Routine: ABMP2511

ABMP2511 ; IHS/SD/SDR - 3P BILLING 2.5 Patch 11 PRE/POST INIT ;

 ;;2.6;IHS 3P BILLING SYSTEM;;NOV 12, 2009

PREINST ;

EN ; EP

 ;WHAT ABOUT PATCH 10 INSTALL CHECK?

 I $G(^DD(9002274.3021,.18,0))="" D EN^ABMPT259  ;if patch 9 not loaded do p9 post install

 D EXPMODES  ;add new export modes 27,28,29 (NPI formats)

 D ERRCODES  ;new 3P Error codes

 D REINDEX^ABMPT259  ;re-index 3p provider taxonomy file

 D PAGE3QS  ;change some page 3 questions to use new display routine ABMDE301

 D UPDT3PCD  ;Update 3P Codes entries

 D TURNON^DIAUTL(9002274.4,.02,"y")  ;turn on audit for 3P BILL field .02

 D TURNON^DIAUTL(9002274.4,.49,"y")  ;turn on audit for 3P BILL field .49

 D TURNON^DIAUTL(9002274.4,411,"y")  ;turn on audit for 3P BILL field 411

EXPMODES ;

 K DIC,DR,DINUM,DLAYGO,DIE

 S DIC="^ABMDEXP("

 S DIC(0)="LM"

 S DLAYGO=9002274

 S X="CMS-1500 (08/05)",DINUM=27

 K DD,DO

 D ^DIC

 Q:Y<0

 S DA=+Y

 S DIE="^ABMDEXP("

 S DR=".04////ABMDF27;.05////ABMDF27X;.06///0;.07///OMB No. 0938-0999;.08///1,2,3,4B,5,7,9,10,12B,13,15,22,34,35,19,25;.11////ABMDES3;.15///H"

 D ^DIE

 K DIC,DR,DINUM,DLAYGO,DIE

 S DIC="^ABMDEXP("

 S DIC(0)="LM"

 S DLAYGO=9002274

 S X="UB-04",DINUM=28

 K DD,DO

 D ^DIC

 Q:Y<0

 S DA=+Y

 S DIE="^ABMDEXP("

 S DR=".04////ABMDF28;.05////ABMDF28X;.06///0;.07///OMB No. 0938-0997;.08///1,2,3,4,5,6,8,13,19,21,22,23,24;.11////ABMDES1;.15///H"

 D ^DIE

 K DIC,DR,DINUM,DLAYGO,DIE

 S DIC="^ABMDEXP("

 S DIC(0)="LM"

 S DLAYGO=9002274

 S X="ADA-2006",DINUM=29

 K DD,DO

 D ^DIC

 Q:Y<0

 S DA=+Y

 S DIE="^ABMDEXP("

 S DR=".04////ABMDF29;.05////ABMDF29X;.06///C;.07///ADA-2006 Dental Claim Form;.08///1,2,3,4,9,16,17,18,34,35;.11////ABMDES4;.15///H"

 D ^DIE

ERRCODES ;

 ;220 - E FOR NPI UNSPECIFIED IN NEW PERSON FILE FOR PROVIDER

 K DIC,X

 S DIC="^ABMDERR("

 S DIC(0)="LM"

 S DINUM=220

 S X="NPI UNSPECIFIED IN NEW PERSON FILE FOR PROVIDER"

 S DIC("DR")=".02///Use TM\PETM option to add NPI"

 S DIC("DR")=DIC("DR")_";.03///E"

 K DD,DO

 D FILE^DICN

 D SITE(220)

 ;221 - W FOR NPI UNSPECIFIED IN NEW PERSON FILE FOR PROVIDER

 K DIC,X

 S DIC="^ABMDERR("

 S DIC(0)="LM"

 S DINUM=221

 S X="NPI UNSPECIFIED IN NEW PERSON FILE FOR PROVIDER"

 S DIC("DR")=".02///Use TM\PETM option to add NPI"

 S DIC("DR")=DIC("DR")_";.03///W"

