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Routine: IBCU41

IBCU41.m

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  1. IBCU41 ;ALB/ARH - THIRD PARTY BILLING UTILITIES (OP VISIT DATES) ;6-JUN-93
  1. ;;2.0;INTEGRATED BILLING;**80,106,51,294,592,714**;21-MAR-94;Build 8
  1. ;;Per VA Directive 6402, this routine should not be modified.
  1. ;
  1. ;
  1. OPV(DATE,IFN) ;input transform for outpatient visit dates (399,43,.01)
  1. ;input: DATE - to add
  1. ; IFN - bill to add to
  1. ;returns: 1 - if OK to add
  1. ; 0 - if not
  1. N X,Y S X=1
  1. I '$$OPV2(DATE,IFN,1) S X=0
  1. I '$$OPV1(IFN,1) S X=0
  1. S Y=$$APPT^IBCU3(DATE,$P($G(^DGCR(399,IFN,0)),U,2),1)
  1. S Y=$$DUPCHK(DATE,IFN,1)
  1. Q X
  1. ;
  1. OPV1(IFN,DISP,CNT) ;edit checks for adding visit dates, if any of these fail then no visit date should be added to the bill
  1. ;these are the types of checks that if they fail a message should be displayed to the user
  1. ;does not check date passed in against existing dates, assumes new visit date
  1. ;input: IFN - required, internal file number of bill to check
  1. ; DISP - if true then error messager will be printed, if any
  1. ; CNT - number of visit dates user wants to add to bill
  1. ;returns: "1^warning message" - if OK to add more visit dates to the bill
  1. ; "0^error message" - if no more visit dates should added to the bill
  1. ;
  1. N X,Y S Y=1 S:$G(CNT)="" CNT=1 S:$G(UN)="" UN=$G(^DGCR(399,+IFN,"U"))
  1. I '$P(UN,U,1) S Y="0^No 'Statement From' date on file ... Can't enter OP visit dates ..." G OPV1E
  1. I '$P(UN,U,2) S Y="0^No 'Statement To' date on file ... Can't enter OP visit dates ..." G OPV1E
  1. G:'$O(^DGCR(399,IFN,"OP",0))&(CNT<2) OPV1E
  1. I $P($G(^DGCR(399,IFN,"OP",0)),U,4)+CNT>30 S Y="0^Maximum of 30 visit dates allowed per bill!" G OPV1E
  1. I +$P($G(^DGCR(399,+IFN,0)),U,19)'=2,$D(^DGCR(399,IFN,"CP","ASC")) S Y="0^Only one visit date allowed on bills with Billable Amb. Surg. Codes!" G OPV1E
  1. ;warnings:
  1. I +Y,+$P($G(^DIC(36,$S(+$G(^DGCR(399,IFN,"MP")):+^("MP"),$$MCRWNR^IBEFUNC(+$$CURR^IBCEF2(IFN)):+$$CURR^IBCEF2(IFN),1:0),0)),U,8) S Y="1^This insurance Company will only accept one visit per bill!" G OPV1E
  1. OPV1E I +$G(DISP),$P(Y,U,2)'="" W !,?10,$P(Y,U,2)
  1. Q Y
  1. ;
  1. OPV2(DATE,IFN,DISP,UN) ;edit checks for adding visit dates, if any if these fail then the given date should not be added to the bill
  1. ;these are the types of checks that determine if a particular visit date should be presented to the user for possible addition to the bill
  1. ;does not check date passed in against existing dates, assumes new visit date
  1. ;also being used for Procedure Date (399,304,1) input transform
  1. ;input: DATE - required, date to check for addition to the bill
  1. ; IFN - required, internal file number of bill to check
  1. ; DISP - if true then error messager will be printed, if any
  1. ; UN - the "U" node of the bill, pass if alrady defined in a var
  1. ;returns: "1^warning message" - if date is OK to add to the bill
  1. ; "0^error message" - if date should not be added to the bill
  1. ;
  1. N IBINDTS
  1. N X,Y S Y=1,DATE=$P(DATE,".",1) S:$G(UN)="" UN=$G(^DGCR(399,+IFN,"U"))
  1. S IBINDTS=+$P($G(^DGCR(399,+IFN,0)),U,28) ; IB*2.0*714
  1. I IBINDTS>0,DATE<IBINDTS S Y="0^Can't enter a visit date prior to the initial date of service..." G OPV2E ; IB*2.0*714
  1. I IBINDTS'>0,DATE<+UN S Y="0^Can't enter a visit date prior to the 'Statement From' date ..." G OPV2E ; IB*2.0*714
