ABME8SBR.m

ABME8SBR ; IHS/ASDST/DMJ - 837 SBR Segment 

 ;;2.6;IHS 3P BILLING SYSTEM;**8,9**;NOV 12, 2009

 ;Transaction Set Header

 ;

 ; IHS/SD/SDR - v2.5 p8 - IM15307/IM14092

 ;    Modified to check MSP reason if Medicare

 ;

 ; IHS/SD/SDR/LSL - v2.5 p8 - IM13693/IM17856

 ;    Send SBR06 for 837D only in loop 2000B (Subscriber)

 ;    Not in loop 2320 (Other Subscriber) or other 837 formats

 ;

 ; IHS/SD/SDR - v2.5 p10 - COB issue

 ;   Added code to check if COB

 ;

 ; IHS/SD/SDR - v2.5 p13 - IM25436

 ;   SBR05 s/b C1 when Medicare Suppl insurer type

 ;

EP(X) ;EP

 ;x=1 (primary), 2 (secondary) or 3 (tertiary)

 K ABMREC("SBR"),ABMR("SBR")

 S ABME("RTYPE")="SBR"

 S ABMPST=X

 D LOOP

 K ABME,ABM

 Q

LOOP ;LOOP HERE

 F I=10:10:100 D

 .D @I

 .I $D(^ABMEXLM("AA",+$G(ABMP("INS")),+$G(ABMP("EXP")),ABME("RTYPE"),I)) D @(^(I))

 .I $G(ABMREC("SBR"))'="" S ABMREC("SBR")=ABMREC("SBR")_"*"

 .S ABMREC("SBR")=$G(ABMREC("SBR"))_ABMR("SBR",I)

 Q

10 ;segment

 S ABMR("SBR",10)="SBR"

 Q

20 ;SBR01 - Payer Responsibility Sequence Number Code

 S ABMR("SBR",20)=$S(ABMPST=1:"P",ABMPST=2:"S",ABMPST=3:"T",1:"P")

 Q

30 ;SBR02 - Individual Relationship Code

 S ABMR("SBR",30)=$G(ABMP("REL",ABMPST))

 I $G(ABMHL)=22 D

 .I $G(ABMCHILD)=0 S ABMR("SBR",30)=18

 .I $G(ABMCHILD)=1 S ABMR("SBR",30)=""

 Q

40 ;SBR03 - Reference Identification (Group Number)

 S ABMR("SBR",40)=$G(ABMP("GRP#",ABMPST))

 Q

50 ;SBR04 - Group Name

 I ABMR("SBR",40)'="" D  Q

 .S ABMR("SBR",50)=""

 S ABMR("SBR",50)=$G(ABMP("GRPNM",ABMPST))

 Q

60 ;SBR05 - Insurance Type Code

 S ABMR("SBR",60)=""

 D PREV^ABMDFUTL

 I (ABMPST=1)&(+$G(ABMP("PD"))=0)&(+$G(ABMP("DED"))=0)&(+$G(ABMP("COI"))=0)&(+$G(ABMP("NONC"))=0) Q

 I $P(ABMP("INS",ABMPST),U,2)="R",(ABMPST=2),($P($G(^ABMNINS(ABMP("LDFN"),$P(ABMP("INS",1),U),0)),U,11)="Y") S ABMR("SBR",60)=$P($G(^ABMDBILL(DUZ(2),ABMP("BDFN"),12)),U)  ;abm*2.6*9 tribal self-insured

 Q:ABMP("EXP")'=22

 I $P(ABMP("INS",ABMPST),U,2)="R",(ABMPST'=1) S ABMR("SBR",60)=$P($G(^ABMDBILL(DUZ(2),ABMP("BDFN"),12)),U)

 I $P(ABMP("INS",ABMPST),U,2)="R",(ABMPST=1),($G(ABMLOOP)=2320) S ABMR("SBR",60)=$G(ABMP("SOP",ABMPST))

 I ($G(ABMR("SBR",60))=""),($G(ABMLOOP)=2320) S ABMR("SBR",60)=$G(ABMP("SOP",ABMPST))

