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Routine: IBCNEHL3

IBCNEHL3.m

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IBCNEHL3 ;DAOU/ALA - HL7 Process Incoming RPI Continued ;03-JUL-2002  ; Compiled June 2, 2005 14:20:19

 ;;2.0;INTEGRATED BILLING;**300,416,497,506,595,621,602,737**;21-MAR-94;Build 19

 ;;Per VA Directive 6402, this routine should not be modified.

 ;

 ;**Program Description**

 ;  This is a continuation of IBCNEHL1 which processes an incoming

 ;  RPI IIV message.

 ;  

 ;  This routine is based on IBCNEHLS which was introduced with patch 184, and subsequently

 ;  patched with patch 271.  IBCNEHLS is obsolete and deleted with patch 300.

 ;

 ;

 Q   ; no direct calls allow

 ;

ERROR(TQN,ERACT,ERCON,TRCN) ; Entry point

 ; Input:  TQN - IEN for eIV Transmission Queue (#365.1), required

 ;         ERACT - Error Action Code (#365.14), required

 ;         ERCON - Error Condition Code (#365.17), required

 ;         TRCN - Trace # from eIV Response (#365)

 ;

 ;         IIVSTAT - IIV status transmitted by EC

 ;                   Note: MAP(IIVSTAT) = IIV STATUS IEN

 N MSG,ERDESC,ERIEN,XMY,DA,DIE,DR

 ;

 I $G(TQN)="" G ERRORX

 ;

 ;/Removed the following lines of code as part of IB*2.0*506 but wanted to

 ;/leave this code available if it should be needed in the future.

 ; Scenarios:

 ; #1 - If error message = "Resubmission Allowed" OR "Please Resubmit

 ; Original Transaction" - set TQ

 ; Fut Trans Dt to T + Comm Failure Days and Status to "Hold"

 ;I ERACT="R"!(ERACT="P") D G ERRORX

 ;. I $P($G(^IBCN(365.1,TQN,0)),U,9)="" D Q ; first time payer asked us to resubmit

 ;. . ; Update IIV TQ fields: "Hold" (4), IIV Site Param Comm Failure Days

 ;. . D UPDATE(TQN,4,+$P($G(^IBE(350.9,1,51)),U,5),ERACT)

 ;. . ;

 ;. ; payer asked us to resubmit for the 2nd time for this inquiry

 ;. ; Update IIV TQ fields: "Response Received" (3), n/a ("")

 ;. D UPDATE(TQN,3,"",ERACT,ERCON)

 ;. ; clear future transmission date so it won't display in the buffer

 ;. S DA=TQN,DIE="^IBCN(365.1,",DR=".09///@" D ^DIE

 ;

 ; #2 - If error message = "Please Wait 30 Days and Resubmit" - set TQ

 ; Fut Trans Dt to T + 30 and Status to "Hold"

 ;I ERACT="W" D G ERRORX

 ;. ; Update IIV TQ fields: "Hold" (4), 30

 ;. D UPDATE(TQN,4,30,ERACT)

 ;

 ; #3 - If error message = "Please Wait 10 Days and Resubmit" - set TQ

 ; Fut Trans Dt to T + 10 and Status to "Hold"

 ;I ERACT="X" D G ERRORX

 ;. ; Update IIV TQ fields: "Hold" (4), 10

 ;. D UPDATE(TQN,4,10,ERACT)

 ;

 ; #4 - If error message = "Resubmission Not Allowed" or

 ; "Do not resubmit ...." OR "Please correct and resubmit"

 ; - set TQ Status to "Response Received"

 ; If we receive error txt, treat as an "N"

 ;I ERACT="" S ERACT="N"

 ;I ERACT="N"!(ERACT="Y")!(ERACT="S")!(ERACT="C") D G ERRORX

 ;. ; Update IIV TQ fields: "Response Received" (3), n/a ("")

 ;. D UPDATE(TQN,3,"",ERACT,ERCON)

 ;

