RCDPEAD ;ALB/PJH - AUTO DECREASE ;Jun 06, 2014@19:11:19
Source file <RCDPEAD.m>
action | A | extended action | Ea | event driver | Ed | subscriber | Su | protocol | O | limited protocol | LP | run routine | RR | broker | B | edit | E | server | Se | P | screenman | SM | inquire | I |
Name | Comments | DBIA/ICR reference |
---|---|---|
EN | ;Auto Decrease - applies to auto-posted claims only
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EN1A(RCDAY,PAID,WHICH) | ; Scan ERA's for auto-posted lines on RCDAY
; PRCA*4.5*345 - Added WHICH ; Input: RCDAY - Day to begin search for auto-posted but not decreased lines ; PAID - 1 - Decrease paid lines only, 2 - Decrease no-pay lines only ; WHICH - 1 - Checking for Medical Claims, 2 - Checking for Rx Claims ; Output: Auto-decreases claims (potentially) ; ; Scan F (Auto-Post) index for ERAs within date range |
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EN2(RCDATE,RCDAY,PAID,WHICH) | ; Scans the 'F' index of the ERA file for ERA entries with an
; AUTOPOST DATE field (#4.03) matching RCDAY ; PRCA*4.5*345 - Added WHICH ; Input: RCDATE - Auto-Post Date of the ERA ; RCDAY - Day to begin search for auto-posted but not decreased lines ; PAID - 1 - Decrease paid lines, 2 - Decrease no-pay lines ; WHICH - 1 - Checking for Medical Claims ; 2 - Checking for Rx Claims ; 3 - Checking for TRICARE Claims |
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EN3(RCDATE,RCERA,RCARRAY,PAID,WHICH) | ; Scan ERA Detail lines in #344.41 for
; auto-posted Medical/Rx claims - PRCA*4.5*345 added WHICH ; Input: RCDATE - Auto-Post Date ; RCERA - IEN of the ERA (#344.4) ; RCARRAY - Array of ERA Scratchpad lines ; PAID - 1 - Decrease paid lines, 2 - Decrease no-pay lines ; WHICH - 1 - Processing Medical Claims, 2 - Processing Rx Claims |
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EN4(RCDATE,RCERA,RCARRAY,PAID,RCLINE,WHICH) | ; Auto-decrease selected lines
; PRCA*4.5*345 - Added WHICH ; Input: RCDATE - Auto-Post Date ; RCERA - IEN of the ERA (#344.4) ; RCARRAY - Array of scratch pad lines ; PAID - 1 - Decrease paid lines ; 2 - Decrease no-pay lines ; RCLINE - IEN of the detail ilne in sub-file 344.41 ; WHICH - 1 - Processing Medical Claims, 2 - Processing Rx Claims |
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SPLIT(RCSCR,RCLINE,RCBILL,RCARRAY) | ;Check for SPLIT/EDIT in scratchpad
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CARCLMT(RCEOB,RCZERO,WHICH,FROMADP,ADATE) | ;EP from COMPILE^RCDPEADP and AUTO^RCDPEWLZ
