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Routine: PSXRPPL2

PSXRPPL2.m

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PSXRPPL2 ;BIR/WPB - Print From Suspense Utilities ;06/10/08

 ;;2.0;CMOP;**65,69,73,74,79,81,83,87,91,92,93,95**;11 Apr 97;Build 16

 ; Reference to ^PSRX( in ICR #1977

 ; Reference to ^PS(52.5, in ICR #1978

 ; Reference to ^PSSLOCK  in ICR #2789

 ; Reference to ^PSOBPSUT in ICR #4701

 ; Reference to ^PSOBPSU1 in ICR #4702

 ; Reference to ^PSOBPSU2 in ICR #4970

 ; Reference to ^PSOBPSU4 in ICR #7212

 ; Reference to ^PSOREJUT in ICR #4706

 ; Reference to ^PSOREJU3 in ICR #5186

 ; Reference to CHANGE^PSOSUCH1 in ICR #5427

 ; Reference to PREVRX^PSOREJP2 in ICR #5912

 ; Reference to $$BILLABLE^IBNCPDP in ICR #6243

 ; Reference to LOG^BPSOSL in ICR #6764

 ; Reference to IEN59^BPSOSRX in ICR #4412

 ;

 ; CHKDFN makes a second pass through the suspense queue, looking for

 ; any additional prescriptions for patients who already have an Rx

 ; included in the current batch.  To accomplish this, it loops through

 ; all the patients in the batch - ^PSX(550.2,Batch,15,"C",Name,DFN) -

 ; and then loops through the suspense queue, starting with the day

 ; after the through date used by SBTECME^PSXRPPL1 and going through

 ; that date plus the 'look ahead' date in the site parameters (see

 ; DRIV^PSXRSUS).  The logic inside the loops is largely identical to

 ; that in SBTECME^PSXRPPL1.

 ;

CHKDFN(THRDT) ;

 ;Input: THRDT - THROUGH DATE to run CMOP transmission

 ;

 ; This procedure assumes the following variables to exist:

 ;   PRTDT = Transmit/Print data through this date

 ;   PSXBAT = Batch, pointer to file#550.2, CMOP Transmission

 ;   PSXDTRG = Pull ahead through date

 ;   PSXTDIV = Division

 ;   PSXTYP = "C" if running for Controlled Substance, "N" otherwise

 ;

 N PSOLRX,PSXPTNM,REC,RESP,RFL,RX,SBTECME,SDT,XDFN

 ;

 ; If there are no prescriptions in the current batch, then Quit.

 ;

 I '$D(^PSX(550.2,PSXBAT,15,"C")) Q

 ;

 S SBTECME=0

 K ^TMP("PSXEPHDFN",$J)

 S PSXPTNM=""

 F  S PSXPTNM=$O(^PSX(550.2,PSXBAT,15,"C",PSXPTNM)) Q:PSXPTNM=""  D

 . S XDFN=0

 . F  S XDFN=$O(^PSX(550.2,PSXBAT,"15","C",PSXPTNM,XDFN)) Q:(XDFN'>0)  D

 . . S SDT=PRTDT

 . . F  S SDT=$O(^PS(52.5,"CMP","Q",PSXTYP,PSXTDIV,SDT)) Q:(SDT>PSXDTRG)!(SDT="")  D

 . . . S REC=0

 . . . F  S REC=$O(^PS(52.5,"CMP","Q",PSXTYP,PSXTDIV,SDT,XDFN,REC)) Q:REC'>0  D

 . . . . S (PSOLRX,RX)=+$$GET1^DIQ(52.5,REC,.01,"I") I 'RX Q

 . . . . S RFL=$$GET1^DIQ(52.5,REC,9,"I") I RFL="" S RFL=$$LSTRFL^PSOBPSU1(RX)

 . . . . I $$XMIT^PSXBPSUT(REC) D

 . . . . . I SDT>THRDT,'$D(^TMP("PSXEPHDFN",$J,XDFN)) Q

 . . . . . I $$PATCH^XPDUTL("PSO*7.0*148") D

 . . . . . . I $$RETRX^PSOBPSUT(RX,RFL),SDT>DT Q

 . . . . . . I $$DOUBLE^PSXRPPL1(RX,RFL) Q

 . . . . . . I $$FIND^PSOREJUT(RX,RFL,,"79,88,943",,1) Q

 . . . . . . ;

 . . . . . . ; If TRI/CVA and the Rx already has a closed eT/eC

 . . . . . . ; pseudo-reject, then do not send another claim.

