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Routine: IBCEF74

IBCEF74.m

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IBCEF74 ;WOIFO/SS - FORMATTER/EXTRACT BILL FUNCTIONS ;31-JUL-03
 ;;2.0;INTEGRATED BILLING;**232,280,155,290,291,320,358,343,374,432,592**;21-MAR-94;Build 58
 ;;Per VA Directive 6402, this routine should not be modified.
 ;
SORT(IBPRNUM,IBPRTYP,IB399,IBSRC,IBDST,IBN,IBEXC,IBSEQ,IBLIMIT) ;
 D SORT^IBCEF77($G(IBPRNUM),$G(IBPRTYP),$G(IB399),.IBSRC,.IBDST,$G(IBN),$G(IBEXC),$G(IBSEQ),$G(IBLIMIT))
 Q
 ;
 ;-- PROVINF --
 ;Create array with prov info
 ;Input:
 ; IB399 - ien #399
 ; IBPRNUM - 1=prim ins, 2= sec, 3 -tert
 ; IBRES - for results
 ; IBSORT - to sort OTHER INSURANCE data 
 ;  if PROVINF is called for "C" mode of PROVIDER subroutine then 
 ;    IBSORT can be any (say 1)
 ;  if PROVINF is called for "O" mode then can be more than set of data
 ;    - need to sort array to use it (like IBXDATA(1) and IBXDATA(2))
 ;    for mode "O" it should be 1 or 2 (see PROVIDER section)
 ;IBINSTP -  "C" -current ins, "O"-other
 ;Output:
 ; IBRES(PRNUM,PRTYPE,SEQ#)=PROV^INSUR^IDTYPE^ID^FORMTYP^CARETYP
 ; where:(see PROVIDER)
PROVINF(IB399,IBPRNUM,IBRES,IBSORT,IBINSTP) ;
 I $G(IB399)="" Q
 I +$G(IBSORT)=0 S IBSORT=$G(IBPRNUM)
 N IBPRTYP,IBINSCO,IBPROV,IBFRMTYP,IBCARE,IB35591,IBN,IBCURR,IBEXC,IBLIMIT
 S IBN=0
 S IBINSCO=+$P($G(^DGCR(399,IB399,"M")),"^",IBPRNUM)
 ;JRA IB*2.0*592 Modify for Dental form 7 - treat the same as CMS-1500
 ;S IBFRMTYP=$$FT^IBCEF(IB399),IBFRMTYP=$S(IBFRMTYP=2:2,IBFRMTYP=3:1,1:0)  ;JRA IB*2.0*592 ';'
 S IBFRMTYP=$$FT^IBCEF(IB399),IBFRMTYP=$S(IBFRMTYP=2:2,IBFRMTYP=7:7,IBFRMTYP=3:1,1:0)  ;JWS 8/30/17;IB*2.0*592;JRA IB*2.0*592
 S IBCARE=$S($$ISRX^IBCEF1(IB399):3,1:0) ;if an Rx refill bill
 S:IBCARE=0 IBCARE=$$INPAT^IBCEF(IB399,1) S:'IBCARE IBCARE=2 ;1-inp,2-out
 S IBLIMIT=$S($G(IBINSTP)="C":5,1:3)  ; Limits on secondary IDs
 F IBPRTYP=1:1:9 D
 . N Z,IB355OV
 . S IBPROV=$$PROVPTR^IBCEF7(IB399,IBPRTYP)
 . Q:+IBPROV=0
 . ;don't create anything if form type not CMS-1500 or UB
 . Q:IBFRMTYP=0
 . N IBRETARR S IBRETARR=0
