ACHSDAR4 ; IHS/ITSC/TPF/PMF - APPEAL TO ALTERNATE RESOURCE (2/3) ;
;;3.1;CONTRACT HEALTH MGMT SYSTEM;;JUN 11, 2001
;
START ;EP
U IO
D BM^ACHS
S ACHSBM=ACHSBM-4,ACHDONE=""
F I=1:1:4 W "*** OFFICE COPY *** "
W !!!
S ACHSPG=1,DIWL=5,DIWR=$S($G(IOM):IOM,1:75),DIWF="W"
DOC ;
D HEADER^ACHSDNL2
;
;get the patient name from one place if not registered,
;from another if they are registered.
I $$DN^ACHS(0,6)'="Y" S ACHDPAT=$G(^ACHSDEN(DUZ(2),"D",ACHSA,10))
E S ACHDPAT=$P($G(^DPT($$DN^ACHS(0,7),0)),U)
;
;reverse the name so that first name is first
S ACHDPAT=$P(ACHDPAT,",",2)_" "_$P(ACHDPAT,",",1)
S ACHDALR=$G(^AUTNINS(ACHDALRS,0))
DOC1 ;
W !!!,?DIWL-1,$$DATE^ACHSDARR($$DN^ACHS(0,2),"MM",1)," ",$$DATE^ACHSDARR($$DN^ACHS(0,2),"DD"),", ",$$DATE^ACHSDARR($$DN^ACHS(0,2),"YY")
W !!!!,?DIWL-1,$P($G(^AUTNINS(ACHDALRS,4)),U)
;
I $P(ACHDALR,U,2)']"" W !!! G DOC2
W !?DIWL-1,$P(ACHDALR,U,2),!?DIWL-1,$P(ACHDALR,U,3)_", "_$P($G(^DIC(5,$P(ACHDALR,U,4),0)),U,2)_" "_$P(ACHDALR,U,5),!
;
DOC2 ;
S ACHDALR=$P(ACHDALR,U)
W !!,?DIWL-1,"Re: Patient: ",ACHDPAT,!,?DIWL+8,"Date of service: ",$$DATE^ACHSDARR($$DN^ACHS(0,4),"MM",1)," ",$$DATE^ACHSDARR($$DN^ACHS(0,4),"DD"),", ",$$DATE^ACHSDARR($$DN^ACHS(0,4),"YY")
D PROV^ACHSDAR5
;
;
W !!,?DIWL-1,"Dear ",$P(ACHDALR,U),",",!!
S ACHDDAT=$P($G(^ACHSDEN(DUZ(2),"D",ACHSA,800,ACHDALRS,0)),U,5)
S ACHDDAT=$$DATE^ACHSDARR(ACHDDAT,"MM",1)_" "_$$DATE^ACHSDARR(ACHDDAT,"DD")_", "_$$DATE^ACHSDARR(ACHDDAT,"YY")
S X="The Indian Health Service (IHS), on behalf of |_|"_ACHDPAT_"|_|,"
D ^DIWP,PG:$Y>ACHSBM Q:$G(ACHSQUIT)
S X="hereby appeals the decision of |_|"_ACHDALR_"|_|,"
D ^DIWP,PG:$Y>ACHSBM Q:$G(ACHSQUIT)
S X="dated |_|"_ACHDDAT_"|_|. The patient has authorized the IHS to act as the"
D ^DIWP,PG:$Y>ACHSBM Q:$G(ACHSQUIT)
S X="representative in this matter by signing the Authorization to Release and"
D ^DIWP,PG:$Y>ACHSBM Q:$G(ACHSQUIT)
S X="Appointment of Representative form, attached herein."
D ^DIWP,PG:$Y>ACHSBM Q:$G(ACHSQUIT) D ^DIWW
S DIWF="I5C60W"
W !!
