PSOREJU2 ;BIRM/MFR - BPS (ECME) - Clinical Rejects Utilities (1) ;10/15/04
;;7.0;OUTPATIENT PHARMACY;**148,260,287,341,290,358,359,385,403,421,427,478,562,680,681,702,704**;DEC 1997;Build 16
; Reference to $$TAXID^IBCEF75 in ICR #6768
; Reference to $$DIVNCPDP^BPSBUTL in ICR #4719
; Reference to File 9002313.23 - BPS NCPDP REASON FOR SERVICE CODE in ICR #4714
; Reference to File 9002313.26 - BPS NCPDP PRIOR AUTHORIZATION TYPE CODE in ICR #5585
; Reference to $$CSNPI^BPSUTIL in ICR #4146
;
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
;
N ARRAY,COM,IDX,REJFLD,REJS,Z
;
I '$D(RFL) S RFL=$$LSTRFL^PSOBPSU1(RX)
S RFL=+$G(RFL)
;
K REJDATA
I '$O(^PSRX(RX,"REJ",0)) Q
;
K REJS
I $G(REJID) D
. I +$P($G(^PSRX(RX,"REJ",REJID,0)),"^",4)'=RFL Q
. I '$G(OKCL),$P($G(^PSRX(RX,"REJ",REJID,0)),"^",5) Q
. S REJS(REJID)=""
E D
. S IDX="A"
. F S IDX=$O(^PSRX(RX,"REJ",IDX),-1) Q:'IDX D
. . I +$P($G(^PSRX(RX,"REJ",IDX,0)),"^",4)'=RFL Q
. . I '$G(OKCL),$P($G(^PSRX(RX,"REJ",IDX,0)),"^",5) Q
. . S REJS(IDX)=""
I '$D(REJS) Q
;
S IDX=0
F S IDX=$O(REJS(IDX)) Q:'IDX D
. N SKIP
. K ARRAY D GETS^DIQ(52.25,IDX_","_RX_",","*","","ARRAY")
. K REJFLD M REJFLD=ARRAY(52.25,IDX_","_RX_",")
. ;
. ; check CODE and RRRFLG to see if we want this reject data
. S SKIP=0 ; default is to include it
. I $G(CODE)'="",REJFLD(.01)'=CODE S SKIP=1 ; CODE exists and doesn't match this reject
. I SKIP,$G(RRRFLG),$G(REJFLD(30))="YES" S SKIP=0 ; but include these if RRRFLG is true and this is an RRR reject
. I $G(CODE)="",$G(RRRFLG),$G(REJFLD(30))'="YES" S SKIP=1 ; want only RRR rejects in this case
. I SKIP Q ; get out if we're skipping this one
. ;
. S REJDATA(IDX,"CODE")=$G(REJFLD(.01))
. S REJDATA(IDX,"DATE/TIME")=$G(REJFLD(1))
. S REJDATA(IDX,"PAYER MESSAGE")=$G(REJFLD(2))
. S REJDATA(IDX,"REASON")=$G(REJFLD(3))
. S REJDATA(IDX,"PHARMACIST")=$G(REJFLD(4))
. S REJDATA(IDX,"INSURANCE NAME")=$G(REJFLD(20))
. S REJDATA(IDX,"INSURANCE POINTER")=$G(REJFLD(33)) ;PSO*427
. S REJDATA(IDX,"COB")=$G(REJFLD(27))
. S REJDATA(IDX,"GROUP NAME")=$G(REJFLD(6))
. S REJDATA(IDX,"GROUP NUMBER")=$G(REJFLD(21))
. S REJDATA(IDX,"BIN")=$G(REJFLD(29))
. S REJDATA(IDX,"PCN")=$G(REJFLD(34))
. S REJDATA(IDX,"CARDHOLDER ID")=$G(REJFLD(22))
. S REJDATA(IDX,"PLAN CONTACT")=$G(REJFLD(7))
. S REJDATA(IDX,"PLAN PREVIOUS FILL DATE")=$G(REJFLD(8))
. S REJDATA(IDX,"STATUS")=$G(REJFLD(9))
. S REJDATA(IDX,"OTHER REJECTS")=$G(REJFLD(17))
. S REJDATA(IDX,"DUR TEXT")=$G(REJFLD(18))
. S REJDATA(IDX,"DUR ADD MSG TEXT")=$G(REJFLD(28))
. S REJDATA(IDX,"REASON SVC CODE")=$G(REJFLD(14))
. S REJDATA(IDX,"RESPONSE IEN")=$G(REJFLD(16))
