| RNBU(encounter,change) |
Update an Outpatient Encounters Claims Tracking
Reason Not Billable. When an encounters Service Connected designation is
changed after check-out this function may be used to update the encounters
Claims Tracking Reason Not Billable.
When the encounter is changed from NSC to SC the Claims Tracking record is
updated to non-billable only if it was identified as billable. When the
encounter is changed from SC to NSC the Claims Tracking record is update to
billable only if it was identified as non-billable due to SC Treatment.
|
| VARIABLES |
TYPE |
VARIABLES DESCRIPTION |
encounter |
Input |
IEN of Outpatient Encounter (#409.68)
|
change |
Input |
1 - Encounter changed from NSC to SC 2 -
Encounter changed from SC to NSC
|
$$RNBU |
Output |
Value returned by the function representing: 1 -
Claims Tracking record updated to non-billable If no Reason Not Billable then
SC TREATMENT added 2 - Claims Tracking record updated to billable If
Reason Not Billable SC TREATMENT then deleted 0 - No change
|
|
CT(encounter) |
Retrieve an Outpatient Encounters Claims Tracking
record.
|
| VARIABLES |
TYPE |
VARIABLES DESCRIPTION |
encounter |
Input |
IEN of Outpatient Encounter (#409.68)
|
$$CT |
Output |
Returns IEN of encounter in Claims Tracking (#356) or
returns null if no record found
|
|
FIRST(encounter) |
Check if an Outpatient Encounter is billable for
First Party. This function checks various elements related to the patient and
encounter. Not all billable elements are checked, for example encounter
Classifications (SC/NSC) are not checked.
|
| VARIABLES |
TYPE |
VARIABLES DESCRIPTION |
encounter |
Input |
IEN of Outpatient Encounter (#409.68)
|
$$FIRST |
Output |
Returns encounter First Party billable status: 1 -
if encounter is billable to patient 0 ^ reason encounter not
billable
|
|
THIRD(encounter) |
Check if an Outpatient Encounter is billable for
Third Party. This function checks various elements related to the patient and
encounter. Not all billable elements are checked, for example encounter
Classifications (SC/NSC) and patient insurance are not checked.
|
| VARIABLES |
TYPE |
VARIABLES DESCRIPTION |
encounter |
Input |
IEN of Outpatient Encounter (#409.68)
|
$$THIRD |
Output |
Returns encounter Third Party billable status: 1 -
if encounter is billable to insurance 0 ^ reason encounter not
billable
|
|
FPBILL(encounter) |
Retrieve an Outpatient Encounters First Party bill
and charge. The AR Bill number/transaction are only defined once charge is
passed to AR so a valid returned charge may only have a Total Charge defined.
|
| VARIABLES |
TYPE |
VARIABLES DESCRIPTION |
encounter |
Input |
IEN of Outpatient Encounter (#409.68)
|
$$FPBILL |
Output |
Returns encounters patient charge data if found: AR
BILL NUMBER (#350,.11) ^ AR TRANSACTION NUMBER (#350,.12) ^ TOTAL CHARGE
(#350,.07) or returns null if no non-cancelled charge found
|
|
TPBILL(encounter) |
Retrieve an Outpatient Encounters Third Party bills.
Encounters may have multiple Third Party bills. This function returns a
string of all Third Party bills that have not been cancelled and have one of
the encounters procedures assigned.
|
| VARIABLES |
TYPE |
VARIABLES DESCRIPTION |
encounter |
Input |
IEN of Outpatient Encounter (#409.68)
|
$$TPBILL |
Output |
Returns encounters third party bill numbers: BILL
NUMBER (#399,.01)^BILL NUMBER (#399,.01)^... or returns null if no
non-cancelled bills found
|
|
TPCHG(encounter) |
Calculate encounter's potential Third Party charges.
Based on encounters procedures and Reimbursable Insurance charges.
|
| VARIABLES |
TYPE |
VARIABLES DESCRIPTION |
encounter |
Input |
IEN of Outpatient Encounter (#409.68)
|
$$TPCHG |
Output |
Returns potential Third Party charges for the
procedures assigned to an encounter: Total Institutional ^ Total
Professional charges or returns 0 if not billable or no charges found
|
|
