IBCNS2 ;ALB/AAS - INSURANCE POLICY CALLS FROM FILE 399 DD ;22-JULY-91
;;2.0;INTEGRATED BILLING;**28,43,80,51,137,155,488,516**;21-MAR-94;Build 123
;;Per VA Directive 6402, this routine should not be modified.
;
Q
DD(IBX,IBDA,LEVEL) ; - called from input transform for field 111,112,113
; -- input ibx = x from input transform
; ibda = internal entry in 399
; level = 1=primary, 2=secondary, 3=tertiary
; -- output returns x=internal entry in 2.3121 (ins. Mult.) if valid
;
N DFN,ACTIVE,INSDT
D VAR
S X=$$SEL(IBX,DFN,INSDT,ACTIVE)
I +X<1 K X
DDQ Q
;
VAR S DFN=$P(^DGCR(399,IBDA,0),"^",2),ACTIVE=1,INSDT=$S(+$G(^DGCR(399,IBDA,"U")):+$G(^("U")),1:DT)
Q
;
SEL(IBX,DFN,INSDT,ACTIVE) ; -- Select insurance policy
; -- Input IBX = x from input transform
; DFN = patient
; INSDT = (optional) Active date of ins. (default = dt)
; ACTIVE = (optional) 1 if want active (default)
; = 2 if want all ins returned
;
; -- Output = pointer to 36 ^ pointer to 2.3121 ^ pointer to 355.3
;
N I,J,Y,DA,DE,DQ,DR,DIC,DIE,DIR,DIV,IBSEL,IBDD,IBD
S IBSEL=1,Y=""
I '$G(ACTIVE) S ACTIVE=1
S:'$G(INSDT) INSDT=DT
I '$G(DFN) G SELQ
D BLD
;
; -- call DIC to choose from list
;WCJ*IB*2.0*488;Display COB on picklist when partial match on more than one entry
;everything else should continue to work as before
N IBOUT,IBSEL2
S IBX=$$UP^XLFSTR(IBX)
I IBX?1A.E D S IBX=$S($G(IBOUT):"^",$G(IBSEL2):IBSEL2,1:IBX)
. N X,Y,ERROR,TARGET,I,G
. ;IB*2.0*516/TAZ - Use HIPAA compliant fields
. ;D LIST^DIC(2.312,","_DFN_",",".01;.2;3;8;1;16;.18;21",,9999,,IBX,,"I $D(IBDD(+Y))",,"TARGET","ERROR")
. D LIST^DIC(2.312,","_DFN_",",".01;.2;3;8;7.02;16;.18;21",,9999,,IBX,,"I $D(IBDD(+Y))",,"TARGET","ERROR") ;516 - baa : add 7.02
. I $D(ERROR) S IBOUT=1 Q ; should not hit this. used more during test
. I '$D(TARGET) S IBOUT=1 Q ; no partial matches
. I +$G(TARGET("DILIST",0))<2 Q ; only one match so work as before
. D DSPTHM ; display them
. S DIR(0)="N^1:"_+$G(TARGET("DILIST",0)) ;allow select of 1 to as many matches
. D ^DIR
. I $G(DIRUT) S IBOUT=1 Q ; user ^, timed out, or entered null
. S IBX="`"_$G(TARGET("DILIST",2,+Y))
. W !
