Home   Package List   Routine Alphabetical List   Global Alphabetical List   FileMan Files List   FileMan Sub-Files List   Package Component Lists   Package-Namespace Mapping  
Routine: IBCNETST

IBCNETST.m

Go to the documentation of this file. 
  1. IBCNETST ;DAOU/ALA - eIV Gate-keeper test scenarios ; 11-OCT-2017
  1.  ;;2.0;INTEGRATED BILLING;**601,732,778**;21-MAR-94;Build 28
  1.  ;;Per VA Directive 6402, this routine should not be modified.
  1.  ;
  1.  ;**Program Description**
  1.  ;This program serves as a gate-keeper to protect FSC from receiving unexpected
  1.  ;transmissions from a test account via the electronic Insurance Verification
  1.  ;interface. Unexpected transmission have been known to take down their test
  1.  ;systems. DO NOT alter or remove this routine.
  1.  ;
  1.  ; IB*2*601/DM XMITOK() Gate-keeper routine moved from IBCNEUT7
  1.  ; IB*2*732/TZ added Test patients for auto-update with no group number
  1.  ; IB*2*732/CKB added Test patients for 'Blues'
  1.  ; IB*2*778/DJW changed acceptable SUBSCRIBER ID for 2 of the scenarios
  1.  ;
  1.  Q
  1.  ;
  1. XMITOK(TQIEN) ;EP
  1.  ; Checks if the site is a test site (not a production site) and if so
  1.  ; only allows transactions in the eIV queue that meet specific criteria
  1.  ; to be transmitted to FSC. Prevents invalid transmissions from a test
  1.  ; site to FSC which blocks the interface and need to be manually resolved
  1.  ; at FSC.
  1.  ; Input:   TQIEN   - IEN of the IIV Transmission Queue entry
  1.  ; Returns: 1       - Ok to add item to the eIV queue
  1.  ;          0       - Not ok to add item to the eIV queue
  1.  ;
  1.  N DFN,GOOD,GRPNUM,IBIEN,IBCNMPI,IENS,IVPIEN,MCARE,PATDOB,PATID,PATNM,PATSEX,PAYRNM,PIEN
  1.  N SUBID,SUBNM,TSITE,XX
  1.  ;
  1.  ; First check to see if the site is a test or a production site
  1.  S TSITE=$S($$PROD^XUPROD(1):0,1:1)
  1.  Q:'TSITE 1                                  ; Production site no checks done
  1.  ;Q 0 ;Don't send anything
  1.  ;
  1.  S MCARE=$$GET1^DIQ(350.9,"1,",51.25,"E")    ; Medicare Payer Name
  1.  ;S XX=$G(^IBCN(365.1,TQIEN,0))              ; IB*732 - invalid code
  1.  S (GRPNUM,PATID,SUBID,SUBNM)=""
  1.  S DFN=$$GET1^DIQ(365.1,TQIEN_",",.02,"I")   ; Patient IEN
  1.  S PATNM=$$GET1^DIQ(2,DFN_",",.01,"I")       ; Patient Name
  1.  S IBCNMPI=$$GET1^DIQ(2,DFN_",",991.01,"I")  ; Integration Control Number MPI
  1.  ; Quit if the Integration Control Number MPI is null - MUST be present
  1.  Q:IBCNMPI="" 0
  1.  ;
  1.  ; If the patient name contains "EICD" they are test scenario's for the "EICD" process.
  1.  I PATNM["EICD" Q 1
  1.  ;
  1.  S PIEN=$$GET1^DIQ(365.1,TQIEN_",",.03,"I")  ; Payer IEN
  1.  S IBIEN=$$GET1^DIQ(365.1,TQIEN_",",.13,"I") ; Insurance multiple number
  1.  ;
  1.  ; If the insurance multiple is not in the transmission queue, get the