; Checks to see if CARCs are included and eligible for auto-decrease ; PRCA*4.5*345 - Added WHICH ; Returns 0 if not, Max Amount ^ CARC if it is. ; Input: RCEOB - Internal IEN for the explanation of benefits field (361.1) ; FROMADP - 1 if being called from COMPILE^RCDPEADP, 0 otherwise ; Optional, default to 0 ; ADATE - Internal Auto-Post Date (only passed if FROMADP=1) ; RCZERO - 0 = ERA Line with payment 1 = ERA Line without payment ; WHICH - 1 - Checking Auto-Decrease for Medical CARCs ; 2 - Checking Auto-Decrease for Rx CARCs ; 3 - Checking Auto-Decrease for TRICARE CARCs ; Optional, defaults to 1 (Medical) ; Returns: A1;A2;A3;A4^B1;B2;B3;B4^...^N1;N2;N3;N4 Where: ; A1 - Auto-Decrease amount of the 1st CARC code in the EOB ; A2 - 1st CARC code in the EOB ; A3 - Deactivation Date of the 1st CARC code in the EOB if ; it has one and is less than today AND FROMADP=0 ; Otherwise Quantity of the first CARC code in the EOB if ; FROMADP=1 ; A4 - Reason of the 1st CARC code in the EOB ; only passed if FROMADP=1 |
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OTHER(RCBILLDA,ORIG) | ; Check if APAR/WL entries exist on other ERA for this bill
; INPUT ; RCBILLDA - IEN for claim in #430 or #399 ; ORIG - IEN for current ERA ; OUTPUT ; RCPEND - 1 = Other ERA payments exist 0 - No other ERA payments exit |
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FIND(RCERA,RCLINE) | ; Search ORIGINAL ERA SEQUENCES for this line
; Input RCERA - Scratchpad IEN ; RCLINE - ERA line to find ; Output RET - Scratchpad line number |
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PAYEX(WHICH,IEN3446) | ; Check if payer is excluded
; Subroutine added for PRCA*4.5*349 ; Input: WHICH - 1=Medical, 2=Rx, 3=TRICARE ; IEN3446 - Internal Entry number of Payer Exclusion file entry ; Returns: 1 if payer is excluded, otherwise 0. |
Name | Field # of Occurrence |
---|---|
$$FIND1^DIC | CARCLMT+51 |
^DIE | EN4+93, EN4+103 |
$$GET1^DIQ | EN+4, EN+5, EN+7, EN+10, EN+12, EN+15, EN+16, EN+18, EN+22, EN+23 , EN+25, EN+28, EN+34, EN+35, EN2+21, EN2+22, EN4+15, EN4+27, EN4+56, EN4+57 , EN4+58, CARCLMT+52, OTHER+17, OTHER+21, OTHER+26, OTHER+28, OTHER+40, OTHER+42, FIND+10, PAYEX+12 , PAYEX+14 |
$$INCDEC^RCBEUTR1 | EN4+84 |
$$ACTCARC^RCDPEAD2 | EN4+77, CARCLMT+45 |
GETCARCS^RCDPEAD2 | CARCLMT+33 |
REJ^RCDPEAD4 | EN+30, EN+37 |
BUILD^RCDPEAP | EN2+32 |
$$PHARM^RCDPEAP1 | EN2+17 |
$$ISTYPE^RCDPEU1 | EN2+15 |
$$PENDPAY^RCDPURET | EN4+67 |
$$FMADD^XLFDT | EN+7, EN+12, EN+18, EN+25, EN1A+8 |
$$FMTE^XLFDT | EN4+81 |
FileNo | Call Tags |
---|---|
^RCY(344.4 - [#344.4] | Classic Fileman Calls, GET1^DIQ |
344.41 | GET1^DIQ |
344.491 | GET1^DIQ |
^RCY(344.6 - [#344.6] | GET1^DIQ |
^RCY(344.61 - [#344.61] | GET1^DIQ |
^RC(345 - [#345] | FIND1^DIC, GET1^DIQ |
Name | Line Occurrences (* Changed, ! Killed) |
