VistA-FOIAVistA/r/FEE_BASIS-FB/FBFHLD5.m

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FBFHLD5 ;OIFO/SAB-GET DATA FOR PHARMACY INVOICE ;10/9/2003
;;3.5;FEE BASIS;**61**;JULY 18, 2003
;;Per VHA Directive 10-93-142, this routine should not be modified.
Q
;
EN ;
; input
; FBAAIN - invoice number
; output
; If transaction type = "X" then only * items are output
; Claim Level Data
; FBD(0,"AMT") = Amount Disbursed^Amount Interest
; *FBD(0,"CAN") = Cancel Date^Cancel Reason^Cancel Activity
; FBD(0,"DT") = Invoice Date
; *FBD(0,"FPPS") = FPPS Claim ID
; *FBD(0,"INV") = Invoice #^Transaction Type^Station #
;
; Line Level Data (# is a sequential number)
; FBD(#,"ADJ") = AdjReason1^AdjGrp1^AdjAmt1^AdjReason2^AdjGrp2^AdjAmt2
; FBD(#,"AMT") = Amount Claimed^Amount Paid
; FBD(#,"CK") = Check Number^Check Date^Payment Method
; FBD(#,"DT") = Date Prescription Filled
; FBD(#,"FPPS") = FPPS Line Item
; FBD(#,"RMK") = Remittance Remark1,Remittance Remark2
;
; If exceptions for invoice
; ^TMP($J,"FBE",FBAAIN,seq number)=message
; If warnings for invoice
; ^TMP($J,"FBW",FBAAIN,seq number)=message
;
; initialize variables
N DA,FBC,FBI,FBIENS,FBRXY,FBSTA,FBTTYP,FBY
K FBD
S FBC=0 ; line count
;
S DA(1)=FBAAIN
S FBY(0)=$G(^FBAA(162.1,DA(1),0))
; loop thru prescriptions on invoice
S DA=0 F S DA=$O(^FBAA(162.1,DA(1),"RX",DA)) Q:'DA D
. S FBIENS=DA_","_DA(1)_","
. F FBI=0,2,3,"FBREJ" S FBRXY(FBI)=$G(^FBAA(162.1,DA(1),"RX",DA,FBI))
. Q:'$$CKLNST() ; skip line if status not OK to transmit
. S FBC=FBC+1
. ; if 1st line then get invoice level data
. I FBC=1 D INVOICE
. I FBTTYP="L" D LINE
Q
;
INVOICE ; determine invoice data from 1st line item
; FBD(0,"AMT") = Amount Disbursed^Amount Interest
; FBD(0,"CAN") = Cancel Date^Cancel Reason^Cancel Activity
; FBD(0,"DT") = Invoice Date
; FBD(0,"FPPS") = FPPS Claim ID
; FBD(0,"INV") = Invoice #^Transaction Type^Station #
; FBSTA = station number
; FBTTYP = transaction type (L or X)
;
N FBDT,FBOB,FBX
; determine Transaction Type (based on CANCELLATION DATE)
S FBTTYP=$S($P(FBRXY(2),U,11)]"":"X",1:"L")
;
; determine station number
S FBSTA=$$RXSTA(FBAAIN,$P(FBRXY(0),U,17))
;
;INV
S FBD(0,"INV")=FBAAIN_U_FBTTYP_U_FBSTA
;
;FPPS
S FBD(0,"FPPS")=$P(FBY(0),U,13)
;
;CAN
; if cancel then get cancel data
I FBTTYP="X" D Q
. S FBD(0,"CAN")=$P(FBRXY(2),U,11)_U_$$GET1^DIQ(162.11,FBIENS,"32:1")_U_$P(FBRXY(2),U,13)
;
;AMT
S FBD(0,"AMT")="0^0" ; initialize sums
;
;DT
; determine invoice date
; (date certified or date paid or date supervisor closed batch)
