- IBVCB1 ;LITS/MRD - VIEW CANCELLED BILL, CONT. ;25-JUN-14
- ;;2.0;INTEGRATED BILLING;**516**;21-MAR-94;Build 123
- ;;Per VA Directive 6402, this routine should not be modified.
- ;
- PART2 ; Chiropractic Data, Ambulance Data, etc.
- ;
- N IBADD1,IBADD2,IBCITY,IBCOM1,IBCOM2,IBDOADD,IBFIND,IBPROV,IBPROVID,IBPUADD,IBREVCD,IBROLE,IBROLEX,IBSTATE,IBX,IBX1,IBX2,IBX3,IBX4,IBX5,IBX6,IBZIP
- ;
- S IBTEXT(1,1)=""
- S IBTEXT(2,1)="Chiropractic Data"
- S IBTEXT(3,1)="-----------------"
- D LINE^IBVCB(.IBTEXT)
- ;
- S IBX1=$$GET1^DIQ(399,IBIFN_",",246,"E")
- S IBX2=$$GET1^DIQ(399,IBIFN_",",245,"E")
- S IBX3=$$GET1^DIQ(399,IBIFN_",",247,"E")
- S IBX4=$$GET1^DIQ(399,IBIFN_",",248,"E")
- I (IBX1_IBX2_IBX3_IBX4)'="" D
- . S IBTEXT(1,1)="Initial TX Date: "_IBX1
- . S IBTEXT(1,2)="Last XRAY Date: "_IBX2
- . S IBTEXT(2,1)="Acute Manifestation Date: "_IBX3
- . S IBTEXT(2,2)="Condition Code: "_IBX4
- . D LINE^IBVCB(.IBTEXT)
- . Q
- E D
- . S IBTEXT(1,1)="*** No Chiropractic Data Found ***"
- . D LINE^IBVCB(.IBTEXT)
- . Q
- ;
- S IBTEXT(1,1)=""
- S IBTEXT(2,1)="Ambulance Data"
- S IBTEXT(3,1)="--------------"
- D LINE^IBVCB(.IBTEXT)
- ;
- S IBADD1=$$GET1^DIQ(399,IBIFN_",",271,"E")
- S IBADD2=$$GET1^DIQ(399,IBIFN_",",272,"E")
- S IBCITY=$$GET1^DIQ(399,IBIFN_",",273,"E")
- S IBSTATE=$$GET1^DIQ(399,IBIFN_",",274,"E")
- S IBZIP=$$GET1^DIQ(399,IBIFN_",",275,"E")
- S IBPUADD=IBADD1_" "_IBADD2_" "_IBCITY_" "_IBSTATE_" "_IBZIP
- ;
- S IBTEXT(1,1)="D/O Location: "_$$GET1^DIQ(399,IBIFN_",",276,"E")
- S IBADD1=$$GET1^DIQ(399,IBIFN_",",277,"E")
- S IBADD2=$$GET1^DIQ(399,IBIFN_",",278,"E")
- S IBCITY=$$GET1^DIQ(399,IBIFN_",",279,"E")
- S IBSTATE=$$GET1^DIQ(399,IBIFN_",",280,"E")
- S IBZIP=$$GET1^DIQ(399,IBIFN_",",281,"E")
- S IBDOADD=IBADD1_" "_IBADD2_" "_IBCITY_" "_IBSTATE_" "_IBZIP
- ;
- S IBX1=$$GET1^DIQ(399,IBIFN_",",287,"E")
- S IBX2=$$GET1^DIQ(399,IBIFN_",",289,"E")
- S IBX3=$$GET1^DIQ(399,IBIFN_",",288,"E")
- S IBX4=$$GET1^DIQ(399,IBIFN_",",290,"E")
- S IBX5=$$GET1^DIQ(399,IBIFN_",",291,"E")
- ;
- I (IBPUADD_IBDOADD_IBX1_IBX2_IBX3_IBX4_IBX5)'="" D
- . S IBTEXT(1,1)="P/U Address: "_IBPUADD
- . S IBTEXT(2,1)="D/O Address: "_IBDOADD
- . S IBTEXT(3,1)="Pt. Weight: "_IBX1
- . S IBTEXT(3,2)="Transport Distance: "_IBX2
- . S IBTEXT(4,1)="Transport Reason: "_IBX3
- . S IBTEXT(5,1)="R/T Purpose: "_IBX4
- . S IBTEXT(6,1)="Stretcher Purpose: "_IBX5
- . D LINE^IBVCB(.IBTEXT)
- . Q
- E D
- . S IBTEXT(1,1)="*** No Ambulance Data Found ***"
- . D LINE^IBVCB(.IBTEXT)
- . Q
- ;
- S IBTEXT(1,1)=""
- S IBTEXT(2,1)="Ambulance Conditions"
- S IBTEXT(3,1)="--------------------"
- D LINE^IBVCB(.IBTEXT)
- ;
- S IBFIND=0,IBX=0
- F S IBX=$O(^DGCR(399,IBIFN,"U9",IBX)) Q:'IBX D
- . S IBFIND=1
- . S IBTEXT(1,1)="Ambulance Condition: "_$$GET1^DIQ(399.0292,IBX_","_IBIFN_",",.01,"E")
- . D LINE^IBVCB(.IBTEXT)
- . Q
- I 'IBFIND D
- . S IBTEXT(2,1)="*** No Ambulance Conditions Found ***"
- . D LINE^IBVCB(.IBTEXT)
- . Q
- ;
- S IBTEXT(1,1)=""
- S IBTEXT(2,1)="Property & Casualty Data"
- S IBTEXT(3,1)="------------------------"
- D LINE^IBVCB(.IBTEXT)
- ;
- S IBX1=$$GET1^DIQ(399,IBIFN_",",261,"E")
- S IBX2=$$GET1^DIQ(399,IBIFN_",",262,"E")
- S IBX3=$$GET1^DIQ(399,IBIFN_",",268,"E")
- S IBX4=$$GET1^DIQ(399,IBIFN_",",269,"E")
- S IBX5=$$GET1^DIQ(399,IBIFN_",",269.1,"E")
- ;
- I (IBX1_IBX2_IBX3_IBX4)'="" D
- . S IBTEXT(1,1)="Claim Number: "_IBX1
- . S IBTEXT(1,2)="Date First Contact: "_IBX2
- . S IBTEXT(2,1)="Contact Name: "_IBX3
- . S IBTEXT(2,2)="Communication No.: "_IBX4_$S(IBX5'="":" Ext."_IBX5,1:"")