 . D PRACT^IBCEF71(IBINSCO,IBFRMTYP,IBCARE,IBPROV,.IBRETARR,IBPRTYP,$G(IBINSTP))
 . S IB355OV="",IBEXC=""
 . S Z=$O(^DGCR(399,IB399,"PRV","B",IBPRTYP,0))
 . I Z S Z=$G(^DGCR(399,IB399,"PRV",Z,0)) D
 .. I $P(Z,U,IBPRNUM+4)'="",$P(Z,U,IBPRNUM+11)'="" S IB355OV=$P(Z,U,IBPRNUM+4)_U_$P(Z,U,IBPRNUM+11)
 . S IBCURR=$$COB^IBCEF(IB399)
 . S IBN=0,IB35591=$$CH35591^IBCEF72(IBINSCO,IBFRMTYP,IBCARE)
 . ;JRA IB*2.0*592 Modify for Dental form 7 - treat the same as CMS-1500
 . I $G(IBINSTP)="C",$G(IBPRNUM)=1,"34"[$G(IBPRTYP),"P"[$G(IBCURR),($G(IBFRMTYP)=2!($G(IBFRMTYP)=7)),$$MCRONBIL^IBEFUNC(IB399) S IB355OV=$$MCR24K^IBCEU3(IB399)_"^12"  ;JRA IB*2.0*592
 . ;Calculate MEDICARE (WNR) specific provider qualifier and ID for CMS-1500 secondary claim  ;JRA IB*2.0*592
 . I $G(IBINSTP)="O","34"[$G(IBPRTYP),"ST"[$G(IBCURR),($G(IBFRMTYP)=2!($G(IBFRMTYP)=7)),$$MCRONBIL^IBEFUNC(IB399) S IB355OV=$$MCR24K^IBCEU3(IB399)_"^12"
 . I $P(IB355OV,U,2) D
 .. I $$CHCKSEC^IBCEF73(IBFRMTYP,IBPRTYP,$G(IBINSTP),$P($G(^IBE(355.97,+$P(IB355OV,U,2),0)),U,3)) D
 ... S IBEXC=$P(IB355OV,U,2),IBN=IBN+1,IBRES(IBSORT,IBPRTYP,IBN)="OVERRIDE^"_IBINSCO_U_$P($G(^IBE(355.97,+IBEXC,0)),U,3)_U_$P(IB355OV,U)_"^^^^^"_+IBEXC
 . I IB35591'="",IBEXC'=$P(IB35591,U,3) S:$$CHCKSEC^IBCEF73(IBFRMTYP,IBPRTYP,$G(IBINSTP),$P(IB35591,"^")) IBN=IBN+1,IBRES(IBSORT,IBPRTYP,IBN)="DEFAULT^"_IBINSCO_"^"_IB35591_"^^",$P(IBRES(IBSORT,IBPRTYP,IBN),U,9)=$P(IB35591,U,3)
 . D SORT(IBSORT,IBPRTYP,IB399,.IBRETARR,.IBRES,IBN,IBEXC,IBPRNUM,IBLIMIT)
 . S IBRES(IBSORT,IBPRTYP)=IBPROV
 S IBRES(IBSORT)=$S(IBPRNUM=3:"T",IBPRNUM=2:"S",1:"P")
 Q
 ;
SECIDCK(IBIFN,IBSEQ,IBTYP,IBIFN1) ; Function returns 1 if ID type ptr in
 ;  IBTYP is valid X12 code for the claim/prov function (IBPROVF)
 ;  as a sec id
 ; IBSEQ = COB seq being checked
 ; IBIFN1 = entry # in PRV multiple being checked
 ;  Called from input transform of fields .12-.14, subfile 399.0222
 I $G(IBIFN)="" Q
 N IBOK,IBFRM,IBCOBN,IBX12,IBPROVF
 S IBPROVF=+$G(^DGCR(399,IBIFN,"PRV",IBIFN1,0))
 S IBFRM=$$FT^IBCEF(IBIFN),IBFRM=$S(IBFRM=3:1,1:2) ; Form type
 S IBCOBN=$$COBN^IBCEF(IBIFN) S:'IBCOBN IBCOBN=1 ; Current COB seq