. S REJDATA(IDX,"RRR FLAG")=$G(REJFLD(30)) ;PSO*421
. S REJDATA(IDX,"RRR THRESHOLD AMT")=$G(REJFLD(31)) ;PSO*421
. S REJDATA(IDX,"RRR GROSS AMT DUE")=$G(REJFLD(32)) ;PSO*421
. I '$G(OKCL) Q
. S REJDATA(IDX,"CLOSED DATE/TIME")=$G(REJFLD(10))
. S REJDATA(IDX,"CLOSED BY")=$G(REJFLD(11))
. S REJDATA(IDX,"CLOSE REASON")=$G(REJFLD(12))
. S REJDATA(IDX,"CLOSE COMMENTS")=$G(REJFLD(13))
. S REJDATA(IDX,"COD1")=$G(REJFLD(14))
. S REJDATA(IDX,"COD2")=$G(REJFLD(15))
. S REJDATA(IDX,"COD3")=$G(REJFLD(19))
. S REJDATA(IDX,"CLA CODE")=$G(REJFLD(24))
. S REJDATA(IDX,"PRIOR AUTH TYPE")=$G(REJFLD(25))
. S REJDATA(IDX,"PRIOR AUTH NUMBER")=$G(REJFLD(26))
. S COM=0 F S COM=$O(^PSRX(RX,"REJ",IDX,"COM",COM)) Q:'COM D
. . S Z=^PSRX(RX,"REJ",IDX,"COM",COM,0)
. . S REJDATA(IDX,"COMMENTS",COM,"DATE/TIME")=$P(Z,"^")
. . S REJDATA(IDX,"COMMENTS",COM,"USER")=$P(Z,"^",2)
. . S REJDATA(IDX,"COMMENTS",COM,"COMMENTS")=$P(Z,"^",3)
Q
;
HELP(OPTS) ; Display the Help Text for the DUR handling options (OVERRIDE/IGNORE/STOP/QUIT)
;
I OPTS["O" D
. W !?1,"(O)verride - This option will provide the prompts for the code sets needed to"
. W !?1," override this reject and get a payable 3rd party claim. Before"
. W !?1," you select this option, you may need to call the 3rd party payer"
. W !?1," to determine which code sets are needed to override a particular"
. W !?1," reject. Once the proper override is accepted the label will print"
. W !?1," and the prescription can be filled."
;
I OPTS["I" D
. W !?1,"(I)gnore - Choosing Ignore will by-pass 3rd party processing and will allow"
. W !?1," you to print a label and fill the prescription. This essentially"
. W !?1," ignores the clinical safety issues suggested by the 3rd party"
. W !?1," payer and will NOT result in a payable claim."
;
I OPTS["Q" D
. W !?1,"(Q)uit - Choosing Quit will postpone the processing of this prescription"
. W !?1," until this 3rd party reject is resolved. A label will not be"
. W !?1," printed for this prescription and it can not be filled/dispensed"
. W !?1," until this reject is resolved. Rejects can be resolved through"
. W !?1," the Worklist option under the ePharmacy menu."
Q
;
DVINFO(RX,RFL,LM) ; Returns header displayable Division Information
;Input: (r) RX - Rx IEN (#52)
; (o) RFL - Refill # (Default: most recent)
; (o) LM - ListManager format? (1 - Yes / 0 - No) - Default: 0
N DVIEN,DVINFO,NCPNPI,PSOTAXID,TXT
S DVIEN=+$$RXSITE^PSOBPSUT(RX,RFL)
S DVINFO="Division : "_$E($$GET1^DIQ(59,DVIEN,.01),1,15)
;
; Check for Controlled Substance Drug and if a BPS Pharmacy for CS has
; been defined. If so, use NCPDP# & NPI for the CS Pharmacy.
