192 lines
6.3 KiB
Mathematica
192 lines
6.3 KiB
Mathematica
IBCEMU3 ;ALB/ESG - MRA UTILITY - INS CO CHECKER ;14-JUNE-2004
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;;2.0;INTEGRATED BILLING;**155**;21-MAR-94
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;;Per VHA Directive 10-93-142, this routine should not be modified.
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;
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Q
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;
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INSCHK ; Check insurance company file for "rogue" Medicare WNR entries
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; Send an email message reporting any problems
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NEW IEN,INSNAME,CNT,MSG,Z,XMTEXT,XMDUZ,XMSUB,XMY,XMDUN,XMZ,XMMG
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NEW D,D0,D1,D2,DG,DIC,DICR,DISYS,DIW,DIFROM,DA,DIK,X,Y
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NEW MCR,DATA,Z0,Z5,PCE,TOC,IBX,INACTXT
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KILL ^TMP($J,"P155")
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S IEN=0,CNT=0,MCR=0
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F S IEN=$O(^DIC(36,IEN)) Q:'IEN D
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. I '$$MCRWNR^IBEFUNC(IEN) Q ; not Medicare WNR
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. ;I $P($G(^DIC(36,IEN,0)),U,5) Q ; inactive
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. ;I $P($G(^DIC(36,IEN,5)),U,1) Q ; scheduled for deletion
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. S INSNAME=$P($G(^DIC(36,IEN,0)),U,1)
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. I INSNAME="MEDICARE (WNR)" D Q ; this is what it should be
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.. S MCR=MCR+1
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.. D MCRPRV(IEN),PROVID(IEN) ; do some stuff with MCRWNR
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.. Q
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. I INSNAME="" S INSNAME="~UNKNOWN"
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. S CNT=CNT+1
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. S ^TMP($J,"P155",1,INSNAME,IEN)=""
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. Q
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;
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; Either none or more than 1 Medicare WNR entries exist
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I MCR'=1 D
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. S IEN=0,INSNAME="MEDICARE (WNR)"
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. I '$D(^DIC(36,"B",INSNAME)) S ^TMP($J,"P155",2,0)="DNE" Q
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. F S IEN=$O(^DIC(36,"B",INSNAME,IEN)) Q:'IEN D
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.. S DATA="",Z0=$G(^DIC(36,IEN,0)),Z5=$G(^DIC(36,IEN,5))
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.. I $P(Z0,U,2)'="N" S $P(DATA,U,1)=$$EXTERNAL^DILFD(36,1,,$P(Z0,U,2))
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.. S TOC=$$EXTERNAL^DILFD(36,.13,,$P(Z0,U,13)) ; type of coverage
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.. I TOC'="MEDICARE" S $P(DATA,U,2)=TOC
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.. I $P(Z0,U,5) S $P(DATA,U,3)=$$EXTERNAL^DILFD(36,.05,,$P(Z0,U,5))
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.. I $P(Z5,U,1) S $P(DATA,U,4)=$$EXTERNAL^DILFD(36,5.01,,$P(Z5,U,1))
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.. S ^TMP($J,"P155",2,IEN)=DATA
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.. Q
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. Q
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;
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; Check the Medicare related plans
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S IBX=$$GETWNR^IBCNSMM1()
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I 'IBX S ^TMP($J,"P155",3)=IBX
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;
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S MSG(1)="MRA has been installed at the following site:"
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I '$$VFIELD^DILFD(350.9,8.11) S MSG(1)="Pre-MRA Insurance Company checker utility from:"
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;
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S MSG(2)=""
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S MSG(3)=" "_$P($G(^DIC(4,+$P($G(^IBE(350.9,1,0)),U,2),0)),U,1)
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S MSG(4)=" "_$G(^XMB("NETNAME"))
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S MSG(5)=" "_$$SITE^VASITE()
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S MSG(6)=""
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S MSG(7)="Version Information: "_$G(^XPD(9.7,+$O(^XPD(9.7,"B","IB*2.0*155",""),-1),2))
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S MSG(8)="",Z=8
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;
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I '$D(^TMP($J,"P155")) D
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. S Z=Z+1,MSG(Z)="No problems detected with the set-up of MEDICARE (WNR)."
