137 lines
6.2 KiB
Mathematica
137 lines
6.2 KiB
Mathematica
IBCNSBL2 ;ALB/CPM - 'BILL NEXT PAYOR' BULLETIN ; 08-AUG-96
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;;2.0;INTEGRATED BILLING;**52,80,153,240**;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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EOB(IBIFN,IBORIG,IBPYMT,IBTXT) ; determine if there may be another payer for this claim that should be billed
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; in general the EOB of the current bill is required to be sent with the next TP bill in the series
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; if there is another Third Party Payer then returns true, if any other payer (including patient) then set array
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;
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; Input: IBIFN -- Pointer to AR (file #430), or Claim (file #399)
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; IBORIG -- Original amount of the claim
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; IBPYMT -- Total Amount paid on the claim
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;
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; Output: IBTXT -- Array, pass by reference, if needed
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; If a another payer (third party or patient) for the claim can be found,
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; this array will contain the text that explains who the next payer is
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;
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; Returns: 0 -- no need to forward EOB (no next Third Party payer found or payment=>amount due)
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; 'true^Next payer' -- if the EOB of the bill needs to be forwarded for inclusion in the next bill,
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; generally there must be another payer for the bill that is
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; third party, non-patient, and payment was not the amount due
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;
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N X,IB,IBPOL,IBCS,IBARCAT,IBSEC,IBRETURN,IBSEQ,IBINS S IBRETURN=0
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I '$G(IBIFN) G EOBQ
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I $G(^PRCA(430,IBIFN,0))="" G EOBQ
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I '$G(IBORIG) G EOBQ
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I $G(IBPYMT)="" G EOBQ
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;
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S IB=$G(^DGCR(399,IBIFN,0)) I IB="" G EOBQ
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;
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; - quit if there is no remaining balance on the bill
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I IBPYMT'<IBORIG G EOBQ
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;
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S IBARCAT=$P($G(^DGCR(399.3,+$P(IB,"^",7),0)),"^",6) I 'IBARCAT G EOBQ
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;
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; - for Champva third party claims, bill the Champva Center next
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I IBARCAT=28 D G EOBQ
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. S IBTXT(14)="You should prepare a claim to be sent to the CHAMPVA Center.",IBRETURN="1^CHAMPVA Center"
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;
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; - for Tricare third party claims, next bill Tricare or the patient
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I IBARCAT=32 D G EOBQ
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. ;
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. ; - third party bill went to Tricare Supplemental carrier, bill patient next
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. S IBSEQ=$P($G(^DGCR(399,IBIFN,0)),U,21),IBSEQ=$S(IBSEQ="P":"I1",IBSEQ="S":"I2",IBSEQ="T":"I3",1:-1)
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. S IBPOL=$G(^DGCR(399,IBIFN,IBSEQ))
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. S IBCS=$D(^IBE(355.1,"D","CS",+$P($G(^IBA(355.3,+$P(IBPOL,"^",18),0)),"^",9)))>0
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. I IBCS D Q
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.. S IBTXT(14)="This claim was sent to the TRICARE Supplemental insurance carrier."
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.. S IBTXT(15)="You should send a copayment charge to the patient."
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. ;
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. ; - otherwise third party bill went to patients Reimb. Ins carrier, bill the tricare FI next
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. S IBRETURN="1^TRICARE Fiscal Intermediary"
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. S IBTXT(14)="You should prepare a claim to send to the TRICARE Fiscal Intermediary."
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;
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; - for Tricare claims, bill the patient or Tricare supplemental policy
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I IBARCAT=30 D G EOBQ
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. ;
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. ; - if the patient has a Tricare supplemental policy, bill it
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. I $$CHPSUP(+$P(IB,"^",2)) D Q
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.. S IBRETURN="1^TRICARE Supplemental policy"
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.. S IBTXT(14)="The patient has a TRICARE Supplemental policy."
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.. S IBTXT(15)="You should prepare a claim to be sent to that carrier."
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. ;
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. ; - otherwise, bill the patient
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. S IBTXT(14)="You should send a copayment charge to the patient."
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;
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; - all other bills: if there is a next payer in the series then a bill needs to be created for that payer
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S IBSEQ=$P($G(^DGCR(399,IBIFN,0)),U,21),IBSEQ=$S(IBSEQ="P":2,IBSEQ="S":3,1:"")
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I +IBSEQ S IBINS=$P($G(^DGCR(399,IBIFN,"M")),U,IBSEQ) I +IBINS D
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. S IBRETURN=+IBINS_U_$P($G(^DIC(36,+IBINS,0)),U,1)
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. S IBTXT(14)="There is a "_$S(IBSEQ=2:"secondary",1:"tertiary")_" payor associated with this claim."
