RCDPEAD4 ;AITC/CJE - AUTO DECREASE ;Jun 06, 2014@19:11:19
;;4.5;Accounts Receivable;**349**;Mar 20, 1995;Build 44
;Per VA Directive 6402, this routine should not be modified.
;
Q
;
REJ(WHICH) ; Process zero balance denial ERA's - PRCA*4.5*326
; PRCA*4.5*345 - Added WHICH
; Input: WHICH - 1 - Medical Claims
; - 3 - TRICARE Claims
;
N FLD,PAID,PAYID,PAYNAM,RCDATE,RCERA,RC3446,RCDAY,RCLINE,RCPARM,RCRTYPE,RCSCR ; PRCA*4.5*345
S FLD=$S(WHICH=1:.12,1:1.1) ; PRCA*4.5*349 - Added line ;
; Get days to wait for payer rejects (rename no-pay lines field)
S RCDAY=$$FMADD^XLFDT(DT\1,-$$GET1^DIQ(344.61,"1,",FLD)) ; PRCA*4.5*345 - Replaced .12 w/FLD
;
; Scan AFD index for ERA received within date range
S RCDATE=$$FMADD^XLFDT(RCDAY,-1)_".99999",PAID=0
F S RCDATE=$O(^RCY(344.4,"AFD",RCDATE)) Q:'RCDATE Q:(RCDATE\1)>RCDAY D
. S RCERA=0
. ; Check for payer reject ERA's
. F S RCERA=$O(^RCY(344.4,"AFD",RCDATE,RCERA)) Q:'RCERA D
. . Q:+$$GET1^DIQ(344.4,RCERA_",",.05) ; Ignore ERA if total paid is not zero
. . Q:+$$GET1^DIQ(344.4,RCERA_",",.16,"I") ; Ignore ERA if removed from worklist
. . Q:$$GET1^DIQ(344.4,RCERA_",",.15)'="NON" ; Ignore ERA if not payment type of NON
. . S RCRTYPE=$$PHARM^RCDPEAP1(RCERA)
. . Q:RCRTYPE ; Quit if ERA is for Pharmacy
. . ;
. . S RCRTYPE=$$ISTYPE^RCDPEU1(344.4,RCERA,"T") ; PRCA*4.5*349 - TRICARE ERA?
. . ; Quit if ERA is not for Medical and processing Medical
. . I WHICH=1,RCRTYPE Q
. . ; Quit if ERA is not for TRICARE and processing TRICARE
. . I WHICH=3,'RCRTYPE ; PRCA*4.5*349 - Added line
. . ;
. . ; Check payer exclusion file for this ERA's payer
. . S PAYID=$P($G(^RCY(344.4,RCERA,0)),U,3)
. . S PAYNAM=$P($G(^RCY(344.4,RCERA,0)),U,6)
. . I PAYID'="",PAYNAM'="" D
. . . S RCPARM=$O(^RCY(344.6,"CPID",PAYNAM,PAYID,""))
. . . S:RCPARM'="" RC3446=$G(^RCY(344.6,RCPARM,0))
. . ;
. . ; Ignore ERA if EXCLUDE MED CLAIMS POSTING (#.06) or EXCLUDE MED CLAIMS DECREASE (#.07) fields set to 'yes'
. . ; PRCA*4.5*345 - Added ,WHICH=1
. . I $G(RC3446)'="",WHICH=1 Q:$P(RC3446,U,6)=1 Q:$P(RC3446,U,7)=1
. . ;
. . ; Ignore ERA if auto-post blocked
. . Q:$$GET1^DIQ(344.4,RCERA_",",.19,"I")
. . ;
. . ; Build Scratchpad (if needed) and Verify Lines
. . K ^TMP($J,"RCDPEWLA")
. . S RCSCR=$$SCRPAD^RCDPEWLZ(RCERA)
. . I 'RCSCR Q
. . ; Ignore ERA if it has PLBs
. . I $D(^TMP($J,"RCDPEWLA","ERA LEVEL ADJUSTMENT EXISTS")) Q
. . ;
. . ; Build index to scratchpad for this ERA
. . N RCARRAY
. . D BUILD^RCDPEAP(RCERA,.RCARRAY)
. . ; Search lines
. . S RCLINE=0
. . F S RCLINE=$O(RCARRAY(RCLINE)) Q:'RCLINE D
. . . ; Ignore claim line if already auto decreased
. . . Q:$P($G(^RCY(344.4,RCERA,1,RCLINE,5)),U,3)
. . . ; Process line
. . . D EN4^RCDPEAD(RCDATE,RCERA,.RCARRAY,PAID,RCLINE,WHICH) ; PRCA*4.5*345 - Added WHICH
Q
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HRCDPEAD4 3025 printed Nov 22, 2024@16:54:27 Page 2
RCDPEAD4 ;AITC/CJE - AUTO DECREASE ;Jun 06, 2014@19:11:19
+1 ;;4.5;Accounts Receivable;**349**;Mar 20, 1995;Build 44
+2 ;Per VA Directive 6402, this routine should not be modified.
