PSOREJUT ;BIRM/MFR - BPS (ECME) - Clinical Rejects Utilities ;06/07/05
Source file <PSOREJUT.m>
| 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 |
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| CLSALL(RX,RFL,USR,REA,COM,COD1,COD2,COD3,CLA,PA) | ; Close/Resolve All Rejects
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| 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 |
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| 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. |
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| FEND | ;
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| 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 |
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| SYNC2 | ;
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| 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 |
| FileNo | Call Tags |
|---|---|
| ^PSRX - [#52] | GET1^DIQ |
| 52.25 | GET1^DIQ |
| ^BPST - [#9002313.59] | GET1^DIQ |
