IBEFUNC ;ALB/RLW - EXTRINSIC FUNCTIONS ;12-JUN-92
;;2.0;INTEGRATED BILLING;**55,91,106,139,51,153,232,155,249,327,420**;21-MAR-94;Build 6
;
ETXT(X) ; -- output error text from 350.8
; -- input error code
N Y S Y=X
I X="" G ETXTQ
S Y=$P($G(^IBE(350.8,+$O(^IBE(350.8,"AC",X,0)),0)),U,2)
ETXTQ Q Y
;
IGN(X,Y) ; ignore means test? for appt type on dates
; -- input x = mas appt type
; y = appt date
; output = true if this appt type should not be billed for
; Means Test billing (352.1,.04) for given date
;
I '$G(X)!('$G(Y)) Q 1
Q +$P($G(^IBE(352.1,+$O(^(+$O(^IBE(352.1,"AIVDT",+X,-(Y+.1))),0)),0)),U,4)
;
DSP(X,Y) ; display on input screen?
; -- input X = mas appt type (P409.1)
; Y = date
; output = true if appt type X (352.1,.02) should be displayed as
; a potential billable visit (352.1,.06) on given date Y (352.1,.03)
;
I '$G(X)!('$G(Y)) Q 0
Q +$P($G(^IBE(352.1,+$O(^(+$O(^IBE(352.1,"AIVDT",+X,-(Y+.1))),0)),0)),U,6)
;
RPT(X,Y) ; print on report?
; -- input X = mas appt type (P409.1)
; Y = date
; output = true if appt type X (352.1,.02) should be printed on 'Vets w/ Ins and Opt
; Visits' report (352.1,.05) on given date Y (352.1,.06)
;
I '$G(X)!('$G(Y)) Q 0
Q +$P($G(^IBE(352.1,+$O(^(+$O(^IBE(352.1,"AIVDT",+X,-(Y+.1))),0)),0)),U,5)
;
NBDIS(X,Y) ; Is disposition non-billable?
; -- input X = disposition (P37)
; Y = date of appt
; output = true (1) if disposition should be ignored for
; Means test billing (352.2,.03) for given date
;
I '$G(X)!('$G(Y)) Q 0
Q +$P($G(^IBE(352.2,+$O(^(+$O(^IBE(352.2,"AIVDT",+X,-(Y+.1))),0)),0)),U,3)
;
NBCSC(X,Y) ; Is clinic stop code non-billable?
; -- input X = clinic stop code (P40.7)
; Y = date of appt
; output = true (1) if clinic stop code should be ignored for
; Means test billing (352.3,.03) for given date
;
I '$G(X)!('$G(Y)) Q 0
Q +$P($G(^IBE(352.3,+$O(^(+$O(^IBE(352.3,"AIVDT",+X,-(Y+.1))),0)),0)),U,3)
;
NBCL(X,Y) ; Is clinic non-billable?
; -- input X = clinic (P44)
; Y = date of appt
; output = true (1) if clinic should be ignored for
; Means test billing (352.4,.03) for given date
;
I '$G(X)!('$G(Y)) Q 0
Q +$P($G(^IBE(352.4,+$O(^(+$O(^IBE(352.4,"AIVDT",+X,-(Y+.1))),0)),0)),U,3)
;
NBST(X,Y) ; Is clinic stop code non-billable for Third Party?
; -- input X = clinic stop code (P40.7), Y = appt date
; output = true (1) if stop non-billable for Third Party (352.3,.05) for given dt
;
I '$G(X)!('$G(Y)) Q 0
Q +$P($G(^IBE(352.3,+$O(^(+$O(^IBE(352.3,"AIVDTT2",+X,-(Y+.1))),0)),0)),U,5)
;
NBCT(X,Y) ; Is clinic non-billable for Third Party?
