186 lines
7.3 KiB
Mathematica
186 lines
7.3 KiB
Mathematica
IBCEU1 ;ALB/TMP - EDI UTILITIES FOR EOB PROCESSING ;10-FEB-99
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;;2.0;INTEGRATED BILLING;**137,155,296,349**;21-MAR-94;Build 46
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;;Per VHA Directive 2004-038, this routine should not be modified.
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;
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CCOB1(IBIFN,NODE,SEQ) ; Extract Claim level COB data
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; for a bill IBIFN
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; NODE = the file 361.1 node(s) to be returned, separated by commas
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; SEQ = the specific insurance sequence you want returned. If not =
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; 1, 2, or 3, all are returned
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; Returns IBXDATA(COB,n,node) where COB = COB insurance sequence,
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; n is the entry number in file 361.1 and node is the node requested
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; = the requested node's data
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;
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N IB,IBN,IBBILL,IBS,A,B,C
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;
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K IBXDATA
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;
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S:$G(NODE)="" NODE=1
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S IB=$P($G(^DGCR(399,IBIFN,"M1")),U,5,7)
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S:"123"'[$G(SEQ) SEQ=""
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;
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F B=1:1:3 S IBBILL=$P(IB,U,B) I IBBILL S C=0 F S C=$O(^IBM(361.1,"B",IBBILL,C)) Q:'C D
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. I '$$EOBELIG(C) Q ; eob not eligible for secondary claim
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. S IBS=$P($G(^IBM(361.1,C,0)),U,15) ; insurance sequence
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. I $S('$G(SEQ):1,1:SEQ=IBS) D
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.. F Z=1:1:$L(NODE,",") D
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... S A=$P(NODE,",",Z)
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... Q:A=""
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... S IBN=$G(^IBM(361.1,C,A))
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... I $TR(IBN,U)'="" S IBXDATA(IBS,C,A)=IBN
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;
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Q
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;
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CCAS1(IBIFN,SEQ) ; Extract all MEDICARE COB claim level adjustment data
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; for a bill IBIFN (subfile 361.11 in file 361.1)
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; SEQ = the specific insurance sequence you want returned. If not =
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; 1, 2, or 3, all are returned
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; Returns IBXDATA(COB,n) where COB = COB insurance sequence,
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; n is the entry number in file 361.1 and
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; = the 0-node of the subfile entry (361.11)
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; and IBXDATA(COB,n,m) where m is a sequential # and
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; = this level's 0-node
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N IB,IBA,IBS,IB0,IB00,IBBILL,B,C,D,E
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;
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S IB=$P($G(^DGCR(399,IBIFN,"M1")),U,5,7)
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S:"123"'[$G(SEQ) SEQ=""
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;
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F B=1:1:3 S IBBILL=$P(IB,U,B) I IBBILL S C=0 F S C=$O(^IBM(361.1,"B",IBBILL,C)) Q:'C D
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. I '$$EOBELIG(C) Q ; eob not eligible for secondary claim
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. S IBS=$P($G(^IBM(361.1,C,0)),U,15) ; insurance sequence
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. I $S('$G(SEQ):1,1:SEQ=IBS) D
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.. S (IBA,D)=0 F S D=$O(^IBM(361.1,C,10,D)) Q:'D S IB0=$G(^(D,0)) D
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... S IBXDATA(IBS,D)=IB0
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... S (IBA,E)=0
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... F S E=$O(^IBM(361.1,C,10,D,1,E)) Q:'E S IB00=$G(^(E,0)) D
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.... S IBA=IBA+1
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.... I $TR(IB00,U)'="" S IBXDATA(IBS,D,IBA)=IB00
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;
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Q
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;
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SEQ(A) ; Translate sequence # A into corresponding letter representation
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S A=$E("PST",A)
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I $S(A'="":"PST"'[A,1:1) S A="P"
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Q A
