VistA-WorldVistAEHR/r/INTEGRATED_BILLING-IB-PRQ--.../IBCNRDV.m

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2009-12-04 00:11:15 -05:00
IBCNRDV ;OAKFO/ELZ - INSURANCE INFORMATION EXCHANGE VIA RDV;27-MAR-03
;;2.0;INTEGRATED BILLING;**214,231,361**;21-MAR-94;Build 9
;;Per VHA Directive 2004-038, this routine should not be modified.
;
; This routine is used to exchange insurance information between
; facilities.
OPT ; Menu option entry point. This is used to select a patient to request
; information about from the remote treating facilities.
N DFN,DIC,X,Y,DTOUT,DUOUT,IBT,%,%Y,IBX,VADM,IBB,IBD,IBH,IBI,IBICN,IBR,IBRZ,IBX,IBY,IBZ,IBWAIT,IBL,DO,IBTYPE,IB1
;
; prompt for patient
AGAIN S DIC="^DPT(",DIC(0)="AEMNQ" D ^DIC Q:Y<1 S DFN=+Y
;
BACKGND ; background/tasked entry point
; IBTYPE is being used as a flag to indicate this is running in background
;
; look up treating facilities
K IBT S IBT=$$TFL^IBARXMU(DFN,.IBT)
I IBT<1,'$D(IBTYPE) W !!,"This patient has no remote treating facilities to query." G AGAIN
I IBT<1 Q
;
; display and verify we want to do this
I '$D(IBTYPE) D DEM^VADPT W !!,"The patient ",VADM(1)," has the following ",IBT," remote facilitie(s)",! S IBX=0 F S IBX=$O(IBT(IBX)) Q:IBX<1 W !?10,$P(IBT(IBX),"^",2)
I '$D(IBTYPE) W !!,"Do you want to perform this Remote Query" S %=1 D YN^DICN G:%'=1 AGAIN
;
; get ICN
S IBICN=$$ICN^IBARXMU(DFN) I 'IBICN,'$D(IBTYPE) W !!,"No ICN for this patient" G AGAIN
I 'IBICN Q
;
; sent off the remote queries and get back handles
S IBX=0 F S IBX=$O(IBT(IBX)) Q:IBX<1 D
. D SEND(.IBH,IBX,IBICN,$S($D(IBTYPE):"IBCN INSURANCE QUERY TASK",1:"IBCN INSURANCE QUERY"))
. X $S(IBH(0)'="":"S $P(IBT(IBX),U,5)=IBH(0)",1:"W:'$D(IBTYPE) !,""No handle returned for "",$P(IBT(IBX),U,2) K IBT(IBX)")
;
; no handles returned
I $D(IBT)<9,'$D(IBTYPE) W !!,"Unable to perform any remote queries.",! G AGAIN
I $D(IBT)<9 Q
;
; go through every IBT()
S IBP="|",IBX=0 F S IBX=$O(IBT(IBX)) Q:IBX<1!($D(IBT)<9) D
. ;
. ; do I have a return data.
. F IBWAIT=1:1:60 W:'$D(IBTYPE) "." H 1 D CHECK(.IBR,$P(IBT(IBX),"^",5)) I $G(IBR(0))["Done" Q
. I $G(IBR(0))'["Done" W:'$D(IBTYPE) !!,"Unable to communicate with ",$P(IBT(IBX),U,2) Q
. K IBR
. D RETURN(.IBR,$P(IBT(IBX),"^",5))
. ;
. ; no data returned or error message
. S IBRZ=$S(-1=+$G(IBR):IBR,$G(IBR(0))="":$G(IBR(1)),1:$G(IBR(0)))
. ;
. ; no info to proceed
. I IBRZ<1 W:'$D(IBTYPE) !,"Response from ",$P(IBT(IBX),U,2),!,$P(IBRZ,"^",2) K IBT(IBX) D:IBRZ="-1^No insurance on file" FILE(0) Q
. ;
. ; received insurance info, need to file and display message
. W:'$D(IBTYPE) !,"Received ",$G(IBR(0))," insurance companies from ",$P(IBT(IBX),U,2) D FILE(+IBR(0))
. ;
. S IBY=0 F S IBY=$O(IBR(IBY)) Q:IBY<1 D
.. F IBL=5:1 S IBT=$P($T(MAP+IBL),";",3) Q:IBT="" D
... ;
... ; am I on the right MAP line
... I $P(IBT,IBP,3)=$S(IBY#6:IBY#6,1:6) S IBZ=$P(IBR(IBY),"^",$P(IBT,IBP,4)) I $L(IBZ) D
.... ;
.... ; xecute code to change external to internal
.... X:$L($P(IBT,IBP,7)) $P(IBT,IBP,7)
.... ;
.... ; put the info in the array for the buffer file
.... S:$D(IBZ) IBB($P(IBT,IBP,5))=IBZ
.. ;
.. ; need to avoid duplicates if possible.
