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DBIA4435 ICR (4435)

DBIA4435    ICR (4435)

Name Value
NUMBER 4435
IA # 4435
DATE CREATED 2004/05/27
CUSTODIAL PACKAGE INTEGRATED BILLING
CUSTODIAL ISC Washington
USAGE Private
TYPE Routine
DBIC APPROVAL STATUS APPROVED
ROUTINE IBNCPDPU
NAME DBIA4435
GENERAL DESCRIPTION
IB functions are to serve AR in matching the ECME
number to the respective IB bill ($$RXBIL component) and to check the status
of a claim in Claims Tracking ($$REJECT component).
STATUS Active
KEYWORDS
  • ECME
  • NCPDP
  • E-PHARMACY
  • BPS
ID IBNCPDPU
COMPONENT/ENTRY POINT
COMPONENT/ENTRY POINT COMPONENT DESCRIPTION VARIABLES
$$RXBIL(.IBINP,.IBERR)
The function $$RXBIL^IBNCPDPU() determines the
respective IB/AR Bill, matching to the given ECME Number, Fill Date and the
Patient Name (optional).

$$RXBIL^IBNCPDPU(.IBINP,.IBERR) returns IEN of the IB Bill (file #399), or 0
if the given ECME Number has not been matched.

If the ECME Number was not matched, the parameter IBERR passed by reference is
set to text description of the problem.
VARIABLES TYPE VARIABLES DESCRIPTION
.IBINP Input
The following will be passed to Integrated Billing:

IBINP("ECME") - the 7-digit or 12-digit ECME Reference Number; IBINP("FILLDT")
- the Rx Fill Date, YYYYMMDD or FileMan format; IBINP("PNM") (optional) - the
patient's last name.
.IBERR Output
Optional parameter passed by reference. If the
matching function was successfull, the parameter IBERR will contain null
string.  If the matching was unsuccessful, IBERR contains text description of
the error.
$$RXBIL Output
the function returns IEN of the IB Bill (file #399)
if matching is successful, or 0 if the given ECME Number has not been matched.

$$REJECT(IBECME,IBDATE)
The new procedure will be used by Accounts Receivable
to check if the e-claim has been rejected by the payer. The call will only be
made if the matching bill is not found in IB/AR. If the electronic EOB
reference number is not "matched" in IB, and if it conforms to to the ECME
format (?1.12N), and the PAID AMOUNT on the  electronic EOB is zero, there is
a chance that the EEOB is related to the rejected e-Pharmacy claims. In those
cases AR will be making the call to this function to make sure that the
electronic EOB is related to the reject.  The function will be checking the
Claims Tracking (CT) record to determine the status of the claim. The status
in CT will be updated by the "SUBMITTED" event from ECME.  If the Payer's
response never received due to any reason, the function will be returning "0".

VARIABLES TYPE VARIABLES DESCRIPTION
IBECME Input
Required: the ECME number (the Reference Number) as
it is shown in the electronic EOB.

IBDATE Input
The date of service as it is reported in the EEOB.
Could be in YYYYMMDD format, or the FileMan format (YYYMMDD).  The parameter
is optional. If not passed, the function will return the latest claim
information.

$$REJECT Output
"1" if the e-Pharmacy claim was rejected.  "0" - if
the claim was not rejected, or payer response not received.

SUBSCRIBING PACKAGE
SUBSCRIBING PACKAGE ISC SUBSCRIBING DETAILS
ACCOUNTS RECEIVABLE Washington/Silver Spring
The IB function and the consumer from the subscribing
patch (AR) were implemented by the NCPDP e-Pharmacy project, accordingly
IB*2.0*223 and PRCA*4.5*202.  Additionally, a second component was added,
$$REJECT, to support PRCA*4.5*230 (HIPAA NCPDP - Global).

In order to determine the IB/AR Bill matching to the given ECME Number and the
Fill Date from the electronic 835, the AR package will call the IB function
$$RXBIL^IBNCPDPU().

Within the AR package the matching API will be consumed by the manual matching
functionality (RECEIPT PROCESSING, LINK PAYMENT) and by the EDI LOCKBOX
automatic 835s matching.



DATE ACTIVATED 2010/12/13