; -- input X = clinic (P44), Y = appt dt
; output = true (1) if clinic non-billable for Third Party (352.4,.05) for given date
;
I '$G(X)!('$G(Y)) Q 0
Q +$P($G(^IBE(352.4,+$O(^(+$O(^IBE(352.4,"AIVDTT2",+X,-(Y+.1))),0)),0)),U,5)
;
NABST(X,Y) ; Returns true (1) if stop code flagged to be ignored by Third Party auto biller (use DT)
S:'$G(Y) Y=DT I '$G(X) Q 0
Q +$P($G(^IBE(352.3,+$O(^(+$O(^IBE(352.3,"AIVDTT2",+X,-(Y+.1))),0)),0)),U,6)
;
NABCT(X,Y) ; Returns true (1) if clinic is flagged to be ignored by Third Party auto biller (use DT)
S:'$G(Y) Y=DT I '$G(X) Q 0
Q +$P($G(^IBE(352.4,+$O(^(+$O(^IBE(352.4,"AIVDTT2",+X,-(Y+.1))),0)),0)),U,6)
;
PT(DFN) ;returns (patient name^long pat id^short pat id) or null if not found
N X,IBX S X="" I $D(DFN) S X=$G(^DPT(+DFN,0)) I X'="" S X=$P(X,U,1)_U_$P($G(^DPT(DFN,.36)),U,3,4) D
. S IBX=$P(^DPT(+DFN,0),U,9)
. I $P(X,U,2)="" S $P(X,U,2)=$E(IBX,1,3)_"-"_$E(IBX,4,5)_"-"_$E(IBX,6,10)
. I $P(X,U,3)="" S $P(X,U,3)=$E(IBX,6,10)
Q X
;
EXSET(X,D0,D1) ;returns external value of a set in file D0, field D1
Q $$EXPAND^IBTRE($G(D0),$G(D1),$G(X))
;
BABCSC(DFN,IBDT) ; -- any billable Third Party visits in encounter file for patient
; -- Input dfn = patient, ibdt = date
; output = 1 if any billable stop on date OR 0 if none
;
N IBX,IBVAL,IBCBK,IBFILTER
S IBX=0
I '$G(DFN)!('$G(IBDT)) G BABQ
;
S IBVAL("DFN")=DFN,IBVAL("BDT")=IBDT\1,IBVAL("EDT")=IBDT\1+.24
;Ignore if not chkd out, no stop, non-billable stop, non-billable clinic
S IBFILTER=""
S IBCBK="I $P(Y0,U,12)=2,$P(Y0,U,3),'$$NBST^IBEFUNC($P(Y0,U,3),+Y0),'$$NBCT^IBEFUNC(+$P(Y0,U,4),+Y0) S (IBX,SDSTOP)=1"
D SCAN^IBSDU("PATIENT/DATE",.IBVAL,"",IBCBK,1) K ^TMP("DIERR",$J)
;
BABQ Q IBX
;
APPTCT(IBOE0) ; Determine if appt encounter/appt has valid status for billing
; Returns 1 if valid, 0 if not
; IBOE0 = the encounter's 0-node (input)
N STAT
S STAT=$P(IBOE0,U,12) ;Encounter stat
I STAT=14 S STAT=2
; Assume 1,2 (and 14 sometimes) are valid, 8 = INPATIENT
Q STAT<3
;
NCTCL(IBOE0) ; Determine if a clinic for an outpt encounter is non-count
; IBOE0 = the 0-node of the encounter
Q ($P($G(^SC(+$P(IBOE0,U,4),0)),U,17)="Y")
;
DISCT(IBOE,IBOE0) ; Determine if disposition has valid status for billing
; Returns 1 if valid, 0 if not valid
; IBOE = encounter ien
; IBOE0 = 0-node of encounter (optional)
N IBX
S IBX=$$DISND^IBSDU(IBOE,$G(IBOE0),2)
Q (IBX<2)
;
NEEDMRA(IBIFN) ; Returns MRA NEEDED STATUS for bill
Q $P($G(^DGCR(399,+IBIFN,"TX")),U,5)
;
REQMRA(IBIFN) ; Determine from site parameter, ins assigned to bill and txmn
; rules if request for MRA is needed (MCRWNR must be current ins co)
; "R" = not needed due to next carrier not requiring it (txmn rules),
; "R1" = not needed due to MRA turned off at site
; 0 = not needed, 1 = needed