.. I $G(IBB(20.01))["MEDICARE (WNR)" S X=0 F S X=$O(^DPT(DFN,.312,X)) Q:X<1 I $P($G(^DIC(36,+$P($G(^DPT(DFN,.312,X,0)),"^"),0)),"^")["MEDICARE (WNR)" K IBB Q
.. Q:'$D(IBB)
.. ;
.. ; file in the buffer file & where else needed
.. I IBY#6=0 D
... I $L($G(IBB(20.01))) D
.... S IBB(.14)=$$IEN^XUAF4(+IBT(IBX))
.... S IBB=$$ADDSTF^IBCNBES($G(IBB(.03),1),DFN,.IBB)
... I '$D(IB1),$D(IBTYPE),$L($G(IBB(20.01))) D SCH^IBTUTL2(DFN,$G(IBSAVEI),$G(IBSAVEJ)):IBTYPE="TRKR",ADM^IBTUTL($G(IBSAVE1),$G(IBSAVE2),$G(IBSAVE3),$G(IBSAVE4)):IBTYPE="ADM" S IB1=1
... W:'$D(IBTYPE)&($L($G(IBB(20.01)))) !,$P($G(IBB),"^")," Buffer File entry for ",$G(IBB(20.01))
... K IBB
;
; flag so I don't do this patient again within 90 days
S ^IBT(356,"ARDV",DFN,$$FMADD^XLFDT(DT,90))=""
;
Q
;
RPC(IBD,IBICN) ; RPC entry for looking up insurance info
N DFN,IBZ,IBX,IBY,IBP,IBI,IBT,IBZ
S DFN=$$DFN^IBARXMU(IBICN) I 'DFN S IBD(0)="-1^ICN Not found" Q
D ALL^IBCNS1(DFN,"IBY",3)
I '$D(IBY) S IBD(0)="-1^No insurance on file" Q
; set up return format
; IBD(0) = # of insurance companies
S IBD(0)=$G(IBY(0))
;
; where n starts at 1 and increments 6 for each insurance company
; IBD(n) = 355.33, zero node format
; IBD(n+1) = 355.33, 20 node format
; IBD(n+2) = 355.33, 21 node format
; IBD(n+3) = 355.33, 40 node format
; IBD(n+4) = 355.33, 60 node format
; IBD(n+5) = 355.33, 61 node format
;
S IBP="|"
S IBI=0 F S IBI=$O(IBY(IBI)) Q:IBI<1 F IBL=5:1 S IBT=$P($T(MAP+IBL),";",3) Q:IBT="" D
. S IBZ=$P($G(IBY(IBI,+IBT)),"^",$P(IBT,IBP,2)) ; set the existing data
. I $L($P(IBT,IBP,6)) X $P(IBT,IBP,6) ; output transform
. S $P(IBD(IBI-1*6+$P(IBT,IBP,3)),"^",$P(IBT,IBP,4))=IBZ ; set data IBD
Q
;
MAP ; this is a mapping of data returned from ALL^IBCNS1 to the buffer file
; format is: node number | piece | extract node | extract piece
; | 355.33 field number | format out code (if any)
; | format in code (if any)
; the extract nodes will be sequential to match buffer file DD
;;0|1|2|1|20.01|N Z X "F Z=0,.11,.13 S IBY(IBI,36+Z)=$G(^DIC(36,IBZ,Z))" S IBZ=$P(IBY(IBI,36),"^");ins co name
;;0|2|5|4|60.04;subscriber id
;;0|4|5|3|60.03;experation date
;;0|6|5|5|60.05;who's insurance
;;0|8|5|2|60.02;effective date
;;0|16|5|6|60.06;pt relationship to insured
;;0|17|5|7|60.07;name of insured
;;0|20|5|12|60.12;coordination of benefits
;;1|3|1|10|.1||I IBZ<$$FMADD^XLFDT(DT,-180) K IBZ;date (last) verified
;;1|9|1|3|.03;source of information
;;2|1|6|5|61.05;send bill to employer
;;2|2|6|6|61.06;employer claims street address (line 1)
;;2|3|6|7|61.07;employer claims street address line 2
;;2|4|6|8|61.08;employer claims street address line 3
;;2|5|6|9|61.09;employer claims city
