PSOREJU3 ;BIRM/LJE - BPS (ECME) - Clinical Rejects Utilities (3) ;04/25/08
;;7.0;OUTPATIENT PHARMACY;**287,290,358,359,385,421,427,448,478,513,482,528,561,562,680,704**;DEC 1997;Build 16
; Reference to 9002313.99 in ICR #4305
; Reference to $$CLAIM^BPSBUTL in ICR #4719
; Reference to LOG^BPSOSL in ICR #6764
; Reference to IEN59^BPSOSRX in ICR #4412
; Reference to $$CSNPI^BPSUTIL in ICR #4146
;
Q
;
TRICCHK(RX,RFL,RESP,FROM,RVTX) ;check to see if Rx is non-billable or in an "In Progress" state on ECME
; Input: (r) RX - Rx IEN (#52)
; (r) RFL - REFILL
; (o) RESP - Response from $$EN^BPSNCPDP api
; TRICCHK assumes that the calling routine has validated that the fill is TRICARE or CHAMPVA.
;
; - \Need to be mindful of foreground and background processing.
;
N ESTAT,ETOUT,NFROM,PSOBEI
I '$D(FROM) S FROM=""
S ESTAT=$P(RESP,"^",4)
S NFROM=0
I FROM="PL"!(FROM="PC") S NFROM=1
Q:ESTAT["PAYABLE"!(ESTAT["REJECTED")
S PSOBEI=$$ELIGDISP^PSOREJP1(RX,RFL)
;
D LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$T(+0)_"-TRICCHK, RESP="_RESP) ; ICR#s 4412,6764
D LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$T(+0)_"-TRICCHK, FROM="_FROM_" ESTAT="_ESTAT)
I ESTAT["IN PROGRESS",FROM="PC" D LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$T(+0)_"-Would have noted in Activity Log that Rx was left in CMOP suspense") Q ; ICR#s 4412,6764
;
I ESTAT["IN PROGRESS",FROM="RRL"!($G(RVTX)="RX RELEASE-NDC CHANGE") D Q
. I 'NFROM D
. . W !!,PSOBEI_" Prescription "_$$GET1^DIQ(52,RX,".01")_" cannot be released until ECME 'IN PROGRESS'"
. . W !,"status is resolved payable.",!!
;
I $D(RESP) D Q
. I +RESP=6 W:'NFROM&('$G(CMOP)) !!,"Inactive ECME "_PSOBEI,!! D Q
. . S ACT="Inactive ECME "_PSOBEI D RXACT^PSOBPSU2(RX,RFL,ACT,"M",DUZ)
. I +RESP=2!(+RESP=3) N PSONBILL S PSONBILL=1 D TRIC2 Q
. I +RESP=4!(ESTAT["IN PROGRESS") D Q
. . ;
. . ; Do not put the Rx into the suspense queue if this claim activity
. . ; was triggered by a release message from OPAI or CMOP.
. . ;
. . I $E(FROM,1,2)="CR" Q
. . ;
. . ; Put the Rx into the suspense queue.
. . ;
. . N PSONPROG S PSONPROG=1 D TRIC2
;
Q
;
TRIC2 ;
N ACTION,DA,DIR,DIRUT,PSCAN,PSOIT,PSORESP,PSOTRIC
N REA,REJ,REJCOD,REJDATA,X,ZZZ
S PSOTRIC=1,REJ=9999999999
D LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$T(+0)_"-TRIC2, CMOP="_$G(CMOP)_" PSONPROG="_$G(PSONPROG))
I $G(CMOP)&($G(PSONPROG)) D TACT Q
;
; If the prescription is non-billable, put the eT/eC reject on the
; Prescription (WRKLST^PSOREJU4), then determine the reject number.
;
I +RESP=2 D
. D WRKLST^PSOREJU4(RX,RFL,,DUZ,DT,1,"",RESP)
. S X=$$FIND^PSOREJUT(RX,RFL,.REJDATA,"eT,eC",1)
. S REJ=0
. F S REJ=$O(REJDATA(REJ)) Q:'REJ I "eT,eC"[REJDATA(REJ,"CODE") Q
. Q
;
Q:$G(CMOP)
D LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$T(+0)_"-TRIC2, NFROM="_NFROM)
I 'NFROM D DISPLAY(RX,REJ)
I 'NFROM&($G(PSONPROG)) D D SUSP Q
. W !!,"This prescription will be suspended. After the third party claim is resolved,"
. W !,"it may be printed or pulled early from suspense.",!
. R !!,"Press <RETURN> to continue...",ZZZ:60,!
I NFROM&($G(PSONPROG)) D TACT Q
Q:NFROM
TRIC3 ;
D MSG
I FROM="PL"!(FROM="PC") D SUSP Q
;cnf, PSO*7*358, add code for options
N ACTION,COM,DEF,DIR,DIRUT,OPTS
TRIC4 S DIR(0)="SO^",DIR("A")="",OPTS="DQ",DEF="D"
S PSORESP=$P($G(RESP),U,2)
I PSORESP["NO ACTIVE/VALID ROI" S DEF="Q" ;IB routine IBNCPDP1 contains this text.
I PSORESP="NOT INSURED" S DEF="Q"
;reference to ^XUSEC( supported by IA 10076
I $D(^XUSEC("PSO TRICARE/CHAMPVA",DUZ)) S OPTS=OPTS_"I" ;PSO*7.0*358, if user has security key, include IGNORE in TRICARE/CHAMPVA options
S:(OPTS["D") DIR(0)=DIR(0)_"D:(D)iscontinue - DO NOT FILL PRESCRIPTION;",DIR("A")=DIR("A")_"(D)iscontinue,"
S:(OPTS["Q") DIR(0)=DIR(0)_"Q:(Q)UIT - SEND TO WORKLIST (REQUIRES INTERVENTION);",DIR("A")=DIR("A")_"(Q)uit,"
S:(OPTS["I") DIR(0)=DIR(0)_"I:(I)GNORE - FILL Rx WITHOUT CLAIM SUBMISSION;",DIR("A")=DIR("A")_"(I)gnore,"
S $E(DIR(0),$L(DIR(0)))="",$E(DIR("A"),$L(DIR("A")))="",DIR("??")="^D HELP^PSOREJU2("""_OPTS_""")"
S:$G(DEF)'="" DIR("B")=DEF D ^DIR I $D(DIRUT) S Y="Q" W !
;
S ACTION=Y
I ACTION="D" S ACTION=$$DC^PSOREJU1(RX,ACTION) ;cnf, PSO*7*358
S PSOIT=""
I ACTION="I" S PSOIT=$$IGNORE^PSOREJU1(RX,RFL)
I $P(PSOIT,"^")=0 D G TRIC4
. I $P(PSOIT,"^",2)'="" D
. . W $C(7),!,"Gross Amount Due is $"_$P(PSOIT,"^",2)_". IGNORE requires EPHARMACY SITE MANAGER key."
