212 lines
8.5 KiB
Mathematica
212 lines
8.5 KiB
Mathematica
BPSRES ;BHAM ISC/BEE - ECME SCREEN RESUBMIT W/EDITS ;19-MAY-06
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;;1.0;E CLAIMS MGMT ENGINE;**3,5**;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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;
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;ECME Resubmit w/EDITS Protocol (Hidden) - Called by [BPS USER SCREEN]
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;
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RESED N BPSEL
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;
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I '$D(@(VALMAR)) G XRESED
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D FULL^VALM1
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;
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;Select the claim to resubmit
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W !,"Enter the line number for the claim to be resubmitted."
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S BPSEL=$$ASKLINE("Select item","Please select a SINGLE claim only when using the Resubmit w/EDITS action option.")
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I BPSEL<1 S VALMBCK="R" G XRESED
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;
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;Attempt to resubmit the claim, update the content of the screen, and display
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;only if claim submitted successfully
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I $$DOSELCTD(BPSEL) D REDRAW^BPSSCRUD("Updating screen for resubmitted claim...")
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E S VALMBCK="R"
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;
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XRESED Q
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;
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;Attempt to Edit and Resubmit Selected Claim
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;
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; Input Value -> BPRXI - Entry with ptr to BPS TRANSACTION file
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;
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; Return Value -> 0 - Claim was not resubmitted
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; 1 - Claim was resubmitted
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;
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DOSELCTD(BPRXI) N BP02,BP59,BPBILL,BPCLTOT,BPDFN,BPDOSDT,BPOVRIEN,BPQ,BPRXIEN,BPRXR,BPSTATUS,BPUPDFLG
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S (BPQ)=""
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S (BPCLTOT,BPUPDFLG)=0
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;
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;Pull BPS TRANSACTION/BPS CLAIMS entries
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S BP59=$P(BPRXI,U,4) I BP59="" W !!,"No Initial Claim Submission Found - Data Elements are NOT Editable for Re-Submission",! G XRES
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S BP02=+$P($G(^BPST(BP59,0)),U,4) I 'BP02 W !!,"No Initial Claim Submission Found - Data Elements are NOT Editable for Re-Submission",! G XRES
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;
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;Write Form Feed
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W @IOF
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;
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;Display selected claim and ask to submit
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S BPDFN=+$P($G(^BPST(BP59,0)),U,6)
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W !,"You've chosen to RESUBMIT the following prescription for "_$E($$PATNAME^BPSSCRU2(BPDFN),1,13)
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W !,@VALMAR@(+$P(BPRXI,U,5),0)
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S BPQ=$$YESNO^BPSSCRRS("Are you sure?(Y/N)")
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I BPQ'=1 S BPQ="^" G XRES
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;
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;Check to make sure claim can be Resubmitted w/EDITS
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S BPRXIEN=$P(BP59,".")
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S BPRXR=+$E($P(BP59,".",2),1,4)
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I $$RXDEL^BPSOS($P(BP59,".",1),+$E($P(BP59,".",2),1,4)) W !!,"The claim: ",!,@VALMAR@(+$P(BPRXI,U,5),0),!,"cannot be Resubmitted w/EDITS because it has been deleted in Pharmacy.",! G XRES
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S BPSTATUS=$P($$CLAIMST^BPSSCRU3(BP59),U)
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I BPSTATUS["IN PROGRESS" W !!,"The claim: ",!,@VALMAR@(+$P(BPRXI,U,5),0),!,"is still In Progress and cannot be Resubmitted w/EDITS",! G XRES
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I BPSTATUS'["E REJECTED" W !!,"The claim: ",!,@VALMAR@(+$P(BPRXI,U,5),0),!,"is NOT Rejected and cannot be Resubmitted w/EDITS",! G XRES
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;
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;Prompt for EDIT Information
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S BPOVRIEN=$$PROMPTS(BP59,BP02) I BPOVRIEN=-1 G XRES
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;
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;Retrieve DOS
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S BPDOSDT=$$DOSDATE^BPSSCRRS(BPRXIEN,BPRXR)
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;
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;Resubmit Claim
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S BPBILL=$$EN^BPSNCPDP(BPRXIEN,BPRXR,BPDOSDT,"ERES","","ECME RESUBMIT","",BPOVRIEN)
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;
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;Print Return Value Message
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W !!