; --- Alt Resource Appeal Option Text
S ACHDOP=0
F S ACHDOP=$O(^ACHSDEN(DUZ(2),"D",ACHSA,800,ACHDALRS,4,ACHDOP)) Q:+ACHDOP=0 D Q:$G(ACHSQUIT)
.S ACHDX=0
.F S ACHDX=$O(^ACHSDENR(DUZ(2),13,ACHDOP,1,ACHDX)) Q:+ACHDX=0 D
..S X=$G(^ACHSDENR(DUZ(2),13,ACHDOP,1,ACHDX,0)) D ^DIWP,PG:$Y>ACHSBM Q:$G(ACHSQUIT)
D ^DIWW
S DIWL=5,DIWR=$S($G(IOM):IOM,1:75)
K DIWF
;
BOTTXT ;
W !!!?DIWL-1,"Please keep me informed on the status of this appeal."
D PG:$Y>ACHSBM Q:$G(ACHSQUIT)
;
SUD ; --- SUD Signature Block
D PG:$Y>(ACHSBM-15) Q:$G(ACHSQUIT)
W !!?30,"Sincerely yours,",!!!!!!?30,$$SUD^ACHS(1)
I $L($$SUD^ACHS(7)) W !?30,$$SUD^ACHS(7)
W !?30,$$SUD^ACHS(2),!?30,$$SUD^ACHS(3),", ",$P($G(^DIC(5,$$SUD^ACHS(4),0)),U,2)," ",$$SUD^ACHS(5),!?30,"Telephone: ",$$SUD^ACHS(6)
;
CMT ; --- Office Comments
I '$D(ACHDONE) D END Q
W !!!,"Denial Number: ",$$DN^ACHS(0,1)
;W !,"Chart Number: ",$S($$DN^ACHS(0,6)="Y":$P($G(^AUPNPAT($$DN^ACHS(0,7),41,DUZ(2),0)),U,2),$L($$DN^ACHS(10,6)):$$DN^ACHS(10,6),1:"No Chart Number Available")
;IS THE 'PATIENT REGISTERED?'
I $$DN^ACHS(0,6)="Y" D
.;IF REGISTERED IS THERE A 'REGISTERED PATIENT' PTR?
.W:'$$DN^ACHS(0,7) !!,"CANNOT FIND A PATIENT POINTER FOR A APPARENTLY REGISTERED PATIENT WITHIN THE 'CHS DENIAL DATA' FILE!!",!,"REPORT THIS TO YOUR SITE MANAGER IMMEDIATELY!",!,"DOCUMENT IEN: ",ACHSA
.Q:'$$DN^ACHS(0,6)
.W $P($G(^AUPNPAT($$DN^ACHS(0,7),41,DUZ(2),0)),U,2)
W $S($L($$DN^ACHS(10,6)):$$DN^ACHS(10,6),1:"No Chart Number Available")
;
I $$DN^ACHS(850,1)'="Y" W !,"No Receipt Information Available",! G CMT1
W !,"Method of receipt: ",$$DN^ACHS(850,2)
W !,"Date of receipt: ",$$FMTE^XLFDT($$DN^ACHS(850,3))
W !,"Received by: ",$$DN^ACHS(850,4)
;
;
CMT1 ; --- Alternate Resources Appeal Comments
I '$D(^ACHSDEN(DUZ(2),"D",ACHSA,800,ACHDALRS,5,0)) D END Q
W !,"Alternate Resources Appeal Comments: ",!
S ACHD=0
F S ACHD=$O(^ACHSDEN(DUZ(2),"D",ACHSA,800,ACHDALRS,5,ACHD)) Q:'ACHD D Q:$G(ACHSQUIT)
.S X=$G(^ACHSDEN(DUZ(2),"D",ACHSA,800,ACHDALRS,5,ACHD,0)) D ^DIWP,PG:$Y>ACHSBM Q:$G(ACHSQUIT)
D ^DIWW
D END
Q
;
END ;EP
W !!!