 S IBX12=$P($G(^IBE(355.97,+IBTYP,0)),U,3) ; X12 code for prov id typ
 Q $$CHSEC^IBCEF73(IBFRM,IBPROVF,$S(IBSEQ=IBCOBN:"C",1:"O"),IBX12)
 ;
DEFID(IBIFN,IBPRV) ;
 ; IBIFN = ien of bill
 ; IBPRV = ien of entry subfile 399.0222
 ;  Function returns default ids: prim id def^sec id def^tert id def
 ;  SSN cannot be the default ID
 I $G(IBIFN)="" Q ""
 N Z,Z1,ID,IBZ,IBINS,IBINS4,IBUB
 S IBZ=""
 S IBUB=($$FT^IBCEF(IBIFN)=3)
 D F^IBCEF("N-ALL ATT/REND PROV SSN/EI","IBZ","",IBIFN)
 S Z=$G(^DGCR(399,IBIFN,"PRV",IBPRV,0)),ID=$P(Z,U,5,7)
 F Z1=1:1:3 I $P(ID,U,Z1)="" D
 . Q:'$G(^DGCR(399,IBIFN,"I"_Z1))  S IBINS=+^("I"_Z1)
 . S $P(ID,U,Z1)=$$GETID^IBCEP2(IBIFN,2,$P(Z,U,2),Z1)
 . ; Set default if null
 . I $P(ID,U,Z1)="" S $P(ID,U,Z1)="VAD000"
 Q ID
 ;
DISPID(IBXIEN) ; Display list of all prov and fac ids that will
 ; extract for this bill if transmitted electronically
 I $G(IBXIEN)="" Q
 N IBID,IBID1,IBZ,IBCT,IBFRM,IBCOBN,IBQUIT,IBTYP,DIR,IBIFN,X,Y,Z,Z0,Z1,CO,IBN,IBCODE
 S IBIFN=IBXIEN
 S IBFRM=$$FT^IBCEF(IBIFN),IBCOBN=$$COBN^IBCEF(IBIFN)
 W @IOF
 W !,"If this bill is transmitted electronically, the following IDs will be sent:"
 ; Returns all prov sec ids to be transmitted in indicated segments
 S Z=+$G(^DGCR(399,IBIFN,"I1")) I Z W !,"  Primary Ins Co: ",$$EXTERNAL^DILFD(399,101,"",Z) I IBCOBN=1 W ?54,"<<<Current Ins"
 S Z=+$G(^DGCR(399,IBIFN,"I2")) I Z W !,"Secondary Ins Co: ",$$EXTERNAL^DILFD(399,101,"",Z) I IBCOBN=2 W ?54,"<<<Current Ins"
 S Z=+$G(^DGCR(399,IBIFN,"I3")) I Z W !," Tertiary Ins Co: ",$$EXTERNAL^DILFD(399,101,"",Z) I IBCOBN=3 W ?54,"<<<Current Ins"
 ;JWS;IB*2.0*592;added Assistant Surgeon records to header display
 W !!,"Provider IDs: (VistA Records OP1,OP2,OP4,OP8,OP9,OP10,OPR,OPR1,OPR2,OPR3,OPR4,",!?29,"OPR5,OPR7,OPR8,OPR9,OPRA,OPRB,OPRC):"
 ;F Z=1:1:3 I $G(^DGCR(399,IBIFN,"I"_Z)) D PROVINF(IBIFN,Z,.IBID,"",$S(IBCOBN=Z:"C",1:"O"))
 ;*432/TAZ - Added call to gather line providers and apply business rules
 D ALLIDS^IBCEFP(IBIFN,.IBID)
 ;*432/TAZ - Rewrote following code to take info from the IBID array instead of File 399.  This allows changes from the application of the business rules.