- . D LINE^IBVCB(.IBTEXT)
- . Q
- E D
- . S IBTEXT(1,1)="*** No Property & Casualty Data Found ***"
- . D LINE^IBVCB(.IBTEXT)
- . Q
- ;
- S IBTEXT(1,1)=""
- S IBTEXT(2,1)="Claim Level Providers"
- S IBTEXT(3,1)="---------------------"
- D LINE^IBVCB(.IBTEXT)
- ;
- S IBFIND=0
- F IBROLE=4,3,2,9,1,5 D
- . S IBROLEX=$S(IBROLE=1:"Referring",IBROLE=2:"Operating",IBROLE=3:"Rendering",IBROLE=4:"Attending",IBROLE=5:"Supervising",IBROLE=9:"Other Oper.",1:"")
- . S IBPROV=0
- . F S IBPROV=$O(^DGCR(399,IBIFN,"PRV",IBPROV)) Q:'IBPROV D
- . . I IBROLE'=$P(^DGCR(399,IBIFN,"PRV",IBPROV,0),U) Q
- . . S IBFIND=1
- . . ;
- . . S IBTEXT(1,1)=IBROLEX_": "_$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.02,"E")
- . . S IBTEXT(1,2)="Credentials: "_$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.03,"E")
- . . S IBTEXT(2,1)="Specialty: "_$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.08,"E")
- . . S IBTEXT(2,2)="Taxonomy: "_$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.15,"E")
- . . ;
- . . S IBPROVID=$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.12,"E")_"/"_$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.05,"E")
- . . S IBTEXT(3,1)="Prim Payer Qual/ID: "_IBPROVID
- . . S IBPROVID=$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.13,"E")_"/"_$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.06,"E")
- . . S IBTEXT(3,2)="Sec Payer Qual/ID: "_IBPROVID
- . . S IBPROVID=$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.14,"E")_"/"_$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.07,"E")
- . . S IBTEXT(4,1)="Tert Payer Qual/ID: "_IBPROVID
- . . D LINE^IBVCB(.IBTEXT)
- . . ;
- . . Q
- . Q
- I 'IBFIND D
- . S IBTEXT(5,1)="*** No Claim Level Providers Found ***"
- . D LINE^IBVCB(.IBTEXT)
- . Q
- ;
- S IBTEXT(1,1)=""
- S IBTEXT(2,1)="Non-VA Facility Data - Fee"
- S IBTEXT(3,1)="--------------------------"
- D LINE^IBVCB(.IBTEXT)
- ;
- S IBX1=$$GET1^DIQ(399,IBIFN_",",232,"E")
- S IBX2=$$GET1^DIQ(399,IBIFN_",",233,"E")
- S IBX3=$$GET1^DIQ(399,IBIFN_",",234,"E")
- S IBX4=$$GET1^DIQ(399,IBIFN_",",244,"E")
- I (IBX1_IBX2_IBX3_IBX4)'="" D
- . S IBTEXT(1,1)="Facility: "_IBX1
- . S IBTEXT(1,2)="Care Type: "_IBX2
- . S IBTEXT(2,1)="Non-VA ID: "_IBX3
- . S IBTEXT(2,2)="Taxonomy: "_IBX4
- . D LINE^IBVCB(.IBTEXT)
- . Q
- E D
- . S IBTEXT(1,1)="*** No Non-VA Facility Data Found ***"
- . D LINE^IBVCB(.IBTEXT)
- . Q
- ;
- S IBTEXT(1,1)=""
- S IBTEXT(2,1)="Comments/Signature Block"
- S IBTEXT(3,1)="------------------------"
- D LINE^IBVCB(.IBTEXT)
- ;
- S IBX1=$$GET1^DIQ(399,IBIFN_",",400,"E")
- S IBX2=$$GET1^DIQ(399,IBIFN_",",459,"E")
- S IBX3=$$GET1^DIQ(399,IBIFN_",",402,"E")
- I (IBX1_IBX2_IBX3)'="" D
- . S IBTEXT(1,1)="Box 31 (CMS1500): "_IBX1
- . S IBTEXT(2,1)="Box 19 (CMS1500): "_IBX2
- . S IBTEXT(3,1)="FL 80 (UB04): "_IBX3
- . D LINE^IBVCB(.IBTEXT)
- . Q
- E D
- . S IBTEXT(1,1)="*** No Comments/Signature Block Data Found ***"
- . D LINE^IBVCB(.IBTEXT)
- . Q
- ;
- S IBTEXT(1,1)=""
- S IBTEXT(2,1)="ECME Data"
- S IBTEXT(3,1)="---------"
- D LINE^IBVCB(.IBTEXT)
- ;
- S IBX1=$$GET1^DIQ(399,IBIFN_",",460,"E")
- S IBX2=$$GET1^DIQ(399,IBIFN_",",461,"E")
- I (IBX1_IBX2)'="" D
- . S IBTEXT(1,1)="ECME Number: "_IBX1
- . S IBTEXT(1,2)="ECME Approval: "_IBX2
- . D LINE^IBVCB(.IBTEXT)
- . Q
- E D
- . S IBTEXT(1,1)="*** No ECME Data Found ***"
- . D LINE^IBVCB(.IBTEXT)
- . Q
- ;
- S IBTEXT(1,1)=""
- S IBTEXT(2,1)="EOB/MRA Data"
- S IBTEXT(3,1)="------------"
- D LINE^IBVCB(.IBTEXT)