I $D(ACHDONE) D G DOC
. F I=1:1:4 W "*** OFFICE COPY *** "
. K ACHDONE
. W @IOF
. S ACHSPG=1,DIWL=5,DIWR=$S($G(IOM):IOM,1:75),DIWF="W"
;
I '$D(ACHDLKER) D ^ACHSDARR ;PATIENT RELEASE OF INFORMATION FORM
I IO=IO(0) D RTRN^ACHS
W @IOF
K ACHSA,ACHDALRS,ACHDLKER,DIR,ACHDOCT,ACHD,ACHDX,ACHDDAT,ACHDPAT,ACHDALR,ACHDOP,ACHDPROV
D ^%ZISC
Q
;
PG ;
D RTRN^ACHS
Q:$G(ACHSQUIT)
S ACHSPG=ACHSPG+1
W @IOF,!!!?DIWL-1,ACHDPAT,?($S($G(IOM):IOM,1:75)-$L(ACHDALR)),ACHDALR,!?($S($G(IOM):IOM,1:75)-$L("Page "_ACHSPG)),"Page ",ACHSPG,!!
Q
;
ACHSDAR4 ; IHS/ITSC/TPF/PMF - APPEAL TO ALTERNATE RESOURCE (2/3) ;
+1 ;;3.1;CONTRACT HEALTH MGMT SYSTEM;;JUN 11, 2001
+2 ;
START ;EP
+1 USE IO
+2 DO BM^ACHS
+3 SET ACHSBM=ACHSBM-4
SET ACHDONE=""
+4 FOR I=1:1:4
WRITE "*** OFFICE COPY *** "
+5 WRITE !!!
+6 SET ACHSPG=1
SET DIWL=5
SET DIWR=$SELECT($GET(IOM):IOM,1:75)
SET DIWF="W"
DOC ;
+1 DO HEADER^ACHSDNL2
+2 ;
+3 ;get the patient name from one place if not registered,
+4 ;from another if they are registered.
+5 IF $$DN^ACHS(0,6)'="Y"
SET ACHDPAT=$GET(^ACHSDEN(DUZ(2),"D",ACHSA,10))
+6 IF '$TEST
SET ACHDPAT=$PIECE($GET(^DPT($$DN^ACHS(0,7),0)),U)
+7 ;
+8 ;reverse the name so that first name is first
+9 SET ACHDPAT=$PIECE(ACHDPAT,",",2)_" "_$PIECE(ACHDPAT,",",1)
+10 SET ACHDALR=$GET(^AUTNINS(ACHDALRS,0))
DOC1 ;
+1 WRITE !!!,?DIWL-1,$$DATE^ACHSDARR($$DN^ACHS(0,2),"MM",1)," ",$$DATE^ACHSDARR($$DN^ACHS(0,2),"DD"),", ",$$DATE^ACHSDARR($$DN^ACHS(0,2),"YY")
+2 WRITE !!!!,?DIWL-1,$PIECE($GET(^AUTNINS(ACHDALRS,4)),U)
+3 ;
+4 IF $PIECE(ACHDALR,U,2)']""
WRITE !!!
GOTO DOC2
+5 WRITE !?DIWL-1,$PIECE(ACHDALR,U,2),!?DIWL-1,$PIECE(ACHDALR,U,3)_", "_$PIECE($GET(^DIC(5,$PIECE(ACHDALR,U,4),0)),U,2)_" "_$PIECE(ACHDALR,U,5),!
+6 ;
DOC2 ;
+1 SET ACHDALR=$PIECE(ACHDALR,U)
+2 WRITE !!,?DIWL-1,"Re: Patient: ",ACHDPAT,!,?DIWL+8,"Date of service: ",$$DATE^ACHSDARR($$DN^ACHS(0,4),"MM",1)," ",$$DATE^ACHSDARR($$DN^ACHS(0,4),"DD"),", ",$$DATE^ACHSDARR($$DN^ACHS(0,4),"YY")
+3 DO PROV^ACHSDAR5
+4 ;
+5 ;
+6 WRITE !!,?DIWL-1,"Dear ",$PIECE(ACHDALR,U),",",!!