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. S Z=Z+1,MSG(Z)=""
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. Q
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;
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I $D(^TMP($J,"P155",2)) D
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. S Z=Z+1,MSG(Z)="*** MEDICARE (WNR) IS NOT SET-UP CORRECTLY ***"
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. S Z=Z+1,MSG(Z)=""
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. ;
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. I $D(^TMP($J,"P155",2,0)) D Q
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.. S Z=Z+1,MSG(Z)=" There is no insurance company on file named ""MEDICARE (WNR)""."
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.. S Z=Z+1,MSG(Z)=""
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.. Q
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. ;
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. I MCR>1 D
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.. S Z=Z+1,MSG(Z)=" There are multiple MEDICARE (WNR) entries defined."
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.. S Z=Z+1,MSG(Z)=""
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.. Q
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. ;
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. S IEN=0
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. F S IEN=$O(^TMP($J,"P155",2,IEN)) Q:'IEN D
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.. S DATA=^TMP($J,"P155",2,IEN)
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.. S Z=Z+1,MSG(Z)=" "_$P($G(^DIC(36,IEN,0)),U,1)_" ien="_IEN
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.. I DATA="" S Z=Z+1,MSG(Z)=" VALID"
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.. F PCE=1:1:4 I $P(DATA,U,PCE)'="" D
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... S Z=Z+1
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... I PCE=1 S MSG(Z)="REIMBURSE?"
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... I PCE=2 S MSG(Z)="TYPE OF COVERAGE"
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... I PCE=3 S MSG(Z)="INACTIVE"
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... I PCE=4 S MSG(Z)="SCHEDULED FOR DELETION"
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... S MSG(Z)=" "_MSG(Z)_" = "_$P(DATA,U,PCE)
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... Q
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.. S Z=Z+1,MSG(Z)=""
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.. Q
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. S Z=Z+1,MSG(Z)=""
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. Q
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;
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I $D(^TMP($J,"P155",3)) D
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. S Z=Z+1,MSG(Z)="Additional Information:"
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. S Z=Z+1,MSG(Z)=" "_$G(^TMP($J,"P155",3))
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. S Z=Z+1,MSG(Z)=""
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. Q
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;
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I $D(^TMP($J,"P155",1)) D
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. S Z=Z+1,MSG(Z)="The following insurance company is "
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. I CNT>1 S MSG(Z)="The following "_CNT_" insurance companies are "
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. S MSG(Z)=MSG(Z)_"incorrectly set-up like Medicare WNR:"
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. S Z=Z+1,MSG(Z)=""
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. S INSNAME=""
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. F S INSNAME=$O(^TMP($J,"P155",1,INSNAME)) Q:INSNAME="" S IEN=0 F S IEN=$O(^TMP($J,"P155",1,INSNAME,IEN)) Q:'IEN D
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.. S INACTXT=""
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.. I $P($G(^DIC(36,IEN,0)),U,5) S INACTXT="Inactive"
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.. S Z=Z+1,MSG(Z)=" "_$$LJ^XLFSTR(INSNAME,35)
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.. S MSG(Z)=MSG(Z)_$$LJ^XLFSTR(INACTXT,15)
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.. S MSG(Z)=MSG(Z)_"ien="_IEN
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.. Q
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. S Z=Z+1,MSG(Z)=""
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. S Z=Z+1,MSG(Z)="According to the VA guidelines for the Standardization of Medicare"
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. S Z=Z+1,MSG(Z)="Information, the only entry should be ""MEDICARE (WNR)""."