 K DD,DO

 D FILE^DICN

 D SITE(221)

 ;222 - E FOR EXPORT MODE DOESN'T SUPPORT NPI

 K DIC,X

 S DIC="^ABMDERR("

 S DIC(0)="LM"

 S DINUM=222

 S X="NPI USAGE SAYS NPI BUT EXPORT MODE DOESN'T SUPPORT IT"

 S DIC("DR")=".02///Change export mode to NPI format"

 S DIC("DR")=DIC("DR")_";.03///E"

 K DD,DO

 D FILE^DICN

 D SITE(222)

 ;223 - NPI UNSPECIFIED FOR REFERRING PROVIDER

 K DIC,X

 S DIC="^ABMDERR("

 S DIC(0)="LM"

 S DINUM=223

 S X="NPI UNSPECIFIED FOR REFERRING PROVIDER"

 S DIC("DR")=".02///Add NPI for referring provider on page 3"

 S DIC("DR")=DIC("DR")_";.03///E"

 K DD,DO

 D FILE^DICN

 D SITE(223)

 ;224 - NPI UNSPECIFIED FOR SUPERVISING PROVIDER

 K DIC,X

 S DIC="^ABMDERR("

 S DIC(0)="LM"

 S DINUM=224

 S X="NPI UNSPECIFIED FOR SUPERVISING PROVIDER"

 S DIC("DR")=".02///Add NPI for supervising provider on page 3"

 S DIC("DR")=DIC("DR")_";.03///E"

 K DD,DO

 D FILE^DICN

 D SITE(224)

SITE(ABMX) ;Add SITE multiple

 S DUZHOLD=DUZ(2)

 S DUZ(2)=0

 F  S DUZ(2)=$O(^ABMDCLM(DUZ(2))) Q:'+DUZ(2)  D

 .S DIC(0)="LX"

 .S DA(1)=ABMX

 .S DIC="^ABMDERR("_DA(1)_",31,"

 .S DIC("P")=$P(^DD(9002274.04,31,0),U,2)

 .S DINUM=DUZ(2)

 .S X=$P($G(^DIC(4,DUZ(2),0)),U)

 .S DIC("DR")=".03////"_$S(DA(1)=221:"W",1:"E")

 .D ^DIC

 .K DA,DIC,DINUM

 S DUZ(2)=DUZHOLD

 K DUZHOLD,DLAYGO,ABMX

PAGE3QS ;

 K DIC,DIE,X,Y,DA

 F DA=30:1:35 D

 .S DIE="^ABMQUES("

 .S DR=".03////ABMDE301"

 .D ^DIE

 K DIC,DIE,X,Y,DA

 S DIK="^ABMQUES("

 S DA=15

 D ^DIK

 K DIC,DIE,X,Y,DA

 S DIC="^ABMQUES("

 S DIC(0)="LM"

 S DINUM=15

 S X="RESUBMISSION (CONTROL) NUMBER"

 S DIC("DR")=".02////W15;.03////ABMDE30;.04////15;1////ABMDE3C"

 D ^DIC

UPDT3PCD ; Use below tags to update 3P Codes

 F ABMI=1:1 S ABMLN=$P($T(CODES+ABMI),";;",2) Q:ABMLN="END"  D

 .S ABMCTYP=$P(ABMLN,U)

 .S ABMCD=$P(ABMLN,U,2)

 .S ABMDESC=$P(ABMLN,U,3)

 .S ABMIFLG=$P(ABMLN,U,4)

 .S DA=+$O(^ABMDCODE("AC",ABMCTYP,ABMCD,0))

 .Q:DA=0  ;no entry found; may need to replace with DIC to add the entry

 .S DIE="^ABMDCODE("

 .S DR=".03////"_ABMDESC

 .I ABMIFLG'="" S DR=DR_";.04////1"

 .D ^DIE

CODES ;