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W:+BPBILL>0 $S(+BPBILL=10:"Reversal but no Resubmit:",1:"Not Processed:"),!," "
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;
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;Change Return Message for SC/EI
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S:$P(BPBILL,U,2)="NEEDS SC DETERMINATION" $P(BPBILL,U,2)="NEEDS SC/EI DETERMINATION"
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W $P(BPBILL,U,2)
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;
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;0 Prescription/Fill successfully submitted to ECME
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;1 ECME did not submit prescription/fill
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;2 IB says prescription/fill is not ECME billable or the data returned from IB is not valid
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;3 ECME closed the claim but did not submit it to the payer
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;4 Unable to queue the ECME claim
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;5 Invalid input
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;10 Reversal Processed But Claim Was Not Resubmitted
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;
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I +BPBILL=0 D
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. D ECMEACT^PSOBPSU1(+BPRXIEN,+BPRXR,"Claim resubmitted to 3rd party payer: ECME USER's SCREEN")
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. S BPUPDFLG=1,BPCLTOT=1
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XRES I BPCLTOT W !,BPCLTOT," claim",$S(BPCLTOT'=1:"s have",1:" has")," been resubmitted.",!
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D PAUSE^VALM1
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Q BPUPDFLG
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;
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;Enter EDIT information for claim
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;
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; Input Values -> BP59 - The BPS TRANSACTION entry
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; BP02 - The BPS CLAIMS entry
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; Output Value -> BPQ - -1 - The user chose to quit
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; "" - The user completed the EDITS
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PROMPTS(BP59,BP02) N %,BP300,BPCLCD,BPFDA,BPFLD,BPOVRIEN,BPMED,BPMSG,BPPSNCD,BPPREAUT,BPPRETYP,BPQ,BPRELCD,DIC,DIR,DIROUT,DTOUT,DUOUT,X,Y
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;
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S BPQ=""
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;
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;Pull Information from Claim
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S BP300=$G(^BPSC(BP02,300))
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S BPRELCD=$TR($E($P(BP300,U,6),3,99)," ")
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S BPPSNCD=$TR($E($P(BP300,U,3),3,99)," ")
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S (BPPRETYP,BPPREAUT,BPCLCD)="",BPMED=0 F S BPMED=$O(^BPSC(BP02,400,BPMED)) Q:'BPMED D I BPPREAUT]"",BPCLCD]"" Q
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.N BP460 S BP460=$G(^BPSC(BP02,400,BPMED,460))
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.S:BPPREAUT="" BPPREAUT=$TR($E($P(BP460,U,2),3,99)," "),BPPRETYP=$TR($E($P(BP460,U),3,99)," ")
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.S:BPCLCD="" BPCLCD=$TR($E($P($G(^BPSC(BP02,400,BPMED,400)),U,20),3,99)," ")
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;
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W ! S DIR(0)="FO^1:1",DIR("A")="Relationship Code"
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S DIR("B")=BPRELCD
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K DIR("?")
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S DIR("?",1)="Select the relationship code that describes the relationship this patient has"
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S DIR("?",2)="to the holder of this insurance policy. The standard NCPDP Patient"
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S DIR("?",3)="Relationship Code list is shown below. However, it is important to note"
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S DIR("?",4)="that some payers use their own set of codes for this field so the field"
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S DIR("?",5)="should be populated based upon the payer's expectations."
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S DIR("?",6)=" "
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S DIR("?",7)="Choose from:"
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S DIR("?",8)=" 0 Not Specified"
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S DIR("?",9)=" 1 Cardholder"
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S DIR("?",10)=" 2 Spouse"
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S DIR("?",11)=" 3 Child"
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S DIR("?")=" 4 Other"
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D ^DIR
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I $G(DTOUT)!$G(DUOUT) S BPQ=-1 G XPROMPTS
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S BPRELCD=Y
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;
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;Person Code
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K DIR("?") S DIR(0)="FO^1:3",DIR("A")="Person Code",DIR("?")="Enter the Specific Person Code Assigned to the Patient by the Payer"
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S DIR("B")=BPPSNCD
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D ^DIR
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I $G(DTOUT)!$G(DUOUT) S BPQ=-1 G XPROMPTS
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S BPPSNCD=Y
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;
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;Pre-Authorization
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K DIR("?") S DIR(0)="FO^1:11",DIR("A")="Prior Authorization Number",DIR("?")="Enter the Number Submitted by the Provider to Identify the Prior Authorization"
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S DIR("B")=BPPREAUT
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D ^DIR