- ;
- S IBX1=$$GET1^DIQ(399,IBIFN_",",22,"E")
- S IBX2=$$GET1^DIQ(399,IBIFN_",",24,"E")
- S IBX3=$$GET1^DIQ(399,IBIFN_",",453,"E")
- S IBX4=$$GET1^DIQ(399,IBIFN_",",454,"E")
- S IBX5=$$GET1^DIQ(399,IBIFN_",",455,"E")
- I (IBX1_IBX2_IBX3_IBX4_IBX5)'="" D
- . S IBTEXT(1,1)="Date MRA Received: "_IBX1
- . S IBTEXT(1,2)="MRA Status: "_IBX2
- . S IBTEXT(2,1)="Primary ICN: "_IBX3
- . S IBTEXT(2,2)="Secondary ICN: "_IBX4
- . S IBTEXT(3,1)="Tertiary ICN: "_IBX5
- . D LINE^IBVCB(.IBTEXT)
- . Q
- E D
- . S IBTEXT(1,1)="*** No EOB/MRA Data Found ***"
- . D LINE^IBVCB(.IBTEXT)
- . Q
- ;
- S IBTEXT(1,1)=""
- S IBTEXT(2,1)="PRV Diagnosis Codes"
- S IBTEXT(3,1)="-------------------"
- D LINE^IBVCB(.IBTEXT)
- ;
- S IBX1=$$GET1^DIQ(399,IBIFN_",",249,"E")
- S IBX2=$$GET1^DIQ(399,IBIFN_",",250,"E")
- S IBX3=$$GET1^DIQ(399,IBIFN_",",251,"E")
- I (IBX1_IBX2_IBX3)'="" D
- . S IBTEXT(1,1)="PRV #1: "_IBX1
- . S IBTEXT(1,2)="PRV #2: "_IBX2
- . S IBTEXT(2,1)="PRV #3: "_IBX3
- . D LINE^IBVCB(.IBTEXT)
- . Q
- E D
- . S IBTEXT(1,1)="*** No PRV Diagnosis Code Found ***"
- . D LINE^IBVCB(.IBTEXT)
- . Q
- ;
- S IBTEXT(1,1)=""
- S IBTEXT(2,1)="Comments"
- S IBTEXT(3,1)="--------"
- D LINE^IBVCB(.IBTEXT)
- ;
- S IBFIND=0,IBCOM1=0
- F S IBCOM1=$O(^DGCR(399,IBIFN,"TXC",IBCOM1)) Q:'IBCOM1 D
- . S IBCOM2=0
- . F S IBCOM2=$O(^DGCR(399,IBIFN,"TXC",IBCOM1,1,IBCOM2)) Q:'IBCOM2 D
- . . S IBFIND=1
- . . S IBTEXT(1,1)="MRA WL Comments: "_$$GET1^DIQ(399.0771,IBCOM2_","_IBCOM1_","_IBIFN_",",.01,"E")
- . . S IBTEXT(2,1)="MRA WL Comments Date: "_$$GET1^DIQ(399.077,IBCOM1_","_IBIFN_",",.01,"E")
- . . S IBTEXT(2,2)="Entered By: "_$$GET1^DIQ(399.077,IBCOM1_","_IBIFN_",",.02,"E")
- . . D LINE^IBVCB(.IBTEXT)
- . . Q
- . Q
- I 'IBFIND D
- . S IBTEXT(1,1)="*** No MRA WL Comments Found ***"
- . D LINE^IBVCB(.IBTEXT)
- . Q
- ;
- S IBFIND=0,IBCOM1=0
- F S IBCOM1=$O(^DGCR(399,IBIFN,"TXC2",IBCOM1)) Q:'IBCOM1 D
- . S IBCOM2=0
- . F S IBCOM2=$O(^DGCR(399,IBIFN,"TXC2",IBCOM1,1,IBCOM2)) Q:'IBCOM2 D
- . . S IBFIND=1
- . . S IBTEXT(1,1)="COB WL Comments: "_$$GET1^DIQ(399.0781,IBCOM2_","_IBCOM1_","_IBIFN_",",.01,"E")
- . . S IBTEXT(2,1)="COB WL Comments Date: "_$$GET1^DIQ(399.078,IBCOM1_","_IBIFN_",",.01,"E")
- . . S IBTEXT(2,2)="Entered By: "_$$GET1^DIQ(399.078,IBCOM1_","_IBIFN_",",.02,"E")
- . . D LINE^IBVCB(.IBTEXT)
- . . Q
- . Q
- I 'IBFIND D
- . S IBTEXT(1,1)="*** No COB WL Comments Found ***"
- . D LINE^IBVCB(.IBTEXT)
- . Q
- ;
- S IBTEXT(1,1)=""
- S IBTEXT(2,1)="Referral/Authorization Code"
- S IBTEXT(3,1)="---------------------------"
- D LINE^IBVCB(.IBTEXT)
- ;
- S IBX1=$$GET1^DIQ(399,IBIFN_",",163,"E")
- S IBX2=$$GET1^DIQ(399,IBIFN_",",230,"E")
- S IBX3=$$GET1^DIQ(399,IBIFN_",",231,"E")
- S IBX4=$$GET1^DIQ(399,IBIFN_",",253,"E")
- S IBX5=$$GET1^DIQ(399,IBIFN_",",254,"E")
- S IBX6=$$GET1^DIQ(399,IBIFN_",",255,"E")
- I (IBX1_IBX2_IBX3_IBX4_IBX5_IBX6)'="" D
- . S IBTEXT(1,1)="A/Primary: "_IBX1
- . S IBTEXT(1,2)="A/Secondary: "_IBX2
- . S IBTEXT(2,1)="A/Tertiary: "_IBX3
- . S IBTEXT(2,2)="R/Primary: "_IBX4
- . S IBTEXT(3,1)="R/Secondary: "_IBX5
- . S IBTEXT(3,2)="R/Tertiary: "_IBX6
- . D LINE^IBVCB(.IBTEXT)
- . Q
- E D
- . S IBTEXT(1,1)="*** No Referral/Authorization Code Data Found ***"
- . D LINE^IBVCB(.IBTEXT)
- . Q
- ;
- S IBTEXT(1,1)=""
- S IBTEXT(2,1)="Revenue Codes"
- S IBTEXT(3,1)="-------------"
- D LINE^IBVCB(.IBTEXT)
- ;
- S IBFIND=0,IBREVCD=0
- F S IBREVCD=$O(^DGCR(399,IBIFN,"RC",IBREVCD)) Q:'IBREVCD D
- . ; Print a blank line if this is not the first revenue code.