 ; #5 - Error message is unfamiliar - new Error Action Code

 ; *** Currently processed in IBCNEHL1 ***

 ;/End of removed code for IB*2.0*506

 ;

 ; /IB*2.0*506 Beginning

 ; For all Scenarios 1 thru 5, set TQ Status to "Response Received"

 I ERACT="" S ERACT="N"

 I ",R,P,W,X,N,Y,S,C,"[(","_ERACT_",") D  G ERRORX

 . ; Update IIV TQ fields: "Response Received" (3), n/a ("")

 . D UPDATE(TQN,3,"",ERACT,ERCON)

 ; /IB*2.0*506 End

 ;

ERRORX ; ERROR exit pt

 Q

 ;

UPDATE(TQN,TSTS,TDAYS,ERACT,ERCON) ;  Update Transmission Queue (#365.1)

 ; Update/Create Buffer information as necessary

 ; * If unsolicited error or negative Verification response do not

 ; update TQ entry.  However, create a new Buffer entry.

 ; Input Variables

 ; ERACT,ERCON,IIVSTAT,TDAYS,TQN,TSTS

 ;

 ; Output Variables

 ; IIVSTAT (updated)

 ;

 ; Init optional param

 S ERCON=$G(ERCON)

 ;

 ; Init vars

 N D,D0,DA,DFN,DI,DIC,DIE,DQ,DR,FTDT,IBDATA,IBIEN,IBQFL,IBSTS,IBSYM

 N INSIEN,RSTYPE,SYMBOL,TQDATA,X

 ;

 ; If no ZEB segment received, set IIVSTAT to "V"

 I $TR(IIVSTAT," ")="" S IIVSTAT="V"

 ;

 S TQDATA=$G(^IBCN(365.1,TQN,0))

 I TQDATA="" G UPDATX

 ;

 ; Ins Buffer IEN

 S IBIEN=$P(TQDATA,U,5)

 S IBQFL=$P(TQDATA,U,11)

 S RSTYPE=$P($G(^IBCN(365,RIEN,0)),U,10)

 ;

 ; If unsolicited error or negative Identification response DON'T

 ; update TQ entry or Buffer (includes not creating a new buffer)

 I RSTYPE="U",(IBQFL="I") G UPDATX

 ;

 I RSTYPE="U" S IBIEN=""  ; makes sure a new buffer is created

 ;

 ; Ins Buffer processing

 I IBIEN'="" D

 . ; Ins Buf data

 . S IBDATA=$G(^IBA(355.33,+IBIEN,0))

 . S IBSTS=$P(IBDATA,U,4)   ; Status

 . S IBSYM=$P(IBDATA,U,12)  ; Symbol

 . ; If IB status is (A)ccepted or (R)ejected or IB symbol is "*"

 . ;  (verified) or IB symbol is "-" (denied), update TQ status to

 . ;  Resp Rec'd (3) and DON'T update the Ins Buffer symbol

 . I IBSTS="A"!(IBSTS="R")!(IBSYM=8)!(IBSYM=9) S TSTS=3 Q

 . ; If TQ status is "Hold", update buffer symbol to "?" (10)

 . I TSTS=4 D BUFF^IBCNEUT2(IBIEN,10) Q  ; Set buffer symbol to "?"

 . ; If TQ status is "Response Received", update buffer symbol to "-" (9) for Error

 . ; Action Codes ('N','Y','S') & Action Codes ('P','R', if 2nd time payer sent that code)

 . I TSTS=3,(ERACT="N"!(ERACT="Y")!(ERACT="S")!(ERACT="C")!(ERACT="P")!(ERACT="R")) D  Q

 .. S SYMBOL=MAP(IIVSTAT)

 .. D BUFF^IBCNEUT2(IBIEN,SYMBOL) ; Set buffer symbol to EC value

 .. D IIVPROC(IBIEN)   ; Set IIV process date & IIV status

 . ; If TQ status is "Response Received", update buffer symbol to "!" (12 = B9) for new Error Action Code

 . I TSTS=3,",W,X,R,P,C,N,Y,S,"'[(","_ERACT_",") D BUFF^IBCNEUT2(IBIEN,22) Q

 ;