 S IBQUIT=0
 ;
 ;JWS;IB*2.0*592; added assistant surgeon
 F IBPRV=4,3,1,2,5,6,9 D  ; Process providers in order: Attending, Rendering, Referring, Operating, Supervising, and Other Operating if they exist
 . I '$D(IBID("PROVINF",IBIFN,"C",1,IBPRV)) Q
 . I ($Y+5)>IOSL S IBQUIT=$$NOMORE() Q:IBQUIT
 . W !!?5,$$EXTERNAL^DILFD(399.0222,.01,"",IBPRV),": "_$$EXTERNAL^DILFD(399.0222,.02,"",$P(IBID("PROVINF",IBIFN,"C",1,IBPRV),U))
 . W !?8,"NPI: ",?40,$S($P($G(IBID("PROVINF",IBIFN,"C",1,IBPRV,0)),U,4)]"":$P(IBID("PROVINF",IBIFN,"C",1,IBPRV,0),U,4),1:"***MISSING***")
 . K IBTYP
 . F CO="C","O" D
 .. F IBN=1,2 I $D(IBID("PROVINF",IBIFN,CO,IBN,IBPRV)) D
 ... F Z0=1:1 Q:'$D(IBID("PROVINF",IBIFN,CO,IBN,IBPRV,Z0))!IBQUIT  D
 .... S IBCODE=+$P(IBID("PROVINF",IBIFN,CO,IBN,IBPRV,Z0),U,9)
 .... Q:$D(IBTYP(IBCODE))  ;1st of each type transmits
 .... I ($Y+5)>IOSL S IBQUIT=$$NOMORE() Q:IBQUIT
 .... S IBTYP(IBCODE)=""
 .... W !,?8,"(",IBID("PROVINF",IBIFN,CO,IBN),") ",$$EXTERNAL^DILFD(36,4.01,"",IBCODE),?40,$P(IBID("PROVINF",IBIFN,CO,IBN,IBPRV,Z0),U,4)
 ;
 I IBQUIT G DISPIDX
 ;
 ; IB*2*320 - display additional IDs for ?ID
 D EN^IBCEF74A(IBIFN,.IBQUIT,.IBID)
 ;
DISPIDX ;
 I '$G(IBQUIT) S DIR(0)="EA",DIR("A")="Press RETURN to continue " W ! D ^DIR K DIR
 Q
 ;
NOMORE() ;
 S DIR(0)="EA",DIR("A")="Press RETURN for more IDs or '^' to exit: " W ! D ^DIR
 W @IOF
 Q (Y'=1)
 ;
DEFSEC(IBIFN,IBARR) ; Returns array in IBARR for default prov sec ids for ien IBIFN
 ; IBARR if passed by ref is returned   IBARR(prov function,COBN)=def id
 I $G(IBIFN)=""
 N IBCAR,IBCOBN,IBPC,IBINS,IBARRX,Q,Z,Z0,ZINS,X
 K IBARR
 S ZINS="",IBCOBN=$$COBN^IBCEF(IBIFN),IBPC=$S($$FT^IBCEF(IBIFN)=3:2,1:1)
 S IBCAR=$$INPAT^IBCEF(IBIFN,1),IBCAR=$S('IBCAR:2,1:1)
 F Z=1:1:3 S ZINS=ZINS_+$G(^DGCR(399,IBIFN,"I"_Z))_U
 F Z=1:1:3 I $P(ZINS,U,Z),'$P($G(^DIC(36,+$P(ZINS,U,Z),4)),U,IBPC) S $P(ZINS,U,Z)=""
 S Z=0 F  S Z=$O(^DGCR(399,IBIFN,"PRV",Z)) Q:'Z  S Z0=$G(^(Z,0)) D
 . F Q=1:1:3 D
 .. I $P(Z0,U,Q+4)'="" S IBARR(+Z0,Q)=$P(Z0,U,Q+4) Q  ; Override
 .. S IBINS=$P(ZINS,U,Q)
 .. Q:'IBINS
 .. S X=$$IDFIND^IBCEP2(IBIFN,"",$P(Z0,U,2),Q,1)
 .. I X'="" S IBARR(+Z0,Q)=X
 Q
 ;