PSOREJUT ;BIRM/MFR - BPS (ECME) - Clinical Rejects Utilities ;06/07/05
Source file <PSOREJUT.m>
| Package | Total | Call Graph |
|---|---|---|
| Outpatient Pharmacy | 8 | $$LSTRFL^PSOBPSU1 $$DUR^PSOBPSU2 ($$RXRLDT,$$RXSITE,$$STATUS)^PSOBPSUT $$TRIC^PSOREJP1 SAVECOM^PSOREJP3 ($$CLEAN,$$DAT,$$DUP,$$OTH)^PSOREJU1 $$REASON^PSOREJU2 ($$EVAL,$$MULTI,$$SINGLE)^PSOREJU4 |
| VA FileMan | 4 | NOW^%DTC FILE^DICN ^DIE $$GET1^DIQ |
| E Claims Management Engine | 3 | $$ADDCOMM^BPSBUTL DUR1^BPSNCPD3 $$IEN59^BPSOSRX |
| Name | Comments | DBIA/ICR reference |
|---|---|---|
| SAVE(RX,RFL,REJ,REOPEN) | ; - Saves DUR Information in the file 52
; Input: (r) RX - Rx IEN (#52) ; (o) RFL - Refill # (Default: most recent) ; (o) REOPEN - value of 1 means claim being reopened; null or no value passed means reopen claim functionality not being used ; (r) REJ - Array containing information about the REJECT on the following subscripts: ; "BIN" - BIN Number ; "PCN" - PCN Number ; "CODE" - Reject Code (79 or 88 or 943) ; "DATE/TIME" - Date/Time Reject Detected ; "PAYER MESSAGE" - Message returned by Payer (up to 140 chars long) ; "REASON" - Reject Reason (up to 100 chars long) ; "DUR TEXT" - Payer's DUR description ; "DUR ADD MSG TEXT" - Payer's DUR additional message text description ; "INSURANCE NAME" - Patient's Insurance Company Name ; "INSURANCE POINTER" - Patient's Insurance Company IEN ; "GROUP NAME" - Patient's Insurance Group Name ; "GROUP NUMBER" - Patient's Insurance Group Number ; "CARDHOLDER ID" - Patient's Insurance Cardholder ID ; "COB" - Coordination of Benefits ; "PLAN CONTACT" - Patient's Insurance Plan Contact (1-800) ; "PREVIOUS FILL" - Plan's Previous Fill Date ; "OTHER REJECTS" - Other Rejects with same Response ; "PHARMACIST" - Pharmacist DUZ ; "RESPONSE IEN" - Pointer to the RESPONSE file in ECME ; "REASON SVC CODE" - Reason for Service Code (pointer to BPS NCPDP REASON FOR SERVICE CODE) ; "RE-OPENED" - Re-Open Flag ; "RRR FLAG" - Reject Resolution Required indicator (expecting 1/0 into SAVE) ; "RRR THRESHOLD AMT" - Reject Resolution Required Dollar Threshold ; "RRR GROSS AMT DUE" - Reject Resolution Required Gross Amount Due |
|
| CLSALL(RX,RFL,USR,REA,COM,COD1,COD2,COD3,CLA,PA) | ; Close/Resolve All Rejects
|
|
| CLOSE(RX,RFL,REJ,USR,REA,COM,COD1,COD2,COD3,CLA,PA,IGNR) | ; - Mark a DUR/REFILL TOO SOON reject RESOLVED