S NCPNPI=$$CSNPI^BPSUTIL(RX,RFL)
;
; If not a Controlled Substance, use NCPDP# & NPI info based on Division.
; Display both NPI and NCPDP numbers
I +NCPNPI=-1 S NCPNPI=$$DIVNCPDP^BPSBUTL(DVIEN)
S $E(DVINFO,28)="NPI: "_$P(NCPNPI,U,2)
S $E(DVINFO,44)="NCPDP: "_$P(NCPNPI,U)
S PSOTAXID=$P($$TAXID^IBCEF75,U,2) ; IA 6768
S $E(DVINFO,62)="TAX ID: "_$E(PSOTAXID,1,2)_"-"_$E(PSOTAXID,3,$L(PSOTAXID))
Q DVINFO
;
PTINFO(RX,LM) ; Returns header displayable Patient Information
;Input: (r) RX - Rx IEN (#52)
; (o) LM - ListManager format? (1 - Yes / 0 - No) - Default: 0
N DFN,VADM,PTINFO,SEX,SSN4
S DFN=$$GET1^DIQ(52,RX,2,"I")
D DEM^VADPT
S SSN4=$P($G(VADM(2)),"^",2)
S PTINFO="Patient : "_$E($G(VADM(1)),1,$S($G(LM):24,1:20))_"("_$E(SSN4,$L(SSN4)-3,$L(SSN4))_")"
S $E(PTINFO,$S($G(LM):61,1:54))="DOB: "_$P($G(VADM(3)),"^",2)_"("_$P($G(VADM(4)),"^")_")"
S SEX="Birth Sex: "_$P($G(VADM(5)),"^")
S $E(SEX,28)="Self-Identified Gender: "_$E($P($G(VADM(14,5)),U,1),1,24)
Q PTINFO_U_SEX
;
RETRXF(RX,RFL,ONOFF) ; - Set/Reset the Re-transmission flag
;Input: (r) RX - Rx IEN (#52)
; (r) RFL - Refill IEN (#52.1)
; (o) ONOFF - Turn flag ON or OFF (1 - ON / 0 - OFF) (Default: OFF)
I RFL>0,'$D(^PSRX(RX,1,RFL,0)) QUIT
N DA,DIE,DR
S DR="82///"_$S($G(ONOFF):"YES",1:"@")
I 'RFL S DA=RX,DIE="^PSRX("
I RFL S DA(1)=RX,DA=RFL,DIE="^PSRX("_RX_",1,"
D ^DIE
Q
;
REASON(TXT) ; Extracts the Reason for service code from the REASON text field
; Input: (r) TXT - Reason text (e.g., NN Reason for Service Code Text)
;Output: REASON - NN (if on valid and on file (#9002313.23), null otherwise)
N REASON,DIC,X,Y
S REASON=$P(TXT," ") I $L(REASON)'=2 Q ""
S DIC=9002313.23,X=REASON D ^DIC I Y<0 Q ""
Q REASON
;
SETOPN(RX,REJ) ; - Set the Reject RE-OPENED flag to YES
;Input: (r) RX - Rx IEN (#52)
; (r) REJ - Reject IEN (#52.25)
;
I '$D(^PSRX(RX,"REJ",REJ)) Q
N DIE,DA,DR
S DIE="^PSRX("_RX_",""REJ"",",DA(1)=RX,DA=REJ,DR="23///YES" D ^DIE
Q
;
PRT(FIELD,P,L) ; Sets the lines for fields that require text wrapping
;Input: FIELD - Subscript name from the DATA(REJ,FIELD) array
; P - Position where the content should be printed
; L - Lenght of the text on each line
N TXT,I
S TXT=DATA(REJ,FIELD) I $L(TXT)'>L W ?P,TXT Q
F I=1:1 Q:TXT="" D
. I I=1 W ?P,$E(TXT,1,L),! S TXT=$E(TXT,L+1,999) Q
. W ?P,$E(TXT,1,L) S TXT=$E(TXT,L+1,999) W:TXT'="" !
