if bill # IBIFN is 'transmittable'
; IBNEW = flag is 1 if new entry - don't check for entry in file 364
; Function returns:
; 0 if not transmittable
; if transmittable, the entire node 3 of the insurance company
; and, if passed by reference IBWHY = reason not transmittable
; 1 if local print
; 2 if EDI/MRA not active
; 3 if rate type not transmittable
; 4 if no transmit for insurance co
; 5 if failed txmn rules
; and IBWHY(0) = ien of rule failed
; 6 if Rx with missing/invalid NDC format
;
N IB,IB0,IBOK,IBCOB,IBMCR,X1
S IBOK=1,IB=IBIFN,IBWHY=""
;
S IBCOB=$$COBN^IBCEF(IB),IB(.07)=+$G(^DGCR(399,IB,"I"_IBCOB))
S IBMCR=$$MCRWNR^IBEFUNC(IB(.07))
; Does bill have force local print flag set?
I 'IBMCR D G:IBWHY TXMTQ ; MCR WNR not curr ins
. I $S($$MRASEC(IBIFN):$P($G(^DGCR(399,IBIFN,"TX")),U,9)=1,1:$P($G(^DGCR(399,IBIFN,"TX")),U,8)=1) S IBOK=0,IBWHY=1
I '$G(IBNEW),'$O(^IBA(364,"B",IBIFN,0)),$P($G(^DGCR(399,IBIFN,0)),U,13)>2,'$$RETN^PRCAFN(IBIFN) S IBOK=0 G TXMTQ ; Not recognized as transmittable when it was authorized
I $O(^IBA(364,"B",IBIFN,0)),$$INSOK(IB(.07)),$$BSTATX(IBIFN)'="X" G TXMTQ ;Already determined to be transmittable - entry exists for bill in transmit bill file
S IB(.03)=$S('IBMCR:1,1:2) ; EDI(1) or MRA(2)
S IB(.04)=$S('$$INPAT^IBCEF(IB,1):1,1:2) ;Outpt(1) or Inpt(2)
S IB(.05)=$S($$FT^IBCEF(IB)=3:1,1:2) ;Inst(1) or Prof(2)
; Execute unmodifiable, general edits
S X1=$$EDIACTV(IB(.03))
I 'X1 S IBWHY=2
I 'IBWHY S X1=$$RATEOK(IBIFN) S:'X1 IBWHY=3
I 'IBWHY S X1=$$INSOK(+IB(.07)) S:'X1 IBWHY=4
I 'IBWHY,$$ISRX^IBCEF1(IBIFN) D ;S:'X1 IBWHY=6
. ; Check for Rxs and NDC # format valid (5-4-2)
. ;IF THIS IS A UB FORM DO NOT SEND ELECTRONIC
. I $$FT^IBCEF(IBIFN)=3 S IBWHY=1
. ;
. Q ;;CHECK REMOVAL SO NON NDC FORMAT NUMBERS WILL GO
. N Z,Z0,Z00
. S Z="" F S Z=$O(^IBA(362.4,"AIFN"_IBIFN,Z)) Q:Z=""!'X1 D Q:'X1
.. S Z0=0 F S Z0=$O(^IBA(362.4,"AIFN"_IBIFN,Z,Z0)) Q:'Z0 D Q:'X1
... S Z00=$G(^IBA(362.4,Z0,0))
... Q:$S($P(Z00,U,8)="":1,1:$L($P(Z00,U,8))=11)
... I $P(Z00,U,9)'=4 S X1=0
; Only continue if general edits are passed
I $$COB^IBCEF(IB)="S" D
. S COBINS=$P($G(^DGCR(399,IB,"M")),U,IBCOB+1)
. I 'COBINS Q
. I IBMCR S IBWHY=1,$P(^DGCR(399,IBIFN,"TX"),U,8)=1
I IBWHY S IBOK=0 G TXMTQ
S IBOK=$$EDIT(IBIFN,.IB,.IBWHY)
G:'IBOK TXMTQ
;
TXMTQ ;
I IBOK S IBOK=$G(^DIC(36,+IB(.07),3))
Q IBOK
;
MRASEC(IBIFN) ; Returns 1 if current bill is secondary to MCR WNR
N IBSEQ,IB,Z
S IB=0
; Chk if MCR WNR is prev insurer with MRA on file
S IBSEQ=$$COBN^IBCEF(IBIFN)-1
S Z=$$MCRONBIL^IBEFUNC(IBIFN,IBSEQ) I +Z=1,$P(Z,U,2)=1,$$CHK^IBCEMU1(IBIFN) S IB=1
Q IB
;
EDIT(IBIFN,IB,IBWHY) ; Find, execute edits applying to bill to see if transmittable
; IBIFN = ien of bill in file 399
; IB = array containing necessary data for xref search from bill
; subscripted by field # in file 364.4
;
; Matrix entries:
