185 lines
9.0 KiB
Mathematica
185 lines
9.0 KiB
Mathematica
PSOCP ;BIR/BAB - Pharmacy CO-PAY Application Utilities for IB ;02/06/92
|
|
;;7.0;OUTPATIENT PHARMACY;**20,46,71,85,137,157,143,219,239,201**;DEC 1997
|
|
;
|
|
;REF/IA - IBARX/125, SDCO22/1579, PS(55/2228, PSDRUG(/221, DGMSTAPI/2716
|
|
CP ;Check if COPAY-Requires RXP,PSOSITE7
|
|
I '$D(PSOPAR) D ^PSOLSET G CP
|
|
K PSOCP
|
|
S PSOCPN=$P(^PSRX(RXP,0),"^",2) ; Set COPAY dfn PTR TO PATIENT
|
|
S PSOCP=$P($G(^PSRX(RXP,"IB")),"^") ; IB action type
|
|
S PSOSAVE=$S(PSOCP:1,1:"") ; save current copay status
|
|
; Set x=service^dfn^actiontype^user duz
|
|
I +$G(PSOSITE7)'>0 S PSOSITE7=$P(^PS(59,PSOSITE,"IB"),"^")
|
|
S X=PSOSITE7_"^"_PSOCPN_"^"_PSOCP_"^"_$P(^PSRX(RXP,0),"^",16)
|
|
;
|
|
RX ;Determine Orig or Refill for RX
|
|
N PSOIB,PSOPFS S (PSOIB,PSOREF)=0
|
|
I $G(^PSRX(RXP,1,+$G(YY),0))]"" S PSOREF=YY
|
|
D PFSA^PSOPFSU1(RXP,PSOREF,2) G PFS:+PSOPFS
|
|
; Check if bill exists
|
|
I 'PSOREF,+$P($G(^PSRX(RXP,"IB")),"^",2)>0 D CHKIB^PSOCP1 I PSOIB G QUIT
|
|
I 'PSOREF,+$P($G(^PSRX(RXP,"IB")),"^",4)>0 G QUIT ; 'POTENTIAL BILL' - ALREADY ATTEMPTED TO BILL, BUT EXCEEDED ANNUAL COPAY CAP
|
|
I PSOREF,+$G(^PSRX(RXP,1,PSOREF,"IB")) D CHKIB^PSOCP1 I PSOIB G QUIT
|
|
I PSOREF,+$P($G(^PSRX(RXP,1,PSOREF,"IB")),"^",2) G QUIT ; POTENTIAL BILL
|
|
PFS ;
|
|
S PSOCHG=1 ; set tem var to copay and check exception
|
|
N MAILMSG
|
|
D COPAYREL
|
|
I 'PSOCHG D D:PSOPFS CHRG^PSOPFSU1(RXP,PSOREF,"CG",PSOPFS) G QUIT
|
|
. I PSOSAVE S PSODA=RXP,PREA="R" D ACTLOG^PSOCPA S $P(^PSRX(RXP,"IB"),"^",1)=""
|
|
I PSOCHG=2 D I 'PSOCP D:PSOPFS CHRG^PSOPFSU1(RXP,PSOREF,"CG",PSOPFS) G QUIT ; IF 'SC' QUESTION APPLIES, BUT HAS NOT BEEN ANSWERED, SEND MAIL MSG AND KEEP COPAY STATUS AS IT WAS
|
|
. D MAIL2^PSOCPE ; SEND MAIL TO PHARMACIST, PROVIDER, AND HOLDERS OF THE PSO COPAY KEY
|
|
I PSOCHG=1,PSOSAVE="" D I PSOREF S PSOCOMM="",PSOOLD="No Copay",PSONW="Copay" S PSODA=RXP,PREA="R" D ACTLOG^PSOCPA
|
|
. I '$D(^PSRX(RXP,"IB")),'PSOREF S $P(^PSRX(RXP,"IB"),"^",1)=1 Q
|
|
. S $P(^PSRX(RXP,"IB"),"^",1)=1
|
|
. S PSOCP=1,$P(X,"^",3)=PSOCP
|
|
I PSOCHG'=2 I $G(MAILMSG) D MAIL2^PSOCPE ; SEND MAIL TO PHARM, PROV, AND HOLDERS OF PSO COPAY KEY HOLDERS
|
|
; Units for COPAY
|
|
S PSOCPUN=$P(($P(^PSRX(RXP,0),"^",8)+29)/30,".",1)
|
|
; Build softlink for x(n)=softlink^units
|
|
S X(1)="52:"_RXP S:PSOREF>0 X(1)=X(1)_";1:"_PSOREF S X(1)=X(1)_"^"_PSOCPUN
|
|
; Set correct user duz if refill
