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Routine: PSOREJU2

Package: Outpatient Pharmacy

Routine: PSOREJU2


Information

PSOREJU2 ;BIRM/MFR - BPS (ECME) - Clinical Rejects Utilities (1) ;10/15/04

Source Information

Source file <PSOREJU2.m>

Entry Points

Name Comments DBIA/ICR reference
GET(RX,RFL,REJDATA,REJID,OKCL,CODE,RRRFLG) ; get reject data from subfile 52.25
; Input: (r) RX - Rx IEN (#52)
; (o) RFL - Refill # (Default: most recent)
; (r) REJDATA(REJECT IEN,FIELD) - Array where these Reject fields will be returned:
; "BIN" - Payer BIN number
; "PCN" - Processor Control Number
; "CODE" - Reject Code (79 or 88 or 943)
; "DATE/TIME" - DATE/TIME Reject was detected
; "PAYER MESSAGE" - Message returned by the payer
; "REASON" - Reject Reason description (from payer)
; "INSURANCE NAME" - Patient's Insurance Company Name
; "INSURANCE POINTER" - Patient Insurance Company Pointer
; "COB" - Coordination of Benefits
; "GROUP NAME" - Patient's Insurance Group Name
; "GROUP NUMBER" - Patient's Insurance Group Number
; "CARDHOLDER ID" - Patient's Insurance Cardholder ID
; "PLAN CONTACT" - Plan's Contact (eg., "1-800-...")
; "PLAN PREVIOUS FILL DATE" - Last time Rx was paid by payer
; "STATUS" - REJECTS status ("OPEN/UNRESOLVED" or "CLOSED/RESOLVED")
; "DUR TEXT" - Payer's DUR description
; "DUR ADD MSG TEXT" - Payer's DUR additional description
; "OTHER REJECTS" - Other Rejects on the same response
; "REASON SVC CODE" - Reason for Service Code
; If REJECT is closed, the following fields will be returned:
; "CLA CODE" - Clarification Code submitted
; "PRIOR AUTH TYPE" - Prior Authorization Type
; "PRIOR AUTH NUMBER" - Prior Authorization Type
; "CLOSED DATE/TIME" - DATE/TIME Reject was closed
; "CLOSED BY" - Name of the user responsible for closing Reject
; "CLOSE REASON" - Reason for closing Reject (text)
; "CLOSE COMMENTS" - User entered comments at close
; (o) REJID - REJECT IEN in the PRESCRIPTION file for retrieve this REJECT
; (o) OKCL - If set to 1, CLOSED REJECTs will also be returned
; (o) CODE - Only REJECTs with this CODE should be returned
; (o) RRRFLG - If set to 1 with CODE present, also return Reject Resolution Required REJECTs
; If set to 1 and CODE not passed, then only return RRR REJECTs
  • ICR #6749
    • Status: Active
    • Usage: Controlled Subscription
    HELP(OPTS) ; Display the Help Text for the DUR handling options (OVERRIDE/IGNORE/STOP/QUIT)
    DVINFO(RX,RFL,LM) ; Returns header displayable Division Information
    PTINFO(RX,LM) ; Returns header displayable Patient Information
    RETRXF(RX,RFL,ONOFF) ; - Set/Reset the Re-transmission flag
    REASON(TXT) ; Extracts the Reason for service code from the REASON text field
    ; Input: (r) TXT - Reason text (e.g., NN Reason for Service Code Text)
    SETOPN(RX,REJ) ; - Set the Reject RE-OPENED flag to YES
    PRT(FIELD,P,L) ; Sets the lines for fields that require text wrapping
    PA() ; - Ask for Prior Authorization Type and Number
    ; Called by PA^PSOREJP1 (PA acton) and SMA^PSOREJP1 (SMA action)
    PANHLP ; Prior Authorization Number Help

    Interaction Calls

    Name Line Occurrences
    Function Call: WRITE
    • Prompt: !?1,"(O)verride - This option will provide the prompts for the code sets needed to"
    • Line Location: HELP+3
    Function Call: WRITE
    • Prompt: !?1," override this reject and get a payable 3rd party claim. Before"
    • Line Location: HELP+4
    Function Call: WRITE
    • Prompt: !?1," you select this option, you may need to call the 3rd party payer"
    • Line Location: HELP+5
    Function Call: WRITE
    • Prompt: !?1," to determine which code sets are needed to override a particular"
    • Line Location: HELP+6
    Function Call: WRITE
    • Prompt: !?1," reject. Once the proper override is accepted the label will print"
    • Line Location: HELP+7
    Function Call: WRITE
    • Prompt: !?1," and the prescription can be filled."
    • Line Location: HELP+8
    Function Call: WRITE
    • Prompt: !?1,"(I)gnore - Choosing Ignore will by-pass 3rd party processing and will allow"
    • Line Location: HELP+11
    Function Call: WRITE
    • Prompt: !?1," you to print a label and fill the prescription. This essentially"
    • Line Location: HELP+12
    Function Call: WRITE
    • Prompt: !?1," ignores the clinical safety issues suggested by the 3rd party"
    • Line Location: HELP+13
    Function Call: WRITE
    • Prompt: !?1," payer and will NOT result in a payable claim."
    • Line Location: HELP+14
    Function Call: WRITE
    • Prompt: !?1,"(Q)uit - Choosing Quit will postpone the processing of this prescription"
    • Line Location: HELP+17
    Function Call: WRITE
    • Prompt: !?1," until this 3rd party reject is resolved. A label will not be"
    • Line Location: HELP+18
    Function Call: WRITE
    • Prompt: !?1," printed for this prescription and it can not be filled/dispensed"
    • Line Location: HELP+19
    Function Call: WRITE
    • Prompt: !?1," until this reject is resolved. Rejects can be resolved through"
    • Line Location: HELP+20
    Function Call: WRITE
    • Prompt: !?1," the Worklist option under the ePharmacy menu."
    • Line Location: HELP+21
    Function Call: WRITE
    • Prompt: ?P,TXT
    • Line Location: PRT+5
    Function Call: WRITE
    • Prompt: ?P,$E(TXT,1,L),!
    • Line Location: PRT+7
    Function Call: WRITE
    • Prompt: "OR you may leave it blank if the claim does not require a number."
    • Line Location: PANHLP+1

    FileMan Files Accessed Via FileMan Db Call

    FileNo Call Tags
    ^PSRX - [#52] Classic Fileman Calls,  GET1^DIQ
    52.25 GETS^DIQ
    ^PS(59 - [#59] GET1^DIQ
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