; IB(.03): 1=EDI specific, 2=MRA specific
; IB(.04): 1=Outpatient or 2=inpatient only (currently defaults to 3)
; IB(.05): 1=Only institutional or 2=only professional
; X: Anything valid
;
; MRA-EDI IN-OUT INST-PROF
; Level ------- ------ ---------
; 1 X X X
; 2 X X IB(.05)
; 3 X IB(.04) X
; 4 X IB(.04) IB(.05)
; 5 IB(.03) X X
; 6 IB(.03) X IB(.05)
; 7 IB(.03) IB(.04) X
; 8 IB(.03) IB(.04) IB(.05)
;
N IB0,IB1,IB2,IB3,IB4,IBDA,IBFT,IBPASS,IBSEQ,IBT,IBNOCK
I '$G(IB(.03)) S IBPASS=0 G EDITQ
S IBFT=$$FT^IBCEF(IBIFN)
;
S IBPASS=1
F IBSEQ=1:1:8 D Q:'IBPASS ; Loop thru levels in matrix
. F IB1=1:1:3 Q:'IBPASS F IB2=1:1:3 Q:'IBPASS F IB3=1:1:3 Q:'IBPASS D
.. S IB4=0 F S IB4=$O(^IBE(364.4,"AD",IB1,IB2,IB3,IB4)) Q:'IB4 I $O(^(IB4,0)) D Q:'IBPASS
... S IBDA=0
... F S IBDA=$O(^IBE(364.4,"AD",IB1,IB2,IB3,IB4,IBDA)) Q:'IBDA S IB0=$G(^IBE(364.4,IBDA,0)) I IB0'="",'$D(IBNOCK(IBDA)) D Q:'IBPASS
.... I $P(IB0,U,2)>DT S IBNOCK(IBDA)="" Q ; Not activated yet
.... I $P(IB0,U,6),$P(IB0,U,6)'>DT S IBNOCK(IBDA)="" Q ; Inactive
.... ;JWS;IB*2.0*592;dental form #7, same as CMS-1500
.... I $P(IB0,U,11),IB3'=3,$S(IBFT=3:IB3'=1,IBFT=2:IB3'=2,IBFT=7:IB3'=2,1:0) S IBNOCK(IBDA)="" Q ; Form type not included - not used for form type rule (0)
.... I IB4=1,'$D(^IBE(364.4,IBDA,3,"B",+IB(.07))) S IBNOCK(IBDA)="" Q ; Ins not included for rule
.... I IB4=2,$D(^IBE(364.4,IBDA,2,"B",+IB(.07))) S IBNOCK(IBDA)="" Q ; Ins is excluded from rule
.... S IBT=$G(^IBE(364.4,IBDA,1))
.... ; Code can assume IBIFN, IBDA and IB(.03 thru .05 and .07) exist
.... I IBT'="" X IBT I '$T S IBPASS=0,IBWHY(0)=IBDA,IBWHY=5
EDITQ Q IBPASS
;
STATUS(IBIFN) ; Function returns whether or not bill currently has a status
; message or EOB message not yet fully reviewed -
; (only for transmittable bills)
; IBIFN = ien of bill in file 399
; Returns:
; 0 = None found
; If found, returns a pieced string as follows:
;
; [1] ien of transmit bill entry (file 364) associated with an
; entry in file 361 with an unreviewed status message
; [2] ien of transmit bill entry (file 364) associated with an
; entry in file 361.1 with an unreviewed EOB
;
N IB,Z,Z0
S IB=""
S Z="" F S Z=$O(^IBM(361,"B",IBIFN,Z),-1) Q:'Z I $P($G(^IBM(361,Z,0)),U,9)<2,$P(^(0),U,11) S $P(IB,U)=$P(^(0),U,11) Q
;
S Z="" F S Z=$O(^IBM(361.1,"B",IBIFN,Z),-1) Q:'Z I $P($G(^IBM(361.1,Z,0)),U,16)<2,$P(^(0),U,19) S $P(IB,U,2)=$P(^(0),U,19) Q
;
Q IB
;
TEST(IBIFN) ; Returns 1 if bill IBIFN is a transmission test bill, 0 if not
Q +$S($G(^TMP("IBEDI_TEST_BATCH",$J)):1,1:+$P($G(^IBA(364,+$$LAST364(IBIFN),0)),U,7))
;
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HIBCEF4 7162 printed Apr 09, 2024@21:15:48 Page 2
IBCEF4 ;ALB/TMP - MRA/EDI ACTIVATED UTILITIES ;06-FEB-96
+1 ;;2.0;INTEGRATED BILLING;**51,137,232,155,296,327,349,592**;21-MAR-94;Build 58
+2 ;;Per VA Directive 6402, this routine should not be modified.