Q
;
PA() ; - Ask for Prior Authorization Type and Number
; Called by PA^PSOREJP1 (PA acton) and SMA^PSOREJP1 (SMA action)
;
;Output:(PAT^PAN) PAT - Prior Authorization Type
; (See DD File #9002313.26 for possible values)
; PAN - Prior Authorization Number (11 digits)
;
N DIC,DIR,DIROUT,DIRUT,DTOUT,DUOUT,PAN,PAT,X,Y
S DIC("B")=0
S DIC(0)="QEAM",DIC=9002313.26,DIC("A")="Prior Authorization Type: "
S DIC("S")="I $P($G(^(0)),""^"",3)'=1"
D ^DIC
I ($D(DUOUT))!($D(DTOUT))!(Y=-1) Q "^" ;Check for "^" or timeout
S PAT=$P(Y,U,2)
;
K DIR,DIC,X,Y
S DIR(0)="52.25,26",DIR("A")="Prior Authorization Number"
S DIR("?")="^D PANHLP^PSOREJU2",DIR("??")=""
D ^DIR I (Y["^")!$D(DTOUT) Q "^"
S PAN=Y
Q (PAT_"^"_PAN)
;
PANHLP ; Prior Authorization Number Help
W "OR you may leave it blank if the claim does not require a number."
Q
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HPSOREJU2 11690 printed Oct 16, 2024@18:34:17 Page 2
PSOREJU2 ;BIRM/MFR - BPS (ECME) - Clinical Rejects Utilities (1) ;10/15/04
+1 ;;7.0;OUTPATIENT PHARMACY;**148,260,287,341,290,358,359,385,403,421,427,478,562,680,681,702,704**;DEC 1997;Build 16
+2 ; Reference to $$TAXID^IBCEF75 in ICR #6768
+3 ; Reference to $$DIVNCPDP^BPSBUTL in ICR #4719
+4 ; Reference to File 9002313.23 - BPS NCPDP REASON FOR SERVICE CODE in ICR #4714
+5 ; Reference to File 9002313.26 - BPS NCPDP PRIOR AUTHORIZATION TYPE CODE in ICR #5585
+6 ; Reference to $$CSNPI^BPSUTIL in ICR #4146
+7 ;
GET(RX,RFL,REJDATA,REJID,OKCL,CODE,RRRFLG) ; get reject data from subfile 52.25
+1 ; Input: (r) RX - Rx IEN (#52)
+2 ; (o) RFL - Refill # (Default: most recent)
+3 ; (r) REJDATA(REJECT IEN,FIELD) - Array where these Reject fields will be returned:
+4 ; "BIN" - Payer BIN number
+5 ; "PCN" - Processor Control Number
+6 ; "CODE" - Reject Code (79 or 88 or 943)
+7 ; "DATE/TIME" - DATE/TIME Reject was detected
+8 ; "PAYER MESSAGE" - Message returned by the payer
+9 ; "REASON" - Reject Reason description (from payer)
+10 ; "INSURANCE NAME" - Patient's Insurance Company Name
+11 ; "INSURANCE POINTER" - Patient Insurance Company Pointer
+12 ; "COB" - Coordination of Benefits
+13 ; "GROUP NAME" - Patient's Insurance Group Name
+14 ; "GROUP NUMBER" - Patient's Insurance Group Number
+15 ; "CARDHOLDER ID" - Patient's Insurance Cardholder ID
+16 ; "PLAN CONTACT" - Plan's Contact (eg., "1-800-...")
