IBCESRV3 ;ALB/TMP - Server based Auto-update utilities - IB EDI ;03/05/96
;;2.0;INTEGRATED BILLING;**137,155,400**;21-MAR-94;Build 52
;;Per VHA Directive 2004-038, this routine should not be modified.
; IA 4129 for call to DUZ^XUP
Q
;
EOB835 ; Explanation of Benefits - auto update
; Input expected: IBTDA = the ien of the message entry in file 364.2
;
; This is the background task that is queued to run by TaskManager.
; This procedure is called via indirection in TRTN^IBCESRV1 which is
; called by ADD^IBCESRV.
;
N IB0,IBBDA,IBBILL,IBMSG,IBFLAG,IBTYP,IBBST,DR,DA,DIE,Z,MRAUSER
;
Q:'$G(IBTDA)
S IB0=$G(^IBA(364.2,IBTDA,0)),IBBDA=+$P(IB0,U,4) ; Batch ien
S IBTYP=$P($G(^IBE(364.3,+$P(IB0,U,2),0)),U) ; IB message type
Q:IBTYP'="835EOB"
;
; The MRA Project is using a specific non-human user for all
; 835 EOB/MRA filing processes. Change the DUZ to be this user.
; *** VA SACC approved this exemption 5-June-2003 ***
; *** Integration Agreement 4129 - Activated on 30-June-2003 ***
;
S MRAUSER=$$MRAUSR^IBCEMU1()
I MRAUSER>0,$$ISITMRA(IBTDA) NEW DUZ D DUZ^XUP(MRAUSER)
;
D UPDEOB(IBTDA)
;
Q
;
UPDEOB(IBTDA) ; Explanation of Benefits or MRA
; Update data base from msg (store EOB in file 361.1)
; IBTDA = ien of message in file 364.2
;
N IBBILL,PRCASV,DA,DIE,DR,DA,X,Y,IBFLAG,IB0,IBS
N IBEOB,IBAUTO,IBIFN,IBERRMSG
;
D UPDMSG^IBCESRV2(IBTDA,"U",0) ; updating data in 364.2
S IB0=$G(^IBA(364.2,IBTDA,0))
;
I '$P(IB0,U,5) G UPDEOBX ; no transmit bill# in file 364
S IBEOB=$$UPDEOB^IBCEOB(IBTDA) ; new entry in file 361.1
I 'IBEOB G UPDEOBX ; exit if some failure
;
; update transmission status of transmission Bill# in file 364
; status is closed (code "Z")
D BILLSTAC^IBCESRV2($P(IB0,U,5),"Z") ;Upd indiv transmitted bill
;
; Delete the entry from file 364.2
D DELMSG^IBCESRV2(IBTDA)
;
; If the EOB is not a Medicare MRA, then we can stop here
I $P($G(^IBM(361.1,IBEOB,0)),U,4)'=1 G UPDEOBX
;
; *** Medicare MRA processing ***
;
; update the claim MRA status of the file 399 bill
; to be "C" - Valid MRA received
D MRASTAT(IBEOB,"C")
;
; Invoke the EOB criteria check and attempt to create and authorize
; the secondary bill
S IBAUTO=$$CRIT^IBCEMQC(IBEOB)
I 'IBAUTO D AUTOMSG(IBEOB,$P(IBAUTO,U,2)) G UPDEOBX
S IBIFN=$P($G(^IBA(364,+$P(IB0,U,5),0)),U,1) ; bill# from file 364
;
; Process COB, create secondary bill
S IBERRMSG=""
D AUTOCOB^IBCEMQA(IBIFN,IBEOB,.IBERRMSG)
I IBERRMSG'="" D AUTOMSG(IBEOB,IBERRMSG) G UPDEOBX
;
; Authorize the secondary bill
D AUTH^IBCEMQA(IBIFN,.IBERRMSG)
I IBERRMSG'="" D AUTOMSG(IBEOB,IBERRMSG) G UPDEOBX
;
UPDEOBX ;
S ZTREQ="@"
Q
;
AUTOMSG(IBEOB,MSG) ; File the automatic bill generation failure message
