151 lines
5.8 KiB
Mathematica
151 lines
5.8 KiB
Mathematica
BPSOSRB ;BHAM ISC/FCS/DRS/FLS - Process claim on processing queue ;06/01/2004
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;;1.0;E CLAIMS MGMT ENGINE;**1,5**;JUN 2004;Build 45
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;;Per VHA Directive 2004-038, this routine should not be modified.
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;
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Q
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BACKGR ;
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I '$$LOCKNOW^BPSOSRX("BACKGROUND") Q
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N TYPE,RXI,RXR,IEN59
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I '$$LOCK^BPSOSRX("BACKGROUND",300) G FAIL
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F TYPE="CLAIM","UNCLAIM" D
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. S RXI="" F S RXI=$O(^XTMP("BPS-PROC",TYPE,RXI)) Q:RXI="" D
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.. S RXR="" F S RXR=$O(^XTMP("BPS-PROC",TYPE,RXI,RXR)) Q:RXR="" D
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... N X S X=$$STATUS^BPSOSRX(RXI,RXR,0)
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... S IEN59=$$IEN59^BPSOSRX(RXI,RXR)
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... D LOG^BPSOSL(IEN59,$T(+0)_"-Dequeuing. Type is "_TYPE)
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... I $P(X,U)="IN PROGRESS" D Q
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.... D LOG^BPSOSL(IEN59,$T(+0)_"-Status is 'IN PROGRESS'. Will retry later.")
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... N TIME,MOREDATA
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... S TIME=^XTMP("BPS-PROC",TYPE,RXI,RXR) ; time requested
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... I '$$LOCK^BPSOSRX("SUBMIT",10) D Q
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.... D LOG^BPSOSL(IEN59,$T(+0)_"-Failed to $$LOCK^BPSOSRX(""SUBMIT""). Will retry later.")
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... I $D(^XTMP("BPS-PROC",TYPE,RXI,RXR,"MOREDATA")) M MOREDATA=^("MOREDATA")
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... E S MOREDATA=0
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... K ^XTMP("BPS-PROC",TYPE,RXI,RXR)
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... D BACKGR1(TYPE,RXI,RXR,TIME,.MOREDATA)
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... D UNLOCK^BPSOSRX("SUBMIT")
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FAIL D UNLOCK^BPSOSRX("BACKGROUND")
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Q
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;
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; BACKGR1 - Further processing of the claim
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; Besides the parameter below, IEN59 also needs to be defined
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BACKGR1(TYPE,RXI,RXR,TIME,MOREDATA) ;
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; Resolve multiple requests
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N SKIP S SKIP=0 ; skip if you already got desired result
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N SKIPREAS
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N RESULT S RESULT=$$STATUS^BPSOSRX(RXI,RXR,0),RESULT=$P(RESULT,U)
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N STARTTIM S STARTTIM=$$STARTTIM(RXI,RXR)
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I TYPE="CLAIM" D
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. I $$RXDEL^BPSOS(RXI,RXR) D Q
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.. S SKIP=1,SKIPREAS="Prescription is marked as DELETED or CANCELLED"
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. ; If it's never been through ECME before, good.
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. I RESULT="" Q
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. ; There's already a complete transaction for this RXI,RXR
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. ; (We screened out "IN PROGRESS" earlier)
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. ; The program to poll indexes would have set DO NOT RESUBMIT.
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. ; Calls from pharm pkg to ECME have '$D(MOREDATA("DO NOT RESUBMIT"))
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. I $D(MOREDATA("DO NOT RESUBMIT")) D
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.. S SKIP=1
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.. S SKIPREAS="MOREDATA(""DO NOT RESUBMIT"") is set"
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. E I TIME<STARTTIM D ; our request was made before trans. began
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.. ; submit claim but only if the prev result was successful reversal
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.. I RESULT="PAPER REVERSAL" Q
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.. I RESULT="E REVERSAL ACCEPTED" Q
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.. S SKIP=1
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.. S SKIPREAS="Prev result "_RESULT_"; claim started "_STARTTIM_">"_TIME_" submitted"
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. E D ; our request was made after it began
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.. ; So we will make a reversal if necessary,
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.. ; and then the claim will be resubmitted.