+17 ; "PLAN PREVIOUS FILL DATE" - Last time Rx was paid by payer
+18 ; "STATUS" - REJECTS status ("OPEN/UNRESOLVED" or "CLOSED/RESOLVED")
+19 ; "DUR TEXT" - Payer's DUR description
+20 ; "DUR ADD MSG TEXT" - Payer's DUR additional description
+21 ; "OTHER REJECTS" - Other Rejects on the same response
+22 ; "REASON SVC CODE" - Reason for Service Code
+23 ; If REJECT is closed, the following fields will be returned:
+24 ; "CLA CODE" - Clarification Code submitted
+25 ; "PRIOR AUTH TYPE" - Prior Authorization Type
+26 ; "PRIOR AUTH NUMBER" - Prior Authorization Type
+27 ; "CLOSED DATE/TIME" - DATE/TIME Reject was closed
+28 ; "CLOSED BY" - Name of the user responsible for closing Reject
+29 ; "CLOSE REASON" - Reason for closing Reject (text)
+30 ; "CLOSE COMMENTS" - User entered comments at close
+31 ; (o) REJID - REJECT IEN in the PRESCRIPTION file for retrieve this REJECT
+32 ; (o) OKCL - If set to 1, CLOSED REJECTs will also be returned
+33 ; (o) CODE - Only REJECTs with this CODE should be returned
+34 ; (o) RRRFLG - If set to 1 with CODE present, also return Reject Resolution Required REJECTs
+35 ; If set to 1 and CODE not passed, then only return RRR REJECTs
+36 ;
+37 NEW ARRAY,COM,IDX,REJFLD,REJS,Z
+38 ;
+39 IF '$DATA(RFL)
SET RFL=$$LSTRFL^PSOBPSU1(RX)
+40 SET RFL=+$GET(RFL)
+41 ;
+42 KILL REJDATA
+43 IF '$ORDER(^PSRX(RX,"REJ",0))
QUIT
+44 ;
+45 KILL REJS
+46 IF $GET(REJID)
Begin DoDot:1
+47 IF +$PIECE($GET(^PSRX(RX,"REJ",REJID,0)),"^",4)'=RFL
QUIT
+48 IF '$GET(OKCL)
IF $PIECE($GET(^PSRX(RX,"REJ",REJID,0)),"^",5)
QUIT
+49 SET REJS(REJID)=""
End DoDot:1
+50 IF '$TEST
Begin DoDot:1
+51 SET IDX="A"
+52 FOR
SET IDX=$ORDER(^PSRX(RX,"REJ",IDX),-1)
if 'IDX
QUIT
Begin DoDot:2
+53 IF +$PIECE($GET(^PSRX(RX,"REJ",IDX,0)),"^",4)'=RFL
QUIT
+54 IF '$GET(OKCL)
IF $PIECE($GET(^PSRX(RX,"REJ",IDX,0)),"^",5)
QUIT
+55 SET REJS(IDX)=""
End DoDot:2
End DoDot:1
+56 IF '$DATA(REJS)
QUIT
+57 ;
+58 SET IDX=0
+59 FOR
SET IDX=$ORDER(REJS(IDX))
if 'IDX
QUIT
Begin DoDot:1
+60 NEW SKIP
+61 KILL ARRAY
DO GETS^DIQ(52.25,IDX_","_RX_",","*","","ARRAY")
+62 KILL REJFLD
MERGE REJFLD=ARRAY(52.25,IDX_","_RX_",")
+63 ;
+64 ; check CODE and RRRFLG to see if we want this reject data
+65 ; default is to include it
SET SKIP=0
+66 ; CODE exists and doesn't match this reject
IF $GET(CODE)'=""
IF REJFLD(.01)'=CODE
SET SKIP=1
+67 ; but include these if RRRFLG is true and this is an RRR reject
IF SKIP
IF $GET(RRRFLG)
IF $GET(REJFLD(30))="YES"
SET SKIP=0
+68 ; want only RRR rejects in this case
IF $GET(CODE)=""
IF $GET(RRRFLG)
IF $GET(REJFLD(30))'="YES"
SET SKIP=1
+69 ; get out if we're skipping this one
IF SKIP
QUIT
+70 ;
+71 SET REJDATA(IDX,"CODE")=$GET(REJFLD(.01))
+72 SET REJDATA(IDX,"DATE/TIME")=$GET(REJFLD(1))
+73 SET REJDATA(IDX,"PAYER MESSAGE")=$GET(REJFLD(2))
+74 SET REJDATA(IDX,"REASON")=$GET(REJFLD(3))
+75 SET REJDATA(IDX,"PHARMACIST")=$GET(REJFLD(4))