NEW DIE,DA,DR,D,D0,DI,DIC,DQ,X,Y
S IBEOB=+$G(IBEOB),MSG=$G(MSG)
I '$D(^IBM(361.1,IBEOB)) G AUMSGX
I MSG="" G AUMSGX
S DIE=361.1,DA=IBEOB,DR="30.01////"_MSG_";30.02////"_$$NOW^XLFDT
D ^DIE
AUMSGX ;
Q
;
MRASTAT(IBEOB,STAT) ; Update the claim MRA status field on the bill
; File 399, Field 24 - CLAIM MRA STATUS
NEW DIE,DA,DR,D,D0,DI,DIC,DIG,DIH,DIU,DIV,DQ,X,Y,IBIFN
S IBEOB=+$G(IBEOB),STAT=$G(STAT)
I '$D(^IBM(361.1,IBEOB)) G MRASTX
I STAT="" G MRASTX
S IBIFN=+$P($G(^IBM(361.1,IBEOB,0)),U,1)
I '$D(^DGCR(399,IBIFN,"TX")) G MRASTX
;
S DIE=399,DA=IBIFN,DR="24////"_STAT
D ^DIE
MRASTX ;
Q
;
ISITMRA(IBTDA) ; Function to return whether or not this transmission
; is a Medicare MRA or a normal EOB
NEW IEN,MRA,STOP,DATA
S (IEN,MRA,STOP)=0
F S IEN=$O(^IBA(364.2,IBTDA,2,IEN)) Q:'IEN D Q:STOP
. S DATA=$$EXT^IBCEMU1($G(^IBA(364.2,IBTDA,2,IEN,0))) Q:DATA=""
. I $P(DATA,U,1)'="835EOB" Q
. I $P(DATA,U,5)="Y" S MRA=1
. S STOP=1
. Q
ISMRAX ;
Q MRA
;
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HIBCESRV3 3849 printed Dec 13, 2024@02:12:27 Page 2
IBCESRV3 ;ALB/TMP - Server based Auto-update utilities - IB EDI ;03/05/96
+1 ;;2.0;INTEGRATED BILLING;**137,155,400**;21-MAR-94;Build 52
+2 ;;Per VHA Directive 2004-038, this routine should not be modified.
+3 ; IA 4129 for call to DUZ^XUP
+4 QUIT
+5 ;
EOB835 ; Explanation of Benefits - auto update
+1 ; Input expected: IBTDA = the ien of the message entry in file 364.2
+2 ;
+3 ; This is the background task that is queued to run by TaskManager.
+4 ; This procedure is called via indirection in TRTN^IBCESRV1 which is
+5 ; called by ADD^IBCESRV.
+6 ;
+7 NEW IB0,IBBDA,IBBILL,IBMSG,IBFLAG,IBTYP,IBBST,DR,DA,DIE,Z,MRAUSER
+8 ;
+9 if '$GET(IBTDA)
QUIT
+10 ; Batch ien
SET IB0=$GET(^IBA(364.2,IBTDA,0))
SET IBBDA=+$PIECE(IB0,U,4)
+11 ; IB message type
SET IBTYP=$PIECE($GET(^IBE(364.3,+$PIECE(IB0,U,2),0)),U)
+12 if IBTYP'="835EOB"
QUIT
+13 ;
+14 ; The MRA Project is using a specific non-human user for all
+15 ; 835 EOB/MRA filing processes. Change the DUZ to be this user.
+16 ; *** VA SACC approved this exemption 5-June-2003 ***
+17 ; *** Integration Agreement 4129 - Activated on 30-June-2003 ***
+18 ;
+19 SET MRAUSER=$$MRAUSR^IBCEMU1()
+20 IF MRAUSER>0
IF $$ISITMRA(IBTDA)
NEW DUZ
DO DUZ^XUP(MRAUSER)
+21 ;
+22 DO UPDEOB(IBTDA)
+23 ;
+24 QUIT
+25 ;
UPDEOB(IBTDA) ; Explanation of Benefits or MRA
+1 ; Update data base from msg (store EOB in file 361.1)
+2 ; IBTDA = ien of message in file 364.2
+3 ;
+4 NEW IBBILL,PRCASV,DA,DIE,DR,DA,X,Y,IBFLAG,IB0,IBS
+5 NEW IBEOB,IBAUTO,IBIFN,IBERRMSG
+6 ;
+7 ; updating data in 364.2
DO UPDMSG^IBCESRV2(IBTDA,"U",0)
+8 SET IB0=$GET(^IBA(364.2,IBTDA,0))
+9 ;