. Q
;WCJ*IB*2.0*488
;
S X=IBX
S DIC="^DPT("_DFN_",.312,",DIC(0)="EQMN"
S DIC("S")="I $D(IBDD(+Y))" ; add not other selection
S DIC("W")="W $P(^DIC(36,+^(0),0),U)_"" Group: ""_$$GRP^IBCNS($P(^DPT(DFN,.312,+Y,0),U,18))"
D ^DIC
SELQ Q +Y
;
;WCJ*IB*2.0*488;
DSPTHM ; display the insurance companies and useful information
W !,?4,"Insurance",?18,"COB",?23,"Subscriber ID",?37,"Group #",?49,"Eff Date",?62,"Exp Date"
N I
F I=1:1 Q:'$D(TARGET("DILIST","ID",I)) D
. W !,I,?4,$E($G(TARGET("DILIST","ID",I,.01)),1,12)
. W ?18,"(",$$LOW^XLFSTR($E($G(TARGET("DILIST","ID",I,.2)),1)),")"
. ;IB*2.0*516/TAZ - Use HIPAA compliant fields
. ;W ?23,$E($G(TARGET("DILIST","ID",I,1)),1,12)
. W ?23,$E($G(TARGET("DILIST","ID",I,7.02)),1,12)
. W ?37,$E($G(TARGET("DILIST","ID",I,21)),1,10)
. W ?49,$G(TARGET("DILIST","ID",I,8))
. W ?62,$G(TARGET("DILIST","ID",I,3))
Q
;WCJ*IB*2.0*488;
;
BLD K IBD,IBDD
S (IBDD,IBCDFN)=0 F S IBCDFN=$O(^DPT(DFN,.312,IBCDFN)) Q:'IBCDFN I $D(^DPT(DFN,.312,IBCDFN,0)) D CHK(IBCDFN,ACTIVE,INSDT)
Q
;
CHK(IBCDFN,ACTIVE,INSDT) ; -- see if active
N X,X1
S X=$G(^DPT(DFN,.312,IBCDFN,0))
S IBDD(IBCDFN)=+X_"^"_IBCDFN_"^"_$P(X,"^",18)
I ACTIVE=2 G CHKQ
S X1=$G(^DIC(36,+X,0)) I X1="" G CQ ;ins co entry doesn't exist
I $P(X,"^",8) G:INSDT<$P(X,"^",8) CQ ;effective date later than care
I $P(X,"^",4) G:INSDT>$P(X,"^",4) CQ ;care after expiration date
I $P($G(^IBA(355.3,+$P(X,"^",18),0)),"^",11) G CQ ;plan is inactive
G:$P(X1,"^",5) CQ ; ;ins company inactive
;G:$P(X1,"^",2)="N" CQ ; ;ins company will not reimburse
G CHKQ
CQ K IBDD(IBCDFN)
CHKQ S:$D(IBDD(IBCDFN)) IBDD=IBDD+1,IBD(IBDD)=IBCDFN
Q
;
;
DDHELP(IBDA,LEVEL) ; -- Executable help
; -- write out list to choose from
N DFN,ACTIVE,INSDT,I,IBINS
D VAR,BLD
;
I $G(IBDD)=0 W !,"No Insurance Policies to Select From" G DDHQ
;
I '$D(IOM) D HOME^%ZIS
N IBDTIN
S IBDTIN=$G(INSDT)
W ! D HDR^IBCNS
S I=0 F S I=$O(IBD(I)) Q:'I D
.;IB*2.0*516/TAZ - Use HIPAA compliant fields
.;S IBINS=$G(^DPT(DFN,.312,$G(IBD(I)),0)) ; 516 - baa
.S IBINS=$$ZND^IBCNS1(DFN,$G(IBD(I))) ; 516 - baa
.D D1^IBCNS
DDHQ Q
;
TRANS(IBDA,Y) ; -- output transform
N DFN,ACTIVE,INSDT
D VAR
S Y=$P($G(^DIC(36,+$P($G(^DPT(DFN,.312,+$G(Y),0)),U),0)),U)
Q Y
;
INSCO(IBDA,IBCDFN) ; -- return pointer value of 36 from pt. file
N DFN,ACTIVE,INSDT
D VAR
S Y=+$G(^DPT(DFN,.312,IBCDFN,0))
Q Y_$S(Y>0:"^"_$P($G(^DIC(36,+Y,0)),"^"),1:"")
;
IX(DA,XREF) ; -- create i1, aic xrefs for fields 112, 113, 114
;
;IB*2.0*516/TAZ - Set up I17, I27 or I37 nodes
N DFN
S DFN=$P($G(^DGCR(399,DA,0)),"^",2)
S ^DGCR(399,DA,XREF)=$$ZND^IBCNS1(DFN,X,399)
I ",I1,I2,I3,"[(","_XREF_","),$G(^DPT(DFN,.312,+X,7))'="" S ^DGCR(399,DA,XREF_"7")=$G(^DPT(DFN,.312,+X,7))
S ^DGCR(399,DA,"AIC",+$G(^DPT(DFN,.312,+X,0)))=""
Q
;
KIX(DA,XREF) ; -- kill logic for above xref
K ^DGCR(399,DA,XREF)
I ",I1,I2,I3,"[(","_XREF_",") K ^DGCR(399,DA,XREF_"7")
K ^DGCR(399,DA,"AIC",+$G(^DPT($P($G(^DGCR(399,DA,0)),"^",2),.312,+X,0)))
Q
;
BPP(IBDA,IBMCR) ; Find Bill Payer Policy based on Payer Sequence and the P/S/T payers assigned to the bill,Ins Co must reimburse
