124 lines
4.9 KiB
Mathematica
124 lines
4.9 KiB
Mathematica
BPSOSHR ;BHAM ISC/SD/lwj/DLF - Format conversion for reversals ;06/01/2004
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;;1.0;E CLAIMS MGMT ENGINE;**1,2,5**;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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; This routine was originally used by IHS to reformat reversal claims
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; into version 5.1 if the original billing request was version 3x.
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; For that purpose, this routine is no longer needed. However,
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; it also executes the special code fields so for that reason, it
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; has not been removed. We also may need to do this if we change
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; from version 5.1 to some other version, such as version 8, in the
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; future.
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;
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; NOTE: There is a problem with special code if it relies on BPS array
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; values, such as BPS("Site","NCPDP") since those variables will not
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; be defined at this point. So, the only special code that will
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; work are hard-coded values or executes of a procedure. If executing
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; a procedure, it also needs to not rely on BPS array elements or needs
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; to distinquish between billing requests and reversals.
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Q
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;
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; Input
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; BPSFORM - Reversal payer sheet IEN
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; CLAIMIEN - Original claim IEN
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; POS - Multiple from original claim
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;
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; Input/Output
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; TMP is the array originally created in BPSECA8. Since it is quite
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; large, we are not passing it into here. It will be modified by
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; this routine.
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;
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REFORM(BPSFORM,CLAIMIEN,POS) ;
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;
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; Validate parameters
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I $G(BPSFORM)="" Q
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I $G(CLAIMIEN)="" Q
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I $G(POS)="" Q
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;
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; Initialize variables
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N FLDIEN,PMODE,ORDER,RECMIEN,FIELD,NODE
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;
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; First go through the header fields. The original IHS logic was only
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; checking four specific fields. Of these, I removed:
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; 109 (Transaction Count) - Always 1 for reversals and it does
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; not make sense for this to be determined by special code.
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; 201 (Service Provider ID) - The logic currently implemented
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; relies on BPS array elements that are not defined here so this
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; was getting set to NULL when it needed to be set. In addition
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; I compared reversal and request (11/30/2006) and this value is
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; always the same for both so reversals will get the right value
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; from the request.
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; 202 (Service Provider ID Qualifier) - It does not make sense
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; to do this field if we are not doing field 201.
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;
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; So that leaves 110 (Software Vendor/Certification ID), which is needed
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; by the WEBMD reversal test payer sheet.
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;
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; Kept looping structure in case other fields are added later
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;
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S NODE=100,ORDER=0
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F S ORDER=$O(^BPSF(9002313.92,BPSFORM,NODE,"B",ORDER)) Q:'ORDER D
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. S RECMIEN=$O(^BPSF(9002313.92,BPSFORM,NODE,"B",ORDER,0))
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. I 'RECMIEN Q
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. S FLDIEN=$P($G(^BPSF(9002313.92,BPSFORM,NODE,RECMIEN,0)),U,2)
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. S FIELD=$P($G(^BPSF(9002313.91,FLDIEN,0)),U)
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. I FIELD'=110 Q
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. ;
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. ; Check to see if the format has special code. If not, quit
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. ; If we change versions (5x to ??), we made need to execute FORMAT
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. ; code no matter what, but for now, only do if there is special
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. ; code.
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. S PMODE=$P($G(^BPSF(9002313.92,BPSFORM,NODE,RECMIEN,0)),U,3)
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. I PMODE'="X" Q
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. ;
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. ; If special code, get the value, format it and store it in TMP
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. D XSPCCODE^BPSOSCF(BPSFORM,NODE,RECMIEN)
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. D FORMAT(NODE,FLDIEN)
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. S TMP(9002313.02,CLAIMIEN,FIELD,"I")=BPS("X")
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;
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; Now reformat the "detail" portion of the claim. For now, the only
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; segment we are going to look at is 130, which is the claim segment
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; If other reversal formats become available, and they require other
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; segments - this section will have to change. Since the claim
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; segment full of optional fields, we wil read through the format
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; and take it a field at a time.
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S NODE=130,ORDER=0
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F S ORDER=$O(^BPSF(9002313.92,BPSFORM,NODE,"B",ORDER)) Q:'ORDER D
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. S RECMIEN=$O(^BPSF(9002313.92,BPSFORM,NODE,"B",ORDER,0))
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. I 'RECMIEN Q
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. S FLDIEN=$P($G(^BPSF(9002313.92,BPSFORM,NODE,RECMIEN,0)),U,2)
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. S FIELD=$P($G(^BPSF(9002313.91,FLDIEN,0)),U)
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. I FIELD=111 Q ; Never do Segment Indentifier
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. ;
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. ; Check to see if the format has special code. If not, quit
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. ; If we change versions (5x to ??), we made need to execute FORMAT
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. ; code no matter what, but for now, only do if there is special
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. ; code.
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. S PMODE=$P($G(^BPSF(9002313.92,BPSFORM,NODE,RECMIEN,0)),U,3)
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. I PMODE'="X" Q
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. ;
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. ; If special code, get the value, format it and store it in TMP
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. D XSPCCODE^BPSOSCF(BPSFORM,NODE,RECMIEN)
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. D FORMAT(NODE,FLDIEN)
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. S TMP(9002313.0201,POS_","_CLAIMIEN,FIELD,"I")=BPS("X")
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Q
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;
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; FORMAT will format the data based on the FORMAT code in BPS NCPDP
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; FIELD DEFS
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FORMAT(NODE,FLDIEN) ;
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N INDEX,MCODE,QUAL
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;
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; Loop through format code and format the data
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S INDEX=0
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F S INDEX=$O(^BPSF(9002313.91,FLDIEN,25,INDEX)) Q:'+INDEX D
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. S MCODE=$G(^BPSF(9002313.91,FLDIEN,25,INDEX,0))
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. I MCODE="" Q
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. I $E(MCODE,1)=";" Q
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. X MCODE
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;
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; If node not equal to 100, append qualifier
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I NODE'=100 D
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. S QUAL=$P(^BPSF(9002313.91,FLDIEN,5),"^",1)
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. S BPS("X")=QUAL_BPS("X")
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Q
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