A ;;A^A^Transfer from a Critical Access Hospital

C ;;C^17^PATIENT IS HOMELESS

 ;;C^A0^TRICARE EXTERNAL PARTNERSHIP PROGRAM

 ;;C^A6^VACCINES/MEDICARE 100%

 ;;C^D2^CHANGES IN REVENUE CODES/HCPCS/HIPPS RATE CODES

 ;;C^D4^CHANGE IN CLINICAL CODES (ISD) FOR DIAGNOSIS AND/OR PROCEDURE

 ;;C^D5^CANCEL TO CORRECT INSURED'S ID OR PROVIDER ID

 ;;C^69^IME/DGME/N&AH Payment only

 ;;C^70^Self Administered Anemia Management Drug

O ;;O^1^ACCIDENT/MEDICAL COVERAGE

 ;;O^2^NO FAULT INSURANCE INVOLVED-INCLUDES AUTO ACCIDENT/OTHER

 ;;O^4^ACCIDENT/EMPLOYMENT RELATED

 ;;O^5^ACCIDENT/NO MEDICAL OR LIABILITY COVERAGE

 ;;O^20^DATE GUARANTEE OF PAYMENT BEGAN

 ;;O^21^DATE UR NOTICE RECEIVED

 ;;O^23^PAYER CODE

 ;;O^12^Date of Onset for a Chronically Dependent Individual

 ;;O^27^Date of Hospice Certification or Re-Certification

 ;;O^30^Date Outpatient Speech Pathology Plan Established or Reviewed

 ;;O^A3^Benefits Exhausted-Payer A

 ;;O^E1^Birthdate-Insured D^I

 ;;O^E2^Effective Date-Insured D Policy^I

 ;;O^E3^Benefits Exhausted^I

 ;;O^F1^Birthdate - Insured E^I

 ;;O^F2^Effective Date - Insured E Policy^I

 ;;O^F3^Benefits Exhausted^I

 ;;O^G1^Birthdate - Insured F^I

 ;;O^G2^Effective Date - Insured F Policy^I

 ;;O^G3^Benefits Exhausted^I

S ;;S^74^NON-COVERED LEVEL OF CARE/LEAVE OF ABSENCE DATES

 ;;S^M0^QIO/UR APPROVED STAY DATES

V ;;V^4^PROFESSIONAL COMPONENT CHARGES WHICH ARE COMBINED

 ;;V^23^RECURRING MONTHLY INCOME

 ;;V^40^NEW COVERAGE NOT IMPLEMENTED BY HMO

 ;;V^E1^Deductible Payer D^I

 ;;V^E2^Coinsurance Payer D^I

 ;;V^E3^Estimated Responsibility Payer D^I

 ;;V^F1^Deductible Payer E^I

 ;;V^F2^Coinsurance Payer E^I

 ;;V^F3^Estimated Responsibility Payer E^I

 ;;V^G1^Deductible Payer F^I

 ;;V^G2^Coinsurance Payer F^I

 ;;V^G3^Estimated Responsibility Payer F^I

 ;;END

ABMP2511  ; IHS/SD/SDR - 3P BILLING 2.5 Patch 11 PRE/POST INIT ;

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

 +2       ;

 +3       ;

 +4        QUIT

PREINST   ;

 +1        QUIT

EN        ; EP

 +1       ;WHAT ABOUT PATCH 10 INSTALL CHECK?

 +2       ;if patch 9 not loaded do p9 post install

           IF $GET(^DD(9002274.3021,.18,0))=""

               DO EN^ABMPT259

 +3       ;add new export modes 27,28,29 (NPI formats)

           DO EXPMODES

 +4       ;new 3P Error codes

           DO ERRCODES

 +5       ;re-index 3p provider taxonomy file

           DO REINDEX^ABMPT259

 +6       ;change some page 3 questions to use new display routine ABMDE301

           DO PAGE3QS

 +7       ;Update 3P Codes entries

           DO UPDT3PCD

 +8       ;turn on audit for 3P BILL field .02

           DO TURNON^DIAUTL(9002274.4,.02,"y")

 +9       ;turn on audit for 3P BILL field .49

           DO TURNON^DIAUTL(9002274.4,.49,"y")