- . I IBFIND S IBTEXT(1,1)="" D LINE^IBVCB(.IBTEXT)
- . S IBFIND=1
- . S IBTEXT(1,1)="Code: "_$$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.01,"E")
- . S IBTEXT(1,2)="Number: "_$$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.001,"E")
- . ;
- . S IBTEXT(2,1)="Charges: "_$$DOLLAR^IBVCB($$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.02,"E"))
- . S IBTEXT(2,2)="Units: "_$$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.03,"E")
- . ;
- . S IBTEXT(3,1)="Total Charges: "_$$DOLLAR^IBVCB($$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.04,"E"))
- . S IBTEXT(3,2)="Bedsection: "_$$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.05,"E")
- . ;
- . S IBTEXT(4,1)="Procedure: "_$$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.06,"E")
- . S IBTEXT(4,2)="RX Procedure: "_$$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.15,"E")
- . ;
- . S IBTEXT(5,1)="Division: "_$$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.07,"E")
- . S IBTEXT(5,2)="Type: "_$$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.1,"E")
- . ;
- . S IBTEXT(6,1)="Non-covered Charges: "_$$DOLLAR^IBVCB($$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.09,"E"))
- . S IBTEXT(6,2)="Component: "_$$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.12,"E")
- . D LINE^IBVCB(.IBTEXT)
- . ;
- . Q
- I 'IBFIND D
- . S IBTEXT(1,1)="*** No Revenue Codes Found ***"
- . D LINE^IBVCB(.IBTEXT)
- . Q
- ;
- Q
- ;
- --- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HIBVCB1 11603 printed Mar 13, 2025@21:34:25 Page 2
- IBVCB1 ;LITS/MRD - VIEW CANCELLED BILL, CONT. ;25-JUN-14
- +1 ;;2.0;INTEGRATED BILLING;**516**;21-MAR-94;Build 123
- +2 ;;Per VA Directive 6402, this routine should not be modified.
- +3 ;
- PART2 ; Chiropractic Data, Ambulance Data, etc.
- +1 ;
- +2 NEW IBADD1,IBADD2,IBCITY,IBCOM1,IBCOM2,IBDOADD,IBFIND,IBPROV,IBPROVID,IBPUADD,IBREVCD,IBROLE,IBROLEX,IBSTATE,IBX,IBX1,IBX2,IBX3,IBX4,IBX5,IBX6,IBZIP
- +3 ;
- +4 SET IBTEXT(1,1)=""
- +5 SET IBTEXT(2,1)="Chiropractic Data"
- +6 SET IBTEXT(3,1)="-----------------"
- +7 DO LINE^IBVCB(.IBTEXT)
- +8 ;
- +9 SET IBX1=$$GET1^DIQ(399,IBIFN_",",246,"E")
- +10 SET IBX2=$$GET1^DIQ(399,IBIFN_",",245,"E")
- +11 SET IBX3=$$GET1^DIQ(399,IBIFN_",",247,"E")
- +12 SET IBX4=$$GET1^DIQ(399,IBIFN_",",248,"E")
- +13 IF (IBX1_IBX2_IBX3_IBX4)'=""
- Begin DoDot:1
- +14 SET IBTEXT(1,1)="Initial TX Date: "_IBX1
- +15 SET IBTEXT(1,2)="Last XRAY Date: "_IBX2
- +16 SET IBTEXT(2,1)="Acute Manifestation Date: "_IBX3
- +17 SET IBTEXT(2,2)="Condition Code: "_IBX4
- +18 DO LINE^IBVCB(.IBTEXT)
- +19 QUIT
- End DoDot:1
- +20 IF '$TEST
- Begin DoDot:1
- +21 SET IBTEXT(1,1)="*** No Chiropractic Data Found ***"
- +22 DO LINE^IBVCB(.IBTEXT)
- +23 QUIT
- End DoDot:1
- +24 ;
- +25 SET IBTEXT(1,1)=""
- +26 SET IBTEXT(2,1)="Ambulance Data"
- +27 SET IBTEXT(3,1)="--------------"
- +28 DO LINE^IBVCB(.IBTEXT)
- +29 ;
- +30 SET IBADD1=$$GET1^DIQ(399,IBIFN_",",271,"E")
- +31 SET IBADD2=$$GET1^DIQ(399,IBIFN_",",272,"E")
- +32 SET IBCITY=$$GET1^DIQ(399,IBIFN_",",273,"E")
- +33 SET IBSTATE=$$GET1^DIQ(399,IBIFN_",",274,"E")
- +34 SET IBZIP=$$GET1^DIQ(399,IBIFN_",",275,"E")
- +35 SET IBPUADD=IBADD1_" "_IBADD2_" "_IBCITY_" "_IBSTATE_" "_IBZIP
- +36 ;
