IBCEMU4 ;ALB/ESG - MRA UTILITIES ;25-OCT-2004
Source file <IBCEMU4.m>
| action | A | extended action | Ea | event driver | Ed | subscriber | Su | protocol | O | limited protocol | LP | run routine | RR | broker | B | edit | E | server | Se | P | screenman | SM | inquire | I |
| Name | Comments | DBIA/ICR reference |
|---|---|---|
| DENDUP(IBEOB,IBMRANOT) | ; Denied for Duplicate Function ;WCJ IB*2.0*432
; Function returns true if MRA is Denied AND Reason code 18 is present (Duplicate claim/service) |
|
| DENDUPX | ;
|
|
| MSPRE(IBIFN,IBEXF,IBTYPLAN) | ; Medicare supplemental PR and Excess calculations
; determine PR amount in order to calculate balance due after medicare for secondary/tertiary ; if type of plan is a Medicare supplemental or EGHP plan secondary to Medicare, PR ; calculations are determined based on the effective date multiple in the TYPE OF PLAN file ; and may or may not included Excess charges (CO-45), based on Plan Type. ; need to pass in: ; IBIFN (REQUIRED) = claim ien ; IBEXF = Excess Flag, set to 1 if NOT to include excess charges in calculation but to ; return "e" (IBE) for excess indicator if plan allows excess and there are ; excess charges. Used by PR column of MRW screen to show PR without excess ; amounts included in calculation. ; IBTYPLAN = ien in TYPE OF PLAN file (355.1) ; returns "" if no effective date for type of plan to calculate on |
|
| CALC(EOBADJ,IBTYPLAN,IBPCE,IBEDT,IBEXF) | ; FUNCTION - Calculate Medicare Supplemental Balance due
; Sums up Amounts on ALL Reason Codes under ALL Group Codes = 'PR' and CO/Reason code=45. ; If those reason codes have an entry in the effective date mutliple, multiples that ; reason amount by the % the Type of plan will pay. If no entry, assume 100% payment for PR. ; any other Group and reason codes would be 0%. ; Adds up all those sums and returns that value as the total PR&CO the Medicare ; Supplemental plan will pay. |
|
| MSEDT(IBIFN,IBTYPLAN) | ; does this claim's TYPE OF PLAN have an effective date multiple on or before the
; claim 'statement covers from' date ; IBIFN = claim ien - REQUIRED ; IBTYPLAN = Type of Plan ien ; returns eff.date calculation multiple to use or null ; called from SKIP^IBCCCB, BLD^IBCECOB1, TOT^IBCECOB2, CRIT^IBCEMQC, & SECOND^IBCEMSR |
|
| TYPLN(IBIFN) | ; find type of plan for claim
; IBIFN = claim ien - REQUIRED ; returns ien from file 355.1 or null if none found |
| Name | Line Occurrences (* Changed, ! Killed) |
|---|---|
| ^DGCR(399 - [#399] | MSPRE+19, MSEDT+18, TYPLN+7 |
| ^IBA(355.3 - [#355.3] | TYPLN+8 |
| ^IBE(355.1 - [#355.1] | CALC+27, CALC+33, CALC+34, CALC+37, CALC+38, MSEDT+19, MSEDT+20 |
| ^IBM(361.1 - [#361.1] | DENDUP+3, DENDUP+10, DENDUP+12, DENDUP+13, MSPRE+29, MSPRE+31, MSPRE+39, MSPRE+41, MSPRE+49 |
| Name | Line Occurrences |