 . . . . . . ;

 . . . . . . I $$TRICVANB^PSXRPPL1(RX,RFL) D  Q

 . . . . . . . D LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$T(+0)_"-CHKDFN, $$TRICVANB returned 1")  ; ICR #4412,6764

 . . . . . . ;

 . . . . . . I '$$RETRX^PSOBPSUT(RX,RFL),'$$ECMESTAT(RX,RFL) Q

 . . . . . . I $$PATCH^XPDUTL("PSO*7.0*289") Q:'$$DUR(RX,RFL)  ; ePharm Host error hold

 . . . . . . I $$PATCH^XPDUTL("PSO*7.0*289") Q:'$$DSH(REC,1)  ; ePharm 3/4 days supply

 . . . . . . ;

 . . . . . . ; ECMESND^PSOBPSU1 initiates the claim submission process.

 . . . . . . ;

 . . . . . . D ECMESND^PSOBPSU1(RX,RFL,"","PC",,1,,,,.RESP)

 . . . . . . ;

 . . . . . . D LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$T(+0)_"-CHKDFN, RESP="_$G(RESP))  ; ICR #4412,6764

 . . . . . . ;

 . . . . . . I $G(RESP)'["IN PROGRESS",$$PATCH^XPDUTL("PSO*7.0*287"),$$TRISTA^PSOREJU3(RX,RFL,.RESP,"PC") S ^TMP("PSXEPHNB",$J,RX,RFL)=$G(RESP)

 . . . . . . ;

 . . . . . . I $D(RESP),'RESP S SBTECME=SBTECME+1

 . . . . . . S ^TMP("PSXEPHDFN",$J,XDFN)=""

 . . . . D PSOUL^PSSLOCK(PSOLRX)

 K ^TMP("PSXEPHDFN",$J)

 I SBTECME>0 H 60+$S((SBTECME*15)>7200:7200,1:(SBTECME*15))

 Q

 ;

 ; EPHARM is called only by GETDATA^PSXRPPL.  The variable EPHQT is

 ; Newed in GETDATA.  If EPHQT is set to 1 here, then GETDATA does

 ; not continue processing the current Rx/Fill; this Rx/Fill will

 ; not be sent to CMOP if EPHQT is set to 1 here.

 ;

EPHARM ; - ePharmacy checks for third party billing

 ;

 ; If CMOP is still processing the previous fill ($$DOUBLE), or if the

 ; RE-TRANSMIT flag is 'Yes' and the send date is in the future, or if

 ; this prescription has an unresolved 79,88,943, or RRR reject, then

 ; Set EPHQT to 1 and Quit.  This Rx/Fill will not be sent to CMOP.

 ;

 I $$DOUBLE^PSXRPPL1(RXN,RFL) S EPHQT=1 Q

 I $$RETRX^PSOBPSUT(RXN,RFL),SDT>DT S EPHQT=1 Q

 I $$FIND^PSOREJUT(RXN,RFL,,"79,88,943",,1) S EPHQT=1 Q

 ;

 ; If an Open/Unresolved eC/eT reject on claim, don't send to CMOP.

 ;

 I $$ECETREJ(RXN) D EPH Q

 ;

 ; $$TRISTA performs checks specific to TRICARE/CHAMPVA.  If the claim

 ; was rejected or is still "IN PROGRESS", or if it is non-billable,

 ; then add this Rx to the ^TMP("PSXEPHIN") array and quit.