+3 ;
EDIACTV(IBEDIMRA) ; Returns 0 if EDI or MRA is not active,
+1 ; otherwise, returns 1
+2 ; IBEDIMRA : 1= checking if EDI is active, 2= checking if MRA is active
+3 NEW IBEDI
+4 SET IBEDI=$PIECE($GET(^IBE(350.9,1,8)),U,10)
+5 QUIT $SELECT('IBEDI:0,IBEDI=3:1,1:IBEDI=IBEDIMRA)
+6 ;
RATEOK(IBIFN) ; Returns 1 if rate type of bill IBIFN is transmittable
+1 QUIT +$PIECE($GET(^DGCR(399.3,+$PIECE($GET(^DGCR(399,IBIFN,0)),U,7),0)),U,10)
+2 ;
INSOK(INS) ; Determine EDI activation status of insurance co
+1 ;1 = TEST, 2 = LIVE, 0 = NOT ACTIVE FOR EDI
QUIT +$GET(^DIC(36,INS,3))
+2 ;
BSTATX(IBIFN) ; Returns internal value of bill's latest transmission status
+1 NEW IBDA
+2 QUIT $PIECE($GET(^IBA(364,+$$LAST364(IBIFN),0)),U,3)
+3 ;
LAST364(IBIFN) ; Determine ien of latest transmit bill record for a bill
+1 QUIT +$ORDER(^IBA(364,"ABDT",IBIFN,+$ORDER(^IBA(364,"ABDT",IBIFN,""),-1),""),-1)
+2 ;
TXMT(IBIFN,IBWHY,IBNEW) ; Determine if bill # IBIFN is 'transmittable'
+1 ; IBNEW = flag is 1 if new entry - don't check for entry in file 364
+2 ; Function returns:
+3 ; 0 if not transmittable
+4 ; if transmittable, the entire node 3 of the insurance company
+5 ; and, if passed by reference IBWHY = reason not transmittable
+6 ; 1 if local print
+7 ; 2 if EDI/MRA not active
+8 ; 3 if rate type not transmittable
+9 ; 4 if no transmit for insurance co
+10 ; 5 if failed txmn rules
+11 ; and IBWHY(0) = ien of rule failed
+12 ; 6 if Rx with missing/invalid NDC format
+13 ;
+14 NEW IB,IB0,IBOK,IBCOB,IBMCR,X1
+15 SET IBOK=1
SET IB=IBIFN
SET IBWHY=""
+16 ;
+17 SET IBCOB=$$COBN^IBCEF(IB)
SET IB(.07)=+$GET(^DGCR(399,IB,"I"_IBCOB))
+18 SET IBMCR=$$MCRWNR^IBEFUNC(IB(.07))
+19 ; Does bill have force local print flag set?
+20 ; MCR WNR not curr ins
IF 'IBMCR
Begin DoDot:1
+21 IF $SELECT($$MRASEC(IBIFN):$PIECE($GET(^DGCR(399,IBIFN,"TX")),U,9)=1,1:$PIECE($GET(^DGCR(399,IBIFN,"TX")),U,8)=1)
SET IBOK=0
SET IBWHY=1
End DoDot:1
if IBWHY
GOTO TXMTQ
+22 ; Not recognized as transmittable when it was authorized
IF '$GET(IBNEW)
IF '$ORDER(^IBA(364,"B",IBIFN,0))
IF $PIECE($GET(^DGCR(399,IBIFN,0)),U,13)>2
IF '$$RETN^PRCAFN(IBIFN)
SET IBOK=0
GOTO TXMTQ
+23 ;Already determined to be transmittable - entry exists for bill in transmit bill file
IF $ORDER(^IBA(364,"B",IBIFN,0))
IF $$INSOK(IB(.07))
IF $$BSTATX(IBIFN)'="X"
GOTO TXMTQ
+24 ; EDI(1) or MRA(2)
SET IB(.03)=$SELECT('IBMCR:1,1:2)
+25 ;Outpt(1) or Inpt(2)
SET IB(.04)=$SELECT('$$INPAT^IBCEF(IB,1):1,1:2)
+26 ;Inst(1) or Prof(2)