; Input: (r) RX - Rx IEN (#52) ; (o) RFL - Refill # (Default: most recent) ; (r) REJ - REJECT ID (IEN) ; (o) USR - User (file #200 IEN) responsible for closing the REJECT ; (r) REA - Reason for closing the REJECT (52.25,12): ; 1:CLAIM RE-SUBMITTED ; 2:RX ON HOLD ; 3:RX SUSPENDED ; 4:RX RETURNED TO STOCK ; 5:RX DELETED ; 6:IGNORED - NO RESUBMISSION ; 7:RX DISCONTINUED ; 8:RX EDITED ; 99:OTHER ; (o) COM - Close comments manually entered by the user ; (o) COD1 - First set of DUR overrides (Reason Code^Professional Code^Result Code) ; (o) COD2 - Second set of DUR overrides (Reason Code^Professional Code^Result Code) ; (o) COD3 - Third set of DUR overrides (Reason Code^Professional Code^Result Code) ; (o) CLA - NCPDP Clarification Code for overriding RTS and DUR REJECTS ; (o) PA - NCPDP Prior Authorization Type and Number (separated by "^") ; (o) IGNR - Ignore Flag; 1=IGNORE, 0=NOT IGNORE |
|
| FIND(RX,RFL,REJDATA,CODE,BESC,RRRFLG) | ; - Returns whether a Rx/fill contains UNRESOLVED rejects
; Input: (r) RX - Rx IEN (#52) ; (o) RFL - Refill # (If not passed, look original and all refills) ; (o) CODE - Can be null, a specific Reject Code(s) to be checked or multiple codes separated by comma's ; (o) BESC - Bypass ECME Status Check (default behavior is to do the check); pass 1 to skip the check below ; We need to skip this check when looking for non-ECME billable rejects (eT or eC for example) ; (o) RRRFLG - Pass a 1 in this parameter to also look for any unresolved Reject Resolution Required (RRR) ; rejects when CODE is also passed. If CODE is not passed in, then pass a 1 here to ONLY look for ; unresolved RRR rejects. ; The default here is 0 if not passed. |
|
| FEND | ;
|
|
| SYNC(RX,RFL,USR,RXCOB) | ;
; Input: (r) RX - Rx IEN (#52) ; (o) RFL - Refill # (Default: most recent) ; (o) USR - User using the system when this routine is called ; (o) RXCOB - Coordination of Benefits code |
|
| SYNC2 | ;
|
|
| AUTORES(RX,RFL,REJ,RSC) | ; Auto-resolve reject check
; Input: (r) RX - Rx IEN (#52) ; (r) RFL - Refill # ; (r) REJ - Reject Code ; (r) RSC - Reason for Service Code |
| Name | Field # of Occurrence |
|---|---|
| NOW^%DTC | SAVE+49, CLOSE+29 |
| $$ADDCOMM^BPSBUTL | SAVE+89, SAVE+94, CLOSE+46, CLOSE+49, CLOSE+52, CLOSE+54, CLOSE+58 |
| DUR1^BPSNCPD3 | SYNC+11 |
| $$IEN59^BPSOSRX | AUTORES+19 |
| FILE^DICN | SAVE+76 |
| ^DIE | CLOSE+34 |
| $$GET1^DIQ | CLOSE+26, AUTORES+17, AUTORES+18, AUTORES+20 |
| $$LSTRFL^PSOBPSU1 | SAVE+31, CLSALL+12, CLOSE+24, SYNC+9 |
| $$DUR^PSOBPSU2 | SYNC+17 |
| $$RXRLDT^PSOBPSUT | AUTORES+14 |
| $$RXSITE^PSOBPSUT | SAVE+32, SYNC+10 |
| $$STATUS^PSOBPSUT | FIND+18 |
| $$TRIC^PSOREJP1 | SYNC+12 |
| SAVECOM^PSOREJP3 | SAVE+82 |