 ;

 I $$PATCH^XPDUTL("PSO*7.0*287"),$$TRISTA^PSOREJU3(RXN,RFL,.RESP,"PC") D EPH Q

 I $$PATCH^XPDUTL("PSO*7.0*287"),$D(^TMP("PSXEPHNB",$J,RXN,RFL)) D EPH Q

 ;

 ; If the claim is still "IN PROGRESS", then add this Rx to the

 ; ^TMP("PSXEPHIN") array and quit.

 ;

 I $$STATUS^PSOBPSUT(RXN,RFL)="IN PROGRESS" D EPH Q

 ;

 ; If this Prescription violates the 3/4 supply (i.e. if it is too soon

 ; to refill), then Set EPHQT to 1 and Quit.  This Rx/Fill will not be

 ; sent to CMOP.

 ;

 I $$PATCH^XPDUTL("PSO*7.0*289"),'$$DSH(REC,0) D  S EPHQT=1 Q

 . D LOG^BPSOSL($$IEN59^BPSOSRX(RXN,RFL),$T(+0)_"-EPHARM, Failed DSH")  ; ICR #4412,6764

 ;

 ; If there is a host reject for this Rx/Fill, then add this Rx to the

 ; ^TMP("PSXEPHIN") array and quit.

 ;

 I $$PATCH^XPDUTL("PSO*7.0*289"),'$$DUR(RXN,RFL) D EPH Q

 Q

 ;

 ; EPH is called only by EPHARM, above.  It adds a prescriptions to the

 ; ^TMP("PSXEPHIN") array.  Of those Prescriptions not sent to the CMOP

 ; facility and left in the suspense queue, some are added to this

 ; array.  Those in this array will be listed in the email sent to users

 ; indicating that they were left in the queue (see ^PSXBPSMS).  That

 ; email states these Rxs were not transmitted to the CMOP facility

 ; because either a) a response from the payer was not received, or b)

 ; the Rx is non-billable.

 ;

EPH ; - Store Rx not xmitted to CMOP in XTMP file for MailMan message.

 S ^TMP("PSXEPHIN",$J,$$RXSITE^PSOBPSUT(RXN),RXN)=RFL,EPHQT=1

 Q

 ;

 ; ECMESTAT checks the Rx's ECME Status to determine if it's acceptable

 ; to resubmit based on reject codes associated with a previous

 ; submission.  If Rx was rejected with host reject errors, and no other

 ; rejects exist, then it's OK to resubmit to ECME.

 ; Input:

 ;   RX = Prescription file #52 IEN

 ;   RFL = Refill number

 ; Returns:

 ;   1 = OK to resubmit

 ;   0 = Don't resubmit

 ;

ECMESTAT(RX,RFL) ;

 I '$$PATCH^XPDUTL("PSO*7.0*148") Q 0

 N CHDAT,HERR,PSXECET,PSXIEN,PSXREJ,STATUS

 ;

 ; If an Open/Unresolved eC/eT reject on claim, don't resubmit

 I $$ECETREJ(RX) Q 0

 ;

 S STATUS=$$STATUS^PSOBPSUT(RX,RFL)

 ; Never submitted before, OK to resubmit

 I STATUS=""!(STATUS["UNSTRANDED") Q 1

 ; If status other than E REJECTED, don't resubmit

 I STATUS'="E REJECTED" Q 0

 ;

 ; check for a previous host reject:

 ;   0 - if not expired, don't resubmit

 ;   1 - if host reject & date expired, allow to resubmit

 ;   2 - if not defined, allow to continue with evaluation for new host reject

 S CHDAT=$$CHHEDT(RX,RFL)

 I CHDAT=0 Q 0  ; The host reject has not expired, so do not resubmit.

 ;

 ;*****************************************************************************************************

 ;   NOTE: MAKE SURE THAT IGNORED REJECTS WILL PROCESS WHENEVER MODIFICATIONS ARE MADE TO HOST REJECT 

 ;         Ignored rejects are handled by default when this subroutine Q 0 at the end.