 ; Non-Ins Buffer processing, create entry only for Verification queries

 I IBIEN="",IBQFL="V" D

 . ; Determine Patient DFN

 . S DFN=$P(TQDATA,U,2)

 . ; Determine Patient Ins record IEN

 . S INSIEN=$P(TQDATA,U,13)  ; If INSIEN="" avoids TQ update

 . ; If ERACT="C" symbol is passed by EC

 . I ERACT="C" S SYMBOL=MAP(IIVSTAT) D BUF Q

 . ;  Resubmission Not Allowed or Do Not Resubmit ...

 . I ERACT="N"!(ERACT="Y")!(ERACT="S") S SYMBOL=MAP(IIVSTAT) D BUF Q

 . ; An unknown error action - generate a '#'

 . I ",W,X,R,P,C,N,Y,S,"'[(","_ERACT_",") S SYMBOL=22 D BUF Q

 ;

 I RSTYPE="U" G UPDATX  ; finished creating new buffer

 ;

 ; Update TQ record - Status

 D SST^IBCNEUT2(TQN,TSTS)

 ;

 ; If TQ Status = "Hold", update TQ record - Future Transmission Date

 I TSTS=4,+$G(TDAYS) D

 . S FTDT=$$FMADD^XLFDT($$DT^XLFDT,TDAYS)

 . S DIE="^IBCN(365.1,",DA=TQN,DR=".09///^S X=FTDT"

 . D ^DIE

 I TSTS=4,$P(TQDATA,U,8) D

 . S DIE="^IBCN(365.1,",DA=TQN,DR=".08///0"

 . D ^DIE

 ;

UPDATX ; UPDATE exit point

 Q

 ;

PCK ; Payer Check

 ;  Find the associated Response IEN

 ;

 ; Input Variables

 ; MSGID

 ;

 ; Output Variables

 ; RIEN,ERFLG

 ;

 ;IB*737/TAZ - Remove references to Most Popular Payer and "~NO PAYER"

 ;

 N BUFF,DA,DFN,DIE,DR,IEN,IERN,IN1DATA,MDTM,QFL,PAYR,PIEN,PP

 N PRDATA,PRIEN,RSIEN,X

 N TQIEN

 ;

 K ^TMP("IBCNEMID",$J)

 D FIND^DIC(365,"","","P",MSGID,"","B","","","^TMP(""IBCNEMID"",$J)")

 ;

 S PP=0,QFL=0,(RIEN,PIEN)=""

 S TQIEN=$O(^IBCN(365.1,"C",MSGID,""))

 F  S PP=$O(^TMP("IBCNEMID",$J,"DILIST",PP)) Q:'PP  D  Q:QFL

 . S PRIEN=$P(^TMP("IBCNEMID",$J,"DILIST",PP,0),U,1)

 . ;

 . ;  If this is a response w/o an IN1 segment

 . ;  Get payer IEN from TQ as original response shell will change

 . ;  if a payer response is received

 . S IN1DATA=$S(EVENTYP=1:"",1:$$GIN1()) ; IB*2.0*621

 . I IN1DATA="",PRIEN'="",TQIEN'="" D

 ..  S QFL=1,PIEN=$P(^IBCN(365.1,TQIEN,0),U,3)

 . ;

 . I 'PIEN D PFN(IN1DATA) I 'PIEN S QFL=1 Q

 . ;

 . ; If message id/payer found & Response (#365) status is NOT

 . ; 'Response Received' update the existing response entry (set RIEN)

 . I $P(^IBCN(365,PRIEN,0),U,3)=PIEN,($P(^IBCN(365,PRIEN,0),U,6)'=3) D  Q

 .. S RIEN=PRIEN,QFL=1

 ..;

 ..; If message id/payer found & Response (#365) status equals

 . ; 'Response Received', RIEN is still null so that this tag knows

 . ; to create a new unsolicited response entry

 ;

 ;  If message id/payer not found or unsolicited response, create new response entry