N IB0,COBINS,COBSEQ,IBOK,Z1,Z0,IBDA,IB00,IB0
;
I $$COB^IBCEF(IBIFN)="A" S IBOK=0 G REQMRAQ ; payer sequence = patient not allowed for MRA
S COBSEQ=$$COBN^IBCEF(IBIFN)
S COBINS=$P($G(^DGCR(399,IBIFN,"M")),U,COBSEQ)
;Curr ins must = MEDICARE WNR
S IBOK=+$$MCRWNR(COBINS)
I 'IBOK G REQMRAQ
;
I '$$EDIACTV^IBCEF4(2) S IBOK="R1" G REQMRAQ ; Site param=NO
;
; Check next ins for MRA needed
I COBSEQ'<3 S IBOK=0 G REQMRAQ
;
S IB0=$G(^DGCR(399,IBIFN,0))
S COBINS=+$P($G(^DGCR(399,IBIFN,"M")),U,COBSEQ+1)
I 'COBINS S IBOK=0 G REQMRAQ ;No next ins
I $$COB^IBCEF(IBIFN)="S" D I IBOK="R2" G REQMRAQ
. S COBINS=$P($G(^DGCR(399,IBIFN,"M")),U,COBSEQ)
. I +$$MCRWNR(COBINS)=1 S IBOK="R2"
;
; Check only rules with rule type = 2 (MRA REQUEST RESTRICTIONS)
S IBDA=0 F S IBDA=$O(^IBE(364.4,"AC",2,IBDA)) Q:'IBDA S IB00=$G(^IBE(364.4,IBDA,0)) D Q:'IBOK
. I $P(IB00,U,2)>DT Q ; Inactive
. I $P(IB00,U,6),$P(IB00,U,6)'>DT Q ; Expired
. S Z0=$$INPAT^IBCEF(IBIFN,1),Z0=$S(Z0=1:2,1:1)
. S Z1=$$FT^IBCEF(IBIFN),Z1=$S(Z1=3:1,1:2)
. I $S($P(IB00,U,4)=3:1,1:$P(IB00,U,4)=Z0),$S($P(IB00,U,5)=3:1,1:$P(IB00,U,5)=Z1) S Z0=$D(^IBE(364.4,IBDA,3,"B",COBINS)) I Z0>0 S IBOK="R"
;
REQMRAQ Q IBOK
;
MCRWNR(IBINS) ;Returns whether the ins co IBINS is MEDICARE WNR (Will
; NOT Reimburse) 0=NO, 1=YES
N Z,Z0
S Z=0,Z0=$G(^DIC(36,+IBINS,0))
I $P(Z0,U,2)="N",$P($G(^IBE(355.2,+$P(Z0,U,13),0)),U)="MEDICARE" S Z=1
Q Z
;
WNRBILL(IBIFN,IBCOB) ; Returns whether the ins for COB seq IBCOB
; is MEDICARE will not reimburse
;
I $G(IBCOB)="" S IBCOB=$$COBN^IBCEF(IBIFN)
S IBCOB=$TR(IBCOB,"PST","123")
Q $$MCRWNR(+$G(^DGCR(399,IBIFN,"I"_IBCOB)))
;
MCR(IBINS) ;Returns whether the ins co IBINS is MCR Will Reimburse
; 0=NO , 1=YES
N Z,Z0
S Z=0,Z0=$G(^DIC(36,+IBINS,0))
I $P(Z0,U,2)'="N",$P($G(^IBE(355.2,+$P(Z0,U,13),0)),U)="MEDICARE" S Z=1
Q Z
;
MRATYPE(IBIEN,IBVAR) ; Returns: A = MEDICARE A B = MEDICARE B
; C = MEDICARE OTHER null = NOT MEDICARE
; for the plan associated with bill ien IBIEN OR grp plan IBIEN
; If IBVAR = "" or 'C', the data is from bill ien in IBIEN
; = 'P', the data is from grp policy ien in IBIEN
;
N IBPLAN
S IBPLAN=$S($G(IBVAR)'="P":+$$POLICY^IBCEF(IBIEN,18),1:IBIEN)
Q $P($G(^IBA(355.3,+IBPLAN,0)),U,14)
;
MCRONBIL(IBIFN,IBFLG,IBTRBIL) ; Returns 0 if MCR WNR not on bill IBIFN
; 1 if on bill, is on or before current ins
; 2 if on bill, but after current ins
; IBFLG = a COB number if second "^" piece of return data should be
; 1 if MCRWNR is the insurance at that COB sequence (optional)
; IBTRBIL = tricare for CL1A-5
;
N Z,IBON,Q
S IBON=0,Q=$$COBN^IBCEF(IBIFN)
F Z=1:1:3 I $$WNRBILL(IBIFN,Z)!$$TRI(IBIFN,Z) S IBON=$S(Q'<Z:1,1:2)_$S('$G(IBFLG):"",Z'=IBFLG:"",1:"^1") Q
Q IBON
;
TRI(IBIFN,Z) ;return 1 if rate type & coverage type-Tricare