---|---|
^IBM(361.1 - [#361.1] | EN4+35, OTHER+10 |
^PRCA(430 - [#430] | EN4+41, EN4+44, EN4+64 |
^RCY(344.4 - [#344.4] | EN1A+10, EN2+13, EN2+23, EN3+12, EN3+16, EN4+32, OTHER+13, OTHER+24 |
^RCY(344.49 - [#344.49] | SPLIT+10, SPLIT+12, SPLIT+14, OTHER+32, OTHER+37, OTHER+38, FIND+7, FIND+8 |
^RCY(344.6 - [#344.6] | EN2+26 |
^TMP($J | EN4+68! |
>> | Not killed explicitly |
* | Changed |
! | Killed |
~ | Newed |
Name | Field # of Occurrence |
---|---|
AD | EN+3~, EN+5*, EN+6, EN+10*, EN+11, EN+16*, EN+17, EN+23*, EN+24, EN+28* , EN+29, EN+35*, EN+36 |
ADATE | CARCLMT~ |
AP | EN+3~, EN+4*, EN+6, EN+11, EN+15*, EN+17, EN+22*, EN+24, EN+29, EN+34* , EN+36 |
AUTOSTA | OTHER+7~, OTHER+17*, OTHER+19, OTHER+21, OTHER+26 |
COMMENT | EN4+12~, EN4+84 |
COMMENT(1 | EN4+74*, EN4+75*, EN4+76*, EN4+77*, EN4+81* |
DA | EN4+91~, EN4+92*, EN4+96~, EN4+97*, FIND+5~, FIND+8*, FIND+10 |
DA(1 | EN4+92* |
DIE | EN4+91~, EN4+92*, EN4+96~, EN4+97* |
DR | EN4+91~, EN4+92*, EN4+96~, EN4+97*, EN4+102* |
DT | EN+7, EN+12, EN+18, EN+25, EN4+92, EN4+97, CARCLMT+53 |
EOBIEN | EN4+12~, EN4+32*, EN4+35, EN4+47 |
FLDA | PAYEX+6~, PAYEX+8*, PAYEX+12 |
FLDD | PAYEX+6~, PAYEX+9*, PAYEX+14 |
FROMADP | CARCLMT~, CARCLMT+24*, CARCLMT+33, CARCLMT+61, CARCLMT+64 |
I | CARCLMT+22~, CARCLMT+36*, CARCLMT+37 |
IEN3446 | EN2+9~, EN2+24*, EN2+26*, EN2+29, PAYEX~, PAYEX+11, PAYEX+12, PAYEX+14 |
IENS | EN3+7~, EN4+27, EN4+28* |
J | EN+3~, EN4+12~, EN4+52* |
ORIG | OTHER~, OTHER+15, FIND+5~, FIND+10*, FIND+12*, FIND+13 |
PAID | EN1A~, EN1A+15, EN2~, EN2+35, EN3~, EN3+19, EN4~, EN4+18, EN4+21, EN4+101 |
PAYID | EN2+9~, EN2+21*, EN2+25, EN2+26 |
PAYNAM | EN2+9~, EN2+22*, EN2+23*, EN2+25, EN2+26 |
PENDING | EN4+12~, EN4+67*, EN4+69 |
RCADJ | EN3+7~, EN4+61*, EN4+71, EN4+88*, EN4+92 |
RCAMT | EN4+12~, EN4+47*, EN4+48, EN4+52, CARCLMT+22~, CARCLMT+25*, CARCLMT+66*, CARCLMT+67*, CARCLMT+68 |
RCARRAY | EN2+9~, EN2+12!, EN2+32, EN2+35, EN3~, EN3+19, EN4~, EN4+38, SPLIT~ |
RCARRAY( | EN4+24, EN4+28, SPLIT+8 |
RCBAL | EN4+12~, EN4+64*, EN4+69 |
RCBILL | EN4+12~, EN4+32*, EN4+35*, EN4+38, EN4+41, EN4+44, EN4+64, EN4+67, EN4+84, SPLIT~ , SPLIT+14 |
RCBILLDA | OTHER~, OTHER+10, OTHER+40 |
RCCAMT | CARCLMT+22~, CARCLMT+39*, CARCLMT+42, CARCLMT+61, CARCLMT+65, CARCLMT+67 |
RCCODE | CARCLMT+22~, CARCLMT+39*, CARCLMT+45, CARCLMT+51, CARCLMT+65, CARCLMT+67 |
RCCODES | CARCLMT+22~, CARCLMT+25*, CARCLMT+33, CARCLMT+36, CARCLMT+37 |
RCDATA | CARCLMT+22~, CARCLMT+45*, CARCLMT+48, CARCLMT+54 |
RCDATE | EN1A+8*, EN1A+9, EN1A+10*, EN1A+11, EN1A+12, EN1A+15, EN2~, EN2+13, EN2+35, EN3~ , EN3+12, EN3+19, EN4~ |
RCDAY | EN+3~, EN+7*, EN+8, EN+12*, EN+13, EN+18*, EN+19, EN+25*, EN+26, EN1A~ , EN1A+8, EN1A+9, EN1A+12, EN1A+15, EN2~ |