+7 SET ACHDDAT=$PIECE($GET(^ACHSDEN(DUZ(2),"D",ACHSA,800,ACHDALRS,0)),U,5)
+8 SET ACHDDAT=$$DATE^ACHSDARR(ACHDDAT,"MM",1)_" "_$$DATE^ACHSDARR(ACHDDAT,"DD")_", "_$$DATE^ACHSDARR(ACHDDAT,"YY")
+9 SET X="The Indian Health Service (IHS), on behalf of |_|"_ACHDPAT_"|_|,"
+10 DO ^DIWP
IF $Y>ACHSBM
DO PG
IF $GET(ACHSQUIT)
QUIT
+11 SET X="hereby appeals the decision of |_|"_ACHDALR_"|_|,"
+12 DO ^DIWP
IF $Y>ACHSBM
DO PG
IF $GET(ACHSQUIT)
QUIT
+13 SET X="dated |_|"_ACHDDAT_"|_|. The patient has authorized the IHS to act as the"
+14 DO ^DIWP
IF $Y>ACHSBM
DO PG
IF $GET(ACHSQUIT)
QUIT
+15 SET X="representative in this matter by signing the Authorization to Release and"
+16 DO ^DIWP
IF $Y>ACHSBM
DO PG
IF $GET(ACHSQUIT)
QUIT
+17 SET X="Appointment of Representative form, attached herein."
+18 DO ^DIWP
IF $Y>ACHSBM
DO PG
IF $GET(ACHSQUIT)
QUIT
DO ^DIWW
+19 SET DIWF="I5C60W"
+20 WRITE !!
+21 ; --- Alt Resource Appeal Option Text
+22 SET ACHDOP=0
+23 FOR
SET ACHDOP=$ORDER(^ACHSDEN(DUZ(2),"D",ACHSA,800,ACHDALRS,4,ACHDOP))
IF +ACHDOP=0
QUIT
Begin DoDot:1
+24 SET ACHDX=0
+25 FOR
SET ACHDX=$ORDER(^ACHSDENR(DUZ(2),13,ACHDOP,1,ACHDX))
IF +ACHDX=0
QUIT
Begin DoDot:2
+26 SET X=$GET(^ACHSDENR(DUZ(2),13,ACHDOP,1,ACHDX,0))
DO ^DIWP
IF $Y>ACHSBM
DO PG
IF $GET(ACHSQUIT)
QUIT
End DoDot:2
End DoDot:1
IF $GET(ACHSQUIT)
QUIT
+27 DO ^DIWW
+28 SET DIWL=5
SET DIWR=$SELECT($GET(IOM):IOM,1:75)
+29 KILL DIWF
+30 ;
BOTTXT ;
+1 WRITE !!!?DIWL-1,"Please keep me informed on the status of this appeal."
+2 IF $Y>ACHSBM
DO PG
IF $GET(ACHSQUIT)
QUIT
+3 ;
SUD ; --- SUD Signature Block
+1 IF $Y>(ACHSBM-15)
DO PG
IF $GET(ACHSQUIT)
QUIT
+2 WRITE !!?30,"Sincerely yours,",!!!!!!?30,$$SUD^ACHS(1)
+3 IF $LENGTH($$SUD^ACHS(7))
WRITE !?30,$$SUD^ACHS(7)
+4 WRITE !?30,$$SUD^ACHS(2),!?30,$$SUD^ACHS(3),", ",$PIECE($GET(^DIC(5,$$SUD^ACHS(4),0)),U,2)," ",$$SUD^ACHS(5),!?30,"Telephone: ",$$SUD^ACHS(6)
+5 ;
CMT ; --- Office Comments
+1 IF '$DATA(ACHDONE)
DO END
QUIT
+2 WRITE !!!,"Denial Number: ",$$DN^ACHS(0,1)
+3 ;W !,"Chart Number: ",$S($$DN^ACHS(0,6)="Y":$P($G(^AUPNPAT($$DN^ACHS(0,7),41,DUZ(2),0)),U,2),$L($$DN^ACHS(10,6)):$$DN^ACHS(10,6),1:"No Chart Number Available")
+4 ;IS THE 'PATIENT REGISTERED?'
