PRCABJ2 ;OIT/hrub - NIGHTLY PROCESS FOR ACCOUNTS RECEIVABLE ;31 Oct 2018 16:00:59
;;4.5;Accounts Receivable;**304,321,326,332,338,351**;Mar 20, 1995;Build 15
;Per VA Directive 6402, this routine should not be modified.
;
; read of ^DGCR(399.2 allowed by DBIA 3822
; refactored 17 October 2018, PRCA*4.5*332
Q
; Auto-audit Paper, Electronic, and Tricare bills if ready
; PRCA*4.5*332 - Whole subroutine re-written
ABAUDIT ;
; APIEN - Accounts Payable (file #430) ien (also same ien for file #399)
N APIEN,ARBILL,C,FLAG,J,PRCA,RTYPE ;PRCA*4.5*321, PRCA*4.5*332
;
S ARBILL("newBillIEN")=$O(^PRCA(430.3,"B","NEW BILL","")) ; New Bill IEN
Q:ARBILL("newBillIEN")="" ; must have the IEN for new bills
; Check parameters to see if audit needs to run
S FLAG("aaMedPaper")=$$GET1^DIQ(342,"1,",7.05,"I") ; (#7.05) AUTO-AUDIT MEDICAL PAPER BILLS [5S]
S FLAG("aaRxPaper")=$$GET1^DIQ(342,"1,",7.06,"I") ; (#7.06) AUTO-AUDIT RX PAPER BILLS [6S]
S FLAG("aaMedEDI")=$$GET1^DIQ(342,"1,",7.07,"I") ; (#7.07) AUTO-AUDIT MEDICAL EDI BILLS [7S] - PRCA*4.5*321
S FLAG("aaRxEDI")=$$GET1^DIQ(342,"1,",7.08,"I") ; (#7.08) AUTO-AUDIT RX EDI BILLS [8S] - PRCA*4.5*321
S FLAG("aaTricare")=$$GET1^DIQ(342,"1,",7.09,"I") ; (#7.09) AUTO-AUDIT TRICARE BILLS [9S] - PRCA*4.5*332
; quit if all auto-audit parameters are 'No'
Q:('FLAG("aaMedPaper"))&('FLAG("aaRxPaper"))&('FLAG("aaMedEDI"))&('FLAG("aaRxEDI"))&('FLAG("aaTricare")) ; PRCA*4.5*321
;
; RTYPE - array of RATE TYPE entries that have (#.11) BILL RESULTING FROM [11P:430.6] - PRCA*4.5*332
S C=0 F S C=$O(^DGCR(399.3,C)) Q:'C S J=$G(^(C,0)) S:$P(J,U,11) RTYPE(C)=J
; loop through new bills
; BILL - info for this bill
; PRCA - bill # and ECME info
; RTDGCR - used for file #399 info (except rate type)
S APIEN="" F S APIEN=$O(^PRCA(430,"AC",ARBILL("newBillIEN"),APIEN)) Q:'APIEN D
. N BILL,PRCA,RTDGCR
. ;
. S BILL("rtTyp")=$$GET1^DIQ(399,APIEN_",",.07,"I") ; (#.07) RATE TYPE [7P:399.3] - PRCA*4.5*326
. Q:'BILL("rtTyp") ; must have rate type
. Q:'$D(RTYPE(BILL("rtTyp"))) ; no auto-audit for this RATE TYPE
. ; BEGIN - PRCA*4.5*321
. Q:$$GET1^DIQ(430,APIEN_",",7,"I")="" ; quit if no (#7) PATIENT [7P:2]
. Q:$$GET1^DIQ(430,APIEN_",",9,"I")="" ; quit if no (#9) DEBTOR [9P:340]
. Q:$$GET1^DIQ(430,APIEN_",",239,"I")="" ; quit if no (#239) INSURED NAME [1F]
. Q:$$GET1^DIQ(430,APIEN_",",243,"I")="" ; quit if no (#243) GROUP NAME [5F]
. Q:$$GET1^DIQ(430,APIEN_",",244,"I")="" ; quit if no (#244) GROUP NUMBER [6F]
. Q:$$BILLREJ^PRCAUDT(APIEN) ; PRCA*4.5*321 - claim has reject messages, do not audit
. ;
. S RTDGCR("type")=$$GET1^DIQ(399,APIEN_",",.07,"E") ; (#.07) RATE TYPE [7P:399.3] (IA 4118)
. S RTDGCR("paper")=$$GET1^DIQ(399,APIEN_",",27,"I") ; (#.27) BILL CHARGE TYPE [27S] (ICR 3820)
. S BILL("audit?")=0 ; Boolean flag, need to audit bill?
. S BILL("doneCheck?")=0 ; Boolean flag, done checking?
