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Routine: RCDPESR9

RCDPESR9.m

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  1. RCDPESR9 ;ALB/TMK,DWA - ERA return file field captions ;09-SEP-2003
  1.  ;;4.5;Accounts Receivable;**173,252,269,302,371**;Mar 20, 1995;Build 29
  1.  ;;Per VA Directive 6402, this routine should not be modified.
  1.  ;
  1.  ; Note: if the 835 flat file changes, make the corresponding changes
  1.  ;       in this routine.
  1. 835 ;;HEADER DATA
  1.  ;;835^^Return Message ID^S Y=X_" (ERA HEADER DATA)"
  1.  ;;835^^X12/Proprietary flag^S Y=$S(X="X":"X12",1:X)
  1.  ;;835^^File Date^S Y=$$FDT^RCDPESR9(X)
  1.  ;;835^^File Time^S Y=$E(X,1,2)-$S($E(X,1,2)>12:12,1:0)_":"_$E(X,3,4)_$S($E(X,1,2)=24:" AM",$E(X,1,2)>11:" PM",1:" AM")
  1.  ;;835^1^MRA^S Y=""
  1.  ;;835^^Payer Name
  1.  ;;835^^Payer ID
  1.  ;;835^^Trace Number
  1.  ;;835^^Date Claims Paid^S Y=$$FDT^RCDPESR9(X)
  1.  ;;835^^Total ERA Amount^S Y=$$ZERO^RCDPESR9(X,1)
  1.  ;;835^^Erroneous Provider Tax ID
  1.  ;;835^^Tax ID correction Flag^S Y=$S(X="E":"CHANGED BY EPHRA",X="C":"DETERMINED FROM CLAIM DATA",X="":"NO CHANGE MADE",1:X)
  1.  ;;835^^Sequence Control #
  1.  ;;835^^Sequence #
  1.  ;;835^^Last Sequence #
  1.  ;;835^^Contact Information
  1.  ;;835^^Payment Method Code
  1.  ;;835^^Billing Provider NPI
  1.  ;
  1. 01 ;;PAYER CONTACT INFORMATION
  1.  ;;01^^Line Type^S Y=X_" (ERA LEVEL CONTACT DATA)"
  1.  ;;01^^ERA Contact Name
  1.  ;;01^^ERA Contact #1
  1.  ;;01^^ERA Contact #1 Type^S Y=$$EXTERNAL^DILFD(344.4,3.03,,X)
  1.  ;;01^^ERA Contact #2
  1.  ;;01^^ERA Contact #2 Type^S Y=$$EXTERNAL^DILFD(344.4,3.05,,X)
  1.  ;;01^^ERA Contact #3
  1.  ;;01^^ERA Contact #3 Type^S Y=$$EXTERNAL^DILFD(344.4,3.07,,X)
  1.  ;
  1. 02 ;;PAYER ADJUSTMENT RECORD
  1.  ;;02^^Line Type^S Y=X_" (ERA LEVEL PAYER ADJUSTMENT RECORD)"
  1.  ;;02^^X12 Adjustment Reason Code
  1.  ;;02^^Provider Adjustment Identifier
  1.  ;;02^^Adjustment Amount^S Y=$$ZERO^RCDPESR9(X,1)
  1.  ;;02^^X12 Reason Text
  1.  ;
  1. 05 ;;CLAIM PATIENT ID
  1.  ;;05^^Line Type^S Y=X_" (CLAIM LEVEL PATIENT ID DATA)"
  1.  ;;05^^Bill #
  1.  ;;05^^Patient Last Name
  1.  ;;05^^Patient First Name
  1.  ;;05^^Patient Middle Name
  1.  ;;05^^Patient ID #
  1.  ;;05^1^Record Contains Patient Name Change^S Y=""
  1.  ;;05^1^Record Contains Patient ID Change^S Y=""
  1.  ;;05^^Statement Start Date^S Y=$$FDT^RCDPESR9(X)
  1.  ;;05^^Statement End Date^S Y=$$FDT^RCDPESR9(X)
  1.  ;
  1. 06 ;;CORECT PATIENT DATA
  1.  ;;06^^Line Type^S Y=X_" (CLAIM LEVEL CORRECT PATIENT DATA)"
  1.  ;;06^^Bill #
  1.  ;;06^^Corrected Patient Last Name
  1.  ;;06^^Corrected Patient First Name
  1.  ;;06^^Corrected Patient Middle Name
  1.  ;;06^^Corrected Patient ID #
  1.  ;
  1. 10 ;;CLAIM STATUS DATA
  1.  ;;10^^Line Type^S Y=X_" (CLAIM LEVEL CLAIM STATUS DATA)"
  1.  ;;10^^Bill #
  1.  ;;10^^Claim Processed^S Y=$$YN^RCDPESR9(X)
  1.  ;;10^^Claim Denied^S Y=$$YN^RCDPESR9(X)
  1.  ;;10^^Claim Pended^S Y=$$YN^RCDPESR9(X)
  1.  ;;10^^Claim Reversal^S Y=$$YN^RCDPESR9(X)
  1.  ;;10^^Claim Status Code
  1.  ;;10^1^Crossed Over Name^S Y=""
  1.  ;;10^1^Crossed Over ID^S Y=""
  1.  ;;10^^Submitted Charge^S Y=$$ZERO^RCDPESR9(X,1)