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I $G(DTOUT)!$G(DUOUT) S BPQ=-1 G XPROMPTS
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S BPPREAUT=Y
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;
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;Prior-Authorization Type Code
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N X,DIC,Y
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S DIC("B")=+BPPRETYP
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S DIC(0)="QEAM",DIC=9002313.82461,DIC("A")="Prior Authorization Type Code: "
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D ^DIC
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;
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;Check for "^" or timeout
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I ($G(DUOUT)=1)!($G(DTOUT)=1)!(Y=-1) S BPQ=-1 K X,DIC,Y G XPROMPTS
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S BPPRETYP=$P(Y,U,2)
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K X,DIC,Y
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;
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;Submission Clarification Code
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N X,DIC,Y
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S DIC("B")=+BPCLCD
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S DIC(0)="QEAM",DIC=9002313.8242,DIC("A")="Submission Clarification Code: "
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D ^DIC
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;
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;Check for "^" or timeout
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I ($G(DUOUT)=1)!($G(DTOUT)=1)!(Y=-1) S BPQ=-1 K X,DIC,Y G XPROMPTS
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S BPCLCD=$P(Y,U,2)
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K X,DIC,Y
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;
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;Ask to proceed
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W ! S BPQ=$$YESNO^BPSSCRRS("Are you sure?(Y/N)")
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I BPQ'=1 S BPQ=-1 G XPROMPTS
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;
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;Save into BPS NCPDP OVERRIDES (#9002313.511)
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S BPFDA(9002313.511,"+1,",.01)=BP59
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D NOW^%DTC
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S BPFDA(9002313.511,"+1,",.02)=%
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S BPFLD=$O(^BPSF(9002313.91,"B",303,"")) I BPFLD]"" S BPFDA(9002313.5111,"+2,+1,",.01)=BPFLD,BPFDA(9002313.5111,"+2,+1,",.02)=BPPSNCD
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S BPFLD=$O(^BPSF(9002313.91,"B",306,"")) I BPFLD]"" S BPFDA(9002313.5111,"+3,+1,",.01)=BPFLD,BPFDA(9002313.5111,"+3,+1,",.02)=BPRELCD
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S BPFLD=$O(^BPSF(9002313.91,"B",462,"")) I BPFLD]"" S BPFDA(9002313.5111,"+4,+1,",.01)=BPFLD,BPFDA(9002313.5111,"+4,+1,",.02)=BPPREAUT
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S BPFLD=$O(^BPSF(9002313.91,"B",461,"")) I BPFLD]"" S BPFDA(9002313.5111,"+5,+1,",.01)=BPFLD,BPFDA(9002313.5111,"+5,+1,",.02)=BPPRETYP
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S BPFLD=$O(^BPSF(9002313.91,"B",420,"")) I BPFLD]"" S BPFDA(9002313.5111,"+6,+1,",.01)=BPFLD,BPFDA(9002313.5111,"+6,+1,",.02)=BPCLCD
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D UPDATE^DIE("","BPFDA","BPOVRIEN","BPMSG")
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;
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I $D(BPMSG("DIERR")) W !!,"Could Not Save Override information into BPS NCPDP OVERRIDES FILES",! S BPQ=-1 G XPROMPTS
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;
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XPROMPTS S BPOVRIEN=$S(BPQ=-1:BPQ,$G(BPOVRIEN(1))]"":BPOVRIEN(1),1:-1)
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Q BPOVRIEN
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;
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;Prompt User for Claim to Resubmit (w/EDITS)
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;
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; Input values -> BPROMPT - prompt string
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; BPERRMES - the message to display when the user tries
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; to make multi line selection (optional)
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; Piece
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;output values -> 1 - 1 = okay, <0 = errors, 0 = quit
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; 2 - patient ien #2
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; 3 - insurance ien #36
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; 4 - ptr to #9002313.59
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; 5 - 1st line for index(es) in LM "VALM" array
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; 6 - patient's index
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; 7 - claim's index
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ASKLINE(BPROMPT,BPERRMES) ;
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N BPRET,BPCNT
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S BPRET="",BPCNT=0
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F S BPRET=$$SELLINE^BPSSCRU4(BPROMPT,"C",VALMAR,"") Q:BPRET'<0 D
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. ;
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. I BPCNT<1 S BPCNT=BPCNT+1 W !
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. E S BPCNT=0 D RE^VALM4
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. I BPRET=-1 W "Invalid line number" ; (invalid Patient summary line)"
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. I BPRET=-8 W $S($G(BPERRMES)]"":BPERRMES,1:" Invalid line number")
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. I BPRET=-4 W "Invalid line number" ; (invalid RX line)"
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. I BPRET=-2 W "Please select Patient's summary line."
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. I BPRET=-3 W "Please specify RX line."
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. I ",-1,-8,-4,-2,-3,"'[(","_BPRET_",") W "Incorrect format." ; Corrupted array (",BPRET,")"
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Q BPRET
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