Routine: IBCNEHLU

Name	Comments	DBIA/ICR reference
HLP(PROTOCOL)	; Find the Protocol IEN
NAME(NM)	; Convert a name that isn't in standard VISTA format -
DODCK(DFN,DOD,MGRP,NAME,RIEN,SSN)	; Date of death check
DODCKX
SPAR
LP
CLNSTR(STRING,CHARS,SUBSEP)
RTRIMCH(STR,CHRS)	; Remove the trailing chars from string
GTICNM(ICN,NAME)	; Retrieve PID segment and set ICN and patient name
PATISSUB(IDATA0)	; check if patient is the subscriber ; IDATA0 - 0 node of file 2.312
ONEPOL(PIEN,IEN2)	; check if patient has only one policy on file for a given payer ; PIEN - payer ien ; IEN2 - patient ien (file 2)
MCRDT(RIEN,EBIEN)	; find effective date for Medicare response ; RIEN - file 365 ien ; EBIEN - subfile 365.02 ien
ISMCR(RIEN)	; Check if response is for Medicare part A/B ; Input: RIEN - Internal ien for file 365 ; Returns A1^A2^A3^A4^A5 Where: ; A1 - 1 if response if for Medicare, 0 otherwise ; A2 - "MA" if response is for Medicare Part A ; "MB" if response is for Medicare Part B ; "B" if response is for both Part A and Part B ; "" if response if not for Medicare ; A3 - Effective date for Medicare Part A if response if for ; Part A or both parts, "" otherwise ; A4 - Effective date for Medicare Part B if response if for ; Part B or both parts, "" otherwise ; A5 - "MA" - Response is for active Medicare Part A only ; "MB" - Response is for active Medicare Part B only ; "B" - Response is for active Medicare Parts A and B ; "" - Response is not for active Medicare ; IB2.0549 - added return of A5
ERRACT(RIEN)	; Pick error action code to use for re-transmission ; Input: RIEN - IEN in file 365 (Transmission file) ; Returns: Error action^Error condition; "" if no error found
ERRACTX
NAMECMP(NAME1,NAME2)	; check if 2 names have the same first name and last name components ; NAME1, NAME2 - names to compare, should be in "last,first [middle]" format
TRNCWARN(GNUM,TRACE)	; send group number truncation warning message
CODECHK(RSUPDT)	; IB2497 ; need to determine if codes and qualifiers sent in the 271 HL7 message ; are new. If code/qualifier does not exist in table then file new code into table ; input - ; RSUPDT = FDA array that will be passed to the DBS filer to update the ; entry/subentry into the IIV RESPONSE file ; example: RSUPDT(365.02,IENS,".02") = data to be filed into 365.02 subfile at field .02 ; order through the RSUPDT array and determine if pointer to file ; if pointer to file then pass file name and value of code/qualifier
PREL(FILE,FIELD,CODE)	; IB2497 code from x12 271 message may need to be converted to 'other' if there is no match. Refer to tag SETLST
SETLST	; SET OF CODES defined to 355.33,60.14 and 2.312,4.03; this tag is not referenced in any procedure. It's here for documentation purposes.

Name

Comments

DBIA/ICR reference

HLP(PROTOCOL)

; Find the Protocol IEN

NAME(NM)

; Convert a name that isn't in standard VISTA format -

DODCK(DFN,DOD,MGRP,NAME,RIEN,SSN)

; Date of death check

DODCKX

SPAR

LP

CLNSTR(STRING,CHARS,SUBSEP)

RTRIMCH(STR,CHRS)

; Remove the trailing chars from string

GTICNM(ICN,NAME)

; Retrieve PID segment and set ICN and patient name

PATISSUB(IDATA0)

; check if patient is the subscriber
; IDATA0 - 0 node of file 2.312

ONEPOL(PIEN,IEN2)

; check if patient has only one policy on file for a given payer
; PIEN - payer ien
; IEN2 - patient ien (file 2)

MCRDT(RIEN,EBIEN)

; find effective date for Medicare response
; RIEN - file 365 ien
; EBIEN - subfile 365.02 ien

ISMCR(RIEN)

; Check if response is for Medicare part A/B
; Input: RIEN - Internal ien for file 365
; Returns A1^A2^A3^A4^A5 Where:
; A1 - 1 if response if for Medicare, 0 otherwise
; A2 - "MA" if response is for Medicare Part A
; "MB" if response is for Medicare Part B
; "B" if response is for both Part A and Part B
; "" if response if not for Medicare
; A3 - Effective date for Medicare Part A if response if for
; Part A or both parts, "" otherwise
; A4 - Effective date for Medicare Part B if response if for
; Part B or both parts, "" otherwise
; A5 - "MA" - Response is for active Medicare Part A only
; "MB" - Response is for active Medicare Part B only
; "B" - Response is for active Medicare Parts A and B
; "" - Response is not for active Medicare
; IB*2.0*549 - added return of A5

ERRACT(RIEN)

; Pick error action code to use for re-transmission
; Input: RIEN - IEN in file 365 (Transmission file)
; Returns: Error action^Error condition; "" if no error found

ERRACTX

NAMECMP(NAME1,NAME2)

; check if 2 names have the same first name and last name components
; NAME1, NAME2 - names to compare, should be in "last,first [middle]" format

TRNCWARN(GNUM,TRACE)

; send group number truncation warning message

CODECHK(RSUPDT)

; IB*2*497
; need to determine if codes and qualifiers sent in the 271 HL7 message
; are new. If code/qualifier does not exist in table then file new code into table
; input -
; RSUPDT = FDA array that will be passed to the DBS filer to update the
; entry/subentry into the IIV RESPONSE file
; example: RSUPDT(365.02,IENS,".02") = data to be filed into 365.02 subfile at field .02
; order through the RSUPDT array and determine if pointer to file
; if pointer to file then pass file name and value of code/qualifier

PREL(FILE,FIELD,CODE)

; IB*2*497 code from x12 271 message may need to be converted to 'other' if there is no match. Refer to tag SETLST

SETLST

; SET OF CODES defined to 355.33,60.14 and 2.312,4.03; this tag is not referenced in any procedure. It's here for documentation purposes.

FileNo	Call Tags
2.312	GET1^DIQ
^IBE(350.9 - [#350.9]	GET1^DIQ
^IBCN(365 - [#365]	GET1^DIQ
365.02	GET1^DIQ
365.28	GET1^DIQ

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Package: Integrated Billing

Routine: IBCNEHLU

Information

Source Information

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Interaction Calls

FileMan Files Accessed Via FileMan Db Call