+3 ;
+4 QUIT
+5 ;
REJ(WHICH) ; Process zero balance denial ERA's - PRCA*4.5*326
+1 ; PRCA*4.5*345 - Added WHICH
+2 ; Input: WHICH - 1 - Medical Claims
+3 ; - 3 - TRICARE Claims
+4 ;
+5 ; PRCA*4.5*345
NEW FLD,PAID,PAYID,PAYNAM,RCDATE,RCERA,RC3446,RCDAY,RCLINE,RCPARM,RCRTYPE,RCSCR
+6 ; PRCA*4.5*349 - Added line ;
SET FLD=$SELECT(WHICH=1:.12,1:1.1)
+7 ; Get days to wait for payer rejects (rename no-pay lines field)
+8 ; PRCA*4.5*345 - Replaced .12 w/FLD
SET RCDAY=$$FMADD^XLFDT(DT\1,-$$GET1^DIQ(344.61,"1,",FLD))
+9 ;
+10 ; Scan AFD index for ERA received within date range
+11 SET RCDATE=$$FMADD^XLFDT(RCDAY,-1)_".99999"
SET PAID=0
+12 FOR
SET RCDATE=$ORDER(^RCY(344.4,"AFD",RCDATE))
if 'RCDATE
QUIT
if (RCDATE\1)>RCDAY
QUIT
Begin DoDot:1
+13 SET RCERA=0
+14 ; Check for payer reject ERA's
+15 FOR
SET RCERA=$ORDER(^RCY(344.4,"AFD",RCDATE,RCERA))
if 'RCERA
QUIT
Begin DoDot:2
+16 ; Ignore ERA if total paid is not zero
if +$$GET1^DIQ(344.4,RCERA_",",.05)
QUIT
+17 ; Ignore ERA if removed from worklist
if +$$GET1^DIQ(344.4,RCERA_",",.16,"I")
QUIT
+18 ; Ignore ERA if not payment type of NON
if $$GET1^DIQ(344.4,RCERA_",",.15)'="NON"
QUIT
+19 SET RCRTYPE=$$PHARM^RCDPEAP1(RCERA)
+20 ; Quit if ERA is for Pharmacy
if RCRTYPE
QUIT
+21 ;
+22 ; PRCA*4.5*349 - TRICARE ERA?
SET RCRTYPE=$$ISTYPE^RCDPEU1(344.4,RCERA,"T")
+23 ; Quit if ERA is not for Medical and processing Medical
+24 IF WHICH=1
IF RCRTYPE
QUIT
+25 ; Quit if ERA is not for TRICARE and processing TRICARE
+26 ; PRCA*4.5*349 - Added line
IF WHICH=3
IF 'RCRTYPE
+27 ;
+28 ; Check payer exclusion file for this ERA's payer
+29 SET PAYID=$PIECE($GET(^RCY(344.4,RCERA,0)),U,3)
+30 SET PAYNAM=$PIECE($GET(^RCY(344.4,RCERA,0)),U,6)
+31 IF PAYID'=""
IF PAYNAM'=""
Begin DoDot:3
+32 SET RCPARM=$ORDER(^RCY(344.6,"CPID",PAYNAM,PAYID,""))
+33 if RCPARM'=""
SET RC3446=$GET(^RCY(344.6,RCPARM,0))
End DoDot:3
+34 ;
+35 ; Ignore ERA if EXCLUDE MED CLAIMS POSTING (#.06) or EXCLUDE MED CLAIMS DECREASE (#.07) fields set to 'yes'
+36 ; PRCA*4.5*345 - Added ,WHICH=1
+37 IF $GET(RC3446)'=""
IF WHICH=1
if $PIECE(RC3446,U,6)=1
QUIT
if $PIECE(RC3446,U,7)=1
QUIT
+38 ;
+39 ; Ignore ERA if auto-post blocked
+40 if $$GET1^DIQ(344.4,RCERA_",",.19,"I")
QUIT
+41 ;
+42 ; Build Scratchpad (if needed) and Verify Lines
+43 KILL ^TMP($JOB,"RCDPEWLA")
+44 SET RCSCR=$$SCRPAD^RCDPEWLZ(RCERA)
+45 IF 'RCSCR
QUIT
+46 ; Ignore ERA if it has PLBs
+47 IF $DATA(^TMP($JOB,"RCDPEWLA","ERA LEVEL ADJUSTMENT EXISTS"))
QUIT
+48 ;
+49 ; Build index to scratchpad for this ERA
+50 NEW RCARRAY
+51 DO BUILD^RCDPEAP(RCERA,.RCARRAY)
+52 ; Search lines
+53 SET RCLINE=0
+54 FOR
SET RCLINE=$ORDER(RCARRAY(RCLINE))
if 'RCLINE
QUIT
Begin DoDot:3
+55 ; Ignore claim line if already auto decreased
+56 if $PIECE($GET(^RCY(344.4,RCERA,1,RCLINE,5)),U,3)
QUIT
+57 ; Process line
+58 ; PRCA*4.5*345 - Added WHICH
DO EN4^RCDPEAD(RCDATE,RCERA,.RCARRAY,PAID,RCLINE,WHICH)
End DoDot:3
End DoDot:2
End DoDot:1
+59 QUIT