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;
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EOBTOT(IBIFN,IBCOBN) ; Total all EOB's for a bill's COB sequence
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; Function returns the total of all EOB's for a specific COB seq
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; IBIFN = ien of bill in file 399
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; IBCOBN = the # of the COB sequence you want EOB/MRA total for (1-3)
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;
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N Z,Z0,IBTOT
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S IBTOT=0
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I $O(^IBM(361.1,"ABS",IBIFN,IBCOBN,0)) D
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. ; Set up prior payment field here from MRA/EOB(s)
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. S (IBTOT,Z)=0
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. F S Z=$O(^IBM(361.1,"ABS",IBIFN,IBCOBN,Z)) Q:'Z D
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.. S IBTOT=IBTOT+$P($G(^IBM(361.1,Z,1)),U,2)
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Q IBTOT
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;
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;
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LCOBOUT(IBXSAVE,IBXDATA,COL) ; Output the line adjustment reasons COB
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; line # data for an electronic claim
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; IBXSAVE,IBXDATA = arrays holding formatter information for claim -
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; pass by reference
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; COL = the column in the 837 flat file being output for LCAS record
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N LINE,COBSEQ,RECCT,GRPCD,SEQ,RCCT,RCPC,DATA,RCREC,SEQLINE K IBXDATA
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S (LINE,RECCT)=0
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S RCPC=(COL#3) S:'RCPC RCPC=3
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S RCREC=$S(COL'<4:COL-1\3,1:0)
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;S RCREC=$S(COL'<4:COL+5\6-1,1:0)
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F S LINE=$O(IBXSAVE("LCOB",LINE)) Q:'LINE D
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. S COBSEQ=0
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. F S COBSEQ=$O(IBXSAVE("LCOB",LINE,"COB",COBSEQ)) Q:'COBSEQ S SEQLINE=0 F S SEQLINE=$O(IBXSAVE("LCOB",LINE,"COB",COBSEQ,SEQLINE)) Q:'SEQLINE S GRPCD="" F S GRPCD=$O(IBXSAVE("LCOB",LINE,"COB",COBSEQ,SEQLINE,GRPCD)) Q:GRPCD="" D
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.. S RECCT=RECCT+1
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.. I COL=2 S IBXDATA(RECCT)=LINE,DATA=LINE D:RECCT>1 ID^IBCEF2(RECCT,"LCAS")
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.. I COL=3 S IBXDATA(RECCT)=$TR(GRPCD," ")
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.. S (SEQ,RCCT)=0
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.. F S SEQ=$O(IBXSAVE("LCOB",LINE,"COB",COBSEQ,SEQLINE,GRPCD,SEQ)) Q:'SEQ I $TR($G(IBXSAVE("LCOB",LINE,"COB",COBSEQ,SEQLINE,GRPCD,SEQ)),U)'="" D
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... S RCCT=RCCT+1
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... Q:COL'<4&(RCCT'=RCREC)&(RCCT'>6)
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... S DATA=$S(COL=2:LINE,COL=3:$TR(GRPCD," "),1:$P($G(IBXSAVE("LCOB",LINE,"COB",COBSEQ,SEQLINE,GRPCD,SEQ)),U,RCPC))
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... I COL'<4,RCCT=RCREC S:DATA'="" IBXDATA(RECCT)=DATA Q
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... I RCCT>6 S RCCT=1,RECCT=RECCT+1 D:COL=2 ID^IBCEF2(RECCT,"LCAS") I DATA'="",$S(COL'>3:1,1:RCCT=RCREC) S IBXDATA(RECCT)=DATA
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Q
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;
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CCOBOUT(IBXSAVE,IBXDATA,COL) ; Output the claim adjustment reasons COB
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; data for an electronic claim
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; IBXSAVE,IBXDATA = arrays holding formatter information for claim -
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; pass by reference
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; COL = the column in the 837 flat file being output for CCAS record
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N COBSEQ,RECCT,GRPSEQ,SEQ,RCPC,RCCT,RCREC,DATA K IBXDATA
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S RECCT=0
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S RCPC=(COL#3) S:'RCPC RCPC=3
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S RCREC=$S(COL'<4:COL+5\6-1,1:0)
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S COBSEQ=0
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F S COBSEQ=$O(IBXSAVE("CCAS",COBSEQ)) Q:'COBSEQ S GRPSEQ="" F S GRPSEQ=$O(IBXSAVE("CCAS",COBSEQ,GRPSEQ)) Q:GRPSEQ="" D
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. S RECCT=RECCT+1
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. I COL=2 S IBXDATA(RECCT)=COBSEQ D:RECCT>1 ID^IBCEF2(RECCT,"CCAS")
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. I COL=3 S IBXDATA(RECCT)=$P($G(IBXSAVE("CCAS",COBSEQ,GRPSEQ)),U)
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. S (SEQ,RCCT)=0
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. F S SEQ=$O(IBXSAVE("CCAS",COBSEQ,GRPSEQ,SEQ)) Q:'SEQ I $TR($G(IBXSAVE("CCAS",COBSEQ,GRPSEQ,SEQ)),U)'="" D