. ; Get Bill number to check if it's a Pharmacy bill
. S PRCA("bill#")=$$GET1^DIQ(430,APIEN_",",.01,"I") ; (#.01) BILL NO. [1F]
. S PRCA("ecme#")=$$GETECME^RCDPENR1(APIEN) ; ECME# from the bill
. ;
. I PRCA("ecme#")'="" D ; has ECME#, check pharmacy flags
.. I RTDGCR("paper"),'FLAG("aaRxPaper") S BILL("doneCheck?")=1 Q ; Skip paper bill if No auto-audit
.. I 'RTDGCR("paper"),'FLAG("aaRxEDI") S BILL("doneCheck?")=1 Q ; Skip EDI bill if No auto-audit
.. S BILL("audit?")="1^pharmacy" ; audit this pharmacy bill
. ;
. I BILL("audit?") D AUDITX^PRCAUDT(APIEN) Q ; audit pharmacy bill, continue loop
. Q:BILL("doneCheck?") ; done checking, continue loop through bills
. ;
. I RTDGCR("type")["TRICARE" D
.. I FLAG("aaTricare") S BILL("audit?")="1^Tricare" ; audit this Tricare bill
.. S BILL("doneCheck?")=1
. I BILL("audit?") D AUDITX^PRCAUDT(APIEN) Q ; audit Tricare bill, continue loop
. Q:BILL("doneCheck?") ; done checking, continue loop through bills
. D ; medical bill, check medical flags
.. I RTDGCR("paper"),'FLAG("aaMedPaper") S BILL("doneCheck?")=1 Q ; Skip paper bill if No auto-audit
.. I 'RTDGCR("paper"),'FLAG("aaMedEDI") S BILL("doneCheck?")=1 Q ; Skip EDI bill if No auto-audit
.. S BILL("audit?")="1^medical" ; audit this medical bill
. Q:BILL("doneCheck?") ; no auto-audit for medical bill
. ; passed medical checks call auto-audit for this Bill
. I BILL("audit?") D AUDITX^PRCAUDT(APIEN)
;
Q
;
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HPRCABJ2 4441 printed Dec 13, 2024@01:39:05 Page 2
PRCABJ2 ;OIT/hrub - NIGHTLY PROCESS FOR ACCOUNTS RECEIVABLE ;31 Oct 2018 16:00:59
+1 ;;4.5;Accounts Receivable;**304,321,326,332,338,351**;Mar 20, 1995;Build 15
+2 ;Per VA Directive 6402, this routine should not be modified.
+3 ;
+4 ; read of ^DGCR(399.2 allowed by DBIA 3822
+5 ; refactored 17 October 2018, PRCA*4.5*332
+6 QUIT
+7 ; Auto-audit Paper, Electronic, and Tricare bills if ready
+8 ; PRCA*4.5*332 - Whole subroutine re-written
ABAUDIT ;
+1 ; APIEN - Accounts Payable (file #430) ien (also same ien for file #399)
+2 ;PRCA*4.5*321, PRCA*4.5*332
NEW APIEN,ARBILL,C,FLAG,J,PRCA,RTYPE
+3 ;
+4 ; New Bill IEN
SET ARBILL("newBillIEN")=$ORDER(^PRCA(430.3,"B","NEW BILL",""))
+5 ; must have the IEN for new bills
if ARBILL("newBillIEN")=""
QUIT
+6 ; Check parameters to see if audit needs to run
+7 ; (#7.05) AUTO-AUDIT MEDICAL PAPER BILLS [5S]
SET FLAG("aaMedPaper")=$$GET1^DIQ(342,"1,",7.05,"I")
+8 ; (#7.06) AUTO-AUDIT RX PAPER BILLS [6S]
SET FLAG("aaRxPaper")=$$GET1^DIQ(342,"1,",7.06,"I")
+9 ; (#7.07) AUTO-AUDIT MEDICAL EDI BILLS [7S] - PRCA*4.5*321
SET FLAG("aaMedEDI")=$$GET1^DIQ(342,"1,",7.07,"I")
+10 ; (#7.08) AUTO-AUDIT RX EDI BILLS [8S] - PRCA*4.5*321
SET FLAG("aaRxEDI")=$$GET1^DIQ(342,"1,",7.08,"I")
+11 ; (#7.09) AUTO-AUDIT TRICARE BILLS [9S] - PRCA*4.5*332
SET FLAG("aaTricare")=$$GET1^DIQ(342,"1,",7.09,"I")
+12 ; quit if all auto-audit parameters are 'No'
+13 ; PRCA*4.5*321
if ('FLAG("aaMedPaper"))&('FLAG("aaRxPaper"))&('FLAG("aaMedEDI"))&('FLAG("aaRxEDI"))&('FLAG("aaTricare"))
QUIT
+14 ;
+15 ; RTYPE - array of RATE TYPE entries that have (#.11) BILL RESULTING FROM [11P:430.6] - PRCA*4.5*332