I ACTION="I" G TRIC4:'$$CONT^PSOREJU1() S COM=$$TCOM^PSOREJP3(RX,RFL) G TRIC4:COM="^" G TRIC4:'$$SIG^PSOREJU1() D
. D CLOSE^PSOREJUT(RX,RFL,REJ,DUZ,6,COM,"","","","","",1) ;TRICARE/CHAMPVA non-billable should have only 1 reject - eT/eC
. D AUDIT^PSOTRI(RX,RFL,,COM,$S($$PSOETEC^PSOREJP5(RX,RFL):"N",1:"R"),$P(RESP,"^",3))
Q
;
MSG ;
W !!,"This is a non-billable "_$$ELIGDISP^PSOREJP1(RX,RFL)_" prescription." ;cnf, PSO*7*358
Q
SUSP ;Suspense Rx due to IN PROGRESS status in ECME
D LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$T(+0)_"-SUSP")
N DA,ACT,RX0,SD,RXS,PSOWFLG,DIK,RXN,XFLAG,RXP,DD,DO,X,Y,DIC,VALMSG,COMM,LFD,DFLG,RXCMOP
N PSOQFLAG,PSORXZD,PSOQFLAG,PSOKSPPL,PSOZXPPL,PSOZXPI,RXLTOP
S DA=RX D SUS^PSORXL1
TACT ;
D LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$T(+0)_"-TACT, PSONPROG="_$G(PSONPROG)_" PSONBILL="_$G(PSONBILL))
S ACT=$$ELIGDISP^PSOREJP1(RX,RFL)_"-Rx placed on Suspense due to"_$S($G(PSONPROG):" ECME IN PROGRESS status",$G(PSONBILL):"the Rx being Non-billable",1:"")
I '$G(DUZ) N DUZ S DUZ=.5
D RXACT^PSOBPSU2(RX,RFL,ACT,"M",DUZ)
Q
;
DISPLAY(RX,REJ,KEY,RRR) ; - Displays REJECT information
; Input: (r) RX - Rx IEN (#52)
; (r) REJ - REJECT ID (IEN)
; (o) KEY - Display "Press any KEY to continue..." (1-YES/0-NO) (Default: 0)
; (o) RRR - Reject Resolution Required information Flag(0/1)^Threshold Amt^Gross Amt Due (Default: 0)
; If Flag = 0, there is no Reject Resolution Required reject code. Parameter added with PSO*421
;
Q:$G(NFROM)
I '$G(RX)!'$G(REJ) Q
I '$D(^PSRX(RX,"REJ",REJ))&('$G(PSONBILL))&('$G(PSONPROG)) Q
;
N DATA,PTINFO,RFL,LINE,%
S RFL=+$$GET1^DIQ(52.25,REJ_","_RX,5)
I '$G(PSONBILL)&('$G(PSONPROG)) D GET^PSOREJU2(RX,RFL,.DATA,REJ) I '$D(DATA(REJ)) Q
;
D HDR
S $P(LINE,"-",74)="" W !?3,LINE
W !?3,$$DVINFO(RX,RFL)
S PTINFO=$$PTINFO^PSOREJU2(RX)
W !?3,$P(PTINFO,U,1)
W !?3,$P(PTINFO,U,2)
W !?3,"Rx/Drug : ",$$GET1^DIQ(52,RX,.01),"/",RFL," - ",$E($$GET1^DIQ(52,RX,6),1,20),?54
W:'$G(PSONBILL)&('$G(PSONPROG)) "ECME#: ",$P($$CLAIM^BPSBUTL(RX,RFL),U,6)
D TYPE G DISP2:$G(PSONBILL)!($G(PSONPROG))
I $G(DATA(REJ,"PAYER MESSAGE"))'="" W !?3,"Payer Message: " D PRT^PSOREJU2("PAYER MESSAGE",18,58)
I $G(DATA(REJ,"DUR TEXT"))'="" W !?3,"DUR Text : ",DATA(REJ,"DUR TEXT")
W !?3,"Insurance : ",DATA(REJ,"INSURANCE NAME"),?50,"Contact: ",DATA(REJ,"PLAN CONTACT")
W !?3,"Group Name : ",$E(DATA(REJ,"GROUP NAME"),1,26)
W ?45,"Group Number: ",$E(DATA(REJ,"GROUP NUMBER"),1,15)
I $G(DATA(REJ,"CARDHOLDER ID"))'="" W !?3,"Cardholder ID: ",$E(DATA(REJ,"CARDHOLDER ID"),1,20)
I DATA(REJ,"PLAN PREVIOUS FILL DATE")'="" D
. W !?3,"Last Fill Dt.: ",DATA(REJ,"PLAN PREVIOUS FILL DATE")
. W:DATA(REJ,"PLAN PREVIOUS FILL DATE")'="" " (from payer)"
;
N PSOAR,PSOCNT,PSOCOMMENT,PSODATA,PSODATE,PSODATE1
N PSODFN,PSOPC,PSOSTATUS,PSOSTR,PSOUSER
;
; Get Patient ID
S PSODFN=$$GET1^DIQ(52,RX,2,"I")
;
; Loop through Patient Comments - Add ACTIVE Comments to PSOAR array
S PSODATE=""
S PSOCNT=0
K PSOAR
F S PSODATE=$O(^PS(55,PSODFN,"PC","B",PSODATE)) Q:PSODATE="" D
. S PSOPC=""
. F S PSOPC=$O(^PS(55,PSODFN,"PC","B",PSODATE,PSOPC)) Q:PSOPC="" D
. . K PSODATA
. . D GETS^DIQ(55.17,PSOPC_","_PSODFN_",",".01;1;2;3","IE","PSODATA")
. . ;
. . ; Only display ACTIVE Patient Comments
. . S PSOSTATUS=$G(PSODATA(55.17,PSOPC_","_PSODFN_",",2,"I"))
. . I PSOSTATUS'="Y" Q
. . ;
. . S PSODATE1=$G(PSODATA(55.17,PSOPC_","_PSODFN_",",.01,"E"))
. . S PSOUSER=$G(PSODATA(55.17,PSOPC_","_PSODFN_",",1,"E"))
. . S PSOCOMMENT=$G(PSODATA(55.17,PSOPC_","_PSODFN_",",3,"E"))
. . S PSOSTR=PSODATE1_" - "_PSOCOMMENT_" ("_PSOUSER_")"
. . S PSOCNT=PSOCNT+1
. . S PSOAR(PSOCNT)=PSOSTR
;
; If PSOAR array exists, display Active Patient Comments
I $D(PSOAR) D
. W !?3,"Patient Billing Comment(s):"
. ;
. ; Loop through PSOAR in reverse order to display Patient
. ; Comments in reverse chronological order
. S PSOCNT=""
. F S PSOCNT=$O(PSOAR(PSOCNT),-1) Q:PSOCNT="" D
. . ;
. . ; Use ^DIWP to display Patient Comments with proper
. . ; line breaking
. . N %,DIW,DIWF,DIWI,DIWL,DIWR,DIWT,DIWTC,DIWX,DN,I,Z
. . K ^UTILITY($J,"W")
. . S X=PSOAR(PSOCNT)
. . S DIWL=1
. . S DIWR=78
. . D ^DIWP
. . ;
. . S PSOLAST=0
. . F PSOY=1:1 Q:('$D(^UTILITY($J,"W",1,PSOY,0))) D
. . . S PSOCOM=$G(^UTILITY($J,"W",1,PSOY,0))
. . . W !?3,PSOCOM
. K ^UTILITY($J,"W")
;
I $G(RRR) D ;added with PSO*421
. W !!?3,"Reject Resolution Required"
. W !?3,"Gross Amount Due ($"_$J($P(RRR,U,3)*100\1/100,0,2)_") is greater than or equal to"
. W !?3,"Threshold Dollar Amount ($"_$P(RRR,U,2)_")"
. W !?3,"Please select Quit to resolve this reject on the Reject Worklist."