 I RIEN="" D  Q:ERFLG

 . I $G(PRIEN)'="" D

 .. S PRDATA=$G(^IBCN(365,PRIEN,0))

 .. S DFN=$P(PRDATA,U,2),IEN=$P(PRDATA,U,5),MDTM=$P(PRDATA,U,8)

 . ;

 . I PIEN="" D  Q:ERFLG

 ..  S IN1DATA=$$GIN1()

 ..  I IN1DATA]"" D PFN(IN1DATA) I 'PIEN S PIEN="",QFL=1

 . S PAYR=PIEN,(RSTYPE,BUFF)=""

 . ;I MDTM="" S MDTM=$$NOW^XLFDT

 . D RESP^IBCNEDEQ

 . S RIEN=RSIEN

 ;

 ; If no payer in response file, set it

 ; IB*2*595/DM correctly identify a payer when the payer name begins with numbers 

 I $G(PIEN)'="",$G(RIEN)'="",$P($G(^IBCN(365,RIEN,0)),U,3)="" D

 . S DIE="^IBCN(365,",DA=RIEN,DR=".03////^S X=PIEN" D ^DIE ;stuff internal value for payer

 Q

 ;

BUF ; Create Buffer Record if Doesn't Exist

 ;

 ; Input Variables

 ; RIEN,RSTYPE,TQN

 ;

 ; Output Variables

 ; ERROR,SYMBOL is killed,TQIEN and IRIEN may be reset

 ;

 N BUFF,IBFDA,UP

 I $G(RSTYPE)="U" S (TQIEN,IRIEN)=""

 D RP^IBCNEBF(RIEN,1)

 S BUFF=+IBFDA

 S UP(365,RIEN_",",.04)=+IBFDA

 I RSTYPE="O" S UP(365.1,TQN_",",.05)=+IBFDA

 D FILE^DIE("I","UP","ERROR")

 K SYMBOL

 Q

 ;

IIVPROC(BUFF) ; Set IIV Processed Date to current dt/tm & IIV stat (aka SYMBOL)

 ; Input Variables

 ; BUFF

 ;

 ; Output Variables

 ; SYMBOL

 ;

 N IDUZ,UP

 S UP(355.33,BUFF_",",.15)=$$NOW^XLFDT()

 ;  Set IDUZ to the specific, non-human user.

 S IDUZ=$$FIND1^DIC(200,"","X","INTERFACE,IB EIV")

 D FILE^DIE("I","UP","ERROR")

 ; set the symbol of the buffer entry

 D BUFF^IBCNEUT2(BUFF,SYMBOL)  ; reset symbol to appropriate value

 Q

 ;

PFN(IN1DATA) ;  Find Payer from HL7 msg

 ;

 ; Input Variables

 ; IN1DATA, TRACE

 ;

 ; Output Variables

 ; ERFLG,ERROR,PIEN

 ;

 N IERN,PAYRID

 S PAYRID=$$CLNSTR^IBCNEHLU($P($P(IN1DATA,HLFS,4),$E(HL("ECH"))),HL("ECH"),$E(HL("ECH")))

 S PIEN=+$$FIND1^DIC(365.12,"","MX",PAYRID)

 I PIEN=0 D  Q

 . S ERFLG=1,IERN=$$ERRN^IBCNEUT7("ERROR(""DIERR"")")

 . S ERROR("DIERR",IERN,"TEXT",1)="National Id: "_PAYRID_" not found in Payer Table"

 . S ERROR("DIERR",IERN,"TEXT",2)="for Trace Number: "_TRACE

 Q

 ;

GIN1() ;Get IN1 segment

 ;

 ; Input Variables

 ; HCT

 ;

 ; Returns value of SEGMT

 ;

 N IPCT,SEGMT

 S IPCT=HCT,SEGMT=""

 F  S IPCT=$O(^TMP($J,"IBCNEHLI",IPCT)) Q:IPCT=""  D

 . I $E(^TMP($J,"IBCNEHLI",IPCT,0),1,3)="IN1" S SEGMT=^TMP($J,"IBCNEHLI",IPCT,0)