 ;*****************************************************************************************************

 ; check host rejects

 S HERR=$$HOSTREJ(RX,RFL,0)

 I HERR&(CHDAT=2) D SHDTLOG(RX,RFL) Q 0  ;Host reject and no suspense hold date defined yet; define it and don't resubmit

 I HERR&(CHDAT) Q 1  ;Host reject & suspense hold date has expired; resubmit

 Q 0  ;NOTE - IF YOU CHANGE THIS Q 0, IGNORED REJECTS WILL RESUBMIT AND REJECT AGAIN WHICH IS VERY BAD.

 ;

 ; DSH determines whether a prescription has a 3/4 days supply hold

 ; condition.

 ;   Input: REC = Pointer to Suspense file (#52.5)

 ;          ACT = 1 or 0, indicating whether an entry should be made

 ;                in the activity log if the 3/4 logic is bypassed.

 ;   Returns: 1 or 0

 ;     1 (one) if 3/4 of days supply has elapsed.

 ;     0 (zero) if 3/4 of days supply has not elapsed.

 ;

DSH(REC,ACT) ;ePharmacy API to check for 3/4 days supply hold

 ;

 N COMM,DA,DAYSSUP,DIE,DR,DSHDT,DSHOLD

 N PREVRX,PSARR,PSINSUR,PSXCOMMENT,RFL,RXIEN,SDT,SFN,SHDT

 ;

 S DSHOLD=1

 S RXIEN=$$GET1^DIQ(52.5,REC,.01,"I")

 S RFL=$$GET1^DIQ(52.5,REC,9,"I")

 I RFL="" S RFL=$$LSTRFL^PSOBPSU1(RXIEN)

 ;

 ; If the Rx/Fill is not e-billable, then Quit out.

 ;

 I '$$EBILLABLE^PSOSULB2(RXIEN,RFL) Q DSHOLD

 ;

 ; If the Bypass 3/4 Day Supply flag is set to "YES", then Quit with

 ; 1 after adding a comment to the Activity Log.

 ;

 I $$FLAG^PSOBPSU4(RXIEN,RFL)="YES" D  Q DSHOLD  ; ICR #7212

 . I '$G(ACT) Q

 . S PSXCOMMENT="3/4 Day Supply logic bypassed during CMOP processing"

 . D RXACT^PSOBPSU2(RXIEN,RFL,PSXCOMMENT,"S",DUZ)

 . Q

 ;

 S DSHDT=$$DSHDT(RXIEN,RFL) ; 3/4 of days supply date

 S PREVRX=$P(DSHDT,U,2)

 S DSHDT=$P(DSHDT,U)

 I DSHDT>DT S DSHOLD=0 D

 . I DSHDT'=$$GET1^DIQ(52.5,REC,10,"I") D  ; Update Suspense Hold Date and Activity Log

 . . ; If a previous Rx is used in the 3/4 days' supply calculation,

 . . ; capture that Rx in the activity log.

 . . S COMM="3/4 of Days Supply SUSPENSE HOLD until "_$$FMTE^XLFDT(DSHDT,"2D")

 . . I PREVRX'="" S COMM=COMM_" (prior Rx "_PREVRX_")"

 . . S COMM=COMM_"."