|
|
I PSOREF S:+$P(^PSRX(RXP,1,PSOREF,0),"^",7)>0 $P(X,"^",4)=$P(^PSRX(RXP,1,PSOREF,0),"^",7)
|
|
;
|
|
IBNEW ; Load ^TMP global for IB call
|
|
Q:$G(RXP)'>0
|
|
I PSOPFS D CHRG^PSOPFSU1(RXP,PSOREF,"CG",PSOPFS)
|
|
G QUIT:PSOPFS
|
|
N D0
|
|
G QUIT:'$D(X)
|
|
S XTMP=X,XTMP(1)=X(1)
|
|
;
|
|
; Requires x=service^dfn^action type^user duz
|
|
; x(n)=softlink^units
|
|
I $P(X,"^",3)="" S $P(X,"^",3)=$P(^PSRX(RXP,"IB"),"^",1)
|
|
D NEW^IBARX
|
|
; Returns y=1^total charges for this group or Y=-1^error code
|
|
; y(n)=IB number^charge for this Rx^AR bill #^Cap met^Partial or Full charge^Copay Exempt^Number from file 354.71
|
|
; Cap met ('1' - If patient has met cap amount or reached cap with this charge or '0' if not)
|
|
; Partial or Full ('P' for partial billing, 'F' for full billing, null for no billing)
|
|
; Copay Exempt - ('1' for exempt, '0' for non-exempt, '-1' for copay off (manila)),
|
|
; ('1' - If patient has met cap amount or reach cap with this charge
|
|
; Entry from file 354.71 will only be saved for fills that met the annual cap and could not be fully billed
|
|
;
|
|
G QUIT:+Y=-1
|
|
S XTMP=XTMP_"^"_Y,XTMP(1)=XTMP(1)_"^"_Y(1)
|
|
;
|
|
; see if exempt or copay cap was met
|
|
I $P(Y(1),"^",6) D G QUIT
|
|
. S PREA="R",PSOOLD="Copay",PSONW="No Copay"
|
|
. S PSOCOMM="RX COPAY INCOME EXEMPTION" S PSODA=RXP D ACTLOG^PSOCPA
|
|
. S $P(^PSRX(RXP,"IB"),"^",1)=""
|
|
I $P(Y(1),"^",4) D
|
|
. S PSOCOMM=$S($P(Y(1),"^",5)="F":" FULL BILLING FOR THIS FILL",$P(Y(1),"^",5)="P":" PARTIAL BILLING FOR THIS FILL ",1:" NO BILLING FOR THIS FILL")
|
|
. S PREA="A"
|
|
. S PSODA=RXP D ACTLOG^PSOCPA
|
|
. I $P(Y(1),"^",5)'="F" D
|
|
. . I PSOREF S $P(^PSRX(RXP,1,PSOREF,"IB"),"^",2)=$P(Y(1),"^",7) Q
|
|
. . S $P(^PSRX(RXP,"IB"),"^",4)=$P(Y(1),"^",7)
|
|
I $P(Y(1),"^",1)="" G QUIT
|
|
;
|
|
FILE ;File IB number in ^PSRX
|
|
S PSOCP2=0
|
|
S PSOCP2=+$P(XTMP(1),":",3)
|
|
S:PSOCP2>0 ^PSRX(RXP,1,PSOCP2,"IB")=$P(XTMP(1),U,3) ; Filing in refill node
|
|
I PSOCP2>0,'$D(^PSRX(RXP,"IB")) S ^PSRX(RXP,"IB")="1^^" ; If refill "IB" exists, need "IB" entry on original fill node
|
|
S:PSOCP2=0 $P(^PSRX(RXP,"IB"),"^",2)=$P(XTMP(1),U,3) ;Filing in original fill (zero node)
|
|
QUIT ;
|
|
K Y,PSOCP1,PSOCP2,QQ,PSOCPN,X,X2,XTMP,PSOCPUN,PSOREF,PSOCHG,PSOSAVE,PSOCOMM,PSOOLD,PSONW,PREA,PSORSN
|
|
Q
|
|
EN D ^PSOLSET
|
|
EN1 S DIR(0)="NO",DIR("A")="Enter PRESCRIPTION number" D ^DIR K DIR G:$D(DIRUT) EXIT S RXP=X I +$G(^PSRX(RXP,0))'>0!+$P($G(^PSRX(RXP,"IB")),"^",0)>0 W !,?10,"RE-CHECK PRESCRIPTION NUMBER AND RE-ENTER " G EN1