RCEOB | CARCLMT~, CARCLMT+33, OTHER+7~, OTHER+9*, OTHER+10*, OTHER+13, OTHER+24 |
RCERA | EN2+9~, EN2+10*, EN2+11, EN2+13*, EN2+14, EN2+15, EN2+17, EN2+21, EN2+22, EN2+23 , EN2+32, EN2+35, EN3~, EN3+12, EN3+16, EN3+19, EN4~, EN4+15, EN4+28, EN4+32 , EN4+38, EN4+92, EN4+97, OTHER+7~, OTHER+12*, OTHER+13*, OTHER+15, OTHER+17, OTHER+21, OTHER+24 , OTHER+26, OTHER+28, OTHER+32, OTHER+34, OTHER+37, OTHER+38, OTHER+40, OTHER+42, FIND~, FIND+7 , FIND+8, FIND+10 |
RCIARR | EN4+12~, EN4+51!, EN4+53 |
RCIARR( | EN4+52*, EN4+62, EN4+69, EN4+71, EN4+74, EN4+75, EN4+77, EN4+80, EN4+81, EN4+84 , EN4+88 |
RCITEM | EN4+52*, CARCLMT+22~, CARCLMT+37*, CARCLMT+38, CARCLMT+39, CARCLMT+65 |
RCITEN | EN4+12~ |
RCJ | EN4+12~, EN4+61*, EN4+62*, EN4+69, EN4+71, EN4+74, EN4+75, EN4+77, EN4+80, EN4+81 , EN4+84, EN4+88 |
RCK | EN4+12~, EN4+62*, EN4+69, EN4+71, EN4+74, EN4+75, EN4+77, EN4+80, EN4+81, EN4+84 , EN4+88 |
RCLINE | EN3+7~, EN3+8*, EN3+11, EN3+12*, EN3+13, EN3+16, EN3+19, EN4~, EN4+15, EN4+24 , EN4+28, EN4+32, EN4+38, EN4+92, SPLIT~, SPLIT+8, OTHER+7~, OTHER+23*, OTHER+24*, OTHER+26 , OTHER+28, OTHER+34, FIND~, FIND+13 |
RCMAX | EN4+12~, EN4+56*, EN4+57*, EN4+58*, EN4+71 |
RCPAID | OTHER+7~, OTHER+28*, OTHER+30, OTHER+32 |
RCPEND | OTHER+7~, OTHER+9*, OTHER+10, OTHER+13, OTHER+24, OTHER+44*, OTHER+45 |
RCRTYPE | EN2+9~, EN2+16*, EN2+17*, EN2+18, EN2+19, EN2+20 |
RCSCR | SPLIT~, SPLIT+10, SPLIT+12, SPLIT+14 |
RCSUB | OTHER+36*, OTHER+37*, OTHER+38, FIND+5~, FIND+6*, FIND+7*, FIND+8, FIND+13 |
RCTAMT | CARCLMT+22~, CARCLMT+54*, CARCLMT+61 |
RCTOT | OTHER+7~, OTHER+23*, OTHER+32*, OTHER+42*, OTHER+44 |
RCTRANDA | EN4+12~, EN4+84*, EN4+85 |
RCZ | OTHER+7~, OTHER+38*, OTHER+40, OTHER+42 |
RCZERO | EN4+12~, EN4+15*, EN4+18, EN4+21, EN4+24, EN4+27, EN4+47, EN4+77, EN4+101, CARCLMT~ , CARCLMT+45 |
RCZL | OTHER+7~, OTHER+34*, OTHER+36, OTHER+37 |
RET | FIND+5~, FIND+6*, FIND+7, FIND+13*, FIND+14 |
RETURN | PAYEX+6~, PAYEX+7*, PAYEX+13*, PAYEX+15*, PAYEX+16 |
STATUS | EN4+12~, EN4+44*, EN4+45 |
SUB | SPLIT+6~, SPLIT+8*, SPLIT+10, SPLIT+12 |
SUB1 | SPLIT+6~, SPLIT+10*, SPLIT+12, SPLIT+14 |
U | EN2+23, EN3+16, EN4+32, EN4+35, EN4+41, EN4+52, EN4+64, EN4+77, SPLIT+12, SPLIT+14 , CARCLMT+54, CARCLMT+67 |
WHICH | EN1A~, EN1A+15, EN2~, EN2+18, EN2+19, EN2+20, EN2+29, EN2+35, EN3~, EN3+19 , EN4~, EN4+47, EN4+56, EN4+57, EN4+73, EN4+77, CARCLMT~, CARCLMT+23*, CARCLMT+45, PAYEX~ , PAYEX+8, PAYEX+9 |
XDT | CARCLMT+22~, CARCLMT+52*, CARCLMT+53*, CARCLMT+67 |
XIEN | CARCLMT+22~, CARCLMT+51*, CARCLMT+52 |
XX | EN2+15*, EN2+16, EN4+73*, EN4+74, CARCLMT+65*, CARCLMT+66, PAYEX+6~, PAYEX+12*, PAYEX+13, PAYEX+14* , PAYEX+15 |