N Z0,Z1,IBINS,IBRTY
S Z1=0
I '$G(IBTRBIL) Q Z1
S IBINS=+$G(^DGCR(399,IBIFN,"I"_Z))
S IBRTY=$P($G(^DGCR(399.3,+$P($G(^DGCR(399,IBIFN,0)),U,7),0)),U)
S Z0=$G(^DIC(36,+IBINS,0))
I IBRTY["TRICARE",$P($G(^IBE(355.2,+$P(Z0,U,13),0)),U)="TRICARE" S Z1=1
Q Z1
;
PROFEE(IBIFN) ; Returns whether any rev codes for prof fees
; included on bill IBIFN 0 = not included, 1 = included,
; 2 = both inst and prof are included
;
N IBPRO,Z
S IBPRO=0,Z=$O(^DGCR(399,IBIFN,"RC","B",959)) ; Rev cds 960-989 are prof
I Z,Z<990 D
. S IBPRO=1
. S Z=$O(^DGCR(399,IBIFN,"RC","B",0))
. I $S(Z:Z<960,1:0)!($O(^DGCR(399,IBIFN,"RC","B",1000),-1)'<990) S IBPRO=2
Q IBPRO
;
GETMOD(IBIFN,IBCPT,EXT) ; Returns 'list' of modifiers for file 399
; procedure for bill IBIFN and proc ien IBCPT
; in modifier seq order, separated by ','
; If EXT = 1, return the actual modifier, not the ptr
N IBMOD,IBZ,IBZ0,IB0,Z
S IBZ=0,IBMOD=""
F S IBZ=$O(^DGCR(399,IBIFN,"CP",IBCPT,"MOD","B",IBZ)) Q:'IBZ S IBZ0=0 F S IBZ0=$O(^DGCR(399,IBIFN,"CP",IBCPT,"MOD","B",IBZ,IBZ0)) Q:'IBZ0 I $D(^DGCR(399,IBIFN,"CP",IBCPT,"MOD",IBZ0,0)) S IB0=$G(^(0)) D
. I '$G(EXT) S Z=$P(IB0,U,2)
. I $G(EXT) S Z=$$MOD^ICPTMOD($P(IB0,U,2),"I"),Z=$S($P(Z,U)=-1:"",1:$P(Z,U,2))
. Q:Z=""
. S IBMOD=IBMOD_$S(IBMOD="":"",1:",")_Z
Q IBMOD
;
MODLST(MODS,DESC,IBMOD) ; Returns string of actual mods
; MOVED
Q $$MODLST^IBEFUNC2(MODS,$G(DESC),.IBMOD)
;
GETSPEC(FILE,FIELD) ; Get fld specifier for FIELD # in FILE
; Use to set DIC("P") for FILE^DICN
N IBZ
D FIELD^DID(FILE,FIELD,"","SPECIFIER","IBZ")
Q $G(IBZ("SPECIFIER"))
;
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HIBEFUNC 10228 printed Oct 16, 2024@18:22:34 Page 2
IBEFUNC ;ALB/RLW - EXTRINSIC FUNCTIONS ;12-JUN-92
+1 ;;2.0;INTEGRATED BILLING;**55,91,106,139,51,153,232,155,249,327,420**;21-MAR-94;Build 6
+2 ;
ETXT(X) ; -- output error text from 350.8
+1 ; -- input error code
+2 NEW Y
SET Y=X
+3 IF X=""
GOTO ETXTQ
+4 SET Y=$PIECE($GET(^IBE(350.8,+$ORDER(^IBE(350.8,"AC",X,0)),0)),U,2)
ETXTQ QUIT Y
+1 ;
IGN(X,Y) ; ignore means test? for appt type on dates
+1 ; -- input x = mas appt type
+2 ; y = appt date
+3 ; output = true if this appt type should not be billed for
+4 ; Means Test billing (352.1,.04) for given date
+5 ;
+6 IF '$GET(X)!('$GET(Y))
QUIT 1
+7 QUIT +$PIECE($GET(^IBE(352.1,+$ORDER(^(+$ORDER(^IBE(352.1,"AIVDT",+X,-(Y+.1))),0)),0)),U,4)
+8 ;
DSP(X,Y) ; display on input screen?
+1 ; -- input X = mas appt type (P409.1)
+2 ; Y = date
+3 ; output = true if appt type X (352.1,.02) should be displayed as
+4 ; a potential billable visit (352.1,.06) on given date Y (352.1,.03)
+5 ;
+6 IF '$GET(X)!('$GET(Y))
QUIT 0
+7 QUIT +$PIECE($GET(^IBE(352.1,+$ORDER(^(+$ORDER(^IBE(352.1,"AIVDT",+X,-(Y+.1))),0)),0)),U,6)
+8 ;
RPT(X,Y) ; print on report?