| $$CLEAN^PSOREJU1 | SYNC+21, SYNC2+12, SYNC2+13, SYNC2+14, SYNC2+21, SYNC2+24, SYNC2+25, SYNC2+26, SYNC2+27, SYNC2+28 , SYNC2+29, SYNC2+30, SYNC2+31, SYNC2+32, SYNC2+34, SYNC2+35, SYNC2+36, SYNC2+37 |
| $$DAT^PSOREJU1 | SYNC2+30 |
| $$DUP^PSOREJU1 | SYNC+21 |
| $$OTH^PSOREJU1 | SYNC2+31 |
| $$REASON^PSOREJU2 | SYNC2+33 |
| $$EVAL^PSOREJU4 | SAVE+43, SYNC+19 |
| $$MULTI^PSOREJU4 | FIND+19 |
| $$SINGLE^PSOREJU4 | FIND+20 |
| FileNo | Call Tags |
|---|---|
| ^PSRX - [#52] | GET1^DIQ |
| 52.25 | GET1^DIQ |
| ^BPST - [#9002313.59] | GET1^DIQ |
| Name | Line Occurrences (* Changed, ! Killed) |
|---|---|
| ^PSRX - [#52] | SAVE+52, SAVE+75, SAVE+96, CLOSE+25 |
| ^PSRX("REJ" | SYNC+8, SYNC+23, SYNC2+39 |
| >> | Not killed explicitly |
| * | Changed |
| ! | Killed |
| ~ | Newed |
| Name | Field # of Occurrence |
|---|---|
| % | SAVE+30~, SAVE+50, SAVE+58, CLOSE+32 |
| BESC | FIND~, FIND+18 |
| BPS59 | AUTORES+13~, AUTORES+19*, AUTORES+20 |
| CLA | CLSALL~, CLSALL+17, CLOSE~, CLOSE+33, CLOSE+40, CLOSE+42, CLOSE+47, CLOSE+48 |
| CNT | SYNC2+18~, SYNC2+19*, SYNC2+20*, SYNC2+21 |
| COD1 | CLSALL~, CLSALL+17, CLOSE~, CLOSE+32, CLOSE+33, CLOSE+40, CLOSE+41, CLOSE+44, CLOSE+45 |
| COD2 | CLSALL~, CLSALL+17, CLOSE~, CLOSE+45 |
| COD3 | CLSALL~, CLSALL+17, CLOSE~, CLOSE+45 |
| CODE | FIND~, FIND+19, FIND+20, SYNC+6~, SYNC+15*, SYNC+16, SYNC+17, SYNC+19, SYNC+22, SYNC2+1* , SYNC2+2*, SYNC2+4, SYNC2+11, SYNC2+25, SYNC2+31 |
| COM | CLSALL~, CLSALL+17, CLOSE~, CLOSE+27*, CLOSE+30, CLOSE+58 |
| >> COMMTXT | SYNC2+12 |
| DA | SAVE+30~, CLSALL+11~, CLOSE+28~, CLOSE+31* |
| DA(1 | SAVE+51*, CLOSE+31* |
| DATA | SYNC+6~, SYNC2+2!, SYNC2+38 |
| DATA("BIN" | SYNC2+36* |
| DATA("CARDHOL | DER ID" , SYNC2+29* |
| DATA("COB" | SYNC2+33* |
| DATA("CODE" | SYNC2+25* |
| DATA("DUR ADD | MSG TEXT" , SYNC2+14* |
| DATA("DUR RES | PONSE DATA" , SYNC2+35* |
| DATA("DUR TEX | T" , SYNC2+13* |
| DATA("GROUP N | AME" , SYNC2+28*, UMBER" , SYNC2+28* |
| DATA("INSURAN | CE NAME" , SYNC2+26*, CE POINTER" , SYNC2+27* |
| DATA("MESSAGE" | SYNC2+34* |
| DATA("OTHER R | EJECTS" , SYNC2+31* |
| DATA("OVERRID | E MSG" , SAVE+77, SYNC2+5*, SYNC2+10*, SYNC2+11*, SYNC2+12* |
| DATA("PAYER M | ESSAGE" , SYNC2+19*, SYNC2+20, SYNC2+22*, SYNC2+24* |
| DATA("PCN" | SYNC2+37* |
| DATA("PHARMACIST" | SYNC2+26* |
| DATA("PLAN CO | NTACT" , SYNC2+29* |
| DATA("PREVIOU | S FILL" , SYNC2+30* |
| DATA("REASON | SVC CODE" , SYNC2+33* |
| DATA("REASON" | SYNC2+25* |
| DATA("RESPONS | E IEN" , SYNC2+32* |
| DATA("RRR FLA | G" , SYNC2+7* |