  1.  ; following fields from the Insurance Verification Processor file
  1.  I IBIEN="" D
  1.  . S IVPIEN=$$GET1^DIQ(365.1,TQIEN_",",.05,"I") ; IVP file IEN
  1.  . S GRPNUM=$$GET1^DIQ(355.33,IVPIEN_",",90.02) ; Group Plan Number
  1.  . S PATID=$$GET1^DIQ(355.33,IVPIEN_",",62.01)  ; Group Plan Number
  1.  . S SUBID=$$GET1^DIQ(355.33,IVPIEN_",",90.03)  ; Subscriber ID
  1.  . S SUBNM=$$GET1^DIQ(355.33,IVPIEN_",",91.01)  ; Subscriber Name
  1.  E  D
  1.  . S IENS=IBIEN_","_DFN_","
  1.  . S XX=$$GET1^DIQ(2.312,IENS,.18,"I")       ; IEN of the Group Plan
  1.  . S GRPNUM=$$GET1^DIQ(355.3,XX_",",2.02)    ; Group Plan Number
  1.  . S PATID=$$GET1^DIQ(2.312,IENS,5.01)       ; Patient ID
  1.  . S SUBID=$$GET1^DIQ(2.312,IENS,1)          ; Subscriber ID
  1.  . S SUBNM=$$GET1^DIQ(2.312,IENS,7.01)       ; Subscriber NM
  1.  ;
  1.  I (SUBID="")!(SUBNM="") Q 0                 ; Key elements not defined
  1.  S XX=$$GET1^DIQ(2,DFN_",",.03,"I")          ; Internal Patient DOB
  1.  S PATDOB=$TR($$FMTE^XLFDT(XX,"7DZ"),"/","") ; YYYYMMDD format
  1.  S PATSEX=$$GET1^DIQ(2,DFN_",",.02,"I")      ; Patient Sex
  1.  S PATNM=$$GET1^DIQ(2,DFN_",",.01,"I")       ; Patient Name
  1.  S PAYRNM=$$GET1^DIQ(365.12,PIEN_",",.01)    ; Payer Name
  1.  S PAYRNM=$$UP^XLFSTR(PAYRNM)
  1.  S GOOD=0
  1.  ;
  1.  I PAYRNM="CMS MBI ONLY" G MBI ; this is an MBI test 
  1.  ;
  1.  I PAYRNM="AETNA",GRPNUM="GRP NUM 13805",SUBID="111111AE" D  Q:GOOD 1
  1.  . Q:SUBNM'="IBSUB,ACTIVE"
  1.  . Q:PATDOB'="19220202"
  1.  . Q:PATSEX'="M"
  1.  . S GOOD=1
  1.  ;
  1.  I PAYRNM="AETNA",GRPNUM="GRP NUM 13188",SUBID="111111FG" D  Q:GOOD 1
  1.  . Q:SUBNM'="IBSUB,INACTIVE"
  1.  . Q:PATDOB'="19480101"
  1.  . Q:PATSEX'="F"
  1.  . S GOOD=1
  1.  ;
  1.  ; IB*778/DJW SUBID below is more generic
  1.  I PAYRNM="CIGNA",GRPNUM="GRP NUM 5442",SUBID="87654321CI" D  Q:GOOD 1
  1.  . Q:SUBNM'="IBSUB,AAAERROR"
  1.  . Q:PATDOB'="19470211"
  1.  . Q:PATSEX'="M"
  1.  . S GOOD=1
  1.  ;
  1.  I PAYRNM="AETNA",GRPNUM="AET1234",SUBID="W1234561111" D  Q:GOOD 1
  1.  . Q:SUBNM'="IBINS,ACTIVE"                  ; Note this patient is male
  1.  . Q:PATID'="W123452222"
  1.  . Q:PATNM'="IBDEP,ACTIVE"
  1.  . Q:PATDOB'="19900304"
  1.  . Q:PATSEX'="F"                            ; Note this is subscriber's spouse
  1.  . S GOOD=1
  1.  ;
  1.  I MCARE'="",PAYRNM=MCARE,SUBID="333113333A",SUBNM="IB,PATIENT" D  Q:GOOD 1
  1.  . Q:PATDOB'="19350309"
  1.  . Q:PATSEX'="M"
  1.  . S GOOD=1
  1.  ;
  1.  I MCARE'="",PAYRNM=MCARE,SUBID="111223333A",SUBNM="IBSUB,TWOTRLRS" D  Q:GOOD 1
  1.  . Q:PATDOB'="19550505"
  1.  . Q:PATSEX'="M"
  1.  . S GOOD=1
  1.  ; 
  1.  ; Added for testing "Stop trigger of EIV Response", FSC's initial response
  1.  ; indicates no insurance identified therefore there are no policies to reverify
  1.  ; automatically.