DISP2 ;
W !?3,LINE,$C(7) I $G(KEY) W !?3,"Press <RETURN> to continue..." R %:DTIME W !
Q
;
TYPE ;
I $G(PSONBILL)!($G(PSONPROG)) D Q
. D NOW^%DTC S Y=% D DD^%DT
. W !?3,"Date/Time: "_$$FMTE^XLFDT(Y)
. W !?3,"Reason : ",$S($G(PSONBILL):"Not Billable.",$G(PSONPROG):"ECME Status is in an 'IN PROGRESS' state and cannot be filled",1:"")
;
I $G(DATA(REJ,"REASON"))'="" W !?3,"Reason : " D PRT^PSOREJU2("REASON",14,62)
N RTXT,OCODE,OTXT,I
S (OTXT,RTXT,OCODE)="",RTXT=$S(DATA(REJ,"CODE")=79:"REFILL TOO SOON",DATA(REJ,"CODE")=88!(DATA(REJ,"CODE")=943):"DUR REJECT",1:$$EXP^PSOREJP1(DATA(REJ,"CODE")))_" ("_DATA(REJ,"CODE")_")"
F I=1:1 S OCODE=$P(DATA(REJ,"OTHER REJECTS"),",",I) Q:OCODE="" D
. S OTXT=OTXT_", "_$S(OCODE=79:"REFILL TOO SOON",OCODE=88!(OCODE=943):"DUR REJECT",1:$$EXP^PSOREJP1(OCODE))_" ("_OCODE_")"
S RTXT=RTXT_OTXT_". Received on "_$$FMTE^XLFDT($G(DATA(REJ,"DATE/TIME")))_"."
S OTXT=""
W !?3,"Reject(s): " D WRAP(RTXT,14)
Q
;
WRAP(PSOTXT,INDENT) ;
N I,K,PSOWRAP,PSOMARG
S PSOWRAP=1,PSOMARG=$S('$G(PSORM):80,$D(IOM):IOM,1:80)-(INDENT+5)
W1 S:$L(PSOTXT)<PSOMARG PSOWRAP(PSOWRAP)=PSOTXT I $L(PSOTXT)'<PSOMARG F I=PSOMARG:-1:0 I $E(PSOTXT,I)?1P S PSOWRAP(PSOWRAP)=$E(PSOTXT,1,I),PSOTXT=$E(PSOTXT,I+1,999),PSOWRAP=PSOWRAP+1 G W1
F K=1:1:PSOWRAP W ?INDENT,PSOWRAP(K),!
Q
;
HDR ; Display the reject notification screen header
N ELDSP,TAB
S ELDSP=$$ELIGTCV^PSOREJP1(RX,RFL,1) ; returns TRICARE, CHAMPVA or VETERAN
I $L(ELDSP) S ELDSP=ELDSP_" - " ; Add the " - " for CVA/TRI only
;
I $G(PSONBILL) S TAB=$S($L(ELDSP):24,1:29) W !!?TAB,"*** "_ELDSP_"NON-BILLABLE ***" Q
I $G(PSONPROG) S TAB=$S($L(ELDSP):18,1:23) W !!?TAB,"*** "_ELDSP_"'IN PROGRESS' ECME status ***" Q
S TAB=$S($L(ELDSP):11,1:16) W !!?TAB,"*** "_ELDSP_"REJECT RECEIVED FROM THIRD PARTY PAYER ***"
Q
;
SUBMIT(RXIEN,RFCNT,PSOTRIC) ;called from PSOCAN2 (routine size exceeded)
N SUBMITE S SUBMITE=$$SUBMIT^PSOBPSUT(RXIEN)
I SUBMITE D
. N ACTION
. D ECMESND^PSOBPSU1(RXIEN,,,$S($O(^PSRX(RXIEN,1,0)):"RF",1:"OF"))
. ; Quit if there is an unresolved TRICARE or CHAMPVA non-billable reject code, PSO*7*358
. I $$PSOET^PSOREJP3(RXIEN) S ACTION="Q" Q
. I $$FIND^PSOREJUT(RXIEN) S ACTION=$$HDLG^PSOREJU1(RXIEN,,"79,88,943","OF","IOQ","Q")
I 'SUBMITE&(PSOTRIC) D
. I $$STATUS^PSOBPSUT(RXIEN,RFCNT'["PAYABLE") D TRICCHK(RXIEN,RFCNT)
Q
;
TRISTA(RX,RFL,RESP,FROM,RVTX) ;called from suspense
N ETOUT,ESTAT,TRESP,TSTAT,PSOTRIC
S:'$D(RESP) RESP=""
S (ESTAT,PSOTRIC)="",PSOTRIC=$$TRIC^PSOREJP1(RX,RFL,PSOTRIC)
Q:'PSOTRIC 0
S TRESP=RESP,ESTAT=$P(TRESP,"^",4) S:ESTAT="" ESTAT=$$STATUS^PSOBPSUT(RX,RFL)
Q:ESTAT["E PAYABLE" 0
I $$TRIAUD(RX,RFL) D Q 0 ;if TRICARE or CHAMPVA Rx is in audit due to override or bypass, allow to print from suspense, cnf
. D LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$T(+0)_"-TRISTA, $$TRIAUD returned 1, $$TRISTA is Quitting with 0") ; ICR#s 4412,6764
I +RESP=2,$$BYPASS^PSOBPSU1($P(RESP,"^",3),$P(RESP,"^",2)) D Q 0 ;if 'Bypass' RX, allow to print from suspense, cnf
. D LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$T(+0)_"-TRISTA, $$BYPASS returned 1, $$TRISTA is Quitting with 0") ; ICR#s 4412,6764
Q:ESTAT["E REJECTED" 1 ;rejected TRICARE or CHAMPVA is not allowed to print from suspense
;if 'in progress' (4) or not billable (2,3) don't allow to print from suspense (IA 4415 Values)
I '$D(RESP)!($P(RESP,"^",1)="")!($G(RESP)="") D
. S TSTAT=$$STATUS^PSOBPSUT(RX,RFL) S TRESP=$S(TSTAT["IN PROGRESS":4,TSTAT["NOT BILLABLE":2,1:0)
. S $P(TRESP,"^",4)=TSTAT
;
I +TRESP=2!(+TRESP=3) D Q 1
. D WRKLST^PSOREJU4(RX,RFL,"",DUZ,DT,1,"",RESP) ;send TRICARE or CHAMPVA non billable to worklist (pseudo reject), cnf
. D LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$T(+0)_"-TRISTA, calling WRKLST~PSOREJU4, $$TRISTA is Quitting with 1") ; ICR#s 4412,6764
I +TRESP=4!(ESTAT["IN PROGRESS") D Q 1
. D LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$T(+0)_"-TRISTA, TRESP="_TRESP_", ESTAT="_ESTAT_", $$TRISTA is Quitting with 1") ; ICR#s 4412,6764
Q 0
;
TRIAUD(RXIEN,RXFILL) ;is RXIEN in the TRICARE/CHAMPVA audit and no open rejects ;cnf
; RXIEN will only be in TRICARE/CHAMPVA audit if a bypass or override has occurred and rejects are closed
; returns 0 if RXIEN is not in TRICARE/CHAMPVA audit at all or not in audit for right fill number
; rejects must be closed for 0 to be returned
; 1 if RXIEN is in TRICARE/CHAMPVA audit for the right fill number and rejects are closed