 +10      ;turn on audit for 3P BILL field 411

           DO TURNON^DIAUTL(9002274.4,411,"y")

 +11       QUIT

EXPMODES  ;

 +1        KILL DIC,DR,DINUM,DLAYGO,DIE

 +2        SET DIC="^ABMDEXP("

 +3        SET DIC(0)="LM"

 +4        SET DLAYGO=9002274

 +5        SET X="CMS-1500 (08/05)"

           SET DINUM=27

 +6        KILL DD,DO

 +7        DO ^DIC

 +8        IF Y<0

               QUIT

 +9        SET DA=+Y

 +10       SET DIE="^ABMDEXP("

 +11       SET DR=".04////ABMDF27;.05////ABMDF27X;.06///0;.07///OMB No. 0938-0999;.08///1,2,3,4B,5,7,9,10,12B,13,15,22,34,35,19,25;.11////ABMDES3;.15///H"

 +12       DO ^DIE

 +13      ;

 +14       KILL DIC,DR,DINUM,DLAYGO,DIE

 +15       SET DIC="^ABMDEXP("

 +16       SET DIC(0)="LM"

 +17       SET DLAYGO=9002274

 +18       SET X="UB-04"

           SET DINUM=28

 +19       KILL DD,DO

 +20       DO ^DIC

 +21       IF Y<0

               QUIT

 +22       SET DA=+Y

 +23       SET DIE="^ABMDEXP("

 +24       SET DR=".04////ABMDF28;.05////ABMDF28X;.06///0;.07///OMB No. 0938-0997;.08///1,2,3,4,5,6,8,13,19,21,22,23,24;.11////ABMDES1;.15///H"

 +25       DO ^DIE

 +26      ;

 +27       KILL DIC,DR,DINUM,DLAYGO,DIE

 +28       SET DIC="^ABMDEXP("

 +29       SET DIC(0)="LM"

 +30       SET DLAYGO=9002274

 +31       SET X="ADA-2006"

           SET DINUM=29

 +32       KILL DD,DO

 +33       DO ^DIC

 +34       IF Y<0

               QUIT

 +35       SET DA=+Y

 +36       SET DIE="^ABMDEXP("

 +37       SET DR=".04////ABMDF29;.05////ABMDF29X;.06///C;.07///ADA-2006 Dental Claim Form;.08///1,2,3,4,9,16,17,18,34,35;.11////ABMDES4;.15///H"

 +38       DO ^DIE

 +39       QUIT

ERRCODES  ;

 +1       ;220 - E FOR NPI UNSPECIFIED IN NEW PERSON FILE FOR PROVIDER

 +2        KILL DIC,X

 +3        SET DIC="^ABMDERR("

 +4        SET DIC(0)="LM"

 +5        SET DINUM=220

 +6        SET X="NPI UNSPECIFIED IN NEW PERSON FILE FOR PROVIDER"

 +7        SET DIC("DR")=".02///Use TM\PETM option to add NPI"

 +8        SET DIC("DR")=DIC("DR")_";.03///E"

 +9        KILL DD,DO

 +10       DO FILE^DICN

 +11       DO SITE(220)

 +12      ;221 - W FOR NPI UNSPECIFIED IN NEW PERSON FILE FOR PROVIDER

 +13       KILL DIC,X

 +14       SET DIC="^ABMDERR("

 +15       SET DIC(0)="LM"

 +16       SET DINUM=221

 +17       SET X="NPI UNSPECIFIED IN NEW PERSON FILE FOR PROVIDER"

 +18       SET DIC("DR")=".02///Use TM\PETM option to add NPI"

 +19       SET DIC("DR")=DIC("DR")_";.03///W"

 +20       KILL DD,DO

 +21       DO FILE^DICN

 +22       DO SITE(221)

 +23      ;222 - E FOR EXPORT MODE DOESN'T SUPPORT NPI

 +24       KILL DIC,X

 +25       SET DIC="^ABMDERR("

 +26       SET DIC(0)="LM"