SET IB(.05)=$SELECT($$FT^IBCEF(IB)=3:1,1:2)
+27 ; Execute unmodifiable, general edits
+28 SET X1=$$EDIACTV(IB(.03))
+29 IF 'X1
SET IBWHY=2
+30 IF 'IBWHY
SET X1=$$RATEOK(IBIFN)
if 'X1
SET IBWHY=3
+31 IF 'IBWHY
SET X1=$$INSOK(+IB(.07))
if 'X1
SET IBWHY=4
+32 ;S:'X1 IBWHY=6
IF 'IBWHY
IF $$ISRX^IBCEF1(IBIFN)
Begin DoDot:1
+33 ; Check for Rxs and NDC # format valid (5-4-2)
+34 ;IF THIS IS A UB FORM DO NOT SEND ELECTRONIC
+35 IF $$FT^IBCEF(IBIFN)=3
SET IBWHY=1
+36 ;
+37 ;;CHECK REMOVAL SO NON NDC FORMAT NUMBERS WILL GO
QUIT
+38 NEW Z,Z0,Z00
+39 SET Z=""
FOR
SET Z=$ORDER(^IBA(362.4,"AIFN"_IBIFN,Z))
if Z=""!'X1
QUIT
Begin DoDot:2
+40 SET Z0=0
FOR
SET Z0=$ORDER(^IBA(362.4,"AIFN"_IBIFN,Z,Z0))
if 'Z0
QUIT
Begin DoDot:3
+41 SET Z00=$GET(^IBA(362.4,Z0,0))
+42 if $SELECT($PIECE(Z00,U,8)=""
QUIT
+43 IF $PIECE(Z00,U,9)'=4
SET X1=0
End DoDot:3
if 'X1
QUIT
End DoDot:2
if 'X1
QUIT
End DoDot:1
+44 ; Only continue if general edits are passed
+45 IF $$COB^IBCEF(IB)="S"
Begin DoDot:1
+46 SET COBINS=$PIECE($GET(^DGCR(399,IB,"M")),U,IBCOB+1)
+47 IF 'COBINS
QUIT
+48 IF IBMCR
SET IBWHY=1
SET $PIECE(^DGCR(399,IBIFN,"TX"),U,8)=1
End DoDot:1
+49 IF IBWHY
SET IBOK=0
GOTO TXMTQ
+50 SET IBOK=$$EDIT(IBIFN,.IB,.IBWHY)
+51 if 'IBOK
GOTO TXMTQ
+52 ;
TXMTQ ;
+1 IF IBOK
SET IBOK=$GET(^DIC(36,+IB(.07),3))
+2 QUIT IBOK
+3 ;
MRASEC(IBIFN) ; Returns 1 if current bill is secondary to MCR WNR
+1 NEW IBSEQ,IB,Z
+2 SET IB=0
+3 ; Chk if MCR WNR is prev insurer with MRA on file
+4 SET IBSEQ=$$COBN^IBCEF(IBIFN)-1
+5 SET Z=$$MCRONBIL^IBEFUNC(IBIFN,IBSEQ)
IF +Z=1
IF $PIECE(Z,U,2)=1
IF $$CHK^IBCEMU1(IBIFN)
SET IB=1
+6 QUIT IB
+7 ;
EDIT(IBIFN,IB,IBWHY) ; Find, execute edits applying to bill to see if transmittable
+1 ; IBIFN = ien of bill in file 399
+2 ; IB = array containing necessary data for xref search from bill
+3 ; subscripted by field # in file 364.4
+4 ;
+5 ; Matrix entries:
+6 ; IB(.03): 1=EDI specific, 2=MRA specific
+7 ; IB(.04): 1=Outpatient or 2=inpatient only (currently defaults to 3)
+8 ; IB(.05): 1=Only institutional or 2=only professional
+9 ; X: Anything valid
+10 ;
+11 ; MRA-EDI IN-OUT INST-PROF
+12 ; Level ------- ------ ---------
+13 ; 1 X X X
+14 ; 2 X X IB(.05)
+15 ; 3 X IB(.04) X
+16 ; 4 X IB(.04) IB(.05)
+17 ; 5 IB(.03) X X
+18 ; 6 IB(.03) X IB(.05)
+19 ; 7 IB(.03) IB(.04) X
+20 ; 8 IB(.03) IB(.04) IB(.05)
+21 ;
+22 NEW IB0,IB1,IB2,IB3,IB4,IBDA,IBFT,IBPASS,IBSEQ,IBT,IBNOCK
+23 IF '$GET(IB(.03))
SET IBPASS=0
GOTO EDITQ
+24 SET IBFT=$$FT^IBCEF(IBIFN)
+25 ;
+26 SET IBPASS=1