  1.  ;;10^^Amount Paid^S Y=$$ZERO^RCDPESR9(X,1)
  1.  ;;10^^ICN
  1.  ;;10^^DRG Code Used
  1.  ;;10^^DRG Weight Used^S Y=$J($$ZERO^RCDPESR9(X,1)/100,4)
  1.  ;;10^^Discharge Fraction^S Y=$$ZERO^RCDPESR9(X,1)
  1.  ;;10^^Rendering NPI
  1.  ;;10^^Entity Type Qualifier
  1.  ;;10^^Last Name
  1.  ;;10^^First Name
  1.  ;
  1. 15 ;;CLAIM STATUS DATA
  1.  ;;15^^Line Type^S Y=X_" (CLAIM LEVEL CLAIM STATUS DATA (CONTINUED))"
  1.  ;;15^^Bill #
  1.  ;;15^^Covered Amount^S Y=$$ZERO^RCDPESR9(X,1)
  1.  ;;15^1^Discount Amount^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;15^1^Day Limit Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;15^1^Interest Amount^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;15^1^Tax Amount^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;15^1^Total Before Taxes Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;15^^Patient Responsibility Amount^S Y=$$ZERO^RCDPESR9(X,1)
  1.  ;;15^1^Negative Reimbursement^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;15^^Health Plan Identifier
  1.  ;
  1. 17 ;;CLAIM LEVEL PAYER CONTACT INFORMATION
  1.  ;;17^^Line Type^S Y=X_" (CLAIM LEVEL PAYER CONTACT INFO)"
  1.  ;;17^^Bill #
  1.  ;;17^^Contact Name
  1.  ;;17^^Contact #1
  1.  ;;17^^Contact #1 Type^S Y=$$EXTERNAL^DILFD(361.1,25.03,,X)
  1.  ;;17^^Contact #2
  1.  ;;17^^Contact #2 Type^S Y=$$EXTERNAL^DILFD(361.1,25.05,,X)
  1.  ;;17^^Contact #3
  1.  ;;17^^Contact #3 Type^S Y=$$EXTERNAL^DILFD(361.1,25.07,,X)
  1.  ;
  1. 20 ;;CLAIM LEVEL ADJUSTMENT DATA
  1.  ;;20^^Line Type^S Y=X_" (CLAIM LEVEL CLAIM ADJUSTMENT DATA)"
  1.  ;;20^^Bill #
  1.  ;;20^^Adjustment Group Code
  1.  ;;20^^Adjustment Reason Code
  1.  ;;20^^Adjustment Amount^S Y=$$ZERO^RCDPESR9(X,1)
  1.  ;;20^^Quantity^S Y=$$ZERO^RCDPESR9(X)
  1.  ;;20^^Reason Code Text
  1.  ;
  1. 30 ;;CLAIM LEVEL MEDICARE INPT ADJUDICATION DATA
  1.  ;;30^^Line Type^S Y=X_" (CLAIM LEVEL MEDICARE INPATIENT ADJUDICATION DATA)"
  1.  ;;30^^Bill #
  1.  ;;30^^Covered Days/Visits^S Y=$$ZERO^RCDPESR9(X)
  1.  ;;30^1^Lifetime Reserve Days Count^S Y=$$ZERO^RCDPESR9(X,,1)
  1.  ;;30^1^Lifetime Psych Days Count^S Y=$$ZERO^RCDPESR9(X,,1)
  1.  ;;30^^Claim DRG Amt^S Y=$$ZERO^RCDPESR9(X,1)
  1.  ;;30^1^Claim Disproportionate Share Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;30^1^Claim MSP Pass thru Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;30^1^Claim PPS Capital Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;30^1^PPS-Capital FSP DRG Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;30^1^PPS-Capital HSP DRG Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;30^1^PPS-Capital DSH DRG Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;30^1^Old Capital Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;30^^Non-Covered Days^S Y=$$ZERO^RCDPESR9(X)
  1.  ;
  1. 35 ;;CLAIM LEVEL MEDICARE ADJUDICATION DATA
  1.  ;;35^^Line Type^S Y=X_" (CLAIM LEVEL MEDICARE ADJUDICATION DATA)"
  1.  ;;35^^Bill #
  1.  ;;35^1^PPS-Capital IME Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;35^1^PPS-Operating Hosp Specific DRG Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;35^1^Cost Report Day Count^S Y=$$ZERO^RCDPESR9(X)