| DATA("RRR GRO | SS AMT DUE" , SYNC2+8* |
| DATA("RRR THR | ESHOLD AMT" , SYNC2+9* |
| DD | SAVE+30~, SAVE+76! |
| DIC | SAVE+30~, SAVE+51* |
| DIC("DR" | SAVE+54*, SAVE+55*, SAVE+57*, SAVE+58*, SAVE+59*, SAVE+60*, SAVE+61*, SAVE+62*, SAVE+63*, SAVE+64* , SAVE+65*, SAVE+66*, SAVE+67*, SAVE+68*, SAVE+71*, SAVE+72*, SAVE+73*, SAVE+74* |
| DIC(0 | SAVE+51* |
| DIE | CLSALL+11~, CLOSE+28~, CLOSE+31* |
| DINUM | SAVE+30~, SAVE+52* |
| DLAYGO | SAVE+30~ |
| DO | SAVE+30~, SAVE+76! |
| DQ | CLOSE+28~ |
| DR | SAVE+30~, CLSALL+11~, CLOSE+28~, CLOSE+32*, CLOSE+33* |
| DUZ | SAVE+80 |
| ERR | SAVE+30~, SAVE+43*, SYNC+6~, SYNC+13*, SYNC+19*, SYNC+20 |
| ESH | SYNC+6~, SYNC+17* |
| I | CLOSE+28~, FIND+15~, SYNC+6~, SYNC+15* |
| IDX | SYNC+6~, SYNC+13*, SYNC+14*, SYNC+20, SYNC+21, SYNC+22, SYNC2+1*, SYNC2+2, SYNC2+5, SYNC2+8 , SYNC2+9, SYNC2+13, SYNC2+14, SYNC2+20, SYNC2+21, SYNC2+25, SYNC2+26, SYNC2+27, SYNC2+28, SYNC2+29 , SYNC2+30, SYNC2+31, SYNC2+32, SYNC2+33, SYNC2+34, SYNC2+35, SYNC2+36, SYNC2+37 |
| IGNR | CLOSE~, CLOSE+58 |
| MSG | SYNC2+18~, SYNC2+21*, SYNC2+22 |
| OPECC | SAVE+43, SYNC+6~, SYNC+13*, SYNC+19, SYNC2+4, SYNC2+11 |
| ORIGIN | SAVE+80~*, SAVE+81*, SAVE+82 |
| OVREJ | SYNC+6~, SYNC+15*, SYNC+20*, SYNC+22 |
| PA | CLSALL~, CLSALL+17, CLOSE~, CLOSE+33, CLOSE+41, CLOSE+42, CLOSE+50, CLOSE+51 |
| PSOAUTO | SAVE+30~, SAVE+53*, SAVE+56, SAVE+91 |
| PSODIV | SAVE+32*, SAVE+43, SYNC+6~, SYNC+10*, SYNC+19 |
| PSOTRIC | SAVE+43, SAVE+88, SYNC+6~, SYNC+12*, SYNC+17, SYNC+19 |
| RCODE | FIND+15~, FIND+16* |
| REA | CLSALL~, CLSALL+17, CLOSE~, CLOSE+27*, CLOSE+30, CLOSE+32 |
| REJ | SAVE~, CLSALL+11~, CLSALL+16*, CLSALL+17, CLOSE~, CLOSE+23, CLOSE+25, CLOSE+26, CLOSE+31, SYNC+6~ , SYNC+11, AUTORES~, AUTORES+21, AUTORES+22 |
| REJ( | SYNC+14, SYNC+21, SYNC2+13, SYNC2+14, SYNC2+20, SYNC2+21, SYNC2+25, SYNC2+26, SYNC2+27, SYNC2+28 , SYNC2+29, SYNC2+30, SYNC2+31, SYNC2+32, SYNC2+33, SYNC2+34, SYNC2+35, SYNC2+36, SYNC2+37 |
| REJ("BIN" | SAVE+33*, SAVE+67 |
| REJ("CARDHOLD | ER ID" , SAVE+48*, SAVE+64 |
| REJ("COB" | SAVE+48*, SAVE+65 |
| REJ("CODE" | SAVE+35*, SAVE+43, SAVE+52, SAVE+53 |
| REJ("DATE/TIME" | SAVE+50*, SAVE+54, SAVE+82 |
| REJ("DUR ADD | MSG TEXT" , SAVE+45*, SAVE+66 |
| REJ("DUR TEXT | " , SAVE+45*, SAVE+63 |
| REJ("GROUP NA | ME" , SAVE+45*, SAVE+55 |
| REJ("GROUP NU | MBER" , SAVE+47*, SAVE+64 |
| REJ("INSURANC | E NAME" , SAVE+46*, SAVE+63, E POINTER" , SAVE+74 |
| REJ("OTHER RE | JECTS" , SAVE+47*, SAVE+63 |
| REJ("OVERRIDE | MSG" , SAVE+77*, SAVE+79, SAVE+81, SAVE+82, SAVE+84 |