S FBDT=$P(FBRXY(0),U,19) ; date certified for payment (lines may differ)
I FBDT="" S FBDT=$P(FBRXY(2),U,8) ; date paid
I FBDT="",$P(FBRXY(0),U,17) S FBDT=$P(^FBAA(161.7,$P(FBRXY(0),U,17),0),U,6) ; date supv closed batch (for 0.00 lines)
S FBD(0,"DT")=FBDT
;
Q
;
LINE ; FBC
; FBD(#,"ADJ") = AdjReason1^AdjGrp1^AdjAmt1^AdjReason2^AdjGrp2^AdjAmt2
; FBD(#,"AMT") = Amount Claimed^Amount Paid
; FBD(#,"CK") = Check Number^Check Date^Payment Method
; FBD(#,"DT") = Date of Service
; FBD(#,"FPPS") = FPPS Line Item
; FBD(#,"RMK") = Remittance Remark1^Remittance Remark2
; FBD(#,"SVC") = Service Code^Qualifier^Mod1,Mod2,Mod3,Mod4^Units
;
N FBADJ
; compare invoice transaction type (L,X) with line cancel status
I ((FBTTYP="X")&($P(FBRXY(2),U,11)=""))!((FBTTYP="L")&($P(FBRXY(2),U,11)]"")) D POST^FBFHLU(FBAAIN,"E","ALL LINES DO NOT HAVE SAME CANCEL STATUS") Q
;
;FPPS
S FBD(FBC,"FPPS")=$P(FBRXY(3),U)
;
;DT
S FBD(FBC,"DT")=$P(FBRXY(0),U,3)
;
;AMT
S FBD(FBC,"AMT")=$P(FBRXY(0),U,4)_U_$P(FBRXY(0),U,16)
;
;ADJ
D LOADADJ^FBRXFA(FBIENS,.FBADJ)
I $D(FBADJ) S FBD(FBC,"ADJ")=$$ADJL^FBUTL2(.FBADJ)
;
;RMK
S FBD(FBC,"RMK")=$$RRL^FBRXFR(FBIENS)
;
;CK
S FBD(FBC,"CK")=$P(FBRXY(2),U,10)_U_$P(FBRXY(2),U,8)_U_$$PAYMETH^FBFHLU($P(FBRXY(2),U,10))
;
;CAMT ; add disbursed and interest amounts to claim (0) level
; note - disbursed amount on file includes the interest
; since FPPS wants it w/o interest - interest is subtracted
S $P(FBD(0,"AMT"),U)=$P(FBD(0,"AMT"),U)+($P(FBRXY(2),U,14)-$P(FBRXY(2),U,15))
S $P(FBD(0,"AMT"),U,2)=$P(FBD(0,"AMT"),U,2)+$P(FBRXY(2),U,15)
Q
;
CKLNST() ; check line status extrinsic function
; result (0 or 1)
; 0 when line should not be sent to FPPS
; 1 when line should be sent to FPPS
N FBRET
S FBRET=1
;
; check if rejected line
I $P(FBRXY("FBREJ"),U)]"" S FBRET=0
;
Q FBRET
;
RXSTA(FBAAIN,FBBATCH) ; determine station number for pharmacy
; input
; FBAAIN - invoice number in FEE BASIS PHARMACY INVOICE file
; FBBATCH - ien of entry in FEE BASIS BATCH (#161.7) file
; returns station number or NULL value
N FBRET
; if batch not input then check all line items for a batch
I 'FBBATCH D
. N DA
. S DA(1)=FBAAIN
. S DA=0 F S DA=$O(^FBAA(162.1,DA(1),"RX",DA)) Q:'DA D Q:FBBATCH
. . S FBBATCH=$P($G(^FBAA(162.1,DA(1),"RX",DA,0)),U,17)
;
; if batch known then call API to get station number
I FBBATCH S FBRET=$$STANO^FBFHLU(FBBATCH)
; if batch not known then get station number based on fee site param.
I 'FBBATCH S FBRET=$$GET1^DIQ(161.4,"1,","27:99")
;
Q FBRET
;
;FBFHLD5