PRCABJ2.m

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 ---PRCABJ2   4441     printed  Feb 18, 2025@23:05:29                                                                                                                                                                                                     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      ;