|
|
S PSOSITE7=$P(^PS(59,PSOSITE,"IB"),"^")
|
|
S PSODFN=$P(^PSRX(RXP,0),"^",2)
|
|
D CP G EN1
|
|
EXIT K RXP D FINAL^PSOLSET Q
|
|
;
|
|
SC(PSODFN,PSODD) ;sup ref for CPRS, Pre-Copay enhancement
|
|
N PSOSC
|
|
I $$DT^PSOMLLDT S PSOSC="" G SCQ
|
|
I $G(PSODD),($P($G(^PSDRUG(PSODD,0)),"^",3)["S")!($P($G(^(0)),"^",3)["I") S PSOSC=1 G SCQ
|
|
I $P($G(^PS(55,+$G(PSODFN),"PS")),"^"),$P($G(^PS(53,+$P(^("PS"),"^"),0)),"^",7) S PSOSC=1 G SCQ
|
|
N I,J,X S (X,PSOSC)=""
|
|
S J=0 F S J=$O(^PS(59,J)) Q:'J I +$G(^(J,"IB")) S X=+^("IB") Q
|
|
G:'X SCQ
|
|
S X=X_"^"_PSODFN D XTYPE^IBARX
|
|
S J="" F S J=$O(Y(J)) Q:'J S I="" F S I=$O(Y(J,I)) Q:I="" S:I>0 PSOSC=I
|
|
SCQ Q $S($G(PSOSC)=2:0,1:1)
|
|
;
|
|
COPAYREL ; Recheck copay status at release
|
|
; check Rx patient status
|
|
I $P(^PSRX(RXP,0),"^",3)'="",$P($G(^PS(53,$P(^PSRX(RXP,0),"^",3),0)),"^",7)=1 S PSOCHG=0,PSOCOMM="Rx Patient Status Change",PSOOLD="Copay",PSONW="No Copay" Q
|
|
; see if drug is investigational or supply
|
|
N DRG,DRGTYP,X
|
|
S DRG=+$P(^PSRX(RXP,0),"^",6),DRGTYP=$P($G(^PSDRUG(DRG,0)),"^",3)
|
|
I DRGTYP["I" S PSOCOMM="Investigational Drug",PSOCHG=0,PSOOLD="Copay",PSONW="No Copay",PSOCHG=0
|
|
I DRGTYP["S" S PSOCOMM="Supply Item",PSOCHG=0,PSOOLD="Copay",PSONW="No Copay",PSOCHG=0
|
|
K PSOTG,CHKXTYPE
|
|
I +$G(^PSRX(RXP,"IBQ")) D XTYPE1^PSOCP1
|
|
I $G(^PSRX(RXP,"IBQ"))["1" D S PSOCHG=0,PSOOLD="Copay",PSONW="No Copay" Q ; COPAY EXEMPT
|
|
. N EXMT,II,PSOCIBQ
|
|
. S PSOCIBQ=$G(^PSRX(RXP,"IBQ"))
|
|
. F II=1,7,3,4,5,6,2 I $P(PSOCIBQ,"^",II)=1 S EXMT=$S(II=1:"SC",II=7:"CV",II=3:"AO",II=4:"IR",II=5:"EC",II=2:"MST",II=6:"HNC",1:"") D:EXMT'="" SETCOMM Q
|
|
D SCNEW(.PSOTG,PSOCPN,DRG,RXP)
|
|
N EXMT
|
|
I '$D(CHKXTYPE) D XTYPE
|
|
F EXMT="SC","CV","AO","IR","EC","MST","HNC" I $D(PSOTG(EXMT)) D I 'PSOCHG Q
|
|
. I PSOTG(EXMT)=1 S PSOCHG=0 D SETCOMM
|
|
I 'PSOCHG S PSOOLD="Copay",PSONW="No Copay" Q
|
|
;
|
|
; If any of the applicable exemption quest have never been answered, send a mail msg with all of the quest
|
|
S EXMT="",MAILMSG=0 F S EXMT=$O(PSOTG(EXMT)) Q:EXMT="" I PSOTG(EXMT)="" S MAILMSG=1 Q
|
|
I MAILMSG,$D(PSOTG("SC")) I $G(PSOTG("SC"))="" S PSOCHG=2 ; 'SC' quest not answered, don't reset copay status to 'copay'
|
|
Q
|
|
;
|
|
SCNEW(PSOTG,PSOPT,PSODR,PSORN) ;CPRS supported ref
|
|
I '$$DT^PSOMLLDT Q
|
|
I '$G(PSOPT) Q
|
|