 +27       SET DINUM=222

 +28       SET X="NPI USAGE SAYS NPI BUT EXPORT MODE DOESN'T SUPPORT IT"

 +29       SET DIC("DR")=".02///Change export mode to NPI format"

 +30       SET DIC("DR")=DIC("DR")_";.03///E"

 +31       KILL DD,DO

 +32       DO FILE^DICN

 +33       DO SITE(222)

 +34      ;223 - NPI UNSPECIFIED FOR REFERRING PROVIDER

 +35       KILL DIC,X

 +36       SET DIC="^ABMDERR("

 +37       SET DIC(0)="LM"

 +38       SET DINUM=223

 +39       SET X="NPI UNSPECIFIED FOR REFERRING PROVIDER"

 +40       SET DIC("DR")=".02///Add NPI for referring provider on page 3"

 +41       SET DIC("DR")=DIC("DR")_";.03///E"

 +42       KILL DD,DO

 +43       DO FILE^DICN

 +44       DO SITE(223)

 +45      ;224 - NPI UNSPECIFIED FOR SUPERVISING PROVIDER

 +46       KILL DIC,X

 +47       SET DIC="^ABMDERR("

 +48       SET DIC(0)="LM"

 +49       SET DINUM=224

 +50       SET X="NPI UNSPECIFIED FOR SUPERVISING PROVIDER"

 +51       SET DIC("DR")=".02///Add NPI for supervising provider on page 3"

 +52       SET DIC("DR")=DIC("DR")_";.03///E"

 +53       KILL DD,DO

 +54       DO FILE^DICN

 +55       DO SITE(224)

 +56       QUIT

SITE(ABMX) ;Add SITE multiple

 +1        SET DUZHOLD=DUZ(2)

 +2        SET DUZ(2)=0

 +3        FOR

               SET DUZ(2)=$ORDER(^ABMDCLM(DUZ(2)))

               IF '+DUZ(2)

                   QUIT

               Begin DoDot:1

 +4                SET DIC(0)="LX"

 +5                SET DA(1)=ABMX

 +6                SET DIC="^ABMDERR("_DA(1)_",31,"

 +7                SET DIC("P")=$PIECE(^DD(9002274.04,31,0),U,2)

 +8                SET DINUM=DUZ(2)

 +9                SET X=$PIECE($GET(^DIC(4,DUZ(2),0)),U)

 +10               SET DIC("DR")=".03////"_$SELECT(DA(1)=221:"W",1:"E")

 +11               DO ^DIC

 +12               KILL DA,DIC,DINUM

               End DoDot:1

 +13       SET DUZ(2)=DUZHOLD

 +14       KILL DUZHOLD,DLAYGO,ABMX

 +15       QUIT

PAGE3QS   ;

 +1        KILL DIC,DIE,X,Y,DA

 +2        FOR DA=30:1:35

               Begin DoDot:1

 +3                SET DIE="^ABMQUES("

 +4                SET DR=".03////ABMDE301"

 +5                DO ^DIE

               End DoDot:1

 +6       ;

 +7        KILL DIC,DIE,X,Y,DA

 +8        SET DIK="^ABMQUES("

 +9        SET DA=15

 +10       DO ^DIK

 +11       KILL DIC,DIE,X,Y,DA

 +12       SET DIC="^ABMQUES("

 +13       SET DIC(0)="LM"

 +14       SET DINUM=15

 +15       SET X="RESUBMISSION (CONTROL) NUMBER"

 +16       SET DIC("DR")=".02////W15;.03////ABMDE30;.04////15;1////ABMDE3C"

 +17       DO ^DIC

 +18       QUIT

UPDT3PCD  ; Use below tags to update 3P Codes

 +1        FOR ABMI=1:1

               SET ABMLN=$PIECE($TEXT(CODES+ABMI),";;",2)

               IF ABMLN="END"

                   QUIT

               Begin DoDot:1

 +2                SET ABMCTYP=$PIECE(ABMLN,U)

 +3                SET ABMCD=$PIECE(ABMLN,U,2)