 Q SEGMT

 ;

 ; =================================================================

WARN ;  Create and send a response processing error warning message

 ;

 ; Input Variables

 ; ERROR, TRACE

 ;

 ; Output Variables

 ; ERFLG=1

 ;

 N MCT,MSG,SUBCNT,VEN,XMY

 S VEN=0,MCT=9,ERFLG=1,SUBCNT=""

 S MSG(1)="IMPORTANT: Error While Processing Response Message from the EC"

 S MSG(2)="-------------------------------------------------------------"

 S MSG(3)="*** IRM *** Please contact Help Desk because the"

 S MSG(4)="response message received from the Eligibility Communicator"

 S MSG(5)="could not be processed.  Programming changes may be necessary"

 S MSG(6)="to properly handle the response."

 S MSG(7)="The associated Trace # is "_$S($G(TRACE)="":"Unknown",1:TRACE)_". If applicable,"

 S MSG(8)="please review the response with the eIV Response Report by Trace#."

 S MSG(9)=" "

 F  S VEN=$O(ERROR("DIERR",VEN)) Q:'VEN  D

 .S MCT=MCT+1,MSG(MCT)="Error:"

 .F  S SUBCNT=$O(ERROR("DIERR",VEN,"TEXT",SUBCNT)) Q:'SUBCNT  S MCT=MCT+1,MSG(MCT)=ERROR("DIERR",VEN,"TEXT",SUBCNT)

 .S MCT=MCT+1,MSG(MCT)=" "

 .I $G(ERROR("DIERR",VEN,"PARAM","FILE"))'="" S MCT=MCT+1,MSG(MCT)="File: "_ERROR("DIERR",VEN,"PARAM","FILE")

 .I $G(ERROR("DIERR",VEN,"PARAM","IENS"))'="" S MCT=MCT+1,MSG(MCT)="IENS: "_ERROR("DIERR",VEN,"PARAM","IENS")

 .I $G(ERROR("DIERR",VEN,"PARAM","FIELD"))'="" S MCT=MCT+1,MSG(MCT)="Field: "_ERROR("DIERR",VEN,"PARAM","FIELD")

 .S MCT=MCT+1,MSG(MCT)=" "

 .Q

 D MSG^IBCNEUT5(MGRP,MSG(1),"MSG(",,.XMY)

 Q

 ;

 ; =================================================================

UEACT ; Send warning msg if Unknown Error Action Code was received or

 ; encountered problem filing date

 ;

 ; Input Variables

 ; ERROR, IBIEN, IBQFL, RIEN, RSTYPE, TQDATA, TRACE

 ;

 ; Output Variables

 ; ERFLG=1 (SET IN WARN TAG)

 ;

 N DFN,SYMBOL

 D WARN  ; send warning msg

 ;

 ; If the response could not be created or there is no associated TQ entry, stop processing

 I '$G(RIEN)!(TQDATA="") Q

 ;

 ;  For an original response, set the Transmission Queue Status to 'Response Received' &

 ;  update remaining retries to comm failure (5)

 I $G(RSTYPE)="O" D SST^IBCNEUT2(TQN,3),RSTA^IBCNEUT7(TQN)

 ;

 ; If it is an identification and policy is not active don't

 ; create buffer entry

 I IBQFL="I",IIVSTAT'=1 Q

 ;

 ; If unsolicited message or no buffer in TQ, create new buffer entry

 I RSTYPE="U" S IBIEN=""

 I IBIEN="" D  Q

 .  S DFN=$P(TQDATA,U,2)        ; Determine Patient DFN

 .  S SYMBOL=22 D BUF^IBCNEHL3  ; Create a new buffer entry

 ;

 ;Update buffer symbol

 D BUFF^IBCNEUT2(IBIEN,22)

 ;

 Q

 ;

CHK1() ; check auto-update criteria for patient who is the subscriber

 ; called from tag AUTOUPD, uses variables defined there

 ;