 S:ABMR("SBR",60)="CI" ABMR("SBR",60)="C1"

 S:ABMR("SBR",60)="BL" ABMR("SBR",60)="C1"

 Q

70 ;SBR06 - Coordination of Benefits Code

 S ABMR("SBR",70)=""

 I ABMI=1,ABMP("EXP")=23 D

 .I $G(ABMP("INS",2)) S ABMR("SBR",70)=1

 .I '$G(ABMP("INS",2)) S ABMR("SBR",70)=6

 .;I ABMPST=1 S ABMR("SBR",70)=""  ;abm*2.6*8 HEAT28632 - Removes "1" from SBR06 for primary payer when 2ndry payer billed  ;abm*2.6*9 NOHEAT

 .I $G(ABMLOOP)=2320,ABMPST=1 S ABMR("SBR",70)=""  ;Removes "1" from SBR06 for primary payer when 2ndry payer billed  ;abm*2.6*9 NOHEAT

 Q

80 ;SBR07 - Yes/No Condition or Response Code

 S ABMR("SBR",80)=""

 Q

90 ;SBR08 - Employment Status Code

 S ABMR("SBR",90)=""

 Q

100 ;SBR09 - Claim Filing Indicator Code

 S ABMR("SBR",100)=$G(ABMP("SOP",ABMPST))

 S:ABMR("SBR",100)="SP" ABMR("SBR",100)="CI"

 Q

ABME8SBR  ; IHS/ASDST/DMJ - 837 SBR Segment 

 +1       ;;2.6;IHS 3P BILLING SYSTEM;**8,9**;NOV 12, 2009

 +2       ;Transaction Set Header

 +3       ;

 +4       ; IHS/SD/SDR - v2.5 p8 - IM15307/IM14092

 +5       ;    Modified to check MSP reason if Medicare

 +6       ;

 +7       ; IHS/SD/SDR/LSL - v2.5 p8 - IM13693/IM17856

 +8       ;    Send SBR06 for 837D only in loop 2000B (Subscriber)

 +9       ;    Not in loop 2320 (Other Subscriber) or other 837 formats

 +10      ;

 +11      ; IHS/SD/SDR - v2.5 p10 - COB issue

 +12      ;   Added code to check if COB

 +13      ;

 +14      ; IHS/SD/SDR - v2.5 p13 - IM25436

 +15      ;   SBR05 s/b C1 when Medicare Suppl insurer type

 +16      ;

EP(X)     ;EP

 +1       ;x=1 (primary), 2 (secondary) or 3 (tertiary)

 +2        KILL ABMREC("SBR"),ABMR("SBR")

 +3        SET ABME("RTYPE")="SBR"

 +4        SET ABMPST=X

 +5        DO LOOP

 +6        KILL ABME,ABM

 +7        QUIT 

LOOP      ;LOOP HERE

 +1        FOR I=10:10:100

               Begin DoDot:1

 +2                DO @I

 +3                IF $DATA(^ABMEXLM("AA",+$GET(ABMP("INS")),+$GET(ABMP("EXP")),ABME("RTYPE"),I))

                       DO @(^(I))

 +4                IF $GET(ABMREC("SBR"))'=""

                       SET ABMREC("SBR")=ABMREC("SBR")_"*"

 +5                SET ABMREC("SBR")=$GET(ABMREC("SBR"))_ABMR("SBR",I)

               End DoDot:1

 +6        QUIT 

10        ;segment

 +1        SET ABMR("SBR",10)="SBR"

 +2        QUIT 

20        ;SBR01 - Payer Responsibility Sequence Number Code

 +1        SET ABMR("SBR",20)=$SELECT(ABMPST=1:"P",ABMPST=2:"S",ABMPST=3:"T",1:"P")

 +2        QUIT 

30        ;SBR02 - Individual Relationship Code

 +1        SET ABMR("SBR",30)=$GET(ABMP("REL",ABMPST))

 +2        IF $GET(ABMHL)=22

               Begin DoDot:1

 +3                IF $GET(ABMCHILD)=0

                       SET ABMR("SBR",30)=18

 +4                IF $GET(ABMCHILD)=1

                       SET ABMR("SBR",30)=""