  1.  ;;35^1^PPS-Operating Fed Specific DRG Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;35^1^Claim PPS Capital Outlier Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;35^1^Claim Indirect Teaching Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;35^1^Non-payable Professional Component Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;35^1^PPS-Capital Exception Amt^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;35^1^Outpatient Reimbursement %^S Y=$$ZERO^RCDPESR9(X)
  1.  ;;35^1^HCPCS Payable Amount^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;35^1^ESRD Paid Amount^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;;35^1^Non-payable Professional Component^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;
  1. 37 ;;CLAIM LEVEL MEDICARE ADJUDICATION DATA REMARKS
  1.  ;;37^^Line Type^S Y=X_" (CLAIM LEVEL MEDICARE ADJUDICATION DATA REMARKS)"
  1.  ;;37^^Bill #
  1.  ;;37^^Type^S Y=$S(X="O":"MOA",X="I":"MIA",1:X)
  1.  ;;37^^Claim Payment Remark Code
  1.  ;;37^^Claim Payment Remark Code Message Text
  1.  ;
  1. 40 ;;SERVICE LINE DATA
  1.  ;;40^^Line Type^S Y=X_" (CLAIM LEVEL SERVICE LINE DATA)"
  1.  ;;40^^Bill #
  1.  ;;40^^Procedure
  1.  ;;40^^Revenue Code
  1.  ;;40^^Modifier 1
  1.  ;;40^^Modifier 2
  1.  ;;40^^Modifier 3
  1.  ;;40^^Modifier 4
  1.  ;;40^^Description
  1.  ;;40^^Original Procedure
  1.  ;;40^^Original Modifier 1
  1.  ;;40^^Original Modifier 2
  1.  ;;40^^Original Modifier 3
  1.  ;;40^^Original Modifier 4
  1.  ;;40^^Original Charge^S Y=$$ZERO^RCDPESR9(X,1)
  1.  ;;40^^Original Units^S Y=$$ZERO^RCDPESR9(X,1)
  1.  ;;40^^Amount Paid^S Y=$$ZERO^RCDPESR9(X,1)
  1.  ;;40^^Covered Units^S Y=$$ZERO^RCDPESR9(X,1)
  1.  ;;40^^Service From Date^S Y=$$FDT^RCDPESR9(X)
  1.  ;;40^^Service To Date^S Y=$$FDT^RCDPESR9(X)
  1.  ;;40^^Procedure Type
  1.  ;;40^^Applies to Billing Line
  1.  ;
  1. 41 ;;SERVICE LINE DATA
  1.  ;;41^^Line Type^S Y=X_" (CLAIM LEVEL SERVICE LINE DATA (CONTINUED))"
  1.  ;;41^^Bill #
  1.  ;;41^^Allowed Amount^S Y=$$ZERO^RCDPESR9(X,1)
  1.  ;;41^1^Per Diem Amount^S Y=$$ZERO^RCDPESR9(X,1,1)
  1.  ;
  1. 42 ;;SERVICE LINE DATA
  1.  ;;42^^Line Type^S Y=X_" (CLAIM LEVEL SERVICE LINE DATA (CONTINUED))"
  1.  ;;42^^Bill #
  1.  ;;42^^Line Item Remark Code
  1.  ;;42^^Line Item Remark Code Text
  1.  ;
  1. 45 ;;SERVICE LINE ADJUSTMENT DATA
  1.  ;;45^^Line Type^S Y=X_" (CLAIM LEVEL SERVICE LINE ADJUSTMENT DATA)"
  1.  ;;45^^Bill #
  1.  ;;45^^Adjustment Group Code
  1.  ;;45^^Adjustment Reason Code
  1.  ;;45^^Adjustment Amount^S Y=$$ZERO^RCDPESR9(X,1)
  1.  ;;45^^Quantity^S Y=$$ZERO^RCDPESR9(X)
  1.  ;;45^^Reason Code Text
  1.  ;
  1. FDT(X) ; returns MM/DD/YYYY or MM/DD/YY from YYYYMMDD or YYMMDD in X
  1.  I $L(X)=8,X?8N S X=$E(X,5,6)_"/"_$E(X,7,8)_"/"_$E(X,1,4)
  1.  I $L(X)=6,X?6N S X=$E(X,3,4)_"/"_$E(X,5,6)_"/"_$E(X,1,2)
  1.  Q X
  1.  ;
  1. ZERO(X,D,NULL) ; Returns numeric value of X without leading 0's
  1.  ; or null if no value wanted for 0 amount
  1.  ; D = 1 if dollar amt
  1.  N Z
  1.  I X["." S Z=$P(X,"."),X=+Z_"."_$P(X,".",2)
  1.  I X'["." D
  1.  . I $G(D) S X=+$E(X,1,$L(X)-2)_"."_$E(X,$L(X)-1,$L(X))
  1.  . S X=$S('$G(D):+X,1:$J(X,"",2))
  1.  Q $S(X:X,$G(NULL):"",1:X)
  1.  ;
  1. YN(X) ; Returns YES for X="Y" and NO for X="N"
  1.  S X=$S(X="Y":"YES",X="N":"NO",1:X)
  1.  Q X
  1.  ;