+1 ; -- input X = mas appt type (P409.1)
+2 ; Y = date
+3 ; output = true if appt type X (352.1,.02) should be printed on 'Vets w/ Ins and Opt
+4 ; Visits' report (352.1,.05) on given date Y (352.1,.06)
+5 ;
+6 IF '$GET(X)!('$GET(Y))
QUIT 0
+7 QUIT +$PIECE($GET(^IBE(352.1,+$ORDER(^(+$ORDER(^IBE(352.1,"AIVDT",+X,-(Y+.1))),0)),0)),U,5)
+8 ;
NBDIS(X,Y) ; Is disposition non-billable?
+1 ; -- input X = disposition (P37)
+2 ; Y = date of appt
+3 ; output = true (1) if disposition should be ignored for
+4 ; Means test billing (352.2,.03) for given date
+5 ;
+6 IF '$GET(X)!('$GET(Y))
QUIT 0
+7 QUIT +$PIECE($GET(^IBE(352.2,+$ORDER(^(+$ORDER(^IBE(352.2,"AIVDT",+X,-(Y+.1))),0)),0)),U,3)
+8 ;
NBCSC(X,Y) ; Is clinic stop code non-billable?
+1 ; -- input X = clinic stop code (P40.7)
+2 ; Y = date of appt
+3 ; output = true (1) if clinic stop code should be ignored for
+4 ; Means test billing (352.3,.03) for given date
+5 ;
+6 IF '$GET(X)!('$GET(Y))
QUIT 0
+7 QUIT +$PIECE($GET(^IBE(352.3,+$ORDER(^(+$ORDER(^IBE(352.3,"AIVDT",+X,-(Y+.1))),0)),0)),U,3)
+8 ;
NBCL(X,Y) ; Is clinic non-billable?
+1 ; -- input X = clinic (P44)
+2 ; Y = date of appt
+3 ; output = true (1) if clinic should be ignored for
+4 ; Means test billing (352.4,.03) for given date
+5 ;
+6 IF '$GET(X)!('$GET(Y))
QUIT 0
+7 QUIT +$PIECE($GET(^IBE(352.4,+$ORDER(^(+$ORDER(^IBE(352.4,"AIVDT",+X,-(Y+.1))),0)),0)),U,3)
+8 ;
NBST(X,Y) ; Is clinic stop code non-billable for Third Party?
+1 ; -- input X = clinic stop code (P40.7), Y = appt date
+2 ; output = true (1) if stop non-billable for Third Party (352.3,.05) for given dt
+3 ;
+4 IF '$GET(X)!('$GET(Y))
QUIT 0
+5 QUIT +$PIECE($GET(^IBE(352.3,+$ORDER(^(+$ORDER(^IBE(352.3,"AIVDTT2",+X,-(Y+.1))),0)),0)),U,5)
+6 ;
NBCT(X,Y) ; Is clinic non-billable for Third Party?
+1 ; -- input X = clinic (P44), Y = appt dt
+2 ; output = true (1) if clinic non-billable for Third Party (352.4,.05) for given date
+3 ;
+4 IF '$GET(X)!('$GET(Y))
QUIT 0
+5 QUIT +$PIECE($GET(^IBE(352.4,+$ORDER(^(+$ORDER(^IBE(352.4,"AIVDTT2",+X,-(Y+.1))),0)),0)),U,5)
+6 ;
NABST(X,Y) ; Returns true (1) if stop code flagged to be ignored by Third Party auto biller (use DT)
+1 if '$GET(Y)
SET Y=DT
IF '$GET(X)
QUIT 0
+2 QUIT +$PIECE($GET(^IBE(352.3,+$ORDER(^(+$ORDER(^IBE(352.3,"AIVDTT2",+X,-(Y+.1))),0)),0)),U,6)
+3 ;
NABCT(X,Y) ; Returns true (1) if clinic is flagged to be ignored by Third Party auto biller (use DT)
+1 if '$GET(Y)
SET Y=DT
IF '$GET(X)
QUIT 0
+2 QUIT +$PIECE($GET(^IBE(352.4,+$ORDER(^(+$ORDER(^IBE(352.4,"AIVDTT2",+X,-(Y+.1))),0)),0)),U,6)
