IBCNSU3 ;ALB/TMP - Functions for billing decisions; 08-AUG-95
Source file <IBCNSU3.m>
| action | A | extended action | Ea | event driver | Ed | subscriber | Su | protocol | O | limited protocol | LP | run routine | RR | broker | B | edit | E | server | Se | P | screenman | SM | inquire | I |
| Name | Comments | DBIA/ICR reference |
|---|---|---|
| PTCOV(DFN,IBVDT,IBCAT,ANYINS,INSONBIL) | ; Determine if patient is covered for coverage category on a visit dt
; Function returns 1 if covered, 0 if not covered ; DFN - ifn of patient (req) ; IBVDT - fileman format visit date (req) ; IBCAT - entry in file 355.31 limitation of coverage category (req) ; ANYINS - optional parameter, but if passed by reference, returns 0 if ; no active insurance at all and 1 if any active insurance found ; INSONBIL - this is an array of insurances on the bill. if it is sent, only those insurances will be checked. ; INSONBIL(INS CO IEN)="" |
|
| PTCOVQ | ||
| PLCOV(IBPL,IBVDT,IBCAT,COMMENT) | ; Determine if a specific plan covers a category of coverage as of a date and returns comments
; IBPL - pointer to file 355.3 group insurance plan (req) ; IBVDT - fileman format visit date (req) ; IBCAT - pointer to file 355.31 limitation of coverage category (req) ; COMMENT - if passed by reference and the coverage is conditional will contain limitation comments |
|
| RIDERS(DFN,IBCDFN,RIDERS) | ; Returns all Riders (355.7) associated with a patient's policy in array if RIDERS is passed by reference
|
| Name | Line Occurrences (* Changed, ! Killed) |
|---|---|
| ^IBA(355.32 - [#355.32] | PLCOV+6, PLCOV+7, PLCOV+8 |
| ^IBA(355.7 - [#355.7] | PTCOV+21, RIDERS+2 |
| ^IBE(355.31 - [#355.31] | PTCOV+13, PTCOV+21 |
| ^IBE(355.6 - [#355.6] | RIDERS+2 |
| Name | Line Occurrences |
|---|---|
| $$PLCOV | PTCOV+20 |
| PTCOVQ | PTCOV+12, PTCOV+13 |
| >> | Not killed explicitly |
| * | Changed |
| ! | Killed |
| ~ | Newed |
| Name | Field # of Occurrence |
|---|---|
| ANYINS | PTCOV~, PTCOV+11*, PTCOV+16* |
| CATLIM | PLCOV+5~, PLCOV+6*, PLCOV+7, PLCOV+8 |
| COMMENT | PLCOV~, PLCOV+5!, PLCOV+8* |
| COMMENT( | PLCOV+8* |
| DFN | PTCOV~, PTCOV+12, PTCOV+15, PTCOV+21, RIDERS~, RIDERS+2 |
| IBCAT | PTCOV~, PTCOV+12, PTCOV+13*, PTCOV+20, PTCOV+21, PLCOV~, PLCOV+6 |
| IBCDFN | RIDERS~, RIDERS+2 |
| IBCOV | PTCOV+10~, PTCOV+11*, PTCOV+17, PTCOV+20*, PTCOV+21*, PTCOVQ |
| IBDD | PTCOV+10~ |
| IBDD( | PTCOV+17, PTCOV+18, PTCOV+19 |
| IBDD(0 | PTCOV+16 |
| IBPL | PLCOV~, PLCOV+6 |
| IBVDT | PTCOV~, PTCOV+12, PTCOV+14*, PTCOV+15, PTCOV+20, PLCOV~, PLCOV+6 |
| INSONBIL | PTCOV~, PTCOV+19 |
| INSONBIL( | PTCOV+19 |
| PLAN | PTCOV+10~, PTCOV+18*, PTCOV+20 |
| POLCY | PTCOV+10~, PTCOV+17*, PTCOV+18, PTCOV+19, PTCOV+21 |
| RIDERS | RIDERS~, RIDERS+1! |
| RIDERS( | RIDERS+2* |
| U | PTCOV+18, PTCOV+19, PTCOV+21, PLCOV+7, RIDERS+2 |
| X | PLCOV+5~, PLCOV+7*, PLCOV+8, PLCOV+9 |
| Y | PLCOV+5~, PLCOV+8*, RIDERS+1~, RIDERS+2* |