               End DoDot:1

 +5        QUIT 

40        ;SBR03 - Reference Identification (Group Number)

 +1        SET ABMR("SBR",40)=$GET(ABMP("GRP#",ABMPST))

 +2        QUIT 

50        ;SBR04 - Group Name

 +1        IF ABMR("SBR",40)'=""

               Begin DoDot:1

 +2                SET ABMR("SBR",50)=""

               End DoDot:1

               QUIT 

 +3        SET ABMR("SBR",50)=$GET(ABMP("GRPNM",ABMPST))

 +4        QUIT 

60        ;SBR05 - Insurance Type Code

 +1        SET ABMR("SBR",60)=""

 +2        DO PREV^ABMDFUTL

 +3        IF (ABMPST=1)&(+$GET(ABMP("PD"))=0)&(+$GET(ABMP("DED"))=0)&(+$GET(ABMP("COI"))=0)&(+$GET(ABMP("NONC"))=0)

               QUIT 

 +4       ;abm*2.6*9 tribal self-insured

           IF $PIECE(ABMP("INS",ABMPST),U,2)="R"

               IF (ABMPST=2)

                   IF ($PIECE($GET(^ABMNINS(ABMP("LDFN"),$PIECE(ABMP("INS",1),U),0)),U,11)="Y")

                       SET ABMR("SBR",60)=$PIECE($GET(^ABMDBILL(DUZ(2),ABMP("BDFN"),12)),U)

 +5        IF ABMP("EXP")'=22

               QUIT 

 +6        IF $PIECE(ABMP("INS",ABMPST),U,2)="R"

               IF (ABMPST'=1)

                   SET ABMR("SBR",60)=$PIECE($GET(^ABMDBILL(DUZ(2),ABMP("BDFN"),12)),U)

 +7        IF $PIECE(ABMP("INS",ABMPST),U,2)="R"

               IF (ABMPST=1)

                   IF ($GET(ABMLOOP)=2320)

                       SET ABMR("SBR",60)=$GET(ABMP("SOP",ABMPST))

 +8        IF ($GET(ABMR("SBR",60))="")

               IF ($GET(ABMLOOP)=2320)

                   SET ABMR("SBR",60)=$GET(ABMP("SOP",ABMPST))

 +9        IF ABMR("SBR",60)="CI"

               SET ABMR("SBR",60)="C1"

 +10       IF ABMR("SBR",60)="BL"

               SET ABMR("SBR",60)="C1"

 +11       QUIT 

70        ;SBR06 - Coordination of Benefits Code

 +1        SET ABMR("SBR",70)=""

 +2        IF ABMI=1

               IF ABMP("EXP")=23

                   Begin DoDot:1

 +3                    IF $GET(ABMP("INS",2))

                           SET ABMR("SBR",70)=1

 +4                    IF '$GET(ABMP("INS",2))

                           SET ABMR("SBR",70)=6

 +5       ;I ABMPST=1 S ABMR("SBR",70)=""  ;abm*2.6*8 HEAT28632 - Removes "1" from SBR06 for primary payer when 2ndry payer billed  ;abm*2.6*9 NOHEAT

 +6       ;Removes "1" from SBR06 for primary payer when 2ndry payer billed  ;abm*2.6*9 NOHEAT

                       IF $GET(ABMLOOP)=2320

                           IF ABMPST=1

                               SET ABMR("SBR",70)=""

                   End DoDot:1

 +7        QUIT 

80        ;SBR07 - Yes/No Condition or Response Code

 +1        SET ABMR("SBR",80)=""

 +2        QUIT 

90        ;SBR08 - Employment Status Code

 +1        SET ABMR("SBR",90)=""

 +2        QUIT 

100       ;SBR09 - Claim Filing Indicator Code

 +1        SET ABMR("SBR",100)=$GET(ABMP("SOP",ABMPST))

 +2        IF ABMR("SBR",100)="SP"

               SET ABMR("SBR",100)="CI"

 +3        QUIT