  1. I DATE>+$P(UN,U,2) S Y="0^Can't enter a visit date later than the 'Statement To' date ..." G OPV2E
  1. OPV2E I +$G(DISP),$P(Y,U,2)'="" W !,?10,$P(Y,U,2)
  1. Q Y
  1. ;
  1. DUPCHK(DATE,IFN,DISP,DFN,RTG,CTE) ;Check for duplicate billing of opt visit - checks for given visit date on other
  1. ;bills with the same rate type and that have not been cancelled (if not IFN then use DFN and RTG)
  1. ;input: DATE - visit date to check
  1. ; IFN - internal file number of bill date is being added to
  1. ; DISP - true if error message should be printed before exit, if any
  1. ; DFN - patient'S IFN (required only if IFN is not passed)
  1. ; RTG - rate group to check for (""), if no rate group (0 passed and/or no IFN) then any bill found for
  1. ; visit date will cause error message
  1. ; CTE - Claims Tracking entry IEN, for autobiller and dental claims - IB*2.0*592
  1. ;returns: 0 - if another bill was not found with this visit date, patient, and rate type
  1. ; (dup IFN)_"^error message" - if duplicate date found, same rate group, IFN of other bill w/visit date
  1. ;(initially set up to check for same rate group because MT billing was done on the UB-82 so it was valid to have multiple bills with different rate groups for the same episode)
  1. N IFN2,Y,X,IBDENT S Y=0,DATE=$P(+$G(DATE),".",1),IFN=+$G(IFN),X=$G(^DGCR(399,IFN,0))
  1. S DFN=$S(+$G(DFN):$G(DFN),1:$P(X,U,2)),RTG=$S($G(RTG)'="":RTG,1:$P(X,U,7)) G:'DFN DUPCHKE
  1. I '$D(^DGCR(399,"AOPV",DFN,DATE)) G DUPCHKE
  1. S IFN2=0 F S IFN2=$O(^DGCR(399,"AOPV",DFN,DATE,IFN2)) Q:'IFN2 I IFN2'=IFN D Q:+Y
  1. . S X=$G(^DGCR(399,IFN2,0)) I $P(X,U,13)=7 Q ; bill for date cancelled
  1. . I +RTG,RTG'=$P(X,U,7) Q ; different rate group
  1. . ;JWS;IB*2.0*592 - allow for Dental claim, just not duplicate Dental claims for same date
  1. . ;IA# 2056
  1. . I +$G(CTE),$P($G(^IBT(356,CTE,0)),"^",3)'="" S IBDENT=$F($$GET1^DIQ(9000010,$P($G(^IBT(356,CTE,0)),"^",3)_",",.08),"DENTAL") I $G(IBDENT),$$FT^IBCEF(IFN2)'=7 Q
  1. . S Y=IFN2_"^A "_$P($G(^DGCR(399.3,+$P(X,U,7),0)),U,1)_" bill ("_$P(X,U,1)_") exists for visit date ("_$$DAT1^IBOUTL(DATE)_")."
  1. DUPCHKE I +$G(DISP),+Y W !,?10,$P(Y,U,2)
  1. Q Y
  1. ;
  1. CTCHK(IBIFN) ; if professional/institutional bill passed in has a corresponding institutional/professional
  1. ; bill defined return it's bill number
  1. ; check/match: patient, bill type, event date, rate type, payer seq, statement from, statement to, not cancelled
  1. ;
  1. N IBFND,IB0,IBCT,IBDFN,IBEVDT,IBBT,IBRT,IBSEQ,IBSTDTS,IBCT1,IBIFN1,IB01 S IBFND=0
  1. S IB0=$G(^DGCR(399,+$G(IBIFN),0)),IBCT=$P(IB0,U,27) I 'IBCT G CTCHKQ
  1. S IBDFN=$P(IB0,U,2),IBEVDT=$P(IB0,U,3),IBBT=$P(IB0,U,5),IBRT=$P(IB0,U,7),IBSEQ=$P(IB0,U,21)
  1. S IBSTDTS=$P($G(^DGCR(399,IBIFN,"U")),U,1,2),IBCT1=$S(IBCT=1:2,IBCT=2:1,1:"") I 'IBCT1 G CTCHKQ
  1. ;
  1. S IBIFN1=0 F S IBIFN1=$O(^DGCR(399,"D",IBEVDT,IBIFN1)) Q:'IBIFN1 D Q:IBFND
  1. . S IB01=$G(^DGCR(399,IBIFN1,0))
  1. . I $P(IB01,U,13)=7 Q ; cancelled bill
  1. . I IBDFN'=$P(IB01,U,2) Q ; patient
  1. . I IBCT1'=$P(IB01,U,27) Q ; charge type
  1. . I IBBT'=$P(IB01,U,5) Q ; bill type/classification
  1. . I IBRT'=$P(IB01,U,7) Q ; rate type
  1. . I '$P($G(^DGCR(399,IBIFN1,"S")),U,7),IBSEQ'=$P(IB01,U,21) Q ; payer sequence (applies to non-MRA claims only; IB*2*294 modification)
  1. . I IBSTDTS'=$P($G(^DGCR(399,IBIFN1,"U")),U,1,2) Q ; from/thru dates
  1. . S IBFND=IBIFN1 ; found a match
  1. . Q
  1. ;
  1. CTCHKQ Q IBFND