|---|---|
| $$CALC | MSPRE+44, MSPRE+50 |
| $$MSEDT | MSPRE+17, CALC+22 |
| $$TYPLN | MSPRE+16, CALC+21, MSEDT+17 |
| DENDUPX | DENDUP+4, DENDUP+5, DENDUP+6 |
| >> | Not killed explicitly |
| * | Changed |
| ! | Killed |
| ~ | Newed |
| Name | Field # of Occurrence |
|---|---|
| ADJ | DENDUP+2~, DENDUP+11*, DENDUP+12*, DENDUP+13 |
| CALC | CALC+19~, CALC+38*, CALC+39 |
| DUP | DENDUP+2~, DENDUP+9*, DENDUP+10, DENDUP+12, DENDUP+13*, DENDUP+17 |
| EOBADJ | MSPRE+14~, MSPRE+40!, MSPRE+41*, MSPRE+44, MSPRE+48!, MSPRE+49*, MSPRE+50, CALC~ |
| EOBADJ( | CALC+24, CALC+25, CALC+29, CALC+30 |
| GRPCD | CALC+19~, CALC+25*, CALC+27, CALC+31, CALC+33, CALC+34, CALC+37, CALC+38 |
| GRPLVL | CALC+19~, CALC+23*, CALC+24*, CALC+25, CALC+29, CALC+30 |
| I | MSPRE+30~, MSPRE+31* |
| IBCOBN | TYPLN+5~, TYPLN+6*, TYPLN+7 |
| IBE | MSPRE+14~, MSPRE+44*, MSPRE+50*, MSPRE+52 |
| IBEDT | MSPRE+14~, MSPRE+17*, MSPRE+44, MSPRE+50, CALC~, CALC+22*, CALC+27, CALC+33, CALC+34, CALC+37 , CALC+38 |
| IBEOB | DENDUP~, DENDUP+3, DENDUP+10, DENDUP+12, DENDUP+13, MSPRE+14~, MSPRE+28*, MSPRE+29*, MSPRE+31, MSPRE+39 , MSPRE+41, MSPRE+49 |
| IBEOB( | MSPRE+31* |
| IBEOB(0 | MSPRE+32 |
| IBEXF | MSPRE~, MSPRE+44, MSPRE+50, CALC~, CALC+37 |
| IBFRMTYP | MSPRE+14~, MSPRE+19*, MSPRE+22, MSPRE+37 |
| IBGRPNO | TYPLN+5~, TYPLN+7*, TYPLN+8 |
| IBIFN | MSPRE~, MSPRE+15, MSPRE+16, MSPRE+17, MSPRE+18, MSPRE+19, MSPRE+29, CALC+21, CALC+22, MSEDT~ , MSEDT+16, MSEDT+17, MSEDT+18, TYPLN~, TYPLN+4, TYPLN+6, TYPLN+7 |
| IBIND | CALC+19~, CALC+37*, CALC+40 |
| IBINPAT | MSPRE+14~, MSPRE+18*, MSPRE+22, MSPRE+37 |
| IBM | DENDUP+2~, DENDUP+3*, DENDUP+4, DENDUP+5, DENDUP+6 |
| IBMGBD | MSPRE+14~, MSPRE+28*, MSPRE+45*, MSPRE+51*, MSPRE+52 |
| IBMRANOT | DENDUP~, DENDUP+4, DENDUP+5 |
| IBPCE | MSPRE+14~, MSPRE+27*, MSPRE+44, MSPRE+50, CALC~, CALC+20, CALC+37, CALC+38 |
| IBPNCAT | MSPRE+14~, MSPRE+21*, MSPRE+22*, MSPRE+27 |
| IBSVDT | MSEDT+15~, MSEDT+18*, MSEDT+19, MSEDT+20 |
| IBTOT | MSPRE+14~, MSPRE+44*, MSPRE+45, MSPRE+50*, MSPRE+51 |
| IBTYPLAN | MSPRE~, MSPRE+16*, MSPRE+17, MSPRE+44, MSPRE+50, CALC~, CALC+21*, CALC+22, CALC+27, CALC+33 , CALC+34, CALC+37, CALC+38, MSEDT~, MSEDT+17*, MSEDT+19, MSEDT+20 |
| IBX | DENDUP+2~, DENDUP+3*, DENDUP+17*, DENDUPX+1 |
| LINE | DENDUP+2~, DENDUP+9*, DENDUP+10*, DENDUP+12, DENDUP+13 |
| LNLVL | MSPRE+14~, MSPRE+39*, MSPRE+41 |
| MCA | CALC+19~, CALC+23*, CALC+33*, CALC+39*, CALC+40 |
| RSN0 | CALC+19~, CALC+30* |
| RSNAMT | CALC+19~, CALC+30*, CALC+33, CALC+39 |
| RSNCD | CALC+19~, CALC+30*, CALC+31, CALC+33, CALC+34, CALC+37, CALC+38 |
| RSNLVL | CALC+19~, CALC+28*, CALC+29*, CALC+30 |
| U | DENDUP+4, DENDUP+5, DENDUP+6, MSPRE+19, MSPRE+32, MSPRE+44, MSPRE+45, MSPRE+50, MSPRE+51, CALC+25 , CALC+30, CALC+37, CALC+38, CALC+40, MSEDT+18, TYPLN+7, TYPLN+8 |