;I $G(PSODR),($P($G(^PSDRUG(PSODR,0)),"^",3)["S")!($P($G(^(0)),"^",3)["I") Q ;CIDC ALWAYS ASK
|
|
N PSOCIBQ,PSOQMSH,PSOQVEH,PSOQRQD,PSOQHNC,PSOQPGW,DFN,PSOSCA,ZXX
|
|
K PSOANSQ("SC>50")
|
|
S DFN=PSOPT
|
|
D SCP^PSORN52D S:PSOSCP>49&(PSOSCA) PSOANSQ("SC>50")=1
|
|
I $G(PSORN) D
|
|
. S PSOCIBQ=$G(^PSRX(PSORN,"IBQ"))
|
|
. I $TR(PSOCIBQ,"^")="" S ZXX=$G(^PSRX(PSORN,"ICD",1,0)) D ICD:ZXX'=""
|
|
I '$G(PSORN) S PSOCIBQ=""
|
|
;Rx Patient Status check is not being done here
|
|
N PSOSCMX,Y,I,J,X S (X,PSOSCMX)=""
|
|
S J=0 F S J=$O(^PS(59,J)) Q:'J I +$G(^(J,"IB")) S X=+^("IB") Q
|
|
G:'X SKIP
|
|
S X=X_"^"_PSOPT D XTYPE^IBARX
|
|
S J="" F S J=$O(Y(J)) Q:'J S I="" F S I=$O(Y(J,I)) Q:I="" S:I>0 PSOSCMX=I
|
|
SKIP ;
|
|
I $G(PSOSCA)!($G(PSOSCMX)=2) S PSOTG("SC")=$S($P(PSOCIBQ,"^")=1:1,$P(PSOCIBQ,"^")=0:0,$G(PSORN)&($P($G(^PSRX(+$G(PSORN),"IB")),"^")):0,1:"")
|
|
S:$$AO^SDCO22(PSOPT) PSOTG("AO")=$S($P(PSOCIBQ,"^",3)=1:1,$P(PSOCIBQ,"^",3)=0:0,1:"")
|
|
S:$$IR^SDCO22(PSOPT) PSOTG("IR")=$S($P(PSOCIBQ,"^",4)=1:1,$P(PSOCIBQ,"^",4)=0:0,1:"")
|
|
S:$$EC^SDCO22(PSOPT) PSOTG("EC")=$S($P(PSOCIBQ,"^",5)=1:1,$P(PSOCIBQ,"^",5)=0:0,1:"")
|
|
S:$P($$GETSTAT^DGMSTAPI(PSOPT),"^",2)="Y" PSOTG("MST")=$S($P(PSOCIBQ,"^",2)=1:1,$P(PSOCIBQ,"^",2)=0:0,1:"")
|
|
I $T(GETCUR^DGNTAPI)]"" N PSONC,PSONCX S PSONCX=$$GETCUR^DGNTAPI(PSOPT,"PSONC") I $P($G(PSONC("IND")),"^")="Y" S PSOTG("HNC")=$S($P(PSOCIBQ,"^",6)=1:1,$P(PSOCIBQ,"^",6)=0:0,1:"")
|
|
S:$P($$CVEDT^DGCV(PSOPT),"^",3) PSOTG("CV")=$S($P(PSOCIBQ,"^",7)=1:1,$P(PSOCIBQ,"^",7)=0:0,1:"")
|
|
Q
|
|
;
|
|
ICD ;
|
|
D ICD^PSOCP1
|
|
Q
|
|
XTYPE ;
|
|
N PSOCIBQ,PSOSCMX,Y,I,J,X,SAVY,ZXX
|
|
S (X,PSOSCMX,SAVY)=""
|
|
S PSOCIBQ=$G(^PSRX(RXP,"IBQ")) I $TR(PSOCIBQ,"^")="" S ZXX=$G(^PSRX(RXP,"ICD",1,0)) D ICD:ZXX'=""
|
|
I $P(PSOCIBQ,"^",1)'="" S PSOTG("SC")=$P(PSOCIBQ,"^",1)
|
|
I $D(PSOTG("SC")),$P(PSOCIBQ,"^",1)="" S PSOTG("SC")="" ; USE "CURRENT" SETTING AS ANS TO SC QUEST IF IT APPLIES
|
|
S J=0 F S J=$O(^PS(59,J)) Q:'J I +$G(^(J,"IB")) S X=+^("IB") Q
|
|
I 'X Q
|
|
S X=X_"^"_PSOCPN D XTYPE^IBARX
|
|
I $G(Y)'=1 Q
|
|
S J="" F S J=$O(Y(J)) Q:'J S I="" F S SAVY=I,I=$O(Y(J,I)) Q:I="" S:I>0 PSOSCMX=I
|
|
I PSOSCMX="",SAVY=0 S PSOCHG=0 S PSOCOMM="Exempt from copayment" Q ; INCOME EXEMPT OR SC
|
|
I PSOSCMX=2,'$D(PSOTG("SC")) S PSOTG("SC")=$S(($G(RXP)&($P($G(^PSRX(+$G(RXP),"IB")),"^")))!($P(PSOCIBQ,"^")=0):0,$P(PSOCIBQ,"^")=1:1,1:"") Q
|
|
Q
|
|
;
|
|
SETCOMM ;
|
|
D SETCOMM^PSOCP1
|
|
Q
|
|
;
|