;
N X,AUDIEN,REJIEN
S X=0,AUDIEN=""
I '$D(^PS(52.87,"C",RXIEN)) Q X ;RXIEN is not in the TRICARE/CHAMPVA audit
;
I $G(RXFILL)="" S RXFILL=$$LSTRFL^PSOBPSU1(RXIEN) ;Get latest fill if not passed in
;
;check audit entries for right fill number
F S AUDIEN=$O(^PS(52.87,"C",RXIEN,AUDIEN)) Q:AUDIEN="" I RXFILL=$$GET1^DIQ(52.87,AUDIEN,2) S X=1 Q
I 'X Q X
;
;make sure rejects are closed
S REJIEN=0
F S REJIEN=$O(^PSRX(RXIEN,"REJ",REJIEN)) Q:'+REJIEN D I 'X Q ;I 'X, then the reject is not closed
. S X=$$CLOSED^PSOREJP1(RXIEN,REJIEN,0)
;
Q X
;
ECMECHK(RX,FILL) ;
; This function returns a '1' if any of the conditions below are met:
; - RX has an unresolved DUR or Refill Too Soon reject
; - RX has an unresolved Reject Resolution Required (RRR) reject (only for Veteran and original fill)
; - RX is TRICARE/CHAMPVA and has any unresolved reject
; - RX is TRICARE/CHAMPVA and IN PROGRESS
; This is used by functions such as PPLADD^PSOSUPOE to determine if
; a label should be printed (we do not want a label for the conditions)
;
; Incoming Parameters:
; RX - Internal IEN of the Prescription File (required)
; FILL - Fill Number (optional, defaults to last fill if not passed in)
; Returns:
; 0 - None of the conditions exists
; 1 - One of the conditions above is met
;
I '$G(RX) Q 0
I $G(FILL)="" S FILL=$$LSTRFL^PSOBPSU1(RX)
;
; DUR or Refill Too Soon or RRR rejects
I $$FIND^PSOREJUT(RX,FILL,"","79,88,943",,1) Q 1
;
; If not TRICARE/CHAMPVA, quit with 0 as the rest of the checks
; are all TRICARE/CHAMPVA dependent
I '$$TRIC^PSOREJP1(RX,FILL) Q 0
;
; No label for TRICARE/CHAMPVA with unresolved rejects
I $$FIND^PSOREJUT(RX,FILL,,,1) Q 1 ; 5th parameter to $$FIND also finds non-billable TRI/CVA rejects
;
;No label for TRICARE/CHAMPVA claims that are IN PROGRESS
I $P($$STATUS^PSOBPSUT(RX,FILL),U)="IN PROGRESS" Q 1
Q 0
;
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,TXT
S DVIEN=+$$RXSITE^PSOBPSUT(RX,RFL)
S DVINFO="Division : "_$$GET1^DIQ(59,DVIEN,.01)
;
; 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=$$CSNPI^BPSUTIL(RX,RFL)
;
; If not a Controlled Substance, use NCPDP# & NPI info based on Division.
; Display both NPI and NCPDP numbers - PSO*7.0*421
I +NCPNPI=-1 S NCPNPI=$$DIVNCPDP^BPSBUTL(DVIEN)
S $E(DVINFO,33)="NPI: "_$P(NCPNPI,U,2)
S $E(DVINFO,$S($G(LM):59,1:52))="NCPDP: "_$P(NCPNPI,U)
Q DVINFO
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HPSOREJU3 16573 printed Dec 13, 2024@02:33:40 Page 2
PSOREJU3 ;BIRM/LJE - BPS (ECME) - Clinical Rejects Utilities (3) ;04/25/08
+1 ;;7.0;OUTPATIENT PHARMACY;**287,290,358,359,385,421,427,448,478,513,482,528,561,562,680,704**;DEC 1997;Build 16
+2 ; Reference to 9002313.99 in ICR #4305
+3 ; Reference to $$CLAIM^BPSBUTL in ICR #4719
+4 ; Reference to LOG^BPSOSL in ICR #6764
+5 ; Reference to IEN59^BPSOSRX in ICR #4412
+6 ; Reference to $$CSNPI^BPSUTIL in ICR #4146
+7 ;
+8 QUIT
+9 ;
TRICCHK(RX,RFL,RESP,FROM,RVTX) ;check to see if Rx is non-billable or in an "In Progress" state on ECME
+1 ; Input: (r) RX - Rx IEN (#52)
+2 ; (r) RFL - REFILL
+3 ; (o) RESP - Response from $$EN^BPSNCPDP api
+4 ; TRICCHK assumes that the calling routine has validated that the fill is TRICARE or CHAMPVA.
+5 ;
+6 ; - \Need to be mindful of foreground and background processing.
+7 ;
+8 NEW ESTAT,ETOUT,NFROM,PSOBEI
+9 IF '$DATA(FROM)
SET FROM=""
+10 SET ESTAT=$PIECE(RESP,"^",4)
+11 SET NFROM=0
+12 IF FROM="PL"!(FROM="PC")
SET NFROM=1
+13 if ESTAT["PAYABLE"!(ESTAT["REJECTED")
QUIT
+14 SET PSOBEI=$$ELIGDISP^PSOREJP1(RX,RFL)
+15 ;
+16 ; ICR#s 4412,6764
DO LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$TEXT(+0)_"-TRICCHK, RESP="_RESP)
+17 DO LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$TEXT(+0)_"-TRICCHK, FROM="_FROM_" ESTAT="_ESTAT)
+18 ; ICR#s 4412,6764
IF ESTAT["IN PROGRESS"
IF FROM="PC"
DO LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$TEXT(+0)_"-Would have noted in Activity Log that Rx was left in CMOP suspense")
QUIT
+19 ;
+20 IF ESTAT["IN PROGRESS"
IF FROM="RRL"!($GET(RVTX)="RX RELEASE-NDC CHANGE")
Begin DoDot:1
+21 IF 'NFROM
Begin DoDot:2
+22 WRITE !!,PSOBEI_" Prescription "_$$GET1^DIQ(52,RX,".01")_" cannot be released until ECME 'IN PROGRESS'"
+23 WRITE !,"status is resolved payable.",!!
End DoDot:2
End DoDot:1
QUIT
+24 ;
+25 IF $DATA(RESP)
Begin DoDot:1
+26 IF +RESP=6
if 'NFROM&('$GET(CMOP))
WRITE !!,"Inactive ECME "_PSOBEI,!!