- +37 SET IBTEXT(1,1)="D/O Location: "_$$GET1^DIQ(399,IBIFN_",",276,"E")
- +38 SET IBADD1=$$GET1^DIQ(399,IBIFN_",",277,"E")
- +39 SET IBADD2=$$GET1^DIQ(399,IBIFN_",",278,"E")
- +40 SET IBCITY=$$GET1^DIQ(399,IBIFN_",",279,"E")
- +41 SET IBSTATE=$$GET1^DIQ(399,IBIFN_",",280,"E")
- +42 SET IBZIP=$$GET1^DIQ(399,IBIFN_",",281,"E")
- +43 SET IBDOADD=IBADD1_" "_IBADD2_" "_IBCITY_" "_IBSTATE_" "_IBZIP
- +44 ;
- +45 SET IBX1=$$GET1^DIQ(399,IBIFN_",",287,"E")
- +46 SET IBX2=$$GET1^DIQ(399,IBIFN_",",289,"E")
- +47 SET IBX3=$$GET1^DIQ(399,IBIFN_",",288,"E")
- +48 SET IBX4=$$GET1^DIQ(399,IBIFN_",",290,"E")
- +49 SET IBX5=$$GET1^DIQ(399,IBIFN_",",291,"E")
- +50 ;
- +51 IF (IBPUADD_IBDOADD_IBX1_IBX2_IBX3_IBX4_IBX5)'=""
- Begin DoDot:1
- +52 SET IBTEXT(1,1)="P/U Address: "_IBPUADD
- +53 SET IBTEXT(2,1)="D/O Address: "_IBDOADD
- +54 SET IBTEXT(3,1)="Pt. Weight: "_IBX1
- +55 SET IBTEXT(3,2)="Transport Distance: "_IBX2
- +56 SET IBTEXT(4,1)="Transport Reason: "_IBX3
- +57 SET IBTEXT(5,1)="R/T Purpose: "_IBX4
- +58 SET IBTEXT(6,1)="Stretcher Purpose: "_IBX5
- +59 DO LINE^IBVCB(.IBTEXT)
- +60 QUIT
- End DoDot:1
- +61 IF '$TEST
- Begin DoDot:1
- +62 SET IBTEXT(1,1)="*** No Ambulance Data Found ***"
- +63 DO LINE^IBVCB(.IBTEXT)
- +64 QUIT
- End DoDot:1
- +65 ;
- +66 SET IBTEXT(1,1)=""
- +67 SET IBTEXT(2,1)="Ambulance Conditions"
- +68 SET IBTEXT(3,1)="--------------------"
- +69 DO LINE^IBVCB(.IBTEXT)
- +70 ;
- +71 SET IBFIND=0
- SET IBX=0
- +72 FOR
- SET IBX=$ORDER(^DGCR(399,IBIFN,"U9",IBX))
- if 'IBX
- QUIT
- Begin DoDot:1
- +73 SET IBFIND=1
- +74 SET IBTEXT(1,1)="Ambulance Condition: "_$$GET1^DIQ(399.0292,IBX_","_IBIFN_",",.01,"E")
- +75 DO LINE^IBVCB(.IBTEXT)
- +76 QUIT
- End DoDot:1
- +77 IF 'IBFIND
- Begin DoDot:1
- +78 SET IBTEXT(2,1)="*** No Ambulance Conditions Found ***"
- +79 DO LINE^IBVCB(.IBTEXT)
- +80 QUIT
- End DoDot:1
- +81 ;
- +82 SET IBTEXT(1,1)=""
- +83 SET IBTEXT(2,1)="Property & Casualty Data"
- +84 SET IBTEXT(3,1)="------------------------"
- +85 DO LINE^IBVCB(.IBTEXT)
- +86 ;
- +87 SET IBX1=$$GET1^DIQ(399,IBIFN_",",261,"E")
- +88 SET IBX2=$$GET1^DIQ(399,IBIFN_",",262,"E")
- +89 SET IBX3=$$GET1^DIQ(399,IBIFN_",",268,"E")
- +90 SET IBX4=$$GET1^DIQ(399,IBIFN_",",269,"E")
- +91 SET IBX5=$$GET1^DIQ(399,IBIFN_",",269.1,"E")
- +92 ;
- +93 IF (IBX1_IBX2_IBX3_IBX4)'=""
- Begin DoDot:1
- +94 SET IBTEXT(1,1)="Claim Number: "_IBX1
- +95 SET IBTEXT(1,2)="Date First Contact: "_IBX2
- +96 SET IBTEXT(2,1)="Contact Name: "_IBX3
- +97 SET IBTEXT(2,2)="Communication No.: "_IBX4_$SELECT(IBX5'="":" Ext."_IBX5,1:"")
- +98 DO LINE^IBVCB(.IBTEXT)
- +99 QUIT
- End DoDot:1
- +100 IF '$TEST
- Begin DoDot:1
- +101 SET IBTEXT(1,1)="*** No Property & Casualty Data Found ***"
- +102 DO LINE^IBVCB(.IBTEXT)
- +103 QUIT
- End DoDot:1
- +104 ;
- +105 SET IBTEXT(1,1)=""
- +106 SET IBTEXT(2,1)="Claim Level Providers"
- +107 SET IBTEXT(3,1)="---------------------"
- +108 DO LINE^IBVCB(.IBTEXT)
- +109 ;
- +110 SET IBFIND=0
- +111 FOR IBROLE=4,3,2,9,1,5
- Begin DoDot:1
- +112 SET IBROLEX=$SELECT(IBROLE=1:"Referring",IBROLE=2:"Operating",IBROLE=3:"Rendering",IBROLE=4:"Attending",IBROLE=5:"Supervising",IBROLE=9:"Other Oper.",1:"")
- +113 SET IBPROV=0
- +114 FOR
- SET IBPROV=$ORDER(^DGCR(399,IBIFN,"PRV",IBPROV))
- if 'IBPROV
- QUIT
- Begin DoDot:2