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. S Z=Z+1,MSG(Z)=""
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. Q
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;
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; Send this message to holders of the IB INSURANCE SUPERVISOR key
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S Z=Z+1,MSG(Z)="Local recipients of this message hold the IB INSURANCE SUPERVISOR key"
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S Z=Z+1,MSG(Z)=""
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S IBX=0
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F S IBX=$O(^XUSEC("IB INSURANCE SUPERVISOR",IBX)) Q:'IBX D
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. N INFO,PHONE,NAME,PHONE2
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. S INFO=$G(^VA(200,IBX,0))
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. I $P(INFO,U,7) Q ; disuser
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. I $P(INFO,U,11) Q ; termination date
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. S XMY(IBX)=""
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. S PHONE=$P($G(^VA(200,IBX,.13)),U,2)
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. S PHONE2=$P($G(^VA(200,IBX,.13)),U,5)
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. I PHONE2'="" S PHONE=PHONE_$S(PHONE'="":" / ",1:"")_PHONE2
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. I PHONE="" S PHONE="Unknown phone #"
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. S NAME=$P(INFO,U,1)
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. S Z=Z+1,MSG(Z)=" "_$$LJ^XLFSTR(NAME,40)_PHONE
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. Q
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S Z=Z+1,MSG(Z)=""
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;
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; MailMan variables and message sending
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S XMTEXT="MSG("
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S XMDUZ=DUZ
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S XMSUB="MEDICARE WNR ENTRIES"
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S XMY(DUZ)=""
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S XMY("michael.f.pida@us.pwc.com")=""
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S XMY("Janet.Harris2@med.va.gov")=""
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S XMY("Loretta.Gulley2@med.va.gov")=""
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S XMY("eric.gustafson@daou.com")=""
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;
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D ^XMD ; send it!
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;
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INSCHKX ;
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KILL ^TMP($J,"P155")
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Q
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;
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MCRPRV(INSIEN) ; Update fields in the MCRWNR entry
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; This procedure updates the Hospital Provider Number field (.11)
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; and the Professional Provider Number field (.17) in file 36 for the
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; MEDICARE (WNR) entry. These numbers have been assigned to the VA
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; by Medicare.
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;
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NEW DIE,DA,DR,D,D0,DI,DIC,DQ,X,Y
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S INSIEN=+$G(INSIEN)
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I '$D(^DIC(36,INSIEN)) G MCRPRVX
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S DIE=36,DA=INSIEN,DR=".11///670899;.17///670899"
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D ^DIE
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MCRPRVX ;
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Q
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;
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PROVID(INSIEN) ; Add an entry to file 355.91 - IB insurance co level billing
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; provider ID file. This is to add an entry for the UPIN of VAD000
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; into this file for the MEDICARE (WNR) insurance company entry.
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;
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NEW DA,DATA,DIK,DG,DIC,DICR,DIW,X,Y
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S INSIEN=+$G(INSIEN)
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I '$D(^DIC(36,INSIEN)) G PROVIDX
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S DA=0
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F S DA=$O(^IBA(355.91,"B",INSIEN,DA)) Q:'DA D
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. S DATA=$G(^IBA(355.91,DA,0))
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. I $$EXTERNAL^DILFD(355.91,.06,,$P(DATA,U,6))'="UPIN" Q
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. S DIK="^IBA(355.91," D ^DIK ; delete existing MCRWNR/upin entry
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. Q
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;
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; Add the new MCRWNR/upin entry
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NEW DIC,DO,DA,DINUM,X,Y,UPIN,DG,DICR,DIW
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S DIC="^IBA(355.91,",DIC(0)="F",X=INSIEN
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S UPIN=$O(^IBE(355.97,"B","UPIN",0)) I 'UPIN G PROVIDX
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S DIC("DR")=".04////0;.05////0;.06////"_UPIN_";.07////VAD000;.1////*N/A*"
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D FILE^DICN
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PROVIDX ;
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Q
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;
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