Begin DoDot:2
+27 SET ACT="Inactive ECME "_PSOBEI
DO RXACT^PSOBPSU2(RX,RFL,ACT,"M",DUZ)
End DoDot:2
QUIT
+28 IF +RESP=2!(+RESP=3)
NEW PSONBILL
SET PSONBILL=1
DO TRIC2
QUIT
+29 IF +RESP=4!(ESTAT["IN PROGRESS")
Begin DoDot:2
+30 ;
+31 ; Do not put the Rx into the suspense queue if this claim activity
+32 ; was triggered by a release message from OPAI or CMOP.
+33 ;
+34 IF $EXTRACT(FROM,1,2)="CR"
QUIT
+35 ;
+36 ; Put the Rx into the suspense queue.
+37 ;
+38 NEW PSONPROG
SET PSONPROG=1
DO TRIC2
End DoDot:2
QUIT
End DoDot:1
QUIT
+39 ;
+40 QUIT
+41 ;
TRIC2 ;
+1 NEW ACTION,DA,DIR,DIRUT,PSCAN,PSOIT,PSORESP,PSOTRIC
+2 NEW REA,REJ,REJCOD,REJDATA,X,ZZZ
+3 SET PSOTRIC=1
SET REJ=9999999999
+4 DO LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$TEXT(+0)_"-TRIC2, CMOP="_$GET(CMOP)_" PSONPROG="_$GET(PSONPROG))
+5 IF $GET(CMOP)&($GET(PSONPROG))
DO TACT
QUIT
+6 ;
+7 ; If the prescription is non-billable, put the eT/eC reject on the
+8 ; Prescription (WRKLST^PSOREJU4), then determine the reject number.
+9 ;
+10 IF +RESP=2
Begin DoDot:1
+11 DO WRKLST^PSOREJU4(RX,RFL,,DUZ,DT,1,"",RESP)
+12 SET X=$$FIND^PSOREJUT(RX,RFL,.REJDATA,"eT,eC",1)
+13 SET REJ=0
+14 FOR
SET REJ=$ORDER(REJDATA(REJ))
if 'REJ
QUIT
IF "eT,eC"[REJDATA(REJ,"CODE")
QUIT
+15 QUIT
End DoDot:1
+16 ;
+17 if $GET(CMOP)
QUIT
+18 DO LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$TEXT(+0)_"-TRIC2, NFROM="_NFROM)
+19 IF 'NFROM
DO DISPLAY(RX,REJ)
+20 IF 'NFROM&($GET(PSONPROG))
Begin DoDot:1
+21 WRITE !!,"This prescription will be suspended. After the third party claim is resolved,"
+22 WRITE !,"it may be printed or pulled early from suspense.",!
+23 READ !!,"Press <RETURN> to continue...",ZZZ:60,!
End DoDot:1
DO SUSP
QUIT
+24 IF NFROM&($GET(PSONPROG))
DO TACT
QUIT
+25 if NFROM
QUIT
TRIC3 ;
+1 DO MSG
+2 IF FROM="PL"!(FROM="PC")
DO SUSP
QUIT
+3 ;cnf, PSO*7*358, add code for options
+4 NEW ACTION,COM,DEF,DIR,DIRUT,OPTS
TRIC4 SET DIR(0)="SO^"
SET DIR("A")=""
SET OPTS="DQ"
SET DEF="D"
+1 SET PSORESP=$PIECE($GET(RESP),U,2)
+2 ;IB routine IBNCPDP1 contains this text.
IF PSORESP["NO ACTIVE/VALID ROI"
SET DEF="Q"
+3 IF PSORESP="NOT INSURED"
SET DEF="Q"
+4 ;reference to ^XUSEC( supported by IA 10076
+5 ;PSO*7.0*358, if user has security key, include IGNORE in TRICARE/CHAMPVA options
IF $DATA(^XUSEC("PSO TRICARE/CHAMPVA",DUZ))
SET OPTS=OPTS_"I"
+6 if (OPTS["D")
SET DIR(0)=DIR(0)_"D:(D)iscontinue - DO NOT FILL PRESCRIPTION;"
SET DIR("A")=DIR("A")_"(D)iscontinue,"
+7 if (OPTS["Q")
SET DIR(0)=DIR(0)_"Q:(Q)UIT - SEND TO WORKLIST (REQUIRES INTERVENTION);"
SET DIR("A")=DIR("A")_"(Q)uit,"
+8 if (OPTS["I")
SET DIR(0)=DIR(0)_"I:(I)GNORE - FILL Rx WITHOUT CLAIM SUBMISSION;"
SET DIR("A")=DIR("A")_"(I)gnore,"
+9 SET $EXTRACT(DIR(0),$LENGTH(DIR(0)))=""
SET $EXTRACT(DIR("A"),$LENGTH(DIR("A")))=""
SET DIR("??")="^D HELP^PSOREJU2("""_OPTS_""")"
+10 if $GET(DEF)'=""
SET DIR("B")=DEF
DO ^DIR
IF $DATA(DIRUT)
SET Y="Q"
WRITE !
+11 ;
+12 SET ACTION=Y
+13 ;cnf, PSO*7*358
IF ACTION="D"
SET ACTION=$$DC^PSOREJU1(RX,ACTION)
+14 SET PSOIT=""
+15 IF ACTION="I"
SET PSOIT=$$IGNORE^PSOREJU1(RX,RFL)
+16 IF $PIECE(PSOIT,"^")=0
Begin DoDot:1
+17 IF $PIECE(PSOIT,"^",2)'=""
Begin DoDot:2
+18 WRITE $CHAR(7),!,"Gross Amount Due is $"_$PIECE(PSOIT,"^",2)_". IGNORE requires EPHARMACY SITE MANAGER key."
End DoDot:2
End DoDot:1
GOTO TRIC4
+19 IF ACTION="I"
if '$$CONT^PSOREJU1()
GOTO TRIC4
SET COM=$$TCOM^PSOREJP3(RX,RFL)
if COM="^"
GOTO TRIC4
if '$$SIG^PSOREJU1()
GOTO TRIC4
Begin DoDot:1
+20 ;TRICARE/CHAMPVA non-billable should have only 1 reject - eT/eC
DO CLOSE^PSOREJUT(RX,RFL,REJ,DUZ,6,COM,"","","","","",1)
+21 DO AUDIT^PSOTRI(RX,RFL,,COM,$SELECT($$PSOETEC^PSOREJP5(RX,RFL):"N",1:"R"),$PIECE(RESP,"^",3))
End DoDot:1
+22 QUIT
+23 ;
MSG ;
+1 ;cnf, PSO*7*358
WRITE !!,"This is a non-billable "_$$ELIGDISP^PSOREJP1(RX,RFL)_" prescription."
