182 lines
6.1 KiB
Mathematica
182 lines
6.1 KiB
Mathematica
BPSOSQ4 ;BHAM ISC/FCS/DRS/DLF - Process responses ;06/01/2004
|
|
;;1.0;E CLAIMS MGMT ENGINE;**1,5**;JUN 2004;Build 45
|
|
;;Per VHA Directive 2004-038, this routine should not be modified.
|
|
;
|
|
; This routine has two components
|
|
; Procedures to report Response info
|
|
; Procedures to handle insurer asleep functions
|
|
Q
|
|
;
|
|
; The following are separate little utilities called from elsewhere.
|
|
;
|
|
PAID(IEN59) ;quick query to see if it's paid
|
|
N TMP D RESPINFO(IEN59,.TMP) Q:'$D(TMP("RSP")) 0
|
|
N X S X=TMP("RSP")
|
|
I X="Payable" Q 1
|
|
Q 0
|
|
RESPINFO(RXI,DST) ;EP - BPSOS6M
|
|
; quick way to get all the response info for a given RXI
|
|
; IMPORTANT!! Do not change spelling, case, wording, or spacing!!!
|
|
; If a reversal was attempted, it complicates things.
|
|
; fills DST array as follows:
|
|
; DST("HDR")=Response Status (header)
|
|
; DST("RSP")=Response Status (prescription)
|
|
; This could be: "Payable" "Rejected" "Captured" "Duplicate"
|
|
; or "Accepted reversal" or "Rejected reversal"
|
|
; or "null" or "null reversal" (no response or corrupt response
|
|
; or maybe someone without insurance, so no request was sent)
|
|
; DST("REJ",0)=count of reject codes
|
|
; DST("REJ",n)=each reject code
|
|
; DST("MSG")=message with the response
|
|
; All of these are defined, even if originals were '$D.
|
|
; The external forms are returned.
|
|
N REVERSAL S REVERSAL=$G(^BPST(RXI,4))>0
|
|
N RESP
|
|
I 'REVERSAL S RESP=$P(^BPST(RXI,0),U,5)
|
|
E S RESP=$P(^BPST(RXI,4),U,2)
|
|
I 'RESP Q
|
|
N ECME S POS=$P(^BPST(RXI,0),U,9) Q:'POS
|
|
N FMT S FMT="E"
|
|
S DST("HDR")=$$RESP500(RESP,FMT)
|
|
S DST("RSP")=$$RESP1000(RESP,POS,FMT)
|
|
S DST("REJ",0)=$$REJCOUNT(RESP,POS,FMT)
|
|
I DST("REJ",0) D
|
|
. N I F I=1:1:DST("REJ",0) S DST("REJ",I)=$$REJCODE(RESP,POS,I,FMT)
|
|
S DST("MSG")=$$RESPMSG(RESP,POS,FMT)
|
|
; Dealing with oddities of PCS (and others'?) response to reversals
|
|
I REVERSAL,DST("RSP")["null" D
|
|
. I DST("RSP")["null" S DST("RSP")=DST("HDR")_" reversal"
|
|
Q
|
|
; In the following quickies:
|
|
; RESP = RESPIEN, pointer to 9002313.03
|
|
; FMT = "I" for internal, "E" for external, defaults to internal
|
|
RESP500(RESP,FMT) ;EP - BPSOS57,BPSOSUC
|
|
; returns the response header status
|
|
N X S X=$P($G(^BPSR(RESP,500)),U)
|
|
I $G(FMT)'="E" Q X
|
|
I X="" S X="null"
|
|
S X=$S(X="A":"Accepted",X="R":"Rejected",1:"?"_X)
|
|
Q X
|
|
RESP1000(RESP,POS,FMT) ;EP - BPSOSUC
|
|
; returns the prescription response status
|
|
; Note! Could be DP or DC for duplicates
|
|
N X S X=$P($G(^BPSR(RESP,1000,POS,500)),U)
|
|
I $G(FMT)'="E" Q X
|
|
I X="" S X="null"
|
|
;
|
|
;IHS/SD/lwj 10/07/02 NCPDP 5.1 changes - they will send an "A" back
|
|
; now on the transaction level to indicate that it has been accepted
|
|
; Next code line remarked out - following added
|
|
;
|
|
S X=$S(X="A":"Accepted",X="P":"Payable",X="R":"Rejected",X="C":"Captured",X="D"!(X="DP")!(X="DC"):"Duplicate",1:"?"_X)
|
|
Q X
|
|
;
|
|
REJCOUNT(RESP,POS,FMT) ; returns rejection count
|
|
Q +$P($G(^BPSR(RESP,1000,POS,511,0)),U,3)
|
|
;
|
|
REJCODE(RESP,POS,N,FMT) ; returns Nth rejection code
|
|
; if FMT="E", returns code:text
|
|
N CODE S CODE=$P($G(^BPSR(RESP,1000,POS,511,N,0)),U)
|
|
I CODE="" S CODE="null"
|
|
I FMT'="E" Q CODE
|
|
N X S X=$O(^BPSF(9002313.93,"B",CODE,0))
|
|
I X]"" S CODE=CODE_":"_$P($G(^BPSF(9002313.93,X,0)),U,2)
|
|
E S CODE="?"_CODE
|
|
Q CODE
|
|
;
|
|
; NCPDP 5.1 changes - message may not come back in 504. They may
|
|
; come back in 526 instead
|
|
RESPMSG(RESP,POS,FMT) ; response message - additional text from insurer
|
|
;
|
|
N MSG
|
|
S MSG=""
|
|
S MSG=$G(^BPSR(RESP,504))
|
|
S:MSG="" MSG=$G(^BPSR(RESP,1000,POS,504))
|
|
S:MSG="" MSG=$G(^BPSR(RESP,1000,POS,526))
|
|
Q MSG
|
|
;
|
|
;
|
|
NOW() N %,%H,%I,X D NOW^%DTC Q %
|
|
;
|
|
; The xxxSLEEP functions are called from BPSOSQL
|
|
;
|
|
; REJSLEEP - Check if the insurer should be asleep
|
|
; based on the reject codes
|
|
; Input
|
|
; RESP - BPS Response IEN
|
|
; POS - Multiple IEN
|
|
; Return
|
|
; 1 if the insurer is asleep
|
|
; 0 if the insurer is not asleep
|
|
REJSLEEP(RESP,POS) ;EP - BPSOSQL
|
|
;
|
|
; DMB - Asleep functionality is disabled for VA until an analysis of reject
|
|
; codes can be done and asleep code needs to handle a stranded prober.