+3 ;
PT(DFN) ;returns (patient name^long pat id^short pat id) or null if not found
+1 NEW X,IBX
SET X=""
IF $DATA(DFN)
SET X=$GET(^DPT(+DFN,0))
IF X'=""
SET X=$PIECE(X,U,1)_U_$PIECE($GET(^DPT(DFN,.36)),U,3,4)
Begin DoDot:1
+2 SET IBX=$PIECE(^DPT(+DFN,0),U,9)
+3 IF $PIECE(X,U,2)=""
SET $PIECE(X,U,2)=$EXTRACT(IBX,1,3)_"-"_$EXTRACT(IBX,4,5)_"-"_$EXTRACT(IBX,6,10)
+4 IF $PIECE(X,U,3)=""
SET $PIECE(X,U,3)=$EXTRACT(IBX,6,10)
End DoDot:1
+5 QUIT X
+6 ;
EXSET(X,D0,D1) ;returns external value of a set in file D0, field D1
+1 QUIT $$EXPAND^IBTRE($GET(D0),$GET(D1),$GET(X))
+2 ;
BABCSC(DFN,IBDT) ; -- any billable Third Party visits in encounter file for patient
+1 ; -- Input dfn = patient, ibdt = date
+2 ; output = 1 if any billable stop on date OR 0 if none
+3 ;
+4 NEW IBX,IBVAL,IBCBK,IBFILTER
+5 SET IBX=0
+6 IF '$GET(DFN)!('$GET(IBDT))
GOTO BABQ
+7 ;
+8 SET IBVAL("DFN")=DFN
SET IBVAL("BDT")=IBDT\1
SET IBVAL("EDT")=IBDT\1+.24
+9 ;Ignore if not chkd out, no stop, non-billable stop, non-billable clinic
+10 SET IBFILTER=""
+11 SET IBCBK="I $P(Y0,U,12)=2,$P(Y0,U,3),'$$NBST^IBEFUNC($P(Y0,U,3),+Y0),'$$NBCT^IBEFUNC(+$P(Y0,U,4),+Y0) S (IBX,SDSTOP)=1"
+12 DO SCAN^IBSDU("PATIENT/DATE",.IBVAL,"",IBCBK,1)
KILL ^TMP("DIERR",$JOB)
+13 ;
BABQ QUIT IBX
+1 ;
APPTCT(IBOE0) ; Determine if appt encounter/appt has valid status for billing
+1 ; Returns 1 if valid, 0 if not
+2 ; IBOE0 = the encounter's 0-node (input)
+3 NEW STAT
+4 ;Encounter stat
SET STAT=$PIECE(IBOE0,U,12)
+5 IF STAT=14
SET STAT=2
+6 ; Assume 1,2 (and 14 sometimes) are valid, 8 = INPATIENT
+7 QUIT STAT<3
+8 ;
NCTCL(IBOE0) ; Determine if a clinic for an outpt encounter is non-count
+1 ; IBOE0 = the 0-node of the encounter
+2 QUIT ($PIECE($GET(^SC(+$PIECE(IBOE0,U,4),0)),U,17)="Y")
+3 ;
DISCT(IBOE,IBOE0) ; Determine if disposition has valid status for billing
+1 ; Returns 1 if valid, 0 if not valid
+2 ; IBOE = encounter ien
+3 ; IBOE0 = 0-node of encounter (optional)
+4 NEW IBX
+5 SET IBX=$$DISND^IBSDU(IBOE,$GET(IBOE0),2)
+6 QUIT (IBX<2)
+7 ;
NEEDMRA(IBIFN) ; Returns MRA NEEDED STATUS for bill
+1 QUIT $PIECE($GET(^DGCR(399,+IBIFN,"TX")),U,5)
+2 ;
REQMRA(IBIFN) ; Determine from site parameter, ins assigned to bill and txmn
+1 ; rules if request for MRA is needed (MCRWNR must be current ins co)
+2 ; "R" = not needed due to next carrier not requiring it (txmn rules),
+3 ; "R1" = not needed due to MRA turned off at site
+4 ; 0 = not needed, 1 = needed
+5 NEW IB0,COBINS,COBSEQ,IBOK,Z1,Z0,IBDA,IB00,IB0
+6 ;
+7 ; payer sequence = patient not allowed for MRA