+2 QUIT
SUSP ;Suspense Rx due to IN PROGRESS status in ECME
+1 DO LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$TEXT(+0)_"-SUSP")
+2 NEW DA,ACT,RX0,SD,RXS,PSOWFLG,DIK,RXN,XFLAG,RXP,DD,DO,X,Y,DIC,VALMSG,COMM,LFD,DFLG,RXCMOP
+3 NEW PSOQFLAG,PSORXZD,PSOQFLAG,PSOKSPPL,PSOZXPPL,PSOZXPI,RXLTOP
+4 SET DA=RX
DO SUS^PSORXL1
TACT ;
+1 DO LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$TEXT(+0)_"-TACT, PSONPROG="_$GET(PSONPROG)_" PSONBILL="_$GET(PSONBILL))
+2 SET ACT=$$ELIGDISP^PSOREJP1(RX,RFL)_"-Rx placed on Suspense due to"_$SELECT($GET(PSONPROG):" ECME IN PROGRESS status",$GET(PSONBILL):"the Rx being Non-billable",1:"")
+3 IF '$GET(DUZ)
NEW DUZ
SET DUZ=.5
+4 DO RXACT^PSOBPSU2(RX,RFL,ACT,"M",DUZ)
+5 QUIT
+6 ;
DISPLAY(RX,REJ,KEY,RRR) ; - Displays REJECT information
+1 ; Input: (r) RX - Rx IEN (#52)
+2 ; (r) REJ - REJECT ID (IEN)
+3 ; (o) KEY - Display "Press any KEY to continue..." (1-YES/0-NO) (Default: 0)
+4 ; (o) RRR - Reject Resolution Required information Flag(0/1)^Threshold Amt^Gross Amt Due (Default: 0)
+5 ; If Flag = 0, there is no Reject Resolution Required reject code. Parameter added with PSO*421
+6 ;
+7 if $GET(NFROM)
QUIT
+8 IF '$GET(RX)!'$GET(REJ)
QUIT
+9 IF '$DATA(^PSRX(RX,"REJ",REJ))&('$GET(PSONBILL))&('$GET(PSONPROG))
QUIT
+10 ;
+11 NEW DATA,PTINFO,RFL,LINE,%
+12 SET RFL=+$$GET1^DIQ(52.25,REJ_","_RX,5)
+13 IF '$GET(PSONBILL)&('$GET(PSONPROG))
DO GET^PSOREJU2(RX,RFL,.DATA,REJ)
IF '$DATA(DATA(REJ))
QUIT
+14 ;
+15 DO HDR
+16 SET $PIECE(LINE,"-",74)=""
WRITE !?3,LINE
+17 WRITE !?3,$$DVINFO(RX,RFL)
+18 SET PTINFO=$$PTINFO^PSOREJU2(RX)
+19 WRITE !?3,$PIECE(PTINFO,U,1)
+20 WRITE !?3,$PIECE(PTINFO,U,2)
+21 WRITE !?3,"Rx/Drug : ",$$GET1^DIQ(52,RX,.01),"/",RFL," - ",$EXTRACT($$GET1^DIQ(52,RX,6),1,20),?54
+22 if '$GET(PSONBILL)&('$GET(PSONPROG))
WRITE "ECME#: ",$PIECE($$CLAIM^BPSBUTL(RX,RFL),U,6)
+23 DO TYPE
if $GET(PSONBILL)!($GET(PSONPROG))
GOTO DISP2
+24 IF $GET(DATA(REJ,"PAYER MESSAGE"))'=""
WRITE !?3,"Payer Message: "
DO PRT^PSOREJU2("PAYER MESSAGE",18,58)
+25 IF $GET(DATA(REJ,"DUR TEXT"))'=""
WRITE !?3,"DUR Text : ",DATA(REJ,"DUR TEXT")
+26 WRITE !?3,"Insurance : ",DATA(REJ,"INSURANCE NAME"),?50,"Contact: ",DATA(REJ,"PLAN CONTACT")
+27 WRITE !?3,"Group Name : ",$EXTRACT(DATA(REJ,"GROUP NAME"),1,26)
+28 WRITE ?45,"Group Number: ",$EXTRACT(DATA(REJ,"GROUP NUMBER"),1,15)
+29 IF $GET(DATA(REJ,"CARDHOLDER ID"))'=""
WRITE !?3,"Cardholder ID: ",$EXTRACT(DATA(REJ,"CARDHOLDER ID"),1,20)
+30 IF DATA(REJ,"PLAN PREVIOUS FILL DATE")'=""
Begin DoDot:1
+31 WRITE !?3,"Last Fill Dt.: ",DATA(REJ,"PLAN PREVIOUS FILL DATE")
+32 if DATA(REJ,"PLAN PREVIOUS FILL DATE")'=""
WRITE " (from payer)"
End DoDot:1
+33 ;
+34 NEW PSOAR,PSOCNT,PSOCOMMENT,PSODATA,PSODATE,PSODATE1
+35 NEW PSODFN,PSOPC,PSOSTATUS,PSOSTR,PSOUSER
+36 ;
+37 ; Get Patient ID
+38 SET PSODFN=$$GET1^DIQ(52,RX,2,"I")
+39 ;
+40 ; Loop through Patient Comments - Add ACTIVE Comments to PSOAR array
+41 SET PSODATE=""
+42 SET PSOCNT=0
+43 KILL PSOAR
+44 FOR
SET PSODATE=$ORDER(^PS(55,PSODFN,"PC","B",PSODATE))
if PSODATE=""
QUIT
Begin DoDot:1
+45 SET PSOPC=""
+46 FOR
SET PSOPC=$ORDER(^PS(55,PSODFN,"PC","B",PSODATE,PSOPC))
if PSOPC=""
QUIT
Begin DoDot:2
+47 KILL PSODATA
+48 DO GETS^DIQ(55.17,PSOPC_","_PSODFN_",",".01;1;2;3","IE","PSODATA")
+49 ;
+50 ; Only display ACTIVE Patient Comments
+51 SET PSOSTATUS=$GET(PSODATA(55.17,PSOPC_","_PSODFN_",",2,"I"))
+52 IF PSOSTATUS'="Y"
QUIT
+53 ;
+54 SET PSODATE1=$GET(PSODATA(55.17,PSOPC_","_PSODFN_",",.01,"E"))
+55 SET PSOUSER=$GET(PSODATA(55.17,PSOPC_","_PSODFN_",",1,"E"))
+56 SET PSOCOMMENT=$GET(PSODATA(55.17,PSOPC_","_PSODFN_",",3,"E"))
+57 SET PSOSTR=PSODATE1_" - "_PSOCOMMENT_" ("_PSOUSER_")"
+58 SET PSOCNT=PSOCNT+1
+59 SET PSOAR(PSOCNT)=PSOSTR
End DoDot:2
End DoDot:1
+60 ;
+61 ; If PSOAR array exists, display Active Patient Comments
+62 IF $DATA(PSOAR)
Begin DoDot:1
+63 WRITE !?3,"Patient Billing Comment(s):"
+64 ;
+65 ; Loop through PSOAR in reverse order to display Patient
+66 ; Comments in reverse chronological order
+67 SET PSOCNT=""
+68 FOR
SET PSOCNT=$ORDER(PSOAR(PSOCNT),-1)
if PSOCNT=""
QUIT
Begin DoDot:2
+69 ;
+70 ; Use ^DIWP to display Patient Comments with proper
+71 ; line breaking
+72 NEW %,DIW,DIWF,DIWI,DIWL,DIWR,DIWT,DIWTC,DIWX,DN,I,Z
+73 KILL ^UTILITY($JOB,"W")
+74 SET X=PSOAR(PSOCNT)
+75 SET DIWL=1
+76 SET DIWR=78
+77 DO ^DIWP
+78 ;
+79 SET PSOLAST=0
+80 FOR PSOY=1:1
if ('$DATA(^UTILITY($JOB,"W",1,PSOY,0)))
QUIT
Begin DoDot:3
+81 SET PSOCOM=$GET(^UTILITY($JOB,"W",1,PSOY,0))
+82 WRITE !?3,PSOCOM
End DoDot:3
End DoDot:2
+83 KILL ^UTILITY($JOB,"W")
End DoDot:1
+84 ;
+85 ;added with PSO*421
IF $GET(RRR)
Begin DoDot:1
+86 WRITE !!?3,"Reject Resolution Required"
+87 WRITE !?3,"Gross Amount Due ($"_$JUSTIFY($PIECE(RRR,U,3)*100\1/100,0,2)_") is greater than or equal to"
+88 WRITE !?3,"Threshold Dollar Amount ($"_$PIECE(RRR,U,2)_")"
+89 WRITE !?3,"Please select Quit to resolve this reject on the Reject Worklist."