; IBMCR = flag that says include MEDICARE WNR
; returns - Bill Payer Policy (ifn of policy entry in patient file)
; - null if either no Payer Sequence or there is no policy defined for the payer sequence
; or the policy defined by the payer sequence Will Not Reimburse and is not MEDICARE
;
N IBI,IBX,IBY,IBP,IBC,IBM0 S IBX="",(IBP,IBC)=0
S IBMCR=+$G(IBMCR)
S IBY=$$COBN^IBCEF(+IBDA) I IBY S IBY=IBY+11
I IBY S IBM0=$G(^DGCR(399,+IBDA,"M")),IBP=$P(IBM0,U,IBY)
I IBP S IBY=IBY-11,(IBI,IBY)=$P(IBM0,U,IBY) I +IBY S IBC=$P($G(^DIC(36,+IBY,0)),U,2)
I IBP,IBI,$S(IBC'="N":1,'IBMCR:0,1:$$MCRWNR^IBEFUNC(+IBY)) S IBX=IBP
Q IBX
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HIBCNS2 6204 printed Jun 11, 2024@22:01:25 Page 2
IBCNS2 ;ALB/AAS - INSURANCE POLICY CALLS FROM FILE 399 DD ;22-JULY-91
+1 ;;2.0;INTEGRATED BILLING;**28,43,80,51,137,155,488,516**;21-MAR-94;Build 123
+2 ;;Per VA Directive 6402, this routine should not be modified.
+3 ;
+4 QUIT
DD(IBX,IBDA,LEVEL) ; - called from input transform for field 111,112,113
+1 ; -- input ibx = x from input transform
+2 ; ibda = internal entry in 399
+3 ; level = 1=primary, 2=secondary, 3=tertiary
+4 ; -- output returns x=internal entry in 2.3121 (ins. Mult.) if valid
+5 ;
+6 NEW DFN,ACTIVE,INSDT
+7 DO VAR
+8 SET X=$$SEL(IBX,DFN,INSDT,ACTIVE)
+9 IF +X<1
KILL X
DDQ QUIT
+1 ;
VAR SET DFN=$PIECE(^DGCR(399,IBDA,0),"^",2)
SET ACTIVE=1
SET INSDT=$SELECT(+$GET(^DGCR(399,IBDA,"U")):+$GET(^("U")),1:DT)
+1 QUIT
+2 ;
SEL(IBX,DFN,INSDT,ACTIVE) ; -- Select insurance policy
+1 ; -- Input IBX = x from input transform
+2 ; DFN = patient
+3 ; INSDT = (optional) Active date of ins. (default = dt)
+4 ; ACTIVE = (optional) 1 if want active (default)
+5 ; = 2 if want all ins returned
+6 ;
+7 ; -- Output = pointer to 36 ^ pointer to 2.3121 ^ pointer to 355.3
+8 ;
+9 NEW I,J,Y,DA,DE,DQ,DR,DIC,DIE,DIR,DIV,IBSEL,IBDD,IBD
+10 SET IBSEL=1
SET Y=""
+11 IF '$GET(ACTIVE)
SET ACTIVE=1
+12 if '$GET(INSDT)
SET INSDT=DT
+13 IF '$GET(DFN)
GOTO SELQ
+14 DO BLD
+15 ;
+16 ; -- call DIC to choose from list
+17 ;WCJ*IB*2.0*488;Display COB on picklist when partial match on more than one entry
+18 ;everything else should continue to work as before
+19 NEW IBOUT,IBSEL2
+20 SET IBX=$$UP^XLFSTR(IBX)
+21 IF IBX?1A.E
Begin DoDot:1
+22 NEW X,Y,ERROR,TARGET,I,G
+23 ;IB*2.0*516/TAZ - Use HIPAA compliant fields
+24 ;D LIST^DIC(2.312,","_DFN_",",".01;.2;3;8;1;16;.18;21",,9999,,IBX,,"I $D(IBDD(+Y))",,"TARGET","ERROR")
+25 ;516 - baa : add 7.02
DO LIST^DIC(2.312,","_DFN_",",".01;.2;3;8;7.02;16;.18;21",,9999,,IBX,,"I $D(IBDD(+Y))",,"TARGET","ERROR")
+26 ; should not hit this. used more during test
IF $DATA(ERROR)
SET IBOUT=1
QUIT
+27 ; no partial matches
IF '$DATA(TARGET)
SET IBOUT=1
QUIT
+28 ; only one match so work as before
IF +$GET(TARGET("DILIST",0))<2
QUIT
+29 ; display them
DO DSPTHM
+30 ;allow select of 1 to as many matches
SET DIR(0)="N^1:"_+$GET(TARGET("DILIST",0))
+31 DO ^DIR
+32 ; user ^, timed out, or entered null
IF $GET(DIRUT)
SET IBOUT=1
QUIT
+33 SET IBX="`"_$GET(TARGET("DILIST",2,+Y))
+34 WRITE !