 +4                SET ABMDESC=$PIECE(ABMLN,U,3)

 +5                SET ABMIFLG=$PIECE(ABMLN,U,4)

 +6                SET DA=+$ORDER(^ABMDCODE("AC",ABMCTYP,ABMCD,0))

 +7       ;no entry found; may need to replace with DIC to add the entry

                   IF DA=0

                       QUIT

 +8                SET DIE="^ABMDCODE("

 +9                SET DR=".03////"_ABMDESC

 +10               IF ABMIFLG'=""

                       SET DR=DR_";.04////1"

 +11               DO ^DIE

               End DoDot:1

 +12       QUIT

CODES     ;

A         ;;A^A^Transfer from a Critical Access Hospital

C         ;;C^17^PATIENT IS HOMELESS

 +1       ;;C^A0^TRICARE EXTERNAL PARTNERSHIP PROGRAM

 +2       ;;C^A6^VACCINES/MEDICARE 100%

 +3       ;;C^D2^CHANGES IN REVENUE CODES/HCPCS/HIPPS RATE CODES

 +4       ;;C^D4^CHANGE IN CLINICAL CODES (ISD) FOR DIAGNOSIS AND/OR PROCEDURE

 +5       ;;C^D5^CANCEL TO CORRECT INSURED'S ID OR PROVIDER ID

 +6       ;;C^69^IME/DGME/N&AH Payment only

 +7       ;;C^70^Self Administered Anemia Management Drug

O         ;;O^1^ACCIDENT/MEDICAL COVERAGE

 +1       ;;O^2^NO FAULT INSURANCE INVOLVED-INCLUDES AUTO ACCIDENT/OTHER

 +2       ;;O^4^ACCIDENT/EMPLOYMENT RELATED

 +3       ;;O^5^ACCIDENT/NO MEDICAL OR LIABILITY COVERAGE

 +4       ;;O^20^DATE GUARANTEE OF PAYMENT BEGAN

 +5       ;;O^21^DATE UR NOTICE RECEIVED

 +6       ;;O^23^PAYER CODE

 +7       ;;O^12^Date of Onset for a Chronically Dependent Individual

 +8       ;;O^27^Date of Hospice Certification or Re-Certification

 +9       ;;O^30^Date Outpatient Speech Pathology Plan Established or Reviewed

 +10      ;;O^A3^Benefits Exhausted-Payer A

 +11      ;;O^E1^Birthdate-Insured D^I

 +12      ;;O^E2^Effective Date-Insured D Policy^I

 +13      ;;O^E3^Benefits Exhausted^I

 +14      ;;O^F1^Birthdate - Insured E^I

 +15      ;;O^F2^Effective Date - Insured E Policy^I

 +16      ;;O^F3^Benefits Exhausted^I

 +17      ;;O^G1^Birthdate - Insured F^I

 +18      ;;O^G2^Effective Date - Insured F Policy^I

 +19      ;;O^G3^Benefits Exhausted^I

S         ;;S^74^NON-COVERED LEVEL OF CARE/LEAVE OF ABSENCE DATES

 +1       ;;S^M0^QIO/UR APPROVED STAY DATES

V         ;;V^4^PROFESSIONAL COMPONENT CHARGES WHICH ARE COMBINED

 +1       ;;V^23^RECURRING MONTHLY INCOME

 +2       ;;V^40^NEW COVERAGE NOT IMPLEMENTED BY HMO

 +3       ;;V^E1^Deductible Payer D^I

 +4       ;;V^E2^Coinsurance Payer D^I

 +5       ;;V^E3^Estimated Responsibility Payer D^I

 +6       ;;V^F1^Deductible Payer E^I

 +7       ;;V^F2^Coinsurance Payer E^I

 +8       ;;V^F3^Estimated Responsibility Payer E^I

 +9       ;;V^G1^Deductible Payer F^I

 +10      ;;V^G2^Coinsurance Payer F^I

 +11      ;;V^G3^Estimated Responsibility Payer F^I

 +12      ;;END

 +13       QUIT

ABMP2511.m