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.. S RCCT=RCCT+1
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.. Q:COL'<4&(RCCT'=RCREC)&(RCCT'>6)
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.. S DATA=$S(COL=2:COBSEQ,COL=3:$P($G(IBXSAVE("CCAS",COBSEQ,GRPSEQ)),U),1:$P($G(IBXSAVE("CCAS",COBSEQ,GRPSEQ,SEQ)),U,RCPC))
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.. I COL'<4,RCCT=RCREC S:DATA'="" IBXDATA(RECCT)=DATA Q
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.. I RCCT>6 S RCCT=1,RECCT=RECCT+1 D:COL=2 ID^IBCEF2(RECCT,"CCAS") I DATA'="",$S(COL'>3:1,1:RCCT=RCREC) S IBXDATA(RECCT)=DATA
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Q
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;
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COBOUT(IBXSAVE,IBXDATA,CL) ;
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N Z,M,N,P,PCCL
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S (N,Z,P)=0 F S Z=$O(IBXSAVE("LCOB",Z)) Q:'Z D
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. S N=N+1
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. S M=$O(IBXSAVE("LCOB",Z,"COB",""),-1) Q:'M
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. S P=$O(IBXSAVE("LCOB",Z,"COB",M,""),-1) Q:'P
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. S PCCL=$P($G(IBXSAVE("LCOB",Z,"COB",M,P)),U,CL)
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. S:PCCL'="" IBXDATA(N)=PCCL
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. Q
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Q
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;
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COBPYRID(IBXIEN,IBXSAVE,IBXDATA) ; cob insurance company payer id
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N CT,Z,N,NUM
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K IBXDATA
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I '$D(IBXSAVE("LCOB")) G COBPYRX
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D ALLPAYID^IBCEF2(IBXIEN,.NUM,1)
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S Z=$$COID^IBCEF2(IBXIEN),NUM=$G(NUM(1))
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S:Z="" Z="0000"
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S NUM=$E(NUM_$J("",5),1,5)_$E(Z_$J("",4),1,4)
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S (CT,N)=0
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F S N=$O(IBXSAVE("LCOB",N)) Q:'N S CT=CT+1,IBXDATA(CT)=NUM
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COBPYRX ;
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Q
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;
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EOBELIG(IBEOB) ; EOB eligibility for secondary claim
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; Function to decide if EOB entry in file 361.1 (ien=IBEOB) is
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; eligible to be included for secondary claim creation process
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; The EOB is not eligible if the review status is not 3, or if there
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; is no insurance sequence indicator, or if the EOB has been DENIED
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; and the patient responsibility for that EOB is $0.
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;
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NEW ELIG,IBDATA,PTRESP
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S ELIG=0
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I '$G(IBEOB) G EOBELIGX
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S IBDATA=$G(^IBM(361.1,IBEOB,0))
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I $P(IBDATA,U,4)'=1 G EOBELIGX ; Only MRA EOB's for now
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I $P(IBDATA,U,16)'=3 G EOBELIGX ; review status - accepted-complete
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I '$P(IBDATA,U,15) G EOBELIGX ; insurance sequence must exist
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S PTRESP=$P($G(^IBM(361.1,IBEOB,1)),U,2) ; Pt Resp Amount for 1500s
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I $$FT^IBCEF(+IBDATA)=3 S PTRESP=$$PTRESPI^IBCECOB1(IBEOB) ; for UBs
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I PTRESP'>0,$P(IBDATA,U,13)=2 G EOBELIGX ; Denied & No Pt. Resp.
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I $D(^IBM(361.1,IBEOB,"ERR")) G EOBELIGX ; filing error
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;
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S ELIG=1
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EOBELIGX ;
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Q ELIG
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;
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EOBCNT(IBIFN) ; This function counts up the number of EOBs that are eligible
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; for the secondary claim creation process for a given bill#.
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NEW CNT,IEN
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S (CNT,IEN)=0
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F S IEN=$O(^IBM(361.1,"B",+$G(IBIFN),IEN)) Q:'IEN D
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. I $$EOBELIG(IEN) S CNT=CNT+1
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. Q
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EOBCNTX ;
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Q CNT
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;
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