| REJ("PAYER ME | SSAGE" , SAVE+44*, SAVE+54 |
| REJ("PCN" | SAVE+34*, SAVE+68 |
| REJ("PHARMACIST" | SAVE+54 |
| REJ("PLAN CON | TACT" , SAVE+46*, SAVE+55 |
| REJ("PREVIOUS | FILL" , SAVE+55 |
| REJ("RE-OPENED" | SAVE+64 |
| REJ("REASON S | VC CODE" , SAVE+53, SAVE+62 |
| REJ("REASON" | SAVE+44*, SAVE+54 |
| REJ("REJECT I | EN" , SAVE+76*, SAVE+82 |
| REJ("RESPONSE | IEN" , SAVE+62 |
| REJ("RRR FLAG | " , SAVE+39*, SAVE+40*, SAVE+43, SAVE+70, SAVE+71, SAVE+87 |
| REJ("RRR GROS | S AMT DUE" , SAVE+73 |
| REJ("RRR THRE | SHOLD AMT" , SAVE+72 |
| REJ(1 | SYNC+12 |
| REJCOM | CLOSE+28~, CLOSE+30*, CLOSE+32 |
| REJDATA | CLSALL+11~, CLSALL+15, FIND~, FIND+17!, FIND+19, FIND+20 |
| REJDATA( | CLSALL+16 |
| REJLST | SYNC+6~ |
| REJRRR | SYNC+7~ |
| REJRRR( | SYNC+20*, SYNC2+5, SYNC2+8, SYNC2+9 |
| REJS | FIND+15~, FIND+16*, FIND+19*, FIND+20*, FEND+1, SYNC+6~, SYNC+13!, SYNC+23 |
| REJS( | SYNC+22*, SYNC2+1, SYNC2+2 |
| RENEW | AUTORES+13~, AUTORES+15, AUTORES+16*, AUTORES+17*, AUTORES+18* |
| REOPEN | SAVE~, SAVE+43 |
| RFL | SAVE~, SAVE+31*, SAVE+32, SAVE+53, SAVE+54, SAVE+89, SAVE+94, CLSALL~, CLSALL+12*, CLSALL+15 , CLSALL+17, CLOSE~, CLOSE+24*, CLOSE+26, CLOSE+46, CLOSE+49, CLOSE+52, CLOSE+54, CLOSE+58, FIND~ , FIND+18, FIND+19, FIND+20, SYNC~, SYNC+9*, SYNC+10, SYNC+11, SYNC+12, SYNC+17, SYNC+19 , SYNC2+38, AUTORES~, AUTORES+14, AUTORES+15, AUTORES+19 |
| RRRFLG | FIND~, FIND+19, FIND+20 |
| RRRVAL | SYNC+7~, SYNC+19, SYNC+20 |
| RSC | AUTORES~, AUTORES+23 |
| RX | SAVE~, SAVE+31, SAVE+32, SAVE+51, SAVE+52, SAVE+53, SAVE+75, SAVE+82, SAVE+89, SAVE+94 , SAVE+96, CLSALL~, CLSALL+12, CLSALL+15, CLSALL+17, CLOSE~, CLOSE+23, CLOSE+24, CLOSE+25, CLOSE+26 , CLOSE+31, CLOSE+46, CLOSE+49, CLOSE+52, CLOSE+54, CLOSE+58, FIND~, FIND+18, FIND+19, FIND+20 , SYNC~, SYNC+8, SYNC+9, SYNC+10, SYNC+11, SYNC+12, SYNC+17, SYNC+19, SYNC+21, SYNC+23 , SYNC2+38, SYNC2+39, AUTORES~, AUTORES+14, AUTORES+17, AUTORES+18, AUTORES+19 |
| RXCOB | SYNC~, SYNC+5*, SYNC+11, SYNC+19 |
| SMA | CLOSE+28~, CLOSE+39*, CLOSE+40*, CLOSE+41*, CLOSE+42*, CLOSE+43 |
| SMACOM | CLOSE+28~, CLOSE+45*, CLOSE+46, CLOSE+48*, CLOSE+49, CLOSE+51*, CLOSE+52, CLOSE+53*, CLOSE+54 |
| TXT | SAVE+85~, SAVE+86*, SAVE+87*, SAVE+88*, SAVE+89, SAVE+92~, SAVE+93*, SAVE+94, SYNC+6~, SYNC+14* , SYNC+15 |
| U | SYNC2+8, SYNC2+9 |
| USR | CLSALL~, CLSALL+17, CLOSE~, CLOSE+32, SYNC~, SYNC2+26 |
| X | SAVE+30~, SAVE+52*, SAVE+85~, SAVE+89*, SAVE+92~, SAVE+94*, CLOSE+28~, CLOSE+46*, CLOSE+49*, CLOSE+52* , CLOSE+54*, CLOSE+58* |
| Y | SAVE+76, CLOSE+28~ |