  1.  I PAYRNM="AETNA",GRPNUM="GRP NUM 13805",SUBID="222222AE" D  Q:GOOD 1
  1.  . Q:SUBNM'="IBSUB,CANNOTFIND"
  1.  . Q:PATDOB'="19220707"
  1.  . Q:PATSEX'="M"
  1.  . S GOOD=1
  1.  ;
  1.  I PAYRNM="CIGNA",GRPNUM="GRP NUM 5442",SUBID="222222CI" D  Q:GOOD 1
  1.  . Q:SUBNM'="IBSUB,ACTIVE"
  1.  . Q:PATDOB'="19220202"
  1.  . Q:PATSEX'="M"
  1.  . S GOOD=1
  1.  ;
  1.  ; IB*2*732/TAZ - Added Non-medicare patient scenario for auto-update, no group number
  1.  I PAYRNM="CIGNA",GRPNUM="GRP NUM 5337",SUBID="555555NO" D  Q:GOOD 1
  1.  . Q:SUBNM'="IBSUB,NOGROUPNUM"
  1.  . Q:PATDOB'="19380311"
  1.  . Q:PATSEX'="M"
  1.  . S GOOD=1
  1.  ;
  1.  ; IB*2*732/TAZ - Added Medicare patient scenario for auto-update, no group number
  1.  ; IB*778/DJW SUBID below is more generic
  1.  I PAYRNM="CMS",GRPNUM="PART A",SUBID="12345678ME" D  Q:GOOD 1
  1.  . Q:SUBNM'="IB,MEDICARENOGRP"
  1.  . Q:PATDOB'="19381110"
  1.  . Q:PATSEX'="F"
  1.  . S GOOD=1
  1.  ;
  1.  ; IB*2*732/CKB - Added patient scenario for 'Blues' testing
  1.  I PAYRNM="BCBS OF COLORADO",GRPNUM="BLU1234",SUBID="COL98765" D  Q:GOOD 1
  1.  . Q:SUBNM'="IBSUB,BLUECROSS WGRP"
  1.  . Q:PATDOB'="19420826"
  1.  . Q:PATSEX'="M"
  1.  . S GOOD=1
  1.  ;
  1.  ; IB*2*732/CKB - Added patient scenario for 'Blues' testing
  1.  I PAYRNM="BCBS OF COLORADO",GRPNUM="BLU1234",SUBID="COL56789" D  Q:GOOD 1
  1.  . Q:SUBNM'="IBSUB,BLUECROSS WOGRP"
  1.  . Q:PATDOB'="19420101"
  1.  . Q:PATSEX'="M"
  1.  . S GOOD=1
  1.  Q 0
  1.  ;
  1. MBI ;
  1.  ; IB*2*601//DM - MBI testing scenarios
  1.  I PAYRNM="CMS MBI ONLY",SUBID="MBIrequest" D  Q:GOOD 1
  1.  . Q:SUBNM'="IB,MBIPATIENTONE"
  1.  . Q:PATDOB'="19380311"
  1.  . Q:PATSEX'="M"
  1.  . S GOOD=1
  1.  ;
  1.  I PAYRNM="CMS MBI ONLY",SUBID="MBIrequest" D  Q:GOOD 1
  1.  . Q:SUBNM'="IB,MBIPATIENTTWO"
  1.  . Q:PATDOB'="19381110"
  1.  . Q:PATSEX'="M"
  1.  . S GOOD=1
  1.  ;
  1.  I PAYRNM="CMS MBI ONLY",SUBID="MBIrequest" D  Q:GOOD 1
  1.  . Q:SUBNM'="IB,MBIPATIENTTHREE"
  1.  . Q:PATDOB'="19470530"
  1.  . Q:PATSEX'="M"
  1.  . S GOOD=1
  1.  ;
  1.  I PAYRNM="CMS MBI ONLY",SUBID="MBIrequest" D  Q:GOOD 1
  1.  . Q:SUBNM'="IB,MBIPATIENTFOUR"
  1.  . Q:PATDOB'="19500130"
  1.  . Q:PATSEX'="M"
  1.  . S GOOD=1
  1.  ;
  1.  I PAYRNM="CMS MBI ONLY",SUBID="MBIrequest" D  Q:GOOD 1
  1.  . Q:SUBNM'="IB,MBIPATIENTFIVE"
  1.  . Q:PATDOB'="19500827"
  1.  . Q:PATSEX'="M"
  1.  . S GOOD=1
  1.  ;
  1.  I PAYRNM="CMS MBI ONLY",SUBID="MBIrequest" D  Q:GOOD 1
  1.  . Q:SUBNM'="IB,MBIPATIENTSIX"
  1.  . Q:PATDOB'="19471022"
  1.  . Q:PATSEX'="M"
  1.  . S GOOD=1
  1.  ;
  1.  I PAYRNM="CMS MBI ONLY",SUBID="MBIrequest" D  Q:GOOD 1
  1.  . Q:SUBNM'="IB,MBIPATIENTSEVEN"
  1.  . Q:PATDOB'="19490603"
  1.  . Q:PATSEX'="M"
  1.  . S GOOD=1
  1.  ;
  1.  I PAYRNM="CMS MBI ONLY",SUBID="MBIrequest" D  Q:GOOD 1
  1.  . Q:SUBNM'="IB,MBIPATIENTEIGHT"
  1.  . Q:PATDOB'="19470921"
  1.  . Q:PATSEX'="M"
  1.  . S GOOD=1
  1.  ;
  1.  I PAYRNM="CMS MBI ONLY",SUBID="MBIrequest" D  Q:GOOD 1
  1.  . Q:SUBNM'="IB,MBIPATIENTNINE"
  1.  . Q:PATDOB'="19430301"
  1.  . Q:PATSEX'="M"
  1.  . S GOOD=1
  1.  ;
  1.  I PAYRNM="CMS MBI ONLY",SUBID="MBIrequest" D  Q:GOOD 1
  1.  . Q:SUBNM'="IB,MBIPATIENTTEN"
  1.  . Q:PATDOB'="19580129"
  1.  . Q:PATSEX'="M"
  1.  . S GOOD=1
  1.  ;
  1.  Q 0