- +115 IF IBROLE'=$PIECE(^DGCR(399,IBIFN,"PRV",IBPROV,0),U)
- QUIT
- +116 SET IBFIND=1
- +117 ;
- +118 SET IBTEXT(1,1)=IBROLEX_": "_$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.02,"E")
- +119 SET IBTEXT(1,2)="Credentials: "_$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.03,"E")
- +120 SET IBTEXT(2,1)="Specialty: "_$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.08,"E")
- +121 SET IBTEXT(2,2)="Taxonomy: "_$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.15,"E")
- +122 ;
- +123 SET IBPROVID=$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.12,"E")_"/"_$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.05,"E")
- +124 SET IBTEXT(3,1)="Prim Payer Qual/ID: "_IBPROVID
- +125 SET IBPROVID=$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.13,"E")_"/"_$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.06,"E")
- +126 SET IBTEXT(3,2)="Sec Payer Qual/ID: "_IBPROVID
- +127 SET IBPROVID=$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.14,"E")_"/"_$$GET1^DIQ(399.0222,IBPROV_","_IBIFN_",",.07,"E")
- +128 SET IBTEXT(4,1)="Tert Payer Qual/ID: "_IBPROVID
- +129 DO LINE^IBVCB(.IBTEXT)
- +130 ;
- +131 QUIT
- End DoDot:2
- +132 QUIT
- End DoDot:1
- +133 IF 'IBFIND
- Begin DoDot:1
- +134 SET IBTEXT(5,1)="*** No Claim Level Providers Found ***"
- +135 DO LINE^IBVCB(.IBTEXT)
- +136 QUIT
- End DoDot:1
- +137 ;
- +138 SET IBTEXT(1,1)=""
- +139 SET IBTEXT(2,1)="Non-VA Facility Data - Fee"
- +140 SET IBTEXT(3,1)="--------------------------"
- +141 DO LINE^IBVCB(.IBTEXT)
- +142 ;
- +143 SET IBX1=$$GET1^DIQ(399,IBIFN_",",232,"E")
- +144 SET IBX2=$$GET1^DIQ(399,IBIFN_",",233,"E")
- +145 SET IBX3=$$GET1^DIQ(399,IBIFN_",",234,"E")
- +146 SET IBX4=$$GET1^DIQ(399,IBIFN_",",244,"E")
- +147 IF (IBX1_IBX2_IBX3_IBX4)'=""
- Begin DoDot:1
- +148 SET IBTEXT(1,1)="Facility: "_IBX1
- +149 SET IBTEXT(1,2)="Care Type: "_IBX2
- +150 SET IBTEXT(2,1)="Non-VA ID: "_IBX3
- +151 SET IBTEXT(2,2)="Taxonomy: "_IBX4
- +152 DO LINE^IBVCB(.IBTEXT)
- +153 QUIT
- End DoDot:1
- +154 IF '$TEST
- Begin DoDot:1
- +155 SET IBTEXT(1,1)="*** No Non-VA Facility Data Found ***"
- +156 DO LINE^IBVCB(.IBTEXT)
- +157 QUIT
- End DoDot:1
- +158 ;
- +159 SET IBTEXT(1,1)=""
- +160 SET IBTEXT(2,1)="Comments/Signature Block"
- +161 SET IBTEXT(3,1)="------------------------"
- +162 DO LINE^IBVCB(.IBTEXT)
- +163 ;
- +164 SET IBX1=$$GET1^DIQ(399,IBIFN_",",400,"E")
- +165 SET IBX2=$$GET1^DIQ(399,IBIFN_",",459,"E")
- +166 SET IBX3=$$GET1^DIQ(399,IBIFN_",",402,"E")
- +167 IF (IBX1_IBX2_IBX3)'=""
- Begin DoDot:1
- +168 SET IBTEXT(1,1)="Box 31 (CMS1500): "_IBX1
- +169 SET IBTEXT(2,1)="Box 19 (CMS1500): "_IBX2
- +170 SET IBTEXT(3,1)="FL 80 (UB04): "_IBX3
- +171 DO LINE^IBVCB(.IBTEXT)
- +172 QUIT
- End DoDot:1
- +173 IF '$TEST
- Begin DoDot:1
- +174 SET IBTEXT(1,1)="*** No Comments/Signature Block Data Found ***"
- +175 DO LINE^IBVCB(.IBTEXT)
- +176 QUIT
- End DoDot:1
- +177 ;
- +178 SET IBTEXT(1,1)=""
- +179 SET IBTEXT(2,1)="ECME Data"
- +180 SET IBTEXT(3,1)="---------"
- +181 DO LINE^IBVCB(.IBTEXT)
- +182 ;
- +183 SET IBX1=$$GET1^DIQ(399,IBIFN_",",460,"E")
- +184 SET IBX2=$$GET1^DIQ(399,IBIFN_",",461,"E")
- +185 IF (IBX1_IBX2)'=""
- Begin DoDot:1
- +186 SET IBTEXT(1,1)="ECME Number: "_IBX1
- +187 SET IBTEXT(1,2)="ECME Approval: "_IBX2