+16 SET C=0
FOR
SET C=$ORDER(^DGCR(399.3,C))
if 'C
QUIT
SET J=$GET(^(C,0))
if $PIECE(J,U,11)
SET RTYPE(C)=J
+17 ; loop through new bills
+18 ; BILL - info for this bill
+19 ; PRCA - bill # and ECME info
+20 ; RTDGCR - used for file #399 info (except rate type)
+21 SET APIEN=""
FOR
SET APIEN=$ORDER(^PRCA(430,"AC",ARBILL("newBillIEN"),APIEN))
if 'APIEN
QUIT
Begin DoDot:1
+22 NEW BILL,PRCA,RTDGCR
+23 ;
+24 ; (#.07) RATE TYPE [7P:399.3] - PRCA*4.5*326
SET BILL("rtTyp")=$$GET1^DIQ(399,APIEN_",",.07,"I")
+25 ; must have rate type
if 'BILL("rtTyp")
QUIT
+26 ; no auto-audit for this RATE TYPE
if '$DATA(RTYPE(BILL("rtTyp")))
QUIT
+27 ; BEGIN - PRCA*4.5*321
+28 ; quit if no (#7) PATIENT [7P:2]
if $$GET1^DIQ(430,APIEN_",",7,"I")=""
QUIT
+29 ; quit if no (#9) DEBTOR [9P:340]
if $$GET1^DIQ(430,APIEN_",",9,"I")=""
QUIT
+30 ; quit if no (#239) INSURED NAME [1F]
if $$GET1^DIQ(430,APIEN_",",239,"I")=""
QUIT
+31 ; quit if no (#243) GROUP NAME [5F]
if $$GET1^DIQ(430,APIEN_",",243,"I")=""
QUIT
+32 ; quit if no (#244) GROUP NUMBER [6F]
if $$GET1^DIQ(430,APIEN_",",244,"I")=""
QUIT
+33 ; PRCA*4.5*321 - claim has reject messages, do not audit
if $$BILLREJ^PRCAUDT(APIEN)
QUIT
+34 ;
+35 ; (#.07) RATE TYPE [7P:399.3] (IA 4118)
SET RTDGCR("type")=$$GET1^DIQ(399,APIEN_",",.07,"E")
+36 ; (#.27) BILL CHARGE TYPE [27S] (ICR 3820)
SET RTDGCR("paper")=$$GET1^DIQ(399,APIEN_",",27,"I")
+37 ; Boolean flag, need to audit bill?
SET BILL("audit?")=0
+38 ; Boolean flag, done checking?
SET BILL("doneCheck?")=0
+39 ; Get Bill number to check if it's a Pharmacy bill
+40 ; (#.01) BILL NO. [1F]
SET PRCA("bill#")=$$GET1^DIQ(430,APIEN_",",.01,"I")
+41 ; ECME# from the bill
SET PRCA("ecme#")=$$GETECME^RCDPENR1(APIEN)
+42 ;
+43 ; has ECME#, check pharmacy flags
IF PRCA("ecme#")'=""
Begin DoDot:2
+44 ; Skip paper bill if No auto-audit
IF RTDGCR("paper")
IF 'FLAG("aaRxPaper")
SET BILL("doneCheck?")=1
QUIT
+45 ; Skip EDI bill if No auto-audit
IF 'RTDGCR("paper")
IF 'FLAG("aaRxEDI")
SET BILL("doneCheck?")=1
QUIT
+46 ; audit this pharmacy bill
SET BILL("audit?")="1^pharmacy"
End DoDot:2
+47 ;
+48 ; audit pharmacy bill, continue loop
IF BILL("audit?")
DO AUDITX^PRCAUDT(APIEN)
QUIT
+49 ; done checking, continue loop through bills
if BILL("doneCheck?")
QUIT
+50 ;
+51 IF RTDGCR("type")["TRICARE"
Begin DoDot:2
+52 ; audit this Tricare bill
IF FLAG("aaTricare")
SET BILL("audit?")="1^Tricare"
+53 SET BILL("doneCheck?")=1
End DoDot:2
+54 ; audit Tricare bill, continue loop
IF BILL("audit?")
DO AUDITX^PRCAUDT(APIEN)
QUIT
+55 ; done checking, continue loop through bills
if BILL("doneCheck?")
QUIT
+56 ; medical bill, check medical flags
Begin DoDot:2
+57 ; Skip paper bill if No auto-audit
IF RTDGCR("paper")
IF 'FLAG("aaMedPaper")
SET BILL("doneCheck?")=1
QUIT
+58 ; Skip EDI bill if No auto-audit
IF 'RTDGCR("paper")
IF 'FLAG("aaMedEDI")
SET BILL("doneCheck?")=1
QUIT
+59 ; audit this medical bill
SET BILL("audit?")="1^medical"
End DoDot:2
+60 ; no auto-audit for medical bill
if BILL("doneCheck?")
QUIT
+61 ; passed medical checks call auto-audit for this Bill
+62 IF BILL("audit?")
DO AUDITX^PRCAUDT(APIEN)
End DoDot:1
+63 ;
+64 QUIT
+65 ;