IF $$COB^IBCEF(IBIFN)="A"
SET IBOK=0
GOTO REQMRAQ
+8 SET COBSEQ=$$COBN^IBCEF(IBIFN)
+9 SET COBINS=$PIECE($GET(^DGCR(399,IBIFN,"M")),U,COBSEQ)
+10 ;Curr ins must = MEDICARE WNR
+11 SET IBOK=+$$MCRWNR(COBINS)
+12 IF 'IBOK
GOTO REQMRAQ
+13 ;
+14 ; Site param=NO
IF '$$EDIACTV^IBCEF4(2)
SET IBOK="R1"
GOTO REQMRAQ
+15 ;
+16 ; Check next ins for MRA needed
+17 IF COBSEQ'<3
SET IBOK=0
GOTO REQMRAQ
+18 ;
+19 SET IB0=$GET(^DGCR(399,IBIFN,0))
+20 SET COBINS=+$PIECE($GET(^DGCR(399,IBIFN,"M")),U,COBSEQ+1)
+21 ;No next ins
IF 'COBINS
SET IBOK=0
GOTO REQMRAQ
+22 IF $$COB^IBCEF(IBIFN)="S"
Begin DoDot:1
+23 SET COBINS=$PIECE($GET(^DGCR(399,IBIFN,"M")),U,COBSEQ)
+24 IF +$$MCRWNR(COBINS)=1
SET IBOK="R2"
End DoDot:1
IF IBOK="R2"
GOTO REQMRAQ
+25 ;
+26 ; Check only rules with rule type = 2 (MRA REQUEST RESTRICTIONS)
+27 SET IBDA=0
FOR
SET IBDA=$ORDER(^IBE(364.4,"AC",2,IBDA))
if 'IBDA
QUIT
SET IB00=$GET(^IBE(364.4,IBDA,0))
Begin DoDot:1
+28 ; Inactive
IF $PIECE(IB00,U,2)>DT
QUIT
+29 ; Expired
IF $PIECE(IB00,U,6)
IF $PIECE(IB00,U,6)'>DT
QUIT
+30 SET Z0=$$INPAT^IBCEF(IBIFN,1)
SET Z0=$SELECT(Z0=1:2,1:1)
+31 SET Z1=$$FT^IBCEF(IBIFN)
SET Z1=$SELECT(Z1=3:1,1:2)
+32 IF $SELECT($PIECE(IB00,U,4)=3:1,1:$PIECE(IB00,U,4)=Z0)
IF $SELECT($PIECE(IB00,U,5)=3:1,1:$PIECE(IB00,U,5)=Z1)
SET Z0=$DATA(^IBE(364.4,IBDA,3,"B",COBINS))
IF Z0>0
SET IBOK="R"
End DoDot:1
if 'IBOK
QUIT
+33 ;
REQMRAQ QUIT IBOK
+1 ;
MCRWNR(IBINS) ;Returns whether the ins co IBINS is MEDICARE WNR (Will
+1 ; NOT Reimburse) 0=NO, 1=YES
+2 NEW Z,Z0
+3 SET Z=0
SET Z0=$GET(^DIC(36,+IBINS,0))
+4 IF $PIECE(Z0,U,2)="N"
IF $PIECE($GET(^IBE(355.2,+$PIECE(Z0,U,13),0)),U)="MEDICARE"
SET Z=1
+5 QUIT Z
+6 ;
WNRBILL(IBIFN,IBCOB) ; Returns whether the ins for COB seq IBCOB
+1 ; is MEDICARE will not reimburse
+2 ;
+3 IF $GET(IBCOB)=""
SET IBCOB=$$COBN^IBCEF(IBIFN)
+4 SET IBCOB=$TRANSLATE(IBCOB,"PST","123")
+5 QUIT $$MCRWNR(+$GET(^DGCR(399,IBIFN,"I"_IBCOB)))
+6 ;
MCR(IBINS) ;Returns whether the ins co IBINS is MCR Will Reimburse
+1 ; 0=NO , 1=YES
+2 NEW Z,Z0
+3 SET Z=0
SET Z0=$GET(^DIC(36,+IBINS,0))
+4 IF $PIECE(Z0,U,2)'="N"
IF $PIECE($GET(^IBE(355.2,+$PIECE(Z0,U,13),0)),U)="MEDICARE"
SET Z=1
+5 QUIT Z
+6 ;
MRATYPE(IBIEN,IBVAR) ; Returns: A = MEDICARE A B = MEDICARE B
+1 ; C = MEDICARE OTHER null = NOT MEDICARE
+2 ; for the plan associated with bill ien IBIEN OR grp plan IBIEN
+3 ; If IBVAR = "" or 'C', the data is from bill ien in IBIEN
+4 ; = 'P', the data is from grp policy ien in IBIEN
+5 ;
+6 NEW IBPLAN
+7 SET IBPLAN=$SELECT($GET(IBVAR)'="P":+$$POLICY^IBCEF(IBIEN,18),1:IBIEN)