- +188 DO LINE^IBVCB(.IBTEXT)
- +189 QUIT
- End DoDot:1
- +190 IF '$TEST
- Begin DoDot:1
- +191 SET IBTEXT(1,1)="*** No ECME Data Found ***"
- +192 DO LINE^IBVCB(.IBTEXT)
- +193 QUIT
- End DoDot:1
- +194 ;
- +195 SET IBTEXT(1,1)=""
- +196 SET IBTEXT(2,1)="EOB/MRA Data"
- +197 SET IBTEXT(3,1)="------------"
- +198 DO LINE^IBVCB(.IBTEXT)
- +199 ;
- +200 SET IBX1=$$GET1^DIQ(399,IBIFN_",",22,"E")
- +201 SET IBX2=$$GET1^DIQ(399,IBIFN_",",24,"E")
- +202 SET IBX3=$$GET1^DIQ(399,IBIFN_",",453,"E")
- +203 SET IBX4=$$GET1^DIQ(399,IBIFN_",",454,"E")
- +204 SET IBX5=$$GET1^DIQ(399,IBIFN_",",455,"E")
- +205 IF (IBX1_IBX2_IBX3_IBX4_IBX5)'=""
- Begin DoDot:1
- +206 SET IBTEXT(1,1)="Date MRA Received: "_IBX1
- +207 SET IBTEXT(1,2)="MRA Status: "_IBX2
- +208 SET IBTEXT(2,1)="Primary ICN: "_IBX3
- +209 SET IBTEXT(2,2)="Secondary ICN: "_IBX4
- +210 SET IBTEXT(3,1)="Tertiary ICN: "_IBX5
- +211 DO LINE^IBVCB(.IBTEXT)
- +212 QUIT
- End DoDot:1
- +213 IF '$TEST
- Begin DoDot:1
- +214 SET IBTEXT(1,1)="*** No EOB/MRA Data Found ***"
- +215 DO LINE^IBVCB(.IBTEXT)
- +216 QUIT
- End DoDot:1
- +217 ;
- +218 SET IBTEXT(1,1)=""
- +219 SET IBTEXT(2,1)="PRV Diagnosis Codes"
- +220 SET IBTEXT(3,1)="-------------------"
- +221 DO LINE^IBVCB(.IBTEXT)
- +222 ;
- +223 SET IBX1=$$GET1^DIQ(399,IBIFN_",",249,"E")
- +224 SET IBX2=$$GET1^DIQ(399,IBIFN_",",250,"E")
- +225 SET IBX3=$$GET1^DIQ(399,IBIFN_",",251,"E")
- +226 IF (IBX1_IBX2_IBX3)'=""
- Begin DoDot:1
- +227 SET IBTEXT(1,1)="PRV #1: "_IBX1
- +228 SET IBTEXT(1,2)="PRV #2: "_IBX2
- +229 SET IBTEXT(2,1)="PRV #3: "_IBX3
- +230 DO LINE^IBVCB(.IBTEXT)
- +231 QUIT
- End DoDot:1
- +232 IF '$TEST
- Begin DoDot:1
- +233 SET IBTEXT(1,1)="*** No PRV Diagnosis Code Found ***"
- +234 DO LINE^IBVCB(.IBTEXT)
- +235 QUIT
- End DoDot:1
- +236 ;
- +237 SET IBTEXT(1,1)=""
- +238 SET IBTEXT(2,1)="Comments"
- +239 SET IBTEXT(3,1)="--------"
- +240 DO LINE^IBVCB(.IBTEXT)
- +241 ;
- +242 SET IBFIND=0
- SET IBCOM1=0
- +243 FOR
- SET IBCOM1=$ORDER(^DGCR(399,IBIFN,"TXC",IBCOM1))
- if 'IBCOM1
- QUIT
- Begin DoDot:1
- +244 SET IBCOM2=0
- +245 FOR
- SET IBCOM2=$ORDER(^DGCR(399,IBIFN,"TXC",IBCOM1,1,IBCOM2))
- if 'IBCOM2
- QUIT
- Begin DoDot:2
- +246 SET IBFIND=1
- +247 SET IBTEXT(1,1)="MRA WL Comments: "_$$GET1^DIQ(399.0771,IBCOM2_","_IBCOM1_","_IBIFN_",",.01,"E")
- +248 SET IBTEXT(2,1)="MRA WL Comments Date: "_$$GET1^DIQ(399.077,IBCOM1_","_IBIFN_",",.01,"E")
- +249 SET IBTEXT(2,2)="Entered By: "_$$GET1^DIQ(399.077,IBCOM1_","_IBIFN_",",.02,"E")
- +250 DO LINE^IBVCB(.IBTEXT)
- +251 QUIT
- End DoDot:2
- +252 QUIT
- End DoDot:1
- +253 IF 'IBFIND
- Begin DoDot:1
- +254 SET IBTEXT(1,1)="*** No MRA WL Comments Found ***"
- +255 DO LINE^IBVCB(.IBTEXT)
- +256 QUIT
- End DoDot:1
- +257 ;
- +258 SET IBFIND=0
- SET IBCOM1=0
- +259 FOR
- SET IBCOM1=$ORDER(^DGCR(399,IBIFN,"TXC2",IBCOM1))
- if 'IBCOM1
- QUIT
- Begin DoDot:1
- +260 SET IBCOM2=0
- +261 FOR
- SET IBCOM2=$ORDER(^DGCR(399,IBIFN,"TXC2",IBCOM1,1,IBCOM2))
- if 'IBCOM2
- QUIT
- Begin DoDot:2
- +262 SET IBFIND=1
- +263 SET IBTEXT(1,1)="COB WL Comments: "_$$GET1^DIQ(399.0781,IBCOM2_","_IBCOM1_","_IBIFN_",",.01,"E")
- +264 SET IBTEXT(2,1)="COB WL Comments Date: "_$$GET1^DIQ(399.078,IBCOM1_","_IBIFN_",",.01,"E")
- +265 SET IBTEXT(2,2)="Entered By: "_$$GET1^DIQ(399.078,IBCOM1_","_IBIFN_",",.02,"E")