|
|
Q 0
|
|
;
|
|
; Validate parameters
|
|
I '$G(RESP) Q 0
|
|
I '$G(POS) Q 0
|
|
;
|
|
; This is basically old IHS logic
|
|
I $G(^BPSR(RESP,1000,POS,504))?1"EV16-".E Q 1
|
|
I $G(^BPSR(RESP,1000,POS,504))?1"EV38-".E Q 1
|
|
I $G(^BPSR(RESP,1000,POS,504))?1"EV32-".E Q 1
|
|
I $G(^BPSR(RESP,1000,POS,504))?1"EV25-".E Q 1 ; BPS*1.0T7*4
|
|
;
|
|
; NDC's, and theoretically, Envoy too, though they seem to do EV- msgs
|
|
I $O(^BPSR(RESP,1000,POS,511,"B",90))="" Q 0 ; cheap check
|
|
;
|
|
; But for a PCS case we see, Code 99 + some code < 90 ; BPS*1.0T7*2
|
|
; isn't "asleep" - 99 is something PCS threw in ; BPS*1.0T7*2
|
|
; so require 99 to be accompanied by something <99 too ; BPS*1.0T7*2
|
|
;
|
|
N RET S RET=0 N I F I=92,93,99 D Q:RET
|
|
. I $D(^BPSR(RESP,1000,POS,511,"B",I)) S RET=1
|
|
. Q:I'=99 Q:'RET ; BPS*1.0T7*2
|
|
. I I=99,$O(^BPSR(RESP,1000,POS,511,"B",0))<90 S RET=0 ; BPS*1.0T7*2
|
|
Q RET
|
|
;
|
|
; INCSLEEP - Increment sleep time for this insurer, if necessary.
|
|
; Input
|
|
; IEN59 - BPS Transaction IEN
|
|
; PAYSH - Payer Sheet IEN
|
|
; Return the scheduled retry time
|
|
INCSLEEP(IEN59,PAYSH) ;EP - BPSOSQL
|
|
;
|
|
; Set retry time to be 10 minutes in the future
|
|
N X,RETRY
|
|
S X=600,RETRY=$$TADDNOWS^BPSOSUD(X)
|
|
;
|
|
; Set retry time to be 10 minutes
|
|
S $P(^BPSF(9002313.92,PAYSH,1),U,12)=RETRY
|
|
S $P(^BPST(IEN59,8),U,1)=RETRY
|
|
S $P(^BPST(IEN59,8),U,3)=PAYSH
|
|
;
|
|
; Fire up a packet process 10 seconds after the RETRY time so that the
|
|
; claims can be processed as soon as the retry time expires
|
|
D TASKAT^BPSOSQA($$TADDNOWS^BPSOSUD(X+10))
|
|
;
|
|
; And run packeter right now, too, to stamp new times on the others in status 31
|
|
D TASK^BPSOSQA
|
|
Q RETRY
|
|
;
|
|
; Clear insurer sleeping condition
|
|
CLRSLEEP(IEN59,PAYSH) ;EP - BPSOSQL
|
|
N RETRY
|
|
;
|
|
; Reset Retry Time and Prober Flga
|
|
I $D(^BPST(IEN59,8)) S $P(^BPST(IEN59,8),U,1)="",$P(^BPST(IEN59,8),U,3)=""
|
|
;
|
|
; Get retry time from the payer sheet and quit if does not exist
|
|
S RETRY=$P($G(^BPSF(9002313.92,PAYSH,1)),U,12)
|
|
;
|
|
; Reset Retry Time and Prober
|
|
S $P(^BPSF(9002313.92,PAYSH,1),U,11)=""
|
|
S $P(^BPSF(9002313.92,PAYSH,1),U,12)=""
|
|
;
|
|
; If this insurer was asleep and there are other asleep transactions, fire off
|
|
; the Packeter task to see if they should be done
|
|
I RETRY,$D(^BPST("AD",31)) D TASK^BPSOSQA
|
|
Q
|