 ; returns 1 if given policy satisfies auto-update criteria, returns 0 otherwise

 N RES

 S RES=0

 I $P(RDATA13,U,2)'=$P(IDATA7,U,2) G CHK1X  ; Subscriber ID doesn't match   ; IB*2.0*497 compare subscriber ID data at their new locations

 I $P(RDATA1,U,2)'=$P(IDATA3,U) G CHK1X  ; DOB doesn't match

 I '$$NAMECMP^IBCNEHLU($P(RDATA13,U),$P(IDATA7,U)) G CHK1X  ; Insured's name doesn't match  ; IB*2.0*497 compare name of insured data at their new locations

 S RES=1

CHK1X ;

 Q RES

 ;

CHK2(MWNRTYP) ; check auto-update criteria for patient who is not the subscriber

 ; called from tag AUTOUPD, uses variables defined there

 ;

 ; returns 1 if policy satisfies auto-update criteria, returns 0 otherwise

 N DOB,ID,IDATA5,IENS,NAME,PDOB,PNAME,RES

 S RES=0

 S IDATA5=$G(^DPT(IEN2,.312,IEN312,5))

 S IENS=IEN2_","

 S ID=$P(RDATA13,U,2)    ; IB*2.0*497 Subscriber ID needs to be retrieved from its new location

 I ID'=$P(IDATA7,U,2),ID'=$P(IDATA5,U) G CHK2X  ; both Subscriber ID and Patient ID don't match ; IB*2.0*497 compare subscriber ID at new locations

 S DOB=$P(RDATA1,U,2),PDOB=$$GET1^DIQ(2,IENS,.03,"I")

 I DOB'=$P(IDATA3,U),DOB'=PDOB G CHK2X  ; both Subscriber and Patient DOB don't match

 S NAME=$P(RDATA13,U),PNAME=$$GET1^DIQ(2,IENS,.01)   ; IB*2.0*497 get name of insured at its new location

 I '+MWNRTYP,'$$NAMECMP^IBCNEHLU(NAME,$P(IDATA7,U)),'$$NAMECMP^IBCNEHLU(NAME,PNAME) G CHK2X  ; non-Medicare, both Subscriber and Patient name don't match ; IB*2*497

 I +MWNRTYP,'$$NAMECMP^IBCNEHLU(NAME,PNAME) G CHK2X  ; Medicare, Patient name doesn't match

 S RES=1

CHK2X ;

 Q RES

 ;

UPDIREC(RIEN,IEN312) ; IB*2*595/DM update INSUR RECORD IEN in the response file (#365,.12) 

 ; RIEN - ien in eIV Response file (365)

 ; IEN312 - ien in pat. insurance multiple (2.312)

 ;

 N DATA,ERROR,IENS

 I RIEN'>0!(IEN312'>0) Q

 ; IB*2*595/DM do not update TQ file. 

 ; The proper INSUR RECORD IEN field is now located in the response file 

 ;S IENS=$P($G(^IBCN(365,RIEN,0)),U,5)_"," I IENS="," Q

 ;S DATA(365.1,IENS,.13)=IEN312

 S DATA(365,RIEN_",",.12)=IEN312

 D FILE^DIE("ET","DATA","ERROR")

 Q

 ;

LCKERR ; send locking error message

 N MSG,XMY

 S MSG(1)="WARNING: Unable to Auto-file Response Message from the EC"

 S MSG(2)="---------------------------------------------------------"

 S MSG(3)="Failed to lock patient insurance entry:"

 S MSG(4)="  Patient name - "_$$GET1^DIQ(2,DFN_",",.01)

 S MSG(5)="  Insurance - "_$$GET1^DIQ(2.312,IENS,.01)

 S MSG(6)="  IENS - "_$S($G(IENS)="":"Unknown",1:IENS)

 S MSG(7)=" "

 S MSG(8)="The response will be filed into Insurance Buffer instead."

 S MSG(9)=" "

 D MSG^IBCNEUT5(MGRP,MSG(1),"MSG(",,.XMY)

 Q

 ;