+76 SET REJDATA(IDX,"INSURANCE NAME")=$GET(REJFLD(20))
+77 ;PSO*427
SET REJDATA(IDX,"INSURANCE POINTER")=$GET(REJFLD(33))
+78 SET REJDATA(IDX,"COB")=$GET(REJFLD(27))
+79 SET REJDATA(IDX,"GROUP NAME")=$GET(REJFLD(6))
+80 SET REJDATA(IDX,"GROUP NUMBER")=$GET(REJFLD(21))
+81 SET REJDATA(IDX,"BIN")=$GET(REJFLD(29))
+82 SET REJDATA(IDX,"PCN")=$GET(REJFLD(34))
+83 SET REJDATA(IDX,"CARDHOLDER ID")=$GET(REJFLD(22))
+84 SET REJDATA(IDX,"PLAN CONTACT")=$GET(REJFLD(7))
+85 SET REJDATA(IDX,"PLAN PREVIOUS FILL DATE")=$GET(REJFLD(8))
+86 SET REJDATA(IDX,"STATUS")=$GET(REJFLD(9))
+87 SET REJDATA(IDX,"OTHER REJECTS")=$GET(REJFLD(17))
+88 SET REJDATA(IDX,"DUR TEXT")=$GET(REJFLD(18))
+89 SET REJDATA(IDX,"DUR ADD MSG TEXT")=$GET(REJFLD(28))
+90 SET REJDATA(IDX,"REASON SVC CODE")=$GET(REJFLD(14))
+91 SET REJDATA(IDX,"RESPONSE IEN")=$GET(REJFLD(16))
+92 ;PSO*421
SET REJDATA(IDX,"RRR FLAG")=$GET(REJFLD(30))
+93 ;PSO*421
SET REJDATA(IDX,"RRR THRESHOLD AMT")=$GET(REJFLD(31))
+94 ;PSO*421
SET REJDATA(IDX,"RRR GROSS AMT DUE")=$GET(REJFLD(32))
+95 IF '$GET(OKCL)
QUIT
+96 SET REJDATA(IDX,"CLOSED DATE/TIME")=$GET(REJFLD(10))
+97 SET REJDATA(IDX,"CLOSED BY")=$GET(REJFLD(11))
+98 SET REJDATA(IDX,"CLOSE REASON")=$GET(REJFLD(12))
+99 SET REJDATA(IDX,"CLOSE COMMENTS")=$GET(REJFLD(13))
+100 SET REJDATA(IDX,"COD1")=$GET(REJFLD(14))
+101 SET REJDATA(IDX,"COD2")=$GET(REJFLD(15))
+102 SET REJDATA(IDX,"COD3")=$GET(REJFLD(19))
+103 SET REJDATA(IDX,"CLA CODE")=$GET(REJFLD(24))
+104 SET REJDATA(IDX,"PRIOR AUTH TYPE")=$GET(REJFLD(25))
+105 SET REJDATA(IDX,"PRIOR AUTH NUMBER")=$GET(REJFLD(26))
+106 SET COM=0
FOR
SET COM=$ORDER(^PSRX(RX,"REJ",IDX,"COM",COM))
if 'COM
QUIT
Begin DoDot:2
+107 SET Z=^PSRX(RX,"REJ",IDX,"COM",COM,0)
+108 SET REJDATA(IDX,"COMMENTS",COM,"DATE/TIME")=$PIECE(Z,"^")
+109 SET REJDATA(IDX,"COMMENTS",COM,"USER")=$PIECE(Z,"^",2)
+110 SET REJDATA(IDX,"COMMENTS",COM,"COMMENTS")=$PIECE(Z,"^",3)
End DoDot:2
End DoDot:1
+111 QUIT
+112 ;
HELP(OPTS) ; Display the Help Text for the DUR handling options (OVERRIDE/IGNORE/STOP/QUIT)
+1 ;
+2 IF OPTS["O"
Begin DoDot:1
+3 WRITE !?1,"(O)verride - This option will provide the prompts for the code sets needed to"
+4 WRITE !?1," override this reject and get a payable 3rd party claim. Before"
+5 WRITE !?1," you select this option, you may need to call the 3rd party payer"
+6 WRITE !?1," to determine which code sets are needed to override a particular"
+7 WRITE !?1," reject. Once the proper override is accepted the label will print"
+8 WRITE !?1," and the prescription can be filled."
End DoDot:1
+9 ;
+10 IF OPTS["I"
Begin DoDot:1
+11 WRITE !?1,"(I)gnore - Choosing Ignore will by-pass 3rd party processing and will allow"
+12 WRITE !?1," you to print a label and fill the prescription. This essentially"
+13 WRITE !?1," ignores the clinical safety issues suggested by the 3rd party"
+14 WRITE !?1," payer and will NOT result in a payable claim."