+8 QUIT $PIECE($GET(^IBA(355.3,+IBPLAN,0)),U,14)
+9 ;
MCRONBIL(IBIFN,IBFLG,IBTRBIL) ; Returns 0 if MCR WNR not on bill IBIFN
+1 ; 1 if on bill, is on or before current ins
+2 ; 2 if on bill, but after current ins
+3 ; IBFLG = a COB number if second "^" piece of return data should be
+4 ; 1 if MCRWNR is the insurance at that COB sequence (optional)
+5 ; IBTRBIL = tricare for CL1A-5
+6 ;
+7 NEW Z,IBON,Q
+8 SET IBON=0
SET Q=$$COBN^IBCEF(IBIFN)
+9 FOR Z=1:1:3
IF $$WNRBILL(IBIFN,Z)!$$TRI(IBIFN,Z)
SET IBON=$SELECT(Q'<Z:1,1:2)_$SELECT('$GET(IBFLG):"",Z'=IBFLG:"",1:"^1")
QUIT
+10 QUIT IBON
+11 ;
TRI(IBIFN,Z) ;return 1 if rate type & coverage type-Tricare
+1 NEW Z0,Z1,IBINS,IBRTY
+2 SET Z1=0
+3 IF '$GET(IBTRBIL)
QUIT Z1
+4 SET IBINS=+$GET(^DGCR(399,IBIFN,"I"_Z))
+5 SET IBRTY=$PIECE($GET(^DGCR(399.3,+$PIECE($GET(^DGCR(399,IBIFN,0)),U,7),0)),U)
+6 SET Z0=$GET(^DIC(36,+IBINS,0))
+7 IF IBRTY["TRICARE"
IF $PIECE($GET(^IBE(355.2,+$PIECE(Z0,U,13),0)),U)="TRICARE"
SET Z1=1
+8 QUIT Z1
+9 ;
PROFEE(IBIFN) ; Returns whether any rev codes for prof fees
+1 ; included on bill IBIFN 0 = not included, 1 = included,
+2 ; 2 = both inst and prof are included
+3 ;
+4 NEW IBPRO,Z
+5 ; Rev cds 960-989 are prof
SET IBPRO=0
SET Z=$ORDER(^DGCR(399,IBIFN,"RC","B",959))
+6 IF Z
IF Z<990
Begin DoDot:1
+7 SET IBPRO=1
+8 SET Z=$ORDER(^DGCR(399,IBIFN,"RC","B",0))
+9 IF $SELECT(Z:Z<960,1:0)!($ORDER(^DGCR(399,IBIFN,"RC","B",1000),-1)'<990)
SET IBPRO=2
End DoDot:1
+10 QUIT IBPRO
+11 ;
GETMOD(IBIFN,IBCPT,EXT) ; Returns 'list' of modifiers for file 399
+1 ; procedure for bill IBIFN and proc ien IBCPT
+2 ; in modifier seq order, separated by ','
+3 ; If EXT = 1, return the actual modifier, not the ptr
+4 NEW IBMOD,IBZ,IBZ0,IB0,Z
+5 SET IBZ=0
SET IBMOD=""
+6 FOR
SET IBZ=$ORDER(^DGCR(399,IBIFN,"CP",IBCPT,"MOD","B",IBZ))
if 'IBZ
QUIT
SET IBZ0=0
FOR
SET IBZ0=$ORDER(^DGCR(399,IBIFN,"CP",IBCPT,"MOD","B",IBZ,IBZ0))
if 'IBZ0
QUIT
IF $DATA(^DGCR(399,IBIFN,"CP",IBCPT,"MOD",IBZ0,0))
SET IB0=$GET(^(0))
Begin DoDot:1
+7 IF '$GET(EXT)
SET Z=$PIECE(IB0,U,2)
+8 IF $GET(EXT)
SET Z=$$MOD^ICPTMOD($PIECE(IB0,U,2),"I")
SET Z=$SELECT($PIECE(Z,U)=-1:"",1:$PIECE(Z,U,2))
+9 if Z=""
QUIT
+10 SET IBMOD=IBMOD_$SELECT(IBMOD="":"",1:",")_Z
End DoDot:1
+11 QUIT IBMOD
+12 ;
MODLST(MODS,DESC,IBMOD) ; Returns string of actual mods
+1 ; MOVED
+2 QUIT $$MODLST^IBEFUNC2(MODS,$GET(DESC),.IBMOD)
+3 ;
GETSPEC(FILE,FIELD) ; Get fld specifier for FIELD # in FILE
+1 ; Use to set DIC("P") for FILE^DICN
+2 NEW IBZ
+3 DO FIELD^DID(FILE,FIELD,"","SPECIFIER","IBZ")
+4 QUIT $GET(IBZ("SPECIFIER"))
+5 ;