- +266 DO LINE^IBVCB(.IBTEXT)
- +267 QUIT
- End DoDot:2
- +268 QUIT
- End DoDot:1
- +269 IF 'IBFIND
- Begin DoDot:1
- +270 SET IBTEXT(1,1)="*** No COB WL Comments Found ***"
- +271 DO LINE^IBVCB(.IBTEXT)
- +272 QUIT
- End DoDot:1
- +273 ;
- +274 SET IBTEXT(1,1)=""
- +275 SET IBTEXT(2,1)="Referral/Authorization Code"
- +276 SET IBTEXT(3,1)="---------------------------"
- +277 DO LINE^IBVCB(.IBTEXT)
- +278 ;
- +279 SET IBX1=$$GET1^DIQ(399,IBIFN_",",163,"E")
- +280 SET IBX2=$$GET1^DIQ(399,IBIFN_",",230,"E")
- +281 SET IBX3=$$GET1^DIQ(399,IBIFN_",",231,"E")
- +282 SET IBX4=$$GET1^DIQ(399,IBIFN_",",253,"E")
- +283 SET IBX5=$$GET1^DIQ(399,IBIFN_",",254,"E")
- +284 SET IBX6=$$GET1^DIQ(399,IBIFN_",",255,"E")
- +285 IF (IBX1_IBX2_IBX3_IBX4_IBX5_IBX6)'=""
- Begin DoDot:1
- +286 SET IBTEXT(1,1)="A/Primary: "_IBX1
- +287 SET IBTEXT(1,2)="A/Secondary: "_IBX2
- +288 SET IBTEXT(2,1)="A/Tertiary: "_IBX3
- +289 SET IBTEXT(2,2)="R/Primary: "_IBX4
- +290 SET IBTEXT(3,1)="R/Secondary: "_IBX5
- +291 SET IBTEXT(3,2)="R/Tertiary: "_IBX6
- +292 DO LINE^IBVCB(.IBTEXT)
- +293 QUIT
- End DoDot:1
- +294 IF '$TEST
- Begin DoDot:1
- +295 SET IBTEXT(1,1)="*** No Referral/Authorization Code Data Found ***"
- +296 DO LINE^IBVCB(.IBTEXT)
- +297 QUIT
- End DoDot:1
- +298 ;
- +299 SET IBTEXT(1,1)=""
- +300 SET IBTEXT(2,1)="Revenue Codes"
- +301 SET IBTEXT(3,1)="-------------"
- +302 DO LINE^IBVCB(.IBTEXT)
- +303 ;
- +304 SET IBFIND=0
- SET IBREVCD=0
- +305 FOR
- SET IBREVCD=$ORDER(^DGCR(399,IBIFN,"RC",IBREVCD))
- if 'IBREVCD
- QUIT
- Begin DoDot:1
- +306 ; Print a blank line if this is not the first revenue code.
- +307 IF IBFIND
- SET IBTEXT(1,1)=""
- DO LINE^IBVCB(.IBTEXT)
- +308 SET IBFIND=1
- +309 SET IBTEXT(1,1)="Code: "_$$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.01,"E")
- +310 SET IBTEXT(1,2)="Number: "_$$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.001,"E")
- +311 ;
- +312 SET IBTEXT(2,1)="Charges: "_$$DOLLAR^IBVCB($$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.02,"E"))
- +313 SET IBTEXT(2,2)="Units: "_$$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.03,"E")
- +314 ;
- +315 SET IBTEXT(3,1)="Total Charges: "_$$DOLLAR^IBVCB($$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.04,"E"))
- +316 SET IBTEXT(3,2)="Bedsection: "_$$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.05,"E")
- +317 ;
- +318 SET IBTEXT(4,1)="Procedure: "_$$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.06,"E")
- +319 SET IBTEXT(4,2)="RX Procedure: "_$$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.15,"E")
- +320 ;
- +321 SET IBTEXT(5,1)="Division: "_$$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.07,"E")
- +322 SET IBTEXT(5,2)="Type: "_$$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.1,"E")
- +323 ;
- +324 SET IBTEXT(6,1)="Non-covered Charges: "_$$DOLLAR^IBVCB($$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.09,"E"))
- +325 SET IBTEXT(6,2)="Component: "_$$GET1^DIQ(399.042,IBREVCD_","_IBIFN_",",.12,"E")
- +326 DO LINE^IBVCB(.IBTEXT)
- +327 ;
- +328 QUIT
- End DoDot:1
- +329 IF 'IBFIND
- Begin DoDot:1
- +330 SET IBTEXT(1,1)="*** No Revenue Codes Found ***"
- +331 DO LINE^IBVCB(.IBTEXT)
- +332 QUIT
- End DoDot:1
- +333 ;
- +334 QUIT
- +335 ;