End DoDot:1
+15 ;
+16 IF OPTS["Q"
Begin DoDot:1
+17 WRITE !?1,"(Q)uit - Choosing Quit will postpone the processing of this prescription"
+18 WRITE !?1," until this 3rd party reject is resolved. A label will not be"
+19 WRITE !?1," printed for this prescription and it can not be filled/dispensed"
+20 WRITE !?1," until this reject is resolved. Rejects can be resolved through"
+21 WRITE !?1," the Worklist option under the ePharmacy menu."
End DoDot:1
+22 QUIT
+23 ;
DVINFO(RX,RFL,LM) ; Returns header displayable Division Information
+1 ;Input: (r) RX - Rx IEN (#52)
+2 ; (o) RFL - Refill # (Default: most recent)
+3 ; (o) LM - ListManager format? (1 - Yes / 0 - No) - Default: 0
+4 NEW DVIEN,DVINFO,NCPNPI,PSOTAXID,TXT
+5 SET DVIEN=+$$RXSITE^PSOBPSUT(RX,RFL)
+6 SET DVINFO="Division : "_$EXTRACT($$GET1^DIQ(59,DVIEN,.01),1,15)
+7 ;
+8 ; Check for Controlled Substance Drug and if a BPS Pharmacy for CS has
+9 ; been defined. If so, use NCPDP# & NPI for the CS Pharmacy.
+10 SET NCPNPI=$$CSNPI^BPSUTIL(RX,RFL)
+11 ;
+12 ; If not a Controlled Substance, use NCPDP# & NPI info based on Division.
+13 ; Display both NPI and NCPDP numbers
+14 IF +NCPNPI=-1
SET NCPNPI=$$DIVNCPDP^BPSBUTL(DVIEN)
+15 SET $EXTRACT(DVINFO,28)="NPI: "_$PIECE(NCPNPI,U,2)
+16 SET $EXTRACT(DVINFO,44)="NCPDP: "_$PIECE(NCPNPI,U)
+17 ; IA 6768
SET PSOTAXID=$PIECE($$TAXID^IBCEF75,U,2)
+18 SET $EXTRACT(DVINFO,62)="TAX ID: "_$EXTRACT(PSOTAXID,1,2)_"-"_$EXTRACT(PSOTAXID,3,$LENGTH(PSOTAXID))
+19 QUIT DVINFO
+20 ;
PTINFO(RX,LM) ; Returns header displayable Patient Information
+1 ;Input: (r) RX - Rx IEN (#52)
+2 ; (o) LM - ListManager format? (1 - Yes / 0 - No) - Default: 0
+3 NEW DFN,VADM,PTINFO,SEX,SSN4
+4 SET DFN=$$GET1^DIQ(52,RX,2,"I")
+5 DO DEM^VADPT
+6 SET SSN4=$PIECE($GET(VADM(2)),"^",2)
+7 SET PTINFO="Patient : "_$EXTRACT($GET(VADM(1)),1,$SELECT($GET(LM):24,1:20))_"("_$EXTRACT(SSN4,$LENGTH(SSN4)-3,$LENGTH(SSN4))_")"
+8 SET $EXTRACT(PTINFO,$SELECT($GET(LM):61,1:54))="DOB: "_$PIECE($GET(VADM(3)),"^",2)_"("_$PIECE($GET(VADM(4)),"^")_")"
+9 SET SEX="Birth Sex: "_$PIECE($GET(VADM(5)),"^")
+10 SET $EXTRACT(SEX,28)="Self-Identified Gender: "_$EXTRACT($PIECE($GET(VADM(14,5)),U,1),1,24)
+11 QUIT PTINFO_U_SEX
+12 ;
RETRXF(RX,RFL,ONOFF) ; - Set/Reset the Re-transmission flag
+1 ;Input: (r) RX - Rx IEN (#52)
+2 ; (r) RFL - Refill IEN (#52.1)
+3 ; (o) ONOFF - Turn flag ON or OFF (1 - ON / 0 - OFF) (Default: OFF)