 . . S DAYSSUP=$$LFDS(RXIEN)

 . . D RXACT^PSOBPSU2(RXIEN,RFL,COMM,"S",+$G(DUZ)) ; Update Activity Log

 . . S DR="10///^S X=DSHDT",DIE="^PS(52.5,",DA=REC D ^DIE ; File Suspense Hold Date

 . . N DA,DIE,DR,PSOX,SFN,INDT,DEAD,SUB,XOK,OLD

 . . S DA=REC,DIE="^PS(52.5,",DR=".02///"_DSHDT D ^DIE

 . . S SFN=REC,DEAD=0,INDT=DSHDT D CHANGE^PSOSUCH1(RXIEN,RFL)

 . . Q

 . Q

 ;

 Q DSHOLD

 ;

DSHDT(RXIEN,RFL) ; ePharmacy function to determine the 3/4 of the days supply date

 ; Input: RXIEN = Prescription file #52 ien

 ;          RFL = fill#

 ; Returns: DATE value of last date of service plus 3/4 of days supply

 ;         PREVRX = Previous Rx if PREVRX^PSOREJP2 identified one that

 ;                  should be used in the 3/4 days' supply calculation.

 ;

 N FILLDT,DAYSSUP,DSH34,PREVRX

 I '$D(^PSRX(RXIEN,0)) Q -1

 I $G(RFL)="" Q -1

 ;

 D PREVRX^PSOREJP2(RXIEN,RFL,,.FILLDT,.DAYSSUP,.PREVRX)

 I FILLDT="" Q -1

 ;

 S DSH34=DAYSSUP*.75 ; 3/4 of Days Supply

 S:DSH34["." DSH34=(DSH34+1)\1

 ; Return last date of service plus 3/4 of Days Supply date

 ; and the previous Rx used in the calculation, if any.

 Q $$FMADD^XLFDT(FILLDT,DSH34)_U_PREVRX

 ;

 ; LFDS returns the DAYS SUPPLY for the latest fill for a prescription.

 ; Input: RXIEN = Prescription file #52 IEN

 ; Returns: DAYS SUPPLY for the latest fill

 ;          -1 if RXIEN is not valid

LFDS(RXIEN) ;

 N RXFIL

 Q:'$D(^PSRX(RXIEN)) -1

 S RXFIL=$$LSTRFL^PSOBPSU1(RXIEN)

 Q $S(RXFIL=0:$P(^PSRX(RXIEN,0),U,8),1:$P(^PSRX(RXIEN,1,RXFIL,0),U,10))

 ;

 ; DUR checks for host errors and the suspense hold date.

 ; Input:

 ;   RX = Prescription file #52 IEN

 ;  RFL = Refill number

 ; Returns: A value of 0 (zero) will be returned when reject code M6,

 ; M8, NN, or 99 are present OR if on susp hold which means the

 ; prescription should not be sent to CMOP.

 ; Otherwise, a value of 1(one) will be returned.

DUR(RX,RFL) ;

 N REJ,IDX,TXT,CODE,SHCODE,SHDT,CHDAT1

 S IDX=""

 I '$D(RFL) S RFL=$$LSTRFL^PSOBPSU1(RX)

 ;

 ; check for a previous host reject:

 ;  0 - host reject date not expired; don't print

 ;  1 - host reject date expired; allow to print

 ;  2 - host reject not define; allow to continue with evaluation

 ;      for new host reject

 S CHDAT1=$$CHHEDT(RX,RFL)

 I CHDAT1=1 Q 1

 I CHDAT1=0 Q 0

 ;

 ; If a host reject exists and no previous Susp Hold Date or log entry,

 ;    create the log entry and hold rx/fill.

 S HERR=$$HOSTREJ(RX,RFL,1)

 I HERR,SHDT="" D SHDTLOG(RX,RFL)

 I HERR Q 0

 Q 1

 ;

CHHEDT(RX,RFL) ;

 ; RX = Prescription File IEN

 ; RFL = Refill

 ;Returns: 

 ; 0 = host reject date not expired

 ; 1 = host reject has expired

 ; 2 = host reject not defined 

 ;

 S SHDT=$$SHDT(RX,RFL) ; Get suspense hold date for rx/refill

 I SHDT="" Q 2

 I DT'<SHDT Q 1

 Q 0

 ;

 ; HOSTREJ checks an RX/FILL for Host Reject Errors returned from

 ; previous ECME submissions.  The host reject errors checked are M6,

 ; M8, NN, and 99.  Host reject errors do not pass to the pharmacy

 ; worklist so it's necessary to check ECME for these type errors.