End DoDot:1
DISP2 ;
+1 WRITE !?3,LINE,$CHAR(7)
IF $GET(KEY)
WRITE !?3,"Press <RETURN> to continue..."
READ %:DTIME
WRITE !
+2 QUIT
+3 ;
TYPE ;
+1 IF $GET(PSONBILL)!($GET(PSONPROG))
Begin DoDot:1
+2 DO NOW^%DTC
SET Y=%
DO DD^%DT
+3 WRITE !?3,"Date/Time: "_$$FMTE^XLFDT(Y)
+4 WRITE !?3,"Reason : ",$SELECT($GET(PSONBILL):"Not Billable.",$GET(PSONPROG):"ECME Status is in an 'IN PROGRESS' state and cannot be filled",1:"")
End DoDot:1
QUIT
+5 ;
+6 IF $GET(DATA(REJ,"REASON"))'=""
WRITE !?3,"Reason : "
DO PRT^PSOREJU2("REASON",14,62)
+7 NEW RTXT,OCODE,OTXT,I
+8 SET (OTXT,RTXT,OCODE)=""
SET RTXT=$SELECT(DATA(REJ,"CODE")=79:"REFILL TOO SOON",DATA(REJ,"CODE")=88!(DATA(REJ,"CODE")=943):"DUR REJECT",1:$$EXP^PSOREJP1(DATA(REJ,"CODE")))_" ("_DATA(REJ,"CODE")_")"
+9 FOR I=1:1
SET OCODE=$PIECE(DATA(REJ,"OTHER REJECTS"),",",I)
if OCODE=""
QUIT
Begin DoDot:1
+10 SET OTXT=OTXT_", "_$SELECT(OCODE=79:"REFILL TOO SOON",OCODE=88!(OCODE=943):"DUR REJECT",1:$$EXP^PSOREJP1(OCODE))_" ("_OCODE_")"
End DoDot:1
+11 SET RTXT=RTXT_OTXT_". Received on "_$$FMTE^XLFDT($GET(DATA(REJ,"DATE/TIME")))_"."
+12 SET OTXT=""
+13 WRITE !?3,"Reject(s): "
DO WRAP(RTXT,14)
+14 QUIT
+15 ;
WRAP(PSOTXT,INDENT) ;
+1 NEW I,K,PSOWRAP,PSOMARG
+2 SET PSOWRAP=1
SET PSOMARG=$SELECT('$GET(PSORM):80,$DATA(IOM):IOM,1:80)-(INDENT+5)
W1 if $LENGTH(PSOTXT)<PSOMARG
SET PSOWRAP(PSOWRAP)=PSOTXT
IF $LENGTH(PSOTXT)'<PSOMARG
FOR I=PSOMARG:-1:0
IF $EXTRACT(PSOTXT,I)?1P
SET PSOWRAP(PSOWRAP)=$EXTRACT(PSOTXT,1,I)
SET PSOTXT=$EXTRACT(PSOTXT,I+1,999)
SET PSOWRAP=PSOWRAP+1
GOTO W1
+1 FOR K=1:1:PSOWRAP
WRITE ?INDENT,PSOWRAP(K),!
+2 QUIT
+3 ;
HDR ; Display the reject notification screen header
+1 NEW ELDSP,TAB
+2 ; returns TRICARE, CHAMPVA or VETERAN
SET ELDSP=$$ELIGTCV^PSOREJP1(RX,RFL,1)
+3 ; Add the " - " for CVA/TRI only
IF $LENGTH(ELDSP)
SET ELDSP=ELDSP_" - "
+4 ;
+5 IF $GET(PSONBILL)
SET TAB=$SELECT($LENGTH(ELDSP):24,1:29)
WRITE !!?TAB,"*** "_ELDSP_"NON-BILLABLE ***"
QUIT
+6 IF $GET(PSONPROG)
SET TAB=$SELECT($LENGTH(ELDSP):18,1:23)
WRITE !!?TAB,"*** "_ELDSP_"'IN PROGRESS' ECME status ***"
QUIT
+7 SET TAB=$SELECT($LENGTH(ELDSP):11,1:16)
WRITE !!?TAB,"*** "_ELDSP_"REJECT RECEIVED FROM THIRD PARTY PAYER ***"
+8 QUIT
+9 ;
SUBMIT(RXIEN,RFCNT,PSOTRIC) ;called from PSOCAN2 (routine size exceeded)
+1 NEW SUBMITE
SET SUBMITE=$$SUBMIT^PSOBPSUT(RXIEN)
+2 IF SUBMITE
Begin DoDot:1
+3 NEW ACTION
+4 DO ECMESND^PSOBPSU1(RXIEN,,,$SELECT($ORDER(^PSRX(RXIEN,1,0)):"RF",1:"OF"))
+5 ; Quit if there is an unresolved TRICARE or CHAMPVA non-billable reject code, PSO*7*358
+6 IF $$PSOET^PSOREJP3(RXIEN)
SET ACTION="Q"
QUIT
+7 IF $$FIND^PSOREJUT(RXIEN)
SET ACTION=$$HDLG^PSOREJU1(RXIEN,,"79,88,943","OF","IOQ","Q")
End DoDot:1
+8 IF 'SUBMITE&(PSOTRIC)
Begin DoDot:1
+9 IF $$STATUS^PSOBPSUT(RXIEN,RFCNT'["PAYABLE")
DO TRICCHK(RXIEN,RFCNT)
End DoDot:1
+10 QUIT
+11 ;
TRISTA(RX,RFL,RESP,FROM,RVTX) ;called from suspense
+1 NEW ETOUT,ESTAT,TRESP,TSTAT,PSOTRIC
+2 if '$DATA(RESP)
SET RESP=""
+3 SET (ESTAT,PSOTRIC)=""
SET PSOTRIC=$$TRIC^PSOREJP1(RX,RFL,PSOTRIC)
+4 if 'PSOTRIC
QUIT 0
+5 SET TRESP=RESP
SET ESTAT=$PIECE(TRESP,"^",4)
if ESTAT=""
SET ESTAT=$$STATUS^PSOBPSUT(RX,RFL)
+6 if ESTAT["E PAYABLE"
QUIT 0
+7 ;if TRICARE or CHAMPVA Rx is in audit due to override or bypass, allow to print from suspense, cnf
IF $$TRIAUD(RX,RFL)
Begin DoDot:1
+8 ; ICR#s 4412,6764
DO LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$TEXT(+0)_"-TRISTA, $$TRIAUD returned 1, $$TRISTA is Quitting with 0")
End DoDot:1
QUIT 0
+9 ;if 'Bypass' RX, allow to print from suspense, cnf
IF +RESP=2
IF $$BYPASS^PSOBPSU1($PIECE(RESP,"^",3),$PIECE(RESP,"^",2))
Begin DoDot:1
+10 ; ICR#s 4412,6764
DO LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$TEXT(+0)_"-TRISTA, $$BYPASS returned 1, $$TRISTA is Quitting with 0")
End DoDot:1
QUIT 0
+11 ;rejected TRICARE or CHAMPVA is not allowed to print from suspense
if ESTAT["E REJECTED"
QUIT 1
+12 ;if 'in progress' (4) or not billable (2,3) don't allow to print from suspense (IA 4415 Values)