+35 QUIT
End DoDot:1
SET IBX=$SELECT($GET(IBOUT):"^",$GET(IBSEL2):IBSEL2,1:IBX)
+36 ;WCJ*IB*2.0*488
+37 ;
+38 SET X=IBX
+39 SET DIC="^DPT("_DFN_",.312,"
SET DIC(0)="EQMN"
+40 ; add not other selection
SET DIC("S")="I $D(IBDD(+Y))"
+41 SET DIC("W")="W $P(^DIC(36,+^(0),0),U)_"" Group: ""_$$GRP^IBCNS($P(^DPT(DFN,.312,+Y,0),U,18))"
+42 DO ^DIC
SELQ QUIT +Y
+1 ;
+2 ;WCJ*IB*2.0*488;
DSPTHM ; display the insurance companies and useful information
+1 WRITE !,?4,"Insurance",?18,"COB",?23,"Subscriber ID",?37,"Group #",?49,"Eff Date",?62,"Exp Date"
+2 NEW I
+3 FOR I=1:1
if '$DATA(TARGET("DILIST","ID",I))
QUIT
Begin DoDot:1
+4 WRITE !,I,?4,$EXTRACT($GET(TARGET("DILIST","ID",I,.01)),1,12)
+5 WRITE ?18,"(",$$LOW^XLFSTR($EXTRACT($GET(TARGET("DILIST","ID",I,.2)),1)),")"
+6 ;IB*2.0*516/TAZ - Use HIPAA compliant fields
+7 ;W ?23,$E($G(TARGET("DILIST","ID",I,1)),1,12)
+8 WRITE ?23,$EXTRACT($GET(TARGET("DILIST","ID",I,7.02)),1,12)
+9 WRITE ?37,$EXTRACT($GET(TARGET("DILIST","ID",I,21)),1,10)
+10 WRITE ?49,$GET(TARGET("DILIST","ID",I,8))
+11 WRITE ?62,$GET(TARGET("DILIST","ID",I,3))
End DoDot:1
+12 QUIT
+13 ;WCJ*IB*2.0*488;
+14 ;
BLD KILL IBD,IBDD
+1 SET (IBDD,IBCDFN)=0
FOR
SET IBCDFN=$ORDER(^DPT(DFN,.312,IBCDFN))
if 'IBCDFN
QUIT
IF $DATA(^DPT(DFN,.312,IBCDFN,0))
DO CHK(IBCDFN,ACTIVE,INSDT)
+2 QUIT
+3 ;
CHK(IBCDFN,ACTIVE,INSDT) ; -- see if active
+1 NEW X,X1
+2 SET X=$GET(^DPT(DFN,.312,IBCDFN,0))
+3 SET IBDD(IBCDFN)=+X_"^"_IBCDFN_"^"_$PIECE(X,"^",18)
+4 IF ACTIVE=2
GOTO CHKQ
+5 ;ins co entry doesn't exist
SET X1=$GET(^DIC(36,+X,0))
IF X1=""
GOTO CQ
+6 ;effective date later than care
IF $PIECE(X,"^",8)
if INSDT<$PIECE(X,"^",8)
GOTO CQ
+7 ;care after expiration date
IF $PIECE(X,"^",4)
if INSDT>$PIECE(X,"^",4)
GOTO CQ
+8 ;plan is inactive
IF $PIECE($GET(^IBA(355.3,+$PIECE(X,"^",18),0)),"^",11)
GOTO CQ
+9 ; ;ins company inactive
if $PIECE(X1,"^",5)
GOTO CQ
+10 ;G:$P(X1,"^",2)="N" CQ ; ;ins company will not reimburse
+11 GOTO CHKQ
CQ KILL IBDD(IBCDFN)
CHKQ if $DATA(IBDD(IBCDFN))
SET IBDD=IBDD+1
SET IBD(IBDD)=IBCDFN
+1 QUIT
+2 ;
+3 ;
DDHELP(IBDA,LEVEL) ; -- Executable help
+1 ; -- write out list to choose from
+2 NEW DFN,ACTIVE,INSDT,I,IBINS
+3 DO VAR
DO BLD
+4 ;
+5 IF $GET(IBDD)=0
WRITE !,"No Insurance Policies to Select From"
GOTO DDHQ
+6 ;
+7 IF '$DATA(IOM)
DO HOME^%ZIS
+8 NEW IBDTIN
+9 SET IBDTIN=$GET(INSDT)
+10 WRITE !