+5 IF $$DN^ACHS(0,6)="Y"
Begin DoDot:1
+6 ;IF REGISTERED IS THERE A 'REGISTERED PATIENT' PTR?
+7 IF '$$DN^ACHS(0,7)
WRITE !!,"CANNOT FIND A PATIENT POINTER FOR A APPARENTLY REGISTERED PATIENT WITHIN THE 'CHS DENIAL DATA' FILE!!",!,"REPORT THIS TO YOUR SITE MANAGER IMMEDIATELY!",!,"DOCUMENT IEN: ",ACHSA
+8 IF '$$DN^ACHS(0,6)
QUIT
+9 WRITE $PIECE($GET(^AUPNPAT($$DN^ACHS(0,7),41,DUZ(2),0)),U,2)
End DoDot:1
+10 WRITE $SELECT($LENGTH($$DN^ACHS(10,6)):$$DN^ACHS(10,6),1:"No Chart Number Available")
+11 ;
+12 IF $$DN^ACHS(850,1)'="Y"
WRITE !,"No Receipt Information Available",!
GOTO CMT1
+13 WRITE !,"Method of receipt: ",$$DN^ACHS(850,2)
+14 WRITE !,"Date of receipt: ",$$FMTE^XLFDT($$DN^ACHS(850,3))
+15 WRITE !,"Received by: ",$$DN^ACHS(850,4)
+16 ;
+17 ;
CMT1 ; --- Alternate Resources Appeal Comments
+1 IF '$DATA(^ACHSDEN(DUZ(2),"D",ACHSA,800,ACHDALRS,5,0))
DO END
QUIT
+2 WRITE !,"Alternate Resources Appeal Comments: ",!
+3 SET ACHD=0
+4 FOR
SET ACHD=$ORDER(^ACHSDEN(DUZ(2),"D",ACHSA,800,ACHDALRS,5,ACHD))
IF 'ACHD
QUIT
Begin DoDot:1
+5 SET X=$GET(^ACHSDEN(DUZ(2),"D",ACHSA,800,ACHDALRS,5,ACHD,0))
DO ^DIWP
IF $Y>ACHSBM
DO PG
IF $GET(ACHSQUIT)
QUIT
End DoDot:1
IF $GET(ACHSQUIT)
QUIT
+6 DO ^DIWW
+7 DO END
+8 QUIT
+9 ;
END ;EP
+1 WRITE !!!
+2 IF $DATA(ACHDONE)
Begin DoDot:1
+3 FOR I=1:1:4
WRITE "*** OFFICE COPY *** "
+4 KILL ACHDONE
+5 WRITE @IOF
+6 SET ACHSPG=1
SET DIWL=5
SET DIWR=$SELECT($GET(IOM):IOM,1:75)
SET DIWF="W"
End DoDot:1
GOTO DOC
+7 ;
+8 ;PATIENT RELEASE OF INFORMATION FORM
IF '$DATA(ACHDLKER)
DO ^ACHSDARR
+9 IF IO=IO(0)
DO RTRN^ACHS
+10 WRITE @IOF
+11 KILL ACHSA,ACHDALRS,ACHDLKER,DIR,ACHDOCT,ACHD,ACHDX,ACHDDAT,ACHDPAT,ACHDALR,ACHDOP,ACHDPROV
+12 DO ^%ZISC
+13 QUIT
+14 ;
PG ;
+1 DO RTRN^ACHS
+2 IF $GET(ACHSQUIT)
QUIT
+3 SET ACHSPG=ACHSPG+1
+4 WRITE @IOF,!!!?DIWL-1,ACHDPAT,?($SELECT($GET(IOM):IOM,1:75)-$LENGTH(ACHDALR)),ACHDALR,!?($SELECT($GET(IOM):IOM,1:75)-$LENGTH("Page "_ACHSPG)),"Page ",ACHSPG,!!
+5 QUIT
+6 ;