+10 ; no transmit bill# in file 364
IF '$PIECE(IB0,U,5)
GOTO UPDEOBX
+11 ; new entry in file 361.1
SET IBEOB=$$UPDEOB^IBCEOB(IBTDA)
+12 ; exit if some failure
IF 'IBEOB
GOTO UPDEOBX
+13 ;
+14 ; update transmission status of transmission Bill# in file 364
+15 ; status is closed (code "Z")
+16 ;Upd indiv transmitted bill
DO BILLSTAC^IBCESRV2($PIECE(IB0,U,5),"Z")
+17 ;
+18 ; Delete the entry from file 364.2
+19 DO DELMSG^IBCESRV2(IBTDA)
+20 ;
+21 ; If the EOB is not a Medicare MRA, then we can stop here
+22 IF $PIECE($GET(^IBM(361.1,IBEOB,0)),U,4)'=1
GOTO UPDEOBX
+23 ;
+24 ; *** Medicare MRA processing ***
+25 ;
+26 ; update the claim MRA status of the file 399 bill
+27 ; to be "C" - Valid MRA received
+28 DO MRASTAT(IBEOB,"C")
+29 ;
+30 ; Invoke the EOB criteria check and attempt to create and authorize
+31 ; the secondary bill
+32 SET IBAUTO=$$CRIT^IBCEMQC(IBEOB)
+33 IF 'IBAUTO
DO AUTOMSG(IBEOB,$PIECE(IBAUTO,U,2))
GOTO UPDEOBX
+34 ; bill# from file 364
SET IBIFN=$PIECE($GET(^IBA(364,+$PIECE(IB0,U,5),0)),U,1)
+35 ;
+36 ; Process COB, create secondary bill
+37 SET IBERRMSG=""
+38 DO AUTOCOB^IBCEMQA(IBIFN,IBEOB,.IBERRMSG)
+39 IF IBERRMSG'=""
DO AUTOMSG(IBEOB,IBERRMSG)
GOTO UPDEOBX
+40 ;
+41 ; Authorize the secondary bill
+42 DO AUTH^IBCEMQA(IBIFN,.IBERRMSG)
+43 IF IBERRMSG'=""
DO AUTOMSG(IBEOB,IBERRMSG)
GOTO UPDEOBX
+44 ;
UPDEOBX ;
+1 SET ZTREQ="@"
+2 QUIT
+3 ;
AUTOMSG(IBEOB,MSG) ; File the automatic bill generation failure message
+1 NEW DIE,DA,DR,D,D0,DI,DIC,DQ,X,Y
+2 SET IBEOB=+$GET(IBEOB)
SET MSG=$GET(MSG)
+3 IF '$DATA(^IBM(361.1,IBEOB))
GOTO AUMSGX
+4 IF MSG=""
GOTO AUMSGX
+5 SET DIE=361.1
SET DA=IBEOB
SET DR="30.01////"_MSG_";30.02////"_$$NOW^XLFDT
+6 DO ^DIE
AUMSGX ;
+1 QUIT
+2 ;
MRASTAT(IBEOB,STAT) ; Update the claim MRA status field on the bill
+1 ; File 399, Field 24 - CLAIM MRA STATUS
+2 NEW DIE,DA,DR,D,D0,DI,DIC,DIG,DIH,DIU,DIV,DQ,X,Y,IBIFN
+3 SET IBEOB=+$GET(IBEOB)
SET STAT=$GET(STAT)
+4 IF '$DATA(^IBM(361.1,IBEOB))
GOTO MRASTX
+5 IF STAT=""
GOTO MRASTX
+6 SET IBIFN=+$PIECE($GET(^IBM(361.1,IBEOB,0)),U,1)
+7 IF '$DATA(^DGCR(399,IBIFN,"TX"))
GOTO MRASTX
+8 ;
+9 SET DIE=399
SET DA=IBIFN
SET DR="24////"_STAT
+10 DO ^DIE
MRASTX ;
+1 QUIT
+2 ;
ISITMRA(IBTDA) ; Function to return whether or not this transmission
+1 ; is a Medicare MRA or a normal EOB
+2 NEW IEN,MRA,STOP,DATA
+3 SET (IEN,MRA,STOP)=0
+4 FOR
SET IEN=$ORDER(^IBA(364.2,IBTDA,2,IEN))
if 'IEN
QUIT
Begin DoDot:1
+5 SET DATA=$$EXT^IBCEMU1($GET(^IBA(364.2,IBTDA,2,IEN,0)))
if DATA=""
QUIT
+6 IF $PIECE(DATA,U,1)'="835EOB"
QUIT
+7 IF $PIECE(DATA,U,5)="Y"
SET MRA=1
+8 SET STOP=1
+9 QUIT
End DoDot:1
if STOP
QUIT
ISMRAX ;
+1 QUIT MRA
+2 ;