+13 IF '$DATA(RESP)!($PIECE(RESP,"^",1)="")!($GET(RESP)="")
Begin DoDot:1
+14 SET TSTAT=$$STATUS^PSOBPSUT(RX,RFL)
SET TRESP=$SELECT(TSTAT["IN PROGRESS":4,TSTAT["NOT BILLABLE":2,1:0)
+15 SET $PIECE(TRESP,"^",4)=TSTAT
End DoDot:1
+16 ;
+17 IF +TRESP=2!(+TRESP=3)
Begin DoDot:1
+18 ;send TRICARE or CHAMPVA non billable to worklist (pseudo reject), cnf
DO WRKLST^PSOREJU4(RX,RFL,"",DUZ,DT,1,"",RESP)
+19 ; ICR#s 4412,6764
DO LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$TEXT(+0)_"-TRISTA, calling WRKLST~PSOREJU4, $$TRISTA is Quitting with 1")
End DoDot:1
QUIT 1
+20 IF +TRESP=4!(ESTAT["IN PROGRESS")
Begin DoDot:1
+21 ; ICR#s 4412,6764
DO LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$TEXT(+0)_"-TRISTA, TRESP="_TRESP_", ESTAT="_ESTAT_", $$TRISTA is Quitting with 1")
End DoDot:1
QUIT 1
+22 QUIT 0
+23 ;
TRIAUD(RXIEN,RXFILL) ;is RXIEN in the TRICARE/CHAMPVA audit and no open rejects ;cnf
+1 ; RXIEN will only be in TRICARE/CHAMPVA audit if a bypass or override has occurred and rejects are closed
+2 ; returns 0 if RXIEN is not in TRICARE/CHAMPVA audit at all or not in audit for right fill number
+3 ; rejects must be closed for 0 to be returned
+4 ; 1 if RXIEN is in TRICARE/CHAMPVA audit for the right fill number and rejects are closed
+5 ;
+6 NEW X,AUDIEN,REJIEN
+7 SET X=0
SET AUDIEN=""
+8 ;RXIEN is not in the TRICARE/CHAMPVA audit
IF '$DATA(^PS(52.87,"C",RXIEN))
QUIT X
+9 ;
+10 ;Get latest fill if not passed in
IF $GET(RXFILL)=""
SET RXFILL=$$LSTRFL^PSOBPSU1(RXIEN)
+11 ;
+12 ;check audit entries for right fill number
+13 FOR
SET AUDIEN=$ORDER(^PS(52.87,"C",RXIEN,AUDIEN))
if AUDIEN=""
QUIT
IF RXFILL=$$GET1^DIQ(52.87,AUDIEN,2)
SET X=1
QUIT
+14 IF 'X
QUIT X
+15 ;
+16 ;make sure rejects are closed
+17 SET REJIEN=0
+18 ;I 'X, then the reject is not closed
FOR
SET REJIEN=$ORDER(^PSRX(RXIEN,"REJ",REJIEN))
if '+REJIEN
QUIT
Begin DoDot:1
+19 SET X=$$CLOSED^PSOREJP1(RXIEN,REJIEN,0)
End DoDot:1
IF 'X
QUIT
+20 ;
+21 QUIT X
+22 ;
ECMECHK(RX,FILL) ;
+1 ; This function returns a '1' if any of the conditions below are met:
+2 ; - RX has an unresolved DUR or Refill Too Soon reject
+3 ; - RX has an unresolved Reject Resolution Required (RRR) reject (only for Veteran and original fill)
+4 ; - RX is TRICARE/CHAMPVA and has any unresolved reject
+5 ; - RX is TRICARE/CHAMPVA and IN PROGRESS
+6 ; This is used by functions such as PPLADD^PSOSUPOE to determine if
+7 ; a label should be printed (we do not want a label for the conditions)
+8 ;
+9 ; Incoming Parameters:
+10 ; RX - Internal IEN of the Prescription File (required)
+11 ; FILL - Fill Number (optional, defaults to last fill if not passed in)
+12 ; Returns:
+13 ; 0 - None of the conditions exists
+14 ; 1 - One of the conditions above is met
+15 ;
+16 IF '$GET(RX)
QUIT 0
+17 IF $GET(FILL)=""
SET FILL=$$LSTRFL^PSOBPSU1(RX)
+18 ;
+19 ; DUR or Refill Too Soon or RRR rejects
+20 IF $$FIND^PSOREJUT(RX,FILL,"","79,88,943",,1)
QUIT 1
+21 ;
+22 ; If not TRICARE/CHAMPVA, quit with 0 as the rest of the checks
+23 ; are all TRICARE/CHAMPVA dependent
+24 IF '$$TRIC^PSOREJP1(RX,FILL)
QUIT 0
+25 ;
+26 ; No label for TRICARE/CHAMPVA with unresolved rejects
+27 ; 5th parameter to $$FIND also finds non-billable TRI/CVA rejects
IF $$FIND^PSOREJUT(RX,FILL,,,1)
QUIT 1
+28 ;
+29 ;No label for TRICARE/CHAMPVA claims that are IN PROGRESS
+30 IF $PIECE($$STATUS^PSOBPSUT(RX,FILL),U)="IN PROGRESS"
QUIT 1
+31 QUIT 0
+32 ;
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,TXT
+5 SET DVIEN=+$$RXSITE^PSOBPSUT(RX,RFL)
+6 SET DVINFO="Division : "_$$GET1^DIQ(59,DVIEN,.01)
+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=$$CSNPI^BPSUTIL(RX,RFL)
+11 ;
+12 ; If not a Controlled Substance, use NCPDP# & NPI info based on Division.
+13 ; Display both NPI and NCPDP numbers - PSO*7.0*421
+14 IF +NCPNPI=-1
SET NCPNPI=$$DIVNCPDP^BPSBUTL(DVIEN)
+15 SET $EXTRACT(DVINFO,33)="NPI: "_$PIECE(NCPNPI,U,2)
+16 SET $EXTRACT(DVINFO,$SELECT($GET(LM):59,1:52))="NCPDP: "_$PIECE(NCPNPI,U)
+17 QUIT DVINFO