+4 IF RFL>0
IF '$DATA(^PSRX(RX,1,RFL,0))
QUIT
+5 NEW DA,DIE,DR
+6 SET DR="82///"_$SELECT($GET(ONOFF):"YES",1:"@")
+7 IF 'RFL
SET DA=RX
SET DIE="^PSRX("
+8 IF RFL
SET DA(1)=RX
SET DA=RFL
SET DIE="^PSRX("_RX_",1,"
+9 DO ^DIE
+10 QUIT
+11 ;
REASON(TXT) ; Extracts the Reason for service code from the REASON text field
+1 ; Input: (r) TXT - Reason text (e.g., NN Reason for Service Code Text)
+2 ;Output: REASON - NN (if on valid and on file (#9002313.23), null otherwise)
+3 NEW REASON,DIC,X,Y
+4 SET REASON=$PIECE(TXT," ")
IF $LENGTH(REASON)'=2
QUIT ""
+5 SET DIC=9002313.23
SET X=REASON
DO ^DIC
IF Y<0
QUIT ""
+6 QUIT REASON
+7 ;
SETOPN(RX,REJ) ; - Set the Reject RE-OPENED flag to YES
+1 ;Input: (r) RX - Rx IEN (#52)
+2 ; (r) REJ - Reject IEN (#52.25)
+3 ;
+4 IF '$DATA(^PSRX(RX,"REJ",REJ))
QUIT
+5 NEW DIE,DA,DR
+6 SET DIE="^PSRX("_RX_",""REJ"","
SET DA(1)=RX
SET DA=REJ
SET DR="23///YES"
DO ^DIE
+7 QUIT
+8 ;
PRT(FIELD,P,L) ; Sets the lines for fields that require text wrapping
+1 ;Input: FIELD - Subscript name from the DATA(REJ,FIELD) array
+2 ; P - Position where the content should be printed
+3 ; L - Lenght of the text on each line
+4 NEW TXT,I
+5 SET TXT=DATA(REJ,FIELD)
IF $LENGTH(TXT)'>L
WRITE ?P,TXT
QUIT
+6 FOR I=1:1
if TXT=""
QUIT
Begin DoDot:1
+7 IF I=1
WRITE ?P,$EXTRACT(TXT,1,L),!
SET TXT=$EXTRACT(TXT,L+1,999)
QUIT
+8 WRITE ?P,$EXTRACT(TXT,1,L)
SET TXT=$EXTRACT(TXT,L+1,999)
if TXT'=""
WRITE !
End DoDot:1
+9 QUIT
+10 ;
PA() ; - Ask for Prior Authorization Type and Number
+1 ; Called by PA^PSOREJP1 (PA acton) and SMA^PSOREJP1 (SMA action)
+2 ;
+3 ;Output:(PAT^PAN) PAT - Prior Authorization Type
+4 ; (See DD File #9002313.26 for possible values)
+5 ; PAN - Prior Authorization Number (11 digits)
+6 ;
+7 NEW DIC,DIR,DIROUT,DIRUT,DTOUT,DUOUT,PAN,PAT,X,Y
+8 SET DIC("B")=0
+9 SET DIC(0)="QEAM"
SET DIC=9002313.26
SET DIC("A")="Prior Authorization Type: "
+10 SET DIC("S")="I $P($G(^(0)),""^"",3)'=1"
+11 DO ^DIC
+12 ;Check for "^" or timeout
IF ($DATA(DUOUT))!($DATA(DTOUT))!(Y=-1)
QUIT "^"
+13 SET PAT=$PIECE(Y,U,2)
+14 ;
+15 KILL DIR,DIC,X,Y
+16 SET DIR(0)="52.25,26"
SET DIR("A")="Prior Authorization Number"
+17 SET DIR("?")="^D PANHLP^PSOREJU2"
SET DIR("??")=""
+18 DO ^DIR
IF (Y["^")!$DATA(DTOUT)
QUIT "^"
+19 SET PAN=Y
+20 QUIT (PAT_"^"_PAN)
+21 ;
PANHLP ; Prior Authorization Number Help
+1 WRITE "OR you may leave it blank if the claim does not require a number."
+2 QUIT