;;2|6|6|10|61.1|S IBZ=$$EXTERNAL^DILFD(2.312,2.06,"",IBZ)|N DIC,X,Y S DIC="^DIC(5,",X=IBZ,DIC(0)="OX" D ^DIC K:+Y<1 IBZ S:+Y>0 IBZ=+Y;employer claims state
;;2|7|6|11|61.11;employer claims zip code
;;2|8|6|12|61.12;employer claims phone
;;2|10|6|1|61.01;esghp
;;2|11|6|3|61.03;employment status
;;2|12|6|4|61.04;retirement date
;;3|1|5|8|60.08;insured's dob
;;3|5|5|9|60.09;insured's ssn
;;3|12|5|13|60.13;insured's sex
;;4|1|5|10|60.1;primary care provider
;;4|2|5|11|60.11;primary provider phone
;;355.3|2|4|1|40.01;is this a group policy
;;355.3|3|4|2|40.02;group name
;;355.3|4|4|3|40.03;group number
;;355.3|5|4|4|40.04;(is) utilization required
;;355.3|6|4|5|40.05;(is) pre-certification required
;;355.3|7|4|7|40.07;exclude pre-existing condition
;;355.3|8|4|8|40.08;benefits assignable
;;355.3|9|4|9|40.09;type of plan
;;355.3|12|4|6|40.06;ambulatory care certification
;;36|2|2|5|20.05;reimburse
;;36.11|1|3|1|21.01;street address line 1
;;36.11|2|3|2|21.02;street address line 2
;;36.11|3|3|3|21.03;street address line 3
;;36.11|4|3|4|21.04;city
;;36.11|5|3|5|21.05|S IBZ=$$EXTERNAL^DILFD(36,.115,"",IBZ)|N DIC,X,Y S DIC="^DIC(5,",X=IBZ,DIC(0)="OX" D ^DIC K:+Y<1 IBZ S:+Y>0 IBZ=+Y;state
;;36.11|6|3|6|21.06;zip code
;;36.13|1|2|2|20.02;phone number
;;36.13|2|2|3|20.03;billing phone number
;;36.13|3|2|4|20.04;precertification phone number
;;
;
SEND(IBH,IBX,IBICN,IBRPC) ; called to send off queries
D EN1^XWB2HL7(.IBH,IBX,IBRPC,"",IBICN)
Q
;
CHECK(IBR,IBH) ; called to check the return status of an RPC
D RPCCHK^XWB2HL7(.IBR,IBH)
Q
;
RETURN(IBR,IBH) ; called to get the return data and clear the broker
N IBZ
D RTNDATA^XWBDRPC(.IBR,IBH),CLEAR^XWBDRPC(.IBZ,IBH)
Q
;
TASK ; queue off task job
N ZTRTN,ZTDESC,ZTDTH,ZTIO,ZTSK,ZTSAVE
S ZTRTN="BACKGND^IBCNRDV",ZTDESC="Query Remote Facilities for Insurance",ZTDTH=$$FMADD^XLFDT($$NOW^XLFDT),(ZTIO,ZTSAVE("DFN"),ZTSAVE("IBSAVE*"),ZTSAVE("IBTYPE"))="" D ^%ZTLOAD
Q
;
TRKR(DFN,IBSAVEI,IBSAVEJ,IBDUZ) ; claims tracking entry
N IBTYPE,IBT
Q:$D(^IBT(356,"ARDV",DFN)) ; have already done recently
Q:'$$TFL^IBARXMU(DFN,.IBT) ; no remote facilities
S IBTYPE="TRKR" D
. I DUZ=.5 N DUZ S DUZ=+$G(IBDUZ),DUZ(2)=+$$SITE^VASITE
. D TASK
Q
;
ADM(DFN,IBSAVE1,IBSAVE2,IBSAVE3,IBSAVE4) ; admit event entry
N IBTYPE S IBTYPE="ADM" D TASK
Q
;
FILE(IBX) ; updates data into the log file
;IBX = number of insurance co's found
N DIC,DA,DIE,IBM,DO,X,Y,IBZ,DR
S IBM=$E($$DT^XLFDT,1,5)_"00",DA=+$O(^IBA(355.34,"B",IBM,0))
I 'DA K DA L +^IBA(355.34,"B",IBM):10 S X=IBM,DIC="^IBA(355.34,",DIC(0)="F" D FILE^DICN S DA=+Y L -^IBA(355.34,"B",IBM)
L +^IBA(355.34,DA):10
S IBZ=^IBA(355.34,DA,0),DIE="^IBA(355.34,"
S DR=".02///"_($P(IBZ,"^",2)+1)_";.03///"_($P(IBZ,"^",3)+IBX) D ^DIE
L -^IBA(355.34,DA)
Q