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.. I RESULT="E PAYABLE"!(RESULT="E DUPLICATE"),$G(MOREDATA("REVERSE THEN RESUBMIT"))'=2 D
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... S MOREDATA("REVERSE THEN RESUBMIT")=1
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E I TYPE="UNCLAIM" D
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. ; It must have gone through ECME with a payable result
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. I RESULT="E PAYABLE" Q
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. I RESULT="E DUPLICATE" Q
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. N RXACTION S RXACTION=$G(MOREDATA("RX ACTION"))
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. I RESULT="E REVERSAL REJECTED",(",DE,EREV,RS,"[(","_RXACTION_",")) Q
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. I RESULT="E REVERSAL STRANDED",RXACTION="EREV" Q
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. S SKIP=1
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. S SKIPREAS="Cannot reverse - previous result was "_RESULT
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E D IMPOSS^BPSOSUE("P","TI","bad arg TYPE="_TYPE,,"BACKGR1",$T(+0))
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I SKIP D Q
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. D LOG^BPSOSL(IEN59,$T(+0)_"-Skipping. Reason: "_SKIPREAS)
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S MOREDATA("SUBMIT TIME")=TIME
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I TYPE="UNCLAIM"!$G(MOREDATA("REVERSE THEN RESUBMIT")) D REVERSE(IEN59,.MOREDATA)
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I TYPE="CLAIM",'$G(MOREDATA("REVERSE THEN RESUBMIT")) D CLAIM(IEN59,.MOREDATA)
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Q
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;
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; STARTTIM - Get START TIME field from BPS Transactions
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STARTTIM(RXI,RXR) Q $P($G(^BPST($$IEN59^BPSOSRX(RXI,RXR),0)),U,11)
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;
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; Process claim request
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; EP - Above and BPSOSU (for a resubmit after a reversal)
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CLAIM(IEN59,MOREDATA) ;
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D LOG^BPSOSL(IEN59,$T(+0)_"-Initiating Claim")
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D EN^BPSOSIZ(IEN59,.MOREDATA)
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Q
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;
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; Process the reversal
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REVERSE(IEN59,MOREDATA) ;
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N MSG,RETVAL,REV
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;
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; Log Reversal or Reversal/Resubmit message.
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; Note that the reversal/resubmit message is needed
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; for Turn-Around Stats - Do NOT delete/alter!!
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S MSG=$T(+0)_"-Initiating Reversal"
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I $G(MOREDATA("REVERSE THEN RESUBMIT"))=1 D
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. S MSG=MSG_" and after that, claim will be resubmitted"
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. N X,X1,X2
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. S X1=DT,X2=30 D C^%DTC
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. S ^XTMP("BPSOSRB",0)=X_U_DT_U_"PASS VARIABLES FOR RESUBMITS"
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. K ^XTMP("BPSOSRB","MOREDATA",IEN59)
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. M ^XTMP("BPSOSRB","MOREDATA",IEN59,"RESUB")=MOREDATA
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D LOG^BPSOSL(IEN59,MSG)
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;
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; Change status to 0% (Waiting to Start), which will reset START TIME,
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; and then to 10% (Building transaction)
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D SETSTAT^BPSOSU(IEN59,0)
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D SETSTAT^BPSOSU(IEN59,10)
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;
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; Update User (#13), RX Action (#1201), and Reversal Reason (#404)
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; in BPS Transactions
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N DIE,DR,DA
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S DIE=9002313.59,DA=IEN59
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S DR="6////"_$G(MOREDATA("SUBMIT TIME"))_";13////"_$G(MOREDATA("USER"))
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S DR=DR_";404////"_$G(MOREDATA("REVERSAL REASON"))_";1201////"_$G(MOREDATA("RX ACTION"))
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;
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; Also update RESUBMIT AFTER REVERSAL field (#1.12) if needed
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I $G(MOREDATA("REVERSE THEN RESUBMIT"))=1 S DR=DR_";1.12////1"
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D ^DIE
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;
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; Log message for reverse without resubmit
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I $G(MOREDATA("REVERSE THEN RESUBMIT"))=2 D LOG^BPSOSL(IEN59,$P($G(MOREDATA("BILL")),U,2)_"-Claim cannot be resubmitted")
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;
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; Store contents of BPST in the Log
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D LOG^BPSOSL(IEN59,$T(+0)_"-Contents of ^BPST("_IEN59_") :")
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D LOG59^BPSOSQA(IEN59) ; Log contents of 9002313.59
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;
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; Add semi-colon to result text
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D PREVISLY^BPSOSIZ(IEN59)
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;
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; Contruct revesal claim
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; If no reversal claim is returned, log error and quit.
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S REV=$$REVERSE^BPSECA8(IEN59)
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I REV=0 D Q
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. D LOG^BPSOSL(IEN59,$T(+0)_"-Reversal claim not created for "_IEN59)
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. D ERROR^BPSOSU($T(+0),IEN59,100,"Reversal Claim not created")
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;
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; Update Reversal Field in the transaction
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S DIE=9002313.59,DA=IEN59,DR="401////"_REV
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D ^DIE
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;
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; Update Log
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D LOG^BPSOSL(IEN59,$T(+0)_"-Reversal claim "_$P(^BPSC(REV,0),U)_" ("_REV_")")
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;
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; Update status to 30% (Building the claim)
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D SETSTAT^BPSOSU(IEN59,30)
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;
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; Fire off task to get this on the HL7 queue
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D TASK^BPSOSQA
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Q
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