DO HDR^IBCNS
+11 SET I=0
FOR
SET I=$ORDER(IBD(I))
if 'I
QUIT
Begin DoDot:1
+12 ;IB*2.0*516/TAZ - Use HIPAA compliant fields
+13 ;S IBINS=$G(^DPT(DFN,.312,$G(IBD(I)),0)) ; 516 - baa
+14 ; 516 - baa
SET IBINS=$$ZND^IBCNS1(DFN,$GET(IBD(I)))
+15 DO D1^IBCNS
End DoDot:1
DDHQ QUIT
+1 ;
TRANS(IBDA,Y) ; -- output transform
+1 NEW DFN,ACTIVE,INSDT
+2 DO VAR
+3 SET Y=$PIECE($GET(^DIC(36,+$PIECE($GET(^DPT(DFN,.312,+$GET(Y),0)),U),0)),U)
+4 QUIT Y
+5 ;
INSCO(IBDA,IBCDFN) ; -- return pointer value of 36 from pt. file
+1 NEW DFN,ACTIVE,INSDT
+2 DO VAR
+3 SET Y=+$GET(^DPT(DFN,.312,IBCDFN,0))
+4 QUIT Y_$SELECT(Y>0:"^"_$PIECE($GET(^DIC(36,+Y,0)),"^"),1:"")
+5 ;
IX(DA,XREF) ; -- create i1, aic xrefs for fields 112, 113, 114
+1 ;
+2 ;IB*2.0*516/TAZ - Set up I17, I27 or I37 nodes
+3 NEW DFN
+4 SET DFN=$PIECE($GET(^DGCR(399,DA,0)),"^",2)
+5 SET ^DGCR(399,DA,XREF)=$$ZND^IBCNS1(DFN,X,399)
+6 IF ",I1,I2,I3,"[(","_XREF_",")
IF $GET(^DPT(DFN,.312,+X,7))'=""
SET ^DGCR(399,DA,XREF_"7")=$GET(^DPT(DFN,.312,+X,7))
+7 SET ^DGCR(399,DA,"AIC",+$GET(^DPT(DFN,.312,+X,0)))=""
+8 QUIT
+9 ;
KIX(DA,XREF) ; -- kill logic for above xref
+1 KILL ^DGCR(399,DA,XREF)
+2 IF ",I1,I2,I3,"[(","_XREF_",")
KILL ^DGCR(399,DA,XREF_"7")
+3 KILL ^DGCR(399,DA,"AIC",+$GET(^DPT($PIECE($GET(^DGCR(399,DA,0)),"^",2),.312,+X,0)))
+4 QUIT
+5 ;
BPP(IBDA,IBMCR) ; Find Bill Payer Policy based on Payer Sequence and the P/S/T payers assigned to the bill,Ins Co must reimburse
+1 ; IBMCR = flag that says include MEDICARE WNR
+2 ; returns - Bill Payer Policy (ifn of policy entry in patient file)
+3 ; - null if either no Payer Sequence or there is no policy defined for the payer sequence
+4 ; or the policy defined by the payer sequence Will Not Reimburse and is not MEDICARE
+5 ;
+6 NEW IBI,IBX,IBY,IBP,IBC,IBM0
SET IBX=""
SET (IBP,IBC)=0
+7 SET IBMCR=+$GET(IBMCR)
+8 SET IBY=$$COBN^IBCEF(+IBDA)
IF IBY
SET IBY=IBY+11
+9 IF IBY
SET IBM0=$GET(^DGCR(399,+IBDA,"M"))
SET IBP=$PIECE(IBM0,U,IBY)
+10 IF IBP
SET IBY=IBY-11
SET (IBI,IBY)=$PIECE(IBM0,U,IBY)
IF +IBY
SET IBC=$PIECE($GET(^DIC(36,+IBY,0)),U,2)
+11 IF IBP
IF IBI
IF $SELECT(IBC'="N":1,'IBMCR:0,1:$$MCRWNR^IBEFUNC(+IBY))
SET IBX=IBP
+12 QUIT IBX