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. S IBTXT(15)="You may need to prepare a claim to be sent to "_$P(IBRETURN,U,2)_"."
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;
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EOBQ Q IBRETURN
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;
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BULL(IBIFN,IBORIG,IBPYMT) ; Generate bulletin detailing next payer for a claim, if any
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;
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; Input: IBIFN -- Pointer to AR (file #430), or Claim (file #399)
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; IBORIG -- Original amount of the claim
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; IBPYMT -- Total Amount paid on the claim
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;
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; Output: Bulletin: Mail Group MEANS TEST BILLING MAIL GROUP: IB MEANS TEST (350.9,.11)
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; If a secondary payor for the claim can be found, a bulletin will be sent
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; to the billing unit to alert them to forward the claim to that payor.
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;
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N X,IB,IBX,IBTXT,IBP,IBGRP
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;
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S IBX=$$EOB($G(IBIFN),$G(IBORIG),$G(IBPYMT),.IBTXT) I '$D(IBTXT) G BULLQ
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;
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S IB=$G(^DGCR(399,IBIFN,0)) I IB="" G BULLQ
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S IBP=$$PT^IBEFUNC(+$P(IB,"^",2))
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;
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; - create remainder of bulletin
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N XMDUZ,XMTEXT,XMY,XMSUB
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S XMSUB="Notification of Subsequent Payor"
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S XMDUZ="INTEGRATED BILLING PACKAGE",XMTEXT="IBTXT("
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K XMY S XMY(DUZ)=""
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;
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S IBTXT(1)="A payment has been made on the following claim, which has been identified"
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S IBTXT(2)="as potentially having a subsequent payor:"
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S IBTXT(3)=" "
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S IBTXT(4)=" Bill Number: "_$P($G(^PRCA(430,IBIFN,0)),"^")
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S IBTXT(5)=" Patient: "_$E($P(IBP,"^"),1,30)_" Pt. Id: "_$P(IBP,"^",2)
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S IBTXT(6)=" Bill Type: "_$P($G(^DGCR(399.3,+$P(IB,"^",7),0)),"^")
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S IBTXT(7)=" Orig Amount: $"_$J(IBORIG,0,2)
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S IBTXT(8)=" Amount Paid: $"_$J(IBPYMT,0,2)
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S IBTXT(9)=" "
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;
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S IBX=$G(^DGCR(399,IBIFN,0))
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S IBTXT(10)="Bill Sequence: "_$$EXSET^IBEFUNC($P(IBX,U,21),399,.21)
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S IBTXT(11)=" Bill Payer: "_$E($P($G(^DIC(36,+$G(^DGCR(399,IBIFN,"MP")),0)),U,1),1,20)
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;
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S IBX=$G(^DGCR(399,IBIFN,"M"))
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I IBX S IBTXT(10)=IBTXT(10)_$J("",(40-$L(IBTXT(10))))_" Primary Carrier: "_$E($P($G(^DIC(36,+IBX,0)),U,1),1,20)
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I +$P(IBX,U,2) S IBTXT(11)=IBTXT(11)_$J("",(40-$L(IBTXT(11))))_"Secondary Carrier: "_$E($P($G(^DIC(36,+$P(IBX,U,2),0)),U,1),1,20)
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I +$P(IBX,U,3) S IBTXT(12)=$J("",40)_" Tertiary Carrier: "_$E($P($G(^DIC(36,+$P(IBX,U,3),0)),U,1),1,20)
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S IBTXT(13)=" "
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;
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; - send to the Means Test billing mailgroup (for now)
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S IBGRP=$P($G(^XMB(3.8,+$P($G(^IBE(350.9,1,0)),"^",11),0)),"^")
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I IBGRP]"" S XMY("G."_IBGRP_"@"_^XMB("NETNAME"))=""
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;
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D ^XMD
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;
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BULLQ Q
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;
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;
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CHPSUP(DFN) ; Does the patient have a TRICARE Supplemental policy?
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; Input: DFN -- Pointer to the patient in file #2
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; Output: 0 - Has no TRICARE Supplemental policy
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; 1 - Yes, patient has such a policy.
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;
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N X,IBINS,IBCS
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D ALL^IBCNS1(DFN,"IBINS",1,DT)
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S (IBCS,X)=0 F S X=$O(IBINS(X)) Q:'X D Q:IBCS
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.I $D(^IBE(355.1,"D","CS",+$P($G(IBINS(X,355.3)),"^",9))) S IBCS=1
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Q IBCS
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