This extrinsic function is the quickest way to
determine if a patient has active billable insurance without returning any of
the insurance data. For billing purposes, a patient is only considered
insured if he has an entry in the INSURANCE TYPE sub-file that meets the
following five conditions:
1. The insurance company is active. 2. The insurance company will reimburse
the government. (If your site tracks Medicare coverage of patients, the entry
in the INSURANCE COMPANY file (#36) should be set to not reimburse.) 3. The
effective date is before the date of care. 4. The expiration date is after
the date of care. (Treat no entry in the EFFECTIVE DATE and EXPIRATION DATE
fields as from the beginning of time to the end of time.) 5. The insurance is
not an indemnity plan.
Output: - 1 if insured or 0 if not insured
Example - Programmers can use this extrinsic variable to make process
determinations when knowing if a patient is insured is needed but knowing the
specific policy is not needed:
I $$INSURED^IBCNS1(DFN,DT) D SET ; only add ins. pts.
VARIABLES
TYPE
VARIABLES DESCRIPTION
DFN
Input
(required) the internal number of the patient in the
patient file
date
Input
(optional) the date to check to see if the patient
is insured.
ALL(DFN,var,flag,date,COB sequence flag)
Output: It will return the 0, 1, and 2 nodes for each
entry in the INSURANCE TYPE sub-file and the 0 node from the GROUP INSURANCE
PLAN file (#355.3) in a 2 dimensional array, Array(x, node) and, optionally, a
3 dimensional array, Array("S",COB sequence #,x) that cross references the
array Array by COB sequence number. The array element Array(0) will be defined
to the count of entries. In Array (x, node) x will be the internal entry in
the INSURANCE TYPE sub-file and node will be 0,1,2 or 355.3. The GROUP NAME
and NUMBER fields have been moved to the GROUP INSURANCE PLAN file (#355.3),
but since many programmers are used to looking for this data on the 0th node
from the INSURANCE TYPE sub-file, the current value from 355.3 is put back
into the respective pieces of the 0th node. In Array("S",COB sequence #,x) x
is the same as in Array(x,node) and COB sequence is the value of the
COORDINATION OF BENEFITS field (or 0 if the field is null). This cross
reference is returned only if the COB sequence flag is set to 1.
Programmers should kill the input variable prior to making this call.
The code for this call looks something like the following:
K IBINS
D ALL^IBCNS1(DFN,"IBINS",1,IBDT) I $G(IBINS(0)) D LIST
or D ALL^IBCNS1(DFN,"^TMP($J)",1,DT) I $G(^TMP($J,0)) D....
or D ALL^IBCNS1(DFN,"IBINS",1,IBDT,1) I $O(IBINS("S",0))
I $D(IBINS("S")) S COB="" F S COB=$O(IBINS("S",COB))
Q:COB="" S X=0 F S X=$O(IBINS("S",COB,X)) Q:'X
S DATA=$G(IBINS(X,0)) D ...; for COB sequence order
VARIABLES
TYPE
VARIABLES DESCRIPTION
DFN
Input
(required) the internal number of the patient in the
patient file
var
Input
the name of the variable you wish to have the data
returned in. This may be either a local or global variable.
flag
Input
(Optional), you can ask for only active insurance
information by putting a "1" or "2". If the value of the active flag is 1,
then the active insurance will be determined as in the call to ACTIVE^IBCNS1.
If the value is 2 then insurance companies with a will not reimburse flag will
be included, but the other screens remain in effect.This is primarily to
retrieve Medicare policies when it is desirable to include them in active
policies,
date
Input
(optional, and only used if the active flag is set)
The date for the insurance to be active on (the default is "today").
COB sequence flag
Input
(optional) You can ask for a cross reference of the
array entries to be returned by COB sequence # if you pass a 1 for this data.
If this variable is set to 1, an additional array (Array("S",COB sequence
#,x)="") is returned to the calling routine. This array works like a cross
reference of Array(x,node) so information on patient policies can be retrieved
easily in COB sequence # order. If the entry does not have a defined COB
sequence #, the value for that entry's COB sequence # is returned as 0. If
this flag is not passed or is passed as something other than 1, the array
Array("S",COB sequence #) is not returned.
$$INSTYP(DFN,DATE)
This function identifies the type of insurance that a
patient has on a specific date. The function will determine the primary
policy which is effective on the given date, and return a code which
identifies the major category of the policy plan type. If the patient has no
insurance coverage on the specified date, the function returns a null value.
VARIABLES
TYPE
VARIABLES DESCRIPTION
DFN
Input
Pointer to the patient in the PATIENT (#2) file.
This required variable specifies the patient for which insurance coverage is
being requested.
DATE
Input
This optional variable specifies the date on which
the insurance coverage must be effective. If this date is not specified, the
current date is used as the default value.
CODE
Output
This value returned by the function is a code which
represents the major category of the patient's primary policy plan type. The
following codes are returned:
null No insurance coverage on the effective date
1 MAJOR MEDICAL
2 DENTAL
3 HMO
4 PPO
5 MEDICARE
6 MEDICAID
7 CHAMPUS
8 WORKMANS COMP
9 INDEMNITY
10 PRESCRIPTION
11 MEDICARE SUPPLEMENTAL
12 ALL OTHER
MAJOR MEDICAL is the default value returned by the function (ie, the patient
has insurance coverage on the effective date, but the major category of the
policy plan type cannot be determined).