+27 ; Loop thru levels in matrix
FOR IBSEQ=1:1:8
Begin DoDot:1
+28 FOR IB1=1:1:3
if 'IBPASS
QUIT
FOR IB2=1:1:3
if 'IBPASS
QUIT
FOR IB3=1:1:3
if 'IBPASS
QUIT
Begin DoDot:2
+29 SET IB4=0
FOR
SET IB4=$ORDER(^IBE(364.4,"AD",IB1,IB2,IB3,IB4))
if 'IB4
QUIT
IF $ORDER(^(IB4,0))
Begin DoDot:3
+30 SET IBDA=0
+31 FOR
SET IBDA=$ORDER(^IBE(364.4,"AD",IB1,IB2,IB3,IB4,IBDA))
if 'IBDA
QUIT
SET IB0=$GET(^IBE(364.4,IBDA,0))
IF IB0'=""
IF '$DATA(IBNOCK(IBDA))
Begin DoDot:4
+32 ; Not activated yet
IF $PIECE(IB0,U,2)>DT
SET IBNOCK(IBDA)=""
QUIT
+33 ; Inactive
IF $PIECE(IB0,U,6)
IF $PIECE(IB0,U,6)'>DT
SET IBNOCK(IBDA)=""
QUIT
+34 ;JWS;IB*2.0*592;dental form #7, same as CMS-1500
+35 ; Form type not included - not used for form type rule (0)
IF $PIECE(IB0,U,11)
IF IB3'=3
IF $SELECT(IBFT=3:IB3'=1,IBFT=2:IB3'=2,IBFT=7:IB3'=2,1:0)
SET IBNOCK(IBDA)=""
QUIT
+36 ; Ins not included for rule
IF IB4=1
IF '$DATA(^IBE(364.4,IBDA,3,"B",+IB(.07)))
SET IBNOCK(IBDA)=""
QUIT
+37 ; Ins is excluded from rule
IF IB4=2
IF $DATA(^IBE(364.4,IBDA,2,"B",+IB(.07)))
SET IBNOCK(IBDA)=""
QUIT
+38 SET IBT=$GET(^IBE(364.4,IBDA,1))
+39 ; Code can assume IBIFN, IBDA and IB(.03 thru .05 and .07) exist
+40 IF IBT'=""
XECUTE IBT
IF '$TEST
SET IBPASS=0
SET IBWHY(0)=IBDA
SET IBWHY=5
End DoDot:4
if 'IBPASS
QUIT
End DoDot:3
if 'IBPASS
QUIT
End DoDot:2
End DoDot:1
if 'IBPASS
QUIT
EDITQ QUIT IBPASS
+1 ;
STATUS(IBIFN) ; Function returns whether or not bill currently has a status
+1 ; message or EOB message not yet fully reviewed -
+2 ; (only for transmittable bills)
+3 ; IBIFN = ien of bill in file 399
+4 ; Returns:
+5 ; 0 = None found
+6 ; If found, returns a pieced string as follows:
+7 ;
+8 ; [1] ien of transmit bill entry (file 364) associated with an
+9 ; entry in file 361 with an unreviewed status message
+10 ; [2] ien of transmit bill entry (file 364) associated with an
+11 ; entry in file 361.1 with an unreviewed EOB
+12 ;
+13 NEW IB,Z,Z0
+14 SET IB=""
+15 SET Z=""
FOR
SET Z=$ORDER(^IBM(361,"B",IBIFN,Z),-1)
if 'Z
QUIT
IF $PIECE($GET(^IBM(361,Z,0)),U,9)<2
IF $PIECE(^(0),U,11)
SET $PIECE(IB,U)=$PIECE(^(0),U,11)
QUIT
+16 ;
+17 SET Z=""
FOR
SET Z=$ORDER(^IBM(361.1,"B",IBIFN,Z),-1)
if 'Z
QUIT
IF $PIECE($GET(^IBM(361.1,Z,0)),U,16)<2
IF $PIECE(^(0),U,19)
SET $PIECE(IB,U,2)=$PIECE(^(0),U,19)
QUIT
+18 ;
+19 QUIT IB
+20 ;
TEST(IBIFN) ; Returns 1 if bill IBIFN is a transmission test bill, 0 if not
+1 QUIT +$SELECT($GET(^TMP("IBEDI_TEST_BATCH",$JOB)):1,1:+$PIECE($GET(^IBA(364,+$$LAST364(IBIFN),0)),U,7))
+2 ;