 ; Input: 

 ;    RX = Prescription File IEN

 ;   RFL = Refill

 ;   ONE = Either 1 or 0 - Defaults to 1

 ;     If 1, At least ONE reject code associated with the RX/FILL must 

 ;     match either M6, M8, NN, or 99.

 ;     If 0, ALL reject codes must match either M6, M8, NN, or 99

 ; Return:

 ;  RETV = 1 OR 0

 ;     1 = host reject exists based on ONE parameter

 ;     0 = no host rejects exists based on ONE parameter

HOSTREJ(RX,RFL,ONE) ;

 N REJ,IDX,TXT,CODE,HRCODE,HRQUIT,RETV

 S IDX="",(RETV,HRQUIT)=0

 I ONE="" S ONE=1

 D DUR1^BPSNCPD3(RX,RFL,.REJ) ; Get reject list from last submission

 F  S IDX=$O(REJ(IDX)) Q:IDX=""  D  Q:HRQUIT

 . S TXT=$G(REJ(IDX,"REJ CODE LST"))

 . F I=1:1:$L(TXT,",") S CODE=$P(TXT,",",I) D  Q:HRQUIT

 . . F HRCODE="M6","M8","NN",99 D  Q:HRQUIT

 . . . I CODE=HRCODE S RETV=1 I ONE S HRQUIT=1 Q

 . . . I CODE'=HRCODE,RETV=1 S RETV=0,HRQUIT=1 Q

 Q RETV

 ;

 ; SHDTLOG sets the EPHARMACY SUSPENSE HOLD DATE field for the rx or

 ; refill to tomorrow and adds an entry to the SUSPENSE Activity Log.

 ; Input:  RX = Prescription File IEN

 ;        RFL = Refill

SHDTLOG(RX,RFL) ;

 N DA,DIE,DR,COMM,SHDT

 I '$D(RFL) S RFL=$$LSTRFL^PSOBPSU1(RX)

 S SHDT=$$FMADD^XLFDT(DT,1)

 S COMM="SUSPENSE HOLD until "_$$FMTE^XLFDT(SHDT,"2D")_" due to host reject error."

 I RFL=0 S DA=RX,DIE="^PSRX(",DR="86///"_SHDT D ^DIE

 E  S DA=RFL,DA(1)=RX,DIE="^PSRX("_DA(1)_",1,",DR="86///"_SHDT D ^DIE

 D RXACT^PSOBPSU2(RX,RFL,COMM,"S",+$G(DUZ)) ; Create Activity Log entry

 Q

 ;

 ; SHDT returns the EPHARMACY SUSPENSE HOLD DATE field for the rx or

 ; the refill

 ; Input:  RX = Prescription File IEN

 ;        RFL = Refill

SHDT(RX,RFL) ;

 N FILE,IENS

 I '$D(RFL) S RFL=$$LSTRFL^PSOBPSU1(RX)

 S FILE=$S(RFL=0:52,1:52.1),IENS=$S(RFL=0:RX_",",1:RFL_","_RX_",")

 Q $$GET1^DIQ(FILE,IENS,86,"I")

 ;

 ;

 ; ECETREJ checks for open/unresolved eC/eT reject on the Rx

 ; Input: (r) RX - Prescription IEN

 ; Output: 0 - No open/unresovled eC/eT Reject on Rx

 ;         1 - Open/unresolved eC/eT Reject on Rx

ECETREJ(RX) ;

 N PSXECET,PSXIEN,PSXREJ

 S PSXREJ=0

 F PSXECET="eC","eT" S PSXIEN="" D

 . F  S PSXIEN=$O(^PSRX(RX,"REJ","B",PSXECET,PSXIEN)) Q:'PSXIEN  D

 . . I $$GET1^DIQ(52.25,PSXIEN_","_RX,9,"I")=0 S PSXREJ=1

 Q PSXREJ

 ;